Resection Of Malignant Tumors Research Articles

Combination of Vascularized and Non-vascularized Fibula Free Flap With Dermofat Graft for Maxilla and Mandibula Reconstruction After Malignant Spindle Cell Tumor Resection.

The spindle cell tumor is a variant of sarcomatoid carcinoma that mostly affects the oral cavity. Bone involvement in this tumor leads to a wide excision, which sometimes requires resection of both the maxilla and mandible. The maxilla and mandible are important bones that function to form the 3-dimensional dimensions of the facial bones. The fibular bone can be selected to replace the facial bone because of its strong structure with a skin paddle, long pedicle, and proper bone shape. The authors present the case of a 24-year-old female who underwent maxillectomy and total hemimandibulectomy after a spindle cell tumor resection. The free fibular flap was harvested and divided into several segments to close the mandible and maxilla. However, the vascularized bone was insufficient; thus, non-vascularized bone was used in combination to reconstruct the maxilla. Six months after bone reconstruction, a dermofat graft was placed to fill the cheek structure. During the 6 months of follow-up, the vascularized and non-vascularized fibular bones were well arranged. Intraoral placement of a skin paddle covering the maxilla and mandible was viable. Both functional and esthetic outcomes were attained in patients with high satisfaction rates. Although there are many reconstruction options for patients with post-wide tumor excision, the fibula free flap remains the main choice as a replacement for facial bones because it has a strong and firm bone structure that can resemble facial bones; thus, a non-vascularized bone graft can be used in combination to cover the defects.

Surgical treatment of pancreatic metastases: More appropriate surgical methods based on a clinicopathologic study of 43 patients.

There is no established surgical method for metastatic lesion to the pancreas. In the case of relatively small lesion, we often hesitate to select which surgical method, that is, wedge/partial resection or Whipple/distal pancreatectomy. Moreover, it is debatable whether lymph node dissection is necessary or not. We investigated clinicopathological characteristics in order to resolve the above problems. Forty-three patients underwent pancreatic resection formetastatic tumors in Cancer Institute of the Japanese Foundation for Cancer Research, whose specimens were investigated clinicopathologically. Primary tumors included renal cell carcinoma(RCC), colorectal carcinoma (CRC), and miscellaneous malignancy (MM) in 23, 9, and 11 cases, respectively. Plural metastases in a resected specimen or mpd, i.e., tumor extension into the main pancreatic duct (MPD) was observed in eleven (26%, 11/43) or 9 (21%, 9/43) patients, respectively. Five of 9 mpd cases had more over 2cm intraductal tumor extention from the main metastatic lesion. Lymph node metastasis surrounding the main metastasis was observed in 11 patients (5 CRCs, 5 MMs, and 1 RCC), with a metastatic rate to lymph node of 56% (5/9), 45% (5/11), and 4% (1/23) for CRCs, MMs, and RCCs, respectively. 1) Wedge or partial resection of the pancreas for metastatic tumor should not be easily chosen, because of positive resection margin due to mpd and/or leaving another metastatic lesion. 2) Lymph node dissection is not strictly necessary for the surgical removal of pancreatic metastasis from RCC, whereas this is highly recommended for patients with metastasis from CRC or MM.

Trapezius Muscle Flap for Posterior Neck and Shoulder Defects Following Malignant Tumor Resection-A Case Series from a Tertiary Cancer Facility.

