Visceral Cancer Research Articles

Nodule de Soeur Marie Josèphe sur cancer ovarien: à propos d’un cas

Sister Mary Joseph’s tumor or nodule is a cutaneous ombilical metastasis of a visceral cancer. It is a rare tumor that constitutes the calling symptom of the cancer disease. Its incidence is from 1 to 3% of all abdominal and pelvic neoplasia. They bring up etiologic diagnosis issue, since the finding of the primitive cancer could be difficult et prognosis. We are reporting a case observed in the Hepato-gastro-enterology Unit of the University Hospital Center of Sino-Central African Friendship in Bangui. This observation will help us show the difficulties of early diagnosis and therapeutic care in a limited resources context.

Prognostic value of [18F]FDG PET/CT in metastatic hormone-sensitive prostate cancer at initial diagnosis: a retrospective cohort study

Introduction This retrospective study aimed to evaluate the prognostic value of [18F]FDG parameters in patients with visceral and bone metastatic hormone-sensitive prostate cancer (mHSPC). Patients and methods This analysis included the mHSPC patients who underwent [18F]FDG PET/CT at the initial diagnosis. Baseline characteristics were analyzed, and the uptake of [18F]FDG was quantified using SUVmax. Kaplan–Meier and Cox proportional hazard regression analysis were employed to evaluate the correlation between SUVmax and patient survival. Results Among the 267 patients enrolled, 90 (33.7%) presented with visceral metastases and 177 (66.3%) had bone metastases. The median follow-up for the visceral metastasis group was 35.5 months (IQR 26–53.8 months). The median overall survival for patients with lung, liver, or both metastases were 30, 21 and 17 months, respectively. Patients exhibiting higher [18F]FDG uptake in metastatic lesions experienced shorter overall survival (OS) in comparison to those with lower [18F]FDG uptake, both in the visceral metastases group (17 vs. 31 months, p = 0.002) and the bone metastases group (27.5 vs. 34.5 months, p < 0.001). Cox regression analysis further revealed that increased [18F]FDG uptake in metastatic lesions emerged as a significant risk factor in both OS and progression-free survival (PFS). In contrast, the variability in [18F]FDG uptake in primary lesions did not provide a reliable indicator for predicting prognosis. Conclusions In mHSPC patients, higher [18F]FDG uptake in metastatic lesions indicates shorter survival and increased risk of disease progression. The [18F]FDG SUVmax in primary tumors did not show significant prognostic value. Our study underscores the unique prognostic potential of [18F]FDG PET/CT in mHSPC patients, highlighting its importance in the management of both bone and visceral metastases.

Association between visceral adiposity index and cancer risk in the UK Biobank cohort.

The visceral adiposity index (VAI) is a marker of visceral fat accumulation and metabolic dysfunction, but there is limited evidence of its association with cancer. The objective of this study was to investigate associations between the VAI and both incident cancer at 23 sites and all-cause cancer. In total, 385,477 participants (53.3% women; mean age, 56.3 years) from the UK Biobank prospective cohort were included in this study. The median follow-up was 8.2 years (interquartile range, 7.3-8.9 years). The VAI was calculated using formula the published by Amato etal. and was categorized into sex-specific tertiles. Twenty-four incident cancers were the outcomes. Cox proportional hazard models were adjusted for sociodemographics, lifestyle factors, and multimorbidity counts. Over the follow-up period, 47,882 individuals developed cancer. In the fully adjusted models, the VAI was associated with a higher risk of six cancer sites. Individuals in the highest tertile, compared with those in the lowest tertile, had higher risks of uterine (hazard ratio [HR], 2.09; 95% confidence interval [CI], 1.76-2.49), gallbladder (HR, 1.83; 95% CI, 1.26-2.66), kidney (HR, 1.39; 95% CI, 1.18-1.64), liver (HR, 1.25; 95% CI, 1.00-1.56), colorectal (HR, 1.14; 95% CI, 1.05-1.24), and breast (HR, 1.11; 95% CI, 1.03-1.19) cancers and of all-cause cancer (HR, 1.05). There was no evidence of a nonlinear association between the VAI and cancer risk. The VAI was associated with six cancer sites and with all-cause cancer. The prognostic and etiologic roles of visceral fat accumulation and dysfunction in cancer warrant further research.

