scholarly journals Sacral Chordoma: A Pitfall in Surgical Management

2020 ◽  
Vol 4 (2) ◽  
pp. 53-57
Author(s):  
Kow R.Y. ◽  
Goh K.L. ◽  
Mohamed Amin M.A. ◽  
Low C.L. ◽  
Mustaffa F.
Keyword(s):  
Surgical Resection ◽  
Surgical Management ◽  
Bowel Perforation ◽  
Locally Advanced ◽  
Surgical Margin ◽  
Wide Resection ◽  
Term Survival ◽  
Sacral Chordoma ◽  
Invasive Tumour ◽  
Close Proximity

Chordomas are rare primary, locally invasive tumour of the bone which derived from notochordal remnants. Currently, the mainstay of treatment of chordomas is surgical resection. Despite the clear advantages of adequate surgical margin, the locally advanced nature of chordomas makes wide resection of the tumour difficult as they are often in close proximity with the surrounding vital organs. The published literatures of sacral chordomas mainly focus on the approach of surgery, reconstruction post-resection, long-term survival and reports on successful surgical resection. We report a case which highlights the pitfall in the surgical management of a sacral chordoma. Our patient developed delayed bowel perforation which may be associated with the sacrum osteotomy.   Keywords: chordoma; sacrum; surgery; pitfall; outcome.

scholarly journals Long-term survival of a patient with locally advanced hilar cholangiocarcinoma (Klatskin tumor): A case report and review on high level evidence

2019 ◽  
Vol 25 (2) ◽  
pp. 25-27
Author(s):  
Jalal Vahedian ◽  
Mohammad Babaei ◽  
Ali Mehrjardi ◽  
Ali Almasi ◽  
Seyyed Ahmadi ◽  
...  
Keyword(s):  
Adjuvant Chemotherapy ◽  
Hilar Cholangiocarcinoma ◽  
Locally Advanced ◽  
Surgical Margin ◽  
R0 Resection ◽  
Klatskin Tumor ◽  
Poor Overall Survival ◽  
Term Survival ◽  
High Level

Cholangiocarcinoma, malignant tumor of epithelial cells of bile ducts has poor overall survival and prognosis. We report a case of non-resectable cholangiocarcinoma with a 57-month survival after incomplete R2 surgical margin resection of the tumor. A 52-year old man with generalized itching, jaundice, brownish urine, mild abdominal pain and weight loss of 8 kg in last two months presented. Imaging and surgical workups showed hilar cholangiocarcinoma (Klatskin tumor). Along with incomplete R2 margin resection we performed stent embedding and post-operative adjuvant chemotherapy. Based on current literature data there is no superiority of adjuvant chemotherapy after complete R0 resection compared to incomplete R2 resection. However, it seems that partial resection along with stent embedding and applied adjuvant chemotherapy in cases of locally advanced non-resectable cholangiocarcinoma may increase survival rate.

scholarly journals Treatment of Advanced Rectal Cancers: Cylindrical abdominoperineal excision of rectum

2017 ◽  
Vol 1 (1) ◽  
pp. 36-41
Author(s):  
Nirmal Lamichhane ◽  
Kenneth G. Walker ◽  
Angus G. Watson ◽  
James Docherty
Keyword(s):  
Rectal Cancer ◽  
Surgical Resection ◽  
Locally Advanced ◽  
Multimodality Treatment ◽  
Advanced Rectal Cancer ◽  
Pelvic Organ ◽  
Abdominoperineal Excision ◽  
Preoperative Imaging ◽  
Term Survival ◽  
Systemic Spread

Treatment for patients with locally advanced low lying rectal cancer differs significantly from patients with rectal cancer restricted to the mesorectum. Surgical resection will be the straightforward option for the early ones but multimodality treatment, including preoperative chemo-radiation and extended surgical resection will be the options for advanced ones. Cylindrical abdominoperineal excision of rectum (C-APER) along with possible composite pelvic organ resection is a surgical method to remove an adequate circumferential margin so to reduce the local recurrence rate and improve long term survival. Adequate preoperative imaging of the pelvis is therefore important to identify these patients and effort should be made to select those patients with advanced tumours with no systemic spread. In this article, we reviewed some consecutive cases of advanced rectal cancer to their immediate surgical outcome.

