Resection Of Recurrence Research Articles

Targeting the Epigenetic Non-Coding RNA MALAT1/Wnt Signaling Axis as a Therapeutic Approach to Suppress Stemness and Metastasis in Hepatocellular Carcinoma.

Background: With recorded under-performance of current standard therapeutic strategies as highlighted by high rates of post-treatment (resection or local ablation) recurrence, resistance to chemotherapy, poor overall survival, and an increasing global incidence, hepatocellular carcinoma (HCC) constitutes a medical challenge. Accumulating evidence implicates the presence of HCC stem cells (HCC-SCs) in HCC development, drug-resistance, recurrence, and progression. Therefore, treatment strategies targeting both HCC-SCs and non-CSCs are essential. Methods: Recently, there has been an increasing suggestion of MALAT1 oncogenic activity in HCC; however, its role in HCC stemness remains unexplored. Herein, we investigated the probable role of MALAT1 in the SCs-like phenotype of HCC and explored likely molecular mechanisms by which MALAT1 modulates HCC-SCs-like and metastatic phenotypes. Results: We showed that relative to normal, cirrhotic, or dysplastic liver conditions, MALAT1 was aberrantly expressed in HCC, similar to its overexpression in Huh7, Mahlavu, and SK-Hep1 HCC cells lines, compared to the normal liver cell line THLE-2. We also demonstrated a positive correlation between MALAT1 expression and poor cell differentiation status in HCC using RNAscope. Interestingly, we demonstrated that shRNA-mediated silencing of MALAT1 concomitantly downregulated the expression levels of β-catenin, Stat3, c-Myc, CK19, vimentin, and Twist1 proteins, inhibited HCC oncogenicity, and significantly suppressed the HCC-SCs-related dye-effluxing potential of HCC cells and reduced their ALDH-1 activity, partially due to inhibited MALAT1-β-catenin interaction. Additionally, using TOP/FOP (TCL/LEF-Firefly luciferase) Flash, RT-PCR, and western blot assays, we showed that silencing MALAT1 downregulates β-catenin expression, dysregulates the canonical Wnt signaling pathway, and consequently attenuates HCC tumorsphere formation efficiency, with concurrent reduction in CD133+ and CD90+ HCC cell population, and inhibits tumor growth in SK-Hep1-bearing mice. Conclusions: Taken together, our data indicate that MALAT1/Wnt is a targetable molecular candidate, and the therapeutic targeting of MALAT1/Wnt may constitute a novel promising anticancer strategy for HCC treatment.

V12-12 ROBOTIC METASTATECTOMY WITH EXTRACTION INCISION AND NATURAL ORIFICE INTRAOPERATIVE RADIATION THERAPY

You have accessJournal of UrologyBladder Cancer & Urinary Diversion (V12)1 Apr 2020V12-12 ROBOTIC METASTATECTOMY WITH EXTRACTION INCISION AND NATURAL ORIFICE INTRAOPERATIVE RADIATION THERAPY Ahmad Shabsigh* Ahmad Shabsigh*Ahmad Shabsigh* More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000957.012AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Open excision of intra-abdominal recurrent malignancies with intraoperative radiation therapy (IORT) is usually a complex and morbid procedure. The objective of this video is to report the outcome of our early experience in robotic excision of abdominal localized malignant recurrences with IORT. METHODS: Retrospective analysis of 4 consecutive patients who underwent robotic resection of localized intra-abdominal malignant recurrences and IORT at a single institution between 2015 and 2018. Wide robotic excision was performed in standard fashion. Three patients underwent IOPRT using a cone inserted through a small extraction incision and the female patient had transvaginal IORT. Intraoperative and postoperative outcomes were assessed. Peri/postoperative complications were reported according Clavien-Dindo classification system. RESULTS: 3 male patients with history of recurrent rectal cancer in the pelvis and one female patient with recurrent urethral adenocarcinoma were included. Complete resection was achieved for all patients. Average estimated blood loss was minimal. No patients needed IV narcotics. One patient developed postoperative ileus and significant prolonged pubic bone pain after discharge that eventually resolved. Average hospitalization was 1.3 days compared to 7.4 days for open surgery. 75% of patients had local disease control for at least 1 year after surgery. CONCLUSIONS: Robotic excision of localized recurrent malignant neoplasms with IORT is feasible, safe and may offer better outcomes. Experienced robotic urologic oncologists are essential to develop these multidisciplinary programs Source of Funding: None © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e1114-e1114 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ahmad Shabsigh* More articles by this author Expand All Advertisement PDF downloadLoading ...

