World Journal of Surgical Oncology - Latest Articles

Scapula alata in early breast cancer patients enrolled in a randomized clinical trial of post-surgery short-course image guided radiotherapy

Nele Adriaenssens — 2012-05-16T00:00:00Z

Background: Scapula alata (SA) is a known complication of breast surgery associated with palsy of serratus anterior, but is seldom mentioned. We evaluated the risk factors associated with SA and the relationship of SA with ipsilateral shoulder/arm morbidity in a series of patients enrolled in a trial of post-surgery radiotherapy (RT). Methods: The trial randomized women with completely resected stage I-II breast cancer to short-course image guided RT, vs. conventional RT. SA, arm volume and shoulder-arm mobility were measured prior to RT and at 1-3 months post-RT. Shoulder/arm morbidities were computed as post-RT percent change relatively to pre-RT measurements. Results: Of 119 evaluable patients, 13 (=10.9%) had pre-RT SA. Age younger than 50 years old, body mass index less than 25 kg/m2, and axillary lymph node dissection, with odds ratios of 4.8 (P=0.009), 6.1 (P=0.016), and 6.1 (P=0.005), respectively. Randomization group was not significant. At 1-3 months post-RT, mean arm volume increased by 4.1% (P=0.036) and abduction decreased by 8.6% (P=0.046) among SA patients, but not among non SA patients. SA resolved in 8, persisted in 5, and appeared in 1 patient. Conclusion: Relationship of SA with lower body mass index suggests that SA might have been underestimated in overweight patients. Despite apparent resolution of SA in most patients, pre-RT SA portended an increased risk of shoulder/arm morbidity. We argue that SA warrants further investigation. Incidentally, the observation of SA occurring after RT in one patient represents the second case of post-RT SA reported in the literature.

A late recurring and easily forgotten tumor: ovarian granulosa cell tumor

Yi-Chan Chen — 2012-05-16T00:00:00Z

Ovarian granulosa cell tumor (GCT) is a malignant tumor with slow progression. The recurrence of granulosa cell tumor often happens after 5 years, leading to a 'forgotten tumor' by the patient. We present the case of a 64-year-old woman with a presentation of left flank pain. An initial computed tomography scan revealed a single tumor with multiple adjacent organ invasions. Surgical intervention was prescribed and the pathological results revealed ametastatic granulosa cell tumor. We also review the literature for the follow-up and further management of this tumor.

Nonerosive Gastroesophageal Reflux Disease And Mild Degree Of Esophagitis: Comparison Of Symptoms, Endoscopic, Manometric And Ph-Metric Patterns.

michele grande — 2012-05-16T00:00:00Z

ObjectiveTo compare patients presenting with gastroesophageal reflux disease in presence or in absence of mild grade of esophagitis (I-II according Savary-Miller's classification).MATERIALS ANDMethodS: Between 2005 and 2007, two hundred and fifteen patients with gastroesophageal reflux disease (67 with reflux associated to I-II degree esophagitis and 148 without esophagitis) were evaluated at the Department of Surgery, University Hospital Tor Vergata Rome and were included in the present study. Evaluation consisted of clinical interview, endoscopy of the high digestive tract, esophageal manometry and pH monitoring. Results: There was no significant difference between the 2 groups in age, sex or symptoms. The incidence of heartburn associated to non cardiac chest pain was greater in the esophagitis group as dysphagia. The incidence of hiatal hernia was similar in both groups. Although the motor pattern was similar in both groups, the length of abdominal esophagus was greater in patients without esophagitis (1.6 cm vs 1.1 cm, p<0.05). The reflux pattern was near identical in both groups. Conclusions: Gastroesophageal reflux without esophagitis can not be regarded as a milder form of the disease but as part of a single disease. Furthermore, these patients often demonstrate lower rates of symptom improvement after antireflux treatment, in comparison with erosive esophagitis patients. Therefore, further trials to assess the treatment algorithm for these patients are warranted.

Gastric tube resection due to metachronic cancer and a recurrence in anastomosis after Ivor-Lewis esophagectomy - case report

Sławomir Jabłoński — 2012-05-16T00:00:00Z

Gastric tube after esophagectomy can be the site of local recurrence or the development of second primary tumor which implies poor prognosis. The study presents an extremely rare case of a patient after Ivor-Lewis esophagectomy for squamous cell carcinoma, in whom there was detected local recurrence in the anastomosis associated with metachronous primary tumor in gastric tube. Esophageal reresection with the upper part of the stomach was performed. Left colonic segment supplied by middle colic vessels transposed through retrosternal route was used as new esophageal substitute.

