Comparison of endoscopic resection techniques for duodenal neuroendocrine tumors: systematic review

Abstract Background and study aims Regardless of size, duodenal neuroendocrine tumors (dNETs) should be considered potentially malignant. A complete resection without complications is essential to increase safety procedures. The aim of this review was to describe effectiveness and possible complications of endoscopic techniques resection for resectioning dNETs in patients with tumors ≤ 20 mm in diameter. Methods An electronic bibliographic search was conducted using MEDLINE (via PubMed), Embase, Cochrane Central, and Google Scholar virtual databases. The types of intervention were endoscopic mucosal resection alone (EMR) or with cap (EMR-C), with a ligation device (EMR-L), with previous elevation of the tumor (EMR-I) or with endoscopic submucosal dissection (ESD); argon plasm coagulation (APC), and polypectomy. The outcome measures adopted were presence of free margin associated with tumor resection, tumor recurrence, complications (bleeding and perforation), and length of the procedure. Results Ten publications were included with the result of 224 dNET resections. EMR alone and polypectomy resulted in the most significantly compromised margin. The most frequent complication was bleeding (n = 21), followed by perforation (n = 8). Recurrence occurred in 13 cases, the majority of those under EMR or EMR-I. Conclusions EMR-C or EMR-I should be preferred for resectioning of dNETs. Polypectomy should not be indicated for resection of dNETs due to the high occurrence of incomplete resections. EMR alone must be avoided due a higher frequency of compromised margin and recurrent surgery. ESD was associated with no recurrence, however, but an increased occurrence of bleeding and perforation.

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MANAGEMENT OF ENDOCRINE DISEASE: Recurrence or new tumors after complete resection of pheochromocytomas and paragangliomas: a systematic review and meta-analysis

Acta Endocrinologica ◽

10.1530/eje-16-0189 ◽

2016 ◽

Vol 175 (4) ◽

pp. R135-R145 ◽

Cited By ~ 21

Author(s):

Laurence Amar ◽

Charlotte Lussey-Lepoutre ◽

Jacques W M Lenders ◽

Juliette Djadi-Prat ◽

Pierre-Francois Plouin ◽

...

Keyword(s):

Systematic Review ◽

Recurrent Disease ◽

Meta Analysis ◽

Random Effect ◽

Tumor Resection ◽

Complete Resection ◽

Sufficient Information ◽

Curative Surgery ◽

Multicenter Studies

Objectives To systematically review the incidence and factors associated with recurrences or new tumors after apparent complete resection of pheochromocytoma or thoraco–abdomino–pelvic paraganglioma. Design A systematic review and meta-analysis of published literature was performed. Methods Pubmed and Embase from 1980 to 2012 were searched for studies published in English on patients with non-metastatic pheochromocytoma or thoraco–abdomino–pelvic paraganglioma, complete tumor resection, postoperative follow-up exceeding 1 month, and recurrence or new tumor documented by pathology, hormonal dosages, or imaging tests. Incidence rates of new events after curative surgery were calculated for each study that had sufficient information and pooled using random-effect meta-analysis. Results In total, 38 studies were selected from 3518 references, of which 36 reported retrospective cohorts from the USA, Europe, and Asia. Patient follow-up was neither standardized nor exhaustive in the included studies. A clear description of patient retrieval methods was available for nine studies and the follow-up protocol and patient flow for four studies. Only two studies used multivariable methods to assess potential predictors of postoperative events. The overall rate of recurrent disease from 34 studies was 0.98 events/100 person-years (95% confidence interval 0.71, 1.25). Syndromic diseases and paragangliomas were consistently associated with a higher risk of a new event in individual studies and in meta-regression analysis. Conclusions The risk of recurrent disease after complete resection of pheochromocytoma may be lower than that previously estimated, corresponding to five events for 100 patients followed up for 5 years after complete resection. Risk stratification is required to tailor the follow-up protocol after complete resection of a pheochromocytoma or paraganglioma. Large multicenter studies are needed to this end.

