Complete Resection Of Primary Tumor Research Articles

Heterogeneity in intracranial relapses after complete resection of lung adenocarcinoma: Distinct features of brain-only relapse versus synchronous extracranial relapse.

Patients with brain oligometastases have better prognosis than those with synchronous extracranial metastases in non-small cell lung cancer (NSCLC). However, studies focusing on intracranial-only recurrence after curative surgery remained scarce. This study aimed to explore distinct features of patients with exclusive brain relapse after resection of lung adenocarcinoma. Records were retrospectively reviewed of 2809 patients who had complete resection and pathologically confirmed stage IB-IIIA NSCLC in our hospital from October 2012 to September 2019. Patients were enrolled if they were adenocarcinoma and developed intracranial recurrence thereafter. They were divided into two groups depending on whether they had synchronous extracranial metastases. Clinical and pathological features of patients enrolled were collected and compared between groups. Ninety-seven lung adenocarcinoma patients with intracranial recurrences were enrolled. The median follow-up time was 40 months. Fifty patients (51.5%) had brain oligometastases and 47 patients had synchronous extracranial metastases (ECM). Multivariate logistic regression suggested EGFR-sensitive mutation and male sex were positively correlated to brain-only recurrence (OR = 2.59, 95%CI 1.04-6.84 and OR = 2.58, 95% CI 1.05-6.75), while higher clinical stage was associated with synchronous ECM (stage II (OR = 0.33, 95%CI 0.09-1.14) or stage IIIA (OR = 0.54, 95%CI 0.20-1.38) versus stage I). No other pathological feature (lymphovascular invasion, visceral pleural invasion, low tumor differentiation, etc.) or adjuvant chemotherapy was associated with intracranial-only relapse after complete resection of primary tumor. Among patients with brain relapse after resection of lung adenocarcinoma, patients with EGFR mutations might have intracranial relapse only without synchronous extracranial metastases. Further prospective studies are warranted to verify this.

Clinical Usefulness of Postoperative Serum Carcinoembryonic Antigen in Patients with Colorectal Cancer with Liver Metastases.

Colorectal cancer with liver metastasis (CLM) has high postoperative recurrence rates; therefore, optimizing perioperative treatment is imperative. Postoperative carcinoembryonic antigen (CEA) can aid in detecting minimal residual disease in colon cancer following curative resection. This study aimed to identify the potential role of serum CEA following liver resection in patients with CLM. This retrospective study was conducted at the Cancer Institute Hospital of the Japanese Foundation for Cancer Research from 2004 to 2018 and enrolled patients with CLM who underwent complete resection of primary tumors and CLM. Associations between perioperative CEA levels and characteristics of recurrence were investigated. Recurrence was detected during a median follow-up period of 90.1 months in 343 (54.2%) out of 633 analyzed patients. Patients in the postoperative CEA level > 5 ng/ml group had a significantly higher recurrence rate (75.7% versus 50.0%,p < 0.01) and shorter time until recurrence (4.4 versus 36.9 months,p < 0.01) than those in the postoperative CEA level ≤ 5 ng/ml group. Multivariate analysis revealed that postoperative CEA level > 5 ng/ml was an independent predictor, with hazard ratios of 2.77 (p < 0.01) for recurrence-free survival (RFS) and 3.18 (p < 0.01) for overall survival (OS). Additionally, RFS was significantly shorter among patients in the postoperative CEA level > 5 ng/ml group who did not have normalized CEA levels following adjuvant chemotherapy than among those in the normalized CEA group. The postoperative and post-adjuvant chemotherapy CEA levels in the CEA level > 5 ng/ml group may be predictors of RFS and OS.

Clinical usefulness of postoperative serum carcinoembryonic antigen in colorectal cancer patients with liver metastases.

