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Utility of D2-40, Cytokeratin 5/6, and High-Molecular-weight Cytokeratin (Clone 34βE12) in Distinguishing Intraductal Spread of Urothelial Carcinoma From Prostatic Stromal Invasion.

Am J Surg Pathol 2021 Sep 23. Epub 2021 Sep 23.

Departments of Pathology and Laboratory Medicine Urology Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL.

Intraductal spread of urothelial carcinoma (UC) is not an uncommon finding in bladder cancer that requires appropriate clinical management. The presence of prostatic stromal invasion in non-muscle-invasive bladder cancer upstages the disease, necessitating cisplatin-based neoadjuvant chemotherapy and subsequent cystroprostatectomy. However, the identification of prostatic stromal invasion can be challenging, especially in biopsy and transurethral resection specimens. Read More

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September 2021

Hyperprogression after Immunotherapy: Nivolumab. Analysis of Imaging Findings Associated with Hyperprogression and Tumor Growth Kinetics.

Indian J Radiol Imaging 2021 Apr 27;31(2):345-349. Epub 2021 Jul 27.

Department of Radiology, Rajiv Gandhi Cancer Institute and Research Centre, Delhi, India.

The increased use of new checkpoint inhibitors in cancer therapy has led to the discovery of new unconventional responses, like pseudoprogression and hyperprogression disease (HPD). The study documents imaging findings of HPD and analyzes the growth kinetics in advanced metastatic cancers patients treated with immunotherapy. We retrospectively reviewed patients treated with anti-PD-1 (anti-progressive disease-1) antibody therapy (nivolumab) between January 2017 and December 2017 at our institute. Read More

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Risk factors for lymphedema after breast surgery: A prospective cohort study in the era of sentinel lymph node biopsy.

Breast Dis 2021 Aug 23. Epub 2021 Aug 23.

Department of Rehabilitation, Hospital Universitari Bellvitge, Idibell, Universitat de Barcelona, Barcelona, Spain.

Introduction: The Objective was to investigate the incidence of lymphedema after breast cancer treatment and to analyze the risk factors involved in a tertiary level hospital.

Methods: Prospective longitudinal observational study over 3 years post-breast surgery. 232 patients undergoing surgery for breast cancer at our institution between September 2013 and February 2018. Read More

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Minimally invasive versus open pelvic exenterations for rectal cancer: a comparative analysis of perioperative and 3-year oncological outcomes.

BJS Open 2021 Sep;5(5)

Department of Colorectal Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, India.

Background: This study compared the surgical and oncological outcomes of open and minimally invasive pelvic exenteration.

Methods: Patients who underwent pelvic exenterations for primary locally advanced rectal cancers with invasion of the urogenital organs (central and anterior disease) between August 2013 and September 2020 were reviewed retrospectively. Patients were categorized as undergoing open or minimally invasive surgery (MIS) and these groups were compared for perioperative outcomes and 3-year survival (overall, recurrence-free and local relapse-free survival). Read More

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September 2021

Meaningful words in rectal MRI synoptic reports: How "polypoid" may be prognostic.

Clin Imaging 2021 Aug 26;80:371-376. Epub 2021 Aug 26.

Department of Radiology, Memorial Sloan Kettering Cancer Center, 530 East 74th Street, New York, NY 10065, USA.

Purpose: This study explored the clinicopathologic outcomes of rectal tumor morphological descriptors used in a synoptic rectal MRI reporting template and determined that prognostic differences were observed.

Methods: This retrospective study was conducted at a comprehensive cancer center. Fifty patients with rectal tumors for whom the synoptic descriptor "polypoid" was chosen by three experienced radiologists were compared with ninety comparator patients with "partially circumferential" and "circumferential" rectal tumors. Read More

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A Retrospective Study on the Feasibility of Completely Laparoscopic Transabdominal Approach Partial Intersphincteric Resection.

