Surgical Oncology Insight最新文献

Robotic right posterior sectionectomy for biliary cystadenoma. Description of standardized approach in anatomical liver resection

Surgical Oncology Insight

Pub Date : 2025-01-27 DOI: 10.1016/j.soi.2025.100127

Parisa Y. Kenary, Sharona Ross, Iswanto Sucandy

Objective

With recent advances in surgical technology, minimally invasive liver resection is gradually becoming the gold-standard practice 1, 2, 4. Biliary cystadenoma is a rare tumor with malignant potential, therefore parenchymal-sparing liver resection is the preferred approach 3, 4. Due to its technical challenge, laparoscopic or robotic anatomical right posterior sectionectomy are infrequently performed in daily practice and rarely described in multimedia literatures. Herein, we describe our standardized technique for robotic right posterior sectionectomy.

Methods

A 65-year-old woman presented with a complex 5.3 cm multiloculated liver cyst involving segment 6/7. CT scan and MRI revealed multiple enhancing solid mural nodules and thickened septum concerning for neoplasm. Right posterior sectoral portal vein and hepatic artery were ligated to establish inflow control. After an adequate liver mobilization and dissection of hepatocaval confluence, the line of the parenchymal transection was drawn toward the root of the right hepatic vein following a demarcation line. Mapping of the middle and right hepatic veins was undertaken using ultrasonic guidance. Parenchymal division was undertaken under intermittent Pringle maneuver as necessary. The operation was completed with transection of the right hepatic vein using a robotic stapler.

Results

The operative time of 5 hours with minimal blood loss. The postoperative course was uneventful. A final pathology report confirmed a 6 cm multiloculated biliary cystadenoma without evidence of invasive carcinoma.

Conclusion

Robotic right posterior sectionectomy is technically demanding, however feasible, safe, and reproducible. We believe this technique can provide an alternative method to the conventional open operation for segment 6/7 liver tumor resection.

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引用次数: 0

Hepatic and peri-hepatic cytoreductive surgery in low-grade appendiceal mucinous neoplasms

Surgical Oncology Insight

Pub Date : 2025-01-22 DOI: 10.1016/j.soi.2025.100125

Catherine R. Lewis, Tamara L. Floyd, Casey J. Allen, David L. Bartlett, Patrick L. Wagner

Background

Low-grade appendiceal mucinous neoplasm (LAMN) is a rare tumor that carries a risk of rupture causing pseudomyxoma peritonei (PMP). With PMP, intraperitoneal surfaces and organs become involved, including the liver capsule, porta hepatis, and peri-hepatic regions. Extensive porta hepatis and peri-hepatic involvement in PMP is often cited as a contraindication for cytoreduction. We present a retrospective review of successful cytoreductive surgery (CRS) in patients with LAMN involvement of the porta hepatis and peri-hepatic tissues.

Methods

A retrospective review identified patients over a 3-year period with a diagnosis of LAMN with porta hepatis and peri-hepatic involvement. Peri-operative records were reviewed for all patients who met study criteria.

Results

We identified 41 patients with LAMN and porta hepatis and/or peri-hepatic involvement who underwent CRS with successful debulking of these regions. Non-anatomic hepatic parenchymal resection was required in 19 patients. Median peritoneal carcinoma index was 28, and median length of stay was 13.5 days. Clavien-Dindo Grade ≥ 3 complications were seen following 36 % of cases, with no liver-specific morbidity and no peri-operative mortalities.

Discussion

Peri-hepatic or portal involvement by PMP can be safely addressed during CRS and should not preclude attempts at complete cytoreduction in appropriate patients who may achieve long-term disease control.

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引用次数: 0

Optimal surveillance for detecting sarcoma lung metastasis – A systematic review 检测肉瘤肺转移的最佳监控方法 - 系统综述

Surgical Oncology Insight

Pub Date : 2025-01-15 DOI: 10.1016/j.soi.2025.100124

Neha Malik, Kate Krause, Emily Z. Keung, Heather G. Lyu, Heather Lillemoe, Christopher Scally, Keila Torres, Kelly Hunt, Mary Austin, Christina L. Roland

Introduction

Accurate diagnosis of lung metastasis for patients with soft tissue sarcoma (STS) can impact overall survival, but there is considerable variability in imaging utilized to detect metastasis. Chest x-ray (CXR) or computer tomography (CT) scan of the chest are the most common studies in current practice.

Methods

A systematic literature search was performed. Databases were searched from inception to January 3, 2024. Articles were reviewed to determine if CXR or CT chest was associated with improved overall or recurrence-free survival in patients with STS. Articles were also reviewed for data on cost-effectiveness of CXR versus CT chest. The quality of evidence was assessed by the Critical Appraisal Skills Programme.

Results

259 abstracts were screened, and twenty-seven studies were selected for full-text review. Nine studies met all inclusion criteria. Seven studies included data on survival or recurrence rates and four included data on the cost of imaging modality. The seven studies all had conflicting results on the impact of CXR versus chest CT on survival and recurrence. The four studies that looked at cost found that CXR was more cost-effective, but in certain patients, screening with chest CT could be cost-effective.

