AIM： To evaluate in a multicenter study whether the sonographic characterization of focal liver lesions can be improved using SonoVue-enhancement; and to compare this method with computed tomography （CT） and magnet...AIM： To evaluate in a multicenter study whether the sonographic characterization of focal liver lesions can be improved using SonoVue-enhancement; and to compare this method with computed tomography （CT） and magnetic resonance imaging （MRI）. METHODS： One hundred and thirty four patients withone focal liver lesion detected in baseline ultrasound （US） were examined with conventional US, contrastenhanced US （n = 134）, contrast-enhanced CT （n = 115） and/or dynamic contrast-enhanced MRI （n = 70）. The lesions were classified as malignant, benign or indeterminate and the type of lesion was determined. The final diagnosis based on the combined information of all imaging examinations, clinical information and histology （n = 32） was used. Comparisons were made to see whether the addition of contrast-enhanced US led to the improvement of the characterization of doubtful focal liver lesions.RESULTS： In comparison with unenhanced US, SonoVue markedly improves sensitivity and specificity for the characterization （malignant/benign） of focal liver lesions. In comparison with CT and/or dynamic MRI, SonoVue -enhanced sonography applied for characterization of focal liver lesions was 30.2% more sensitive in the recognition of malignancy and 16.1% more specific in the exclusion of malignancy and overall 22.9% more accurate. In the subgroup with confirmative histology available （n = 30）, sensitivity was 95.5% （CEUS）, 72.2% （CT） and 81.8% （MRI）, and specificity was 75.0% （CEUS）, 37.5% （CT） and 42.9% （MRI）. The sensitivity and specificity of CEUS for the identification of focal nodular hyperplasia （FNH） and hemangiomas was 100% and 87%, resulting in an accuracy of 94.5%.CONCLUSION： SonoVue-enhanced sonography emerges as the most sensitive, ost specific and thus most accurate imaging modality for the characterization of focal liver lesions.展开更多
Aim of the study is to comprehensively review the latest trends in laparoscopic complete mesocolic excision(CME) with central vascular ligation(CVL) for the multimodal management of right colon cancer. Historical and ...Aim of the study is to comprehensively review the latest trends in laparoscopic complete mesocolic excision(CME) with central vascular ligation(CVL) for the multimodal management of right colon cancer. Historical and up-to-date anatomo-embryological concepts are analyzed in detail,focusing on the latest studies of the mesenteric organ,its dissection by mesofascial and retrofascial cleavage planes,and questioning the need for a new terminology in colonic resections. The rationale behind Laparoscopic CME with CVL is thoroughly investigated and explained. Attention is paid to the current surgical techniques and the quality of the surgical specimen,yielded through mesocolic,intramesocolic and muscularis propria plane of surgery. We evaluate the impact on long term oncologic outcome in terms of local recurrence,overall and disease-free survival,according to the plane of resection achieved. Conclusions are drawn on the basis of the available evidence,which suggests a pivotal role of laparoscopic CME with CVL in the multimodal management of right sided colonic cancer: performed in the right mesocolic plane of resection,laparoscopic CME with CVL demonstrates better oncologic results when compared to standard non-mesocolic planes of surgery,with all the advantages of laparoscopic techniques,both in faster recovery and better immunological response. The importance of minimally invasive mesoresectional surgery is thus stressed and highlighted as the new frontier for a modern laparoscopic total right mesocolectomy.展开更多
AIM: To evaluate the 5-year survival after laparoscopic surgery vs open surgery for stages Ⅱ and Ⅲ rectal cancer.METHODS:This study enrolled 406 consecutive patients who underwent curative resection for stagesⅡand...AIM: To evaluate the 5-year survival after laparoscopic surgery vs open surgery for stages Ⅱ and Ⅲ rectal cancer.METHODS:This study enrolled 406 consecutive patients who underwent curative resection for stagesⅡandⅢrectal cancer between January 2000 and December 2009[laparoscopic rectal resection(LRR),n=152;open rectal resection(ORR),n=254].Clinical characteristics,operative outcomes,pathological outcomes,postoperative recovery,and 5-year survival outcomes were compared between the two groups.RESULTS:Most of the clinical characteristics were similar except age(59 years vs 55 years,P=0.033)between the LRR group and ORR group.The proportion of anterior resection was higher in the LRR group than that in the ORR group(81.6%vs 66.1%,P=0.001).The LRR group had less estimated blood loss(50m L vs 200 m L,P<0.001)and a lower rate of blood transfusion(4.6%vs 11.8%,P=0.019)compared to the ORR group.The pathological outcomes of the two groups were comparable.The LRR group was associated with faster recovery of bowel function(2.8 d vs 3.7 d,P<0.001)and shorter postoperative hospital stay(11.7 d vs 13.7 d,P<0.001).The median followup time was 63 mo in the LRR group and 65 mo in the ORR group.As for the survival outcomes,the 5-year local recurrence rate(16.0%vs 16.4%,P=0.753),5-year disease-free survival(DFS)rate(63.0%vs63.1%,P=0.589),and 5-year overall survival(OS)rate(68.1%vs 63.5%,P=0.682)were comparable between the LRR group and the ORR group.Stageby stage,there were also no statistical differences between the LRR group and the ORR group in terms of the 5-year local recurrence rate(stageⅡ:6.3%vs 8.7%,P=0.623;stageⅢ:26.4%vs 23.2%,P=0.747),5-year DFS rate(stageⅡ:77.5%vs 77.6%,P=0.462;stageⅢ:46.5%vs 50.9%,P=0.738),and5-year OS rate(stageⅡ:81.4%vs 74.3%,P=0.242;stageⅢ:53.9%vs 54.1%,P=0.459).CONCLUSION:LRR for stagesⅡandⅢrectal cancer can yield comparable long-term survival while achieving short-term benefits compared to open surgery.展开更多
Percutaneous endoscopic gastrostomy is an established method to provide nutrition to patients with restricted oral uptake of fluids and calories.Here,we review the methods,indications and complications of this procedu...Percutaneous endoscopic gastrostomy is an established method to provide nutrition to patients with restricted oral uptake of fluids and calories.Here,we review the methods,indications and complications of this procedure.While gastrostomy can be safely and easily performed during gastroscopy,the right patients and timing for this intervention are not always chosen.Especially in patients with dementia,the indication for and timing of gastrostomies are often improper.In this patient group,clear data for enteral nutrition are lacking;however,some evidence suggests that patients with advanced dementia do not benefit,whereas patients with mild to moderate dementia might benefit from early enteral nutrition.Additionally,other patient groups with temporary or permanent restriction of oral uptake might be a useful target population for early enteral nutrition to maintain mobilization and muscle strength.We plead for a coordinated study program for these patient groups to identify suitable patients and the best timing for tube implantation.展开更多
