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1.
Andreas Andreou Sebastian Knitter Fritz Klein Thomas Malinka Moritz Schmelzle Benjamin Struecker Rosa B. Schmuck Alina Roxana Noltsch Daniela Lee Uwe Pelzer Timm Denecke Johann Pratschke Marcus Bahra 《Surgical oncology》2018,27(4):688-694
Background
The role of hepatectomy for patients with liver metastases from ductal adenocarcinoma of the pancreas (PLM) remains controversial. Therefore, the aim of our study was to examine the postoperative morbidity, mortality, and long-term survivals after liver resection for synchronous PLM.Methods
Clinicopathological data of patients who underwent hepatectomy for PLM between 1993 and 2015 were assessed. Major endpoint of this study was to identify predictors of overall survival (OS).Results
During the study period, 76 patients underwent resection for pancreatic cancer and concomitant hepatectomy for synchronous PLM. Pancreatoduodenectomy, distal pancreatectomy, and total pancreatectomy were performed in 67%, 25%, and 8% of the patients, respectively. The median PLM size was 1 (1–13) cm and 36% of patients had multiple PLM. The majority of patients (96%) underwent a minor liver resection. After a median follow-up time of 130 months, 1-, 3-, and 5-year OS rates were 41%, 13%, and 7%, respectively. Postoperative morbidity and mortality rates were 50% and 5%, respectively. Preoperative and postoperative chemotherapy was administered to 5% and 72% of patients, respectively. In univariate analysis, type of pancreatic procedure (P?=?.020), resection and reconstruction of the superior mesenteric artery (P?=?.016), T4 stage (P?=?.086), R1 margin status at liver resection (P?=?.001), lymph node metastases (P?=?.016), poorly differentiated cancer (G3) (P?=?.037), no preoperative chemotherapy (P?=?.013), and no postoperative chemotherapy (P?=?.005) were significantly associated with worse OS. In the multivariate analysis, poorly differentiated cancer (G3) (hazard ratio [HR]?=?1.87; 95% confidence interval [CI]?=?1.08–3.24; P?=?.026), R1 margin status at liver resection (HR?=?4.97; 95% CI?=?1.46–16.86; P?=?.010), no preoperative chemotherapy (HR?=?4.07; 95% CI?=?1.40–11.83; P?=?.010), and no postoperative chemotherapy (HR?=?1.88; 95% CI?=?1.06–3.29; P?=?.030) independently predicted worse OS.Conclusions
Liver resection for PLM is feasible and safe and may be recommended within the framework of an individualized cancer therapy. Multimodal treatment strategy including perioperative chemotherapy and hepatectomy may provide prolonged survival in selected patients with metastatic pancreatic cancer. 相似文献2.
Alberto Biondi Annamaria Agnes Federica Del Coco Carmelo Pozzo Antonia Strippoli Domenico D&#x;Ugo Roberto Persiani 《Surgical oncology》2018,27(3):575-583
Background
The administration of perioperative chemotherapy represents the Western standard of care for patients with locally advanced gastric cancer. The aim of this study is to determine if the administration of the preoperative component of the perioperative regimen is beneficial in the entire population of patients with locally advanced gastric cancer.Methods
Seventy patients undergoing preoperative therapy were compared with 347 patients undergoing upfront gastrectomy. Survival analyses were conducted with Kaplan-Meier curves and Cox regression. Patients undergoing preoperative therapy or undergoing upfront gastrectomy were matched 1:1 using the propensity score matching (PSM) method, and a survival analysis was conducted on matched patients. A subgroup analysis was conducted by tumor location and Lauren histotype.Results
In patients undergoing preoperative therapy, factors significantly associated with survival were T and N downstaging, type of gastrectomy, resection status and Lauren histotype. Preoperative therapy was not significantly associated with survival (p?=?0,761 before PSM and p?=?0,519 after PSM). After PSM, the independent variables significantly associated with survival were type of gastrectomy, type of lymphadenectomy, R status and postoperative therapy. In the subgroup analysis, preoperative therapy demonstrated a selective association with the location of the tumor (p?=?0,055) and with Lauren intestinal histotype (p?=?0,002).Conclusions
Preoperative therapy had a non-significant impact on survival in the entire population of gastric cancer patients. The advantage of preoperative therapy seems to be limited to patients with proximal tumors and an intestinal histology. Future studies should better evaluate the diverse response of the different phenotypes of gastric cancer to preoperative therapy. 相似文献3.
