scholarly journals Hepatic Cryotherapy for Cancer: A Reviewand Critique

HPB Surgery ◽  
1996 ◽  
Vol 9 (2) ◽  
pp. 118-120 ◽  
Author(s):  
D. L. Morris
Keyword(s):  
Postoperative Complications ◽  
Hepatic Resection ◽  
Study Design ◽  
Hepatic Failure ◽  
Resection Margin ◽  
Early Experience ◽  
Resection Margins ◽  
Tumor Clearance

Background: Wedge or other nonanatomic hepatic resections, performed in an attempt to spare functional parenchyma, often are not accomplished with clear resection margins and may be complicated by hemorrhage from the depth of the resection.Study Design: The current study describes a technique of cryoassisted hepatic resection that allows for controlled resection with well-defined margins. The early experience in managing 16 tumors in 13 patients is reported.Results: A cryoprobe is inserted into the tumor and freezing performed to a predetermined resection margin using ultrasound control. The ice ball, so formed, is then maintained and excised. The management of these 13 patients was associated with one intraoperative and two postoperative complications, including a death of a patient with cirrhosis who had infected ascites and died as a result of hepatic failure.Conclusions: Cryoassisted hepatic resection seems to be safe and allows resection with good tumor clearance and maximal preservation of functional parenchyma.

Intraoral Sonography–Assisted Resection of T1–2 tongue Cancer for Adequate deep Resection

2008 ◽  
Vol 139 (6) ◽  
pp. 805-810 ◽  
Author(s):  
Chung-Hwan Baek ◽  
Young-Ik Son ◽  
Han-Sin Jeong ◽  
Man Ki Chung ◽  
Ki-Nam Park ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Study Design ◽  
Resection Margin ◽  
Tongue Cancer ◽  
Tumor Thickness ◽  
Clinical Usefulness ◽  
Resection Margins ◽  
Control Group ◽  
T Stage ◽  
Safety Margins

Objective To investigate the clinical usefulness of intraoral sonography-assisted resection for securing adequate deep resection margins in T1–2 tongue cancers. Study Design Prospective clinical trial. Materials and Methods Twenty consecutive patients with clinical T1–2 tongue cancers were enrolled and their lesions were removed by intraoral sonography-assisted resection. We then retrospectively collected data from 20 T stage-matched patients without intraoral sonography-assisted resection as the control group. All resections were performed with a goal of 15 mm margin. The mucosal and deep safety margins were compared between the two groups. Results Intraoral sonography could predict the paraffin-embedded tumor thickness with an error of 3.16 ± 2.24 mm. The deep safety margins were more adequate for intraoral sonography–assisted resection (9.8 ± 5.2 mm) than for conventional resection (4.0 ± 2.03 mm) ( P < 0.001), while the mucosal safety margins were not different Conclusion Intraoral sonography-assisted resection provides a more adequate deep resection margin for early T-stage tongue cancers.

scholarly journals Difference in surgical outcomes of rectal cancer by study design: meta-analyses of randomized clinical trials, case-matched studies, and cohort studies

BJS Open ◽  
2021 ◽  
Vol 5 (2) ◽  
Author(s):  
N Hoshino ◽  
T Sakamoto ◽  
K Hida ◽  
Y Takahashi ◽  
H Okada ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Laparoscopic Surgery ◽  
Robotic Surgery ◽  
Cohort Studies ◽  
Anastomotic Leakage ◽  
Study Design ◽  
Randomized Clinical Trials ◽  
Postoperative Mortality ◽  
Resection Margins ◽  
Meta Analyses

