肿瘤外科档案

Objectives: Prevention of thromboembolic complications is a concern in patients who undergo resection of Soft Tissue Sarcomas (STS). The risk of thrombosis must be balanced with the increased risk of haemorrhage and wound healing complications in this difficult patient population. In this study we aim to determine if multiple anticoagulant use increases the risk of post-operative Major Wound Complications (MWC) in STS of the lower extremity.
Material and methods: Between 2000-2015, 134 patients with localized STS of the lower extremity underwent limb-salvage surgery. Patient and treatment variables, including anticoagulant use, wound outcomes, and thrombotic events were reviewed. Predictors for MWC were evaluated using the fisher exact test for Univariate (UVA) and logistic regression for Multivariate Analysis (MVA).
Results: The overall MWC rate in this patient population with lower extremity and buttock tumours was 35%. The MWC rate in patients on ≥2 anticoagulants were 60% versus 24% in patients taking <2 anticoagulants (p<0.001). Patients on warfarin had a higher MWC rate, 61%, versus those not taking warfarin, 28% (p=0.004). On MVA, warfarin use (p=0.02, OR 3.6) On MVA, ≥2 anticoagulants (p<0.001, OR 4.3) and warfarin use (p=0.02, OR 3.6) were found to have an increased propensity for MWCs.
Conclusion: Patients administered, ≥2 anticoagulants and warfarin use was associated a higher risk of post-operative MWCs. Anticoagulants used for DVT prophylaxis were not associated with an increased risk of MWC alone, but only when combined with other anti-coagulants.

The aim of this study is to analyse how patient’s or melanoma’s characteristics influence the prognosis. Therefore, we retrospectively reviewed and analysed our database, selecting 466 patients with most complete data. At diagnosis, average age is 55 years; most melanomas are in stage Ib, mean thickness amounts to 2.14 mm, with gradual reduction over the time. Ulceration is detected in 24% of cases, being associated with augmented thickness and reduced survival. Mostly, the number of mitosis per mm2 is >1 and nodal infiltration is present in mild form. Women have more frequently primitive melanomas of the limbs; men often develop primitives on the trunk. In the head and neck district we find the highest percentages of advanced nodular melanomas. The sentinel node is positive in about 20% of cases. Elderly patients, despite lower lymphatic involvement rates, show worst prognosis. Univariate estimates on the likelihood to have positive SNs linked to individual prognostic factors demonstrate the importance of high thickness, nodular type, advanced age, presence of ulceration and absence of regression. Mean number of excised nodes during CLND is around 17. At deadline, mortality is 13.48%, overall survival at 1, 3 and 5 years is 99, 93 and 88% respectively. Survival improved among time (88 vs. 95% at 3 years, 83% vs. 90% at 5 years). Analysis of survival indicates advanced stage at diagnosis, high thickness, nodular type, head and neck location, male sex and advanced age as negative prognostic factors. The presence and quality of nodal involvement strongly affects survival: Positive nodal biopsy patients show 30% lower OS5y values, mostly in case of macroscopic tumor burden.

Introduction: Colon cancer is the most common of the digestive tract. It is the second cause of cancer in women and the third cause in men, it conventionally concerns the patients of more than 60 years; it is pauci symptomatic, but can be revealed during a digestive surgical emergency, posing the problem of its management and its prognosis particularly in poor areas such as sub-Saharan Africa.
Patients and methods: It was cases study of patients operated in emergency in the year 2016 for histologically confirmed colonic tumor.
Results: Four cases of colonic tumors were histologically confirmed; they were 3 men and 1 woman with an average age of 42.5 year-old. The clinical expression was acute generalized peritonitis with 2 cases and acute intestinal occlusion with 2 cases. The follow-up post-operative was simple with 3 cases; a postoperative complication was noted in 1 patient and his death occurred secondarily.
Conclusion: Colon cancer is a redoubtable disease; it is not only limited to the elderly patients; the young person is also a susceptible population suffered colon cancer in poor areas. It is paucisymptomatic and its treatment remains a major preoccupation in sub-Saharan Africa, In view of the financial and geographical inaccessibility to chemotherapy.