Tumor Resectability Research Articles

Long-term outcomes of endoscopic or surgical resection in T1 colorectal cancer patients: a retrospective cohort study.

The personalized treatments of T1 colorectal cancer (CRC) remains controversial. We compared the long-term outcomes of T1 CRC patients after endoscopic resection (ER) and surgery, and evaluated the risk factors for the long-term prognosis. T1 CRCs after resection at the Cancer Hospital, Chines Academy of Medical Sciences from June 2011 to November 2021 were reviewed. High-risk factors included positive resection margin, poor differentiation, deep submucosal invasion (DSI ≥ 1000 μm), lymphovascular invasion and intermediate/high tumor budding. Comparative analyses were conducted based on three treatment methods: follow-up after ER (Group A), additional surgery after ER (Group B) and initial surgery (Group C). The primary endpoints included recurrence-free survival (RFS) and overall survival (OS). Cox proportional hazard regression models were constructed to identify risk factors for RFS and OS. A total of 528 patients were enrolled (173 patients in Group A, 102 patients in Group B, 253 patients in Group C). The 3-year RFS, 5-year RFS, 3-year OS, and 5-year OS rates were 96.7%, 94.7%, 99.1%, and 97.8%, respectively. In the absence of other high-risk factors, RFS (P = 0.321) and OS (P = 0.155) of patients with DSI after ER were not inferior to those after surgery. Multivariate analyses identified sex (HR 0.379; 95% CI 0.160-0.894), Charlson comorbidities index (CCI) (HR 3.330; 95% CI 1.571-7.062), margin (HR 8.212; 95% CI 2.325-29.006), and budding (HR 3.794; 95% CI 1.686-8.541) as independent predictive factors of RFS, and identified CCI (HR 10.266; 95% CI 2.856-36.899) as an independent predictive factor of OS. The long-term outcomes of ER are comparable to those of surgery in T1 CRC patients with DSI when other high-risk factors are negative. Resection margin, tumor budding, sex, and CCI may be the most important long-term prognostic factors for T1 CRC patients.

Usefulness of magnetic resonance imaging characteristics in discriminating H3 K27M-mutant gliomas from wildtype gliomas in spinal cord.

The aim of this study was to determine the usefulness of magnetic resonance imaging (MRI) characteristics in discriminating H3 K27M-mutant gliomas from wildtype gliomas in the spinal cord. Fifty-eight patients with spinal cord gliomas were enrolled in this study. The H3 K27 gene status was identified by Sanger sequencing or immunohistochemistry test of resection tumor specimens. The MR imaging characteristics were evaluated and compared between H3 K27M-mutant and wildtype gliomas using the χ2 test and the Mann-Whitney U test. Of 58 recruited patients, 23 (39.7%) were diagnosed with H3 K27M-mutant glioma. The H3 K27M-mutant gliomas were found to more likely occur in men compared with wildtype gliomas (87.0% vs. 42.9%, p = 0.001). On T2-weighted MR images, the signal-to-noise ratio (SNR) of H3 K27M-mutant gliomas was significantly lower than that of wildtype gliomas (103.9 ± 72.0 vs. 168.9 ± 86.8, p < 0.001). Of 35 wildtype tumors, 60% showed well-defined margin but this feature was not found in all mutant tumors (p < 0.001). The SNR of tumors on contrast-enhanced T1-weighted images of the H3 K27M-mutant gliomas was significantly lower than that of wildtype gliomas (187.7 ± 160.4 vs. 295.1 ± 207.8, p = 0.006). Receiver operating-characteristic analysis revealed that area under curve (AUC) of combination of 1/SNR on T2-weighted images, 1/SNR on contrast-enhanced T1-weighted images, ill-defined margin, and sex reached 0.937 (95% CI, 0.873-1.000) in discriminating H3 K27M-mutant gliomas. The MR imaging characteristics are valuable in discriminating H3 K27M-mutant from wildtype gliomas in the spinal cord and the combination of these imaging features with sex had a high strength in this discrimination.

Correlation of staging and resectability of tumor by imaging, intra-operative findings and postoperative histopathology in periampullary and pancreatic tumors

Correlation of staging and resectability of tumor by imaging, intra-operative findings and postoperative histopathology in periampullary and pancreatic tumors

Assessing the effectiveness of targeted agents in adjuvant therapy for patients with metastatic colorectal cancer undergoing surgical resection: a retrospective cohort study.