Abstract Background RCTs are considered the standard in surgical research, whereas case-matched studies and propensity score matching studies are conducted as an alternative option. Both study designs have been used to investigate the potential superiority of robotic surgery over laparoscopic surgery for rectal cancer. However, no conclusion has been reached regarding whether there are differences in findings according to study design. This study aimed to examine similarities and differences in findings relating to robotic surgery for rectal cancer by study design. Methods A comprehensive literature search was conducted using PubMed, Scopus, and Cochrane CENTRAL to identify RCTs, case-matched studies, and cohort studies that compared robotic versus laparoscopic surgery for rectal cancer. Primary outcomes were incidence of postoperative overall complications, incidence of anastomotic leakage, and postoperative mortality. Meta-analyses were performed for each study design using a random-effects model. Results Fifty-nine articles were identified and reviewed. No differences were observed in incidence of anastomotic leakage, mortality, rate of positive circumferential resection margins, conversion rate, and duration of operation by study design. With respect to the incidence of postoperative overall complications and duration of hospital stay, the superiority of robotic surgery was most evident in cohort studies (risk ratio (RR) 0.83, 95 per cent c.i. 0.74 to 0.92, P &lt; 0.001; mean difference (MD) –1.11 (95 per cent c.i. –1.86 to –0.36) days, P = 0.004; respectively), and least evident in RCTs (RR 1.12, 0.91 to 1.38, P = 0.27; MD –0.28 (–1.44 to 0.88) days, P = 0.64; respectively). Conclusion Results of case-matched studies were often similar to those of RCTs in terms of outcomes of robotic surgery for rectal cancer. However, case-matched studies occasionally overestimated the effects of interventions compared with RCTs.

scholarly journals Management of colorectal polyp cancers

2012 ◽  
Vol 94 (8) ◽  
pp. 574-578 ◽  
Author(s):  
S Naqvi ◽  
S Burroughs ◽  
HS Chave ◽  
G Branagan
Keyword(s):  
Lymph Node ◽  
Lymph Node Metastases ◽  
Resection Margin ◽  
Adverse Outcome ◽  
Colorectal Polyps ◽  
Adverse Outcomes ◽  
Resection Margins ◽  
Residual Tumour ◽  
Clear Resection Margin ◽  
Node Metastases

INTRODUCTION Management of malignant colorectal polyps is controversial. The options are resection or surveillance. Resection margin status is accepted as an independent predictor of adverse outcome. However, the rate of adverse outcome in polyps with a resection margin of <1mm has not been investigated. METHODS A retrospective search of the pathology database was undertaken. All polyp cancers were included. A single histopathologist reviewed all of the included polyp cancers. Polyps were divided into three groups: clear resection margin, involved resection margin and unknown resection margin. Polyps were also analysed for tumour grade, morphology, Haggitt/Kikuchi level and lymphovascular invasion. Adverse outcome was defined as residual tumour at the polypectomy site and/or lymph node metastases in the surgical group and local or distant recurrence in the surveillance group. RESULTS Sixty-five polyps (34 male patients, mean age: 73 years, range: 50–94 years) were included. Forty-six had clear polyp resection margins; none had any adverse outcomes. Sixteen patients had involved polyp resection margins and twelve of these underwent surgery: seven had residual tumour and two of these patients had lymph node metastases. Four underwent surveillance, of whom two developed local recurrence. Three patients had resection margins on which the histopathologist was unable to comment. All patients with a clear resection margin had no adverse outcome regardless of other predictive factors. CONCLUSIONS Polyp cancers with clear resection margins, even those with <1mm clearance, can be treated safely with surveillance in our experience. Polyp cancers with unknown or involved resection margins should be treated surgically.

Does a histologically inflamed resection margin increase postoperative complications in patients with Crohn’s disease?

2018 ◽  
Vol 53 (3) ◽  
pp. 279-283 ◽  
Author(s):  
Gisele Aaltonen ◽  
Ari Ristimäki ◽  
Ilona Keränen ◽  
Monika Carpelan-Holmström ◽  
Anna Lepistö
Keyword(s):  
Crohn’S Disease ◽  
Postoperative Complications ◽  
Crohn's Disease ◽  
Resection Margin

Malnutrition as a risk factor of adverse postoperative outcomes in patients undergoing hepatic resection: analysis of US hospitals

2021 ◽  
pp. 1-28
Author(s):  
David Uihwan Lee ◽  
Edwin Wang ◽  
Gregory Hongyuan Fan ◽  
David Jeffrey Hastie ◽  
Elyse Ann Addonizio ◽  
...  
Keyword(s):  
Risk Factor ◽  
Postoperative Complications ◽  
Length Of Stay ◽  
Hepatic Resection ◽  
Nearest Neighbor ◽  
Postoperative Mortality ◽  
Wound Complications ◽  
Hospital Death ◽  
Study Approach ◽  
Hospitalization Costs