Reconstructing defects of the shoulder and posterior scalp, arising following tumor resection, requires careful consideration of available options. While free tissue transfers and local advancement flaps have their established roles, the trapezius muscle flap offers a unique set of advantages like proximity, versatility, and reliability as it has a robust blood supply and relatively straightforward surgical technique. In this retrospective analysis, demographic and disease profiles of 10 patients with posterior scalp and shoulder defects following tumor resection, which were reconstructed with a trapezius flap between November 2020 and November 2023, were studied. Complications and functional outcomes were analyzed. Ten patients (9 men and 1 woman) were reconstructed using a trapezius flap. The mean age of the study sample was 45.3 years (30-60 years). Two patients developed donor site seroma and one of them developed wound dehiscence; one patient had partial necrosis of the flap tip, all managed conservatively, and one patient had tumor recurrence. However, the long-term result was good in all patients except the one with recurrence. The post-excision defects in the shoulder and posterior scalp were of mean size 13 ± 2 × 6 ± 2 cm, and the donor site morbidity analyzed by using VAS (visual analog scale) had a mean score of less than 3. This case series provides valuable insights into the successful use of the trapezius muscle flap for shoulder and posterior scalp defects following malignant tumor resection. The documented complications are minimal in comparison to the overall positive outcomes, making the trapezius muscle flap a viable and reliable option for reconstruction in this specific clinical scenario. However, further research is required to improve the design of the flap for different types of defects, refine surgical techniques, and compare outcomes with other reconstruction methods.

When Is Resection of a Cardiac Tumor With Metastatic Disease Acceptable?

Metastatic disease is a relative contraindication for resection of malignant cardiac tumors. However, certain situations may present themselves when primary cardiac resection may be warranted. We present a 21-year-old male diagnosed with metastatic epithelioid hemangioendothelioma with right ventricular outflow tract involvement for whom surgical resection was successfully performed and discuss strategies.

Advancement Flap in Paralateronasal Defect Reconstruction.

Various techniques for local flap reconstructions of the facial region have been documented in the literature, including the advancement flap. This flap is one of the most versatile options for reconstructing various skin defects across different areas of the body. The purpose of this study is to demonstrate the safety and effectiveness of the advancement flap for reconstructing the paralateronasal region after the excision of skin cancer. The following article presents a retrospective case series of 6 patients in whom the advancement flap was used to reconstruct skin defects resulting from malignant tumor resections in the paralateronasal region. No restrictions were collected regarding etiology, location, size, age, sex, or any other patient factors. The recruited patients were treated in the Maxillofacial Surgery Unit of Floraspe Renzetti Hospital of Lanciano, and the study was conducted in collaboration with Sapienza University of Rome, from February 2023 to February 2024. All the flaps settled with no complications, and all the patients were FOD (free of disease) 6 months after surgery. So, in accordance with the literature, the advancement flap turns out to be a rapid and reliable option that could be easily applied for cutaneous defects of the face even for the oldest and/or emaciated patient.

Outcome and survival analysis of pulmonary metastasectomy for primary sarcoma with pulmonary metastases.

Sarcomas are rare malignancies, accounting for approximately 1% of all cancers. Pulmonary metastases are the most preferential site for distant metastasis in malignant soft tissue sarcomas. Despite the lack of evidence from large randomized trials to support treatment guidelines, surgical resection of resectable metastatic tumors remains the current standard of care. This study aimed to explore the survival status of patients with soft tissue sarcoma after resection of pulmonary metastases. This study is a retrospective analysis of patients who mestastasectomy by means of lobar or sublobar resections at National Taiwan University Hospital and its branches. The statistical and investigation period was from February 2007 to December 2020. Among 110 samples during the investigation period, the overall 5-year survival rate was 62.9%, which was higher than the 15%-50.9% reported previously. A disease-free interval of more than 12 months and the occurrence of local recurrence of sarcoma at the time of resection of pulmonary metastases are associated with overall survival. Most of the samples were treated with minimally invasive surgery (VATS), and therefore, most patients had a shorter hospital stay and better postoperative recovery. For pulmonary metastatic sarcoma, pulmonary metastasectomy is a relatively safe treatment method with short hospital stay and short ICU stay. The results of this study suggest that VATS is preferred over thoracotomy, but further observations are needed to confirm these findings.

Manual Hair Removal for Intraoral Flaps: a Simple Practice for Professional Education and Patient Cancer Care.

