Primary Retroperitoneal Sarcomas are relatively uncommon tumors with varied manifestations, ill-defined prognostic factors and uncertain management modalities. We undertook this study to review patients who presented with primary or recurrent RPS at our institute during the study period. Between 2008 and 2010, 23 patients were evaluated. Statistical analysis was done using the chi square test or Fisher's exact test. Recurrence was calculated using Kaplan Meier curves. The log-rank test was used to compare differences in survival or relapse. Among the 23 patients, 13 were males. Majority (52.2 %) presented with abdominal lump located in umbilical and right hypochondrial region. Surgery was done in 20 (87 %) patients for primary RPS and three (13 %) for recurrent RPS at initial presentation. 14 (61 %) received complete tumor resection, six (27 %) incomplete microscopic resection, and three (13 %) incomplete macroscopic resection. In univariate Cox's proportional hazard model on time ('timer') to event ('relapse') analysis, all the variables like older age (p = 0.027), male sex (p = 0.012), incomplete resection (p = 0.008), large size (0.047) and high grade (p = 0.047) became significant predictor of early recurrence. However, multivariate analysis showed that only extent of resection, grade and sex were statistically significant predictors. Complete tumor resection of retroperitoneal sarcoma (n = 14) was associated with a significantly lesser recurrence compared with unclear resection (n = 9, p = 0.002). The median time between surgery and first recurrence was 15 months. High-grade sarcomas had a significantly higher recurrence (n = 10; median: 24, 95 % CI) than low-grade sarcomas (n = 13, median: 15; 95 %CI P < 0.01). Furthermore, the survival of male patients were worse than that of females (p = 0.036). Completeness of resection, tumor grade and sex are prognostic factors of retroperitoneal soft tissue sarcomas.
Zusammenfassung. Grundlagen: Jejunogastrische Intussuszeption ist selten. Wir fassten 3 Fälle zusammen, die sich während eines Monats bei uns präsentierten. Diese Studie sollte die Rolle der Sonographie in der Diagnostik und im Management (i.e. Wahl des chirurgischen Vorgehens) untersuchen.Methodik: Fallbericht und Literaturübersicht. Ergebnisse: Die Patienten präsentierten sich mit Schmerzen, Bluterbrechen, Oberbauchtumor, Zustand nach Vagotomie und Gastrojejunostomie vor mehr als 10 Jahren wegen Magenulkus. Die Sonographie war in allen Fällen diagnostisch erfolgreich.Schlussfolgerungen: Die Sonographie ist höchst aussagekräftig und Zeit-und Ressourcen-sparend in der Diagnose der jejunogastrischen Intussuszeption und zum Planen des Vorgehens. Dieses ist die Resektion und Fixation der Anastomose, um ein Wiederauftreten zu verhindern.Schlüsselwörter: Jejunogastrische Intussuszeption, Magenchirurgie, Sonographie, Ulkustherapie.Summary. Background: Jejunogastric intussusceptions are rare. We reviewed three cases presented to us in a span of one month. This study has been conducted to assess the role of ultrasonography and to determine the type of surgery we should perform in such cases.Methods: Case report and literature review.Results: The cases presented with the classic triad of pain, hematemesis, and upper abdominal mass, with a history of vagotomy and gastrojejunostomy more than a decade ago for gastric ulcer. Ultrasonography was diagnostic in all. The diagnosis was confirmed on laparotomy. All three cases required resection anastomosis, as the bowels were already gangrenous. One case required revision surgery.Conclusions: Ultrasonography is diagnostic and can save time and resources for out of hour CT=Endoscopy. Early operation is recommended. Reduction of the intussusceptions, viability assessment and if require resection anastomosis with fixation to prevent recurrence are the standards of care.
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