Our Summary

The researchers conducted this study to better understand the best treatment for primary tumors of the brachial plexus (a network of nerves in the shoulder area). They reviewed various databases and articles to gather information on the outcomes of surgical treatment for these tumors.

They found that out of the 687 patients studied, most tumors (90.8%) were benign, or non-cancerous, while a small portion (9.2%) were malignant, or cancerous. The majority of these tumors originated from the supraclavicular region (above the collarbone), with the trunks of the brachial plexus most commonly affected.

The study showed that completely removing the tumor surgically (gross total resection) was the ideal treatment strategy. However, in some cases, particularly for a type of tumor called neurofibromas, only partially removing the tumor (subtotal resection) might be better to save as much nerve function as possible.

They found that pain and sensory issues often improved quickly after surgery, but problems with movement (motor deficits) often did not fully recover. There was a low rate of the tumor coming back or spreading to other parts of the body. The overall death rate among the patients studied was 3.1%.

One of the limitations of this research was the lack of high-quality evidence (level I and II). The researchers concluded that the extent of surgical removal should depend on the specific characteristics and location of the tumor.

FAQs

  1. What was the primary aim of this study on primary tumors of the brachial plexus?
  2. What was the preferred treatment strategy for these tumors according to the study and when might partial removal be a better option?
  3. What were the typical outcomes after surgery and what was the overall death rate among the patients studied?

Doctor’s Tip

A helpful tip a doctor might tell a patient about tumor resection is to follow post-operative care instructions carefully, including any physical therapy or rehabilitation recommended. This can help improve recovery and maximize the chances of regaining function after surgery. It is also important to attend follow-up appointments to monitor for any signs of recurrence or complications.

Suitable For

Patients who are typically recommended tumor resection are those with primary tumors of the brachial plexus, especially if the tumor is causing pain, sensory issues, or motor deficits. The ideal candidates for tumor resection are those with benign tumors that can be completely removed, as this often leads to improved symptoms and a low chance of the tumor recurring. In some cases, patients with malignant tumors may also be recommended for tumor resection to prevent further spread of the cancer. The decision to undergo tumor resection should be based on the specific characteristics and location of the tumor, as well as individual patient factors.

Timeline

Before tumor resection:

  1. Patient may experience symptoms such as pain, numbness, weakness, or loss of function in the affected area.
  2. Patient undergoes diagnostic tests such as imaging studies (MRI, CT scan) to determine the size and location of the tumor.
  3. Patient may undergo preoperative preparations such as blood tests, physical exams, and consultations with the surgical team.

After tumor resection:

  1. Patient undergoes surgery to remove the tumor, either completely (gross total resection) or partially (subtotal resection).
  2. Patient may experience pain and discomfort immediately after surgery, which is managed with pain medications.
  3. Patient undergoes postoperative monitoring and rehabilitation to regain strength and function in the affected area.
  4. Patient may require physical therapy or occupational therapy to aid in recovery.
  5. Patient is monitored for any signs of tumor recurrence or complications post-surgery.

What to Ask Your Doctor

  1. What type of tumor do I have and what are the chances of it being cancerous?
  2. What are the potential risks and complications associated with tumor resection surgery?
  3. What is the success rate of completely removing the tumor (gross total resection) in my case?
  4. Are there alternative treatment options to consider besides surgery?
  5. How long is the recovery process expected to be and what kind of physical therapy or rehabilitation will be needed?
  6. Will I need any additional treatments, such as chemotherapy or radiation therapy, after the surgery?
  7. What are the chances of the tumor coming back or spreading to other parts of my body?
  8. How will the surgery impact my nerve function and what are the potential long-term effects on movement and sensation?
  9. What are the specific characteristics and location of my tumor that will determine the extent of surgical removal?
  10. Are there any clinical trials or research studies that I may be eligible for to explore other treatment options?

Reference

Authors: Shekouhi R, Chim H. Journal: Int J Surg. 2023 Apr 1;109(4):972-981. doi: 10.1097/JS9.0000000000000309. PMID: 37097618