Sa1936 CLINICAL OUTCOME OF PER-ORAL ENDOSCOPIC TUMOR RESECTION FOR SUBMUCOSAL TUMORS OF THE ESOPHAGUS AND GASTRIC CARDIA

Abstract BACKGROUND Increasing knowledge on pilocytic astrocytoma (PCA) biology now points towards an aberration in BRAF/MAPK/ERK pathway which has both diagnostic and therapeutic implications. This study was done to note the impact of BRAF aberrations on clinical outcome in childhood PCA. METHODS FFPE tissues of all childhood PCA diagnosed during 2011–2017 were evaluated for BRAFV600E mutation by Sanger sequencing and KIAA1549 fusion transcripts (16–9;15–9;16-11) by reverse transcriptase polymerase chain reaction. Children undergoing gross tumor resection received no adjuvant treatment. Unresectable tumors (only biopsy) and NF-1 associated PCAs, were treated if clinically indicated. Only patients with documented therapy details/followup were included for analysis. STUDY RESULTS Ninety-eight patients (median age-7.7yrs; boy:girl ratio-1.4) were included. Major sites were: Cerebellum-37(38%), 3rd Ventricle-26(27%), Cerebrum-15(15%). While BRAFV600E mutation was noted in 7/89(8%) specimens, BRAF-fusions were found in 34/85(40%). Following surgery/biopsy, 23(24%) and 21(22%) received adjuvant chemotherapy and radiotherapy respectively. The 1-year/3-year/5-year-EFS of the overall cohort was 90.7%/81.3%/67.4% respectively. Cerebellar tumors did better vis-à-vis other sites(5yr-EFS:74.3% v/s 66.4%;p=0.403). The 5yr-EFS of BRAF-fusion positive tumors (34), tumors without any BRAF aberration (40) and BRAFV600E mutant tumors (7) was 84.8%/ 69.6%/ 42.9% (p=0.215). CONCLUSIONS BRAF-fusion and BRAFV600E mutation were associated with good and poor outcomes respectively. Lack of statistical significance could be attributed to use of radiation as planned therapy in patients from earlier years. Data on BRAF aberrations in PCAs aids decision making regarding adjuvant therapy and choosing appropriate salvage-therapy especially in relapsed/refractory PCAs.

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Endoscopic tumor resection of the inferior vena cava

Journal of Thoracic and Cardiovascular Surgery ◽

10.1016/j.jtcvs.2006.04.029 ◽

2006 ◽

Vol 132 (3) ◽

pp. 687-688 ◽

Cited By ~ 4

Author(s):

H. Jeanmart ◽

P. Lecompte ◽

F. Casselman ◽

J. Coddens ◽

G. Van Vaerenberg ◽

...

Keyword(s):

Inferior Vena Cava ◽

Inferior Vena ◽

Tumor Resection ◽

Vena Cava ◽

Endoscopic Tumor Resection

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1674 RISK OF COMPLICATIONS OF PERIOPERATIVE MITOMYCIN (MMC) AMONG BLADDER CANCER PATIENTS UNDERGOING ENDOSCOPIC TUMOR RESECTION

The Journal of Urology ◽

10.1016/j.juro.2012.02.1532 ◽

2012 ◽

Vol 187 (4S) ◽

Author(s):

Christopher Filson ◽

Jeffrey Montgomery ◽

Stephen Dailey ◽

Heather Crossley ◽

Paul Al-Attar ◽

...

Keyword(s):

Bladder Cancer ◽

Cancer Patients ◽

Tumor Resection ◽

Endoscopic Tumor Resection

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Application of indocyanine green video angiography in parasagittal meningioma surgery

Neurosurgical FOCUS ◽

10.3171/2013.12.focus13385 ◽

2014 ◽

Vol 36 (2) ◽

pp. E13 ◽

Cited By ~ 17

Author(s):

Alessandro Della Puppa ◽

Oriela Rustemi ◽

Giorgio Gioffrè ◽

Giuseppe Rolma ◽

Marzia Grandis ◽

...

