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Journal of Gastrointestinal Cancer Jun 2024GISTs arising from organs outside GI tract are defined as extragastrointestinal GISTs (EGIST). The majority of EGISTs arise from small intestinal mesentry, mesocolon,... (Review)
Review
PURPOSE
GISTs arising from organs outside GI tract are defined as extragastrointestinal GISTs (EGIST). The majority of EGISTs arise from small intestinal mesentry, mesocolon, omentum, retroperitoneum, abdominal wall, liver and pancreas with pancreas comprising less than 5% of it. Due to limited data, it is unknown if the results of GIST can be generalised for EGISTs. We thereby present the largest single-centre case series of primary pancreatic GIST so far with review of existing literature.
METHODS
A total of 9 patients of primary pancreatic GIST were treated at our institute from September 2016 to February 2023. After literature search for all studies published before February 2023, 51 articles including 57 patients were identified. Their clinicopathological data and survival analysis were assessed.
RESULTS
The median age of patients treated at our centre was 53 years with a female predominance. The most common epicentre was pancreatic head with abdominal pain as the most common presenting symptom. All 57 patients documented in literature belonged to a similar age group with similar gender predilection. The factors impacting DFS were histologic type, mitotic index, NIH risk category and adjuvant therapy. The median DFS was 74 months with a 5-year DFS being 71.9%, while the 5-year OS was 90.4%.
CONCLUSION
Pancreatic GIST is a rare entity. Due to limited evidence and evolving literature, results cannot be generalised to a larger population. Larger case series with longer follow-up data are required to further understand the disease biology and long-term outcomes of pancreatic GIST.
Topics: Humans; Gastrointestinal Stromal Tumors; Middle Aged; Pancreatic Neoplasms; Female; Male; Aged; Adult
PubMed: 38324136
DOI: 10.1007/s12029-024-01024-8 -
Journal of Gastrointestinal Cancer Jun 2024The relative success of cisplatin-based chemotherapy regimens for PDAC in clinical trials warrants a review of the literature to assess the cumulative results. This... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
The relative success of cisplatin-based chemotherapy regimens for PDAC in clinical trials warrants a review of the literature to assess the cumulative results. This study aims to assess the efficacy of cisplatin-containing regimens for PDAC in terms of survival and response outcomes using a systematic review and proportional meta-analysis.
METHODS
In this study, an electronic search was conducted on PubMed, Cochrane Library, Scopus, and Google Scholar to find relevant literature. The random effects model was used to assess pooled overall response rate, stable disease rate, progressive disease rate, 1-year overall survival rate, and their 95% CIs. Publication bias was assessed using funnel plot symmetry and the one-tailed Eggers' test. In all cases, p-value < 0.05 was indicative of significant results. The review is registered with PROSPERO: CRD42023459243.
RESULTS
A total of 34 studies consisting of 1599 patients were included in this review. All the included studies were of good quality. In total, 906 patients were male, and the median age of the patients was 58-69 years. Overall, 599 patients had cancer of the pancreatic head, 139 had cancer of the pancreatic body, and 102 patients had cancer of the pancreatic tail. The pooled risk ratios (RRs) revealed an overall response rate of 19.2% (95% CI, 14.6-24.2%), a stable disease rate of 42.3% (95% CI, 36.6-48.8), a 1-year overall survival rate of 40% (95% CI, 34.3-45.8), and progressive disease rate of 24.7% (95% CI, 18.8-31.2). Commonly reported adverse events were anemia, thrombocytopenia, abdominal adverse events, neutropenia, fatigue, leukopenia, alopecia, anorexia, mucositis, stomatitis, and hepatobiliary adverse events.
CONCLUSION
Cisplatin-containing regimens have shown moderate efficacy with significant improvement in overall survival at 1 year, stable disease rate, and progressive disease rate; however, only a small percentage of patients achieved an overall response rate.
