Completion Pneumonectomy for Patients with Recurrent Lung Cancer: The Impact of Microvessel Density on Outcome

P < 0.0001). The vessel densities in the primary and recurrent tumors of 2 of 3 long-term survivors were found to be relatively low. These results indicate the high-grade malignant potential of recurrent tumors, which led us to conclude that the use of CP should be carefully evaluated in patients with recurrence. Assessing the vasculature in primary tumors may be a useful indicator for determining which patients could benefit from CP. (Received for publication on Jan. 21, 1999; accepted on July 13, 1999)     

Impact of Postoperative Complication and Completion of Multimodality Therapy on Survival in Patients Undergoing Gastrectomy for Advanced Gastric Cancer

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补充性全肺切除术治疗肺癌

目的　评估补充性全肺切除术的适应证、危险性和结果。　方法　回顾性分析 49例残肺恶性病变患者的补充性全肺切除术 ,其中第二原发性肺癌 14例 ,肺癌复发 35例 ;再次手术平均间隔期为 2 9个月。　结果　全组死亡6例 ,1例死于术中 ,5例死于术后 ,手术死亡率为 12 .2 4%。术后随访 1个月～ 5年 ,中位数生存时间 2 .5年 ,5年生存率为 33%。　结论　补充性全肺切除术治疗残肺癌 ,手术死亡率和术后 5年生存率接近标准的全肺切除术     

Completion Thyroidectomy: Effect of Timing on Clinical Complications and Oncologic Outcome in Patients With Differentiated Thyroid Cancer

Background  

Despite improved preoperative diagnostics, incidental postoperative detection of differentiated thyroid cancer in the final histology is still common. In most of these cases, completion thyroidectomy is recommended by national and international guidelines, although secondary surgery is associated with an increased operative risk. The optimal timing of completion thyroidectomy is still controversial.     

Radioactive Iodine Remnant Uptake After Completion Thyroidectomy: Not Such a Complete Cancer Operation

Background

Given limitations in preoperative diagnostics, thyroid lobectomy followed by completion thyroidectomy (CT) for differentiated thyroid cancer (DTC) may be required. It is unclear whether resection quality by CT differs from that by total thyroidectomy (TT). Additional surgeon or patient factors may also influence the “completeness” of resection. This study evaluated how CT and surgeon volume influence the adequacy of resection as measured by radioactive iodine (RAI) remnant uptake.

Methods

A retrospective review of a prospectively collected thyroid database was queried for patients treated for DTC with TT or CT followed by RAI ablation. CT patients were matched 1:2 by age, sex, and tumor size to TT patients. Surgeon volume, time to completion, and continuity of surgeon care were reviewed.

Results

Over 18 years, 45 patients with DTC had CT and RAI. Mean age was 48 ± 2 years, and 76 % were female, with a tumor size of 2.7 ± 0.3 cm. CT had higher remnant uptake than TT (0.07 vs. 0.04 %; p = 0.04). CT performed by a high-volume surgeon had much lower remnant uptakes (0.06 vs. 0.22 %; p = 0.04). Remnant uptake followed a stepwise decrease with involvement of a high-volume surgeon for part or all of the surgical management (p = 0.11). Multiple regression analysis found CT (p = 0.02) and surgeon volume (p = 0.04) to significantly influence uptake after controlling for other factors.

Conclusions

Single-stage TT provides a better resection based on smaller thyroid remnant uptakes than CT for patients with thyroid cancer. If a staged operation for cancer is necessary, surgeon volume may affect the completeness of resection.     

The Impact of Obesity on Breast Cancer: A Retrospective Review

Background

Obesity has been linked to many adverse health consequences, including breast cancer; however, the impact on clinical presentation, tumor characteristics, and survival outcomes has yet to be clearly defined.

Methods

Retrospective review of a prospectively collected database of patients treated at a single institution for invasive breast cancer from 2000?C2008 comparing two groups: nonobese (body mass index of <30) and obese (body mass index of ??30) patients. Continuous variables, categorical variables, and survival data were analyzed.

Results

Of 1352 total patients, 76% were classified as nonobese and 24% were obese. When comparing age, obese patients presented less frequently than nonobese patients <50?years old (10% vs. 90%), and when comparing patients >50?years old (18% vs. 82%, P?=?0.0019). Obese patients were more likely to present with disease detected by imaging when compared to nonobese patients (67% vs. 56%, P?=?0.0006). Obese patients had larger tumors (1.7?cm vs. 1.4?cm, P?P?=?0.026). On multivariate analysis, obesity was associated with nonpalpable tumors, larger tumors, a higher incidence of LN metastasis, lower incidence of Her2 positivity, lower incidence of multifocality, and less likely to undergo reconstruction after mastectomy.

Conclusions

Obese patients clinically present at older ages with mammographically detected breast cancer at more advanced stages than nonobese patients. Strategies to encourage screening among the obese patient population are important.     