Effects of Blended (Yellow) vs Forced Coagulation (Blue) Currents on Adverse Events, Complete Resection, or Polyp Recurrence After Polypectomy in a Large Randomized Trial

There is debate over the type of electrosurgical setting that should be used for polyp resection. Some endoscopists use a type of blended current (yellow), whereas others prefer coagulation (blue). We performed a single-blinded, randomized trial to determine whether type of electrosurgical setting affects risk of adverse events or recurrence. Patients undergoing endoscopic mucosal resection of nonpedunculated colorectal polyps 20 mm or larger (n= 928) were randomly assigned, in a 2× 2 design, to groups that received clip closure or no clip closure of the resection defect (primary intervention) and then to either a blended current (Endocut Q) or coagulation current (forced coagulation) (Erbe Inc) (secondary intervention and focus of the study). The study was performed at multiple centers, from April 2013 through October 2017. Patients were evaluated 30 days after the procedure (n= 919), and 675 patients underwent a surveillance colonoscopy at a median of 6 months after the procedure. The primary outcome was any severe adverse event in a per patient analysis. Secondary outcomes were complete resection and recurrence at first surveillance colonoscopy in a per polyp analysis. Serious adverse events occurred in 7.2% of patients in the Endocut group and 7.9% of patients in the forced coagulation group, with no significant differences in the occurrence of types of events. There were no significant differences between groups in proportions of polyps that were completely removed (96% in the Endocut group vs 95% in the forced coagulation group) or the proportion of polyps found to have recurred at surveillance colonoscopy (17% and 17%, respectively). Procedural characteristics were comparable, except that 17% of patients in the Endocut group had immediate bleeding that required an intervention, compared with 11% in the forced coagulation group (P= .006). In a randomized trial to compare 2 commonly used electrosurgical settings for the resection of large colorectal polyps (Endocut vs forced coagulation), we found no difference in risk of serious adverse events, complete resection rate, or polyp recurrence. Electrosurgical settings can therefore be selected based on endoscopist expertise and preference. Clinicaltrials.gov ID NCT01936948.

Molecular profiling of an osseous metastasis in glioblastoma during checkpoint inhibition: potential mechanisms of immune escape

Peripheral metastases of glioblastoma (GBM) are very rare despite the ability of GBM cells to pass through the blood-brain barrier and be disseminated through the peripheral blood. Here, we describe a detailed genetic and immunological characterization of a GBM metastasis in the skeleton, which occurred during anti-PD-1 immune checkpoint therapy. We performed whole genome sequencing (WGS) and 850 K methylation profiling of the primary and recurrent intracranial GBM as well as one of the bone metastases. Copy number alterations (CNA) and mutational profiles were compared to known genomic alterations in the TCGA data base. In addition, immunophenotyping of the peripheral blood was performed. The patient who was primarily diagnosed with IDH-wildtype GBM. After the resection of the first recurrence, progressive intracranial re-growth was again detected, and chemotherapy was replaced by PD-1 checkpoint inhibition, which led to a complete intracranial remission. Two months later MR-imaging revealed multiple osseous lesions. Biopsy confirmed the GBM origin of the skeleton metastases. Immunophenotyping reflected the effective activation of a peripheral T-cell response, with, however, increase of regulatory T cells during disease progression. WGS sequencing demonstrated distinct genomic alterations of the GBM metastasis, with gains along chromosomes 3 and 9 and losses along chromosome 4, 10, and 11. Mutational analysis showed mutations in potentially immunologically relevant regions. Additionally, we correlated tumour-infiltrating lymphocyte and microglia presence to the occurrence of circulating tumour cells (CTCs) in a larger cohort and found a decreased infiltration of cytotoxic T cells in patients positive for CTCs. This study exemplifies that the tumour microenvironment may dictate the response to immune checkpoint therapy. In addition, our study highlights the fact that despite an effective control of intracranial GBM, certain tumour clones have the ability to evade the tumour-specific T-cell response and cause progression even outside of the CNS.