After resection of malignant tumors of the head and neck, reconstructions are commonly performed using surgical free flaps. In non-irradiated patients, hair may continue to grow at the reconstruction site after surgery, causing undesirable effects such as difficult to maintain oral hygiene, food and saliva accumulation, halitosis, dysphagia, moral distress, and impact on intimacy and sexuality. Until a standardized laser therapy protocol is available, manual depilation isan option that should not be underestimated to improve the patient's quality of life and available to every oral healthcare team. This case illustrates a simple practice that contributes to improving patients' quality of life and oral health in an interprofessional way.

Surgical Treatment and Clinical Evaluation of Calvarial Metastases.

The aim of this study is to explore surgical treatment techniques and clinical attributes associated with calvarial metastases, while providing a comprehensive review of the treatment experiences relevant to this particular type of tumor. This study involves a retrospective analysis of clinical data from 12 patients diagnosed with calvarial metastatic tumors who underwent surgical intervention. Among these patients, 5 had a history of previous malignant tumor resections, while 7 presented with calvarial metastatic tumors as their initial symptom. In all cases, the surgical approach consisted of calvarial tumor resection followed by titanium mesh repair. Following the surgical intervention, all patients underwent a comprehensive course of treatment, encompassing both local radiotherapy and systemic chemotherapy. In 1 instance, a patient presented with multiple tumors located in the central area of the frontal bone and the right temporal bone. The larger tumor situated in the middle of the frontal bone was surgically excised, while the tumor in the right temporal bone was treated using radiotherapy. In 2 cases characterized by multiple metastases within the skull, a comprehensive excision of all tumors was accomplished in a single surgical procedure. In the remaining cases featuring a solitary metastatic growth, the respective tumors were surgically removed. There were 10 instances of dura mater invasion and 3 cases involving the invasion of brain tissue. Pathologic examinations revealed 1 case of metastatic lung adenocarcinoma, 1 case of metastatic paraganglioma, 1 case of metastatic hepatocellular carcinoma, 2 cases of metastatic thyroid carcinoma, and 7 cases of metastatic clear cell renal cell carcinoma. Throughout the follow-up period, spanning from 14 to 90 months, various outcomes were noted. These included three occurrences of in situ recurrence. In addition, 1 patient required 3 distinct surgical interventions, while 2 other patients underwent 2 separate surgical procedures each. Notably, 1 of these cases involved the exposure of the titanium mesh on the scalp, necessitating the removal of the titanium mesh. Regrettably, there have been 9 recorded fatalities among the patients, while 3 individuals have survived. Solitary metastasis of calvarium region is rare, and surgical resection is effective. However, it is necessary to extend the resection range and combine with local radiotherapy to avoid local recurrence. Surgical intervention can significantly enhance the quality of life for affected patients. The prognosis of the patients mainly depends on the treatment of the primary disease and the situation of important organ dissemination and treatment.

Outcome of Robotic-Assisted Resection of Large Primary Thymic Tumors: A Single High-Volume Institutional Experience

BackgroundThe role of robotic-assisted resection for large primary thymic malignant tumors is uncertain. This study compares outcomes of robotic-assisted resection by tumor size. MethodsRobotic resections for anterior mediastinal masses were identified from an institutionally maintained database and were retrospectively analyzed. Cases were stratified by tumor size. Data points collected included patient demographics, tumor characteristics, and perioperative outcomes. ResultsFrom 2014 to 2022, 67 robotic-assisted mediastinal resections were performed for primary thymic malignant tumors. The average tumor size was 5.6 cm (range, 0.7-14.0 cm). The median length of stay was 3 days (range, 1-73 days). The median operative time was 186 minutes (range, 69-644 minutes). Tumors ≤4 cm (n = 21; 31%) vs >4 cm (n = 46; 69%), trended toward a shorter median operative time (157 minutes vs 208 minutes; P = .06), length of stay (2 days vs 3.5 days; P = .18), and lower positive margins (21 [100%] R0 resections in the ≤4-cm group vs 40 [87%] R0 resections in the >4-cm group; P = .09). There was no difference in major complications (2 [9.5%] vs 3 [2.5%]; P = 1.0). ConclusionsRobotic-assisted resection can be safe and effective for primary thymic malignant tumors. Concern regarding increased rates of positive margins vs an open approach for large tumors remain. Although a robotic approach for larger tumors may spare selected patients the morbidity of an open procedure without compromising outcomes, a low threshold should exist for conversion to open surgery.

