Removal Of Primary Tumor Research Articles

Beeinflussung maligner Tumoren durch Anästhesieverfahren

Malignant tumors are the second major cause of death in Germany. The essential therapy of operable cancer is surgical removal of primary tumors combined with adjuvant therapy. However, several consequences of surgery may promote metastasis, such as shedding of tumor cells into the circulation, decrease in tumor-induced antiangiogenesis factors, excessive release of growth factors for wound healing and suppression of immunity induced by surgical stress. In the last decade it has become clear that cell-mediated immunity controls the development of metastasis. Various perioperative factors, such as surgical stress, certain anesthetic and analgesic drugs and pain can suppress the patients' immune system perioperatively. On the other hand, by modifications of the anesthesia technique (e.g. regional anesthesia) and perioperative management to minimize immunosuppression, anesthesiologists can play a considerable role for a better outcome in patients having malignant tumors. Sufficient clinical evidence is not yet available to prove or disprove the hypothesis that anesthesia practice can improve cancer prognosis. Despite difficulties in study design, several prospective randomized trials are currently running and the results are awaited to elucidate this topic.

Predictors of primary and distant site surgery in patients with stage IV colorectal cancer.

499 Background: Operative management of primary tumor and distant metastases in stage IV colorectal cancer is highly variable and removal of asymptomatic primary tumors in the setting of distant disease remains controversial. The purpose of our study was to describe the patterns of surgery in stage IV colorectal cancer patients in a US population-based cohort and explore patient and tumor characteristics associated with treatment selection and survival. Methods: Stage IV colorectal cancer patients in Los Angeles County from 2000 to 2006 were identified using the LA County Cancer Surveillance Program registry. The cohort included 2,956 patients (2,211 stage IV colon and 745 stage IV rectal cancers). Cox proportional hazard models were used to estimate survival. Treatment was categorized as primary surgery, distant site surgery, or chemotherapy only. Multivariate logistic regression was used to identify patient and tumor variables associated with treatment. Results: Greater than 65% of the stage IV colorectal cohort had primary tumor surgery of which 51% had chemotherapy. Only 4.5% had surgery to remove distant disease. Patients who had chemotherapy only and no surgery was 15%. Median survival of primary surgery, distant surgery, or chemo only was 14, 21, and 11 months. Multivariate Cox regression revealed that primary surgery and distant surgery had a decreased risk of death compared to no surgery (HR= 0.4 p<.0001, HR=0.7 p<.004). Multivariate logistic regression was used to identify predictors associated with treatment selection. Patients >65 years (p<.003); low socioeconomic status (p<0.05); and rectal tumors (p<.0001) were less likely to have surgery of the primary tumor. Female gender (p<.0001) and primary tumor surgery (p<.0001) were predictors for distant site surgery whereas age>65 years (p<.0001) had a negative association. Conclusions: Our population-based study of stage IV colorectal cancer patients suggests that the majority of stage IV patients with distant disease have surgery, but less than 5% have surgery for distant disease. Although survival of stage IV colorectal patients is improved with surgery, increasing age, low socioeconomic status, and rectal tumors are negative predictors for undergoing surgery.

Emerging concept of tailored lymphadenectomy in endometrial cancer.

Emerging concept of tailored lymphadenectomy in endometrial cancer.

Therapeutic application of injectable thermosensitive hydrogel in preventing local breast cancer recurrence and improving incision wound healing in a mouse model

Many drug delivery systems (DDSs) have been investigated for local targeting of malignant disease with the intention of increasing anti-tumor activity and minimizing systemic toxicity. An injectable thermosensitive hydrogel was applied to prevent locoregional recurrence of 4T1 breast cancer in a mouse model. The presented hydrogel, which is based on poly(ethyleneglycol)-poly(ε-caprolactone)-poly(ethylene glycol) (PEG-PCL-PEG, PECE), flows freely at normal temperature, forms a gel within seconds in situ at body temperature, and eventually releases the drug in a consistent and sustained fashion as it gradually biodegrades. Locoregional recurrence after primary tumor removal was significantly inhibited in mice treated with the paclitaxel (PTX)-loaded PECE hydrogel subcutaneously (9.1%) administered, compared with the blank hydrogel (80.0%), systemic (77.8%) and locally (75.0%) administered PTX, and the control group (100%) (P < 0.01). In addition, tensile strength measurements of the surgical incisions showed that the PECE hydrogel accelerates wound healing at postoperative day 7 (P < 0.05), and days 4 and 14 (P > 0.05), in agreement with histopathological examinations. This novel DDSs represents a promising approach for local adjuvant therapy in malignant disease.

