CONTEXT: Cystic pheochromocytomas are uncommon neuroendocrine tumors that originate from the adrenal medulla. Differing from the more frequent solid pheochromocytomas, which produce catecholamines and present adrenergic syndrome, cystic pheochromocytomas may not produce these. Their symptoms are generally associated with an abdominal mass or even pain, particularly if the mass attains large dimensions. Similarly, radiological diagnosis may also be difficult. Right-side lesions may be confounded with cystic hepatic tumors or even retroperitoneal sarcomas with cystic areas, using radiological methods. Sometimes, there may be a preoperative diagnosis of malignancy. Invasion of organs in this region (i.e. liver or kidney), or even the presence of a large retroperitoneal mass (of uncertain origin) with which multiple organs are involved, may be indicative of malignant origin. CASE REPORT: Two cases of giant cystic pheochromocytoma that invaded the right hepatic lobe are described. These presented as abdominal masses. Both cases were malignant. They were treated by radical right nephrectomy plus right hepatectomy.
A series of five cases of right-colon adenocarcinoma that invaded the proximal duodenum is presented. All patients underwent successful en-bloc pancreatoduodenectomy plus right hemicolectomy by General Surgery Service of the Teaching Hospital of the ABC Medical School, Santo André, SP, Brazil. The study was conducted between 2000 and 2007. There were two major complications but no mortality. Three patients did not present any recurrence over the course of 15 to 54 months of follow-up. Multivisceral resection with en-bloc pancreatoduodenectomy should be considered for patients who are fit for major surgery but do not present distant dissemination. Long-term survival may be attained.
HEADINGS -Laparoscopy. Hepatectomy. Liver neoplasms/surgery. Neoplasic metastases.ABSTRACT -Background -Resection of neoplasms arising in the posterior right sector is usually a technical challenge due to approach difficulties. Additionally, laparoscopic hepatectomy has become an interesting alternative with several advantages (low morbidity, short hospital stay, early return work activities and good cosmetic results). Aim -To report a series of patients who underwent laparoscopic right posterior sectioniectomy performed by a single surgical team. Methods -Five patients were operated. Their ages ranged from 21 to 63 years (median 43 years). There were four women and one man. Etiology of the neoplasm was: adenoma (n=2), hepatocellular carcinoma (n=1) and metastasis (n=2). There was a single lesion in three cases (60 %). The mean lesion diameter was 3,3 cm (1,8-5). It was analyzed: operative time, intraoperative bleeding, morbidity, length of stay and time of return to usual activity. Results -The mean surgical time was 160 minutes (90-260). The mean intraoperative blood loss was 200 ml (0-500). None of the patients received transfusions. There was no mortality and no morbidity. The median hospital stay was three days (2-5). The median length of time taken to return to day-to-day activities was 12 days (7-20). The median follow-up period was 13 months (1-20). There was no tumor recurrence. Conclusion -Laparoscopic right posterior sectioniectomy (bi-segmentectomy VI + VII) is a good option to treat hepatic tumors located in the posterior sector of the right lobe. It is a safe procedure that avoids large incisions with no mortality or morbidity is this series. This approach also bring good cosmetic result and early return to work.RESUMO -Introdução -A ressecção de neoplasias no setor posterior direito costuma ser um desafio técnico pela dificuldade de sua abordagem. Adicionalmente, as hepatectomias laparoscópicas tem se tornado alternativa interessante em virtude de muitas vantagens (baixa morbidade, curto tempo de internação, retorno precoce as atividades laborais e bons resultados cosméticos). Objetivo -Relatar experiência em doentes submetidos à setorectomia posterior direita laparoscópica por uma única equipe. Métodos -Cinco doentes foram operados entre novembro de 2008 a agosto de 2010. A idade variou de 21 a 63 anos com mediana de 43 anos. Foram quatro mulheres e um homem. A causa das neoplasias foi: adenoma (n=2), hepatocarcinoma (n=1) e metástases (n=2). A lesão foi solitária em três casos (60 %). A média do tamanho das lesões foi 3,3 cm (1,8-5). Foram analisados: tempo cirúrgico, sangramento operatório, morbimortalidade, tempo de internação e tempo de retorno à atividade habitual. Resultados -A média de tempo cirúrgico foi de 160 minutos (90-260). A de sangramento intra-operatório foi de 200 ml (0-500). Nenhum doente foi transfundido. Não houve mortalidade e a morbidade foi nula. A mediana de internação foi de três dias (2-5). A mediana de retorno às atividades cotidianas foi de 12 dias (7-20). A mediana de...
INTRODUÇÃOO câncer de reto localmente avançado (T4) bem como a recidiva pélvica isolada representam situações clínicas desafiadoras na prática clínica diária. Ambas as condições condenam o doente a um sofrimento atroz e duradouro, comprometendo seriamente tanto sua sobrevida em longo prazo quanto sua própria qualidade de vida. Apresentam freqüências variáveis nas diferentes séries descritas. Estima-se que entre 6 e 10% de todas as neoplasias retais se encontrem no estádio T4 no momento de seu diagnóstico (1-3). Por
INTRODUÇÃOAtualmente, a ressecção cirúrgica de metástases hepáticas de etiologia colorretal é a única modalidade com intenção curativa ou de prolongamento da sobrevida. Em séries mais recentemente publicadas, a sobrevida dos pacientes submetidos à sua ressecção completa (R0) tem variado de 25 % até 55 % em cinco anos (1-3). Em contrapartida, quando indivíduos com disseminação hepática são submetidos a tratamento quimioterápico exclusivo, raramente alcançam mais do que três anos de sobrevida (4).
