Prevention Of Local Recurrence Research Articles

High-Grade Chondrosarcoma of Mandibular Molar Region- A Case Report and Review of Literature

Chondrosarcomas are malignant tumors of cartilaginous origin with only 5-10% reported in the head and neck region. Intraorally it has higher incidence of occurrence in anterior maxilla followed by posterior mandible. The 5-year survival and metastases rates are adversely affected by the grade of tumor, which necessitates its early diagnosis. Histopathology and immunohistochemistry are vital for its accurate diagnosis. Chondrosarcomas being radio-and chemoresistant are treated surgically although adjuvant radiotherapy helps in prevention of local recurrences. A case of high-grade chondrosarcoma of the mandibular molar region is presented, along with pertinent review of literature.

Simvastatin/hydrogel-loaded 3D-printed titanium alloy scaffolds suppress osteosarcoma via TF/NOX2-associated ferroptosis while repairing bone defects

Postoperative anatomical reconstruction and prevention of local recurrence after tumor resection are two vital clinical challenges in osteosarcoma treatment. A three-dimensional (3D)-printed porous Ti6Al4V scaffold (3DTi) is an ideal material for reconstructing critical bone defects with numerous advantages over traditional implants, including a lower elasticity modulus, stronger bone-implant interlock, and larger drug-loading space. Simvastatin is a multitarget drug with anti-tumor and osteogenic potential; however, its efficiency is unsatisfactory when delivered systematically. Here, simvastatin was loaded into a 3DTi using a thermosensitive poly (lactic-co-glycolic) acid (PLGA)-polyethylene glycol (PEG)-PLGA hydrogel as a carrier to exert anti-osteosarcoma and osteogenic effects. Newly constructed simvastatin/hydrogel-loaded 3DTi (Sim-3DTi) was comprehensively appraised, and its newfound anti-osteosarcoma mechanism was explained. Specifically, in a bone defect model of rabbit condyles, Sim-3DTi exhibited enhanced osteogenesis, bone in-growth, and osseointegration compared with 3DTi alone, with greater bone morphogenetic protein 2 expression. In our nude mice model, simvastatin loading reduced tumor volume by 59%–77 % without organic damage, implying good anti-osteosarcoma activity and biosafety. Furthermore, Sim-3DTi induced ferroptosis by upregulating transferrin and nicotinamide adenine dinucleotide phosphate oxidase 2 levels in osteosarcoma both in vivo and in vitro. Sim-3DTi is a promising osteogenic bone substitute for osteosarcoma-related bone defects, with a ferroptosis-mediated anti-osteosarcoma effect.

The Evolving Neoadjuvant Treatment Paradigm for Patients with Locoregional mismatch Repair Proficient Rectal Cancer.

The standard of care for locally advanced rectal cancer (LARC) has included preoperative chemoradiation, total mesorectal excision surgery and post operative adjuvant chemotherapy based on histopathology. The current therapeutic landscape in LARC has many different options with different directions of travel - depending on the goal of treatment. Enthusiasm for delivering total neoadjuvant therapy (TNT) for patients with locally advanced rectal cancer (LARC) is increasing in the light of recently published randomised phase III trials - RAPIDO and PRODIGE-23. There is a wide diversity of different potential schedules and a multitude of approaches, which include induction neoadjuvant chemotherapy (NACT) with a range of chemotherapy options (CAPEOX, FOLFOX, FOLFOXIRI) and a varying duration of 6-18 weeks, or consolidation NACT. These schedules either precede or follow short-course preoperative radiation therapy (SCPRT) using 5 × 5Gy or long-course chemoradiation (LCCRT) using 45-60Gy respectively. The different strategies of induction and consolidation neoadjuvant chemotherapy have been compared and have similar long-term outcomes, but consolidation chemotherapy may facilitate organ-sparing. The results are driving novel paradigms with both intensification and de-intensification treatment strategies. The ideal combination, sequence or duration of such a TNT approach remains undefined. As yet, there are no robust clinical, genetic, molecular, immune or imaging features (alone or integrated), which either direct or aid these choices. Currently, the selection of neoadjuvant treatment is driven by the impact on avoidance or feasibility of surgery or reducing the risk of metastases rather than prevention of local recurrence. Most believe that TNT will improve overall survival, despite the present lack of evidence. Both the inherent heterogeneity in LARC and the observed range of different responses underline the need for response biomarkers to individually tailor therapy rather than 'a one size fits all' approach.

