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[PMID]:28687171
[Au] Autor:Pouwer AW; Hinten F; van der Velden J; Smolders RGV; Slangen BFM; Zijlmans HJMAA; IntHout J; van der Zee AGJ; Boll D; Gaarenstroom KN; Arts HJ; de Hullu JA
[Ad] Endereço:Department of Obstetrics and Gynaecology, Radboud university medical center, PO Box 9101, 6500 HB Nijmegen, the Netherlands. Electronic address: Anne-Floor.W.Pouwer@radboudumc.nl.
[Ti] Título:Volume-controlled versus short drainage after inguinofemoral lymphadenectomy in vulvar cancer patients: A Dutch nationwide prospective study.
[So] Source:Gynecol Oncol;146(3):580-587, 2017 Sep.
[Is] ISSN:1095-6859
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: Inguinofemoral lymphadenectomy for patients with vulvar squamous cell carcinoma is associated with a high incidence of postoperative wound complications, which may be influenced by inguinal drain management. The aim of this nationwide prospective study (MAMBO: Morbidity And Measurement of the BOdy) was to assess the feasibility and the incidence of complications after volume-controlled versus short drainage. METHODS: The MAMBO study consisted of two observational studies in all eight oncology centers in the Netherlands, conducted between 2012 and 2016. In the first study, the drain was removed when the production was <30ml/24h, except in the first 48h, and after a maximum of 28days (MAMBO-IA). In the second study, the drain was removed five days postoperatively regardless of production (MAMBO-IB). We assessed the complications within eight weeks after surgery using logistic regression to compare the incidence of one or more complications between the two drainage protocols, adjusting for possible confounders. RESULTS: We included 77 patients (139 groins) for volume-controlled drainage and 64 patients (112 groins) for short drainage. Volume-controlled drainage was associated with significant less lymphocele formation. Moreover, we found no difference in wound infection or primary wound breakdown. The estimated incidence of one or more complications was 46% per groin after volume-controlled drainage versus 75% after short drainage, (RD 29% (95% CI 8, 49) p=0.006). CONCLUSIONS: This prospective study shows that volume-controlled drainage is associated with significantly less complications compared to short drainage. We therefore recommend volume-controlled drainage after inguinofemoral lymphadenectomy in patients with vulvar squamous cell carcinoma.
[Mh] Termos MeSH primário: Carcinoma de Células Escamosas/cirurgia
Drenagem/métodos
Excisão de Linfonodo/efeitos adversos
Linfocele/epidemiologia
Infecção da Ferida Cirúrgica/epidemiologia
Neoplasias Vulvares/cirurgia
[Mh] Termos MeSH secundário: Adulto
Idoso
Idoso de 80 Anos ou mais
Estudos de Viabilidade
Feminino
Seres Humanos
Incidência
Canal Inguinal
Linfocele/etiologia
Meia-Idade
Países Baixos/epidemiologia
Estudos Prospectivos
Deiscência da Ferida Operatória/epidemiologia
Deiscência da Ferida Operatória/etiologia
Infecção da Ferida Cirúrgica/etiologia
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE; MULTICENTER STUDY; OBSERVATIONAL STUDY
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170919
[Lr] Data última revisão:
170919
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170709
[St] Status:MEDLINE


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[PMID]:28382800
[Au] Autor:Kim YH; Shin HJ; Ju W; Kim SC
[Ad] Endereço:Department of Obstetrics and Gynecology, Ewha Womans University School of Medicine, Seoul, Korea. kimyhmd@ewha.ac.kr.
[Ti] Título:Prevention of lymphocele by using gelatin-thrombin matrix as a tissue sealant after pelvic lymphadenectomy in patients with gynecologic cancers: a prospective randomized controlled study.
[So] Source:J Gynecol Oncol;28(3):e37, 2017 May.
