scholarly journals En bloc resection of a thoracic chordoma is possible using minimally invasive anterior access: An 8-year follow-up

2016 ◽  
Vol 7 (01) ◽  
pp. 138-140 ◽  
Author(s):  
Anand Goomany ◽  
Jake Timothy ◽  
Craig Robson ◽  
Abhay Rao
Keyword(s):  
Minimally Invasive ◽  
Thoracic Spine ◽  
Interbody Fusion ◽  
Traditional Approach ◽  
Tumor Resection ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
En Bloc ◽  
Perioperative Morbidity ◽  
First Case

ABSTRACTThoracic spine chordomas are a rare clinical entity and present several diagnostic and management challenges. Posterior debulking techniques are the traditional approach for the resection of thoracic tumors involving the vertebral body. Anterior approaches to the thoracic spine enable complete tumor resection and interbody fusion. However, this approach has previously required a thoracotomy incision, which is associated with significant perioperative morbidity, pain, and the potential for compromised ventilation and subsequent respiratory sequelae. The extreme lateral approach to the anterior spine has been used to treat degenerative disorders of the lower thoracic and lumbar spine, and reduces the potential complications compared with the anterior transperitoneal/transpleural approach. However, such an approach has not been utilized in the treatment of thoracic chordomas. We describe the first case of an en bloc resection of a thoracic chordoma via a minimally invasive eXtreme lateral interbody fusion approach.

scholarly journals En bloc resection and reconstruction of a huge chondrosarcoma involving multilevel upper thoracic spine and chest wall: case report

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Xiaodong Tang ◽  
Zhenyu Cai ◽  
Ruifeng Wang ◽  
Tao Ji ◽  
Wei Guo
Keyword(s):  
Case Report ◽  
Chest Wall ◽  
Thoracic Spine ◽  
Tumor Resection ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Thoracic Cavity ◽  
En Bloc ◽  
Upper Thoracic Spine ◽  
Upper Thoracic

Abstract Background En bloc resection of malignant tumors involving upper thoracic spine is technically difficult. We surgically treated a patient with grade 2 chondrosarcoma involving T1–5, left upper thoracic cavity, and chest wall. Case presentation A 37 years old, male patient was referred to our hospital for a huge lump involved left shoulder and chest wall. In order to achieve satisfied surgical margins, anterior approach, posterior approach, and lateral approach were carried out sequentially. After en bloc tumor resection, the upper thoracic spine was reconstructed with a 3D-printed modular vertebral prosthesis, and the huge chest wall defect was repaired by a methyl methacrylate layer between 2 pieces of polypropylene mesh. Postoperatively, the patient suffered from pneumonia and neurological deterioration which fully recovered eventfully. At 24 months after operation, the vertebral prosthesis and internal fixation were intact; there was no tumor local recurrence, and the patient was alive with stable pulmonary metastases. Conclusion This case report describes resection of a huge chondrosarcoma involving not only multilevel upper thoracic spine, but also entire left upper thoracic cavity and chest wall. Although with complications, en bloc tumor resection with combined surgical approach and effective reconstructions could improve oncologic and functional prognosis in carefully selected spinal tumor patients.

scholarly journals Usefulness of tumor traction with a snare and endoclips in gastric submucosal tumor resection: a propensity-score-matching analysis

2020 ◽  
Author(s):  
Qiang Zhang ◽  
Jian-Qun Cai ◽  
Zhen Wang
Keyword(s):  
Propensity Score ◽  
Propensity Score Matching ◽  
Operative Time ◽  
Perioperative Complications ◽  
Tumor Resection ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Resection Rate ◽  
En Bloc ◽  
Gastric Submucosal Tumors

