Complete Tumor Resection Research Articles

A neuroendocrine tumor within an anterior mediastinal mature teratoma: a case report

BackgroundMature teratomas are benign germ cell tumors. On rare occasions, they have been associated with somatic malignancies and are termed rare germ cell tumors with a somatic-type malignancy (GCTSM). Mature teratomas commonly comprise adenocarcinomas; only seven previous cases of mature teratomas with neuroendocrine tumors have been reported to date. Here, we report a patient with a neuroendocrine tumor whithin a mature teratoma.Case presentationA 26-year-old man visited our department complaining of chest tightness. Contrast-enhanced computed tomography (CT) scans showed a strongly enhanced lesion within a 10-cm encapsulated cystic lesion in the anterior mediastinum. Positron emission tomography (PET) scans showed no areas of significant 18F-fluorodeoxyglucose (18F-FDG) accumulation. He underwent complete tumor resection via the transsternal approach. Histopathological examination of the specimen indicated a neuroendocrine tumor contained within a mature teratoma.ConclusionsIn this case, a neuroendocrine tumor was contained within a mature teratoma. Our patient had no specific symptoms and his serum markers were within the normal range. Although PET is beneficial for diagnosing other GCTSM, it is not useful in detecting a neuroendocrine tumor. Therefore, the preoperative diagnosis of neuroendocrine tumors contained within mature teratomas remains challenging. However, GCTSM should be suspected in patients exhibiting CT findings of a mediastinal tumor, measuring ≥ 6 cm, in addition to characteristic GCTSM findings. Moreover, surgery should be performed carefully in such cases.

Pneumologie meets Onkologie

Lung cancer is common and associated with a high mortality. After major therapeutic advances in the palliative situation of non-small cell lung cancer (NSCLC), new therapeutic concepts including immunotherapy and targeted tumor therapy have now also reached the curative stages. Osimertinib and atezolizumab have recently been approved under certain conditions in adjuvant therapy after complete tumor resection. In addition, the first approval of a neoadjuvant immunochemotherapy in Germany is expected soon. In the palliative therapy setting, comprehensive molecular pathological diagnostics on oncogenic mutations are required. Many drugs addressing these targets are now available predominantly for first line therapy but also although less for second line therapy. If there are no possibilities to address driver mutations, immunotherapy and immunochemotherapy are available depending on the programmed death ligand 1 (PD-L1) status. Overall, these new therapeutic options have already significantly improved therapy tolerability and the prognosis of lung cancer. Specific side effects must be considered. For small cell lung cancer (SCLC), palliative immunochemotherapy provides a moderate improvement in the prognosis. The introduction of lung cancer screening by low-dose computed tomography (CT) in Germany is to be expected in the coming years. The advantages are a relative reduction in lung cancer mortality of approximately 20% with a number needed to screen of 250. The disadvantage is particularly the expected number of false positive findings. A screening program must be established as a structured and quality assured procedure.

Minimally Invasive Resection of Benign Osseous Tumors of the Spinal Column: 10 Years' Experience and Long-Term Outcomes of a Specialized Center.