Marine Gilabert Olivier Turrini Jacques Ewald Laurence Moureau-Zabotto Flora Poizat Jean-Luc Raoul Jean-Robert Delpero 《Surgical oncology》2018,27(4):619-624
Background
To describe, in patients with resectable pancreatic ductal adenocarcinoma (PDAC), the laparotomy findings, treatments and outcomes before (period 1) and after 2010 (period 2).Methods
From 2000 to 2015, patients newly diagnosed with resectable PDAC at Paoli-Calmettes Institute, France, were evaluated. Survival was examined using the Kaplan-Meier method, and statistical comparisons were conducted using log rank tests.Results
Among 1175 patients diagnosed with pancreatic mass, 164 underwent laparotomy with an intention of pancreatic resection. Some of them did not undergo pancreatic resection due to peroperative discovery of advanced disease. For those who were finally resected (n?=?119), there were fewer pancreaticoduodenectomies (p?=?0.045), shorter operation times (p?<?0.01), lower mortality rates (p?=?0.02), more advanced-stage tumors (T3), more frequent perineural invasion and R1 resection in period 2. This group had a trend of better outcomes after 2010 (51 months vs. 36 months (p?=?0.065)).Conclusion
Improvement in surgical procedures and postoperative management led to prolonged survival of those who underwent surgery for resectable pancreatic cancer since 2010, despite a higher frequency of advanced tumors at the diagnosis in our institution. 相似文献4.
Lucas Goense Els Visser Nadia Haj Mohammad Stella Mook Rob H.A. Verhoeven Gert J. Meijer Peter S.N. van Rossum Jelle P. Ruurda Richard van Hillegersberg 《European journal of surgical oncology》2018,44(5):620-625
Background
The aim of this population-based cohort study was to determine whether the addition of neoadjuvant chemoradiotherapy (nCRT) to surgery is associated with improved pathologic outcomes and survival in patients with cT2N0M0 esophageal cancer.Methods
Patients who underwent nCRT followed by surgery or surgery alone for cT2N0M0 esophageal cancer were identified from The Netherlands Cancer Registry database (2005–2014). Accuracy of clinical staging was assessed using the resection specimen as gold standard. After propensity score matching, influences of both treatment strategies on radical resection (R0) rates and overall survival were compared.Results
In total 533 patients were included; 353 underwent nCRT followed by surgery and 180 underwent surgery alone. In the nCRT group 32% of patients achieved a pathologic complete response. Clinical understaging was observed in 62% of the patients in the surgery alone group based on pT-stage (n = 30, 27%), pN-stage (n = 26, 23%), or both (n = 55, 50%). Propensity score matching resulted in 78 patients who underwent nCRT plus surgery versus 78 who underwent surgery alone. In the nCRT group radical resections were more frequently observed (99% vs. 89% p = 0.031) and resulted in improved 5-year overall survival (46% vs. 33%, p = 0.017).Conclusion
In this population-based study, clinical staging of cT2N0M0 esophageal cancer was highly inaccurate. Compared to surgery alone, neoadjuvant chemoradiotherapy was associated with higher radical resection rates and improved overall survival. 相似文献5.
A.E. Vallance J. van der Meulen A. Kuryba M. Braun D.G. Jayne J. Hill I.C. Cameron K. Walker 《European journal of surgical oncology》2018,44(10):1588-1594
Background
Socioeconomic inequalities in colorectal cancer (CRC) survival are well recognised. The aim of this study was to describe the impact of socioeconomic deprivation on survival in patients with synchronous CRC liver-limited metastases, and to investigate if any survival inequalities are explained by differences in liver resection rates.Methods
Patients in the National Bowel Cancer Audit diagnosed with CRC between 2010 and 2016 in the English National Health Service were included. Linked Hospital Episode Statistics data were used to identify the presence of liver metastases and whether a liver resection had been performed. Multivariable random-effects logistic regression was used to estimate the odds ratio (OR) of liver resection by Index of Multiple Deprivation (IMD) quintile. Cox-proportional hazards model was used to compare 3-year survival.Results
13,656 patients were included, of whom 2213 (16.2%) underwent liver resection. Patients in the least deprived IMD quintile were more likely to undergo liver resection than those in the most deprived quintile (adjusted OR 1.42, 95% confidence interval (CI) 1.18–1.70). Patients in the least deprived quintile had better 3-year survival (least deprived vs. most deprived quintile, 22.3% vs. 17.4%; adjusted hazard ratio (HR) 1.20, 1.11–1.30). Adjusting for liver resection attenuated, but did not remove, this effect. There was no difference in survival between IMD quintile when restricted to patients who underwent liver resection (adjusted HR 0.97, 0.76–1.23).Conclusions
Deprived CRC patients with synchronous liver-limited metastases have worse survival than more affluent patients. Lower rates of liver resection in more deprived patients is a contributory factor. 相似文献6.
