Surgical Oncology - Articles in Press

Individuals at high-risk for pancreatic cancer development: Management options and the role of surgery - Corrected Proof

2012-01-16

Abstract: Pancreatic cancer (PC) is a highly lethal disease. Despite advances regarding the safety and long-term results of pancreatectomies, early diagnosis remains the only hope for cure. This necessitates the implementation of an intensive screening program (based mainly on modern imaging), which – given the incidence of PC – is not cost effective for the general population. However, this screening program is recommended for individuals at high-risk for PC development. Indications for screening include the following three clinical settings: hereditary cancer predisposition syndromes associated with PC, hereditary pancreatitis and familial pancreatic cancer syndrome. The aim of this strategy is to identify pre-invasive (precursor) lesions, which are curable. Surgery is recommended in the presence of recognizable lesion on imaging lesions. Partial (anatomic) pancreatectomy – depending on the location of the suspicious lesion – is the most widely accepted type of surgical intervention in this setting; occasionally, however, total pancreatectomy may be required, in carefully selected patients. Despite that experience still remains limited, there is evidence that this aggressive strategy allows early detection of neoplastic lesions, thereby improving the effectiveness of surgery and prognosis.

Management of recurrent cervical cancer: A review of the literature - Corrected Proof

M. Peiretti, I. Zapardiel, V. Zanagnolo, F. Landoni, C.P. Morrow, A. Maggioni — 2012-01-16

Abstract: Objective: The aim of this narrative review is to update the current knowledge on the treatment of recurrent cervical cancer based on a literature review.Material and methods: A web based search in Medline and CancerLit databases has been carried out on recurrent cervical cancer management and treatment. All relevant information has been collected and analyzed, prioritizing randomized clinical trials.Results: Cervical cancer still represents a significant problem for public health with an annual incidence of about half a million new cases worldwide. Percentages of pelvic recurrences fluctuate from 10% to 74% depending on different risk factors. Accordingly to the literature, it is suggested that chemoradiation treatment (containing cisplatin and/or taxanes) could represent the treatment of choice for locoregional recurrences of cervical cancer after radical surgery. Pelvic exenteration is usually indicated for selected cases of central recurrence of cervical cancer after primary or adjuvant radiation and chemotherapy with bladder and/or rectum infiltration neither extended to the pelvic side walls nor showing any signs of extrapelvic spread of disease. Laterally extended endopelvic resection (LEER) for the treatment of those patients with a locally advanced disease or with a recurrence affecting the pelvic wall has been described.Conclusions: The treatment of recurrences of cervical carcinoma consists of surgery, and of radiation and chemotherapy, or the combination of different modalities taking into consideration the type of primary therapy, the site of recurrence, the disease-free interval, the patient symptoms, performance status, and the degree to which any given treatment might be beneficial.

Stimulation of neo-angiogenesis by combined use of irradiated and vascularized living bone graft for oncological reconstruction - Corrected Proof

2012-01-12

Abstract: Reconstruction for large bone and osteochondral defects following musculoskeletal tumor excision remains challenging. Mega-prosthesis is clearly a useful reconstructive tool. Because the survival time of tumor patients has been increasing due to better treatment options, the aim of our group is to achieve complete biological reconstruction without using any artificial materials. With this approach, durability would not be a limitation. In the present study, we reviewed the biological reconstructive procedures currently available for large bone defects after tumor excision.Devitalized bone autograft is particularly well suited in the region where allografts are not readily available. However, the complication rate, such as infection and spontaneous bone resorption, was unexpectedly high due to non-viable graft. In an attempt to reduce these complications, we have used irradiated bone autograft in combination with free vascularized viable bone graft. In an experimental study, we demonstrated a neo-vascularization effect of vascularized bone graft with devitalized bone autograft, i.e. to convert dead bone into living bone. Clinically, this technique is best indicated for reconstruction of intercalary bone defect, especially tibial shaft. Some degree of articular change occurs after irradiation and cannot be prevented, even with the combined use of vascularized bone graft. In our experience, secondary procedures such as surface replacement prosthesis are necessary to treat the osteoarthritis in such cases, even if the radiological finding is severe.The rationale for a combined vascularized and irradiated bone autograft is the cumulative advantage provided by the biological properties of the former with the mechanical endurance of the latter.

Sentinel lymph node biopsy in breast cancer: A history and current clinical recommendations - Corrected Proof

Desiree D. D’Angelo-Donovan, Diana Dickson-Witmer, Nicholas J. Petrelli — 2012-01-11

Abstract: The advent of sentinel lymph node biopsy changed the way the surgical community treated breast cancer. It also reduced the post operative morbidity for millions of patients. Now that sentinel lymph node biopsy has become the mainstay of treatment, new clinical questions have arisen and continued research is being done to answer these questions. This report details a brief history of sentinel lymph node biopsy and how it was applied in the treatment a breast cancer. This report also includes a review of the current literature regarding unique clinical scenarios involving sentinel lymph node biopsy in breast cancer including the ACOSOG Z011 trial.

Application of propensity score model to examine the prognostic significance of lymph node number as a care quality indicator - Corrected Proof

Yun-Jau Chang, Li-Ju Chen, Yao-Jen Chang, Kuo-Piao Chung, Mei-Shu Lai — 2012-01-06

Abstract: Purpose: There is a controversy about whether lymph node yield can be used as a proxy of quality care for patient with colorectal cancer. We aim to use propensity score models to investigate the association between lymph node number and long-term survival for colorectal cancer patients.Materials and methods: Taiwan Cancer Database was employed to review all patients with newly diagnosed colorectal cancer from 2003 to 2005. Exclusion criteria included those patients with stage IV disease or without information of lymph node. Propensity score models (examined lymph node >12 or <12 as dependent variable) were applied to group of patients with Stage II or Stage III disease and primary end point was 5-year survival (and mortality). We also report results of Stage I–III for comparison.Results: We identified 15,731 newly diagnosed colorectal cancers during study period, among which a total of 10,517 colorectal cancer patients treated at 32 hospitals fulfilled the inclusion criteria. Pathology reports of about 63 % (6658/10517) patients revealed lymph node retrieval >12. After propensity score matching, there were 2888, 1079, 1094 pairs recruited for Stage I–III, Stage II and Stage III, respectively. According to analysis of these matched pairs, the 5-year risk adjusted overall mortality were lower for lymph node examined ≥12 than <12 among Stage II (24.3% vs. 31.1%, p=0.012) and Stage I–III (20.8% vs. 23.6%, p=0.003), but insignificant for Stage III (40.2% vs. 45.6%, p=0.073). Similar situation happened with regard to disease-free and disease-specific mortality.Conclusion: For patients with colorectal cancer undergoing colorectal surgery, the quality metric of lymph node is associated with significantly better 5-year survival except for Stage III disease.

Prediction of normal tissue toxicity as part of the individualized treatment with radiotherapy in oncology patients - Corrected Proof

2012-01-03

Abstract: Normal tissue toxicity caused by radiotherapy conditions the success of the treatment and the quality of life of patients. Radiotherapy is combined with surgery in both the preoperative or postoperative setting for the treatment of most localized solid tumour types. Furthermore, radical radiotherapy is an alternative to surgery in several tumour locations. The possibility of predicting such radiation-induced toxicity would make possible a better treatment schedule for the individual patient. Radiation-induced toxicity is, at least in part, genetically determined. From decades, several predictive tests have been proposed to know the individual sensitivity of patients to the radiotherapy schedules. Among them, initial DNA damage, radiation-induced apoptosis, gene expression profiles, and gene polymorphisms have been proposed. We report here an overview of the main studies regarding to this field. Radiation-induced apoptosis in peripheral blood lymphocytes seem to be the most promising assay tested in prospective clinical trials, although they have to be validated in large clinical studies. Other promising assays, as those related with single nucleotide polymorphisms, need to be validated as well.