Background and Objectives: Benign osseous tumors of the spinal column comprise about 10% of all spinal tumors and are rare cause for surgery. However, these tumors pose various management challenges and conventional surgery may be associated with significant morbidity. Previous reports on minimally invasive resection of these lesions are rare. We report a series of patients managed by total resection of benign osseous spine tumors using MIS techniques. Surgical decisions and technical considerations are discussed. Materials and Methods: A retrospective evaluation of prospectively collected data of patients who underwent minimally invasive surgery for removal of benign osseous vertebral tumors. Demographic, clinical and radiographic features, operative details and final pathological reports were summarized. Primary outcomes were completeness of tumor resection and pain relief assessed by VAS for back and leg pain. Secondary outcome measures were recurrence of tumor on repeat post-operative MRI and postoperative unstable deformity on standing scoliosis X-rays. Results: This series included 32 cases of primary osseous spine tumors resected by minimally invasive techniques. There were 17 males and 15 females aged 5-68 years (mean 23.3). The follow-up period was 8-90 months (mean 32 months) and the preoperative symptoms duration was 9-96 months. Axial spinal pain was the presenting symptom in all the patients. Five patients also complained about radicular pain and four patients had antalgic scoliosis. The tumor involved the thoracic spine in 12 cases, the lumbar segment in 11, the cervical in 5 and the sacral area in 4 cases. Complete tumor removal was performed in all patients. No procedure-related complications were encountered. Histopathology showed osteoid osteoma in 24 patients, osteoblastoma in 5 patients, and fibrous dysplasia, fibroadenoma and eosinophilic granuloma in one case each. All patients experienced significant pain relief after surgery, and had stopped pain medications by 12 months postoperatively. No patient suffered from tumor recurrence or spinal deformity. Conclusions: Minimally invasive surgery is feasible for total removal of selected benign vertebral tumors and may have some advantages over conventional surgical techniques.

Long-term Surgical Outcomes in Oligometastatic Non-small Cell Lung Cancer: A Single-Center Study

We reviewed the clinical outcomes of patients with oligometastatic (OM) non-small cell lung cancer (NSCLC) who received multimodal therapy including lung surgery. We retrospectively analyzed 117 patients with OM NSCLC who underwent complete resection of the primary tumor from 2014 to 2017. The median follow-up duration was 2.91 years (95% confidence interval, 1.48-5.84 years). The patients included 73 men (62.4%), and 76 patients (64.9%) were under the age of 65 years. Based on histology, 97 adenocarcinomas and 14 squamous cell carcinomas were included. Biomarker analysis revealed that 53 patients tested positive for epidermal growth factor receptor, anaplastic lymphoma kinase, or ROS1 mutations, while 36 patients tested negative. Metastases were detected in the brain in 74 patients, the adrenal glands in 12 patients, bone in 5 patients, vertebrae in 4 patients, and other locations in 12 patients. Radiation therapy for organ metastasis was performed in 81 patients and surgical resection in 27 patients. The 1-year overall survival (OS) rate in these patients was 82.8%, and the 3- and 5-year OS rates were 52.6% and 37.2%, respectively. Patients with positive biomarker test results had 1-, 3-, and 5-year OS rates of 98%, 64%, and 42.7%, respectively. These patients had better OS than those with negative biomarker test results (p=0.031). Patients aged ≤65 years and those with pT1-2 cancers also showed better survival (both p=0.008). Surgical resection of primary lung cancer is a viable treatment option for selected patients with OM NSCLC in the context of multimodal therapy.

Predictors of seizure outcomes in patients with diffuse low-grade glioma-related epilepsy after complete glioma removal.

We aimed to identify predictors of postoperative seizures in patients with diffuse low-grade glioma (DLGG)-related epilepsy after complete tumor resection in this study. We retrospectively collected data from individuals with DLGG-related epilepsy whose tumors were completely resected at Xiangya Hospital, Central South University between January 2014 and January 2020. The predictors of seizure outcomes were assessed by employing univariate analysis and a multivariate logistic regression model in a backward binary logistic regression model. Among the 118 cases that met the inclusion criteria, 83.05% were seizure-free following an average follow-up of 4.27 ± 1.65 years, all of whom were classified as International League Against Epilepsy class I outcome. Univariate and multivariate analyses indicated that seizure duration of >6 years (odds ratio [OR], 6.62; 95% confidence interval [CI], 1.76-24.98; p=0.005) and first clinical symptoms other than seizures (OR, 4.51; 95% CI, 1.43-14.23; p=1.010) were both independent predictors of unfavorable seizure outcomes. Our results imply that satisfactory seizure outcomes can be achieved in most patients with DLGG-related epilepsy after complete tumor resection. Patients with seizure duration of >6 years or first clinical symptoms other than seizures were more likely to experience postoperative seizure recurrence.

