Conventional Surgical Resection Research Articles

Irinotecan-loaded magnetite-silica core-shell systems for colorectal cancer treatment

Colorectal cancer represents a worldwide spread type of cancer and it is regarded as one of the leading death causes, along with lung, breast, and prostate cancers. Since conventional surgical resection and chemotherapy proved limited efficiency, the use of alternative drug delivery systems that ensure the controlled release of cytostatic agents possess immense potential for treatment. In this regard, the present study aimed to develop and evaluate the efficiency of a series of irinotecan-loaded magnetite-silica core–shell systems. The magnetite particles were obtained through a solvothermal treatment, while the silica shell was obtained through the Stöber method directly onto the surface of magnetite particles. Subsequently, the core–shell systems were physico-chemically and morpho-structurally evaluated trough X-ray diffraction (XRD) and (high-resolution) transmission electron microscopy ((HR-)TEM) equipped with a High Annular Angular Dark Field Detector (HAADF) for elemental mapping. After the irinotecan loading, the drug delivery systems were evaluated through Fourier-transform infrared spectroscopy (FT-IR), thermogravimetry and differential scanning calorimetry (TG-DSC), and UV–Vis spectrophotometry. Additionally, the Brunauer–Emmett-Teller (BET) method was employed for determining the surface area and pore volume of the systems. The biological functionality of the core-shells was investigated through the MTT assay performed on both normal and cancer cells. The results of the study confirmed the formation of highly crystalline magnetite particles comprising the core and mesoporous silica layers of sizes varying between 2 and 7 nm as the shell. Additionally, the drug loading and release was dependent on the type of the silica synthesis procedure, since the lack of hexadecyltrimethylammonium bromide (CTAB) resulted in higher drug loading but lower cumulative release. Moreover, the nanostructured systems demonstrated a targeted efficiency towards HT-29 colorectal adenocarcinoma cells, as in the case of normal L929 fibroblast cells, the cell viability was higher than for the pristine drug. In this manner, this study provides the means and procedures for developing drug delivery systems with applicability in the treatment of cancer.

NDC80/HEC1 promotes macrophage polarization and predicts glioma prognosis via single-cell RNA-seq and invitro experiment.

Glioma is the most frequent and lethal form of primary brain tumor. The molecular mechanism of oncogenesis and progression of glioma still remains unclear, rendering the therapeutic effect of conventional radiotherapy, chemotherapy, and surgical resection insufficient. In this study, we sought to explore the function of HEC1 (highly expressed in cancer 1)in glioma; a component of the NDC80 complex in glioma is crucial in the regulation of kinetochore. Bulk RNA and scRNA-seq analyses were used to infer HEC1 function, and invitro experiments validated its function. HEC1 overexpression was observed in glioma and was indicative of poor prognosis and malignant clinical features, which was confirmed in human glioma tissues. High HEC1 expression was correlated with more active cell cycle, DNA-associated activities, and the formation of immunosuppressive tumor microenvironment, including interaction with immune cells, and correlated strongly with infiltrating immune cells and enhanced expression of immune checkpoints. Invitro experiments and RNA-seq further confirmed the role of HEC1 in promoting cell proliferation, and the expression of DNA replication and repair pathways in glioma. Coculture assay confirmed that HEC1 promotes microglial migration and the transformation of M1 phenotype macrophage to M2 phenotype. Altogether, these findings demonstrate that HEC1 may be a potential prognostic marker and an immunotherapeutic target in glioma.

Intraoperative rapid molecular diagnosis aids glioma subtyping and guides precise surgical resection.