Primary tumor resection and metastasectomy may be beneficial for many patients with metastatic colorectal cancer (mCRC). To assess the differences in postoperative survival outcomes between adjuvant therapy with chemotherapy alone and chemotherapy plus targeted agents (TAs). Retrospective cohort study. Patients with mCRC who underwent surgical resection for primary colorectal tumor and distant metastases and received adjuvant therapy from 1 January 2010 to 31 December 2017 were enrolled in the Taiwan Cancer Registry. We analyzed the overall survival of patients with resectable or initially unresectable mCRC who received adjuvant chemotherapy alone and chemotherapy plus TAs. We enrolled 1124 and 542 patients with resectable and initially unresectable mCRC, respectively. Adjuvant chemotherapy plus TAs and chemotherapy alone resulted in similar mortality rates among patients with resectable mCRC [adjusted hazard ratio (aHR) = 1.13; 95% confidence interval (CI), 0.93-1.36]; however, it marginally reduced the mortality rate among patients with initially unresectable mCRC who underwent conversion surgery after neoadjuvant therapy (aHR = 0.81; 95% CI, 0.62-1.06). The subgroup analysis of patients who received more than nine cycles of TAs preoperatively and anti-epidermal growth factor receptor agents revealed aHRs of 0.48 (95% CI, 0.27-0.87) and 0.33 (95% CI, 0.18-0.60), respectively. Adjuvant chemotherapy plus TAs may improve survival in patients with initially unresectable tumors who underwent conversion surgery following neoadjuvant therapy with TAs, especially in those who respond well to the targeted therapy. Our study underscores the importance of stratifying patients with mCRC based on tumor resectability when selecting the adjuvant therapy regimen.

Meta-analysis of laparoscopic versus open D2 gastrectomy in managing locally advanced gastric cancer: early postoperative course and pathological outcomes

Background With a fifth incidence and a third death rate among all malignancies, stomach cancer is a serious worldwide health problem. The best course of treatment is removing all lymph nodes together with the tumor, increasing the likelihood of survival. Laparoscopic gastrectomy has become more common because of its advantages in terms of appearance, decreased discomfort, and shorter hospital stays; this is especially true in Korea and Japan. For locally advanced gastric cancer, it is still unclear if laparoscopic D2 gastrectomy is more feasible and effective than open surgery. Patients and methods This study conducted a systematic review and meta-analysis to evaluate the differences between laparoscopic and open D2 gastrectomy in terms of feasibility, radicality, surgical outcomes, and postoperative complications. PRISMA statement guidelines and Cochrane handbook for Systematic Reviews of Interventions were followed. Relevant databases were searched, and studies published between 2017 and September 2022 were included. Key outcome measures included operative time, blood loss, postoperative recovery, pathological outcomes, and lymph node involvement. Results The meta-analysis included a total of 22 studies. The operative time was significantly shorter for laparoscopic D2 gastrectomy compared with open surgery. However, laparoscopic D2 gastrectomy was associated with higher blood loss. Postoperative recovery measures, such as the time to first flatus and first oral intake, were significantly shorter for laparoscopic D2 gastrectomy. Pathological outcomes showed no significant differences in terms of resection margins and tumor size. The number of harvested lymph nodes did not significantly differ between laparoscopic and open D2 gastrectomy. Laparoscopic D2 gastrectomy demonstrated a lower rate of positive lymph nodes compared with open surgery. Conclusion Based on the findings of this meta-analysis, laparoscopic D2 gastrectomy seems to be a safe and practical procedure for treating patients with locally advanced gastric cancer. It is associated with reduced blood loss, faster postoperative recovery, equivalent postoperative complications, and comparable oncological safety. These results support the use of laparoscopic D2 gastrectomy as an effective alternative to open surgery in the management of advanced gastric cancer.

Vascular reconstruction and transplantation technologies in liver surgery (part II)

To systematize tactical and technical aspects of liver resections with reconstruction of afferent and efferent blood supply and/or inferior vena cava; to study postoperative outcomes in patients with focal liver lesions using transplantation technologies. We enrolled 413 patients with parasitic lesions, primary and secondary liver tumors involving great vessels (portal vein, hepatic artery, hepatic veins, inferior vena cava, right atrium). All ones underwent liver resections with vascular resection and reconstruction, as well as liver autotransplantation in vivo, ante situ (ex situ in vivo), extracorporeal liver resections with autotransplantation (ex vivo). We obtained satisfactory immediate results after liver resections using transplantation technologies. Transplantation technologies in liver surgery can significantly increase resectability of tumors and survival of patients. Transplantation technologies are an important new surgical strategy and necessary option in modern hepatic surgery.