18FDG-PET/CT for detection of mediastinal nodal metastasis in non-small cell lung cancer: A meta-analysis - Corrected Proof

Lin Zhao, Zhi-Yi He, Xiao-Ning Zhong, Miao-Ling Cui — 2011-12-26

Abstract: Background: We performed a meta-analysis to evaluate the role of 18F-fluorodeoxyglucos -e positron emission tomography/computed tomography (18FDG-PET/CT) in detecting mediastinal nodal metastasis in patients with non-small cell lung cancer (NSCLC).Methods: Studies about 18FDG-PET/CT for detecting mediastinal nodal metastasis in patient with NSCLC were systematically searched in the MEDLINE, EMBASE, and EBM Review databases from January 1, 2000 to July 26, 2011. A software called “Meta-Disc” was used to obtain pooled estimates of sensitivity, speciﬁcity, positive likelihood ratio (PLR), and negative likelihood ratio (NLR), respectively. We also calculated summary receiver operating characteristic (SROC) curves, and the Q* index.Results: 20 articles fulﬁlled all inclusion criteria (3028 eligible patients). The pooled sensitivity, and speciﬁcity with 95% confidence interval for PET/CT on a per-patient analysis were 0.719 (0.683–0.753), and 0.898 (0.882–0.912). Corresponding values for PET/CT on a per-nodal-station analysis were 0.610 (0.582–0.636), 0.924 (0.918–0.930). The Q* index estimates under SROC were 0.8464 and 0.8067, respectively.Conclusions: 18FDG-PET/CT had more specificity but less sensitivity for mediastinal nodal metastasis in patients with NSCLC.

Multicentre validation of different predictive tools of non-sentinel lymph node involvement in breast cancer - Corrected Proof

2011-12-26

Abstract: Sentinel lymph node (SN) biopsy offers the possibility of selective axillary treatment for breast cancer patients, but there are only limited means for the selective treatment of SN-positive patients. Eight predictive models assessing the risk of non-SN involvement in patients with SN metastasis were tested in a multi-institutional setting. Data of 200 consecutive patients with metastatic SNs and axillary lymph node dissection from each of the 5 participating centres were entered into the selected non-SN metastasis predictive tools. There were significant differences between centres in the distribution of most parameters used in the predictive models, including tumour size, type, grade, oestrogen receptor positivity, rate of lymphovascular invasion, proportion of micrometastatic cases and the presence of extracapsular extension of SN metastasis. There were also significant differences in the proportion of cases classified as having low risk of non-SN metastasis. Despite these differences, there were practically no such differences in the sensitivities, specificities and false reassurance rates of the predictive tools. Each predictive tool used in clinical practice for patient and physician decision on further axillary treatment of SN-positive patients may require individual institutional validation; such validation may reveal different predictive tools to be the best in different institutions.

Rectal cancer surgery: A brief history - Corrected Proof

Avi S. Galler, Nicholas J. Petrelli, Shanthi P. Shakamuri — 2011-10-17

Abstract: In the last 250 years, the treatment of rectal cancer has changed dramatically. Once considered an incurable disease, combined modality therapy has improved mortality from 100% to less than 4% for locally advanced rectal cancer. This dramatic reduction paralleled surgical techniques based on a growing understanding of anatomy and disease pathology. In order to understand modern treatment, it is necessary to recognize the achievements of preceding surgeons.

Vascular encasement as element of risk stratification in abdominal neuroblastoma - Corrected Proof

2011-10-17

Abstract: Background: Vascular encasement of major vessels has been introduced as element of image defined risk factors (IDRF) for stratification of abdominal neuroblastoma. Some subgroups of this tumor entity are still subject of discussion regarding surgical approach and radicality. Aim of this study was to analyse a cohort of related patients.Patients and methods: Children operated on for neuroblastoma with encasement of major abdominal vessels (April 2002–April 2009) were retrospectively evaluated regarding surgical procedures, intra- and postoperative complications, and outcome.Results: There were 18 patients with abdominal NB and encasement of major vessels. Mean age at operation was 43.5 months (2.5–113), mean operation time was 228 minutes (157–428). Complete macroscopic tumor resection was realised in 14 children. Vascular reconstruction was necessary in 5 patients. Tumor progression/relapses requiring further operation occurred in 3 patients. Major postoperative complications were 1 loss of unilateral renal function with subsequent nephrectomy, 1 renal vein thrombosis (operative revision), 1 renal artery embolism (operative revision), and 1 ureteral obstruction (stenting). Mean follow up was 34.8 months (2–78).Conclusions: Vascular encasement as part of IDRF is a valuable tool for stratification of abdominal NB. Surgery of NB with vascular encasement includes divers and complex procedures. Children seem to benefit from complete tumor resection or at least relevant tumor reduction although operations can mean a relevant strain for the patients.

The effects of radiofrequency ablation on the hepatic parenchyma: Histological bases for tumor recurrences - Corrected Proof

G. Gravante, S.L. Ong, M.S. Metcalfe, N. Bhardwaj, D.M. Lloyd, A.R. Dennison — 2011-10-17

Abstract: Background: This review examines histological modifications obtained after liver radiofrequency ablation (RFA).Methods: A literature search has been undertaken for all pre-clinical and clinical studies involving RFA and in which ablation zones have been excised for a complete histological examination.Results: Two main histological areas are present, a central zone of coagulative necrosis and a peripheral rim of congestion and extravasation. Both corresponded to specific microscopic characteristics that evolved over time and that are influenced by the proximity of patent vessels and the liver perfusion status. Viable cells are not present in the central zone but have been described in the ischemic peripheral rim where they survive the ischemia and inflammation process. These correspond in clinical studies to residual viable tumor cells that lead to failure of the procedure.Conclusions: Histological changes following RFA are complex and interactions take place at both a cellular and tissue level. Changes in the peripheral zone must be considered in future studies in order to extend the volume of reliable tumor destruction and increase the effectiveness of the procedure.

Effect of 103Pd radioactive stent on caspase-9, cholangiocarcinoma cell growth and its radiosensitivity - Corrected Proof

2011-10-17

Abstract: Background: To investigate the effect of 103Pd radioactive stent on Caspase-9, cholangiocarcinoma cell growth and its radiosensitivity.Methods: Cholangiocarcinoma was treated with 103Pd radioactive stent at different period. Radiosensitivity of the cells was detected by methyl thiazolyl tetrazolium (MTT) method. Apoptosis of cholangiocarcinoma cells was detected by immunohistochemistry and electron microscope. The activity of Caspase-9 was detected by non-radioimmunoprecipitation, while its protein expression was detected by Western blot.Results: 103Pd radioactive stent had significant inhibitive effect on cholangiocarcinoma cells and it could induce apoptosis. After treatment by 103Pd radioactive stent for 10 days, the activity of Caspase-9 was gradually enhanced, which was markedly decreased in common stent group. Cholangiocarcinoma cells had relatively high sensitivity to 103Pd radiation.Conclusion: 103Pd radioactive stent can activate caspase-9 gene to induce apoptosis of cholangiocarcinoma cell, inhibit its growth and enhance its radiosensitivity.

