表浅型食管癌经内镜黏膜下剥离术导致非治愈性切除的危险因素及长期生存分析

Objective To identify risk factors of non-curative resection in superficial esophageal cancer (SEC) after endoscopic submucosal dissection and to evaluate the prognosis. Methods We retrospectively analyzed the data of 207 SEC patients who received ESD. The median follow-up was 48 months. Results The en bloc resection rate was 89.25% (191/214), the complete resection rate was 80.84 % (173/214), the curative resection rate was 70.09% (150/214) and the non-curative resection rate was 29.91% (64/214). The maximum long diameter of specimen was 110 mm. Age, gender, tumor size, lesions performance during surgery and operation time were associated with the non-curative resection (P<0.05). Female, lesion diameter≥50mm and poorly performed lesions were identified as significant risk factors for non-curative resection. In the noncurative resection group, there was no difference in cancer-free survival and survival between patients who had no additional treatmeat after ESD and those who underwent surgery or radiotherapy. Conclusion For patients with poor general condition who are not willing to undergo surgery or chemoradiotherapy, regular endoscopy seems to be an option. © 2020, CHINA RESEARCH ON PREVENTION AND TREATMENT. All rights reserved.     

1470 nm激光在解剖性切除非肌层浸润性膀胱癌中的临床应用

目的探讨1470 nm激光在解剖性切除非肌层浸润性膀胱癌中的临床疗效。方法回顾性分析2018年1月至2019年12月于本院泌尿外科行1470 nm激光解剖性切除浅表性膀胱肿瘤患者60例的临床资料,所有患者均通过膀胱镜检查和CT或MRI检查,术前诊断为非肌层浸润性膀胱癌。分析1470 nm激光在解剖性切除非肌层浸润性膀胱癌中的应用效果。结果所有患者均顺利完成手术,无中转开放手术,并且术中无并发症,手术时间为10~30 min,平均(15.3±4.9)min,术后冲洗液无色或淡粉色,未见血块,术后1周拔除导尿管。结论1470 nm激光应用于解剖性切除浅表性膀胱肿瘤中效果显著,具有无瘤原则,利于肿瘤分期,可减少闭孔反射。     

Tumor teratoide/rabdoide atípico con diferenciación tipo ganglioglioma: reporte de caso

BackgroundAtypical teratoide/rhabdoid tumor is a very rare and aggressive disease that primarily presents in pediatric patients. To the best of our knowledge, the initial presentation of this type of tumor with ganglioglioma-like differentiation is rare in the literature.Case reportWe present the case of a 9-month-old patient with left facial paralysis. An MRI revealed a lesion at the left cerebellopontine angle. Complete macroscopic surgical resection was performed. Histopathology and immunohistochemistry testing revealed an atypical teratoid/rhabdoid tumor with ganglioglioma-like differentiation.ConclusionsThis case report presents an atypical teratoid/rhabdoid tumor with initial gangligioma-like differentiation. This study adds to the data in the literature and promotes the study of this type of histogenesis. It lays a foundation for encouraging further studies to determine whether changes should be made to existing management protocols and, at the same time, determine whether there would be any variation with regard to disease prognosis.     

Association between R1 resection and oncological outcome in resectable gastrointestinal stromal tumors without tumor rupture: A systematic review and meta-analysis

BackgroundThe influence of positive microscopic margin (R1) resection on the prognosis of gastrointestinal stromal tumors (GISTs) is controversial. Tumor rupture is significantly associated with the occurrence of R1 resection and may be a confounder of R1 resection in GISTs. The present meta-analysis evaluated the real influence of R1 resection on the prognosis of GISTs by excluding the confounding effect of tumor rupture.MethodsThe PubMed, Embase, Web of Science, Cochrane Central Register of Controlled Trials (CENTRAL), and ClinicalTrials.gov databases were searched. Studies that compared R1 with negative microscopic margin (R0) resection in GIST patients and reported the time-to-event data of recurrence-free survival (RFS) or disease-free survival (DFS) were eligible for inclusion. The quality of the observational studies was assessed using the Newcastle–Ottawa scale.ResultsOf the 4896 records screened, 23 retrospective studies with 6248 participants were selected. In the overall analysis, R1 resection resulted in a significantly shorter RFS/DFS than R0 resection for GISTs (HR = 1.80, 95% CI = 1.54–2.10, P < 0.001, I² = 14%). However, the inferior RFS/DFS vanished when tumor rupture cases were excluded (HR = 1.34, 95% CI = 0.98–1.83, P = 0.07, I² = 33%). Sensitivity analysis by high-quality studies brought about a more robust HR of 1.15 (95% CI = 0.88–1.50, P = 0.29), with low heterogeneity (I² = 0%). The qualities of evidence for the outcomes were high.ConclusionsThis meta-analysis shows that R1 resection did not influence the survival outcome of GISTs. Reresection may not be necessary when positive microscopic margins exist. This analysis could provide high-quality evidence for the development of guidelines.     

