ORCID Profile
0000-0002-4263-1017
Current Organisations
UNSW Sydney
,
Queensland Health
,
University of New South Wales
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Publisher: Springer Science and Business Media LLC
Date: 22-05-2015
DOI: 10.1007/S00423-015-1307-X
Abstract: When the mesenterico-portal vein is stenosed due to tumor related compression, venous collaterals develop and flow occurs antegrade towards the portal vein through the collateral tributaries. Undertaking pancreatoduodenectomy for pancreatic cancer in this setting may result in significant blood loss during the process of ligation of these tributaries. We describe the technique of endovascular stenting of the mesenterico-portal vein to reduce flow within these collateral tributaries and hence blood loss, to facilitate extended pancreatoduodenectomy and vein resection. Percutaneous transhepatic placement of endovascular stent into a stenotic mesentero-portal vein facilitates pancreatoduodenectomy by reducing operative time, which would otherwise be required in dealing with the extensive venous collaterals and hence also reducing blood loss.
Publisher: Springer Science and Business Media LLC
Date: 08-03-2016
DOI: 10.1245/S10434-016-5172-9
Abstract: Only few small studies in the literature have explored the impacts of preoperative serum albumin level and clinical outcomes of patients with peritoneal surface malignancy (PSM) who underwent cytoreductive surgery (CRS) and perioperative intraperitoneal chemotherapy (PIC). This study aimed to evaluate the value of preoperative serum albumin as a prognostic factor for long-term survival outcomes after CRS and PIC in a large patient cohort and to determine whether preoperative serum albumin is correlated with perioperative complications. This retrospective study examined prospectively collected data for patients with PSM who underwent CRS and PIC by one surgical team at St George Hospital in Sydney, Australia. The study used 35 g/L as the cuffoff for normal serum albumin level. The study enrolled 591 patients. Hypoalbuminemia was found to be associated with a significantly higher rate of major morbidity (p < 0.001), a longer ICU stay (p = 0.003), a longer HDU stay (p < 0.001), a longer total hospital stay (p < 0.001), and a shorter overall survival (OS) (p = 0.016). Factor analysis showed preoperative serum hypoalbuminemia to be a prognostic factor for a poor perioperative outcome (p = 0.018) and a poor OS (p = 0.026). Preoperative hypoalbuminemia is associated with poor perioperative outcomes. More importantly, it is a predictor of poorer OS for patients with PSM independent of the PCI, age, and completeness of cytoreduction. In the future, strategies should be undertaken to improve preoperative nutrition of malnourished patients as a means of improving clinical outcomes for patients with PSM.
Publisher: Elsevier BV
Date: 03-2017
DOI: 10.1016/J.SURG.2016.08.061
Abstract: Robotic cholecystectomy is a novel approach that offers the surgeon improved high-definition, 3-dimensional views and enhanced instrument ergonomics, which represent a technical development from previous operative platforms that include conventional and single-incision laparoscopy. This review compares its short-term outcomes with conventional laparoscopic cholecystectomy by a meta-analysis. A literature search was conducted using the MEDLINE, EMBASE, and PubMed databases (January 1990-October 2015). Studies identified were appraised with standard selection criteria. Data were extracted and a meta-analysis performed according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses. Thirteen studies, 12 retrospective trials and one randomized controlled trial comprising 1,589 patients (laparoscopic cholecystectomy, n = 921 robotic cholecystectomy, n = 668) were examined. There was a trend of a greater median total operative time (115.3 min vs 128.0 min pooled MD = 31.22, 95% confidence interval = -2.48 to 59.96 Z = 2.13 P = .03) and preoperative time (32.4 min vs 53.4 min pooled MD = 20.98, 95% confidence interval = 15.74 to 26.23 Z = 7.84 P < .001) in the robotic cholecystectomy group. Intraoperative complications (P = .52), conversion rate (P = .06), estimated blood loss (P = .55), postoperative complications (P = .28), duration of hospital stay (P = .36), and readmission rate (P = .85) were similar between both groups. Robotic cholecystectomy is associated with greater operative times related primarily to the preparatory phase of the operation but with similar safety and perioperative outcome as conventional laparoscopic cholecystectomy. For it to gain acceptance, future studies are required to define specific measures to quantify equipment benefits to the surgeon and to evaluate the potential advantage of its use in the acute setting.
Publisher: Springer Science and Business Media LLC
Date: 29-01-2016
DOI: 10.1007/S11605-015-3037-3
Abstract: Mucinous appendiceal neoplasm occurs in less than 1% of appendicectomies. Majority of what is known in the literature is about pseudomyxoma peritonei, which exists as its disseminated form. Pictorial imagery of its pre-disseminated form is rarely observed. We present in a case report form a case of low-grade mucinous neoplasm of the appendix resulting in focal intussusception including images captured from this unique case that will become a learning case for readers of the journal.
Publisher: Springer Science and Business Media LLC
Date: 31-01-2012
DOI: 10.1245/S10434-011-2197-Y
Abstract: The role of surgical resection of melanoma lung metastases (MLM) remains controversial. Some authorities advocate an aggressive surgical approach, while others recommend a conservative strategy. This study sought to identify the clinicopathologic and predictors of outcome after surgical management of MLM in a large series of melanoma patients from a single institution. All patients undergoing surgical management of MLM between November 1984 and April 2010 were identified and predictors of outcome analyzed. Of the 292 patients eligible for the study, 112 (38%) had previously undergone surgery for nonpulmonary recurrences. Four patients (1%) died within 30 days of surgery for MLM. The median progression-free survival time was 10 months. The median overall survival and 3- and 5-year survival were 23 months [95% confidence interval (CI) 17–30], 41 and 34%, respectively. Metastasis size >2 cm [hazard ratio (HR) 1.4, 95% CI 1.0–1.8, P = 0.03, HR 1.6, 95% CI 1.2–2.2 P = 0.002] and positive surgical margin (HR 1.5, 95% CI 1.2–1.9, P < 0.001 HR 1.4, 95% CI 1.1–1.7, P = 0.003) were independently associated with poorer progression-free survival and overall survival, respectively. The presence of more than one metastasis (HR 1.4, 95% CI 1.1–1.7, P = 0.013) was independently associated with poorer overall survival. The results support the role of pulmonary metastasectomy in selected patients with MLM. Patients with small (<2 cm) and solitary tumors that can be completely resected with a negative margin are most likely to experience prolonged survival.
Publisher: Elsevier BV
Date: 03-2021
Publisher: Springer Science and Business Media LLC
Date: 09-04-2010
DOI: 10.1007/S11605-009-1129-7
Abstract: This systematic review objectively evaluates the safety and outcomes of extended pancreaticoduodenectomy with vascular resection for pancreatic cancer involving critical adjacent vessels namely the superior mesenteric-portal veins, hepatic artery, superior mesenteric artery, and celiac axis. Electronic searches were performed on two databases from January 1995 to August 2009. The end points were: firstly, to evaluate the safety through reporting the mortality rate and associated complications and, secondly, the outcome by reporting the survival after surgery. This was synthesized through a narrative review with full tabulation of results of all included studies. Twenty-eight retrospective studies comprising of 1,458 patients were reviewed. Vein thrombosis and arterial involvement were reported as contraindications to surgery in 62% and 71% of studies, respectively. The median mortality rate was 4% (range, 0% to 17%). The median R0 and R1 rates were 75% (range, 14% to 100%) and 25% (range, 0% to 86%), respectively. In high volume centers, the median survival was 15 months (range, 9 to 23 months). Nine of 10 (90%) studies comparing the survival after extended pancreaticoduodenectomy with vascular resection versus standard pancreaticoduodenectomy reported statistically similar (p > 0.05) survival outcomes. Undertaking vascular resection was not associated with a poorer survival. The morbidity, mortality, and survival outcome after undertaking extended pancreaticoduodenectomy with vascular resection for pancreatic cancer with venous involvement and/or limited arterial involvement is acceptable in the setting of an expert referral center and should not be a contraindication to a curative surgery.
Publisher: Elsevier BV
Date: 02-2016
DOI: 10.1016/J.EJSO.2015.08.167
Abstract: Resection of the involved mesenteric-portal vein (MPV) is increasingly performed in pancreatoduodenectomy. The primary aim of this study is to assess the rate of R0 resection in transverse closure (TC) versus segmental resection with end-to-end (EE) closure and the secondary aims are to assess the short-term morbidity and long-term survival of TC versus EE. Patients undergoing pancreatoduodenectomy with MPV resection were identified from a prospectively database. The reconstruction technique were examined and categorized. Clinical, pathological, short-term and long-term survival outcomes were compared between groups. 110 patients underwent PD with MPV resection of which reconstruction was performed with an end-to-end technique in 92 patients (84%) and transverse closure technique in 18 patients (16%). Patients undergoing transverse closure tended to have had a shorter segment of vein resected (≤2 cm) compared to the end-to-end (83% vs. 43% P = 0.004) with no difference in R0 rate. Short-term morbidity was similar. The median and 5-year survival was 30.0 months and 18% respectively for patients undergoing transverse closure and 28.6 months and 7% respectively for patients undergoing end-to-end reconstruction (P = 0.766). Without compromising the R0 rate, transverse closure to reconstruct the mesenteric-portal vein is shown to be feasible and safe in the setting when a short segment of vein resection is required during pancreatoduodenectomy. Synopsis - We describe a vein closure technique, transverse closure, which avoids the need for a graft, or re-implantation of the splenic vein when resection of the mesenteric-portal vein confluence is required during pancreatoduodenectomy.
Publisher: Springer Science and Business Media LLC
Date: 12-2010
Publisher: Springer Science and Business Media LLC
Date: 02-05-2009
DOI: 10.1007/S00268-009-0059-6
Abstract: Lymph node metastasis is common in patients with colorectal cancer. Its significance in patients at the time of primary colorectal surgery and later in patients who develop colorectal cancer peritoneal carcinomatosis (CRPC) is unknown. Lymphatic metastasis reflects a systemic spread of cancer and its implication on patients who undergo cytoreductive surgery (CRS) and perioperative intraperitoneal chemotherapy (PIC) for carcinomatosis needs to be studied. Patients with CRPC underwent CRS and PIC according to a standardized treatment protocol in our institution. Pathology reports from the primary colorectal surgery and at the time of treatment for CRPC was retrospectively retrieved and appraised. Comparison of survival outcomes using the log-rank test was performed for patients with and without lymphatic metastasis. Sixty patients were treated for CRPC with CRS and PIC. At the time of colorectal surgery, patients with lymph node involvement had similar survival outcomes compared with patients without lymph node involvement (median survival: 31 months, 36 months p = 0.9). However, when they subsequently develop peritoneal carcinomatosis and underwent treatment with CRS and PIC, patients with lymph node involvement did significantly worse (median survival: 20 months, 38 months p = 0.003). The results of our study suggest that lymph node metastasis in patients with CRPC is an indicator of a poor prognosis and requires further investigation and recognition.
Publisher: American Society of Clinical Oncology (ASCO)
Date: 20-12-2009
Abstract: This multi-institutional registry study evaluated cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) for diffuse malignant peritoneal mesothelioma (DMPM). A multi-institutional data registry that included 405 patients with DMPM treated by a uniform approach that used CRS and HIPEC was established. The primary end point was overall survival. The secondary end point was evaluation of prognostic variables for overall survival. Follow-up was complete in 401 patients (99%). The median follow-up period for the patients who were alive was 33 months (range, 1 to 235 months). The mean age was 50 years (standard deviation [SD], 14 years). Three hundred eighteen patients (79%) had epithelial tumors. Twenty-five patients (6%) had positive lymph nodes. The mean peritoneal cancer index was 20. One hundred eighty-seven patients (46%) had complete or near-complete cytoreduction. Three hundred seventy-two patients (92%) received HIPEC. One hundred twenty-seven patients (31%) had grades 3 to 4 complications. Nine patients (2%) died perioperatively. The mean length of hospital stay was 22 days (SD, 15 days). The overall median survival was 53 months (1 to 235 months), and 3- and 5-year survival rates were 60% and 47%, respectively. Four prognostic factors were independently associated with improved survival in the multivariate analysis: epithelial subtype (P .001), absence of lymph node metastasis (P .001), completeness of cytoreduction scores of CC-0 or CC-1 (P .001), and HIPEC (P = .002). The data suggest that CRS combined with HIPEC achieved prolonged survival in selected patients with DMPM.
Publisher: Frontiers Media SA
Date: 02-02-2021
DOI: 10.3389/FSURG.2021.617286
Abstract: Backgrounds: Pancreaticoduodenectomy (PD) remains the only hope of a cure in selected patients with pancreatic adenocarcinoma (PAC). With an aging population, there will be an increasing number of very elderly patients being diagnosed with PAC of whom a selected proportion would be suitable for PD. However, the literature on outcomes of elderly patients after PD remains ambiguous. Therefore, the aim of this study was to examine the safety and efficacy of PD in octogenarians with PAC. Methods: A retrospective analysis of 304 patients with PAC undergoing PD. Patients were ided into two age groups using age of 80 years old as the cut-off. Results: Overall mortality and major morbidity rates were 0.5 and 18.5%, respectively. The octogenarian group had a higher rate of mortality (6.3%, n = 1, p & 0.001), a higher rate of major morbidity (37.5%, n = 6, p = 0.042) and a longer hospital stay ( p = 0.035). However, median survival of octogenarians was 15.6 months. Multivariate analysis showed age was not identified as a prognostic factor for major morbidity and overall survival. Conclusion: Age alone should not be an exclusion criterion for consideration of PD. With careful selection, PD can be safely performed in octogenarians. Elderly patients should be referred to a specialized unit for an objective assessment to determine the suitability for this aggressive but potential curative approach.
Publisher: Wiley
Date: 23-01-2018
DOI: 10.1111/ANS.14385
Publisher: Springer Science and Business Media LLC
Date: 14-05-2010
DOI: 10.1007/S11605-010-1203-1
Abstract: Intrahepatic cholangiocarcinoma is rare, but its incidence is rapidly increasing in developed countries. Early detection and surgical extirpation offer the only hope for cure. Given the rarity of intrahepatic cholangiocarcinoma, there is limited knowledge regarding its natural history, clinicopathological characteristics, or outcomes following surgery. The primary aim of the current study is to report overall survival and recurrence-free survival outcomes following resection of intrahepatic cholangiocarcinoma. The secondary aim is to evaluate the impact of prognostic variables on outcomes. Between November 1990 and November 2009, 88 patients were evaluated for their suitability for potentially curative surgery of these, 40 patients underwent potentially curative surgery. These patients are the principal subjects of the current analysis. Patients were assessed at monthly intervals for the first 3 months and then at six monthly intervals after treatment. Recurrence-free survival and overall survival were determined 17 clinicopathological and treatment-related factors associated with recurrence-free survival and overall survival were evaluated through univariate and multivariate analyses. No patient was lost to follow-up. The median follow-up was 31 months (range = 0-142 months). The median recurrence-free survival and overall survival after resection were 21 and 33 months, respectively. The 5-year survival rate was 28%. Four factors were associated with overall survival: carbohydrate antigen 19.9 (p = 0.020), clinical stage (p = 0.018), histological grade (p = 0.020), and lymph node metastases (p = 0.003). Two factors were associated with recurrence-free survival: carbohydrate antigen 19.9 (p = 0.002) and margin status (p = 0.002). Hepatic resection is an efficacious treatment for intrahepatic cholangiocarcinoma. Clincopathological factors can predict outcome and should be used in the preoperative assessment of operability.
Publisher: Wiley
Date: 08-2013
DOI: 10.1111/CODI.12256
Abstract: Resection of the primary tumour in patients with Stage IV colorectal cancer may be performed to avoid future tumour-related complications whilst on systemic treatment. We compared the safety and efficacy of laparoscopic and open colectomy in this patient group. PubMed, MEDLINE and the Cochrane Library were searched in the English literature for studies between January 2000 and October 2012 dealing with laparoscopic resection of the primary tumour in Stage IV disease. Single-arm laparoscopic studies were systematically reviewed. Prospective and retrospective studies were included for meta-analysis. End-points include safety, complications, mortality and cancer specific outcome including 5-year and median survival. Eleven studies comprising 1165 patients undergoing palliative laparoscopic colectomy for Stage IV colorectal cancer were included. Five studies were comparative studies of laparoscopic and open colectomy. The former took longer (pooled mean difference (MD) = 41.52, 95% CI = 11.47-71.56, Z = 2.71, P = 0.007), but resulted in a shorter length of stay (pooled MD = -2.41, 95% CI = -3.84 to -0.99, Z = 3.32, P = 0.0009), with fewer postoperative complications (pooled odds ratio = 0.53, 95% CI = 0.32-0.87, Z = 2.51, P = 0.01) and lower estimated blood loss (pooled MD = -47.71, 95% CI = -80.00 to -15.42, Z = 2.90, P = 0.004). Median survival ranged between 11.4 and 30.1 months. Palliative colectomy performed laparoscopically is associated with a better perioperative outcome than open colectomy. Survival is dependent on the response to systemic chemotherapy.
Publisher: Oxford University Press (OUP)
Date: 18-09-2009
DOI: 10.1510/ICVTS.2009.218743
Abstract: Percutaneous radiofrequency ablation (RFA) is an alternate treatment modality for pulmonary metastasis in non-surgical candidates. Four patients not suitable for surgery underwent percutaneous RFA for pulmonary metastases from leiomyosarcoma. Success of RFA was assessed with computed tomography (CT). The median length from the radiographic diagnosis of metastatic pulmonary disease (CT-scan) from the primary tumor diagnosis was 67.0 months with a range of 15.0-81.0 months. The median disease free interval following RFA was 19.0 months with a range of 4.0-35.0 months. Three of four patients underwent the procedure uneventfully. RFA is a safe and minimally invasive intervention in non-surgical candidates with sarcoma pulmonary metastases.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 04-2012
Publisher: Elsevier BV
Date: 09-2012
DOI: 10.1016/J.SURONC.2012.05.001
Abstract: Neuroendocrine tumours (NET) most commonly metastasize to the liver. Hepatic resection of NET hepatic metastases (NETHM) has been shown to improve symptomology and survival. A systematic review of clinical studies before September 2010 was performed to examine the efficacy of hepatic resection for NETHM. As a secondary end-point, the impact of treatment on safety and symptomology were determined and prognostic variables were identified. The quality of each study was also assessed using predefined criteria incorporating 9 characteristics. Clinical outcome was synthesized through a narrative review with full tabulation of results of all included studies. Twenty-nine included reported survival outcomes with a median 3-, 5- and 10-year overall survival of 83% (range, 63-100%), 70.5% (range, 31-100%), and 42% (range, 0-100%), respectively. The median progression-free survival (PFS) was 21 months (range, 13-46 months) and median 1-,3-,5- and 10-year PFS of 63% (range, 50-80 %), 32% (range, 24-69%), 29% (range, 6-66%) and 1% (range, 0-11%), respectively. Poor histologic grade, extra-hepatic disease and a macroscopically incomplete resection were associated with a poor prognosis. Studies reported a median rate of symptomatic relief from surgery in 95% of patients (range, 50-100%). Hepatic resection for NETHM provides symptomatic benefit and is associated with favourable survival outcomes although the majority of patients invariably develop disease progression.
Publisher: Informa UK Limited
Date: 11-2012
DOI: 10.2147/CMAR.S31070
Publisher: Elsevier BV
Date: 08-2020
Publisher: Elsevier BV
Date: 05-2015
Publisher: Wiley
Date: 20-04-2010
DOI: 10.1002/CNCR.24952
Abstract: Radiofrequency ablation (RFA) is an alternative to local treatment for pulmonary metastases in patients who are nonsurgical candidates. Based on previously documented efficacy of this treatment, the authors retrospectively studied the prognostic factors for long-term survival. One hundred patients with unresectable colorectal pulmonary metastases underwent percutaneous RFA. Clinical and treatment variables were collected and evaluated using univariate and multivariate analyses with overall survival as the primary endpoint. At a median follow-up period of 23 (range, 1 to 96) months from the time of RFA treatment, 49 patients have died. The median overall survival after RFA treatment was 36 months and 5-year overall survival rates of 30%. Univariate analyses demonstrated that histopathological grade (p < .001), time to RFA treatment (p = .017), response to treatment (p < .001), repeat RFA treatments (p = .001), presence of extrapulmonary metastases (p < .001), presence of mediastinal lymphadenopathy (p = .007), and adjunct systemic chemotherapy (p < .001) were associated with overall survival. Multivariate analyses demonstrated that response to RFA treatment (p < .001), repeat RFA treatment (p = .002), presence of extrapulmonary metastases (p = .008), and use of adjunct systemic chemotherapy (p = .05) were independent predictors for survival. Radiofrequency ablation for colorectal pulmonary metastases represents a step forward towards a nonsurgical option of combining systemic and local treatment for metastatic disease and is a safe treatment with a low risk profile.
Publisher: Wiley
Date: 11-06-2012
DOI: 10.1002/JSO.23189
Abstract: Peritoneal metastases remain an under addressed problem for which this review serves to investigate the efficacy of systemic chemotherapy and radical surgical treatments in this disease entity. The literature between 1995 and June 2009 was surveyed systematically through a review of published studies on the treatment outcomes of metastatic colorectal cancer to the peritoneum on the Medline and PubMed databases. A total of 2,492 patients from 19 studies were reviewed. One thousand and eighty-four patients treated with complete cytoreductive surgery (CCS) and hyperthermic intraperitoneal chemotherapy (HIPEC) and 1,408 patients were treated with palliative surgery and/or systemic chemotherapy. For CCS HIPEC, the overall survival ranged between 20 and 63 (median 33) months, and 5-year survival ranged between 17% and 51% (median 40%). For palliative surgery and/or systemic chemotherapy, the overall survival ranged between 5 and 24 (median 12.5) months, and 5-year survival ranged between 13% and 22% (median 13%). Systemic therapies have not proved effective and randomised clinical trials have not sufficiently addressed patient subpopulations with metastatic disease of this entity. Current evidence have demonstrated the efficacy associated with CCS HIPEC for which should now be embraced as the standard of care.
