Organ-preserving Surgery Research Articles

Outcomes of surgical treatment of thyroid disease in children

Background. In recent years there has been a tendency of increase in the proportion of nodular goiter and Graves’ disease in thyroid pathology in children, which necessitates a choice of rational tactics for treatment of these diseases. At present there is no optimal method of treatment for thyroid gland pathology, but one of the methods is surgery. Thyroid surgery due to the determination of the indications and choice of the optimal volume of the surgical intervention continues to be under debate as postoperative complications of surgical treatment of thyroid diseases in children are possible. Aim: to study the outcomes of surgical treatment for thyroid pathology in children, depending on the volume of operation. Materials and methods. This article presents the results of a survey of 77 children operated on in the period of 2002–2016 for Graves’ disease, single-node goiter, and multinodular goiter. The examination included the determination of the levels of ionized calcium and TSH, FT4, FT3 in the blood serum, the evaluation of the functional state of the pituitary-thyroid system, thyroid ultrasound examination, and examination by an otolaryngologist. Results. The incidence of adverse outcomes of surgical treatment in children with nodular goiter was 27%. Adverse outcomes were observed equally often after organ-preserving operations and after thyroidectomy, but they were of different structure. The frequency of postoperative complications after thyroidectomy performed on the nodular goiter was 27%. Complications presented as postsurgical hypoparathyroidism and vocal cord paresis. In children with nodular goiter, after thyroidectomy hypoparathyroidism occurred more frequently than paresis of the vocal folds. Symptomatic hypocalcemia was observed more frequently than the asymptomatic variant, and in most cases hypoparathyrodism was transient. Among children with a single-node goiter who underwent organ-preserving surgery on the thyroid gland postoperative complications such as hypoparathyroidism and paresis of the vocal folds were not identified. Adverse outcomes (disease recurrence, postoperative hypothyroidism) were observed equally often after hemithyrodectomy and node enucleation. But the risk of recurrence of nodular goiter was significantly more common in children after node enucleation than after hemithyroidectomy and postsurgical hypothyroidism was more common in children with nodular goiter after hemithyrodectomy than after node enucleation. The frequency of adverse outcomes of surgical treatment of Graves’ disease in children was 14%. Complications were presented by post-surgical hypoparathyroidism and vocal cord paresis. All complications occurred only after thyroidectomy. When compared adverse outcomes of thyroidectomy were equally common in both nodular goiter and Graves ‘disease, but persistent dysfunction in the form of permanent hypoparathyroidism and permanent vocal cord paresis were more common in Graves’ disease than in nodular goiter. Conclusion. The results obtained demonstrate the heterogeneity of surgical treatment outcomes structure which depends on the surgical intervention volume.

Organ Preservation Surgery for Carcinoma Penis.

Carcinoma of the penis is not uncommon in India. A sizeable number of patients do not report to the doctors in fear of mutilation to the organ and hence subsequently end up with advanced disease. Many patients with T1 or T2 disease when carefully selected are amenable to organ-preserving penile procedures including surgery, topical therapy, laser, and radiation therapy. Identification of appropriate patients and institution of these treatments has been noted to produce oncologically comparable results to extirpative surgeries. In this article, we review the criteria to identify patients qualifying for organ-preserving treatments and also review outcomes with a variety of penile-preserving procedures.

Effect of postoperative adjuvant radiotherapy on treatment outcome of patients with localized soft tissue sarcoma

