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Mufty H, Houthoofd S, Daenens K, Maes R, Fourneau I. The Role of the Omniflow II Biosynthetic Graft in Postoperative Wound Problems After Lower Limb Revascularization: A Single Center Prospective Registry. Ann Vasc Surg 2024; 108:179-186. [PMID: 38950853 DOI: 10.1016/j.avsg.2024.04.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Revised: 04/12/2024] [Accepted: 04/29/2024] [Indexed: 07/03/2024]
Abstract
OBJECTIVE To investigate the role of the Omniflow II prosthesis in the prevention of vascular graft infection (VGI) in patients with peripheral arterial disease and to report on short-and mid-term graft-related morbidity. MATERIAL AND METHODS Patients were included in prospective registry between October 2019 and March 2023. The primary endpoint was to report infection-related problems, operation-related wound problems, and short- and mid-term graft-related morbidity. Secondary endpoint was to report the bypass patency rates and limb salvage rates. RESULTS A total of 146 Omniflow II grafts were implanted in 125 patients. Sixty-seven patients (45.9%) received a femoral interposition graft, and 77 patients (52.7%) underwent ipsilateral bypass surgery (femoropopliteal or femorocrural). Forty-one patients (28.1%) underwent crural bypass surgery. Seventy-six patients (52.1%) had previous vascular operation in the groin. The mean follow-up time was 352 days (range 0-1108 days). 3.4% of the patients suffered a wound infection limited to the dermis, and in 8.2%, the subcutaneous tissue was involved. Five early VGI (3.4%) and one late VGI (0.7%) occurred. One year primary patency rate of above-the-knee bypass was significantly better compared to the bypass below the knee (74.5% ± 0.131 versus 54% ± 0.126 (P = 0.049)). This difference was not significantly different when below-the-knee bypass surgery was compared with crural bypass surgery (54% ± 0.126 versus 23.8% ± 0.080 (P = 0.098)). CONCLUSIONS The performance of the Omniflow II prosthesis in the preventive setting is highly influenced by the anatomic location of the distal anastomosis. No influence on the incidence of postoperative wound problems could be observed. The rate of Omniflow II VGI in a high-risk population is similar to reported outcomes in other prosthetic grafts.
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Affiliation(s)
- Hozan Mufty
- Department of Vascular Surgery, University Hospitals Leuven, Leuven, Belgium; Department of Cardiovascular Sciences, Research Unit of Vascular Surgery, KU Leuven, Leuven, Belgium.
| | - Sabrina Houthoofd
- Department of Vascular Surgery, University Hospitals Leuven, Leuven, Belgium; Department of Cardiovascular Sciences, Research Unit of Vascular Surgery, KU Leuven, Leuven, Belgium
| | - Kim Daenens
- Department of Vascular Surgery, University Hospitals Leuven, Leuven, Belgium; Department of Cardiovascular Sciences, Research Unit of Vascular Surgery, KU Leuven, Leuven, Belgium
| | - Raf Maes
- Department of Vascular Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Inge Fourneau
- Department of Vascular Surgery, University Hospitals Leuven, Leuven, Belgium; Department of Cardiovascular Sciences, Research Unit of Vascular Surgery, KU Leuven, Leuven, Belgium
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Oulkadi S, Lam SW, Jardinet T. Lymphangiography Using Water-Soluble Contrast Media and Cone-Beam CT-Guided Sclerotherapy to Treat Infrainguinal Lymphatic Leak. AJR Am J Roentgenol 2024:1-2. [PMID: 38864698 DOI: 10.2214/ajr.24.31482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2024]
Affiliation(s)
