Overall Recurrence Rate Research Articles

Long-term outcomes of hepatic resection for colorectal liver metastases at a New Zealand tertiary level public hospital.

Colorectal cancer is common with half of all patients developing metastases to the liver. The aim of this study was to document the survival for patients undergoing liver resection for colorectal cancer metastases. A review of all patients undergoing hepatic resection for colorectal liver metastases at a New Zealand tertiary level public hospital over a 9-year period was performed. Primary survival outcomes assessed were overall survival (OS) and disease-free survival (DFS). Of the 116 patients followed-up with a median (range) of 53 (10-116) months, the OS at 5 years was 53%. Median survival was 6.5 years. At end of follow-up, 57% of patients were alive and 49% were alive without recurrence. The overall rate of recurrence was 39%. This study confirms that excellent long term survival can be achieved with hepatic resection for colorectal liver metastases.

Clinical outcome after Doppler-guided hemorrhoidal artery ligation and rubber-band ligation for the treatment of primary symptomatic hemorrhoids

Objective The aim of this study was to compare the efficacy and clinical outcome after rubber-band ligation (RBL) and Doppler-guided hemorrhoidal artery ligation (DG-HAL) for primary symptomatic (grades II and III) hemorrhoids. Patients and methods Fifty patients with symptomatic grade II and grade III uncomplicated internal hemorrhoids were randomly assigned to be treated with either RBL or DG-HAL. Patients were assessed clinically for postoperative complications and recurrence through 6 months after surgery. Results Preoperative characteristics were similar between the two groups. The main preoperative complaint was protrusion of piles followed by bleeding. The overall rate of complications was 16% after RBL (9.1% for grade II and 21.4% for grade III) and 4% after DG-HAL (6.7% for grade II and 0% for grade III) (P = 0.07). The overall rate of recurrence was 12% after RBL (9.1% for grade II and 14.3% for grade III) and 4% after DG-HAL (0% for grade II and 10% for grade III) (P = 0.2). All complications were conservatively controlled with no need for reintervention. At the end of 6 months of follow-up, the overall freedom from symptoms was 88% after RBL (90.9% for grade II and 85.7% for grade III) and 96% after DG-HAL (100% for grade II and 90% for grade III). With regard to grade of hemorrhoids (II or III), there were statistically insignificant differences between the two procedures in terms of recurrence and complications. Conclusion DG-HAL is safer and effective compared with RBL in the treatment of grade III hemorrhoids; however, in grade II patients, both procedures had nearly equal rate of complications despite no recurrence with DG-HAL.

Outcomes of Laparoscopic versus Open Fascial Component Separation for Complex Ventral Hernia Repair

Ventral hernia recurrence rates have improved with advancements in technique. Open and laparoscopic fascial component separation techniques improve recurrence rates by allowing a tension free closure. This study examines laparoscopic component separation (LCS) and open component separation (OCS) techniques in the repair of complex ventral hernias and compares factors affecting patient outcomes. A retrospective chart review of patients who underwent ventral hernia repair with LCS and OCS was conducted between 2009 and 2013. Patient characteristics and outcomes were documented. Hernia recurrence was determined using physical exam and computed tomography if physical exam was equivocal. Univariate and multivariate analyses were performed. Ten patients underwent LCS and 38 underwent OCS. The rate of wound infection in the LCS group was 20 per cent versus 50 per cent in the OCS group. The overall rate of recurrence after LCS was 20 per cent, and 26 per cent in the OCS group. For body mass index > 30, the recurrence rate was 20 per cent in the LCS group and 29 per cent (P = 0.5) in the open group. The use of LCS demonstrates a trend in the reduction of hernia recurrence and wound infection overall and in patients with body mass index > 30 compared with OCS.

