1,720,988 research outputs found
International Guidelines And Recommendations For Surgery During Covid-19 Pandemic: A Systematic Review
No full textDuring the COVID-19 pandemic, surgical departments were forced to re-schedule their activity giving priority to urgent procedures and non-deferrable oncological cases. There is a lack of evidence-based literature providing clinical and organizational guidelines for the management of a general surgery department. Aim of our study was to review the available recommendations published by general Surgery Societies and Health Institutions and evaluate the underlying Literature
Simultaneous laparoscopic resection of distal pancreas and liver nodule for pancreatic neuroendocrine tumor
Full text linkLaparoscopic distal pancreatectomy (LDP) with or without splenic preservation is increasingly performed for benign or border-line neoplasms of the body and tail of the pancreas. Pancreatic neuroendocrine tumors appear as an excellent indication for laparoscopic resection and this procedure is becoming the gold standard for the surgical treatment of such neoplasms. The safety and advantage of laparoscopic resection over open distal pancreatectomy (ODP) have been proven. In this video, we present a LDP with splenectomy for a neuroendocrine tumor of distal pancreas, with associated wedge resection of a liver nodule. Technical considerations were also discussed
Technical Aspects of Unilateral Dual Kidney Transplantation from Expanded Criteria Donors: Experience of 100 Patients
No full textOne option for using organs from donors with a suboptimal nephron mass, e.g. expanded criteria donors (ECD) kidneys, is dual kidney transplantation (DKT). In adult recipients, DKT can be carried out by several techniques, but the unilateral placement of both kidneys (UDKT) offers the advantages of single surgical access and shorter operating time. One hundred UDKT were performed using kidneys from ECD donors with a mean age of 72 years (Group 1). The technique consists of transplanting both kidneys extraperitoneally in the same iliac fossa. The results were compared with a cohort of single kidney transplants (SKT) performed with the same selection criteria in the same study period (Group 2, n = 73). Ninety-five percent of UDKTs were positioned in the right iliac fossa, lengthening the right renal vein with an inferior vena cava patch. In 69% of cases, all anastomoses were to the external iliac vessels end-to-side. Surgical complications were comparable in both groups. At 3-year follow-up, patient and graft survival rates were 95.6 and 90.9% in Group 1, respectively. UDKT can be carried out with comparable surgical complication rates as SKT, leaving the contralateral iliac fossa untouched and giving elderly recipients a better chance of receiving a transplant, with optimal results up to 3-years follow-up
Hepatic resection (HR) after liver transplantation (LT) for cancer: A safe graft-saving procedure
No full textDifferences in surgical outcomes between hepatitis b and hepatitis C-related hepatocellular carcinoma a retrospective analysis of a single North American center
No full textObjective: Compare surgical outcomes for hepatitis B virus (HBV)-hepatocellular carcinoma (HCC) versus hepatitis C virus (HCV)-hepatocellular carcinoma (HCC).
Background: HCC is the second leading cause of death from cancer worldwide and is associated with hepatitis virus infection in 80% of cases.
Methods: Between 1997 and 2011, 1008 patients with hepatitis B (HBV, n = 431) or hepatitis C (HCV, n = 577) underwent resection (n = 567) or transplantation (n = 441). Resection was indicated for Child's A patients with single HCC; transplantation was indicated for patients within Milan criteria. Univariate and multivariate analyses were performed as well as survival and recurrence analysis using log-rank test.
Results: Based on uniform application of these criteria, resection: transplantation ratio was 3.6 for patients with HBV and 0.67 for patients with HCV. Resection: Patients with HBV had larger tumors and higher alpha-fetoprotein but less satellites and macrovascular invasion; 68% of HBV versus 89% of HCV were cirrhotic. Survival was better (P < 0.001) and recurrence was lower (P = 0.009) for HBV. Independent predictors of death included HCV (P = 0.024), transfusion (P = 0.013), and HCC of greater than 5 cm (P = 0.013). Limiting analysis to patients with cirrhosis, survival with HBV remained superior (P = 0.020) but recurrence did not. Transplantation: Tumors were similar in HBV and HCV. Survival was better (P = 0.002) for HBV; recurrence was similar. Independent predictors of death were HCV (P < 0.001), poor differentiation (P = 0.049), vascular invasion (P = 0.002), and outside Milan (P = 0.032). Limiting analysis to patients within Milan, HBV survival remained better for both resection (P = 0.030) and transplantation (P = 0.002).