Stefano Di Sandro Vincenzo Bagnardi Marc Najjar Vincenzo Buscemi Andrea Lauterio Riccardo De Carlis Maria Danieli Enrico Pinotti Laura Benuzzi Luciano De Carlis 《Surgical oncology》2018,27(4):722-729
Background
Laparoscopic liver resection (LLR) has gained significant popularity over the last 10 years. First experiences of LLR compared to open liver resection (OLR) reported a similar survival and a better safety profile for LLR.Materials and methods
This is a retrospective analysis of prospectively collected data of all consecutive patients treated by liver resection for HCC on liver cirrhosis between January 2005 and March 2017. The choice of procedure (LLR vs OLR) was generally based on tumor localization, history of previous upper abdominal surgery and patient's preference. The type of resection and indication for surgery were unrelated to the adopted technique. Based on pre-operative variables and confirmed cirrhosis, a 1:1 propensity score matching (PSM) model was developed to compare outcomes of LLR and OLR in patients with HCC. Outcomes of interest included morbidity, mortality and long-term cure potential.Results
After-PSM, the LLR group demonstrated better perioperative results including: lower complication rate (50.7% in OLR vs 29.3% in LLR, p?=?0.0035), significantly lower intra-operative blood loss (200?ml in OLR vs 150?ml in LLR, p?=?0.007) and shorter hospital length of stay (median 9 days in OLR vs 7 days in LLR, p?=?0.0018). Moreover there was no significant difference between the two groups in 3-year survival (76%, CI: 60%–86% in LLR vs 68%, CI: 55%–79% in OLR, p?=?0.32) or recurrence-free survival rates (44%, CI: 28%–58%, vs 44%, CI: 31%–57%, p?=?0.94).Conclusions
Minor LLR appeared significantly safer compared to minor OLR for HCC. LLR was associated with fewer post-operative complication, lower operative blood loss and a shorter hospital stay along with similar survival and recurrence-free survival rates 相似文献7.
William W. Tseng Denice D. Tsao-Wei Dario Callegaro Giovanni Grignani Lorenzo D&#x;Ambrosio Sylvie Bonvalot Cecilia G. Ethun Kenneth Cardona John T. Mullen Robert J. Canter John E. Mullinax Ricardo J. Gonzalez Frits van Coevorden Markus Albertsmeier Kiran K. Dhanireddy Salvatore L. Renne Alessandro Gronchi 《European journal of surgical oncology》2018,44(6):810-815
Background
In retroperitoneal sarcoma (RPS), the optimal extent of resection must balance adequate disease control with potential for morbidity. We sought to study the frequency and outcomes after a Whipple procedure or pancreaticoduodenectomy (PD) in patients undergoing resection for primary RPS.Methods
Participating referral centers within the Trans-Atlantic Retroperitoneal Sarcoma Working Group provided retrospective data from January 2007 to December 2016 for patients with primary RPS who underwent PD along with the total number of consecutive resections done during the same time period. Data from participating centers were combined for analysis.Results
In total, 29 patients underwent PD among 2068 resections performed for primary RPS (1.4%). The predominant histologic subtypes were liposarcoma and leiomyosarcoma. All PD patients underwent concomitant resection of additional organs (median: 2, range: 1–5), including 13 patients (45%) who also received vena cava resection. Definitive evidence of microscopic invasion of the duodenum or pancreas was seen in 84% of patients. Postoperatively, 10 patients (34%) had major complications including 8 (28%) that developed a clinically-significant pancreatic leak. One postoperative death (3.4%) occurred. With a median follow-up of 4.8 years, 19 patients (66%) developed disease recurrence. The patterns of recurrence were dependent on histologic subtype.Conclusion
Although infrequent, when PD is done for primary RPS, resection of additional organs is often required and major complication rates are moderate. The recurrence rate is overall high and the pattern of recurrence is dictated by histologic subtype. 相似文献8.