The molecular era of glioma diagnosis and treatment has arrived, and a single rapid histopathology is no longer sufficient for surgery. This study sought to present an automatic integrated gene detection system (AIGS), which enables rapid intraoperative detection of IDH/TERTp mutations. A total of 78 patients with gliomas were included in this study. IDH/TERTp mutations were detected intraoperatively using AIGS in 41 of these patients, and they were guided to surgical resection (AIGS detection group). The remaining 37 underwent histopathology-guided conventional surgical resection (non-AIGS detection group). The clinical utility of this technique was evaluated by comparing the accuracy of glioma subtype diagnosis before and after TERTp mutation results were obtained by pathologists and the extent of resection (EOR) and patient prognosis for molecular pathology-guided glioma surgery. With NGS/Sanger sequencing and chromosome detection as the gold standard, the accuracy of AIGS results was 100%. And the timing was well matched to the intraoperative rapid pathology report. After obtaining the TERTp mutation detection results, the accuracy of the glioma subtype diagnosis made by the pathologists increased by 19.51%. Molecular pathology-guided surgical resection of gliomas significantly increased EOR (99.06% vs. 93.73%, p < 0.0001) and also improved median OS (26.77 vs. 13.47 months, p = 0.0289) and median PFS (15.90 vs. 10.57 months, p = 0.0181) in patients with glioblastoma. Using AIGS intraoperatively to detect IDH/TERTp mutations to accurately diagnose glioma subtypes can help achieve maximum safe resection of gliomas, which in turn improves the survival prognosis of patients.

Risk factors for lymph node metastasis in T2 colorectal cancer: a systematic review and meta-analysis.

Lymph node metastasis (LNM) occurs in 20-25% of patients with T2 colorectal cancer (CRC). Identification of risk factors for LNM in T2 CRC may help identify patients who are at low risk and thereby potential candidates for endoscopic full-thickness resection. We examined risk factors for LNM in T2 CRC with the goal of establishing further criteria of the indications for endoscopic resection. MEDLINE, CENTRAL, and EMBASE were systematically searched from inception to November 2023. Studies that investigated the association between the presence of LNM and the clinical and pathological factors of T2 CRC were included. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated. Certainty of evidence (CoE) was assessed using the GRADE approach. Fourteen studies (8349 patients) were included. Overall, the proportion of LNM was 22%. The meta-analysis revealed that the presence of lymphovascular invasion (OR, 5.5; 95% CI 3.7-8.3; high CoE), high-grade tumor budding (OR, 2.4; 95% CI 1.5-3.7; moderate CoE), poor differentiation (OR, 2.2; 95% CI 1.8-2.7; moderate CoE), and female sex (OR, 1.3; 95% CI 1.1-1.7; high CoE) were associated with LNM in T2 CRC. Lymphatic invasion (OR, 5.0; 95% CI 3.3-7.6) was a stronger predictor of LNM than vascular invasion (OR, 2.4; 95% CI 2.1-2.8). Lymphovascular invasion, high-grade tumor budding, poor differentiation, and female sex were risk factors for LNM in T2 CRC. Endoscopic resection of T2 CRC in patients with very low risk for LNM may become an alternative to conventional surgical resection. PROSPERO, CRD42022316545.

Urachal (U) and non-urachal (NU) adenocarcinomas (adenoCA) of the bladder: A comparative comprehensive genomic profiling (CGP) study.

