Recurrence following anastomotic leakage after surgery for carcinoma of the distal esophagus and gastroesophageal junction. a systematic review

BACKGROUND: Esophageal cancer is the ninth most common cancer. The only potentially curative treatment is surgical resection, which unfortunately is still associated with major complications, the most important being anastomotic leakage, currently with an overall rate of up to 26% morbidity. The aim of this systematic review was to evaluate the relationship between anastomotic leakage and recurrence of disease. MATERIALS AND METHODS: A literature search was systematically performed. Seven out of 312 articles dated between 2009 and 2018 fulfilled the selection for a total of 5,433 patients. RESULTS: The frequency of anastomotic leakage ranged from 7.2 to 11.2%. Patients affected by anastomotic leakage had a recurrence rate of 9-56%. CONCLUSION: Closer follow-up or even more aggressive oncological therapy should be considered for patients affected by anastomotic leakage after surgery for carcinoma of the distal esophagus and gastroesophageal junction

Treatment options for PNET liver metastases. a systematic review

Pancreatic neuroendocrine tumors (PNETs) are rare pancreatic neoplasms. About 40-80% of patients with PNET are metastatic at presentation, usually involving the liver (40-93%). Liver metastasis represents the most significant prognostic factor. The aim of this study is to present an up-to-date review of treatment options for patients with liver metastases from PNETs

Induction Therapy and Stem Cell Mobilization in Patients with Newly Diagnosed Multiple Myeloma

Autologous stem cell transplantation (ASCT) is considered the standard therapy for younger patients with newly diagnosed symptomatic multiple myeloma (MM). The introduction into clinical practice of novel agents, such as the proteasome inhibitor bortezomib and the immunomodulatory derivatives (IMiDs) thalidomide and lenalidomide, has significantly contributed to major advances in MM therapy and prognosis. These novel agents are incorporated into induction regimens to enhance the depth of response before ASCT and further improve post-ASCT outcomes. Between January 2000 and November 2011, 65 patients with MM were transplanted in the Department of Biomedical Science and Clinical Oncology at the University of Bari. According to Durie-Salmon, 60 patients had stage III of disease and 5 stage II. Only 7 patients were in stage B (renal failure). Induction regimens that were administered in two or more cycles were VAD (vincristine, adriamycin, and dexamethasone), Thal-Dex (thalidomide, dexamethasone), Len-Dex (lenalidomide, dexamethasone), Vel-Dex (bortezomib, dexamethasone), VTD (bortezomib, thalidomide, and dexamethasone), and PAD (bortezomib, pegylated liposomal doxorubicin, and dexamethasone). In mobilization procedure, the patients received cyclophosphamide and granulocyte colony-stimulating factor (G-CSF). The number of cells collected through two or more leukapheresess, response after induction, and toxicity were evaluated to define the more adequate up-front induction regimen in transplantation-eligible MM patients

Overall Survival Following Anastomotic Leakage After Surgery for Carcinoma of the Esophagus and Gastroesophageal Junction: A Systematic Review

The effect of anastomotic leakage, in patients who underwent surgery for carcinoma of the esophagus and gastroesophageal junction, on overall survival (OS) is a debated and controversial topic. The aim of this systematic review was to clarify the impact of anastomotic leakage on long-term survival of patients with esophageal cancer undergoing esophagectomy. A systematic literature review was carried out from 2000 to 2022. We chose articles reporting data from patients who underwent surgery for carcinoma of the esophagus and gastroesophageal junction. Data regarding 1-, 3- and 5-year OS were analyzed. Twenty studies met the inclusion criteria, yielding a total of 9,279 patients. Analyzing data from selected studies, anastomotic leakage was found to be associated with decreased OS in 5,456 cases while in the remaining 3,823 it had no impact on long term survival (p<0.05). However, this result did not emerge from the other studies considered in the systematic review. Anastomotic leakage is a severe postoperative complication, which seems to have an impact on overall survival. However, the topic remains debated and not supported by all case series included in this systematic review

Is a surgical approach justified in metachronous Krukenberg tumor from gastric cancer? A systematic review

Abstract BACKGROUND: The treatment of metachronous Krukenberg tumor (mKT) from gastric cancer remains unexplored. We performed a literature review to evaluate whether or not surgical treatment improves survival. METHODS: A systematic review according to PRISMA guidelines was performed. Studies reporting on patients who underwent surgical treatment for mKT from gastric cancer were selected. Metachronous disease was divided as follows: confined to the ovaries, confined to the pelvis, or beyond the pelvis. Outcomes evaluated included overall survival (OS), progression-free survival (PFS), resection rate (R0), and factors predicting survival. RESULTS: 13 retrospective reports fulfilled the selection criteria (512 patients). Most of the patients presented at a premenopausal age. The median presentation interval from gastrectomy ranged from 16 to 21.4 months. Median OS ranged between 9 and 36 months. 1-year OS ranged between 52.5 and 59%, and 3-years OS between 9.8 and 36.5%. Resection margin, peritoneal seeding, and chemotherapy regimen and cycles influenced survival. CONCLUSION: Surgical treatment and adjuvant chemotherapy in patients with mKT from gastric cancer seems to be associated with improved survival and is justified especially in young patients. Disease location and R0 resection should be considered when selecting patients. © 2018 S. Karger GmbH, Freiburg

