Ann Surg Oncol. 2020 Jan 14. doi: 10.1245/s10434-020-08207-0. [Epub ahead of print]
Proposed Definition for Oligometastatic Recurrence in Biliary Tract Cancer Based on Results of Locoregional Treatment: A Propensity-Score-Stratified Analysis.
Morino K1, Seo S2, Yoh T1, Fukumitsu K1, Ishii T1, Taura K1, Morita S3, Kaido T1, Uemoto S1.
Author information
Abstract
BACKGROUND:
Oligometastatic recurrence involves relapsed tumors for which locoregional treatment (LT) may yield a survival benefit. However, there are no clear criteria for selecting patients for LT or determining the effects of LT in recurrent biliary tract cancer (BTC). The aim of this retrospective study is to assess the effects of LT on survival outcomes and to identify potential criteria for selecting LT in recurrent BTC.
PATIENTS AND METHODS:
In the present work, 232 consecutive patients with recurrent BTC who initially underwent curative surgery between 1996 and 2015 were evaluated. The primary outcome was length of survival after recurrence (SAR). Propensity score stratification with various tumor-related factors was used to identify patients who would likely benefit from LT.
RESULTS:
Among the cohort, 60 (25.9%) patients underwent LT, whereas 172 (74.1%) patients did not. The multivariate Cox model identified carbohydrate antigen 19-9 levels of > 50 U/mL, multiorgan recurrence, tumor number > 3, tumor size > 30 mm, and early recurrence (≤ 1 year) as independent predictors of poor SAR (P < 0.001 for each factor). In the propensity-score-stratified analysis, LT was associated with survival benefits for patients representing single-organ recurrence with at most three tumors and late-onset recurrence (> 1 year) (median SAR: 48.6 vs. 14.2 months, n = 33 vs. n = 34, hazard ratio: 0.10, 95% confidence interval: 0.04-0.20, P < 0.001).
CONCLUSIONS:
Patients with recurrent BTC may benefit from LT if they have single-organ recurrence with at most three tumors and late-onset recurrence. We propose that these patients may have clinically relevant "oligometastatic recurrence" of BTC.
KEYWORDS:
Biliary tract cancer; Locoregional treatment; Oligometastasis; Oligorecurrence
PMID: 31939034 DOI: 10.1245/s10434-020-08207-0
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Select item 319390332.
Ann Surg Oncol. 2020 Jan 14. doi: 10.1245/s10434-020-08200-7. [Epub ahead of print]
Comment on "Diagnostic Laparoscopy as a Selection Tool for Patients with Colorectal Peritoneal Metastases to Prevent a Non-therapeutic Laparotomy During Cytoreductive Surgery".
Pameijer CR1.
Author information
PMID: 31939033 DOI: 10.1245/s10434-020-08200-7
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Select item 312863133.
Ann Surg Oncol. 2019 Sep;26(9):3009-3010. doi: 10.1245/s10434-019-07603-5. Epub 2019 Jul 8.
Laparoscopic Hyperthermic Intraperitoneal Chemotherapy for Patients with Gastric Peritoneal Metastases: Limitations and Perspectives.
Eveno C1,2, Voron T3, Piessen G3,4.
Author information
Erratum in
Correction to: Laparoscopic Hyperthermic Intraperitoneal Chemotherapy for Patients with Gastric Peritoneal Metastases: Limitations and Perspectives. [Ann Surg Oncol. 2019]
Comment in
Reply to the Letter to the Editor Regarding "Laparoscopic Hyperthermic Intraperitoneal Chemotherapy is Safe for Patients with Peritoneal Metastases from Gastric Cancer and May Lead to Gastrectomy". [Ann Surg Oncol. 2019]
PMID: 31286313 DOI: 10.1245/s10434-019-07603-5
[Indexed for MEDLINE]
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Select item 312863084.
Ann Surg Oncol. 2019 Sep;26(9):2969-2970. doi: 10.1245/s10434-019-07608-0. Epub 2019 Jul 8.
ASO Author Reflections: Which Patients Benefit the Most From Lymphadenectomy During Resection for Intrahepatic Cholangiocarcinoma?
Sahara K1,2, Tsilimigras DI1, Pawlik TM3.
Author information
PMID: 31286308 DOI: 10.1245/s10434-019-07608-0
[Indexed for MEDLINE]
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Select item 312863075.
Ann Surg Oncol. 2019 Sep;26(9):2831-2838. doi: 10.1245/s10434-019-07585-4. Epub 2019 Jul 8.
Methylprednisolone Inhibits Tumor Growth and Peritoneal Seeding Induced by Surgical Stress and Postoperative Complications.
Taniguchi Y1, Kurokawa Y2, Hagi T1, Takahashi T1, Miyazaki Y1, Tanaka K1, Makino T1, Yamasaki M1, Nakajima K1, Mori M1, Doki Y1.
Author information
Abstract
BACKGROUND:
Surgery often introduce inflammatory response, which may promote tumor growth and metastasis of residual cancer cells. We investigated the impacts of methylprednisolone on the tumor growth and peritoneal seedings in mice treated with lipopolysaccharide (LPS), which mimics systemic inflammation induced by surgical stress and postoperative complications.
METHODS:
The serum interleukin-6 (IL-6) levels, tumor volume, tumor weight, and the number of peritoneal nodules were investigated in tumor growth model and peritoneal seeding model using BALB/c mice and murine CT26 cancer cell lines in vivo. We conducted functional analyses of IL-6 in Western blotting and proliferation assays in vitro. We also investigated whether preoperative administration of methylprednisolone decreased postoperative serum IL-6 levels in cancer patients in a randomized clinical study.
RESULTS:
In the in vivo study, methylprednisolone inhibited the LPS-induced increase of serum IL-6 levels (mean, 33,756 pg/ml vs. 5917 pg/ml; P < 0.001), tumor volume (mean, 397 mm3 vs. 274 mm3; P = 0.019), tumor weight (mean, 0.38 g vs. 0.15 g; P = 0.020), and the number of peritoneal nodules (mean, 112 vs. 47; P = 0.002). In the in vitro study, IL-6 enhanced JAK/STAT signaling and increased the cell proliferation, and IL-6R-neutralizing antibody attenuated these effects. In the clinical study, serum IL-6 levels were significantly decreased by methylprednisolone (median, 97.5 pg/ml vs. 18.0 pg/ml; P = 0.030).
CONCLUSIONS:
Surgical stress and postoperative complications may enhance tumor growth due to the increase of IL-6. However, methylprednisolone can decrease serum IL-6 levels, thus inhibiting tumor growth and peritoneal seeding.
PMID: 31286307 DOI: 10.1245/s10434-019-07585-4
[Indexed for MEDLINE]
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Select item 312641196.
Ann Surg Oncol. 2019 Sep;26(9):2952-2958. doi: 10.1245/s10434-019-07482-w. Epub 2019 Jul 1.
Long-Term Prognosis of Unilateral and Multifocal Papillary Thyroid Microcarcinoma After Unilateral Lobectomy Versus Total Thyroidectomy.
Jeon YW1, Gwak HG1, Lim ST1, Schneider J2, Suh YJ3,4.
Author information
Abstract
BACKGROUND:
Multifocal papillary thyroid microcarcinoma (PTMC) has been associated with poor outcomes; however, we often encounter pathologically confirmed unilateral multifocal PTMC after surgery. To date, no consensus on the proper surgical extent for patients with this form of PTMC has been reported.
OBJECTIVE:
The aim of this study was to analyze the effect of the type of surgical treatment on disease recurrence in patients with unilateral multifocal PTMC.
METHODS:
We retrospectively analyzed data from 255 patients with unilateral, multifocal, node-negative PTMC between March 1999 and December 2012. We evaluated two groups of patients: those who underwent unilateral lobectomy (Group I, n = 127) and those who underwent total thyroidectomy (Group II, n = 128). During the follow-up period, which lasted a median of 94.8 months, we assessed locoregional recurrence (LRR).