[Is] ISSN:2005-0399
[Cp] País de publicação:Korea (South)
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: This prospective randomized controlled pilot study aimed to find whether gelatin-thrombin matrix used as a tissue sealant (FloSeal) can prevent the occurrence of pelvic lymphocele in patients with gynecologic cancer who has undergone pelvic lymphadenectomy. METHODS: Each patient, who undergo a laparotomic pelvic lymph node dissection on both sides, was randomly assigned for FloSeal application on 1 side of the pelvis. The other side of the pelvis without any product application being the control side. The amount of lymph drainage at each side of the pelvis was measured for 3 days, and computed tomography scans were obtained 7 days and 6 months after surgery for detection of pelvic lymphocele. RESULTS: Among 37 cases, the median amount of lymph drainage was significantly decreased in the hemi-pelvis treated with FloSeal compared to the control hemi-pelvis (p=0.025). The occurrence of lymphocele was considerably reduced in treated hemi-pelvis (8/37, 21.6%) compared with control hemi-pelvis (12/37, 32.4%) after 7 post-operative days (p=0.219), and more decreased in the treated hemi-pelvis (5/37, 13.5%) compared with control hemi-pelvis (9/37, 24.3%) after postoperative 6 months (p=0.344). CONCLUSION: The application of FloSeal as a tissue sealant in lymph nodes resected tissues can reduce the incidence of pelvic lymphocele in gynecologic cancer patients. A large randomized controlled study could confirm these preliminary results.
[Mh] Termos MeSH primário: Esponja de Gelatina Absorvível/uso terapêutico
Neoplasias dos Genitais Femininos/cirurgia
Excisão de Linfonodo/efeitos adversos
Linfocele/prevenção & controle
Complicações Pós-Operatórias/prevenção & controle
[Mh] Termos MeSH secundário: Adulto
Idoso
Drenagem
Feminino
Seres Humanos
Excisão de Linfonodo/métodos
Meia-Idade
Pelve/cirurgia
Projetos Piloto
Estudos Prospectivos
[Pt] Tipo de publicação:JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
[Nm] Nome de substância:
0 (FloSeal Matrix)
[Em] Mês de entrada:1708
[Cu] Atualização por classe:170829
[Lr] Data última revisão:
170829
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170407
[St] Status:MEDLINE
[do] DOI:10.3802/jgo.2017.28.e37


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[PMID]:27921286
[Au] Autor:Abadi P; Johansen A; Godballe C; Gerke O; Høilund-Carlsen PF; Thomassen A
[Ad] Endereço:Department of Nuclear Medicine, Odense University Hospital, Søndre Boulevard 29, 5000, Odense C, Denmark. pey.abadi@gmail.com.
[Ti] Título:F-FDG PET/CT to differentiate malignant necrotic lymph node from benign cystic lesions in the neck.
[So] Source:Ann Nucl Med;31(2):101-108, 2017 Feb.
[Is] ISSN:1864-6433
[Cp] País de publicação:Japan
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: Patients presenting with cystic lesions in the neck without obvious signs of malignancy constitute a diagnostic challenge since fine needle aspiration is often insufficient and a diagnosis may not be reached until surgical resection/biopsy is performed. The differential diagnosis of a cystic cervical mass comprises a variety of benign conditions, but malignancy must be ruled out. We examined the diagnostic performance of fluorine-18 fluorodeoxyglucose ( F-FDG) PET/CT to identify malignancy. METHODS: We retrospectively included consecutive patients referred from the Department of ENT Head and Neck Surgery for F-FDG PET/CT-scans because of a solitary neck cyst. Scan results were compared to histopathology and follow-up. RESULTS: The study comprised 58 patients. Twenty patients (34%) were diagnosed with cancer during follow-up. PET/CT suggested malignancy in 34 patients (19 true positive, 15 false positive) and showed no malignancy in 24 (23 true negative, 1 false negative). The sensitivity, specificity, accuracy, positive and negative predictive values were 95% (76-99%), 61% (45-74%), 72% (60-82%), 56% (39-71%), and 96% (80-99%), respectively (95% confidence intervals in brackets). The primary tumor was identified in 14 out of the 20 patients with confirmed cancer. Increased metabolism, as evaluated by PET, was the only imaging characteristic among several others, which associated independently with malignancy in the cystic neck lesions, odds ratio 1.27 (1.07-1.50), p = 0.006. CONCLUSION: F-FDG PET/CT could reliably rule out malignancy (NPV 96%), albeit with a high frequency of false positive scans, requiring further diagnostic work-up. Increased metabolism was the best imaging parameter to differentiate between malignant and benign lesions.
