INNV-09. SURGICAL STRATEGIES FOR OLDER PATIENTS WITH GLIOBLASTOMA

2021 ◽  
Vol 23 (Supplement_6) ◽  
pp. vi107-vi107
Author(s):  
Tanyeri Barak ◽  
Lee Hwang ◽  
Justin Chen ◽  
Lan Jin ◽  
Danielle Miyagishima ◽  
...  
Keyword(s):  
Overall Survival ◽  
Postoperative Complications ◽  
Surgical Resection ◽  
Patient Population ◽  
Older Patients ◽  
Intraoperative Ultrasound ◽  
Extent Of Resection ◽  
Cancer Center ◽  
Karnofsky Performance Score ◽  
Significant Clinical Improvement

Abstract OBJECTIVE Though image-guided surgery with intraoperative magnetic resonance imaging (IoMRI) is associated with higher extent of resection, we aimed to determine the clinical outcome of its use, compared to other less time-consuming intraoperative ultrasound (IoUS), in this patient population. METHODS Clinical data of 221 consecutive patients aged 70 years or older, who underwent surgical resection for GBM with intraoperative ultrasonography (IoUS) alone or combination of IoMRI + IoUS at Yale New Haven Hospital and Memorial Sloan Kettering Cancer Center were retrospectively reviewed. Variables were analyzed, and comparative analyses were performed, including predictors of overall survival. RESULTS The addition of IoMRI was not superior to IoUS alone in terms of overall survival (OS) (HR=0.85, 95% CI 0.49-1.47; P= 0.56) or Karnofsky Performance Score (KPS) at 6 weeks postoperatively (OR=0.51, 95% CI 0.22-1.15; P= 0.102). On the contrary, the length of surgery (LOSx) was significantly longer (P< 0.0001) in the IoMRI group. Postoperative complications were significantly less in the IoUS-only group (OR=0.17, 95% CI 0.3-0.46; P=0.002) and in patients who had a preoperative KPS score of 70 or higher (OR=0.092, 95% CI 0.018-0.47; P=0.004). Patients with relatively lower preoperative KPS scores (< 70) showed significant clinical improvement at 6 weeks postoperatively (P=0.0002). Patients with postoperative complications were more likely to have lower KPS scores at 6 weeks postoperatively (OR=0.30, 95% CI 0.10-0.89; P= 0.031), while increased extent of resection was associated with improved KPS scores at 6 weeks postoperatively (OR=2.171, 95% CI 1.22-3.87; P= 0.009). CONCLUSION Aggressive management with surgical resection should be considered in older patients with GBM, even those with relatively poor KPS scores. The use of IoMRI in this patient population does not appear to yield any survival benefit over IoUS but instead significantly prolongs the length of surgery, increasing the risk for potential postoperative complications.

Intracranial Hemangiopericytoma

Neurosurgery ◽  
2013 ◽  
Vol 73 (4) ◽  
pp. 624-631 ◽  
Author(s):  
Amol J. Ghia ◽  
Eric L. Chang ◽  
Pamela K. Allen ◽  
Anita Mahajan ◽  
Marta Penas-Prado ◽  
...  
Keyword(s):  
Overall Survival ◽  
Postoperative Radiotherapy ◽  
Extent Of Resection ◽  
Cancer Center ◽  
Subtotal Resection ◽  
University Of Texas ◽  
Institutional Experience ◽  
Unknown Status ◽  
Meningeal Hemangiopericytoma ◽  
The University