Whole body diffusion for metastatic disease assessment in neuroendocrine carcinomas: comparison with OctreoScan(R) in two cases

Rachel Jorge Cossetti — 2012-05-16T00:00:00Z

Neuroendocrine tumor (NET) patients must be adequately staged in order to improve amultidisciplinary approach and optimal management for metastatic disease. Currentlyavailable imaging studies include somatostatin receptor scintigraphy, like OctreoScan(R),computed tomography (CT), scans and magnetic resonance imaging (MRI), which analyzevascular concentration and intravenous contrast enhancement for anatomic tumorlocalization. However, these techniques require high degree of expertise for interpretationand are limited by their availability, cost, reproducibility, and follow-up imagingcomparisons. NETs significantly reduce water diffusion as compared to normal tissue.Diffusion-weighted imaging (DWI) in MRI has an advantageous contrast difference: thetumor is represented with high signal over a black normal surrounding background. Thewhole-body diffusion (WBD) technique has been suggested to be a useful test for detectingmetastasis from various anatomic sites. In this article we report the use of DWI in MRI andWBD in two cases of metastatic pulmonary NET staging in comparison with OctreoScan(R) inorder to illustrate the potential advantage of DWI and WBD in staging NETs.

Schwannoma of ascending colon treated by laparoscopic right hemicolectomy

Hun Jin Kim — 2012-05-15T00:00:00Z

Schwannomas of the colon are rare and are difficult to diagnose preoperatively, since they often defy endoscopic and radiographic detection. Immunohistochemical stains are useful postoperatively to confirm this tumor, but more reliable diagnostic techniques (such as colonoscopic biopsy with immunohistochemistry) have emerged to enhance preoperative diagnostic accuracy. Here we report an instance of schwannoma arising in the ascending colon, where immunohistochemical staining of a preoperative biopsy facilitated diagnosis. After laparoscopic resection, histologic examination was confirmatory.

CT-guided percutaneous microwave ablation of pulmonary malignancies: results in 69 cases

Qiang Lu — 2012-05-07T00:00:00Z

Background: Microwave ablation (MWA) has attracted a worldwide attention gradually in treatinginoperable pulmonary malignancies. However, in the lung tissues treated with MWArecurrence of tumor may still occur and few data in large patient groups till now werereported about the safety or effectiveness of microwave ablation in treating primary lungcancer and metastatic pulmonary malignancies. The purpose of this study is to evaluate theclinical curative effect (local control, survival data) MWA and its safety as well. Methods: From 1 January 2005 to 1 January 2008, retrospective analyses, 69 patients underwentcomputed tomography (CT)-guided percutaneous MWA of pulmonary malignancies. Allpatients were deemed medically inoperable. The correlation of tumor sizes and localprogression after ablation was analyzed and the survival rates within 3 years post surgerywere compared between non-small-cell lung cancer and pulmonary metastases groups also. Results: Pneumothorax was the most frequent complication and occurred in 24.64% patients afterablation. Neither needle track implantation was found nor did patient death occur in thesepatients within 30 days. The 1-, 2-, and 3-year overall survival rates were 66.7%, 44.9% and24.6%, respectively. The overall survival rates for NSCLC patients in 1 year, 2 years, and 3years were 75.0%, 54.2%, and 29.2%, respectively. The overall survival rates for pulmonarymetastatic tumor patients in 1 year, 2 years, and 3 years were 47.6%, 23.8%, and 14.3%,respectively. The recurrence-free survival rates for NSCLC patients in 1 year, 2 years, and 3years were 72.9%, 50.0%, and 27.1%, respectively. The mortality rates for pulmonarymetastatic tumor patients in 1 year, 2 years, and 3 years were 47.6%, 19.0%, and 14.3%,respectively. Conclusions: Percutaneous microwave coagulation therapy was one safe and effective method and could bebeneficial for the improvement of inoperable pulmonary malignancies treatment effect.

