Removal Of Large Tumors Research Articles

Association of relative resection volume with patient-reported outcomes applying different levels of oncoplastic breast conserving surgery – A retrospective cohort study

IntroductionThe American Society of Breast Surgeons (ASBrS) recently classified oncoplastic breast conserving surgery (OBCS) into two levels. The association of resection ratio during OBCS with patient-reported outcomes (PRO) is unclear. Materials and methodsPatients with stage 0-III breast cancer undergoing OBCS between 01/2011-04/2023 at a Swiss university hospital, who completed at least one postoperative BREAST-Q PRO questionnaire were identified from a prospectively maintained institutional database. Outcomes included differences in PROs between patients after ASBrS level I (<20 % of breast tissue removed) versus level II surgery (20–50 %). ResultsOf 202 eligible patients, 129 (63.9 %) underwent level I OBCS, and 73 (36.1 %) level II. Six patients (3.0 %) who underwent completion mastectomy were excluded. The median time to final PROs was 25.4 months. Patients undergoing ASBrS level II surgery were more frequently affected by delayed wound healing (p < 0.001). ASBrS level was not found to independently predict any BreastQ domain. However, delayed wound healing was shown to reduce short-term physical well-being (estimated difference −26.27, 95 % confidence interval [CI] −39.33 to −13.22, p < 0.001). Higher age was associated with improved PROs. ConclusionASBrS level II surgery allows the removal of larger tumors without impairing PROs. Preventive measures for delayed wound healing and close postoperative follow-up to promptly treat wound healing disorders may avoid short-term reductions in physical well-being.

Associated Liver Partition and Portal Vein Ligation for Staged Hepatectomy (ALPPS) Registry: What Have We Learned?

In 2007, the first associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) procedure was performed in Regensburg, Germany. ALPPS is a variation of two-stage hepatectomy to induce rapid liver hypertrophy allowing the removal of large tumors otherwise considered irresectable due to a too small future liver remnant. In 2012, the international ALPPS registry was created, and it now contains more than 1,000 cases. During the past years, improved patient selection and refinements in operative techniques, in particular, less invasive approaches such as Partial ALPPS, Tourniquet ALPPS, Ablation-assisted ALPPS, Hybrid ALPPS or Laparoscopic or Robotic approaches, have resulted in significant improvements in safety. The most frequent indication for ALPPS is colorectal liver metastases. In the first randomized controlled study, ALPPS provided a higher resectability rate than conventional two-stage hepatectomy, with similar complication rates. Long-term outcome data are still missing. The initial results of ALPPS for hepatocellular carcinoma and for perihilar cholangiocarcinoma were devastating, but with progress in surgical technic and better patient selection, ALPPS could serve as a treatment alternative in carefully selected cases, even for these tumors. ALPPS has enlarged the armamentarium of hepato-pancreato-biliary surgeons, but there is still discussion regarding how to use this novel technique, which may allow resection of tumors that are otherwise deemed irresectable.

Elongated Miofascial Temporal Flap in Comparison with Standard Surgical Procedure of Temporal Muscle Reconstruction.

Introduction:Flap of the temporal muscle (m. temporalis) with its natural position, its mass and its length, compared with other bound and free microvascular flaps, is the method of choice for covering the middle part of the face after the removal of large tumor masses.Material:The study included a sample of 36 patients who were surgically treated due to malignant process at the middle face level with the performed partial, total or bilateral maxillectomy at the Clinic for Maxillofacial Surgery, University Clinical Center in Sarajevo. The sample is divided into three groups.Methods:The usual procedure of lifting the temporal flap in the first group, at the second extension of the coronoid processus. A group of three-elongated myofascial flap, which includes lifting the muscle along with deep temporal branches of maxillary artery with deep temporal fascia, its two layers and associated stem of thesuperficial temporal artery.Results:Statistical analysis of the length indicated that in group III the mean length was 9.83 cm, group II- 8.25, and group I- 6 cm. The longest segmental lobe in group three provides safer work and the length of the lifted lobe with double vascular stem. This provides coverage of defects that cross over the median line of the middle face. The results coincide with the comparative world studies.Conclusion:For large defects at the meddle part of the face that overlap the median line, an extraordinary solution is elongated myofascial flap with double vascular supply, with a larger flap mass and a length of about 9.83 cm.

Biological Reconstruction in Bone Sarcomas: Lessons from Three Decades of Experience.

