Role Of Surgical Resection Research Articles

Meta-analysis of pancreatic re-resection for locally recurrent pancreatic cancer following index pancreatectomy.

The role of surgical resection in patients with recurrent pancreatic cancer is unclear. We aimed to evaluate the survival outcomes of pancreatic re-resection for locally recurrent pancreatic cancer following index pancreatectomy. A literature search was carried out in CENTRAL, EMBASE, MEDLINE, CINAHL, and Web of Science. Proportion meta-analysis model was constructed to quantify 1 to 5-year survival after pancreatic re-resection for locally recurrent pancreatic cancer. Random-effects modelling was applied to calculate pooled outcome data. Fifteen retrospective studies were included, reporting a total of 250 patients who underwent pancreatic re-resection for locally recurrent pancreatic cancer following their index pancreatectomy. Pancreatic re-resection was associated with 1-year survival 70.6% (95% confidence interval [CI], 65.0-76.2), 2-year survival 38.8% (95% CI, 28.6-49.0), 3-year survival 20.2% (95% CI, 13.8-26.7), and 5-year survival 9.2% (95% CI, 5.5-12.8). The between-study heterogeneity was insignificant in all outcome syntheses. Repeat pancreatectomy for local recurrence of pancreatic cancer in the remnant pancreas following the index pancreatectomy is associated with acceptable overall patient survival. We recommend selective re-resection of such recurrences in younger patients with favorable tumor size and location. Our findings may encourage more robust studies to be conducted in this context to provide stronger evidence.

Re-consideration of Lymph Node Metastasis in Pancreatic Cancer Patients Following Radical Resection: A Retrospective Study.

Perioperative chemotherapy has become more common in patients with pancreatic cancer (PC), and the significance of lymph node (LN) metastasis and the role of surgical resection in PC have gradually evolved. In the present study, we reconsidered the significance of LN metastasis for patients with PC. We analyzed 142 PC patients who underwent radical resection at our hospital between September 2012 and December 2021. Patients were divided into three groups based on the performance of preoperative chemotherapy, as follows: up-front surgery (US, n=109), neoadjuvant chemotherapy (NAC, n=22), and conversion surgery (CS, n=11). The characteristics of patients with LN metastasis in the US group were clarified, and a prognostic analysis was performed. The prognostic impact of LN metastasis in the NAC/CS group was examined and compared to that in the US group. Multivariate analysis revealed that high CA19-9 levels, large tumor size, and positive lymphatic invasion were significantly associated with LN metastasis. LN metastasis and portal vein invasion were independent poor prognostic factors in multivariate analysis. Patients without LN metastasis in the NAC group tended to have a better prognosis than those in the US group; however, the prognosis of patients with LN metastasis was similar between the two groups. In the CS and US groups, the prognosis was comparable for patients with and without LN metastasis. LN metastasis is a notably poor prognostic factor for PC patients, even after NAC, and more aggressive perioperative treatments may be considered for these patients.

The role of comorbidity indices and histochemical markers in surgically resected and non-resected primary central nervous system lymphoma.

The role of surgical resection in primary central nervous system lymphoma (PCNSL) was not recognized until recently. However, prognostic factors for surgically treated PCNSL remain unclear. In the present study, we aimed to identify and compare the prognostic value of comorbidity indices and immunohistochemical markers in patients with surgically and non-surgically treated PCNSL. This retrospective single-center study analyzed patients who underwent either surgical resection or stereotactic biopsy for newly diagnosed PCNSL between January 2012 and December 2021. Clinical demographics, comorbidity indices, and immunohistochemical markers were analyzed. We included 23 and 18 patients who underwent stereotactic biopsy and surgical resection, respectively. The median overall survival (OS) was 11.05months. Using multivariate Cox regression, we identified pretreatment prognostic nutritional index (PNI) (p = 0.009), positive BCL2 staining (p = 0.026), and infratentorial involvement (p = 0.004) as independent prognostic factors of OS. Predictors of progression-free survival (PFS) included PNI (p = 0.040), infratentorial involvement (p = 0.021), and surgical resection for PCNSL (p = 0.048). Subgroup analyses revealed that positive BCL2 (p = 0.048) and PD-L1 (p = 0.037) staining were associated with worse OS in the biopsy group. PNI and infratentorial involvement could significantly impact both OS and PFS in patients with PCNSL. Surgical resection could predict favorable PFS but not OS. Moreover, BCL2 and PD-L1 expression can be employed as prognostic markers in these patients.

