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Abu-Abeid A, Yuval JB, Keidar A, Nizri E, Lahat G, Eldar SM. Technical Considerations in One Anastomosis Gastric Bypass-the Israeli Society of Metabolic and Bariatric Surgery Experience. Obes Surg 2024:10.1007/s11695-024-07223-3. [PMID: 38649670 DOI: 10.1007/s11695-024-07223-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Revised: 03/30/2024] [Accepted: 04/10/2024] [Indexed: 04/25/2024]
Abstract
BACKGROUND One anastomosis gastric bypass (OAGB) is gaining popularity worldwide due to its safety and effectiveness. OAGB is the most commonly performed metabolic bariatric surgery (MBS) in Israel. Israel is the only country where OAGB is the most prevalent MBS. Our aim is to address OAGB technical aspects using a national survey completed by members of the Israeli Society of Metabolic and Bariatric Surgery (ISMBS). MATERIALS AND METHODS An online-survey composed of a 17-item-based questionnaire was sent to ISMBS members. All responses were collected and analyzed. RESULTS A total of 47/64 (73.4%) ISMBS members participated in the survey. Most surgeons (74.5%) had > 10 years of MBS experience, and most (61.7%) performed > 100 MBS/year. The majority (78.7%) perform OAGB as their most common procedure. Most surgeons fashion a 10-15-cm pouch and use a 36-Fr bougie, (57.4% and 38.3%). Regarding bowel length measurement, 70% use visual estimation and 10.6% routinely measure total small bowel length (TSBL). The most common reasons for creating a longer biliopancreatic limb (BPL) were high body mass index (BMI) and revisional surgery (83.3% and 66%, respectively). In a primary procedure of a patient with a BMI = 40, most (76.6%) would create a 150-200-cm BPL. In patients with a BMI > 50 or revisional cases, most (70.2% and 68.0%) would create a 175-225-cm BPL. CONCLUSION OAGB is the most prevalent MBS performed in Israel. This survey showed common preferences and variations among ISMBS members. Further studies are needed in order to standardize and build a consensus on OAGB technique.
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Affiliation(s)
- Adam Abu-Abeid
- Division of General Surgery, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, 6 Weizman Street, 64230906, Tel Aviv, Israel.
| | - Jonathan Benjamin Yuval
- Division of General Surgery, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, 6 Weizman Street, 64230906, Tel Aviv, Israel
| | - Andrei Keidar
- Division of General Surgery, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, 6 Weizman Street, 64230906, Tel Aviv, Israel
| | - Eran Nizri
- Division of General Surgery, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, 6 Weizman Street, 64230906, Tel Aviv, Israel
| | - Guy Lahat
- Division of General Surgery, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, 6 Weizman Street, 64230906, Tel Aviv, Israel
| | - Shai Meron Eldar
- Division of General Surgery, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, 6 Weizman Street, 64230906, Tel Aviv, Israel
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Abu-Abeid A, Bendayan A, Yuval JB, Eldar SM, Lahat G, Lessing Y. Primary versus Revisional One Anastomosis Gastric Bypass - Outcomes of patients with at least eight-year follow-up. Obes Facts 2024:000538768. [PMID: 38593760 DOI: 10.1159/000538768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Accepted: 04/05/2024] [Indexed: 04/11/2024] Open
Abstract
BACKGROUND One anastomosis gastric bypass (OAGB) prevalence is increasing worldwide and shows good mid- to long-term results. Data on long-term outcomes of revisional OAGB (rOAGB) is limited. This study objective is to evaluate the long-term outcomes of patients undergoing primary OAGB (pOAGB) and rOAGB. METHODS A retrospective analysis of a prospectively maintained patient registry at a single-tertiary center. Patients undergoing OAGB from January 2015 to May 2016 were included and grouped to pOAGB and rOAGB. RESULTS There were 424 patients, of which 363 underwent pOAGB, and 61 underwent rOAGB. Baseline characteristics were insignificantly different between groups except for type 2 diabetes (T2D) rate which was higher in pOAGB (26% vs. 11.5%, p=0.01). The mean follow-up time was 98.5±3.9 months and long-term follow up data was available for 52.5% of patients. The mean total weight loss (TWL) was higher in the pOAGB group (31.3±14 vs. 24.1±17.6, p=0.006), however TWL was comparable when relating to the weight at primary surgery for rOAGB. The rate of T2D and hypertension resolution was 79% and 72.7% with no difference between groups. 13 patients (5.9%) underwent OAGB revision during follow-up, with no difference between groups. Two deaths occurred during follow-up, both non-related to OAGB. CONCLUSION OAGB is effective as a primary and as a revisional procedure for severe obesity with good long-term results in terms of weight loss and resolution of associated diseases. In addition, the revisional surgery rates and chronic complications are acceptable. Further large prospective studies are required to clarify this data.
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Goldstein AL, Nevo N, Nizri E, Shimonovich M, Maman Y, Pencovich N, Lahat G, Karin E. The Use of Inlay Bridge of the Posterior Fascia as Adjuvants to a Modified Rives-Stoppa Repair for Difficult Abdominal Wall Hernias. Am Surg 2023; 89:4616-4624. [PMID: 36069008 DOI: 10.1177/00031348221114027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Major abdominal wall defects remain a highly morbid complication. Occasionally a fascial defect is encountered, that despite all surgical efforts, is unable to completely approximate at the midline. Here we describe our method and outcomes of using a bridging mesh when the posterior fascia was unable to be approximated during the repair of large postoperative ventral hernias using the modified Rives-Stoppa technique. METHODS A retrospective review was conducted looking at all the open abdominal wall hernia repairs between 2014 and 2020. The cohort of patients who had a bridge placed in addition to the traditional open modified Rives-Stoppa repair were used for this study. RESULTS Nineteen patients had a mesh inlay bridge placed in addition to a modified Rives-Stoppa repair with a sublay (retrorectus) Ultrapro mesh. For the inlay mesh 13 Symbotex composite meshes were placed and 6 Vicryl meshes used. The average surface area of the defect was 358.1 cm^2. The average length of hospitalization was 8.8 days with a range of 3-24 days. During the immediate postoperative course there were 6 minor complications. During the follow-up period there were 2 recurrences. DISCUSSION The use of inlay mesh bridge as an adjuvant to a modified Rives-Stoppa repair with a sublay ultrapro mesh is an effective technique for difficult abdominal wall repairs where the posterior fascia is unable to be approximated without tension.
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Affiliation(s)
| | - Nadav Nevo
- Department of Surgery, Tel Aviv Medical Center, Ichilov Hospital, Tel Aviv, Israel
| | - Eran Nizri
- Department of Surgery, Tel Aviv Medical Center, Ichilov Hospital, Tel Aviv, Israel
| | - Michal Shimonovich
- Department of Surgery, Tel Aviv Medical Center, Ichilov Hospital, Tel Aviv, Israel
| | - Yossi Maman
- Department of Surgery, Tel Aviv Medical Center, Ichilov Hospital, Tel Aviv, Israel
| | - Niv Pencovich
- Department of Surgery B, Tel Hashomer (Sheba) Hospital, Ramat Gan, Israel
| | - Guy Lahat
- Department of Surgery, Tel Aviv Medical Center, Ichilov Hospital, Tel Aviv, Israel
| | - Eliad Karin
- Department of Surgery, Tel Aviv Medical Center, Ichilov Hospital, Tel Aviv, Israel
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Mor E, Schtrechman G, Nizri E, Shimonovitz M, Asher N, Ben-Betzalel G, Grynberg S, Stoff R, Miodovnik M, Adileh M, Ben-Yaacov A, Steinberg Y, Shapira R, Schachter J, Lahat G, Nissan A, Zippel D, Laks S. PET-CT underestimates the true pathological extent of disease at lymphadenectomy for melanoma patients after systemic therapy. Eur J Surg Oncol 2023; 49:106950. [PMID: 37301639 DOI: 10.1016/j.ejso.2023.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Revised: 05/20/2023] [Accepted: 06/05/2023] [Indexed: 06/12/2023]
Abstract
INTRODUCTION Modern systemic therapy has revolutionized the treatment of melanoma. Currently, patients with clinically involved lymph nodes require lymphadenectomy with associated morbidities. Positron Emission Tomography - Computed Tomography (PET-CT) has demonstrated accuracy in melanoma detection and response to therapy. We aimed to identify whether a PET-CT directed lymphatic resection after systemic therapy is oncologically sound. MATERIALS AND METHODS Retrospective review of patients who underwent lymphadenectomy after systemic therapy for melanoma with a preoperative PET-CT. Examined demographic, clinical, and perioperative parameters including extent of disease, systemic therapy and response, and PET-CT findings compared to pathological outcomes. We compared patients with "as or less than expected" outcomes on pathology against those with "more than expected" pathological outcomes. RESULTS Thirty-nine patients met inclusion criteria. In 28 (71.8%), pathological outcomes were "as or less than expected" by PET-CT, and in 11 (28.2%) pathological outcome were "more than expected". "More than expected" occurred more frequently with advanced disease at presentation with 75% presenting with regional/metastatic disease versus only 42.9% in the "as or less than expected" group (p = 0.015). Poor response to therapy also trended towards the "more than expected" group with only 27.3% favorable response versus 53.6% favorable response in the "as or less than expected" group, not statistically significant. Extent of disease on imaging failed to predict pathological concordance. CONCLUSION PET-CT underestimates pathological extent of disease in the lymphatic basin in 30% of patients after systemic therapy. We failed to identify predictors of more extensive disease and warn against limited PET-CT directed lymphatic resections.
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Affiliation(s)
- Eyal Mor
- Sheba Tel Hashomer Medical Center, Department of Surgery C and Surgical Oncology, Ramat Gan, Israel
| | - Gal Schtrechman
- Sheba Tel Hashomer Medical Center, Department of Surgery C and Surgical Oncology, Ramat Gan, Israel
| | - Eran Nizri
- Department of Surgery B, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Michal Shimonovitz
- Department of Surgery B, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Nethanel Asher
- Sheba Tel Hashomer Medical Center, Department of Oncology, Ramat Gan, Israel
| | - Guy Ben-Betzalel
- Sheba Tel Hashomer Medical Center, Department of Oncology, Ramat Gan, Israel
| | - Shirly Grynberg
- Sheba Tel Hashomer Medical Center, Department of Oncology, Ramat Gan, Israel
| | - Ronen Stoff
- Sheba Tel Hashomer Medical Center, Department of Oncology, Ramat Gan, Israel
| | - Mor Miodovnik
- Institute of Oncology, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Mohammad Adileh
- Sheba Tel Hashomer Medical Center, Department of Surgery C and Surgical Oncology, Ramat Gan, Israel
| | - Almog Ben-Yaacov
- Sheba Tel Hashomer Medical Center, Department of Surgery C and Surgical Oncology, Ramat Gan, Israel
| | - Yael Steinberg
- Sheba Tel Hashomer Medical Center, Department of Oncology, Ramat Gan, Israel
| | - Ronnie Shapira
- Sheba Tel Hashomer Medical Center, Department of Oncology, Ramat Gan, Israel
| | - Jacob Schachter
- Sheba Tel Hashomer Medical Center, Department of Oncology, Ramat Gan, Israel
| | - Guy Lahat
- Department of Surgery B, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Aviram Nissan
- Sheba Tel Hashomer Medical Center, Department of Surgery C and Surgical Oncology, Ramat Gan, Israel
| | - Douglas Zippel
- Sheba Tel Hashomer Medical Center, Department of Surgery C and Surgical Oncology, Ramat Gan, Israel
| | - Shachar Laks
- Sheba Tel Hashomer Medical Center, Department of Surgery C and Surgical Oncology, Ramat Gan, Israel.
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Osher E, Geva R, Wolf I, Tordjman K, Klausner J, Sofer Y, Scapa E, Shibolet O, Ben –Ami Shor D, Bar-Yishay I, Lubezky N, Goykhman Y, Lahat G, Yakir O, Pelles S, Aizic A, Blachar A, Stern N, Greenman Y. Dysglycemia in non-functioning pancreatic neuroendocrine tumors (NF-PNET): Further insights into an under recognized entity. J Clin Transl Endocrinol 2023; 33:100322. [PMID: 37663867 PMCID: PMC10470380 DOI: 10.1016/j.jcte.2023.100322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 07/23/2023] [Accepted: 08/13/2023] [Indexed: 09/05/2023] Open
Abstract
Objective Pancreatic neuroendocrine tumors (PNETs) are rare, but their incidence has risen significantly in recent years. Whereas diabetes mellitus (DM) is recognized in association with chronic pancreatitis and pancreatic cancer, it has not been well-characterized concerning non-functioning (NF)-PNETs.Study aim: to determine whether NF-PNETs are associated with DM/ Pre-DM and characterize the features of this putative association. Methods Retrospective study to evaluate rate of Pre-DM /DM in subjects with NF-PNETs. Results Study cohort of 129 patients with histologically confirmed NF-PNETs, ∼60% were men (M/F: 77/52). Abnormal glucose metabolism that preceded any treatment was seen in 70% of this cohort: overt DM in 34% and Pre-DM in 36% of the subjects. However, during follow-up, the overall prevalence rose to 80.6%, owing exclusively to newly diagnosed DM in subjects who received treatment.Patients with DM/Pre-DM were older (65 ± 11; 54 ± 14; p < 0.0001), the tumor was more commonly localized in the pancreatic body and tail (76.5% vs. 23.5% p = 0.03), while BMI (27 ± 6 vs. 28 ± 5 kg/m2), and tumor size (2.4 ± 2 vs. 2.9 ± 3.2 cm) were similar. The relative prevalence of DM in our cohort of NF-PNETs was 1.6 higher than that in the age and gender-adjusted general Israeli population (95 %CI: 1.197-2.212p = 0.03). Conclusions We found a high rate of impaired glucose metabolism, either DM or Pre-DM, in a large cohort of NF-PNETs. The high prevalence of diabetes/pre-diabetes was unrelated to obesity or tumor size. This observation should increase awareness of the presence of DM on presentation or during treatment of "NF"-PNETs.
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Affiliation(s)
- Esther Osher
- Institute of Endocrinology, Metabolism, and Hypertension, Tel Aviv-Sourasky Medical Center, Faculty of Medicine, Tel Aviv University, Israel
| | - Ravit Geva
- Department of Oncology, Tel Aviv-Sourasky Medical Center, Faculty of Medicine, Tel Aviv University, Israel
| | - Ido Wolf
- Department of Oncology, Tel Aviv-Sourasky Medical Center, Faculty of Medicine, Tel Aviv University, Israel
| | - Karen Tordjman
- Institute of Endocrinology, Metabolism, and Hypertension, Tel Aviv-Sourasky Medical Center, Faculty of Medicine, Tel Aviv University, Israel
| | - Joseph Klausner
- Department of Surgery, Tel Aviv-Sourasky Medical Center, Faculty of Medicine, Tel Aviv University, Israel
| | - Yael Sofer
- Institute of Endocrinology, Metabolism, and Hypertension, Tel Aviv-Sourasky Medical Center, Faculty of Medicine, Tel Aviv University, Israel
| | - Erez Scapa
- Department of Gastroenterology, Tel Aviv-Sourasky Medical Center, Faculty of Medicine, Tel Aviv University, Israel
| | - Oren Shibolet
- Department of Gastroenterology, Tel Aviv-Sourasky Medical Center, Faculty of Medicine, Tel Aviv University, Israel
| | - Dana Ben –Ami Shor
- Department of Gastroenterology, Tel Aviv-Sourasky Medical Center, Faculty of Medicine, Tel Aviv University, Israel
| | - Iddo Bar-Yishay
- Department of Gastroenterology, Tel Aviv-Sourasky Medical Center, Faculty of Medicine, Tel Aviv University, Israel
| | - Nir Lubezky
- Department of Surgery, Tel Aviv-Sourasky Medical Center, Faculty of Medicine, Tel Aviv University, Israel
| | - Yaacov Goykhman
- Department of Surgery, Tel Aviv-Sourasky Medical Center, Faculty of Medicine, Tel Aviv University, Israel
| | - Guy Lahat
- Department of Surgery, Tel Aviv-Sourasky Medical Center, Faculty of Medicine, Tel Aviv University, Israel
| | - Oz Yakir
- Department of Surgery, Tel Aviv-Sourasky Medical Center, Faculty of Medicine, Tel Aviv University, Israel
| | - Sharon Pelles
- Department of Oncology, Tel Aviv-Sourasky Medical Center, Faculty of Medicine, Tel Aviv University, Israel
| | - Asaf Aizic
- Institute of Pathology, Tel Aviv-Sourasky Medical Center, Faculty of Medicine, Tel Aviv University, Israel
| | - Arye Blachar
- Insitute of Radiology, Tel Aviv-Sourasky Medical Center, Faculty of Medicine, Tel Aviv University, Israel
| | - Naftali Stern
- Institute of Endocrinology, Metabolism, and Hypertension, Tel Aviv-Sourasky Medical Center, Faculty of Medicine, Tel Aviv University, Israel
| | - Yona Greenman
- Institute of Endocrinology, Metabolism, and Hypertension, Tel Aviv-Sourasky Medical Center, Faculty of Medicine, Tel Aviv University, Israel
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Dayan D, Kanani F, Bendayan A, Nizri E, Lahat G, Abu-Abeid A. The Effect of Revisional One Anastomosis Gastric Bypass After Sleeve Gastrectomy on Gastroesophageal Reflux Disease, Compared with Revisional Roux-en-Y Gastric Bypass: Symptoms and Quality of Life Outcomes. Obes Surg 2023; 33:2125-2131. [PMID: 37166738 DOI: 10.1007/s11695-023-06636-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 04/26/2023] [Accepted: 05/04/2023] [Indexed: 05/12/2023]
Abstract
BACKGROUND Gastroesophageal reflux disease (GERD) is common after sleeve gastrectomy (SG). We aimed to evaluate the effect of revisional one anastomosis gastric bypass (OAGB) on GERD, compared with revisional Roux-en-Y gastric bypass (RYGB) METHODS: A retrospective single-center study of a prospectively maintained patient registry (2018-2022). All patients with GERD undergoing OAGB and RYGB after SG were retrieved and included in the study. RESULTS Seventy-eight SG patients had conversion to OAGB (n=31) and RYGB (n=47). Baseline characteristics were similar except age (43.8±11.5 vs. 50.3±13.4 years; p=0.03), body mass index (39.9±8.8 vs. 30.6±6 kg/m2; p<0.001), time interval (8±2.7 vs. 6.4±3.4 years; p=0.01), and sleep apnea (29% vs 8.5%; p=0.01), respectively. There was no significant difference between groups in number of patients consuming proton pump inhibitors (70.1% vs. 72.3%; p=0.66), GERD-health-related quality of life (HRQL) score (9.6±7.2 vs. 13.1±8; p=0.06), and pathological endoscopic findings (48.4% vs. 46.8%; p=0.89). Major complication rates were 0% vs. 8.5% (p=0.09). At 32.4 months follow-up, total weight loss was 22%±12.9 and 4.4%±14.6 (p<0.001), GERD resolution 77.4% and 91.9% (p=0.03), HRQL scoring improved to 1.7±4.5 and 1.7±2.7; p=0.94 for OAGB and RYGB, respectively. CONCLUSIONS SG conversion to RYGB provides better chances for definitive treatment of GERD. OAGB results in good symptom resolution and improved quality of life and may be considered for post-SG GERD treatment. The most appropriate solution should be individualized to each patient.