Publisher: Wiley
Date: 06-10-2022
DOI: 10.1111/ANS.18091
Abstract: Emergency colorectal surgery tends to be associated with poorer outcomes compared to elective colorectal surgery. This study assessed the morbidity and mortality in patients undergoing emergency and elective colorectal resection in two metropolitan hospitals. Patients were identified retrospectively from two institutions between April 2018 and July 2020. Baseline, operative and postoperative parameters were collected for comparative analysis between emergency and elective surgery groups. A binary logistic regression was performed to identify independent predictors of postoperative complications. During the study period, 454 patients underwent colorectal resection, 135 were emergency cases (29.74%) and 319 were elective cases (70.26%). Compared with elective resections, patients undergoing emergency resections were observed to have a higher American Society of Anesthesiologists (ASA) score of III to IV (53.33% vs. 38.56%) ( P = 0.004). The mortality rate was similar between the emergency and elective group (1.48% vs. 0.63%, P = 0.369). The overall complication rate was higher in patients undergoing emergency resections (64.44% vs. 36.68%, P 0.001), but the major complication rate was similar between groups (12.59% vs. 10.34%, P = 0.484). Independent predictors for postoperative complications included emergency surgery (Odds Ratio (OR) 2.77, 95% Confidence Interval (CI): 1.66 to 4.61) and an ASA Score of III to IV (OR 2.87, 95% CI: 1.84 to 4.47). The overall complication rate was higher in patients undergoing emergency colorectal resection, however, rates of major complications and mortality were similar between groups. Higher complication rates reflect advanced disease pathology in patients who are more comorbid.
Publisher: Wiley
Date: 18-06-2009
DOI: 10.1002/JSO.21315
Abstract: Small bowel adenocarcinoma is a rare malignancy that presents both a diagnostic and therapeutic challenge. The late presentation is often associated with disseminated carcinomatosis which is regarded a terminal event. We review our experience with small bowel peritoneal carcinomatosis following treatment with cytoreductive surgery (CRS) and perioperative intraperitoneal chemotherapy (PIC). From a prospective database of CRS and PIC, seven patients were identified to have undergone treatment for small bowel peritoneal carcinomatosis with CRS and hyperthermic intraperitoneal chemotherapy (Mitomycin C) and early postoperative intraperitoneal chemotherapy (5FU). A retrospective review was undertaken to describe the clinicopathological characteristics and survival outcomes. The median follow-up was 17 months (range, 5-46 months). Six of seven patients have died. The disease-free survival was 12 months and the overall median survival was 25 months. The 1-, 2-, and 3-year survivals were 57%, 38%, and 20% respectively. Tumor histology of poorly differentiated adenocarcinoma with signet ring, lymphovascular invasion and perineural invasion appeared to be associated with a poor outcome. Cytoreductive surgery and perioperative intraperitoneal chemotherapy is a treatment option for small bowel cancer peritoneal carcinomatosis with encouraging survival results.
Publisher: Wiley
Date: 05-04-2022
DOI: 10.1111/ANS.17682
Publisher: Wiley
Date: 11-08-2023
DOI: 10.1111/ANS.18652
Publisher: Springer Science and Business Media LLC
Date: 03-03-2011
DOI: 10.1007/S12029-011-9272-2
Abstract: Hepatic resection is a potentially curative option for patients with colorectal liver metastases who are candidates for surgery. With the increasing availability of highly effective chemotherapy, surgery may be further advanced by the improved tumor response and better long-term outcomes associated with its use in the perioperative setting. A commentary about the optimal timing of chemotherapy from the currently available evidence was performed. There is evidence to suggest that adjuvant chemotherapy after surgery for colorectal liver metastases improves disease-free and overall survival. The recent EORTC trial (40983) by Nordlinger and co-workers provides evidence for improved progression-free survival with the use of perioperative chemotherapy compared to surgery alone. Both adjuvant and perioperative chemotherapy appear to be beneficial over surgery alone for resectable colorectal liver metastases. Whether one is superior over the other remains unknown. Participation in ongoing trials to optimize the perioperative sequencing of chemotherapy would be important in identifying the optimal peri-surgical chemotherapy management of resectable colorectal liver metastases.
Publisher: Wiley
Date: 30-05-2012
DOI: 10.1002/JSO.23170
Abstract: Surgical resection is associated with improved long-term survival in patients with colorectal liver metastases (CLM). However, majority of patients have unresectable bilobar advanced liver metastases. Two-stage resection (TSR) allows selected patients to achieve complete resection when combined with chemotherapy and interventional radiological procedures. Electronic search of the MEDLINE and PubMed databases (January 2000-October 2011) to identify studies examining the outcomes of the surgical approach of TSR of advanced CLM was undertaken. Twelve studies were examined. This comprised 488 patients. A median of 77% (range: 64-100%) of planned patients completed TSR. The most common reason for failure was due to disease progression observed in a median of 100% (range: 56-100%) of patients. Second-stage resection appeared to be more morbid compared to first-stage resection with higher complication rates (33% vs. 14%) and requiring more blood transfusions (3 U vs. 1 U). Completed TSR achieved a median survival of 37 (range: 18-66) months, median 3-year survival rate of 60% (range: 45-84%), and median 5-year survival rate of 48% (range: 32-70%). In patients who failed TSR, the median survival was 16 (range: 10-29) months. In carefully selected candidates with advanced bilobar CLM, the TSR approach achieves long-term survival in patients who would otherwise be considered for palliative chemotherapy only. Despite failing to complete TSR, patients had an encouraging survival outcome that appeared to compare favorably over palliative chemotherapy alone.
Publisher: Wiley
Date: 19-03-2020
DOI: 10.1111/ANS.15829
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 06-2009
Publisher: Springer Science and Business Media LLC
Date: 23-04-2009
DOI: 10.1245/S10434-009-0341-8
Abstract: Cytoreductive surgery (CRS) and perioperative intraperitoneal chemotherapy (PIC) has been recognized as a treatment option for pseudomyxoma peritonei. This study reports the survival outcomes, clinicopathological prognostic factors, and a learning curve from a single institution's experience. Patients with pseudomyxoma peritonei underwent CRS and PIC, which was comprised of hyperthermic intraperitoneal chemotherapy (HIPEC) and/or early postoperative intraperitoneal chemotherapy (EPIC), according to a standardized treatment protocol in our institution. Clinicopathological factors were analyzed to determine their prognostic value for survival using univariate and multivariate analysis. Time period comparison was performed to study the effect of a learning curve. A total of 106 patients (43 men and 63 women) were treated. The mortality rate was 3% and severe morbidity rate was 49%. The median follow-up was 23 (range, 0-140) months. The overall median survival was 104 months with a 5-year survival rate of 75%. The progression-free survival was 40 months with a 1-year progression-free survival rate of 71%. Factors influencing survival include histopathological type of tumor, use of both HIPEC and EPIC, peritoneal cancer index, completeness of cytoreduction, and severe morbidity. The results demonstrate a learning curve where patients with a higher peritoneal cancer index (PCI) were treated, reduced amount of blood products required, more patients undergoing HIPEC and the combined HIPEC and EPIC, more redo-procedures performed, and a longer progression-free survival. This report demonstrates long-term survival outcomes, acceptable perioperative outcomes, and a learning curve associated with the treatment of patients with pseudomyxoma peritonei.
Publisher: Wiley
Date: 14-07-2015
DOI: 10.1111/ANS.13152
Abstract: Peritoneal carcinomatosis ( PC ) results from the secondary spread of many intraabdominal tumour types, such as colorectal malignancy (colorectal cancer, CRC ), disseminated peritoneal adenomucinosis ( DPAM ), appendiceal cancer, ovarian carcinoma, sarcoma or from the occurrence of primary peritoneal disease such as peritoneal mesothelioma. The combination of cytoreductive surgery ( CRS ) and hyperthermic intraperitoneal chemotherapy ( HIPEC ) has seen improvements in survival in selected cases of these cancers. Between 1996 and 2014, a prospective database of 675 patients was created for the peritonectomy unit at our hospital. In total, 827 peritonectomy procedures (including redo CRS ) were performed for the major subgroups of PC : DPAM 220 appendiceal cancer (peritoneal mucinous adenocarcinoma ( PMCA )) 191 CRC 234 diffuse malignant peritoneal mesothelioma ( DMPM ) 73 and others 109. There were 152 redo‐peritonectomy procedures within the total mentioned earlier ( CRC 26 DPAM 58 DMPM 18 appendix 40 other 10). The 5‐year survivals for DPAM and PMCA were 80% and 42% respectively. The 5‐year survivals for appendiceal cancer with peritoneal cancer index ( PCI ) , 10–20 and were 60, 57 and 37% respectively ( P = 0.09). The 2‐ and 5‐year survivals for CRC were 56 and 24% respectively. The 5‐year survivals for PCI 0–5, 6–10, 11–15 and were 59, 15, 7 and 0% respectively ( P = 0.000). The 5‐year survival for DMPM with PCI 10, 10–20 and were 100, 55 and 39% respectively ( P = 0.01). CRS in combination with HIPEC provides a chance of long‐term survival in selected cases of PC when compared with systemic therapy alone.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 04-2011
Publisher: Wiley
Date: 07-2011
Publisher: Springer Science and Business Media LLC
Date: 23-05-2014
DOI: 10.1245/S10434-014-3798-Z
Abstract: Extensive clinical experience suggests that hyperthermic intraperitoneal chemotherapy (HIPEC) may play an important role in the management of colorectal cancer patients with peritoneal carcinomatosis (CRCPC). However, there remains no established nonsurgical process to rationally select patients for this management, either for inclusion/stratification in clinical trials or as a component of standard of care. The Peritoneal Surface Disease Severity Score (PSDSS) was introduced as a basis to improve patient selection. The American Society of Peritoneal Surface Malignancies conducted a retrospective review of 1,013 CRCPC patients. The PSDSS was evaluated on 3 specific criteria obtained before surgery (symptoms, extent of peritoneal dissemination, and primary tumor histology). Overall survival was analyzed according to four tiers of disease severity, and a comparison was made between patients who underwent cytoreductive surgery + HIPEC and those who did not. The PSDSS was calculated on 884 patients (87 %). The median survival of 275 patients not undergoing CRS/HIPEC based on their PSDSS-I (n = 8), II (n = 80), III (n = 55), and IV (n = 132)-was 45, 19, 8, and 6 months, respectively. The median survival of 609 patients who underwent CRS/HIPEC based on their PSDSS-I (n = 75), II (n = 317), III (n = 82), and IV (n = 135)-was 86, 43, 29, and 28 months, respectively. These data support that the PSDSS, undertaken before surgery, is capable of defining CRCPC populations who have a statistically defined high or considerably lower likelihood of long-term survival after CRS/HIPEC. The PSDSS can be quite useful in the decision to enter CRCPC patients into, and their stratification within, clinical trials.
Publisher: Springer Science and Business Media LLC
Date: 27-05-2009
Publisher: Elsevier BV
Date: 10-2012
DOI: 10.1016/J.SOC.2012.07.010
Abstract: Peritoneal mesothelioma is a rare malignancy where life expectancy with systemic chemotherapy remains poor. Most patients with this disease are diagnosed late with extensive peritoneal disease burden leading to nausea, pain, and abdominal distention as a result of ascites and a partial bowel obstruction. A newly proposed staging system comprising elements of the tumor burden measured by the peritoneal cancer index, abdominal nodal status, and extra-abdominal metastases has been demonstrated to reliably stratify patient outcomes based on staging subgroups after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. This new staging system may form the basis of selecting patients for radical surgery and improve survival outcomes.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 10-2014
Publisher: Springer Science and Business Media LLC
Date: 11-09-2013
DOI: 10.1007/S00432-013-1517-Y
Abstract: Cytoreductive surgery (CS) combined with intraperitoneal chemotherapy (IPC) is a multimodal approach to the treatment of peritoneal metastases (PM) of lower gastrointestinal origin. This study examines patient outcomes and critically evaluates its patterns of recurrences relative to the site of metastatic origin. Patients treated with CS/IPC from 2000 to 2012 where PM arose from a primary tumour of the appendix, colon and rectum were identified from a prospective database for retrospective evaluation. The primary end points were survival (overall and disease-free), and secondary end points include patterns of recurrence and prognostic factors associated with overall outcomes. Two hundred and eleven patients were followed up for a median of 23.3 months (range 1-156). Overall median survival was 46.8 months, and the 1-, 3-, 5-year survival rates were 87, 56 and 42 %, respectively. The 5-year survival of patients with appendiceal, colonic and rectal PM was 55, 33 and 20 %, respectively. Tumour origin was the only independent prognostic factor associated with overall survival (p = 0.03). Recurrences were more common in patients of colorectal origin over appendiceal origin (p < 0.001) and were more likely to be of a systemic nature (p = 0.05). CS/IPC provides an option for improved survival in patients with PM of lower gastrointestinal origin and appears to be most promising in patients with disease of appendiceal origin.
Publisher: Springer Science and Business Media LLC
Date: 18-02-2016
DOI: 10.1007/S11605-016-3106-2
Abstract: The pancreas and peripancreatic region may be a site of metastasis from distant sites. Recent data suggest that pancreatic metastasectomy may achieve long-term survival. We seek to examine our experience with this metastasectomy by reporting the perioperative and survival outcomes. Patients undergoing resection of isolated pancreatic metastasis were identified from a prospective pancreatic surgical database at the Department of Gastrointestinal Surgery, North Shore c us of the University of Sydney between January 2004 and June 2015 and selected for retrospective review. Data on operative morbidity and mortality were reported. Survival analysis was performed using the Kaplan-Meier method. Fifteen patients underwent pancreatic metastasectomy after a median disease-free interval of 63 months (range 0 to 199). Pancreatoduodenectomy was performed in six patients (40 %), distal pancreatectomy with or without splenectomy in three patients (20 %), and pancreatectomy with other visceral organ resection in six patients (40 %). Major complications occurred in six patients (40 %) without mortality. The median survival was 40 months (95 % CI 24.3 to 53.7), and 1-, 3-, and 5-year survival were 76, 48, and 31 % respectively. Cox proportional hazard model identified margin negative resection (hazard ratio (HR) 10.5 P = 0.044) as a predictor of improved survival. Long-term survival may be achieved in selected patients with pancreatic metastasis through pancreatic metastasectomy with acceptable morbidity. Selection of patients should be in idualized and based on their primary disease origin, biological behavior of the tumor, resectability of the tumor, and the relative effectiveness of systemic or targeted therapies.
Publisher: Wiley
Date: 02-08-2014
DOI: 10.1002/JSO.23728
Abstract: Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC) are gaining acceptance as treatment for selected patients with colorectal cancer with peritoneal carcinomatosis (CRCPC). Tremendous variations exist in the HIPEC delivery. The American Society of Peritoneal Surface Malignancies (ASPSM) examined the overall survival in patients with CRCPC who underwent a complete cytoreduction and HIPEC with Oxaliplatin vs. Mitomycin C (MMC), stratifying them by the Peritoneal Surface Disease Severity Score (PSDSS). Median overall survival (OS) of 539 patients with complete cytoreduction was 32.6 months, 32.7 months for the MMC group and 31.4 months for the Oxaliplatin group (P = 0.925). However, when stratified by PSDSS, median OS rates in PSDSS I/II patients were 54.3 months in those receiving MMC vs. 28.2 months in those receiving oxaliplatin (P = 0.012), whereas in PSDSS III/IV patients, median OS rates were 19.4 months in those receiving MMC vs. 30.4 months in those receiving Oxaliplatin (P = 0.427). These data suggest that MMC might be a better agent for HIPEC delivery than Oxaliplatin in patients with CRCPC, favorable histologies and low burden of disease (PSDSS I/II) undergoing complete cytoreduction. Prospective studies are warranted, which stratify patients by their PSDSS and randomize them to HIPEC with MMC vs. Oxaliplatin.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 08-2010
Publisher: Springer Science and Business Media LLC
Date: 04-01-2011
DOI: 10.1245/S10434-010-1522-1
Abstract: To evaluate the role of modern systemic therapies and its role as palliative or curative therapy for patients with colorectal peritoneal carcinomatosis with an emphasis on patient selection with the colorectal Peritoneal Surface Disease Severity Score (PSDSS). From three specialized treatment centers, patients with colorectal peritoneal carcinomatosis were identified between December 1988 to December 2009 to receive best supportive care, standard, or modern systemic therapies. Intent was classified as palliative or curative (if treated by cytoreductive surgery combined with perioperative intraperitoneal chemotherapy). Patients were stratified according to the PSDSS. Survival was estimated by the Kaplan-Meier method. Palliative and curative treatment achieved a median survival of 9 (95% confidence interval [95% CI] 5.9-12.8) and 38 (95% CI 30.2-45.2) months, respectively (P < 0.001). The type of chemotherapy in the palliative and curative group influenced outcome (P < 0.001, P = 0.011, respectively). In the palliative group, PSDSS I/II had a median survival of 24 (95% CI 15.6-32.6) and PSDSS III/IV had a median survival of 6 (95% CI 4.9-8.0) months (P < 0.001). In the curative group, PSDSS I/II had a median survival of 49 (95% CI 40.0-58.3) and PSDSS III/IV had a median survival of 31 (95% CI 20.4-40.9) months (P = 0.002). Modern systemic therapies were associated with improved outcome in patients with colorectal peritoneal carcinomatosis treated systemically alone or with cytoreductive surgery combined with perioperative intraperitoneal chemotherapy. Preoperative evaluation with the PSDSS may improve patient selection and optimize outcomes.
Publisher: Elsevier BV
Date: 10-2021
DOI: 10.1016/J.EJSO.2021.04.005
Abstract: Pancreatic cancer is the 8th commonest cancer and the 5th commonest cause of cancer-related death in Australia, with a 9% average 5-year survival. This study aims to investigate the effects of neoadjuvant treatment on overall survival (OS) and recurrence-free survival (RFS) in borderline resectable (BRPC) and locally advanced (LAPC) pancreatic adenocarcinoma followed by curative resection. Prospectively-collected demographic, medical, surgical and pathological data of patients with BRPC and LAPC treated with both neoadjuvant therapy (NAT) and surgery at a single tertiary referral centre in Australia were reviewed and analysed. Between 2012 and 2018, 60 patients, 34 with BRPC and 26 with LAPC, were treated with NAT followed by curative resection. The commonest neoadjuvant chemotherapy regimens were Gemcitabine + Abraxane (51.7%) and FOLFIRINOX (35.0%), with 48.3% of patients additionally receiving neoadjuvant radiotherapy. Median RFS was 30 months and median OS was 35 months. On multivariable analysis, inferior OS was predicted by enlarged loco-regional lymph nodes on initial computed tomography (p = 0.032), larger tumour size post-NAT (p = 0.006) and Common Terminology Criteria for Adverse Events post-NAT toxicity greater than grade 2 (p = 0.015). LAPC patients received more neoadjuvant chemotherapy (p = 0.008) and radiotherapy (p = 0.021) than BRPC and achieved a superior pathological response (p = 0.010). Patients who respond to NAT likely have a favourable disease biology and will progress well following resection. It is these patients who should be selected for more aggressive upfront management, and those with resistant disease should be spared from high-risk surgery.
Publisher: Elsevier BV
Date: 06-2020
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 08-2015
Publisher: Asian Society of Gynecologic Oncology; Korean Society of Gynecologic Oncology and Colposcopy
Date: 2011
Publisher: Elsevier BV
Date: 5
DOI: 10.1016/J.PAN.2017.02.014
Abstract: Pancreatoduodenectomy (PD) remains a technically challenging surgical procedure with morbidity rates ranging between 30 and 50%. It is suggested that the liberal use of fluids is associated with a poor perioperative outcome. This review examines the impact of fluid administration on outcomes after PD. A literature search was conducted using the MEDLINE, EMBASE and PubMed database (June 1966-June 2016). Studies identified were appraised with standard selection criteria. Data points were extracted and meta-analysis was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Eleven studies, seven retrospective trials and four randomized control trials comprising 2842 patients were included. Seven studies were meta-analyzed. There was no difference in length of hospital stay (P = 0.25), pancreas specific complications (P = 0.20), pulmonary (P = 0.58), cardiovascular (P = 0.75), gastrointestinal (P = 0.49), hepatobiliary (P = 0.53), urogenital (P = 0.42), wound complication (P = 0.79), reoperation rate (P = 0.69), overall morbidity (P = 0.18), major morbidity (P = 0.91), 30-day mortality (P = 0.07) and 90-day mortality (P = 0.58) in low or high fluid groups. The current available data fails to demonstrate an association between the amount of perioperative intravenous fluid administration and postoperative complications in patients undergoing PD.
Publisher: Elsevier BV
Date: 11-2178
DOI: 10.1016/J.SURG.2010.06.008
Abstract: Neuroendocrine neoplasms most commonly metastasize to the liver. Operative extirpation of neuroendocrine neoplasm hepatic metastases improves symptoms and seems to improve survival, but subsequent evidence is required. The current study evaluates the progression-free survival and overall survival of patients after resection (with or without ablation) of neuroendocrine neoplasm hepatic metastases. As a secondary endpoint, the prognostic factors associated with progression-free survival and overall survival were evaluated. Seventy-four patients with neuroendocrine neoplasm hepatic metastases underwent hepatic resection between December 1992 and December 2009. Thirty-eight patients underwent synchronous cryoablation. Patients were assessed radiologically and serologically at monthly intervals for the first 3 months and then at 6-month intervals after treatment. Progression-free survival and overall survival were determined clinicopathologic and treatment-related factors associated with progression-free survival and overall survival were evaluated through univariate and multivariate analyses. No patient was lost to follow-up. The median follow-up for the patients who were alive was 41 months (range, 1-162). The median progression-free survival and overall survival after hepatic resection were 23 and 95 months, respectively. Five- and 10-year overall survival were 63% and 40%, respectively. Two independent factors were associated with overall survival: histologic grade (P < .001) and extrahepatic disease (P = .021). The only independent predictor for progression-free survival was pathologic margin status (P = .023). In selected patients, aggressive operative extirpation of neuroendocrine neoplasm hepatic metastases is effective in achieving long-term survival. Disease progression, however, is a common occurrence therefore, a multimodality treatment approach for progressive disease is necessary. Integrating the knowledge of identified prognostic factors can both improve patient selection and identify patients at greatest risk of treatment failure.
