Skin cancer is the most common type of cancer and represents more than half of the diagnosed malignant tumors. There are more than one million new cases per year in the United States and about ...120.000 new cases in Brazil. Cutaneous melanoma represents 5% of all primary cutaneous neoplasms; however, it has a worse prognosis. Adequate treatment of the primary lesion is the main cure factor, with free surgical margins, thus avoiding recurrences of the lesion.
The present study aims to evaluate and quantify the retraction of the surgical specimen in three moments, in-vivo, ex-vivo and in-vitro, and also evaluating possible factors related to retraction, such as formalin fixation, age, patient's gender, and lesion location.
This is a prospective, single-center cohort that evaluated 145 surgical specimens from patients who underwent oncological surgery of cutaneous melanoma margins enlargement. Lesions were marked with a standard brush, and surgical margins were measured with a sterile ruler, according to their initial staging. After resection, new surgical specimens measurements were obtained, and, after fixation in formalin, the last measurement was performed. The same oncological surgeon performed all procedures, and the same pathologist analyzed the specimens.
Regarding the area of the specimens, there was a general median retraction of 38.15% between in-vivo and ex-vivo (p < 0.001), and 43.97% between in-vivo and in-vitro. When the measure of the specimen length (L) was evaluated, there was a 17% retraction between in-vivo and ex-vivo, and 20.42% between in-vivo and in-vitro, with statistical significance. The younger population has a higher rate of retraction, and lesions on the back have a lower rate of shrinkage on the opposite of lower limbs that had higher shrinkage.
Corroborating the literature, this study showed an average shrinkage of 20.42% for length measurements between in-vivo and in-vitro, and the main predictors of greater or lesser retraction were age and location of the lesion. It is also noted that the most considerable retraction occurs immediately after surgical resection, indicating that skin characteristics, such as degree of elasticity and tension, are determinant for the retraction. Formalin action does not significantly impact retraction. This study shows the importance of adequate treatment of the primary lesion, with adequate surgical margins, and that the measure measured by the pathologist, in general, represents 80% of the margins performed in the perioperative time.
•The performed margin by the surgeon is not the same measured by the pathologist.•A precise surgical margin described at the pathological report is strategic.•Male and female have different width shrinkage per lesion site and surgical margins.
According to Brazilian Law 12.732/12 (“60‐day law”), cancer patients have 60 days after diagnosis for beginning treatment at the Unified Health System (SUS). The study aimed to evaluate the ...achievement and effectiveness of the ‘60‐day law’ for melanoma patients in a SUS cancer reference unit. A retrospective study analysed 58 medical charts from patients with the initial diagnosis performed before and after the “60‐day law”. The Law does not change the time interval between diagnosis and the beginning of treatment, and after the Law, patients presented a worse overall survival (p < 0.001). In conclusion, the ‘60‐day law’ was not effective.
Highlights
Brazilian law requires that cancer treatment begins within 60 days of diagnosis.
This time is an indicator of access to health services.
The law is insufficient for a better outcome for melanoma patients.
Melanoma awareness tools must be used for patients and general practitioners.
National epidemiologic data on melanoma are scarce in Brazil. The current work presents final demographic, clinical, and pathologic results from the Brazilian Melanoma Group database to detail how ...patients with melanoma present at diagnosis.
The online database includes patients diagnosed between 1982 and 2015 and evaluated at their centers of origin between 2001 and 2016. The primary objective was to describe the demographic, clinical, and pathologic characteristics of the patients, and secondary objectives were to investigate the association between clinical and pathologic variables of interest.
A total of 1,596 patients were included. Median age was 52 years, 57% were women, and the majority were identified as white. Invasive melanoma was diagnosed in 1,297 patients, mostly localized, whereas 299 (19%) had in situ disease (TisN0M0). Only 165 patients had initial lymph node involvement. Fitzpatrick skin types I or II were slightly more frequent with in situ melanoma (73%) than with invasive disease (67%;
= .054). The median Breslow thickness was 0.95 mm, Clark levels 2 and 3 comprised nearly 70% of cases, and ulceration was present in 18% of patients. The mitotic rate was significantly associated with the presence of ulceration and both vascular and perineural invasion but not with margin positivity, whereas histologic regression was associated with both intratumoral and peritumoral inflammatory infiltrates.
Despite the limitations of an observational, registry-based study, the current results provide a general profile of patients with cutaneous melanoma in Brazil at the time of diagnosis.
