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737/surgery_report.txt

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+After active patient identification, the patient is brought into the operating theater. Carrying out the team time-out. Introductory consultation with the anesthesia department. Induction of anesthesia and nasotracheal intubation of the patient. Positioning of the patient by the surgeon. Insertion of the mouth guard. Entry with the small water tube and re-inspection of the tumor extension. If the findings are still transorally laser resectable, the decision is now made to resect the tumor with the CO2 laser as initially planned. Before this, however, oesophagogastroscopy and PEG placement are performed. Advancement of the endoscope under visualization and constant air insufflation into the stomach. This shows a typical gastric mucosal relief on all sides. Insertion of the PEG tube using the thread pull-through method in the typical manner. This is performed without any problems after a clear diaphanoscopy. Repositioning of the patient. Insertion of the mouth guard. Insertion of the spreading laryngoscope with the aid of support autoscopy. Endoscopic-assisted laser resection of the tumor. The tumor extensions extend from the caudal tonsil pole on the right side to the middle of the right-sided base of the tongue. From there, extension into the vallecula and microscopically also to the right-sided lingual epiglottis. Furthermore, extension over the glossotonsillar groove and the aryepiglottic fold. During the tumor resection, it is revealed that the tumor corresponds to a T3 finding due to its extensive submucosal growth and is larger than initially suspected. Dissection is considerably more difficult. There is heavy bleeding from the lingual artery in the area of the lateral pharyngeal wall. This can ultimately be stopped with two clips and a re-stitching. Due to the unexpected extent of the tumor, it cannot be resected using the en bloc resection technique, but rather using the piecemeal technique. As a result, a total of 14 marginal samples were meticulously removed. R0 status as part of the telephone frozen section announcement. Due to the extent of the tumor, the decision is made intraoperatively to forego neck dissection of the right side and to perform this in the interval. The patient is repositioned for neck dissection on the left side. Skin spray disinfection and infiltration anesthesia. Abjode the surgical site. Sterile draping. Mark the planned incision from the tip of the mastoid over the anterior edge of the sternocleidomastoid muscle in a curved line. Cut sharply through the cutis and subcutis. Exposure of the anterior margin of the sternocleidomastoid muscle. Exposure of the omohyoid muscle as the caudal border. Exposure of the accessorius nerve and the posterior digastric venter muscle as the cranial border. Displacement and, at the end of the operation, re-embedding of the accessorius nerve in the sense of a neurolysis. Insertion of the retractors. Exposure of the cervical vascular sheath in the sense of dissection of the internal jugular vein, the facial vein, the common carotid artery, the bifurcation and the external and internal carotid arteries. Exposure and protection of the vagus nerve. Displacement and, at the end of the operation, re-embedding of the vagus nerve in the sense of a neurolysis. Development of the lateral neck preparation while sparing all plexus branches. Turning to the medial neck preparation. Exposure of the capsule of the submandibular gland. Exposure and protection of the hypoglossal nerve. Displacement and, at the end of the operation, re-embedding of the hypoglossal nerve in the sense of a neurolysis. Development of the medial neck preparation. Exposure and protection of the cervical nerve. Hemostasis using bipolar coagulation. Wound irrigation with H2O2 and Ringer's solution. Insertion of a 10-gauge Redon drain. Subcutaneous suture with Vicryl 4.0 and skin suture with Ethilon 4.0. Application of a pressure bandage. Transition to protective tracheotomy. Due to the extensive resection area and the bleeding that has taken place in the area of the lingual artery on the right side, a protective tracheotomy is now indicated. Palpatory identification of the level of the cricoid cartilage. Signs of the planned incision in the form of an inverted T. Sharp transection of the cutis and subcutis. Exposure of the infrahyoid musculature. Locate the linea alba. Blunt lateral dissection of the same. Palpatory identification of the lower edge of the cricoid cartilage and a tender thyroid isthmus. Undermining of the tender thyroid isthmus and bipolar coagulation of the same. Entering the trachea between the 2nd and 3rd cricoid cartilage. Performing a visor tracheotomy. Circular tension-free epithelialization of the tracheostoma. Re-intubation of the patient onto a 9-gauge tracheostomy tube. Application of a pressure dressing. Completion of the operation without complications. Final consultation with the anesthetist. The patient is then transferred to the local intensive care unit in a cardiorespiratory stable condition. In the interval of approx. two weeks, the corresponding neck dissection should be performed on the right side.