- Sanad Oulkadi
- Department of Radiology, Universitair Ziekenhuis Antwerpen, Drie Eikenstraat 655, Edegem 2650, Belgium
| | - Siu W Lam
- Department of Radiology, Universitair Ziekenhuis Antwerpen, Drie Eikenstraat 655, Edegem 2650, Belgium
| | - Thomas Jardinet
- Department of Radiology, Universitair Ziekenhuis Antwerpen, Drie Eikenstraat 655, Edegem 2650, Belgium
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Sotelo R, Sayegh AS, Medina LG, Perez LC, La Riva A, Eppler MB, Gaona J, Tobias-Machado M, Spiess PE, Pettaway CA, Lima Pompeo AC, Lima Mattos PA, Wilson TG, Villoldo GM, Chung E, Samaniego A, Ornellas AA, Pinheiro V, Brazão ES, Subira-Rios D, Koifman L, Zequi SDC, Pontillo Z HM, Rodrigues Calixto JDR, Campos Silva R, Smithers BM, Garzon S, Haase O, Sommariva A, Fruscio R, Martins F, de Oliveira PS, Levi Sandri GB, Clementi M, Astigueta J, Metwally IH, Bharathan R, Jindal T, Nakamura Y, Abdel Mageed H, Jeevarajan S, Rodriguez Lay R, García-Perdomo HA, Rodríguez González O, Ghodoussipour S, Gill I, Cacciamani GE. Complications and adverse events in lymphadenectomy of the inguinal area: worldwide expert consensus. BJS Open 2024; 8:zrae056. [PMID: 38987232 PMCID: PMC11236483 DOI: 10.1093/bjsopen/zrae056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 04/01/2024] [Accepted: 04/09/2024] [Indexed: 07/12/2024] Open
Abstract
BACKGROUND Inguinal lymph node dissection plays an important role in the management of melanoma, penile and vulval cancer. Inguinal lymph node dissection is associated with various intraoperative and postoperative complications with significant heterogeneity in classification and reporting. This lack of standardization challenges efforts to study and report inguinal lymph node dissection outcomes. The aim of this study was to devise a system to standardize the classification and reporting of inguinal lymph node dissection perioperative complications by creating a worldwide collaborative, the complications and adverse events in lymphadenectomy of the inguinal area (CALI) group. METHODS A modified 3-round Delphi consensus approach surveyed a worldwide group of experts in inguinal lymph node dissection for melanoma, penile and vulval cancer. The group of experts included general surgeons, urologists and oncologists (gynaecological and surgical). The survey assessed expert agreement on inguinal lymph node dissection perioperative complications. Panel interrater agreement and consistency were assessed as the overall percentage agreement and Cronbach's α. RESULTS Forty-seven experienced consultants were enrolled: 26 (55.3%) urologists, 11 (23.4%) surgical oncologists, 6 (12.8%) general surgeons and 4 (8.5%) gynaecology oncologists. Based on their expertise, 31 (66%), 10 (21.3%) and 22 (46.8%) of the participants treat penile cancer, vulval cancer and melanoma using inguinal lymph node dissection respectively; 89.4% (42 of 47) agreed with the definitions and inclusion as part of the inguinal lymph node dissection intraoperative complication group, while 93.6% (44 of 47) agreed that postoperative complications should be subclassified into five macrocategories. Unanimous agreement (100%, 37 of 37) was achieved with the final standardized classification system for reporting inguinal lymph node dissection complications in melanoma, vulval cancer and penile cancer. CONCLUSION The complications and adverse events in lymphadenectomy of the inguinal area classification system has been developed as a tool to standardize the assessment and reporting of complications during inguinal lymph node dissection for the treatment of melanoma, vulval and penile cancer.