J Laparoendosc Adv Surg Tech A 2021 Sep 6. Epub 2021 Sep 6.

Department of Gastrointestinal Surgery and Affiliated Hospital of Chengde Medical University, Chengde, China.

With the development of surgical techniques, gastrointestinal surgeons seek ways to improve the quality of life (QOL) for postoperative patients, while ensuring the tumor radical effect, such as reducing trauma, alleviating pain, and preserving the anus. This article discusses the postoperative outcomes of completely laparoscopic transabdominal approach partial intersphincteric resection (CLTPISR). The clinical data of 68 patients who underwent CLTPISR at the Affiliated Hospital of Chengde Medical College between May 2017 and June 2020, including procedure-related data, general postoperative conditions, and postoperative anal function data, were retrospectively analyzed to investigate the feasibility and safety of CLTPISR. Read More

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September 2021

Risk factors and treatment of rectal stenosis after transanal endoscopic microsurgery.

Colorectal Dis 2021 Sep 7. Epub 2021 Sep 7.

Department of General Surgery, First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Key Laboratory of Metabolism and Gastrointestinal Tumor, the First Affiliated Hospital of Shandong First Medical University, Key Laboratory of Laparoscopic Technology, the First Affiliated Hospital of Shandong First Medical University, Shandong Medicine and Health Key Laboratory of General Surgery, Jinan, Shandong, China.

Aim: Rectal stenosis is a relatively rare complication after transanal endoscopic microsurgery (TEM). This study aims to identify the predictive parameters for stenosis and the application of TEM in the treatment.

Method: The clinical data of patients who underwent TEM for rectal adenoma and early cancer from 2008 to 2019 were retrospectively reviewed. Read More

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September 2021

Accuracy of magnetic resonance imaging staging of tumour and nodal stage in rectal cancer treated by primary surgery: a population-based study.

Colorectal Dis 2021 Sep 7. Epub 2021 Sep 7.

Department of Clinical Sciences in Malmö, Lund University, Malmö, Sweden.

Aim: The preoperative stage of rectal cancer is an important prognostic factor affecting treatment recommendations. Currently, magnetic resonance imaging (MRI) is used for clinical staging to identify patients who should be recommended for neoadjuvant oncological treatment. The aim of this work was to investigate the accuracy of the preoperative T- and N-stage and also involvement of the mesorectal fascia (MRF) as determined by MRI in a Swedish national cohort. Read More

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September 2021

Intra-arterial chemoembolization with chemotherapy for unresectable locally advanced rectal cancer: a case report and literature review.

Ann Palliat Med 2021 Aug;10(8):9281-9287

Department of Gastrointestinal Surgery, Yongchuan Hospital, Chongqing Medical University, Chongqing, China.

Preoperative intra-arterial chemoembolization has been successfully applied in many malignant tumors but is rarely reported in patients with locally advanced rectal cancer (LARC). Herein we report a 69-year-old female diagnosed as rectal adenocarcinoma by endoscopic biopsy and the clinical stage was cT4aN2M0, IIIB. After computed tomography (CT) and magnetic resonance imaging (MRI) examinations, the neoplasm was considered unresectable. Read More

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Comparison of endoscopic treatments for small gastric adenomas.

Surg Endosc 2021 Sep 3. Epub 2021 Sep 3.

Department of Internal Medicine, Seoul National University Bundang Hospital, 82, Gumi-ro 173Beon-gil, Bundang-gu, Seongnam, Gyeonggi-do, 13620, South Korea.

Background: Gastric adenomas can be successfully treated with endoscopic resection, including endoscopic submucosal dissection (ESD) and endoscopic mucosal resection (EMR). The aim of this study was to evaluate and compare the efficacy of ESD and EMR with circumferential precutting (EMR-P) in the treatment of small gastric adenomas.

Methods: This study included 1014 gastric adenomas ≤ 15 mm in diameter treated with ESD or EMR-P from 2012 to 2019, retrospectively. Read More

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September 2021

Surgical refinement of the purse-string suture for skin and soft tissue defects of the head and neck.