Completion pneumonectomy is safe and effective in select patients with recurrent non-small cell lung cancer

BackgroundLocoregional recurrence rates for non-small cell lung cancer (NSCLC) remain high, even following curative surgical resection. While national guidelines advocate surgical resection for locoregional recurrence, it is rarely offered when resection would require completion pneumonectomy, which available literature associates with a 12–36% perioperative mortality and 40–80% morbidity. Additionally, survival advantages to radical surgery in this scenario are largely unknown, particularly because available series often include patients undergoing completion pneumonectomy for benign indications or metastatic disease from other primary sites, making extrapolation to primary lung cancer patients challenging. As systemic therapy options continue to evolve, particularly as it relates to immunotherapy, we expect that there will be more and more opportunities for locoregional surgical control. The aim of this study was to evaluate outcomes following completion pneumonectomy for recurrent NSCLC.MethodsWe retrospectively reviewed all patients who underwent completion pneumonectomy for recurrent NSCLC at our institution between 2000 and 2015. Factors affecting perioperative morbidity and mortality, as well as overall survival, were analyzed.ResultsBetween 2000 and 2015, 28 patients underwent completion pneumonectomy for recurrent lung cancer (14 female, 14 male). The median age was 64.2 years (range, 36.7–84.0). There were 11 left-sided and 17 right-sided operations. Fourteen patients (50.0%) underwent chemotherapy or chemoradiotherapy prior to surgery. Perioperative morbidity was seen in 13 of 28 (46.4%) patients, and atrial fibrillation was the most common complication. Mortality at 30- and 90-day intervals was 3.6%, and 14.3% respectively. Five-year overall survival was 43.1% and was not associated with preoperative chemotherapy or chemoradiotherapy use. Patients over 70 years old (n=5) experienced a statistically higher rate of postoperative complications (100.0% vs. 34.8%, P=0.013), and this translated into a higher mortality rate at 60 and 90 days. Left-sided resections were associated with increased risk of recurrent laryngeal nerve injury (RLN) compared to right-sided resections (36.4% vs. 0%, P=0.016), and those patients with RLN injury were more likely to be reintubated (50.0% vs. 4.2%, P=0.04). Bronchopleural fistula occurred in 1 patient (3.6%).ConclusionsCompletion pneumonectomy is a viable treatment option for patients with recurrent NSCLC. We attribute our low risks of major morbidity, such as bronchopleural fistula, to careful patient selection and technique. In patients over 70 years, morbidity is higher which should inform discussion regarding surgical options.

A89 IMPLEMENTING ENDOSCOPIC SUBMUCOSAL DISSECTION IN A WESTERN CANADIAN SETTING: OUTCOMES, LEARNING CURVE AND LOGISTICAL CONSIDERATIONS

