Rare Cancer News & Clinical Trials

Appendix Cancer (281 unread)

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Factors associated with stoma closure after cytoreductive surgery

Fetched: December 3rd, 2023, 5:01am GMT by Marianna Maspero

Am J Surg. 2023 Nov 30:S0002-9610(23)00641-4. doi: 10.1016/j.amjsurg.2023.11.037. Online ahead of print.

ABSTRACT

BACKGROUND: The rate of stoma closure after cytoreductive surgery (CRS) ± hypethermic intraperitoneal chemotherapy (HIPEC) is reportedly low. This study aimed to assess predictors of stoma reversal.

METHODS: We retrospectively analyzed all patients who underwent CRS with temporary ostomy at our center between 2009 and 2021, and compared reversed versus non-reversed patients.

RESULTS: Out of 625 CRS, 72 (11.5%) patients were included (median age 62 years, 65% female, 75% with HIPEC): 53 (74%) achieved stoma closure. Reversed patients had less high grade tumors, more appendiceal mucinous neoplasms, less ovarian primaries, and more loop ileostomies. The most common reason for non-reversal was disease progression or death (14 cases, 74%). At multivariate analysis, low/intermediate grade tumor differentiation was associated with higher stoma closure rate.

CONCLUSION: In our study, 74% of patients achieved stoma closure after CRS with temporary ostomy. The strongest predictor of stoma closure was a low/intermediate grade tumor.

PMID:38042719 | DOI:10.1016/j.amjsurg.2023.11.037

Risk of appendiceal malignancy in conservatively treated acute appendicitis

Fetched: December 2nd, 2023, 5:01am GMT by Shaima Ramadan

Scand J Surg. 2023 Dec;112(4):227-234. doi: 10.1177/14574969231190293. Epub 2023 Sep 13.

ABSTRACT

BACKGROUND AND AIMS: Appendectomy has historically been the standard treatment of acute appendicitis, but lately, conservative treatment of uncomplicated acute appendicitis with antibiotics has successfully been used in selected patients. Complicated acute appendicitis is often treated conservatively initially, but may benefit from interval appendectomy due to the higher risk of appendiceal malignancy and recurrence. Recommendations for follow-up after conservatively treated appendicitis vary. Furthermore, the risk of underlying malignancy and the necessity of routine interval appendectomy are unclear. This study aims to evaluate follow-up status, recurrence, and underlying appendiceal malignancy in conservatively treated uncomplicated and complicated acute appendicitis.

METHODS: This study included patients with conservatively treated acute appendicitis at Skåne University Hospital, Sweden during 2012-2019. Information on patient demographics at index admission and data on follow-up, recurrence, number of appendectomies after initial conservative treatment, and underlying malignancy were retrieved from medical charts.

RESULTS: The study cohort included 391 patients, 152 with uncomplicated and 239 with complicated acute appendicitis. Median time of study follow-up was 52 months. The recurrence risk was 23 (15.1%) after uncomplicated and 58 (24.3%) after complicated acute appendicitis (p = 0.030). During follow-up, 55 (23%) patients with complicated acute appendicitis underwent appendectomy. Appendiceal malignancies were found in 12 (5%) patients with previous complicated acute appendicitis versus no appendiceal malignancies after uncomplicated acute appendicitis (p = 0.002).

CONCLUSION: The risk of appendiceal malignancy and recurrent appendicitis was significantly higher in patients with complicated acute appendicitis compared with uncomplicated acute appendicitis.

PMID:37705259 | DOI:10.1177/14574969231190293

Taking Caution at Road's End: Incidental Finding of Appendiceal Goblet Cell Tumor on Colonoscopy

Fetched: November 30th, 2023, 5:01am GMT by Kyler Kozacek

ACG Case Rep J. 2023 Nov 15;10(11):e01211. doi: 10.14309/crj.0000000000001211. eCollection 2023 Nov.

ABSTRACT

Cancer of the appendix is an uncommon malignancy that is rarely diagnosed on colonoscopy. We present a case of incidentally discovered goblet cell adenocarcinoma of the appendix and the subsequent management. The patient initially presented with progressive epigastric pain in the setting of a family history of gastric cancer and personal history of colon polyps, for which surveillance was due. Bidirectional endoscopy was performed, from which biopsied tissue of an abnormal-appearing appendiceal orifice confirmed goblet cell adenocarcinoma. This case highlights the importance of identification of the appendiceal orifice in all colonoscopies and tissue sampling in cases of atypical-appearing anatomy.

PMID:38025845 | PMC:PMC10651346 | DOI:10.14309/crj.0000000000001211

B cell immune profiles in dysbiotic vermiform appendixes of pancreatic cancer patients

Fetched: November 30th, 2023, 5:01am GMT by Eveline E Vietsch

Front Immunol. 2023 Nov 10;14:1230306. doi: 10.3389/fimmu.2023.1230306. eCollection 2023.

ABSTRACT

Pancreatic ductal adenocarcinoma (PDAC) remains one of the deadliest solid tumors and is resistant to immunotherapy. B cells play an essential role in PDAC progression and immune responses, both locally and systemically. Moreover, increasing evidence suggests that microbial compositions inside the tumor, as well as in the oral cavity and the gut, are important factors in shaping the PDAC immune landscape. However, the gut-associated lymphoid tissue (GALT) has not previously been explored in PDAC patients. In this study, we analyzed healthy vermiform appendix (VA) from 20 patients with PDAC and 32 patients with colon diseases by gene expression immune profiling, flow cytometry analysis, and microbiome sequencing. We show that the VA GALT of PDAC patients exhibits markers of increased inflammation and cytotoxic cell activity. In contrast, B cell function is decreased in PDAC VA GALT based on gene expression profiling; B cells express significantly fewer MHC class II surface receptors, whereas plasma cells express the immune checkpoint molecule HLA-G. Additionally, the vermiform appendix microbiome of PDAC patients is enriched with Klebsiella pneumoniae, Bifidobacterium animalis, and Adlercreutzia equolifaciens, while certain commensals are depleted. Our findings may suggest impaired B cell function within the GALT of PDAC patients, which could potentially be linked to microbial dysbiosis. Additional investigations are imperative to validate our observations and explore these potential targets of future therapies.

PMID:38022530 | PMC:PMC10667699 | DOI:10.3389/fimmu.2023.1230306

Low-Grade Pseudomyxoma Peritonei Behaving as a High-Grade Disease: A Case Series and Literature Review

Fetched: November 28th, 2023, 5:00am GMT by Petros Bangeas

Curr Oncol. 2023 Nov 18;30(11):9996-10006. doi: 10.3390/curroncol30110726.

ABSTRACT

Patients with low-grade appendiceal mucinous carcinomas (LAMNs) treated with cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) have a favorable prognosis. However, a subgroup of patients presents a clinically aggressive course with disease progression despite receiving treatment. The purpose of this study is to report the experience of clinically aggressive LAMN patients treated by the same team, and to present a review of the literature. The cases of four patients with clinically aggressive LAMNs were reviewed. Clinical and histopathological characteristics were re-examined. Recurrences and the time of recurrence, as well as the survival time, were recorded. These patients were four men with clinically aggressive LAMNs treated with CRS plus HIPEC. One of them underwent CC-0 surgery, two underwent CC-1 surgery, and one underwent CC-3 surgery. All patients received systemic chemotherapy after surgery. Recurrence was recorded in three of the patients within 4-23 months after the initial treatment. Two of the patients underwent secondary CRS. Three patients died of disease recurrence within 13-23 months, and one is alive with a disease relapse at 49 months after his initial surgery. LAMNs were identified in both the initial specimens and the specimens obtained during reoperation. The prognosis of LAMN patients treated with CRS plus HIPEC is favorable. A small number of patients present a clinically aggressive course that is unresponsive to any treatment. Molecular and genetic studies are required to identify this group of LAMN patients who have an unfavorable prognosis.

PMID:37999146 | PMC:PMC10670747 | DOI:10.3390/curroncol30110726

Permalink for 'Difficult differential diagnosis of delayed mesh infection following inguinal hernia surgery involving appendiceal cancer: A case report'

Difficult differential diagnosis of delayed mesh infection following inguinal hernia surgery involving appendiceal cancer: A case report

Fetched: November 22nd, 2023, 5:01am GMT by Yusuke Kitagawa

Int J Surg Case Rep. 2023 Dec;113:109057. doi: 10.1016/j.ijscr.2023.109057. Epub 2023 Nov 18.

ABSTRACT

INTRODUCTION: We present a case of post-inguinal hernia repair delayed mesh infection that was initially misdiagnosed as appendiceal cancer.

PRESENTATION OF CASE: The patient was an 82-year-old man who underwent right inguinal hernia repair with a plug mesh 7 years before he presented with a lump in the right inguinal region. No skin infection signs were evident; blood tests revealed no inflammation or abnormal tumor markers. Abdominal contrast-enhanced computed tomography revealed a tumorous lesion in the right lower abdomen, raising the suspicion of appendiceal cancer with lymph node and lung metastases. Lower gastrointestinal endoscopy revealed extrinsic cecal wall compression. During laparoscopic ileocecal resection with lymph node dissection, a pus-filled abscess exposed the mesh in the inguinal region; hence, a diagnosis of a mesh infection was made. There were no macroscopic cancer signs in the appendix or cecum. Partial cecal resection involving the infected mesh was performed. Pathological tests did not reveal cancer, confirming the delayed mesh infection diagnosis.

DISCUSSION: This case presents the diagnostic challenges posed by post-inguinal hernia repair delayed mesh infections, emphasizing the lack of typical clinical and imaging indications and the potential for misdiagnosis as appendiceal cancer. It also highlights the importance of early recognition and appropriate management of these infections.

CONCLUSION: This case emphasizes the complexity of diagnosing post-inguinal hernia repair delayed mesh infections. These infections may mimic other conditions such as appendiceal cancer, stressing the need for vigilance and careful evaluation. Early recognition and proper management are essential to avoid unnecessary extensive surgeries.

PMID:37984260 | PMC:PMC10679770 | DOI:10.1016/j.ijscr.2023.109057

Surgical management of 1- to 2-cm neuroendocrine tumors of the appendix: Appendectomy or right hemicolectomy?

Fetched: November 20th, 2023, 5:01am GMT by Fasih Ali Ahmed

Surgery. 2023 Nov 17:S0039-6060(23)00717-1. doi: 10.1016/j.surg.2023.09.048. Online ahead of print.

ABSTRACT

BACKGROUND: The surgical management of 1- to 2-cm neuroendocrine tumors of the appendix is an area of debate. We analyzed the clinical outcomes of appendectomy and compared them to right hemicolectomy.

METHODS: We queried the National Cancer Database to identify patients treated for 1- to 2-cm ANETs from 2004 to 2018. Patients were stratified by surgical approach (appendectomy vs. hemicolectomy). Multivariable models were used to identify factors associated with the choice of surgical approach and the association between surgical approach and overall survival.

RESULTS: Of the 3,189 patients we included, 1,573 (49.3%) underwent right hemicolectomy and 1,616 (50.7%) appendectomy. The appendectomy rate increased from 37.7% in 2004 to 58.9% in 2018. On multivariable analysis, patients with grade 2 and 3 tumors were less likely to undergo appendectomy alone (odds ratio = 0.41, 95% confidence interval = 0.26-0.66). Longer travel distance was associated with a higher likelihood of undergoing appendectomy (odds ratio = 2.52, 95% confidence interval = 1.15-5.51). After adjusting for tumor grade, appendectomy alone had similar survival to hemicolectomy (hazard ratio = 1.03, 95% confidence interval = 0.67-1.59).

CONCLUSION: In this updated analysis of the National Cancer Database, right hemicolectomy was not associated with improved overall survival compared to appendectomy alone for 1- to 2-cm neuroendocrine tumors of the appendix. Although patients with grade 2 or 3 tumors are more likely to undergo right hemicolectomy, this procedure may not improve their treatment or overall outcome.

PMID:37981548 | DOI:10.1016/j.surg.2023.09.048

Case report: Acute appendicitis in appendix duplication

Fetched: November 20th, 2023, 5:01am GMT by Jonathon Clymo

Int J Surg Case Rep. 2023 Dec;113:109044. doi: 10.1016/j.ijscr.2023.109044. Epub 2023 Nov 14.

ABSTRACT

INTRODUCTION: Duplication of the appendix is a very rare presentation. According to the Cave-Wallbridge classification, there are three types of duplicate appendix.

PRESENTATION OF CASE: A 43 year old female presented with classical symptoms of acute appendicitis, with unremarkable inflammatory markers. The diagnosis was confirmed on pre-operative computer tomography (CT). During laparoscopy two tubular structures were identified: one arising from the tenia libera of the caecum adjacent to the terminal ileum and one retrocaecally at the confluence of the teniae. Both structures were excised using a laparoscopic linear stapler. Histopathological analysis demonstrated the accessory structure to be a microscopically unremarkable blind-ended tubular structure. The other specimen demonstrated acute gangrenous inflammation of the appendix. The patient had an uneventful recovery and was discharged home the following day.

DISCUSSION: Appendix duplication is rare; however, failure to recognise it in a patient with acute appendicitis could result in a retained source of sepsis, requiring subsequent re-exploration of the abdomen. The case presented here represents a Type B2 according to the Cave-Wallbridge classification and is the most susceptible to inadvertent error due to having appendixes in both typical and atypical anatomical locations. This case also highlights the probability of this diagnosis being missed on pre-operative CT.

CONCLUSION: This case report presents a unique opportunity for surgical trainees to review intra-operative laparoscopic images of a duplicate appendix, both to allow them to recognise this pathology if encountered in the future, and to embed the importance of ruling it out with thorough intra-operative examination.

PMID:37979553 | DOI:10.1016/j.ijscr.2023.109044

Role of colectomy in the management of appendiceal tumors: a retrospective cohort study

Fetched: November 19th, 2023, 5:00am GMT by Victoria A Marks

BMC Gastroenterol. 2023 Nov 17;23(1):398. doi: 10.1186/s12876-023-03019-4.

ABSTRACT

BACKGROUND: Appendiceal tumors represent a range of histologies that vary in behavior. Recommendations for treatment with appendectomy versus right hemicolectomy (RHC) for different tumor types are evolving and sometimes conflicting. This study sought to characterize variation in the United States around surgical treatment of major appendiceal tumor types over time and describe differences in outcomes based on procedure.

METHODS: Patients diagnosed with appendiceal goblet cell adenocarcinoma (GCA), mucinous adenocarcinoma, neuroendocrine neoplasm (NEN), or non-mucinous adenocarcinoma from 2004-2017 were identified in the National Cancer Database. Trends in RHC over time and predictors of RHC were identified. Surgical outcomes for each histologic type and stage were compared.

RESULTS: Of 18,216 patients, 11% had GCAs, 34% mucinous adenocarcinoma, 31% NENs, and 24% non-mucinous adenocarcinoma. Rate of RHC for NEN decreased from 68% in 2004 to 40% in 2017 (p = 0.008) but remained constant around 60-75% for other tumor types. Higher stage was associated with increased odds of RHC for all tumor types. RHC was associated with higher rate of unplanned readmission (5% vs. 3%, p < 0.001) and longer postoperative hospital stay (median 5 days vs. 3 days, p < 0.001). On risk-adjusted analysis, RHC was significantly associated with increased survival versus appendectomy for stage 2 disease of all tumor types (HRs 0.43 to 0.63) and for stage 1 non-mucinous adenocarcinoma (HR = 0.56).

CONCLUSIONS: Most patients with appendiceal tumors undergo RHC, which is associated with increased readmission, longer length of stay, and improved survival for stage 2 disease of all types. RHC should be offered selectively for appendiceal tumors.

PMID:37978348 | PMC:PMC10655451 | DOI:10.1186/s12876-023-03019-4

Long-term outcomes among adults with Langerhans cell histiocytosis

Fetched: November 15th, 2023, 5:01am GMT by Gaurav Goyal

Blood Adv. 2023 Nov 14;7(21):6568-6578. doi: 10.1182/bloodadvances.2023010706.