Conclusion

The literature defining the optimal surveillance method for lung metastases for patients with STS is limited. Most of the studies had a low quality of evidence due to study design and significant risk of bias. Randomized controlled trials are needed to further understand the best imaging modality for lung metastasis surveillance in this patient population.

导言软组织肉瘤（STS）患者肺转移的准确诊断会影响患者的总生存率，但用于检测转移的成像技术存在很大差异。胸部 X 光（CXR）或胸部计算机断层扫描（CT）是目前最常用的检查方法。检索了从开始到 2024 年 1 月 3 日的数据库。对文章进行了审查，以确定 CXR 或胸部 CT 是否与 STS 患者总生存率或无复发生存率的提高有关。还对文章进行了审查，以了解 CXR 与胸部 CT 的成本效益数据。结果筛选出 259 篇摘要，并选择了 27 项研究进行全文综述。九项研究符合所有纳入标准。其中七项研究包含存活率或复发率数据，四项研究包含成像方式成本数据。在 CXR 与胸部 CT 对生存率和复发率的影响方面，这七项研究的结果相互矛盾。对成本进行调查的四项研究发现，CXR 更具成本效益，但在某些患者中，使用胸部 CT 进行筛查可能更具成本效益。由于研究设计和严重的偏倚风险，大多数研究的证据质量较低。需要进行随机对照试验，以进一步了解该患者群体肺转移监测的最佳成像模式。

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引用次数: 0

Impact of clinicopathologic factors on the number of lymph nodes examined in patients with melanoma

Surgical Oncology Insight

Pub Date : 2025-01-13 DOI: 10.1016/j.soi.2025.100123

Jason M. Lizalek, Collin E. Dougherty, Juan A. Santamaria-Barria, Bradley N. Reames, Jason Foster, Joshua M.V. Mammen

Background

Melanoma is amongst the malignancies with the greatest annual increase in incidence. The prognosis for melanoma is partially dependent on lymph node status. Staging of lymph node basins in patients without clinical evidence of lymphadenopathy is typically by sentinel lymph node (SLN) biopsy. In this study, we sought to determine factors associated with the number of sentinel lymph nodes examined.

Methods

The National Cancer Database Participant User File from 2018 to 2020 was queried for clinical node negative patients who underwent sentinel lymph node biopsy. Descriptive statistics were obtained. Stepwise negative binomial regression analysis was performed in addition to ANOVA, chi-squared and Student’s t-tests.

Results

We identified 32,516 clinically node negative patients with melanoma from 2018 to 2020 who had undergone sentinel lymph node biopsy. Using a stepwise negative binomial model, male patients had a 3.8 % increase in the number of SLNs examined compared to females, while each year of age predicted a 0.3 % decrease in the number of SLNs examined. Breslow thickness > 2 mm was associated with a 6.9 % increase in SLN examined. Primary sites with multiple potential lymphatic drainage basins including ear, lip, scalp & neck, and trunk were associated with a 55.2 %, 29.6 %, 46.6 %, 43.4 % increase in SLNs examined, respectively. The study did not identify a difference in overall survival based on the number of lymph nodes examined (p = 0.25).

Conclusion

The number of sentinel lymph nodes examined in melanoma patients is associated positively with younger age, male sex, Breslow thickness, and primary site.

Synopsis

A National Cancer Database study of sentinel lymph node biopsy yield in clinically node-negative melanoma patients showed association with age, sex, Breslow thickness, and primary site. Clinicopathologic factors were predictive of sentinel lymph node yield, indicating other influences rather than objective sentinel lymph node criteria on node biopsy.