Keyword(s):

Clinical Outcome ◽

Indocyanine Green ◽

Tumor Resection ◽

Postoperative Outcome ◽

Extent Of Resection ◽

Morbidity Rate ◽

Flow Measurements ◽

Dural Opening ◽

Meningioma Surgery ◽

Parasagittal Meningioma

Object There are no doubts about the role that indocyanine green video angiography (ICGVA) can play in current vascular neurosurgery. Conversely, in brain tumor surgery, and particularly in meningioma surgery, this role is still unclear. Vein management is pivotal for approaching parasagittal meningiomas, because venous preservation is strictly connected to both extent of resection and clinical outcome. The authors present the technical traits and the postoperative outcome of the application of ICGVA in patients undergoing parasagittal meningioma surgery. Methods The authors retrospectively collected demographic, radiological, intraoperative, and follow-up data in 43 patients with parasagittal meningiomas who underwent surgery with the assistance of ICGVA at Padua Neurosurgical Department between October 2010 and July 2013. Intraoperative ICGVA findings at different stages (before dural opening, after dural opening, during resection, after resection) were reviewed. Additional data on functional monitoring, temporary venous clipping, and flow measurements were also recorded. The overall postoperative outcome was evaluated by assessing both the extent of resection and the clinical outcome data. Results The ICGVA studies were performed 125 times in 43 patients, providing helpful data for vein management and tumor resection in all stages of surgery. In 16% of meningiomas completely occluding the superior sagittal sinus, the ICGVA data differed from radiological findings and changed the surgical approach. In 20% of cases the intraoperative ICGVA findings directly guided the surgical strategy: venous sacrifice was necessary in 7 cases, without postoperative consequences; temporary clipping with neurophysiological monitoring proved to be predictive of safe venous sacrifice. In 7% of cases the ICGVA data needed to be supplemented with flow measurements. Simpson Grade I–II and Grade III resections were achieved in 86% and 14% of cases, respectively, with a 4.6% rate of overall morbidity. Conclusions This study shows that ICGVA can assist the different stages of parasagittal meningiomas surgery, guiding the vein management and tumor resection strategies with a favorable final clinical outcome. However, in the authors' experience the use of other complementary tools was mandatory in selected cases to preserve functional areas. Further studies are needed to confirm that the application of ICGVA in parasagittal meningioma surgery may improve the morbidity rate, as reported in this study.

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Transcranial versus Endoscopic Transsphenoidal Approaches in Management of Recurrent Giant Pituitary Adenomas

Open Access Macedonian Journal of Medical Sciences ◽

10.3889/oamjms.2020.4213 ◽

2020 ◽

Vol 8 (B) ◽

pp. 273-280

Author(s):

Mohamed Ismail ◽

Omar Abdel Aleem Abdel Moneim Ragab ◽

Mohamed M. Salama ◽

Basim M. Ayoub ◽

Wael Elmahdy

Keyword(s):

Clinical Outcome ◽

Pituitary Adenomas ◽

Tumor Resection ◽

Transsphenoidal Approach ◽

Subtotal Resection ◽

Visual Improvement ◽

Group A ◽

Transcranial Approach ◽

Giant Pituitary Adenomas ◽

Group B

AIM: The aim of this study was to compare the transcranial and the endoscopic transsphenoidal approaches for patients with recurrent giant pituitary adenomas as regards the extent of tumor resection and the clinical outcome. METHODS: The study included 21 patients with recurrent giant pituitary adenomas divided into two groups; Group A included nine patients operated on by transcranial approaches and Group B included 12 patients operated on by the endoscopic transsphenoidal approach. Both groups were compared as regards the extent of tumor resection and the post-operative clinical outcome, particularly the visual and endocrinological outcomes, in addition to morbidity and mortality. RESULTS: There was a higher incidence of total and near-total resection in Group B (41.7%) and a higher incidence of subtotal resection in Group A (55.6%). The incidence of visual improvement was higher in Group B (55.6%) than in Group A (28.6%). Post-operative biochemical remission was achieved in 100% of Group B patients and in 50% of Group A patients with functioning adenomas. The incidence of post-operative complications was higher in Group A (77.8%) than in Group B (50%). CONCLUSION: The endoscopic transsphenoidal approach for recurrent giant pituitary adenomas is associated with a higher extent of tumor resection, better rates of visual improvement and endocrinological remission, and lower incidence of complications. The transcranial approach should be reserved for some adenomas with marked lateral or anterior extensions, fibrous tumors, and after the failure of the endoscopic transsphenoidal approach.

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Influence of pre-operative oral carbohydrate loading vs. standard fasting on tumor proliferation and clinical outcome in breast cancer patients ─ a randomized trial

BMC Cancer ◽

10.1186/s12885-019-6275-z ◽

2019 ◽

Vol 19 (1) ◽

Cited By ~ 3

Author(s):

Tone Hoel Lende ◽

Marie Austdal ◽

Anne Elin Varhaugvik ◽

Ivar Skaland ◽

Einar Gudlaugsson ◽

...

