Oncological Follow-up Research Articles

Comparison of uniportal robotic-assisted thoracic surgery pulmonary anatomic resections with multiport robotic-assisted thoracic surgery: a multicenter study of the European experience.

Robotic-assisted thoracic surgery (RATS) has seen increasing interest in the last few years, with most procedures primarily being performed in the conventional multiport manner. Our team has developed a new approach that has the potential to convert surgeons from uniportal video-assisted thoracic surgery (VATS) or open surgery to robotic-assisted surgery, uniportal-RATS (U-RATS). We aimed to evaluate the outcomes of one single incision, uniportal robotic-assisted thoracic surgery (U-RATS) against standard multiport RATS (M-RATS) with regards to safety, feasibility, surgical technique, immediate oncological result, postoperative recovery, and 30-day follow-up morbidity and mortality. We performed a large retrospective multi-institutional review of our prospectively curated database, including 101 consecutive U-RATS procedures performed from September 2021 to October 2022, in the European centers that our main surgeon operates in. We compared these cases to 101 consecutive M-RATS cases done by our colleagues in Barcelona between 2019 to 2022. Both patient groups were similar with respect to demographics, smoking status and tumor size, but were significantly younger in the U-RATS group [M-RATS =69 (range, 39-81) years; U-RATS =63 years (range, 19-82) years; P<0.0001]. Most patients in both operative groups underwent resection of a primary non-small cell lung cancer (NSCLC) [M-RATS 96/101 (95%); U-RATS =60/101 (59%); P<0.0001]. The main type of anatomic resection was lobectomy for the multiport group, and segmentectomy for the U-RATS group. In the M-RATS group, only one anatomical segmentectomy was performed, while the U-RATS group had twenty-four (24%) segmentectomies (P=0.0006). All M-RATS and U-RATS surgical specimens had negative resection margins (R0) and contained an equivalent median number of lymph nodes available for pathologic analysis [M-RATS =11 (range, 5-54); U-RATS =15 (range, 0-41); P=0.87]. Conversion rate to thoracotomy was zero in the U-RATS group and low in M-RATS [M-RATS =2/101 (2%); U-RATS =0/101; P=0.19]. Median operative time was also statistically different [M-RATS =150 (range, 60-300) minutes; U-RATS =136 (range, 30-308) minutes; P=0.0001]. Median length of stay was significantly lower in U-RATS group at four days [M-RATS =5 (range, 2-31) days; U-RATS =4 (range, 1-18) days; P<0.0001]. Rate of complications and 30-day mortality was low in both groups. U-RATS is feasible and safe for anatomic lung resections and comparable to the multiport conventional approach regarding surgical outcomes. Given the similarity of the technique to uniportal VATS, it presents the potential to convert minimally invasive thoracic surgeons to a robotic-assisted approach.

Uniportal-VATS vs. open McKeown esophagectomy: Surgical and long-term oncological outcomes.

Till now there are very few reports about surgical results of Uniportal-VATS esophagectomy and no one about long-term outcomes. This study is the first comparing surgical and oncological outcomes of Uniportal-VATS with open McKeown esophagectomy, with the largest reported series and longest oncological follow-up. The prospectively collected clinical, surgical and oncological data of 75 patients, undergone McKeown esophagectomy at our Thoracic Surgery Department, from January 2012 to August 2022, were retrospectively analyzed. Nineteen patients underwent esophagectomy by thoracotomy and reconstruction according to McKeown technique while 56 by Uniportal-VATS approach. Gastric tubulization was performed totally laparoscopic or through a mini-laparatomic access and cervical anastomosis was made according to Orringer's technique. The mean operative thoracic time was similar in both accesses (102.34 ± 15.21 min in Uniportal-VATS vs. 115.56 ± 23.12 min in open, p: 0.646), with a comparable number of mediastinal nodes retrieved (Uniportal-VATS:13.40 ± 8.12 vs. open:15.00 ± 6.86, p: 0.275). No case needed conversion from VATS to open. The learning curve in Uniportal-VATS was completed after 34 cases, while the Mastery was reached after 40. Both approaches were comparable in terms of minor post-operative complications (like pneumonia, lung atelectasis, anemization, atrial fibrillation, anastomotic-leak, left vocal cord palsy, chylothorax), while the number of re-operation for major complications (bleeding or mediastinitis) was higher in open group (21.0% vs. 3.6%, p: 0.04). Both techniques were also effective in terms of surgical radicality and local recurrence but VATS approach allowed a significantly lower chest tube length (11.89 ± 9.55 vs. 25.82 ± 24.37 days, p: 0.003) and post-operative stay (15.63 ± 11.69 vs. 25.53 ± 23.33, p: 0.018). The 30-day mortality for complications related to surgery was higher in open group (p: 0.002). The 2-, 5- and 8-year survival of the whole series was 72%, 50% and 33%, respectively. Combined 2- and 5-year OS in Uniportal-VATS group was 76% and 47% vs. 62% and 62% in open group, respectively (Log-rank, p: 0.286; Breslow-Wilcoxon: p: 0.036). No difference in DFS was recorded between the two approaches (5 year-DFS in Uniportal-VATS: 86% vs. 72%, p: 0.298). At multivariate analysis, only pathological stage independently affected OS (p: 0.02), not the surgical approach (p: 0.276). Uniportal-VATS seems to be a safe, feasible and effective technique for performing McKeown esophagectomy, with equivalent surgical and long-term oncological results to standard thoracotomy, but with a faster and unharmed recovery, and a quite short learning curve.

