Extra-regional Node Research Articles

S3401 Solitary Cystic Psoas Muscle Metastasis From Rectosigmoid Adenocarcinoma

INTRODUCTION: Colorectal adenocarcinoma is the most common subtype of colon cancer and has lower rates of metastasis when compared to other subtypes (signet-ring and mucinous). 20% of Colorectal Cancer (CRC) cases have metastatic disease at the time of presentation. Metastasis are most frequently found in the liver, lung, peritoneum, bone and extra-regional lymph nodes. Reports involving metastatic disease to skeletal muscle are rare. CASE DESCRIPTION/METHODS: A routine screening colonoscopy of a 52-year-old female revealed an 8mm flat, umbilicated, and ulcerated polyp in the rectum. Subsequent staging CT scans showed a cystic fluid-filled cavity in the left psoas muscle. This cystic iliopsoas muscle lesion, initially diagnosed as an infected fluid collection, was subsequently identified as a metastasis from rectosigmoid adenocarcinoma. Following this diagnosis the patient underwent primary surgical resection for rectosigmoid carcinoma and received chemotherapy. DISCUSSION: This patient presented with a rare metastasis of rectosigmoid adenocarcinoma. This type of metastasis is significant not only for its rarity, but also in its negative prognostic features.

Role of lymphadenectomy in resectable pancreatic cancer.

Pancreatic cancer (PC) remains one of the most devastating malignant diseases, predicted to become the second leading cause of cancer-related death by 2030. Despite advances in surgical techniques and in systemic therapy, the 5-year relative survival remains a grim 9% for all stages combined. The extent of lymphadenectomy has been discussed intensively for decades, given that even in early stages of PC, lymph node (LN) metastasis can be detected in approximately 80%. The primary objective of this review was to provide an overview of the current literature evaluating the role of lymphadenectomy in resected PC. For this, we evaluated randomized controlled studies (RCTs) assessing the impact of extent of lymphadenectomy on OS and studies evaluating the prognostic impact of anatomical site of LN metastasis and the impact of the number of resected LNs on OS. Lymphadenectomy plays an essential part in the multimodal treatment algorithm of PC and is an additional therapeutic tool to increase the chance for surgical radicality and to ensure correct staging for optimal oncological therapy. Based on the literature from the last decades, standard lymphadenectomy with resection of at least ≥ 15 LNs is associated with an acceptable postoperative complication risk and should be recommended to obtain local radicality and accurate staging of the disease. Although radical surgery including appropriate lymphadenectomy of regional LNs remains the only chance for long-term tumor control, future studies specifically assessing the impact of neoadjuvant therapy on extraregional LNs are warranted.

Utility of PET-CT CMR after neoadjuvant chemotherapy with DCF for esophageal cancer as a predictive factor of recurrence.

434 Background: PET-CT is considered as standard modality for evaluating metastasis of esophageal cancer before treatment. On the other hand, it is unclear whether PET-CT CMR (complete metabolic response) could be useful for assessment after neoadjuvant chemotherapy. To clarify the utility of PET-CT CMR as an adequate modality of prediction for recurrence after neoadjuvant chemotherapy with DCF for esophageal cancer. Methods: Fifty-eight cases of esophageal cancer (cStageII-IVa) who received the esophagectomy with neoadjuvant chemotherapy of DCF since June 2013 in Oita University. We evaluated the clinicopathological factors, RFS and OS between CMR group (n=22, 38%) and non-CMR group (n=36, 62%). Results: In the clinical stage before chemotherapy, T-factor was higher in the non-CMR group (p = 0.044), but there were no significant differences of lymph node metastasis (p = 0.27) and stage (p = 0.94) between the two groups. There was no significant difference of the SUV max (16.4 ± 6.5 vs 15.7 ± 6.5, p = 0.98) of the main lesion before chemotherapy and the FDG accumulation rate of lymph nodes (14 cases (63.6%) vs 21 cases) (58.3%), p = 0.69) between the two groups. There were no significant differences of the surgical procedure, lymph node dissection area, number of harvested lymph nodes, amount of bleeding, operation time, curability, and intra/post-operative complications between the two groups. There were 5 cases (15%) with postoperative recurrence in the CMR group (lung 1 case, extra-regional lymph nodes 3 cases, bone 1 case), 17 cases (47%) in the non-CMR group (local 4 cases, lung 3 cases, livers 5 cases, extra regional lymph nodes 6 cases, bone 4 cases, pleura 2 cases), but there was no significant difference between the two groups (p = 0.062). There were significant differences between the two groups for 3-year RFS (81.3 vs 65.3 months, p=0.021) and 3-year OS (93.8 vs 61.6 months, p=0.011). Conclusions: PET-CR CMR could not predict recurrence at present. PET-CR CMR cases had better prognosis compared to non-CMR cases in terms of 3-year RFS and 3-years OS.