Colorectal cancer(CRC)is the third most commonly diagnosed cancer globally and the second cancer in terms of mortality.The prevalence of sarcopenia in patients with CRC ranges between 12%-60%.Sarcopenia comes from the...Colorectal cancer(CRC)is the third most commonly diagnosed cancer globally and the second cancer in terms of mortality.The prevalence of sarcopenia in patients with CRC ranges between 12%-60%.Sarcopenia comes from the Greek“sarx”for flesh,and“penia”for loss.Sarcopenia is considered a phenomenon of the aging process and precedes the onset of frailty(primary sarcopenia),but sarcopenia may also result from pathogenic mechanisms and that disorder is termed secondary sarcopenia.Sarcopenia diagnosis is confirmed by the presence of low muscle quantity or quality.Three parameters need to be measured:muscle strength,muscle quantity and physical performance.The standard method to evaluate muscle mass is by analyzing the tomographic total cross-sectional area of all muscle groups at the level of lumbar 3rd vertebra.Sarcopenia may negatively impact on the postoperative outcomes of patients with colorectal cancer undergoing surgical resection.It has been described an association between sarcopenia and numerous poor short-term CRC outcomes like increased perioperative mortality,postoperative sepsis,prolonged length of stay,increased cost of care and physical disability.Sarcopenia may also negatively impact on overall survival,disease-free survival,recurrence-free survival,and cancerspecific survival in patients with non-metastatic and metastatic colorectal cancer.Furthermore,patients with sarcopenia seem prone to toxic effects during chemotherapy,requiring dose deescalations or treatment delays,which seems to reduce treatment efficacy.A multimodal approach including nutritional support(dietary intake,high energy,high protein,and omega-3 fatty acids),exercise programs and anabolic-orexigenic agents(ghrelin,anamorelin),could contribute to muscle mass preservation.Addition of sarcopenia screening to the established clinical-pathological scores for patients undergoing oncological treatment(chemotherapy,radiotherapy or surgery)seems to be the next step for the best of care of CRC patients.展开更多
After the rapid acceptance of laparoscopy to manage multiple benign diseases arising from gastrointestinal districts,some surgeons started to treat malignancies by the same way.However,if the limits of laparoscopy for...After the rapid acceptance of laparoscopy to manage multiple benign diseases arising from gastrointestinal districts,some surgeons started to treat malignancies by the same way.However,if the limits of laparoscopy for benign diseases are mainly represented by technical issues,oncologic outcomes remain the foundation of any procedures to cure malignancies.Cancerous patients represent an important group with peculiar aspects including reduced survival expectancy,worsened quality of life due to surgery itself and adjuvant therapies,and challenging psychological impact.All these issues could,potentially,receive a better management with a laparoscopic surgical approach.In order to confirm such aspects,similarly to testing the newest weapons(surgical or pharmacologic)against cancer,long-term follow-up is always recommendable to assess the real benefits in terms of overall survival,cancer-free survival and quality of life.Furthermore,it seems of crucial importance that surgeons will be correctly trained in specific oncologic principles of surgical oncology as well as in modern miniinvasive technologies.Therefore,laparoscopic treatment of gastrointestinal malignancies requires more caution and deep analysis of published evidences,as compared to those achieved for inflammatory bowel diseases,gastroesophageal reflux disease or diverticular disease.This review tries to examine the evidence available to date for the use of laparoscopy and robotics in malignancies arising from the gastrointestinal district.展开更多
The long-term survival outcomes of radical prostatectomy(RP)in Chinese prostate cancer(PCa)patients are poorly understood.We conducted a single-center,retrospective analysis of patients undergoing RP to study the prog...The long-term survival outcomes of radical prostatectomy(RP)in Chinese prostate cancer(PCa)patients are poorly understood.We conducted a single-center,retrospective analysis of patients undergoing RP to study the prognostic value of pathological and surgical information.From April 1998 to February 2022,782 patients undergoing RP at Queen Mary Hospital of The University of Hong Kong(Hong Kong,China)were included in our study.Multivariable Cox regression analysis and Kaplan–Meier analysis with stratification were performed.The 5-year,10-year,and 15-year overall survival(OS)rates were 96.6%,86.8%,and 70.6%,respectively,while the 5-year,10-year,and 15-year PCa-specific survival(PSS)rates were 99.7%,98.6%,and 97.8%,respectively.Surgical International Society of Urological Pathology PCa grades(ISUP Grade Group)≥4 was significantly associated with poorer PSS(hazard ratio[HR]=8.52,95%confidence interval[CI]:1.42–51.25,P=0.02).Pathological T3 stage was not significantly associated with PSS or OS in our cohort.Lymph node invasion and extracapsular extension might be associated with worse PSS(HR=20.30,95%CI:1.22–336.38,P=0.04;and HR=7.29,95%CI:1.22–43.64,P=0.03,respectively).Different surgical approaches(open,laparoscopic,or robotic-assisted)had similar outcomes in terms of PSS and OS.In conclusion,we report the longest timespan follow-up of Chinese PCa patients after RP with different approaches.展开更多
Significant advances in ultrasound technology have created new opportunities for its use in oncologic imaging. The advent of new transducers with focal beam technology and higher frequency has solidified the role of i...Significant advances in ultrasound technology have created new opportunities for its use in oncologic imaging. The advent of new transducers with focal beam technology and higher frequency has solidified the role of intraoperative sonography (IOUS) as an invaluable imaging modality in oncologic surgery of the liver, kidneys and pancreas. The ability to detect and characterize small lesions and the precise intraoperative localization of such tumors is essential for adequate surgical planning in segmental or lobar hepatic resections, metastasectomy, nephron-sparing surgery, and partial pancreatectomy. Also, diagnostic characterization of small equivocal lesions deemed indeterminate by conventional preoperative imaging such as multidetector computed tomography or magnetic resonance imaging, has become an important application of IOUS. This article will review the current applications of IOUS in the liver, kidneys and pancreas.展开更多