Persistent increase in alpha-fetoprotein level in a patient without underlying liver disease who underwent curative resection of hepatocellular carcinoma. A case report and review of the literature

Isidoro Di Carlo — 2012-05-06T00:00:00Z

IntroductionAlpha-fetoprotein (AFP) is an oncofetal protein produced by hepatocellular carcinoma(HCC). AFP level can also be elevated in other neoplastic or non-neoplastic conditions. Anelevated AFP level has high diagnostic significance for HCC; at a level of >200 ng/mL, theprobability of HCC is >90%. The aim of the present paper is to report a patient whounderwent curative resection of HCC, who had a persistently elevated AFP levelpostoperatively but did not develop recurrence during a 2-year follow-up period. A review ofthe literature is also presented.Case reportAn 82-year-old male was referred following a computed tomography scan showing a 160 mmdiameter mass in the left lobe of the liver. This huge mass was diagnosed as HCC, arising inthe absence of cirrhosis or viral hepatitis. After tumor removal, the patient's high AFP levelpersisted for 2 years. Conclusion: As steatosis was the only pathological change in the remnant liver, this may have caused thepersistently elevated AFP level in this patient.

Half forehead reconstruction with a single rotational scalp flap for dermatofibrosarcoma protuberans treatment

Stefano Mori — 2012-05-06T00:00:00Z

Background: Dermatofibrosarcoma protuberans (DFSP) is a soft tissue neoplasm of intermediate to lowgrade malignancy. Although metastasis rarely occurs, DFSP has a locally aggressive behavior with a high recurrence rate. In the head and neck area, resection involving a wide margin of healthy tissue can be difficult because of functional and cosmetic considerations. We describe a novel reconstructive method for half forehead defects with an innovative single local wide scalp flap following excision of DFSP with a 3 cm margin of healthy tissue. Methods: Two patients underwent wide resection of forehead DFSP and reconstruction with a single rotational scalp flap. The scalp flap blood supply was provided from three main vessels: thesuperficial temporal artery, occipital artery and posterior auricular artery. Results: No early or late complications were observed in either patient with no local recurrence after 18 months of follow-up. The donor area could be closed primarily in both cases and the flapssurvived completely. Conclusion: This innovative technique allowed a radical excision of forehead DFSP with sufficient healthy margins, thus potentially decreasing tumor recurrence rate. Reconstruction was achieved avoiding microsurgery, skin expanders and large skin grafts. Moreover, all main reconstructive criteria, such as functional and cosmetic tissue characteristics, were completelyfulfilled.

Clinicodemographic aspect of resectable pancreatic cancer and prognostic factors for resectable cancer

Kun-Chun Chiang — 2012-05-04T00:00:00Z

Background: Pancreatic adenocarcinoma (PCA) is one of the most lethal human malignancies, and radicalsurgery remains the cornerstone of treatment. After resection, the overall 5-year survival rateis only 10% to 29%. At the time of presentation, however, about 40% of patients generallyhave distant metastases and another 40% are usually diagnosed with locally advancedcancers. The remaining 20% of patients are indicated for surgery on the basis of the results ofpreoperative imaging studies; however, about half of these patients are found to be unsuitablefor resection during surgical exploration. In the current study, we aimed to determine theclinicopathological characteristics that predict the resectability of PCA and to conduct aprognostic analysis of PCA after resection to identify favorable survival factors. Methods: We retrospectively reviewed the medical files of 688 patients (422 men and 266 women) whohad undergone surgery for histopathologically proven PCA in the Department of Surgery atChang Gung Memorial Hospital in Taiwan from 1981 to 2006. We compared the clinicalcharacteristics of patients who underwent resection and patients who did not undergoresection in order to identify the predictive factors for successful resectability of PCA, andwe conducted prognostic analysis for PCA after resection. Results: A carbohydrate antigen 19-9 (CA 19-9) level of 37 U/ml or greater and a tumor size of 3 cmor more independently predicted resectability of PCA. In terms of survival after resection,PCA patients with better nutritional status (measured as having an albumin level greater than3.5 g/dl), radical resection, early tumor stage and better-differentiated tumors were associatedwith favorable survival. Conclusions: Besides traditional imaging studies, preoperative CA 19-9 levels and tumor size can also beused to determine the resectability of PCA. Better nutritional status, curative resection, earlytumor stage and well-differentiated tumors predict the favorable prognosis of PCA patientsafter resection.