Background and Objectives The primary treatment for locally advanced cases of cervical cancer is chemoradiation followed by high‐dose brachytherapy. When this treatment fails, pelvic exenteration (PE) is an option in some cases. This study aimed to develop recommendations for the best management of patients with cervical cancer undergoing salvage PE. Methods A questionnaire was administered to all members of the Brazilian Society of Surgical Oncology. Of them, 68 surgeons participated in the study and were divided into 10 working groups. A literature review of studies retrieved from the National Library of Medicine database was carried out on topics chosen by the participants. These topics were indications for curative and palliative PE, preoperative and intraoperative evaluation of tumor resectability, access routes and surgical techniques, PE classification, urinary, vaginal, intestinal, and pelvic floor reconstructions, and postoperative follow‐up. To define the level of evidence and strength of each recommendation, an adapted version of the Infectious Diseases Society of America Health Service rating system was used. Results Most conducts and management strategies reviewed were strongly recommended by the participants. Conclusions Guidelines outlining strategies for PE in the treatment of persistent or relapsed cervical cancer were developed and are based on the best evidence available in the literature.
Although colorectal tumors are fairly common surgical conditions, 5 to 12% of these tumors are locally advanced (T4 tumors) upon diagnosis. In this particular situation, the efficacy of en bloc multivisceral resection has been proven. When right-colon cancer invades the proximal duodenum or even the pancreatic head, a challenging dilemma arises due to complexity of the curative surgical procedure. Therefore, en bloc pancreaticoduodenectomy with right hemicolectomy should be performed to obtain free margins. The present study reports three cases of locally advanced right-colon cancer invading the proximal duodenum. All of these cases underwent successful en bloc pancreaticoduodenectomy plus right hemicolectomy, with no death occurrence. Long-term survival was observed in two cases (30 and 50 months). In the third case, the patient did not present any recurrence twelve months after surgical treatment. Multivisceral resection with en bloc pancreaticoduodenectomy should be considered for patients who present acceptable risk for major surgery and no distant dissemination. This approach seems justified since the length of postoperative survival is longer in radically ressected groups (R0) than in palliativelly resected groups (R1-2).Keywords: Pancreaticoduodenectomy; Colorectal neoplasms; Colonic neoplasms; Adenocarcinoma; Case reports resUMo Embora os tumores colorretais sejam afecções cirúrgicas relativamente comuns, 5 a 12% dos casos são diagnosticados como localmente avançados (Tumores T4). Nessa situação particular, a eficácia da ressecção em monobloco já foi comprovada. Quando tumores do cólon direito invadem o duodeno proximal ou ainda a cabeça do pâncreas, um desafiador dilema é observado devido à complexidade do procedimento cirúrgico curativo. Dessa maneira, uma pancreaticoduodenectomia com hemicolectomia direita em monobloco deve ser realizada para se obterem margens livres. O presente artigo relata três casos de tumor de cólon direito localmente avançado com invasão do duodeno proximal. Todos esses casos foram submetidos à pancreaticoduodenectomia e hemicolectomia direita em monobloco de forma bem sucedida e sem mortalidade. Sobrevida em longo prazo foi observada em dois doentes (30 e 50 meses). No terceiro caso, o paciente não apresentava recidiva após 12 meses de seu tratamento cirúrgico. A ressecção multivisceral com pancreaticoduodenectomia em monobloco deve ser considerada em doentes com risco cirúrgico aceitável para cirurgia de grande porte e sem disseminação à distância. Essa conduta permanece justificada, pois a sobrevida a longo prazo dos doentes submetidos à ressecção radical (R0) é mais longa do que daqueles cuja ressecção é paliativa (R1-2).
CONTEXT: Regional lymph node involvement in patients with malignant melanomas has been associated with poor prognosis. In-transit metastases also lead to poor long-term survival. Whereas for nodal disease only regional lymphadenectomy offers adequate locoregional control, for in-transit metastasis both local excision and isolated limb perfusion with chemotherapy plus tumor necrosis factor-alpha can be used for disease control. In cases of tumors located in the distal region of the legs, the lymphatic dissemination most commonly observed is to the inguinal chain. Consequently, therapeutic inguinal lymphadenectomy or even selective lymphadenectomy (sentinel lymph node biopsy) have been recommended. On the other hand, involvement of the popliteal chain is very rare. When this occurs, popliteal lymphadenectomy should be indicated. Local excision may be the logical approach for a few small in-transit metastases because of the low morbidity in this procedure, when compared with isolated limb perfusion. CASE REPORT: A case of melanoma of the heel with popliteal chain involvement and in-transit metastases is presented. This was treated by means of regional lymphadenectomy plus in-transit metastases excision, with a good postoperative course.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
334 Leonard St
Brooklyn, NY 11211
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.