Abstract Background Endoscopic resection, including endoscopic submucosal dissection (ESD) and endoscopic full-thickness resection (EFR), was used to resect small gastric submucosal tumors (SMTs). Our team explored a method of tumor traction using a snare combined with endoclips to assist in the resection of SMTs. This study aims to explore the safety and effectiveness of the method. Methods This research performed a propensity-score-matching (PSM) analysis to compare ESD/EFR assisted by a snare combined with endoclips (ESD/EFR with snare traction) with conventional ESD/EFR for the resection of gastric SMTs. Comparisons were made between the two groups, including operative time, en bloc resection rate, perioperative complications, and operation-related costs. Results A total of 253 patients with gastric SMTs resected between January 2012 and March 2019 were included in this study. PSM yielded 51 matched pairs. No significant differences were identified between the two groups in perioperative complications or the costs of disposable endoscopic surgical accessories. However, the ESD/EFR-with-snare-traction group had a shorter median operative time (39 vs 60 min, P = 0.005) and lower rate of en bloc resection (88.2% vs 100%, P = 0.027). Conclusions ESD/EFR with snare traction demonstrated a higher efficiency and en bloc resection rate for gastric SMTs, with no increases in perioperative complications and the costs of endoscopic surgical accessories. Therefore, the method seems an appropriate choice for the resection of gastric SMTs.

scholarly journals How I do it: minimally invasive resection of a sub-ependymoma of the fourth ventricle

2020 ◽  
Author(s):  
Marco V. Corniola ◽  
Torstein R. Meling
Keyword(s):  
Minimally Invasive ◽  
Surgical Management ◽  
Fourth Ventricle ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Midline Incision ◽  
En Bloc

Abstract Background A 54-year-old female was referred to our clinic with a lesion of the lower fourth ventricle extending to the median aperture. Here, we report the use a minimally invasive sub-occipital approach (MISA) as a safe and effective surgical management. Method We performed a MISA using a short midline incision and a 1-cm sub-occipital craniectomy. Dissection of the lesion was performed, and “en bloc” resection could be achieved. The lesion was confirmed to be a grade I sub-ependymoma. Conclusion MISA can be safely used when confronted to a lesion of the lower fourth ventricle.

scholarly journals Successful treatment of multifocal pedal Prototheca wickerhamii infection in a feline immunodeficiency virus-positive cat with multiple Bowenoid in situ carcinomas containing papillomaviral DNA sequences

2017 ◽  
Vol 3 (1) ◽  
pp. 205511691668859 ◽  
Author(s):  
Allan E Kessell ◽  
Derek McNair ◽  
John S Munday ◽  
Richard Savory ◽  
Catriona Halliday ◽  
...  
Keyword(s):  
Dna Sequences ◽  
Feline Immunodeficiency Virus ◽  
Skin Lesions ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
En Bloc ◽  
First Case ◽  
Immunodeficiency Virus ◽  
Prototheca Wickerhamii

Case summary A 16-year-old, castrated male, feline immunodeficiency virus (FIV)-positive, domestic shorthair cat developed multiple skin lesions. Most of these were Bowenoid carcinoma in situ and contained DNA sequences consistent with Felis catus papillomavirus type 2. Two additional lesions that developed in the skin and subcutaneous tissues between the digital and carpal pads on the left forelimb and right hindlimb were shown by cytology, histology and culture to be caused by Prototheca wickerhamii. These lesions failed to improve in response to systemic therapy treatment with itraconazole, but excision by sharp en bloc resection with follow-up oral itraconazole therapy proved curative for one lesion, although the other lesion recurred, necessitating a second surgery. Relevance and novel information This is only the second reported case of feline protothecosis from Australia and the first case that has been cultured and identified to the species level. Also of great interest was the presence of multiple papillomavirus-associated neoplastic lesions, which may have afforded a portal of entry for the algal pathogen and the cat’s positive FIV status; the latter might have impacted on both viral and algal pathogenesis by effects on immunocompetence.

scholarly journals Covered Stent of the Left Common Carotid and Subclavian Arteries Assist the Invasive Tumor Resection

2020 ◽  
Vol 2020 ◽  
pp. 1-5
Author(s):  
Yo Tsukamoto ◽  
Takeo Nakada ◽  
Soichiro Fukushima ◽  
Mitsuo Yabe ◽  
Naoki Toya ◽  
...  
Keyword(s):  
Tumor Resection ◽  
Neurofibromatosis Type ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Covered Stent ◽  
Nerve Sheath Tumor ◽  
En Bloc ◽  
Invasive Tumor ◽  
Superior Mediastinum ◽  
Fatal Bleeding

Background. Some recent reports have described the usefulness of thoracic aortic stent grafts to facilitate en bloc resection of tumors invading the aortic wall. We report on malignant peripheral nerve sheath tumor resection in the left superior mediastinum of a 16-year-old man with neurofibromatosis type 1. The pathological margin was positive at the time of the first tumor resection, and radiation therapy was added to the same site. After that, a local recurrence occurred. The tumor was in wide contact with the left common carotid and subclavian arteries and was suspected of infiltration. After stent graft placement of these arteries to avoid fatal bleeding and cerebral ischemia by clamping these arteries and bypass procedure, we successfully resected the tumor without any complications. Conclusions. Here, we report the usefulness of the prior covered stent placement to aortic branch vessels for the resection of invasive tumor.

