Incomplete Excision Research Articles

Endoscopic management of intralingual thyroglossal duct cysts: Case series and systematic review

ObjectiveTo discuss our institutional experience with endoscopic management of intralingual thyroglossal duct cyst (TGDC) and review cases in the published literature in a systematic review. MethodsPediatric patients with intralingual TGDC treated with endoscopic surgery at our institution from 2009-2019 were identified. Metrics from our case series were then compared to those in the literature in a systematic review to assess pooled outcomes of endoscopic or transoral management. Patient demographics, age of presentation, presenting symptomatology, size of cyst on imaging, type of surgery, and post-operative outcomes were assessed. ResultsWe identified 5 institutional cases of intralingual TGDC and 48 cases of intralingual TGDC described in the literature. The average age of presentation was 20.36 months. 69.8% (N=37) of patients presented with at least one respiratory symptom, 22.6% (N=12) presented with dysphagia, 9.4% (N=5) presented with an identified mass in the oropharynx, and 15.1% (N=8) had the cyst discovered as an incidental finding. Three patients required revision surgeries due to prior incomplete TGDC excisions and one patient experienced a recurrence >6 months after primary excision requiring a second procedure. Our data pooled with published case series in systematic review confirms that endoscopic or transoral management are excellent options for definitive management of intralingual TGDC. ConclusionsIntralingual TDGC is a potentially life-threatening variant of TGDC. Our results pooled with published series in a systematic review suggest that endoscopic or transoral management of intralingual TGDC are excellent minimally invasive treatments with a low risk of recurrence. Postoperative surveillance up to one year is recommended.

Risk factors and outcome in dogs with recurrent massive hepatocellular carcinoma: A Veterinary Society of Surgical Oncology case-control study.

Local recurrence after surgical excision of canine massive hepatocellular carcinoma (HCC) has been poorly studied in veterinary medicine with scant information published regarding risk factors for and outcome following recurrence. The aim of this case–control study was to describe the time to recurrence, evaluate potential risk factors for recurrence, and report the outcome in dogs with massive HCC. Medical records for 75 dogs who developed recurrence and 113 dogs who did not develop recurrence were reviewed. Statistical analyses were performed to determine risk factors for recurrence as well as the median time to develop recurrence and overall survival time (OS). None of the risk factors evaluated were significant for the development of recurrence. The median time to develop recurrence was 367 days (range 32–2096 days). There was no significant difference in median OS for dogs who developed recurrence vs. those who did not (851 vs. 970 days). For dogs with recurrent HCC, treatment at recurrence trended toward prolonged OS but was not significantly different from dogs not undergoing treatment at recurrence. There was no significant difference in median OS for dogs with histologically complete vs. incomplete tumour excision (990 vs. 903 days). Although specific risk factors for recurrence were not identified, elevations in liver values were noted in patients with recurrent disease and could act as a noninvasive surveillance tool. Recurrence was noted earlier in dogs who had routine post‐operative surveillance (228 vs. 367 days). Routine surveillance for recurrence is recommended especially in dogs where further intervention is possible and should extend beyond 1 year. Patients with massive HCC have a good long‐term prognosis regardless of incomplete excision, pulmonary metastasis, or recurrent local disease.