Abstract Background Endoscopic submucosal dissection (ESD) is an advanced resection technique for large gastrointestinal lesions. ESD was developed in Japan and is popular in countries with gastric cancer screening and a high incidence of gastric cancer. ESD has benefits over endoscopic mucosal resection (EMR) such as increased complete resection, en bloc resection and lower recurrence. However, ESD is a longer procedure and is difficult to master in countries with low incidence of early gastric neoplasia which is the ideal anatomic location for learning. There is increasing interest in using ESD techniques including hybrid ESD/EMR in western centers. Barriers include procedure time, perforation risk and challenges accumulating sufficient experience. Aims To present our experience implementing an ESD program in British Columbia including outcomes and logistical considerations of interest. Methods All ESD procedures since implementation of the program in May 2015 to July 2019 were included. Descriptive statistics and performance indicators over time are reported. All procedures were performed by a staff endoscopist after specialized training. Procedures were performed at two hospitals in British Columbia. Cases were referred from endoscopists and were assessed with dedicated endoscopy with or without endoscopic ultrasound prior to booking ESD. Results 40 procedures were performed, though only one procedure was performed in the first year (Mean age 70, 67.5% male). ASA class ranged from 1–4 (mean 2.08). 22 lesions were gastric, 13 were rectal, with the remainder throughout the colon. Mean lesion size was 25mm in maximum dimension (interquartile range 15-30mm). 18 procedures were performed under general anesthesia and the remainder using procedural sedation. Total surgical time ranged from 22 to 398 minutes. Mean surgical time was 104 minutes, or 126 minutes including anesthesia. 50% of procedures were performed using hybrid ESD/EMR technique. R0 resection rate across all cases was 68% (60% for hybrid procedures, 80% for strict ESD). En bloc resection rate was 60%. Recurrence rate was 10%. Complication rate was 7.5% all were post-procedure bleeds requiring hospitalization. No perforations occurred. 3 patients required surgery for incomplete resection or invasive cancer on pathology, 3 required repeat endoscopic resection. Surgical time per cm of lesion improved significantly from the first 10 cases to the last 10 (time per cm resected 75 min to 32 min p<0.006). Conclusions ESD is an effective therapy for GI neoplasia. ESD is feasible in a Canadian setting. Hybrid techniques tend to be faster though at the expense of R0 resection. Patient centered outcomes in this sample are favorable and comparable to large ESD series. Monitoring of ESD quality is critical for comparison with standard of care as experience with ESD in Canada grows. Funding Agencies None

Feasibility and oncologic outcome of salvage surgery in isolated seminal vesical remnants after radical prostatectomy.

137 Background: Improved imaging modalities identify metastatic prostate cancer earlier. Atypical and oligometastatic disease is identified more often. Thus a more individual treatment approach in oligometastatic prostate cancer is getting more popular. We demonstrate our results in recurrent disease in seminal vesical remnants after radical prostatectomy and radiotherapy. Methods: A total of 33 patients underwent open resection of locoregional recurrence in seminal vesicals. In case of suspicious 68Ga-PSMA-PET findings in the small pelvis an additional ipsilateral lymph node dissection was performed in 10 patients. 11 patients already received hormone treatment fulfilling the definition of castration resistant prostate cancer. Age, PSA-DT, PSA, time to recurrence after primary treatment resection status were used in a uni and multivariate-cox regression analysis for biochemical relapse after surgery. Results: Median patient age at time of salvage surgery was 70(57-77) years. Median PSA and PSA-DT was 2.79(0.4-61.54)ng/ml and 5.4(1.6-20.1)months respectively. Median surgical time and hospital stay was 132 (75-313)min and 5.5(4-13)days. Median progression-free survival was 29 (8-47) months. After a mean follow-up of 22 months (3-68) months three patients died 8, 14, and 40 months after salvage surgery. In a univariable cox-regression analyses age at time of surgery, preoperative PSA and the time from primary treatment to salvage surgery have been identified as significant parameters for biochemichal relapse. Only the interval from primary to salvage surgery was significant with a Hazard ratio of 1.008 (95%-CI 1.001-1.015, p=0,018) in multivariate analysis. 4 adjunctive surgeries (Ureterovericoneostomy n=3 and one nephrectomy) were needed due to local progressive disease. Conclusions: Seminal vesicle resection is feasible with no significant intra and postoperative complications even in CRPC. Although there is a good median progression-free survival after 5 years almost all patients had biochemical or systemic relapse. Salvage surgery must be seen as prevention for local symptoms, to our experience most often postrenal ipsilateral obstruction.

Prognostic Impact of Curative Resection for Peritoneal Recurrence of Colorectal Cancer.

