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Qian H, Chi C, Tricard T, Zhu Y, Dong L, Wang Y, Sha J, Wang J, Ma Z, Wang Y, Liu J, Dong B, Pan J, Xue W. A Prospective Randomized Trial of Neoadjuvant Chemohormonal Therapy vs Hormonal Therapy in Locally Advanced Prostate Cancer Treated by Radical Prostatectomy. J Urol 2024; 211:648-655. [PMID: 38591703 DOI: 10.1097/ju.0000000000003876] [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: 08/11/2023] [Accepted: 01/15/2024] [Indexed: 04/10/2024]
Abstract
PURPOSE Benefits of docetaxel-based neoadjuvant chemohormonal therapy (NCHT) before radical prostatectomy (RP) remain largely unknown. We explored whether docetaxel-based NCHT would bring pathological benefits and improve biochemical progression-free survival (bPFS) over neoadjuvant hormonal therapy (NHT) in locally advanced prostate cancer. MATERIALS AND METHODS A randomized trial was designed recruiting 141 locally advanced, high-risk prostate cancer patients who were randomly assigned at the ratio of 2:1 to the NCHT group (75 mg/m2 body surface area every 3 weeks plus androgen deprivation therapy for 6 cycles) and the NHT group (androgen deprivation therapy for 24 weeks). The primary end point was 3-year bPFS. Secondary end points were pathological response including pathological downstaging and minimal residual disease rates. RESULTS The NCHT group showed significant benefits in 3-year bPFS compared to the NHT group (29% vs 9.5%, P = .002). At a median follow-up of 53 months, the NCHT group achieved a significantly longer median bPFS time than the NHT group (17 months vs 14 months). No significant differences were found between the 2 groups in pathological downstaging and minimal residual disease rates. CONCLUSIONS NCHT plus RP achieved significant bPFS benefits when compared with NHT plus RP in high-risk, locally advanced prostate cancer. A larger cohort with longer follow-up duration is essential in further investigation.
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Affiliation(s)
- Hongyang Qian
- Department of Urology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, People's Republic of China
| | - Chenfei Chi
- Department of Urology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, People's Republic of China
| | - Thibault Tricard
- Department of Urology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, People's Republic of China
- Department of Urology, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Yinjie Zhu
- Department of Urology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, People's Republic of China
| | - Liang Dong
- Department of Urology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, People's Republic of China
| | - Yanqing Wang
- Department of Urology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, People's Republic of China
| | - Jianjun Sha
- Department of Urology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, People's Republic of China
| | - Jiayi Wang
- Department of Urology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, People's Republic of China
| | - Zehua Ma
- Department of Urology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, People's Republic of China
| | - Yan Wang
- Department of Urology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, People's Republic of China
| | - Jiazhou Liu
- Department of Urology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, People's Republic of China
| | - Baijun Dong
- Department of Urology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, People's Republic of China
| | - Jiahua Pan
- Department of Urology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, People's Republic of China
| | - Wei Xue
- Department of Urology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, People's Republic of China
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Kano Y, Yamamoto Y, Ikematsu H, Sasabe M, Minakata N, Watanabe T, Yamashita H, Mitsui T, Inaba A, Sunakawa H, Nakajo K, Murano T, Kadota T, Shinmura K, Yano T. Investigation of vertical margin involvement in endoscopic resection for T1 colorectal cancer. Dig Endosc 2024; 36:455-462. [PMID: 37572330 DOI: 10.1111/den.14660] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 08/09/2023] [Indexed: 08/14/2023]
Abstract
OBJECTIVES The resection of vertical margin-negative submucosally invasive colorectal cancer (CRC) relies on the pathological risk assessment of lymph node metastasis. However, no large-scale study has clarified the endoscopic resection (ER) outcome for submucosally invasive CRC, focusing on the vertical margin status. This retrospective study aimed to examine vertical margin involvement in ER for submucosally invasive CRC and explore the treatment consequences associated with vertical margin status. METHODS We analyzed 395 submucosally invasive CRC cases in 389 patients who underwent ER at our hospital between 2008 and 2020. The presence of residual tumors and simultaneous lymph node metastasis in patients who underwent additional surgery was assessed and compared between the vertical incomplete ER and the vertical margin-negative groups. RESULTS Among the patients, 270 were men, with a median age of 69 years. The vertical incomplete ER rate was 21.5%, with positive vertical margins and unclear vertical margins identified in 12.2% and 9.3% of the cases, respectively. Among 154 patients who underwent additional surgery after ER, the vertical incomplete ER group had a significantly higher residual tumor rate than the vertical margin-negative group (P = 0.001). The vertical incomplete ER group had a significantly higher lymph node metastasis rate than the vertical margin-negative group (P = 0.029). CONCLUSION This study clarified the substantial risk of vertical incomplete ER in submucosally invasive CRC and revealed the high risk of residual tumor and lymph node metastasis in vertical incomplete ER for submucosal CRC.
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Affiliation(s)
- Yuki Kano
- Department of Gastroenterology and Endoscopy, National Cancer Center Hospital East, Chiba, Japan
| | - Yoichi Yamamoto
- Department of Gastroenterology and Endoscopy, National Cancer Center Hospital East, Chiba, Japan
| | - Hiroaki Ikematsu
- Department of Gastroenterology and Endoscopy, National Cancer Center Hospital East, Chiba, Japan
| | - Maasa Sasabe
- Department of Gastroenterology and Endoscopy, National Cancer Center Hospital East, Chiba, Japan
| | - Nobuhisa Minakata
- Department of Gastroenterology and Endoscopy, National Cancer Center Hospital East, Chiba, Japan
| | - Takashi Watanabe
- Department of Gastroenterology and Endoscopy, National Cancer Center Hospital East, Chiba, Japan
| | - Hiroki Yamashita
- Department of Gastroenterology and Endoscopy, National Cancer Center Hospital East, Chiba, Japan
| | - Tomohiro Mitsui
- Department of Gastroenterology and Endoscopy, National Cancer Center Hospital East, Chiba, Japan
| | - Atsushi Inaba
- Department of Gastroenterology and Endoscopy, National Cancer Center Hospital East, Chiba, Japan
| | - Hironori Sunakawa
- Department of Gastroenterology and Endoscopy, National Cancer Center Hospital East, Chiba, Japan
| | - Keiichiro Nakajo
- Department of Gastroenterology and Endoscopy, National Cancer Center Hospital East, Chiba, Japan
| | - Tatsuro Murano
- Department of Gastroenterology and Endoscopy, National Cancer Center Hospital East, Chiba, Japan
| | - Tomohiro Kadota
- Department of Gastroenterology and Endoscopy, National Cancer Center Hospital East, Chiba, Japan
| | - Kensuke Shinmura
- Department of Gastroenterology and Endoscopy, National Cancer Center Hospital East, Chiba, Japan
| | - Tomonori Yano
- Department of Gastroenterology and Endoscopy, National Cancer Center Hospital East, Chiba, Japan
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Liu Y, Ye F, Yang C, Jiang H. Use of in vivo Raman spectroscopy and cryoablation for diagnosis and treatment of bladder cancer. Spectrochim Acta A Mol Biomol Spectrosc 2024; 308:123707. [PMID: 38043292 DOI: 10.1016/j.saa.2023.123707] [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] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Revised: 11/13/2023] [Accepted: 11/27/2023] [Indexed: 12/05/2023]
Abstract
Transurethral resection of bladder tumor (TURBT) is the first-line treatment option for non-muscle invasive bladder cancer (NMIBC), but residual tumor often remains after TURBT, thereby leading to cancer recurrence. Here, we introduce combined use of in vivo Raman spectroscopy and in vivo cryoablation as a new approach to detect and remove residual bladder tumor during TURBT. Bladder cancer (BCa) patients treated with TURBT at our urological department between Dec 2019 and Jan 2021 were collected. First, Raman signals were collected from 74 BCa patients to build reference spectra of normal bladder tissue and of bladder cancers of different pathological types. Then, another 53 BCa patients were randomly categorized into two groups, 26 patients accepted traditional TURBT, 27 patients accepted TURBT followed by Raman scanning and cryoablation if Raman detected existence of residual tumor. The recurrence rates of the two groups until Oct 2022 were compared. Raman was capable of discriminating normal bladder tissue and BCa with a sensitivity and specificity of 90.5% and 80.8 %; and discriminating invasive (T1, T2) and noninvasive (Ta) BCa with a sensitivity and specificity of 83.3 % and 87.3 %. During follow-up, 2 in 27 patients had cancer recurrence in Raman-Cryoablation group, while 8 in 26 patients had cancer recurrence in traditional TURBT group. Combined use of Raman and cryoablation significantly reduced cancer recurrence (p = 0.0394). Raman and cryoablation can serve as an adjuvant therapy to TURBT to improve therapeutic effects and reduce recurrence rate.
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Affiliation(s)
- Yufei Liu
- Department of Urology, Huashan Hospital, Fudan University, Shanghai 200040, China.
| | - Fangdie Ye
- Department of Urology, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Chen Yang
- Department of Urology, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Haowen Jiang
- Department of Urology, Huashan Hospital, Fudan University, Shanghai 200040, China.
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Barbagallo GM, Maione M, Peschillo S, Signorelli F, Visocchi M, Sortino G, Fiumanò G, Certo F. Intraoperative computed tomography, navigated ultrasound, 5-amino-levulinic acid fluorescence and neuromonitoring in brain tumor surgery: overtreatment or useful tool combination? J Neurosurg Sci 2024; 68:31-43. [PMID: 31298506 DOI: 10.23736/s0390-5616.19.04735-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [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: 11/08/2022]
Abstract
BACKGROUND Brain tumor surgery is routinely supported by several intraoperative techniques, such as fluorescence, brain mapping and neuronavigation, which are often used independently. Efficacy of navigation is limited by the brain-shift phenomenon, particularly in cases of large or deep-sited lesions. Intraoperative imaging was introduced also to update neuronavigation data, to try and solve the brain-shift phenomenon-related pitfalls and increase overall safety. Nevertheless, each intraoperative imaging modality has some intrinsic limitations and technical shortcomings, making its clinical use challenging. We used a multimodal intraoperative imaging protocol to update neuronavigation, based on the combination of intraoperative Ultrasound (i-US) and intraoperative Computed Tomography (i-CT) integrated with 5-ALA fluorescence and neuromonitoring-guided resection. METHODS This is a pilot study on 52 patients (29 men), including four children, with a mean age of 57.67 years, suffering from brain low- (N.=10) or high-grade (N.=34) glioma or metastasis (N.=8), prospectively and consecutively enrolled. They underwent 5-ALA fluorescence-guided microsurgical tumor resection and neuromonitoring was used in cases of lesions located in eloquent areas, according to preoperative clinical and neuroradiological features. Navigated B-mode ultrasound acquisition was carried out after dural opening to identify the lesion. After tumor resection, i-US was used to identify residual tumor. Following further tumor resection or in cases of unclear US images, post-contrast i-CT was performed to detect and localize small tumor remnants and to allow further correction for brain shift. A final i-US check was performed to verify the completeness of resection. Clinical evaluation was based on comparison of pre- and postoperative Karnofsky Performance Score (KPS) and assessment of overall survival (OS) and progression-free survival (PFS). Extent of tumor resection (EOTR) was evaluated by volumetric postoperative Magnetic Resonance performed within 48 h after surgery. RESULTS Forty-one of the 52 (78.8%) patients were alive and still under follow-up in December 2017. 5-ALA was strongly or vaguely positive in 45 cases (86.5%). Seven lesions (four low-grade glioma, one high-grade glioma, and two metastases) were not fluorescent. i-US visualized residual tumor after resection of all fluorescent or pathological tissue in 22 cases (42.3%). After i-US guided resection, i-CT documented the presence of further residual tumor in 11 cases (21.1%). Mean EOTR was 98.79% in the low-grade gliomas group, 99.84% in the high-grade gliomas group and 100% in the metastases group. KPS changed from 77.88, preoperatively, to 72.5, postoperatively. At the last follow-up, mean KPS was 84.23. CONCLUSIONS The combination of different intraoperative imaging modalities may increase brain tumor safety and extent of resection. In particular, i-US seems to be highly sensitive to detect residual tumors, but it may generate false positives due to artifacts. Conversely, i-CT is more specific to localize remnants, allowing a more reliable updating of navigation data.
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Affiliation(s)
- Giuseppe M Barbagallo
- Department of Neurological Surgery, Policlinico "G. Rodolico" University Hospital, Catania, Italy -
- Interdisciplinary Research Center on Brain Tumors Diagnosis and Treatment, University of Catania, Catania, Italy -
| | - Massimiliano Maione
- Department of Neurological Surgery, Policlinico "G. Rodolico" University Hospital, Catania, Italy
| | - Simone Peschillo
- Department of Neurological Surgery, Policlinico "G. Rodolico" University Hospital, Catania, Italy
- Interdisciplinary Research Center on Brain Tumors Diagnosis and Treatment, University of Catania, Catania, Italy
| | - Francesco Signorelli
- Department of Neurosurgery, Policlinico di Bari University Hospital, Bari, Italy
| | - Massimiliano Visocchi
- Institute of Neurosurgery, Sacred Heart Catholic University, Rome, Italy
- Department of Radiodiagnostics and Oncological Radiotherapy, Policlinico Vittorio Emanuele University Hospital, Catania, Italy
| | - Giuseppe Sortino
- Interdisciplinary Research Center on Brain Tumors Diagnosis and Treatment, University of Catania, Catania, Italy
| | - Giuseppa Fiumanò
- Interdisciplinary Research Center on Brain Tumors Diagnosis and Treatment, University of Catania, Catania, Italy
| | - Francesco Certo
- Department of Neurological Surgery, Policlinico "G. Rodolico" University Hospital, Catania, Italy
- Interdisciplinary Research Center on Brain Tumors Diagnosis and Treatment, University of Catania, Catania, Italy
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Kim MJ, Lee GJ, Lee EJ, Lee S, Chay DB, Lee CH, Kim JH, Roh JW. Lugol's Solution Reduces Positive Margins and Residual Disease After the Large Loop Excision of Transformation Zone. J Low Genit Tract Dis 2024; 28:12-17. [PMID: 38032756 DOI: 10.1097/lgt.0000000000000784] [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: 12/02/2023]
Abstract
OBJECTIVE This study aimed to examine whether the intraoperative use of Lugol's solution reduces the proportion of positive resection margins (RMs) using the data of women who underwent large loop excision of the transformation zone (LLETZ). MATERIALS AND METHODS A total of 1,751 consecutive women with cervical intraepithelial neoplasia (CIN) who underwent LLETZ with or without Lugol's solution were retrospectively retrieved from each database of 3 university hospitals in South Korea. Outcomes included positive RMs and residual disease pathologically confirmed within 6 months after LLETZ. RESULTS Positive RMs were noted in 345 cases (19.7%). Among 1,507 women followed up, residual disease was diagnosed in 100 cases (6.6%) (69/308 cases with positive RMs; 31/1,199 cases with negative RMs). The Lugol's solution group was less likely to have positive RMs (11.8% vs 25.5%, p < .01), to require additional surgical intervention (5.4% vs 10.2%, p < .01), and to have residual disease (4.9% vs 8.0%, p = .02). On multiple logistic regression analysis, Lugol's solution reduced the proportion of positive RMs (adjusted odds ratio [aOR], 0.31). Age (50 years or older; aOR, 1.64), preconization cervical cytology (aOR, 1.53), high-risk human papillomavirus (aOR, 1.75), and CIN 2 or 3 (aOR, 2.65) were independent risk factors for margin positivity ( p < .01 for all except high-risk human papillomavirus of p = .05). CONCLUSIONS Lugol's solution optimizes CIN treatment by reducing the proportion of positive RMs and residual disease after LLETZ.