535 Background: Although both U and NU bladder adenoCA share several histological similarities, they differ in site of origin and optimal treatment paradigms. They are both relatively resistant to conventional cisplatin-based chemotherapy and surgical resection is the only curative option for organ-confined stages. The purpose of this study is to investigate the differences of genomic alterations (GA) between these tumor types, with the aim of identifying potential therapy targets. Methods: A total of 133 U and 328 NU adenoCA were analyzed from a series of Formalin-Fixed Paraffin-Embedded tissues obtained from clinically advanced bladder tumors. Hybrid-capture-based CGP was performed to evaluate all classes of GA. Genomic ancestry and gene signatures, including the somatic-germline nature, were determined with algorithm-based analysis of sequencing data. Tumor mutational burden (TMB) was determined based on at least 0.8 Mbp of sequenced DNA, and microsatellite instability (MSI) was assessed on at least 1500 loci. All p-values were two-sided, and multiple hypothesis testing correction was performed using the Benjamini–Hochberg procedure to calculate the false discovery rate. Results: Sex distribution for U adenoCA was similar (M: 50.4%; F: 49.6%), whereas more men were diagnosed with NU adenoCA (M: 63.4%; F: 36.6%). Median ages were similar between the two groups (60 vs 62 years for U and NU respectively). The most frequent GA in both U and NU cohorts included TP53 (86.5% vs 81.1%) and KRAS (34.6% vs 27.7%). GAs characteristic of colorectal adenocarcinoma, such as SMAD4 and GNAS, were more common in U vs NU (28.6% vs 16.5% for SMAD4, p= 0,069; 18% vs 8.8% for GNAS, p= 0,071). Conversely, mutations typical of urothelial carcinoma, including TERT and RB1, were prevalent in NU adenoCA (14.7% vs 0.77% for TERT, p&lt;0.01; 9.2% vs 2.3% for RB, p=0,071). Notably, both U and NU adenoCA exhibited targetable GA in PIK3CA (7.5% vs 7.9%) and ERBB2 (6.8% vs 7.6%). Biomarkers associated with potential benefit from anti-PD(L)1 were infrequent. These tumors were generally MSI stable, with a low TMB (2.61 vs 3.48 mut/Mb for U and NU respectively) and did not frequently show PD-L1 expression even at a low cut-off of &gt; 1% (5 cases in U vs 4 in NU). Genomic ancestry distributions were similar, with EUR frequency 66% in U and 68% in NU patients. Genomic signatures were similar with both tumor types featuring a predominant mix of APOBEC (25/50%) and MMR signatures (75/36%). Conclusions: U and NU adenoCA revealed notable differences in GA, while PIK3CA and ERBB2 were identified as potential therapy targets. Putative biomarkers of response to anti-PD(L)1 were uncommon. Limitations include lack of clinical data, tumor heterogeneity and retrospective nature. This study highlights the potential of CGP to personalize the treatment of bladder adenoCA and may inform clinical trial designs for these tumors.

Inducible caspase 9-mediated suicide gene therapy using AAV6 vectors in a murine model of breast cancer

Breast carcinoma has one of the highest incidence rates (11.7%), with significant clinical heterogeneity. Although conventional chemotherapy and surgical resection are the current standard of care, the resistance and recurrence, after these interventions, necessitate alternate therapeutic approaches. Cancer gene therapy for breast cancer with the suicide gene is an attractive option due to their directed delivery into the tumor. In this study, we have developed a novel treatment strategy against breast cancer with recombinant adeno-associated virus (AAV) serotype 6 vectors carrying a suicide gene, inducible Caspase 9 (iCasp9). Upon treatment with AAV6-iCasp9 vectors and the chemical inducer of dimerizer, AP20187, the viability of murine breast cancer cells (4T1) was significantly reduced to ∼40%-60% (mock control 100%). Following intratumoral delivery of AAV6-iCasp9 vectors in an orthotopic breast cancer mouse model, we observed a significant increase in iCasp9 transgene expression and a significant reduction in tumor growth rate. At the molecular level, immunohistochemical analysis demonstrated subsequent activation of the effector caspase 3 and cellular death. These data highlight the potential of AAV6-iCasp9-based suicide gene therapy for aggressive breast cancer in patients.

A miniature fiber optic ablation probe manufactured via ultrafast laser inscription and selective chemical etching

Picosecond laser ablation has recently emerged as a minimally invasive alternative to conventional surgical resection of early tumors, offering high precision and limited thermal damage to surrounding tissue. Potential clinical application routes include deployment through the working channels of endoscopes or needle bores, which require the delivery of ultrashort high energy pulses through flexible optical fibers with focusing optics at the distal end. The manufacture of distal end optical systems for fiber ablation is challenging, inhibiting translation toward clinical applications. Here, we present a miniature fiber-coupled ablation probe developed using ultrafast laser inscription and chemical etching, employing a hollow-core fiber for pulse delivery. Its design, fabrication, and characterization are detailed, along with a feasibility demonstration for the ablation of stainless steel and chicken tissue.

CAR-NK cell therapy for glioblastoma: what to do next?