Objective To investigate the treatment outcome of patients with localized soft tissue sarcoma (STS) and related prognostic factors, with a focus of the role of postoperative radiotherapy in the treatment of STS. Methods A retrospective analysis was performed for the clinical data of 203 STS patients who underwent organ preservation surgery in Fudan University Shanghai Cancer Center from July 2000 to July 2010. Of all the patients, 76(37.4%) received adjuvant radiotherapy, which was delivered via anterior-posterior parallel opposed fields at a dose of 45-70 Gy. The Kaplan-Meier method was used to calculate survival rates, the log-rank test was used for survival difference analysis, and the Cox proportional hazards model was used for multivariate analysis. Results The follow-up rate was 100%. The 5-year overall survival (OS) rate, local failure-free survival rate, and distant metastasis-free survival rate were 69.1%, 69.2%, and 68.0%, respectively. The multivariate analysis showed that pathological subtype, tumor size, resection margin status, and postoperative radiotherapy were influencing factors for OS. Among these factors, postoperative radiotherapy was associated with a significantly reduced risk of local recurrence in STS patients (HR=0.327, 95% CI 0.177-0.605, P=0.000) and a significantly increased OS rate (HR=0.489, 95% CI 0.266-0.897, P=0.021). Conclusions Postoperative radiotherapy can reduce local recurrence and improve OS in patients with localized STS, and further studies are needed to clarify its role. Key words: Soft tissue sarcoma/radiotherapy; Radiotherapy, postoperative; Prognosis

Tumor bed brachytherapy for locally advanced laryngeal cancer: a feasibility assessment of combination with ferromagnetic hyperthermia

Purpose. To assess the feasibility of adding hyperthermia to an original method of organ-preserving brachytherapy treatment for locally advanced head and neck tumors. Methods and materials. The method involves organ-preserving tumor resection and adjunctive high-dose-rate (HDR) brachytherapy delivered via afterloading catheters. These catheters are embedded in a polymeric implant prepared intraoperatively to fill the resection cavity, allowing precise computer planning of dose distribution in the surrounding at-risk tumor bed tissue. Theoretical and experimental analyzes address the feasibility of heating the tumor bed implant by coupling energy from a 100 kHz magnetic field applied externally into ferromagnetic particles, which are uniformly distributed within the implant. The goal is to combine adjuvant hyperthermia (40 °C–45 °C) to at-risk tissue within 5 mm of the resection cavity for thermal enhancement of radiation and chemotherapy response. Results. A five-year relapse free survival rate of 95.8% was obtained for a select group of 48 male patients with T3N0M0 larynx tumors, when combining organ-preserving surgery with HDR brachytherapy from a tumor bed implant. Anticipating the need for additional treatment in patients with more advanced disease, a theoretical analysis demonstrates the ability to heat at-risk tissue up to 10 mm from the surface of an implant filled with magnetically coupled ferromagnetic balls. Using a laboratory induction heating system, it takes just over 2 min to increase the target tissue temperature by 10 °C using a 19% volume fraction of ferromagnetic spheres in a 2 cm diameter silicone implant. Conclusion. The promising clinical results of a 48 patient pilot study demonstrate the feasibility of a new organ sparing treatment for laryngeal cancer. Anticipating the need for additional therapy, theoretical estimations of potential implant heating are confirmed with laboratory experiments, preparing the way for future implementation of a thermobrachytherapy implant approach for organ-sparing treatment of locally advanced laryngeal cancer.

Management of Extra-Hepatopulmonary Hydatid Cysts (157 cases).

Hydatid cyst disease (HCD) is a zoonotic infestation of Echinococcus granulosus, which is frequently seen in some regions of the world. Unusual localization of Echinococcus granulosus is very rare. Hence, we would like to present our experience of identifying an extra-hepatopulmonary location of hydatid cysts. A total of 157 patients with an unusual location of hydatid cysts treated between 2000 and 2012 were retrospectively evaluated according to their age, sex, symptoms, diagnosis, stage, location of the cyst, and treatment modality. Out of 157 patients, 68 were male and 89 were female. The mean age was 43.65 (4-85) years. The most involved organ was the spleen. The cysts were classified in 96, 57, and 4 patients as type I-II, III, and IV-V, respectively. The Puncture, Aspiration, Injection, and Reaspiration regimen should be the primary treatment option for hydatid cysts with unusual locations. As much as possible, organ-preserving surgery should be a treatment of choice in extra-hepatopulmonary hydatid cysts.

Ex vivo organ-preserving surgery on kidneys for renal cell carcinoma and renal artery aneurysms

Objectives: development of operative technique and evaluation of renal arteries patency after ex vivo surgery.