Publisher: Oxford University Press (OUP)
Date: 02-06-2010
DOI: 10.1002/BJS.7163
Abstract: The Editors welcome topical correspondence from readers relating to articles published in the Journal. Responses should be sent electronically via the BJS website (www.bjs.co.uk). All letters will be reviewed and, if approved, appear on the website. A selection of these will be edited and published in the Journal. Letters must be no more than 250 words in length.
Publisher: Informa UK Limited
Date: 19-12-2011
DOI: 10.3109/00365521.2012.640823
Abstract: Evidence of the clinical benefit of surgery or metastasectomy for metastatic colorectal cancer to disease sites including the liver, lung, peritoneum, and pelvis as a potentially curative option is now available in the literature. The oncologic outcome of this treatment strategy achieves 5-year survival ranging between 20% and 50%. These survival gains have not been previously observed in the management of metastatic colorectal cancer. Treatment of potential surgical candidates requires a combined modality approach with systemic therapies to achieve macroscopic tumor removal and microscopic targeting of tumor deposits to achieve disease control. In nonsurgical candidates, systemic therapy, radiation therapy, and interventional oncology procedures may potentially facilitate sufficient disease downstaging for surgery. The purpose of this article is to provide a comprehensive review of the therapeutic advances in the surgical management of metastatic colorectal cancer.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 10-2010
DOI: 10.1016/J.JAMCOLLSURG.2010.06.011
Abstract: Cytoreductive surgery and perioperative intraperitoneal chemotherapy (PIC) is recognized as an effective treatment modality for patients with pseudomyxoma peritonei. This study investigates its role as a secondary definitive treatment procedure after earlier primary treatments. Patients with pseudomyxoma peritonei undergoing secondary cytoreduction combined with PIC were identified from a prospective database. Retrospective analysis investigated the outcomes, prognostic factors, critical time points, and impact of malignant dedifferentiation. Survival analysis was performed via the Kaplan-Meier method and compared via the log-rank test. The median time to progression after secondary cytoreduction was 28 months (95% CI 14 to 41 months), median survival was 97 months (95% CI 82 to 113 months), and 10-year survival was 25%. Median overall survival from initial diagnosis was 17 years and 10-year survival rate was 75%. Forty-five patients remained disease free (63%). Requiring an urgent treatment (waiting time 30 days) after disease progression (waiting up to 15 days, p = 0.010 waiting up to 30 days, p = 0.005). Malignant dedifferentiation appeared to affect survival from initial diagnosis (p = 0.062) and after secondary cytoreduction (p = 0.006). Secondary cytoreduction with PIC achieves long-term survival. Tumors that undergo malignant dedifferentiation appear to adversely affect survival, and this may support the rationale for early definitive treatment with cytoreduction and PIC.
Publisher: Informa UK Limited
Date: 23-01-2012
DOI: 10.3109/00365521.2012.640825
Abstract: Peritoneal carcinomatosis occurs in patients with advanced gastrointestinal and gynecological malignancies and also in patients who experience recurrence after treatment failure of the primary tumor. Malignant disease in the peritoneal cavity is a morbid and significant predictor of a diminished survival in a cancer patient. Systemic chemotherapy alone will not be adequate to palliate or treat patients with peritoneal carcinomatosis. Cytoreductive surgery is a new surgical technique that is performed using peritonectomy procedures to allow total eradication of peritoneal tumors. Intraperitoneal chemotherapy regimens such as intraoperative hyperthermic intraperitoneal chemotherapy (HIPEC) and early postoperative intraperitoneal chemotherapy (EPIC) are effective adjuvant treatment to treat the minimal residual disease after cytoreductive surgery to reduce the risk of locoregional recurrence. A substantial body of evidence available in the current literature has documented the survival benefits of combining cytoreductive surgery and intraperitoneal chemotherapy to treat a previously fatal phase of malignancy. This review provides a summary of the developments in the understanding and treatment of peritoneal surface malignancy from colorectal cancer.
Publisher: Wiley
Date: 02-2020
Abstract: Acute perforated erticulitis is frequently observed and spans a spectrum in the severity of its presentation. Emergency surgery is required in patients with generalized peritonitis however, a large proportion of patients are clinically stable with localized peritonitis. This article aimed to examine this specific group of patients by reviewing the outcomes of their conservative management. A systematic literature search was performed on the MEDLINE and PubMed databases. The management outcomes of patients undergoing non-operative treatment for acute perforated erticulitis were synthesized and tabulated. Of 479 patients, 407 (85%) were successfully managed non-operatively. In total 70 (14.6%) patients failed non-operative treatment and underwent operative surgical management, and two (0.4%) died. Emergency surgery includes a Hartmann's operation (40%) and resection with anastomosis with or without stoma (24%), laparoscopic lavage (16%) and surgical drainage (20%). The success rate of conservative management was 94.0% and 71.4% for patients with pericolic and distant free air, respectively. Treatment failure was associated with a high volume of free air, distant free air and the presence of abscess. Conservative management is safe and successful in patients with acute perforated erticulitis without generalized peritonitis. The early recognition of patients who show clinical signs of persistent perforation is important to ensure the success of this strategy.
Publisher: Research Square Platform LLC
Date: 05-10-2021
DOI: 10.21203/RS.3.RS-885174/V1
Abstract: BACKGROUND Even with modern diagnostics, appendicitis can be difficult to diagnose accurately. Negative appendicectomies (NA) and delayed diagnosis of complicated appendicitis (CA, i.e. perforation or abscess) remain common. Serum bilirubin has been proposed as an additional biomarker to assist with the diagnosis of appendicitis. In this large series, we assessed the value of bilirubin in the diagnosis of appendicitis. METHODS A retrospective review of patients with suspected appendicitis at three hospitals over a three year period was performed. All consecutive patients with appendicectomy were included. In addition, a “discharged” sub-group of consecutive patients who were admitted with suspected appendicitis but discharged without an operation was also identified.Demographic data, presence of fever, tachycardia, total white cell count (WCC), neutrophil count, total serum bilirubin, operative findings and final histology were recorded. Multivariate logistic regression was performed to determine independent predictors of appendicitis and CA. Receiver-operator analysis was performed to compare bilirubin to WCC and neutrophil count. RESULTS There were 2024 patients: 1167 had uncomplicated appendicitis, 355 had CA and 303 underwent NA. 200 non-surgical "discharged" patients were included for comparison. Compared to those without appendicitis (NA and discharged groups), increased serum bilirubin was associated with an increased likelihood of appendicitis (OR 1.030 (1.013, 1.048), p .0001) and increased likelihood of CA (OR 1.035, 95% CI (1.021, 1.050), p .001). These results remained significant when the discharged group, NA group and uncomplicated appendicitis groups were analyzed separately.The sensitivity and specificity of bilirubin was inferior to neutrophil count for the diagnosis of appendicitis (AUC 0.657 versus 0.725, p .0001). Bilirubin, WCC and neutrophils each were all relatively insensitive and non-specific over a variety of cut-off values and combinations did not improve their accuracy. CONCLUSION Hyperbilirubinaemia was independently associated with an increased likelihood of both uncomplicated and complicated appendicitis, however had similar sensitivity and specificity when compared to WCC or neutrophils. Bilirubin, neutrophil count and WCC alone are not discriminatory enough to be used in isolation but may be incrementally useful adjuncts in pre-operative assessment of patients with suspected appendicitis.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 11-2015
DOI: 10.1016/J.IJSU.2015.08.078
Abstract: The combination of cytoreductive surgery (CRS) and perioperative chemotherapy (PIC) have been proposed as an innovative technique for peritoneal carcinomatosis and is currently considered as a standard treatment for colorectal peritoneal carcinomatosis (CRPC) in selected patients. Peritoneal cancer index (PCI) has been suggested to be the most important prognostic factors for the outcomes of patients with CRPC. In this paper, we have studied patients with CRPC and a very low PCI of 5 or less and their survival outcomes. This is a retrospective study of prospectively collected data of 60 consecutive patients with CRPC and PCI ≤ 5, who underwent CRS and PIC by the same surgical team at St George hospital in Sydney, Australia between January 1996 and April 2015. Clinical outcomes of these patients were analysed. Hospital mortality was 0%. 14 patients (23.4%) had grade III/IV morbidity. The median follow-up was 22.2 months (range = 0.1-104.2). The median survival was 80.6 months (95% confidence interval (CI) = 35.1-126.1), with an overall 1-year, 3-year, and 5-year survival rate of 96.1%, 72.6% and 54.7% respectively. Among 60 patients, 31 patients experienced the recurrence of the disease (51.7%). The median disease-free survival was 10.8 months (95% CI = 7.2-14.4). This innovative approach combining CRS and PIC has shown encouraging outcomes and offers hope for patients with CRPC. Our results suggest that CRS and PIC can be performed safely to provide significant survival benefits for patients with low volume of disease. Early referral to specialist centre for evaluation is warranted for better survival outcomes.
Publisher: Springer Science and Business Media LLC
Date: 05-01-2011
DOI: 10.1245/S10434-010-1492-3
Abstract: This study evaluates the accuracy of computed tomography (CT) scoring of the peritoneal cancer index (PCI) and examines its association with surgical morbidity and outcomes in pseudomyxoma peritonei. Forty-seven patients with pseudomyxoma peritonei had preoperative evaluation of CT scans and were treated with cytoreductive surgery and perioperative intraperitoneal chemotherapy. Their radiological PCI and intraoperative PCI were scored for determination of accuracy and for correlation with morbidity and outcomes. Accuracy in detecting peritoneal lesions regardless of size ranged from 51% to 85% in the abdominopelvic regions and 21% to 25% in the small intestinal regions. The sensitivity of CT detection of peritoneal implants ranged from 67% to 84% in the abdominopelvic regions and from 56% to 57% in the small intestinal regions. The specificity of CT detection of peritoneal lesions was 100% in all regions. Preoperative CT identification of larger peritoneal lesions in the right upper quadrant (P = 0.016), epigastrium (P = 0.003), left upper quadrant (P = 0.019), proximal jejunum (P = 0.022), distal jejunum (P = 0.022), and proximal ileum (P = 0.022) predicted development of severe complications. Similarly, larger peritoneal lesions in the right upper quadrant (P = 0.039), epigastrium (P = 0.024), right flank (P = 0.005), and right lower quadrant (P = 0.034) were negatively associated with disease-free survival, and the right upper quadrant (P = 0.037) was negatively associated with overall survival. Preoperative CT scan depicting extensive upper abdominal and small bowel disease predicts the presence of severe complications after cytoreduction. Extensive disease in the right upper quadrant seems to be associated with a poorer survival outcome.
Publisher: American Society of Clinical Oncology (ASCO)
Date: 10-07-2012
Abstract: Pseudomyxoma peritonei (PMP) originating from an appendiceal mucinous neoplasm remains a biologically heterogeneous disease. The purpose of our study was to evaluate outcome and long-term survival after cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) consolidated through an international registry study. A retrospective multi-institutional registry was established through collaborative efforts of participating units affiliated with the Peritoneal Surface Oncology Group International. Two thousand two hundred ninety-eight patients from 16 specialized units underwent CRS for PMP. Treatment-related mortality was 2% and major operative complications occurred in 24% of patients. The median survival rate was 196 months (16.3 years) and the median progression-free survival rate was 98 months (8.2 years), with 10- and 15-year survival rates of 63% and 59%, respectively. Multivariate analysis identified prior chemotherapy treatment (P .001), peritoneal mucinous carcinomatosis (PMCA) histopathologic subtype (P .001), major postoperative complications (P = .008), high peritoneal cancer index (P = .013), debulking surgery (completeness of cytoreduction [CCR], 2 or 3 P .001), and not using HIPEC (P = .030) as independent predictors for a poorer progression-free survival. Older age (P = .006), major postoperative complications (P .001), debulking surgery (CCR 2 or 3 P .001), prior chemotherapy treatment (P = .001), and PMCA histopathologic subtype (P .001) were independent predictors of a poorer overall survival. The combined modality strategy for PMP may be performed safely with acceptable morbidity and mortality in a specialized unit setting with 63% of patients surviving beyond 10 years. Minimizing nondefinitive operative and systemic chemotherapy treatments before definitive cytoreduction may facilitate the feasibility and improve the outcome of this therapy to achieve long-term survival. Optimal cytoreduction achieves the best outcomes.
Publisher: Wiley
Date: 08-06-2020
DOI: 10.1111/ANS.16020
Publisher: Elsevier BV
Date: 06-2012
Abstract: Combined therapy involving cytoreductive surgery (CRS) and perioperative intraperitoneal chemotherapy has been shown to improve survival outcomes for patients with diffuse malignant peritoneal mesothelioma (DMPM). The present study aims to investigate gender as a potential prognostic factor on overall survival. Over a period of two decades, 294 patients who underwent CRS and perioperative intraperitoneal chemotherapy were selected from a large multi-institutional registry to assess the prognostic significance of gender on overall survival. Female patients were shown to have a significantly improved survival outcome than male patients (P < 0.001). Staging according to a recently proposed tumor-node-metastasis categorization system was significant in both genders. Older female patients had significantly worse survival than younger female patients (P = 0.019), a finding that was absent in male patients. Female patients with low-stage disease were found to have a very favorable long-term outcome after combined treatment. Gender has demonstrated a significant impact on overall survival for patients with DMPM after CRS and perioperative intraperitoneal chemotherapy. An improved understanding of the role of estrogen in the pathogenesis of DMPM may improve the prognostication of patients and determine the role of adjuvant hormonal treatment in the future.
Publisher: Wiley
Date: 07-06-2020
DOI: 10.1111/ANS.16022
Publisher: Informa UK Limited
Date: 09-04-2013
DOI: 10.3109/07357907.2013.784777
Abstract: Bromelain is a mixture of proteolytic enzymes that is capable of hydrolyzing glycosidic linkages in glycoprotein. Glycoprotein's are ubiquitously distributed throughout the body and serve a variety of physiologic functions. Faulty glycosylation of proteins may lead to cancer. Antitumor properties of bromelain have been demonstrated in both, in vitro and in vivo studies, along with scanty anecdotal human studies. Various mechanistic pathways have been proposed to explain the anticancer properties of bromelain. However, proteolysis by bromelain has been suggested as a main pathway by some researchers. MUC1 is a glycoprotein that provides tumor cells with invasive, metastatic, and chemo-resistant properties. To date, there is no study that examines the effect of bromelain on MUC1. However, the viability of MUC1 expressing pancreatic and breast cancer cells are adversely affected by bromelain. Further, the efficacy of cisplatin and 5-FU are enhanced by adjuvant treatment with bromelain, indicating that the barrier function of MUC1 may be affected. Other studies have also indicated that there is a greater accumulation of 5-FU in the cell compartment on treatment with 5-FU and bromelain. Malignant peritoneal mesothelioma (MPM) expresses MUC1 and initial studies have shown that the viability of MPM cells is adversely affected by exposure to bromelain. Further, bromelain in combination with either 5-FU or cisplatin, the efficacy of the chemotherapeutic drug is enhanced. Hence, current evidence indicates that bromelain may have the potential of being developed into an effective anticancer agent for MPM.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 04-2011
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 12-2010
Publisher: Springer Science and Business Media LLC
Date: 21-03-2014
DOI: 10.1007/S00432-014-1633-3
Abstract: In the setting of colorectal cancer, female gender has been associated with superior long-term outcomes. Our aim is to investigate the gender differences for metastatic epithelial neoplasms of the appendix treated by cytoreductive surgery (CS) and intraperitoneal chemotherapy (IPC). The survival outcomes of patients treated with CS/IPC from 1996 to 2013 at St. George Hospital, Sydney, Australia, for peritoneal metastases of appendiceal origin were retrospectively analysed. Two hundred and fifty-seven consecutive patients were followed for a median of 35.3 months. Baseline characteristics between genders were comparable, including age (p = 0.13) and peritoneal cancer index (p = 0.94). Median overall survival (OS) and progression-free survival (PFS) was not reached (NR) and 44.4 months, with a 3-, 5- and 10-year survival of 82, 74 and 64 %. OS and PFS for females was NR and 50.7 months, compared to NR (p = 0.007) and 31.5 months for males (p = 0.07). Three-, 5- and 10-year survival rates for females were 88, 84 and 72 % compared to 74, 61 and 53 % for males. Observed gender differences for neoplasms of the appendix may direct future research in gender-specific tumour markers and the development of adjuvant therapies to improve patient outcomes.
Publisher: Springer Science and Business Media LLC
Date: 29-06-2010
DOI: 10.1007/S11605-010-1277-9
Abstract: Identification of clinicopathological determinants that predict for risk of recurrence and overall survival after undergoing potentially curative hepatic resection for hepatocellular carcinoma is a strategy towards personalizing therapy to improve outcome. Through evaluation of a center's experience with treatment of a disease, determinants unique to the treated patient cohort may be identified. Ninety-seven patients with hepatocellular carcinoma underwent liver resection. Clinical, treatment, and histopathological variables were collected and evaluated using univariate and multivariate analyses with disease-free survival (DFS) and overall survival (OS) as the endpoints. The median follow-up period of 19 (range, 1 to 188) months from the time of hepatic resection. The median DFS and OS after resection of HCC were 17 and 41 months, respectively. Five-year overall survival rate was 45%. Eight independent factors associated with disease-free and overall survival were identified through a multivariate analysis. Three factors: Child-Pugh score (DFS p = 0.045, OS p = 0.001), histopathological grade (DFS p < 0.001, OS p < 0.001), and histological diagnosis of cirrhosis (DFS p < 0.001, OS p < 0.001) predicted for both disease-free and overall survival. Integrating the knowledge of identified prognostic factors into clinical decision making may provide a clinicopathological signature that could identify patients at greatest risk of treatment failure such that novel interventions may be applied to improve the survival outcome.
Publisher: AMPCo
Date: 07-2009
Publisher: Elsevier BV
Date: 09-2015
DOI: 10.1016/J.SURONC.2015.06.014
Abstract: Hepatic arterial infusion chemotherapy (HAIC) has been shown to be beneficial in the management of unresectable colorectal liver metastases (CRLM). This systematic review evaluates the potential role of HAIC as a neoadjuvant downstaging therapy, prior to hepatic resection with curative intent for initially unresectable CRLM. A literature search was conducted using Pubmed, EMBASE and Medline databases from January 2000 to November 2013. Studies adopting HAIC as a neoadjuvant bridging therapy for hepatic resection for CRLM were included. Eleven studies (n = 1514) were included. HAIC response rate was 50% and achieved conversion to surgery rate in 18% of patients. The median overall and 5-year survival for patients who underwent conversion to hepatectomy was 53 months and 49% compared to 16 months and 3% for patients who did not undergo surgery. Meta-analysis demonstrated strong association between hepatectomy and improved 5-year survival (RR 0.56, 95% CI = 0.48-0.65, Z = 7.26, p < 0.00001). For patients presenting with unresectable CRLM, HAIC in conjunction with current systemic chemotherapy may allow some patients to undergo resection and potentially provide long-term survival.
Publisher: Wiley
Date: 07-08-2013
DOI: 10.1002/IJC.28380
Abstract: Although numerous clinical attempts have been made to disintegrate mucin secreted by pseudomyxoma peritonei (PMP), none are clinically recommended. Through examination of the pharmacologic characteristics of two novel agents, we titrated an optimized combination of bromelain and N-acetyl cysteine (NAC) that demonstrates in vitro and in vivo efficacy in the dissolution of mucinous ascites from PMP. In the in vitro experiments, 1 g of mucin was incubated in varying concentrations of bromelain (0-400 µg/ml) and NAC (0-5%) in idually followed by a combination before arriving at a therapeutic combination dose of 300 µg/ml bromelain+4% NAC. This established an effective dose of bromelain 300 µg/ml+4% NAC at pH 7.0, when tested in a rat model implanted with 3 g of mucin intraperitoneally (IP). IP administration of the drug in a rat model of PMP was shown to result in mucin disintegration within 72 hr with no toxicity observed.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 2010
Publisher: Springer Science and Business Media LLC
Date: 19-03-2013
DOI: 10.1038/BJC.2013.82
Publisher: ASEAN Heart Journal
Date: 12-2014
Publisher: Elsevier BV
Date: 10-2009
Publisher: Springer Science and Business Media LLC
Date: 25-07-2012
DOI: 10.1007/S00384-012-1537-0
Abstract: This study aimed to compare single-incision laparoscopic colectomy (SILC) to conventional multiport laparoscopic colectomy (MLC). Single-incision laparoscopic surgery (SILS) is a minimally invasive technique being recently applied to colorectal surgery. A number of studies comparing SILC to conventional MLC have recently been published. A literature search of PubMed and MEDLINE databases for studies comparing SILC to conventional MLC was conducted. The primary outcome measures for meta-analysis were postoperative complications, length of stay, and operative time. Secondary outcome measures were incision length, estimated blood loss, and number of lymph nodes harvested. Fifteen studies comparing 467 patients undergoing SILC to 539 patients undergoing conventional MLC were reviewed and the data pooled for analysis. Patients undergoing SILC had a shorter length of stay (pooled weighted mean difference (WMD) = -0.68 95 % CI = -1.20 to -0.16 p = 0.0099), shorter incision length (pooled WMD = -1.37 95 % CI = -2.74 to 0.000199 p = 0.05), less estimated blood loss (pooled WMD = -20.25 95 % CI = -39.25 to -1.24 p = 0.037), and more lymph nodes harvested (pooled WMD = 1.75 95 % CI = 0.12 to 3.38 p = 0.035), while there was no significant difference in the number of postoperative complications (pooled odds ratio = 0.83 95 % CI = 0.57 to 1.20 p = 0.33) or operative time (pooled WMD = 5.06 95 % CI = -2.91 to 13.03 p = 0.21). SILC appears to have comparable results to conventional MLC in the hands of experienced surgeons. Prospective randomized trials are necessary to define the relative benefits of one procedure over the other.
