Application of artificial ligament in treatment of lower abdominal wall reconstruction after pubic tumor resection / 北京大学学报(医学版)

OBJECTIVE@#For patients who had hemipelvectomies involving the resection of a portion or the whole of the pubis, bony reconstruction was not recommended commonly. However, the soft tissue reconstruction of the lower abdominal wall may benefit these patients. The object of the study was to determine the clinical effect of lower abdominal wall reconstruction with LARS ligament after pubic tumor resection interms of patient-reported and objective outcome.@*METHODS@#In this series, we reviewed twenty-five patients who underwent pubic tumor resection followed by reconstruction with LARS ligament between February 2012 and February 2018 retrospectively. We evaluated the clinical outcome and complication of this surgical treatment. The function outcome was evaluated according the musculoskeletal tumor society scores (MSTS) for all the patients at the end of the last follow-up.@*RESULTS@#All the patients were stable during the surgery. There were eight patients who underwent resection of superior ramus of pubis, five patients who had resection of inferior ramus of pubis, and twelve patients who received both superior and inferior ramus of pubis. For all the patients, the mean blood loss was (774±580) mL. The mean operation time was (138±25) min. The mean hospital stay was (19±6) d. For the patients who had resection of superior ramus, inferior ramus, as well as both superior and inferior ramus, the mean blood loss were (763±802) mL, (730±315) mL and (808±485) mL, respectively. The mean operation time were (133±27) min, (135±35) min and (143±20) min, respectively. The mean hospital stay were (18±5) d, (22±9) d and (19±6) d, respectively. The mean follow-up time was (37±21) months. Local recurrence was observed in one patient with chondrosarcoma. One patient with renal cancer metastasis died of the disease. No ligament infection, ligament related complication and incisional hernias were observed. Twenty-three patients could ambulate without assistive devices, and the remaining two could walk by crutches. Postoperative pain was reported as none in nineteen patients, mild in three, and moderate in three. From a functional point, the mean MSTS score was 87±4.@*CONCLUSION@#Lower abdominal wall reconstruction with LARS ligament after pubic tumor resection could have satisfactory clinical outcome. It could prevent the occurrence of herniation, decrease the infection rate by minishing the dead space, and achieve good patient-reported outcome.

Evaluation of prognostic factors for synovial sarcoma / 中华外科杂志

<p><b>OBJECTIVE</b>To determine the independent prognostic factors of primary synovial sarcoma.</p><p><b>METHODS</b>The clinical data of 52 patients followed up from 66 patients with synovial sarcoma treated between September 1997 and September 2008 was analyzed retrospectively. There were 28 male and 24 female patients aged from 11 to 71 years old. Three and five-year overall survival (OS), recurrence rate and 9 prognostic factors were analyzed in this study. Univariate and multivariate analysis were performed to determine the prognostic factors of OS.</p><p><b>RESULTS</b>Fifty-two patients were followed up with the follow-up time ranged from 6 to 88 months (median 32 months). The 3-, 5-year overall survival rate and local recurrence rate were 52.8%, 30.3% and 32.7% respectively. Univariate showed tumor size < 5 cm, tumor located at extremities, adequate surgical margin and radical resection combined with radiotherapy had better survival rate (P < 0.05). Multivariate analysis demonstrated that tumor size, primary site and adequate surgical margin were independent prognostic factors for OS. Patients received radical resection combined with radiotherapy have longer median relapse time (25 months) compared with marginal resection combined with radiotherapy (18 months) and single radical resection (12 months). Thirty-five (67%) patients were treated with chemotherapy and seventeen (33%) patients received no chemotherapy for the primary tumor. Treatment with chemotherapy was not associated with an improved OS (P = 0.52).</p><p><b>CONCLUSIONS</b>The independent prognostic factors of synovial sarcoma are tumor size, primary site and adequate surgical margin. Doxorubicin and ifosfamide based chemotherapy was not associated with an improved OS in patients with synovial sarcoma. Radical resection combined with radiotherapy can best control local condition.</p>

Resection and reconstruction of upper thoracic tumor by high transthoracic approach / 中华外科杂志

<p><b>OBJECTIVES</b>To define the role of high transthoracic approach in the treatment of cervicothoracic and high thoracic tumor, and analyze the problem encountered during tumor resection and reconstruction of this technique and oncological results of patients who received this type of surgery.</p><p><b>METHODS</b>Twenty-one patients with cervicothoracic and high thoracic tumor (T(1 - 4)) were treated with high transthoracic approach. This series included metastatic tumor 11 patients, eosinophilic granuloma of bone 2 patients, osteosarcoma 1 patient, Ewing's sarcoma 2 patients, chondrosarcoma 2 patients, giant cell tumor 2 patients, lymphoma 1 patient. High transthoracic approach was applied to these patients for tumor resection and spinal cord decompression. Reconstruction method included artificial vertebrae implantation or bone graft implantation combined with anterior internal fixation.</p><p><b>RESULTS</b>Chest-back pain of all patients relieved significantly after operation. Paraplegia of 3 patients was improved from grade A to grade D according to Frankel grading system, the other 2 patients recovered completely. Pulmonary infection and pulmonary atelectasis occurred in 2 patients; cerebrospinal fluid leakage happened in 1 patient; thoracic aorta rupture happened in 1 patient. The follow-up period was 11 - 58 months, 9 patients died, including 7 patients with metastatic cancer, 1 patient with Ewing's sarcoma, 1 patient with osteosarcoma.</p><p><b>CONCLUSIONS</b>High transthoracic approach is a satisfactory method in dealing with the lesion of cervicothoracic and high thoracic vertebrae, especially with the lesion involving the vertebrae and single vertebral arch. The thoracic canal can be decompressed effectively by this approach.</p>

