{"title":"Endoscopic Stenting as Bridge to Surgery versus Emergency Resection for Left-Sided Malignant Colorectal Obstruction: An Updated Meta-Analysis.","authors":"Niccolò Allievi, Marco Ceresoli, Paola Fugazzola, Giulia Montori, Federico Coccolini, Luca Ansaloni","doi":"10.1155/2017/2863272","DOIUrl":"10.1155/2017/2863272","url":null,"abstract":"<p><strong>Introduction: </strong>Emergency resection represents the traditional treatment for left-sided malignant obstruction. However, the placement of self-expanding metallic stents and delayed surgery has been proposed as an alternative approach. The aim of the current meta-analysis was to review the available evidence, with particular interest for the short-term outcomes, including a recent multicentre RCT.</p><p><strong>Methods: </strong>We considered randomized controlled trials comparing stenting as a bridge to surgery and emergency surgery for the management of left-sided malignant large bowel obstruction, performing a systematic review in MEDLINE, PubMed database, and the Cochrane libraries.</p><p><strong>Results: </strong>We initially identified a total of 2543 studies. After the elimination of duplicates and the screening of titles and abstracts, seven studies, for a total of 448 patients, were considered. The current meta-analysis revealed no difference in the mortality rate between the stent group and the emergency surgery group; the postoperative complication rate (37.84% versus 54.87%, <i>P</i> = 0.02), the stoma rate (28.8% versus 46.02%, <i>P</i> < 0.0001), and the incidence of wound infection (8.11% versus 15.49%, <i>P</i> = 0.01) were reduced after stent as a bridge to surgery.</p><p><strong>Conclusion: </strong>Colonic stenting as a bridge to surgery appears to be a safe approach to malignant large bowel obstruction. Possible advantages of this treatment can be identified in a reduced incidence of postoperative complications and a lower stoma rate. Further RCTs considering long-term outcomes and cost-effectiveness analysis are needed.</p>","PeriodicalId":45960,"journal":{"name":"International Journal of Surgical Oncology","volume":"2017 ","pages":"2863272"},"PeriodicalIF":1.5,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5516723/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35370969","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":"Management Options for Advanced Low or Intermediate Grade Gastroenteropancreatic Neuroendocrine Tumors: Review of Recent Literature.","authors":"Vladimir Neychev, Electron Kebebew","doi":"10.1155/2017/6424812","DOIUrl":"https://doi.org/10.1155/2017/6424812","url":null,"abstract":"<p><p>Our understanding of the biology, genetics, and natural history of neuroendocrine tumors (NETs) of the gastrointestinal tract and pancreas has improved considerably in the last several decades and the spectrum of available therapeutic options is rapidly expanding. The management of patients with metastatic low or intermediate grade NETs has been revolutionized by the development of new treatment strategies such as molecular targeting therapies with everolimus and sunitinib, somatostatin analogs, tryptophan hydroxylase inhibitors, and peptide receptor radionuclide therapy that can be used alone or as a multimodal approach with or without surgery. To further define and clarify the utility, appropriateness, and the sequence of the growing list of available therapies for this patient population will require more high level evidence; however, data from well-designed randomized phase III clinical trials is rapidly accumulating that will further stimulate development of new management strategies. It is therefore important to thoroughly review emerging evidence and report major findings in frequent updates, which will expand our knowledge and contribute to a better understanding, characterization, and management of advanced NETs.</p>","PeriodicalId":45960,"journal":{"name":"International Journal of Surgical Oncology","volume":"2017 ","pages":"6424812"},"PeriodicalIF":1.5,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2017/6424812","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35070127","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}
Mariane Campagnari, Andrea S Jafelicci, Helio A Carneiro, Eduard R Brechtbühl, Eduardo Bertolli, João P Duprat Neto
{"title":"Dermal Substitutes Use in Reconstructive Surgery for Skin Tumors: A Single-Center Experience.","authors":"Mariane Campagnari, Andrea S Jafelicci, Helio A Carneiro, Eduard R Brechtbühl, Eduardo Bertolli, João P Duprat Neto","doi":"10.1155/2017/9805980","DOIUrl":"https://doi.org/10.1155/2017/9805980","url":null,"abstract":"<p><p>Reconstructive surgery following skin tumor resection can be challenging. Treatment options after removing the tumor are skin grafting, local pedicled and axial flaps, or microsurgery for complex and extensive wounds correction. Recently, the use of dermal substitutes has been extended to reconstructive surgery in cutaneous oncology. <i>Objectives</i>. To report both a single-center experience using dermal substitutes in reconstructive surgery for skin malignancies and reconstructive surgery's outcomes. <i>Methods and Results</i>. Among