PD21-06 INFLAMMATORY MYOFIBROBLASTIC TUMOR OF THE GENITOURINARY TRACT: A SYSTEMATIC REVIEW

You have accessJournal of UrologyCME1 May 2022PD21-06 INFLAMMATORY MYOFIBROBLASTIC TUMOR OF THE GENITOURINARY TRACT: A SYSTEMATIC REVIEW Nikolas Moring, Daniel Swerdloff, Mahmut Akgul, Tipu Nazeer, and Badar Mian Nikolas MoringNikolas Moring More articles by this author , Daniel SwerdloffDaniel Swerdloff More articles by this author , Mahmut AkgulMahmut Akgul More articles by this author , Tipu NazeerTipu Nazeer More articles by this author , and Badar MianBadar Mian More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002559.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Inflammatory myofibroblastic tumor (IMT) is a rare tumor that has been described in nearly every organ system in the body. IMT generally lack metastatic potential, but these tumors often exhibit locally invasive and progressive disease which can mimic locally advanced malignancy. In the genitourinary tract (GU), IMT can manifest with signs and symptoms (mass, hematuria, pain) of common GU cancers such as renal cell carcinoma, testicular mass, or transitional cell carcinoma of the bladder. Due to its novel nature and lack of a singularly agreed upon definition, IMT prevalence and incidence are difficult to ascertain. We conducted a comprehensive systematic review with the aim to identify all reports of IMT in the GU tract, and describe the presenting symptoms, contemporary management, and pathologic features. METHODS: Systematic review using the following search terms were performed: “Inflammatory Pseudotumor” OR “Pseudosarcoma” OR “Inflammatory Pseudo-Tumor” OR “Inflammatory Myofibroblastic Tumor” AND “Urology” OR “Urologic” OR “Genitourinary”. Two reviewers performed independent initial screening of all abstracts. All potentially eligible articles underwent full text review and data extraction. The data for each GU organ site was analyzed separately. RESULTS: Of the 259 articles initially identified, and 101 were used in the systematic review. The articles consisted primarily of small case series and case reports, for a total of 110 cases of GU IMT. Pediatric IMT accounted for 9% of GU IMT cases. Most common presenting symptoms included pain, mass, hematuria and voiding symptoms. The most frequently involved sites and treatment included bladder (63 cases; 52% had radical/partial cystectomy), kidney (19; 93% had radical/partial nephrectomy), epididymis (6), urachus (6), ureter (5), prostate (4), testis (4), and spermatic cord (3). Anti-inflammatory, antibiotic and antineoplastic therapy used in 8% of cases was ineffective. Anaplastic lymphoma kinase expression, noted in half the cases, is a favorable prognostic indicator. Incomplete excision is associated with risk of recurrence while complete surgical excision provides excellent disease control with rare recurrence or metastatic transformation (<2%). CONCLUSIONS: IMT exhibit locally invasive, symptomatic and progressive phenotype that can affect all GU organs, especially bladder, kidney and scrotal contents. Clinical and radiologic features mimic GU malignancy. IMT require complete surgical excision since incomplete resection increases the risk of symptomatic recurrence. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e362 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Nikolas Moring More articles by this author Daniel Swerdloff More articles by this author Mahmut Akgul More articles by this author Tipu Nazeer More articles by this author Badar Mian More articles by this author Expand All Advertisement PDF DownloadLoading ...

Risk factors for incomplete excision of cutaneous squamous cell carcinoma: a large cohort study.

BackgroundThe standard treatment for cutaneous squamous cell carcinoma (cSCC) is surgical excision. Failure to radically remove a cSCC is a risk for recurrence, progression and metastasis.ObjectivesThis study investigates several risk factors for incomplete excision of cSCC.MethodsAll consecutive patients in a single institution treated with wide local excision for primary cSCC over a 10‐year period were included in this study. Risk factors such as: gender, age, immunosuppression, tumour size, location, differentiation grade, tumour depth, perineural and lymphovascular invasion (PNI and LVI) were extracted from the database. Univariable and (if applicable) multivariable logistic regression analysis were used to identify risk factors (P < 0.05). Generalized estimating equations (GEEs) were used for multiple tumours within the same patients.ResultsA total of 566 patients with 1159 cSCC were identified. Univariable and multivariable logistic regression analysis showed that depth beyond the dermis (OR: 5.7 95% CI: 3.1–10.5) was the only risk factor for incomplete excision of cSCC. Immunosuppression was only a risk factor in the deep plane (OR: 2.5, 95% CI: 1.3–4.6).ConclusionTumour depth beyond the dermis is the most important risk factor for incomplete excision of cSCC. Immunosuppression is a risk factor in the deep plane but its relevance is uncertain. Immunosuppression is not consistently included in the current cSCC staging systems, but care should be taken when treating these patients.

Do we need to rethink the diagnoses melanoma in situ and severely dysplastic naevus?

Do we need to rethink the diagnoses melanoma in situ and severely dysplastic naevus?

Current Management and Treatment of Extramammary Paget's Disease.

Extramammary Paget's disease (EMPD) is a rare neoplastic disease affecting areas rich in apocrine glands in the elderly. EMPD clinically resembles a benign inflammatory skin disease, and ill-defined tumor borders can lead to misdiagnosis and incomplete excision. Several prognostic factors have been reported, including nodule formation, tumor thickness, tumor invasion, lymphovascular invasion, and a perianal location, which are characteristic of primary tumors. EMPD typically presents as an in situ tumor spreading horizontally within the epidermis and then invading into the dermis as it transitions to a vertical growth phase. For this reason, tumor thickness, rather than tumor size, is correlated with patient prognosis. The best treatment for resectable EMPD is complete surgical removal of the tumor. EMPD sometimes has unclear tumor borders, and it can unexpectedly spread beyond its clinical boundaries. Surgical resection in such cases is often associated with tumor-positive margins, which can result in recurrence. However, surgical excision with wide margins may deteriorate patients' organ functions and quality of life. Mohs micrographic surgery may be ideal for controlling the surgical margins and minimizing the sacrifice of normal tissue, but this technique is not always feasible because of constraints associated with the medical environment. No standard treatment for unresectable or metastatic EMPD has been established. Although conventional chemotherapy has been used as the first-line treatment, it frequently causes adverse events, and consequently, targeted therapy will become more valuable in the near future.

