Multidisciplinary Surgical Approach Research Articles

MANAGEMENT AND RECONSTRUCTION OF RECURRENT SIALOBLASTOMA AND ITS COMPLICATIONS IN A PEDIATRIC PATIENT: A MULTIDISCIPLINARY APPROACH

Background: Sialoblastoma is an exceedingly rare congenital epithelial tumor of salivary gland origin, predominantly affecting infants. It exhibits aggressive behavior with potential for recurrence and requires a multidisciplinary approach for management. This case report highlights the challenges of diagnosing and treating recurrent sialoblastoma in a pediatric patient, emphasizing innovative reconstructive techniques. Case Presentation: A 2-year-old South Asian boy presented with a progressively enlarging left cheek swelling since infancy. Initial imaging and cytology suggested a salivary gland neoplasm, leading to total parotidectomy. Histopathological analysis confirmed sialoblastoma. Despite adjuvant chemotherapy, local recurrence occurred, requiring further surgical intervention, including hemimandibulectomy. Postoperative radiotherapy was administered; however, complications such as wound dehiscence and tumor recurrence necessitated additional surgical and reconstructive measures. Intervention and Outcomes: The patient underwent a multidisciplinary surgical approach involving lesion excision, removal of the exposed mandibular plate, and mandibular reconstruction using a pedicled osseomyocutaneous pectoralis major flap with the sixth rib. Six-month follow-up showed no recurrence, with satisfactory functional and cosmetic outcomes. Conclusion: This case underscores the aggressive nature of sialoblastoma, the importance of complete tumor excision, and the utility of innovative surgical reconstruction techniques. Multidisciplinary management and vigilant long-term follow-up are crucial for improving outcomes in pediatric sialoblastoma.

Multidisciplinary Surgical Care for a Cervical Esophageal Duplication Cyst.

We present a case of a three-month-old male who presented with a cervical esophageal duplication cyst requiring early surgical intervention. The patient presented with feeding difficulties, poor weight gain, and respiratory distress. Due to the position of the cervical esophageal duplication cyst and airway compression, this unique case required a multidisciplinary surgical approach involving both otolaryngology and cardiothoracic surgery.

Role of the endonasal endoscopic approach in intraorbital tumor surgery: insights from a single-center experience.

This study aimed to evaluate the effectiveness of the endoscopic endonasal approach (EEA) in the surgical management of intraorbital tumors and analyze the adjunctive role of the transorbital approach (TOA) and extended modified medial maxillectomy (EMMM) in addressing anatomically complex tumors. This study retrospectively reviewed 13 cases of primary intraorbital tumors managed with EEA, integrating TOA and EMMM, based on specific tumor location and extent. A detailed analysis was conducted on the surgical techniques used, tumor size and location in relation to critical structures such as the optic nerve, and overall surgical outcomes, with a focus on the extent of resection and postoperative visual function. Of the 13 cases analyzed (4 cavernous hemangiomas, 3 schwannomas, mucosa-associated lymphoid tissue lymphoma, diffuse large B-cell lymphoma, liposarcoma, inflammatory myofibroblastic tumor, osteoma, and myxoid spindle tumor), the EEA served as the primary surgical method, especially for the 8 intraconal tumors situated medially to the optic nerve, with 1 tumor situated inferiorly to the optic nerve. Extraconal tumors, present in 5 cases, necessitated additional approaches: TOA was utilized for tumors with anterior extension, and EMMM was applied to those extending toward the inferior orbital wall. Gross-total resection was accomplished in 80% of the operative cases, with an overall improvement in visual function observed in 69.2% of the patients postsurgery. Complications were infrequent, with enophthalmos requiring subsequent reconstruction and a permanent slight visual field defect in the upper outer quadrant, occurring in 1 case each, underscoring the safety and efficacy of integrated surgical approaches. The combination of EEA with TOA and EMMM provides a comprehensive and adaptable surgical strategy for intraorbital tumors, accommodating various lesion locations and complexities. This combined approach not only facilitates extensive tumor resection but also maximizes the preservation of ocular function and cosmetic outcomes. The favorable results of this study support the use of a multidisciplinary surgical approach and highlight the potential for improved patient outcomes with the continued development of endoscopic techniques. Further research with a larger cohort is essential to validate these findings and establish guidelines for the combined use of these surgical methods.