ABSTRACT

Advances in the treatment of Langerhans cell histiocytosis (LCH) have resulted in a growing survivor population. There is a lack of data on long-term outcomes among adults with LCH. We conducted a retrospective record review of 219 adults (aged ≥18 years) with LCH. Most common presentation was multisystem (34.2%), followed by single-system pulmonary (32%), unifocal (28.3%), and single-system multifocal (5.5%) LCH. Risk organ involvement (the liver, spleen, or bone marrow) was seen in 8.7% of cases, and 40 of 88 (45.5%) tested cases were BRAFV600E. At a median follow-up of 74 months, 5-year progression-free survival (PFS) was 58.3% and estimated median PFS was 83 months. Median overall survival (OS) was not reached; 5- and 10-year OS rates were 88.7% and 74.5%, respectively. Risk organ involvement was associated with worse PFS (hazard ratio [HR], 4.5) and OS (HR, 10.8). BRAFV600E was not associated with risk organ involvement or survival. When compared with matched unaffected US population, individuals with LCH had a significantly higher risk of overall mortality (standardized mortality ratio [SMR], 2.66), specifically among those aged <55 years at diagnosis (SMR, 5.94) and those with multisystem disease (SMR, 4.12). Second cancers occurred in 16.4% cases, including diverse hematologic and solid organ malignancies. LCH-associated deaths constituted 36.1% of deaths and occurred within 5 years of diagnosis. After 5 years, non-LCH causes of death, including second cancers, chronic obstructive pulmonary disease, and cardiovascular diseases, predominated. Our study highlights, to our knowledge, for the first time, that adults with LCH experience early and late mortality from non-LCH causes and the need for development of targeted survivorship programs to improve outcomes.

PMID:37698994 | PMC:PMC10641096 | DOI:10.1182/bloodadvances.2023010706

Permalink for 'Incidence trends and survival analysis of appendiceal tumors in the United States: Primarily changes in appendiceal neuroendocrine tumors'

Incidence trends and survival analysis of appendiceal tumors in the United States: Primarily changes in appendiceal neuroendocrine tumors

Fetched: November 14th, 2023, 5:01am GMT by Dan Wang

PLoS One. 2023 Nov 13;18(11):e0294153. doi: 10.1371/journal.pone.0294153. eCollection 2023.

ABSTRACT

BACKGROUND: Appendiceal tumors are considered to be a relatively rare tumor of the gastrointestinal tract and the prognosis is unclear. This study comprehensively investigated trends in the epidemiology and survival of appendiceal tumors in the United States over the past approximately 20 years.

METHODS: Patients with pathologically confirmed appendiceal tumors from 2000 to 2017 were selected from the Surveillance, Epidemiology and End Results (SEER) database. Age-adjusted incidence rates were calculated by SEER*Stat 8.4.0. The Kaplan-Meier method was used to analyze survival and prognostic factors were investigated by a multivariate Cox proportional risk model.

RESULTS: Ultimately, 13,546 patients with appendiceal tumors between 2000 and 2017 were included. The annual incidence of colonic adenocarcinoma and mucinous adenocarcinoma remained relatively stable. Interestingly, the annual incidence of appendiceal neuroendocrine tumors (aNETs) increased significantly, from 0.03 to 0.90 per 100,000 person-years, with the most dramatic increase in the number of patients with localized disease. Patients with aNETs showed a significant improvement in survival between 2009-2017, compared to the period 2000-2008. Moreover, this improvement in survival over time was seen at all stages (localized, regional, distant) of aNETs. However, this improved survival over time was not seen in colonic and mucinous adenocarcinoma.

CONCLUSIONS: The incidence of appendiceal neoplasms has increased significantly over the past nearly two decades, which is mainly due to the increased incidence and significant migration to earlier stages in aNETs. We must note that despite the increased incidence of aNETs, survival rates have improved at different disease stages.

PMID:37956190 | PMC:PMC10642837 | DOI:10.1371/journal.pone.0294153

Permalink for 'Health related quality of life is excellent and sustained at two decades after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in survivors of pseudomyxoma peritonei of appendiceal origin'

Health related quality of life is excellent and sustained at two decades after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in survivors of pseudomyxoma peritonei of appendiceal origin

Fetched: November 14th, 2023, 5:01am GMT by Victor Kung

Eur J Surg Oncol. 2023 Nov;49(11):107045. doi: 10.1016/j.ejso.2023.107045. Epub 2023 Aug 29.

ABSTRACT

INTRODUCTION: Optimal management of pseudomyxoma peritonei (PMP) is by cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC), which can achieve 20-year disease-free, and overall survival. There is limited information on the health-related quality of life (HRQOL) of PMP survivors beyond five years. We report longitudinal HRQOL in patients with PMP of appendiceal origin up to 17-years after their CRS and HIPEC in 2003-2004.

METHODS: Patients had HRQOL assessed with EORTC QLQ-C30 questionnaires pre-operatively, and at 1-, 10- and 17-years post-operatively. Comparisons in global health-related QOL (global-HRQOL) measures were made with (1) an age- and sex-matched normal European population, (2) between patients who underwent complete cytoreduction (CRS CC0/1) versus maximal tumor debulking (MTD), and (3) between those with and without peritoneal recurrence.

RESULTS: Forty-six patients underwent CRS & HIPEC for appendiceal PMP. One patient withdrew from the study. Of the 45 patients, 23 patients were alive at ten and 15 patients at 17-years post-operatively. 21/23 (91%) and 14/15 patients (93%) completed questionnaires respectively. Pre-operatively, patients had significantly lower global-HRQOL compared with the reference population. Over follow-up, patients experienced improvements in their global-HRQOL. By post-operative year-10 and -17, there was no difference between the global-HRQOL of patients and reference population. As expected, patients with CC0/1 and without peritoneal tumor recurrence had better global-HRQOL at ten- and 17-years post-operatively compared with those with MTD or recurrence.

CONCLUSIONS: Optimal CRS and HIPEC is an effective treatment for appendiceal PMP that can achieve long-term survival. HRQOL is excellent and maintained, in those who have CC0/1 without recurrence.

PMID:37677915 | DOI:10.1016/j.ejso.2023.107045

Permalink for 'Incidence rate and histology of appendiceal neoplasms in complicated versus uncomplicated appendicitis: A meta-analysis and systematic review'

Incidence rate and histology of appendiceal neoplasms in complicated versus uncomplicated appendicitis: A meta-analysis and systematic review

Fetched: November 9th, 2023, 5:01am GMT by Paola Solis-Pazmino

Langenbecks Arch Surg. 2023 Nov 9;408(1):432. doi: 10.1007/s00423-023-03164-0.

ABSTRACT

INTRODUCTION: Studies evaluating the rate and histology of appendiceal neoplasms between complicated and uncomplicated appendicitis include a small number of patients. Therefore, we sought a meta-analysis and systematic review comparing the rates and types of appendiceal neoplasm between complicated and uncomplicated appendicitis.

METHODS: We included articles published from the time of inception of the datasets to September 30, 2022. The electronic databases included English publications in Ovid MEDLINE In-Process & Other Non-Indexed Citations, Ovid MEDLINE, Ovid EMBASE, and Scopus.

RESULTS: A total of 4962 patients with appendicitis enrolled in 4 comparative studies were included. The mean age was 43.55 years (16- 94), and half were male (51%). Based on intra-operative findings, 1394 (38%) had complicated appendicitis, and 3558 (62%) had uncomplicated appendicitis. The overall incidence rate of neoplasm was 1.98%. No significant difference was found in the incidence rate of appendiceal neoplasm between complicated (3.29%) and uncomplicated (1.49%) appendicitis (OR 0.44, 95% CI 0.16- 1.23; p < 0.087; I2 = 54.9%). The most common appendiceal neoplasms were Neuroendocrine Tumors (NET) (49.21%), Nonmucinous Adenocarcinoma (24.24%), Mixed Adeno-Neuroendocrine Tumor (MANEC) (11.40%), Mucinous Adenocarcinoma (4.44%). There was a significant difference between complicated and uncomplicated appendicitis in rates of adenocarcinoma (50% vs. 13%), NET (31% vs. 74%), MANEC (19% vs. 13%) (P < 0.001).

CONCLUSION: While there was no significant difference in the overall neoplasm rate between complicated and uncomplicated appendicitis, the NET rate was significantly higher in uncomplicated appendicitis. In comparison, the Adenocarcinoma rate was considerably higher in Complicated appendicitis. These findings emphasize the importance of evaluating risk factors for neoplasm when considering appendectomy in patients with appendicitis.

PMID:37940770 | PMC:PMC10632310 | DOI:10.1007/s00423-023-03164-0

Permalink for 'Impact of Successful Implementation of an Enhanced Recovery After Surgery Protocol for Patients Undergoing Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy'

Impact of Successful Implementation of an Enhanced Recovery After Surgery Protocol for Patients Undergoing Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy

Fetched: November 9th, 2023, 5:01am GMT by Beatrice J Sun

Ann Surg Oncol. 2023 Dec;30(13):8156-8165. doi: 10.1245/s10434-023-14222-8. Epub 2023 Sep 8.

ABSTRACT

BACKGROUND: Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) are complex operations for the treatment of peritoneal metastases. Enhanced recovery after surgery (ERAS) protocols are intended to standardize preoperative, intraoperative, and postoperative pathways, with the goal of improving patient care. This study describes feasibility and outcomes after implementing an ERAS protocol for CRS/HIPEC at a tertiary academic center.

METHODS: A single-institution experience of CRS/HIPEC was reviewed from January 2020 to March 2023. Patients were categorized according to whether they underwent CRS/HIPEC before or after ERAS initiation. Outcomes and protocol adherence were evaluated.

RESULTS: A total of 115 CRS/HIPEC operations were included-74 before and 41 after ERAS implementation. Median age was younger in the post-ERAS group, whereas sex, comorbidities, peritoneal carcinomatosis index, operation performed, and operative time were similar between groups. The most common primary cancer sites were gynecologic (40%), appendiceal (24%), and colorectal (22%). Adherence to all postoperative ERAS components was 76%. More post-ERAS patients ambulated by postoperative day (POD) 1 (90% vs. 54%; p < 0.001), tolerated liquid diet by POD 2 (88% vs. 32%; p < 0.001), and had foley removed by POD 3 (86% vs. 43%; p < 0.001). There was a trend toward decreased length of stay in the post-ERAS cohort (7 vs. 8 days; p = 0.092), with no difference in major complications, intensive care unit admission, or 30-day readmission.

CONCLUSIONS: Despite the heterogeneity of CRS/HIPEC operations, implementing an ERAS protocol for our patients was feasible and resulted in postoperative outcomes and adherence comparable with that of other major abdominal surgeries. This supports the potential for success in ERAS programs for CRS/HIPEC patients.

PMID:37684372 | DOI:10.1245/s10434-023-14222-8

Permalink for 'Systemic Therapy Update on 177Lutetium-PSMA-617 for Metastatic Castration-Resistant Prostate Cancer: ASCO Guideline Rapid Recommendation Update'

Systemic Therapy Update on 177Lutetium-PSMA-617 for Metastatic Castration-Resistant Prostate Cancer: ASCO Guideline Rapid Recommendation Update

Fetched: November 7th, 2023, 5:01am GMT by Rohan Garje

J Clin Oncol. 2023 Nov 6:JCO2302128. doi: 10.1200/JCO.23.02128. Online ahead of print.

ABSTRACT

ASCO Rapid Recommendation Updates highlight revisions to select ASCO guideline recommendations as a response to the emergence of new and practice-changing data. The rapid updates are supported by an evidence review and follow the guideline development processes outlined in the ASCO Guideline Methodology Manual. The goal of these articles is to disseminate updated recommendations, in a timely manner, to better inform health practitioners and the public on the best available cancer care options. Guidelines and updates are not intended to substitute for independent professional judgment of the treating provider and do not account for individual variation among patients. See appendix for disclaimers and other important information (Appendix 1 and Appendix 2, online only).

PMID:37931186 | DOI:10.1200/JCO.23.02128

Clinical features, treatments and prognosis of appendiceal bleeding: a case series study

Fetched: November 7th, 2023, 5:01am GMT by Xiao-Cun Xing

BMC Gastroenterol. 2023 Nov 3;23(1):377. doi: 10.1186/s12876-023-03025-6.

ABSTRACT

BACKGROUND: Appendiceal bleeding is a rare cause of lower gastrointestinal bleeding, could be overlooked and diagnosed as obscure gastrointestinal bleeding. Due to limited real-world cases, the optimized management of appendiceal bleeding is unclear. We here shared our experiences in the past 20 years.

METHODS: A retrospective study was conducted at West China Hospital of Sichuan University. We reviewed data of 28,175 colonoscopies from 43,095 gastrointestinal bleeding patients between June 2003 and June 2023. Six patients diagnosed as appendiceal bleeding were included. Data including symptoms, laboratory tests, imaging results, endoscopic findings, treatment and prognosis were collected and analyzed.

RESULTS: Appendiceal bleeding accounts for 0.014% in gastrointestinal bleeding patients. Of the six patients, five were male, with a mean age of 48.5 years. Hematochezia was the most common symptom. The etiology included appendiceal angiodysplasia, appendicitis and appendectomy associated bleeding. Hemostasis was achieved by appendectomy, endoscopic therapy or medication according to different cases. One patient did not receive any treatment because of self-limiting bleeding.

CONCLUSIONS: The diagnosis of appendiceal bleeding is challenging, repeated flushing during endoscopy is helpful. Appendectomy is the priority option for treatment as well as the etiology clarification, therapeutic endoscopy and medication could be considered case by case.

PMID:37924017 | PMC:PMC10625278 | DOI:10.1186/s12876-023-03025-6

Appendiceal Neuroendocrine Tumor Mimicking Acute Appendicitis

Fetched: November 3rd, 2023, 5:01am GMT by N Gautam

Kathmandu Univ Med J (KUMJ). 2022 Oct-Dec;20(80):532-534.

ABSTRACT

Appendiceal carcinoids are the most frequent tumors arising from the appendix, comprising between 32 and 57% of all the appendiceal tumors. The gross appearance of the appendix showed perforation at the tip with 30 ml of periappendicular collection. On histopathological examination, carcinoid tumor on the tip of appendix was found with tumor cells arranged in tubules, acini and nests infiltrating the muscularis propria and sub serosa. Perineural and vascular invasion was not seen. Immunohistochemistry for Synaptophysin was positive with Ki-67 labelling index of 2%. We present a case of appendiceal neuroendocrine tumor with the chief complaint of acute appendicitis.

PMID:37795739

Permalink for 'Does Hospital Operative Volume Influence the Outcomes of Patients After Heated Intraperitoneal Chemotherapy for Peritoneal Carcinomatosis?'

Does Hospital Operative Volume Influence the Outcomes of Patients After Heated Intraperitoneal Chemotherapy for Peritoneal Carcinomatosis?

Fetched: November 1st, 2023, 5:00am GMT by Praveen D Chatani

Ann Surg Oncol. 2023 Oct 31. doi: 10.1245/s10434-023-14450-y. Online ahead of print.

ABSTRACT

BACKGROUND: For some cancer operations, center volume is associated with improved patient outcomes. Whether this association is true for cytoreductive surgery/heated intraperitoneal chemotherapy (CRS/HIPEC) is unclear. Given the rapidly expanding use of CRS/HIPEC, the aim of this analysis was to determine whether a volume-outcome relationship exists for this strategy.

METHODS: The Vizient Clinical Database® was queried for CRS/HIPEC cases from January 2020 through December 2022. Low-, medium-, and high-volume designations were made by sorting hospitals by case volume and creating equal tertiles based on total number of cases. Analysis was performed via one-way ANOVA with post-hoc Tukey test, as indicated.

RESULTS: In the 36-month study period, 5165 cases were identified across 149 hospitals. Low- (n = 113), medium- (n = 25), and high-volume (n = 11) centers performed a median of 4, 21, and 47 cases per annum, respectively. Most cases were performed for appendiceal (39.3%) followed by gynecologic neoplasms (20.4%). Groups were similar with respect to age, gender, race, comorbidities, and histology. Low-volume centers were more likely to utilize the ICU post-operatively (59.6% vs. 40.5% vs. 36.3%; p = 0.02). No differences were observed in morbidity (9.4% vs. 7.1% vs. 9.0%, p = 0.71), mortality (0.9% vs. 0.6% vs. 0.7%, p = 0.93), length of stay (9.3 vs. 9.4 vs. 10 days, p = 0.83), 30-day readmissions (5.6% vs. 5.6% vs. 5.6%, p = 1.0), or total cost among groups.

CONCLUSIONS: No association was found between CRS/HIPEC hospital volume and post-operative outcomes. These data suggest that in academic medical centers with HIPEC programs, outcomes for commonly treated cancers are not associated with hospital volume.