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Affiliation(s)
- Danit Dayan
- Division of General Surgery, Tel Aviv Sourasky Medical Center, 6 Weizman Street, 64230906, Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Division of General Surgery, Bariatric Unit, Tel Aviv Sourasky Medical Center, Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Fahim Kanani
- Division of General Surgery, Tel Aviv Sourasky Medical Center, 6 Weizman Street, 64230906, Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Anat Bendayan
- Division of General Surgery, Tel Aviv Sourasky Medical Center, 6 Weizman Street, 64230906, Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eran Nizri
- Division of General Surgery, Tel Aviv Sourasky Medical Center, 6 Weizman Street, 64230906, Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Guy Lahat
- Division of General Surgery, Tel Aviv Sourasky Medical Center, 6 Weizman Street, 64230906, Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Division of General Surgery, Bariatric Unit, Tel Aviv Sourasky Medical Center, Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Adam Abu-Abeid
- Division of General Surgery, Tel Aviv Sourasky Medical Center, 6 Weizman Street, 64230906, Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
- Division of General Surgery, Bariatric Unit, Tel Aviv Sourasky Medical Center, Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
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Maman Y, Goykhman Y, Yakir O, Barenboim A, Geva R, Peles-Avraham S, Wolf I, Klausner JM, Lahat G, Lubezky N. Adjuvant FOLFIRINOX in Patients with Resectable Pancreatic Cancer Is Effective but Rarely Feasible in Real Life: Is Neoadjuvant FOLFIRINOX a Better Option? Cancers (Basel) 2023; 15:cancers15113049. [PMID: 37297011 DOI: 10.3390/cancers15113049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Revised: 05/30/2023] [Accepted: 06/01/2023] [Indexed: 06/12/2023] Open
Abstract
BACKGROUND The recommended treatment for resectable pancreatic cancer (PC) is resection followed by adjuvant FOLFIRINOX. We assessed the proportion of patients that managed to complete the 12 courses of adjuvant FOLFIRINOX and compared their outcome with that of patients with borderline resectable pancreatic cancer (BRPC) who underwent resection after neoadjuvant FOLFIRINOX. METHODS A retrospective analysis was performed on a prospectively maintained database of all PC patients who underwent resection with (2/2015-12/2021) or without (1/2018-12/2021) neoadjuvant therapy. RESULTS A total of 100 patients underwent upfront resection, and 51 patients with BRPC received neoadjuvant treatment. Only 46 resection patients started adjuvant FOLFIRINOX, and only 23 completed 12 courses. The main reasons for not starting/completing adjuvant therapy were poor tolerance and rapid recurrence. Significantly more patients in the neoadjuvant group received at least six FOLFIRINOX courses (80.4% vs. 31%, p < 0.001). Patients who completed at least 6 courses, either pre- or postoperatively, had better overall survival (p = 0.025) than those who did not. In spite of having more advanced disease, the neoadjuvant group had comparable overall survival (p = 0.062) regardless of the number of treatment courses. CONCLUSION Only a minority of patients (23%) undergoing upfront pancreatic resection completed the planned 12 courses of FOLFIRINOX. Patients who received neoadjuvant treatment were significantly more likely to receive at least six treatment courses. Patients receiving at least six courses had better overall survival than those who received fewer than six courses, regardless of the timing of treatment relative to surgery. Potential ways to increase chemotherapy adherence, such as administering treatment before surgery, should be considered.
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Affiliation(s)
- Yossi Maman
- Departments of Surgery, Tel-Aviv Medical Center, Sackler School of Medicine, The Nicholas and Elizabeth Cathedra of Experimental Surgery, Tel-Aviv University, Tel-Aviv 69978, Israel
| | - Yaacov Goykhman
- Departments of HPB and Transplant Surgery, Tel-Aviv Medical Center, Sackler School of Medicine, The Nicholas and Elizabeth Cathedra of Experimental Surgery, Tel-Aviv University, Tel-Aviv 69978, Israel
| | - Oz Yakir
- Departments of HPB and Transplant Surgery, Tel-Aviv Medical Center, Sackler School of Medicine, The Nicholas and Elizabeth Cathedra of Experimental Surgery, Tel-Aviv University, Tel-Aviv 69978, Israel
| | - Alex Barenboim
- Departments of Surgery, Tel-Aviv Medical Center, Sackler School of Medicine, The Nicholas and Elizabeth Cathedra of Experimental Surgery, Tel-Aviv University, Tel-Aviv 69978, Israel
| | - Ravit Geva
- Institute of Oncology, Tel-Aviv Medical Center, Sackler School of Medicine, The Nicholas and Elizabeth Cathedra of Experimental Surgery, Tel-Aviv University, Tel-Aviv 69978, Israel
| | - Sharon Peles-Avraham
- Institute of Oncology, Tel-Aviv Medical Center, Sackler School of Medicine, The Nicholas and Elizabeth Cathedra of Experimental Surgery, Tel-Aviv University, Tel-Aviv 69978, Israel
| | - Ido Wolf
- Institute of Oncology, Tel-Aviv Medical Center, Sackler School of Medicine, The Nicholas and Elizabeth Cathedra of Experimental Surgery, Tel-Aviv University, Tel-Aviv 69978, Israel
| | - Joseph M Klausner
- Departments of Surgery, Tel-Aviv Medical Center, Sackler School of Medicine, The Nicholas and Elizabeth Cathedra of Experimental Surgery, Tel-Aviv University, Tel-Aviv 69978, Israel
| | - Guy Lahat
- Departments of Surgery, Tel-Aviv Medical Center, Sackler School of Medicine, The Nicholas and Elizabeth Cathedra of Experimental Surgery, Tel-Aviv University, Tel-Aviv 69978, Israel
| | - Nir Lubezky
- Departments of HPB and Transplant Surgery, Tel-Aviv Medical Center, Sackler School of Medicine, The Nicholas and Elizabeth Cathedra of Experimental Surgery, Tel-Aviv University, Tel-Aviv 69978, Israel
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8
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Cohen SJ, Meyerovich G, Blank S, Ovdat E, Loewenstein S, Kania-Almog J, Cohen M, Lahat G, Klausner JM, Lubezky N. Microbiota transfer following liver surgery involves microbial extracellular vesicle migration that affects liver immunity. Hepatol Commun 2023; 7:02009842-202306010-00024. [PMID: 37255349 DOI: 10.1097/hc9.0000000000000164] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 04/02/2023] [Indexed: 06/01/2023] Open
Abstract
BACKGROUND Short-term perioperative administration of probiotics was shown to alleviate postoperative complications and promote liver recovery among patients undergoing resection for liver malignancy. The mechanisms by which probiotic bacteria effectively influence the gut microbiome composition during the perioperative time are controversial. Here, we aim to elucidate the short-term direct biological effect of probiotic microbiota-derived vesicles on host liver cells during the perioperative period. METHODS Probiotic-derived vesicles (pbMVs) were administered postoperatively. pbMVs were isolated and characterized from probiotics, mainly from the bacteria genus Lactobacillus, Bifidobacterium, and Lactococcus. Mice underwent bile duct ligation, sham laparotomy (SHAM), or 70% partial hepatectomy (70%PH). pbMVs were tracked in vivo, and intrahepatic cellular and molecular aspects were analyzed by flow cytometry and qRT-PCR techniques. Liver sinusoidal endothelial cells (LSECs) analysis for Vascular Cell Adhesion Molecule-1(VCAM-1) expression following pbMV stimulation of cultured liver non-parenchymal cells which had been activated by LPS. RESULTS The administered pbMV rapidly translocated to the liver after surgery. pbMV administrations following surgeries enhanced neutrophil clearance; there was a dramatic decline in the liver neutrophil-to-lymphocyte ratio Ly6G+/CD3+ and an increase in IL6 levels. pbMVs reduced intrahepatic VCAM1 and ICAM2 expression compared with control following SHAM and decrease in IL10 levels following 70%PH. The administration of pbMV improved liver regeneration 72 hours following surgical liver resection with a significant decrease in IL17 expression. pbMVs modulated VCAM-1 on liver sinusoidal endothelial cells in liver cell culture. CONCLUSIONS Our study findings provide mechanistic insights into the liver-gut axis following surgery and illustrate how probiotic vesicles can reduce adhesion molecule expression and affect immune cell invasion and liver immunity, resulting in improved liver recovery following hepatic surgery.
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Affiliation(s)
- Shmuel J Cohen
- Laboratory of the Immuno-HPB and Transplant Surgery, Department of HPB and Transplant Surgery, Tel-Aviv Sourasky Medical Center Affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- Department of HPB and Transplant Surgery, Tel-Aviv Sourasky Medical Center Affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Guy Meyerovich
- Laboratory of the Immuno-HPB and Transplant Surgery, Department of HPB and Transplant Surgery, Tel-Aviv Sourasky Medical Center Affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- Department of HPB and Transplant Surgery, Tel-Aviv Sourasky Medical Center Affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Simcha Blank
- Laboratory of the Immuno-HPB and Transplant Surgery, Department of HPB and Transplant Surgery, Tel-Aviv Sourasky Medical Center Affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Esther Ovdat
- Laboratory of the Immuno-HPB and Transplant Surgery, Department of HPB and Transplant Surgery, Tel-Aviv Sourasky Medical Center Affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- Department of HPB and Transplant Surgery, Tel-Aviv Sourasky Medical Center Affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Shelly Loewenstein
- Department of Surgery, Tel-Aviv Sourasky Medical Center Affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- Consultancy Services, Israel
| | - Juliane Kania-Almog
- Laboratory of the Immuno-HPB and Transplant Surgery, Department of HPB and Transplant Surgery, Tel-Aviv Sourasky Medical Center Affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | | | - Guy Lahat
- Department of Surgery, Tel-Aviv Sourasky Medical Center Affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Joseph M Klausner
- Department of Surgery, Tel-Aviv Sourasky Medical Center Affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Nir Lubezky
- Laboratory of the Immuno-HPB and Transplant Surgery, Department of HPB and Transplant Surgery, Tel-Aviv Sourasky Medical Center Affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- Department of HPB and Transplant Surgery, Tel-Aviv Sourasky Medical Center Affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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9
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Dayan D, Bendayan A, Nevo N, Nizri E, Lahat G, Abu-Abeid A. Comparison of One Anastomosis Gastric Bypass and Sleeve Gastrectomy for Revision of Laparoscopic Adjustable Gastric Banding: 5-Year Outcomes. Obes Surg 2023:10.1007/s11695-023-06588-1. [PMID: 37046172 DOI: 10.1007/s11695-023-06588-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 04/04/2023] [Accepted: 04/05/2023] [Indexed: 04/14/2023]
Abstract
PURPOSE Laparoscopic adjustable gastric banding (LAGB) is in continuous decline due to low effectiveness and high reoperation rates. This study aims to evaluate outcomes of converting LAGB to one anastomosis gastric bypass (OAGB) and sleeve gastrectomy (SG) for insufficient weight loss or weight regain. MATERIALS AND METHODS Retrospective comparative study, based on prospective registry database of a tertiary center (2012-2019). RESULTS In all, 276 LAGB patients were converted to OAGB (n = 125) and SG (n = 151). Body mass index (BMI) at revision was 41.3 ± 6.6 and 42.3 ± 9.6 kg/m2 (P = 0.34) in OAGB and SG patients, respectively. Time interval was longer in OAGB patients (p < 0.001). Major early complication rates were comparable (2.4% and 4%; p = 0.46). At 5-years, OAGB patients had lower BMI (31.9 vs. 34.5 kg/m2; p = 0.002), and a higher total weight loss (25.1% vs. 18.8%; p = 0.003), compared with SG patients. Resolution of type 2 diabetes was higher in OAGB patients (93.3% vs. 66.6%; p = 0.047), while resolution of hypertension was not significantly different (84.6% and 80.5%; p = 0.68). Revision due to delayed complications was required in five (4%) OAGB patients and nine (8.6%) SG patients (p = 0.14). CONCLUSION OAGB for revision after LAGB due to insufficient weight loss or weight regain is safe, and has better effectiveness in weight reduction and resolution of type 2 diabetes than SG.
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Affiliation(s)
- Danit Dayan
- Division of General Surgery, Tel Aviv Sourasky Medical Center, affiliated to Sackler Faculty of Medicine, Tel Aviv University, 6 Weizman Street, 64230906, Tel Aviv, Israel
- Division of General Surgery, Bariatric Unit, Tel Aviv Sourasky Medical Center, affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Anat Bendayan
- Division of General Surgery, Tel Aviv Sourasky Medical Center, affiliated to Sackler Faculty of Medicine, Tel Aviv University, 6 Weizman Street, 64230906, Tel Aviv, Israel
| | - Nadav Nevo
- Division of General Surgery, Tel Aviv Sourasky Medical Center, affiliated to Sackler Faculty of Medicine, Tel Aviv University, 6 Weizman Street, 64230906, Tel Aviv, Israel
| | - Eran Nizri
- Division of General Surgery, Tel Aviv Sourasky Medical Center, affiliated to Sackler Faculty of Medicine, Tel Aviv University, 6 Weizman Street, 64230906, Tel Aviv, Israel
| | - Guy Lahat
- Division of General Surgery, Tel Aviv Sourasky Medical Center, affiliated to Sackler Faculty of Medicine, Tel Aviv University, 6 Weizman Street, 64230906, Tel Aviv, Israel
- Division of General Surgery, Bariatric Unit, Tel Aviv Sourasky Medical Center, affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Adam Abu-Abeid
- Division of General Surgery, Tel Aviv Sourasky Medical Center, affiliated to Sackler Faculty of Medicine, Tel Aviv University, 6 Weizman Street, 64230906, Tel Aviv, Israel.
- Division of General Surgery, Bariatric Unit, Tel Aviv Sourasky Medical Center, affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
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10
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Nevo N, Lee Goldstein A, Bar-David S, Abu-Abeid A, Dayan D, Lahat G, Nizri E. Immunological effects of heated intraperitoneal chemotherapy can be augmented by thymosin α1. Int Immunopharmacol 2023; 116:109829. [PMID: 36758296 DOI: 10.1016/j.intimp.2023.109829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 01/22/2023] [Accepted: 01/25/2023] [Indexed: 02/10/2023]
Abstract
BACKGROUND Peritoneal metastases of colorectal carcinoma origin (PM-CRC) are treated by cytoreductive surgery and heated intraperitoneal chemotherapy (HIPEC). However, the majority of patients recur, calling for novel treatments. We explored the immunogenic changes induced by HIPEC and the possibility to use thymosin α1 (Tα1) as an immune-stimulatory agent. METHODS We used an experimental murine model of PM-CRC combined with mitomycin (MMC)-based HIPEC. We determined immune cell infiltration into tumor metastases after HIPEC administration by means of immunohistochemistry, and determined immunogenic cell death signals in tumor cells by real-time polymerase chain reaction. RESULTS Mice with PM-CRC treated by HIPEC had increased overall survival (OS) compared to sham-treated mice (median OS 22.8 vs 18.9 days, respectively; P < 0.001). HIPEC induced increased infiltration of CD4+, CD8+, CD68 + and CD20 + cells into omental and visceral metastases at a magnitude of 40-100 %. We searched for potential immune signals induced by HIPEC by determining its effects on known immunogenic cell death proteins (heat-shock protein [HSP]-70, HSP-90 and calreticulin). HIPEC significantly increased HSP-90 mRNA expression (2.37 ± 1.5 vs 1-fold change, P < 0.05). The OS of Tα1 treated mice significantly improved compared to HIPEC-treated mice (16.3 ± 0.8 vs 14.1 ± 0.6 days, respectively, P = 0.02) and vs sham (11.8 ± 0.8 days, P = 0.007). CONCLUSIONS HIPEC induced immunogenic changes that led to increased immune cell infiltration. These changes were further augmented by Tα1 treatment. Future studies aimed at optimizing Tα1 treatment should focus upon the immune response it evokes.