Peritoneal recurrence (PR) of colorectal cancer is a poor prognostic factor but may be treatable by curative resection. We investigated the efficacy of this treatment and identified risk factors for postoperative recurrence. The subjects were patients who underwent radical surgery for colorectal cancer between January 2006 and March 2014. Those with PR were retrospectively reviewed. Prognostic factors for overall survival (OS) and risk factors for postoperative recurrence were identified. Among 2256 patients, 66 had PR (2.9%). Surgical resection of PR was performed in 41 patients. Curative resection was achieved macroscopically in 38 cases without diffuse metastases in the peritoneum distant from the primary tumor and with a peritoneal cancer index < 10. In multivariate analysis, curative resection was a significant prognostic factor [hazard ratio (HR) 0.198] for better 5-year OS compared with cases without curative resection (68.7% vs. 6.3%, P < 0.001). In 28 cases with concurrent metastasis, curative resection significantly improved 5-year OS compared with no curative resection (78.7% vs. 0%, P = 0.008). In the 38 patients with curative resection, the 3-year recurrence-free survival rate was 21.4%. In multivariate analysis, concurrent metastasis was a significant risk factor [HR 3.394] for postoperative recurrence, and cases with concurrent metastasis more frequently had recurrence within 2years after curative resection. Curative resection improved the prognosis in patients with limited and resectable PR of colorectal cancer with or without concurrent metastasis. However, recurrence after curative resection was common and concurrent metastasis was a risk factor for this recurrence.

Isolated giant plexiform neurofibroma of lower back: a rare case presentation

Plexiform neurofibroma is a rare benign tumor of the peripheral tissue cells that develops in the perineurium that is often considered pathognomonic of neurofibromatosis type 1 (NF1 or von Recklinghausen disease). They occur most frequently in the craniomaxillofacial region, rarely on back and extremities. They are extremely vascular and there is 15-20% potential for malignant transformation. A 35-year-old married female presented with painless swelling in left lower back that began at around 8 years of age. The swelling gradually increased in size. The patient reported embarrassment over the disfigurement caused by the mass. Her medical history was unremarkable and none of the relatives was known to be affected. Surgical resection of the swelling with primary closure was done. Histopathology findings were consistent with neurofibromatosis. Hereby reporting a rare case of isolated plexiform neurofibroma of lower back which was surgically cured as a perusal of rare entity. We also try to emphasize on the need of sprightful clinical diagnosis with multidisciplinary approach in the management of these type of tumors. Finally, we insist on the need of a long term clinical and radiological follow-up of these patients to assess post resection recurrence or malignant transformation.

Resection of soft tissue tumours : Pitfalls, typical complications and prevention strategies

Benign soft tissue lesions are 300times as common as soft tissue sarcomas; hence, the likelihood of confusion is high. Lesions that are larger than 5 cm, deep, show infiltrative growth, or recur despite benign histology are suspicious for soft tissue sarcoma. The biopsy incision must be carefully chosen; in large lipomas, atypical lipomatous tumor should be considered in the differential diagnosis. Lymphomas can be misdiagnosed and treated as undifferentiated soft tissue sarcoma. Vascular tumors and epithelioid lesions require more attention in histopathologic diagnostics and staging. Inflammatory lesions and aggressive fibromatosis (desmoid tumor) should also be borne in mind. In general, staging should be adapted to the underlying tumor biology. Neoadjuvant and adjuvant multimodal therapy must be discussed with the patient and used in atargeted manner. Superficial infiltrating sarcomas are prone to intralesional resection and may require intraoperative frozen section histology. If plastic reconstruction is necessary, atwo-step procedure after proven tumor-free margins can be beneficial. Cavities and seromas, tight sutures, and closing the wound with clips are particularly critical. Wound drains at the thigh, pelvis, and groin should be left longer. Early revision in cases of hematoma or critical wound healing have proven beneficial. Adjuvant therapies are best planned before discharge from hospital. Overall, tumor-specific follow-up can significantly reduce the disadvantages of a recurrence resection.

How well do we manage non-muscle invasive bladder tumors? A UK audit of real-life practices.