Whether surgical resection or biopsy makes difference in single lesion primary central nervous system lymphoma: a single center retrospective cohort study

BackgroundPrimary central nervous system lymphoma (PCNSL) is a rare and aggressive disease. The role of surgical resection in PCNSL has always been the center of debate. Here we investigated the clinical and follow-up data of single lesion PCNSL operated in our center, focusing on the comparison between surgical resection and biopsy.MethodsAll consecutive cases of single lesion PCNSL between October 2004 and December 2019 were retrospectively collected from the database of the Second Affiliated Hospital of Zhejiang University, School of Medicine. Patients were divided into resection group and biopsy group. Clinical information including age, gender, Karnofsky performance status, imaging features and postoperative treatment was collected from the medical records. All the patients were followed for survival analysis.ResultsA total of 105 patients with PCNSL were finally involved in our analysis. Neither PFS nor OS were significantly different between the resection group and biopsy group. The univariate analysis revealed that age < 60 and therapeutic treatment were significant predictors of longer PFS and OS. In the multivariate analysis, age (HR = 3.09, 95% CI 1.31–7.28, p = 0.01) and therapeutic treatment (HR = 0.25, 95% CI 0.07– 0.83, p = 0.02) were independent prognostic markers with OS. Multivariable Cox regression analyses also revealed that only age (HR = 2.29 (95% CI, 1.11–4.71, p = 0.03) was independent prognostic marker for PFS.ConclusionsIn single lesion PCNSL, there was no significant difference between the resection group and biopsy group for both PFS and OS. Younger age and postoperative treatment have been proved to be indicators of better prognosis.

Spontaneous regression of colloid cyst on the third ventricle: a case report with the review of the literature

BackgroundColloid cyst (CC) is a rare and benign cyst found in the third ventricle near the foramen of Monro. Although the role of surgical resection is well established in symptomatic large-sized CC, it remains debatable whether surgical removal of CC with no symptoms or minimal symptoms is necessary.Case presentationA 49-year-old male patient visited our institute for incidentally detected intracranial mass. MRI demonstrated typical, 12 mm-sized CC located in the third ventricle. It was noticed that the cyst spontaneously decreased in size from 12 mm to 4 mm on MRI at 18 months after the first visit.ConclusionAlthough spontaneous regression is a very rare phenomenon in CC, regular imaging study and frequent neurologic examination can be an alternative option for well-selected, asymptomatic cases.

Survival comparison of chemotherapy vs. chemotherapy plus surgery for women with ovarian cancer with distant metastatic disease (387)