Glioblastoma is a malignant tumor with the highest morbidity and mortality in the central nervous system. Conventional surgical resection combined with radiotherapy or chemotherapy has a high recurrence rate and poor prognosis. The 5-year survival rate of patients is less than 10%. In tumor immunotherapy, CAR-T cell therapy represented by chimeric antigen receptor-modified T cells has achieved great success in hematological tumors. However, the application of CAR-T cells in solid tumors such as glioblastoma still faces many challenges. CAR-NK cells are another potential adoptive cell therapy strategy after CAR-T cells. Compared with CAR-T cell therapy, CAR-NK cells have similar anti-tumor effects. CAR-NK cells can also avoid some deficiencies in CAR-T cell therapy, a research hotspot in tumor immunity. This article summarizes the preclinical research status of CAR-NK cells in glioblastoma and the problems and challenges faced by CAR-NK in glioblastoma.

Local Treatment of Neuroendocrine Liver Metastases: How Effective and Safe is Stereotactic Microwave Ablation?

Abstract Background The less invasiveness of local ablation techniques such as stereotactic microwave ablation (SMWA) for the treatment of malignant hepatic lesions has made it an attractive alternative to conventional surgical resection. Aims The aim of this retrospective study was to assess the successful ablation rate of neuroendocrine tumor liver metastases (NETLM) 3 months after SMWA, the recurrence-free survival time, as well as the rate of peri- and early post interventional complications. Methods Retrospective analysis including all patients treated with SMWA for NETLM in our institution between 03/2015 and 07/2022. SMWA was performed as per the decision of the interdisciplinary tumorboard. Patients were included independent of location of primary tumors, disease stage, prior treatments. Patients underwent follow-up imaging (FU) every 1-6 months. Results 41 metastases were ablated in 21 interventions in 17 patients with a mean age of 63.6±9.7 years. A median of two lesions (range 1-4) were ablated per intervention. Mean time until first FU was 2.8±1.5 months. 39 of 41 (95.1%) lesions were fully ablated at the first FU. The two incompletely ablated lesions were treated using re-ablation and systemic treatment, respectively. A local recurrence occurred in further two ablation zones (4.9%) after 3.6 years in a patient with a progressive disease. Remaining 37 (90.2%) patients had no tumor recurrence in the ablation zone at the latest available FU (mean 24.3±17.3 months). Postinterventional length of hospital stay was a median of 1 [IQR 1;1.5]. No complications higher than Clavien Dindo Grade II occurred. Conclusions SMWA is a good minimal invasive intervention for the treatment of NETLM with low morbidity and high local efficacy.

Immune cell membrane-based biomimetic nanomedicine for treating cancer metastasis.

Metastasis is the leading cause of cancer-related death. Despite extensive treatment, the prognosis for patients with metastatic cancer remains poor. In addition to conventional surgical resection, radiotherapy, immunotherapy, chemotherapy, and targeted therapy, various nanobiomaterials have attracted attention for their enhanced antitumor performance and low off-target effects. However, nanomedicines exhibit certain limitations in clinical applications, such as rapid clearance from the body, low biological stability, and poor targeting ability. Biomimetic methods utilize the natural biomembrane to mimic or hybridize nanoparticles and circumvent some of these limitations. Considering the involvement of immune cells in the tumor microenvironment of the metastatic cascade, biomimetic methods using immune cell membranes have been proposed with unique tumor-homing ability and high biocompatibility. In this review, we explore the impact of immune cells on various processes of tumor metastasis. Furthermore, we summarize the synthesis and applications of immune cell membrane-based nanocarriers increasing therapeutic efficacy against cancer metastases via immune evasion, prolonged circulation, enhanced tumor accumulation, and immunosuppression of the tumor microenvironment. Moreover, we describe the prospects and existing challenges in clinical translation.

Clinical efficacy of 5-aminolevulinic acid-mediated photodynamic therapy versus topical antifungal agent and surgical excision for the treatment of hyperplastic candidiasis.