Impact of metabolic syndrome on clinicopathological characteristics and survival of patients with colorectal cancer

Objective To examine the impact of metabolic syndrome (MS) on the clinicopathological characteristics and prognosis of patients with colorectal cancer (CRC). Methods The clinical data of 650 patients with CRC admitted in Shanxi Provincial Cancer Hospital between January 2010 and December 2011 were retrospectively analyzed. Among 650 patients there were 190 cases complicated with MS (MS group) and 460 cases without MS (non-MS group), the clinicopathological features and prognosis were compared between two groups. Results The serum insulin and insulin-like growth factor-1 (IGF-1) levels in MS group were significantly higher than those in non-MS group [(9.2±4.7) vs.(6.8±4.7)μIU/L, t=8.88, P<0.01 and (200.2±44.1) vs.(136.7±63.2)mg/L,t=12.63, P<0.01]. The proportions of stage T3 and T4 cancer, extra-regional lymph node metastasis (ELN), and TNM stage Ⅲ and Ⅳ patients in MS group were significantly higher than those in non-MS group [(83.2% (158/190) vs. 72.6% (334/460), χ2=8.19, P=0.04; 9.5% (18/190) vs. 4.8%(22/460),χ2=8.61, P=0.04; 56.3% (107/190) vs. 45.2%(208/460), χ2=8.22, P=0.04, respectively]. The 5-year disease-free survival (DFS) in MS group was significantly lower than that in non-MS group [57.9%(99/171)vs. 66.1%(279/422), P<0.01]. Multivariate analysis indicated that MS(HR=1.623, 95%CI:1.511-1.963, P=0.03), IGF(HR=1.382, 95%CI:1.031-1.765, P=0.02) and, ELN(HR=4.270, 95%CI:2.177-7.463, P<0.01)were independent factors affecting the prognosis of CRC patients. Conclusion Metabolic syndrome is one of the risk factors affecting the prognosis of CRC patients. Key words: Colorectal neoplasms; Metabolic syndrome X; Clinicopathological characteristics; Prognosis

Lymph Node Progression and Optimized Node Dissection of Middle Thoracic Esophageal Squamous Cell Carcinoma in the Latest Therapeutic Surgical Strategy.

The aim of this study is to elucidate the optimized lymph node dissection range in middle thoracic (Mt) esophageal squamous cell carcinoma (ESCC) requiring surgery. We retrospectively analyzed 165 ESCC patients who underwent surgery with curative intent between 2009 and 2016, including 99 (60%) with MtESCC. Preoperative chemotherapy was administered in more than 80% of cStage II/III MtESCC patients. The rates of pathological and potential metastasis (representing recurrences) to lymph nodes and prognosis (median follow-up 52months) were clarified. Lymph node dissection efficacy was assessed by calculating the efficacy index (EI) for each lymph node. No. 2R had the highest rate of metastasis, with frequencies of 13/38/46% in cStage I/II/III, respectively, with the highest EI in MtESCC. Recurrences were seen in about 2-10% in the regional (nos. 1, 2L, 4R, and 10) and extraregional lymph nodes (paraaortic lymph node). The EI of lymph nodes was found to exhibit the highest score of 15 for no. 2R, followed by 11.5 for no. 17. The 5-year overall survival (OS) in MtESCC patients who underwent no. 2R lymph node dissection was 73.8%, while those who did not undergo no. 2R dissection did never reach 5-year OS (P = 0.002). Meticulous lymph node dissection of no. 2R is the most important for long-term survival, and mandatory with the highest priority in MtESCC.

Clinicopathologic Features and Prognostic Factors of Primary Cutaneous Melanoma: a Multicenter Study in Korea.