RESULTS:
There was no statistically significant difference between the two groups with regard to LRR at follow-up (3.15% for Group I vs. 0.78% for Group II; p = 0.244). The association between the type of surgical treatment and LRR remained nonsignificant after adjusting for potential confounders such as age, tumor size, microscopic extrathyroidal extension, and lymphovascular invasion (p = 0.115). During follow-up, the incidence of transient hypocalcemia (0% vs. 8.6%; p = 0.001) and vocal fold paralysis (1.6% vs. 9.4%; p = 0.011) was higher in Group II than in Group I.
CONCLUSIONS:
Even though randomized controlled trials are the only option to obtain a definitive answer to this question, unilateral lobectomy may be a safe operative option for selected patients with unilateral, multifocal, node-negative PTMC.
PMID: 31264119 DOI: 10.1245/s10434-019-07482-w
[Indexed for MEDLINE]
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Select item 312503467.
Ann Surg Oncol. 2019 Sep;26(9):2821-2830. doi: 10.1245/s10434-019-07508-3. Epub 2019 Jun 27.
Mathematical Modeling of the Metastatic Colorectal Cancer Microenvironment Defines the Importance of Cytotoxic Lymphocyte Infiltration and Presence of PD-L1 on Antigen Presenting Cells.
Lazarus J1, Oneka MD2, Barua S2, Maj T1, Lanfranca MP1, Delrosario L1, Sun L1, Smith JJ3, D'Angelica MI3, Shia J4, Fang JM5, Shi J5, Di Magliano MP1, Zou W1, Rao A6,2,7, Frankel TL8.
Author information
Abstract
BACKGROUND:
Although immune-based therapy has proven efficacious for some patients with microsatellite instability (MSI) colon cancers, a majority of patients receive limited benefit. Conversely, select patients with microsatellite stable (MSS) tumors respond to checkpoint blockade, necessitating novel ways to study the immune tumor microenvironment (TME). We used phenotypic and spatial data from infiltrating immune and tumor cells to model cellular mixing to predict disease specific outcomes in patients with colorectal liver metastases.
METHODS:
Formalin fixed paraffin embedded metastatic colon cancer tissue from 195 patients were subjected to multiplex immunohistochemistry (mfIHC). After phenotyping, the G-function was calculated for each patient and cell type. Data was correlated with clinical outcomes and survival.
RESULTS:
High tumor cell to cytotoxic T lymphocyte (TC-CTL) mixing was associated with both a pro-inflammatory and immunosuppressive TME characterized by increased CTL infiltration and PD-L1+ expression, respectively. Presence and engagement of antigen presenting cells (APC) and helper T cells (Th) were associated with greater TC-CTL mixing and improved 5-year disease specific survival compared to patients with a low degree of mixing (42% vs. 16%, p = 0.0275). Comparison of measured mixing to a calculated theoretical random mixing revealed that PD-L1 expression on APCs resulted in an environment where CTLs were non-randomly less associated with TCs, highlighting their biologic significance.
CONCLUSION:
Evaluation of immune interactions within the TME of metastatic colon cancer using mfIHC in combination with mathematical modeling characterized cellular mixing of TCs and CTLs, providing a novel strategy to better predict clinical outcomes while identifying potential candidates for immune based therapies.
PMID: 31250346 PMCID: PMC6684475 [Available on 2020-09-01] DOI: 10.1245/s10434-019-07508-3
[Indexed for MEDLINE]
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Select item 312436668.
Ann Surg Oncol. 2019 Sep;26(9):2943-2951. doi: 10.1245/s10434-019-07516-3. Epub 2019 Jun 26.
Maximal-Effort Cytoreductive Surgery for Ovarian Cancer Patients with a High Tumor Burden: Variations in Practice and Impact on Outcome.
Hall M1, Savvatis K2,3, Nixon K4, Kyrgiou M4, Hariharan K1, Padwick M5, Owens O5, Cunnea P4, Campbell J6, Farthing A4, Stumpfle R6, Vazquez I1, Watson N7, Krell J4, Gabra H4,8, Rustin G1, Fotopoulou C9,10.
Author information
Abstract
BACKGROUND:
This study aimed to compare the outcomes of two distinct patient populations treated within two neighboring UK cancer centers (A and B) for advanced epithelial ovarian cancer (EOC).
METHODS:
A retrospective analysis of all new stages 3 and 4 EOC patients treated between January 2013 and December 2014 was performed. The Mayo Clinic surgical complexity score (SCS) was applied. Cox regression analysis identified the impact of treatment methods on survival.
RESULTS:
The study identified 249 patients (127 at center A and 122 in centre B) without significant differences in International Federation of Gynecology and Obstetrics (FIGO) stage (FIGO 4, 29.7% at centers A and B), Eastern Cooperative Oncology Group (ECOG) performance status (ECOG < 2, 89.9% at centers A and B), or histology (serous type in 84.1% at centers A and B). The patients at center A were more likely to undergo surgery (87% vs 59.8%; p < 0.001). The types of chemotherapy and the patients receiving palliative treatment alone were equivalent between the two centers (3.6%). The median SCS was significantly higher at center A (9 vs 2; p < 0.001) with greater tumor burden (9 vs 6 abdominal fields involved; p < 0.001), longer median operation times (285 vs 155 min; p < 0.001), and longer hospital stays (9 vs 6 days; p < 0.001), but surgical morbidity and mortality were equivalent. The independent predictors of reduced overall survival (OS) were non-serous histology (hazard ratio [HR], 1.6; 95% confidence interval [CI] 1.04-2.61), ECOG higher than 2 (HR, 1.9; 95% CI 1.15-3.13), and palliation alone (HR, 3.43; 95% CI 1.51-7.81). Cytoreduction, of any timing, had an independent protective impact on OS compared with chemotherapy alone (HR, 0.31 for interval surgery and 0.39 for primary surgery), even after adjustment for other prognostic factors.
CONCLUSIONS:
Incorporating surgery into the initial EOC management, even for those patients with a greater tumor burden and more disseminated disease, may require more complex procedures and more resources in terms of theater time and hospital stay, but seems to be associated with a significant prolongation of the patients overall survival compared with chemotherapy alone.
Comment in
Denominator Based Studies Need Full Disclosure of the Origins of Patients Treated. [Ann Surg Oncol. 2019]
PMID: 31243666 PMCID: PMC6682567 DOI: 10.1245/s10434-019-07516-3
[Indexed for MEDLINE] Free PMC Article
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Select item 312405929.
Ann Surg Oncol. 2019 Sep;26(9):2994-3004. doi: 10.1245/s10434-019-07530-5. Epub 2019 Jun 25.
The CANLPH Score, an Integrative Model of Systemic Inflammation and Nutrition Status (SINS), Predicts Clinical Outcomes After Surgery in Renal Cell Carcinoma: Data From a Multicenter Cohort in Japan.
Komura K1,2,3, Hashimoto T4, Tsujino T5, Muraoka R4, Tsutsumi T5, Satake N4, Matsunaga T5,6, Yoshikawa Y5, Takai T5, Minami K5, Taniguchi K7, Uehara H5, Tanaka T7, Hirano H5, Nomi H5, Ibuki N5, Takahara K8, Inamoto T5, Ohno Y4, Azuma H5.
Author information
Abstract
BACKGROUND:
A myriad of studies have demonstrated the clinical association of systemic inflammatory and nutrition status (SINS) including C-reactive protein/albumin ratio (CAR), the neutrophil/lymphocyte ratio (NLR), and the platelet/hemoglobin ratio (PHR). This study aimed to investigate the predictive value of the score integrating these variables (CANLPH) in patients with renal cell carcinoma (RCC).
METHODS:
Using cohort data from a multi-institutional study, 757 of 1109 patients were retrospectively analyzed. The optimal cutoff value for outcome prediction of continuous variables in CAR, NLR, and PHR was determined and the CANLPH score was then calculated as the sum score of 0 or 1 by the cutoff value in each ratio.
