The Survival after Laparoscopic Versus Open Curative Excision for Rectal Cancer

Background: Management of rectal cancer has been evolved over the past two decades with the introduction of total mesorectal excision (TME) and laparoscopic resection. Objective: This study aims to assess the difference in the long term outcomes after laparoscopic and open resection for potentially curable, non-metastatic rectal cancer patients.Methods: This is a retrospective study which has been conducted in a single tertiary care center where the patients were recruited from the colorectal database of the Section of Colon and Rectal Surgery at King Faisal Specialist Hospital & Research Centre (KFSH&RC). It included all the patients who had non-metastatic rectal cancer and underwent laparoscopic or open curative resection regardless of their age or the comorbid status during the period from January 2012 – December 2015. We studied the long-term outcomes for those patients which included the completeness of resection of the tumor, overall 3-year survival, 3-year disease free survival, local recurrence and distal recurrence of the cancer.Results:120 patients were included in this study, 69 of them were males and 51 were females. 86 (71.7%) of them underwent open surgery while 34 (28.3%) underwent laparoscopic surgery. After a mean follow up of 32.4 months: 104 patients were alive, 7 deceased and 9 were lost of follow up. Local recurrence in the open approach (OA), and laparoscopic approach (LA) groups was 3/86 (3.5%) and 4/34 (11.8%) respectively. Distal recurrence occurred in 12/86 (14%) of OA and 5/34 (14.7%) of LA. Overall 3-years survival for OA and LA was 89% and 97% respectively and the 3-years disease free survival was 49% and 57% respectively.Conclusion: Laparoscopic and open rectal excision were similar in their outcome.

A Mechanistic Investigation into Ischemia-Driven Distal Recurrence of Glioblastoma

Glioblastoma (GBM) is the most aggressive primary brain tumor with a short median survival. Tumor recurrence is a clinical expectation of this disease and usually occurs along the resection cavity wall. However, previous clinical observations have suggested that in cases of ischemia following surgery, tumors are more likely to recur distally. Through the use of a previously established mechanistic model of GBM, the Proliferation Invasion Hypoxia Necrosis Angiogenesis (PIHNA) model, we explore the phenotypic drivers of this observed behavior. We have extended the PIHNA model to include a new nutrient-based vascular efficiency term that encodes the ability of local vasculature to provide nutrients to the simulated tumor. The extended model suggests sensitivity to a hypoxic microenvironment and the inherent migration and proliferation rates of the tumor cells are key factors that drive distal recurrence.

Modeling the Role of Hypoxia in Glioblastoma Growth and Recurrence Patterns

A typical feature of glioblastoma (GBM) growth is local recurrence after surgery. However, some GBMs recur distally. It has been noted that GBM patients with perioperative ischemia are more likely to have distal recurrence and that GBM cells migrate faster under hypoxic conditions. We apply the Proliferation Invasion Hypoxia Necrosis Angiogenesis (PIHNA) model to examine the effect of faster hypoxic cell migration on simulated GBM growth. Results suggest that a highly migratory hypoxic cell population drives the growth of the whole tumor and leads to distant recurrence, as do higher normoxic tumor cell migration and low cellular proliferation rates.

Outcome of wire localized lumpectomies for nonpalpable breast lesion following neoadjuvant chemotherapy.

96 Background: Wire localized lumpectomies for non-palpable breast lesions is not yet a widespread practice in Pakistan. Shaukat Khanum Memorial Hospital is one of the few centers practicing this technique. It remains an effective and cost efficient procedure .The aim of this study is to evaluate wire-guided localization for nonpalpable breast cancer following neoadjuvant chemotherapy focusing on post-operative outcome and survival rate. Methods: It is retrospective analysis of consecutive series of patients treated at SKMH with BCS after wire localization for nonpalpable breast cancer following neoadjuvant chemotherapy from August 2005 to December 2011.The records were reviewed for patient, radiological, histological and surgical characteristics. The tumor volume analysis was calculated according to the Krekel et al method. Data was analyzed using SPSS (Version 19). Kaplan Meier curves were used to conduct survival analysis with respect to stage at presentation and pathological response to therapy. Results: A total of 195 patients were reviewed. The rate of positive margins; taken as less than 2mm, following initial BCT was 9.7%. Out of the 19 patients with positive margins 13 had re-excision of margins and 2 had completion surgery. One patient refused completion surgery. The rate of local recurrence was 6.6% and distal recurrence 17.9%.Out of 49 patients with recurrence 6 patients (12.24%) had both loco-regional and distal recurrence. The median resection ratio was 16.39. The median survival was 44 months (SD 17.162). There was a significant survival benefit (p = 0.03) in patients presenting at an early clinical stage whereas some clinic yet statistically non-significant survival advantage in patients undergoing surgery following complete radiological response after chemotherapy. Conclusions: Wire localized lumpectomies in post neoadjuvant chemotherapy patients at our institution has a low recurrence rate and an internationally acceptable re-excision rate. The size of the specimen can be optimized further. Early detection and management remains the mainstay of treatment for breast cancer. Patient education and screening are goals that are yet to be achieved on the grand scale in Pakistan.

Distal Recurrence of Periosteal Osteosarcoma After Complete Excision of Proximal Primary Tumour With Good Excision Margins

We present this case of an unusual recurrence of a periosteal osteosarcoma in the distal right tibia 2 years after a successful proximal right tibia primary periosteal osteosarcoma excision with a successful fibular graft. This recurrence lead to a right below-knee amputation.