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Rhabdomyosarcoma
Published in Mark Davenport, James D. Geiger, Nigel J. Hall, Steven S. Rothenberg, Operative Pediatric Surgery, 2020
Gideon Sandler, Andrea Hayes-Jordan
All patients over 10 years of age and any patient with radiologically suspicious nodes should undergo retroperitoneal lymph node sampling. Positive retroperitoneal nodes are treated with formal ipsilateral retroperitoneal lymph node dissection and/or RT. Complications include lymphocele, ejaculatory dysfunction, lymphedema of the lower extremity, and intestinal obstruction.
Pediatric Oncology
Published in Pat Price, Karol Sikora, Treatment of Cancer, 2020
Stephen Lowis, Rachel Cox, John Moppett, Helen Rees
Scrotal biopsy is NOT recommended, and an inguinal orchidectomy is the correct operation, with control of vascular structures before mobilization. Pathological examination of the most proximal margin is required to assess the completeness of resection. Retroperitoneal lymph node dissection is not usually considered appropriate.
Germ cell tumours
Published in Brice Antao, S Irish Michael, Anthony Lander, S Rothenberg MD Steven, Succeeding in Paediatric Surgery Examinations, 2017
Roshni Dasgupta, Richard G Azizkhan
In children with testicular germ cell tumours with enlarged lymph nodes, the primary treatment should be an inguinal radical orchidectomy with a sampling of the retroperitoneal lymph nodes. In adults, retroperitoneal lymph node dissection has been used as a primary treatment modality for low-volume non-seminomatous germ cell tumours localised to the retroperitoneum as well as a salvage therapy for residual masses following chemotherapy. In children, routine selective lymph node dissection is only indicated for patients with enlarged nodes between 2 and 4 cm. Those greater than 4 cm are considered positive. Retroperitoneal lymph node dissection may also be used in boys with persistently elevated levels of tumour markers after chemotherapy. In children diagnosed with paratesticular rhabdomyosarcoma over the age of 10, however, routine retroperitoneal lymph node dissection is indicated.
The Effect of Mechanical Bowel Preparation on the Surgical Field in Laparoscopic Gynecologic Surgeries: A Prospective Randomized Controlled Trial
Published in Journal of Investigative Surgery, 2022
Ugur Kemal Ozturk, Sami Acar, Serkan Akış, Esra Keles, Cihat Murat Alınca, Murat Api
The present study had a number of strengths. The key strength is its prospective single-blind randomized design that evaluated MBP versus no bowel preparation. The fact that all the surgical procedures were performed using a minimally invasive approach by a highly experienced gynecologic surgeon is both a strength and a limitation, as it may contribute to obtaining more consistent data, but it may not be representative of all physicians who perform laparoscopy. Another point worth mentioning is that subgroup analysis was conducted according to BMI in the present study, as obese patients undergoing laparoscopic procedures are well known to present some difficulties concerning intraoperative visualization of the surgical field. This is due to the difficulty in placing sleeping obese patients in a steep Trendelenburg position for a long time. Our study also included a wide range of laparoscopic surgeries, ranging from basic laparoscopy, such as hysterectomy, to advanced laparoscopy, such as pelvic or para-aortic lymph node dissection, whereas most of the previously published research considered gynecological cancer and deep infiltrating endometriosis as exclusion criteria. Therefore, we were able to evaluate the effect of MBP on the surgical field when performing retroperitoneal lymph node dissection.
Prognostic significance of inflammatory parameters and nutritional index in clinical stage IVB endometrial carcinomas
Published in Journal of Obstetrics and Gynaecology, 2019
Kaori Kiuchi, Kiyoshi Hasegawa, Shoko Ochiai, Emi Motegi, Tatsuya Kuno, Nobuaki Kosaka, Ichio Fukasawa
The treatment methods included (some patients underwent more than one type of therapy) surgery (n = 12), primary debulking surgery (n = 5), surgery after chemotherapy (n = 7), chemotherapy alone (n = 8), combination treatment with chemotherapy (n = 14), combination treatment with radiotherapy (n = 8), medroxyprogesterone acetate (MPA; n = 2) and the best supportive care (BSC; n = 7). Chemotherapy regimens were either cisplatin-based (primarily the PAC (cyclophosphamide, doxorubicin and cisplatin) regimen) or taxane- and platinum-based. Maximum cytoreduction, including hysterectomy and bilateral salpingo-oophorectomy with or without omentectomy, was performed to control local primary disease in 12 patients. Retroperitoneal lymph node dissection was performed when complete surgical resection could be achieved after a careful inspection of the tumour spread in the intraperitoneal cavity in nine patients. One patient also underwent partial resection of the bladder.
How can we mitigate treatment-associated morbidity in patients with germ cell tumors?
Published in Expert Review of Anticancer Therapy, 2021
Raj R. Bhanvadia, Fady J. Baky, John T. Lafin, Aditya Bagrodia
Surgical management of regionally advanced testicular cancer is performed with retroperitoneal lymph node dissection (RPLND) in either a primary (P-RPLND) or post-chemotherapy (PC-RPLND) fashion. While well tolerated in the majority of patients, RPLND carries risk of vascular injury, bowel injury or obstruction, chronic edema, chylous ascites, and retrograde ejaculation [19]. In the hands of experienced surgeons, nerve sparing approaches even in those patients with larger tumors are the standard of care with a strong chance of maintaining antegrade ejaculation [20]. This treatment should occur at a high volume center of excellence, where a multi-disciplinary team is available both for surgical treatment and for long-term surveillance and multimodal therapy [1,9].