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Oncol
Selected AbstractsZygomaticomaxillary buttress reconstruction of midface defects with the osteocutaneous radial forearm free flapHEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 10 2008Patricio Andrades MD Abstract Background. The purpose of this study was to evaluate morbidity, functional, and aesthetic outcomes in midface zygomaticomaxillary buttress reconstruction using the osteocutaneous radial forearm free flap (OCRFFF). Methods. A retrospective review of 24 consecutive patients that underwent midface reconstruction using the OCRFFF was performed. All patients had variable extension of maxillectomy defects that requires restoration of the zygmatico-maxillary buttress. After harvest, the OCRFFF was fixed transversely with miniplates connecting the remaining zygoma to the anterior maxilla. The orbital support was given by titanium mesh when needed that was fixed to the radial forearm bone anteriorly and placed on the remaining orbital floor posteriorly. The skin paddle was used for intraoral lining, external skin coverage, or both. The main outcome measures were flap success, donor-site morbidity, orbital, and oral complications. Facial contour, speech understandability, swallowing, oronasal separation, and socialization were also analyzed. Results. There were 6 women and 18 men, with an average age of 66 years old (range, 34,87). The resulting defects after maxillectomy were (according to the Cordeiro classification; Disa et al, Ann Plast Surg 2001;47:612,619; Santamaria and Cordeiro, J Surg Oncol 2006;94:522,531): type I (8.3%), type II (33.3%), type III (45.8%), and type IV (12.5%). There were no flap losses. Donor-site complications included partial loss of the split thickness skin graft (25%) and 1 radial bone fracture. The most significant recipient-site complications were severe ectropion (24%), dystopia (8%), and oronasal fistula (12%). All the complications occurred in patients with defects that required orbital floor reconstruction and/or cheek skin coverage. The average follow-up was 11.5 months, and over 80% of the patients had adequate swallowing, speech, and reincorporation to normal daily activities. Conclusions. The OCRFFF is an excellent alternative for midface reconstruction of the zygomaticomaxillary buttress. Complications were more common in patients who underwent resection of the orbital rim and floor (type III and IV defects) or external cheek skin. © 2008 Wiley Periodicals, Inc. Head Neck, 2008 [source] Influence of glutathione- S -transferase theta (GSTT1) and mu (GSTM1) gene polymorphisms on the susceptibility of hepatocellular carcinoma in Taiwan,JOURNAL OF SURGICAL ONCOLOGY, Issue 4 2010Chia-Chun Kao MD Abstract Background and Objectives Hepatocellular carcinoma (HCC) is one of the most frequent malignant neoplasms worldwide and is the second leading cause of cancer death in Taiwan. Genetic polymorphism has been reported as a factor for increased susceptibility of HCC. Glutathione- S -transferases theta (GSTT1) and mu (GSTM1) play essential roles in detoxification of ingested xenobiotics and modulation of the susceptibility of gene-related cancer. The aim of this study was to estimate the relationships between these two gene polymorphisms and HCC risk and clinicopathological status in Taiwanese. Methods Polymerase chain reaction (PCR) was used to determine gene polymorphisms of 102 patients with HCC and 386 healthy controls. Results Both gene polymorphisms were not associated with the clinical pathological status of HCC and serum levels of liver-related clinical pathological markers. While no relationship between GSTM1 gene polymorphism and HCC susceptibility was found, individuals of age <56 years old with GSTT1 present genotype have a risk of 2.77-fold (95% CI: 1.09,7.09) for HCC compared to that with null variant, after adjustment for other confounders. Conclusions GSTT1 and GSTM1 null genotypes do not associate with increased risk of HCC. J. Surg. Oncol. 2010;102:301,307. © 2010 Wiley-Liss, Inc. [source] Delphian node metastasis in head and neck cancers,Oracle or myth?,JOURNAL OF SURGICAL ONCOLOGY, Issue 4 2010FRCS, N. Gopalakrishna Iyer MD Abstract Delphian node (DN) refers to the pre-laryngeal or pre-cricoid nodal tissue often identified during laryngeal or thyroid surgery. The original nomenclature is based on the assumption that metastasis to this node was predictive of aggressive disease and poor outcome for patients. In this article, we review the existing literature on the topic to determine the significance of DN metastasis in laryngeal, hypopharyngeal and thyroid cancers. J. Surg. Oncol. 2010;102:354,358. © 2010 Wiley-Liss, Inc. [source] Low Ki-67 proliferation index is an indicator of poor prognosis in gastric cancerJOURNAL OF SURGICAL ONCOLOGY, Issue 3 2010Hee Eun Lee MD Abstract Background and Objectives We designed this study to assess the biologic significance of Ki-67 proliferation index (PI) in gastric cancer. Methods Gastric cancer tissue from 245 patients were immunostained for Ki-67. Ki-67 PI was defined as the percentage of tumor cells positive for Ki-67. In addition, we have previously evaluated the expressions of nine epithelial mesenchymal transition (EMT)-related proteins. The relationship between Ki-67 PI and clinicopathologic parameters, patient survival, and EMT data were sought. Results Low Ki-67 PI was correlated with poorly differentiated histology (P,=,0.034), an advanced T stage (P,<,0.001), and lymph node metastasis (P,=,0.011). Also, the low PI group was found to have a significantly worse prognosis than the high PI group (P,=,0.003, log-rank test). Multivariate analysis revealed that Ki-67 PI remained as an independent prognostic factor (hazard ratio (95% CI),=,0.670 (0.450,0.999)). Furthermore, greater expressional changes of EMT-related proteins were found to be significantly associated with low Ki-67 PI (P,=,0.025). Conclusions These findings suggest that Ki-67 PI is an effective tool for predicting survival in gastric cancer. In addition, we found that an invasive property presented as EMT-related protein expressional changes was inversely correlated with a proliferative activity in gastric cancer. J. Surg. Oncol. 