Analysis of complications of osteosarcoma around knee treated by resection and replacement of tumor-type prosthesis / 中华外科杂志

<p><b>OBJECTIVE</b>To summarize the effects and complications of osteosarcoma around knee treated by wide resection and replacement by the tumor-type prosthesis.</p><p><b>METHODS</b>Between July 1997 and July 2004, 117 patients with osteosarcoma around the knee had been treated with wide resection and reconstruction with prosthesis. Alcohol-devitalized tumor bone prosthetic composite were used for reconstruction in 13 patients, and allograft prosthetic composite (APC) were used in 25 patients. All patients accepted 2 cycles of chemotherapy before the surgery.</p><p><b>RESULTS</b>The mean follow-up period was 3.5 years (1 - 8 years). Nine patients had failure of union at the graft-host junction. Fracture of the stem of the prosthesis occurred in 5 patients, late infection was found in 19 patients, and aseptic loosening occurred in 3 patients. Bone fracture occurred in 1 patient and prosthesis sinking occurred in 2 patients.</p><p><b>CONCLUSIONS</b>The tumor-type prosthetic reconstruction offers the best knee function after resection of the tumor around the knee, and recurrence rate can be accepted. However, the tumor-type prosthesis needs further improvement because of the high complication rate.</p>

Surgical treatment of metastatic spinal tumors by anterial approach / 中国医学科学院学报

<p><b>OBJECTIVE</b>To investigate the efficacy of surgical treatment of the patients with metastatic spinal tumors by anterial decompression and stabilization.</p><p><b>METHODS</b>From December 1997 to December 2003, 93 patients (40 women and 53 men) with metastatic spinal tumors were treated in our department. The locations of the tumor included, thoracic vertebra (53 cases), lumbar vertebra (33 cases), and cervical region (7 cases). The original tumors included lung cancer (21 cases), renal cancer (13 cases), prostate cancer (8 cases), hepatic cancer (5 cases), breast cancer (13 cases), thyroid cancer (5 cases), gastrointestinal tumor (3 cases), and multiple myeloma (8 cases). However, no primary tumor was found in the rest of 17 cases. Among 54 of 93 patients who presented with neurological dysfunction, 16 patients completely paralyzed and others incompletely paralyzed. The follow-up time ranged from 10 to 72 months.</p><p><b>RESULTS</b>Pain was relieved in 87 of 93 patients (93.5%) and neurological function was improved in 47 of the 54 patients. Among 16 completely paralyzed patients, 7 patients experienced a neurological function improvement (from Frankel grade A or B to C or D after decompression). The average amount of blood transfused was 3000 ml. No severe complications were seen in our series. The one-year survival rate was 85% (79 cases).</p><p><b>CONCLUSIONS</b>The integrity of the spinal column structure and neurological function should be considered firstly in the treatment of spinal metastasis. Thorough resection of metastatic tumor and stable internal fixation by anterior approach should be performed when single or two vertebra are involved. In order to alleviate paralysis, promote spinal stability, and improve the quality of life, urgent decompression should be performed on patient with spinal metastasis.</p>

The surgical palliation of operation combined with vertebroplasty for multiple spinal neoplasm / 中华外科杂志

<p><b>OBJECTIVE</b>To discuss the effect and complication of spinal operation combined with vertebroplasty in treating for multiple spinal neoplasm.</p><p><b>METHODS</b>During the last two years, 20 patients (13 male and 7 female) with multiple spinal neoplasm including metastases, multiple myeloma and lymphoma were treated by operation combined with vertebroplasty, 2 vertebral body segments were involved in 5 cases, 3 to 4 vertebral body segments were involved in 11 cases, more than 5 segments were involved in other 4 cases. Neurological function deficit and severe pain were seen in all the cases. Patients were evaluated by Tomita prognostic scoring system before the operation; The average point was 7.2 (from 3 to 9 points).</p><p><b>RESULTS</b>The pain relief rate was 85% (17/20), and neurological recovery was found in 10 out of 12 patients who had neurological deficit. According to the system of Frankel and neurological function, 1 patient recovered from grade B to grade C after the operation, and there was no change in another patients who was evaluated as grade A before the operation. The main complication of vertebroplasty was leakage of PMMA. Six patients had leakage of PMMA into adjacent structures in this series.</p><p><b>CONCLUSIONS</b>Better results of pain relief and neurological function recovery and living quality can be achieved by surgical palliation of operation combined with vertebroplasty for multiple spinal neoplasm.</p>

