scholarly journals Optimal Surveillance of Intraductal Papillary Mucinous Neoplasms of the Pancreas Focusing on Remnant Pancreas Recurrence After Surgical Resection

2021 ◽  
Author(s):  
Tomokazu FUJI ◽  
Yuzo UMEDA ◽  
Kosei TAKAGI ◽  
Ryuichi YOSHIDA ◽  
Kazuhiro YOSHIDA ◽  
...  
Keyword(s):  
Risk Factors ◽  
Clinical Features ◽  
De Novo ◽  
Surgical Margin ◽  
Preoperative Assessment ◽  
Positive Surgical Margin ◽  
Low Grade ◽  
International Consensus ◽  
Remnant Pancreas ◽  
International Consensus Guidelines

Abstract Background: The international consensus guidelines for intraductal papillary mucinous neoplasm of the pancreas (IPMN) presented clinical features as indications for surgery. Whereas surveillance for recurrence including de novo lesions is essential, optimal surveillance protocols have not been established.Aim and Methods: The aim of this study was to assess the clinical features of recurrence at the remnant pancreas (Rem-Panc) and extra-pancreas (Ex-Panc) after surgery for IPMN. Ninety-one cases of IPMN that underwent detailed preoperative assessment and pancreatectomy were retrospectively analyzed, focusing especially on the type of recurrence.Results: The IPMNs were finally diagnosed as low-grade dysplasia (LDA, n=42), high-grade dysplasia (HAD, n=19), and invasive carcinoma (IPMC, n=30). Recurrence was observed in 26 cases (28%), of which recurrence was seen at Rem-Panc in 19 cases and at Ex-Panc in 7 cases. The frequency of Rem-Panc recurrence was 10% in LDA, 21% in HDA, and 37% in IPMC. On the other hand, Ex-Panc recurrence was observed only in IPMC (23%). Ex-Panc recurrence showed shorter median recurrence-free survival (RFS) and overall survival (OS) than Rem-Panc recurrence (median RFS 8 months vs 35 months, p<0.001; median OS 25 months vs 72 months, p<0.001). Regarding treatment for Rem-Panc recurrence, repeat pancreatectomy resulted in better OS than no-pancreatectomy (MST 36 months vs 15.5 months, p=0.03). On multivariate analysis, main duct stenosis or disruption as a preoperative feature (hazard ratio [HR] 10.6, p=0.002) and positive surgical margin (HR 4.4, p=0.018) were identified as risk factors for Rem-Panc recurrence.Conclusions: The risk factors for Rem-Panc and Ex-Panc recurrence differ. Optimal surveillance based on these features is desirable to ensure that repeat pancreatectomy for Rem-Panc recurrence can be an appropriate surgical intervention.

scholarly journals Favorable Response After Gemcitabine-Radiotherapy for Invasive Pancreatic Intraductal Papillary Mucinous Neoplasm: A Case Report

2013 ◽  
Vol 98 (4) ◽  
pp. 340-345 ◽  
Author(s):  
Takanori Ochiai ◽  
Kimihiro Igari ◽  
Takaki Furuyama ◽  
Hiromitsu Ito ◽  
Yusuke Mitsunori ◽  
...  
Keyword(s):  
Pancreatic Duct ◽  
Intraductal Papillary Mucinous Neoplasm ◽  
Ductal Carcinoma ◽  
Total Pancreatectomy ◽  
Surgical Margin ◽  
Resected Specimen ◽  
Pancreatic Ductal Carcinoma ◽  
Positive Surgical Margin ◽  
Mucinous Neoplasm ◽  
Remnant Pancreas

Abstract The efficacy of chemoradiotherapy for invasive pancreatic ductal carcinoma derived from an intraductal papillary mucinous neoplasm (IPMN) has not been established. The subject of the present report was a 53-year-old man admitted for the treatment of IPMN. The tumor, located in the pancreatic body, was of the mixed type of IPMN, and it involved the branch duct, where it was 38 mm in diameter, and the main duct, where it was 6 mm in diameter. Distal pancreatectomy was performed and the postoperative course was uneventful; however, histopathologic diagnosis revealed invasive ductal carcinoma with a positive surgical margin in the pancreatic duct. Although total pancreatectomy was recommended, chemoradiotherapy (50.4-Gy irradiation and gemcitabine) was preferred by the patient. At 9-month follow up, computed tomography and magnetic resonance imaging showed a cystic mass at the surgical margin of the pancreas. Endoscopic ultrasonography showed a 44-mm cystic lesion with nodules in the remnant pancreas, on the basis of which he underwent total pancreatectomy. Pathologic examination of the resected specimen revealed absence of the epithelium at the surgical margin of the main pancreatic duct, and malignant cells were not detected.

