Surgical Resection for Metastatic Tumors in the Pancreas: A Single-Center Experience and Systematic Review
Qiuyi HuangHaiyang ZhouChen LiuKaizhou JinKun FanCheng HeZhiyao FanChao YangLiang LiuJiang LongJin XuQuanxing NiZhiqian HuXianjun Yu
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Keywords:
Metastasectomy
Resection margin
Surgical oncology
Clinical endpoint
【Objective】To investigate the main factors that cause the enucleation of eyeball in clinical setting. 【Methods】We retrospectively reviewed all the patients with enucleation of eyeballs in our hospital from January 2003 to November 2010.【Results】The most common cause of destructive procedure was trauma(34.4%), followed by neoplasms(29.5%), and infection(27.5%). Regarding neoplasms, females were more likely to be enucleated while the reverse was so for traumas and infection(all P 0.05). 【Conclusions】The most common reason to cause the enucleation of eyeballs was trauma. Men were much frequently involved in the eyeball enucleation with reasons of trauma and infection, while in the cases with neoplasms, their amount was less than women's. The key points of reducing the occurrence rate of enucleation are to increase the awareness of family accident and improve the early diagnosis of ocular neoplasms.
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Resection margin
Distal pancreatectomy
Surgical margin
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The first, and perhaps most famous, planned pulmonary
metastasectomy in the United States was performed in 1933 by Barney
and Churchill for metastatic renal cell carcinoma. During the
nineteenth century there were sporadic reports of lung resections for
metastatic tumors reported in the European literature. The first one of
these reports was in 1855, by the French surgeon Sedillot, who removed
a chest wall tumor and excised disease extending into the lung.
Almost 30 years later, in 1882, Weinlechner was credited for the
first resection of a true pulmonary metastases.It was not for another 40
years that metastasectomy was performed as a separate procedure by
Divis in Europe. This was followed soon after by similar reports in
the American literature by Torek and Tudor Edwards in the early
twentieth century. These early reports, and others like them, paved the way toward
general acceptance of pulmonary metastasectomy. In 1947 Alexander
and Haight reported the first series of pulmonary metastasectomies.
By the 1950s there were numerous case series with similar accounts.
Today the indications for resection of secondary pulmonary
malignancies have been broadened to include patients not only with
recurrent disease, but those with multiple metastases, bilateral lesions,
and essentially all histologies.
AIMS AND OBJECTIVES :
1. To assess the long term results of pulmonary metastasectomy.
2. To assess prognostic factors which are likely to influence long term outcomes.
3. To find out a favourable subset of prognostic group who may
benefit from pulmonary metastasectomy
METHOD :
Between January 1997 to December 2006 , all patients who
underwent pulmonary metastasectomy were included in this analysis.
Individual patient data were obtained from the case records in the
MMTR which also serves as a HBTR for Cancer Institute (WIA). A total
of 53 patient records were obtained , of that only 42 cases were taken
analysis. Patients who underwent planned sequential or staged
metastasectomies were considered to have single metastasectomy and
redo surgery. Analysis was done using SPSS 11.0.1 statistical package.
Following variables were tested : DFI ,unilateral or bilateral
presentation, number of metastases, histological type and site of primary
tumor, margin status, size of metastases, mediastinal nodes. Survival was
calculated from the time of first metastasectomy to the last date of follow
up by means of Kaplan – Meier estimate.
CONCLUSION :
Pulmonary metastasectomy is a potentially curative treatment that
can be done safely with low mortality or morbidity.
Good prognostic variables like increasing DFI (> 1 year), ability
to do R0 resection, solitary metastasis, size of the lesion less than
1 cm, and absence of mediastinal nodal positivity showed a trend
towards improved survival. Good prognostic group selected on the
basis of the risk factors like completely resected lesions, DFI and
number of metastases show a difference in survival between good
risk and poor risk groups ( 88% and 65% at 36 months). Although
these were not found to be significant in univariate or multivariate
analysis using Cox regression analysis.
There is a need for larger multicenteric analysis of data with larger
duration of follow up, from specialized centres who practice
pulmonary metastasectomy, to arrive at definite conclusions.
Metastasectomy
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Surgical oncology
Distal pancreatectomy
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Oocytes of Yanbian Yellow Cattle were enucleated by methods of squeezing enucleation,blind enucleation and point-hitting enucleation,then compared in operating time,achievement rate,enucleation rate and proportion of reconstituted embryos.The results showed that blind enucleation was lower than the other two ways in enucleation rate.Higher success rate were obtained using squeezing enucleation and point-hitting enucleation.The shorter time-consuming methods were squeezing enucleation and blind enucleation;there is no significant difference in cleavage rate and blastocyst rate.Therefore,the methods of squeezing enucleation was a practical enucleation method of Yanbian Yellow Cattle oocytes.
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Resection margin
Superior mesenteric vein
Vascular surgery
Vascular invasion
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Purpose . To identify prognostic factors for metastatic osteosarcoma patients and establish indication for repeat metastasectomy. Methods . Data from 37 patients with pulmonary metastasis from osteosarcoma who underwent metastasectomy in our institute from 1979 to 2013 were retrospectively reviewed. Results . Prognostic factors analyzed were age, sex, maximal diameter of the tumor at first pulmonary metastasectomy, total number of resected pulmonary metastases at first metastasectomy, number of surgeries, and disease free interval. In our analysis, characteristics associated with an increased overall survival were age > 15 years and fewer metastases (≤3). Of the 37 patients, 13 underwent repeat metastasectomy after the first metastasectomy. Of the 7 patients that underwent only two metastasectomies, three remained disease-free. In contrast, all six patients that underwent three or more metastasectomies died of relapse. Patients who had five or less lesions at second metastasectomy showed better survival compared to those who had six or more lesions. Conclusion . Age > 15 years and number of metastases at first metastasectomy were independent prognostic factors. Metastasectomy may provide curative treatment even in cases requiring repeat surgery. The number of metastases at second metastasectomy may be a potential predictor of the need for repeat surgery.
Metastasectomy
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To date, the parameters for evaluating enucleation efficiency have only considered enucleation time, although operators simultaneously consume both time and energy during holmium laser enucleation of the prostate. This study was undertaken to find a better way of assessing enucleation skills, considering both enucleation time and consumed energy.One hundred (n=100) consecutive patients who underwent holmium laser enucleation of the prostate from April 2012 to April 2014 by a single surgeon were enrolled. Ten groups of 10 consecutive cases were used to analyze the parameters of enucleation efficiency.The mean enucleation time, consumed energy, and enucleated weight were 41.3±19.2 minutes, 66.2±36.0 kJ, and 26.6±21.8 g, respectively. Concerning learning curves, like enucleation time-efficacy (=enucleated weight/enucleation time), enucleation energy-efficacy (=enucleated weight/consumed energy) also had an increasing tendency. Enucleation ratio efficacy (=enucleated weight/transitional zone volume/enucleation time) plateaued after 30 cases. However, enucleation time-energy-efficacy (=enucleated weight/enucleation time/consumed energy) continued to increase after 30 cases and plateaued at 61 to 70 cases. Furthermore, one-way analysis of variance showed that group means for enucleation time-energy-efficacy (F=3.560, p=0.001) were significantly different, but that those of enucleation ratio efficacy (F=1.931, p=0.057) were not.When both time and energy were considered, enucleation skills continued to improve even after 30 cases and plateaued at 61 to 70 cases. Therefore, we propose that enucleation time-energy-efficacy should be used as a more appropriate parameter than enucleation ratio efficacy for evaluating enucleation skills.
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