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Sørensen TM, Scahill K, Ruperez JE, Olejnik M, Swinbourne F, Verwilghen DR, Nolff MC, Baines S, Marques C, Vilen A, Duarte EL, Dias M, Dewulf S, Wichtowska A, Valencia AC, Pelligand L, Broens EM, Toutain PL, Alishani M, Brennan ML, Weese JS, Jessen LR, Allerton F. Antimicrobial prophylaxis in companion animal surgery: A scoping review for European Network for Optimization of Antimicrobial Therapy (ENOVAT) guidelines. Vet J 2024; 304:106101. [PMID: 38490359 DOI: 10.1016/j.tvjl.2024.106101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 03/09/2024] [Accepted: 03/10/2024] [Indexed: 03/17/2024]
Abstract
Surgical antimicrobial prophylaxis (SAP) is widely used to reduce the risk of surgical site infections (SSI), but there is uncertainty as to what the proportion of SSI reduction is. Therefore, it is difficult for surgeons to properly weigh the costs, risks and benefits for individual patients when deciding on the use of SAP, making it challenging to promote antimicrobial stewardship in primary practice settings. The objective of this study was to map the veterinary evidence focused on assessing the effect of SAP on SSI development and in order to identify surgical procedures with some research evidence and possible knowledge gaps. In October 2021 and December 2022, Scopus, CAB Abstracts, Web of Science Core Collection, Embase and MEDLINE were systematically searched. Double blinded screening of records was performed to identify studies in companion animals that reported on the use of SAP and SSI rates. Comparative data were available from 34 out of 39123 records screened including: eight randomised controlled trials (RCT), 23 cohort studies (seven prospective and 16 retrospective) and three retrospective case series representing 12476 dogs and cats in total. Extracted data described peri- or post-operative SAP in nine, and 25 studies, respectively. In the eight RCTs evaluating SAP in companion animals, surgical procedure coverage was skewed towards orthopaedic stifle surgeries in referral settings and there was large variation in SAP protocols, SSI definitions and follow-up periods. More standardized data collection and agreement of SSI definitions is needed to build stronger evidence for optimized patient care.
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Affiliation(s)
- T M Sørensen
- Department of Veterinary Clinical Sciences, University of Copenhagen, Dyrlaegevej 16, Frederiksberg C 1870, Denmark; ESCMID Study Group for Veterinary Microbiology (ESGVM), Basel, Switzerland.
| | - K Scahill
- College of Medicine and Veterinary Medicine, University of Edinburgh, 49 Little France Crescent, Edinburgh EH16 4SB, United Kingdom; Evidensia Södra Djursjukhuset Kungens Kurva, Månskärarvägen 13, Kungens Kurva 14175, Sweden; ESCMID Study Group for Veterinary Microbiology (ESGVM), Basel, Switzerland
| | - J Espinel Ruperez
- College of Veterinary Medicine, Murdoch University, Murdoch, Perth, WA 6150, Australia
| | - M Olejnik
- Department of Fundamental and Preclinical Sciences, Nicolaus Copernicus University, Jurija Gagarina 11, Toruń 87-100, Poland
| | - F Swinbourne
- Lumbry Park Veterinary Specialists, Selborne Rd, Alton GU34 3HL, United Kingdom
| | - D R Verwilghen
- Sydney School of Veterinary Science, University of Sydney, Regimental Dr, Camperdown, NSW 2050, Australia
| | - M C Nolff
- Clinic for Small Animal Surgery, Vetsuisse Faculty, University Zürich, Winterthurerstrasse 260, TFA 01.51, Zürich 8057, Switzerland
| | - S Baines
- Willows Veterinary Centre & Referral Service, Solihull B90 4NH, United Kingdom
| | - C Marques
- Universidade Lusófona de Humanidades e Tecnologias, Campo Grande 376, Lisboa 1749-024, Portugal; Centre for Interdisciplinary Research in Animal Health (CIISA), Faculty of Veterinary Medicine, University of Lisbon, Tapada da Ajuda, Lisboa, Portugal
| | - A Vilen
- AniCura Landskrona Smådjursklinik, Föreningsgatan 165, Landskrona 261 51, Sweden
| | - E L Duarte
- Mediterranean Institute for Agriculture, Environment and Development & Departamento de Medicina Veterinária, Escola de Ciências e Tecnologia, Universidade de Évora, Universidade de Évora, Pólo da Mitra Apartado 94, Évora 7006-554, Portugal; ESCMID Study Group for Veterinary Microbiology (ESGVM), Basel, Switzerland
| | - M Dias