Survival Patterns Based on First-site–specific Visceral Metastatic Prostate Cancer: Are Outcomes of Visceral Metastases the Same?

Background and objectiveVisceral metastatic disease in prostate cancer patients conveys a poor prognosis. Using advanced imaging techniques, studies have demonstrated increasing detection rates of visceral metastasis. Visceral metastases are now seen in up to 30–60% of prostate cancer patients. Survival patterns of site-specific visceral metastasis are described poorly in the literature. Here, we sought to investigate survival patterns in prostate cancer patients according to their first detected site of visceral metastasis. MethodsRetrospectively, we identified 203 prostate cancer patients with visceral metastases from the Mayo Clinic Advanced Prostate Cancer Registry. Patients were divided into three groups according to the first site of visceral metastases detected: lung, brain, or liver. Visceral metastases were detected primarily on either metabolic imaging (C-11 choline) or prostate-specific membrane antigen positron emission tomography computed tomography (CT) scan. Confirmation of visceral metastasis diagnosis was established with either biopsy when feasible or focused conventional imaging, including focused CT or magnetic resonance imaging. Overall survival and cancer-specific survival were estimated using the Kaplan-Meier method. Univariate and multivariate Cox regression model was conducted to assess different variables that affect overall and cancer-specific survival. Key findings and limitationsOver a median (interquartile range) follow-up duration of 16.2 (3.9–49.8) mo, the overall and cancer-specific survival of the entire cohort suggests better survival patterns in patients with first-site lung metastases than in patients with first-site brain or liver metastases (p < 0.0001). In univariate and multivariate analyses of factors impacting patients’ overall and cancer-specific survival, a high prostate-specific antigen level at diagnosis of visceral metastasis, concomitant bone and lymph node disease, and more than four visceral metastases were associated with poor overall and cancer-specific survival (p < 0.05). On the contrary, first-site lung metastasis was associated with improved overall and cancer-specific survival, compared with first-site liver and brain metastases (p < 0.001). Conclusions and clinical implicationsThese data suggest that prostate cancer patients with visceral metastatic disease have varying survival patterns according to first-site detected visceral metastasis. In our cohort, patients with first-site lung metastasis demonstrated better survival outcomes than patients with first-site brain or liver metastasis. Patient summaryOur study explored the survival outcomes among patients with visceral metastatic prostate cancer employing cutting-edge imaging methods. Prostate cancer patients with metastases to different organs have different survival rates. Patients with cancer spreading to the lungs first showed better survival than those with cancer spreading to the brain or liver first.

Perioperative pain management with regional analgesia techniques for visceral cancer surgery: A systematic review and meta-analysis

Study objectiveRegional analgesia following visceral cancer surgery might provide an advantage but evidence for best treatment options related to risk-benefit is unclear. DesignSystematic review of randomized controlled trials (RCT) with meta-analysis and GRADE assessment. SettingPostoperative pain treatment. PatientsAdult patients undergoing visceral cancer surgery. InterventionsAny kind of peripheral (PRA) or epidural analgesia (EA) with/without systemic analgesia (SA) was compared to SA with or without placebo treatment or any other regional anaesthetic techniques. MeasurementsPrimary outcome measures were postoperative acute pain intensity at rest and during activity 24 h after surgery, the number of patients with block-related adverse events and postoperative paralytic ileus. Main results59 RCTs (4345 participants) were included. EA may reduce pain intensity at rest (mean difference (MD) -1.05; 95% confidence interval (CI): −1.35 to −0.75, low certainty evidence) and during activity 24 h after surgery (MD -1.83; 95% CI: −2.34 to −1.33, very low certainty evidence). PRA likely results in little difference in pain intensity at rest (MD -0.75; 95% CI: −1.20 to −0.31, moderate certainty evidence) and pain during activity (MD -0.93; 95% CI: −1.34 to −0.53, moderate certainty evidence) 24 h after surgery compared to SA. There may be no difference in block-related adverse events (very low certainty evidence) and development of paralytic ileus (very low certainty of evidence) between EA, respectively PRA and SA. ConclusionsFollowing visceral cancer surgery EA may reduce pain intensity. In contrast, PRA had only limited effects on pain intensity at rest and during activity. However, we are uncertain regarding the effect of both techniques on block-related adverse events and paralytic ileus. Further research is required focusing on regional analgesia techniques especially following laparoscopic visceral cancer surgery.