Diagnosis, prevention and organ-preserving method of delivery in pregnant women with placenta accreta

The article considers one of the causes of maternal mortality - uterine postpartum bleeding developing as a result of the placental growth into the uterus and surrounding organs. It is highlighted that the processes of trophoblast invasion during pregnancy and tumor progression have much in common. The article describes a significant role of Kiss1-gene and its receptor GPR54 in the placenta accreta development. The causes of placental abnormalities and conventional methods of treatment and surgical management in placenta accreta (controlled uterine balloon tamponade, uterine vessels ligation, uterine compression sutures, uterine artery embolization, internal iliac arteries ligation, temporary clamping or major uterine vessels ligation, hysterectomy, «Triple-P» method) are analyzed, the possible complications of these methods of treatment are listed. The developed at the Department of Obstetrics and Gynecology №1 of Kazan State Medical University examination algorithm when planning pregnancy, gestation management and organ-preserving method of delivery in pregnant women with abnormal placental attachment is presented. Used by authors methods of uterine scar examination after organ-preserving surgery or caesarean section in women in the non-pregnant state (hysterography, hysteroscopy, ultrasound scan, double-contrast study) and sonographic signs of scar failure (myometrial thinning in the scar area, irregular contour of the scar, discontinuous contours of the scar, significant number of hyperechoic inclusions, presence of non-vascular liquid formations in the scar area, triangle in the scar area) are listed. Interesting illustrative material is also presented.

Laryngeal Preservation in Glottic Cancer: A Comparison of Hospital Charges and Morbidity among Treatment Options.

When total laryngectomy is not required, organ preservation surgery or radiotherapy is considered the standard of care for primary glottic cancer. These accepted treatment options are available for early and advanced glottic cancers due to equivalent locoregional control and survival rates. However, in today's climate of accountable care, the financial burden of treatment choices continues to increase in significance. We therefore compared hospital charges and treatment-related morbidity between organ-preserving surgery and radiation with or without chemotherapy-herein, (chemo)radiation-in the primary treatment of glottic cancer. Nationwide Inpatient Sample Database was analyzed to assess clinical and financial information. Population-based analysis. Patients (N = 5499) with primary glottic cancer undergoing treatment with laryngeal preservation strategies. Patients were subdivided by ICD-9 codes into 3 treatment groups: endoscopic resection, open partial laryngectomy, and (chemo)radiation. Treatment-related outcomes, charges, and length of hospitalization were analyzed among treatment groups. When adjusting for sex, age, race, comorbidity, and primary payer, (chemo)radiotherapy was associated with increased direct charges (P < .001; coefficient, $23,658.99; 95% confidence interval [95% CI]: $10,227.15-$37,090.84) and length of hospitalization (P < .001; hazard ratio, 0.593; 95% CI: 0.502-0.702) when compared with endoscopic surgery. As compared with open surgery, endoscopic surgery was associated with reduced hospital charges (P = .012; coefficient, $11,967.01; 95% CI: $2,784.17-$21,249.85) and duration of hospitalization (P < .001; hazard ratio, 0.749; 95% CI: 0.641-0.876). This analysis suggests that increased utilization of endoscopic surgery in patients with primary glottic cancer not requiring total laryngectomy may lead to reduced financial burden and duration of hospitalization when compared with open surgery or (chemo)radiation therapy.

Focal therapy of prostate cancer in Germany

Prostate cancer (PCa) is the most common cancer in men, which is increasingly diagnosed at alocalized stage due to the widespread use of PSA (prostate-specific antigen)-screening. Traditionally, definite treatment options for PCa include radical prostatectomy, external beam radiotherapy, or brachytherapy. However, treatment-related side effects such as urinary incontinence and erectile dysfunction are common. Alternatively, national and international guidelines recommend active surveillance (AS) as atreatment option for low-risk PCa. Organ-preserving surgery is commonly used in other organs, such as organ-conserving surgery for breast cancer. Focal therapy (FT) for PCa may close the gap between radical treatment options and active surveillance while reducing side effects. This article highlights the current therapy options for FT in Germany including their limitations and perspectives. Currently, different therapy options are available for FT in PCa. However, the use of FT is still embedded in clinical trials and has not been approved for routine use yet. Initial results seem to be promising, but most studies are currently enrolling or have not been published yet.