Deep Learning Techniques for Pancreatic Cancer Analysis: A Systematic Review and Implantation Prerequisites

Of all the cases of pancreatic cancer reported in 2022, 52% of patients belonged to stage IV with a 2.9% 5-year survival rate. Lower survival rates are reported because the advanced-stage incidences leave only <20% of patients eligible for in-patient tumor resect-ability. Due to the fatal consequences, researchers have been rigorously implementing artificial intelligence techniques for early detection and analysis of cancer. This systematic review scrutinizes published research from 2020 to 2023 to map key concepts based on objectives, techniques, imaging modalities, datasets, and current limitations in the emerging field of deep learning strategies applied to image analysis of the ailment. To achieve this aim, a research methodology was developed to investigate articles pertinent to deep learning deployment, radiological imaging modalities, and publicly available imaging datasets for pancreatic cancer classification. Based on the findings, the authors discussed major applications, the maximum applied computed tomography imaging modality, and 3 datasets. The authors emphasized future enhancements including multimodal detection, dataset generation, and ways to improve clinical applications. The summarized results also enlist optimum implementation prerequisites for the disease’s detection which are substantial to aid researchers, scholars, and academicians in gaining deep insights into related strategies for future experiments.

Resectability of Small Duodenal Tumors: A Randomized Controlled Trial Comparing Underwater Endoscopic Mucosal Resection and Cold Snare Polypectomy.

Underwater endoscopic mucosal resection (UEMR) and cold snare polypectomy (CSP) are novel endoscopic procedures for superficial nonampullary duodenal epithelial tumors (SNADET). However, consensus on how to use both procedures appropriately has not been established. In this study, we evaluated treatment outcomes of both procedures, including resectability. In this single-center randomized controlled study conducted between January 2020 and June 2022, patients with SNADET ≤12 mm were randomly allocated to UEMR and CSP groups. The primary end point was sufficient vertical R0 resection (SVR0), which was defined as R0 resection including a sufficient submucosal layer. We compared treatment outcomes including SVR0 rate between groups. The SVR0 rate was significantly higher in the UEMR group than in the CSP group (65.6% vs 41.5%, P = 0.01). By contrast, the R0 resection rate was not significantly different between study groups (70.3% vs 61.5%, P = 0.29). The submucosal layer thickness was significantly greater in the UEMR group than in the CSP group (median 546 [range, 309-833] μm vs 69 [0-295] μm, P < 0.01). CSP had a shorter total procedure time (median 12 [range, 8-16] min vs 1 [1-3] min, P < 0.01) and fewer total bleeding events (9.4% vs 1.5%, P = 0.06). UEMR has superior vertical resectability compared with CSP, but CSP has a shorter procedure time and fewer bleeding events. Although CSP is preferable for most small SNADET, UEMR should be selected for lesions that cannot be definitively diagnosed as mucosal low-grade neoplasias.

Resectability versus Operability in Early-Stage Non-Small Cell Lung Cancer.