Abstract BACKGROUND: Meningeal hemangiopericytoma (M-HPC) is a rare entity. OBJECTIVE: To characterize our institutional experience in treating M-HPC. METHODS: We reviewed the medical records of patients with M-HPC evaluated at The University of Texas M.D. Anderson Cancer Center between 1979 and 2009. RESULTS: We identified 63 patients diagnosed between 1979 and 2009 with M-HPC treated with surgery alone or with postoperative radiotherapy (PORT). The majority were male (59%) and with a median age of 40.9 years (range, 0-71). Gross total resection (GTR) predominated (n = 31, 49%) followed by subtotal resection (n = 23, 37%) and unknown status (n = 9, 14.3%). PORT was delivered to 39 of the 63 patients (62%). The 5-, 10-, and 15-year overall survival were 90%, 68%, and 28%, respectively. The 5-, 10-, and 15-year local control (LC) were 70%, 37%, and 20%, respectively. The 5-, 10-, and 15-year metastasis-free survival were 85%, 39%, and 7%. PORT resulted in improved LC (hazard ratio [HR] 0.38, P = .008). Radiotherapy (RT) dose ≥60 Gy correlated with improved LC relative to <60 Gy (HR 0.12, P = .045). GTR correlated with improved LC (HR 0.40, P = .03). On multivariate analysis, PORT (HR 0.33, P = .003), GTR (HR = 0.33, P = .008), and RT dose ≥60 Gy (HR 0.33, P = .003) correlated with improved LC. Among those with GTR, PORT resulted in improved LC (HR 0.18, P = .027). Extent of resection and PORT did not correlate with improved overall survival. CONCLUSION: In M-HPC, both PORT and GTR independently correlate with improved LC. PORT improves LC following GTR. We recommend RT dose ≥60 Gy to optimize LC.

HLA Homozygosity and Haplotype Bias Among Patients with Chronic Lymphocytic Leukemia: Implications for Disease Control by Physiologic Immune Surveillance

Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 1370-1370
Author(s):  
Nina Shah ◽  
William Decker ◽  
Ruth Lapushin ◽  
Dongxia Xing ◽  
Simon Robinson ◽  
...  
Keyword(s):  
Overall Survival ◽  
Clinical Outcome ◽  
Patient Population ◽  
Research Funding ◽  
Advanced Disease ◽  
Immune Surveillance ◽  
Prognostic Significance ◽  
Cancer Center ◽  
Cell Transplant ◽  
Hla Alleles

Abstract Abstract 1370 Background: Though the cancer immune surveillance hypothesis was first proposed a century ago, there has been limited evidence to support the role of antigen presentation in the detection or suppression of CLL. In this study we evaluated the frequencies of HLA haplotype and homozygosity and subsequent impact on clinical outcome in CLL patients with advanced disease. Methods: We performed a retrospective chart review of 249 CLL patients who were referred for allogeneic stem cell transplant at MD Anderson Cancer Center. We compared HLA allele frequencies of the patient population with those of local, race-matched controls and identified specific HLA alleles which were more frequent in the patient population. We also compared HLA homozygosity between the patient and control population. The Kaplan-Meier method was then used to determine the prognostic significance of the identified HLA alleles and homozygosity on clinical outcome within our patient population. Progression-free survival (PFS) was calculated from the time of first treatment to the time of progression or death. Results: CLL patients with advanced disease were significantly more likely to express HLA-A1 (OR=1.49, 95% CI 1.15–1.94, p=0.0003) or HLA- C7 (OR 1.24, 95% CI 1.00–1.53, p=0.05). In addition, these patients were more likely to be homozygous at any HLA locus than were controls (OR=1.20, 95% CI 0.97–1.48, p=0.04), particularly at HLA-C (OR=1.62, 95% CI 1.13–2.33, p=0.002) and at multiple HLA loci (OR=1.69, 95% CI 1.06–2.70, p=0.006). CLL patients who were HLA-A1+, HLA-A1/C7+ or homozygous at any allele demonstrated worse PFS in comparison with CLL patients without any of these HLA allelic characteristics. Median survival was 23.9 months for HLA-A1+ patients, 13.9 months for HLA-A1/C7+ patients and 25.7 months for patients with homozygosity, in comparison to 31.8 months for the population without any detrimental alleles or homozygosity (p=0.02, p=0.0008, and p=0.007 respectively, Figure 1: A, B, C). Analysis of patients possessing only HLA-C7 as a risk factor demonstrated a trend toward decreased PFS but was not quite statistically significant (p=0.07, data not shown). Conclusions: Patients with advanced CLL appear to express certain HLA alleles and exhibit HLA homozygosity more frequently than normal controls. In addition, these HLA characteristics may predispose CLL patients to a worse outcome. Because HLA allelic variation determines the specificity of antigens presented to the immune system, the data suggest that immune surveillance may play a physiologic role in the control of leukemic disease and provide a theoretical framework for the identification of CLL antigens which could eventually serve as targets for immunotherapy. A. Negative effects of HLA-A1 allele on overall survival of patients with advanced CLL are B. synergistically worsened by the presence of the HLA-C7 allele. C. Homozygosity at any HLA allele also imparted a negative impact upon overall survival. Disclosures: O'Brien: Novartis: Research Funding; BMS: Research Funding.