178 Background: Colorectal cancer with liver metastases (CLM) has high post operative recurrence rates, and optimizing the perioperative treatment is imperative. Post operative carcinoembryonic antigen (CEA) can help detecting minimal residual disease in colon cancer after curative resection. Methods: The aim of this study was to identify the potential role of serum CEA after liver resection in patients with CLM. This study was conducted at the Cancer Institute Hospital, Japanese Foundation for Cancer Research from 2004 to 2018. Patients with CLM who underwent complete resection of primary tumors and liver metastases were enrolled in this study. We studied the associations between the perioperative CEA levels and characteristics of recurrence. Results: Recurrence was detected during the median follow-up time of 50.9 months in 343 (54.1%) of the total 633 patients analyzed. Patients with postoperative CEA (&gt;5) group had a significantly higher recurrence rate (75.7% vs 50.0%, p &lt; 0.01), with a shorter time until recurrence (4.4 months vs 36.9 months, p &lt; 0.01) than those with a postoperative CEA level (≤5) group. In multivariate analysis, a postoperative CEA level &gt;5 ng/ ml was an independent predictor, with the highest hazard ratio for both recurrence free survival (RFS) and overall survival (OS) (RFS: 2.77, 95% confidence interval [CI] 2.14–3.60, p &lt;0.01, OS: 3.18, 95% CI 2.41–4.19, p &lt;0.01). In addition, there was a significantly shorter RFS in the postoperative CEA level (&gt;5) group who did not have normalized CEA levels after adjuvant chemotherapy compared to normalized CEA group (3.3 months vs 18.5 months, p = 0.008). Conclusions: The postoperative CEA and postadjuvant chemotherapy CEA level in the CEA level (&gt;5) group after surgery may be a predictor of RFS and OS.

Macroscopic and microscopic characteristics of low grade appendiceal mucinous neoplasms (LAMN) on appendectomy specimens and correlations with pseudomyxoma peritonei development risk

Low grade appendiceal mucinous neoplasm (LAMN) is the primary source of pseudomyxoma peritonei (PMP). PMP may develop after seemingly complete resection of primary tumor by appendectomy, which is unpredictable due to lack of reliable prognostic indicators. We retrospectively reviewed 154 surgically resected LAMNs to explore if any of the macroscopic and microscopic characteristics may be associated with increasing risk of PMP development. Our major findings include: (1) As compared to those without PMP, the cases that developed PMP were more frequent to have (a) smaller luminal diameter (<1 cm) and thicker wall, separate mucin aggregations, and microscopic perforation/rupture, all suggestive of luminal mucin leakage; (b) microscopic acellular mucin presenting on serosal surface and not being confined to mucosa; and (c) neoplastic epithelium dissecting outward beyond mucosa, however, with similar frequency of neoplastic cells being present in muscularis propria. (2) Involvement of neoplastic cells or/and acellular mucin at surgical margin did not necessarily lead to tumor recurrence or subsequent PMP, and clear margin did not absolutely prevent PMP development. (3) Coexisting diverticulum, resulted from neoplastic or non-neoplastic mucosa being herniated through muscle-lacking vascular hiatus of appendiceal wall, was seen in a quarter of LAMN cases, regardless of PMP. The diverticular portion of tumor involvement was often the weakest point where rupture occurred. In conclusion, proper evaluation of surgical specimens with search for mucin and neoplastic cells on serosa and for microscopic perforation, which are of prognostic significance, should be emphasized.

Management of Ileal Neuroendocrine Tumors with Liver Metastases

PurposeAssessment of treating metastatic ileal neuroendocrine tumors (NETs) with complete resection of primary tumor, nodal and liver metastases, plus administration of long-acting somatostatin analogues (SSAs). MethodsA prospective database was queried for patients with ileal or pancreatic NETs with pathology-confirmed liver metastases and tumor somatostatin receptors. Patients did not have MEN-1 and had no previous treatment. The impacts of SSA treatment on the primary outcome of survival and secondary outcome of progression-free survival were assessed with Kaplan–Meier analysis. Log rank test was used to compare overall and progression-free survival among groups. ResultsSeventeen ileal NET patients and 36 pancreatic NET patients who underwent surgical resection between 2001 and 2018, who had pathology-confirmed liver metastases and confirmed tumor somatostatin receptors, did not have MEN-1, and had no previous treatment were identified. Median follow-up for patients with ileal NETs was 80 months (range 0–197 months) and 32 months (range 1–182 months) for pancreatic NETs. Five-year survival was 93% and 72% for ileal and pancreatic NET, respectively. Progression-free 5-year survival was 70% and 36% for ileal and pancreatic NET, respectively. Overall 5-year survival for pNETs was greater in those patients treated with SSA (79%) compared to those who underwent surgery alone (34%, p < 0.01). The average ECOG score was low for surviving patients with ileal (0.15) and pancreatic NET (0.73) indicating a good quality of life. ConclusionsResection of primary lymph node and liver metastatic ileal or pancreatic NETs followed with continued SSAs is associated with an excellent progression-free and overall survival and minimal side effects.