2010;102:201,206. © 2010 Wiley-Liss, Inc. [source] Safety and efficacy of curative intent surgery for peri-ampullary liver metastasisJOURNAL OF SURGICAL ONCOLOGY, Issue 3 2010Mechteld C. de Jong MD Abstract Introduction The management of patients with peri-ampullary liver metastasis remains controversial. We sought to assess the safety and efficacy of curative intent surgery for peri-ampullary liver metastasis. Methods Between 1993 and 2009, 40 patients underwent curative intent surgery (resection and/or radiofrequency ablation (RFA)) for peri-ampullary liver metastasis. Clinicopathologic and outcome data were collected and analyzed. Results Location of the primary tumor was pancreas head (n,=,20), ampulla of Vater (n,=,10), distal bile duct (n,=,5), or duodenum (n,=,5). Most patients (n,=,27) presented with synchronous disease, while 13 patients presented with metachronous disease following a median disease-free interval of 22 months. Most patients (n,=,25) presented with hepatic metastasis from pancreaticobiliary origin (pancreatic or distal common bile duct) compared with 15 patients who had metastasis from an intestinal-type primary (ampullary or duodenal). There were no differences in metastatic tumor number or size between these groups (P,>,0.05). Post-operative morbidity and mortality was 30% and 5% respectively. Overall 1- and 3-year survival was 55% and 18%. Patients who underwent resection of liver metastasis from intestinal-type tumors experienced a longer survival compared with patients who had pancreaticobiliary lesions (median: 13 months vs. 23 months; P,=,0.05). Conclusion Curative intent surgery for peri-ampullary liver metastasis was associated with post-operative morbidity and a 5% mortality rate. Although the overall survival benefit was modest, patients with liver metastasis from intestinal-type tumors experienced improved survival following resection of liver metastasis compared with pancreaticobiliary lesions. J. Surg. Oncol. 2010;102:256,263. © 2010 Wiley-Liss, Inc. [source] Genetic polymorphism of CCR2-64I increased the susceptibility of hepatocellular carcinoma,JOURNAL OF SURGICAL ONCOLOGY, Issue 3 2010Chao-Bin Yeh MD Abstract Background and Objectives The purpose of this study was to investigate genetic impact of monocyte chemoattractant protein-1 (MCP-1) and its receptor chemokine receptor-2 (CCR2) gene polymorphisms on the susceptibility and clinicopathological characteristics of hepatocellular carcinoma (HCC). Methods A total of 446 subjects, including 344 healthy controls and 102 patients with HCC, were recruited in this study and subjected to PCR-RFLP to estimate the impact of these two polymorphic variants on HCC. Results No relationship between MCP-1 ,2518G/A gene polymorphism and HCC risk was found among our recruited HCC patients and healthy controls. However, there was a significantly increased risk (AOR,=,1.91; 95% CI,=,1.11,3.29) of having HCC among subjects with GA heterozygotes of CCR2 V64I after adjusting for other confoundings. There was no synergistic effect between gene polymorphism and environmental risk factors, including tobacco and alcohol consumptions, as well as clinicopathological parameters of HCC for MCP-1 ,2518G/A and CCR2 V64I genes, respectively. Conclusions CCR2-64I gene polymorphism is an important factor for the susceptibility of HCC but it might not influence the clinical pathological progression of HCC, and the contribution of CCR2-64I gene polymorphism on the susceptibility of HCC could be not through the affection of liver injury-related clinical pathological characteristics. J. Surg. Oncol. 2010;102:264,270. © 2010 Wiley-Liss, Inc. [source] Distant nodal metastases from intrathoracic esophageal squamous cell carcinoma: Characteristics of long-term survivors after chemoradiotherapyJOURNAL OF SURGICAL ONCOLOGY, Issue 2 2010Yin-Kai Chao MD Abstract Background Non-regional lymph node metastasis in intrathoracic esophageal cancer is classified as M1 lesion with poor prognosis following surgery alone. We studied the controversial question of whether chemoradiotherapy (CRT) improves survival of these patients. Methods A cohort of patients with clinically overt nodal M1 disease, which could be encompassed by a tolerable radiation therapy port, was selected from the database of the Chang Gung Memorial Hospital. Results From 1994 to 2005, 54 nodal stage IV intrathoracic esophageal squamous cell carcinoma (SCC) patients received neoadjuvant CRT. Significant response occurred in 24 patients. Scheduled esophagectomy was performed in 26 patients. The 3-year overall survival (OS) and disease-free survival (DFS) for the whole group were 27% (median: 14.2 months) and 22% (median: 14.7 months), respectively. Multivariate analysis identified pretherapy lymph nodes classified as M1a and R0 resection after CRT as independent favorable prognosticators. Median survival reached 36.9 months in the pretherapy M1a subgroup as opposed to 12.5 months in the M1b subgroup (3-year-DFS: 40% vs. 10%, P,=,0.0117). Scheduled surgery after CRT benefits only after R0 resection (3-year-DFS: 36%, median survival: 45 months). The group with incomplete resection had a high surgical risk and dismal survival compared to the non-surgery group (3-year-DFS: 0% vs. 9%, 9.5 vs. 10.5 months). Conclusions Pretherapy M1a disease had a significantly better survival than nodal M1b disease after CRT in SCC. Aggressive surgical treatment after CRT is reserved for cases when complete resection is anticipated. J. Surg. Oncol. 