Residual Tumor Rate Research Articles

Value of Magnetic Resonance Diffusion‐Weighted Imaging for the Prediction of Radiosensitivity in Nasopharyngeal Carcinoma

The effectiveness of radiotherapy in nasopharyngeal carcinoma (NPC) is closely related to the radiosensitivity of the carcinoma; however, there is currently no effective method to predict radiosensitivity in NPC. We explored the predictive value of magnetic resonance diffusion-weighted imaging (MR-DWI) for radiosensitivity in NPC. Study Design Prospective cohort study. Setting Single hospital. Patients with NPC who received intensity-modulated radiotherapy (IMRT) with or without chemotherapy were enrolled from April 2010 through November 2011. Primary tumor apparent diffusion coefficient (ADC) was measured before treatment (ADC0) and 2 weeks after the start of IMRT (ADC1). ADC change (ΔADC) was calculated as (ADC1 - ADC0)/ADC0 * 100%. Three months after the end of radiotherapy, the short-term effect of radiotherapy was assessed using the World Health Organization's response evaluation criteria in solid tumors. Of 134 eligible NPC patients, 121 received combination chemotherapy. Three months after radiotherapy, residual local tumors were detected in 23 (17.2%) cases, and no residual tumors were detected in 111 (82.8%) cases. There was no significant difference in the residual tumor rates of patients receiving combination chemotherapy vs those who did not (P = 1.000). There were no significant differences in the ADC0 or ADC1 values of patients with and without residual tumors (P = .083 and .262). The ΔADC values of patients with (49.77% ± 31.02%) and without (68.35% ± 34.22%) residual tumors were significantly different (t = -2.406, P = .017). Logistic regression analysis indicated that ΔADC was an independent prognostic factor for the short-term effect of IMRT in NPC. Magnetic resonance diffusion-weighted imaging may potentially have value for predicting radiosensitivity in NPC.

Time between First and Second Transurethral Resection of Bladder Tumors in Patients with High-Grade T1 Tumors: Is It a Risk Factor for Residual Tumor Detection?

Purpose: We evaluated the risk factors for residual tumor detection after transurethral resection of bladder tumors (TURBT) in patients with newly diagnosed high-grade T1 transitional cell carcinoma of the bladder. Patients and Methods: Overall 132 patients underwent TURBT for primary bladder tumors and were diagnosed as high-grade T1 bladder cancer. Patients with incomplete resections were excluded from the study. Clinical and pathologic characteristics of the patients were compared and multivariate analysis was performed to determine independent prognostic factors. Results: Residual tumor was demonstrated in 57 (43.1%) of the patients. The residual tumor rate was significantly lower in patients with solitary tumors, tumors <3 cm in diameter, muscle presence in the initial TURBT pathologic sample and treated by an expert surgeon. In patients with solitary bladder tumors, tumors at the dome and posterior wall of the bladder exhibited higher rates of residual tumor (p < 0.0001). The time elapsed between first and second TURBT was significantly shorter in patients without residual tumor compared to patients with residual tumor at second TURBT (32.6 ± 9.1 vs. 39.3 ± 10.9 days, respectively, p = 0.001). Multivariate analysis demonstrated that time elapsed between first and second TURBT is the most important parameter for residual tumor detection. Conclusion: Our study revealed that multiple tumors, tumors >3 cm in size, absence of detrusor muscle in the initial TURBT specimen, TURBT performed by trainees and finally, as a new finding, prolonged interval between first and second TURBT are independent predictors for residual tumor detection in patients with high-grade T1 tumors.

Is photodynamic diagnosis ready for introduction in urological clinical practice?

