Timing Of Postoperative Chemotherapy Research Articles

The effects of anaesthesia and analgesia on short- and long-term outcomes following colorectal cancer surgery

BACKGROUND Colorectal cancer (CRC) is the second most frequent cause of global cancer mortality. Most patients with CRC require surgical tumour resection, with certain stages of CRC (Stage II/III) also requiring postoperative chemotherapy. The timing of postoperative chemotherapy is largely determined by postoperative recovery. Delayed return to intended oncologic therapy (RIOT) by >8 weeks results in worse oncologic outcomes. RIOT is thus an important surrogate marker of outcome for patients with stage II/III CRC. We will test the hypothesis that anaesthetic technique during CRC resection surgery may affect RIOT. OBJECTIVE To test the association between anaesthetic and analgesic technique during CRC surgery and RIOT. To document Short-term Secondary outcomes including individual postoperative complications and a composite of all postoperative complications, the Comprehensive Complications Index (CCI) and to measure the time to recurrence (TTR) of cancer at 3 years. DESIGN This is a prospective, international, multicentre, observational cohort study. SETTING Global healthcare setting, with >140 centres in >30 nations. PATIENTS Inclusion criteria: All patients age >18 years, ASA I–III, with CRC stage I–III scheduled for elective CRC surgery (open or minimally invasive). Exclusion criteria: Uncontrolled renal or liver disease, restrictive (limiting mobility) heart failure or ischemic heart disease (ASA IV–V). Speech, language, or cognitive difficulties precluding signing informed consent to participate and Stage IV CRC. PRIMARY OUTCOME MEASURES Short -term: The duration from day of surgery to RIOT among patients expected to receive postoperative chemotherapy. Long-term: incidence of recurrence and time to recurrence (TTR) at 3 years after primary curative surgery SECONDARY OUTCOMES Postoperative complications within 30 days of surgery, length of hospital stay, Days at Home at 30 and 90 days (DAH-30, DAH-90) after surgery, and adverse events related to oncological treatment. We will also assess the burden of preoperative modifiable comorbid disease in patients. Exploratory endpoints will assess practice variation (including incidence of RIOT by demographic e.g. gender of patient, type of institution, country). RESULTS N/A. CONCLUSIONS N/A. TRIAL REGISTRATION The Effects of aNesthesia in COloREctal cancer outcome study: ENCORE, ClinicalTrials.gov Identifier: NCT04493905.

CT-determined sarcopenia is associated with neutropenia in patients undergoing hyperthermic intraperitoneal chemotherapy for gastrointestinal cancer

BackgroundWith better patient selection and the increasing experience in patients undergoing hyperthermic intraperitoneal chemotherapy (HIPEC) combined surgery, the rate of severe postoperative complications and mortality decreased significantly. However, leukopenia and neutropenia were still a particular concern, and their relation to sarcopenia was not clarified.MethodsData of consecutive patients who underwent HIPEC for gastrointestinal cancer were collected and analyzed retrospectively between September 2020 and August 2022. Sarcopenia was assessed using psoas muscle index (PMI) at the L3 level on preoperative computed tomography (CT).ResultsAmong 103 patients enrolled, 37 (35.9%) were classified as sarcopenic. Most leukopenia and neutropenia occurred during the hospital leaving period after HIPEC and surgery. Before the first time of postoperative chemotherapy, the blood tests revealed 11 (29.73%) and 6 (9.09%) patients were diagnosed with neutropenia in sarcopenia and no sarcopenia groups, respectively. Logistic regression analysis revealed sarcopenia was independently associated with the increased risk of neutropenia (OR 5.58, 95% CI 1.70–18.29, p = 0.005). An incremental albumin level was protective against the occurrence of leukopenia and neutropenia.ConclusionsSarcopenia and low albumin level were significantly associated with an increased rate of delayed neutropenia after HIPEC in that disease setting and could be the preoperative risk predictors.