PMID:37906385 | DOI:10.1245/s10434-023-14450-y

Safety of current treatment options for NTRK fusion-positive cancers

Fetched: November 1st, 2023, 5:00am GMT by Adeline T Yang

Expert Opin Drug Saf. 2023 Jul-Dec;22(11):1073-1089. doi: 10.1080/14740338.2023.2274426. Epub 2023 Nov 28.

ABSTRACT

INTRODUCTION: Oncogenic NTRK fusions have been found in multiple cancer types affecting adults and/or children, including rare tumors with pathognomonic fusions and common cancers in which fusions are rare. The tropomyosin receptor kinase inhibitors (TRKi) larotrectinib and entrectinib are among the first agents with tissue agnostic FDA approvals for cancer treatment, and additional TRKi are undergoing development. As experience with TRKi grow, novel mechanisms of resistance and on/off target side effects have become increasingly important considerations.

AREAS COVERED: Authors reviewed literature published through July 2023 on platforms such as PubMed, clinicaltrials.gov, and manufacturer/FDA drug labels, focusing on the development of TRKi, native functions of TRK, phenotype of congenital TRK aberrancies, efficacy, and safety profile of TRKi in clinical trials and investigator reports, and on/off target adverse effects associated with TRKi (Appendix A).

EXPERT OPINION: TRKi have histology-agnostic activity against tumors with NTRK gene fusions. TRKi are generally well tolerated with a side effect profile that compares favorably to cytotoxic chemotherapy. There are numerous ongoing studies investigating TRKi as frontline, adjuvant, and salvage therapy. It will be critical to continue to gather long-term safety data on the use of these agents, particularly in children.

PMID:37869783 | DOI:10.1080/14740338.2023.2274426

Spatial transcriptomic profiling reveals the pathophysiology of early-stage hidradenitis suppurativa

Fetched: October 26th, 2023, 5:01am GMT by Christine Suh-Yun Joh

Br J Dermatol. 2023 Oct 25;189(5):643-645. doi: 10.1093/bjd/ljad274.

NO ABSTRACT

PMID:37590958 | DOI:10.1093/bjd/ljad274

Incidence of occult appendiceal neoplasm in patients over 40 years with acute appendicitis: A single-institution review

Fetched: October 26th, 2023, 5:01am GMT by Samantha Jolly

Aust J Rural Health. 2023 Oct 25. doi: 10.1111/ajr.13055. Online ahead of print.

ABSTRACT

OBJECTIVE: To investigate the incidence of occult appendiceal neoplasm in patients aged 40 years and over who underwent appendicectomy for appendicitis.

METHODS: The clinical coding electronic database was used to identify patients aged 40 years and over who were diagnosed with appendicitis from September 2010 to September 2022. Patients were included if they were managed operatively.

DESIGN: Retrospective cohort study.

SETTING: Modified Monash category 3 (large rural town).

PARTICIPANTS: Patients aged 40 years and over undergoing appendicectomy for appendicitis.

MAIN OUTCOME MEASURES: Incidence of appendiceal neoplasm within appendicectomy specimen.

RESULTS: A total of 279 patients aged 40 years and over underwent appendicectomy, with a median age of 53 years (range 40-95). Nineteen patients (7%) were found to have a primary neoplastic lesion within the appendix: seven neuroendocrine neoplasms (37%), six sessile serrated lesions (32%), two colonic-type adenocarcinoma (11%), two goblet cell adenocarcinoma (11%) and two appendiceal mucinous neoplasms (11%). Additionally, one patient had a metastatic adenocarcinoma of pancreaticobiliary aetiology.

CONCLUSIONS: Occult appendiceal neoplasm was higher than reported in the literature in our cohort. This would support appendicectomy as the treatment of choice for patients aged 40 years and over with acute appendicitis and caution against nonoperative management in this demographic.

PMID:37876354 | DOI:10.1111/ajr.13055

Small Cell Neuroendocrine Carcinoma of the Lung Discovered by Acute Appendicitis Metastasis: An Experience at Our Hospital

Fetched: October 24th, 2023, 5:00am GMT by César J Treviño-Arizmendi

Cureus. 2023 Sep 21;15(9):e45732. doi: 10.7759/cureus.45732. eCollection 2023 Sep.

ABSTRACT

Acute appendicitis is the most common cause of abdominal pain that requires surgery. Appendiceal cancer is rare, comprising nearly 4% of all gastrointestinal diagnoses. It is common to find neuroendocrine neoplasms due to metastasis in this site. Appendix tumors are usually asymptomatic; however, if they are advanced or have metastases, they can cause abdominal symptoms. Computed tomography (CT) is commonly used to diagnose acute appendicitis in these cases. CT usually shows an increased appendiceal diameter with thickening (>3 mm) of the appendiceal wall, an intraluminal fluid depth >2.6 mm, and periappendiceal inflammation. Histopathological findings confirm the diagnosis. Medical and surgical management depends on physical characteristics such as size, location, and degree of evolution. We present the case of a 77-year-old woman with a family history of well-controlled type 2 diabetes mellitus and hypertension. She was referred to our institution after four days of abdominal pain in the epigastrium and both flanks accompanied by fever. An abdominal CT showed left pleural effusion and appendicular thickening. Laboratory tests showed high blood glucose levels, leukocytosis at the expense of neutrophils, an increased platelet count, and decreased albumin and total proteins. The CT scan also showed a calcified granuloma in the anterior segment of the right upper lobe and an irregular image with partially defined hypodense borders in the liver in segment IVb. We report our experience with the diagnosis, management, and treatment decisions of this case. It is important to mention that the first diagnosis was acute appendicitis. This diagnosis motivated us to seek other symptoms and signs by direct questioning and imaging studies leading us to diagnose metastatic lung cancer.

PMID:37868387 | PMC:PMC10590259 | DOI:10.7759/cureus.45732

Permalink for 'Epidemiology and survival outcomes of colorectal mixed neuroendocrine-non-neuroendocrine neoplasms and neuroendocrine carcinoma'

Epidemiology and survival outcomes of colorectal mixed neuroendocrine-non-neuroendocrine neoplasms and neuroendocrine carcinoma

Fetched: October 23rd, 2023, 5:01am GMT by Mohammed O Suraju

Surgery. 2023 Oct 20:S0039-6060(23)00614-1. doi: 10.1016/j.surg.2023.09.019. Online ahead of print.

ABSTRACT

BACKGROUND: Mixed neuroendocrine-non-neuroendocrine neoplasms are a rare subtype of neuroendocrine neoplasm consisting of ≥30% each of neuroendocrine and non-neuroendocrine differentiation. Neuroendocrine carcinomas are poorly differentiated neuroendocrine tumors. The epidemiology and prognosis of colorectal mixed neuroendocrine-non-neuroendocrine neoplasms and neuroendocrine carcinomas are not clearly defined in the literature. We sought to examine the presentation, patterns of care, and outcomes of patients with mixed neuroendocrine-non-neuroendocrine neoplasms and neuroendocrine carcinomas.

METHODS: We identified patients diagnosed with stage I-III colorectal (excluding appendix) mixed neuroendocrine-non-neuroendocrine neoplasms or neuroendocrine carcinomas with only one-lifetime cancer diagnosis who underwent surgical resection between 2010 and 2018 from the National Cancer Database. We performed bidirectional selection to identify variables to include in a multivariable Cox proportional hazards model.

RESULTS: We identified 189 patients with a diagnosis of stage I to III colorectal mixed neuroendocrine-non-neuroendocrine neoplasms, 66% of whom had poorly differentiated tumors and 482 with neuroendocrine carcinomas. Among patients with stage III disease, 68% of patients with mixed neuroendocrine-non-neuroendocrine neoplasms and 54% of patients with neuroendocrine carcinomas received adjuvant chemotherapy. The median survival for the overall patients with mixed neuroendocrine-non-neuroendocrine neoplasms and neuroendocrine carcinomas cohorts were 38 and 42 months, respectively (P = .22), and the median survival for patients with mixed neuroendocrine-non-neuroendocrine neoplasms and neuroendocrine carcinomas with stage III disease were 30 and 25 months, respectively (P = .27). In multivariable analysis, fewer number of positive nodes and receipt of adjuvant chemotherapy were independently associated with decreased risk of mortality for patients with mixed neuroendocrine-non-neuroendocrine neoplasms and neuroendocrine carcinomas.

CONCLUSION: Adjuvant chemotherapy is associated with improved survival in stage III mixed neuroendocrine-non-neuroendocrine neoplasms and neuroendocrine carcinomas. Future studies are warranted to identify subsets of patients benefiting most from adjuvant therapy.

PMID:37867105 | DOI:10.1016/j.surg.2023.09.019

Hemicolectomy versus appendectomy alone for appendiceal neuroendocrine tumours between 1-2 cm in size-are we overtreating?

Fetched: October 21st, 2023, 5:01am GMT by Said Bachiri

Transl Cancer Res. 2023 Sep 30;12(9):2420-2424. doi: 10.21037/tcr-23-655. Epub 2023 Aug 17.

NO ABSTRACT

PMID:37859747 | PMC:PMC10583003 | DOI:10.21037/tcr-23-655

The Clinical Significance of CEA, CA19-9, and CA125 in Management of Appendiceal Adenocarcinoma

Fetched: October 20th, 2023, 5:00am GMT by Abdelrahman Yousef

medRxiv. 2023 Sep 11:2023.09.10.23295319. doi: 10.1101/2023.09.10.23295319. Preprint.

ABSTRACT

IMPORTANCE: Serum tumor markers CEA, CA19-9, & CA125 have been useful in the management of gastrointestinal and gynecological cancers, however there is limited information regarding their utility in patients with appendiceal adenocarcinoma.

OBJECTIVE: Assessing the association of serum tumor markers (CEA, CA19-9, and CA125) with clinical outcomes, pathologic, and molecular features in patients with appendiceal adenocarcinoma.

DESIGN: This is a retrospective study with results reported in 2023. The median follow-up time was 43 months.

SETTING: Single tertiary care comprehensive cancer center.

PARTICIPANTS: Under an approved Institutional Review Board protocol, the Palantir Foundry software system was used to query the MD Anderson internal patient database to identify patients with a diagnosis of appendiceal adenocarcinoma and at least one tumor marker measured at MD Anderson between 2016 and 2023.

RESULTS: A total of 1,338 patients with appendiceal adenocarcinoma were included, with a median age of 56.5 years. The majority of the patients had metastatic disease (80.7%). CEA was elevated in more than half of the patients tested (56%), while CA19-9 and CA125 were elevated in 34% and 27%, respectively. Individually, elevation of CEA, CA19-9, or CA125 were associated with worse 5-year survival; 82% vs 95%, 84% vs 92%, and 69% vs 93% elevated vs normal for CEA, CA19-9, and CA125 respectively (all p<0.0001). Quantitative evaluation of tumor markers increased prognostic ability. Patients with highly elevated (top 10^th percentile) CEA, CA19-9 or CA125 had markedly worse survival with 5-year survival rates of 59%, 64%, and 57%, respectively (HR vs. normal : 9.8, 6.0, 7.6, all p<0.0001). Although metastatic tumors had higher levels of all tumor markers, when restricting survival analysis to 1080 patients with metastatic disease elevated CEA, CA19-9 or CA125 were all still associated worse survival (HR vs. normal : 3.4, 1.8, 3.9, p<0.0001 for CEA and CA125, p=0.0019 for CA19-9). Interestingly tumor grade was not associated with CEA or CA19-9 level, while CA-125 was slightly higher in high relative to low-grade tumors (18.3 vs. 15.0, p=0.0009). Multivariable analysis identified an incremental increase in the risk of death with an increase in the number of elevated tumor markers, with a 11-fold increased risk of death in patients with all three tumor markers elevated relative to those with none elevated. Mutation in KRAS and GNAS were associated with significantly higher levels of CEA and CA19-9.

CONCLUSIONS: These findings demonstrate the utility of measuring CEA, CA19-9, and CA125 in the management of appendiceal adenocarcinoma. Given their prognostic value, all three biomarkers should be included in the initial workup of patients diagnosed with appendiceal adenocarcinoma.

PMID:37745596 | PMC:PMC10516068 | DOI:10.1101/2023.09.10.23295319

High-grade appendiceal mucinous neoplasm presenting as renal colic; a case report and review of literature

Fetched: October 20th, 2023, 5:00am GMT by Baraa Amir

J Surg Case Rep. 2023 Oct 17;2023(10):rjad567. doi: 10.1093/jscr/rjad567. eCollection 2023 Oct.

ABSTRACT

High-grade appendiceal mucinous neoplasms (HAMN) are rare mucinous appendiceal tumors that are mostly incidentally discovered and histologically show marked cytoplasmic atypia. We report a 62-year-old female patient who was diagnosed with acute right flank pain mimicking renal colic. Abdominal and pelvis CT scans showed no calculi or hydronephrosis. Incidentally, a markedly distended retrocecal appendix was identified and an appendectomy was performed. Histopathology revealed an HAMN of size 5.8 cm. HAMN are one of the rare and somewhat recently described epithelial appendiceal tumors. The latest 2019 classification is based on histologic appearance and on the consensus for classification and pathologic reporting of Pseudomyxoma peritonei and associated appendiceal neoplasia (Peritoneal Surface Pathology Group International, modified Delphi process). Histologically, appendiceal mucinous lesions are classified as nonneoplastic/mucocele and neoplastic lesions with separate subcategorization. Despite its rarity, it is crucial for clinicians to be aware of HAMN to distinguish it from other clinical differentials.

PMID:37854517 | PMC:PMC10581701 | DOI:10.1093/jscr/rjad567

Novel heterotopic continental ileal reservoir based on the Mitrofanoff principle: a case report and review of the literature

Fetched: October 17th, 2023, 5:00am GMT by Hou Yakun

Front Surg. 2023 Sep 29;10:1202649. doi: 10.3389/fsurg.2023.1202649. eCollection 2023.

ABSTRACT

For patients undergoing radical cystectomy with standard lymphadenectomy for bladder cancer, appropriate urinary diversion (with a pouch and conduit) improves postoperative quality of life, reduces postoperative complications, and prolongs survival. We developed a novel heterotopic ileal reservoir to achieve these goals. This report describes the methodology involved and the incidence of intraoperative and postoperative complications. Three patients who underwent novel heterotopic ileal reservoir creation following radical cystectomy and standard lymphadenectomy (for bladder cancer) were evaluated. The ileum served as a pouch in which the ureters and appendix were implanted by extramural tunnelling. The appendix served as a conduit and pelvic reperitonealization was performed. Operative times, intraoperative blood loss, time to intestinal function recovery, incidence of intestinal obstruction and ureteric reflux, and bladder volumes and continence levels were evaluated. The surgical intervention was successful with operation times ranging 410-525 min, blood loss ranging 300-700 ml, and recovery time for intestinal function ranging 3-5 days. The postoperative hospitalization time was 11-15 days. Subileus occurred in patient B, who recovered after fasting and fluid replacement. Patients B and C achieved complete continence 6 weeks after surgery, while patient A experienced umbilical urine leakage with catheterization time intervals that exceeded 4 h. At 3 months after surgery, the bladder capacities of all patients ranged 250-370 ml. Follow-up cystography suggested the presence of bilateral ureteral reflux in patient A, with mild and moderate reflux on the left right sides, respectively. All patients achieved complete continence. Patients were followed for 3-9 months postoperatively; chest and abdominal computed tomography and cystography showed absence of hydronephrosis, recurrence, or distant metastasis during this period. The novel heterotopic continent ileal reservoir described in this study may be suitable for selected patients. The surgical procedure is safe when performed by well-trained and highly experienced urologists.

PMID:37841813 | PMC:PMC10570455 | DOI:10.3389/fsurg.2023.1202649

Permalink for 'Neighborhood-Level Socioeconomic Disadvantage Predicts Outcomes in Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy for Peritoneal Malignancy'

Neighborhood-Level Socioeconomic Disadvantage Predicts Outcomes in Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy for Peritoneal Malignancy

Fetched: October 13th, 2023, 5:00am GMT by Nolan M Winicki

Ann Surg Oncol. 2023 Nov;30(12):7840-7847. doi: 10.1245/s10434-023-14074-2. Epub 2023 Aug 24.

ABSTRACT

BACKGROUND: Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) improves survival in select patients with peritoneal metastases (PM), but the impact of social determinants of health on CRS/HIPEC outcomes remains unclear.

