Showing papers in "Journal of Surgical Oncology in 2009"

Phase II trial of neoadjuvant/adjuvant imatinib mesylate (IM) for advanced primary and metastatic/recurrent operable gastrointestinal stromal tumor (GIST): early results of RTOG 0132/ACRIN 6665.

Abstract: Background Therapy for gastrointestinal stromal tumors (GIST) has changed significantly with the use of imatinib mesylate (IM). Despite the success of this drug in metastatic GIST, disease progression remains a perplexing clinical issue suggesting the need for multimodality management. There have been no prospective studies either evaluating the neoadjuvant use of IM in primary GIST or as a preoperative cytoreduction agent for metastatic GIST. Methods RTOG 0132/ACRIN 6665 was a prospective phase II study evaluating safety and efficacy of neoadjuvant IM (600 mg/day) for patients with primary GIST or the preop use of IM in patients with operable metastatic GIST. The trial continued postop IM for 2 years. Results Sixty-three patients were entered (52 analyzable), 30 patients with primary GIST (Group A) and 22 with recurrent metastatic GIST (Group B). Response (RECIST) in Group A was (7% partial, 83% stable, 10% unknown), in Group B (4.5% partial, 91% stable, 4.5% progression). Two-year progression free survival (Group A 83%, Group B 77%). Estimated overall survival (Group A 93%, Group B 91%). Complications of surgery and IM toxicity were minimal. Conclusion This trial represents the first prospective report of preop IM in GIST. This approach is feasible, requires multidisciplinary consultations, and is not associated with notable postop complications. J. Surg. Oncol. 2009;99:42–47. © 2008 Wiley-Liss, Inc.

A novel image-guided surgery of hepatocellular carcinoma by indocyanine green fluorescence imaging navigation

Abstract: Background and Objectives The clear delineation between tumor and normal tissue is ideal for real-time surgical navigation imaging. We present a novel indocyanine green (ICG) fluorescence imaging technique to visualize hepatocellular carcinoma (HCC). Methods Ten patients with solitary HCC underwent hepatectomy between February and September 2007 at Osaka Medical Center for Cancer and Cardiovascular Diseases. ICG had been injected intravenously several days before surgery at a dose of 0.5 mg/kg body weight. After laparotomy, the liver was inspected with intraoperative ultrasonography (IOUS), and then with a near-infrared (NIR) fluorescence imaging system (PDE; Hamamatsu Photonics K.K. Hamamatsu, Japan). Results All the 10 primary tumors showed bright fluorescent signals and could be completely removed with negative margins under the guide of PDE. In four cases (40.0%), new HCC nodules that were not detected by use of any preoperative examinations including IOUS were detected by PDE. These newly identified HCC nodules were very small in size and most of the tumors were well-differentiated HCCs. Conclusions This novel technique is simple and safe, and is therefore considered to be a promising tool for routine intraoperative imaging during a hepatic resection and further clinical exploration for HCC. J. Surg. Oncol. 2009;100:75–79. © 2009 Wiley-Liss, Inc.

Cancers of the ampulla of vater: Demographics, morphology, and survival based on 5,625 cases from the SEER program

Abstract: Background Cancers of the ampulla are unusual and morphologically heterogeneous. The NCI's SEER Program is now large enough so that unusual cancers can be studied. Based on pathologic and epidemiologic characteristics of cancer of the ampulla available in SEER, important clinicopathological correlations can be made. Methods All patients with cancer of the ampulla were identified between 1973 and 2005. Demographic features, distribution of histological types, age-specific incidence rates, and 5-year survival rates according to stage and histologic type were compared. Results There were 5,625 cases of ampullary cancer. Ampullary cancer has been increasing since 1973. In both African Americans and Caucasians, the disease is more common in men. Adenocarcinomas, NOS comprised 65% of all histological types. Survival depends on stage, grade, and histologic type. Papillary carcinomas had a more favorable survival than other types; carcinomas arising in adenomas had a more favorable survival than adenocarcinomas not associated with adenomas. Logarithmic transformation of age-related incidence data demonstrates that cancers having differing histopathologic phenotypes represent a single population of tumors. Conclusions Prognostic factors include histologic type, grade, stage, and coexisting adenomas. These data should be included in pathology reports. Although certain histologic types exhibit morphologic differences, their pathogenesis appears to be similar. J. Surg. Oncol. 2009;100:598–605. © 2009 Wiley-Liss, Inc.

Using the NCDB for cancer care improvement: an introduction to available quality assessment tools.