Andreas Andreou Benjamin Struecker Nathanael Raschzok Felix Krenzien Philipp Haber Simon Wabitsch Christoph Waldbaur Eva-Maria Touet Anne-Christine Eichelberg Georgi Atanasov Matthias Biebl Marcus Bahra Robert Öllinger Moritz Schmelzle Johann Pratschke 《Surgical oncology》2018,27(4):751-758
Background
Minimal-invasive hepatectomy (MIH) has been increasingly performed for benign and malignant liver lesions with most promising results. However, the role of MIH for the treatment of patients with hepatocellular carcinoma (HCC) needs further investigation.Methods
Clinicopathological data of patients who underwent liver resection for HCC between 2005 and 2016 were assessed. Postoperative outcomes und long-term survivals of patients following MIH were compared with those of patients undergoing conventional open hepatectomy (OH) after 1:1 propensity score matching.Results
During the study period, 407 patients underwent liver resection for HCC with curative intent. Fifty-six patients underwent MIH and were compared with a matched cohort of 56 patients who underwent OH. The rate of patients with fibrosis/cirrhosis (82% vs. 86%, p?=?0.959), multiple lesions (32% vs. 32%, p?=?1.00), tumor size >30?mm (61% vs. 55%, p?=?0.566), and major resection (16% vs. 16%, p?=?1.00) was comparable between the two groups (MIH vs. OH). MIH was associated with lower 90-day complication rate (32% vs. 54%, p?=?0.022), lower postoperative major complication rate (14% vs. 30%, p?=?0.041), lower liver failure rate (0% vs. 7%, p?=?0.042), lower 90-day mortality rate (0 vs. 7%, p?=?0.042), and shorter length of hospital stay (9 vs. 12 days, p?=?0.009) compared to OH. After a median follow-up time of 51 months, MIH and OH showed comparable 5-year overall survival (54% vs. 41%, p?=?0.151), and 5-year disease-free survival rates (50% vs. 38%, p?=?0.956).Conclusions
MIH for HCC is associated with lower postoperative morbidity and mortality and shorter length of hospital stay, resulting in oncologic outcomes similar to those achieved with the established OH. Our findings suggest that MIH should be considered as the preferred method for the treatment of curatively resectable HCC. 相似文献9.
Xiao-wei Qi Jun-ze Du Peng Tang Xue Liu Qing-qing He Ling Zhong Xiu-wu Bian Jun Jiang 《Surgical oncology》2018,27(2):185-191
Purpose
Internal mammary nodes (IMNs) is a major pathway of lymphatic drainage for breast cancer, apart from axillary lymph node (ALN). However, owing to lack of a feasible and safe biopsy method, management of IMNs is still controversial in breast surgery.Methods
From 2005 to 2009, a total of 337 consecutive breast cancer women patients were recruited. All patients underwent IMNs biopsy through intercostal space or endoscopic lymphatic chain resection. The ER, PR and HER-2 status were retested according to the current ASCO/CAP guidelines. We analyzed the relationship between clinical pathological parameters and IMNs metastasis and investigated the high risk factors and prognostic values of IMNs metastasis in breast cancer.Results
Among 337 patients, 314 patients underwent intercostal space IMNs biopsy and 23 patients underwent endoscopic lymphatic chain resection. A total of 63 (18.69%) patients were pathologically diagnosed with IMNs metastasis. Among them, 28 (44.44%) patients changed the pathological lymph node staging, and 15 cases (23.81%) changed the postoperative comprehensive treatment program and accepted extended postoperative radiotherapy. Multivariate analysis showed that compared with no ALN involvement, the risk of IMNs metastasis was significantly increased in patients with 1–3 ALN involvement (OR?=?42.097, 95% CI?=?5.225–339.178; P?=?0.0004) and ≥4 ALN involvement (OR?=?82.429, 95%CI?=?10.134–670.496; P?<?0.0001). The risk of IMNs metastasis in HER-2 positive patients was significantly higher than that in negative patients (OR?=?5.452, 95% CI?=?2.353–12.634; P?<?0.0001). However, we did not find IMNs involvement was an independent indicator for both overall survival and disease-free survival.Conclusions
Our clinical practice and data indicated that IMNs biopsy through intercostal space and endoscopic lymphatic chain resection are effective and minimally invasive methods to detect the IMNs status, which may be helpful for accurate tumor staging, risk assessment and option of chemotherapy or radiotherapy to improve the patients' survival. 相似文献10.