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Affiliation(s)
- René Sotelo
- Catherine and Joseph Aresty Department of Urology, University of Southern California Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Aref S Sayegh
- Catherine and Joseph Aresty Department of Urology, University of Southern California Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
- Department of Surgery, MedStar Franklin Square Medical Center, Baltimore, Maryland, USA
| | - Luis G Medina
- Catherine and Joseph Aresty Department of Urology, University of Southern California Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Laura C Perez
- Catherine and Joseph Aresty Department of Urology, University of Southern California Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Anibal La Riva
- Catherine and Joseph Aresty Department of Urology, University of Southern California Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
- Department of General Surgery, Digestive Disease & Surgery Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Michael B Eppler
- Catherine and Joseph Aresty Department of Urology, University of Southern California Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - José Gaona
- Universidad de Santander, Instituto Uromédica, Bucaramanga, Colombia
| | - Marcos Tobias-Machado
- Department of Urology, Instituto do Câncer Arnaldo Vieira de Carvalho, São Paulo, Brazil
| | - Philippe E Spiess
- Department of Genitourinary Oncology and Tumor Biology, Moffitt Cancer Center, Tampa, Florida, USA
| | - Curtis A Pettaway
- The University of Texas, M.D. Anderson Cancer Center, Houston, Texas, USA
| | | | | | - Timothy G Wilson
- Department of Urology, Providence St. John’s Cancer Institute, Santa Monica, California, USA
| | - Gustavo M Villoldo
- Department of Urology, Instituto Alexander Fleming, Buenos Aires, Argentina
| | - Eric Chung
- Department of Urology, Princess Alexandra Hospital, University of Queensland, Brisbane, Queensland, Australia
| | - Aldo Samaniego
- Department of Urology, Servicio de Urología del Hospital Central del Instituto de Previsión Social, Asunción, Paraguay
| | | | | | - Eder S Brazão
- Department of Urology, AC Camargo Cancer Center, São Paulo, Brazil
| | - David Subira-Rios
- Department of Urology, Gregorio Marañon Universitary Hospital, Madrid, Spain
| | - Leandro Koifman
- Serviço de Urologia, Hospital Municipal Souza Aguiar, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Stênio de Cassio Zequi
- Department of Urology, AC Camargo Cancer Center-São Paulo, São Paulo, Brazil
- Department of Urology, National Institute for Science and Technology in Oncogenomics and Therapeutic Innovation, São Paulo, Brazil
- Graduate School of Urology, Escola Paulista de Medicina-Universidade Federal de São Paulo, São Paulo, Brazil
| | | | | | - Rafael Campos Silva
- Department of Urology, Hospital Universitário Presidente Dutra—HUPD/UFMA, São Luís, Maranhão, Brazil
| | - B Mark Smithers
- University of Queensland, Queensland Melanoma Project, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Simone Garzon
- Department of Surgery, Dentistry, Pediatrics, and Gynecology, University of Verona, Verona, Italy
| | - Oliver Haase
- Department of Surgery, University Medicine Berlin—Charité, Berlin, Germany
| | - Antonio Sommariva
- Veneto Institute of Oncology Institute Oncology Veneto, Istituto Di Ricovero e Cura a Carattere Scientifico, Padova, Italy
| | - Robert Fruscio
- Department of Medicine and Surgery, University of Milan Bicocca, Azienda Socio Sanitaria Territoriale Monza, Italy
| | - Francisco Martins
- Department of Urology, Centro Hospitalar Universitário Lisboa Norte, Hospital de Santa Maria, Lisbon, Portugal
| | - Pedro S de Oliveira
- Department of Urology, Centro Hospitalar Universitário Lisboa Norte, Hospital de Santa Maria, Lisbon, Portugal
| | | | - Marco Clementi
- Department of Medicine, Health and Life, University of L'Aquila, L'Aquila, AQ, Italy
| | - Juan Astigueta
- Department of Urology, Universidad Privada Antenor Orrego, Trujillo, Perú
| | - Islam H Metwally
- Surgical Oncology Department, Oncology Center Mansoura University (OCMU), Mansoura, Egypt
| | - Rasiah Bharathan
- Department of Gynaecological Oncology, Medical University of Vienna, Vienna, Austria
| | - Tarun Jindal
- Department of Uro-oncology, Narayana Super Speciality Hospital, Howrah, India
| | - Yasuhiro Nakamura
- Department of Skin Oncology/Dermatology, Saitama Medical University International Medical Center, Saitama, Japan
| | - Hisham Abdel Mageed
- Surgical Oncology Department, National Cancer Institute Cairo University, Cairo, Egypt
| | | | | | - Herney Andrés García-Perdomo
- Division of Urology/Urooncology, Department of Surgery, School of Medicine, Universidad del Valle, Cali, Colombia
| | - Omaira Rodríguez González
- Chief of Surgical Department, Clínicas Caracas Hospital, Faculty of Medicine, Central University of Venezuela, Caracas, Venezuela
| | - Saum Ghodoussipour
- Sections of Urologic Oncology, Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Inderbir Gill
- Catherine and Joseph Aresty Department of Urology, University of Southern California Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Giovanni E Cacciamani
- Catherine and Joseph Aresty Department of Urology, University of Southern California Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
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Ji H, Hu C, Yang X, Liu Y, Ji G, Ge S, Wang X, Wang M. Lymph node metastasis in cancer progression: molecular mechanisms, clinical significance and therapeutic interventions. Signal Transduct Target Ther 2023; 8:367. [PMID: 37752146 PMCID: PMC10522642 DOI: 10.1038/s41392-023-01576-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 07/04/2023] [Accepted: 07/26/2023] [Indexed: 09/28/2023] Open
Abstract
Lymph nodes (LNs) are important hubs for metastatic cell arrest and growth, immune modulation, and secondary dissemination to distant sites through a series of mechanisms, and it has been proved that lymph node metastasis (LNM) is an essential prognostic indicator in many different types of cancer. Therefore, it is important for oncologists to understand the mechanisms of tumor cells to metastasize to LNs, as well as how LNM affects the prognosis and therapy of patients with cancer in order to provide patients with accurate disease assessment and effective treatment strategies. In recent years, with the updates in both basic and clinical studies on LNM and the application of advanced medical technologies, much progress has been made in the understanding of the mechanisms of LNM and the strategies for diagnosis and treatment of LNM. In this review, current knowledge of the anatomical and physiological characteristics of LNs, as well as the molecular mechanisms of LNM, are described. The clinical significance of LNM in different anatomical sites is summarized, including the roles of LNM playing in staging, prognostic prediction, and treatment selection for patients with various types of cancers. And the novel exploration and academic disputes of strategies for recognition, diagnosis, and therapeutic interventions of metastatic LNs are also discussed.