Abstract: Improving the quality of cancer care requires high-quality data, mechanisms to feed back information to hospitals, systems to act on the data, and participation of providers. The purpose of this review is to describe how the National Cancer Database (NCDB) can be utilized to improve the quality of cancer care in the United States through a variety of benchmarking reports and data feedback mechanisms available to hospitals approved by the Commission on Cancer (CoC). J. Surg. Oncol. 2009;99:488–490. © 2009 Wiley-Liss, Inc.

Standardized synoptic cancer pathology reporting: a population-based approach.

Abstract: Cancer pathology reports contain information which is critical for patient management and for cancer surveillance, resource planning, and quality purposes. The College of American Pathologists (CAP) has defined scientifically validated content of checklists that form the basis for synoptic cancer pathology reporting. We outline how the CAP standards were implemented in a large Canadian province over a 3-year period resulting in improvements in rates of synoptic reporting and completeness of cancer pathology reporting.

Patient and tumor characteristics associated with increased mortality in young women (≤40 years) with breast cancer

Abstract: Background The goal of the current study is to identify predictors responsible for mortality disparities between young (≤40 years) and older (>40 years) women with breast cancer. Methods From 1998 to 2006, 344 patients ≤40 years were treated for breast cancer. Cox regression models calculated adjusted hazard ratios (aHR) and 95% confidence intervals (CI) to determine differences in breast cancer mortality in women ≤40 years versus >40 years (n = 3,252), controlling for potential confounders in univariate tests. Results From 1998 to 2006, 3,596 patients were treated for breast cancer; 9.6% were ≤40 years and 90.4% were >40 years. Young women were more likely to be African-American, with a family history of breast cancer, diagnosed at advanced stage, and treated by mastectomy (P 40 years) (aHR 1.52, CI 1.37–1.74). Conclusions Young women (≤40 years) with breast cancer are diagnosed at a more advanced stage and have tumors with poor prognostic features. Young women (≤40 years) are 52% more likely to die from breast cancer compared to older women (>40 years). J. Surg. Oncol. 2009;100:248–251. © 2009 Wiley-Liss, Inc.

Lipopolysaccharide (LPS) increases the invasive ability of pancreatic cancer cells through the TLR4/MyD88 signaling pathway.

Abstract: Background Inflammation plays a multifaceted role in cancer progression, and NF-κB is one of the key factors connecting inflammation with cancer progression. We have shown that lipopolysaccharide (LPS) promotes NF-κB activation in colon cancer cells and pancreatic cancer cells. However, it is unclear why inflammatory stimuli can induce NF-κB activation in cancer cells. Methods We used two human pancreatic cancer cells, Panc-1 and AsPC-1, as target cells. LPS was used as an inflammatory stimulus. To confirm the participation of TLR4/NF-κB signaling pathway, we used three different NF-κB inhibitors (PDTC, IκBα mutant, and NF-κB decoy ODN) and siRNAs (against TLR4, MyD88, and MMP-9). Effect of LPS on pancreatic cancer cell invasive ability was determined by Matrigel invasion assay. Results LPS increased the invasive ability of pancreatic cancer cells, while blockade of NF-κB pathway decreased the LPS-dependent increased invasive ability. Blockade of TLR4 or MyD88 by siRNA also decreased the LPS-dependent increased invasive ability. Conclusion These results suggest that TLR/MyD88/NF-κB signaling pathway plays a significant role in connecting inflammation and cancer invasion and progression. J. Surg. Oncol. 2009;100:725–731. © 2009 Wiley-Liss, Inc.

Evaluation of a peritoneal surface disease severity score in patients with colon cancer with peritoneal carcinomatosis

Abstract: Introduction Systemic therapy and cytoreduction (CRS) with hyperthermic intra-peritoneal chemotherapy (HIPEC) may benefit selected patients with carcinomatosis from colon cancer (PC). This study presents the results of a consecutive series of patients evaluated under a single strategy. Patients and Methods Forty patients with PC referred for CRS were evaluated. Evaluation of their treatment was determined according to disease severity scored on a 3-point scale including: (1) symptoms, (2) extent of peritoneal dissemination (PCI), and (3) primary tumor histology. Overall survival (OS) was analyzed using Kaplan–Meier product-limit method and log rank testing according to four tiers of estimated disease severity based on the above parameters. Results For patients with disease severity score I, II, III, and IV, 2-year OS following treatment was 100%, 80%, 80%, and 0%, respectively. Median OS with most advanced disease (IV: n = 20) was 5 months versus 36 months for disease of lesser severity (I–III: n = 20; P < 0.001; RR = 0.2; 95%CI 0.1–0.5). Advanced disease (IV) was an independent predictor of adverse outcome on multivariate analysis with 2.6-fold increased likelihood of mortality. Conclusion A treatment strategy based on disease severity determined at time of diagnosis, stratifies patients into prognostic groups and may improve selection of patients for appropriate therapy. J. Surg. Oncol. 2009;99:9–15. Published 2008 Wiley-Liss, Inc.