Fritz Klein Finja Berresheim Matthäus Felsenstein Thomas Malinka Uwe Pelzer Timm Denecke Johann Pratschke Marcus Bahra 《European journal of surgical oncology》2018,44(7):1094-1099
Background
Extended pancreatic resections including resections of the portal (PV) may nowadays be performed safely. Limitations in distinguishing tumor involvement from inflammatory adhesions however lead to portal vein resections (PVR) without evidence of tumor infiltration in the final histopathological examination. The aim of this study was to analyze the impact of these “false negative” resections on operative outcome and long-term survival.Methods
40 patients who underwent pancreatic resection with PVR for pancreatic adenocarcinoma (PA) without tumor infiltration of the PV (PVR-group) were identified. In a 1:3 match these patients were compared to 120 patients after standard pancreatic resection without PVR (SPR-group) with regard to operative outcome and overall survival.Results
Survival analysis revealed that median survival was significantly shorter in the PVR group (311 days) as compared to the SPR group (558 days), (p = 0.0011, hazard ratio 1.98, 95% CI: 1.31–2.98). Also postoperative complications ≥ Clavien III occurred significantly more often in the PVR group (37.5% vs. 20.8%).Conclusions
Radical resection affords the best chance for long-term survival in patients with PA. Based on the results of this study a routine resection of the PV as recently proposed may however not be recommended. 相似文献11.
Diamantis I. Tsilimigras Ioannis Ntanasis-Stathopoulos Fabio Bagante Demetrios Moris Jordan Cloyd Eleftherios Spartalis Timothy M. Pawlik 《Surgical oncology》2018,27(2):280-288
Background
Hepatic resection is considered the optimal potentially curative treatment for colorectal liver metastases (CRLM). Following resection, up to two-thirds of patients will develop recurrence within 5-years. Genetic mutation analysis of CRLM, especially KRAS status, has been proposed as a means to guide treatment, as well as identifying patients who can derive the most survival benefit from hepatic resection.Methods
A systematic review of the literature was conducted the PubMed, Embase and Cochrane library through February 8th, 2018. The following algorithm was applied: “(colorectal OR rectal OR colon OR colonic) AND (liver OR hepatic) AND (metastasis OR metastases) AND (gene OR mutation OR KRAS OR BRAF OR SMAD4 OR RAS OR TP53 OR P53 OR APC OR PI3K OR MSI OR EGFR OR MACC1 OR microsatellite).”Results
From the 2404 records retrieved, 78 studies were finally deemed eligible; 47 studies reported mutational data on patients with resectable CRLM, whereas 31 studies reported on patients with unresectable CRLM. Mutational analyses were mostly performed on the CRLM specimen rather than the primary CRC. The vast majority of studies reported on the KRAS mutational status (88.5%, n?=?69/78). Prevalence of KRAS mutations ranged from 25% to 52%. Most studies reported that RAS mutation was a negative prognostic factor for overall (OS) (n?=?24) and recurrence-free (RFS) (n?=?9) survival; a few reports noted no effect of RAS mutational status on OS (n?=?4) or RFS (n?=?6). Twelve studies reported on BRAF mutations with a prevalence of BRAF mutation ranging from 0 to 9.1% in resected CRLM specimens. BRAF mutation was strongly associated with a worse prognosis. TP53 and PIK3CA gene mutations did not affect long-term outcomes.Conclusions
The biological status of each tumor provides the basis for individualized cancer therapeutics. Data on the mutational status on CRLM should be a part of multidisciplinary discussions to help inform the therapeutic approach, type of chemotherapy, as well as timing and approach of surgical resection. 相似文献12.
Ronak N. Kotian Varun Puvanesarajah Sandesh Rao Jad M. El Abiad Carol D. Morris Adam S. Levin 《Surgical oncology》2018,27(3):462-467
Background
Surgical decision-making can be challenging when treating patients with osseous metastases. Numerous factors, including expected duration of survival, must be considered to ensure optimal operative stabilization of the affected bone. However, life expectancy of patients with metastatic carcinoma is often difficult to estimate. The goal of our study was to assess the associations of various clinical and demographic factors with survival time after intramedullary nail fixation of impending or completed pathologic femur fractures.Methods
One hundred thirty-eight consecutive patients treated with intramedullary nail fixation for impending or completed pathologic femur fractures between 2005 and 2017 were included in this study. Factors related to patient survival were assessed with Cox multivariate survival analysis. For all analyses, p?<?0.05 was considered significant.Results
The median overall postoperative survival time was 8.4 months. Lower hemoglobin concentration (p?=?0.001), lower albumin concentration (p?=?0.002), and having a group 2 primary cancer (p?=?0.001) were associated with shorter survival on multivariate analysis. When considering the subgroup of 88 prophylactically stabilized patients, lower hemoglobin concentration (p?=?0.005), lower albumin concentration (p?=?0.015), and having a group 2 primary cancer (p?=?0.037) were predictive of shorter survival.Conclusion
Several factors are associated with shorter survival after intramedullary nail fixation of pathologic femur fractures. These factors should be considered by orthopedic surgeons when educating patients and determining appropriate treatment. 相似文献13.
