scholarly journals The Role of Exenterative Surgery in Advanced Urological Neoplasms

2020 ◽  
Vol 14 (2) ◽  
pp. 57-65
Author(s):  
Colla Cunneen ◽  
Michael Kelly ◽  
Gregory Nason ◽  
Eanna Ryan ◽  
Ben Creavin ◽  
...  
Keyword(s):  
Locally Advanced ◽  
Surgical Techniques ◽  
Life Outcomes ◽  
Extensive Resection ◽  
Pelvic Malignancies ◽  
Centralized Care ◽  
Urological Neoplasms ◽  
Exenterative Surgery

Pelvic exenterative surgery is both complex and challenging, especially in the setting of locally recurrent disease. In recent decades, improved surgical techniques have facilitated more extensive resection of both locally advanced and recurrent pelvic malignancies, but its role in urological cancer surgery is highly selective. However, it remains an important part of the armamentarium for the management of bladder and prostate cancer cases where there is local invasion into adjacent organs or localized recurrence. Better diagnostics, reconstructive options and centralized care have reduced associated morbidity considerably, and it is still used rarely in palliative settings. Despite this, there is sparse prospective evidence reporting on long-term oncological or quality of life outcomes.

Locally Advanced Head and Neck Cancer

2013 ◽  
pp. 237-244
Author(s):  
Anthony J. Cmelak ◽  
Kyle Arneson ◽  
Nicole G. Chau ◽  
Ralph W. Gilbert ◽  
Robert I. Haddad
Keyword(s):  
Head And Neck ◽  
Multidisciplinary Approach ◽  
Locally Advanced ◽  
Surgical Techniques ◽  
Squamous Cell Carcinomas ◽  
Advanced Head ◽  
Organ Function ◽  
Definitive Therapy

Treatment of locally advanced head and neck squamous cell carcinomas requires a multidisciplinary approach to be able to offer patients definitive therapy while aiming to preserve organ function and minimize acute and long-term toxicities. Advances in surgical techniques will be reviewed for both primary sites and the neck and also in the salvage settings. Recent data on concurrent versus sequential chemoradiotherapy in these patients will be reviewed, with emphasis on identification of appropriate patients for sequential chemoradiotherapy. Finally, advances in modern radiotherapy modalities that have resulted in improved dosimetry and quality of life following treatment will be reviewed.

Robotics in Keyhole Transcranial Endoscope-Assisted Microsurgery: A Critical Review of Existing Systems and Proposed Specifications for New Robotic Platforms

2013 ◽  
Vol 10 (1) ◽  
pp. 84-96 ◽  
Author(s):  
Hani J. Marcus ◽  
Carlo A. Seneci ◽  
Christopher J. Payne ◽  
Dipankar Nandi ◽  
Ara Darzi ◽  
...  
Keyword(s):  
Surgical Techniques ◽  
Robotic Systems ◽  
Neurosurgical Procedures ◽  
Surgical Robots ◽  
Surgical Performance ◽  
Guided Surgery ◽  
Robotic Platforms ◽  
Further Development

Abstract BACKGROUND: Over the past decade, advances in image guidance, endoscopy, and tube-shaft instruments have allowed for the further development of keyhole transcranial endoscope-assisted microsurgery, utilizing smaller craniotomies and minimizing exposure and manipulation of unaffected brain tissue. Although such approaches offer the possibility of shorter operating times, reduced morbidity and mortality, and improved long-term outcomes, the technical skills required to perform such surgery are inevitably greater than for traditional open surgical techniques, and they have not been widely adopted by neurosurgeons. Surgical robotics, which has the ability to improve visualization and increase dexterity, therefore has the potential to enhance surgical performance. OBJECTIVE: To evaluate the role of surgical robots in keyhole transcranial endoscope-assisted microsurgery. METHODS: The technical challenges faced by surgeons utilizing keyhole craniotomies were reviewed, and a thorough appraisal of presently available robotic systems was performed. RESULTS: Surgical robotic systems have the potential to incorporate advances in augmented reality, stereoendoscopy, and jointed-wrist instruments, and therefore to significantly impact the field of keyhole neurosurgery. To date, over 30 robotic systems have been applied to neurosurgical procedures. The vast majority of these robots are best described as supervisory controlled, and are designed for stereotactic or image-guided surgery. Few telesurgical robots are suitable for keyhole neurosurgical approaches, and none are in widespread clinical use in the field. CONCLUSION: New robotic platforms in minimally invasive neurosurgery must possess clear and unambiguous advantages over conventional approaches if they are to achieve significant clinical penetration.