Skin lesion assessment and management model: optimising existing resources in the management of non-melanoma skin cancer

Abstract &#x0D; Background&#x0D; Skin cancer is a relatively common cancer in Australia, with early, simple treatment conferring a high likelihood of cure. Early diagnosis and treatment are important to reduce morbidity and mortality. A see-and-treat clinic seeks to offer earlier diagnosis and treatment as compared with a traditional model of care. The aim was to implement this model using pre-existing infrastructure with a hypothesis that this service will reduce wait times with reduced costs and high levels of patient satisfaction &#x0D; &#x0D; Methods&#x0D; Referrals were screened and those suitable underwent consultation with a Plastic and Reconstructive Surgeon and same-day operative management with their choice of anaesthesia. Patients were reviewed 1 week and 4 weeks postoperatively.&#x0D; &#x0D; Results&#x0D; 206 patients had 286 skin lesions removed over 23 operating lists. Over 75% of excisions were on the face. Local anaesthetic with sedation was the most popular anaesthetic technique There were 22 complications and the incomplete excision rate was 4.2%. Average wait time for SLAM-suitable patients reduced by 76%, and category 1 outpatient waitlists were reduced by 100%. An estimated gross saving of $1,339 per patient was calculated. A survey of patients post-operatively showed all patients would recommend this model.&#x0D; &#x0D; Conclusion&#x0D; This see-and-treat model was shown to reduce wait times and cost, along with high levels of patient satisfaction. It was also easily implemented using pre-existing infrastructure. It is a service that continues to be offered and expanded, with ongoing patient satisfaction.

Clinical Features and Outcomes of Patients with Orbital Schwannoma.

To report the clinical features, treatment, and outcome of 11 patients with orbital schwannoma in Korean patients. The medical records of 11 orbital schwannoma patients treated between April 2007 and April 2021 were retrospectively reviewed. The demographic data, clinical characteristics, radiological features, and outcomes were reviewed. The mean age at the time of diagnosis was 49.00 ± 14.45 years. The most common initial symptom was ocular protrusion (n = 7), and other symptoms were decreased visual acuity ( n = 5), restriction of eye movement ( n = 4), swelling ( n = 3), and pain ( n = 2). Locations of tumors were superomedial; followed by the orbital apex and inferolateral. The most common shape seen in our patients was beads like multilobulated appearance; followed by a round, oval, fusiform, and dumbbell shape. MRI of T1-weighted revealed isointense or hypointense, whereas the T2-weighted indicated hyper or isointense lesion. Five patients had optic neuropathy at presentation, and 1 of them showed improved vision after surgery. Complete or incomplete excision was performed for all. Surgical complications include decreased vision and paraesthesia. There has been no recurrence to date. Orbital schwannoma is a rare disease and it is difficult to distinguish it from other orbital tumors because the initial symptoms are nonspecific. Differential diagnosis by combining the shape, location, and contrast enhancement findings seen on computed tomography and magnetic resonance imaging can be helpful in surgical treatment. Complete excision gives the best results without recurrence, but if the patient is in an inaccessible location, only surgery to reduce the volume can satisfy the patient without recurrence.

The role of radiotherapy in the management of cutaneous squamous cell carcinoma: a retrospective study on 92 cases.

Cutaneous squamous cell carcinoma (cSCC) is the second most common nonmelanoma skin cancer in the world after basal cell carcinoma. Treatment of choice for cSCC is surgery, but radiotherapy (RT) is a valid alternative and has been recommended in selected cases. The aim was to evaluate the cure rate of RT for cSCC and to compare the results in the two settings of RT as exclusive or second line treatment. The outcome of 92 cSCC treated with RT in the period from 2002 to 2019 in our department was retrospectively reviewed. In 56 cases RT was first-line treatment while in 36 it was administered as second-line treatment after incomplete excision or failure of previous treatments. The five-year cure-rate was 74% (71.34% in patients treated with primary RT and 77.37% in patients treated with RT as second-line treatment), while the ten-year cure-rate was 67% (57.07% and 77.37% respectively in patients treated with primary RT or with second line RT). Log rank test showed statistical significance between the cure-rate of the two groups with better therapeutic results after second-line RT (P<0.05). Our data confirm RT as an effective therapy for cSCC when surgery excision is contraindicated or in case of tumors localized in certain regions where the cosmetic-functional outcome is better than surgery. Better therapeutic results are achieved with second-line RT.