The aim of this review is to provide an up-to-date review of the available literature on photodynamic diagnosis (PDD) for nonmuscle-invasive bladder cancer, to present the technique in a comprehensive approach and, finally, to discuss the relevance of PDD in clinical practice in terms of indications, outcomes and its development trend. A literature search was conducted up to July 2012, using MEDLINE and EMBASE via Ovid databases to identify published studies on PDD for nonmuscle-invasive bladder cancer. Only English-language and human-based full manuscripts that reported on case series and studies with >40 participants, concerning clinical evidence of the technique, its efficacy and safety data were included. Evidence showed that PDD significantly improves detection of bladder cancer compared with standard white-light cystoscopy, having proven to be more effective for the diagnosis of carcinoma in situ. This condition seems to facilitate more complete resections, resulting in a lower residual tumor rate, which, in turn consecutively leads to higher recurrence-free survival rates. The literature search demonstrated that for mid- and long-term follow-up, PDD showed acceptable outcomes in terms of tumor detection, as well as lower residual tumor and lower recurrence rates compared with white-light cystoscopy. It has proven to be safe and well tolerated; the major limitations of PDD are its low specificity and elevated costs.

Incompletely Excised Basal Cell Carcinoma: Residual Tumor Rates at Mohs Re-Excision

Basal cell carcinoma (BCC) is the most common skin cancer, and incompletely excised BCC is a commonly encountered clinical scenario. To investigate the incidence of histologic and clinical evidence of residual BCC at Mohs micrographic surgery (MMS) for the treatment of incompletely excised BCC. One hundred incompletely excised BCCs, from our practice and referred to our practice by local family doctors, treated using MMS between 2005 and 2007 were studied. Patient data included sex, age, anatomic location of tumor, histologic subtype, margin involved, initial closure and closure after MMS, and Mohs stages required for histologic clearance. Sixty-nine percent of incompletely excised BCCs had residual tumor at MMS re-excision, and 12% had clinically evident residual disease. Immediate re-excision using MMS is recommended for treatment of incompletely excised BCC because the majority of cases have histologically detectable BCC. Watch and wait advice could lead to significant morbidity because recurrence may necessitate more extensive closures and costs. Long-term follow-up is recommended. It is important to conduct self-audits of incomplete excisions and follow up these patients.

A second transurethral resection could be not necessary in all high grade non-muscle-invasive bladder tumors

ObjectivesTo evaluate the rate of residual tumor, understaging and perioperative complications in patients with high grade non-muscle-invasive bladder cancer who underwent second transurethral resection (re-TUR). Materials and methodsA retrospective review of 47 patients with high grade non-muscleinvasive bladder cancer who underwent second TUR from January 2007 to December 2009 at our institution. We evaluated the rate of residual tumor and understaging detected by re-TUR, complications, and the cost of the surgery. ResultsTwenty-two patients underwent second TUR because of the absence of muscle in the initial resection specimen (cTx). We observed residual disease in 8/47 patients (17%) and understaging in 2 cases (4.2%); in only 2 patients understaged, muscularis propria was not present in the sample of initial TUR. The other 20 cTx (90%) were cT0 in the re-TUR. We did not identify any case of cT1 understaged in the re-TUR (≥cT2). Six patients (12.6%) reported complications related with the second TUR (one urethral stricture, two patients required reintervention because of bleeding, one febrile urinary infection and two bladder perforations). ConclusionsOur findings show that the absence of muscle in the initial resection specimen is the only risk factor for understaging. Therefore, we consider re-TUR is mandatory in these cases. On the other hand, when complete TUR has been performed and the muscularis propria is present and tumor free (cTa-T1), we consider that systematic re-TUR is not necessary and only indicated in selected patients, even more if we consider that re-TUR is not exempt from complications.

La re-resección transuretral puede no ser necesaria en todos los tumores vesicales no músculo-invasivos de alto grado

ObjectivesEvaluate the rate of residual tumor, understaging and perioperative complications in patients with high grade non-muscle-invasive bladder cancer who underwent second transurethral resection (re-TUR). Material and methodsA retrospective review of 47 patients with high grade non-muscle-invasive bladder cancer who underwent second TUR from January 2007 to December 2009 at our institution. We evaluated the rate of residual tumor and understaging detected by re-TUR, complications, and the cost of the surgery. ResultsTwenty-two patients underwent second TUR because of the absence of muscle in the initial resection specimen (cTx). We observed residual disease in 8/47 patients (17%) and understaging in 2 cases (4.2%), the only 2 patients understaged muscularis propria was not present in the sample of initial TUR. The other 20 cTx (90%) were cT0 in the re-TUR. We did not identify any case of cT1 understaged in the re-TUR (≥cT2). Six patients (12.6%) reported complications related with the second TUR (one urethral stricture, two patients required reintervention because of bleeding, one febrile urinary infection and two bladder perforations). ConclusionsOur findings show that the absence of muscle in the initial resection specimen is the only risk factor for understaging. Therefore, we consider re-TUR is mandatory in these cases. On the other hand, when complete TUR has been performed and the muscularis propria is present and tumor free (cTa-T1), we consider systematic re-TUR is not necessary and only indicated in selected patients, even more if we consider that re-TUR is not exempt from complications.

