Radical Surgery Research Articles

SIALOLITHIASIS: REVIEW

Objectives. Sialolithiasis is the most common obstructive salivary gland disease, responsible for approximately 50% of salivary glands pathology cases. The aim of this study is to provide the literature review to present the incident rate, etiology, diagnostic and treatment trends of sialolithiasis Materials and methods: Data from the Medline database, PubMed.gov and supplementary sources were used to conduct a systematic literature search. Results: The 116 studies were analyzed. The relevant data were exported, summarized and presented. Conclusion: The most of available studies regarding the incidence rate of sialolithiasis have been based on selected hospital data and there are a few multicenter analyses. The etiology of salivary stones formation remains not completely clear and various hypotheses have been put forward, thus research into etiologic factors is still continues. Despite the introduction of new technologies in the diagnostics of salivary gland, the routine methods like radiographs and ultrasound examination are still relevant and widely used. Gland preserving techniques in the treatment of sialolithiasis have continuously replaced radical surgery

Breast cancer: agreement between residual tumor size after neoadjuvant chemotherapy measurement with different imaging methods and the histological data

BackgroundThe evaluation of residual tumor size post-neoadjuvant chemotherapy (NAC) could have an impact on surgical planning. Accurate measurement may avoid overly radical surgery or reduce the need for repeat surgery. The purpose of this study is to evaluate the size of residual tumor after NAC using mammography and ultrasound or MRI and thereby establish which imaging method shows most agreement with histological result.MethodsData from 125 patients, from 40 to 86 years old, with primary breast cancer and indication for neoadjuvant chemotherapy were analyzed in a retrospective study. All patients underwent conventional imaging (mammography and ultrasound) or MRI in addition to conventional imaging, after NAC and before surgery. Intra-class correlation (ICC) was calculated, and a Bland–Altman plot was used to determine the agreement between imaging residual tumor size (from US/mammography and MRI) and histological residual tumor size. The results were divided into the groups: invasive ductal carcinoma (IDC) + ductal carcinoma in situ (DCIS), invasive ductal carcinoma (IDC), invasive lobular carcinoma (ILC) and “other tumors” (i.e., mucinous carcinoma).ResultsOf 125 analyzed patients, 44 (34.65%) underwent MRI and 81 (65.35%) had conventional imaging only. Agreement between residual tumor size founded on MRI and histological size is stronger than the data from conventional imaging.ConclusionsMRI performance was generally superior to conventional imaging, and it may be considered the most appropriate test to evaluate the residual tumor size post-NAC before surgery.

Clinical, Histologic, and Therapeutic Pattern of Posterior Fossa Tumors in Children in Cameroon: A Cross-sectional Study.

Posterior fossa tumors are significant in pediatric neurooncological populations due to their frequency and morbimortality. We convey a 10-year experience managing pediatric posterior fossa tumors at two reference centers in Cameroon. We conducted a cross-sectional study with data collected retrospectively in the Neurosurgery Department of the Central and General Hospitals of Yaounde from January 2010 to December 2019. Included in the study were all patients aged 0-15 years who underwent surgery for posterior fossa tumors. We retained 43 pediatric posterior fossa tumor files, representing 47.89% of pediatric brain tumors. The male/female sex ratio was 0.86, with a mean age of 6.93 ± 4.345 years. The predominant clinical presentations were headaches + vomiting (97.7%), visual impairment (67.4%), and altered consciousness (14%). The vermis was the most frequent site affected (46.5%). Hydrocephalus was found to be associated with the tumor in 30 patients (69.8%). Tumor excision was total in 90.7% of cases, with cerebrospinal fluid diversion performed within the surgery in 83% of cases. Pilocytic astrocytomas represented 37.2%, medulloblastomas 30.25%, ependymomas 6.9%, and brainstem gliomas 4.6%. The postoperatory mortality rate was 20.9%. The survival rate at 5 years for medulloblastomas was 43%. Pediatric posterior fossa tumors are frequent. Pilocytic astrocytomas are the most common histologic type, followed by medulloblastomas. Radical surgery is the leading standard of care. Adjuvant treatment remains limited.