PATIENTS AND METHODS: A retrospective review was conducted of a multi-institutional database of patients with PM who underwent CRS/HIPEC in the USA between 2000 and 2017. The area deprivation index (ADI) was linked to the patient's residential address. Patients were categorized as living in low (1-49) or high (50-100) ADI residences, with increasing scores indicating higher socioeconomic disadvantage. The primary outcome was overall survival (OS). Secondary outcomes included perioperative complications, hospital/intensive care unit (ICU) length of stay (LOS), and disease-free survival (DFS).

RESULTS: Among 1675 patients 1061 (63.3%) resided in low ADI areas and 614 (36.7%) high ADI areas. Appendiceal tumors (n = 1102, 65.8%) and colon cancer (n = 322, 19.2%) were the most common histologies. On multivariate analysis, high ADI was not associated with increased perioperative complications, hospital/ICU LOS, or DFS. High ADI was associated with worse OS (median not reached versus 49 months; 5 year OS 61.0% versus 28.2%, P < 0.0001). On multivariate Cox-regression analysis, high ADI (HR, 2.26; 95% CI 1.13-4.50; P < 0.001), cancer recurrence (HR, 2.26; 95% CI 1.61-3.20; P < 0.0001), increases in peritoneal carcinomatosis index (HR, 1.03; 95% CI 1.01-1.05; P < 0.001), and incomplete cytoreduction (HR, 4.48; 95% CI 3.01-6.53; P < 0.0001) were associated with worse OS.

CONCLUSIONS: Even after controlling for cancer-specific variables, adverse outcomes persisted in association with neighborhood-level socioeconomic disadvantage. The individual and structural-level factors leading to these cancer disparities warrant further investigation to improve outcomes for all patients with peritoneal malignancies.

PMID:37620532 | PMC:PMC10592201 | DOI:10.1245/s10434-023-14074-2

Permalink for 'ASO Visual Abstract: Safety and Efficacy of Oxaliplatin Pressurized Intraperitoneal Aerosolized Chemotherapy (PIPAC) in Colorectal and Appendiceal Cancer with Peritoneal Metastases: Results of a Multicenter Phase I Trial in the United States'

ASO Visual Abstract: Safety and Efficacy of Oxaliplatin Pressurized Intraperitoneal Aerosolized Chemotherapy (PIPAC) in Colorectal and Appendiceal Cancer with Peritoneal Metastases: Results of a Multicenter Phase I Trial in the United States

Fetched: October 13th, 2023, 5:00am GMT by Mustafa Raoof

Ann Surg Oncol. 2023 Nov;30(12):7869-7870. doi: 10.1245/s10434-023-14109-8.

NO ABSTRACT

PMID:37598124 | DOI:10.1245/s10434-023-14109-8

Permalink for 'Contrast-enhanced ultrasonography findings of LAMNs with peritoneal and splenic metastases: a case report and literature review'

Contrast-enhanced ultrasonography findings of LAMNs with peritoneal and splenic metastases: a case report and literature review

Fetched: October 12th, 2023, 5:00am GMT by Mei Chen

Front Oncol. 2023 Sep 25;13:1238042. doi: 10.3389/fonc.2023.1238042. eCollection 2023.

ABSTRACT

Low-grade appendiceal mucinous neoplasms (LAMNs) are rare appendiceal tumors that are primarily diagnosed using computed tomography(CT) enhancement and magnetic resonance imaging (MRI). Herein, we report the sonographic features, especially for contrast-enhanced ultrasound (CEUS), of a 70-year-old female with an unusual LAMN metastasizing to the peritoneum and spleen. The patient had a right pelvic mass 2 days prior to presentation. Two-dimensional (2D) ultrasound revealed a mixed cystic-solid mass in the right lower abdomen and spleen parenchyma; CEUS showed heterogeneous enhancement in both areas, suspected to be a mucinous mass. CT enhancement and MRI findings revealed concurrent findings. Histopathologically, LAMN lesions were confirmed in the appendix, spleen, and peritoneum of the specimens obtained during exploratory laparoscopy. No recurrences were reported at three years postoperatively. LAMN lesions may metastasize to abdominal organs, and imaging examinations are essential for diagnosis. This study presents major ultrasonography and CEUS findings for the diagnosis of LAMNs.

PMID:37817772 | PMC:PMC10561767 | DOI:10.3389/fonc.2023.1238042

Efficacy of endoscopic ultrasound-guided pelvic abscess drainage for pelvic abscesses: A case series study

Fetched: October 10th, 2023, 5:01am GMT by Koichi Soga

Arab J Gastroenterol. 2023 Aug;24(3):149-154. doi: 10.1016/j.ajg.2023.07.003. Epub 2023 Sep 9.

ABSTRACT

BACKGROUND AND STUDY AIM: This is a retrospective study to evaluate the safety and efficacy of endoscopic ultrasound-guided pelvic abscess drainage (EUS-PAD) in a single hospital setting.

PATIENTS AND METHODS: The referral criteria for EUS-PAD included patients with a pelvic abscess (PA) that was amenable for the procedure. A total of 14 patients with PA treated with EUS-PAD were included in this study. The mean patient age was 57.4 years, and male-to-female ratio was 7:7. Overall, there were six cases of appendiceal perforation, five of rectal cancer and one case each of the diverticular perforation, perianal abscess, and walled-off necrosis.

RESULTS: Overall, 100% of procedures were successful. Clinical success was achieved in 11 patients and they were discharged after EUS-PAD within 21.4 days on an average and the average duration of stent placement before removal was 27.0 days. Of all, six patients achieved complete improvement status where the cause was appendiceal perforation while two and one of the patients were recovered where the causes were post-curative operation for carcinoma and walled-off necrosis, respectively. Eight out of eleven patients who exhibited appendiceal perforation or underwent radical rectal cancer surgery were discharged after an average of 9.4 days post EUS-PAD. Although two patients showed temporary improvement, with perianal abscess and controlled rectal carcinoma, the PA worsened as the primary disease intensified. The PA drainage was ineffective in three patients where two of them had uncontrolled rectal cancer and one had diverticular perforation.

CONCLUSION: Conclusively, the EUS-PAD is not only a reliable, safe, and efficient alternative to surgical and percutaneous drainage but also a valuable procedure with a high success rate for patients with acute infections, such as those who have had an appendiceal perforation or curative surgery. Poor indications and contraindications for EUS-PAD include uncontrolled gastrointestinal perforation and direct tumor invasion.

PMID:37689578 | DOI:10.1016/j.ajg.2023.07.003

Management of Metastatic Renal Clear Cell Cancer: ASCO Guideline Rapid Recommendation Update

Fetched: October 10th, 2023, 5:01am GMT by Eric A Singer

J Clin Oncol. 2023 Nov 20;41(33):5184-5186. doi: 10.1200/JCO.23.01977. Epub 2023 Oct 9.

ABSTRACT

ASCO Rapid Recommendation Updates highlight revisions to select ASCO guideline recommendations as a response to the emergence of new and practice-changing data. The rapid updates are supported by an evidence review and follow the guideline development processes outlined in the ASCO Guideline Methodology Manual. The goal of these articles is to disseminate updated recommendations, in a timely manner, to better inform health practitioners and the public on the best available cancer care options. See the Appendix for disclaimers and other important information (Appendix 1 and Appendix 2, online only).

PMID:37812756 | DOI:10.1200/JCO.23.01977

Low-Grade Appendiceal Mucinous Neoplasm: What Is the Best Treatment?

Fetched: October 10th, 2023, 5:01am GMT by Murat Guner

Cureus. 2023 Oct 6;15(10):e46591. doi: 10.7759/cureus.46591. eCollection 2023 Oct.

ABSTRACT

BACKGROUND: Low-grade appendiceal mucinous neoplasm (LAMN) is an uncommon tumor of the appendix that is usually diagnosed incidentally after surgery. Although LAMN may be asymptomatic, it can rupture and seed mucin and neoplastic epithelium into the peritoneum, causing pseudomyxoma peritonei (PMP).

MATERIALS AND METHODS: Data from 53 patients were retrospectively analyzed. Age, sex, tumor size, margin status, peritoneal carcinomatosis index, surgical procedures, postoperative results with histologic diagnosis, T stage, recurrence, and mortality of the patients were evaluated.

RESULTS: Appendectomy was performed in 37 patients, right hemicolectomy in nine patients, cytoreductive surgery in one patient, and cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in six patients. Recurrence occurred in four patients. Of the patients who developed recurrence, one patient had stage T4a disease, and the other three patients had T4b disease (p<0.001). Eighteen patients had acellular mucin in the serosa and four of these patients developed recurrence (p=0.004). Twelve patients had appendix perforation, and three of these patients had PMP on exploration (p<0.001). The mean survival time was 93.3 months in patients without recurrence and 32 months in patients with recurrence (p=0.021).

CONCLUSIONS: Low-grade appendiceal mucinous neoplasms are rare appendiceal tumors. The appropriate management of this tumor is controversial. T stage, appendix perforation, presence of acellular mucin on the serosa, and surgical margins are risk factors for the development of PMP. Appendectomy is considered sufficient when there are no risk factors for Tis (LAMN) and T3 disease. Right hemicolectomy may be sufficient if there are no risk factors for T4a disease, but cytoreductive surgery and hyperthermic intraperitoneal chemotherapy seem to be the most appropriate treatments in the presence of the stated risk factors for T4b disease.

PMID:37808597 | PMC:PMC10560074 | DOI:10.7759/cureus.46591

A wireless, battery-free device enables oxygen generation and immune protection of therapeutic xenotransplants in vivo

Fetched: October 8th, 2023, 5:01am GMT by Siddharth R Krishnan

Proc Natl Acad Sci U S A. 2023 Oct 3;120(40):e2311707120. doi: 10.1073/pnas.2311707120. Epub 2023 Sep 22.

ABSTRACT

The immune isolation of cells within devices has the potential to enable long-term protein replacement and functional cures for a range of diseases, without requiring immune suppressive therapy. However, a lack of vasculature and the formation of fibrotic capsules around cell immune-isolating devices limits oxygen availability, leading to hypoxia and cell death in vivo. This is particularly problematic for pancreatic islet cells that have high O2 requirements. Here, we combine bioelectronics with encapsulated cell therapies to develop the first wireless, battery-free oxygen-generating immune-isolating device (O2-Macrodevice) for the oxygenation and immune isolation of cells in vivo. The system relies on electrochemical water splitting based on a water-vapor reactant feed, sustained by wireless power harvesting based on a flexible resonant inductive coupling circuit. As such, the device does not require pumping, refilling, or ports for recharging and does not generate potentially toxic side products. Through systematic in vitro studies with primary cell lines and cell lines engineered to secrete protein, we demonstrate device performance in preventing hypoxia in ambient oxygen concentrations as low as 0.5%. Importantly, this device has shown the potential to enable subcutaneous (SC) survival of encapsulated islet cells, in vivo in awake, freely moving, immune-competent animals. Islet transplantation in Type I Diabetes represents an important application space, and 1-mo studies in immune-competent animals with SC implants show that the O2-Macrodevice allows for survival and function of islets at high densities (~1,000 islets/cm²) in vivo without immune suppression and induces normoglycemia in diabetic animals.

PMID:37738292 | PMC:PMC10556620 | DOI:10.1073/pnas.2311707120

The application of 3D brachytherapy in cervical stump cancer: A retrospective study

Fetched: October 7th, 2023, 5:01am GMT by Yuxuan Wang

J Contemp Brachytherapy. 2023 Aug;15(4):275-282. doi: 10.5114/jcb.2023.130898. Epub 2023 Aug 31.

ABSTRACT

PURPOSE: Cervical stump cancer is a carcinoma that grows on the cervical stump after a sub-total hysterectomy. There have been no studies on the application of 3D brachytherapy in cervical stump cancer. In the present study, we aimed to compare the curative effects, toxicity, and dosimetry of 3D and 2D brachytherapy in cervical stump cancer.

MATERIAL AND METHODS: Thirty-one patients admitted between 2012 and 2021, who were concurrently treated with intensity-modulated radiation therapy and brachytherapy for cervical stump cancer were divided into three groups according to the brachytherapy techniques: 2D brachytherapy, 3D image-guided brachytherapy (3D-IGBT), and 2D + 3D. For patients undergoing 2D brachytherapy and 3D-IGBT, data on survival, complications, and dose to target area or organs at risk (OARs) were collected and compared. Furthermore, dosimetry difference was investigated by reconstructing the 2D plan into a 3D plan.

RESULTS: The median follow-up duration of all patients was 58 months. The overall 5-year progression-free survival, overall survival, and local control rates were 69.6%, 90.2%, and 78.2%, respectively. Late complications in the rectum, sigmoid colon, and bladder were milder in 3D brachytherapy than in 2D brachytherapy. Concerning the D90 value of clinical target volume (CTV) and D2cm³ value of OARs in EQD2, the 3D brachytherapy provided a lower dose to CTV (76.5 Gy vs. 95.9 Gy, on average) and OARs compared with 2D brachytherapy.

CONCLUSIONS: Despite lacking statistical significance, 3D brachytherapy showed better outcomes regarding late toxicity than 2D brachytherapy, owing to the lower dose coverage in the bladder, rectum, sigmoid colon, and small intestine.

PMID:37799122 | PMC:PMC10548426 | DOI:10.5114/jcb.2023.130898

A case of diffuse goblet cell adenocarcinoma of the appendix showing carcinoid-like expansion

Fetched: October 7th, 2023, 5:01am GMT by Daichi Yamakawa

Pathol Int. 2023 Oct;73(10):527-529. doi: 10.1111/pin.13363. Epub 2023 Sep 1.

NO ABSTRACT

PMID:37655540 | DOI:10.1111/pin.13363

Are Antibiotics the New Appendectomy?

Fetched: October 5th, 2023, 5:00am GMT by Janan Alajaimi

Cureus. 2023 Sep 1;15(9):e44506. doi: 10.7759/cureus.44506. eCollection 2023 Sep.

ABSTRACT

Prior to the development of laparoscopic procedures, open appendectomy was the standard of care for the majority of appendicitis cases. Recently, studies have debated using antibiotics as a first-line treatment in uncomplicated appendicitis cases. The definition of uncomplicated appendicitis is not always clear-cut; however, with the large-scale accessibility of radiologic techniques, it is becoming increasingly easier to classify patient groups. As suggested by clinical and radiological patient data, this has raised the speculation of considering antibiotic therapy as the sole treatment modality in uncomplicated appendicitis cases. We aim to compare the options of surgery and antibiotics only in terms of efficacy, complications, and financial cost. A range of databases and search strategies were adopted, and various databases were used, including PubMed, ScienceDirect, Google Scholar, and JAMA. Collectively, 30 studies were reviewed, but only 18 were included. Efficacy rates were higher in the appendectomy group. Nevertheless, the antibiotics-only group maintained an efficacy rate greater than 70% at one-year follow-up. Risk factors that decreased the efficacy in medical management included the presence of appendicolith, neoplasm, appendiceal dilatation, peri-appendiceal fluid collection, higher mean temperature, CRP, and bilirubin. Complications were more frequent and significant in the surgery group. These included complications related to anaesthesia, surgical site infections, damage to nearby structures, and pulmonary embolism. Despite several years of follow-up and disease recurrences, higher financial costs were observed in surgically treated patients compared to the antibiotics-only group. Given the high success rates post-appendectomy for acute appendicitis over the decades, the efficacy of conservatively treated acute appendicitis raises a strong argument when choosing one of the two options. The efficacy remained consistently higher across the literature in the surgery group than in the antibiotics-only group. However, it is still arguable that antibiotics may be a preferable option given an efficacy rate of more than 70% at one year and overall higher complications associated with surgery. The argument of missing a neoplasm by avoiding surgery is valid. However, most are carcinoid neuroendocrine neoplasms with a low probability of metastasis (<5%) and are usually considered benign. Given the current practice focused on conservative and minimally invasive treatments and recently the COVID-19 pandemic, with its restrictions and lessons learnt, antibiotics may be the future standard for treating uncomplicated acute appendicitis. Lastly, we noticed higher efficacy rates in articles published recently than those published at least five to ten years earlier. Antibiotics-only therapy for uncomplicated appendicitis is cost-effective with fewer complications than surgery. However, appendectomies have higher efficacy. Thus, surgical treatment prevails as the standard of care. Future literature should yield larger sample sizes and explore the numbers of emergency appendectomies mandated following antibiotics-only therapy.