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Affiliation(s)
- Nadav Nevo
- Department of Surgery B, Weizman 6, Tel-Aviv 6423906, Israel; Laboratory of Surgical Oncology, Division of Surgery, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | | | - Shoshi Bar-David
- Laboratory of Surgical Oncology, Division of Surgery, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Adam Abu-Abeid
- Department of Surgery B, Weizman 6, Tel-Aviv 6423906, Israel
| | - Danit Dayan
- Department of Surgery B, Weizman 6, Tel-Aviv 6423906, Israel
| | - Guy Lahat
- Department of Surgery B, Weizman 6, Tel-Aviv 6423906, Israel; The Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Eran Nizri
- Department of Surgery B, Weizman 6, Tel-Aviv 6423906, Israel; The Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
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11
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Alon G, Geva R, Lahat G, Nizri E. ASO Author Reflections: HIPEC Immunogenic Changes Could be Further Exploited by Immunotherapy to Treat Peritoneal Metastases from Colorectal Cancer. Ann Surg Oncol 2023; 30:2664-2665. [PMID: 36807022 DOI: 10.1245/s10434-023-13254-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 02/05/2023] [Indexed: 02/19/2023]
Affiliation(s)
- Gilad Alon
- Peritoneal Surface Malignancy and Melanoma Unit, Department of Surgery A, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel.,Laboratory of Surgical Oncology, Division of Surgery, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Ravit Geva
- Institute of Oncology, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel.,Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Guy Lahat
- Peritoneal Surface Malignancy and Melanoma Unit, Department of Surgery A, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel.,Laboratory of Surgical Oncology, Division of Surgery, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel.,Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Eran Nizri
- Peritoneal Surface Malignancy and Melanoma Unit, Department of Surgery A, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel. .,Laboratory of Surgical Oncology, Division of Surgery, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel. .,Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
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12
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Dayan D, Dvir N, Nizri E, Abu-Abeid S, Lahat G, Abu-Abeid A. Safety of concomitant cholecystectomy during one anastomosis gastric bypass compared with sleeve gastrectomy and Roux-en-Y gastric bypass. Updates Surg 2023; 75:671-678. [PMID: 36790632 DOI: 10.1007/s13304-023-01463-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Accepted: 02/10/2023] [Indexed: 02/16/2023]
Abstract
Candidates of metabolic and bariatric surgery (MBS) are prone for gallstone formation. Concomitant cholecystectomy (CC) during MBS is controversial. This study is first to examine the safety of CC during one anastomosis gastric bypass (OAGB), compared with sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB). Single-center retrospective comparative study of CC (2012-2021) during OAGB, to SG and RYGB. CC was performed in 115 patients during OAGB (n = 50), SG (n = 39), and RYGB (n = 26). All procedures were completed laparoscopically. Baseline characteristics were similar except age, body mass index, gastroesophageal reflux disease, obstructive sleep apnea, and previous MBS (p < 0.05). Intraoperative complications occurred in one OAGB patient (2% vs. 0%, 0%; p = 0.52), which was not cholecystectomy related. There were no differences in total (6% vs. 2.6%, 15.4%; p = 0.13) and major (2% vs. 0%, 3.8; p = 0.50) early-complication rates. Of them, cholecystectomy-related complications occurred in one OAGB, compared with none of SG and one RYGB (2% vs. 0%, 3.8%; p = 0.50). The former was major, and the latter was minor complication. None of the OAGB patients needed re-admission (0% vs. 0%, 11.5; p = 0.04). All CC outcome parameters were similar between asymptomatic and symptomatic gallstones. Previous bariatric procedures were found to be a significant risk for major complications and readmissions (OR = 16.87, p = 0.019). CC during OAGB for gallstones seems safe, as in SG and RYGB. No cholecystectomy-related intraoperative complications occurred, and postoperative complication rates were low and acceptable. Outcomes for asymptomatic gallstones were similar to symptomatic ones, and we cautiously support CC in the presence of gallstones.
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Affiliation(s)
- Danit Dayan
- Division of General Surgery, Tel Aviv Sourasky Medical Center, affiliated to Sackler Faculty of Medicine, Tel Aviv University, 6, Weizman Street, 6423906, Tel Aviv, Israel.,Division of General Surgery, Bariatric Unit, Tel Aviv Sourasky Medical Center, affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Nadav Dvir
- Division of General Surgery, Tel Aviv Sourasky Medical Center, affiliated to Sackler Faculty of Medicine, Tel Aviv University, 6, Weizman Street, 6423906, Tel Aviv, Israel
| | - Eran Nizri
- Division of General Surgery, Tel Aviv Sourasky Medical Center, affiliated to Sackler Faculty of Medicine, Tel Aviv University, 6, Weizman Street, 6423906, Tel Aviv, Israel
| | - Subhi Abu-Abeid
- Division of General Surgery, Tel Aviv Sourasky Medical Center, affiliated to Sackler Faculty of Medicine, Tel Aviv University, 6, Weizman Street, 6423906, Tel Aviv, Israel.,Division of General Surgery, Bariatric Unit, Tel Aviv Sourasky Medical Center, affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Guy Lahat
- Division of General Surgery, Tel Aviv Sourasky Medical Center, affiliated to Sackler Faculty of Medicine, Tel Aviv University, 6, Weizman Street, 6423906, Tel Aviv, Israel.,Division of General Surgery, Bariatric Unit, Tel Aviv Sourasky Medical Center, affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Adam Abu-Abeid
- Division of General Surgery, Tel Aviv Sourasky Medical Center, affiliated to Sackler Faculty of Medicine, Tel Aviv University, 6, Weizman Street, 6423906, Tel Aviv, Israel. .,Division of General Surgery, Bariatric Unit, Tel Aviv Sourasky Medical Center, affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
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13
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Alon G, Bar-David S, Geva R, Lahat G, Nizri E. Harnessing the immunogenic effect of heated intraperitoneal chemotherapy by check point inhibitor to treat peritoneal metastases from colonic origin in an experimental murine model. European Journal of Surgical Oncology 2023. [DOI: 10.1016/j.ejso.2022.11.528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
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14
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Loewenstein S, Gerstenhaber F, Kalfon T, Leibou S, Sher O, Nizri E, Lahat G. New insights into the role of mesothelial cells in peritoneal metastasis. European Journal of Surgical Oncology 2023. [DOI: 10.1016/j.ejso.2022.11.540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
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15
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Geva R, Alon G, Nathanson M, Bar-David S, Nevo N, Aizic A, Peles-Avraham S, Lahat G, Nizri E. PD-1 Blockade Combined with Heated Intraperitoneal Chemotherapy Improves Outcome in Experimental Peritoneal Metastases from Colonic Origin in a Murine Model. Ann Surg Oncol 2023; 30:2657-2663. [PMID: 36595112 DOI: 10.1245/s10434-022-13025-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 12/13/2022] [Indexed: 01/04/2023]
Abstract
BACKGROUND Heated intraperitoneal chemotherapy (HIPEC) was shown to induce immunogenicity of peritoneal metastases from colorectal cancer (PM-CRC) by induction of immunogenic cell death. We aimed to explore whether the addition of a checkpoint inhibitor would augment the effect of HIPEC in an experimental murine model of PM-CRC. METHODS PM-CRC was established in C57BL mice by intraperitoneal inoculation of MC38 colon cancer cells. HIPEC was administered using the closed technique with mitomycin C (MMC). Clinical and immunological parameters were compared between animals treated with HIPEC alone and those treated with HIPEC + anti-programmed death receptor-1 (aPD-1). RESULTS MMC-based HIPEC increased the overall survival of animals compared with sham-treated animals (22.8; 95% confidence interval [CI] 21.14-24.53 vs. 18.9 days; 95% CI 17.6-20.3, p < 0.001). The extent of peritoneal disease as measured by the modified peritoneal carcinomatosis index was also reduced by HIPEC. This clinical benefit was accompanied by increased infiltration of CD8+, CD68+, and CD20+ cells into tumor metastases in HIPEC-treated animals compared with sham-treated animals. We identified heat shock protein (HSP) 90 as a potential immunogenic cell death protein whose expression is increased under HIPEC conditions (fold change: 2.37 ± 1.5 vs. 1 without HIPEC, p < 0.05). Combined HIPEC + PD-1 treatment ameliorated survival compared with HIPEC alone and sham treatment (24.66; 95% CI 20.13-29.2 vs. 19; 95% CI 15.85-22.14 and 14.33 days; 95% CI 9.6-19.04, respectively; p = 0.008). This clinical effect was accompanied by increased CD8+ tumor infiltration. CONCLUSIONS HIPEC induced the expression of immunogenic cell death signals that can support an anti-tumor immune response. This response can be further exploited by a checkpoint inhibitor.
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Affiliation(s)
- Ravit Geva
- Institute of Oncology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Gilad Alon
- Department of Surgery A, Peritoneal Surface Malignancy and Melanoma Unit, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Laboratory of Surgical Oncology, Division of Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Maya Nathanson
- Department of Surgery, Assaf Harofeh Medical Center, Zerifin, Israel
| | - Shoshi Bar-David
- Department of Surgery A, Peritoneal Surface Malignancy and Melanoma Unit, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Laboratory of Surgical Oncology, Division of Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Nadav Nevo
- Department of Surgery A, Peritoneal Surface Malignancy and Melanoma Unit, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Laboratory of Surgical Oncology, Division of Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Asaf Aizic
- Institute of Pathology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Sharon Peles-Avraham
- Institute of Oncology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Guy Lahat
- Department of Surgery A, Peritoneal Surface Malignancy and Melanoma Unit, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Laboratory of Surgical Oncology, Division of Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eran Nizri
- Department of Surgery A, Peritoneal Surface Malignancy and Melanoma Unit, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel. .,Laboratory of Surgical Oncology, Division of Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel. .,Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
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16
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Pines G, Ben-Ishay O, Hochstein D, Lahat G, Ohana G, Sebbag G, Kluger Y, Halvey A. The Israeli Surgical Oral Board Examination: Improved Objectivity Increases Knowledge Authenticity. Indian J Surg 2022; 84:269-274. [PMID: 35437339 PMCID: PMC9008620 DOI: 10.1007/s12262-022-03408-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 04/04/2022] [Indexed: 11/28/2022] Open
Abstract
The oral board examination in general surgery in Israel was recently revised aiming for improved objectivity and standardization. Herein, we describe the current exam model. Between 05/2018 and 11/2020, two exams per year were conducted with the current exam model. The examination consists of 12 stations, each focusing on a different field. Passing score is 80%. At the end of the examination, examiners and candidates complete a questionnaire regarding the examination’s process and quality (scale 1–5). A total of 142 residents attended six oral board examinations. Mean pass rate was 76.6 ± 9.5%. Questions with overall highest pass rates were acute-care surgery (86.6 ± 4.8%), foregut surgery (84.6 ± 7.6%), and colorectal surgery (84 ± 8.1%). Questions with the highest fail rates were surgical oncology (31.7 ± 13.3%) and abdominal-wall surgery (28.8 ± 16.9%). Examiners’ feedback scored highest the following: standardization of the exam (4.45 ± 0.63) and whether the presented cases reflect the daily work of an attending surgeon (4.35 ± 0.87). Candidates’ feedback scored highest the following: did the examiners treat you in an appropriate manner (4.08 ± 1.17). In conclusion, oral exams are challenging and bear limitations, but properly constructed exams allow good evaluation of the trainees’ thinking process and decision-making skills, without compromising exam’s integrity and standardization.
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Affiliation(s)
- Guy Pines
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
- Department of Thoracic Surgery, Kaplan Medical Center, Jerusalem, Israel
| | - Ofir Ben-Ishay
- Rambam Medical Center and the Technion Medical School, Haifa, Israel
| | - David Hochstein
- Rambam Medical Center and the Technion Medical School, Haifa, Israel
| | - Guy Lahat
- Tel Aviv Medical Center and Sakler Medical School, Tel Aviv, Israel
| | - Gil Ohana
- Barzilay Medical Center, Ashkelon and the Ben-Gurion University Medical School, Beer-Sheva, Israel
| | - Gilbert Sebbag
- Soroka Medical Center and the Ben-Gurion University Medical School, Beer-Sheva, Israel
| | - Yoram Kluger
- Rambam Medical Center and the Technion Medical School, Haifa, Israel
| | - Ariel Halvey
- Emeritus Professor of Surgery, Sakler Medical School, Tel Aviv, Israel
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17
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Nevo N, Pencovich N, Lessing Y, Lasmanovich R, Barnes S, Lahat G, Nachmany I, Klausner JM. Preoperative biopsy for suspected adenocarcinoma of the pancreatic head: yield and complications. Minerva Surg 2022; 77:118-123. [PMID: 34338453 DOI: 10.23736/s2724-5691.21.08719-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Histologic confirmation before pancreaticoduodenectomy (PD) for suspected pancreatic cancer is often performed. We assessed the yield of preoperative biopsy in these patients considering the associated complications. METHODS We retrospectively evaluated 216 patients that underwent PD for suspected carcinoma (CA) between 2012 and 2018. Post procedure complications and delay in surgery were assessed, as well as the postoperative diagnosis in relation to preoperative parameters. RESULTS Preoperative biopsy was performed in 142 patients (65.7%). Pathologic findings suggestive of CA were found in 106 (74.6%), while benign histology was found in 23 (16.1%), and non-diagnostic findings in 12 (8.4%). Seventy-four patients (34.3%) were operated without a preoperative biopsy. The time from diagnosis to surgery was significantly prolonged in those that underwent biopsy compared to patients that were taken straight to surgery (40±14 versus 18±15 days, P<0.001), and 18 patients (12.6%) suffered from clinically significant post procedure complications. Patients with a preoperative biopsy suggestive of CA, and those that were operated without a preoperative histologic confirmation had comparable rates of CA as a final pathological diagnosis (95.2% and 94.5%, respectively). Nevertheless, in patients with a benign or a non-diagnostic biopsy, the rates of pathologic diagnosis of CA were 69.6% and 73.6% respectively. Elevated levels of CA19-9 and a positive preoperative biopsy were associated with a final pathology of CA. CONCLUSIONS Preoperative histology is not uniformly required in patients with suspected pancreatic cancer. If preoperative biopsy is performed, benign histology does not rule out cancer but warrants additional evaluation prior to surgery.
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Affiliation(s)
- Nadav Nevo
- Division of Surgery, Department of General Surgery B, Tel-Aviv Sourasky Medical Center, The Nikolas and Elizabeth Shlezak Fund for Experimental Surgery, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Niv Pencovich
- Department of Surgery and Transplantation, Sheba Medical Center, Tel-Hashomer, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel -
| | - Yonatan Lessing
- Division of Surgery, Department of General Surgery B, Tel-Aviv Sourasky Medical Center, The Nikolas and Elizabeth Shlezak Fund for Experimental Surgery, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Rinat Lasmanovich
- Division of Surgery, Department of General Surgery B, Tel-Aviv Sourasky Medical Center, The Nikolas and Elizabeth Shlezak Fund for Experimental Surgery, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Sophie Barnes
- Department of Radiology, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Guy Lahat
- Division of Surgery, Department of General Surgery B, Tel-Aviv Sourasky Medical Center, The Nikolas and Elizabeth Shlezak Fund for Experimental Surgery, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Ido Nachmany
- Department of Surgery and Transplantation, Sheba Medical Center, Tel-Hashomer, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Joseph M Klausner
- Division of Surgery, Department of General Surgery B, Tel-Aviv Sourasky Medical Center, The Nikolas and Elizabeth Shlezak Fund for Experimental Surgery, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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18
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Nessim C, Raut CP, Callegaro D, Barretta F, Miceli R, Fairweather M, Blay JY, Strauss D, Rutkowski P, Ahuja N, Gonzalez R, Grignani G, Quagliuolo V, Stoeckle E, Lahat G, De Paoli A, Pillarisetty VG, Canter RJ, Mullen JT, Pennacchioli E, van Houdt W, Swallow CJ, Schrage Y, Cardona K, Fiore M, Gronchi A, Bagaria SP. Correction: ASO Visual Abstract: An Analysis of Differentiation Changes and Outcomes at the First Recurrence of Retroperitoneal Liposarcoma by the Transatlantic Australasian Retroperitoneal Sarcoma Working Group (TARPSWG). Ann Surg Oncol 2022. [DOI: 10.1245/s10434-022-11601-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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19
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Nessim C, Raut CP, Callegaro D, Barretta F, Miceli R, Fairweather M, Rutkowski P, Blay JY, Strauss D, Gonzalez R, Ahuja N, Grignani G, Quagliuolo V, Stoeckle E, De Paoli A, Pillarisetty VG, Swallow CJ, Bagaria SP, Canter RJ, Mullen JT, Schrage Y, Pennacchioli E, van Houdt W, Cardona K, Fiore M, Gronchi A, Lahat G. Correction to: Postoperative Morbidity After Resection of Recurrent Retroperitoneal Sarcoma: A Report from the Transatlantic Australasian RPS Working Group (TARPSWG). Ann Surg Oncol 2022; 29:10.1245/s10434-022-11602-4. [PMID: 35307809 DOI: 10.1245/s10434-022-11602-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2024]
Affiliation(s)
- Carolyn Nessim
- Department of Surgery, The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada.
| | - Chandrajit P Raut
- Department of Surgery, Brigham and Women's Hospital and Dana-Farber Cancer Institute, Boston, MA, USA
| | - Dario Callegaro
- Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Francesco Barretta
- Unit of Clinical Epidemiology and Trial Organization, Department of Applied Research and Technological Development, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Rosalba Miceli
- Unit of Clinical Epidemiology and Trial Organization, Department of Applied Research and Technological Development, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Mark Fairweather
- Department of Surgery, Brigham and Women's Hospital and Dana-Farber Cancer Institute, Boston, MA, USA
| | - Piotr Rutkowski
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Jean-Yves Blay
- Department of Medical Oncology, Center Léon Bérard Cancer Center, Lyon, France
| | - Dirk Strauss
- Department of Surgery, Royal Marsden Hospital NHS Foundation Trust, London, UK
| | | | - Nita Ahuja
- Department of Surgery, Yale School of Medicine, New Haven, CT, USA
| | - Giovanni Grignani
- Division of Medical Oncology, Candiolo Cancer Institute, FPO-IRCCS, Candiolo, TO, Italy
| | | | | | - Antonino De Paoli
- Department of Radiation Oncology, Centro di Riferimento Oncologico, Aviano, Italy
| | - Venu G Pillarisetty
- Department of Surgery, University of Washington School of Medicine, Seattle, WA, USA
| | - Carol J Swallow
- Department of Surgery, Mount Sinai Hospital and Princess Margaret Cancer Center, Toronto, Canada
| | | | | | - John T Mullen
- Department of Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Yvonne Schrage
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
- Department of Surgery, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Elisabetta Pennacchioli
- Division of Melanoma, Sarcomas and Rare Tumors, IEO, European Institute of Oncology, IRCCS, Milan, Italy
| | - Winan van Houdt
- Department of Surgery, Istituto Europeo di Oncologia, Milan, Italy
| | - Kenneth Cardona
- Department of Surgery, Winship Cancer Institute, Emory University School of Medicine, Atlanta, GA, USA
| | - Marco Fiore
- Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Alessandro Gronchi
- Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Guy Lahat
- Department of Surgery, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
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20
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Nessim C, Raut CP, Callegaro D, Barretta F, Miceli R, Fairweather M, Blay JY, Strauss D, Rutkowski P, Ahuja N, Gonzalez R, Grignani G, Quagliuolo V, Stoeckle E, Lahat G, De Paoli A, Pillarisetty VG, Canter RJ, Mullen JT, Pennacchioli E, van Houdt W, Swallow CJ, Schrage Y, Cardona K, Fiore M, Gronchi A, Bagaria SP. Correction to: Analysis of Differentiation Changes and Outcomes at Time of First Recurrence of Retroperitoneal Liposarcoma by Transatlantic Australasian Retroperitoneal Sarcoma Working Group (TARPSWG). Ann Surg Oncol 2022; 29:10.1245/s10434-022-11600-6. [PMID: 35307808 DOI: 10.1245/s10434-022-11600-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2024]
Affiliation(s)
- Carolyn Nessim
- Department of Surgery, The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada.
