Case series study: the diagnosis and treatment of fifty tumors and pseudotumors at the proximal femur

Original Research

Abstract

Introduction: Tumor and pseudotumor (TP) at the proximal femur (PF) can seriously affect mortality, extremity function, and body integrity. However, reports often focused on a specific tumor, not regional lesions. This study focuses on clinical findings, imaging, micro-pathology, and the treatment of all TP at the site.

Methods: The study involved all patients who had a confirmed tumor or pseudotumor diagnosis at the PF. The clinical findings, X-ray, and biopsy were recorded and analyzed. Treatment was optional depending on the patient's situation and available condition of the hospital. The functional outcome, bone healing were defined at the last examination or two years of follow-up.

Results: Fifty patients were involved in the study. Twenty-four patients had apparent tumors. TP at the PF, neck-trochanter, trochanters, and neck were 21 (42%), 16 (32%), 9 (18%), and 4 (8%) cases, respectively. There were 29 (58%) pathologic fractures. Biopsy was made for all patients. Twenty-three cases (46%) were malignant, and 8 (16%) cases were giant cell tumors. Thirtythree patients suffered from an operation. Ennerking's functional score was excellent, good, fair, and poor in 24 (48%), 5 (10%), 1 (2%), and 20 (40%) patients, respectively. For the last outcomes of 33 operated patients, 17 healed, three unchanged, one worse, and two dead.

Conclusions: For the PF TP, the rate of malignant and pathological fracture was high. The giant cell tumor was not rare. The resection of the TP combined with grafts using ordinary fixation devices was satisfactory.

Graphical abstract

The short-term result of distal pancreatectomy with splenic preservation

English version

Abstract

Introduction: The tumor of pancreatic body and tail are relatively rare compared to those of head of pancreas.  Splenic preservation in pancreatic carcinoma’s surgery should be decided on every case. This study to determine the feasibility of distal pancreatectomy with splenic preservation, the rate of early complications of splenectomy surgery to preserve the spleen and the factors: tumor size, tumor location, tumor characteristic to help assess the possibility of preserving the splenic vessels in distal pancreatectomy with splenic preservation.

Methods: retrospective study, case series description for all patients aged 16 years and older with distal pancreatectomy and splenic preservation from 01/01/2012 to 31/12/2017.

Result: We had 47 case of distal pancreatectomy with splenic preservation. There were 26 cases of splenic preservation with preserving the splenic vessels (Kimura technique), 13 cases of splenectomy but not preserving the splenic vessels (Warshaw technique). There were 16 cases of laparoscopic surgery, 31 cases open surgery, general complication in surgery 11 cases. The mean age was 41.13 (17-76 years old). The mean hospital stay was 7.7 days (3 days - 21 days). General complication after surgery in 7 cases, pancreatic fistula in 5 cases, no cases need re-operation, no mortality.

Conclusion: The rate of intraopertative incidence was 23.4%; complications after surgery 14.9%. No case of re-operation or mortality in the study. Factors such as tumor size, tumor location, tumor characteristic did not help assess the possibility of preserving the splenic vessels in of distal pancreatectomy with splenic preservation.

Graphical abstract

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