Lower Extremity Traumatic Wound Management: Relative Significance of Negative Pressure Wound Therapy in the Orthopedic Setting.

Significance: Lower extremity traumatic wounds are associated with numerous perioperative challenges. Their etiologies determine the characteristics and extent of the injury. The timing of subsequent surgical intervention and wound healing optimization after lower extremity trauma are integral to successful perioperative lower extremity wound management. Recent Advances: Managing trauma to the lower extremities uses a multidisciplinary surgical approach. The objective of this review is to summarize lower limb trauma assessment, advancements in lower extremity trauma management, and the clinical applications of advanced wound care in lower limb traumatic wounds. The advent of lower limb reconstruction and the development of advanced wound care modalities have helped to improve the management of these complex injuries. Critical Issues: The extensive involvement of bone, soft tissues, nerves, and blood vessels of severe lower extremity trauma wounds presents a challenge for clinicians in both the acute care setting and during patient rehabilitation. If not properly managed, these injuries may be subject to a decline in limb function and may possibly result in limb loss. To reveal developing limb-threatening conditions, serial examinations should be performed. Future Directions: The majority of lower limb traumatic wound will benefit from the perioperative administration of an appropriate negative pressure wound therapy (NPWT)-based system, which can help to promote granulation tissue and remove wound exudate before definitive closure and/or reconstruction. NPWT should be included as an important adjunct in the surgical management of lower limb traumatic wounds.

Advances in the multidisciplinary surgical approach to primary spinal sarcomas: insights from a retrospective case series on outcomes and survival

IntroductionThe management of spinal sarcomas is complex, given their widespread involvement and high recurrence rates. Despite consensus on the need for a multidisciplinary approach with surgery at its core, there is a lack of definitive guidelines for clinical decision-making. This study examines a case series of primary spinal sarcomas, focusing on the surgical strategies, clinical results, and survival data to inform and guide therapeutic practices.MethodsWe conducted a retrospective analysis of patients who underwent surgical resection for primary spinal sarcomas between 2005 and 2022. The study focused on gathering data on patient demographics, surgical details, postoperative complications, overall hospital stay, and mortality within 90 days post-surgery.ResultsThe study included 14 patients with a primary diagnosis of spinal sarcoma, with an average age of 48.6 ± 12.6 years. Chondrosarcoma emerged as the most common tumor type, representing 57.1% of cases, followed by Ewing sarcoma at 35.7%, and synovial sarcoma at 7.1%. Patients with chondrosarcoma were treated with en-bloc resection, while the patient with synovial sarcoma underwent intra-lesional excision and those with Ewing sarcoma received decompression and tumor debulking. Postoperative assessments revealed significant improvements in neurological conditions. Notably, functional status as measured by the Karnofski Performance Index (KPI), improved substantially post-surgery (from 61.4 to 80.0%) The mean follow-up was 34.9 ± 9.2 months. During this time period one patient experienced fatal bleeding after en-bloc resection complications involving the vena cava. None of the patient needed further surgery.ConclusionsOur 16-year study offers vital insights into managing primary spinal sarcomas, showcasing the effectiveness of surgical intervention, particularly en-bloc resection. Despite their rarity and complexity, our multidisciplinary treatment approach yields improved outcomes and highlights the potential for refined surgical strategies to become standardized care in this challenging domain.

