Salvage surgery for nasopharyngeal cancer

Nasopharyngeal carcinoma (NPC) is a special type of head and neck cancer with a widely variable geographical variation in incidence.The central location of the tumor inside the head coupled with the radiosensitivity of the tumor to radiation made radiation therapy the first choice in primary treatment of NPC.Advances in radiotherapy and chemotherapy have markedly improved the local control of NPC.Unfortunately, a small but significant number of patients still suffered from loco-regional failures that would be amenable to re-treatment.Traditional form of retreatment was to employ a second course of radiation.The efficacy of re-irradiation to treat local of regional recurrent NPC has been suboptimal.Moreover, the local tissue had already received a high dose of radiation and the second radiation could result in radiation toxicities to the local tissue, leading to significant complications.Surgical salvage, on the other hand, could spare the patients from complications of retreatment.Due to the difficult access of the nasopharynx, various surgical approaches had been devised for nasopharyngectomy.The maxillary swing approach had the largest published experience with over 300 cases from various centers.In the recent decade, the endoscopic approach with or without robotic assistance had gained popularity for resecting small, centrally located recurrences.This minimally invasive approach further reduced the morbidity for treating locally recurrent NPC.Nodal recurrences had been a rare entity after the introduction of modern radiotherapy technique and concurrent chemotherapy.Treatment of nodal failure with second radiation has dismal results.Surgical removal of the lymph node harboring the recurrence should be in the form of a formal radical neck dissection.In cases of extensive nodal recurrence where microscopic disease may be present after a formal neck dissection, additional radiotherapy can be delivered with after-loading brachytherapy.Surgical treatment played a definitive role in salvage of loco-regional failures of nasopharyngeal carcinoma.

The role of salvage surgery in oral squamous cell carcinoma

Aim:To select and analyze the most representative papers published in the literature concerning oral squamous cell carcinoma(OSCC),specifically dealing with salvage surgery following primary treatment by surgery with or without by postoperative radiotherapy,specifically focusing in the oral cavity and oropharynx locations.Methods:A bibliography search on MEDLINE and EMBASE databases for studies published from March 2000 to March 2016 was conducted.The authors only included studies published in the English language and those dealing with“squamous cell carcinoma of the oral cavity and/or oropharynx”.The following technical bibliographic exclusion criteria were applied:(1)case reports;(2)technical report;(3)animal or in vitro studies;(4)review articles;(5)uncontrolled clinical studies;and(6)publications in which the same data were published by the same group of researchers.The abstracts of yielded results were reviewed and the full text of those with apparent relevance was obtained.Results:A total amount of 188 studies were found using the above reported searching parameters.Thirteen original papers were finally selected according to the inclusion and exclusion criteria.From 1,692 analyzed patients,overall recurrence rate was 26%(range:15-41.7%),with a mean 47.3%,35.1%and 10.9%local,regional and loco-regional recurrence,respectively.Mean 5-year overall survival rate was 40.2%(range:37.5-42.9%).Conclusion:Salvage surgery is the best option for the treatment of recurrent OSCC,either local,regional or loco-regional,with the highest rates in terms of survival and with an acceptable morbidity.

Expandable endoprostheses in skeletally immature patients:Where we are

Approximately 45 percent of malignant bone tumors are seen under the age of 16 and one of the important results of growth plate sacrification in patients with immature skeletons is limb inequality.Until the early 1990s,the treatment options for these patients were rotationplasty or amputation.Multimodal approaches that combine imaging,chemotherapy,and surgical techniques have enabled the development of limb-preserving methods with satisfactory results.In order to overcome inequality problems,expandable prostheses have been developed in the 1980s.Extendable endoprosthesis replacements have been improved over the years and are now an established and safe alternative.Noninvasive prostheses appear to be advantageous compared to minimally invasive expandable prostheses that require multiple surgical procedures,but the complication rate remains high.Therefore,although expandable prostheses are not the definitive answer to the treatment of bone sarcomas in skeletally immature children,they are still a suitable interim choice until full adulthood is achieved.Due to reported high complication rates,the procedures require significant experience and are recommended for use only in specialized cancer centers.

Inserting the Ulnar Prosthesis into Radius as a Novel Salvage Surgery for Revision Total Elbow Arthroplasty with Massive Bone Defect

Background： Infection and aseptic loosening are common complications of total elbow arthroplasty （TEA） and often require revision surgery. However, bone defects, along with other complications, bring an extra difficulty to the second surgery, especially for patients with a massive bone defect in the proximal ulna. Several methods including allograft or autograft have been introduced into practice, but none sufficiently solves these problems. Methods： We conducted a new surgical method for patients with a massive ulnar bone defect needing revision TEA. During revision arthroplasty, the ulnar prosthesis was inserted into the radius as a salvage procedure. Four consecutive patients received revision arthroplasty with this method between 2013 and 2016. Patients＇ data were collected to evaluate the clinical outcome. Results： All patients had a Grade Ill ulnar bone defect. At the last follow-up session, all patients reported a painless, functional elbow joint. Three patients suffered from a periprosthetic infection that was completely cured using the two-stage method. No major complications, including infection, aseptic loosening, or wound problems were found. One patient had a transient ulnar neuritis, and another had a transient radial neuritis. Both patients had full recovery at the last follow-up session. Conclusions： Inserting an ulnar prosthesis into the radius is a novel procedure for patients with a massive bone defect due to infection or aseptic loosening. It is a safe, quick, and effective treatment with a promising short-term outcome. This method should be provided as a salvage procedure for patients with a nonreconstructable ulnar bone defect.

Current indications for endoscopic submucosal dissection of early gastric cancer

The development of endoscopic treatment technology has further promoted the minimally invasive treatment of early gastric cancer(EGC).Endoscopic treatment has achieved better therapeutic effects in terms of safety and prognosis and is the preferred treatment method for patients who meet the indications for endoscopic treatment.However,the consequent problem is that some patients receiving endoscopic treatment may undergo non-curative resection,and the principle of follow-up management for non-curative resection patients deserves further attention.In addition,there are still debates on how to improve the accuracy of clinical staging,select a reasonable treatment method for patients who meet the expanded indications for endoscopic treatment,manage patients with positive endoscopic surgical margins,conduct research on function-preserving surgery,and manage the treatment of EGC under the current situation in China.Consequently,we aim to review current indications for endoscopic submucosal dissection of EGC in order to better inform treatment options.

Intensive or not surveillance of patients with colorectal cancer after curative resection

It is common practice to follow patients with colorectal cancer for some years after resection and/or adjuvant treatment.Data are lacking about how often patients should be seen,what tests should be performed,and what surveillance strategy has a signifi cant impact on patient outcome.Seven randomized trials have addressed this issue,but none had sufficient statistical power.Four published meta-analyses have established that overall survival is significantly improved for patients in the more intensive programs of follow-up.This improvement amounts to a risk difference of 7%(95% CI:3%-12%,P=0.002) in 5-year survival.This should be partly attributable to more frequent reoperation for cure of asymptomatic recurrence,or more intense follow-up,as well other factors,such increased psychosocial support and well-being,diet and lifestyle optimization,and/or improved treatment of coincidental diseases.A large-scale multicenter European study [Gruppo Italiano di Lavoro per la Diagnosi Anticipata(GILDA)] is underway to answer the question of what constitutes optimal surveillance for patients after primary therapy,based on an adequately powered study.