Korean journal of clinical oncology最新文献

Descending necrotizing mediastinitis (DNM) is a life-threatening complication secondary to oropharyngeal abscesses, cervical esophageal perforation, or neck infections spreading along the fascial planes into the mediastinum. Post-thyroidectomy surgical site infection is a highly unusual complication that is typically localized around the incision, but may be propagated into the mediastinum, causing DNM. We encountered a case of this rare complication after thyroidectomy. The patient was a 33-year-old woman who was admitted to our center for left hemithyroidectomy. The surgery was performed without any intraoperative events. However, she later developed fever, hypotension, and tachycardia. Imaging revealed deep neck emphysema and focal pneumomediastinum with infiltration in the anterior neck and mediastinum with abscess formation. Additional imaging at 7 days postoperatively revealed reduced fluid collection deep in the neck with minimal changes in fluid collection in the mediastinum. Esophageal perforation was excluded via an esophagogram, which lead to the conclusion that the infection may have been caused by open thyroidectomy. The patient was treated with prompt medical and surgical intervention. After treatment, she was discharged from the hospital with no further complications. We present our case report as well as a literature review of the diagnosis and treatment of this disease.

Purpose: The purpose of this study was to compare the clinical characteristics and outcomes of hormone receptor-positive (HR+) human epidermal growth factor 2-negative (HER2-) breast cancer among elderly patients (over 65 years old) and younger patients.

Methods: This was a retrospective cohort study of 328 patients who were treated for breast cancer at Pusan National University Yangsan Hospital between January 2009 and December 2014. Tumor characteristics, surgical methods, and survival outcomes were compared between the two age groups (<65 and ≥65 years old). Kaplan-Meier curves for disease-free survival (DFS) and overall survival (OS) were also constructed according to the age groups.

Results: Among the 328 patients with HR+ HER2- breast cancer, 184 (56.1%) were <65 years old and 144 (43.9%) were ≥65 years old. Breast cancer stages were similar between the two age groups, but the older patients were treated less often with chemotherapy (81% vs. 66%, P=0.002). During the follow-up period, 17 deaths and 36 cases of recurrence or metastasis were reported. There was no difference in DFS between the two groups (P=0.840); however, the OS of the older age group was significantly lower than that of the younger age group (P=0.015).

Conclusion: This study suggested that HR+ HER2- breast cancer patients belonging to the two age groups had no significant difference in DFS. However, older age is an independent factor affecting OS rate. Therefore, even if patients are old, but their physical condition is satisfactory, standard and active treatment may be necessary, similar to that given to younger patients.

Purpose: Adjuvant chemotherapy is recommended after curative surgery in patients with colon cancer of high-risk stage II and stage III. However, a considerable number of patients cannot complete the scheduled adjuvant treatment for various reasons. This study investigates the hindering factors to the adherence to adjuvant chemotherapy and their impact on long-term survival.

Methods: A retrospective study was conducted for patients with colon cancer and had curative resection from 2009 to 2014. Among patients with pathologic stage II and III, stage II with low-risk features, double primary cancers, R2 resection cases were excluded. Patients were grouped into three groups: no-adjuvant therapy, adjuvant therapy for less than 3 months, and more than 3 months. Factors for withdrawal and the oncologic outcome were analyzed.

Results: Of 571 patients, adjuvant chemotherapy was recommended in 403. One hundred and sixteen patients (28.8%) did not receive adjuvant chemotherapy, 78 (19.4%) withdrew within 3 months, and 209 (51.9%) maintained for more than 3 months. Factors for not receiving adjuvant chemotherapy or withdrawing within 3 months were older than 70 and American Society of Anesthesiologists class 3 or higher. Main reasons for discontinuation before 3 months were chemotoxicity and patient's refusal. The long-term oncologic outcome of the patients who received adjuvant chemotherapy for more than 3 months was significantly better than others.

Conclusion: No-adjuvant therapy or receiving them for lesser than 3 months is significantly affected by the patient's performance status and social support, which coincides with a poor oncologic outcome. Social support and rehabilitation system may help to improve the survival outcome.

[This corrects the article on p. 110 in vol. 16.].

Purpose: Rectal neuroendocrine tumors (NETs) <10 mm are endoscopically resected, while those ≥20 mm are treated with radical surgical resection. The choice of treatment for 10-20 mm sized rectal NETs remains controversial. This study aimed to verify factors predicting lymph node metastasis (LNM) of 10-20 mm sized rectal NET and utilize them to decide upon the treatment strategy.

Methods: Twenty-eight patients with 10-20 mm sized rectal NETs treated at Pusan National University Yangsan Hospital from January 2009 to September 2020 were divided into LNM (+) and LNM (-) groups, and their respective data were analyzed.

