Surgical Staging System Research Articles

Perioperative complications of en bloc resection and anterior column reconstruction for thoracic and lumbar spinal tumors

PurposeTo evaluate the perioperative clinical outcomes of en bloc resection and anterior column reconstruction for thoracolumbar spinal tumors.MethodsThis study conducted a retrospective analysis of prospective data collection of 86 consecutive patients, including 40 males and 46 females, with an average age of 39 years (ranged from 10 to 71 years). There were 35 cases of a malignant primary tumor,42 cases of an aggressive benign tumor, and nine cases of metastases. The main lesions were located in 65 cases of thoracic spine, 17 cases of lumbar spine, and 4 cases of thoracolumbar spine. Tumors involved one level in 45 patients, two levels in 12 patients, three levels in 21 patients, four levels in five patients, five levels in two patients, and six levels in one patient.ResultsAccording to the Weinstein-Boriani-Biagini surgical staging system, all patients achieved en bloc resections, including 74 cases of total en bloc spondylectomy and 12 cases of sagittal resections. The mean surgical time was 559 min (210–1208 min), and the mean total blood loss was 1528 ml (260–5500 ml). A total of 122 complications were observed in 62(72.1%) patients, of which 18(20.9%) patients had 25 major complications and one patient (1.2%) died of complications. The combined approach (P = 0.002), total blood loss (P = 0.003), staged surgery (P = 0.004), previous surgical history (P = 0.045), the number of involved vertebrae (P = 0.021) and lumbar location (P = 0.012) were statistically significant risk factors for major complication. When all above risk factors were incorporated in multivariate analysis, only the combined approach (P = 0.052) still remained significant.ConclusionsEn bloc resection and anterior column reconstruction is accompanied by a high incidence of complications, especially when a combined approach is necessary.

The Predictive Value of Preoperative Inflammatory Markers / Lymphocyte Ratios for Endometrial Cancer; What does the eosinophil to lymphocyte ratio means for survival?

Aim: 
 In various solid tumors, cancer-associated inflammation is associated with adverse long-term outcomes. The purpose of this study was to examine the influence of the preoperative neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR) and other systemic inflammatory markers on lymph node metastasis and 5-year survival in endometrial cancer.
 Materials and Method: 
 A total of 379 female patients at the Gynecology and Obstetrics Clinic of the University Hospital with a final postoperative pathology of endometrial cancer were included in the 5-year survival study. The preoperative total neutrophil, monocyte, eosinophil, and platelet counts were divided by the lymphocyte count to obtain the NLR, monocyte-to-lymphocyte ratio (MLR), eosinophil-to-lymphocyte ratio (ELR), and PLR values. All patients underwent bilateral pelvic paraaortic lymph node dissection and omentectomy in addition to total abdominal hysterectomy and bilateral salpingo-oophorectomy (TAH + BSO). The pathology lab at our university evaluated all cytology and postoperative specimens. The staging system used was the FIGO 2009 surgical staging system.
 Results: 
 The results of our study showed significant correlations between lymph node metastasis and NLR, eosinophil-to-lymphocyte ratio (ELR), and PLR. Only a significant correlation between ELR and survival was discovered when the relationship with 5-year survival was examined. Aditionally significant correlations existed between NLR and cervical stromal involvement, cytology positivity, and stage.
 Conclusion: 
 The prognostic factors for lymph node metastasis are NLR, PLR, and ELR. Only ELR is predictive of 5-year survival, but more prospective studies on ELR survival prediction are needed.

Outcome of Total Surgical Debridement of Covid Associated Rhino-Orbito-Cerebral Mucormycosis Based on a New Surgical Staging System: A Cohort Study.

