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[PMID]: 29206996 [Au] Autor: Fokas E; Ströbel P; Fietkau R; Ghadimi M; Liersch T; Grabenbauer GG; Hartmann A; Kaufmann M; Sauer R; Graeven U; Hoffmanns H; Raab HR; Hothorn T; Wittekind C; Rödel C; German Rectal Cancer Study Group [Ad] Endereço: Department of Radiotherapy and Oncology, University of Frankfurt, Frankfurt, Germany. [Ti] Título: Tumor Regression Grading After Preoperative Chemoradiotherapy as a Prognostic Factor and Individual-Level Surrogate for Disease-Free Survival in Rectal Cancer. [So] Source: J Natl Cancer Inst;109(12), 2017 Dec 01. [Is] ISSN: 1460-2105 [Cp] País de publicação: United States [La] Idioma: eng [Ab] Resumo: Background: We investigated tumor regression grading (TRG) as a prognostic marker and individual-level surrogate for disease-free survival (DFS) in patients with rectal carcinoma treated within the Chirurgische Arbeitsgemeinschaft fur Onkologie/Arbeitsgemeinschaft Radiologische Onkologie/Arbeitsgemeinschaft Internistische Onkologie (CAO/ARO/AIO)-04 randomized trial. Methods: TRG was recorded prospectively using the Dworak classification in 1179 patients after preoperative fluorouracil-based chemoradiotherapy (CRT) with or without oxaliplatin. Multivariable analysis was performed using Cox regression models adjusted for treatment arm, resection status, and pathologic stage. Individual-level surrogacy of TRG for DFS was examined using the four Prentice criteria (PC1-4). All statistical tests were two-sided. Results: With a median follow-up of 50 months, the addition of oxaliplatin to fluorouracil-based CRT led to statistically significantly improved three-year DFS (75.9%, 95% CI = 72.3 to 79.5, vs 71.3%, 95% CI = 67.6 to 74.9, P = .04, PC 1) and a shift toward more advanced TRG groups ( P < .001, PC 2) compared with CRT with fluorouracil alone. The three-year DFS was 64.6% (95% CI = 57.3 to 71.9), 77.6% (95% CI = 74.5 to 80.7), and 92.3% (95% CI = 88.4 to 96.2) for TRG 0 + 1 (poor regression), TRG 2 + 3 (intermediate regression), and TRG 4 (complete regression), respectively ( P < .001, PC 3). TRG constituted an independent prognostic factor for DFS (TRG 2 + 3 vs TRG 0 + 1, HR = 0.68, 95% CI = 0.51 to 0.90, P = .007). Due to multicollinearity, TRG 4 and pathologic stage could not be tested within the same model. The treatment effect on DFS was captured by TRG, satisfying individual-level PC4. Conclusions: Higher TRG after preoperative CRT predicted a favorable long-term outcome. At the individual patient level, TRG was a surrogate marker for DFS. Further phase III trials are needed to validate TRG as a surrogate at trial level. [Mh] Termos MeSH primário: Carcinoma/secundário Carcinoma/terapia Recidiva Local de Neoplasia Neoplasias Retais/patologia Neoplasias Retais/terapia [Mh] Termos MeSH secundário: Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico Quimiorradioterapia Adjuvante Intervalo Livre de Doença Feminino Fluoruracila/administração & dosagem Seguimentos Seres Humanos Masculino Margens de Excisão Gradação de Tumores Recidiva Local de Neoplasia/patologia Neoplasia Residual Compostos Organoplatínicos/administração & dosagem Período Pré-Operatório [Pt] Tipo de publicação: CLINICAL TRIAL, PHASE III; JOURNAL ARTICLE; MULTICENTER STUDY; RANDOMIZED CONTROLLED TRIAL [Nm] Nome de substância: 0 (Organoplatinum Compounds); 04ZR38536J (oxaliplatin); U3P01618RT (Fluorouracil) [Em] Mês de entrada: 1712 [Cu] Atualização por classe: 180308 [Lr] Data última revisão: 180308 [Sb] Subgrupo de revista: IM [Da] Data de entrada para processamento: 171206 [St] Status: MEDLINE [do] DOI: 10.1093/jnci/djx095

