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      Cirugía conservadora frente a amputación en tumores malignos de mano: revisión sistemática Translated title: Conservative surgery versus amputation in malignant tumors of the hand: a systematic review

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          Abstract

          Resumen Introducción y objetivo. Los tumores malignos de la mano, aunque excepcionales, a menudo tienen características exclusivas de su ubicación anatómica en particular. Su tratamiento es controvertido: cirugía conservadora frente a amputación. El objetivo del presente trabajo es evaluar la menor tasa de recidiva, las complicaciones tras la aplicación de la técnica, y las técnicas quirúrgicas utilizadas actualmente según el tipo de tumor maligno, preguntándonos ¿qué procedimiento tiene menor tasa de recidiva en los tumores malignos de mano, la cirugía conservadora o la amputación? Material y método. Revisión sistemática bajo los criterios de Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA); sólo tomamos en cuenta artículos publicados entre 2011-2021, en español e inglés, gratuitos y en texto completo. Las bases de datos revisadas fueron: PubMed, SciELO y Google Scholar. Para el manejo de sesgos empleamos las herramientas de Cochrane: RoB 2, ROBINS-I y robvis. Resultados. Las complicaciones presentadas fueron recidiva local, recurrencia, propagación metastásica y fallo del colgajo. La tasa de recidiva tras la aplicación de la técnica quirúrgica osciló entre el 0% y el 35%. Conclusiones. La menor tasa de recidiva se presentó tras la amputación. La cirugía conservadora presenta mayores complicaciones en comparación con la amputación. Las técnicas conservadoras son las más utilizadas.

          Translated abstract

          Abstract Background and objective. Malignant tumors of the hand, although exceptional, often have characteristics that are unique to their particular anatomical location. The optimal treatment for these tumors is controversial: conservative surgery versus amputation. Our objective was to evaluate lowest recurrence rate, complications after the surgical technique and surgical techniques currently used according to the type of malignant tumor. The question was: which procedure has the lowest recurrence rate for malignant tumors of the hand: conservative surgery or amputation? Methods. Systematic review under the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) criteria, only those articles published between 2011-2021, written in the Spanish and English languages and that are free and in full text, were taken into account. The data bases reviewed were: PubMed, SciELO and Google Scholar. To manage biases, the Cochrane tools-RoB 2, ROBINS-I y robvis-were used. Results. The adverse effects presented were local recurrence, recurrence, metastatic spread, and flap failure. In turn, the recurrence rate after the application of the surgical technique ranged between the studies from 0 % to 35%. Conclusions. The lowest recurrence rate occurred after amputation. When performing conservative surgery, there are greater complications compared to amputation. Conservative techniques are the most used.

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          Risk‐of‐bias VISualization (robvis): An R package and Shiny web app for visualizing risk‐of‐bias assessments

          Despite a major increase in the range and number of software offerings now available to help researchers produce evidence syntheses, there is currently no generic tool for producing figures to display and explore the risk-of-bias assessments that routinely take place as part of systematic review. However, tools such as the R programming environment and Shiny (an R package for building interactive web apps) have made it straightforward to produce new tools to help in producing evidence syntheses. We present a new tool, robvis (Risk-Of-Bias VISualization), available as an R package and web app, which facilitates rapid production of publication-quality risk-of-bias assessment figures. We present a timeline of the tool's development and its key functionality.
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            The burden of cutaneous melanoma and status of preventive measures in Central and South America

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              Amputation for extremity soft tissue sarcoma does not increase overall survival: a retrospective cohort study.

              To determine if amputation increases survival when compared to limb salvage surgery in patients with a soft tissue sarcoma (STS) of the extremity when there is often a misconception among physicians and patients that ablative surgery eliminates local recurrence and increases overall survival. This retrospective cohort study assessed 278 patients with STS and compared 18 patients who had undergone amputations for soft tissue sarcomas of the extremities to a comparative cohort of 260 patients who underwent limb salvage surgery during the same time period. Our limb salvage surgery (LSS) rate was 94% overall for soft tissue sarcomas with a median follow-up of 3.1 years. Patients undergoing amputations either had tumors that involved a critical neurovascular bundle (in particular nerve rather than vessel resection was more responsible for a decision toward ablation), or underlying bone or had neoplasms whose large size would require such an enormous resection that a functional limb would not remain. In comparing prognostic effects, mainly death due to sarcoma, distant metastasis and local recurrence, it was found that there was no statistically significant difference between patients undergoing amputation to those undergoing limb salvage surgery (p > 0.05). While amputations do not increase overall survival in soft tissue sarcomas of the extremity as compared to LSS, they are still a valuable option in a surgeon's arsenal. In particular, amputations can provide improved local control and symptomatic treatment in patients who might not be candidates for limb salvage surgery.
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                Author and article information

                Journal
                cpil
                Cirugía Plástica Ibero-Latinoamericana
                Cir. plást. iberolatinoam.
                Sociedad Española de Cirugía Plástica, Reparadora y Estética (SECPRE) (Madrid, Madrid, Spain )
                0376-7892
                1989-2055
                September 2022
                : 48
                : 3
                : 321-328
                Affiliations
                [1] orgnameInstituto Tecnológico de Santo Domingo República Dominicana
                [2] orgnameInstituto Tecnológico de Santo Domingo República Dominicana
                Article
                S0376-78922022000300321 S0376-7892(22)04800300321
                10.4321/s0376-78922022000300009
                d7e523f3-9384-4756-a296-b1c5467307c9

                This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.

                History
                : 15 August 2022
                : 16 May 2022
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 22, Pages: 8
                Product

                SciELO Spain

                Categories
                Miembro Superior

                Hand tumors,Hand malignancies,Amputación mano,Amputation,Neoplasias mano,Tumores malignos mano,Tumores mano

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