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European Spine Journal : Official... Feb 2020To compare surgical outcomes between seven different approaches for thoracolumbar corpectomy/spondylectomy in the setting of spinal metastasis. (Review)
Review
OBJECTIVE
To compare surgical outcomes between seven different approaches for thoracolumbar corpectomy/spondylectomy in the setting of spinal metastasis.
METHODS
A systematic review of literature was performed including articles on corpectomy for thoracolumbar spinal metastasis. Data were extracted and sorted by surgical approach: en bloc spondylectomy (group 1), transpedicular (group 2), costotransversectomy (group 3), mini-open retropleural/retroperitoneal (group 4a), lateral extracavitary approach (group 4b), open transthoracic/transretroperitoneal (group 5), and thoracoscopic (group 6). Comparison of demographics, blood loss, directly procedure related complications, operating time, and postoperative improvement of pain.
RESULTS
A total of 63 articles were included comprising data of 774 patients with various primary tumor entities. Mean age was 51.8 years, 54% of patients were female, on average 1.46 levels were treated per patient, and mean follow-up was 1.59 years. The following statistically significant findings were observed: Blood loss was lowest for the mini-open retropleural/retroperitoneal (917 ml), thoracoscopic (1107 ml) and transthoracic approach (1172 ml) versus the posterior approach groups (1633-2261 ml); directly procedure related complications were lowest for mini-open retropleural/retroperitoneal and thoracoscopic approach (0% each) versus 7-15% in the other groups; operating time was lowest in mini-open retropleural/retroperitoneal approach (184 min) versus 300-588 min in the other groups.
CONCLUSION
Less invasive approaches (mini-open retropleural/retroperitoneal and thoracoscopic) not only had superior outcome in terms of blood loss and operating time, but also were shown to be safe techniques in cancer patients with low rates of procedure-related complications. These slides can be retrieved under Electronic Supplementary Material.
Topics: Female; Humans; Lumbar Vertebrae; Male; Middle Aged; Orthopedic Procedures; Spinal Neoplasms; Thoracic Vertebrae; Treatment Outcome
PubMed: 31641907
DOI: 10.1007/s00586-019-06179-8 -
Surgical Oncology Jun 2019Retroperitoneal sarcomas (RPS) are rare mesenchymal tumours. Their rarity challenges our ability to understand expected outcomes. The aim of this systematic review was...
Retroperitoneal sarcomas (RPS) are rare mesenchymal tumours. Their rarity challenges our ability to understand expected outcomes. The aim of this systematic review was to examine 30-day morbidity and mortality, overall survival rates and prognostic predictors from population-based studies for patients undergoing curative resection for primary RPS. A systematic literature review of EMBASE, MEDLINE, PUBMED and the Cochrane library was performed using PRISMA for population-based studies reporting from nationally registered databases on primary RPS surgical resections in adults. The main outcomes evaluated were 30-day morbidity and mortality and overall survival rates. The use of additional treatment modalities and predictors of overall survival were also examined. Fourteen studies (n = 12 834 patients) reporting from 3 national databases, (Surveillance, Epidemiology and End Results (SEER), the United States National Cancer Database (US NCDB) and the American College of Surgeons' National Surgical Quality Improvement Program (ACS NSQIP)) were analysed. The reported overall 30-day morbidity and mortality were 23% (n = 191/846) and 3% (n = 278/10 181) respectively. Reported use of perioperative radiotherapy was 28%. No study reported loco-regional recurrence rates. Overall reported 5-year survival ranged from 52% to 62%. Independent predictors of overall survival were age of the patient, resection margin, tumour grade and size, histological subtype and receipt of radiotherapy. This review of population-based data demonstrated relatively low 30-day morbidity rates in patients undergoing curative surgical resections for primary RPS. Thirty-day mortality rates were similar to other abdominal tumour groups. There remains a paucity of data reporting recurrence rates, however 5-year survival rates ranged from 52 to 62%.
Topics: Databases, Factual; Humans; Incidence; Neoplasm Recurrence, Local; Postoperative Complications; Prognosis; Retroperitoneal Neoplasms; Sarcoma; Surgical Procedures, Operative; Survival Rate
PubMed: 31196494
DOI: 10.1016/j.suronc.2019.03.002 -
Revista Da Associacao Medica Brasileira... Jun 2019The Guidelines Project, an initiative of the Brazilian Medical Association, aims to combine information from the medical field in order to standardize producers to...
The Guidelines Project, an initiative of the Brazilian Medical Association, aims to combine information from the medical field in order to standardize producers to assist the reasoning and decision-making of doctors. The information provided through this project must be assessed and criticized by the physician responsible for the conduct that will be adopted, depending on the conditions and the clinical status of each patient.