Topics: Humans; Cisplatin; Pancreatic Neoplasms; Antineoplastic Combined Chemotherapy Protocols; Carcinoma, Pancreatic Ductal; Male; Survival Rate; Female; Middle Aged; Treatment Outcome; Aged
PubMed: 38315331
DOI: 10.1007/s12029-024-01025-7 -
Critical Reviews in Oncology/hematology Mar 2024This review assesses the possibility of utilizing malignant effusions (MEs) for generating patient-derived tumor organoids (PDTOs). Obtained through minimally invasive... (Review)
Review
This review assesses the possibility of utilizing malignant effusions (MEs) for generating patient-derived tumor organoids (PDTOs). Obtained through minimally invasive procedures MEs broaden the spectrum of organoid sources beyond resection specimens and tissue biopsies. A systematic search yielded 11 articles, detailing the successful generation of 190 ME-PDTOs (122 pleural effusions, 54 malignant ascites). Success rates ranged from 33% to 100%, with an average of 84% and median of 92%. A broad and easily applicable array of techniques can be employed, encompassing diverse collection methods, variable centrifugation speeds, and the inclusion of approaches like RBC lysis buffer or centrifuged ME supernatants supplementation, enhancing the versatility and accessibility of the methodology. ME-PDTOs were found to recapitulate primary tumor characteristics and were primarily used for drug screening applications. Thus, MEs are a reliable source for developing PDTOs, emphasizing the need for further research to maximize their potential, validate usage, and refine culturing processes.
Topics: Humans; Neoplasms; Biopsy; Organoids
PubMed: 38311013
DOI: 10.1016/j.critrevonc.2024.104285 -
Asian Journal of Surgery May 2024
Meta-Analysis
Both thoracic and abdominal muscles can be used as effective indicators for sarcopenia in patients with lung cancer undergoing surgery: A systematic review and meta-analysis.
Topics: Humans; Sarcopenia; Lung Neoplasms; Abdominal Muscles
PubMed: 38302351
DOI: 10.1016/j.asjsur.2024.01.106 -
Journal of Medical Imaging and... Mar 2024Interventional radiology employs minimally invasive image-guided procedures for diagnosing and treating various conditions. Among these procedures, alcohol and thermal... (Review)
Review
BACKGROUND
Interventional radiology employs minimally invasive image-guided procedures for diagnosing and treating various conditions. Among these procedures, alcohol and thermal ablation techniques have shown high efficacy. However, these procedures present challenges such as increased procedure time, radiation dose, and risk of tissue injury. This scoping review aims to explore how augmented reality (AR) can mitigate these challenges and improve the accuracy, precision, and efficiency of image-guided tumor ablation while improving patient outcomes.
METHODS
A scoping review of the literature was performed based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guideline to identify published literature investigating AR in image-guided tumor ablations. We conducted our electronic searches using PubMed, Scopus, Web of Sciences and CINAHL from inception to April 27th, 2023. The following Boolean terms were used for the search: ("augmented reality" OR "AR" OR "navigation system" OR "head mounted device" OR "HMD") AND ("tumor ablation" OR "radiofrequency tumor ablation" OR "microwave tumor ablation" OR "cryoablation"). We considered articles eligible for our scoping review if they met the following conditions: (1) published in English only, (2) focused on image-guided tumour ablations, (3) incorporated AR techniques in their methodology, (4) employed an aspect of AR in image-guided tumour ablations, and (5) exclusively involved human subjects. Publications were excluded if there was no mention of applying AR, or if the study investigated interventions other than image-guided tumour ablations.
RESULTS
Our search results yielded 1,676 articles in our initial search of the databases. Of those, 409 studies were removed as duplicates. 1,243 studies were excluded during the title and abstract screening. 24 studies were assessed for eligibility in the full-text stage. 19 studies were excluded, resulting in a final selection of only five studies that satisfied our inclusion criteria. The studies aimed to assess AR's efficacy in tumor ablations. Two studies compared an optical-based AR system with CT guidance. Two studies used a head-mounted AR device, while one used a dual-camera setup. Various tumor types were examined, including bone, abdominal soft tissue, breast, hepatic, renal, colorectal, and lung lesions. All studies showed positive results, including reduced radiation exposure, shorter procedures, and improved navigation, and targeting assistance.