thirteen patients, seven (53.8%) were male with mean age of 62.6 years. Regarding diagnosis, there were five cases (38.5%) of basal cell carcinoma (BCC), two (15.4%) of melanoma in situ, two (15.4%) of dermatofibrosarcoma protuberans, one (7.7%) of squamous cell carcinoma (SCC), one (7.7%) of angiosarcoma, and one (7.7%) of eccrine carcinoma (EC). The most common site of injury was scalp (53.8%) and lower limbs (23.1%). Seven (53.8%) patients used NPWT and six (46.2%) patients underwent Brown's dressing. The most frequent complication of the first stage was wound contamination (38.5%). Average time to second-stage skin grafting was 43.9 days. Three (23%) patients developed tumor recurrence and one died. <i>Conclusions</i>. Use of dermal substitutes in oncology can be an option for reconstruction after extended resections, providing good aesthetical and functional results.</p>","PeriodicalId":45960,"journal":{"name":"International Journal of Surgical Oncology","volume":"2017 ","pages":"9805980"},"PeriodicalIF":1.5,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2017/9805980","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35205922","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":"Treatment Outcome of Carcinoma Vulva Ten-Year Experience from a Tertiary Cancer Centre in South India.","authors":"Sakthiushadevi Jeevarajan, Amudhan Duraipandian, Rajkumar Kottayasamy Seenivasagam, Subbiah Shanmugam, Rajaraman Ramamurthy","doi":"10.1155/2017/7161437","DOIUrl":"10.1155/2017/7161437","url":null,"abstract":"<p><strong>Background: </strong>Carcinoma vulva is a rare disease accounting for 1.3% of all gynaecological malignancies. The present study is a 10-year retrospective review of our experience of the surgical options, morbidity, failure pattern, and survival for invasive carcinoma vulva.</p><p><strong>Materials and methods: </strong>Retrospective analysis of case records of 39 patients who underwent surgery for invasive vulval cancer between 2004 and 2013 in the Department of Surgical Oncology at the Government Royapettah Hospital, Chennai.</p><p><strong>Results: </strong>The median age was 55 years. Radical vulvectomy was the preferred surgery. 31 patients underwent lymphadenectomy. Seroma formation and groin skin necrosis were the most common postoperative complications. With a median follow-up of 32 months, 8 patients (20.5%) developed recurrence (systemic = 1, regional = 4, and local = 3). The estimated 5-year disease-free survival (DFS) was 65.4% and the overall survival (OS) was 85.1%. On univariate analysis, stage and lymph node involvement significantly affected OS. Nodal involvement with extracapsular spread (ECS) significantly affected both DFS and OS.</p><p><strong>Conclusion: </strong>The treatment of carcinoma vulva should be individualized with multidisciplinary cooperation. The paucity of data, especially from India, necessitates the need for more studies, preferably multicentric, keeping in mind the low prevalence.</p>","PeriodicalId":45960,"journal":{"name":"International Journal of Surgical Oncology","volume":"2017 ","pages":"7161437"},"PeriodicalIF":1.5,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5745700/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35782749","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}
Evgeni Brotfain, Gilbert Sebbag, Michael Friger, Boris Kirshtein, Abraham Borer, Leonid Koyfman, Dmitry Frank, Yoav Bichovsky, Jochanan G Peiser, Moti Klein
{"title":"Invasive <i>Candida</i> Infection after Upper Gastrointestinal Tract Surgery for Gastric Cancer.","authors":"Evgeni Brotfain, Gilbert Sebbag, Michael Friger, Boris Kirshtein, Abraham Borer, Leonid Koyfman, Dmitry Frank, Yoav Bichovsky, Jochanan G Peiser, Moti Klein","doi":"10.1155/2017/6058567","DOIUrl":"https://doi.org/10.1155/2017/6058567","url":null,"abstract":"<p><p>Upper gastrointestinal tract (GIT) surgical procedures are more likely to cause nosocomial <i>Candida peritonitis</i> than lower GIT procedures and they thus constitute an independent risk factor for mortality. Because of the severity of postsurgical fungal infections complications, intensivists and surgeons need to be extremely aware of their clinical importance in critically ill postsurgical intensive care unit (ICU) patients. We analyzed the clinical and microbiological data of 149 oncologic patients who were hospitalized in the ICU at Soroka Medical Center between January 2010 and January 2015 after undergoing upper GIT surgery for gastric cancer. Invasive fungal infections related to secondary peritonitis following oncologic upper GIT surgery had a higher mortality rate than patients with nonfungal postoperative infectious complications. The presence of gastroesophageal junction leakage and advanced age were found to be independent risk factors for invasive fungal infection after oncologic upper GIT surgery.