- Mediterranean Institute for Agriculture, Environment and Development & Departamento de Medicina Veterinária, Escola de Ciências e Tecnologia, Universidade de Évora, Universidade de Évora, Pólo da Mitra Apartado 94, Évora 7006-554, Portugal
| | - S Dewulf
- Veterinary Epidemiology Unit, Faculty of Veterinary Medicine, Ghent University, Gebouw D4, Salisburylaan 133, Merelbeke, Ghent 9820, Belgium
| | - A Wichtowska
- Department of Fundamental and Preclinical Sciences, Nicolaus Copernicus University, Jurija Gagarina 11, Toruń 87-100, Poland
| | - A Carranza Valencia
- Department of Clinical Veterinary Medicine, Vetsuisse Faculty, Bern University, Länggassstrasse 120, Bern 3012, Switzerland
| | - L Pelligand
- Dept. Comparative Biomedical Sciences, The Royal Veterinary College, University of London, 4 Royal College St, London NW1 0TU, United Kingdom; ESCMID Study Group for Veterinary Microbiology (ESGVM), Basel, Switzerland
| | - E M Broens
- Faculty of Veterinary Medicine, Utrecht University, Yalelaan 1, Utrecht 3584 CL, the Netherlands; ESCMID Study Group for Veterinary Microbiology (ESGVM), Basel, Switzerland
| | - P L Toutain
- Dept. Comparative Biomedical Sciences, The Royal Veterinary College, University of London, 4 Royal College St, London NW1 0TU, United Kingdom; INTHERES, Université de Toulouse, INRAE, ENVT, 23 Chem. des Capelles Entrée n°1, Toulouse 31300, France
| | - M Alishani
- Department of Veterinary Medicine, Faculty of Agriculture and Veterinary, University of Prishtina "Hasan Prishtina", Prishtina 10 000, Kosovo
| | - M L Brennan
- Centre for Evidence-based Veterinary Medicine, The University of Nottingham, Loughborough LE12 5RD, United Kingdom
| | - J S Weese
- Dept of Pathobiology, Ontario Veterinary College, University of Guelph, 419 Gordon St, Guelph, ON N1G 2W1, Canada
| | - L R Jessen
- Department of Veterinary Clinical Sciences, University of Copenhagen, Dyrlaegevej 16, Frederiksberg C 1870, Denmark; ESCMID Study Group for Veterinary Microbiology (ESGVM), Basel, Switzerland
| | - F Allerton
- Willows Veterinary Centre & Referral Service, Solihull B90 4NH, United Kingdom
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Ossowska M, Picornell JA, Finotello R, Amores-Fuster I, Tanis JB. Pre-operative neoadjuvant vinblastine-prednisolone in canine mast cell tumours: A single-centre retrospective cohort study. Vet Comp Oncol 2023; 21:447-459. [PMID: 37183272 DOI: 10.1111/vco.12904] [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: 01/22/2023] [Revised: 04/24/2023] [Accepted: 04/26/2023] [Indexed: 05/16/2023]
Abstract
Neoadjuvant chemotherapy can be used in canine mast cell tumours (MCTs) to optimise surgical margins or to enable marginal excision in challenging locations. The objective of this study was to describe the outcome of dogs with cutaneous and subcutaneous MCTs treated with neoadjuvant vinblastine-prednisolone (NA-VP). Records of treatment-naïve dogs with cutaneous/subcutaneous MCT that received NA-VP were reviewed including signalment, indication for NA-VP, staging results, clinical response, surgical data and histopathology reports. For dogs with post-operative follow-up ≥365 days, predictive factors for local recurrence (LR) were evaluated. Forty-four dogs were included. NA-VP was indicated to optimise surgical margins (group MARG) in 19 dogs (43.2%) and to enable surgery (group MORB) in 25 dogs (56.8%). Complete and partial response were documented in 40.9% of dogs and 30 dogs (68.2%) underwent surgery. The indication for NA-VP was significantly associated with undergoing surgery (p < .001) on multivariable analysis. Twelve (48%) and 18 dogs (94.7%) underwent surgery in the group MORB and MARG, respectively. Five dogs (16.7%) experienced wound dehiscence. Complete excision was achieved in 14 dogs (46.7%). In dogs undergoing surgery with ≥365 days of follow-up, LR was documented in five cases (20.8%). None of the factors analysed including mitotic count, completeness of excision and response to NA-VP were associated with LR; notably, LR occurred in 3/11 (27.2%) completely excised MCTs. In a pre-operative setting, NA-VP appears safe and could be beneficial in selected cases. Prognostic factors such as clinical response, mitotic count and completeness of excision should be interpreted with caution following NA-VP.