Corrected Proof

Yuen Cheng Looi — 2011-10-17

Pain associated with cancer, with its various other complications, remains a challenge for many. Any book that can shed more light in this area is thus always welcomed. This 643-page tome aims to “provide a reference for both those who seek the basics and those who seek a scholarly review of the many domains relevant to an in-depth understanding of cancer pain and specialist skills in practice, including syndrome identification and multi-dimensional assessment, the relationships between pain management and cancer medicine and between pain and other quality of life concerns, the many pharmacologic and non-pharmacologic best practices in pain care and the diverse needs of special populations”. These are ambitious aims. Unfortunately, it does not quite deliver.

Recent advances in non-invasive axillary staging for breast cancer - Corrected Proof

O.C. Iwuchukwu, S. Wahed, A. Wozniak, M. Dordea, A. Rich — 2011-10-17

Abstract: Nodal staging in breast cancer is a key predictor of prognosis and directs subsequent adjuvant therapy. This article addresses current modalities of nodal staging in breast cancer but focuses on promising non-invasive alternatives for staging the axilla.

Corrected Proof

M. de Matas — 2011-10-17

This publication is co-authored by a Professor of Neurosurgery and an Associate Professor of Neurology who have specialist interests in both complex spinal surgery and spinal disorders with neurological complications. Both are recognised experts in their fields.

Immunotherapy for treating metastatic colorectal cancer - Corrected Proof

Shahe Boghossian, Stuart Robinson, Alexei Von Delwig, Derek Manas, Steve White — 2011-10-17

Abstract: Background: Colorectal cancer remains one of the leading causes of death in the world. Surgery still remains the mainstay of treatment for primary and metastatic colorectal cancer. Immunotherapy used as an adjunct to surgery can play an important role in controlling the spread of tumour.Methods: The online databases PubMed, Medline, Scirus and Medscape Oncology were used to identify articles of relevance. Keywords included; “Immunotherapy”, “Cellular Immunotherapy”, “Metastatic Colorectal Cancer”, “Monoclonal Antibody” “Tumour Vaccines” and “Adoptive Cell Therapy”. The databases search was from the period of June 1995 until May 2010 inclusive.Results: Our understanding of tumour immunology has allowed the development of some successful therapies. Immunotherapy through the use of monoclonal antibodies is an effective adjunct to chemotherapy for metastatic colorectal cancer. Other modalities that are in the stages of development are cellular and conjugated vaccines. However, these vaccines are being experimented in advanced stages of colorectal tumours.Conclusion: Colorectal cancer vaccines are being developed for advanced stages of colorectal tumour. However, their use as an early adjunct could potentially limit the spread of tumour or even result in cure. Further trials are required to ensure the safety and efficacy of cellular vaccines against colorectal tumours to allow their use on patients early in their disease presentation.

Intrahepatic radiofrequency ablation versus electrochemical treatment in vivo - Corrected Proof

2011-10-17

Abstract: Background: Radiofrequency ablation (RFA) and electrochemical treatment (ECT) are two methods of local liver tumour ablation. The objective of this study was to compare these methods when applied in proximity to vessels in vivo.Methods: In a total of ten laparotomised pigs, we used ECT (Group A, four animals) and RFA (Group B, four animals) to create four areas of ablation per animal under ultrasound guidance within 10 mm of a vessel. Group C consisted of two control animals. Chemical laboratory tests were performed immediately before and after each procedure and on days 1, 3 and 7 after surgery. Following the last tests, the livers were harvested for morphological evaluation.Results: The mean duration of surgery was 5 h 40 min in Group A (ECT), 2 h 47 min in Group B (RFA), and 2 h 30 min in Group C (control animals). After ECT, the harvested livers showed a mean volume of necrosis of 1.84 cm3 ± 0.88 at the anode and 2.59 cm3 ± 1.06 at the cathode. The presence of vessels did not influence the formation of necrotic zones. Ablation time was 67 min when a charge of 200 coulombs was delivered. We measured pH values of 1.2 (range: 0.9–1.7) at the anode and 11.7 (range: 11.0–12.1) at the cathode. In one of the 16 RFA ablations (6%), the target temperature was not reached and the procedure was discontinued. After 14 of 16 RFA procedures (88%), morphological analysis showed incomplete ablation in perivascular sites. Both ECT and RFA were associated with a reversible increase in monocyte, C-reactive protein (CRP) and aspartate aminotransferase (AST) levels. There was no significant increase in interleukin-1β (IL-1β), tumour necrosis factor-α (TNF-α) and IL-6.Conclusion: In the majority of cases, intrahepatic RFA in vivo leads to incomplete necrosis in proximity to vessels and the presence of histologically intact perivascular cells. Without a reduction in liver perfusion, the central application of RFA should be considered problematic. ECT is a safe alternative. It is not associated with a heat sink effect but has the disadvantage of long treatment times.

Clinico-pathologic features of primary melanoma and sentinel lymph node predictive for non-sentinel lymph node involvement and overall survival in melanoma patients: A single centre observational cohort study - Corrected Proof

2011-10-17

Abstract: Objective: Completion Lymph Node Dissection (CLND) is the current standard of practice for patients with a positive Sentinel Lymph Node Biopsy (SLNB). Significant morbidity is associated to CLND, so we tried to evaluate which prognostic variables could predict NSLN invasion in SLN-positive patients and their impact on the overall survival (OS).Methods: A retrospective chart review of 603 patients that had undergone SLNB for melanoma between 2000 and 2009 at our department was done. 100 SLN were positive at the histopathological analysis of SLN. Demographic variables, primary melanoma, SLN pathologic features and results of CLND were analysed. Multivariate logistic regression and OS analyses were carried out to test the prognostic relevance of clinico-pathologic variables on CLND results and disease course.Results: Breslow thickness, ulceration and micro/macrometastatic pattern of SLN invasion carried a significantly independent higher likelihood of NSLN involvement; Starz classification did not maintain a statistical significance in multivariate analysis. Only one patient (4.3%) without adverse prognostic factors showed NSLN involvement, which was found in 33.3% of patients with one and 55.9% with two or more adverse parameters (p = 0.0001). OS analyses confirmed the prognostic significance of these factors.Conclusion: Waiting for the results of Multicenter Selective Lymphadenectomy Trial II, our study suggests a clinically useful and easily applicable means of identifying patients with an unfavourable disease course. The presence of one or more adverse factors identifies patients in whom CLND is mandatory to include thereafter in a more strict follow-up program. Moreover, the finding of no adverse prognostic indicators associated to the presence of significant co-morbidities and/or elderly age, could be useful in identifying patients not to treat by CLND.

Peritoneal surface malignancies and regional treatment: A review of the literature - Corrected Proof

2011-10-17

Abstract: Recent studies have lead to a renewed interest in cytoreductive surgery and intraperitoneal chemotherapy as a regional treatment modality for patients with peritoneal surface malignancies. There have been multiple phase III randomized trials that have shown a survival advantage with intraperitoneal chemotherapy in certain patients. More well designed phase III studies are needed to further define which groups of patients may benefit from cytoreductive surgery and intraperitoneal chemotherapy.