738/ops_codes.txt

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+Sonstige Laryngektomie mit Rekonstruktion mit lokaler Schleimhaut[5-303.x1 ] Diagnostische Tracheobronchoskopie: Mit starrem Instrument: Sonstige[1-620.1x ] Anlegen ösophagotracheale Fistel zur Einlage Stimmprothese[5-429.0 ] Selektive Neck dissection in 4 Regionen[5-403.03 B] Permanente Tracheostomaanlage[5-312.0 ]

738/surgery_description.txt

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+Laryngectomy, Selective neck dissection, and Tracheotomy

738/surgery_report.txt

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+The patient is first taken to the operating theater, followed by active patient identification. Consultation with anesthesia colleagues. Carrying out the team time-out. Induction of anesthesia by the anesthesia colleagues. Subsequent tracheobronchoscopy with 0° optics by the surgeon and <CLINICIAN_NAME>. This reveals the carcinoma described above, which describes the entire vocal fold with infiltration and encasement of the arytenoid cartilage on the left side and also grows into the anterior commissure. The vocal folds cannot be passed. Here is an attempt at anesthesia for transnasal intubation. This is initially unsuccessful due to the extension of the tumor into the subglottic and glottic areas. There is a drop in saturation. Only after considerable effort can the tube be inserted orotracheally by the anesthesia colleagues. The anesthesia is now deepened and a perioperative ultrasound is performed. As can also be seen on the CT scan, the tumor masses surround the arytenoid cartilage. For this reason and due to the panendoscopy findings described above with a minimum submucosal extension of 1 cm subglottically, <CLINICIAN_NAME> decided to perform a laryngectomy. CT and ultrasound also show a wide subglottic extension of the tumor towards the cricoid cartilage. Infiltration of the cricoid cartilage is also highly probable here. Now head positioning by the surgeon. Skin disinfection and infiltration anesthesia in the area of the planned skin incision with a total of 10 ml Ultracaine. Skin disinfection and sterile draping of the surgical area. Marking of the landmarks on both sides of the mandibular angle, mandibular branch, chin, incisura thyroidea, cricoid cartilage, jugulum, sternocleidomastoid and the mastoid as well as the skin incision in the sense of an apron flap. Now creation of an apron flap in a typical manner. Start of neck dissection on the left side through <CLINICIAN_NAME>. Expose the sternocleidomastoid, the omohyoid muscle, the submandibular gland and the digastric muscle and follow them. Exposure of the accessorius nerve, the hypoglossal nerve and release of the neck level II a to V a while sparing the plexus branches and the superior thyroid artery. There are 2 spherical, suspicious masses in the area mainly in level II and in level V below the plexus branches. The vagus nerve is visualized and spared. Also the cervical vascular sheath with the common carotid artery and the internal jugular vein in level IV. Extensive bipolar coagulation. No evidence of chyle fistula. Now exposing the hyoid bone. Release of the hyoid bone on the left side. Detachment of the cervical vascular sheath from the larynx and pharyngeal region. Detachment of the thyroid gland. Undermining of the thyroid isthmus using Pean clamps and ligation of the thyroid isthmus after severing it. Exposure of the superior laryngeal nerve, artery and vein. Dissection of the same and coagulation of the same. Now move to the opposite side to the right and perform right neck dissection by <CLINICIAN_NAME>. Identical procedure. Expose the sternocleidomastoid, the omohyoid, the submandibular gland and the digaster venter muscle posteriorly and anteriorly. Exposure of the nervus accessorius, hypoglossus, ansa and vagus and sparing of the same. Now clearing from level II to level V a, also sparing the plexus branches and the vagus nerve. Exposure of the common carotid artery. Release of the hyoid bone. Removal of the hyoid bone. Skeletonization of the thyroid cartilage on both sides. Exposure of the superior laryngeal nerve, artery and vein. Separation and bipolar coagulation of the same. Detachment of the cervical vascular sheath from the larynx and laryngeal region. Detachment of the thyroid gland and mobilization from the trachea. Detachment of the infrahyoid musculature and the laryngeal musculature. Perform a tracheotomy between the 2nd and 3rd tracheal cartilage and transfer intubation to a laryngectomy tube. Further skeletonization of the larynx on the right side. Release and removal of the piriform sinus. Same procedure on the left side. Enter the pharynx at the level of the epiglottis from the right side. Pull out the epiglottis through a pharyngotomy and incise the mucosa along the edge of the epiglottis up to the arytenoid region. Here, release the mucosa caudally from the arytenoid cartilage. Detachment and separation of the larynx. It can now be seen that the tumor completely surrounds the arytenoid cartilage and extends far into the subglottic region, infiltrating the cricoid cartilage. Overall growth of at least 1 ˝ cm from the glottic level to the subglottic level. Suture mark tracheal posterior wall caudal, lateral wall left, aryepiglottic fold on both sides and arytenoid cartilage dorsal left. Here the frozen section shows free on all sides, in the ary area dorsal left just in sano, here a cone draws close to the resection margin. Now create an oesophagotracheal fistula and insert a size 8 Provox prosthesis. Now perform the pharyngeal suture in three layers as usual, alternating between <CLINICIAN_NAME> and <CLINICIAN_NAME>. Now inspect the wound again. Irrigation with H2O2 and Ringer. Bipolar coagulation. Dry wound conditions. Insertion of a 10 Redon on both sides. Incision of the skin in the area of the stoma and two-layer wound closure. The operation is now completed without complications. The patient goes to the intensive care unit awake. Please continue antibiotics 3x 3 g Unacid. Please feed only via nasogastric tube for 10 days, then X-ray gruel.