PMID:37790034 | PMC:PMC10544542 | DOI:10.7759/cureus.44506

Permalink for 'Increased Incidence of Liver Metastases in Colorectal Versus Appendiceal Adenocarcinoma Peritonectomy Patients Despite Equivocal Survival'

Increased Incidence of Liver Metastases in Colorectal Versus Appendiceal Adenocarcinoma Peritonectomy Patients Despite Equivocal Survival

Fetched: October 3rd, 2023, 5:01am GMT by Celine Garrett

Anticancer Res. 2023 Oct;43(10):4657-4662. doi: 10.21873/anticanres.16661.

ABSTRACT

BACKGROUND/AIM: Colorectal adenocarcinoma (CRAdenoCa) and appendiceal adenocarcinoma (AAdenoCa) are diseases of the same histopathological type that metastasise to the liver and peritoneum. In selected subgroups, peritonectomy and heated intraperitoneal chemotherapy (HIPEC) may be indicated as part of the multimodal treatment plan. However, literature comparing the survival outcomes and preoperative tumour activity and burden of CRAdenoCa and AAdenoCa peritonectomy patients without synchronous liver metastases (sLM) is scarce. Little is also known about the comparative incidence of sLM and metachronous LM (mLM) between CRAdenoCa and AAdenoCa peritonectomy patients. This study aimed to clarify the above.

PATIENTS AND METHODS: A retrospective cohort study of 684 CRAdenoCa and AAdenoCa primary peritonectomy patients between 2001-2021 was conducted at St George Hospital in Sydney, Australia.

RESULTS: Median overall survival (years) was equivocal between CRAdenoCa and AAdenoCa peritonectomy patients (1.7 vs. 1.9, p=0.35). Peritoneal cancer index and preoperative carcinoembryonic antigen (CEA) were significantly elevated (25 vs. 9, p<0.0001 and 7.9 vs. 5, p=0.0080) in AAdenoCa versus CRAdenoCa peritonectomy patients without sLM. The incidence of sLM and mLM was increased in CRAdenoCa peritonectomy patients (24% vs. 3.1%, p<0.0001 and 26% vs. 10%, p=0.0001).

CONCLUSION: This study demonstrates similar survival outcomes between CRAdenoCa and AAdenoCa peritonectomy patients. Despite elevated preoperative tumour burden and biological activity in AAdenoCa patients, CRAdenoCa patients had higher rates of sLM and mLM. Further studies are warranted to validate and identify cellular and molecular targets that increase CRAdenoCa's ability to metastasise to the liver.

PMID:37772565 | DOI:10.21873/anticanres.16661

High Incidence of Appendiceal Neoplasms in the Elderly: A Critical Concern for Non-Surgical Treatment

Fetched: October 2nd, 2023, 5:01am GMT by Gizem Issin

Med Princ Pract. 2023 Oct 1. doi: 10.1159/000534347. Online ahead of print.

ABSTRACT

OBJECTIVE: Appendiceal neoplasms (ANs) are rare tumors that are often discovered incidentally during histopathological examinations. The increasing incidence of ANs is a critical issue in the non-operative management of acute appendicitis. This study aims to document the temporal trends over a twelve-year period by analyzing the clinical presentation, imaging findings, and histopathological features of ANs.

SUBJECTS AND METHODS: Health records of patients who underwent appendectomy from 2011 to 2022 were examined. Demographic and clinical data, laboratory results, imaging findings, and histopathological features were documented. The characteristics of both ANs and non-neoplastic cases were evaluated.

RESULTS: A total of 22,304 cases were identified, of which 330 (1.5%) were diagnosed with ANs. The odds ratio for ANs increased with age, with the highest odds ratio observed in patients aged 70 or older. Receiver Operating Characteristic analysis showed that age and appendiceal diameter were significant predictors of ANs. An optimal age cut-off point of 28.5 years was determined, yielding a sensitivity of 72% and a specificity of 64%. For appendiceal diameter, the optimal cut-off was found to be 9.5 mm, exhibiting a sensitivity of 77% and a specificity of 56%.

CONCLUSION: Although the incidence of ANs remains relatively low, a steady increase has been observed over the past decade. The increasing rate of ANs raises concerns regarding non-surgical management options. The results of this study highlight the importance of considering ANs as a potential diagnosis in older patients and in patients with an appendix diameter greater than 9.5 mm. These findings may have implications for treatment and management.

PMID:37778333 | DOI:10.1159/000534347

Permalink for 'Issues in Assigning the T Category in the Staging of Low-Grade Appendiceal Mucinous Neoplasm and High-Grade Appendiceal Mucinous Neoplasm'

Issues in Assigning the T Category in the Staging of Low-Grade Appendiceal Mucinous Neoplasm and High-Grade Appendiceal Mucinous Neoplasm

Fetched: September 30th, 2023, 5:01am GMT by Sarah E Umetsu

Arch Pathol Lab Med. 2023 Oct 1;147(10):1107a-1107. doi: 10.5858/arpa.2023-0069-LE.

NO ABSTRACT

PMID:37756595 | DOI:10.5858/arpa.2023-0069-LE

Permalink for 'Low-grade appendiceal mucinous neoplasm encountered during risk-reducing salpingo-oophorectomy: A case of laparoscopic surgery'

Low-grade appendiceal mucinous neoplasm encountered during risk-reducing salpingo-oophorectomy: A case of laparoscopic surgery

Fetched: September 30th, 2023, 5:01am GMT by Katsuyuki Konnai

J Obstet Gynaecol Res. 2023 Dec;49(12):2975-2978. doi: 10.1111/jog.15802. Epub 2023 Sep 28.

ABSTRACT

Low-grade appendiceal mucinous neoplasm (LAMN) is a rare epithelial malignancy of the appendix. If it perforates the abdominal cavity, it can cause a serious clinical syndrome called pseudomyxoma peritonei. In the present case, we laparoscopically removed a LAMN encountered during risk-reducing salpingo-oophorectomy (RRSO). The patient was a 53-year-old woman who was diagnosed with hereditary breast and ovarian cancer syndrome. RRSO was planned, and magnetic resonance imaging revealed a large cystic tumor in the right lower abdomen. We expected an ovarian cyst; however, it was a primary tumor of the appendix. Partial cecal resection was performed laparoscopically by a surgical oncologist. The pathological diagnosis was LAMN. Gynecologists may encounter this disease incidentally. Mucinous appendiceal neoplasm (MAN) may be encountered during RRSO. If a right lower abdominal mass is found near a normal ovary preoperatively, gynecologists should consider MAN as well as paraovarian cyst.

PMID:37771102 | DOI:10.1111/jog.15802

Surgery of peritoneal surface malignancies - surgical cytoreduction and hyperthermic intraperitoneal chemotherapy

Fetched: September 29th, 2023, 5:01am GMT by Gergely Huszty

Magy Onkol. 2023 Sep 28;67(3):247-258. Epub 2023 Sep 12.

ABSTRACT

Peritoneal carcinosis has historically been considered as inoperable, although the technique of its resesection together with high dose intraperitoneal chemotherapy potentiated by heat has been described decades ago. It has not became a widely practiced routine except in specialized centers - the complex technique, weakly standardized but resource demanding chemotherapy, lacking financial background and the many times questionable clinical benefit at a cost of high surgical load might have been the key factors. Refined technology, developing chemotherapy protocols together with growing clinical evidence are now more sharply delineating the range of indications where the procedure might be beneficial, increases survival, or is the only curative therapy. These include tumors of the appendix and pseudomyxoma peritonei, mesothelioma, and selected cases of ovarian, colorectal and gastric cancer. In addition to technical description of the intervention, we summarize the currently valid indications and describe our institutional protocol for the treatment of appendiceal malignancies.

PMID:37768120

Struma Ovarii with Papillary Thyroid Carcinoma and Metastasis to the Appendix: A Case Report and Literature Review

Fetched: September 28th, 2023, 5:01am GMT by Samuel Addisu Abera

Int Med Case Rep J. 2023 Sep 21;16:571-578. doi: 10.2147/IMCRJ.S432333. eCollection 2023.

ABSTRACT

Struma ovarii is an infrequent type of teratoma arising from the ovary accounting for only 2% of all ovarian teratomas. These tumors have a benign biology with rare malignant transformation in about 3% of cases. The most common malignant transformation that arises from struma ovarii is papillary thyroid carcinoma. These neoplasms act in the same way as those arising from the thyroid gland, but due to the rarity of their occurrence there is still a debate over therapeutic options. We present a case of a 41-year-old Ethiopian Para IX woman presented with abdominal swelling for four years, accompanied by dull pain, satiety, and weight loss. Her vital signs were normal, and her abdominal examination revealed a large abdominopelvic mass. Her CA-125 was elevated, and her blood count, organ function tests, and serum electrolyte levels were normal. Abdominal ultrasound revealed a complex abdominopelvic mass with cystic and solid components, possibly ovarian teratoma. The patient underwent surgery, revealing a 14 by 10 cm right ovarian mass and a 3×3 cm appendiceal mass. Subsequently, total abdominal hysterectomy, bilateral salpingo-oophorectomy, total omentectomy, and appendectomy was done. Histopathologic evaluation revealed follicular proliferation of enlarged cells, with no papillary growth pattern. The case was diagnosed as malignant struma ovarii, a follicular variant of papillary thyroid carcinoma (FVPTC) with secondary deposits on the appendix. A complete thyroidectomy was done after the histopathology diagnosis. Malignant struma ovarii is rare making it challenging to treat since there are no established prognosticating histopathologic or clinical characteristics. The tumor size and metastasis determine the surgical treatment scope. Large-scale investigations are essential for prognostication and treatment options considering pathologic traits.

PMID:37753203 | PMC:PMC10519172 | DOI:10.2147/IMCRJ.S432333

Permalink for 'Multi-institutional assessment of the prevalence of neuroendocrine tumors in children undergoing laparoscopic appendectomy for acute appendicitis in the United States'

Multi-institutional assessment of the prevalence of neuroendocrine tumors in children undergoing laparoscopic appendectomy for acute appendicitis in the United States

Fetched: September 27th, 2023, 5:01am GMT by Suhail Zeineddin

Pediatr Blood Cancer. 2023 Nov;70(11):e30620. doi: 10.1002/pbc.30620. Epub 2023 Aug 9.

ABSTRACT

As non-operative management of acute appendicitis in children has become more common, missed incidental appendiceal pathology can be an unintended consequence. We assessed the prevalence of neuroendocrine tumors in appendectomy specimens from eight US children's hospitals from 2012 to 2021. The prevalence of neuroendocrine tumors (NET) was found to be 1:271, with a median age of 14 years and 62% female. Most tumors were small (median 6 mm; interquartile range [IQR]: 3-10), and no recurrence was noted during the follow-up period (median 22.5 months; IQR: 3-53). The possibility of delayed diagnosis of these tumors should be part of the discussion for non-operative management of pediatric acute appendicitis.

PMID:37555297 | DOI:10.1002/pbc.30620

Determinants of Outcome with Reoperative Surgery for Pseudomyxoma Peritonei in 186 Patients

Fetched: September 26th, 2023, 5:01am GMT by Paul H Sugarbaker

Ann Surg Open. 2023 Sep 15;4(3):e335. doi: 10.1097/AS9.0000000000000335. eCollection 2023 Sep.

ABSTRACT

OBJECTIVE: To describe the long-term survival and clinical- and treatment-related variables that determine the outcome of repeat cytoreductive surgery (CRS) for mucinous appendiceal neoplasms with peritoneal dissemination.

SUMMARY BACKGROUND: After patients with peritoneal dissemination of an appendiceal mucinous neoplasm have a CRS, disease progression may require secondary cytoreductive surgery (SCRS) and other treatments performed in a timely manner to prolong survival and help preserve an optimal quality of life.

METHODS: The clinical- and treatment-related variables associated with the index CRS and the SCRS were statistically assessed for their impact on survival.

RESULTS: One hundred eighty-six of 687 complete CRS patients (27.1%) had SCRS. The median follow-up was 10 years and the median survival was 12 years. There were 95 males (51%) and the median age was 45.0 years. Survival benefit was associated with the index CRS by use of early postoperative intraperitoneal chemotherapy (EPIC) with 5-fluorouracil [Hazard ratio (HR), 0.4; P = 0.0004]. Also, survival of low-grade mucinous appendiceal neoplasms versus mucinous appendiceal adenocarcinoma (HR, 2.8; P < 0.0001) was improved. The interval between index CRS and SCRS was significant at ≤12 months versus 12-36 months versus >36 months (P < 0.0001). Change in peritoneal cancer index and disease distribution as focal or diffuse was significant by univariant and multivariant analyses.

CONCLUSIONS: If the CRS was complete, the use of EPIC 5-fluorouracil, the interval between the index CRS and the SCRS, the histologic grade of the mucinous neoplasm, and the extent of recurrent disease were prognostic variables that should be used to help select patients for SCRS.

PMID:37746617 | PMC:PMC10513308 | DOI:10.1097/AS9.0000000000000335

Fragmentation of Care in Patients with Peritoneal Metastases Undergoing Cytoreductive Surgery

Fetched: September 23rd, 2023, 5:01am GMT by Mason Vierra

Ann Surg Oncol. 2023 Sep 22. doi: 10.1245/s10434-023-14318-1. Online ahead of print.

ABSTRACT

BACKGROUND: The delivery of multimodal treatment at a high-volume center is known to optimize the outcomes of gastrointestinal malignancies. However, patients undergoing cytoreductive surgery (CRS) for peritoneal metastases often must 'fragment' their surgical and systemic therapeutic care between different institutions. We hypothesized that this adversely affects outcomes.

PATIENTS AND METHODS: Adults undergoing CRS for colorectal or appendiceal adenocarcinoma at our institution between 2016 and 2022 were identified retrospectively and grouped by care network: 'coordinated care' patients received exclusively in-network systemic therapy, while 'fragmented care' patients received some systemic therapy from outside-network providers. Factors associated with fragmented care were also ascertained. Overall survival (OS) from CRS and systemic therapy-related serious adverse events (SAEs) were compared across the groups.

RESULTS: Among 85 (80%) patients, 47 (55%) had colorectal primaries and 51 (60%) received fragmented care. Greater travel distance [OR 1.01 (CI 1.00-1.02), p = 0.02] and educational status [OR 1.04 (CI 1.01-1.07), p = 0.01] were associated with receiving fragmented care. OS was comparable between patients who received fragmented and coordinated care in the colorectal [32.5 months versus 40.8 months, HR 0.95 (CI 0.43-2.10), p = 0.89] and appendiceal [31.0 months versus 27.4 months, HR 1.17 (CI 0.37-3.74), p = 0.55] subgroups. The frequency of SAEs (7.8% versus 17.6%, p = 0.19) was also similar.

CONCLUSIONS: There were no significant differences in survival or SAEs based on the networks of systemic therapy delivery. This suggests that patients undergoing CRS at a high-volume center may safely receive systemic therapy at outside-network facilities with comparable outcomes.

PMID:37737968 | DOI:10.1245/s10434-023-14318-1

Site-specific trends in gastroenteropancreatic neuroendocrine neoplasms in Bavaria, Germany

Fetched: September 23rd, 2023, 5:01am GMT by Nina Grundmann

Cancer Med. 2023 Oct;12(19):19949-19958. doi: 10.1002/cam4.6510. Epub 2023 Sep 22.

ABSTRACT

INTRODUCTION: Neuroendocrine neoplasms (NEN) are rare and heterogeneous epithelial tumors, occurring throughout the body. For gastroenteropancreatic (GEP)-NEN, rising incidence rates were reported for the last decades, with underlying causes remaining largely unexplained. We evaluated NEN trends stratifying by their histologic subtypes.

METHODS: Incident cases of GEP-NEN diagnosed between 2005 and 2019 were retrieved from the prospective, population-based Bavarian Cancer Registry. GEP-NEN were divided in their histologic subtypes, that is, neuroendocrine tumors (NET) G1, NET G2/G3, other NET versus small-cell neuroendocrine carcinoma (NEC), large-cell NEC, and other NEC. We calculated annual age-standardized incidence rates (ASIRs) per 100,000 persons for the total of GEP-NEN, NEN histologic subtypes, and tumor sites. We used an annual percentage change (APC) approach including a joinpoint analysis to investigate NEN incidence trends.

