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Purwono G, Lee YT, Chua JH, Loh AH. Systematic Lymphatic Repair for Reduction of Postoperative Lymphatic Leak Following Neuroblastoma Resection. J Pediatr Surg 2024; 59:1591-1599. [PMID: 38493026 DOI: 10.1016/j.jpedsurg.2024.02.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Accepted: 02/12/2024] [Indexed: 03/18/2024]
Abstract
BACKGROUND Gross total resection of neuroblastoma is associated with lymphatic leaks that can delay postoperative resumption of treatment. To prevent postoperative lymphatic leak, we introduced systematic lymphatic repair (SLR), which involved oversewing the entire edge of the disrupted lymphatic plane after neuroblastoma resection. We sought to study the impact of SLR on postoperative lymphatic leak and time to return to treatment. METHODS We reviewed 60 neuroblastoma patients who underwent gross total resection at KK Women's and Children's Hospital. Patient, disease, and operative factors were correlated with surgical drainage, treatment delay and length of stay (LOS). Among patients with sufficient records, the interaction between variables associated with drainage, delay and LOS outcomes were compared in 14 patients who had SLR versus 35 historical controls who had targeted lymphatic repair (TLR). RESULTS Postoperative drain duration and volume were significantly higher in tumors with ≥2 image-derived risk factors (IDRFs, P = 0.005 and P = 0.013, respectively) or vessel encasement (P = 0.031 and P = 0.024, respectively). Longer LOS was significantly associated with ≥2 IDRFs (P = 0.006). All forms of suture repair of lymphatics and use of Tachosil™ were associated with significantly longer postoperative drain duration (P < 0.05); the former was also associated with significantly higher total drain volume (P < 0.05) - indicating appropriate use of these adjuncts in patients at risk of chyle leak. In patients who had suture repair of lymphatics, SLR was significantly associated with reduced postoperative interval to chemotherapy resumption (P = 0.014, two-way ANOVA). CONCLUSION A systematic approach to repair of lymphatic channels following neuroblastoma resection can significantly reduce time to postoperative resumption of treatment. TYPE OF STUDY Clinical Research. LEVEL OF EVIDENCE III.
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Affiliation(s)
| | - York Tien Lee
- Duke-NUS Medical School, Singapore; Department of Paediatric Surgery, KK Women's and Children's Hospital, Singapore; VIVA-KKH Paediatric Brain and Solid Tumour Programme, KKH Children's Blood and Cancer Centre, KK Women's and Children's Hospital, Singapore
| | - Joyce Hy Chua
- Department of Paediatric Surgery, KK Women's and Children's Hospital, Singapore
| | - Amos Hp Loh
- Duke-NUS Medical School, Singapore; Department of Paediatric Surgery, KK Women's and Children's Hospital, Singapore; VIVA-KKH Paediatric Brain and Solid Tumour Programme, KKH Children's Blood and Cancer Centre, KK Women's and Children's Hospital, Singapore.
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2
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Polamraju P, Oliphant M, Aribindi S, Ponnatapura J. Navigating the labyrinth of peritoneal and extraperitoneal anatomy: abdominal spread made easy with a case based review. Abdom Radiol (NY) 2024:10.1007/s00261-024-04429-y. [PMID: 38904709 DOI: 10.1007/s00261-024-04429-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: 03/28/2024] [Revised: 05/29/2024] [Accepted: 05/30/2024] [Indexed: 06/22/2024]
Abstract
Essential to understanding disease spread in abdomen is to separate the peritoneum from the extraperitoneum. These areas have distinct anatomy with well-define separate pathways. The peritoneum is comprised of connected recesses that are potential spaces, normally not imaged except when containing excess fluid or air. Peritoneal recesses are formed by the opposing peritoneal surfaces and subdivided by the attachments of the ligaments and mesenteries to the parietal peritoneum. Disease flows within the recesses by changes in abdominal pressure. This forms a distinct spread pattern. The extraperitoneum is traditionally stratified by the renal fascia into the anterior and posterior pararenal spaces and the perirenal space. The fascia contains and directs spread from the contained organs with the compartments. Each space has a unique spread pattern defined by the containing fascia. The extraperitoneum is connected to the mesenteries and ligaments forming the subperitoneal space. This space interconnects the extraperitoneum with the mesenteries allowing for the normal continuum of blood vessels, lymphatics, and nerves but also forms the pathways for bidirectional spread of disease.