Restaging Transurethral Resection of Bladder Tumor for High-risk Stage Ta and T1 Bladder Cancer

Bladder cancer is the most common malignancy of the urinary tract. About 75%-85% of patients present with non-muscle-invasive bladder cancer (NMIBC). However, patients with pT1 tumors, as well as all those with high-grade disease, make up a subset with a high-risk of recurrence and disease progression. Although still regarded as the gold standard, clinical evidence from contemporary published series clearly demonstrates that transurethral resection of tumor (TUR) is a procedure far from optimal, highlighting its limitations and the need for further diagnostic accuracy. Routine use of a restaging TUR (re-TUR), supported by the American Urological Association and European Association of Urology guidelines, detects residual tumor in a significant number of cases after initial TUR. It provides a more accurate staging of the disease and, consequently, helps to guide its treatment. Recent years have seen rapid development of novel optical techniques aimed to optimize resection. Routine implementation of these novel techniques in the context of re-TUR is promising and may potentially result in more tumors being identified and completely resected, leading to significantly lower residual tumor rates than with the standard white-light TUR. This article will focus on re-TUR in the management of high-risk NMIBC, with an up-to-date review of the available literature and detailed analysis of the published series.

Simultaneous Anterior and Posterior Synovectomies for Treating Diffuse Pigmented Villonodular Synovitis

The current treatment methods for diffuse intraarticular or extraarticular type pigmented villonodular synovitis (PVNS) include arthroscopic synovectomy or staged anterior and posterior open synovectomies. However, it is unclear whether simultaneous anterior and posterior synovectomies achieve local control and recovery of function. We therefore determined the recurrence rate and function in patients with diffuse PVNS treated with anterior and posterior synovectomies and adjuvant radiotherapy. We retrospectively reviewed all 19 patients with diffuse PVNS involving the knee treated with anterior and posterior synovectomies and adjuvant radiotherapy between January 2001 and November 2007. From the records, we determined local recurrence and Tegner-Lysholm scores. The minimum followup was 42months (median, 98months; range, 42-143months). Postoperative MRI revealed residual tumor in five of the 19 patients, although three had no disease progression during followup and had knee scores of 86 to 90. Two patients had recurrences at 6 and 9months with knee scores of 88 at 42months and 90 at 68months. The mean Tegner-Lysholm knee score improved from 59 to 93 points. Mean maximum extension and flexion angles improved from 11° to 2° and from 76° to 127°, respectively. Compared with the literature, simultaneous anterior and posterior synovectomies associated with postoperative radiotherapy provided rates of residual or recurrent tumor and knee function recovery comparable to that with staged synovectomies reported in the literature. Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

Narrow Band Imaging Cystoscopy and Bipolar Plasma Vaporization for Large Nonmuscle-invasive Bladder Tumors—Results of a Prospective, Randomized Comparison to the Standard Approach