2010;102:158,162. © 2010 Wiley-Liss, Inc. [source] Hypoxia inducible factor-1, gene polymorphism G1790A and its interaction with tobacco and alcohol consumptions increase susceptibility to hepatocellular carcinoma,JOURNAL OF SURGICAL ONCOLOGY, Issue 2 2010Pei-Ching Hsiao MD Abstract Background and Objectives The aim of this study was to examine the potential associations of two hypoxia inducible factor-1, (HIF-1,) gene polymorphisms, C1772T and G1790A, with the susceptibility and clinicopathological status of hepatocellular carcinoma. Methods A total of 449 subjects, including 347 healthy controls and 102 patients with hepatocellular carcinoma, were recruited in this study and subjected to polymerase chain reaction,restriction fragment length polymorphism (PCR-RFLP) analyses to estimate the impact of these two polymorphic variants on hepatocellular carcinoma. Results G1790A heterozygotes showed a higher risk for hepatocellular carcinoma, compared with GG genotypes after adjusting for other confounders (AOR,=,3.97; 95%CI,=,1.70,9.22), indicating a significant association between hepatocellular carcinoma susceptibility and G1790A polymorphism. Moreover, results also revealed the presence of synergistic effect between gene polymorphism of HIF-1, G1790A and environmental risk factors, such as tobacco and alcohol consumptions while there was no significant association between HIF-1, gene polymorphism and clinicopathological parameters of hepatocellular carcinoma. Conclusions Genetic polymorphism at G1790A of HIF-1, is an important factor for determining the susceptibility to hepatocellular carcinoma. The interaction effects of G1790A heterozygotes to tobacco and to alcohol consumption significantly increase the risk to develop hepatocellular carcinoma. J. Surg. Oncol. 2010;102:163,169. © 2010 Wiley-Liss, Inc. [source] Meeting the 12 lymph node (LN) benchmark in colon cancer,JOURNAL OF SURGICAL ONCOLOGY, Issue 1 2010A. Rajput MD Abstract Background Examining ,12 LN in colon cancer has been suggested as a quality metric. The purpose of this study was to determine whether the 12 LN benchmark is achieved at NCCN centers compared to a US population-based sample. Methods Patients with stage I,III disease resected at NCCN centers were identified from a prospective database (n,=,718) and were compared to 12,845 stage I,III patients diagnosed in a SEER region. Age, gender, location, stage, number of positive nodes were compared for NCCN and SEER data in regards to number of nodes evaluated. Multivariate logistic regression models were developed to identify factors associated with evaluating 12 LNs. Results 92% of NCCN and 58% of SEER patients had ,12 LN evaluated. For patients treated at NCCN centers, factors associated with not meeting the 12 LN target were left-sided tumors, stage I disease and BMI >30. Conclusions ,12 LN are almost always evaluated in NCCN patients. In contrast, this target is achieved in 58% of SEER patients. With longer follow-up of the NCCN cohort we will be able to link this quality metric to patterns of recurrence and survival and thereby better understand whether increasing the number of nodes evaluated is a priority for cancer control. J. Surg. Oncol. 2010;102:3,9. © 2010 Wiley-Liss, Inc. [source] Pathological prognostic score as a simple criterion to predict outcome in gastric carcinomaJOURNAL OF SURGICAL ONCOLOGY, Issue 1 2010Tadahiro Nozoe MD Abstract Purpose The aim of this study was to establish a simple criterion to predict prognosis of patients with gastric carcinoma. Methods Two hundred four patients with gastric carcinoma, who had been treated with curative resection, were enrolled. One point was added for each category among four pathological factors of depth of tumor, lymph node metastasis, venous invasion, and lymphatic invasion. Pathological Prognostic Score (PPS) was determined by an aggregate of these points for each category. Results There existed a significant difference between survivals of patients with PPS 0 or 1 and 2 or 3 (P,=,0.0002). Similarly, there also existed a significant difference between survivals of patients with PPS 2 or 3 and 4 (P,=,0.010). Conclusions PPS can be quite simple criteria to predict prognosis of gastric carcinoma with a strict stratification. J. Surg. Oncol. 2010;102:11,17. J. Surg. Oncol. 2010;102:73,76. © 2010 Wiley-Liss, Inc. [source] Assessment of open versus laparoscopy-assisted gastrectomy in lymph node-positive early gastric cancer: A retrospective cohort analysisJOURNAL OF SURGICAL ONCOLOGY, Issue 1 2010Ji Yeong An MD Abstract Background Laparoscopy-assisted gastrectomy (LAG) is still limited for early gastric cancer (EGC) with low possibility of lymph node (LN) metastasis, due to the concern for incomplete LN dissection and controversial long-term outcomes. We assessed oncological outcomes of laparoscopy-assisted versus open gastrectomy (OG) for patients with LN positive EGC. Methods Between 2003 and 2007, 204 patients underwent surgery for LN positive EGC. We evaluated adequacy of LN dissection and early and long-term outcomes after OG (n,=,162) and LAG (n,=,42). Results Operative time was longer but hospital stay was shorter for LAG than OG. Postoperative complications occurred in 14 patients (8.6%) after OG and 1 patient (2.4%) after LAG (P,=,0.316). Mean number of retrieved LNs and number of retrieved and metastatic LNs for each station did not differ between the two groups. During median 35 months of follow-up, 14 patients (8.6%) developed recurrence after OG, compared with 4 patients (9.5%) after LAG (P,=,0.769). Overall 5-year disease-free survival was 89.9% and 89.7% after OG and LAG. Status of LN metastasis was the only independent prognostic factor for disease-free survival. Conclusions LAG is an oncologically safe procedure even for LN positive EGC. Adequate LN dissection and comparable long-term outcomes to OG can be achieved by LAG. J. Surg. Oncol. J. Surg. Oncol. 