Radical Procedures Research Articles

Radical Surgical Procedure in Management of Hepatic Hydatid Cysts. 10 Years Centre Experience.

Radical Surgical Procedure in Management of Hepatic Hydatid Cysts. 10 Years Centre Experience.

The role of multiple bowel resections in advanced ovarian cancer: survival and surgical outcomes—a narrative review

: Ovarian cancer (OC) is the fifth most common cancer-related cause of death in women and the most lethal gynecologic malignancies in developed countries. In more than two thirds of the cases it is diagnosed as an advanced stage disease. The treatment requires a surgical step, aiming to remove the macroscopically visible disease, either as a primary debulking surgery or interval debulking surgery (IDS) after neoadjuvant chemotherapy (NACT). In both cases radical, complex and invasive surgical procedures are needed in order to achieve complete resection of the tumor, frequently involving bowel surgery. Considering the spread of the disease in the abdominal cavity, involvement of multiple bowel segments is common. Multiple bowel resections (MBR) are often needed to a complete cytoreduction but are linked to a higher rate of bowel diversion and postoperative morbidity, including severe postoperative complications, as anastomotic leakage (AL), and even death. These complications not only affect short term morbidity but may even postpone the administration of adjuvant chemotherapy, thus significantly affecting the outcomes of the treatment. NACT may help reducing the aggressiveness of debulking surgery and therefore the rate of its complications. This strategy represents a valid therapeutic option, especially in fragile patients, reducing the surgical related morbidity and the risk of bowel resections, without affecting the overall survival.

Non-small cell lung cancer: 10-year survival after surgery

Objective: 10-Year survival (10YS) after radical surgery for non-small cell lung cancer (LC) pa­tients (LCP) (T1-4N0-2M0) was analyzed. Methods: We analyzed data of 768 consecutive LCP (age=57.6±8.3 years; tumor size=4.1±2.4 cm) radically operated (R0) and monitored in 1985-2021 (m=660, f=108; upper lobectomies=277, lower lobectomies=177, middle lobectomies=18, bilobectomies=42, pneumonectomies=254, mediastinal lymph node dissection=768; combined procedures with resection of trachea, carina, atrium, aorta, VCS, vena azygos, pericardium, liver, diaphragm, ribs, esophagus=193; only surgery-S=618, adjuvant chemoimmunoradiotherapy-AT=150: CAV/gemzar + cisplatin + thymalin/taktivin + radiotherapy 45-50Gy; T1=320, T2=255, T3=133, T4=60; N0=516, N1=131, N2=121, M0=768; G1=194, G2=243, G3=331; squamous=417, adenocarcinoma=301, large cell=50; early LC=214, invasive LC=554; right LC=412, left LC=356; central=290; peripheral=478. Variables selected for 10YS study were input levels of 45 blood parameters, sex, age, TNMG, cell type, tumor size. Survival curves were estimated by the Kaplan-Meier method. Differences in curves between groups of LCP were evaluated using a log-rank test. Multivariate Cox modeling, analysis, clustering, SEPATH, Monte Carlo, bootstrap and neural networks computing were used to determine any significant dependence. Results: Overall life span (LS) was 2244.9±1750.3 days and cumulative 5-year survival (5YS) reached 72.9%, 10 years – 64.3%, 20 years – 43.1%. 502 LCP lived more than 5 years (LS=3128.7±1536.8 days), 145 LCP – more than 10 years (LS=5068.5±1513.2 days).199 LCP died because of LC (LS=562.7±374.5 days). AT significantly improved 10YS (52.4% vs. 27.7%) (P=0.00002 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 10YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time, weight, color index (P=0.000-0.039). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 10YS and PT early-invasive LC (rank=1), thrombocytes/CC (rank=2), PT N0—N12(rank=3), segmented neutrophils/CC (4), healthy cells/CC (5), lymphocytes/CC (6), erythrocytes/CC (7), stick neutrophils/CC (8), eosinophils/CC (9), leucocytes/CC (10), monocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0). Conclusions: 10-Year survival of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) anthropometric data; 10) surgery type. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.