RESULTS:
The median follow-up time was 76 months for the patients who survived (n = 585) and 31 months for those who died (n = 172). The Youden Index offered an optimal cutoff of 1.5 for CAR and 2.8 for NLR, and a higher value from the cutoff was assigned as a score of 1. The cutoff value of the PHR was defined as 2.1 for males and 2.3 for females. The patients were assigned a CANLPH score of 0 (47.2%), 1 (31.3%), 2 (13.1%), or 3 (8.5%). In the multivariate analysis, the CANLPH score served as an independent predictor of cancer-specific mortality in both localized and metastatic RCC.
CONCLUSION:
The score was well-correlated with clinical outcome for the RCC patients. Because this score can be concisely measured at the point of diagnosis, physicians may be encouraged to incorporate this model into the treatment for RCC.
PMID: 31240592 DOI: 10.1245/s10434-019-07530-5
[Indexed for MEDLINE]
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Select item 3124058810.
Ann Surg Oncol. 2019 Sep;26(9):2855-2863. doi: 10.1245/s10434-019-07505-6. Epub 2019 Jun 25.
Focused Ultrasound Surveillance of Lymph Nodes Following Lymphoscintigraphy Without Sentinel Node Biopsy: A Useful and Safe Strategy in Elderly or Frail Melanoma Patients.
Ipenburg NA1,2, Thompson JF3,4,5, Uren RF4,6, Chung D4,6, Nieweg OE3,4,5.
Author information
Abstract
BACKGROUND:
Sentinel node (SN) biopsy (SNB) has become standard of care in clinically localized melanoma patients. Although it is minimally invasive, advanced age and/or comorbidities may render SNB inadvisable in some patients. Focused ultrasound follow-up of SNs identified by preoperative lymphoscintigraphy may be an alternative in these patients. This study examines the outcomes in patients managed in this way at a major melanoma treatment center.
METHODS:
All patients with clinically localized cutaneous melanoma who underwent lymphoscintigraphy and in whom SNB was intentionally not performed due to advanced age and/or comorbidities were included.
RESULTS:
Between 2000 and 2009, 160 patients (5.2% of the total) underwent lymphoscintigraphy without SNB because of advanced age and/or comorbidities. Compared with the 2945 patients who had a SNB, the 160 patients were older, had thicker melanomas that were more often located in the head and neck region, and had more SNs in more nodal regions. Of the 160 patients, 150 (94%) were followed with ultrasound examination of their SNs at each follow-up visit; this identified 33% of the nodal recurrences before they became clinically apparent. Compared with SN-positive patients who were treated by completion lymph node dissection, observed patients who developed nodal recurrence had more involved nodes when a delayed lymphadenectomy was performed. Melanoma-specific survival, recurrence-free survival, and distant recurrence-free survival rates were similar, while regional lymph node-free survival was worse.
CONCLUSIONS:
Lymphoscintigraphy with focused ultrasound follow-up of SNs is a reasonable management alternative to SNB in patients who are elderly and/or have substantial comorbidities.
PMID: 31240588 PMCID: PMC6682569 DOI: 10.1245/s10434-019-07505-6
[Indexed for MEDLINE] Free PMC Article
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MeSH terms, Supplementary concept
Select item 3122813111.
Ann Surg Oncol. 2019 Sep;26(9):2985-2993. doi: 10.1245/s10434-019-07449-x. Epub 2019 Jun 21.
Quality of Life Following Major Laparoscopic or Open Pancreatic Resection.
Torphy RJ1, Chapman BC1, Friedman C1, Nguyen C1, Bartsch CG1, Meguid C1, Ahrendt SA1, McCarter MD1, Del Chiaro M1, Schulick RD1, Edil BH2, Gleisner A3.
Author information
Abstract
PURPOSE:
This study was designed to compare quality of life (QoL) among patients who underwent open versus laparoscopic pancreatic resection, including distal pancreatectomy and pancreaticoduodenectomy, and to identify clinical characteristics that are associated with changes in QoL.
METHODS:
Quality of life (QoL) was assessed in patients undergoing pancreatic resection with the Functional Assessment of Cancer Therapy-Hepatobiliary questionnaire preoperatively and 2 weeks, 1, 3, and 6 months postoperatively. Multilevel regression modeling was used to determine the variability in each QoL domain within the first 2 weeks (postoperative period) and thereafter (recovery period).
RESULTS:
Among 159 patients, 60.4% underwent open and 39.6% underwent laparoscopic surgery. Physical, functional, hepatobiliary, and total QoL scores decreased in the postoperative period but returned to baseline levels by 6 months postoperatively. Emotional QoL improved from baseline by 2 weeks after surgery (p < 0.001) and social QoL improved from baseline by 3 months after surgery (p < 0.001). Emotional QoL was the only domain where significant differences were observed in QoL in the postoperative and recovery periods between patients who underwent open and laparoscopic pancreatic resection. Controlling for surgical approach, patients who experienced a grade III or IV complication experienced greater declines in physical, functional, hepatobiliary, and total QoL in the postoperative period. The negative impact of complications on QoL resolved by 6 months postoperatively.
CONCLUSIONS:
The impact of pancreatic resection on QoL was comparable between patients who underwent laparoscopic versus open pancreatic resection. Complications were strongly associated with changes in postoperative QoL, suggesting that performing a safe operation is the best approach for optimizing patient reported QoL.
PMID: 31228131 DOI: 10.1245/s10434-019-07449-x
[Indexed for MEDLINE]
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MeSH terms
Select item 3120967412.
Ann Surg Oncol. 2019 Sep;26(9):2874-2881. doi: 10.1245/s10434-019-07498-2. Epub 2019 Jun 17.
Discrepancy Between the Clinical and Final Pathological Findings of Lymph Node Metastasis in Superficial Esophageal Cancer.
Aoyama J1, Kawakubo H2, Mayanagi S1, Fukuda K1, Irino T1, Nakamura R1, Wada N1, Suzuki T3, Kameyama K4, Kitagawa Y1.
Author information
Abstract
BACKGROUND:
Recent advances in endoscopic examinations have resulted in the detection of a larger number of early esophageal cancers; however, there have been many cases with clinically negative but pathologically positive lymph node metastasis (LNM). In this study, we aimed to evaluate the discrepancy between the clinical and pathological diagnoses of LNM in patients with cT1a-MM/cT1b N0M0 esophageal cancer, and assess LNM size in these patients to clarify the presence of LNM that cannot be detected with current modalities.
METHODS:
This study included 50 patients who underwent surgery for cT1a-MM/cT1b N0M0 thoracic esophageal squamous cell carcinoma between January 2012 and November 2016 at our institution. The maximum size of involved LNs and metastatic nests were measured, and the distribution of LNM was investigated.
RESULTS:
Of the 50 patients, 13 (26%) had LNM on pathological examination. Lymphatic invasion was significantly more frequent in the LNM-positive group than in the LNM-negative group (p = 0.005). The median sizes of 28 involved LNs and metastatic nests were 3 and 1.6 mm, respectively. Of these LNs, 20 (71%) were classified as micrometastases (≤ 2 mm). The involved nodes were distributed across three fields.
CONCLUSIONS:
There was a discrepancy between the clinical and final pathological findings of LNM in patients with cT1a-MM/cT1b N0M0 esophageal cancer. The detection of involved nodes with current modalities in these patients was difficult because of the small size of LNM. Therefore, continued strong consideration for extended LN dissection is necessary in these patients to ensure appropriate diagnosis and treatment.
PMID: 31209674 DOI: 10.1245/s10434-019-07498-2
[Indexed for MEDLINE]
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MeSH terms
Select item 3120967313.
Ann Surg Oncol. 2019 Sep;26(9):2805-2811. doi: 10.1245/s10434-019-07503-8. Epub 2019 Jun 17.
Circulating Tumor Cells in Patients Undergoing Resection of Colorectal Cancer Liver Metastases. Clinical Utility for Long-Term Outcome: A Prospective Trial.
Arrazubi V1, Mata E2, Antelo ML3, Tarifa A4, Herrera J4, Zazpe C4, Teijeira L2, Viudez A2, Suárez J4, Hernández I2, Vera R2.
Author information
Abstract
BACKGROUND:
Patients with resected colorectal cancer liver metastases display heterogeneous clinical behavior. The identification of new prognostic factors would help in making more accurate decisions.