Comparative study of endoscopic thyroidectomy versus conventional open thyroidectomy in papillary thyroid microcarcinoma (PTMC) patients.

Abstract: Background The aim of this study was to evaluate and compare the early surgical outcomes of endoscopic and conventional open thyroidectomies in patients with papillary thyroid microcarcinoma (PTMC). Methods Between September 2005 and December 2007, 499 patients with PTMC were enrolled. 275 patients underwent gasless endoscopic thyroidectomy via the axillary route (endo group), and 224 patients underwent conventional open thyroidectomy (open group). We analyzed the patient's clinico-pathologic characteristics and surgical completeness between the two groups. Results The endo group was younger than the open group. The open group underwent more extensive surgery than the endo group. The operative time was longer in the endo group than the open group (138.5 ± 49.0 min vs. 105.5 ± 41.6 min; P 1 ng/ml of serum Tg post-operatively. Tumor recurrence was detected in the open group only (n = 6). Also we checked the post-operative Tg in patients who had undergone lobectomy in the two groups, and found that there were no statistical differences in the two groups. Conclusions According to our experience, gasless endoscopic thyroidectomy using a trans-axillary approach is a safe and feasible alternative to conventional open thyroidectomy in selected patients with PTMC. J. Surg. Oncol. 2009;100:477–480. © 2009 Wiley-Liss, Inc.

Safety and efficacy of bidirectional chemotherapy for treatment of patients with peritoneal dissemination from gastric cancer: Selection for cytoreductive surgery.

Abstract: There is no standard treatment for peritoneal carcinomatosis (PC) from gastric cancer. New bidirectional chemotherapy (neoadjuvant intraperitoneal-systemic chemotherapy protocol (NIPS)) was developed. The aim of the present study was to assess the safety and efficacy of NIPS and to show the selection for cytoreductive surgery on PC from gastric cancer. Seventy-nine patients with PC from gastric cancer were treated with NIPS. A peritoneal port system was introduced into the abdominal cavity. The peritoneal wash cytological examination through a port was done before and after NIPS. The patients were treated with oral TS-1 twice a daily for 21 days, followed by a 1-week rest. On day 1, 8, and 15 from the start of oral TS-1 administration, 30 mg/m(2) of Docetaxel and 30 mg/m(2) of cisplatinum with 500 ml of saline were introduced into the peritoneal cavity through the port. A median course of oral TS-1 was 2.1 course and a median time of IP chemoterapy was 5.8. Peritoneal free cancer cells (PFCCs) had been detected in 65 (82.2%) patients before NIPS, and the positive cytology changed to be negative in 41 (63.0%) patients after NIPS. After NIPS, 41 patients underwent laparotomy, and complete cytoreduction was done in 32 (78%) patients. Complete cytoreduction was done in 27 (51.9%) of 52 patients with negative cytology but in only 4 (14.8%) of 27 patients with positive cytology (P < 0.001). Patients with negative cytology after NIPS survived significantly longer than those with positive cytology. The adverse effects after NIPS were mild and there was no treatment-related deaths. The grade 3/4 hematological adverse effects were found in 2 (2.6%) patients. Grade 3 renal toxicity and port site infection was found in three patients, respectively. NIPS using a port system is a safe and effective treatment for PC. Peritoneal wash cytology through a port system is a good indicator to select the patients to perform cytoreductive surgery.

Intra-abdominal tumor dissemination pattern and surgical outcome in 214 patients with primary ovarian cancer.

Abstract: Introduction We performed a systematic evaluation of tumor pattern and surgical outcome in 214 consecutive patients with primary ovarian cancer. Methods Based on the surgical and histological reports we retrospectively analyzed tumor localizations, surgical and clinical outcome. Cox-regression analysis was performed to identify independent predictors of complete tumor resection and mortality. Results Median age was 57.7 years (range: 20–88). FIGO-stage-I was classified in 8.4% and IV in 16.4% of all patients. The peritoneum was the structure most affected (76%) followed by the colon (52%) and diaphragm (44%). Upper abdominal tumor involvement was associated with a significantly higher rate of lymph node metastasis and a significantly lower rate of complete surgical tumor resection, when compared to patients with tumor limited to the lower abdomen. Median overall survival was 56; 61 and 27 months for patients with tumor load in the upper, lower and whole abdomen respectively (P < 0.05). Conclusions The intraoperative tumor dissemination pattern and the post-operative tumor residuals are decisive for the prognosis in primary ovarian cancer. There is an urgent need to use a systematic and standardized tumor documentation protocols to define the predictive and prognostic role of specific tumor pattern and to compare the surgical outcomes of different tumor centers. J. Surg. Oncol. 2009;99:424–427. © 2009 Wiley-Liss, Inc.

