Malignant Neoplasms
Amy J. Litterini, Christopher M. Wilson in Physical Activity and Rehabilitation in Life-threatening Illness, 2021
The mainstays of oncologic medical management in most countries includes surgical oncology, for the removal of tumors, medical oncology, the treatment of cancer with medicine, and radiation oncology, the treatment of cancer with radioactive sources. Access to these treatment modalities varies widely across the globe, and is heavily influenced by the availability of the practitioners, medications and equipment, proximity to cancer centers, and socioeconomic status and insurance status. Depending on the diagnosis, some individuals will receive all three treatment modalities, and may receive medical oncology and radiation oncology interventions simultaneously or concurrently. Some treatments occur pre-operatively, or neoadjuvantly, or postoperatively, or adjuvantly.
The history of lymphatic mapping: a gynecologic perspective
Charles F. Levenback, Ate G.J. van der Zee, Robert L. Coleman in Clinical Lymphatic Mapping in Gynecologic Cancers, 2022
At the time of Morton’s studies, there was a major debate regarding the management of patients with early-stage melanoma. The vast majority of these patients, 90%, have negative nodes, and the efficacy of regional lymphadenectomy in the 10% with positive nodes was the subject of intense debate. Some clinicians recommended a complete lymphadenectomy in all patients with stage I disease, while others recommended observation. Morton set out to determine whether the sentinel node as described by Cabanas and others could be identified intraoperatively. His group studied various dyes in a feline model29 and selected isosulfan blue as the best choice for intraoperative lymphatic mapping. In 1992, Morton et al.30 described their results in 223 patients with cutaneous melanoma. A total of 237 lymphatic basins were mapped, and the sentinel node was identified in 82% of them. More than 3000 lymph nodes were removed, of which 8% were sentinel, and in only two cases did nonsentinel nodes contain metastatic disease when the sentinel nodes were disease free. This paper is one of the most cited references in modern surgical oncology and prompted an explosion of interest in this technique.
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].
Impact of the first wave of the SARS-CoV-2/Covid-19 pandemic on digestive surgical activities: a Belgian National Survey
Published in Acta Chirurgica Belgica, 2022
Gabriel Liberale, Hans Van Veer, Jean Lemaitre, Marc Duinslager, Dirk Ysebaert, Arnaud De Roover, Charles de Gheldere, Niels Komen
This observation could have two major impacts in the near future. First, a post-Covid-19 pandemic wave of malignant disease diagnoses; second, the risk of being confronted with more advanced disease that will potentially impair patient prognoses and be observed as an indirect effect of Covid-19 on cancer mortality in the world. A recent Italian study from the largest tertiary center in the Piedmont, which was the most affected region during the first pandemic wave in Italy, has more specifically evaluated the oncological surgical activity during a 2-month period from 8 March to 8 May [12]. The authors observed a steady state for all surgical oncology activities except for breast cancer. They also evaluated the number of cholecystectomies performed for acute cholecystitis, observing a decrease of 80% in comparison with previous years.
A feasibility study of circulating melanoma cells in the perioperative context of hyperthermic isolated limb perfusion (HILP) in 20 patients
Published in International Journal of Hyperthermia, 2021
Dimosthenis Michelakis, Konstantinos Lasithiotakis, Ippokratis Messaritakis, Christos Ioannou, Kostas Perisynakis, Ioannis Souglakos, Dimitrios Stamatiou, Gregory Chlouverakis, Eelco de Bree, Ioannis Romanos, Odysseas Zoras
Demographic data, presentation of the disease, prior treatment history, treatment details, and outcome were retrieved from a prospectively maintained database of the Department of Surgical Oncology. Treatment response was evaluated two months after the surgical procedure according to the response evaluation criteria in solid tumors (RECIST) [14]. No biopsies of limb lesions were routinely performed for the assessment of response. Follow-up was performed every 3–6 months by the surgical oncologists and/oncologists. The study was conducted with the formal approval of the Institutional Review Board and Bioethics Committee of the University Hospital of Heraklion. Informed consent was obtained from all patients for being included in the study.
Breaking Down Silos
Published in Oncology Issues, 2019
Pamela R. Proman, William D. James, Nancy H. Johnson
Through the SLAMs, a focus on departmental timelines for charge input, review, and approval prior to charge export surfaced (see Figure 5, right). Best practices in the medical and radiation oncology practices were carried over to improve practices within surgical oncology. Additionally, surgical oncology faced interdepartmental barriers associated with a time lag for completed pathology and operative reports. Although this delay remains a work in progress that is being addressed by the information services department, the problem would have gone undiscovered without a concerted effort to identify departmental silos.
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