In vitro antitumor immune response induced by fusion of dendritic cells and Ewing's sarcoma cells / 中华外科杂志

<p><b>OBJECTIVE</b>Human Ewing sarcoma A673 cells and human peripheral blood-derived DCs were fused to induce an antitumor activity against human EW.</p><p><b>METHODS</b>EW A673 cells and human peripheral blood-derived DCs were fused with polyethylene glycol (PEG).</p><p><b>RESULTS</b>Mature DCs with highly expressed surface markers (CD80, CD86, CD83 and HLA-DR) were generated in vitro and flow cytometry. It showed that the highest fusion efficiency was 23.01%. T cell proliferation assay indicated that the novel dendritomas in fused DCs/A673 cells were the most potent in activation of autologous T cell proliferation. The IFN-gamma assay showed that The IFN-gamma secretion by CTLs activated by the novel dendritomas increased more than by other stimulators. CTL assay demonstrated that the novel dendritomas induced A673 cell-specific cytotoxic responses to lyse the A673 cells in the context of MHC class I.</p><p><b>CONCLUSION</b>The data indicates that fusion of tumor cells with DCs is an attractive strategy to induce tumor rejection.</p>

Resection and reconstruction for primary pelvic tumors around acetabular / 中华外科杂志

<p><b>OBJECTIVE</b>To discuss the resection of tumors, reconstruction of defects and the postoperative complications.</p><p><b>METHODS</b>Thirty-one patients with tumors around acetabular were treated surgically in People's Hospital between July 1997 and July 2003. The series comprised 19 males and 12 females. Twelve patients were diagnosed with chondrosarcoma, 1 with Ewing sarcoma, 3 with osteosarcoma, 1 with lymphoma, 1 with carcinosarcoma, 1 with malignant fibrohistiocytoma (MFH), 2 with myeloma, 9 with giant cell tumor (GCT), 1 with aneurysmal bone cyst. Among 31 patients with peri-acetabular tumors, 8 were reconstructed with hemi-pelvic prosthesis, 7 with saddle prosthesis, 6 with cauterized tumor bone and total hip arthroplasty, 10 with total hip replacement after curettage of lesion and cemented.</p><p><b>RESULTS</b>Among 21 patients who underwent tumor resection and reconstruction in region II, 6 had local relapse. Two of 3 patients with osteosarcoma were dead. Five of 12 patients with chondrosarcoma were free of disease. Twenty-one patients with acetabular reconstruction after resection of lesions in region II could sit and stand normally and walked with a cane, several of which even had normal gait.</p><p><b>CONCLUSION</b>Allograft or pelvic prosthesis can be used to reconstruct the acetabulum after resection of tumors. We must pay more attention on the following points in the surgical treatment of periacetabular tumors: (1) Extensively resect tumors as far as possible; (2) Be acquainted with advantages and disadvantages of different reconstructive methods of acetabulum to prevent the complications; (3) The reconstructed acetabulum is unstable, so the patients must stand with a cane to protect the reconstructed hip joint; (4) Prevent wound necrosis and infection; (5) Surgical treatment of pelvic tumors would easily result in poor wound healing especially in the patients receiving chemotherapy or radiotherapy because of extensive soft tissue stripping. The destroyed soft tissue caused by chemotherapy or radiotherapy may increase the great tissue tension after implantation of allograft. And the factors of poor blood supply and hematoma in the wound theoretically increase the chance of infection.</p>

Surgery for multiple myeloma of the bone / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the indication, approach and results of the surgical treatment of multiple myeloma.</p><p><b>METHODS</b>The authors reported 29 surgically-treated patients with solitary or multiple myeloma of the bone between January 1997 and January 2002. There are 17 males and 12 females with average age of 59.5 years (range 38 - 76 years). The primary tumour localizations were: vertebral column in 9, rib in1, humerus in 2, proximal femur in 2, femur shaft in 3, pelvis in 6, sacrum in 6. The 29 patients had undergone the following surgical procedures: vertebral tumours were excited through the anterior or posterior approach, combined with a stabilizing procedure in 7 cases. Tumors on thoracic spine were resected using anterior approach. 4 endoprotheses of replacement were performed, indnding two on proximal femur, one on humerus, and one on pelvis. The pathologic fracture was fixated by internal fixation. Neurological impairment was evaluated according to Frankel system. The study evaluated the complications, neurologic function improvement, life quality, and survival after the surgical treatment.</p><p><b>RESULTS</b>The pain was relieved in all cases and the neurological function was improved after the surgery. Local recurrence were found in three cases during the follow-up time.</p><p><b>CONCLUSION</b>The symptom of the patients can be relieved by the surgery. Our experience suggests that surgical interruption on multiple myeloma in some cases may be rewarding.</p>