To propose a surgical staging system with management protocol for post-covid Rhino-orbito-cerebral mucormycosis (ROCM) with central skull base osteomyelitis. A prospective cohort study of a total of 193 post-covid ROCM patients was conducted between May 2021 and January 2022 at a tertiary care centre. Patients were assessed radiologically and staged from I to V. Follow up period was 16months and the surgical outcome in terms of recurrent disease was assessed. A total of 193 patients (129 primary and 64 revision) were studied. Maxilla was found to be the epicenter of anterior disease (69.3%) and pterygoid wedge was noted to be the epicenter of posterior disease (85.6%). More than 65% of our patients, at the time of presentation, presented with involvement of the central skull base. Intracranial disease was noted in 13.9% of patients and the mortality rate was 6.2%. This staging system provides a systematic step-by-step protocol for the management of ROCM, with emphasis on meticulous disease clearance at the central skull base.

The application of 3D-printed auto-stable artificial vertebral body in en bloc resection and reconstruction of thoracolumbar metastases

BackgroundNerve compression symptoms and spinal instability, resulting from spinal metastases, significantly impact the quality of life for patients. A 3D-printed vertebral body is considered an effective approach to reconstruct bone defects following en bloc resection of spinal tumors. The advantage of this method lies in its customized shape and innermost porous structure, which promotes bone ingrowth and leads to reduced postoperative complications.ObjectiveThe purpose of this study is to assess the effectiveness of 3D-printed auto-stable artificial vertebrae in the en bloc resection and reconstruction of thoracolumbar metastases.MethodsThis study included patients who underwent en bloc resection of thoracolumbar metastases based on the Weinstein-Boriani-Biagini surgical staging system, between January 2019 and April 2021. The patients were divided into two groups: the observation group, which was reconstructed using 3D-printed auto-stable vertebral bodies, and the control group, treated with titanium cages and allograft bone. Evaluation criteria for the patients included assessment of implant subsidence, instrumentation-related complications, VAS score, and Frankel grading of spinal cord injury.ResultsThe median follow-up period was 21.8 months (range 12–38 months). Among the patients, 10 received a customized 3D-printed artificial vertebral body, while the remaining 10 received a titanium cage. The observation group showed significantly lower operation time, intraoperative blood loss, and postoperative drainage compared to the control group (P < 0.05). At the final follow-up, the average implant subsidence was 1.8 ± 2.1 mm for the observation group and 5.2 ± 5.1 mm for the control group (P < 0.05). The visual analog scale (VAS) scores were not statistically different between the two groups at preoperative, 24 h, 3 months, and 1 year after the operation (P < 0.05). There were no statistically significant differences in the improvements of spinal cord functions between the two groups.ConclusionThe utilization of a 3D-printed auto-stable artificial vertebra for reconstruction following en bloc resection of thoracolumbar metastases appears to be a viable and dependable choice. The low occurrence of prosthesis subsidence with 3D-printed prostheses can offer immediate and robust stability.

Surgical Outcomes, Long-Term Survivals and Staging Systems of World Health Organization G3 Pancreatic Neuroendocrine Tumors.

Background: In 2017, the World Health Organization (WHO) defined a new category of pancreatic neuroendocrine neoplasms named G3 pancreatic neuroendocrine tumors (p-NETs), whose surgical outcomes, long-term survivals and staging systems have not been well documented. Methods: Data from eligible patients with G3 p-NETs defined using the WHO 2017 grading classification at our institute were retrospectively analyzed. Results: Our study enrolled 80 patients with WHO G3 p-NETs, including 50 women and 30 men. The accumulative 5-year overall survival (OS) of G3 p-NETs was 29.7%. The current staging system by the American Joint Committee on Cancer (AJCC) failed to discriminate the survival difference between Stage II and Stage III (p = 0.172), while notable differences with regard to the OS were statistically offered between each stage using the modified tumor–node–metastasis (mTNM) staging system (all p < 0.05). The OS of patients receiving surgical resection was significantly better than those with palliative operation (p < 0.05). Both the current AJCC system and proposed mTNM system were independent predictors for the OS of G3 p-NETs (p = 0.017 and p = 0.032, respectively). The 95% confidence intervals of the proposed mTNM staging system were smaller than that of the current AJCC system (0.626–8.217 and 0.329–10.013, respectively), indicating a relatively more accurate predictive ability. Conclusion: Our demonstration revealed that surgical resection was an independent predictor for the favorable prognosis of patients with G3 p-NETs. Moreover, the new mTNM staging system was more suitable and practical than the current AJCC system for stratifying G3 p-NETs into prognostic groups.