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Affiliation(s)
- Praveen Polamraju
- Department of Diagnostic Radiology, Wake Forest University School of Medicine, 1, Medical Center Blvd, Winston Salem, NC, 27157, USA
| | - Michael Oliphant
- Department of Diagnostic Radiology, Wake Forest University School of Medicine, 1, Medical Center Blvd, Winston Salem, NC, 27157, USA
| | - Swetha Aribindi
- Department of Diagnostic Radiology, Wake Forest University School of Medicine, 1, Medical Center Blvd, Winston Salem, NC, 27157, USA
| | - Janardhana Ponnatapura
- Department of Diagnostic Radiology, Wake Forest University School of Medicine, 1, Medical Center Blvd, Winston Salem, NC, 27157, USA.
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Brown IS, Sokolova A, Rosty C, Graham RP. Cystic lesions of the retrorectal space. Histopathology 2023; 82:232-241. [PMID: 35962741 DOI: 10.1111/his.14769] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 08/03/2022] [Accepted: 08/09/2022] [Indexed: 12/24/2022]
Abstract
Cysts of the retrorectal space comprise a heterogeneous group of rare lesions. Most develop from embryological remnants and include tailgut cysts, dermoid cysts, rectal duplication cysts, anal canal duplication cysts, sacrococcygeal teratomas and anterior meningocoele. Tailgut cyst is the most common cyst of developmental origin, usually presenting as a multilocular cystic mass with mucoid content and lined by multiple epithelial types. Compared with tailgut cysts, rectal duplication cysts display all layers of the large bowel wall including a well-defined muscularis propria. Retrorectal cysts of non-developmental origin are far less common and represent lesions that either infrequently involve the retrorectal space or undergo extensive cystic change. This review provides an overview of the various histological types of cystic lesions of the retrorectal space, divided into cysts of developmental origin and those of non-developmental origin. A practical pathological and multidisciplinary approach to diagnosing these lesions is presented.
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Affiliation(s)
- Ian S Brown
- Envoi Specialist Pathologists, Brisbane, Queensland, Australia.,Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.,University of Queensland, Brisbane, Queensland, Australia
| | - Anna Sokolova
- Sullivan Nicolaides Pathology, Brisbane, Queensland, Australia
| | - Christophe Rosty
- Envoi Specialist Pathologists, Brisbane, Queensland, Australia.,University of Queensland, Brisbane, Queensland, Australia
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Livani A, Angelis S, Skandalakis PN, Filippou D. The Story Retold: The Kocher Manoeuvre. Cureus 2022; 14:e29409. [PMID: 36304342 PMCID: PMC9586190 DOI: 10.7759/cureus.29409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/21/2022] [Indexed: 11/05/2022] Open
Abstract
The Kocher manoeuvre is used for mobilization of the duodenum and head of the pancreas and bears the name of Theodor Kocher, who published it in 1903. We describe the embryology of the duodenum and pancreas, relating it to surgical anatomy applied during the procedure. Finally, we present the key points of the procedure, providing more insights into the anatomical structures that are mainly involved.