Hyperplastic candidiasis (HC) is a chronic infection of oral mucosa caused by Candida. Owing to its potential for malignant transformation, its intervention requires attention. Conventional surgical resection might lead to irreversible damage and impact the patient's quality of life. Hence, this study aimed to evaluate the clinical efficacy of 5-aminolevulinic acid (5-ALA)-mediated photodynamic therapy (PDT) alone and in combination with topical antifungal therapy (i.e., nystatin [combination therapy]) in comparison with nystatin and surgical resection for the treatment of HC. Forty subjects with clinical and histopathological diagnoses of HC were included in the study. Four study groups, with 10 participants each, were formed as follows: Group-I - receiving antifungal agent [nystatin]; Group-II - receiving surgical resection; Group-III - receiving PDT; and Group-IV - receiving 5-ALA-mediated PDT and nystatin [combination therapy]. Salivary and mucosal samples were collected for the quantification of Candida albicans and the treatment responses to different interventions were recorded at week-4, week-6, and week-8 after finishing therapies. At the 3rd follow-up (i.e., at end of the 8th week after the interventions), complete improvement in 3 (30%), 2 (20%), 1 (10%), and 5 (50%) patients in group-I, group-II, group-III, and group-IV, respectively was observed. A statistically significant difference was obtained when the intervention responses were compared at week-4 (p<0.01), week-6 (p<0.01), and week-8 (p<0.0001) follow-ups in group-I, group-II, and group-IV subjects. At the 8-week follow-up regarding the salivary and mucosal samples, the lowest colony-forming units/milliliter score of C. albicans was observed in group-IV subjects. The application of 5-ALA-mediated PDT in combination with nystatin gel possesses the potential as a well-tolerated and safe therapeutic modality for the treatment of patients with HC.

Association between malformation type, location and functional deficits in lymphatic malformations of the head and neck in children

PurposeLymphatic malformations (LM) are congenital malformations of the lymphatic system, mainly located in the head and neck area. They can be staged based on location according to de Serres and based on different morbidity items using the Cologne Disease Score (CDS), a clinical staging system. In many cases, functional impairment greatly affects the life of patients suffering from lymphatic malformations. The present study aims to analyze a cohort of pediatric patients with LM.MethodsA retrospective analysis of 144 pediatric patients with head and neck LM was performed. Location, type of malformation (microcystic, macrocystic, mixed), scoring according to two different scoring systems and therapy were analyzed. Kruskal–Wallis test was used to analyze the difference in CDS between the patient groups and Dunn’s test was used for post-hoc pairwise comparison.ResultsThe average age at presentation was 6.1 years. The most common sites were neck (47%), cheek/parotid gland (26%), tongue (17%) and orbit (8%). Macrocystic malformations dominated the lateral neck, while microcystic malformations were predominantly localized in the tongue and floor of mouth. Macrocystic malformations (mean CDS 9.44) were associated with significantly better CDS than microcystic (mean CDS 7.11) and mixed (mean CDS 5.71) malformations (p < 0.001). LM in stage V according to de Serres had the lowest values (mean CDS: 4.26). The most common therapeutic procedures were conventional surgical (partial) resection, laser therapy and sclerotherapy with OK-432.ConclusionsThere is an association between malformation type, location according to de Serres and CDS in children with LM of the head and neck. Patients with microcystic and mixed malformations in stage V had lowest CDS levels.

SURG-23. EFFICACY OF LASER INTERSTITIAL THERMAL THERAPY (LITT) FOR NEWLY DIAGNOSED AND RECURRENT IDH WILD-TYPE GLIOBLASTOMA