With increased detection of early-stage non-small cell lung cancer (NSCLC) owing to screening, determining optimal management increasingly hinges on assessing resectability and operability. Resectability refers to the feasibility of achieving microscopically negative margins based on tumour size, location and degree of local invasion and achieving an anatomical lobar resection. Operability reflects the patient's tolerance for resection based on comorbidities, cardiopulmonary reserve and frailty. Standardized criteria help guide these assessments, but application variability contributes to practice inconsistencies. This review synthesizes a strategic approach to evaluating resectability and operability in contemporary practice. Standardization promises reduced care variability and optimized patient selection to maximize curative outcomes in this new era of early detection. Recent pivotal trials demonstrate equivalency of sublobar resection to lobectomy for small, peripheral, node-negative NSCLC, expanding options for parenchymal preservation in borderline surgical candidates. Furthermore, recent phase 3 trials have highlighted the benefit of chemoimmunotherapy as a neoadjuvant treatment with an excellent pathological response and a down staging of the tumour, improving the resectability of the early-stage NSCLC. A good assessment of the operability and resectability is paramount in order to offer the best course of treatment for our patients. European and American societies have issued recommendations to help clinicians assess the cardiopulmonary function and predict the extension of pulmonary resection that could afford the patient. This operability assessment is closely linked with the evaluated tumour resectability which will determine the extension of pulmonary resection that is needed for the patient in order to achieve a good oncological outcome. Some major progresses have been done recently to improve the operability and resectability of patients. For instance, prehabilitation program allows better postoperative morbidity. Some studies have shown a potential good oncological outcome with sublobar resection expending access to surgery for patient with reduced lung function. Some others have identified the neoadjuvant immunochemotherapy as a potential solution for downstaging tumours. Work-up of early-stage NSCLC is a key moment and has to be done thoroughly and in full knowledge of the recent findings in order to propose the most appropriate treatment for the patient.

Effects of Cystic Duct Margin Involvement on the Survival Rates of Patients With Gallbladder Cancer: A Propensity Score-Matched Case-Control Study.

Background In gallbladder cancer (GBC), extrahepatic bile duct (EHBD) resection is selectively performed if gross direct extension or microscopic involvement of the cystic duct margin (CDM) is detected. Although CDMis usually sent for frozen biopsy intraoperatively in most centers, there are no studies regarding the routine use of CDM frozen biopsy irrespective of the tumor location and paucity of literature regarding the impact ofCDM status on recurrence-free and overall survival inGBC. The presence of obstructive jaundice in GBC usually indicates the involvement of EHBD or cystic duct-bile duct junction. The present study aimed to analyze the necessity of routineCDM frozen biopsy inpatients with resectable GBC withoutjaundice, regardless of the tumor location. The impact of positive CDM on survival was also evaluated. Methods This retrospective observational case-control study was conducted from May 2009 to March 2021 and included 105 patients with resectable GBC without macroscopic EHBD infiltration andjaundice. Patients were divided into CDM-negative (n=91) and CDM-positive (n=14) groups. Propensity score matchingwas performed for variables such asperformance status, tumor size, tumor-node-metastasis (TNM) stage, and adjuvant chemotherapy. After propensity score matching, 27 patients (CDM-negative=13, CDM-positive=14) were included. The primary outcome was to analyze the role of routine CDM frozen biopsy regardless of tumor location, and secondary outcomes were to study the impact of positive CDM status on survival andevaluate predictive factors for CDM positivity. A subgroup analysis was conducted to assess clinicopathologic characteristics and outcomes of the anatomical location of the tumor. Results Of 105 patients, 91 had negative CDM, and 14 had positive CDM. Among 14 patients with positive CDM, only one patient had a tumor in the fundus/body, and the remaining had a tumor involving the neck. All CDM-positive patients underwent bile duct excision with hepaticojejunostomy. Common bile duct (CBD) involvement was present in 50% of patients with positive CDM in the final histopathological examination. In the matched population, patients with positive CDM had a significantly higher rate of neck tumors (p=0.001). Recurrence-free survival (24 vs. 12 months, p=0.30) and overall survival (24.5 vs. 20 months, p=0.417) were comparable between CDM-negative and CDM-positive groups, respectively. On multivariate analysis, preoperative and intraoperative tumor location were independent predictive factors for CDM positivity. On subgroup analysis, 30 patients had tumor involving the neck of the gallbladder, and the remaining 75 had at the fundus and body of the gallbladder. Neck tumors had inferior recurrence-free survival (17 vs. 30 months, p=0.012) and overall survival (24 vs. 36 months, p=0.048) compared to non-neck tumors. Conclusions Routine use of CDM frozen analysis in patients with resectable GBC without jaundice, regardless of tumor location, can be avoided. Itcan be selectively preferred in patients with GBC involving the neck since tumor location is found to be an independent predictive factorfor CDM positivity. Positive CDM has comparable survival outcomes to negative CDM, providing a similarR0 resection rate and tumor stage.However, neck tumors have aworse prognosis than non-neck tumors.

Clinicopathological significance of intestinal metaplasia in endoscopically resected early gastric carcinoma.