Abstract In patients with liver cancer or space-occupying cysts, they suffer from malnutrition due to compression of gastric and digestive structures, liver and cancer-mediated dysmetabolism, and impaired nutrient absorption. As proportion of these patients require removal of lesions through hepatic resection, it is important to evaluate the effects of malnutrition on post-hepatectomy outcomes. In our study approach, 2011-2017 National Inpatient Sample was used to isolate in-hospital hepatectomy cases, which were stratified using malnutrition (composite of malnutrition, sarcopenia, and weight loss/cachexia). The malnutrition-absent controls were matched to cases using nearest neighbor propensity score match method and compared to following endpoints: mortality, length of stay, hospitalization costs, and postoperative complications. There were 2531 patients in total who underwent hepatectomy with matched number of controls from the database; following the match, malnutrition cohort (compared to controls) were more likely to experience in-hospital death (6.60% vs 5.25% p<0.049, OR 1.27 95%CI 1.01-1.61), and were more likely to have higher length of stay (18.10d vs 9.32d p<0.001) and hospitalization costs ($278,780 vs $150,812 p<0.001). In terms of postoperative complications, malnutrition cohort was more likely to experience bleeding (6.52% vs 3.87% p<0.001 OR 1.73 95%CI1.34-2.24), infection (6.64% vs 2.49% p<0.001, OR 2.79 95%CI 2.07-3.74), wound complications (4.5% vs 1.38% p<0.001, OR 3.36 95%CI 2.29-4.93), and respiratory failure (9.40% vs 4.11% p<0.001 OR 2.42 95%CI 1.91-3.07). In multivariate, malnutrition was associated with higher mortality (p<0.028, aOR 1.3 95%CI 1.03-1.65). Thus, we conclude that malnutrition is an independent risk factor of postoperative mortality in patients undergoing hepatectomy.

705 SIGNIFICANCE OF CLEAR CIRCUMFERENTIAL RESECTION MARGIN IN ESOPHAGEAL CANCER

2021 ◽  
Vol 34 (Supplement_1) ◽  
Author(s):  
Catherine Cheang ◽  
Pradeep Patil
Keyword(s):  
Esophageal Cancer ◽  
Multimodal Therapy ◽  
Resection Margin ◽  
Locally Advanced ◽  
Radical Resection ◽  
Resection Margins ◽  
R0 Resection ◽  
Term Survival ◽  
R1 Resection

Abstract   Circumferential resection margins (CRM) of an esophagectomy specimen for oesophageal cancer is a key prognostic factor of overall survival (OS). This retrospective study aims to compare OS of post-esophagectomy patients with CRM of &gt;1 mm (R0) and &lt; 1 mm (R1) with further subgroup analysis of locally advanced T3R0 vs T3R1 resection. Methods A total of 110 esophagectomies conducted between 2010 and 2020 were analysed. We recorded R stage based on pathological CRM &gt;1 mm (R0) or &lt; 1 mm (R1). OS was calculated from the day of surgery to day of death or otherwise censored. All patients underwent multimodal therapy including chemotherapy and similar pre-surgical and post-surgical management. 58 of these patients with pT3 stage esophageal cancer (EC) were selected and compared. Statistical analysis was carried out using SPSS. Results Of 110 patients, 78 (71.5%) patients had a R0 resection. Mean OS in R0 resections was 73 months (6 years) compared to 25.2 months (2 years) in R1 resection (p = 0.001). 58 of the 110 patients were pathological stage T3(pT3) despite downstaging with chemotherapy showing the burden of advanced disease. In patients with stage pT3 (n = 58), 32 patients were R0 resections, and 26 patients had R1 resections. Mean OS in T3R0 resections was 51.5 months compared to 28.5 months in T3R1 resection. OS comparison is significant (p = 0.011). Conclusion This study emphasizes the importance of clear CRM in all patients and especially in locally advanced pT3/T4a esophageal cancer in achieving long term survival. Techniques used to ensure a clear CRM such multimodality therapy combined with surgical radical resection concepts such as mesoesophagectomy should be employed.

scholarly journals The Pattern of Colorectal Cancer Surgery in Lithuania in 2005: Do Results Meet Expectations?