{"title":"Impact of clinicopathologic factors on the number of lymph nodes examined in patients with melanoma","authors":"Jason M. Lizalek, Collin E. Dougherty, Juan A. Santamaria-Barria, Bradley N. Reames, Jason Foster, Joshua M.V. Mammen","doi":"10.1016/j.soi.2025.100123","DOIUrl":"10.1016/j.soi.2025.100123","url":null,"abstract":"<div><h3>Background</h3><div>Melanoma is amongst the malignancies with the greatest annual increase in incidence. The prognosis for melanoma is partially dependent on lymph node status. Staging of lymph node basins in patients without clinical evidence of lymphadenopathy is typically by sentinel lymph node (SLN) biopsy. In this study, we sought to determine factors associated with the number of sentinel lymph nodes examined.</div></div><div><h3>Methods</h3><div>The National Cancer Database Participant User File from 2018 to 2020 was queried for clinical node negative patients who underwent sentinel lymph node biopsy. Descriptive statistics were obtained. Stepwise negative binomial regression analysis was performed in addition to ANOVA, chi-squared and Student’s t-tests.</div></div><div><h3>Results</h3><div>We identified 32,516 clinically node negative patients with melanoma from 2018 to 2020 who had undergone sentinel lymph node biopsy. Using a stepwise negative binomial model, male patients had a 3.8 % increase in the number of SLNs examined compared to females, while each year of age predicted a 0.3 % decrease in the number of SLNs examined. Breslow thickness > 2 mm was associated with a 6.9 % increase in SLN examined. Primary sites with multiple potential lymphatic drainage basins including ear, lip, scalp & neck, and trunk were associated with a 55.2 %, 29.6 %, 46.6 %, 43.4 % increase in SLNs examined, respectively. The study did not identify a difference in overall survival based on the number of lymph nodes examined (p = 0.25).</div></div><div><h3>Conclusion</h3><div>The number of sentinel lymph nodes examined in melanoma patients is associated positively with younger age, male sex, Breslow thickness, and primary site.</div></div><div><h3>Synopsis</h3><div>A National Cancer Database study of sentinel lymph node biopsy yield in clinically node-negative melanoma patients showed association with age, sex, Breslow thickness, and primary site. Clinicopathologic factors were predictive of sentinel lymph node yield, indicating other influences rather than objective sentinel lymph node criteria on node biopsy.</div></div>","PeriodicalId":101191,"journal":{"name":"Surgical Oncology Insight","volume":"2 1","pages":"Article 100123"},"PeriodicalIF":0.0,"publicationDate":"2025-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143183473","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Fusobacterium nucleatum in appendiceal cancer: Prevalence and influence on the tumor immune microenvironment

Surgical Oncology Insight

Pub Date : 2025-01-12 DOI: 10.1016/j.soi.2025.100122

Hyun Park , Chelsea Knotts , Rose Blodgett , Catherine R. Lewis , David L. Bartlett , Neda Dadgar , Patrick L. Wagner

Introduction

Fusobacterium nucleatum (Fn) has gained notoriety for its propensity toward mucosal invasion in acute appendicitis and its potential involvement in development or progression of colorectal cancer. We hypothesized that Fn may be linked to appendiceal cancer (AC). To explore the potential connection, we quantitatively examined the presence of Fn in appendiceal tissue across various histological diagnoses.

Methods

A total of 50 formalin-fixed paraffin-embedded tissues were obtained from archival appendectomy specimens. RNA-in situ hybridization (RNA-ISH) with an Fn-specific probe was performed, and immunohistochemical staining was performed on tumor-associated CD3 + and CD8 + lymphocytes. The digital images were analyzed using QuPath and Aperio ImageScope.

Results

RNA-ISH showed significantly higher Fn content in the appendiceal pathology with increased Fn levels in acute appendicitis, low-grade AC, and high-grade AC relative to the Fn level of a normal appendix. Also, Fn content was strongly associated with decreased CD8 + lymphocyte density within high-grade AC, but no significant association was found with CD3 + lymphocyte density and tumor grades.

Discussion

In this study, we confirmed previous reports of Fn levels within normal appendiceal tissue and acute appendicitis and extended this finding to a range of appendiceal neoplasms. The inverse relationship between Fn and CD8 + cell density within high-grade AC in our series also suggests a potential role for Fn in shaping the AC microenvironment toward an immune-suppressed or immune-excluded phenotype. Further study is planned to include larger case numbers with a wider variety of histological subtypes of AC and peritoneal metastatic lesions to enrich the understanding of the immunological and microbial microenvironment in AC for novel opportunities for targeted therapy.

导言：核分枝杆菌（Fn）因其在急性阑尾炎中的粘膜侵袭倾向及其可能参与结肠直肠癌的发生或发展而广为人知。我们假设 Fn 可能与阑尾癌（AC）有关。为了探索这种潜在的联系，我们定量检测了Fn在不同组织学诊断的阑尾组织中的存在情况。用 Fn 特异性探针进行 RNA 原位杂交（RNA-ISH），并对肿瘤相关 CD3 + 和 CD8 + 淋巴细胞进行免疫组化染色。结果RNA-ISH显示阑尾病理中的Fn含量明显增高，急性阑尾炎、低级别阑尾炎和高级别阑尾炎中的Fn含量相对于正常阑尾的Fn含量增高。此外，Fn 含量与高级别 AC 中 CD8 + 淋巴细胞密度下降密切相关，但与 CD3 + 淋巴细胞密度和肿瘤级别无明显关联。讨论在这项研究中，我们证实了之前关于正常阑尾组织和急性阑尾炎中 Fn 含量的报道，并将这一发现扩展到一系列阑尾肿瘤。在我们的系列研究中，Fn 与高级别 AC 中 CD8 + 细胞密度之间的反比关系也表明，Fn 在使 AC 微环境向免疫抑制或免疫排斥表型转变方面发挥着潜在作用。我们计划开展更多的研究，纳入更多不同组织学亚型的 AC 病例和腹膜转移病灶，以丰富对 AC 免疫学和微生物微环境的了解，从而为靶向治疗提供新的机会。