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Affiliation(s)
- Haoran Ji
- Department of Thoracic Surgery, Shanghai Key Laboratory of Tissue Engineering, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China
| | - Chuang Hu
- Department of Thoracic Surgery, Shanghai Key Laboratory of Tissue Engineering, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China
| | - Xuhui Yang
- Department of Thoracic Surgery, Shanghai Key Laboratory of Tissue Engineering, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China
| | - Yuanhao Liu
- Department of Thoracic Surgery, Shanghai Key Laboratory of Tissue Engineering, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China
| | - Guangyu Ji
- Department of Thoracic Surgery, Shanghai Key Laboratory of Tissue Engineering, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China
| | - Shengfang Ge
- Department of Ophthalmology, Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Xiansong Wang
- Department of Thoracic Surgery, Shanghai Key Laboratory of Tissue Engineering, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China.
| | - Mingsong Wang
- Department of Thoracic Surgery, Shanghai Key Laboratory of Tissue Engineering, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China.
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Gerken ALH, Jawny P, Weigl H, Yang C, Hardt J, Menge F, Hohenberger P, Weiß C, Reißfelder C, Jakob J. Postoperative drainage management and wound complications following resection of lower limb soft tissue tumors: a retrospective cohort study. Langenbecks Arch Surg 2023; 408:202. [PMID: 37209306 PMCID: PMC10199851 DOI: 10.1007/s00423-023-02939-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 05/12/2023] [Indexed: 05/22/2023]
Abstract
PURPOSE Postoperative wound complications are common in patients undergoing resection of lower extremity soft tissue tumors. Postoperative drainage therapy ensures adequate wound healing but may delay or complicate it. The aim of this study is to evaluate the incidence of postoperative wound complications and delayed or prolonged drainage treatment and to propose a standardized definition and severity grading of complex postoperative courses. METHODS A monocentric retrospective analysis of 80 patients who had undergone primary resection of lower extremity soft tissue tumors was performed. A new classification was developed, which takes into account postoperative drainage characteristics and wound complications. Based on this classification, risk factors and the prognostic value of daily drainage volumes were evaluated. RESULTS According to this new definition, regular postoperative course grade 0 (no wound complication and timely drainage removal) occurred in 26 patients (32.5%), grade A (minor wound complications or delayed drainage removal) in 12 (15.0%), grade B (major wound complication or prolonged drainage therapy) in 31 (38.8%), and grade C (reoperation) in 11 (13.7%) patients. Tumor-specific characteristics, such as tumor size (p = 0.0004), proximal tumor location (p = 0.0484), and tumor depth (p = 0.0138) were identified as risk factors for complex postoperative courses (grades B and C). Drainage volume on postoperative day 4 was a suitable predictor for complex courses (cutoff of 70 ml/d). CONCLUSION The proposed definition incorporates wound complications and drainage management while also being clinically relevant and easy to apply. It may serve as a standardized endpoint for assessing the postoperative course after resection of lower extremity soft tissue tumors.