To investigate the clinicopathological and prognostic significance of intestinal metaplasia (IM) in endoscopically resected early gastric carcinoma (EGC). Altogether 136 consecutive cases with EGC resected by endoscopic submucosal dissection over 5 years were included and divided into theearly gastric cardiac (EGCC; n = 60) and non-cardiac carcinoma (EGNCC; n = 76) groups. Goblet cell IM and subtypes were determined with histology and immunostaining. Recurrence-free survival (RFS) was compared among various IM groups. IM was identified in 128 (94.1%) EGC cases, including complete IM (n = 39), incomplete IM (n = 27), and mixed IM (n = 62). Incomplete IM was significantly more common in EGCC and exhibited a lower frequency of en bloc resection than the complete subtype. The frequency of synchronous or metachronous gastric tumor was significantly more common in EGCC with complete IM than in those with incomplete IM. Compared to EGC without IM, EGC with IM showed a significantly higher frequency of non-poorly cohesive carcinoma, en bloc resection, and non-eCuraC-1 grade. EGNCC with IM was significantly associated with negative resection margins and en bloc resection. The 5-year RFS was significantly lower in EGNCC patients with incomplete IM compared with those with mixed IM. The independent risk factors for RFS included tumor size >2 cm and eCuraC-1 grade. Subtyping IM in EGC helped predict endoscopic resectability, prognosis, and risk of synchronous or metachronous gastric tumor. The significance of IM differed between EGCC and EGNCC. Large studies with longer follow-up are warranted to validate our findings.

Targeted Polymeric Nanoparticles as a Strategy for the Treatment of Glioblastoma: A Review.

Glioblastoma multiforme is the most common and aggressive malignant tumor that affects the central nervous system, with high mortality and low survival. Glioblastoma multiforme treatment includes resection tumor surgery, followed by radiotherapy and chemotherapy adjuvants. However, the drugs used in chemotherapy present some limitations, such as the difficulty of crossing the bloodbrain barrier and resisting the cellular mechanisms of drug efflux. The use of polymeric nanoparticles has proven to be an effective alternative to circumvent such limitations, as it allows the exploration of a range of polymeric structures that can be modified in order to control the biodistribution and cytotoxic effect of the drug delivery systems. Nanoparticles are nanometric in size and allow the incorporation of targeting ligands on their surface, favoring the transposition of the blood-brain barrier and the delivery of the drug to specific sites, increasing the selectivity and safety of chemotherapy. The present review has described the characteristics of chitosan, poly(vinyl alcohol), poly(lactic-coglycolic acid), poly(ethylene glycol), poly(β-amino ester), and poly(ε-caprolactone), which are some of the most commonly used polymers in the manufacture of nanoparticles for the treatment of glioblastoma multiforme. In addition, some of the main targeting ligands used in these nanosystems are presented, such as transferrin, chlorotoxin, albumin, epidermal growth factor, and epidermal growth factor receptor blockers, explored for the active targeting of antiglioblastoma agents.

RBIO-01. GAMMATILE ® (GT) AS A BRACHYTHERAPY PLATFORM FOR RAPIDLY GROWING BRAIN METASTASIS

Abstract BACKGROUND A subset of brain metastasis (BM) shows rapid recurrence post-initial resection or aggressive tumor growth between interval scans. Here we provide a pilot experience in the treatment of these brain metastasis with GammaTile ® (GT), a collagen tile-embedded Cesium 131 (131Cs) brachytherapy platform. METHODS We identified ten consecutive patients (2019-2023) with brain metastasis that showed either 1) symptomatic recurrence while awaiting post-resection radiosurgery or 2) enlarged by &amp;gt;25% of tumor volume on serial imaging and underwent surgical resection followed by GT placement. Procedural complication, 30-day readmission, local control, and overall survival were assessed. RESULTS For this cohort of ten BM patients, three patients suffered tumor progression while awaiting radiosurgery and seven showed &amp;gt;25% tumor growth prior to surgery and GT placement. There were no procedural complications or 30-day mortality. All patients were discharged home, with a median hospital stay of two days (range: 1-9 days). 4/10 patients experienced symptomatic improvement while the remaining patients showed stable neurologic conditions. With a median follow-up of 186 days (6.2 mo, range: 69-452 days), no local recurrence was detected. The median overall survival (mOS) for the newly diagnosed BM was 265 days from the time of GT placement. No patients suffered from adverse radiation effects. CONCLUSION Our pilot experience suggests that GT offers favorable local control and safety profile in patients suffering from brain metastases that exhibit aggressive growth patterns and support the future investigation of this treatment paradigm.

