European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology
-
Comparative Study
Placement of an arterial hepatic catheter after a major hepatectomy for colorectal liver metastases: is this safe?
Studies have suggested that hepatic arterial infusion of chemotherapy (HAI) after resection of colorectal liver metastasis (CRLM) may improve patient's survival. The placement of a catheter in the hepatic artery at the time of hepatic surgery should therefore be considered in patients at high risk of hepatic recurrence. The aim of this study was to compare post-operative outcomes in patients who underwent at least a major hepatectomy (≥3 segments) for CRLM with or without catheter placement. ⋯ Although the placement of an arterial catheter during a major hepatectomy does not significantly increase the rate of postoperative complications two patients died post-operatively in this study from vascular thrombosis. In case of extended and complex hepatectomy, with a higher risk of post-operative complications, delaying the catheter placement could be recommended.
-
Considering the morbidity and mortality after abdominal surgery for rectal cancer, our aim was to determine whether local excision in Stage I rectal cancer provides long-term survival equivalent to TME surgery, particularly in elderly patients. ⋯ Local excision has a poor outcome in the elderly. A negative selection bias towards old age and high co-morbidity could explain this. Hartmann's procedure has a high risk for mortality and local recurrence in younger patients.
-
The use of adjuvant radiotherapy in ductal carcinoma in situ is accepted by most radiation oncologists worldwide; the role of a boost on the tumor bed is however more controversial. ⋯ Our experience showed the negative prognostic impact of surgical margins <1 mm and the protective role of radiation boost on LR rate. Anyway, results from ongoing prospective Phase III studies are strongly necessary to better identify high-risk DCIS patients.
-
The aim of this study was to determine whether we could identify a subset of axillary clearance patients in whom the procedure yielded negative nodes and was therefore of no therapeutic benefit. ⋯ Preoperative ultrasound in conjunction with FNAC and clinical judgement identifies most patients with positive axillary nodes and such patients have more widespread disease. The additional value of completion axillary ANC in patients with ultrasonographically normal axillae but positive SNB appears small as sentinel node 'biopsy' serves to clear the axilla of metastases in most of these patients.
-
Multicenter Study Comparative Study
Prediction of outcome in patients with urothelial carcinoma of the bladder following radical cystectomy using artificial neural networks.
The outcome of patients with urothelial carcinoma of the bladder (UCB) after radical cystectomy (RC) shows remarkable variability. We evaluated the ability of artificial neural networks (ANN) to perform risk stratification in UCB patients based on common parameters available at the time of RC. ⋯ ANN predicted tumour recurrence, CSM, and ACD in UCB patients after RC with reasonable accuracy. In this study, ANN significantly outperformed the Cox models regarding prediction of CSM and ACD using the same patients and variables. ANNs are a promising approach for individual risk stratification and may optimize individual treatment planning.