Laparoscopic and open operations in the treatment of hepatic echinococcosis. Analysis of short- and long-term results

Aim: to evaluate the short- and long-term outcomes of laparoscopic and open operations in the treatment of hepatic echinococcosis.Materials and methods. The results of laparoscopic and open echinococcectomies performed from 2013 to 2020 were retrospectively studied. Laparoscopic operations were considered the method of choice. Open operations were performed in cases with contraindications to the laparoscopic approach.Results. In total, 57 patients were operated: 47 laparoscopically (including robotic approach in 4 cases), 9 patients underwent open surgery. Radical procedures prevailed among laparoscopic cystectomies: 46 (98%). In the groups of laparoscopic/open cystectomies, partial pericystectomy was performed in 1/3 of patients, subtotal – in 24/4, total – in 13/0, and liver resection – in 9/2 patients, respectively. Laparoscopic procedures were performed mainly for types 1 and 3 of cysts, open procedures – for type 2 (WHO), recurrent and extrahepatic abdominal cysts were indication for open surgery. The frequency of severe complications did not differ between the groups. In the laparoscopic group, 1 (2%) patient died. After laparoscopic cystectomies, the mean (median) hospital stay (8 vs 10 days) and duration of abdominal drainage (10 vs 12 days) were significantly shorter. Relapse occurred only after conservative cystectomies, in one patient in each group.Conclusion. Laparoscopic radical surgery for liver hydatid cysts may be the method of choice if performed in a specialized HPB center. Patient selection criteria should be based on the center's experience in laparoscopic liver surgery.

Hind-Foot Synovial Sarcoma Treated With Wide Resection and Sural Fasciocutaneous Flap – A Case Report

Synovial sarcoma comprises about 5% to 10% of soft tissue sarcomas. Initial growth is often slow and a small circumscribed tumour may misleadingly appear to a benign lesion by clinical examination and imaging, occurring in up to 50% of cases. The modalities of treatment of foot malignant conditions depend on histological diagnosis and staging. A radical surgical procedure in the distal region of the lower limb is often difficult due to a limited soft-tissue situation and can result in soft-tissue defects. Plastic surgical techniques remain particularly indispensable in the treatment of such distal tumors. Authors present a hindfoot synovial sarcoma, diagnosed with a incisional biopsy, in which a wide margin surgery was achieved and a limb salvage was permitted by a sural fasciocutaneous flap.

Extended En Bloc Reoperation for Recurrent or Persistent Parathyroid Carcinoma: Analysis of 31 Cases in a Single Institute Experience.

Parathyroid carcinoma (PC) is a rare malignancy that is difficult to eradicate completely after recurrence. We assessed the efficiency of extended en bloc resection (EEBR) in the management of recurrent or persistent PC. In this observational cohort study, 31 patients who underwent reoperations for recurrent or persistent PC were enrolled after 2-9 surgeries by other medical teams. EEBRs, which provided the oncologic resection by removing all possible tumor-bearing scar tissues, were adopted in 25 patients. The other 6 with gross infiltration into the upper aerodigestive tract (UAT) underwent less radical procedures for unwillingness to sacrifice laryngeal function. The 5-year overall survival (OS) rate after EEBR was 59.6% compared with 16.7% after less radical procedures, with an improved median expected survival time of 90.0 months compared with 13.0 months after local excision. EEBR exhibited a favorable local control of relapses in 84.0% of patients after a median follow-up period of 27.0 months, 40.0% even achieved disease-free survival, although 56.0% had subsequent distant metastases (DMs) and suffered a worse 5-year OS of 36.7% in contrast with 100.0% in the absence of DM (p = 0.011). UAT invasion, rather than age, number of previous operations, or preoperative PTH levels, was the unique independent factor associated with both DM (HR = 5.466, p = 0.006) and mortality (HR = 7.606, p = 0.011). EEBRs provide better outcomes than other conventional surgical approaches and might offer a second chance of cure for patients with recurrent or persistent PC in the absence of DM.

Laparoscopic Mitrofanoff Withradical Utethrectomy Withmartius FLAP Reconstructionforvaginal Tumour Infiltrating Urethra

<h3>Study Objective</h3> Laparoscopic Mitrofanoff with Radical Utethrectomy for Vaginal Tumour Infiltrating Urethra <h3>Design</h3> Laparoscopic. <h3>Setting</h3> Open and Laparoscopic. <h3>Patients or Participants</h3> One. <h3>Interventions</h3> Laparoscopic Mitrofanoff with Radical Utethrectomy with Martius Flap Reconstruction. <h3>Measurements and Main Results</h3> Tumour clearence with uterus and bladder preservation with continent pouch. <h3>Conclusion</h3> In locally advanced urethro vaginal tumours inspite of radical procedures like anterior exenteration we should consider preservation of bladder and uterus function by Laparoscopic Mitrofanoff procedure.