Update on MRI in Evaluation and Treatment of Endometrial Cancer

Endometrial cancer is the second most common gynecologic cancer worldwide and the most common gynecologic cancer in the United States, with an increasing incidence in high-income countries. Although the International Federation of Gynecology and Obstetrics (FIGO) staging system for endometrial cancer is a surgical staging system, contemporary published evidence-based data and expert opinions recommend MRI for treatment planning as it provides critical diagnostic information on tumor size and depth, extent of myometrial and cervical invasion, extrauterine extent, and lymph node status, all of which are essential in choosing the most appropriate therapy. Multiparametric MRI using a combination of T2-weighted sequences, diffusion-weighted imaging, and multiphase contrast-enhanced imaging is the mainstay for imaging assessment of endometrial cancer. Identification of important prognostic factors at MRI improves both treatment selection and posttreatment follow-up. MRI also plays a crucial role for fertility-preserving strategies and in patients who are not surgical candidates by helping guide therapy and identify procedural complications. This review is a product of the Society of Abdominal Radiology Uterine and Ovarian Cancer Disease-Focused Panel and reflects a multidisciplinary international collaborative effort to summarize updated information highlighting the role of MRI for endometrial cancer depiction and delineation, treatment planning, and follow-up. The article includes information regarding dedicated MRI protocols, tips for MRI reporting, imaging pitfalls, and strategies for image quality optimization. The roles of MRI-guided radiation therapy, hybrid PET/MRI, and advanced MRI techniques that are applicable to endometrial cancer imaging are also discussed. Online supplemental material is available for this article. ©RSNA, 2022.

3D-printed vertebral body for anterior spinal reconstruction in patients with thoracolumbar spinal tumors.

A 3D-printed vertebral prosthesis can be used to reconstruct a bone defect more precisely because of its tailored shape, with its innermost porous structure inducing bone ingrowth. The aim of this study was to evaluate the clinical outcomes of using a 3D-printed artificial vertebral body for spinal reconstruction after en bloc resection of thoracolumbar tumors. This was a retrospective analysis of 23 consecutive patients who underwent surgical treatment for thoracolumbar tumors at our hospital. En bloc resection was performed in all cases, based on the Weinstein-Boriani-Biagini surgical staging system, and anterior reconstruction was performed using a 3D-printed artificial vertebral body. Prosthesis subsidence, fusion status, and instrumentation-related complications were evaluated. Stability of the anterior reconstruction method was evaluated by CT, and CT Hounsfield unit (HU) values were measured to evaluate fusion status. The median follow-up was 37 (range 24-58) months. A customized 3D-printed artificial vertebral body was used in 10 patients, with an off-the-shelf 3D-printed artificial vertebral body used in the other 13 patients. The artificial vertebral body was implanted anteriorly in 5 patients and posteriorly in 18 patients. The overall fusion rate was 87.0%. The average prosthesis subsidence at the final follow-up was 1.60 ± 1.79 mm. Instrument failure occurred in 2 patients, both of whom had substantial subsidence (8.47 and 3.69 mm, respectively). At 3 months, 6 months, and 1 year postoperatively, the mean CT HU values within the artificial vertebral body were 1930 ± 294, 1997 ± 336, and 1994 ± 257, respectively, with each of these values being significantly higher than the immediate postoperative value of 1744 ± 321 (p < 0.05). The use of a 3D-printed artificial vertebral body for anterior reconstruction after en bloc resection of the thoracolumbar spinal tumor may be a feasible and reliable option. The low incidence of prosthesis subsidence of 3D-printed endoprostheses can provide good stability instantly. Measurement of HU values with CT is a valuable method to evaluate the osseointegration at the bone-metal interface of a 3D-printed vertebral prosthesis.

CORR Insights®: Does Adding Femoral Lengthening at the Time of Rotation Hip Transposition After Periacetabular Tumor Resection Allow for Restoration of Limb Length and Function? Interim Results of a Modified Hip Transposition Procedure.