2010;102:77,81. © 2010 Wiley-Liss, Inc. [source] Salvage of pelvic recurrence of colorectal cancerJOURNAL OF SURGICAL ONCOLOGY, Issue 8 2010Kimberly A. Varker MD Abstract Although the incidence of locally recurrent colorectal cancer has been reduced by improved surgical techniques and the frequent use of multimodality therapy, pelvic recurrence remains a significant problem. Radiation or chemotherapy may provide palliation but it is often short-lived. For fit candidates without evidence of extrapelvic disease, surgical resection (anterior resection, abdominoperineal resection, pelvic exenteration, or abdominosacral resection) may be the most appropriate treatment. For patients with unresectable disease, isolated pelvic perfusion may provide effective palliation. J. Surg. Oncol. 2010; 101:649-660. © 2010 Wiley-Liss, Inc. [source] Surgical technique refinements in head and neck oncologic surgery,JOURNAL OF SURGICAL ONCOLOGY, Issue 8 2010Jeffrey C. Liu MD Abstract The head and neck region poses a challenging arena for oncologic surgery. Diseases and their treatment can affect a myriad of functions, including sight, hearing, taste, smell, breathing, speaking, swallowing, facial expression, and appearance. This review discusses several areas where refinements in surgical techniques have led to improved patient outcomes. This includes surgical incisions, neck lymphadenectomy, transoral laser microsurgery, minimally invasive thyroid surgery, and the use of vascularized free flaps for oromandibular reconstruction. J. Surg. Oncol. 2010; 101:661-668. © 2010 Wiley-Liss, Inc. [source] Sentinel node biopsy in melanoma: Technical considerations of the procedure as performed at the john wayne cancer instituteJOURNAL OF SURGICAL ONCOLOGY, Issue 8 2010Sanjay P. Bagaria MD Abstract Since its first description in 1990, sentinel node (SN) biopsy has become the standard for accurate staging of a melanoma-draining regional lymphatic basin. This minimally invasive, multidisciplinary technique can detect occult metastases by selective sampling and focused pathologic analysis of the first nodes on the afferent lymphatic pathway from a primary cutaneous melanoma. An understanding of preoperative lymphoscintigraphy, intraoperative lymphatic mapping, and the definition of SN are critical for surgical expertise with SN biopsy. J. Surg. Oncol. 2010; 101:669-676. © 2010 Wiley-Liss, Inc. [source] Characteristics and prognosis of primary thyroid non-Hodgkin's lymphoma in Chinese patientsJOURNAL OF SURGICAL ONCOLOGY, Issue 7 2010Tuan-Qi Sun MD Abstract Background and Objectives There exists no universally accepted treatment for primary thyroid non-Hodgkin's lymphoma (TNHL) due to the rarity of this entity. The aim of this study is to assess the role of surgery and to explore prognostic factors in Chinese TNHL patients. Methods Patient presentations, pathologies, surgical interventions, multidisciplinary treatment, prognostic factors and the value of fine needle aspiration were analyzed. Results Between 1991 and 2007, 40 patients of TNHL were diagnosed. Thirty-eight patients underwent an initial surgical procedure. Further treatments consisted of radiotherapy or chemotherapy alone, and the majority of patients were treated with combined chemo-radiation. After a median follow-up of 95 months, the 5-year overall survival (OS) and relapse-free survival (RFS) was 82% and 74%, respectively. Survival curves showed no significant difference between therapeutic operations when compared with diagnostic operations. A univariate analysis showed both International Prognostic Index (IPI) and staging significantly influenced OS and RFS. In multivariate analysis, IPI was found to be the only prognostic factor. Conclusions Combined chemotherapy and radiotherapy may offer better outcome without the need for extensive resection, and surgery should be reserved to providing tissue for diagnosis. The patients with low-intermediate risk (IPI,=,2) or stage IIE need be treated more aggressively. J. Surg. Oncol. 