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[PMID]: 29390405 [Au] Autor: Shin YD; Choi YJ; Kim DH; Park SS; Choi H; Kim DJ; Park S; Yun HY; Song YJ [Ad] Endereço: Department of Anesthesiology. [Ti] Título: Comparison of outcomes of surgeon-performed intraoperative ultrasonography-guided wire localization and preoperative wire localization in nonpalpable breast cancer patients undergoing breast-conserving surgery: A retrospective cohort study. [So] Source: Medicine (Baltimore);96(50):e9340, 2017 Dec. [Is] ISSN: 1536-5964 [Cp] País de publicação: United States [La] Idioma: eng [Ab] Resumo: This study aimed to determine the efficacy of intraoperative ultrasonography-guided wire localization guided breast-conserving surgery (BCS) for nonpalpable breast cancer and compare it to conventional preoperative wire localization (PWL) guided surgery.We retrospectively analyzed the medical charts of 214 consecutive nonpalpable breast cancer patients who underwent BCS using intraoperative ultrasonography-guided wire localization by a surgeon (IUWLS) and PWL, between April 2013 and March 2017. Positive surgical margins, reexcision rates, and resection volumes were investigated.Of the total cohort, 124 patients underwent BCS with IUWLS and 90 patients with PWL. The following did not differ between the IUWLS and PWL groups: positive margin status, re-excision rate, conversion rate, permanent positive margin status, reoperation rate, median optimal resection volume (ORV), median total resection volume (TRV), and median closest tumor-free margin. Rather, median (range) widest tumor-free margin was significantly smaller in the IUWLS group (9 mm [5-12]) than in the PWL group (14 mm [9-20]; P = .003]). Median (range) calculated resection ratio (CRR) was significantly lower in the IUWLS group (1.67 [0.87-9.38]) than in the PWL group (4.83 [1.63-21.04]; P = .02).In nonpalpable breast cancer patients undergoing BCS, IUWLS showed positive resection margins and reexcision rates equivalent to those of the conventional PWL method. Additionally, excision volume and widest tumor-free margin were smaller with IUWLS, confirming that healthy breast tissue is less likely to be resected with this method. Our results suggest that IUWLS offers an excellent alternative to PWL, while avoiding PWL-induced patient discomfort. [Mh] Termos MeSH primário: Neoplasias da Mama/diagnóstico por imagem Neoplasias da Mama/cirurgia Mastectomia Segmentar Ultrassonografia Mamária/métodos [Mh] Termos MeSH secundário: Adulto Idoso Idoso de 80 Anos ou mais Feminino Seres Humanos Cuidados Intraoperatórios Margens de Excisão Meia-Idade Cuidados Pré-Operatórios Reoperação Estudos Retrospectivos Resultado do Tratamento [Pt] Tipo de publicação: COMPARATIVE STUDY; JOURNAL ARTICLE [Em] Mês de entrada: 1802 [Cu] Atualização por classe: 180301 [Lr] Data última revisão: 180301 [Sb] Subgrupo de revista: AIM; IM [Da] Data de entrada para processamento: 180203 [St] Status: MEDLINE [do] DOI: 10.1097/MD.0000000000009340

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[PMID]: 29297651 [Au] Autor: Shelygin YA; Chernyshov SV; Mainovskaya OA; Zarodnyuk IV; Orlova LP; Rybakov EG [Ti] Título: Early Rectal Cancer: Can Transanal Endoscopic Microsurgery (TEM) Become the Standard Treatment? [So] Source: Vestn Ross Akad Med Nauk;71(4):3223-31, 2016. [Is] ISSN: 0869-6047 [Cp] País de publicação: Russia (Federation) [La] Idioma: eng [Ab] Resumo: Aim: Transanal endoscopic microsurgery (TEM) is a main treatment technique for rectal adenomas, but can also be used for selected malignant tumors. This study presents TEM experience. Methods: The study enrolled patients with rectal adenomas, and selected adenocarcinomas. Preoperative work-up included: digital rectal examination, rectoscopy with biopsy, colonoscopy, EUS, pelvic MRI. Results: Three hundred and thirty patients [mean age of 61,4±10 (33­88)] underwent TEM. The mean size ± SD of tumors was 3.2±1.2 cm (0.6­10.0). Mean distance from anal verge was 6.7±2.6 cm (2.0­14.0). Preoperative biopsy revealed: adenoma ­ 263/330 (79,7%), adenocarcinoma ­ 67/330 (20,3%). The median operating time was 40 (15­220) min. Tumor-free margins were obtained in all operative specimens. In 5/330 (1.5%) cases tumors were fragmented. The morbidity rate was 19/330 (5.7%). Pathological investigation revealed: adenoma in 192/330 (58.1%) cases, adenocarcinoma stage Tis, T1, T2 and T3 in 138/330 (41.9%). Median follow-up lasted for 24 (1­57) months. Five patients (2.0%) with adenoma and four patients (5.2%) with adenocarcinoma had local recurrence. Conclusion: Transanal endoscopic microsurgery for rectal adenomas and selected malignant tumors is associated with low morbidity and low recurrents rates. [Mh] Termos MeSH primário: Adenocarcinoma Adenoma Complicações Pós-Operatórias Neoplasias Retais Microcirurgia Endoscópica Transanal [Mh] Termos MeSH secundário: Adenocarcinoma/diagnóstico Adenocarcinoma/patologia Adenocarcinoma/cirurgia Adenoma/diagnóstico Adenoma/patologia Adenoma/cirurgia Adulto Idoso Idoso de 80 Anos ou mais Biópsia/estatística & dados numéricos Seres Humanos Margens de Excisão Meia-Idade Recidiva Local de Neoplasia/epidemiologia Recidiva Local de Neoplasia/patologia Estadiamento de Neoplasias Duração da Cirurgia Complicações Pós-Operatórias/diagnóstico Complicações Pós-Operatórias/epidemiologia Prognóstico Neoplasias Retais/diagnóstico Neoplasias Retais/patologia Neoplasias Retais/cirurgia Federação Russa/epidemiologia Microcirurgia Endoscópica Transanal/efeitos adversos Microcirurgia Endoscópica Transanal/métodos Resultado do Tratamento [Pt] Tipo de publicação: JOURNAL ARTICLE [Em] Mês de entrada: 1802 [Cu] Atualização por classe: 180208 [Lr] Data última revisão: 180208 [Sb] Subgrupo de revista: IM [Da] Data de entrada para processamento: 180104 [St] Status: MEDLINE [do] DOI: 10.15690/vramn719

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[PMID]: 27770376 [Au] Autor: Tsou YK; Liu CY; Fu KI; Lin CH; Lee MS; Su MY; Ohata K; Chiu CT [Ad] Endereço: Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan. [Ti] Título: Endoscopic Submucosal Dissection of Superficial Esophageal Neoplasms Is Feasible and Not Riskier for Patients with Liver Cirrhosis. [So] Source: Dig Dis Sci;61(12):3565-3571, 2016 12. [Is] ISSN: 1573-2568 [Cp] País de publicação: United States [La] Idioma: eng [Ab] Resumo: BACKGROUND: Esophageal endoscopic submucosal dissection (ESD) has rarely been reported for the treatment of cirrhotic patients. AIM: To report the results of ESD treatment of superficial esophageal neoplasms (SENs) for cirrhotic patients. METHODS: Forty patients with 50 consecutive SENs undergoing 46 sessions of ESD were retrospectively reviewed. The cirrhotic group included eight patients (11 SENs) with liver cirrhosis consisting of six patients classified as Child-Pugh class A liver cirrhosis and two patients classified as class B liver cirrhosis. Four patients (6 SENs) had coexisting esophageal varices. Parameters were compared between the cirrhotic patients and the non-cirrhotic controls (32 patients, 39 SENs). RESULTS: Platelet counts of the cirrhotic group were significantly lower, while international normalized ratio was significantly higher. When the cirrhotic group and non-cirrhotic group were compared, the mean tumor length (4 vs. 3.7 cm, p = 0.56) and median procedure time (15.1 vs. 11.5 min/cm , p = 0.30) were similar. The en bloc resection rates were 81.8 and 89.7 % (p = 0.60). Within the cirrhotic group, both lesions without en bloc resection were patients with esophageal varices. The rates of submucosal disease for the cirrhotic group and non-cirrhotic groups were 54.5 and 25.6 % (p = 0.064), respectively, while the R0 resection rates were 77.8 and 94.3 % (p = 0.16), respectively. The two lesions without R0 resection in cirrhotic group had positive vertical but not horizontal margins due to submucosal invasion. Intraprocedural bleeding occurred more frequently in cirrhotic patients than non-cirrhotic patients (18.2 vs. 0 %, p = 0.045). None of the patients suffered from esophageal perforation, postoperative bleeding, or death that was related to the ESD. CONCLUSION: Esophageal ESD seems to be safely and can be effectively performed on cirrhotic patients, particularly those without severe liver dysfunction. [Mh] Termos MeSH primário: Perda Sanguínea Cirúrgica/estatística & dados numéricos Carcinoma de Células Escamosas/cirurgia Ressecção Endoscópica de Mucosa/métodos Neoplasias Esofágicas/cirurgia Cirrose Hepática/sangue [Mh] Termos MeSH secundário: Adulto Idoso Carcinoma de Células Escamosas/complicações Carcinoma de Células Escamosas/diagnóstico por imagem Carcinoma de