Deploying Indocyanine Green Fluorescence-Guided Navigation System in Precise Laparoscopic Resection of Pediatric Hepatoblastoma.

Background: Hepatoblastoma (HB) is the most common form of liver cancer in children. To date, complete tumor resection is still the gold standard for treating HB. Indocyanine green (ICG) has been identified as a sensitive adjunct that is highly effective in the identification and surgical management of local and metastatic HB. It has thus becomes an increasingly popular choice among surgeons in HB resection surgeries that are fluorescence-guided. However, laparotomy remains the preferred choice in most cases since the applications and limitations of fluorescence-guided laparoscopic surgery in treating HB remain unclear. In this study, the characteristics and outcomes of laparoscopic HB resections that were guided by intraoperative ICG fluorescent imaging were investigated. Methods: Seven HB patients underwent ICG-guided laparoscopic HB resection surgery from August 2019 to December 2021. ICG was intravenously administered to the patients at a dosage of 0.5 mg/kg 48 h prior to the scheduled operation. During operation, tumor localization and resection boundary were guided by fluorescence visualization. The data on surgical and clinical features were collected retrospectively. Results: The resection area and tumor boundary could be clearly viewed in real-time under the ICG fluorescence imaging navigation system during operation, except for one patient who had received interventional chemoembolization before surgery. The image produced by laparoscopic fluorescence navigation was clear since it was not affected by ambient light. All tumors were completely resected as confirmed by negative margins for HB during postoperative pathological examination. No residual or recurrence were also found through computed tomography during follow-up visits from 9 to 37 months. Conclusions: ICG fluorescence-guided laparoscopic surgery is safe and effective in treating HB due to its ability to provide clear information on tumor localization and delineate tumor margins in real-time.

Indocyanine green near infrared-guided surgery in children, adolescents, and young adults with otolaryngologic malignancies

ObjectiveHead and neck cancers represent critical challenges due to the restricted anatomical space in children and the proximity of critical neurovascular structures which can compromise complete tumor resection. Applications of Indocyanine green (ICG) near infrared (NIR) fluorescent image-guided surgery (FGS) have recently expanded into the pediatric population, emphasizing its relevance for tumor delineation and evaluation of tissue perfusion. The objectives of the present study are twofold. First, we aim to assess the role of ICG NIR imagery in identifying neoplastic disease and second, to evaluate its role as an adjunct to identify metastatic deposits in cervical lymph node in children, adolescents, and young adults with head and neck cancers. MethodsEight patients with head and neck malignancies underwent ICG NIR FGS, between January 2019 and November 2021. ICG NIR findings were compared with preoperative cross-sectional imaging and results of operative tissue pathology analyses. ResultsAll primary tumors were identified on preoperative imaging and intraoperatively with ICG NIR; however, for one case, extension of tumor was revealed with ICG NIR and confirmed by histopathological examination but was not otherwise visible on preoperative imaging or with naked eye visual and tactile assessment. ICG NIR assisted the decision process in a difficult case for which curative resection, without significant functional morbidity and potential mortality, was unrealistic. Although ICG NIR evaluation of the surgical bed did not display residual tumor, margins were found positive in two cases. ICG NIR evaluation for local metastases changed the surgical strategy in one patient by prompting conversion to bilateral neck dissections. The sensitivity of preoperative multimodality imaging to identify cervical levels of invasion was 75% with a specificity of 70%, a PPV of 33%, a NPV of 78% and an accuracy of 72%. The ICG NIR sensitivity was 83%, its specificity was 88% with a PPV of 91%, a NPV of 80% and an accuracy of 86%. The combination of preoperative multimodality imaging with ICG NIR findings led to a sensitivity of 83%, specificity of 88% and accuracy of 86%. ConclusionThis case series provides a proof of concept of the feasibility of ICG NIR, as an adjunct in tumor and local metastases identification in young patients with head and neck tumors. It revealed to be feasible and safe for intra-operative tumor identification, thus guiding and facilitating resection. However, it showed some limitations in precise tumor margin assessment. The combination of preoperative multimodality imaging with ICG NIR findings improved local metastases localization.