RESULTS: ASIR of GEP-NEN rose from 2.2 in 2005 to 4.8 in 2019, characterized by a significant increase until 2012 (APC 2005-2012: 10.1%), followed by modest rise (APC 2012-2019: 1.5%). In the last decade, this increase was mainly driven by the rise of NET G1 and G2/G3, while incidence for NEC declined. Over the study period, ASIR increased significantly for all GEP-sites except the colon. APCs were largest for the stomach, the appendix, the pancreas, and the rectum.

CONCLUSIONS: This study found a significant increase in the incidence of GEP-NET. Though this development may partially be attributable to the increased use of advanced detection techniques and changes in NEN classification, further research should also focus on the identification of NEN risk factors.

PMID:37737059 | PMC:PMC10587981 | DOI:10.1002/cam4.6510

Incidence of appendiceal neoplasms in appendectomy patients

Fetched: September 23rd, 2023, 5:01am GMT by Ricardo E Núñez-Rocha

BMC Surg. 2023 Sep 21;23(1):287. doi: 10.1186/s12893-023-02183-4.

ABSTRACT

BACKGROUND: Non-operative management has been suggested as a therapy for uncomplicated appendicitis. Notwithstanding, the risk of missing an appendiceal tumor must be considered, being the surgical piece crucial to rule out neoplasms. Therefore, we aim to determine the incidence of appendiceal neoplasms in patients with acute appendicitis, tumor types and the importance of the anatomopathological study of the surgical piece.

STUDY DESIGN: Retrospective study in which we described patients who underwent emergent appendectomy with histopathological findings of appendiceal neoplasms from January 2012 to September 2018. Descriptive analysis included demographic variables, diagnostic methods, and surgical techniques.

RESULTS: 2993 patients diagnosed with acute appendicitis who underwent an emergency appendectomy. 64 neoplasms of the appendix were found with an incidence of 2,14%. 67.2% were women, the mean age was 46,4 years (± 19.5). The most frequent appendiceal neoplasms were neuroendocrine tumors (42,2%), followed by appendiceal mucinous neoplasms (35,9%), sessile serrated adenomas (18,8%), and adenocarcinomas (3,1%). In 89,1% of the cases, acute appendicitis was determined by imaging, and 14% of cases were suspected intraoperatively. Appendectomy was performed in 78,1% without additional procedures.

CONCLUSIONS: Appendiceal tumors are rare and must be ruled out in patients with suspected acute appendicitis. The incidence of incidental neoplasms is higher in this study than in the previously reported series. This information must be included in decision-making when considering treatment options for acute appendicitis.

PMID:37735406 | PMC:PMC10512515 | DOI:10.1186/s12893-023-02183-4

Validation of the Absent-Cell Theory for Staging Mucinous Appendiceal Cancer

Fetched: September 21st, 2023, 5:00am GMT by Frederick L Greene

Ann Surg Oncol. 2023 Oct;30(11):6299-6300. doi: 10.1245/s10434-023-13877-7. Epub 2023 Jul 15.

NO ABSTRACT

PMID:37454015 | DOI:10.1245/s10434-023-13877-7

Permalink for 'One-Lung Ventilation and Postoperative Pulmonary Complications After Major Lung Resection Surgery. A Multicenter Randomized Controlled Trial'

One-Lung Ventilation and Postoperative Pulmonary Complications After Major Lung Resection Surgery. A Multicenter Randomized Controlled Trial

Fetched: September 21st, 2023, 5:00am GMT by Federico Piccioni

J Cardiothorac Vasc Anesth. 2023 Dec;37(12):2561-2571. doi: 10.1053/j.jvca.2023.04.029. Epub 2023 Apr 27.

ABSTRACT

OBJECTIVES: The effect of one-lung ventilation (OLV) strategy based on low tidal volume (TV), application of positive end-expiratory pressure (PEEP), and alveolar recruitment maneuvers (ARM) to reduce postoperative acute respiratory distress syndrome (ARDS) and pulmonary complications (PPCs) compared with higher TV without PEEP and ARM strategy in adult patients undergoing lobectomy or pneumonectomy has not been well established.

DESIGN: Multicenter, randomized, single-blind, controlled trial.

SETTING: Sixteen Italian hospitals.

PARTICIPANTS: A total of 880 patients undergoing elective major lung resection.

INTERVENTIONS: Patients were randomized to receive lower tidal volume (LTV group: 4 mL/kg predicted body weight, PEEP of 5 cmH2O, and ARMs) or higher tidal volume (HTL group: 6 mL/kg predicted body weight, no PEEP, and no ARMs). After OLV, until extubation, both groups were ventilated using a tidal volume of 8 mL/kg and a PEEP value of 5 cmH2O. The primary outcome was the incidence of in-hospital ARDS. Secondary outcomes were the in-hospital rate of PPCs, major cardiovascular events, unplanned intensive care unit (ICU) admission, in-hospital mortality, ICU length of stay, and in-hospital length of stay.

MEASUREMENTS AND MAIN RESULTS: ARDS occurred in 3 of 438 patients (0.7%, 95% CI 0.1-2.0) and in 1 of 442 patients (0.2%, 95% CI 0-1.4) in the LTV and HTV group, respectively (Risk ratio: 3.03 95% CI 0.32-29, p = 0.372). Pulmonary complications occurred in 125 of 438 patients (28.5%, 95% CI 24.5-32.9) and in 136 of 442 patients (30.8%, 95% CI 26.6-35.2) in the LTV and HTV group, respectively (risk ratio: 0.93, 95% CI 0.76-1.14, p = 0.507). The incidence of major complications, in-hospital mortality, and unplanned ICU admission, ICU and in-hospital length of stay were comparable in both groups.

CONCLUSIONS: In conclusion, among adult patients undergoing elective lung resection, an OLV with lower tidal volume, PEEP 5 cmH2O, and ARMs and a higher tidal volume strategy resulted in low ARDS incidence and comparable postoperative complications, in-hospital length of stay, and mortality.

PMID:37730455 | PMC:PMC10133024 | DOI:10.1053/j.jvca.2023.04.029

ASO Visual Abstract: Treatment Variation and Long-Term Outcomes of Low-Grade Appendiceal Neoplasms

Fetched: September 21st, 2023, 5:00am GMT by Michael G White

Ann Surg Oncol. 2023 Dec;30(13):8176. doi: 10.1245/s10434-023-13556-7.

NO ABSTRACT

PMID:37728822 | DOI:10.1245/s10434-023-13556-7

APPENDICEAL MUCINOUS NEOPLASMS: A CASE REPORT AND REVIEW OF LITERATURE

Fetched: September 20th, 2023, 5:01am GMT by Jia Wu

Gastroenterol Nurs. 2023 Sep 20. doi: 10.1097/SGA.0000000000000778. Online ahead of print.

NO ABSTRACT

PMID:37725797 | DOI:10.1097/SGA.0000000000000778

Treatment Variation and Long-Term Outcomes of Low-Grade Appendiceal Neoplasms

Fetched: September 14th, 2023, 5:00am GMT by Michael G White

Ann Surg Oncol. 2023 Dec;30(13):8138-8143. doi: 10.1245/s10434-023-13501-8. Epub 2023 Sep 13.

ABSTRACT

BACKGROUND: Heterogenous nomenclature describing appendiceal neoplasms has added to uncertainty around their appropriate treatment. Although a recent consensus has established the term low-grade appendiceal neoplasm (LAMN), we hypothesize that significant variation remains in the treatment of LAMNs.

METHODS: We retrospectively reviewed our prospectively maintained appendiceal registry, identifying patients with LAMNs from 2009 to 2019. We assessed variability in treatment, including whether patients underwent colectomy, spread of disease at presentation, and long-term outcomes.

RESULTS: Of 136 patients with LAMNs, 88 (35%) presented with localized disease and 48 (35%) with disseminated peritoneal disease. Median follow-up was 2.9 years (IQR 1.9-4.4), and 120 (88%) patients underwent pre-referral surgery. Among 26 pre-referral colectomy patients, 23 (88%) were performed for perceived oncologic need/nodal evaluation; no nodal metastases were identified. In patients with resected LAMNs without radiographic evidence of disseminated disease, 41 (47%) underwent second look diagnostic laparoscopy (DL) to evaluate for occult metastases. No peritoneal metastases were identified. Patients with disseminated disease were treated with cytoreductive surgery/heated intraperitoneal chemotherapy (CRS/HIPEC). For patients undergoing CRS/HIPEC, 5-year recurrence-free survival was 94% (95% CI 81-98%). For patients with localized disease, 5-year RFS was 98% (95% CI 85-99%).

CONCLUSIONS: Significant variation exists in treatment patterns for LAMNs, particularly prior to referral to a high-volume center. Patients frequently underwent colectomy without apparent oncologic benefit. In the current era of high-quality cross sectional imaging, routine use of DL has low yield and is not recommended. Recurrence in this population is rare, and low-intensity surveillance can be offered. Overall prognosis is excellent, even with peritoneal disease.

PMID:37702905 | DOI:10.1245/s10434-023-13501-8

Is It Worth Considering Colonic Evaluation After Appendicectomy?

Fetched: September 12th, 2023, 5:01am GMT by Ramprasad P Rajebhosale

Cureus. 2023 Aug 9;15(8):e43248. doi: 10.7759/cureus.43248. eCollection 2023 Aug.

ABSTRACT

Introduction The association of acute appendicitis with caecal or colorectal cancer is known. One of the proposed theories for acute appendicitis is luminal blockage by mass at the base of the appendix. There have been no national recommendations or guidelines for follow-up with patients aged 40 and older after an emergency appendicectomy. The purpose of this study was to evaluate the prevalence of caecal and colonic cancer or polyps in patients over the age of 40 who have undergone an appendicectomy. This shall enable us to develop the necessary strategies to investigate and diagnose associated caecal and colonic pathology in acute appendicitis to prevent delayed diagnosis of colon cancer. Methods All patients who underwent appendicectomy between October 2011 and October 31, 2021, and who were 40 years of age or older were included in this retrospective cohort study. Patients aged 40 to 54 years old and patients 55 years or older underwent subgroup analyses. We looked at any investigations of the colon (CT pneumocolon or colonoscopy) within three years before the appendicectomy or three years after an appendicectomy. All colorectal cancers diagnosed within five years of the index episode of appendicitis were included in the analysis. Results A total of 1076 appendicectomies were performed on patients aged 40 and older during the study period of 10 years. A total of 769 patients were confirmed to have appendicitis on histology. One hundred and fifty-seven patients had colonic investigations within three years of the diagnosis of acute appendicitis. In our study, 51 of the 769 patients (6.63%) were found to have colorectal neoplasms. Eight patients (8/769, 1.04%) were diagnosed with colorectal cancers, and the occurrence of caecal cancer was 0.26% (2/769). The mortality rate was 75% (6/8) in these patients diagnosed with colorectal cancer. Four out of six died due to advanced metastatic colonic cancer. In comparison to patients aged 40 to 54, patients over the age of 55 had a statistically significant increased risk of caecal pathology (polyp and cancer) (p = 0.07). Conclusion There seems to be an increased risk of significant colorectal neoplasm in patients over the age of 55 who are admitted with acute appendicitis, and there appears to be an increased severity with a poor prognosis of cancer in these individuals. We recommend the use of routine colonoscopy or CT pneumocolon, particularly for those over the age of 55 who present with acute appendicitis or the histology of appendicular neoplasms.

PMID:37692620 | PMC:PMC10491947 | DOI:10.7759/cureus.43248

De novo germline pathogenic variant in Lynch Syndrome: A rare event or the tip of the iceberg?

Fetched: September 12th, 2023, 5:01am GMT by Clorinda Brignola

Tumori. 2023 Sep 11:3008916231197113. doi: 10.1177/03008916231197113. Online ahead of print.

ABSTRACT

Lynch Syndrome is an autosomal dominant cancer predisposition syndrome caused by germline pathogenic variants or epimutation in one of the DNA mismatch repair genes. De novo pathogenic variants in mismatch repair genes have been described as a rare event in Lynch Syndrome (1-5%), although the prevalence of de novo pathogenic variants in Lynch Syndrome is probably underestimated. The de novo pathogenic variant was identified in a 26-year-old woman diagnosed with an adenocarcinoma of the caecum with mismatch repair protein deficiency at immunohistochemistry and a synchronous neuroendocrine tumor of the appendix with normal expression of mismatch repair proteins. DNA testing revealed deletion of exon 6 of the MLH1 gene. It appeared to be a de novo event, as the deletion was not detected in the patient's parents. The presence of a mosaicism in the patient was excluded and haplotype analysis demonstrated the paternal origin of the chromosome harboring the deletion. The de novo deletion probably originated either from a very early postzygotic or a single prezygotic mutational event, or from a gonadal mosaicism. In conclusion, the identification of de novo pathogenic variants is crucial to allow proper genetic counseling and appropriate management of the patient's family.

PMID:37691472 | DOI:10.1177/03008916231197113

Incidental presentation of appendix neuroendocrine tumor: Long-term results from a single institution

Fetched: September 12th, 2023, 5:01am GMT by Marlen Süleyman

Ulus Travma Acil Cerrahi Derg. 2023 Sep;29(9):972-977. doi: 10.14744/tjtes.2023.78038.

ABSTRACT

BACKGROUND: Appendix neuroendocrine tumors (NETs) are the most common tumors of the appendix and are most often diagnosed incidentally. The aim of this study was to retrospectively evaluate appendix NETs diagnosed incidentally in our clinic.

METHODS: Of 8304 patients who underwent appendectomy with the diagnosis of acute appendicitis in Ankara Training and Re-search Hospital, General Surgery Clinic between January 2009 and January 2022, 33 had histopathology results evaluated as appendix NET, and a retrospective analysis was made of these cases. The patients were evaluated in terms of age, gender, tumor infiltration, tumor location, tumor size, surgical margin, tumor World Health Organization grade, surgery performed, lymph node metastasis, Ki67 index, number of mitosis, follow-up time, and survival.

RESULTS: The rate of appendix NET was found to be 0.4%. The 33 cases comprised 15 (45.5%) males and 18 (54.5%) females with a mean age of 35.48 years (range: 16-84 years). Positive surgical margin was determined in 1 (3.03%) case, in which right hemicolectomy was performed. All other cases were followed up after appendectomy. The median follow-up was 89 (7-145) months. No recurrence was observed in any case. Mortality developed during follow-up in one case due to non-tumoral causes.

CONCLUSION: Appendix NETs are generally asymptomatic and appear incidentally after appendectomy due to acute appendicitis. Appendix NETs diagnosed incidentally are generally below 2 cm and have a good prognosis.

PMID:37681719 | PMC:PMC10560821 | DOI:10.14744/tjtes.2023.78038

Permalink for 'Colorectal endoscopic submucosal dissection with a calibrated, small-caliber tip, transparent hood for tumors in the appendiceal orifice'

Colorectal endoscopic submucosal dissection with a calibrated, small-caliber tip, transparent hood for tumors in the appendiceal orifice

Fetched: September 12th, 2023, 5:01am GMT by Tatsuma Nomura

Dig Endosc. 2023 Sep;35(6):e123-e124. doi: 10.1111/den.14638. Epub 2023 Aug 1.

NO ABSTRACT

PMID:37526072 | DOI:10.1111/den.14638

European Neuroendocrine Tumor Society (ENETS) 2023 guidance paper for appendiceal neuroendocrine tumours (aNET)

Fetched: September 9th, 2023, 5:01am GMT by Gregory Kaltsas

J Neuroendocrinol. 2023 Oct;35(10):e13332. doi: 10.1111/jne.13332. Epub 2023 Sep 8.

ABSTRACT

The aim of the present guidance paper is to update the previous ENETS guidelines on well differentiated appendiceal neuroendocrine tumours (NET), providing practical guidance for the diagnosis and management of appendiceal NET (aNET); poorly differentiated neoplasms are dealt with in a separate guidance paper. This paper is structured on a question-answer format in order to also address controversial issues and areas where uncertainty regarding the management and follow-up of aNET exists. All recommendations are offered on the basis of the best available evidence, along with the authors' experiences in managing these neoplasms. Each recommendation for treatment will provide a level of evidence and grade of recommendation as per the GRADE system (adapted in Infectious Disease Society of United States Public Health Service grading system).

PMID:37682701 | DOI:10.1111/jne.13332

A Case of Low-Grade Appendiceal Mucinous Neoplasm That Led to Surgery After 12 Years of No Treatment

Fetched: September 8th, 2023, 5:01am GMT by Akihiro Makino

Cureus. 2023 Aug 6;15(8):e43024. doi: 10.7759/cureus.43024. eCollection 2023 Aug.

