Carbon dioxide laser surgery as a treatment for equine sarcoid: outcome and complications in 47 patients at a U.K. first-opinion practice.

Transcription

1 Carbon dioxide laser surgery as a treatment for equine sarcoid: outcome and complications in 47 patients at a U.K. first-opinion practice. Kemp-Symonds, J.G., Clarkson, K. H., Lee, J.C. and Portus, B.J.

2 The equine sarcoid (1) First described in 1936, the sarcoid is a locally aggressive, fibroblastic tumour of equine skin Six, distinct types are currently recognised: Fibroblastic Verrucous Occult Nodular Mixed Malevolent/malignant

3 The equine sarcoid (2) World-wide distribution Prevalence of some 7-9% in UK The most commonlyencountered tumour of horses, ponies and donkies (c. 30% of reported cancer) The most common skinrelated cause of euthanasia in equines

4 Benefits of CO 2 laser vs scalpel (1) Inflammation reduction: Less tissue handling; no crushing, shearing or tearing Cauterisation of lymphatic vessels Low level laser therapy (LLLT) produces photobioactive reaction Wound contamination reduction: Laser operates at over 95 C, destroying pathogens inc. BPV Less seeding of tumour cells Improved haemostasis: Cauterisation of small vessels Less surgical time Improved accuracy and precision

5 Benefits of CO 2 laser vs scalpel (2) Pain reduction: Sealing of nerve endings Reduced analgesia Standing surgery Post-operative benefits: Reduced hospitilisation Rapid healing and return to work Reduced need for antibiotics and NSAIDs Client benefits: Reduced cost High level of customer satisfaction Pre-op 4 weeks post-op

6 Day-patient protocol Standing sedation: Alpha 2 + butorphanol ± CRI (GA only used for surgical access and safety) Analgesia: Pre-operative flunixin ± Local anaesthesia Laser settings: 5 to 12 watts Continuous pulse Post-op care: 5-day course of antibiotics and NSAIDs Benign neglect

7 Retrospective study of outcomes Survey of 68 patients referred from a single UK practice Surveyed in March 2012 Random selection of cases: 67 horses/ponies and 1 donkey Mares : geldings = 28% : 72% 53% of patients aged 6-10 y.o. Peak incidence usually quoted as <6 y.o. Competition/performance horse practice 15% of patients had hx of prior tx Patients treated from August 2008 to September 2011 I.e. 6 months to 42 months post-op Treated with laser surgery alone Data supplied by: Contemporaneous clinical records Owners surveyed by telephone questionnaire by independent researcher

8 High rate of remission (92%) at site of surgery : Prior treatment failure more than doubled the risk of recrudescence Rapid return to work: 57% within 1 month Further 23% within 2-3 months Very low rate of 2 infection: Those affected (4%) responded to short courses of TMP-S Little influence on return to work 87% client satisfaction: 66% very satisfied 21% satisfied Headline results

9 Evenly distributed occurrence: From 6 months to 42 months postop In remission vs cured Owner awareness and vigilance Even distribution between mares and geldings Significant factors affecting recrudescence: History of prior treatment failure: More than doubled the risk Hence, imperative for aggressive, appropriate, timely initial tx Multiple sarcoids: Patients with multiple sarcoids at presentation at increased risk If recrudescence occurred at the site of surgery, tumours also developed elsewhere: aggressive sarcoid type Recrudescence

10 Owner satisfaction and perception 87% either satisfied (21%) or very satisfied (66%): Unrelated to whether scarring occurred (scarring reported in 45% of cases): Scarring obviously correlated to the size of tumour(s) Hence, thorough pre-op briefing to manage expectations No white hair regrowth at sx site 85% would recommend laser surgery for sarcoid tx 70% thought the tx was value for money : Strong correlation with recrudescence Important therefore to manage expectations in cases with poorer prognosis Strong correlation with GA cases: More than doubled the cost

11 Other indications for CO 2 laser surgery Exuberant granulation tissue Non-healing wounds Melanoma Mast cell tumour Squamous cell carcinoma Equine eosinophilic granuloma

12 Acknowledgements Paton and Lee Equine Veterinary Surgery, Essex Nottingham Trent University