ObjectiveTo explore the application of MDT mode in the diagnosis and treatment of a large retroperitoneal small cell carcinoma.MethodsA huge retroperitoneal tumor about 25 cm×18 cm was found by the preoperative abdominal MRI examination, which was considered as the malignant tumor. Considering the patient’s condition, MDT consultation of the specialists in radiology, oncology, vascular surgery, urinary surgery, and anesthesiology was conducted.ResultsBy MDT discussion, the general condition of patient was good. At present, the diagnosis of the huge retroperitoneal tumor was confirmed. Although the tumor was surrounded with related organs closely, yet the radical operation was finished smoothly and the R0 resection was achieved through the collaboration of MDT. The operation lasted 365 minutes, and the intraoperative blood loss was about 200 mL. Postoperative pathology confirmed that the tumor margin was negative and no postoperative complication occurred. The total number of hospital stays was 23 days. The patient’s return to the hospital for review in 4 months after discharge revealed a tumor recurrence. Then, combined with radiotherapy and chemotherapy, the patient’s condition was stable during treatment.ConclusionFor rare cases of retroperitoneal small cell carcinoma involving multiple disciplines, the treatment based on MDT is able to bring better clinical outcome to patients due to safer and more feasible.
ObjectiveTo summarize the experience of diagnosis and treatment of a case of adult hepatic fibrohistiocytoma with recurrent rupture and hemorrhage.MethodsRetrospective analysis on this case of recurrent adult fibrohistiocytoma with rupture and hemorrhage admitted to Shengjing Hospital Affiliated to China Medical University in May 2018 was conducted, discussion on MDT was conducted before surgery, and the causes of recurrent rupture and hemorrhage, as well as the experience of diagnosis and treatment were summarized and analyzed.ResultsThis patient was generally in good condition. After MDT discussions among the imaging department, oncology department, interventional department, and hepatobiliary surgeons, it was considered that surgical treatment was the best treatment scheme. After full communication with the patient and his family, the patient had chosen open tumor resection and the operation was smooth. The operation time was 278 min, intraoperative bleeding was about 100 mL, and no blood transfusion was performed. No bleeding, abdominal infection, gastroparesis, and other complications occurred after the operation, and the patient was discharged successfully on the 13th day after the operation. The patient had been interviewed for 8 months and the tumor recurred again 1 month ago. Currently, oral apatinib had been targeted for treatment for more than 1 month, and the follow-up treatment continued.ConclusionsRecurrent adult fibrous histiocytoma with rupture and hemorrhage is rare in clinical practice, and the treatment is mainly based on surgical resection. Postoperative comprehensive treatment combined with radiotherapy, chemotherapy, molecular targeting, and immunotherapy is the main treatment. Its short-term efficacy is satisfactory, but long-term efficacy still needs to befurther observed.
ObjectiveTo summarize the diagnosis and clinicopathological features of primary intestinal extranodal nasal type NK/T-cell lymphoma (PI-ENKTCL), and to enhance the diagnostic and differential diagnosis of this rare disease.MethodsThe clinicopathologic data of a patient with PI-ENKTCL admitted to Gansu Provincial Hospital in January 2019 were retrospectively analyzed.ResultsWe diagnosed PI-ENKTCL doubtfully by PET-CT , and after the discussion of MDT, we finished radical operation which achieved R0 resection. The pathological type was consistent with PI-ENKTCL diagnosis. The operation lasted 280 minutes, and the intraoperative blood loss was about 50 mL. Postoperative pathology confirmed that the tumor margin was negative and no postoperative complication occurred, and the patient was discharged successfully on the 13th day after the operation. The patient, followed for five months after operation, was treated with L-GMOEX [gemcitabine+oxaliplatin combined with L-asparaginase (L-ASP)] chemotherapy for four periods at time, and the treatment effect continued to be followed up.ConclusionsIt is necessary to discuss by MDT for doubtfully diagnosing PI-ENKTCL because of the disease being rare. The imaging diagnosis is mainly PET-CT. Surgical resection is the main treatment, we should formulate the best chemotherapy according to post-operation pathological results, for improving the patient’s prognosis and prolonging patient’s life with PI-ENKTCL.
ObjectiveTo summarize the treatment measures and experience for one patient with acute pulmonary thromboembolism after modified radical mastectomy for breast cancer. MethodsThe discussion on MDT (multi-disciplinary team) of a breast cancer patient admitted to The First Hospital of Lanzhou University in March 2018 and the results of the discussion on acute pulmonary thromboembolism after operation were summarized. ResultsThis patient had many high risk factors for deep venous thrombosis of the lower extremities, such as obesity, advanced age, hypertension, malignant tumor, and surgical stress. The operative time was about 90 min and the blood loss was 30 mL, without nerve and vascular injuries. Acute pulmonary thromboembolism occurred suddenly on 10 days after operation, which led to heart failure. Eventually, the patient died of the peripheral circulatory insufficiency caused by respiratory failure and heart failure. ConclusionSurgeons should pay great attention to the perioperative management of the patients with many high-risk factors, who may occur acute pulmonary thromboembolism caused by deep venous thrombosis of lower limbs after radical mastectomy.
Objective To develop tailored treatment regimens for a patient with simultaneous liver metastasis of rectal cancer. Methods Considering the patient's specific condition of different teatment stage, the specialists of oncology, imaging, gastroenterology, hepatic surgery, and radiotherapy conduct multidisciplinary consultation. Results After hepatic metastatic tumor was resected, 4 cycles of XELOX chemotherapy combined with radiotherapy, tumor recurrence did not found in the liver. After resection of rectal cancer, the patient received 6 cycles of XELOX. The CEA and the thoracic, abdominal CT and pelvic MRI were reviewed 9 months after operation and no recurrence of the tumor was found. Conclusion The MDT mechanism can provide individualized treatment for patients with advanced rectal cancer and benefit these patients.