scholarly journals Factors affecting survival in 43 consecutive patients after surgery for spinal metastases from thyroid carcinoma

2015 ◽  
Vol 23 (4) ◽  
pp. 419-428 ◽  
Author(s):  
Jonathan N. Sellin ◽  
Dima Suki ◽  
Viraat Harsh ◽  
Benjamin D. Elder ◽  
Daniel K. Fahim ◽  
...  
Keyword(s):  
Overall Survival ◽  
Multivariate Analysis ◽  
Thyroid Cancer ◽  
Postoperative Complications ◽  
Systemic Disease ◽  
Univariate Analysis ◽  
Spinal Metastases ◽  
Neurological Deficits ◽  
Cancer Center ◽  
Preoperative Embolization

OBJECT Spinal metastases account for the majority of bone metastases from thyroid cancer. The objective of the current study was to analyze a series of consecutive patients undergoing spinal surgery for thyroid cancer metastases in order to identify factors that influence overall survival. METHODS The authors retrospectively reviewed the records of all patients who underwent surgery for spinal metastases from thyroid cancer between 1993 and 2010 at the University of Texas MD Anderson Cancer Center. RESULTS Forty-three patients met the study criteria. Median overall survival was 15.4 months (95% CI 2.8–27.9 months) based on the Kaplan-Meier method. The median follow-up duration for the 4 patients who were alive at the end of the study was 39.4 months (range 1.7–62.6 months). On the multivariate Cox analysis, progressive systemic disease at spine surgery and postoperative complications were associated with worse overall survival (HR 8.98 [95% CI 3.46–23.30], p < 0.001; and HR 2.86 [95% CI 1.30–6.31], p = 0.009, respectively). Additionally, preoperative neurological deficit was significantly associated with worse overall survival on the multivariate analysis (HR 3.01 [95% CI 1.34–6.79], p = 0.008). Conversely, preoperative embolization was significantly associated with improved overall survival on the multivariate analysis (HR 0.43 [95% CI 0.20–0.94], p = 0.04). Preoperative embolization and longer posterior construct length were significantly associated with fewer and greater complications, respectively, on the univariate analysis (OR 0.24 [95% CI 0.06–0.93] p = 0.04; and OR 1.24 [95% CI 1.02–1.52], p = 0.03), but not the multivariate analysis. CONCLUSIONS Progressive systemic disease, postoperative complications, and preoperative neurological deficits were significantly associated with worse overall survival, while preoperative spinal embolization was associated with improved overall survival. These factors should be taken into consideration when considering such patients for surgery. Preoperative embolization and posterior construct length significantly influenced the incidence of postoperative complications only on the univariate analysis.

scholarly journals Rationale and Clinical Implications of Fluorescein-Guided Supramarginal Resection in Newly Diagnosed High-Grade Glioma

2021 ◽  
Vol 11 ◽  
Author(s):  
Linda M. Wang ◽  
Matei A. Banu ◽  
Peter Canoll ◽  
Jeffrey N. Bruce
Keyword(s):  
Overall Survival ◽  
Surgical Resection ◽  
Local Treatment ◽  
Standard Of Care ◽  
High Grade Glioma ◽  
Extent Of Resection ◽  
Brain Parenchyma ◽  
Clinical Implications ◽  
Current Standard ◽  
Supramarginal Resection