scholarly journals Approaches to phyllodes tumour of the breast: a review article

2017 ◽  
Vol 4 (3) ◽  
pp. 841 ◽  
Author(s):  
Firdaus Hayati ◽  
Ho Hui Lian ◽  
Nornazirah Azizan ◽  
Aishath Aznan Ali ◽  
Zainal Adwin Zainal Abidin ◽  
...  
Keyword(s):  
Surgical Margin ◽  
Asian Population ◽  
Preoperative Assessment ◽  
Positive Surgical Margin ◽  
Breast Pathology ◽  
Histologic Diagnosis ◽  
Triple Assessment ◽  
Phyllodes Tumour ◽  
Phyllodes Tumours

Phyllodes tumours are rare entities of fibroepithelial diseases. The exact pathogenesis and their relationship with fibroadenomas are oblivious. Women aged between 35 to 55 years are commonly affected, even younger in Asian population. Triple assessment should be applied as a guide to management in any breast pathology. Clinical appearances are typically diagnostic for phyllodes tumours. Even though sometimes inconclusive, mammography and ultrasonography are the main imaging modalities. Although the role of cytology is debatable, presence of both epithelial and stromal elements supports the diagnosis especially in malignant type. Core biopsy is rather favored in view of higher accuracy for the diagnosis. Accurate preoperative assessment and histologic diagnosis allow correct surgical intervention and subsequent avoidance of reoperation. Surgical management can be either wide excision with more than 1 cm margins or mastectomy without axillary surgery. Local recurrence has been associated with inadequate excision of the pseudopod. Adjuvant radiotherapy is recommended for positive surgical margin and for local control of borderline and malignant phyllodes tumors. The role of chemotherapy and endocrine therapy has not been fully studied.

scholarly journals The Role of Lymph Node Dissection in Intrahepatic Cholangiocarcinoma: A Multicenter Retrospective Study. 

2021 ◽  
Author(s):  
Hanjie Hu ◽  
Gang Xu ◽  
Shunda Du ◽  
Zhiwen Luo ◽  
Hong Zhao ◽  
...  
Keyword(s):  
Risk Factors ◽  
Lymph Node ◽  
Lymph Nodes ◽  
Lymph Node Dissection ◽  
Intrahepatic Cholangiocarcinoma ◽  
Surgical Margin ◽  
Disease Free Survival ◽  
Positive Surgical Margin ◽  
Node Dissection ◽  
Independent Risk Factors

Abstract BackgroundLymph node dissection (LND) is of great significance in intrahepatic cholangiocarcinoma (ICC). Although the National Comprehensive Cancer Network (NCCN) guidelines recommend routine LND in ICC, the effects of LND remains controversial. This study aimed to explore the role and application of LND in ICC.MethodsPatients were identified in two Chinese academic centers. Inverse probability of treatment weighting (IPTW) was used to reduce bias. Kaplan–Meier curves and Cox proportional hazards models were used to compare overall survival (OS) and disease-free survival (DFS).ResultsOf 232 patients, 177 (76.3%) underwent LND, and 71 (40.1%) had metastatic lymph nodes. A minimum of 6 lymph nodes were dissected in 66 patients (37.3%). LND did not improve the prognosis of ICC. LNM >3 may have worse OS and DFS than LNM 1-3, especially in the LND >=6 group. For nLND patients, the adjuvant treatment group had better OS and DFS.ConclusionsCA 19-9, CEA, operative time, positive surgical margin, and T stage were independent risk factors for OS; CEA and differentiation were independent risk factors for DFS. LND has no definite predictive effect on prognosis. Patients with 4 or more LNMs may have a worse prognosis than patients with 1-3 LNMs. Adjuvant therapy may benefit patients of nLND.

scholarly journals Revisiting Surgical Strategies for Hepatocellular Carcinoma With Microvascular Invasion

2021 ◽  
Vol 11 ◽  
Author(s):  
Er-lei Zhang ◽  
Qi Cheng ◽  
Zhi-yong Huang ◽  
Wei Dong
Keyword(s):  
Hepatocellular Carcinoma ◽  
Surgical Outcomes ◽  
Surgical Margin ◽  
Preoperative Assessment ◽  
Microvascular Invasion ◽  
Pathological Examination ◽  
R0 Resection ◽  
International Consensus ◽  
Surgical Strategies ◽  
The Impact