| | - Chandrajit P Raut
- Department of Surgery, Brigham and Women's Hospital and Dana-Farber Cancer Institute, Boston, MA, USA
| | - Dario Callegaro
- Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Francesco Barretta
- Department of Applied Research and Technological Development, Unit of Clinical Epidemiology and Trial Organization, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Rosalba Miceli
- Department of Applied Research and Technological Development, Unit of Clinical Epidemiology and Trial Organization, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Mark Fairweather
- Department of Surgery, Brigham and Women's Hospital and Dana-Farber Cancer Institute, Boston, MA, USA
| | - Jean-Yves Blay
- Department of Medical Oncology, Center Léon Bérard Cancer Center, Lyon, France
| | - Dirk Strauss
- Department of Surgery, Royal Marsden Hospital NHS Foundation Trust, London, UK
| | - Piotr Rutkowski
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Nita Ahuja
- Department of Surgery, Yale School of Medicine, New Haven, CT, USA
- John Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Giovanni Grignani
- Division of Medical Oncology, Candiolo Cancer Institute, FPO-IRCCS, Candiolo, TO, Italy
| | | | | | - Guy Lahat
- Department of Surgery, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Antonino De Paoli
- Department of Radiation Oncology, Centro di Riferimento Oncologico, Aviano, Italy
| | - Venu G Pillarisetty
- Department of Surgery, University of Washington School of Medicine, Seattle, WA, USA
| | | | - John T Mullen
- Department of Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Elisabetta Pennacchioli
- Division of Melanoma, Sarcomas and Rare Tumors, IEO, European Institute of Oncology, IRCCS, Milan, Italy
| | - Winan van Houdt
- Department of Surgery, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Carol J Swallow
- Department of Surgery, Mount Sinai Hospital and Princess Margaret Cancer Center, Toronto, Canada
| | - Yvonne Schrage
- Department of Surgery, Netherlands Cancer Institute, Amsterdam, The Netherlands
- Department of Surgery, Mount Sinai Hospital and Princess Margaret Cancer Center, Toronto, Canada
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Kenneth Cardona
- Department of Surgery, Winship Cancer Institute, Emory University School of Medicine, Atlanta, GA, USA
| | - Marco Fiore
- Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Alessandro Gronchi
- Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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21
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Nizri E, Berger Y, Green E, Matan Kyzer, Aizic A, Nevo N, Gerstenhaber F, Klausner JM, Gutman M, Lahat G, Hoffman A, Geva R. ASO Visual Abstract: Lymph Node Metastases from Visceral Peritoneal Colorectal Metastases are Associated with Systemic Recurrence. Ann Surg Oncol 2021. [PMID: 34812986 DOI: 10.1245/s10434-021-10966-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Eran Nizri
- Department of Surgery A, Peritoneal Surface Malignancy and Melanoma Unit, Tel-Aviv Sourasky Medical Center, 6 Weizman Street, 6423906, Tel-Aviv, Israel. .,The Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
| | - Yaniv Berger
- The Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Department of Surgery B, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Eraan Green
- Department of Surgery A, Peritoneal Surface Malignancy and Melanoma Unit, Tel-Aviv Sourasky Medical Center, 6 Weizman Street, 6423906, Tel-Aviv, Israel
| | - Matan Kyzer
- The Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Department of Surgery B, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Asaf Aizic
- Institute of Pathology, Tel- Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Nadav Nevo
- Department of Surgery A, Peritoneal Surface Malignancy and Melanoma Unit, Tel-Aviv Sourasky Medical Center, 6 Weizman Street, 6423906, Tel-Aviv, Israel
| | - Fabian Gerstenhaber
- Department of Surgery A, Peritoneal Surface Malignancy and Melanoma Unit, Tel-Aviv Sourasky Medical Center, 6 Weizman Street, 6423906, Tel-Aviv, Israel
| | - Joseph M Klausner
- Department of Surgery A, Peritoneal Surface Malignancy and Melanoma Unit, Tel-Aviv Sourasky Medical Center, 6 Weizman Street, 6423906, Tel-Aviv, Israel.,The Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Mordechai Gutman
- The Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Department of Surgery B, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Guy Lahat
- Department of Surgery A, Peritoneal Surface Malignancy and Melanoma Unit, Tel-Aviv Sourasky Medical Center, 6 Weizman Street, 6423906, Tel-Aviv, Israel.,The Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Aviad Hoffman
- Department of General Surgery, Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Ravit Geva
- The Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Oncology Division, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
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22
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Nizri E, Berger Y, Green E, Kyzer M, Aizic A, Nevo N, Gerstenhaber F, Klausner JM, Gutman M, Lahat G, Hoffman A, Geva R. Lymph Node Metastases from Visceral Peritoneal Colorectal Metastases are Associated with Systemic Recurrence. Ann Surg Oncol 2021; 29:2069-2075. [PMID: 34622371 DOI: 10.1245/s10434-021-10869-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 09/13/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND Visceral peritoneal colorectal metastases (VPCMs) may further metastasize to lymph nodes that drain those organs. The rate of lymph node metastases (LNMs) from VPCMs and their clinical and prognostic significance are unknown. METHODS This study retrospectively analyzed the authors' institutional databases of 160 patients with peritoneal colorectal metastases who underwent cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. Patients with LNM-VPCM (n = 12) were identified by pathologic reports, and both their short- and long-term outcomes were compared with those of patients without LNM-VPCM. RESULTS The clinical presentation and primary tumor pathologic characteristics did not differ between the two groups. The patients with LNM-VPCM had a higher tumor burden (measured by the peritoneal carcinomatosis index [PCI]) and visible remnant disease compared with those who had no LNM-VPI (10 vs 5.5 [p = 0.03] vs 33.3% vs 6.8% [p = 0.007], respectively). The postoperative outcomes also were comparable. The patients with LNM-VPCM had a shorter overall survival (OS) than those without LNM-VPCM (median OS, 22.5 months; 95% confidence interval [CI], 15.1-29.9 months vs 40.1 months; 95% CI, 38.1-42 months; p = 0.02). However, only tumor grade and PCI were predictors of OS in the multivariate analysis (hazard ratio [HR], 2.33 [p = 0.001]; 1.77 [p = 0.03], respectively). The study showed that LNM-VPCM was associated with systemic but not peritoneal recurrence compared with non-LNM-VPCM (81.8% vs 51.6% for systemic recurrence, respectively; p = 0.05). CONCLUSION The small distinct group of patients defined by LNM-VPCM were prone to systemic recurrence. Given its correlation with systemic recurrence, LNM-VPCM may indicate the need for adjuvant treatment.
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Affiliation(s)
- Eran Nizri
- Peritoneal Surface Malignancy and Melanoma Unit, Department of Surgery A, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel. .,The Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
| | - Yaniv Berger
- The Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Department of Surgery B, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Eraan Green
- Peritoneal Surface Malignancy and Melanoma Unit, Department of Surgery A, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Matan Kyzer
- The Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Department of Surgery B, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Asaf Aizic
- Institute of Pathology, Tel- Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Nadav Nevo
- Peritoneal Surface Malignancy and Melanoma Unit, Department of Surgery A, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Fabian Gerstenhaber
- Peritoneal Surface Malignancy and Melanoma Unit, Department of Surgery A, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Joseph M Klausner
- Peritoneal Surface Malignancy and Melanoma Unit, Department of Surgery A, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel.,The Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Mordechai Gutman
- The Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Department of Surgery B, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Guy Lahat
- Peritoneal Surface Malignancy and Melanoma Unit, Department of Surgery A, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel.,The Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Aviad Hoffman
- Department of General Surgery, Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Ravit Geva
- The Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Oncology Division, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
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23
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Shnell M, Nevo N, Lahat G, Abu-Abeid S, Goldstein AL, Fishman S, Eldar SM. Endoscopic Management of Sleeve Stenosis. Obes Surg 2021; 31:4749-4753. [PMID: 34426909 DOI: 10.1007/s11695-021-05613-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 07/14/2021] [Accepted: 07/20/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE Sleeve gastrectomy is one of the most popular bariatric procedures performed. A complication of this surgery is sleeve stenosis, causing significant morbidity and the need for corrective intervention. Endoscopic treatment using pneumatic dilation has evolved as an effective, and minimally invasive, technique to successfully treat this complication. Here we report our experience with endoscopic management of sleeve stenosis at a tertiary bariatric center. MATERIAL AND METHODS We identified all patients that underwent endoscopic management of sleeve stenosis at a tertiary bariatric center from 2010. We reviewed patient demographics, operative data, interval to endoscopic treatment, and outcomes of pneumatic dilations. RESULTS Sixty seven patients underwent 130 endoscopic dilations. The majority of these patients were female (71%), and at the time of sleeve gastrectomy average age was 43.3 years (range 18-68 years) and average BMI was 41.5 kg/m2 (range 31-63 kg/m2). The time interval to first endoscopic procedure was 7.2 months (range 0.75-53 months), with an average of 2 procedures per patient. During the follow-up period, the success rate of endoscopic dilatation was 76.1%, while the remaining 16 patients underwent conversion to gastric bypass. Two patients underwent emergency conversion to gastric bypass for sleeve perforation during the procedure (1.5%). There was a modest weight gain of 3 kg (4.2% total body weight) after sleeve dilatation. CONCLUSIONS Endoscopic management of sleeve stenosis is safe and effective, with a success rate of over 75%. During endoscopic management, there was a 1.5% risk of sleeve perforation requiring emergency surgery. Mild weight regain occurred following endoscopic sleeve dilation.
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Affiliation(s)
- Mati Shnell
- Department of Gastroenterology and Liver Diseases, Tel Aviv Sourasky Medical Center, affiliated with Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Nadav Nevo
- Department of Surgery, Tel Aviv Sourasky Medical Center, affiliated with Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Guy Lahat
- Department of Surgery, Tel Aviv Sourasky Medical Center, affiliated with Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Subhi Abu-Abeid
- Department of Surgery, Tel Aviv Sourasky Medical Center, affiliated with Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Adam L Goldstein
- Department of Surgery, Tel Aviv Sourasky Medical Center, affiliated with Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Sigal Fishman
- Department of Gastroenterology and Liver Diseases, Tel Aviv Sourasky Medical Center, affiliated with Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shai Meron Eldar
- Department of Surgery, Tel Aviv Sourasky Medical Center, affiliated with Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
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24
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Kuten J, Levine C, Shamni O, Pelles S, Wolf I, Lahat G, Mishani E, Even-Sapir E. Head-to-head comparison of [ 68Ga]Ga-FAPI-04 and [ 18F]-FDG PET/CT in evaluating the extent of disease in gastric adenocarcinoma. Eur J Nucl Med Mol Imaging 2021; 49:743-750. [PMID: 34302504 PMCID: PMC8803763 DOI: 10.1007/s00259-021-05494-x] [Citation(s) in RCA: 53] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Accepted: 07/08/2021] [Indexed: 12/31/2022]
Abstract
BACKGROUND [18F]-Fluorodeoxyglucose (FDG) positron emission tomography-computed tomography (PET/CT) may sometimes be suboptimal for imaging gastric adenocarcinoma. The recently introduced [68Ga]Ga-FAPI-04 (FAPI) PET/CT targets tumor stroma and has shown considerable potential in evaluating the extent of disease in a variety of tumors. METHODS We performed a head-to-head prospective comparison of FAPI and FDG PET/CT in the same group of 13 patients with gastric adenocarcinoma who presented for either initial staging (n = 10) or restaging (n = 3) of disease. Lesion detection and maximum standardized uptake value (SUVmax) were compared between the two types of radiotracers. RESULTS All ten primary gastric tumors were FAPI-positive (100% detection rate), whereas only five were also FDG-positive (50%). SUVmax was not significantly different, but the tumor-to-background ratio was higher for FAPI (mean, median, and range of 4.5, 3.2, and 0.8-9.7 for FDG and 12.9, 11.9, and 2.2-23.9 for FAPI, P = 0.007). The level of detection of regional lymph node involvement was comparable. FAPI showed a superior detection rate for peritoneal carcinomatosis (100% vs. none). Two patients with widespread peritoneal carcinomatosis underwent a follow-up FAPI scan after chemotherapy: one showed partial remission and the other showed progressive disease. CONCLUSIONS The findings of this pilot study suggest that FAPI PET/CT outperforms FDG PET/CT in detecting both primary gastric adenocarcinoma and peritoneal carcinomatosis from gastric cancer. FAPI PET/CT also shows promise for monitoring response to treatment in patients with peritoneal carcinomatosis from gastric cancer; however, larger trials are needed to validate these preliminary findings.
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Affiliation(s)
- Jonathan Kuten
- Department of Nuclear Medicine, Tel Aviv Medical Center, affiliated to the Sackler School of Medicine, Tel Aviv University, 6 Weizmann St, 6423906 Tel Aviv, Israel
| | - Charles Levine
- Department of Nuclear Medicine, Tel Aviv Medical Center, affiliated to the Sackler School of Medicine, Tel Aviv University, 6 Weizmann St, 6423906 Tel Aviv, Israel
| | - Ofer Shamni
- Cyclotron Radiochemistry Unit, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Sharon Pelles
- Division of Oncology, Tel Aviv Medical Center, affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ido Wolf
- Division of Oncology, Tel Aviv Medical Center, affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Guy Lahat
- Department of Surgery, Tel Aviv Medical Center, affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eyal Mishani
- Cyclotron Radiochemistry Unit, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Einat Even-Sapir
- Department of Nuclear Medicine, Tel Aviv Medical Center, affiliated to the Sackler School of Medicine, Tel Aviv University, 6 Weizmann St, 6423906 Tel Aviv, Israel
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25
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Nessim C, Raut CP, Callegaro D, Barretta F, Miceli R, Fairweather M, Blay JY, Strauss D, Rutkowski P, Ahuja N, Gonzalez R, Grignani G, Quagliuolo V, Stoeckle E, Lahat G, De Paoli A, Pillarisetty VG, Canter RJ, Mullen JT, Pennacchioli E, van Houdt W, Swallow CJ, Schrage Y, Cardona K, Fiore M, Gronchi A, Bagaria SP. ASO Visual Abstract: An Analysis of Differentiation Changes and Outcomes at the First Recurrence of Retroperitoneal Liposarcoma by the Transatlantic Australasian Retroperitoneal Sarcoma Working Group (TARPSWG). Ann Surg Oncol 2021. [PMID: 34148160 DOI: 10.1245/s10434-021-10095-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Carolyn Nessim
- Department of Surgery, The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada.
| | - Chandrajit P Raut
- Department of Surgery, Brigham and Women's Hospital and Dana-Farber Cancer Institute, Boston, MA, USA
| | - Dario Callegaro
- Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Francesco Barretta
- Department of Applied Research and Technological Development, Unit of Clinical Epidemiology and Trial Organization, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Rosalba Miceli
- Department of Applied Research and Technological Development, Unit of Clinical Epidemiology and Trial Organization, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Mark Fairweather
- Department of Surgery, Brigham and Women's Hospital and Dana-Farber Cancer Institute, Boston, MA, USA
| | - Jean-Yves Blay
- Department of Medical Oncology, Center Léon Bérard Cancer Center, Lyon, France
| | - Dirk Strauss
- Department of Surgery, Royal Marsden Hospital NHS Foundation Trust, London, United Kingdom
| | - Piotr Rutkowski
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Nita Ahuja
- Department of Surgery, Yale School of Medicine, New Haven, CT, USA.,John Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Giovanni Grignani
- Division of Medical Oncology, Candiolo Cancer Institute, FPO-IRCCS, Candiolo, TO, Italy
| | | | | | - Guy Lahat
- Department of Surgery, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Antonino De Paoli
- Department of Radiation Oncology, Centro di Riferimento Oncologico, Aviano, Italy
| | - Venu G Pillarisetty
- Department of Surgery, University of Washington School of Medicine, Seattle, WA, USA
| | | | - John T Mullen
- Department of Surgery, Massachusetts General Hospital, Boston, MA, USA
| | | | - Winan van Houdt
- Department of Surgery, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Carol J Swallow
- Department of Surgery, Mount Sinai Hospital and Princess Margaret Cancer Center, Toronto, Canada
| | - Yvonne Schrage
- Department of Surgery, Netherlands Cancer Institute, Amsterdam, The Netherlands.,Department of Surgery, Mount Sinai Hospital and Princess Margaret Cancer Center, Toronto, Canada.,Department of Surgery, Leiden University Medical Center, Leiden, Netherlands
| | - Kenneth Cardona
- Department of Surgery, Winship Cancer Institute, Emory University School of Medicine, Atlanta, GA, USA
| | - Marco Fiore
- Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Alessandro Gronchi
- Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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26
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Lahat G, Gronchi A, Raut CP, Nessim C. ASO Author Reflections: Selecting Patients for Recurrent Retroperitoneal Sarcoma Surgery: The Challenging Trade-Off Between Oncologic Outcome and Morbidity. Ann Surg Oncol 2021; 28:852-853. [PMID: 33954869 DOI: 10.1245/s10434-021-10067-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 04/10/2021] [Indexed: 11/18/2022]
Affiliation(s)
- Guy Lahat
- Department of Surgery, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Alessandro Gronchi
- Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Chandrajit P Raut
- Department of Surgery, Brigham and Women's Hospital and Dana-Farber Cancer Institute, Boston, MA, USA
| | - Carolyn Nessim
- Department of Surgery, The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada.