Diagnostic accuracy of T and N stages with endoscopy, stomach protocol CT, and endoscopic ultrasonography in early gastric cancer

Abstract: Background Preoperative accurate diagnosis of the T and N stages in early gastric cancer (EGC) is important in determining the application of various limited treatments. The aim of this study is to analyze the accuracy of T and N staging of EGC with esophagogastroduodenoscopy (EGD), Stomach protocol CT (S-CT), and endoscopic ultrasonography (EUS), and the factors influencing the accuracy. Methods Four hundred and thirty-four patients preoperatively diagnosed as EGC using EGD or S-CT and undergoing curative gastrectomy at Seoul National University Hospital in 2005 were included. The T and N stage reviewed by experienced personnel were compared with the surgical pathology. Results The predictive values for EGC of EGD, S-CT, and EUS were 87.4%, 92.2%, and 94.1%, respectively. The predictive values for node negativity of S-CT, and EUS were 90.1% and 92.6%, respectively. The factors leading to underestimation of T stage with EGD were the upper third location, the size greater than 2 cm, and diffuse type of tumor. Those with S-CT were female sex, the upper third location and lesion size greater than 2 cm. Conclusions Before applying limited treatment for EGC, a surgeon should consider the risk factors of underestimation of T stage with EGD or S-CT. J. Surg. Oncol. 2009;99:20–27. © 2008 Wiley-Liss, Inc.

Hepatic resection for hepatocellular carcinoma in the elderly

Abstract: Background and Objectives Aging of the population has significantly increased the number of elderly patients undergoing surgery for hepatocellular carcinoma (HCC). We aimed to compare the results of hepatectomy for HCC in patients ≥70 years old with those for younger patients. Methods Clinicopathological data and outcomes for 155 elderly patients and 333 younger patients with HCC who underwent hepatectomy between 1992 and 2007 were retrospectively compared. Results The elderly group had a higher incidence of associated diseases, but had better preoperative liver function. Although postoperative delirium was more common in the elderly group, there were no significant differences between the two groups with regard to operative morbidity, hospital death, disease-free survival, and overall survival. The overall recurrence rate was significantly higher in the elderly patients with alcohol abuse than in younger patients with alcohol abuse. Multivariate analysis revealed that preoperative alcohol abuse was a prognostic factor for elderly patients. Conclusions The short-term and long-term outcomes of surgery for HCC were similar in elderly and younger patients. Elderly patients with preoperative alcohol abuse should be followed closely, even after R0 surgery, because alcohol abuse is strongly correlated with postoperative recurrence and worse survival. J. Surg. Oncol. 2009;99: 154–160. © 2009 Wiley-Liss, Inc.

Interaction of B7‐H1 on intrahepatic cholangiocarcinoma cells with PD‐1 on tumor‐infiltrating T cells as a mechanism of immune evasion

Abstract: Background and Objectives The B7-H1/PD-1 pathway has recently been found to contribute to immune evasion of cancer cells from host immune system This study aimed to investigate the expression of B7-H1 and its receptor PD-1 and to explore their significance in the progression of intraheptic cholangiocarcinoma (ICC) Methods Thirty-one surgically resected ICC tissues and the corresponding cancer adjacent tissues were enrolled from 2006 to 2007 Immunohistochemical studies were performed with antibody of B7-H1, PD-1, CD8, and CD4 Apoptosis status of tumor-infiltrating lymphocytes (TILs) was detected by TUNEL assay Results Expression of B7-H1 and PD-1 was found to be up-regulated in ICC tissues compared with the cancer adjacent tissues Tumor-related B7-H1 expression was significantly correlated with both tumor differentiation and pTNM stage and was inversely correlated with CD8+ TILs but not CD4+ TILs TILs in primary carcinoma showed a high level of apoptosis Conclusion B7-H1/PD-1 pathway may be linked to malignant potential of ICC and contribute to tumor immune evasion by promoting CD8+ TILs apoptosis Thus, this pathway may indeed be a potential therapeutic target in the treatment of this disease J Surg Oncol 2009;100:500–504 © 2009 Wiley-Liss, Inc

Technical feasibility and safety of laparoscopy-assisted total gastrectomy in gastric cancer: a comparative study with laparoscopy-assisted distal gastrectomy.