Treatment strategy for early gastric cancer - Corrected Proof

J. Wang, J.-C. Yu, W.-M. Kang, Z.-Q. Ma — 2011-10-17

Abstract: Gastric cancer ranks the second leading cause of cancer-specific mortality worldwide. With a poor prognosis, 5-year survival rate of gastric cancer is less than 20%–25% in the USA, Europe, and China . However, early gastric cancer(EGC) offers an excellent (over 90%) chance of cure based on surgical resection . As the increasing detection of EGC, more treatment options have been developed both curatively and minimally invasively to maintain a good quality of life(QOL). One of the advanced therapeutic techniques is endoscopic dissection. Improvements in surgical treatment include minimizing lymph node dissection, reconstruction methods, laparoscopy-assisted surgery, and sentinel node navigation surgery(SNNS) . With technological advances, even Natural Orifice Transluminal Endoscopy Surgery (NOTES) and robotic surgery are expected to represent the next revolution . However, there still remains much dispute among these treatments, which arouses further clinical trials to verify. Update of the treatments, controversial indications, prognosis and current strategies for EGC are discussed in this review.

Survivin expression and targeting in breast cancer - Corrected Proof

Kumkum Jha, Mridula Shukla, Manoj Pandey — 2011-10-17

Abstract: Introduction: Survivin a multifunctional protein that controls cell division, inhibition of apoptosis and promotion of angiogenesis. It is expressed in most human neoplasm, but is absent in normal and differentiated tissues. The purpose of this article is to overview the expression of survivin, effect of its expression in response to treatment, correlation with other markers and newer advancement in targeting survivin.Methods: A detailed search of Medline was carried out using the following search strategy: “((survivin) OR ((apoptosis) AND (inhibitor OR inhibitors))) AND ((breast) AND (neoplasm OR neoplasms OR tumor OR tumor OR cancer OR carcinoma))”. Abstract of all articles thus identified were reviewed to identify the relevant studies, full articles of studies thus identified were then obtained and reviewed. All relevant data was extracted and tabulated.Results: Survivin expression by Immunohistochemistry was identified in 65.3% (55.2–90.0%) of the breast cancer patients among the identified studies while survivin mRNA by RT-PCR was identified in 93.6% (90–97%). Survivin expression has been reported to be associated with over expression of HER 2, vascular endothelial growth factor (VEGF), urokinase plasminogen activator (uPA)/PAI-1.Conclusion: Survivin is over expressed in majority of breast cancers. The over expression of survivin is found to correlate with HER 2 and EGFR expression. Survivin expression has been found to confer resistance to chemotherapy and radiation. Targeting survivin in experimental models improves survival. More studies are needed on the role of survivin in multi drug resistance (MDR) in the presence of Pgp/uPA/PAI-1 and the impact of survivin over expression in triple negative breast cancer.

The role of oncoplastic therapeutic mammoplasty in breast cancer surgery- A review - Corrected Proof

O.C. Iwuchukwu, J.R. Harvey, M. Dordea, A.C. Critchley, P.J. Drew — 2011-10-17

Abstract: Background: Reduction mammoplasty is an established technique for symptom relief in women with breast hypertrophy. Therapeutic mammoplasty and radiotherapy may allow cancers to be surgically treated whilst maintaining oncological safety and improving cosmetic outcome. This article aims to review the evidence upon which therapeutic mammoplasty is based and to outline an approach for surgical planning and selection.Methods: A systematic PubMed and Medline literature search was carried out. All abstracts were studied and papers that dealt primarily with breast conservation using plastic surgery techniques were reviewed.Results and conclusion: Therapeutic mammoplasty is a useful procedure for breast conserving cancer surgery in women with large breasts, conferring a good cosmetic and functional outcome. This article proposes that breast surgeons experienced in oncological surgery can safely resect tumours from all aspects of the breast with a minimal number of variations in standard mammoplasty technique.

Exploring the role of resection of extrahepatic metastases from hepatocellular carcinoma - Corrected Proof

Terence C. Chua, David L. Morris — 2011-10-17

Abstract: The role of hepatic resection, taking into consideration the functional status of the liver, for localized hepatocellular carcinoma (HCC) is an established curative treatment. In advance disease, a variety of interventional-based liver-directed therapies and more recently systemic therapy with sorafenib are available to treat unresectable tumors. Extrahepatic Metastasis (EHM) of HCC may occur at initial diagnosis or during recurrence following treatment. This may occur with or without concurrent intrahepatic disease. We reviewed the published works on surgical metastasectomy for common sites of EHM of HCC metastases. It appears from the studies reported in the literature that from selected cases reported, long-term survival may be achieved from resecting metastasis at sites of the abdominal lymph node, adrenal gland, lung, and peritoneum. The encouraging results presented demonstrate that highly selected fit patients may be suitable candidates for these radical curative pursuits. It is likely that indications for resection of EHM HCC may benefit patients with limited isolated metastasis, who have a preserved liver function, and whose primary tumor has been adequately controlled. A registry study to pull the results of case reports and institutional experiences may be useful in cumulating evidence of this practice.

The evolving role of axillary lymph node dissection in the modern era of breast cancer management - Corrected Proof

J.M. Barry, W.P. Weber, V. Sacchini — 2011-10-17

Abstract: The standard of practice in breast cancer surgery is that all patients with a positive sentinel node mandate an axillary lymph node dissection (ALND). Recently, this dogma has been challenged by a trial from ACOSOG (American College Of Surgeons Oncology Group) (Trial Z0011) which demonstrated that patients (without clinically/radiologically apparent axillary metastases) undergoing breast conserving surgery (i.e lumpectomy followed by whole breast radiotherapy) with positive sentinel nodes failed to derive any significant benefit by having an axillary lymph node dissection (ALND) . The logical progression from this study is to question the validity of performing routine axillary lymph node dissections on all patients with positive sentinel lymph nodes (SLN). In addition to the Z0011 trial, there is emerging data that additional patients exist who fail to derive any benefit from axillary surgery. The aim of this article is to discuss the potential subpopulations of patients that may avoid unnecessary ALND in the modern era of breast cancer management.

A case of multiple brain metastases of uterine leiomyosarcoma with a literature review - Corrected Proof

2011-10-17

Abstract: Brain metastasis from uterine leiomyosarcoma is extremely rare, and prognostically alarming despite various treatments. The authors report a case of multiple brain metastases from uterine leiomyosarcoma who took a favorable course after tumor resection and γ-knife treatment. A 50-year-old woman with a history of hysterectomy for uterine leiomyosarcoma two years earlier, presented with a recent onset of headaches and vomiting. Multiple cerebral lesions were found by magnetic resonance imaging (MRI). The Karnofsky performance scale (KPS) was 40 with left hemiparesis and cerebellar ataxia. She was treated by resection of the left occipital and cerebellar tumors, followed by γ-knife irradiation of the residual tumors. KPS was 70 at her discharge from the hospital. MRI failed to show recurrence of the intracranial lesions 6 months after irradiation. She remained at home until she died from massive intra-abdominal bleeding. This is the first case with multiple brain metastases from uterine leiomyosarcoma, who survived with remarkable neurological improvement for 12 months. No comparable survival has been reported in the literature. It is evident that surgical resection and additional γ-knife irradiation contributed to early neurological recovery.

Corrected Proof

Chris Bebb — 2011-10-17

Although this book relates to professional health carers, in the main it is written with particular reference for family and friends who are supporting loved ones during the diagnosis, treatment and palliative phases of a life threatening and life changing illness, including cancer.