739/TumorCenter_CD3_block7_x4_y7_patient739_1.json

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+{
+  "patient_tma_measurements": {
+    "Centroid X µm": 13492.9,
+    "Centroid Y µm": 17690.6,
+    "Num Detections": 18349,
+    "Num Negative": 17452,
+    "Num Positive": 897,
+    "Positive %": 4.889,
+    "Num Positive per mm^2": 371.36
+  }
+}

739/TumorCenter_CD8_block7_x3_y7_patient739_0.json

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+{
+  "patient_tma_measurements": {
+    "Centroid X µm": 10669.4,
+    "Centroid Y µm": 17565.7,
+    "Num Detections": 21965,
+    "Num Negative": 21787,
+    "Num Positive": 178,
+    "Positive %": 0.8104,
+    "Num Positive per mm^2": 73.61
+  }
+}

739/history_text.txt

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+The patient presented with a tumor growing from the soft palate parauvularly on the left, infiltrating via the tonsillar lobe into the base of the tongue. Because of this, the indication for resection of the tumor using TORS was given.

739/icd_codes.txt

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+Karzinom weicher Gaumen[C05.1 ]

739/ops_codes.txt

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+Direkte diagnostische Pharyngoskopie[1-611.0 ] Anwendung eines OP-Roboters (Zusatzkode)[5-987 ] Transorale radikale Resektion des Pharynx [Pharyngektomie] mit Rekonstruktion mit lokaler Schleimhaut[5-296.01 ]

739/patient_clinical_data.json

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+{
+  "year_of_initial_diagnosis": 2014,
+  "age_at_initial_diagnosis": 62,
+  "sex": "female",
+  "smoking_status": "smoker",
+  "primarily_metastasis": "no",
+  "survival_status": "living",
+  "survival_status_with_cause": "living",
+  "first_treatment_intent": "curative",
+  "first_treatment_modality": "local surgery",
+  "days_to_first_treatment": 32,
+  "adjuvant_treatment_intent": "curative",
+  "adjuvant_radiotherapy": "yes",
+  "adjuvant_radiotherapy_modality": "percutaneous radiotherapy",
+  "adjuvant_systemic_therapy": "yes",
+  "adjuvant_systemic_therapy_modality": "fluorouracil + cisplatin",
+  "adjuvant_radiochemotherapy": "yes"
+}

739/patient_pathological_data.json

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+{
+  "patient_id": "739",
+  "primary_tumor_site": "Oropharynx",
+  "pT_stage": "pT3",
+  "pN_stage": "NX",
+  "grading": "G3",
+  "hpv_association_p16": "negative",
+  "number_of_positive_lymph_nodes": NaN,
+  "number_of_resected_lymph_nodes": 0,
+  "perinodal_invasion": null,
+  "lymphovascular_invasion_L": "no",
+  "vascular_invasion_V": "no",
+  "perineural_invasion_Pn": "no",
+  "resection_status": "R0",
+  "resection_status_carcinoma_in_situ": "CIS Absent",
+  "carcinoma_in_situ": "no",
+  "closest_resection_margin_in_cm": "<0.1",
+  "histologic_type": "SCC_Conventional-Keratinizing",
+  "infiltration_depth_in_mm": 6.0
+}

739/surgery_description.txt

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+Pharyngectomy, Robotic surgery, Pharyngoscopy

739/surgery_report.txt

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+Introductory consultation with the anesthesiologist. Repeated panendoscopy and inspection of the tumor, which has not changed significantly compared to the previous findings from the panendoscopy a week ago. Insertion of the FK oral retractor and exposure of the tumor, which is successful without any problems. Insertion of the spandex blocker. Docking the robot and positioning the optics and the robot arms. Inserting the instruments, on the left the monopolar blades, on the right the Maryland clamp. Careful marking of the resection margins with the monopolar blade. Start of the resection from the parauvular side on the left, via the soft palate into the tonsil larynx. Care is taken to maintain a macroscopic safety margin of 0.5 cm in the entire area. The resection is then carried out via the tonsil lobe to the base of the tongue, where the tumor has infiltrated into the base of the tongue in a spherical shape. Therefore, resection of an area around the tumor from the base of the tongue. The resection extends forward from the soft palate into the glossotonsillar groove. An appropriate safety distance is also maintained here. Finally, the entire tumor preparation can be completely removed. Careful hemostasis. Removal of representative marginal samples from the area of the base of the tongue, the glossotonsillar groove and the anterior and posterior margin of the palate. All marginal samples are sent for frozen section diagnostics. The specimens of the palatal arch are thread-marked. The first frozen section inspection shows that both the marginal sample at the base of the tongue and the marginal sample in the glossotonsillar groove cannot be assessed due to thermal artifacts. For this reason, we again take marginal samples from the area of the glossotonsillar groove and the base of the tongue with the scissors. These are sent again for frozen section diagnostics. The marginal sample in the area of the glossotonsillar groove now shows infiltrations of the tumor. The marginal sample at the base of the tongue is assessed as tumor-free. An extensive resection is therefore performed in the area of the transition between the glossotonsillar groove and the base of the tongue, so that the resection extends to the bone of the ascending mandibular branch. These resections are sent for final histopathological assessment. Again, marginal samples are taken from the area of the glossotonsillar groove and the ascending mandible. Both marginal samples are now found to be tumor-free in the frozen section. After careful hemostasis, the instruments are removed. There is now a clearly enlarged velopharyngeal space, so that regurgitation of food cannot be ruled out with certainty. An attempt is therefore made to reconstruct the soft palate using the tissue of the remaining uvula. This is therefore first deepithelialized on the left side and sutured into the soft palate in three layers. Despite all this, a large velopharyngeal gap remains, so that the patient's swallowing function must be examined first. If there is massive regurgitation, treatment with a radial flap is necessary here. Due to this fact, neck dissection is not performed today for cN0 status. Depending on the clinical picture of swallowing function, this is performed either in combination with radial flap treatment or, if swallowing function is good, as a selective neck dissection. After another bleeding check, the patient is fitted with a nasogastric feeding tube and transferred via the recovery room to the in-house intensive care unit for postoperative monitoring. Final consultation with the anesthesia department.