Multidisciplinary approach to introducing new technologies and reconstructive surgeries in diagnosis and treatment of neoplastic diseases of the female reproductive organs

Multidisciplinary approach that comprises the passing the examination in the exam room with the Pap test, questionnaires, ultrasound or digital mammography screening (MS) according to the age is a promising way of solving the problems with the visual localization of cancer, in particular with the reproductive organs. A minimally invasive removal technology that helped to determine the nature of tumor pathologies and remove those potentially dangerous hotbeds at the same time, was an important component of this secondary prevention system. Organ preserving and reconstructive surgeries (to our knowledge to 38,8% of patients with breast cancer and 95% of patients with vulvar cancer and vulvar dysplasia) have a positive effect not only on women’s life quality, but also become a good motivation for regular women’s screening in the region. Nothing is more convincing than the vivid example and “word of mouth”. A multidisciplinary approach to solving problem with the help of different specialists helped to reduce mortality rates for breast cancer by 30,03 ± 2,1% compared with 2009 (after the introduction of reconstructive surgery) and vulvar cancer by 83,3 ± 5,7% in comparison with 2005 (after the introduction of reconstructive surgery) at the continuing trend of increasing incidence rate. Cytological screening for dysplasia and early forms of cervical cancer needs a serious adjustment in accordance with the WHO recommendations and per capita accounting used in Russia.

Surgical treatment of neuroendocrine tumors of the pancreas. A single institution's experience

Introduction: Neuroendocrine tumors of the pancreas (pNET) range from 1 to 2% of pancreatic oncological pathology, the frequency during lifetime diagnostics is 12–15 cases per 1 million of population. Aim: Introduce the largest experience of surgical treatment of neuroendocrine tumors of the pancreas in Ukraine. Methods: In the National Institute of Surgery and Transplantology from January 2004 to December 2014 were treated 173 patients with neuroendocrine tumors of the pancreas, to whom were performed 181 surgeries. Non-functioning pNET were diagnosed in 103 patients (59.5%), hormone-active were in 70 (40.5%). In non-functioning NET (dominated resection surgeries (Whipple procedure, left-side pancreatectomy), at hormone-active were performed mostly organ-preserving surgeries (enucleation of tumor). Results: Postoperative complications occurred in 18.4% of patients with pNET, the most common complication was external pancreatic fistula (9.8%). Total postoperative mortality was 1.2%. The overall 5-year survival was 82.3%, NET G1 - 100%, NET G2 - 84.3%, neuroendocrine carcinoma, NEC G3 – 38.7%. Conclusion: The level of postoperative complications and mortality indicators complies with all tumors of the pancreas. The level of the overall 5-year survival is quite high, allowing for organ-preserving and laparoscopic surgeries for localized forms of pNET. Advance forms of pNET are not a contraindication to surgical treatment, but such cases must be evaluated individually. Relatively few of occurrences of pNET, the complexity and importance of preoperative diagnostic to choose the optimal treatments strategy, justifying perform the treatment of these patients in specialized centers.

Outcomes of 101 Consecutive Surgical Resections of Gastroenteropancreatic Neuroendocrine Tumours (GEPNETs) at Tata Memorial Hospital: a Referral Bias for Nonfunctional Duodenopancreatic Tumours and the Need for Greater Awareness of GEPNETs as a Distinct Entity.

