The Experts below are selected from a list of 411 Experts worldwide ranked by ideXlab platform
Michael Hall - One of the best experts on this subject based on the ideXlab platform.
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Obturator Canal lymph node metastasis from rectal carcinoid tumors total mesorectal excision may be insufficient
Journal of Gastrointestinal Surgery, 2016Co-Authors: Yizarn Wang, David T Beyer, Michael HallAbstract:Optimal surgical treatment for small early rectal carcinoids is controversial. Large tumors (greater than 2 cm) and those with imaging evidence of lymph node metastasis are generally treated by low anterior resection (LAR) with total mesorectal excision (TME). We first observed and reported that midgut carcinoid with extensive mesenteric lymphadenopathy often develops alternated lymphatic drainage pathways. We hypothesize that rectal carcinoids have the same potential to develop alternated lymphatic pathways outside the mesorectal envelope, which allows tumor deposits to be missed by traditional TME. Twenty-two consecutive rectal carcinoid surgical patient charts were reviewed to determine if alternated lymphatic drainage occurred and resulted in extra-mesorectal metastasis. We attempted to identify any risk factor(s) that may lead to developing such alternated lymphatic drainage pathways. Thirteen patients underwent initial LAR with TME (13/22, 59 %) and nine underwent a staged debulking for locoregional residual disease or regional/distant metastasis after previous resection (9/22, 41 %). Fourteen (14/22, 64 %) underwent radio-guided surgery in attempt to achieve a higher level of pelvic/distant metastatic disease detection and debulking. Six patients (6/22, 27 %) had Obturator Canal lymph node metastases confirmed histologically. Based on our study, at least 27 % of rectal carcinoid patients may have extra-mesorectal metastasis that would be missed by the traditional TME. Radio-guided surgery can identify and remove such metastasis. The effect of having such extra-mesorectal metastasis and its surgical removal on long-term survival has yet to be determined.
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Obturator Canal lymph node metastasis from rectal carcinoid tumor
Journal of Clinical Oncology, 2012Co-Authors: Yizarn Wang, Michael HallAbstract:440 Background: The optimal treatment option for rectal carcinoid tumor remains unsettled. Trans-anal excision has been accepted for small tumors (< 1-2 cm in size) without lymph node involvement. Larger tumors, and those with lymph node metastasis, however, are usually treated via low anterior resection (LAR) with total mesorectal excision (TME). Midgut carcinoid tumors have been found to have the tendency to obstruct lymphatic flow and create a detour in lymphatic passage. We hypothesize that rectal carcinoid may have similar potential to develop alternative lymphatic pathways outside of the mesorectal envelope, thus escaping surgical removal with traditional TME. Methods: A retrospective chart review of rectal carcinoid patients who underwent radical LAR with TME between 2006 and 2011 was conducted to determine if any extra-mesorectal metastasis had occurred. Results: 19 patients who underwent LAR with TME for rectal carcinoid were identified. 14 patients had radio-guided surgery (RGS). 12 of which, we...
Yizarn Wang - One of the best experts on this subject based on the ideXlab platform.
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Obturator Canal lymph node metastasis from rectal carcinoid tumors total mesorectal excision may be insufficient
Journal of Gastrointestinal Surgery, 2016Co-Authors: Yizarn Wang, David T Beyer, Michael HallAbstract:Optimal surgical treatment for small early rectal carcinoids is controversial. Large tumors (greater than 2 cm) and those with imaging evidence of lymph node metastasis are generally treated by low anterior resection (LAR) with total mesorectal excision (TME). We first observed and reported that midgut carcinoid with extensive mesenteric lymphadenopathy often develops alternated lymphatic drainage pathways. We hypothesize that rectal carcinoids have the same potential to develop alternated lymphatic pathways outside the mesorectal envelope, which allows tumor deposits to be missed by traditional TME. Twenty-two consecutive rectal carcinoid surgical patient charts were reviewed to determine if alternated lymphatic drainage occurred and resulted in extra-mesorectal metastasis. We attempted to identify any risk factor(s) that may lead to developing such alternated lymphatic drainage pathways. Thirteen patients underwent initial LAR with TME (13/22, 59 %) and nine underwent a staged debulking for locoregional residual disease or regional/distant metastasis after previous resection (9/22, 41 %). Fourteen (14/22, 64 %) underwent radio-guided surgery in attempt to achieve a higher level of pelvic/distant metastatic disease detection and debulking. Six patients (6/22, 27 %) had Obturator Canal lymph node metastases confirmed histologically. Based on our study, at least 27 % of rectal carcinoid patients may have extra-mesorectal metastasis that would be missed by the traditional TME. Radio-guided surgery can identify and remove such metastasis. The effect of having such extra-mesorectal metastasis and its surgical removal on long-term survival has yet to be determined.
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Obturator Canal lymph node metastasis from rectal carcinoid tumor
Journal of Clinical Oncology, 2012Co-Authors: Yizarn Wang, Michael HallAbstract:440 Background: The optimal treatment option for rectal carcinoid tumor remains unsettled. Trans-anal excision has been accepted for small tumors (< 1-2 cm in size) without lymph node involvement. Larger tumors, and those with lymph node metastasis, however, are usually treated via low anterior resection (LAR) with total mesorectal excision (TME). Midgut carcinoid tumors have been found to have the tendency to obstruct lymphatic flow and create a detour in lymphatic passage. We hypothesize that rectal carcinoid may have similar potential to develop alternative lymphatic pathways outside of the mesorectal envelope, thus escaping surgical removal with traditional TME. Methods: A retrospective chart review of rectal carcinoid patients who underwent radical LAR with TME between 2006 and 2011 was conducted to determine if any extra-mesorectal metastasis had occurred. Results: 19 patients who underwent LAR with TME for rectal carcinoid were identified. 14 patients had radio-guided surgery (RGS). 12 of which, we...