Intraoperative margin assessment by wireless signals in thoracoscopic anterior (S3) segmentectomy using a radiofrequency identification marker

Despite the use of near-infrared thoracoscopy with intravenous indocyanine green, intraoperative assessment of the surgical margin for the resection of non-palpable tumors located near the intersegmental plane requires highly advanced surgical skill for the prevention of local recurrence. Because the demarcation line is limited to the pleural surface, to overcome uncertainty in tumor palpation for deeply located small-sized lesions, other supplemental localization techniques have been proposed. Here, we present a novel surgical technique using radiofrequency identification markers for intraoperative assessment of the lateral surgical margin in segmentectomy.

The role of ultrasonography in head and neck Non-Melanoma Skin Cancer approach: an update with a review of the literature.

Non-Melanoma Skin Cancer is one of the most common cancer types and the face is the most affected region. The diagnosis of the skin cancer relies on clinical inspection, palpation, dermoscopy followed by incisional or excisional biopsy. When skin cancers are removed from the face, many factors are involved, including aesthetics. In addition, surgical planning with preoperative acknowledgement of the tumour margins is often the key to avoid incomplete excision, the need for reintervention, or in the prevention of functional and aesthetical defects in the treatment of skin tumours. In recent years, the development of new technologies in sonography, including high frequencies transducers can provide a full range of data. It can offer valuable information regarding the size of the tumour including the depth of invasion, the extent of the tumour, histology and subtypes of the lesions which are helpful for the treatment plan. It also may be efficient in detection of positive margins after surgery and it could play a role in the treatment of skin cancer, prevention of local recurrences and overall control of the disease. K.

Memenin Filloides Tümörlerinin Klinikopatolojik Özellikleri

Aim: Phyllodes tumors are rare breast neoplasms comprising less than 1% of all breast neoplasms. The objective of this study was to consider the clinicopathological features of phyllodes tumors that underwent surgery in our hospital.Material and Methods: We retrospectively analyzed the medical records of 16 patients who had histologically diagnosed phyllodes tumors over 9 years.Results: There were 16 female patients with a mean age of 45.6±15.3 years. Magnetic resonance imaging was performed in 5 cases for preoperative diagnosis, and 4 were reported as phyllodes tumors, all of these patients were having high-grade phyllodes tumors (borderline or malignant) histopathologically. Preoperative core biopsy was performed in 14 patients, and histopathologically phyllodes tumor was diagnosed in two patients. In six patients, differentiation between hypercellular fibroadenoma and phyllodes tumor could not be performed. Breast-conserving surgery was the most common type of operation performed in 10 (62.5%) patients, three patients with positive margins were underwent reoperation. The pathological diagnoses were benign, borderline, and malignant in seven (43.8%), five (31.3%) and four (25.0%) patients, respectively. The median diameter of the tumors was measured as 6 cm after the postoperative pathological analysis. The median follow-up time was 36 months. During this time, there was no local or systemic recurrence.Conclusion: Wide excision with a clear margin appears to be the most important factor in the management of these tumors and in the prevention of local recurrence. The preoperative diagnosis of phyllodes tumors contributes to decreasing the necessity for secondary surgical intervention avoiding border positivity.