Minimally Invasive Endoscopy-Assisted Approach for En Bloc Resection of Septal Tumors

2014 ◽  
Vol 75 (S 01) ◽  
Author(s):  
Anuraag Parikh ◽  
Justin Cohen ◽  
Monica Tadros ◽  
Rahmatullah Rahmati
Keyword(s):  
Minimally Invasive ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
En Bloc

Pediatric Malignant Glomus Tumor of the Cervical Paraspinal Tissue: Case Report and Review of the Literature

2020 ◽  
Author(s):  
Andrea Ziegler ◽  
Eric Thorpe
Keyword(s):  
Glomus Tumor ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
The Body ◽  
Long Term Outcomes ◽  
Mesenchymal Tumors ◽  
En Bloc ◽  
Glomus Tumors ◽  
First Case

AbstractGlomus tumors are mesenchymal tumors that arise from glomus bodies and most frequently occur in the distal extremities. These tumors can occur throughout the body and are typically benign. However, a very small fraction of glomus tumors displays aggressive features and are considered atypical or malignant. We report on our experience and management of the first case in the literature of a malignant glomus tumor in a child originating in the paraspinal region with involvement of the cervical spine. Malignant glomus tumors tend to be locally aggressive, and en bloc resection is difficult, especially when the tumors occur in the head and neck. Additional studies on disease progression and adjuvant treatment outcomes are necessary to determine the best treatment approach and long-term outcomes in patients with malignant glomus tumors.

485 MINIMALLY INVASIVE EN-BLOC OESOPHAGECTOMY: ANALYSIS OF THE OUTCOMES ALONG A LEARNING CURVE

2020 ◽  
Vol 33 (Supplement_1) ◽  
Author(s):  
F Di Maggio ◽  
A Lee ◽  
Z Vrakopoulou ◽  
H Deere ◽  
A Botha
Keyword(s):  
Survival Rate ◽  
Minimally Invasive ◽  
Learning Curve ◽  
Hospital Stay ◽  
Open Surgery ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Resection Margins ◽  
En Bloc ◽  
Minimally Invasive Oesophagectomy

Abstract   Minimally invasive oesophagectomy is technically demanding but benefits perioperative morbidity and intra-hospital mortality. We previously described open total adventitial resection of the cardia (TARC) as an optimal anatomical resection technique for lower oesophageal and gastro-esophageal junction cancers. We wanted to investigate whether the peri-operative benefits of minimally invasive techniques, along with en-bloc resection of the primary tumour, translate into long term survival benefit in a specialized high volume center along a surgeon learning curve. Methods Data from 198 consecutive patients undergoing oesophagectomy by a single surgeon was collected prospectively. Patient stratification was made to chronologically reflect four main stages of our learning curve: open surgery, Laparoscopic Ivor Lewis, laparoscopy/thoracoscopy with mini-thoracotomy and laparoscopic TARC. Primary outcomes included five-year survival rate, operating time, hospital stay, specimen lymphnodes. Peri-operative complications and mortality are also described. 45 patients had open surgery; laparoscopy (n = 50) was initiated after two years, and thoracoscopy (n = 56) introduced after case 94. MIO was performed for the last 47 patients. Patients in all groups had similar demographics, histological diagnosis, preoperative and pathological staging. Results 158 patients were male (79.8%); age was 63 +/− 10 years. Overall five-year survival rate was 45%; perioperative mortality rate was 1.5% (n = 3); 13 patients were returned to theatre. Hospital stay was 22+/−23 days. Specimen lymph nodes were 21+/− 8. Resection margins were negative (ACP) in 193 cases (97.4%). Five-year survival rates during the 4 phases were 38.6%, 44.9%, 42.8% and 59% respectively, showing a benefit trend towards the end of the learning curve (p = 0.03). Specimen lymph nodes were: open = 20.5+/−9.5; Lap = 19.5+/− 7; mini-tho = 19.9+/− 7; MIO = 25+/− 10 (p = 0.027). Resection margins were > 1 mm in 68.1%(open), 67.3%(lap), 64.2%(mini-tho) and 79.5(MIO). Conclusion Laparoscopic en-bloc resection of cancers of the OGJ requires a long learning curve. Proficiency gains along this learning curve affects oncological quality of oesophageal resectional surgery and benefits patients survival after minimally invasive oesophagectomy.