CORR Insights®: Does Adding Femoral Lengthening at the Time of Rotation Hip Transposition After Periacetabular Tumor Resection Allow for Restoration of Limb Length and Function? Interim Results of a Modified Hip Transposition Procedure.

Clinical advances in nasopharyngeal carcinoma surgery and a video demonstration

Nasopharyngeal carcinoma (NPC) is highly radiosensitive, and radiotherapy is recommended for newly diagnosed NPC. Because of the poor visual surgical field, narrow operating space, difficulty protecting the internal carotid artery (ICA) and poor wound healing, the development of NPC surgery has been severely limited. For recurrent NPC, some open surgical approaches, such as the maxillary swing, successfully solve the above major problems. However, these operations are traumatic and lead to many postoperative complications. With the development of minimally invasive surgery, two concepts, the “third-hand technique” and “dumpling making technique”, have been proposed, combining with the intraoperative navigation systems and multiple anatomical landmarks for identifying ICA. Endoscopic nasopharyngectomy (ENPG) can also break through the above restrictions and has become a first-line treatment for locally recurrent NPC. Moreover, a new surgical staging system for recurrent NPC was devised to aid clinicians in choosing the most suitable treatment for these patients. A current study on ENPG alone for newly diagnosed stage I NPC shows that the long-term survival outcomes after ENPG are similar to those after IMRT. ENPG was associated with low medical costs and satisfactory QOL and might be an alternative strategy for treating newly diagnosed localized stage I NPC patients who refuse radiotherapy.

Surgical Approach Algorithm in the Treatment of Lumbar and Thoracolumbar Pyogenic Spondylodiscitis.

To reveal the efficiency of our surgical approach algorithm in patients with thoracolumbar pyogenic spondylodiscitis based on the involvement of anatomical structure. Data of patients who underwent debridement or stabilization surgery for thoracolumbar pyogenic spondylodiscitis from January 2012 to December 2018 were reviewed. Lumbar and thoracolumbar spondylodiscitis was classified into four stages based on anatomical involvement. Infection was limited in the disc space, which had not spread to the endplate in stage 1 and progressed as two-level corpus involvement of > 1/2 of vertebral corpus bony destruction or as failed treatment in stage 4. Neurological function was evaluated using Frankel's grading postoperatively. Functional outcomes were categorized according to the Kirkaldy-Willis criteria. The study included 39 patients, with a mean age of 58.2 years. Of these patients, 10, 12, 13, and 4 had stages 1, 2, 3, and 4 spondylodiscitis, respectively. The mean follow-up period was 60.2 (12-184) months. All patients with stages 1 and 2 spondylodiscitis had grade E injury; 2 and 10 patients with stage 3 had grades D and E injuries, respectively; two patients with stage 4 had grade D injury and two had grade E injury at the last follow-up. Moreover, 100%, 84.6%, and 50% of the patients with stages 1 and 2, 3, and 4 spondylodiscitis achieved good or excellent results, respectively. The choice of the surgical technique depends on the destruction severity at the adjacent vertebral corpus. Surgical staging system for spondylodiscitis is useful and reliable in choosing appropriate surgical techniques.

Evaluation of total scapular arthroplasty after total scapulectomy for scapular tumors