Publisher: Springer Science and Business Media LLC
Date: 24-01-2014
DOI: 10.1007/S12094-013-1154-6
Abstract: Although there have been recent advances in the treatment of metastatic colorectal cancer, particularly with systemic chemotherapy, new biological agents and surgical metastasectomy, the disease remains difficult to treat. To personalise the management of mCRC and optimise patient outcomes, it is vital to acquire a deeper understanding of its natural history and mechanisms behind disease progression. This may be achieved by extensive study of tumour biomarkers: proteins or genetic alterations within neoplastic cells or their surrounding stroma that may be used to predict patient outcomes, disease trajectory and response to various therapies. The discovery of mutant Kirsten-RAS in determining patients who may be refractory to anti-epidermal growth factor receptor treatments has reinvigorated and reiterated the importance of our attempts to in idualise cancer care. While many biomarkers have been studied and shown promise in the setting of mCRC, they are, with the exception of K-ras testing not used currently in a clinical setting due to conflicting results, small patient s les and methodological variations. Larger, multi-centric studies with uniform methods of tumour marker study are required to effectively tailor systemic therapies and select appropriate candidates for surgical metastasectomy.
Publisher: Wiley
Date: 27-02-2017
DOI: 10.1111/ANS.13913
Abstract: The dogma of administering sufficient intravenous fluids aggressively to avoid under-resuscitation has recently been challenged. Evidence suggests that excessive perioperative fluid administration may be associated with negative clinical outcomes in gastrointestinal surgery. This study examines the impact of fluid administration on perioperative outcomes in patients undergoing pancreatoduodenectomy (PD). A retrospective analysis of 202 patients undergoing PD between January 2004 and August 2015 was performed. A cut-off value of 10 mL/kg/h was applied (low fluid group: <10 mL/kg/h versus high fluid group: ≥10 mL/kg/h). There were 76 patients in the low fluid group and 126 patients in the high fluid group. Both groups had comparable age, American Society of Anesthesiologists score and preoperative morbidity rates. Patients in the high fluid group received significantly more total fluids, crystalloids and colloids intraoperatively (P < 0.0001, P < 0.0001 and P = 0.013, respectively) without a significant difference in estimated blood loss (P = 0.586). The net fluid balance on post-operative day 0 was also significantly higher in the high fluid group (P < 0.0001). The mortality rate was 0% in the cohort. Major morbidity rate was 46.1% and 44.4% in low and high fluid groups, respectively (P = 0.836). Reoperation rate was 5.3% for the low fluid group and 1.6% for the high fluid group (P = 0.136). There were no significant differences between the groups for any of the in idual complications. This study did not identify a difference in post-operative outcomes between the low and high fluid regime in patients undergoing PD.
Publisher: Oxford University Press (OUP)
Date: 24-09-2010
DOI: 10.1002/BJS.7263
Abstract: This study was undertaken to measure survival of patients with multicystic peritoneal mesothelioma treated by cytoreductive surgery and hyperthermic intraperitoneal chemotherapy through a multi-institutional collaboration. A multi-institutional data registry, established by the Peritoneal Surface Oncology Group, was used to identify patients with peritoneal mesothelioma and the subgroup with multicystic tumours, treated by cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. Outcomes for this subgroup are reported. The primary endpoint was overall survival. A secondary endpoint was the incidence of treatment-related complications. Of 405 patients with peritoneal mesothelioma, 26 (6·4 per cent) had multicystic tumours. There were 20 women and six men with a mean(s.d.) age of 42(12) years. The median peritoneal carcinomatosis index (PCI) was 14 (range 6–39). There was no perioperative mortality. Six patients developed grade III or IV complications. After a median follow-up of 54 (range 5–129) months, all 26 patients were still alive. Multicystic peritoneal mesothelioma appears to be a distinct subtype of peritoneal mesothelioma, where long-term survival may be achieved through cytoreductive surgery and hyperthermic intraperitoneal chemotherapy.
Publisher: Mary Ann Liebert Inc
Date: 07-2022
Publisher: Hindawi Limited
Date: 2012
DOI: 10.1155/2012/247107
Abstract: Rectal cancer is a distinct subset of colorectal cancer where specialized disease-specific management of the primary tumor is required. There have been significant developments in rectal cancer surgery at all stages of disease in particular the introduction of local excision strategies for preinvasive and early cancers, standardized total mesorectal excision for resectable cancers incorporating preoperative short- or long-course chemoradiation to the multimodality sequencing of treatment. Laparoscopic surgery is also increasingly being adopted as the standard rectal cancer surgery approach following expertise of colorectal surgeons in minimally invasive surgery gained from laparoscopic colon resections. In locally advanced and metastatic disease, combining chemoradiation with radical surgery may achieve total eradication of disease and disease control in the pelvis. Evidence for resection of metastases to the liver and lung have been extensively reported in the literature. The role of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for peritoneal metastases is showing promise in achieving locoregional control of peritoneal dissemination. This paper summarizes the recent developments in approaches to rectal cancer surgery at all these time points of the disease natural history.
Publisher: Elsevier BV
Date: 10-2016
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 04-2013
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 2011
Publisher: Elsevier BV
Date: 10-2012
DOI: 10.1016/J.CTRV.2011.10.006
Abstract: Mesotheliomas are aggressive and lethal neoplasms arising from mesothelial cells lining the pleura, peritoneum, tunica vaginalis testis and pericardium. Malignant peritoneal mesothelioma accounts for about 30% of all mesotheliomas. Asbestos is the main known cause of the disease. Presenting symptoms in these patients include: ascites, abdominal pain, asthenia, weight loss, anorexia, abdominal mass, fever, diarrhea and vomiting. Electron microscopy, immunohistochemistry, computed tomography scan, echotomography, magnetic resonance imaging, positron emission tomography and laparoscopy are used in diagnosis and follow-up. Chemotherapy alone is considered as a palliative treatment for these patients who are not eligible for radical surgery. The most promising non-surgical approach today in the management of peritoneal mesothelioma is the use of the combination chemotherapy regime of an antifolate (pemetrexed and raltitrexed) and a platinum based (cisplatin) agent with a median survival of about 12-14 months. Due to peritoneal confinement of malignant mesothelioma and low occurrence of metastasis, a locoregional approach consisting of cytoreductive surgery and perioperative intraperitoneal chemotherapy has been introduced as a curative treatment option over the last decade with an overall 5-year survival rate of 29-63%. In this locoregional approach, surgery can separate the adhesions and remove the bulky tumor, leaving microscopic residual tumors much more susceptible to the killing effect of chemotherapeutic drugs. Here in St. George hospital, cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (using cisplatin and doxorubicin) resulted in significant survival advantage. This article describes how the prognosis of the disease has changed over the last decade.
Publisher: Informa UK Limited
Date: 2010
Publisher: Elsevier BV
Date: 11-2009
Publisher: Wiley
Date: 18-01-2011
DOI: 10.1002/JSO.21864
Abstract: Hepatic resection of colorectal liver metastases (CLM) is now regarded the standard of care. Evaluation of true long-term survivors will demonstrate the curative potential of this therapy with cure being defined as actual 10-year survival versus a satisfactory oncological outcome of 5-year survival. Limited data exists on outcomes of patients beyond 5 years. Studying the rates of cure and predictive factors for cure are essential to define the true benefit of this therapy. Retrospective review of a prospectively maintained hepatobiliary surgical database was performed on patients who underwent hepatic resection of CLM between 1991 and 2005 with a minimum of 5-year follow-up. Survival was calculated from the time of surgery using the Kaplan-Meier method. There were 455 consecutive patients with a minimum of 5-year follow-up. The actuarial median overall survival was 33 months (95% CI, 29-37%), actuarial 5-, and 10-year survival rates were 34% and 25%, respectively. Hundred twenty four patients were identified as actual 5-year survivors (27%) with their actuarial median overall survival being 11.1 years, actuarial 10-year survival rate of 59%, and a median disease-free survival of 4.9 years. Patients requiring subsequent treatment of modern systemic chemotherapy for post-resection recurrence (P = 0.003) was a negative predictors of cure from multivariate analysis. This study demonstrate that approximately one in three patients undergoing resection for CLM will become actual 5-year survivors from which approximately half will go on to survive 10-years and be cured of CLM.
Publisher: Elsevier BV
Date: 09-2017
DOI: 10.1016/J.EJSO.2017.06.012
Abstract: Pancreatic ductal adenocarcinoma (PDAC) is a deadly disease. Neoadjuvant therapy (NA) with chemotherapy (NAC) and radiotherapy (RT) prior to surgery provides promise. In the absence of prospective data, well annotated clinical data from high-volume units may provide pilot data for randomised trials. Medical records from a tertiary hospital in Sydney, Australia, were analysed to identify all patients with resectable or borderline resectable PDAC. Data regarding treatment, toxicity and survival were collected. Between January 1 2010 and April 1 2016, 220 sequential patients were treated: 87 with NA and 133 with upfront operation (UO). Forty-three NA patients (52%) and 5 UO patients (4%) were borderline resectable at diagnosis. Twenty-four borderline patients received NA RT, 22 sequential to NAC. The median overall survival (OS) in the NA group was 25.9 months (mo) 95% CI (21.1-43.0 mo) compared to 26.9 mo (19.7, 32.7) in the UO HR 0.89 log-ranked p-value = 0.58. Sixty-nine NA patients (79%) were resected, mOS was 29.2 mo (22.27, not reached (NR)). Twenty-two NA (31%) versus 22 UO (17%) were node negative at operation (N0). In those managed with NAC/RT the mOS was 29.0 mo (17.3, NR). There were no post-operative deaths with NA within 90-days and three in the UO arm. This is a hypothesis generating retrospective review of a selected real-world population in a high-throughput unit. Treatment with NA was well tolerated. The long observed survival in this group may be explained by lymph node sterilisation by NA, and the achievement of R0 resection in a greater proportion of patients.
Publisher: Wiley
Date: 23-11-2010
DOI: 10.1002/JSO.21748
Publisher: Springer Science and Business Media LLC
Date: 06-03-2013
DOI: 10.1007/S00432-013-1408-2
Abstract: Malignant peritoneal mesothelioma (MPM) is a rare and fatal cancer. Females are found to survive longer than males after treatment, suggesting a possible involvement of hormonal factors. Estradiol is involved in cellular proliferation of a number of cancers and acts mainly through oestrogen receptors (ERs). Hence, we examined the expression of oestrogen receptors with correlation to prognosis. Oestrogen receptors expression was examined using immunohistochemistry on 42 paraffin-embedded sections of MPM tumours. Kaplan-Meier survival curves were analysed to determine the significance of ER expression in relation to prognosis. ER-β (nuclear) was detected in 33 (79 %) patients. ER-β was also detected in the cellular cytoplasm of 9 (21 %) patients. Presence of ER-β (nuclear) was associated with favourable survival (univariate analysis, P = 0.001), whereas the presence of ER-β (cytoplasm) was associated with a poor survival (P = 0.014). Multivariate Cox regression analysis revealed the absence of ER-β (nuclear) and the presence of ER-β (cytoplasm) to be independent predictive factors for poor disease outcome (hazard ratio 5.4, 95 % confidence interval 1.86-15.75 P = 0.002 and hazard ratio 8.0, 95 % confidence interval 1.8-34 P = 0.005), respectively. ER-α (nuclear) was detected in only 4 (9 %) of patients and not statistically significant (univariate analysis, P = 0.066). The presence of ER-β (cytoplasm) is associated with poor prognosis. The favourable survival association observed in patients with ER-β (nuclear) raises a question about the molecular mechanisms of the tumorigenic roles of ER-β in each cellular compartment and requires further studies.
Publisher: Oxford University Press (OUP)
Date: 20-10-2014
DOI: 10.1002/BJS.9674
Abstract: The learning curves for cytoreductive surgery with intraperitoneal chemotherapy for treatment of pseudomyxoma peritonei (PMP) were explored between international centres/surgeons to identify institutional or other factors that might affect performance. Data from patients with PMP treated with the combined procedure across 33 international centres between 1993 and 2012 were analysed retrospectively. A risk-adjusted sequential probability ratio test was conducted after defining the target outcome as early oncological failure (disease progression within 2 years of treatment), an acceptable risk for the target outcome (odds ratio) of 2, and type I/II error rates of 5 per cent. The risk prediction model was elaborated and patients were evaluated sequentially for each centre/surgeon. The learning curve was considered to be overcome and proficiency achieved when the odds ratio for early oncological failure became smaller than 2. Rates of optimal cytoreduction, severe postoperative morbidity and early oncological failure were 84·4, 25·7 and 29·0 per cent respectively. The median annual centre volume was 17 (range 6–66) peritoneal malignancies. Only eight of the 33 centres and six of 47 surgeons achieved proficiency after a median of 100 (range 78–284) and 96 (86–284) procedures respectively. The most important institutional factor affecting surgical performance was centre volume. The learning curve is extremely long, so centralization and/or networking of centres is necessary to assure quality of services. One centre for every 10–15 million inhabitants would be ideal.
Publisher: Wiley
Date: 23-07-2022
DOI: 10.1111/ANS.17933
Abstract: Lumbar hernias are rare and its posterior location presents challenges in its repair. This article provides a pictorial description of the approach to repairing a lumbar hernia demonstrating a laparoscopic transabdominal preperitoneal technique that is easy to follow and take up.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 02-2020
DOI: 10.1097/MPA.0000000000001472
Abstract: Little data exist on the utility of fluorodeoxyglucose positron emission tomography (FDG-PET) in operable pancreatic ductal adenocarcinoma (PDAC) treated with neoadjuvant (NA) therapy. Consecutively treated patients with potentially operable PDAC were recruited from a quaternary referral center between 2015 and 2018. Data were collated on demographic, clinical, radiological, treatment, and disease-free and overall survival (OS) outcome measures, correlated with FDG-PET findings. Of 115 patients recruited, 61% were deemed upfront operable (n = 70), 33% borderline (n = 38), and 6% (n = 7) locally advanced. Ninety-five (83%) received NA chemotherapy with 23 (24%) sequential radiotherapy. Sixty-nine (73%) treated with NA were resected, 37 (54%) attained an R0 resection, 43 (62%) had N1 disease with median tumor viability of 50%. The median OS in the entire cohort was 30.48 months and in those who received NA chemotherapy followed by resection 37.98 months. Twelve percent (n = 13) were upstaged during NA therapy by PET. Preoperative standardized uptake value maximum of less than 5 versus 5 or greater after NA predicted for improved OS, 42.95 months versus 26.05 months, P = 0.02. In this real-world cohort study of PDAC, the utility of FDG-PET in informing the patient treatment pathway was meaningfully demonstrated.
Publisher: Springer Science and Business Media LLC
Date: 05-2009
DOI: 10.1245/S10434-009-0484-7
Abstract: Cytoreductive surgery (CRS) combined with perioperative intraperitoneal chemotherapy (PIC) has demonstrated improved survival in selected patients with peritoneal carcinomatosis (PC). This treatment modality is associated with high blood loss and often requires massive allogenic red blood cell transfusion (MABT). Our study is the first of its kind to evaluate the risk factors for intraoperative MABT in peritonectomy procedures. Two hundred and forty-three consecutive CRS and PIC procedures were evaluated. The associations between 17 preoperative and intraoperative risk factors and intraoperative MABT (>or=6 units) were assessed by univariate and multivariate analysis. One hundred and eighty-six (77%) procedures required intraoperative transfusion of packed red blood cells. Ninety-one procedures required MABT (37%). Multivariate analysis showed six significant risk factors for intraoperative MABT: operative length > 9 h (p < 0.001), preoperative hemoglobin < 125 g/l (p or= 16 (p = 0.006), preoperative international normalized ratio (INR) >or= 1.2 (p = 0.008), and number of peritonectomy procedures >or= 4 (p = 0.021). Statistical analysis also revealed that MABT was associated with increased intensive care unit (ICU) (p < 0.001), high-dependency unit (HDU) (p = 0.020), and total hospital stay (p < 0.001) and with severe morbidity (p < 0.001). Patients with preoperative anemia, impaired coagulation profile or extensive tumor burden are at high risk of MABT. Appropriate blood conservation strategies should be adopted in these patients on the basis of their risk factors.
Publisher: Elsevier BV
Date: 08-2014
DOI: 10.1016/J.EJSO.2013.10.022
Abstract: To clarify the role of repeat CRS for recurrent colorectal carcinoma (CRC) through: (i) Systematic review of the literature (ii) Analysis of survival outcomes in a prospective cohort. (i) Pubmed and MEDLINE from 1980 to July 2013 searched using terms: colorectal carcinoma, peritonectomy, cytoreductive surgery, hyperthermic intraperitoneal chemotherapy (HIPEC), redo, repeat, and iterative. (ii) Kaplan-Meier Survival analysis of consecutive patients undergoing repeat CRS at St George Hospital between Jan 2000 and July 2013. (i) The search strategy yielded 309 articles, 5 meeting inclusion criteria, reporting on 91 patients. Median overall survival from first CRS ranged from 39 to 57.6 months with 3-yr survival of 50%, and 5-year survival of 30%. Median survival from second CRS was 20-months with 1-yr survivals of 72% and 66% and 2-year survivals of 50% and 44%. (ii) Repeat CRS performed on 18 patients found median survival from first CRS was 59 months, with 1, 3, and 5-year survival of 100%, 52% and 26% respectively. Median survival from repeat CRS was 22.6 months with 1, 2, and 3-year survival of 94%, 48% and 12% respectively. The current data on repeat CRS in CRC is relatively immature and more data is required before drawing clear conclusions. Patient selection should be on a case by case basis conducted through a MDT process with emphasis on surrogate markers for favourable outcomes.
Publisher: Springer Science and Business Media LLC
Date: 23-02-2012
DOI: 10.1007/S10637-012-9797-7
Abstract: Pseudomyxoma peritonei is a disease characterised by the accumulation of mucinous ascites. Thus far, cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy (HIPEC) has been shown to be effective at eradicating disease. Chemotherapy has been less effective, providing disease stabilization but not demonstrating significant treatment responses. Mucolytic is a potential class of drug that may be exploited in the chemical management of this disease. A variety of potential mucolytic agents are explored in this review providing evidence of basic biochemical evidence of its efficacy with potential translational application.
Publisher: Springer Science and Business Media LLC
Date: 19-08-2011
DOI: 10.1007/S00384-011-1303-8
Abstract: The aim of this study was to identify predictors of early recurrence to optimize outcomes. A comparison of clinicopathological factors between patients who developed early recurrence (≤12 months) and late recurrence (>12 months) was performed to identify predictors of treatment failure through univariate and multivariate analyses. Survival parameters were estimated using the Kaplan-Meier method. A total of 113 patients with a median PCI of 24 (range, 2-39) underwent cytoreductive surgery. The median progression-free and overall survival was 48 and 104 months, respectively. Multivariate analysis identified prior operations >1, ≥10 units of fresh frozen plasma (FFP) transfusion, incomplete cytoreduction and not undergoing definitive cytoreductive surgery within 12 months of diagnosis as predictors for disease recurrence. Twenty of 41 patients (49%) developed early recurrence. The median overall survival of patients who developed early recurrence was 38 months and in patients who did not develop early recurrence was 97 months (P = 0.002). Subgroup analysis of patients with recurrence identified the male gender (P = 0.028), elevated CA 125 (P = 0.037), having elevated carcinoembryonic antigen (CEA), CA 125 and CA 19-9 (P = 0.029), peritoneal cancer index >25 (P = 0.020), incomplete cytoreduction (P = 0.020), >6 units of blood transfusion (P = 0.020) and >10 units of FFP transfusion (P = 0.009) as factors associated with early recurrence. Early recurrence of pseudomyxoma peritonei occurs despite achieving high rates of oncologically optimal cytoreduction. The clinicopathologic factors associated with early recurrence identified in this study may inform us about patients at greatest risk of treatment failure during the post cytoreduction follow-up.
Publisher: Elsevier BV
Date: 05-2012
DOI: 10.1016/J.JSS.2011.10.038
Abstract: This study examines the potential efficacy of hydrogen peroxide and ascorbic acid in the dissolution of mucinous ascites from pseudomyxoma peritonei. The mucolytic action of both ascorbic acid (0%-0.2%) and hydrogen peroxide (0%-3%) are investigated as single agent on mucin s les derived from patient. This was followed by examining the joint action of ascorbic acid (0.2%) and hydrogen peroxide (0%-3.0%) on mucin. To lower the concentration of hydrogen peroxide in the mixture, the action of equal concentration of ascorbic acid/hydrogen peroxide ranging from 0%-0.3% are then examined. Finally, the pH (4.5-7.0) effect on mucolytic properties of equal concentration (0.2%) of ascorbic acid/hydrogen peroxide was studied. At the concentrations examined (0%-0.2%), ascorbic acid showed highest mucolytic activity at 0.2%. Similarly, hydrogen peroxide as a single agent (0%-3.0%) showed highest mucolytic activity at 3.0%. The mucolytic action of hydrogen peroxide (0%-3.0%) containing 0.2% ascorbic acid demonstrated synergistic effects. At equal concentration of the two agents, ranging from 0%-0.5%, maximal mucolytic action was observed at 0.2%. The mucolytic property of the final mixture (0.2% ascorbic acid/0.2% hydrogen peroxide) was pH-dependent and showed maximal degradation at pH 4.5 and declined as it reached towards neutral pH. The current study introduces the potential applicability of a formulation that holds promise as a mucolytic agent in patients with mucinous ascites from pseudomyxoma peritonei.
Publisher: Wiley
Date: 05-2010
Publisher: Springer Science and Business Media LLC
Date: 24-10-2009
DOI: 10.1245/S10434-009-0781-1
Abstract: Neoadjuvant chemotherapy prior to hepatectomy in patients with resectable colorectal liver metastases (CLM) may facilitate the resectability of the liver lesions and treat occult metastasis but may also lead to hepatic parenchyma damage. There is argument over the oncologic benefit of this practice in patients who would already be suitable for a curative hepatectomy. Extensive literature search of databases (MEDLINE and PubMed) to identify published studies of preoperative systemic chemotherapy for resectable CLM was undertaken with clinical response to treatment and survival outcomes as the endpoints. Twenty-three studies were reviewed: 1 phase III randomized control trial, 3 phase II studies, and 19 observational studies, comprising 3,278 patients. Objective (complete artial) radiological response was observed in 64% (range 44-100%) [complete 4% (range 0-38%), partial 52% (range 10-90%)] of patients after neoadjuvant chemotherapy. Pathologically, a median of 9% (range 2-24%) and 36% (range 20-60%) had complete and partial response, respectively. Of patients, 41% (range 0-65%) had stable or progressive disease whilst on neoadjuvant chemotherapy. Median disease-free survival (DFS) was 21 (range 11-40) months. Median overall survival (OS) was 46 (range 20-67) months. Current evidence suggests that objective response to neoadjuvant chemotherapy may be achieved with improvement in DFS in patients with resectable CLM. A prospective randomized trial of neoadjuvant therapy versus adjuvant therapy after liver resection is required to determine the optimal perisurgical treatment regimen.