Charlotte E.L. Klaver Karin A.T.G.M. Wasmann Marlies Verstegen Jarmila D.W. van der Bilt Iris D. Nagtegaal Bert van Ramshorst Pieter J. Tanis Albert M. Wolthuis Hjalmar C. van Santvoort Johannes H.W. de Wilt André D&#x;Hoore 《European journal of surgical oncology》2018,44(12)
Introduction
Patients with pT4 colon cancer are at risk of developing intra-abdominal recurrence. Infectious complications have shown to negatively influence disease free survival (DFS) and overall survival (OS) in stage I-III colon cancer. The aim of this study was to determine whether surgical site infections (SSIs) also increase the risk of intra-abdominal recurrence in pT4 colon cancer patients.Methods
All consecutive patients with pT4N0-2M0 colon cancer from four centres between January 2000 and December 2014 were included. Patients were categorized into 2 groups; with and without a postoperative (<30 days) SSIs. SSIs included both deep incisional as well as organ/space SSIs. The primary outcome was intra-abdominal recurrence (including local/incisional recurrence, peritoneal metastases) and was assessed using Kaplan-Meier and Cox regression analyses. Secondary outcome measures were DFS and OS.Results
Out of 420 patients, 62 (15%) developed a SSI. The 5-year intra-abdominal recurrence rates were 44% and 27% for patients with and without a SSI, respectively (p?=?0.011). After multivariate analysis, SSI was independently associated with intra-abdominal recurrence (HR 1.807 (1.091–2.992)), worse DFS (HR 1.788 (1.226–2.607)), and worse OS (HR 1.837 (1.135–2.973)). Other independent risk factors for intra-abdominal recurrence were a R1 resection (HR 2.616 (1.264–5.415)) and N2-stage (HR 2.096 (1.318–3.332)).Conclusion
SSIs after resection of a pT4N0-2M0 colon cancer are associated with an increased risk of intra-abdominal recurrence and worse survival. This finding supports the hypothesis that infection-based immunologic pathways play a role in colon cancer cell dissemination and outgrowth. 相似文献14.
Judith Stift Alexandra Graf Christoph Schwarz Dietmar Tamandl Patrick Starlinger Merima Herac Andrea Beer Friedrich Wrba Martin Bodingbauer Klaus Kaczirek Stefan Stremitzer 《European journal of surgical oncology》2018,44(1):139-147
Background
The value of microscopic biliary and perineural invasion as prognostic biomarkers in patients with resectable colorectal liver metastases (CLM) who undergo neoadjuvant chemotherapy and liver resection is still unclear. This retrospective study was performed to elucidate this issue.Methods
Histologic slides of resected CLM of patients who underwent neoadjuvant bevacizumab-based chemotherapy and liver resection were investigated with respect to biliary and perineural invasion. Presence of invasion was correlated with radiologic and histologic response, recurrence-free survival (RFS) and overall survival (OS).Results
One hundred forty-one patients were enrolled. There was a significant association between biliary and perineural invasion, respectively (P = 0.001). Moreover, both biliary and perineural invasion were associated with bilobar metastatic spread and higher number of metastases, while perineural invasion was also associated with a higher Fong score. No significant association was found with response. In univariable analysis, biliary and perineural invasion were associated with shorter RFS (median 10.1 vs. 13.5 months, HR 2.09, P = 0.010 and 7.6 vs. 14.0, HR 2.23, P = 0.001, respectively). Biliary invasion was also associated with shorter OS (median 32.8 months vs. not reached, HR 2.78, P = 0.010), however these results did not remain significant in multivariable analysis.Conclusions
In patients with resectable colorectal liver metastases undergoing neoadjuvant bevacizumab-based chemotherapy and liver resection, biliary and perineural invasion are associated with higher tumor load but may not be prognostic biomarkers. 相似文献15.