To evaluate the effectiveness of total scapular arthroplasty after total scapulectomy for scapular tumors. A clinical data of 17 patients with scapular tumors treated with total scapulectomy and total scapular arthroplasty between January 2010 and December 2017 were retrospectively reviewed. There were 9 males and 8 females with an average age of 34.4 years (range, 13-64 years). Seven patients were diagnosed with chondrosarcoma, 3 with osteosarcoma, 2 with Ewing's sarcoma, 1 with high-grade sarcoma, 1 with polymorphic dedifferentiated sarcoma, 1 with fibrosarcoma, 1 with plasmacytoma, and 1 with bone giant cell tumor. According to the surgical staging system described by Enneking et al, 1 patient was rated as stage 3, 8 as stageⅠB, 8 as stageⅡB. According to the classifications of shoulder girdle resections of Malawer et al, 11 patients were type ⅢB, 5 were type ⅣB, 1 was type ⅥB. The disease duration ranged from 0.5 to 8.0 months (mean, 3.2 months) and tumor size ranged from 11.0 cm×7.5 cm×6.0 cm to 18.5 cm×18.0 cm×12.5 cm. The 1993 Musculoskeletal Tumor Society (MSTS) upper limb function scoring system and shoulder mobility were used to evaluate postoperative shoulder joint function. Tumor recurrence and metastases were monitored by radiograph. Poor superficial incision healing occurred in 1 patient, the rest incisions achieved healing by first intention. All patients were followed up 20-72 months (mean, 45.4 months). Two of the 17 patients died of multiple organ dysfunction syndrome caused by tumor metastases; 3 patients suffered from pulmonary metastases and were alive with disease. No local recurrence occurred in all patients. The overall survival rate was 88.2% (15/17) and the disease-free survival rate was 70.6% (12/17). Rib fracture after trauma, aseptic loosening, and atrophy of the deltoid muscle occurred in 1, 1, and 1 case, respectively. The other related complication was not observed. At last follow-up, the MSTS score was 26.1±1.4, and the flexion, extension, and abduction range of motion of shoulder joint were (70.0±7.5), (31.2±11.3), and (54.4 ±12.5) °, respectively. Reconstruction with total scapular arthroplasty after total scapulectomy can obtain a satisfactory shoulder contour and an acceptable functional outcomes in patients with scapular tumors.

Prognostic factors in endometrial cancer Stages III and IV: a single academic institution experience of 49 patients

Background: To evaluate the clinical and pathologic factors associated with survival in patients with advanced staged endometrial carcinoma. Matreials and Methods: Between 2005 and 2017 all patients with endometrial carcinoma type I were identified from tumor registry databases at this Academic hospital. The impact of clinical and pathologic risk factors on the survival of patients with endometrial carcinoma was evaluated using Kaplan-Meier life table analyses and log-rank tests. Results: Forty-nine patients with advanced endometrial cancer were collected. The median progression-free survival (PFS) for all patients was 42 months whereas the median overall survival (OS) was 69 months for all patients. Univariate analysis was extended to all prognostic factors for all stages showed as statistically significant positive cytology and cervical invasion, whereas for Stage III only cervical invasion. For Stage IIIA the prognostic factors statistically significant were cervical invasion and lymphovascular space invasion (LVSI). Furthermore, prognosis was worse in tumors belonging to Stage IV with positive cytology. Conclusion: Prognostic factors related to a lower survival rate in advanced stages of endometrial cancer are represented by cervical invasion, LVSI, and positive peritoneal cytology. These factors with respect to LVSI and positive peritoneal cytology should be included in FIGO 2009 surgical staging system because associated to a poor prognosis.

Gadoxetic acid enhanced magnetic resonance imaging for prediction of the postoperative prognosis of intrahepatic mass-forming cholangiocarcinoma.

To identify imaging markers that independently predict the post-operative outcome of intrahepatic mass-forming cholangiocarcinoma (IMCC) using gadoxetate disodium-enhanced magnetic resonance imaging (MRI). Data from 54patients who underwent pre-operative gadoxetate disodium-enhanced MRI and curative surgery for IMCC were retrospectively evaluated. The prognostic power of various imaging and pathological features reportedly associated with recurrence-free survival (RFS) and overall survival (OS) was analyzed using Cox regression models. A model combining imaging and pathological features was developed and its performance was evaluated using the Harrell C-index and Akaike information criterion. Capsule penetration (P = 0.016) and tumor size (P = 0.015) were independent markers for worse RFS, while capsule penetration (P = 0.012) and hepatic vein obstruction (HVO, P = 0.016) were independent markers for worse OS, respectively, in the imaging-based model. Capsule penetration was the only imaging marker identified in the combined prediction model of RFS, and the combined model showed a higher C-index and lower AIC value compared with the model based on pathological features alone. Capsule penetration and HVO on MRI are significantly worse imaging prognostic factors for post-operative outcomes in patients with IMCC. Incorporation of capsule penetration and HVO into a surgical staging system may improve prediction of the post-operative prognosis of IMCC.