ObjectiveTo review research on all patients treated by biological reconstruction after resection of bone sarcomas between 1987 and 2015 at our hospital.MethodsOne thousand one hundred and sixty‐seven cortical allografts and 166 cortical autografts were retrospectively analyzed. Radiological studies had been performed to determine the timing of consolidation of the grafts at both the metaphyseal and diaphyseal osteotomies. A prospective isotopic study with 99 Tc was done in order to evaluate the revascularization of allografts. Histological, immunohistochemistry and fluorescence techniques were used on retrieved allografts to evaluate their integration. Complications, functional results and possible relationships with human leukocyte antigen (HLA) compatibility, were also reviewed.ResultsThe mean age of these patients with bone sarcomas was 19 years (range, 3–69 years). The mean length of cortical allografts was 19.5 cm (range, 4–42 cm) and of autografts 8 cm (range, 6–15 cm). The mean consolidation time of diaphyseal osteotomies was 16 months. The mean time to consolidation was 5 months for vascularized autografts and 12 months for non‐vascularized grafts. New bone formation was observed at the host bone–allograft junction. Complications included non‐union (16.2%), fractures (8.2%) and infections (11.8%). The incidence of complications was higher in the non‐compatible group; however, no significant relationship was found between HLA compatibility (or lack thereof) and the occurrence of complications.ConclusionsAllografts are a good option for reconstruction after removal of larger tumors. It is necessary to take into account the mechanisms of incorporation and the measures that can be taken to reduce complications.

Intraoperative use of diffusion tensor imaging-based tractography for resection of gliomas located near the pyramidal tract: comparison with subcortical stimulation mapping and contribution to surgical outcomes

Introduction. For gliomas, the goal of surgery is maximal tumour removal with the preservation of neurological function. We evaluated the contribution of the combination of diffusion tensor imaging-based fibre tracking (DTI-FT) of the pyramidal tract (PT) integrated to the navigation and subcortical direct electrical stimulations (DESs) to surgical outcomes. Method. Ten patients underwent surgery for gliomas located in close relationship with the subcortical course of the PT. Preoperative DTI was performed with a three-Tesla magnetic resonance scanner applying an echo-planar sequence with 20 diffusion directions. DTI-FT data were systematically loaded into the navigation for intraoperative guidance. When the resection closely approached the PT as illustrated on navigation images, subcortical DESs were used to confirm the proximity of the PT by observing motor responses. The location of all subcortically stimulated points with positive motor response was correlated with the illustrated PT. Motor deficits were evaluated pre- and postoperatively, and compared with the extent of tumour removal. Results. DTI-FT of the PT was successfully performed in all patients. A total of fifteen positive subcortical DESs were obtained in 8 of 10 patients; in these cases, the mean distance from the stimulated point to the PT was 6.2 ± 3.6 mm. The mean tumoural volumetric resection was 90.8 ± 10.4%, with a gross total resection in four patients. At one month after surgery, only one patient had a slight impairment of motor function (decreased fine motor hand skills). Conclusions. DTI-FT is an accurate technique to map the PT in the vicinity of brain tumours. By combining anatomical (DTI-FT) and functional (subcortical DES) studies for intraoperative localization of the PT, the authors achieved a good volumetric resection of tumours located in eloquent motor areas, with low morbidity. Careful use of this protocol requires the knowledge of some pitfalls, mainly the occurrence of brain shift during removal of large tumours.

Qualité de vie chez les patients opérés d’un schwannome vestibulaire

To determine the prognoses criteria of quality of life's impairment after vestibular schwannoma surgery. Our study includes retrospectively 104 consecutive patients operated between 1991 & 2000 of a vestibular schwannoma. Patients with bilateral tumors were not included, neither patients lost of follow-up. The french version of the Short Form-36 self assessment questionnaire was sent to all patients. The response rate was 68% (71 patients). The patients' postoperative quality of life was lower of the norm, especially for psychical dimensions. This impairing of health whatever age, tumor size, operative approach or follow-up time. Sex and 2nd surgery were the only factors associated with a lower score. Women had worse rating of physical functioning. To operate small tumors should not assume that the impact on patients'life would be necessary less than following the removal of larger tumors. Women should have particularly clear explications before surgery and while follow-up.

The combined subcranial-pterional approach to the anterolateral skull base

We present a combined approach for the removal of large tumors involving the skull base, called the "combined pterional-subcranial approach." Use of the subcranial approach allows for a wide exposure of nearly the entire anterior skull base, from the cribriform roof of the ethmoid labyrinth posteriorly to the sphenoid and clivus, and laterally to the orbital roofs, with relatively little retraction of the brain. Addition of a unilateral pterional approach adds exposure to the most lateral aspect of the ipsilateral orbit, the retro-orbital region, as well as the sellar and chiasmatic regions. Dissection in the region of the cavernous sinus is also made easier by this combined technique. We review the background of these 2 surgical approaches and describe the technique of the combined approach.

