A Possible Definition of Oligometastases in Pancreatic Cancers and Their Survival Outcomes

Background: Among advanced metastatic cancers, oligometastatic cancers (OM) are defined as having limited visible metastases, possibly associated with relatively better survival outcomes. We attempted to identify cases that are in line with the concept of OM among unresectable metastatic pancreatic cancer, using a retrospective cohort.Methods: A total of 130 cases with unresectable metastatic pancreatic cancer received non-curative surgery (palliative surgery or staging laparotomy) from April 2001 to December 2019. Metastatic sites, clinicopathological information, and surgical outcomes were collected to reveal definition of OM.Results: Primary tumor sites were pancreatic head in 80 cases and others in 50 cases. Performed operations were gastrointestinal tract bypass in 68 cases and staging laparotomy in 62 cases. Based on the survival outcome differences, OM criteria were defined as single organ metastasis, a few countable lesions (4 or fewer organ metastases or limited peritoneal metastases) and low serum CA19-9 level (< 2000 U/ml). The median overall survival time (MST) after non-curative surgery of OM cases (n=54) was 13.0 months and was significantly better than non-OM cases (n=76) (MST:8.4months, P = 0.003).Conclusion: We propose single organ metastasis of limited tumor volume (H1 or P1-2 by the Japanese Society of Cancer of the Colon and Rectum classification) and low serum CA19-9 (< 2000 U/ml) as a new criteria for OM.

Hyperreactio leuteinalis: benign tumour associated with pregnancy mimicking ovarian malignancy

Hyperreactio leuteinalis refers to pregnancy related enlargement of B/L ovaries rarely unilateral ovary, moderate to marked size due to multiple theca leutein cysts. It is a rare finding associated with pregnancy seen commonly in multiple gestation, GTDs and fetal abnormalities: viz hydrops. It is caused by elevated B-hcg level. We report a case of 28 years old female, primi with 13 spontaneously conceived weeks pregnancy who presented to ANC OPD for regular check-up and vague abdominal discomfort. USG revealed a large right sided ovarian mass, solid cystic in appearance pushing the uterus to left side and upwards. Staging laparotomy was done at 14 weeks viewing it to be a malignant mass. Unilateral right sided oophorectomy was done along with biopsy taken from left ovary. On microscopic histological examination diagnosis of hyperreactio leuteinalis unilateral ovary was made. Hyperreactio leuteinalis mimicking ovarian malignancy on USG results in unnecessary surgical intervention.

Primary Carcinoma of the Fallopian Tube: A Review of a Single Institution Experience of 8 Cases

Aims and Objectives. To evaluate the clinicopathologic features, response to cytoreductive surgery and adjuvant platinum-based chemotherapy with or without paclitaxel.Materials and Methods. A retrospective observational study of 8 women with a histopathologic diagnosis of primary fallopian tube carcinoma (PFTC) from January 2000 to February 2013.Results. 4/8 (50%) of the women were in the early stage and an intraoperative frozen section was 100% effective in identifying fallopian tube carcinoma and then a staging laparotomy was performed. All 4/8 cases in the early stage had received and responded to single agent carboplatin and all are alive without clinical, radiological, or biochemical evidence of recurrence at the end of 2 years and the longest survivor has completed 13 years. Primary optimal cytoreductive surgery was achievable in 3/4 (75%) in advanced disease. All showed response to adjuvant paclitaxel and carboplatin (T+C), but all had succumbed to the disease following recurrence with mean progression-free survival of 19 months (range 15–21 months) and mean overall survival of 27 months (range 22–36 months).Conclusion. The pivotal role played by a frozen section in diagnosing PFTC which is rare needs to be reemphasized, therefore justifying a primary staging laparotomy in an early stage. Prolonged survival observed in this group following an optimum tailored adjuvant single agent carboplatin is worth noting.

Long-term complications after staging laparotomy for Hodgkin lymphoma.

e20007 Background: There are over 164,000 long-term survivors of Hodgkin lymphoma in the US. Awareness of the potential for preventable high risk late complications is critical for avoiding early mortality and insuring quality of life. We sought to identify key late complications in patients who had undergone staging laparotomy Methods: Retrospective review of hospital records and database of cancer survivors at our institution. Results: 95 patients with HL were identified; of these 24 patients with HL underwent staging laparotomy from 1971-1994. 18 patients had complete data available with median age at diagnosis of 13.7 years and median follow-up of 27.9 years. 16 patients underwent splenectomy, 12 patients received chemotherapy and 17 received XRT. Six patients (33%) had findings of intra-abdominal disease on laparotomy. Three patients (17%) required four repeat laparotomies for bowel obstruction more than 10 years after staging laparotomy. Of the 3 patients requiring repeat laparotomy for bowel obstruction, one had radiation to the inguinal region, one had mantle radiation (patient with 2 bowel obstructions requiring laparotomy and lysis of adhesions), and one had unknown radiation therapy history. In contrast, there were no cases of bowel obstruction in the other 71 patients who did not receive initial staging laparotomy. There were no documented cases of post-splenectomy sepsis and all post splenectomy patients received some prophylactic antibiotics. Conclusions: This is the first study to examine long term complications after staging laparotomy in a longitudinal cohort of survivors of HL. In long term follow-up, patients who underwent staging laparotomy for HL appear to have an increased incidence of repeat laparotomy, 3-4 fold higher than the expected rate of post laparotomy bowel obstruction incidence in the literature. Otherwise, the long term outcome of splenectomy in these patients appears to be very good with no episodes of post splenectomy sepsis, These findings underscore the importance of a high index of suspicion for bowel obstruction and related complications in HL survivors who had previous abdominal operative procedures. This work also underscores the importance of long term follow-up and screening in this population.