Surgical Approach to Retroperitoneal Sarcomas with Involvement of the Permeable Inferior Vena Cava: Use of the Femorojugular Bypass

Introduction: Retroperitoneal sarcomas with Inferior Vena Cava (IVC) involvement are rare cases and complex to manage. Radical surgical resection is the only potentially curative treatment and sometimes clamping of the IVC is necessary, which can cause hemodynamic alterations. In this study, we describe the use of femorojugular bypass with perfusion pump as a technique to optimize the hemodynamic situation during the resection of retroperitoneal sarcomas with IVC involvement. Methods: We collected data from patients presenting with retroperitoneal sarcomas with IVC involvement operated at the Hospital de la Santa Creu i Sant Pau (Barcelona), a sarcoma referral center, between March 2021 and May 2023. The technical details of the surgical procedures were analyzed, including the IVC involvement, surgical approach to treatment, and the use of femorojugular bypass. Postoperative complications and oncologic outcomes were also recorded. Results: A total of seven patients diagnosed with retroperitoneal sarcoma with IVC involvement were operated on. In two of the cases, a femorojugular bypass was performed prior to clamping the IVC. In five of the cases, radical resection of the tumor was achieved without leaving macroscopic disease. The mean estimated blood loss was 2.21 L and there was no postoperative mortality. Overall survival was 75% at 12 months with a mean follow-up of 11.86 months. Conclusion: The use of femorojugular bypass during the resection of retroperitoneal sarcomas with IVC involvement may improve the hemodynamic situation of the patient and allow for complete tumor resection. This multidisciplinary surgical approach in referral centers may be effective in the treatment of this rare disease. However, further studies are needed to confirm these results and to establish standardized management guidelines.

Pelvic Exenteration Surgery Outcomes Following Establishment of a Complex Pelvic Surgery Multidisciplinary Tertiary Unit

Background: Pelvic exenteration surgery (PES) is a complex operation associated with significant morbidity. PES requires sub-specialised multidisciplinary input along with expertise in complex pelvic surgery and anatomy. The majority of published data on PES comes from high volume units, however there is emerging evidence of comparable short and long-term outcomes in lower volume units where dedicated multidisciplinary teams are established. This study reports outcomes of PES in a lower volume centre with a collaborative multidisciplinary surgical approach. Methods: A retrospective review of patients who underwent PES for benign or malignant pathology at Liverpool and Macquarie University Hospitals between September 2015 and June 2022. Descriptive statistics were performed and KaplanMeier survival analysis for patients treated for malignancy with curative intent. Results: A total of 67 patients undergoing pelvic exenteration were included (53.8% female; with mean age 59 years). Indications for PES were colorectal cancer (56.7%), gynaecological cancer (22.4%), other malignancy (9.0%) and complex benign pathology (11.9%). Posterior or total pelvic exenteration was performed in 88.1%. Median hospital stay was 16 days. Clavien-Dindo grade III or IV complications occurred in 34.3%. There were two post-operative deaths (3.0%; one palliative intent). For patients treated with curative intent (n=51), R0 resection margin was achieved in 92.2%, and R1 margin in 7.8%. Estimated five-year disease-free survival was 57.1%, and five-year overall survival was 65.5%. Conclusion: Short and long-term outcomes of PES in a low volume unit with appropriate multidisciplinary expertise are comparable to published data on pelvic exenteration from higher volume units.

Conservative or surgical management of orbital schwannomas: a population-based case series