Testicular Torsion with Synchronous Adrenal Rest Tumors in a Patient with Congenital Adrenal Hyperplasia

Abstract This is the case report of a 20-year-old male patient who was admitted to our clinic with a sudden onset of severe left testicular pain. Color Doppler ultrasonography revealed normal vascular supply of both testes nevertheless, but when compared with the right testis, the axis of the left testicular cord was located more posteriorly and along with swelling of the epididymis made the diagnosis of partial torsion highly probable. Bilaterally hypervascularized testicular and epididymal solid masses (up to 20 mm) were also present. Reposition of the left testicle followed by warm sponge compress was performed. The patient was suffering from congenital adrenal hyperplasia (CAH) and he was in steroid replacement therapy all his life. Testicular adrenal rest tumor is an important complication of classical CAH due to 21-hydroxylase deficiency that can potentially lead to gonadal dysfunction and infertility in adulthood. If the presence of enlarged testicular rest tumor deteriorates the stability of the testicular cord stability and renders the testis more vulnerable to torsion is a hypothesis that is hard to prove since these tumors are rare and torsion in these patients is even rarer. Nevertheless, the physicians must be aware of this condition and its benign course in order to correctly differentiate it from other diseases and avoid more radical procedures.

Abdominal and Laparoscopic Cervical Carcinoma Therapy - a Comparative Economic Assessment.

Objective The LACC (Laparoscopic Approach to Cervical Cancer) study revealed advantages in terms of overall survival and relapse risk favouring abdominal radical hysterectomy over the laparoscopic procedure. The present paper will compare the two surgical techniques from the economic point of view based on a process cost calculation. Material/Methods A retrospective cost analysis of all radical hysterectomies from the year 2018 was done at the Hanover University Medical School based on the bottoms-up method and guided by the clinical treatment pathway. Result Of 51 primary cases treated, 19 patients underwent radical hysterectomies, of which 8 were performed using the abdominal technique and 11 as endoscopic surgeries. 89.4% of the cancers were FIGO IB1 carcinomas. The total cost of a laparoscopic radical hysterectomy with an average hospital stay of 4.6 days came to € 2512.34, compared to an abdominal radical hysterectomy at € 2586.78 with an average hospital stay of 7.6 days. The greatest cost factor in which the laparoscopic method exceeded abdominal radical hysterectomy was the surgical procedure itself (€ 1836.75 vs. € 1411.21). Personnel represented the largest cost item in the surgical theatre (59%), so that surgery time was a significant multiplying factor. Average surgical time required for abdominal radical hysterectomy was 154 minutes, whereby the laparoscopic procedure required an average of 220.1 minutes. Inpatient care in the abdominal radical procedure cases was more costly by € 499.98 due to the longer hospitalization and additional medication required. Profit levels, including the DRG revenues, were higher with the abdominal method than with the laparoscopic method by € 186.21 despite longer hospital stays. Conclusion The present paper shows slightly greater profitability for the abdominal radical hysterectomy. On the other hand, this method entails longer hospitalization and a higher level of personnel deployment. Adequate occupancy management could make up for the revenue shortfall observed with the laparoscopic method.