Abstract Treatment options for glioblastoma remain limited, particularly for those who are not eligible for traditional resection, whether due to lesion location or inability to tolerate open craniotomy. Maximal-safe resection followed by radiation with concurrent and adjuvant temozolomide offers the best outcomes for patients. Unfortunately, not all tumors are amenable to conventional surgical resection at the time of diagnosis with only about 1/3 of patients able to receive a gross-total resection and 15-25% of patients receiving biopsy only, thus reducing their projected overall survival to 9 months. Laser interstitial thermal therapy (LITT) is a minimally invasive, cytoreductive tool, that has demonstrated safety as a surgical approach to treat primary brain tumors. METHODS Data from LAANTERN prospective multicenter registry (NCT02392078) was analyzed to determine clinical outcomes for patients with new and recurrent IDH wild-type glioblastoma (N=89). Demographics, intraprocedural data, adverse events, KPS, health-economics, and survival data were prospectively collected then analyzed separately for newly diagnosed GBM (N=29) and recurrent GBM (N=60). RESULTS Median overall-survival was 9.73 months (95% CI: 5.16, 15.91) for newly diagnosed patients and median post-procedure survival was 8.97 (6.94, 12.36) months for recurrent patients. Median overall-survival for newly diagnosed patients receiving post-LITT chemoradiotherapy was 16.14 months (6.11, not reached). The median length of hospital stay was 50 hours and 80% of patients were discharged to home. CONCLUSIONS LITT offers an effective cytoreductive approach for patients with newly diagnosed and recurrent IDH wild-type glioblastoma. Importantly, its use in newly diagnosed patients who receive post-LITT chemoradiotherapy leads to a median OS similar to that of patients treated with conventional surgical resection. LITT remains an important alternative for patients with inoperable tumors or those not amenable to resection. Enrollment in LAANTERN is ongoing and these cohorts will be revisited as data continues to mature. Benefits beyond cytoreduction are also being actively explored.

DDEL-06. HEAT-ACTIVATED DOXORUBICIN UPTAKE FACILITATED BY LASER INTERSTITIAL THERMAL THERAPY

Abstract Although surgery has been shown to provide a survival benefit in patients with glioblastoma multiforme (GBM), tumor location and geometry may restrict maximal resection. Additionally, the margin of resection cavity contains infiltrating tumor cells that result in recurrence and therapy resistance. Laser interstitial thermal therapy (LITT) is a treatment modality that uses thermal energy to destroy tumor cells. LITT is useful for tumors that are not appropriate for conventional surgical resection. Our laboratory has developed a LITT model to study LITT in a genetically engineered mouse model of GBM. The combination of heat activated nanoparticles and LITT represents an opportunity to target the infiltrating tumor margin, extending the treatment penumbra. We hypothesized that heat-activated liposomes containing doxorubicin (ThermoDox, Celsion) would demonstrate infiltration into the brain parenchyma after treatment with LITT. We treated tumor-bearing mice with LITT or sham (laser fiber implanted but not activated) after either ThermoDox (5mg/kg) or PBS infusion, 30 minutes before performing LITT or sham treatment. We euthanized these mice 1 hour after LITT or sham treatment, harvested brains, and performed immunofluorescence to identify doxorubicin in parenchymal cells. Doxorubicin was identified in 100% of mice treated with LITT following ThermoDox administration which is in contrast with groups treated with LITT and PBS, sham and ThermoDox, and sham and PBS. Here, we show that heat-activated nanoparticles are disrupted through hyperthermia followed by the release of doxorubicin only in the presence of hyperthermia, which paves way for the clinical use of ThermoDox as adjunct chemotherapy following LITT in treatment-resistant GBM treatment.

Recurrence benefit from supramarginal resection in brain metastases of lung adenocarcinoma

BackgroundThere is growing evidence that brain metastases (BM) have no well-defined boundaries and that conventional microsurgical circumferential dissection of BM is often inadequate to prevent local tumor recurrence. Previous studies have suggested that supramarginal resection can significantly improve local tumor control. We retrospectively analyzed the local tumor control in a series of patients with BM from lung adenocarcinoma. MethodsWe retrospectively analyzed 48 patients with BM for lung adenocarcinoma in Shenzhen Second People’s Hospital from May 2015 to May 2020. 26 resected lesions were located in eloquent areas and underwent standard gross total resection (GTR group); 22 resected lesions were located in ineloquent areas, after standard gross total resection, the periphery was expanded and resected by 5 mm (MTR group). The postoperative tumor recurrence was compared between the two groups. ResultsDuring the follow-up period, the local recurrence rates in the GTR group and the MTR group were 61.5% and 27.3% (p = 0.022), respectively. Within 6 months after surgery, the local recurrence rates in the GTR group and the MTR group were 42.3% and 13.6% (p = 0.029), respectively. Within 12 months after surgery, the local recurrence rates in the GTR group and the MTR group were 57.7% and 22.7% (p = 0.014), respectively. The median progression-free survival time after surgery was 7.0 months (95% CI 4.0–10.0 months) in the GTR group and 14.0 months (95% CI 11.4–16.6 months) in the MTR group (Log-Rank p = 0.008). Compared with the MTR group, the HR of local recurrence in the GTR group was 3.74 (95% CI 1.38–10.39, p = 0.010). Cox multivariable analysis showed no other factors associated with local recurrence except for the surgical method (p = 0.012). ConclusionsOn the basis of conventional surgical total resection, expanded peripheral resection of 5 mm around the brain metastases of lung adenocarcinoma can significantly reduce the local recurrence rate and prolongs the progression-free survival time.

