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206 POSTER Malnutrition related complications in post external hemipelvectomy patients
Poster session: Soft tissue sarcoma [4] Veronesi U, Paganelli G, Viale G, et al. A randomized comparison of sentinel node biopsy with routine Axillary dissection in breast cancer. N Engl J Med 2003; 349: 546-53. 205
POSTER
The role of open lymph node biopsy in the definitive diagnosis and treatment of peripheral lymphadenopathy G. Fragandreas 1 , K. Mandala 2 , A. Ntinas 3 , I. Venizelos 1 , S. Arapoglou 1 , S. Papadopoulos 1 , T. Gerasimidis 1 . 1 Aristotle University of Thessaloniki, Hippokrateio, 5th Surgical Clinic, Thessaloniki, Greece; 2 Aristotle University of Thessaloniki, Hippokrateio, Haematology Laboratory, Thessaloniki, Greece; 3 Aristotle University of Thessaloniki, Hippokrateio, Pathology Laboratory, Thessaloniki, Greece Peripheral lymph node enlargement may be malignant or benign in origin and presents a common diagnostic problem. The aim of this study is the investigation of the causes of peripheral lymphadenopathy in adults. Material and Methods: A retrospective analysis of the open biopsies of 138 patients performed at the 5th Surgical clinic during the last decade was carried out. Of these 138 patients 75 were male and 63 female, aging from 15 to 63 years old (mean age 48 years old). The biopsy site was the cervical region in 93 patients, axillary in 10 patients, inguinal in 22 patients, subclavian in 13 patients, and submandibular in 5 patients. All the patients underwent open biopsy with local anaesthesia by xylocaine 1% injection. Results: Malignant Benign Non-Hodgkin’s’ lymphoma 25 Reactive lymphadenopathy 43 Hodgkin’s’ lymphoma 11 Granulomatous lymphadenopathy 14 Metastatic carcinoma 21 Tuberculosis 5 Acute Lymphogenic Leukemia 3 Sarcoidosis 3 Chronic Lymphogenic Leukemia 2 Insufficient material 5 Kaposi’s Sarcoma 2 Conclusion: Open biopsy is necessary for the definitive diagnosis of lymphadenopathy and therefore for the prompt initiation of suitable treatment. Lymphomas (usually non-Hogkin ones) are the most frequent cause of painless unilateral lymph node enlargement (19,5%). The correlation of histological findings with the patient’s history, clinical presentation and laboratory findings is necessary. In a significant percentage (31,15%), reactive lymphadenopathy was the only finding. This, of course, helps in ruling out malignancy, but if clinical suspicion is high, a repeat biopsy is recommended.
POSTER SESSION
Soft tissue sarcoma 206
POSTER
Malnutrition related complications in post external hemipelvectomy patients M.G. Serna Thome 1 , C.D. Lever Rosas 2 , I. Zeichner Gancz 3 , A.E. Padilla Rosciano 2 . 1 National Cancer Institute Mexico, Nutrition, Naucalpan Edo de Mexico., Mexico; 2 National Cancer Institute, Soft Tissue and Bone Sarcomas, Naucalpan Edo de Mexico, Mexico; 3 National Cancer Institute, Clinical Research, Naucalpan Edo de Mexico, Mexico Introduction: Hemipelvectomy is a very radical surgical procedure that is not performed frequently, the magnitude of this surgery causes a high consumption of energy and protein, conducting the patients to a state of hypercatabolism. It is reported that hemipelvectomy presents about 50-70% of complications in the surgical wound and the flap and its relation with the malnutrition that patients suffer after this surgical procedure. Material and Methods: In this study were included 14 patients, consisting in those patients that suffered any local complication secondary to the procedure such as infection, abscess or wound dehiscence. Data on sex, age, weigth, heigth, size, body mass index, albumin levels prior to surgery and 1-2 weeks after the complication. For the albumin it was considered a mild depletion when the levels was from 2.8-3.4 g/dl, moderate 2.1-2.7 g/dl and severe below 2g/dl. The body mass index was considered normal from 20-24.9 kg/m2 and overweigth from 25-29.9 kg/m2 . The analysis was performed with the statistical software stata 7, using descriptive measures.