Células Escamosas/patologia Estudos de Casos e Controles Endossonografia Neoplasias Esofágicas/complicações Neoplasias Esofágicas/diagnóstico por imagem Neoplasias Esofágicas/patologia Perfuração Esofágica/epidemiologia Varizes Esofágicas e Gástricas/etiologia Esofagoscopia Feminino Seres Humanos Coeficiente Internacional Normatizado Cirrose Hepática/complicações Masculino Margens de Excisão Meia-Idade Invasividade Neoplásica Salas Cirúrgicas Contagem de Plaquetas Hemorragia Pós-Operatória/epidemiologia Estudos Retrospectivos Índice de Gravidade de Doença Carga Tumoral [Pt] Tipo de publicação: JOURNAL ARTICLE [Em] Mês de entrada: 1707 [Cu] Atualização por classe: 171212 [Lr] Data última revisão: 171212 [Sb] Subgrupo de revista: AIM; IM [Da] Data de entrada para processamento: 161023 [St] Status: MEDLINE

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[PMID]: 28745699 [Au] Autor: Tsarkov PV; Efetov SK; Sidorova LV; Tulina IA [Ad] Endereço: Sechenov First Moscow State Medical University, Department of colorectal and endoscopic surgery, Moscow, Russia. [Ti] Título: [Sacral resection in surgical treatment of locally advanced primary and recurrent rectal and anal cancer: short-term outcomes]. [Ti] Título: Rezektsiia kresttsa pri khirurgicheskom lechenii mestno-rasprostranennogo pervichnogo i reditsivnogo raka priamoi kishki i anal'nogo kanala: neposredstvennye rezul'taty.. [So] Source: Khirurgiia (Mosk);(7):4-13, 2017. [Is] ISSN: 0023-1207 [Cp] País de publicação: Russia (Federation) [La] Idioma: rus [Ab] Resumo: AIM: To assess safety of rectum removal with distal sacral resection. MATERIAL AND METHODS: The short-term results of surgical treatment of primary and recurrent locally advanced rectal and anal cancer with sacral fixation have been analyzed. 32 patients underwent combined operations with sacral resection at the level of S2-S5. In 12 patients only one point of tumor fixation (F1) was revealed, 10 patients had two points of fixation (F2), three patients had three fixation points (F3) and in 7 cases the tumor was fixed to four points (F4) of fixation to different pelvic structures. RESULTS AND DISCUSSION: Mean intraoperative blood loss and surgery time was 551±81 ml and 320±20 min in cases of sacral fixation only that was significantly lower compared with F2 cases - 1278±551 ml and 433±45 min, F3 cases - 2200±600 ml and 620±88 min, F4 cases - 2157±512.5 ml and 519±52,3 min, respectively (Ñ€<0.05). Complications requiring surgical intervention occurred in 9% patients (n=3). Among 23 patients with intact bladder and ureters urinary disorders occurred in 42% (n=10). Resection margin was negative along posterior surface of the specimen in all cases. CONCLUSION: Advanced surgery with distal sacral resection is advisable for radical removal of locally advanced and recurrent rectal and anal canal cancer fixed to the sacrum with negative resection margin. These operations are feasible in specialized centers and should be performed by specially trained oncological or colorectal surgeon. [Mh] Termos MeSH primário: Adenocarcinoma Neoplasias do Ânus Procedimentos Cirúrgicos do Sistema Digestório Recidiva Local de Neoplasia Complicações Pós-Operatórias Neoplasias Retais [Mh] Termos MeSH secundário: Adenocarcinoma/patologia Adenocarcinoma/cirurgia Neoplasias do Ânus/patologia Neoplasias do Ânus/cirurgia Procedimentos Cirúrgicos do Sistema Digestório/efeitos adversos Procedimentos Cirúrgicos do Sistema Digestório/métodos Estudos de Viabilidade Feminino Seres Humanos Masculino Margens de Excisão Meia-Idade Invasividade Neoplásica Recidiva Local de Neoplasia/patologia Recidiva Local de Neoplasia/cirurgia Estadiamento de Neoplasias Duração da Cirurgia Avaliação de Processos e Resultados (Cuidados de Saúde) Complicações Pós-Operatórias/diagnóstico Complicações Pós-Operatórias/epidemiologia Neoplasias Retais/patologia Neoplasias Retais/cirurgia Federação Russa Sacro/patologia Sacro/cirurgia [Pt] Tipo de publicação: JOURNAL ARTICLE [Em] Mês de entrada: 1711 [Cu] Atualização por classe: 171130 [Lr] Data última revisão: 171130 [Sb] Subgrupo de revista: IM [Da] Data de entrada para processamento: 170727 [St] Status: MEDLINE [do] DOI: 10.17116/hirurgia201774-13