Atypical neoplastic solitary focal uptake of 18F-PSMA-1007 in PET/CT in patients with biochemically recurrent prostate cancer

It is established that prostate-specific membrane antigen (PSMA), despite its name, is expressed in many tissues other than the prostate gland, both within physiological conditions and in various pathological processes. Additionally, apart from prostate cancer, other malignant tumors are characterized by increased PSMA expression which, according to many authors, is associated with neoangiogenesis. These factors are reflected in the results of PSMA-radioligand imaging and require comprehensive approach to image interpretation including evaluation of computed tomography and magnetic resonance semiotics. In addition, rare cases of distant visceral prostate cancer metastasis in the form of solitary lesions also should be considered during interpretation of the results of radiologic imaging including positron emission tomography/computed tomography.We present two clinical cases in which positron emission tomography/computed tomography revealed solitary foci of pathological 18F-PSMA-1007 uptake outside the areas of typical metastatic spread (with exception of advanced disease) of prostate cancer, specifically in the stomach wall and the left cerebellar hemisphere. In the first case histological examination results revealed a metachronous low grade neuroendocrine tumor of the stomach, in the second case a metastatic lesion of the cerebellum was diagnosed as part of the underlying disease.

Spectrum of Cutaneous Metastasis in Visceral and Haematolymphoid Malignancies: A Cross-sectional Study at a Tertiary Care Centre in Kolkata, West Bengal, India

Introduction: Cutaneous Metastasis (CM) is the spread of malignant cells from a primary site of malignancy to the skin. The incidence of CM ranges from 0.5% to 9% of all patients with cancer. CM may be the first sign of clinically silent visceral cancer or can even be a clue to tumour recurrence and heralds a poor prognosis requiring intense chemoradiotherapy. Aim: To study the spectrum of CM of internal malignancies, including haematolymphoid neoplasms. Materials and Methods: This cross-sectional study was conducted at Department of Pathology, Command Hospital Kolkata, West Bengal, India, over a period of two years from April 2020 to March 2022 and data was analysed over the next six months. A total of 16 patients who developed CM secondary to underlying solid organ or haematological malignancy were analysed. Categorical variables were summarised as percentages. Data in tables were presented as the frequency of variables (categories) or as absolute numbers. Results: The parameters studied included the primary site of malignancies, the frequency of various histological types at the primary site, and the common cutaneous metastatic regions. The mean patient age was 55.25 years (ranges 24- 72 years) with no gender predilection (M:F=1:1). The most common primary cancer site was the kidney and the oral cavity 4 each (25%), followed by breast, lung, and haematolymphoid malignancy, 2 each (12.5%), and 1 each of thyroid and gallbladder (6.25%). The most common site of CM was the head, abdomen, and epigastric wall 07/16 each (43.75%). The majority of the CM were identified as adenocarcinoma on histopathology. Conclusion: The CM occurs rarely and can be the initial presentation of an occult internal malignancy or may suggest recurrence if diagnosed later. Renal cell carcinomas and squamous cell carcinomas of the oral cavity are the tumours that have a high predisposition for CM, and hence these patients require close follow-up and surveillance.

Association Between Visceral Fat Area and Cancer Prognosis: A Population-Based Multicenter Prospective Study

