Background Locally advanced breast cancer is commonly found in Indonesia. In this group of patients, aggressive treatment such as axillary lymph nodes dissection (ALND) with or without regional nodal irradiation (RNI) will increase the risk of breast cancer treatment-related lymphedema (BCRL) in our patients. Lymphaticovenular anastomosis (LVA) has been established as a minimally invasive approach in lymphedema surgery. In this study, we report our first experience of LVAs in BCRL patients. Methods This was a cross-sectional study taken from breast cancer patients receiving ALND with or without RNI. From December 2018 until June 2020, we collected and described general patient information, tumor characteristics, diagnostic methods, and the outcome of LVA. Postoperative subjective symptoms scores (lymphedema quality-of-life score [LeQOLiS]) and lymphedematous volume (upper extremity lymphedema [UEL] index) were compared with preoperative ones. Results Seventy patients experienced BCRL with the mean age of 54.8 (9.4) years and mean body mass index of 28.1 (4.5). ALND was performed in 66 (97.1%) cases and RNI was given in 58 (82.9%) patients. Thirty-one (44.3%) patients were in the International Society of Lymphology stage 1, 24 (34.3%) in stage 2A, and 15 (21.4%) in stage 2B. The mean lymphatic vessel diameter was 0.5 (0.26) mm and 0.80 (0.54) mm for the vein. Lymphosclerosis severity was 7 (4%) in S0 type, 129 (74.1%) in S1 type, 37 (21.3%) in S2 type, and 1 (0.6%) in S3 type. In histopathology examination, S1 types were in lower grade injury, while S2 and S3 types were in the higher grade. Seven (53.8%) cases of S2 type showed severe fibrosis from trichrome staining. Postoperative LeQOLiSs were significantly lower than preoperative ones (5.6 ± 2.4 vs. 3.7 ± 2.6; p = 0.000). With the mean follow-up of 7.4 (3.7) months, the overall UEL index reduction was 9.2%; mean –11 (16.8). Postoperative UEL index was significantly lower than preoperative ones (117.7 ± 26.5 vs. 106.9 ± 18.5; p = 0.000). No complications were observed during this period. Conclusion LVA reduced the subjective symptoms and UEL index in BCRL cases. Future studies using updated imaging technologies of the lymphatic system and longer follow-up time are needed to confirm our results.
Background: Oncological reconstructive surgery is a new paradigm in which it combines oncologic principles with reconstruction techniques. This study aims to present patients’ characteristics who had undergone oncological reconstructive surgery at the Department of Surgical Oncology, Dharmais National Cancer Center. Methods: This descriptive study identified patients’ characteristics who underwent oncological reconstructive surgery, their cancer types, and their therapies. All data were obtained from surgery registration and medical records from January 2019 to January 2020. Data were then presented in number and percentage.Results: A total of 174 patients had undergone oncological reconstructive surgery within one year. The mean age of all patients was 48.2 ± 16.7 years old. Most patients were female (72.1%), with breast cancer making up most cases (43.7%). Most of the participants also underwent mastectomy (42.1%), which was later followed by various reconstruction types. Sixty patients received free tissue transfer with microsurgery (34.4%), of which head and neck cancer constituted most cases. In addition, the most common donor site for the free flap was the Anterolateral Thigh (41.7%). Of all 174 patients, 75.2% presented with locally advanced cancer, and 17.8% had metastatic cancer. Within one year of follow-up, the survival rate was 87.4%, while local recurrence was 3%. Conclusions: The oncological reconstructive surgery approach plays a therapeutic and reconstructive role, and such might be the preferred method of choice for patients presenting with advanced-stage cancer
Background Head and neck cancer is one of the leading cancers worldwide. Complex head and neck procedures are potentially aerosol-generating and considered high risk for coronavirus disease 2019 (COVID-19) transmission between the patients, surgeons, and other health-care workers (HCWs). Several adjustments in the microsurgery procedure were needed. The COVID-19 protocol was developed and applied to minimize the COVID-19 transmission. The study objectives were to describe the preoperative, intraoperative, and postoperative protocols applied and the characteristics of patients who underwent head and neck reconstructive microsurgery during the COVID-19 pandemic in Dharmais Cancer Hospital-National Cancer Center. Methods This study was a retrospective descriptive study of patients who underwent head and neck reconstructive microsurgery between March 2020 and December 2020 in the plastic surgery department and surgical oncology department, Dharmais Cancer Hospital-National Cancer Center, Jakarta, Indonesia. The patients' characteristics including sex, age, location of the defects, the flap type, flap survival, and complications were obtained from medical records and analyzed using SPSS version 23. Results There were 55 patients, 30 (54.54%) patients were female, and 25 (45.45%) patients were male. The mean age at the time of surgery was 51.32 ± 1.85 years. The most common cancer type was squamous cell carcinoma for 49.09% (n = 27/55). The most frequent location was tongue for 25.45% (n = 14/55). Anterolateral thigh flap was also the most used flap in this study for 50.91% (n = 14/55). The overall survival rate of this study was 83.64% (n = 46/55). There were nine patients (16.36%) who were found with postoperative complications. There was no nosocomial infection with COVID-19 for patients, surgeons, and other HCWs. Conclusion Microsurgery can be performed even in the COVID-19 pandemic as the gold standard for oncologic head and neck reconstruction by applying protocols to protect the patients, surgeons, and other HCWs.
Objective: Lymphoepithelial carcinoma (LEC) is rarely found as one type of salivary gland malignancy, especially the parotid gland. Based on data only covers 0.86% of all cases of salivary gland malignancies with an annual incidence rate of 0.01 cases per 100,000 population. Liver metastasis from this type of cancer is very uncommon. Methode: We reported a 64-year-old female patient who presented with a lump in the left neck which enlarged within four years. Total parotidectomy and modified radical neck dissection were done and the diagnosis of lymphoepithelial carcinoma of the parotid gland was establishes based on pathology examination. The patient was then given adjuvant radiotherapy. Five months after initial treatment, the patient shows no locoregional recurrence. However, the patient developed multifocal liver metastases which were deemed inoperable. Results: Liver metastases in the case of lymphoepithelial carcinoma have a worse prognosis than other types of cancer because it usually manifests in multiple and disseminated lesions rather than solitary.
Introduction:Hindquarter amputation or known as hemipelvectomy is a surgical technique that is primarily used for the eradication of malignant primary soft tissue and bone tumors of the pelvis, hip, and upper thigh regions. Occasionally, hindquarter amputation has been employed in the treatment of severe trauma, metastases, and infection. This case report aims to give a lesson in the case of the High-Grade Pleomorphic Sarcoma of the Groin because this is a very rare case and most patients are not willing to undergo amputation.Case Presentation: A 54-year-old male patient came with a complaint of a lump in the thigh. Initially, the lump was as big as a marble and has been getting bigger since last year. The size of the lump was approximately 30 x 30 x 30 cmConclusions: The most common indications for amputation in patients with the primary localized disease were extensive involvement of the limb-girdle, multiple muscle compartment involvement, multifocality, and unsuitability for limb-sparing surgery, typically due to lack of a salvage option. Hindquarter amputation was used as a treatment for 13% of all pelvic bone sarcomas where there is a realistic chance of control of symptoms or long-term survival.comas.
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