Surgical excision of a solitary osteochondroma arising from the lesser trochanter in an adult: a case report

<p>The occurrence of osteochondroma around the proximal femur is rarely reported as most cases are asymptomatic. We report a rare case of symptomatic solitary osteochondroma arising from the lesser trochanter in a skeletally mature patient causing significant impairment of hip function managed by surgical excision. A 32-year-old male labourer presented with pain and swelling over right hip region for nine months. Radiographic examination (X-ray, MRI, CT) revealed the pathognomonic continuity of the cortex and medulla of the lesion with the parent bone. Cartilage cap cover (measuring 15 mm) on MRI helped to clinch the diagnosis. CT guided biopsy was also suggestive of osteochondroma. The tumour was excised en bloc by posterior approach without the need for hip dislocation. The base of the lesser trochanter was osteotomised and the entire mass with the cartilage cap was removed. A two year follow up has shown no evidence of local recurrence. Surgical excision of a symptomatic osteochondroma is a successful form of treatment with low mortality. Adequate pre-operative radiographic examination is helpful to know the location and local spread of the tumour. Measurement of cartilage cap thickness on MRI is an essential tool to diagnose malignant changes. A safe and adequate resection should be carried out in an effective manner with attention to femoral head vascularity and prevention of local recurrences. Patients with solitary osteochondroma around the proximal femur should be kept under observation to help early detection of malignant changes.</p>

P-201 Neoadjuvant hypofractionated intensity-modulated radiotherapy with a simultaneous integrated boost combined with capecitabine in locally advanced rectal cancer

Neoadjuvant chemoradiotherapy followed by total mesorectal excision is the standard treatment in locally advanced rectal cancer (LARC) (stages II T3/T4N0 y III T N1/N2). It aims at reducing the risk of distant recurrence while pelvic radiotherapy focuses on the prevention of local recurrence. The use of advanced techniques such as Intensity-Modulated Radiotherapy (IMRT) based on multileaf collimator (MLC) allows higher doses to be delivered to the tumor volume, taking into account the tolerance dose in the organs at risk.

3D printed core-shell hydrogel fiber scaffolds with NIR-triggered drug release for localized therapy of breast cancer.

Localized therapy using hydrogels-based drug delivery system (DDS) is a promising strategy for the treatment of diseases such as cancer in superficial tissues. In this study, we presented a facile method to prepare core-shell hydrogel fibers/scaffolds with controlled drug delivery and designed structures for the treatment of the residual breast cancer and prevention of local recurrence after surgery. Mixtures of polydopamine (PDA) and concentrated alginate inks (15.3wt%) as the shell layer, and drug-loaded temperature-sensitive hydrogels as the core part were co-injected and coaxial 3D printed into core-shell hydrogel fibers and scaffolds. Under near infrared (NIR) irradiation, PDA with excellent photothermal effect could raise the temperature of core-shell fibers, which induced the gel-sol transition of the core gels, and subsequently resulted in the drug release from the loosened hydrogel network. The photothermal effect and the released drugs could eliminate cancer effectively. Thus, our prepared core/shell fibers and scaffolds with NIR-triggered on-demand drug release would be promising candidates to fill the cavity of breast tissues after surgical resection of cancer achieving a therapeutic effect for the residual and recurred cancer.

Intrahepatic cholangiocarcinoma surgery: the impact of lymphadenectomy.

Intrahepatic cholangiocarcinoma (ICC) is the second most common primary hepatic malignant tumor and its incidence is increasing over the world. At present times, radical liver resection is still the most effective treatment for ICC patients to achieve long term survival. Pathological lymph node metastases (LMN), found in 15% to 45% of the patients, have been recognized as an extremely poor prognostic risk factor, even if curative resection is performed. So, considering this issue, it acquires relevance to determine the validity of surgical resection for LNM cases that are diagnosed in the preoperative setting, or whether a routine lymphadenectomy should be performed systematically in all hepatectomies for ICC. The role of routine lymphadenectomy in the surgical treatment of ICC remains controversial, with some centers considering it standard whereas other surgeons perform lymphadenectomy only as a selective indication. Recently, a growing widespread adoption of lymphadenectomy was demonstrated that nearly doubled its commonly reported execution rate. The newly updated eight edition of the American Joint Committee on Cancer (AJCC) staging system now recommends that six nodes need to be analyzed to stage patients with ICC. In this review, we analyzed and summarized some anatomic considerations of the lymphatic anatomy of the liver and the current knowledge and potential advantages of performing a routine lymphadenectomy in patients with ICC, especially looking at pathological staging, prognosis, prevention of local recurrence and outcome. New areas like lymphadenectomy in cirrhotic patients and laparoscopic lymphadenectomy are also discussed.