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Affiliation(s)
- Min-Jeong Kim
- Department of Obstetrics and Gynecology, CHA Hospital Ilsan Medical Center, Goyang-si, South Korea
| | | | - Eun Ji Lee
- Department of Obstetrics and Gynecology, Chung-Ang University Hospital, Seoul, South Korea
| | - Seungmee Lee
- Department of Obstetrics and Gynecology, Keimyung University School of Medicine, Daegu, South Korea
| | - Doo Byung Chay
- Department of Obstetrics and Gynecology, Sahmyook Medical Center, Seoul, South Korea
| | - Chae Hyeong Lee
- Department of Obstetrics and Gynecology, Dongguk University Ilsan Hospital, Goyang-si, South Korea
| | - Jae-Hoon Kim
- Department of Obstetrics and Gynecology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Ju-Won Roh
- Department of Obstetrics and Gynecology, CHA Hospital Ilsan Medical Center, Goyang-si, South Korea
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Yanagisawa T, Kawada T, von Deimling M, Bekku K, Laukhtina E, Rajwa P, Chlosta M, Pradere B, D'Andrea D, Moschini M, Karakiewicz PI, Teoh JYC, Miki J, Kimura T, Shariat SF. Repeat Transurethral Resection for Non-muscle-invasive Bladder Cancer: An Updated Systematic Review and Meta-analysis in the Contemporary Era. Eur Urol Focus 2024; 10:41-56. [PMID: 37495458 DOI: 10.1016/j.euf.2023.07.002] [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: 05/06/2023] [Revised: 06/04/2023] [Accepted: 07/13/2023] [Indexed: 07/28/2023]
Abstract
CONTEXT Repeat transurethral resection (reTUR) is a guideline-recommended treatment strategy in high-risk non-muscle-invasive bladder cancer (NMIBC) patients treated with transurethral resection of bladder tumor (TURBT); however, the impact of recent procedural/technological developments on reTUR outcomes has not been assessed yet. OBJECTIVE To assess the outcomes of reTUR for NMIBC in the contemporary era, focusing on whether temporal differences and technical advancement, specifically, photodynamic diagnosis and en bloc resection of bladder tumor (ERBT), affect the outcomes. EVIDENCE ACQUISITION Multiple databases were queried in February 2023 for studies investigating reTUR outcomes, such as residual tumor and/or upstaging rates, its predictive factors, and oncologic outcomes, including recurrence-free (RFS), progression-free (PFS), cancer-specific (CSS), and overall (OS) survival. We synthesized comparative outcomes adjusting for the effect of possible confounders. EVIDENCE SYNTHESIS Overall, 81 studies were eligible for the meta-analysis. In T1 patients initially treated with conventional TURBT (cTURBT) in the 2010s, the pooled rates of any residual tumors and upstaging on reTUR were 31.4% (95% confidence interval [CI]: 26.0-37.2%) and 2.8% (95% CI: 2.0-3.8%), respectively. Despite a potential publication bias, these rates were significantly lower than those in patients treated in the 1990-2000s (both p < 0.001). ERBT and visual enhancement-guided cTURBT significantly improved any residual tumor rates on reTUR compared with cTURBT based on both matched-cohort and multivariable analyses. Among studies adjusting for the effect of possible confounders, patients who underwent reTUR had better RFS (hazard ratio [HR]: 0.78, 95% CI: 0.62-0.97) and OS (HR: 0.86, 95% CI: 0.81-0.93) than those who did not, while it did not lead to superior PFS (HR: 0.74, 95% CI: 0.47-1.15) and CSS (HR: 0.94, 95% CI: 0.86-1.03). CONCLUSIONS reTUR is currently recommended for high-risk NMIBC based on the persistent high rates of residual tumors after primary resection. Improvement of resection quality based on checklist applications and recent technical/procedural advancements hold the promise to omit reTUR. PATIENT SUMMARY Recent endoscopic/procedural developments improve the outcomes of repeat resection for high-risk non-muscle-invasive bladder cancer. Further investigations are urgently needed to clarify the potential impact of the use of these techniques on the need for repeat transurethral resection in the contemporary era.
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Affiliation(s)
- Takafumi Yanagisawa
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Tatsushi Kawada
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Markus von Deimling
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Kensuke Bekku
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Ekaterina Laukhtina
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - Pawel Rajwa
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Department of Urology, Medical University of Silesia, Zabrze, Poland
| | - Marcin Chlosta
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Clinic of Urology and Urological Oncology, Jagiellonian University, Krakow, Poland
| | - Benjamin Pradere
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Department of Urology, La Croix Du Sud Hospital, Quint Fonsegrives, France
| | - David D'Andrea
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Marco Moschini
- Department of Urology, IRCCS San Raffaele Hospital and Vita-Salute San Raffaele University, Milan, Italy
| | - Pierre I Karakiewicz
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montreal Health Center, Montreal, Canada
| | - Jeremy Yuen-Chun Teoh
- S.H. Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China
| | - Jun Miki
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Takahiro Kimura
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Shahrokh F Shariat
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia; Hourani Center for Applied Scientific Research, Al-Ahliyya Amman University, Amman, Jordan; Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA; Department of Urology, Second Faculty of Medicine, Charles University, Prague, Czech Republic; Department of Urology, Weill Cornell Medical College, New York, NY, USA; Karl Landsteiner Institute of Urology and Andrology, Vienna, Austria.
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Boerner T, Carr R, Hsu M, Tan KS, Sigel C, Tang L, Harrington C, Ku GY, Ilson DH, Janjigian YY, Wu AJ, Sihag S, Bains MS, Bott MJ, Isbell JM, Park BJ, Jones DR, Molena D. Prognostic value of circumferential radial margin involvement in esophagectomy for esophageal cancer: a case series. Int J Surg 2023; 109:3251-3261. [PMID: 37549056 PMCID: PMC10651231 DOI: 10.1097/js9.0000000000000609] [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: 02/02/2023] [Accepted: 07/01/2023] [Indexed: 08/09/2023]
Abstract
BACKGROUND Residual tumor at the proximal or distal margin after esophagectomy is associated with worse survival outcomes; however, the significance of the circumferential resection margin (CRM) remains controversial. In this study, we sought to evaluate the prognostic significance of the CRM in patients with esophageal cancer undergoing resection. MATERIALS AND METHODS We identified patients who underwent esophagectomy for pathologic T3 esophageal cancer from 2000 to 2019. Patients were divided into three groups: CRM- (residual tumor >1 mm from the CRM), CRM-close (residual tumor >0 to 1 mm from the CRM), and CRM+ (residual tumor at the surgical CRM). CRM was also categorized and analyzed per the Royal College of Pathologists (RCP) and College of American Pathologists (CAP) classifications. RESULTS Of the 519 patients included, 351 (68%) had CRM-, 132 (25%) had CRM-close, and 36 (7%) had CRM+. CRM+ was associated with shorter disease-free survival [DFS; CRM+ vs. CRM-: hazard ratio (HR), 1.53 [95% CI, 1.03-2.28]; P =0.034] and overall survival (OS; CRM+ vs. CRM-: HR, 1.97 [95% CI, 1.32-2.95]; P <0.001). Survival was not significantly different between CRM-close and CRM-. After adjustment for potential confounders, CAP+ was associated with poor oncologic outcomes (CAP+ vs. CAP-: DFS: HR, 1.47 [95% CI, 1.00-2.17]; P =0.050; OS: HR, 1.93 [95% CI, 1.30-2.86]; P =0.001); RCP+ was not (RCP+ vs. RCP-: DFS: HR, 1.21 [95% CI, 0.97-1.52]; P =0.10; OS: HR, 1.21 [95% CI, 0.96-1.54]; P =0.11). CONCLUSION CRM status has critical prognostic significance for patients undergoing esophagectomy: CRM+ was associated with worse outcomes, and outcomes between CRM-close and CRM- were similar.
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Affiliation(s)
| | | | - Meier Hsu
- Department of Epidemiology and Biostatistics
| | - Kay See Tan
- Department of Epidemiology and Biostatistics
| | | | | | | | | | | | | | - Abraham J. Wu
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
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Ibrahim E, Akrmah M, Ligato S. Does a Positive Appendiceal Resection Margin in Low-Grade Appendiceal Mucinous Neoplasms, Warrant Additional Surgery? Our Institution Experience and Literature Review. Ann Surg Oncol 2023; 30:7189-7195. [PMID: 37477747 DOI: 10.1245/s10434-023-13930-5] [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] [Received: 01/13/2023] [Accepted: 06/01/2023] [Indexed: 07/22/2023]
Abstract
BACKGROUND Management of low-grade appendiceal mucinous neoplasm (LAMN) with positive resection margin is controversial. Some guidelines recommend surgical reexcision, whereas others recommend a conservative approach. The purpose of our study was to determine whether involvement of the resection margin by LAMN is a risk factor for local recurrence requiring additional surgery. DESIGN This is a retrospective study (January 2000-December 2020) of uncomplicated LAMNs with neoplastic epithelium or dissecting mucin at the resection margin. For cases treated with additional surgery, the presence of residual tumor was evaluated. Clinical follow-up was attained in all cases. We also conducted a literature review. RESULTS The study investigated 98 patients. Eight with median age of 67 (range: 45-91) years had a LAMN involving the resection margin (8.2%). Five of eight LAMNs (62.5%) with neoplastic epithelium at the margin underwent surgery, and no residual neoplasm was identified. The other three cases were followed conservatively, and no patient developed recurrence (follow-up: 18-69 months with a mean of 45 months). In a review of the literature, we identified 52 LAMNs with positive margin. Although three cases had acellular mucin and one residual LAMN in the reexcision specimen (7.7%), neither of these four cases or any of the other 46 followed conservatively had recurrence of disease. CONCLUSIONS These data suggest that for patients with uncomplicated LAMN confined to the appendix, the involvement of the appendiceal margin does not necessary lead to recurrence of LAMN, and a conservative management is a reasonable alternative.
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Affiliation(s)
- Elsayed Ibrahim
- Department of Pathology and Laboratory Medicine, Hartford Hospital, Hartford, CT, USA.
| | - Muhammad Akrmah
- Department of Pathology and Laboratory Medicine, Hartford Hospital, Hartford, CT, USA
| | - Saverio Ligato
- Department of Pathology and Laboratory Medicine, Hartford Hospital, Hartford, CT, USA
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Vega EA, Mellado S, Chirban AM, Panettieri E, Sanhueza M, Mege R, Diaz C, Brañes A, Briceño E, Viñuela E. Analysis of the Extent of Liver Oncological Extended Resection for Incidental Gallbladder Cancer: How Much Is Too Much? Ann Surg Oncol 2023; 30:6594-6600. [PMID: 37460736 DOI: 10.1245/s10434-023-13861-1] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 06/19/2023] [Indexed: 09/20/2023]
Abstract
BACKGROUND Liver resection is pivotal in treating incidental gallbladder cancer (IGBC). However, the adequate volume of liver resection remains controversial. METHODS A cross-sectional retrospective analysis was performed on resected IGBC patients between 1999 and 2018. Morbidity was evaluated according to the Clavien-Dindo classification. The theoretical volume of a 2-cm and 1.5-cm wedge liver resection was calculated (105 cm3 and 77.5 cm3, respectively) and used as reference. Overall survival (OS) was estimated using Kaplan-Meier and Cox regression analyses. RESULTS Among 111 patients re-resected for IGBC, 84 provided sufficient data to calculate liver resection volume. Patients with a resection volume ≥ 105 cm3 had a higher rate of overall morbidity (P = 0.001) and length of stay (P = 0.012), with no difference in mortality. There was no significant difference in OS according to residual cancer or T-category. A resection volume ≥ 77.5 cm3 was more frequent in T ≥ 3 than in T1-2 patients (P = 0.026), and residual cancer was higher (P = 0.041) among patients with ≥ 77.5 cm3 resected. Cox multivariate regression showed that residual cancer (HR = 11.47, P < 0.001), perineural/lymphovascular invasion (HR = 2.48, P = 0.021), and Clavien-Dindo ≥ IIIa morbidity (HR = 5.03, P = 0.003) predict worse OS, but not liver volume resection. CONCLUSION There are no significant differences in OS based on resected liver volume of IGBC, when R0 is achieved. There is a significant difference in morbidity and length of stay when liver wedges are ≥ 105 cm3, which is lost when analyzed by Clavien-Dindo ≥ IIIa. A 77.5-105 cm3 resection is indicated in ≥ T3 patients, minimizing morbidity risk, while addressing concerns of overall survival.
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Affiliation(s)
- Eduardo A Vega
- Department of Surgery, St. Elizabeth's Medical Center, Hepato-Pancreato-BiliarySurgery, Boston University School of Medicine, Boston, MA, USA.
- Department of Digestive Surgery, Hepato-Pancreato-Biliary Surgery Unit, Surgery Service, Faculty of Medicine, Sotero del Rio Hospital, Pontificia Universidad Catolica of Chile, Santiago, Chile.
| | - Sebastian Mellado
- Department of Surgery, St. Elizabeth's Medical Center, Hepato-Pancreato-BiliarySurgery, Boston University School of Medicine, Boston, MA, USA
- Tufts University School of Medicine, Boston, MA, USA
| | - Ariana M Chirban
- Department of Surgery, St. Elizabeth's Medical Center, Hepato-Pancreato-BiliarySurgery, Boston University School of Medicine, Boston, MA, USA
- University of California San Diego School of Medicine, San Diego, CA, USA
| | - Elena Panettieri
- Department of Surgery, St. Elizabeth's Medical Center, Hepato-Pancreato-BiliarySurgery, Boston University School of Medicine, Boston, MA, USA
- Hepatobiliary Surgery Unit, Fondazione "Policlinico Universitario A. Gemelli" IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Marcel Sanhueza
- Department of Digestive Surgery, Hepato-Pancreato-Biliary Surgery Unit, Surgery Service, Faculty of Medicine, Sotero del Rio Hospital, Pontificia Universidad Catolica of Chile, Santiago, Chile
- Department of Digestive Surgery, Faculty of Medicine, Catholic University of Chile, Santiago, Chile
| | - Rosemarie Mege
- Department of Digestive Surgery, Hepato-Pancreato-Biliary Surgery Unit, Surgery Service, Faculty of Medicine, Sotero del Rio Hospital, Pontificia Universidad Catolica of Chile, Santiago, Chile
- Department of Digestive Surgery, Faculty of Medicine, Catholic University of Chile, Santiago, Chile
| | - Cristian Diaz
- Department of Digestive Surgery, Hepato-Pancreato-Biliary Surgery Unit, Surgery Service, Faculty of Medicine, Sotero del Rio Hospital, Pontificia Universidad Catolica of Chile, Santiago, Chile
- Department of Digestive Surgery, Faculty of Medicine, Catholic University of Chile, Santiago, Chile
| | - Alejandro Brañes
- Department of Digestive Surgery, Hepato-Pancreato-Biliary Surgery Unit, Surgery Service, Faculty of Medicine, Sotero del Rio Hospital, Pontificia Universidad Catolica of Chile, Santiago, Chile
- Department of Digestive Surgery, Faculty of Medicine, Catholic University of Chile, Santiago, Chile
| | - Eduardo Briceño
- Department of Digestive Surgery, Faculty of Medicine, Catholic University of Chile, Santiago, Chile
| | - Eduardo Viñuela
- Department of Digestive Surgery, Hepato-Pancreato-Biliary Surgery Unit, Surgery Service, Faculty of Medicine, Sotero del Rio Hospital, Pontificia Universidad Catolica of Chile, Santiago, Chile.
- Department of Digestive Surgery, Faculty of Medicine, Catholic University of Chile, Santiago, Chile.
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Giray B, Kabaca C, Uzun MG. The characteristics of the residual disease after cervical conization: A retrospective analysis from a tertiary gynecological cancer center. Indian J Cancer 2023; 60:390-395. [PMID: 36861714 DOI: 10.4103/ijc.ijc_238_20] [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] [Indexed: 12/03/2022]
Abstract
Background Patients with a biopsy-confirmed cervical intraepithelial neoplasia 2 and 3 have an increased risk of disease progression to invasive cancer and should be treated with an excisional method. However, after treatment with an excisional method, a high-grade residual lesion may remain in patients with positive surgical margins. We aimed to investigate the risk factors for a residual lesion in patients with a positive surgical margin after cervical cold knife conization. Methods Records of 1008 patients who underwent conization at a tertiary gynecological cancer center were retrospectively reviewed. One hundred and thirteen patients with a positive surgical margin after cold knife conization were included in the study. We have retrospectively analyzed the characteristics of the patients treated with re-conization or hysterectomy. Results Residual disease was identified in 57 (50.4%) patients. The mean age of the patients with residual disease was 42.47 ± 8.75 years. Age greater than 35 years (P = 0.002; OR, 4.926; 95%CI [Confidence Interval] - 1.681-14.441), more than one involved quadrant (P = 0.003; OR, 3.200; 95% CI - 1.466-6.987), and glandular involvement (P = 0.002; OR, 3.348; 95% CI - 1.544-7.263) were risk factors for residual disease. The rate of high-grade lesion positivity in post-conization endocervical biopsy at initial conization was similar between patients with and without residual disease (P = 0.16). The final pathology of the residual disease was microinvasive cancer in four patients (3.5%) and invasive cancer in one patient (0.9%). Conclusion In conclusion, residual disease is found in about half of the patients with a positive surgical margin. In particular, we found that age greater than 35 years, glandular involvement, and more than 1 involved quadrant were associated with the residual disease.