Large language model answers medical questions about standard pathology reports.

This study aims to evaluate the feasibility of large language model (LLM) in answering pathology questions based on pathology reports (PRs) of colorectal cancer (CRC). Four common questions (CQs) and corresponding answers about pathology were retrieved from public webpages. These questions were input as prompts for Chat Generative Pretrained Transformer (ChatGPT) (gpt-3.5-turbo). The quality indicators (understanding, scientificity, satisfaction) of all answers were evaluated by gastroenterologists. Standard PRs from 5 CRC patients who received radical surgeries in Shanghai Changzheng Hospital were selected. Six report questions (RQs) and corresponding answers were generated by a gastroenterologist and a pathologist. We developed an interactive PRs interpretation system which allows users to upload standard PRs as JPG images. Then the ChatGPT's responses to the RQs were generated. The quality indicators of all answers were evaluated by gastroenterologists and out-patients. As for CQs, gastroenterologists rated AI answers similarly to non-AI answers in understanding, scientificity, and satisfaction. As for RQ1-3, gastroenterologists and patients rated the AI mean scores higher than non-AI scores among the quality indicators. However, as for RQ4-6, gastroenterologists rated the AI mean scores lower than non-AI scores in understanding and satisfaction. In RQ4, gastroenterologists rated the AI scores lower than non-AI scores in scientificity (P = 0.011); patients rated the AI scores lower than non-AI scores in understanding (P = 0.004) and satisfaction (P = 0.011). In conclusion, LLM could generate credible answers to common pathology questions and conceptual questions on the PRs. It holds great potential in improving doctor-patient communication.

Cost Analysis of Pelvic Exenteration Surgery for Advanced Pelvic Malignancy.

Pelvic exenteration (PE) is a radical procedure involving multi-visceral resection for locally advanced pelvic malignancies. Such radical surgery is associated with prolonged operating theater time and hospital stay, as well as a substantial risk of postoperative complications, and therefore significant financial cost. This study aimed to comprehensively detail the inpatient cost of PE at a specialist center in the Australian public sector. A retrospective costing review of consecutive PE operations at Royal Prince Alfred Hospital in Sydney between March 2014 and June 2022 was performed. Clinical data were extracted from a prospectively maintained database, and in-hospital costing data were provided by the hospital Performance Unit. All statistical analyses were performed using SPSS. Pelvic exenteration was performed for 461 patients, of whom 283 (61 %) had primary or recurrent rectal cancer, 160 (35 %) had primary or recurrent non-rectal cancer, and 18 (4 %) had a benign indication. The median admission cost was $108,259.4 ($86,620.8-$144,429.3) (Australian dollars [AUD]), with the highest costs for staffing followed by the operating room. Overall, admission costs were higher for complete PE (p < 0.001), PE combined with cytoreductive surgery (CRS) (p < 0.001), and older patients (p = 0.006). The total admission cost for patients undergoing PE reflects the complexity of the procedure and the multidisciplinary requirement. Patients of advanced age undergoing complete PE and PE combined with CRS incurred greater costs, but the requirement of a sacrectomy, vertical rectus abdominal flap reconstruction, major nerve or vascular excision, or repair were not associated with higher overall cost in the multivariate analysis.