BackgroundMalignant melanoma is a cutaneous malignancy with a high mortality rate and high potential for metastases. Detailed information on the clinicopathologic characteristics and prognostic factors of cutaneous melanoma is currently limited in Korea. This study aimed to identify the epidemiological and clinicopathologic characteristics of primary cutaneous melanoma in Korean patients, and to assess which prognostic variables could influence both the development of metastases in primary cutaneous melanoma and overall survival (OS).MethodsA total of 261 patients diagnosed with primary cutaneous melanoma in seven medical centers between 1997 and 2017 were retrospectively investigated with regard to clinical presentation, localization of the tumor, histopathologic subtype, and survival time.ResultsThe nodular histologic subtype, ulceration, and Breslow thickness were significantly associated with the development of metastasis; and overweight and obesity (body mass index > 23) were significantly associated with increased Breslow thickness. The location of the metastases appeared to influence OS: brain metastases were associated with the highest risk of death, followed by gastrointestinal, lung, and extra-regional lymph node metastases.ConclusionIn this study, tumor thickness, nodular histologic subtype, and ulceration predicted metastatic spread of primary cutaneous melanoma. In addition, OS was associated with the location of metastases. Obesity was related to the prognosis of primary cutaneous melanoma. Clinicians should bear these findings in mind when forming a diagnosis because of the risk of a poor prognosis.

Association between primary origin (head, body and tail) of metastasised pancreatic ductal adenocarcinoma and oncologic outcome: A population-based analysis

IntroductionThe relation between the primary origin of metastasised pancreatic ductal adenocarcinoma (PDAC)—head, body or tail—metastatic patterns and outcomes has not yet been investigated in large population-based studies. MethodsPatients with metastasised PDAC at diagnosis from the Netherlands Cancer Registry were included (2005–2015). We compared number of metastatic organ sites (1, 2, ≥3) and specific metastatic organ sites (peritoneum, liver, lung and extra-regional lymph nodes) for the different primary tumour locations. Cox regression analyses were used to determine the association of tumour location and metastatic organ site(s) with overall survival. ResultsOverall, we included 9952 patients with metastasised PDAC. The primary origin was head in 5644 (57%), body in 1671 (17%) and tail in 2637 (26%) patients. Differences between primary origins were the number of metastatic organ sites (proportions ≥3 sites for head: 4%, for body: 8% and for tail: 13%, p < 0.0001) and peritoneal metastases (present in 13% for head, 24% for body and 30% for tail; p < 0.0001). Median overall survival was 2.6 months for head PDAC (reference), 2.4 months for body PDAC (HR 1.02 [0.97–1.08]) and 1.9 months for tail PDAC (HR 1.20 [1.15–1.26]). Of patients with one metastatic organ site, the worst survival compared with other sites was seen with liver only metastases (2.5 months vs. 2.7–5.1 months), and the best survival for patients, with extra-regional lymph node only metastases (5.1 months). ConclusionMetastatic patterns differ among the primary origins for PDAC with metastasised tail tumours having more metastatic sites, more often peritoneal metastases and worse survival.

The impact of radiological retroperitoneal lymphadenopathy on survival after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for colorectal peritoneal metastases

ObjectivesTo investigate the impact of retroperitoneal lymphadenopathy (RPLP) on pre-operative CT scan on overall survival (OS) and disease-free survival (DFS) after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) for peritoneal metastases (PM) of colorectal cancer. BackgroundIn patients with PM enlarged retroperitoneal lymph nodes (RPLP) are usually considered extra-regional lymph node metastases and therefore these patients may be excluded from CRS-HIPEC. This is a clinical dilemma since it is often hard to obtain histology from these nodes. MethodsIn this multicenter, retrospective study all consecutive patients with colorectal PM treated with CRS-HIPEC between 2004 and 2013 were included. The preoperative CT-scan was re-analyzed for the presence of RPLP based on the radiological appearance of enlarged lymph nodes. Outcomes were OS and DFS. Kaplan-Meier methods and Cox regression modeling were used to analyze the impact of RPLP on OS and DFS. ResultsIn 25 of 401 patients (6.1%) RPLP was observed on the preoperative CT-scan. Patient, tumor and surgical characteristics did not statistically significantly differ between groups with and without RPLP. After a median follow-up of 46 months, the one-, three- and five-year survival was 80%, 59%, 38% and 90%, 50%, 36% in the group with and without RPLP respectively. Median OS (47 vs. 35 months, logrank: p = 0.70) and median DFS (14 vs. 15 months, logrank: p = 0.81) did not statistically significantly differ between groups. In multivariable analysis, RPLP did not significantly influence survival. ConclusionEnlarged retroperitoneal lymph nodes on a pre-operative CT-scan should not automatically exclude patients from CRS-HIPEC.