{"title":"Fusobacterium nucleatum in appendiceal cancer: Prevalence and influence on the tumor immune microenvironment","authors":"Hyun Park , Chelsea Knotts , Rose Blodgett , Catherine R. Lewis , David L. Bartlett , Neda Dadgar , Patrick L. Wagner","doi":"10.1016/j.soi.2025.100122","DOIUrl":"10.1016/j.soi.2025.100122","url":null,"abstract":"<div><h3>Introduction</h3><div><em>Fusobacterium nucleatum</em> (<em>Fn</em>) has gained notoriety for its propensity toward mucosal invasion in acute appendicitis and its potential involvement in development or progression of colorectal cancer. We hypothesized that <em>Fn</em> may be linked to appendiceal cancer (AC). To explore the potential connection, we quantitatively examined the presence of <em>Fn</em> in appendiceal tissue across various histological diagnoses.</div></div><div><h3>Methods</h3><div>A total of 50 formalin-fixed paraffin-embedded tissues were obtained from archival appendectomy specimens. RNA-in situ hybridization (RNA-ISH) with an <em>Fn</em>-specific probe was performed, and immunohistochemical staining was performed on tumor-associated CD3 + and CD8 + lymphocytes. The digital images were analyzed using QuPath and Aperio ImageScope.</div></div><div><h3>Results</h3><div>RNA-ISH showed significantly higher <em>Fn</em> content in the appendiceal pathology with increased <em>Fn</em> levels in acute appendicitis, low-grade AC, and high-grade AC relative to the Fn level of a normal appendix. Also, <em>Fn</em> content was strongly associated with decreased CD8 + lymphocyte density within high-grade AC, but no significant association was found with CD3 + lymphocyte density and tumor grades.</div></div><div><h3>Discussion</h3><div>In this study, we confirmed previous reports of <em>Fn</em> levels within normal appendiceal tissue and acute appendicitis and extended this finding to a range of appendiceal neoplasms. The inverse relationship between <em>Fn</em> and CD8 + cell density within high-grade AC in our series also suggests a potential role for <em>Fn</em> in shaping the AC microenvironment toward an immune-suppressed or immune-excluded phenotype. Further study is planned to include larger case numbers with a wider variety of histological subtypes of AC and peritoneal metastatic lesions to enrich the understanding of the immunological and microbial microenvironment in AC for novel opportunities for targeted therapy.</div></div>","PeriodicalId":101191,"journal":{"name":"Surgical Oncology Insight","volume":"2 1","pages":"Article 100122"},"PeriodicalIF":0.0,"publicationDate":"2025-01-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143183474","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Circulating tumor DNA predicts recurrence in patients receiving adjuvant hepatic artery infusion chemotherapy for resected colorectal liver metastases

Surgical Oncology Insight

Pub Date : 2025-01-03 DOI: 10.1016/j.soi.2024.100121

Noah A. Cohen , Nazanin Khajoueinejad , Umut Sarpel , Spiros Hiotis , Parissa Tabrizian , Myron Schwartz , Benjamin J. Golas , Daniel M. Labow , Celina Ang

Objective

The role of circulating tumor DNA (ctDNA) in management of patients with colorectal cancer is evolving, however, there are no data on ctDNA monitoring in patients with resected colorectal liver metastases (CRLM) who receive adjuvant hepatic artery (HAI) chemotherapy. We report our center’s initial experience with postoperative ctDNA monitoring in patients receiving adjuvant HAI chemotherapy.

Summary background

Adjuvant HAI chemotherapy improves survival after CRLM resection. ctDNA has been shown to predict recurrence in patients with resected CRLM, however no ctDNA data are available in patients who receive adjuvant HAI chemotherapy.

Methods

All patients with CRLM who underwent surgical resection and HAI pump placement at our center were included in this study. Demographic, clinicopathologic, radiographic, and ctDNA data are reported.

Results

From 2019–2024, 13 patients with CRLM underwent surgical resection and HAI pump placement and had ctDNA testing. With median follow-up of 2.6 years (1.14–4.15), 11 (85 %) patients experienced recurrence at a median of 7.9 months (2.3–22.5). In total, 10 (77 %) patients were ctDNA-positive all of whom had radiographic evidence of recurrence. Three patients have died at the time of last follow-up.

Conclusions

After surgical resection and HAI chemotherapy, ctDNA was detectable in most patients, and was associated with radiographic recurrence in all ctDNA-positive patients. We report a high recurrence rate in this series of heavily-pretreated patients with known risk factors for recurrence.