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[PMID]: 29112560 [Au] Autor: Xu Z; Becerra AZ; Justiniano CF; Boodry CI; Aquina CT; Swanger AA; Temple LK; Fleming FJ [Ad] Endereço: 1 Department of Surgery, University of Rochester Medical Center, Rochester, New York 2 Division of Epidemiology, Department of Public Health Sciences, University of Rochester Medical Center, Rochester, New York. [Ti] Título: Is the Distance Worth It? Patients With Rectal Cancer Traveling to High-Volume Centers Experience Improved Outcomes. [So] Source: Dis Colon Rectum;60(12):1250-1259, 2017 Dec. [Is] ISSN: 1530-0358 [Cp] País de publicação: United States [La] Idioma: eng [Ab] Resumo: BACKGROUND: It is unclear whether traveling long distances to high-volume centers would compensate for travel burden among patients undergoing rectal cancer resection. OBJECTIVE: The purpose of this study was to determine whether operative volume outweighs the advantages of being treated locally by comparing the outcomes of patients with rectal cancer treated at local, low-volume centers versus far, high-volume centers. DESIGN: This was a population-based study. SETTINGS: The National Cancer Database was queried for patients with rectal cancer. PATIENTS: Patients with stage II or III rectal cancer who underwent surgical resection between 2006 and 2012 were included. MAIN OUTCOME MEASURES: The outcomes of interest were margins, lymph node yield, receipt of neoadjuvant chemoradiation, adjuvant chemotherapy, readmission within 30 days, 30-day and 90-day mortality, and 5-year overall survival. RESULTS: A total of 18,605 patients met inclusion criteria; 2067 patients were in the long-distance/high-volume group and 1362 in the short-distance/low-volume group. The median travel distance was 62.6 miles for the long-distance/high-volume group and 2.3 miles for the short-distance/low-volume group. Patients who were younger, white, privately insured, and stage III were more likely to have traveled to a high-volume center. When controlled for patient factors, stage, and hospital factors, patients in the short-distance/low-volume group had lower odds of a lymph node yield ≥12 (OR = 0.51) and neoadjuvant chemoradiation (OR = 0.67) and higher 30-day (OR = 3.38) and 90-day mortality (OR = 2.07) compared with those in the long-distance/high-volume group. The short-distance/low-volume group had a 34% high risk of overall mortality at 5 years compared with the long-distance/high-volume group. LIMITATIONS: We lacked data regarding patient and physician decision making and surgeon-specific factors. CONCLUSIONS: Our results indicate that when controlled for patient, tumor, and hospital factors, patients who traveled a long distance to a high-volume center had improved lymph node yield, neoadjuvant chemoradiation receipt, and 30- and 90-day mortality compared with those who traveled a short distance to a low-volume center. They also had improved 5-year survival. See Video Abstract at http://links.lww.com/DCR/A446. [Mh] Termos MeSH primário: Adenocarcinoma Mucinoso/cirurgia Adenocarcinoma/cirurgia Acesso aos Serviços de Saúde Neoplasias Retais/cirurgia Viagem [Mh] Termos MeSH secundário: Adenocarcinoma/mortalidade Adenocarcinoma Mucinoso/mortalidade Idoso Quimiorradioterapia Quimioterapia Adjuvante Feminino Hospitais com Alto Volume de Atendimentos Seres Humanos Excisão de Linfonodo Masculino Margens de Excisão Meia-Idade Estadiamento de Neoplasias Readmissão do Paciente/estatística & dados numéricos Neoplasias Retais/mortalidade Neoplasias Retais/patologia Fatores de Risco Taxa de Sobrevida Resultado do Tratamento Estados Unidos [Pt] Tipo de publicação: JOURNAL ARTICLE [Em] Mês de entrada: 1711 [Cu] Atualização por classe: 171113 [Lr] Data última revisão: 171113 [Sb] Subgrupo de revista: IM [Da] Data de entrada para processamento: 171108 [St] Status: MEDLINE [do] DOI: 10.1097/DCR.0000000000000924