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Affiliation(s)
- Burak Giray
- Department of Gynaecologic Oncology, University of Health Sciences, Zeynep Kamil Training and Research Hospital, Istanbul, Turkey
| | - Canan Kabaca
- Department of Gynaecologic Oncology, University of Health Sciences, Zeynep Kamil Training and Research Hospital, Istanbul, Turkey
| | - Mine Guray Uzun
- Department of Gynaecologic Oncology, University of Health Sciences, Zeynep Kamil Training and Research Hospital, Istanbul, Turkey
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Samanci Y, Essibayi MA, Askeroglu MO, Budak M, Karaköse F, Peker S. Frameless Hypofractionated Gamma Knife Radiosurgery for Residual or Recurrent Craniopharyngioma. Neurosurgery 2023; 93:102-111. [PMID: 36722947 DOI: 10.1227/neu.0000000000002382] [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] [Received: 09/21/2022] [Accepted: 12/04/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND The management of craniopharyngiomas is challenging, usually requiring multidisciplinary care. Gamma Knife radiosurgery (GKRS) is an essential technique for residual/recurrent craniopharyngiomas. OBJECTIVE To evaluate the efficacy of frameless hypofractionated GKRS (hfGKRS) for craniopharyngioma and factors which affect tumor control and complications. METHODS This retrospective study involved 24 patients managed with hfGKRS. Clinical and radiological data, tumor characteristics, and procedural details were analyzed. RESULTS There were 15 (62.5%) female patients. The median age was 38.5 years (range, 3-66 years). The mean tumor volume was 2.4 (1.93) cm 3 , with a mean solid volume of 1.6 (1.75) cm 3 . The median marginal dose was 20 Gy (range, 18-25 Gy) delivered in a median of 5 fractions (range, 3-5). During a median radiological follow-up of 23.5 months (range, 12-50 months), tumor progression was noted in 5 (20.8%) patients. The 2-year and 4-year progression-free survival were 81.8% and 61.4%, respectively. No deaths were identified at a median clinical follow-up of 31.3 months (range, 12-54 months). Visual deficits attributable to progression were noted in 3 (12.5%) patients with pre-GKRS visual field defects. An additional 4 (16.7%) patients with pre-GKRS visual deficit developed new minor visual field defects. Four (16.7%) patients showed improvement of vision after GKRS. There were no new-onset post-GKRS hormonal deficits. CONCLUSION The management of craniopharyngioma requires a multidisciplinary approach, and irradiation represents effective treatment option for residual/recurrent tumors after surgery. To the best of our knowledge, this is the first study that addresses the efficacy of frameless hfGKRS in managing craniopharyngiomas over sufficient follow-up.
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Affiliation(s)
- Yavuz Samanci
- Department of Neurosurgery, Koç University Hospital, Istanbul, Turkey
- Department of Neurosurgery, Gamma Knife Center, Koç University Hospital, Istanbul, Turkey
| | - Muhammed Amir Essibayi
- Department of Neurosurgery, Gamma Knife Center, Koç University Hospital, Istanbul, Turkey
| | - Mehmet Orbay Askeroglu
- Department of Neurosurgery, Gamma Knife Center, Koç University Hospital, Istanbul, Turkey
| | - Mustafa Budak
- Department of Radiation Oncology, Koç University Hospital, Istanbul, Turkey
| | - Fatih Karaköse
- Department of Radiation Oncology, Koç University Hospital, Istanbul, Turkey
| | - Selcuk Peker
- Department of Neurosurgery, Gamma Knife Center, Koç University Hospital, Istanbul, Turkey
- Department of Neurosurgery, School of Medicine, Koç University, Istanbul, Turkey
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Diaz S, Starnoni D, Tuleasca C, Dunet V, Peters D, Messerer M, Levivier M, Daniel RT. Radiological Evolution of Fat Graft Used for Optic Neuropexy During Surgery for Parasellar Meningiomas. Neurosurgery 2023; 92:1208-1215. [PMID: 36700760 PMCID: PMC10150850 DOI: 10.1227/neu.0000000000002351] [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: 08/22/2022] [Accepted: 11/08/2022] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Stereotactic radiosurgery (SRS) is an effective adjuvant therapy for residual tumor after subtotal resection of parasellar meningiomas. Fat graft placement between the optic nerve/chiasm and residual tumor (optic neuropexy [OPN]) allows for safe SRS therapy. OBJECTIVE To evaluate the radiological temporal profile of the fat graft after OPN, immediately after surgery and at 3, 6, and 12 months intervals, to elucidate the optimal time point of adjuvant SRS. METHODS A single-center, retrospective, cohort study of 23 patients after surgery for parasellar meningioma was conducted. Fat graft volume and MRI signal ratios were calculated. SRS dosimetric parameters (tumor/optic nerve) were measured at the time of SRS and compared with a hypothetical dosimetric plan based on an early postoperative MRI. RESULTS Of 23 patients, 6 (26%) had gross total resection and 17 (74%) had subtotal resection. Fat grafts showed a progressive loss of volume and signal ratio over time. Radiosurgery was performed in 14 (82.3%; 8 hypofractionated radiosurgery and 6 single fraction). At 3 months, there is a loss of 46% of the fat volume and degradation of its tissue intensity, decreasing differentiation from tumor and nerve. The hypothetical treatment plan (performed on an early postoperative MRI) showed that single-fraction SRS would have been possible in 6 of the 8 hypofractionated cases. CONCLUSION OPN is a technique that can be safely performed after resection of parasellar meningiomas. Because of the reduction of the fat volume and tissue differentiation between fat and tumor/nerves, adjuvant radiosurgery is better performed within the first 3 months after surgery.
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Affiliation(s)
- Simon Diaz
- Department of Neurosurgery, University Hospital of Lausanne and Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - Daniele Starnoni
- Department of Neurosurgery, University Hospital of Lausanne and Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - Constantin Tuleasca
- Department of Neurosurgery, University Hospital of Lausanne and Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
- Signal Processing Laboratory (LTS 5), Ecole Polytechnique Fédérale de Lausanne (EPFL) Lausanne, Lausanne, Switzerland
| | - Vincent Dunet
- Department of Medical Radiology, University Hospital of Lausanne and Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - David Peters
- Department of Neurosurgery, University Hospital of Lausanne and Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - Mahmoud Messerer
- Department of Neurosurgery, University Hospital of Lausanne and Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - Marc Levivier
- Department of Neurosurgery, University Hospital of Lausanne and Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - Roy Thomas Daniel
- Department of Neurosurgery, University Hospital of Lausanne and Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
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Pfob A, Heil J. Artificial intelligence to de-escalate loco-regional breast cancer treatment. Breast 2023; 68:201-204. [PMID: 36842193 PMCID: PMC9988657 DOI: 10.1016/j.breast.2023.02.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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: 11/24/2022] [Revised: 02/14/2023] [Accepted: 02/18/2023] [Indexed: 02/22/2023] Open
Abstract
In this review, we evaluate the potential and recent advancements in using artificial intelligence techniques to de-escalate loco-regional breast cancer therapy, with a special focus on surgical treatment after neoadjuvant systemic treatment (NAST). The increasing use and efficacy of NAST make the optimal loco-regional management of patients with pathologic complete response (pCR) a clinically relevant knowledge gap. It is hypothesized that patients with pCR do not benefit from therapeutic surgery because all tumor has already been eradicated by NAST. It is unclear, however, how residual cancer after NAST can be reliably excluded prior to surgery to identify patients eligible for omitting breast cancer surgery. Evidence from clinical trials evaluating the potential of imaging and minimally-invasive biopsies to exclude residual cancer suggests that there is a high risk of missing residual cancer. More recently, AI-based algorithms have shown promising results to reliably exclude residual cancer after NAST. This example illustrates the great potential of AI-based algorithms to further de-escalate and individualize loco-regional breast cancer treatment.
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Affiliation(s)
- André Pfob
- Department of Obstetrics & Gynecology, Heidelberg University Hospital, Germany; National Center for Tumor Diseases (NCT) and German Cancer Research Center (DKFZ), Heidelberg, Germany.
| | - Joerg Heil
- Department of Obstetrics & Gynecology, Heidelberg University Hospital, Germany; Breast Centre Heidelberg, Klinik St. Elisabeth, Heidelberg, Germany
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Kerschbaumer J, Demetz M, Krigers A, Pinggera D, Spinello A, Thomé C, Freyschlag CF. Mind the gap-the use of sodium fluoresceine for resection of brain metastases to improve the resection rate. Acta Neurochir (Wien) 2023; 165:225-230. [PMID: 36369398 PMCID: PMC9840582 DOI: 10.1007/s00701-022-05417-1] [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] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Accepted: 10/30/2022] [Indexed: 11/13/2022]
Abstract
INTRODUCTION AND PURPOSE Brain metastases appear to be well resectable due to dissectable tumor margins, but postoperative MRI quite often depicts residual tumor with potential influence on tumor control and overall survival. Therefore, we introduced sodium fluoresceine into the routine workflow for brain metastasis resection. The aim of this study was to evaluate whether the use of fluorescence-guided surgery has an impact on postoperative tumor volume and local recurrence. MATERIAL AND METHODS We retrospectively included patients who underwent surgical resection for intracranial metastases of systemic cancer between 11/2017 and 05/2021 at our institution. Tumor volumes were assessed pre- and postoperatively on T1-CE MRI. Clinical and epidemiological data as well as follow-up were gathered from our prospective database. RESULTS Seventy-nine patients (33 male, 46 female) were included in this study. Median preoperative tumor volume amounted to 11.7cm3 and fluoresceine was used in 53 patients (67%). Surgeons reported an estimated gross total resection (GTR) in 95% of the cases, while early postoperative MRI could confirm GTR in 72%. Patients resected using fluoresceine demonstrated significantly lower postoperative residual tumor volumes with a difference of 0.7cm3 (p = 0.044) and lower risk of local tumor recurrence (p = 0.033). The use of fluorescence did not influence the overall survival (OS). Postoperative radiotherapy resulted in a significantly longer OS (p = 0.001). DISCUSSION While GTR rates may be overrated, the use of intraoperative fluorescence may help neurosurgeons to achieve a more radical resection. Fluoresceine seems to facilitate surgical resection and increase the extent of resection thus reducing the risk for local recurrence.
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Affiliation(s)
- Johannes Kerschbaumer
- Department of Neurosurgery, Medical University of Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria
| | - Matthias Demetz
- Department of Neurosurgery, Medical University of Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria.
| | - Aleksandrs Krigers
- Department of Neurosurgery, Medical University of Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria
| | - Daniel Pinggera
- Department of Neurosurgery, Medical University of Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria
| | - Antonio Spinello
- Department of Neurosurgery, Medical University of Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria
| | - Claudius Thomé
- Department of Neurosurgery, Medical University of Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria
| | - Christian F Freyschlag
- Department of Neurosurgery, Medical University of Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria
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Kobyletskaya TM, Chuguev AS, Zaytsev AM, Kaprin AD, Datsenko PV. [Extent of resection in patients with glioblastoma]. Zh Vopr Neirokhir Im N N Burdenko 2023; 87:63-68. [PMID: 37830470 DOI: 10.17116/neiro20238705163] [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] [Subscribe] [Scholar Register] [Indexed: 10/14/2023]
Abstract
OBJECTIVE To investigate the impact of resection quality on subsequent survival of patients with glioblastoma. MATERIAL AND METHODS There were 141 patients with morphologically confirmed glioblastoma (grade 4). Fractionation with the prescribed dose of 2 and 3 Gy was alternately used (pairwise modeling strategy). Total resection was performed in 29.8% of patients (EOR: 100%; n=42), subtotal - 56.7% (EOR: 70-99%; n=80). Extent of resection 1-69% was registered in 19 patients (13.5%). RESULTS As of December 2022, 124 out of 141 patients (87.9%) were diagnosed with primary progression, 101 (71.6%) ones died. We analyzed the threshold role of EOR. The most informative level was 70% (p=0.002). EOR 100% was followed by median overall survival about 32.2 months (95% Cl: 15.3-49.1), EOR 70-99% - 21.3 months (95% Cl: 15.1-27.5), EOR 1-69% - 10.3 months (95% Cl: 3.8-16.9; p=0.003). Fractionation mode with the prescribed dose of 3 Gy partially eliminated significance of EOR (p=0.148) in contrast to standard fractionation (p=0.015). Tumor growth in the interval between surgery and radiotherapy (REP) reduces significance of EOR (p=0.042). Inclusion of second-line therapy with bevacizumab in multivariate analysis model (OR=0.488; p=0.002) makes EOR less significant (OR=0.749; p=0.085) in contrast to REP (OR=2.482; p<0.0001). CONCLUSION To date, the principle of maximum safe resection remains fundamental in neurosurgery. EOR about 70% is sufficient regarding overall survival, but total resection should be sought if possible.
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Affiliation(s)
| | - A S Chuguev
- Herzen Moscow Oncology Research Institute, Moscow, Russia
| | - A M Zaytsev
- Herzen Moscow Oncology Research Institute, Moscow, Russia
| | - A D Kaprin
- Herzen Moscow Oncology Research Institute, Moscow, Russia
| | - P V Datsenko
- Herzen Moscow Oncology Research Institute, Moscow, Russia
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Kim AA, Dono A, Khalafallah AM, Nettel-Rueda B, Samandouras G, Hadjipanayis CG, Mukherjee D, Esquenazi Y. Early repeat resection for residual glioblastoma: decision-making among an international cohort of neurosurgeons. J Neurosurg 2022; 137:1618-1627. [PMID: 35364590 PMCID: PMC10972535 DOI: 10.3171/2022.1.jns211970] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 01/31/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The importance of extent of resection (EOR) in glioblastoma (GBM) has been thoroughly demonstrated. However, few studies have explored the practices and benefits of early repeat resection (ERR) when residual tumor deemed resectable is unintentionally left after an initial resection, and the survival benefit of ERR is still unknown. Herein, the authors aimed to internationally survey current practices regarding ERR and to analyze differences based on geographic location and practice setting. METHODS The authors distributed a survey to the American Association of Neurological Surgeons and Congress of Neurological Surgeons Tumor Section, Society of British Neurological Surgeons, European Association of Neurosurgical Society, and Latin American Federation of Neurosurgical Societies. Neurosurgeons responded to questions about their training, practice setting, and current ERR practices. They also reported the EOR threshold below which they would pursue ERR and their likelihood of performing ERR using a Likert scale of 1-5 (5 being the most likely) in two sets of 5 cases, the first set for a patient's initial hospitalization and the second for a referred patient who had undergone resection elsewhere. The resection likelihood index for each respondent was calculated as the mean Likert score across all cases. RESULTS Overall, 180 neurosurgeons from 25 countries responded to the survey. Neurosurgeons performed ERRs very rarely in their practices (< 1% of all GBM cases), with an EOR threshold of 80.2% (75%-95%). When presented with 10 cases, the case context (initial hospitalization vs referred patient) did not significantly change the surgeon ERR likelihood, although ERR likelihood did vary significantly on the basis of tumor location (p < 0.0001). Latin American neurosurgeons were more likely to pursue ERR in the provided cases. Neurosurgeons were more likely to pursue ERR when the tumor was MGMT methylated versus unmethylated, with a resection likelihood index of 3.78 and 3.21, respectively (p = 0.004); however, there was no significant difference between IDH mutant and IDH wild-type tumors. CONCLUSIONS Results of this survey reveal current practices regarding ERR, but they also demonstrate the variability in how neurosurgeons approach ERR. Standardized guidelines based on future studies incorporating tumor molecular characteristics are needed to guide neurosurgeons in their decision-making on this complicated issue.
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Affiliation(s)
- Anya A. Kim
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Antonio Dono
- Vivian L. Smith Department of Neurosurgery, McGovern Medical School, The University of Texas Health Science Center at Houston, Texas
| | - Adham M. Khalafallah
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Barbara Nettel-Rueda
- Department of Neurosurgery, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Mexican Social Security Institute, México City, México
| | - George Samandouras
- Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, Queen Square, London, United Kingdom
| | - Constantinos G. Hadjipanayis
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, New York
| | - Debraj Mukherjee
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Yoshua Esquenazi
- Vivian L. Smith Department of Neurosurgery, McGovern Medical School, The University of Texas Health Science Center at Houston, Texas
- Memorial Hermann Hospital-Texas Medical Center, Houston, Texas
- Center for Precision Health, School of Biomedical Informatics, The University of Texas Health Science Center at Houston, Texas
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Abstract
OBJECTIVE The purpose of this study was to assess if cytology can be omitted in the follow-up after treatment for cervical intraepithelial neoplasia grade 2 or worse (CIN2+) and if human papillomavirus (HPV) test can be used alone as test of cure (TOC) after stratifying for resection margins. MATERIAL AND METHODS In this retrospective register-based study, women who had a conization performed in Denmark between January 1 and December 31, 2013, were included. Histology, cytology, and HPV test results were obtained from The Danish Pathology Data Bank for a 3-year follow-up. RESULTS A total of 5,174 women were included, of whom 6.1% (318/5,174) had histological residual/recurrent disease in the follow-up period. In the group with free margins, 2.6% (73/2,780) had residual/recurrent disease in contrast to 10.2% (245/2,394) in the group with involved margins. In the group with free resection margins and negative HPV test results, residual/recurrent disease was found in 0.5% (13/2,780) compared with 0.3% (9/2,780) in the group with negative HPV test results and normal cytology at 6 months' follow-up. Based on margin status and HPV test result as follow-up, the sensitivity, specificity, and positive and negative predictive values were 95.9%, 43.2%, 10.0%, and 99.4% respectively, and for combined testing (margin status, HPV, and cytology), 97.2%, 41.2%, 9.8%, and 99.6%, respectively. CONCLUSIONS Using the HPV test at the first post-treatment control as TOC for cervical intraepithelial neoplasia grade 2 or worse after stratifying for resection margins in cone resections yields an equally high sensitivity and negative predictive value as cotesting with cytology. We suggest that women with free resection margins return to the routine screening program after negative HPV test result as TOC at 6 months.