scholarly journals Surgical Treatment of Intrahepatic Cholangiocarcinoma: Current and Emerging Principles

2020 ◽  
Vol 10 (1) ◽  
pp. 104
Author(s):  
Eliza W. Beal ◽  
Jordan M. Cloyd ◽  
Timothy M. Pawlik
Keyword(s):  
Intrahepatic Cholangiocarcinoma ◽  
Early Stage ◽  
Preoperative Evaluation ◽  
Locally Advanced ◽  
Surgical Techniques ◽  
Future Liver Remnant ◽  
Surgical Morbidity ◽  
Early Stage Disease ◽  
Liver Remnant

Intrahepatic cholangiocarcinoma (ICC) is a rare, aggressive cancer of the biliary tract. It often presents with locally advanced or metastatic disease, but for patients with early-stage disease, surgical resection with negative margins and portahepatis lymphadenectomy is the standard of care. Recent advancements in ICC include refinement of staging, improvement in liver-directed therapies, clarification of the role of adjuvant therapy based on new randomized controlled trials, and advances in minimally invasive liver surgery. In addition, improvements in neoadjuvant strategies and surgical techniques have enabled expanded surgical indications and reduced surgical morbidity and mortality. However, recurrence rates remain high and more effective systemic therapies are still necessary to improve recurrence-free and overall survival. In this review, we focus on current and emerging surgical principals for the management of ICC including preoperative evaluation, current indications for surgery, strategies for future liver remnant augmentation, technical principles, and the role of neoadjuvant and adjuvant therapies.

scholarly journals Role of systematic lymphadenectomy in postoperative mortality and morbidity in patients with gastric cancer

2004 ◽  
Vol 57 (7-8) ◽  
pp. 381-385
Author(s):  
Dejan Stevanovic ◽  
Dragan Radovanovic ◽  
Ivan Pavlovic ◽  
Nebojsa Mitrovic
Keyword(s):  
Gastric Cancer ◽  
Postoperative Complications ◽  
Gastric Carcinoma ◽  
Anastomotic Leakage ◽  
Surgical Techniques ◽  
Postoperative Mortality ◽  
Mortality And Morbidity ◽  
Systematic Lymphadenectomy

Introduction Surgical techniques and postoperative care for gastric cancer have significantly improved in recent years. However, whether postoperative morbidity and mortality rates after gastrectomy for gastric cancer have been reduced or not in recent years is still unclear. In this study we would like to point out the role of systematic lymphadenectomy in postoperative mortality and morbidity. Material and methods In this investigestion we analyzed two groups of patients. The first group of 126 patients with gastric carcinoma underwent peritumor lymphadenectomy D1. The second group of 114 patients with gastric carcinoma underwent more radical types of lymphadenectomy (D2, D2%, D3). In this study we analyzed differences between these two groups of patients in regard to:1) early postoperative mortality, 2) early postoperative complications and 3) long-term postoperative complications. Results Early postoperative mortality rate was 4.76% in D1 group and 5,26% in group with systematic lymphadenectomy (SL). 14.3% of patients in D1 group and 15.7% of patients in SL group had postoperative complications. The most frequent complications in D1 group were non-surgical complications of the respiratory system. In SL group the most common postoperative complications were anastomotic leakage (5/18, 27.77%) and wound infection (6/18. 33.3%). The most common long-term complications in both groups were: ventral postoperative hernia, anemia, small bowel obstruction and gallbladder calculosis. Discussion Early postoperative death occurred in patients with stage IV gastric cancer. The rates of anastomotic leakage, as main cause of early postoperative mortality and morbitity in patients with systematic lymphadenectomy, were reduced in the last few years with stapling surgery. Conclusions There were no significant differences in the postoperative mortality and morbidity rates between the two analyzed groups in our investigation.

scholarly journals VRAM flap for locally advanced breast cancer

Mastology ◽  
2021 ◽  
Vol 31 ◽  
Author(s):  
René Aloisio da Costa Vieira ◽  
Raphael Luiz Haikel ◽  
Luciano Ipólito Branquinho ◽  
Idam de Oliveira-Junior
Keyword(s):  
Breast Cancer ◽  
Advanced Breast Cancer ◽  
Myocutaneous Flap ◽  
Locally Advanced Breast Cancer ◽  
Locally Advanced ◽  
Radical Mastectomy ◽  
Advanced Breast ◽  
Extensive Resection ◽  
Vram Flap