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[PMID]: 29029929 [Au] Autor: Hiscox B; Hardin MR; Orengo IF; Rosen T; Mir M; Diwan AH [Ad] Endereço: Department of Dermatology, Baylor College of Medicine, Houston, Texas. [Ti] Título: Approach to moderately dysplastic nevi with positive histologic margins. [So] Source: J Am Acad Dermatol;77(5):e147, 2017 11. [Is] ISSN: 1097-6787 [Cp] País de publicação: United States [La] Idioma: eng [Mh] Termos MeSH primário: Síndrome do Nevo Displásico Melanoma [Mh] Termos MeSH secundário: Seres Humanos Margens de Excisão Neoplasias Cutâneas [Pt] Tipo de publicação: LETTER; COMMENT [Em] Mês de entrada: 1711 [Cu] Atualização por classe: 171106 [Lr] Data última revisão: 171106 [Sb] Subgrupo de revista: IM [Da] Data de entrada para processamento: 171015 [St] Status: MEDLINE

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[PMID]: 28991082 [Au] Autor: Zeng WG; Liu MJ; Zhou ZX; Wang ZJ [Ad] Endereço: 1 Department of General Surgery, Beijing Chao-yang Hospital, Capital Medical University, Beijing, China 2 Department of Ultrasound, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China 3 Department of Colorectal Surgery, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China. [Ti] Título: A Distal Resection Margin of ≤1 mm and Rectal Cancer Recurrence After Sphincter-Preserving Surgery: The Role of a Positive Distal Margin in Rectal Cancer Surgery. [So] Source: Dis Colon Rectum;60(11):1175-1183, 2017 Nov. [Is] ISSN: 1530-0358 [Cp] País de publicação: United States [La] Idioma: eng [Ab] Resumo: BACKGROUND: There is little information about the prognostic value of a microscopically positive distal margin in patients who have rectal cancer. OBJECTIVE: We aimed to investigate the influence of a distal margin of ≤1 mm on oncologic outcomes after sphincter-preserving resection for rectal cancer. DESIGN: This is a retrospective cohort study. SETTINGS: The study was conducted at 2 hospitals. PATIENTS: A total of 6574 patients underwent anterior resection for rectal cancer from January 1999 to December 2014; 97 (1.5%) patients with a distal margin of ≤1 mm were included in this study. For comparative analyses, patients were matched with 194 patients with a negative distal margin (>1 mm) according to sex, age, BMI, ASA score, neoadjuvant treatment, tumor location, and stage. MAIN OUTCOME MEASURES: The oncologic outcomes of the 2 groups were compared. RESULTS: Perineural and lymphovascular invasion rates were significantly higher in patients with a positive distal margin (54.6% vs 28.9%; 67.0% vs 42.8%; both p < 0.001) compared with to patients with negative distal margin. Comparison between microscopically positive and negative distal margin showed worse oncologic outcomes in patients with a microscopically positive distal margin, including 5-year local recurrence rate (24.1% vs 12.0%, p = 0.005); 5-year distant recurrence rate (35.5% vs 20.2%, p = 0.011); 5-year disease-free survival (45.5% vs 69.5%, p < 0.001); and 5-year OS (69.2% vs 79.7%, p = 0.004). Among the 97 patients with a microscopically positive distal margin, the 5-year disease-free survival rate was higher in patients who received adjuvant therapy (52.0% vs 30.7%, p = 0.089). LIMITATIONS: This is a retrospective study; bias may exist. CONCLUSIONS: A distal margin of 1 mm is associated with worse oncologic results. Our data indicate the importance of achieving a clear distal margin in the surgical treatment of rectal cancer. Adjuvant therapy should be used in these patients to reduce recurrence. See Video Abstract at http://links.lww.com/DCR/A408. [Mh] Termos MeSH primário: Adenocarcinoma/cirurgia Margens de Excisão Recidiva Local de Neoplasia/etiologia Neoplasias Retais/cirurgia Reto/cirurgia [Mh] Termos MeSH secundário: Adenocarcinoma/mortalidade Adenocarcinoma/patologia Adulto Idoso Idoso de 80 Anos ou mais Feminino Seguimentos Seres Humanos Masculino Meia-Idade Recidiva Local de Neoplasia/diagnóstico Recidiva Local de Neoplasia/mortalidade Recidiva Local de Neoplasia/prevenção & controle Prognóstico Neoplasias Retais/mortalidade Neoplasias Retais/patologia Reto/patologia Estudos Retrospectivos Análise de Sobrevida [Pt] Tipo de publicação: JOURNAL ARTICLE; VIDEO-AUDIO MEDIA [Em] Mês de entrada: 1710 [Cu] Atualização por classe: 171013 [Lr] Data última revisão: 171013 [Sb] Subgrupo de revista: IM [Da] Data de entrada para processamento: 171010 [St] Status: MEDLINE [do] DOI: 10.1097/DCR.0000000000000900