<b>Objectives:</b> Standard treatment of advanced epithelial ovarian cancer (EOC) is a combination of surgical cytoreduction and chemotherapy. However, the impact of cytoreductive surgery for patients with unresectable metastatic disease, in whom optimal cytoreduction is not feasible, is not well described. <b>Methods:</b> The National Cancer Database (NCDB) was used to identify patients with Stage IV EOC with distant organ metastasis at the time of diagnosis, treated from 2005 to 2016. Distant organ metastasis was defined as metastasis to the brain, lung, liver, bone, or distant lymph node. To represent unresectable distant metastasis, a restricted population with only metastasis to the brain, lung, or bone was also analyzed. All patients received chemotherapy with or without surgery. Overall survival was analyzed using the Kaplan-Meier method, Cox proportional hazards models, and propensity score-weighted analyses. In these analyses, the variables included were surgery, age, year of diagnosis, race, Charlson/Deyo Comorbidity Condition (CDCC) Score, facility type, primary insurance, histology, site of metastasis, urban versus rural residence, education, and median household income. <b>Results:</b> We identified 9025 patients with EOC with distant organ metastasis in the NCDB. Among these patients, 2074 received chemotherapy alone, and 6951 received chemotherapy plus surgery (C+S). Those who received chemotherapy alone were older with higher CDCC scores, lived in areas of lower median household incomes, and had lower high school graduation rates. These individuals had a higher proportion of metastatic disease to the liver, bone, or brain. Race was significantly different between groups, with a higher proportion of those receiving chemotherapy alone being Black (12.7% vs 8.2%). Survival was significantly improved for patients who received C+S (HR: 0.46, p<0.0001). Propensity score-weighted analysis similarly showed improved survival for patients undergoing C+S (HR: 0.49, p<0.0001). Individuals who received single-agent chemotherapy had worse overall survival (HR: 1.35, p<0.0001). When accounting for the impact of single-agent chemotherapy on the survival comparison, the benefit of surgery remained significant (HR: 0.47, p<0.0001). In the group defined as unresectable distant metastasis, we identified 1424 patients, of which 396 received chemotherapy alone and 1028 received C+S. A survival benefit was again shown for patients who received C+S, by Cox model (HR: 0.42, p<0.0001) and propensity score-weighted analysis (HR: 0.44, p<0.0001). <b>Conclusions:</b> Despite the poor prognosis associated with Stage IV EOC, obtaining local control with surgery in addition to chemotherapy may provide an added oncologic benefit. Because of the retrospective nature of this analysis, the absolute benefit of surgery for patients with Stage IVB EOC cannot be established. However, this study may provide added value to patient-centered counseling on the role of surgical resection in the setting of ovarian cancer with distant metastatic disease.

Machine Learning Based on Diffusion Kurtosis Imaging Histogram Parameters for Glioma Grading.

Glioma grading plays an important role in surgical resection. We investigated the ability of different feature reduction methods in support vector machine (SVM)-based diffusion kurtosis imaging (DKI) histogram parameters to distinguish glioma grades. A total of 161 glioma patients who underwent magnetic resonance imaging (MRI) from January 2017 to January 2020 were included retrospectively. The patients were divided into low-grade (n = 61) and high-grade (n = 100) groups. Parametric DKI maps were derived, and 45 features from the DKI maps were extracted semi-automatically for analysis. Three feature selection methods [principal component analysis (PCA), recursive feature elimination (RFE) and least absolute shrinkage and selection operator (LASSO)] were used to establish the glioma grading model with an SVM classifier. To evaluate the performance of SVM models, the receiver operating characteristic (ROC) curves of SVM models for distinguishing glioma grades were compared with those of conventional statistical methods. The conventional ROC analysis showed that mean diffusivity (MD) variance, MD skewness and mean kurtosis (MK) C50 could effectively distinguish glioma grades, particularly MD variance. The highest classification distinguishing AUC was found using LASSO at 0.904 ± 0.069. In comparison, classification AUC by PCA was 0.866 ± 0.061, and 0.899 ± 0.079 by RFE. The SVM-PCA model with the lowest AUC among the SVM models was significantly better than the conventional ROC analysis (z = 1.947, p = 0.013). These findings demonstrate the superiority of DKI histogram parameters by LASSO analysis and SVM for distinguishing glioma grades.