Gastrointestinal stromal tumors (GISTs) are rare tumors of the GI tract.Surgical resection remains the mainstay of non-metastatic disease.However,the ability to provide an adequate oncologic resection using laparoscop...Gastrointestinal stromal tumors (GISTs) are rare tumors of the GI tract.Surgical resection remains the mainstay of non-metastatic disease.However,the ability to provide an adequate oncologic resection using laparoscopic surgery is still an area of debate.This is a thorough review of the current literature,looking particularly at the use of laparoscopic surgery for larger GISTs and the long-term oncologic outcomes compared to the results of open surgery.Laparoscopic resections provide an adequate oncologic result for GISTs of all sizes,including those greater than 5 cm in size.展开更多
The aim of this study was to evaluate the accuracy of multiple detector computed tomography (MDCT) in the preoperative staging of gastric cancer, prospectively comparing CT findings with pathological findings at surge...The aim of this study was to evaluate the accuracy of multiple detector computed tomography (MDCT) in the preoperative staging of gastric cancer, prospectively comparing CT findings with pathological findings at surgery, in a single-center study. A total of 19 consecutive patients with primary cancer recruited between March and July 2014 were submitted to preoperative MDCT staging according to a standard protocol. All diagnostic procedures were performed by dedicated radiologists who were unaware of the final pathological results. Subsequently, 16 patients underwent surgical treatment and 15 were finally included in the study. The primary tumor was detected at CT in all 15 cases. CT results for T staging were in agreement with pathological findings in 12 of 15 cases, with overall accuracy of 80%. Stage-specific sensibility was high for advanced stages (sensibility for T1, T3, and T4 resulted 60%, 85.7%, and 100%, respectively), while earlier stages showed higher specificity (specificity for T1, T3, and T4 resulted 100%, 75%, and 91.7%, respectively). Overall N staging accuracy was 86.7%, with 13 of 15 patients correctly staged. Stage-specific sensibility was 75% for N0 and 100% for N3, while specificity was 100% for N0 and lower for advanced stages. Accuracy for peritoneal involvement was 100%. Our findings show a good performance of the diagnostic protocol performed with MDCT tested in this study.展开更多
There is no robust evidence to define a safe proximal margin by distance for early gastric cancer (EGC). The discussion on resection margin should not only focus on the oncologic safety, but also the postgastrectomy q...There is no robust evidence to define a safe proximal margin by distance for early gastric cancer (EGC). The discussion on resection margin should not only focus on the oncologic safety, but also the postgastrectomy quality of life. The distance 1-10 mm is only acceptable for those endoscopic treatment fit EGC patients. For endoscopic unfit EGC cases, if the borderline of tumor is able to be clearly determined intraoperatively, the distance 1-3 cm is recommended for proximal resection margin. If there is any uncertainty on the tumor borderline, the distance 3-5 cm should be considered for proximal margin. (C) 2014 Baishideng Publishing Group Inc. All rights reserved.展开更多
AIM To compare radiation dose and image quality of lowdose computed tomography(CT) protocol combined with hybrid-iterative reconstruction algorithm with standarddose CT examinations for follow-up of oncologic patients...AIM To compare radiation dose and image quality of lowdose computed tomography(CT) protocol combined with hybrid-iterative reconstruction algorithm with standarddose CT examinations for follow-up of oncologic patients. METHODS Fifty-one patients with known malignant diseases which underwent, during clinical follow-up, both standarddose and low-dose whole-body CT scans were enrolled. Low-dose CT was performed on 256-row scanner, with 120 kV and automated m A modulation, and iterative reconstruction algorithm. Standard-dose CT was performed on 16-rows scanner, with 120 kV, 200-400 m As(depending on patient weight). We evaluated density values and signal-to-noise ratio, along with image noise(SD), sharpness and diagnostic quality with 4-point scale.RESULTS Density values in liver, spleen and aorta were higher in lowdose images(liver 112.55 HU vs 103.90 HU, P < 0.001), as SD values in liver and spleen(liver 16.81 vs 14.41). Volumetric-Computed-Tomographic-Dose-Index(CTDIvol) and Dose-Length-Product(DLP) were significantly lower in low-dose CT as compared to standard-dose(DLP 1025.6 m Gy*cm vs 1429.2 m Gy*cm, P < 0.001) with overall dose reduction of 28.9%. Qualitative analysis did not reveal significant differences in image noise and diagnostic quality.CONCLUSION Automatic tube-current modulation combined with hybriditerative algorithm allows radiation dose reduction of 28.9% without loss of diagnostic quality, being useful in reducing dose exposure in oncologic patients.展开更多
Cell-cell fusion is a normal biological process playing essential roles in organ formation and tissue differentiation,repair and regeneration.Through cell fusion somatic cells undergo rapid nuclear reprogramming and e...Cell-cell fusion is a normal biological process playing essential roles in organ formation and tissue differentiation,repair and regeneration.Through cell fusion somatic cells undergo rapid nuclear reprogramming and epigenetic modifications to form hybrid cells with new genetic and phenotypic properties at a rate exceeding that achievable by random mutations.Factors that stimulate cell fusion are inflammation and hypoxia.Fusion of cancer cells with non-neoplastic cells facilitates several malignancy-related cell phenotypes,e.g.,reprogramming of somatic cell into induced pluripotent stem cells and epithelial to mesenchymal transition.There is now considerable in vitro,in vivo and clinical evidence that fusion of cancer cells with motile leucocytes such as macrophages plays a major role in cancer metastasis.Of the many changes in cancer cells after hybridizing with leucocytes,it is notable that hybrids acquire resistance to chemo-and radiation therapy.One phenomenon that has been largely overlooked yet plays a role in these processes is polyploidization.Regardless of the mechanism of polyploid cell formation,it happens in response to genotoxic stresses and enhances a cancer cell’s ability to survive.Here we summarize the recent progress in research of cell fusion and with a focus on an important role for polyploid cells in cancer metastasis.In addition,we discuss the clinical evidence and the importance of cell fusion and polyploidization in solid tumors.展开更多