740/InvasionFront_CD3_block1_x1_y11_patient740_0.json

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+{
+  "patient_tma_measurements": {
+    "Centroid X µm": 3548.1,
+    "Centroid Y µm": 29234.5,
+    "Num Detections": 18042,
+    "Num Negative": 17754,
+    "Num Positive": 288,
+    "Positive %": 1.596,
+    "Num Positive per mm^2": 121.11
+  }
+}

740/InvasionFront_CD3_block1_x2_y11_patient740_1.json

@@ -0,0 +1,11 @@
+{
+  "patient_tma_measurements": {
+    "Centroid X µm": 5971.8,
+    "Centroid Y µm": 29209.5,
+    "Num Detections": 16764,
+    "Num Negative": 16356,
+    "Num Positive": 408,
+    "Positive %": 2.434,
+    "Num Positive per mm^2": 178.03
+  }
+}

740/InvasionFront_CD8_block1_x1_y11_patient740_0.json

@@ -0,0 +1,11 @@
+{
+  "patient_tma_measurements": {
+    "Centroid X µm": 3773.0,
+    "Centroid Y µm": 27685.3,
+    "Num Detections": 15393,
+    "Num Negative": 15142,
+    "Num Positive": 251,
+    "Positive %": 1.631,
+    "Num Positive per mm^2": 106.53
+  }
+}

740/InvasionFront_CD8_block1_x2_y11_patient740_1.json

@@ -0,0 +1,11 @@
+{
+  "patient_tma_measurements": {
+    "Centroid X µm": 6271.7,
+    "Centroid Y µm": 27535.4,
+    "Num Detections": 16557,
+    "Num Negative": 16263,
+    "Num Positive": 294,
+    "Positive %": 1.776,
+    "Num Positive per mm^2": 132.33
+  }
+}

740/TumorCenter_CD8_block1_x1_y11_patient740_0.json

@@ -0,0 +1,11 @@
+{
+  "patient_tma_measurements": {
+    "Centroid X µm": 6621.5,
+    "Centroid Y µm": 36880.5,
+    "Num Detections": 15371,
+    "Num Negative": 15297,
+    "Num Positive": 74,
+    "Positive %": 0.4814,
+    "Num Positive per mm^2": 33.06
+  }
+}

740/TumorCenter_CD8_block1_x2_y11_patient740_1.json

@@ -0,0 +1,11 @@
+{
+  "patient_tma_measurements": {
+    "Centroid X µm": 9245.1,
+    "Centroid Y µm": 36705.6,
+    "Num Detections": 15568,
+    "Num Negative": 15505,
+    "Num Positive": 63,
+    "Positive %": 0.4047,
+    "Num Positive per mm^2": 27.36
+  }
+}

740/history_text.txt

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+Today the patient underwent a neck dissection and an enoral tumor resection for cT1 to 2 oropharyngeal carcinoma on the left. Postoperatively, 90 ml of blood in the redon within 2 hours and a swollen neck on the left side. The wound was therefore opened in the recovery room and a large hematoma was relieved and there was significant post-operative bleeding, so the patient was taken to the operating room on an emergency basis.

740/icd_codes.txt

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+Nachblutung[T81.0 L]

740/ops_codes.txt

@@ -0,0 +1 @@
+Wiedereröffnung Wunde Schilddrüsen-Gebiet zur [postoperativen] Blutstillung[5-060.3 ]

740/patient_clinical_data.json

@@ -0,0 +1,18 @@
+{
+  "year_of_initial_diagnosis": 2016,
+  "age_at_initial_diagnosis": 59,
+  "sex": "male",
+  "smoking_status": "former",
+  "primarily_metastasis": "no",
+  "survival_status": "deceased",
+  "survival_status_with_cause": "deceased tumor specific",
+  "first_treatment_intent": "curative",
+  "first_treatment_modality": "local surgery",
+  "days_to_first_treatment": 41,
+  "adjuvant_treatment_intent": "curative",
+  "adjuvant_radiotherapy": "yes",
+  "adjuvant_radiotherapy_modality": "percutaneous radiotherapy",
+  "adjuvant_systemic_therapy": "no",
+  "adjuvant_systemic_therapy_modality": null,
+  "adjuvant_radiochemotherapy": "no"
+}