Complications in Postoperative Evolution After Resection for Rectal Cancer and The Time of Postoperative Chemotherapy

Background: Same studies found that postoperative complications after rectal cancer resection influence the timing of chemotherapy. The relevance of severity of postoperative complications after rectal cancer resection with curative intent on survival / recurrence rates is a matter of controversy. The aim: To investigate the import of postoperative complications on survival after curative resection for rectal cancer. The second obiectiv was to shown the risk factors for delays in chemotherapy and the consecvence of delayed therapy on long –term survival. Material and methods:We investigate 177 patients with curative resection for rectal cancer between 2005-2015 , operated in I-st surgical clinic.This study was a retrospective review with univariate analysis to identify risk factors for delayed chemotherapy. In the present study were included the patients category who underwent resection with primary curative intent were excluded all other cases with proctectomy for rectal cancer. Results:Delays in chemotherapy > 8 weeks after resection were associated with postoperative complications worse local and distant reccurences rates and worse overall survival were observed in patients with chemotherapy > 8 weeks. In present study there was no significant difference between patients without complications, minor complications and major complications in terms of overall disease –free survival. Our study is retrospective and was performed at a single institution, and this is a possible limitation of this study. Conclusions: After rectal resection with curative intent , the severity of postoperative complications accordind to Clavien classification system does not have significant effect o overall and disease – free survival.Our results shown that the presence of postoperative complications are risk factors for delayed chemotherapy.

Abstract 4727: Analysis of PIK3CA mutations and PI3K signaling proteins as prognostic biomarkers for advanced gastric cancer

Abstract Although surgery and chemotherapy has extended the survival of patients with advanced gastric cancer, some patients experience relapse. In cases of potentially curative gastrectomy, no visible tumor mass should be present at the time of post-operative chemotherapy. Therefore, relapse may be attributed to very small cancer cell populations that survive and develop drug resistance. Previously, we found that changes in the phosphatidylinositide 3-phosphate kinase (PI3K) pathway protein levels were responsible for the growth of drug-resistant cancer cells. In the present study, we postulated that the oncogenic mutations in PIK3CA and PI3K pathway proteins could be prognostic biomarkers for patients with advanced gastric cancer. A retrospective cohort of 160 patients with advanced gastric cancer, receiving potentially curative surgery with/without chemotherapy was investigated for PIK3CA mutations and PI3K pathway protein levels in the context of 5-year overall survival (OS) and relapse-free survival (RFS). Mutations were screened by direct sequencing followed by validation through allele-specific quantitative real-time PCR, digital PCR, and ultra-deep sequencing. Tissue microarrays were produced from tumor-rich areas of surgically removed specimens. Protein levels were assessed by incubation with specific primary antibodies against total and phosphorylated proteins including PI3K (p85), AKT, mTOR, and PTEN, followed by colorimetric detection. Samples were deemed to have positive staining when more than 5% of the cancer cells were stained. OS and RFS periods were estimated using the Kaplan-Meier method. A log-rank test and Cox proportional hazards model was used to compare the survival and hazards ratio, respectively. Subgroup analysis was also performed. Thirteen patients (13/111 11.7%) had PIK3CA mutations in codon 545, whereas one patient (1/94 1.1%) had a mutation in the PIK3CA codon 1047. Phosphorylated-AKT positive (p-AKT(+)) patients in the surgery-only group showed good prognosis in terms of OS and RFS. Both OS and RFS of PTEN(+) patients were higher than those of PTEN(-) patients in both surgery-only and chemotherapy groups although statistical significance was not confirmed. PTEN(+) patients showed similar survival curves for up to 2 years post-operation, and separated thereafter. No significant association was observed between PIK3CA mutations and PI3K pathway protein levels. Subgroup analysis demonstrated that both p-AKT(+) and PTEN(+) were better prognostic factors for survival. There was no interaction between the protein levels and any clinicopathological/mutational factors. This study revealed that: (i) PIK3CA hotspot mutations occurred with low frequency in gastric cancer; (ii) PIK3CA hotspot mutations were not directly associated with PI3K pathway activation; and (iii) p-AKT(+) may be a biomarker for better outcomes in gastric cancer patients undergoing gastrectomy. Citation Format: Satoshi S. Nishizuka, Chie Ito, Kohei Kume, Takeshi Iwaya, Keisuke Koeda, Akira Sasaki. Analysis of PIK3CA mutations and PI3K signaling proteins as prognostic biomarkers for advanced gastric cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 4727. doi:10.1158/1538-7445.AM2017-4727

Minimally Invasive Resection of Colorectal Cancer Liver Metastases Leads to an Earlier Initiation of Chemotherapy Compared to Open Surgery