Publisher: Elsevier BV
Date: 12-2011
DOI: 10.1016/J.SURONC.2011.05.003
Abstract: There has been an interest in the interdisciplinary and multimodality approach that combines chemotherapy and radiation therapy as a preoperative treatment for patients with resectable pancreatic cancer. Literature search of databases (Medline and PubMed) to identify published studies of preoperative chemoradiation for resectable pancreatic cancer (potentially resectable and borderline resectable) was undertaken. Response to treatment and survival outcomes was examined as endpoints of this review. Seventeen studies eight phase II studies, and nine observational studies, comprising of 977 patients were reviewed. Gemcitabine-based chemotherapy with radiotherapy was the most common preoperative regimen. Following preoperative treatment, pancreatic surgical resection was performed in 35-100% (median=61%) of patients after a range of 6-32 weeks (median=7 weeks). Rate of pathological response was complete in 5-15% of patients, partial in 33-60% and minimal in 38-42%. The median overall survival ranged from 12 months to 40 months (median=25 months) with a 5-year overall survival rate ranging between 8% and 36% (median=28%). Patients who underwent chemoradiation but did not undergo surgery survived a median period of 7-11 months (median=9 months). Preoperative gemcitabine-based chemoradiation followed by restaging and surgical evaluation for pancreatic resection may identify a sub-population of patients with resectable disease who would benefit the most from surgery. Investigation of this schema of preoperative therapy in a randomized setting of resectable pancreatic cancer is warranted.
Publisher: Public Library of Science (PLoS)
Date: 16-03-2016
Publisher: SAGE Publications
Date: 07-2013
DOI: 10.5301/JBM.5000038
Abstract: Overexpression of MUC1 predicts poor survival in most cancers. Routine immunohistochemical detection of MUC1 is performed for differential diagnosis in malignant peritoneal mesothelioma (MPM). However, the prognostic significance of MUC1 in MPM has not been determined. We investigated MUC1 expression and other prognostic factors in relation to survival in 42 patients (20 males and 22 females) for whom archival s les were available, using immunohistochemistry. MUC1 was expressed in 38/42 (90%) patients. Its prognostic significance was statistically analyzed using the Kaplan-Meier method. High expression of MUC1 (immunohistochemical score of 5-8), was correlated with poor survival in several categories: all subtypes of tumors (p=0.001), male gender (p=0.017), female gender (p=0.001), epitheloid tumors (p=0.001), epitheloid tumors in males (p=0.005), epitheloid tumors in females (p=0.003), and age at diagnosis (AAD) years (p=0.001). Amongst the other clinicopathological variables, univariate analysis also showed that male gender (p=0.007), sarcomatoid histology (p=0.001), peritoneal cancer index (PCI) ≥20 (p=0.013) and AAD ≥60 (p=0.001), correlated with poor survival. Multivariate analysis showed that only AAD ≥60 (p=0.049) was an independent prognostic factor, and that high MUC1 expression significantly correlated with the following categories: all subtypes of tumors (p=0.001), male gender (p=0.002), female gender (p=0.031), epitheloid tumors (p=0.031), and AAD y (p=0.012). AAD and high MUC1 expression in the tumor are indicators of poor prognosis. MUC1 evaluation by immunohistochemistry may serve as a useful prognostic tool in MPM, but may need further confirmation in a larger patients' cohort.
Publisher: Springer Science and Business Media LLC
Date: 23-08-2009
DOI: 10.1007/S00432-009-0667-4
Abstract: Advanced and recurrent ovarian cancer results in extensive spread of tumor on the peritoneal surfaces of the abdomen and pelvis. We collectively review studies in the literature that report the efficacy of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) for ovarian cancer peritoneal carcinomatosis. An electronic search of all relevant studies published in peer-reviewed journals before May 2009 was performed on three databases. The quality of each study was independently assessed and classified according to the time point of HIPEC use in various setting of ovarian cancer from the consensus statement of the Peritoneal Surface Oncology Group. Clinical efficacy was synthesized through a narrative review with full tabulation of the results of each included study. Nineteen studies each of more than ten patients reporting treatment results of HIPEC of patients with both advanced and recurrent ovarian cancer were included and data were extracted. All studies were observational case series. The overall rate of severe perioperative morbidity ranged from 0 to 40% and mortality rate varied from 0 to 10%. The overall median survival following treatment with HIPEC ranged from 22 to 64 months with a median disease-free survival ranging from 10 to 57 months. In patients with optimal cytoreduction, a 5-year survival rate ranging from 12 to 66% could be achieved. Despite the heterogeneity of the studies reviewed, current evidence suggest that complete CRS and HIPEC may be a feasible option with potential benefits that are comparable with the current standard of care. A randomized trial is required to establish the role of HIPEC in ovarian cancer.
Publisher: Springer Science and Business Media LLC
Date: 20-09-2013
Publisher: Oxford University Press (OUP)
Date: 09-10-2019
DOI: 10.1002/BJS.11326
Abstract: Ileus is common after elective colorectal surgery, and is associated with increased adverse events and prolonged hospital stay. The aim was to assess the role of non-steroidal anti-inflammatory drugs (NSAIDs) for reducing ileus after surgery. A prospective multicentre cohort study was delivered by an international, student- and trainee-led collaborative group. Adult patients undergoing elective colorectal resection between January and April 2018 were included. The primary outcome was time to gastrointestinal recovery, measured using a composite measure of bowel function and tolerance to oral intake. The impact of NSAIDs was explored using Cox regression analyses, including the results of a centre-specific survey of compliance to enhanced recovery principles. Secondary safety outcomes included anastomotic leak rate and acute kidney injury. A total of 4164 patients were included, with a median age of 68 (i.q.r. 57–75) years (54·9 per cent men). Some 1153 (27·7 per cent) received NSAIDs on postoperative days 1–3, of whom 1061 (92·0 per cent) received non-selective cyclo-oxygenase inhibitors. After adjustment for baseline differences, the mean time to gastrointestinal recovery did not differ significantly between patients who received NSAIDs and those who did not (4·6 versus 4·8 days hazard ratio 1·04, 95 per cent c.i. 0·96 to 1·12 P = 0·360). There were no significant differences in anastomotic leak rate (5·4 versus 4·6 per cent P = 0·349) or acute kidney injury (14·3 versus 13·8 per cent P = 0·666) between the groups. Significantly fewer patients receiving NSAIDs required strong opioid analgesia (35·3 versus 56·7 per cent P & 0·001). NSAIDs did not reduce the time for gastrointestinal recovery after colorectal surgery, but they were safe and associated with reduced postoperative opioid requirement.
Publisher: Wiley
Date: 17-11-2009
DOI: 10.1002/JSO.21177
Abstract: Peritoneal mesothelioma is a rapidly progressing malignancy with a median survival of 6-12 months. Palliative surgery, chemotherapy and radiotherapy are futile and have not shown to improve survival. This paper reports the outcomes of cytoreductive surgery (CRS) and Hyperthermic intraperitoneal chemotherapy (HIPEC) for the treatment of this disease. An observational study of 20 patients with peritoneal mesothelioma treated with CRS and HIPEC at the St George Hospital, Sydney, Australia. Survival analysis was performed using the Kaplan-Meier method and comparison using the Log Rank test. There were six females. The mean age was 55.7 (9.0) years. The median survival was 29.5 (0.46-87.2) months with 1- and 3-year survival of 78.2% and 46.3%, respectively. Survival was found to be influenced by completeness of cytoreduction (P = 0.02) and histological subtype (P = 0.01). Patients with epitheloid peritoneal mesothelioma who had a CC0 had a median survival of 87.2 months. CRS and HIPEC is a treatment option for peritoneal mesothelioma. Patients with epithelioid tumor who undergo complete cytoreduction may potentially benefit from this procedure.
Publisher: Springer Science and Business Media LLC
Date: 14-03-2012
DOI: 10.1007/S10147-012-0397-5
Abstract: Perioperative intraperitoneal chemotherapy (PIC) is delivered by intraoperative hyperthermic intraperitoneal chemotherapy (HIPEC) and early postoperative intraperitoneal chemotherapy (EPIC). The relative survival benefits of each or both regimens are explored in this large series of patients undergoing cytoreduction at a single institution. Patients with a complete (CCR0) or optimal (CCR1) cytoreduction who received intraperitoneal chemotherapy for appendiceal and colorectal peritoneal carcinomatosis were included for analysis. PIC regimens were delivered according to the treatment protocol. Standardized statistical analyses were performed. Of 262 patients, 98 patients (37%) had colorectal peritoneal carcinomatosis, 108 patients (41%) had low-grade pseudomyxoma peritonei and 56 patients (21%) had appendiceal peritoneal carcinomatosis. For pseudomyxoma peritonei, recurrence-free survival (RFS) did not vary with PIC regimen, 5-year survival was 86% in the HIPEC and EPIC group and 64% in the HIPEC or EPIC group (P = 0.070). For appendiceal peritoneal carcinomatosis, RFS and overall survival (OS) did not vary with PIC regimen. For colorectal peritoneal carcinomatosis, the median RFS was 33 months in the HIPEC and EPIC group, 19 months in the HIPEC alone group and 20 months in the EPIC alone group (P = 0.046). OS did not vary with PIC regimen. From our experience, without compromising the perioperative morbidity and mortality, PIC consisting of HIPEC and EPIC appears to be associated with potential survival benefits of improved OS in pseudomyxoma peritonei and RFS in colorectal peritoneal carcinomatosis.
Publisher: Wiley
Date: 05-06-2013
DOI: 10.1002/JSO.23356
Abstract: Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) achieves disease control within the peritoneum but recurrences occur. This study examines the outcomes of iterative CRS (iCRS) HIPEC for treatment of recurrent peritoneal metastases. Patients who underwent iCRS in a single tertiary referral center were identified from a prospective database. Safety analysis was performed and clinicopathological variables were analyzed to assess factors predictive of major morbidity and survival. The demographics of patients who underwent primary cytoreductive surgery (pCRS) (n = 466) and iCRS (n = 79) were balanced between groups. pCRS was shown to require more blood transfusion (P = 0.019) and albumin use (P = 0.013). The mortality and major complication rates were comparable (1.2% vs. 0% P = 0.600, and 42% vs. 41% P = 0.806). Residual pneumothorax occurred more frequently after pCRS (12% vs. 4% P = 0.030). Factors associated with major complications after iCRS include use of HIPEC (P = 0.042) and length of hospital stay (P = 0.024). The overall median survival was 48 months and 5-year survival was 34%. By cancer type, the 3-year survival was 0%, 74%, 80%, and 72% for colorectal, appendiceal pseudomyxoma, peritoneal mesothelioma, and appendix cancer, respectively. Independent predictors of survival include age (P = 0.049), interval between pCRS and iCRS (P = 0.008), small bowel resection (P < 0.001), and use of HIPEC (P = 0.005). Iterative CRS achieved further peritoneal disease control without adverse effects on morbidity. Patients with appendiceal tumors and peritoneal mesothelioma appear to benefit most after iCRS. Intraoperative HIPEC remains important in the repetoire of managing these patients.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 04-2010
Publisher: Springer Science and Business Media LLC
Date: 28-06-2011
DOI: 10.1245/S10434-011-1859-0
Abstract: To evaluate our experience of radiofrequency ablation (RFA) of pulmonary metastases in patients with resected colorectal liver metastases who had concomitant or recurrent pulmonary metastases. Clinical and treatment variables of patients undergoing RFA were collected, and their association with survival was examined. Survival analysis was performed by the Kaplan-Meier method. RFA was performed as concomitant sequential treatment of extrahepatic pulmonary metastases after hepatectomy in 19 patients (30%) and as salvage treatment for pulmonary recurrences after hepatectomy in 45 patients (70%). Patients undergoing sequential treatment had a median survival of 31 (95% confidence interval [CI] 21.8-40.6) months compared to 59 (95% CI 35.0-82.0) months in the salvage treatment group (P = 0.142). The disease-free survival (DFS) was 9 (95% CI 1.0-18.8) months in the sequential treatment group and 16 (95% CI 8.1-23.1) months in the salvage treatment group (P = 0.023). Liver metastases occurring within 12 months of the primary tumor negatively influenced overall survival (OS) and DFS in the sequential treatment group (P = 0.003 and P = 0.091). Poorly differentiated tumor (P = 0.001) was associated with a poorer OS, and prehepatectomy carcinoembryonic antigen > 200 ng/ml (P = 0.017) and bilateral pulmonary metastases (P = 0.030) were associated with a shorter DFS in the salvage treatment group. The DFS and OS of patients undergoing sequential RFA of extrahepatic pulmonary metastases after hepatectomy appeared shorter when compared to patients who underwent RFA as salvage treatment for pulmonary recurrences after hepatectomy. It nonetheless remains better than the historical results of chemotherapy alone and thus supports the use of RFA as an ablative technology to achieve tumor control.
Publisher: Wiley
Date: 20-07-2011
DOI: 10.1002/JSO.22019
Abstract: The combined treatment of cytoreductive surgery (CRS) and perioperative chemotherapy (PIC) for colorectal peritoneal carcinomatosis (PC) is a rigorous surgical treatment most suited for fit and young patients. With technical maturity and improved perioperative care, we examined the outcomes of elderly patients undergoing CRS and PIC for colorectal PC. All consecutive patients treated in two tertiary centers for PC of colorectal cancer who were 70 years of age or older at the time of surgery were included. Data on patient characteristics, concomitant diseases, operation details, perioperative course, and follow-up were retrieved from medical charts. Primary outcomes were perioperative morbidity and mortality. Secondary outcomes were disease-free and overall survival. Twenty-four patients (11 male) were included in this study (mean age 73.5 years). In eight patients major complications occurred. In six patients the postoperative course was complicated by minor adverse events. There was no perioperative mortality. Median overall survival was 35 months with a 6, 12, and 18 months survival rate of 94%, 83%, and 68%, respectively. CRS and PIC for colorectal PC may be safely performed with acceptable morbidity in selected elderly patients. When considering patients for surgery, performance status, and the disease extent should be used as eligibility criteria rather than age.
Publisher: Wiley
Date: 23-10-2010
DOI: 10.1002/JSO.21601
Abstract: Evaluation of peritoneal metastases by computed tomography (CT) scans is challenging and has been reported to be inaccurate. A multi-institutional prospective observational registry study of patients with peritoneal carcinomatosis from colorectal cancer was conducted and a subset analysis was performed to examine peritoneal cancer index (PCI) based on CT and intraoperative exploration. Fifty-two patients (mean age 52.6 ± 12.4 years) from 16 institutions were included in this study. Inaccuracies of CT-based assessment of lesion sizes were observed in the RUQ (P = 0.004), LLQ (P < 0.0005), RLQ (P = 0.003), distal jejunum (P = 0.004), and distal ileum (P < 0.0005). When CT-PCI was classified based on the extent of carcinomatosis, 17 cases (33%) were underestimations, of which, 11 cases (21%) were upstaged from low to moderate, 4 cases (8%) were upstaged from low to severe, and 2 cases (4%) were upstaged from moderate to severe. Relevant clinical discordance where an upstage occurred to severe carcinomatosis constituted a true inaccuracy and was observed in six cases (12%). The actual clinical impact of inaccuracies of CT-PCI was modest. CT-PCI will remain as a mandatory imaging tool and may be supplemented with other tools including positron emission tomography scan or diagnostic laparoscopy, in the patient selection for cytoreductive surgery and hyperthermic intraperitoneal chemotherapy.
Publisher: Springer Science and Business Media LLC
Date: 03-07-2018
DOI: 10.1007/S00268-018-4716-5
Abstract: In 2015, the public media in Australia reported a series of life stories of victims who had been subjected to inappropriate behaviors in their surgical careers, bringing the profession into disrepute. Currently, limited data are available in the medical literature on discrimination, bullying and harassment (DBH) in surgery. This significant information gap prompted a systematic review to compile relevant information about DBH in surgical practice and training, in particular, its prevalence and impact. A literature search was conducted using the MEDLINE, EMBASE and PubMed databases (May 1929-October 2017). Studies identified were appraised with standard selection criteria. Data points were extracted, and meta-analysis was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Eight studies, comprising 5934 participants, were examined. Discrimination occurred in a pooled estimate of 22.4% [95% Confidence Interval (CI) = 14.0-33.9%]. One of the papers reported the prevalence of bullying using two methods including Revised Negative Acts Questionnaire and a definition by Einarsen. Pooled estimate of incidence rate was thus 37.7% (95% CI = 34.0-41.5%) and 40.3% (95% CI = 34.7-46.2%), respectively. In terms of harassment, pooled prevalence was 31.2% (95% CI = 10.0-65.0%). DBH is a significant issue in surgery. The true incidence of these issues may remain underestimated. Actions are being taken by professional bodies to create a positive culture in surgery. The effectiveness of these strategies is yet to be determined. More studies are warranted to investigate the magnitude of these issues given their psychological impact, and more importantly to monitor the effectiveness of current measures.
Publisher: Wiley
Date: 17-11-2011
DOI: 10.1002/IJC.26292
Abstract: With the availability of a therapeutic target and an effective agent in trastuzumab, a systematic examination of the literature to investigate the role of human epidermal growth factor 2 (HER2) as a prognostic factor for survival and its association with clinicopathologic markers may improve treatment. An electronic search of the MEDLINE and PubMed databases (January 1990 to January 2011) was undertaken to identify translational studies that correlated HER2 with clinicopathologic markers and/or survival outcome. This review included 49 studies totaling 11,337 patients. Forty-four percent of patients had Stage I/II, and 56% had Stage III/IV disease. Immunohistochemistry was most commonly used to assess HER2 expression, identifying a median rate of 18% (range, 4-53%) of gastric cancer demonstrating HER2 overexpression. In patients with and without HER2 overexpression, the median 3-year disease-free survival rate was 58% (range, 50-88%) and 86% (range, 62-97%), respectively. Of the 35 studies reporting the impact of HER2 overexpression on survival, 20 studies (57%) reported no difference in overall survival, two studies (6%) reported significantly longer overall survival in patients with HER2 overexpression and 13 studies (37%) reported significantly poorer overall survival in patients with HER2 overexpression. The median overall survival and 5-year survival rate was 21 (range, 10-57) months and 42%, and 33 (range, 13-80) months and 52% in patients with and without HER2 overexpression, respectively. HER2 overexpression appears to be associated with poorer survival and with intestinal-type gastric cancer in this group of patients for whom majority undergone curative gastrectomy.
Publisher: Wiley
Date: 13-01-2020
DOI: 10.1111/ANS.15651
Abstract: Patients may present with a resectable pancreatic tumour in the context of a concurrent primary extra-pancreatic malignancy. These patients pose a dilemma regarding their suitability for surgery. We evaluated our experience with such patients who underwent pancreatic resection with curative intent and detailed their outcomes and rationale for surgical decision-making. A retrospective review of patients with pancreatic concurrent extra-pancreatic primary malignancy who underwent pancreatic resection at our institution over a 12-year period (2005-2016) was performed. Clinical, histopathological and perioperative outcomes were reviewed. Ten patients with a median age of 74 years (40-85 years) were identified. Secondary primary tumours included thyroid (n = 2), gastrointestinal (n = 4), small bowel neuroendocrine (n = 1), renal (n = 1) and haematological malignancies (n = 2). Pancreatic tumours included pancreatic ductal adenocarcinomas (n = 6), solid pseudopapillary neoplasms (n = 2) and ullary carcinomas (n = 2). After a median follow up of 41.3 months (31.3-164 months), 8 of 10 patients were still alive. Two patients died due to metastatic disease from the secondary malignancy (small bowel neuroendocrine tumour and sigmoid colon adenocarcinoma). The post-operative complication rate was 30% with no perioperative 90-day mortality. Selected patients with a pancreatic and concurrent primary extra-pancreatic malignancy may undergo curative pancreatic resection with favourable outcomes.
Publisher: Elsevier BV
Date: 06-2012
DOI: 10.1016/J.SURONC.2011.01.005
Abstract: The role of hepatic resection, taking into consideration the functional status of the liver, for localized hepatocellular carcinoma (HCC) is an established curative treatment. In advance disease, a variety of interventional-based liver-directed therapies and more recently systemic therapy with sorafenib are available to treat unresectable tumors. Extrahepatic Metastasis (EHM) of HCC may occur at initial diagnosis or during recurrence following treatment. This may occur with or without concurrent intrahepatic disease. We reviewed the published works on surgical metastasectomy for common sites of EHM of HCC metastases. It appears from the studies reported in the literature that from selected cases reported, long-term survival may be achieved from resecting metastasis at sites of the abdominal lymph node, adrenal gland, lung, and peritoneum. The encouraging results presented demonstrate that highly selected fit patients may be suitable candidates for these radical curative pursuits. It is likely that indications for resection of EHM HCC may benefit patients with limited isolated metastasis, who have a preserved liver function, and whose primary tumor has been adequately controlled. A registry study to pull the results of case reports and institutional experiences may be useful in cumulating evidence of this practice.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 10-2012
Publisher: Elsevier BV
Date: 12-2011
Publisher: Springer Science and Business Media LLC
Date: 14-02-2019
DOI: 10.1007/S12022-019-9570-Y
Abstract: Pancreatic neuroendocrine tumours (PNETs) are relatively uncommon, accounting for 1-2% of all pancreatic neoplasms. Tumour grade (based on the Ki67 proliferative index and mitotic rate) is associated with metastatic risk across large cohorts however, predicting the behaviour of in idual tumours can be difficult. Therefore, any tool which could further stratify metastatic risk may be clinically beneficial. We sought to investigate microRNA (miRNA) expression as a marker of metastatic disease in PNETs. Tumours from 37 patients, comprising 23 with locoregional disease (L) and 14 with distant metastases (DM), underwent miRNA profiling. In total 506 miRNAs were differentially expressed between the L and DM groups, with four miRNAs (miR-3653 upregulated, and miR-4417, miR-574-3p and miR-664b-3p downregulated) showing statistical significance. A database search demonstrated that miRNA-3653 was associated with ATRX abnormalities. Mean survival between the two groups was correlated with mean expression of miRNA-3653 however, this did not reach statistical significance (p = 0.204). Although this is a small study, we conclude that miRNA-3653 upregulation may be associated with an increased risk of metastatic disease in PNETS, perhaps through interaction with ATRX and the alternate lengthening of telomeres pathway.
