• Shoulder morbidity after pectoralis major flap reconstruction for head and neck cancer.

      Merve, Ashriwad; Mitra, Indu; Swindell, Ric; Homer, Jarrod J; Department of Surgery, Christie Hospital, Manchester, United Kingdom. (2009-04-21)
      BACKGROUND.: The effect of pectoralis major flap (PMF) harvest on shoulder function, allowing for the effects of neck dissection, has not previously been objectively measured. METHODS.: Twenty-two patients who underwent PMF reconstruction were studied. The control group comprised 35 patients with neck dissection (without PMF). Neck dissections in both groups were classified into 3 grades; grade 1: no neck dissection/selective neck dissection; grade 2: modified radical neck dissection; grade 3: radical neck dissection/extended radical neck dissection. Objective shoulder assessments were carried out using Constant score. RESULTS.: Constant score deteriorated with grade of neck dissection (p < .005). The median Constant score for PMF group and neck dissection only group were 82 and 90, respectively (p = .40). Subgroup analysis within neck dissection grade did not show any significant difference, but the effect of PMF was noted to be greatest in grade 2 patients (p = .064). CONCLUSIONS.: There is minimal or low shoulder morbidity, additional to neck dissection, caused by PMF reconstruction in head and neck surgery. (c) 2009 Wiley Periodicals, Inc. Head Neck, 2009.
    • Skin-sparing mastectomy.

      Baildam, Andrew D; The Christie Hospital Cancer Centre, Manchester, United Kingdom. (2011-09)
    • The small-nucleolar RNAs commonly used for microRNA normalisation correlate with tumour pathology and prognosis.

      Gee, H E; Buffa, F M; Camps, C; Ramachandran, A; Leek, R; Taylor, M; Patil, M; Sheldon, H; Betts, Guy N J; Homer, J; et al. (2011-03-29)
      To investigate small-nucleolar RNAs (snoRNAs) as reference genes when measuring miRNA expression in tumour samples, given emerging evidence for their role in cancer.
    • A study to explore the patient's experience of peritoneal surface malignancies: pseudomyxoma peritonei.

      Witham, Gary; Willard, Carole; Ryan-Woolley, Bernadette; O'Dwyer, Sarah T; Peritoneal Tumour Service, Christie Hospital NHS Foundation Trust, Withington, Manchester M20 4BX, UK. G.Witham@mmu.ac.uk (2008-04)
      Pseudomyxoma peritonei (PMP) is a rare tumour originating from the appendix and producing extensive mucus accumulation within the abdomen and pelvis. Since UK government policy reinforces the importance of involving patients in the delivery of healthcare, it is essential to explore patients views so that service development can be fully responsive to the patients need. The primary objective of this study was to explore the impact of PMP on the lives of patients. The secondary objectives were to explore the sources of psychological support for patients, the symptoms experienced and their information concerns. In-depth interviews were conducted with a purposive sample of 13 patients. The interviews were tape recorded, with permission, transcribed in full and analysed for content and emerging themes. The emergent themes included significant uncertainty about the diagnosis and treatment of this rare condition. The difficulties associated with confirming an initial diagnosis and living with an uncertain prognosis were highlighted. Patients' choice and access to support by a specialist team were important themes. The data highlighted the particular needs of this under-researched patient group and provided evidence to further develop patient support, particularly using the Internet.
    • Supraorbital neuroma masquerading as local recurrence from a previously excised microcystic adnexal carcinoma.

      Seaward, J R; Kalipershad, Sujala N R; Ross, Gary L; Department of Plastic Surgery, The Christie NHS Foundation Trust, Wilmslow Road, Manchester M20 4BX, United Kingdom. jpras@jseaward.com (2010-03)
      We present a case of a 53 year old gentleman with a previous history of a microcystic adnexal carcinoma in the supraorbital region who represented with pain and tenderness 3 years postoperatively. Although this was thought to represent local recurrence, it proved to be a supraorbital neuroma.
    • Synchronous chemoradiotherapy in patients with locally advanced squamous cell carcinoma of the head and neck using capecitabine: a single-centre, open-label, single-group phase II study.