Erythroid‐specific inactivation of Slc12a6/Kcc3 by EpoR promoter‐driven Cre expression reduces K‐Cl cotransport activity in mouse erythrocytes

Investigation of erythrocytes from spontaneous or engineered germ‐line mutant mice has been instrumental in characterizing the physiological functions of components of the red cell cytoskeleton and membrane. However, the red blood cell expresses some proteins whose germline loss‐of‐function is embryonic‐lethal, perinatal‐lethal, or confers reduced post‐weaning viability.Promoter regions of erythroid‐specific genes have been used to engineer erythroid‐specific expression of Cre recombinase. Through breeding with mice carrying appropriately spaced insertions of loxP sequences, generation of erythroid‐specific knockouts has been carried out for signaling enzymes, transcription factors, peptide hormones, and single transmembrane span signaling receptors. We report here the use of Cre recombinase expression driven by the erythropoietin receptor (EpoR) promoter to generate EpoR‐Cre;Kcc3f / f mice, designed to express erythroid‐specific knockout of the KCC3 K‐Cl cotransporter encoded by Kcc3/Slc12A6. We confirm KCC3 as the predominant K‐Cl cotransporter of adult mouse red cells in mice with better viability than previously exhibited by Kcc3 −/− germline knockouts. We demonstrate roughly proportionate preservation of K‐Cl stimulation by hypotonicity, staurosporine, and urea in the context of reduced, but not abrogated, K‐Cl function in EpoR‐Cre;Kcc3f / f mice. We also report functional evidence suggesting incomplete recombinase‐mediated excision of the Kcc3 gene in adult erythroid tissues.

Vocal fold myxoma: a case report and review of current literature

BackgroundVocal fold myxoma is a rare mesenchymal tumor with unknown exact etiology. The aim of this report is to review current literature on demographic and clinical features of vocal fold myxomas in order to increase awareness among otorhinolaryngologists on management of this rare vocal fold pathology.Case presentationWe report a case of a 46-year-old female teacher presented with 1 year history of progressive dysphonia with no airway obstructive or constitutional symptoms. Flexible laryngoscopy revealed a polypoid mass at the anterior two thirds of the left vocal fold. We proceeded with endolaryngeal microsurgery, where a left vocal fold mass with prominent overlying blood vessels was incompletely excised due to poor plane, in an attempt to prevent injury to vocal ligament. The histopathological findings were consistent with myxoma. No evidence of recurrence was noted at 2 months postoperatively.ConclusionsVocal fold myxoma should be considered as a differential diagnosis of vocal fold pathology clinically resembling vocal fold polyp, especially in older male adults. Complete excision with removal of a rim of surrounding tissue is the gold-standard treatment to prevent recurrence. If diagnosis is uncertain, intraoperative frozen section can be performed to ensure margins are free from tumor. Life-long follow-up is recommended in incomplete excision of tumor.

Routine four-quadrant cavity shaving at the time of wide local excision for breast cancer reduces re-excision rate.

Breast conservation therapy (BCT) has been shown to have comparable long-term survival outcomes when compared with mastectomy. Clearance of excision margin is one of the mainstays of the surgical treatment, which if not achieved at the first operation of BCT results in the need for subsequent surgery. This study evaluated the impact of routinely taken cavity shavings on re-excision rates. This retrospective two-centre study describes the use of routine four-quadrant cavity shaving in 449 patients with consecutively treated with wide local excision for invasive cancer or ductal carcinoma in situ. The overall incomplete excision rate was 10.6%. Routine cavity shaving prevented the need for re-excision in 84 patients (18.7%) and identified the need for further re-excision in 33 patients (7.3%). Median time from surgery to radiotherapy was 50 days (range 13-209) for non-re-excised patients versus 78 days (range 47-260) for re-excised patients (p<0.001). Median time to chemotherapy (n=75) was 44 days (range 14-106) for non-re-excised patients versus 56 days (range 35-116) for re-excised patients (p=0.017). This study demonstrates that routine cavity shaving decreases re-excision rate in patients treated with wide local excision and prevents delays to adjuvant treatment due to incomplete excision.