Patient self-reported follow-up for radiation oncology patients during COVID-19: feasibility and patient-clinician agreement

Introduction COVID-19 required health services to be innovative and quickly adapt their health service delivery, including adopting health technology in cancer clinical practice. COVID-19 restrictions forced us to introduce follow-up consultations for many patients via telehealth. At the same time, we adapted an existing Patient Reported Outcome messaging service that linked to the patient’s medical record to allow patients to self-report their health and disease status before their telehealth follow-up consultation. This study aimed to evaluate the feasibility of self-reporting for cancer follow-up care, and determine the patient-clinician level of agreement.&#x0D; Methods Cross-sectional clinical practice study. Patients on radiation oncology follow-up care were sent a text message with a weblink to a survey to self-report their health before their radiation oncologist appointment. Radiation oncologists completed the same set of questions during or within a day of the telehealth follow-up consultation. Descriptive statistics were analysed to evaluate the uptake of self-reporting. Percent agreement and Cohen’s Kappa were used to determine patient-clinician agreement.&#x0D; Results A moderate response rate of 62% was achieved from the 145 patients. There was no difference in the age of patients that were able to complete the assessment. Percent agreement between the patient-reported and the clinician-reported for weight change, appetite, physical performance, side effects was acceptable (&gt;75%). However, percent agreement was moderate for pain and sleep. For most items, Cohen’s Kappa indicated moderate agreement, with pain, side effects, and recurrence being fair. Patients were more likely to report themselves worse than the clinician for all items, except for side effects.&#x0D; Conclusion Patient self-reported health can provide useful information for clinicians to remotely follow-up their patients. This holds promise for future models of follow-up care, particularly for rural and remote patients, and during pandemics and other disasters where clinic attendance is not possible.

El estado inmunológico-inflamatorio-nutricional predice los resultados oncológicos tras la cistectomía radical por carcinoma urotelial de vejiga

ObjectiveTo perform the first investigation of the role of immune-inflammatory-nutritional status (INS) on oncological outcomes in patients undergoing open radical cystectomy (ORC) for urothelial carcinoma (UC). Materials and methodsThe records of consecutive patients who underwent ORC for non-metastatic bladder cancer between 2009 and 2020 were retrospectively analyzed. Neoadjuvant chemotherapy, non-urothelial tumor biology, and absence of oncological follow-up were exclusion criteria. Systemic immune-inflammatory index (SII) and prognostic nutritional index (PNI) values were calculated and optimal cut-off values for these were used to designate four subgroups: «high SII-high PNI», «low SII-high PNI», «low SII-low PNI», and «high SII-low PNI». The low SII-high PNI INS group had best overall survival (OS) rate while the remainder were included in non-favorable INS group. Survival curves were constructed, and a multivariate Cox regression model was used for OS and recurrence-free survival (RFS). ResultsAfter exclusions, the final cohort size was 173 patients. The mean age was 64.31±8.35 and median follow-up was 21 (IQR: 9-58) months. Optimal cut-off values for SII and PNI were 1216 and 47, respectively. The favorable INS group (low SII-high PNI, n=89) had the best OS rate (62.9%). Multivariate Cox regression analysis indicated that non-favorable INS (n=84) was a worse independent prognostic factor for OS (HR: 1.509, 95% CI: 1.104-3.145, P=.001) and RFS (HR: 1.285; 95% CI: 1.009-1.636, P=.042). ConclusionPreoperative assessment of INS may be a useful prognostic panel for OS and RFS in patients who had ORC for UC.