</p>","PeriodicalId":45960,"journal":{"name":"International Journal of Surgical Oncology","volume":"2017 ","pages":"6058567"},"PeriodicalIF":1.5,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2017/6058567","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35650510","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":"The Role of [18F]FDG-PET/CT in Predicting Malignant Transformation of Plexiform Neurofibromas in Neurofibromatosis-1","authors":"D. Tovmassian, Muzib Abdul Razak, K. London","doi":"10.1155/2016/6162182","DOIUrl":"https://doi.org/10.1155/2016/6162182","url":null,"abstract":"Background. Malignant peripheral nerve sheath tumours (MPNSTs) are difficult to diagnose and treat and contribute to significant morbidity and mortality for patients with Neurofibromatosis-1 (NF-1). FDG-PET/CT is being increasingly used as an imaging modality to discriminate between benign and malignant plexiform neurofibromas. Objectives. To assess the value of FDG-PET/CT in differentiating between benign and malignant peripheral nerve lesions for patients with Neurofibromatosis-1. Methods. A systematic review of the literature was performed prior to application of stringent selection criteria. Ultimately 13 articles with 796 tumours were deemed eligible for inclusion into the review. Results. There was a significant difference between mean SUVmax of benign and malignant lesions (1.93 versus 7.48, resp.). Sensitivity ranged from 89 to 100% and specificity from 72 to 94%. ROC analysis was performed to maximise sensitivity and specificity of SUVmax cut-off; however no clear value was identified (range 3.1–6.1). Significant overlap was found between the SUVmax of benign and malignant lesions making differentiation of lesions difficult. Many of the studies suffered from having a small cohort and from not providing histological data on all lesions which underwent FDG-PET/CT. Conclusion. This systematic review is able to demonstrate that FDG-PET/CT is a useful noninvasive test for discriminating between benign and malignant lesions but has limitations and requires further prospective trials.","PeriodicalId":45960,"journal":{"name":"International Journal of Surgical Oncology","volume":"2016 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2016-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2016/6162182","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"64460899","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}
H. Saeed, D. King, C. Johnstone, J. Charlson, D. Hackbarth, J. Neilson, M. Bedi
{"title":"Preoperative Radiation Therapy Followed by Reexcision May Improve Local Control and Progression-Free Survival in Unplanned Excisions of Soft Tissue Sarcomas of the Extremity and Chest-Wall","authors":"H. Saeed, D. King, C. Johnstone, J. Charlson, D. Hackbarth, J. Neilson, M. Bedi","doi":"10.1155/2016/5963167","DOIUrl":"https://doi.org/10.1155/2016/5963167","url":null,"abstract":"Background. The management for unplanned excision (UE) of soft tissue sarcomas (STS) has not been established. In this study, we compare outcomes of UE versus planned excision (PE) and determine an optimal treatment for UE in STS. Methods. From 2000 to 2014 a review was performed on all patients treated with localized STS. Clinical outcomes including local recurrence-free survival (LRFS), progression-free survival (PFS), and overall survival (OS) were evaluated using the Kaplan-Meier estimate. Univariate (UVA) and multivariate (MVA) analyses were performed to determine prognostic variables. For MVA, Cox proportional hazards model was used. Results. 245 patients were included in the analysis. 14% underwent UE. Median follow-up was 2.8 years. The LR rate was 8.6%. The LR rate in UE was 35% versus 4.2% in PE patients (p < 0.0001). 2-year PFS in UE versus PE patients was 4.2 years and 9.3 years, respectively (p = 0.08). Preoperative radiation (RT) (p = 0.01) and use of any RT for UE (p = 0.003) led to improved PFS. On MVA, preoperative RT (p = 0.04) and performance status (p = 0.01) led to improved PFS. Conclusions. UEs led to decreased LC and PFS versus PE in patients with STS. The use of preoperative RT followed by reexcision improved LC and PFS in patients who had UE of their STS.","PeriodicalId":45960,"journal":{"name":"International Journal of Surgical Oncology","volume":"2016 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2016-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2016/5963167","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"64451638","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}
Rajan P. Dang, D. McFarland, V. Le, Nadia Camille, B. Miles, M. Teng, E. Genden, K. Misiukiewicz
{"title":"Neoadjuvant Therapy in Differentiated Thyroid Cancer","authors":"Rajan P. Dang, D. McFarland, V. Le, Nadia Camille, B. Miles, M. Teng, E. Genden, K. Misiukiewicz","doi":"10.1155/2016/3743420","DOIUrl":"https://doi.org/10.1155/2016/3743420","url":null,"abstract":"Objectives. Invasion of differentiated thyroid cancer (DTC) into surrounding structures can lead to morbid procedures such as laryngectomy and tracheal resection. In these patients, there is a potential role for neoadjuvant therapy. Methods. We identified three studies involving the treatment of DTC with neoadjuvant chemotherapy: two from Slovenia and one from Japan. Results. These studies demonstrate that in selected situations, neoadjuvant chemotherapy can have a good response and allow for a more complete surgical resection, the treatment of DTC. Additionally, the SELECT