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27
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Nessim C, Raut CP, Callegaro D, Barretta F, Miceli R, Fairweather M, Blay JY, Strauss D, Rutkowski P, Ahuja N, Gonzalez R, Grignani G, Quagliuolo V, Stoeckle E, Lahat G, De Paoli A, Pillarisetty VG, Canter RJ, Mullen JT, Pennacchioli E, van Houdt W, Swallow CJ, Schrage Y, Cardona K, Fiore M, Gronchi A, Bagaria SP. Analysis of Differentiation Changes and Outcomes at Time of First Recurrence of Retroperitoneal Liposarcoma by Transatlantic Australasian Retroperitoneal Sarcoma Working Group (TARPSWG). Ann Surg Oncol 2021; 28:7854-7863. [PMID: 33907921 DOI: 10.1245/s10434-021-10024-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 04/03/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND Local recurrence following resection of retroperitoneal liposarcoma (RLPS) is common. Well-differentiated (WD) and dedifferentiated (DD) RLPS are distinct entities with differing outcomes. A few reports suggest that WDLPS can recur as DDLPS and that DDLPS can recur as WDLPS. This study evaluates whether this change in differentiation from the primary tumor to the first local recurrence impacts long-term outcomes. METHODS Retrospective review from 22 sarcoma centers identified consecutive patients who underwent resection for a first locally recurrent RLPS from January 2002 to December 2011. Outcomes measured included overall survival, local recurrence, and distant metastasis. RESULTS A total of 421 RPLS patients were identified. Of the 230 patients with primary DDLPS, 34 (15%) presented WDLPS upon recurrence (DD → WD); and of the 191 patients with primary WDLPS, 54 (28%) presented DDLPS upon recurrence (WD → DD). The 6-year overall survival probabilities (95% CI) for DD → DD, DD → WD, WD → WD, and WD → DD were 40% (32-48%), 73% (58-92%), 76% (68-85%), and 56% (43-73%) (p < 0.001), respectively. The 6-year second local recurrence incidence was 66% (59-73%), 63% (48-82%), 66% (57-76%), and 77% (66-90%), respectively. The 6-year distant metastasis incidence was 13% (9-19%), 3% (0.4-22%), 5% (2-11%), and 4% (1-16%), respectively. On multivariable analysis, DD → WD was associated with improved overall survival when compared with DD → DD (p < 0.001). Moreover, WD → DD was associated with a higher risk of LR (p = 0.025) CONCLUSION: A change in RLPS differentiation from primary tumor to first local recurrence appears to impact survival. These findings may be useful in counseling patients on their prognosis and subsequent management.
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Affiliation(s)
- Carolyn Nessim
- Department of Surgery, The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada.
| | - Chandrajit P Raut
- Department of Surgery, Brigham and Women's Hospital and Dana-Farber Cancer Institute, Boston, MA, USA
| | - Dario Callegaro
- Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Francesco Barretta
- Department of Applied Research and Technological Development, Unit of Clinical Epidemiology and Trial Organization, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Rosalba Miceli
- Department of Applied Research and Technological Development, Unit of Clinical Epidemiology and Trial Organization, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Mark Fairweather
- Department of Surgery, Brigham and Women's Hospital and Dana-Farber Cancer Institute, Boston, MA, USA
| | - Jean-Yves Blay
- Department of Medical Oncology, Center Léon Bérard Cancer Center, Lyon, France
| | - Dirk Strauss
- Department of Surgery, Royal Marsden Hospital NHS Foundation Trust, London, UK
| | - Piotr Rutkowski
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Nita Ahuja
- Department of Surgery, Yale School of Medicine, New Haven, CT, USA.,John Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Giovanni Grignani
- Division of Medical Oncology, Candiolo Cancer Institute, FPO-IRCCS, Candiolo, TO, Italy
| | | | | | - Guy Lahat
- Department of Surgery, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Antonino De Paoli
- Department of Radiation Oncology, Centro di Riferimento Oncologico, Aviano, Italy
| | - Venu G Pillarisetty
- Department of Surgery, University of Washington School of Medicine, Seattle, WA, USA
| | | | - John T Mullen
- Department of Surgery, Massachusetts General Hospital, Boston, MA, USA
| | | | - Winan van Houdt
- Department of Surgery, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Carol J Swallow
- Department of Surgery, Mount Sinai Hospital and Princess Margaret Cancer Center, Toronto, Canada
| | - Yvonne Schrage
- Department of Surgery, Netherlands Cancer Institute, Amsterdam, The Netherlands.,Department of Surgery, Mount Sinai Hospital and Princess Margaret Cancer Center, Toronto, Canada.,Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Kenneth Cardona
- Department of Surgery, Winship Cancer Institute, Emory University School of Medicine, Atlanta, GA, USA
| | - Marco Fiore
- Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Alessandro Gronchi
- Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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Maman Y, Lee Goldstein A, Neeman U, Lessing Y, Orbach L, Sirhan S, Falk E, Lahat G. The Impact of the COVID-19 Pandemic on an Israeli Acute Care Surgery Unit: Fewer Patients, More Disease. Am Surg 2021; 88:2863-2870. [PMID: 33856956 DOI: 10.1177/00031348211011132] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND The COVID-19 pandemic has transformed and affected every aspect of health care. Like any catastrophic event, the stress on hospitals to maintain a certain level of function is immense. Acute surgical pathologies cannot be prevented or curtailed; therefore, it is important to understand patterns and outcomes during catastrophes in order to optimize care and organize the health care system. METHODS In a single urban tertiary care center, a retrospective study examined the first complete lockdown period of Israel during the COVID-19 pandemic. This was compared to the same time period the previous year. RESULTS During the pandemic, time to hospitalization was significantly decreased. There was also an overall reduction in surgical admissions yet with a higher percentage being hospitalized for further treatment (69.2% vs 23.5%). The patients admitted during this time had a higher APACHE-II score and Charlson comorbidity index score. During the pandemic, time to surgery was decreased, there were less laparoscopic procedures, and more RBC units were used per patient. There were no differences in overall complications, except when sub-analyzed for major complications (9.7% vs 6.3%). There was no significant difference in overall in-house mortality or morbidity. Length of hospitalization was significantly decreased in the elderly population during the pandemic. CONCLUSION During the COVID-19 pandemic, despite a significantly less number of patients presenting to the hospital, there was a higher percentage of those admitted needing surgical intervention, and they were overall sicker than the previous year.
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Affiliation(s)
- Yossi Maman
- Department of General Surgery, 26738Tel-Aviv Sourasky Medical Center, Ichilov Hospital, Tel. Aviv, Israel
| | | | - Uri Neeman
- Department of General Surgery, 26738Tel-Aviv Sourasky Medical Center, Ichilov Hospital, Tel. Aviv, Israel
| | - Yonatan Lessing
- Department of General Surgery, 26738Tel-Aviv Sourasky Medical Center, Ichilov Hospital, Tel. Aviv, Israel
| | - Lior Orbach
- Department of General Surgery, 26738Tel-Aviv Sourasky Medical Center, Ichilov Hospital, Tel. Aviv, Israel
| | - Saad Sirhan
- Department of General Surgery, 26738Tel-Aviv Sourasky Medical Center, Ichilov Hospital, Tel. Aviv, Israel
| | - Ela Falk
- Department of General Surgery, 26738Tel-Aviv Sourasky Medical Center, Ichilov Hospital, Tel. Aviv, Israel
| | - Guy Lahat
- Department of General Surgery, 26738Tel-Aviv Sourasky Medical Center, Ichilov Hospital, Tel. Aviv, Israel
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Nessim C, Raut CP, Callegaro D, Barretta F, Miceli R, Fairweather M, Rutkowski P, Blay JY, Strauss D, Gonzalez R, Ahuja N, Grignani G, Quagliuolo V, Stoeckle E, De Paoli A, Pillarisetty VG, Swallow CJ, Bagaria SP, Canter RJ, Mullen JT, Schrage Y, Pennacchioli E, van Houdt W, Cardona K, Fiore M, Gronchi A, Lahat G. Postoperative Morbidity After Resection of Recurrent Retroperitoneal Sarcoma: A Report from the Transatlantic Australasian RPS Working Group (TARPSWG). Ann Surg Oncol 2021; 28:2705-2714. [PMID: 33389288 DOI: 10.1245/s10434-020-09445-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Accepted: 10/13/2020] [Indexed: 01/17/2023]
Abstract
BACKGROUND This study aimed to evaluate perioperative morbidity after surgery for first locally recurrent (LR1) retroperitoneal sarcoma (RPS). Data concerning the safety of resecting recurrent RPS are lacking. METHODS Data were collected on all patients undergoing resection of RPS-LR1 at 22 Trans-Atlantic Australasian Retroperitoneal Sarcoma Working Group (TARPSWG) centers from 2002 to 2011. Uni- and multivariable logistic models were fitted to study the association between major (Clavien-Dindo grade ≥ 3) complications and patient/surgery characteristics as well as outcome. The resected organ score, a method of standardizing the number of organs resected, as previously described by the TARPSWG, was used. RESULTS The 681 patients in this study had a median age of 59 years, and 51.8% were female. The most common histologic subtype was de-differentiated liposarcoma (43%), the median resected organ score was 1, and 83.3% of the patients achieved an R0 or R1 resection. Major complications occurred for 16% of the patients, and the 90-day mortality rate was 0.4%. In the multivariable analysis, a transfusion requirement was found to be a significant predictor of major complications (p < 0.001) and worse overall survival (OS) (p = 0.010). However, having a major complication was not associated with a worse OS or a higher incidence of local recurrence or distant metastasis. CONCLUSIONS A surgical approach to recurrent RPS is relatively safe and comparable with primary RPS in terms of complications and postoperative mortality when performed at specialized sarcoma centers. Because alternative effective therapies still are lacking, when indicated, resection of a recurrent RPS is a reasonable option. Every effort should be made to minimize the need for blood transfusions.
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Affiliation(s)
- Carolyn Nessim
- Department of Surgery, The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada.
| | - Chandrajit P Raut
- Department of Surgery, Brigham and Women's Hospital and Dana-Farber Cancer Institute, Boston, MA, USA
| | - Dario Callegaro
- Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Francesco Barretta
- Unit of Clinical Epidemiology and Trial Organization, Department of Applied Research and Technological Development, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Rosalba Miceli
- Unit of Clinical Epidemiology and Trial Organization, Department of Applied Research and Technological Development, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Mark Fairweather
- Department of Surgery, Brigham and Women's Hospital and Dana-Farber Cancer Institute, Boston, MA, USA
| | - Piotr Rutkowski
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Jean-Yves Blay
- Department of Medical Oncology, Center Léon Bérard Cancer Center, Lyon, France
| | - Dirk Strauss
- Department of Surgery, Royal Marsden Hospital NHS Foundation Trust, London, UK
| | | | - Nita Ahuja
- Department of Surgery, Yale School of Medicine, New Haven, CT, USA
| | - Giovanni Grignani
- Division of Medical Oncology, Candiolo Cancer Institute, FPO-IRCCS, Candiolo, TO, Italy
| | | | | | - Antonino De Paoli
- Department of Radiation Oncology, Centro di Riferimento Oncologico, Aviano, Italy
| | - Venu G Pillarisetty
- Department of Surgery, University of Washington School of Medicine, Seattle, WA, USA
| | - Carol J Swallow
- Department of Surgery, Mount Sinai Hospital and Princess Margaret Cancer Center, Toronto, Canada
| | | | | | - John T Mullen
- Department of Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Yvonne Schrage
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands.,Department of Surgery, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | | | - Winan van Houdt
- Department of Surgery, Istituto Europeo di Oncologia, Milan, Italy
| | - Kenneth Cardona
- Department of Surgery, Winship Cancer Institute, Emory University School of Medicine, Atlanta, GA, USA
| | - Marco Fiore
- Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Alessandro Gronchi
- Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Guy Lahat
- Department of Surgery, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
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Bahat AV, Bar-David S, Brooks A, Aizic A, Greenberg O, Wolf I, Klausner JM, Lahat G, Nizri E. Protective Desmoplasia in Pancreatic Adenocarcinoma: High Vitamin D Receptor Expression and Collagen Content. Anticancer Res 2020; 40:6457-6464. [PMID: 33109584 DOI: 10.21873/anticanres.14667] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Revised: 09/18/2020] [Accepted: 09/21/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM Vitamin D receptor (VDR) has been shown to suppress desmoplasia in pancreatic ductal adenocarcinoma (PDAC). Our aim was to assess the clinical effects of VDR expression and its correlation with collagen content in the desmoplasia of PDAC patients. PATIENTS AND METHODS This is a retrospective analysis of 127 patients with peritumoral desmoplasia resected for PDAC. VDR expression and collagen content were assessed by immunohistochemistry and correlated with clinical outcome. RESULTS Patients were classified into those with high and those with low VDR expression. High VDR expression was associated with improved overall survival (OS) in localized disease (N0) (median= 33; 95%CI=26.4-39.6 vs. 18; 15.5-20.5 months, p=0.01). Patients with high vs. low collagen content had improved OS [34, (range=22.3-45.6 months) vs. 17, (range=14.4-19.6 months), p<0.001]. The number of VDR+ cells was the same for patients with either high or low collagen content. CONCLUSION Protective desmoplasia is associated with increased VDR expression and collagen content.
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Affiliation(s)
- Adi Vaknine Bahat
- Department of Surgery A, Tel-Aviv University, Tel-Aviv, Israel.,Laboratory of Surgical Oncology, Tel-Aviv University, Tel-Aviv, Israel
| | - Shoshi Bar-David
- Laboratory of Surgical Oncology, Tel-Aviv University, Tel-Aviv, Israel
| | - Abigail Brooks
- Department of Surgery A, Tel-Aviv University, Tel-Aviv, Israel.,Laboratory of Surgical Oncology, Tel-Aviv University, Tel-Aviv, Israel
| | - Asaf Aizic
- Institute of Pathology, Tel-Aviv University, Tel-Aviv, Israel
| | - Orli Greenberg
- Institute of Pathology, Tel-Aviv University, Tel-Aviv, Israel
| | - Ido Wolf
- Institute of Oncology, Tel-Aviv Sourasky Medical Center, Tel-Aviv University, Tel-Aviv, Israel.,The Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Joseph M Klausner
- Department of Surgery A, Tel-Aviv University, Tel-Aviv, Israel.,Laboratory of Surgical Oncology, Tel-Aviv University, Tel-Aviv, Israel.,The Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Guy Lahat
- Department of Surgery A, Tel-Aviv University, Tel-Aviv, Israel.,Laboratory of Surgical Oncology, Tel-Aviv University, Tel-Aviv, Israel.,The Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Eran Nizri
- Department of Surgery A, Tel-Aviv University, Tel-Aviv, Israel .,Laboratory of Surgical Oncology, Tel-Aviv University, Tel-Aviv, Israel.,The Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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31
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Nizri E, Netanyahu Y, Gerstenhaber F, Shamai S, Sher O, Merimsky O, Lahat G, Klausner JM. Severe Postoperative Complications are Associated with Impaired Survival in Primary but not in Recurrent Retroperitoneal Sarcoma. Ann Surg Oncol 2020; 28:2693-2699. [PMID: 33025356 DOI: 10.1245/s10434-020-09179-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 09/08/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND Retroperitoneal sarcoma (RPS) surgery entails multivisceral resection, which may cause postoperative complications. We assessed the effects of complications on survival to identify their predisposing factors in primary (PRPS) and recurrent (RRPS) RPS. METHODS We retrospectively analyzed our institutional database. Severe postoperative complications (SC) were defined as Clavien-Dindo classification ≥ 3. Predisposing factors for complications were investigated, as was their effect on long-term outcomes. RESULTS In total, 154 RPS resections (78 PRPS and 76 RRPS) performed between January 2008 and December 2018 were included. Neoadjuvant chemotherapy and multifocal tumors were more common in RRPS than PRPS (34.2% vs. 11.3%, P = 0.001 and 42.1% vs. 10.3%, P < 0.001, respectively). Although surgical extent in RRPS was limited compared with PRPS (weighted organ score 1 vs. 2, P = 0.01; transfusion requirement 23.6% vs. 35.8%, P = 0.04), SC and mortality rates were comparable. SC rates were 30.1% and 35.5% for PRPS and RRPS, respectively. NACT rate tended to be higher in PRPS patients with SC (20.8% vs. 7.4%, P = 0.09), whereas weighted organ score and transfusion requirement were increased in RRPS patients with SC (2 vs. 1, P = 0.01; 40.7% vs. 14.3%, P = 0.009, respectively). PRPS patients with SC had decreased overall survival (35 months, 95% confidence interval [CI] 12.2-57.7) compared with those without SC (90 months, 95% CI 71.4-108.5, P = 0.01). CONCLUSIONS Postoperative complications are associated with impaired outcomes in PRPS but not in RRPS. The negative effects of complications on outcomes should be factored to perioperative management.