A Rare Hernia Mimicking Implant in a Patient with Rectal Adenocarcinoma: Internal Herniation.

Internal herniation may be seen more frequently in patients with intra-abdominal surgery and malignancy history. We presented a 58-year-old male patient diagnosed with rectal adenocarcinoma seven years ago with a history of surgery and pelvic radiotherapy. When the abdominal computed tomography (CT) image was taken during routine oncology follow-up, a lesion mimicking a serosal implant on the anterior abdominal wall was detected. 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET)/CT imaging was performed the suspicion of recurrence. It was concluded that the lesion, which was evaluated as an implant in abdominal CT with 18F-FDG PET/CT imaging, was a spontaneously reducing internal herniation. 18F-FDG PET/CT imaging in cancer patients is crucial in illuminating the suspicion of recurrent lesions in these patients and sheds light on the course of the patients in oncology practice.

Immune-inflammatory-nutritional status predicts oncologic outcomes after radical cystectomy for urothelial carcinoma of bladder

ObjectiveTo perform the first investigation of the role of immune-inflammatory-nutritional status (INS) on oncological outcomes in patients undergoing open radical cystectomy (ORC) for urothelial carcinoma (UC). Materials and MethodsThe records of consecutive patients who underwent ORC for non-metastatic bladder cancer between 2009 and 2020 were retrospectively analyzed. Neoadjuvant chemotherapy, non-urothelial tumor biology, and absence of oncological follow-up were exclusion criteria. Systemic immune-inflammatory index (SII) and Prognostic Nutritional Index (PNI) values were calculated and optimal cut-off values for these were used to designate four subgroups: “high SII-high PNI”, “low SII-high PNI”, “low SII-low PNI”, and “high SII-low PNI”. The Low SII-high PNI INS group had best overall survival (OS) rate while the remainder were included in non-favorable INS group. Survival curves were constructed, and a multivariate Cox regression model was used for OS and recurrence-free survival (RFS). ResultsAfter exclusions, the final cohort size was 173 patients. The mean age was 64.31 ± 8.35 and median follow-up was 21 (IQR: 9-58) months. Optimal cut-off values for SII and PNI were 1216 and 47, respectively. The favorable INS group (low SII-high PNI, n = 89) had the best OS rate (62.9%). Multivariate Cox regression analysis indicated that non-favorable INS (n = 84) was a worse independent prognostic factor for OS (HR: 1.509, 95%CI: 1.104–3.145, p = 0.001) and RFS (HR: 1.285; 95%CI: 1.009–1.636, p = 0.042). ConclusionPreoperative assessment of INS may be a useful prognostic panel for OS and RFS in patients who had ORC for UC.

Management of Low Anterior Resection Syndrome (LARS) Following Resection for Rectal Cancer.

A total of 60-80% of patients undergoing rectal resection (mostly as a treatment for rectal cancer) suffer from a variety of partly severe functional problems despite preservation of the anal sphincter. These patients are summarized under the term low anterior resection syndrome (LARS). Preoperative radiotherapy, vascular dissection and surgical excision of the low rectum and mesorectum lead, alone or all together, to a significant impairment of colonic and (neo-) rectal motility. This results in a variety of symptoms (multiple defecation episodes, recurrent episodes of urge, clustering, incontinence, etc.) which are associated with severe impairment of quality of life (QOL). This narrative review summarizes the present state of knowledge regarding the pathophysiology of LARS as well as the evidence for the available treatment options to control the symptoms resulting from this condition. A review of the literature (Medline, Pubmed) reveals a variety of treatment options available to control symptoms of LARS. Medical therapy, with or without dietary modification, shows only a modest effect. Pelvic floor rehabilitation consisting of muscle exercise techniques as well as biofeedback training has been associated with improvement in LARS scores and incontinence, albeit with limited scientific evidence. Transanal irrigation (TAI) has gained interest as a treatment modality for patients with LARS due to an increasing number of promising data from recently published studies. Despite this promising observation, open questions about still-unclear issues of TAI remain under debate. Neuromodulation has been applied in LARS only in a few studies with small numbers of patients and partly conflicting results. LARS is a frequent problem after sphincter-preserving rectal surgery and leads to a marked impairment of QOL. Due to the large number of patients suffering from this condition, mandatory identification, as well as treatment of affected patients, must be considered during surgical as well as oncological follow-up. The use of a standardized treatment algorithm will lead to sufficient control of symptoms and a high probability of a marked improvement in QOL.