Current standard of care for glioblastoma is surgical resection followed by temozolomide chemotherapy and radiation. Recent studies have demonstrated that &gt;95% extent of resection is associated with better outcomes, including prolonged progression-free and overall survival. The diffusely infiltrative pattern of growth in gliomas results in microscopic extension of tumor cells into surrounding brain parenchyma that makes complete resection unattainable. The historical goal of surgical management has therefore been maximal safe resection, traditionally guided by MRI and defined as removal of all contrast-enhancing tumor. Optimization of surgical resection has led to the concept of supramarginal resection, or removal beyond the contrast-enhancing region on MRI. This strategy of extending the cytoreductive goal targets a tumor region thought to be important in the recurrence or progression of disease as well as resistance to systemic and local treatment. This approach must be balanced against the risk of impacting eloquent regions of brain and causing permanent neurologic deficit, an important factor affecting overall survival. Over the years, fluorescent agents such as fluorescein sodium have been explored as a means of more reliably delineating the boundary between tumor core, tumor-infiltrated brain, and surrounding cortex. Here we examine the rationale behind extending resection into the infiltrative tumor margins, review the current literature surrounding the use of fluorescein in supramarginal resection of gliomas, discuss the experience of our own institution in utilizing fluorescein to maximize glioma extent of resection, and assess the clinical implications of this treatment strategy.

scholarly journals Ovoid Foramen Magnum Shape is Associated with Increased Complications and Decreased Extent of Resection for Anterolateral Foramen Magnum Meningiomas

2020 ◽  
Author(s):  
Hakan Kina ◽  
Ufuk Erginoglu ◽  
Sahin Hanalioglu ◽  
Burak Ozaydin ◽  
Mustafa K. Baskaya
Keyword(s):  
Surgical Resection ◽  
Statistical Significance ◽  
Tumor Resection ◽  
Extent Of Resection ◽  
Foramen Magnum ◽  
Radiographic Evaluation ◽  
Symptom Duration ◽  
Karnofsky Performance Score ◽  
Complication Rates ◽  
Lower Cranial Nerve

Abstract Background Antero-laterally located meningiomas of the foramen magnum (FM) pose significant surgical resection challenges. The effect of FM shape on surgical resection of FM meningiomas has not been previously studied. The present study investigates how FM shape effects the extent of tumor resection and complication rates in antero-lateral FM meningiomas. Materials and Methods This retrospective study included 16 consecutive patients with antero-lateral FM meningiomas operated on by a single surgeon. FMs were classified as ovoid (n = 8) and nonovoid (n = 8) using radiographic evaluation. Results Sixteen patients were examined: seven males and nine females (mean age of 58.5, and range of 29 to 81 years). Gross total resection was achieved in 81% of patients, with tumor encased vertebral arteries in 44%. Patient characteristics were similar including age, sex, preoperative tumor volume, relationship of vertebral artery with tumor, preoperative Karnofsky performance score (KPS), symptom duration, and presence of lower cranial nerve symptoms. The ovoid FM group had lower volumetric extents of resection without statistical significance (93 ± 10 vs. 100 ± 0%, p = 0.069), more intraoperative blood loss (319 ± 75 vs. 219 ± 75 mL, p = 0.019), more complications per patient (1.9 ± 1.8 vs. 0.3 ± 0.4, p = 0.039), and poorer postoperative KPS (80 ± 21 vs. 96 ± 5, p = 0.007). Hypoglossal nerve palsy was more frequent in the ovoid FM group (38 vs. 13%). Conclusion This is the first study demonstrating that ovoid FMs may pose surgical challenges, poorer operative outcomes, and lower rates of extent of resection. Preoperative radiological investigation including morphometric FM measurement to determine if FMs are ovoid or nonovoid can improve surgical planning and complication avoidance.

scholarly journals P14.116 Lack of correlation between incidental ipsilateral subventricular zone radiation dose and overall survival in glioblastoma patients

2019 ◽  
Vol 21 (Supplement_3) ◽  
pp. iii95-iii96
Author(s):  
G Hallaert ◽  
H Pinson ◽  
D Vanhauwaert ◽  
L Staelens ◽  
C Vandenbroecke ◽  
...  
Keyword(s):  
Overall Survival ◽  
Radiation Dose ◽  
Subventricular Zone ◽  
Cox Regression ◽  
Extent Of Resection ◽  
Gross Total Resection ◽  
Karnofsky Performance Score ◽  
Mgmt Methylation ◽  
Gene Methylation ◽  
Total Resection