To evaluate the efficacy of narrow band imaging (NBI) cystoscopy associated with bipolar plasma vaporization (BPV) in cases of large nonmuscle-invasive bladder tumors (NMIBTs) compared with white light cystoscopy (WLC) and monopolar transurethral resection of bladder tumors (TURBTs). A total of 220 cases with ≥ 1 bladder tumor >3 cm determined by abdominal ultrasonography, computed tomography, and flexible WLC were included in the present trial. The patients in the first arm underwent WLC and NBI cystoscopy followed by BPV, and the patients in the second arm underwent only WLC and TURBT. The patients with NMIBTs underwent standard repeat TUR at 4 weeks and follow-up urinary cytology and WLC at 3, 6, 9, and 12 months. The carcinoma in situ, Stage pTa, and overall NMIBT detection rates were significantly improved for NBI compared with WLC. BPV provided lower obturator nerve stimulation and bladder wall perforation rates and significantly reduced the mean hemoglobin decrease, catheterization period, and hospital stay compared with TURBT. The repeat TUR overall and primary site residual tumor rates were significantly decreased in the NBI-BPV group (6.3% vs 17.5% and 4.2% vs 13.4%, respectively). The overall and other site 1-year recurrence rates were significantly reduced in the NBI-BPV series (7.9% vs 17.8% and 3.4% vs 12.2%, respectively). NBI cystoscopy significantly improved the diagnostic accuracy in cases of large NMIBTs, and BPV emphasized superior efficacy and safety compared with TURBT. This combined approach provided a lower residual tumor rate at repeat TUR and a reduced 1-year recurrence rate.

Endoscopic Endonasal Approach for Giant Pituitary Adenomas: Advantages and Limitations

Introduction: Giant pituitary adenomas (measuring more than 4 cm in maximum diameter) are associated with high rates of residual tumor regardless of the surgical approach. We present the results of the endoscopic endonasal approach (EEA) and analyze the factors that influence the degree of resection.

Effects of fluorescent light‐guided transurethral resection on non‐muscle‐invasive bladder cancer: a systematic review and meta‐analysis

What's known on the subject? and What does the study add? It was well known that FL-guided TURBT could reduce the residual rate of NMIBC, but our systematic review suggested that it was not superior to conventional WL-guided TURBT in diagnostic accuracy and it had no significant effect on short-term RFS and PFS. To assess the diagnostic accuracy and therapeutic outcomes of fluorescent light (FL)-guided transurethral resection (TUR) in non-muscle-invasive bladder cancer (NMIBC). A systematic search of PUBMED, EMBASE and Cochrane Library was performed to identify randomized controlled trials comparing the outcomes of FL- and white-light (WL)-guided TUR of bladder tumours (TURBT). Outcomes included tumour detection rate, false-positive diagnosis rate, carcinoma in situ (CIS) detection rate, residual tumour rate, recurrence-free survival (RFS) and progression-free survival (PFS). RevMan 5.1 software was used for the meta-analysis. Data from 14 studies, involving 4078 patients with suspected or proven NMIBC, were pooled and included in the meta-analysis. There was no significant difference in tumour detection rate (relative risk [RR] 0.99; 95% confidence interval [CI] 0.96-1.03; P = 0.64) and CIS detection rate (RR 0.82; 95% CI 0.67-1.02; P = 0.07) between the FL and the WL groups. The false-positive diagnosis rate of the FL group was higher than that of the WL group (RR 0.69; 95% CI 0.49-0.97; P = 0.03). The tumour residual rate was higher in the WL group than in the FL group (RR 2.77; 95% CI 1.47-5.02; P = 0.002). No significant differences were found between groups at 3-month follow-up (RR 1.15; 95% CI 0.79-1.66; P = 0.46) or 12-month follow-up (RR 0.86; 95% CI 0.70-1.06; P = 0.16) or in terms of either RFS or PFS at 12-month (RR 0.99; 95% CI 0.94-1.04; P = 0.57) and 24-month follow-up (RR 1.02; 95% CI 0.98-1.06; P = 0.35). FL-guided TURBT was not superior to conventional WL in diagnostic accuracy. Although FL-guided TURBT had an advantage in reducing the residual tumour rate, it had no significant effect on short-term RFS and PFS.

Clinicopathologic Characteristics of Patients Who Underwent Curative Additional Gastrectomy after Endoscopic Submucosal Dissection for Early Gastric Cancer or Adenoma