scholarly journals Intra- and Extra- Pelvic Multidisciplinary Surgical Approach of Retroperitoneal Sarcoma: Case Series Report

2021 ◽  
Author(s):  
Heekyoung Song ◽  
Jung Hwan Ahn ◽  
Yuyeon Jung ◽  
Jae Yeon Woo ◽  
Yang-Guk Chung ◽  
...  
Keyword(s):  
Surgical Resection ◽  
Surgical Approach ◽  
Bowel Perforation ◽  
Case Series ◽  
Surgical Margin ◽  
Progression Free Survival ◽  
Skin Incision ◽  
Retroperitoneal Sarcoma ◽  
R0 Resection ◽  
Estimated Blood Loss

Abstract Objective: We aim to describe our experience of multidisciplinary surgical resection of retroperitoneal sarcoma (RPS), including intra- and extrapelvic approaches.Method: Multidisciplinary surgery is an anatomical approach combining intra- and extraperitoneal access within the same surgery to achieve complete RPS removal. This retrospective review of the records of patients who underwent multidisciplinary surgery for RPS analyzed surgical and survival outcomes.Result: Eight patients underwent 10 intra- and extrapelvic surgical resection and their median mass size was 12.75 cm (range, 6–45.5 cm). Using an intrapelvic approach, laparoscopy-assisted surgery was performed in 4 cases and laparotomy surgery in 6 cases. Using an extrapelvic approach, ilioinguinal and posterior approaches were used in 4 cases each, prone position and midline skin incision were shared in 1 case. All patients’ RPS masses were removed completely and 4 patients achieved R0 resection through intra- and extrapelvic surgery. Additionally, pelvic lymph node dissections or prophylactic fixation or revision of structures were conducted. The median estimated blood loss was 2000 mL (range, 300–20 000 mL) and the median hospitalization was 12.6 days (range, 9–69 days). Reoperation was needed in 2 patients (one for wound necrosis, the other for bowel perforation and wound necrosis). The median overall survival rate and median progression-free survival were 64.6 months and 13.7 months, respectively.Conclusion: RPS are therapeutically challenging based on their locations and high risk of recurrence. Considering that, intra- and extrapelvic surgical approach could improve the macroscopic security of the surgical margin.

Treatment of borderline resectable (BR) and locally advanced (LA) pancreatic cancer in the era of FOLFIRINOX and gemcitabine plus nab-paclitaxel: A multi-institutional study.

2016 ◽  
Vol 34 (4_suppl) ◽  
pp. 451-451 ◽  
Author(s):  
Kamran Idrees ◽  
Alexander A. Parikh ◽  
Lauren McLendon Postlewait ◽  
Sharon M. Weber ◽  
Clifford Suhyun Cho ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Surgical Resection ◽  
Residual Disease ◽  
Locally Advanced ◽  
R0 Resection ◽  
Recurrence Rates ◽  
Borderline Resectable ◽  
Venous Resection ◽  
Term Survival ◽  
Treatment Protocols