Richard J. Cassidy Jeffrey M. Switchenko Melinda L. Yushak Nicholas Madden Mohammad K. Khan David K. Monson Jonathan J. Beitler Jerome C. Landry Karen D. Godette Theresa W. Gillespie Kirtesh R. Patel 《Surgical oncology》2018,27(4):A3-A8
Background
Scalp angiosarcomas (SA) are rare, representing <1% of soft tissue sarcomas. The optimal management of these tumors is unknown, with management based on small case series. We sought to assess the impact of different therapies on overall survival (OS), the practice patterns nationally, and identify factors associated with OS for non-metastatic scalp angiosarcomas.Methods
A prospectively maintained database was used to identify non-metastatic scalp angiosarcomas who received some form of definitive therapy. Logistics regression, Kaplan-Meier, and Cox proportional-hazard models were utilized.Results
A total of 589 patients met study entry criteria with a median follow-up of 4.2 years. The majority (482 patients, 81.8%) had upfront definitive resection and an additional 317 patients (65.8%) received postoperative radiation. Of the 107 patients who didn't have surgery, the majority (65 patients, 60.7%) received definitive radiation and 42 patients (39.3%) received radiation and chemotherapy. One-year and five-year survival estimates for patients not receiving definitive surgery were 68.0% (95%CI: 57.5–76.4) and 18.0% (95%CI: 10.2–27.5) respectively compared to 78.2% (95%CI: 74.0–81.9) and 34.1% (95%CI: 28.9–39.3) for patients receiving definitive surgery (p?<?0.01). On multivariable analysis, age ≥65 years, tumor size ≥5?cm, and not receiving definitive surgery was associated with worse OS.Conclusions
The majority of patients with non-metastatic scalp angiosarcomas had upfront definitive surgery, with a subsequent improvement in OS, including when accounting for other patient and tumor factors. Postoperative radiation was frequently given. Our large series confirmed age and tumor size as prognostic factors for this rare disease. 相似文献16.
Sung Il Kang Heung-Kwon Oh Jae Suk Yoo Soyeon Ahn Min Hyun Kim Myung Jo Kim Il Tae Son Duck-Woo Kim Sung-Bum Kang Young Soo Park Chang Jin Yoon Rumi Shin Seung Chul Heo In Taek Lee Eui Gon Youk Min Jung Kim Tae Young Chang Sung-Chan Park Kyu Joo Park 《Surgical oncology》2018,27(2):216-224
Background
Colonic self-expanding metallic stenting (SEMS) is widely used for the treatment of malignant colonic obstruction as a bridge to elective surgery. However, the effects of colonic stenting on long-term oncologic outcomes are debatable. This study aimed to compare the long-term oncologic outcomes of preoperative SEMS insertion with those of immediate surgery in patients with obstructing left-sided colorectal cancer.Methods
A cohort of consecutive patients who underwent radical surgery for obstructing left-sided colorectal cancer between 2004 and 2011 in five tertiary referral hospitals were analyzed. Long-term survivals were analyzed and adjusted using the inverse probability of treatment weighting method, based on propensity scores, to reduce selection bias.Results
One hundred and nine patients underwent immediate surgery, and 226 underwent stent insertion before surgery. Disease-free survival did not differ significantly in both the unadjusted population (hazard ratio [HR] 1.063, 95% confidence interval [CI] 0.730–1.548; Log-rank, p?=?0.746) and the adjusted population (HR 0.122, 95% CI 0.920–1.987; Log-rank, p?=?0.122). Overall survival also did not differ significantly in both the unadjusted population (HR 0.871, 95% CI 0.568–1.334; Log-rank, p?=?0.526) and the adjusted population (HR 1.023, 95% CI 0.665–1.572; Log-rank, p?=?0.916). Defunctioning stoma formation was less in the SEMS insertion group than immediate surgery group (adjusted, 14.6% vs. 41.3%, p?<?0.001).Conclusion
The ‘bridge to surgery’ strategy using metallic stents was oncologically comparable to immediate surgery in patients with malignant left-sided colorectal obstruction. 相似文献17.