Results: Seven patients (25%) had LNM while 21 patients (75%) did not. Endorectal ultrasound findings showed tumor size was significantly larger in the LNM (+) than in the LNM (-) group (15 mm vs. 10 mm, P=0.018); however, pathologically, there was no significant difference in tumor size (13 mm vs. 11 mm, P=0.109). The mitotic count (P=0.011), Ki-67 index (P=0.008), and proportion of tumor grade 2 patients (5 cases, 71% vs. 1 case, 5%; P=0.001) were significantly higher in the LNM (+) group. In multivariate analysis, tumor grade 2 was the independent factor predicting LNM (odds ratio, 61.32; 95% confidence interval, 3.17-1,188.64; P=0.010).

Conclusion: Tumor grade 2 was the independent factor predicting LNM in 10-20 mm sized rectal NETs. Therefore, it could be considered as the meaningful factor in determining whether radical resection is necessary.

[This corrects the article on p. 89 in vol. 16.].

Purpose: Adjuvant chemotherapy (AC) improves survival outcomes in patients with advanced gastric cancer (GC) after curative surgery; however, some patients do not receive or complete chemotherapy. This study aimed to identify factors related to patient compliance with chemotherapy after curative surgery for advanced GC.

Methods: The data of patients who underwent curative gastrectomy for pathologic stage II-III GC between 2012 and 2016 were reviewed. Patients were divided into an AC completion group (group C), AC incompletion group (group I), and surgery-only group (group S). The AC regimen was either tegafur/gimeracil/oteracil (S-1) or capecitabine plus oxaliplatin (XELOX).

Results: The study enrolled 417 patients; group C had 222 patients, group I had 110, and group S had 85. The most common reason for not initiating AC was poor general condition (36.5%), while chemotherapy-related complications was the common reason for AC incompletion (43.6%). In multivariate analysis, age over 65 years, Eastern Cooperative Oncology Group performance status ≥1, Charlson comorbidity index ≥1, and the presence of postoperative complications were independent risk factors for not initiating AC (odds ratio: 4.32, 2.62, 1.84, and 2.17, respectively). Age over 65 years, longer postoperative stay, and XELOX regimen were significant risk factors for incompletion of AC (odds ratio: 2.68, 1.72, and 2.23, respectively).

Conclusion: Old age, poor performance status, comorbidities, and postoperative complications, longer postoperative hospital stay, and XELOX regimen were associated with poor compliance with AC in GC patients. Clinicians can improve compliance with AC by managing postoperative complications and selecting the most appropriate treatment regimen.

Malakoplakia is a rare chronic granulomatous disease found in the genitourinary tract, mainly. It is considered to be related to immunosuppression and/or infectious processes. We would like to present an operative case of cecal malakoplakia in a patient with a history of surgical resection and chemotherapy for cervical cancer. A 74-year-old female patient visited our hospital for 1-year follow-up after operation and chemo-radiotherapy for cervical cancer. An infiltrative mass of 6 cm, between the cecal base and the right psoas muscle, was observed on computed tomography. An ileocectomy was performed for diagnosis. Histopathologic examination revealed cecal malakoplakia. After surgery, based on previous reports, antibiotics therapy was added. Then the patient was discharged and treated in the outpatient clinic. To our knowledge, a rare case has been described of cecal malakoplakia during observation after surgery and chemo-radiotherapy for cervical cancer. Malakoplakia is known to be related to immunosuppressive condition. Therefore, our case suggests that close observation should be made in patients on immunosuppressive condition, such as chemotherapy.

Extrauterine parasitic lipoleiomyoma is a very rare fatty tumor, with uncertain histopathogenesis. Although imaging studies play an important role in preoperative localization and diagnosis of lipoleiomyoma, a pathological evaluation is paramount for confirmation of diagnosis. We describe a case of a 49-year-old woman with a palpable mass in the right inguinal area. Computed tomography of the abdomen and pelvis revealed a fluid- and fat-containing mass. Histopathological examination of the mass, which was successfully resected, confirmed the diagnosis of lipoleiomyoma. The patient was discharged on a postoperative day 2 without any complications.

Purpose: This study aimed to investigate the clinical outcomes after totally implantable access port (TIAP) implantation performed by general surgery residents in patients with colorectal cancer.

Methods: A total of 291 consecutive patients who underwent TIAP implantations were evaluated. The patients were divided into three groups: second-, third-, and fourth-grade residents.

Results: The mean follow-up was 22.1 months (range, 1-87 months). The total times of operation, puncture, and cannulation decreased as the resident grade increased (P<0.001). Early complications significantly decreased with higher resident grades (P=0.039). The non-use of ultrasonography and non-use of C-arm were identified as independent risk factors for complications. Resident grades between second and third (P=0.005) and between second and fourth (P=0.041) were identified as independent risk factors for optimal tip position.

Conclusion: TIAP implantation can be safely and effectively performed by residents. Low-grade residents were associated with early complications.