Metastatic Malignant Melanoma to Colon from Cutaneous Melanoma: A Case Report

Metastatic melanoma to the Gastrointestinal (GI) tract is rare and the colon is a less common site of GI tract metastasis for this cancer. We report a case of a 76-year-old male with history of cutaneous malignant melanoma since 2018 and two years later he developed metastasizing to the brain, axillary lymph node and descending colon. He was treated with stereotactic radiosurgery (SRS) for single brain metastasis, he subsequently underwent a combined left axillary node dissection and left colectomy. Importance of long-term surveillance and role of 18F-fluorodeoxyglucose positron emission tomography-computed tomography (18F-FDG PET/CT) and colonoscopy are discussed along with the role of surgical resection in improving survival. Nevertheless, metastatic malignant melanoma to the colon is difficult to identify diagnosis and treatment, multidisciplinary team discussion is necessary to determine the most appropriate treatment strategy.

Metastatic Malignant Melanoma to Colon from Cutaneous Melanoma: A Case Report

Metastatic melanoma to the Gastrointestinal (GI) tract is rare and the colon is a less common site of GI tract metastasis for this cancer. We report a case of a 76-year-old male with history of cutaneous malignant melanoma since 2018 and two years later he developed metastasizing to the brain, axillary lymph node and descending colon. He was treated with stereotactic radiosurgery (SRS) for single brain metastasis, he subsequently underwent a combined left axillary node dissection and left colectomy. Importance of long-term surveillance and role of 18F-fluorodeoxyglucose positron emission tomography-computed tomography (18F-FDG PET/CT) and colonoscopy are discussed along with the role of surgical resection in improving survival. Nevertheless, metastatic malignant melanoma to the colon is difficult to identify diagnosis and treatment, multidisciplinary team discussion is necessary to determine the most appropriate treatment strategy.

Survival According to Primary Tumor Location, Stage, and Treatment Patterns in Locoregional Gastroenteropancreatic High-grade Neuroendocrine Carcinomas.

BackgroundAlthough the gastrointestinal tract (including the pancreas, gastroenteropancreatic (GEP) is the most common site for extrapulmonary neuroendocrine carcinoma (NEC), the current treatment patterns of locoregional GEP NEC and in particular, the role of surgical resection is unclear.MethodsData from the National Cancer Database between 2004 and 2016 were used for this study.ResultsOf 2314 GEP NEC cases (stages I–III), 52.5% were stage III. Colon was the most common site (30%); 30.9% of all cases were small cell morphology. Age, morphology, stage, and primary site were associated with significant differences in treatment patterns. Management of NEC mimicked that of adenocarcinomas arising at the respective sites: colon NEC most likely to be treated with surgery and chemotherapy; anal and esophageal NEC was primarily likely to receive chemotherapy and radiation, and rectal NEC mostly likely to receive trimodality therapy. However, 25%-40% of patients did not undergo surgical resection even at sites typically managed with curative resection, and there was a trend toward lesser resection over time. The prognostic impact of surgical resection was significant across all stages and correlated with variations in survival across primary sites. Even in patients undergoing chemoradiation, surgery was the only prognostic variable that significantly affected survival in stages I–II patients (HR 0.63) and showed a strong trend in stage III (HR 0.77) patients.ConclusionsTreatment patterns in GEP NEC vary considerably according to stage and primary tumor site. Surgery significantly improved survival in stages I–II patients and showed a strong trend in stage III patients regardless of primary tumor location and other perioperative therapies.

Role of Surgical Resection in Management of Hepatic Cysts: Results from a Standardized Approach