{"title":"Circulating tumor DNA predicts recurrence in patients receiving adjuvant hepatic artery infusion chemotherapy for resected colorectal liver metastases","authors":"Noah A. Cohen , Nazanin Khajoueinejad , Umut Sarpel , Spiros Hiotis , Parissa Tabrizian , Myron Schwartz , Benjamin J. Golas , Daniel M. Labow , Celina Ang","doi":"10.1016/j.soi.2024.100121","DOIUrl":"10.1016/j.soi.2024.100121","url":null,"abstract":"<div><h3>Objective</h3><div>The role of circulating tumor DNA (ctDNA) in management of patients with colorectal cancer is evolving, however, there are no data on ctDNA monitoring in patients with resected colorectal liver metastases (CRLM) who receive adjuvant hepatic artery (HAI) chemotherapy. We report our center’s initial experience with postoperative ctDNA monitoring in patients receiving adjuvant HAI chemotherapy.</div></div><div><h3>Summary background</h3><div>Adjuvant HAI chemotherapy improves survival after CRLM resection. ctDNA has been shown to predict recurrence in patients with resected CRLM, however no ctDNA data are available in patients who receive adjuvant HAI chemotherapy.</div></div><div><h3>Methods</h3><div>All patients with CRLM who underwent surgical resection and HAI pump placement at our center were included in this study. Demographic, clinicopathologic, radiographic, and ctDNA data are reported.</div></div><div><h3>Results</h3><div>From 2019–2024, 13 patients with CRLM underwent surgical resection and HAI pump placement and had ctDNA testing. With median follow-up of 2.6 years (1.14–4.15), 11 (85 %) patients experienced recurrence at a median of 7.9 months (2.3–22.5). In total, 10 (77 %) patients were ctDNA-positive all of whom had radiographic evidence of recurrence. Three patients have died at the time of last follow-up.</div></div><div><h3>Conclusions</h3><div>After surgical resection and HAI chemotherapy, ctDNA was detectable in most patients, and was associated with radiographic recurrence in all ctDNA-positive patients. We report a high recurrence rate in this series of heavily-pretreated patients with known risk factors for recurrence.</div></div>","PeriodicalId":101191,"journal":{"name":"Surgical Oncology Insight","volume":"2 1","pages":"Article 100121"},"PeriodicalIF":0.0,"publicationDate":"2025-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143182588","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Real-world outcomes with T-VEC in patients with anti-PD-1 resistant in-transit disease from melanoma and Merkel cell carcinoma

Surgical Oncology Insight

Pub Date : 2024-12-22 DOI: 10.1016/j.soi.2024.100120

David G. Su , Madeline McNamara , Margaret A. Kaszycki , Alexander E. Frey , Jeffrey J. Ishizuka , Philippos A. Costa , Thuy T. Tran , Harriet M. Kluger , James E. Clune , Sarah A. Weiss , Kelly L. Olino

Background and Objectives

Talimogene laherparepvec (T-VEC) is an intralesional cancer immunotherapy in patients with unresectable stage IIIB-IV melanoma and Merkel cell carcinoma (MCC). This study assesses T-VEC outcomes in patients with in-transit melanoma and MCC refractory to anti-PD-1 blockade.

Methods

All patients with advanced melanoma or MCC with ≥ 1 measurable lesion(s) were retrospectively evaluated from 2019 to 2023. Only those who received ICI therapy for ≥ 3 months with progression of regional metastasis prior to receiving T-VEC were included. Clinicopathologic and treatment data were reviewed.

Results

Seventeen patients underwent T-VEC therapy, consisting of thirteen melanoma and four MCC cases. Median age was 75.9 and 79.6 for melanoma and MCC cases respectively. Eleven melanoma (84 %) and three MCC (75 %) cases received extremity injections. Median number of in-transit metastatic sites for melanoma and MCC were 4 and 10; respectively, and the median number of treatment cycles per patient was five in both groups. Ten total patients responded with 8 complete responses and 2 partial responses, while five (4 melanoma; 1 MCC) had disease progression. Of seventeen patients, two discontinued T-VEC due to grade 3 + adverse events.

Conclusion

T-VEC following or in conjunction with immunotherapy exhibits tolerability and potential benefit in patients with advanced MCC and melanoma.

{"title":"Real-world outcomes with T-VEC in patients with anti-PD-1 resistant in-transit disease from melanoma and Merkel cell carcinoma","authors":"David G. Su , Madeline McNamara , Margaret A. Kaszycki , Alexander E. Frey , Jeffrey J. Ishizuka , Philippos A. Costa , Thuy T. Tran , Harriet M. Kluger , James E. Clune , Sarah A. Weiss , Kelly L. Olino","doi":"10.1016/j.soi.2024.100120","DOIUrl":"10.1016/j.soi.2024.100120","url":null,"abstract":"<div><h3>Background and Objectives</h3><div>Talimogene laherparepvec (T-VEC) is an intralesional cancer immunotherapy in patients with unresectable stage IIIB-IV melanoma and Merkel cell carcinoma (MCC). This study assesses T-VEC outcomes in patients with in-transit melanoma and MCC refractory to anti-PD-1 blockade.</div></div><div><h3>Methods</h3><div>All patients with advanced melanoma or MCC with ≥ 1 measurable lesion(s) were retrospectively evaluated from 2019 to 2023. Only those who received ICI therapy for ≥ 3 months with progression of regional metastasis prior to receiving T-VEC were included. Clinicopathologic and treatment data were reviewed.</div></div><div><h3>Results</h3><div>Seventeen patients underwent T-VEC therapy, consisting of thirteen melanoma and four MCC cases. Median age was 75.9 and 79.6 for melanoma and MCC cases respectively. Eleven melanoma (84 %) and three MCC (75 %) cases received extremity injections. Median number of in-transit metastatic sites for melanoma and MCC were 4 and 10; respectively, and the median number of treatment cycles per patient was five in both groups. Ten total patients responded with 8 complete responses and 2 partial responses, while five (4 melanoma; 1 MCC) had disease progression. Of seventeen patients, two discontinued T-VEC due to grade 3 + adverse events.</div></div><div><h3>Conclusion</h3><div>T-VEC following or in conjunction with immunotherapy exhibits tolerability and potential benefit in patients with advanced MCC and melanoma.</div></div>","PeriodicalId":101191,"journal":{"name":"Surgical Oncology Insight","volume":"2 1","pages":"Article 100120"},"PeriodicalIF":0.0,"publicationDate":"2024-12-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143183472","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Prognostic impact of the CALLY index in patients with resectable pancreatic cancer CALLY指数对可切除胰腺癌患者预后的影响