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Affiliation(s)
- Lærke Valsøe Bruhn
- Department of Pathology, Southern Jutland Hospital, Denmark
- Department of Pathology, Odense University Hospital, Denmark
- OPEN Open Patient Data Explorative Network, Odense University Hospital, Denmark
| | - Nana Hyldig
- Department of Hematology, Odense University Hospital, Denmark
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Hwang ES, Beitsch P, Blumencranz P, Carr D, Chagpar A, Clark L, Dekhne N, Dodge D, Dyess DL, Gold L, Grobmyer S, Hunt K, Karp S, Lesnikoski BA, Wapnir I, Smith BL. Clinical Impact of Intraoperative Margin Assessment in Breast-Conserving Surgery With a Novel Pegulicianine Fluorescence-Guided System: A Nonrandomized Controlled Trial. JAMA Surg 2022; 157:573-580. [PMID: 35544130 PMCID: PMC9096689 DOI: 10.1001/jamasurg.2022.1075] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Importance Positive margins following breast-conserving surgery (BCS) are often identified on standard pathology evaluation. Intraoperative assessment of the lumpectomy cavity has the potential to reduce residual disease or reexcision rate following standard of care BCS in real time. Objective To collect safety and initial efficacy data on the novel pegulicianine fluorescence-guided system (pFGS) when used to identify residual cancer in the tumor bed of female patients undergoing BCS. Design, Setting, and Participants This prospective single-arm open-label study was conducted as a nonrandomized multicenter controlled trial at 16 academic or community breast centers across the US. Female patients 18 years and older with newly diagnosed primary invasive breast cancer or ductal carcinoma in situ DCIS undergoing BCS were included, excluding those with previous breast cancer surgery and a history of dye allergies. Of 283 consecutive eligible patients recruited, 234 received a pegulicianine injection and were included in the safety analysis; of these, 230 were included in the efficacy analysis. Patients were enrolled between February 6, 2018, and April 10, 2020, and monitored for a 30-day follow-up period. Data were analyzed from April 10, 2020, to August 5, 2021. Interventions Participants received an injection of a novel imaging agent (pegulicianine) a mean (SD) of 3.2 (0.9) hours prior to surgery at a dose of 1 mg/kg. After completing standard of care (SOC) excision, pFGS was used to scan the lumpectomy cavity to guide the removal of additional shave margins. Main Outcomes and Measures Adverse events and sensitivity, specificity, and reexcision rate. Results Of 234 female patients enrolled (median [IQR] age, 62.0 [55.0-69.0] years), 230 completed the trial and 1 patient with a history of allergy to contrast agents had an anaphylactic reaction and recovered without sequelae. Correlation of pFGS with final margin status on a per-margin analysis showed a marked improvement in sensitivity over standard pathology assessment of the main lumpectomy specimen (69.4% vs 38.2%, respectively). On a per-patient level, the false-negative rate of pFGS was 23.7% (9 of 38), and sensitivity was 76.3% (29 of 38). Among 32 patients who underwent excision of pFGS-guided shaves, pFGS averted the need for reexcision in 6 (19%). Conclusions and Relevance In this pilot feasibility study, the safety profile of pegulicianine was consistent with other imaging agents used in BCS, and was associated with a reduced need for second surgery in patients who underwent intraoperative additional excision of pFGS-guided shaves. These findings support further development and clinical performance assessment of pFGS in a prospective randomized trial. Trial Registration ClinicalTrials.gov Identifier: NCT03321929.
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Affiliation(s)
- E. Shelley Hwang
- Duke Cancer Institute and Duke University Health System, Durham, North Carolina
| | | | - Peter Blumencranz
- The Comprehensive Breast Care Center, BayCare Medical Group, Clearwater, Florida
| | - David Carr
- Novant Health, Winston-Salem, North Carolina
| | | | | | | | | | - Donna L. Dyess
- Mitchell Cancer Institute, University of South Alabama, Mobile
| | | | | | - Kelly Hunt
- MD Anderson Cancer Center, Houston, Texas
| | - Stephen Karp
- Beth Israel Lahey Health, Burlington, Massachusetts
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Deguelte S, Hammoutene C, Poncet G, Brunaud L, Perrier M, Kianmanesh R, Cadiot G. Concept of reintervention with thorough lymphadenectomy after suboptimal resection of small-intestine neuroendocrine neoplasms: A multicentre preliminary study. J Neuroendocrinol 2022; 34:e13117. [PMID: 35434838 DOI: 10.1111/jne.13117] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 01/09/2022] [Accepted: 02/05/2022] [Indexed: 11/26/2022]
Abstract
Complete surgical resection is the only hope to cure small intestine neuroendocrine neoplasms (SiNENs). However, inadequate lymphadenectomy or entire small bowel palpation for multiple primary tumours renders at least 20% of resections suboptimal. This study was undertaken to investigate reintervention outcomes after initial suboptimal resections (ISORs), and agreement between residual tumour identification on interval imaging and during reintervention. This retrospective, multicentre study included all patients undergoing reintervention within 18 months post ISOR. Disease-free survival (DFS) was defined as the time from reintervention resection date to recurrence or any-cause of death. The kappa coefficient assessed agreement rates between suspected residual tumour on interval imaging and its presence at reintervention. A total of 21 patients underwent reintervention for nonmetastatic SiNENs (median follow-up 2.3 [IQR 0.6-3.75] years). Residual tumour, suspected in 17/21 (81%) patients based on interval imaging, was found in 20/21 (95%) during reintervention. Interval imaging-intraoperative detection agreement was fair for residual primary tumours (kappa = 0.28, 95% CI: 0.05-0.62; p = .09) and residual lymph node metastases (kappa = 0.17, 95% CI: 0.28-0.62; p = .45). Reintervention achieved complete tumour clearance in 16/21 (76%) patients, among whom 5/16 (31%) developed liver metastases during follow-up. Median DFS was 70.6 months (IQR 39.7-not reached). Reintervention post-ISOR can obtain tumour clearance and prolonged remission. It should be systematically discussed after suspected ISOR, even when postoperative imaging does not find any residual tumour. To maximize detection of potentially resectable residual disease, imaging modalities after "curative" surgery should be redefined.
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Affiliation(s)
- Sophie Deguelte
- Department of Endocrine, Digestive and Oncological Surgery, Robert-Debré University Hospital, Reims, France
- Faculty of Medicine, UR 3797 Ageing, Frailty (VieFra), University of Reims Champagne-Ardenne, Reims, France
- Reims Medical School, University of Champagne Ardennes, Reims, France
| | - Cheryne Hammoutene
- Department of Endocrine, Digestive and Oncological Surgery, Robert-Debré University Hospital, Reims, France
| | - Gilles Poncet
- Digestive and Oncologic Surgery, Edouard-Herriot University Hospital, Claude-Bernard Lyon 1 University, Lyon, France
| | - Laurent Brunaud
- Department of Digestive, Hepato-Biliary and Endocrine Surgery, University Hospital Nancy Brabois, Vandoeuvre-les-Nancy, France
| | - Marine Perrier
- Department of Hepato-Gastro-Enterology, Robert-Debré University Hospital, Reims, France
| | - Reza Kianmanesh
- Department of Endocrine, Digestive and Oncological Surgery, Robert-Debré University Hospital, Reims, France
- Reims Medical School, University of Champagne Ardennes, Reims, France
| | - Guillaume Cadiot
- Reims Medical School, University of Champagne Ardennes, Reims, France
- Department of Hepato-Gastro-Enterology, Robert-Debré University Hospital, Reims, France
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Žemličková B, Brisuda A. Prognostic factors of early second transurethral resection of non-muscle invasive bladder cancer − 10 years of experience of a referral center. Persp In Surg 2022; 101:119-128. [PMID: 35387468 DOI: 10.33699/pis.2022.101.3.119-128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Introduction: Urothelial bladder cancer invading the submucosal layer (T1) is a tumor with a high risk of progression to invasive disease. In case of pT1 histology or absence of detrusor muscle in the specimen, an early second resection of the bladder tumor (reTUR) is indicated. According to retrospective studies, the histology finding of reTUR has a prognostic value. The aim of this study is to present the outcomes of second resection at a tertiary referral center.
Methods: In total, 146 patients with non-muscle invasive bladder cancer (NMIBC) were analyzed retrospectively. These patients underwent (the first) transurethral resection of their bladder tumor and an early reTUR between 3/2010 and 2/2021. Recurrence, progression and cystectomy free survival rates (RFS, PFS, CFS) were calculated using the Kaplan-Meier curves and the correlation of 7 clinical and pathologic factors (age, gender, muscle in specimen, presence of residual tumor and carcinoma in situ in reTUR, intravesical chemotherapy and BCG therapy) was evaluated using univariate and multivariate analyses.
Results: Median RFS was 2.15 years, 1-year RFS was 66.9% and 3-year RFS was 43.4%. One-year and 3-year PFS was 93.5% and 88.4%, respectively. One-year and 3-year CFS was 91.0% and 82.4%, respectively. Based on the multivariate analysis, presence of any residual tumor in reTUR was a negative prognostic marker for RFS, while intravesical chemotherapy and BCG therapy were positive prognostic markers. Presence of any residual tumor in reTUR was the only negative prognostic marker for PFS and CFS.
Conclusion: The quality of the first resection of bladder tumor as determined by its completeness and presence of detrusor muscle in the histology specimen is the cornerstone of an adequate diagnosis and proper treatment. If an early reTUR is indicated, presence of any residual tumor in the histology specimen is a significant prognostic marker according to our findings.
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Silva AHD, Constantinides M, Valetopoulou A, Sgardelis P, Mankad K, D'Arco F, Jankovic I, Thompson D. Paediatric spinal cord low-grade gliomas-evaluation and management of post-surgical residual disease. Childs Nerv Syst 2022; 38:577-586. [PMID: 34855000 DOI: 10.1007/s00381-021-05412-4] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 11/06/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE To assess the evaluation and management of post-surgical residual disease for low-grade intramedullary spinal cord tumours (IMSCT) in childhood. METHODS A single-centre retrospective review of low-grade IMSCTs treated between 2000 and 2019. All surgeries were performed with intent of safe maximal resection guided by intra-operative neurophysiological monitoring (IONM). Pre- and post-operative MRIs were reviewed to assess the extent of resection (EOR), recorded as follows: gross total resection (GTR), near total resection (NTR), sub-total resection (STR) and partial resection (PR). Outcome measures were time to recurrence, need for and modality of additional therapy and ambulatory status at last follow-up. RESULTS Thirty patients underwent surgery for IMSCT (median age 6.9 years). EOR was GTR = 8, NTR = 4, STR = 9, PR = 9. All patients were alive at last follow-up (median follow-up 73 months [IQR 93 months]). Eighteen patients (60%) remained radiologically stable. Twelve patients (40%) developed recurrence during surveillance. Progression free survival was significantly better in cases with GTR + NTR in comparison to either STR or PR (p = 0.039). 10/30 (33%) patients were treated with additional therapy. At last follow-up, 26/30 patients were independently mobile. CONCLUSION Survival rates for low-grade IMSCT are excellent. Radical micro-surgical resection, guided by IONM provides effective means of balancing the objectives of maximal safe resection, functional outcome and tumour control. Whilst evidence of 'residual disease' was identified in over 2/3 of immediate post-operative MRI scans, additional treatment was required in only 1/3 of cases. Critical appraisal of post-operative imaging findings is required to better define 'residual disease'. Small volume residual disease (< 5%) does not compromise progression-free survival.
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Affiliation(s)
- A H D Silva
- Department of Paediatric Neurosurgery, Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond Street, London, WC1N 3JH, UK
| | - M Constantinides
- Department of Paediatric Neurosurgery, Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond Street, London, WC1N 3JH, UK
| | - A Valetopoulou
- Department of Paediatric Neurosurgery, Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond Street, London, WC1N 3JH, UK
| | - P Sgardelis
- Department of Paediatric Neurosurgery, Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond Street, London, WC1N 3JH, UK
| | - K Mankad
- Department of Paediatric Neurosurgery, Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond Street, London, WC1N 3JH, UK
| | - F D'Arco
- Department of Paediatric Neurosurgery, Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond Street, London, WC1N 3JH, UK
| | - I Jankovic
- Department of Paediatric Neurosurgery, Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond Street, London, WC1N 3JH, UK
| | - D Thompson
- Department of Paediatric Neurosurgery, Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond Street, London, WC1N 3JH, UK.
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Di Napoli A, Firmani G, Sorotos M, Lopez G, Noccioli N, De Sanctis V, Tafuri A, Santanelli di Pompeo F. Successful Treatment of a Patient With Breast Implant-Associated Anaplastic Large Cell Lymphoma With Local Residual Disease: A Case Report. Ann Plast Surg 2022; 88:152-156. [PMID: 34711728 DOI: 10.1097/sap.0000000000003033] [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: 11/26/2022]
Abstract
BACKGROUND Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is a hematological malignancy that may occur in patients undergoing breast implant placement. It more commonly behaves as a solid tumor, and the criterion standard treatment consists in an en bloc capsulectomy, which may not always be possible, according to the location of the implant. When local residual disease is present, BIA-ALCL must be treated with adjuvant therapies. CASE PRESENTATION We describe the case of a 76-year-old woman who underwent unilateral placement of a breast implant after breast cancer surgery in 2004 and developed BIA-ALCL in 2019. A multidisciplinary team managed her case, and en bloc capsulectomy was indicated for the treatment of the malignancy. The histological report showed focal neoplastic infiltration of the posterolateral margin of resection, further supported by positron emission tomography/computed tomography scan, which showed a local uptake in the right anterolateral chest wall. Therefore, adjuvant radiotherapy treatment was indicated for the management of local residual disease, alongside a stringent follow-up protocol. More than 1 year later, imaging scans show no signs of BIA-ALCL recurrence. CONCLUSIONS Local residual disease in BIA-ALCL is bound to be a progressively more common occurrence, as awareness of BIA-ALCL increases and more cases are diagnosed worldwide. Currently, there is no established consensus on a standard approach for the treatment for patients with a higher risk of local recurrence. Our experience describes the protocol we used to successfully manage a case of BIA-ALCL with incomplete surgical margins, which hopefully can serve colleagues treating patients with similar cases.
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Affiliation(s)
- Arianna Di Napoli
- From the Pathology Unit, Department of Clinical and Molecular Medicine, Sapienza University, Sant'Andrea Hospital, Rome, Italy
| | - Guido Firmani
- Plastic Surgery Unit, Department of Neuroscience, Mental Health and Sense Organs (NESMOS), Sapienza University, Sant'Andrea Hospital, Rome
| | - Michail Sorotos
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana," University of Salerno, Salerno
| | - Gianluca Lopez
- From the Pathology Unit, Department of Clinical and Molecular Medicine, Sapienza University, Sant'Andrea Hospital, Rome, Italy
| | - Niccolò Noccioli
- From the Pathology Unit, Department of Clinical and Molecular Medicine, Sapienza University, Sant'Andrea Hospital, Rome, Italy
| | - Vitaliana De Sanctis
- Radiotherapy Oncology, Department of Medicine and Surgery and Translational Medicine, Sant'Andrea Hospital, Sapienza University, Rome, Italy
| | - Agostino Tafuri
- Hematology Unit, Department of Clinical and Molecular Medicine, Sant'Andrea Hospital, Sapienza University, Rome, Italy
| | - Fabio Santanelli di Pompeo
- Plastic Surgery Unit, Department of Neuroscience, Mental Health and Sense Organs (NESMOS), Sapienza University, Sant'Andrea Hospital, Rome
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Hoffman A, Ashkenazi I. The efficiency of MarginProbe in detecting positive resection margins in epithelial breast cancer following breast conserving surgery. European Journal of Surgical Oncology 2022; 48:1498-1502. [PMID: 35219544 DOI: 10.1016/j.ejso.2022.02.021] [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] [Received: 12/09/2021] [Revised: 02/08/2022] [Accepted: 02/16/2022] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Up to 30% of patients undergoing lumpectomy for breast cancer are in need for re-excision due to either close or involved margins. We evaluated the yield of Margin Probe© (MP; Dilon Technologies, USA) in a cohort of patients undergoing lumpectomy for both palpable and non-palpable tumors. METHODS Following lumpectomy, margins were evaluated with MP and readings were compared to the lumpectomies' pathological evaluation irrespective of whether additional margins were removed during surgery. Involved margins or the presence of DCIS within 1 mm of the resection margins were considered as positive margins. RESULTS 48 patients with 51 tumors underwent lumpectomy. Thirteen of the 51 lumpectomies had pathological close or involved margins. MP identified 3 out of the 13 positive margins. False-positive readings were recorded in 97 out of 287 margins. The sensitivity, specificity, positive predictive value and negative predictive value were 23.1% (95%CI 5.0% 53.8%), 66.4% (95%CI 60.7%-71.9%), 3% (95%CI 0.6%-8.5%), and 95.1% (95%CI 91.1%-97.6%) respectively. CONCLUSIONS MP cancer detection rate is relatively low while high false-positive rate leads to unnecessary shavings in almost all patients. Evaluation of MP performance should be based on comparing MP read to pathology report.
