ABSTRACT
Dermatofibrosarcoma protuberans (DFSP) is a rare, locally invasive soft tissue sarcoma. The local recurrence rate is high, in some studies upwards of 60%, likely reflecting a failure to remove occult extensions of tumor. Surgical excision has been the treatment of choice for the resection of DFSP. Any pitfall on management therapy of DFSP not only increase the recurrence rate but also add new problems to patients with DFSP. 58-year-old male patient, came with a local recurrent of DFSP on his right leg. Then performed excision with margin one centimetre, and closing defect using pedicle sural flap, durante surgery turned pedicle on the flap is too short and because of poor soft tissue handling pedicle was injured. It consulted into the vascular division for evaluated and treatment pedicle. Postoperative evaluation, the flap experiences bluish due to vascularization compromised. It was decided to expose the flap and the defect was covered with skin graft. 2 months postoperative evaluation found local recurrent on skin graft area. Excision margins between 2 to 5 cm can reduce the recurrence rate. Proper planning in designing flaps to cover defects and the ability of good soft tissue handling is required to avoid new problems on management DFSP.
ABSTRACT
Objective@#To investigate the therapeutic effects of surgical management for local retroperitoneal recurrence of renal cell carcinoma after radical nephrectomy.@*Methods@#Clinical and follow-up data of 33 cases of local recurrence after radical nephrectomy in Renji Hospital from January 2010 to April 2018 were retrospectively analyzed.@*Results@#In these 33 patients, 25 was male and 8 was female; The median age was 54 years old. The pathological stage of radical nephrectomy included 14 cases of pT1-2N0M0 stage, 16 cases of pT3-4 N0M0 stage, and 3 cases of pN1 stage. Only 4 relapsing patients had symptoms, the others were all found to have recurrence by imaging examination during follow up period of postoperation.The median recurrence time for all patients was 30 months, and the median diameter of recurrent tumors was 4.5 cm.Twenty-nine patients underwent complete resection of local recurrent lesions, and 4 patients whose recurrent lesions could not be completely resected converted receive palliative surgery. The median intraoperative blood loss was 500 ml and the median hospital stay after surgery was 4 days. Clavien grade Ⅰ-Ⅱ complications occurred in 5 patients after surgery, and no serious complications of Clavien grade Ⅲ-Ⅴ complications occurred. Six patients received postoperative adjuvant target therapy and distant metastasis occurred in one patient.In the 27 patients without adjuvant target therapy, postoperative distant metastases occurred in 12 patients. The median survival time for all patients after local recurrence surgery was 31 months. The 1-year and 3-year survival rates were 86.8% and 36.9%, respectively.@*Conclusions@#The rigorous imaging examination after radical nephrectomy can detect local recurrent lesions as early as possible in most relapsing patients and imaging examination can predict the integrity of surgical resection of local recurrence.Although intraoperative bleeding of resection of local recurrence is relatively high, the operation is safe and the postoperative complications are controllable. Postoperative adjuvant therapy may also provide better survival benefit for patients with local recurrence.
ABSTRACT
Objective To investigate the clinical effects, the therapy reactions,the living qualities of three treatments in advanced nasopharyngeal carcinoma. Methods From Jan 2001 to Jun 2002, 120 patients pathologically confirmed NPC who firstly underwent radiotherapy were divided into two groups: radiotherapy with concurrent chemotherapy group(RC, n = 60, 5 fractions per week, one time per day, 200 cGy per day to a total dose of 7 000 ～ 8 000 cGy. cisplatin and 5-Fu two cycles in the first and fourth week during radioation); radiotherapy with AiDi injection group(RAD, n = 60, radiotherapy was the same as that of RC. Continuously injecting AiDi for 10 days 50 ml per day was one cycle which was repeated 3 cycles every alternation of 7 days); another 60 patients who contemporaneity reciceved radiotherapy alone (radiotherapy was the same as that of RC) because of some reasons and were comparable in clilical materials were regarded as the third group (R) to compare with the above two groups. The life quality, 3-year survival rate, and acute or chronic radiation reactions in the three groups were observed. Results All patients were followed up for more than 3 years: the 3-year survival rate in RC (73.3%),which was homologous as that in RAD(65.0 %, P =0.347), was higher than that in R group(53.3%,P = 0.028), and the local recurrent was inverse(10.0%,26.7%,P = 0.033 6). The acute and chronic radiation reactions in RC was highest whereas that in RAD group is lowest(P