BackgroundDiverse indicators have been used to represent adipose tissue, while the relationship between body adipose mass and the prognosis of patients with cancer remains controversial. ObjectiveThis study aimed to explore the indicators of optimal body composition that represent body fat mass to predict risk of cancer-related mortality. MethodsWe conducted a population-based multicenter prospective cohort study of patients with initial cancer between February 2012 and September 2020. Clinical information, body composition indicators, hematologic test results, and follow-up data were collected. Body composition indicators were analyzed using principal component analysis to select the most representative indicators, and the cutoff value was set according to the optimal stratification method. The hazard ratio (HR) for mortality was calculated using Cox proportional hazards regression models. ResultsAmong 14,018 patients with complete body composition data, visceral fat area (VFA) is a more optimal indicator for body fat content (principal component index: 0.961) than body mass index (principal component index: 0.850). The cutoff points for VFA in terms of time to mortality were 66 cm2 and 102 cm2 for gastric/esophageal cancer and other cancers, respectively. Among the 2788 patients treated systemically, multivariate analyses demonstrated that a lower VFA was associated with a higher risk of death in patients with cancer of diverse types (HR: 1.33; 95% CI: 1.08, 1.64; P = 0.007), especially gastric cancer (HR: 2.13; 95% CI: 1.3, 3.49; P = 0.003), colorectal cancer HR: 1.81; 95% CI: 1.06, 3.08; P = 0.030) and nonsmall-cell lung cancer (HR: 1.27; 95% CI: 1.01, 1.59; P = 0.040). ConclusionVFA is an independent prognostic indicator of muscle mass in patients with diverse types of cancer, particularly gastric, colorectal, and nonsmall-cell lung cancers. Trial registration numberChiCTR1800020329.

PO-1466 PFS Following SBRT for Visceral Oligometastatic Prostate Cancer: A Multicenter Retrospective Study

PO-1466 PFS Following SBRT for Visceral Oligometastatic Prostate Cancer: A Multicenter Retrospective Study

The Therapeutic Value of Tetrodotoxin

Tetrodotoxin is a very important toxin to study because there are many cases of intoxication of tetrodotoxin. In this review, we will illustrate the therapeutic value of tetrodotoxin by explaining the mechanism of tetrodotoxin, the importance of tetrodotoxin as a pain treatment, and some clinical evidence. Tetrodotoxin can prevent the neurons from traveling through the voltage-gated sodium ion channel and stop the transmission of the neurons and stimuli, which makes tetrodotoxin able to treat several types of pain such as visceral pain and cancer pain. By blocking the neurons and stimuli in the body, the feeling of pain will not occur in the body. The two clinical examples show that Tetrodotoxin is effective in treating pain but not as effective as morphine. Therefore, the use of tetrodotoxin to treat pain may reduce the use of morphine.

Survival patterns based on site-specific visceral metastasis in patients with metastatic prostate cancer: Are outcomes of visceral metastases the same?

269 Background: Metastatic visceral involvement in prostate cancer patients conveys a poor prognosis. Survival patterns of site-specific visceral metastasis are poorly understood. Here, we sought to investigate survival patterns in prostate cancer patients according to their first detected site of visceral metastasis. Methods: Retrospectively, we identified 200 patients with visceral metastatic prostate cancer. Patients were divided into three groups according to first site detected with visceral metastases; first-site lung metastases, first-site brain metastases, and first-site liver metastases. Visceral metastases were detected on either conventional imaging (CT/MRI), metabolic imaging (C-11 choline), or PSMA PET-CT scan. Follow up duration of our study was 80 months. Results: Clinicopathological variables are shown. The K-M curve of overall survival of the entire cohort suggests better survival patterns in patients with first-site lung metastases compared to patients with first-site brain or liver metastases (p&lt;0.0001). In subset analysis of patients with CRPC, the K-M curve of overall survival, which demonstrates better survival outcomes in patients with first-site lung metastases in comparison with patients with first-site brain or liver metastases (p&lt;0.0001). Conclusions: Our data suggests that prostate cancer patients with visceral metastatic disease have different survival patterns according to the first site detected with visceral metastasis. In our cohort, patients with first-site lung metastasis demonstrated better survival outcomes than patients with first-site brain or liver metastasis. Further studies are warranted. [Table: see text]

Синдром Мьюир-Торре – предиктор рака желудка (клиническое наблюдение)