M. Wortmann I. Alldinger D. Böckler A. Ulrich A. Hyhlik-Dürr 《European journal of surgical oncology》2017,43(2):407-415
Purpose
Soft tissue sarcomas (STS) of the retroperitoneum and the lower limb with invasion of major blood vessels are very rare malignancies. This study analyses the outcome of patients with vascular replacement during resection of STS of the retroperitoneum and the lower extremity with either arterial or concomitant arterial and venous infiltration.Methods
Patients with vascular replacement during resection of sarcoma of the retroperitoneum and the lower extremity between 1990 and 2014 were included in this retrospective single center study. Patients with a sole infiltration of a major vein were excluded. The follow up was obtained from medical records, the general practitioner and a clinical examination whenever possible. The main endpoints were survival, graft patency and the rate of major amputations.Results
Fourty seven patients were included in this study. Twenty patients have received an operation for a retroperitoneal STS, twenty seven for a STS of the lower extremity. The median follow-up was 24.5 months. The median survival was 113 months with a median tumor-free survival of 25 months. The two-year patency for arterial bypasses in the retroperitoneum and the lower extremity was 88% and 66%, respectively. Limb salvage rate was 89%.Conclusions
Invasion of major blood vessels is no contraindication for a resection of a STS in the retroperitoneum and the lower extremity, but it is accompanied by a high postoperative morbidity. Since surgical resection is the only curative therapy in these patients, it should also be offered to patients with infiltration of major blood vessels. 相似文献18.
Xue-Pei Huang Tian-Tian Ye Li Zhang Rui-Feng Liu Xing-Jian Lai Liang Wang Meng Yang Bo Zhang Xiao-Yi Li Zi-Wen Liu Yu Xia Yu-Xin Jiang 《Surgical oncology》2018,27(2):172-176
Objective
To study the correlations between the sonographic features of papillary thyroid microcarcinoma (PTMC) and the presence of high-volume lymph node metastasis.Method
Medical records of 2363 PTMC patients were reviewed form October 2013 to December 2015. All the patients with lymph node metastasis identified by histopathology were included. Preoperative sonographic features, such as multifocality, tumour size, echogenicity, calcification, vascularity of papillary microcarcinoma, and capsule invasion, were recorded. Univariate and multivariate analyses were performed to investigate the relationships between sonographic features and high-volume lymph node metastasis (number of metastatic lymph nodes >5).Results
In total, 152 patients had high-volume central lymph node metastasis (6.4%, 152/2363). Multiple logistic regression analysis showed that the preoperative ultrasonic features of microcalcifications (OR?=?3.33, p?=?0.022), larger tumour size (>7?mm) (OR?=?2.802, p?<?0.001), and capsule invasion (OR?=?2.141, p?=?0.006) were independent risk factors for high-volume lymph node metastasis in the central compartment of PTMC.Conclusion
The sonographic features of primary papillary microcarcinoma of the thyroid are correlated with high-volume central lymph node metastasis. 相似文献19.
Björn Bolmstrand Per J. Nilsson Torbjörn Holm Christian Buchli Gabriella Palmer 《European journal of surgical oncology》2018,44(10):1513-1517
Background
Multi-visceral resection, including parts of the urinary tract, is sometimes warranted to achieve cancer clear resection margins and optimize survival in patients with locally advanced colorectal and anal cancer. The aim of this study was to assess morbidity after urinary tract reconstruction dictated by colorectal and anal malignancy and to identify potential predictors of urological complications.Methods
All patients undergoing surgery for colorectal or anal malignancy, including urinary tract resection and synchronous reconstruction, performed at the Karolinska University Hospital during 2004–2015 were included in this retrospective cohort study. Data was collected from medical records with follow-up until at least one year after the index surgery. Complications were graded according to the Clavien-Dindo classification system of surgical complications.Results
The study included 189 patients; 121 underwent cystectomy and 68 partial ureter resection. The rate of high grade urological complications was 22%. The risk of major urological complications was significantly higher in patients subjected to ureter resection compared to after cystectomy (OR 2.60, 95% CI 1.23–5.49). Also, preoperative radiotherapy and intestinal anastomotic dehiscence significantly increased the risk of high grade urological complications.Conclusion
To achieve potentially curative resections with uninvolved margins in patients with locally advanced colorectal and anal cancer, multi-visceral resection including urinary tract reconstruction can be performed with reasonable morbidity. 相似文献20.
Kiyohiko Omichi Takashi Mizuno Masayuki Okuno Ching-Wei D. Tzeng Claudius Conrad Yun Shin Chun Thomas A. Aloia Jean-Nicolas Vauthey 《European journal of surgical oncology》2017,43(11):2129-2134