P68.13 Lung Cancer Prognosis and Cell Ratio Factors

We examined cell ratio factors (CRF) significantly affecting non-small cell lung cancer (LC) patients (LCP) survival. CRF - ratio between cancer cells (CC) and blood cells subpopulations. We analyzed data of 768 consecutive LCP (T1-4N0-2M0) (age=57.6±8.3 years; tumor size=4.1±2.4 cm) radically operated (R0) and monitored in 1985-2021 (m=660, f=108; upper lobectomies=277, lower lobectomies=177, middle lobectomies=18, bilobectomies=42, pneumonectomies=254, mediastinal lymph node dissection=768; combined procedures with resection of trachea, carina, atrium, aorta, VCS, vena azygos, pericardium, liver, diaphragm, ribs, esophagus=193; only surgery-S=618, adjuvant chemoimmunoradiotherapy-AT=150: CAV/gemzar + cisplatin + thymalin/taktivin + radiotherapy 45-50Gy; T1=320, T2=255, T3=133, T4=60; N0=516, N1=131, N2=121, M0=768; G1=194, G2=243, G3=331; squamous=417, adenocarcinoma=301, large cell=50; right LC=412, left LC=356; central=290; peripheral=478. Variables selected for prognosis study were input levels of 45 blood parameters, sex, age, TNMG, cell type, tumor size. Survival curves were estimated by the Kaplan-Meier method. Differences in curves between groups of LCP were evaluated using a log-rank test. Multivariate Cox modeling, discriminant analysis, clustering, SEPATH, Monte Carlo, bootstrap and neural networks computing were used to determine any significant dependence. Overall life span (LS) was 2244.9±1750.3 days and cumulative 5-year survival (5YS) reached 72.9%, 10 years – 64.3%, 20 years – 43.1%. 502 LCP lived more than 5 years (LS=3128.7±1536.8 days), 145 LCP – more than 10 years (LS=5068.5±1513.2 days).199 LCP died because of LC (LS=562.7±374.5 days). Cox modeling displayed that LCP survival significantly depended on CRF: leucocytes/CC, segmented neutrophils/CC, lymphocytes/CC, healthy cells/CC (P=0.000-0.016). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and healthy cells/CC (rank=1), segmented neutrophils/CC (rank=2), erythrocytes/CC (rank=3), thrombocytes/CC (4), leucocytes/CC (5), lymphocytes/CC (6), eosinophils/CC (7), monocytes/CC (8), stick neutrophils/CC (9). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0). Lung cancer patients survival after radical procedures significantly depended on cell ratio factors.

Transcatheter arterial chemoembolization followed by surgical resection for hepatocellular carcinoma: a focus on its controversies and screening of patients most likely to benefit.

Surgical resection (SR) is recommended as a radical procedure in the treatment of hepatocellular carcinoma (HCC). However, postoperative recurrence negatively affects the long-term efficacy of SR, and preoperative adjuvant therapy has therefore become a research hotspot. Some clinicians adopt transcatheter arterial chemoembolization (TACE) as a preoperative adjuvant therapy in patients undergoing SR to increase the resection rate, reduce tumor recurrence, and improve the prognosis. However, the findings of the most relevant studies remain controversial. Some studies have confirmed that preoperative TACE cannot improve the long-term survival rate of patients with HCC and might even negatively affect the resection rate. Which factors influence the efficacy of preoperative TACE combined with SR is a topic worthy of investigation. In this review, existing clinical studies were analyzed with a particular focus on several topics: screening of the subgroups of patients most likely to benefit from preoperative TACE, exploration of the optimal treatment regimen of preoperative TACE, and determination of the extent of tumor necrosis as the deciding prognostic factor.

Radical versus conservative surgical management for liver hydatid cysts: A single-center prospective cohort study.

Background and AimWe prospectively compared the clinical outcomes of radical and conservative surgical procedures for primary liver hydatid cysts, additionally radical surgical procedures with and without the two‐month administration of albendazole after the operation were compared.MethodsOverall, 90 patients undergoing open surgical treatment for liver hydatid cysts were divided into three surgical groups: first group, patients who underwent radical surgery (pericystectomy) followed by albendazole treatment for 2 months following the operation group; second group, patients who underwent radical surgery(pericystectomy) without receiving albendazole after surgery group; third group, patients, who underwent conservative surgery (partial cystectomy) with albendazole treatment after surgery. The clinical outcomes and rate of recurrence were analyzed in follow‐up period.ResultsThe mean surgery duration in the Radical groups was significantly longer in comparison to the Conservative surgery + Albendazole group. (212.0 and 202.5 min vs. 173.2 min; p < 0.05). Blood loss in the Radical groups was significantly higher in comparison to the Conservative surgery + Albendazole group (218.3 and 174.6 ml vs. 67.2 ml; p < 0.05). However, postoperative complication rate in the Radical group was significantly lower in comparison to Conservative surgery + Albendazole group (13.3% [n = 4] and 6.7% [n = 2] vs. 36% [n = 11]; p < 0.05). The postoperative hospital stay in both Radical groups was significantly lower in comparison to the Conservative surgery + Albendazole group (7.9 and 7.4 days vs. 11.3 days; p < 0.05).ConclusionIn comparison to conservative surgery, radical surgery is a preferable treatment modality for patients with active liver hydatid cysts. Postoperative albendazole treatment is preferable, regardless of the type of surgical procedure.