Arch Craniofac Surg 2021 Aug 20;22(4):183-192. Epub 2021 Aug 20.

Department of Plastic and Reconstructive Surgery, Daegu Fatima Hospital, Daegu, Korea.

Background: The purse-string suture (PSS) is a simple and rapid wound closure method that results in minimal scarring. It has been used to treat circular or oval skin defects caused by tumor excision or trauma. However, due to obscurity, it is not widely used, especially for the head and neck. Read More

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Impact of Surgical Approach on Surgical Resection Quality in Mid- and Low Rectal Cancer, A Bayesian Network Meta-Analysis.

Front Oncol 2021 11;11:699200. Epub 2021 Aug 11.

Department of Colorectal Surgery, Union Hospital, Fujian Medical University, Fuzhou, China.

Aim: To evaluate the evidence concerning the quality of surgical resection in laparoscopic (LapTME), robotic (RobTME) and transanal (TaTME) total mesorectal excision for mid-/low rectal cancer.

Methods: A systematic literature search of the PubMed, EMBASE and Cochrane Central Register of Controlled Trials databases was performed. A Bayesian network meta-analysis was utilized to compare surgical resection involved in these 3 surgical techniques by using ADDIS software. Read More

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Surgical Outcome of Large Solid Posterior Fossa Hemangioblastoma without Preoperative Embolization.

J Neurol Surg A Cent Eur Neurosurg 2021 Aug 25. Epub 2021 Aug 25.

Department of Neurosurgery, AIIMS, Raipur, Chhattisgarh, India.

Background:  Large solid hemangioblastoma in the posterior fossa has an abundant blood supply as an arteriovenous malformation. The presence of adjacent vital neurovascular structures makes them vulnerable and difficult to operate. Complete surgical resection is always a challenge to the neurosurgeon. Read More

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Hemodynamics and remodeling of the portal confluence in patients with malignancies of the pancreatic head: a pilot study towards planned and circumferential vein resections.

Langenbecks Arch Surg 2021 Aug 25. Epub 2021 Aug 25.

General and Pancreatic Surgery Unit, Pancreas Institute, University of Verona Hospital Trust, Piazzale L.A. Scuro n. 10, 37134, Verona, Italy.

Background: We designed a retrospective computational study to evaluate the effects of hemodynamics on portal confluence remodeling in real models of patients with malignancies of the pancreatic head.

Methods: Patient-specific models were created according to computed tomography data. Fluid dynamics was simulated by using finite-element methods. Read More

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MRI features of signet ring rectal cancer.

Abdom Radiol (NY) 2021 Aug 24. Epub 2021 Aug 24.

Tata Memorial Hospital, Homi Bhabha National Institute, Dr. Ernest Borges Road, Mumbai, Maharashtra, 400012, India.

Purpose: Signet Ring Rectal Cancer (SRRC) of rectum is rare high-grade subtype with poor prognosis and characteristic histopathology. We evaluated its imaging appearance and correlated its outcomes.

Materials And Methods: We conducted a retrospective review of the rectal MRIs of 97 patients with rectal SRRC, evaluating tumor morphology, T2 signal, length, location, pattern of tumor growth, nodal status and location, EMVI (extramural vascular invasion), site of metastases, and response to chemotherapy. Read More

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[Comparison of the mid- and long-term outcomes between natural orifice specimen extraction surgery and conventional laparoscopic surgery with abdominal auxiliary incision in the treatment of rectal cancer based on propensity score matching method].

S Xu H Zhang

Zhonghua Wei Chang Wai Ke Za Zhi 2021 Aug;24(8):698-703

Department of Colorectal Tumor Surgery, Department of General Surgery, Shengjing Hospital, China Medical University, Shenyang 110004, China.