Degradation of the Escherichia coli Essential Proteins DapB and Dxr Results in Oxidative Stress, which Contributes to Lethality through Incomplete Base Excision Repair.

ABSTRACTVarious lethal stresses, including bactericidal antibiotics, can trigger the production of reactive oxygen species (ROS) that contribute to killing. Incomplete base excision repair (BER) of oxidized nucleotides, especially 8-oxo-dG, has been identified as a major component of ROS-induced lethality. However, the relative contributions of this pathway to death vary widely between stresses, due in part to poorly understood complex differences in the physiological changes caused by these stresses. To identify new lethal stresses that kill cells through this pathway, we screened an essential protein degradation library and found that depletion of either DapB or Dxr leads to cell death through incomplete BER; the contribution of this pathway to overall cell death is greater for DapB than for Dxr. Depletion of either protein generates oxidative stress, which increases incorporation of 8-oxo-dG into the genome. This oxidative stress is causally related to cell death, as plating on an antioxidant provided a protective effect. Moreover, incomplete BER was central to this cell death, as mutants lacking the key BER DNA glycosylases MutM and MutY were less susceptible, while overexpression of the nucleotide sanitizer MutT, which degrades 8-oxo-dGTP to prevent its incorporation, was protective. RNA sequencing of cells depleted of these proteins revealed widely different transcriptional responses to these stresses. Our discovery that oxidative stress-induced incomplete BER is highly dependent on the exact physiological changes that the cell experiences helps explain the past confusion that arose concerning the role of ROS in antibiotic lethality.

Long-term outcomes of transanal endoscopic microsurgery for the treatment of rectal neuroendocrine tumors

BackgroundTransanal endoscopic microsurgery (TEM) has been accepted worldwide for the treatment of local rectal lesions. We aimed to assess the efficacy and safety of TEM in the treatment of rectal neuroendocrine tumors (RNET).MethodsA retrospective study of patients who had undergone TEM for RNET at our institution between December 2006 and June 2019 was performed. Demographic and tumor characteristics, operative and pathological details, complications, anal function questionnaires, and follow-up data were included.ResultsA total of 144 patients was included. TEM was performed as primary excision in 54 patients, after endoscopic forceps biopsy in 57 patients, and after incomplete resection by endoscopic excision in 33 patients. The median size of all primary tumors was 0.6 cm (range, 0.3–2.0 cm), and the negative resection margin was achieved in 142 (98.6%) patients. Postoperative complications (referring to only bleeding) occurred in 3 (2.1%) patients and was successfully managed with conservative method. After a median follow-up of 75.5 months after surgery, 3 patients died of other causes, and 2 patients suffered metastasis. An anal function questionnaire was posted 24 months after TEM. Among the results, 3 (2.1%) patients complained of major low anterior resection syndrome (LARS), including 1 (0.7%) who suffered from complete incontinence, while 6 (4.2%) patients had minor LARS.ConclusionsTEM has satisfying long-term outcomes and relatively low anal function disturbance as for the treatment of small RNET. TEM also acts as a preferred salvage treatment for incomplete endoscopic excision.

Congenital granular cell tumor in a neonate\u2014a case report

BackgroundCongenital granular cell tumor (CGCT) is a rare benign soft tissue tumor of the new born. It is also called congenital epulis.Case presentationWe report the case of a 3-day-old male neonate who was postnatally noted to have a 2-cm mass over the maxillary alveolar ridge in the midline. The mass was causing feeding difficulties, and hence, decision for surgical excision was taken. The postoperative recovery was uneventful.ConclusionCongenital granular cell tumor (CGCT) is commonly seen on the gingival margins of the maxilla or mandible. Large tumors may cause polyhydramnios in the antenatal period or feeding and respiratory difficulties in the postnatal period. Diagnosis is usually confirmed by histopathology. Malignant change or recurrence has not been reported following incomplete excision of this mass.

A retrospective cohort study of dermatofibrosarcoma protuberans at a large metropolitan academic center

To the Editor: Dermatofibrosarcoma protuberans (DFSP) is a rare, low-grade dermal mesenchymal malignancy that commonly presents as a slow-growing, asymptomatic nodule.1,2 Although its metastasis is uncommon, the tumor tends to recur locally following incomplete excision.3 The clinicopathologic features associated with poor outcomes include treatment with wide local excision (WLE), compared with that with Mohs micrographic surgery (MMS); positive histologic margins; the presence of a fibrosarcomatous change; age >50 years; a large tumor size (>5 cm); African American ethnicity; male sex; and a location on the head, neck, or extremity rather than on the trunk.