Improving Selection for Resection of Synchronous Para-Aortic Lymph Node Metastases in Colorectal Cancer

Introduction: The clinical benefit of extended lymphadenectomy for synchronous extraregional lymph node metastasis, such as para-aortic lymph node (PALN) metastasis in colorectal cancer, remains highly controversial. Aim: To evaluate the clinical benefit of PALN dissection in colorectal cancer patients with synchronous PALN metastasis with or without multiorgan metastases. Methods: Thirty-six patients with pathologically positive PALN metastasis below the renal veins who underwent concurrent PALN dissection and primary colorectal cancer resection from January 1984 through September 2011 at the National Cancer Center Hospital in Tokyo, Japan, were included in this retrospective cohort study. We examined 5-year recurrence-free survival (RFS) rates in patient groups depending on the number of nodes involved (≤2 and ≥3 nodes) and on the presence or absence of other organ involvement (M1a and M1b,c categories in TNM staging). Results: The 5-year RFS rate was significantly different depending on the number of metastatic PALNs (42.1 and 0.6% for PALN ≤2 and ≥3, respectively, p = 0.01). The 5-year RFS rate was significantly better in patients in the M1a category than in patients in the M1b and M1c categories (27.6 and 0.0%, respectively, p < 0.01). Twenty-nine patients (80.6%) experienced recurrence after PALN dissection. Postoperative complications were seen in 14 (38.9%) patients. Conclusion: PALN dissection below the renal veins for patients with isolated PALN metastasis with 2 or fewer involved PALNs may be effective in improving prognosis in colorectal cancer.

Additional lymph node dissection for primary colorectal cancer invading another colon region.

Surgery remains the curative treatment of choice for colorectal cancer (CRC). However, to our knowledge, no report has addressed the usefulness of additional regional lymph node dissection for primary CRC that has invaded another colon region. We reviewed the clinicopathological characteristics and outcomes of eight patients who underwent surgery between March, 2005 and August, 2014, for CRC that invaded another region of the colon. Five patients underwent additional regional lymph node dissection in the area of the invaded colon and one patient had lymph node metastasis in the region. Two of three patients who did not undergo additional regional lymph node dissection were found to have regional lymph node recurrences in the area during the follow-up period. Although there was no statistical correlation between extra-regional lymph node metastasis and clinicopathological or operative factors, the patients with extra-regional lymph node metastasis or recurrence had primary regional lymph node metastasis. For curative intent, surgeons may need to perform additional regional lymph node dissection for primary CRC invading another colon region.

MP78-10 HIGHER RISK OF RECURRENCE AT EXTRAREGIONAL NODES AFTER RADICAL NEPHROURETERECTOMY IN PATIENTS WITH LEFT THAN IN PATIENTS WITH RIGHT URETERAL CANCER

