Internal hemipelvectomy, a limb saving procedure, NCI experience

Treatment of primary malignant tumors involving the pelvic girdle traditionally necessitated the sacrifice of a healthy lower extremity. Internal hemipelvectomy offers a safe alternative to this problem. With careful selection, the lower limb can be salvaged with acceptable function and hip stability. This study comprised 40 patients with malignant tumors of the pelvic bone treated by different types of internal hemipelvectomy at the National Cancer Institute [NCI], Cairo University in the period extending from 1996 to 2005. According to the location and extent of their tumors, they were ascribed to one of three groups. Group A included 28 patients who underwent type I hemipelvectomy [iliac bone resection], Group B included 8 patients who underwent type I+II hemipelvectomy [iliac and peri-acetabular resection] and group C included 4 patients who underwent type III hemipelvectomy [pubic bone resection]. The mean age for groups A, B and C was 35 +/- 11.9, 39 +/- 17.8 and 33.5 +/- 13 years; respectively. The study comprised 14 patients with Ewing's sarcoma, 12 patients with chondrosarcoma, 6 patients with osteosarcoma, 4 patients with giant cell tumor, 2 patients with aneurysmal bone cysts and 2 patients with malignant fibrous histocytoma. Neoadjuvant chemotherapy was given to 11 patients and 7 received preoperative chemotherapy and radiotherapy; whereas 22 patients received no neoadjuvant treatment. The mean +/- SD duration of the surgical procedure was 2.67 +/- 0.32 hours and the mean +/- SD intra-operative blood loss was 1323 +/- 233 ml. The difference between groups A, B, and C was statistically significant [p <0.05]. Intra-operative complications were encountered in 9 patients where 5 patients had various nerve injuries, 2 patients had vascular injury and 2 had bladder injury. In the postoperative period, 4 patients developed deep vein thrombosis, 7 showed wound infection, 3 had deep pelvic infection and 2 developed hematuria secondary to intra-operative bladder injury. Upon evaluation of the functional results obtained, 50% of the patients were judged to have good results and 30% had fair results and ambulation aids could be discarded after 6-8 months. The remaining 20%, who had undergone type I+II hemipelvectomy, demonstrated a poor functional result in the form of flail hip. At a median follow-up of 18 months, 70% of the patients were alive and free of disease, 17.5% were alive with loco-regional recurrence and 5 died; 3 from lung metastases and 2 of unrelated causes. Internal hemipelvectomy can achieve limb salvage in most cases of pelvic tumors without compromise to surgical margins, local control or survival rates. Functional results obtained with this technique were quite satisfactory when the hip joint could be preserved

Management of parapharyngeal space tumors at the national cancer institute, Egypt

The purpose of this study is to evaluate parapharyngeal space [PPS] tumors as regards clinicopathological features, preoperative assessment, different surgical approaches, perioperative complications, patterns of recurrence and the role of non-surgical treatment. This study included twenty five patients with [PPS] tumors presented to the NCI, Cairo University, from October 2001 to March 2003. The data of each patient included age, sex, presenting symptoms and signs, provisional diagnosis, preoperative investigations, operative data, histopathological examination, non-surgical treatment and state at follow up. All were collected and analyzed. This study included 12 males and 13 females. The mean age was 37.1 years. The main presenting symptom and sign was neck swelling. All patients were subjected to CT scan, while 9 patients had MRI. Nineteen patients underwent fine needle aspiration cytology [FNAC] which was conclusive in only 16 patients. Benign lesions were found in 12 patients [48%] and malignant lesions in 13 patients [52%]. Parotid gland tumors [40%] and neurogenic tumors [16%] were the commonest. Surgical excision was done in 22 cases. There was no postoperative mortality and overall postoperative morbidity was 9% [2/22]. Eight patients received postoperative radiotherapy. Three patients with lymphoma were treated with chemotherapy and two of them received involved field radiotherapy to the Waldyer's ring region. On follow up to 12-30 months, there were only one local and two distant recurrences in the malignant group. Surgery is the mainstay treatment for tumors of the [PPS]. The addition of postoperative radiotherapy in certain indications in malignant tumors of the [PPS] will improve the local control

Ileocecal interpositional graft for gastric replacement after total gastrectomy

The aim of this study is to evaluate the technique of ileocecal segment interpositional graft after total gastrectomy for gastric cancer with assessment of its advantages and disadvantages. This is a prospective study carried out at the National Cancer Institute, Cairo University. Twenty four patients with gastric carcinoma were identified from December 1998 to February 2003. All of them were submitted to surgery after preoperative clinical, radiological and endoscopic diagnosis. Total gastrectomy with ileocecal interpositional graft were done [19 subdiaphragmatic reconstruction and 5 intrathoracic reconstruction]. Patients were followed up for at least 12 months for postoperative morbidity, body weight, reflux and dumping symptoms. Gastrografin swallow, barium swallow, upper GIT endoscopy were routinely done in all patients and pouch emptying time by Tc-99m sulpher colloid was done in 11 patients only. Perioperative mortality was 8.3% [2/24]. No patient reported reflux symptoms-or showed endoscopic findings of reflux esophagitis in the subdiaphraematic reconstruction group and mild reflux was noted in only one patient in the intrathoracic reconstruction group. No patient reported dumping symptoms. Emptying time showed good capacity as a reservoir of food. Postoperative decrease in body weight averaged less than 10% of preoperative weight. ileocecal interposition graft after total gastrectomy has the advantages of preventing reflux esophagitis and providing functional replacement of the stomach as a reservoir for ingested food. It can be done with acceptable morbidity and mortality. It is simpler than some of the pouch reconstructions and deserves more attention