OGC P35 Reporting of core outcomes in gastric cancer surgery trials over the past 25 years

Abstract Background Gastric cancer presents a significant health burden as the fifth most common malignancy and a significant cause of cancer-related mortality worldwide. A multi-modal approach has led to modest improvement in survival in recent years but surgery remains the cornerstone of curative treatment. A variety of surgical approaches are available, including newer minimally-invasive techniques: laparoscopic and robotic surgery. Determining the optimal approach requires appraisal of high-quality evidence, such as randomised controlled trials (RCTs) and systematic reviews with meta-analyses. However, heterogeneity within the literature hinders this, allowing little consensus. Surgical trials often report different outcomes and even the same outcome may be defined or measured differently. This challenge spans specialties and has been addressed by the development of core outcome sets (COS): a standardised set of outcomes that should be measured and reported as a minimum. The GASTROS group developed a COS for gastric cancer surgical trials. This process involved key stakeholders, patients and clinicians, better reflecting their priorities. These core outcomes are disease-free survival, disease-specific survival, surgery-related death, recurrence, completeness of tumour removal, overall quality of life, nutritional effects, and ‘serious’ adverse events. The aim of this review was to determine what proportion of trials report these core outcomes. Methods This review was an update of an earlier systematic review by our group spanning years 1996 to 2016. We systematically reviewed databases Evidence Based Medicine Reviews, MEDLINE, EMBASE and CINAHL from the years 2016 to 2021, specifically focusing on ‘type 2’ surgical RCTs: trials comparing two or more therapeutic surgical interventions. We separately reviewed systematic reviews of RCTs. The data extracted was outcomes reported, definitions, measuring tools used and when outcomes were measured. Results A total of 2213 abstracts were screened and 295 included. After full paper review this yielded 53 relevant articles. A further 47 articles from our previous systematic review were included. Twenty-two systematic reviews of RCTs were also identified. Of the 101 trials, no trial reported all core outcomes. Serious adverse events were reported by nearly all trials, 98.4%, but these were reported heterogeneously; as pooled and individual complications and graded using different severity tools. Other commonly reported outcomes were surgery-related death, 85.3%, and completeness of tumour resection, 73.8%. Survival outcomes were often reported as overall survival. Only 54.1% reported disease-free survival 54.10% and even fewer, 4.9%, reported disease-specific survival. Tumour recurrence was reported by just over a third of trials. Outcomes likely to be most important to patients, quality of life and nutritional effects, were reported least at 23% and 16.4% respectively. Over the past 25 years there has been no significant improvement in the reporting of core outcomes. An expectedly similar spread of outcome reporting was seen in systematic reviews of RCTs, with serious adverse events and surgery-related death reported most and quality of life, nutritional effects and survival outcomes reported least. Conclusions Surgical trials must report outcomes relevant to key stakeholders, importantly patients as well as surgeons. This review demonstrates that outcomes from the COS are poorly reported at present. The value of the COS needs to be disseminated to the wider research community in order to increase its uptake. As part of this, we intend to contact ongoing trials with the results of this review. Consistent reporting of core outcomes in future will allow for meaningful appraisal of evidence, ultimately improving clinical outcomes.

Efficacy and influencing factors of surgery combined with neoadjuvant chemoradiotherapy in the treatment of children with non-orbital head and neck rhabdomyosarcoma