Abstract: Background and Objective Only a few surgeons with much experience of laparoscopic surgery perform laparoscopy-assisted total gastrectomy (LATG), because of its technical difficulty and concern about subsequent complications. The aim of this study was to evaluate the technical feasibility and safety of LATG as compared with laparoscopy-assisted distal gastrectomy (LADG) in gastric cancer. Methods From January 2002 to December 2007, LADG was performed in 473 patients and LATG in 67 patients at the Korean National Cancer Center. Surgical procedures and short-term surgical outcomes of LATG were analyzed. Results D2 lymph node dissection was performed in 35 LATG (52.2%) cases and in 274 LADG (57.9%) cases (P = 0.378). Mean blood losses during operation were 156.8 ± 158.0 ml and 190.7 ± 176.2 ml, respectively (P = 0.114). The open conversion rate for LATG was higher than LADG without significance (4.3% vs. 1.7%, P = 0.153). Complications occurred in 18 LATG cases (26.9%) and 38 LADG cases (8.0%) (P < 0.001). The most common postoperative complication of LATG was anastomotic stricture after esophagojejunostomy. Conclusions LATG is a technically feasible procedure as compared with LADG. However, its postoperative complication rate is higher than that of LADG, especially that of anastomotic stricture. A more effective anastomotic method during LATG is required to prevent stricture. J. Surg. Oncol. 2009;100:392–395. © 2009 Wiley-Liss, Inc.

Liver tumor ablation: Percutaneous and open approaches†

Abstract: The global incidence of liver cancer is greater than a million cases a year. Surgical resection where applicable is still the standard of care for these patients. Various liver-directed regional therapies have been developed in an effort to treat the vast majority of unresectable liver tumors. This article reviews the principles behind various ablation therapies currently available for malignant liver tumors and their outcomes.

Clinicopathological aspects and prognostic value with respect to age: an analysis of 3,362 consecutive gastric cancer patients.

Abstract: Background and Objectives Several studies have reported controversial results about clinicopathological features and prognoses in gastric cancer patients with respect to age, partly due to variable definitions of young age and inhomogeneity of the patient population. The aim of study was to analyze clinicopathological features and prognostic value of all stages of gastric cancer in a large consecutive series. Methods Between 2000 and 2005, 3,362 patients with all stages of gastric cancer were enrolled in database. Patients were divided into three groups: group 1 (≤45), group 2 (46–70), and group 3 (≥71). Results Upper location and linitis plastica were more frequent in group 1. Young patients had a higher proportion of poorly differentiated and signet ring cell type with elevated CA19-9 level. Depressed type was more frequent in early gastric cancer (EGC) while Bormann type IV and Lauren diffuse type were more common in AGC in group 1. In curatively resected patients, a 5-year survival rate was significantly higher in group 1 than older groups. Stage, vein invasion, curative resection, and CA19-9 level were significant prognostic factors in all gastric cancer. Conclusions Clinicopathological features associated with young gastric cancer include upper location, linitis plastica, histopathologically diffuse type, and unresectability. J. Surg. Oncol. 2009;99:395–401. © 2009 Wiley-Liss, Inc.

The role of lymphadenectomy in the management of papillary carcinoma of the thyroid.

Abstract: Impact of nodal involvement in papillary thyroid cancer remains controversial. The incidence of nodal metastases is high and the presence of involved nodes has a negative impact on recurrence and possibly on survival as well, particularly in older patients. The risk of nodal disease increases with age, tumor size, and BRAF oncogene expression. Most thyroid surgeons sample the ipsilateral central nodes as a minimum and clear the central compartment if there is gross adenopathy present. Lateral compartment neck dissection is reserved for patients with known metastatic disease. This article attempts to review the literature on surgery of lymph nodes in papillary thyroid cancer.

Salvage esophagectomy after definitive chemoradiotherapy for thoracic esophageal cancer.

Abstract: Background and Objectives Although locoregional failure frequently occurs after definitive chemoradiotherapy (CRT), the role of salvage esophagectomy has not been fully evaluated. The aim of this study was to compare the outcome of salvage esophagectomy after high-dose definitive CRT with neoadjuvant CRT. Methods From 1994 to 2007, 33 patients with thoracic esophageal cancer underwent salvage esophagectomy after definitive CRT, and 115 patients underwent neoadjuvant CRT followed by surgery. Results The postoperative mortality rate in the salvage group (12%) was higher than in the neoadjuvant group (3.6%, P = 0.059). The rates of postoperative complications were significantly higher in the salvage group than in neoadjuvant group: Anastomotic leakage (39% vs. 22%, respectively, P = 0.049), bleeding (15% vs. 1.7%, respectively, P = 0.002), cardiovascular complications (24% vs. 5.4%, respectively, P = 0.001). Univariate analysis showed that pretherapy T stage, pretherapy lymph node status, pathological T stage, and operative curability were significant prognostic factors affecting survival of patients who underwent salvage esophagectomy. In particular, patients with cT3–T4 tumors or cN1 tumors before definitive CRT showed worse prognosis after salvage esophagectomy. Conclusions Salvage esophagectomy after high-dose definitive CRT was associated with higher postoperative mortality and morbidity rates compared with neoadjuvant CRT. Only selected patients can be rescued by salvage esophagectomy. J. Surg. Oncol. 2009;100:442–446. © 2009 Wiley-Liss, Inc.