Corrected Proof

Paolo Giorgi Rossi — 2011-10-17

In this book the authors report some results of a monumental literature revision lead by the National Infectious Agents Committee working under the umbrella of the Primary Prevention Action Group, sponsored by the Canadian Partnership Against cancer and the Canadian Cancer Society though the National Cancer Institute of Canada.

Local recurrence of pancreatic cancer after primary surgical intervention: How to deal with this devastating scenario? - Corrected Proof

2011-10-17

Abstract: The dismal prognosis of pancreatic cancer reflects into the increased recurrence rate, even after R0 pancreaticoduodenectomy. Although, conventional radiation-, chemo- or surgical therapy in much selected cases, seem to work out favorably long term, less invasive and non-toxic methods with more immediate results are always preferred, concerning the already aggravated status of this group of patients.We present hereby a comprehensive review of the literature concerning the treatment of recurrent pancreatic cancer based on the case of a patient who 20 months after a pancreaticoduodenectomy developed portal hypertension and symptomatic first degree esophageal, gastric and mesenteric varices, caused by the nearly complete splenic vein obstruction at the portal vein confluence. The varices were revascularized by a percutaneous transhepatic placement of an endovascular stent into the splenic vein, along with a sequent stereotactic body radiation therapy for the local tumor control.Thanks to the accuracy and safety of the present combined treatment, the patient one year later presents control of the disease and its complications.Our paper is the first in the international literature that tries to review all the treatment modalities available (surgical, adjuvant, neoadjuvant and palliative therapy) and their efficacy, concerning the locally recurrent pancreatic cancer; furthermore, we tried to analyze the application of the above mentioned combined therapeutic approach in similar cases, elucidating simultaneously all the questions that arise. The limited existing data in the international literature and the lack of randomized controlled trials make this effort difficult, but the physician should be aware after all of all the available and innovative treatment modalities, before he chooses one. Finally, we would like to emphasize the fact that not only the local control but also the management of the complications are important for a prolonged median survival and a better quality of life after all.

Corrected Proof

Heather Mc Dowell — 2011-10-17

Jean Bracken whose daughter was diagnosed with malignancy in 1977 subsequently wrote the 1st edition of this book in 1986. The author acknowledges that much has changed since that time, but the present edition is an update on knowledge, in regard to genetic implications and epidemiology along with most recent advances in the various modes of treatment. The 1st part of the book gives an overall view of what cancer is and an update on possible causes and genetic factors running in families. It is unfortunate that on two occasions the phrase “contract cancer” is used giving readers the impression that this is a contagious condition. The main bulk of the book is systematic chapters on all the tissue subtypes of malignancy found within childhood and continuing into early adulthood. Thereafter, a substantial proportion of this book deals with problems particularly relevant to North America, where the author originates, e.g. giving advice on dealing with insurance and healthcare pathways within the North American health care system. Thus, a large part of the book is irrelevant to European readers. At the end of each chapter there is a bibliography, but again this is very biased towards North American literature.

Management of non metastatic phyllodes tumors of the breast: Review of the literature - Corrected Proof

Parham Khosravi-Shahi — 2011-10-17

Abstract: Phyllodes tumors of the breast are rare tumors, accounting for less than 0.5% of all breast tumors. These tumors are comprised of both stromal and epithelial elements; and traditionally they are graded by the use of a set of histologic features into benign, borderline, and malignant subtypes. Unfortunately, the histologic classification of phyllodes tumors does not reliably predict clinical behavior.The mainstay of treatment of non metastatic phyllodes tumors of the breast is complete surgical resection with wide resection margins. Lumpectomy or partial mastectomy is the preferred surgical therapy. However, despite the complete surgical resection, local failure rate may be high; and 22% of malignant tumors may give rise to haematogenous metastases. The most frequent site of distant metastases is the lungs. Several predictive factors of recurrence and metastases have been described in the literature, such as positive surgical margins, increased stromal cellularity, stromal overgrowth, stromal atypia and increased mitotic activity.Nevertheless, the role of adjuvant therapies (radiotherapy and chemotherapy) is presently undefined and should be tested in multicenter, prospective, randomized trials.

A systematic review of cancer related patient outcomes after anterior resection and abdominoperineal excision for rectal cancer in the total mesorectal excision era - Corrected Proof

P. How, O. Shihab, P. Tekkis, Gina Brown, P. Quirke, R. Heald, B. Moran — 2011-10-17

Abstract: Purpose: It is a widely held view that anterior resection (AR) for rectal cancer is an oncologically superior operation to abdominoperineal excision (APE). However, some centres have demonstrated better outcomes with APE. We conducted a systematic review of high-quality studies within the total mesorectal excision (TME) era comparing outcomes of AR and APE.Methods: A literature search was performed to identify studies within the TME era comparing AR and APE with regard to the following: circumferential resection margin (CRM) status, tumour perforation rates, specimen quality, local recurrence, overall survival (OS; 3 or 5 year), cancer-specific survival (CSS) and disease-free survival (DFS). Additional data regarding patient demographics and tumour characteristics was collected.Results: Twenty four studies fulfilled the eligibility criteria with Newcastle–Ottawa scores of six or greater. Where a significant difference was found, all studies reported lower and more advanced tumours for APE and 4/5 studies observed more frequent use of neoadjuvant and adjuvant therapies in APE patients. Tumour perforation rates and CRM involvement where reported, were significantly greater for APE. 8 out of 10 studies showing significant differences in local recurrence reported higher rates for APE but no differences were observed with distant recurrence. Where differences were noted, AR was reported to have increased DFS, CSS and OS compared to APE.Conclusions: Patients treated with AR have lower rates of tumour perforation and CRM involvement and tend to have better outcomes with regard to disease recurrence and survival. However, tumours treated by APE are lower and more locally advanced.

Resection of perihilar biliary schwannoma - Corrected Proof

2011-10-17

Abstract: Introduction: Schwannomas are usually benign nerve sheath tumors, which typically arise in the head, neck, spinal cord and extremities. Schwannoma of the biliary tract is an extremely rare finding. Patients generally lack symptoms and seek medical attention when tumor growth causes obstructive jaundice. Preoperative diagnosis is difficult and resection is the treatment of choice.Methods: A 54 year-old female with history of back and right labia minor melanoma for which she underwent complete excision and right inguinal lymph node dissection more than 10 years ago, was evaluated for new onset gastroesophageal reflux symptoms and found to have markedly abnormal liver enzymes. Imagining studies revealed intrahepatic ductal dilatation and a 5.2 cm mass in the porta hepatis that was not consistent with cholangiocarcinoma or hepatocellular carcinoma. Multiple percutaneous biopsies of the mass failed to provide a definitive diagnosis. With a high clinical suspicion of metastatic melanoma and no other evident sites of disease, operative intervention was undertaken for diagnosis and definitive treatment.Results: Diagnostic laparoscopy was performed initially, but access to the mass was difficult, given its location. Subsequently, the patient underwent laparotomy, with tumor excision, common bile duct resection and hepato-jejunostomy. Pathologic examination and analysis were consistent with cellular schwannoma. Postoperatively, the patient recovered uneventfully, and liver function studies returned to normal.Conclusion: Schwannomas are uncommon tumors, which very rarely arise from the biliary tract and cause biliary obstruction. Exploration is indicated in order to establish the diagnosis and to render definitive treatment.