Topics: Adrenal Gland Neoplasms; Adrenalectomy; Humans; Laparoscopy; Peritoneum; Reproducibility of Results; Retroperitoneal Space; Treatment Outcome
PubMed: 31166429
DOI: 10.1590/1806-9282.65.5.578 -
European Urology Oncology Dec 2018Management of locally recurrent renal cancer is complex. (Review)
Review
CONTEXT
Management of locally recurrent renal cancer is complex.
OBJECTIVE
In this systematic review we analyse the available literature on the management of local renal cancer recurrence.
EVIDENCE ACQUISITION
A systematic search (PubMed, Web of Science, CINAHL, Clinical Trials, and Scopus) of English literature from 2000 to 2017 was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines.
EVIDENCE SYNTHESIS
The search identified 1838 articles. Of those, 36 were included in the evidence synthesis. The majority of the studies identified were retrospective and not controlled. Local recurrence after thermal ablation (TA) may be managed with repeat TA. Alternatively, salvage nephrectomy is possible. However, a higher rate of complications should be expected than after primary nephrectomy. Salvage nephrectomy and TA represent treatment options for local recurrence after partial nephrectomy. Local retroperitoneal recurrence after radical nephrectomy is ideally treated with surgical resection, for which minimally invasive approaches might be applicable to select patients. For large recurrences, addition of intraoperative radiation may improve local control. Local tumour destruction appears to be more beneficial than systemic therapy alone for local recurrences.
CONCLUSIONS
Management of local renal cancer relapse varies according to the clinical course and prior treatments. The available data are mainly limited to noncontrolled retrospective series. After nephron-sparing treatment, TA represents an effective treatment with low morbidity. For local recurrence after radical nephrectomy, the low-level evidence available suggests superiority of surgical excision relative to systemic therapy or best supportive care. As a consequence, surgery should be prioritised when feasible and applicable.
PATIENT SUMMARY
In renal cell cancer, the occurrence and management of local recurrence depend on the initial treatment. This cancer is a disease with a highly variable clinical course. After initial organ-sparing treatment, thermal ablation offers good cancer control and low rates of complications. For recurrence after radical nephrectomy, surgical excision seems to provide the best long-term cancer control and it is superior to medical therapy alone.
Topics: Carcinoma, Renal Cell; Humans; Kidney Neoplasms; Neoplasm Recurrence, Local; Nephrectomy; Organ Sparing Treatments; Prognosis; Salvage Therapy
PubMed: 31158097
DOI: 10.1016/j.euo.2018.06.007 -
Journal of Robotic Surgery Feb 2020To systematically review world literature and compare peri-operative outcome including operating time (OT), estimated blood loss (EBL), warm ischemia time (WIT), length... (Meta-Analysis)
Meta-Analysis
Trans-peritoneal vs. retroperitoneal robotic assisted partial nephrectomy in posterior renal tumours: need for a risk-stratified patient individualised approach. A systematic review and meta-analysis.
To systematically review world literature and compare peri-operative outcome including operating time (OT), estimated blood loss (EBL), warm ischemia time (WIT), length of stay (LOS) and complications between retroperitoneal robotic assisted partial nephrectomy (RP-RAPN) and trans-peritoneal robotic assisted partial nephrectomy (TP-RAPN) for posteriorly located renal masses. All randomised trials and observational studies comparing RP-RAPN and TP-RAPN for posteriorly located renal masses were considered. The GRADE approach (Grading of Recommendations Assessment, Development and Evaluation, GRADE) was used to rate the quality of evidence. 82 potential publications were identified. 3 were included in the review. All three studies were observational comparative studies. 347 and 550 patients underwent RP-RAPN and TP-RAPN, respectively, for posteriorly located tumours. There was statistically significant difference in LOS between the 2 techniques, favouring the RP-RAPN cohort: risk ratio (M-H, random, 95% CI), - 0.42 [- 0.67, - 0.18], p < 0.0006. There was no statistically significant difference in overall complication rates between the two techniques: risk ratio (M-H, fixed, 95% CI), 0.80 [0.49, 1.30], p = 0.37. There was no statistically significant difference in ≥ Clavien 3a complication rates between the two t echniques: risk ratio (M-H, fixed, 95% CI), 1.17 [0.62, 2.19], p = 0.63. OT, EBL, WIT and positive margin rates were similar for both approaches. The quality of evidence for complications, LOS and remaining outcomes were 'moderate', 'low' and 'very low', respectively, on GRADE approach. The current review suggests that the LOS with RP-RAPN are significantly lesser than TP-RAPN for posterior tumours. The RP-RAPN does not appear to offer any advantage over TP-RAPN for other peri-operative outcomes such as WIT, OT and EBL. The surgical margin rates and morbidity between the two approaches appear to be similar.