Publisher: SAGE Publications
Date: 27-06-2014
Abstract: Objectives. Percutaneous bipolar radiofrequency ablation (RFA) is a minimally invasive technique for treating liver tumors. It is not always possible to insert the bipolar probes parallel to each other on either side of tumor, since it restricts maneuverability away from vital structures or ablate certain tumor shape. Therefore, we investigated how nonparallel placement of probes affected ablation. Methods. Bipolar RFA in parallel and in ergent positions were submerged in tissue model (800 mL egg white) at 37°C and ablated. Temperature probes, T1 and T2 were placed 8.00 mm below the tip of the probes, T3 in between the probe coil elements and T4 and T5 at water inlet and outlet, respectively. Both models with heat sink (+HS) and without (−HS) were investigated. Results. The mean ablated tissue volume, mass, density and height increased linearly with unit angle increase for −HS model. With +HS, a smaller increase in mean volume and mass, a slightly greater increase in mean density but a reduction in height of tissue was seen. The mean ablation time and duration of maximum temperature with +HS was slightly larger, compared with −HS, while −HS ablated at a slightly higher temperature. The heat sink present was minimal for probes in parallel position compared to nonparallel positions. Conclusion. Divergence from parallel insertion of bipolar RFA probes increased the mean volume, mass, and density of tissue ablated. However, the presence of large heat sinks may limit the application of this technique, when tumors border on larger vessels.
Publisher: Wiley
Date: 24-10-2011
Publisher: SAGE Publications
Date: 16-10-2013
Abstract: Background. Radiofrequency ablation (RFA) is widely used for treating liver tumors recurrence is common owing to proximity to blood vessels possibly due to the heat sink effect. We seek to investigate this phenomenon using unipolar and bipolar RFA on an egg white tumor tissue model and an animal liver model. Materials and methods. Temperature profiles during ablation (with and without vessel simulation) were studied, using both bipolar and unipolar RFA probes by 4 strategically placed temperature leads to monitor temperature profile during ablation. The volume of ablated tissue was also measured. Results. The volume ablated during vessel simulation confirmed the impact of the heat sink phenomenon. The heat sink effect of unipolar RFA was greater compared with bipolar RFA (ratio of volume affected 2:1) in both tissue and liver models. The volume ablated using unipolar RFA was less than the bipolar RFA (ratio of volume ablated = 1:4). Unipolar RFA achieved higher ablation temperatures (122°C vs 98°C). Unipolar RFA resulted in tissue damage beyond the vessel, which was not observed using bipolar RFA. Conclusion. Bipolar RFA ablates a larger tumor volume compared with unipolar RFA, with a single ablation. The impact of heat sink phenomenon in tumor ablation is less so with bipolar than unipolar RFA with sparing of adjacent vessel damage.
Publisher: Wiley
Date: 18-11-2010
DOI: 10.1002/CNCR.25640
Abstract: Currently, no tumor-node-metastasis (TNM) staging system exists for patients with diffuse malignant peritoneal mesothelioma (DMPM). The primary objective was to formulate a clinicopathological staging system through the identification of significant prognostic parameters. Eight international institutions with prospectively collected data on patients who underwent cytoreductive surgery and hyperthermic intraperitoneal chemotherapy contributed to the registry. Two hundred ninety-four patients had complete clinicopathological data and formed the basis of this staging project. Peritoneal cancer index (PCI) was categorized into T(1) (PCI 1-10), T(2) (PCI 11-20), T(3) (PCI 21-30), and T(4) (PCI 30-39). Twenty-two patients had positive lymph nodes (N(1) ) and 12 patients had extra-abdominal metastases (M(1) ). The survival for patients with T(1) (PCI 1-10) N(0) M(0) was significantly superior to the other patients. This group of patients is therefore designated as Stage I. The survival of patients with T(2) (PCI 11-20) and T(3) (PCI 21-30), in absence of N(1) or M(1) disease, was similar. This group of patients was categorized as Stage II. The survival of patients with T(4) (PCI 30-39), N(1,) and/or M(1) was similarly poor. This group of patients was therefore categorized as Stage III. Three prognostic factors were independently associated with survival in the multivariate analysis: histological subtype, completeness of cytoreduction, and the proposed TNM staging. The 5-year survival associated with Stage I, II, and III disease was 87%, 53%, and 29%, respectively. The proposed TNM staging system resulted in significant stratification of survival by stage when applied to the current multi-institutional registry data.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 08-2016
DOI: 10.1016/J.IJSU.2016.06.033
Abstract: Peritoneal cancer index (PCI) has been suggested to be the most important prognostic factors for the outcomes in colorectal peritoneal carcinomatosis (CRPC). This was a retrospective study of prospectively collected data of 168 consecutive patients with CRPC following cytoreductive surgery (CRS) and perioperative intraperitoneal chemotherapy (PIC). Patients were ided into five groups according to their PCI. Hospital mortality was 0%. Patients in low PCI groups had a significantly lower major morbidity rate, shorter intensive care unit and high dependency unit stay and higher overall survival (p=0.017, 0.001, 0.046, p<0.001 respectively). Combined CRS with PIC can be safely performed to provide encouraging survival benefits for patients with CRPC. Our findings suggest that this approach is particularly beneficial for patients with low volume of disease. Early referral to specialist centre for evaluation is warranted for better survival outcomes.
Publisher: Wiley
Date: 19-12-2014
DOI: 10.1111/JGH.12399
Abstract: Upfront liver transplantation is the gold standard in the treatment of patients with hepatocellular carcinoma (HCC) and cirrhosis, but a shortage of donor organs negatively impacts on survival outcomes, with significant disease progression during long waiting lists. This systematic review evaluates the safety and efficacy of salvage liver transplantation (SLT) as treatment for recurrent HCC after initial hepatic resection. Electronic searches of Pubmed, Embase, and Medline databases identified 130 abstracts, from which 16 eligible studies comprising 319 patients were selected for review. Studies adopting SLT following primary hepatic resection for recurrent HCC with more than five patients were included. Demographic details, morbidity and mortality indices, and survival outcomes were collected from each study and were tabulated. All patients included in the studies had liver cirrhosis, with the majority being Child-Pugh A (50%) and B (33%). The etiology of liver disease was hepatitis B in the majority of patients (84%). Disease recurrence occurred in 27-80% of patients at a median of 21.4 months (range 14.5-34) following initial resection. SLTs were performed on 41% of recurrences, and were associated with biliary complications (8%), infection (11%), bleeding (8%), and vascular complications (7%). There were 18 perioperative deaths (5.6%). The median 1-, 3-, and 5-year overall and disease-free survival was 89%, 80%, and 62%, and 86%, 68%, and 67%, respectively. Synthesis of available observational studies suggests that SLT following primary hepatic resection is a highly applicable strategy with long-term survival outcomes that are comparable to upfront liver transplantation.
Publisher: Springer Science and Business Media LLC
Date: 30-07-2009
DOI: 10.1245/S10434-009-0536-Z
Abstract: Primary signet-ring cell carcinoma (SRC) of colorectal and appendiceal origin is a rare entity with an aggressive biology and clinical behavior. The majority of patients develop peritoneal carcinomatosis (PC) early in the disease. Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) may potentially improve survival. An observational study of 33 patients with SRC of colorectal or appendiceal origin was identified through a retrospective review of two peritoneal surface malignancy databases between January 1997 and December 2008. Survival analysis was performed using the Kaplan-Meier method. Thirty-three patients (18 women (55%) mean age at diagnosis of carcinomatosis, 49 (standard deviation = 12) years) were identified to have SRC, with 15 cases of colorectal and 18 of appendiceal origin. For patients with colonic SRC who underwent complete CRS and HIPEC versus systemic chemotherapy only, the median survival was 13 and 18 months (P = 0.75). For patients with appendiceal SRC who underwent complete CRS and HIPEC versus systemic chemotherapy only, the median survival was 27 and 15 months (P = 0.12). There seems to be less survival benefits after a complete CRS and HIPEC as a curative treatment for PC from colorectal SRC compared with that for non-SRC colorectal adenocarcinoma. However, in patients with appendiceal SRC, long-term survival is a reality after treatment.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 08-2012
Publisher: Springer Science and Business Media LLC
Date: 29-07-2009
Publisher: Elsevier BV
Date: 09-2011
DOI: 10.1016/J.AMJSURG.2010.08.041
Abstract: Hilar cholangiocarcinoma (HC) is invariably fatal without surgical intervention. The primary aim of the current study was to report overall survival and recurrence-free survival outcomes after surgical resection of HC. Between December 1992 and December 2009, 85 patients were evaluated of these, 42 patients underwent potentially curative surgery. These patients are the principal subjects of this study. Patients were assessed monthly for the first 3 months and then at 6-month intervals after treatment. Recurrence-free survival and overall survival were determined 18 clinicopathologic and treatment-related factors associated with recurrence-free survival and overall survival were evaluated through univariate and multivariate analyses. No patient was lost to follow-up evaluation. The median follow-up period was 20 months (range, 0-106 mo). The median recurrence-free survival and overall survival after resection was 15 and 28 months, respectively. The 5-year survival rate was 24%. Two factors were associated with overall survival: histologic grade (P = .002) and margin status (P = .033). Only histologic grade (P = .029) was associated with recurrence-free survival. Surgical resection is an efficacious treatment for HC. Patient selection based on identified prognostic factors can improve treatment outcomes.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 03-2015
Publisher: Elsevier BV
Date: 12-2012
DOI: 10.1016/J.SURONC.2012.07.001
Abstract: This review examines the clinical efficacy and safety of the use of hepatic arterial chemoembolization, bland embolization and radioembolization in the treatment of unresectable neuroendocrine tumor liver metastases (NETLM). Response to treatment, survival outcome and toxicity were examined in this review of 37 studies comprising 1575 patients. These therapies are safe and effective in the treatment of NETLM. Prospective clinical trials to compare the relative efficacy and toxicity are warranted.
Publisher: Elsevier BV
Date: 08-2012
DOI: 10.1016/J.EJCA.2011.10.034
Abstract: Recent data suggest that hepatectomy for patients with colorectal liver metastases (CLM) with concomitant extrahepatic disease (EHD) achieve encouraging survival result. The authors examine the clinical efficacy of this treatment approach through a systematic review of the published literature. Electronic search of the MEDLINE and PubMed databases (January 2000 to January 2011) to identify studies reporting outcomes of hepatectomy for CLM with resection of EHD was undertaken. Two reviewers independently appraised each study using a predetermined protocol. Clinical efficacy was synthesised through a narrative review with full tabulation of results of all included studies. Twenty-two studies were examined. This comprised 1142 patients. The median disease-free survival was 12 (range, 4-22) months, median overall survival was 30 (range, 14-44) months and median 5-year survival rate was 19% (range, 0-42%). Median 5-year survival of patients with R0 hepatectomy with resection of EHD was 25% (range, 19-36%). Survival based on site of EHD include lung median survival (M/S) was 41 (range, 32-46) months, porto-caval lymph node M/S was 25 (range, 19-48) months, peritoneal metastases M/S was 25 (range, 18-32) months. In the era of effective systemic therapies, surgical resection of CLM and concomitant EHD in carefully selected patients may achieve survival results superior to non-surgically treated patients. This treatment strategy may be considered appropriate especially when a R0 hepatectomy and complete resection of EHD may be achieved.
Publisher: Wiley
Date: 09-10-2012
DOI: 10.1111/J.1754-9485.2012.02459.X
Abstract: To compare the outcomes (survival and adverse events) of the authors' use of (90) Y microsphere radioembolisation in patients with chemotherapy-refractory liver metastases with published data from other groups using radioembolisation. To retrospectively evaluate the efficiency, in particular survival benefits, of radioembolisation in the treatment of liver metastases. Over 5 years, 339 patients underwent (90) Y microsphere radioembolisation for unresectable liver metastases and were evaluated for adverse events at the time of treatment and 1 and 3 months after treatment. Overall survival (OS) was calculated by the Kaplan-Meier method. The results from the present retrospective study were compared with a number of prospective and retrospective clinical trials which have addressed the use of (90) Y microspheres as a salvage treatment for liver metastases. The OS time of the present study (12.0 months) compares favourably with survival times reported by other groups. The incidence of late grade 2 adverse events (e.g. duodenal or gastric ulceration, radiation-induced liver disease, gall bladder complications) is comparable to previous studies, with a lower prevalence of grade 2/3 ulcerations (3.7%) at our centre. The survival results, together with the low acute and late toxicity observed in our data and previous studies, support the use of radioembolisation to aid in the local control of unresectable liver metastases in the salvage setting. The present study contributes to the growing evidence for efficiency, in particular survival gains, of radioembolisation in the treatment of liver metastases.
Publisher: Wiley
Date: 06-2009
Publisher: Elsevier BV
Date: 12-2009
DOI: 10.1016/J.EJSO.2009.07.005
Abstract: An aggressive therapy comprising of cytoreductive surgery (CRS) and perioperative intraperitoneal chemotherapy (PIC) and liver resection/ablation is generally not offered to patients with both colorectal peritoneal carcinomatosis (CRPC) and liver metastases (LM) as it no longer represents a loco-regional disease. We review the outcomes of patients who underwent an aggressive treatment with a curative intent for both CRPC and LM as a prelude towards determining the suitability of this treatment. Patients with CRPC were treated with cytoreductive surgery and perioperative intraperitoneal chemotherapy in our institution. Patients with LM underwent additional treatment of liver resection/ablation. The characteristics and survival of patients with isolated CRPC and those with both CRPC and LM were compared. Fifty-five patients underwent complete cytoreductive surgery for treatment of CRPC, amongst which 16 patients had LM. The overall median survival was 36 months. Fourteen of the 16 patients treated for CRPC and LM underwent synchronous treatment. When patients with CRPC alone or CRPC with LM were compared, patients with CRPC and LM had a lower PCI (p=0.03), received less HIPEC infusion (p<0.001), received less of both HIPEC and EPIC infusion (p=0.007), had a shorter procedural duration (p=0.001) and required less blood transfusion (p=0.02). There was no difference in survival between patients who had CRPC alone or CRPC with LM who underwent aggressive treatment (p=0.77). A curative procedure may be offered to selected patients with CRPC and LM, especially in those with a low peritoneal cancer index.
Publisher: Springer Science and Business Media LLC
Date: 30-10-2009
DOI: 10.1245/S10434-009-0777-X
Abstract: There are no treatment options for unresectable intrahepatic cholangiocarcinoma (ICC) with proven efficacy. The objective of this study was to present data on the safety and efficacy of a novel treatment option, yttrium-90 ((90)Y) radioembolization for unresectable ICC. Twenty-five patients underwent resin-based (90)Y radioembolization for unresectable ICC between January 2004 and May 2009. Patients were assessed at 1 month and then at 3-month intervals after treatment. Radiologic response was evaluated with the Response Criteria in Solid Tumors (RECIST) criteria. Clinical and biochemical toxicities were prospectively recorded. Survival was calculated by the Kaplan-Meier method and potential prognostic variables were identified. No patient was lost to follow-up. The median follow-up was 8.1 (range, 0.4-56) months and the median survival after (90)Y radioembolization was 9.3 months. Two patients died within 1 month of treatment the median follow-up for the remaining 23 was 8.9 (range, 1.5-56) months. Two factors were associated with an improved survival: peripheral tumor type (vs. infiltrative, P = .004) and Eastern Cooperative Oncology Group performance status of 0 (vs. 1 and 2, P < .001). On imaging follow-up of 23 patients, a partial response to treatment was observed in 6 patients (24%), stable disease in 11 patients (48%), and progressive disease in 5 patients (20%). The most common clinical toxicities were fatigue (64%) and self-limiting abdominal pain (40%). Two patients (8%) each developed grade III bilirubin and albumin toxicity. One patient (4%) developed grade III alkaline phosphatase toxicity. (90)Y radioembolization may be a relatively safe and efficacious treatment for unresectable ICC. In the absence of other effective therapeutic options, this treatment warrants further investigation.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 10-2010
Publisher: Wiley
Date: 06-04-2011
DOI: 10.1002/JSO.21942
Abstract: To evaluate the distribution and scope of surgical research in Australia relating to malignant diseases in the field of surgery. Surgical publications relating to adult malignant diseases originating from Australia were identified from a systematic literature examination using PubMed during a 12-year period between 1998 and 2009. The origin of the article, journal impact factor (IF), type of research and its subspecialty discipline were recorded. Over a 12-year period, 1,132 papers were published in various journals at a median annual rate of 98 papers. Four hundred eighty-five (43%) papers arose from institutions in New South Wales, 225 (20%) papers from Victoria, 150 (13%) papers from South Australia, 106 (9%) papers from Western Australia, and 77 (7%) papers from Queensland. The mean IF was 3.22 (SD = 2.5). Papers were most commonly published in journals including the ANZ Journal of Surgery (n = 237, 21%), Annals of Surgical Oncology (n = 50, 4%), British Journal of Surgery (n = 38, 3%), and Diseases of the Colon and Rectum (n = 36, 3%). The mean IF of papers published per year ranged from 2.55 to 3.87. The most number of papers were published in the fields of urological oncology (n = 103, 9%), hepatopancreaticobiliary oncology (n = 144, 13%), breast oncology (n = 174, 15%), and colorectal oncology (n = 222, 20%). Bibliometric findings of this review suggest that there is a growth in high scientific research publications in the field of surgical oncology in Australia, indicating an interest in this discipline. This research trend may impact on the national research strategy for clinical cancer control.
Publisher: Springer Science and Business Media LLC
Date: 14-04-2011
DOI: 10.1245/S10434-011-1714-3
Abstract: Surgical cytoreduction and intraperitoneal chemotherapy is increasingly accepted as an effective treatment modality for mucinous appendiceal neoplasm. For the majority of patients with low-grade histology, outcomes have been encouraging. The survival of patients with neoplasms of malignant character is protracted and this study was designed to evaluate the effectiveness of this surgical strategy on outcomes. Forty-six consecutive patients with mucinous and nonmucinous appendiceal cancer with peritoneal dissemination were studied. Clinicopathological and treatment related factors were obtained from a prospective database. The study's end points of disease-free survival (DFS) and overall survival (OS) were analyzed using the Kaplan-Meier method. The median DFS and OS after cytoreduction were 20.5 and 56.4 months respectively. Five-year overall survival rate was 45%. Five independent factors associated with DFS and OS were identified through a multivariate analysis: age (DFS p = 0.001, OS p = 0.002), completeness of cytoreduction (DFS p = 0.001, OS p = 0.003), previous chemotherapy treatment (DFS p = 0.021), CA 199 levels (DFS p = 0.013), and tumor grade (OS p = 0.005). Cytoreductive surgery and intraperitoneal chemotherapy may achieve long-term survival in appendiceal malignancies with peritoneal dissemination for which the predictors of outcomes identified through this study may tailor the disease management to commit patients early toward this successful surgical strategy.
Publisher: Springer Science and Business Media LLC
Date: 29-04-2009
DOI: 10.1007/S12253-009-9170-0
Abstract: Gender influence on survival in mesothelioma has been observed in several large clinical series. However, this gender effect has not been investigated. Female patients often have less aggressive tumors and survive longer. However, few studies in the literature have explained the molecular basis of this finding. Understanding this difference at a molecular level may offer the hope of improving survival via hormonal manipulation.We investigate the expression of Ki-67 and sex steroid receptors estrogen receptors (ER), progesterone receptors (PR) and androgen receptors (AR) to elucidate any pathognomonic difference that characterize this gender difference. Positive expression of markers was observed in 95% (Ki-67), 80% (ER), 100% (PR) and 65% (AR) of patients. Expression of markers between gender showed a higher Ki-67 in males (M = 1.3%, F = 0.6%), higher estrogen receptor in females (M = 0.6%, F = 1.7%) and higher progesterone receptor in females (M = 1.0%, F = 1.4%). Twenty patients were treated with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in our peritonectomy unit. Paraffin sections of the tumor specimens were retrieved for immunohistochemical analysis. The immunostaining was performed using monoclonal mouse anti-human antibodies on an autostainer (Autostainer Plus Dako, Inc.). The intensity of the stains were quantified using the Image-Pro Plus (IPP) 4.5 (Media Cybernetics, Silver Spring, MD). For the first time, we demonstrate the presence of sex steroid receptors in peritoneal mesothelioma. Once the exact functional effects of these receptors are understood, the use of established therapeutic options that are clinically available to target the sex steroid pathway may become a reality.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 05-2020
DOI: 10.1097/MPA.0000000000001551
Abstract: The development of increasingly effective chemotherapy regimens and increasing tumor necrosis is allowing radical pancreatectomy to be re-evaluated. This systematic review examines the outcome of patients with locally advanced cancer of the pancreatic head after pancreatectomy with arterial resection. Electronic searches were performed on PubMed and Medline databases between January 2000 and December 2018. The end points were to determine the safety and overall survival after arterial resection in pancreatectomy. Thirteen studies with 467 patients were included. Celiac, hepatic, mesenteric, and splenic arteries were resected across all studies. The median overall morbidity was 52% (range, 37%–100%) and with major complications occurring in a median of 25% (range, 12%–54%) of patients. The median 90-day mortality was 5% (range, 0%–17%). R0 was achieved in 66% (range, 43%–100%) and R1 in 31% (range, 0%–74%). The median survival was 17 (range, 7–29) months with a 1- and 3-year survival of 59% (range, 16%–92%) and 17% (range, 0%–13%), respectively. Pancreatectomy with arterial resection may be safely performed in high-volume centers with acceptable survival results in highly selected patients. Pooling of data through a multi-institutional registry will allow a more accurate assessment of the safety and efficacy of this treatment strategy.