The aim of this study was to assess the quality of TURBT (transurethral resection of bladder tumor) using surrogate parameters and evaluate adherence to the guidelines regarding the management of bladder tumors. A clinical audit of all new diagnosis of bladder cancer was undertaken from January 2016 to January 2017. A total of 101 new bladder cancer cases were included. Surrogates of TURBT quality including presence of detrusor in the specimen, rate of re-TUR, presence of carcinoma in situ, and 3-month recurrence rates were analyzed. Adherence to guidelines regarding management of non-muscle invasive bladder cancer including time to re-TUR and utilization of single instillation chemotherapy was evaluated. Absence of detrusor muscle in the specimen of the initial TURBT was noted in 22.8% of the cases. The chance of including muscle in the specimen was almost four-fold for tumors larger than 3 cm. A single instillation of intravesical chemotherapy following TURBT was administered in only 40% of eligible patients; 54.3% of patients had a re-TUR, the majority (61.3%) for high-grade non-muscle invasive bladder cancer on initial TURBT. Re-TUR was done on average 10 weeks after initial TURBT. The 3-month recurrence rate was 36.0% with larger tumors (>3 cm) being more prone to early recurrences. Early recurrences were not affected by intravesical instillations with bacillus Calmette-Guérin or mitomycin C although there was a positive association between the presence of carcinoma in situ on initial resection and early recurrences. One in two patients will have a re-TUR, and approximately one in two patients will have tumor on re-TUR. Single immediate chemotherapy instillations after TURBT are underutilized. The presence of carcinoma in situ on initial TURBT and tumor size were predictors of early recurrences.

P739 Patients with Crohn’s disease with intestinal failure have less active disease than patients with Crohn’s disease without intestinal failure

Abstract Background Intestinal failure (IF) is an uncommon complication of severe Crohn’s disease (CD) due to extensive or recurrent resections or complications. It is observed that disease activity might remit once IF develops. This is unexpected given the previous disease course. The aim of this study is to compare the number of patients in deep remission with CD–intestinal failure (CD-IF) to CD without IF. Methods A single tertiary centre retrospective analysis was performed on CD-IF patients on parenteral nutrition due to short bowel vs. patients with small bowel CD. CD patients were selected from consecutive hospital clinics if they lived in the local catchment area. Deep remission was defined by the lack of objective indicators of inflammation during the year prior to their latest clinic; including imaging, endoscopy and faecal calprotectin. Results 94 CD-IF and 94 CD patients were included. The proportion of female patients was 56.4% (CD-IF) and 46.8% (CD); mean age was 51.2 (CD-IF) and 41.5 years (CD); mean duration of disease 24 (CD-IF) and 16 years (CD); proportion with a stoma 73.4% (CD-IF) and 7.4% (CD). In the CD-IF group, 80.9% were in deep remission compared with 37.2% in the CD group (p &amp;lt; 0.0001) (Table 1). Medication requirements were higher in the CD group. 45/94 (47.9%) (CD-IF) vs. 27/94 (28.7%) (CD) (p = 0.005) were not on medications Biologics were required by 23/94 (24.5%) (CD-IF) vs. 48/94 (51.1%) (CD) (p = 0.0003). Combination therapy (immunomodulator and a biologic) was required by 6/94 (6.4%) (CD-IF) vs. 26/94 (27.7%) (CD) (p = 0.0003) (Table 2). 17 of the 27 CD patients not on medications were in remission and 10 had active disease (of whom 2 refused treatment, 1 was pregnant and 7 had stable mild disease with no major symptoms). 38 of the 45 CD-IF patients off medications were in remission and 7 had active disease (of whom 2 had surgery, 2 are due to start biologics, 1 died and 2 had stable mild disease). Conclusion CD-IF patients were more often in remission than those with CD; they required less medications and less biologics. Plausible reasons for this observation could include that there is less bowel which can inflame; perhaps parenteral nutrition or an altered diet has a protective effect via modulation of the microbiota.

Circulating epigenetic biomarkers for detection of recurrent colorectal cancer.

