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Asian Journal of Surgery May 2024
Topics: Adult; Female; Humans; Retroperitoneal Neoplasms; Teratoma; Tomography, X-Ray Computed
PubMed: 38458867
DOI: 10.1016/j.asjsur.2024.02.050 -
International Journal of Surgery... Jun 2024
A commentary on 'Incidence, risk factors, and outcomes of venous thromboembolism in patients undergoing surgery for retroperitoneal tumors: a propensity-matched retrospective cohort study'.
Topics: Humans; Venous Thromboembolism; Risk Factors; Retrospective Studies; Incidence; Retroperitoneal Neoplasms; Propensity Score; Postoperative Complications; Male; Female
PubMed: 38445490
DOI: 10.1097/JS9.0000000000001243 -
Cureus Jan 2024Desmoplastic small round cell tumors (DSRCT) are very rare and aggressive diseases typically present with abdominal or retroperitoneal masses. We present a case of a...
Desmoplastic small round cell tumors (DSRCT) are very rare and aggressive diseases typically present with abdominal or retroperitoneal masses. We present a case of a young female who presented with ST-segment elevation myocardial infarction and cardiac tamponade and who was found to have DSRCT. The patient was coded at the emergency department. Left heart catheterization showed normal coronary arteries, and pericardiocentesis removed 1,260 mL of bloody pericardial effusions. The patient was stabilized, and a positron emission tomography scan revealed left intrahilar, hilar, and cardiophrenic masses with associated hypermetabolic right hilar, left hilar, subcarinal, costophrenic, aortopulmonary, paratracheal, and mediastinal lymphadenopathy. Cardiac magnetic resonance imaging showed multiple masses visualized in the pericardium, one mass anterior to the right ventricular outflow tract/pulmonary artery, and a second mass adjacent to the right ventricular apex. Computed tomography abdomen/pelvis showed no evidence of metastatic malignancy in the abdomen/pelvis. A biopsy of lung mass and lymph nodes showed desmoplastic small round cell tumors with sarcoma fusion gene detected (Ewing sarcoma RNA-binding protein 1-Wilms' tumor 1). We performed cycle 1 of chemotherapy, including doxorubicin, vincristine, and cyclophosphamide, and the patient was transferred to an oncology center for further care. This case suggested that one of the differential diagnoses of lung and pericardium masses at a young age can be desmoplastic small round cell tumors. This case also highlighted that ST-segment elevation myocardial infarction can be secondary to neoplasm, especially at a young age besides myocardial infarction.
PubMed: 38435931
DOI: 10.7759/cureus.53333 -
Current Oncology Reports Apr 2024This narrative review provides a comprehensive overview of the evolving role of retroperitoneal lymph node dissection (RPLND) in the management of testicular cancer... (Review)
Review
PURPOSE OF REVIEW
This narrative review provides a comprehensive overview of the evolving role of retroperitoneal lymph node dissection (RPLND) in the management of testicular cancer (TC). It explores the significance of RPLND as both a diagnostic and therapeutic tool, highlighting its contribution to accurate staging, its impact on oncological outcomes, and its influence on subsequent treatment decisions.
RECENT FINDINGS
RPLND serves as an essential diagnostic procedure, aiding in the precise assessment of lymph node involvement and guiding personalized treatment strategies. It has demonstrated therapeutic value, particularly in patients with specific risk factors and disease stages, contributing to improved oncological outcomes and survival rates. Recent studies have emphasized the importance of meticulous patient selection and nerve-sparing techniques to mitigate complications while optimizing outcomes. Additionally, modern imaging and surgical approaches have expanded the potential applications of RPLND. In the context of TC management, RPLND remains a valuable and evolving tool. Its dual role in staging and therapy underscores its relevance in contemporary urological practice. This review highlights the critical role of RPLND in enhancing patient care and shaping treatment strategies, emphasizing the need for further research to refine patient selection and surgical techniques.
