Annals of surgical oncology
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Esophageal carcinoma is among the cancers with the worst prognosis. Real chances for cure depend on both early recognition and early treatment. The ability to predict lymph node involvement allows early curative treatment with less invasive approaches. ⋯ The most important factors for predicting lymph node metastasis in early esophageal cancer are depth of tumor infiltration, angiolymphatic invasion, neural invasion and grade of lymphocytic infiltration. The best candidates for endoscopic therapy are tumors with high-grade lymphocytic infiltration, no angiolymphatic or neural invasion, mucosal infiltration or sm1 (only for ADK), and tumor <1 cm in size. For sm SCC and sm2/3 ADK the treatment of choice remains esophagectomy with standard lymphadenectomy.
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Intraductal papillary mucinous neoplasm (IPMN) of the pancreas is reported to have a high prevalence of extrapancreatic malignancy (EPM). The aims of this study were to evaluate the prevalence and associated factors of EPMs in IPMN patients and to compare these data with those of non-IPMN pancreatic cystic neoplasm (PCN) patients. ⋯ The EPM prevalence of IPMN patients was 33.8%. Advanced age at IPMN diagnosis was the only factor significantly associated with EPMs in our IPMN cohort. In our PCN cohort, advanced age at PCN diagnosis was associated with malignant PCN and IPMN showed a borderline positive association with EPM.
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Despite the widespread use of endoscopic biliary stenting in patients presenting with potentially resectable pancreatic cancer, there is no general consensus regarding whether this represents a superior management approach over expeditious surgical intervention. The objective of this study was to investigate the influence of preoperative biliary stenting and resolution of jaundice on subsequent postoperative survival following resection for pancreatic cancer. ⋯ These results suggest that the presence of jaundice at the time of resection has an adverse impact on early, but not overall, postoperative survival in pancreatic cancer patients undergoing preoperative biliary drainage.
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Carcinomatosis of colorectal origin is increasingly treated by cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CS-HIPEC). This procedure commonly involves multivisceral resection (MVR) with potentially high morbidity. We analyzed the effect of MVR on the outcome after CS-HIPEC. ⋯ Increased risk of complications is associated with the number of intestinal anastomoses, but not with multivisceral resection in CS-HIPEC. Long-term survival is not affected by the number of resected organs.
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Cytoreductive surgery (CS) followed by hyperthermic intraperitoneal chemotherapy (HIPEC) results in limited survival benefit and high morbidity and mortality rates in patients with peritoneal carcinomatosis (PC). Radioimmunotherapy (RIT) after CS of experimental PC has been shown to increase survival and compare favorably to HIPEC. The effects of RIT and HIPEC on wound healing after CS need to be determined. ⋯ As adjuvant to CS, HIPEC showed a decrease in anastomotic and abdominal wall wound strength in a model of PC of CRC, whereas RIT did not.