Application of total en bloc spondylectomy in spinal tumors

Total en bloc spondylectomy is a surgical technique cutting off tumors of spine and its satellite. Previous studies have shown that this technique could reduce postoperative recurrence rate of spinal tumor, but surgical indications are not unified. Wide application of spinal tumor surgical staging and life expectancy system make it more clear for surgery. However, it is difficult to carry out extensive operation for the characteristics of more bleeding, great difficulty and high risk. As for continuous improvement of TES technology, application of endoscopy and appearance of 3D printing artificial vertebral body could push the operation becoming mature.

Impact of 3-year survival rate on treating IIB limb osteosarcoma patients with methotrexate plus DIA chemotherapy regimen

Objecitve To evaluate the impact of adding methotrexate into DIA chemotherapy regimen (cisplatin, theraru-bicin and ifosfamide) on 3-year disease-free and overall survival of patients with IIB osteosarcoma in extremities. Methods Retro-spectively analyzed 34 cases of IIB limb osteosarcoma according to the Musculoskeletal Tumor Society (MSTS) surgical staging system with pathologically diagnosed concurrent chemotherapy and comprehensive surgical treatment from May 2008 to April 2014. There were 20 males and 14 females, with an average age of 19.5±7.7 years (ranged from 9 to 44 years). 28 patients underwent limb salvage surgery, and 6 patients received amputation. Tumor site included distal femur in 21 patients, proximal tibia in 9 patients, other sites in 4 patients. Seventeen patients underwent cisplatin, THP and ifosfamide (DIA) regimen of chemotherapy. The other 17 patients underwent cisplatin, THP, ifosfamide and methotrexate (MDIA) regimen. Patients charts were reviewed to get demographic data including age, gender, site, tumor size, surgery type, chemotherapy regimen, alkaline phosphatase, lactase dehydrogenase. The prognostic value of these factors on 3 years disease free survival and overall survival were calculated with Kaplan-Meier method and compared with Log-Rank test between different groups in univariate comparison and COX model for multivariate analysis was used to determine whether these demographic factors are independent prognostic factor for survival. Results Two patients had local recurrence, 7 patients had metastasis, and 2 patients had both local recurrence and metastasis. The 3-year survival of the whole group was 67.6% (23/34). Seven patients died during follow-up. The overall survival was 79.4% (27/34). The 3-year disease-free survival in DIA group and MDIA group was 70.6% (12/17) and 64.7% (11/17), respectively. The 3-year overall survival was 82.4% (14/17) and 76.5% (13/17) in DIA group and MDIA group, respectively. Univariate analysis showed that there was no significant difference in either 3-year disease-free survival (χ2=0.113, P=0.737) or overall survival (χ2=0.197, P=0.657) between DIA and MDIA. Age was significantly correlated with prognostic in univariate analysis (χ2=5.869, P=0.015), while gender, tumor site, tumor size, surgery type, ALP, LDH was not correlated with disease-free survival. Kaplan-meier analysis with Log-Rank test showed age (χ2=6.134, P=0.013) and tumor size (χ2=5.108, P=0.024) were statistically correlated with overall survival. Multivariate analysis with COX model showed that chemotherapy regimen was not an independent prognostic factor for 3-year disease-free survival or overall survival. Age was an independent prognostic factor for 3-year disease-free survival (HR=5.836, P=0.017). Conclusion The addition of MTX on the basis of DIA chemotherapy regimen did not significantly improve the 3-year disease-free survival and overall survival of stage IIB limb osteosarcoma. Key words: Osteosarcoma; Extremities; Antineoplastic combined chemotherapy protocols; Survival rate

Applications of one-stage total spondylectomy by anterior and posterior approaches for solitary plasmacytoma of cervical spine

