Biphenotypic sinonasal sarcoma: European multicentre case-series and systematic literature review

Objective. Biphenotypic sinonasal sarcoma (BSNS) is a rare low-grade cancer that was included from the 4th edition of WHO classification of head and neck tumours. The purpose of this study is to analyse clinical behaviour, pattern of recurrences and survival outcomes of this neoplasm. Methods. Retrospective review of patients affected by BSNS who were treated via an en-doscopic-assisted approach in 6 European tertiary-care referral hospitals. Cases of BSNS described in literature since 2012 to date were fully reviewed, according to PRISMA guide-lines. Results. A total of 15 patients were included. Seven patients were treated via an endoscopic endonasal approach, 4 with endoscopic transnasal craniectomy, and 4 via a cranio-endoscopic approach. Adjuvant treatment was delivered in 2 cases. After a mean follow-up of 27.3 months, systemic metastasis was observed in 1 case; the 5-year overall survival and disease-free survival rates were 100% and 80 ± 17.9%, respectively. Conclusions. BSNS is a locally aggressive tumour with a low recurrence rate and encour-aging survival outcomes if properly treated with surgical resection and free margins fol-lowed by adjuvant radiotherapy for selected cases. Endoscopic-assisted surgery is safe and effective as an upfront treatment within a multidisciplinary care protocol

Postoperative analgesia and early functional recovery after day-case anterior cruciate ligament reconstruction: A randomized trial on local anesthetic delivery methods for continuous infusion adductor canal block

BACKGROUND: This study assessed the effects of different local anesthetic delivery techniques for continuous adductor canal block, after arthroscopic day-case anterior cruciate ligament reconstruction (ACLR).METHODS: We enrolled 80 patients to randomly receive a ropivacaine 0.2% infusion 6 mL per hour through an adductor canal catheter by an electronic pump as follow: intermittent automatic bolus (intermittent group, N.=40) versus continuous infusion (continuous group, N.=40). Patient controlled bolus was 4 ml,, lock out 20 minutes. Primary endpoint was postoperative pain by a numerical rating scale (NRS), secondary endpoints were rescue local anesthetic dose, opioid consumption, and physical performance at 72 h. A P<0.05 was considered significant.RESULTS: No difference was found between the groups in NRS, opioid consumption, and physical performance at 72 h. The intermittent group required significantly less local anesthetic than continuous group throughout the postoperative period; the median [IQR (range)] at 24 h was 149 [140-164 (140-227)] mL in the intermittent group versus 165 [147-210 (140-280)] ml. in the continuous group (P=0.004). At 48 It it was 295 [284-310 (280-367)] mt., in the intermittent group versus 308 [296-367 (284-500)] mL in the continuous group (P 0.002), while at 72 h it was 432 [426-450 (320-528)] mL in the intermittent group and 452 [436-487 (412-671)] mL in the continuous group respectively (P<0.001).CONCLUSIONS: Intermittent boluses did not provide superior analgesia over continuous infusion for adductor canal block after outpatient ACLR, but significantly decreased the local anesthetic consumption. Both techniques are suitable for the early functional recovery

Oncological outcomes of unexpected uterine leiomyosarcoma: A single-center retrospective analysis of 5528 consecutive hysterectomies

Background and Methods: Uterine leiomyosarcomas (uLMS) are rare malignant tumors, often incidentally discovered, with an estimated annual incidence of five cases per one million women in the United States. This study aimed to compare the oncological outcomes of two groups of patients: those with uLMS incidentally found during surgery and those who underwent surgery due to suspected or confirmed uLMS before the procedure. The study assessed patients who had undergone hysterectomy and were diagnosed with stage I uLMS at a tertiary gynecologic oncology referral center in Italy between January 2000 and December 2019. Data on patients' baseline characteristics, surgical procedures, and oncological outcomes were collected. The patients were classified into two groups based on whether uLMS was unexpectedly discovered or suspected before the surgery. Survival rates and factors influencing recurrence were analyzed. Results: The study included 36 patients meeting the inclusion criteria, with 12 having preoperatively suspected or proven uLMS and 24 having incidentally discovered uLMS. No significant differences were observed between the two groups regarding disease-free survival (23.7 vs. 27.3 months, log rank = 0.28), disease-specific survival (median not reached, log rank = 0.78), or sites of relapse. Notably, among patients who underwent laparoscopic hysterectomy (compared to open surgery), a significantly higher rate of locoregional recurrence was found (78% vs. 33.3%, p = 0.04). Nevertheless, no significant differences in survival were observed based on the surgical approach. Conclusions: Preoperative suspicion for uLMS did not seem to impact survival outcomes or the pattern of recurrence. Furthermore, although patients who underwent laparoscopic hysterectomy showed a higher rate of locoregional relapse, this did not affect their overall survival