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Affiliation(s)
- A L H Gerken
- Department of Surgery, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - P Jawny
- Department of Surgery, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- Department of Cardiothoracic Surgery, University Hospital Augsburg, Medical Faculty Augsburg, Augsburg University, Augsburg, Germany
| | - H Weigl
- Department of Surgery, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - C Yang
- Department of Surgery, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - J Hardt
- Department of Surgery, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - F Menge
- Sarcoma Unit, Department of Surgery, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Theodor Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - P Hohenberger
- Sarcoma Unit, Department of Surgery, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Theodor Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - C Weiß
- Department of Biometry and Statistics, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - C Reißfelder
- Department of Surgery, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- DKFZ-Hector Cancer Institute, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - J Jakob
- Sarcoma Unit, Department of Surgery, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Theodor Kutzer-Ufer 1-3, 68167, Mannheim, Germany.
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Perioperative and oncologic outcomes of laparoscopic versus open liver resection for combined hepatocellular-cholangiocarcinoma: a propensity score matching analysis. Surg Endosc 2023; 37:967-976. [PMID: 36076103 DOI: 10.1007/s00464-022-09579-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 08/12/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND Laparoscopic liver resection (LLR) has now been established as a safe and minimally invasive technique that is deemed feasible for treating hepatocellular carcinoma (HCC) and intrahepatic cholangiocarcinoma (ICC). However, the role of LLR in treating combined hepatocellular-cholangiocarcinoma (cHCC-CC) patients has been rarely reported. This study aimed to assess the efficacy of LLR when compared with open liver resection (OLR) procedure for patients with cHCC-CC. METHODS A total of 229 cHCC-CC patients who underwent hepatic resection (34 LLR and 195 OLR patients) from January 2014 to December 2018 in Zhongshan Hospital, Fudan University were enrolled and underwent a 1:2 propensity score matching (PSM) analysis between the LLR and OLR groups to compare perioperative and oncologic outcomes. Overall survival (OS) and recurrence-free survival (RFS) parameters were assessed by the log-rank test and the sensitivity analysis. RESULTS A total of 34 LLR and 68 OLR patients were included after PSM analysis. The LLR group displayed a shorter postoperative hospital stay (6.61 vs. 8.26 days; p value < 0.001) when compared with the OLR group. No significant differences were observed in the postoperative complications' incidence or a negative surgical margin rate between the two groups (p value = 0.409 and p value = 1.000, respectively). The aspartate aminotransferase (AST), alanine aminotransferase (ALT), and inflammatory indicators in the LLR group were significantly lower than those in the OLR group on the first and third postoperative days. Additionally, OS and RFS were comparable in both the LLR and OLR groups (p value = 0.700 and p value = 0.780, respectively), and similar results were obtained by conducting a sensitivity analysis. CONCLUSION LLR can impart less liver function damage, better inflammatory response attenuation contributing to a faster recovery, and parallel oncologic outcomes when compared with OLR. Therefore, LLR can be recommended as a safe and effective therapeutic modality for treating selected cHCC-CC patients, especially for those with small tumors in favorable location.
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Walensi M, Juntermanns B, Hoffmann JN. Postoperative lymphatische Komplikationen der Leistenregion in der Gefäßchirurgie. GEFÄSSCHIRURGIE 2022. [DOI: 10.1007/s00772-022-00953-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
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Hardt JL, Merkow RP, Reissfelder C, Rahbari NN. Quality assurance and quality control in surgical oncology. J Surg Oncol 2022; 126:1560-1572. [PMID: 35994027 DOI: 10.1002/jso.27074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 08/10/2022] [Indexed: 11/09/2022]
Abstract
Even though surgery has remained a key component within multi-disciplinary cancer care, the expectations have changed. Instead of serving as a modality to free a patient of a mass at all means and at the risk of high morbidity, modern cancer surgery is expected to provide adequate tumor clearance with lowest invasiveness. This review summarizes the evidence on quality assurance in surgical oncology and gives a comprehensive overview of quality improvement tools.