BackgroundThe sensitive detection of recurrent colorectal cancer (CRC) by the measurement of circulating tumor DNA (ctDNA) might improve the chance of a cure. This study compared a quantitative methylated ctDNA test with carcinoembryonic antigen (CEA) in the setting of surveillance for recurrence.MethodsBlood samples collected either during surveillance or within 12 months of the confirmation of recurrence were assayed for ctDNA (methylated branched‐chain amino acid transaminase 1 [BCAT1]/Ikaros family zinc‐finger 1 protein [IKZF1]) and CEA. The optimal ctDNA threshold was determined by receiver operating characteristic analysis, and the test performance for the detection of recurrence was compared with CEA (5 ng/mL threshold).ResultsThe study cohort comprised 144 eligible patients and included 50 recurrence events. The sensitivity of the methylated ctDNA test for recurrence was 66.0% (95% confidence interval [CI], 57.1%‐69.3%), which was significantly higher than the sensitivity of CEA (31.9%; 95% CI, 22.8%‐36.6%; P < .001). The sensitivity for resectable recurrence (n = 20) was also higher (ctDNA, 60.0%; CEA, 20.0%; P = .01). The specificity did not differ between the tests (ctDNA, 97.9%; 95% CI, 93.2%‐99.6%; CEA, 96.4%; 95% CI, 91.4%‐99.0%). When adjustments were made for other predictors of the presence of recurrence, a positive ctDNA test was an independent predictor (odds ratio, 155.7; 95% CI, 17.9‐1360.6; P < .001), whereas CEA was not (odds ratio, 2.5; 95% CI, 0.3‐20.6; P = .407).ConclusionsThe quantitative ctDNA test showed superior sensitivity in comparison with CEA without a difference in the specificity for detecting recurrent CRC. Longitudinal studies are warranted to further assess the utility (specifically the survival benefit) of methylated BCAT1/IKZF1 ctDNA in the surveillance of patients with CRC.

A systematic review of surgical margins utilized for removal of cutaneous mast cell tumors in dogs

BackgroundTraditionally, wide lateral surgical margins of 3 cm and one fascial plane deep have been recommended for resection of canine cutaneous mast cell tumor (MCT). Several studies have been published assessing surgical margins of less than this traditional recommendation. The objective of this systematic review was to determine if resection MCT with lateral surgical margins < 3 cm results in low rates of incomplete resection and local tumor recurrence. Systematic searches of digital bibliographic databases were performed with two authors (AR & LES) screening abstracts to identify relevant scientific articles. Studies regarding surgical treatment of dogs with cutaneous MCT were reviewed. Data abstraction was performed and the quality of individual studies and the strength of the body of evidence for utilization of surgical margins < 3 cm for removal of MCTs was assessed.ResultsFrom the initial 78 citations identified through the database searches, four articles were retained for data abstraction after both relevance screenings were performed. Two studies were retrospective observational studies, one was a prospective case series and one was a prospective clinical trial. Assessment of the quality level of the body of evidence identified using the GRADE system was low. Excision of MCT at 2 cm and 3 cm was associated with comparably low rates of incomplete excision and recurrence.ConclusionsDespite the low quality of the overall body of evidence, a recommendation can be made that resection of canine cutaneous MCTs (< 4 cm) of Patnaik grade I and II with 2 cm lateral margins and 1 fascial plane deep results in low rates of incomplete excision and local tumor recurrence.

Colloid Cysts: Evolution of Surgical Approach Preference and Management of Recurrent Cysts.

Optimal management of third ventricular colloid cysts remains debated. While microsurgery offers greater resection rates and lower recurrences, endoscopy offers a perceived less invasive option. To describe the evolution of our practice to favor microsurgery and determine the optimal management of recurrent colloid cysts. Any patient having undergone surgery for a colloid cyst by the senior author was identified and included in the study cohort. Clinical, radiographic, and operative records were reviewed, with attention paid to those patients requiring recurrent surgery. Thirty-three patients were treated for intracranial colloid cysts between 1995 and 2017. Two patients had initial surgical treatment at an outside institution prior to presentation at our institution. Microsurgery was used in 15/31 initial cases, endoscopy in 13 cases, and ventriculoperitoneal shunting in 3 cases. Between 1995 and 2005, 89% of colloid cysts (8/9 cases) were resected endoscopically, whereas 74% of colloid cysts (14/19 cases) were resected by microsurgery after 2005. Of the 13 patients treated endoscopically, 6 (46%) required surgery for recurrent cysts. Incomplete cyst wall resection at the initial operation increased the recurrence rate to 55%. There were no recurrences in the microsurgery cohort. Surgical resection of recurrent colloid cysts should focus on complete removal of the cyst wall to minimize the chance of recurrence. Microsurgery has been shown to provide the highest success rates for cyst wall resection and lowest rates of recurrence and is therefore recommended for patients undergoing surgery for primary and recurrent colloid cysts.