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Affiliation(s)
- Eran Nizri
- Surgical Oncology Unit, Department of Surgery A, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel. .,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
| | - Yael Netanyahu
- Surgical Oncology Unit, Department of Surgery A, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Fabian Gerstenhaber
- Surgical Oncology Unit, Department of Surgery A, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Sivan Shamai
- Institute of Oncology, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Osnat Sher
- Institute of Pathology, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Ofer Merimsky
- Institute of Oncology, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Guy Lahat
- Surgical Oncology Unit, Department of Surgery A, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Joseph M Klausner
- Surgical Oncology Unit, Department of Surgery A, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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Netanyahu Y, Gerstenhaber F, Shamai S, Sher O, Merimsky O, Klausner JM, Lahat G, Nizri E. Innate inflammatory markers for predicting survival in retroperitoneal sarcoma. J Surg Oncol 2020; 122:1655-1661. [PMID: 32808301 DOI: 10.1002/jso.26178] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 08/07/2020] [Indexed: 12/27/2022]
Abstract
INTRODUCTION Existing prognostic tools for retroperitoneal sarcomas (RPS) utilize parameters that can be accurately determined only postoperatively. This study evaluated the application of the neutrophil-to-lymphocyte ratio (NLR) and C-reactive protein (CRP) levels for predicting prognosis in primary RPS. MATERIALS AND METHODS We retrospectively analyzed our database of patients with primary RPS operated between 2008 and 2018. The NLR was calculated from preoperative blood tests and its association with outcomes was determined. RESULTS The NLR values of 78 suitable patients were analyzed. Patients were classified in the NLR-high group if the NLR was ≥2.1. High-grade tumors were more common in the NLR-high group (71.6% vs 48%, P = .02). NLR-high patients had impaired overall survival (OS) and progression-free survival (PFS) compared to NLR-low patients (median OS not reached vs 74 months 95% confidence interval [CI]: 21.6-126.4, P = .03; median PFS not reached vs 48 months 95% CI: 6.5-98.6, P = .06, respectively). Multivariate analysis showed statistical significance only for PFS but not for OS (hazard ratio [HR] = 4.1, P = .03; HR = 2.3, P = .3). Patients with low CRP levels had improved OS and PFS. CONCLUSIONS The NLR may serve as a preoperative, easily derived marker for prognosis in RPS. Serum biomarkers may prove useful in these large and spatially heterogeneous tumors.
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Affiliation(s)
- Yael Netanyahu
- Surgical Oncology Unit, Department of Surgery A, The Sackler Faculty of Medicine, Tel-Aviv Sourasky Medical Center, Tel-Aviv University, Tel-Aviv, Israel
| | - Fabian Gerstenhaber
- Surgical Oncology Unit, Department of Surgery A, The Sackler Faculty of Medicine, Tel-Aviv Sourasky Medical Center, Tel-Aviv University, Tel-Aviv, Israel
| | - Sivan Shamai
- Institute of Oncology, Tel-Aviv Sourasky Medical Center, The Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Osnat Sher
- Institute of Pathology, Tel-Aviv Sourasky Medical Center, The Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Ofer Merimsky
- Institute of Oncology, Tel-Aviv Sourasky Medical Center, The Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Joseph M Klausner
- Surgical Oncology Unit, Department of Surgery A, The Sackler Faculty of Medicine, Tel-Aviv Sourasky Medical Center, Tel-Aviv University, Tel-Aviv, Israel
| | - Guy Lahat
- Surgical Oncology Unit, Department of Surgery A, The Sackler Faculty of Medicine, Tel-Aviv Sourasky Medical Center, Tel-Aviv University, Tel-Aviv, Israel
| | - Eran Nizri
- Surgical Oncology Unit, Department of Surgery A, The Sackler Faculty of Medicine, Tel-Aviv Sourasky Medical Center, Tel-Aviv University, Tel-Aviv, Israel
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Houdt WJ, Fiore M, Barretta F, Rutkowski P, Blay J, Lahat G, Strauss D, Gonzalez RJ, Ahuja N, Grignani G, Quagliuolo V, Stoeckle E, De Paoli A, Schrage Y, Cardona K, Pennacchioli E, Pillarisetty VG, Nessim C, Swallow CJ, Bagaria SP, Canter R, Mullen JT, Callegaro D, Fairweather M, Miceli R, Raut CP, Gronchi A, Gladdy RA. Patterns of recurrence and survival probability after second recurrence of retroperitoneal sarcoma: A study from TARPSWG. Cancer 2020; 126:4917-4925. [DOI: 10.1002/cncr.33139] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 07/02/2020] [Accepted: 07/02/2020] [Indexed: 12/22/2022]
Affiliation(s)
- Winan J. Houdt
- Department of Surgical Oncology The Netherlands Cancer Institute Amsterdam The Netherlands
| | - Marco Fiore
- Department of Surgical Oncology Fondazione IRCCS Istituto Nazionale dei Tumori Milan Italy
| | - Francesco Barretta
- Medical Statistics, Biometry and Bioinformatics Unit Fondazione IRCCS Istituto Nazionale dei Tumori Milan Italy
| | - Piotr Rutkowski
- Department of Soft Tissue/Bone Sarcoma and Melanoma Maria Sklodowska‐Curie Memorial Cancer Center Warsaw Poland
| | - Jean‐Yves Blay
- Department of Medical Oncology Leon Berard Center, Claude Bernard Lyon 1 University Lyon France
| | - Guy Lahat
- Department of General Surgery Tel Aviv Sourasky Medical Center Tel Aviv Israel
| | - Dirk Strauss
- Sarcoma Unit, Department of Surgery Royal Marsden Hospital London United Kingdom
| | | | - Nita Ahuja
- Department of Surgery Yale School of Medicine New Haven Connecticut
| | - Giovanni Grignani
- Sarcoma Unit, Division of Medical Oncology Candiolo Cancer InstituteFPO‐IRCCS Candiolo Italy
| | | | - Eberhard Stoeckle
- Department of Surgery Bergonie InstituteRegional Cancer Centre Bordeaux Cedex France
| | - Antonino De Paoli
- Department of Radiation Oncology Oncology Reference Center (CRO), CRO‐IRCCS Aviano Italy
| | - Yvonne Schrage
- Department of Surgery Leiden University Medical Center Leiden The Netherlands
| | - Kenneth Cardona
- Department of Surgery Winship Cancer InstituteEmory University Atlanta Georgia
| | | | - Venu G. Pillarisetty
- Department of Surgery Seattle Cancer Care AllianceUniversity of Washington School of Medicine Seattle Washington
| | - Carolyn Nessim
- Department of Surgery The Ottawa HospitalUniversity of Ottawa Ottawa Ontario Canada
| | - Carol J. Swallow
- Division of General Surgery Mount Sinai HospitalPrincess Margaret HospitalUniversity of Toronto Toronto Ontario Canada
| | - Sanjay P. Bagaria
- Section of Surgical Oncology Department of Surgery Mayo Clinic Jacksonville Jacksonville Florida
| | - Robert Canter
- Department of Surgery University of California at Davis School of Medicine Davis California
| | - John T. Mullen
- Department of Surgery Massachusetts General HospitalHarvard Medical School Boston Massachusetts
| | - Dario Callegaro
- Department of Surgical Oncology Fondazione IRCCS Istituto Nazionale dei Tumori Milan Italy
| | - Mark Fairweather
- Division of Surgical Oncology Department of Surgery Brigham and Women's Hospital Dana‐Farber Cancer Institute Harvard Medical School Boston Massachusetts
| | - Rosalba Miceli
- Medical Statistics, Biometry and Bioinformatics Unit Fondazione IRCCS Istituto Nazionale dei Tumori Milan Italy
| | - Chandrajit P. Raut
- Department of Surgery Massachusetts General HospitalHarvard Medical School Boston Massachusetts
| | - Alessandro Gronchi
- Department of Surgical Oncology Fondazione IRCCS Istituto Nazionale dei Tumori Milan Italy
| | - Rebecca A. Gladdy
- Division of General Surgery Mount Sinai HospitalPrincess Margaret HospitalUniversity of Toronto Toronto Ontario Canada
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34
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Shapira S, Kazanov D, Shimon MB, Levy MH, Mdah F, Asido S, Carmel N, Yossepowitch O, Grisaru D, Fliss D, Isakov O, Lahat G, Nachmany I, Gluck N, Peer M, Wolf I, Arber N. O-15 The dark age of single organ screening is over: CD24 is a novel universal simple blood test for early detection of cancer. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.04.068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Orbach L, Nachmany I, Goykhman Y, Lahat G, Yossepowitch O, Beri A, Ben-Gal Y, Klausner JM, Lubezky N. Surgical Approach to Abdominal Tumors Involving the Inferior Vena Cava. Isr Med Assoc J 2020; 22:364-368. [PMID: 32558442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
BACKGROUND Abdominal tumors invading the inferior vena cava (IVC) present significant challenges to surgeons and oncologists. OBJECTIVES To describe a surgical approach and patient outcomes. METHODS The authors conducted a retrospective analysis of surgically resected tumors with IVC involvement by direct tumor encasement or intravascular tumor growth. Patients were classified according to level of IVC involvement, presence of intravascular tumor thrombus, and presence of hepatic parenchymal involvement. RESULTS Study patients presented with leiomyosarcomas (n=5), renal cell carcinoma (n=7), hepatocellular carcinoma (n=1), cholangiocarcinoma (n=2), Wilms tumor (n=1), neuroblastoma (n=1), endometrial leiomyomatosis (n=1), adrenocortical carcinoma (n=1), and paraganglioma (n=1). The surgeries were conducted between 2010 and 2019. Extension of tumor thrombus above the hepatic veins required a venovenous bypass (n=3) or a full cardiac bypass (n=1). Hepatic parenchymal involvement required total hepatic vascular isolation with in situ hepatic perfusion and cooling (n=3). Circular resection of IVC was performed in five cases. Six patients had early postoperative complications, and the 90-day mortality rate was 10%. Twelve patients were alive, and six were disease-free after a mean follow-up of 1.6 years. CONCLUSIONS Surgical resection of abdominal tumors with IVC involvement can be performed in selected patients with acceptable morbidity and mortality. Careful patient selection, and multidisciplinary involvement in preoperative planning are key for optimal outcome.
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Affiliation(s)
- Lior Orbach
- Department of Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ido Nachmany
- Department of Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yaacov Goykhman
- Department of Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Guy Lahat
- Department of Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ofer Yossepowitch
- Department of Urology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Avi Beri
- Department of Urology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yanai Ben-Gal
- Department of Cardiothoracic Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Joseph M Klausner
- Department of Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Nir Lubezky
- Department of Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Barenboim A, Lahat G, Nachmany I, Nakache R, Goykhman Y, Geva R, Osher E, Scapa E, Wolf I, Orbach L, Brazowski E, Isakov O, Klausner JM, Lubezky N. Resection Versus Observation of Small Asymptomatic Nonfunctioning Pancreatic Neuroendocrine Tumors. J Gastrointest Surg 2020; 24:1366-1374. [PMID: 31197692 DOI: 10.1007/s11605-019-04285-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Accepted: 05/26/2019] [Indexed: 01/31/2023]
Abstract
BACKGROUND Management of asymptomatic, nonfunctioning small pancreatic neuroendocrine tumors (PNETs) is controversial because of their overall good prognosis, and the morbidity and mortality associated with pancreatic surgery. Our aim was to compare the outcomes of resection with expectant management of patients with small asymptomatic PNETs. METHODS Retrospective review of patients with nonfunctioning asymptomatic PNETs < 2 cm that underwent resection or expectant management at the Tel-Aviv Medical Center between 2001 and 2018. RESULTS Forty-four patients with small asymptomatic, biopsy-proven low-grade PNETs with a KI67 proliferative index < 3% were observed for a mean of 52.48 months. Gallium67DOTATOC-PET scan was completed in 32 patients and demonstrated uptake in the pancreatic tumor in 25 (78%). No patient developed systemic metastases. Two patients underwent resection due to tumor growth, and true tumor enlargement was evidenced in final pathology in one of them. Fifty-five patients underwent immediate resection. Significant complications (Clavien-Dindo grade ≥ 3) developed in 10 patients (18%), mostly due to pancreatic leak, and led to one mortality (1.8%). Pathological evaluation revealed lymphovascular invasion in 1 patient, lymph node metastases in none, and a Ki67 index ≥ 3% in 5. No case of tumor recurrence was diagnosed after mean follow-up of 52.8 months. CONCLUSIONS No patients with asymptomatic low-grade small PNETs treated by expectant management were diagnosed with regional or systemic metastases after a 52.8-month follow-up. Local tumor progression rate was 2.1%. Surgery has excellent long-term outcomes, but it harbors significant morbidity and mortality. Observation can be considered for selected patients with asymptomatic, small, low grade PNETs.
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Affiliation(s)
- Alex Barenboim
- Unit of Liver Surgery Department of Surgery, Tel-Aviv Medical Center, Tel Aviv, Israel
| | - Guy Lahat
- Unit of Liver Surgery Department of Surgery, Tel-Aviv Medical Center, Tel Aviv, Israel
| | - Ido Nachmany
- Unit of Liver Surgery Department of Surgery, Tel-Aviv Medical Center, Tel Aviv, Israel
| | - Richard Nakache
- Unit of Liver Surgery Department of Surgery, Tel-Aviv Medical Center, Tel Aviv, Israel
| | - Yaakov Goykhman
- Unit of Liver Surgery Department of Surgery, Tel-Aviv Medical Center, Tel Aviv, Israel
| | - Ravit Geva
- Institute of Oncology, Tel-Aviv Medical Center, Tel Aviv, Israel
| | - Ester Osher
- Department of Endocrinology, Tel-Aviv Medical Center, Tel Aviv, Israel
| | - Erez Scapa
- Institute of Gastroenterology, Tel-Aviv Medical Center, Tel Aviv, Israel
| | - Ido Wolf
- Institute of Oncology, Tel-Aviv Medical Center, Tel Aviv, Israel
| | - Lior Orbach
- Unit of Liver Surgery Department of Surgery, Tel-Aviv Medical Center, Tel Aviv, Israel
| | - Eli Brazowski
- Institute of Pathology, Tel-Aviv Medical Center, Tel Aviv, Israel
| | - Ofer Isakov
- Department of Internal Medicine "T", Tel-Aviv Medical Center, (affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel.), Tel Aviv, Israel
| | - Joseph M Klausner
- Unit of Liver Surgery Department of Surgery, Tel-Aviv Medical Center, Tel Aviv, Israel
| | - Nir Lubezky
- Unit of Liver Surgery Department of Surgery, Tel-Aviv Medical Center, Tel Aviv, Israel.
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Shapira S, Kazanov D, Ben Shimon M, Hay Levy M, Mdah F, Asido S, Carmel N, Yossepowitch O, Grisaru D, Fliss D, Isakov O, Lahat G, Nachmany I, Gluck N, Peer M, Wolf I, Arber N. The dark age of single organ screening is over: CD24 is a novel universal simple blood test for early detection of cancer. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.e15591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e15591 Background: More than 1.8 million new cancer cases are expected to be diagnosed in 2020. Only in the U.S, about 606,520 Americans are expected to die this year, which translates to about 1,660 deaths per day. However, when found early, in the asymptomatic phase, cancer is often effectively treated or even cured. The few cancer screens available today, including mammograms and colonoscopies, each look for a single type of cancer. CD24 is hardly expressed in normal cells (but to B-lymphocytes, differentiating neuroblasts and neutrophils) but is overexpressed in numerous human cancers. Aim: To establish a universal cancer screening blood test. Methods: Blood samples were obtained from consecutive patients and healthy volunteers. 1x106 leukocytes were stained using anti-CD11b-PerCp-Cy5.5 and anti-CD24-FITC and analyzed by flow cytometry (CyFlow Cube 6, Sysmex, Germany). Percentage of positive cells was determined by subtracting the percentage of CD24 and CD11b-positive cells (dual stain) from CD24-positive cells (single stain). The cut off for cancer detection was 25. Healthy subjects underwent a thorough evaluation at the health promotion center and integrated cancer prevention center. All cancers were verified histologically. Results: CD24/CD11b expression in the healthy population was evaluated in 337 women and 408 men, ages 20-85. There were 222 cancer patients. After excluding thyroid and bladder cancers, the assay detected 146 out of 196 (75%) cancers at all stages and even in 31 out of colonic adenomas (table). The levels of CD24 drop back to near normal level following successful surgery/chemotherapy. The test score was not affected by age, gender, fasting and the time of the day that the blood sample is taken. In 55 cases the test was performed twice, with similar results, as well as when the test was performed in another flow cytometry, after 1d, 1w, 1m after freezing . Conclusions: 1. CD24 is a universal cancer screening. 2. It can detect pre malignant lesions like adenomas in the colon. 3. Preliminary results suggest that it can serve as a predictive marker. [Table: see text]
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Affiliation(s)
- Shiran Shapira
- Health promotion and Integrated Cancer Prevention Center, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Dina Kazanov
- Health Promotion and Integrated Cancer Prevention Center, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Marina Ben Shimon
- Health Promotion and Integrated Cancer Prevention Center, Tel Aviv medical center, Tel-Aviv, Israel
| | - Mori Hay Levy
- Health Promotion and Integrated Cancer Prevention Center, Tel Aviv medical center, Tel Aviv, Israel
| | - Fatin Mdah
- Health Promotion and Integrated Cancer Prevention Center, Tel Aviv medical center, Tel-Aviv, Israel
| | - Shir Asido
- Health Promotion and Integrated Cancer Prevention Center, Tel Aviv medical center, Tel-Aviv, Israel
| | - Narin Carmel
- Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | | | - Dan Grisaru
- Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Dan Fliss
- Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Ofer Isakov
- Integrated Cancer Prevention Center, Tel-Aviv Medical Center, Tel Aviv, Israel
| | - Guy Lahat
- Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Ido Nachmany
- Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Nathan Gluck
- Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Michael Peer
- Integrated Cancer Prevention Center, Tel-Aviv Medical Center, Tel-Aviv, Israel
| | - Ido Wolf
- Tel Aviv Sourasky medical center, Tel Aviv, Israel
| | - Nadir Arber
- Integrated Cancer Prevention Center, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
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Ehrenwald M, Tordjman KM, Stern N, Klausner J, Nachmany I, Lahat G, Lubezky N, Goykhman Y, Wolf I, Geva R, Aizic A, Barnes S, Greenman Y, Osher E. SAT-180 Adrenocortical Carcinoma - A Tertiary Center’s Recent 5-Year Experience. J Endocr Soc 2020. [PMCID: PMC7207697 DOI: 10.1210/jendso/bvaa046.1015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND: Adrenocortical carcinoma (ACC) is a rare endocrine malignancy with poor prognosis. The aim of this study was to characterize patients diagnosed with ACC at a single center between 2014-2019. METHODS: We retrospectively reviewed data regarding demographics, tumor characteristics and functionality, treatment and survival. RESULTS: The study cohort included 27 subjects (56% females), followed for 27±10.6 months. The mean age at diagnosis was 49.4±9 years. Co-morbidities at presentation included hypertension (63%), diabetes mellitus (22%) and dyslipidemia (26%). 74.1% of tumors were functioning – of which 85% were cortisol-secreting and 15% androgen-secreting. Aldosterone was secreted additionally in 15%. ENSAT stage at diagnosis was stage 1 in 15%, stage 2 in 35%, stage 3 in 12% and stage 4 in 38%. Eighty-nine % of patients underwent surgery. Treatment with mitotane was initiated in 82% of patients, reaching a mean maximal dose of 3.3 ±0.4 grams/day. Chemotherapy and/or radiation were given in 37% and 22%, respectively. Several patients (14.8%) had a second primary cancer, diagnosed before ACC in 75%. Progression was observed in 48% of patients, with a progression-free survival of 8.3±6.6 months. Thirty-five % of patients died during follow up, time to death was 12.8±0.4 months. Twenty two % of patients survived over 30 months after diagnosis. KI67 above 20% or stage above 2 negatively affected survival. CONCLUSIONS: ACC remains a rare disease with a poor prognosis. However, it is a heterogeneous disease, with some patients achieving survival of over 30 months after diagnosis. Further characterization of this population may improve our understanding of the biology and treatment of this rare disease.