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Affiliation(s)
- Aviad Hoffman
- Breast Cancer Clinic, General Surgery Department, Rambam Medical Center, Haaliya Hashnia 8, Haifa, 3109601, Israel.
| | - Itamar Ashkenazi
- Breast Cancer Clinic, General Surgery Department, Rambam Medical Center, Haaliya Hashnia 8, Haifa, 3109601, Israel
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Rubin A, Haroon A, Rao BK, Firoz BF. Utility of Optical Imaging in a Patient With Recurrent, Multifocal Hydroxyurea-Associated Basal Cell Carcinoma. Dermatol Surg 2022; 48:155-156. [PMID: 34743120 DOI: 10.1097/dss.0000000000003279] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Alexandra Rubin
- Department of Pathology & Laboratory Medicine, Rutgers Robert Wood Johnson Medical School, Center for Dermatology, Somerset, New Jersey
- Rao Dermatology, Atlantic Highlands, New Jersey
| | | | - Babar K Rao
- Rao Dermatology, Atlantic Highlands, New Jersey
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Jimenez-Rodriguez RM, Quezada-Diaz F, Hameed I, Kalabin A, Patil S, Smith JJ, Garcia-Aguilar J. Organ Preservation in Patients with Rectal Cancer Treated with Total Neoadjuvant Therapy. Dis Colon Rectum 2021; 64:1463-1470. [PMID: 34508014 PMCID: PMC8820240 DOI: 10.1097/dcr.0000000000002122] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Retrospective studies suggest that watch-and-wait is a safe alternative to total mesorectal excision in selected patients with a clinical complete response after chemoradiotherapy. OBJECTIVE This study aimed to determine the proportion of patients with rectal cancer who may benefit from watch-and-wait. DESIGN This study is a retrospective analysis of data from prospectively maintained databases. SETTING This study was conducted at a comprehensive cancer center. PATIENTS Consecutive patients with stage II or III rectal adenocarcinoma who were treated with total neoadjuvant therapy using induction chemotherapy between 2012 and 2019 under the care of the same surgeon were included. INTERVENTION Induction-type total neoadjuvant therapy consisted of 8 cycles of leucovorin-fluorouracil-oxaliplatin or 5 cycles of capecitabine-oxaliplatin before chemoradiotherapy. Patients with a clinical complete response were offered watch-and-wait, and patients with residual tumor were offered total mesorectal excision. MAIN OUTCOMES AND MEASURES Tumor response was assessed with a digital rectal examination, endoscopy, and MRI. Patient characteristics and recurrence-free survival were compared between the watch-and-wait group and the total mesorectal excision group. RESULTS A total of 88 patients were included in the analysis. One (1%) died during neoadjuvant therapy. Fifty-five patients (62.5%) had an incomplete clinical response and underwent surgery, 10 (18%) of the 55 developed distant metastasis, and 3 (5%) developed local recurrence. The remaining 32 patients (36.3%) had a clinical complete response and underwent watch-and-wait. On average, patients in the watch-and-wait group were older and had smaller, more distal tumors compared with patients in the surgery group. The median radiation dose, number of chemotherapy cycles, rate of adverse events, and length of follow-up did not differ substantively between the total mesorectal excision group and the watch-and-wait group. In the watch-and-wait group, 2 (6%) patients developed tumor regrowth, and one of them had distant metastasis. Recurrence-free survival was significantly higher in the watch-and-wait group. LIMITATIONS Generalizability, sample size, and follow-up duration were limitations of this study. CONCLUSIONS Approximately one-third of patients with stage II or III rectal cancer can benefit from a watch-and-wait approach with the aim of preserving the rectum if treated with induction-type total neoadjuvant therapy and followed by an experienced multidisciplinary team. See Video Abstract at http://links.lww.com/DCR/B688. CONSERVACIN DE RGANOS EN PACIENTES CON CNCER DE RECTO TRATADOS CON TERAPIA NEOADYUVANTE TOTAL ANTECEDENTES:Estudios retrospectivos sugieren que observar y esperar es una alternativa segura a la escisión mesorrectal total en pacientes seleccionados con una respuesta clínica completa después de la quimiorradioterapia.OBJETIVO:Determinar la proporción de pacientes con cáncer de recto que pueden beneficiarse de observar y esperar.DISEÑO:Análisis retrospectivo de datos de bases de datos mantenidas de forma prospectiva.ESCENARIO:Centro Oncológico Integral.PACIENTES:Pacientes consecutivos con adenocarcinoma de recto en estadio II o III tratados con TNT utilizando quimioterapia de inducción entre 2012 y 2019 bajo el cuidado del mismo cirujano.INTERVENCIÓN:La terapia neoadyuvante total de tipo inducción consistió en ocho ciclos de leucovorín-fluorouracilo-oxaliplatino o cinco ciclos de capecitabina-oxaliplatino antes de la quimiorradioterapia. A los pacientes con una respuesta clínica completa se les ofreció observar y esperar, y a los pacientes con tumor residual se les ofreció la escisión mesorrectal total.PRINCIPALES RESULTADOS Y MEDIDAS:La respuesta del tumor se evaluó con un tacto rectal, endoscopia y resonancia magnética. Se compararon las características de los pacientes y la supervivencia libre de recurrencia entre el grupo de observación y espera y el grupo de escisión mesorrectal total.RESULTADOS:Se incluyó en el análisis a un total de 88 pacientes. Uno (1%) murió durante la terapia neoadyuvante. Cincuenta y cinco pacientes (62.5%) tuvieron una respuesta clínica incompleta y se sometieron a cirugía; 10 (18%) de los 55 desarrollaron metástasis a distancia y 3 (5%) desarrollaron recidiva local. Los 32 pacientes restantes (36.3%) tuvieron una cCR (respuesta clínica completa) y se sometieron a observar y esperar. En promedio, los pacientes del grupo de observación y espera eran mayores y tenían tumores más pequeños y distales en comparación con el grupo de cirugía. La dosis mediana de radiación, el número de ciclos de quimioterapia, la tasa de eventos adversos y la duración del seguimiento no difirieron sustancialmente entre el grupo de escisión mesorrectal total y el grupo de observación y espera. En el grupo de observación y espera, 2 (6%) pacientes desarrollaron recrecimiento del tumor y uno de ellos tuvo metástasis a distancia. La supervivencia libre de recurrencia fue significativamente mayor en el grupo de observación y espera.LIMITACIONES:Generalizabilidad, tamaño de la muestra, duración del seguimiento.CONCLUSIONES:Aproximadamente un tercio de los pacientes con cáncer de recto en estadio II o III pueden beneficiarse de un abordaje de observación y espera con el objetivo de preservar el recto si se tratan con terapia neoadyuvante total de tipo inducción y son seguidos por un equipo multidisciplinario experimentado. Consulte Video Resumen en http://links.lww.com/DCR/B688.
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Affiliation(s)
| | | | - Irbaz Hameed
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York
| | - Aleksandr Kalabin
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York
| | - Sujata Patil
- Department of Epidemiology-Biostatistics, Memorial Sloan Kettering Cancer Center, New York
| | - J. Joshua Smith
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York
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Wang Y, Guo J, Li B, Li D, Meng Z, Sun SK. Biocompatible therapeutic albumin/genipin bioglue for postoperative wound adhesion and residual tumor ablation. Biomaterials 2021; 279:121179. [PMID: 34700226 DOI: 10.1016/j.biomaterials.2021.121179] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [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: 05/20/2021] [Revised: 10/01/2021] [Accepted: 10/06/2021] [Indexed: 01/23/2023]
Abstract
Surgical adhesives have partly replaced traditional sutures to seal and reattach tissues due to their superiorities in preventing liquids leakage and avoiding secondary damage in the surrounding wound area. Most of the existing adhesives are committed to promoting wound healing and functional recovery. A therapeutic adhesive that assists in clearing the residual tumors in the surgical area is undoubtedly meaningful to obtain a better clinical outcome. Herein, enlightened by commercial BioGlue (albumin/glutaraldehyde sealant), a biocompatible therapeutic albumin/genipin bioglue is designed for postoperative wound adhesion and tumor ablation. The albumin/genipin bioglue is formed by simple mixing of bovine serum albumin (BSA) and genipin (GP) under a 35 °C water bath for 24 h without further purification. The obtained dark-blue fluorescent adhesive exhibits a significant temperature increase accompanied by heating-induced curing once irradiated with an 808-nm laser. This unique characteristic allows BSA-GP a therapeutic adhesive for postoperative wound adhesion and photothermal elimination of residual tumors under laser irradiation. Moreover, its easy injectability and impressive photothermal efficacy also make it feasible for in situ tumor photothermal ablation. The ultrasimple synthetic strategy by mimicking BioGlue endows BSA-GP adhesive with large-scale production capacity and clinical transformation potential, which is a successful paradigm for reforming existing clinical products.
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Affiliation(s)
- Yaqiong Wang
- Department of Nuclear Medicine, Tianjin Medical University General Hospital, Tianjin, 300052, China
| | - Jingjing Guo
- Department of Radiology, Tianjin Huanhu Hospital, Tianjin, 300350, China
| | - Bingjie Li
- Department of Radiology, Tianjin Medical University General Hospital, Tianjin, 300052, China
| | - Dong Li
- Department of Radiology, Tianjin Medical University General Hospital, Tianjin, 300052, China.
| | - Zhaowei Meng
- Department of Nuclear Medicine, Tianjin Medical University General Hospital, Tianjin, 300052, China.
| | - Shao-Kai Sun
- School of Medical Imaging, Tianjin Medical University, Tianjin, 300203, China.
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Seejore K, Alavi SA, Pearson SM, Robins JMW, Alromhain B, Sheikh A, Nix P, Wilson T, Orme SM, Tyagi A, Phillips N, Murray RD. Post-operative volumes following endoscopic surgery for non-functioning pituitary macroadenomas are predictive of further intervention, but not endocrine outcomes. BMC Endocr Disord 2021; 21:116. [PMID: 34112169 PMCID: PMC8194144 DOI: 10.1186/s12902-021-00777-8] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 05/04/2021] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Transsphenoidal surgery (TSS) remains the treatment of choice for non-functioning pituitary macroadenomas (NFPMA). The value of measuring tumour volumes before and after surgery, and its influence on endocrine outcomes and further treatment of the residual or recurrent tumour are unknown. METHODS Data from patients who underwent endoscopic TSS for a NFPMA (2009-2018) in a UK tertiary centre were analysed for pre- and post-operative endocrine and surgical outcomes. RESULTS Of 173 patients with NFPMA, 159 (61% male) were treatment naïve. At presentation, 76.2% (77/101) had ≥1 pituitary axis deficit. Older age (p = 0.002) was an independent predictor for multiple hormonal deficiencies. Preoperative tumour volume did not correlate with degree of hypopituitarism. Postoperative tumour volume and extent of tumour resection were not predictive of new onset hypopituitarism. Hormonal recovery was observed in 16 patients (20.8%) with impaired pituitary function, with the greatest recovery in the hypothalamic-pituitary-adrenal axis (21.2%, 7/33). A larger residual tumour volume was predictive of adjuvant radiotherapy (3.40 vs. 1.24 cm3, p = 0.005) and likelihood for repeat surgery (5.40 vs. 1.67cm3, p = 0.004). CONCLUSION Pre- and post-operative NFPMA volumes fail to predict the number of pituitary hormone deficits, however, greater post-operative residual volumes increase the likelihood of further intervention to control tumour growth.
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Affiliation(s)
- K Seejore
- Leeds Centre for Diabetes & Endocrinology, St James's University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, UK
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - S A Alavi
- Department of Neurosurgery, Leeds Centre for Neurosciences, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - S M Pearson
- Leeds Centre for Diabetes & Endocrinology, St James's University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, UK
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - J M W Robins
- Department of Neurosurgery, Leeds Centre for Neurosciences, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - B Alromhain
- Department of Neurosurgery, Leeds Centre for Neurosciences, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - A Sheikh
- Department of Neurosurgery, Leeds Centre for Neurosciences, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - P Nix
- Department of Ear, Nose and Throat (ENT) Surgery, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - T Wilson
- Department of Ear, Nose and Throat (ENT) Surgery, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - S M Orme
- Leeds Centre for Diabetes & Endocrinology, St James's University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - A Tyagi
- Department of Neurosurgery, Leeds Centre for Neurosciences, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - N Phillips
- Department of Neurosurgery, Leeds Centre for Neurosciences, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - R D Murray
- Leeds Centre for Diabetes & Endocrinology, St James's University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, UK.
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK.
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Sinukumar S, Rajan F, Mehta S, Damodaran D, Zaveri S, Kammar P, Bhatt A. A comparison of outcomes following total and selective peritonectomy performed at the time of interval cytoreductive surgery for advanced serous epithelial ovarian, fallopian tube and primary peritoneal cancer - A study by INDEPSO. Eur J Surg Oncol 2021; 47:75-81. [PMID: 30857879 DOI: 10.1016/j.ejso.2019.02.031] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [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: 11/28/2018] [Accepted: 02/22/2019] [Indexed: 12/27/2022]
Abstract
OBJECTIVES To compare clinical outcomes following total and selective peritonectomy performed during interval cytoreductive surgery (CRS) for stage IIIC/IVA serous epithelial ovarian cancer. METHODS In this retrospective study, extent of peritonectomy was classified as total parietal peritonectomy (TPP) which comprised of removal of the entire parietal peritoneum and the greater and lesser omenta or selective parietal peritonectomy (SPP) that included 1/>1 of parietal peritonectomies performed to resect sites of residual disease. A comparison of patient and disease characteristics, morbidity, mortality and survival outcomes between the two groups was made. RESULTS From January 2013 to December 2017, 79 patients underwent CRS (TPP-30, SPP-49) with or without intraperitoneal chemotherapy (IPC). The median PCI was 14 for TPP and 8 for SPP. The 90-day grade 3-4 morbidity (23.3% for TPP, 14.2% for SPP, p = 0.58) the 90-day mortality was similar (p = 0.58). The median disease free survival (DFS) was 37 months for SPP and 33 months for TPP (p = 0.47) and median overall survival (OS) not reached for both. The 3-year OS was 95% for TPP and 70.8% for SPP (p = 0.06). The only independent predictor of OS was grade 3-4 morbidity (p = 0.01) and not TPP (p = 0.09). Microscopic residual disease was seen in 23.3% with normal looking peritoneum in TPP group. CONCLUSIONS TPP was not associated with increased morbidity compared to SPP. There was a trend towards a longer OS in the TPP group and the finding of residual disease in 'normal looking' peritoneum' warrants prospective evaluation of the benefit of TPP in this setting.
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MESH Headings
- Adult
- Aged
- Female
- Humans
- Middle Aged
- Antineoplastic Combined Chemotherapy Protocols
- Carcinoma, Ovarian Epithelial/drug therapy
- Carcinoma, Ovarian Epithelial/mortality
- Carcinoma, Ovarian Epithelial/pathology
- Carcinoma, Ovarian Epithelial/surgery
- Cytoreduction Surgical Procedures
- Fallopian Tube Neoplasms/drug therapy
- Fallopian Tube Neoplasms/mortality
- Fallopian Tube Neoplasms/pathology
- Fallopian Tube Neoplasms/surgery
- Neoplasm Recurrence, Local/drug therapy
- Neoplasm Recurrence, Local/mortality
- Neoplasm Recurrence, Local/pathology
- Neoplasm Recurrence, Local/surgery
- Neoplasm Staging
- Neoplasm, Residual/drug therapy
- Neoplasm, Residual/mortality
- Neoplasm, Residual/pathology
- Neoplasm, Residual/surgery
- Peritoneal Neoplasms/drug therapy
- Peritoneal Neoplasms/mortality
- Peritoneal Neoplasms/pathology
- Peritoneal Neoplasms/surgery
- Postoperative Complications
- Retrospective Studies
- Survival Rate
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Affiliation(s)
- Snita Sinukumar
- Department of Surgical Oncology, Jehangir Hospital, Pune, India
| | - Firoz Rajan
- Department of Surgical Oncology, Kovai Medical Center, Coimbatore, India
| | - Sanket Mehta
- Department of Surgical Oncology, Saifee Hospital, Mumbai, India
| | - Dileep Damodaran
- Department of Surgical Oncology, MVR Cancer Centre and Research Institute, Calicut, India
| | | | - Praveen Kammar
- Department of Surgical Oncology, Saifee Hospital, Mumbai, India
| | - Aditi Bhatt
- Department of Surgical Oncology, Zydus Hospital, Ahmedabad, India.
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Abstract
The work of modern neurosurgical glioma practice combines securing accurate diagnoses, under the 2016 revised World Health Organization (WHO) Classification of Tumors of the Central Nervous System, with an aggressive and safe surgical pursuit of tumor removal. The evidence base that drives clinical decision-making has undergone a critical reevaluation with the incorporation of molecular classifiers into the updated WHO diagnoses including the 3 most common diffuse gliomas in adults: glioblastoma IDH wild-type, astrocytoma IDH mutant, and oligodendroglioma IDH mutant 1p/19q codeleted. The studies that form the foundation of modern practice, and the areas for future inquiry are reviewed.