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[PMID]: 28973708 [Au] Autor: Mattingly AE; Ma Z; Smith PD; Kiluk JV; Khakpour N; Hoover SJ; Laronga C; Lee MC [Ad] Endereço: From Breast Oncology, Biostatistics and Bioinformatics, and Plastic Surgery, H. Lee Moffitt Center and Cancer Institute, Tampa, Florida. [Ti] Título: Early Postoperative Complications after Oncoplastic Reduction. [So] Source: South Med J;110(10):660-666, 2017 Oct. [Is] ISSN: 1541-8243 [Cp] País de publicação: United States [La] Idioma: eng [Ab] Resumo: BACKGROUND: Breast-conserving surgery with adjuvant radiation therapy (BCT) has been established as safe oncologically. Oncoplastic breast surgery uses both oncologic and plastic surgery techniques for breast conservation to improve cosmetic outcomes. We evaluated the risk factors associated with complications after oncoplastic breast reduction. METHODS: A single-institution, institutional review board-approved, retrospective review of electronic medical records of female patients with breast cancer who underwent oncoplastic breast reduction from 2008 to 2014. A review of electronic medical records collected relevant medical history, clinical and pathological information, and data on postoperative complications within 6 months stratified into major or minor complications. Categorical variables analyzed with the χ exact method; continuous variables were analyzed with the Wilcoxon rank sum test exact method. RESULTS: We identified 59 patients; 4 required re-excision for positive margins, and 1 moved on to completion mastectomy. The overall complication rate was 33.9% (n = 20): 12 major (20.3%) and 8 minor (13.6%). Of the continuous variables (age, body mass index, and tissue removed), increased age was associated with minor complications ( = 0.02). Among the categorical variables (stratified body mass index, prior breast surgery, hypertension, diabetes mellitus, hyperlipidemia, vascular disease, pulmonary disease, and stratified weight of tissue removed), none were associated with overall or major complications. Pulmonary disease was associated with minor complications ( = 0.03). Bilateral versus unilateral oncoplastic breast reduction showed no statistically significant increase in complications. CONCLUSIONS: The overall complication rate after oncoplastic breast reduction was markedly higher than that in nationally published data for breast-conserving surgery. The complication rate resembled more closely the complication rate after bilateral mastectomy with immediate reconstruction. No risk factors were associated with major or overall complications. Age and pulmonary disease were associated with minor complications. Patients should be selected and counseled appropriately when considering oncoplastic breast reduction. [Mh] Termos MeSH primário: Neoplasias da Mama/cirurgia Mamoplastia Mastectomia Segmentar Complicações Pós-Operatórias/epidemiologia [Mh] Termos MeSH secundário: Adulto Fatores Etários Idoso Neoplasias da Mama/patologia Feminino Seres Humanos Hiperlipidemias/epidemiologia Hipertensão/epidemiologia Pneumopatias/epidemiologia Margens de Excisão Mastectomia Meia-Idade Obesidade/epidemiologia Sobrepeso/epidemiologia Radioterapia Adjuvante Reoperação Estudos Retrospectivos Fatores de Risco Carga Tumoral [Pt] Tipo de publicação: JOURNAL ARTICLE [Em] Mês de entrada: 1710 [Cu] Atualização por classe: 171010 [Lr] Data última revisão: 171010 [Sb] Subgrupo de revista: AIM; IM [Da] Data de entrada para processamento: 171004 [St] Status: MEDLINE [do] DOI: 10.14423/SMJ.0000000000000706