Medicina ◽  
2013 ◽  
Vol 49 (3) ◽  
pp. 20 ◽  
Author(s):  
Eligijus Poškus ◽  
Saulius Mikalauskas ◽  
Valdemaras Jotautas ◽  
Paulius Žeromskas ◽  
Tomas Poškus ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Postoperative Complications ◽  
Demographic Data ◽  
Preoperative Evaluation ◽  
University Hospital ◽  
Pathological Examination ◽  
National Database ◽  
Resection Margins ◽  
Neoadjuvant Radiotherapy ◽  
Vilnius University

The aim of this study was to expose the pattern of the surgical treatment of colorectal cancer in Lithuania in 2005. Material and Methods. A retrospective analysis of 590 patients treated for colorectal cancer in the surgical departments of the Hospital of Lithuanian University of Health Sciences, the Institute of Oncology of Vilnius University, and Vilnius University Hospital Santariškių Klinikos in 2005 was performed. Demographic data, preoperative evaluation, postoperative complications assessed according to the Clavien-Dindo classification, the quality of pathological examination, and survival rates were analyzed. Results. A total of 590 patients, 269 women (45.6%) and 321 men (54.4%), were included in this study; the mean age was 68.3 years (SD, 11.2). Tumors were found in the colon of 274 patients (46.4%) and in the rectum of 316 patients (53.6%). An abdominal ultrasound scan was preoperatively performed in 516 patients (87.5%) and a chest x-ray in 316 patients (53.6%); 35 patients (5.9%) underwent abdominal computed tomography. Endorectal ultrasound was done in 99 (31.7%) cases. Neoadjuvant radiotherapy for T3 and T4 rectal tumors was applied in 42 cases (18.1%). Besides, 211 patients (35.8%) developed postoperative complications with an anastomotic leak emerging in 20 cases (3.4%). Death occurred in 7 patients (1.18%). On the average, 11.15 lymph nodes (SD, 6.02) were found in pathological specimens. Circumferential resection margins were assessed in 58 cases (18.4%). The overall 5-year survival rate was 52.06%. Conclusions. The preoperative evaluation and the treatment of patients with colorectal cancer were not sufficiently consistent in Lithuania in 2005. In order to improve the treatment of colorectal cancer, standardization or the national database of colorectal cancer is necessary.

Analysis of Clinical Efficiency and Safety of Laparoscopic Anus-Conserving Operation for Ultralow Rectal Cancer

2019 ◽  
Vol 85 (5) ◽  
pp. 539-548
Author(s):  
Zhongkun Zuo ◽  
Ke Ding ◽  
Tenglong Tang ◽  
Leiyi Zhang ◽  
Weihui Peng ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Postoperative Complications ◽  
Hospital Stay ◽  
Incidence Rate ◽  
Anal Sphincter ◽  
Resection Margin ◽  
Survival Rates ◽  
Incidence Rates ◽  
Control Group ◽  
Experimental Group

To explore the efficiency and safety of laparoscopic anus-conserving operation for ultralow rectal cancer, we retrospectively reviewed 236 patients with ultralow rectal cancer who underwent laparoscopic anus-conserving operation (experimental group, n = 124) or conventional open surgery (control group, n = 112). Operation-related indexes, pathological results of mesentery, incidence rates of postoperative complications, anus preservation rates, anal sphincter controllability after surgery, and survival rates of the first, second, and third years after operation were compared between the two groups. The amount of intraoperative bleeding, first postoperative exhaust time, abdominal drainage, pain score, and hospital stay in the experimental group were significantly less than those in the control group ( P < 0.05). There were no significant differences in the postoperative circumferential resection margin, distal resection margin, number of dissected lymph nodes, successful resection rate, and quality of mesorectum between the two groups ( P > 0.05). The total incidence rate of postoperative complications, anal sphincter controllability, and survival rates after surgery were similar between the two groups ( P > 0.05). The anus preservation rate of the experimental group (84.7%) was significantly higher than that of the control group (69.6%) ( P < 0.05). Laparoscopic anus-conserving operation is effective and safe in treatment of patients with ultralow rectal cancer, which has advantages such as small trauma, less intra-operative bleeding, short hospital stay, rapid recovery, a low incidence rate of postoperative complications, and a high anus-preserving rate, so it is worthy of clinical application.

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