A 5-year-old 4.0-kg (8.8-lb) castrated male domestic shorthair cat was referred because of grade 4/5 left hind limb lameness and swelling in the region of the second metatarsal bone of that limb.
Computed tomography revealed an expansile osteolytic lesion of the second metatarsal bone associated with a periosteal reaction on the third metatarsal bone. There was no evidence of metastases.
TREATMENT AND OUTCOME
Amputation of the second and third metatarsal bones was performed but resulted in medial instability of the remaining metatarsal bones. The instability was treated by placing a loop of 2-0 monofilament, nonabsorbable suture from a screw placed in the distal row of the tarsal bones to a tunnel in the proximal metaphysis of the fourth metatarsal bone. Clinical reevaluation of the cat 7, 15, 30, 60, 90, and 210 days after surgery and radiographic reevaluation 90 and 210 days after surgery showed complete recovery of the cat. The implants were removed at the time of the 7-month reevaluation. Clinical evaluation 18 months after implant removal showed the treated joint to be stable.
The surgical stabilization technique described here provided medial stability of the tarsometatarsal joint after amputation of the second and third meta-tarsal bones. This method may be an alternative to arthrodesis while maintaining articular function in cats. (J Am Vet Med Assoc 2021;259:294–299)
Objective—To evaluate predictors of survival time in dogs undergoing adrenalectomy and identify risk factors associated with adrenal gland tumor metastasis and vein thrombosis.
Design—Retrospective case series.
Animals—52 dogs with primary adrenal gland tumors.
Procedures—Medical records were reviewed. Signalment, tumor features, and information from surgical procedures were evaluated to identify factors predictive of overall survival time, which was defined as the time from surgery until death. The association between metastasis or vein thrombosis and tumor type, size, and site (right or left adrenal gland) was investigated.
Results—On the basis of results of univariate analysis, survival time was significantly shorter for dogs with adenocarcinoma, tumor major axis length ≥ 5 cm, metastasis, and vein thrombosis and when adrenalectomy was combined with an additional abdominal surgical intervention. On multivariate analysis, survival time was significantly shorter for dogs with an adrenal gland tumor with major axis length ≥ 5 cm and for dogs with metastasis or vein thrombosis. Significant associations were found between metastasis and adenocarcinoma and between vein thrombosis and tumors with major axis length ≥ 5 cm.
Conclusions and Clinical Relevance—Dogs with an adrenal gland tumor with major axis length ≥ 5 cm, documented metastasis, or vein thrombosis had a poorer prognosis. Metastasis was more frequent in dogs with adenocarcinoma and vein thrombosis when tumors were ≥ 5 cm in length.
Objective—To identify prognostic factors in cats with injection-site sarcomas (ISSs).
Design—Retrospective case series.
Animals—57 cats with ISSs.
Procedures—Medical records of cats were reviewed with regard to sex, age, anatomic site of tumor, tumor size, histologic grade, excision of a primary tumor versus excision of a recurrent ISS, use of excision alone versus excision plus adjuvant therapy, local tumor recurrence, and development of distant metastasis to predict overall survival time (ie, time from tumor excision to death).
Results—In univariate analyses, local recurrence and development of distant metastasis were significantly associated with survival time in cats. On multivariate analysis, development of distant metastasis remained a significant prognostic factor. Histologic grade was associated with distant metastasis, with cats having grade 3 tumors being significantly more likely to develop metastasis than cats with grade 1 and 2 tumors. Factors associated with local recurrence of ISSs were not identified.
Conclusions and Clinical Relevance—The development of distant metastasis, which may occur later during the course of the disease, was identified as a prognostic factor for overall survival time in cats with ISSs. In addition, cats with histologic grade 3 ISSs should be considered for further interventional studies with chemotherapy to prevent the high rate of distant metastasis.
Objective—To determine factors predicting survival in dogs with high-grade multicentric lymphoma.
Design—Retrospective cohort study.
Animals—127 dogs with high-grade multicentric lymphoma evaluated at 4 veterinary hospitals from 2000 to 2009.
Procedures—Records were reviewed to identify dogs with completely staged high-grade multicentric lymphoma treated with chemotherapy. Data collected included signalment, history, hematologic findings, tumor characteristics, treatment, and outcome. Long-term survival was defined as surviving > 2 years after diagnosis. Variables were analyzed for associations with dogs living > 2 years.
Results—Among the 127 enrolled dogs, 13 (10%) survived > 2 years with a median survival time of 914 days (range, 740 to 2,058 days). Survival rates at 3, 4, and 5 years were 4%, 3%, and 1 %, respectively. At diagnosis, 11 of the 13 long-term survivors had a body weight ≥ 10 kg, PCV ≥ 35%, absence of ionized hypercalcemia, centroblastic lymphoma, immunophenotype B, absence of bone marrow involvement, and lymphoma stages I through IV and were not previously treated with corticosteroids. The same combination of factors was present in 26 of 114 (23%) dogs surviving ≤ 2 years, yielding a negative predictive value of 97.8% for long-term survivors. Four of the 6 long-term survivors that died during the study died of another cancer; 3 of them had osteosarcoma.
