Clinical Surgical Oncology最新文献

{"title":"Impact of diverting stoma on long-term survival in patients with rectal cancer: A nationwide study based on health insurance claims data","authors":"Nobuaki Hoshino ,&nbsp;Koya Hida ,&nbsp;Yudai Fukui ,&nbsp;Yoshimitsu Takahashi ,&nbsp;Takeo Nakayama ,&nbsp;Kazutaka Obama","doi":"10.1016/j.cson.2023.100030","DOIUrl":"https://doi.org/10.1016/j.cson.2023.100030","url":null,"abstract":"<div><h3>Background</h3><p>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.</p></div><div><h3>Methods</h3><p>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.</p></div><div><h3>Results</h3><p>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, <em>P</em> ​= ​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, <em>P</em> ​= ​0.031) and that of patients without stoma closure was significantly poorer (HR 2.21, 95% CI 1.34–3.64, <em>P</em> ​= ​0.002).</p></div><div><h3>Conclusion</h3><p>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.</p></div>","PeriodicalId":100278,"journal":{"name":"Clinical Surgical Oncology","volume":"2 4","pages":"Article 100030"},"PeriodicalIF":0.0,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2773160X23000223/pdfft?md5=2cb2b9b3a9f749bae1e0af83a2c747c4&pid=1-s2.0-S2773160X23000223-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138465854","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}

{"title":"Low axillary sampling to stage post neoadjuvant axilla in breast cancer patients - A practical approach in developing world","authors":"Abinaya R.N ,&nbsp;Kurian Cherian ,&nbsp;Rexeena Bhargavan ,&nbsp;Aleyamma Mathew ,&nbsp;Paul Augustine","doi":"10.1016/j.cson.2023.100029","DOIUrl":"https://doi.org/10.1016/j.cson.2023.100029","url":null,"abstract":"<div><h3>Background</h3><p>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.</p></div><div><h3>Materials and methods</h3><p>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.</p></div><div><h3>Results</h3><p>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.</p></div><div><h3>Conclusions</h3><p>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.</p></div>","PeriodicalId":100278,"journal":{"name":"Clinical Surgical Oncology","volume":"2 4","pages":"Article 100029"},"PeriodicalIF":0.0,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2773160X23000211/pdfft?md5=abd50a9b0257c4f00e3e5a29b1b71f47&pid=1-s2.0-S2773160X23000211-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138474031","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}

{"title":"Microsatellite instability in gastric cancer: An institutional case series analysis in patients treated with neoadjuvant therapy","authors":"Laura Lorenzon,&nbsp;Alberto Biondi,&nbsp;Gloria Santoro,&nbsp;Annamaria Agnes,&nbsp;Antonio Laurino,&nbsp;Antonia Strippoli,&nbsp;Riccardo Ricci,&nbsp;Roberto Persiani,&nbsp;Domenico D'Ugo","doi":"10.1016/j.cson.2023.100031","DOIUrl":"https://doi.org/10.1016/j.cson.2023.100031","url":null,"abstract":"<div><h3>Introduction</h3><p>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.</p></div><div><h3>Methods</h3><p>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.</p><p>Secondary outcomes included the overall (OS), and disease-free (DFS) survivals comparing MSI <em>vs</em> microsatellite stable (MSS) GCs, and GCs presenting complete-major response (TRG1-2) <em>vs</em> partial response (TRG3-4) and absence of response (TRG5).</p></div><div><h3>Results</h3><p>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 <em>vs</em> MSS patients (ypT0 respectively 11.1% vs 1.6%, p ​&lt; ​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% <em>vs</em> 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% <em>vs</em> 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 <em>vs</em> TRG3-4 <em>vs</em> TRG5, OS and DFS log-rank test respectively p 0.017 and p 0.0029).</p></div><div><h3>Conclusion</h3><p>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.</p></div>","PeriodicalId":100278,"journal":{"name":"Clinical Surgical Oncology","volume":"3 1","pages":"Article 100031"},"PeriodicalIF":0.0,"publicationDate":"2023-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2773160X23000235/pdfft?md5=50f1d3d1c0e2bdacc97c4552e00380f1&pid=1-s2.0-S2773160X23000235-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138557583","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}