CONCLUSION
AR systems enhance image-guided tumor ablations by improving the accuracy of ablation probe placements and increasing efficiency. They offer real-time guidance, enhanced visualization, and improved navigation, resulting in optimal needle placement. AR reduces radiation exposure and shortens procedure times compared to traditional CT-guided techniques. However, limitations like small sample sizes and technical challenges require further research. Despite this, AR shows potential benefits and larger, diverse studies are needed for validation.
Topics: Humans; Augmented Reality; Neoplasms; Liver
PubMed: 38290953
DOI: 10.1016/j.jmir.2023.12.006 -
Pain Physician Jan 2024Splanchnic nerve neurolysis (SNN) is commonly used as an alternative pain control technique to celiac plexus neurolysis (CPN) in patients with distortion of anatomy, but... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Splanchnic nerve neurolysis (SNN) is commonly used as an alternative pain control technique to celiac plexus neurolysis (CPN) in patients with distortion of anatomy, but the analgesic effect and relative risks of the 2 procedures remain controversial in general condition.
OBJECTIVES
The aim of this study was to evaluate the pain condition, safety, and symptom burden of SNN compared with CPN.
STUDY DESIGN
A systematic review and meta-analysis of neurolysis therapy for intractable cancer-related abdominal pain.
METHODS
A systematic search was performed for randomized controlled trials comparing SNN and CPN using the PubMed, Medline, Cochrane Library, Web of Science, Google Scholar, and China National Knowledge Infrastructure databases. Meta-analysis was performed using Stata Version 15.0. Outcomes included pain condition, opioid consumption, adverse effects, quality of life (QOL), and survival rate. Standardized mean difference (SMD) was calculated for continuous outcomes with its corresponding 95% CI.
LIMITATIONS
Study limitations include challenges to make subgroup analysis by intervention measures and addressing inevitable heterogeneity. Larger studies are needed for survival rates and further insights.
RESULTS
Seven studies involving 359 patients were included. No significant difference was found in pain condition at 2 weeks [SMD = 0.75, 95% CI (-0.25, 1.74), P > 0.05], 2 months [SMD = 1.10, 95% CI (-0.21, 2.40), P > 0.05] and 6 months [SMD = 0.53, 95% CI (-0.02, 1.08), P > 0.05] between SNN and CPN. Opioid consumption was comparable at 2 weeks [SMD = 0.57, 95% CI (-1.21, 2.34), P > 0.05] and one month [SMD = 0.37, 95% CI (-1.33, 2.07), P > 0.05]. However, SNN was associated with a statistically significant reduction in the opioid consumption at 2 months postoperatively [SMD = 0.99, 95% CI (0.68, 1.30), P < 0.05]. A systematic review was performed for adverse effects and QOL.
CONCLUSIONS
Our evidence supports that the analgesic effect of SNN is equivalent to that of CPN, independent of changes in the anatomical structure of the abdominal nerve plexus. SNN requires less use of opioids at 2 months and does not show greater improvement in pain burden compared to CPN.
Topics: Humans; Cancer Pain; Quality of Life; Splanchnic Nerves; Analgesics, Opioid; Celiac Plexus; Abdominal Pain; Abdominal Neoplasms
PubMed: 38285023
DOI: No ID Found -
Surgical Endoscopy Mar 2024The use of direct oral anticoagulants (DOACs) as an alternative to low-molecular-weight heparin (LMWH) for extended thromboprophylaxis of abdominal/pelvic cancer-related... (Meta-Analysis)
Meta-Analysis Review
Direct oral anticoagulants (DOACs) versus low-molecular-weight heparin (LMWH) for extended thromboprophylaxis following major abdominal/pelvic cancer-related surgery: a systematic review and meta-analysis.