Preoperative Workup, Staging, and Treatment Planning of Colorectal Cancer

AbstractColorectal cancer (CRC) remains a leading cause of death in the United States. CRC is the second to third most common cancer globally and it impacts both genders. Screening initiatives are of paramount importance to eradicate the disease at a precancerous or early stage. Recommendations for screening are based on multiple factors including age, ethnicity, individual patient risk factors, and family history. Short- and long-term outcomes and survival data correlate with the stage of disease at the time of diagnosis emphasizing the need for appropriate baseline staging. Furthermore, stage of disease determines the necessity for any neoadjuvant or adjuvant therapy and provides recommendations for long-term oncologic follow-up. Preoperative workup includes physical examination, blood tests such as tumor markers and liver function tests, endoscopic evaluation, and cross-sectional imaging. In a select group of patients, genetic testing is part of the initial evaluation as it can impact the treatment plan, long-term follow-up, and testing of potential offspring. In general, surgical intervention remains the predominant treatment modality for stage I to III colon cancers with chemotherapy administration as adjuvant therapy for stages II to III to minimize recurrence or as a palliative modality for patients with stage IV disease. The treatment of rectal cancer remains more complex. Traditionally, early rectal cancer has been treated with surgical resection and locally advanced rectal cancer with neoadjuvant chemoradiation followed by surgical resection and postoperative chemotherapy. In the last decade, several protocols have been implemented to modify the neoadjuvant treatment with a trend toward more extended chemotherapy with the intent to further downstage the rectal cancer. Furthermore, the introduction of various protocols of total neoadjuvant chemoradiation may offer in a select group of patients with complete pathologic response, the possibility of observation without surgery. Finally, the management of stage IV CRC is in continuous evolution with the palliative goal of prolonging survival in most patients while offering the opportunity in some patients with limited metastatic disease to become potential candidates for resection of the primary lesion in addition to the metastatic disease.

A rare coexistence: Poland’s syndrome and cardiac angiosarcoma

Poland’s syndrome, a rare genetic disorder that accompanies malignancies, musculoskeletal disorders, cardiac and genitourinary syndromes. There is no study that represents the association between cardiac angiosarcoma and Poland’s syndrome. A 24-year-old female patient previously diagnosed with Poland’s syndrome was admitted to our hospital complaining of dyspnea. Diagnostic imaging showed an irregular mass in the right atrial cavity. After successful surgery, she was discharged uneventfully and the 3rd month oncologic follow-up reveals none of residual mass. The coexistence has not been diagnosed and treated in a cardiac surgery department before. With this presentation, we aimed to contribute to the literature with this presentation, for the right and early diagnosis and management of possible new cases in the future can be diagnosed and treated correctly and early.

Does 3D laparoscopic video technology affect long-term survival in right hemicolectomy for cancer compared to standard 2D? A propensity score study.

There are few studies focused on the short-term results of laparoscopic right hemicolectomy performed with 2D (two-dimension) or 3D (three-dimension) video technology and none on the oncologic effects. The aim of the study was to assess the long-term results of laparoscopic right hemicolectomy (LRH) with intracorporeal anastomosis using 3D or 2D video in patients with right colon cancer with at least three years of oncologic follow-up. Data from patients undergoing laparoscopic right hemicolectomy (LRH) with intracorporeal anastomosis for cancer in an 11-year period (June 2008-June 2019) and ≥ 3years of follow-up were prospectively collected. Surgical procedures were performed by two expert laparoscopic surgeons. 111 patients were included in the study: 56 (50.5%) in the 3D group and 55 (49.5%) in the 2D group. Tumor stage and number of lymph nodes harvested were similar. Overall and disease-free survival were not different in the two groups. Local recurrence occurred in none of the patients, and distant metachronous metastases were similar in the two groups. A propensity score weighting approach was used to account for potential confounding related to patients' nonrandom allocation to the 2 groups. The effects of the intervention on postoperative outcomes were assessed with a weighted regression approach. Laparoscopic 3D technology allows similar oncological results as 2D vision in LRH with intracorporeal anastomosis. Larger prospective randomized studies might confirm these results in the long-term follow-up.