Background: The standard of care for symptomatic hepatic cyst management is cyst fenestrations, aspirations, and de-bulking procedures. These procedures are effective at immediate symptom improvement but are susceptible to recurrence. There is limited data surrounding the recurrence rate after a partial hepatectomy as a means of cyst removal. We report our experience using the maximal diameter of the cyst to guide complete resection. Methods: This study is a retrospective analysis of patients undergoing surgical management for hepatic cysts between the years of 2008 and 2016. There were 76 cyst resections performed by the senior author. For both simple cyst and polycystic liver disease (PCLD) cyst resections, the standard of care was a laparoscopic approach with the maximal diameter concept (MDC) of the cyst used to guide resection. The cases were followed with imaging and symptomatology to determine recurrence. Results: Of resections included in the study, 73 were done utilizing the maximal diameter concept (MDC) and 3 were simple cyst fenestrations. 66 patients were female, with a median age of 62 (range 56-71). Simple cysts (n=49) and PCLD (n=27) were the two etiologies. Of the 49 simple liver cyst cases, 47 of them were MDC resections and two were cyst fenestrations. 54 cases (71%) were done laparoscopically. Three patients (6%) had previous liver cyst fenestrations. Average operating time was 105min (±46), average length of stay (LOS) was 2 days (±1.7), and average diameter of the removed specimen was 13.0cm (±14). One patient (2%) in this group developed a recurrence of symptomatic liver at an average of 4.4 years after the operation. Of the 27 PCLD cases, 26 of them were complete resections and one was a cyst fenestration. 13 cases were done laparoscopically. Five patients (29.63%) had previous liver cyst fenestrations. Average operating time was 156min (±74), average length of hospital stay was 4 days (±3), and average diameter of the removed specimen was 9.7cm (±6). Five patients (18.52%) required blood transfusions during surgery. Three patients (11.11%) in this group developed a recurrence of symptomatic liver cysts at an average of 4.6 years after the operation. Conclusion: Patients undergoing surgical management of liver cysts using the MDC had favorable outcomes and an exceedingly small chance of recurrence. This contrasts with data in literature where up to a 10% risk of recurrence has been noted.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Prognostic factors influencing survival following re-resection for isocitrate dehydrogenase (IDH) -wildtype glioblastoma multiforme – Data from a national neuro-oncology registry

The role of surgical resection in recurrent Glioblastoma Multiforme (GBM) remains unclear. We aimed to investigate survival outcomes and associated prognostic factors in patients undergoing surgical re-resection for recurrent IDH-wildtype GBM in a national neuro-oncology center. We evaluated all patients who underwent re-resection for recurrent GBM following adjuvant treatment between 2015 and 2018. 32 patients were eligible for inclusion. 19 (59%) were male,median age at re-resection was 53. Median time from initial surgery to re-resection was 13.5 months. Median overall survival (OS) was 28.6 months from initial surgery and 9.5 months from re-resection. MGMT methylation was significantly associated with improved OS from initial surgery, 40 months versus 19.1 months, (p = 0.004), and from re-resection, 9.47 months versus 6.93 months, (p = 0.028). A late re-resection was associated with improved OS compared to an early re-resection, 44.1 months versus 15.7 months, (p = 0.002). There was a trend for improved outcomes in younger patients, median OS from initial surgery 44.1 months for <53 years compared to 21.7 months for patients ≥53, (p = 0.099). Higher Karnofsky Performance Status (KPS) at re-resection was associated with improved median OS, 9.5 months versus 4.1 months for KPS ≥70 and <70 respectively, (p = 0.013). Furthermore, there was a trend for improved OS with greater extent of re-resection, however this did not reach statistical significance, possibly due to small sample size. Re-resection for recurrent GBM was associated with improved OS in those with good performance status and could be considered in carefully selected cases.

ASO Author Reflections: Liver Stiffness by Ultrasonic Elastography-A Role in Surgical Resection for Hepatocellular Carcinoma.

ASO Author Reflections: Liver Stiffness by Ultrasonic Elastography-A Role in Surgical Resection for Hepatocellular Carcinoma.

The Role of Surgical Resection and Liver Transplantation for the Treatment of Intrahepatic Cholangiocarcinoma.