740/patient_pathological_data.json

@@ -0,0 +1,20 @@
+{
+  "patient_id": "740",
+  "primary_tumor_site": "Oropharynx",
+  "pT_stage": "pT2",
+  "pN_stage": "pN0",
+  "grading": "G3",
+  "hpv_association_p16": "negative",
+  "number_of_positive_lymph_nodes": 0.0,
+  "number_of_resected_lymph_nodes": 13,
+  "perinodal_invasion": null,
+  "lymphovascular_invasion_L": "no",
+  "vascular_invasion_V": "no",
+  "perineural_invasion_Pn": "no",
+  "resection_status": "R0",
+  "resection_status_carcinoma_in_situ": "CIS Absent",
+  "carcinoma_in_situ": "no",
+  "closest_resection_margin_in_cm": "0.5",
+  "histologic_type": "SCC_Conventional-Keratinizing",
+  "infiltration_depth_in_mm": 4.0
+}

740/surgery_description.txt

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+Transoral tumor resection

740/surgery_report.txt

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+Intubation by anesthesia colleagues and sterile draping. Subsequent reopening of the cutaneous and subcutaneous suture. Aspiration of the hematoma. Overall, there is diffuse bleeding in several places and a minimal vascular stump cranial to the paralaryngeal omohyoid muscle. This is ligated, but then breaks off; it can no longer be found during the dissection, but this site is extensively coagulated and no further bleeding occurs centrally. Other sites are also extensively bipolar coagulated. Overall, no large or medium-sized vessel can be identified that could have caused the bleeding. Repeated irrigation with Ringer's and finally also with H2O2, again no relevant bleeding, not even after raising the systolic blood pressure above 120 mmHg. Therefore, another Redon insertion, subcutaneous and skin sutures with 4.0 Vicryl and 4.0 Ethilon. Enorally dry conditions, therefore termination of the operation. Note: At the beginning of the operation, the patient again received 7 ampoules of Minirin and 1 platelet concentrate intraoperatively. He also received 1000 mg tranexamic acid. Tranexamic acid 1000 mg please 3 times daily, BGA check in intensive care unit. Minirin 7 ampoules every 12 hours. Before the next administration, please check the PFA and platelet aggregation in the laboratory and consult the transfusion medicine colleagues again tomorrow. The patient goes to the intensive care unit intubated and ventilated.

741/InvasionFront_CD3_block1_x3_y3_patient741_0.json

@@ -0,0 +1,11 @@
+{
+  "patient_tma_measurements": {
+    "Centroid X µm": 11693.8,
+    "Centroid Y µm": 9220.1,
+    "Num Detections": 23134,
+    "Num Negative": 22431,
+    "Num Positive": 703,
+    "Positive %": 3.039,
+    "Num Positive per mm^2": 293.76
+  }
+}

741/InvasionFront_CD3_block1_x4_y3_patient741_1.json

@@ -0,0 +1,11 @@
+{
+  "patient_tma_measurements": {
+    "Centroid X µm": 14392.4,
+    "Centroid Y µm": 9320.1,
+    "Num Detections": 25041,
+    "Num Negative": 24380,
+    "Num Positive": 661,
+    "Positive %": 2.64,
+    "Num Positive per mm^2": 251.55
+  }
+}

741/InvasionFront_CD8_block1_x3_y3_patient741_0.json

@@ -0,0 +1,11 @@
+{
+  "patient_tma_measurements": {
+    "Centroid X µm": 11793.8,
+    "Centroid Y µm": 7770.9,
+    "Num Detections": 23252,
+    "Num Negative": 22619,
+    "Num Positive": 633,
+    "Positive %": 2.722,
+    "Num Positive per mm^2": 262.59
+  }
+}

741/InvasionFront_CD8_block1_x4_y3_patient741_1.json

@@ -0,0 +1,11 @@
+{
+  "patient_tma_measurements": {
+    "Centroid X µm": 14517.3,
+    "Centroid Y µm": 7920.8,
+    "Num Detections": 24111,
+    "Num Negative": 23722,
+    "Num Positive": 389,
+    "Positive %": 1.613,
+    "Num Positive per mm^2": 149.35
+  }
+}

741/TumorCenter_CD3_block1_x3_y5_patient741_0.json

@@ -0,0 +1,11 @@
+{
+  "patient_tma_measurements": {
+    "Centroid X µm": 10619.4,
+    "Centroid Y µm": 12743.3,
+    "Num Detections": 22370,
+    "Num Negative": 14927,
+    "Num Positive": 7443,
+    "Positive %": 33.27,
+    "Num Positive per mm^2": 2852.4
+  }
+}

741/TumorCenter_CD3_block1_x4_y5_patient741_1.json

@@ -0,0 +1,11 @@
+{
+  "patient_tma_measurements": {
+    "Centroid X µm": 13168.0,
+    "Centroid Y µm": 12618.3,
+    "Num Detections": 25708,
+    "Num Negative": 20321,
+    "Num Positive": 5387,
+    "Positive %": 20.95,
+    "Num Positive per mm^2": 1969.9
+  }
+}

