Surgical treatment of melanoma metastases to the small bowel: A single cancer referral center real-life experience

IntroductionTreatment of metastatic melanoma has rapidly changed during the last years, and patients often require a multidisciplinary approach to achieve effective results. We aimed to assess the survival benefit achieved through surgical approach to patients with small bowel (SB) metastases from cutaneous melanoma, to emphasize the potential role of surgery in association with novel therapies.MethodsNinety consecutive patients with cutaneous melanoma diagnosed as having resectable SB metastases from 1995 to 2015 were retrospectively investigated.ResultsMedian age at surgery of melanoma metastases was 53.4 years. Among 30 patients who had a curative-intent resection, the 5- and 10-year survival rates were 61% and 54%, respectively, while among 60 patients treated with a palliative surgery the corresponding rates were both 4%. Among 29 patients, for whom the interval time between the occurrence of SB metastases and the previous surgical event on GI tract was ≥36 months, the 5-year overall survival rate was 42%; for 56 patients who had an interval time <36 months the corresponding survival rate was 14%. Within the whole series, an absence of any residual disease after surgery (R0) was a factor affecting better survival, regardless of the evidence of metastases in other organs.ConclusionOur observational data showed that surgical treatment for patients with SB metastases from melanoma might increase survival, but further studies are needed to confirm this finding. In the age of novel available therapies, the increase in survival time given by surgery may offer important chances for patients to benefit from systemic therapies.     

Clinical outcome after surgical resection of lung metastases from melanoma

Background. Surgical therapy plays an important role in the management of selected patients with metastatic melanoma. Purpose. A retrospective review of 13 patients who underwent surgical resection of lung metastases from melanoma from 1996 to 2003 was performed. The aim of the study was to analyze the clinical outcome and survival time. Materials and methods. Mean age was 45 years old (range: 31-64). Complete tumour resection was confirmed histologically. Nine patients presented one single pulmonary lesion, two lesions (n = 3) and three lesions (n = 1) but in all cases confined in the same pulmonary lobe. Results. Median survival time (MST) for the entire group was 20 months (95% confidence interval (CI): 16-24 months). The median time to disease progression after lung metastasectomy was 5 months (95% CI: 3-7 months). MST, according to the prognostic groups proposed by the International Registry of Lung Metastases, was 17 months (95% CI: 6-28 months) for group I (n = 6), MST of 20 months (95% CI: 16-24 months) for group II (n = 5) and MST of 4 months for group III (n = 2), without differences statistically significant (log-rank p = 0.423). MST regarding the time of disease free interval from diagnostic of primary tumour and lung metastases (< 36 months [n = 5] vs > 36 months [n = 8]) was 20 months and 17 months respectively, without differences statistically significant (log rank p = 0.222). Conclusions. Surgical resection when feasible provides survival rates superior to any available nonsurgical therapy. In carefully selected patients, when the resection is performed with curative intent, it may result in improved survival.     

Surgical and medical management of small bowel gastrointestinal stromal tumors: A report of the Dutch GIST registry

BackgroundA cohort of 201 patients with small bowel gastrointestinal stromal tumors (GIST) treated between January 1st, 2009 and December 31st, 2016 in five GIST expertise centers in the Netherlands was analyzed. Goal of this study was to describe the clinical, surgical and pathological characteristics of this rare subpopulation of GIST patients, registered in the Dutch GIST registry.MethodsClinical outcomes and risk factors of patients with small bowel GIST who underwent surgery or treated with systemic therapy were analyzed. A classification was made based on disease status at diagnosis (localized vs. metastasized).Results201 patients with small bowel GIST were registered of which 138 patients (69%) were diagnosed with localized disease and 63 patients (31%) with metastatic disease. Approximately 19% of the patients had emergency surgery, and in 22% GIST was an accidental finding. In patients with high risk localized disease, recurrence occurred less often in patients who received adjuvant treatment (4/32) compared to patients who did not (20/31, p < 0.01). Disease progression during palliative imatinib treatment occurred in 23 patients (28%) after a median of 20.7 (range 1.8–47.1) months. Ongoing response was established in 52/82 patients on first line palliative treatment with imatinib after a median treatment time of 30.6 (range 2.5–155.3) months.ConclusionPatients with small-bowel GIST more frequently present with metastatic disease when compared to patients with gastric GIST in literature. We advocate for Prospective registration of these patients and investigate the use of surgery in patients with limited metastatic disease.     