IntroductionOrbital schwannomas (OS) are rare occurrences with no more than 500 cases reported in the literature. The tumor’s potential to compromise the delicate neuro-ophthalmic structures within the orbit prompts surgical removal. Tumor removal is performed by ophthalmologists, often requiring a multidisciplinary surgical approach. The literature contains a very limited number of cases managed non-surgically. However, the inherent risks of orbital surgery warrant a comparison of the outcomes of conservative and surgical management strategies.AimsTo review the national Swedish experience with the management of orbital schwannomas.MethodsThe study center is the primary Swedish referral center for the multidisciplinary management of orbital tumors, including schwannomas. During the period of 2005 to 2021, 16 patients with an OS diagnosis were managed at the center.ResultsFour patients initially underwent surgery where gross total resection (GTR) was achieved in three (75%) and subtotal resection (STR) in one (25%) case. The remaining 12 patients, who had a low risk of neuro-ophthalmic impairment, were managed conservatively with radiological and clinical examinations at regular intervals. After an average follow-up of 17 months, surgery was performed in three of these cases (25%). No recurrences or tumor growths were detected on radiological follow-ups (mean 50 months), and all patients experienced postoperative improvement at clinical follow-up (mean 65 months). The remainder of the conservatively treated patients (n=9) experienced no clinical progression (mean 30 months). A slight radiological tumor progression was detected in one patient after 17 months.ConclusionThere were no differences in long-term outcome between patients who had been managed with early surgery and those operated later after an initially conservative management. Conservatively treated patients had minimal to no symptoms and remained clinically stable throughout the follow-up period. Based on these findings, conservative management may successfully be adopted in cases with mild symptoms, no signs of compressive optic neuropathy and low risk of neuro-ophthalmic impairment. Conversion to surgical management is indicated upon clinical deterioration or tumor growth. Based on the findings of this study a decision tree for the management of orbital schwannomas is suggested.

Multidisciplinary Surgical Approach to Increase Survival for Advanced Ovarian Cancer in a Tertiary Gynaecological Oncology Centre.

The purpose of this paper is to report on changes in overall survival, progression-free survival, and complete cytoreduction rates in the 5-year period after the implementation of a multidisciplinary surgical team (MDT). Two cohorts were used. Cohort A was a retrospectively collated cohort from 2006 to 2015. Cohort B was a prospectively collated cohort of patients from January 2017 to September 2021. This study included 146 patients in cohort A (2006-2015) and 174 patients in cohort B (2017-2021) with FIGO stage III/IV ovarian cancer. Median follow-up in cohort A was 60 months and 48 months in cohort B. The rate of primary cytoreductive surgery increased from 38% (55/146) in cohort A to 46.5% (81/174) in cohort B. Complete macroscopic resection increased from 58.9% (86/146) in cohort A to 78.7% (137/174) in cohort B (p < 0.001). At 3 years, 75% (109/144) patients had disease progression in cohort A compared with 48.8% (85/174) in cohort B (log-rank, p < 0.001). Also at 3 years, 64.5% (93/144) of patients had died in cohort A compared with 24% (42/174) of cohort B (log-rank, p < 0.001). Cox multivariate analysis demonstrated that MDT input, residual disease, and age were independent predictors of overall (hazard ratio [HR] 0.29, 95% confidence interval [CI] 0.203-0.437, p < 0.001) and progression-free survival (HR 0.31, 95% CI 0.21-0.43, p < 0.001). Major morbidity remained stable throughout both study periods (2006-2021). Our data demonstrate that the implementation of multidisciplinary-team, intraoperative approach allowed for a change in surgical philosophy and has resulted in a significant improvement in overall survival, progression-free survival, and complete resection rates.

Early Voice and Swallowing Disturbance Incidence and Risk Factors After Revision Anterior Cervical Discectomy and Fusion Using a Multidisciplinary Surgical Approach: A Retrospective Cohort Evaluation of a Prospective Database.

