P7. A multidisciplinary onco-plastic approach for management of chest wall tumours

Autor: Haitham Khalil, M. Djearaman, Maninder S Kalkat
Rok vydání: 2012
Předmět:
Zdroj: European Journal of Surgical Oncology (EJSO). 38:1107
ISSN: 0748-7983
DOI: 10.1016/j.ejso.2012.07.128
Popis: S 769 3 Institute of Cancer Research, Targeted Therapy Team/ Microsurgery Research Fellow, London, United Kingdom 4 Institute of Cancer Research, Targeted Therapy Team, London, United Kingdom Royal Marsden Hospital NHS Trust, Plastic and Reconstructive Surgery, London, United Kingdom 6 Institute of Cancer Research/ Royal Marsden Hospital NHS Trust, Targeted Therapy Team, London, United Kingdom Introduction: Free flap is an integral part of the surgical management of cancer, but serves no direct function in treating the malignant disease. However, the field of gene therapy has opened up the possibility of genetically modifying free flaps while they are detached from the patient (ex vivo period). Aim: To establish a working tumour model, in Fischer 344 adult male rats, assessing the ability to treat microscopic residual disease [MRD], following cancer resection. Materials and Methods: The Superficial Inferior Epigastric Artery (SIEA) was used in Fischer 344 Adult male rats. A reliable tumour cell line (rat glioma) was established in an isolated vascular territory [IVT]) and also to mimic MRD. Adenovirus encoding a thymidine kinase gene was transduced into the flap and Ganciclovir (50 mg/ml) was given systemically. Therapeutic efficacy was determined by the level of tumour growth/regression that occurred. Results: This study demonstrated a significant delay in tumour growth, within the IVT (p1⁄40.004) and in MRD model (p1⁄40.0005); a significant increase in survival (p1⁄40.0010) and a significant difference in time to reach measurable tumour growth (p 1⁄4 0.0001). Conclusion: Free flaps can be used as vehicles to transmit gene therapy onto a resected tumour bed, thereby treating MRD. 113. A multidisciplinary onco-plastic approach for management of chest wall tumours H. Khalil, M. Djearaman, M. Kalkat 1 Heart of England NHS Foundation Trust (Teaching Hospital), Department of Oncoplasty and Reconstructive Surgery, Birmingham West Midlands, United Kingdom Heart of England NHS Foundation Trust (Teaching Hospital), Department of Radiology, Birmingham West Midlands, United Kingdom Heart of England NHS Foundation Trust (Teaching Hospital), Department of Thoracic Surgery, Birmingham West Midlands, United Kingdom Background: Management of complex thoracic defects post-tumour expiration represents a challenging group due to nature of pathology/radical approach/insertion of hardware prosthetic material and required biomechanical stability. Provision of versatile coverage is of immense importance to improve outcome, early convalescence, resist infection, more efficient biomechanical movements and for postoperative radiotherapy. Reconstructive options depend on size, location and flap availability. We present our experience as multidisciplinary onco-plastic team in management of chest wall tumours and outcome. Material and methods: Thirty three patients were treated between 2009-2012, age range 17 -73 with thymic carcinoma, soft tissue and bony sarcoma, desmoids tumour and locally advanced invasive breast cancer. Sites of defects included posterolateral, lateral and anterolateral and anterior with range of rib resection 2-6. Bony reconstruction was performed using polyprolene mesh/ marlex methacrylate composite prosthesis and reconstructive titanium plates. Soft tissue reconstruction included latissimus dorsi, serratus anterior, pectoralis major , pedicled V/TRAM, free TRAM, omental flap +/graft. The range of flaps used 1-3 to achieve complete coverage. Results: All resection margins were clear except one, all flaps showed complete survival and healing, one patient experience MRSA infection, one fractured bar and another donor site hematoma. Five mortalities were experienced due to disease progression within a range 8 20 months postoperative with two experiencing local recurrence. Hospital stays range 5-10 days, no biomechanical chest wall deficit. Conclusion: Management of complex thoracic defects requires a multidisciplinary oncoplastic approach in order to achieve radicality and provision of a versatile coverage with eventual good chest wall stability. 114. Optical coherence tomography in vulvar intraepithelial neoplasia R.Wessels, D.M. Bruin de, D.J. Faber, H.H. Boven van, A. Vincent, T.G. Leeuwen van, M. Beurden van, T.J.M. Ruers 1 Netherlands Cancer Institute, Department of Surgery, Amsterdam, The Netherlands Academic Medical Centre, Department of Biomedical Engineering and Physics, Amsterdam, The Netherlands Netherlands Cancer Institute, Department of Pathology, Amsterdam, The Netherlands Netherlands Cancer Institute, Department of Statistics, Amsterdam, The Netherlands Netherlands Cancer Institute, Department of Gynaecology, Amsterdam, The Netherlands Netherlands Cancer Institute, University Twente, Department of Surgery, Department of Nanobiophysics, MIRA Institute, Amsterdam, Enschede, The Netherlands Background: Vulvar squamous cell carcinoma (VSCC) is the fourth most common gynaecological type of cancer with an incidence of approximately 2-3 per 100,000 women. VSCC arises from premalignant lesions called vulvar intraepithelial neoplasia (VIN). VIN is diagnosed through a punch biopsy, which can be painful. Optical coherence tomography (OCT) measures backscattered light like ultrasound measures backscattered sound waves. The backscattered light versus the depth is described by the attenuation coefficient (moct). The moct may vary along different histological types of tissue. We hypothesize thickness of the epidermal layer of the skin, measured in the OCT-images, will be different in normal tissue and VIN. Furthermore, we hypothesize that quantitative measurements of moct by using OCT can differentiate between VIN and normal vulvar tissue. Material and methods: All OCTimages were conducted in vivo in the outpatient clinic or in the operation room. Directly after imaging, punch or incisional biopsy was performed. Measurements of the epidermal thickness were performed in cross-sectional OCT-images. Analysis of the attenuation coefficient measurements were made based on the difference in moct between normal and VIN tissue within individual patients. Results: Twenty suspicious lesions from sixteen patients were imaged with OCT and the epidermal thickness and the attenuation coefficient were determined. Paired Mann-Whitney-test showed a statistically significant difference between epidermal layer thickness in VIN lesions and normal tissue within individual patients (p < 0.0001). The attenuation coefficient of these tissues was significantly different (P < 0.0001) as well. Epidermal layer thickness and attenuation coefficient were not related to each other. Conclusion: This study shows that the epidermal thickness and the attenuation coefficient of vulvar epithelial tissue containing VIN is different from normal vulvar tissue. Therefore, OCT seems to be a promising tool to discriminate between normal and VIN tissue. 115. The predictive ability of timed “Up & Go” in oncogeriatric surgical patients M.G. Huisman, B.L. Van Leeuwen, C. Stabilini, J. Spiliotis, E. Farinella, G.Z. Stanojevic, M.D. Nestorovic, N. De Liguori Carino, G. Ugolini, R.A. Audisio 1 University Medical Center Groningen, Department of Surgery, Groningen, The Netherlands 2 San Martino University Hospital, Department of Surgery, Genua, Italy Metaxa Cancer Hospital, Department of Surgery, Piraeus, Greece
Databáze: OpenAIRE
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