Data from India regarding the disease spectrum and surgical results of neuroendocrine tumours (GEPNETs) are sparse. Tempered surgical radicality in a high-volume oncology centre, conforming to existing guidelines, may further our understanding of tumour characteristics and behavioural patterns of nonfunctional GEPNETs. Surgical outcomes of patients with histopathologically confirmed GEPNETs from January 2003 to December 2013 were analyzed from a prospectively maintained database. Tumour grade, organ of primary tumour, perioperative factors, quality/radicality of resection and presence of metastatic disease were correlated with perioperative outcomes, overall survival and disease-free survival. Ninety of the 101 operated patients had nonfunctional tumours. These comprised radical resections (n = 69), organ-preserving procedures (n = 16) and inoperable tumours (n = 5). The primary tumour sites were pancreatic in 48 patients and gastroenteric in 42 patients. The overall perioperative morbidity and mortality rates were 30 and 3%, respectively. Fifteen patients harboured metastatic disease at presentation. At a median follow-up of 22months, 18 patients had residual disease, 7 developed recurrences and 10 patients died. The estimated actuarial 5-year overall survival was 81.6%, and disease-free survival was 67.2%. Tumour grade and organ of origin (pancreatic vs. gastroenteric) did not influence long-term survival (p = 0.315 and p = 0.624, respectively), but presence of metastatic disease at presentation significantly affected long-term survival (p = 0.009). Nonfunctional pancreatic/duodenal neuroendocrine tumours (NETs) accounted for 76% of surgical resections at our centre with the minority being other resections. In selected patients with nonfunctional NETs, organ-preserving surgery may provide equivalent long-term survival with decreased operative morbidity. Although tumour grade is considered to be an important prognostic factor, the presence of metastatic disease at presentation also determines long-term survival. The referral bias suggests the need for greater awareness given the favourable long-term outcomes of these tumours. There is a need to correct this referral bias by increasing the awareness of GEPNETs in India.

An Update on Current Treatment Options for Pediatric Genitourinary Tract Tumors

Most of the success and advances made in the care of children with genitourinary (GU) cancer over the last 50 years are thanks in large part to the efforts of the cooperative pediatric oncology groups both in North America and Europe. Currently, children with tumors of the kidney, bladder, prostate, and testis/para-testis largely enjoy a good prognosis thanks to the outstanding research into these relatively rare diseases. Evidence-based and protocol-driven care has resulted in outstanding rates of cure. The future of the care for these children with GU malignancy is to preserve these outcomes while minimizing the morbidity of therapy. One area of great interest across these entities is risk stratification which holds the potential to reduce the burden of therapy in those who can afford to do so and reserve more aggressive treatments for those with risk factors for poor prognosis. From a surgical standpoint, there is an increasing interest in reducing morbidity as well. For renal tumors, this includes nephron-sparing and minimally invasive surgery when possible. For bladder and prostate tumors, there is an increasing emphasis on organ preservation and non-exenterative surgery. Regardless of these surgical advances, the future of pediatric GU cancer therapy likely rests more in tumor-biology-driven risk stratification and personalized therapy. Thus, from a surgical standpoint, there is motivation for surgeons to think beyond just the surgery and to be involved and be knowledgeable about all of the multidisciplinary aspects of pediatric cancer care.

Predictable swallowing function after open horizontal supraglottic partial laryngectomy.

After horizontal supraglottic partial laryngectomy, patients have an increased risk of dysphagia as they are not able to close the laryngeal entrance during swallowing, especially if the surgical defect of the tongue base has increased. There is no investigation that studies risk factors for impaired swallow function, or that predicts postoperative swallow outcomes based on radiologically determined tumor dimensions. The present study investigated the impact of the tongue base tumor extension (determined by CT scan in patients undergoing partial laryngectomy) on the recovery rate of swallow function. The retrospective study in a tertiary hospital between 2000 and 2015 included all patients who underwent open horizontal supraglottic partial laryngectomy due to oropharyngeal cancer of the tongue base, or supraglottic laryngeal cancer with tongue base infiltration. All clinicopathological data were collected. The dimension of tongue base infiltration was measured using CT scan. Swallow function was recorded by Fiberoptic Endoscopic Evaluation of Swallowing and determined by evaluating both the duration until nasogastric tube removal and changing of the cuffed tracheostomy tube for an uncuffed speech cannula. The study included 26 patients (44-76 years, median 59 years). The clinical tumor (cT) classification included cT2 and cT3, while the pathologic tumor (pT) classification included pT2 and pT3 in 90% and pT1 and pT4 in 10% respectively. The duration until using the speech cannula was not associated with clinicopathological data, including the investigated radiologic tumor dimensions (biggest tumor diameter, tongue base infiltration depth, width, height, area and volume). The duration until nasogastric tube removal was significantly associated with the tongue base infiltration width (p=0.012), height (p=0.026) and area (p<0.0001). The patients were divided into two groups according to the median tongue base infiltration area estimated as 6.20cm(2). In patients <6.20cm(2), 50% of the nasogastric tubes were removed after 4 days (95% CI 0-8.6 days) and in patients ≥6.20cm(2), 50% were removed after 22 days (95% CI 6.8-37.2 days; p<0.0001). The postoperative swallow function after open horizontal supraglottic partial laryngectomy depends on the tumor extension of the tongue base. The tongue base infiltration area is a useful tool for surgical planning as it can be used to predict postoperative swallow function. In foreseeably permanent dysphagia, as well as permanent and necessary tracheotomy tube cuffs after organ-preserving surgery, alternative therapy methods should be particularly preferred as the primary chemoradiation.