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Affiliation(s)
- Daniel P Cahill
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Yawkey 9E, Boston, MA 02114, USA.
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30
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Chang X, Deng L, Ni W, Li C, Han W, Gao LR, Wang S, Zhou Z, Chen D, Feng Q, Liang J, Bi N, Lv J, Gao S, Mao Y, Xue Q, Xiao Z. Salvage chemoradiation therapy for recurrence after radical surgery or palliative surgery in esophageal cancer patients: a prospective, multicenter clinical trial protocol. BMC Cancer 2020; 20:877. [PMID: 32928136 PMCID: PMC7488997 DOI: 10.1186/s12885-020-07315-0] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 08/18/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Currently, adjuvant therapy is not recommended for patients with thoracic esophageal squamous cell cancer (TESCC) after radical surgery, and a proportion of these patients go on to develop locoregional recurrence (LRR) within 2 years. Besides, there is no evidence for salvage chemoradiation therapy (CRT) in patients with residual tumor after esophagectomy (R1/R2 resection). In addition, factors like different failure patterns and relationship with normal organs influence the decision for salvage strategy. Here, we aimed to design a modularized salvage CRT strategy for patients without a chance of salvage surgery according to different failure patterns (including R1/R2 resection), and further evaluated its efficacy and safety. METHODS Our study was designed as a one arm, multicenter, prospective clinical trial. All enrolled patients were stratified in a stepwise manner based on the nature of surgery (R0 or R1/2), recurrent lesion diameter, involved regions, and time-to-recurrence, and were further assigned to undergo either elective nodal irradiation or involved field irradiation. Then, radiation technique and dose prescription were modified according to the distance from the recurrent lesion to the thoracic stomach or intestine. Ultimately, four treatment plans were established. DISCUSSION This prospective study provided high-level evidence for clinical salvage management in patients with TESCC who developed LRR after radical surgery or those who underwent R1/R2 resection. TRIAL REGISTRATION Prospectively Registered. ClinicalTrials.gov NCT03731442 , Registered November 6, 2018.
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Affiliation(s)
- Xiao Chang
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17 South Panjiayuan lane, Chaoyang District, Beijing, 100021 China
| | - Lei Deng
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17 South Panjiayuan lane, Chaoyang District, Beijing, 100021 China
| | - Wenjie Ni
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17 South Panjiayuan lane, Chaoyang District, Beijing, 100021 China
| | - Chen Li
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17 South Panjiayuan lane, Chaoyang District, Beijing, 100021 China
| | - Weiming Han
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17 South Panjiayuan lane, Chaoyang District, Beijing, 100021 China
| | - Lin-rui Gao
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17 South Panjiayuan lane, Chaoyang District, Beijing, 100021 China
| | - Shijia Wang
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17 South Panjiayuan lane, Chaoyang District, Beijing, 100021 China
| | - Zongmei Zhou
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17 South Panjiayuan lane, Chaoyang District, Beijing, 100021 China
| | - Dongfu Chen
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17 South Panjiayuan lane, Chaoyang District, Beijing, 100021 China
| | - Qinfu Feng
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17 South Panjiayuan lane, Chaoyang District, Beijing, 100021 China
| | - Jun Liang
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17 South Panjiayuan lane, Chaoyang District, Beijing, 100021 China
| | - Nan Bi
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17 South Panjiayuan lane, Chaoyang District, Beijing, 100021 China
| | - Jima Lv
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17 South Panjiayuan lane, Chaoyang District, Beijing, 100021 China
| | - Shugeng Gao
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yousheng Mao
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Qi Xue
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zefen Xiao
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17 South Panjiayuan lane, Chaoyang District, Beijing, 100021 China
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Fang C, Zhang Y, Zhao L, Chen X, Xia L, Zhang P. The relationship between retroperitoneal lymphadenectomy and survival in advanced ovarian cancer patients. BMC Cancer 2020; 20:654. [PMID: 32660444 PMCID: PMC7359502 DOI: 10.1186/s12885-020-07144-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 07/07/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Systematic retroperitoneal lymphadenectomy has been widely used in the surgical treatment of advanced ovarian cancer patients. Nevertheless, the corresponding therapeutic may not provide a survival benefit. The aim of this study was to assess the effect of systematic retroperitoneal lymphadenectomy in such patients. METHODS Patients with advanced ovarian cancer (stage III-IV, according to the classification presented by the International Federation of Gynecology and Obstetrics) who were admitted and treated in Zhejiang Cancer Hospital from January 2004 to December 2013 were enrolled and reviewed retrospectively. All patients were optimally or suboptimally debulked (absent or residual tumor < 1 cm) and divided into two groups. Group A (no-lymphadenectomy group, n = 170): patients did not undergo lymph node resection; lymph nodes resection or biopsy were selective. Group B (n = 240): patients underwent systematic retroperitoneal lymphadenectomy. RESULTS A total of 410 eligible patients were enrolled in the study. The patients' median age was 51 years old (range, 28-72 years old). The 5-year overall survival (OS) and 2-year progression-free survival (PFS) rates were 78 and 24% in the no-lymphadenectomy group and 76 and 26% in the lymphadenectomy group (P = 0.385 and 0.214, respectively). Subsequently, there was no significant difference in 5-year OS and 2-year PFS between the two groups stratified to histological types (serous type or non-serous type), the clinical evaluation of negative lymph nodes or with macroscopic peritoneal metastasis beyond pelvic (IIIB-IV). Multivariate Cox regression analysis indicated that systematic retroperitoneal lymphadenectomy was not a significant factor influencing the patients' survival. Patients in the lymphadenectomy group had a higher incidence of postoperative complications (incidence of infection treated with antibiotics was 21.7% vs. 12.9% [P = 0.027]; incidence of lymph cysts was 20.8% vs. 2.4% [P < 0.001]). CONCLUSIONS Our study showed that systematic retroperitoneal lymphadenectomy did not significantly improve survival of advanced ovarian cancer patients with residual tumor < 1 cm or absent after cytoreductive surgery, and were associated with a higher incidence of postoperative complications.
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MESH Headings
- Adenocarcinoma, Clear Cell/mortality
- Adenocarcinoma, Clear Cell/secondary
- Adenocarcinoma, Clear Cell/surgery
- Adenocarcinoma, Mucinous/mortality
- Adenocarcinoma, Mucinous/secondary
- Adenocarcinoma, Mucinous/surgery
- Adult
- Aged
- Cystadenocarcinoma, Serous/mortality
- Cystadenocarcinoma, Serous/secondary
- Cystadenocarcinoma, Serous/surgery
- Cytoreduction Surgical Procedures/mortality
- Endometrial Neoplasms/mortality
- Endometrial Neoplasms/secondary
- Endometrial Neoplasms/surgery
- Female
- Follow-Up Studies
- Humans
- Lymph Node Excision/mortality
- Lymphatic Metastasis
- Middle Aged
- Neoplasm, Residual/mortality
- Neoplasm, Residual/pathology
- Neoplasm, Residual/surgery
- Ovarian Neoplasms/mortality
- Ovarian Neoplasms/pathology
- Ovarian Neoplasms/surgery
- Peritoneal Neoplasms/mortality
- Peritoneal Neoplasms/secondary
- Peritoneal Neoplasms/surgery
- Prognosis
- Retroperitoneal Space/pathology
- Retroperitoneal Space/surgery
- Retrospective Studies
- Survival Rate
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Affiliation(s)
- Chenyan Fang
- Department of Gynecological Oncology, Cancer Hospital of University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Cancer Research and Basic Medicine (IBMC), Chinese Academy of Sciences, 1 Banshan East Road, Hangzhou, 310022 Zhejiang Province China
| | - Yingli Zhang
- Department of Gynecological Oncology, Cancer Hospital of University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Cancer Research and Basic Medicine (IBMC), Chinese Academy of Sciences, 1 Banshan East Road, Hangzhou, 310022 Zhejiang Province China
| | - Lingqin Zhao
- Department of Gynecological Oncology, Cancer Hospital of University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Cancer Research and Basic Medicine (IBMC), Chinese Academy of Sciences, 1 Banshan East Road, Hangzhou, 310022 Zhejiang Province China
| | - Xi Chen
- Department of Gynecological Oncology, Cancer Hospital of University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Cancer Research and Basic Medicine (IBMC), Chinese Academy of Sciences, 1 Banshan East Road, Hangzhou, 310022 Zhejiang Province China
| | - Liang Xia
- Department of Neurosurgery, Cancer Hospital of University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Cancer Research and Basic Medicine (IBMC), Chinese Academy of Sciences, 1 Banshan East Road, Hangzhou, 310022 Zhejiang Province China
| | - Ping Zhang
- Department of Gynecological Oncology, Cancer Hospital of University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Cancer Research and Basic Medicine (IBMC), Chinese Academy of Sciences, 1 Banshan East Road, Hangzhou, 310022 Zhejiang Province China
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Della Pepa GM, Ius T, La Rocca G, Gaudino S, Isola M, Pignotti F, Rapisarda A, Mazzucchi E, Giordano C, Dragonetti V, Chiesa S, Balducci M, Gessi M, Skrap M, Olivi A, Marchese E, Sabatino G. 5-Aminolevulinic Acid and Contrast-Enhanced Ultrasound: The Combination of the Two Techniques to Optimize the Extent of Resection in Glioblastoma Surgery. Neurosurgery 2020; 86:E529-E540. [PMID: 32186345 DOI: 10.1093/neuros/nyaa037] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [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: 05/23/2019] [Accepted: 12/15/2019] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND The survival benefit in maximizing resection in glioblastomas (GBMs) has been demonstrated by numerous studies. The true limit of infiltration of GBMs has been an overwhelming obstacle, and several technological advances have been introduced to improve the identification of residual tumors. OBJECTIVE To evaluate whether the integration of 5-aminolevulinic acid (5-ALA) with microbubble contrast-enhanced ultrasound (CEUS) improves residual tumor identification and has an impact on the extent of resection (EOR), overall survival (OS), and progression-free survival (PFS). METHODS A total of 230 GBM procedures were retrospectively studied. Cases were stratified according to the surgical procedure into 4 groups: 5-ALA- and CEUS-guided surgeries, 5-ALA-guided surgeries, CEUS-guided surgeries, and conventional microsurgical procedures. RESULTS Patients undergoing conventional microsurgical procedures showed the worst EORs compared to the assisted techniques (5-ALA and CEUS procedures). Both 5-ALA and CEUS techniques improved the EOR compared to conventional microsurgical procedures. However, their combination gave the best results in terms of the EOR (P = .0003). The median EOR% and the number of supramarginal resections are hence superior in the 5-ALA + CEUS + group compared to the others; this observation had consequences on PFS and OS in our series. CONCLUSION In terms of the EOR, the best results can be achieved through a combination of both techniques, where the 5-ALA-guided procedure is followed by a final survey with CEUS. Compared with other intraoperative imaging techniques, CEUS is a real-time, readily repeatable, safe, and inexpensive technique that provides valuable information to the surgeon before, during, and after resection.
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Affiliation(s)
- Giuseppe Maria Della Pepa
- Institute of Neurosurgery, Fondazione Policlinico Universitario Agostino Gemelli, IRCSS, Catholic University of Rome, Rome, Italy
| | - Tamara Ius
- Department of Neurosurgery, University Hospital, Udine, Italy
| | - Giuseppe La Rocca
- Institute of Neurosurgery, Fondazione Policlinico Universitario Agostino Gemelli, IRCSS, Catholic University of Rome, Rome, Italy
- Department of Neurosurgery, Mater Olbia Hospital, Olbia, Italy
| | - Simona Gaudino
- Institute of Radiology, Fondazione Policlinico Universitario Agostino Gemelli IRCSS, Catholic University of Rome, Rome, Italy
| | - Miriam Isola
- Department of Medicine, University of Udine, Udine, Italy
| | - Fabrizio Pignotti
- Institute of Neurosurgery, Fondazione Policlinico Universitario Agostino Gemelli, IRCSS, Catholic University of Rome, Rome, Italy
- Department of Neurosurgery, Mater Olbia Hospital, Olbia, Italy
| | - Alessandro Rapisarda
- Institute of Neurosurgery, Fondazione Policlinico Universitario Agostino Gemelli, IRCSS, Catholic University of Rome, Rome, Italy
| | - Edoardo Mazzucchi
- Institute of Neurosurgery, Fondazione Policlinico Universitario Agostino Gemelli, IRCSS, Catholic University of Rome, Rome, Italy
| | - Carolina Giordano
- Institute of Radiology, Fondazione Policlinico Universitario Agostino Gemelli IRCSS, Catholic University of Rome, Rome, Italy
| | - Valentino Dragonetti
- Institute of Radiology, Fondazione Policlinico Universitario Agostino Gemelli IRCSS, Catholic University of Rome, Rome, Italy
| | - Silvia Chiesa
- Department of Radiation Oncology, Fondazione Policlinico Universitario Agostino Gemelli IRCSSl, Catholic University of Rome, Rome, Italy
| | - Mario Balducci
- Department of Radiation Oncology, Fondazione Policlinico Universitario Agostino Gemelli IRCSSl, Catholic University of Rome, Rome, Italy
| | - Marco Gessi
- Department of Neuro-Pathology, Fondazione Policlinico Universitario Agostino Gemelli IRCSS, Catholic University of Rome, Rome, Italy
| | - Miran Skrap
- Department of Neurosurgery, University Hospital, Udine, Italy
| | - Alessandro Olivi
- Institute of Neurosurgery, Fondazione Policlinico Universitario Agostino Gemelli, IRCSS, Catholic University of Rome, Rome, Italy
| | - Enrico Marchese
- Institute of Neurosurgery, Fondazione Policlinico Universitario Agostino Gemelli, IRCSS, Catholic University of Rome, Rome, Italy
| | - Giovanni Sabatino
- Institute of Neurosurgery, Fondazione Policlinico Universitario Agostino Gemelli, IRCSS, Catholic University of Rome, Rome, Italy
- Department of Neurosurgery, Mater Olbia Hospital, Olbia, Italy
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Marcus HJ, Borg A, Hussein Z, Jaunmuktane Z, Baldeweg SE, Grieve J, Dorward NL. Rathke's cleft cysts following transsphenoidal surgery: long-term outcomes and development of an optimal follow-up strategy. Acta Neurochir (Wien) 2020; 162:853-861. [PMID: 31982988 PMCID: PMC7066099 DOI: 10.1007/s00701-020-04237-5] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 01/18/2020] [Indexed: 01/09/2023]
Abstract
BACKGROUND In patients with symptomatic Rathke's cleft cyst, transsphenoidal surgery is highly effective at preventing further visual loss and usually allows for some recovery of vision. However, cyst recurrence and the need for re-operation are well recognized. To this end, the aim of this study was to investigate patterns of recurrence and long-term outcomes and to use this information to develop an optimal follow-up strategy. METHOD A prospectively maintained database was searched over a 10-year period between 1 January 2008 and the 1 January 2018 to identify all adults that underwent transsphenoidal surgery with a new diagnosis of Rathke's cleft cyst. A retrospective case note review was performed for each patient to extract data on their presentation, investigation, treatment, and outcome. RESULTS In all, 61 eligible patients were identified. The median follow-up was 34 months (range 2-112 months). In the 22 patients with pre-operative visual loss, the outcomes at 6 months were as follows: normal vision (2/22; 9.1%), improved but not normal (7/22; 31.8%), stable (12/22; 54.5%), worse but not blind (1/22; 4.5%), and blind (0/22; 0%). The overall rate of regrowth and re-operation in our study was 19.7 and 11.5%, respectively. The only factor that was significantly associated with recurrence was the presence of residual cystic disease on the post-operative MRI (p < 0.001). CONCLUSIONS We propose a follow-up strategy that stratifies patients at "low risk" if there is no residual cyst, with increasing interval scans, or "high risk" if there is residual cyst, with annual visual assessment and scans.
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Affiliation(s)
- Hani J Marcus
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK.
