Clinical Surgical Oncology最新文献

Background

Pancreatic undifferentiated carcinomas with rhabdoid features (PUCR) are infrequent, yet incredibly aggressive neoplasms. Recent advances in the histopathological understanding of PUCR have been made, however the optimal treatment of PUCR remains unclear and the decision to operate on the neoplasm is left to the physicians own judgement. Most of the literature published on this neoplasm constitutes case reports and case series, therefore our aim is to present a pooled analysis including the up-to-date literature and elucidate whether surgical treatment is the finest choice for PUCR.

Methods

This pooled analysis compared the data from 9 articles and a case that presented to our unit, yielding 28 cases. Treatment modalities reported in the literature were noted, and the surgical and post-operative adjuvant chemotherapy and >3month survival were screened for dependence using a Chi-square test.

Results

The patient's median survival following a surgical resection of the neoplasm was three months. 77.7% who were treated surgically died within one year following the surgery. The relationship between surgical resection and survival calculated using the chi-square is not significant (p-value: 0.261). The median survival of patients who received post-operative chemotherapy was 7 months. The relationship between the post-operative adjuvant chemotherapy and survival 3 months is also not significant (p-value: 0.065)

Conclusions

The aggressive nature of PUCR results in a rapid deterioration regardless of the treatment modality chosen. Surgery even in resectable patients doesn't carry a significant survival benefit. Chemotherapy should remain the mainstay of therapy for this patient cohort.

Background

A diverting stoma is often created to prevent anastomotic leakage when a low anterior resection (LAR) is performed for rectal cancer. However, it remains unclear how a diverting stoma impacts the prognosis.

Methods

We identified patients with rectal cancer in the National Database of Health Insurance Claims and Specific Health Checkups of Japan who underwent LAR in 2014 and received adjuvant chemotherapy within 12 months of surgery. Overall survival was compared according to the presence or absence of a diverting stoma. Only patients with a stoma were selected to compare overall survival according to the timing of stoma closure.

Results

Patients with a diverting stoma had a significantly better prognosis than those without a diverting stoma (hazard ratio [HR] 0.79, 95% confidence interval [CI] 0.63–0.99, P ​= ​0.039). Compared with patients with early closure, the prognosis of patients with late closure was significantly better (HR 0.56, 95% CI 0.33–0.95, P ​= ​0.031) and that of patients without stoma closure was significantly poorer (HR 2.21, 95% CI 1.34–3.64, P ​= ​0.002).

Conclusion

Among patients with rectal cancer who underwent LAR followed by adjuvant chemotherapy, those who had a diverting stoma had better prognosis than those who did not. Patients with a diverting stoma who underwent late closure had the best prognosis.

Background

Post-neoadjuvant sentinel lymph node biopsy or targeted axillary dissection in carcinoma breast patients need costly infrastructure, making it out of reach for resource constrained developing countries. This study assesses the diagnostic accuracy of low axillary node sampling to predict the nodal status of the post-chemotherapy node-negative axilla.

Materials and methods

This is a prospective study which included cytology proven node positive carcinoma breast patients who had node negative axilla after chemotherapy and underwent low axillary sampling with complete axillary lymph node dissection. Nodes below second intercostobrachial nerve were sent as low axillary sample.

Results

211 patients with carcinoma breast underwent FNAC of the axillary node prior to neoadjuvant systemic therapy (NAST). Low axillary sampling was performed on 77 patients who had clinically and radiologically node negative axilla after NAST. Out of 77, 24 (31%) had early breast cancer and 32 (41.5%) had T4 disease prior to NAST. In this cohort, 36 patients (47%) had a good biology tumour, 57 (74%) had Grade 3 tumour and 20 (26%) had lymphovascular invasion (LVI). Pathological complete response of breast and axilla was seen in 24 patients (31%). Low axillary sampling had a range of 1–12 nodes with median lymph nodal yield of 6. The false negative rate (FNR) of low axillary sampling was 8.3%. Good tumour biology, post NAST residual breast tumour and lymphovascular invasion were the independent predictors of positive low axillary nodes.

Conclusions

Low axillary sampling is an economical and feasible option to de-escalate axillary surgery with acceptable false negative rate in carcinoma breast patients who had node negative axilla post neoadjuvant systemic therapy.