Ginsenoside Rg3 inhibits growth of liver metastases in nude mice after surgical removal of primary tumor

Ginsenoside Rg3 inhibits growth of liver metastases in nude mice after surgical removal of primary tumor

Dietary supplementation with methylseleninic acid, but not selenomethionine, reduces spontaneous metastasis of Lewis lung carcinoma in mice

The present study investigated the effects of dietary supplementation with methylseleninic acid (MSeA), in comparison with selenomethionine (SeMet), on spontaneous metastasis of Lewis lung carcinoma (LLC) in male C57BL/6 mice using intramuscular and subcutaneous injection models. Mice were fed AIN93G control diet or that diet supplemented with MSeA or SeMet at 2.5 mg selenium/kg for 4 weeks at which time they were injected intramuscularly or subcutaneously with 2.5 × 10(5) viable LLC cells. Experiments were terminated 2 weeks later for mice injected intramuscularly or 2 weeks after surgical removal of primary tumors from mice subcutaneously injected with cancer cells. Dietary supplementation with MSeA significantly reduced pulmonary metastatic yield when compared with the controls (p < 0.05) in both models; however, SeMet did not have such an effect. Supplementation with MSeA significantly decreased plasma concentrations of urokinase-type plasminogen activator (p < 0.05) and plasminogen activator inhibitor-1 (p < 0.05). Furthermore, MSeA significantly reduced plasma concentrations of vascular endothelial growth factor (p < 0.05), fibroblast growth factor basic (p < 0.05) and platelet-derived growth factor-BB (p < 0.05) when compared with the controls. Selenomethionine did not affect any of the aforementioned measurements. These results demonstrate that MSeA reduces spontaneous metastasis of LLC in mice, perhaps through inhibition of the urokinase plasminogen activator system and reducing angiogenesis.

P2-15-05: Excision of the Primary Tumour in Patients with Metastatic Breast Cancer – Will E2108 Provide the Definitive Answer?

Abstract Background: Approximately 10% of new breast cancer patients will present with overt synchronous metastatic disease. Controversy exists about the optimal local management of these patients. While several series suggest that removal of primary tumour is associated with a survival benefit, the retrospective nature of these studies raises considerable methodological challenges. We decided to evaluate the experience at our centre around the impact of surgery in patients with synchronous metastasis. Method: Case records of all patients seen with primary breast cancer and concurrent distant metastases between 2005 to 2007 were reviewed. Demographic and treatment data was collected. The study endpoints compared both overall survival and symptomatic local progression rates between patients who had breast surgery and those who did not. RESULTS: 111 patients were identified. Median follow-up 40 months (0.6-71 months). Patients were divided into two groups: those patients who underwent breast surgery (n=48; 29/48 had surgery immediate prior to metastatic diagnosis) and those that did not have surgery(n = 63). The surgical group were less likely to present with T4 tumours (20% vs 36%), N3 nodal disease (8% vs 19%) and visceral metastasis (67% vs 73%)when compared with non-surgical group. Improved overall survival (49 months vs 33 months; p=0.01) and less symptomatic local progression rates ( 15% vs 43%, p &amp;lt; 0.001 ) were seen in the surgical group compared to the non-surgical group. CONCLUSIONS: The optimal local management of patients with metastatic breast cancer is unknown. Despite the surgery group demonstrating an improved overall survival and symptomatic local control, this group had less aggressive disease at presentation. These results confirm the need for prospective randomized studies. E2108, an ongoing Phase III Trial, was designed to assess the effect of breast surgery in metastatic patients responding to first line systemic therapy. If excision of the primary tumour is associated with a survival benefit, then the pre-selected subgroup of patients that have responded to initial systemic therapy is the desired population to put this hypothesis to test. Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P2-15-05.