Compressive vertebral hemangiomas with neurological deficits: diagnosis, surgical strategies and long term outcome

Purpose Compressive vertebral hemangiomas with neurological deficits (CVHND) form a rare, unique subset of lesions comprising of differing clinico-imaging findings, pathologic behavior and treatment, when compared to the commoner and usually incidental intra-osseus vertebral hemangiomas (VH). Though various surgical strategies and a broad array of adjuncts have evolved and changed over the years, there is paucity of comprehensive data from sizeable series of such patients treated surgically with long term follow up. The purpose of this study is to device an optimum management strategy in CVHND based on our surgical experience. Materials and methods The data from electronic medical records of 26 consecutive patients operated in our department from 2009 to 2019 were retrospectively analyzed. Results There were 11 males and 15 females with a mean age of 34.7 years. Neurological examination revealed paraparesis or paraplegia with myelopathy in all patients with Frankel score of B, C and D in 1 (3.9%), 11 (42.3%) and 14 (53.8%) patients respectively. Sixteen patients (61%) underwent laminectomy and gross total excision of extradural soft tissue component, 7 (27%) laminectomy with posterolateral fusion, three (12%) underwent additional anterior interbody support. The mean follow up was 72.4 months and at last follow-up 24 patients (92%) were Frankel E. Symptomatic recurrence was seen in two patients operated early in the series, they underwent re-surgery, gross total excision with posterolateral fusion, remaining neurologically intact at last follow up. Conclusions Pre-operative embolization, surgical excision of extradural component and intra-operative vertebroplasty form the mainstay of treatment for CVHND. Instrumented posterolateral fusion with optional anterior interbody support accomplished through the same approach is required only in a minority of cases. The long-term outcome following timely and appropriate treatment is excellent. Anterior or anterolateral approaches for intervertebral support and radical procedures like total en-bloc spondylectomy (TES) are not usually required.

Partial Versus Total Thyroidectomy: What Influences Most Surgeons' Decision? Analysis of a Nationwide Cohort of 375,810 Patients Over 10 Years.

The ain of this study was to describe thyroid surgery and to identify the factors leading to either a total or a partial thyroidectomy regardless of the severity of the thyroid disease. National and international guidelines about thyroid surgery seem to be moving more and more toward less radical surgical procedures but everyday practice does not seem to always align with them. We based this nationwide retrospective cohort study on a national database that compiles discharge abstracts for every admission for thyroidectomy to French acute healthcare facilities (PMSI database 2010 to 2019). In this study, 375,810 patients (male: 23%; age = 53 ± 15 years) had a thyroidectomy (partial: 28%) for cancer (17%), hyperthyroidism (16%), nonfunctioning goiter (64%), or other (3%). We noticed a global trend toward more partial thyroidectomy (P < 0.001) with a significant increase in the proportion of lobectomy in the post-ATA recommendations' period (P < 0.001) as well as in the "French Levothyrox crisis" period, in which we saw an unexpected rise of adverse events notifications associated with the marketing of a new formula of Levothyrox (P < 0.001) amid widespread media coverage. In a multivariate analysis, we also identified that complete resection was more frequently performed in centers with a caseload >40/year [P < 0.001, odds ratio (OR) = 1.48], for obese patients (body mass index >30 kg/m2; P < 0.001, OR = 1.42), and according to the indication of surgery (OR benign = 1, OR cancer = 2.25, OR hyperthyroidism = 4.13). We describe for the first time the role of non-surgical parameters in the surgeon's choice for thyroid surgery.

Should spring water cysts of the mediastinum require excisional resection? A case report.