Muir-Torre syndrome is a hereditary autosomal dominant syndrome that belongs to HNPCC (Lynch syndrome), being its subspecies. The disease is associated with a high risk of developing colorectal cancer, as well as other cancers of the gastrointestinal tract, genitourinary tract and skin lesions in the form of tumors of the sebaceous glands and keratoacanthus. Visceral cancer in the syndrome is characterized by multiple localization and a low degree of malignancy. Mutations in the genes MSH2 and MLH1 - loci 2p22–p21 and 3p21.3 in the DNA repair system were detected in patients with Muir-Torre syndrome, which leads to its microsatellite instability. Skin tumors may precede visceral cancer, may develop in parallel with the malignant process of internal organs. The importance of timely diagnosis of skin neoplasms (sebaceous gland adenomas and keratoacanthus) as a marker of Muir-Torre syndrome is emphasized. The article presents a clinical case of Muir-Torre syndrome in a 50-year-old patient, which was manifested by a combination of gastric cancer, multiple adenomas of the sebaceous glands and solitary keratoacanthoma. The first manifestations of the syndrome were adenomas of the sebaceous glands of the facial skin, mistakenly regarded by dermatologists as a papular form of rosacea. After 4 years, the patient underwent surgery for a keratoacanthoma of the shin, a couple of months later, the patient was diagnosed with stage IIA gastric cancer (T3N0M0), a ring-cell variant. Skin rashes were regarded as hereditary paraneoplastic Muir–Torre syndrome. In order to detect oncological diseases early, it is necessary to improve the qualifications of doctors in the clinic and diagnosis of hereditary paraneoplastic dermatoses.

Cervical Pap smear: A retrospective study on symptomatic women in a tertiary care hospital.

Background: Cancer of the cervix is an increasing health problem and an important cause of mortality in womenworldwide. Cervical cancer ranks 2nd most common visceral cancer in females and stands 3rd in causing death in women inthe world. Pap smear is used as primary screening test for detection of early cervical epithelial changes, cervical epithelialneoplasia and early stage of invasive cervical cancer. Recommendations for Pap smear generally starts around 21 years ofage or within 3 years of onset of sexual activity and thereafter every 3 yearsMethods: This retrospective study was conducted on 100 patients to evaluate all previously reported cervical smearsin the Department of Pathology GMC Kathua, who came with different gynaecological complaints in GynaecologicalOPD at GMC Kathua, J&amp;K.Smears were obtained with the help of Ayre’s spatula and cytobrush to collect specimen fromtransformation zone. The cellular material is quickly spread on 2 clean glass slides and fixed immediately by immersingthem in copulin jar containing 95% ethyl alcohol. The smears were stained with Papanicolaou stain. After mounting theslides with DPX and examined under light microscope , they are reported by pathologists according to Revised BethesdaSystem.Conclusion: Pap smear test is a simple, inexpensive, non -invasive and an OPD performed to detect various premalignantand malignant lesions of cervix. By conducting health camps, increasing awareness programmes and performing Papsmears, the incidence of cervical cancer can be greatly reduced.

A case report of immediate effects of acupuncture on neuropathic cancer breakthrough pain

IntroductionAcupuncture is a promising treatment for visceral cancer pain, but to date, evidence for immediate effects on neuropathic pain is limited. Case presentationThis report presents a case of immediate pain relief by single-needle acupuncture on opioid-refractory neuropathic breakthrough pain in a 78-year-old female breast cancer patient with cervical bone metastases. Acupuncture was applied at a single point neuroanatomically correlating to the pain affected spinal segment. DiscussionImmediately after acupuncture, the patient reported a complete pain relief lasting for one day. In the following days, neuropathic breakthrough pain was better manageable with reduced dosages of opioids. Acupuncture is possibly effective in providing immediate and safe pain relief in neuropathic cancer pain through neuromodulating effects on the spinal and central nervous level. Randomized controlled studies with individualized acupuncture point protocols are needed to establish efficacy and safety.