P2-15-10: Do Patients with Incurable Advanced Breast Tumor and Distant Metastasis Derive Any Benefit from Primary Tumor Resection?

Abstract Background Metastatic breast cancer (MBC) is considered incurable. Surgical removal of primary tumors has not been established as a standard treatment for MBC because it is generally accepted that local therapy provides no survival advantage once metastases have occurred. Additionally, tumor excision may further stimulate metastasis.4 Therefore, primary tumor resection in patients with MBC is usually only applied as a palliative treatment for symptomatic wound complications such as bleeding, ulcer formation, unpleasant smell, and purulent discharge. In recent years, however, some retrospective studies have reported advantages of debulking surgery in terms of improving patient outcome. We retrospectively analyzed the surgical benefits and prognostic factors for patients with MBC who were treated at our center. Methods: We retrospectively reviewed individual medical records from the Hokkaido Cancer Center. In this study, incurable advanced breast cancer is defined as the presence of a tumor, larger than 5 cm, and shows either (invasion to chest wall or skin or is an inflammatory carcinoma) and at least one metastatic site, including distant lymph nodes, bone, or visceral organs (lung, pleura, mediastinum, liver, and brain) at diagnosis. Between January 2000 and June 2010, 92 women were diagnosed with incurable advanced breast cancer at our institute. The effect of surgical treatment on survival was evaluated. Patient demographics and tumor characteristics were also investigated. Results: Thirty-six patients had surgery for resection of primary tumors. There were no substantive differences between individuals, or between tumor characteristics, for patients who underwent surgery versus patients who did not. The median survival time for surgically treated patients was 25.0 months versus 24.8 months for patients who did not undergo surgical resection (P=0.352). Only three patients relapsed within three months of surgery. For the remaining majority of patients, primary tumor resection gave some relief from the often severe symptoms that come from harboring a large tumor for an extended time. In univariate and subsequent multivariate analyses of predictive indicators, a diagnosis of triple-negative breast cancer and/or metastasis to more than three sites was significantly associated with a severe prognosis. Conclusion: Primary tumor resection failed to prolong overall survival times in patients with incurable advanced breast cancer that was greater than 5 cm. However, surgery did improve the quality of life in patients who were expected to have a relatively long prognosis. Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P2-15-10.

Increased Signal Transducer and Activator of Transcription 3 (STAT3) and Decreased Cyclin D1 in Recurrent Astrocytic Tumours Compared with Paired Primary Astrocytic Tumours

This study compared the levels of signal transducer and activator of transcription 3 (STAT3) and cyclin D1 protein in paired primary and recurrent astrocytic tumours, and analysed their correlation with clinicopathological and treatment factors. A total of 48 samples from 24 patients who had undergone surgical removal of primary and recurrent astrocytic tumours were analysed. Levels of STAT3 and cyclin D1 protein were detected using immunohistochemistry. Increased STAT3 and decreased cyclin D1 levels were observed in recurrent astrocytic tumours compared with their paired primary tumours. There was a significant correlation between higher levels of STAT3 protein and shorter progression-free survival in primary tumours after surgery (r = 0.417), and a significant correlation between decreased cyclin D1 protein levels and radiotherapy in recurrent tumours (r = 0.468). It was concluded that increased STAT3 and decreased cyclin D1 protein levels may contribute to the recurrence of astrocytic tumours. Detection of STAT3 may be useful in predicting progressionfree survival in primary astrocytic tumours after surgery. In addition, radiotherapy may decrease cyclin D1 levels in astrocytic tumours, but the nature of this association requires further investigation.

Removal of primary tumor improves survival in metastatic breast cancer. Does timing of surgery influence outcomes?