741/TumorCenter_CD8_block1_x3_y3_patient741_0.json

@@ -0,0 +1,11 @@
+{
+  "patient_tma_measurements": {
+    "Centroid X µm": 13592.8,
+    "Centroid Y µm": 16316.4,
+    "Num Detections": 19361,
+    "Num Negative": 19157,
+    "Num Positive": 204,
+    "Positive %": 1.054,
+    "Num Positive per mm^2": 90.55
+  }
+}

741/TumorCenter_CD8_block1_x4_y3_patient741_1.json

@@ -0,0 +1,11 @@
+{
+  "patient_tma_measurements": {
+    "Centroid X µm": 16191.4,
+    "Centroid Y µm": 16266.4,
+    "Num Detections": 19574,
+    "Num Negative": 19339,
+    "Num Positive": 235,
+    "Positive %": 1.201,
+    "Num Positive per mm^2": 107.4
+  }
+}

741/history_text.txt

@@ -0,0 +1 @@
+The patient has a histologically confirmed G3 squamous cell carcinoma (P16 negative) of the left-sided oropharynx (cT3 cN0 cM0). In our interdisciplinary tumor conference on <2016>, it was decided to resect the tumor with defect coverage by means of flap plasty as well as neck dissection on both sides and tracheotomy. The patient was informed in detail preoperatively and had sufficient time to ask questions.

741/icd_codes.txt

@@ -0,0 +1 @@
+Karzinom Oropharynx mehrere Teilbereiche überlappend[C10.8 L] Atherom[L72.1 ]

741/ops_codes.txt

@@ -0,0 +1 @@
+Transplantat[5-295.04 ] Radikale zervikale Lymphadenektomie [Neck dissection] radikal modifiziert 5 Regionen[5-403.21 B] Transorale partielle Resektion der Zunge mit Rekonstruktion mit freiem mikrovaskulär-anastomosiertem Transplantat[5-251.02 ] Temporäre Tracheotomie[5-311.0 ] Transorale Tumortonsillektomie[5-281.2 ] Wechsel eines vaskulären Implantates[5-394.3 ] Wechsel eines vaskulären Implantates[5-394.3 ] Spalthaut Entnahmestelle Oberschenkel und Knie[5-901.0e R] Spalthaut großflächig Empfängerstelle sonstige[5-902.4x L] Atheromexstirpation und Wundverschluss Hals[5-894.15 ]

741/patient_clinical_data.json

@@ -0,0 +1,18 @@
+{
+  "year_of_initial_diagnosis": 2016,
+  "age_at_initial_diagnosis": 71,
+  "sex": "male",
+  "smoking_status": "former",
+  "primarily_metastasis": "no",
+  "survival_status": "deceased",
+  "survival_status_with_cause": "deceased not tumor specific",
+  "first_treatment_intent": "curative",
+  "first_treatment_modality": "local surgery",
+  "days_to_first_treatment": 31,
+  "adjuvant_treatment_intent": "curative",
+  "adjuvant_radiotherapy": "yes",
+  "adjuvant_radiotherapy_modality": "percutaneous radiotherapy",
+  "adjuvant_systemic_therapy": "no",
+  "adjuvant_systemic_therapy_modality": null,
+  "adjuvant_radiochemotherapy": "no"
+}

741/patient_pathological_data.json

@@ -0,0 +1,20 @@
+{
+  "patient_id": "741",
+  "primary_tumor_site": "Oropharynx",
+  "pT_stage": "pT3",
+  "pN_stage": "pN1",
+  "grading": "G3",
+  "hpv_association_p16": "negative",
+  "number_of_positive_lymph_nodes": 1.0,
+  "number_of_resected_lymph_nodes": 43,
+  "perinodal_invasion": "no",
+  "lymphovascular_invasion_L": "no",
+  "vascular_invasion_V": "no",
+  "perineural_invasion_Pn": "no",
+  "resection_status": "R0",
+  "resection_status_carcinoma_in_situ": "CIS Absent",
+  "carcinoma_in_situ": "no",
+  "closest_resection_margin_in_cm": "0.1",
+  "histologic_type": "SCC_Basaloid",
+  "infiltration_depth_in_mm": 7.0
+}

741/surgery_description.txt

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+Tumor resection, Bilateral neck dissection, Tracheotomy, Defect coverage, Free flap (Radial)