Objective: To evaluate the efficacy and influencing factors of surgery combined with neoadjuvant chemoradiotherapy in the treatment of children with non-orbital head and neck rhabdomyosarcoma (HNRMS). Methods: Information from 45 children diagnosed as non-orbital HNRMS and subjected to surgery combined with neoadjuvant chemoradiotherapy in Beijing Children's Hospital affiliated to Capital Medical University from August 2017 to July 2021 was analyzed. The patients included 25 males and 20 females, aged from 1 to 17 years old. The primary tumor site, pathological subtype, clinical stage, risk group, therapeutic regimen, resection range and outcome of all cases were also collected. The survival curves were made using the Kaplan-Meier method and the potential prognostic factors were investigated by Cox regression analysis. Results: Fifteen (33.3%) of 45 children achieved negative surgical margin under complete tumor resection. The postoperative pathological results showed that there were 20 cases of embryonic subtype, 19 cases of alveolar subtype and 6 cases of spindle sclerosis subtype. The postoperative follow-up time ranged from 4 to 71 months, with a median of 26 months. During the follow-up period, 13 children died, among whom brain metastasis was the most common cause of death, accounting for 7/13. The 3-year overall survival rate was 67.6%. Multivariate analysis showed that non-embryonic subtype (HR=6.26, 95%CI: 1.52-25.87, P=0.011) and failure to reach R0 resection (HR=9.37, 95%CI: 1.18-74.34, P=0.034) were independent risk factors affecting overall survival rate. Conclusion: Surgery combined with neoadjuvant chemoradiotherapy can offer a good efficacy for children with non-orbital HNRMS. Non-embryonic subtype and resection without negative operative microscopic margins are independent risk factors for poor prognosis, and brain metastasis is the main cause of death in these children.

S1-Guideline: Microscopically controlled surgery.

Microscopically controlled surgery (MCS) comprises various methods allowing histologically proven complete resection of malignant tumors while at the same time sparing the tumor-free tissue in the immediate vicinity as much as possible. All procedures subsumed under MCS have in common the marking of the excised tissue for topographical orientation, which provides an assignment of remaining tumor remnants. Indications for MCS are malignant skin tumors in problem localizations as well as aggressive subtypes of skin tumors. Established indications for MCS include basal cell carcinoma, cutaneous squamous cell carcinoma, Bowen's disease as well as Bowen's carcinoma, dermatofibrosarcoma protuberans, melanoma in chronically light-damaged skin as well as acral lentiginous melanoma and Merkel cell carcinoma. For other tumors such as extramammary Paget's disease and various cutaneous sarcomas, evidence exists that MCS has demonstrated benefits, such as local recurrence rates. In addition, MCS is indicated when it is foreseeable that a complex closure technique is required and complete resection of the tumor must be assured. Various methods of MCS have been described, including 3D histology, horizontal method and Mohs surgery. A close cooperation of qualified surgeons and (dermato)pathologists as well as laboratory staff is essential for the successful application of MCS.

Surgical Strategies to Dissect around the Superior Mesenteric Artery in Robotic Pancreatoduodenectomy

The concept of the superior mesenteric artery (SMA)-first approach has been widely accepted in pancreatoduodenectomy. However, few studies have reported surgical approaches to the SMA in robotic pancreatoduodenectomy (RPD). Herein, we present our surgical strategies to dissect around the SMA in RPD. Among the various approaches, our standard protocol for RPD included the right approach to the SMA, which can result in complete tumor resection in most cases. In patients with malignant diseases requiring lymphadenectomy around the SMA, we developed a novel approach by combining the left and right approaches in RPD. Using this approach, circumferential dissection around the SMA can be achieved through both the left and right sides. This approach can also be helpful in patients with obesity or intra-abdominal adhesions. The present study summarizes the advantages and disadvantages of both the approaches during RPD. To perform RPD safely, surgeons should understand the different surgical approaches and select the best approach or a combination of different approaches, depending on demographic, anatomical, and oncological factors.

A Case Report of Cutaneous Low-grade Myofibroblastic Sarcoma in the Neck

Myofibroblastic sarcoma can be classified as low-, intermediate-, and high-grade. Low-grade myofibroblastic sarcoma (LGMS) is uncommon and rarely appears on the skin. LGMS is diagnosed based on histopathological and immunohistochemical findings. Additionally, LGMS metastases are rare as well. Herein, the authors describe a case of cutaneous LGMS in the neck. To the best of our knowledge, there are no cases regarding cutaneous LGMS in the neck present in the existing literature. Surgical resection is considered as the most important treatment for LGMS. Therefore, a complete tumor resection was performed in this case. However, another mass in the uterus was identified on abdominal computed tomography performed post-surgery.