Clinical Outcome and Prognostic Factors of Malignant Spinal Dumbbell Tumors.

Introduction To investigate the clinical outcome and prognostic factors of malignant spinal dumbbell tumors (m-SDTs). Methods We retrospectively reviewed the clinical outcome of 22 consecutive cases of m-SDTs and analyzed the prognostic factors associated with worse outcome. Results Nineteen of the 22 cases were managed with surgery (86%), and gross total resection (GTR) was achieved in four cases (21%). The duration of overall survival (OS) ranged from 3 to 140 months, with a median survival time of 15.3 months. The 5 year OS rate was 55.6%. In multivariate analysis, histological subtype (high-grade malignant peripheral nerve sheath tumor) (hazard ratio [HR] 14.9, p = 0.0191), GTR (HR 0.07, p = 0.0343), and presence of local recurrences (HR 11.2, p = 0.0479) were significant and independent predictors of OS. Conclusions On the basis of clinical data, we propose that GTR and prevention of local recurrence may improve the clinical outcome of m-SDTs.

Phase I/II trial of combined kyphoplasty and intraoperative radiotherapy in spinal metastases

Background ContextSpinal metastases occur in 30%–50% of patients with systemic cancer. The primary goals of palliation are pain control and prevention of local recurrence. PurposeThis study aimed to test the safety and efficacy of a combined modality approach consisting of kyphoplasty and intraoperative radiotherapy (Kypho-IORT). Study Design/SettingKyphoplasty and intraoperative radiotherapy was a prospective, single-center phase I/II trial. Patients were enrolled in a classical 3+3 scheme within the initial phase I, where Kypho-IORT was applied using a needle-shaped 50 kV X-ray source at three radiation dose levels (8 Gy in 8-mm, 8 Gy in 11-mm, and 8 Gy in 13-mm depth). Thereafter, cohort expansion was performed as phase II of the trial. The trial is registered with clinicaltrials.gov, number NCT01280032. Patient SamplePatients aged 50 years and older with a Karnofsky Performance Status of at least 60% and with one to three painful vertebral metastases confined to the vertebral body were eligible to participate. Outcome MeasuresThe primary end point was safety as per the occurrence of dose-limiting toxicities. The secondary end points were pain reduction, local progression-free survival (L-PFS), and overall survival (OS). MethodsPain was measured using the visual analog scale (VAS) and local control was assessed in serial computed tomography or magnetic resonance imaging scans. ResultsNone of the nine patients enrolled in the phase I showed dose-limiting toxicities at any level and thus, 52 patients were subsequently enrolled into a phase II, where Kypho-IORT was performed at various dose levels. The median pain score significantly dropped from 5 preoperatively to 2 at the first postoperative day (p<.001). Of 43 patients who reported a pre-interventional pain level of 3 or more, 30 (69.8%) reported a reduction of ≥3 points on the first postoperative day. A persistent pain reduction beyond the first postoperative day of ≥3 points was seen in 34 (79.1%) patients. The 3, 6, and 12 month L-PFS was excellent with 97.5%, 93.8%, and 93.8%. The 3, 6, and 12 months OS was 76.9%, 64.0%, and 48.4%. ConclusionKyphoplasty and intraoperative radiotherapy is safe and immediately provided sustained pain relief with excellent local control rates in patients with painful vertebral metastases.