Dysphagia and vocal cord palsy (VCP) are common otolaryngological complications after revision anterior cervical discectomy and fusion (rACDF) procedures. Our objective was to determine the early incidence and risk factors of VCP and dysphagia after rACDF using a 2-team approach. Single-institution, retrospective analysis of a prospectively collected database of patients undergoing rACDF was enrolled from September 2010 to July 2021. Of 222 patients enrolled, 109 patients were included in the final analysis. All patients had prior ACDF surgery with planned revision using a single otolaryngologist and single neurosurgeon. MD Anderson Dysphagia Inventory and fiberoptic endoscopic evaluation of swallowing (FEES) were used to assess dysphagia. VCP was assessed using videolaryngostroboscopy. Seven patients (6.7%) developed new postoperative VCP after rACDF. Most cases of VCP resolved by 3 months postoperatively (mean time-to-resolution 79 ± 17.6 days). One patient maintained a permanent deficit. Forty-one patients (37.6%) reached minimum clinically important difference (MCID) in their MD Anderson Dysphagia Inventory composite scores at the 2-week follow-up (MCID decline of ≥6), indicating new clinically relevant swallowing disturbance. Forty-nine patients (45.0%) had functional FEES Performance Score decline. On univariate analysis, there was an association between new VCPs and the number of cervical levels treated at revision ( P = .020) with long-segment rACDF (≥4 levels) being an independent risk factor ( P = .010). On linear regression, there was an association between the number of levels treated previously and at revision for FEES Performance Score decline ( P = .045 and P = .002, respectively). However, on univariate analysis, sex, age, body mass index, operative time, alcohol use, smoking, and individual levels revised were not risk factors for reaching FEES Performance Score decline nor MCID at 2 weeks postoperatively. VCP is more likely to occur in long-segment rACDF but is often temporary. Clinically relevant and functional rates of dysphagia approach 37% and 45%, respectively, at 2 weeks postoperatively after rACDF.

Multidisciplinary care improves outcomes for patients with carotid body paragangliomas-The UCLA experience.

To evaluate the effects and outcomes of multidisciplinary surgical approaches in the management of carotid body tumors (CBT). A single-center retrospective study at the University of California-Los Angeles Medical Center was conducted on patients who presented with CBTs and underwent surgical resections from 1998 to 2020. Statistical analysis was performed using IBM SPSS v27 and Excel. A total of 75 patients with 79 CBT resections were included. Operating surgical subspecialties included: 41.8% vascular surgery, 24.1% otolaryngology head and neck surgeons (OHNS), and 31.6% combined OHNS and vascular. 68.4% of tumors underwent preoperative embolization. EBL was directly correlated with tumor size. CBT size was similar for OHNS (30 mm) and vascular (31 mm) but was significantly larger for combined OHNS and vascular cases (38 mm). EBL was higher in combined cases (301 mL) compared to OHNS (124 mL) or vascular (203 mL) alone. Incidence of postoperative cranial nerve deficits was 7.8%, with combined OHNS and vascular cases having an incidence of 4.0% when compared to OHNS (5.3%) versus vascular surgery alone (12.1%). CBTs can be managed effectively by single surgical specialties with similar outcomes between vascular surgery and OHNS. In larger, higher grade tumors, however, a combined vascular and OHNS approach had lower incidence of postoperative cranial nerve injuries when compared to single specialty resections, despite a larger EBL. Thus, a multidisciplinary surgical approach suggests favorable outcomes with fewer incidence of cranial nerve deficits for larger, more complex CBT resections. 2b-Individual retrospective cohort study.

D73. Multidisciplinary Approach to Cranioplasty - Outcomes from a 10-year Retrospective Study

PURPOSE: Cranioplasty to reconstruct large-sized skull defect has a high risk of major complications, including 15- 30% reoperation rate. The objective of this study was to determine whether multidisciplinary surgical approach at a tertiary care institution impacted cranioplasty outcomes. METHODS: We performed a retrospective chart review of patients undergoing cranioplasty from 2011- 2021. Pertinent demographic and surgical data were extracted. Risk factors associated with cranioplasty failure were assessed using chi-square and t-tests. Logistical regression was used to assess odds ratio between number of cranial operations and team involved. RESULTS: A total of 255 patients underwent 301 cranioplasty procedures. Fifty-three patients (20%) had a major complication requiring reoperation, with the most common complications being infection (n = 31, 12%), hematoma (n=11, 4%) and dehiscence (n= 7, 3%). Cases were performed by either a neurosurgeon only (n=248), neurosurgeon plus otolaryngologist (n=23), neurosurgeon plus plastic surgeon (n=30), or all three types of surgeons together (n=1). Plastic surgeons were more likely to be involved in cases with multiple previous cranial operations, including cranioplasty failures (p=0.0205). Interestingly, cases with a plastic surgeon involved (n=30) were associated with fewer complications postoperatively (n=3, 10%, p=0.0302). CONCLUSION: Plastic surgeons are typically consulted after multiple previous cranioplasty failures, despite decreased risk of complications when one is involved. This data further underscores the need for 1) continued efforts to develop neuroplastic surgery multidisciplinary centers for cranioplasty, and 2) a validated, algorithmic approach to predict complications in cranioplasty and risk stratify patients who may benefit from earlier plastic surgery involvement.