ABSTRACT

Low-grade appendiceal mucinous neoplasm (LAMN) is a relatively rare, non-invasive appendiceal tumor. We experienced a case of LAMN that led to surgery after 12 years of no treatment. Until now, LAMN has been reported to progress more slowly than other tumors, but there have been no reports of long-term follow-up of appendiceal tumors without treatment. Although the tumor had grown over the course of 12 years, there was no mixing or migration of other histological types, and it did not lead to pseudomyxoma peritonei. As this course is considered to be relatively rare, we report it along with a literature review.

PMID:37674965 | PMC:PMC10478797 | DOI:10.7759/cureus.43024

Prediction of Early Recurrence Following CRS/HIPEC in Patients With Disseminated Appendiceal Cancer

Fetched: September 5th, 2023, 5:01am GMT by Gopika SenthilKumar

J Surg Res. 2023 Dec;292:275-288. doi: 10.1016/j.jss.2023.06.054. Epub 2023 Sep 2.

ABSTRACT

INTRODUCTION: In patients with disseminated appendiceal cancer (dAC) who underwent cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC), characterizing and predicting those who will develop early recurrence could provide a framework for personalizing follow-up. This study aims to: (1) characterize patients with dAC that are at risk for recurrence within 2 y following of CRS ± HIPEC (early recurrence; ER), (2) utilize automated machine learning (AutoML) to predict at-risk patients, and (3) identifying factors that are influential for prediction.

METHODS: A 12-institution cohort of patients with dAC treated with CRS ± HIPEC between 2000 and 2017 was used to train predictive models using H2O.ai's AutoML. Patients with early recurrence (ER) were compared to those who did not have recurrence or presented with recurrence after 2 y (control; C). However, 75% of the data was used for training and 25% for validation, and models were 5-fold cross-validated.

RESULTS: A total of 949 patients were included, with 337 ER patients (35.5%). Patients with ER had higher markers of inflammation, worse disease burden with poor response, and received greater intraoperative fluids/blood products. The highest performing AutoML model was a Stacked Ensemble (area under the curve = 0.78, area under the curve precision recall = 0.66, positive predictive value = 85%, and negative predictive value = 63%). Prediction was influenced by blood markers, operative course, and factors associated with worse disease burden.

CONCLUSIONS: In this multi-institutional cohort of dAC patients that underwent CRS ± HIPEC, AutoML performed well in predicting patients with ER. Variables suggestive of poor tumor biology were the most influential for prediction. Our work provides a framework for identifying patients with ER that might benefit from shorter interval surveillance early after surgery.

PMID:37666090 | DOI:10.1016/j.jss.2023.06.054

Permalink for 'Epidemiologic characteristics and risk factors associated with overall survival for patients with mucinous colorectal cancer: A population-based study'

Epidemiologic characteristics and risk factors associated with overall survival for patients with mucinous colorectal cancer: A population-based study

Fetched: September 5th, 2023, 5:01am GMT by Jiao Jiang

World J Gastrointest Oncol. 2023 Aug 15;15(8):1461-1474. doi: 10.4251/wjgo.v15.i8.1461.

ABSTRACT

BACKGROUND: Mucinous adenocarcinoma (MC) has attracted much attention as a distinct histologic subtype of colorectal cancer in recent years. However, data about its epidemiologic and prognostic characteristics are limited. Therefore, patient data extracted from the National Cancer Institute's Surveillance, Epidemiology, and End Results Program were collected to analyze the epidemiologic and clinicopathological characteristics of MC.

AIM: To determine the epidemiologic and clinicopathological characteristics of MC.

METHODS: The incidence trend of MC was calculated through the Joinpoint Regression Program. Cox regression analyses were performed to identify prognostic factors associated with overall survival (OS). A nomogram was established to predict the survival probability of individual patients with MC.

RESULTS: We found that rates of MC decreased from 4.50/100000 in 2000 to 1.54/100000 in 2018. Rates of MCs in patients aged ≤ 50 years decreased 2.27%/year during 2000-2018. The incidence of appendiceal MCs increased from 0.14/100000 in 2000 to 0.24/100000 in 2018, while the incidence in other anatomic subsites continued to decrease. On multivariable Cox analyses, age, race, tumor site, T stage, N stage, M stage, surgery, and chemotherapy were associated with OS. A nomogram was developed based on these factors, and the area under the curve for 1-year, 3-year, and 5-year OS in the training cohort was 0.778, 0.778, and 0.768, respectively.

CONCLUSION: Our results demonstrated that MC incidence decreased in almost all anatomic subgroups except for the appendix. A nomogram predicting the survival probability of patients with MCs showed good performance.

PMID:37663939 | PMC:PMC10473928 | DOI:10.4251/wjgo.v15.i8.1461

Permalink for 'Exploring the Relationship: Low-Grade Appendiceal Mucinous Neoplasms (LAMN) and Mucinous Adenocarcinoma as Phases of the Same Disease Spectrum'

Exploring the Relationship: Low-Grade Appendiceal Mucinous Neoplasms (LAMN) and Mucinous Adenocarcinoma as Phases of the Same Disease Spectrum

Fetched: August 29th, 2023, 5:00am GMT by Lance D Miller

Ann Surg Oncol. 2023 Nov;30(12):6976-6977. doi: 10.1245/s10434-023-14076-0. Epub 2023 Aug 28.

NO ABSTRACT

PMID:37639030 | DOI:10.1245/s10434-023-14076-0

Permalink for 'ASO Visual Abstract: Patterns of Recurrence in Appendix Cancer After Complete Cytoreduction and Hyperthermic Intraperitoneal Chemotherapy'

ASO Visual Abstract: Patterns of Recurrence in Appendix Cancer After Complete Cytoreduction and Hyperthermic Intraperitoneal Chemotherapy

Fetched: August 28th, 2023, 5:01am GMT by Andrei Nikiforchin

Ann Surg Oncol. 2023 Nov;30(12):7874-7875. doi: 10.1245/s10434-023-14236-2.

NO ABSTRACT

PMID:37635191 | DOI:10.1245/s10434-023-14236-2

Patterns of Recurrence in Appendix Cancer After Complete Cytoreduction and Hyperthermic Intraperitoneal Chemotherapy

Fetched: August 28th, 2023, 5:01am GMT by Andrei Nikiforchin

Ann Surg Oncol. 2023 Nov;30(12):7848-7857. doi: 10.1245/s10434-023-14145-4. Epub 2023 Aug 26.

ABSTRACT

BACKGROUND: It is thought that low-grade (LG) appendiceal cancer (AC) demonstrates predominantly intraperitoneal recurrence (IPR) after cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS/HIPEC), whereas high-grade (HG) tumors progress both intra- and extraperitoneally (EPR). However, evidence supporting this conception is lacking; therefore, we assessed recurrence in various AC histologies.

METHODS: A retrospective, cohort study was conducted by using a single-center database (1998-2022). Recurrence patterns (IPR, EPR, combined) were identified for LG, HG, high-grade with signet ring cells (SRC), and goblet cell carcinoma (GCC).

RESULTS: We included 432 complete (CC-0/1) CRS/HIPECs: 200 LG, 114 HG, 72 SRC, and 46 GCC. Median follow-up was 78 (95% confidence interval [CI] 70-86) months. Overall, 34% (n = 148) of patients recurred. IPR was the most common (LG 16%, HG 27%, SRC 36%, GCC 26%) with median time to recurrence (MTR) of 21 (IQR: 12-40) months. EPR (liver, lung, pleura, lymph nodes, or bones) occurred in LG 3%, HG 9%, SRC 22%, and GCC 7%. MTR was 11 (IQR: 4-16) months. Combined pattern occurred in LG 0%, HG 8%, SRC 7%, and GCC 0%. MTR was 13 (IQR: 7-18) months. Iterative surgery was performed in 53% IPR, 18% EPR, and 51% combined. Median post-recurrence survival was longer after IPR compared with EPR and combined recurrence: 36 (95% CI 25-47) versus 13 (95% CI 7-19) and 18 (95% CI 6-30) months (p < 0.01).

CONCLUSIONS: After complete CRS/HIPEC, IPR was the predominant pattern in all AC histologies and occurred later. Post-recurrence survival after IPR was longer. Knowing AC recurrence patterns can help to understand its biology and plan follow-up and post-relapse management.

PMID:37633853 | DOI:10.1245/s10434-023-14145-4

Defining a role for systemic chemotherapy in local and advanced appendix adenocarcinoma

Fetched: August 26th, 2023, 5:01am GMT by M C Strach

ESMO Open. 2023 Oct;8(5):101619. doi: 10.1016/j.esmoop.2023.101619. Epub 2023 Aug 24.

ABSTRACT

BACKGROUND: Appendix adenocarcinomas (AAs) are rare tumours that often present late, with a propensity for peritoneal metastases (PMs). This study aimed to evaluate outcomes of AA patients undergoing cytoreductive surgery (CRS) with curative intent and determine the role of systemic chemotherapy.

MATERIALS AND METHODS: Data were collected from a prospective database and classified according to World Health Organization (WHO) 2019 classification. Tumour clearance from CRS was described using a completeness of cytoreduction (CC) score ranging from 0 [no residual disease (RD)] to 3 (>2.5 cm RD). Patients with CC0-2 CRS received hyperthermic intraperitoneal chemotherapy (HIPEC). Systemic chemotherapy was categorised as 'prior' (>6 months before), 'neoadjuvant' (<6 months before), 'adjuvant' (<6 months after CC0-1 CRS) or 'palliative' (after CC2-3 CRS). Analyses used Kaplan-Meier and Cox regression methods.

RESULTS: Between January 2005 and August 2021, 216 AA patients were identified for inclusion. Median age was 59 years (21-81 years). CRS/HIPEC was carried out in 182 (84%) patients, of whom 164/182 (76%) had mitomycin C HIPEC. CC0-1 was achieved in 172 (80%) patients. Systemic chemotherapy was given to 97 (45%) patients from the whole cohort and to 37/46 (80%) patients with positive nodes. Median overall survival (OS) was 122 months (95% confidence interval 61-182 months). After multivariate analysis, patients with acellular and lower-grade PM had similar OS to those with localised (M0) disease (P = 0.59 and P = 0.19). For patients with positive nodes, systemic chemotherapy was associated with reduced risk of death compared to no chemotherapy (P < 0.0019).

CONCLUSION: This study identifies AA patients with positive lymph nodes derive the most benefit from systemic chemotherapy. We confirm the prognostic importance of stage and peritoneal grade, with excellent outcomes in patients with acellular mucin and lower-grade PM.

PMID:37625193 | PMC:PMC10619141 | DOI:10.1016/j.esmoop.2023.101619

ASO Author Reflections: Let's Redouble Efforts to Stop Peritoneal Recurrence in All Types of Appendix Cancer

Fetched: August 26th, 2023, 5:01am GMT by Andrei Nikiforchin

Ann Surg Oncol. 2023 Nov;30(12):7865-7866. doi: 10.1245/s10434-023-14160-5. Epub 2023 Aug 25.

NO ABSTRACT

PMID:37624519 | DOI:10.1245/s10434-023-14160-5

Extent of Disease on Visceral Peritoneal Surfaces of Mucinous Appendiceal Neoplasms Controls Survival

Fetched: August 22nd, 2023, 5:00am GMT by Paul H Sugarbaker

Ann Surg Open. 2022 Sep 7;3(3):e193. doi: 10.1097/AS9.0000000000000193. eCollection 2022 Sep.

ABSTRACT

OBJECTIVE: To determine causes of treatment failure of low-grade appendiceal mucinous neoplasms (LAMN).

BACKGROUND: For 3 decades, LAMN have been treated by cytoreductive surgery (CRS) and perioperative intraperitoneal chemotherapy. This combined treatment has resulted in a large change in the survival of these patients.

METHODS: A retrospective review of a prospectively maintained database was performed. A restricted cohort of patients with only LAMN histology and complete CRS were included in the statistical analysis.

RESULTS: Four hundred and fifty patients were available with a median follow-up of 15.3 years (range 10-35 years). The median age was 49.7 and there were 196 males (43.6%). The mean survival was 24.5 years. Extent of parietal peritonectomy, resection of uterus, ovaries and apex of vagina had no impact on survival. Variables that indicated an increased extent of disease on visceral peritoneal surfaces had a significant impact on survival. Early postoperative intraperitoneal chemotherapy with 5-fluorouracil did not augment hyperthermic intraperitoneal chemotherapy (HIPEC). Patients who required reoperation for recurrence or patients with class 4 adverse events had a reduced prognosis.

CONCLUSIONS: The mean survival of LAMN treated by complete CRS and perioperative chemotherapy was 24.5 years. Extent of disease quantitated on visceral peritoneal surfaces by the extent of visceral resections was the variable associated with treatment failure. Peritonectomy plus HIPEC was able to control disease on parietal peritoneal surfaces. Not only a larger extent of disease but also its location on visceral peritoneal surfaces controlled survival.

PMID:37601148 | PMC:PMC10431514 | DOI:10.1097/AS9.0000000000000193

Lung cancer in nonsmokers- A risk factor analysis

Fetched: August 21st, 2023, 5:01am GMT by Denise Albano

Cancer Epidemiol. 2023 Oct;86:102439. doi: 10.1016/j.canep.2023.102439. Epub 2023 Aug 18.

ABSTRACT

INSTITUTIONS: STONY BROOK MEDICAL CENTERRATIONALE: Lung Cancer screening for the high-risk smoking population has been proven to save lives. However, in 2022, 20% of newly diagnosed lung cancers (47,300) were in nonsmokers. These patients were found to be diagnosed at later stages. This may be at least partly due to not meeting criteria for and participating in current lung cancer screening. This study aims to describe characteristics of a never smoker patient population to help identify common risk factors which might merit inclusion in lung cancer screening and thus improve patient outcomes.

METHODS: This retrospective single center study included never-smoker patients diagnosed with lung nodules and never-smoker patients diagnosed with lung cancer from 2016 to 2022. Data was obtained from the Stony Brook Medical Center electronic medical record. 16,056 patients were identified as never-smokers who were asked by the medical assistant if they ever smoked in their lifetime. Patients were eliminated if they had any smoking history up to first diagnosis date. Demographics, radiology, histology, diagnosis dates, comorbidities, smoking status, and exposures collected through ICD10 codes and not self-reported, were investigated.

RESULTS: Of 16,056 never-smoking patients, 9315 (58.02%) were females diagnosed with lung nodules and 6741 (41.98%) were males diagnosed with lung nodules. The univariate analysis showed significant differences between gender, age at nodule diagnosis, and patients with and without comorbidities including chronic obstructive pulmonary disease (COPD), hypertension (HTN), and family history (FHX) of lung cancer. The percentage of lung cancer patients among females was significantly higher than among males. Patients having lung cancer were older. The percentages of lung cancer patients with these comorbidities were significantly higher than those without. However, there was no significant difference found between patients with and without diabetes mellitus (DM). The multivariable logistic regression suggested that age at nodule diagnosis and comorbidities including COPD (which included asthma, emphysema and chronic bronchitis) and family history of lung cancer were significantly associated with lung cancer. Older patients and patients with those comorbidities had a higher risk of developing cancer than those who were younger or without those comorbidities. The study excluded HTN and included age at nodule diagnosis in the logistic regression model as HTN was found to be protective against lung cancer due to age at lung nodule diagnosis. Please refer to the appendix for further details.

CONCLUSION: Never-smoker patients who were older and with COPD and Family History of lung cancer had higher risk of developing lung cancer than younger patients without these comorbidities. In this study, gender had no impact on outcome.

PMID:37598649 | DOI:10.1016/j.canep.2023.102439

Oncological aspect of incidental appendectomy with regard to histopathological findings: A retrospective cohort study

Fetched: August 20th, 2023, 5:00am GMT by Ante Tavra

Eur J Surg Oncol. 2023 Oct;49(10):107013. doi: 10.1016/j.ejso.2023.107013. Epub 2023 Aug 11.

ABSTRACT

INTRODUCTION: The aim of this retrospective cohort study was to describe the findings on histopathological examination of removed, macroscopically non-diseased, vermicular appendix during another primary surgical procedure (incidental appendectomy (IA)). Previous studies disapproved IA but were based on the possibility of complicated appendicitis. We observed the prevalence of neoplasms of the appendix in IA versus the appendectomy performed due to acute appendicitis (AA).