A Case of Adenoid Cystic Carcinoma Mimicking Orbital Pseudotumor

Introduction: Clinical approach to the case of dacryoadenitis. Case Report: A 41-year-old male patient was admitted to our clinic with complaints of decreased vision in the left eye, periorbital and headache for 2 days. On examination, his visual acuity was full on the right and counting fingers at 2 meters on the left. There was a slight swelling and dimness in the margins of the optic disc on the left, other eye examination findings were normal. The patient was treated with intravenous methylprednisolone at a dose of 1gr/day for three days with the prediagnosis of orbital pseudotumor. However, it was observed that the patient's complaints recurred after methylprednisolone was discontinued. In repeated orbital MRI, at the level of the orbital apex on the left, infiltrating the dural structures, indenting the cavernous sinus, affecting the soft tissue structures adjacent to the nasopharyngeal lumen on the left, are seen. The left optic nerve was found to be slightly thicker than normal, especially at the apex level. For histopathological diagnosis, endoscopic biopsy was performed from the tumor and surrounding tissue from the left maxillary sinus. The biopsy result was reported as adenoid cystic carcinoma. Discussion: The diagnosis of orbital pseudotumor is made in accordance with clinical, radiological and pathological data. Orbital pseudotumor is histopathologically characterized by polymorphous inflammatory cell infiltration accompanied by varying degrees of fibrosis. It is difficult to distinguish an orbital pseudotumor from a true neoplasm. Lymphomas constitute 20% of orbital mass lesions. Our case was initially treated with a preliminary diagnosis of orbital pseudotumor localized in the posterior orbit and responded to steroids. However, lack of complete recovery and recurrence after steroid discontinuation brought to mind other underlying pathologies and directed to further examination and biopsy. As a matter of fact, the patient, who was diagnosed with adenoid cystic carcinoma as a result of biopsy, was included in the oncological follow-up and treatment program. It is necessary to be vigilant in terms of malignancy in orbital pseudotumors and not to avoid biopsies in suspected cases.

Korean Practice Guidelines for Gastric Cancer 2022: An Evidence-based, Multidisciplinary Approach.

Gastric cancer is one of the most common cancers in Korea and the world. Since 2004, this is the 4th gastric cancer guideline published in Korea which is the revised version of previous evidence-based approach in 2018. Current guideline is a collaborative work of the interdisciplinary working group including experts in the field of gastric surgery, gastroenterology, endoscopy, medical oncology, abdominal radiology, pathology, nuclear medicine, radiation oncology and guideline development methodology. Total of 33 key questions were updated or proposed after a collaborative review by the working group and 40 statements were developed according to the systematic review using the MEDLINE, Embase, Cochrane Library and KoreaMed database. The level of evidence and the grading of recommendations were categorized according to the Grading of Recommendations, Assessment, Development and Evaluation proposition. Evidence level, benefit, harm, and clinical applicability was considered as the significant factors for recommendation. The working group reviewed recommendations and discussed for consensus. In the earlier part, general consideration discusses screening, diagnosis and staging of endoscopy, pathology, radiology, and nuclear medicine. Flowchart is depicted with statements which is supported by meta-analysis and references. Since clinical trial and systematic review was not suitable for postoperative oncologic and nutritional follow-up, working group agreed to conduct a nationwide survey investigating the clinical practice of all tertiary or general hospitals in Korea. The purpose of this survey was to provide baseline information on follow up. Herein we present a multidisciplinary-evidence based gastric cancer guideline.

ANKLE ARTHRODESIS WITH INTRAMEDULLARY RETROGRADE NAIL FOR BONE TUMORS. PRELIMINARY RESULTS AND SURGICAL TECHNIQUE.

Present the preliminary results of a case series using the surgical ankle arthrodesis technique with an intramedullary retrograde nail for bone tumors. We present the preliminary data of 4 patients, 3 males and 1 female, with a mean age of 46,2 (range 32 to 58) years, with histology proven Giant Cell Tumour of bone in 3 and osteosarcoma in 1. The mean resection length of distal tibia was 11,75 (range 9 to 16) cm, and all the patients underwent reconstruction with a tibiotalocalcaneal arthrodesis with an intercalary allograft fixed by a retrograde intramedullary nail. Oncological follow-up evolved without evidence of local recurrence or disease progression in all patients. After a mean time of 69.5 (range 32 to 98 months), patients had a mean MSTS12 functional score of 82.5% (range 75 to 90). All tibial arthrodesis and diaphyseal osteotomy sites were fused within 6 months with a return to activities without complications related to coverage skin or infection. No complications were recorded; all arthrodesis and diaphysial tibial osteotomy sites fused by 6 months, and the mean follow-up of those patients was 69,5 (range 32 to 988) months, with a mean functional MSTS score of 82,5% (range 75-90). Level of Evidence: IV; Retrospective Case Series.