Cumulative survival analysis of patients with spinal myxopapillary ependymomas in the first 2 decades of life

Reports of myxopapillary ependymomas (MPEs) of the spinal cord in pediatric patients are scarce. In the literature, various authors have shared their experiences with small groups of patients, which makes it difficult to create a consensus regarding the treatment approach for spinal MPEs in young patients. The aim of this study was to perform a survival analysis of patients in the first 2 decades of life whose cases were selected from the published studies, and to examine the influence of various factors on outcomes. A comprehensive search of studies published in English was performed on PubMed. Patients whose age was ≤ 20 years were included for integrative analysis. Information about age, treatment characteristics, critical events (progression, recurrence, and death), time to critical events, and follow-up duration was recorded. The degree of association of the various factors with the survival outcome was calculated by using Kaplan-Meier estimator and Cox proportional hazard model techniques. A total of 95 patients were included in the analysis. The overall rate of recurrence (RR) was 34.7% (n = 33), with a median time to recurrence of 36 months (range 2-100 months). Progression-free survival (PFS) and overall survival rates at 5 years were 73.7% and 98.9%, respectively. Addition of radiotherapy (RT) following resection significantly improved PFS (log-rank test, p = 0.008). In patients who underwent subtotal resection (STR), administering RT (STR + RT) improved outcome with the lowest failure rates (10.3%), superior to patients who underwent gross-total resection (GTR) alone (RR 43.1%; log-rank test, p < 0.001). Addition of RT to patients who underwent GTR was not beneficial (log-rank test, p = 0.628). In patients who had disseminated tumor at presentation, adjuvant RT controlled the disease effectively. High-dose RT (≥ 50 Gy) did not change PFS (log-rank test, p = 0.710). Routine inclusion of RT in the treatment protocol for spinal MPEs in young patients should be considered. Complete resection is always the goal of tumor resection. However, when complete resection does not seem to be possible in complex lesions, RT should be used as an adjunct to avoid aggressive resection and to minimize inadvertent injury to the surrounding neural tissues. High-dose RT (≥ 50 Gy) did not provide additional survival benefits, although this association needs to be evaluated by prospective studies.

Goiter size as a parameter for predicting remission in patients suffering from Graves disease treated by thyrosupressive drug therapy

Graves' disease is defined as hyperthyroidism with diffuse goiter caused by immune disorders. Efforts to identify factors that may indicate the likelihood of achieving remission or relapse upon cessation of thyrosupressive drug therapy are continuously ongoing. Reports on the achievement of long-term remission range between 14-80% in the treated, and the overall rate of recurrence after withdrawal of treatment is about 30- 50%. Determination of the early prognostic factors for the outcome of thyrosupressive drug therapy could allow the differentiation between patients who respond and do not respond to therapy and timely selection of ablative therapy. The aim of this study was to determine the effect of goiter size as a predictor of remission during thyrosupressive drug therapy. The study was conducted in a prospective manner including 106 consecutive patients with newly diagnosed autoimmune hyperethyroidism who were given thyrosupressive drug therapy. After the diagnosis of the disease by anamnestic, clinical and biochemical examination at the beginning and 12 months after the initiation of thyrosupressive drug therapy, the presence and goiter size were followed by palpation and by echosonographic volumetry. In the majority of the patients (90%) at the beginning of the disease goiter was small or absent (grade 0A, 0B, 0-I). During the MTT the presence and goiter size did not change significantly. The average thyroid volume at the beginning of the disease in our patients was about 21 ml. During MTT and twelve months after the start of MTT, significant changes in the size of thyroid were not observed. It was observed that there was no significant difference in the presence and goiter site, whether it was determined by palpation, or measured echosonographically among patients in remission, and in those who had no remission. The results indicate that the presence and goiter size at the onset of the disease are not relevant for the prediction of remission in patients with Graves' disease treated by the thyrosupressive drug therapy.

Decreasing the dose of radioiodine for remnant ablation does not increase structural recurrence rates in papillary thyroid carcinoma

Our aim was to compare the rate of structural recurrence between patients who had lesser doses of radioactive iodine (RAI) and those who had traditional greater doses for remnant ablation after total thyroidectomy for papillary thyroid carcinoma (PTC). A retrospective cohort study of patients who had undergone thyroidectomy and RAI for PTC was undertaken. We divided the cohort into those who had < or =3 GBq (75 mCi) RAI (group A) and those who had >3 GBq (75 mCi) RAI (group B). The primary outcome measure was the rate of structural recurrence. Of 1,171 patients with PTC from 1990 to 2012 who were followed for a mean of 60 months, 970 with T1–T3 tumors underwent RAI in addition to thyroidectomy. The mean first dose of RAI was 2.5 GBq (68 mCi) for group A (n = 153) and 4.7 GBq (127 mCi) for group B (n = 817; P < .001). The overall rate of recurrence was 8%. When corrected for T stage, the recurrence rates were not different for T1 tumors (2% group A versus 4% group B; P = .54) nor for T2 and T3 tumors (P = .36 and .55, respectively). On multivariate analysis, the dose of RAI was not an independent predictor for structural recurrence. Decreasing the dose of RAI at initial ablation for patients with pT1–pT3 PTC does not seem to be associated with an increased risk of structural cancer recurrence.