Abstract B015: Duodenal aspiration biopsy in diagnosis of pancreatic neoplasms

Abstract Introduction Intraductal papillary mucinous neoplasms (IPMNs) are a subset of lesions with elevated malignant potential, warranting their inclusion in screening standards. Despite endoscopic ultrasound (EUS) with fine-needle aspiration biopsy (FNAB) serving as the standard for verification, the occurrence of erroneous conclusions remains significant. Consequently, analysis of pancreatic juice is considered as a potential adjunctive diagnostic method. However, the absence of methods for obtaining pancreatic juice in adequate volume and quality poses a barrier to the widespread adoption of this approach.Materials and MethodsA method of duodenal aspiration biopsy (DAB) was developed involving active aspiration from the lumen of duodenum, yielding large volume of the mix of pancreatic juice and bile uncontaminated by gastric juice. Patients diagnosed with pancreatic neoplasms utilizing EUS with FNAB, were enrolled and ALB was implemented as an adjunctive diagnostic procedure. Cytological analysis of the material obtained was performed along with measuring the level of carcinoembryonic antigen (CEA). The level &amp;gt;192 ng/mL was considered significant, according to the Fukuoka 2017 guidelines.ResultsIn patients with cystic neoplasms of the pancreas undergoing DAB, results of cytological examination were non-informative in certain cases. However, analysis of CEA levels in the pancreatic juice and bile mixture always demonstrated strong concordance with the degree of dysplasia. In some instances, elevated CEA values facilitated the adoption of a more aggressive treatment strategy, leading to the detection of carcinoma. Conversely, low CEA levels prompted the decision to opt for observation rather than radical surgery in other cases.ConclusionDiagnosing precancerous transformations of the pancreas remains a challenging task, characterized by a notable rate of false-positive or false-negative conclusions. The DAB method offers a promising solution, seamlessly integrating into routine clinical practice and offering supplementary data to enhance the verification of pancreatic cancer. Citation Format: Aleksei Kashintsev, Vitali Proutski. Duodenal aspiration biopsy in diagnosis of pancreatic neoplasms [abstract]. In: Proceedings of the AACR Special Conference in Cancer Research: Advances in Pancreatic Cancer Research; 2024 Sep 15-18; Boston, MA. Philadelphia (PA): AACR; Cancer Res 2024;84(17 Suppl_2):Abstract nr B015.

Adjuvant Pembrolizumab versus Observation in Muscle-Invasive Urothelial Carcinoma.

Muscle-invasive urothelial carcinoma is an aggressive disease with high rates of relapse. Whether pembrolizumab as adjuvant therapy would be effective in patients with high-risk muscle-invasive urothelial carcinoma after radical surgery is unknown. In this phase 3 trial, we randomly assigned patients, in a 1:1 ratio, to receive pembrolizumab at a dose of 200 mg every 3 weeks for 1 year or to undergo observation. Randomization was stratified according to pathological stage, centrally tested programmed death ligand 1 (PD-L1) status, and previous neoadjuvant chemotherapy. The coprimary end points were disease-free survival and overall survival in the intention-to-treat population. We considered the trial to be successful if either disease-free survival or overall survival was significantly longer with pembrolizumab than with observation. A total of 702 patients underwent randomization; 354 were assigned to receive pembrolizumab, and 348 were assigned to observation. As of July 5, 2024, the median duration of follow-up for disease-free survival was 44.8 months. The median disease-free survival was 29.6 months (95% confidence interval [CI], 20.0 to 40.7) with pembrolizumab and 14.2 months (95% CI, 11.0 to 20.2) with observation (hazard ratio for disease progression or death, 0.73; 95% CI, 0.59 to 0.90; two-sided P = 0.003). Grade 3 or higher adverse events (regardless of attribution) occurred in 50.7% of the patients in the pembrolizumab group and in 31.6% of the patients in the observation group. Among patients with high-risk muscle-invasive urothelial carcinoma after radical surgery, disease-free survival was significantly longer with adjuvant pembrolizumab than with observation. (Funded by the National Cancer Institute of the National Institutes of Health and others; Alliance A031501 AMBASSADOR ClinicalTrials.gov number, NCT03244384.).

Clinical Impact of Weight Loss During Hospitalization on Prognosis After Pancreatic Surgery.