Use of preoperative ultrasonography as guidance for neck dissection in patients with papillary thyroid carcinoma.

Abstract: Background Preoperative neck ultrasonography (US) may detect nodal metastases of papillary thyroid carcinoma (PTC) but its utility in detecting metastases at specific neck subsites and levels is not known. We therefore evaluated preoperative US in detecting cervical metastases of PTC according to neck subsites and levels. Methods Preoperative US was performed in 133 new patients to detect metastases at three central cervical subsites and five lateral cervical levels. All patients underwent total thyroidectomy and bilateral central neck dissection. Thirty-four patients with lateral nodal metastases underwent modified radical neck dissection. Results Lymph node metastases to the central and lateral cervical compartments were identified in 57.9% and 25.6%, respectively. The sensitivity and specificity of US for detecting central nodal metastasis were 61.0% and 92.8%, respectively. In the lateral neck, US detected non-palpable lymph node metastases in 6 of 34 patients (17.6%). Overall, US was >85.0% specific at all cervical subsites and levels. Conclusion Preoperative US may detect cervical metastases of PTC and may assist in determining the necessity and extent of neck dissection in PTC patients. J. Surg. Oncol. 2009;99:28–31. © 2008 Wiley-Liss, Inc.

Value of multidetector-row computed tomography in the preoperative T and N staging of gastric carcinoma: a large-scale Chinese study.

Abstract: Objectives To investigate the value of multidetector-row computed tomography (MDCT) in the preoperative T and N staging of gastric carcinoma and to further investigate the clinicopathological factors affecting the diagnostic accuracy Methods Seven hundred ninety gastric carcinoma patients underwent preoperative MDCT examination The results of MDCT were compared with surgical and pathological findings Results Early gastric carcinoma patients whose primary tumor was detected by MDCT had higher incidence of lymph node metastasis, larger tumor size, and deeper invasion The overall accuracy of MDCT in determining T stage of gastric carcinoma was 7380% (T1 4593%, T2 5303%, T3 8649%, and T4 8579%) The overall accuracy of MDCT in preoperative N staging was 7522% (N0 7617%, N1 6881%, and N2 8063%) The overall diagnostic sensitivity, specificity, and accuracy of MDCT for determining lymph node metastasis was 8626%, 7617%, and 8209%, respectively Multivariate analysis showed that the diagnostic sensitivity of MDCT in determining lymph node metastasis related with tumor size, N stage, and number of metastatic lymph nodes Conclusions The clinical value of MDCT in the preoperative T and N staging of gastric carcinoma is relatively high MDCT can be the first choice for the preoperative evaluation of patients with gastric carcinoma J Surg Oncol 2009;100:205–214 © 2009 Wiley-Liss, Inc

Prognostic factors for extra‐abdominal and abdominal wall desmoids: A 20‐year experience at a single institution

Abstract: Background and Objective Previous reports even large studies discussing the prognosis of desmoids have included tumors from intra- and extra-abdominal sites as well as incomplete resection. The purpose of this study was to explore prognostic factors associated with the recurrence free survival (RFS) rate in surgically treated extra-abdominal and abdominal wall desmoids. Patients and Methods A total of 198 consecutive desmoid patients were treated with surgery over a 20-year period at a single institution. Of these, 151 patients with extra-abdominal and abdominal wall tumors were retrospectively reviewed. One hundred thirteen patients were referred for the primary tumor and the other 38 for recurrent disease initially treated elsewhere. All patients underwent a macroscopically complete resection. Results The median follow-up interval was 102 months. Thirty-one patients (20.5%) had a local recurrence (LR). No patients died of the disease. The 5- and 10-year RFS was 79.7% and 78.5%, respectively. Admission status, gender, tumor size, margin status, location, and number, were predictors of LR in univariate analysis. Tumor size and margin status were independent prognostic factors in multivariate analysis. Positive margins were predictive of recurrence of primary disease, and also showed a trend for recurrent disease, which was not statistically significant. The selective use of adjuvant radiation did not show significant benefit over local control. Conclusions Regardless of primary or recurrent disease, microscopically negative margins should always be the goal for extra-abdominal desmoids surgery, if no cosmetic defects or function demolition is encountered. Extra-abdominal desmoids deserve more attention and should be treated more aggressively, especially when leaving positive margins. J. Surg. Oncol. 2009;100:563–569. © 2009 Wiley-Liss, Inc.