Endoscopic submucosal dissection (ESD) has been widely performed. However, procedure related-complications and the risk of tumor recurrence are limitations. We analyzed the clinicopathological characteristics of patients who underwent curative additional gastrectomy (gastrectomy) after ESD. The clinical characteristics of cases underwent gastrectomy after ESD were retrospectively analyzed. Between January 2002 and August 2010, 1,512 cases underwent ESD for early gastric cancer (n=511) or adenoma (n=1,001). Thirty-two cases (2.1%) underwent gastrectomy after ESD. Thirty cases (2.0%) were EGC and 2 cases (0.1%) were adenoma. Extended indication, larger tumor size and piecemeal resection were risk factors for gastrectomy after ESD. According to the causes of gastrectomy, 13 cases underwent gastrectomy due to complications (40.6%; bleeding in 9, perforation in 4), and 19 cases based on pathological results (incomplete resection in 13, lymphatic invasion in 6). In cases with incomplete resection, the rate of residual tumor and lymph node metastasis after gastrectomy was 69.2% (75% lateral margin, 60% deep and 75% both) and 7.7%, respectively. Three (50%) of the 6 cases with lymphatic invasion had lymph node metatstasis. The causes of gastrectomy after ESD were the procedure-related complications, the incomplete resection and lymphatic invasion. For complete and curative ESD, endoscopists should try to minimize complications and determine the depth of invasion accurately before ESD.

Intérêt et modalités pratiques de la cystoscopie de fluorescence en 2011 pour la prise en charge des carcinomes urothéliaux de la vessie : une revue du Comité de cancérologie de l’Association française d’urologie

Fluorescence-guided cystoscopy is a useful tool for bladder tumour detection in association with white-light cystoscopy and decreases the residual tumour rate. The aim of the study was to provide an overview of the pertinent literature on this subject. The data were provide from a Medline(®) research by using the follow keywords: urinary bladder neoplasms; cystoscopy; fluorescence; prognosis; intraepithelial neoplasm. No evidence 1 level data was available. The fluorescence-guided cystoscopy improves the bladder cancer detection rate, especially the flat lesions, and improve the recurrence-free survival by decreasing the residual tumour rate. The specific indications for fluorescence-guided cystoscopy in the diagnosis and management of non-muscle invasive bladder cancer (NMIBC) should benefit the patients. The fluorescence-guided cystoscopy is a benefical tool in association with white-light cystoscopy in NMIBC diagnosis. It has been shown to have a positive impact on recurrence-free survival but not on progression-free survival. More investigations with significant follow-up should be lead in the future to accurately assess its therapeutic impact on patients.

Volumetric Measurement for Comparison of the Accuracy between Intraoperative CT and Postoperative MR Imaging in Pituitary Adenoma Surgery

To improve the resection rate of unexpected residual pituitary tumor under image guidance, iCT provides a less time-consuming and more convenient approach of promising the safety of the trans-sphenoidal surgery. However, iCT was thought to have worse image quality than MR imaging. This study was designed to determine the predictive concordance of iCT with standard postoperative high-strength MR imaging for the detection of residual tumors. From February to December 2009, 33 patients with pituitary macroadenomas were enrolled in this prospective study. All patients received endoscopic trans-sphenoidal surgery for tumor removal and underwent iCT before the surgery finished. If an accessible tumor remnant was suspected and resectable, the surgery was continued. To assess the accuracy of intraoperative evaluation of tumor resection, the intraoperative findings were compared with MR imaging findings obtained 2 to 3 months after surgery by individually calculating the residual tumor volume. There were no statistically significant differences in the comparison between iCT and postoperative MR imaging findings (P > .05), and the predictive rates were also high (R(2) value >0.9). The GTR rate in the case of the noninvasive and fresh cases was 89% (17/19). The overall GTR rate was 58% (19/33), the second-look rate was 21% (7/33), and only one-fourth of the recurrent cases reached GTR. The extent of resection in trans-sphenoidal surgery can be reliably assessed by iCT. Compared with postoperative MR imaging findings, the findings in this study provided quantitative evidence that iCT not only holds significant promise for maximizing the extent of tumor resection but also eliminates the unnecessary blind surgical manipulation, thus increasing the safety of the procedure.