Recurrent Gastrointestinal Stromal Tumor With Limited Disease Spread: Role of Surgical Resection

Gastrointestinal stromal tumor (GIST) occurs mostly in the stomach and presents usually with gastrointestinal bleeding, abdominal pain, and rarely with perforation. It remains asymptomatic, if advanced far enough, liver metastasis is the frequent site of malignancy. A 61 years old male with a history of a large GIST tumor status post en bloc resection together with partial gastrectomy, distal pancreatectomy and splenectomy with the diaphragmatic implant presented for routine follow up after six months. Post-operatively, he was non-compliant to his adjuvant imatinib therapy due to financial restraints. CT scan and MRI at this follow up visit revealed a 2 cm lesion in the liver concerning for metastatic disease. The patient was taken for elective surgery for laparoscopic lysis of adhesions, exploratory laparotomy, and metastasectomy in segment 2/3 of liver for the metastatic liver lesion. Surveillance CT chest showed no metastasis to the lung. Final pathology from metastectomy showed 2.2 cm High-grade GIST tumor with negative margins. Patient has remained asymptomatic pre- and post-op and had only a surgical scar on abdominal examination. GIST is considered the most common gastrointestinal mesenchymal tumor; the age-adjusted incidence in the United States is 6.8 per million in the Surveillance Epidemiology and End Result (SEER) registry data collected from 1992-2000. Very characteristic of GIST is KIT (CD117) positivity, and in 80% of non-KIT positive GISTs, there is a platelet-derived growth factor receptor alpha (PDGFRa) mutation. There was a 61% decrease in relative risk in progression-free survival in the high dose group on imatinib with the KIT/PDGFRa mutation. Surgical resection, on the other hand, remains the mainstay of therapy especially in cases where the lesion is >2 cm or for non-metastatic localized tumors. Complete resection can be achieved only in few of these patients. Our case was unique in which a metastatic lesion was successfully resected using a limited surgical approach. More than half of GIST cases can experience recurrence even after complete resection of primary tumor, however, in our case the patient lost follow ups and it was difficult to determine the long-term success of metastatic GIST resection.2658_A Figure 1. CT scan abdomen showing 2 cm cystic lesion (arrow).2658_B Figure 2. Histology showing spindle cell lesion in the hepatic parenchyma2658_C Figure 3. Immunofluorescent stain positive for CD117.

Role of Neoadjuvant Radio-chemotherapy for the Treatment of High Rectal Cancer

Controversy exists regarding treatment of high rectal cancer. The role of neoadjuvant radio-chemotherapy was investigated. Fifty-four patients receiving neoadjuvant radio-chemotherapy (50.4 Gy & 2 courses of concurrent chemotherapy) for stage II/III high rectal cancer (10.1-15.0 cm from anal verge) were retrospectively analyzed. Following microscopicallly complete resection of primary tumor and involved lymph nodes in all patients, ≤6 courses of chemotherapy were given. Five-year rates of local control (LC), metastases-free survival (MFS) and overall survival (OS) were 90%, 79% and 77%. On multivariate analyses, LC was associated with lower pathological UICC-stage at surgery (p=0.003) and successful downstaging (p=0.007), MFS with higher regression grade (p=0.014) and OS with lower Union for International Cancer Control (UICC)-stage (p=0.017) and downstaging (p=0.034). Grade 3 acute toxicities occurred in 19% of patients; grade ≥3 late toxicities were not observed. Manageable surgery-related complications occurred in 43%. Neoadjuvant radio-chemotherapy for high rectal cancer was well tolerated and led to promising results. Comparative studies are required to investigate whether it is superior to postoperative chemotherapy alone.