Surgical Oncology Insight

Pub Date : 2024-12-19 DOI: 10.1016/j.soi.2024.100119

Satoshi Matsui, Yoshiyasu Kato, Katsuhisa Ohgi, Ryo Ashida, Mihoko Yamada, Shimpei Otsuka, Katsuhiko Uesaka, Teiichi Sugiura

Background

The prognostic significance of the preoperative C-reactive protein-albumin-lymphocyte (CALLY) index has been reported in various cancers. However, its role in pancreatic cancer remains unclear.

Methods

A cohort of 307 patients with resectable pancreatic cancer (RPC) who underwent curative surgery without neoadjuvant therapy, between July 2012 and December 2019, was analyzed. The CALLY index was defined as (albumin × lymphocytes)/ (C-reactive protein × 10⁴). The cutoff value of the CALLY index was determined according to　receiver operating characteristics analysis using survival status at 3-year follow-up. The association of the CALLY index with disease-free survival (DFS) and overall survival (OS) was investigated using univariate and multivariate analyses.

Results

The median CALLY index was 4.5, with an interquartile range of 1.4–12.3. The cutoff value of the CALLY index was set at 3.0, dividing patients into a CALLY-high group (> 3.0; n = 180) and a CALLY-low group (≤ 3.0; n = 127). The DFS and OS were significantly worse in the CALLY-low group versus the CALLY-high group (p < 0.001 and p < 0.001, respectively). Multivariate analysis, using preoperative clinicopathological variables, revealed a CALLY index ≤ 3.0 as an independent prognostic factor for DFS (hazard ratio [HR] 1.43, p = 0.041) and OS (HR 1.56, p = 0.012).

Conclusions

In RPC, survival outcomes were significantly stratified by the CALLY index = 3.0, with < 3 being a significantly poor prognostic factor for DFS and OS. The CALLY index may be useful in predicting long-term survival in patients with RPC.

{"title":"Prognostic impact of the CALLY index in patients with resectable pancreatic cancer","authors":"Satoshi Matsui, Yoshiyasu Kato, Katsuhisa Ohgi, Ryo Ashida, Mihoko Yamada, Shimpei Otsuka, Katsuhiko Uesaka, Teiichi Sugiura","doi":"10.1016/j.soi.2024.100119","DOIUrl":"10.1016/j.soi.2024.100119","url":null,"abstract":"<div><h3>Background</h3><div>The prognostic significance of the preoperative C-reactive protein-albumin-lymphocyte (CALLY) index has been reported in various cancers. However, its role in pancreatic cancer remains unclear.</div></div><div><h3>Methods</h3><div>A cohort of 307 patients with resectable pancreatic cancer (RPC) who underwent curative surgery without neoadjuvant therapy, between July 2012 and December 2019, was analyzed. The CALLY index was defined as (albumin × lymphocytes)/ (C-reactive protein × 10<sup>4</sup>). The cutoff value of the CALLY index was determined according to　receiver operating characteristics analysis using survival status at 3-year follow-up. The association of the CALLY index with disease-free survival (DFS) and overall survival (OS) was investigated using univariate and multivariate analyses.</div></div><div><h3>Results</h3><div>The median CALLY index was 4.5, with an interquartile range of 1.4–12.3. The cutoff value of the CALLY index was set at 3.0, dividing patients into a CALLY-high group (> 3.0; n = 180) and a CALLY-low group (≤ 3.0; n = 127). The DFS and OS were significantly worse in the CALLY-low group versus the CALLY-high group (<em>p</em> < 0.001 and <em>p</em> < 0.001, respectively). Multivariate analysis, using preoperative clinicopathological variables, revealed a CALLY index ≤ 3.0 as an independent prognostic factor for DFS (hazard ratio [HR] 1.43, <em>p</em> = 0.041) and OS (HR 1.56, <em>p</em> = 0.012).</div></div><div><h3>Conclusions</h3><div>In RPC, survival outcomes were significantly stratified by the CALLY index = 3.0, with < 3 being a significantly poor prognostic factor for DFS and OS. The CALLY index may be useful in predicting long-term survival in patients with RPC.</div></div>","PeriodicalId":101191,"journal":{"name":"Surgical Oncology Insight","volume":"2 1","pages":"Article 100119"},"PeriodicalIF":0.0,"publicationDate":"2024-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143182587","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Risk factors for early versus late venous thromboembolism after cytoreductive surgery and HIPEC 细胞再生手术和 HIPEC 后早期与晚期静脉血栓栓塞的风险因素