OBJECTIVE:
The aim of this study was to evaluate the survival impact of circulating tumor cells (CTCs) in this setting.
METHODS:
We conducted a prospective study of patients with resected liver metastases of colorectal cancer. Patients were included in the study from February 2009 to January 2013. The CellSearch System™ was employed for the detection of pre- and postsurgery CTCs. A positive test was defined as two or more CTCs/7.5 mL of blood. Recurrence rate, disease-free survival, and overall survival were calculated, and univariate and multivariate analyses were performed.
RESULTS:
Forty-four patients were included in our study. After a median follow-up of 60 months (range 28-74), 32 patients experienced recurrence (72.7%). The CTCs number was determined and the test was positive in 8 patients (18.6%) before surgery and 13 patients (29.5%) after surgery. The postoperative detection of CTCs was not related to any clinical outcome; however, the preoperative detection of CTCs was significantly related to behavior. All patients in the preoperative CTC-positive group relapsed, versus 65% in the CTC-negative group (p = 0.051). Disease-free survival was 19 months in the preoperative CTC-negative group versus 7 months in the CTC-positive group (p = 0.01). Additionally, overall survival was 69 months in the preoperative CTC-negative group versus 17 months in the CTC-positive group (p = 0.004). Preoperative CTC count remained significant in multivariate analysis.
CONCLUSIONS:
In this cohort of colorectal cancer liver metastases patients, the presence of two or more preoperative CTCs was associated with disease progression and poor survival despite complete resection.
PMID: 31209673 DOI: 10.1245/s10434-019-07503-8
[Indexed for MEDLINE]
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MeSH terms
Select item 3120967114.
Ann Surg Oncol. 2019 Sep;26(9):2797-2804. doi: 10.1245/s10434-019-07502-9. Epub 2019 Jun 17.
Assessment of the Value of Comorbidity Indices for Risk Adjustment in Colorectal Surgery Patients.
Strombom P1, Widmar M1, Keskin M1, Gennarelli RL2, Lynn P1, Smith JJ1, Guillem JG1, Paty PB1, Nash GM1, Weiser MR1, Garcia-Aguilar J3.
Author information
Abstract
BACKGROUND AND PURPOSE:
Comorbidity indices (CIs) are widely used in retrospective studies. We investigated the value of commonly used CIs in risk adjustment for postoperative complications after colorectal surgery.
METHODS:
Patients undergoing colectomy without stoma for colonic neoplasia at a single institution from 2009 to 2014 were included. Four CIs were calculated or obtained for each patient, using administrative data: Charlson-Deyo (CCI-D), Charlson-Romano (CCI-R), Elixhauser Comorbidity Score, and American Society of Anesthesiologists classification. Outcomes of interest in the 90-day postoperative period were any surgical complication, surgical site infection (SSI), Clavien-Dindo (CD) grade 3 or higher complication, anastomotic leak or abscess, and nonroutine discharge. Base models were created for each outcome based on significant bivariate associations. Logistic regression models were constructed for each outcome using base models alone, and each index as an additional covariate. Models were also compared using the DeLong and Clarke-Pearson method for receiver operating characteristic (ROC) curves, with the CCI-D as the reference.
RESULTS:
Overall, 1813 patients were included. Postoperative complications were reported in 756 (42%) patients. Only 9% of patients had a CD grade 3 or higher complication, and 22.8% of patients developed an SSI. Multivariable modeling showed equivalent performance of the base model and the base model augmented by the CIs for all outcomes. The ROC curves for the four indices were also similar.
CONCLUSIONS:
The inclusion of CIs added little to the base models, and all CIs performed similarly well. Our study suggests that CIs do not adequately risk-adjust for complications after colorectal surgery.
PMID: 31209671 PMCID: PMC6684474 [Available on 2020-09-01] DOI: 10.1245/s10434-019-07502-9
[Indexed for MEDLINE]
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Select item 3120966615.
Ann Surg Oncol. 2019 Sep;26(9):3005-3006. doi: 10.1245/s10434-019-07462-0. Epub 2019 Jun 17.
Reflection on Consensus Statement on Oncoplastic Surgery.
Zucca-Matthes G1,2, Lebovic G3,4.
Author information
Comment in
Author's Response to Reflexion on Consensus Statement on Oncoplastic Surgery, by Zucca-Matthes, Gustavo, et al. [Ann Surg Oncol. 2019]
PMID: 31209666 DOI: 10.1245/s10434-019-07462-0
[Indexed for MEDLINE]
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Select item 3120966516.
Ann Surg Oncol. 2019 Sep;26(9):2846-2854. doi: 10.1245/s10434-019-07509-2. Epub 2019 Jun 17.
Utility of Level III Axillary Node Dissection in Melanoma Patients with Palpable Axillary Lymph Node Disease.
Mahvi DA1, Fairweather M1, Yoon CH1, Cho NL2.
Author information
Abstract
BACKGROUND:
The Multicenter Selective Lymphadenectomy Trial II results suggest that future radical axillary lymphadenectomy (ALND) will be performed for bulkier metastatic disease. The utility of level III lymph node (LN) dissection in melanoma patients with palpable metastatic axillary disease was assessed.
METHODS:
We performed a retrospective chart review of patients who underwent ALND (levels I-III) for metastatic melanoma from 2005 to 2017. We assessed the frequency of level III positive nodes in patients undergoing radical axillary lymphadenectomy (ALND) for metastatic melanoma as well as the prognostic role and factors predictive of level III LN positivity.
RESULTS:
A total of 190 patients underwent ALND during the study period. Of these, 85 patients had palpable axillary disease, of which 71 had separate level III pathologic assessment. Level III LNs were positive in 16.9% of patients with palpable disease versus 0% with positive sentinel LN. The 1-, 3-, and 5-year overall survival (OS) for patients with palpable disease was 82.9%, 58.9%, and 39.0%, respectively. Median disease-free survival was 26.8 months, and the axillary recurrence rate was 8.2%. High level I/II LN ratio, BRAF mutation, and total LN examined were significant predictors of level III positivity (all p ≤ 0.05). Patients with positive level III LN had significantly worse OS (median 18.6 months vs. not reached, p = 0.001). No preoperative factors were predictive of level III LN positivity.
CONCLUSIONS:
Level III axillary disease is not uncommon in melanoma patients with clinically palpable nodal disease and provides useful prognostic information for OS. We recommend that full level I-III ALND be considered in this patient cohort.
PMID: 31209665 DOI: 10.1245/s10434-019-07509-2
[Indexed for MEDLINE]
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MeSH terms
Select item 3119021017.
Ann Surg Oncol. 2019 Sep;26(9):2905-2911. doi: 10.1245/s10434-019-07455-z. Epub 2019 Jun 12.
Natural History of Gastric Cancer: Observational Study of Gastric Cancer Patients Not Treated During Follow-Up.
Oh SY1,2, Lee JH1, Lee HJ3,4, Kim TH1,5, Huh YJ1,6, Ahn HS7, Suh YS1, Kong SH1, Kim GH8,9, Ahn SJ10, Kim SH10, Choi Y11, Yang HK1,12.
Author information
Abstract
BACKGROUND:
Understanding the natural progression of untreated gastric cancer is critical for determining the disease prognosis as well as treatment options and timing. The aim of this study is to analyze the natural history of gastric cancer.
PATIENTS AND METHODS:
We included patients with gastric cancer who had not received any treatment and were staged using endoscopy/endoscopic ultrasonography and computed tomography on at least two follow-up visits during intervals of nontreatment. Tumor volumes were also measured in addition to the staging. Survival of each stage at diagnosis was also analyzed.
RESULTS:
A total of 101 patients were included. The mean follow-up period was 35.1 ± 34.4 months. The gastric cancer doubling time was 11.8 months for T1 and 6.2 months for T4. The progression time from early gastric cancer to advanced gastric cancer was 34 months. It decreased as the stages advanced: from 34 months between tumor-nodes-metastasis stage I and II to 1.8 months between stage III and IV. No variable was identified as a risk factor for cancer progression. The 5-year survival rates of untreated patients were 46.2% in stage I and 0% in stage II, stage III, and stage IV.
