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BACKGROUND AND PURPOSE: Doctor's delay in diagnosing Ewing sarcoma is often long. We examined the initial symptoms of Ewing sarcoma of the rib to find characteristics that could help to shorten the delay in diagnosis and hopefully influence the prognosis. PATIENTS AND METHODS: We examined the records from the first visit for symptoms related to Ewing sarcoma of the rib in 26 consecutive patients, all of whom were <30 years of age and had been diagnosed between 1981 and 2000. All patients had a minimum of 5 years follow-up. RESULTS: A tumor was suspected at the first visit in only 5 of the 26 patients; pleurisy was the most common misdiagnosis. 23 patients complained of pain, localized or pleuritic, and 11 had a palpable mass. 15 of the 26 patients had chest radiographs taken at the first visit, but a tumor was suspected in only 4 cases. The most common radiographic finding was pleural effusion--diagnosed in 10 of the 15 patients. 23 patients were operated. It is noteworthy that in 6 patients no tumor was suspected before surgery. 12 patients died from the Ewing sarcoma. Median survival was 2.4 years. Doctor's delay was median 3.0 (0-10) months, but it exceeded 7 months in 4 patients. Patient's delay was 2.5 (0-10) months. INTERPRETATION: The most important clinical finding in Ewing sarcoma of the rib was a palpable mass and pleural effusion. Both findings are rare in this age group and should be thoroughly investigated. [ABSTRACT FROM AUTHOR]

BACKGROUND: The time between the initial symptoms of osteosarcoma and Ewing sarcoma and the correct diagnosis and treatment is long. Over the last two decades, the prognosis for patients with these diseases has dramatically improved due to a new chemotherapy regimen. As a consequence, a limb-sparing operation has become an alternative to amputation. The aim of this study was to establish the initial symptoms and physical signs of osteosarcoma and Ewing sarcoma from the records of the first medical visit and to identify early characteristics of the diseases to shorten the delay to diagnosis. METHODS: A group of patients with osteosarcoma or Ewing sarcoma was identified from the Swedish Cancer Register of patients thirty years old and younger. Records from the first medical visit due to symptoms related to the bone tumor were obtained for 102 patients with osteosarcoma and forty-seven patients with Ewing sarcoma. RESULTS: Pain related to strain was reported by eighty-seven (85 percent) of the patients with osteosarcoma and thirty (64 percent) of those with Ewing sarcoma, but only twenty-one (21 percent) of the patients with osteosarcoma and nine (19 percent) of those with Ewing sarcoma reported pain at night. Forty-eight (47 percent) of the patients with osteosarcoma and twelve (26 percent) of those with Ewing sarcoma related the onset of symptoms to minor trauma occurring around the same time. A palpable mass was noted in forty (39 percent) of the patients with osteosarcoma and sixteen (34 percent) of those with Ewing sarcoma at the first visit, and in most cases the tumor diagnosis was suspected. There was a broad spectrum of misdiagnoses; the most common was tendinitis, which was the initial diagnosis in thirty-two (31 percent) of the patients with osteosarcoma and ten (21 percent) of those with Ewing sarcoma. The doctor's delay (the period from the first medical visit due to the symptoms to the correct diagnosis) was longer for Ewing sarcoma than for osteosarcoma (nineteen weeks and nine weeks, respectively; p < 0.0001). CONCLUSIONS: An initial symptom of both osteosarcoma and Ewing sarcoma was pain, which was intermittent and often related to strain but not frequently felt at night. A history of trauma was common, but the clinical course often diverged from what was expected from trauma. The clinical course of osteosarcoma and particularly of Ewing sarcoma was not steadily progressive but intermittent, which often misled the doctor into believing that the condition was temporary. The most important clinical feature was a palpable mass, which was noted in more than one-third of the patients at the first visit. This finding emphasizes that a thorough physical examination is absolutely necessary. [ABSTRACT FROM AUTHOR]