      Jegannathen, Apurna; Mais, Kathleen L; Sykes, Andrew J; Lee, Lip W; Yap, Beng K; Birzgalis, Andrew R; Homer, Jarrod J; Ryder, W David J; Slevin, Nicholas J; Department of Clinical Oncology, Christie NHS Foundation Trust, Manchester, UK. (2011-03)
      To evaluate the efficacy of concurrent oral capecitabine with accelerated hypofractionated radical radiotherapy in locally advanced squamous cell carcinoma of the head and neck (SCCHN).
    • Systematic reviews and meta-analyses in coloproctology: interpretation and potential pitfalls.

      Wille-Jørgensen, P; Renehan, Andrew G; Department of Surgery K, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark. pwj01@bbh.regionh.dk (2008-01)
      A systematic review (SR) is the unbiased appraisal of systematically identified relevant studies. Implicit in its definition is a robust and scientifically valid process, and when performed as such, SR is an important clinical research tool and influence in health policy decision-making. This educational paper outlines that, from the original prototype based on randomized trials, there are now many other types of SRs including those based on: nonrandomized comparative studies, observational studies, prognostic studies, and studies of diagnostic and screening tools. While each of these has a similar 'anatomy' or format, at an individual class level, there are principles specific to each SR type. Several examples from the coloproctology literature are used as case-studies to illustrate potential pitfalls, and upon re-analysis, often reverse or attenuate the conclusions stated in the original publication. These examples serve to emphasize the need for health professionals to understand the process of SR and meta-analysis so that we all arrive at appropriate interpretations to the benefit of our patients.
    • Technical aspects of cytoreductive surgery.

      Kusamura, Shigeki; O'Dwyer, Sarah T; Baratti, Dario; Younan, Rami; Deraco, Marcello; Department of Surgery, National Cancer Institute of Milan, Milan, Italy. (2008-09-15)
      At the Fifth International Workshop on Peritoneal Surface Malignancy, in Milan, the consensus on technical aspects of cytoreductive surgery (CRS) for peritoneal surface malignancy was obtained through the Delphi process. Five conflicting points were discussed: radicality of the peritonectomy procedure, cytoreduction of neoplastic nodules <2.5 mm, the timing of bowel anastomoses in relation to hyperthermic intraperitoneal chemotherapy (HIPEC) and indications of protective ostomies. According to the panel of experts a partial parietal peritonectomy restricted to the macroscopically involved regions could be indicated in all listed clinical conditions with the exception of peritoneal mesothelioma. No expert was of the opinion that a radical parietal peritonectomy is advisable irrespective of the disease being treated. All the experts agreed that electrovaporization of small (<2.5 mm) non-infiltrating metastatic nodules in the mesentery would be appropriate, even if theoretically the HIPEC affords microscopic cytoreduction. The panel also agreed that in the closed technique for HIPEC administration the intestinal anastomoses should be fashioned after completion of the perfusion. Finally when considering the place for protective ostomies the experts voted for a flexible approach allowing the surgeon to exercise discretion for individual patients.
    • A ten-year experience of multiple flaps in head and neck surgery: how successful are they?

      Ross, Gary L; Ang, Erik S W; Lannon, Declan; Addison, Patrick; Golger, Alex; Novak, Christine B; Lipa, Joan E; Gullane, Patrick J; Neligan, Peter C; Division of Plastic Surgery, Christie Hospital, Manchester, United Kingdom. (2008-04)
      Ablative surgery in the head and neck often results in defects that require free flap reconstruction. With improved ablation/reconstructive and adjuvant techniques, improved survival has led to an increase in the number of patients undergoing multiple free flap reconstruction. We retrospectively analyzed a single institution's 10-year experience (August 1993 to August 2003) in free flap reconstruction for malignant tumors of the head and neck. Five hundred eighty-two flaps in 534 patients were identified with full details regarding ablation and reconstruction with a minimum of 6-month follow-up. Of these 584 flaps, 506 were for primary reconstruction, 50 for secondary reconstruction, 12 for tertiary reconstruction, and 8 patients underwent two flaps simultaneously for extensive defects. Overall flap success was 550/584 (94%). For primary free flap surgery, success was 481/506 (95%), compared with 44/50 (88%) for a second free flap reconstruction and 9/12 (75%) for a third free flap reconstruction ( P < 0.05). Eight extensive defects were reconstructed with 16 flaps, all of which were successful. More than one free flap may be required for reconstruction of head and neck defects, although success decreases as the number of reconstructive procedures increases.
    • The use of a combined radial forearm flap and radial fascial flap for layered dural lining and an orbital defect reconstruction.