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Endoscope-Assisted Retrosigmoid Approach for Cerebellopontine Angle Epidermoid Tumor

Journal of Neurological Surgery Part B Skull Base ◽

10.1055/s-0038-1669983 ◽

2018 ◽

Vol 79 (S 05) ◽

pp. S409-S410

Author(s):

Francisco Vaz-Guimaraes ◽

Paul Gardner ◽

Juan Fernandez-Miranda

Keyword(s):

Surgical Resection ◽

Cerebellopontine Angle ◽

Clinical Symptoms ◽

Tumor Resection ◽

Cranial Nerves ◽

Complete Resection ◽

Retrosigmoid Approach ◽

Incomplete Resection ◽

Endoscopic Techniques ◽

Epidermoid Tumor

Objectives Surgical resection is the only effective treatment modality for epidermoid tumors. Complete resection with preservation of neurological function must be pursued whenever possible, because it offers a cure for patients. However, the inability to identify hidden remnants, interdigitating around cranial nerves, especially in larger tumors, may be a contributing factor for incomplete resection. This operative video demonstrates the technical nuances in achieving complete resection of a cerebellopontine angle epidermoid tumor via an endoscope-assisted retrosigmoid approach. Design and Setting Operative video of an endoscope-assisted retrosigmoid, approach for complete resection of a cerebellopontine angle epidermoid tumor. The patient was a 16-year-old female, who presented with 1-year history of worsening headaches and imbalance. Her neurological exam was normal, including normal cranial nerve function, and hearing. Radiological evaluation revealed an epidermoid tumor in the right cerebellopontine angle, extending to the interpeduncular cistern. Surgical resection was recommended. Given extension of the tumor across the midline, an endoscope-assisted procedure was planned to increase the odds of complete resection. Results The video demonstrates the surgical technique applied for tumor resection. The patient's clinical symptoms resolved completely after surgery and she remained neurologically intact. Postoperative magnetic resonance imaging (MRI) confirmed complete tumor resection. There were no postoperative complications. Conclusions The use of endoscopic techniques for resection of cerebellopontine angle epidermoid tumor is safe and effective and may increase the odds of complete resection, especially in larger tumors spreading across the midline, by enabling the surgeon clear visualization of deep-seated and contralateral relevant neurovascular structures, not readily accessible by the surgical microscope.The link to the video can be found at: https://youtu.be/X6YP_7OeQQE.

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Proteomics of Pancreatic Neuroendocrine Tumors: A Systematic Review

Protein and Peptide Letters ◽

10.2174/0929866527666200504122116 ◽

2020 ◽

Vol 27 (12) ◽

pp. 1276-1287

Author(s):

Brigida Anna Maiorano ◽

Giovanni Schinzari ◽

Sabrina Chiloiro ◽

Felicia Visconti ◽

Domenico Milardi ◽

...

Keyword(s):

Systematic Review ◽

Neuroendocrine Tumors ◽

Prognostic Markers ◽

State Of The Art ◽

Therapeutic Targets ◽

The State ◽

Pancreatic Neuroendocrine Tumors ◽

Rare Tumors ◽

Personalized Approach ◽

Future Management

Pancreatic neuroendocrine tumors (PanNETs) are rare tumors having usually an indolent behavior, but sometimes with unpredictable aggressiveness. PanNETs are more often non-functioning (NF), unable to produce functioning hormones, while 10-30% present as functioning (F) - PanNETs, such as insulinomas , gastrinomas , and other rare tumors. Diagnostic and prognostic markers, but also new therapeutic targets, are still lacking. Proteomics techniques represent therefore promising approaches for the future management of PanNETs. We conducted a systematic review to summarize the state of the art of proteomics in PanNETs. A total of 9 studies were included, focusing both on NF- and F-PanNETs. Indeed, proteomics is useful for the diagnosis, the prognosis and the detection of therapeutic targets. However, further studies are required. It is also warranted to standardize the analysis methods and the collection techniques, in order to validate proteins with a relevance in the personalized approach to PanNETs management.