Abstract BACKGROUND The role of the subventricular zone (SVZ) in glioblastoma (GBM) is controversial. The past decade, several retrospective studies were published concerning the potential correlation between incidental radiation of the SVZ and survival in GBM patients. Although these publications showed conflicting results, a large study claimed an overall survival (OS) benefit for GBM patients after gross total resection if the ipsilateral SVZ received a higher dose than 40 Gy. We investigated this finding in our own population of GBM patients. MATERIAL AND METHODS A multicenter retrospective study was conducted including all adult patients treated for histologically proven GBM from 2003–2014. All patients received 60 Gy radiation therapy after surgery and concomitant temozolomide. Exclusion criteria were: infratentorial GBM; presence of other neoplasm(s); known previous history of low grade glioma; incomplete radiotherapy data. Demographic data were collected from the patient charts. O6-methylguanin-DNA-methyltransferase-promotor-gene (MGMT) methylation was determined on stored tumor samples using semi quantitative methylation-specific polymerase chain reaction (qMSP). SVZs (ipsilateral, contralateral and bilateral) were contoured on radiotherapy treatment plans. Multivariate Cox regression analysis was used to study the correlation between incidental SVZ radiation dose and OS. Age (cut-off 65 years), Karnofsky Performance Score (KPS; cut-off 70), methylation of the MGMT-promotor gene and extent of resection (biopsy; subtotal resection, groos total resection) were used as covariates. Patients alive at time of database closure were censored for analysis. RESULTS 183 patients were eligible for analysis. Mean age at diagnosis was 62 years, with an average KPS of 70. In 34% of patients, gross total resection (GTR) was achieved, while in 28% only a biopsy was taken. MGMT-promoter gene methylation was present in 39% of cases. Median ipsilateral, contralateral and bilateral SVZ doses were 46.1 Gy, 25.35 Gy and 34.8 Gy resp. In multivariate Cox regression, all covariates (age, P = 0.011; KPS, P = 0.001; MGMT methylation, P = 0.000; extent of resection, P = 0.000) were significantly associated with OS. Mean OS was 23 months, but median OS 13 months. There was no correlation between incidental radiation dose of the ipsilateral SVZ and OS for 46 Gy or 40 Gy (hazard ratio 0.82 (0.6–1.1), P = 0.225 and 0.89 (0.63–1.23), P = 0.52 resp.) for the whole group nor for the subgroup of gross total resection. CONCLUSION In this group of GBM patients, age, KPS, extent of resection and methylation of the MGMT-promotor gene were significantly correlated with OS, but not incidental ipsilateral SVZ radiation dose. The previously published positive results may result from bias, possibly arising from lack of inclusion of MGMT-promotor gene methylation as an important independent prognostic factor.

Impact Of Dialysis-Dependent Renal Failure At Time Of Myeloma Diagnosis On Overall Survival - a 15-Year Single Centre Analysis

Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 3230-3230
Author(s):  
Philip T Murphy ◽  
Cherisse Baldeo ◽  
Patrick O'Kelly ◽  
Jeremy Sargant ◽  
Patrick Thornton ◽  
...  
Keyword(s):  
Overall Survival ◽  
Renal Impairment ◽  
Patient Population ◽  
Older Patients ◽  
Conflicts Of Interest ◽  
Wilcoxon Test ◽  
High Dose ◽  
Term Survival ◽  
Old Patients ◽  
Younger Patients