Correlation between post-chemotherapy MRI and histopathology of malignant bone tumors treated with extra-articular resection.

Magnetic resonance imaging (MRI) remains the gold standard for diagnosing tumoral joint involvement; however, its interpretation remains uncertain due to the presence of perilesional edema that can lead to unjustified arthrectomy. The aim of the study is to identify precise MRI signs that are predictive of joint involvement. This retrospective multicenter study included 25 patients who underwent extra-articular resection for malignant bone tumor with suspected joint involvement at the shoulder, hip, or knee, between January 2004 and July 2023. Joint resection was indicated based on preoperative MRI examination. MRI signs of joint involvement were joint effusion, capsuloligamentous invasion, disruption of articular cartilage, and intra-articular tumor mass. We then compared histopathological "true" joint involvement of the resected specimen with its preoperative MRI diagnosis. Extra-articular resection was performed in 9 shoulders, 4 hips, and 12 knees. Histological analysis confirmed wide resections for all patients. Based on histopathological analysis, extra-articular resection was unjustified in 40% (44%, 0%, and 50%, respectively). The most specific iconographic criteria were intra-capsular cortical breach and the presence of a tumor mass inside the joint. Articular cartilage disruption is often the most accurate sign. Our results suggest that MRI has a poor ability to accurately diagnose joint involvement. To date, however, this is the best tool available. In addition to obvious signs of joint involvement, MRI analysis must be performed with a thorough understanding of capsular anatomy and its particularities for each joint so as not to miss other signs, such as intra-capsular cortical effraction.

Limberg Flap for Lateral Midface Reconstruction.

Several local skin flaps and tissue rearrangement techniques have been described in the literature, including the rhomboid flap. The Limberg flap is one of the most versatile local flaps that can be used for reconstruction of a wide range of skin defects in different parts of the body. The purpose of this study is to demonstrate the safety and applicability of the Limberg flap for reconstruction of skin facial defects, particularly after cutaneous tumor resection. The following article presents a retrospective case series of 8 patients in whom the Limberg flap was used to reconstruct skin defects resulting from malignant tumor resections in the lateral part of the face. No restrictions were collected regarding etiology, location, size, age, sex, or any other patient factors. The recruited patients were treated in the Maxillofacial Surgery Unit of Floraspe Renzetti Hospital of Lanciano and the study was conducted in collaboration with Sapienza University of Rome, from April 2023 to April 2024. All the flaps settled with no complications and all the patients were FOD (free of disease) 6 months after surgery. So, in accordance with the literature, the Limberg flap turns out to be a rapid and reliable option that could be easily applied for small (size around 1-2cm) and medium-sized (size around 2-4cm) cutaneous defects of the face even for the oldest and/or emaciated patients.

Proximal Tibia Hemiarthroplasty Reconstruction Following Resection of Malignant Bone Tumors in Skeletally Immature Patients