Objective We aimed to compare perioperative and oncologic outcomes for patients undergoing robotic-assisted radical cystectomy(RARC)with intracorporeal ileal conduit(IC)and neobladder(NB)urinary diversion.Methods Pati...Objective We aimed to compare perioperative and oncologic outcomes for patients undergoing robotic-assisted radical cystectomy(RARC)with intracorporeal ileal conduit(IC)and neobladder(NB)urinary diversion.Methods Patients undergoing RARC with intracorporeal urinary diversion between January 2017 and January 2022 at the Icahn School of Medicine at Mount Sinai,New York,NY,USA were indexed.Baseline demographics,clinical characteristics,perioperative,and oncologic outcomes were analyzed.Survival was estimated with Kaplan-Meier plots.Results Of 261 patients(206[78.9%]male),190(72.8%)received IC while 71(27.2%)received NB diversion.Median age was greater in the IC group(71[interquartile range,IQR 65-78]years vs.64[IQR 59-67]years,p<0.001)and BMI was 26.6(IQR 23.2-30.4)kg/m^(2).IC group was more likely to have prior abdominal or pelvic radiation(15.8%vs.2.8%,p=0.014).American Association of Anesthesiologists scores were comparable between groups.The IC group had a higher proportion of patients with pathological tumor stage 2(pT2)tumors(34[17.9%]vs.10[14.1%],p=0.008)and pathological node stages pN2-N3(28[14.7%]vs.3[4.2%],p<0.001).The IC group had less median operative time(272[IQR 246-306]min vs.341[IQR 303-378]min,p<0.001)and estimated blood loss(250[150-500]mL vs.325[200-575]mL,p=0.002).Thirty-and 90-day complication rates were 44.4%and 50.2%,respectively,and comparable between groups.Clavien-Dindo grades 3-5 complications occurred in 27(10.3%)and 34(13.0%)patients within 30 and 90 days,respectively,with comparable rates between groups.Median follow-up was 324(IQR 167-552)days,and comparable between groups.Kaplan-Meier estimate for overall survival at 24 months was 89%for the IC cohort and 93%for the NB cohort(hazard ratio 1.23,95%confidence interval 1.05-2.42,p=0.02).Kaplan-Meier estimate for recurrence-free survival at 24 months was 74%for IC and 87%for NB(hazard ratio 1.81,95%confidence interval 0.82-4.04,p=0.10).Conclusion Patients undergoing intracorporeal IC urinary diversion had higher postoperative cancer stage展开更多
BACKGROUND Endoprosthetic distal femoral replacement(DFR)is a well-established salvage procedure following resection of malignant tumors within the distal femur.Use of an all-polyethylene tibial(APT)component is cost-...BACKGROUND Endoprosthetic distal femoral replacement(DFR)is a well-established salvage procedure following resection of malignant tumors within the distal femur.Use of an all-polyethylene tibial(APT)component is cost-effective and avoids failure due to locking-mechanism issues and backside wear,but limits modularity and the option for late liner exchange.Due to a paucity of literature we sought to answer three questions:(1)What are the most common modes of implant failure for patients undergoing cemented DFR with APT for oncologic indications?(2)What is the survivorship,rate of all-cause reoperation,and rate of revision for aseptic loosening of these implants?And(3)Is there a difference in implant survivorship or patient demographics between cemented DFRs with APT performed as a primary reconstruction vs those performed as a revision procedure?AIM To assess outcomes of cemented DFRs with APT components used for oncologic indications.METHODS After Institutional Review Board approval,a retrospective review of consecutive patients who underwent DFR between December 2000 to September 2020 was performed using a single-institutional database.Inclusion criteria consisted of all patients who underwent DFR with a GMRS®(Global Modular Replacement System,Stryker,Kalamazoo,MI,United States)cemented distal femoral endoprosthesis and APT component for an oncologic indication.Patients undergoing DFR for non-oncologic indications and patients with metal-backed tibial components were excluded.Implant failure was recorded using Henderson's classification and survivorship was reported using a competing risks analysis.RESULTS 55 DFRs(55 patients)with an average age of 50.9±20.7 years and average body mass index of 29.7±8.3 kg/m2 were followed for 38.8±54.9 mo(range 0.2-208.4).Of these,60.0%were female and 52.7%were white.The majority of DFRs with APT in this cohort were indicated for oncologic diagnoses of osteogenic sarcoma(n=22,40.0%),giant cell tumor(n=9,16.4%),and metastatic carcinoma(n=8,14.6%).DFR with APT implantation was展开更多
Implant-based reconstruction is the most common method of breast reconstruction.Autologous breast reconstruction is an indispensable option for breast reconstruction demanding keen microsurgical skills and robust anat...Implant-based reconstruction is the most common method of breast reconstruction.Autologous breast reconstruction is an indispensable option for breast reconstruction demanding keen microsurgical skills and robust anatomical understanding.The reconstructive choice is made by the patient after a discussion with the plastic surgeon covering all the available options.Advantages and disadvantages of each technique along with long-term oncologic outcome are reviewed.展开更多
Background The specificity and precision of lymphadenopathy assessment using US, CT and MRI are generally unsatisfactory, while fluorodeoxyglucose-positron emission tomography/computed tomography （18F-FDG PET/CT） ca...Background The specificity and precision of lymphadenopathy assessment using US, CT and MRI are generally unsatisfactory, while fluorodeoxyglucose-positron emission tomography/computed tomography （18F-FDG PET/CT） can support this process by providing additional information about the lymph node features. However, which image features of 18F-FDG PET/CT play the key role in the diagnosis and cutoffs of malignant cervical lymphadenopathy still needs to be determined by further studies. Our study aimed to identify 18F-FDG PET/CT abnormalities that would assist in making a reliable diagnosis of malignant cervical lymphadenopathy in enlarged cervical lymph nodes of patients with unknown primary diseases. Methods One hundred and ninety-one consecutive patients of cervical lymphadenopathy with unknown primary causes were examined by 18F-FDG PET/CT from May 2007 to October 2011 and a definite diagnosis was established by pathologic biopsy. 