trial shows that the targeted therapy lenvatinib is effective in the treatment of DTC and could be useful as neoadjuvant therapy for this disease due to its short time to response. Pazopanib has also demonstrated promise in phase II data. Conclusions. Thus, chemotherapy in the neoadjuvant setting could possibly be useful for managing advanced DTC. Additionally, some of the new tyrosine kinase inhibitors (TKIs) hold promise for use in the neoadjuvant setting in DTC.","PeriodicalId":45960,"journal":{"name":"International Journal of Surgical Oncology","volume":"2016 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2016-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2016/3743420","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"64345986","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}
M. Breijer, N. Visser, N. van Hanegem, A. V. D. van der Wurff, B. Opmeer, H. V. van Doorn, B. Mol, J. Pijnenborg, A. Timmermans
{"title":"A Structured Assessment to Decrease the Amount of Inconclusive Endometrial Biopsies in Women with Postmenopausal Bleeding","authors":"M. Breijer, N. Visser, N. van Hanegem, A. V. D. van der Wurff, B. Opmeer, H. V. van Doorn, B. Mol, J. Pijnenborg, A. Timmermans","doi":"10.1155/2016/3039261","DOIUrl":"https://doi.org/10.1155/2016/3039261","url":null,"abstract":"Objective. To determine whether structured assessment of outpatient endometrial biopsies decreases the number of inconclusive samples. Design. Retrospective cohort study. Setting. Single hospital pathology laboratory. Population. Endometrial biopsy samples of 66 women with postmenopausal bleeding, collected during the usual diagnostic work-up and assessed as insufficient for a reliable histological diagnosis. Methods. Endometrial biopsy samples were requested from the pathology laboratories. The retrieved samples were systematically reassessed by a single pathologist specialized in gynecology. Main Outcome Measure. Disagreement between initial assessment and conclusion after structured reassessment. Results. We retrieved 36 of 66 endometrial biopsy samples from six different pathology laboratories. Structured reassessment of the retrieved samples by a single pathologist specialized in gynecology did not change the conclusion in 35 of the 36 samples. The remaining sample contained a large amount of endometrial tissue and the diagnosis at reassessment was endometrial hyperplasia without atypia. All other samples contained insufficient material for a reliable diagnosis. Conclusion. A structured reassessment of endometrial biopsies samples, which were classified as inconclusive due to insufficient material, did not change the conclusion. Although it might be helpful for pathologists to have diagnostic criteria for adequacy and/or inadequacy of an endometrial biopsy sample, the gain in efficiency is likely to be small.","PeriodicalId":45960,"journal":{"name":"International Journal of Surgical Oncology","volume":"162 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2016-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2016/3039261","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"64312297","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":"Prognostic Relevance of the Peritoneal Surface Disease Severity Score Compared to the Peritoneal Cancer Index for Colorectal Peritoneal Carcinomatosis","authors":"J. Ng, W. Ong, C. Chia, G. Tan, K. Soo, M. Teo","doi":"10.1155/2016/2495131","DOIUrl":"https://doi.org/10.1155/2016/2495131","url":null,"abstract":"Background. Peritoneal Carcinomatosis Index (PCI) is a widely established scoring system that describes disease burden in isolated colorectal peritoneal carcinomatosis (CPC). Its significance may be diminished with complete cytoreduction. We explore the utility of the recently described Peritoneal Surface Disease Severity Score (PSDSS) and compare its prognostic value against PCI. Methods. The endpoints were overall survival (OS), progression-free survival (PFS), and survival less than 18 months (18 MS). Results. Fifty patients underwent cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) for CPC from 2003 to 2014, with 98% achieving complete cytoreduction. Median OS was 28.8 months (95% CI, 18.0–39.1); median PFS was 9.4 months (95% CI, 7.7–13.9). Univariate analysis showed that higher PCI was significantly associated with poorer OS (HR 1.11; 95% CI, 1.03–1.20) and PFS (HR 1.09; 95% CI, 1.03–1.14). Conversely, PSDSS was not associated with either endpoint. Multivariate analysis showed that PCI, but not PSDSS, was predictive of OS and PFS. PCI was also able to discriminate survival outcomes better than PSDSS for both OS and PFS. There was no association between 18 MS and either score. Conclusion. PCI is superior to PSDSS in predicting OS and PFS and remains the prognostic score of choice in CPC patients undergoing CRS/HIPEC.","PeriodicalId":45960,"journal":{"name":"International Journal of Surgical Oncology","volume":"2016 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2016-02-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2016/2495131","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"64276494","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}