Although liver resection (LR) and liver transplantation (LT) are widely considered as potentially curative therapies for selected patients with hepatocellular carcinoma (HCC); however, there is still high risk of tumor recurrence in majority of HCC patients. Previous studies demonstrated that the presence of microvascular invasion (MVI), which was defined as the presence of tumor emboli within the vessels adjacent to HCC, was one of the key factors of early HCC recurrence and poor surgical outcomes after LR or LT. In this review, we evaluated the impact of current MVI status on surgical outcomes after curative therapies and aimed to explore the surgical strategies for HCC based on different MVI status with evidence from pathological examination. Surgical outcomes of HCC patients with MVI have been described as a varied range after curative therapies due to a broad spectrum of current definitions for MVI. Therefore, an international consensus on the validated definition of MVI in HCC is urgently needed to provide a more consistent evaluation and reliable prediction of surgical outcomes for HCC patients after curative treatments. We concluded that MVI should be further sub-classified into MI (microvessel invasion) and MPVI (microscopic portal vein invasion); for HCC patients with MPVI, local R0 resection with a narrow or wide surgical margin will get the same surgical results. However, for HCC patients with MI, local surgical resection with a wide and negative surgical margin will get better surgical outcomes. Nowadays, MVI status can only be reliably confirmed by histopathologic evaluation of surgical specimens, limiting its clinical application. Taken together, preoperative assessment of MVI is of utmost significance for selecting a reasonable surgical modality and greatly improving the surgical outcomes of HCC patients, especially in those with liver cirrhosis.

scholarly journals Surgical strategy for intraductal papillary mucinous neoplasms of the pancreas

Surgery Today ◽  
2019 ◽  
Vol 50 (1) ◽  
pp. 50-55 ◽  
Author(s):  
Seiko Hirono ◽  
Hiroki Yamaue
Keyword(s):  
Surgical Resection ◽  
Treatment Strategy ◽  
Mucinous Carcinoma ◽  
Current Treatment ◽  
Low Grade ◽  
Intraductal Papillary Mucinous Neoplasms ◽  
International Consensus ◽  
Branch Duct ◽  
Remnant Pancreas ◽  
Mucinous Neoplasms

AbstractThe current treatment strategy for intraductal papillary mucinous neoplasms (IPMNs), based on the international consensus guideline, has been accepted widely. However, reported outcomes after surgical resection for IPMN show that once the tumor progresses to invasive intraductal papillary mucinous carcinoma (IPMC), recurrence is not uncommon. The surgical treatment for IPMN is invasive and sometimes followed by complications. Therefore, the best timing for resection might be at the point when high-grade dysplasia (HGD) is evident. According to previous reports, main duct type IPMN has a high malignant potential and its surgical resection is universally accepted, whereas, the incidence of HGD/invasive IPMC in branch duct and mixed type IPMNs is thought to be lower. In addition to mural nodules and a dilated main pancreatic duct, cytology and measurement of the carcinoembryonic antigen level in the pancreatic juice might be useful to differentiate HGD/invasive IPMC from low-grade dysplasia. The nomogram proposed recently to predict the risk of HGD/invasive IPMC in IPMN patients might help surgeons decide on the best treatment strategy, depending on the patient’s age and general condition. Second resection for high-risk lesions in the remnant pancreas might improve the survival of IPMN patients.

Risk factors for and characteristics of pneumonitis in patients treated with anti-programmed death-1 therapy.

2018 ◽  
Vol 36 (5_suppl) ◽  
pp. 128-128
Author(s):  
YI HU ◽  
Pengfei Cui ◽  
Jing Zhang
Keyword(s):  
Risk Factors ◽  
Combination Therapy ◽  
Clinical Features ◽  
Steroid Therapy ◽  
Low Grade ◽  
Thoracic Radiotherapy ◽  
Programmed Death ◽  
Lung Condition ◽  
History Of ◽  
Programmed Death 1

128 Background: Pneumonitis is an uncommon but potentially fatal toxicity of anti–programmed death-1 (PD-1) monoclonal antibodies (mAbs), but its prevalence, risk factors and clinical features are poorly described. Methods: The medical records of 234 patients with advanced cancer who underwent anti–PD-1mAbs therapies between September 2015 and September 2017 at the Cancer Center of the Chinese PLA (People’s Liberation Army) General Hospital were analyzed with regard to patient background and clinical features. Pneumonitis was diagnosed by the treating investigator; cases with confirmed malignant lung infiltration or infection were excluded. Univariate and multivariate analyses were performed to identify independent predictive factors for pneumonitis. Clinical features, management and prognosis of pneumonitis were also collected. Results: A total of 55 patients (23.5%) developed pneumonitis. Anti–PD-1mAbs induced pneumonitis was significantly associated with male sex, a history of prior thoracic radiotherapy, combination therapy and underlying lung condition (odds ratios 3.380, 3.081, 2.538 and 2.559, respectively). Time to onset of pneumonitis ranged from 2 days to 277days (median time was 85days). 85.4% (47 of 55) of cases were grade 1 to 2, 25.5% (14 of 55) were treated with steroid therapy, of which 85.7% (12 of 14) resolved/ improved. Nine (16.4%) patients worsened clinically and one died during the course of pneumonitis treatment. Conclusions: Pneumonitis associated with anti–PD-1 mAbs is a serious adverse effect in the clinical setting that cannot be ignored. However, patient selection based on sex, history of prior thoracic radiotherapy, combination therapy and underlying lung condition can minimize pneumonitis risk. Most events are low grade and resolved/ improved with steroid therapy. Rarely, pneumonitis worsens despite steroid therapy, and may result in death.