Topics: Male; Humans; Testicular Neoplasms; Retroperitoneal Space; Lymph Node Excision; Lymph Nodes; Neoplasms, Germ Cell and Embryonal; Retrospective Studies; Treatment Outcome; Neoplasm Staging
PubMed: 38430323
DOI: 10.1007/s11912-024-01511-y -
Journal of Minimally Invasive Gynecology May 2024To determine the anatomical distribution of sentinel lymph nodes (SLNs), the overall, unilateral, and bilateral detection rates, and the bilateral SLN concordance in... (Observational Study)
Observational Study
Anatomical Distribution of Sentinel Lymph Nodes Harvested by Retroperitoneal vNOTES in 34 Consecutive Patients With Early-Stage Endometrial Cancer: Analysis of 124 Lymph Nodes.
STUDY OBJECTIVE
To determine the anatomical distribution of sentinel lymph nodes (SLNs), the overall, unilateral, and bilateral detection rates, and the bilateral SLN concordance in patients with endometrial cancer (EC) mapped through a retroperitoneal transvaginal natural orifice transluminal endoscopic surgery (vNOTES) approach.
DESIGN
Prospective single-center observational study.
SETTING
Swiss teaching hospital.
PATIENTS
Patients with EC or endometrial complex atypical hyperplasia who had undergone surgical staging with SLN mapping by a retroperitoneal vNOTES approach between October 2021 and November 2023.
INTERVENTIONS
Patients were placed in a horizontal dorsal lithotomy position under general anesthesia, and indocyanine green (ICG) was injected into the cervix. Access to the retroperitoneal space was achieved through vaginal incisions. A 7 cm GelPoint V-Path Transvaginal Access Platform was used as a vNOTES port, and CO was insufflated to expand the retroperitoneal space. The pelvic retroperitoneal space was inspected for ICG uptake by lymph nodes. After identification, SLNs were removed and sent for definitive histological examination.
MEASUREMENT AND MAIN RESULTS
A total of 34 patients were included in this study; 33 (97.1%) had a successful procedure (unilateral or bilateral mapping), and 1 (2.9%) had failed mapping. A total of 124 SLNs were identified and removed. SLNs were observed in the obturator region (81.5%), the external iliac region (10.5%), the internal iliac region (4.8%), and the common iliac region (3.2%). Similar proportions were observed on both pelvic sides. No SLNs were detected in other regions. The SLN locations were symmetrical in 22/31 (71.0%) patients. SLNs were negatives in 120 cases (96.8%), while 2 lymph nodes (1.6%) presented isolated tumor cells, and 2 others (1.6%) presented macrometastases.
CONCLUSION
We report anatomical distributions and detection rates for SLNs mapped by retroperitoneal vNOTES. Our results suggest substantial differences in the localization of SLNs compared to those reported for laparoscopic mapping.
Topics: Humans; Female; Endometrial Neoplasms; Middle Aged; Retroperitoneal Space; Prospective Studies; Aged; Sentinel Lymph Node; Sentinel Lymph Node Biopsy; Natural Orifice Endoscopic Surgery; Neoplasm Staging; Indocyanine Green; Adult; Lymph Node Excision; Lymphatic Metastasis
PubMed: 38428574
DOI: 10.1016/j.jmig.2024.02.007 -
In Vivo (Athens, Greece) 2024Neuroblastoma is a common childhood cancer with poor survival for children with high-risk disease, and ongoing research to improve outcomes is needed. Patient-derived...
BACKGROUND/AIM
Neuroblastoma is a common childhood cancer with poor survival for children with high-risk disease, and ongoing research to improve outcomes is needed. Patient-derived xenografts (PDX) and genetically engineered mouse models (GEMM) are reliable models for oncologic research; however, they are resource-intensive, expensive, and require significant expertise to develop and maintain. We developed an orthotopic xenograft murine model of neuroblastoma that utilizes cryopreserved banks of human neuroblastoma cell lines, requires minimal equipment, and is easily reproducible.
MATERIALS AND METHODS
The neuroblastoma cell line NB1643 was obtained from the Children's Oncology Group (COG) Childhood Cancer Repository. Nod-SCID-gamma (NSG) mice underwent orthotopic injection of 2x10 NB1643 cells suspended in 10 μl of collagen hydrogel directly into the adrenal gland via an open retroperitoneal surgical approach. Mice were monitored by ultrasound and in vivo imaging system (IVIS) until the tumor reached the volume of the ipsilateral kidney. Tumor identity was confirmed by necropsy and histologic analysis.