Quality of life after acoustic neuroma surgery.

To assess how surgery affected the quality of life of patients with acoustic neuromas and to investigate possible predictors of the functional outcome following surgery. A questionnaire based on the Glasgow Benefit Inventory was completed by patients randomly selected following acoustic neuroma surgery. Skull base surgery unit of a university teaching hospital (tertiary referral center). Fifty-three patients with acoustic tumors (follow-up, 1 to 3 y). With regard to overall quality of life, nine patients (17.4%) reported that it became better, 28 patients (53.8%) worse, and 15 patients (28.8%) that it remained the same. Four patients (7.8%) became better off financially, 15 patients (29.4%) worse, and 32 (62.8%) remained unchanged. Forty-one patients (78.8%) did not change their occupation, and 11 (21.2%) had to change their occupation, mainly because of the adverse effects of the operation. With regard to the age at operation, older patients were found to have better overall quality of life. Moreover, younger patients had worse postoperative financial status and they were more likely to change their occupation after the operation. The tumor size did not significantly affect the overall postoperative quality, but it did affect the postoperative financial status (patients with larger tumors were more likely to have worse postoperative financial status). Acoustic neuroma surgery has a significant impact on patients' overall quality of life. Surgeons proposing to operate on small tumors should not assume that the impact on patients' life will be necessarily less than that following the removal of larger tumors. All patients, especially in the younger age group, should be prepared and thoroughly informed about the consequences of the operation on their quality of life.

How big is too big?

How big is too big?

Epithelial Ovarian Carcinoma: Principles of Primary Surgery

Surgery remains the most important facet in the initial management of epithelial ovarian cancer. Initial surgical therapy involves the establishment of the diagnosis, appropriate surgical staging, and primary cytoreductive surgery. For patients with advanced disease, surgical staging of ovarian cancer is obvious, but for apparently early disease (Stage I or II), appropriate surgical staging is extremely important and will result in the upstaging of about one-third of patients (usually to Stage III). The theoretical benefit of initial cytoreductive surgery is the removal of large necrotic tumors with a poor blood supply and the removal of large tumors that are in a slower growth phase, leaving behind tumors that are more sensitive to the effects of chemotherapy. There are multiple clinical studies indicating that "optimal" cytoreduction (removal of all tumor larger than 2 cm) results in improved complete response rates to chemotherapy, improved progression-free and overall survival, and a significant increase in the number of patients who will have a negative second-look surgical reassessment. Recent studies by the Gynecologic Oncology Group have further clarified the role of initial surgery, showing that the "biology" of the tumor is also important and that survival is directly related to residual disease within the following categories: (i) microscopic disease, (ii) optimal disease (2 cm or less in residual diameter), and (iii) suboptimal disease (greater than 2 cm diameter of residual disease). In the latter group (suboptimal disease), there may be a benefit to second attempts at surgical cytoreduction (interval cytoreductive surgery).

The use of myocutaneous pectoralis major flap in reconstruction of the head and neck

The surgical treatment of advanced carcinomas of the head and neck often requires extensive resections, recessitating large flaps for neconstruction. In recent years, there has been wide appreciation of immediate repairs following the removal of large tumours, using the various myocutaneous flaps. The present paper discusses the use of pectoralis major myocutaneous flap in 16 of such patients.

Glomus Tumors of the Temporal Bone: Contemporary Evaluation and Therapy

Surgical management of glomus tumors of the temporal bone requires accurate preoperative assessment and a knowledge of temporal bone anatomy, contemporary microsurgical techniques, and appropriate postoperative management. Care should be exercised to minimize postoperative neurologic deficit and deformity resulting from surgery of this usually benign lesion. The primary preoperative goal is to determine the extent of the lesion; although the history and physical examination are helpful, radiologic delineation of the tumor is imperative. Recent advances in surgical approaches and techniques have allowed the removal of larger tumors with lessened mortality and morbidity. Our overall experience in this series of glomus tumors leads us to believe that surgical excision is the treatment of choice for the treatment of glomus tumors of the temporal bone.

Problems of primary closure of extensive defects after removal of large tumors in the head and neck region

Problems of primary closure of extensive defects after removal of large tumors in the head and neck region