Complicaciones en cirugía ortopédica oncológica: una nueva propuesta de clasificación / Complications in orthopaedic oncology surgery: A new proposal for classification

Se presenta un análisis de las clasificaciones previamente publicadas para las complicaciones que ocurren después de una cirugía realizada para extirpar un tumor que afecta a los huesos. En cuanto a la importancia de ofrecer una propuesta sencilla, fácil de entender, completa, y orientada a las posibilidades de manejo de esas complicaciones, se presenta una nueva propuesta de clasificación(AU)

An analysis of previously published classifications for complications happening after a surgery performed to remove a tumor affecting bones, is presented, and commented. Regarding the importance of offering a simple, easy to understand, complete, and aimed at the possibilities of management of those complications, a new proposal for classification is presented(AU)

Versatilidad del colgajo miofascial de temporal para la reconstrucción tras cirugía oncológica / Versatility of the temporal myofascial flap for reconstruction after oncological surgery

RESUMEN Introducción: La magnitud de las resecciones de tumores de cabeza y cuello, depende del tamaño tumoral, la adecuación de los márgenes y factores inherentes al paciente. El músculo temporal, constituye una excelente opción para reconstruir defectos de zonas aledañas a su sitio de implantación. Objetivo: Demostrar la versatilidad del colgajo miofascial de temporal para la reconstrucción tras, cirugía oncológica de cabeza y cuello, en el Hospital Provincial Universitario "Camilo Cienfuegos Gorriarán" desde enero de 2017 a diciembre de 2018. Métodos: Se realizó una revisión retrospectiva de los informes operatorios de los casos intervenidos con cirugía oncológica de cabeza y cuello, en el servicio de cirugía maxilofacial; se tomó de muestra a pacientes a los que, se les realizó reconstrucción del defecto quirúrgico, utilizándose colgajo miofascial de temporal. Resultados: Fueron sometidos a reconstrucción, 12 pacientes de forma inmediata, en un solo tiempo quirúrgico. El defecto se presentó mayormente en lesiones de piel. La edad promedio de los pacientes fue 66,2 años. Se observó una distribución equitativa en cuanto a sexo, con 6 pacientes para cada grupo. El seguimiento osciló entre 2 y 20 meses, con una media de 11,25 meses, de los cuales todos los pacientes se encontraban vivos y controlados. Conclusiones: El colgajo temporal continúa siendo una opción válida para la reconstrucción en cirugía oncológica de cabeza y cuello. En la serie revisada no ocurrió necrosis, lo que, lo hace un colgajo muy seguro, con buenos resultados estéticos y funcionales y con buena tolerancia ante los tratamientos oncoespecíficos adyuvantes(AU)

ABSTRACT Introduction: The magnitude of the resections of head and neck tumors depends on the tumor size, the adequacy of the margins and factors inherent to the patient. The temporal muscle is an excellent option for reconstructing defects in areas surrounding its implantation site. Objective: To demonstrate the versatility of the temporal myofascial flap for reconstruction after oncological head and neck surgery, at the "Camilo Cienfuegos Gorriarán" Provincial University Hospital from January 2017 to December 2018. Methods: A retrospective review of the operative reports of the cases intervened with oncological head and neck surgery was performed in the maxillofacial surgery service; A sample was taken from patients who underwent reconstruction of the surgical defect, using a temporal myofascial flap. Results: 12 patients underwent reconstruction immediately, in a single surgical time. The defect occurred mainly in skin lesions. The average age of the patients was 66.2 years. An equitable distribution in terms of sex was observed, with 6 patients for each group. Follow-up ranged from 2 to 20 months, with a mean of 11.25 months, of which all the patients were alive and controlled. Conclusions: The temporary flap continues to be a valid option for reconstruction in head and neck cancer surgery. Necrosis did not occur in the revised series, which makes it a very safe flap, with good aesthetic and functional results and with good tolerance to adjuvant oncospecific treatments(AU)

Duodenopancreatectomia e hemicolectomia no tratamento do câncer de cólon avançado / Pancreaticoduodenectomy and hemicolectomy in the treatment of advanced colon cancer

O tratamento das lesões neoplásicas localmente avançadas de cólon permanece um desafio pelo envolvimento e invasão de órgãos como o pâncreas e o duodeno. Apresentamos um caso de câncer de cólon avançado de um paciente submetido a colectomia direita associada a duodenopancreatectomia. No seguimento de cinco anos, o paciente permanecia livre de doença. Apesar da elevada morbidade, a ressecção multivisceral associada a quimioterapia adjuvante apresenta boa sobrevida e até mesmo cura em longo prazo (AU)