Laparoscopic extralevator abdominoperineal resection for low rectal cancer: The myth of reinventing the wheel.

To review oncological outcomes of laparoscopic extralevator abdominoperineal excision (LAP-ELAPE) for low rectal cancer.In locally advanced low rectal cancer, ELAPE which is en-bloc resection of levator muscles along with the tumor in a prone position has significantly decreased the rate of having either positive circumferential resection margin (CRM) or tumor perforation. The aim of the study was to determine the oncological outcomes of laparoscopic extralevator abdominoperineal excision (LAP-ELAPE) for low rectal cancer. This retrospective study was performed at Shaukat Khanum Cancer Hospital and Research Centre Lahore. Patients who underwent ELAPE for low rectal and anal cancer from January 2014 to December 2019 were selected. Data was collected using an electronic database through a hospital information system. A total of 82 patients were included in the study having a median age of 39 years. Clinically preoperative tumor sizes were T2:2, T3:65, T4:15. Neo-adjuvant chemo radiotherapy was administered to 79 (96.3%) patients. Pathologically tumor sizes were T0:12, T2:15, T3:50, T4:5 with 79.2% (n=65) R0 resections. The mean operative time was 340.36±64.51 minutes and the mean blood loss was 99 milliliters. The mean postoperative hospital stay was 6.58±4.64 days. Seventeen (20.7%) cases had pathological circumferential resection margins positive (pCRM<1mm). However, tumor perforation was found in 8(9.8%) patients. Ninety days mortality was none while 36 patients experienced recurrence (local: 23, distant: 30, local + distant 17). The median survival time was 53.00±2.69 months. For locally advanced low rectal cancer, ELAPE has evolved as a safe oncological procedure with acceptable outcomes.

Predicting resection margin status of pancreatic neuroendocrine tumors on CT: performance of NCCN resectability criteria.

To test the performance of the National Comprehensive Cancer Network (NCCN) CT resectability criteria for predicting the surgical margin status of pancreatic neuroendocrine tumor (PNET) and to identify factors associated with margin-positive resection. Eighty patients with pre-operative CT and upfront surgery were retrospectively enrolled. Two radiologists assessed the CT resectability (resectable [R], borderline resectable [BR], unresectable [UR]) of the PNET according to NCCN criteria. Logistic regression was used to identify factors associated with resection margin status. κ statistics were used to evaluate interreader agreements. Kaplan-Meier method with log-rank test was used to estimate and compare recurrence-free survival (RFS). Forty-five patients (56.2%) received R0 resection and 35 (43.8%) received R1 or R2 resection. R0 resection rates were 63.6-64.2%, 20.0-33.3%, and 0% for R, BR, and UR diseases, respectively (all p ≤ 0.002), with a good interreader agreement (κ, 0.74). Tumor size (<2 cm, 2-4 cm, and >4 cm; odds ratio (OR), 9.042-18.110; all p ≤ 0.007) and NCCN BR/UR diseases (OR, 5.918; p = 0.032) were predictors for R1 or R2 resection. The R0 resection rate was 91.7% for R disease <2 cm and decreased for larger R disease. R0 resection and smaller tumor size in R disease improved RFS. NCCN resectability criteria can stratify patients with PNET into distinct groups of R0 resectability. Adding tumor size to R disease substantially improves the prediction of R0 resection, especially for PNETs <2 cm. Tumor size and radiologic resectability independently predicted margin status of PNETs.

The Role of Interleukin 6 (IL6), Cancer Antigen-125 (CA-125), and Human Epididymis Protein 4 (HE4) to predict tumor resectability in the advanced epithelial ovarian cancer patients.