Preoperative chemoradiation followed by surgical resection for resectable pancreatic cancer: A review of current results - Corrected Proof

Terence C. Chua, Akshat Saxena — 2011-10-17

Abstract: Background: There has been an interest in the interdisciplinary and multimodality approach that combines chemotherapy and radiation therapy as a preoperative treatment for patients with resectable pancreatic cancer.Methods: Literature search of databases (Medline and PubMed) to identify published studies of preoperative chemoradiation for resectable pancreatic cancer (potentially resectable and borderline resectable) was undertaken. Response to treatment and survival outcomes was examined as endpoints of this review.Results: Seventeen studies; eight phase II studies, and nine observational studies, comprising of 977 patients were reviewed. Gemcitabine-based chemotherapy with radiotherapy was the most common preoperative regimen. Following preoperative treatment, pancreatic surgical resection was performed in 35–100% (median=61%) of patients after a range of 6–32 weeks (median=7 weeks). Rate of pathological response was complete in 5–15% of patients, partial in 33–60% and minimal in 38–42%. The median overall survival ranged from 12 months to 40 months (median=25 months) with a 5-year overall survival rate ranging between 8% and 36% (median=28%). Patients who underwent chemoradiation but did not undergo surgery survived a median period of 7–11 months (median=9 months).Conclusion: Preoperative gemcitabine-based chemoradiation followed by restaging and surgical evaluation for pancreatic resection may identify a sub-population of patients with resectable disease who would benefit the most from surgery. Investigation of this schema of preoperative therapy in a randomized setting of resectable pancreatic cancer is warranted.

Breast cancer in reproductive age. The new plaque or just myth? - Corrected Proof

2011-10-17

Abstract: It is interesting to assess the hitherto knowledge, on breast cancer in reproductive and young females, aged <35. Even if breast cancer is rare in this group, it is, also physically and emotionally devastating. It is characterized by worse prognosis and outcome, in a stage of life, which is delicate for the female patients. This rare subgroup of breast cancer patients is ought to be the center of investigation in future studies. This paper’s mail goal is to elucidate this entity, by presenting several aspects of the disease including risk factors, therapy, natural history and major differences between the groups of breast cancer patients and last but not least, the psychosocial features of this clinical entity, by reviewing the current and past medical literature till April 2011.

Co-expression of stem cell genes CD133 and CD44 in colorectal cancers with early liver metastasis - Corrected Proof

Xiaodong Huang, Yu Sheng, Ming Guan — 2011-10-17

Abstract: Purpose: To investigate the expression status and clinical implications of stem cell genes CD133 and CD44 in the colorectal cancers with early liver metastasis.Materials and methods: The differential genes of early liver metastases in colorectal cancer were detected by RT2 Profiler™ PCR Array. The expression and the relationship of stem cell gene CD133 and CD44 were analyzed by immunofluorescent tests.Results: CD133 and CD44 were significantly higher co-expressed in colorectal cancer with early liver metastases compared to those without early liver metastases, and the content of CD133 and CD44 proteins decreased following growth of the transplanted tumors. Of the 80 cases without early liver metastases, 12 were observed CD133 and CD44 proteins co-expression, while 36 of the 40 cases with early liver metastases were found CD133 and CD44 proteins co-expression (15% vs. 90%, P < 0.05). Survival analysis revealed CD133 and CD44 proteins co-expression was associated with poorest prognosis (57.14% vs. 87.41%, X2 = 48.49, P = 0.001). After Cox regression, age, Duck’s stage, lymph node metastasis, and CD133 and CD44 proteins co-expression were shown to be the independent prognostic factors of colorectal cancers.Conclusions: CD133 and CD44 proteins were highly co-expressed in colorectal cancer with early liver metastases, and may be a potential biomarker for the early liver metastases.Highlights: ► CD133 and CD44 were co-expressed in colorectal cancer with early liver metastases. ► CD133 and CD44 proteins co-expression were shown to be the independent prognostic factors of colorectal cancers. ► CD133 and CD44 proteins may be a potential biomarker for the early liver metastases.

Cancer and pregnancy: A comprehensive review - Corrected Proof

E. Voulgaris, G. Pentheroudakis, N. Pavlidis — 2011-10-17

Abstract: Background: Pregnancy complicated by cancer is relatively rare but, as women in western societies tend to delay childbearing to the third and fourth decade of life, this phenomenon is going to be encountered more often in the future.Material and methods: Review of the literature and description of the different diagnostic and therapeutic approaches which are required to diagnose and treat pregnant mothers with cancer.Results: As in non-pregnant patients, every effort should be made to provide the maximal benefit and best prognosis to the pregnant patient. In most cases, in order to avoid any harm to the fetus, different diagnostic approach should be incorporated and treatment should be tailored to each pregnant woman. Cooperation of multidisciplinary teams, incorporating medical and radiation oncologists, surgeons, obstetricians, neonatologists and experienced nursing staff, is required to provide optimal care for the patient. The benefits from use of surgery, chemotherapy and/or radiotherapy as well as the mother’s wishes and beliefs need to be factored into recommendations and treatment planning.Conclusions: With the experience gained, the developments in clinical and radiation oncology and the cooperation of multidisciplinary teams, treatment of cancer during pregnancy with normal fetal outcome is feasible.Highlights: ► Review of the diagnostic and therapeutic dilemmas in cancer during pregnancy. ► Optimal care for the pregnant with minimal harm to the fetus should be the aim. ► Diagnostic approach and treatment needs to be tailored to each woman. ► Strict protocols and multidisciplinary cooperation is mandatory. ► Treatment of gestational cancer with normal fetal outcome is feasible.

Mandibular conservation in oral cancer - Corrected Proof

Latha P. Rao, Mridula Shukla, Vinay Sharma, Manoj Pandey — 2011-10-17

Abstract: Surgery is one of the established modes of initial definitive treatment for a majority of oral cancers. Invasion of bony or cartilaginous structures by advanced upper aero-digestive tract cancer has been considered an indication for primary surgery on the basis of historic experience of poor responsiveness to radiation therapy . The mandible is a key structure both in the pathology of intra-oral tumours and their surgical management. It bars easy surgical access to the oral cavity, yet maintaining its integrity is vital for function and cosmesis. Management of tumours that involve or abut the mandible requires specific understanding of the pattern of spread and routes of tumour invasion into the mandible. This facilitates the employment of mandibular sparing approaches like marginal mandibulectomy and mandibulotomy, as opposed to segmental or hemimandibulectomy which causes severe functional problems, as the mandibular continuity is lost. Accurate preoperative assessment that combines clinical examination and imaging along with the understanding of the pattern of spread and routes of invasion is essential in deciding the appropriate level and extent of mandibular resection in oral squamous cell carcinoma. Studies have shown that local control rates achieved with marginal mandibulectomy are comparable with that of segmental mandibulectomy. In carefully selected patients, marginal mandibulectomy is an oncologically safe procedure to achieve good local control and provides a better quality of life. This article aims to review the mechanism of spread, evaluation and prognosis of mandibular invasion, various techniques and role of mandibular conservation in oral squamous cell carcinoma.