ObjectiveTo explore the safety and feasibility of surgical treatment of simultaneous multiple primary cancer–hepatocellular carcinoma and esophageal squamous cell carcinoma.MethodThe clinical data of one patient with simultaneous multiple primary cancer of hepatocellular carcinoma and esophageal squamous cell carcinoma, who treated in the First Affiliated Hospital of Guangxi Medical University in April 2019 was analyzed retrospectively. ResultsThe patient was diagnosed as hepatocellular carcinoma and esophageal squamous cell carcinoma on admission. After MDT in the hospital, the patient underwent anterior right hepatectomy + cholecystectomy and radical resection of esophageal carcinoma in turn. The procedure of anterior right hepatectomy + cholecystectomy was smooth, the duration of the surgery was 270 min, and the total blood loss was 500 mL, and postoperative pathology showed that hepatocellular carcinoma was in grade Ⅱ. The operation process of radical resection of esophageal cancer was smooth too, the duration of the surgery was 176 min, and the total blood loss was 100 mL, and postoperative pathology showed moderately differentiated squamous cell carcinoma. No related surgical complications occurred after the operation. Thirteen months after the operation of liver cancer and 10 months after the operation of esophageal cancer, the patient was generally in good condition, well wound healing, and no clinical recurrence. The follow-up of the patient was continued.ConclusionIn allusion to simultaneous multiple primary cancers, it is safe and feasible to evaluate the location, pathological stage, and general condition of the patient by combining multi-disciplinary diagnosis and treatment and then performing radical operations in turn.
ObjectiveTo summarize the diagnosis and treatment experience of one case of abdominal aortic aneurysm with iliac arteriovenous fistula.MethodsA case of abdominal aortic aneurysm with left iliac arteriovenous fistula admitted to Nanchong Central Hospital in December 2019 was retrospectively analyzed. The diagnosis and treatment of the patient and the MDT discussion results were summarized.ResultsThe clinical manifestations of this patient was refractory heart failure, and he received heart medicine treatment in Nanchong Center Hospital. The patient diagnosed as abdominal aortic aneurysm with left iliac arteriovenous fistula after computed tomography angiography (CTA), abdominal aorta lumen coated stents isolation (EVAR) during operation was performed after the MDT discussion. Postoperative imaging revealed a tumor cavity abdominal aortic aneurysm and left iliac arteriovenous fistula completely closed, then the heart failure symptoms of the patient was quickly relieved. The whole operation went smoothly, with a duration of about 120 min and intraoperative blood loss of about 100 mL. The patient was discharged from hospital on the 7th day after the operation. CTA and color doppler ultrasound were rechecked in 3 months after the operation, and the stent was found to have unobtrusional blood flow and no internal leakage, and the pseudoaneurysm of the left iliac artery disappeared.ConclusionsFor patients with refractory heart failure, if accompanied by lower limb swelling, the possibility of arteriovenous fistula of the great vessels should be taken into account, and the medical history and physical examination should be collected comprehensively, and necessary examinations should be carried out timely to avoid missed diagnosis or misdiagnosis. Meanwhile, compared with traditional surgery, EVAR is a more reliable, minimally invasive, and safe treatment for abdominal aortic aneurysm with iliac arteriovenous fistula.
ObjectiveTo summarize the experience of diagnosis and treatment of a patient with liver and lung metastasis and retroperitoneal metastasis from right colon cancer.MethodsA retrospective analysis of a patient with liver, lung, and retroperitoneal metastasis from right colon cancer who received treatment at The First Affiliated Hospital of Kunming Medical University in August 2016 was conducted. In order to provide reference for domestic doctors to treat advanced colorectal cancer.ResultsAfter receiving several cycles of chemotherapy and three surgical resections of the primary and metastatic lesions before the MDT, the patient again found a retroperitoneal mass. After discussions of Department of Imaging, Oncology, Radiotherapy, and Gastrointestinal and Hernia Surgery, we thought that, at present, the treatment of the patient was mainly surgery and oral chemotherapy. So the patient underwent retroperitoneal tumor resection+abdominal adhesion release, and had been interviewed for 3 months. No recurrence or metastasis was found during follow-up.ConclusionThe therapy of liver-lung metastasis and retroperitoneal metastasis in right colon cancer are mainly based on surgical resection of lesions, postoperative combined with radiotherapy and chemotherapy, molecular targeted therapy, and postoperative monitoring of CEA changes.
Objective To summarize the specific treatment for a patient diagnosed with recurrence of hepatocellular carcinoma following liver transplantation. Methods Considering the patient’s condition, multidisciplinary team (MDT) consultation of the specialists in radiology, oncology, radiotherapy, and liver surgery was conducted. Results After the MDT consultation, the patient was advised to receive surgery if the metastasis could be excluded. Surgical removal of the mass located at the body and tail of pancreas+splenectomy+enterodialysis was conducted. The alpha fetoprotein (AFP) level and abdominal CT were reviewed and no recurrence was found during the follow up period (by the end of May. 2018). Conclusion The MDT mechanism could provide individualized treatment for patients with complicated hepatocellular carcinoma and benefit those patients.
To challenge the 15% enhancement of 5-year survival of cancer for the plan of “Health-China 2030”, we must strive the following measurements to complete the 15% enhancement of 5-year survival of liver cancer: conduct conversion therapy and conversion to resectability for the 70% of unresectable intermediate-to-advanced stage liver cancer so as to prolong survival; try our best to identify and treat the people of HBV and HCV infection, and to screen the risk people so as to reduce the incidence of liver cancer and the proportion for intermediate-to-advanced stage liver cancer; continue to try our best in the full course management of liver cancer under the frame of MDT.