Risk of recurrence after surgical resection of small-sized invasive lung adenocarcinoma

Objective: It has been reported that small-sized invasive lung adenocarcinomas, i.e., those classified as type C through type F according to Noguchi’s classification, may also recur even after complete resection. We evaluated the prognostic value of molecular biologic markers (apoptosis, Ki-67, p53, epidermal growth factor) and clinicopathological factors in patients with small-sized invasive lung adenocarcinomas. Methods: The clinical records of all patients who had had a peripheral adenocarcinoma surgically resected between 1996 and 2002, and histologically diagnosed as type C through type F according to Noguchi’s classification were retrospectively reviewed. The apoptotic index (AI) was determined by the triphosphate biotin nick end-labeling method and the expression of Ki-67, aberrant p53 protein and epidermal growth factor receptor was determined by immunohistochemical staining. Results: Data from 28 patients who had been followed up for a mean period of 41.8 months (range: 16 to 89 months) were evaluated. During the follow-up period, recurrence was seen in 6 patients. The log-rank test showed that AI was a significant predictor of cancer recurrence. The 5-year disease-free survival rate of the 10 patients in the high AI group (AI>0.3%) was 100%; while that of the 18 patients in the low AI group (AI≤0.3%) was 50.5% (p=0.036). None of the other molecular biologic markers or clinicopathological factors were found to be a significant predictor of cancer recurrence. Conclusion: Peripheral small-sized invasive lung adenocarcinomas with a low AI carry an increased risk of distant metastases, indicating that adjuvant chemotherapy after complete resection might be needed.     

Characteristics and timing of recurrence during postoperative surveillance after curative resection for lung adenocarcinoma

Purpose

To establish the most effective methods of postoperative surveillance to detect early recurrence of lung adenocarcinoma.

Methods

The subjects of this retrospective study were 485 patients with p-stage I–III lung adenocarcinoma, who underwent postoperative surveillance. We examined the sites and detection modes of recurrence and calculated the recurrence-free probabilities. Patients with stage I disease were divided into low- and high-risk recurrence groups using a risk score calculated by assigning points proportional to risk factor regression coefficients.

Results

Of the 112 patients with recurrence, 86 had intrathoracic recurrence. Routine computed tomography (CT) revealed recurrence in 60 patients. The recurrence-free probability curves showed that 95% of recurrences were identified within the first 4 years after resection in patients with stage II/III disease. In patients with stage I disease, the predictors of recurrence included male sex, positive pleural lavage cytology, moderate-to-poor differentiation, and visceral pleural invasion. Postoperative recurrences were detected throughout the follow-up period in the high-risk group.

Conclusions

Routine chest CT plays an important role in the postoperative surveillance of lung adenocarcinoma. We recommend intensive follow-up during the early post-resection period for patients with advanced stage disease and long-term follow-up for high-risk patients with stage I disease.

     

Local recurrence after curative resection of colorectal adenocarcinoma

A total of 853 patients with 861 colorectal adenocarcinomas were operated on at our institution between 1965 and 1981. Complete follow-up information was obtained in all but six patients (99.4%), and all available histologic slides were reviewed to determine pathologic stage and characteristics. Six hundred fifty-one patients (76.3%) underwent a potentially curative procedure, and their operative mortality rate was 2.8%. Of the 627 patients available for analysis, 50 (8%) had a local recurrence. The median time to local recurrence was 18 months, and only 16% of local recurrences were diagnosed 5 years after the original resection. Median survival of patients with a local recurrence was 3 1/2 years from the original resection, and 16 patients (32%) survived 5 years or longer. A multivariate logistic regression analysis was conducted to examine the influence of several clinical and pathologic characteristics on local recurrence among Dukes' stages B and C adenocarcinomas (n = 539) after exclusion of patients with synchronous tumors (n = 8), postoperative deaths (n = 18), loss to follow-up (n = 6), or incomplete data (n = 11). This analysis revealed that the local recurrence rate was significantly related to depth of invasion (B1 + C1 = 0%; B2 + C1 = 10%; p less than 0.01), site of origin (right plus transverse colon = 6%; left plus rectosigmoid colon = 10%; rectum = 12%; p less than 0.05), and lymphatic or capillary microinvasion (absent, 6%; present, 14%; p less than 0.05). This analysis attempts to identify patients at high risk for development of local recurrent disease to select candidates for postoperative adjuvant therapy.     