NMP22: Does it have a predictive potential for recurrence and progression in non-muscle-invasive bladder cancer?

The overall rate of recurrence for non-muscle invasive bladder cancer (NMIBC) is 60% to 70%, and the rate of progression is 30% to 60% in patients with high-risk features. Transurethral resection of bladder tumour (TURBT) followed by BCG induction with maintenance is the standard treatment option for high-risk NMIBC. All patients are recommended to undergo a cystoscopy at 3 months following TURBT, as cystoscopic findings at 3 months has been shown to be a prognostic factor of recurrence and progression of disease. Although there is no consensus for surveillance strategies, one recommendation that is widely adopted is to perform a follow-up cystoscopy with urine cytology every 3 to 4 months for 2 years, then every 6 months for the next 2 years, then yearly thereafter in patients with high-risk NMIBC. Despite stringent surveillance, many patients progress to muscle or metastatic disease and miss the window of opportunity for cure by radical extirpation. Recently, several studies have advocated immediate cystectomy in patients with high-risk NMIBC (particularly T1G3), as 30% to 50% will progress despite intravesical therapy. However, there remains a significant risk of overtreatment with this strategy subjecting the patients to unnecessary morbidity of radical surgery including erectile dysfunction. Efforts are needed to better evaluate patients with high-risk NMIBC to identify more precisely those patients who will progress to muscle invasion and counsel them towards an early cystectomy. Several studies have demonstrated the effectiveness of nuclear matrix protein 22 (NMP22) as a diagnostic tool for detection and surveillance of bladder cancer. However, no study has adequately assessed the role of NMP22 in predicting recurrence or progression. Two conflicting results have been reported on the prediction of recurrences in patients with positive NMP22 and negative cystoscopic findings; both studies were based on a small number of patients and did not stratify patients according to stage and grade.1,2 Lau and colleagues demonstrated that NMP22 appears to have a predictive value for future tumour recurrence but did not predict for progression in high-risk NMIBC.3 Since NMP22 could not predict for progression of disease, it cannot be used as an adjunct tool for the recommendation of early cystectomy in this patient population where progression rates are elevated. Over the next decade, as more molecular markers are being further evaluated in a prospective manner, an increasing role of risk-adapted management based on tumour molecular profiling will become integrated in clinical decision-making, particularly for patients with T1G3 disease. Interestingly, NPM22 results did predict for recurrence of disease. Low-and intermediate-risk NMIBC (e.g., multi-focal low grade Ta lesions) are associated with high recurrence and low progression rates. In this setting, NMP22 results may play a role to evaluate whether less stringent surveillance protocols (that includes invasive procedures such as cystoscopy) can be implemented. However, since the current study3 included high-risk tumours only with a relatively small sample size, the NMP22 predictive potential would need to be tested in a larger sample of patients with lower-risk tumours as the presented findings may not be applicable in the lower-risk setting.

Staging laparoscopy for the management of early-stage ovarian cancer: a metaanalysis

We sought to perform a quantitative analysis on operative outcomes of laparoscopic staging surgery in patients with presumed early-stage ovarian cancer using a metaanalysis. Electronic searches for studies of laparoscopic staging surgery in patients with ovarian cancer were performed within 3 electronic databases (Medline, Embase, and the Cochrane Library) using the key words "ovarian cancer," "early stage," "laparoscopy," "staging surgery," "staging laparoscopy," and "recurrence." Two authors independently screened articles, and those meeting the defined inclusion/exclusion criteria were included in the metaanalysis. We identified 11 observational studies. The combined results of 3 retrospective studies showed that the estimated blood loss in laparoscopy was significantly lower than that for laparotomy (P< .001). The overall upstaging rate after laparoscopic surgery was 22.6% (95% confidence interval [CI], 18.1-27.9%) without significant heterogeneity among all study results. The overall incidence of conversion from laparoscopy to laparotomy was 3.7% (95% CI, 2.0-6.9%). The overall rate of recurrence in studies with a median follow-up period of ≥19 months was 9.9% (95% CI, 6.7-14.4%). Through our quantitative analysis, we concluded that the operative outcomes of a laparoscopic approach in patients with early-stage ovarian cancer could be compatible with those of laparotomy. In the future, further randomized controlled trials may be needed.