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Affiliation(s)
- Małgorzata Ossowska
- Department of Small Animal Clinical Sciences, Institute of Veterinary Science, University of Liverpool, Neston, UK
| | - Jose Alvarez Picornell
- Department of Small Animal Clinical Sciences, Institute of Veterinary Science, University of Liverpool, Neston, UK
| | - Riccardo Finotello
- Department of Small Animal Clinical Sciences, Institute of Veterinary Science, University of Liverpool, Neston, UK
- Department of Veterinary Medicine, University of Bari, Valenzano, Italy
| | - Isabel Amores-Fuster
- Department of Small Animal Clinical Sciences, Institute of Veterinary Science, University of Liverpool, Neston, UK
| | - Jean-Benoit Tanis
- Department of Small Animal Clinical Sciences, Institute of Veterinary Science, University of Liverpool, Neston, UK
- Department of Molecular & Clinical Cancer Medicine, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK
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Haine DL, Pittaway R, Berlato D, Demetriou J. Incomplete histological margins following planned narrow excision of canine appendicular soft tissue sarcomas and mast cell tumors, using the residual tumor classification scheme. Vet Surg 2022; 51:1078-1086. [PMID: 35830150 PMCID: PMC9912198 DOI: 10.1111/vsu.13852] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 05/27/2022] [Accepted: 06/15/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To describe the frequency of incomplete histological margins following planned narrow excision (PNE) of mast cell tumors (MCTs) and soft tissue sarcomas (STSs), and to assess the residual tumor classification (R) scheme for reporting histological margins in clinical cases. STUDY DESIGN Retrospective clinical study. SAMPLE POPULATION Forty-four client-owned dogs with 47 masses. METHODS Medical records of dogs undergoing planned narrow excision of STSs and MCTs were reviewed (2016-2019). Histologic specimens were reviewed by a single pathologist and assigned R scoring (histologically incomplete/R1 margins defined as "tumor on ink"). RESULTS Six out of 23 (26%) MCT PNEs and 10/42 (42%) of STS PNEs resulted in R1 margins. R1 margins were more likely when performing PNE with 6-10 mm lateral measured surgical margins (LMSMs) versus 0-5 mm LMSM for MCTs (1/14 vs 5/9), but not STSs (3/7 vs 7/17) (P = .049). The R scheme resulted in higher retrospective percentage agreement in histological reporting than defining incomplete histological margin as tumor cells within ≤1 mm of the margin (83% vs 68% agreement). Complications occurred in 12/47 surgeries, with none requiring additional surgery. Tumors recurred in 3/18 (17%) STSs and 2/18 (11%) MCTs. CONCLUSION Fewer R1 margins were obtained when PNE with LMSM of 6-10 mm was performed for mast cell tumors. The use of the R scheme increased agreement in histopathological margin assessment. CLINICAL SIGNIFICANCE Planned narrow excision is a viable technique for histopathological diagnosis of appendicular soft tissue sarcomas and mast cell tumors for limb salvage.
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Affiliation(s)
- David L. Haine
- Cave Veterinary Specialists, part of Linnaeus Veterinary Limited
| | | | - Davide Berlato
- AniCura Animal Oncology and Imaging CenterHünenbergSwitzerland
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Evaluation of Tumor Grade and Proliferation Indices before and after Short-Course Anti-Inflammatory Prednisone Therapy in Canine Cutaneous Mast Cell Tumors: A Pilot Study. Vet Sci 2022; 9:vetsci9060277. [PMID: 35737330 PMCID: PMC9227510 DOI: 10.3390/vetsci9060277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 05/30/2022] [Accepted: 06/03/2022] [Indexed: 11/30/2022] Open
Abstract
Glucocorticoid administration is a common clinical practice that attempts to decrease the inflammation associated with and improve the resectability of canine mast cell tumors (MCTs). However, the impact of neoadjuvant glucocorticoids on the histological features and proliferation indices of canine MCTs is unknown. The objective of this study was to evaluate changes in tumor grade, mitotic count, Ki67, AgNOR, and AgNORxKi67 scores following short-course anti-inflammatory neoadjuvant prednisone in canine patients with MCTs. This was a prospective single-arm pilot study. Client-owned dogs with treatment-naïve cytologically confirmed MCTs were enrolled. Patients underwent an initial incisional biopsy followed by a 10–14-day course of anti-inflammatory prednisone and surgical resection. All histological samples were randomized, masked, and evaluated by a single pathologist. Unstained paired pre- and post-treatment samples were submitted to a commercial laboratory for Ki67 and AgNOR immunohistochemical analysis. There were 11 dogs enrolled with 11 tumors. There were no statistical differences between the pre- and post-treatment histological parameters of mitotic index, Ki67, AgNOR, or Ki67xAgNOR. There were no clinically significant alterations between pre-treatment and post-treatment in the assignment of tumor grades. A short course of anti-inflammatory prednisone does not appear to alter the histological parameters that affect grade determination or significantly alter the proliferation indices in canine MCTs.
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