S61
Results: 71% of the patients were male and 29% female, mean age was 35.5 years (male 34.2 years and female 39 years) Heigth of 1.61 meters (males 1.64 meters women 1.60 meters). Mean corporal weigth was 67.4 k (male 63.2 female 80.17 k). Body mass index was 25.8 k/m2 (male 24.6 k/m2 , female 29.8 k/m2 . Initial seric albumin levels was 3.3 g/dl (male 3.7 g/dl female 2.2 g/dl (and final concentration was 2.4 g/dl (male 2.6 g/dl female 2.0 g/dl(. Infection was observed in 92.8% of the cases, without abscess and 50% had wound dehiscence, six patients (42.8%) had two complications. Conclusions: All patients were admitted with a normal to obese nutritional state, according to the body mass index. Mild albumin depletion was observed in this patients, at the time of the complication. The albumin depletion was from mild and even severe in female population, high percentage of patients suffer malnutrition during the hospital stay (from time the surgery to the presence of complication (this probably contributes to the presence of local complications, it is required special attention in the nutritional status of the patients during the immediate postoperative period, even though tolerate oral nutrition because this is not enough to cover the nutrimental requirement during this time of hypercatabolism, secondary to the external hemipelvectomy. 207
POSTER
Management of complex large volume groin tumours with rectus abdominus myocutaneous flaps – a case series P. Fischer 1 , I.M. Cranshaw 1 , J. Staiano 2 , J.M. Thomas 1 . 1 Royal Marsden Hospital, Sarcoma and Melanoma Unit, London, United Kingdom; 2 Royal Marsden Hospital, Plastic Surgical Unit, London, United Kingdom Introduction: Resection of large volume soft tissue tumours and metastatic disease in the groin commonly involves extensive resection of abdominal wall and overlying skin to achieve adequately wide surgical margins. There are many reconstructive techniques available to replace the resected structures and protect the underlying neurovascular elements. Often these reconstructions require specialised plastic surgical input. We have routinely used vertical rectus abdominus myocutaneous flaps (VRAM)to reconstruct these defects and our impression was that these flaps provided good cover with few complications. Methods: A search of our operative database between 1999 and 2005 to identify large volume groin tumours which had been immediately reconstructed with a VRAM. We recorded information on patient demographics, tumour characteristics, reconstruction type, postoperative complications, follow-up and survival data. Results: 18 patients fulfilled our criteria and were included in the study. Tumour pathology was sarcoma 11 (61%), melanoma 4 (22%) and squamous cell carcinoma 3 (17%). Only 6 cases were potientially curative resections for primary tumours with, 5 palliative procedures for recurrent sarcoma and 7 for metastatic. Patients with palliative resections did poorly with and average survival of 17 months (range 6-36 months) but complications were uncommon with partial flap necrosis requiring split skin grafting in one case only. Primary tumours with potentially curative resections did better with no local recurrences and only one death from disease at 44 months. Conclusion: VRAM reconstruction following resection of large volume groin tumours was very successful in our series. The flap is not technically difficult and provides excellent cover in the groin with few complications. The technique is useful in achieving robust surgical palliation and appears equally effective for potentially curative cases. 208
POSTER
Tikhoff Linberg procedure for tumors in the scapulo-humeral space. Experience at National Cancer Institute Mexico A.E. Padilla Rosciano 1 , A. Rojas Calvillo 1 , L.M. Dominguez Parra 1 , I. Zeichner Gancz 2 , H. Martinez Said 1 . 1 National Cancer Institute Mexico, Soft Tissue and Bone Sarcomas, Naucalpan Edo de Mexico., Mexico; 2 National Cancer Institute, Clinical Research, Naucalpan Edo de Mexico, Mexico Introduction: Tikhoff Linberg is a rare procedure performed in the management of benign and malignant bone and soft tissue sarcomas in the scapulo-humeral region, the function of the forearm, wrist and hand should be normal or nearly normal following a scapulo-humeral resections. Material and Methods: Retrospectively were reviewed the clinical records