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Affiliation(s)
- Julia L Hardt
- Department of Surgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Ryan P Merkow
- Surgical Outcomes and Quality Improvement Center, Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Christoph Reissfelder
- Department of Surgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Nuh N Rahbari
- Department of Surgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
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Lymphatic Function of the Lower Limb after Groin Dissection for Vulvar Cancer and Reconstruction with Lymphatic SCIP Flap. Cancers (Basel) 2022; 14:cancers14041076. [PMID: 35205824 PMCID: PMC8870617 DOI: 10.3390/cancers14041076] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 02/14/2022] [Accepted: 02/16/2022] [Indexed: 01/27/2023] Open
Abstract
Inguinofemoral lymphadenectomy, frequently performed for vulvar cancer, is burdened with substantial immediate and long-term morbidity. One of the most disabling treatment-related sequelae is lower limb lymphedema (LLL). The present study aims to describe the wound complications and the severity of LLL in patients who have undergone groin dissection for vulvar cancer and immediate inguinal reconstruction with the Lymphatic Superficial Circumflex Iliac Perforator flap (L-SCIP). We retrospectively reviewed the data of patients who underwent bilateral groin dissection and unilateral inguinal reconstruction with the L-SCIP. The presence and severity of postoperative LLL during the follow-up period were assessed by lymphoscintigraphy and limbs' volume measurement. In addition, immediate complications at the level of the inguinal area were registered. The changes between preoperative and postoperative limb volumes were analyzed by Student's t test. p values < 0.05 were considered significant. Thirty-one patients were included. The mean variation of volume was 479 ± 330 cc3 in the side where groin reconstruction had been performed, and 683 ± 425 cc3 in the contralateral side, showing smaller variation in the treated side (p = 0.022). Lymphoscintigraphy confirmed the clinical findings. Based on our results, inguinal reconstruction with L-SCIP performed at the same time of groin dissection in patients treated for vulvar cancer can provide a significant protective effect on LLL.
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Diagnosis and Treatment of Lymphatic Complications of the Groin Following Open Lower Extremity Revascularization with Plastic Surgery Closure. Ann Vasc Surg 2021; 82:197-205. [PMID: 34902473 DOI: 10.1016/j.avsg.2021.10.065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 09/14/2021] [Accepted: 10/23/2021] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Lymphatic complications following vascular procedures involving the groin require prompt treatment to limit morbidity. Several treatments have been described, including conservative management, aspiration, sclerotherapy, and direct lymphatic ligation with or without a muscle flap have been described. To date, there is no data indicating which treatment results in the shortest time to recovery. We sought to address this gap by conducting a retrospective cohort study. METHODS We reviewed all patients who developed a lymphatic complication after undergoing an open revascularization procedure in the groin between 2014 and 2020 in which plastic surgery was involved in the closure. A control group consisted of patients from the same timespan who did not develop a lymphatic complication. Demographics, comorbidities, operative details, and outcomes were compared between these groups. For cases identified with a lymphatic complication, the method of diagnosis, culture data, and treatment details were collected, and outcomes were compared for surgical management versus sclerotherapy. RESULTS There were 27 lymphatic complications and 60 control patients. The complication group had a higher incidence of aortofemoral bypass (25.8% vs. 8.3%, p=0.04), and a lower incidence of femoral-to-distal bypass (11.1% vs. 45.0%, p<0.01). Daily drain output volume from postoperative days 1-5, and days 6-10, was significantly higher in the complication group than in the controls (194.0 vs. 44.0, p<0.01; and 429.5 vs. 35.0, p<0.01, respectively). In the lymphatic leak group, 16 patients (59.3%) had surgical treatment and six (22.2%) had sclerotherapy. Of those who had surgery, 71.4% had successful outcomes without the need for an additional intervention, whereas all of the patients analyzed who were treated with sclerotherapy had successful outcomes without further intervention. The average time to resolution was significantly shorter for surgery than for sclerotherapy (38.7 vs. 86.0 days, p=0.03). CONCLUSIONS Daily postoperative drain volume can assist with early diagnosis of a lymphatic leak in the groin following an open revascularization procedure. Sclerotherapy and surgery were each successful, but surgery resulted in significantly shorter times to resolution. In the appropriate candidates, surgery should be considered first line management of a lymphatic leak.
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Ngoc Cuong N, Hong Canh P, Tuan Linh L, Minh Duc N, Thi Tra My T, Hoan L. Intranodal Lymphangiography and Lymphatic Embolization Treatment for Groin Lymphorrhea: A Preliminary Vietnamese Report. REPORTS IN MEDICAL IMAGING 2021. [DOI: 10.2147/rmi.s333582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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