2010; 101:545,550. © 2010 Wiley-Liss, Inc. [source] Radiofrequency ablation of colorectal liver metastases induces an inflammatory response in distant hepatic metastases but not in local accelerated outgrowthJOURNAL OF SURGICAL ONCOLOGY, Issue 7 2010Maarten W. Nijkamp MD Abstract Background Recently, we have shown in a murine model that radiofrequency ablation (RFA) induces accelerated outgrowth of colorectal micrometastases in the transition zone (TZ) surrounding the ablated lesion. Conversely, RFA also induces an anti-tumor T-cell response that may limit tumor growth at distant sites. Here we have evaluated whether an altered density of inflammatory cells could be observed in the perinecrotic (TZ) metastases compared to hepatic metastases in the distant reference zone (RZ). Methods RFA-treated tumor-bearing mice (n,=,10) were sacrificed. The inflammatory cell density (neutrophils, macrophages, CD4+ T-cells, and CD8+ T-cells) of tumors in the TZ (TZ tumors) was compared to that in tumors in the RZ (RZ tumors). Sham-operated, tumor-bearing mice (n,=,10) were analyzed simultaneously as controls (sham-treated tumors). Results In RFA-treated, tumor-bearing mice RZ tumors contained a significantly higher density of neutrophils and CD4+ T-cells, but not macrophages and CD8+ T-cells compared to sham-treated tumors. Notably, TZ tumors had a significantly lower density of neutrophils, CD4+ T-cells, and CD8+ T-cells, but not macrophages, when compared to RZ tumors. Conclusions The accelerated perinecrotic tumor outgrowth following RFA is associated with a reduced density of neutrophils and T-cells compared to distant hepatic metastases. This may have implications for local tumor recurrence following RFA. J. Surg. Oncol. 2010; 101:551,556. © 2010 Wiley-Liss, Inc. [source] Local recurrence rate of fine-needle aspiration biopsy in primary high-grade sarcomasJOURNAL OF SURGICAL ONCOLOGY, Issue 7 2010Benjamin H. Kaffenberger BS Abstract Background Fine-needle aspiration biopsy (FNAB) is an emerging technique for diagnosis of bone and soft tissue lesions. While multiple studies have demonstrated efficacy, cost-effectiveness, and convenience, none have attempted to determine if the modality leads to an increased rate of local recurrence. Our objective was to determine whether FNAB could be linked to an increased rate of local recurrence. Methods We reviewed a database containing records of 388 patients who underwent FNAB without surgical biopsy tract excision between September 2002 and December 2006 in the orthopedics department at our institution. After application of rigid criteria to minimize confounding variables, 20 patients were retrospectively examined for local recurrence and distant metastasis. Results In this cohort, no local recurrences were seen over a mean follow-up of 45 months. Fifteen percent of our patients developed one or more distant metastases over the same time interval. Our experience offers preliminary evidence for the safety of this method. Conclusions While further studies are needed, our data combined with already reported studies on efficacy, cost-effectiveness, and convenience are encouraging for expanding the use of FNAB in the diagnosis of bone and soft tissue tumors. J. Surg. Oncol. 2010; 101:618,621. © 2010 Wiley-Liss, Inc. [source] Prognostic indicators in node-negative advanced gastric cancer patientsJOURNAL OF SURGICAL ONCOLOGY, Issue 7 2010Hiroaki Saito MD Abstract Background and Objectives Despite carrying better overall prognoses, some node-negative gastric cancer patients die from recurrent malignancies. Identifying factors associated with disease-specific survival in adequately staged node-negative gastric cancer is important, as these patients are presumably free of microscopic regional metastases and may derive significant benefit from existing or future adjuvant strategies. Methods To investigate significant prognostic indicators in node-negative advanced gastric cancer patients, we reviewed 777 advanced gastric cancer patients who had undergone curative gastrectomies. Results The 5-year survival rate of node-negative advanced gastric cancer patients is 84.9%, which is significantly better than that of patients with lymph node metastasis. Multivariate analysis indicated that tumor size, histology, and depth of invasion are independent prognostic factors. The 5-year survival rate of patients with larger tumors (,7,cm), poorly differentiated adenocarcinoma, and serosal invasion was 49.1%, which was significantly worse that of patients with fewer or none of these factors. Conclusions Tumor size, histology, and the presence of serosal invasion are strong indicators of poor prognosis in node-negative advanced gastric cancer patients. J. Surg. Oncol. 2010; 101:622,625. © 2010 Wiley-Liss, Inc. [source] Qualitative assessment of patient experiences following sacrectomy,JOURNAL OF SURGICAL ONCOLOGY, Issue 6 2010K.M. Davidge MD Abstract Background and Objectives The primary objective was to investigate patient experiences following sacral resection as a component of curative surgery for advanced rectal cancers, soft tissue and bone sarcomas. Methods Qualitative methods were used to examine the experiences, decision-making, quality of life, and supportive care needs of patients undergoing sacrectomy. Patients were identified from two prospective databases between 1999 and 2007. A semi-structured interview guide was generated and piloted. Patient interviews were transcribed verbatim and analyzed using standard qualitative research methodology. Grounded theory guided the generation of the interview guide and analysis. Results Twelve patients were interviewed (6 female, 32,82 years of age). The mean interview time was 34,min. Five themes were identified, including: (1) the life-changing impact of surgery on both patients' and their family's lives, (2) patient satisfaction with immediate care in hospital, (3) significant chronic pain related to sacrectomy, (4) patients' need for additional information regarding long-term recovery, and (5) patients' gratitude to be alive. Conclusions Sacrectomy is a life-changing event for patients and their families. Patients undergoing sacrectomy need further information regarding the long-term consequences of this procedure. This need should be addressed in both preoperative multi-disciplinary consultations and at follow-up visits. J. Surg. Oncol. 