18F-FDG PET/CT images were evaluated to identify the relevant abnormalities. All image features were analyzed by optimal scale regression tests to determine the important factors that were predictive for the diagnosis of malignant cervical lymphadenopathy and the cutoffs. Results The factors studied in 18F-FDG PET/CT images for predicting malignant cervical lymphadenopathy were sex, age, node location, size, shape, margins, maximum standard uptake value （SUV）, mean SUV, FDG uptake pattern and number of nodes. It was found that mean SUV, maximum SUV, FDG uptake pattern, location, size and margins were the important risk factors of cervical lymph nodes that could predict malignant cervical lymphadenopathy. Signs of mean SUV〉2.5 （or maximum SUV〉3.5）, nodular FDG uptake pattern, location of IIA, III, IV, VB, VI and VII regions, size〉1.5 cm and vague margins had their optimal diagnostic accuracy （Ac） and Youden index （YI）, further, combination of any three factors of these six important risk factors would led to the best diagnosticAc of 96% and YI of 0.93. Conclusion展开更多
文摘AIM： To evaluate in a multicenter study whether the sonographic characterization of focal liver lesions can be improved using SonoVue-enhancement; and to compare this method with computed tomography （CT） and magnetic resonance imaging （MRI）. METHODS： One hundred and thirty four patients withone focal liver lesion detected in baseline ultrasound （US） were examined with conventional US, contrastenhanced US （n = 134）, contrast-enhanced CT （n = 115） and/or dynamic contrast-enhanced MRI （n = 70）. The lesions were classified as malignant, benign or indeterminate and the type of lesion was determined. The final diagnosis based on the combined information of all imaging examinations, clinical information and histology （n = 32） was used. Comparisons were made to see whether the addition of contrast-enhanced US led to the improvement of the characterization of doubtful focal liver lesions.RESULTS： In comparison with unenhanced US, SonoVue markedly improves sensitivity and specificity for the characterization （malignant/benign） of focal liver lesions. In comparison with CT and/or dynamic MRI, SonoVue -enhanced sonography applied for characterization of focal liver lesions was 30.2% more sensitive in the recognition of malignancy and 16.1% more specific in the exclusion of malignancy and overall 22.9% more accurate. In the subgroup with confirmative histology available （n = 30）, sensitivity was 95.5% （CEUS）, 72.2% （CT） and 81.8% （MRI）, and specificity was 75.0% （CEUS）, 37.5% （CT） and 42.9% （MRI）. The sensitivity and specificity of CEUS for the identification of focal nodular hyperplasia （FNH） and hemangiomas was 100% and 87%, resulting in an accuracy of 94.5%.CONCLUSION： SonoVue-enhanced sonography emerges as the most sensitive, ost specific and thus most accurate imaging modality for the characterization of focal liver lesions.
文摘Aim of the study is to comprehensively review the latest trends in laparoscopic complete mesocolic excision(CME) with central vascular ligation(CVL) for the multimodal management of right colon cancer. Historical and up-to-date anatomo-embryological concepts are analyzed in detail,focusing on the latest studies of the mesenteric organ,its dissection by mesofascial and retrofascial cleavage planes,and questioning the need for a new terminology in colonic resections. The rationale behind Laparoscopic CME with CVL is thoroughly investigated and explained. Attention is paid to the current surgical techniques and the quality of the surgical specimen,yielded through mesocolic,intramesocolic and muscularis propria plane of surgery. We evaluate the impact on long term oncologic outcome in terms of local recurrence,overall and disease-free survival,according to the plane of resection achieved. Conclusions are drawn on the basis of the available evidence,which suggests a pivotal role of laparoscopic CME with CVL in the multimodal management of right sided colonic cancer: performed in the right mesocolic plane of resection,laparoscopic CME with CVL demonstrates better oncologic results when compared to standard non-mesocolic planes of surgery,with all the advantages of laparoscopic techniques,both in faster recovery and better immunological response. The importance of minimally invasive mesoresectional surgery is thus stressed and highlighted as the new frontier for a modern laparoscopic total right mesocolectomy.
基金Supported by National Key Clinical Specialty Construction Project of China,the National High Technology Research and Development Program of China No.2012AA021103the Research Fund of Public Welfare in Health Industry,National Health and Family Planning Commission of China,No.201502039
文摘AIM: To evaluate the 5-year survival after laparoscopic surgery vs open surgery for stages Ⅱ and Ⅲ rectal cancer.METHODS:This study enrolled 406 consecutive patients who underwent curative resection for stagesⅡandⅢrectal cancer between January 2000 and December 2009[laparoscopic rectal resection(LRR),n=152;open rectal resection(ORR),n=254].Clinical characteristics,operative outcomes,pathological outcomes,postoperative recovery,and 5-year survival outcomes were compared between the two groups.RESULTS:Most of the clinical characteristics were similar except age(59 years vs 55 years,P=0.033)between the LRR group and ORR group.The proportion of anterior resection was higher in the LRR group than that in the ORR group(81.6%vs 66.1%,P=0.001).The LRR group had less estimated blood loss(50m L vs 200 m L,P<0.001)and a lower rate of blood transfusion(4.6%vs 11.8%,P=0.019)compared to the ORR group.The pathological outcomes of the two groups were comparable.The LRR group was associated with faster recovery of bowel function(2.8 d vs 3.7 d,P<0.001)and shorter postoperative hospital stay(11.7 d vs 13.7 d,P<0.001).The median followup time was 63 mo in the LRR group and 65 mo in the ORR group.As for the survival outcomes,the 5-year local recurrence rate(16.0%vs 16.4%,P=0.753),5-year disease-free survival(DFS)rate(63.0%vs63.1%,P=0.589),and 5-year overall survival(OS)rate(68.1%vs 63.5%,P=0.682)were comparable between the LRR group and the ORR group.Stageby stage,there were also no statistical differences between the LRR group and the ORR group in terms of the 5-year local recurrence rate(stageⅡ:6.3%vs 8.7%,P=0.623;stageⅢ:26.4%vs 23.2%,P=0.747),5-year DFS rate(stageⅡ:77.5%vs 77.6%,P=0.462;stageⅢ:46.5%vs 50.9%,P=0.738),and5-year OS rate(stageⅡ:81.4%vs 74.3%,P=0.242;stageⅢ:53.9%vs 54.1%,P=0.459).CONCLUSION:LRR for stagesⅡandⅢrectal cancer can yield comparable long-term survival while achieving short-term benefits compared to open surgery.
