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1.
Ann Surg Oncol ; 28(1): 203, 2021 Jan.
Article in English | MEDLINE | ID: covidwho-1456031

ABSTRACT

The increasing prevalence of morbid obesity in the United States has been accompanied by a concomitant rise in bariatric surgery to help combat the epidemic. The relationship between obesity and certain cancers, such as esophageal adenocarcinoma, is well established. The need for minimally invasive techniques to treat esophageal cancer in patients with previous bariatric surgery is growing and can present a unique surgical challenge. This report presents the case of a 55-year-old woman with a previous Roux-en-Y gastric bypass who was shown by endoscopy to have an invasive adenocarcinoma located in the distal thoracic esophagus. This necessitated an excision of the thoracic esophagus and the gastric pouch. A laparoscopic and thoracoscopic Ivor-Lewis esophagogastrectomy was performed for this complex patient with esophageal adenocarcinoma. The remnant stomach was fashioned into a gastric conduit using a 60-mm linear stapler with a staple height of 4.1 mm (Echelon, Ethicon Endosurgery, Blue Ash, OH). The reconstruction was performed using a 25-mm Orvil (Covidien, Minneapolis, MN, USA) and EEA 25-mm DST XL (Covidien) to create a circular stapled thoracic esophagogastric anastomosis. A feeding jejunostomy was placed in the residual 130-cm Roux limb. The study demonstrated that minimally invasive esophagectomy is safe and technically feasible with appropriate oncologic outcomes for patients with previous gastric bypass. This cohort of patients will undoubtedly continue to grow in the coming years.


Subject(s)
Adenocarcinoma , Esophageal Neoplasms , Gastric Bypass , Laparoscopy , Adenocarcinoma/surgery , Anastomosis, Surgical , Esophageal Neoplasms/surgery , Esophagectomy , Female , Gastrectomy , Humans , Middle Aged
2.
Ann Thorac Surg ; 113(4): e243-e245, 2022 04.
Article in English | MEDLINE | ID: covidwho-1293575

ABSTRACT

A 65-year-old woman was diagnosed with early-stage lung cancer in 2020 and scheduled for robotic assisted-left upper lobectomy. Unfortunately, the patient contracted symptomatic COVID-19, resulting in postponement of lung resection. She was admitted for surgery 6 weeks after the acute infection. A preoperative computed tomographic scan showed widespread interstitial pneumonitis. However, the operation went ahead given concerns over tumor progression, albeit with a lesser resection to preserve lung tissue because the patient was slightly hypoxic. Her postoperative recovery was uneventful, and she was discharged 5 days later. Final histology confirmed a fully resected stage T1c N0 M0 adenocarcinoma of the lung.


Subject(s)
Adenocarcinoma , COVID-19 , Lung Neoplasms , Pneumonia , Adenocarcinoma/complications , Adenocarcinoma/diagnosis , Adenocarcinoma/surgery , Aged , Female , Humans , Lung Neoplasms/pathology , Pneumonectomy/methods , Pneumonia/surgery
3.
J. coloproctol. (Rio J., Impr.) ; 41(2): 210-214, June 2021. ilus
Article in English | WHO COVID, LILACS (Americas) | ID: covidwho-1258615

ABSTRACT

Abstract Jejunal adenocarcinoma is a rare type of primary small bowelmalignancy. It is generally diagnosed at late stages and as a surgical finding, with abdominal pain or discomfort being the main associated symptom. Cases presenting with perforation are even rarer, especially without disseminated disease. The relationship between cancer and coronavirus disease 2019 (COVID-19) is still being studied, as well as the postsurgical evolution of COVID-19 patients and its possible causality of intestinal perforation. We present the case of a perforated jejunal adenocarcinoma in a COVID-19-positive patient, in whom the symptomatology secondary to the perforation led to an early diagnosis, treatment and adequate postsurgical evolution, despite the concomitant condition.