Multiple synchronous primaries of the gastrointestinal tract: a molecular case report

Six synchronous gastrointestinal primaries were identified in a 70 year old male with no known cancer predisposition syndrome or recognized risk factors except alcohol abuse. These specimens appeared to be independent and unrelated by gross and histopathological examination. In order to further evaluate the six tumors, we analyzed selected DNA sequences for alterations in the K-ras oncogene and p53 tumor suppressor gene. In addition, three loci were analyzed to determine microsatellite instability. Using the polymerase chain reaction, single stranded conformational polymorphism, and DNA sequencing, we demonstrated that each primary manifests genetic characteristics typical of the tissue of origin. In addition, one primary, a moderately differentiated colon adenocarcinoma, exhibited mutations not detected in the other specimens. This study suggests that these synchronous primaries arose independently and progressed along different carcinogenic pathways.     

头颈部粘膜恶性黑色素瘤临床分析

 目的　探讨头颈部粘膜恶性黑色素瘤的诊断和治疗方法。方法　回顾性分析64例头颈部粘膜恶性黑色素瘤的病例资料,分组统计预后。结果　手术治疗组5年生存率为20%。以手术为主的综合治疗组为21%,非手术治疗组为0。结论　头颈部粘膜恶性黑色素瘤首选手术治疗。免疫组化病理有助确诊。     

脉络膜恶性黑色素瘤立体定向放射外科治疗初探

目的　评价立体定向放射外科治疗脉络膜恶性黑色素瘤的临床价值。方法　1 6例脉络膜恶性黑色素瘤患者中,2例接受单次立体定向放射外科治疗,1 4例采用分次立体定向放射外科治疗。靶中心1～2个,准直器1 5～4 0mm ,参考剂量曲线70 %～90 %,单次治疗DT2 5Gy/次和DT35Gy/次,分次治疗总剂量DT4 2～5 5Gy/ 3～4次,共4～1 6d。结果　中位随访期6 6个月(3～1 0 0个月) ,1 6例患者全部生存。1 6例中,有1 3例随诊满5年,其5年生存率为1 0 0 %。有7例患者疗后4～1 5个月摘除眼球,其中担心肿瘤未控中断观察2例,继发性青光眼3例,角膜溃疡2例。全组有1例发现远处转移。结论　立体定向放射外科治疗脉络膜恶性黑色素瘤是安全有效的,适用于肿瘤位于后极(或位于赤道后1 / 2 )、最大径线<2 0mm、厚度<1 5mm的脉络膜恶性黑色素瘤。     

A rational surgical approach to the treatment of distant melanoma metastases

The optimal treatment of melanoma involves multidisciplinary care. To many, this means surgical resection of early, localized disease and treatment of metastatic disease with chemotherapy, immunotherapy, or radiation. Because it is effective, results in little morbidity and may be repeated, surgery should have a central role in the treatment of selected patients with American Joint Committee on Cancer (AJCC) stage IV melanoma.     

Effects of Helicobacter pylori infection in gastrointestinal tract malignant diseases: From the oral cavity to rectum

Helicobacter pylori (H. pylori) has infected approximately fifty percent of humans for a long period of time. However, improvements in the public health environment have led to a decreased chance of H. pylori infection. However, a high infection rate is noted in populations with a high incidence rate of gastric cancer (GC). The worldwide fraction of GC attributable to H. pylori is greater than 85%, and a high H. pylori prevalence is noted in gastric mucosa-associated lymphoid tissue lymphoma patients. These results indicate that the majority of GC cases can be prevented if H. pylori infection is eliminated. Because H. pylori exhibits oral-oral or fecal-oral transmission, the relationship between this microorganism and other digestive tract malignant diseases has also attracted attention. This review article provides an overview of H. pylori and the condition of the whole gastrointestinal tract environment to further understand the correlation between the pathogen and the host, thus allowing improved realization of disease presentation.     