Keyword(s):

Breast Cancer ◽

Clinical Outcome ◽

Well Being ◽

Tumor Proliferation ◽

Relapse Free Survival ◽

Free Survival ◽

C Peptide ◽

Er Positive ◽

Carbohydrate Load ◽

Per Oral

Abstract Background Conflicting results have been reported on the influence of carbohydrates in breast cancer. Objective To determine the influence of pre-operative per-oral carbohydrate load on proliferation in breast tumors. Design Randomized controlled trial. Setting University hospital with primary and secondary care functions in South-West Norway. Patients Sixty-one patients with operable breast cancer from a population-based cohort. Intervention Per-oral carbohydrate load (preOp™) 18 and 2–4 h before surgery (n = 26) or standard pre-operative fasting with free consumption of tap water (n = 35). Measurements The primary outcome was post-operative tumor proliferation measured by the mitotic activity index (MAI). The secondary outcomes were changes in the levels of serum insulin, insulin-c-peptide, glucose, IGF-1, and IGFBP3; patients’ well-being, and clinical outcome over a median follow-up of 88 months (range 33–97 months). Results In the estrogen receptor (ER) positive subgroup (n = 50), high proliferation (MAI ≥ 10) occurred more often in the carbohydrate group (CH) than in the fasting group (p = 0.038). The CH group was more frequently progesterone receptor (PR) negative (p = 0.014). The CH group had a significant increase in insulin (+ 24.31 mIE/L, 95% CI 15.34 mIE/L to 33.27 mIE/L) and insulin c-peptide (+ 1.39 nM, 95% CI 1.03 nM to 1.77 nM), but reduced IGFBP3 levels (− 0.26 nM; 95% CI − 0.46 nM to − 0.051 nM) compared to the fasting group. CH-intervention ER-positive patients had poorer relapse-free survival (73%) than the fasting group (100%; p = 0.012; HR = 9.3, 95% CI, 1.1 to 77.7). In the ER-positive patients, only tumor size (p = 0.021; HR = 6.07, 95% CI 1.31 to 28.03) and the CH/fasting subgrouping (p = 0.040; HR = 9.30, 95% CI 1.11 to 77.82) had independent prognostic value. The adverse clinical outcome of carbohydrate loading occurred only in T2 patients with relapse-free survival of 100% in the fasting group vs. 33% in the CH group (p = 0.015; HR = inf). The CH group reported less pain on days 5 and 6 than the control group (p < 0.001) but otherwise exhibited no factors related to well-being. Limitation Only applicable to T2 tumors in patients with ER-positive breast cancer. Conclusions Pre-operative carbohydrate load increases proliferation and PR-negativity in ER-positive patients and worsens clinical outcome in ER-positive T2 patients. Trial registration CliniTrials.gov; NCT03886389. Retrospectively registered March 22, 2019.

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“An Odyssey of Third Space Endoscopy”—from Entry into the Tunnel to Entry into the Peritoneal Cavity

Journal of Digestive Endoscopy ◽

10.1055/s-0039-3402313 ◽

2019 ◽

Vol 10 (03) ◽

pp. 142-149

Author(s):

Harshal S. Mandavdhare ◽

Shubhra Mishra ◽

Jayanta Samanta ◽

Jimil Shah ◽

Rakesh Kochhar

Keyword(s):

Peritoneal Cavity ◽

Paradigm Shift ◽

Bowel Movement ◽

Submucosal Tumor ◽

Tumor Resection ◽

Third Space ◽

Esophageal Lumen ◽

History Of ◽

Endoscopic Myotomy ◽

Per Oral

AbstractThe last decade has seen the growth of a completely new and exciting entity called the third space endoscopy (TSE) that has brought about a paradigm shift in the way we manage various disorders of the gastrointestinal tract. The journey started with per oral endoscopic myotomy (POEM) for achalasia cardia and within a decade the concept has been exploited to its best potential for disorders including submucosal tumor resection, pyloromyotomy for gastroparesis, complete division of septum without the risk of perforation in diverticular diseases of esophagus, restoration of esophageal lumen in long strictures, restoration of bowel movement in Hirschsprung’s disease, and then taking the concept to the next level of pure NOTES (natural orifice transluminal endoscopic surgery) by entering the peritoneal cavity and performing fundoplication. This review will discuss the history of TSE with brief discussion about the various applications and what has been achieved till present.

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