[Mh] Termos MeSH primário: Fluordesoxiglucose F18
Linfonodos/diagnóstico por imagem
Linfocele/diagnóstico por imagem
Linfoma/diagnóstico por imagem
Tomografia Computadorizada com Tomografia por Emissão de Pósitrons
Compostos Radiofarmacêuticos
[Mh] Termos MeSH secundário: Adulto
Idoso
Idoso de 80 Anos ou mais
Diagnóstico Diferencial
Feminino
Seguimentos
Neoplasias de Cabeça e Pescoço/diagnóstico por imagem
Neoplasias de Cabeça e Pescoço/patologia
Seres Humanos
Linfonodos/patologia
Linfocele/patologia
Linfoma/patologia
Masculino
Meia-Idade
Necrose
Estudos Retrospectivos
Sensibilidade e Especificidade
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Radiopharmaceuticals); 0Z5B2CJX4D (Fluorodeoxyglucose F18)
[Em] Mês de entrada:1702
[Cu] Atualização por classe:170206
[Lr] Data última revisão:
170206
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:161207
[St] Status:MEDLINE
[do] DOI:10.1007/s12149-016-1142-3


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[PMID]:27726421
[Au] Autor:White CL; Olivieri B; Restrepo R
[Ad] Endereço:1 University of Colorado Aurora, CO.
[Ti] Título:Reply to "Imaging Appearance of Lymphatic Malformations".
[So] Source:AJR Am J Roentgenol;208(1):W30, 2017 Jan.
[Is] ISSN:1546-3141
[Cp] País de publicação:United States
[La] Idioma:eng
[Mh] Termos MeSH primário: Anormalidades Linfáticas/diagnóstico por imagem
Linfocele/diagnóstico por imagem
Imagem por Ressonância Magnética/métodos
Neoplasias de Tecido Conjuntivo e de Tecidos Moles/diagnóstico por imagem
Teratoma/diagnóstico por imagem
Malformações Vasculares/diagnóstico por imagem
[Mh] Termos MeSH secundário: Diagnóstico Diferencial
Seres Humanos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1703
[Cu] Atualização por classe:170817
[Lr] Data última revisão:
170817
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:161012
[St] Status:MEDLINE
[do] DOI:10.2214/AJR.16.17128


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[PMID]:27657191
[Au] Autor:Arrivé L; Monnier-Cholley L; Mouhadi SE
[Ad] Endereço:1 Sorbonne Universités, UPMC Université, and Saint-Antoine Hospital Paris, France.
[Ti] Título:Imaging Appearance of Lymphatic Malformations.
[So] Source:AJR Am J Roentgenol;208(1):W29, 2017 Jan.
[Is] ISSN:1546-3141
[Cp] País de publicação:United States
[La] Idioma:eng
[Mh] Termos MeSH primário: Anormalidades Linfáticas/diagnóstico por imagem
Linfocele/diagnóstico por imagem
Imagem por Ressonância Magnética/métodos
[Mh] Termos MeSH secundário: Adulto
Diagnóstico Diferencial
Feminino
Seres Humanos
Neoplasias de Tecido Conjuntivo e de Tecidos Moles/diagnóstico por imagem
Malformações Vasculares/diagnóstico por imagem
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Em] Mês de entrada:1703
[Cu] Atualização por classe:170817
[Lr] Data última revisão:
170817
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:160923
[St] Status:MEDLINE
[do] DOI:10.2214/AJR.16.17039


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[PMID]:28040117
[Au] Autor:Tonni G; Palmisano M; Lituania M; Grisolia G; Baffico AM; Bonasoni MP; Pattacini P; De Felice C; Araujo Júnior E
[Ad] Endereço:Prenatal Diagnostic Unit, Department of Obstetrics and Gynecology, AUSL (Azienda Unità Sanitaria Locale) Reggio Emilia, Italy. Electronic address: tonnig@ausl.re.it.
[Ti] Título:Skeletal dysplasia with bowing long bones: Proposed flowchart for prenatal diagnosis with case demonstration.
[So] Source:Taiwan J Obstet Gynecol;55(6):771-776, 2016 Dec.
[Is] ISSN:1875-6263
[Cp] País de publicação:China (Republic : 1949- )
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: Skeletal dysplasia with bowing long bones is a rare group of multiple characterized congenital anomalies. MATERIALS AND METHODS: We introduce a simple, practical diagnostic flowchart that may be helpful in identifying the appropriate pathway of obstetrical management. RESULTS: Herein, we describe four fetal cases of bent bony dysplasia that focus on ultrasound findings, phenotype, molecular tests, distinctive X-ray features, and chondral growth plate histology. The first case was a typical campomelic dysplasia resulting from a de novo mutation in the SOX9 gene. The second fetus was affected by osteogenesis imperfecta Type II carrying a mutation in the COLA1 gene. The third case was a rare presentation of campomelic dysplasia, Cumming type, in which SOX9 examination was normal. Subsequently, a femoral hypoplasia unusual facies syndrome is also discussed. CONCLUSION: Targeted molecular tests and genetic counseling are required for supplementing ultrasound imaging in order to diagnose the correct skeletal disorders.