Topics: Humans; Kidney Neoplasms; Nephrectomy; Operative Time; Peritoneum; Precision Medicine; Retroperitoneal Space; Risk; Robotic Surgical Procedures
PubMed: 31089965
DOI: 10.1007/s11701-019-00973-8 -
Medicine Apr 2019Well-differentiated liposarcomas (WDLPS) are rare retroperitoneal tumors that can reach significant size as they can grow without constrains before becoming symptomatic....
RATIONALE
Well-differentiated liposarcomas (WDLPS) are rare retroperitoneal tumors that can reach significant size as they can grow without constrains before becoming symptomatic. Laparotomic open radical tumor resection represents the most common surgical approach.
PATIENT CONCERNS
A mass with "fat fluid level" was found in the right pelvis of an asymptomatic woman undergoing routine transvaginal ultrasound: the preoperative diagnosis was right mature ovarian teratoma.
DIAGNOSIS
Postoperative histopathology confirmed the diagnosis of WDLPS.
INTERVENTIONS
A radical laparoscopic excision of the retroperitoneal mass with bilateral salpingectomy was performed.
OUTCOMES
Patient is free of disease at 18 months after surgery.
LESSON
Despite computed tomography scan is the gold standard technique to identify WDLPS, such neoplasms can be misdiagnosed for mature ovarian teratomas. When a retroperitoneal mass is incidentally discovered during a surgery, an open core-needle biopsy is usually performed, and appropriate treatment planned only after complete staging and final pathology are available. Instead, when tumor margins are identified, resection of an incidentally diagnosed WDLPS would benefit from laparoscopic magnification that could improve distinguishing the disease from the surrounding tissues. Therefore, laparoscopy could represent a safe and effective technique to diagnose and treat retroperitoneal diseases.
Topics: Female; Humans; Incidental Findings; Laparoscopy; Liposarcoma; Middle Aged; Ovarian Neoplasms; Retroperitoneal Neoplasms; Salpingectomy; Teratoma; Ultrasonography
PubMed: 30985710
DOI: 10.1097/MD.0000000000015184 -
American Journal of Clinical Oncology May 2019Misnaming low-grade lipomatous tumors poses a clinical and medicolegal challenge, potentially subjecting patients to expensive and unnecessary surgeries. The terms... (Comparative Study)
Comparative Study Meta-Analysis
OBJECTIVES
Misnaming low-grade lipomatous tumors poses a clinical and medicolegal challenge, potentially subjecting patients to expensive and unnecessary surgeries. The terms atypical lipomatous tumor (ALT) and "well-differentiated" liposarcoma (WDL) have been used interchangeably in pathology reports, scholarly works and consensus recommendations, creating vagaries between low-virulence extremity tumors and retroperitoneal disease with metastatic potential.
METHODS
A systematic review was performed on all studies that reported on the local recurrence rate and metastasis of ALTs and WDLs in living human subjects. Local recurrence and metastases were compared using Fisher's Exact Test.
RESULTS
In total, 20 studies evaluated ALTs (n=936), whereas 13 studied WDLs (n=626). Mean follow-up was 6.6±2.0 years (median, 7.0 y). No metastatic disease was observed among ALTs, whereas 15 patients with WDLs (2.7%, P<0.0001) had metastases. The local recurrence rate of ALTs was significantly lower than WDLs after both marginal (15.1%, 141/936 vs. 46.0%, 288/626, P<0.0001) and wide excisions (3.3%, 2/59 in ALT vs. 17.4%, 19/109, P=0.007).
CONCLUSIONS
ALT should be reserved for extremity lesions meeting appropriate histopathologic criteria that represent nonmetastatic disease, reducing over-diagnosis, over-treatment, and patient risk.
Topics: Biopsy, Needle; Combined Modality Therapy; Diagnosis, Differential; Disease-Free Survival; Extremities; Female; Humans; Immunohistochemistry; In Situ Hybridization, Fluorescence; Liposarcoma; Male; Neoplasm Recurrence, Local; Soft Tissue Neoplasms; Survival Analysis
PubMed: 30932920
DOI: 10.1097/COC.0000000000000540 -
JSLS : Journal of the Society of... 2019The goal of the study was to evaluate retroperitoneal sarcomas with continuous growth into the scrotum through the inguinal canal with regard to diagnostic approach,...