Konrad Prenner - One of the best experts on this subject based on the ideXlab platform.
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the value of Obturator Canal bypass
2017Co-Authors: T Sautner, Bruno Niederle, Friedrich Herbst, G Kretschmer, P Polterauer, Karl H Rendl, Konrad PrennerAbstract:Results: The postoperative mortality rate in the present series was 14.7%. The limb salvage rate after 5 years was 76.5%. One- and 5-year secondary patency rates were 75.3% and 54.9%, respectively. All grafts in patients without atherosclerosis were patent at a median of 34 months. For 57 cases documented in the literature, 1- and 5-year patency rates were 70.8% and 59.7%, respectively. Combined analysis of 90 Obturator Canal bypasses revealed rates of 72.7% and 56.9% of patent grafts at 1- and 5-years, respectively. Conclusions: The use of Obturator Canal bypass is recommended in deep groin infections and especially in patients with lesions of the pelvic vessels due to other occlusive vascular disease.
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the value of Obturator Canal bypass a review
Archives of Surgery, 1994Co-Authors: T Sautner, Bruno Niederle, Friedrich Herbst, G Kretschmer, P Polterauer, Karl H Rendl, Konrad PrennerAbstract:Objective: To review the value of Obturator Canal bypass with respect to long-term results. Design: Case series and literature review. Setting: University of Vienna Medical School in Austria. Patients/Methods: Personal experience with 34 consecutive patients and 125 cases published since 1982 with respect to patient data, patency, and survival are compared and jointly analyzed retrospectively. Interventions: Patients received Obturator Canal bypass for lesions of the pelvic or common femoral vessels precluding orthotopic reconstruction. Main Outcome Measures: The rates of patient survival, limb salvage, and graft patency were analyzed. Results: The postoperative mortality rate in the present series was 14.7%. The limb salvage rate after 5 years was 76.5%. One- and 5-year secondary patency rates were 75.3% and 54.9%, respectively. All grafts in patients without atherosclerosis were patent at a median of 34 months. For 57 cases documented in the literature, 1- and 5-year patency rates were 70.8% and 59.7%, respectively. Combined analysis of 90 Obturator Canal bypasses revealed rates of 72.7% and 56.9% of patent grafts at 1- and 5-years, respectively. Conclusions: The use of Obturator Canal bypass is recommended in deep groin infections and especially in patients with lesions of the pelvic vessels due to other occlusive vascular disease. (Arch Surg. 1994;129:718-722)
Eric Daniels - One of the best experts on this subject based on the ideXlab platform.
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arterial bypass via the Obturator Canal
Perspectives in Vascular Surgery and Endovascular Therapy, 2000Co-Authors: Samuel S Ahn, Eric DanielsAbstract:The Obturator bypass was initially employed to avoid the infected groin during revascularization. In the literature, placement of over 300 Obturator bypass grafts has been reported for a variety of indications, although the number of procedures performed was undoubtedly much higher. Important factors that must be considered before performing such a bypass include the proper assessment of adequate inflow, outflow, and the anatomic site of infection or other complicating circumstances. Although different surgical approaches have been advocated by several authors, the technique will ultimately be determined by patient circumstances and physician resourcefulness. A recent review of the literature showed 1- and 5-year patency rates for all indications of Obturator bypass to be 71% and 60%, respectively As the procedure is generally safe, this extraanatomic bypass may be used to circumvent a variety of obstacles that preclude a standard revascularization procedure. Therefore, the technique should be included in...
David T Beyer - One of the best experts on this subject based on the ideXlab platform.
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Obturator Canal lymph node metastasis from rectal carcinoid tumors total mesorectal excision may be insufficient
Journal of Gastrointestinal Surgery, 2016Co-Authors: Yizarn Wang, David T Beyer, Michael HallAbstract:Optimal surgical treatment for small early rectal carcinoids is controversial. Large tumors (greater than 2 cm) and those with imaging evidence of lymph node metastasis are generally treated by low anterior resection (LAR) with total mesorectal excision (TME). We first observed and reported that midgut carcinoid with extensive mesenteric lymphadenopathy often develops alternated lymphatic drainage pathways. We hypothesize that rectal carcinoids have the same potential to develop alternated lymphatic pathways outside the mesorectal envelope, which allows tumor deposits to be missed by traditional TME. Twenty-two consecutive rectal carcinoid surgical patient charts were reviewed to determine if alternated lymphatic drainage occurred and resulted in extra-mesorectal metastasis. We attempted to identify any risk factor(s) that may lead to developing such alternated lymphatic drainage pathways. Thirteen patients underwent initial LAR with TME (13/22, 59 %) and nine underwent a staged debulking for locoregional residual disease or regional/distant metastasis after previous resection (9/22, 41 %). Fourteen (14/22, 64 %) underwent radio-guided surgery in attempt to achieve a higher level of pelvic/distant metastatic disease detection and debulking. Six patients (6/22, 27 %) had Obturator Canal lymph node metastases confirmed histologically. Based on our study, at least 27 % of rectal carcinoid patients may have extra-mesorectal metastasis that would be missed by the traditional TME. Radio-guided surgery can identify and remove such metastasis. The effect of having such extra-mesorectal metastasis and its surgical removal on long-term survival has yet to be determined.