Strengths and Weaknesses of an Artificial Intelligence Polyp Detection Program as Assessed by a High-Detecting Endoscopist

Strengths and Weaknesses of an Artificial Intelligence Polyp Detection Program as Assessed by a High-Detecting Endoscopist

Association of Plasma Zinc and Prostate-Specific Antigen in Patients with Prostatic Cancer in Khartoum

Background: Prostate cancer is the most common visceral cancer in males, ranking as the second most common cause of cancer-related deaths in men older than 50 years of age, after carcinoma of the lung. It is predominantly a disease of older males, with a peak incidence between the ages of 65 and 75 years. This study aimed to estimate the plasma zinc level and plasma prostate-specific antigen (PSA) level in patients suffer from prostate cancer. Materials and Methods: A case–control study was conducted in Khartoum on 100 males aged more than 50 years old which were divided into 50 apparently healthy as control and 50 with prostate cancer as case. A 5 ml of blood specimens was collected in lithium heparin anticoagulants for the estimation of plasma zinc level using Buck model 210 VGP Atomic Absorption Spectrophotometer (East Norwalk, CT 06855) made in the USA and the plasma total PSA that was measured by immunoassay Sandwich principle HITACHI ROCHE COBAS E 411 (serial number 04641655190 V 13.0). Results: The mean level of plasma zinc was 0.35 mg/L ± standard deviation [SD] 0.14 in case and in control was 0.68mg/L ± SD 0.13, so the P value was 0.002 and PSA was 43.08 ng/ml ± SD 20.08 in case and 3.53 ng/ml ± SD 3.90 in control, so the P value was 0.000, the correlation between the level of plasma PSA with plasma zinc in patients with prostate cancer give R was 0.01 and R 2 was 0.001. Conclusion: This study concluded that PSA is significantly increased in patients with prostate cancer and plasma zinc level is significantly decreased in patients with prostate cancer. However, it is statistically significant.

Assessment of locomotive syndrome in patients with visceral cancer, the comparison with non-cancer patients using propensity score matching

BackgroundWhen treating cancer patients, the progression of symptoms is accompanied by the deterioration of systemic conditions and motor function. From a risk-benefit perspective, a certain level of physical function must be maintained to continue cancer treatment. Recently, outpatient cancer treatment has become more common. Motor function is important to determine the feasibility of continuing cancer treatment. The study aimed to evaluate the motor function of patients with visceral cancer using locomo tests established by Japanese Orthopaedic Association. MethodsLocomo tests were performed, and the results were compared with data from non-cancer individuals. Background data were matched by propensity score matching. Data from 53 cancer patients (group C) were compared with that of 75 non-cancer patients (group N). ResultsThe average score in the two-step test of group C was lower than that of group N (1.27: 1.37, p = 0.004). The average function in the stand-up test of group C was worse than that of group N (p = 0.001). The average score in the 25-question geriatric locomotive function scale (GLFS) of group C was significantly higher than that of group N (19.92: 5.29, SE 2.21, p < 0.001). Higher 25-question GLFS scores indicate reduced mobility. The proportion of the locomo stage 2 in group C was significantly higher than in group N (51%: 13%, p < 0.001). The results of the two field tests revealed a clinically minimal difference between the two groups, but a statistically significant difference. Locomo tests may be detect potential motor dysfunction in outpatient cancer patients with apparently maintained motor function. ConclusionsEven in cancer patients who attend outpatient clinics, their motor functions could be potentially impaired. Therapeutic interventions to maintain and enhance motor function for cancer patients could be useful for continuing cancer treatment, and furthermore, improving prognosis.

Outcomes of celiac plexus block and neurolysis, as well as technique in the management of refractory visceral cancer pain

