Outcomes Of Surgical Resection Research Articles

Practice of stereoelectroencephalography (sEEG) in drug-resistant epilepsy: Retrospective series with surgery and thermocoagulation outcomes

ObjectiveThe aim of this study was to determine the success rate of sEEG in locating the epileptogenic zone (EZ) in patients with pharmaco-resistant epilepsy. Secondary objectives were to analyze sEEG-related morbidity and outcomes for post-sEEG thermocoagulation and cortical resection. MethodsData were collected on 49 sEEGs from 46 consecutive patients between 2010 and 2018. Following sEEG, either resective or palliative surgery with vagus nerve stimulation was performed. In 8 patients, EZ thermocoagulation was performed before EEG leads were withdrawn. Outcomes were collected based on the Engel and ILAE outcome scales. ResultssEEG was contributive in 45 of 49 recordings, with a success rate of 92% in locating the EZ. Minor complications, such as transient neurologic deficit and electrode implantation failures, occurred in 6%. One major complication occurred, with death due to atypical late hematoma. Thermocoagulation was performed in 8 patients and stopped or significantly reduced seizure frequency in 7 (88%). Outcome of surgical resection (n=33) was good, with 20 (61%) seizure-free patients and 32 (97%) with definite improvement. ConclusionsOur findings suggest that sEEG is an effective technique for EZ location in patients with drug-resistant epilepsy. sEEG was contributive in up to 92% of patients, allowing thermocoagulation and/or surgical resection that resulted in seizure-freedom in two-thirds and seizure-reduction in one-third of cases. This study highlights the need for strict selection of implantation candidates, with strong initial hypothesis as to EZ location.

Surgical resection versus radiofrequency ablation for Barcelona Clinic Liver Cancer very early stage hepatocellular carcinoma: long-term results of a single-center study

BackgroundWe aimed to compare long-term outcomes of surgical resection (SR) and percutaneous radiofrequency ablation (RFA) for Barcelona Clinic Liver Cancer (BCLC) very early stage hepatocellular carcinoma (HCC). MethodsTotal of 387 patients (SR group, 156; RFA group, 231) with well-preserved liver function (Child-Pugh A) diagnosed with a solitary HCC less than 2 cm were included. The overall survival (OS) and recurrence-free survival (RFS) rates were compared. ResultsThe median follow-up period was 39 months. The overall tumor recurrence rate was 16.7% in the SR group and 27.7% in the RFA group. The 1-, 3-, and 5-year OS rates were 100%, 97.2%, and 93.4%, respectively, in the SR group, compared with 100%, 88.6%, and 73.5%, respectively, in the RFA group (P < 0.001). The 1-, 3-, and 5-year RFS rates were 94.6%, 84.1%, and 78.3%, respectively, in the SR group, and 87.7%, 62.1%, and 46.8%, respectively, in the RFA group (P < 0.001). ConclusionsSurgical resection provides better OS and RFS compared with percutaneous RFA for patients with BCLC very early HCC in long-term follow-up.

Long-term outcome of surgical resection in patients with gastroenteropancreatic neuroendocrine neoplasia: results from a German nation-wide multi-centric registry.

Neuroendocrine neoplasia (NEN) are rare and heterogenous tumours. Few data exist on the impact of surgical therapy. This is a retrospective analysis of prospectively collected data of gastroenteropancreatic NEN in the German NET-Registry (1999-2012). It focuses on patients without distant metastases (limited disease, LD, stage I-IIIB). Data of 2239 patients with NEN were recorded. Median age was 59years, the gender ratio was 1:1.3 (f:m). A total of 986 patients (44%) had LD, and the 5-year survival rate (5years) was 77% for all and 90% for patients with LD. A total of 1635 patients (73%) received a surgical therapy (1st to 6th line); the 5 and 10 ysr were 83/65% after and 59/35% without surgery for all patients (p < .001). The resection margins in the LD patients were 76%, 16%, and 3% for R0, R1 and R2, respectively. The 10 ysr was 84%, 59% and 42% for R0, R1 and R2 resections, respectively (p = .021 R0/R1, p < .001 R0/R2). The R0 resection rate was 75% for G1/G2 NET and 67% for G3 NEC. The rate of complete tumour resection (R0) in LD is independent of tumour grading, and R0 resection is the key determinant of long-term survival, as demonstrated by the 10 ysr. of 84%. All NEN patients with limited disease should be considered for operation, if possible, as the best 10-year survival is shown after an R0 resection.