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Affiliation(s)
- Anastasia Livani
- Department of Surgery, Agia Sophia Children's Hospital, Athens, GRC
- Department of Anatomy and Surgical Anatomy, Medical School, National and Kapodistrian University of Athens, Athens, GRC
| | - Stavros Angelis
- Department of Anatomy and Surgical Anatomy, Medical School, National and Kapodistrian University of Athens, Athens, GRC
| | - Panagiotis N Skandalakis
- Department of Anatomy and Surgical Anatomy, Medical School, National and Kapodistrian University of Athens, Athens, GRC
| | - Dimitrios Filippou
- Department of Anatomy and Surgical Anatomy, Medical School, National and Kapodistrian University of Athens, Athens, GRC
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5
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Abstract
Objective:to conduct a systematic literature review of the published studies on retroperitoneal non-organ liposarcomas.Material and Methods.A literature search was performed using Pubmed, Elibrary, COSMIC databases. The data of retrospective and prospective clinical trials were analyzed. Results. The article reviews contemporary data on epidemiology, classification, clinicalmorphological and molecular-genetic characteristics, as well as diagnosis and treatment of retroperitoneal non-organ liposarcomas. Conclusion. Retroperitoneal sarcomas account for about 13 % of all types of soft tissue sarcomas. Liposarcoma is the most common retroperitoneal mesenchymal tumor. Diagnosis and treatment of non-organ retroperitoneal liposarcoma remain challenging due to poor long-term treatment outcomes. As experience is gained with the diagnosis and treatment of retroperitoneal nonorganic liposarcomas, changes occur in the system of understanding the problem that determines the strategy for providing medical care in this category of patients. The article presents modern concept of retroperitoneal non-organ liposarcomas.
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Affiliation(s)
- A. Yu. Volkov
- N. N. Blokhin National Medical Research Centre of Oncology, Health Ministry of Russia
| | - S. N. Nered
- N. N. Blokhin National Medical Research Centre of Oncology, Health Ministry of Russia
| | - L. N. Lyubchenko
- N. N. Blokhin National Medical Research Centre of Oncology, Health Ministry of Russia; I.M. Sechenov First Moscow State Medical University, Ministry of Health of the Russian Federation
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Roncati L, Manenti A, Gallo G, Bernardelli G, Farinetti A. Prognostic Elements of Portal Vein Thrombosis. Ann Vasc Surg 2019; 65:e307-e308. [PMID: 31639482 DOI: 10.1016/j.avsg.2019.10.035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 10/11/2019] [Accepted: 10/13/2019] [Indexed: 02/07/2023]
Affiliation(s)
- Luca Roncati
- Department of Pathology, University of Modena, Polyclinic Hospital, Modena, Italy
| | - Antonio Manenti
- Department of Surgery, University of Modena, Polyclinic Hospital, Modena, Italy.
| | - Graziana Gallo
- Department of Pathology, University of Modena, Polyclinic Hospital, Modena, Italy
| | - Giuditta Bernardelli
- Department of Pathology, University of Modena, Polyclinic Hospital, Modena, Italy
| | - Alberto Farinetti
- Department of Surgery, University of Modena, Polyclinic Hospital, Modena, Italy
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Impact of 3D Printing Technology on Comprehension of Surgical Anatomy of Retroperitoneal Tumor. World J Surg 2018; 42:2339-2343. [DOI: 10.1007/s00268-018-4489-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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8
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Injectate spread following anterior sub-costal and posterior approaches to the quadratus lumborum block. Eur J Anaesthesiol 2017; 34:587-595. [DOI: 10.1097/eja.0000000000000680] [Citation(s) in RCA: 86] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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9
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Contour variations of the body and tail of the pancreas: evaluation with MDCT. Jpn J Radiol 2017; 35:310-318. [DOI: 10.1007/s11604-017-0635-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Accepted: 03/16/2017] [Indexed: 01/27/2023]
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Adhikary SD, El-Boghdadly K, Nasralah Z, Sarwani N, Nixon AM, Chin KJ. A radiologic and anatomic assessment of injectate spread following transmuscular quadratus lumborum block in cadavers. Anaesthesia 2016; 72:73-79. [DOI: 10.1111/anae.13647] [Citation(s) in RCA: 72] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/14/2016] [Indexed: 11/29/2022]
Affiliation(s)
- S. D. Adhikary
