There is no difference in outcome between laparoscopic and open surgery for rectal cancer : a systematic review and meta-analysis on short- and long-term oncologic outcomes

Background Until recently there has been little data available about long-term outcomes of laparoscopic rectal cancer surgery. But new randomized controlled trials regarding laparoscopic colorectal surgery have been published. The aim of this study was to compare the short- and long-term oncologic outcomes of laparoscopy and open surgery for rectal cancer through a systematic review of the literature and a meta-analysis of relevant RCTs. Methods A systematic review of Medline, Embase and the Cochrane library from January 1966 to October 2016 with a subsequent meta-analysis was performed. Only randomized controlled trials with data on circumferential resection margins were included. The primary outcome was the status of circumferential resection margins. Secondary outcomes included lymph node yield, distal resection margins, disease-free and overall survival rates for 3 and 5 years and local recurrence rates. Results Eleven studies were evaluated, involving a total of 2018 patients in the laparoscopic group and 1526 patients in the open group. The presence of involved circumferential margins was reported in all studies. There were no statistically significant differences in the number of positive circumferential margins between the laparoscopic group and open group, RR 1.16, 95% CI 0.89–1.50 and no significant differences in involvement of distal margins (RR 1.13 95% CI 0.35–3.66), completeness of mesorectal excision (RR 1.22, 95% CI 0.82–1.82) or number of harvested lymph nodes (mean difference = −0.01, 95% CI −0.89 to 0.87). Disease-free survival rates at 3 and 5 years were not different (p = 0.26 and p = 0.71 respectively), and neither were overall survival rates (p = 0.19 and p = 0.64 respectively), nor local recurrence rates (RR 0.88, 95% CI 0.63–1.23). Conclusions Laparoscopic surgery for rectal cancer is associated with similar short-term and long-term oncologic outcomes compared to open surgery. The oncologic quality of extracted specimens seems comparable regardless of the approach used

Dawkowanie chemioterapii u otyłych chorych. Aktualne stanowisko Komisji Inicjatyw Klinicznych Polskiego Towarzystwa Onkologii Klinicznej

Overweight and obesity represent an important epidemiological problem. Also among cancer patientsthe incidence of these metabolic conditions is continuously increasing. The dosage of chemotherapydrugs is usually calculated according to patient’s body surface area (BSA). However, many oncologistconsider to use either ideal body weight or adjusted ideal body weight or to cap the BSA at, for example2.0 m2 rather than use actual body weight to calculate BSA. It leads to inappropriate dosage of cytotoxicdrugs in obese or overweight patients whose BSA exceeds 2 m2 that may decrease the efficacy ofsystemic treatment and worsen patients’ outcomes. The following article reflects the position of PolishSociety of Clinical Oncology (PTOK) regarding the recently published guidelines of American Societyof Clinical Oncology on appropriate chemotherapy dosing for obese adult patients with cancer. PTOK recommends that full weight-based cytotoxic chemotherapy doses be used to treat obese patients withcancer, particularly when the goal of treatment is cure.Nadwaga i otyłość stają się istotnym problemem epidemiologicznym. Dotyczy to również chorych na nowotwory, wśród których coraz częściej występują osoby z nadwagą (BMI>25) lub otyłością (BMI>30) wymagające leczenia systemowego. Dawkowanie większości leków cytostatycznych dostosowywane jest do powierzchni ciała chorego. Często spotykaną praktyką jest jednak ograniczanie maksymalnej dawki chemioterapii do powierzchni 2m2. W przypadku większości otyłych chorych i licznych chorych z nadwagą, u których powierzchnia ciała przekracza 2m2 dawka chemioterapii stosowana wg ww. ograniczeń jest relatywnie mniejsza niż u chorych z prawidłową masą ciała. Może to w konsekwencji zmnieszyć skuteczność leczenia systemowego i znacząco pogorszyć rokowanie chorych. Niniejszy artykuł przedstawia stanowisko Polskiego Towarzystwa Onkologii Klinicznej oparte na aktualnych rekomendacjach ASCO dotyczących stosowania chemioterapii u otyłych chorych. Komisja Inicjatyw Klinicznych PTOK zaleca dawkowanie chemioterapii w oparciu  o rzeczywistą (wyliczoną przy użyciu wszystkich, stosowanych obecnie wzorów matematycznych) powierzchnię ciała chorego

Miejsce chemioterapii w leczeniu chorych na zaawansowanego lub nawrotowego raka ślinianki

Since malignant tumors of salivary glands are heterogeneous and rare it is hardly possible to conduct randomizedclinical trials devoted to these malignancies. Therefore clinical data available in the literature come almost solelyfrom small retrospective clinical studies or case reports. Among several malignant tumors of salivary gland theadenoid cystic carcinoma is most frequently described and discussed in the literature. There are no formal recommendationsissued by oncologic societies on the systemic treatment of patients with advanced/metastaticsalivary gland malignancies. This article is aimed to summarize available data on systemic treatment of patientswith malignant salivary gland tumors with special interest in clinical efficacy of various chemotherapy regimensin particular tumor types.Duża różnorodność typów raków ślinianek oraz mała częstotliwość ich występowania utrudnia przeprowadzeniebadań klinicznych. W piśmiennictwie znajdujemy najczęściej retrospektywne opisy przypadków, nie prospektywnebadania kliniczne. Rak gruczołowo-torbielowaty jest typem histologicznym, który z tej rzadkiej grupy nowotworówwystępuje najczęściej w badanych populacjach.Do tej pory nie ustalono optymalnego schematu chemioterapii w przypadku miejscowo zaawansowanej/przerzutowejchoroby, która mogłaby wpłynąć na zmniejszenie objawów. Podejmowano próby zastosowania mono- i polichemioterapii.Potrzebna jest weryfikacja schematów leczenia, która pozwoliłaby określić najbardziej aktywne lekizarówno w przypadku raka gruczołowo-torbielowatego, jak i pozostałych typach histologicznych raków ślinianek

Prediction of technical difficulties in laparoscopic splenectomy and analysis of risk factors for postoperative complications in 468 cases

Prediction of intraoperative difficulties may be helpful in planning surgery; however, few studies explored this issue in laparoscopic splenectomy (LS). We performed retrospective analysis of consecutive 468 patients undergoing LS from 1998 to 2017 (295 women; median age 47 years). The patients were divided into difficult LS and control groups. The inclusion criteria for difficult LS were operative time ≥mean + 2SD; intraoperative blood loss ≥500 mL, intraoperative adverse events (IAE), conversion. Primary outcomes were risk factors for difficult splenectomy and secondary outcomes for perioperative morbidity. Fifty-six patients were included in the difficult LS group (12%). Spleens ≥19 cm and higher participation of younger surgeons in consecutive years were predictive for difficult splenectomy. Age ≥53 years and diagnosis other than idiopathic thrombocytopenic purpura (ITP) were independent risk factors of spleen ≥19 cm. The perioperative morbidity was 8.33%; its OR was increased only by blood loss and IAEs. Only blood loss significantly increased serious morbidity. Male sex, spleens ≥19 cm, and IAEs were independent risk factors for intraoperative hemorrhage. Spleen length ≥19 cm was a risk factor for difficult LS and intraoperative hemorrhage. Diagnoses other than ITP in patients aged ≥53 years with ≥19 cm spleens are predictive for intraoperative difficulties and perioperative complications