RESULTS
A total of 55 mice underwent surgery. Eight died due to anesthetic or surgical complications. 39/47 (78%) survivors grew primary adrenal tumors. Average anesthesia time was 30 min. Ultrasound and IVIS successfully characterized tumor growth in all mice. Average time to target tumor size was 5 weeks (range=3-9). Gross pathologic and histologic analysis confirmed adrenal tumors consistent with neuroblastoma in all mice with adrenal masses.
CONCLUSION
A cell-derived orthotopic xenograft murine model can be successfully used to create an in vivo model of neuroblastoma. This model can be utilized in environments where PDX or GEMM models are not feasible.
Topics: Child; Humans; Animals; Mice; Disease Models, Animal; Heterografts; Mice, SCID; Neuroblastoma; Adrenal Gland Neoplasms; Xenograft Model Antitumor Assays; Cell Line, Tumor
PubMed: 38418146
DOI: 10.21873/invivo.13471 -
Journal of Robotic Surgery Feb 2024Literature meta-analyses comparing transperitoneal versus retroperitoneal approach to robotic partial nephrectomy (RPN) suggested some advantages favoring... (Comparative Study)
Comparative Study
Postoperative outcomes of transperitoneal versus retroperitoneal robotic partial nephrectomy: a propensity-score matched comparison focused on patient mobilization, return to bowel function, and pain.
Literature meta-analyses comparing transperitoneal versus retroperitoneal approach to robotic partial nephrectomy (RPN) suggested some advantages favoring retroperitoneoscopy. Unfortunately, patient-centered data about mobilization, canalization, pain, and use of painkillers remained anecdotally reported. The present analysis aimed to compare transperitoneal versus retroperitoneal RPN focusing on such outcomes. Study data including baseline variables, perioperative, and postoperative outcomes of interest were retrieved from prospectively maintained institutional database (Jan 2018-May 2023) and compared between treatment groups (transperitoneal versus retroperitoneal). Propensity score matching was performed using the STATA command psmatch2 considering age, sex, body mass index, previous abdominal surgery, RENAL score, tumor size and location, and cT stage. The logit of propensity score was used for matching, with a 1:1 nearest neighbor algorithm, without replacement (caliper of 0.001). A total of 442 patients were included in the unmatched analysis: 330 underwent transperitoneal RPN 112 retroperitoneal RPN. After propensity score, 98 patients who underwent retroperitoneal RPN were matched with 98 patients who underwent transperitoneal RPN. Matched cohorts had comparable patients' demographics and tumor features. We found similarity between the two laparoscopic accesses in all outcomes but in blood loss, which favored retroperitoneoscopic RPN (median 150 (IQR 100-300) versus 100 (IQR 0-100) ml, p = 0.03). No differences were found in terms of time to mobilization with ambulation, return to complete bowel function, postoperative pain, but higher painkillers consumption was reported after transperitoneal RPN (p < 0.004). The present study compared the transperitoneal versus the retroperitoneal approach to RPN, confirming the similarity between the two approaches in all perioperative outcomes. Based on our findings, the choice of the surgical approach to RPN may remain something that the surgeon decides.
Topics: Humans; Defecation; Kidney Neoplasms; Laparoscopy; Nephrectomy; Pain, Postoperative; Propensity Score; Retrospective Studies; Robotic Surgical Procedures; Treatment Outcome
PubMed: 38413473
DOI: 10.1007/s11701-024-01860-7 -
Annals of Surgical Oncology May 2024
Topics: Humans; Liposarcoma; Retroperitoneal Neoplasms
PubMed: 38409372
DOI: 10.1245/s10434-024-15090-6 -
Clinical Journal of Gastroenterology Jun 2024A 69-year-old woman presented to our department with the chief complaint of diarrhea. She had undergone left nephrectomy for renal cancer 14 years earlier. Three years...