文摘Percutaneous endoscopic gastrostomy is an established method to provide nutrition to patients with restricted oral uptake of fluids and calories.Here,we review the methods,indications and complications of this procedure.While gastrostomy can be safely and easily performed during gastroscopy,the right patients and timing for this intervention are not always chosen.Especially in patients with dementia,the indication for and timing of gastrostomies are often improper.In this patient group,clear data for enteral nutrition are lacking;however,some evidence suggests that patients with advanced dementia do not benefit,whereas patients with mild to moderate dementia might benefit from early enteral nutrition.Additionally,other patient groups with temporary or permanent restriction of oral uptake might be a useful target population for early enteral nutrition to maintain mobilization and muscle strength.We plead for a coordinated study program for these patient groups to identify suitable patients and the best timing for tube implantation.
文摘Colorectal cancer(CRC)is the third most commonly diagnosed cancer globally and the second cancer in terms of mortality.The prevalence of sarcopenia in patients with CRC ranges between 12%-60%.Sarcopenia comes from the Greek“sarx”for flesh,and“penia”for loss.Sarcopenia is considered a phenomenon of the aging process and precedes the onset of frailty(primary sarcopenia),but sarcopenia may also result from pathogenic mechanisms and that disorder is termed secondary sarcopenia.Sarcopenia diagnosis is confirmed by the presence of low muscle quantity or quality.Three parameters need to be measured:muscle strength,muscle quantity and physical performance.The standard method to evaluate muscle mass is by analyzing the tomographic total cross-sectional area of all muscle groups at the level of lumbar 3rd vertebra.Sarcopenia may negatively impact on the postoperative outcomes of patients with colorectal cancer undergoing surgical resection.It has been described an association between sarcopenia and numerous poor short-term CRC outcomes like increased perioperative mortality,postoperative sepsis,prolonged length of stay,increased cost of care and physical disability.Sarcopenia may also negatively impact on overall survival,disease-free survival,recurrence-free survival,and cancerspecific survival in patients with non-metastatic and metastatic colorectal cancer.Furthermore,patients with sarcopenia seem prone to toxic effects during chemotherapy,requiring dose deescalations or treatment delays,which seems to reduce treatment efficacy.A multimodal approach including nutritional support(dietary intake,high energy,high protein,and omega-3 fatty acids),exercise programs and anabolic-orexigenic agents(ghrelin,anamorelin),could contribute to muscle mass preservation.Addition of sarcopenia screening to the established clinical-pathological scores for patients undergoing oncological treatment(chemotherapy,radiotherapy or surgery)seems to be the next step for the best of care of CRC patients.
文摘After the rapid acceptance of laparoscopy to manage multiple benign diseases arising from gastrointestinal districts,some surgeons started to treat malignancies by the same way.However,if the limits of laparoscopy for benign diseases are mainly represented by technical issues,oncologic outcomes remain the foundation of any procedures to cure malignancies.Cancerous patients represent an important group with peculiar aspects including reduced survival expectancy,worsened quality of life due to surgery itself and adjuvant therapies,and challenging psychological impact.All these issues could,potentially,receive a better management with a laparoscopic surgical approach.In order to confirm such aspects,similarly to testing the newest weapons(surgical or pharmacologic)against cancer,long-term follow-up is always recommendable to assess the real benefits in terms of overall survival,cancer-free survival and quality of life.Furthermore,it seems of crucial importance that surgeons will be correctly trained in specific oncologic principles of surgical oncology as well as in modern miniinvasive technologies.Therefore,laparoscopic treatment of gastrointestinal malignancies requires more caution and deep analysis of published evidences,as compared to those achieved for inflammatory bowel diseases,gastroesophageal reflux disease or diverticular disease.This review tries to examine the evidence available to date for the use of laparoscopy and robotics in malignancies arising from the gastrointestinal district.
基金This work was in supported by grants from National Natural Science Foundation of China(grant No.81772741,No.81972405,and No.81972645)Shanghai Youth Talent Support Program,and the Shanghai Sailing Program(22YF1440500)。
文摘The long-term survival outcomes of radical prostatectomy(RP)in Chinese prostate cancer(PCa)patients are poorly understood.We conducted a single-center,retrospective analysis of patients undergoing RP to study the prognostic value of pathological and surgical information.From April 1998 to February 2022,782 patients undergoing RP at Queen Mary Hospital of The University of Hong Kong(Hong Kong,China)were included in our study.Multivariable Cox regression analysis and Kaplan–Meier analysis with stratification were performed.The 5-year,10-year,and 15-year overall survival(OS)rates were 96.6%,86.8%,and 70.6%,respectively,while the 5-year,10-year,and 15-year PCa-specific survival(PSS)rates were 99.7%,98.6%,and 97.8%,respectively.Surgical International Society of Urological Pathology PCa grades(ISUP Grade Group)≥4 was significantly associated with poorer PSS(hazard ratio[HR]=8.52,95%confidence interval[CI]:1.42–51.25,P=0.02).Pathological T3 stage was not significantly associated with PSS or OS in our cohort.Lymph node invasion and extracapsular extension might be associated with worse PSS(HR=20.30,95%CI:1.22–336.38,P=0.04;and HR=7.29,95%CI:1.22–43.64,P=0.03,respectively).Different surgical approaches(open,laparoscopic,or robotic-assisted)had similar outcomes in terms of PSS and OS.In conclusion,we report the longest timespan follow-up of Chinese PCa patients after RP with different approaches.