[Mh] Termos MeSH primário: Algoritmos
Displasia Campomélica/diagnóstico
Fêmur/anormalidades
Linfocele/diagnóstico
Rim Displásico Multicístico/diagnóstico
Osteogênese Imperfeita/diagnóstico
Síndrome de Pierre Robin/diagnóstico
Diagnóstico Pré-Natal
Baço/anormalidades
[Mh] Termos MeSH secundário: Anormalidades Múltiplas
Adulto
Displasia Campomélica/genética
Evolução Fatal
Feminino
Fêmur/diagnóstico por imagem
Doenças Fetais
Seres Humanos
Linfocele/genética
Masculino
Rim Displásico Multicístico/genética
Osteogênese Imperfeita/genética
Síndrome de Pierre Robin/genética
Gravidez
Radiografia
Tíbia/anormalidades
Tíbia/diagnóstico por imagem
Tomografia Computadorizada por Raios X
Ultrassonografia Pré-Natal
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Em] Mês de entrada:1707
[Cu] Atualização por classe:170713
[Lr] Data última revisão:
170713
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170102
[St] Status:MEDLINE


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[PMID]:27932116
[Au] Autor:Moreno de la Higuera Díaz MA; Calvo Romero N; Pérez-Flores I; Calvo Arévalo M; Rodríguez Cubillo B; Shabaka A; López de la Manzanara V; Gómez Vegas Á; Blázquez Izquierdo J; Sánchez-Fructuoso AI
[Ad] Endereço:Nephrology Department, Hospital Clinico San Carlos, Madrid, Spain. Electronic address: angie.moreno@gmail.com.
[Ti] Título:Surgical Complications in En Bloc Renal Transplantation.
[So] Source:Transplant Proc;48(9):2953-2955, 2016 Nov.
[Is] ISSN:1873-2623
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:En bloc pediatric transplantation (EBPT) began with the aim of increasing the donor pool due to the existing high demand for donors. At its inception, it was considered a type of suboptimal transplantation due to its association with a high incidence of vascular, urologic, and immunologic complications. The main objective of this study was to update information on EBPT with the largest case series that exists on a worldwide scale. In a retrospective study, the results obtained from brain-dead donors (BDDs; n = 770) were compared to those of EBPT (n = 100) from January 1990 to December 2012. The median of follow-up was 12.8 years (interquartile range 8.1 to 17.2). The variables collected for analysis were demographic factors (age and sex of recipients, age and weight of donors), renal function, graft survival, recipient survival, surgical complications (thrombosis, lymphocele, urologic complications, and renal artery stenosis and need for revascularization with angioplasty and/or stents). Subsequently in a second analysis, we studied the association between graft survival, thrombosis, angioplasty, stents, and appearance of lymphoceles with the different factors that were considered to be related in accordance with published literature and our own experience. Graft loss due to surgical complications was more frequent in EBPT than in BDD (15% vs 2.2 % in BDD; P < .001), and interstitial fibrosis and tubular atrophy were more frequent in BDD (13% vs 2%; P < .001). EBPT offers a good survival rate after overcoming the possible surgical complications that may arise.
[Mh] Termos MeSH primário: Sobrevivência de Enxerto
Transplante de Rim/efeitos adversos
Complicações Pós-Operatórias/etiologia
[Mh] Termos MeSH secundário: Adolescente
Morte Encefálica
Criança
Pré-Escolar
Feminino
Seguimentos
Seres Humanos
Transplante de Rim/métodos
Transplante de Rim/mortalidade
Linfocele/etiologia
Masculino
Complicações Pós-Operatórias/mortalidade
Obstrução da Artéria Renal/etiologia
Estudos Retrospectivos
Taxa de Sobrevida
Trombose/etiologia
Doadores de Tecidos/provisão & distribuição
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1706
[Cu] Atualização por classe:170817
[Lr] Data última revisão:
170817
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:161210
[St] Status:MEDLINE


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[PMID]:27742284
[Au] Autor:Araújo JC; Barbosa RW; Machado MF; Furtado PS; Pugas CM; Filho JS; Lopes CF; Mattoso RJ; Neves CL
[Ad] Endereço:Univerisdade Federal Da Bahia, Salvador, Bahia, Brazil. Electronic address: zeheck@hotmail.com.
[Ti] Título:Clinical Impact of Surgical Complications in Kidney Transplant Recipients in a Reference Hospital in Salvador, Bahia, Brazil.