Intrahepatic cholangiocarcinoma (iCCA) is a rare and complex malignancy of the biliary epithelium. Due to its silent presentation, patients are frequently diagnosed late in their disease course, resulting in poor overall survival. Advances in molecular profiling and targeted therapies have improved medical management, but long-term survival is rarely seen with medical therapy alone. Surgical resection offers a survival advantage, but negative oncologic margins are difficult to achieve, recurrence rates are high, and the need for adequate future liver remnant limits the extent of resection. Advances in neoadjuvant and adjuvant treatments have broadened patient treatment options, and these agents are undergoing active investigation, especially in the setting of advanced, initially unresectable disease. For those who are not able to undergo resection, liver transplantation is emerging as a potential curative therapy in certain cases. Patient selection, favorable tumor biology, and a protocolized, multidisciplinary approach are ultimately necessary for best patient outcomes. This review will discuss the current surgical management of locally advanced, liver-limited intrahepatic cholangiocarcinoma as well as the role of liver transplantation for select patients with background liver disease.

Role of surgical resection and its alternative local therapy for pulmonary metastasis of colorectal cancer.

We reviewed surgical and alternative treatments for pulmonary metastasis of colorectal cancer, focusing on recent reports. The standard treatment for pulmonary metastasis of colorectal cancer is pulmonary resection, if resectable, despite the fact that the metastasis is hematogenous to distant organs. Guidelines in several countries, including Japan, have described pulmonary resection as a useful option because of the favorable long‐term prognosis reported in various studies pertaining to pulmonary resection. The indications for pulmonary resection have been reviewed in several studies; additionally, the number of metastases, pretreatment carcinoembryonic antigen value, and disease‐free interval from the primary resection to pulmonary recurrence have been proposed. However, no consensus has been reached to date. Contrastingly, recent advances in chemotherapy have remarkably improved the outcome of distant metastases, indicating that it is time to reconsider the significance of local treatment, including pulmonary resection. In addition to surgical resection, minimally invasive therapies, such as stereotactic body radiation therapy and radiofrequency ablation have been developed as local treatments for pulmonary metastases, and their long‐term results have been reported. Prospective controlled trials and large‐scale data analyses are needed to determine the best local treatment for pulmonary metastases and to find the appropriate indication for each treatment.

The role of surgical resection in primary central nervous system lymphoma: a single-center retrospective analysis of 70 patients

BackgroundThe aim of this study was to evaluate the effect of surgical resection and stereotactic biopsy on the complication rate, progression-free survival (PFS) and overall survival (OS) of 70 patients diagnosed at a single institution with primary central nervous system lymphoma (PCNSL) and to explore the predictors of selection for resection and the prognostic factors of PCNSL.MethodsA retrospective analysis was performed of 70 patients with PCNSL that was diagnosed by surgical resection or stereotactic brain biopsy in our department from January 2013 to May 2019. We divided the patients into two groups: a resection group (n = 28) and a stereotactic biopsy group (n = 42). Data on clinical characteristics, imaging findings, complication rates, PFS and OS were retrospectively reviewed and compared between these two groups. We also analysed the predictors of selection for resection and prognostic factors of PCNSL by multivariate analysis.ResultsThe median age was 53.3 ± 14.3 years, and there was a male predominance with a sex ratio of 1.33:1. The most common clinical manifestation was a headache. The complication rate in the resection group was 10.7% versus 7.1% in the stereotactic biopsy group, and there was no statistically significant difference. The rate of improvement in symptoms of the resection group was significantly higher than that of the stereotactic biopsy group. Multivariable analysis identified a single tumour and not involving deep structures as predictors of selection for resection. With a median follow-up of 30 months (range 1–110), the mean OS and PFS of all patients were 16.1 months and 6.2 months, respectively. Patients who underwent surgical resection had a mean OS of 23.4 months and PFS of 8.6 months versus 11.2 months and 4.6 months for those who had a brain biopsy performed. In addition, multivariable analysis showed that not involving deep structures and resection were favourable prognostic factors for PCNSL.ConclusionsThe outcomes of patients with PCNSL treated in our cohort are still poor. In our series, surgical resection might play a role in significantly improving OS and PFS compared with stereotactic biopsy in a subset of patients. The type of surgery and tumour location are prognostic factors for PCNSL.

Identification of Resectable N2 in NSCLC: A Single Center Experience and Review of the SEER Database.