Publisher: Elsevier BV
Date: 06-2013
DOI: 10.1016/J.SURONC.2013.02.009
Abstract: Primary hepatectomy is an accepted treatment for primary hepatocellular carcinoma (HCC) with good long-term survival, but high rates of recurrence. This review aims to evaluate the safety and efficacy of repeat hepatectomy for recurrent HCC after initial hepatectomy. Electronic searches identified 22 eligible studies comprising of 1125 patients for systematic review. Studies with >10 patients, adopting repeat hepatectomy treatment for recurrent HCC initially treated with hepatectomy were selected for inclusion. A predetermined set of data comprising demographic details, morbidity and mortality indices and survival outcomes were collected for every study and tabulated. Majority of patients selected for repeat hepatectomy had Child-Pugh A (median 94%, range 40-100). Intrahepatic recurrence occurred at a median of 22.4 (range 12-48) months in this patient cohort with single nodule recurrences comprising of 70% of cases. The median mortality rate was 0% (range 0-6%). Prolonged ascites was observed in a median of 4% (range 0-32%), bleeding in 1% (range 0-9%), bile leak in 1% (range 0-6%) and liver failure in 1% (range 0-2%). The median disease-free survival was 15 (range 7-32) months and median overall survival was 52 (range 22-66) months. Median 3-year and 5-year survival was 69% (range 41-88%) and 52% (range 22-83%) respectively. Recurrences occurring 12-18 months after initial hepatectomy was consistently associated with improved survival. Synthesized data from observational studies of repeat hepatectomy suggests that this treatment approach for recurrent HCC is safe and achieves long-term survival. Standardization of criteria for repeat hepatectomy and a randomized trial are warranted.
Publisher: Elsevier BV
Date: 04-2019
DOI: 10.1016/J.AMJSURG.2018.12.037
Abstract: This study examines the impact of intraoperative macroscopic tumour consistency on short-term and long-term outcomes after cytoreductive surgery (CRS) with intraperitoneal chemotherapy (IPC) for appendiceal adenocarcinoma with peritoneal metastases. Macroscopic intraoperative tumour consistency was classified in three groups as soft (jelly-like geltatinous tumours), hard (hard tumour nodules without gelatinous features) and intermediate (both soft and hard features). In-hospital mortality, major morbidity, intensive care unit (ICU), high dependency unit (HDU) and total hospital stay, disease-free survival (DFS) and overall survival (OS) were compared. The three groups had similar perioperative short-term outcomes. Patients with soft, intermediate and hard tumours revealed differences in OS (p < 0.001) and DFS (p = 0.03). Multivariable analysis revealed a shorter OS for patients with hard versus soft tumours (HR for hard tumours = 4.43, 95%CI 2.19-9.00). Intraoperative macroscopic tumour consistency may be used as a prognostic marker for survival in patients with appendiceal adenocarcinoma with peritoneal metastases.
Publisher: Wiley
Date: 07-01-2020
DOI: 10.1111/ANS.15678
Publisher: Springer Science and Business Media LLC
Date: 29-12-2009
DOI: 10.1245/S10434-009-0875-9
Abstract: Cytoreductive surgery (CRS) combined with perioperative intraperitoneal chemotherapy (PIC) has demonstrated improved survival in selected patients with pseudomyxoma peritonei (PMP). However, this aggressive treatment modality has been consistently associated with variable rates of perioperative mortality between 0% and 18% and morbidity between 30% and 70%. This study evaluates the clinical and treatment-related risk factors for perioperative morbidity and mortality in PMP patients who underwent CRS and PIC. A total of 145 consecutive CRS and PIC procedures for PMP performed between January 1996 and March 2009 were evaluated. The association of 12 clinical and 20 treatment-related risk factors with grades III and IV/V morbidity were assessed by univariable and multivariable analysis. The mortality (grade V) rate was 3%. The morbidity rates of grades III and IV were 23% and 22%, respectively. Eight factors were associated with grade IV/V morbidity on univariable analysis: peritoneal cancer index >or=21 (P = .034), ASA score >or=3 (P = .003), operation duration >or=10 h (P or=6 units (p = 0.011). Multivariable analysis showed 2 significant risk factors for grade IV/V morbidity: ASA >or= 3 (P = .006) and an operation length >or=10 h (P < .001). CRS and PIC has an acceptable rate of perioperative mortality and morbidity in selected patients with PMP. Patients with bulky disease who undergo a long operation are at a particularly high risk of a severe adverse event.
Publisher: Wiley
Date: 30-11-2019
DOI: 10.1111/ANS.15558
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 06-2011
Publisher: Wiley
Date: 24-03-2017
DOI: 10.1111/JGH.13583
Publisher: Wiley
Date: 19-11-2013
DOI: 10.1111/ANS.12459
Publisher: Elsevier BV
Date: 07-2009
Publisher: Springer Science and Business Media LLC
Date: 20-01-2010
DOI: 10.1245/S10434-009-0898-2
Abstract: Cytoreductive surgery (CRS) and perioperative intraperitoneal chemotherapy (PIC) has improved survival in selected patients with peritoneal carcinomatosis. This study evaluates the morbidity of postoperative pancreatic fistula (PF) within the context of CRS and PIC. Two hundred seventy-one consecutive CRS and PIC procedures were evaluated. Diagnosis and classification of postoperative PF were performed according to the international study group on PF criteria. The associations between 8 clinical and 20 treatment-related factors with postoperative PF were determined by univariate and multivariate analysis. The management and clinical sequelae of postoperative PF were discussed. Seventeen patients (6.3%) developed postoperative PF. None of these patients died during their in-hospital stay. Multivariate analysis identified three independent risk factors for PF: transfusion of >or=6 units of blood (P = 0.029), operation duration of >or=9 h (P = 0.035), and splenectomy (P = 0.020). Conservative management of PF was instituted in all 17 patients and was successful in 16 (94%). The overall time to PF closure was 26 (standard deviation 16) days after diagnosis. Although PF did not contribute to procedure-related mortality, it was associated with increased length of hospital stay (P < 0.001). CRS and PIC presented an acceptable rate of PF that did not increase the procedure-related mortality. However, PF was associated with longer hospital stay. Most patients with PF were treated conservatively and did not require surgical intervention.
Publisher: AME Publishing Company
Date: 04-2021
Publisher: Elsevier BV
Date: 10-2011
DOI: 10.1016/J.EJCA.2011.06.024
Abstract: Systemic chemotherapy is the mainstay of treatment for metastatic breast cancer with the role of surgery being strictly limited for palliation of metastatic complications or locoregional relapse. An increasing number of studies examining the role of therapeutic hepatic metastasectomy show encouraging survival results. A systematic review was undertaken to define its safety, efficacy and to identify prognostic factors associated with survival. Electronic search of the MEDLINE and PubMed databases (January 2000-January 2011) to identify studies reporting outcomes of hepatectomy for breast cancer liver metastases (BCLM) with hepatectomy was undertaken. Two reviewers independently appraised each study using a predetermined protocol. Safety and clinical efficacy was synthesised through a narrative review with full tabulation of results of all included studies. Nineteen studies were examined. This comprised of 553 patients. Hepatectomy for BCLM was performed at a rate of 1.8 (range, 0.7-7.7) cases per year in reported series. The median time to liver metastases occurred at a median of 40 (range, 23-77) months. The median mortality and complication rate were 0% (range, 0-6%) and 21% (range, 0-44%), respectively. The median overall survival was 40 (range, 15-74) months and median 5-year survival rate was 40% (range, 21-80%). Potential prognostic factors associated with a poorer overall survival include a positive liver surgical margin and hormone refractory disease. Hepatectomy is rarely performed for BCLM but the studies described in this review indicate consistent results with superior 5-year survival for selected patients with isolated liver metastases and in those with well controlled minimal extrahepatic disease. To evaluate its efficacy and control for selection bias, a randomised trial of standard chemotherapy with or without hepatectomy for BCLM is warranted.
Publisher: Wiley
Date: 17-10-2011
DOI: 10.1002/JSO.22114
Abstract: Surgery confers the best chance of long-term survival in patients with neuroendocrine neoplasm hepatic metastases (NENHM). Disease progression invariably occurs in the majority of patients. No previous study has addressed the outcomes after treatment of hepatic disease progression in patients who initially underwent surgical extirpation of NENHM. This was the principal aim of the current study. Seventy-four patients with NENHM underwent surgery for NENHM between December 1992 and December 2009. Of these, 50 patients developed disease progression in the liver. These patients were then treated with specific liver-directed therapies according to consensus of a multidisciplinary team. The current study evaluates progression-free survival (PFS) and overall survival (OS) following treatment of hepatic disease progression with specific liver-directed therapies. No patient was lost to follow up. The median follow-up after treatment of progression was 29 months (range = 2-137). The median PFS and OS after diagnosis of disease progression were 15 and 48 months, respectively. Specific liver-directed therapies included surgery in 10 patients, radioembolization in 15, cytotoxic chemotherapy in 14, and conservative therapy in 11. Four independent factors associated with PFS and OS were identified through a multivariate analysis. These were initial progression-free survival (PFS, P = 0.006, HR= 0.32), extra-hepatic disease (OS, P = 0.029, HR = 4.04 PFS, P = 0.004, HR = 4.03), histological grade (PFS, P = 0.006, HR = 4.08), and type of secondary intervention (PFS, P = 0.024, HR = 0.63). A multimodality approach towards treatment of disease progression as shown in this study that includes repeat surgery or radioembolization has been shown to achieve a superior outcome in the setting of disease progression/recurrence.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 04-2017
DOI: 10.1097/DCR.0000000000000719
Abstract: It has been increasingly recognized that appendiceal mucinous neoplasm with peritoneal dissemination is not a homogenous disease. This study aimed to examine the impact of different histological subtypes on survival of a large cohort of patients with appendiceal mucinous neoplasms uniformly treated by cytoreductive surgery and intraperitoneal chemotherapy. This was a retrospective study of prospectively collected data of patients with peritoneal dissemination of appendiceal neoplasm who underwent cytoreductive surgery and intraperitoneal chemotherapy. The study was conducted by 1 surgical team at St. George Hospital. A total of 444 patients formed the cohort of this study. Histological diagnoses were categorized based on Carr criteria to include acellular mucin, disseminated peritoneal adenomucinosis, peritoneal mucinous neoplasms without signet ring cells, and peritoneal mucinous carcinomatosis with signet cells. Patients with low-grade appendiceal mucinous neoplasms with neoplastic epithelium absent tended to have lower CEA, CA19-9, and CA125 levels preoperatively ( p = 0.109, 0.008, and 0.034). Factor analysis showed that histological diagnosis was an independent prognostic factor for survival outcomes (HR = 3.13 (95% CI, 2.34–4.39) p 0.001), adjusted for peritoneal cancer index , completeness of cytoreductive score ≥2, use of early postoperative intraperitoneal chemotherapy, transfusion units, CEA .0 mg/L, CA19-9 .0 U/mL, and CA125 U/mL. This study was limited by its retrospective nature, lack of uniform classifications of appendiceal mucinous neoplasms in early years, and the heterogeneity of this study cohort given the long study period. Histological subtype remains a significant prognostic factor for survival outcomes in patients with appendiceal mucinous neoplasms. It should be taken into account when selecting patients for cytoreductive surgery, tailoring appropriate adjuvant therapies and follow-up surveillance plan.
Publisher: Wiley
Date: 05-10-2017
DOI: 10.1111/ANS.14191
Abstract: The impact of the public and private hospital systems on major abdominal operations that are demanding on clinical resources, such as pancreatic surgery, has not been explored in an Australian setting. This study examines the perioperative outcome of patients undergoing pancreatoduodenectomy (PD) at a major public and private hospital. Patients undergoing PD between January 2004 and October 2015 were classified based on their health insurance status and location of where the surgery was performed. Clinical variables relating to perioperative outcome were retrieved and compared using univariate and multivariate analyses. Four hundred and twenty patients underwent PD of whom 232 patients (55%) were operated on in the private hospital. Overall, there was no difference in morbidity and mortality in the public versus the private hospital. However, there were variations in public versus private hospital, this included longer duration of surgery (443 min versus 372 min P < 0.001), increased estimated blood loss (683 mL versus 506 mL P < 0.001) and more patients requiring perioperative blood transfusion (25% versus 13% P = 0.001). Of the 10 complications compared, post-operative bleeding was higher in the private hospital (11% versus 5% P = 0.051) and intra-abdominal collections were more common in the public hospital (11% versus 5% P = 0.028). Independent predictive factors for major complications were American Society of Anesthesiologists score (odds ratio (OR) = 1.91 P = 0.050), patients requiring additional visceral resection (OR = 3.36 P = 0.014) and post-operative transfusion (OR = 3.37 P < 0.001). The hospital type (public rivate) was not associated with perioperative outcome. Comparable perioperative outcomes were observed between patients undergoing PD in a high-volume specialized unit in both the public and private hospital systems.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 02-2008
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 05-2010
Publisher: Wiley
Date: 20-03-2017
DOI: 10.1111/ANS.13897
Abstract: Neoadjuvant therapy is increasingly recognized as an effective strategy prior to pancreatoduodenectomy. We investigate the role of neoadjuvant chemotherapy (NAC) followed by surgery and the predictive role of viable residual tumour cells histopathologically on outcomes. The study population comprised of 195 consecutive patients with pancreatic adenocarcinoma who were treated with either NAC or a surgery-first (SF) strategy. Histopathological viable tumour cells were examined in the NAC patients and clinicopathological factors were correlated with overall survival. Forty-two patients (22%) were treated with NAC and 153 patients (78%) underwent SF. NAC was associated with higher estimated blood loss during surgery (928 mL versus 615 mL P = 0.004), fewer ( 65% residual tumour cells was 45% and 90% in patients who had <65% residual tumour cells (P = 0.022). Favourable responders (<65% viable tumour cells) were observed to have shorter operation time (<420 min) (55% versus 13% P = 0.038), trend towards negative lymph node status (38% versus 10% P = 0.067) and greater lymph node harvest in node positive patients (≥4 positive lymph nodes) (77% versus 37% P = 0.045). The improved survival of patients undergoing NAC indicates effective management of micrometastatic disease and is an effective option requiring further investigation. Histopathological viable tumour cells after NAC was a surrogate marker for survival.
Publisher: Impact Journals, LLC
Date: 04-08-2017
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 02-2012
Publisher: Wiley
Date: 04-02-2022
DOI: 10.1111/ANS.17513
Abstract: Obesity is a perceived risk factor for poorer surgical outcomes, including increased complication rates and mortality. As obesity rates rise annually, evaluating surgical outcomes in the obese population has become increasingly important. This study examines the impact of obesity on outcomes following emergency laparoscopic cholecystectomy (LC) for acute cholecystitis. A retrospective review of patients who underwent emergency LC for acute cholecystitis between March 2018 and March 2021 was performed. A total of 326 patients were included and stratified by body mass index (BMI) into two groups: obese (BMI ≥30 kg/m 2 , n = 156) and non‐obese (BMI kg/m 2 , n = 170). Primary outcomes included length of stay, time to definitive surgery, and postoperative complications. Secondary outcomes included total operative time and intraoperative findings. Obese patients were younger than non‐obese patients (median, 45 [34.3–56.8] and 48.5 [34.0–66.3] years p 0.001) and had a higher prevalence of diabetes (13.5% versus 6.5% p = 0.034). Higher American Society of Anesthesiologists (ASA) classification ( p 0.001) and operative grading scores were observed in the obese group (76.3% versus 40.6%, p 0.001), who were more likely to have a distended gallbladder (19.9% versus 11.2%, p = 0.030) and gallstone impaction (23.1% versus 11.8%, p = 0.007) in comparison to the non‐obese group. Length of hospital stay, time to definitive surgery, and postoperative complication rates were similar between groups. Although obesity is associated with greater technical difficulty during surgery than non‐obese patients, similar postoperative outcomes were achieved. Obesity should not be a contraindication for LC and can be safely performed in the emergency setting.
Publisher: Wiley
Date: 10-12-2020
DOI: 10.1111/JGH.15349
Publisher: Springer Science and Business Media LLC
Date: 20-02-2014
DOI: 10.1038/JHG.2014.11
Publisher: Wiley
Date: 12-06-2014
DOI: 10.1111/CODI.12611
Abstract: Local excision of early rectal cancer is a less morbid alternative to major abdominal surgery. This review evaluates the role of local excision with neoadjuvant or adjuvant chemoradiotherapy to identify a select group of patients where local excision is appropriate without significantly compromising the oncological outcome. MEDLINE, PubMed and the Cochrane Central Register of Controlled Trials databases were searched to identify relevant articles investigating the role of local excision with adjuvant or neoadjuvant chemoradiotherapy in patients with T1/T2N0M0 disease. Eleven studies comprising 455 patients were selected. Oncological end-points included overall survival, disease-free and disease-specific survival, recurrence rates as well as perioperative morbidity and mortality. At a range of 30.5-115.2 months, median overall survival, disease-specific and disease-free survival were 75% (66-80.6%), 89% (75-93.3%) and 74% (64-85.2%), respectively. Median local, distant and overall recurrence rates were 10% (4.8-25%), 4.7% (4-11.8%) and 13.1% (10.7-23.5%), respectively. Mortality was 0% in all studies except one (2.9%). Most reported complications were minor and were treated conservatively. This systematic review provides data suggesting that selected patients with T1/T2N0M0 rectal cancer may undergo local excision without compromising the oncological outcome otherwise conferred by total mesorectal excision. It may be a particularly useful option in patients in whom radical surgery is contraindicated. Randomized trials comparing both management strategies to consolidate this finding may lead to a paradigm change in the management of early rectal cancer.
Publisher: Wiley
Date: 07-2016
DOI: 10.1111/JGH.13285
Publisher: Elsevier BV
Date: 06-2017
DOI: 10.1016/J.AMJSURG.2016.09.046
Abstract: A significant proportion of patients with peritoneal surface malignancy (PSM) experienced recurrence after initial cytoreductive surgery (CRS). Thus the aims of this study were to determine short-term outcomes and long-term survivals associated with repeat CRS. This was a retrospective study of prospectively collected data of consecutive patients with PSM who underwent CRS by one surgical team at St George Hospital in Sydney, Australia between Jan 1996 and May 2016. There was no significant difference in hospital mortality (p=0.343) and major morbidity rate (p=0.454). Patients who underwent repeat surgery had a significantly higher 5-year overall survival (OS) rate (p<0.001) and a longer median disease free interval (DFS) (p<0.001). Repeat CRS was also found to be a significant prognostic factor for OS (p<0.001) and DFS (p<0.001). Repeat CRS with or without perioperative intraperitoneal chemotherapy could provide long-term survival benefits to patients with PSM with acceptable mortality and morbidity rates. 1. Repeat CRS with or without PIC provides long-term survival benefits to patients with PSM. 2. Repeat CRS with or without PIC is feasible and can be performed without acceptable mortality and morbidity rates.
Publisher: Wiley
Date: 28-07-2010
Publisher: Wiley
Date: 02-2010
DOI: 10.1111/J.1478-3231.2009.02166.X
Abstract: Resection of hepatocellular carcinoma (HCC) offers the only hope for cure. However, in patients undergoing resection, recurrences, in particular, intrahepatic recurrence are common. The effectiveness of transarterial chemoembolization (TACE) as a neoadjuvant therapy for unresectable HCC was exploited by numerous liver units and employed preoperatively in the setting of resectable HCC with an aim to prevent recurrence and prolong survival. A systematic literature search of databases (Medline and PubMed) to identify published studies of TACE administered preoperatively as a neoadjuvant treatment for resectable HCC was undertaken. A systematic review by tabulation of the results was performed with disease-free survival (DFS) as the primary endpoint. Overall survival (OS), rate of pathological response, impact on surgical morbidity and mortality and pattern of recurrences were secondary endpoints of this review. Eighteen studies three randomized trials and 15 observational studies were evaluated. This comprised of 3927 patients, of which, 1293 underwent neoadjuvant TACE. The median DFS in the TACE and non-TACE group ranged from 10 to 46 and 8 to 52 months, respectively, with 67% of studies reporting similar DFS between groups despite higher extent of tumour necrosis from the resected specimens indicating a higher rate of pathological response (partial TACE 27-72% vs. non-TACE 23-52% complete TACE 0-28% vs. non-TACE zero), with no difference in surgical morbidity and mortality outcome. No conclusion could be drawn with respect to OS. Both randomized and non-randomized trials suggest the use of TACE preoperatively as a neoadjuvant treatment in resectable HCC is a safe and efficacious procedure with high rates of pathological responses. However, it does not appear to improve DFS.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 02-2010
Publisher: Wiley
Date: 27-12-2012
DOI: 10.1002/JSO.23303
Abstract: Primary cytoreductive surgery (CRS) and peri-operative intraperitoneal chemotherapy (PIC) is the only curative option for patients with colorectal cancer peritoneal carcinomatosis (PC). A significant proportion of patients develop peritoneal recurrence. Outcomes of patients undergoing secondary CRS and PIC for recurrent PC were examined. All patients undergoing second procedures with curative intent for recurrent appendiceal or colorectal cancer PC in three centers were included. Patients with recurrent pseudomyxoma peritonei (PMP) were excluded. Morbidity and mortality, overall survival, and disease-free survival were primary outcome parameters. The study included 18 patients (13 colorectal and 5 appendiceal cancer). At primary CRS, mean Peritoneal Cancer Index (PCI) was 9.1. In 13 patients complete resection was achieved. Median time to recurrence was 14 months (range: 1-33). At secondary CRS, mean PCI was 6.3 and CRS was complete in 13 patients. There was no 30-day mortality and 1- and 2-year survival were 74% and 50%, respectively. In 14 patients a recurrence after the second procedure was diagnosed. A secondary CRS for recurrent colorectal or appendiceal cancer PC is safe and feasible, however, relapse is frequent. Further investigations are required to critically assess the efficacy of a secondary procedure and to define optimal patient selection criteria in the era of effective modern chemotherapy.