To compare the mid- and long-term outcomes between natural orifice specimen extraction surgery (NOSES) and conventional laparoscopic surgery with abdominal auxiliary incision in the treatment of rectal cancer. A propensity score matching study was conducted. Patients with pathological diagnosis of rectal adenocarcinoma, preoperative imaging assessment of T1-3 and body mass index <28 kg/m(2) were included. Read More

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An Integrated Surgical Management for Giant Dermatofibrosarcoma Protuberans of Anterior Abdominal Wall.

Cureus 2021 Aug 9;13(8):e17038. Epub 2021 Aug 9.

Department of Pathology, LN Medical College and Research Centre, Bhopal, IND.

Giant dermatofibrosarcoma protuberans (DFSP) is a very rare dermal sarcoma whose diagnosis and management are important because of the high local recurrence but low metastatic potential. Complete surgical excision of giant DFSP in a single stage is difficult but has a high cure rate. A 47-year-old man presented with a gradually increasing large (18 x 15 x 7 cm) DFSP in the epigastrium. Read More

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Novel approaches to minimize intraoperative bleeding during endoscopic submucosal dissection of a large rectal lateral spreading tumor extended to the dentate line with internal hemorrhoids.

VideoGIE 2021 Aug 28;6(8):344-346. Epub 2021 May 28.

Division of Gastroenterology, Universidad de La Sabana, Chía, Colombia.

Video 1Endoscopic submucosal dissection (ESD) of large rectal lateral spreading tumors (LSTs) that extend to the dentate line with internal hemorrhoids is a challenging procedure because of the increased risk of bleeding from penetrating and hemorrhoidal vessels and the reduced visual field caused by the dilated venous packages and the narrow anal lumen.This video describes novel technical approaches to minimize the risk of intraoperative bleeding.The described approaches are indicated in large rectal LSTs that extend to the dentate line with large internal hemorrhoids. Read More

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Assessing the histopathology reports of colorectal carcinoma surgery: An audit of three years with emphasis on lymph node yield.

Indian J Cancer 2021 Jun 24. Epub 2021 Jun 24.

Department of Pathology, Tata Memorial Hospital, Parel, Mumbai, Maharashtra, India.

Background: A comprehensive histopathology report of colorectal carcinoma surgery is important in cancer staging and planning adjuvant treatment. Our aim was to review histopathology reports of operated specimens of colorectal carcinoma in our institution between 2013 and 2015 to assess different histological parameters, including lymph node yield, and to evaluate compliance to minimum data sets.

Methods: After approval by the institutional review board (IRB), we analyzed 1230 histopathology reports of colorectal carcinoma between 2013 and 2015. Read More

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Paraaortic dissection in "total mesopancreas excision" and "mesopancreas-first resection" pancreaticoduodenectomies for pancreatic cancer: Useless, optional, or necessary?A systematic review.

Nadia Peparini

Surg Oncol 2021 Sep 2;38:101639. Epub 2021 Aug 2.

Azienda Sanitaria Locale Roma 6, Distretto 3, via Mario Calo' 5, 00043, Ciampino (Rome), Italy. Electronic address:

The mesopancreas does not have well-defined boundaries but is continuous and connected through its components with the paraaortic area. The mesopancreatic resection margin has been indicated as the primary site for R1 resection after PD in pancreatic head cancer and total mesopancreas excision has been proposed to achieve adequate retropancreatic margin clearance and to minimize the likelihood of R1 resection. However, the anatomy of the mesopancreas requires extended dissection of the paraaortic area to maximize posterior clearance. Read More

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September 2021

Fracture Risk of Long Bone Metastases: A Review of Current and New Decision-Making Tools for Prophylactic Surgery.

Cancers (Basel) 2021 Jul 21;13(15). Epub 2021 Jul 21.

Orthopedics and Trauma Department, University Hospital Hôtel-Dieu, UHC of Nantes, 44000 Nantes, France.