CONCLUSIONS:
The progression and doubling times of gastric cancer shorten as the stages advance. Objective data reported in this study can be a critical factor in determining treatment timing and screening interval.
KEYWORDS:
Doubling time; Gastric cancer; Natural history; Progression; Survival benefit
PMID: 31190210 DOI: 10.1245/s10434-019-07455-z
[Indexed for MEDLINE]
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Select item 3118736518.
Ann Surg Oncol. 2019 Sep;26(9):2899-2904. doi: 10.1245/s10434-019-07499-1. Epub 2019 Jun 11.
Prophylactic Cervical Lymph Node Dissection in Thoracoscopic Esophagectomy for Esophageal Cancer Increases Postoperative Complications and Does Not Improve Survival.
Koterazawa Y1, Oshikiri T2, Takiguchi G2, Hasegawa H2, Yamamoto M2, Kanaji S2, Yamashita K2, Matsuda T3, Nakamura T2, Fujino Y4, Tominaga M4, Suzuki S5, Kakeji Y2.
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Abstract
BACKGROUND:
Esophagectomy with three-field lymph node dissection is common, but the effects of cervical lymph node dissection on overall survival in patients with thoracic esophageal cancer remain controversial. Recently, we performed thoracoscopic esophagectomy and superior mediastinum and paracervical esophageal lymph nodes could have been effectively dissected from the thoracic cavity. This study assessed the risks and benefits of prophylactic supraclavicular lymph node dissection in patients who underwent thoracoscopic esophagectomy.
METHODS:
This retrospective study included 294 patients who underwent thoracoscopic esophagectomy at Kobe University Hospital and Hyogo Cancer Center between April 2010 and December 2015. Patients in the two-field (paracervical esophageal lymph nodes were dissected from the thoracic cavity) and three-field lymph node dissection groups were matched using propensity score matching. We compared overall survival and the incidence of postoperative complications in the matched cohort and assessed the estimated efficacy of additional lymphadenectomy for supraclavicular lymph node recurrence in the entire cohort.
RESULTS:
In the matched cohort, overall survival was not significantly different between the two groups, but the incidence of recurrent laryngeal nerve palsy was significantly higher in the 3FL group than in the 2FL group. In the entire cohort, 162 patients underwent a two-field lymph node dissection; 11 experienced supraclavicular nodal recurrence. We performed additional supraclavicular lymph node dissection in three patients without systemic metastasis, all of whom are alive without any other recurrence.
CONCLUSIONS:
Prophylactic cervical lymph nodes dissection in thoracoscopic esophagectomy does not improve long-term survival but does increase the risk of postoperative complications.
PMID: 31187365 DOI: 10.1245/s10434-019-07499-1
[Indexed for MEDLINE]
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Select item 3118364119.
Ann Surg Oncol. 2019 Sep;26(9):2890-2898. doi: 10.1245/s10434-019-07393-w. Epub 2019 Jun 10.
Nomogram to Predict Overall Survival for Thoracic Esophageal Squamous Cell Carcinoma Patients After Radical Esophagectomy.
Deng W1, Zhang W2, Yang J3, Ni W1, Yu S4, Li C1, Chang X1, Zhou Z1, Chen D1, Feng Q1, Chen X5, Lin Y6, Zhu K5, Zheng X7, He J8, Gao S8, Xue Q8, Mao Y8, Cheng G8, Sun K8, Liu X8, Fang D8, Chen J9, Xiao Z10.
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Abstract
BACKGROUND:
Effective tools evaluating the prognosis for patients with esophageal cancer undergoing surgery is lacking. The current study aimed to develop a nomogram to predict overall survival (OS) and provide evidence for adjuvant therapy for patients with esophageal carcinoma after esophagectomy.
METHODS:
The study retrospectively reviewed patients with pathologic T1N +/T2-4aN0-3, M0 thoracic esophageal squamous cell carcinoma after radical esophagectomy, with or without adjuvant therapy, in one institution as the training cohort (n = 2281). A nomogram was established using Cox proportional hazard regression to identify prognostic factors for OS, which were validated in an independent validation cohort (n = 1437). Area under curve (AUC) values of receiver operating characteristic curves were calculated to evaluate prognostic efficacy.
RESULTS:
In the training cohort, the median OS was 50.46 months, and the 5-year OS rate was 47.08%. Adjuvant therapy, sex, tumor location, grade, lymphovascular invasion, removed lymph nodes, and T and N categories were identified as predictive factors for OS. The nomogram showed favorable prognostic efficacy in the training and validation cohorts (5-year OS AUC: 0.685 and 0.744, respectively), which was significantly higher than that of the American Joint Committee on Cancer (AJCC) staging system. The nomogram distinguished OS rates among six risk groups, whereas AJCC could not separate the OS of 2A and 1B, 3C and 3B, or 3A and 2B. Patients with a nomogram score of 72 to 227 were predicted to achieve a 5-year OS increase of 10% or more from adjuvant therapy.
CONCLUSION:
The nomogram could effectively predict OS and aided decision making in adjuvant therapy for patients with thoracic esophageal squamous cell carcinoma after esophagectomy.
PMID: 31183641 DOI: 10.1245/s10434-019-07393-w
[Indexed for MEDLINE]
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Select item 3118364020.
Ann Surg Oncol. 2019 Sep;26(9):2864-2873. doi: 10.1245/s10434-019-07478-6. Epub 2019 Jun 10.
Cardiorespiratory Comorbidity and Postoperative Complications following Esophagectomy: a European Multicenter Cohort Study.
Klevebro F1,2, Elliott JA3,4, Slaman A5, Vermeulen BD6, Kamiya S7,8, Rosman C9, Gisbertz SS5, Boshier PR10, Reynolds JV3,4, Rouvelas I7,8, Hanna GB10, van Berge Henegouwen MI5, Markar SR10.
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Abstract
BACKGROUND:
The impact of cardiorespiratory comorbidity on operative outcomes after esophagectomy remains controversial. This study investigated the effect of cardiorespiratory comorbidity on postoperative complications for patients treated for esophageal or gastroesophageal junction cancer.
PATIENTS AND METHODS:
A European multicenter cohort study from five high-volume esophageal cancer centers including patients treated between 2010 and 2017 was conducted. The effect of cardiorespiratory comorbidity and respiratory function upon postoperative outcomes was assessed.
RESULTS:
In total 1590 patients from five centers were included; 274 (17.2%) had respiratory comorbidity, and 468 (29.4%) had cardiac comorbidity. Respiratory comorbidity was associated with increased risk of overall postoperative complications, anastomotic leak, pulmonary complications, pneumonia, increased Clavien-Dindo score, and critical care and hospital length of stay. After neoadjuvant chemoradiotherapy, respiratory comorbidity was associated with increased risk of anastomotic leak [odds ratio (OR) 1.83, 95% confidence interval (CI) 1.11-3.04], pneumonia (OR 1.65, 95% CI 1.10-2.47), and any pulmonary complication (OR 1.52, 95% CI 1.04-2.22), an effect which was not observed following neoadjuvant chemotherapy or surgery alone. Cardiac comorbidity was associated with increased risk of cardiovascular and pulmonary complications, respiratory failure, and Clavien-Dindo score ≥ IIIa. Among all patients, forced expiratory volume in 1 s (FEV1)/forced vital capacity (FVC) ratio > 70% was associated with reduced risk of overall postoperative complications, cardiovascular complications, atrial fibrillation, pulmonary complications, and pneumonia.
CONCLUSIONS:
The results of this study suggest that cardiorespiratory comorbidity and impaired pulmonary function are associated with increased risk of postoperative complications after esophagectomy performed in high-volume European centers. Given the observed interaction with neoadjuvant approach, these data indicate a potentially modifiable index of perioperative risk.
PMID: 31183640 PMCID: PMC6682565 DOI: 10.1245/s10434-019-07478-6
[Indexed for MEDLINE] Free PMC Article
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Select item 3115227221.
