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JAMA Oncology Apr 2019The watch-and-wait (WW) strategy aims to spare patients with rectal cancer unnecessary resection.
IMPORTANCE
The watch-and-wait (WW) strategy aims to spare patients with rectal cancer unnecessary resection.
OBJECTIVE
To analyze the outcomes of WW among patients with rectal cancer who had a clinical complete response to neoadjuvant therapy.
DESIGN, SETTING, AND PARTICIPANTS
This retrospective case series analysis conducted at a comprehensive cancer center in New York included patients who received a diagnosis of rectal adenocarcinoma between January 1, 2006, and January 31, 2015. The median follow-up was 43 months. Data analyses were conducted from June 1, 2016, to October 1, 2018.
EXPOSURES
Patients had a clinical complete response after completing neoadjuvant therapy and agreed to a WW strategy of active surveillance and possible salvage surgery (n = 113), or patients underwent total mesorectal excision and were found to have a pathologic complete response (pCR) at resection (n = 136).
MAIN OUTCOMES AND MEASURES
Kaplan-Meier estimates were used for analyses of local regrowth and 5-year rates of overall survival, disease-free survival, and disease-specific survival.
RESULTS
Compared with the 136 patients in the pCR group, the 113 patients in the WW group were older (median [range], 67.2 [32.1-90.9] vs 57.3 [25.0-87.9] years, P < .001) with cancers closer to the anal verge (median [range] height from anal verge, 5.5 [0.0-15.0] vs 7.0 [0.0-13.0] cm). All 22 local regrowths in the WW group were detected on routine surveillance and treated by salvage surgery (20 total mesorectal excisions plus 2 transanal excisions). Pelvic control after salvage surgery was maintained in 20 of 22 patients (91%). No pelvic recurrences occurred in the pCR group. Rectal preservation was achieved in 93 of 113 patients (82%) in the WW group (91 patients with no local regrowths plus 2 patients with local regrowths salvaged with transanal excision). At 5 years, overall survival was 73% (95% CI, 60%-89%) in the WW group and 94% (95% CI, 90%-99%) in the pCR group; disease-free survival was 75% (95% CI, 62%-90%) in the WW group and 92% (95% CI, 87%-98%) in the pCR group; and disease-specific survival was 90% (95% CI, 81%-99%) in the WW group and 98% (95% CI, 95%-100%) in the pCR group. A higher rate of distant metastasis was observed among patients in the WW group who had local regrowth vs those who did not have local regrowth (36% vs 1%, P < .001).
CONCLUSIONS AND RELEVANCE
A WW strategy for select rectal cancer patients who had a clinical complete response after neoadjuvant therapy resulted in excellent rectal preservation and pelvic tumor control; however, in the WW group, worse survival was noted along with a higher incidence of distant progression in patients with local regrowth vs those without local regrowth.
Topics: Adult; Aged; Aged, 80 and over; Female; Humans; Male; Middle Aged; Neoadjuvant Therapy; Neoplasm Recurrence, Local; Rectal Neoplasms; Remission Induction; Retrospective Studies; Treatment Outcome; Watchful Waiting
PubMed: 30629084
DOI: 10.1001/jamaoncol.2018.5896 -
National Journal of Maxillofacial... 2017Schwannoma is a benign tumor of the nerve sheath arising from the perineural schwann cells. The nerves most commonly involved in schwannomas of the head and neck are the...
Schwannoma is a benign tumor of the nerve sheath arising from the perineural schwann cells. The nerves most commonly involved in schwannomas of the head and neck are the vagus and the cervical sympathetic chain. Trigeminal schwannomas are rare tumours. A 17 year old male patient with a chief complaint of swelling on face was diagnosed as suffering from bening tumor extending from cranial base (from foramen ovale) to the parapharengeal space. Mandibular access osteotomy was done to expose the tumor. Surgical excision of the tumor was done along with the preservation of the nerve. Schwannomas can occur along the pathway of any somatic or sympathetic nerve. Superficial schwannomas require simple exposure and excision but the one which are deep and large, may require complex access osteotomies. Careful surgery is required to preserve the nerve function. Once completely excised, the prognosis is excellent.
PubMed: 29386819
DOI: 10.4103/njms.NJMS_82_14 -
BMC Research Notes Jun 2016Schwannoma is a benign tumor arising from Schwann cells of the peripheral nerve sheath. Perineal schwannomas are exceptional, and rarely reported in the literature. We...
BACKGROUND
Schwannoma is a benign tumor arising from Schwann cells of the peripheral nerve sheath. Perineal schwannomas are exceptional, and rarely reported in the literature. We report a case of a perineal schwannoma, close to the anal sphincter, and provide a short summary of clinical, radiological and surgical features of this rare entity.