Sorafenib or sunitinib as postoperative adjuvant therapy for Chinese patients with locally advanced clear cell renal cell carcinoma at high risk for disease recurrence

ObjectiveTo evaluate the efficacy and safety of targeted agents (sorafenib and sunitinib) as postoperative adjuvant therapy in Chinese patients with clear cell renal cell carcinoma (CC-RCC) who are at high risk for disease recurrence. Materials and methodsForty-three patients treated at our center between December 2007 and December 2010 with locally advanced CC-RCC who were at a high risk for disease recurrence were enrolled into the study. The criteria for high risk of CC-RCC recurrence postoperatively were defined according to the Mayo Clinic stage, size, grade, and necrosis (SSIGN) score for CC-RCC. After radical nephrectomy, patients received either sorafenib (group A, n = 20) or sunitinib (group B, n = 23) and were followed up for at least 1 year to determine the efficacy and safety of the test products. The duration of maintenance targeted medication treatment was approximately 1 year. Group C consisted of 388 CC-RCC patients treated at our center between 1992 and 2007, who were at high risk for disease recurrence and who received no adjuvant therapy. ResultsThe demography characteristics were similar among the 3 groups. The overall rate of recurrence in groups A and B was not different (15.0% and 17.4% (P > 0.05), respectively), which was lower than that of group C (38.7%, P < 0.05 compared with groups A and B). Disease-free survival (DFS) was longer in groups A and B (18.9 ± 5.9 months and 16.9 ± 6.1 months [P > 0.05], respectively), compared with group C (13.3 ± 7.2 months, P < 0.05 compared with groups A and B). The common adverse effects of targeted therapy included hand-foot syndrome, fatigue, diarrhea, taste disturbance, rash, hypertension, alopecia, stomatitis, neutropenia, nausea, pruritus, hypothyroidism in groups A and B. The adverse effects were mild in both groups and the incidence was not significantly different between groups A and B. ConclusionsTargeted adjuvant therapy postoperatively with sorafenib or sunitinib in patients with CC-RCC who are at a high risk for disease recurrence was well tolerated and effective in reducing the rate of CC-RCC recurrence in these patients. This study is an attempt to assess the utility of adjuvant tyrosine kinase inhibitors (TKIs) after surgery for renal carcinoma. The apparently improved outcomes, compared with a historical control population, are of sufficient interest to support the continuation of an ongoing randomized clinical trial to validate the hypothesis.

Arthroscopic ganglionectomy of the foot and ankle

To study the efficacy of arthroscopic ganglionectomy in the management of ganglia of the foot and ankle. From 2006 to 2010, arthroscopic ganglionectomy was performed for 89 ganglia in the foot and ankle of 88 patients. Clinical and intra-operative details were reviewed retrospectively. Ganglion stalk was identified in 6 % of the cases. The overall rate of presence of pathology was 26 %. The overall rate of recurrence or residual lesion was 12 % with high recurrent rate for extensor tendon ganglia and toe pulp ganglia. Arthroscopic ganglionectomy of the foot and ankle ganglion by either internal drainage or complete resection is a feasible approach. Good results can be achieved in case of adequate internal drainage of the ganglion to the joints or fibrous tendon sheath.

Surgical management of frontal sinus inverted papilloma: A systematic review

Surgical management of frontal sinus (FS) inverted papilloma (IP) remains a significant challenge. This study systematically reviews the FS IP literature to delineate outcomes based on surgical strategy. Systematic review. Cases for inclusion were identified by literature query for the terms frontal sinus and inverted papilloma between 1995 and 2010. Cases reported with sufficient outcomes data, defined as specific surgical approach and disease-free follow-up, were included. Statistical analysis was performed to identify significant risk factors for recurrence. The reported length of follow-up for each surgical approach was analyzed as an indicator of the strength of the reported literature for each approach. Fifty-seven cases were identified in 13 studies, with 49 cases deemed adequate for additional analysis. Twenty-four cases (49%) were primary, and 25 (51%) were secondary (residual or recurrent disease) IP. Bilateral FS involvement was reported in eight cases (16.3%). Surgical approaches employed included endoscopic frontal sinusotomy (EFS) in 21 (42.9%), endoscopic modified Lothrop (EML) in 10 (20.4%), osteoplastic flap in 13 (26.5%), and endoscopic trephination and EFS in five (10.2%) patients. The overall rate of recurrence was 22.4%. Mean follow-up time was 27 months. The recent reported literature of FS IP demonstrates high prevalence of recurrent and bilateral cases. Although statistical analysis of this accrued data is unable to delineate the best surgical approach for FS IP, more aggressive approaches frequently employed for secondary or bilateral disease may facilitate better disease control.