451 Background: FOLFIRINOX or Gemcitabine+nab-Paclitaxel (Gem/nPac) has superior overall survival (OS) compared with gemcitabine alone in pts with Stage 4 pancreatic cancer (PC). Based on these results, FOLFIRINOX or Gem/nPac has been utilized in neoadjuvant (NA) setting for BR and LA PC. This report describes our multi-institutional experience with NA treatment with FOLFIRINOX or Gem/nPac followed by surgical resection. Methods: Pts with BR and LA PC who received NA FOLFIRINOX or Gem/nPac and underwent surgical resection between 2011 and 2015 at 7 high volume pancreas centers were reviewed. Pre-operative chemoradiation therapy (pCXRT) was administered selectively based on radiographic response (RR). Near-complete (minimal residual disease) or complete pathologic response (PR) was categorized as marked PR. Results: 86 pts received either NA FOLFIRINOX (69%) or Gem/nPac therapy (31%) for BR (67%), LA (32%) PC. pCXRT was administered in 71% of pts. Pts received a median of 4 cycles of FOLFIRINOX (range 1-28) and 3 cycles of Gem/nPac (range 2-13). No grade 4-5 toxicities were noted. The majority of pts underwent pancreaticoduodenectomy (84%) and vascular resection was performed in 53% - 40 with venous resection and 6 with arterial resection. R0 resection rate was 86% with no difference between two treatment groups (p = 0.9). Reduction in CA 19-9 or RR did not correlate with pathological response (p = 0.8). A marked PR was seen in 12 pts – 13.6% vs. 15.4% for FOLFIRINOX and Gem/nPac, respectively (p = 0.8). Adjuvant chemotherapy or CXRT was administered in 44% of pts. With a median follow up of 20 months (mo), OS was 27.4 mo with median OS in marked PR was 53 vs. 25 mo in moderate PR/non-responders (p = 0.04). Recurrence was noted in 45 pts – 49% had distant recurrence, 20% had local recurrence and 31% had both. Conclusions: Neoadjuvant FOLFIRINOX or Gem/nPac therapy in conjunction with aggressive surgical resection in BR and select LA PDAC pts result in significant long-term survival especially in marked pathologic responders. Further, optimization of treatment protocols in the neoadjuvant and adjuvant setting is warranted since recurrence rates are high.

scholarly journals The Role of Surgical Resection and Liver Transplantation for the Treatment of Intrahepatic Cholangiocarcinoma

2021 ◽  
Vol 10 (11) ◽  
pp. 2428
Author(s):  
Guergana Panayotova ◽  
Jarot Guerra ◽  
James V. Guarrera ◽  
Keri E. Lunsford
Keyword(s):  
Liver Transplantation ◽  
Surgical Resection ◽  
Intrahepatic Cholangiocarcinoma ◽  
Locally Advanced ◽  
Tumor Biology ◽  
Future Liver Remnant ◽  
Patient Treatment ◽  
Term Survival ◽  
Liver Remnant

Intrahepatic cholangiocarcinoma (iCCA) is a rare and complex malignancy of the biliary epithelium. Due to its silent presentation, patients are frequently diagnosed late in their disease course, resulting in poor overall survival. Advances in molecular profiling and targeted therapies have improved medical management, but long-term survival is rarely seen with medical therapy alone. Surgical resection offers a survival advantage, but negative oncologic margins are difficult to achieve, recurrence rates are high, and the need for adequate future liver remnant limits the extent of resection. Advances in neoadjuvant and adjuvant treatments have broadened patient treatment options, and these agents are undergoing active investigation, especially in the setting of advanced, initially unresectable disease. For those who are not able to undergo resection, liver transplantation is emerging as a potential curative therapy in certain cases. Patient selection, favorable tumor biology, and a protocolized, multidisciplinary approach are ultimately necessary for best patient outcomes. This review will discuss the current surgical management of locally advanced, liver-limited intrahepatic cholangiocarcinoma as well as the role of liver transplantation for select patients with background liver disease.

The impact of pancreatic cancer resection in the era of effective systemic treatment.

2020 ◽  
Vol 38 (4_suppl) ◽  
pp. 722-722
Author(s):  
Yaacov Richard Lawrence ◽  
Ofer Margalit ◽  
Galia Jacobson ◽  
Liat Hamer ◽  
Uri Amit ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Surgical Resection ◽  
Systemic Treatment ◽  
Locally Advanced ◽  
Tumor Resection ◽  
Phase Iii ◽  
Term Survival ◽  
Systemic Treatments ◽  
Metastatic Setting ◽  
The Impact