Robotic surgery costs: Revealing the real villains Rodrigues Martins, Yves Melo; Romanelli de Castro, Pedro; Drummond Lage, Ana Paula ...
The international journal of medical robotics + computer assisted surgery,
December 2021, 2021-12-00, 20211201, Letnik:
17, Številka:
6
Journal Article
Recenzirano
Background
This study aimed to evaluate the main drivers of robot assisted radical prostatectomy (RARP) hospitalization costs, in addition to assess perioperative predictors that impact costs.
...Methods
Overall, 474 RARP were analyzed between February 2018 and December 2019. The association between perioperative variables and total direct costs was analyzed by simple and multiple linear regression.
Discussion
The main drivers of RARP hospitalization costs were robotic surgical supplies. Costs increased with American Society of Anesthesiologists score 3, a one‐hour increase in OR time, increased utilization of polymeric clip packs and longer length of hospital stay. There was a 11.5% reduction in costs with the use of four robotic instruments instead of five.
Conclusion
Costs of hospitalization were mainly influenced by the OR time, use of surgical supplies and length of hospital stay. Reducing the number of robotic instruments used in RARP represented the potentially modifiable factor with the greatest impact on cost reduction.
Patients undergoing esophagectomy for cancer are a difficult to treat group of patients. At diagnosis they will present some degree of malnutrition in up to 80% and the causes are from multifactorial ...origin: the inability of food ingestion, advanced age, taste disturbances, and morbidity related to neoadjuvant treatment. In order to restaure the nutritional status, enteral nutritional support is preferable to parenteral support because of the risks of septic complications associated with venous catheters. During the postoperative period, the oral route is often inaccessible in these patients due to swallowing disorders and eventually mechanical ventilation, and if possible, often it does not provide sufficient caloric amounts for postoperative energy balance. For these reasons, it is usually recommended additional nutritional support. There are few studies in the literature that specifically address which is the most adequate route for enteral nutrition in patients undergoing esophagectomy. Nasojejunal catheters present a higher incidence of local complications, such as displacement and occlusion, whereas jejunostomy is more associated with reinterventions for the treatment of complications secondary to extravasation. Although there is weak evidence in the literature and a lack of randomized, prospective and multicenter studies evaluating the best enteral nutrition route in the postoperative period of esophagectomy, the use of the nasoenteric catheter seems to be adequate due to its simplicity of positioning and low rates of severe complications. In this paper a review is performed of the evidence about this subject.
ABSTRACT Objective: to suggest a script for surgical oncology assistance in COVID-19 pandemic in Brazil. Method: a narrative review and a “brainstorming” consensus were carried out after discussion ...with more than 350 Brazilian specialists and renowned surgeons from Portugal, France, Italy and United States of America. Results: consensus on testing for COVID-19: 1- All patients to be operated should be tested between 24 and 48 before the procedure; 2- The team that has contact with sick or symptomatic patients should be tested; 3 - Chest tomography was suggested to investigate pulmonary changes. Consensus on protection of care teams: 1 - Use of surgical masks inside the hospitals. Use of N95 masks for all professionals in the operating room; 2 - Selection of cases for minimally invasive surgery and maximum pneumoperitoneal aspiration before removal of the surgical specimen; 2 - Optimization of the number of people in teams, with a minimum number of professionals, reducing their occupational exposure, the consumption of protective equipment and the circulation of people in the hospital environment; 3 - Isolation of contaminated patients. Priority consensus: 1- Construction of service priorities; 2 - Interdisciplinary discussion on minimally invasive or conventional pathways. Conclusion: the Brazilian Society of Surgical Oncology (BSSO) suggests a script for coping with oncological treatment, remembering that the impoundment in the assistance of these cases, can configure a new wave of overload in health systems.