Apronectomy combined with laparotomy for morbidly obese endometrial cancer patients - Corrected Proof

2011-10-17

Abstract: Background: The surgical management of morbidly (BMI >40) and super obese (BMI >50) women with endometrial cancer is challenging. The aim of this study was to describe the short and long term outcomes of apronectomy combined with laparotomy for endometrial cancer staging and tumour debulking.Methods: A retrospective case note review of morbidly obese patients undergoing combined apronectomy and laparotomy for suspected endometrial cancer between 2007 and 2009 was performed. Short term (operating time, estimated blood loss, complication rates, duration of hospital stay) and long term outcomes (weight profile over 24-month follow up period) were evaluated.Results: Twenty-one patients were identified with a median age of 58 years and a median BMI of 49 (range 37–64). Apronectomy combined with laparotomy took 192 min on average to complete, with a mean estimated blood loss of 497 ml. There were no intra-operative complications. Postoperative complications included anaemia (14% required a blood transfusion), urinary tract infection (5%) and wound complications (wound infection in 29% and partial wound dehiscence in 5%). The median post-operative stay was 9 days. At twenty-four months, one-third of patients were heavier (mean 5 kg, range 2–8 kg) but almost two-thirds of patients were considerably lighter than they had been pre-operatively (mean 13 kg lighter, range 9–17 kg).Conclusions: Apronectomy combined with laparotomy was safe and well tolerated in this group of patients. Sustained weight loss by two-thirds of the patients over the two-year follow up period may reflect lifestyle changes instigated by individual patients following surgery. Combined apronectomy and laparotomy may provide an alternative to standard surgery for this challenging group of patients.Highlights: ► We combined apronectomy with laparotomy for morbidly obese endometrial cancer patients. ► The short and long term outcomes of 21 patients (median age 58, BMI 49) were retrospectively reviewed. ► On average, surgery lasted 192 min with an EBL of 497 ml; there were no intra-operative complications. ► Wound complications were common (29%) and the median post-operative stay was 9 days. ► At 24 months, two-thirds of the patients weighed less than pre-operatively (mean 13 kg range 9–17 kg).

Sentinel lymph node micrometastasis in human breast cancer: An update - Corrected Proof

Mohamed Salhab, Neill Patani, Kefah Mokbel — 2011-10-17

Abstract: Introduction: The advent of sentinel lymph node biopsy (SLNB) and advances in histopathological and molecular analysis techniques have been associated with an increase in micrometastasis (MM) detection rate. However, the clinical significance of sentinel lymph node micrometastasis (SLN MM) continues to be a subject of much debate. In this article we review the literature concerning SLN MM, with particular emphasis on the prognostic significance of SLN MM. The controversies regarding histopathological assessment, clinical relevance and management implications are also discussed.Methods: Literature review facilitated by Medline and PubMed databases. Cross referencing of the obtained articles was used to identify other relevant studies.Results: Published studies have reported divergent and rather conflicting results regarding the clinical significance and implications of axillary lymph node (ALN) MM in general and SLN MM in particular. Some earlier studies demonstrated no associations, however most recent studies have found SLN MM to be an indicator of poorer prognosis and to be associated with non-SLN involvement.The use of adjuvant chemotherapy and/or hormonal manipulation therapy is associated with an improved survival in patients with SLN MM. Complete ALND may be safely omitted provided that adjuvant systemic therapy recommendations are equal to patients with node-positive disease. However, optimal management of SLN MM is yet to conclude.Furthermore, the identification of MM remains largely dependant on the analytical technique employed and the use of immunohistochemistry (IHC) increases the detection rate of SLN MM. Discrepancies in the histopathological interpretation of TNM classification of SLN tumour burden do exist. Published studies were non-randomized and have significant limitations including a small sample size, limited follow-up period, and lack of standardization and reproducibility of pathological examination of the SLN.Conclusion: Patients with SLN MM have a poorer prognosis than those who are SLN negative. Therapeutic recommendations regarding patients with SLN MM should be taken in the context of multidisciplinary team setting and in selected cases of SLN MM, complete ALND may be safely omitted. A better reproducibility of pathological interpretation of the TNM classification is required so that future therapeutic guidelines can be applied without confusion.Highlights: ► The presence of SLN MM is an indicator of poorer prognosis in breast cancer. ► Use of adjuvant therapy in SLN MM patients is associated with improved survival. ► Complete axillary dissection may be safely omitted in patients with SLN MM. ► The optimal management of SLN MM is yet to conclude.

Primary pancreatic cystic neoplasms of the pancreas revisited. Part IV: Rare cystic neoplasms - Corrected Proof

2011-10-17

Abstract: Primary pancreatic cystic neoplasms are being recognized with increasing frequency due to modern imaging techniques. In addition to the more common cystic neoplasms—serous cystadenoma, primary mucinous cystic neoplasm, and intraductal papillary mucinous neoplasm—there are many other less common neoplasms that appear as cystic lesions. These cystic neoplasms include solid pseudopapillary neoplasm of the pancreas (the most common rare cystic neoplasm), cystic neuroendocrine neoplasm, cystic degeneration of otherwise solid neoplasms, and then the exceedingly rare cystic acinar cell neoplasm, intraductal tubular neoplasm, angiomatous neoplasm, lymphoepithelial cysts (not true neoplasms), and few others of mesenchymal origin. While quite rare, the pancreatic surgeon should at the least consider these unusual neoplasms in the differential diagnosis of potentially benign or malignant cystic lesions of the pancreas. Moreover, each of these unusual neoplasms has their own natural history/tumor biology and may require a different level of operative aggressiveness to obtain the optimal outcome.Highlights: ►Apart from the three common primary pancreatic cystic neoplasms (serous cystic neoplasms, mucinous cystic neoplasms, intraductal papillary mucinous neoplasm), other rare cystic pancreatic neoplasms can be encountered in clinical practice. ►Accurate preoperative identification is not usually possible. ►Surgery is typically required to establish the diagnosis. ►Prognosis depends on the histological type of the neoplasm.

Long term survival in patients with hepatocellular carcinoma directly invading the gastrointestinal tract: Case reports and literature review - Corrected Proof

2011-10-17

Abstract: Hepatocellular carcinoma (HCC) directly invading the gastrointestinal (GI) organs is rare and is associated with poor survival outcome. We report two patients with good long-term outcome following resection of HCC that invaded the stomach and duodenum, respectively. A literature review was conducted to elucidate the course of patients with this pathology. Two cases (57-year-old and 72-year-old males) with enlarged hepatic tumors directly invading the stomach and duodenum underwent hepatectomies with en-bloc resection of the involved organs. Both patients are still alive at 80 and 68 months following the surgery. Our literature review showed that most of the patients with this pathology have manifested, and died of persistent GI bleeding. Patients who were treated surgically had a statistically significant longer survival than those who were treated with non-surgical palliative treatments (P < 0.001). In addition, patients who were treated with surgery with curative intent tend to have a longer survival times than those who were treated with surgery to palliate the bleeding but the difference was not statistically significant (P < 0.174). Removing the tumor completely could significantly prolong the survival of patients with HCC invading the GI tract.

Anterior thigh flap extended hemipelvectomy and spinoiliac arthrodesis - Corrected Proof

2011-10-17

Abstract: We present the technique of anterior thigh flap extended external hemipelvectomy with spinoiliac arthrodesis in treatment of the patient with recurrent low-grade pelvic chondrosarcoma extending to the lower lumbar spine. Extended hemipelvectomy involves skeletal resection beyond the standard hemipelvectomy that is the SI joint by removal of contiguous musculoskeletal structures, such as elements of the sacral and lumbar spine or contralateral pelvic bone, in addition to the affected innominate bone. Spinoiliac arthrodesis reestablishes spinopelvic stability; the anterior thigh musculocutaneous flap provides reliable well-vascularized soft tissue coverage. This technique may serve an important role in the surgical management of patients with low-grade pelvic malignancies.Highlights: ►We present the anterior thigh flap extended external hemipelvectomy and spinoiliac arthrodesis. ►Extended hemipelvectomy involves resection of contiguous structures beyond the SI joint. ►Spinoiliac arthrodesis reestablishes spinopelvic stability. ►The anterior thigh flap provides reliable well-vascularized soft tissue coverage. ►This technique may serve an important role for patients with low-grade pelvic malignancies.