Long-term oncological follow-up after mold-based pulsed dose rate brachytherapy for early stage squamous cell carcinoma of the nasal vestibule: A single center experience of 68 patients over a 17-year period

PURPOSECancer of the nasal vestibule is a rare type of malignancy constituting less than one percent of all head and neck cancers. These tumors are typically diagnosed at an early stage. Both surgery and radiotherapy provide excellent oncological results, but esthetic results are better after radiotherapy. The aim of this study was to evaluate the long-term oncological follow-up after brachytherapy for early stage squamous cell carcinoma of the nasal vestibule. METHODS AND MATERIALSRetrospective analysis of patients with carcinoma of the nasal vestibule who were treated with primary brachytherapy in the Utrecht University Medical Center. RESULTSIn this single center experience over a 17-year period 68 patients with early stage squamous cell carcinoma of the nasal vestibule were treated with brachytherapy. Two patients had lymph node metastases at first clinical presentation. Median follow-up duration was 46.5 months. Five-year locoregional recurrence-free survival, disease-specific survival, and overall survival were 91.1%, 96.1%, and 66.2%, respectively. All recurrences occurred within the first 3 years of follow-up. CONCLUSIONSBrachytherapy offers excellent oncological outcomes and is a safe and effective treatment for early stage carcinoma of the nasal vestibule. Recurrences typically occur within 3 years after treatment.

The role of rectal endoscopic ultrasonography plus fine needle aspirartion and fine needle biopsy in pelvic masses.

The diagnostic role of endoscopic ultrasound (EUS) guided fine needle aspiration (FNA) and fine needle biopsy (FNB) of pelvic masses has not been well established. We aimed to evaluate the diagnostic accuracy of EUS plus FNA/FNB in suspected local recurrence of pelvic masses. All consecutive patients with a history of lower gastrointestinal and pelvic mass undergone EUS-FNA/FNB were included in the study. In total 34 patients who underwent EUS-guided FNA or FNB of a perirectal mass were enrolled. The sampled lesion was a mass in 22 patients (64.7%) and a lymph node in 10 patients (29.4%). The univariate logistic regression analysis for diagnostic accuracy showed lesion size as a significant predictor of diagnostic accuracy [odds ratio (OR), 1.61; 1.08-2.27; P = 0.02]. Diagnostic sensitivity was 100% (71.5-100%) with EUS-FNB and 75% (34.9-96.8%) with EUS-FNA ( P = 0.12); specificity was 100% in both groups ( P = 1.0). Sample adequacy was 94.1% in the whole cohort, with 20/20 adequacy rate (100%) in the EUS-FNB group and 12/14 (85.7%) in the EUS-FNA group ( P = 0.28). This is the first study demonstrating the diagnostic yield of EUS plus FNA/FNB in patients with pelvic masses comparing the two needles. Our results highlight the relevance of this technique, especially in undefined masses during oncological follow-up.

Robotic surgery in early and advanced ovarian cancer: Case selection for surgical staging and interval debulking surgery