Resumo O adenocarcinoma jejunal é um tipo raro de malignidade primária do intestino delgado, o qual geralmente é diagnosticado em estágios tardios e como achado cirúrgico, sendo a dor ou o desconforto abdominal o principal sintoma associado. Casos que apresentam perfuração são ainda mais raros, principalmente sem doença disseminada. A relação entre câncer e a cornonavirus disease 2019 (covid-19) ainda está sendo estudada, assim como a evolução pós-cirúrgica de pacientes com covid-19 e sua possível causalidade de perfuração intestinal. Apresentamos o caso de um adenocarcinoma jejunal perfurado em um paciente positivo para covid-19, em que a sintomatologia secundária à perfuração levou a um diagnóstico precoce, tratamento e evolução pós-cirúrgica adequada, apesar da condição concomitante.


Subject(s)
Humans , Female , Adenocarcinoma/diagnosis , COVID-19 , Intestinal Perforation , Adenocarcinoma/surgery , Intestinal Neoplasms
4.
Eur Rev Med Pharmacol Sci ; 25(7): 3116-3121, 2021 04.
Article in English | MEDLINE | ID: covidwho-1194852

ABSTRACT

OBJECTIVE: Since minimally invasive surgery and general anesthesia are both aerosol-generating procedures, their use became controversial during the outbreak of coronavirus disease 2019 (COVID-19). Moreover, social distancing resulted in serious psychological consequences for inpatients. This case report investigates pain distraction during awake laparotomy, as well as new possibilities for emotional postoperative support to inpatients. PATIENTS AND METHODS: A 72-year-old man affected by middle rectal adenocarcinoma underwent lower anterior resection plus total mesorectal excision under combined spinal-epidural anesthesia. A 3D mobile theatre (3DMT) was intraoperatively used for pain distraction. A postoperative "Cuddle delivery" service was instituted: video-messages from relatives and close friends were delivered daily to the patient through the 3DMT. Emotional correlations were investigated through a clinical interview by the psychologist of our Hospital. RESULTS: Intraoperative, as well as postoperative pain, resulted well-controlled: visual analogue scale (VAS) ≤3. Conversion to general anesthesia and postoperative intensive support/monitoring were unnecessary. The "Cuddle delivery" initiative positively fed our patient's mood and attitude, strengthening his bond to life. CONCLUSIONS: During pandemic, awake laparotomy under loco-regional anesthesia may be a crucial option in delivering acute care surgery to selected patients when intensive care beds are unavailable. Our procedure introduces potential ways to optimize this approach.


Subject(s)
Adenocarcinoma/surgery , Computers, Handheld , Family , Pain Management/methods , Pain, Postoperative/therapy , Pain, Procedural/therapy , Rectal Neoplasms/surgery , Video Recording , Aged , Anesthesia, Epidural/methods , Anesthesia, Spinal/methods , COVID-19/prevention & control , Humans , Laparotomy/methods , Male , Motion Pictures , Pain Measurement , Postoperative Care , Proctectomy/methods , SARS-CoV-2 , Wakefulness
5.
Ann Surg ; 273(5): 850-857, 2021 05 01.
Article in English | MEDLINE | ID: covidwho-1171640

ABSTRACT

OBJECTIVE: The purpose of this study is to evaluate the impact of extended delay to surgery for stage I NSCLC. SUMMARY OF BACKGROUND DATA: During the COVID-19 pandemic, patients with NSCLC may experience delays in care, and some national guidelines recommend delays in surgery by >3 months for early NSCLC. METHODS: Using data from the National Lung Screening Trial, a multi-center randomized trial, and the National Cancer Data Base, a multi-institutional oncology registry, the impact of "early" versus "delayed" surgery (surgery received 0-30 vs 90-120 days after diagnosis) for stage I lung adenocarcinoma and squamous cell carcinoma (SCC) was assessed using multivariable Cox regression analysis with penalized smoothing spline functions and propensity score-matched analyses. RESULTS: In Cox regression analysis of the National Lung Screening Trial (n = 452) and National Cancer Data Base (n = 80,086) cohorts, an increase in the hazard ratio was seen the longer surgery was delayed. In propensity score-matched analysis, no significant differences in survival were found between early and delayed surgery for stage IA1 adenocarcinoma and IA1-IA3 SCC (all P > 0.13). For stage IA2-IB adenocarcinoma and IB SCC, delayed surgery was associated with worse survival (all P < 0.004). CONCLUSIONS: The mortality risk associated with an extended delay to surgery differs across patient subgroups, and difficult decisions to delay care during the COVID-19 pandemic should take substage and histologic subtype into consideration.