O094 Novel technique and cohort study: Stoppa approach to sciatic notch clearance in locally advanced / recurrent pelvic cancer pelvic cancer

Abstract Introduction Locally advanced / recurrent pelvic cancers (LARC) extending into the greater sciatic notch represent a significant clinical challenge. Conventional surgical resection is associated with high rates of R1/2 resection, while locoregional oncological treatments often fail to control the disease. In this study we present the first report of a modified Stoppa approach that facilitates en bloc excision of pelvic sidewall structures with LARC. Methods This is a retrospective review of patients who underwent surgery for LARC with the novel Stoppa approach between 2016 and 2020 in our centre. Result 7 patients (6 female and 1 male) were identified from the institutional database with Median age of 66 (37–74). Three separate tumour types were included in the cohort: rectal adenocarcinoma - 4 (57%), anal squamous cell carcinoma - 2 (29%), and prostate adenocarcinoma - 1 (14%). 3 (42%) patients developed Clavien Dindo Class III complications (2 returned to theatre for minor flap revisions; 1 pre-sacral collection required radiological drainage). All patients lost active ipsilateral foot dorsiflexion due to planned nerve root transection. Median hospital stay was 46 days (17–114). All resections were R0. Conclusion This is the first report of a novel Stoppa approach for en bloc pelvic sidewall excision. The presented pathological resection results are promising; however, this procedure is associated with significant morbidity. Future studies will be necessary to confirm the presented oncological results and determine if the associated morbidity can be decreased. Take-home message Modified Stoppa technique is feasible to achieve Sciatic Notch tumour clearance in primary or recurrent locally advanced pelvic cancer. Further research needed to assess long term oncological outcome and reduce post operative morbidity.

Study of CT-Guided Localization in Pulmonary Nodule Resection.

Objective In recent years, with the attention of the general people to health, the surgical treatment of small nodules has become necessary. However, some nodules are too small, too deep, or difficult to reach, and it is difficult to accurately locate small nodules in the process of routine resection. In order to solve this problem and increase the success rate of puncture surgery, this study analyzed the application value of zoning localization method guided by CT in patients with pulmonary nodules. Methods The clinical history of patients with pulmonary nodules treated in Anhui Third Affiliated Hospital was retrospectively studied and analyzed. 97 patients with solitary pulmonary nodules treated in Anhui Third Affiliated Hospital from June 2021 to August 2021 were divided into observation group and reference group according to whether CT-guided localization method was used during operation. The operation rate, 1-year survival rate, recurrence rate, and pulmonary nodule metastasis rate of the two groups were compared; the results showed that the CT-guided zonal localization method was long and short, accurate, safe, and reliable. Comprehensive comparison through market survey on postoperative recovery compares the variability of patient data by using the statistical bivariatet-calibration method and using sensitivity specificity to analyze whether the CT-guided positioning method has advantages.Results The data underlying the results presented in the study are available within the manuscript. The results showed that there were 37 cases of pulmonary nodules, accounting for 38.14%; there were 8 patients with lung cancer, accounting for 8.24%; the proportion of diagnosis and analysis results of pulmonary nodules in hospitalized patients was significant; the medical history and clinical diagnosis information of 37 patients with pulmonary nodules were tracked and analyzed in detail. The diagnostic results were as follows: 8 patients (21.62%) with stage I, 11 patients (29.72%) with stage II, and 18 patients (48.64%) with stage III. The proportion of severe patients in the third stage was significantly higher than that in the first two stages; the results of CT-guided localization and conventional surgical resection were T < 10.000 and P < 0.05; the observation of prognosis and quality of life in the later stage of resection treatment showed that the observation group had obvious advantages over the reference group in terms of postoperative survival rate, recurrence rate, and nodule deterioration rate. The results show that the CT-guided zoning positioning operation is accurate, safe, and reliable.Conclusion The application of the CT-guided localization in the surgical treatment of pulmonary nodules is more safe and reliable. It can not only reduce the trauma but also improve the success rate of operation and reduce postoperative complications. It has the value of clinical promotion.

