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.

Ewing's sarcoma of the pelvis: treatment results of 31 patients / 中华外科杂志

<p><b>OBJECTIVE</b>To define oncologic and functional outcomes of multidisciplinary treatment methods combined chemotherapy, surgery and radiotherapy, patients with Ewing's sarcoma of the pelvis who were treated at our center were analyzed.</p><p><b>METHODS</b>Thirty-one patients with Ewing's sarcoma of the pelvis were eligible for this analysis. Primary lung metastases occurred in ten patients who were classified as stage III according to the system of Musculoskeletal Tumor Society (MSTS). All the patients received multidisciplinary treatment methods combined chemotherapy, surgery and radiotherapy. Twenty-eight patients underwent limb-sparing surgery, three patients underwent hemipelvectomy. The complications, including radiation or surgery-related complications and mechanical failures were recorded, besides the functional results were evaluated according to the MSTS 93 criteria. Kaplan-Meier survival analysis and Cox multivariate analysis were used as statistical methods.</p><p><b>RESULTS</b>The 5-year overall survival (OS) rate for all the patients was 42.3%. The 5-year OS for patients with small tumor (< 10 cm) had a significant better prognosis than patients with large tumor (≥ 10 cm, 58.2% vs. 26.0%, χ(2) = 4.382, P < 0.05). The 5-year OS for patients with surgical stage IIb was significantly better than for those with surgical stage III (50.2% vs. 30.3%, χ(2) = 4.521, P < 0.05). The 5-year OS for patients with wide or radical surgery had a better prognosis than patients with marginal, intralesional surgery or no surgery (60.0% vs. 29.4%, χ(2) = 4.851, P < 0.05). In multivariate analysis, surgical stage III (RR = 2.480, 95%CI: 0.857 - 7.173) and resection margin (RR = 2.576, 95%CI: 0.474 - 14.011) were independent prognostic factors. The mean MSTS 93 score for all the patients was 63.3%. The complication rate in patients treated with surgery was 29.0% (9/31).</p><p><b>CONCLUSIONS</b>Patients with Ewing'sarcoma of the pelvis can benefit from multidisciplinary treatment in terms of improved survival, acceptable functional results and reasonable complications. Surgical staging and resection margin are independent prognostic factors.</p>

An analysis of prognostic factors for malignant fibrous histiocytoma of bone / 中华外科杂志

<p><b>OBJECTIVE</b>To study the risk factors related to the survival rate, recurrence and metastasis of malignant fibrous histiocytoma of bone.</p><p><b>METHODS</b>From July 1997 and July 2010, 56 patients with malignant fibrous histiocytoma of bone were treated. Univariate and multivariate analysis were performed to determine the probable risk factors including gender, age, tumor location, tumor size and so on.</p><p><b>RESULTS</b>Forty-four cases were followed up ranged from 2 weeks to 78 months (medium 33.3). The 5-year overall survival rate was 50.1%, local recurrence rate 40.9% with a median time of 12 months (3 to 60 months) and metastatic rate 27.5% (11/40) with a median time of 6.5 months (2 to 23 months). Univariate analysis indicated that gender, condition of presentation (primary case or recurrence case), tumor location, surgical margin and surgical stage were significantly related to survival rate (P < 0.05), and tumor location and surgical margin were related to local recurrence rate (P < 0.05), and important vessel or nerve invasion was related to metastatic rate (P < 0.05). Multivariate analysis showed that surgical margin and surgical stage were independent risk factors for survival rate, of which surgical margin was the independent risk factor for recurrence rate.</p><p><b>CONCLUSIONS</b>Surgical margin and surgical stage are independent risk factors for survival rate, of which surgical margin is the independent risk factor for recurrence rate.</p>

The survival and functional outcome of primary bone sarcomas in distal lower extremity / 中华外科杂志

<p><b>OBJECTIVE</b>To analyze the oncological and functional outcome of limb salvage in this location.</p><p><b>METHODS</b>From November 2003 to January 2010, 20 patients with primary malignant bone tumors of the distal lower extremity were treated. There were 15 male and 5 female, the mean age was 20 years. Among 14 patients with malignant distal tibial sarcoma, 11 patients had ankle arthrodesis reconstructed by using allograft (7 patients) or autografts (4 patients), the other 3 patients underwent below-knee amputation. Three patients with osteosarcoma of distal fibula reconstructed with ipsilateral fibular head, 3 patients with calcaneus osteosarcoma underwent total calcanectomy and reconstructed with fibular segment and iliac crest. The mean follow-up was 36.4 months.</p><p><b>RESULTS</b>Five of 7 (71.4%) patients with allograft reconstruction were associated with delayed wound healing, however, only 1 of 10 patients with autograft had this problem (P = 0.036). One local recurrence was observed, 2 osteosarcoma patients died of disseminated disease. The estimated 2-year and 5-year overall survival for the patients with malignant tibial sarcomas were 92.9% and 79.6% respectively, for the patients with distal tibial high-grade osteosarcoma were 87.5% and 70.0% respectively. The mean functional MSTS score was 82% for limb salvage patients.</p><p><b>CONCLUSIONS</b>The survival of patients with primary malignant bone tumor of distal lower extremity seems to be better than that of other sites. Limb salvage can provide satisfactory local control and functional results.</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>

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>