BACKGROUND
The use of direct oral anticoagulants (DOACs) as an alternative to low-molecular-weight heparin (LMWH) for extended thromboprophylaxis of abdominal/pelvic cancer-related postoperative thromboembolism (VTE) is unclear. We aim to investigate the efficacy and safety of DOACs vs. LMWH in these patients.
METHODS
A systematic review was conducted using EMBASE, MEDLINE, CENTRAL, and Web of science through May 19th, 2023 for all randomized controlled trials (RCTs) and observational studies that compared the outcomes with DOACs vs. LMWH for extended thromboprophylaxis among patients undergoing abdominal/pelvic cancer surgery. Primary efficacy outcome was clinical VTE, and safety outcome was clinically relevant bleeding complications reported within the 30-day postoperative period. This study was registered in PROSPERO (CRD42023413175).
RESULTS
We identified 5078 articles and selected 29 full-text articles for eligibility. A total of 9 studies (2 RCTs and 7 observational studies) encompassing 2651 patients were included for systematic review and 7 for meta-analysis. When compared with LMWH extended thromboprophylaxis, DOACs had a similar incidence of VTE (RR: 0.65 [95% CI: 0.32-1.33], I = 0%), major bleeding (RR: 1.68 [95% CI: 0.36-7.9], I = 26%), and clinically relevant non-major bleeding (RR: 0.68 [95% CI: 0.39-1.19], I = 0%). Subgroup analysis suggested no difference according to the study type (RCTs versus observational studies) regarding clinical VTE or major bleeding (P = 0.43 and P = 0.71, respectively).
CONCLUSION
Our results suggest that DOACs for extended thromboprophylaxis were an effective and safe alternative to LMWH after major abdominal/pelvic cancer-related surgery.
Topics: Humans; Heparin, Low-Molecular-Weight; Anticoagulants; Pelvic Neoplasms; Venous Thromboembolism; Hemorrhage; Neoplasms
PubMed: 38267639
DOI: 10.1007/s00464-023-10649-y -
Seminars in Oncology Nursing Feb 2024Patients with gynecologic cancers experience a very high symptom burden that has a negative impact on their quality of life. This systematic review aims to identify the... (Review)
Review
OBJECTIVE
Patients with gynecologic cancers experience a very high symptom burden that has a negative impact on their quality of life. This systematic review aims to identify the common co-occurring symptoms, the prevalence of common symptoms, common instruments used to measure symptoms, associated risk factors, and the symptom burden in patients with gynecologic cancers.
DATA SOURCES
A search of four databases (ie, PubMed, Embase, Web of Science, and CINAHL) was done from January 1, 2012, through September 5, 2022. A qualitative synthesis of the extant literature was performed using Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines (PRISMA 2020).
CONCLUSION
A total of 118 studies met the prespecified inclusion criteria. Ninety-six symptoms were assessed across these studies. The top six symptoms and their grand mean prevalence rates were lack of energy (64.4%), fatigue (62.1%), abdominal pain (53.3%), depression (52.6%), concentration dysfunction (52.0%), and drowsiness (51.9%). Numerous methodologic challenges were evident across studies. Future research needs to develop a disease-specific symptom assessment measure, evaluate for risk factors associated with a higher symptom burden, and determine the impact of multiple symptoms on patient outcomes.
IMPLICATION FOR NURSING PRACTICE
The results are relevant for oncology clinicians to assess patients with gynecologic cancers for the presence of common symptoms and risk factors for higher symptom burden in the patients and to offer effective management interventions.