- Department of Anesthesiology and Perioperative Medicine; Penn State Hershey Medical Center; Pennsylvania USA
| | - K. El-Boghdadly
- Department of Anesthesia; Toronto Western Hospital; University of Toronto; Toronto Ontario Canada
| | - Z. Nasralah
- Department of Science Education; Hofstra Northwell School of Medicine; Hempstead New York USA
| | - N. Sarwani
- Department of Radiology; Penn State Hershey Medical Center; Pennsylvania USA
| | - A. M. Nixon
- Department of Neurosurgery; Penn State College of Medicine; Pennsylvania USA
| | - K. J. Chin
- Department of Anesthesia; Toronto Western Hospital; University of Toronto; Toronto Ontario Canada
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Pulikkottil BJ, Pezeshk RA, Daniali LN, Bailey SH, Mapula S, Hoxworth RE. Lateral Abdominal Wall Defects: The Importance of Anatomy and Technique for a Successful Repair. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2015; 3:e481. [PMID: 26495194 PMCID: PMC4560214 DOI: 10.1097/gox.0000000000000439] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Accepted: 06/03/2015] [Indexed: 11/25/2022]
Abstract
Flank and lateral abdominal wall defects can be an extremely challenging phenomenon for surgeons to undertake. Their rarity and specific idiosyncrasies in regard to embryologic and anatomical characteristics must be taken into consideration when formulating an operative plan. We will discuss these cardinal points including technical recommendations by notable experts in the field to gain a better understanding in the diagnosis and treatment of this infrequent but morbid occurrence.
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Affiliation(s)
- Benson J Pulikkottil
- Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, Tex
| | - Ronnie A Pezeshk
- Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, Tex
| | - Lily N Daniali
- Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, Tex
| | - Steven H Bailey
- Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, Tex
| | - Steven Mapula
- Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, Tex
| | - Ronald E Hoxworth
- Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, Tex
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Matthyssens LE, Creytens D, Ceelen WP. Retroperitoneal liposarcoma: current insights in diagnosis and treatment. Front Surg 2015; 2:4. [PMID: 25713799 PMCID: PMC4322543 DOI: 10.3389/fsurg.2015.00004] [Citation(s) in RCA: 74] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Accepted: 01/28/2015] [Indexed: 12/15/2022] Open
Abstract
Retroperitoneal liposarcoma (RLS) is a rare, biologically heterogeneous tumor that present considerable challenges due to its size and deep location. As a consequence, the majority of patients with high-grade RLS will develop locally recurrent disease following surgery, and this constitutes the cause of death in most patients. Here, we review current insights and controversies regarding histology, molecular biology, extent of surgery, (neo)adjuvant treatment, and systemic treatment including novel targeted agents in RLS.
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Affiliation(s)
| | - David Creytens
- Department of Pathology, Ghent University Hospital , Ghent , Belgium
| | - Wim P Ceelen
- Department of Surgery, Ghent University Hospital , Ghent , Belgium
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Nelson J, Rinard K, Haynes A, Filleur S, Nelius T. Extraluminal colonic carcinoma invading into kidney: a case report and review of the literature. ISRN UROLOGY 2011; 2011:707154. [PMID: 22084803 PMCID: PMC3198615 DOI: 10.5402/2011/707154] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/28/2011] [Accepted: 03/06/2011] [Indexed: 12/03/2022]
Abstract
Renal metastasis from primary colon cancer is very rare, comprising less than 3% of secondary renal neoplasms. There are just 11 cases reported in the medical literature of colonic adenocarcinoma metastatic to the kidney. Of these cases, none occurred via direct invasion. We report a unique case of a 51-year-old female with extraluminal colonic adenocarcinoma which directly invaded into the kidney. Additionally, we investigate the causal relationship between the site of invasion and a previous stab injury by reviewing the role of the peritoneum and Gerota's fascia in preventing the spread of metastatic cancer into the perirenal space. Due to the rarity of this event, we present this case including a review of the existing literature relative to the diagnosis and treatment.
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Affiliation(s)
- J Nelson
- Department of Urology, Texas Tech University Health Sciences Center, Lubbock, TX 79430-7260, USA
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