Intraoperative High-Field Magnetic Resonance Imaging Combined With Fiber Tract Neuronavigation-Guided Resection of Cerebral Lesions Involving Optic Radiation

Intraoperative magnetic resonance imaging (iMRI) combined with optic radiation neuronavigation may be safer for resection of cerebral lesions involving the optic radiation. To investigate whether iMRI combined with optic radiation neuronavigation can help maximize tumor resection while protecting the patient's visual field. Forty-four patients with cerebral tumors adjacent to the optic radiation were enrolled in the study. The reconstructed optic radiations were observed so that a reasonable surgical plan could be developed. During the surgery, microscope-based fiber tract neuronavigation was routinely implemented. The lesion location (lateral or not to the optic radiation) and course of the optic radiation (stretched or not) were categorized, and their relationships to the visual field defect were determined. Analysis of the visible relationship between the optic radiation and the lesion led to a change in surgical approach in 6 patients (14%). The mean tumor residual rate for glioma patients was 5.3% (n = 36) and 0% for patients with nonglioma lesions (n = 8). Intraoperative MRI and fiber tract neuronavigation increased the average size of resection (first and last iMRI scanning, 88.3% vs 95.7%; P < .01). Visual fields after surgery improved in 5 cases (11.4%), exhibited no change in 36 cases (81.8%), and were aggravated in 3 cases (6.8%). Diffusion tensor imaging information was helpful in surgical planning. When iMRI was combined with fiber tract neuronavigation, the resection rate of brain lesions involving the optic radiation was increased in most patients without harming the patients' visual fields.

Narrow band imaging-assisted transurethral resection for non-muscle invasive bladder cancer significantly reduces residual tumour rate

PurposeTo investigate whether narrow band imaging (NBI)-assisted transurethral resection (TUR) (NBI-TUR) has an impact on non-muscle invasive bladder cancer (NMIBC) residual tumour rate compared to white light (WL)-assisted TUR (WL-TUR).MethodsPatients with NMIBC treated with either NBI- or WL-TUR were compared in a frequency-matched index-control setting. During NBI-TUR, all suspicious lesions identified by either WL or NBI were resected. Index patients (NBI-TUR, n = 40) were prospectively recruited and control patients (WL-TUR, n = 120) were retrospectively collected, whilst being blinded for their first follow-up (fFU)-status. Non-radical TUR cases, patients without evidence of urothelial carcinoma in the pathology specimen and those with isolated carcinoma in situ or muscle invasive disease were excluded. Matching was based on the risk of tumour recurrence defined by (a) the EORTC risk score for recurrence and (b) the administration or not of one single chemotherapeutic intravesical instillation immediately after TUR. All patients underwent routine follow-up with WL cystoscopy supplemented with cytology at 3 months or re-TUR in selected cases. The residual tumour rates at fFU (RR-fFU) of patients with NMIBC submitted to either NBI- or WL-TUR were compared.ResultsBaseline patient and tumour characteristics were comparable between groups. The RR-fFU for WL- and NBI-TUR was 30.5% (36 out of 118 patients) and 15.0% (6 out of 40 patients), respectively (OR: 2.7, one-sided 95% CI: 1.2–6.1; P = 0.03).ConclusionNBI-TUR decreases residual tumour rate significantly when compared to a matched cohort of WL-TUR.

Emerging optical techniques in advanced cystoscopy for bladder cancer diagnosis: A review of the current literature

Background and objective:The current standard for the diagnosis and followup of bladder cancer remains white light cystoscopy, despite its well-known limitations. The aim of this paper is to review the current literature on three optical diagnostics that have been developed to improve the performance of white light cystoscopy: photodynamic diagnosis, narrow-band imaging and optical coherence tomography.Materials and Methods:A PubMed search was performed for all articles on bladder cancer and photodynamic diagnosis, narrow-band imaging, and optical coherence tomography. Relevant papers on the working mechanism or clinical performance of the techniques were selected.Results:Photodynamic diagnosis and narrow-band imaging both aim to improve the visualization of bladder cancer. Both techniques have demonstrated an improved detection rate of bladder cancer. For photodynamic diagnosis, decreased residual tumor rates and increased recurrence free survival after photodynamic diagnosis-assisted transurethral resection have been shown. Both techniques have a relatively high false positive rate. Optical coherence tomography is a technique aiming at real-time noninvasive pathological diagnosis. Studies have shown that optical coherence tomography can accurately discriminate bladder cancer from normal bladder mucosa, and even suggest that a reliable estimation of the stage of a bladder tumor can be made.Conclusions:Photodynamic diagnosis is the technique with most evidence of clinical effectiveness to date, but low specificity is limiting a widespread use. For the novelties, narrow-band imaging, and optical coherence tomography, more evidence is needed before these techniques can be implemented in daily urological practice.