ObjectiveDuring the last decade several case series have been published on robotic surgery in early and advanced stage ovarian cancer. Although most studies lack a significant oncological follow-up, more importantly criteria for patient selection for both robotic surgical staging (R-SS) and robotic interval debulking surgery (R-IDS) are not well defined. The objective of this study was to assess the surgical and oncological outcomes, using well-defined selection criteria, between robotic and open surgery in early and advanced stage ovarian cancer. Study designSingle-center retrospective case cohort study including 96 ovarian cancer patients. For early stage ovarian cancer, patients were selected for R-SS after laparoscopic salpingo-oophorectomy of a suspicious adnexal mass. For advanced stage ovarian cancer, only patients receiving neoadjuvant chemotherapy and IDS were included in the study. Exclusion criteria were the presence of residual peritoneal disease after NACT and/or patients requiring additional complex surgical procedures. ResultsFor early stage ovarian cancer, similar median operative times were seen between R-SS and open surgical staging (O-SS), 132 min and 120 min respectively. Pelvic/para-aortic lymph node yield was similar between R-SS and O-SS, 22/11 nodes and 18/8 nodes respectively. Surgical upstaging occurred in 11.5% in the R-SS group and in 27.6% in the O-SS group. In advanced stage ovarian cancer, the BMI was significantly higher in the R-IDS group compared to the O-IDS group (27.8 vs 23.5; p =.006). The median follow was 52 months in the R-IDS group and 31 months in the O-IDS group. Recurrent disease occurred in 42.9% of the R-IDS group and in 45% of the O-IDS group. The length of hospitalization was significantly longer in the O-SS and O-IDS group (p <.00001). ConclusionPatients with clinically early stage ovarian cancer, confirmed after laparoscopic removal of a suspicious adnexal mass, are candidates for R-SS whilst maintaining similar surgical and oncological outcome measures as O-SS. In advanced ovarian cancer, suitable candidates for R-IDS are those who receive NACT with good response and no residual peritoneal disease, especially in patients with a high BMI, but large prospective randomized trials with well-defined criteria are needed.

Cardiotoxicity in patients with early breast cancer treated with adjuvant trastuzumab

Introduction. Breast cancer is the most common cancer among women in Poland. The aim of this study was to evalu­ate the incidence of cardiotoxicity in patients treated with adjunctive trastuzumab, as well as to determine risk factors for cardiotoxicity. Material and methods. The study covered 100 patients who completed one year of trastuzumab therapy or discon­tinued treatment due to acute cardiac complications. They underwent an oncological, cardiological, questionnaire and laboratory follow-up. Results. Acute cardiac complications (CC(+)) occurred in 11 (11%) patients. Patients in the CC(+) group were more likely to have hypertension, ischemic heart disease, hypothyroidism, and were more likely to smoke compared to the gro­up without cardiac complications (CC(–)). They had a lower left ventricular ejection fraction before, during and after trastuzumab therapy, and larger left ventricular dimensions in systole and diastole after treatment. The CC(+) received a higher dose of anthracyclines compared to CC(–). The NT-proBNP value remained elevated in the CC(+) group after treatment, despite normal LVEF values, and was higher than in the CC(–) group. Conclusions. Based on the study, type II cardiotoxicity, diagnosed early and treated appropriately, was found to be reversible.

V-037 PARASTOMAL MESH INFECTIONS WITH INTESTINAL FISTULA: 2 RARE SURGICAL CASES AND HOW WE FIXED THEM

Abstract Parastomal hernias (PSH) occur in 50–80% after stoma formation and its treatment is considered a real challenge. According to the recent literature, the use of prophylactic mesh at the time of primary stoma should decrease the odds of hernia formation. The most common occurrences after PSH surgery are: recurrence, seroma and wound complications. In this video, we report 2 cases of mesh infection with fistula necessitated removal after 10 and 4 years of mesh placement. The first patient was a 66 years-old male. In 2007 he underwent radical prostatectomy and pelvic lymphadenectomy following radiotherapy. He underwent a radical cystectomy and Bricker's cutaneous uretero-ileostomy for stenosis of the vesicourethral anastomosis. In 2012 for PSH he underwent laparo-alloplasty with a placement of an intraperitoneal mesh. In February 2022, with fever and dyspnoea, at the CT-scan of the abdomen we found air bubbles near the mesh and a suspected sigmoid-to-mesh fistula. The second patient was a 66 years old male. In 2018 the patient underwent neoadjuvant radiotherapy, then Miles’ procedure and prophylactic 3D intraperitoneal mesh, subsequent adjuvant therapy. During the oncological follow-up an abdominal CT-scan showed air bubbles around the stoma and suspicion of fistula on the adjacent intestinal loops. In both cases there was an infection of the area around the stoma due to a fistula between the mesh and the intestine. We proceeded, in laparoscopy, to remove the infected mesh. We converted in open surgery with the resection of the fistulized intestine tract and we did a new ostomy.