2010; 101:447,450. © 2010 Wiley-Liss, Inc. [source] Advanced gastric cancer in the middle one-third of the stomach: Should surgenos perform total gastrectomy?JOURNAL OF SURGICAL ONCOLOGY, Issue 6 2010You-Jin Jang MD Abstract Background and Objectives To determine which optimal surgical procedure for middle-third advanced gastric cancer (AGC) based on comparative study of the long-term prognosis between total gastrectomy (TG) and distal gastrectomy (DG). Methods Between March 1993 and December 2005, 402 patients with middle-third AGC who underwent gastric resection were enrolled in this study. We analyzed the long-term prognosis according to the length of the proximal resection margin (PRM) and the extent of gastric resection, and determined independent prognostic factors. Results TG was performed in 244 patients (60.7%) and DG was performed in 158 patients (39.3%). There were no significant differences in the 5-year survival rates according to the length of PRM. The 5-year survival rates of patients who underwent DG were significantly higher than the rates of the patients who underwent TG in curative cases (67.8% vs. 58.4%, P,=,0.037). Nevertheless, there was no significant difference in the stage-stratified survival rates according to the extent of gastric resection. Multivariate analysis revealed that surgical curability, extent of lymphadenectomy, and stage were independent prognostic factors. Conclusion If curative resection can be performed, the long-term prognosis of patients with middle-third AGC was not affected by the length of PRM or the extent of gastric resection. J. Surg. Oncol. 2010; 101:451,456. © 2009 Wiley-Liss, Inc. [source] Cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy to treat gastric cancer with ascites and/or peritoneal carcinomatosis: Results from a Chinese centerJOURNAL OF SURGICAL ONCOLOGY, Issue 6 2010Xiao-Jun Yang MD Abstract Background This work was to evaluate cytoreductive surgery (CRS) plus hyperthermic intraperitoneal chemotherapy (HIPEC) for advanced gastric cancer (GC). Methods CRS and HIPEC were performed on 28 GC patients with peritoneal carcinomatosis (PC) and/or malignant ascites, with survival and perioperative safety as study endpoints. Results A total of 30 CRS and HIPEC procedures were performed. Cytoreduction scores ratings (CCR) were CCR-0 in 11 (39.2%), CCR-1 in 6 (21.4%), CCR-2 in 8 (28.8%), and CCR-3 in 3 (10.6%) cases. The 6-, 12-, 18-, and 24-month survival rates were 75%, 50%, 43%, and 43%, respectively. The median survivals of patients with PCI ,20 and high PCI >20 were 27.7 months (95% CI 15.2,40.3 months) and 6.4 months (95% CI 3.8,8.9 months) (P,=,0.000). The estimated median survival for patients with CCR-0, CCR-1, and CCR-2 and 3 were 43.4 months (95% CI, 26.9,59.9 months), 9.5 months (95% CI 6.4,12.6 months), and 7.5 months (95% CI 3.0,13.6 months) (P,=,0.001, CCR0 vs. CCR1-3). No perioperative death but 1 (3.6%) serious adverse event occurred. Conclusions CRS plus HIPEC could offer survival advantage for selected GC patients with PC and/or ascites, with acceptable safety profile. J. Surg. Oncol. 2010; 101:457,464. © 2010 Wiley-Liss, Inc. [source] Angiosarcoma developing in a non-functioning arteriovenous fistula post-renal transplantJOURNAL OF SURGICAL ONCOLOGY, Issue 6 2010Yassar A. Qureshi MBBS Abstract Background Angiosarcomas comprise less than 1% of all sarcomas, arising from endothelial cells of blood or lymph vessels. Chronic immunosuppression increases the risk of many malignancies and an association between the development of angiosarcoma with an immunosuppressed state is established. A few cases have been reported of angiosarcomas arising in the post-renal transplant patient. Specifically, there have been six cases of an angiosarcoma arising in arteriovenous (AV) fistulae in this patient population. We describe a further case and review the relevant literature with specific emphasis on a possible mechanism for the development of angiosarcoma in the post-transplant patient. Case Presentation We report the case of a 48-year-old male who developed an angiosarcoma in a ligated native AV fistula. The lesion arose on the background of immunosuppression following a successful ABO-incompatible renal transplant for chronic renal failure. Conclusion Angiosarcomas are extremely rare tumours but should be considered as a differential diagnosis for an evolving mass near the site of an AV fistula. Diagnosis relies on an index of suspicion and obtaining a definitive histological diagnosis. Both clinicians and patients should be aware that an evolving mass within or around an AV fistula should prompt urgent biopsy. J. Surg. Oncol. 2010; 101:520,523. © 2010 Wiley-Liss, Inc. [source] The parasympathetic supply to the distal colon,one marker for precisely locating the posterior dissection plane in the operation of TMEJOURNAL OF SURGICAL ONCOLOGY, Issue 6 2010Bi Dong-song MD Abstract Background It is important for surgeons to locate the reliable surgical planes in the operation of total mesorectal excision (TME); we observe the parasympathetic nerve to the distal colon can be served as one of useful markers for precisely locating the posterior dissection plane in TME. Materials and Methods From October 2006 to January 2008, 26 patients underwent TME for rectal cancer. The dissections of the parasympathetic nerves to the distal colon were performed and the relationship of these nerves to the prehypogastric nerve fascia was observed. Results Some parasympathetic nerves ran upwards and lay anteromedial to the hypogastric nerves. In the avascular space between prehypogastric nerve fascia and the fascia propria of the rectum, the prehypogastric nerve fascia enveloped parasymphathetic nerve up to the fascia propria of rectum. Conclusions The parasympathetic nerve to the distal colon is evident between the fascia propria of the rectum and the prehypogastric nerve fascia. As the precise dissection plane of TME lay between the fascia propria of the rectum and the prehypogastric nerve fascia, these nerves could be served as useful marker for precisely locating the posterior dissection plane in TME. J. Surg. Oncol. 