Purpose This study aimed to elucidate the relationship between early-stage weight loss (WL) during hospitalization after pancreatic surgery and prognosis and investigate risk factors affecting WL. Methods We included 68 patients diagnosed with pancreatic ductal adenocarcinoma (PDAC) who underwent radical surgery. The %WL value was calculated based on the percentage of body weight at discharge compared with the body weight at admission. High WL was defined as %WL >10%. We initially evaluated the association between %WL and postoperative survival using the Kaplan-Meier method. Subsequently, we analyzed the factors affecting %WL using a logistic regression model. Results In terms of overall survival (OS), the high %WL group exhibited a significantly worse prognosis than the low %WL group (p=0.043). Univariate analysis revealed a hazard ratio of 2.244 (95% confidence interval (CI), 1.006-5.006; p=0.048) for high %WL in relation to overall survival. Multivariate analysis identified an operative time >450 min (odds ratio, 17.8; 95% confidence interval, 1.01-312.42; p=0.049) and postoperative complications (odds ratio, 12.1; 95% confidence interval, 2.01-72.79; p<0.01) as independent risk factors for high %WL. Conclusion Preventing high %WL by streamlining surgical procedures, minimizing postoperative complications, and implementing medical nutritional therapy (MNT) is imperative to improve the prognosis of patients with PDAC.

A case report of retroperitoneal liposarcoma.

Retroperitoneal liposarcoma is a rare and complex tumor originating from the mesenchymal tissues, with no specific manifestations in the early stage, and a large tumor size in the late stage. Patients often consult a physician because of large abdominal mass, increased abdominal circumference, and abdominal pain, and rarely because of leukocytosis. A 54-year-old female presented to our hospital with complaints of "abdominal distension for over 3 months, left lumbar pain for over 2 months." Considering the comprehensive symptoms, examinations, computed tomography scans, and pathological results, the possibility of retroperitoneal liposarcoma is high. Retroperitoneal liposarcoma with leukocytosis. Open retroperitoneal mass excision along with transcystoscopic left ureteral Double-J Ureterl Stent Insertion tube placement and left nephrectomy. The postoperative pathological findings of the abdominal mass, combined with morphological and immunohistochemical results, are consistent with retroperitoneal liposarcoma. The patient had no recurrence in 7 months of postoperative follow-up conducted on the telephone and is now in continued follow-up. Retroperitoneal liposarcoma is highly malignant and prone to recurrence. Radical surgery is currently the primary treatment modality for patients with this condition. Analogous to cancer patients, those with elevated white blood cell counts and retroperitoneal liposarcoma may have poor prognoses, with a high likelihood of local recurrence and distant metastasis. Close postoperative follow-up is necessary. Therefore, regular postoperative review of blood routine may be a relatively economical and convenient method for the early detection of recurrence and metastasis of retroperitoneal liposarcoma.

Exploring clinical factors to predict the survival of patients with resectable non-small cell lung cancer with neoadjuvant immunotherapy.

The goal was to explore clinical factors and build a predictive model for the disease-free and overall survival of patients with non-small cell lung cancer (NSCLC) receiving neoadjuvant chemotherapy combined with immune checkpoint inhibitors. Inclusion criteria for patients in this multicentre study were as follows: (i) Patients who were diagnosed with stages I-III NSCLC after a bronchoscopy biopsy or puncture; (ii) patients who were examined with computed tomography/positron emission tomography-computed tomography before treatment and surgery; (iii) patients who received neoadjuvant chemotherapy combined with immune checkpoint inhibitors for 2 to 6 cycles preoperatively; (iv) patients whose peripheral blood indicators and tumour markers were assessed before treatment and preoperatively; (v) patients who underwent radical lung cancer surgery after neoadjuvant therapy. Cases were divided into high- and low-risk groups according to 78 clinical indicators based on a 10-fold Least Absolute Shrinkage and Selection Operator selection. We used Cox proportional hazards models to predict disease-free and overall survival. Then, we used time-dependent area under the curve and decision curve analyses to examine the accuracy of the results. Data were collected continuously, and 212 and 85 cases were randomly assigned to training and testing sets, respectively. The area under the curve for the prediction of disease-free survival (training: 1 year, 0.83; 2 years, 0.81; 3 years, 0.83 versus testing: 1 year, 0.65; 2 years, 0.66; 3 years, 0.70), overall survival (training: 1 year, 0.86; 2 years, 0.85; 3 years, 0.86 versus testing: 1 year, 0.66; 2 years, 0.57; 3 years, 0.70) were determined. The coefficient factors including pathological response; preoperative tumour maximum diameter; preoperative lymph shorter diameter; preoperative tumour and lymph maximum standardized uptake value; change in tumour standardized uptake value preoperatively; and blood-related risk factors were favourably associated with prognosis (P < 0.001). Our prediction model, which integrated data from preoperative positron emission tomography-CT, preoperative blood parameters and pathological response, was able to make highly accurate predictions for disease-free and overall survival in patients with NSCLC receiving neoadjuvant immunity with chemical therapy.