文摘Significant advances in ultrasound technology have created new opportunities for its use in oncologic imaging. The advent of new transducers with focal beam technology and higher frequency has solidified the role of intraoperative sonography (IOUS) as an invaluable imaging modality in oncologic surgery of the liver, kidneys and pancreas. The ability to detect and characterize small lesions and the precise intraoperative localization of such tumors is essential for adequate surgical planning in segmental or lobar hepatic resections, metastasectomy, nephron-sparing surgery, and partial pancreatectomy. Also, diagnostic characterization of small equivocal lesions deemed indeterminate by conventional preoperative imaging such as multidetector computed tomography or magnetic resonance imaging, has become an important application of IOUS. This article will review the current applications of IOUS in the liver, kidneys and pancreas.
文摘Gastrointestinal stromal tumors (GISTs) are rare tumors of the GI tract.Surgical resection remains the mainstay of non-metastatic disease.However,the ability to provide an adequate oncologic resection using laparoscopic surgery is still an area of debate.This is a thorough review of the current literature,looking particularly at the use of laparoscopic surgery for larger GISTs and the long-term oncologic outcomes compared to the results of open surgery.Laparoscopic resections provide an adequate oncologic result for GISTs of all sizes,including those greater than 5 cm in size.
文摘The aim of this study was to evaluate the accuracy of multiple detector computed tomography (MDCT) in the preoperative staging of gastric cancer, prospectively comparing CT findings with pathological findings at surgery, in a single-center study. A total of 19 consecutive patients with primary cancer recruited between March and July 2014 were submitted to preoperative MDCT staging according to a standard protocol. All diagnostic procedures were performed by dedicated radiologists who were unaware of the final pathological results. Subsequently, 16 patients underwent surgical treatment and 15 were finally included in the study. The primary tumor was detected at CT in all 15 cases. CT results for T staging were in agreement with pathological findings in 12 of 15 cases, with overall accuracy of 80%. Stage-specific sensibility was high for advanced stages (sensibility for T1, T3, and T4 resulted 60%, 85.7%, and 100%, respectively), while earlier stages showed higher specificity (specificity for T1, T3, and T4 resulted 100%, 75%, and 91.7%, respectively). Overall N staging accuracy was 86.7%, with 13 of 15 patients correctly staged. Stage-specific sensibility was 75% for N0 and 100% for N3, while specificity was 100% for N0 and lower for advanced stages. Accuracy for peritoneal involvement was 100%. Our findings show a good performance of the diagnostic protocol performed with MDCT tested in this study.
基金Supported by Grants from National Natural Science Foundation of China,No.81372344 and No.81301866
文摘There is no robust evidence to define a safe proximal margin by distance for early gastric cancer (EGC). The discussion on resection margin should not only focus on the oncologic safety, but also the postgastrectomy quality of life. The distance 1-10 mm is only acceptable for those endoscopic treatment fit EGC patients. For endoscopic unfit EGC cases, if the borderline of tumor is able to be clearly determined intraoperatively, the distance 1-3 cm is recommended for proximal resection margin. If there is any uncertainty on the tumor borderline, the distance 3-5 cm should be considered for proximal margin. (C) 2014 Baishideng Publishing Group Inc. All rights reserved.
文摘AIM To compare radiation dose and image quality of lowdose computed tomography(CT) protocol combined with hybrid-iterative reconstruction algorithm with standarddose CT examinations for follow-up of oncologic patients. METHODS Fifty-one patients with known malignant diseases which underwent, during clinical follow-up, both standarddose and low-dose whole-body CT scans were enrolled. Low-dose CT was performed on 256-row scanner, with 120 kV and automated m A modulation, and iterative reconstruction algorithm. Standard-dose CT was performed on 16-rows scanner, with 120 kV, 200-400 m As(depending on patient weight). We evaluated density values and signal-to-noise ratio, along with image noise(SD), sharpness and diagnostic quality with 4-point scale.RESULTS Density values in liver, spleen and aorta were higher in lowdose images(liver 112.55 HU vs 103.90 HU, P < 0.001), as SD values in liver and spleen(liver 16.81 vs 14.41). Volumetric-Computed-Tomographic-Dose-Index(CTDIvol) and Dose-Length-Product(DLP) were significantly lower in low-dose CT as compared to standard-dose(DLP 1025.6 m Gy*cm vs 1429.2 m Gy*cm, P < 0.001) with overall dose reduction of 28.9%. Qualitative analysis did not reveal significant differences in image noise and diagnostic quality.CONCLUSION Automatic tube-current modulation combined with hybriditerative algorithm allows radiation dose reduction of 28.9% without loss of diagnostic quality, being useful in reducing dose exposure in oncologic patients.
文摘Cell-cell fusion is a normal biological process playing essential roles in organ formation and tissue differentiation,repair and regeneration.Through cell fusion somatic cells undergo rapid nuclear reprogramming and epigenetic modifications to form hybrid cells with new genetic and phenotypic properties at a rate exceeding that achievable by random mutations.Factors that stimulate cell fusion are inflammation and hypoxia.Fusion of cancer cells with non-neoplastic cells facilitates several malignancy-related cell phenotypes,e.g.,reprogramming of somatic cell into induced pluripotent stem cells and epithelial to mesenchymal transition.There is now considerable in vitro,in vivo and clinical evidence that fusion of cancer cells with motile leucocytes such as macrophages plays a major role in cancer metastasis.Of the many changes in cancer cells after hybridizing with leucocytes,it is notable that hybrids acquire resistance to chemo-and radiation therapy.One phenomenon that has been largely overlooked yet plays a role in these processes is polyploidization.Regardless of the mechanism of polyploid cell formation,it happens in response to genotoxic stresses and enhances a cancer cell’s ability to survive.Here we summarize the recent progress in research of cell fusion and with a focus on an important role for polyploid cells in cancer metastasis.In addition,we discuss the clinical evidence and the importance of cell fusion and polyploidization in solid tumors.