You have accessJournal of UrologyBladder Cancer: Upper Tract Transitional Cell Carcinoma II1 Apr 2017MP78-10 HIGHER RISK OF RECURRENCE AT EXTRAREGIONAL NODES AFTER RADICAL NEPHROURETERECTOMY IN PATIENTS WITH LEFT THAN IN PATIENTS WITH RIGHT URETERAL CANCER Tsunenori Kondo, Isao Hara, Toshio Takagi, Yoshiki Kodama, Kenji Omae, Junpei Iizuka, Kazuhiko Yoshida, Hironori Fukuda, and Kazunari Tanabe Tsunenori KondoTsunenori Kondo More articles by this author , Isao HaraIsao Hara More articles by this author , Toshio TakagiToshio Takagi More articles by this author , Yoshiki KodamaYoshiki Kodama More articles by this author , Kenji OmaeKenji Omae More articles by this author , Junpei IizukaJunpei Iizuka More articles by this author , Kazuhiko YoshidaKazuhiko Yoshida More articles by this author , Hironori FukudaHironori Fukuda More articles by this author , and Kazunari TanabeKazunari Tanabe More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.2098AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES We reported the lack of therapeutic effect of lymphadenectomy on lower ureteral cancer (LUC). We further examined this mechanism by analyzing the recurrence pattern and factors influencing the outcome of LUC. METHODS From January 1988 to September 2016, we performed radical nephroureterectomy for 83 patients with non-metastatic (clinically N0 M0) LUC at two Japanese institutes. The lower ureter was designated as located below the crossing of the common iliac artery. Metastatic sites were identified with radiological imaging studies or resected specimens. Regional nodes of LUC were identified as ipsilateral pelvic nodes below the aortic bifurcation, according to the description in our previous study. RESULTS The mean age of the 83 patients was 71.2 years (range: 38–90 years), and the mean follow-up period was 48 months (range: 2–225 months). Radical nephroureterectomy was performed for 41 patients with right LUC and for 42 patients with left LUC. No significant difference was found in the patients who underwent template-based lymphadenectomy (34% in the right and 36% in the left LUC, p=0.88). The 5-year recurrence-free and cancer-specific survival rates were respectively 71.9% and 80.1% in the right LUC, and 50.6% and 62.7% in the left LUC. The difference was statistically significant (p=0.02 and 0.03, respectively; Figure 1). The incidence of lymph node recurrence was even higher in the patients with left LUC (24%) than in those with right LUC (2%), and 60% of the lymph node recurrences occurred at the extraregional nodes in the left LUC. The multivariate analysis revealed that the factors that influenced cancer-specific survival were left ureteral tumors (hazard ratio [HR], 3.38; p=0.02) and pathological stage T3 or higher (HR, 28.9; p=0.002). Template-based lymphadenectomy or adjuvant chemotherapy was not a significant factor. CONCLUSIONS This multi-institutional study shows a higher risk of extraregional nodes recurrence after nephroureterectomy in patients with left LUC, which is likely to be associated with worse oncological outcome of left LUC than right LUC. Template-based lymphadenectomy alone appears inadequate to improve patient survival in left LUC. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e1034-e1035 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Tsunenori Kondo More articles by this author Isao Hara More articles by this author Toshio Takagi More articles by this author Yoshiki Kodama More articles by this author Kenji Omae More articles by this author Junpei Iizuka More articles by this author Kazuhiko Yoshida More articles by this author Hironori Fukuda More articles by this author Kazunari Tanabe More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Conversion surgery after combination chemotherapy of docetaxel, cisplatin and S-1 (DCS) for far-advanced gastric cancer.

A triplet regimen of docetaxel, cisplatin, and S-1(DCS) is highly effective against metastatic gastric cancer. We performed this study to clarify the safety and efficacy of surgical resection in patients with initially unresectable gastric cancer, after down-staging or disease control was achieved by DCS chemotherapy. The subjects of this retrospective study were 31 consecutive patients with initially unresectable gastric cancer, who underwent surgical resection between October, 2006 and December, 2012, after down-staging or disease control was achieved by DCS chemotherapy. We evaluated the clinicopathological factors and clinical outcomes and assessed radiographic response based on the RECIST criteria, not by central review. Before DCS chemotherapy, 18 patients had extra-regional lymph node metastasis, 5 had liver metastasis, 8 had macroscopic peritoneal metastasis, and 8 had pancreatic head invasion. Twenty-three (74.2%) of the 31 patients underwent R0 resection. Postoperative morbidity and mortality rates were 16.1 and 0%. During chemotherapy, grade 3/4 toxicities included neutropenia (54.8%), leukopenia (32.3%), and anemia (16.1%). Median progression-free survival and median overall survival (OS) were 42.1 and 56.1 months, respectively. These results were similar for all patients, except those with locally advanced disease alone. In the multivariate analysis for OS, ypN remained an independent negative prognostic factor (p = 0.018). Surgical resection after DCS chemotherapy for initially unresectable gastric cancer was safe and provided a reasonable R0 resection rate and good mid-term survival.