Tamoxifen and Anastrozole As a Sequencing Strategy: A Randomized Controlled Trial in Postmenopausal Patients With Endocrine-Responsive Early Breast Cancer From the Austrian Breast and Colorectal Cancer Study Group

Anastrozole (ANA) alone delivers significant disease-free survival benefits over tamoxifen (TAM) monotherapy in postmenopausal women with early estrogen receptor-positive breast cancer. The ABCSG-8 (Austrian Breast and Colorectal Cancer Study Group 8) study is a large phase III clinical trial addressing the sequence strategy containing ANA in comparison with 5 years of TAM in a low- to intermediate-risk group of postmenopausal patients. Endocrine receptor-positive patients with G1 or G2 tumors were eligible. After surgery, patients were randomly assigned to 5 years of TAM or 2 years of TAM followed by 3 years of ANA. Adjuvant chemotherapy and G3 and T4 tumors were exclusion criteria. Intention-to-treat and censored analyses of on-treatment recurrence-free survival (RFS) were performed, and exploratory survival end points and toxicity were investigated. Information from 3,714 patients, including 17,563 woman-years, with a median of 60 months of follow-up was available for this analysis. Median age was 63.8 years, 75% were node negative, and 75% had T1 tumors. Sequencing of ANA after identical 2-year treatment with TAM in both arms did not result in a statistically significant improvement of RFS (hazard ratio [HR], 0.80; 95% CI, 0.63 to 1.01; P = .06). Exploratory analyses of distant relapse-free survival indicated a 22% improvement (HR, 0.78; 95% CI, 0.60 to 1.00). On-treatment adverse events and serious adverse events were consistent with known toxicity profiles of ANA and TAM treatment. Despite a low overall rate of recurrence in a population with breast cancer at limited risk of relapse, the a priori sequence strategy of 2 years of TAM followed by 3 years of ANA led to small outcome and toxicity benefits.

Symptomatic Rathke cleft cysts: extent of resection and surgical complications

Rathke cleft cysts (RCCs) are benign masses arising from the embryological Rathke pouch, and are commonly treated by transsphenoidal surgery. The authors retrospectively compared RCC extent of resection-either gross-total resection (GTR) or decompression-to the primary outcome measure, which was recurrences resulting in repeat surgery, and the secondary outcome measure, which was complications. Seventy-four patients presenting to the neurosurgical department with RCC were analyzed retrospectively. Sixty-eight patients had a total of 78 surgical procedures, with the diagnosis of RCC confirmed by histological investigation; of these, 61 patients had adequate operative notes for the authors to evaluate extent of resection. Groups were separated into GTR (32 patients) or decompression (subtotal resection or fenestration into the sphenoid sinus; 29 patients) based on operative notes and postoperative imaging. The mean follow-up duration was 60.5 ± 72.1 months (the mean is expressed ± SD throughout). The average age at the time of the initial surgery was 42.8 ± 17.4 years, and 70% of patients were female. The mean cyst diameter preoperatively was 16.9 ± 17.8 mm. Eight patients had repeat surgery, our primary outcome measure; 3 repeat operations occurred in the GTR group, and 5 in the decompression group. There was no significant difference in recurrence when comparing groups (GTR 9%, decompression 17%; p = 0.36). There were no major complications; however, analysis of postoperative minor complications revealed that 11 (34%) GTRs resulted in surgical complications, whereas the decompression cohort accounted for only 3 complications (10%) (p = 0.03), with diabetes insipidus (6) and CSF leaks (5) being the most common. Gross-total resection also resulted in an increase in postoperative hyperprolactinemia compared with decompression (p = 0.03). It appears that RCCs require repeat surgery in 13% of cases, and attempted GTR does not appear to reduce the overall rate of recurrence. However, more aggressive resections are associated with more complications in this series.

