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2.
Ann Surg Oncol ; 23(9): 2802-8, 2016 09.
Artigo em Inglês | MEDLINE | ID: mdl-27034079

RESUMO

PURPOSE: We addressed the impact of separate cavity margin excision (shaving) during breast-conserving surgery (BCS) for breast cancer on specimen volume, tumor margin clearance, re-excision rate, local recurrence and survival. METHODS: A retrospective case-matched study was performed on 298 women with stage 0-III breast cancer; 179 patients received shaving (shaving + lumpectomy group; SLG) and 119 patients did not (lumpectomy group; LG). RESULTS: The two groups had similar baseline characteristics. The median volume of surgical specimen was 131.9 cc in the SLG versus 134.8 cc in the LG (p = 0.81), and surgical margins were tumor-free in 90.7 % of cases in the LG versus 92.7 % in the SLG (87.1 % before shaving) (p = 0.69). The re-excision rate was 14.3 % in the LG versus 10.6 % in the SLG (p = 0.44). In the SLG, shaving spared 10 (5.6 %) patients from reoperation (positive lumpectomy margins but tumor-free shaving margins) (p = 0.11), and only 2/19 (10.5 %) patients in the SLG had tumor-free response at histological examination of re-excised margins compared with 10/17 (58.8 %) cases in the LG (p = 0.004). Tumor in shavings was found in 44/156 (28.2 %) patients having tumor-free lumpectomy margins. At multivariate analysis, distance of tumor from lumpectomy margins, tumor multifocality, receptor status, and tumor size were related to tumor persistence in shavings. Median follow-up was 27 months (range 23-35), and two patients had tumor relapse in the SLG versus none in the LG (p = 0.16). Overall survival was 100 % in both groups. CONCLUSIONS: Shaving does not significantly decrease the re-excision rate but provides wider clear margins in most procedures. It ensures more accurate margin examination and decreases false-positive margin rate, without any increase in removed breast-tissue volume.


Assuntos
Mama/cirurgia , Margens de Excisão , Mastectomia Segmentar/métodos , Recidiva Local de Neoplasia/patologia , Manejo de Espécimes/métodos , Idoso , Mama/metabolismo , Mama/patologia , Estudos de Casos e Controles , Reações Falso-Positivas , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasia Residual , Receptor ErbB-2/metabolismo , Receptores de Estrogênio/metabolismo , Receptores de Progesterona/metabolismo , Reoperação , Estudos Retrospectivos , Taxa de Sobrevida , Carga Tumoral
3.
Int J Surg Case Rep ; 5(8): 527-31, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-25016079

RESUMO

INTRODUCTION: Rectovaginal fistula (RVF) is a rare but debilitating complication of a variety of pelvic surgical procedures. PRESENTATION OF CASE: We report the case of a 45-year-old female who underwent the STARR (Stapled Trans Anal Rectal Resection) procedure, that was complicated by a 30mm rectovaginal fistula (RVF). We successfully repaired the fistula by trans-perineal approach and pubo-coccygeus muscle interposition. Seven months later we can confirm the complete fistula healing and good patient's quality of life. We carefully describe our technique showing the advantages over alternative suturing, flap reconstruction or resection procedures. DISCUSSION: This technique is fairly easy to perform and conservative. The pubo-coccygeus muscle is quickly recognizable during the dissection of the recto-vaginal space and the tension-free approximation of this muscle by single sutures represents an easy way of replacement of the recto-vaginal septum. CONCLUSION: In our experience the use of pubo-coccygeus muscle interposition is an effective technique for rectovaginal space reconstruction and it should be considered as a viable solution for RVF repair.

4.
World J Surg ; 37(5): 1072-81, 2013 May.
Artigo em Inglês | MEDLINE | ID: mdl-23408049

RESUMO

INTRODUCTION: The purpose of the present study was to assess the impact of body mass index (BMI) on perioperative and pathologic outcomes after total gastrectomy with "over-D1" dissection for gastric cancer. METHODS: Data on 161 patients undergoing total gastrectomy between 2005 and 2011 were reviewed. Patients were grouped into three categories by BMI: BMI < 25 kg/m(2) (63 normal-weight patients; 39.1 %), BMI ≥ 25-<30 kg/m(2) (73 overweight patients; 45.3 %), and BMI ≥ 30 kg/m(2) (25 obese patients; 15.6 %) and matched for the analysis of perioperative and cancer-related outcomes. RESULTS: Operative time was longer for obese patients. Medical (mainly pulmonary) and surgical (mainly bleeding and wound infection) complications occurred more frequently in overweight/obese subjects. However, they were mostly managed conservatively (grade I-II in the Clavien-Dindo classification). The overall postoperative mortality was 0.9 %. Multivariate analysis identified the American Society of Anesthesiologists score and splenectomy, but not obesity, as independent risk factors for postoperative complications. The median number of lymph nodes retrieved differed significantly from group to group: obese 21 (IQR 18-26), versus overweight 24, versus normal weight 28 (p = 0.031). No difference was found in lymph node ratio and cancer-related parameters. CONCLUSIONS: Obese patients with operable gastric cancer can be candidates for standard extensive surgical resection, provided that pre-existing co-morbidities and potential intraoperative and postoperative complications are considered.


Assuntos
Adenocarcinoma/cirurgia , Gastrectomia , Excisão de Linfonodo/métodos , Obesidade/complicações , Neoplasias Gástricas/cirurgia , Abdome , Adenocarcinoma/complicações , Adenocarcinoma/mortalidade , Adulto , Idoso , Idoso de 80 Anos ou mais , Análise de Variância , Índice de Massa Corporal , Feminino , Gastrectomia/métodos , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Duração da Cirurgia , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Fatores de Risco , Neoplasias Gástricas/complicações , Neoplasias Gástricas/mortalidade , Resultado do Tratamento
5.
Am J Surg ; 204(5): 732-40, 2012 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-22633445

RESUMO

BACKGROUND: We aimed to evaluate risk factors for postoperative complications after total gastrectomy with "over-D1" lymphadenectomy. METHODS: Data on 161 patients (54 cases aged >75 years: elderly group) operated on between 2005 and 2011 were reviewed. Risk factors analyzed for complications (Clavien-Dindo classification) included sex, age, American Society of Anesthesiologists (ASA) grade, body mass index (BMI), pTNM stage, long-term antiplatelets therapy, operative time, and splenectomy. RESULTS: The median age of the study population was 71 (interquartile range [IQR] 62-77) years (79 [range 76-90] years for elderly patients vs 65 [range 33-75] years for the control group, P < .0001). ASA classification was the only baseline characteristic significantly different in the intergroup analysis; 79.6% of the elderly patients were in ASA class III to IV versus 39.2% of the controls (P < .0001). Univariate analysis showed that patient age, ASA score, BMI, and splenectomy were predictive of postoperative complications. Multivariate analysis confirmed ASA score and splenectomy as independent risk-factors. CONCLUSIONS: Regardless of age, fit elderly patients with operable gastric cancer should be candidates for the recommended standard extensive surgical resection provided that pre-existing comorbidities are considered.


Assuntos
Gastrectomia , Excisão de Linfonodo , Complicações Pós-Operatórias/etiologia , Neoplasias Gástricas/cirurgia , Abdome , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Excisão de Linfonodo/métodos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Razão de Chances , Complicações Pós-Operatórias/epidemiologia , Análise de Regressão , Estudos Retrospectivos , Fatores de Risco , Tórax , Resultado do Tratamento
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