The role of CT in assessment of extra-regional lymph node involvement in pancreatic and peri-ampullary cancer: A prospective diagnostic accuracy study

The role of CT in assessment of extra-regional lymph node involvement in pancreatic and peri-ampullary cancer: A prospective diagnostic accuracy study

Advanced Studies in Clinical and Experimental Research in Gastroenterology.

Current research in gastroenterology and hepatology (both clinical and experimental) made great and rapid progress in new methods, in biomedical technology, and last but not least in practical application of basic scientific achievements during the last decade. Original research articles focusing on new, advanced studies in clinical and experimental research in gastroenterology and hepatology that have a potential to influence our daily practice and further clinical and experimental research were sent to this journal to be published by many leading gastroenterology specialists. We bring ten articles in this special issue focused on the most interesting topics in gastroenterology and hepatology research. One of the leading areas of advanced studies in gastroenterology is cancer research. Colorectal cancer is one of the most common malignancies worldwide in terms of incidence and mortality. Although clear progress in both diagnosis and treatment has been achieved, efficacy of surgery and chemotherapy remains unsatisfactory due to late diagnosis. A possible new prognostic marker and therapeutic target in this disease is discussed in the article “ATAD2 Overexpression Identifies Colorectal Cancer Patients with Poor Prognosis and Drives Proliferation of Cancer Cells.” The aim of another article dealing with the colorectal cancer “Molecular Features and Methylation Status in Early Onset (≤40 Years) Colorectal Cancer: A Population Based, Case-Control Study” was to define the frequency of known hereditary colorectal syndromes and to characterise genetic and epigenetic features of early nonhereditary tumours in order to elucidate possible pathogenetic mechanisms. Colonoscopy plays an important role in colorectal cancer screening in many countries worldwide. Quality of colonic cleansing achieved is crucial for good quality of colonoscopy screening. Possible improvements in the field of low volume colonoscopy cleansing were described in the article “A Randomized Controlled Trial Evaluating a Low-Volume PEG Solution Plus Ascorbic Acid versus Standard PEG Solution in Bowel Preparation for Colonoscopy.” Second malignancy, which is discussed in a special issue in more detail, is the third most common cause of cancer-related death in the world: the gastric cancer. In the article “The Prevalence of Gastric Intestinal Metaplasia and Distribution of Helicobacter pylori Infection, Atrophy, Dysplasia, and Cancer in Its Subtypes,” the prevalence of the precancerous gastric lesions (intestinal metaplasia especially) in a large cohort of patients within the region with a high risk of gastric cancer was described. The metastatic involvement of the posterior lymph nodes along the common hepatic artery (the extra-regional lymph nodes called No.8p) was identified as a prognostic factor in the retrospective study: “Prognostic Value of Metastatic No.8p LNs in Patients with Gastric Cancer.” The research based on the use of experimental animals still plays an important role in gastroenterology and the rat is one of the most extensively used experimental animal models. The study “Surgical Anatomy of the Gastrointestinal Tract and Its Vasculature in the Laboratory Rat” investigated the functional anatomy and vasculature of the stomach, liver, and intestine in the laboratory rat and compared it with human morphology. Nonsteroidal anti-inflammatory drug-induced gastropathy and ulcers represent an important complication related to one of the most commonly used drugs worldwide. Possible mucosal protective effect of Syzygium cumini (L.) Skeels aqueous extract in experimental mice model of indomethacin-induced gastric damage was proven in article “Anti-Inflammation Property of Syzygium cumini (L.) Skeels on Indomethacin-Induced Acute Gastric Ulceration.” Research in hepatology is represented in three articles: “Assessing the Effect of Leptin on Liver Damage in Case of Hepatic Injury Associated with Paracetamol Poisoning,” “Lower Viral Response to Pegylated Interferon Alpha 2a Treatment of Chronic Hepatitis B in Roma People in Eastern Slovakia,” and “Serum Liver Fibrosis Markers for Predicting the Presence of Gastroesophageal Varices in Liver Cirrhosis: A Retrospective Cross-Sectional Study.” The special issue cannot be a complete overview of research in the field of gastroenterology and hepatology. However, we believe that it is an interesting look at this area and provides a preview with an important impact on clinical medicine. Ilja Tacheci Jithinraj Edakkanambeth Varayil Zuzana Zelinkova Marcela Kopacova Miroslav Zavoral

Oncologic Outcomes of Colon Cancer Patients with Extraregional Lymph Node Metastasis: Comparison of Isolated Paraaortic Lymph Node Metastasis with Resectable Liver Metastasis.