      Bondin, D; Ross, Gary L; The Christie NHS Foundation Trust, Wilmslow Road, Manchester, UK. (2011-07)
      Variable reconstruction methods for craniofacial tumour resections have been devised with the primary purpose to improve quality of life and disease control. The reconstructive aims are to provide a watertight seal, cranial base support while allowing a cosmetically pleasing result. For defects involving the orbit, maintenance of the depth of the orbital socket remains important for prosthetic fitting and a bulky flap is not advisable for this purpose. This case demonstrates the use of a combination pericranial flap, radial forearm fascial flap and cutaneous radial forearm flap. We have been able to achieve a watertight seal of dura in multiple layers, provide adequate support to the cranial base while giving a non bulky reconstruction of the orbit.
    • Vaginal leiomyosarcoma.

      Umeadi, Uchenna P; Ahmed, Ahmed S; Slade, Richard J; Menasce, Lia P; Department of Surgery, Christie Hospital NHS Foundation Trust, Manchester, UK. uchenna.umeadi@christie.nhs.uk (2008-07)
    • The value of FDG positron emission tomography/computerised tomography (PET/CT) in pre-operative staging of colorectal cancer: a systematic review and economic evaluation.

      Brush, J; Boyd, K; Chappell, F; Crawford, F; Dozier, M; Fenwick, E; Glanville, J; McIntosh, H; Renehan, Andrew G; Weller, D; et al. (2011-09)
      In the UK, colorectal cancer (CRC) is the third most common malignancy (behind lung and breast cancer) with 37,514 cases registered in 2006: around two-thirds (23,384) in the colon and one-third (14,130) in the rectum. Treatment of cancers of the colon can vary considerably, but surgical resection is the mainstay of treatment for curative intent. Following surgical resection, there is a comprehensive assessment of the tumour, it's invasion characteristics and spread (tumour staging). A number of imaging modalities are used in the pre-operative staging of CRCs including; computerised tomography (CT), magnetic resonance imaging, ultrasound imaging and positron emission tomography (PET). This report examines the role of CT in combination with PET scanning (PET/CT 'hybrid' scan). The research objectives are: to evaluate the diagnostic accuracy and therapeutic impact of fluorine-18-deoxyglucose (FDG) PET/CT for the pre-operative staging of primary, recurrent and metastatic cancer using systematic review methods; undertake probabilistic decision-analytic modelling (using Monte Carlo simulation); and conduct a value of information analysis to help inform whether or not there is potential worth in undertaking further research.
    • What does failure after surgery or radiation mean?

      Clarke, Noel W; Christie and Salford Royal Hospitals, Manchester, UK (2008)
    • What Three Wise Men have to say about diagnosis.

      Mani, Navin; Slevin, Nicholas J; Hudson, Andrew M; Department of Head and Neck Surgical Oncology, Christie Hospital, Manchester M20 4BX, UK. (2011)
    • Which venous system to choose for anastomosis in head and neck reconstructions?

      Ross, Gary L; Ang, Erik S W; Golger, Alex; Lannon, Declan; Addison, Patrick; Snell, Laura; Novak, Christine B; Lipa, Joan E; Gullane, Patrick J; Neligan, Peter C; et al. (2008-10)
      It has been postulated that venous thrombosis in free flap surgery necessitates the use of 2 venous anastomoses into different venous systems.We retrospectively analyzed a single surgeon's 10-year experience (August 1993 to August 2003) in primary free flap reconstruction for malignant tumors of the head and neck. Of 492 primary reconstructions that did not need a vein graft, vein loop, or cephalic turnover procedure, 251 used the internal jugular venous system as venous outflow, 140 used the subclavian system as outflow, and 101 used both.Two hundred thirty-eight of 251 (95%) of flaps utilizing the internal jugular venous system for outflow were successful compared with 129 of 140 (92%) of flaps utilizing the subclavian system. Where both venous systems were used the success rate was 101 of 101 (100%) (P < 0.05).Where possible, a second venous anastomosis should be performed utilizing both venous drainage systems.