Conclusions and Clinical Relevance—Absence of the aforementioned combination of variables at diagnosis may help identify dogs with lymphoma that will not survive > 2 years. Other types of neoplasia, in particular osteosarcoma, may develop in long-term–surviving dogs.
To report perioperative characteristics and outcome following bilateral, single-session, laparoscopic adrenalectomy (BSSLA) in dogs.
Client-owned dogs (n = 6).
CLINICAL PRESENTATION AND PROCEDURES
Medical records were reviewed and perioperative data collected, including preoperative diagnostic imaging, operative details, complications, and need for conversion to open laparotomy. Bilateral, single-session, laparoscopic adrenalectomy was performed on the right or left side with a standard 3- or 4-portal transperitoneal technique. The dog was repositioned to contralateral recumbency, and laparoscopic adrenalectomy was repeated. Follow-up information was collected by telephone interviews with the owners and/or referring veterinarian.
Median age and weight of dogs were 126 months and 14.75 kg, respectively. Contrast-enhanced CT (CECT) was performed in all dogs. Median maximal tumor diameter was 2.6 and 2.3 cm for the right and left-sided tumors, respectively. Median surgical and anesthesia times were 158 and 240 minutes, respectively. Conversion to open laparotomy was performed in 1 dog following renal vein laceration during initial adrenalectomy. Left adrenalectomy and ureteronephrectomy were performed, and the right adrenal tumor was left in situ. Cardiac arrest occurred in 1 dog following initial adrenalectomy (left); however, the dog was resuscitated successfully, and contralateral laparoscopic adrenalectomy was performed without complication. All dogs survived to hospital discharge. Follow-up ranged from 60 to 730 days (median, 264 days) for dogs that successfully underwent BSSLA.
BSSLA was associated with favorable outcomes in this cohort of dogs. Laparoscopy may be considered in dogs with bilateral, modestly sized, noninvasive adrenal tumors.
To report the perioperative characteristics and outcomes of dogs undergoing laparoscopic-assisted splenectomy (LAS).
136 client-owned dogs.
Multicentric retrospective study. Medical records of dogs undergoing LAS for treatment of naturally occurring splenic disease from January 1, 2014, to July 31, 2020, were reviewed. History, signalment, physical examination and preoperative diagnostic test results, procedural information, complications, duration of hospitalization, histopathologic diagnosis, and perioperative outcomes were recorded. Perioperative complications were defined using the Veterinary Cooperative Oncology Group – Common Terminology Criteria for Adverse Events (VCOG-CTCAE v2) guidelines.
LAS was performed for treatment of a splenic mass (124/136 [91%]), immune-mediated disease (7/136 [5%]), splenomegaly (4/136 [3%]), or immune-mediated disease in conjunction with a splenic mass (1/136 [1%]). Median splenic mass size was 1.3 cm3/kg body weight. Conversion to open laparotomy occurred in 5.9% (8/136) of dogs. Complications occurred in 78 dogs, with all being grade 2 or lower. Median surgical time was 47 minutes, and median postoperative hospital stay was 28 hours. All but 1 dog survived to discharge, the exception being postoperative death due to a suspected portal vein thrombus.
In the dogs of this report, LAS was associated with low rates of major complications, morbidity, and mortality when performed for a variety of splenic pathologies. Minimally invasive surgeons can consider the LAS technique to perform total splenectomy in dogs without hemoabdomen and with spleens with modest-sized splenic masses up to 55.2 cm3/kg, with minimal rates of complications, morbidity, and mortality.
To report the short- and long-term outcomes of laparoscopic adrenalectomy (LA) for resection of unilateral adrenal masses and to document risk factors for conversion and peri- and postoperative morbidity.
255 client-owned dogs.
Dogs were included if LA was attempted for resection of a unilateral adrenal mass. Medical records were evaluated and relevant data were reported, including complications, conversion, perioperative death, and long-term outcomes. Signalment, clinicopathological data, and surgical experience were factors statistically evaluated for possible associations with capsular penetration during surgery, conversion, surgical time, duration of hospital stay, death prior to discharge, mass recurrence, and survival time.
155 dogs had left-sided tumors, and 100 had right-sided tumors. Conversion to an open approach was performed in 9.4% of cases. Capsular penetration (19.2%) and major hemorrhage (5.4%) were the most prevalent intraoperative complications. Of the dogs operated on, 94.9% were discharged from the hospital. Lesion side, portion of the gland affected, and surgeon experience influenced surgical time. Conversion rate increased with increasing body condition score and lesion size. Risk of death prior to discharge increased with increasing lesion size. Risk of conversion and death prior to discharge were lower when performed by more experienced surgeons. Capsular penetration during LA increased the risk of tumor recurrence.
LA for resection of unilateral adrenal masses is associated with excellent outcomes in experienced centers. Surgeons with greater experience with LA have lower surgical times, conversion rates, and risk of death prior to discharge.