Clinical features,treatment, and prognosis of different histological types of primary small bowel adenocarcinoma: A propensity score matching analysis based on the SEER database

PurposeThis aim of this study was to provide a comprehensive understanding of the clinical characteristics, treatment, and prognosis of patients with small bowel adenocarcinoma (SBA), mucinous small bowel adenocarcinoma (MSBA), and signet ring cell carcinoma of the small bowel (SRCSB).MethodsInformation on patients with SBA, MSBA, and SRCSB (2004–2015) was obtained from the Surveillance, Epidemiology and End Results (SEER) database. Cox proportional hazards models and Kaplan–Meier curves were used for the survival analyses. Propensity-score matching (PSM) was implemented to determine the differences among these tumors.ResultsIn all, 3697 patients with SBA (n = 3196), MSBA (n = 325) and SRCSB (n = 176) were ultimately eligible for this study. Poor differentiation, local invasion, and lymph node metastasis were more likely to be observed in SRCSB than in SBA and MSBA. Surgery was the most common treatment modality in all groups. The prognosis of SBA was similar to that of MSBA, but better than that of SRCSB in both unmatched and matched cohorts. M stage, surgery, and chemotherapy were identified as independent predictors of survival in all patients. Surgery and chemotherapy could significantly improve outcomes in all groups before and after PSM. Radiotherapy was associated with a survival benefit in patients with SBA, but this trend was not maintained after PSM. Survival advantages of SBA and MSBA were remarkable in the stratified analysis of surgery after PSM.ConclusionPatients with SRCSB had the worst prognosis among all histological types examined. However, surgery and chemotherapy could improve patients survival, regardless of histological type.     

Surgical management of liver metastases from uveal melanoma: 16 years' experience at the Institut Curie

Background

Uveal melanoma is characterised by a high prevalence of liver metastases and a poor prognosis.

Aim

To review the evolving surgical management of this challenging condition at a single institution over a 16-year period.

Patients and Methods

Between January 1991 and June 2007, among 3873 patients with uveal melanoma, 798 patients had liver metastases. We undertook a detailed retrospective review of their clinical records and surgical procedures. The data was evaluated with both uni- and multivariate statistical analysis for predictive survival indicators.

Results

255 patients underwent surgical resection. The median interval between ocular tumour diagnosis and liver surgery was 68 months (range 19–81). Liver surgery was either microscopically complete (R0; n = 76), microscopically incomplete (R1; n = 22) or macroscopically incomplete (R2; n = 157). The median overall postoperative survival was 14 months, but increased to 27 months when R0 resection was possible.With multivariate analysis, four variables were found to independently correlate with prolonged survival: an interval from primary tumour diagnosis to liver metastases >24 months, comprehensiveness of surgical resection (R0), number of metastases resected (≤4) and absence of miliary disease.

Conclusions

Surgical resection, when possible, is able to almost double the survival and appears at present the optimal way of improving the prognosis in metastatic uveal melanoma. Advances in medical treatments will be required to further improve survival.     

Intestinal metastasis from breast cancer: Presentation,treatment and survival from a systematic literature review

BACKGROUNDIntestinal metastases from breast cancer (BC) arerare; available data depend mainly on case reports and case series.AIMTo conduct a review of the literature regarding presentation, diagnosis, treatment and survival of patients with intestinal metastasis from BC.METHODSWe identified all articles that described patients with intestinal metastasis (from duodenum to anum) from BC using MEDLINE (1975 to 2020) and EMBASE (1975 to 2020) electronic databases.RESULTSWe found 96 cases of intestinal metastasis of BC. Metastasization involved large bowel (cecum, colon, sigmoid, rectum) (51%), small bowel (duodenum, jejunum, ileum) (49%), and anum (< 1%). Median age of patients was 61-years. The most frequent histology was infiltrating lobular carcinoma followed by infiltrating ductal carcinoma. In more than half of patients, the diagnosis was made after the diagnosis of BC (median: 7.2 years) and in many cases of emergency, for bowel obstruction, bleeding or perforation. Diagnosis was achieved through endoscopy, radiological examination or both. In most of the cases, patients underwent surgery with or without systemic therapies. Survival of patients included in this review was available in less than 50% of patients and showed an overall median of 12 mo since diagnosis of the intestinal metastasis.CONCLUSIONAlthough, intestinal metastases of BC are considered a rare condition, clinicians should consider the possibility of intestinal involvement in case of abdominal symptoms even in acute setting and many years after the diagnosis of BC, especially in patients with a histology of lobular carcinoma.     

Diagnosis of melanoma in the elderly and surgical implications

The diagnosis of primary melanoma is mainly related to the precocity on which a patient is referred to the specialist, but in elderly patients this may present some peculiar characteristics, one is anatomical, a typical melanoma of the face, the lentigo maligna melanoma and the second is attitudinal, the fact that elderly patients often do not refer a changing cutaneous lesion to a doctor until becoming symptomatic. The therapeutic approach has to be discussed with an anaesthesiologist if the procedure has to be conducted under general anaesthesia or with a cardiologist if under local anaesthesia. Once there are no contraindications medically, a similar oncological approach should be proposed without any reduction in radicality due to the elderly age.     