Background Resection of intact primary tumor is controversial in metastatic breast cancer patients. The aim of this study is to review the impact of surgical resection of primary tumor on overall survival and to assess the role of timing of surgery on survival rates. Methods 208 patients with metastatic breast cancer diagnosed between 1982 and 2005 in the Hospital Clinico of Valencia (Spain) were analysed. Exclusion criteria were age >80, PS 3–4, Charlson score 3 or follow-up < 90 days. 123 of these underwent surgery and 85 did not. In order to assess the role of timing, the "surgery" cohort was divided into two sub-groups: "before" ( n = 78) or "after" ( n = 45) diagnosis of disseminated disease. Results In the surgery group, patients underwent mastectomy with axillary dissection (82.9%), without axillary dissection (8.9%) and conservative surgery (8.1%). After a median follow-up of 29.68 months, median OS in the "surgery" and the "non-surgery" groups were, 40.4 and 24.3 months. Removal of the primary tumor therefore had a significant positive impact on survival rates ( p < 0.001). Benefits of surgery were observed mainly in patients with visceral disease ( p = 0.005); no statistical differences were found in those with bone disease ( p = 0.79). Univariate analysis for overall survival (OS) identified surgery, performance status, clinical T stage, hormone receptors and number and type of metastases as variables that impacted on survival. In the multivariate test, only resection of primary tumor and estrogen receptors maintained statistical significance, surgery having a protective effect with an HR 0.52 (95% CI 0.35–0.77). No differences in survival were found between the two sub-groups according to the timing of surgery: "before" vs "after"( p = 0.996). Conclusions Resection of primary tumor should be considered not only as a palliative or preventive strategy but also as an approach that possibly contributes to the control of the disease in selected patients.

The influence of removal of primary tumor on incidence and phenotype of circulating tumor cells in primary breast cancer

Recent studies have shown that the detection of circulating tumor cells (CTC) pre- and postoperatively in the peripheral blood of primary breast cancer patients may be an indicator for poor survival. This study aimed to investigate the influence of removal of the primary tumor on incidence and phenotype of circulating tumor cells in primary breast cancer.

Use of Fibrin-Based Sealants and Gelatin-Matrix Hemostats in Laparoscopic Liver Surgery

During surgery, liver tissue is particularly prone to bleeding which can be difficult to control, especially in patients with liver disease-associated coagulopathy. Topical sealants and hemostats can enhance clot formation and wound healing, and can be useful for controlling or preventing troublesome bleeding during surgical interventions where conventional methods of hemostasis are inadequate. An extensive customized literature search was conducted using medical reference databases to identify publications related to the use of potential agents in laparoscopic liver surgery. Citations from these articles were also used. Details of the authors' own experience in this area is also included. Routine use of fibrin-based sealants in open liver surgery now seems to be widespread. Data from several large prospective randomized controlled clinical trials have indicated that application of fibrin-based sealants to the cut liver surface during hepatectomy does provide some benefit in terms of a shorter time to hemostasis and a reduction in postoperative drainage fluid, even when compared with argon beam coagulation. Another trial found no additional benefit of fibrin sealants when applied after coagulation of the cut liver surface. A prospective, uncontrolled study found that application of the flowable gelatin matrix-based hemostat Floseal provided rapid effective control of mild-to-severe bleeding during surgical removal of primary or metastatic liver tumors, even in those with cirrhosis. Some of these topical hemostatic agents are already being used on a routine basis by many surgeons performing laparoscopic liver surgery. Although there are no randomized clinical trials, there are several anecdotal or case reports of their effective use during laparoscopic liver surgery. On the basis of current evidence of using hemostats and sealants in open liver surgery, there is potential of developing these strategies in laparoscopic liver surgery.

The influence of removal of primary tumor on incidence and phenotype of circulating tumor cells in primary breast cancer