Efficacy and safety of adjuvant nivolumab after radical surgery for high-risk urothelial carcinoma: a preliminary report of real-world data from a single institution.

The phase 3 CheckMate 274 trial demonstrated superiority of adjuvant nivolumab over placebo after radical surgery in patients with high-risk urothelial carcinoma (UC). However, real-world data on the efficacy and safety profile of adjuvant nivolumab in Japan have not been reported. This retrospective study enrolled patients with high-risk UC who received adjuvant nivolumab therapy following radical surgery between 2022 and 2024 at our institution. We evaluated immune-related adverse events (irAEs) according to the Common Terminology Criteria for Adverse Events, version 5.0. Kaplan-Meier curves were used to assess disease-free survival (DFS) and overall survival (OS). Thirty-three patients with high-risk UC receiving adjuvant nivolumab therapy following radical surgery were identified, and median follow-up was 11months. Three patients experienced grade 3 irAEs, and 8 discontinued adjuvant nivolumab therapy due to irAEs. No grade 4 or 5 irAEs were observed. Eight patients have completed 1year of treatment, and nine are currently on treatment. Nine patients had recurrences and one died of cancer. Of the nine patients with recurrences, six relapsed while on adjuvant nivolumab therapy, two relapsed after completing 1year of treatment, and one relapsed after discontinuation of irAE. The 1- and 2-year OS rates were 100% and 90%, respectively, and median OS was not reached. The 1- and 2-year DFS rates were 70% and 60%, respectively, and median DFS was 26months. Adjuvant nivolumab appears to have some efficacy in Japanese patients. Since this is a postoperative adjuvant therapy, careful patient selection is warranted.

Colon cancer radical surgery postoperative morbidity and mortality

Colon cancer radical surgery postoperative morbidity and mortality

Vasculogenic mimicry triggers early recidivation and resistance to adjuvant therapy in esophageal cancer

ObjectiveTo investigate the impact of vasculogenic mimicry (VM) and postoperative adjuvant therapy on the prognosis and survival of patients with esophageal squamous cell carcinoma (ESCC), as well as to assess whether VM affects the clinical benefit of postoperative adjuvant therapy.MethodsThis single-center retrospective analysis included patients who underwent radical surgery for ESCC, which was documented in the medical record system. The presence or absence of VM in surgical specimens was determined using double staining with PAS/CD31. Stratification was applied based on adjuvant therapy and VM status. Survival curves and COX modeling were used to analyze the impact of the presence or absence of VM on the benefit of adjuvant therapy and the survival prognosis of patients.ResultsVM-positive patients were more prone to postoperative recurrence and metastasis. VM was identified as an independent risk factor for progression-free survival (PFS) (p < 0.001, 95% CI:1.809–3.852) and overall survival (OS) (p < 0.001, 95% CI:1.603–2.786) in postoperative ESCC. Postoperative adjuvant therapy significantly prolonged PFS (p = 0.008) and OS time (p < 0.001) in patients with stage II and III ESCC, with concurrent chemoradiotherapy being the most effective. However, the presence of VM significantly reduced the benefits of postoperative adjuvant therapy (p < 0.001).ConclusionVM negatively impacts the prognosis of postoperative ESCC patients and reduces the efficacy of postoperative adjuvant therapy.