Ocular surface squamous neoplasia (OSSN) in an 84‐year‐old female patient

AbstractPurposeTo report a case of Ocular Surface Squamous Neoplasia, in an 84 years old woman. The patient referred 4 months of red vascularized elevated corneal lesion.MethodsOur proposal was an exportation of the conjunctival corneal neoformation and histological examination. During the surgical procedure, we found an elevated lesion with feeder vessels, the surgical excision biopsy was done and the specimen was sent for histopathological evaluation, which revealed an invasive, poorly differentiated carcinoma extending to subcutis. Immunohistochemical staining for p63 gave dubious results on the integrity of the basement membrane. These findings associated with the incomplete excision of the lesion did not allow us to express a possible invasiveness in the lateral margin affected.ResultsIn the post‐operative, we used Mitomycin C 0.04% topical treatment, 4 times a day for a week, then 3 weeks off for a total of 3 cycles. During this period the patient did not display any adverse systemic or ocular reactions. At the end of the treatment, we found a complete regression of the disease. During the control at 6 months and 1 year, the patient was asymptomatic.ConclusionsDiagnosis of invasive Squamous Cell Carcinoma mainly rests on the histopathological examination of the excised lesion. No serious ocular or systemic side effects were observed during the Mitomycin C 0.04% eye drops treatment. Mitomycin C 0.04% seems to be a safe and effective treatment for ocular surface squamous neoplasia.

Malignant Transformation in a Case of Recurrent Sinonasal Inverted Papilloma

Inverted papilloma or Ringertz tumour is an uncommon benign tumour that arises from the Schneiderian membrane of the ectoderm. It accounts for approximately 70% of all sinonasal papillomas and 0.5-4.0% of all sinonasal tract neoplasms. It often originates in the middle meatus of the lateral nasal wall and is well-known for its local invasiveness and high recurrence rate. Nasal obstruction, nasal bleeding, and diminished sense of smell are the most common symptoms. Hereby, authors report a case of 58-year-old male complaining of right nasal obstruction since 3 months. Patient had nasal growth for which he underwent nasal endoscopy. History revealed that he had similar growth on left side 10 years ago. A nasal endoscopic biopsy was performed and the histopathological examination show an inverted growth pattern from the sinonasal papilloma. Surgical techniques must be extensively explored and customised, with enhanced radiological assessment of tumour borders, in order to adequately remove the tumour, since incomplete excision increases the risk of recurrence and malignant transformation of the residual disease.

Dermoscopy as an adjunct to surgical excision of non-melanoma skin lesions: a systematic review and meta-analysis

Background: Non-melanoma skin cancers (NMSC) have an incidence of 152,000 cases per year in the UK which continues to rise. Incomplete excision rates for NMSC are estimated to be around 10% and Result in patients having a higher risk of recurrence or having to undertake further treatment.

Macroscopically complete excision is a beneficial strategy for selected patients with peritoneal sarcomatosis.

The occurrence of peritoneal sarcomatosis (PS) in patients with retroperitoneal sarcoma (RPS) indicates a poor prognosis. However, the appropriate treatment modality remains unclear. This study aimed to identify its prognostic factors and further explore the role of macroscopically complete excision (CE) in the management of PS. A retrospective database was established to evaluate patients with RPS who underwent resection between January 2011 and January 2019. Univariate and multivariate survival analyses were performed to analyze the prognostic factors and identify the population that will optimally benefit from CE. This study included a total of 49 patients with PS from 211 patients with RPS, and 34 (69.4%) patients of whom with PS underwent CE successfully. The median follow-up time was 36.0 months. There were 8 patients excluded because of loss to follow-up (n = 4) or death from complications within 90 days postoperatively (n = 4). The CE group had a marginally better prognosis compared to the macroscopically incomplete excision (IE) group (median disease-specific survival: 20 months vs. 8 months). Multivariate survival analysis demonstrated that completeness of operation (CE vs. IE) was the only independent prognostic factor in PS patients (P = 0.042). There was no significant difference in the overall complications between the CE and IE groups (P = 0.205). In conclusion, completeness of macroscopical excision is an independent prognostic predictor of PS. If technically possible, CE is a feasible strategy to improve the prognosis of selected patients with PS.