Outcomes of surgical resection for gastric cancer liver metastases: a retrospective analysis

BackgroundThe indications for the surgical treatment of gastric cancer liver metastases (GCLMs) remain controversial. In addition, the outcome of surgery for the treatment of liver metastases of alpha-fetoprotein-producing gastric cancer (AFP-GC) has not yet been reported. We assessed the clinicopathologic features, including AFP-GC, and the surgical results of these patients.MethodsThis retrospective study analyzed 20 patients who underwent hepatectomy for GCLM at Odawara Municipal Hospital between April 2006 and January 2016.ResultsThe actuarial 1-, 3-, and 5-year overall survival (OS) rates after primary hepatectomy were 80.0%, 55.5%, and 31.7%, respectively, with a median OS of 42 months. Four patients survived for more than 5 years after their final hepatectomy procedures. A multivariate analysis showed multiple metastases in the liver, the elevated level of carbohydrate antigen 19-9 (CA19-9), and an age of less than 70 years to be independently associated with a poor prognosis in terms of OS. No significant differences were noted between the AFP-GC and AFP-negative GC groups.ConclusionSurgical treatment is therefore considered to be a feasible option for GCLM. The findings of the present study showed the number of metastatic liver tumors, the level of CA19-9, and the patient age to be prognostic indicators for the surgical treatment of GCLM.

Abstract TMP118: Clinical Outcomes of Surgical Resection After Stereotactic Radiosurgery Among Patients With Cerebral Arteriovenous Malformations

Introduction: Surgical treatment of arteriovenous malformations (AVMs), particularly higher grade lesions, can be aided by staged treatment consisting of stereotactic radiosurgery (SRS) followed by surgical resection in a delayed fashion. This strategy can be used to downgrade the AVM S-M grade, reduce blood flow through the AVM and often results in histopathological changes making AVMs more amenable to microsurgical resection. We present our 28-year clinical experience in managing AVMs with pre-operative SRS as a surgical adjunct. Methods: We retrospectively reviewed and analyzed records of all patients treated for cerebral AVMs between February 1991 and July 2019 at our institution. All patients that underwent SRS, with and without embolization, followed by microsurgery were included in the study. Of the 1245 cerebral AVM patients treated at our institution, 62 patients met eligibility criteria. Univariate and multivariate regression analysis was performed where appropriate to examine relationships between key variables and outcomes. Results: The majority of lesions (50%) were high grade (SM 4-5), 28.6% were intermediate (SM 3), while 21.4% were low grade (SM 1-2). Hemorrhage was the presenting sign among 22.6% of patients. Complete resection was achieved among 64.5%, 79% and 82% of patients after first, second and third surgical stages respectively; 16.1% of patients had partial resection requiring further treatment. Radiographic cure was achieved among 53 patients (85.5%), while 8 (12.9%) patients had residual AVM at last follow up. Six of 8 patients without radiographic cure received post-operative SRS. Thirty-seven patients (63.8%) had improved (26, 44.8%) or stable mRS scores (11, 19%), while 21 (36.2%) had a decline in mRS at final follow up compared to mRS at presentation; this includes 4 (6.9%) deaths due to hemorrhage, outside of the perioperative period, but occurring during follow up prior to AVM obliteration. Conclusion: SRS is a useful adjunct in the surgical management of cerebral AVMs. Multimodal therapy allowed for high obliteration rates with acceptable morbidity in this series of patients with predominantly high grade AVMs.