2010; 101:524,526. © 2010 Wiley-Liss, Inc. [source] Braun enteroenterostomy is associated with reduced delayed gastric emptying and early resumption of oral feeding following pancreaticoduodenectomyJOURNAL OF SURGICAL ONCOLOGY, Issue 5 2010Steven N. Hochwald MD Abstract Background and Objectives Morbidity rates following pancreaticoduodenectomy (PD) remain high with delayed gastric emptying (DGE) and slow resumption of oral diet contributing to increased postoperative length of stay. A Braun enteroenterostomy has been shown to decrease bile reflux following gastric resection. We hypothesize that addition of Braun enteroenterostomy during PD would reduce the sequelae of DGE. Methods From our PD database, patients were identified that underwent classic PD with partial gastrectomy from 2001 to 2006. All patients with reconstruction utilizing a single loop of jejunum at the University of Florida Shands Hospital were reviewed. Demographics, presenting signs and symptoms, pathologic diagnoses, and postoperative morbidity were compared in those patients undergoing reconstruction with an additional Braun enteroenterostomy (n,=,70) to those not undergoing a Braun enteroenterostomy (n,=,35). Results Patients undergoing a Braun had NG tubes removed earlier (Braun: 2 days, no Braun: 3 days, P,=,0.002) and no significant change in postoperative vomiting (Braun: 27%, no Braun: 37%, P,=,0.37) or NG tube reinsertion rates (Braun: 17%, no Braun: 29%, P,=,0.21). Median postoperative day with tolerance of oral liquids (Braun: 5, no Braun: 6, P,=,0.01) and solid diets (Braun: 7, no Braun: 9, P,=,0.01) were significantly sooner in the Braun group. DGE defined by two criteria including the inability to have oral intake by postoperative day 10 (Braun: 10%, no Braun: 26%, P,<,0.05) and the international grading criteria (grades B and C, Braun: 7% vs. no Braun: 31%, P,=,0.003) were significantly reduced in those undergoing the Braun procedure. In addition, the median length of stay (Braun: 10 days, no Braun: 12 days, P,<,0.05) was significantly reduced in those undergoing the Braun procedure. The rate of pancreatic anastomotic failure was similar in the two groups (Braun: 17% vs. no Braun: 14%, P,=,0.79). Median bile reflux was 0% in those undergoing a Braun. Conclusions The present study suggests that Braun enteroenterostomy can be safely performed in patients undergoing PD and may reduce the indicence of DGE and its sequelae. Further studies of Braun enteroenterostomy in larger randomized trials of patients undergoing PD are warranted. J. Surg. Oncol. 2010; 101:351,355. © 2010 Wiley-Liss, Inc. [source] Loss of E-cadherin and ,-catenin is correlated with poor prognosis of ampullary neoplasmsJOURNAL OF SURGICAL ONCOLOGY, Issue 5 2010Hui-Ping Hsu MD Abstract Background and Objectives Distant metastasis resulting from carcinoma cell detachment from the primary tumor involves modification of adhesion molecules. This study was conducted to examine the correlation of E-cadherin/,-catenin expression with survival and recurrence in ampullary neoplasms. Methods Patients with diagnoses of ampullary neoplasms were enrolled in the study. Demographics, operative findings, and histopathological data were collected by retrospective chart review. Expression of E-cadherin and ,-catenin were detected by immunohistochemistry. Results A total of 110 patients were enrolled in the study. Preservation of membranous staining of E-cadherin was noted in 41 (37%) patients, aberrant cytoplasmic staining in 48 (44%) patients, and complete loss in 21 (19%) patients. Loss of E-cadherin was associated with pancreatic invasion, recurrence, and poor prognosis. Membranous staining of ,-catenin was noted in 65 (59%) patients, cytoplasmic or nuclear accumulation in 16 (15%) patients, and complete loss in 29 (26%) patients. Loss of ,-catenin expression was associated with tumor markers, ulcerative type, liver metastases, and poor prognosis. Pancreatic invasion, lymph node involvement, and loss of ,-catenin expression were predictors of disease recurrence. Conclusions Loss of the E-cadherin/,-catenin complex is related to poor prognosis in ampullary cancer. Loss of ,-catenin is predictor of recurrence in multivariate analysis. J. Surg. Oncol. 2010; 101:356,362. © 2010 Wiley-Liss, Inc. [source] LAPTM4B-35 is a novel prognostic factor of hepatocellular carcinomaJOURNAL OF SURGICAL ONCOLOGY, Issue 5 2010Hua Yang MD Abstract Background LAPTM4B-35 is a 35-kDa tetra-transmembrane protein overexpressed in hepatocellular carcinoma (HCC) and promotes cell survival, proliferation, and tumorigenesis. However, the potential clinical implications of LAPTM4B-35 in HCC are still unclear. This study is aimed to investigate the correlations between LAPTM4B-35 expression and prognosis in patients with HCC. Methods Western blot and immunohistochemistry assays were used to determine the expression of LAPTM4B-35 in HCCs and their paired noncancerous liver tissues from 65 patients. The correlations of LAPTM4B-35 expression with clinicopathological parameters were assessed by Chi-square test. Patient survival was determined by Kaplan,Meier method and log-rank test. Cox regression was adopted for multivariate analysis of prognostic factors. Results LAPTM4B-35 overexpression occurred in 76.9% of HCC tissues, while only in 4.6% of noncancerous liver tissues. Overexpression of LAPTM4B-35 was significantly associated with TNM staging and invasive tumors. Patients with higher LAPTM4B-35 expression had significantly poorer overall survival (OS) and disease-free survival (DFS) (both P,<,0.001). On multivariate analysis, elevated expression of LAPTM4B-35 was found to be an independent prognostic factor for OS and DFS (P,=,0.009, 0.043, respectively). Conclusions LAPTM4B-35 overexpression is an independent prognostic factor for OS and DFS of HCC. J. Surg. Oncol. 