A Comparison of Treatments and Outcomes for Medullary versus Nonmedullary Colon Cancer: A Single Institutional Experience Showing a Worse Prognosis for Stage 3 Disease

Background. Prior studies have shown a better prognosis with medullary colon cancer (MCC) compared to nonmedullary colon carcinomas (NMC); however, data are inconsistent and lacking the evaluation of treatments received. As we did not see similar survival outcomes, we aimed to retrospectively examine survival and receipt of treatment differences between MCC and NMC within the Geisinger Health System. Methods. The Cancer Registry was retrospectively reviewed for MCC and NMC from 2006 to 2017. Demographics and treatments were compared using T-test and chi-squared analyses, also comparing MCC to poorly differentiated (PD) or undifferentiated (UD) NMC. Overall survival was analyzed using Kaplan–Meier curves and log-rank tests. Results. 33 MCC and 1775 NMC patients were identified and 31 (93.9%) MCC and 1433 (87.0%) NMC underwent resection. MCC were older (p=0.0002), had a higher Charlson Comorbidity Index (p=0.013) and were more likely right sided (p=0.013). Seven patients (22.6%) with MCC vs. 149 (10.4%) NMC underwent resection of contiguous organs. Overall median survival was significantly worse for MCC as compared to NMC (19.6 vs. 60.5 months, p=0.0002). Only stage 3 patients had a significantly worse median survival when compared to PD/UD NMC (9.6 vs. 47.2 months, p<0.001). Contiguous organ resection and failure to receive chemotherapy were not found as contributing factors to decreased survival. Conclusion. Multiple previous studies showed a better prognosis for MCC compared to PD/UD NMC. We, however, found stage 3 patients had a worse prognosis which may be secondary to higher comorbidities, increased stage, and higher rate of UD

Is port site resection necessary in the surgical management of gallbladder cancer?

BACKGROUND: In selected patients with incidental gallbladder carcinoma (GBCA) diagnosed after laparoscopic cholecystectomy (LC), definitive resection is warranted. Port site excision has been advocated but remains controversial. METHODS: Patients with GBCA were identified through institutional/departmental databases. The subset of patients with incidental tumors identified after LC and submitted to definitive surgical therapy were selected. Those subjected to port site resection were compared with patients who underwent resection without port site removal and analyzed for differences in recurrence patterns and survival. RESULTS: From 1992 to 2009, 113 patients with incidental GBCA presented for definitive resection after LC; 69 patients had port site resection and 44 did not. In the resected port site group, depth of tumor invasion was T1b = 6, T2 = 35, T3 = 28, and 13 (19%) had port site metastases. Port site disease was seen only in patients with T2 or T3 tumors and correlated with the development of peritoneal metastases (P = 0.01). Median survival of patients with T2/T3 tumors without port site metastases was 42 months compared to 17 months in patients with port site disease (P = 0.005). When only R0 resected patients were compared and adjusted for T and N stage, port site resection was not associated with overall survival (P = 0.23) or recurrence-free survival (P = 0.69). CONCLUSIONS: In patients with incidental GBCA, port site metastases were associated with peritoneal disease and decreased survival. Port site resection was not associated with improved survival or disease recurrence and should not be considered mandatory during definitive surgical treatment

Tolerance to spherical aberration induced by rigid contact lenses

We have investigated the effects of spherical aberration (SA) on visual performance by fitting subjects with rigid lenses of varying front surface asphericity. Three pairs of lenses were worn by each subject with front surface asphericities of Q = 0 (conventional spherical surface), Q = -0.26 (similar to the average corneal asphericity) and Q = -0.51. The calculated average change in spherical aberration induced by each pair of contact lenses in photopic conditions was +0.02 D (Q = 0), -0.49 D (Q = -0.26) and -0.94 D (Q = -0.51). In mesopic conditions these same lenses induced an average change in spherical aberration of +0.01 D (Q = 0), -1.18 D (Q = -0.26) and -2.16 D (Q = -0.51). In this double-blind study, 12 adapted, low to moderate myopic rigid lens wearers wore each pair of lenses for one week and noted visual performance. With each pair of lenses we also measured the subject's visual acuity with high and low contrast logMAR charts. All measurements were conducted using the right eye at distance in photopic and mesopic conditions. When forced to select the lenses they would accept as compensation for participation in the study, most subjects (9 out of 12) chose the Q = 0 lenses, 3 subjects those the Q = -0.26 lenses and none of the subjects chose the Q = -0.51 lenses. Visual performance measures showed little difference between the Q = 0 and Q = -0.26 lenses. However, the Q = -0.51 lenses significantly reduced visual acuity in mesopic conditions with the low contrast acuity chart