Efficacy and feasibility of snare-assisted endoscopic resection of small submucosal gastric tumors: A retrospective analysis.

The prevalence of small submucosal gastric tumors is rising. Despite the fact that high success rate of endoscopic resection of small submucosal gastric tumors originating from the muscularis propria has been reported, the procedure is technically challenging and has a high rate of complications. In this study, we investigated the efficacy and feasibility of a novel snare-assisted endoscopic resection technique for small submucosal gastric tumors. This is a single-center consecutive study of 50 patients who were diagnosed with small submucosal gastric tumors originating from the muscularis propria and who subsequently underwent snare-assisted endoscopic resection between January 2019 and January 2021 at our hospital. Data on the demographic characteristics, procedural success rate, complications, recurrence rate, and histopathology of the resected specimen were collected and analyzed retrospectively. The majority of the patient's population was male (66%) with the mean age of 48.4 ± 9 years (range, 20-70 years). The mean size of the tumor confirmed by endoscopic ultrasonography was 6.4 ± 1.6mm (range, 3.1-9.8 mm). All the tumors were resected successfully using snare-assisted endoscopic resection technique. The mean procedure time was 22.8 ± 9.6 (range, 15-35 min). The technical (performed the procedure successfully without converting to surgery) and clinical (the patient fully recovered after the procedure without experiencing any complications) success rate of the procedure was 100%. Eighteen (24%) patients had very small amount of mucosal damage, and wound closure was not needed in these patients. During 6-24 months of follow-up, no recurrence or metastasis occurred. No adverse event was noted during the follow-up time. The novel approach of snare-assisted endoscopic resection is simple, feasible, and effective for tumors with small size and originating from the gastric muscularis propria. In addition, it offers a better alternative therapy for the complete resection of small submucosal gastric tumors. Its advantages compared with traditional endoscopic approaches such as endoscopic submucosal resection and endoscopic submucosal dissection include shorter procedure times, lesser cost, and a lower rate of complications (perforation, bleeding, and infection).

Unusual presentation of aneurysmal bone cyst with scoliosis: a case report

BackgroundAneurysmal bone cysts are benign bone tumors that not uncommonly involves the spine. However, this involvement can cause scoliosis, albeit rarely. This report focuses on the importance of proper management for complete tumor resection to prevent recurrence and spinal deformity.Case presentationA 12-year-old Middle Eastern boy, with a history of T11 aneurysmal bone cyst resection and bone grafting carried out at another hospital, presented with spine deformity of 4 months’ duration. The deformity was not associated with pain or neurological deficit. A whole-spine magnetic resonance imaging with contrast confirmed the recurrence of the aneurysmal bone cyst. Posterior spinal instrumentation with corpectomy of T11 was then performed, and confirmed with histopathology the recurrence of aneurysmal bone cyst. Two years post-corpectomy, deformity correction was done from T5–L4.ConclusionManagement of aneurysmal bone cysts requires meticulous planning and full excision to prevent recurrence, especially in the growing spine. If neglected, it can cause major spinal deformities and cord compression, which places a medical burden on the patient and family. To avoid such complications, treating aneurysmal bone cysts along with scoliosis correction can prevent deformity progression.

Surgical and functional outcomes of microsurgical resection of tentorial meningiomas: A single-center study