BACKGROUND AND OBJECTIVES
The goal of the study was to evaluate retroperitoneal sarcomas with continuous growth into the scrotum through the inguinal canal with regard to diagnostic approach, surgical treatment, and outcome. The analysis is based on a comprehensively documented case and a complete systematic review of published literature. Potential pitfalls are highlighted.
METHODS
We describe the case of a 57-year-old male Caucasian who presented with a swelling in the right groin. Suspecting a scrotal hernia, transabdominal preperitoneal plasty surgery was planned but intraoperatively a large retroperitoneal mass was revealed. After computed tomography scan and magnetic resonance imaging, a complete resection of the tumor was performed. Ten previously published cases describing the same pathology were retrieved from the PubMed database and analyzed systematically in a complete literature review.
RESULTS
Histology showed a well-differentiated liposarcoma with tumor-free resection margins. Twenty-two months postoperatively, the patient is in complete clinical remission.
CONCLUSION
Preoperative clinical suspicion of retroperitoneal involvement is paramount for developing of a surgical strategy and in unclear cases demands extended preoperative diagnostic workup. Following the appropriate patient management is crucial to prognosis.
Topics: Hernia, Inguinal; Herniorrhaphy; Humans; Inguinal Canal; Liposarcoma; Magnetic Resonance Imaging; Male; Middle Aged; Retroperitoneal Neoplasms; Scrotum; Tomography, X-Ray Computed
PubMed: 30700965
DOI: 10.4293/JSLS.2018.00064 -
The Cochrane Database of Systematic... Dec 2018Laparoscopic adrenalectomy is an accepted treatment worldwide for adrenal gland disease in adults. The transperitoneal approach is more common. The retroperitoneal...
BACKGROUND
Laparoscopic adrenalectomy is an accepted treatment worldwide for adrenal gland disease in adults. The transperitoneal approach is more common. The retroperitoneal approach may be preferred, to avoid entering the peritoneum, but no clear advantage has been demonstrated so far.
OBJECTIVES
To assess the effects of laparoscopic transperitoneal adrenalectomy (LTPA) versus laparoscopic retroperitoneal adrenalectomy (LRPA) for adrenal tumours in adults.
SEARCH METHODS
We searched CENTRAL, MEDLINE, Embase, ICTRP Search Portal, and ClinicalTrials.gov to 3 April 2018. We applied no language restrictions.
SELECTION CRITERIA
Two review authors independently scanned the abstract, title, or both sections of every record retrieved to identify randomised controlled trials (RCTs) on laparoscopic adrenalectomy for preoperatively assessed adrenal tumours. Participants were affected by corticoid and medullary, benign and malignant, functional and silent tumours or masses of the adrenal gland, which were assessed by both laboratory and imaging studies.
DATA COLLECTION AND ANALYSIS
Two review authors independently extracted data, assessed trials for risk of bias, and evaluated overall study quality using GRADE criteria. We calculated the risk ratio (RR) for dichotomous outcomes, or the mean difference (MD) for continuous variables, and corresponding 95% confidence interval (CI). We primarily used a random-effects model for pooling data.
MAIN RESULTS
We examined 1069 publications, scrutinized 42 full-text publications or records, and included five RCTs. Altogether, 244 participants entered the five trials; 127 participants were randomised to retroperitoneal adrenalectomy and 117 participants to transperitoneal adrenalectomy. Two trials had a follow-up of nine months, and three trials a follow-up of 31 to 70 months. Most participants were women, and the average age was around 40 years. Three trials reported all-cause mortality; in two trials, there were no deaths, and in one trial with six years of follow-up, four participants died in the LRPA group and one participant in the LTPA group (164 participants; low-certainty evidence). The trials did not report all-cause morbidity. Therefore, we analysed early and late morbidity, and included specific adverse events under these outcome measures. The results were inconclusive between LRPA and LTPA for early morbidity (usually reported within 30 to 60 days after surgery; RR 0.56, 95% CI 0.27 to 1.16; P = 0.12; 5 trials, 244 participants; very low-certainty evidence). Nine out of 127 participants (7.1%) in the LRPA group, compared with 16 out of 117 participants (13.7%) in the LTPA group experienced an adverse event. Participants in the LRPA group may have a lower risk of developing late morbidity (reported as latest available follow-up; RR 0.12, 95% CI 0.01 to 0.92; P = 0.04; 3 trials, 146 participants; very low-quality evidence). None of the 78 participants in the LRPA group, compared with 7 of the 68 participants (10.3%) in the LTPA group experienced an adverse event.None of the trials reported health-related quality of life. The results were inconclusive for socioeconomic effects, assessed as time to return to normal activities and length of hospital stay, between the intervention and comparator groups (very low-certainty evidence). Participants who had LRPA may have had an earlier start on oral fluid or food intake (MD -8.6 hr, 95% CI -13.5 to -3.7; P = 0.0006; 2 trials, 89 participants), and ambulation (MD -5.4 hr, 95% CI -6.8 to -4.0 hr; P < 0.0001; 2 trials, 89 participants) than those in the LTPA groups. Postoperative and operative parameters (duration of surgery, operative blood loss, conversion to open surgery) showed inconclusive results between the intervention and comparator groups.