RESUMO Objetivo: sugerir roteiro de assistência oncológica cirúrgica em meio à pandemia COVID-19 no Brasil. Método: foi realizada revisão narrativa da literatura e consenso tipo “brainstorming” após discussão com mais de 350 especialistas brasileiros e cirurgiões renomados de Portugal, França, Itália e Estados Unidos da América. Resultados: consenso sobre testagem para COVID-19: 1-Todos os pacientes a serem operados devem ser testados entre 24 e 48 antes do procedimento; 2-Equipe que tenha contato com doentes ou sintomáticos deve ser testada; 3-Tomografia de tórax foi sugerida para pesquisa de alterações pulmonares. Consenso sobre proteção das equipes de assistência: 1-Uso de máscaras cirúrgicas dentro de hospitais. Uso de máscaras N95 para todos os profissionais na sala cirúrgica; 2-Seleção dos casos para cirurgia minimamente invasiva e aspiração máxima do pneumoperitônio antes da retirada da peça cirúrgica; 2-Otimização das equipes, com número mínimo de profissionais, reduzindo a exposição ocupacional, o consumo de equipamento de proteção e a circulação de pessoas no ambiente hospitalar; 3 -Isolamento de pacientes contaminados. Consenso sobre priorizações: 1-Construção de prioridades de atendimento; 2- Discussão interdisciplinar sobre via minimamente invasiva ou convencional. Conclusão: a Sociedade Brasileira de Cirurgia Oncológica (SBCO) sugere roteiro de enfrentamento para o tratamento oncológico, lembrando que o represamento na assistência desses casos, pode configurar uma nova onda de sobrecarga em sistemas de saúde.
•The access to optimal treatment for patients with MM in Brazil is far from being acceptable.•In Brazil, most of the patients do not have the opportunity of an early and curative melanoma ...approach.•Brazilian health regulatory system and the incorporation of health technologies in the public and private health settings.•For patients of the public health system, only dacarbazine is available.•The introduction of innovations could accentuate the existing inequalities in the delivery of healthcare in Brazil..
Melanoma is the most dangerous type of skin cancer, and pre 2011 the prognosis of metastatic melanoma was very poor. In developing countries, such as Brazil, a vast majority of patients do not have access to the opportunity of an early, curative melanoma approach and this leads to metastatic disease. In this sense, the purpose of this paper is to illustrate the distinct lack of access to innovative melanoma treatments, based on immunotherapy and target therapy, in the public and private health sectors in Brazil. We analyzed the Brazilian health regulatory system and the incorporation of health technologies in the public and private health settings. At present, for patients being treated within the public health system, only dacarbazine is available. Whereas, immune-oncology agents and target therapies are available for patients being treated within the private health sector. In this scenario, we concluded that the introduction of innovations could accentuate the existing inequalities in the delivery of healthcare in Brazil.
Abstract Introduction: melanoma is a very aggressive cancer, with increasing incidence, and is currently the fifth most common cancer in men and the sixth most common in women in the United States. ...Melanoma is not unusual in pregnancy, with an estimated occur-rence rate of 1:1.000. Although not the most common cancer in pregnancy, melanoma is the tumor with the highest incidence ofplacenta and fetus metastases. Description: a 29-year-old lady, 4 weeks after conception underwent resection of an atypical pigmented lesion after a diagnosis of stage T4b melanoma. At 16 weeks she underwent a broad local excision and sentinel lymph node (SLN) biopsy. SLN was evaluated histologically and tested positive for melanoma. A radical axillary lymphadenectomy was performed on the patient without evidence of metas-tasis in any other LN. In the 40th week of pregnancy, labor was induced and a healthy newborn was deli-vered via cesarean. Discussion: melanoma management in pregnancy is more complex and requires multidisciplinary coor-dination, as well as extensive discussion with the patient and her family. We present a case report description in which treatment recommendations are established according to no pregnancy experience.
Cancer is a leading cause of death in Brazil and worldwide. However, Brazilian medical education fails to include oncology as an essential topic. This creates a gap between the health status of the ...population and medical education. Bone sarcomas fall into both the group of malignant neoplasms and rare diseases and are thus doubly influenced by misinformation. To assess medical students' knowledge of imaging diagnostic methods for bone sarcomas. A cross-sectional, quantitative study was undertaken by obtaining the responses of medical students to a questionnaire containing radiographic images and questions about the radiological aspects of bone sarcomas. The categorical variables were compared using the chi-square test. The level of significance was 5% for all the tests. SPSS software version 25.0 was used for the analysis. A total of 325 responses were collected, with 72% of the participants having no interest in oncology and 55.6–63.9% not knowing how to diagnose a periosteal reaction on bone radiography. Only 11.1–17.1% of the students correctly interpreted the radiographic image of osteosarcoma
.
Medical students fail to correctly interpret images of bone sarcomas. It is important to promote oncology undergraduate education in general and to include the approach to bone sarcomas in this context.
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