Clincal practice of pelvic exenteration for late complications of pelvic radiation injury

Pelvic radiation injury can potentially involve multiple pelvic organs, and due to its progressive and irreversible nature, its late stage can be complicated by fistulas, perforations, obstructions and other complications involved multiple pelvic organs, which seriously affect the long-term survival and the quality of life of patients. As a multidisciplinary surgical approach, pelvic exenteration has potential application in the treatment of late complications of pelvic radiation injury by completely removing the irradiated lesion, relieving symptoms and avoiding recurrence of symptoms. In clinical practice, we should advocate the concept of "pelvic radiation injury", emphasize multidisciplinary collaboration, fully evaluate the overall status of patients, primary tumor and pelvic radiation injury. We should follow the principles of "damage-control" and "extended resection", and follow the principle of enhanced recovery after surgery to achieve the goal of ensuring the surgical safety, relieving patients' symptoms and improving patients' quality of life and long-term survival.

A Multidisciplinary Surgical Approach to Mediastinal Masses in Children.

The aim of this study is to demonstrate the safety and advantages of a multidisciplinary approach to surgical resection of mediastinal masses in children. Eight patients underwent resection of a mediastinal mass by a team involving both a pediatric general surgeon and pediatric cardiothoracic surgeon. One patient required rapid initiation of cardiopulmonary bypass to complete the tumor resection and repair an aortic injury that occurred when removing adherent tumor from the structure. Perioperative outcomes were excellent for all patients. This series shows that a multidisciplinary surgical approach can be potentially life saving.

Morbidity and Long-Term Patient-Reported Outcomes Following Advanced Carotid Body Tumor Resection

The reported risk of a cranial nerve (CN) injury is up to one in four patients in large registries of carotid body tumor (CBT) resection. Functional outcome for this population is unknown. We evaluated consecutive patients who underwent CBT resection from November 2013 through October 2020. Demographics, intraoperative details, complications, and out- comes were recorded from the medical record. Permanent CN nerve injury was defined as deficits lasting >6 months. Frequency statistics, averages, chi-square test, and multiple logistic regression were completed for primary end points of complications and disease-free survival. Patient reported outcomes were gathered via telephone survey of patients conducted in September 2021. Fifty-one patients presented with CBTs and the following Shamblin classes: I (n=7; 14%), II (n = 36; 69%), and III (n = 9; 17%). Head and neck oncology and vascular surgery jointly did 52% of CBT resections, including six of nine Shamblin III cases. Eight patients (15.3%, all Shamblin II or III) suffered a total of 12 CN injuries - eight CN XII (five temporary and three permanent), three CN X (all permanent), and one CN XI (permanent). Seven of the CN injury subgroup had preoperative embolization and five were joint oncology/vascular cases. Additionally, four separate carotid injuries required repair. Notably, all patients had disease-free survival postoperatively at a mean follow-up of 6 months. Patient reported outcomes (PRO) obtained in 70.6% of patients one year or more from index operation demonstrated that two-thirds of patients live without any permanent functional deficits, and the majority of those with continued deficits rate the symptoms as daily but mild in severity. In a series of complex CBT patients treated with preoperative embolization capabilities and multidisciplinary surgical approach, disease free survival was achieved in all patients despite a high rate of iatrogenic CN injuries, most commonly CN XII. PRO survey results indicate that injuries identified on clinical exam underreport patients' true post-operative CN deficits - especially branches of CN X. This data supports the practice of aggressive primary resection of CBTs while providing guidance for expected functional outcomes due to CN injury risk.