A 69-year-old woman presented to our department with the chief complaint of diarrhea. She had undergone left nephrectomy for renal cancer 14 years earlier. Three years earlier, metastasis was detected in the left retroperitoneal cavity, and pazopanib administration was initiated. In the 29th month after the start of chemotherapy, the patient developed diarrhea, and on the 31st month, computed tomography showed thickening of the intestinal wall. Colonoscopy revealed white villi, intramucosal hemorrhage in the terminal ileum, and rough inflammatory mucosa with inflammatory polyps extending from the transverse to the sigmoid colon. Suspecting pazopanib-induced enteritis, we discontinued the medication, and the diarrhea resolved within 3 days. On the 21st day after discontinuation, colonoscopy revealed that the inflammatory polyps had shrunk, and the inflammatory findings had improved. Biopsy of the white villi of the ileum revealed histiocytes. The patient resumed treatment with pazopanib at 400 mg/day and developed soft stool on the 7th day after resumption. Compared with other tyrosine-kinase inhibitor-induced enteritis cases, this case showed less bleeding and more extensive inflammatory findings. There are similarities as well as differences from cases of previously reported pazopanib-induced enteritis. The mechanisms and characteristics of this disease require further investigation.
Topics: Humans; Female; Pyrimidines; Aged; Carcinoma, Renal Cell; Sulfonamides; Indazoles; Kidney Neoplasms; Enteritis; Diarrhea; Angiogenesis Inhibitors; Colonoscopy
PubMed: 38407743
DOI: 10.1007/s12328-024-01919-w -
Cancers Feb 2024Image-guided renal mass biopsy is gaining increased diagnostic acceptance, but there are limited data concerning the safety and diagnostic yield of biopsy for small...
INTRODUCTION
Image-guided renal mass biopsy is gaining increased diagnostic acceptance, but there are limited data concerning the safety and diagnostic yield of biopsy for small renal masses (≤4 cm). This study evaluated the safety, diagnostic yield, and management after image-guided percutaneous biopsy for small renal masses.
METHODS
A retrospective IRB-approved study was conducted on patients who underwent renal mass biopsy for histopathologic diagnosis at a single center from 2015 to 2021. Patients with a prior history of malignancy or a renal mass >4 cm were excluded. Descriptive statistics were used to summarize patient demographics, tumor size, the imaging modality used for biopsy, procedure details, complications, pathological diagnosis, and post-biopsy management. A biopsy was considered successful when the specimen was sufficient for diagnosis without need for a repeat biopsy. Complications were graded according to the SIR classification of adverse events. A chi-squared test (significance level set at ≤ 0.05) was used to compare the success rate of biopsies in different lesion size groups.
RESULTS
A total of 167 patients met the inclusion criteria. The median age was 65 years (range: 26-87) and 51% were male. The median renal mass size was 2.6 cm (range: one-four). Ultrasound was solely employed in 60% of procedures, CT in 33%, a combination of US/CT in 6%, and MRI in one case. With on-site cytopathology, the median number of specimens obtained per procedure was four (range: one-nine). The overall complication rate was 5%. Grade A complications were seen in 4% ( = 7), consisting of perinephric hematoma ( = 6) and retroperitoneal hematoma ( = 1). There was one grade B complication (0.5%; pain) and one grade D complication (0.5%; pyelonephritis). There was no patient mortality within 30 days post-biopsy. Biopsy was successful in 88% of cases. A sub-group analysis showed a success rate of 85% in tumors <3 cm and 93% in tumors ≥3 cm ( = 0.01). Pathological diagnoses included renal cell carcinoma (65%), oncocytoma (18%), clear cell papillary renal cell tumors (9%), angiomyolipoma (4%), xanthogranulomatous pyelonephritis (1%), lymphoma (1%), high-grade papillary urothelial carcinoma (1%), and metanephric adenoma (1%), revealing benign diagnosis in 30% of cases. The most common treatment was surgery (40%), followed by percutaneous cryoablation (22%). In total, 37% of patients were managed conservatively, and one patient received chemotherapy.
CONCLUSION
This study demonstrates the safety and diagnostic efficacy of image-guided biopsy of small renal masses. The diagnostic yield was significantly higher for masses 3-4 cm in size compared to those <3 cm. The biopsy results showed a high percentage of benign diagnoses and informed treatment decisions in most patients.
PubMed: 38398226
DOI: 10.3390/cancers16040835