Conjunctival Melanoma: A Clinical Review and Update.

Conjunctival melanoma (Co-M) is an aggressive, invasive eye and eyelid cancer. Its global incidence of ~1 in a million is increasing at a rate ratio of ~1.4, but this rises sharply in over 65-year-olds. Although rare, Co-M has a devastating impact on the lives of those who develop it. Co-M is often misdiagnosed or overlooked, leading to vision loss either from the destructive effects of the tumour or side effects of therapy, facial disfigurement from radical surgery, and death from metastases. Due to its rarity, there is limited evidence for diagnosis and management; hence, there is no standardised treatment and not all cases are referred to a specialised ocular oncology centre. Recent progress in cancer immunology and genetics have revolutionised the treatment of cutaneous melanomas, which share some similarities to Co-M. Importantly, a better understanding of Co-M and its precursor lesions is urgently needed to lead to the development of novel targeted and immunotherapies both for local tumour control and disseminated disease. This review aims to provide a comprehensive clinical overview of the current knowledge regarding Co-M, its epidemiology, pathogenesis, presentation, diagnosis and recent changes in the classification of its precursor lesions, management, and recent advances in novel biological therapies for personalised treatment of this disease.

Mandibular Ameloblastoma: A Reported Case

Ameloblastoma is a benign aggressive odontogenic tumor which requires early diagnosis and appropriate treatment. It commonly affects the mandible and radical surgery is the gold standard treatment. We report the case of a patient with ameloblastoma in extremely advanced phase affecting the retromolar trigone who was treated with concomitant chemoradiation therapy. Mandibular ameloblastoma is not well documented in the literature. It is usually diagnosed at the later stage when optimal surgery cannot be performed. This case study aimed to demonstrate that radiation therapy is a real therapeutic alternative in the treatment of advanced and inoperable forms of ameloblastoma.

ThP5.4 - Which Resection for Distal Cholangiocarcinoma?: Retrospective Study

Abstract Introduction The treatment of distal cholangiocarcinoma (DCC) is contingent upon the patient's condition and the local and lymphatic extent of the disease. Surgery remains the sole radical treatment, albeit infrequently feasible and often followed by biliary drainage. The surgical procedure involves resecting the bile duct with healthy distal and proximal margins, accompanied by lymphadenectomy. Cephalic pancreatectomy (DPC) is deemed the optimal oncological treatment for DCC. Method This retrospective study encompasses cancers of the main bile duct. Various factors influencing treatment were analyzed, focusing on the type of resection (biliary and pancreatic). Results From January 2014 to December 2021, 119 patients were treated for distal cholangiocarcinoma (88 men, 31 women, average age: 61 years). Twenty-one patients underwent endoscopic drainage, 17 transhepatic drainage, and 55 surgical interventions. Among them, 9 underwent preoperative drainage, 28 radical resection, 10 DPC, 18 biliary resections, and one total pancreatectomy. In 27 patients, radical surgery was impossible; 20 underwent drainage, and 7 did not. Three early surgical revisions in the biliary resection group, with incidents of digestive hemorrhage and hemoperitoneum. Two moderate pancreatic fistulas and immediate postoperative hypoglycemia were recorded. Two deaths in the biliary resection group and 7 in-hospital deaths in the biliary drainage group. All patients with external drainage died before 12 months, while 8 patients from the endoscopic drainage group survived after 12 months. Patients with radical surgery and adjuvant treatment exhibited longer survivals (36 months vs. 45 months). Conclusion Improving the prognosis of DCC requires early diagnosis and radical surgery combined with adjuvant treatment.

Extra-abdominal and intra-abdominal FET::CREM fusion mesenchymal neoplasms: comparative clinicopathological study of 9 new cases further supporting a distinct potentially aggressive sarcoma and report of novel sites.