ACANTHOSIS NIGRICANS: THE TELLTALE SIGN OF A GASTRIC CANCER RECURRENCE

Background: Acanthosis nigricans (AN) is a skin condition characterized by focal or diffuse hyperkeratotic, symmetrically distributed hyperpig- mented lesions of skin or mucous membranes. It has been associated with a wide spectrum of diseases such as type 2 diabetes mellitus, obesity, drugs and malignancies (Malignant Acanthosis Nigricans, MAN). MAN mostly occurs in elderly patients, without gender differences and its most com- mon cause is gastric cancer (55-61%), followed by pancreatic, gynecolog- ical and pulmonary malignancies. Coexisting neoplasm should always be suspected in elders with new onset AN. Here we present the case of a woman with severe MAN associated with gastric adenocarcinoma. Skin lesions disappeared after treatment. In our case, development of MAN represented the first sign of tumour recurrence. Materials and Methods: We report a case of malignant acanthosis nig- ricans associated with both onset and recurrence of gastric carcinoma. A 63 years old woman presented with hyperkeratotic, papillomatous plaques on neck, armpits and chest. Endoscopy revealed an extensive ulcerated gastric neoplasm. Surgical resection and adjuvant chemotherapy were followed by complete regression of the skin lesions. Unfortunately after 8 months cancer recurrence occurred and it was preceded by development of malignant acanthosis nigricans. Results: MAN is a rare paraneoplastic condition often associated with malignancies: the most common is gastric carcinoma (55-61% of all MAN cases). Prevalence of MAN is estimated to be 2/12000 cancer patients. Its pathogenesis remains unclear: TGF-alpha secretion and EGF-R hyper- expression may play a role in the development of skin lesions. Usually MAN is more severe and spreads faster than AN associated with benign pathologies. MAN regression is observed in 90-95% of patients who un- dergo treatment of the primary tumour: the skin lesions usually are resistant to conventional treatments such as corticoids or vitamin D. Although in literature there are several cases of MAN in patients with primary gastric neoplasm, to our knowledge only one paper reports the development of MAN in gastric cancer recurrence (Tab. 1). Conclusions: In conclusion, acanthosis nigricans has a wide range of underlying causes but it always has to be investigated as it may lead to the diagnosis either of a malignancy either of its recurrence. It could be therefore considered pathognomonic for tumour recurrence in elder pa- tients with positive history for abdominal neoplasms

IVC resection with prosthesis replacement for recurrent leiomyosarcoma ( with video )

Inferior vena cava (IVC) leiomyosarcoma (LY) is a rare tumor with poor prognosis and recurring in one third of patients, radical surgery represents the only chance of cure. Whether caval flow has to be reestablished with IVC reconstruction is a matter of debate as well as neoadjuvant therapy. We herein present a case of recurrent IVC LY managed with caval resection and reconstruction with polyethylene terephthalate (PET) prosthesis and left lateral liver resection for suspected metastases. Although the patient experienced a prosthesis occlusion and transient renal failure, at 24 months’ follow-up is recurrence free with a normal renal function and no sign of lower limbs edema

LIVER TRANSPLANT FOLLOWING BARIATRIC SURGERY: A MINI REVIEW

Background: As obesity prevalence has been increasing dramatically in the last decades, bariatric surgery is on the rise as an effective and feasible option to treat metabolic diseases related to overweight. One rare, but potentially fatal, complication of bariatric surgery is hepatic failure requiring rescue liver transplantation. Materials and Methods: Following the criteria of the PRISMA statement, a literature search was conducted focusing on papers concerning patients who underwent liver transplantation for hepatic failure following bariatric surgery. Due to the rarity of the described condition, both retrospective studies and case reports were included in this mini-review. Results: Literature review was performed on PubMed, Embase and Med- line, using (“liver transplantation” OR “liver graft”) AND (“bariatric sur- gery” OR “obesity surgery” OR “metabolic surgery”) as search terms. This led to the identification of 145 papers. We restricted the search to humans and english language articles resulting in 101 eligible articles to review. Title and abstract revision led to the identification of 14 papers for full text analysis. Cross-reference check provided 4 more articles to review. After final full text review, 6 papers, of which 2 were case reports and 4 case series, were included in this study. The timeframe between bariatric sur- gery and liver transplant varied between bariatric surgery techniques, ranging from 7 months to 25 years: jejunoileal bypass had a longer latency of hepatic failure, while biliopancreatic diversion, long limb gastric bypass and biliointestinal bypass showed a more rapid decay of liver function. Out of 24 patients listed for liver transplant, 3 died on waiting list and 1 was still on transplant list at the time of publication. Conclusions: Liver failure following bariatric surgery is an extremely serious condition, that can occur in both sub-acute and chronic setting. Although rare, its real incidence is not known and probably underreported in literature. Due to the worldwide spread of bariatric surgery, our goal is to highlight the importance of early recognition of liver failure in those patients