Single Stage Resection of Renal Cell Carcinoma with Right Atrial Extension– A Case Report

Renal cell carcinoma (RCC) is the commonest primary tumor of the kidney which may invade through the renal vein into the inferior vena cava (IVC), and then it can extend intraluminally with subsequent tumor-thrombus formation. Here we report a case involving excision of a primary RCC with tumor-thrombus involving IVC up to right atrium with the use of extracorporeal circulation. Single stage surgical procedure was performed in collaboration with a urological team aiming complete resection of primary tumor, para-aortic lymphadenectomy and removal of IVC thrombus extending to right atrium with the help of cardiopulmonary bypass. After arresting heart, RA was opened and the mass was removed through RA from IVC and hepatic vein level. Abdominal IVC was opened and the entire residual mass was removed from below also small amount of thrombus removed from left renal vein. Postoperative venous doppler showed no residual thrombus in venous system. Histopathology report confirmed papillary renal cell carcinoma. The patient was discharged from hospital in the 12th post-operative day without any complication.J Bangladesh Coll Phys Surg 2018; 36(2): 77-79

Prognostic factors for soft tissue sarcoma patients with lung metastases only who are receiving first-line chemotherapy: An exploratory, retrospective analysis of the European Organization for Research and Treatment of Cancer-Soft Tissue and Bone Sarcoma Group (EORTC-STBSG).

The prognosis of adult soft tissue sarcoma (STS) patients with metastases is generally poor. As little is known about the impact of the involvement of different metastatic sites and the extent of pulmonary lesions on the outcome for patients receiving first‐line chemotherapy, we aimed to establish prognostic factors for STS patients with lung metastases only. A retrospective, exploratory analysis was performed on 2,913 metastatic STS patients who received first‐line chemotherapy. Detailed information from 580 patients who had lung metastases only, was used for prognostic factor analysis. Patients with lung metastases only were more often asymptomatic and had undergone complete primary tumor resection more frequently compared to patients with additional metastases outside the lung or without lung metastases. For extremity STS, the incidence of lung metastases only was much higher compared to non‐extremity STS. Lung involvement only was an independent favorable prognostic factor for overall survival (OS) with regard to metastatic site. Within this subgroup, in a multivariate model, other factors associated with improved OS included: good performance status (PS), no progression at primary site, low histological grade, younger age, long interval between initial diagnosis and trial registration, and smaller diameter of the largest lung lesion. This unique analysis on prognostic factors in STS patients with lung metastases confirms well‐known patient factors (such as age and PS), and tumor characteristics (including tumor grade, interval between primary diagnosis, and metastases), but also identifies diameter of the largest lung lesion as a new prognostic factor. Knowledge about these factors may support decision‐making within multidisciplinary tumor boards.

Effectiveness of 125I seed implantation in the treatment of non-small cell lung cancer during R2 resection.

The aim of the present study was to investigate the effectiveness of 125I particle implantation during R2resection for non-small cell lung cancer (NSCLC). Data from 23 patients with NSCLC and macroscopic residual diseasefollowing surgery (R2 resection) between March 2010 and May 2014 were retrospectively analyzed. Among these patients, 12 patients [4 with T-residual disease (incomplete resection of primary tumor but complete dissection of regional lymph node), 8 with N-residual disease (complete resection of primary tumor but incomplete resection of metastatic regional lymph node)] underwent 125I particle implantation during the operation, while the other 11 (4 with T-residual disease and 7 with N-residual disease) received postoperative conventional radiotherapy. The local control rate, overall survival, and distant metastasis were evaluated. Additionally, the efficacy and safety of brachytherapy using 125I particle implantation during surgery for locally advanced NSCLC were investigated. The 23 patients were followed up for 3–40 months. For the 125I group, the 2-year local control rate was 100%, and the median survival time was 24 months. The 1–2-year survival rates were 83.3 and 58.33%, respectively. For the postoperative radiotherapy group, the median survival time was 12 months, andthe 1- and 2-year survival rates were 54.5 and 27.7%, respectively. No statistically significant difference in 2-year survival rates was detected between the two treatment groups, but the particle implantation group exhibited a higher survival rate trend. For patients with T-residual disease, the survival rate was higher for the 125I seed implantation group compared with the postoperative radiotherapy group. However, there was no significant difference in the rates of metastasis between the two groups for patients with N-residual disease. Therefore, intraoperative implantation of 125I particles during R2 resection of NSCLC may be a safer and more reliable method to reduce the local recurrence rate compared with conventional radiotherapy. Although not statistically significant, the overall survival rate of patients in the 125I seed implantation group was higher compared with the postoperative radiotherapy group.

Carcinoembryonic antigen testing after curative liver resection for synchronous liver metastasis of colorectal cancer: a Japanese multicenter analysis.