Local recurrence after sphincter-saving resection for rectal adenocarcinoma

Local pelvic-perineal recurrences were evaluated in 40 patients who underwent a sphincter-saving resection for rectal adenocarcinoma at Roswell Park Memorial Institute. The length of follow-up was at least 5 years or until death in all but one patient. There were 24 women and 16 men with a median age of 63 years. In 31 patients, the resection was considered to be curative and was considered palliative in the remaining 9 patients. Seven of the 31 patients (23 percent) developed a local recurrence. Two of the seven local recurrences had further resection for curative intent, with one person alive at 88 months. Margins of resection were available in 27 patients. Local recurrence occurred in 4 of 8 patients with distal margins of resection less than 2 cm and in 3 of 19 patients with margins greater than 2 cm. When the lesion was less than 10 cm from the anal verge, local recurrence was more likely to occur than at margins above this level.     

Preoperative monocyte count is a predictor of recurrence after Stage I lung adenocarcinoma resection

Open in a separate window OBJECTIVESHigh-grade tumours are observed even in Stage I lung adenocarcinomas. Tumour spread through air spaces (STAS) is a risk factor for recurrence after resection. However, there is no ideal predictive biomarker for STAS in high-grade Stage I lung adenocarcinoma. This study assessed the prognostic impact of the preoperative peripheral monocyte count in lung adenocarcinoma.METHODSWe retrospectively analysed the data of 444 patients with resected Stage I lung adenocarcinoma during 2006–2016. Univariable and multivariable Cox proportional analyses of recurrence-free probability (RFP) and overall survival (OS) were used to analyze preoperative complete peripheral blood cell count data. Since monocyte count was associated with poor prognosis, the relationship between preoperative peripheral monocyte count and clinicopathological factors, including STAS, was assessed. In addition, immunohistochemical CD68 staining was performed to evaluate tumour-associated macrophages (TAMs).RESULTSA higher preoperative peripheral monocyte count was a predictor of lower RFP (P = 0.004) and lower OS (P < 0.001). In multivariable analysis, a higher peripheral monocyte count was an independent prognostic factor for RFP and OS (hazard ratio: 1.88, 95% confidence interval: 1.07–3.31, P = 0.029; hazard ratio: 2.13, 95% confidence interval: 1.22–3.75, P = 0.008, respectively). A higher peripheral monocyte count was associated with a higher frequency of STAS (P = 0.017) and higher number of CD68+ TAMs (P = 0.013).CONCLUSIONSA higher preoperative peripheral monocyte count was an independent marker for a poor prognosis in Stage I lung adenocarcinoma and was associated with a higher frequency of STAS.     

Local recurrence and survival after laparoscopic mesorectal resection for rectal adenocarcinoma

Background: Laparoscopic resection for rectal cancer is controversial. Actuarial survival and local recurrence rates have not been determined. Methods: A prospective database containing 80 consecutive unselected laparoscopic resections of rectal cancers performed between November 1991 and 1999 was reviewed. Local recurrence was defined as any detectable local disease at follow-up assessment occurring either alone or in conjunction with generalized recurrence. The tumor node metastases (TNM) classification for colorectal cancers and the Kaplan-Meier method were used to determine staging and survival curves. The mesorectal excision technique was used during surgery. Results: The median follow-up period was 31 months for patients with stages I, II, and III cancer, and 15.5 months for patients with stage IV cancer. The overall 5-year survival rate was 65.1% for all cancer stages and 72.1% for stages I, II, and III cancer. No trocar-site recurrence was observed. The overall local recurrence rate was 3.75% (3/80) for all cancer stages, and 4.3% (3/70) for stages I, II, and III cancer. Conclusions: The survival and local recurrence rates for patients with rectal cancer treated by laparoscopic mesorectal excision do not differ negatively from those in the literature for open mesorectal excision. Further validation is needed.     