Novel prognostication of patients with spinal and pelvic chondrosarcoma using deep survival neural networks

BackgroundWe used the Surveillance, Epidemiology, and End Results (SEER) database to develop and validate deep survival neural network machine learning (ML) algorithms to predict survival following a spino-pelvic chondrosarcoma diagnosis.MethodsThe SEER 18 registries were used to apply the Risk Estimate Distance Survival Neural Network (RED_SNN) in the model. Our model was evaluated at each time window with receiver operating characteristic curves and areas under the curves (AUCs), as was the concordance index (c-index).ResultsThe subjects (n = 1088) were separated into training (80%, n = 870) and test sets (20%, n = 218). The training data were randomly sorted into training and validation sets using 5-fold cross validation. The median c-index of the five validation sets was 0.84 (95% confidence interval 0.79–0.87). The median AUC of the five validation subsets was 0.84. This model was evaluated with the previously separated test set. The c-index was 0.82 and the mean AUC of the 30 different time windows was 0.85 (standard deviation 0.02). According to the estimated survival probability (by 62 months), we divided the test group into five subgroups. The survival curves of the subgroups showed statistically significant separation (p < 0.001).ConclusionsThis study is the first to analyze population-level data using artificial neural network ML algorithms for the role and outcomes of surgical resection and radiation therapy in spino-pelvic chondrosarcoma.

Long-term outcomes of surgical resection for T1b gallbladder cancer: an institutional evaluation

BackgroundThere is no comprehensive agreement concerning the overall performance of radical resection for T1b gallbladder cancer (GBC). This research focused on addressing whether T1b GBC may spread loco-regionally and whether radical resection is necessary.MethodsA retrospective analysis was conducted of 1032 patients with GBC who underwent surgical resection at our centre and its affiliated institutions between January 1982 and December 2018. A total of 47 patients with T1b GBC, 29 (62%) of whom underwent simple cholecystectomy and 18 (38%) of whom underwent radical resection with regional lymph node dissection, were enrolled in the study.ResultsGBC was diagnosed pre-operatively in 16 patients (34%), whereas 31 patients (66%) had incidental GBC. There was no blood venous or perineural invasion in any patient on histology evaluation, except for lymphatic vessel invasion in a single patient. There were no metastases in any analysed lymph nodes. The open surgical approach was more prevalent among the 18 patients who underwent radical resection (open in all 18 patients) than among the 29 patients who underwent simple cholecystectomy (open in 21; laparoscopic in 8) (P = 0.017). The cumulative 10- and 20-year overall survival rates were 65 and 25%, respectively. The outcome following simple cholecystectomy (10-year overall survival rate of 66%) was akin to that following radical resection (64%, P = 0.618). The cumulative 10- and 20-year disease-specific survival rates were 93 and 93%, respectively. The outcome following simple cholecystectomy (10-year disease-specific survival rate of 100%) was equivalent to that following radical resection (that of 86%, P = 0.151). While age (> 70 years, hazard ratio 5.285, P = 0.003) and gender (female, hazard ratio 0.272, P = 0.007) had a strong effect on patient overall survival, surgical procedure (simple cholecystectomy vs. radical resection) and surgical approach (open vs. laparoscopic) did not.ConclusionsMost T1b GBCs represent local disease. As pre-operative diagnosis, including tumour penetration of T1b GBC, is difficult, the decision of radical resection is justified. Additional radical resection is not required following simple cholecystectomy provided that the penetration depth is restricted towards the muscular layer and that surgical margins are uninvolved.

Outcomes of surgical resection in type iii and type IV peri-hilar cholangiocarcinoma