S2081 Rare Colonic Polyps: A Case of Langerhans Histiocytosis

Introduction: Langerhans Cell Histiocytosis (LCH) is a rare inflammatory myeloid disorder mostly seen in children before the age of 5. The clinical presentation is heterogeneous with potential for wide-ranging organ involvement, primarily in the bone, skin, and lungs. Gastrointestinal tract involvement is very rare in LCH, and in symptomatic patients, etiology could be confused with infectious, allergic, and autoimmune bowel diseases. In children, LCH GI tract involvement has been associated with decreased survival due to multisystem involvement and digestive complications including diarrhea, vomiting, malabsorption, and failure to thrive. Review of literature shows less than twenty adults with incidences of GI tract involvement of LCH and only 4 cases of adults with LCH colon polyps. Case Description/Methods: A 66-year-old man presented for screening colonoscopy. He reported generally good health without any GI or systemic symptoms or medical history. Family history was significant for leukemia in his brother. He currently smokes cigarettes and has a 2.5 pack-year history. On colonoscopy, 6 benign-appearing polyps were removed using cold snare polypectomy: 3 from the ascending colon (largest 0.5 cm in size), one from the splenic flexure of the transverse colon (0.4 cm in size), and 2 from the rectum (largest 0.4 cm in size). Quality of bowel preparation was excellent and the procedure was without complication. Rectal polyps were hyperplastic. Submucosal sections of the ascending and transverse colon polyps stained positive for CD1a, CD68, and S-100, consistent with Langerhans-type cells. The LCH diagnosis was further supported by irregular nuclei within focal nuclear grooves and an eosinophilic cytoplasm. Genomic testing of the colon sample revealed BRAFV600E mutation, the most recognized targetable mutation in LCH. He underwent further testing with PET scan and bone marrow biopsy, both of which were negative for LCH. Surveillance colonoscopy was recommended in 7 years (Figure 1). Discussion: With his lack of systemic disease and asymptomatic presentation, watchful waiting and Oncology follow-up was recommended. Given the unusual diagnosis of LCH via a colon polyp, it is possible for lesions to be clinically unsuspected and histologically overlooked. With increasing rates of screening colonoscopy, more polyps demonstrating LCH on histopathology may be identified. Reports of LCH in the GI tract and colon polyps are infrequent and characterization of outcomes will rely on further cases in this population.Figure 1.: Positive immunostaining for CD1a, classically expressed by Langerhans cells.

S3605 Gastrointestinal Stromal Tumor Presenting as a Fistulizing Cavitary Lesion

Introduction: Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal neoplasms of the stomach. GISTs can vary from small, asymptomatic lesions managed with surveillance to large lesions presenting with life-threatening complications, including gastrointestinal hemorrhage. Complications such cavitary lesions and luminal GI fistulas have been reported but are exceedingly rare. Case Description/Methods: A 65 year-old woman developed mild, constant abdominal pain. Her past medical history includes HTN, GERD, COPD and 50 pack-year smoking history. One month after symptom onset, she was admitted to an outside hospital with upper GI bleed. EGD was reportedly normal at that time. She was readmitted one month later with recurrent anemia. CT scan showed a large gastric diverticulum or possible cavitary lesion. EGD was repeated and showed an opening to a large diverticulum or cavity distal to the gastroesophageal junction with ulcerated cavity wall. Pathology showed ulcerated gastric mucosa and granulation tissue with atypical spindle cells. Biopsies were negative for H. pylori. She was then admitted to our hospital for severe anemia and work-up of suspected GIST. A third EGD showed a 2 cm fistula to a 10 cm necrotic cavity on the fundus and proximal greater curvature of the gastric body. Multiple biopsies of the cavity wall were taken. Biopsies were positive for spindle cell-type GIST (CD117+, CD34+, Cam 5.2-). She then had a feeding jejunostomy placed due to difficulty tolerating PO intake. She was treated with pantoprazole and imatinib and discharged with Medical Oncology and Surgery follow-up for resection. (Figure) Discussion: The most common site of origin for GISTs is the stomach. Radiographic appearance is variable and can include endoluminal, exophytic or dumbbell-shaped pattern and there is frequently necrosis. Other imaging findings include calcifications, cyst formation, cystic degeneration and rarely, cavitary lesions and fistulas. In fact, there are only 2 case reports in the last 10 years of GISTs presenting as a gastric fistula or a gastrobronchial fistula. CT findings including: hemorrhage, necrosis, calcifications, intralesional cavitation, cystic degeneration, size >10cm, irregular margins and heterogeneous enhancement all portend a poor prognosis. Enlarged feeding or draining vessels can predict relapse. Our patient’s case shows that it is important to have a high index of suspicion for diagnosis of GIST, particularly in the setting of atypical presentation.Figure 1.: Upper GI endoscopy image of the interior of the GIST cavity.