Analysis of prognostic factors in patients with multiple recurrences of papillary thyroid carcinoma - Corrected Proof

Kwang-Min Kim, Joon-Beom Park, Keum-Seok Bae, Seong-Joon Kang — 2011-10-17

Abstract: Purpose: Numerous studies in the past have mentioned various factors that influence the recurrence of papillary thyroid carcinoma, including age, tumor size, advanced stage, extrathyroidal extension, and distant metastasis, and attempts have been made to classify the disease into low-risk and high-risk group based on these clinicopathological factors. However, there has been relatively scarce study on patients with multiple recurrent papillary thyroid carcinoma. This study analyzed the risk factors associated with such cases.Materials and methods: This study investigated various clinicopathological factors of 416 patients who were diagnosed with papillary thyroid carcinoma and received primary surgery at Yonsei University Wonju College of Medicine, Department of Surgery, from January 1983 to December 2006 and were followed up until October 2010. An investigation of factors associated with patients showing multiple recurrences was made.Results: Patients were divided into 3 groups: group 1 (no recurrence, n=380), group 2 (1 recurrence only, n=21), and group 3 (multiple recurrences, n=15). The univariate analysis on risk factors revealed tumor size greater than 2cm, multifocality, clinical apparent lymph node metastasis to be risk factors associated with multiple recurrences of papillary thyroid carcinoma. A multivariate analysis performed on variables selected from univariate analysis demonstrated no significant risk factor. The 10-year disease-specific survival for 3 different patient groups (group 1, 2, and 3) was 100%, 100%, and 83.1%, respectively, and patients in more clinically advanced group demonstrated poorer prognosis (p<0.001). The 10-year overall survival rate for the 3 patient groups was 93.9%, 100%, and 92%, respectively, and clinically advanced groups tended to show poorer overall survival rate as well (p=0.046).Discussion: A more aggressive and extensive surgery, as well as closer follow up, is to be required when operating on patients with tumor size greater than 2cm, multifocality, clinical apparent lymph node metastasis. The use of imaging modalities, such as ultrasonography and PET-CT scan, may be desirable when monitoring such patients.

Prophylactic total gastrectomy for hereditary diffuse gastric cancer. Review of the literature - Corrected Proof

2011-10-17

Abstract: Hereditary diffuse gastric cancer (HDGC) is characterized as an autosomal dominant cancer susceptibility syndrome largely attributable to germline mutations and deletions in the gene encoding E-cadherin, CDH1. Mutation carriers have a more than 70% lifetime risk of developing DGC and an elevated probability of lobular breast cancer. The aim of this review was to evaluate the results of surgical treatment for HDGC with special reference to the extent of its histological spread and to analyze the recent literature in order to provide an update on the current concepts of prophylactic gastrectomy for disease prevention. Nevertheless, it is not clear that our current knowledge of molecular and genetic diagnostics calls for the addition of HDGC to the roster of malignant familial syndromes in which early counseling and preventive surgical intervention should become the standard of care. Endoscopic screening cannot be recommended because the stomach appears normal and biopsies often fail to demonstrate signet ring cell adenocarcinoma. Prophylactic gastrectomy has provided many members of affected families with relief from GC with minimal implications.

Corrected Proof

Riccardo A. Audisio, Matilde M. Audisio — 2011-10-17

It was a surprise to receive this book intended for reviewing on our cancer Journal which focuses mainly on surgical treatments. Due to this, I was not able to assign this text to any members of our accomplished panel of surgical experts, and therefore decided to attempt reviewing this myself. Furthermore, I have approached and included Matilde in order to expand my critical mass on this subject. Consequently, please accept our apologies for our simple words and assumptions as we are certainly not experts in narrative or social gerontology, psychology or mental care.

Corrected Proof

Devi C.R. Beena, Tieng Swee Tang — 2011-10-17

Ms Altilio and Ms Otis-Green, with other authors, have compiled an extraordinarily informative book, touching on a pertinent aspect under palliative care. They should be commended for this exhaustive effort. Although social work is explained in most books on palliative care, this one brings a refreshing approach to the topic. It provides some new information, like defining the palliative care social worker, genetics and social work, and adds information on existing topics.

Clinical impact of lymph node status in rectal cancer - Corrected Proof

2011-10-17

Abstract: Lymph node status at the time of diagnosis remains one of the principal indicators of prognosis in patients with rectal cancer. Involvement of loco-regional lymph nodes is relevant to surgical and clinical oncologists and continues to impact significantly upon local and systemic management strategies, in both neo-adjuvant and adjuvant settings. In this review, the clinical impact of lymph node status in the surgical management of rectal cancer is considered, with particular reference to the significance of lymphadenectomy and the potential implications for rectal tumours amenable to trans-anal excision. Current standards of care are reviewed and the extent to which the determination of lymph node status influences oncological decisions regarding neo-adjuvant and adjuvant therapies are discussed with areas of controversy highlighted.

The tumor microenvironment - Corrected Proof

Cynthia E. Weber, Paul C. Kuo — 2011-10-17

Abstract: The concept of the tumor microenvironment, developed from Paget’s “seed and soil” theory is made up of the cancer cells, the stromal tissue, and the extracellular matrix. In this mini-review, each of the components of this dynamic network will be examined. We will show that there are a multitude of complex interactions and a host of molecules involved in tumorogenesis and metastasis. We will further illustrate this notion with examples from the tumor microenvironment of breast cancer. Lastly, we conclude with thoughts about how this will influence the surgical field with examples of therapeutic agents already in use that target aspects of this microenvironment.

Quality of life, functional ability and physical activity after different surgical interventions for bone cancer of the leg: A systematic review - Corrected Proof

2011-10-17

Abstract: Purpose: To systematically review published studies comparing Quality of Life (QoL), functional ability and/or physical activity between different surgical interventions due to a malignant bone tumour of the leg.Methods: A systematic literature search, covering the years 2000–2010 was performed using the PubMed, Embase, Web of science and Cochrane databases. Studies were included if they described and statistically compared QoL, functional ability and/or physical activity of at least two surgical interventions for lower extremity bone cancer. In addition, the methodological quality of the selected studies was evaluated by using a 24-point scale. Where appropriate, a qualitative analysis or meta-analysis was performed.Results: The search strategy resulted in a list of 246 citations. Based on titles and abstracts 50 full-text articles were selected, of which 13 articles describing 12 studies, were finally included. Overall, the methodological quality of the studies was moderate. Studies were heterogeneous with respect to their categorisation of surgical interventions, average age of patients and average duration of follow-up. Overall, results regarding differences between ablative and limb-sparing surgery varied largely. Meta-analysis was considered to be not appropriate due to clinical heterogeneity, methodological differences and flaws.Conclusion: Twelve studies comparing the outcomes of QoL, functional ability and physical activity between limb-sparing and ablative surgery groups were identified, with an overall moderate methodological quality. Their largely varying outcomes suggest that no general conclusions on the advantage of either limb-sparing or ablative surgery in patients with malignant bone tumours of the lower extremity can be drawn.