TREATMENT OUTCOMES IN PATIENTS WITH PELVIC CHONDROSARCOMA

The purpose of the study : to evaluate the efficacy of surgical and combined modality treatment in patients with pelvic chondrosarcoma. Materials and methods . The study included 52 patients with pelvic chondrosarcoma. Forty-two (81 %) patients had well-differentiated and 10 (19 %) patients had poorly differentiated chondrosarcoma. Sixteen (30 %) patients underwent interiliac-abdominal resection of the pelvis and 36 (70 %) patients were treated with organ-preserving surgery. Of the patients treated with organpreserving surgery, 22 (61 %) patients underwent reconstructive surgery. The follow-up period was 45 months (range, 8 –18 months). Results . Positive resection margins were found in 8 (15 %) patients. Postoperative complications were observed in 13 (25 %) patients. The median MSTS score was 92 % (range, 62–100%) for 14 (27 %) patients, who underwent surgery without reconstruction and 67 % (range, 40–95 %) for 22 (61 %) patients, who underwent reconstructive surgery. For 16 (30 %) patients, who underwent interiliacabdominal resection of the pelvis, the median MSTS score was 45 % (range, 25–68 %). Disease progression was observed in 16 (31 %) patients. The overall 5-year survival rate was 75 % and the 5-yaer disease-free survival rate was 60 %. Conclusion . The oncology and functional outcomes are consistent with other recent studies, which indicate that organ-preserving surgery may be an appropriate approach in the treatment of patients with pelvic chondrosarcoma.

WATCH AND WAIT APPROACH IN RECTAL CANCER TREATMENT

Introduction: The colorectal carcinoma is the most common gastrointestinal neoplasm worldwide and in Bulgaria. Often the choice of surgical treatment is difficult, and organ-preserving surgery is not feasible. In borderline situations when choosing a surgical approach is difficult, a neoadjuvant chemoradiotherapy may downstage the disease and provide better results and more surgical options. If the treatment response is partial or complete, the possibility of carrying out sphincter-sparing surgery is increased. The aim of the study is to present a clinical case of a patient with rectal carcinoma, submitted to multimodal treatment. Case report: The presented patient is a 65-year old female with alarming symptoms and diagnosed rectal adenocarcinoma. The patient underwent preoperative neoadjuvant treatment. After a full course of treatment, the patient was restaged and reported a complete clinical response to therapy. After recommended period, she underwent an anterior resection of the rectum. This case is an example of the potential possibilities of a multidisciplinary team in surgical oncology. Conclusions: There are certain criteria, regarding the waiting approach in rectal carcinoma, and it subjected to a set of indications in case of a complete response to the treatment. The current case is an excellent example of performing a sphincter-spearing surgery, which may lead to higher quality of life for the target patient group. The ESMO guidelines for neoadjuvant treatment of rectal adenocarcinoma are applicable in Bulgaria.

The role of MRI in the diagnosis of acute radiation reaction in breast cancer patient

A clinical case with acute radiation reaction of the left breast after organ-preserving surgery with 10 Gy IORT (24.8 Gy) conventional radiation therapy has been presented. Comprehensive MRI examination showed signs of radiation- induced damage to skin, soft tissues and vessels of the residual breast.