Introduction: Peri-hilar cholangiocarcinoma (PH-CCA) is a rare tumour of the liver hilus. The majority of patients are not candidates for surgery either because of co-morbidity or advanced cancer stage. This is a single-centre case cohort series of prospectively collected data with an emphasis on criteria for resectability, type of surgery and outcome. Methods: During the 10 year period January 2009 to January 2019, 384 patients underwent hepatectomy by an individual HPB surgeon (AKS) in a regional liver surgery service. 20 underwent hepatectomy for type III or type IV peri-hilar cholangiocarcinoma and constitute the study population of this report. Patients undergoing surgery for intra-hepatic cholangiocarcinoma are excluded. Pre-operative preparation included percutaneous trans-hepatic drainage of the future liver remnant followed by cardiopulmonary exercise testing. Biliary involvement was assessed by pre-operative contrast-enhanced magnetic resonance scan. No patients underwent laparoscopy. There was no policy of neoadjuvant chemo- or radiotherapy. Hepatic resection was with CUSA (Valleylab, Boulder CO, USA). Resection included segment I and reconstruction of biliary drainage was by Roux hepaticojejunostomy. The study was listed as an audit. Results: 7 (35%) were IIIa, 7 (35%) were IIIb and 6 were type IV. During the period of this study no patients underwent laparotomy without resection. The median (range) operating time was 600 (240-720) minutes) with a median transection time of 100 (60- 150) minutes. 1 (5%) required early re-operation for bleed. There were no post-operative deaths. Histology confirmed an R0 resection margin in 15 (75%). Conclusion: This is a highly selected series and care must be exercised when extrapolating from these Results. However, the data show that liver resection in the hands of an experienced team is a feasible option in carefully assessed patients with type III and type IV PH-CCA.

Are hepatic and pancreatic resections justified for metastases from thyroid cancer: Outcomes from a systematic review of the literature

Background: The most common sites for distant metastases from thyroid carcinomas include the lung, followed by the bones, the brain, the liver and even more rarely the pancreas. The objective of our systematic review was to evaluate the long-term outcomes of surgical resection as a treatment strategy for liver (TCLM) and pancreatic metastases (TCPM) from thyroid cancer (TC). Materials and Methods: A systematic search of 3 electronic databases for articles published up to October 2018 was conducted. All appropriate observational studies and case reports which reported outcomes from patients with TC metastatic to the liver or pancreas were considered eligible for inclusion in the present systematic review. Results: A total of 15 studies, which comprised of 16 patients that underwent hepatic or pancreatic resection for TC metastasis, were included in the present systematic review; among them, 5 presented with metastasis to the liver, whereas 11 had pancreatic metastatic disease. The median time interval between the initial thyroidectomy and the diagnosis of metastases (either hepatic or pancreatic) was 60 months (SE: 23.8, 95% CI: 13.3-106.7) for the entire cohort and the mean overall survival was 37.6 months (SE: 8, 95% CI: 22-53.3). Five patients with pancreatic metastases presented with recurrence whereas no recurrences were noted in patients with liver metastases. Conclusions: Surgical resection of liver and pancreatic metastases from TC seems to be a safe and efficient treatment option for selected patients. In that setting, long term outcomes in patients with resected TCLM are encouraging given the absence of recurrence as reported from the included studies whereas in the case of TCPM, survival is limited due to advanced disease at diagnosis and recurrence rates.

Short-term outcomes of surgical resection and radiofrequency in treatment of hepatocellular carcinoma

Backgroundand aim To evaluate surgical liver resection in comparison with radiofrequency in the treatment of early hepatocellular carcinoma (HCC) regarding intraoperative blood loss and transfusion, time of respectability, time of operation, ICU stay, hospital stay, postoperative morbidity, mortality, and overall survival.Introduction Surgical resection and radiofrequency ablation (RFA) in the treatment of HCC are different modalities for the treatment of HCC.Patients and methods This is a prospective study that included 60 patients with HCC randomized into hepatic resection and RFA groups at Al-Zahraa University Hospital from 2016 to 2019. Demographic and biochemical characteristics, intraoperative data, postsurgical complications, and overall survival rate were compared between groups.Results Surgical resection group had longer operative time, resection time, blood loss and blood transfusion, hospital stay, and ICU stay than RFA group. Postoperative hemorrhage, bile leak, and chest infection were markedly decreased in RFA group than surgical resection group. Wound infection and ascites are similar in the two patient groups. Regarding the median follow-up during the 3 years, there were no significant differences between the treatment groups in 1- and 3-year overall survival.Conclusion Surgical resection is considered the primary solution if the patient’s liver function and general conditions are good enough to undergo surgical intervention. RFA is considered superior to hepatic resection in the treatment of HCC in terms of operation duration and other complications like hemorrhage and bile leak. RFA revealed similar overall survival to surgical resection. RFA is accessible and a promising liver resection method with very good results.

