General, Urological and Gynaecological Surgery
Elizabeth Combeer in The Final FRCA Short Answer Questions, 2019
This question is virtually identical to one from 2006, and then recurs in 2016. I am slightly unclear as to why the College underlined the word laparoscopy when they clearly wanted you to discuss issues related to the position of the patient. Generally, though, if they mention the type of operation a patient is having, it is for a reason. Cancer surgery? Minimal opportunity for delaying for optimisation, consider impact of radio- and chemotherapy. Pelvic or lower abdominal laparoscopic surgery? Often Trendelenberg position, with its attendant issues. Ear surgery? Consider nausea and vomiting. Day case surgery? Think about optimising analgesia and antiemesis in order to get the patient out within 24 hours. However, note that the College was approving of those who had used a ‘good systematic approach’.
Approach to risk stratification in cardio-oncology
Susan F. Dent in Practical Cardio-Oncology, 2019
Cancer patients make up an increasing number of all surgeries, both elective operations to improve prognosis and urgent operations when dealing with surgical complications of cancer. In the VISION trials, approximately one in four patients had active cancer at the time of surgery, and such patients had twice the 30 day adjusted mortality compared to patients without cancer (81,82). As cardiologists approach perioperative cardiac assessment, it is important to recognize the cancer patient as a high risk patient. The mechanism of this excess risk is currently not well understood. The effects of upstream cancer treatment using chemotherapy or radiation, the risk increase associated with multimorbidity and frailty owing to a concomitant cancer diagnosis, or perhaps biological mediators that may increase risk (35,75). Further research in perioperative medicine is needed to better understand factors that make cancer patients high risk, and cardio-oncology research should consider the issue of cancer surgery as a time of particular vulnerability to short-term events.
Gastrinoma (Zollinger–Ellison syndrome) and rare neuroendocrine tumors
Demetrius Pertsemlidis, William B. Inabnet III, Michel Gagner in Endocrine Surgery, 2017
The extent of surgery depends upon the size and location of the primary tumor. Every tumor identified by imaging should be accounted for during the exploration. Small pancreatic tumors may be enucleated so long as the main pancreatic duct will not be disrupted. This practice, however, does not follow traditional surgical oncology principles, and at least one retrospective study suggests formal resection may result in a longer disease-free interval [84]. There has not been a randomized controlled trial to determine whether formal pancreas resection or enucleation results in similar local control. The Whipple procedure is necessary for tumors within the pancreatic head that cannot be enucleated. Likewise, distal pancreatectomy should be performed for tumors located within the body and tail that cannot be safely enucleated. Patients with multiple tumors should have all tumors excised by either enucleation or en bloc with formal pancreatic resection. All extrapancreatic tumors, including nodal metastases, should be excised. Duodenal endoscopic transillumination and duodenotomy with palpation are essential in every patient undergoing exploration [85, 86].
Current status and novel insights into the role of metastasectomy in the era of immunotherapy
Published in Expert Review of Anticancer Therapy, 2023
Efstathia Liatsou, Diamantis I. Tsilimigras, Panagiotis Malandrakis, Maria Gavriatopoulou, Ioannis Ntanasis-Stathopoulos
Cancer surgery is an integral part of the modern multidisciplinary approach to patients with solid malignancies [1]. Over the years, the role of surgery in metastatic cancer has been mainly correlated with palliative resections. It was not before the late 1930s, when the term ‘metastasectomy’ was introduced by some referral institutions that presented encouraging survival outcomes from case series of patients with cancer who had undergone resection of foci of metastatic disease. Grünhagen et al. presented the timeline of the introduction of hepatic metastasis resection in patients with primary colorectal cancer [2]. In 1939, Barney et al. reported no disease progression for 5 years after a patient with renal cell carcinoma had undergone nephrectomy and left lobectomy for lung metastasis [3]. Later on, Bartlett et al. analyzed the incidence rates of metastasectomy from the U.S. National Database including different cancer types from 2000 to 2011 [4]. Metastasectomy was more commonly performed in cases of colorectal cancer, followed by lung cancer, breast cancer, and melanoma [4]. The inpatient mortality rate was decreased and the comorbidity trend was lower for high-volume centers in comparison with low-volume centers. This led to a gradual increase in the use of metastasectomy along with the standardization of resection practices according to the experience of high-volume institutions centers [4–8].
Measurement of objective shoulder function following breast cancer surgery: a scoping review
Published in Physical Therapy Reviews, 2020
Angelica E. Lang, Soo Y. Kim, Clark R. Dickerson, Stephan Milosavljevic
Two working definitions were developed to include relevant studies in this scoping review. Breast cancer surgery was defined as any surgical intervention used to examine, remove, or repair tissue as a part of a breast cancer treatment plan [19]. Examples of breast cancer treatment surgeries are breast conservation (lumpectomy), mastectomy, axillary node dissection, and reconstruction surgery. This review focused on adult women who have undergone the above mentioned treatment, as the proportion of men that experience breast cancer is extremely low [4]. Studies including men were excluded. Shoulder function was defined as the measured ability, capacity, or movement strategies of survivors of breast cancer while performing shoulder-centric movements or tasks, such as arm elevation, internal/external rotation, reaching, or lifting [20–25].
Gastric cancer: factors affecting survival
Published in Acta Chirurgica Belgica, 2019
Suleyman Orman, Haci Murat Cayci
Lymph node dissection may support the philosophy that cancer surgery is a lymph pathway surgery rather than an organ surgery. Although extensive LND is recommended in resectable GCs, its effect on survival is still under debate [9]. Early studies have reported high morbidity and mortality rates in cases where routine resection of the tail of pancreas and spleen were performed and D2 LND was carried out. No significant difference was reported between D1 and D2 LND in terms of survival advantage; however, these studies reported lower rates of locoregional recurrence in the long term and lower rates of cancer-related deaths [8,21,22]. Randomized controlled studies reported a higher rate of postoperative mortality after D2 LND compared to D1 LND, but there was no significant difference with respect to overall survival rate [12,23]. In a Dutch study, D2 LND, splenectomy, pancreatectomy, and advanced age (>70 years) were found to be associated with increased rate of morbidity and mortality [24]. No difference was reported between D2 LND and D2 LND + paraaortic LND in terms of survival [7].
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