[So] Source:Transplant Proc;48(7):2301-2305, 2016 Sep.
[Is] ISSN:1873-2623
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Renal transplantation is the treatment of choice for patients with stage V chronic kidney disease, which does not have contraindications to the procedure and is more cost-effective than dialysis treatments and provides better survival and quality of life. OBJECTIVE: The objective of this study was to evaluate the incidence of postoperative complications in kidney transplant recipients in a reference hospital. METHODOLOGY: This was a descriptive and retrospective study involving the analysis of patient records during hospitalization and outpatient treatment. We analyzed the demographics, clinical indicators, surgical techniques, and postoperative complications. RESULTS: In the analysis of 147 transplantations, there was a higher incidence of transplantation in female recipients, average age of 37 years with a predominance of cadaveric transplantation. Of all pretransplantation comorbidities, hypertension was the most frequent. The overall incidence of surgical complications was 29.9%, with an incidence of vascular complications of 12.7%, 13.4% of surgical site complications, 8.2% of urologic complications, and 3% of hemorrhagic complications. DISCUSSION: Vascular complications are serious complications and are associated with increased risk of graft loss (relative risk, 8.4), particularly arterial thrombosis. Patients with ureteral anastomosis using Lich-Gregoir technique showed lower urologic complications compared with patients with anastomosis by Leadbetter-Politano technique. CONCLUSION: Surgical complications have different clinical effects, depending on their category. The vascular complications are associated with graft lost.
[Mh] Termos MeSH primário: Anastomose Cirúrgica/métodos
Falência Renal Crônica/cirurgia
Transplante de Rim/métodos
Complicações Pós-Operatórias/epidemiologia
Trombose/epidemiologia
[Mh] Termos MeSH secundário: Abscesso/epidemiologia
Adulto
Transfusão de Sangue
Brasil/epidemiologia
Feminino
Seres Humanos
Incidência
Hérnia Incisional/epidemiologia
Linfocele/epidemiologia
Masculino
Hemorragia Pós-Operatória/epidemiologia
Hemorragia Pós-Operatória/terapia
Qualidade de Vida
Diálise Renal
Reoperação
Estudos Retrospectivos
Infecção da Ferida Cirúrgica/epidemiologia
Transplantados
Ureter/cirurgia
Obstrução Ureteral/epidemiologia
Fístula Urinária/epidemiologia
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1704
[Cu] Atualização por classe:170817
[Lr] Data última revisão:
170817
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:161016
[St] Status:MEDLINE


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[PMID]:27720313
[Au] Autor:Timsit MO; Kleinclauss F; Richard V; Thuret R
[Ad] Endereço:Service d'urologie, hôpital européen Georges-Pompidou, AP-HP, 20, rue Leblanc, 75015 Paris, France; Université Paris Descartes, 75006 Paris, France. Electronic address: marc-olivier.timsit@egp.aphp.fr.
[Ti] Título:[Surgical complications of renal transplantation].
[Ti] Título:Complications chirurgicales de la transplantation rénale..
[So] Source:Prog Urol;26(15):1066-1082, 2016 Nov.
[Is] ISSN:1166-7087
[Cp] País de publicação:France
[La] Idioma:fre
[Ab] Resumo:OBJECTIVE: To report the nature, incidence, diagnosis and treatment options of surgical complications after renal transplantation. MATERIAL AND METHODS: Relevant publications were identified through Medline (http://www.ncbi.nlm.nih.gov/) and Embase (http://www.embase.com/) database from 1960 to 2016 using the following keywords "fistula; lymphocele; stricture; thrombosis", in association with "renal transplantation" in Title/Abstract field. Articles were selected according to methods, language of publication and relevance. A total of 7618 articles were identified including specifically 981 for vascular complications, 1016 for urologic complications and 239 for lymphocele; after careful selection 190 publications were eligible for our review. RESULTS: Surgical complications occur in 1 to 30% of renal transplantations while being incompletely reported without consensual management. Angioplasty techniques led to a significant improvement of short- and long-term vascular complications outcome. Risk factors for transplant thrombosis are a right allotransplant, multiple renal arteries or vasculopathy in the donor, diabetes, arterial disease or thrombophilia in the recipient and hemodynamic changes during procedure. Urinary complications and lymphocele significantly impair overall outcome and recipients quality of life with no demonstrated impact on allotransplant survival. Immediate or salvage pelvi-ureterostomy is a main treatment option for ureteral strictures and fistula. CONCLUSION: Prevention of surgical complications following renal transplantation relies on careful allotransplant preparation and strict respect of surgical best practices. Increasing comorbidities in recipients as well as marginal donors are significant limits for the improvement of post-transplant surgical outcome.