Clinicopathologic characteristics and outcomes of gastric cancers with the MSI-H phenotype.

Abstract: Objectives We examined the correlation between microsatellite instability (MSI) status and the clinicopathological features and prognostic value in gastric cancer and compared the efficacy of immunohistochemical staining for hMLH1 and hMSH2 with a polymerase chain reaction (PCR)-based test. Methods MSI status was examined in 328 consecutive gastric adenocarcinomas using tissue preserved in paraffin blocks. DNA extracted from tumor sections and the corresponding normal tissue was analyzed using PCR at the five microsatellite loci recommended by the National Cancer Institute (NCI). Immunohistochemical staining for hMLH1 and hMSH2 was performed and the results were compared with the MSI status measured using PCR. The relationship of the clinicopathologic variables to MSI status was analyzed. Results Of the gastric cancers, 8.2% (n = 27) contained MSI-H and this was associated with older age (>70 years), distal tumor location, tumor size, and intestinal subtype. Lymphatic and vascular invasion were associated with the disease-free survival. On immunohistochemical staining, the loss of expression of hMLH1 or hMSH2 was observed in 11% (n = 36). The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of immunohistochemical staining were 63.0%, 93.7%, 47.2%, 96.6%, and 91.2%, respectively. Conclusions Gastric cancers with MSI-H have specific clinicopathologic characteristics, such as older age at diagnosis, distal tumor location, increased tumor size, and intestinal histologic type. However, immunohistochemical staining for hMLH1 and hMSH2 is not as accurate as the PCR-based MSI test. J. Surg. Oncol. 2009;99: 143–147. © 2008 Wiley-Liss, Inc.

Medium to long-term results after reconstruction of bone defects at the knee with tumor endoprostheses.

Abstract: Background and Objectives Limb salvage and reconstruction with tumor endoprostheses is considered as therapeutic standard in the treatment of bone defects at the knee. Few studies report long-term results so far. Methods Seventy-seven patients who had a cementless or cemented MUTARS® endoprosthesis implanted were followed-up for a mean period of 46 months (3–128 months). The defects were due to primary tumor lesions in 69 cases or metastases in 8 cases. The distal femur (n = 49) or the proximal tibia (n = 28) was reconstructed predominantly with cementless implants (femur: 69%, tibia: 92%). The resection of the tumor was intraarticular in 46 and extraarticular in 31 patients. Results After 10 years probability of limb salvage was 92% with a recurrence rate of 3%. Complications were frequent with a revision rate of 58% and lead to a cumulative probability of survival of the initially implanted prosthesis of 57% after 5 years. Locking mechanism failure (n = 15) and aseptic loosening (n = 13) were the most frequent failure modes. Conclusions Regardless of achieving a low recurrence rate and satisfactory functional results, we found a high complication rate after implantation of a megaprosthesis. This was particularly evident for extraarticular resections and cemented fixation, which should be avoided when possible. J. Surg. Oncol. 2010;101:166–169. © 2009 Wiley-Liss, Inc.

Oct4, a novel marker for human gastric cancer.

Abstract: Background and Objective Octamer-4 (Oct4), a transcription factor involved in regulating human embryonic stem cells (ESCs), may play a role in tumorigenesis. Since little is known about the efficacy of Oct4 as a potential biomarker for gastric cancer (GC), we investigated its expression in GC tissues and its relationship to various clinicopathological parameters. Methods Primary tumor tissues and matching, adjacent non-cancerous tissues were obtained from 62 GC patients, and Oct4 expression was examined by reverse transcription-PCR (RT-PCR) and real-time PCR. Twenty biopsy specimens of atrophic gastritis and gastric ulcer individually were collected as control. To detect Oct4 expression in the paired GC and non-cancerous tissues at the protein level, Western blotting and immunohistochemistry (IHC) were employed. Correlation analyses were conducted to assess the relationship between Oct4 expression and clinicopathological parameters. Results Oct4 expression levels were higher in GC tissues compared to matching, adjacent non-cancerous tissues, atrophic gastritis and gastric ulcer tissues. Additionally, Oct4 expression in GC tumors correlated with their differentiation status, but not with patient age or gender, tumor size, TNM stage, depth of invasion, or the presence of lymph node metastasis. Conclusions Oct4 may be a potential biomarker for the initiation, progression, and differentiation of human GC. J. Surg. Oncol. 2009;99:414–419. © 2009 Wiley-Liss, Inc.