Pleomorphic Liposarcoma of the Uterine Corpus With Focal Smooth Muscle Differentiation

We describe a rare case of a pleomorphic liposarcoma (>95%) of the uterine corpus with focal leiomyosarcomatous (<5%) differentiation, and review the literature on 10 purely mesenchymal liposarcomatous tumors of the uterine corpus reported earlier. The patients, including this case, ranged in age from 45 to 78 years (mean and median 59 y) and frequently presented with abnormal uterine bleeding and/or abdominal pain. The tumors were typically large (average tumor size 15.79 cm, range: 7 to 28 cm), and displayed a cut surface with hemorrhage and gross degeneration. Most tumors were confined to the uterus after initial evaluation. Follow up was available in 10 (91%) of the 11 patients. Five (50%) of the 10 patients showed no evidence of tumor recurrence or metastases at an average follow-up of 30.4 months. The remaining 5 patients experienced recurrence within the first year of their extirpative operations. However, 2 (40%) of the 5 patients who showed no recurrence had limited follow-up (2 and 6 mo). After excluding cases without follow-up and nonrecurring cases with less than 1-year follow-up, the overall rate of recurrence or metastases was 62.5% (5 of 8). Eight (72.7%) of the 11 reported cases were associated with smooth muscle neoplasia, including 2 cases designated as "mesenchymoma" with liposarcomatous, leiomyosarcomatous, and osteosarcomatous elements; 1 case of a myxoid liposarcoma arising from a leiomyoma; and 5 cases of tumors with varying amounts of leiomyosarcomatous and liposarcomatous components. On the basis of this review, we postulate that a significant subset of liposarcomatous tumors of the uterus may actually represent an unusual form of divergent differentiation of leiomyosarcomas. This may have adjuvant management implications for patients with these rare tumors.

Superficial bladder tumours: recurrence and progression.

To determine various presentations of superficial bladder cancer, its management, recurrence and progression rates. Case series. Department of Urology, Jinnah Postgraduate Medical Centre, Karachi, from January 2002 to December 2009. Patients with pathologically proven superficial transitional cell carcinoma (TCC) with minimal 2 years of follow-up were included. Their clinical presentations and management was recorded. Complete transurethral resection of bladder tumour (TURBT) was attempted in all patients. Tumour grading and staging was performed. Intra-vesical single instillation of Mitomycin-C was given postoperatively in selected patients. Cystoscopic surveillance was used to assess recurrence in all patients according to standard protocol. Metastatic work-up and biopsy record of follow-up TURBT was used to document progression in high risk patients. Results were described as simple descriptive statistics. A total of 92 patients were studied. The median age of patient was 62 years, with male preponderance (88%). Hematuria with lower urinary tract symptoms (LUTS) was most common presentation (47.8%), followed by hematuria alone (25.7%), LUTS alone (9.2%) and upper tract symptom in 1.8% of patients. Complete TURBT in first attempt was possible in 72 patients (78.3%). Multiple tumours were seen in 34 patients (39.6%). Intravesical mitomycin was given in 70% patients. Over-all recurrence rate of 68.4% was noted. Patients with TaG2-3 showed recurrence rate of 58.8% which occurred late with good recurrence free interval. T1G2-3 patients have more and early recurrences (80.4%). Progression seen in 13 patients (14%), 6 patients have up-grading, four showed stage progression, one developed pelvic lymphadenopathy and another one had bone metastasis. One female patient (TaG2) developed right renal pelvic recurrence and progression while her bladder disease was well controlled. The number of patients with T1 disease was 45% in this study which is comparatively higher than other studies. Early recurrences and progression were observed with T1G2-3, while late recurrence were seen with Ta disease, having tumour free interval between 6 months to 2 years. Early radical cystectomy was advised to T1G3 disease and with multiple recurrences, but patient's compliance was poor..