To identify the possible roles of carcinoembryonic antigen (CEA) testing after liver resection for synchronous colorectal liver metastasis (CLM). The subjects of this retrospective study were patients who underwent complete resection of primary tumors and synchronous CLM between 1997 and 2007 at 20 institutions in Japan. We studied the associations between perioperative CEA levels and the characteristics of recurrence. Recurrence was detected during the median follow-up time of 52months in 445 (73.7%) of the total 604 patients analyzed. A postoperative CEA level >5ng/ml was an independent predictor, with the highest hazard ratio (2.25, 95% confidence interval 1.29-3.91, P=0.004). A postoperative CEA level >5ng/ml had a specificity of 86.2% and a positive predictive value of 84.2% for recurrence. Patients with a high postoperative CEA level had a significantly higher recurrence rate, with a shorter time until recurrence and a higher frequency of multiple metastatic sites than those with a low postoperative CEA level. Among the patients with recurrence, 173 (52.7%) had an elevated CEA level (>5ng/ml) when recurrence was detected. A postoperative CEA level >5ng/ml was an independent predictor of recurrence; however, CEA testing was not a reliable surveillance tool to identity recurrence after liver resection.

The survival outcome after hepatic resection in patients with liver metastasis from gastric cancer.

161 Background: Optimal treatment strategy for patients with liver metastasis from gastric cancer (LMGC) has not yet been established. Although systemic chemotherapy remains mainstay of treatment for LMGC, complete resection of primary tumor and LMGC may improve survival outcome. Thus, the aim of this study is to investigate survival outcome and prognostic factors of patients who underwent hepatic resection for LMGC. Methods: From September 2002 to February 2014, 30 patients underwent hepatic resection for LMGC in our hospital. Indications of hepatic resection were as follows; (1) hepatic lesion is not more than three, (2) without extrahepatic metastasis other than lymph node metastasis, (3) adequate liver function. We investigated the overall median survival time (MST) and 5-year survival rate of all eligible patients. Univariate and multivariate analyses were performed to assess the association between each clinicopathological features and overall survival time. Results: There were 25 males and 5 females with a median age of 72 (range, 39-86). There were 16 synchronous LMGCs and 14 metachronous LMGCs. With respect to the number of LMGC, 22 patients had 1 lesion, 7 patients had 2 lesions, and 1 patient had 3 lesions. Overall MST and 5 year survival rates after hepatic resection were 2.8 years and 31.0%, respectively. The significant prognostic factors were age (70 years or older, p=0.029) and blood transfusion (p=0.013). Multivariate analysis showed that lymph node metastasis was an only independent indicator of poor prognosis (HR=6.13, p=0.026). Conclusions: Hepatic resection for patients with LMGC might be a promising treatment strategy, with 5-year survival rate of 31.0%. Lymph node metastasis was an only independent prognostic factor. A multi-institutional confirmatory study will be required to evaluate the role of hepatic resection in patients with LMGC.

297. Multimodal approach to stage IV rectal cancer treatment

297. Multimodal approach to stage IV rectal cancer treatment

Minimally invasive surgical techniques are safe in the diagnosis and treatment of pediatric malignancies.

Minimally invasive surgical (MIS) techniques have become an established part of the care of the adult oncology patient. As surgeons have become more experienced with these advances in technique, MIS has recently seen an expanding role in the diagnosis and treatment of pediatric malignancies. We hypothesize that MIS techniques can be used to provide reliable diagnosis and safe therapeutic resection of many pediatric malignancies. We performed a retrospective review of all patients who underwent a minimally invasive operation for diagnosis or treatment of a malignant solid tumor at the Children's Hospital Colorado over a ten-year period. A total of 105 minimally invasive procedures were performed in 98 patients, 61% of which were male. The majority of cases, 78 (74%) were thoracoscopic procedures and the remaining 27 (26%) were laparoscopic procedures. Twenty-one (27%) thoracoscopic procedures were performed for complete resection of primary tumor or metastases, with only three cases (14%) converted to open thoracotomy. Tumors that were successfully removed thoracoscopically include neuroblastomas (n = 8), metastatic disease (n = 7), and a schwannoma. Of the 28 laparoscopic procedures, nine were performed for tumor resection with one case converted to open. Tumors that were successfully removed laparoscopically include 6 adrenal neuroblastomas and one pseudopapillary pancreatic tumor. There were no major surgical complications. No port site or surgical site recurrences were reported. MIS techniques can be used safely and effectively for the diagnosis and resection of pediatric malignancies and treatment decisions can be made accurately based on tissue obtained.