{"title":"Incorporating laparoscopic interval cytoreductive surgery for advanced ovarian cancer-lessons learnt","authors":"Yael Naaman ,&nbsp;Deborah Neesham ,&nbsp;Antonia Jones ,&nbsp;Rosemary McBain ,&nbsp;Tom Cade ,&nbsp;Orla McNally","doi":"10.1016/j.cson.2023.100028","DOIUrl":"10.1016/j.cson.2023.100028","url":null,"abstract":"<div><h3>Objective</h3><p>To assess the utility of laparoscopy for interval cytoreductive surgery (CRS) in patients with advanced ovarian cancer after Neo-Adjuvant Chemotherapy (NACT).</p></div><div><h3>Methods</h3><p>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.</p></div><div><h3>Results</h3><p>86 patients had interval CRS by the laparoscopic route during the study period. The optimal cytoreduction rate (R ​&lt; ​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.</p></div><div><h3>Conclusion</h3><p>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.</p></div>","PeriodicalId":100278,"journal":{"name":"Clinical Surgical Oncology","volume":"2 4","pages":"Article 100028"},"PeriodicalIF":0.0,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2773160X2300020X/pdfft?md5=e679af68b402c7131a0392b47f71f5a0&pid=1-s2.0-S2773160X2300020X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135221149","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}

{"title":"COL8A1 is a prognostic-related biomarker and correlated with immune infiltration in gastric cancer","authors":"Hao Feng ,&nbsp;Chenyang Jiang ,&nbsp;Dengfei Xu ,&nbsp;Shundong Cang","doi":"10.1016/j.cson.2023.100027","DOIUrl":"https://doi.org/10.1016/j.cson.2023.100027","url":null,"abstract":"<div><h3>Background</h3><p>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.</p></div><div><h3>Methods</h3><p>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.</p></div><div><h3>Results</h3><p>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.</p></div><div><h3>Conclusion</h3><p>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.</p></div>","PeriodicalId":100278,"journal":{"name":"Clinical Surgical Oncology","volume":"2 4","pages":"Article 100027"},"PeriodicalIF":0.0,"publicationDate":"2023-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2773160X23000193/pdfft?md5=68ec9e84a33430c7d42fee749a1effad&pid=1-s2.0-S2773160X23000193-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"92115801","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}

{"title":"Opportunities and challenges of liquid biopsy in liver cancer","authors":"Yu-Chen Zhong ,&nbsp;Jian-Wen Cheng ,&nbsp;Peng-Xiang Wang,&nbsp;Jia Fan,&nbsp;Jian Zhou,&nbsp;Xin-Rong Yang","doi":"10.1016/j.cson.2023.100026","DOIUrl":"https://doi.org/10.1016/j.cson.2023.100026","url":null,"abstract":"<div><p>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.</p></div>","PeriodicalId":100278,"journal":{"name":"Clinical Surgical Oncology","volume":"2 4","pages":"Article 100026"},"PeriodicalIF":0.0,"publicationDate":"2023-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2773160X23000181/pdfft?md5=b5f90d8b3a08577c92e78dd4159ccd04&pid=1-s2.0-S2773160X23000181-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"92115695","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}