Aim: Assessment of Celiac Plexus Block and Neurolysis Outcomes and Technique in the Management of Refractory Visceral Cancer PainMethods: A retrospective study was conducted in the Department of Surgery, & Anesthesiology, Rama medical college hospital & research centre, Hapur, UP, India from September 2019 to August 2020. 80 Patients with non resectable abdominal malignancy, moderate or severe abdominal and/or back pain poorly controlled with pharmacotherapy were included in this study. The age, gender, duration of pain, origin of tumor, opioid dosage, type of radiological guidance (i.e., fluoroscopic Vs computed tomography [CT]), single- vs double- needle technique, type of block (i.e., anterocrural, retrocrural, or mixed), immediate vs delayed neurolysis, volume of local anesthetic employed for diagnostic block, use and type of sedation, and volume of alcohol used for neurolysis were examined.Results: A total of 80 patients underwent CPB with CPN over the period of the study. Mean age was 55.8 years (range 35–77). There were 45 male patients (56.25%) and 35 female patients (43.75%). Duration of pain was equally split, with 40 patients (50%) having pain for less than 6 months and the same number with pain for greater than 6 months. Our sample consisted primarily of patients with pancreatic cancer (70, 87.5%) with the remainder (10, 12.5%) of other visceral origin. 41 tumors were located in the pancreatic head (58.57%), 22 in the body (31.43%), 8 in the tail (11.43%), and 12 in the neck (17.14%). The majority of patients had metastatic disease detected (65, 81.25%), while 5 patients (6.25%) did not have metastatic disease and in 10 patients (15%) this variable was undocumented. The average daily morphine equivalent dose was 248.2 mg (range 0–1165 mg). There were 30 procedures (37.5%) done under fluoroscopic guidance and 50(62.5%) done under CT guidance. Those variables that were clearly associated with a positive outcome included morphine equivalent dose per day below 250 mg and the absence of sedation for the procedure (both P>0.05). Strongly associated with positive outcome but falling just short of statistical significance were the use of CT guidance for the procedure and the use of less than 20 cc volume of local anesthetic for the diagnostic block prior to neurolysis (P

Visceral Adiposity and Cancer: Role in Pathogenesis and Prognosis.

The prevalence of being overweight and obese has been expanded dramatically in recent years worldwide. Obesity usually occurs when the energetic introit overtakes energy expenditure from metabolic and physical activity, leading to fat accumulation mainly in the visceral depots. Excessive fat accumulation represents a risk factor for many chronic diseases, including cancer. Adiposity, chronic low-grade inflammation, and hyperinsulinemia are essential factors of obesity that also play a crucial role in tumor onset. In recent years, several strategies have been pointed toward boundary fat accumulation, thus limiting the burden of cancer attributable to obesity. While remodeling fat via adipocytes browning seems a tempting prospect, lifestyle interventions still represent the main pathway to prevent cancer and enhance the efficacy of treatments. Specifically, the Mediterranean Diet stands out as one of the best dietary approaches to curtail visceral adiposity and, therefore, cancer risk. In this Review, the close relationship between obesity and cancer has been investigated, highlighting the biological mechanisms at the basis of this link. Finally, strategies to remodel fat, including browning and lifestyle interventions, have been taken into consideration as a major perspective to limit excess body weight and tumor onset.

Influence of the introduction of caseload requirements on indication for visceral cancer surgery in Switzerland

BackgroundIn 2013 Swiss health authorities implemented annual hospital caseload requirements (CR) for five areas of visceral surgery. We assess the impact of the implementation of CR on indication for surgery in esophageal, pancreatic and rectal cancer. Materials and methodsRetrospective analysis of national registry data of all inpatient admissions between January 1st, 2005 and December 31st, 2015. Primary end-point was the age-adjusted resection rate for esophageal, pancreatic and rectal cancer among patients with at least one cancer-specific hospitalization per year. We calculated age-adjusted rate ratios for period effects before and after implementation of CR and odds ratios (OR) based on a generalized estimation equation. A relative increase of 5% in age-adjusted relative risk was set a priori as relevant from a health policy perspective. ResultsAge-adjusted resection rates before and after the implementation of CR were 0.12 and 0.13 (Relative Risk [RR] 1.08; 95%-Confidence Interval [CI] 0.85–1.36) in esophageal cancer, 0.22 and 0.26 (RR 1.17; 95%-CI 0.85–1.58) in pancreatic cancer and 0.38 and 0.43 (RR 1.14; 95%-CI 0.99–1.30) in rectal cancer.In adjusted models OR for resection after the implementation of CR were 1.40 (95%-CI 1.24–1.58) in esophageal cancer, 1.05 (95%-CI 0.96–1.15) in pancreatic cancer and 0.92 (95%-CI 0.87–0.97) in rectal cancer. ConclusionImplementation of CR was associated with an increase of resection rates above the a priori set margins in all resections groups. In adjusted models, odds for resection were significantly higher for esophageal cancer, while they remained unchanged for pancreatic and decreased for rectal cancer.