Primary epithelioid angiosarcoma.

10578 Background: Epithelioid angiosarcoma (EAS) is a rare sarcoma. Complete surgical resection, when feasible, is the mainstay of therapy. Relapse rate after complete resection of primary tumor ranges from 45 to 70%, with a median survival (OS) of about 5 years. A multidisciplinary approach combining surgery, radiotherapy (RT) and/or chemotherapy (CT) is advocated by many, but there are no definitive data on the efficacy of (neo)adjuvant CT. Methods: We retrospectively reviewed all primary, localized, completely resected EAS observed at our institution (INT) from 1/2005 to 6/2013. We considered patients (pts) in whom at least one phase of treatment (surgery and/or RT and/or CT) was performed at INT. We excluded pts not amenable to complete surgery. Diagnosis was centrally reviewed. Results: Fifty-one pts were identified (46 surgically treated at INT). M/F: 16/35. RT-related: 20. Primary tumor site: breast, 29 (skin/gland: 22/7); extremities, 10; other, 12. Single versus multifocal: 39/13. Median tumor si...

Abstract 375: Fluorescence-guided surgery leads to improved resection of primary pancreatic cancer and prolonged survival

Abstract The aim of this study was to determine if fluorescence-guided surgery (FGS) could improve surgical outcomes, reduce recurrence rates and improve overall survival in orthotopic mouse models of human pancreatic cancer. Orthotopic mouse models of human pancreatic cancer were established using the BxPC-3 RFP-expressing pancreatic cancer cell line in nude mice. Two weeks after implantation, the mice were randomized to undergo bright light surgery (BLS) or fluorescence-guided surgery (FGS). Pre- and postoperative images were obtained with the Olympus OV-100 Small Animal Imaging System to assess completeness of surgical resection. Whole body imaging of the mice was performed weekly in the postoperative period to assess for recurrence and follow tumor progression. Additionally, half of the mice were randomly selected to undergo 4 weeks of postoperative gemcitabine treatment. At six weeks postoperatively, or when premorbid, the mice were sacrificed and primary pancreatic tumor burden was measured using ImageJ v1.440. A more complete resection of pancreatic cancer was achieved using FGS compared to BLS: 98.9% vs 77.1%, p=0.005. Sixty-three percent of the mice undergoing BLS had evidence of gross residual disease, whereas 20% of mice undergoing FGS received a complete resection and an additional 75% of the mice were left with minimal residual disease (p=0.0001). At six weeks, the primary pancreatic tumor burden was significantly less with FGS compared to BLS: 19.341 ± 5.26 mm2 vs. 6.194 ± 3.61 mm2, p=0.048. In a pilot survival study, FGS alone was associated with a decreased risk of tumor recurrence (HR=0.093, 95% CI 0.013-0.645), and mean overall survival was lengthened from 18.5 weeks to 28.2 weeks. The addition of adjuvant gemcitabine (GEM) to FGS further lengthened mean overall survival to 42.75 weeks (p=0.019). Three of the four mice in the FGS with adjuvant gemcitabine group were alive at 12 months postoperatively and all of the mice (n=4) were free of tumor at time of sacrifice. In this study, we achieved improved surgical outcomes in primary pancreatic cancer under fluorescence-guidance. FGS afforded a more complete resection of primary tumor and improved disease-free survival and overall survival. The combination of FGS and GEM lengthened disease-free survival and improved overall survival. This novel approach has potential to improve outcomes in the surgical treatment of pancreatic cancer. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 103rd Annual Meeting of the American Association for Cancer Research; 2012 Mar 31-Apr 4; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2012;72(8 Suppl):Abstract nr 375. doi:1538-7445.AM2012-375

Successful surgical treatment of advanced follicular thyroid carcinoma with tumor thrombus infiltrating the superior vena cava: report of a case

We report a case of advanced follicular thyroid carcinoma with massive involvement of the great veins of the cervix and mediastinum, and extensive tumor thrombus growing intraluminally into the superior vena cava. The patient, a 70-year-old Japanese woman, was treated successfully by a cooperative surgical team of endocrine and cardiovascular surgeons. Total thyroidectomy with thrombectomy was performed via a minimum phlebotomy in the right brachiocephalic vein, sacrificing only the right internal jugular vein, achieving complete primary tumor resection. She recovered quickly without any complications, and received (131)I radioisotope ablation for her multiple lung metastases. At the time of writing, more than 12 months after surgery, she was well. These treatments thus achieved progression-free survival without impairing her quality of life. Following the case report, we discuss the surgical indications for locally advanced thyroid carcinoma involving the great veins of the mediastinum by reviewing previous reports.