Subject(s)
Carcinoma, Non-Small-Cell Lung/mortality , Carcinoma, Non-Small-Cell Lung/surgery , Lung Neoplasms/mortality , Lung Neoplasms/surgery , Time-to-Treatment , Adenocarcinoma/mortality , Adenocarcinoma/surgery , COVID-19/epidemiology , Carcinoma, Non-Small-Cell Lung/pathology , Carcinoma, Squamous Cell/mortality , Carcinoma, Squamous Cell/surgery , Clinical Decision-Making , Humans , Lung Neoplasms/pathology , Neoplasm Staging , Pandemics , Propensity Score , Proportional Hazards Models , Retrospective Studies , SARS-CoV-2
6.
Ann Surg ; 273(5): 850-857, 2021 05 01.
Article in English | MEDLINE | ID: covidwho-1101937

ABSTRACT

OBJECTIVE: The purpose of this study is to evaluate the impact of extended delay to surgery for stage I NSCLC. SUMMARY OF BACKGROUND DATA: During the COVID-19 pandemic, patients with NSCLC may experience delays in care, and some national guidelines recommend delays in surgery by >3 months for early NSCLC. METHODS: Using data from the National Lung Screening Trial, a multi-center randomized trial, and the National Cancer Data Base, a multi-institutional oncology registry, the impact of "early" versus "delayed" surgery (surgery received 0-30 vs 90-120 days after diagnosis) for stage I lung adenocarcinoma and squamous cell carcinoma (SCC) was assessed using multivariable Cox regression analysis with penalized smoothing spline functions and propensity score-matched analyses. RESULTS: In Cox regression analysis of the National Lung Screening Trial (n = 452) and National Cancer Data Base (n = 80,086) cohorts, an increase in the hazard ratio was seen the longer surgery was delayed. In propensity score-matched analysis, no significant differences in survival were found between early and delayed surgery for stage IA1 adenocarcinoma and IA1-IA3 SCC (all P > 0.13). For stage IA2-IB adenocarcinoma and IB SCC, delayed surgery was associated with worse survival (all P < 0.004). CONCLUSIONS: The mortality risk associated with an extended delay to surgery differs across patient subgroups, and difficult decisions to delay care during the COVID-19 pandemic should take substage and histologic subtype into consideration.


Subject(s)
Carcinoma, Non-Small-Cell Lung/mortality , Carcinoma, Non-Small-Cell Lung/surgery , Lung Neoplasms/mortality , Lung Neoplasms/surgery , Time-to-Treatment , Adenocarcinoma/mortality , Adenocarcinoma/surgery , COVID-19/epidemiology , Carcinoma, Non-Small-Cell Lung/pathology , Carcinoma, Squamous Cell/mortality , Carcinoma, Squamous Cell/surgery , Clinical Decision-Making , Humans , Lung Neoplasms/pathology , Neoplasm Staging , Pandemics , Propensity Score , Proportional Hazards Models , Retrospective Studies , SARS-CoV-2
7.
JAMA Netw Open ; 3(12): e2028320, 2020 12 01.
Article in English | MEDLINE | ID: covidwho-970845