Abstract In myeloma, the use of autologous stem cell transplantation in younger patients as well as the introduction of thalidomide, lenalidomide and bortezomib has resulted in improvement in long-term survival of both younger and older patients. Bortezomid and high dose dexamethasone is currently recommended to treat newly diagnosed myeloma patients presenting with renal impairment and may lead to varying degrees of improvement in renal function. We have assessed not only survival trends for all patients diagnosed at our centre over the past 18 years but also the survival of the subset of patients with severe renal impairment who required dialysis at diagnosis. All patients diagnosed with myeloma at our centre between January 1995 and December 2012 were included. We constructed Kaplan-Meier curves and used the Breslow generalised Wilcoxon test to evaluate overall survival (OS) patterns (diagnosed in three calendar periods: 1995-2000; 2001-2006; 2007-2012) for our total patient population as well as the subset of patients who required dialysis within 4 weeks of diagnostic bone marrow test. 262 patients (60.3% males) were diagnosed between 1995 and 2012. For all patients, median OS significantly increased from 13.2 months in period 1995-2000 to 27 months in period 2001-2006 with median OS not yet reached in period 2007-2012 (p=0.0001). In patients 70 years old or less, median OS significantly increased from 25.4 months in period 1995-2000 to 46.7 months in period 2001-2006 with median OS not yet reached in period 2007-2012 (p=0.0482). Improved median OS was also seen in patients > 70 years old: 4.4 months in period 1995-2000, 17.4 months in period 2001-2006 and 25.1 months in period 2007-2012 (p<0.0001). In contrast, patients requiring dialysis at diagnosis (n = 44) had much worse outcomes: median OS in the period 1995-2000 was 2.8 months and although there was a slight improvement in median OS in the period 2001-2006 (p=0.0318), there has been no further improvement in median OS in the period 2007-2012. In our overall myeloma patient population, median OS has continued to increase over the time periods 1995-2000, 2001-2006 and 2007-2012, both for younger patients 70 years old or less and older patients >70 years old. Patients requiring dialysis at diagnosis, however, continue to have much poorer median OS, despite the use of bortezomib and dexamethasone containing regimens in recent years. The possible benefit of improved supportive measures and the early use of other emerging novel agents in this poor prognostic subgroup should be explored in the clinical trial setting. Disclosures: No relevant conflicts of interest to declare.

scholarly journals Extent of Glioma Resection on Intraoperative Ultrasound Correlates Well with Postoperative MRI Results

2019 ◽  
pp. 1-7
Author(s):  
Ahmed Aly ◽  
Radwan Noubi ◽  
Mahmoud Ragab ◽  
Khalid Abdelaziz ◽  
Simon Howarth ◽  
...  
Keyword(s):  
Surgical Resection ◽  
Intraoperative Imaging ◽  
Intraoperative Ultrasound ◽  
Extent Of Resection ◽  
Control Group ◽  
P Value ◽  
Low Grade ◽  
Ultrasound Images ◽  
Glioma Surgery ◽  
Number Of Patients

Background: Maximal surgical resection is thought to confer survival benefit for both high- and low-grade gliomas. Intraoperative imaging assists with achieving maximal surgical resection. Different intraoperative imaging modalities have been implemented, but intra-operative MRI has a high cost that may limit its uptake in resource scarce healthcare systems. Objectives: This study aims to evaluate intraoperative ultrasound as a surrogate for intra and post-operative MRI for assessing the extent of resection of glioma. Methods: A partially prospective comparative study, which compares a prospective cohort group with a historical control group. We evaluated 74 glioma patients, who all underwent surgery in a regional UK Neurosurgical centre between October 2013 and October 2017. The study population was divided into 2 groups based on the use of ultrasound to guide the resection. We compared the size of the lesion prior and after excision to evaluate the extent of resection and undertook comparison with post-operative MRI. Results: The mean extent of resection on the ultrasound images was 96.1 % and 97.7 % on the postoperative MR. Using Spearman’s correlation; extent of resection on the ultrasound images was strongly correlated with the extent of resection on the postoperative MR images (P=value <0.001). The use of intraoperative ultrasound was associated with a significant increase in the number of patients in whom 95% or greater extent of resection was achieved (Fisher’s exact test P= value 0.033). Conclusion: Intra-operative ultrasonography could provide a reliable and cheaper alternative to intraoperative MRI to improve the extent of resection in glioma surgery.

scholarly journals Surgery vs. Biopsy in the Treatment of Butterfly Glioblastoma: A Systematic Review and Meta-Analysis