Time from Completion of Neo‐adjuvant Chemotherapy to Surgery: Effects on Outcomes in Breast Cancer Patients

There is no consensus on the ideal time interval between the completion of neo‐adjuvant chemotherapy (NAC) and definitive surgery for patients with breast cancer. This study sought to determine the ideal time interval from completion of systemic therapy to surgery in an attempt to define a best practice. A retrospective analysis of all patients undergoing NAC for Stage I‐III breast cancer from 1998‐2010 was undertaken. Analysis of all demographic and clinical information was performed, with emphasis on interval from completion of systemic therapy to definitive surgical management. Three hundred and eighty eight patients met the inclusion criteria with a median age of 50 (61.9% white, 33.8% black and 4.3% other). Overall, 2.8% of patients were Stage I, 57.2% Stage II and 40% Stage III. Median follow‐up was 85 months. Pathologic response to systemic therapy was complete in 20.6%, partial in 67.8% and no response or progression in 11.6%; responders (pCR or pPR) were noted to have significantly improved Disease free survival (DFS) and Overall survival (OS). Patients undergoing surgical intervention 4‐6 weeks after completion of NAC were noted to have a trend towards improved DFS and OS on multivariable analysis. These findings were also observed in the nonlinear relationship between survival risk and surgery time window using martingale residual plots. Timing of surgical intervention following the receipt of NAC may not appear to affect DFS or OS.     

Treatment Sequencing for Resectable Pancreatic Cancer: Influence of Early Metastases and Surgical Complications on Multimodality Therapy Completion and Survival

Barriers to multimodality therapy (MMT) completion among patients with resectable pancreatic adenocarcinoma include early cancer progression and postoperative major complications (PMC). We sought to evaluate the influence of these factors on MMT completion rates of patients treated with neoadjuvant therapy (NT) and surgery-first (SF) approaches. We evaluated all operable patients treated for clinically resectable pancreatic head adenocarcinoma at our institution from 2002 to 2007. Rates of MMT completion, 90-day PMC, and overall survival (OS) were evaluated. Ninety-five of 115 (83 %) NT and 29/50 (58 %) SF patients completed MMT. Patients who completed MMT lived longer than those who did not (36 vs. 11 months, p?<?0.001). The most common reason that NT (11 %) and SF (26 %) patients failed to complete MMT was early disease progression. The rates of PMC among NT and SF patients were similar. Among SF patients, 69 % with no PMC completed MMT versus 29 % after PMC (p?=?0.040). PMC were associated with decreased OS in SF patients but not in NT patients. The impact of early cancer progression and PMC upon completion of MMT is reduced by delivery of nonoperative therapies prior to pancreaticoduodenectomy. NT sequencing is a practical treatment strategy, particularly for patients at high biological or perioperative risk.     

Surgical Impact on Gastric Cancer with Locoregional Invasion

Background  

The benefit of resection of gastric cancer with locoregional invasion is still under debate. This study aimed to investigate the impact of surgery on patients with gastric cancer with locoregional invasion.     

Predictors and Outcomes of Completion Axillary Node Dissection Among Older Breast Cancer Patients

Background

The role of completion axillary lymph node dissection (ALND) for older women who had sentinel lymph node-positive (SLN+) invasive breast cancer is unclear. We examined factors predictive of ALND and the association between ALND, adjuvant chemotherapy administration, and survival.

Methods

Using the Surveillance, Epidemiology, and End Results (SEER)-Medicare database, we reviewed records of women age >65 diagnosed with stage I/II breast cancer from 1998–2005. Adjusted Cox proportional hazards and multivariate logistic regression were used to identify patient and disease variables associated with ALND, and assess association between ALND and all-cause and breast cancer-specific survival.

Results

Among SLN+ patients, 88 % underwent ALND. Earlier diagnosis year, greater nodal involvement, younger age, registry location, and larger tumor size were all associated with a significantly higher likelihood of ALND. The ALND in SLN+ patients was not significantly associated with 5-year breast cancer-specific survival (hazard ratio [HR] 1.22, 95 % confidence interval [CI] 0.76–1.96). The SLN+ patients who underwent ALND were more likely to receive adjuvant chemotherapy (odds ratio [OR] 1.8, 95 % CI 1.45–2.24). However, younger age (OR 18.0, 95 % CI 14.4–23.9), estrogen receptor-negative (ER-) status (OR 4.2, 95 % CI 3.4–5.3), and fewer comorbidities (OR 2.6, 95 % CI 1.7–4.0) were all more strongly linked to receipt of chemotherapy.

Conclusions

ALND for older patients with SLN+ breast cancer is not associated with improved 5-year all-cause or breast cancer-specific survival. Younger age, fewer comorbidities, and estrogen receptor-negative (ER-) status were more strongly associated with receipt of chemotherapy than ALND. Consideration should be given to omitting ALND in older patients, particularly if findings of ALND will not influence adjuvant therapy decisions.     

Chemotherapy-Associated Liver Injury: Impact on Surgical Management of Colorectal Cancer Liver Metastases

Chemotherapy is integral to the management of patients with advanced colorectal cancer liver metastases. Due to their improved efficacy, modern regimens can sometimes convert unresectable disease to a resectable state. As chemotherapy is often administered prior to hepatic resection, adverse effects on the liver are increasingly being recognized. Investigators have identified a wide spectrum of effects on the underlying liver parenchyma, ranging from mild forms of steatosis to severe steatohepatitis and sinusoidal obstruction syndrome. As the histopathologic definitions of these changes evolve, studies have identified specific patterns of hepatic injury related to the various chemotherapeutic agents. The impact of these changes on perioperative outcome after partial hepatectomy remains controversial. Timing and duration of chemotherapy may play a key role and account for discrepancies in outcomes seen among studies. In this review, we provide an overview of the spectrum of chemotherapy-associated liver injury and discuss its relevance to perioperative management of patients undergoing hepatic resection of colorectal cancer liver metastases.