To investigate the feasibility of one-stage total spondylectomy by anterior and posterior approaches for treating solitary plasmacytoma (SP) of cervical spine. Between June 2000 and March 2015, the clinical data, diagnosis, and treatment of 12 patients with SP of cervical spine were retrospectively analyzed. There were 8 males and 4 females, with a mean age of 46 years (range, 28-74 years). The mean disease duration was 8.4 months (range, 3-15 months). There were 2 cases in C 2 segment, 4 cases in C 3, 2 cases in C 4, 1 recurrent case in C 5, C 6, and 3 cases in C 7. According to WBB (Weinstein-Boriani-Biagini) surgical staging system, the tumor mainly occupied the vertebral body areas and expanded outside to 4 or 9 radiating zone in 8 cases, expanded both outsides to 4 or 9 radiating zones in 4 cases; 7 cases of them affected A to D layers, other 5 cases affected B to D layers. Preoperative Frankel system showed grade B in 1 case, grade C in 6 cases, and grade D in 5 cases. One vertebra segment was involved in 11 cases, and 2 vertebra segments were involved in 1 case. The unilateral vertebral artery was involved in 4 cases and bilateral vertebral artery in 1 case. One-stage total spondylectomy by anterior and posterior approaches for SP of cervical spine was applied in all patients, which all received adjuvant radiotherapy postoperatively. The operation time, intraoperative blood loss, complications, Frankel system, and visual analogue scale (VAS) score were recorded and analyzed. The operation time was 6.8-9.3 hours (mean, 7.2 hours), and the intraoperative blood loss was 1 100-2 600 mL (mean, 1 600 mL). Esophageal leakage occurred in 1 patient with C 5, C 6 recurrent SP at 1 week after operation and 1 case presented with fat liquefaction of wound, who were cured by symptomatic treatment. Other patients showed no neurological deficit, major vascular injury (especially vertebral artery), phrenic nerve injury, superior laryngeal nerve injury, laryngeal nerve injury, respiratory failure, or other complications. All the 12 patients were followed up 27-98 months (mean, 58 months). The symptoms of spinal cord compression disappeared or improved after operation. At last follow-up, the nerve function was recovered to Frankel grade E in all patients; the VAS score decrease to 1.1±0.7, showing significant difference when compared with preoperative value (6.7±2.7) ( t=2.485, P=0.014). Two patients had local recurrence at 29 months and 37 months after operation respectively, which were treated with adjuvant chemotherapy. One of them finally progressed to multiple myeloma and died of multiple organ failure after 43 months, the other one survived with residual tumor. One case presented with internal fixator loosening and breaking at 4 years after operation, who was performed revision surgery. The other patients had no tumor recurrence or malignant change during the follow-up, no complication such as internal fixator loosening or breaking occurred. For patients with SP of cervical spine, surgical intervention is an acceptable treatment option. One-stage total spondylectomy by anterior and posterior approaches can decline the local recurrence and relieve the symptoms of spinal cord compression, so as to improve patients' life quality. However, patients with progression to multiple myeloma should be treated with individualized therapeutic regimen, and the prognosis may be poor.

The new classifications of ovarian, fallopian tube, and primary peritoneal cancer and their clinical implications

The roles of histologic characterization and staging are to provide reproducible metrics for cancer classification with which to direct the most appropriate clinical care and to yield the most stable reliable system to allow both prospective and retrospective data analysis. Both the histologic and staging classifications of malignant ovarian/tubal/peritoneal cancers have recently changed. The World Health Organization sponsored a review and reclassification of the pathology of cancers of the ovaries, fallopian tubes, and peritoneum, and published these updates in 2014. In so doing, they codified the two-tiered grading system that has been in use in serous ovarian cancers for nearly a decade. In parallel, FIGO reviewed and updated the surgical staging system, applied to all histotypes of ovarian, tubal, and peritoneal cancers, also published in 2014. In both cases, the changes made are meant to encompass a better understanding of disease, but both have important merits and drawbacks. Changes in staging complicate analysis of retrospective data against current data. Though in some aspects controversial, the changes overall are meant to represent a better biologic understanding of disease that we hope will lead to an improvement in patient care and directed therapy.

Complete surgical resection and short-term survival in acute invasive fungal rhinosinusitis.