Long bone pathological fractures very much reflect bone metastases morbidity in many types of cancer. Bearing in mind that they not only compromise patient function but also survival, identifying impending fractures before the actual event is one of the main concerns for tumor boards. Indeed, timely prophylactic surgery has been demonstrated to increase patient quality of life as well as survival. Read More

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Total Neoadjuvant Therapy versus Standard Neoadjuvant Chemoradiation in Patients with Locally Advanced Rectal Cancer: A Comparison of Short- and Long-term Oncologic Outcomes.

Ann Surg 2021 Aug 4. Epub 2021 Aug 4.

Division of Colon & Rectal Surgery, Department of Surgery, University of Minnesota, Minneapolis, MN Department of Surgery, Raleigh General Hospital, Beckley, WV Holden Comprehensive Cancer Center, University of Iowa Hospitals & Clinics, Iowa City, IA Department of Surgical Oncology, The University of Texas, MD Anderson Cancer Center, Houston, TX. Department of Surgery, University of Iowa Hospitals & Clinics, Iowa City, IA, USA.

Objective: To evaluate the impact of neoadjuvant multi-agent systemic chemotherapy and radiation (TNT) vs neoadjuvant single-agent chemoradiation (nCRT) and multi-agent adjuvant chemotherapy on overall survival (OS), tumor downstaging, and circumferential resection margin (CRM) status in patients with locally advanced rectal cancer.

Summary Background Data: Outside of clinical trials and small institutional reports, there is a paucity of data regarding the short and long-term oncologic impact of TNT as compared to nCRT.

Methods: Adult patients with stage II-III rectal adenocarcinoma were identified in the National Cancer Database [2006-2015]. Read More

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Anterolateral thigh versus radial forearm flap for cervical esophageal reconstruction in cancer patients: A retrospective cohort study in Colombia.

Cir Cir 2021 ;89(4):461-468

Department of Plastic and Microsurgery, Instituto Nacional De Cancerologia, Bogota. Colombia.

Objetivo: Este estudio tuvo como objetivo describir los resultados clínicos del colgajo anterolateral de muslo y radial de antebrazo, para la reconstrucción hipofaríngea y esofágica en un hospital de cuarto nivel en Bogotá, Colombia.

MÉtodos: Estudio retrospectivo inlcuyo 38 pacientes a los que se les realizó reconstrucción funcional esofágica con colgajo de antebrazo radial o anterolateral de muslo (ALT) entre febrero de 2010 y diciembre de 2017.

Resultados: Edad media fue de 51 años. Read More

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January 2021

American Society of Breast Surgeons' Practice Patterns for Patients at Risk and Affected by Breast Cancer-Related Lymphedema.

Ann Surg Oncol 2021 Oct 31;28(10):5742-5751. Epub 2021 Jul 31.

Mayo Clinic Florida, Jacksonville, FL, USA.

Background: In 2017, the American Society of Breast Surgeons (ASBrS) published expert panel recommendations for patients at risk for breast cancer-related lymphedema (BCRL) and those affected by BCRL. This study sought to determine BCRL practice patterns.

Methods: A survey was sent to 2975 ASBrS members. Read More

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October 2021

Augmented reality head-mounted display-based incision planning in cranial neurosurgery: a prospective pilot study.

Neurosurg Focus 2021 08;51(2):E3

1Department of Neurological Surgery, University of Miami Miller School of Medicine; and.

Objective: Monitor and wand-based neuronavigation stations (MWBNSs) for frameless intraoperative neuronavigation are routinely used in cranial neurosurgery. However, they are temporally and spatially cumbersome; the OR must be arranged around the MWBNS, at least one hand must be used to manipulate the MWBNS wand (interrupting a bimanual surgical technique), and the surgical workflow is interrupted as the surgeon stops to "check the navigation" on a remote monitor. Thus, there is need for continuous, real-time, hands-free, neuronavigation solutions. Read More

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Wound Healing on the Dorsal Hands: An Intrapatient Comparison of Primary Closure, Purse-String Closure, and Secondary Intention.