A study of tumor resectability in pre-operative patients with advanced epithelial ovarian cancer is required to predict primary surgical benefits accurately. This study aims to investigate IL6, CA-125 and HE4 to predict tumor resectability in the pre-operative patients with advanced epithelial ovarian cancer. This cross-sectional study was conducted in the polyclinic, oncology and gynecology inpatient room of Dr. M. Jamil Padang Hospital from June until December 2022. Advanced epithelial ovarian cancer stage based on histology result from FIGO stages IIIB-IVA. IL6, CA-125, and HE4 were measured using ECLIA (electrochemiluminescence immunoassay). Categorical data were assessed using Chi-square and Mann-Whitney tests. Numerical variable correlations were analyzed using Pearson Correlation tests. While the correlation between numerical and nominal variables was analyzed using the Eta correlation test. A p-value of <0,05 was considered a significant correlation. The cut-off value of serum IL6, CA-125, and HE4 was determined with a ROC curve. The sensitivity and specificity of each clinical parameter were calculated. There was a significant difference in IL-6 (1328 vs 752 pg/ml; p<0,001), CA-125 (1260,5 vs 819,5 U/ml; p<0,001), and HE4 levels (1320 vs 760 pmol/L; p<0,001) between patients with tumor resectability of > 1 cm (suboptimal) vs < 1 cm (optimal). There was a correlation between IL6 (r = 0,832), CA-125 (r = 0,716), and HE4 (r = 0,716) with tumor resectability. Measuring IL6, CA-125, and HE4 levels is useful for clinicians to predict tumor resectability in pre-operative patients with advanced epithelial ovarian cancer.

The role of 3D modeling in pancreas surgery: a review

INTRODUCTION: Surgical interventions on the pancreas are technically complex and are accompanied by a fairly large number of complications, which is largely due to the variant anatomy of the pancreas.OBJECTIVE: The aim of this paper is to evaluate the possibilities of 3D modeling in the surgical treatment of pancreatic diseases according to the literature.MATERIALS AND METHODS: Literature searched in Russian and English for the period from 2017 to 2022 in Medline/PubMed, RSCI/Elibrary, CyberLeninka, Google Scholar databases. The search was conducted on the keywords: pancreas, chronic pancreatitis, pancreatic cancer, pancreatic resection, computed tomography, 3-D modeling, 3-D reconstruction, surgical planning, surgical intervention, pancreas, chronic pancreatitis, pancreas cancer, pancreatectomy, computed tomography, 3-D modeling, 3D reconstruction, surgical planning.RESULTS: 49 publications on various aspects of the use of 3D modeling in pancreatic surgery were included in the final analysis. The diagnostic value of building three-dimensional models in assessing the resectability of pancreatic tumors, identifying individual topographic and anatomical features of the pancreatobiliary zone, which should be taken into account during surgery to avoid intra- and postoperative complications, is shown. Examples of a description based on 3D modeling of rare vascular anomalies and cysts that are not visualized according to standard computed tomography in patients who are scheduled for pancreatic surgery are presented. The importance of postoperative 3D modeling of the pancreas for assessing the adequacy of the surgical intervention and early detection of possible complications of the operation is indicated.CONCLUSION: 3D modeling is an innovative and promising diagnostic method that allows increasing the information content of standard computed tomography in pancreatic surgery. 3D models make it possible to select patients for pancreatic resection and substantiate the most optimal surgical strategy. In the future, we should expect an improvement in the results of surgical treatment of pancreatic tumors and complicated pancreatitis.

Improving the Reliability of Medical Diagnostic Models through Rule-Based Decision Deferral

Pancreatic ductal adenocarcinoma (PDAC) is a highly lethal cancer, and accurate assessment of tumor resectability is crucial for determining appropriate treatment. AI-based models have shown promise in classifying tumor resectability, but reliability concerns have impeded clinical implementation. We propose extending the AI-based VasQNet model for classifying tumor resectability on AI-generated segmentations of computed tomography scans (CTs) to improve the models’ reliability. This extension allows VasQNet to defer decisions when the AI-generated segmentations violate pre-established rules on vascular anatomy, tumor location, and tumor size. We conducted experiments using CTs of (borderline) resectable and non-resectable PDAC patients. We evaluated the performance of the baseline VasQNet and the extended VasQNet with rule-based decision deferral (RBDD) by comparing their classifications to a ground-truth provided by a radiologist, employing agreement as a metric. Our results demonstrate that the extended VasQNet achieved a significantly higher agreement (90%) with the radiologist’s classification than the baseline VasQNet (67%). Notably, 17/31 (54%) deferred decisions would have been incorrect had they not been deferred. Our study demonstrates the effectiveness of RBDD in improving the reliability of clinical diagnostic models through the exemplification of VasQNet. In conclusion, RBDD can enhance the reliability of clinical diagnostics models, facilitating integration into clinical practice. The documented code is available on GitHub (https://github.com/PHAIR-Consortium/Vessel-Involvement-Quantifier).