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A technique for endoscopic pituitary tumor removal

Neurosurgical FOCUS ◽

10.3171/foc.1996.1.1.3 ◽

1996 ◽

Vol 1 (1) ◽

pp. E3 ◽

Cited By ~ 18

Author(s):

Michael D. Cusimano ◽

Ronald S. Fenton

Keyword(s):

Case Report ◽

Minimally Invasive ◽

Pituitary Tumor ◽

Tumor Resection ◽

Region Of Interest ◽

Operating Microscope ◽

Tumor Removal ◽

Endoscopic Techniques ◽

Effective Manner ◽

Highly Effective

A number of milestones have marked the development of transsphenoidal pituitary tumor resection this century. The introduction of headlamp illumination, followed by the use of the operating microscope and fluoroscopy have allowed neurosurgeons to perform this surgery in a safe and highly effective manner. With the aid of a case report, we describe the incorporation of endoscopic techniques in pituitary tumor resection. The technique described is minimally invasive, avoiding septal dissection and allowing unsurpassed, unobstructed, and panoramic visualization of the region of interest to the surgeon and operative team.

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Effects of dignity therapy on palliative patients’ family members: A systematic review

Palliative & Supportive Care ◽

10.1017/s147895152100033x ◽

2021 ◽

pp. 1-10

Author(s):

Leonor Grijó ◽

Carolina Tojal ◽

Francisca Rego

Keyword(s):

Systematic Review ◽

Palliative Care ◽

End Of Life ◽

Meaning In Life ◽

Family Members ◽

Cochrane Library ◽

Publication Date ◽

Dignity Therapy ◽

Bibliographic Search ◽

Palliative Patients

Abstract Objective Dignity therapy (DT) is a kind of psychotherapy that identifies the main concerns of end-of-life patients that affect their perception of dignity and helps them to find a new meaning in life. Most prior studies on DT analyze outcomes for palliative care patients. The aim of this systematic review is to explore the outcomes of DT in palliative care patients’ family members. Method In June 2020, a bibliographic search was performed using the terms “Dignity Therapy” and “Palliative Care” in the following databases: Cochrane library, TRIP database, PUBMED, Scopus, and Web of Knowledge. Of the 294 articles found, 8 met the selection criteria and were considered in the present study. No articles were excluded based on their publication date. Results Family members generally believe that DT helps them to better prepare the patient's end-of-life and overcome the bereavement phase. The legacy document was considered a source of comfort, and most would recommend DT to other people in their situation. DT is generally considered as important as any other aspect of the patient's treatment. Significance of results There is evidence of the benefits of DT for palliative patients’ family members. However, there are still few studies that evaluate these outcomes. The existing evidence is poorly generalized, and thus, further studies are needed to deeply explore the benefits of this therapy both for patients and their families.

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Impact of combined use of intraoperative MRI and awake microsurgical resection on patients with gliomas: a systematic review and meta-analysis

Neurosurgical Review ◽

10.1007/s10143-021-01488-3 ◽

2021 ◽

Author(s):

Constantin Tuleasca ◽

Henri-Arthur Leroy ◽

Iulia Peciu-Florianu ◽

Ondine Strachowski ◽

Benoit Derre ◽

...

Keyword(s):