Ann Surg Oncol. 2019 Sep;26(9):2959-2968. doi: 10.1245/s10434-019-07483-9. Epub 2019 May 31.
Therapeutic Index Associated with Lymphadenectomy Among Patients with Intrahepatic Cholangiocarcinoma: Which Patients Benefit the Most from Nodal Evaluation?
Sahara K1,2, Tsilimigras DI1, Merath K1, Bagante F3, Guglielmi A3, Aldrighetti L4, Weiss M5, Bauer TW6, Alexandrescu S7, Poultsides GA8, Maithel SK9, Marques HP10, Martel G11, Pulitano C12, Shen F13, Soubrane O14, Koerkamp BG15, Matsuyama R2, Endo I2, Pawlik TM16,17.
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Abstract
BACKGROUND:
Although lymph node metastasis (LNM) is an important prognostic indicator for patients with intrahepatic cholangiocarcinoma (ICC), the benefit and indication for lymphadenectomy remain unclear.
METHODS:
Patients diagnosed with ICC between 1990 and 2016 were identified in the international multi-institutional dataset. To determine the survival benefit from lymphadenectomy, the therapeutic index was calculated by multiplying the frequency of LNM in a particular group of patients by the 3-year cancer-specific survival (CSS) rate of patients with LNM in that subgroup.
RESULTS:
Among 471 patients who met the inclusion criteria, approximately half had LNM (n = 205, 43.5%). The median number of resected and metastatic LNs were 4 [interquartile range (IQR) 2-8] and 0 (IQR 0-1), respectively. Three-year CSS in the entire cohort was 29.9%, reflecting a therapeutic index value of 13.0. The therapeutic index was lower among patients with major vascular invasion (5.4), preoperative carcinoembryonic antigen (CEA) > 5.0 (8.2), and LNM in areas other than the hepatoduodenal ligament (5.2). Of note, a therapeutic index difference of more than 10 points was noted only when examining the number of LNs harvested [1-2 (4.1) vs. 3-6 (16.1) vs. ≥ 7 (17.8)].
CONCLUSION:
The survival benefit derived from lymphadenectomy was poor among patients with major vascular invasion, CEA > 5.0, and LNM in areas other than the hepatoduodenal ligament. Resection of three or more LNs was associated with the highest therapeutic value among patients with LNM.
PMID: 31152272 DOI: 10.1245/s10434-019-07483-9
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Select item 3114799022.
Ann Surg Oncol. 2019 Sep;26(9):2933-2942. doi: 10.1245/s10434-019-07472-y. Epub 2019 May 30.
Impact of Radical Hysterectomy Versus Simple Hysterectomy on Survival of Patients with Stage 2 Endometrial Cancer: A Meta-analysis.
Liu T1, Tu H2, Li Y3, Liu Z2, Liu G2, Gu H4.
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Abstract
BACKGROUND:
The strategy of radical surgery for stage 2 endometrial cancer (EC) remains controversial. This meta-analysis aimed to investigate the impact of radical hysterectomy (RH) versus simple hysterectomy (SH) on survival of patients with stage 2 EC.
METHODS:
A systematic review was conducted to identify studies comparing survival between RH and SH in International Federation of Gynecology and Obstetrics (FIGO) stage 2 EC patients by searching several databases to July 2018. Hazard ratios (HRs) with 95% confidence intervals (CIs) for overall survival and progression-free survival were pooled using Stata V.12.0.
RESULTS:
The study included 10 retrospective cohort studies enrolling 2866 patients. Patients who received RH did not show a significant survival benefit for either overall survival (pooled HR 0.92; 95% CI 0.72-1.16; P = 0.484) or progression-free survival (pooled HR 0.75; 95% CI 0.39-1.42; P = 0.378). The result remained consistent after it was balanced with possible impact from adjuvant radiotherapy (pooled HR 0.85; 95% CI 0.62-1.16; P = 0.300). In earlier studies that staged patients according to FIGO 1988, RH showed a 27% survival benefit (pooled HR 0.73; 95% CI 0.53-1.00; P = 0.050), whereas in newly published studies based on FIGO 2009 staging, it reversely showed increased risk of death (pooled HR 1.24; 95% CI 0.86-1.77; P = 0.245). However, no statistical significance was reached under either staging criterion.
CONCLUSIONS:
Based on the results of this meta-analysis, RH does not significantly improve survival in stage 2 EC. The choice of RH remains controversial and should be considered carefully in clinical practice. More qualified studies are needed to determine the best treatment strategy for stage 2 EC.
PMID: 31147990 DOI: 10.1245/s10434-019-07472-y
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Select item 3114798923.
Ann Surg Oncol. 2019 Sep;26(9):2981-2984. doi: 10.1245/s10434-019-07474-w. Epub 2019 May 30.
Robotic Left Hepatectomy and Roux-en-Y Hepaticojejunostomy After Bile Duct Injury.
Machado MA1,2, Surjan RC3,4, Ardengh AO4, Makdissi F4,5.
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Abstract
BACKGROUND:
Bile duct injuries after cholecystectomy remain a major concern because their incidence has not changed through the years despite technical advances. This video presents a robotic left hepatectomy and Roux-en-Y hepaticojejunostomy as a treatment for a complex bile duct injury after laparoscopic cholecystectomy.
METHODS:
A 52-year-old man underwent laparoscopic cholecystectomy at another institution 8 years previously, which resulted in a bile duct injury. His postoperative period was complicated by jaundice and cholangitis. He was treated with endoscopic retrograde cholangiopancreatography and multiple endoprostheses for 3 years, after which the endoprostheses were removed, and he was sent to the authors' institution. Computed tomography showed that the left liver had signs of disturbed perfusion and dilation of the left intrahepatic bile duct. The patient was asymptomatic and refused any further attempt at surgical correction of the lesion. He was accompanied for 5 years. Magnetic resonance imaging showed progressive atrophy of the left liver. Finally, 3 months before this writing, he presented with intermittent episodes of cholangitis. A multidisciplinary team decided to perform left hepatectomy with Roux-en-Y hepatojejunostomy via a robotic approach. The left liver was atrophied, and left hepatectomy was performed. Fluorescence imaging was used to identify the right bile duct. At opening of the right bile duct, small stones were found and removed. Antecolic Roux-en-Y hepaticojejunostomy then was performed.
RESULTS:
The operative time was 335 min. Recovery was uneventful, and the patient was discharged on postoperative day 4.
CONCLUSIONS:
Robotic repair of bile duct injuries is feasible and safe, even when liver resection is necessary. This video may help oncologic surgeons to perform this complex procedure.
PMID: 31147989 DOI: 10.1245/s10434-019-07474-w
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Select item 3114798824.
Ann Surg Oncol. 2019 Sep;26(9):2812-2820. doi: 10.1245/s10434-019-07481-x. Epub 2019 May 30.
The Disease-Free Interval Between Resection of Primary Colorectal Malignancy and the Detection of Hepatic Metastases Predicts Disease Recurrence But Not Overall Survival.
Höppener DJ1, Nierop PMH1, van Amerongen MJ2, Olthof PB3,4, Galjart B1, van Gulik TM3, de Wilt JHW5, Grünhagen DJ1, Rahbari NN6, Verhoef C7.
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Abstract
INTRODUCTION:
The disease-free interval (DFI) between resection of primary colorectal cancer (CRC) and diagnosis of liver metastases is considered an important prognostic indicator; however, recent analyses in metastatic CRC found limited evidence to support this notion.
OBJECTIVE:
The current study aims to determine the prognostic value of the DFI in patients with resectable colorectal liver metastases (CRLM).
METHODS:
Patients undergoing first surgical treatment of CRLM at three academic centers in The Netherlands were eligible for inclusion. The DFI was defined as the time between resection of CRC and detection of CRLM. Baseline characteristics and Kaplan-Meier survival estimates were stratified by DFI. Cox regression analyses were performed for overall (OS) and disease-free survival (DFS), with the DFI entered as a continuous measure using a restricted cubic spline function with three knots.