The influence of a gene expression profile on breast cancer decisions.

Abstract: Purpose The Oncotype Dx® Recurrence Score (RS), is often employed in patients with estrogen receptor-positive, node negative (ER+LN−) breast cancer. We investigated the impact of the RS on actual chemotherapy administration and the effect of the assay on a panel of breast oncology experts. Patients and Methods The prospective adjuvant chemotherapy recommendations (prior to RS) and actual adjuvant therapy (after RS) for consecutive patients with ER+LN− breast cancer were recorded. After 6 months and with the same information, a panel of five experts made adjuvant therapy recommendations with and without RS and rated the strength of their recommendations. Rates of panel consensus, recommendation changes, and changes in recommendation strength were compared. Results There were 29 patients (28 women). RS results altered the plan for chemotherapy in 9 patients (31%); 7 of 13 patients (54%) initially recommended for chemotherapy did not receive it, and 2 of 16 (13%) received chemotherapy following initial recommendations against it. RS results changed the panel's chemotherapy recommendation in 7 patients (24%): 5 of 12 (42%) recommendations for changed to against, and 2 of 17 (12%) recommendations against changed to for chemotherapy. RS increased consensus by the panel 10%, but did not increase the reported strength in chemotherapy recommendations. Conclusions RS results were associated with real-world decision changes in 31% of patients and 24% of panel recommendations and increased panel consensus by 10%. However RS did not increase the strength of panelist's recommendations. J. Surg. Oncol. 2009;99:319–323. Published 2009 Wiley Periodicals, Inc.

Residual disease after re‐excision lumpectomy for close margins

Abstract: Introduction: While a positive margin after an attempt at breast conservation therapy (BCT) is a reason for concern, there is more controversy regarding close margins. When re-excisions are performed, there is often no residual disease in the new specimen, calling into question the need for the procedure. We sought to examine the incidence of residual disease after re-excision for close margins and to identify predictive factors that may better select patients for re-excision. Methods: Our IRB-approved prospective breast cancer database was queried for all breast cancer patients who underwent a re-excision lumpectomy for either close or positive margins after an attempt at BCT. Close margins are defined as � 2 mm for invasive carcinoma and � 3m m for DCIS. Clinicopathologic features were correlated with the presence of residual disease in the re-excision specimen. Results: Three hundred three patients (32%) underwent re-operation for either close (173) or positive (130) margins. Overall, 33% had residual disease identified, 42% of DCIS patients and 29% of patients with invasive disease, nearly identical to patients with positive margins. For patients with DCIS, only younger age was significantly related to residual disease. For patients with invasive cancer, only multifocality was significantly associated with residual disease (OR 3.64 [1.26‐10.48]). However, patients without multifocality still had a substantial risk of residual disease. Discussion: The presence of residual disease appears equal between re-excisions for close and positive margins. No subset of patients with either DCIS or invasive cancer could be identified with a substantially lower risk of residual disease. J. Surg. Oncol. 2009;99:99–103. 2008 Wiley-Liss, Inc.

Surgical technique of parietal and visceral peritonectomy for peritoneal surface malignancies.

Abstract: Peritoneal surface malignancies have been traditionally regarded as rapidly fatal conditions. Encouraging survival results has been associated to an innovative strategy involving aggressive cytoreductive surgery with total peritonectomy and heated intraperitoneal chemotherapy. Many controversial issues still remain regarding the optimization of the cytoreductive surgical procedures. The present article critically analyzes the relevant modifications from the original technique emerged during a 15-year experience in a single center. Operative outcome results are presented. J. Surg. Oncol. 2009;100:321–328. © 2009 Wiley-Liss, Inc.

Laparoscopic hyperthermic intraperitoneal peroperative chemotherapy (HIPEC) in the management of refractory malignant ascites: A multi‐institutional retrospective analysis in 52 patients

Abstract: Malignant ascites is a debilitating condition affecting cancer patients in their terminal stage of disease. Recently, laparoscopic hyperthermic intraperitoneal peroperative chemotherapy (HIPEC) was introduced as a new approach. From September 2001 to August 2008, 52 patients were treated with this new modality. No treatment-related mortality was observed. Median survival was 98 days. One patient developed a clinical recurrence. Laparoscopic HIPEC is a safe and effective method for palliating malignant ascites. J. Surg. Oncol. 2009;100:331–334. © 2009 Wiley-Liss, Inc.