Intrahepatic cholangiocarcinoma - Repeated resection of tumor recurrence

Intrahepatic cholangiocarcinoma - Repeated resection of tumor recurrence

A Case of Robot-assisted Abdominoperineal Resection for Local Recurrence of T1a Cancer of the Lower Rectum after 6 Years of Curative ESD

A Case of Robot-assisted Abdominoperineal Resection for Local Recurrence of T1a Cancer of the Lower Rectum after 6 Years of Curative ESD

Main bronchial stump resection for a local recurrence of lung cancer

Main bronchial stump resection for a local recurrence of lung cancer

Locoregional therapies in patients with recurrent intrahepatic cholangiocarcinoma after curative resection

Background:Hepatectomy is one potential treatment for intrahepatic cholangiocarcinoma (IHCC). Recurrent rate is high after curative resection and most recurrences occur within residual liver parenchyma. The aim of this study was to elucidate the impact of different treatment modalities on recurrent diseases in patients with IHCC after primary liver resection.Methods:Between February 1999 and December 2015, we retrospectively identified patients who received curative resection for IHCC. Patients who experienced recurrences were included. Locoregional therapies included re-hepatectomy, radiofrequent ablation, and transhepatic arterial chemoembolization. These patients were categorized into three groups: intrahepatic recurrence without locoregional therapies (group A), intrahepatic recurrence with locoregional therapies (group B) and extrahepatic metastases (group C).Results:Forty-three patients were included and there were 12, 15, and 16 patients in groups A, B, and C, respectively. The median disease-free survival times were 8.3, 9.1, and 8.7 months in groups A, B, and C (p = 0.099). The median after-recurrence overall survival times (period between recurrence and death/censor) were 6.4, 34.0, and 8.3 months in groups A, B, and C (p = 0.001). Locoregional therapies showed favorable benefit in multivariant analysis (hazard ratio: 0.274, confidence interval: 0.083–0.908, p = 0.010).Conclusion:Locoregional therapies offered favorable benefits for patients with recurrent intrahepatic cholangiocarcinoma.

Multidisciplinary approach for Borderline pancreatic adenocarcinoma of the head of the pancreas

Background: Borderline pancreatic adenocarcinoma (BPAC) may be technically resectable with high risks of R1 resection and postoperative recurrence. Neoadjuvant chemotherapy (NAC) is used without clear consensus. We present the preliminary Results of multidisciplinary management of BPAC patients Methods: We adopted the definition of the National Comprehensive Cancer Network (NCCN) for BPAC. All patients received neoadjuvant chemotherapy with at minimum 4 cures. The goal of this study was to investigate the morbidity and survival after surgical resection depending on the quality of oncological resection. Results: From September 2012 to December 2018,120 patients underwent pancreaticoduodenectomy (PD) for adenocarcinoma of the head of the pancreas. Among them, 34 (28%) had BPAC. Vascular resection was performed in 32% of patient. R0 resection was achieved in 56% of cases and R1 in 44%. According to surgical margin, R1 resections were divided into R1 0mm (54%) and R1 low ]0,1 mm[ (46%) Ninety-day mortality was nil. A pancreatic fistula occurred in 6% of patients. In terms of survival, overall (p=0.71) and recurrence-free (P=0.32) survival were similar to those in patients with resectable tumors. Same findings were noted between R0 et R1 low (p=0.72). Survival was statistically lower in the group R1 0mm when compared to survival of R0 group (P=0.05). Conclusions: Using a multidisciplinary approach to manage BPAC, good outcome could be achieved. Oncological quality of resection with at least R1 low resection is of paramount importance to ensure optimal survival.