- Wellcome EPSRC centre for Interventional and Surgical Sciences, University College London, 8.02 Malet Place Building, Gower Street, London, WC1E 6BT, UK.
| | - Anouk Borg
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK
| | - Ziad Hussein
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK
- Department of Endocrinology, University College London Hospital, London, UK
| | - Zane Jaunmuktane
- Department of Neuropathology, National Hospital for Neurology and Neurosurgery, London, UK
| | - Stephanie E Baldeweg
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK
- Department of Endocrinology, University College London Hospital, London, UK
| | - Joan Grieve
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK
| | - Neil L Dorward
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK
- Wellcome EPSRC centre for Interventional and Surgical Sciences, University College London, 8.02 Malet Place Building, Gower Street, London, WC1E 6BT, UK
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Tang SJ, Naga YM, Wu R, Zhang S. Over-the-scope clip-assisted endoscopic full thickness resection: a video-based case series. Surg Endosc 2020; 34:2780-2788. [PMID: 32189117 DOI: 10.1007/s00464-020-07481-z] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2019] [Accepted: 02/26/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND In the management of mucosal neoplasm and early cancer, therapeutic gastrointestinal endoscopy evolved from simply polypectomy, endoscopic mucosal resection, endoscopic submucosal dissection (ESD), to endoscopic full thickness resection (EFTR). Full thickness clip closure followed by transmural resection mimics surgical principles. It is safe, effective, and technically less demanding compared to other techniques. Over-the-scope clip (OTSC)-assisted EFTR or OTSC-EFTR enables the endoscopists to manage difficult lesions. METHODS We video recorded and report our 1-year single center experience of 12 consecutive EFTR cases since the dedicated OTSC-EFTR device was approved in the USA. RESULTS We demonstrate that OTSC-EFTR can be very useful to manage residual neoplastic tissue that cannot be removed during conventional mucosal resection due to deeper invasion, submucosal fibrosis, scaring from prior intervention, and appendiceal involvement. Caution should be used for EFTR of the ileocecal valve lesions. CONCLUSION We propose that layered or stacked biopsy of the appendiceal stump after EFTR should be performed to rule out a positive residual base. Due to the limited size of the FTRD resection hood (13 mm internal diameter × 23 mm depth), for larger sessile adenomas in the colon, we propose a hybrid approach for complete removal: piecemeal EMR for tumor debulking followed by OTSC-EFTR to achieve R0 resection. We believe OTSC-EFTR offers safety and efficiency with very high success rate.
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Affiliation(s)
- Shou-Jiang Tang
- Division of Digestive Diseases, Department of Medicine, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS, 39216, USA.
| | - Yehia M Naga
- Division of Digestive Diseases, Department of Medicine, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS, 39216, USA
| | - Ruonan Wu
- Division of Digestive Diseases, Department of Medicine, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS, 39216, USA
| | - Shengyu Zhang
- Department of Gastroenterology, Peking Union Medical College Hospital, Beijing, China
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Heringer LC, Machado de Lima M, Rotta JM, Botelho RV. Effect of Stereotactic Radiosurgery on Residual or Relapsed Pituitary Adenoma: A Systematic Review and Meta-Analysis. World Neurosurg 2019; 136:374-381.e4. [PMID: 31899390 DOI: 10.1016/j.wneu.2019.11.041] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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: 10/16/2019] [Revised: 11/06/2019] [Accepted: 11/07/2019] [Indexed: 12/26/2022]
Abstract
BACKGROUND In pituitary tumors, the presence of residual tumor after transsphenoidal surgery and recurrence of the tumor after resection are frequent, and the best treatment is not well established. The effects and complications of stereotactic radiosurgery have not been extensively studied. OBJECTIVE We aimed to reveal the effect of stereotactic radiosurgery on residual and recurrent adenomas. METHODS A systematic review of the literature in the MEDLINE/PubMed, Cochrane Central Database, and Google Scholar was conducted using the criteria of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. The search was structured according to the PICOT (i.e., Participants, types of Interventions, Comparator between the treatments, types of Outcome measures, and Follow-up [Time of duration]) strategy. The methodologic quality assessment (risk of bias) was performed according to the Methodological Index for Non-Randomized Studies scale. The studies were grouped and analyzed after data extraction using the software "R". RESULTS Twenty-six articles including 2315 patients were analyzed, with an average follow-up duration of 57.8 months and mean radiation marginal dose of 19.6 Gy. The overall tumor control rate was 95%, tumor reduction rate was 46%, and hormonal control rate was 67%. The side effects were evaluated. CONCLUSIONS Stereotactic radiosurgery was efficient in residual or recurrence tumor control, with few side effects, and is recommended for treating residual or recurrent tumors, both secreting and nonsecreting tumors. A limitation of this study is that there were no randomized trials included in the synthesis.
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Affiliation(s)
| | - Maíra Machado de Lima
- Instituto de Assistência Médica ao Servidor Público do Estado de São Paulo, São Paulo, Brazil
| | - José Marcus Rotta
- Instituto de Assistência Médica ao Servidor Público do Estado de São Paulo, São Paulo, Brazil
| | - Ricardo Vieira Botelho
- Instituto de Assistência Médica ao Servidor Público do Estado de São Paulo, São Paulo, Brazil.
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Ikuta S, Aihara T, Yamanaka N. Preoperative C-reactive protein to albumin ratio is a predictor of survival after pancreatic resection for pancreatic ductal adenocarcinoma. Asia Pac J Clin Oncol 2019; 15:e109-e114. [PMID: 30632282 DOI: 10.1111/ajco.13123] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 12/17/2018] [Indexed: 12/27/2022]
Abstract
AIM Systemic inflammation and nutritional status are associated with clinical outcomes of cancer patients. We investigated the prognostic value of preoperative C-reactive protein to albumin ratio (CAR) in patients with pancreatic ductal adenocarcinoma (PDA) after pancreatic resection. METHODS One-hundred and thirty-six PDA patients who underwent pancreatic resection between January 2005 and June 2017 were retrospectively enrolled. Preoperative inflammation-based scores including CAR, modified Glasgow prognostic score (mGPS), neutrophil to lymphocyte ratio, platelet to lymphocyte ratio, lymphocyte to monocyte ratio (LMR) and prognostic nutritional index (PNI) were evaluated as potential predictor of overall survival (OS) using Cox regression models. An optimal cutoff value for the continuous variable was estimated by receiver-operating characteristic (ROC) analysis. RESULTS Patients were categorized by CAR using a cutoff value of 0.09. High CAR was associated with advanced stage, increased mGPS and decreased LMR and PNI, but not with other factors such as tumor location, preoperative biliary drainage or preoperative chemotherapy. In univariate analysis, patients with high CAR had poor OS compared with those with low CAR (P = 0.01). Multivariate analysis indicated that high CAR was an independent predictor of poor OS (P = 0.03) in addition to advanced stage and residual tumors. The predictive ability of CAR evaluated by area under the ROC curve was consistently higher than that of other inflammation-based factors. CONCLUSION Preoperative CAR was an independent and superior predictor of survival after pancreatic resection in patients with PDA. [Correction added on 17 January 2019, after first online publication: In Conclusion, "in" has been corrected to "independent" for clarity.].
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Yen AW, Amato A, Cadoni S, Friedland S, Hsieh YH, Leung JW, Liggi M, Sul J, Leung FW. Underwater polypectomy without submucosal injection for colorectal lesions ≤ 20 mm in size-a multicenter retrospective observational study. Surg Endosc 2019; 33:2267-2273. [PMID: 30334167 PMCID: PMC6470040 DOI: 10.1007/s00464-018-6517-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Accepted: 10/11/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Underwater polypectomy (UWP) of large (≥ 20 mm) colorectal lesions is well described, but reports of UWP for lesions ≤ 20 mm in size, which account for > 95% of polyps encountered in routine clinical practice, are limited. We assessed the feasibility of UWP in routine practice across various sites for colorectal lesions ≤ 20 mm in size. METHODS A multicenter retrospective study was performed on pooled data from nine colonoscopists at 3 U.S., 1 Taiwanese and 2 Italian sites. Outcomes related to UWP on lesions ≤ 20 mm in size were analyzed. RESULTS In 117 patients, UWP netted 169 lesions. Polypectomy by hot (HSP, 54%) or cold (CSP, 41%) snare, and cold forceps (CFP, 5%) were performed successfully without endoscopic evidence of residual neoplasia or immediate clinically significant adverse events. The majority (74.6%) were tubular adenomas; 60.9% were from the proximal colon. Histopathologic margins were positive in 4 and unavailable in 26 CSP and 24 HSP specimens. The remainder had negative resection margins on pathologic reports. CONCLUSION UWP for colorectal lesions ≤ 20 mm in routine practice across multiple sites confirms the feasibility and acceptability of this technique. Improvement of resection outcomes by UWP in routine practice deserves further evaluation in a randomized controlled trial.
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Affiliation(s)
- A W Yen
- Division of Gastroenterology, Sacramento VA Medical Center, VANCHCS, 10535 Hospital Way, 111/G, Mather, CA, 95655, USA.
- University of California Davis School of Medicine, Sacramento, CA, USA.
| | - A Amato
- Division of Gastroenterology, Valduce Hospital, Como, Italy
| | - S Cadoni
- Digestive Endoscopy Unit, S. Barbara Hospital, 09016, Iglesias, CI, Italy
| | - S Friedland
- Division of Gastroenterology, Palo Alto VAMC, Palo Alto, CA, USA
- Stanford University, Palo Alto, CA, USA
| | - Y H Hsieh
- Division of Gastroenterology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan, Republic of China
- Tzu Chi University, Hualien, Taiwan, Republic of China
| | - J W Leung
- Division of Gastroenterology, Sacramento VA Medical Center, VANCHCS, 10535 Hospital Way, 111/G, Mather, CA, 95655, USA
- University of California Davis School of Medicine, Sacramento, CA, USA
| | - M Liggi
- Digestive Endoscopy Unit, S. Barbara Hospital, 09016, Iglesias, CI, Italy
| | - J Sul
- Division of Gastroenterology, West Los Angeles VAMC, VAGLAHS, Los Angeles, CA, USA
- David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - F W Leung
- David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
- Division of Gastroenterology, VAGLAHS, Sepulveda ACC, North Hill, CA, USA
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Spiteri I, Caravagna G, Cresswell GD, Vatsiou A, Nichol D, Acar A, Ermini L, Chkhaidze K, Werner B, Mair R, Brognaro E, Verhaak RGW, Sanguinetti G, Piccirillo SGM, Watts C, Sottoriva A. Evolutionary dynamics of residual disease in human glioblastoma. Ann Oncol 2019; 30:456-463. [PMID: 30452544 PMCID: PMC6442656 DOI: 10.1093/annonc/mdy506] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Glioblastoma is the most common and aggressive adult brain malignancy against which conventional surgery and chemoradiation provide limited benefit. Even when a good treatment response is obtained, recurrence inevitably occurs either locally (∼80%) or distally (∼20%), driven by cancer clones that are often genomically distinct from those in the primary tumour. Glioblastoma cells display a characteristic infiltrative phenotype, invading the surrounding tissue and often spreading across the whole brain. Cancer cells responsible for relapse can reside in two compartments of residual disease that are left behind after treatment: the infiltrated normal brain parenchyma and the sub-ventricular zone. However, these two sources of residual disease in glioblastoma are understudied because of the difficulty in sampling these regions during surgery. PATIENT AND METHODS Here, we present the results of whole-exome sequencing of 69 multi-region samples collected using fluorescence-guided resection from 11 patients, including the infiltrating tumour margin and the sub-ventricular zone for each patient, as well as matched blood. We used a phylogenomic approach to dissect the spatio-temporal evolution of each tumour and unveil the relation between residual disease and the main tumour mass. We also analysed two patients with paired primary-recurrence samples with matched residual disease. RESULTS Our results suggest that infiltrative subclones can arise early during tumour growth in a subset of patients. After treatment, the infiltrative subclones may seed the growth of a recurrent tumour, thus representing the 'missing link' between the primary tumour and recurrent disease. CONCLUSIONS These results are consistent with recognised clinical phenotypic behaviour and suggest that more specific therapeutic targeting of cells in the infiltrated brain parenchyma may improve patient's outcome.
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Affiliation(s)
- I Spiteri
- Evolutionary Genomics & Modelling Lab, Centre for Evolution and Cancer, The Institute of Cancer Research, London
| | - G Caravagna
- Evolutionary Genomics & Modelling Lab, Centre for Evolution and Cancer, The Institute of Cancer Research, London
| | - G D Cresswell
- Evolutionary Genomics & Modelling Lab, Centre for Evolution and Cancer, The Institute of Cancer Research, London
| | - A Vatsiou
- Evolutionary Genomics & Modelling Lab, Centre for Evolution and Cancer, The Institute of Cancer Research, London
| | - D Nichol
- Evolutionary Genomics & Modelling Lab, Centre for Evolution and Cancer, The Institute of Cancer Research, London
| | - A Acar
- Evolutionary Genomics & Modelling Lab, Centre for Evolution and Cancer, The Institute of Cancer Research, London
| | - L Ermini
- Evolutionary Genomics & Modelling Lab, Centre for Evolution and Cancer, The Institute of Cancer Research, London; Centre for Evolution and Cancer, The Institute of Cancer Research, London
| | - K Chkhaidze
- Evolutionary Genomics & Modelling Lab, Centre for Evolution and Cancer, The Institute of Cancer Research, London
| | - B Werner
- Evolutionary Genomics & Modelling Lab, Centre for Evolution and Cancer, The Institute of Cancer Research, London
| | - R Mair
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - E Brognaro
- Department of Neurosurgery, S. Maria Della Misericordia Hospital, Rovigo, Italy
| | - R G W Verhaak
- Jackson Laboratory for Genomic Medicine, Farmington, USA
| | - G Sanguinetti
- School of Informatics, University of Edinburgh, Edinburgh, UK
| | - S G M Piccirillo
- Division of Hematology and Oncolog, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, USA.
| | - C Watts
- Institute of Cancer Genome Sciences, University of Birmingham, Birmingham, UK.
| | - A Sottoriva
- Evolutionary Genomics & Modelling Lab, Centre for Evolution and Cancer, The Institute of Cancer Research, London.
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Abdelmaksoud A, Fu P, Alwalid O, Elazab A, Zalloom A, Xiang W, Jiang XB, Zhao HY. Degrees of Diaphragma Sellae Descent during Transsphenoidal Pituitary Adenoma Resection: Predictive Factors and Effect on Outcome. Curr Med Sci 2018; 38:888-893. [PMID: 30341525 DOI: 10.1007/s11596-018-1958-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [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: 04/07/2018] [Revised: 07/02/2018] [Indexed: 02/07/2023]
Abstract
This study is aimed to classify degrees of diaphragma sellae (DS) descent into sella turcica according to the surgical field block caused by the descent and to construct predictive imaging criteria for the degree of descent, and in addition, to determine whether there is any correlation between the degree of DS descent and the operative outcome (in the form of cerebrospinal fluid leak and/or presence of residual tumor). Totally, 72 patients were enrolled in our study. Their clinical and radiological data as well as the high definition videos of operations were retrospectively reviewed. The degree of DS descent during the operation was classified into five degrees according to surgical field block caused by the descent. We investigated the correlation between these five degrees and the clinical findings, radiological findings as well as the surgical outcomes. We found that the most important determining factors of DS descent degree were the volume and the height of the tumor portion above diaphragma opening. On the other hand, the total tumor volume, the maximum tumor height and the morphological pattern according to Wilson's system (modified from Hardy) had no statistically significant correlation with DS degree of descent. Presence of residual tumor on postoperative magnetic resonance images was significantly correlated with Wilson's classification and with supradiaphragmatic tumor height. On the other hand, cerebrospinal fluid leak showed no statistically significant difference between variable degrees of DS descent. Volumetric data of the tumor portion above the diaphragma opening are more important than morphological data for prediction of surgical field block caused by descended DS. While DS prolapse significantly increases the difficulty of the operative procedure, residual tumor presence is mainly dependent on morphological classification, especially cavernous sinus invasion.
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Affiliation(s)
- Ahmed Abdelmaksoud
- Department of Neurosurgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Peng Fu
- Department of Neurosurgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Osamah Alwalid
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Ahmed Elazab
- School of Biomedical Engineering, Health Science Center, Shenzhen University, Shenzhen, 518060, China
- Computer Science Department, Misr Higher Institute for Commerce and Computers, Mansoura, 11001, Egypt
| | - Ahmed Zalloom
- Department of Neurosurgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Wei Xiang
- Department of Neurosurgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Xiao-Bing Jiang
- Department of Neurosurgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Hong-Yang Zhao
- Department of Neurosurgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
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Niwa H, Ozawa R, Kurahashi Y, Kumamoto T, Nakanishi Y, Okumura K, Matsuda I, Ishida Y, Hirota S, Shinohara H. The eCura system as a novel indicator for the necessity of salvage surgery after non-curative ESD for gastric cancer: A case-control study. PLoS One 2018; 13:e0204039. [PMID: 30273388 PMCID: PMC6166923 DOI: 10.1371/journal.pone.0204039] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Accepted: 09/01/2018] [Indexed: 12/12/2022] Open
Abstract
Endoscopic submucosal dissection (ESD) for early gastric cancer does not always lead to complete cancer resection. The aim of this study was to determine indicators for cancer residue (CR) status in cases of non-curative ESD. We analyzed 47 cases of non-curative ESD followed by salvage surgery and collected data regarding the rates of CR, which included both local CR and lymph node metastasis (LNM). To elucidate the risk factors for CR status, we compared the CR positive and the CR negative groups among surgical specimens according to the following variables obtained from ESD findings: tumor location, tumor size, depth of invasion, lympho-vascular invasion, histological margin, and histological diagnosis. The eCura system, which is an LNM risk scoring system, was also applied and scores were calculated in each case as follows: 3 points for lymphatic invasion and 1 point each for tumor size >30 mm, positive vertical margin, venous invasion, and submucosal invasion ≥500 μm. There were 9 (19%) CR positive cases, which included 6 cases of local CR and 4 cases of LNM; no cancer was detected in over 80% of the patients. The eCura scoring system was the only significant factor for CR status: the higher the eCura score, the greater the CR positivity (p = 0.0128). In particular, all patients in the low-risk group (score = 0-1 point) had no CR. Although no cancer recurrence was observed during a median follow-up of 4 years, 2 patients died of pneumonia. In conclusion, the eCura system might make it possible to select appropriate cases for salvage surgery.