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Affiliation(s)
- Michal Ehrenwald
- Institute of Endocrinology, Metabolism and Hypertension, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Karen Michele Tordjman
- Institute of Endocrinology, Metabolism and Hypertension, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Naftali Stern
- Institute of Endocrinology, Metabolism and Hypertension, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Joseph Klausner
- Department of Surgery, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ido Nachmany
- Department of Surgery, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Guy Lahat
- Department of Surgery, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Nir Lubezky
- Department of Surgery, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yaakov Goykhman
- Department of Surgery, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ido Wolf
- Department of Oncology, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ravit Geva
- Department of Oncology, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Asaf Aizic
- Institute of Pathology, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Sophie Barnes
- Department of Radiology, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yona Greenman
- Institute of Endocrinology, Metabolism and Hypertension, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Esther Osher
- Institute of Endocrinology, Metabolism and Hypertension, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Osher E, Tordjman KM, Klausner J, Nachmany I, Sagie B, Stern N, Lahat G, Wolf I, Zac L, Otremski S, Barnes S, Aizic A, Zohar NE, Greenman Y. MON-194 Phaeochromocytoma-Paraganglioma (PPGL): Post-Operative Hypotension Is a Vanishing Phenomenon. J Endocr Soc 2020. [PMCID: PMC7208395 DOI: 10.1210/jendso/bvaa046.956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
Background: Treatment of hemodynamic instability in patients with PPGL in the intra-and postoperative periods is challenging. Persistent postoperative hypotension is a common and serious complication, reportedly occurring in 30-60% of PPGL patients. This phenomenon reflects 1) high doses of pre-operative antihypertensive drugs; 2) low intravascular volume secondary to chronic catecholamine-induced vasoconstriction with pressure natriuresis; 3) the sudden drop in circulating catecholamines after surgery. It has been shown that tumor size and preoperative levels of catecholamines are directly related to the need for treatment with vasopressor agents in the early period after tumor removal. The aim of this study was to evaluate the efficacy and safety of the current perioperative treatment protocol for PPGL used in our Institute. Methods: We retrospectively reviewed the rate of hemodynamic instability and postoperative hypotension in relation to catecholamine levels, and the efficiency of preoperative pharmacological preparation in consecutive patients with PPGL treated between 2000-2019. Results: There were 39 patients (F/M 19/20; mean age 50.4 ±16.5 years) 33 of which had adrenal lesions and 6 had extra-adrenal tumors. Mean tumor size was 3.9 ±2.2 cm. Median metanephrine and normetanephrine levels were 5 and 10 fold the upper limit of the normal range respectively. All patients were treated with α-blockade (phenoxybenzamine-17, mean dose 60±38 mg/day; doxazosin-22; mean dose 9.6±6.1mg/day) along with β- blockade, and high sodium diet and IV saline 24 hours before the operation. The length of the preoperative preparation period was 3.4±2 weeks. Within the first 24-48 hours from surgery, no episodes of hypotension (<90 mmHg systolic pressure) were recorded. Mean systolic BP was 121 ±14 (range 95-150) with a mean diastolic BP of 70 ±11 (range 89-46). In contrast, intraoperative hypotension occurred in 22% of the patients; and BP surge occurred in 36% of patients, mostly during tumor manipulation. There were no differences between subjects with and without such BP rises/falls in terms of pre/post- surgical BP, catecholamine levels or type of medical treatment. Conclusion: In contrast with older literature and previous reports, the patients in our cohort did not experience postoperative hypotension. This is most likely due to tight BP control while avoiding pre-operative hypotension, and adequate volume control. We propose that proper preoperative management in the modern era can drastically minimize intraoperative hemodynamic instability and post-operative hypotension.
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Affiliation(s)
- Esther Osher
- Institute of Endocrinology, Metabolism and Hypertension, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Israel., Tel-Aviv, Israel
| | - Karen Michele Tordjman
- Institute of Endocrinology, Metabolism and Hypertension, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Israel., Tel-Aviv, Israel
| | - Joseph Klausner
- Department of Surgery, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Israel., Tel-Aviv, Israel
| | - Ido Nachmany
- Department of Surgery, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Israel., Tel-Aviv, Israel
| | - Boaz Sagie
- Department of Surgery, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Israel., Tel-Aviv, Israel
| | - Naftali Stern
- Institute of Endocrinology, Metabolism and Hypertension, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Israel., Tel-Aviv, Israel
| | - Guy Lahat
- Department of Surgery, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Israel., Tel-Aviv, Israel
| | - Ido Wolf
- Department of Oncology; Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Israel., Tel-Aviv, Israel
| | - Lilach Zac
- Department of Anesthesiology Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Israel., Tel-Aviv, Israel
| | - Sorina Otremski
- Department of Anesthesiology Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Israel., Tel-Aviv, Israel
| | - Sophie Barnes
- Department of Radiology;Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Israel., Tel-Aviv, Israel
| | - asaf Aizic
- Department of Pathology, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Israel., Tel-Aviv, Israel
| | - Naomi Even Zohar
- Institute of Endocrinology, Metabolism and Hypertension, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Israel., Tel-Aviv, Israel
| | - Yona Greenman
- Institute of Endocrinology, Metabolism and Hypertension, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Israel., Tel-Aviv, Israel
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Golan T, Barenboim A, Lahat G, Nachmany I, Goykhman Y, Shacham-Shmueli E, Halpern N, Brazowski E, Geva R, Wolf I, Goldes Y, Ben-Haim M, Klausner JM, Lubezky N. Increased Rate of Complete Pathologic Response After Neoadjuvant FOLFIRINOX for BRCA Mutation Carriers with Borderline Resectable Pancreatic Cancer. Ann Surg Oncol 2020; 27:3963-3970. [PMID: 32314163 DOI: 10.1245/s10434-020-08469-8] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Indexed: 12/16/2022]
Abstract
BACKGROUND Neoadjuvant FOLFIRINOX is a standard-of-care treatment for BRPC patients. Patients with gBRCAm who have demonstrated improved response to platinum-based chemotherapy may have impaired homologous repair deficiency. This study aimed to describe the pathologic complete response rate and long-term survival for patients with germline BRCA1 or BRCA2 mutation (gBRCAm) and borderline resectable pancreatic cancer (BRPC) treated with neoadjuvant FOLFIRINOX. METHODS A dual-center retrospective analysis was performed. Patients who had BRPC treated with neoadjuvant FOLFIRINOX followed by curative resection were identified from clinical databases. Pathologic complete response was defined as no viable tumor cells present in the specimen. Common founder Jewish germline BRCA1 or BRCA2 mutation was determined for available patients. RESULTS The 61 BRPC patients in this study underwent resection after neoadjuvant FOLFIRINOX. Analysis of BRCA mutation was performed for 39 patients, and 9 patients were found to be BRCA2 germline mutation carriers. The pathologic complete response rate was 44.4% for the gBRCAm patients and 10% for the BRCA non-carriers (p = 0.009). The median disease-free survival was not reached for the gBRCAm patients and was 7 months for the BRCA non-carriers (p = 0.03). The median overall survival was not reached for the gBRCAm patients and was 32 months for the BRCA non-carriers (p = 0.2). After a mean follow-up period of 33.7 months, all eight patients with pathologic complete response were disease-free. CONCLUSIONS The study showed that gBRCAm patients with BRPC have an increased chance for pathologic complete response and prolonged survival after neoadjuvant FOLFIRINOX. The results support the benefit of exposing gBRCAm patients to platinum-based chemotherapy early in the course of the disease. Neoadjuvant FOLFIRINOX should be considered for BRCA carriers who have resectable pancreatic cancer.
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Affiliation(s)
- Talia Golan
- Institute of Oncology, Sheba Medical Center, Tel Hashomer, Israel
| | - Alex Barenboim
- Liver Surgery Unit, Department of Surgery, Tel-Aviv Medical Center, Tel Aviv, Israel
| | - Guy Lahat
- Liver Surgery Unit, Department of Surgery, Tel-Aviv Medical Center, Tel Aviv, Israel
| | - Ido Nachmany
- Liver Surgery Unit, Department of Surgery, Tel-Aviv Medical Center, Tel Aviv, Israel
| | - Yacov Goykhman
- Liver Surgery Unit, Department of Surgery, Tel-Aviv Medical Center, Tel Aviv, Israel
| | | | - Naama Halpern
- Institute of Oncology, Sheba Medical Center, Tel Hashomer, Israel
| | - Eli Brazowski
- Institute of Pathology, Tel-Aviv Medical Center, Tel Aviv, Israel
| | - Ravit Geva
- Institute of Oncology, Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Ido Wolf
- Institute of Oncology, Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Yuri Goldes
- Department of Surgery, Sheba Medical Center, The Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Menahem Ben-Haim
- Department of Surgery, Shaarey Zedek Medical Center, Jerusalem, Israel
| | - Joseph M Klausner
- Liver Surgery Unit, Department of Surgery, Tel-Aviv Medical Center, Tel Aviv, Israel
| | - Nir Lubezky
- Liver Surgery Unit, Department of Surgery, Tel-Aviv Medical Center, Tel Aviv, Israel.
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Cohen SJ, Papoulas M, Graubardt N, Ovdat E, Loewenstein S, Kania-Almog J, Pasmanik-Chor M, Brazowski E, Cagnano E, Nachmany I, Lahat G, Klausner JM, Lubezky N. Micro-RNA Expression Patterns Predict Metastatic Spread in Solid Pseudopapillary Neoplasms of the Pancreas. Front Oncol 2020; 10:328. [PMID: 32232006 PMCID: PMC7082878 DOI: 10.3389/fonc.2020.00328] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 02/25/2020] [Indexed: 12/17/2022] Open
Abstract
Solid pseudopapillary neoplasm (SPN) of pancreas is a rare pancreatic neoplasm with a low metastatic potential. Up to 10% of patients with localized disease at presentation will develop systemic metastases, usually in the peritoneum or the liver. Due to the rarity of SPNs and the overall excellent prognosis, reliable prognostic factors to predict malignant biological behavior remain undetermined. Therefore, we aimed to define clinical, histological, and microRNA patterns that are associated with metastatic disease. We conducted a retrospective single center study on all patients operated for SPN of pancreas between 1995 and 2018. Clinical and pathological data were collected, and expression patterns of 2,578 human microRNAs were analyzed using microRNA array (Affimetrix 4.1) in normal pancreases (NPs), localized tumors (LTs), and metastatic tumors (MTs). The diagnosis of SPN was confirmed in 35 patients who included 28 females and 3 males, with a mean age of 33.8 ± 13.9 years. The only clinical factor associated with metastases was tumor size (mean tumor size 5.20 ± 3.78 in LT vs. 8.13± 1.03 in MT, p < 0.012). Microscopic features of malignancy were not associated with metastases, nor were immunohistochemical stains, including the proliferative index KI67. Higher expressions of miR-184, miR-10a, and miR-887, and lower expressions of miR-375, miR-217, and miR-200c were observed in metastatic tissues on microarray, and validated by real-time polymerase chain reaction. Hierarchal clustering demonstrated that the microRNA expression pattern of MTs was significantly different from that of LTs. The only clinical factor associated with metastases of SPN of pancreas was tumor size. Histological features and immunohistological staining were not predictive of metastases. A panel of six microRNAs was differentially expressed in MTs, and these findings could potentially be used to predict tumor behavior. Validation of these results is needed in larger series.
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Affiliation(s)
- Shmuel Jaffe Cohen
- Surgical Division Research Laboratory, Tel-Aviv Sourasky Medical Center Affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Michail Papoulas
- Department of Surgery, Tel-Aviv Sourasky Medical Center Affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Nadine Graubardt
- Surgical Division Research Laboratory, Tel-Aviv Sourasky Medical Center Affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Esther Ovdat
- Department of Surgery, Tel-Aviv Sourasky Medical Center Affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Shelly Loewenstein
- Surgical Division Research Laboratory, Tel-Aviv Sourasky Medical Center Affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Juliane Kania-Almog
- Surgical Division Research Laboratory, Tel-Aviv Sourasky Medical Center Affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | | | - Eli Brazowski
- Tel-Aviv Sourasky Medical Center Affiliated to the Sackler Faculty of Medicine, Institute of Pathology, Tel-Aviv University, Tel-Aviv, Israel
| | - Emanuela Cagnano
- Tel-Aviv Sourasky Medical Center Affiliated to the Sackler Faculty of Medicine, Institute of Pathology, Tel-Aviv University, Tel-Aviv, Israel
| | - Ido Nachmany
- Department of Surgery, Tel-Aviv Sourasky Medical Center Affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Guy Lahat
- Department of Surgery, Tel-Aviv Sourasky Medical Center Affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Joseph M Klausner
- Department of Surgery, Tel-Aviv Sourasky Medical Center Affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Nir Lubezky
- Surgical Division Research Laboratory, Tel-Aviv Sourasky Medical Center Affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Department of Surgery, Tel-Aviv Sourasky Medical Center Affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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Dayan D, Abu-Abeid S, Kuriansky J, Lahat G, Sagie B. Rare Primary Retroperitoneal Neoplasms. Isr Med Assoc J 2020; 22:53-59. [PMID: 31927807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND Primary retroperitoneal neoplasms (PRN) arise from diverse retroperitoneal tissues. Soft tissue sarcomas (STS) comprise the majority and are well studied. Other non-sarcomatous PRN are very rare and less familiar. OBJECTIVES To evaluate the clinicopathologic and radiologic features of non-sarcomatous PRN, as well as the outcome of complete tumor resection (TR). METHODS Retrospective data were collected on consecutive patients (June 2006 to January 2015) who underwent resection of retroperitoneal lesions at our department. Final pathology of non-sarcomatous PRN was included. RESULTS The study population included 36 patients (26% with PRN). PRN were neurogenic (17%), fat-containing (3%), and cystic (6%). The preoperative diagnosis was correct in only 28%. All patients underwent TR via laparotomy (72%) or laparoscopy (28%), for mean operative time of 120 ± 46 minutes. En bloc organ resection was performed in 11%. Complete TR was achieved in 97%. Intra-operative spillage occurred in 8%. Intra-operative, 90-day postoperative complications, and mortality rates were 11%, 36%, and 0%, respectively. The mean length of stay was 6.5 ± 5.5 days. The median overall survival was 53 ± 4.9 months. CONCLUSIONS Familiarity with radiologic characteristics of PRN is important for appropriate management. Counter to STS, other PRN are mostly benign and have an indolent course. Radical surgery is not required, as complete TR confers good prognosis. Expectant management is reserved for small, asymptomatic, benign neoplasms.
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Affiliation(s)
- Danit Dayan
- Department of General Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Subhi Abu-Abeid
- Department of General Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Joseph Kuriansky
- Department of General Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Guy Lahat
- Department of General Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Boaz Sagie
- Department of General Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Abstract
BACKGROUND It is not uncommon to encounter patients seeking a third, fourth, or even fifth bariatric procedure. With higher expected complication rates and questionable patient benefit, the indication for multiple revisions is still in doubt. To evaluate the perioperative and post-operative outcomes of patients undergoing gastric bypass after two previous bariatric surgeries or more. METHODS We identified all patients that underwent gastric bypass following at least 2 previous bariatric surgeries. We looked at patient demographics, previous bariatric surgeries, pre-operative body mass index (BMI) and obesity-related co-morbidities, perioperative complications, length of stay (LOS), re-admissions and re-operations, percentage of excess weight loss, and resolution or improvement in comorbidities. RESULTS Forty-two patients met the inclusion criteria, the majority being females (31, 73.8%). Average age was 45.6 years (range 27-62), average weight and BMI was 116 kg (range 75-175 kg) and 41.1 kg/m2 (range 25.6-58.7 kg/m2), respectively. Thirty-two patients had two previous bariatric surgeries (73.8%), and 10 patients had 3 former bariatric surgeries (23.8%), and for one patient, this was the fifth bariatric procedure (2.4%). Mean LOS was 10 days (range 2-56 days). Eight patients (19%) needed re-admission and 5 (11.9%) needed re-operation. At a median follow up of 48 months (range 7-99 months), the average BMI was 34.5 kg/m2 (range 23.7-55.1 kg/m2) reflecting an excess BMI loss of 43.3%. CONCLUSIONS Gastric bypass as a third or more bariatric procedure is effective yet associated with high complication rates, re-admissions, and re-operations.