Publisher: Wiley
Date: 23-08-2010
DOI: 10.1002/CNCR.25283
Abstract: Hepatic artery administration of iodine-131-Lipiodol serves as a modality that delivers targeted radiation therapy to hepatocellular carcinoma. Its efficacy has been promising according to trials conducted in the adjuvant setting after hepatic resection. Further investigation of its role in the palliative setting is warranted. A retrospective review of 72 patients with unresectable hepatocellular carcinoma treated with iodine-131-Lipiodol and followed up by the St. George Hospital Sydney's hepatobiliary service was conducted. Efficacy of treatment was determined based on progression-free and overall survival as the endpoints using the Kaplan-Meier method. Sixty men and 12 women with a mean age of 65 years (standard deviation = 11) underwent iodine-131-Lipiodol treatment. Chronic viral hepatitis was present in 29 (41%) patients. Fifty (69%) patients were Child-Pugh class A. Median progression-free survival was 6 months, and overall survival was 14 months the 1-, 2-, and 3-year survival rates were 52%, 33% and 20%, respectively. Factors associated with survival include the American Joint Committee on Cancer stage (P = .03), Barcelona Clinic Liver Cancer stage (P = .05), Cancer of the Liver Italian Program score (P = .008), tumor size (P = .01), extrahepatic disease (P < .001), previous surgery (P = .02), and response to treatment (P < .001). The response to treatment was identified through a multivariate analysis as the single independent predictor for survival (hazard ratio, 3.5 95% confidence interval, 2.2-5.4 P < .001). Encouraging survival outcomes may be derived through administration of iodine-131-Lipiodol in patients with unresectable hepatocellular carcinoma. The overall success of treatment may be determined by the response to treatment.
Publisher: Springer Science and Business Media LLC
Date: 24-07-2014
DOI: 10.1007/S10151-014-1189-X
Abstract: There have been conflicting opinions regarding the superiority of open and laparoscopic surgery in preserving bladder and sexual function after rectal cancer surgery. This systematic review and meta-analysis aims to pool the available data comparing the impact of surgical approaches on postoperative sexual and urinary function. A search of Pubmed, Medline, Cochrane and Embase was undertaken and studies from January 2000 to February 2013 were identified. We included, in our meta-analysis, both prospective and retrospective studies that compared laparoscopic surgery and open surgery for rectal cancer. A total of 876 patients undergoing rectal cancer surgery (lap n = 468, open n = 408) were examined. In men, postoperative ejaculatory function and erectile dysfunction evaluated from two studies comprising of 74 patients showed no difference between groups. The rate of overall sexual dysfunction evaluated from five studies comprising of 289 patients revealed a rate of 34 % in both the open and lap groups. Postoperative urinary function evaluated from five studies comprising of 312 patients showed no difference between groups. In women, postoperative sexual and urinary function were evaluated from five studies comprising of 321 patients. Three studies (n = 219) reported no difference in sexual function between groups. Postoperative urinary function evaluated from four studies comprising of 212 patients was found to be comparable. The available data are limited, but suggest that neither form of surgical approach be it laparoscopy or open surgery demonstrate superiority in preservation of sexual and bladder function. Further research into the technical aspects of surgery and evaluating newer minimally invasive technologies such as the robot may prove to be useful in improving functional outcomes of rectal cancer patients.
Publisher: Elsevier BV
Date: 02-2011
DOI: 10.1016/J.AMJSURG.2010.02.012
Abstract: Peritoneal carcinomatosis imposes an enormous clinical burden to the oncologic community. This study reports the patterns of care of the locoregional approach of cytoreductive surgery (CRS) and perioperative intraperitoneal chemotherapy as a curative procedure for peritoneal carcinomatosis from the experience of a single tertiary center in Australia. We performed a review of clinical records from a prospective database of patients who were treated at the St George Hospital Peritoneal Surface Malignancy Program according to a standard protocol. A total of 308 CRS were performed in 249 patients with peritoneal surface malignancy the mean age was 53 years and 55% were women. Over the years, we expanded the age limit for treatment (P = .03), reduced intensive care unit stays (P = .04), reduced amount of blood transfusion (P = .03), treated patients with a higher peritoneal cancer index (P < .001), achieved higher rates of complete cytoreduction (P = .003), increased use of PIC (P < .001), and improved complication rate (P = .02) and mortality rate (P = .01). The median survival of patients treated over the years also improved (P = .001). We show the maturity of the treatment of peritoneal carcinomatosis with CRS and perioperative intraperitoneal chemotherapy in our institution after an initial learning curve with expansion of the selection criteria, improved perioperative outcomes, improved surgical results, and long-term survival outcomes.
Publisher: Elsevier BV
Date: 10-2010
Abstract: Image-guided percutaneous radiofrequency ablation (RFA) has been proposed as an efficacious local therapy for lung metastases in nonsurgical candidates. Reports of long-term outcome from this treatment have been limited. A prospective open-labeled trial of RFA was initiated in November 2000 for treatment of lung metastases in nonsurgical candidates. RFA was carried out under fluoroscopic computed tomography. Treatment complications and survival parameters were analyzed. Of 148 patients treated, 66 patients (46%) had a complete response, 38 patents (26%) had a partial response, 57 patients (39%) had stable disease and 23 patients (16%) had progressive disease. The median progression-free survival was 11 months [95% confidence interval (CI) 9-14]. The median overall survival and 3- and 5-year survivals were 51 months (95% CI 19-83) and 60% and 45%, respectively. Disease-free interval (P = 0.013) and response to treatment (P = 0.002) were independent predictors for overall survival. Complications occurred in up to 45% of patients, of which 45 patients (30%) required chest tube placement. This analysis confirms that RFA of lung metastases may achieve long-term survival in nonsurgical candidates with an acceptable complication rate hence supporting its incorporation into the oncosurgical management of lung metastases for the purposes of cure, stabilization and disease prolongation.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 02-2015
Publisher: Wiley
Date: 18-10-2019
DOI: 10.1111/ANS.15466
Publisher: Massachusetts Medical Society
Date: 09-12-2010
DOI: 10.1056/NEJMC1011061
Publisher: Wiley
Date: 18-01-2021
DOI: 10.1111/ANS.16558
Publisher: Elsevier BV
Date: 06-2017
DOI: 10.1016/J.AMJSURG.2016.09.049
Abstract: Distal cholangiocarcinoma remains a rare cancer associated with a dismal outcome. There is a lack of effective treatment options and where disease is amendable to resection, surgery affords the best potential for long-term survival. The aim of this study was to examine the survival outcomes and prognostic factors of patients undergoing pancreatoduodenectomy for distal cholangiocarcinoma. Between January 2004 to May 2016, patients who had undergone pancreatoduodenectomy with histologically proven distal cholangiocarcinoma were identified. Clinicopathologic data and survival outcomes were reported. Pancreatoduodenectomy alone was performed in 20 patients (71%) and eight patients (29%) required concomitant vascular resection. The major complication rate was 43% (n = 12). Nineteen patients (68%) had node positive disease. Eighteen patients (64%) had R0 resection. The median survival was 36 months (95%CI 9.7 to 63.8) and 5-year survival rate was 24%. Univariate analysis identified ASA (P < 0.001), tumor grade (P = 0.009) and margin status (P = 0.042) as prognostic factors associated with survival. Long-term survival may be achieved in selected patients undergoing pancreatoduodenectomy for distal cholangiocarcinoma, especially in patients who achieved an R0 resection.
Publisher: Springer Science and Business Media LLC
Date: 13-02-2019
DOI: 10.1007/S00423-019-01759-0
Abstract: Delayed massive post-pancreatectomy haemorrhage (PPH) is a highly lethal complication after pancreatectomy. Angiographic procedures have led to improved outcomes in the management of these patients. In the setting of an acute haemorrhage, laparotomy and packing are often required to help stablise the patient. However, re-operative surgery in the post-pancreatectomy setting is technically challenging. A novel strategy of incorporating the resuscitative endovascular balloon occlusion of the aorta (REBOA) is described. Two patients where the specific application of this technique uses the REBOA were described. The REBOA serves as a useful adjunct in haemorrhage control and haemodynamic stablisation to allow successful management of delayed massive PPH.
Publisher: Elsevier BV
Date: 07-2009
Publisher: Wiley
Date: 07-2013
DOI: 10.1111/ANS.12306
Abstract: There is now a considerable body of published evidence supporting the use of a multimodal approach consisting of cytoreductive surgery (CS) and heated intraperitoneal chemotherapy (HIPEC) in the treatment of peritoneal metastases (PM) arising from selected gastrointestinal tract malignancies. In the absence of systemic metastases, it is thought that disease confined to the peritoneum may be eradicated through optimum cytoreduction. This review critically evaluates the current body of published evidence for the use of CS/HIPEC in the treatment of advanced colorectal, appendiceal and gastric cancer. Although its role remains less defined in patients with gastric PM, current evidence provides a compelling argument for its use in PM of colorectal and appendiceal origin. With a low mortality and acceptable morbidity rate, CS/HIPEC may offer hope of long-term survival and cure in a defined group of patients with this disease.
Publisher: Wiley
Date: 05-08-2010
Publisher: Wiley
Date: 10-2009
Publisher: Wiley
Date: 03-2017
DOI: 10.1111/ANS.13755
Publisher: Springer Science and Business Media LLC
Date: 09-11-2010
DOI: 10.1007/S10147-010-0143-9
Abstract: Resection of hepatocellular carcinoma (HCC) is potentially curative however, recurrence is common. To date, few or no effective adjuvant therapies have been adequately investigated. This study evaluates the efficacy of adjuvant iodine-131-lipiodol after hepatic resection through the experience of a single-center hepatobiliary service of managing this disease. All patients who underwent hepatic resection for HCC and received adjuvant iodine-131-lipiodol between January 1991 and August 2009 were selected for inclusion into the experimental group. A group composed of patients treated during the same time period without adjuvant iodine-131-lipiodol was identified through the unit's HCC surgery database for comparison. The endpoints of this study were disease-free survival and overall survival. Forty-one patients who received adjuvant iodine-131-lipiodol after hepatic resection were compared with a matched group of 41 patients who underwent hepatic resection only. The median disease-free and overall survival were 24 versus 10 months (P = 0.032) and 104 versus 19 months (P = 0.001) in the experimental and control groups, respectively. Rates of intrahepatic-only recurrences (73 vs. 37% P = 0.02) and surgical and nonsurgical treatments for recurrences (84 vs. 56% P = 0.04) were higher in the experimental group compared to the control group. The finding of this study corroborates the current evidence from randomized and nonrandomized trials that adjuvant iodine-131-lipiodol improves disease-free and overall survival in patients with HCC after hepatic resection. The lengthened disease-free survival after adjuvant iodine-131-lipiodol allows for further disease-modifying treatments to improve the overall survival.
Publisher: Wiley
Date: 17-03-2009
DOI: 10.1002/JSO.21230
Abstract: Pleural dissemination of pseudomyxoma peritonei (PMP) is considered an advanced/terminal disease. We review our experience with thoracic cytoreductive surgery (CRS) and intraoperative hyperthermic intrathoracic chemotherapy (HITHOC) for the treatment of pleural recurrence of PMP following previous intraabdominal surgery. An observational study of five patients with pleural dissemination from PMP treated with thoracic CRS and intraoperative HITHOC with mitomycin C for 90 min at 41.5 degrees C. There were three men. The mean age was 46.5 (10.5) years. Postoperatively, one patient developed Grade I, one patient developed Grade III and one patient developed Grade IV postoperative complication. Two patients had an unremarkable postoperative recovery. Only one patient has died 38 months since treatment from abdominal complication of this disease with no evidence of thoracic disease. The four surviving patients are still alive 4.6-47.4 months after treatment. Two patients have evidence of an intraabdominal recurrence. Thoracic CRS and intraoperative HITHOC is a safe and effective procedure to treat pleural dissemination from PMP. Long-term disease-free survival can be achieved from this treatment for which no other potentially curative therapy has been described.
Publisher: Springer Science and Business Media LLC
Date: 13-09-2011
DOI: 10.1245/S10434-011-2025-4
Abstract: Only 15% of patients with colorectal liver metastases (CLM) are candidates for curative hepatectomy at time of diagnosis, limited by anatomical location and tumor burden. Ablative therapies may extend this. This study reports a single institution's long-term experience with hepatic cryotherapy for advanced CLM. Between April 1990 and June 2009, 304 patients were curatively treated with cryotherapy. Survival was estimated by Kaplan-Meier method. Prognostic factors for survivals were determined by using univariate and multivariate analyses. A total of 293 patients were included into analysis. The median number of lesions treated per patient was three (range, 1-13). The median overall survival was 29 (range, 3-220) months. The 1-, 3-, 5-, and 10-year survivals were 87%, 41.8%, 24.2%, and 13.3%, respectively. A total of 161 patients developed intrahepatic recurrences: cryosite (23%) edge recurrence (14%) and within the liver remnant (78%). The median disease-free survival (DFS) was 9 (range, 1-220) months. The 1-, 3-, 5-, and 10-year DFS rates were 37.9%, 17.2%, 13.4%, and 10.8%, respectively. Univariate analysis identified four factors that significantly affect survival: node-positive primary tumor (p=0.001), preoperative CEA level (p<0.001), number of lesions (p<0.001), and use of neoadjuvant chemotherapy (p<0.001). However, only primary tumor nodal status was independently prognostic (hazards ratio=2.023 95% confidence interval, 1.444-2.835 p<0.001). Hepatic cryotherapy seems to be a safe and effective ablative technique for the treatment of colorectal liver metastases and may offer long-term survival in otherwise unresectable disease.
Publisher: Springer Science and Business Media LLC
Date: 15-04-2011
DOI: 10.1007/S12029-011-9278-9
Abstract: Emerging data suggest that in the current era of modern systemic therapies, resection of colorectal liver metastases with concomitant extrahepatic disease may be a curative option in selected patients. A commentary of several key recent papers including an international multi-institutional registry study may provide directions in the future management of this disease entity. The premise of selecting patients for a surgical approach to resect colorectal liver metastases and concomitant extrahepatic disease should be in idualized. Incorporation of key prognostic factors that include the site of extrahepatic disease, the ability to undertake a complete resection, disease responding to chemotherapy, and an assessment of tumor biology through examining an in idual's disease history may guide the selection of suitable patients for this therapeutic pursuit. A 5-year survival of 30% may be realized in well-selected patients. Concomitant extrahepatic disease in patients with colorectal liver metastases should not be a contraindication to resection of colorectal cancer metastases.
Publisher: Elsevier BV
Date: 2012
DOI: 10.1016/J.JVIR.2011.09.028
Abstract: To retrospectively evaluate the safety and survival of patients with chemotherapy-refractory liver metastases treated with yttrium-90 ((90)Y) resin microspheres, and to compare survival in this patient group versus survival after standard/supportive care to assess whether radioembolization contributes to survival gains in the salvage setting. While 339 patients with chemotherapy-refractory liver metastases underwent (90)Y microspheres radioembolization at a single institution between 2006 and 2011, 51 patients were referred back to their treating physician for conservative treatment or best supportive care. Adverse events were assessed at the time of treatment and at 1 and 3 months after treatment. Overall survival (OS) was calculated by the Kaplan-Meier method for the radioembolization cohort (as a whole and according to two subcohorts: patients with colorectal primary cancer and patients with all other primary cancers, eg, breast or neuroendocrine) and the standard-care cohort. The median OS after (90)Y radioembolization (339 patients) was 12.0 months, versus 6.3 months for the standard-care cohort (51 patients P < .001). The median OS times for the two subcohorts were 11.9 months and 12.7 months, respectively. At the 3-month follow-up, the incidence of more serious adverse events was low, with 11 cases (3%) of ulceration, 10 cases (2.9%) of radiation-induced liver disease, and six complications (1.8%) involving the gallbladder (eg, cholecystitis). The present study suggests that radioembolization shows promise as an effective and safe treatment for patients with chemotherapy-refractory hepatic metastases and improves overall survival in a select population of patients in a salvage setting compared with best supportive care alone.
Publisher: Wiley
Date: 06-07-2022
DOI: 10.1111/ANS.17893
Publisher: Springer Science and Business Media LLC
Date: 10-2009
DOI: 10.1007/S12253-009-9210-9
Abstract: Peritoneal mesothelioma is one of the peritoneal surface malignancies where long-term survival is a reality after cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC). Tumor angiogenesis has been shown to be of prognostic significance on survival in mesothelioma. We investigated the impact of survival of patients with peritoneal mesothelioma following CRS and HIPEC to determine the impact of tumor angiogenesis on survival after this radical surgical treatment. Paraffin sections of 23 patients who were treated with CRS and HIPEC were retrieved for immunohistochemical analysis. The immunostaining was performed using monoclonal mouse anti-human antibodies (VEGF-C and CD31) on an autostainer (Autostainer Plus Dako, Inc.). The intensity of the stains were quantified using the Image-Pro Plus (IPP) 4.5 (Media Cybernetics, Silver Spring, MD). VEGF expression and microvessel density (MVD) using CD31 staining were studied. The median survival was 94 months with a 3-year survival rate of 51%. There was no impact on patient's age, sex, peritoneal cancer index, tumor histopathology and survival outcomes between patients with low or high MVD and VEGF expression. After CRS and HIPEC, our results demonstrate that the prognostic significance of tumor angiogenesis is negated, highlighting the potential importance of other co-contributory mechanisms in mesotheliomagenesis and undergoing radial treatment.
Publisher: Wiley
Date: 17-08-2020
DOI: 10.1111/ANS.16203
Publisher: Wiley
Date: 11-03-2020
DOI: 10.1111/AJO.13145
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 06-2011
Publisher: Springer Science and Business Media LLC
Date: 22-12-2009
DOI: 10.1245/S10434-009-0866-X
Abstract: In patients with colorectal cancer peritoneal carcinomatosis (CRPC), only patients with a complete cytoreduction will benefit. The current selection criteria are ill-defined. The Peritoneal Surface Disease Severity (PSDS) staging was introduced as a basis of scoring patients into prognostic groups to improve patient selection. This study determines the impact on survival of the PSDS in a cohort of patients undergoing complete cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) for CRPC. A retrospective review of two prospective databases of patients with complete CRS and HIPEC for CRPC was performed to score patients on the PSDS. Survival was analyzed using the Kaplan-Meier method. Univariate and multivariate analyses were performed to determine the impact of various clinicopathological factors on survival. There were 56 patients who underwent complete cytoreduction and HIPEC. Of these, 6 patients (11%) were PSDS stage I and median survival (MS) has not been reached, 33 patients (59%) were PSDS stage II and MS was 38 months, 10 patients (18%) were PSDS stage III and MS was 24 months, and 7 patients (13%) were PSDS stage IV and MS was 7 months. Univariate analysis demonstrated the association of clinical symptoms (P = .022), PSDS (P = .002), and tumor histopathology (P = .074) as factors affecting survival. Multivariate analysis demonstrated that PSDS (P = .002) was an independent positive predictive factor associated with survival. In patients with CRPC who undergo a complete cytoreduction and HIPEC, the PSDS staging system has been demonstrated to be an important prognostic indicator. It appears that even with a complete cytoreduction and HIPEC, patients with PSDS stage IV do not benefit from treatment.
Publisher: Springer Science and Business Media LLC
Date: 22-09-2010
DOI: 10.1007/S00432-010-0948-Y
Abstract: To evaluate the role of radioembolization and systemic chemotherapy as a combined modality therapy for unresectable colorectal liver metastases. Prospective database of a major yttrium-90 microsphere radioembolization treatment center in Sydney, Australia, that included 140 patients with unresectable colorectal liver metastases was analyzed. Tumor response, overall survival, treatment-related complications and an evaluation of its role as a combined modality therapy with systemic chemotherapy were performed. One hundred and thirty-three patients (95%) had a single treatment, and seven patients (5%) had repeated treatments. Response following treatment was complete in two patients (1%), partial in 43 patients (31%), stable in 44 patients (31%), and 51 patients (37%) developed progressive disease. Combining chemotherapy with radioembolization was associated with a favorable treatment response (P = 0.007). The median overall survival was 9 (95% CI 6.4-11.3) months with a 1-, 2-, and 3-year survival rate of 42, 22, and 20%, respectively. Primary tumor site (P = 0.019), presence of extrahepatic disease (P = 0.033), and a favorable treatment response (P < 0.001) were identified as independent predictors for survival. Combined modality therapy appears to improve tumor response rates. Survival is influenced by tumor site, presence of extrahepatic disease, and response to therapy. Yttrium-90 microsphere radioembolization is safe and may best be combined with systemic chemotherapy for patients with unresectable colorectal liver metastases.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 02-2014
Publisher: Springer Science and Business Media LLC
Date: 26-08-2015
DOI: 10.1245/S10434-015-4826-3
Abstract: The appropriate surgical strategy in patients with small pancreatic lesions of low malignant potential, such as pancreatic neuroendocrine tumors, remains unknown. Increasing reports suggest limited pancreatic surgery may be a safe option for parenchymal preservation. PubMed and MEDLINE were searched in the English literature for studies from January 2000 to February 2015 examining enucleation for pancreatic lesions that were single-arm and comparative studies (versus resection). Single-arm enucleation studies were systematically reviewed. Comparative studies were included for meta-analysis. Endpoints include safety, complications, mortality, survival, and parenchymal-related outcomes. Thirteen studies comprising of 1101 patients undergoing enucleation were included. Seven studies were comparative studies of enucleation and standardized pancreatic resection. Enucleation was a shorter procedure (pooled mean differences (MD) = 109, 95 % confidence interval (CI) 105-114 Z = 46.37 P < 0.001) associated with less blood loss (pooled MD = 314, 95 % CI 297-330 Z = 37.47 P < 0.001). Both enucleation and resection had similar mortality and complication rates, but the rate of pancreatic fistula (all grades) (pooled odds ratio (OR) = 1.99 95 % CI 1.2-3.4 Z = 2.57 P = 0.01] and rate of pancreatic fistula (grade B/C) (pooled OR = 1.58 95 % CI 1.0-2.5 Z = 2.06 P = 0.04) was higher in the enucleation group. Enucleation resulted in lower rates of endocrine (pooled OR = 0.22 95 % CI 0.1-0.5 Z = 3.21 P = 0.001) and exocrine (pooled OR = 0.07 95 % CI 0.02-0.2 Z = 5.08 P < 0.001) insufficiency. The median 5-year survival was 95 % (range 93-98) and 84 % (range 79-90). Enucleation appears to be a safe procedure and achieves parenchymal preservation for small pancreatic lesions of low malignant potential. Its oncologic efficacy compared with standardized pancreatic resection with respect to long-term survival and recurrences have not been reported adequately and hence may not be concluded as being comparable.
No related grants have been discovered for TERENCE CHUA.