Endobronchial brachytherapy for intra-luminal recurrence after lung cancer resection

A 63-year-old man who had squamous cell carcinoma in left lung was received left lower lobectomy with lymph node dissection (pT3N0M0). Twenty months after surgery, the patient showed bloody sputum and bronchofiberscopy revealed intra-luminal recurrence on trachea. Endobronchial brachytherapy in combination with external beam radiotherapy was selected and complete remission was achieved. After the brachytherapy, bronchitis was observed and was healed 23 months after the therapy.     

Locoregional recurrence and survival after curative resection of adenocarcinoma of the colon

BACKGROUND: There is wide variability in reported locoregional recurrence rates after curative resection of adenocarcinoma of the intraperitoneal colon, and there is no universally accepted surgical technique regarding length of the resected specimen or extent of lymphadenectomy. The aim of this study was to determine the disease-free survival, locoregional failure, and perioperative morbidity of patients undergoing curative resection of colon adenocarcinoma. STUDY DESIGN: The records of 316 consecutive patients undergoing curative resection for primary adenocarcinoma of the intraperitoneal colon between 1990 and 1995 were reviewed. Locoregional recurrence was defined as disease at the anastomosis or in the adjacent mesentery, peritoneum, retroperitoneum, or carcinomatosis. The product-limit method (Kaplan-Meier) was used to analyze survival and tumor recurrence. RESULTS: The study population comprised 167 men and 149 women, mean age 70+/-12 years (range 22 to 95 years). Median followup was 63+/-25 months. Five-year disease-free survival was 84% overall. Disease-free survival paralleled tumor stage: stage I, 99% (n = 73); stage II, 87% (n = 151); stage III, 72% (n = 92). The predominant pattern of tumor recurrence was distant failure only. Overall locoregional recurrence (locoregional and locoregional plus distant) at 5 years was 4%. Locoregional recurrence paralleled tumor stage: stage I, 0%; stage II, 2%; stage III, 10%. Of the 12 patients who suffered locoregional recurrence, 9 (75%) had T4 primary tumors, N2 nodal disease, or both. Major and minor complications occurred in 93 patients (29%) including: anastomotic leak or intraabdominal abscess (n = 4, 1%); hemorrhage (n = 8, 3%); cardiac complications (n= 17, 5%); pulmonary embolism (n=4, 10%); death (n=2, 1%). Multivariate analysis (Cox proportional hazards) revealed that the only independent predictor of disease-free survival and locoregional control was tumor stage. CONCLUSION: Longterm survival and locoregional control can be achieved for patients with colon cancer, with low morbidity. In the absence of adjacent organ invasion and N2 nodal disease, locoregional recurrence should be a rare event. Just as for rectal cancer, the technical aspects of colectomy for colon cancer deserve renewed attention.     

食管胃结合部癌根治术后早期复发相关因素分析

目的:探讨食管胃结合部癌病人根治术后早期复发的相关临床病理因素。方法 :采用回顾性研究的方法,收集我院1995年12月至2007年12月收治的食管胃结合部癌根治术后复发的147例病人临床资料。通过卡方检验和Logistic多因素回归分析研究影响术后肿瘤早期复发的危险因素。结果:食管胃结合部癌根治术后平均复发时间为16.3±1.2个月,1年内复发率为76.6%。单因素分析结果显示,食管胃结合部癌根治术后早期复发与组织分化类型为低分化/未分化、阳性淋巴结转移数目、脉管浸润相关(P<0.05)。结论:组织分化类型和脉管浸润是预测食管胃结合部癌根治后早期复发的重要因素。     

Incidence and patterns of recurrence after intersphincteric resection for very low rectal adenocarcinoma

BACKGROUND: The aim of this study was to evaluate the incidence and patterns of recurrence, or oncologic safety, after intersphincteric resection (ISR) without radiotherapy for very low rectal adenocarcinoma. STUDY DESIGN: One hundred eight consecutive patients with T1-T3 rectal cancers located 1 to 5 cm (median 3 cm) from the anal verge underwent ISR. A retrospective analysis of prospectively recorded data from the 106 patients not receiving radiotherapy was performed. RESULTS: There were 23 T1, 40 T2, and 43 T3 tumors. Morbidity and mortality rates were 33% and 1%, respectively. The 3-year rates of overall local recurrence and survival were 5.7% and 95%, respectively. The 3-year cumulative local recurrence rate was 0% for the patients with T1-T2 tumors as compared with 15% for those with T3 tumors (p=0.0012). In T3 tumors, the 2-year local recurrence rate was 5% for patients with negative surgical margins as compared with 33% for those with positive margins (p=0.0001). The incidences of distant recurrence for stages I, II, III, and IV disease were 4%, 5%, 18%, and 33%, respectively. CONCLUSIONS: ISR does not increase local or distant recurrences. For T1-T2 tumors, meticulous dissection and irrigation after closure of the distal stump allows local control without radiotherapy. With T3 tumors, preoperative therapy should be considered if resection margins are estimated to be insufficient.     