Background: The quality of total extraperitoneal groin hernia repair and recurrence rates are influenced by various factors, potentially including the annual surgical unit volume of repairs. The precise nature of this relationship remains unclear. The aim of this study was to investigate the influence of surgical unit volume on reoperation rates for recurrence following total extraperitoneal groin hernia repair., Methods: This observational nationwide population-based study utilized prospectively collected data from the Swedish Hernia Register. Patients aged 15 years old or older who underwent a total extraperitoneal groin hernia repair from 1 January 2015 to 31 August 2019 were eligible. Follow-up time was until 31 August 2022. Surgical units were grouped into low-volume (fewer than 12 repairs per year), low-medium-volume (12-50 repairs per year), medium-high-volume (greater than 50-150 repairs per year), and high-volume (greater than 150 repairs per year) units. The primary outcome was reoperation for recurrence. The secondary outcome was postoperative complications., Results: A total of 20 656 elective total extraperitoneal groin hernia repairs were included across 75 surgical units. The reoperation rate for recurrence was higher in all three lower-volume groups (low-volume, 5.3%; low-medium-volume, 3.8%; and medium-high-volume, 3.5%) compared with the high-volume group (2.9%). Adjusted multivariable Cox regression analysis revealed a statistically significant increased HR for reoperation for recurrence in the low-volume group (1.87 (95% c.i. 1.31 to 2.67)) and the low-medium-volume group (1.32 (95% c.i. 1.07 to 1.62)) compared with the high-volume group. No difference was seen between the groups regarding the risk of postoperative complications., Conclusion: The risk of reoperation for recurrence following total extraperitoneal groin hernia repair is significantly increased in surgical units that perform fewer than 51 repairs per year. The findings may influence guidelines on required annual surgical unit volume to improve patient outcomes following total extraperitoneal groin hernia repair., (© The Author(s) 2024. Published by Oxford University Press on behalf of BJS Foundation Ltd.)

Background: Bone sarcomas in Sweden are generally referred to a multidisciplinary team at specialized sarcoma centers. This practice is strictly followed for sarcomas of long bones, but not for chest wall chondrosarcomas. Delay in diagnosis and treatment is often considerable for bone sarcomas. This report focuses on the symptoms and diagnostic problems of chest wall chondrosarcoma and factors related to long doctor's delay., Methods: The material included all 106 consecutive patients with chondrosarcoma of the chest wall diagnosed in Sweden 1980-2002. Pathological specimens were re-evaluated and graded by the Scandinavian Sarcoma Group pathology board. Files from the very first medical visit for symptoms related to the chondrosarcoma were traced and used to characterize the initial symptoms and calculate patient's and doctor's delay., Results: The most prominent initial symptom for the chest wall chondrosarcomas was a palpable mass found in 69% (73/106) of the patients at the first visit. Two-thirds of the patients experienced no local chest pain. A tumor was suspected at the first visit in 83% of the patients. Patients delay was median 3 (0-118) months and doctor's delay was 4.5 (0.1-197) months. Doctor's delay was >6 months for 40% of the patients. Patients with an initial plain chest radiograph interpreted as normal (35 patients), and/or normal or inconclusive results of a fine-needle aspiration biopsy had longer doctor's delay. Fine-needle aspiration cytology done at non-specialty units resulted in only 26% correct malignant diagnoses; at sarcoma centers 94% were correctly diagnosed. Long total delay was unfavorable. Patients who died from the chondrosarcoma had longer total delay (p<0.05)., Conclusion: Chest wall chondrosarcoma presents as a lump, usually painless. Plain chest radiographs and fine-needle aspiration cytology, when done at a non-specialty center, are often normal or inconclusive. Patients should be referred to sarcoma centers for diagnosis and treatment.

Objectives: Chondrosarcoma of the chest wall is the most frequent primary malignant chest wall tumor. Surgery remains the only effective treatment. Sarcoma treatment in Sweden is centralized to sarcoma centers; however, sarcomas of the chest wall have also been handled by thoracic and general surgeons., Methods: One hundred six consecutive reports of chondrosarcomas of the rib and sternum over a 22-year period (1980 to 2002) were studied, with a median of 9 (4 to 23) years of follow-up for survivors. Clinical files were gathered and pathologic specimens reviewed and graded 1 to 4 by the Scandinavian sarcoma pathology group. Surgical margins were defined as wide, marginal, or intralesional., Results: Ninety-seven patients were treated with a curative intent. Patients operated with wide surgical margins had a 10-year survival of 92% compared with 47% for those with intralesional resections. The 10-year survival was 75% for patients treated at sarcoma centers and 59% for those treated by thoracic or general surgeons. Local recurrence rate was highly dependent of the surgical margins-4% after wide resections and 73% after intralesional resections. The proportion of intralesional resections was higher outside sarcoma centers. Prognostic factors (multivariate analysis) for local recurrence included surgical margin and histological grade; for metastases, prognostic factors included histologic grade, tumor size, and local recurrence. Metastases occurred in 21 of the patients and only 2 were cured., Conclusions: Patients operated with wide surgical margins resulted in fewer local recurrences and better overall survival. Patients with chest wall tumors should be referred to sarcoma centers and not to general thoracic surgery clinics for diagnosis and treatment.