ABSTRACT

Importance: There is a lack of data evaluating the association of surgical delay time (SDT) with outcomes in patients with localized, high-risk prostate cancer. Objective: To investigate the association of SDT of radical prostatectomy and final pathological and survival outcomes. Design, Setting, and Participants: This cohort study used data from the US National Cancer Database (NCDB) and identified all patients with clinically localized (cT1-2cN0cM0) high-risk prostate adenocarcinoma diagnosed between 2006 and 2016 who underwent radical prostatectomy. Data analyses were performed from April 1 to April 12, 2020. Exposures: SDT was defined as the number of days between the initial cancer diagnosis and radical prostatectomy. SDT was categorized into 5 groups: 31 to 60, 61 to 90, 91 to 120, 121 to 150, and 151 to 180 days. Main Outcomes and Measures: The primary outcomes were predetermined as adverse pathological outcomes after radical prostatectomy, including pT3-T4 disease, pN-positive disease, and positive surgical margin. The adverse pathological score (APS) was defined as an accumulated score of the 3 outcomes (0-3). An APS of 2 or higher was considered a separate outcome to capture cases with more aggressive pathological features. The secondary outcome was overall survival. Results: Of the 32 184 patients included in the study, the median (interquartile range) age was 64 (59-68) years, and 25 548 (79.4%) were non-Hispanic White. Compared with an SDT of 31 to 60 days, longer SDTs were not associated with higher risks of having any adverse pathological outcomes (odds ratio [OR], 0.95; 95% CI, 0.80-1.12; P = .53), pT3-T4 disease (OR, 0.99; 95% CI, 0.83-1.17; P = .87), pN-positive disease (OR, 0.79; 95% CI, 0.59-1.06; P = .12), positive surgical margin (OR, 0.88; 95% CI, 0.74-1.05; P = .17), or APS greater than or equal to 2 (OR, 0.90; 95% CI, 0.74-1.05; P = .17). Longer SDT was also not associated with worse overall survival (for SDT of 151-180 days, hazard ratio, 1.12; 95% CI, 0.79-1.59, P = .53). Subgroup analyses performed for patients with very high-risk disease (primary Gleason score 5) and sensitivity analyses with SDT considered as a continuous variable yielded similar results. Conclusions and Relevance: In this cohort study of patients who underwent radical prostatectomy within 180 days of diagnosis for high-risk prostate cancer, radical prostatectomy for high-risk prostate cancer could be safely delayed up to 6 months after diagnosis.


Subject(s)
Adenocarcinoma , Prostate/pathology , Prostatectomy , Prostatic Neoplasms , Time-to-Treatment/statistics & numerical data , Adenocarcinoma/pathology , Adenocarcinoma/surgery , Cohort Studies , Humans , Male , Middle Aged , Neoplasm Grading , Neoplasm Staging , Prostatectomy/adverse effects , Prostatectomy/methods , Prostatic Neoplasms/epidemiology , Prostatic Neoplasms/pathology , Prostatic Neoplasms/surgery , Risk Assessment/methods , Risk Assessment/statistics & numerical data , Risk Factors , United States/epidemiology
8.
Ann R Coll Surg Engl ; 103(2): 134-137, 2021 Feb.
Article in English | MEDLINE | ID: covidwho-921027

ABSTRACT

INTRODUCTION: Elective surgery in the UK came to a halt during the early part of the COVID-19 pandemic. As COVID-19-related infection and mortality rates in Devon and Cornwall were relatively low, however, urgent elective surgery continued in Plymouth, with the necessary precautions in place. This study aimed to assess outcomes following Ivor Lewis oesophagectomy (ILO) during the pandemic. METHODS: We prospectively analysed details of 20 consecutive patients who underwent ILO for cancer over a 3-month period between 17 March and 12 June 2020. All patients underwent COVID-19 swab testing 24-48 hours before surgery and during admission when clinically indicated. The primary outcome measure was COVID-19-related morbidity. Secondary outcome measures were non-COVID-19-related morbidity, mortality and length of hospital stay. RESULTS: Twenty patients underwent ILO during the study period. All patients identified as white British. No patients tested positive for COVID-19 pre- or postoperatively. There was no COVID-19-related morbidity. There was no in-hospital mortality. Seven patients developed pneumonia, which settled with antibiotics. One patient developed an anastomotic leak, which was treated conservatively. One patient returned to theatre for a para-conduit hernia repair. The median length of hospital stay was nine days. One patient required admission to the high dependency unit for inotropic support for two days. CONCLUSIONS: ILO can be performed safely during the COVID-19 pandemic with the necessary precautions in place.