A Planned Multidisciplinary Surgical Approach to Treat Primary Pelvic Malignancies.

The pelvic anatomy poses great challenges to orthopedic surgeons. Sarcomas are often large in size and typically enclosed in the narrow confines of the pelvis with the close proximity of vital structures. The aim of this study is to report a systematic planned multidisciplinary surgical approach to treat pelvic sarcomas. Seventeen patients affected by bone and soft tissue sarcomas of the pelvis, treated using a planned multidisciplinary surgical approach, combining the expertise of orthopedic oncology and other surgeons (colleagues from urology, vascular surgery, abdominal surgery, gynecology and plastic surgery), were included. Seven patients were treated with hindquarter amputation; 10 patients underwent excision of the tumor. Reconstruction of bone defects was conducted in six patients with a custom-made 3D-printed pelvic prosthesis. Thirteen patients experienced at least one complication. Well-organized multidisciplinary collaborations between each subspecialty are the cornerstone for the management of patients affected by pelvic sarcomas, which should be conducted in specialized centers. A multidisciplinary surgical approach is of paramount importance in order to obtain the best successful surgical results and adequate margins for achieving acceptable outcomes.

Multidisciplinary Surgical Management of Extensive Basal Cell Carcinomas

Basal Cell Carcinoma (BCC) is the most common malignancy that can cause local tissue destruction. While treatment options for BCC vary depending on the degree of malignant progression, surgical intervention is generally required when there is significant tissue involvement. We present a case of a 40-year-old woman with extensive BCCs requiring a multidisciplinary surgical approach for treatment. Our case highlights the importance of utilizing a multidisciplinary team as well as different surgical management options for late stage BCCs.

Image-Guided Surgery in Complex Skull Base and Facial Fractures: Initial Experience on the Role of Intra-Operative Computer Tomography.

Surgery of fractures involving the skull base and the facial skeleton often presents challenges that should be addressed to prevent secondary brain injuries (i.e., cerebro-spinal fluid leak), preserve visual functioning, and guarantee a good esthetic result. Complex craniofacial reconstruction can be aided by navigation and pre-operative planning. In recent years, computerized planning of surgical reconstruction drastically increased the safety and efficacy of surgery, but the impact of intraoperative high quality image devices such as an intraoperative computed tomography (CT) scan has not been investigated yet. This case-control study reports the institutional preliminary experience of using intraoperative CT scans in the surgical management of complex cranio-facial fractures. The results in terms of accuracy of bony reconstruction and neurological or surgical complications have been analyzed in 12 consecutive patients treated with (6 cases) or without (6 cases) i-CT. Comparative analysis demonstrated a greater accuracy of reconstruction in patients treated with the assistance of i-CT. Intraoperative CT is a useful tool with a promising role in a multidisciplinary surgical approach to complex cranio-facial surgery.

HPB P19 Our experience comparing multi-visceral and single organ excision of retroperitoneal sarcomas from a HPB centre