Clinical Outcomes of Gastrectomy after Incomplete EMR/ESD

PurposeEndoscopic resection is widely accepted as standard treatment for early gastric cancer (EGC) without lymph node metastasis. The procedure is minimally invasive, safe, and convenient. However, surgery is sometimes needed after endoscopic mucosal resection/endoscopic submucosal dissection endoscopic mucosal resection (EMR)/endoscopic submucosal dissection (ESD) due to perforation, bleeding, or incomplete resection. We evaluated the role of surgery after incomplete resection.Materials and MethodsWe retrospectively studied 29 patients with gastric cancer who underwent a gastrectomy after incomplete EMR/ESD from 2006 to 2010 at Korea University Hospital.ResultsThere were 13 incomplete resection cases, seven bleeding cases, three metachronous lesion cases, three recurrence cases, two perforation cases, and one lymphatic invasion case. Among the incomplete resection cases, a positive vertical margin was found in 10, a positive lateral margin in two, and a positive vertical and lateral margin in one case. Most cases (9/13) were diagnosed as mucosal tumors by endoscopic ultrasonography, but only three cases were confirmed as mucosal tumors on final pathology. The positive residual tumor rate was two of 13. The lymph node metastasis rate was three of 13. All lymph node metastasis cases were submucosal tumors with positive lymphatic invasion and no residual tumor in the gastrectomy specimen. No cases of recurrence were observed after curative resection.ConclusionsA gastrectomy is required for patients with incomplete resection following EMR/ESD due to the risk of residual tumor and lymph node metastasis.

Surgical treatment of large vestibular schwannomas (stages III and IV)

Study the results of surgical treatment of large vestibular schwannomas. Between January 1995 and December 2005, 87 stage III and IV unilateral vestibular schwannomas (Koos classification) were operated. The approach used was for the most part translabyrinthine. Nine patients were operated in two phases. Tumor exeresis was total in 79% of the cases, nearly total in 17%, and subtotal in 3.6%. Good facial function was preserved in 63% of the patients. Mortality was zero. Tumor control after a mean follow-up of 45 months was 86%. Surgery for large vestibular schwannomas should have a 0% mortality rate and low morbidity. Otoneurosurgical collaboration, with a preference for the translabyrinthine approach, with surgery undertaken in several phases if need be, provides maximum safety and good functional results as well as an acceptable residual tumor rate.

Maximizing the extent of tumor resection during transsphenoidal surgery for pituitary macroadenomas: can endoscopy replace intraoperative magnetic resonance imaging?

Endoscopic approaches to pituitary tumors have become an effective alternative to traditional microscopic transsphenoidal approaches. Despite a proven potential to decrease unexpected residual tumor, intraoperative MR (iMR) imaging is infrequently used even in the few operating environments in which such technology is available. Its use is prohibitive because of its cost, increased complexity, and longer operative times. The authors assessed the potential of intrasellar endoscopy to replace the need for iMR imaging without sacrificing the maximum extent of resection. In this retrospective study, 27 consecutive patients underwent fully endoscopic resection of pituitary macroadenomas. Intrasellar endoscopy was used to determine the presence of residual tumor within the sella turcica and tumor cavity. Intraoperative MR imaging was used to identify rates of unexpected residual tumor and the need for further tumor resection. Intraoperative estimates of the extent of tumor resection were correct in 23 patients (85%). Of 4 patients with unacceptable tumor residuals, 3 underwent further tumor resection. After iMR imaging, the rate of successful completion of the planned extent of resection increased to 26 patients (96%). Rates of both endocrinopathy reversal and postoperative complications were consistent with previously published results for microscopic and endoscopic resection techniques. The findings in this study provided quantitative evidence that intrasellar endoscopy has significant promise for maximizing the extent of tumor resection and is a useful adjunct to surgical approaches to pituitary tumors, particularly when iMR imaging is unavailable. A larger prospective study on the extent of resection following endoscopic transsphenoidal surgery would strengthen these findings.