Clinical outcome of surgical resection for liver metastases of biliary tract cancer

Clinical outcome of surgical resection for liver metastases of biliary tract cancer

Long-Term Surgical Resection Outcomes of Pediatric Myxopapillary Ependymoma: Experience of Two Centers and Brief Literature Review

Myxopapillary ependymoma (MPE) is a rarely reported lesion of the spinal cord in the pediatric population. Based on their low mitotic index and slow-growth, MPEs are classified as low-grade glial tumors. However, MPEs have malignant characteristics, such as distant neural axis and extraneural axis dissemination. We present the long-term surgical resection outcomes of 5 consecutive pediatric MPE cases and the results of a literature search for reported cases of pediatric spinal MPE. We retrospectively reviewed the medical records of 38 primary spinal MPE cases who underwent surgery at 2 neurosurgical centers over a 16-year period from January 2004 to January 2019. All pediatric cases (age <18 years; n= 5) who were diagnosed with MPE composed the core sample for this study. This series comprised 5 patients (3 females and 2 males), with a mean age at first presentation of 13.6 ± 2.3 years. The mean preoperative course was 8.2 ± 9.3 months. The predominant location was the lumbar spine, for 4 tumors. Gross total resection (GTR) was achieved in 4 patients. All patients were diagnosed histopathologically as MPE, World Health Organization grade I. No adjuvant treatment was provided after the first surgery. Three patients experienced spinal drop metastasis. The mean interval between the first diagnosis and diagnosis of neural dissemination was 44.0 ± 31.5 months. The location of neural dissemination in all patients was the sacral spine; 1 patient experienced distant metastasis in the brain along with her sacral metastasis. The mean duration of follow-up was 75.0 ± 37.6 months. Even with GTR, pediatric MPE has a high propensity for neural axis dissemination. We recommend close clinical and radiologic follow-up for pediatric patients with MPE.

Outcomes of Surgical Resection of Isolated Pancreatic Metastases from Renal Cell Carcinoma

Background: Isolated pancreatic metastases from renal cell cancer (isPM) is a rare entity with this comprising only 1.5 – 3% of all metastatic RCC cases. Synchronous disease is exceptionally rare with only four case reports in the literature. Our case series examined the outcomes of patients who underwent resection of the pancreas due to renal cell carcinoma with isolated metastasis.

Surgery Versus Surveillance for Well-Differentiated, Nonfunctional Pancreatic Neuroendocrine Tumors: An 11-Year Analysis of the National Cancer Database