BackgroundNon-small cell lung carcinoma (NSCLC) with ipsilateral and/or subcarinal mediastinal lymphatic spread (N2) is a heterogeneous disease. The role of surgical resection in patients with N2 NSCLC remains controversial and no survival-based definition of “resectable N2” exists. The purpose of this study is to evaluate the factors that potentially affect the survival of N2 NSCLC patients who receive surgical resection and to define “resectable N2” based on the survival benefits.MethodsData from the open Surveillance, Epidemiology, and End Results (SEER) database from the National Cancer Institute in the United States were used to construct a nomogram. Patients who received surgery between 2010 and 2015 for N2 NSCLC were included. Independent prognostic factors for survival identified through Cox regression analysis were used to create the nomogram. The C-index, receiver operating characteristics (ROC) analyses, calibration curves, and risk stratification were used to evaluate the nomogram. The nomogram was also validated using data from 222 patients from Peking Union Medical College Hospital (PUMCH). Furthermore, lung cancer–related deaths were compared using competitive risk analysis.ResultsIn total, 4267 patients were included in the SEER cohort. Male gender, old age, high T stage and grade, adenosquamous and squamous cell carcinoma, lower lobe and overlapping lesions, extended lobe or bilobectomy and pneumonectomy, no chemotherapy, radiation before and after surgery, positive number of lymph nodes, and lymph node ratio (LNR) were identified as independent risk factors for higher mortality. The nomogram was created using these parameters. The C-index was 0.665 (95% confidence interval (CI), 0.651-0.679) and 0.722 (95% CI, 0.620-0.824) in the SEER and PUMCH cohorts, respectively. The calibration curves showed satisfactory consistency between the predicted and actual survival status in both the SEER and PUMCH cohorts. Competitive risk analysis confirmed that the variables in the nomogram, except radiation, are risk factors for prognosis.Conclusions“Resectable N2” should be assessed by a multidisciplinary team. The novel nomogram developed in this study may help with clinical decision-making for this patient population.

P76.80 The Role of Surgical Resection of Advanced Non-Small Cell Lung Cancer after a Response to EGFR-TKI

P76.80 The Role of Surgical Resection of Advanced Non-Small Cell Lung Cancer after a Response to EGFR-TKI

Role of surgical resection in management of hepatic cysts: results from a standardized approach

Role of surgical resection in management of hepatic cysts: results from a standardized approach

A case report of rare isolated Ewing sarcoma of left maxillary sinus

BackgroundEwing sarcoma is a malignant round cell neoplasm and categorized as part of Ewing family tumor (EFT). Only 1-4% of all Ewing sarcomas are primarily located in the head and neck region and the isolated primary sinonasal sarcoma represents a rare entity. This case was reported due to its rarity and dilemma in diagnosis of recurrent post-treatment.Case presentationWe report a rare case of isolated left maxillary sinus Ewing sarcoma, presented with frequent unprovoked epistaxis, nasal blockage, and rhinorrhea from the left nostril for more than 2 years. Histopathological and immunohistochemical studies performed on the tissue taken from the left nasal mass confirmed Ewing sarcoma. He responded well to the 9 cycles of chemotherapy, evidenced by regression of mass from repeated CECT. However, the post-treatment scan showed multifocal nodular mucosal thickening involving the medial, anterior, and lateral walls of the maxillary sinus with corresponding bony resorption of the medial wall, raising a suspicion of residual disease. As such, he underwent endoscopic medial maxillectomy, which intraoperative findings revealed mild thickening of normal mucosa within the left maxillary sinus and histopathological examination showed no evidence of malignant cell. He showed no signs of recurrence during subsequent follow-up.ConclusionAs a conclusion, in a case of suspicious residual or recurrent disease detected post-chemotherapy, MRI is an option to differentiate between mucosal thickening and residual tumor. However, the role of surgical resection is equally important in assisting the tissue diagnosis and ensures a better local control, perhaps can increase the survival rate.