Efficacy of trabectedin in metastatic solitary fibrous tumor

Solitary fibrous tumor is a rare tumor type and has an unpredictable course. Local recurrence rate varies between 9 and 19%, and rate of metastatic involvement between 0 and 36 %. It is characterized by a typical architecture and immuno-histochemistry tests. The most important prognostic factor is the complete resection of primary tumor. Treatment of recurrences is not clearly established. If a solitary fibrous tumor is too advanced to allow surgical resection, radiotherapy and chemotherapy may be used. The most often used drugs are doxorubicine and\\or ifosfamide. We report the case of man with metastatic solitary fibrous tumor treated with trabectedin, administered at a dose of 1.5 mg/m² every 3 weeks. After 3 cycles, metastases had significantly decreased. Recurrence of the disease was demonstrated 8 months after the start of trabectedin. This case shows that trabectedin is a possible treatment option.

The Utility of Frozen Section Margin Analysis in Transoral Robotic Surgery

Objective: Determine the benefit of frozen section margin analysis on oncologic specimens resected via Transoral Robotic Surgery (TORS). Method: A retrospective, single institution chart review of 150 consecutive patients with upper aerodigestive tract malignancies who underwent Transoral Robotic Surgery with intraoperative frozen section margin analysis between April 2007 and November 2010. Results: A total of 105 of the 150 cases were found to have negative tumor margins on initial tumor extripation. None of these patients were found to have delayed positive margins on permanent section analysis. Forty-five patients were found to have 1 or more positive margins on frozen section analysis following initial tumor, and/or tumor margin resection. These positive margins were all re-resected until frozen section pathology was consistent with tumor free margins (no evidence of CIS or invasive carcinoma). Of the 45 patients who underwent re-resection of initial tumor involved margins, 2 were found to have positive margin disease on permanent section pathology. Conclusion: Frozen section margin analysis is a critical intraoperative tool in Transoral Robotic Surgery that accurately accesses margin free tumor resection. This technique allows for a single operative encounter consisting of initial tumor biopsy with rapid diagnosis, followed by immediate complete primary tumor resection with synchronous neck dissection when oncologically indicated.

Late Recurrence of Non-Small Cell Lung Cancer More Than 5 Years After Complete Resection: Incidence and Clinical Implications in Patient Follow-up

The purpose of this study was to evaluate the risk of late recurrence in patients who had undergone complete resection for non-small cell lung cancer (NSCLC) and remained recurrence-free for > or = 5 years. Between 1993 and 2002, 1,358 patients with NSCLC underwent complete primary tumor resection and systematic lymph node dissection. Of these, 819 patients remained recurrence-free for 5 years. Recurrence-free probability was estimated from the benchmark of 5 years after primary tumor resection to the date of first recurrence or last follow-up, using the Kaplan-Meier method. Multivariate Cox regression was used to test the relationship of recurrence-free probability to various clinicopathologic factors. Of the 819 patients who were free of recurrence at 5 years, 87 (11%) developed a subsequent recurrence. The recurrence-free probabilities at 3 years and 5 years from the point of 5 years after primary tumor resection were 92% and 87%, respectively. The 5-year recurrence-free probabilities from the point of 5 years after primary tumor resection were 81% for patients with intratumoral vascular invasion (P < .001), and 89%, 84%, and 65% for patients with N0, N1, and N2 cancers, respectively (P < .001). Multivariate Cox analysis demonstrated that intratumoral vascular invasion and nodal involvement significantly influenced recurrence 5 years after complete resection (P = .030, P = .022, respectively). Patients with NSCLC with selected tumor characteristics have a significant risk of late recurrence. Therefore, 5 years might not be a sufficient amount of time to declare that NSCLC has been cured.