原发性胃肠道恶性淋巴瘤的诊断与治疗

目的 :探讨原发性胃肠道恶性淋巴瘤的诊断及治疗。方法 :分析我院近12年来收治的69例原发性胃肠道恶性淋巴瘤的临床资料 ,其生存率由寿命表法计算获得。结果 :本组术前确诊率为27.5 % ,其2年、5年和10年生存率分别是 :Ⅰ期91.7%、83.3%和25 % ,Ⅱ期52 %、32%和20 %。结论 :掌握本病钡餐造影的特点和内镜取材深度 ,可望提高本病的术前诊断率 ,争取手术切除 ,术后辅助化疗、放疗 ,以提高本病生存率。     

Percutaneous radio-frequency ablation of hepatocellular carcinoma adjacent to the gastrointestinal tract

Purpose: The purpose of the study was to prospectively evaluate the safety and the efficacy of percutaneous radio-frequency ablation of hepatocellular carcinoma adjacent to the gastrointestinal tract.

Materials and methods: From April 2012 to November 2015, 141 hepatocellular carcinoma nodules that underwent ultrasound-guided percutaneous radio-frequency ablation were included. A total of 52 lesions were located less than 5?mm from the gastrointestinal tract in the study group, and 89 lesions were located more than 5?mm from hepatic surface in the control group. Ethanol (2.5–9.6?mL) was injected into marginal tissue of tumour in five lesions of the study group. During the ablation, the temperature of marginal ablation tissue proximal to the gastrointestinal tract was monitored and controlled at 45–56?°C for more than 10?min in the study group. We compared the results of ablation between the two groups.

Results: In total 48 of 52 tumours (92.3%) in the study group and 84 of 89 tumours (94.4%) in the control group achieved complete ablation (P?=?0.63). Local tumour progression was found in eight tumours (15.4%) in the study group and 11 tumours (12.4%) in the control group during follow-up (P?=?0.61). There were neither immediate nor peri-procedural major complications in both groups, grade I (Clavien–Dindo classification). One case developed biloma at 5-month follow-up in the study group, Clavien–Dindo gradeIII.

Conclusions: Percutaneous radio-frequency ablation is safe and achieves a high complete ablation rate for the treatment of hepatocellular carcinoma adjacent to the gastrointestinal tract.     

The increasing role of abdominal metastesectomy for malignant melanoma in the era of modern therapeutics

BackgroundMetastatic spread of malignant melanoma to the abdomen presents a therapeutic challenge. Targeted and Immune-therapies dramatically improve patients’ survival, yet some patients may still benefit from surgical intervention. This study investigates the outcomes of surgical treatment of abdominal metastatic melanoma in the era of modern therapy.MethodsThis is a retrospective study of all patients who underwent surgical resection for abdominal metastatic melanoma between the years 2009–2021 (n = 80). We examined the clinical, operative, perioperative, and oncological outcomes of these patients.ResultsThe cohort included a therapeutic group (T, n = 43) and palliative group (P, n = 37). The rate of overall post-operative complications was lower in the T group (n = 3, 9.3%) compared to the P group (n = 10, 27.1%) (p = 0.04), but no difference in major complications rate (p = 0.41). The median follow-up was 13.4 months (range, 0.5–107), with an estimated 2- and 5-years survival of 66.5% and 45.3% respectively. The estimated 2- and 5-years survival of the T group was 76.61% and 69.65%, and 49.01% and 28.01% in the P group (p = 0.005). Univariate analysis identified Therapeutic resection (HR 3.2, p = 0.008), isolated lesions (HR 1.47, p = 0.033) and major complication score (HR 1.8, p=<0.001) to be correlated with survival. On multivariate analysis, Therapeutic resection (HR 2.53, p = 0.042) and major complication score (HR 1.62, p = 0.004) remained significant independent factors correlated with survival. In patients who progressed on treatment, and their progression was treated with surgical resection 46.1% where able to be maintained on the same preoperative treatment strategy.ConclusionWe have demonstrated that abdominal metastesectomy is a safe and oncologically efficacious therapy in selected patients. Especially in the era of modern therapeutics, patients with isolated disease site, limited resectable progression on therapy, or patients with symptomatic metastases should be considered for surgical resection.