BackgroundReconstruction of the proximal tibia following resection of malignant bone tumors in pediatric patients is traditionally limited to osteoarticular allografts or endoprostheses. Endoprostheses typically require resection or disruption of the distal femoral physis, which can lead to a leg length discrepancy (LLD). We introduce a novel form of proximal tibia limb reconstruction using a Compress® tibia hemiarthroplasty, which spares the distal femoral physis. MethodsWe retrospectively reviewed 5 patients who underwent proximal tibia osteosarcoma resection and reconstruction with a custom Compress® proximal tibia hemiarthroplasty. Data on function, survival, LLD, complications, and patient-reported outcomes were collected. ResultsMean age at resection was 10.4 years [range: 8.8-12.9 years]. Mean implant survival was 59 months [range: 34-83 months]. One patient developed a deep infection, and two patients required implant lengthening. Both were later converted to a rotating hinged total knee arthroplasty (RHTKA) ​> ​58 months after index surgery. At the last follow-up, all living patients had knee range of motion from 0 to 110°, walked unassisted, and had no LLD or knee instability. Mean Toronto Extremity Salvage Score was 90 [range: 80-97]. ConclusionsProximal tibia hemiarthroplasty reconstruction after tumor resection in skeletally immature patients preserves the distal femoral physis and may potentially reduce LLD and delay conversion to an RHTKA until after skeletal maturity. Key Concepts(1)Osteosarcoma is the most common primary malignant bone tumor in children, arising most frequently around the knee.(2)Complete resection often requires excising the adjacent growth plate, creating a challenge for reconstruction in growing children to maintain function and avoid significant limb length inequality.(3)The custom expandable tibia hemiarthroplasty is a novel reconstruction option for skeletally immature patients requiring resection of the proximal tibia.(4)Although future research is needed, results of this study suggest that tibia hemiarthroplasty is a reasonable reconstruction option in growing children requiring oncologic resection of a primary bone tumor from the proximal tibia. Level of EvidenceCase series, Level IV

Procedural volume is linearly associated with mortality, major complications, and readmissions in patients undergoing malignant brain tumor resection.

Improved outcomes have been noted in patients undergoing malignant brain tumor resection at high-volume centers. Studies have arbitrarily chosen high-volume dichotomous cutoffs and have not evaluated volume-outcome associations at specific institutional procedural volumes. We sought to establish the continuous association of volume with patient outcomes and identify cutoffs significantly associated with mortality, major complications, and readmissions. We hypothesized that a linear volume-outcome relationship can estimate likelihood of adverse outcomes when comparing any two volumes. The patient cohort was identified with ICD-10 coding in the Nationwide Readmissions Database(NRD). The association of volume and mortality, major complications, and 30-/90-day readmissions were evaluated in multivariate analyses. Volume was used as a continuous variable with two/three-piece splines, with various knot positions to reflect the best model performance, based on the Quasi Information Criterion(QIC). From 2016 to 2018, 34,486 patients with malignant brain tumors underwent resection. When volume was analyzed as a continuous variable, mortality risk decreased at a steady rate of OR 0.988 per each additional procedure increase for hospitals with 1-65 cases/year(95% CI 0.982-0.993, p < 0.0001). Risk of major complications decreased from 1 to 41 cases/year(OR 0.983, 95% CI 0.979-0.988, p < 0.0001), 30-day readmissions from 1 to 24 cases/year(OR 0.987, 95% CI 0.979-0.995, p = 0.001) and 90-day readmissions from 1 to 23 cases/year(OR 0.989, 95% CI 0.983-0.995, p = 0.0003) and 24-349 cases/year(OR 0.9994, 95% CI 0.999-1, p = 0.01). In multivariate analyses, institutional procedural volume remains linearly associated with mortality, major complications, and 30-/90-day readmission up to specific cutoffs. The resulting linear association can be used to calculate relative likelihood of adverse outcomes between any two volumes.

Patient-specific guides for consistently achieving R0 bone margins after resection of primary malignant bone tumors of the pelvis

AimsPrimary malignant bone tumor of the pelvis is an uncommon lesion, the resection of which via freehand osteotomy is subject to inaccuracy due to its three-dimensional anatomy. Patient-Specific Guides (PSG), also called Patient-Specific Instruments (PSI) are essential to ensure surgical planning and resection adequacy. Our aim was to assess their use and effectiveness.MethodsA monocentric retrospective study was conducted on 42 adult patients who underwent PSG-based resection of a primary malignant bone tumor of the pelvis. The primary outcome was the proportion of R0 bone margins. The secondary outcomes were the proportion of overall R0 margins, considering soft-tissue resection, the cumulative incidence of local recurrence, and the time of production for the guides. A comparison to a previous series at our institution was performed regarding histological margins.ResultsUsing PSGs, 100% R0 safe bone margin was achieved, and 88% overall R0 margin due to soft-tissue resection being contaminated, while the comparison to the previous series showed only 80% of R0 safe bone margin. The cumulative incidences of local recurrence were 10% (95% CI: 4–20%) at one year, 15% (95% CI: 6–27%) at two years, and 19% (95% CI: 8–33%) at five years. The median overall duration of the fabrication process of the guide was 35 days (Q1–Q3: 26–47) from the first contact to the surgery date.ConclusionsPatient-Specific Guides can provide a reproducible safe bony margin.