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Affiliation(s)
- Hirotaka Niwa
- Department of Surgery, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Rie Ozawa
- Department of Surgery, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Yasunori Kurahashi
- Department of Surgery, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Tsutomu Kumamoto
- Department of Surgery, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Yasutaka Nakanishi
- Department of Surgery, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Koichi Okumura
- Department of Surgery, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Ikuo Matsuda
- Department of Surgical Pathology, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Yoshinori Ishida
- Department of Surgery, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Seiichi Hirota
- Department of Surgical Pathology, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Hisashi Shinohara
- Department of Surgery, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
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Yoshimatsu K, Satake M, Sano M, Kodera A, Imaizumi R, Ito Y, Koike T, Yokomizo H, Yano Y, Okayama S, Yamada Y, Asaka S, Usui T, Yamaguchi K, Shiozawa S, Shimakawa T, Katsube T, Naritaka Y. [A Case of Stage IV Rectal Cancer Achieving Long-Term Stable Disease Treated with Chemotherapy and Residual Tumor Resection]. Gan To Kagaku Ryoho 2018; 45:1527-1529. [PMID: 30382067] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
We herein report a Stage IV case ofrectal cancer in a patient who achieved stable disease and was treated monthly with fluorouracil(FU)monotherapy plus bevacizumab(Bmab)against relapse after residual tumor resection and withdrawal because ofref usal to continue chemotherapy, even though a marked response was obtained with standard chemotherapy. A 73-year-old woman visited a former hospital in 2014, and was diagnosed with rectal cancer with liver and lung metastases (diagnosed with Rb, T3, M1b[liver, lung]cStage IV). Chemotherapy(mFOLFOX6 plus Bmab)was initiated with a consideration of conversion. After 5 courses, she moved to our hospital. Since she was not aggressive to chemotherapy from the beginning, an imaging examination was performed after 9 courses. The primary lesion and lung metastases had disappeared, and there was only one liver metastasis. Partial hepatic resection was performed to attempt chemotherapy withdrawal following informed consent. Six months after surgery with no therapy, since relapse in the rectum and lungs was confirmed, laparoscopic rectal amputation was performed to control the primary tumor. Chemotherapy containing FU monotherapy plus Bmab was reinitiated after 15 months of withdrawal because liver and lung metastases increased 5 months after rectal amputation. Two months after resuming chemotherapy, the metastatic lesion decreased in size, and the tumor marker level normalized. The same regimen is continued monthly, and the response has been maintained for 17 months(infusions of 5-FU/LV plus Bmab, 18 courses).
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Abstract
The feasibility of laparoscopic retroperitoneal lymphadenectomy (RLA) for testicular cancer was shown >25 years ago. Initially the indication was clinical stage I (CS I) nonseminomatous germ cell tumor (NSGCT). Compared with that of open surgery, the morbidity was much decreased. However, in Europe, surgery for CS I is now replaced by chemotherapy. A relatively new indication is laparoscopic retroperitonal lymphadenectomy for small unilateral residual tumor after chemotherapy. The technique of unilateral lymphadenectomy for both indications is described in detail and with a video. The most recent development is bilateral laparoscopic RLA for residual tumors larger than 5 cm.
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Affiliation(s)
- Lukas Lusuardi
- Department of Urology, Paracelsus Medical University , Salzburg, Austria
| | - Thomas Kunit
- Department of Urology, Paracelsus Medical University , Salzburg, Austria
| | - Günter Janetschek
- Department of Urology, Paracelsus Medical University , Salzburg, Austria
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Abstract
The microscopic identification of residual tumor tissue in the oral or aboral resection margins (R1 resection) of esophageal specimens following oncologic esophageal resection, increases the risk of tumor recurrence and disease-related morbidity. Esophageal resection with its associated risks is only meaningful, if an R0 situation can be safely achieved. The relevance of microscopic involvement of the circumferential resection margin (CRM) in esophageal carcinoma in its different definitions by the British and the American Societies of Pathology has up to now never been investigated in a prospective study. According to the German S3 guideline, radiochemotherapy should be performed in a postoperatively proven R1 situation, which cannot be converted by a curative extended re-resection into an R0 situation or in unfavorable conditions for an extended re-resection, independent of neoadjuvant therapy. In the case of an R1 situation in the region of the CRM, an extended re-resection is not simply possible on account of the anatomical conditions with corresponding limitations by the aorta and the spinal column, in contrast to extensions of the re-resection orally or aborally.
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Affiliation(s)
- I Gockel
- Klinik für Viszeral‑, Transplantations‑, Thorax- und Gefäßchirurgie, Universitätsklinikum Leipzig, AöR, Liebigstr. 20, 04103, Leipzig, Deutschland.
| | - C Wittekind
- Institut für Pathologie, Universitätsklinikum Leipzig, AöR, Leipzig, Deutschland
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Abstract
BACKGROUND Nowadays, there is a general trend in vestibular schwannoma (VS) surgery favoring near-total or subtotal tumor resection (NTR/STR) with facial nerve (FN) function preservation rather than gross total resection (GTR) with high risk of FN damage. METHODS The surgical technique of FN sparing in large VS includes patient-tailored image-guided craniotomy, continuous intraoperative neurophysiological monitoring (INM), intracapsular wide tumor debulking, and only final extracapsular dissection with FN course identification and brainstem decompression. A small amount of residual tumor along the FN is accepted in order to not damage the nerve. Postoperative radiosurgery workup is then recommended. CONCLUSIONS NTR/STR resection with FN function sparing is a valid option for large VS.
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Affiliation(s)
- Paolo Ferroli
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria 11, 20133, Milan, Italy
| | - Lorenzo Bosio
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria 11, 20133, Milan, Italy
| | - Morgan Broggi
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria 11, 20133, Milan, Italy.
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Feliciano Y, Mamtani A, Morrow M, Stempel MM, Patil S, Jochelson MS. Do Calcifications Seen on Mammography After Neoadjuvant Chemotherapy for Breast Cancer Always Need to Be Excised? Ann Surg Oncol 2017; 24:1492-1498. [PMID: 28058550 PMCID: PMC5485840 DOI: 10.1245/s10434-016-5741-y] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Indexed: 11/18/2022]
Abstract
BACKGROUND This study aimed to determine the relationship between mammographic calcifications and magnetic resonance imaging (MRI) tumoral enhancement before and after neoadjuvant chemotherapy (NAC) and to assess the impact of these findings on surgical management. METHODS This Institutional Review Board-approved, Health Insurance Portability and Accountability Act (HIPAA)-compliant retrospective study involved breast cancer patients who underwent NAC between 2009 and 2015. The study cohort comprised 90 patients with pre- and posttreatment MRI and mammograms demonstrating calcifications within the tumor bed either at presentation or after treatment. The data gathered included pre- and post-NAC imaging findings and post-NAC histopathology, particularly findings associated with calcifications. Comparisons were made using Fisher's exact test, with p values lower than 0.05 considered significant. RESULTS Complete resolution of MRI enhancement occurred for 44% of the patients, and a pathologic complete response (pCR) was achieved for 32% of the patients. No statistically significant correlation between changes in mammographic calcifications and MRI enhancement was found (p = 0.12). Resolution of enhancement was strongly correlated with pCR (p < 0.0001). The majority of the patients with pCR demonstrated complete resolution of enhancement (79%, 23/29). No statistically significant relationship was found between changes in calcifications and rates of pCR (p = 0.06). A pCR was achieved most frequently for patients with resolution of enhancement and new, increasing, or unchanged calcifications (p < 0.0001). CONCLUSIONS Although calcifications seen on post-NAC mammography may be associated with benign disease, loss of MRI enhancement does not predict the absence of residual tumor with sufficient accuracy to leave calcifications in place. Complete excision of tumor bed calcifications remains standard practice and a substantial limitation to NAC use for downstaging patients to be eligible for breast conservation treatment.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Breast Neoplasms/diagnostic imaging
- Breast Neoplasms/drug therapy
- Breast Neoplasms/pathology
- Breast Neoplasms/surgery
- Calcinosis/diagnostic imaging
- Calcinosis/drug therapy
- Calcinosis/pathology
- Calcinosis/surgery
- Carcinoma, Ductal, Breast/diagnostic imaging
- Carcinoma, Ductal, Breast/drug therapy
- Carcinoma, Ductal, Breast/pathology
- Carcinoma, Ductal, Breast/surgery
- Carcinoma, Lobular/diagnostic imaging
- Carcinoma, Lobular/drug therapy
- Carcinoma, Lobular/pathology
- Carcinoma, Lobular/surgery
- Chemotherapy, Adjuvant
- Contrast Media
- Female
- Follow-Up Studies
- Humans
- Magnetic Resonance Imaging/methods
- Mammography
- Mastectomy
- Middle Aged
- Neoadjuvant Therapy
- Neoplasm Invasiveness
- Neoplasm, Residual/diagnostic imaging
- Neoplasm, Residual/drug therapy
- Neoplasm, Residual/pathology
- Neoplasm, Residual/surgery
- Prognosis
- Retrospective Studies
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Affiliation(s)
- Yara Feliciano
- Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Anita Mamtani
- Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Monica Morrow
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Michelle M Stempel
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Sujata Patil
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Maxine S Jochelson
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
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46
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Falt P, Štěpán M, Andělová R, Urban O. [Combination of endoscopic mucosal resection and full-thickness resection in the treatment of local residual neoplasia of the colon two case reports]. Rozhl Chir 2017; 96:394-398. [PMID: 29063775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
We present the case of a 61-year-old patient with local residual neoplasia (LRN) of the rectum and the case of a 65-year-old patient with LRN of the cecum. In both cases, the lesion measured 25 mm in diameter and its center was fixed by submucosal fibrosis causing the non-lifting sign. For endoscopic treatment, which was uneventful,a combination of endoscopic mucosal resection (EMR) and full-thickness resection (FTR) was used. In both cases, histological examination showed completely resected tubular adenoma with HGIN.Key words: colorectal carcinoma local residual neoplasia full-thickness resection endoscopic mucosal resection.
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Abstract
Patients with locally advanced thyroid carcinoma were studied to document survival, posttreatment vocal cord function, and dysphagia. A retrospective medical record review collected patient data recorded, including age, gender, and tumor-specific data. The outcome data collected included vocal cord function, presence of a tracheotomy or feeding tube, and the presence or absence of dysphagia. I studied 95 patients with surgically managed thyroid cancer. Forty-three patients had locally invasive disease and/or recurrent disease. During a median follow-up of 5 years, 18% of the patients with invasive cancer died of disease. The patients with completely resected invasive cancers had a significantly better survival rate than did the patients with microscopic residual disease. I conclude that complete resection of invasive disease provides a survival advantage and should be accomplished if speech and swallowing can be preserved. Most patients can obtain local control with minimal morbidity, and they rarely die of local disease.
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Affiliation(s)
- Jan L Kasperbauer
- Department of Otorhinolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
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Irawati N, Vaish R, Chaukar D, Deshmukh A, D'Cruz A. Surgical anatomy of the pyramidal lobe in cancer patients: A Prospective Cohort in a Tertiary Centre. Int J Surg 2016; 30:166-8. [PMID: 27177982 DOI: 10.1016/j.ijsu.2016.04.051] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [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: 03/12/2016] [Revised: 04/20/2016] [Accepted: 04/26/2016] [Indexed: 11/19/2022]
Abstract
INTRODUCTION To study the characteristics of pyramidal lobe (PL) in cancer patients with emphasis on its involvement in patients subjected to thyroidectomy at a tertiary care cancer centre. METHODS Retrospective review of prospectively maintained data of 103 patients (33 males and 70 females) who underwent thyroidectomy from January 1st 2011-August 31st 2013. Surgery was performed by single surgeon, findings recorded by the lead author and all measurements taken with specimen in situ prior to mobilization of thyroid gland with intact anatomy. Thyroid specimens were examined for presence, location, length and histology of PL. RESULTS PL was identified in 38 (36.89%) patients. PL was commoner on left 27 (71.05%) compared to 11 (28.95%) on right side. The frequency of PL was higher in males 51.51% compared to females 30%. The length varied from 4 to 35 mm. The mean length was 18.0 ± 12.4 mm. In 10.53% cases PL contained deposits of papillary carcinoma of thyroid. DISCUSSION Meticulous clearance of disease is of utmost importance in thyroid cancer surgery in order to prevent recurrence and ensure reliable follow up with serum thyroglobulin. PL is a common site of residual thyroid tissue which if involved by cancer can be a cause of local recurrence. CONCLUSIONS PL is a well established entity which is present in over one third of patients. Efforts should be made to identify PL during surgery given its bearing on the management of thyroid carcinoma as nearly 10% of these will be site of multifocal papillary carcinoma.
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Affiliation(s)
- Nina Irawati
- Department of Head and Neck Oncology, Tata Memorial Hospital, India.
| | - Richa Vaish
- Department of Head and Neck Oncology, Tata Memorial Hospital, India.
| | - Devendra Chaukar
- Department of Head and Neck Oncology, Tata Memorial Hospital, India.
| | - Anuja Deshmukh
- Department of Head and Neck Oncology, Tata Memorial Hospital, India.
| | - Anil D'Cruz
- Department of Head and Neck Oncology, Tata Memorial Hospital, India.
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Thamtorawat S, Rojwatcharapibarn S, Tongdee T, Siriapisith T. The Outcome of Radiofrequency Ablation of Metastatic Liver Tumors. J Med Assoc Thai 2016; 99:424-432. [PMID: 27396228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
OBJECTIVE To determine outcome of radiofrequency ablation (RFA) in metastatic liver tumor and to evaluate related factors of residual or local tumor recurrences. MATERIAL AND METHOD With Institutional Review Board approval, we retrospectively reviewed RFA procedure between June 2006 and September 2013. Fifty-seven metastatic nodules in 36 patients were treated. The primary tumors were colorectal carcinoma (n = 30), neuroendocrine tumor (n = 2), gallbladder carcinoma (n = 1), adenocarcinoma of head of pancreas (n = 1), and gastrointestinal stromal tumor (n = 2). Tumor characteristics, RFA techniques, success rate, complication, and follow-up imaging were reviewed and recorded Clinical outcome and overall survival were analyzed. RESULTS Complete ablation were found in 48/57 nodules (84.2%). The mean follow-up time was 17.9 ± 13.1 months (range, 1 to 47 months). Local tumor recurrence were noted in 12/57 nodules (21.1%), which mean time to recurrence was 8.3 ± 3.8 months (2 to 15 months). Residual tumor was associate with tumor larger than 3 cm (p = 0.009). The 1-, 3-, and 5-year overall survival rates were 93.6%, 56.2%, and 20%, respectively. Median overall survival was 37.8 ± 10.9 months. Major complication rate occurred about 5.3%. CONCLUSION Radiofrequency ablation is effective and feasible method to treat small metastatic liver tumor Tumor size larger than 3 cm is significant risk factor of residual tumor. Tumor in high-risk location is not associated either incomplete ablation or local tumor recurrence.
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50
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Guyotat J, Pallud J, Armoiry X, Pavlov V, Metellus P. 5-Aminolevulinic Acid-Protoporphyrin IX Fluorescence-Guided Surgery of High-Grade Gliomas: A Systematic Review. Adv Tech Stand Neurosurg 2016:61-90. [PMID: 26508406 DOI: 10.1007/978-3-319-21359-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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] [Indexed: 05/23/2023]
Abstract
The current first-line treatment of malignant gliomas consists in surgical resection (if possible) as large as possible. The existing tools don't permit to identify the limits of tumor infiltration, which goes beyond the zone of contrast enhancement on MRI. The fluorescence-guided malignant gliomas surgery was started 15 years ago and had become a standard of care in many countries. The technique is based on fluorescent molecule revelation using the filters, positioned within the surgical microscope. The fluorophore, protoporphyrin IX (PpIX), is converted in tumoral cells from 5-aminolevulinic acid (5-ALA), given orally before surgery. Many studies have shown that the ratio of gross total resections was higher if the fluorescence technique was used. The fluorescence signal intensity is correlated to the cell density and the PpIX concentration. The current method has a very high specificity but still lower sensibility, particularly regarding the zones with poor tumoral infiltration. This book reviews the principles of the technique and the results (extent of resection and survival).
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Affiliation(s)
- Jacques Guyotat
- Department of Neurosurgery, Neurological Hospital, Lyon, France.
| | - Johan Pallud
- Department of Neurosurgery, Sainte Anne Hospital, Paris, France.
- Paris Descartes University, Paris, France.
| | - Xavier Armoiry
- Délégation à la recherche clinique et à l'innovation, cellule innovation Hospices Civils de, Lyon, France.
| | - Vladislav Pavlov
- Department of Neurosurgery, Neurological Hospital, Lyon, France.
| | - Philippe Metellus
- Department of Neurosurgery, Timone Hospital, Marseille, France.
- University Aix Marseille, Marseille, France.
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