Organization of Medical Care for Children with Cancer in the Arkhangelsk Region

Introduction: Malignant tumors (MT) in children are not common but contribute significantly to infant mortality . Materials and methods: We evaluate the available equipment and the competence of the staff of the Oncology Department of cancer chemotherapy at the SBPHF AR Regional Children's Hospital (ARCH) in accordance with the requirements of the Annexes 5-6 to the Order of Ministry of Health of the Russian Federation № 560n dated October 31, 2012 (as amended September 02, 2013 № 608n) “On approval of procedures for the provision of healthcare services in the profile ‘Pediatric oncology’”. The analysis of the case histories of patients with solid tumors (except brain tumors) treated in the period from 2011 to 2015 was also performed. Results: During the period from 2011 to 2015 specialized and symptomatic treatment was provided to 49 patients (23 (46.9%) girls and 26 (53.1%) boys, mean age, 5.9 years; range 1 month – 17 years) with solid malignant tumors (excluding brain tumors). Out of 49 patients, eleven (22.4%) had neuroblastomas, ten (20.4%) – nephroblastomas, six (12.2%) – liver tumors, five (10.2 %) – thyroid cancer, three (6.1%) – osteosarcomas, three (6.1%) – rhabdomyosarcoma (RMS), two (4%) – Ewing's sarcoma, two (4%) – organ RMC, two (4%) – retinoblastomas, one (2%) – synovial sarcoma, one (2%) – fibrosarcoma, one (2%) – juvenile granulosa cell tumor, one (2%) – primitive neuroectodermal tumor, one (2%) – testicular cancer. Seven (14.3%) patients presented with stage I disease, twenty-two (44.9%) – with stage II, five (10.2%) – with stage III, fourteen (28.6%) – with stage IV, and one (2%) patient with unidentified tumor stage. Currently, forty (81.6%) patients from the analyzed group are alive: four (10%) continued treatment and thirty-six (90%) achieved remission. Nine (18.4%) patients died from the progression of the underlying disease. Conclusion: Medical facilities of the Arkhangelsk Region have the opportunities to provide specialized medical care for children with the majority of malignant tumors. The specialized department can provide chemotherapy and surgery, excluding complex organ preservation surgery (in patients with bone sarcomas) as it requires professionals with extensive experience.

初回治療に喉頭機能温存手術を施行した局所進行喉頭癌の治療成績

初回治療に喉頭機能温存手術を施行した局所進行喉頭癌の治療成績

Hysteroscopic, morphofunctional and immunohistochemical endometriun features in women with uterine leiomyoma after different types of organ-preserving treatment

Uterus leiomyoma is the most common benign tumor that takes one of the leading places in the structure of gynecological pathology. According to different authors proportion of this disease in the infertility structure is 48–55.3%, in the structure of pregnancy miscarriage – 14–18%, in pregnancy and childbirth complications – 10–30%. Uterus leiomyoma reduces in vitro fertilization results from 29% to 9% in cases of submucous nodus localization, lowers pregnancy rate to 28.2% against 63.4% after hysteroscopic node resection. The authors performed a study to improve the efficiency of uterine fibroids treatment through the development of methods to improve the functional state of the endometrium after use of different types of organ-preserving surgery. Following data were received after various types of organ saving surgical procedures: patients with normal endometrium structure (73.33%) dominated at first group. Endometrial hypoplasia was found in 20% cases of the identified pathology. Endometrial fibro-glandular type polyps were found in 6.67% of cases. The main features of this group were uneven focal estrogen receptor down regulation, disturbance of natural killer cells CD16 and CD56 and CD45 expression, compared to the control group. Immunohistochemical study showed positive expression of CD138 (plasma) in 25% of cases in endometrium of women after uterine artery embolization, indicating the presence of chronic endometritis in this group. Immunohistochemical studies of endometrium in the third group showed high level expression of inflammatory markers (CD45, CD16 and CD56). It was detected a significant increase in expression of the proliferation marker Ki-67 in endometrial stroma in the IIIb group, indicating a potential risk of hyper proliferation against a background of inflammatory process of the endometrium. Thus, endometrium changes after organ saving surgical treatment of uterine leiomyoma, such as uterine artery embolization, conservative myomectomy, hysteroscopic resection of node determines the need for the prevention of endometrial dysfunction after surgery.