The role of radiofrequency ablation to liver transection surface in patients with close tumor margin of HCC during hepatectomy-a case matched study.

To review the outcome of using radiofrequency ablation (RFA) for patients with close resection margin during hepatectomy. From Oct 2004 to Sept 2013, 862 patients received hepatectomy for hepatocellular carcinoma (HCC) in the Department of Surgery, Queen Mary Hospital in Hong Kong. Fourteen patients received additional RFA because of close resection margin (<1 cm) during the operation for HCC. The result of 28 patients with close liver resection margin was selected for comparison. The two groups of patients were matched in terms of tumor size, tumor number, stage of disease and magnitude of resection. In the RFA group (n=14), the median age of the patients was 58.5 (range, 25-78 years). The median tumor size was 2.25 cm (range, 1.2-12 cm). In the resection alone group (n=28), the median age for the patients was 61 (range, 36-79 years). The median tumor size was 2.7 cm (range, 1-11 cm). There was no difference in terms of liver function assessment between the two groups. There was no RFA related complication recorded during the study period. There was no hospital mortality in both groups. The 1- and 3-year disease free survival was 38.3% and 25.5% respectively in the RFA group vs. 57.4% and 39.3% respectively in the liver resection alone group (P=0.563). The 1- and 3-year overall survival was 81.5% and 69.8% respectively in the RFA group vs .88.4% and 59.9% respectively in the liver resection alone group (P=0.83). RFA to hepatectomy resection surface in patients with close margin is a safe treatment option but its effectiveness on prevention of local recurrence has yet to be confirmed.

Ductal Carcinoma In Situ: How Much Treatment Is Enough, How Much Is Too Much?

In the accompanying article, Wood concisely reviews currentmanagement of ductal carcinoma in situ (DCIS), with a focus on the use of radiotherapy (RT) after breastconserving surgery (BCS). The crux of his argument is that because RT does not prolong survival, its usemust be considered optional and the risks and benefits of RT considered in the context of patient values. Henotes that“nearly twice asmanywomen will have an inferior cosmetic outcome result as will benefit from avoiding a recurrent breast lesion,” and that the use of RT for initial treatment necessitates mastectomy for any subsequent recurrence. The importance of considering patient preference in decision making when there is equipoise in survival outcomes is inarguable.Wesurveyedpatients aboutpriorities and treatment choices in a population-based study of 1,629 patientswithDCIS and stage I and II breast cancer. Concern about disease recurrence was the most important factor in treatment choice, greatly influencing 37%, whereas concerns about radiation or body image greatly influenced only 15% and5%of patients, respectively. Prevention of local recurrence in DCIS is particularly relevant to patient concerns, because 50% of these recurrences are invasive carcinoma, and randomized trials have demonstrated a significant increase in mortality in patients experiencing invasive recurrence after DCIS treatment. Thus, it is not particularly surprising that risk-averse patients opt for RTor, increasingly, forbilateralmastectomy. Endocrine Therapy Wood also notes that endocrine therapy is an alternative to RT for risk reduction in women with DCIS. Endocrine therapy has the advantage of reducing the incidence of both ipsilateral and contralateral breast events, but the absolute benefit of 5 years of treatment is modest. In a meta-analysis of the National Surgical Adjuvant Breast and Bowel Project B24 trial and the United Kingdom, Australia, New Zealand trials of adjuvant tamoxifen in DCIS, no significant difference in all-cause mortality was seen with tamoxifen treatment compared with placebo, but tamoxifen treatment did statistically significantly reduce ipsilateral and contralateral DCIS events and contralateral invasive cancers, with a trend toward reduction of ipsilateral invasive cancer. The number needed to treat for a protective effect against all breast events was 15. However, ameta-analysis of 10-year event rates in9,404patientswithDCIS found that the local recurrence rate after BCS and RTwas 14.4%, compared with 24.7% with BCS and tamoxifen, suggesting that if the goal is to minimize recurrence, RT is the more effective strategy. A decision to use tamoxifen (or an aromatase inhibitor) also subjects the patient to 5 years of the welldocumented side effects of endocrine therapy. Most importantly, the acceptance of tamoxifen among patients with DCIS is limited. In a Canadian population-based cohort of women with DCIS treated in