IntroductionPrevious studies have shown benefit not only from postoperative chemotherapy but also from a short interval to initiation of treatment after resection of primary colorectal cancer. The aim of this study was to determine difference in timing to postoperative chemotherapy for minimally invasive resection (MIR) vs. open resection (OR) of colorectal cancer liver metastases (CRCLM). MethodsThis is a retrospective review of 1:1 matched patients undergoing MIR (n = 66) and OR (n = 66) for CRCLM at a single institution. ResultsPatients undergoing MIR of CRCLM had significantly shorter length of hospital stay, fewer major complications, and shorter interval to postoperative chemotherapy (median 42 vs. 63 days, p < 0.001). Univariable analysis showed that surgical approach, postoperative complications, blood loss, number of lesions, and length of stay were associated with timing to chemotherapy. On multivariable analysis, surgical approach was still associated with timing to chemotherapy, and postoperative complications resulted in a delay of chemotherapy among patients who underwent OR but not among those who underwent MIR. In addition, worse disease-free survival was seen among patients who received postoperative chemotherapy more than 60 days after surgery. ConclusionBy modifying the deleterious effects of postoperative complications on timing of postoperative chemotherapy, patients undergoing MIR for CRCLM are treated with chemotherapy sooner after surgery compared to those undergoing OR.

Intestinal lymphoma--a review of the management of emergency presentations to the general surgeon.

Intestinal non-Hodgkin's lymphoma (NHL) is uncommon but not rare. This paper aims to review the recent evidence for the management of perforated NHL of the intestine, consider when chemotherapy should be commenced and examine the likely outcomes and prognosis for patients presenting as surgical emergencies with this condition. MEDLINE and Cochrane databases were searched using intestinal lymphoma, clinical presentation, perforation, management and prognosis. The full text of relevant articles was retrieved and reference lists checked for additional articles. Emergency surgery was required at disease presentation for between 11 and 64% of intestinal NHL cases. Perforation occurs in 1-25% of cases, and also occurs whilst on chemotherapy for NHL. Intestinal bleeding occurs in 2-22% of cases. Obstruction occurs more commonly in small bowel (5-39%) than large bowel NHL and intussusceptions occur in up to 46%. Prognosis is generally poor, especially for T cell lymphomas. There is a lack of quality evidence for the elective and emergency treatment of NHL involving the small and large intestine. There is a lack of information regarding the impact an emergency presentation has on the timing of postoperative chemotherapy and overall prognosis. It is proposed that in order to develop evidence-based treatment protocols, there should be an intestinal NHL registry.

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Staging laparoscopy promotes increased utilization of postoperative therapy for unresectable intra-abdominal malignancies

Staging laparoscopy avoids unnecessary laparotomies in patients with unresectable intra-abdominal malignancies. However, the postoperative oncologic treatment of these patients has not been documented. This study compares rates and timing of postoperative chemotherapy (ChT) and/or radiation therapy (XRT) in patients with unresectable intra-abdominal malignancies initially evaluated by staging laparoscopy (SL) or exploratory laparotomy (EL). The records of patients surgically evaluated for esophageal, gastric, hepatobiliary, and pancreatic cancers or abdominal lymphoma were retrospectively reviewed. Data gathered included type of exploration (SL or EL), resectability, whether postoperative cancer treatment was given (ChT, XRT, or both), and the time from surgery to the beginning of such treatment. This study includes only patients with unresectable malignancies. Twenty-one patients underwent SL and 58 EL. Sixteen of the SL patients (76%) and 25 of the EL patients (43%) received postoperative cancer treatment ( P = 0.009). The median number of days from surgery to postoperative cancer treatment was 13 days (range 5 to 41 days) for the SL group and 35 days (range 16 to 89 days) for the EL group ( P = 0.0004). We conclude that patients with unresectable intra-abdominal malignancies discovered by SL are more likely to receive postoperative ChT and/or XRT than patients surgically evaluated by EL. Further studies to determine whether this better utilization of postoperative treatment results in better outcomes in these patients are needed.

Effect of timing of postoperative chemotherapy on survival of dogs with osteosarcoma

Effect of timing of postoperative chemotherapy on survival of dogs with osteosarcoma