Introduction and importanceMediastinal cysts account for 20–32% of all mediastinal lesions. Complete surgical excision is the standard therapy for mediastinal cysts. Translucent cysts containing crystal-clear fluid are called “spring water cysts.” We experienced a case of mediastinal spring water cyst fenestrated under video-assisted thoracoscopy with a miniaturized endoscope (mini-VATS) as an alternative to excisional resection.Case presentationA 49-year-old woman presented with back pain. Chest CT revealed a posterior mediastinal mass measuring 4.2 × 1.8 × 3.2 cm closed to the tenth thoracic vertebra. Chest MRI demonstrated hypo-intensity on T1-weighted images and hyper-intensity on T2-weighted images. It was estimated that the posterior mediastinal mass did not contain a tumor component. The tumor was growing and symptomatic; therefore, we performed surgical cyst fenestration without excision of the cyst under mini-VATS. The patient experienced complete relief of symptoms. Fluid accumulation in the cyst was not observed on CT images 12 months postoperatively.Clinical discussionKozu et al. reported that all 108 primary mediastinal cysts were resected completely and were recurrence-free after a mean follow-up of 41 ± 26 months. In the case of a functional hydrocele such as spring water cyst, we believe that even if fluid is produced, the thoracic pleura is capable of absorbing the fluid, and the cyst wall might not recur even if the wall is left in place. Fluid drainage through fenestration may prevent recurrent fluid collection.ConclusionFenestration of non-neoplastic mediastinal cysts under mini-VATS might be a less invasive radical procedure compared to complete resection.

Risk factors associated with 30-day postoperative complications following contemporary pelvic exenterations for gynecologic cancer

Objectives: Pelvic exenteration (PE) is an uncommon radical procedure associated with high perioperative morbidity due to the nature and extent of surgery. Due to surgical innovation and perioperative care advances, postoperative outcomes may have improved for PE. The purpose of this study is to evaluate rates of 30-day postoperative complications (POC) and risk factors associated with POC following PE for gynecologic malignancies. Methods: Data was obtained from the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database. All patients who underwent PE for a gynecologic cancer from 2012-2018 were identified using appropriate CPT, ICD-9 and ICD-10 codes. Comparative analyses were performed and stratified by admission status to evaluate demographics, preoperative and intraoperative variables, and surgical outcomes. Statistical tests were performed with R Studio v.1.1.456. Results: Between 2012-2018, 473 patients who had undergone a PE for a gynecologic malignancy were identified. The median age at time of surgery was 59 years (range, 22-90 years) and median body mass index (BMI) was 26.1 kg/m2 (range, 15.5-65.7 kg/m2). The median operative time was 385 minutes (range, 55-1090 minutes). At the time of their PE, 21.2% of patients underwent a concurrent myocutaneous flap and 12.3% a urinary conduit. The median length of hospital stay was 10 days (range, 0-114 days). At time of discharge, 79.2% were discharged home, 20.4% were transferred to an acute care or rehab facility, and 0.4% expired. The overall POC rate was 75.9%, but when urinary tract infections and blood transfusions were excluded, the POC rate was 37.6%. The 30-day readmission rate was 20.3% and re-operation rate was 10.4%. Lower preoperative albumin and hematocrit values, longer operative times, higher American Society of Anesthesiology (ASA) class, concurrent flap, and urinary conduit procedures were associated with higher POC rates (Table 1). When adjusting for these factors on multivariate analysis, preoperative albumin levels, and longer operative times remained independent risk factors for higher POC rates. Download : Download high-res image (123KB) Download : Download full-size image Conclusions: There remains a high rate of 30-day POC following PE; although a significant proportion of the POC are driven by the development of urinary tract infections and administration of blood transfusions. The contemporary mortality rate appears to be lower than previously reported historical rates. Preoperative albumin levels and longer operative times may be modifiable risk factors that can reduce POC rates.

Perioperative risk factors and postoperative outcomes following pelvic exenterations for gynecologic versus non-gynecologic malignancies

