Surgical oncology
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Comparative Study
Neck dissection versus "watchful-waiting" in early squamous cell carcinoma of the tongue our experience on 127 cases.
Early oral squamous cell carcinoma (EOSCC) represents about 90% of the oral cancers especially in older males. The etiology is multifactorial, strongly related to tobacco and alcohol abuse, but also infective agents, Human papillomaviruses (HPV16-18), genetic factors and pre-neoplastic lesions seem to be implicated. There is no consensus in the literature for the treatment of early squamous cell carcinoma of the tongue (stages I-II); both an elective neck dissection policy and a watchful-waiting policy have their proponents in the different centers. ⋯ A significant difference was found between the two groups as concerns tumor stage and pathologic tumor classification (p < 0.001). No significant differences were present between the two groups as concerns mean follow up (P = 0.2), relapse rate (p = 0.3) and relapse-free survival time (p = 0.2). In T1 stage tumors with depth of infiltration ≤4 mm, or low grade (G1-G2), the "watchful waiting" strategy for cervical metastases is appropriate, given the low regional recurrence rate (15%) and overall survival of 100%. In case of T2 lesions with depth of infiltration ≥4 mm or high grade (G3) we prefer to perform the elective neck dissection, with 13% of local recurrence and 100% of survival at 6 years.
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We aimed to identify prognostic factors of early-stage cervical adenocarcinoma (AC) and adenosquamous carcinoma (ASC) treated with primary radical surgery, and to evaluate the impact of postoperative adjuvant therapy on outcome. ⋯ PLN metastasis, PI, DSI, and LVSI were independent prognostic factors. Prospective studies of postoperative adjuvant therapy with prognostic score and nodal status stratification for cervical AC/ASC are necessary.
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Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) is an effective treatment for peritoneal carcinomatosis (PC) from multiple origins, however is associated with increased complications compared to conventional gastrointestinal surgery. The aetiology of enterocutaneous fistulas (ECF) in most cases is a result of various contributing factors and therefore remains a major clinical problem, occurring in 4-34% of patients post-CRS. The aim of this study was to analyze the incidence and outcome of ECF following CRS/HIPEC. ⋯ CRS/HIPEC remains an effective treatment modality for PC in selected patients with a comparable ECF incidence to reported elective gastrointestinal surgery rates. This study identifies multiple risk factors that should be considered in patients undergoing CRS/HIPEC.
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Clinical Trial Observational Study
Clinical outcome and patient satisfaction with the use of bovine-derived acellular dermal matrix (SurgiMend™) in implant based immediate reconstruction following skin sparing mastectomy: A prospective observational study in a single centre.
The advent of acellular dermal matrix devices (ADMs) has enhanced both the scope of implant-based immediate breast reconstruction (IBR) following skin sparing mastectomy (SSM) for the treatment or risk reduction of breast cancer. Currently, there are a wide range of options available for the use of ADMs. ⋯ SurgiMend™ is an effective adjunct to implant based IBR following SSM. It is associated with a very low rate of implant loss and a high level of patient satisfaction and is associated with a very low incidence of inflammatory reaction. Neither prior radiotherapy nor post-mastectomy radiotherapy (PMRT) represents a contraindication to its use.
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Clinical Trial
Extreme cytoreductive surgery and hyperthermic intraperitoneal chemotherapy: Outcomes from a single tertiary center.
Multivisceral resection as part of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) may be required in order to achieve optimal debulking. This study aimed to assess perioperative and long-term outcomes of the most extensive CRS/HIPEC procedures. ⋯ Extreme multivisceral resection as part of CRS/HIPEC is associated with higher major morbidity and inferior oncologic outcomes; therefore CRS/HIPEC provides the best outcomes in patients with fewer organs involved.