Introduction

Past studies documented that microsatellite instability (MSI) is associated with improved survival in gastric cancer (GC). The aim of this study was to evaluate MSI status in a series of GCs treated with neoadjuvant therapy in relation to the tumors' characteristics and oncological outcomes.

Methods

Patients with GCs treated between 2017 and 2022 ​at a single Italian high-volume Institution undergoing pre-operative treatment followed by resection were included if studied for their microsatellite status. Clinicopathological data were analyzed for the association with MSI. The same features were analyzing pooling the series with a subset of patients from another European trial.

Secondary outcomes included the overall (OS), and disease-free (DFS) survivals comparing MSI vs microsatellite stable (MSS) GCs, and GCs presenting complete-major response (TRG1-2) vs partial response (TRG3-4) and absence of response (TRG5).

Results

Among 73 patients selected, 12.3% were MSI. In the single institutional analysis, we documented a difference in the distribution of ypT stages with a prevalence of ypT0 patients in MSI vs MSS patients (ypT0 respectively 11.1% vs 1.6%, p ​< ​0.0001). However, this difference was not of statistical value when pooling patients with those from the European trial (overall 108 patients, 9.2% MSI; ypT0 respectively 10.0% vs 2.0%, p 0.144). In the pooled analysis, a prevalence of female patients was reported in the MSI group comparing MSS (respectively, 70.0% vs 27.6%, p 0.01). At a mean follow-up of 27.7 months, OS and DFS survivals were reported similar comparing MSS and MSI (log-rank test respectively p 0.18 and p 0.96), however TRG1-2 ​GCs had improved OS and DFS comparing other sub-groups (TRG1-2 vs TRG3-4 vs TRG5, OS and DFS log-rank test respectively p 0.017 and p 0.0029).

Conclusion

This study could not demonstrate a correlation between microsatellite status and survival in gastric cancer patients who underwent pre-operative treatment. A complete/major response was the only variable correlated with mid-term survival.

Objective

To assess the utility of laparoscopy for interval cytoreductive surgery (CRS) in patients with advanced ovarian cancer after Neo-Adjuvant Chemotherapy (NACT).

Methods

A retrospective cohort study of interval CRS by laparoscopy in patients with advanced epithelial ovarian cancer treated at a single tertiary gynaecological cancer centre between October 2017 and September 2020.

Results

86 patients had interval CRS by the laparoscopic route during the study period. The optimal cytoreduction rate (R ​< ​1 ​cm) was 92%, and complete cytoreduction rate with no residual disease (R ​= ​0) was 35%. The intra-operative complication rate was 8% and the estimated blood loss (EBL) was 90 ​ml. The post-operative complication rate was 15%, mostly grade I-II, and the median length of hospital stay was 3 days.

Conclusion

For most patients with advanced ovarian cancer after NACT, laparoscopic interval CRS is feasible and effective in achieving optimal cytoreduction while providing a favourable peri-operative outcome. In some cases, however, recourse to laparotomy will optimise complete macroscopic resection.

Background

Gastric cancer (GC) ranks as the fifth most prevalent malignancy and stands as the third principal contributor to cancer-related fatalities globally. COL8A1 (collagen type VIII, alpha-1) emerges as a pivotal regulator of tumor progression, but whether COL8A1 drives immune infiltration in GC remains elusive. The aim of our investigation is to elucidate the correlation between COL8A1 and the prognosis as well as immune infiltration in gastric cancer.

Methods

The GSE79973 and UALCAN databases were used for assessing the expression of COL8A1. Clinical data was obtained from the TCGA database to analyze the association between the expression of COL8A1 and clinicopathologic features of GC patients. Survival data of GC patients were acquired from the Kaplan-Meier Plotter database. Gene set enrichment analysis was conducted to characterize biological pathways of COL8A1. Immune infiltration analysis was conducted using the CIBERSORT method based on the TCGA database and online analysis within the TIMER2.0 database.

Results

We unveiled a noteworthy upregulation of COL8A1 expression across multiple cancer types, particularly in GC. Subsequent analysis underscored a positive linkage between heightened COL8A1 expression and an unfavorable clinical progression in GC patients. Survival analysis indicated that GC patients with elevated COL8A1 expression exhibited a poorer prognosis. Gene enrichment analysis hinted that COL8A1 might participate in physiological processes such as anatomical structure morphogenesis, cell adhesion, focal adhesion, and ECM-receptor interaction et al. in GC. Eventually, we discerned a established association between COL8A1 expression and immune cell infiltration in GC.