Parathyroid carcinoma. Mini-series of patients successfully treated with minimally invasive surgery using intra-operative PTH assays, and literature review.

2009 ◽  
Vol 54 (2) ◽  
pp. 58-58
Author(s):  
OO Komolafe ◽  
AG McMinn ◽  
JC Doughty ◽  
CR Wilson
Keyword(s):  
Minimally Invasive Surgery ◽  
Minimally Invasive ◽  
Invasive Surgery ◽  
Single Case ◽  
Radical Resection ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Parathyroid Cancer ◽  
En Bloc ◽  
Initial Surgery

Parathyroid cancer is a rare cause of primary hyperparathyroidism, with a surgeon anecdotally expected to see a single case in his/her entire career. In our unit, however, we have treated three patients recently. The accepted optimal treatment of parathyroid cancer is radical resection at the initial surgery, but a low index of suspicion means that most parathyroid cancers are not identified pre- or intra-operatively. This results in the majority of patients having inadequate surgery. All three patients were treated by minimally invasive surgery, with radical en bloc resection based on intra-operative suspicion of malignancy. Pre-operative imaging guides the neck exploration, and intra-operative PTH assays confirm excision of the source of excess PTH. All patients have remained well with no recurrence to date. We review the literature on parathyroid cancer, and suggest features that point to a parathyroid tumour being malignant.

COMPARATIVE RISK OF LEPTOMENINGEAL DISSEMINATION OF CANCER AFTER SURGERY OR STEREOTACTIC RADIOSURGERY FOR A SINGLE SUPRATENTORIAL SOLID TUMOR METASTASIS

Neurosurgery ◽  
2009 ◽  
Vol 64 (4) ◽  
pp. 664-676 ◽  
Author(s):  
Dima Suki ◽  
Mustafa Aziz Hatiboglu ◽  
Akash J. Patel ◽  
Jeffrey S. Weinberg ◽  
Morris D. Groves ◽  
...  
Keyword(s):  
Brain Metastasis ◽  
Stereotactic Radiosurgery ◽  
Tumor Resection ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Cancer Center ◽  
Leptomeningeal Disease ◽  
En Bloc ◽  
University Of Texas ◽  
The Difference

Abstract OBJECTIVE To test the hypothesis that differential risks of developing leptomeningeal disease (LMD) exist in patients having a single supratentorial brain metastasis resected via a piecemeal or en bloc approach or treated with stereotactic radiosurgery (SRS). METHODS Between 1993 and 2006, 827 patients with a supratentorial brain metastasis underwent resection or SRS at The University of Texas M.D. Anderson Cancer Center. The primary outcome was the incidence of LMD. RESULTS Resection was performed piecemeal in 191 patients and en bloc in 351 patients; 285 patients received SRS. LMD occurred in 33 patients, 29 in the resection group and 4 in the SRS group. Risk of LMD was significantly higher with piecemeal tumor resection than with other procedures (SRS: hazard ratio [HR] for piecemeal, 5.8; 95% confidence interval [CI], 1.9–17.2; P = 0.002; en bloc, HR for piecemeal, 2.7; 95% CI, 1.3–5.6; P = 0.009). The difference between piecemeal and en bloc was particularly pronounced in patients with a melanoma primary (HR, 8.4; 95% CI, 1.8–39.2; P = 0.007). The risk of LMD was not significantly different between en bloc resection and SRS (HR for en bloc, 2.1; 95% CI, 0.7–6.4; P = 0.21). Similar results were obtained when comparing effects of SRS and both resection approaches after limiting the sample to patients with tumors in a specific volume range. CONCLUSION Piecemeal resection of a supratentorial brain metastasis carries a higher risk of LMD than en bloc resection or SRS. Further assessment of the role of the 2 surgical resection approaches and SRS in a controlled prospective setting with large numbers of patients is warranted.

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