BackgroundTentorial meningiomas are uncommon entity, related to tentorium and representing 3–6% of intracranial meningiomas. Being related to surrounding vital neurovascular structures, complete surgical resection of such tumors was limited in the early stages with poor outcomes, but with the continuous improvements in microsurgery and the advent of new imaging modalities, the prognosis of such cases has improved significantly. We aimed to assess different surgical approaches, and functional outcome of patients with tentorial meningioma who underwent microsurgical resection at a single institution in a developing country. MethodsA Retrospective analysis of clinical data of tentorial meningioma patients who underwent microsurgical excision at our institution between 2014 and 2021 was done. Tumour characteristics, location based on the modified Yasargil classification, different surgical approaches, operative details, extent of resection, and functional postoperative outcome according to modified Rankin scale were also assessed. Results18 patients diagnosed with tentorial meningioma were included in our study, (66.7% females and 33.3% males) with mean age (50.1 ± 8.6) years. Headache was the most common presentation in (83.3%) of our patients and 5 patients (27.8%) had preoperative hydrocephalus. Gross total resection had been achieved in 66.7% of patients, while 16.7% of patients had subtotal resection and 16.7% had partial resection. 12 patients were considered in the (Good outcome) group and had score from 0 to 2 in the modified Rankin scale, while 6 cases had (Poor outcome) were between 3 and 6 on the scale. Factors that might predict the functional outcome were evaluated and were statistically insignificant. ConclusionTentorial meningiomas are challenging, microsurgical excision results in favorable surgical and functional outcome in most cases however, when gross total resection isn’t feasible, subtotal resection followed by adjuvant therapy is recommended.

SURG-39. SURGICAL RESULTS AND LONG-TERM OUTCOME IN SUPRATENTORIAL INTRAVENTRICULAR TUMORS

Abstract BACKGROUND Intraventricular tumors (IVTs) are rare lesions of various entities, which pose a surgical challenge. We aimed to elaborate on surgical approaches and outcomes, postoperative morbidity, and elucidate whether preoperative hydrocephalus necessitates shunting despite surgical resection. METHODS We retrospectively searched the institutional database for patients with supratentorial intraventricular tumours that were treated in the Department of Neurosurgery of the Ludwig-Maximilians-University Munich, Germany between 2014 and 2022. RESULTS We identified 59 patients with supratentorial intraventricular tumors comprising over 15 different tumor entities, most often subependymoma (8/59 patients, 14%). Median age at diagnosis was 41.4 years (range 0-86 years) with 31 male patients (53%) and 28 female patients (48%). Microsurgical tumor resection was completed in 46/59 patients (78%) with incomplete tumor resection (≥ 1ml postoperative tumor volume) in 13/46 patients (28%) and complete tumor resection (< 1ml postoperative tumor volume) in 33/46 patients (72%). In cases where neurosurgical tumor resection was not feasible, stereotactic biopsy was provided in 13/59 patients (22%), often combined with stereotactic internal shunt implantation (5/59 patients, 8%). Mean follow-up was 24 months; median overall survival was not reached. Postoperative persistent hydrocephalus necessitating ventriculoperitoneal shunt placement was rare (5/59 patients, 8%). Ventriculocisternostomy was performed in one patient. New postoperative focal neurological deficits – mostly transient – were encountered in 16/59 patients (27%) at discharge with mild to moderate permanent focal neurological deficits at 3 months in 3/59 patients (5%). CONCLUSION Complete resection of IVT can often be achieved and forms the basis for favourable outcome. Permanent neurological deficits are rare, and hydrocephalus can almost always be alleviated which prevents the need for long-term shunting. If microsurgical resection is not feasible, stereotactic biopsy along with internal shunting represents an effective approach to establish diagnosis and ameliorate symptoms.

QLTI-01. THE EFFECT OF COMPLETE RESECTION OF CONTRAST-ENHANCING TUMOR ON SURVIVAL IN PATIENTS WITH GLIOBLASTOMA OVER A 16-YEAR PERIOD IN A GEOGRAPHICALLY DEFINED POPULATION