722 Background: Surgical resection is the only curative modality in pancreatic cancer, yet the vast majority of patients undergoing surgery succumb of their disease. No randomized studies have been performed to assess the survival impact of the procedure. We hypothesized that in the era of effective systemic treatments, the survival advantage of surgical resection would be lessened. Methods: A meta-analysis of published phase III clinical trials in pancreatic cancer in both the post resection adjuvant setting and the locally advanced metastatic setting, based upon indirect aggregate data. Data was stratified based upon the systemic agents used. Patients from trials arms for which there were not complementary data sets with/without surgical resection were excluded. Primary endpoint was 3 year overall survival (OS). Results: Trials were published between 1997 and 2018. A total of 2722 patients were included in the data analysis, of whom 1645 underwent tumor resection and 814 were metastatic. Median follow-up was 40 months. Analyses were performed of five systemic options with / without tumor resection. Across the trials averaged 3 yr OS was 0%, 0.8%, 0%, and 3.8% for 5FU, gemcitabine, gemcitabine + capecitabine, & FOLFIRINOX respectively; and 18.1%, 30.0%, 37.9%, 42.5%, and 62.5% for the same systemic treatments delivered following surgical resection. Hence the additive impact of surgical resection on absolute 3 yr OS was only 18.1% in the absence of systemic treatment, but 30.0%, 37.1%, 42.5% and 58.8% in the presence of 5FU, gemcitabine, gemcitabine + capecitabine, FOLFIRINOX respectively. Conclusions: Within the limitations of this analysis, it appears that our hypothesis was incorrect, and that the opposite is true. The introduction of effective systemic therapies has greatly increased the impact of pancreatic surgery on long-term survival in pancreatic cancer. Consequently, every effort should be made to bring patients to curative resection.

scholarly journals Efficacy of perioperative chemotherapy for synovial sarcoma: a retrospective analysis of a Nationwide database in Japan

BMC Cancer ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Gang Xu ◽  
Hisaki Aiba ◽  
Norio Yamamoto ◽  
Katsuhiro Hayashi ◽  
Akihiko Takeuchi ◽  
...  
Keyword(s):  
Overall Survival ◽  
Synovial Sarcoma ◽  
Survival Rates ◽  
Surgical Margin ◽  
Oncologic Outcomes ◽  
Wide Resection ◽  
Perioperative Chemotherapy ◽  
Relapse Free Survival ◽  
Free Survival ◽  
Distant Relapse

Abstract Background Synovial sarcoma is an aggressive but chemosensitive soft-tissue tumor. We retrospectively analyzed the efficacy of perioperative chemotherapy for synovial sarcoma with data from the nationwide database, Bone and Soft Tissue Tumor Registry in Japan. Methods This study included 316 patients diagnosed with synovial sarcoma between 2006 and 2012. Oncologic outcomes were analyzed using a Cox-hazard regression model. Moreover, the effects of perioperative chemotherapy on outcomes were evaluated using a matched-pair analysis. The oncologic outcomes of patients who did or did not receive chemotherapy were compared (cx + and cx-). Results Multivariate analysis revealed significant correlations of age (over 40, hazard ratio [HR] = 0.61, p = 0.043), margin status (marginal resection, HR = 0.18, p < 0.001 and intralesional resection, HR = 0.30, p = 0.013 versus wide resection) with overall survival; surgical margin type (marginal resection, HR = 0.14, p = 0.001 and intralesional resection, HR = 0.09, p = 0.035 versus wide resection) with local recurrence; and postoperative local recurrence (HR = 0.30, p = 0.027) and surgical margin (marginal resection, HR = 0.31, p = 0.023 versus wide resection) with distant relapse-free survival. Before propensity score matching, perioperative chemotherapy was mainly administered for young patients and patients with deeper tumor locations, larger tumors, more advanced-stage disease, and trunk location. The 3-year overall survival, local control, and distant relapse-free survival rates were 79.8%/89.3% (HR = 0.64, p = 0.114), 89.6%/93.0% (HR = 0.37, p = 0.171) and 71.4%/84.5% (HR = 0.60, p = 0.089) in the cx+/cx- groups, respectively. After propensity score matching, 152 patients were selected such that the patient demographics were nearly identical in both groups. The 3-year overall survival, local control, and distant relapse-free survival rates were 71.5%/86.0% (HR = 0.48, p = 0.055), 92.5%/93.3% (HR = 0.51, p = 0.436) and 68.4%/83.9% (HR = 0.47, p = 0.046) in the cx+/cx- groups, respectively. Conclusion This large-sample study indicated that the margin status and postoperative disease control were associated directly or indirectly with improved oncologic outcomes. However, the efficacy of perioperative chemotherapy for survival outcomes in synovial sarcoma patients was not proven in this Japanese database analysis.

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