POSTER
The role of open lymph node biopsy in the definitive diagnosis and treatment of peripheral lymphadenopathy G. Fragandreas 1 , K. Mandala 2 , A. Ntinas 3 , I. Venizelos 1 , S. Arapoglou 1 , S. Papadopoulos 1 , T. Gerasimidis 1 . 1 Aristotle University of Thessaloniki, Hippokrateio, 5th Surgical Clinic, Thessaloniki, Greece; 2 Aristotle University of Thessaloniki, Hippokrateio, Haematology Laboratory, Thessaloniki, Greece; 3 Aristotle University of Thessaloniki, Hippokrateio, Pathology Laboratory, Thessaloniki, Greece Peripheral lymph node enlargement may be malignant or benign in origin and presents a common diagnostic problem. The aim of this study is the investigation of the causes of peripheral lymphadenopathy in adults. Material and Methods: A retrospective analysis of the open biopsies of 138 patients performed at the 5th Surgical clinic during the last decade was carried out. Of these 138 patients 75 were male and 63 female, aging from 15 to 63 years old (mean age 48 years old). The biopsy site was the cervical region in 93 patients, axillary in 10 patients, inguinal in 22 patients, subclavian in 13 patients, and submandibular in 5 patients. All the patients underwent open biopsy with local anaesthesia by xylocaine 1% injection. Results: Malignant Benign Non-Hodgkin’s’ lymphoma 25 Reactive lymphadenopathy 43 Hodgkin’s’ lymphoma 11 Granulomatous lymphadenopathy 14 Metastatic carcinoma 21 Tuberculosis 5 Acute Lymphogenic Leukemia 3 Sarcoidosis 3 Chronic Lymphogenic Leukemia 2 Insufficient material 5 Kaposi’s Sarcoma 2 Conclusion: Open biopsy is necessary for the definitive diagnosis of lymphadenopathy and therefore for the prompt initiation of suitable treatment. Lymphomas (usually non-Hogkin ones) are the most frequent cause of painless unilateral lymph node enlargement (19,5%). The correlation of histological findings with the patient’s history, clinical presentation and laboratory findings is necessary. In a significant percentage (31,15%), reactive lymphadenopathy was the only finding. This, of course, helps in ruling out malignancy, but if clinical suspicion is high, a repeat biopsy is recommended.
POSTER SESSION
Soft tissue sarcoma 206
POSTER
Malnutrition related complications in post external hemipelvectomy patients M.G. Serna Thome 1 , C.D. Lever Rosas 2 , I. Zeichner Gancz 3 , A.E. Padilla Rosciano 2 . 1 National Cancer Institute Mexico, Nutrition, Naucalpan Edo de Mexico., Mexico; 2 National Cancer Institute, Soft Tissue and Bone Sarcomas, Naucalpan Edo de Mexico, Mexico; 3 National Cancer Institute, Clinical Research, Naucalpan Edo de Mexico, Mexico Introduction: Hemipelvectomy is a very radical surgical procedure that is not performed frequently, the magnitude of this surgery causes a high consumption of energy and protein, conducting the patients to a state of hypercatabolism. It is reported that hemipelvectomy presents about 50-70% of complications in the surgical wound and the flap and its relation with the malnutrition that patients suffer after this surgical procedure. Material and Methods: In this study were included 14 patients, consisting in those patients that suffered any local complication secondary to the procedure such as infection, abscess or wound dehiscence. Data on sex, age, weigth, heigth, size, body mass index, albumin levels prior to surgery and 1-2 weeks after the complication. For the albumin it was considered a mild depletion when the levels was from 2.8-3.4 g/dl, moderate 2.1-2.7 g/dl and severe below 2g/dl. The body mass index was considered normal from 20-24.9 kg/m2 and overweigth from 25-29.9 kg/m2 . The analysis was performed with the statistical software stata 7, using descriptive measures.