741/surgery_report.txt

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+Carrying out the team time out and consultation with the anesthesia colleagues. Induction of intubation anesthesia by colleagues. Sterile wiping of the patient and start of the operation with the tracheotomy. Skin incision approx. 3 cm along just below the cricoid cartilage. Separation of the skin, the subcutis and the platysma. Dissection of the straight infrahyoid muscles. Push the muscles to the side and expose the thyroid isthmus. Undermining of the thyroid isthmus with a clamp and transection of the thyroid isthmus after extensive bipolar coagulation. Incision of the trachea between the 2nd and 3rd tracheal cartilage. Creation of a visor tracheotomy in the usual manner. Re-intubation with an 8-gauge laryngectomy tube. Cover and wipe the patient again and start neck dissection on the right side. Creation of an apron flap. Separation of the cutaneous and subcutaneous tissue and platysma. Subplatysmal dissection cranially until the submandibular gland is exposed. Release of the gland. Exposure of the anterior border of the sternocleidomastoid muscle. Exposure of the omohyoid muscle and dissection cranially to the hyoid bone. Exposure of the posterior venter of the digastric muscle and exposure up to the hyoid bone. Division of the neck preparation into a medial and a lateral compartment by free preparation of the internal jugular vein. The external jugular vein and the auricular nerve can be spared. Exposure of the accessorius nerve. This can also be spared. Removal of the neck preparation (region II to V) from the depths with constant coagulation of minor bleeding. Irrigation with hydrogen and Ringer and completion of the neck dissection without complications. Therefore, creation of an apron flap and start with the neck dissection on the left side. Exposure of the sternocleidomastoid muscle, the submandibular gland, the omohyoid muscle and the digastric muscle. Exposure of the cervical vascular sheath. Visualization of the jugular vein, visualization of the external jugular vein, visualization of the facial vein. Removal of the neck preparation II a to V a while sparing the plexus branches. Removal of the submandibular gland and transection of the omoyhoid muscle. This takes the tumor transorally. The tumor can be dislocated cervically and resected from the transcervical side. It can be completely removed. Take margin samples from all around the specimen so that the tumor specimen can be covered circularly with margin samples. The margin samples are taken from the specimen in frozen section R0. Also in depth. Measurement of the defect. 15 x 6 x 8 cm. Exposure and preparation of the neck vessels. The facial vein and the external jugular vein are dissected as venous connections. The arterial connection is the facial artery. The lingual artery was also removed during tumor resection, as was the lingual nerve. Lifting of the split skin by <CLINICIAN_NAME> from the right thigh. This is successful without any problems. Treatment of the forearm using <CLINICIAN_NAME> and <CLINICIAN_NAME>. Exposed tendons are sutured over with muscle. The defect is covered with split skin and treated in the usual way with sewn-on swabs and compresses. Application of a dorsal forearm splint. Please continue antibiotics postoperatively for at least 24 hours. Regular flap checks. First forearm dressing change on the 7th postoperative day. Earlier of course if symptoms occur. Demonstration to the surgeon. Tumor resection by <CLINICIAN_NAME>. Sterile washing and draping. Insertion of the McIvor mouth blocker and start of tumor resection. The tumor extends from the soft palate parauvularly over the alveolar ridge and the tonsillar lobe caudally, it spreads to the edge and base of the tongue on the left in the caudal region. Start with tumor resection in the soft palate area and continue the resection caudally, taking part of the alveolar ridge with it. However, the tumor itself can be easily moved away from the bone. To be on the safe side, the bone is ground down again. Dissection up to the base of the tongue. The overview then makes it no longer possible to resect the tumor further from the transoral side. Elevation of the radial lobe from the left forearm: After appropriate measurement of the size and three-dimensional configuration of the defect after ensuring R0 resection, the flap is marked accordingly on the forearm. Incision of the flap first from the ulnar and lifting subfascially. The incision is then extended into the crook of the elbow. Exposure of the superficial venous system and the connection to the deep venous system. Subsequently incision of the flap also from radial and lifting subfascial. Exposure of the radial artery. This is first clamped off. Then expose the pedicle and the connection to the superficial venous system. Further lifting of the flap subfascially from the radial side. Exposure and preservation of the lateral antebrachial cutaneous nerve as far as possible. The pedicle must be isolated under the brachioradialis muscle. The radial artery should then be removed. Saturation always in the normal range after clamping. The radial artery is ligated caudally and distally. Lift the radial artery flap along the pedicle. Outgoing small vessels are bipolarly coagulated or clipped. A total of two outlets from the cephalic vein can be visualized in the antecubital region. A smaller vein branches off from one of the outlets. A common confluence above the radial artery can also be visualized and preserved. The interosseous artery is clamped and later severed. The radial artery is detached and closed using 6.0 Vascufil in the area of the brachialis stump. Veins are removed and ligated. Flap is irrigated with heparin. The forearm is primarily closed cranially. Caudal closure using a split-thickness skin graft taken from the right thigh. This succeeds completely and without tension. Ball swabs are sutured to some areas. Octenilin gel is then applied. Application of Mepilex, which is fixed with sutures. Subsequent application of cloud swabs and wrapping of these with a absorbent cotton bandage. Then fitting of a Cramer splint, which is fixed to the forearm in the functional position using an elastic bandage. Subsequent positioning of the arm. The flap is then sutured into the defect. First suture the flap transorally or transcervically. This is done with 3.0 Vicryl single button sutures, partly with the sutures in place. Complete tension-free closure of the defect is achieved. This includes parts of the anterior and posterior palatal arch, the pharyngeal wall, the vallecula and the base of the tongue as well as the posterior parts of the floor of the mouth. The left pedicle is drained into the left side of the neck. The second facial artery, which has been dissected, is used as the connecting vessel. First, after conditioning the two arteries, anastomosis of the facial artery with the radial artery using 8.0 Ethilon single-button sutures. After opening the clamps, good arterial flow and good venous return. Subsequent conditioning of the external jugular vein and the facial vein for the venous connection. A portion of the cephalic vein is anastomosed using a 3.5 mm coupler after conditioning of the veins. Good venous flow after opening the clamp. Positive smear phenomenon. The other part of the cephalic vein is anastomosed with the facial vein using a 2.5 mm coupler at an outlet. Here too, after opening the clamp, good venous flow, positive smear phenomenon. The confluence is clipped, as are other outlets from the facial vein. Subsequent careful hemostasis. Irrigation of the sides of the neck on both sides. Closure of the skin with insertion of a Redon drain on the right and two flaps on the left and epithelialization of the tracheostoma. Insertion of an 8 mm tracheal cannula, which is fixed with sutures. In the area of the skin above the vascular anastomosis, a suture marker is placed for Doppler control. Hydrogel dressing is applied to the thigh area. Thoracic inspection shows good circulation in the area of the flap. The procedure is completed without complications. Patient transferred to the intensive care unit on mechanical ventilation. Please continue antibiotics, which were started intraoperatively, for a total of one week postoperatively. Feeding via the PEG tube for approx. 10 days, followed by gruel and, if necessary, a diet. Continue intraoperative therapy with heparin perfusor for 5 days at 500 units per hour. Check the flap clinically and by Doppler according to the scheme for 5 days. Overall cT4a cN2c oropharyngeal carcinoma on the right. Presentation after receiving the final histology in the interdisciplinary tumor conference.