The treatment of locally advanced neoplastic lesions of right colon remains a challenge due to the involvement and invasion of organs such as pancreas and duodenum. We report a case of advanced colon cancer of a patient that underwent right hemicolectomy in association with pancreaticoduodenectomy. The 5-year follow-up showed that the patient remained free of disease. Despite the high morbidity rate, multi-visceral resection associated with adjuvant chemotherapy seems to provide an increase in survival or even long-term cure (AU)

Surgical-site infection risk in oncologic digestive surgery

Surgical-site infection (SSI) is the most prevalent type of hospital infection in surgical patients and is associated with an increase in hospital stay, costs and morbidity/lethality. The knowledge of the main risk factors for this type of infection is important for the establishment of prevention measures regarding modifiable risks factors. The objective of the preset study was to assess the occurrence of SSI and study the risk factors in oncologic surgeries of the digestive system at Hospital de Câncer in Barretos, São Paulo, Brazil. Individuals undergoing oncologic surgeries of the digestive system in the period of 08/01/2007 to 08/10/2008 were prospectively followed for 30 days after surgery. Possible risk factors related to the patient and to the surgical procedure were also studied. A total of 210 surgeries were analyzed, with a global SSI incidence of 23.8 percent. The following variables were independently associated with SSI: time and type of surgery, radiotherapy before surgery and surgeon's years of experience. The risk factors found in this study have been described by other authors and are not amenable to intervention for SSI prevention. Further studies are recommended with the objective of investigating interventions that could reduce the risk for SSI in this type of surgery.

The impact of previous para-areolar incision in the upper outer quadrant of the breast on the localization of the sentinel lymph node in a canine model

OBJECTIVES: This paper discusses the influence of a para-areolar incision in the upper outer quadrant of the breast on the location of the sentinel lymph node in a canine model. METHODS: The sentinel lymph node was marked with technetium-99, which was injected into the subareolar skin of the cranial breast. After the marker had migrated to the axilla, an arcuate para-areolar incision was performed 2 cm from the nipple in the upper outer quadrant. Patent blue dye was then injected above the upper border of the incision. At the marked site, an axillary incision was made, and the sentinel lymph node was identified by gamma probe and/or by direct visualization of the dye. The agreement between the two injection sites and the two sentinel lymph node identification methods was determined. Our sample group consisted of 40 cranial breasts of 23 adult females of the species Canis familiaris. The data were analyzed by using the McNemar test and by determining the kappa agreement coefficient. RESULT: Our findings showed that in 95 percent of the breasts, the sentinel lymph node was identified by the injection of technetium-99 m into the subareolar region, and in 82 percent of the cases, the sentinel lymph node was identified by the injection of patent blue dye above the upper border of the incision. The methods agreed 82 percent of the time. CONCLUSIONS: Previous para-areolar incisions in the upper outer quadrant did not interfere significantly with the biopsy when the dye was injected above the upper border of the incision.

Is Laparoscopic Procedure Adequate for Colorectal Cancer Surgery?

PURPOSE: To evaluate the possibility that laparoscopic procedure could perform surgeries keeping the principle of oncologic surgery. METHODS: From July 1993 to June 1996, thrity patients undergone laparoscopic assisted colon and rectal resections (LR) for malignant disease at Yeungman university hospital. Margins of resection and lymph nodes (LNs) recovered were compared with those of thirty stage matched open resection cases (OR, n=30) retrospectively. There was no operative mortality in both group. Operative techniques used in LR vs OR were colectomy, 5:6; anterior resection, 6:5; low anterior resection, 11:12 and abdominoperineal resection, 8:7. Parameters were analgesic use, duration of postoperative ileus, operative time, hospital stay, margins of rescetion, lymph node yield (LNs), and recurrence. RESULTS: Patients who underwent LR had less pain, a shorter period of postoperative ileus and hospital stay than patients who underwent OR. But, the length of operative time was greater for patients undergoing LR. Mean lymph node yield in the laparoscopic group was 16 compared with 18.1 in the open group (P=0.560). Average margins of resection in LR vs OR were 13.9 cm vs 14.1 cm proximally (P=0.823), 3.6 cm vs 5.2 cm distally (P=0.498). In no case did the margins contain tumor. There was no statistical significance in dissected LNs and the length of both resection margins in both groups. Recurrence was similar in both groups. CONCLUSIONS: In this study, there is no evidence that laparoscopic technique is inadequate in following the cancer surgery principle.