Topics: Humans; Female; Quality of Life; Genital Neoplasms, Female; Medical Oncology
PubMed: 38246840
DOI: 10.1016/j.soncn.2023.151572 -
Journal of Gastrointestinal Cancer Jun 2024This systematic review and meta-analysis of randomized controlled trials (RCTs) aimed to assess the efficacy of perioperative or postoperative probiotics as a... (Meta-Analysis)
Meta-Analysis
Perioperative or Postoperative Probiotics Reduce Treatment-Related Complications in Adult Colorectal Cancer Patients Undergoing Surgery: A Systematic Review and Meta-analysis.
PURPOSE
This systematic review and meta-analysis of randomized controlled trials (RCTs) aimed to assess the efficacy of perioperative or postoperative probiotics as a therapeutic approach for managing colorectal cancer treatment-related complications in patients undergoing surgery, with or without adjuvant therapy.
METHODS
MEDLINE, Embase, and Scopus databases were searched.
RESULTS
Ten RCTs with 1276 patients were included. There was a significant decrease in the incidence of diarrhea (odds ratio (OR) 0.42; 95% CI 0.31 to 0.55; p < 0.001), surgical site infection (OR 0.44; 95% CI 0.22 to 0.89; p = 0.023), urinary infection (OR 0.43; 95% CI 0.20 to 0.91; p = 0.028), pulmonary infection (OR 0.30; 95% CI 0.15 to 0.60; p < 0.001), abdominal distention (OR 0.43; 95% CI 0.25 to 0.76; p = 0.004), length of ATB therapy (mean difference (MD) - 1.66 days; 95% CI - 2.13 to - 1.19 days; p < 0.001), and duration of postoperative pyrexia (MD - 0.80 days; 95% CI - 1.38 to - 0.22 days; p = 0.007) in the probiotic group. Nevertheless, length of hospital stay, time to first defecation, and time to first solid diet were not different between groups.
CONCLUSION
Our findings suggest that perioperative or postoperative probiotics is effective for reducing treatment-related complications in patients with colorectal cancer undergoing surgery, with a lower rate of adverse events.
Topics: Humans; Probiotics; Colorectal Neoplasms; Postoperative Complications; Perioperative Care; Randomized Controlled Trials as Topic; Adult
PubMed: 38231290
DOI: 10.1007/s12029-024-01016-8 -
Naunyn-Schmiedeberg's Archives of... Jun 2024One-third of cancer pain patients do not experience adequate pain relief using analgesic ladder by the World Health Organization. Interventional procedures, such as...
One-third of cancer pain patients do not experience adequate pain relief using analgesic ladder by the World Health Organization. Interventional procedures, such as epidural morphine, have been considered. This study aimed to review the literature comparing the effects of epidural administration of morphine with the oral route. This systematic review included randomized controlled trials (RCTs) conducted with patients with gastrointestinal neoplasm. A search was conducted on PubMed, EMBASE, Web of Science, Scopus, Cochrane Library, and CINAHL databases to identify studies published up to May 2023. The retrieved study was evaluated using the Risk of Bias 2 (RoB 2) tool and qualitatively synthesized. The certainty of evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach (Prospero: CRD42021264728). Only one RCT, a crossover trial, was included in this systematic review. The study was conducted with ten participants (one withdrawal) and reported a statistically significant difference between both subcutaneous and epidural morphine solutions and oral morphine. The adverse events were not described. The included study presents some concerns of bias and low certainty of evidence on the effectiveness and security of epidural morphine administration. The available literature does not suffice to elucidate whether morphine administration via the epidural route is more effective than other routes. Further RCTs are necessary to improve the level of evidence on the effectiveness and risk-benefit of epidural morphine in the management of cancer pain in gastrointestinal neoplasm patients.
Topics: Humans; Administration, Oral; Analgesia, Epidural; Analgesics, Opioid; Cancer Pain; Gastrointestinal Neoplasms; Morphine; Randomized Controlled Trials as Topic; Treatment Outcome
PubMed: 38180558
DOI: 10.1007/s00210-023-02925-4