CASE PRESENTATION
A 62 year-old male patient was admitted for a suspected perineal mass. At clinical examination, he had a soft mass, located on the right of the anus. Computed tomography showed a perineal mass, located on the right side of the anal sphincter that enhanced after injection of the contrast medium. Complete surgical excision of the tumor was performed. The most challenging part during the surgery was the dissection and preservation of the anal sphincter to avoid anal incontinence. Pathologic examination revealed a completely excised schwannoma.
CONCLUSIONS
Perineal schwannomas are very rare tumors that are usually asymptomatic, and which present as large masses. Complete excision is necessary to avoid recurrences. Surgical resection may be difficult depending of proximity to the anal sphincter. A cautious dissection in such cases is required in order to reduce the risk of incontinence.
Topics: Anal Canal; Humans; Immunohistochemistry; Male; Middle Aged; Neurilemmoma; Perineum; S100 Proteins; Tomography, X-Ray Computed; Treatment Outcome
PubMed: 27297080
DOI: 10.1186/s13104-016-2108-1 -
World Journal of Gastroenterology Oct 2014Complete mesocolic excision is a relatively new concept in western literature. It follows the same concept of total mesorectal excision and units' routinely performing... (Review)
Review
Complete mesocolic excision is a relatively new concept in western literature. It follows the same concept of total mesorectal excision and units' routinely performing complete mesocolic excisions have good pathological results as well as good improvements in overall survival, disease free survival and local recurrence. And yet unlike total mesorectal excision, uptake in the West has been relatively slow with many units sceptical of the true benefits gained by taking up a more technically challenging and potentially more morbid procedure when there is a paucity of literature to support these claims. This article reviews complete mesocolic excision for colon cancer, attempting to identify the risks and benefits of the technique and particularly looking at the reasons why its uptake has not been universal. It also discusses the similarities of a complete mesocolic excision to a colon resection with a D3 lymphadenectomy as well as the role of a laparoscopic approach to this technique. Considering a D3 lymphadenectomy has been the standard of care for stage II and III colon cancers in many of our Asian neighbours for over 20 years, combining this data with data on complete mesocolic excision may provide enough evidence to support or refute the need for complete mesocolic excisions. Maybe there might be lessons to be learnt from our colleagues in the east.
Topics: Asia; Attitude of Health Personnel; Colectomy; Colorectal Neoplasms; Diffusion of Innovation; Healthcare Disparities; Humans; Laparoscopy; Lymph Node Excision; Neoplasm Staging; Patient Selection; Practice Patterns, Physicians'; Risk Factors; Treatment Outcome; Western World
PubMed: 25339817
DOI: 10.3748/wjg.v20.i39.14301 -
Mediastinum (Hong Kong, China) 2023Bronchogenic cysts represent a rare form of cystic malformation of the respiratory tract. Primarily located in the mediastinum if occurring early in gestation as opposed... (Review)
Review
BACKGROUND AND OBJECTIVE
Bronchogenic cysts represent a rare form of cystic malformation of the respiratory tract. Primarily located in the mediastinum if occurring early in gestation as opposed to the thoracic cavity if arising later in development. However, they can arise from any site along the foregut. They exhibit a variety of clinical and radiologic presentations, representing a diagnostic challenge, especially in areas with endemic hydatid disease. Endoscopic drainage has emerged as a diagnostic and potentially therapeutic option but has been complicated by reports of infection. Surgical excision remains the standard of care allowing for symptomatic resolution and definitive diagnosis via pathologic examination; minimally invasive approaches such as robotic and thoracoscopic approaches aiding treatment. Following complete resection, prognosis is excellent with essentially no recurrence.
METHODS
A review of the available electronic literature was performed from 1975 through 2022, using PubMed and Google Scholar, with an emphasis on more recent series. We included all retrospective series and case reports. A single author identified the studies, and all authors reviewed the selection until there was a consensus on which studies to include.
KEY CONTENT AND FINDINGS
The literature consisted of relatively small series, mixed between adult and pediatric patients, and the consensus remains that all symptomatic lesions should be excised via minimally invasive approach where feasible.
CONCLUSIONS
Surgical excision of symptomatic bronchogenic cysts remains the gold standard, with endoscopic drainage being reserved for diagnosis or as a temporizing measure in clinically unstable patients.
PubMed: 37701638
DOI: 10.21037/med-22-46 -
BMJ Case Reports Apr 2014Subareolar abscess of the male breast is a rare condition, which can be complicated by a fistula from the areolar skin into a lactiferous duct. In 1951, Zuska et al...