Outcome of Endoprosthetic Hip Reconstruction Following Resection of Malignant Bone Tumors.

Over the past few decades, tumor arthroplasty has evolved into an established therapeutic approach for addressing bone defects following tumor resection in the extremities. As the diagnosis has a significant impact on patients' lives, it is important to give clear expectations for functional recovery. Therefore, we investigated both the functional outcomes and the quality of life (QoL) after tumor arthroplasty for malignant hip tumors. This retrospective study included patients who had undergone resections of malignant hip tumors with consecutive modular hip arthroplasty between 2010 and 2018. Demographics, tumor entity, and complications stemming from both tumors and treatments were evaluated through the analysis of medical records and perioperative records. The assessment of functional outcomes was conducted with the following patient-reported outcome measures (PROMs): the Harris Hip Score (HHS), Musculoskeletal Tumor Society Score (MSTS), and the Short Form Survey 36 (SF-36). Furthermore, we performed subgroup analysis in two groups: one divided into survivors and non-survivors, as well as younger individuals (<57 years) and older individuals (>57 years). A total of 30 patients were included in the study. At the time of follow-up, 19 patients were deceased. The average duration of follow-up was 3.2 (±2.51) years. The average age at the time of surgery was 60.3 (±15.20) years. Notably, there were no cases of amputation reported (0%). Five cases of implant failure were identified (16.67%). Among these, one was attributed to infection (3.3%), while four resulted from aseptic loosening (13.3%). In terms of functional outcomes, MSTS indicated good results (18 ± 7; range: 7-28; 60%), and the HHS demonstrated moderate outcomes (75.3%). Younger survivors (<57 years) exhibited notably superior results in terms of both the MSTS and physical functioning in the SF-36 (p = 0.03). In summary, this study shows declining tumor arthroplasty-related complications and satisfying functional outcomes as well as QoL. Noteworthy aspects include the relatively low rates of amputation and local tumor recurrences, which significantly favor the selection of appropriate therapeutic options. Moreover, the findings underscore the substantial impact of patients' age on overall functionality and engagement in daily activities.

Effects of Aureobasidium Pullulans produced β-1,3-1,6-glucan on CA19-9, sCD44, IgA and sCD209 in patients undergoing surgical resection of malignant pancreatic tumors.