Acute invasive fungal rhinosinusitis (AIFR) is a fulminant fungal infection seen in patients who are immunocompromised. Due to its rarity, there is little evidence regarding the appropriate antifungal treatment regimen, especially the degree of surgical intervention. To assess factors that impact short-term survival in AIFR as defined by survival to hospital discharge and to develop a staging system to predict survival and complete surgical resection. Fifty-four patients with histopathologically diagnosed AIFR who met inclusion criteria were identified between 1984 and 2014. Patient characteristics, disease extent, treatment modality, and short-term survival data were collected. Univariate analysis was performed to assess for factors associated with survival and increased likelihood of surgical resection. Of 52 patients with adequate documentation, 36 (69.2%) survived their hospital stay. Complete surgical resection was the only factor associated with improved survival (survival, 95.5%; p < 0.01). A surgical staging system was proposed to guide probability of complete resection and overall prognosis, with stage I disease limited to the nasal cavity, stage II involving the paranasal sinuses, stage III involving the orbit, and stage IV with skull base or intracranial extension. The χ2 analyses showed a decreased likelihood of complete surgical resection with stage III or IV disease compared with stage I (resection, 90.9%) (stage III resection, 37.5% [p = 0.01]; stage IV resection, 16.7% [p = 0.002]). There was a decreased likelihood of survival associated with increasing disease stage compared with stage I (survival, 100%) (stage II survival, 60% [p = 0.009]; stage III survival, 62.5% [p = 0.02]; stage IV survival, 54.6%, [p = 0.006]). Although further studies are needed to define specific treatment protocols, analysis of these data indicated that endoscopic sinus surgery with the goal of complete surgical resection may provide the best survival outcomes in select patients when complete surgical resection can be performed. Our staging system represents the first attempt to predict surgical success and prognosis in patients with AIFR.

Approaches to surgical staging of cancer of the uterine cervix

Cancer of the uterine cervix is staged using a clinical, rather than a surgical staging system, which is the approach used for other gynecologic tumors. Surgical staging is potentially more accurate. However, the International Federation of Gynecology and Obstetrics (FIGO) has determined that clinical staging is preferable for assessing locally advanced disease (i. e., tumor size, vaginal and parametrial involvement); and it allows to avoid surgery in women who are not candidates for surgical treatment. The staging and pelvic and paraaortic lymph node evaluation for cervical cancer are reviewed here.

Retrospective analysis of cases with Endometrial Cancer

We planned this study with the aim of determining histological types, clinical, surgical stage and grade of endometrial cancer cases which were followed-up and operated on in our clinic and giving an opinion on epidemiological features. Our study was a retrospective study consisted of 298 patients who had medical operations with the diagnosis of endometrial cancer. Endometrial cancer was diagnosed via dilatation and curettage. Routine preoperative examinations were wanted from the cases. Clinical stage was determined. After the diagnosis, total abdominal hysterectomy and bilateral salpingo-ooforectomy (TAH+BSO) were applied; while only pelvic lymph node dissection was applied on the patients who had good prognostic data, total pelvic and paraaortic lymph node dissection were applied to the group with bad prognostic data. All materials were examined in the pathology laboratory of our hospital. In endometrial cancer staging, FIGO surgical staging system -2009 was used. FIGO was used in grade classification and World Health Organization Classification of Tumors system was used for the histological classification. Our study was composed of 298 patients who had endometrial cancer. Of the patients who were included in the study, average age was 56.54±9.69, BMI average was 31.47±6.20, gravida average was 4.16±2.59, and parity average was 3.41±2.15. Distributions of the patients by surgical stages were as follows; there were 32 patients whose tumor stage was in 1A (%10.7), 127 patients in 1B (42.6%), 47 patients in 1C (15.8%), 18 patients in 2A (6.0%), 7 patients in 2B (2.3%), 30 patients in 3A (10.1%), 2 patients in 3B (0.7%), 30 patients in 3C (10.1%), 2 patients in 4A (0.7%) and 3 patients in 4B (1.0%). Of the patients with endometrial cancer in our study, tumors of 102 patients were (34.2%) in grade I, 139 were (46.6%) in grade II and 57 were (19.1%) in grade III. Because endometrial cancer shows earlier symptoms than the other gynecological cancers, it can be diagnosed in early stages. There is a surgical standard treatment, but it changes according to the stages and general state of the patients.