Subject(s)
Adenocarcinoma/surgery , COVID-19/epidemiology , Esophageal Neoplasms/surgery , Esophageal Squamous Cell Carcinoma/surgery , Esophagectomy , Hospital Mortality , Length of Stay/statistics & numerical data , Postoperative Complications/epidemiology , Adult , Aged , Aged, 80 and over , COVID-19 Nucleic Acid Testing , Female , Humans , Male , Middle Aged , Neoadjuvant Therapy , Preoperative Care , Prospective Studies , SARS-CoV-2
9.
Eur J Cardiothorac Surg ; 58(6): 1222-1227, 2020 12 01.
Article in English | MEDLINE | ID: covidwho-910370

ABSTRACT

OBJECTIVES: The coronavirus disease 2019 (COVID-19) pandemic has resulted in patient reluctance to seek care due to fear of contracting the virus, especially in New York City which was the epicentre during the surge. The primary objectives of this study are to evaluate the safety of patients who have undergone pulmonary resection for lung cancer as well as provider safety, using COVID-19 testing, symptoms and early patient outcomes. METHODS: Patients with confirmed or suspected pulmonary malignancy who underwent resection from 13 March to 4 May 2020 were retrospectively reviewed. RESULTS: Between 13 March and 4 May 2020, 2087 COVID-19 patients were admitted, with a median daily census of 299, to one of our Manhattan campuses (80% of hospital capacity). During this time, 21 patients (median age 72 years) out of 45 eligible surgical candidates underwent pulmonary resection-13 lobectomies, 6 segmentectomies and 2 pneumonectomies were performed by the same providers who were caring for COVID-19 patients. None of the patients developed major complications, 5 had minor complications, and the median length of hospital stay was 2 days. No previously COVID-19-negative patient (n = 20/21) or healthcare provider (n = 9: 3 surgeons, 3 surgical assistants, 3 anaesthesiologists) developed symptoms of or tested positive for COVID-19. CONCLUSIONS: Pulmonary resection for lung cancer is safe in selected patients, even when performed by providers who care for COVID-19 patients in a hospital with a large COVID-19 census. None of our patients or providers developed symptoms of COVID-19 and no patient experienced major morbidity or mortality.


Subject(s)
COVID-19/prevention & control , Carcinoma, Non-Small-Cell Lung/surgery , Infection Control/methods , Infectious Disease Transmission, Patient-to-Professional/prevention & control , Lung Neoplasms/surgery , Pneumonectomy , Postoperative Complications/prevention & control , Adenocarcinoma/surgery , Adult , Aged , Aged, 80 and over , COVID-19/diagnosis , COVID-19/epidemiology , COVID-19/transmission , COVID-19 Testing , Cross Infection/diagnosis , Cross Infection/epidemiology , Cross Infection/prevention & control , Female , Follow-Up Studies , Health Services Accessibility , Hospitalization , Humans , Infectious Disease Transmission, Patient-to-Professional/statistics & numerical data , Male , Middle Aged , New York City/epidemiology , Pandemics , Patient Safety/statistics & numerical data , Patient Selection , Perioperative Care/methods , Postoperative Complications/diagnosis , Postoperative Complications/epidemiology , Retrospective Studies , Treatment Outcome
12.
Ann Thorac Surg ; 110(6): e461-e463, 2020 12.
Article in English | MEDLINE | ID: covidwho-549140

ABSTRACT

The novel coronavirus disease 2019 is a highly contagious viral infection caused by the severe acute respiratory syndrome coronavirus 2 virus. Its rapid spread and severe clinical presentation influence patient management in all specialties including thoracic surgery. We report 3 cases of coronavirus disease 2019 occurring in patients shortly after thoracotomy and thoracoscopy procedures, illustrating the imminent threat of severe acute respiratory syndrome coronavirus 2 infection for thoracic surgery patients.