Port site recurrence after video-assisted thoracoscopic resection of chest wall schwannoma

Schwannoma is a benign neurogenic tumor, and no cases of metastasis or implantation from this tumor have been reported. We first describe a case of port site recurrence after video-assisted thoracoscopic resection of chest wall schwannoma. She has been well with no evidence of disease for 2 years after resection of the recurrent tumor. We stress the importance of using a specimen bag and careful manipulation during video-assisted thoracic surgery, even for benign tumors.     

Axillary lymph node metastasis following resection of abdominal wall laparoscopic port site recurrence of gallbladder cancer

Abdominal wall port site recurrence of gallbladder cancer is well described in the literature in patients that have undergone laparoscopic cholecystectomy with the incidental finding of a gallbladder cancer. The etiology and consequences of this type of metastatic recurrence are unclear. This report describes two cases with the unique sequelae of the interval development of nodal metastases to the axillary lymph nodes following resection of an abdominal wall laparoscopic port site recurrence of gallbladder cancer. The first case involves a patient who developed an isolated left axillary lymph node metastasis approximately 10 months after undergoing resection of a left-sided abdominal wall port site recurrence for a T2 gallbladder cancer. The original tumor had been found at laparoscopic cholecystectomy and definitively treated surgically approximately 3 years earlier. The second case involves a patient who developed isolated nodal metastases to the right axillary lymph nodes approximately 4 months after undergoing resection of right-sided abdominal wall port site recurrence, segment 4/5 hepatic resection, and portal lymphadenectomy for a T2 gallbladder cancer. This tumor had originally been found at laparoscopic cholecystectomy approximately 1 year earlier. These unique sequelae of the interval development of nodal metastases to the axillary lymph nodes demonstrated in both cases has not been previously reported.     

Effect of neoadjuvant therapy on local recurrence after resection of pancreatic adenocarcinoma

BACKGROUND: It is unknown whether neoadjuvant chemoradiotherapy, compared with adjuvant chemoradiotherapy, decreases the rate of local recurrence after resection of pancreatic adenocarcinoma. STUDY DESIGN: This is a retrospective case review of 102 patients with pancreatic adenocarcinoma who underwent pancreatic resection between 1993 and 2005. RESULTS: Of 102 patients with pancreatic adenocarcinoma who underwent surgical resection, 19 (19%) had no additional treatment, 41 (40%) underwent adjuvant chemoradiotherapy, and 42 (41%) were treated preoperatively with neoadjuvant chemoradiotherapy. Patients selected to receive neoadjuvant therapy were more likely to have locally advanced tumors. Based on initial CT scan, the percentage of patients with unresectable or borderline resectable tumors in the neoadjuvant group was 67%, compared with 22% in the adjuvant group. Nevertheless, patients receiving neoadjuvant chemoradiotherapy were less likely to have a local recurrence develop than patients receiving adjuvant chemoradiotherapy (5% versus 34%, p = 0.02). For those patients with tumors determined to be resectable on initial CT scan, local recurrences were observed in 31% (10 of 32) of patients in the adjuvant therapy group, compared with only 7% (1 of 14) of the neoadjuvant group. Intraoperative radiation therapy, administered to 51% of patients, was not associated with a lower rate of local recurrence. CONCLUSIONS: Neoadjuvant chemoradiotherapy is associated with improved local tumor control in patients undergoing resection for pancreatic carcinoma.     

Expansion of the lung after partial resection for gangrene

On the basis of the experience with the treatment of 69 patients with lung gangrene the authors recommend to use a combination of active aspiration from the pleural cavity, occlusion of the segment bronchus and pneumoperitoneum for the efficient expansion of the lung after its resection in the early postoperative period.