5 years local recurrencce rates following post-operative 2D radiotherapy treatment planning patients – An institutional experience

Introduction: In India, almost 150,000 women are diagnosed with breast cancer every year and almost half of patients expected to die of the disease. In India most of patients with breast cancer diagnosed with advanced stage of the disease. As breast cancer treatment is multimodality approach Radiation therapy has significant impact on prevention of local recurrence. So, purpose of the study is to assess 5 year rates of local recurrence following post-operative 2D Radiotherapy treatment planning. Methods and Materials: We have selected 198 patients treated for post-operative 2D Radiotherapy treatment planning from September 2009-September 2010. All patients had undergone surgery in form of mastectomy or modified radical mastectomy. None of the patients with breast conservation surgery had been selected. All patients underwent chemotherapy either Induction chemotherapy following surgery or chemotherapy after surgery. All patients had been treated with 2D conventional Radiotherapy treatment plan with tangential fields and supraclavicular and axillary fields according to histopathology report. Patients were first taken on simulator machine and planning was done with breast wedge in position and fully abducted arm of the patient. Radiotherapy treatment dose was – 45Gy/20#, 2.25Gy/#, 5 days/week, total 4 weeks of treatment. Patients were assessed for acute toxicity every week. Patients were followed every monthly for 2 years, 2 monthly for 3rd year, 4 monthly for 4th year up to 5 year. Patients were assessed for Local recurrence up to 5 years. Results: 152 (77%) patients had undergone upfront Surgery. 46 (23%) patients were diagnosed with LABC, and had undergone chemotherapy first for downstage of the disease. After a median follow up of 34 months (range: 9-67 months), out of total 198 patients, 8.6% patients developed local recurrence. In which 6.5% (10 patients out of 152) in upfront surgery group and 15.2% (7 patients out of 46) in LABC group developed local recurrence. So, total 5% (10 patients) in upfront surgery group and 3.5% (7 patients) in LABC group out of 198 total patients developed local recurrence. Conclusion: Local recurrence after treatment of breast cancer with mastectomy+radiotherapy+/-systemic therapy is associated with a significantly higher risk of distant metastasis and death. So, in this retrospective study we have shown comparable results after 2D Conventional Radiotherapy Treatment Planning for prevention of local recurrence. Approach is safe, easy, and feasible, less time consuming and in Indian scenario where patients come in advanced stage of the disease and most of the time death is due to disease itself it is quite suitable approach at our centre. Also, we use hypofractionation regimen of 45Gy/20#, which is also feasible to reduce total treatment time and it has also shown equivalent results.

En Bloc Resection of Cervical Sarcoma Involving C1: Report of Two Cases and Surgical Considerations

Study background: A two patient case series describing the surgical management of upper cervical sarcoma. Due to the density of critical neurovascular structures in the upper cervical spine, these rare sarcomas require primary surgical treatment that preempts local recurrence. Recurrence secondary to tumor spillage is problematic due to scar tissue formation and radiation effect creating surgically inaccessible tissue planes. En bloc resection of sarcomas during an index procedure provides the best chance at cure and prevention of local recurrence. Meticulous planning, familiarity with anatomy and surgical technique is critical for the success of these operations. Methods: Two patients: a 30-year-old and 36-year-old female, were referred to our institution with malignant spine tumors involving C1. The first was found to have a left sided synovial sarcoma anterolateral to C1 and C2. The second presented with metastatic alveolar soft tissue sarcoma at C1. Both patients underwent multi-stage en bloc surgical removal of their tumors. Results: Successful en bloc tumor excision and instrumented stabilization of the cervical spine without neurovascular complication was performed. Tumor margins were negative and x-rays demonstrated adequate spinal alignment. At six month followup, MRI evaluation demonstrated no local recurrence in either patient. Conclusions: En bloc resection is a highly effective, but technically demanding method of treating upper cervical sarcomas. In conjunction with adjuvant radiotherapy, en bloc surgery has the lowest risk of local recurrence and highest quality of life outcomes. Due to the proximity of critical neurovascular structures in the upper cervical spine, meticulous planning, staging and technique is required. A multidisciplinary surgical team should be assembled that includes a head and neck, skull-base, neuro-endovascular and spine surgeon. With appropriate planning, understanding of anatomy and surgical technique, en bloc resections of upper cervical sarcomas can be successfully performed.

