Mediastinal and abdominal node dissection for carcinoma of thoracic and abdominal esophagus

To evaluate the safety and complications of mediastinal and abdominal dissection in association with subtotal and total esophagectomy for carcinoma of thoracic and abdominal esophagus. 29 patients having curable carcinoma of the esophagus underwent mediastinal and abdominal node dissection. Subtotal esophagectomy was performed in 16 patients while total esophagectomy was performed in 13 patients. Pathological staging was: stage I 0%, stage IIA 24%, stage IIB 62% and stage III 13%. Positive mediastinal and celiac lymph nodes was found in 38% with a mean number of 6 [range1 -12]. The mean number of dissected lymph nodes was 14 [range 8 - 34]. Chest infection occurred in 27%. Early surgical complications were intrathoracic anastomotic leakage 6%, cervical leakage 10%, anastomotic bleeding in one patient and recurrent laryngeal nerve palsy in two patients. Postoperative mortality was 10%. Four patients had locoregional recurrence. Three-year survival rate were 21% for stage IIA and ranged from 11- 0% for stage IIB and III. The technique of mediastinal and abdominal dissection can be performed with subtotal and total esophagectomy with low rate of complications. This leads to more accurate staging, but it is unclear from this small study whether it has an impact on the survival or not

Giant cell tumors of long bones: a preliminary report of treatment and outcome

The present study was performed to determine whether there is a difference in the functional outcome and recurrence rate after different methods of treatment of giant-cell tumor of long bones. Thirty-four patients, 23 females and 11 males with a mean age of 26 years were treated. According to the grading system developed by Campanacci et al., three lesions were grade I, 20 lesions were grade II and 11 lesions were grade III. The follow up ranged from 12-40 months with an average of 15 months. The patients were evaluated with regard to pain, postoperative function and local recurrence. Twenty- two patients were treated by curettage, while 12 by resection. After curettage, liquid nitrogen was used in 14 patients and high speed burr only was used in 8 patients. After curettage, the cavity was filled with autograft [iliac bone chips] in 15 patients and cement in 7 patients. After wide resection, arthrodesis was performed in five patients, endoprostheses were inserted in five patients and replacement of the distal radius by an ipsilateral fibular graft for two patients. Four of the 34 patients had a local recurrence during a mean follow up period of 15 months, including three patients having recurrence after curettage and one after resection. The functional result according to Mankin's classification was excellent in 19 patients, good in seven patients, fair in four patients and failed in four patients

Salvage surgery for local recurrence after breast cancer conservative mangement: lumpectomy or mastectomy

A cohort of 85 patients with intra-breast tumor recurrences [IBTR] were assigned to either wide local resection [LR] [n=25] or salvage mastectomy [SM] [n=60] using specified criteria of selection during the period 1988-1998. The mean tumor size for LR group was smaller than SM group [1.6 vs. 2.8 cm]. Nevertheless, the two groups were comparable regards other prognostic factors, like relapse-free interval, tumor location relative to the previous resection scar, method of diagnosis and tumor multiplicity. Adjuvant chemotherapy was given to 13 patients post LR and 31 cases post SM. Wide local resection can be considered in selected patients with IBTR as a salvage treatment because the type of surgery did not seem to affect survival. It should be used for late recurrences [>2 years] and noninvasive relapses

Pharyngo-cutaneous fistula following total laryngectomy for laryngeal cancer: incidence, predisposing factors and management

Pharyngo-cutaneous fistula [PCF] is a Common and serious complication following total laryngectomy for laryngeal cancer. Despite its relative frequency, there is still uncertainty about its incidence and predisposing factors. This study was designed to determine the incidence, possible predisposing factors and management of this complication. The records of 150 consecutive patients who underwent total laryngectomy for squamous cell carcinoma of the larynx were reviewed and analyzed. We evaluated the overall Incidence of PCF, factors potentially predisposing to fistula formation [T-stage of the tumor, extent of surgery, concurrent neck dissection, preoperative tracheotomy, preoperative, radiotherapy, postoperative hemoglobin level lower than 12 g dl, type of pharyngeal closure, type of suture material and onset of oral feeding] and the potential management. PCF developed in 32% of patients with a mean time of 9 days following surgery. There was statistically significant association between tumor stage, extent of surgical resection and type of pharyngeal closure and PCF formation. The other contributing factors- such as preoperative radiotherapy, preoperative tracheotomy, concurrent neck dissection and low postoperative hemoglobin level failed to show statistically significant effect. Spontaneous closure with wound care was achieved in 79% of cases. 4 patients [8.3%] required surgical closure by direct suture of the pharyngeal mucosa, while deltopectoral flaps were used in 3 cases [6.2%] pectoral is major myocutaneous flaps in 2 cases [4.1%] and free jejunal interposition flap in 1 case [2%]. Advanced T-stage of the tumor, extended laryngectomy and type of pharyngeal closure were found to have significant role in PCF formation but no statistical significant difference could be demonstrated for other investigated parameters. Our experience confirmed that most fistulas can be successfully managed with conservative treatment except in some cases where surgical suture is appropriate when conservative treatment has failed