Surgical Oncology Insight

Pub Date : 2024-12-13 DOI: 10.1016/j.soi.2024.100118

Sohini Khan , Kaitlyn Kelly , Jula Veerapong , Andrew M. Lowy , Joel M. Baumgartner

Background

Patients undergoing cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) often have extensive cancer burden, long operative times, and reduced mobility postoperatively – known risk factors for venous thromboembolism (VTE). It is unknown whether risk factors differ for early versus late VTEs post-CRS-HIPEC.

Methods

We retrospectively studied patients undergoing CRS-HIPEC from 2007 to 2021 and analyzed VTEs occurring within 60 days of surgery. VTEs ≤ postoperative day (POD) 7 were “early”; those after POD 7 were “late”. Associated risk factors were analyzed using student’s t-test, Chi-squared test, and logistic regression.

Results

By POD 60, 35 of 682 CRS-HIPEC patients (5.1 %) had VTEs – eight (22.9 %) early and 27 (77.1 %) late. All early VTEs were pulmonary emboli vs. 63 % of late VTEs (p = 0.041); five (62.5 %) early VTEs were serious (Clavien-Dindo grade ≥3) vs. two (7.4 %) late VTEs (p = 0.005). Early VTEs were associated with primary ovarian cancer (37.5 % vs. 4.2 %, p < 0.001), extensive pelvic dissection (87.5 % vs. 50.1 %, p = 0.035), PCI 31–39 (p = 0.002), OR time (558 vs. 420 min, p = 0.015), EBL (650 vs. 150 mL, p = 0.005), and intraoperative transfusion (62.5 % vs. 13.1 %, p = 0.002). Late VTEs were associated with higher Caprini score (9 vs. 8, p = 0.038), lower serum albumin (4.1 vs. 4.3, p = 0.002), PCI 31–39 (p = 0.012) and serious inpatient postoperative complications (22.2 % vs. 7.3 %, p = 0.008).

Conclusions

Severity and risk factors are markedly different for early vs. late VTEs following CRS-HIPEC. Early VTEs are more serious and associated with primary ovarian cancer and extensive cytoreduction including pelvic dissection highlighting the need for alternative prophylaxis strategies and clinical scrutiny in these populations.

{"title":"Risk factors for early versus late venous thromboembolism after cytoreductive surgery and HIPEC","authors":"Sohini Khan , Kaitlyn Kelly , Jula Veerapong , Andrew M. Lowy , Joel M. Baumgartner","doi":"10.1016/j.soi.2024.100118","DOIUrl":"10.1016/j.soi.2024.100118","url":null,"abstract":"<div><h3>Background</h3><div>Patients undergoing cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) often have extensive cancer burden, long operative times, and reduced mobility postoperatively – known risk factors for venous thromboembolism (VTE). It is unknown whether risk factors differ for early versus late VTEs post-CRS-HIPEC.</div></div><div><h3>Methods</h3><div>We retrospectively studied patients undergoing CRS-HIPEC from 2007 to 2021 and analyzed VTEs occurring within 60 days of surgery. VTEs ≤ postoperative day (POD) 7 were “early”; those after POD 7 were “late”. Associated risk factors were analyzed using student’s t-test, Chi-squared test, and logistic regression.</div></div><div><h3>Results</h3><div>By POD 60, 35 of 682 CRS-HIPEC patients (5.1 %) had VTEs – eight (22.9 %) early and 27 (77.1 %) late. All early VTEs were pulmonary emboli vs. 63 % of late VTEs (p = 0.041); five (62.5 %) early VTEs were serious (Clavien-Dindo grade ≥3) vs. two (7.4 %) late VTEs (p = 0.005). Early VTEs were associated with primary ovarian cancer (37.5 % vs. 4.2 %, p < 0.001), extensive pelvic dissection (87.5 % vs. 50.1 %, p = 0.035), PCI 31–39 (p = 0.002), OR time (558 vs. 420 min, p = 0.015), EBL (650 vs. 150 mL, p = 0.005), and intraoperative transfusion (62.5 % vs. 13.1 %, p = 0.002). Late VTEs were associated with higher Caprini score (9 vs. 8, p = 0.038), lower serum albumin (4.1 vs. 4.3, p = 0.002), PCI 31–39 (p = 0.012) and serious inpatient postoperative complications (22.2 % vs. 7.3 %, p = 0.008).</div></div><div><h3>Conclusions</h3><div>Severity and risk factors are markedly different for early vs. late VTEs following CRS-HIPEC. Early VTEs are more serious and associated with primary ovarian cancer and extensive cytoreduction including pelvic dissection highlighting the need for alternative prophylaxis strategies and clinical scrutiny in these populations.</div></div>","PeriodicalId":101191,"journal":{"name":"Surgical Oncology Insight","volume":"2 1","pages":"Article 100118"},"PeriodicalIF":0.0,"publicationDate":"2024-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143183471","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Analysis of 3144 case reports in the gastrointestinal stromal tumor literature: Identification of underappreciated demographics, clinical presentations, and biology