Risk factors for recurrence and re‐recurrence of ovarian endometriomas after laparoscopic excision

Since ovarian endometrioma is frequently diagnosed in women of reproductive age, laparoscopic excision of the endometrioma is performed for most cases. However, endometriomas frequently recurs even after repeated surgical procedures. The aim of our study is to identify risk factors for recurrence and re-recurrence of endometriomas after the first and second laparoscopic excision. We retrospectively evaluated 173 patients who had a minimum of one year postoperative follow-up after the laparoscopic excision of endometriomas. Ten and eight factors were evaluated to assess their effect on the risk of recurrence and re-recurrence, respectively. Factors were analyzed using univariate and the Cox regression test. The overall rate of recurrence and re-recurrence were 45.1% and 45.5%, respectively. A high revised American Society for Reproductive Medicine score (1997) was associated with an increased risk of recurrence. Only postoperative pregnancy was associated with a decreased risk of recurrence. Short periods of normal menstruation without pregnancy or gonadotrophin-releasing hormone analogues from first surgery to recurrence were associated with higher rate of re-recurrence. A high revised American Society for Reproductive Medicine score was a risk factor, and postoperative pregnancy was protective against recurrence. The patient with short periods of normal menstruation without pregnancy or gonadotrophin-releasing hormone analogues from first surgery to recurrence had a high risk of re-recurrence.

Ductal carcinoma in situ of the breast in younger women: A subgroup of patients at high risk

Background After breast conservative treatment (BCT), young age is a predictive factor for recurrence in patients with Ductal Carcinoma In Situ (DCIS) of the breast. The purpose of this study was to evaluate predictive factors for recurrence and outcomes in these younger women (under 40 years) treated for pure DCIS. Methods From 1974 to 2003, 207 cases were collected in 12 French Cancer Centers. Median age was 36.3 years and median follow-up 160 months. Seventy four (35.8%) underwent mastectomy, 67 (32.4%) lumpectomy alone and 66 (31.9%) lumpectomy plus radiotherapy. Results 37 recurrences occurred (17.8%): 14 (38%) were in situ and 23 (62%) invasive. After BCT, the overall rate of recurrence was 27% (33% in the lumpectomy plus radiotherapy group vs. 21% in the lumpectomy alone group). Comedocarcinoma subtype ( p = 0.004), histological size more than 10 mm ( p = 0.011), necrosis ( p = 0.022) and positive margin status ( p = 0.019) were statistically significant predictive factors for recurrence. The actuarial 15-year rates of local recurrence were 29%, 42% and 37% in the lumpectomy alone, lumpectomy and whole breast radiotherapy and lumpectomy + whole breast radiotherapy with additional boost groups respectively. After recurrence, the 10-year overall survival rate was 67.2%. Conclusion High recurrence rates (mainly invasive) after BCT in young women with DCIS are confirmed. BCT in this subgroup of patients is possible if clear and large margins are obtained, tumor size is under 11 mm and necrosis- and/or comedocarcinoma-free.

HydroCoils, Occlusion Rates, and Outcomes: A Large Single-Center Study

The HydroCoil is an expansile hydrogel coil designed to produce a greater degree of volumetric packing within cerebral aneurysms when compared with bare platinum coils. This increased packing is, in turn, believed to decrease the risk of recurrence within aneurysms and hence the risk of their rupture in the long term. The aim of this work was to assess whether the use of HydroCoils and the proportion of HydroCoil used have any influence on the subsequent occlusion and recurrence rates of treated aneurysms. A retrospective study was performed of 328 patients during 5 years at a single institution. The initial angiographic and follow-up angiographic occlusion rates were recorded as were any procedural complications. The proportion of HydroCoil used was described as the relative amount of HydroCoil length to the total coil length used during an aneurysm treatment, thus forming 4 groups: 0%-19%, 20%-49%, 50%-69%, 70%-100%, and the subgroups with 100%. Two hundred seventy patients had angiographic follow-up during an average of 13 months. The overall risk of permanent neurologic deficit and death was 3%. The rate of complete occlusion was 31% immediately postcoiling and 64.8% on follow-up. At the latest follow-up, 25.6% had residual necks and 9.6% had residual aneurysms. There was a statistically significant trend for HydroCoils to produce greater occlusion rates on follow-up when >70% HydroCoil was used (P = .025). The overall rate of recurrence for all aneurysms as a group was 15.5%. The retreatment rate was 6.6%. There has been 1 rebleed in the 328 patients. The overall results following the use of HydroCoils to occlude aneurysms compare well with those in other reported series. HydroCoils do produce a statistically significantly greater rate of occlusion when >70% of total aneurysm coil length is HydroCoil compared with coiling with <20% HydroCoil. There was no significant difference, however, in the recurrence or retreatment rate when comparing these groups.