AUTHORS' CONCLUSIONS
The body of evidence on laparoscopic retroperitoneal adrenalectomy compared with laparoscopic transperitoneal adrenalectomy is limited. Late morbidity might be reduced following laparoscopic retroperitoneal adrenalectomy, but we are uncertain about this effect because of very low-quality evidence. The effects on other key outcomes, such as all-cause mortality, early morbidity, socioeconomic effects, and operative and postoperative parameters are uncertain. LRPA might show a shorter time to oral fluid or food intake and time to ambulation, but we are uncertain whether this finding can be replicated. New long-term RCTs investigating additional data, such as health-related quality of life, surgeons' level of experience, treatment volume of surgical centres, and details on techniques used are needed.
Topics: Activities of Daily Living; Adrenal Gland Neoplasms; Adrenalectomy; Adult; Cause of Death; Female; Humans; Laparoscopy; Length of Stay; Male; Peritoneum; Randomized Controlled Trials as Topic; Retroperitoneal Space
PubMed: 30595004
DOI: 10.1002/14651858.CD011668.pub2 -
Drug Design, Development and Therapy 2019To evaluate the efficacy and safety of neoadjuvant platinum-based chemotherapy during pregnancy in women with cervical cancer. (Meta-Analysis)
Meta-Analysis
Efficacy of neoadjuvant platinum-based chemotherapy during the second and third trimester of pregnancy in women with cervical cancer: an updated systematic review and meta-analysis.
PURPOSE
To evaluate the efficacy and safety of neoadjuvant platinum-based chemotherapy during pregnancy in women with cervical cancer.
METHODS
The PubMed, Embase, and Cochrane Library databases were fully searched to find eligible studies regarding platinum use during pregnancy in women with cervical cancer from January 1980 to September 2018. Data were extracted from the selected studies independently by two authors. Descriptive statistics were calculated for categorical data (frequency and percentage) and numeration data (mean and SD for normally distributed data and median and range for abnormally distributed data). Survival analyses were performed using Kaplan-Meier survival curves and log-rank tests to estimate overall survival and progression-free survival for all patients.
RESULTS
A total of 39 studies including 88 cervical cancer patients with platinum administration during pregnancy were selected in this meta-analysis, and 64 women provided International Federation of Gynecology and Obstetrics stage information. Among the latter, 56 of 64 (87.5%) were diagnosed with early stages (I and IIA) and the remaining 8 of 64 (12.5%) had advanced stages (IIB, III, and IV). In relation to cisplatin, 86 pregnant women were identified, whereas only 2 pregnant women with carboplatin application were retrieved. Overall, 88 newborns were delivered from 84 pregnancies, including two sets of twins and one set of triplets, among which 71 neonates (71 of 88, 80.7%) were completely healthy at birth. All children were healthy at the end of follow-up (median 17 months, range 0-149.5 months), except one who was diagnosed with retroperitoneal embryonal rhabdomyosarcoma at 5 years old and one who had acute myeloid leukemia at 22 months of age. At the end of follow-up (range 4.75-156 months), 16 of 81 (19.8%) patients were diagnosed with recurrence of cervical cancer, and 11 (90%) of those died because of cancer relapse. Neither median overall survival nor median progression-free survival were reached.
CONCLUSION
Our results demonstrated that neoadjuvant platinum-based chemotherapy could be a favorable choice for the management of patients with cervical cancer during the second and third trimesters. To reduce the side effects of chemotherapy, cisplatin might be good to use as monotherapy in these patients.
Topics: Adult; Antineoplastic Combined Chemotherapy Protocols; Carboplatin; Chemotherapy, Adjuvant; Cisplatin; Female; Humans; Live Birth; Neoadjuvant Therapy; Neoplasm Recurrence, Local; Neoplasm Staging; Pregnancy; Pregnancy Complications, Neoplastic; Pregnancy Trimester, Second; Pregnancy Trimester, Third; Progression-Free Survival; Risk Factors; Time Factors; Uterine Cervical Neoplasms; Young Adult
PubMed: 30587930
DOI: 10.2147/DDDT.S186966