Neoadjuvant Radiation Therapy in the Treatment of Breast Cancer

Radiation therapy improves locoregional control and increases breast cancer patient's survival. Its neoadjuvant setting is a rarely used alternative that favors tumor resectability and, in addition, allows immediate breast reconstruction. This study aims to characterize locally advanced breast cancer patients that were treated with neoadjuvant radiotherapy (naRT), its indications and results. Medical records were reviewed retrospectively. All patients diagnosed with breast cancer treated with curative-intent naRT in a Chilean oncologic hospital between January 2017 and 2019 were included. Inflammatory breast cancer cases and sarcomas were excluded. We described demographic, clinical and treatment characteristics, naRT indications and outcomes. Information was collected from 112 patients (98% women) referred from 7 public hospitals. The median age was 57 years [28-85 years]. At diagnosis, 78% corresponded to clinical stage cT4b, and 83% had cN+ axilla (axillary biopsy was performed in 44 cases, 35 were positive). 53% were classified as luminal B, 19% as triple negative, 17% as luminal A, and 11% as HER2 enriched. 98% of patients began treatment with neoadjuvant systemic therapy (91 patients received chemotherapy and 19 patients hormone therapy). naRT indications were: immediate breast reconstruction in 23% and contraindication or unsatisfactory response to systemic therapy in 77%. In 99% of naRT the dose was 45-50 Gy to the breast/chest wall and peripheral lymphatics. 86% of patients underwent surgery (14 patients did not undergo surgery due to disease progression or because they refused surgery and 2 patients were on the waiting list at the time of follow up). Immediate breast reconstruction was performed in 31 patients with a median age of 45 years, all of them were derived from 2 referral centers that suggest this altered sequence of treatments. Surgical biopsies of 96 patients were reviewed: 13% had pathological complete response in the breast/chest wall, 55% in the axilla, and 12% at both levels. 30% of post-surgical complications were reported in the subgroup of patients who continued follow-up in our institution (total of 47 patients). With a median follow-up of 29 months, 18% of the patients had died from breast cancer. naRT is not only an option when systemic therapy is not a good alternative, but also favors resectability of locally advanced tumors making pathological complete response and immediate breast reconstruction possible in selected cases, obtaining an oncological and reconstructive objective in the same surgery.

Extreme hepatectomy with modified ALPPS in a rat model: gradual portal vein restriction associated with hepatic artery restriction

Background & aimAssociating liver partition and portal vein ligation (PVL) for staged hepatectomy (ALPPS) is a creative strategy for enlarging the future liver remnant (FLR) and increasing the tumor resectability rate. However, the indications for ALPPS must have a certain limit when the FLR is too small. We aimed to establish a modified ALPPS model with more widen applicability in rats.MethodsAn extreme ALPPS model was established in rodents with only a 6.5% FLR. The portal vein (PV) was subjected to restriction to different degrees, then the portal vein pressure (PVP) was measured. Then, different modifications of ALPPS, including hepatic artery restriction (HAR), gradual portal vein restriction (GPVR), and GPVR-associated HAR (HAR+GPVR), were applied in the extreme ALPPS models.ResultsPVL or PVR provoked an immediate increase in the PVP. The PVP in the PVR -1.28 mm, PVR -0.81 mm, PVR -0.63 mm, and PVL groups was 11.05±1.57 cmH2O, 16.18±1.92 cmH2O, 20.66±1.99 cmH2O, and 24.10±3.33 cmH2O, respectively, and the corresponding 3-day survival rate was 100%, 90.09%, 36.33% and 0, respectively. Then, in the extreme ALPPS model, the growth ratio of the FLR in the control, HAR, GPVR, and HAR+GPVR groups was 0.43±0.21, 0.50±0.16, 4.80±0.86, and 7.40±2.56, and as a consequence, the corresponding 30-day survival rate was 9.09%, 15.38%, 84.61% and 92.90%, respectively.ConclusionALPPS itself has a limit, and high PVP after PVL contributes to postoperative death in the extreme ALPPS model. Furthermore, a modified method for extreme ALPPS is proposed, i.e., GPVR+HAR in place of PVL, which significantly improves the survival rate of extreme hepatectomy in rat models.