The authors presented a case of a patient with locally advanced breast cancer, with mammary and axillary localization, initially considered non-resectable, with good response after neoadjuvant chemotherapy. Due to the location of the lesion and the need for extensive resection, radical mastectomy was performed, associated with reconstruction with myocutaneous flap of the vertical rectus abdominis muscle. Different therapeutic options, the reasons that determine this choice, and local long-term control were discussed.

scholarly journals Multivisceral Resection of Advanced Pelvic Tumors: From Planning to Implementation

2020 ◽  
Vol 33 (05) ◽  
pp. 268-278
Author(s):  
R. Mirnezami ◽  
A. Mirnezami
Keyword(s):  
Pelvic Exenteration ◽  
Tumor Staging ◽  
Locally Advanced ◽  
Surgical Techniques ◽  
Multivisceral Resection ◽  
Current State ◽  
Pelvic Tumors ◽  
Patient Optimization ◽  
Exenterative Surgery

AbstractPelvic exenteration involves radical multivisceral resection for locally advanced and recurrent pelvic tumors. Advances in tumor staging, oncological therapies, preoperative patient optimization, surgical techniques, and critical care medicine have permitted the safe expansion of pelvic exenterative surgery at specialist units. It is now understood that in carefully selected patients, 5-year survival can exceed 60% following pelvic exenteration, and that very low mortality figures and an optimum postexenteration quality of life are possible. In the present review, we provide a contemporary summary of the current state of the art in pelvic exenterative surgery following all key phases of the treatment pipeline from patient staging and tumor assessment, to treatment planning and surgery.

scholarly journals Management of recurrent phyllodes with full thickness chest wall resection

1970 ◽  
Vol 1 (1) ◽  
pp. 9-13
Author(s):  
R Awwal ◽  
SA Shashi ◽  
MS Khondokar ◽  
SH Khundkar
Keyword(s):  
Chest Wall ◽  
Locally Advanced ◽  
Good Prognosis ◽  
Chest Wall Resection ◽  
Full Thickness ◽  
Extensive Resection ◽  
Unique Challenge ◽  
Phyllodes Tumour ◽  
Phyllodes Tumours

Phyllodes tumours are biphasic fibroepithelial neoplasms of the breast and each case represents a unique challenge. Even after apparent wide local excision of benign lesions, they recur and recurrences can occur even for 5-6 times. The ultimate end result is chest wall invasion and reconstruction then becomes an essential part of the curative surgical procedure. For a locally advanced breast malignancy, treatment is always palliative with simple coverage and oncologic support. But as Phyllodes tumour is of low aggressiveness, wide excision of even locally advanced malignant phyllodes can result in a good prognosis. Wide and extensive resection always invites the need of reconstruction, and surely it is a challenge when it is for a post-mastectomy recurrent lesion, where the role of plastic surgeons becomes essential. Two such cases are presented where disease control was only possible after full thickness chest wall resection.DOI: http://dx.doi.org/10.3329/bdjps.v1i1.6486Bangladesh Journal of Plastic Surgery (2010) Vol. 1 (1) pp.9-13

Critical Review of Neoadjuvant Chemotherapy Followed by Surgery for Locally Advanced Cervical Cancer

2010 ◽  
Vol 20 (Suppl 2) ◽  
pp. S47-S48 ◽  
Author(s):  
Nicoletta Colombo ◽  
Michele Peiretti
Keyword(s):  
Cervical Cancer ◽  
Neoadjuvant Chemotherapy ◽  
Locally Advanced ◽  
Standard Of Care ◽  
Advanced Cervical Cancer ◽  
Therapeutic Approaches ◽  
Locally Advanced Cervical Cancer ◽  
High Incidence

Cervical cancer is the second most common cause of female cancer mortality worldwide. Concurrent chemoradiotherapy represents the standard of care for patients with stage IB2-IIIB cervical cancer. However, the lack of radiotherapy departments, especially in developing countries, the presumed high incidence of long-term complications, and the poor control of metastatic disease have brought about the development of different therapeutic approaches such as neoadjuvant chemotherapy followed by surgery. We reviewed the literature concerning the role of neoadjuvant chemotherapy for locally advanced cervical cancer.

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