Laparoscopic surgery for rectal cancer: the standard of care?

In a recent issue of the Surgical Endoscopy, Miyajima et al.[1] reported their results with laparoscopic surgery forrectal cancer. Although theirs was a retrospective studywith no level 1 evidence from randomized controlled trials,the data provided by authors still may be important andworthy of consideration.In the treatment of gastrointestinal cancers, the qualityof surgery plays a central role in achieving both goodquality of life and favorable oncologic outcomes [2]. Forexample, appropriate lymph node dissection seems to beimportant for reducing locoregional recurrence. Althoughcontroversy still exists, at least 15 or, according to others,20 lymph nodes should be resected and pathohistologicallyexamined for accurate nodal staging, which is important foradjuvant treatment decisions [3–7].Particularly for rectal cancer, surgical quality stronglyaffects quality of life and survival. Total mesorectal exci-sion, sphincter-preserving surgery, and sigmoid mesentericlymph node dissection currently are increasingly acceptedfor optimal treatment of distal rectal tumors.All these goals can be better achieved with laparoscopictechniques. Indeed, recent advances in laparoscopic gas-trointestinal surgery allow improved postoperative mor-bidity and quality of life without any worsening ofoncologic outcomes [8, 9]. However, concern arises whenrandomized controlled trials, required to prove the safetyand efficacy of laparoscopic procedure versus open rectalsurgery, are lacking [10, 11].Therefore, the results for 1,057 selected patients withrectal cancer who underwent laparoscopic surgery between1994 and 2006 in 28 Japanese centers [1] may attract ourconsideration. Most of the 938 patients underwent rectalanterior resection, and a conversion to open procedure wasrequired for only 7.3% of these patients. Postoperativesurgical complications were observed for 235 patients(22%), including anastomotic leakage in 84 patients (9%).The local recurrence rate was only 1%, and the overallrecurrence rate was 6.6% for the 1,011 patients who hadundergone a pathohistologically confirmed completeresection. Further evaluation, if feasible, with phase 3 trialsrequires the possibility of expanding indications forsphincter-preserving laparoscopic rectal resection so morepatients can benefit from this technique.The low local and overall recurrence rates reported fromthis large retrospective study provides further evidence forthe safety and efficiency of laparoscopic rectal resection.The refinement and new generation of robotic da Vincisystems will further improve patient outcomes [12].Undoubtedly, new technologies drive the future. Inclinical practice, the second-generation da Vinci S highdefinition (HD) surgical system likely will become thetechnique required especially for low anterior rectumresection. In biomedical sciences, new research based onnext-generation DNA sequencing is increasingly incorpo-rated into research projects to assist us in understanding thecomplex heterogeneity of cancer. The past three decadeshave seen important advances in conventional single-pro-tein-coding gene research. But cancer mortality stillremains high, reflecting the need for new directions. Cur-rently, a new era with cancer genome research, systemsapproaches, and network modeling provide major hope for

Prevalence, Morphology, and Prognosis of Human Papillomavirus in Tonsillar Cancer

We sought to identify the prevalence of human papillomavirus (HPV) in tonsillar squamous cell carcinoma, and to examine the relationship of HPV to prognosis and tumor morphology. We performed in situ hybridization for HPV and retrospective clinical outcome analysis. Of the 48 patients with tonsillar carcinoma, in situ hybridization identified 35% as HPV-positive tumors. Age-matched controls had no evidence of HPV. There was no significant difference between HPV-positive and HPV-negative patients regarding age (p = 0.34), tobacco consumption (p = 0.59), alcohol consumption (p = 0.91), or treatment method (p = 0.39). Forty-four patients were eligible for outcome analysis. The overall rate of recurrence in this population was 25%, and the disease-specific survival rate was 84%. There was no significant difference between the two groups either in the incidence of recurrence (p = 0.14) or in the disease-specific survival rate (p = 0.19). HPV-associated tumors developed from the tonsillar crypts significantly more frequently than did HPV-negative tumors (p = 0.01). As previously described, HPV is significantly associated with squamous cell carcinoma of the tonsil; however, HPV status in our series did not correlate with clinical outcome. Morphologically, we found that HPV-positive tumors had their origin in the tonsillar crypts, whereas HPV-negative tumors arose from the surface epithelium.