2010; 101:363,369. © 2010 Wiley-Liss, Inc. [source] Extra-departmental anatomic pathology expert consultation inTaiwan: A research grant supported 4-year experienceJOURNAL OF SURGICAL ONCOLOGY, Issue 5 2010Chih-Yi Hsu MD Abstract Background This report analyzed a research project supported nationwide expert consultation of anatomic pathology in Taiwan. Methods The data were collected from the requisitions and consultation reports of 2,686 cases in this project from 2003 to 2006. The number of cases, tissue origin, additional special stains, turnaround time (TAT), concordance, discordance, referring pathologists, and consultants were analyzed. Results Skin, hematopoietic system, and bone and soft tissue were the most common (48.3%) specimens sent for consultation. The tentative diagnosis and consultation diagnosis were discordant in 1,074 (64.3%) cases. Major discrepancy was seen in 205 (12.3%) cases, of which 66.8% were changed from malignant to benign, 21.0% were changed from benign to malignant, whereas 12.2% were changed from one category of malignancy to another. Additional special stains were performed on 38.7% of cases and hematology specimen was the most frequent. The mean TAT was 3.4 days. Pathologists working in institutes having fewer pathologists sent more cases for consultation. The opinion of the estimated annual consultation rate from the pathologists in Taiwan was 0.7%. Conclusions This program was beneficial simply by helping the referring pathologists in the workup and diagnosis. This result made the entire program a reasonable quality improvement program. J. Surg. Oncol. 2010; 101:430,435. © 2010 Wiley-Liss, Inc. [source] Intraoperative magnetic resonance imaging in the surgical treatment of cerebral metastasesJOURNAL OF SURGICAL ONCOLOGY, Issue 5 2010Christian Senft MD Abstract Background and Objectives To report on the value of intraoperative magnetic resonance imaging (iMRI) in the neurosurgical treatment of cerebral metastases (CM). Methods We performed a total of 204 surgical procedures with the use of a mobile ultra-low-field iMRI-unit. Of these, there were 12 craniotomies and 2 minimal-invasive procedures for CM, and 63 craniotomies for glioblastoma (GBM). Results On intraoperative imaging, all tumors could be localized and targeted with the help of the integrated neuronavigation system. Intraoperative imaging resulted in continued tumor resection due to unexpected residual tumor tissue in 13 patients harboring GBM (20.6%), but no patient with a CM (0%). In two patients with cystic CM, iMRI helped to achieve complete collapse of cysts by means of stereotactic aspiration, relieving mass effect and allowing for adjuvant radiotherapy. All patients subsequently received adjuvant treatment according to clinical protocols. Conclusion Surgical resection represents one of several treatment modalities in metastatic brain disease. iMRI is useful for neuronavigation and resection control and as an adjunct in minimal-invasive procedures in patients with CM; however, its exact value is yet to be determined by prospective randomized trials. J. Surg. Oncol. 2010; 101:436,441. © 2010 Wiley-Liss, Inc. [source] Neoadjuvant therapy for breast cancerJOURNAL OF SURGICAL ONCOLOGY, Issue 4 2010Stephen V. Liu MD Abstract The past few decades have seen an increase in both the role and the complexity of neoadjuvant therapy for breast cancer. Neoadjuvant therapy was initially described as systemic chemotherapy for inflammatory or locally advanced breast cancer but now entails a combination of chemotherapy, endocrine therapy, and targeted therapy. Neoadjuvant systemic therapy is employed for inoperable inflammatory and locally advanced breast cancer, and also for patients with operable breast cancers who desire breast-conserving therapy (BCT) but are not candidates based on the initial size of the tumor in relation to the size of the breast. Neoadjuvant therapy in this subset of patients may impact the surgical options. This review will summarize the benefits of neoadjuvant systemic therapy and implications for BCT, the timing of sentinel node biopsy, and the utility of magnetic resonance imaging (MRI) to predict response to therapy. J. Surg. Oncol. 2010; 101:283,291. © 2010 Wiley-Liss, Inc. [source] Induction chemotherapy in the management of head and neck cancerJOURNAL OF SURGICAL ONCOLOGY, Issue 4 2010Matthew G. Fury MD Abstract The strategy of induction chemotherapy prior to planned definitive local therapy for head and neck squamous cell carcinoma has been studied for over 30 years, and appears to have a role in select clinical situations. Here we review landmark studies regarding induction chemotherapy, both in the pre-taxane era and in the current taxane era, and we address some of the unresolved questions regarding the role of induction chemotherapy in head and neck cancer. J. Surg. Oncol. 2010; 101:292,298. © 2010 Wiley-Liss, Inc. [source] | ||||||||||