scholarly journals Surgical safety margin of gastroenterological cancer surgery: A truth or a dream?

2014 ◽  
Vol 47 (3) ◽  
pp. 83-89 ◽  
Author(s):  
Chen-Guo Ker
Keyword(s):  
Safety Margin ◽  
Cancer Surgery ◽  
Surgical Safety ◽  
Gastroenterological Cancer

scholarly journals Correlation between Intraoperative Blood Transfusion and Postoperative Infection in Gastroenterological Cancer Surgery

1998 ◽  
Vol 23 (4) ◽  
pp. 611-617
Author(s):  
Nozomi SHINOZUKA ◽  
Isamu KOYAMA ◽  
Yoshitaka SUZUKI ◽  
Satomi NAKAMURA ◽  
Tsunenori ARAI ◽  
...  
Keyword(s):  
Blood Transfusion ◽  
Postoperative Infection ◽  
Cancer Surgery ◽  
Gastroenterological Cancer

scholarly journals Multiple Primary Cutaneous Melanomas in a Bulgarian Patient: The Possible Role of One Step Melanoma Surgery (OSMS) As the Most Adequate Treatment Approach!

2018 ◽  
Vol 6 (11) ◽  
pp. 2155-2160
Author(s):  
Georgi Tchernev ◽  
Ivanka Temelkova
Keyword(s):  
Safety Margin ◽  
Simultaneous Occurrence ◽  
Radical Excision ◽  
Complete Regression ◽  
Adequate Treatment ◽  
Surgical Safety ◽  
Melanocytic Lesions ◽  
Multiple Primary ◽  
The Individual ◽  
The Right

BACKGROUND: Simultaneous occurrence of multiple primary melanomas is a rare, however possible phenomenon, and it is believed that older, male, white, Atypical Mole Syndrome carriers (sporadic and familial) are part of the possible risk factors for its occurrence. In these patients, it is possible to observe involutional changes or (partial/complete) regression of melanocytic lesions, which are likely to be caused by the generation of a spontaneous immune reaction against specific tumour antigens. CASE REPORT: A 58-year-old male patient is presented with two melanocytic lesions located in the right clavicle (subclavicular area) and left the scapular area that meets clinically and dermatoscopically the requirements for malignant melanoma. The lesions were removed by a radical excision with 0.5 cm surgical safety margin in all directions. During the subsequent histological verification it was established it was melanoma with a tumour thickness of 1 mm that in one case, and the other 2 mm. A week later, according to the recommendations of the current guidelines, a re-excision was performed with a surgical safety margin of 1.5 cm in all directions. Considering the complications that are possible during the parallel removal of a draining lymph node recommended for these tumour thicknesses, the patient definitively refused its detection and removal. CONCLUSION: A rare case of a Bulgarian patient with multiple primary, however partially involutional melanomas existing for over 20 years, is described. The individual recommendations of dermato-oncologists for the patient (according to AJCC) were not in favour of radicality but of a more sparing, individualised approach, appropriate for that patient. Unfortunately, the approach we used, in this case, was inconsistent with the AJCC or OSMS guidelines. The reason for individualising the approach in the case we have described is due to the variability of the recommendations for surgical treatment of melanomas laid down in the AJCC.

Application of Three-Dimensional Computed Tomography Bronchography and Angiography Reconstruction in Thoracoscopic Segmentectomy and Segmental Structure Analysis

2020 ◽  
Vol 12 (9) ◽  
pp. 1137-1143
Author(s):  
Chao Yang Pan ◽  
Guoqiu Xu ◽  
Bin Xu ◽  
Wei Gan ◽  
Yunkun Liu ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Three Dimensional ◽  
Safety Margin ◽  
Pulmonary Nodules ◽  
Anatomical Variations ◽  
Surgical Safety ◽  
Segmental Bronchus ◽  
The Individual ◽  
The Right ◽  
Segmental Arteries

In thoracoscopic segmentectomy, accurate preoperative identification of intersegmental vessels, bronchi, and the surgical safety margin is vital. We applied three dimensional computed tomography bronchography and angiography (3D-CTBA) reconstruction to appropriately plan thoracoscopic segmentectomy for Patients with pulmonary nodules. In this study, we evaluated the effectiveness and accuracy of 3D-CTBA reconstruction for the identification of segmental anatomical structures and variation during thoracoscopic segmentectomy.We retrospectively analyzed data of 30 patients who underwent 3D-CTBA reconstruction before thoracoscopic segmentectomy between January and May 2019 in the Department of Thoracic Surgery, First Affiliated Hospital of Nanchang University. We compared the individual target segment arteries, veins, and bronchi identified during surgery with the preoperative 3D-CTBA model to evaluate its effectiveness and accuracy. The accuracy of the preoperative 3D-CTBA model for the identification of target segmental arteries, veins, and bronchi was 99.08% (108/109), 98.39% (122/124), and 100% (118/118), respectively. Through 3DCTBA modeling, we found mediastinal and interlobar types of lingular segmental arteries in six patients, and central veins were not found in seven patients. In addition, we detected rare anatomical variations in two patients; one patient had the right apical segmental bronchus that stemmed solely from the right primary bronchus (tracheal bronchus), and the other had rare right basal segmental variant bronchi and vessels. The 3D-CTBA model can precisely predict segmental bronchi and vessels and identify anatomical structure variations before operation, which can aid surgeons to avoid incorrect operation and improve surgical efficiency. This has important implications for thoracoscopic segmentectomy.