Objectives: Pelvic exenteration (PE) is an aggressive, radical procedure associated with high rates of postoperative complications (POC). Although PE was first described for the palliation of gynecologic malignancies, this has been adopted for the management of colorectal and genitourinary cancers. The objective of this study is to evaluate the perioperative risk factors and 30-day surgical outcomes following PE for gynecologic and non-gynecologic cancers. Methods: Data was obtained from the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database. All women who underwent PE from 2012-2018 were identified using appropriate CPT codes and gender. Comparative analyses were performed and stratified by admission status to evaluate demographics, preoperative and intraoperative variables, and surgical outcomes. Statistical tests were performed with R Studio v.1.1.456. Results: A total of 2,069 women who had undergone a PE were identified from 2012-2018. Of these, 73 were performed for an unknown indication and 109 were for a nonmalignant indication, and these were excluded. The remaining 1,887 were used for our analysis: 473 (25.1%) had a PE for a gynecologic cancer, 973 (51.6%) for a genitourinary cancer, 427 (22.6%) for a colorectal cancer, and 14 (0.74%) for an unspecified cancer. PE performed for gynecologic malignancy were associated with longer operative times (median 385 vs 350 minutes, p Download : Download high-res image (107KB) Download : Download full-size image Conclusions: PE performed for gynecologic malignancies are associated with higher morbidity compared to PE done for non-gynecologic cancers. Flaps are performed more often during PE for gynecologic cancers, which may contribute to the increased morbidity seen in these patients following PE. Data on prior radiation therapy which is not available through the NSQIP database, could be evaluated in future studies.

Iron(II) and Copper(I) Control the Total Regioselectivity in the Hydrobromination of Alkenes.

A new method that allows the complete control of the regioselectivity of the hydrobromination reaction of alkenes is described. Herein, we report a radical procedure with TMSBr and oxygen as common reagents, where the formation of the anti-Markovnikov product occurs in the presence of parts per million amounts of the Cu(I) species and the formation of the Markovnikov product occurs in the presence of 30 mol % iron(II) bromide. Density functional theory calculations combined with Fukui’s radical susceptibilities support the obtained results.

Radical Hemiscrotectomy and En Bloc Orchidectomy: Surgical Technique and Perioperative and Oncologic Outcomes of a Supra-Regional UK Referral Centre

Background and PurposeHemiscrotectomy with en bloc orchidectomy represents a radical primary, completion, or salvage option in men with inguinoscrotal cancers. We describe our surgical technique and peri-operative and oncological outcomes.Patients and MethodsRetrospective cohort study of 16 men treated at a supra-regional referral centre with open radical hemiscrotectomy with or without en bloc orchidectomy between 2010 and 2020. Peri-operative and survival outcomes were analysed.ResultsRadical hemiscrotectomy with or without en bloc orchidectomy was performed on 16 patients comprising 7 well-differentiated liposarcomas, 4 dedifferentiated liposarcomas, 2 leiomyosarcomas, 1 mesothelioma, 1 rhabdomyosarcoma and 1 mammary type myofibroblastoma. Primary hemiscrotectomy was performed in four, completion hemiscrotectomy in nine and salvage hemiscrotectomy in three. The median hospital stay was 2 days [interquartile range (IQR) 2–4]. Four patients (25%) had post-operative complications including wound infection or haematoma. During a median follow-up of 18 months (IQR 2–66), one patient (6%) died following a recurrence in the pelvis and retroperitoneum.Discussionand ConclusionsIf careful dissection is performed, radical hemiscrotectomy and en bloc orchidectomy is a radical but safe procedure with a short hospital stay. Haematoma and infection represent the main complications, and within limited follow-up most men showed no recurrence.

Psychological and Aesthetic Outcomes in Breast Cancer Patients.

Background:Patients who undergo breast cancer treatment require psychosocial and aesthetic rehabilitation. Advantages of breast reconstruction in-patient rehabilitation are well known. Oncoplastic organ-preserving surgery offers aesthetically better results, yet is often considered less safe than more radical procedures. We compared the aesthetic and psychological outcomes in patients undergoing breast reconstruction and oncoplastic breast cancer treatment.Methods:In total, 1130 patients who received either breast reconstruction or oncoplastic breast cancer surgery were included in the study. Patients were classified into two groups. Group 1 included 510 patients who received breast reconstruction surgery. Group 2 included 620 patients who received oncoplastic surgery. The following aspects were compared between the two groups: demographics, tumor progression, and immunohistochemical aspects, complications, hospitalization stay, and psychological and aesthetic outcomes.Results:Patients in the oncoplastic group showed statistically significant higher psychosocial and aesthetic outcomes, as well as lower incidence of complications, revision rate, disease progression, and recurrence. The majority of oncoplastic patients were treated in early stages of breast cancer.Conclusion:Offering superior treatment results, oncoplastic organ-preserving surgery should be favored in patients with earlier stages of cancer progression.