RESULTS:
In total, 1374 patients were included. Patients with a shorter DFI more often had lymph node involvement of the primary, more frequently received neoadjuvant chemotherapy for CRLM, and had higher number of CRLM at diagnosis. The DFI significantly contributed to DFS prediction (p =0.002), but not for predicting OS (p =0.169). Point estimates of the hazard ratio (95% confidence interval) for a DFI of 0 versus 12 months and 0 versus 24 months were 1.284 (1.114-1.480) and 1.444 (1.180-1.766), respectively, for DFS, and 1.111 (0.928-1.330) and 1.202 (0.933-1.550), respectively, for OS.
CONCLUSION:
The DFI is of prognostic value for predicting disease recurrence following surgical treatment of CRLM, but not for predicting OS outcomes.
PMID: 31147988 PMCID: PMC6682566 DOI: 10.1245/s10434-019-07481-x
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Select item 3114414325.
Ann Surg Oncol. 2019 Sep;26(9):2779-2786. doi: 10.1245/s10434-019-07480-y. Epub 2019 May 29.
Clinicopathological Features and Disease Outcome in Breast Cancer Patients with Hormonal Receptor Discordance between Core Needle Biopsy and Following Surgical Sample.
Zhu S1, Wu J1, Huang O1, He J1, Zhu L1, Li Y1, Chen W1, Fei X2, Chen X3, Shen K4.
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Abstract
BACKGROUND:
There are limited data about how to manage patients with discordant hormonal receptor (HR) status between core needle biopsy (CNB) and following surgical sample (FSS). This study aimed to evaluate clinicopathological features and disease outcome for these HR discordance patients.
PATIENTS AND METHODS:
Invasive breast cancer patients with paired HR between CNB and FSS were retrospectively analyzed, being classified into three groups: HR positive, HR negative, and HR discordance. Patient characteristics, treatment decisions, and disease outcome were compared among above groups.
RESULTS:
A total of 1710 patients (1233 HR positive, 417 HR negative, and 60 HR discordance patients) were enrolled. Compared with the HR positive group, HR discordance patients were associated with more human epidermal growth factor receptor 2 positivity (P < 0.001) and higher Ki67 level (P = 0.001) tumors. The fraction of patients receiving adjuvant chemotherapy was 95.0% and 93.8% in the HR discordance or HR negative groups, much higher than in the HR positive group (66.7%, P < 0.001). Of 60 HR discordance patients, 34 (56.7%) received adjuvant endocrine therapy. The 5-year disease-free survival (DFS) rate was 90.4% for HR discordant patients, showing no statistical difference compared with HR positive (87.0%, P = 0.653) or HR negative (83.2%, P = 0.522) groups. For HR discordance patients, there was no difference in DFS between patients who received adjuvant endocrine therapy or not (P = 0.259).
CONCLUSIONS:
HR discordance patients had similar tumor characteristics, adjuvant chemotherapy treatment, and DFS compared with HR negative patients. The benefit of endocrine therapy in these HR discordance patients is uncertain and deserves further clinical evaluation.
PMID: 31144143 PMCID: PMC6682563 DOI: 10.1245/s10434-019-07480-y
[Indexed for MEDLINE] Free PMC Article
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Select item 3111134926.
Ann Surg Oncol. 2019 Sep;26(9):2839-2845. doi: 10.1245/s10434-019-07448-y. Epub 2019 May 20.
A Population-Based Comparison of the AJCC 7th and AJCC 8th Editions for Patients Diagnosed with Stage III Cutaneous Malignant Melanoma in Sweden.
Isaksson K1, Katsarelias D2, Mikiver R3, Carneiro A4, Ny L5, Olofsson Bagge R2,6.
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Abstract
BACKGROUND:
Cutaneous melanoma is steadily increasing worldwide. The new AJCC 8th edition was recently launched and introduced several changes in melanoma staging, particularly for stage III. We conducted a population-based registry study with the purpose to evaluate the impact and prognostic accuracy of the new classification in Sweden.
METHODS:
Consecutive patients diagnosed with stage III melanoma between January 2005 and September 2017 were identified by the Swedish Melanoma Registry (SMR) and included for analyses. Patients with multiple primary melanomas were excluded. Patients were classified according to the AJCC 7th as well as the 8th edition. Melanoma-specific survival (MSS) was retrieved from the Swedish Cause of Death Registry.
RESULTS:
A total of 2067 eligible patients were identified from the SMR; 1150 patients (57%) changed stage III subgroup when reclassified according to the AJCC 8th edition. The median 5- and 10-year MSS for the whole cohort of stage III melanoma patients was 59% and 51% respectively. The MSS for substage IIIA, B, and C were all improved when patients were reclassified by using to the AJCC 8th edition. The newly defined substage IIID had the worst prognosis with a 10-year MSS of 16%.
CONCLUSIONS:
A high proportion of patients diagnosed with stage III melanoma in Sweden between 2005 and 2017 was restaged to another subgroup, when they were reclassified according to the AJCC 8th of staging manual. We established an improved MSS for all substages compared with the former AJCC 7th edition. This may have implications on decisions about adjuvant treatment.
PMID: 31111349 PMCID: PMC6682854 DOI: 10.1245/s10434-019-07448-y
[Indexed for MEDLINE] Free PMC Article
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Select item 3110209327.
Ann Surg Oncol. 2019 Sep;26(9):2980. doi: 10.1245/s10434-019-07461-1. Epub 2019 May 17.
Laparoscopic Isolated Total Caudate Lobectomy for Hepatocellular Carcinoma Located in the Paracaval Portion of the Cirrhotic Liver.
Liu F1, Wei Y2, Li B1.
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Abstract
BACKGROUND:
Despite the widespread use of laparoscopic hepatectomies in past decades, laparoscopic isolated total caudate lobectomy for hepatocellular carcinoma (HCC) remains challenging,1,2 especially for patients with cirrhosis. Moreover, a laparoscopic isolated total caudate lobectomy for HCC originating in the paracaval portion of the caudate lobe is very rare. We herein present a video showing laparoscopic total caudate lobectomy for a cirrhotic patient with HCC located in the paracaval portion of the caudate lobe.
METHODS:
A 58-year-old woman who suffered from hepatitis C virus-related cirrhosis was admitted to our institution. The preoperative computed tomography showed a 2.5 × 2.0 cm liver mass located in segment I that was very close to the right hepatic pedicle. Although her liver function was Child-Pugh A, the indocyanine green (ICG)-15 test was high at 10.9%. Right hepatectomy plus caudate lobectomy was not adopted because of the severe cirrhosis and the elevated ICG-15. Thus, laparoscopic isolated total caudate lobectomy was contemplated.
RESULTS:
The patient was placed in the supine position. After full mobilization, the caudate lobe was exposed. The third porta of the liver was then dissected and the short hepatic veins were controlled with clips and LigaSure. The dissection was finished when the whole third porta of the liver was freed. Subsequently, the portal branches to the caudate lobe were ligated and cut. The combination between the left- and right-sided laparoscopic approaches was used to transect liver parenchyma. The superficial parenchyma was divided using an harmonic scalpel, while the deeper tissue was divided using a Cavitron ultrasonic aspirator (CUSA). The Pringle maneuver was used intermittently during the parenchymal transection as necessary. In the left-sided approach, the caudate lobe was resected along the left and middle hepatic vein toward the right side, to expose the dorsal semicircle of the right hepatic vein. In the right-sided approach, the resection started from the right border of the process portion to the root of the right hepatic vein in the cranial direction. Finally, the whole caudate lobe was resected and the three main hepatic veins were exposed on the cutting plane. The specimen was removed from suprapubic incision. The operative time was 300 min and the total Pringle time was 50 min. The postoperative course was uneventful.
CONCLUSIONS:
A laparoscopic isolated total caudate lobectomy for HCC located in the paracaval portion of the cirrhotic liver seems to be feasible and safe in selected patients.
PMID: 31102093 DOI: 10.1245/s10434-019-07461-1
[Indexed for MEDLINE]
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Select item 3110209228.
Ann Surg Oncol. 2019 Sep;26(9):2971-2979. doi: 10.1245/s10434-019-07457-x. Epub 2019 May 17.
