Phyllodes Tumor of Breast:A 17 Years Audit of 260 Patients with Biopsy Proven Phyloldes Tumor Treated in our Institute

Phyllodes are rare breast neoplasms with higher rate of local and systemic recurrence. This study presents the results of an audit of all cases of biopsy proven phyllodes tumor presenting to breast services in Liquat National University Hospital Karachi, Pakistan, from 1993 to 2010. Total 260 female patients were retrospectively audited, 151 had benign, 35 borderline and 74 had malignant histology. Mean follow up duration for all types was 2 years. The mean age for benign lesions was 28, for borderline 36.8 and for malignant lesions 41 years. For all histopathological types the mean tumor size was 6.2 cm. It was 5.4 cm for benign, 7.8 cm for borderline and 11.2 cm for malignant lesions. 200/260 (76.9%) patients had breast conservation while 60/260 (23.0%) had mastectomy. Histopathology type and grade has statistically significant relationship with recurrence ( p value .0001 % ) Overall recurrence rate was 20/260 (7.69%) with one patient with malignant phyllodes having recurrence 6 times despite clear margins and two patients with borderline phyllodes having recurrence twice . Tumor recurred in 2/151(1.3% ) of benign , 5.7% borderline ( 2/35 ) and 21.6% malignant ( 16/74 ) cases .Malignant group had 8 (10.8% ) systemic and 12 (16.2%)local recurrences. All patients with local recurrence and involved margins had reexcision except for 2 who had mastectomy with muscles involved posteriorly during the first surgery where re-excision was not possible. mortality rate for malignant phyllodes was 5.4 % ( 4/74 deaths as a result of systemic recurrence ) Conclusion: Phyllodes tumor is an aggressive disease, in our series, grade and type of tumor on histopathology is the significant risk factor for local and systemic recurrence with rate reaching up 21.6% for local and 10.8% for systemic recurrence in malignant lesions.

Clinical impact of abdominal versus mediastinal metastases as a prognostic factor for poor outcomes following esophageal cancer surgery: a retrospective study

Background Surgery is still the mainstay of radical treatment for resectable esophageal cancer (EC). It is apparent that the presence or spread of lymph node metastasis (LNM) is a powerful prognostic factor in patients with EC who are eligible for curative treatment. Although the importance and efficacy of lymph node dissection in radical esophagectomy have been reported, the clinical or prognostic relevance of specific metastatic patterns within the mediastinal cavity and abdomen remains unclear. Methods We retrospectively analyzed the association of postoperative survival with clinical mediastinal LNM (cMLNM) and abdominal LNM (cALNM) in 157 patients who underwent radical EC surgery at our hospital between May 2012 and March 2018. Results A significant difference in cause-specific survival (CSS) was observed between patients with and without cALNM (log-rank p = 0.000). A multivariate Cox regression analysis revealed that cALNM and thoracic surgery (mediastinal lymphadenectomy via conventional open right thoracotomy or video-assisted thoracoscopic surgery) independently predicted CSS (p = 0.0007 and 0.021, respectively). Moreover, a significant difference in systemic recurrence-free survival was observed between those with and without cALNM (log-rank p = 0.000). Multivariate Cox regression analysis revealed that cALNM and sex independently predicted systemic recurrence-free survival (p = 0.000 and 0.015, respectively). Conclusion cALNM was an independent poor prognostic factor for CSS after EC surgery. It may also be an independent prognostic factor for postoperative systemic recurrence, which can shorten the CSS. For patients with cALNM-positive EC who have a high potential risk of systemic metastases, more extensive treatment besides the conventional perioperative systemic chemotherapy may be necessary.

Systemic chemotherapy in patients with brain only metastatic breast cancer: A retrospective analysis.

1093 Background: The treatment of patients with brain only metastatic breast cancer (BO-MBC) remains very challenging. There is also very limited literature informing on appropriate treatment or natural history of this entity. Systemic chemotherapy in addition to targeted therapy and/or anti-estrogen treatment is often used, but little is known if it adds to the overall or disease free survival. In this retrospective study, we examine this, as well as other factors which may be associated with increased risk of CNS or systemic recurrence in these patients. Methods: A database search at a single institution identified 178 patients with brain metastases (BM) from breast cancer out of which 45 patients had BO-MBC between 2007-2020. We collected demographic, clinical, radiographic and other treatment data. Leptomeningeal disease (LMD) was diagnosed by cerebrospinal fluid (CSF) cytology, neuroimaging, or both. We used the Brookmeyer and Crowley method. Results: The patients were followed for a median of 17.9 months; 36 out of 45 patients (80%) received local treatment for BM (surgery/radiation/both) and HER2 directed antibodies or tyrosine kinase inhibitors and/or anti-estrogen treatment, whereas 9 out of 45 patients (20%) received systemic chemotherapy in addition. There were 22 out of 45 (49%) HER2 +, 5 out of 45 (11%) HR + and 18 out of 45 (40%) triple negative breast cancer (TNBC) patients. There were 17 out of 45 patients (38%) who were deemed to have low burden of BM (defined as one to three BM and largest being ≤3 cm) whereas there were 24 out of 45 patients (53%) who had high burden of BM (defined as four or more BM or largest being > 3 cm). Conclusions: Patients with BO-MBC represent a distinct entity. Despite having better survival than patients with BM and extra CNS disease these patients have a high risk of developing LMD, CNS and systemic recurrences. The addition of chemotherapy to targeted therapy and/or anti-estrogens does not decrease the rates of systemic or CNS recurrence. The ER+ subset have a lower rate of development of systemic disease, as expected due to their relatively indolent biology. The CNS and systemic recurrence seem to be higher in patients with HER2+ cancers and counterintuitively even in those with low burden of BM; albeit these were statistically insignificant.[Table: see text]

A global systematic review and meta-analysis on laparoscopic vs open right hemicolectomy with complete mesocolic excision

Purpose The aim of this study was to compare the outcomes of right hemicolectomy with CME performed with laparoscopic and open surgery. Methods PubMed, Scopus, Web of Science, China National Knowledge Infrastructure, Wanfang Data, Google Scholar and the ClinicalTrials.gov register were searched. Primary outcome was the overall number of harvested lymph nodes. Secondary outcomes were short and long-term course variables. A meta-analysis was performed to calculate risk ratios. Results Twenty-one studies were identified with 5038 patients enrolled. The difference in number of harvested lymph nodes was not statistically significant (MD 0.68, − 0.41–1.76, P = 0.22). The only RCT shows a significant advantage in favour of laparoscopy (MD 3.30, 95% CI − 0.20–6.40, P = 0.04). The analysis of CCTs showed an advantage in favour of the laparoscopic group, but the result was not statically significantly (MD − 0.55, 95% CI − 0.57–1.67, P = 0.33). The overall incidence of local recurrence was not different between the groups, while systemic recurrence at 5 years was lower in laparoscopic group. Laparoscopy showed better short-term outcomes including overall complications, lower estimated blood loss, lower wound infections and shorter hospital stay, despite a longer operative time. The rate of anastomotic and chyle leak was similar in the two groups. Conclusions Despite the several limitations of this study, we found that the median number of lymph node harvested in the laparoscopic group is not different compared to open surgery. Laparoscopy was associated with a lower incidence of systemic recurrence.