Recent studies have shown that the detection of circulating tumor cells (CTC) pre and postoperatively in the peripheral blood of primary breast cancer patients may be an indicator for poor survival. This study aimed to investigate the influence of removal of the primary tumor on incidence and phenotype of circulating tumor cells in primary breast cancer. 209 primary breast cancer patients could be included into this analysis. Blood sampling was performed both pre and postoperatively. The blood specimens were immunomagnetically enriched using AdnaTest BreastCancerSelect within 4 h after blood withdrawal, followed by RNA isolation and subsequent gene expression analysis by reverse transcription and multiplex PCR using AdnaTest BreastCancerDetect. Three breast cancer-associated tumor markers and two hormone receptor genes were amplified: GA733-2, Muc-1, Her-2, ER, PR. In addition, bone marrow (BM) status was intraoperatively determined. Forty-three of 209 patients (21%) had pre and/or postoperatively circulating tumor cells. The positivity rates after surgery were higher but did not differ significantly (12% pre and 16% postoperatively, P = 0.264). Disseminated tumor cells in BM were seen in 32 of 209 cases (15%). Patients with positive BM status had significantly higher CTC positivity rates both pre and postoperatively compared to those with negative BM status. The most common CTC phenotype was triple negative (24 patients) followed by HER2+/ER-/PR- subtype (10) and ER and/or PR positive (9). Interestingly, 41 of 43 primary tumors (95%) were ER and PR positive. Removal of the primary tumor did not alter the phenotype of CTC. Surgery does not significantly influence the tumor cell load in the blood stream. CTC phenotype before and after the surgery generally remains identical but may differ from that of the primary tumor.

Abstract SY12-01: Stem cell approaches dissect lung cancer biology

Abstract Lung cancer is the major cause of death from cancer worldwide. The five-year survival rate for the majority of lung cancer patients is only 16% because their tumors are refractory to chemotherapeutics or quickly become resistant to therapeutic response. Also contributing to morbidity, most lung cancer patients already have advanced, metastatic disease at the time of diagnosis or develop metastases after surgical removal of early-stage primary lung tumors. The cancer stem cell (CSC) hypothesis is an attractive explanation for tumor growth, recurrence after treatment, and metastasis in some cancers, yet the precise role of CSCs in lung tumors has not been established. Since successful cancer therapy requires the elimination or incapacitation of all tumor cells capable of regenerating a tumor, it is crucial to characterize the cells that are able to propagate a tumor in vivo. We refer to these functionally important cancer cells as tumor-propagating cells (TPCs). Importantly, understanding the identity and molecular nature of TPCs will provide new opportunities for early detection, treatment and prevention of metastatic disease, whether or not they fit the CSC model in each type of cancer. My laboratory recently showed that murine lung adenocarcinomas, the most prevalent lung cancer subtype, contain a TPC population. In mice bearing tumors initiated with oncogenic Kras and deletion of p53, the cell surface marker Sca1 identifies cancer cells with stem cell properties. In contrast, TPCs are Sca1-negative in lung tumors that express a mutant EGFR. Thus, the predominant driving oncogenotype is an important determinant in the identification of TPC phenotype in lung cancer. This finding suggests that treatments directed against cancer stem cells should be targeted to subsets of patients grouped according to their oncogenotype. We have recently obtained global gene expression data from the Sca1-sorted populations of murine lung tumor cells, as well as their normal wild-type counterparts, to uncover the molecular pathways responsible for tumor propagation in lung adenocarcinoma. I will also discuss new avenues we have taken to understand the connections between TPCs and metastasis in mouse models as well as translating the importance of our findings in human lung cancer cells and patient samples. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 102nd Annual Meeting of the American Association for Cancer Research; 2011 Apr 2-6; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2011;71(8 Suppl):Abstract nr SY12-01. doi:10.1158/1538-7445.AM2011-SY12-01

Gastric adenocarcinoma in children and adolescents

Gastric adenocarcinoma (GAC) is an extremely rare cancer in children with very limited information on the clinical presentation and outcome. We report five pediatric patients with GAC-treated between 1990 and 2008 at our institution. Median age at diagnosis was 17 years (range: 8-17). Our case series suggests that pediatric GAC patients present with diffuse metastatic disease (four patients) and with patterns of spread similar to adult GAC. Initial chemotherapy was mainly platinum-based. Median time to progression was 4 months. The only long-term survivor was a patient with localized disease who had complete surgical removal of primary tumor.