Abstract Background Sarcomas are a heterogenous set of soft tissue cancers with an estimated incidence of up to 5.0 cases per 100,00 worldwide. Retroperitoneal sarcomas (RPS) account for up to 20% of these. The aetiology behind the pathogenesis is not truly understood, but to date, surgery remains the only curative treatment. Owing to resistance, systemic chemotherapy only plays a role in attempts to downstage the tumour, or in the palliative setting. RPS are slow growing and owing to the lack of symptoms have variable presentation. The ability to excise RPS traditionally was limited by vascular invasion, which increases the complexity of the resection and poses uncertainty about the long-term oncological benefit. Although small, emerging case series over the last couple of decades have established the feasibility of multi-visceral resection with vascular reconstruction. Here we present our outcomes comparing multi-visceral resections with single organ resections with vascular reconstructions. Methods All patients who underwent excision of a retroperitoneal sarcoma between January 2005 and April 2021 were included in the analysis. Patients were identified from a database which was prospectively completed by the operating surgeon. Data collected included patient demographics, clinicopathologic characteristics and intra-operative variables. Endpoints included perioperative morbidity and mortality, oncological clearance status, recurrence status, and survival. Complications were graded using the Clavien-Dindo classification. All patients were discussed in a local multi-disciplinary team meeting. When aortic/iliac artery involvement was suspected on pre-operative imaging (Computer Tomography or Magnetic Resonance Imaging), patients were referred appropriately to vascular for further pre-operative discussion regarding treatment and/or conduit plans. Continuous data was presented as medians (range) and compared using ANOVA (analysis of variance). Survival probabilities were calculated using the Kaplan-Meier method and log-rank test. Normally distributed data was assessed with the Student's t-test, and skewed data with Mann-Whitney test. A two-sided p value &amp;lt; 0.05 was considered significant. Results From January 2005 to April 2021, 122 patients underwent 170 operations for RPS resections. 112 (68.9%) underwent a visceral resection (90 (53.0%) multi-visceral (MVR) and 22 (15.9%) single organ (SOR)). In the MVR group, 23 (25.6%) involved a synchronous vascular resection with a complete resection margin in 94.7%. In the SOR group, 6 (27.3%) underwent a synchronous vascular resection with a 96.3% complete resection margin. Multi-visceral resections included 39 nephrectomies, 33 segmental colectomies, 16 liver resections, 16 splenectomies, pancreatic resections in 19, and partial gastrectomy in 12 cases. The inferior vena cava was resected in 17 and 5 cases in the MVR and SOR group, respectively. Aortic and iliac artery resection and reconstruction with Dacron graft took place in 4 cases. Histologically, leiomyosarcomas and dedifferentiated liposarcomas were the most common subtype, accounting for 33 and 30 (36.7% and 33.3%) in the MVR group and 10 and 6 (37.0% and 22.2%) in the SOR group, respectively. Overall 5-year survival for all resections was 60%. There was no significant difference in complication rate[HM1] [AR2], length of stay, 30-day mortality (2% and 1%) or 1- (71.1% and 77.8%) or 3-year (33.3% and 25.9%) survival between the MVR and SOR groups. Conclusions RPS are prone to localised invasion as well as into surrounding viscera. Although traditionally, these patients may not have been deemed suitable for surgical intervention, our case series shows multi-visceral resections with vascular resections can be undertaken safely with no impact on overall survival. The series also highlights the need for a multi-disciplinary surgical approach to address the technical complexities of the operation. In conclusion, the need for multi-visceral resection or vascular resection and reconstruction should not deter surgical treatment, and these cases should be managed within a MDT with appropriate surgical expertise.

Microsurgical Reconstruction in Orthopedic Tumor Resections as Part of a Multidisciplinary Surgical Approach for Sarcomas of the Extremities.

A central element of modern sarcoma therapy is complete surgical tumor resection with an adequate safety margin, embedded in an interdisciplinary multimodal therapy concept. Along with ensuring patient survival, functional limb preservation is an important goal for sarcomas of the extremities. This review provides an overview of the relevant literature on indications and goals of reconstructive options, the scope and contribution of microsurgical reconstructive procedures, and the associated interdisciplinary decision making and workup. Furthermore, the impact of (neo)-adjuvant therapy on reconstructive decisions will be highlighted. These aspects will be illustrated by four comprehensive case studies that demonstrate both useful strategies and the need for individually tailored therapies. Nowadays, extremity-preserving therapy is possible in more than 90% of sarcomas. Technical and procedural innovations such as microsurgery and microsurgical reconstructive procedures have significantly contributed to this evolution of therapy.