{"title":"Salvage surgery after combination immunotherapy for initially unresectable or metastastic hepatocellular carcinoma: A retrospective clinical study","authors":"Jun-Shuai Xue,&nbsp;Hui Liu,&nbsp;Rui-Zhe Li,&nbsp;Si-Yu Tan,&nbsp;Yu-Chuan Yan,&nbsp;Zhao-Ru Dong,&nbsp;Jian-Guo Hong,&nbsp;En-Yu Liu,&nbsp;Qiang-Bo Zhang,&nbsp;Zhi-Qiang Chen,&nbsp;Dong-Xu Wang,&nbsp;Tao Li","doi":"10.1016/j.cson.2023.100025","DOIUrl":"https://doi.org/10.1016/j.cson.2023.100025","url":null,"abstract":"<div><h3>Background</h3><p>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.</p></div><div><h3>Methods</h3><p>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).</p></div><div><h3>Results</h3><p>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%).</p></div><div><h3>Conclusions</h3><p>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.</p></div>","PeriodicalId":100278,"journal":{"name":"Clinical Surgical Oncology","volume":"2 4","pages":"Article 100025"},"PeriodicalIF":0.0,"publicationDate":"2023-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49752595","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Robotic synchronous resection of rectal cancer and liver metastases: Current evidence and review","authors":"A. Pathanki ,&nbsp;S. Bhanderi ,&nbsp;A. Bajwa ,&nbsp;J. Ahmad","doi":"10.1016/j.cson.2023.100024","DOIUrl":"https://doi.org/10.1016/j.cson.2023.100024","url":null,"abstract":"<div><h3>Introduction</h3><p>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.</p></div><div><h3>Methods</h3><p>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.</p></div><div><h3>Results</h3><p>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.</p></div><div><h3>Conclusion</h3><p>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.</p></div>","PeriodicalId":100278,"journal":{"name":"Clinical Surgical Oncology","volume":"2 4","pages":"Article 100024"},"PeriodicalIF":0.0,"publicationDate":"2023-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49759876","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcomes of two-stage revision of endoprostheses of the lower-limb in oncology surgery: Limb-salvage","authors":"Amirul Adlan ,&nbsp;Robert McCulloch ,&nbsp;Scott Evans ,&nbsp;Michael Parry ,&nbsp;Lee Jeys ,&nbsp;Jonathan Stevenson","doi":"10.1016/j.cson.2023.100016","DOIUrl":"https://doi.org/10.1016/j.cson.2023.100016","url":null,"abstract":"<div><h3>Background</h3><p>Two-stage revision remains the gold standard to eradicate deep infection of endoprosthetic replacements following bone tumour removal. We aim to (1) report the infection eradication and limb-salvage rate with two-stage revision surgery and to (2) report the common causative microorganisms.</p></div><div><h3>Patients and methods</h3><p>A retrospective review of 44 consecutive patients who underwent two-stage revision surgery to treat periprosthetic joint infection was conducted between 1999 and 2018 ​at a tertiary orthopaedic oncology centre from prospectively collated oncology database. Patients’ mean age was 36.1 years (range 12–78 years). The sites of prosthesis were distal femur in 22 patients (50%), proximal femur in five patients (11%), proximal tibia in 16 patients (36%) and total femur with proximal tibia replacement in one patient (2%). The mean duration of follow-up was 96 months (6–251 months).</p></div><div><h3>Results</h3><p>Infection was eradicated in 26 patients (59%). The infection-free survival was 93% (CI 85–100%) at two years, 78% (66–92%) at five years and 61% (46–80%) at 10 years. 11 patients (25%) had amputation following failure of limb-salvage surgery. The amputation-free survival was at 100% at two years, 89% (79–100%) at five years and 73% (58–92%) at 10 years. Polymicrobial infection was reported in 8 patients (18%) and multi-drug resistance in 14 patients (32%). Coagulase-negative staphylococcus was the commonest microorganism isolated in 21 patients (48%).</p></div><div><h3>Conclusion</h3><p>Two-stage revision is a reliable approach to achieve limb-salvage. Infected tumour endoprostheses have a high rate of multi-drug resistance and polymicrobial infections. PJI recurrence still has a high rate of amputation.</p></div>","PeriodicalId":100278,"journal":{"name":"Clinical Surgical Oncology","volume":"2 3","pages":"Article 100016"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49750586","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cytoreductive surgery for metastatic gastrointestinal stromal tumors treated with ripretinib: A single-center experience","authors":"Zhaoming Guan ,&nbsp;Shaohua Yang ,&nbsp;Kaiyu Sun ,&nbsp;Yihang Shi ,&nbsp;Yun Feng ,&nbsp;Shirong Cai ,&nbsp;Xinhua Zhang ,&nbsp;Yulong He","doi":"10.1016/j.cson.2023.100019","DOIUrl":"https://doi.org/10.1016/j.cson.2023.100019","url":null,"abstract":"<div><h3>Background</h3><p>Cytoreductive surgery (CRS) has been advocated as an additional treatment with survival benefits for advanced gastrointestinal stromal tumor (GIST), especially in patients with responsive disease or focal progression after treatment with imatinib. Ripretinib is a fourth-line therapy for advanced GIST. This single-center pilot study investigated the short-term safety and efficacy of CRS after treatment with ripretinib in selected patients with recurrent or metastatic GIST.</p></div><div><h3>Methods</h3><p>Medical records of patients with recurrent or metastatic GIST who underwent CRS after ripretinib in the First Affiliated Hospital of Sun Yat-sen University between June 1^st, 2020 and June 1^st, 2022 were retrospectively reviewed. Patients’ clinicopathological characteristics, preoperative treatment and general condition, surgical information, and postoperative management were recorded.</p></div><div><h3>Results</h3><p>This study included 7 patients who underwent CRS after ripretinib. Radiographic response to ripretinib included partial response (n ​= ​1), stable disease (n ​= ​5), and progressive disease (n ​= ​1). The cumulative size of targeted lesions shrank by 4.8%–45.3% in 5 patients. R0/R1 resection was achieved in 6 (85.7%) patients. Postoperative complications (IId) were reported in 2 (28.6%) patients. There were no delayed post-operative complications. Median follow-up was 11.8 months. Median time-to-progression and median post-operative progression-free survival were not reached. Four patients who did not progress before surgery had no evidence of disease.</p></div><div><h3>Conclusion</h3><p>Ripretinib combined with CRS is safe and effective in select patients with advanced GIST despite extensive prior therapy.</p></div>","PeriodicalId":100278,"journal":{"name":"Clinical Surgical Oncology","volume":"2 3","pages":"Article 100019"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49750632","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}