Diagnostic Usefulness of 3’-Deoxy-3’-[18F]Fluorothymidine Positron Emission Tomography in Recurrent Brain Tumor

We evaluated the diagnostic usefulness of 3'-deoxy-3'-[F]fluorothymidine (FLT) compared with 2-[F]fluoro-2-deoxy-D-glucose (FDG) positron emission tomography (PET) in recurrent brain tumors. Twenty patients with suspected recurrence after surgical removal of primary tumors were studied. The uptake was assessed visually and quantified by standardized uptake value (SUV) and SUV ratio of tumor to white matter, tumor to gray matter, and tumor to normal tissue. Final diagnoses were made by histopathology or clinical and radiological follow-up. Of 20 lesions, 15 were recurrences. 3'-Deoxy-3'-[F]fluorothymidine PET showed high diagnostic sensitivity (15/15 [100%]) and moderate specificity (3/5 [60.0%]). 2-[F]fluoro-2-deoxy-D-glucose PET showed moderate diagnostic sensitivity (11/15 [73.3%]) and specificity (4/5 [80%]). All of 4 recurrent tumors without FDG uptake showed FLT uptake. Tumor-to-normal tissue ratios (3.99 ± 1.72) of recurrent tumors on FLT PET were significantly higher than tumor-to-white matter ratios (1.96 ± 0.93) and tumor-to-gray matter ratios (1.32 ± 0.33) on FDG PET (P < 0.001), although SUVs (0.62 ± 0.32) of recurrent tumors on FLT PET were lower than those (2.44 ± 1.02) on FDG PET (P < 0.001). 3'-Deoxy-3'-[F]fluorothymidine PET has a high sensitivity but a lower specificity, which has a limited role in the diagnosis of recurrent brain tumors as a complimentary tool of magnetic resonance imaging.

Abstract P3-03-01: Minimal Residual Disease Monitoring in Breast Cancer Patients

Abstract BACKGROUND: Breast cancer (BC) patients still harbor a considerable risk of metastatic relapse caused by minimal residual disease (MRD) despite of complete removal of primary tumor. The aim of this study was to identify single disseminated tumor cells (DTC) in the bone marrow and circulating tumor cells (CTC) in the peripheral blood as potential biomarkers for therapy response monitoring and metastatic relapse risk prediction. Finally, the gene expression profiles of CTCs have been analyzed. METHODS: A total of 87 patients with diagnosed BC at stage I to III and 115 metastatic patients were enrolled into a prospective study between years 2008 - 2010. Peripheral blood (5ml) for CTC-detection was collected from primary BC patients before chemotherapy (CHT), after 2 cycles of CHT and after the CHT. Metastatic BC patients have been examined for CTCs before starting a new line of the treatment. Bone marrow aspirates from 16 premenopausal BC patients (mean age 31) with primary tumor were analyzed for the presence of DTC by immunocytochemistry using the pan-cytokeratin antibody A45-B/B3 (Epimet™, AS Diagnostik, Germany) before surgery. CTC detection in blood was performed by AdnaTest BreastCancerTM(AdnaGen AG, Germany), which is based on the detection of EpCAM, HER2 and MUC1 specific transcripts in enriched CTC-lysates. cDNA from isolated CTCs has been further pre-amplified and used for multimarker qPCR gene expression profiling using Biomark® microfluidic 48x48 GE Dynamic arrays (Fluidigm, USA). qPCR results have been analyzed by GENEX vs. 5.2 software (MultiD Analysis). RESULTS: 286 CTC samples have been analyzed in total. The analysis has shown that the expression profiles of CTCs from primary BC patients have been significantly different comparing them to the CTC-profiles from metastatic BC patients for several of tested genes (e.g., CK19, GA7332, MLFIP1, SATB1, PTEN). Interestingly, before surgery of primary tumor DTCs were found in 5/16 patients (31 %) and CTCs in 7/16 (43 %). Both DTCs and CTCs together were found in 4/16 (25%) patients. In 18% of the primary BC patients no dissemination markers were found CONCLUSIONS: Information based on the CTCs-gene expression profiles could provide an additional support for therapy management. Metastatic potential of enriched CTCs will be further evaluated on the single cell level. This work has been supported by Grant Agency of Ministry of Health, Czech Republic (IGA NS9976) and Grant Agency of Charles University in Prague, Czech Republic no. 7709 and 59410. Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P3-03-01.