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Affiliation(s)
- Nadav Nevo
- General Surgery Division, The Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel. .,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Subhi Abu-Abeid
- General Surgery Division, The Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Bariatric Surgery Unit, The Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - David Hazzan
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,General Surgery Department C, Sheba Medical Center, Ramat Gan, Israel
| | - Guy Lahat
- General Surgery Division, The Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Bariatric Surgery Unit, The Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Ido Nachmani
- General Surgery Division, The Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shai Meron Eldar
- General Surgery Division, The Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Bariatric Surgery Unit, The Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel
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44
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Meyerovich G, Goykhman Y, Nakache R, Nachmany I, Lahat G, Shibolet O, Menachem Y, Katchman H, Wolf I, Geva R, Klausner JM, Lubezky N. Resection vs Transplant Listing for Hepatocellular Carcinoma: An Intention-to-Treat Analysis. Transplant Proc 2019; 51:1867-1873. [PMID: 31399171 DOI: 10.1016/j.transproceed.2019.02.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2018] [Revised: 01/30/2019] [Accepted: 02/18/2019] [Indexed: 01/15/2023]
Abstract
BACKGROUND Liver transplantation (LT) and liver resection (LR) are curative treatment options for patients with hepatocellular carcinoma within the Milan criteria. Severe organ shortage dictates the preference for LR. Our aim was to provide an intention-to-treat retrospective comparison of survival between patients who were placed on waiting lists for LT and those who underwent LR. METHODS The medical records of patients with hepatocellular carcinoma within the Milan criteria treated by LR or listed for LT between 2007 and 2016 were reviewed. We performed intention-to-treat analyses of overall survival and recurrence. RESULTS There were 54 patients on the waiting list for LT, and 30 of them underwent LR. Thirteen of the 54 patients (24%) were not transplanted because of disease-related mortality or tumor progression. The median waiting time to transplantation was 304 days. The 90-day mortality was higher in transplanted patients (9.8% vs 3.3%, P = .003). Intention-to-treat survival was similar for the LT and LR groups (5-year survival, 47.8% vs 55%, respectively, P = .185). There was a trend toward improved 5-year disease-free survival for listed patients (56.2% vs 26.3% for patients undergoing LR, P = .15). CONCLUSION Intention-to-treat survival is similar in patients undergoing LR and those on waiting lists for LT. There is a 24% risk to drop from the transplant list. The higher perioperative mortality among patients undergoing LT is balanced by a higher tumor recurrence rate after LR.
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Affiliation(s)
- Guy Meyerovich
- Department of Surgery, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Yaacov Goykhman
- Department of Surgery, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Richard Nakache
- Department of Surgery, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Ido Nachmany
- Department of Surgery, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Guy Lahat
- Department of Surgery, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Oren Shibolet
- Institute of Gastroenterology, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Yoram Menachem
- Institute of Gastroenterology, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Helena Katchman
- Institute of Gastroenterology, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Ido Wolf
- Institute of Oncology, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Ravit Geva
- Institute of Oncology, Tel Aviv Medical Center, Tel Aviv, Israel
| | | | - Nir Lubezky
- Department of Surgery, Tel Aviv Medical Center, Tel Aviv, Israel.
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45
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Kersy O, Loewenstein S, Lubezky N, Sher O, Simon NB, Klausner JM, Lahat G. Omental Tissue-Mediated Tumorigenesis of Gastric Cancer Peritoneal Metastases. Front Oncol 2019; 9:1267. [PMID: 31803630 PMCID: PMC6876669 DOI: 10.3389/fonc.2019.01267] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 11/01/2019] [Indexed: 12/21/2022] Open
Abstract
The peritoneal cavity, especially the omentum, is a common site for gastric cancer metastasis, representing advanced disease stage and poor prognosis. Here, we studied the effects of omental tissue on gastric cancer tumor progression in vitro and in vivo. Utilizing in vitro models, we found that omental tissue secreted factors increased gastric cancer cellular growth (by 30–67%, P < 0.05), motility (>8-fold, P < 0.05), invasiveness (>7-fold, P < 0.05) and chemoresistance to platinum-based chemotherapeutic agents (>1.2-fold for oxaliplatin and >1.6-fold for cisplatin, P < 0.05). Using a robust proteomic approach, we identified numerous molecules secreted into the omental tissue conditioned medium (CM) which may promote gastric cancer cellular aggressiveness (i.e., IL-6, IL-8, MMP9, FN1, and CXCL-5). Next, an in vivo xenograft mouse model showed an increased human gastric adenocarcinoma tumor volume of cells co-cultured with human omental tissue secreted factors; 1.6 ± 0.55 vs. 0.3 ± 0.19 cm3 (P < 0.001), as well as increased angiogenesis. Finally, exosomes were isolated from human omental tissue CM of gastric cancer patients. These exosomes were taken up by gastric cancer cells enhancing their growth (>8-fold, P < 0.01) and invasiveness (>8-fold, P < 0.001). Proteomic analysis of the content of these exosomes identified several established cancer- related proteins (i.e., IL-6, IL-8, ICAM-1, CCl2, and OSM). Taken together, our findings imply that the omentum play an active role in gastric cancer metastasis. The data also describe specific cytokines that are involved in this cross talk, and that omental tissue- derived exosomes may contribute to these unique cellular interactions with gastric cancer cells. Further studies aimed at understanding the biology of gastric cancer intra peritoneal spread are warranted. Hopefully, such data will enable to develop future novel therapeutic strategies for the treatment of metastatic gastric cancer.
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Affiliation(s)
- Olga Kersy
- Laboratory of Surgical Oncology, Tel-Aviv Sourasky Medical Center, Tel Aviv-Yafo, Israel.,Division of Surgery, Tel-Aviv Sourasky Medical Center, Tel Aviv-Yafo, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv-Yafo, Israel
| | - Shelly Loewenstein
- Laboratory of Surgical Oncology, Tel-Aviv Sourasky Medical Center, Tel Aviv-Yafo, Israel.,Division of Surgery, Tel-Aviv Sourasky Medical Center, Tel Aviv-Yafo, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv-Yafo, Israel
| | - Nir Lubezky
- Division of Surgery, Tel-Aviv Sourasky Medical Center, Tel Aviv-Yafo, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv-Yafo, Israel
| | - Osnat Sher
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv-Yafo, Israel.,Institute of Pathology, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Natalie B Simon
- College of Arts and Sciences, University of Virginia, Charlottesville, VA, United States
| | - Joseph M Klausner
- Division of Surgery, Tel-Aviv Sourasky Medical Center, Tel Aviv-Yafo, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv-Yafo, Israel.,The Nikolas and Elizabeth Shlezak Cathedra for Experimental Surgery, Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv-Yafo, Israel
| | - Guy Lahat
- Laboratory of Surgical Oncology, Tel-Aviv Sourasky Medical Center, Tel Aviv-Yafo, Israel.,Division of Surgery, Tel-Aviv Sourasky Medical Center, Tel Aviv-Yafo, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv-Yafo, Israel
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46
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Margalit S, Avraham S, Shahal T, Michaeli Y, Gilat N, Magod P, Caspi M, Loewenstein S, Lahat G, Friedmann-Morvinski D, Kariv R, Rosin-Arbesfeld R, Zirkin S, Ebenstein Y. 5-Hydroxymethylcytosine as a clinical biomarker: Fluorescence-based assay for high-throughput epigenetic quantification in human tissues. Int J Cancer 2019; 146:115-122. [PMID: 31211411 DOI: 10.1002/ijc.32519] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 05/29/2019] [Accepted: 06/03/2019] [Indexed: 12/31/2022]
Abstract
Epigenetic transformations may provide early indicators for cancer and other disease. Specifically, the amount of genomic 5-hydroxymethylcytosine (5-hmC) was shown to be globally reduced in a wide range of cancers. The integration of this global biomarker into diagnostic workflows is hampered by the limitations of current 5-hmC quantification methods. Here we present and validate a fluorescence-based platform for high-throughput and cost-effective quantification of global genomic 5-hmC levels. We utilized the assay to characterize cancerous tissues based on their 5-hmC content, and observed a pronounced reduction in 5-hmC level in various cancer types. We present data for glioblastoma, colorectal cancer, multiple myeloma, chronic lymphocytic leukemia and pancreatic cancer, compared to corresponding controls. Potentially, the technique could also be used to follow response to treatment for personalized treatment selection. We present initial proof-of-concept data for treatment of familial adenomatous polyposis.
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Affiliation(s)
- Sapir Margalit
- School of Chemistry, Center for Nanoscience and Nanotechnology, Center for Light-Matter Interaction, Raymond and Beverly Sackler Faculty of Exact Sciences, Tel Aviv University, Tel Aviv, Israel
| | - Sigal Avraham
- School of Chemistry, Center for Nanoscience and Nanotechnology, Center for Light-Matter Interaction, Raymond and Beverly Sackler Faculty of Exact Sciences, Tel Aviv University, Tel Aviv, Israel
| | - Tamar Shahal
- School of Chemistry, Center for Nanoscience and Nanotechnology, Center for Light-Matter Interaction, Raymond and Beverly Sackler Faculty of Exact Sciences, Tel Aviv University, Tel Aviv, Israel
| | - Yael Michaeli
- School of Chemistry, Center for Nanoscience and Nanotechnology, Center for Light-Matter Interaction, Raymond and Beverly Sackler Faculty of Exact Sciences, Tel Aviv University, Tel Aviv, Israel
| | - Noa Gilat
- School of Chemistry, Center for Nanoscience and Nanotechnology, Center for Light-Matter Interaction, Raymond and Beverly Sackler Faculty of Exact Sciences, Tel Aviv University, Tel Aviv, Israel
| | - Prerna Magod
- Sagol School of Neuroscience, Department of Biochemistry and Molecular Biology, The George S. Wise Faculty of Life Sciences, Tel Aviv University, Tel Aviv, Israel
| | - Michal Caspi
- Department of Clinical Microbiology and Immunology, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shelly Loewenstein
- Department of Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Guy Lahat
- Department of Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Dinorah Friedmann-Morvinski
- Sagol School of Neuroscience, Department of Biochemistry and Molecular Biology, The George S. Wise Faculty of Life Sciences, Tel Aviv University, Tel Aviv, Israel
| | - Revital Kariv
- Department of Clinical Microbiology and Immunology, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Gastroenterology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Rina Rosin-Arbesfeld
- Department of Clinical Microbiology and Immunology, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shahar Zirkin
- School of Chemistry, Center for Nanoscience and Nanotechnology, Center for Light-Matter Interaction, Raymond and Beverly Sackler Faculty of Exact Sciences, Tel Aviv University, Tel Aviv, Israel
| | - Yuval Ebenstein
- School of Chemistry, Center for Nanoscience and Nanotechnology, Center for Light-Matter Interaction, Raymond and Beverly Sackler Faculty of Exact Sciences, Tel Aviv University, Tel Aviv, Israel
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Lemberger M, Loewenstein S, Lubezky N, Nizri E, Pasmanik-Chor M, Barazovsky E, Klausner JM, Lahat G. MicroRNA profiling of pancreatic ductal adenocarcinoma (PDAC) reveals signature expression related to lymph node metastasis. Oncotarget 2019; 10:2644-2656. [PMID: 31080555 PMCID: PMC6498999 DOI: 10.18632/oncotarget.26804] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Accepted: 02/22/2019] [Indexed: 12/13/2022] Open
Abstract
Lymph node (LN) metastasis occurs frequently in pancreatic ductal adenocarcinoma (PDAC), representing an advanced disease stage and independently predicting patient survival. Current nodal staging is inadequate preoperatively and even less so postoperatively, and molecular biomarkers are needed to improve prognostication and selection of therapy. Recent data have suggested important roles of miRNAs in PDAC tumorigenesis and progression. The aim of the present study was to identify miRNA expression signature for nodal spread in PDAC patients. Using PDAC human tissue specimens, we identified 39 miRNAs which were differently expressed in LN positive compared to LN negative PDAC samples. Of them, six miRNAs have been reported to play a role in cancer invasion and metastasis. A high versus low six- miRNA signature score was predictive of LN metastasis in the PDAC validation cohort. We demonstrated a similar expression pattern of four out of the six miRNAs in the plasma of PDAC patients. The results of our in-vitro studies revealed that miR-141 and miR-720 are involved in the process of epithelial to mesenchymal-transition in PDAC. These miRNAs significantly inhibited in vitro proliferation, migration and invasion of PDAC cells as evidence by gain- and loss- of function studies, specifically, via ZEB-1 and TWIST1 transcription factors, as well as through the activation of the MAP4K4/JNK signaling pathway.
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Affiliation(s)
- Moran Lemberger
- Laboratory of Surgical Oncology, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel.,Division of Surgery, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Shelly Loewenstein
- Laboratory of Surgical Oncology, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel.,Division of Surgery, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Nir Lubezky
- Laboratory of Surgical Oncology, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel.,Division of Surgery, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Eran Nizri
- Laboratory of Surgical Oncology, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel.,Division of Surgery, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | | | - Eli Barazovsky
- Institute of Pathology, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Joseph M Klausner
- Division of Surgery, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,The Nikolas and Elizabeth Shlezak Cathedra for Experimental Surgery, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Guy Lahat
- Laboratory of Surgical Oncology, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel.,Division of Surgery, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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48
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Raut CP, Callegaro D, Miceli R, Barretta F, Rutkowski P, Blay JY, Lahat G, Strauss DC, Gonzalez R, Ahuja N, Grignani G, Quagliuolo V, Stoeckle E, De Paoli A, Pillarisetty VG, Nessim C, Swallow CJ, Bagaria S, Canter R, Mullen J, Gelderblom HJ, Pennacchioli E, van Coevorden F, Cardona K, Fiore M, Fairweather M, Gronchi A. Predicting Survival in Patients Undergoing Resection for Locally Recurrent Retroperitoneal Sarcoma: A Study and Novel Nomogram from TARPSWG. Clin Cancer Res 2019; 25:2664-2671. [DOI: 10.1158/1078-0432.ccr-18-2700] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Revised: 11/21/2018] [Accepted: 01/24/2019] [Indexed: 11/16/2022]
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49
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Lessing Y, Pencovich N, Nevo N, Lubezky N, Goykhman Y, Nakache R, Lahat G, Klausner JM, Nachmany I. Early reoperation following pancreaticoduodenectomy: impact on morbidity, mortality, and long-term survival. World J Surg Oncol 2019; 17:26. [PMID: 30704497 PMCID: PMC6357503 DOI: 10.1186/s12957-019-1569-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Accepted: 01/23/2019] [Indexed: 02/08/2023] Open
Abstract
Background Reoperation following PD is a surrogate marker for a complex post-operative course and may lead to devastating consequences. We evaluate the indications for early reoperation following PD and analyze its effect on short- and long-term outcome. Methods Four hundred and thirty-three patients that underwent PD between August 2006 and June 2016 were retrospectively analyzed. Results Forty-eight patients (11%; ROp group) underwent 60 reoperations within 60 days from PD. Forty-two patients underwent 1 reoperation, and 6 had up to 6 reoperations. The average time to first reoperation was 10.1 ± 13.4 days. The most common indications were anastomotic leaks (22 operations in 18 patients; 37.5% of ROp), followed by post-pancreatectomy hemorrhage (PPH) (14 reoperations in 12 patients; 25%), and wound complications in 10 (20.8%). Patients with cholangiocarcinoma had the highest reoperation rate (25%) followed by ductal adenocarcinoma (12.3%). Reoperation was associated with increased length of hospital stay and a high post-operative mortality of 18.7%, compared to 2.6% for the non-reoperated group. For those who survived the post-operative period, the overall and disease-free survival were not affected by reoperation. Conclusions Early reoperations following PD carries a dramatically increased mortality rate, but has no impact on long-term survival.
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Affiliation(s)
- Yonatan Lessing
- Department of General Surgery B, Division of General Surgery, Tel-Aviv Sourasky, Medical Center, Affiliated with the Sackler Faculty of Medicine, Tel Aviv University, 6 Weizmann St., 64239, Tel-Aviv, Israel.
| | - Niv Pencovich
- Department of General Surgery B, Division of General Surgery, Tel-Aviv Sourasky, Medical Center, Affiliated with the Sackler Faculty of Medicine, Tel Aviv University, 6 Weizmann St., 64239, Tel-Aviv, Israel
| | - Nadav Nevo
- Department of General Surgery B, Division of General Surgery, Tel-Aviv Sourasky, Medical Center, Affiliated with the Sackler Faculty of Medicine, Tel Aviv University, 6 Weizmann St., 64239, Tel-Aviv, Israel
| | - Nir Lubezky
- Department of General Surgery B, Division of General Surgery, Tel-Aviv Sourasky, Medical Center, Affiliated with the Sackler Faculty of Medicine, Tel Aviv University, 6 Weizmann St., 64239, Tel-Aviv, Israel
| | - Yaacov Goykhman
- Department of General Surgery B, Division of General Surgery, Tel-Aviv Sourasky, Medical Center, Affiliated with the Sackler Faculty of Medicine, Tel Aviv University, 6 Weizmann St., 64239, Tel-Aviv, Israel
| | - Richard Nakache
- Department of General Surgery B, Division of General Surgery, Tel-Aviv Sourasky, Medical Center, Affiliated with the Sackler Faculty of Medicine, Tel Aviv University, 6 Weizmann St., 64239, Tel-Aviv, Israel
| | - Guy Lahat
- Department of General Surgery B, Division of General Surgery, Tel-Aviv Sourasky, Medical Center, Affiliated with the Sackler Faculty of Medicine, Tel Aviv University, 6 Weizmann St., 64239, Tel-Aviv, Israel
| | - Joseph M Klausner
- Department of General Surgery B, Division of General Surgery, Tel-Aviv Sourasky, Medical Center, Affiliated with the Sackler Faculty of Medicine, Tel Aviv University, 6 Weizmann St., 64239, Tel-Aviv, Israel
| | - Ido Nachmany
- Department of General Surgery B, Division of General Surgery, Tel-Aviv Sourasky, Medical Center, Affiliated with the Sackler Faculty of Medicine, Tel Aviv University, 6 Weizmann St., 64239, Tel-Aviv, Israel
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50
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Nizri E, Lahat G, Klausner J. ASO Author Reflections: Even in Pancreatic Cancer, not all N Diseases are Created Equal. Ann Surg Oncol 2018; 25:804-805. [PMID: 30284129 DOI: 10.1245/s10434-018-6813-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Indexed: 11/18/2022]
Affiliation(s)
- Eran Nizri
- Division of Surgery, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel. .,Laboratory of Surgical Oncology, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel. .,Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel.
| | - Guy Lahat
- Division of Surgery, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel.,Laboratory of Surgical Oncology, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Joseph Klausner
- Division of Surgery, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel.,The Nikolas and Elizabeth Shlezak Cathedra for Experimental Surgery, Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
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