Subareolar abscess of the male breast is a rare condition, which can be complicated by a fistula from the areolar skin into a lactiferous duct. In 1951, Zuska et al first characterised this entity in women. Literature on mammillary fistulas in men is scarce and therefore standardisation of treatment does not exist. We present two cases of recurrent subareolar abscesses with draining fistulas. Both patients were successfully treated by complete excision of the lactiferous duct fistula, and continue to do well with no evidence of disease recurrence. When male patients present with a draining subareolar abscess, one should have a high index of suspicion for a mammillary fistula. Failure to identify and surgically excise the fistula may lead to recurrence of the abscess and prolonged morbidity. The most effective management of this uncommon entity includes complete excision of the lactiferous duct fistula.
Topics: Abscess; Adult; Breast Diseases; Fistula; Humans; Male; Mammary Glands, Human; Nipples; Recurrence
PubMed: 24706699
DOI: 10.1136/bcr-2013-201922 -
Turkish Journal of Medical Sciences 2014To analyze patients with Castleman disease who were diagnosed by surgery.
AIM
To analyze patients with Castleman disease who were diagnosed by surgery.
MATERIALS AND METHODS
We retrospectively investigated the postoperative pathological records of operations performed between January 1992 and December 2012 in our hospital. Files of 19 patients with the diagnosis of Castleman disease were analyzed.
RESULTS
There were 13 male and 6 female patients with a mean age of 40.1 + 11.4 (range: 20-57) years. Fifteen thoracotomies and 3 video-assisted thoracoscopies, 12 on the right side and 6 on the left side, and 1 mediastinoscopy were performed. Biopsies and mass excisions were performed in 2 and 17 cases, respectively. Histopathological findings were hyaline vascular-type (n = 16), plasma cellular- type (n = 2), and hyaline vascular plus plasma cellular-type (n = 1) Castleman disease.
CONCLUSION
Castleman disease can occur in all areas of the thorax, but the mediastinum and hilum are the most common locations. Surgical excision is the best method of diagnosis and treatment. Complete excision is curative for local forms of the disease. However, complete excision may not be possible at all times due to local invasion and hypervascularization. Multimodal treatment, including chemotherapy, is recommended in patients with a multicentric form of the disease, and they should be followed closely.
Topics: Adult; Castleman Disease; Female; Humans; Male; Mediastinoscopy; Middle Aged; Retrospective Studies; Thoracic Diseases; Thoracic Surgery, Video-Assisted; Thoracotomy; Tomography, X-Ray Computed; Young Adult
PubMed: 25536724
DOI: 10.3906/sag-1304-38 -
Current Oncology (Toronto, Ont.) Nov 2021Surgeries for gastrointestinal tract malignancies are based on the paradigm that we should remove the tumour together with its lymphatic drainage in one block. This... (Review)
Review
Surgeries for gastrointestinal tract malignancies are based on the paradigm that we should remove the tumour together with its lymphatic drainage in one block. This concept was initially proposed in rectal surgery and called a total mesorectal excision. This procedure gained much interest and has improved oncological results in rectal cancer surgery. The same idea for mesogastric and complete mesogastric excisions was proposed but, because of the complexity of the gastric mesentery, it has not become a standard technique. In this review, we analysed anatomical and embryological factors, proposed technical aspects of this operation and incorporated the available initial results of this concept. We also discussed analogies to other gastrointestinal organs, as well as challenges to this concept.
Topics: Gastrectomy; Humans; Lymph Node Excision; Mesentery; Rectal Neoplasms; Stomach Neoplasms
PubMed: 34898586
DOI: 10.3390/curroncol28060413 -
Cureus Jul 2022Background In this study, we aim to present the experience of a tertiary center regarding penile epidermoid cysts over 15 years. Methodology Patient files of those who...
Background In this study, we aim to present the experience of a tertiary center regarding penile epidermoid cysts over 15 years. Methodology Patient files of those who underwent surgical excision for penile epidermoid cysts between 2005 and 2019 were reviewed retrospectively. The demographics, clinical characteristics, etiological factors, cyst features, surgical techniques, complications, and follow-up data were analyzed. Results In total, 24 penile epidermoid cysts were excised in 21 boys. The median age at the time of surgery was 52 (15-204) months. The median duration between previous surgery and cyst excision was 40 (1-180) months. In total, 11 cases had a history of circumcision, and 10 had undergone hypospadias surgery. There was no significant difference between these two etiologic groups (p > 0.05). The main symptom was an asymptomatic penile mass. The average cyst size was 9.4 ± 6.7 mm. All cysts were completely excised with incisions made over old scars, except one. No complications were observed during a median follow-up period of 50 (12-120) months, and only one recurrence was noted. Conclusions Acquired penile epidermoid cysts may present as an early or late complication after penile surgery. Complete excision with an incision along the existing scars seems to be an effective solution for preventing new scars.
PubMed: 36060345
DOI: 10.7759/cureus.27462