Cholangiographic Tumor Classification for Simple Patient Selection Prior to Hepatopancreatoduodenectomy for Cholangiocarcinoma.
Toyoda Y1, Ebata T2, Mizuno T1, Yokoyama Y1, Igami T1, Yamaguchi J1, Onoe S1, Watanabe N1, Nagino M1.
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Abstract
BACKGROUND:
Hepatopancreatoduodenectomy (HPD) is employed for patients with laterally advanced cholangiocarcinoma. However, the survival benefit of this extended approach remains controversial. The aim of this study is to identify a tumor feature benefiting from HPD from the standpoint of long-term survival.
PATIENTS AND METHODS:
Patients with cholangiocarcinoma who underwent HPD with curative intent between 2001 and 2017 were retrospectively analyzed. Tumors were radiologically classified by preoperative cholangiogram. Diffuse type was defined as significant tumor/stricture located from the hilar to intrapancreatic duct; localized type was defined as tumor otherwise. Univariable and multivariable analyses were performed to identify prognostic indicators.
RESULTS:
Of 100 study patients, 28 (28%) patients had diffuse tumor type, while the remaining 72 (72%) patients had localized tumors. The former group showed significantly longer lateral length (43 versus 22 mm, P < 0.001) and more frequent pancreatic invasion (50% versus 32%, P = 0.110), advanced T classification (64% versus 49%, P = 0.185), and nodal metastasis (57% versus 47%, P = 0.504), compared with the latter group. The survival for patients with diffuse tumor type was significantly worse than that for patients with localized tumor type, with 5-year survival rates of 59.0% versus 26.3%, respectively (P = 0.003). Multivariable analysis identified four independent factors deteriorating long-term survival: cholangiographic diffuse tumor (P = 0.021), higher age (P = 0.020), percutaneous biliary drainage (P = 0.007), and portal vein resection (P = 0.007).
CONCLUSIONS:
Presurgical cholangiographic classification, diffuse or localized type, is a tumor-related factor closely associated with survival probability; therefore, it may be a useful feature for patient selection prior to HPD for cholangiocarcinoma.
PMID: 31102092 DOI: 10.1245/s10434-019-07457-x
[Indexed for MEDLINE]
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Select item 3107693029.
Ann Surg Oncol. 2019 Sep;26(9):2912-2932. doi: 10.1245/s10434-019-07417-5. Epub 2019 May 10.
In Patients with Localized and Resectable Gastric Cancer, What is the Optimal Extent of Lymph Node Dissection-D1 Versus D2 Versus D3?
Mogal H1, Fields R2, Maithel SK3, Votanopoulos K4.
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Abstract
BACKGROUND:
Despite advances in the treatment of patients with gastric cancer, the debate over the optimal extent of lymphadenectomy continues.
METHOD:
A review of the classification, rationale for, and boundaries of lymphadenectomy is presented. A review of the available literature comparing D1 versus D2 versus D3 lymphadenectomy was performed and included randomized controlled trials, and prospective and retrospective comparative and non-comparative studies.
RESULTS:
Earlier studies demonstrated increased morbidity with D2 compared with D1 lymphadenectomy, with no significant survival benefit. More recent studies have demonstrated survival benefit of a pancreas and spleen-sparing D2 lymphadenectomy in patients with advanced, node-positive tumors. Para-aortic/D3 dissections contribute to increased morbidity, with no survival benefit.
CONCLUSIONS:
In patients with resectable gastric adenocarcinoma, a D2 lymph node dissection preserving the pancreas and spleen should be considered standard for optimal staging and treatment, provided it is performed by surgeons with sufficient expertise. Extended lymph node dissections beyond D2 should not be routinely performed as it has been shown to have increased morbidity, with no improvement in outcomes. While systemic chemotherapy should be considered standard in patients undergoing D2 lymphadenectomy, the role of adjuvant radiation continues to evolve.
PMID: 31076930 DOI: 10.1245/s10434-019-07417-5
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Select item 3103743330.
Ann Surg Oncol. 2019 Sep;26(9):2882-2889. doi: 10.1245/s10434-019-07334-7. Epub 2019 Apr 29.
Treatment-Related Lymphopenia Predicts Pathologic Complete Response and Recurrence in Esophageal Squamous Cell Carcinoma Undergoing Neoadjuvant Chemoradiotherapy.
Li Q1, Zhou S1, Liu S1, Liu S2, Yang H3, Zhao L1, Liu M1, Hu Y4, Xi M5.
Author information
Abstract
PURPOSE:
To investigate the relationship between treatment-related lymphopenia and pathologic response to neoadjuvant chemoradiotherapy (CRT) in patients with esophageal squamous cell carcinoma (ESCC).
METHODS:
Between 2002 and 2016, 220 ESCC patients treated with neoadjuvant CRT followed by surgery were retrospectively analyzed. Absolute lymphocyte count was determined before, during, and 1 month after neoadjuvant CRT. Treatment-related lymphopenia was graded using Common Terminology Criteria for Adverse Events version 4.0. Relationship between lymphopenia with pathologic complete response (pCR) and recurrence were evaluated.
RESULTS:
Ninety-five patients (43.2%) achieved a pCR after neoadjuvant CRT and 71 patients (32.3%) developed recurrences. The incidence of grade 0, 1, 2, 3, and 4 lymphopenia during CRT were 1.8%, 6.8%, 31.4%, 38.2% and 21.8%, respectively. Patients with grade 4 lymphopenia had a significantly lower pCR rate than those with grade 0-3 lymphopenia (22.9% vs. 48.8%, P = 0.001). Moreover, grade 4 lymphopenia was significantly associated with a higher risk of recurrences (45.8% vs. 28.5%, P = 0.023). Multivariable analysis identified that primary tumor length, tumor location, and radiation dose were independent predictors for grade 4 lymphopenia.
CONCLUSIONS:
ESCC patients with grade 4 lymphopenia during neoadjuvant CRT were associated with a significantly lower pCR rate and a higher recurrence risk.
PMID: 31037433 DOI: 10.1245/s10434-019-07334-7
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Select item 3098949831.
Ann Surg Oncol. 2019 Sep;26(9):2787-2796. doi: 10.1245/s10434-019-07346-3. Epub 2019 Apr 15.
Oncologic Outcomes of Self-Expandable Metallic Stent as a Bridge to Surgery and Safety and Feasibility of Minimally Invasive Surgery for Acute Malignant Colonic Obstruction.
Yang SY1, Park YY2, Han YD1, Cho MS1, Hur H1, Min BS1, Lee KY1, Kim NK3.
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Abstract
BACKGROUND:
Although self-expandable metal stents (SEMS) are widely used as a bridge to surgery (BTS) in patients with malignant colorectal cancer obstruction, there has been some debate about their effect on long-term oncological outcomes. Furthermore, data on the safety and feasibility of minimally invasive surgery (MIS) combined with stent placement are scarce. We aimed to determine the long-term oncological outcomes of SEMS as a BTS, and the short-term outcomes of SEMS used with minimally invasive colorectal surgery.
METHODS:
Data from patients who were admitted with malignant obstructing colon cancer between January 2006 and December 2015 were retrospectively reviewed; 71 patients underwent direct surgery and 182 patients underwent SEMS placement as a BTS. Long-term and short-term outcomes of the groups were compared. In a subgroup analysis of the BTS group, the short-term outcomes of conventional open surgery and MIS were compared.
RESULTS:
There were no differences in long-term oncologic outcomes between groups. The primary anastomosis rate was higher in the stent group than in the direct surgery group. In the stent group, postoperative complication rates were lower in the minimally invasive group than in the open surgery group. Time to flatus and time to soft diet resumption were shorter in the minimally invasive group, as was length of hospital stay.
CONCLUSIONS:
Elective surgery after stent insertion does not adversely affect long-term oncologic outcomes. Furthermore, MIS combined with stent insertion for malignant colonic obstruction is safe and feasible.
PMID: 30989498 DOI: 10.1245/s10434-019-07346-3
[Indexed for MEDLINE]
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