Abstract INTRODUCTION The median survival for patients with glioblastoma is less than one year, and survival beyond five years is rare. Radiotherapy combined with chemotherapy has improved survival since its introduction in 2005. No new treatment modalities have been widely adopted after this, but treatment development has focused on achieving maximal resection and the introduction of coordinated clinical care pathways. We hypothesize that these changes in approach have resulted in an improved survival in surgically treated patients. METHODS Retrospective analysis of a prospectively collected database in the adult population (2.4 million habitants) of South-Eastern Norway. Patients were divided in three periods; radiotherapy- (2003-2005), temozolomide- (2006-2012), and resection focused-period (2013-2019). Patients were also stratified according to age and grade of resection. Relative survival, Cox hazard-ratio, 3- and 5- year survival were calculated. RESULTS We identified 1663 surgically treated glioblastoma patients eligible for the study. The median overall survival was 11.4 months. Complete resection of contrast-enhanced tumor (CRCET) was achieved in 387 (23.2%) patients. The frequency of CRCET increased during the observation time (32 - 116 - 239), but there was no increase in reoperation rates (13%). Significant improvement between the last period and the first two periods was observed (12.3 vs. 10.5 months, p < 0.006), with a significant increase in 3- and 5- year survival probability between the first two groups (p = 0.01). No difference was found in median survival in CRCET among periods. Patients with CRCET demonstrated significantly longer median survival than patients with non-CRCET (16.1 vs. 10.8 months; p < 0.001). Incidence in the elder group increased from 2.6 to 13.2 per 100,000 habitants, and median survival doubled when CRT was achieved. CONCLUSIONS There is an increase in median survival, 3- and 5- year survival probability when comparing time-periods. We suggest this survival benefit is related to improved CRCET rates.

A two-team approach for the complete resection of a bulky gastrointestinal stromal tumor on the anterior wall of the lower rectum after neoadjuvant treatment.

A two-team approach for the complete resection of a bulky gastrointestinal stromal tumor on the anterior wall of the lower rectum after neoadjuvant treatment.

Microsurgical Reconstruction in Orthopedic Tumor Resections as Part of a Multidisciplinary Surgical Approach for Sarcomas of the Extremities.

A central element of modern sarcoma therapy is complete surgical tumor resection with an adequate safety margin, embedded in an interdisciplinary multimodal therapy concept. Along with ensuring patient survival, functional limb preservation is an important goal for sarcomas of the extremities. This review provides an overview of the relevant literature on indications and goals of reconstructive options, the scope and contribution of microsurgical reconstructive procedures, and the associated interdisciplinary decision making and workup. Furthermore, the impact of (neo)-adjuvant therapy on reconstructive decisions will be highlighted. These aspects will be illustrated by four comprehensive case studies that demonstrate both useful strategies and the need for individually tailored therapies. Nowadays, extremity-preserving therapy is possible in more than 90% of sarcomas. Technical and procedural innovations such as microsurgery and microsurgical reconstructive procedures have significantly contributed to this evolution of therapy.

Photoacoustic imaging of tumor vascular involvement and surgical margin pathology for feedback-guided intraoperative tumor resection

Surgery represents the mainstream therapeutic modality in oncology. Aggressive radical surgery to achieve no residual tumor would improve survival, which is mainly affected by vascular involvement and accuracy of judging the negative margin of tumor resection. However, there is currently no intraoperative tool that can simultaneously perform microscopic analysis of the peritumoral vasculature in vivo and the surgical margin pathology of the tumor ex vivo, which leads to the randomness of one-time complete resection of the tumor, and the patient may have to undergo secondary surgery. To address this critical need, we developed a 532/266 nm dual-wavelength photoacoustic (PA) microscopy imaging (532/266-PAI) system that enables both in vivo tumor regional vascular involvement analysis and pathological margin assessment of fresh ex vivo tumor samples. A mammary tumor animal model was established to mimic the process of tumor resection, from in vivo imaging vascular involvement of tumor to intraoperative judgment of negative tumor margins. It is proved that the 532/266-PAI technology can identify the tumor vascular involvement through vascular visualization, determine the surgical plan, and then judge whether the tumor is completely removed through ultraviolet PA (UPA) tumor pathological imaging. Re-excision and secondary margin evaluation are performed when margin positive is diagnosed in the intraoperation UPA imaging. The 266/532-PAI technique has great potential for complete tumor resection in surgical navigation.