Rationale and Design of the CAN Study: an RCT of Survival after Propofol- or Sevoflurane-based Anesthesia for Cancer Surgery

2019 ◽  
Vol 25 (28) ◽  
pp. 3028-3033
Author(s):  
Mats Enlund ◽  
Anna Enlund ◽  
Anders Berglund ◽  
Leif Bergkvist
Keyword(s):  
Large Scale ◽  
Randomized Study ◽  
Safety Margin ◽  
Cancer Surgery ◽  
Open Label ◽  
Absolute Increase ◽  
Protocol Adherence ◽  
Animal Data ◽  
Primary Hypothesis ◽  
After Cancer

Background: Based on animal data only, some clinicians have adopted propofol-based anesthesia for cancer surgery with the aim of increased survival. Objective: Our objective is to verify or refute the hypothesis that survival increases after cancer surgery with propofol compared with sevoflurane for anesthesia maintenance. This aim deserves a large-scale randomized study. The primary hypothesis is an absolute increase of minimum 5%-units in 1- and 5-year survival with propofol- based anesthesia for breast or colorectal cancer after radical surgery, compared with sevoflurane-based anesthesia. Method: Ethics and medical agency approvals were received and pre-study registrations at clinicaltrial.gov and EudraCT were made for our now ongoing prospective, randomized, open-label, multicenter study. A power analysis based on a retrospective study, including a safety margin for drop outs, resulted in a total requirement of 8,000 patients. The initial inclusion period constituted a feasibility phase with an emphasis on the functionality of the infrastructure at the contributing centers and at the monitoring organization, as well as on protocol adherence. Conclusion: The infrastructure and organization work smoothly at the different contributing centers. Protocol adherence is good, and the monitors are satisfied. We expect this trial to be able to either verify or refute that propofol is better than sevoflurane for cancer surgery.

scholarly journals Comparative Analysis of the ʺScholasticʺ Recommendations of the AJCC From 2011 for the Surgical Treatment of Cutaneous Melanoma with the Newly Suggested Guidelines for OSMS From the Bulgarian Society For Dermatologic Surgery!

2018 ◽  
Vol 6 (12) ◽  
pp. 2369-2372 ◽  
Author(s):  
Georgi Tchernev ◽  
Ivanka Temelkova
Keyword(s):  
Cutaneous Melanoma ◽  
Safety Margin ◽  
Tumor Thickness ◽  
Cosmetic Result ◽  
Dermatologic Surgery ◽  
Two Stage ◽  
Variable Model ◽  
Surgical Safety ◽  
Face Area ◽  
The Face

BACKGROUND: The American Joint Committee on Cancer (AJCC) offers a two-stage, often insufficient or so-called variable model of cutaneous melanoma treatment. This model starts with primary excision and an initial operational safety margin of 0.5 cm in all directions, followed by a re-excision with an additional field of operational security, determined by histologically established tumor thickness (with or without removal of SLN). We present a brand new method of melanoma surgery, the so-called One Step melanoma surgery (OSMS), in which cutaneous melanomas (regardless of their thickness) could be removed by single surgical intervention. CASE REPORT: We describe a case of a patient with cutaneous melanoma, with postoperatively established Breslow’s tumor thickness of 6 mm, operated on the AJCC model within two surgical sessions. The usual primary excision was performed with a surgical safety margin of 0.5 cm in all directions, followed by a secondary excision with an additional surgical security field of 1.2 cm in all directions (due to the patient's wish for the optimal cosmetic result, agreed and approved by the dermatosurgeon performing the manipulation). CONCLUSION: The two-stage method for the treatment of melanomas is often insufficient due to: 1) the inability (in this case) secondary excision in the face area to be conducted with an additional recommended operational security field of 1.5 cm in all directions; and 2) the patient's wish for a better cosmetic result, which should be achieved with less surgical security field, resulting in a compromise solution for re-excision with an additional surgical field of 1.2 cm in all directions.

The limits of human performance

2008 ◽  
Vol 44 ◽  
pp. 11-26 ◽  
Author(s):  
Ralph Beneke ◽  
Dieter Böning
Keyword(s):  
Human Performance ◽  
Safety Margin ◽  
Afferent Input ◽  
Metabolic Energy ◽  
Human Organism ◽  
Mechanical Resistance ◽  
As Doping ◽  
Gene And Protein Expression ◽  
Underlying Mechanisms ◽  
Biochemical Research

Human performance, defined by mechanical resistance and distance per time, includes human, task and environmental factors, all interrelated. It requires metabolic energy provided by anaerobic and aerobic metabolic energy sources. These sources have specific limitations in the capacity and rate to provide re-phosphorylation energy, which determines individual ratios of aerobic and anaerobic metabolic power and their sustainability. In healthy athletes, limits to provide and utilize metabolic energy are multifactorial, carefully matched and include a safety margin imposed in order to protect the integrity of the human organism under maximal effort. Perception of afferent input associated with effort leads to conscious or unconscious decisions to modulate or terminate performance; however, the underlying mechanisms of cerebral control are not fully understood. The idea to move borders of performance with the help of biochemicals is two millennia old. Biochemical findings resulted in highly effective substances widely used to increase performance in daily life, during preparation for sport events and during competition, but many of them must be considered as doping and therefore illegal. Supplements and food have ergogenic potential; however, numerous concepts are controversially discussed with respect to legality and particularly evidence in terms of usefulness and risks. The effect of evidence-based nutritional strategies on adaptations in terms of gene and protein expression that occur in skeletal muscle during and after exercise training sessions is widely unknown. Biochemical research is essential for better understanding of the basic mechanisms causing fatigue and the regulation of the dynamic adaptation to physical and mental training.

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