Comparison of anatomic and non-anatomic resections for very early-stage hepatocellular carcinoma: The importance of surgical resection margin width in non-anatomic resection

BackgroundThe superiority of anatomic resection (AR) over non-anatomic resection (NAR) for very early-stage hepatocellular carcinoma (HCC) has remained a topic of debate. Thus, this study aimed to compare the prognosis after AR and NAR for single HCC less than 2 cm in diameter.MethodsConsecutive patients with single HCC of diameter less than 2 cm who underwent curative hepatectomy between 1997 and 2017 were included in this retrospective study.ResultsIn total, 159 patients were included in this study. Of these, 52 patients underwent AR (AR group) and 107 patients underwent NAR (NAR group). No significant differences were noted in recurrence-free survival (RFS) and overall survival (OS) between the AR and NAR groups (P = 0.236 and P = 0.363, respectively). Multivariate analysis revealed that low preoperative platelet count and presence of satellite nodules were independent prognostic factors of RFS and OS. Wide surgical resection margin did not affect RFS (P = 0.692) in the AR group; however, in the NAR group, RFS was found to be higher with surgical resection margin widths ≥1 cm than with surgical resection margin widths <1 cm (P = 0.038).ConclusionsPrognosis was comparable between the NAR and AR groups for very early-stage HCC with well-preserved liver function. For better oncologic outcomes, surgeons should endeavor in keeping the surgical resection margin widths during NAR ≥1 cm.     

Assessment of the deep resection margin during oral cancer surgery: A systematic review

The main challenge for radical resection in oral cancer surgery is to obtain adequate resection margins. Especially the deep margin, which can only be estimated based on palpation during surgery, is often reported inadequate. To increase the percentage of radical resections, there is a need for a quick, easy, minimal invasive method, which assesses the deep resection margin without interrupting or prolonging surgery. This systematic review provides an overview of technologies that are currently being studied with the aim of fulfilling this demand.A literature search was conducted through the databases Medline, Embase and the Cochrane Library. A total of 62 studies were included. The results were categorized according to the type of technique: ‘Frozen Section Analysis’, ‘Fluorescence’, ‘Optical Imaging’, ‘Conventional imaging techniques’, and ‘Cytological assessment’. This systematic review gives for each technique an overview of the reported performance (accuracy, sensitivity, specificity, positive predictive value, negative predictive value, or a different outcome measure), acquisition time, and sampling depth.At the moment, the most prevailing technique remains frozen section analysis. In the search for other assessment methods to evaluate the deep resection margin, some technologies are very promising for future use when effectiveness has been shown in larger trials, e.g., fluorescence (real-time, sampling depth up to 6 mm) or optical techniques such as hyperspectral imaging (real-time, sampling depth few mm) for microscopic margin assessment and ultrasound (less than 10 min, sampling depth several cm) for assessment on a macroscopic scale.     

Outcomes of vascular resection associated with curative intent hepatectomy for intrahepatic cholangiocarcinoma

Background and aimsWe aimed to investigate the impact of vascular resection (VR) on postoperative outcomes and survival of patients undergoing hepatectomy for intrahepatic cholangiocarcinoma (ICC).MethodsA retrospective analysis of a multi-institutional series of 270 patients with resected ICC was carried out. Patients were divided into three groups: portal vein VR (PVR), inferior vena cava VR (CVR) and no VR (NVR). Univariate and multivariate analysis were applied to define the impact of VR on postoperative outcomes and survival.ResultsThirty-one patients (11.5%) underwent VR: 15 (5.6%) to PVR and 16 (5.9%) to CVR. R0 resection rates were 73.6% in NVR, 73.3% of PVR and 68.8% in CVR. The postoperative mortality rate was increased in VR groups: 2.5% in NVR, 6.7% in PVR and 12.5% in CVR. The 5-years overall survival (OS) rates progressively decreased from 38.4% in NVR, to 30.1% in CVR and to 22.2% in PVR, p = 0.030. However, multivariable analysis did not confirm an association between VR and prognosis. The following prognostic factors were identified: size ≥50 mm, patterns of distribution of hepatic nodules (single, satellites or multifocal), lymph-node metastases (N1) and R1 resections. In the VR group the 5-years OS rate in patients without lymph-node metastases undergoing R0 resection (VRR0N0) was 44.4%, while in N1 patients undergoing R1 resection was 20% (p < 0.001).ConclusionVascular resection (PVR and CVR) is associated with higher operative risk, but seems to be justified by the good survival results, especially in patients without other negative prognostic factors (R0N0 resections).