With the wide use of RNA sequencing technologies, the family of FET::CREB fusion mesenchymal neoplasms has expanded rapidly to include potentially aggressive neoplasms, not fitting any well established WHO entity. Recently, a group of intra-abdominal FET(EWSR1/FUS)::CREB(CREM/ATF1) fused unclassified neoplasms has been reported followed by recent recognition of an analogous extra-abdominal category of unclassified neoplasms carrying EWSR1::ATF1 fusions. We describe 9 additional tumors (5 extra-abdominal and 4 abdominal) carrying an EWSR1::CREM (n = 8) and FUS::CREM (n = 1) fusion. Patients were 7 females and 2 males aged 10 to 75years (median, 34). Extra-abdominal tumors originated in the head and neck (2 sinonasal, 1 orbital) and soft tissues (1 gluteal, 1 inguinal). Abdominal tumors involved stomach (2), mesentery (1), and kidney (1). Tumor size ranged from 3.5 to 11cm (median, 6). Treatment was radical surgery with (5) or without (2) neo/adjuvant radio/chemotherapy. Extended follow-up of 5 patients (21-52months; median, 24) showed an aggressive course in two (40%); one died of disseminated metastases 52months after several intensified chemotherapy regimens, and one was alive with progressive abdominal disease at 21months. The immunophenotype of the two subcohorts was significantly overlapping with variable expression of EMA (7 of 8), keratin AE1/AE3 (5 of 9), CD99 (4 of 7), MUC4 (2 of 8), ALK (3 of 8), synaptophysin (3 of 9), chromogranin (1 of 8), CD34 (3 of 6), CD30 (1 of 6), PAX8 (1 of 7), and inhibin (1 of 7), but no reactivity with desmin (0 of 8), S100 (0 of 8), and SOX10 (0 of 8). This series further solidifies the notion that FET::CREB fusions are not limited to the triad of angiomatoid fibrous histiocytoma, clear cell sarcoma, and malignant gastrointestinal neuroectodermal tumor, but characterize an emerging family of potentially aggressive neoplasms occurring at both intra- and extra-abdominal sites. These tumors underscore the promiscuity of the FET::CREB fusions and highlight the pivotal role of phenotype-oriented classification of these neoplasms that share the same genotype, still featuring significant biological and behavioral distinctness.

Long-term outcomes and risk profile of cT3N0 breast cancer treated with neoadjuvant chemotherapy and curative surgery.

We evaluated the treatment outcomes and failure patterns in cT3N0 breast cancer patients classified for rigorous pretreatment evaluation and treated with neoadjuvant chemotherapy (NAC) and curative surgery. We reviewed the records of 87 cT3N0 breast cancer patients who received NAC and curative surgery between 2000 and 2015. The clinical high-risk group was defined as having two or more risk factors: age < 40, histologic grade 3, lymphovascular invasion, hormone receptor negativity, and Ki-67 labeling index >20%. Of the patients, 84 (96.6%) and 79 (90.8%) were initially evaluated using magnetic resonance imaging and positron emission tomography/computed tomography. Most patients received anthracycline based NAC regimen (n = 69, 79.3%) and modified radical mastectomy (n = 61, 70.1%). During a 91.5-month median follow-up, ten patients experienced distant metastasis (DM) only, two had isolated local recurrence, one had local recurrence and DM, and another had local recurrence, regional recurrence, and DM. The 5-year rates of locoregional recurrence, DM, any recurrence (AR), and overall survival (OS) were 1.2%, 11.6%, 11.6%, and 90.8%, respectively. The risk group was an independent prognostic factor of recurrence, and the high-risk group had worse rates of DM (19.2% vs. 0%, P = 0.009), AR (19.2% vs. 0%, P = 0.016) and OS (82.8% vs. 100%, P = 0.001). Patients with cT3N0 breast cancer classified for rigorous pretreatment evaluation and treated with NAC and radical surgery had favourable oncological outcomes. A clinical risk group based on clinical and immunohistochemical risk factors was an excellent predictor of survival and recurrence.