Subject(s)
Betacoronavirus , Coronavirus Infections/diagnosis , Cross Infection/diagnosis , Lung Neoplasms/surgery , Pneumonectomy/adverse effects , Pneumonia, Viral/diagnosis , Postoperative Complications/diagnosis , Adenocarcinoma/pathology , Adenocarcinoma/surgery , Aged , COVID-19 , Carcinoma, Squamous Cell/pathology , Carcinoma, Squamous Cell/surgery , Coronavirus Infections/etiology , Coronavirus Infections/therapy , Cross Infection/etiology , Cross Infection/therapy , Female , Humans , Lung Neoplasms/pathology , Male , Middle Aged , Pandemics , Pneumonia, Viral/etiology , Pneumonia, Viral/therapy , Postoperative Complications/etiology , Postoperative Complications/therapy , SARS-CoV-2 , Thoracoscopy/adverse effects , Thoracotomy/adverse effects
13.
Virchows Arch ; 477(5): 743-748, 2020 Nov.
Article in English | MEDLINE | ID: covidwho-143976

ABSTRACT

Despite the current pandemic season, reports on pathologic features of coronavirus disease 19 (Covid-19) are exceedingly rare at the present time. Here we describe the pathologic features of early lung involvement by Covid-19 in a surgical sample resected for carcinoma from a patient who developed SARS-CoV-2 infection soon after surgery. The main histologic findings observed were pneumocyte damage, alveolar hemorrhages with clustering of macrophages, prominent and diffuse neutrophilic margination within septal vessels, and interstitial inflammatory infiltrates, mainly represented by CD8+ T lymphocytes. These features are similar to those previously described in SARS-CoV-1 infection. Subtle histologic changes suggestive pulmonary involvement by Covid-19 may be accidentally encountered in routine pathology practice, especially when extensive sampling is performed for histology. These findings should be carefully interpreted in light of the clinical context of the patient and could prompt a pharyngeal swab PCR test to rule out the possibility of SARS-CoV-2 infection in asymptomatic patients.


Subject(s)
Adenocarcinoma/surgery , Betacoronavirus , Clinical Laboratory Techniques/methods , Coronavirus Infections/diagnosis , Lung Neoplasms/surgery , Lung/pathology , Pneumonia, Viral/diagnosis , Postoperative Complications/diagnosis , Adenocarcinoma/pathology , Adenocarcinoma/virology , Betacoronavirus/isolation & purification , COVID-19 , COVID-19 Testing , Coronavirus Infections/etiology , Coronavirus Infections/pathology , Humans , Lung/surgery , Lung/virology , Lung Neoplasms/pathology , Lung Neoplasms/virology , Male , Middle Aged , Pandemics , Pneumonectomy , Pneumonia, Viral/etiology , Pneumonia, Viral/pathology , Postoperative Complications/pathology , Postoperative Complications/virology , SARS-CoV-2
14.
J Thorac Oncol ; 15(5): 700-704, 2020 05.
Article in English | MEDLINE | ID: covidwho-2529

ABSTRACT

There is currently a lack of pathologic data on the novel coronavirus (severe acute respiratory syndrome coronavirus 2) pneumonia, or coronavirus disease 2019 (COVID-19), from autopsy or biopsy. Two patients who recently underwent lung lobectomies for adenocarcinoma were retrospectively found to have had COVID-19 at the time of the operation. These two cases thus provide important first opportunities to study the pathology of COVID-19. Pathologic examinations revealed that apart from the tumors, the lungs of both patients exhibited edema, proteinaceous exudate, focal reactive hyperplasia of pneumocytes with patchy inflammatory cellular infiltration, and multinucleated giant cells. Hyaline membranes were not prominent. Because both patients did not exhibit symptoms of pneumonia at the time of operation, these changes likely represent an early phase of the lung pathology of COVID-19 pneumonia.


Subject(s)
Adenocarcinoma/surgery , Coronavirus Infections/complications , Lung Neoplasms/surgery , Lung/pathology , Pneumonia, Viral/complications , Adenocarcinoma/complications , Aged , Aged, 80 and over , Betacoronavirus , COVID-19 , Female , Humans , Lung/diagnostic imaging , Lung/surgery , Lung Neoplasms/complications , Male , Pandemics , Retrospective Studies , SARS-CoV-2 , Tomography, X-Ray Computed
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