文摘Objective We aimed to compare perioperative and oncologic outcomes for patients undergoing robotic-assisted radical cystectomy(RARC)with intracorporeal ileal conduit(IC)and neobladder(NB)urinary diversion.Methods Patients undergoing RARC with intracorporeal urinary diversion between January 2017 and January 2022 at the Icahn School of Medicine at Mount Sinai,New York,NY,USA were indexed.Baseline demographics,clinical characteristics,perioperative,and oncologic outcomes were analyzed.Survival was estimated with Kaplan-Meier plots.Results Of 261 patients(206[78.9%]male),190(72.8%)received IC while 71(27.2%)received NB diversion.Median age was greater in the IC group(71[interquartile range,IQR 65-78]years vs.64[IQR 59-67]years,p<0.001)and BMI was 26.6(IQR 23.2-30.4)kg/m^(2).IC group was more likely to have prior abdominal or pelvic radiation(15.8%vs.2.8%,p=0.014).American Association of Anesthesiologists scores were comparable between groups.The IC group had a higher proportion of patients with pathological tumor stage 2(pT2)tumors(34[17.9%]vs.10[14.1%],p=0.008)and pathological node stages pN2-N3(28[14.7%]vs.3[4.2%],p<0.001).The IC group had less median operative time(272[IQR 246-306]min vs.341[IQR 303-378]min,p<0.001)and estimated blood loss(250[150-500]mL vs.325[200-575]mL,p=0.002).Thirty-and 90-day complication rates were 44.4%and 50.2%,respectively,and comparable between groups.Clavien-Dindo grades 3-5 complications occurred in 27(10.3%)and 34(13.0%)patients within 30 and 90 days,respectively,with comparable rates between groups.Median follow-up was 324(IQR 167-552)days,and comparable between groups.Kaplan-Meier estimate for overall survival at 24 months was 89%for the IC cohort and 93%for the NB cohort(hazard ratio 1.23,95%confidence interval 1.05-2.42,p=0.02).Kaplan-Meier estimate for recurrence-free survival at 24 months was 74%for IC and 87%for NB(hazard ratio 1.81,95%confidence interval 0.82-4.04,p=0.10).Conclusion Patients undergoing intracorporeal IC urinary diversion had higher postoperative cancer stage
文摘BACKGROUND Endoprosthetic distal femoral replacement(DFR)is a well-established salvage procedure following resection of malignant tumors within the distal femur.Use of an all-polyethylene tibial(APT)component is cost-effective and avoids failure due to locking-mechanism issues and backside wear,but limits modularity and the option for late liner exchange.Due to a paucity of literature we sought to answer three questions:(1)What are the most common modes of implant failure for patients undergoing cemented DFR with APT for oncologic indications?(2)What is the survivorship,rate of all-cause reoperation,and rate of revision for aseptic loosening of these implants?And(3)Is there a difference in implant survivorship or patient demographics between cemented DFRs with APT performed as a primary reconstruction vs those performed as a revision procedure?AIM To assess outcomes of cemented DFRs with APT components used for oncologic indications.METHODS After Institutional Review Board approval,a retrospective review of consecutive patients who underwent DFR between December 2000 to September 2020 was performed using a single-institutional database.Inclusion criteria consisted of all patients who underwent DFR with a GMRS®(Global Modular Replacement System,Stryker,Kalamazoo,MI,United States)cemented distal femoral endoprosthesis and APT component for an oncologic indication.Patients undergoing DFR for non-oncologic indications and patients with metal-backed tibial components were excluded.Implant failure was recorded using Henderson's classification and survivorship was reported using a competing risks analysis.RESULTS 55 DFRs(55 patients)with an average age of 50.9±20.7 years and average body mass index of 29.7±8.3 kg/m2 were followed for 38.8±54.9 mo(range 0.2-208.4).Of these,60.0%were female and 52.7%were white.The majority of DFRs with APT in this cohort were indicated for oncologic diagnoses of osteogenic sarcoma(n=22,40.0%),giant cell tumor(n=9,16.4%),and metastatic carcinoma(n=8,14.6%).DFR with APT implantation was
文摘Implant-based reconstruction is the most common method of breast reconstruction.Autologous breast reconstruction is an indispensable option for breast reconstruction demanding keen microsurgical skills and robust anatomical understanding.The reconstructive choice is made by the patient after a discussion with the plastic surgeon covering all the available options.Advantages and disadvantages of each technique along with long-term oncologic outcome are reviewed.
文摘Background The specificity and precision of lymphadenopathy assessment using US, CT and MRI are generally unsatisfactory, while fluorodeoxyglucose-positron emission tomography/computed tomography （18F-FDG PET/CT） can support this process by providing additional information about the lymph node features. However, which image features of 18F-FDG PET/CT play the key role in the diagnosis and cutoffs of malignant cervical lymphadenopathy still needs to be determined by further studies. Our study aimed to identify 18F-FDG PET/CT abnormalities that would assist in making a reliable diagnosis of malignant cervical lymphadenopathy in enlarged cervical lymph nodes of patients with unknown primary diseases. Methods One hundred and ninety-one consecutive patients of cervical lymphadenopathy with unknown primary causes were examined by 18F-FDG PET/CT from May 2007 to October 2011 and a definite diagnosis was established by pathologic biopsy. 18F-FDG PET/CT images were evaluated to identify the relevant abnormalities. All image features were analyzed by optimal scale regression tests to determine the important factors that were predictive for the diagnosis of malignant cervical lymphadenopathy and the cutoffs. Results The factors studied in 18F-FDG PET/CT images for predicting malignant cervical lymphadenopathy were sex, age, node location, size, shape, margins, maximum standard uptake value （SUV）, mean SUV, FDG uptake pattern and number of nodes. It was found that mean SUV, maximum SUV, FDG uptake pattern, location, size and margins were the important risk factors of cervical lymph nodes that could predict malignant cervical lymphadenopathy. Signs of mean SUV〉2.5 （or maximum SUV〉3.5）, nodular FDG uptake pattern, location of IIA, III, IV, VB, VI and VII regions, size〉1.5 cm and vague margins had their optimal diagnostic accuracy （Ac） and Youden index （YI）, further, combination of any three factors of these six important risk factors would led to the best diagnosticAc of 96% and YI of 0.93. Conclusion