Hydrocephalus associated with vestibular schwannomas: management options and factors predicting the outcome

The current, generally accepted optimal management for hydrocephalus related to vestibular schwannomas (VSs) is primary tumor removal, with further treatment reserved only for patients who remain symptomatic. Previous studies have shown, however, that this management can lead to an increase in surgery-related complications. In this study, the authors evaluated their experience with the treatment of such patients, with the aim of identifying the following: 1) the parameters correlating to the need for specific hydrocephalus treatment following VS surgery; and 2) patients at risk for developing hydrocephalus-related complications. This was a retrospective study of a 400-patient series. The complication rates and outcomes following primary hydrocephalus treatment versus primary VS removal were compared. Patients undergoing primary tumor removal were further subdivided on the basis of the need for subsequent hydrocephalus treatment. The 3 categories of parameters tested for correlation with the need for such subsequent treatment as well as with heightened risk for developing complications were patient-, tumor-, and hydrocephalus-related. Of the entire series, 53 patients presented with hydrocephalus. Forty-eight of 53 patients underwent primary VS surgery, of whom 42 (87.5%) did not require additional hydrocephalus treatment. Of the 6 patients who did require additional hydrocephalus treatment, only 3 ultimately required a VP shunt. Factors correlating to the need of hydrocephalus treatment after VS removal were large tumor size, irregular tumor surface, and severe preoperative hydrocephalus. Patients with a longer symptom duration prior to surgery, those with polycyclic tumors, or with inhomogeneous VS, were at heightened risk for the development of CSF leaks. The general and functional outcome of surgery showed no correlation to the presence of preoperative hydrocephalus. Primary tumor removal is the optimum management of disease in patients with VS with associated hydrocephalus; it leads to resolution of the hydrocephalus in the majority of cases, and the outcome is similar to that of patients without hydrocephalus. Certain factors may aid in identifying patients at risk for developing persistent hydrocephalus as well as those at risk for CSF leaks.

Khirurgicheskoe lechenie bol'nykh s metastazami kolorektal'nogo raka v pecheni i legkikh

The authors give data on 39 patients operated on for colorectal cancer metastases to the liver and lung. Resurgeries were made in 6 cases. Predictors were defined. In patients with simultaneous metastases, 3-year survival was 36% with a median of 21 months and in those with metachronic metastases, it was 69% with a median of 31 months. Better results were obtained in the patients who had undergone hepatectomy and, following 2-3 weeks, metastasis removal from the lung particularly when secondary foci were detected only 6 months or more after primary tumor removal.

The North American Neuroendocrine Tumor Society Consensus Guideline for the Diagnosis and Management of Neuroendocrine Tumors

Pheochromocytomas, intra-adrenal paraganglioma, and extra-adrenal sympathetic and parasympathetic paragangliomas are neuroendocrine tumors derived from adrenal chromaffin cells or similar cells in extra-adrenal sympathetic and parasympathetic paraganglia, respectively. Serious morbidity and mortality rates associated with these tumors are related to the potent effects of catecholamines on various organs, especially those of the cardiovascular system. Before any surgical procedure is done, preoperative blockade is necessary to protect the patient against significant release of catecholamines due to anesthesia and surgical manipulation of the tumor. Treatment options vary with the extent of the disease, with laparoscopic surgery being the preferred treatment for removal of primary tumors. Medullary thyroid cancer (MTC) is a malignancy of the thyroid C cells or parafollicular cells. Thyroid C cells elaborate a number of peptides and hormones, such as calcitonin, carcinoembryonic antigen, and chromogranin A. Some or all of these markers are elevated in patients with MTC and can be used to confirm the diagnosis as well as to follow patients longitudinally for recurrence. Medullary thyroid cancer consists of a spectrum of diseases that ranges from extremely indolent tumors that are stable for many years to aggressive types associated with a high mortality rate. Genetic testing for RET mutations has allowed identification of familial cases and prophylactic thyroidectomy for cure. The only curative treatment is complete surgical resection.