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[PMID]: 28953554 [Au] Autor: Delpero JR; Jeune F; Bachellier P; Regenet N; Le Treut YP; Paye F; Carrere N; Sauvanet A; Adham M; Autret A; Poizat F; Turrini O; Boher JM [Ad] Endereço: *Department of Surgery, Paoli-Calmettes Institute, Marseille, France †Department of Surgery, La Pitié-Salpêtrière - Université Pierre and Marie Curie, Paris VI, France ‡Department of Surgery, Hautepierre Hospital, University of Strasbourg, Strasbourg, France §Department of Surgery, Hotel Dieu Hospital, University of Nantes, Nantes, France ¶Department of Surgery, Hospital de la Conception, University of Aix-Marseille, Marseille, France ||Department of Surgery, Saint Antoine Hospital, University of Paris VI, Paris, France **Department of Surgery, Purpan Hospital, University of Toulouse Hospital Centre, Toulouse, France ††Department of Surgery, Beaujon Hospital, University of Paris VII, Clichy, France ‡‡Groupement Hospitalier Edouard Herriot, Université Claude Bernard Lyon 1, France §§Department of Histopathology, Paoli-Calmettes Institute, Marseille, France ¶¶Department of Biostatistics, Paoli-Calmettes Institute, Aix Marseille Univeristy, INSERM, IRD, SESSTIM, Marseille, France. [Ti] Título: Prognostic Value of Resection Margin Involvement After Pancreaticoduodenectomy for Ductal Adenocarcinoma: Updates From a French Prospective Multicenter Study. [So] Source: Ann Surg;266(5):787-796, 2017 Nov. [Is] ISSN: 1528-1140 [Cp] País de publicação: United States [La] Idioma: eng [Ab] Resumo: OBJECTIVE: The aim of the study was to assess the relevance of resection margin status for survival after resection of pancreatic-head ductal adenocarcinoma. SUMMARY BACKGROUND DATA: The definition and prognostic value of incomplete microscopic resection (R1) remain controversial. METHODS: Prognostic factors were analyzed in 147 patients included in a prospective multicenter study on the impact of tumor clearance evaluated using a standardized pathology protocol. RESULTS: Thirty patients received neoadjuvant treatment (NAT = 20%); 41 had venous resection (VR = 28%), and 70% received adjuvant chemotherapy. In-hospital mortality was 3% (5/147). Follow-up was 83 months. Tumor clearance was 0, <1.0, <1.5, and <2.0 mm in 35 (25%), 92 (65%), 95 (67%), and 109 (77%) patients, respectively. R0-resection rates decreased from 75% to 35% when changing the definition of R1 status from R1-direct invasion (0 mm) to R1 <1.0 mm. On univariate analysis, clearance <1.0 or <1.5 mm, pT stage, pN stage, LNR ≥0.2, tumor grade 3, and lymphovascular invasion were significantly associated with 5-year survival. On multivariate analysis, pN was the most powerful independent predictor (P = 0.004). Clearance <1.0 or <1.5 mm had borderline significance for the entire cohort, but was relevant in certain subgroups (upfront pancreatectomy (n = 117; P = 0.049); without VR or NAT (n = 87; P = 0.003); N+ without VR or NAT (n = 50; P = 0.004). No N0-patient had R1-0 mm. Additional independent risk predictors were (1) R1 <1.0 mm for the SMA-margin in specific subgroups (upfront pancreatectomy, N0 patients without NAT, N+ patients without NAT or VR; (2) R1-0 mm posterior-margin for the NAT group (P = 0.004). CONCLUSION: Tumor clearance <1.0 or <1.5 mm was an independent determinants of postresection survival in certain subgroups. To avoid misinterpretation, future trials should specify the clearance margin in millimeter. TRIAL REGISTRATION: ClinicalTrials.gov: NCT00918853. [Mh] Termos MeSH primário: Carcinoma Ductal Pancreático/cirurgia Margens de Excisão Neoplasias Pancreáticas/cirurgia Pancreaticoduodenectomia [Mh] Termos MeSH secundário: Adulto Idoso Idoso de 80 Anos ou mais Carcinoma Ductal Pancreático/mortalidade Carcinoma Ductal Pancreático/patologia Feminino Seguimentos Seres Humanos Masculino Meia-Idade Estadiamento de Neoplasias Neoplasias Pancreáticas/mortalidade Neoplasias Pancreáticas/patologia Prognóstico Estudos Prospectivos Análise de Sobrevida Resultado do Tratamento [Pt] Tipo de publicação: CLINICAL TRIAL; JOURNAL ARTICLE; MULTICENTER STUDY [Em] Mês de entrada: 1710 [Cu] Atualização por classe: 171018 [Lr] Data última revisão: 171018 [Sb] Subgrupo de revista: AIM; IM [Da] Data de entrada para processamento: 170928 [St] Status: MEDLINE [do] DOI: 10.1097/SLA.0000000000002432

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