WP3.4 - Partial gastrectomy as a day case procedure for the treatment of Gastrointestinal Stromal Tumours – a single centre experience

Abstract Aims Gastrointestinal stromal tumours (GISTs) are malignant growths that may be managed effectively with radical surgery if diagnosed at an early stage. The majority of GISTs are found in the stomach and many may be managed effectively via a laparoscopic partial gastrectomy (PG). Day case surgery is becoming a more feasible option for patients undergoing laparoscopic PG. This study examined the outcomes of patients who underwent laparoscopic PG as a day case procedure at a UK tertiary centre. Methods The records of patients who underwent a partial gastrectomy to treat extra-luminal gastric GISTs between January 2021 to December 2023 were retrospectively reviewed. The rates of readmission and post-operative complications were noted for the patients were assessed. Patients with tumours near the gastro-oesophageal junction, lesser curve or with a significant intraluminal component were excluded. Results 42 patients aged between 52 - 81 years were ultimately included in this analysis and 31 (73.8%) underwent surgery as a day case procedure. There were no readmissions, peri- or post-operative complications and none of the patients required a conversion from a laparoscopic to an open approach. Conclusions This single centre analysis suggests that laparoscopic day case PG is a safe option for selected patients. Overall this experience suggests that day case surgery should be carefully considered in those deemed likely to be able to recover well post-operatively. Additional larger studies are required to further evaluate the safety of day case laparoscopic PG.

[18F]AlF-PSMA-11 PET in diagnosing prostate cancer: a head-to-head comparison with [68Ga]Ga-PSMA-11 PET and an exploration of dual-phase scanning

PurposeTo evaluate the physiological distribution and tumour detection ability of [18F]AlF-PSMA-11 positron emission tomography (PET) dual-phase scans in patients with prostate cancer (PCa).MethodsAs a retrospective study, clinical and PET data of PCa patients who underwent dual-phase [18F]AlF-PSMA-11 PET of routine scan (45–50 min) and delayed scan (120 min) from November 2020 to June 2021 were collected, and physiological and pathological regions of interest were quantified to determine the time-dependent maximum standardized uptake value (SUVmax) of [18F]AlF-PSMA-11. Part of the above subjects who underwent [68Ga]Ga-PSMA-11 PET in the following 6 months were included in a head-to-head comparison. The difference with a p-value < 0.05 was defined as statistical significance. Diagnosis accuracy of primary and metastatic lesions was measured referring to the surgical findings, pathology, and follow-up imaging.Results[68Ga]Ga-PSMA-11 and [18F]AlF-PSMA-11 were of the comparable uptake in glands in head, but the latter was of a significant lower distribution in liver and spleen. For the 25 patients initially diagnosed with prostate cancer and 3 patients with biochemical recurrence after radical surgery, the SUVmax of the primary lesions, lacrimal glands, parotid glands and submandibular glands was higher at 120 min compared to that at 45–50 min, but not a significant difference. SUVmax of the liver, spleen and bladder decreased significantly at 120 min, but the bladder SUVmax remained higher than that of primary lesions. SUVmax of the kidneys and centrum was the same in dual-phase scans. For the 31 primary lesions detected in [18F]AlF-PSMA-11 PET, both the SUVmax of the two phases kept the positive correlation with PSA, Gleason score and initial risk stratification. For the 39 distant metastatic lesions, 94.87% accuracy of routine scan and 100% accuracy of delayed scan were acquired, and 7.14% patients (2/28) benefited from the dual-phase [18F]AlF-PSMA-11 scans that revealed novel information on metastatic lesions compared to the routine scan.Conclusion[18F]AlF-PSMA-11 PET expanded the time window and further decreased metabolic background of [68Ga]Ga-PSMA-11 PET. The dual-phase scan of [18F]AlF-PSMA-11 PET can benefit prostate cancer diagnosis via providing more PSMA-specific information.