742/InvasionFront_CD3_block19_x1_y11_patient742_0.json

@@ -0,0 +1,11 @@
+{
+  "patient_tma_measurements": {
+    "Centroid X µm": 3997.9,
+    "Centroid Y µm": 28684.8,
+    "Num Detections": 16528,
+    "Num Negative": 13684,
+    "Num Positive": 2844,
+    "Positive %": 17.21,
+    "Num Positive per mm^2": 1580.3
+  }
+}

742/InvasionFront_CD3_block19_x2_y11_patient742_1.json

@@ -0,0 +1,11 @@
+{
+  "patient_tma_measurements": {
+    "Centroid X µm": 6321.7,
+    "Centroid Y µm": 29009.6,
+    "Num Detections": 13221,
+    "Num Negative": 12961,
+    "Num Positive": 260,
+    "Positive %": 1.967,
+    "Num Positive per mm^2": 157.3
+  }
+}

742/InvasionFront_CD8_block19_x1_y11_patient742_0.json

@@ -0,0 +1,11 @@
+{
+  "patient_tma_measurements": {
+    "Centroid X µm": 3871.0,
+    "Centroid Y µm": 37024.6,
+    "Num Detections": 0,
+    "Num Negative": 0,
+    "Num Positive": 0,
+    "Positive %": NaN,
+    "Num Positive per mm^2": NaN
+  }
+}

742/InvasionFront_CD8_block19_x2_y11_patient742_1.json

@@ -0,0 +1,11 @@
+{
+  "patient_tma_measurements": {
+    "Centroid X µm": 6071.8,
+    "Centroid Y µm": 36905.5,
+    "Num Detections": 0,
+    "Num Negative": 0,
+    "Num Positive": 0,
+    "Positive %": NaN,
+    "Num Positive per mm^2": NaN
+  }
+}

742/TumorCenter_CD3_block19_x1_y11_patient742_0.json

@@ -0,0 +1,11 @@
+{
+  "patient_tma_measurements": {
+    "Centroid X µm": 6792.2,
+    "Centroid Y µm": 29203.8,
+    "Num Detections": 0,
+    "Num Negative": 0,
+    "Num Positive": 0,
+    "Positive %": NaN,
+    "Num Positive per mm^2": NaN
+  }
+}

742/TumorCenter_CD3_block19_x2_y11_patient742_1.json

@@ -0,0 +1,11 @@
+{
+  "patient_tma_measurements": {
+    "Centroid X µm": 9216.4,
+    "Centroid Y µm": 28849.1,
+    "Num Detections": 0,
+    "Num Negative": 0,
+    "Num Positive": 0,
+    "Positive %": NaN,
+    "Num Positive per mm^2": NaN
+  }
+}

742/TumorCenter_CD8_block19_x1_y11_patient742_0.json

@@ -0,0 +1,11 @@
+{
+  "patient_tma_measurements": {
+    "Centroid X µm": 6737.3,
+    "Centroid Y µm": 38439.4,
+    "Num Detections": 0,
+    "Num Negative": 0,
+    "Num Positive": 0,
+    "Positive %": NaN,
+    "Num Positive per mm^2": NaN
+  }
+}

742/TumorCenter_CD8_block19_x2_y11_patient742_1.json

@@ -0,0 +1,11 @@
+{
+  "patient_tma_measurements": {
+    "Centroid X µm": 9376.7,
+    "Centroid Y µm": 38533.9,
+    "Num Detections": 0,
+    "Num Negative": 0,
+    "Num Positive": 0,
+    "Positive %": NaN,
+    "Num Positive per mm^2": NaN
+  }
+}

742/history_text.txt

@@ -0,0 +1 @@
+The patient has been suffering from swallowing problems for months, alio loco a panendoscopy and sampling was performed. This revealed the above-mentioned laryngeal carcinoma, CT morphology showed a clear thyroid cartilage infiltration on the right side, hence the indication for the above-mentioned procedure.