Conclusions: Survival after both resection and transplantation for HCC was better in HBV- than in HCV-related HCC whereas recurrence was also lower for HBV-HCC in the resection group, these differences are influenced by both liver and tumor factors
PROLIFERATION SIGNAL INHIBITORS (PSI) CAN BE SAFELY USED AB INITIO AFTER DUAL KIDNEY TRANSPLANTATION (DKT) FROM ELDERLY DONORS (ED)
No full textAre Clinical Guidelines for the Management of Intraductal Papillary Mucinous Neoplasms followed? A Single Center Analysis
No full textCervical Esophageal Cancer Treatment Strategies: A Cohort Study Appraising the Debated Role of Surgery
No full textBackground: Few studies have examined optimal treatment specifically for cervical esophageal carcinoma. This study evaluated the outcome of three common treatment strategies with a focus on the debated role of surgery. Methods: All patients with cervical esophageal cancer treated at a single center were identified and their outcomes analyzed in terms of morbidity, mortality, and recurrence according to the treatment they received, i.e. surgery alone, definitive platinum-based chemoradiation (CRT), or CRT followed by surgery. Results: The study population included 148 patients with cervical esophageal cancer from a prospective database of 3445 patients. Primary surgery was the treatment of choice for 56 (37.83%) patients, definitive CRT was the treatment of choice for 52 (35.13%) patients, and CRT followed by surgery was the treatment of choice for 40 (27.02%) patients. CRT-treated patients obtained 36.96% complete clinical response, with overall morbidity and mortality rates of 36.95 and 2.17%, respectively. Surgical complete resection was achieved in 71.88% of surgically treated cases, with morbidity and mortality rates of 52.17 and 6.25%, respectively. No significant survival difference existed among the three treatments, but patients who underwent surgery alone had a significantly lower stage of disease (p = 0.031). Compared with patients with complete response after CRT, surgery did not confer any significant survival benefit, and overall 5-year survival was lower than definitive CRT alone. In contrast, surgery improved survival significantly in patients with non-complete response after definitive CRT (p = 0.023). Conclusions: Definitive platinum-based CRT should be the treatment of choice for cervical esophageal cancer. Surgery has a role for patients with non-complete response as it adds significant survival benefit, with acceptable morbidity and mortality. © 2018 Society of Surgical Oncolog
Surgery for Recurrent Pancreatic Cancer: Is It Effective?
Full text linkDespite improvements to surgical procedures and novel combinations of drugs for adjuvant and neoadjuvant therapies for pancreatic adenocarcinoma, the recurrence rate after radical surgery is still high. Little is known about the role of surgery in the treatment of isolated recurrences of pancreatic cancer. The aim of this study was to review the current literature dealing with surgery for recurrent pancreatic cancer in order to examine its feasibility and effectiveness. An extensive literature review was conducted according to the 2009 Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and 14 articles dealing with re-resections for recurrent pancreatic adenocarcinoma were analyzed, focusing on the characteristics of the primary neoplasm and its recurrence, the surgical procedures used, and patient outcomes. Data were retrieved on a total of 301 patients. The interval between surgery for primary pancreatic cancer and the detection of a recurrence ranged from 2 to 120 months. The recurrence was local or regional in 230 patients, and distant in 71. The median overall survival was 68.9 months (range 3-152) after resection of the primary tumor, and 26.0 months (range 0-112) after surgery for recurrent disease. The disease-free interval after the resection of recurrences was 14.2 months (range 4-29). Although data analysis was performed on a heterogeneous and limited number of patients, some of these may benefit from surgery for isolated recurrence of pancreatic adenocarcinoma. Further studies are needed to identify these cases
NURSING CARE IN PATIENTS WITH CERVICAL CANCER UNDERGOING BRACHYTHERAPY: LITERATURE REVIEW
No full textreservedBackground: la brachiterapia ginecologica è una forma di radioterapia interna, applicata per il trattamento di tumori ginecologici, come il carcinoma della cervice uterina, della vagina e dell’endometrio, che oggi colpiscono moltissime donne. Questa tecnica permette di sfruttare sorgenti radioattive inserite all’interno o in prossimità della zona da trattare, con lo scopo di erogare in modo localizzato un dosaggio prestabilito di radiazioni, riducendo al minimo l’esposizione ai tessuti sani adiacenti alla zona tumorale. All’interno dell’equipe multidisciplinare, la figura infermieristica è di fondamentale importanza per somministrare efficacemente e in sicurezza il trattamento, prevenendo in anticipo le possibili complicanze che potrebbero insorgere e garantendo, oltre al supporto fisico, anche un supporto emotivo alla paziente, fornendole tutte le informazioni necessarie per raggiungere il massimo comfort e qualità di cure possibili.