Pancreatic neuroendocrine tumors (panNETs) are a rare group of tumors that make up 2%-3% of pancreatic tumors. Recommended treatment for panNETs generally consists of resection for symptomatic or large asymptomatic tumors; however, optimal management for localized disease is still controversial, with conflicting recommendations in established guidelines. Our study aim is to compare surgical intervention versus active surveillance in nonmetastatic panNETs by size of primary tumor. Using the National Cancer Database, we identified 2,004 patients diagnosed with localized well-differentiated, nonfunctional panNETs (NF-panNETs) between 2004 and 2015. Patients' clinicopathologic characteristics, treatment modalities, and overall survival (OS) were analyzed using frequency statistics, chi-square, and Kaplan-Meier curves. The objective of the study is to assess the outcome of surgical resection versus nonoperative management in patients with panNETs with different tumor sizes. Tumor sizes were divided into three categories: <1 cm, 1-2 cm, and >2 cm. The number of patients with tumor size <1 cm, 1-2 cm, and >2 cm was 220 (11%), 794 (39.6%), and 990 (49.4%), respectively. Overall, 1,781 underwent surgical resection, whereas 223 patients did not. Median follow-up was 25.9 months. After adjusting for covariates, surgical resection was associated with improved OS in patients with tumor size 1-2 cm (hazard ratio [HR] = 0.37) and >2c m (HR = 0.30) but not <1 cm (HR = 2.81). Independent prognostic factors were age at diagnosis, Charlson-Deyo comorbidity score, stage, tumor location, and surgical resection. Higher tumor grade was not associated with worse OS. Our findings suggest that active surveillance is potentially a safe approach for NF-panNETs <1 cm. Larger tumors likely need active intervention. Intermediate-grade tumors did not result in worse survival outcome compared with low-grade tumors. Future studies might consider prospective randomized clinical trials to validate our findings. The present study seeks to address the discrepancy in treatment recommendations in the management of nonfunctional pancreatic neuroendocrine tumors (NF-panNETs) by evaluating whether surgical resection is associated with improved overall survival in different tumor size groups as well as elucidating independent prognostic factors in patients with NF-panNETs. Data from the National Cancer Database were reviewed. This study's findings suggest that active surveillance is potentially a safe approach for NF-panNETs <1 cm. Larger tumors likely need active intervention. Independent prognostic factors include age at diagnosis, Charlson-Deyo comorbidity score, stage, tumor location, and surgical resection. These findings will help guide medical and surgical oncologists when formulating treatment plans for patients with small NF-panNETs.

EP1.18-03 Outcome of Surgical Resection for Invasive Mucinous Adenocarcinoma: Experience at a Single Institution

EP1.18-03 Outcome of Surgical Resection for Invasive Mucinous Adenocarcinoma: Experience at a Single Institution

Outcomes of Surgical Resection After Induction Treatment in Non-Small Cell Lung Cancer (SRaIT)

Outcomes of Surgical Resection After Induction Treatment in Non-Small Cell Lung Cancer (SRaIT)

Clinical Outcomes of Surgical Resection for Leiomyosarcoma of the Inferior Vena Cava

Leiomyosarcoma of the inferior vena cava (IVC) is a rare mesenchymal tumor with poor prognosis. Surgical resection is currently the only potential curative treatment. This study analyzed long-term outcomes of patients who underwent surgical resection of leiomyosarcoma of the IVC. The charts of 12 patients who underwent surgical resection of leiomyosarcoma of the IVC from January 1999 to December 2017 at a single center were retrospectively reviewed. Of the 12 patients, 10 (83.3%) were women. Median age at diagnosis was 63years (range 42-67). Leiomyosarcoma involved the middle segment of the IVC in 9 patients (75.5%) and the lower segment in 3 (25.0%). Ten patients underwent IVC resection, followed by reconstruction with polytetrafluoroethylene in 9 patients and a bovine patch in 1. Two patients underwent IVC resection followed by ligation of the IVC. Eleven patients (91.7%) underwent grossly radical resection, with 1 (8.3%) having peritoneal seeding at the first operation. After resection, 8 patients received adjuvant chemotherapy and 7 received adjuvant radiotherapy. No patient experienced regional recurrence at the resection margins of the IVC, but 9 patients (75.5%) experienced distant metastases to sites such as the lungs, liver, bones, pelvis, peritoneum, and scalp. Median follow-up was 41months (range 6-149). Median disease-free survival (DFS) was 49months (range 8-88), and median overall survival (OS) was 127months (range 25-149). The 3- and 5-year DFS rates were 77.9% and 39.0%, respectively, and the 3-, 5-, and 10-year OS rates were 87.5%, 75.0%, and 56.3%, respectively. Although there is no established treatment for leiomyosarcoma of the IVC and metastasis after surgery is frequent, surgical resection followed by chemotherapy and/or radiotherapy can enhance long-term survival.

High-risk lesions in the remnant pancreas: fate of the remnant pancreas after pancreatic resection for pancreatic cancer and intraductal papillary mucinous neoplasms.