S61
Results: 71% of the patients were male and 29% female, mean age was 35.5 years (male 34.2 years and female 39 years) Heigth of 1.61 meters (males 1.64 meters women 1.60 meters). Mean corporal weigth was 67.4 k (male 63.2 female 80.17 k). Body mass index was 25.8 k/m2 (male 24.6 k/m2 , female 29.8 k/m2 . Initial seric albumin levels was 3.3 g/dl (male 3.7 g/dl female 2.2 g/dl (and final concentration was 2.4 g/dl (male 2.6 g/dl female 2.0 g/dl(. Infection was observed in 92.8% of the cases, without abscess and 50% had wound dehiscence, six patients (42.8%) had two complications. Conclusions: All patients were admitted with a normal to obese nutritional state, according to the body mass index. Mild albumin depletion was observed in this patients, at the time of the complication. The albumin depletion was from mild and even severe in female population, high percentage of patients suffer malnutrition during the hospital stay (from time the surgery to the presence of complication (this probably contributes to the presence of local complications, it is required special attention in the nutritional status of the patients during the immediate postoperative period, even though tolerate oral nutrition because this is not enough to cover the nutrimental requirement during this time of hypercatabolism, secondary to the external hemipelvectomy. 207
POSTER
Management of complex large volume groin tumours with rectus abdominus myocutaneous flaps – a case series P. Fischer 1 , I.M. Cranshaw 1 , J. Staiano 2 , J.M. Thomas 1 . 1 Royal Marsden Hospital, Sarcoma and Melanoma Unit, London, United Kingdom; 2 Royal Marsden Hospital, Plastic Surgical Unit, London, United Kingdom Introduction: Resection of large volume soft tissue tumours and metastatic disease in the groin commonly involves extensive resection of abdominal wall and overlying skin to achieve adequately wide surgical margins. There are many reconstructive techniques available to replace the resected structures and protect the underlying neurovascular elements. Often these reconstructions require specialised plastic surgical input. We have routinely used vertical rectus abdominus myocutaneous flaps (VRAM)to reconstruct these defects and our impression was that these flaps provided good cover with few complications. Methods: A search of our operative database between 1999 and 2005 to identify large volume groin tumours which had been immediately reconstructed with a VRAM. We recorded information on patient demographics, tumour characteristics, reconstruction type, postoperative complications, follow-up and survival data. Results: 18 patients fulfilled our criteria and were included in the study. Tumour pathology was sarcoma 11 (61%), melanoma 4 (22%) and squamous cell carcinoma 3 (17%). Only 6 cases were potientially curative resections for primary tumours with, 5 palliative procedures for recurrent sarcoma and 7 for metastatic. Patients with palliative resections did poorly with and average survival of 17 months (range 6-36 months) but complications were uncommon with partial flap necrosis requiring split skin grafting in one case only. Primary tumours with potentially curative resections did better with no local recurrences and only one death from disease at 44 months. Conclusion: VRAM reconstruction following resection of large volume groin tumours was very successful in our series. The flap is not technically difficult and provides excellent cover in the groin with few complications. The technique is useful in achieving robust surgical palliation and appears equally effective for potentially curative cases. 208
POSTER
Tikhoff Linberg procedure for tumors in the scapulo-humeral space. Experience at National Cancer Institute Mexico A.E. Padilla Rosciano 1 , A. Rojas Calvillo 1 , L.M. Dominguez Parra 1 , I. Zeichner Gancz 2 , H. Martinez Said 1 . 1 National Cancer Institute Mexico, Soft Tissue and Bone Sarcomas, Naucalpan Edo de Mexico., Mexico; 2 National Cancer Institute, Clinical Research, Naucalpan Edo de Mexico, Mexico Introduction: Tikhoff Linberg is a rare procedure performed in the management of benign and malignant bone and soft tissue sarcomas in the scapulo-humeral region, the function of the forearm, wrist and hand should be normal or nearly normal following a scapulo-humeral resections. Material and Methods: Retrospectively were reviewed the clinical records