Surgical Oncology Insight

Pub Date : 2024-12-12 DOI: 10.1016/j.soi.2024.100117

Tannaz Ranjbarian , Mark Antkowiak , Terence M. Doherty , Yeseob Jee , Jason K. Sicklick

Objective

Gastrointestinal stromal tumors (GIST) were first described in 1998 and are now known to be the most common soft tissue sarcoma. Numerous case reports are still frequently published reporting various aspects of GIST. This prompted us to review these reports to identify common elements, changes over time, and underappreciated aspects of GIST, as well as to ask whether further exploration is truly warranted.

Methods

A search of the NCBI PubMed database from 5/1/1998–8/5/2023 identified all case reports on GIST using the terms “GIST” OR “gastrointestinal stromal tumor” AND “case report.” Publications were classified into 19 categories, subcategorized, and analyzed using descriptive statistics.

Results

A total of 4350 articles were found, with 3144 case reports representing 3348 patients included for analysis. The five most represented categories were tumor location (30.3 %), presentation (27.5 %), operative approach (12.1 %), concomitant malignancy (9.2 %), and metastatic site (8.4 %). Notable findings included rare but clinically important features such as tumor-associated paraneoplastic syndromes (0.6 %) and brain metastases (0.6 %). Additionally, 38 cases (1.2 %) were reported in neonates, infants, and children ≤ 12 years old.

Conclusions

We describe GIST case reports published over a 25-year period and classified them based upon abstract content. We were surprised to uncover an array of underappreciated aspects of GIST, speaking to the narrow but important role of publishing case reports on the novel and unusual aspects of rare diseases that would otherwise not be appreciated in larger case series or in population-based studies. Thus, we recommend judicious publication of GIST case reports, particularly those that emphasize previously unknown or unappreciated aspects of disease biology or novel approaches to management.

{"title":"Analysis of 3144 case reports in the gastrointestinal stromal tumor literature: Identification of underappreciated demographics, clinical presentations, and biology","authors":"Tannaz Ranjbarian , Mark Antkowiak , Terence M. Doherty , Yeseob Jee , Jason K. Sicklick","doi":"10.1016/j.soi.2024.100117","DOIUrl":"10.1016/j.soi.2024.100117","url":null,"abstract":"<div><h3>Objective</h3><div>Gastrointestinal stromal tumors (GIST) were first described in 1998 and are now known to be the most common soft tissue sarcoma. Numerous case reports are still frequently published reporting various aspects of GIST. This prompted us to review these reports to identify common elements, changes over time, and underappreciated aspects of GIST, as well as to ask whether further exploration is truly warranted.</div></div><div><h3>Methods</h3><div>A search of the NCBI PubMed database from 5/1/1998–8/5/2023 identified all case reports on GIST using the terms “GIST” OR “gastrointestinal stromal tumor” AND “case report.” Publications were classified into 19 categories, subcategorized, and analyzed using descriptive statistics.</div></div><div><h3>Results</h3><div>A total of 4350 articles were found, with 3144 case reports representing 3348 patients included for analysis. The five most represented categories were tumor location (30.3 %), presentation (27.5 %), operative approach (12.1 %), concomitant malignancy (9.2 %), and metastatic site (8.4 %). Notable findings included rare but clinically important features such as tumor-associated paraneoplastic syndromes (0.6 %) and brain metastases (0.6 %). Additionally, 38 cases (1.2 %) were reported in neonates, infants, and children ≤ 12 years old.</div></div><div><h3>Conclusions</h3><div>We describe GIST case reports published over a 25-year period and classified them based upon abstract content. We were surprised to uncover an array of underappreciated aspects of GIST, speaking to the narrow but important role of publishing case reports on the novel and unusual aspects of rare diseases that would otherwise not be appreciated in larger case series or in population-based studies. Thus, we recommend judicious publication of GIST case reports, particularly those that emphasize previously unknown or unappreciated aspects of disease biology or novel approaches to management.</div></div>","PeriodicalId":101191,"journal":{"name":"Surgical Oncology Insight","volume":"2 1","pages":"Article 100117"},"PeriodicalIF":0.0,"publicationDate":"2024-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143183469","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0