Cutis 2021 Jun;107(6):318-319

Drs. Miedema and Varma are from the Department of Dermatology, University of North Carolina at Chapel Hill. Dr. Miedema also is from the Department of Pathology. Dr. Hsia is from the Department of Dermatology, Medical University of South Carolina, Charleston.

Nonmelanoma skin cancers are common on the dorsal hands where reserve tissue is limited. We highlight the case of an elderly man who had 3 nonmelanoma skin cancers on the left hand that were treated on the same day and left similar wounds. The wounds were repaired by primary closure, secondary intention, and purse-string circumferential closure. Read More

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Inferior Vena Cava Syndrome as a Manifestation of Metastatic Carcinoid Tumor.

Gastrointest Tumors 2021 Jun 13;8(3):138-143. Epub 2021 Apr 13.

Department of Interventional Radiology, UF Health Jacksonville, University of Florida, Jacksonville, Florida, USA.

Small bowel-origin carcinoid tumor is indolent but may metastasize relentlessly to various sites, including the liver. Over the past 9 years, we have treated a 69-year-old woman who has undergone 5 percutaneous liver ablations, 5 hepatic intra-arterial chemoembolizations, an ovarian cryoablation, and a trans-ventral hernia mesenteric cryoablation. These interventions are all related to her inoperable carcinoid malignancy. Read More

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Type of recurrence is associated with disease-free survival after salvage surgery for locally recurrent rectal cancer.

Int J Colorectal Dis 2021 Jul 22. Epub 2021 Jul 22.

Department of Surgery, Memorial Sloan Kettering Cancer Center, New York City, NY, USA.

Purpose: To compare the characteristics and outcomes of rectal cancer patients with local recurrence at a perianastomotic site (PA), a surgical field (SF) site, or in lateral lymph nodes (LLN).

Methods: A total of 114 consecutive patients who underwent surgery for recurrent, non-metastatic rectal cancer at a single comprehensive cancer center between 1997 and 2012 were grouped on the basis of radiographic assessment of type of recurrence: PA, 76 (67%) patients; SF, 25 (22%) patients; LLN, 13 (11%) patients. Demographic, clinical, and pathological features were compared between the three groups, as were disease-free survival (DFS) and overall survival (OS). Read More

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Hospital variation in sphincter-preservation rates in rectal cancer treatment: results of a population-based study in the Netherlands.

BJS Open 2021 Jul;5(4)

Department of Surgery, Radboud University Medical Centre, Nijmegen, The Netherlands.

Background: This study aimed to examine the sphincter-preservation rate variations in rectal cancer surgery. The influence of hospital volume on sphincter-preservation rates and short-term outcomes (anastomotic leakage (AL), positive circumferential resection margin (CRM), 30- and 90-day mortality rates) were also analysed.

Methods: Non-metastasized rectal cancer patients treated between 2009 and 2016 were selected from the Netherlands Cancer Registry. Read More

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[Rectal cancer: Towards personalized medicine].

Cancer Radiother 2021 Oct 12;25(6-7):650-654. Epub 2021 Jul 12.

Service de chirurgie digestive et oncologique, hôpital Bicêtre, AP-HP, Le Kremlin Bicêtre, France; Université Paris Saclay, UMR-S 1193, 94800 Villejuif, France.

The standard of care for patients with locally advanced rectal cancer has recently changed and is now based on the concept of total neoadjuvant therapy with the association of radiotherapy and systemic chemotherapy before radical surgery. The addition of noeadjuvant systemic chemotherapy before or after radiotherapy during preoperative course significantly decreased the risk of distant metastases and prolonged disease-free survival after surgery. The risk of recurrence varies among patients and the standard management associating chemotherapy, radiotherapy and surgery may expose many patients to overtreatment and can negatively affect quality of life. Read More

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October 2021