The treatment strategy and benefit of extended lymph node dissection among patients with preoperatively diagnosed paraaortic lymph node metastasis (PALNM) in colon cancer remains highly controversial. In the current study, we analyzed the oncologic outcomes of patients who underwent extraregional lymph node dissection for colon cancer with isolated PALNM. From March 2000 to December 2009, the study group included 1082 patients who underwent curative surgery for colonic adenocarcinoma with pathological lymph node metastasis. Of 1082 patients who underwent curative surgery for colonic carcinoma, 953 (88.1%) patients underwent regional lymphadenectomy, and 129 (11.9%) patients underwent paraaortic lymph node dissection. Pathologic examination revealed N1 stage disease in 738 (68.2%), N2 in 295 (27.3%), and PALNM in 49 (4.5%). Five-year overall survival (OS) and disease-free survival (DFS) rate were significantly better in the regional LNM group than in the PALNM group (OS 75.1 vs. 33.9%, p<0.001; DFS 66.2 vs. 26.5%, p<0.001). Five-year OS and DFS were not significantly different between the PALNM and resectable liver metastasis patients who underwent curative resection (OS 33.9 vs. 38.7%, p=0.080; DFS 26.5 vs. 27.6%, p=0.604). PALNM in colon cancer is associated with poorer survival than regional lymph node metastasis and showed comparable survival rates with metastasectomy for liver metastasis. Further studies evaluating the net benefit of upfront chemotherapy compared with initial resection for patients with potentially resectable PALNM are needed.

The significance of extended lymphadenectomy for colorectal cancer with isolated synchronous extraregional lymph node metastasis

The significance of extended lymphadenectomy for colorectal cancer with extraregional lymph node metastasis, such as para-aortic lymph node metastasis, has not been established. The purpose of this study was to evaluate the significance of extended lymphadenectomy for colorectal cancer with synchronous isolated extraregional lymph node metastasis. Between July 2004 and December 2013, 16 patients with synchronous extraregional lymph node metastasis without other organ metastases underwent curative resection and extended lymphadenectomy (R0 group). The clinical characteristics and survival outcomes of the R0 group were compared with those of 12 patients with extraregional lymph node metastasis who underwent palliative surgery (control group). In the R0 group, the 5-year cancer-specific survival (CSS) rate was 70.3% and the 5-year relapse-free survival (RFS) rate was 60.5%. The 5-year CSS differed significantly between the R0 and control groups (70.3% vs. 12.5%; p=0.0003). Univariate analyses revealed that the total numbers of metastatic lymph nodes and metastatic regional lymph nodes present were significantly associated with RFS (p=0.019 for both). Findings from our study suggest that extended lymphadenectomy for colorectal cancer with synchronous isolated extraregional lymph node metastasis might be effective in carefully selected patients.

P3-6-5 - An investigation about the efficacy of measuring serum CA 19-9 in patients with advanced urothelial carcinoma

Background: The present study was undertaken to investigate whether serum levels of carbohydrate antigen (CA) 19-9 is effective for predicting prognosis in patients with advanced urothelial carcinoma (UC). Methods: Patients diagnosed as locally advanced or metastatic or recurrent UC in our department between Apr 2008 to Oct 2014 were evaluated retrospectively. Pathological TNM stage was showed if patients underwent radical surgery, and clinical TNM stage was showed if not. Metastatic disease was defined as positive for extra-regional lymph node metastasis or metastasis in other organs. CA 19-9 was assayed with ELISA reader for all cases and expressed in U/ml with 30 U/ml taken as the cut-off upper value for normal. One-way analysis of variance and Student's or Welch's t-test were used for comparative data analysis. Kaplan-Meier method and log-rank test were used to compare survival time. Results: Out of 40 cases enrolled, 7 patients who showed a low value in serum CA 19-9 (<= 2 U/ml) were eliminated because they were highly suspected of Lewis A negative blood type. Two patients in advanced state with multiple liver metastases were also eliminated. Median follow-up time was 12 months. The mean values of CA 19-9 was 36.6 U/ml. The values in serum CA 19-9 were not significantly different among three types of UC. The percentage of rise in CA 19-9 for >= T3 tumors was significantly high when compared to <= T2 tumors (p = 0.034). Conversely, the percentage of rise in CA 19-9 for metastatic disease was not significantly high when compared to non-metastatic disease (p = 0.276). T stage and metastatic state did not correlate with prognosis except DSS in metastatic disease (p = 0.014), however, patiens with high serum CA 19-9 levels demonstrated significantly better prognosis in DSS and OS than that of low levels (p = 0.022, p = 0.019, respectively). Conclusion: Patients of advanced urothelial carcinoma with high serum CA 19-9 levels may predict good prognosis.