Artificial Intelligence Algorithm-Based Intraoperative Magnetic Resonance Navigation for Glioma Resection.

The study aimed to analyze the application value of artificial intelligence algorithm-based intraoperative magnetic resonance imaging (iMRI) in neurosurgical glioma resection. 108 patients with glioma in a hospital were selected and divided into the experimental group (intraoperative magnetic resonance assisted glioma resection) and the control group (conventional surgical experience resection), with 54 patients in each group. After the resection, the tumor resection rate, NIHSS (National Institute of Health Stroke Scale) score, Karnofsky score, and postoperative intracranial infection were calculated in the two groups. The results revealed that the average tumor resection rate in the experimental group was significantly higher than that in the control group (P < 0.05). There was no significant difference in Karnofsky score before and after the operation in the experimental group (P > 0.05). There was no significant difference in NIHSS score between the experimental group and the control group after resection (P > 0.05). The number of patients with postoperative neurological deficits in the experimental group was smaller than that in the control group. In addition, there was no significant difference in infection rates between the two groups after glioma resection (P > 0.05). In summary, intraoperative magnetic resonance navigation on the basis of a segmentation dictionary learning algorithm has great clinical value in neurosurgical glioma resection. It can maximize the removal of tumors and ensure the integrity of neurological function while avoiding an increased risk of postoperative infection, which is of great significance for the treatment of glioma.

ID: 3521319 COMPARISON OF SAFETY AND EFFICACY FOR ENDOSCOPIC AND SURGICAL RESECTION OF GASTROINTESTINAL STROMAL TUMORS IN THE STOMACH: US EXPERIENCE FROM A TERTIARY CARE CENTER.

Gastrointestinal Stromal Tumors (GISTs) are subepithelial lesions and the most common mesenchymal tumors of the gastrointestinal tract. In recent years, some centers have reported endoscopic resection of small gastric GISTs. However, no studies within the United States have compared the clinical outcomes between endoscopic and (conventional) surgical resection of these tumors. Our study aimed to compare the efficacy and safety of small gastric GISTs (≤ 5cm) resected by both these methods at our institution.

Defining the Extracellular Matrix of Rhabdomyosarcoma.

Rhabdomyosarcoma (RMS) is the most common soft-tissue sarcoma of childhood with a propensity to metastasize. Current treatment for patients with RMS includes conventional systemic chemotherapy, radiation therapy, and surgical resection; nevertheless, little to no improvement in long term survival has been achieved in decades—underlining the need for target discovery and new therapeutic approaches to targeting tumor cells or the tumor microenvironment. To evaluate cross-species sarcoma extracellular matrix production, we have used murine models which feature knowledge of the myogenic cell-of-origin. With focus on the RMS/undifferentiated pleomorphic sarcoma (UPS) continuum, we have constructed tissue microarrays of 48 murine and four human sarcomas to analyze expression of seven different collagens, fibrillins, and collagen-modifying proteins, with cross-correlation to RNA deep sequencing. We have uncovered that RMS produces increased expression of type XVIII collagen alpha 1 (COL18A1), which is clinically associated with decreased long-term survival. We have also identified significantly increased RNA expression of COL4A1, FBN2, PLOD1, and PLOD2 in human RMS relative to normal skeletal muscle. These results complement recent studies investigating whether soft tissue sarcomas utilize collagens, fibrillins, and collagen-modifying enzymes to alter the structural integrity of surrounding host extracellular matrix/collagen quaternary structure resulting in improved ability to improve the ability to invade regionally and metastasize, for which therapeutic targeting is possible.