Cancers ◽  
2022 ◽  
Vol 14 (2) ◽  
pp. 314
Author(s):  
Shreya Chawla ◽  
Vasileios K. Kavouridis ◽  
Alessandro Boaro ◽  
Rasika Korde ◽  
Sofia Amaral Medeiros ◽  
...  
Keyword(s):  
Systematic Review ◽  
Postoperative Complications ◽  
Surgical Resection ◽  
Meta Analysis ◽  
Case Series ◽  
Extent Of Resection ◽  
Random Effects Model ◽  
Review Of The Literature ◽  
Hazard Ratios ◽  
Significant Difference

Butterfly glioblastomas (bGBM) are grade IV gliomas that spread to bilateral hemispheres by infiltrating the corpus callosum. Data on the effect of surgery are limited to small case series. The aim of this meta-analysis was to compare resection vs. biopsy in terms of survival outcomes and postoperative complications. A systematic review of the literature was conducted using PubMed, EMBASE, and Cochrane databases through March 2021 in accordance with the PRISMA checklist. Pooled hazard ratios were calculated and meta-analyzed in a random-effects model including assessment of heterogeneity. Out of 3367 articles, seven studies were included with 293 patients. Surgical resection was significantly associated with longer overall survival (HR 0.39, 95%CI 0.2–0.55) than biopsy. Low heterogeneity was observed (I2: 0%). In further analysis, the effect persisted in extent of resection subgroups of both ≥80% and <80%. No statistically significant difference between surgery and biopsy was detected in terms of postoperative complications, although these were numerically larger for surgery. In patients with bGBM, surgical resection was associated with longer survival prospects compared with biopsy.

Factors associated with surgical resection for pancreatic and periampullary carcinomas in a cancer center in Mexico City.

2012 ◽  
Vol 30 (4_suppl) ◽  
pp. 191-191
Author(s):  
Luis F. Onate-Ocana ◽  
Elyzabeth Bermudez-Benitez ◽  
Miguel Angel Ortiz-Toledo ◽  
Francisco J. Ochoa-Carrillo ◽  
Vincenzo Aiello-Crocifoglio
Keyword(s):  
Overall Survival ◽  
Surgical Resection ◽  
Cox Model ◽  
Ampullary Carcinoma ◽  
Cancer Center ◽  
Neuroendocrine Neoplasms ◽  
Malignant Neoplasms ◽  
Factors Associated ◽  
Periampullary Neoplasms ◽  
Periampullary Region

191 Background: Medical information regarding periampullary neoplasms is scarce in Mexico. Therefore, our aim is to report our experience with pancreatic and periampullary neoplasms, with attention to factors associated to surgical resection in a Cancer Center. Methods: A retrospective analysis of medical records of all patients with malignant neoplasms located at periampullary region demonstrated by biopsy from January 2005 to December 2010. Factors associated to resectability or survival were calculated employing logistic regression or Cox models. Results: A total of 464 patients with neoplasms of the periampullary region were identified, 249 women and 215 males (mean age 60.2 years). Pancreatic cancer was reported in 269 cases (58%), ampullary in 91 (19.6%), duodenal in 63 (13.6%), intrapancreatic bile duct in 15 (3.2%), neuroendocrine neoplasms in 13 (2.8%) and other types in 13 (2.8%). Sixty-two pancreatoduodenectomies were performed in this 6-year period (13.4% resectability). Sixty-one patients were stages I or II, and 403 stages III or IV. Age (odds ratio [OR] 0.97; 95% confidence interval [CI] 0.96-0.99) and ampullary carcinoma (OR 6.09; 95% CI 3.4-10.8) were the only factors associated to resectability (p<0.0001). Median overall survival of the cohort was 2.9 months (95% CI 2.4-3.4). Factors associated to overall survival with their estimators of the Cox model (p<0.00001) are shown in the Table. Conclusions: Resectability is low and advanced stages are frequent. Young age and location in the ampulla defines increased probability of resection. Overall survival is associated to younger age, being female, ampullary carcinoma, neuroendocrine carcinoma and surgical resection. [Table: see text]

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