Conclusion

Our results demonstrated that COL8A1 is a key factor which governs immune cell recruitment to GC, representing a valuable prognostic biomarker in GC patients and potentially playing a crucial role in modulating immune cell infiltration.

Liver cancer is currently the third leading cause of cancer-related mortality worldwide. Due to late diagnosis and difficulty in monitoring, there is a pressing need for early detection and recurrence monitoring in patients with liver cancer. Recent advancements in liquid biopsy technology, like circulating tumor cells (CTCs), circulating tumor DNA (ctDNA), and exosomes, have made it possible to obtain a tumor’s characteristics and dynamic monitor easily. This, in turn, helps in identifying a personalized therapy for individual patients. However, the application progress of liquid biopsy techniques in liver cancer lag behind due to various challenges in clinical practice. In this review, we aim to provide insights into the development of liquid biopsy technology in liver cancer, highlighting its clinical significance in diagnosis, prognosis and treatment response prediction. We hope to focus on the key opportunities and challenges associated with these biomarkers and inspire a potential direction for future research.

Background

Combination immunotherapy has gradually become the mainstay of systematic therapy for advanced hepatocellular carcinoma (HCC), however, whether preoperative immunotherapy has the potential to reduce tumor activity, increase the resection rate and improve prognosis remains unclear. This study aimed to investigate the efficacy and safety of preoperative combined immunotherapies for patients with initially unresectable HCC.

Methods

This retrospective, real-world study involved patients with initially unresectable HCC receiving combined immunotherapies based on PD-1/L1 blockade before surgery. Tumor treatment responses, pathological manifestations in postoperative specimens and overall survival (OS) were evaluated. Treatment related adverse events (AEs) were assessed according to the National Cancer Institute Common Terminology Criteria for Adverse Events (NCI CTCAE, version 4.0).

Results

The study consecutively included 54 initially unresectable HCC patients and 34 patients were evaluated for the safety, efficacy, and possibility of subsequent radical surgery. Among these patients with surgical resection, 57.1% (n=8) receiving combination immunotherapy before surgery achieved a partial response (PR). Pathological evaluation of postoperative specimens confirmed that 21.4% (n=3) achieved complete responses, and 78.6% (n=11) achieved PR. 28.6% (4/14) patients encountered grade 3 or 4 AEs. The main AEs included fatigue (n=11; 78.6%), leukocytopenia (n=8; 57.1%) and aspartate aminotransferase (AST) elevation (n=6; 42.9%).

Conclusions

After combination immunotherapy, patients should be comprehensively evaluated whether they meet the criteria for surgical resection. Surgical resection following combination immunotherapy might effectively and safely control tumor progression and could improve the prognosis at least for some patients with initially unresectable HCC.

Introduction

Synchronous rectal and liver resection for metastatic colorectal cancer offers a unique opportunity to treat patients with a single stage procedure. Traditional open resections were out of favour due to a high morbidity profile. Robotic resections offer these benefits with an apparent reduction in morbidity and similar oncological outcomes. The present review aims to ascertain the feasibility, safety and available outcomes for patients undergoing synchronous resections for rectal cancer with liver metastases.

Methods

A systematic review was performed along the PRISMA guidelines with “robotic”, “rectal cancer”, “colorectal”, “synchronous resection” and “liver metastases” as the key words on the MEDLINE, EMBASE and Cochrane databases. Appropriate studies published between May 1^st 2015 and May 1^st 2023 were chosen and the data were collated from individual patients and analysed.

Results

A total of 12 studies were included, comprising of 48 patients. Eight included studies were case series and the rest were case reports and brief communications. There were no appropriate prospective studies for analysis. The median age was 61 years (IQR- 55–73 years) and 80% of patients whose gender data were available (n-15) were men. The median operative duration was 376 ​min (IQR- 312–424 min) with estimated blood loss of 175 ​ml (125–225 ​ml). The median length of hospital stay was 5.5 days (IQR- 3.5-7). There was no mortality and all the resections were R0.

Conclusion

Synchronous robotic resections for rectal cancer with liver metastases is feasible on the current review and has good short term and peri-operative outcomes. However, there is paucity of high quality published data in this subset of patients. Further prospective studies are needed to confirm the findings of the current review and to resolve the lack of high quality evidence.