Prevention and Treatment of Local Breast Cancer Recurrence Using 6.3 MeV Fast Neutrons

The study included 138 breast cancer patients, who received the complex treatment and radiotherapy alone with the use of 6.3 MeV fast neutrons generated within U-120 cyclotron. Neutron therapy used for the prevention of local recurrence was shown to be effective in multimodality treatment of patients with locally advanced breast cancer, and in cases with locally advanced tumor recurrences it is often the only treatment to prolong life of breast cancer patients.

Update on the prevention of local recurrence and peritoneal metastases in patients with colorectal cancer.

The prevention of a disease process has always been superior to the treatment of the same disease throughout the history of medicine and surgery. Local recurrence and peritoneal metastases occur in approximately 8% of colon cancer patients and 25% of rectal cancer patients and should be prevented. Strategies to prevent colon or rectal cancer local recurrence and peritoneal metastases include cytoreductive surgery and hyperthermic perioperative chemotherapy (HIPEC). These strategies can be used at the time of primary colon or rectal cancer resection if the HIPEC is available. At institutions where HIPEC is not available with the treatment of primary malignancy, a proactive second-look surgery is recommended. Several phase II studies strongly support the proactive approach. If peritoneal metastases were treated along with the primary colon resection, 5-year survival was seen and these results were superior to the results of treatment after peritoneal metastases had developed as recurrence. Also, prophylactic HIPEC improved survival with T3/T4 mucinous or signet ring colon cancers. A second-look has been shown to be effective in two published manuscripts. Unpublished data from MedStar Washington Cancer Institute also produced favorable date. Rectal cancer with peritoneal metastases may not be so effectively treated. There are both credits and debits of this proactive approach. Selection factors should be reviewed by the multidisciplinary team for individualized management of patients with or at high risk for peritoneal metastases.

Funktionelle Langzeitergebnisse nach Sarkomresektionen

Multimodal treatment of malignant tumors of the musculoskeletal system with R0 in sano resection plays a key role in prevention of local recurrence in soft tissue and bone sarcoma. In cases of unavoidable neuromuscular or osseous defects, current plastic and orthoplastic reconstruction techniques avoid limb amputation in the majority of patients. Clinical long-term results demonstrate that large resection defects do not necessarily result in impaired limb function if multidisciplinary procedures are integrated. In oncologically necessary major limb amputation, segmental resection and replantation of distal limb parts should be considered which provide end-bearing long stump formation. The functional conditions of long-term surviving elderly patients should be integrated into surgical decision-making and rehabilitation efforts.

The pull-through procedure: A new role for an old operation

During the last few decades numerous treatments of rectal cancer have lead to a significant improvement in the prevention of local recurrence and quality of life. Apart from radio and chemotherapy, surgical approach has gone through many modifications. In spite of the significant understanding of rectal cancer, we have reached the point when with the strict selection of patients we can taylor a surgical approach to each patient, especially ion cases when low anterior resection is indicated. We are presenting our approach of delayed end-to-end colo-anal anastomosis, along with the discussion of advantages, potential problems and selection criteria and technical details.