Obiettivo: lo scopo di questa revisione intende evidenziare l’importanza e il contributo che l’infermiere ha all’interno del percorso clinico-assistenziale delle pazienti affette da cancro della cervice uterina sottoposte a procedura di brachiterapia ginecologica. Si intende, in particolar modo delineare le varie funzioni infermieristiche svolte nelle diverse fasi di svolgimento del trattamento di brachiterapia, evidenziando come il ruolo infermieristico possa garantire la massima efficacia e tollerabilità al trattamento, garantendo la miglior esperienza da parte della paziente, ottenuta da un efficiente supporto psicologico.
Materiali e Metodi: la ricerca è stata condotta consultando banche dati scientifiche quali “Pubmed”, “ScienceDirect”, “EBSCOhost”, “Cochrane Library”, “Google Scholar”, ottenendo informazioni aggiuntive consultando siti internet ufficiali quali IEO (Istituto Europeo di Oncologia), AIRC (Associazione Italiana per la Ricerca sul Cancro), ISS (Istituto Superiore della Sanità), AIOM (Associazione Italiana Oncologia Medica), WHO (World Health Organization) e line guida americane (NCCN – National Comprehensive Cancer Network) ed europee (ESMO – European Society for Medical Oncology). Gli articoli individuati sono stati selezionati utilizzando stringhe di ricerca e criteri di inclusione ed esclusioni appropriate al quesito di studio riguardante l’assistenza infermieristica nel trattamento di brachiterapia e sul beneficio in termini di efficacia di trattamento e supporto psicologico delle pazienti.
Risultati: Dalla revisione della letteratura, sono state individuate 12 pubblicazioni che hanno permesso di identificare cinque categorie principali, che costituiscono un quadro di approfondimento dell'assistenza infermieristica nel trattamento di brachiterapia ginecologica per le pazienti con tumore alla cervice uterina. Le categorie individuate sono: 1) coordinamento e comunicazione interdisciplinare, 2) ruolo educativo e informativo, 3) assistenza fisica e gestione degli effetti collaterali, 4) supporto psicologico e gestione dell'ansia, 5) soddisfazione complessiva delle pazienti.
Conclusioni: L’assistenza infermieristica nella brachiterapia risulta di fondamentale importanza per migliorare l’esperienza del paziente e la qualità del trattamento. L'infermiere svolge un ruolo centrale non solo nel monitoraggio e nella gestione dei sintomi, ma anche nel supporto psicologico e educativo. È fondamentale che gli infermieri siano adeguatamente formati e che vengano attuati modelli assistenziali centrati sulla persona, che permettano una gestione ottimale degli effetti collaterali e migliorino la qualità di vita delle pazienti durante e dopo il trattamento. Infine, un miglioramento della comunicazione e un rafforzamento del lavoro svolto dall’equipe multidisciplinare sono essenziali per garantire un'assistenza alle pazienti di alta qualità
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