Systematic Review ◽

Postoperative Complications ◽

Brain Tumors ◽

Standard Error ◽

Complete Resection ◽

Awake Craniotomy ◽

Intraoperative Mri ◽

Primary Brain Tumors ◽

Combined Use ◽

Microsurgical Resection

AbstractMicrosurgical resection of primary brain tumors located within or near eloquent areas is challenging. Primary aim is to preserve neurological function, while maximizing the extent of resection (EOR), to optimize long-term neurooncological outcomes and quality of life. Here, we review the combined integration of awake craniotomy and intraoperative MRI (IoMRI) for primary brain tumors, due to their multiple challenges. A systematic review of the literature was performed, in accordance with the Prisma guidelines. Were included 13 series and a total number of 527 patients, who underwent 541 surgeries. We paid particular attention to operative time, rate of intraoperative seizures, rate of initial complete resection at the time of first IoMRI, the final complete gross total resection (GTR, complete radiological resection rates), and the immediate and definitive postoperative neurological complications. The mean duration of surgery was 6.3 h (median 7.05, range 3.8–7.9). The intraoperative seizure rate was 3.7% (range 1.4–6; I^2 = 0%, P heterogeneity = 0.569, standard error = 0.012, p = 0.002). The intraoperative complete resection rate at the time of first IoMRI was 35.2% (range 25.7–44.7; I^2 = 66.73%, P heterogeneity = 0.004, standard error = 0.048, p < 0.001). The rate of patients who underwent supplementary resection after one or several IoMRI was 46% (range 39.8–52.2; I^2 = 8.49%, P heterogeneity = 0.364, standard error = 0.032, p < 0.001). The GTR rate at discharge was 56.3% (range 47.5–65.1; I^2 = 60.19%, P heterogeneity = 0.01, standard error = 0.045, p < 0.001). The rate of immediate postoperative complications was 27.4% (range 15.2–39.6; I^2 = 92.62%, P heterogeneity < 0.001, standard error = 0.062, p < 0.001). The rate of permanent postoperative complications was 4.1% (range 1.3–6.9; I^2 = 38.52%, P heterogeneity = 0.123, standard error = 0.014, p = 0.004). Combined use of awake craniotomy and IoMRI can help in maximizing brain tumor resection in selected patients. The technical obstacles to doing so are not severe and can be managed by experienced neurosurgery and anesthesiology teams. The benefits of bringing these technologies to bear on patients with brain tumors in or near language areas are obvious. The lack of equipoise on this topic by experienced practitioners will make it difficult to do a prospective, randomized, clinical trial. In the opinion of the authors, such a trial would be unnecessary and would deprive some patients of the benefits of the best available methods for their tumor resections.

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Levels of Circulating PD-L1 Are Decreased in Patients with Resectable Cholangiocarcinoma

International Journal of Molecular Sciences ◽

10.3390/ijms22126569 ◽

2021 ◽

Vol 22 (12) ◽

pp. 6569

Author(s):

Christoph Roderburg ◽

Sven H. Loosen ◽

Jan Bednarsch ◽

Patrick H. Alizai ◽

Anjali A. Roeth ◽

...

Keyword(s):

Tumor Recurrence ◽

Tumor Biology ◽

Tumor Resection ◽

Postoperative Outcome ◽

Serum Levels ◽

Strong Trend ◽

Programmed Cell Death 1 ◽

Early Tumor ◽

Circulating Levels

Tumor resection represents the only curative treatment option for patients with biliary tract cancers (BTCs), including intrahepatic cholangiocarcinoma (CCA), perihilar and extrahepatic CCA and gallbladder cancer. However, many patients develop early tumor recurrence and are unlikely to benefit from surgery. Therefore, markers to identify ideal surgical candidates are urgently needed. Circulating programmed cell death 1 ligand 1 (PD-L1) has recently been associated with different malignancies, including pancreatic cancer which closely resembles BTC in terms of patients’ prognosis and tumor biology. Here, we aim at evaluating a potential role of circulating PD-L1 as a novel biomarker for resectable BTC. Methods: Serum levels of PD-L1 were analyzed by ELISA in 73 BTC patients and 42 healthy controls. Results: Circulating levels of preoperative PD-L1 were significantly lower in patients with BTC compared to controls. Patients with low PD-L1 levels displayed a strong trend towards an impaired prognosis, and circulating PD-L1 was negatively correlated with experimental markers of promalignant tumor characteristics such as CCL1, CCL21, CCL25 and CCL26. For 37 out of 73 patients, postoperative PD-L1 levels were available. Interestingly, after tumor resection, circulating PD-L1 raised to almost normal levels. Notably, patients with further decreasing PD-L1 concentrations after surgery showed a trend towards an impaired postoperative outcome. Conclusion: Circulating PD-L1 levels were decreased in patients with resectable BTC. Lack of normalization of PD-L1 levels after surgery might identify patients at high risk for tumor recurrence or adverse outcome.

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