96 Background: Pancreatic cancer is a highly refractory tumor with poor prognosis, which aggressively progresses by suppressing the immunity. Surgical procedure related stress further weakens the immunity and aids cancer stem cell metastases, warranting immune enhancement strategies. AFO-202 strain of Aureobasidium Pullulans produced β-1,3-1,6 glucan (Nichi BRITE), having yielded immune enhancement in earlier studies, we evaluated its effects in patients undergoing surgical resection of malignant pancreatic tumors. Methods: 30 subjects in two groups were enrolled; control arm (n=15, "P" group) received a placebo, and treatment arm (n=15, "G" group) received Nichi BRITE 250mg/day, in three divided doses, for 22 days from the pre-operative day. Serum beta glucan specific IgA2 (BG-IgA), total IgA (IgA), sCD209, Serum Amyloid A (SAA), sCD44 and CA19-9 were evaluated at base line and at periodic intervals. Results: sCD44 significantly decreased 48.94% in “G” group and only 4.58% in “P” group (p = &lt; 0.0001) on day 21. sCD209 on day 21 in “G” group increased by 54.68% (p = 0.04) against 15.03% in “P”. BG-IgA at day 10 increased around 150% in “G”, and only by 6% in “P”. Total IgA, increased by 20.60% in “G” and only 5.73% in “P”. SAA increased to 251.32% in “G” on day 21 and in “P” it decreased by 6.11%. Decreased sCD44 when correlated against Neutrophil to Lymphocyte Ratio (NLR), a significant positive correlation was in “G” (r statistic= 0.758; p-value =0.006; 95% CI= 0.2907~0.9335), but a negative correlation in “P”. Pancreatic cancer marker CA19-9 decreased significantly in three months follow up in “G” (-86.02 U/ml) whereas it increased in “P” by +5.91 U/ml. Mean survival of Nichi BRITE group was 25.9 months against 22.3 months in “P” group. Conclusions: Administration of Nichi BRITE glucans to patients undergoing surgical resection of malignant pancreatic tumor was safe and it enhanced biomarkers of innate and adaptive immunity. Nichi BRITE significantly decreased the circulating cancer stem cell marker sCD44 implying a lesser recurrence risk, especially in patients with high NLR ratio who have a poor prognosis, and significantly reduced the CA 19-9 levels implying a better prognosis, making us recommend it as an adjuvant to patients undergoing surgeries for malignant tumors, and be included in the guidelines of clinical nutrition.

Formation of pulmonary vein stump thrombus after anatomical lung resection and anticoagulant therapy.

It has recently been suggested that the formation of pulmonary vein stump thrombus (PVST) after anatomical lung resection is an underlying cause of arterial thromboembolism including cerebrovascular infarction. This study aimed to investigate the incidence and risk factors of PVST and to evaluate the efficacy and safety of anticoagulant therapy for PVST. Patients who underwent anatomical lung resection for malignant lung tumors were eligible for inclusion in this study. Chest contrast-enhanced (CE) computed tomography (CT) was performed after surgery to detect PVST. If PVST was observed, patients received anticoagulant therapy. The size of the PVST was followed-up by repeated chest CE-CT. In total, 176 patients were enrolled in this study. Chest CE-CT was performed on postoperative day 1-13 (median, postoperative day 6). PVST was detected in 22 (12.5%) patients. The median size of PVST was 9.5 (4.1-33.4) mm. Thrombus was most commonly observed in patients who underwent left upper lobectomy (9/36, 25.0%). Hypertension, dyslipidemia, arteriosclerosis, and arrhythmia were not associated with PVST formation. Anticoagulant therapy was administered to all 22 patients with PVST until the PVST disappeared. The median duration between the detection and disappearance of PVST was 77days (range: 6-146days). During the period between the detection and disappearance of PVST, cerebrovascular infarction or arterial thromboembolic events were not observed. Postoperative PVST is commonly observed, especially in patients who undergo left upper lobectomy. Anticoagulant therapy for PVST was safely introduced and was efficient to improve PVST without subsequent arterial thromboembolic events.

Complications of chest wall around malignant tumors: differences based on reconstruction strategy