Progress in diagnostic modalities, surgical procedures, and multidisciplinary treatment for pancreatic diseases has increased the number of long-term survivors after pancreatic resection. Several reports have focused on high-risk lesions (HRLs), including high-grade pancreatic intraepithelial neoplasia (PanIN), pancreatic ductal adenocarcinoma, high-grade intraductal papillary mucinous neoplasm (IPMN), and IPMN with an associated invasive carcinoma, in the remnant pancreas after partial pancreatic resection for pancreatic cancer or IPMN. The etiology of HRLs in the remnant pancreas is thought to be either isolated local recurrence of the initial lesion in the remnant pancreas or a newly developed primary lesion. Although it is difficult to distinguish between local recurrence and a new primary lesion, comparison of genetic alterations between two lesions may help with this distinction. Early detection of HRLs in the remnant pancreas may improve the prognosis of patients, and several investigators have proposed predictive factors for HRLs in the remnant pancreas after partial pancreatic resection for pancreatic cancer or IPMN. The reported short- and long-term outcomes of surgical resection of HRLs in the remnant pancreas are relatively favorable. Life-long surveillance of the remnant pancreas is recommended after partial pancreatic resection for pancreatic cancer or IPMN.

Outcomes of surgical resections for benign colon polyps: a systematic review

Not all benign colonic polyps are suitable for endoscopic resection, although criteria for endoscopic non-resectability vary worldwide. Clinical decision-making largely depends on endoscopic treatment options, as well as postoperative risks after surgical resection. This systematic review aimed to determine postoperative outcomes and the characteristics of surgically resected benign colonic polyps. MEDLINE, EMBASE, and the Cochrane Library were searched for studies investigating the outcomes of surgical resection for benign colonic polyps since 1980. Studies were considered eligible when at least one postoperative outcome (morbidity and/or mortality) was reported. Meta-analyses were conducted for the primary outcome measures (morbidity and mortality) for studies that included patients only after the year 2000. Of the 4210 studies retrieved, 26 studies describing 139 897 patients were included. The most common indications for surgical resection were polyp location in the right-sided colon, non-pedunculated morphology, and large polyp size. The pooled 1-month complication and mortality rates of studies that included patients after the year 2000 were 24 % (95 % confidence interval [CI] 15 % - 36 %) and 0.7 % (95 %CI 0.6 % - 0.8 %), respectively. The postoperative morbidity and mortality after colonic resection for benign polyps are substantial. Referral to an advanced interventional endoscopist should be considered before referral for surgery to evaluate the possibilities for endoscopic treatment of large, non-pedunculated, and/or colonic polyps in difficult locations without suspicion of submucosal malignant invasion.

Prognostic Factors and Survival Outcomes of Surgical Resection of Huge Hepatocellular Carcinomas.

The aim of the study was to analyze the various prognostic factors that influence survival and clinical outcomes in patients undergoing liver resection for huge hepatocellular carcinomas. The records of patients who underwent curative surgery between 1991 and 2011 for huge hepatocellular carcinoma were analyzed. Various prognostic factors that influenced the survival were studied. The patients were followed up till November 2016. The number of patients who underwent liver resection with huge hepatocellular carcinoma during the study period was 17; this included 14 males and 3 females. The median age of the study population was 52years. The median serum AFP in the study population was 132.3ng/ml (range 2 to 187,000ng/ml). 41.2% of the patients were hepatitis B positive. The overall morbidity was 6%. The mortality rate was nil. The mean size of the resected specimen was 13.9cm ± 3.6cm. The overall recurrence rate was 76.5%. The local recurrence rate was 29.4%. The median time to recurrence was 8months. The 5-year disease-free survival and overall survival of the study group were 26% and 32%, respectively. The factors that predicted an adverse survival outcome after the log-rank test for univariate analysis using life-table method were presence of lymphovascular invasion (p = 0.047), age ≤ 55years (p = 0.021), and raised serum AFP (p = 0.041). The factors that predict an adverse outcome after surgery in patients with huge hepatocellular carcinomas were the presence of lymphovascular invasion, raised serum AFP, and age ≤ 55years.