[Mh] Termos MeSH primário: Transplante de Rim/efeitos adversos
Complicações Pós-Operatórias/etiologia
[Mh] Termos MeSH secundário: Árvores de Decisões
Seres Humanos
Linfocele/diagnóstico
Linfocele/etiologia
Linfocele/terapia
Complicações Pós-Operatórias/diagnóstico
Complicações Pós-Operatórias/terapia
Doadores de Tecidos
Doenças Urológicas/diagnóstico
Doenças Urológicas/etiologia
Doenças Urológicas/terapia
Doenças Vasculares/diagnóstico
Doenças Vasculares/etiologia
Doenças Vasculares/terapia
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Em] Mês de entrada:1706
[Cu] Atualização por classe:170601
[Lr] Data última revisão:
170601
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:161011
[St] Status:MEDLINE


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[PMID]:27533924
[Au] Autor:Nicolai N; Cattaneo F; Biasoni D; Catanzaro M; Torelli T; Zazzara M; Necchi A; Giannatempo P; Raggi D; Piva L; Colecchia M; Salvioni R; Stagni S
[Ad] Endereço:1 Testis Surgery Unit, Fondazione IRCCS Istituto Nazionale Tumori , Milan, Italy .
[Ti] Título:Laparoscopic Postchemotherapy Retroperitoneal Lymph-Node Dissection Can Be a Standard Option in Defined Nonseminomatous Germ Cell Tumor Patients.
[So] Source:J Endourol;30(10):1112-1119, 2016 Oct.
[Is] ISSN:1557-900X
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Residual retroperitoneal masses in NSGCT need postchemotherapy retroperitoneal lymph-node dissection (PC-RPLND). Open (O) PC-RPLND is a standardized procedure, but morbidity is not negligible and mostly attributable to laparotomy. Laparoscopic (L) PC-RPLND may improve tolerability profile. We evaluated viability, toxicity, and short to medium-term oncologic outcome of L-PC-RPLND following well-defined selection criteria. PATIENTS AND METHODS: Since February 2011, consecutive patients with a unilateral residual mass (≥1 cm or growing), normalized markers, and limited encasement of inferior vena cava and/or aorta were candidate to unilateral L-PC-RPLND. Surgical performances, histology, hospital stay, complications within 30 days, and survival were recorded. Patients were regularly followed up. Adjuvant chemotherapy was not provided. RESULTS: Sixty-seven patients (stage IIA = 14; IIB = 41; IIC = 7; III = 5), representing 29% of all those candidate to PC-RPLND in this time frame, underwent L-PC-RPLND up to August 2015. Median size of the mass was 27 mm (interquartile range [IQR] 15-31). Median operative time was 234 minutes (IQR 184-250). Three procedures were converted to open surgery. Mean hospital stay was 3 days (IQR 2-4). Out of three (4.5%), one grade III (lymphocele requiring drainage) complication occurred. Sixty-six (98.5%) patients maintained antegrade ejaculation. Histology revealed teratoma in 76%, fibronecrotic tissue in 21%, and viable cancer in 3% patients. All patients are alive and event free after a median follow-up of 21 months (IQR 10-30). CONCLUSIONS: In a referral center, L-PC-RPLND is a transferable option for a proportion of patients with a residual mass. Tolerability is acceptable, and current oncologic outcome is consistent with a safe oncologic profile.
[Mh] Termos MeSH primário: Laparoscopia/métodos
Excisão de Linfonodo/métodos
Linfocele/cirurgia
Neoplasias Embrionárias de Células Germinativas/tratamento farmacológico
Neoplasias Embrionárias de Células Germinativas/cirurgia
Espaço Retroperitoneal/cirurgia
Neoplasias Testiculares/tratamento farmacológico
Neoplasias Testiculares/cirurgia
[Mh] Termos MeSH secundário: Adolescente
Adulto
Quimioterapia Adjuvante
Bases de Dados Factuais
Estudos de Viabilidade
Seguimentos
Seres Humanos
Laparotomia
Tempo de Internação
Linfocele/etiologia
Masculino
Meia-Idade
Duração da Cirurgia
Período Pós-Operatório
Estudos Retrospectivos
Resultado do Tratamento
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1708
[Cu] Atualização por classe:170823
[Lr] Data última revisão:
170823
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:160818
[St] Status:MEDLINE



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