BackgroundMalignant chest wall tumors need to be excised with wide resection to ensure tumor free margins, and the reconstruction method should be selected according to the depth and dimensions of the tumor. Vascularized tissue is needed to cover the superficial soft tissue defect or bone tissue defect. This study evaluated differences in complications according to reconstruction strategy.MethodsForty-five patients with 52 operations for resection of malignant tumors in the chest wall were retrospectively reviewed. Patients were categorized as having superficial tumors, comprising Group A with simple closure for small soft tissue defects and Group B with flap coverage for wide soft tissue defects, or deep tumors, comprising Group C with full-thickness resection with or without mesh reconstruction and Group D with full-thickness resection covered by flap with or without polymethyl methacrylate. Complications were evaluated for the 52 operations based on reconstruction strategy then risk factors for surgical and respiratory complications were elucidated.ResultsTotal local recurrence-free survival rates in 45 patients who received first operation were 83.9% at 5 years and 70.6% at 10 years. The surgical complication rate was 11.5% (6/52), occurring only in cases with deep tumors, predominantly from Group D. Operations needing chest wall reconstruction (p = 0.0016) and flap transfer (p = 0.0112) were significantly associated with the incidence of complications. Operations involving complications showed significantly larger tumors, wider areas of bony chest wall resection and greater volumes of bleeding (p < 0.005). Flap transfer was the only significant predictor identified from multivariate analysis (OR: 10.8, 95%CI: 1.05–111; p = 0.0456). The respiratory complication rate was 13.5% (7/52), occurring with superficial and deep tumors, particularly Groups B and D. Flap transfer was significantly associated with the incidence of respiratory complications (p < 0.0005). Cases in the group with respiratory complications were older, more frequently had a history of smoking, had lower FEV1.0% and had a wider area of skin resected compared to cases in the group without respiratory complications (p < 0.05). Preoperative FEV1.0% was the only significant predictor identified from multivariate analysis (OR: 0.814, 95%CI: 0.693–0.957; p = 0.0126).ConclusionsSurgical complications were more frequent in Group D and after operations involving flap transfer. Severe preoperative FEV1.0% was associated with respiratory complications even in cases of superficial tumors with flap transfer.

Incidence of air leaks in patients undergoing robotic thoracic surgery and video-assisted thoracic surgery.

Postoperative air leakage is the most common complication in surgery for malignant lung tumors, leading to extended hospital stays and substantial medical expenses. This study aimed to identify the incidence and characteristics of intraoperative and postoperative air leaks in both robotic-assisted thoracic surgery (RATS) and video-assisted thoracic surgery (VATS), as well as the causes of persistent air leakage following RATS. We conducted a retrospective analysis of patients who underwent lung resection for malignant lung tumors at our institution from October 2018 to August 2022. We compared the incidence rates of intraoperative air leak, postoperative air leak, and persistent air leak between patients who underwent RATS and those who underwent VATS. Background factors were adjusted using propensity score matching. A subanalysis was performed to compare unexpected air leaks, defined as air leaks not observed intraoperatively but confirmed postoperatively. The study included 295 cases of RATS and 227 cases of VATS. In both the overall population and the matched group (187 cases each for RATS and VATS), RATS demonstrated a significantly higher incidence of persistent air leaks compared to VATS (11% vs 3%, p < 0.01; 9% vs 3%, p = 0.02, respectively). RATS also had a significantly higher incidence of unexpected air leaks compared with VATS (29% vs 18%, p = 0.05). Although there was no statistically significant difference in hospital stays, RATS showed a higher incidence of postoperative persistent air leaks and unexpected postoperative air leaks than VATS.

Endoprosthetic replacement with preservation of the epiphysis for proximal tibial reconstruction after osteosarcoma resection in children: a case report

BackgroundLimb salvage surgery is an important method for treating malignant tumors of the bone involving the adjacent parts of the major joints in children. This technique allows for preservation of limb function, especially in the lower limb. However, the reconstruction of the proximal end of the tibia after removing the tumor mass with a rational scale to preserve the total knee joint and reduce limb length discrepancy presents a challenge.Case presentationWe present a case of osteosarcoma of the proximal tibia. After being treated with an extended tumor resection, the proximal tibia of the child was restructured using endoprosthetic replacement with epiphyseal preservation. This procedure preserves the entire articular surface and growth plate of the knee joint of the affected limb and provides a feasible alternative protocol for retaining the function and growth potential of the affected limb. The patient remained disease-free and normal limb motor function was observed during the 3.5 year follow-up since the initial surgery.ConclusionsPreservation of the epiphysis enabled our patient to perform better limb function after limb-saving surgery as a result of his undamaged knee joint and minimized limb-length discrepancy. We believe that endoprosthetic replacement with preservation of the epiphysis can provide the best strategy for reconstruction after resection of focal malignant tumors in long bones without epiphytic involvement.