Risk Factors of Stomal Recurrence After Laryngectomy: A Systematic Review and Meta-analysis

2017 ◽  
Vol 126 (9) ◽  
pp. 654-668 ◽  
Author(s):  
Jinyu Mei ◽  
Zhaohui Huang ◽  
Kaile Wu ◽  
Yi Zhao ◽  
Jianming Yang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Local Recurrence ◽  
Recurrence Rate ◽  
Postoperative Radiotherapy ◽  
Meta Analysis ◽  
Surgical Margin ◽  
Epidemiological Studies ◽  
Cochrane Library ◽  
Positive Surgical Margin ◽  
T Classification

Objective: We wished to investigate the risk factors for stoma recurrence following laryngectomy. Methods: PubMed, Cochrane Library, and Embase were searched to identify primary research studies published between January 1, 1967, and October 31, 2016. We only included observational epidemiological studies and used risk ratios (RRs) and 95% confidence intervals (CI) to summarize the primary risk factors associated with recurrence following laryngectomy. Results: A total of 44 articles, including 11 928 patients, were included in the current meta-analysis. The pooled estimates of the stomal recurrence rate and the local recurrence rate following laryngectomy were 6.60% (95% CI, 5.40-7.90) and 19.40% (95% CI, 14.00%-24.80%), respectively. For stomal recurrence, we confirmed a series of earlier identified factors, including tumor site, prior tracheotomy, tracheotomy timing, T-classification, lymph node metastases, postoperative pharyngoperistomal fistula, and a positive surgical margin. For local recurrence, postoperative radiotherapy, overexpression of p53, and overexpression of p21 were significant, while preoperative tracheostomy and postoperative pharyngoperistomal fistula had an unexpectedly low impact on risk. Conclusion: This study has confirmed a series of earlier identified factors for stomal recurrence and local recurrence following laryngectomy. Our results will provide important insights for clinical practice.

Mammary phyllodes tumour: a 15-year multicentre clinical review

2017 ◽  
Vol 71 (6) ◽  
pp. 493-497 ◽  
Author(s):  
Michael Co ◽  
Clement Chen ◽  
Julia Y Tsang ◽  
Gary Tse ◽  
Ava Kwong
Keyword(s):  
Risk Factors ◽  
Local Recurrence ◽  
Tumour Size ◽  
Significant Risk ◽  
Surgical Margin ◽  
Breast Conserving Surgery ◽  
Positive Surgical Margin ◽  
Biological Behaviour ◽  
Phyllodes Tumour ◽  
Long Term Prognosis

AimsPhyllodes tumour (PT) is an uncommon fibroepithelial tumour of the breast. It has a spectrum of aggressiveness in biological behaviour with chance of local recurrence and, occasionally, metastasis.MethodsA 15-year retrospective review from a multicentre database in Hong Kong was performed.ResultsClinical and pathological records of 465 patients with 469 PTs between 1998 and 2014 were reviewed. Median age of occurrence was 44 years (range 12–86 years). 281 (59.9%) PTs were benign, 124 (26.4%) were borderline and 64 (13.6%) were malignant. About half of all PTs (239, 51.5%) were between 2 and 5 cm while another 186 (40.1%) were >5 cm in size. Most PT (84.6%) were radiologically benign. Breast-conserving surgery (BCS) was feasible in 384 (82%) patients, whereas 84 (18%) patients had mastectomy. Multivariate analysis found that positive surgical margin (P<0.001) and BCS (P<0.001) were the only significant risk factors for local recurrence, while large tumour size (P=0.008) and malignant PT histotype (P<0.001) were the only significant risk factors for metastasis. Long-term prognosis of benign and borderline PT was excellent. After median follow-up interval of 85 months (range 12–180 months), the disease-specific survival of benign, borderline and malignant PT were 99.6%, 100% and 90.6%, respectively.ConclusionsLocal recurrence of PTs occurs irrespective of the tumour grade. Surgical margin is the only amendable factor to reduce the chance of recurrence.

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