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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:S0022-3468(24)00098-8. [PMID: 38493026 DOI: 10.1016/j.jpedsurg.2024.02.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [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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How GY, Kuick CH, Yong MH, Soh SY, Hee EX, Wong MK, Quek R, Harunal MF, Selvarajan S, Sittampalam K, Dhamne CA, Lee V, Chang KT, Loh AH. Clinicopathological and treatment response characteristics of updated rhabdomyosarcoma histomolecular subtypes: An Asian population-based study. Asia Pac J Clin Oncol 2023. [PMID: 37434429 DOI: 10.1111/ajco.13975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Revised: 06/13/2023] [Accepted: 06/18/2023] [Indexed: 07/13/2023]
Abstract
AIM New histomolecular subtypes of rhabdomyosarcoma have recently been defined but their corresponding clinical characteristics are not well described. Also, these clinical phenotypes vary greatly by age and ethnicity but have not been profiled in Asian populations. Thus, we sought to determine the landscape of rhabdomyosarcoma subtypes in a national Asian cohort and compare clinical characteristics among age groups and molecular subtypes. METHODS We performed a retrospective population-based study of all rhabdomyosarcoma patients in Singapore public hospitals from 2004 to 2014 (n = 67), and assigned histomolecular subtypes according to the updated 2020 WHO classification of soft tissue tumors following central pathology review and molecular profiling. RESULTS Age-specific prevalence followed a tri-modal peak. There were significantly more embryonal and alveolar (p = 0.032) and genitourinary (non-bladder/prostate) tumors (p = 0.033) among children. Older age was associated with complete resection among spindle cell/sclerosing tumors (p = 0.027), with the omission of chemotherapy among embryonal tumors (p = 0.001), and with poorer survival among embryonal and alveolar tumors (p = 0.026, p = 0.022, respectively). Overall survival differed with stage, group, and surgical resection, adjusted for age group (p = 0.004, p = 0.001, p = 0.004, respectively). Spindle-cell/sclerosing tumors showed an indolent phenotype with a significantly lower incidence of nodal metastasis (p = 0.002), but two of 15 patients with MYOD1 mutations had a contrastingly aggressive disease. CONCLUSION Disease and treatment response profiles of rhabdomyosarcoma subtypes vary significantly between adults and children, especially surgical resectability. In our Asian population, poorer outcomes were observed in adults with embryonal and alveolar tumors, while activating mutations influence the behavior of otherwise favorable spindle cell/sclerosing tumors.
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Affiliation(s)
- Guo Yuan How
- Department of Paediatric Surgery, KK Women's and Children's Hospital, Singapore, Singapore
| | - Chik Hong Kuick
- Department of Pathology and Laboratory Medicine, KK Women's and Children's Hospital, Singapore, Singapore
| | - Min Hwee Yong
- Department of Pathology and Laboratory Medicine, KK Women's and Children's Hospital, Singapore, Singapore
| | - Shui Yen Soh
- KK Women's and Children's Hospital, VIVA-KKH Paediatric Brain and Solid Tumour Programme, Children's Blood and Cancer Centre, Singapore, Singapore
- Department of Paediatric Subspecialties Haematology/Oncology Service, KK Women's and Children's Hospital, Singapore, Singapore, Singapore
- Duke NUS Medical School, Duke NUS Medical School, Singapore, Singapore
| | - Esther Xy Hee
- KK Women's and Children's Hospital, VIVA-KKH Paediatric Brain and Solid Tumour Programme, Children's Blood and Cancer Centre, Singapore, Singapore
| | - Meng Kang Wong
- KK Women's and Children's Hospital, VIVA-KKH Paediatric Brain and Solid Tumour Programme, Children's Blood and Cancer Centre, Singapore, Singapore
| | - Richard Quek
- Duke NUS Medical School, Duke NUS Medical School, Singapore, Singapore
- National Cancer Centre Singapore, Division of Medical Oncology, Singapore, Singapore
| | - Mohd Farid Harunal
- Duke NUS Medical School, Duke NUS Medical School, Singapore, Singapore
- National Cancer Centre Singapore, Division of Medical Oncology, Singapore, Singapore
| | - Sathiyamoorthy Selvarajan
- Duke NUS Medical School, Duke NUS Medical School, Singapore, Singapore
- Department of Anatomical Pathology, Singapore General Hospital, Singapore, Singapore
| | - Kesavan Sittampalam
- Duke NUS Medical School, Duke NUS Medical School, Singapore, Singapore
- Department of Anatomical Pathology, Singapore General Hospital, Singapore, Singapore
| | - Chetan Anil Dhamne
- National University of Singapore, Division of Paediatric Haematology and Oncology, Singapore, Singapore
| | - Victor Lee
- Department of Pathology, National University of Singapore, Singapore, Singapore
| | - Kenneth Te Chang
- Department of Pathology and Laboratory Medicine, KK Women's and Children's Hospital, Singapore, Singapore
- KK Women's and Children's Hospital, VIVA-KKH Paediatric Brain and Solid Tumour Programme, Children's Blood and Cancer Centre, Singapore, Singapore
- Duke NUS Medical School, Duke NUS Medical School, Singapore, Singapore
| | - Amos Hp Loh
- Department of Paediatric Surgery, KK Women's and Children's Hospital, Singapore, Singapore
- KK Women's and Children's Hospital, VIVA-KKH Paediatric Brain and Solid Tumour Programme, Children's Blood and Cancer Centre, Singapore, Singapore
- Duke NUS Medical School, Duke NUS Medical School, Singapore, Singapore
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