Diabetes mellitus, obesity and chronic pancreatitis? Independent risk factors for pancreatic adenocarcinoma (PAC) in Romanian Black Sea coast area

Patients & methods: Prospective diagnostic accuracy study in a tertiary HPB center according to the STARD guidelines. We included patients undergoing pancreatoduodenectomy or radiofrequency ablation (RFA) combined with bypass surgery. Extra-regional lymph nodes were defined as lymph nodes in the aortocaval window. An expert HPB-radiologist prospectively assessed aortocaval lymph nodes on preoperative CT according to a standardized protocol. All tissue from the aortocaval window was harvested intra-operatively. The reference test was histopathology. Results: Between March 2013 and December 2014, 77 consecutive patients were included. In 69 patients (90%) a pancreatoduodenectomy was performed and 8 patients underwent RFA (n1⁄47) or only bypass (n1⁄41). A median of 3 aortocaval lymph nodes(IQR 1-4) were harvested per patient. Nine patients (12%) had aortocaval LNM. Negative predictive value of CT in assessing aortocaval LNM was 88%(95%CI 77-94%) and positive predictive value was 10%(CI 1-46%). Overall diagnostic accuracy was 22%. Conclusion: CT has a low diagnostic accuracy in assessing extraregional LNM in pancreatic or peri-ampullary cancer, mainly due to the high number of false positive results. Signs of aortocaval LNM on CT should therefore not be a contra-indication for surgical exploration or other treatments that are part of a strategy with curative intent.

The role of CT in assessment of extra-regional lymph node involvement in pancreatic and peri-ampullary cancer: A prospective diagnostic accuracy study

The role of CT in assessment of extra-regional lymph node involvement in pancreatic and peri-ampullary cancer: A prospective diagnostic accuracy study

Patterns of metachronous metastases after curative treatment of colorectal cancer

BackgroundThis study aimed to provide information on timing, anatomical location, and predictors for metachronous metastases of colorectal cancer based on a large consecutive series of non-selected patients. MethodsAll patients operated on with curative intent for colorectal cancer (TanyNanyM0) between 2003 and 2008 in the Dutch Eindhoven Cancer Registry were included (N=5671). By means of active follow-up by the Cancer Registry staff within ten hospitals, data on development of metastatic disease were collected. Median follow-up was 5.0 years. ResultsOf the 5671 colorectal cancer patients, 1042 (18%) were diagnosed with metachronous metastases. Most common affected sites were the liver (60%), lungs (39%), extra-regional lymph nodes (22%), and peritoneum (19%). 86% of all metastases was diagnosed within three years and the median time to diagnosis was 17 months (interquartile range 10–29 months). Male gender (HR=1.2, 95%CI 1.03–1.32), an advanced primary T-stage (T4 vs. T3 HR=1.6, 95%CI 1.32–1.90) and N-stage (N1 vs. N0 HR=2.8, 95%CI 2.42–3.30 and N2 vs. N0 HR=4.5, 95%CI 3.72–5.42), high-grade tumour differentiation (HR=1.4, 95%CI 1.17–1.62), and a positive (HR=2.1, 95%CI 1.68–2.71) and unknown (HR=1.7, 95%CI 1.34–2.22) resection margin were predictors for metachronous metastases. ConclusionsDifferent patterns of metastatic spread were observed for colon and rectal cancer patients and differences in time to diagnosis were found. Knowledge on these patterns and predictors for metachronous metastases may enhance tailor-made follow-up schemes leading to earlier detection of metastasized disease and increased curative treatment options.