METHODS: The database of histopathology reports of the Surgery Department, University Hospital of Split was reviewed in the period from January 1, 2017, to December 31, 2021. A total of 2832 histopathology reports were reviewed.

RESULTS: There was no difference in gender distribution between these two groups, but AA had a statistically significantly lower median patient age compared to the group IA (40 vs. 68 years; P < 0.001). In the AA group, there were 84.5% acute appendicitis, 11.1% normal appendiceal reports, 3.2% appendiceal neoplasms, and 1.2% other pathologies. The group IA had 89.5% normal findings of the appendix, 7.2% appendiceal neoplasms, and 0.5% other pathology. The difference in neoplasm prevalence between IA and AA groups was 4.0% (95%CI: 2.2 to 5.8), P < 0.001. The number of incidental appendectomies needed to detect one neoplasm of the appendix is 25.

CONCLUSION: Incidental appendectomies in patients undergoing abdominal surgery revealed a relatively high prevalence of appendiceal neoplasms above the age of 60 years. Prospective studies about incidental appendectomies, their clinical consequences, and impact on prognosis should be performed to define the value of incidental appendectomy in those patients.

PMID:37597285 | DOI:10.1016/j.ejso.2023.107013

Deep-learning based detection of vessel occlusions on CT-angiography in patients with suspected acute ischemic stroke

Fetched: August 18th, 2023, 5:01am GMT by Gianluca Brugnara

Nat Commun. 2023 Aug 15;14(1):4938. doi: 10.1038/s41467-023-40564-8.

ABSTRACT

Swift diagnosis and treatment play a decisive role in the clinical outcome of patients with acute ischemic stroke (AIS), and computer-aided diagnosis (CAD) systems can accelerate the underlying diagnostic processes. Here, we developed an artificial neural network (ANN) which allows automated detection of abnormal vessel findings without any a-priori restrictions and in <2 minutes. Pseudo-prospective external validation was performed in consecutive patients with suspected AIS from 4 different hospitals during a 6-month timeframe and demonstrated high sensitivity (≥87%) and negative predictive value (≥93%). Benchmarking against two CE- and FDA-approved software solutions showed significantly higher performance for our ANN with improvements of 25-45% for sensitivity and 4-11% for NPV (p ≤ 0.003 each). We provide an imaging platform ( [https:] ) for online processing of medical imaging data with the developed ANN, including provisions for data crowdsourcing, which will allow continuous refinements and serve as a blueprint to build robust and generalizable AI algorithms.

PMID:37582829 | PMC:PMC10427649 | DOI:10.1038/s41467-023-40564-8

Patterns in Cancer Incidence Among People Younger Than 50 Years in the US, 2010 to 2019

Fetched: August 17th, 2023, 5:01am GMT by Benjamin Koh

JAMA Netw Open. 2023 Aug 1;6(8):e2328171. doi: 10.1001/jamanetworkopen.2023.28171.

ABSTRACT

IMPORTANCE: Emerging data suggest that the incidence of early-onset cancers, defined as cancers diagnosed in people younger than 50 years, is increasing, but updated data are limited.

OBJECTIVE: To characterize the patterns in the incidence of early-onset cancers in the US from 2010 to 2019 and provide granular data on the cancers with the fastest-growing incidence rates.

DESIGN, SETTING, AND PARTICIPANTS: This population-based cohort study analyzed data from 17 National Cancer Institute Surveillance, Epidemiology, and End Results registries from January 1, 2010, to December 31, 2019. Age-standardized incidence rates per 100 000 people were extracted for early-onset cancers, with rates age adjusted to the US standard population. A total of 562 145 patients with early-onset cancer between 2010 and 2019 were identified and included. Data were analyzed from October 16, 2022, to May 23, 2023.

MAIN OUTCOMES AND MEASURES: Primary outcomes were incidence rates and descriptive epidemiological data for people younger than 50 years with cancer. The annual percentage change (APC) of the age-standardized incidence rate was estimated using the Joinpoint regression program.

RESULTS: Among 562 145 patients (324 138 [57.7%] aged 40-49 years; 351 120 [62.5%] female) with early-onset cancer, 4565 (0.8%) were American Indian or Alaska Native, 54 876 (9.8%) were Asian or Pacific Islander, 61 048 (10.9%) were Black, 118 099 (21.0%) were Hispanic, 314 610 (56.0%) were White, and 8947 (1.6%) were of unknown race and/or ethnicity. From 2010 to 2019, the age-standardized incidence rate of early-onset cancers increased overall (APC, 0.28%; 95% CI, 0.09%-0.47%; P = .01) and in female individuals (APC, 0.67%; 95% CI, 0.39%-0.94%; P = .001) but decreased in male individuals (APC, -0.37%; 95% CI, -0.51% to -0.22%; P < .001). In contrast, the age-standardized incidence rate of cancers in individuals aged 50 years and older decreased over the study period (APC, -0.87%; 95% CI, -1.06% to -0.67%; P < .001). In 2019, the highest number of incident cases of early-onset cancer were in the breast (n = 12 649). From 2010 to 2019, gastrointestinal cancers had the fastest-growing incidence rates among all early-onset cancer groups (APC, 2.16%; 95% CI, 1.66%-2.67%; P < .001). Among gastrointestinal cancers, those with the fastest-growing incidence rates were in the appendix (APC, 15.61%; 95% CI, 9.21%-22.38%; P < .001), intrahepatic bile duct (APC, 8.12%; 95% CI, 4.94%-11.39%; P < .001), and pancreas (APC, 2.53%; 95% CI, 1.69%-3.38%; P < .001).

CONCLUSIONS AND RELEVANCE: In this cohort study, the incidence rates of early-onset cancer increased from 2010 to 2019. Although breast cancer had the highest number of incident cases, gastrointestinal cancers had the fastest-growing incidence rates among all early-onset cancers. These data may be useful for the development of surveillance strategies and funding priorities.

PMID:37585204 | PMC:PMC10433086 | DOI:10.1001/jamanetworkopen.2023.28171

A case of low-grade intestinal-type mucinous neoplasm of the fallopian tube with KRAS exon 2 mutation

Fetched: August 17th, 2023, 5:01am GMT by Kiyotaka Nagahama

Gynecol Oncol Rep. 2023 Aug 3;49:101252. doi: 10.1016/j.gore.2023.101252. eCollection 2023 Oct.

ABSTRACT

Several types of mucinous lesions of the fallopian tube have been reported, including metaplastic and neoplastic lesions, most of which exhibit gastric phenotypes. Here, we report a unique case of a mucinous tumor arising in the right fallopian tube of a 36-year-old female who presented with refractory abdominal pain for approximately one year. Abdominal CT and MRI found a cystic lesion leading to the diagnosis of hematosalpinx, thus right salpingo-oophorectomy and appendectomy were performed. Macroscopic findings included cystic dilatation of the distal portion of the right fallopian tube, filled with gelatinous mucin. Histologically, mucinous columnar cells proliferated in papillary configurations in the cystic region without invasion, resembling low-grade appendiceal mucinous neoplasms. Immunohistochemical analysis revealed that the neoplastic cells expressed CDX-2 and SATB2, but not WT-1, PAX8, ER, PgR, or claudin 18. Sanger sequencing of the mucinous lesion identified a KRAS exon 2 mutation (p.G12A), confirming similar pathologic and genetic characteristics to ovarian mucinous borderline tumors. This rare low grade intestinal-type mucinous tumor indicates the fallopian tube epithelium can give rise to tumors resembling low-grade appendiceal mucinous neoplasms and cause pseudomyxoma peritonei without appendiceal lesions.

PMID:37583589 | PMC:PMC10424131 | DOI:10.1016/j.gore.2023.101252

Safety and feasibility of right colectomy via a transvaginal approach: early experience from a single center

Fetched: August 16th, 2023, 5:01am GMT by Y Xiao

Zhonghua Wei Chang Wai Ke Za Zhi. 2023 Jun 25;26(6):588-594. doi: 10.3760/cma.j.cn441530-20221020-00422.

ABSTRACT

Objective: To investigate the safety and feasibility of performing right colectomy via a transvaginal approach. Methods: This was a retrospeltive cohort study. Data of 30 patients who had undergone transvaginal laparoscopic right colectomy (transvaginal group) and 23 women who had undergone laparoscopic right colectomy (laparoscopic group) from January 2019 to March 2022 in the Division of Colorectal Surgery, Department of General Surgery, Peking Union Medical College Hospital were collected retrospectively. The inclusion criteria for the transvaginal group were as follows: (1) post-menopausal woman; (2) transverse diameter of the tumor < 6 cm; and (3) diagnosis of benign polyps that were unresectable by endoscopy, mucinous tumors of the appendix, or confirmed right colon cancer not requiring D3 lymphadenectomy. The inclusion criteria for the laparoscopic group were as follows: (1) pathologically confirmed adenocarcinoma or high-grade intraepithelial neoplasia; (2) lesion located from the cecum to the right third of the transverse colon; and (3) clinically stage T1-4NanyM0. The exclusion criteria for the laparoscopic group were as follows: (1) distant metastasis discovered during surgical exploration; (2) multiple organ resection required or R0 resection not possible; or (3) conversion to open surgery required. Safety was evaluated on the basis of intra- and post-operative complications. Feasibility was assessed by postoperative recovery and quality of operative specimen. The body mass index was lower in the transvaginal than the laparoscopic group (22.0±3.1 kg/m² vs. 24.1±2.6 kg/m², t=2.617, P=0.012). Results: Among the 30 transvaginal laparoscopic right colectomies, 26 were pure transvaginal surgeries, three required laparoscopic assistance because of difficulties with anastomosis (n=2) or abdominal adhesions (n=1), and one required conversion to laparoscopic surgery because of vascular injury. Compared with the laparoscopic group, the transvaginal group had a longer surgery time (175.0 [147.5, 216.3] minutes vs. 120.0 [100.0, 120.0] minutes, U=63.000, P<0.001) and more blood loss (30.0 [10.0, 50.0] ml vs. 23.0 [10.0, 20.0] ml, U=208.000, P=0.011). The incidence of intraoperative complications (16.7% [5/30) vs. 0, P=0.061] was comparable between the two groups. In the transvaginal group, the sites of intraoperative injuries were bladder (n=3), ileocecal artery (n=1), and right uterine artery (n=1). The incidence of postoperative complications (20.0% [6/30] vs. 17.4% [4/23], χ²<0.001,P>0.999) was also comparable between the two groups. Clavien-Dindo grade III postoperative complications occurred in two patients in the transvaginal group (one patient had a pelvic hematoma that required embolization; the other had a vesico-vaginal fistula that required surgery). Postoperative visual analogue scale scores were significantly lower (P<0.001) in the transvaginal group. Times to first flatus, ambulation, and first intake and duration of postoperative hospital stay were comparable between the two groups (P>0.05). The proportion of specimens of moderate quality was 83.3% (25/30) in the transvaginal group and 100% (23/23) in the laparoscopic group; this difference is not significant (P=0.061). Among patients who underwent D2 lymph node dissection, the number of lymph nodes examined was comparable between the transvaginal (n=23) and laparoscopic groups (n=7) (18 [15, 27] vs. 20 [16, 29], U=69.500, P=0.589). Conclusion: Transvaginal right colon surgery is associated with less postoperative pain than laparoscopic surgery, but is not yet the preferred alternative because of the incidence of surgical complications.

PMID:37583013 | DOI:10.3760/cma.j.cn441530-20221020-00422

Clinical features and outcomes of appendiceal neuroendocrine tumours: 10 year audit from the Irish NET Centre of Excellence

Fetched: August 15th, 2023, 5:00am GMT by Darragh Storan

J Neuroendocrinol. 2023 Oct;35(10):e13329. doi: 10.1111/jne.13329. Epub 2023 Aug 13.

ABSTRACT

Appendiceal neuroendocrine tumours (aNETs) are rare neoplasms of the gastrointestinal tract often diagnosed incidentally at the time of appendicectomy. Appendicectomy is considered curative in the majority of cases but guidelines recommend right-sided hemicolectomy (RHC) for those with specific high-risk features despite no data supporting a survival benefit. We performed a retrospective search of multi-disciplinary tumour board and pathology databases from 2012 to 2022 to identify cases of aNET treated at our centre. Follow-up data were obtained from the electronic healthcare records. A total of 142 cases of aNET were included for analysis. Mean age at presentation was 34, of which 76% were female and 92% of aNETs were located in the tip/middle of the appendix; 90% were grade 1, and 93% had R0 resection. Tumour size was <1 cm in 54%, 1-2 cm in 36%, >2 cm in 9%. A total of 43 patients (30%) underwent RHC with lymph node metastases identified in 16 (37%). Lymph node metastases were associated with tumour size >2 cm (p = .008) and higher tumour grade (p = .041) on multivariate analysis. For aNET 1-2 cm, lymph node metastases were identified in 7/22 who had RHC (32%) with tumour grade the only significant risk factor (p = .046). Distant metastases were identified in 2 cases (1%), diagnosed synchronously and associated with grade 2 tumours. Overall survival for those with lymph node metastases was 100% after a median 4 years. Progression-free survival was 93%, with a single case of disease progression associated with synchronous distant metastases at initial diagnosis. Lymph node metastases in aNET are associated with higher tumour grade and tumour size >2 cm. Disease progression in the setting of lymph node metastases is rare. The significance of lymph node metastases and need for completion RHC remains uncertain.

PMID:37574769 | DOI:10.1111/jne.13329

Appendiceal Neuroendocrine Neoplasms: A Comprehensive Review

Fetched: August 15th, 2023, 5:00am GMT by Renjith Padmanabhan Nair Sobha

J Comput Assist Tomogr. 2023 Aug 11. doi: 10.1097/RCT.0000000000001528. Online ahead of print.

ABSTRACT

Appendiceal neuroendocrine neoplasm (NEN) is the most common adult appendiceal malignant tumor, constituting 16% of gastrointestinal NENs. They are versatile tumors with varying morphology, immunohistochemistry, secretory properties, and cancer genomics. They are slow growing and clinically silent, to begin with, or present with features of nonspecific vague abdominal pain. Most acute presentations are attributed clinically to appendicitis, with most cases detected incidentally on pathology after an appendectomy. Approximately 40% of them present clinically with features of hormonal excess, which is likened to the functional secretory nature of their parent cell of origin. The symptoms of carcinoid syndrome render their presence clinically evident. However, slow growing and symptomatically silent in its initial stages, high-grade neuroendocrine tumors and neuroendocrine carcinomas of the appendix are aggressive and usually have hepatic and lymph node metastasis at presentation. This review article focuses on imaging characteristics, World Health Organization histopathological classification and grading, American Joint Committee on Cancer/Union or International Cancer Control, European Neuroendocrine Tumor Society staging, European Neuroendocrine Tumor Society standardized guidelines for reporting, data interpretation, early-stage management protocols, and advanced-stage appendiceal NENs. Guidelines are also set for the follow-up and reassessment. The role of targeted radiotherapy, chemotherapy, and high-dose somatostatin analogs in treating advanced disease are discussed, along with types of ablative therapies and liver transplantation for tumor recurrence. The search for newer location-specific biomarkers in NEN is also summarized. Regarding the varying aggressiveness of the tumor, there is a scope for research in the field, with plenty of data yet to be discovered.

PMID:37574653 | DOI:10.1097/RCT.0000000000001528

The Promise of Epigenetics Research in the Treatment of Appendiceal Neoplasms

Fetched: August 12th, 2023, 5:00am GMT by Luisa Ladel

Cells. 2023 Jul 29;12(15):1962. doi: 10.3390/cells12151962.

ABSTRACT

Appendiceal cancers (AC) are a rare and heterogeneous group of malignancies. Historically, appendiceal neoplasms have been grouped with colorectal cancers (CRC), and treatment strategies have been modeled after CRC management guidelines due to their structural similarities and anatomical proximity. However, the two have marked differences in biological behavior and treatment response, and evidence suggests significant discrepancies in their respective genetic profiles. In addition, while the WHO classification for appendiceal cancers is currently based on traditional histopathological criteria, studies have demonstrated that histomorphology does not correlate with survival or treatment response in AC. Due to their rarity, appendiceal cancers have not been studied as extensively as other gastrointestinal cancers. However, their incidence has been increasing steadily over the past decade, making it crucial to identify new and more effective strategies for detection and treatment. Recent efforts to map and understand the molecular landscape of appendiceal cancers have unearthed a wealth of information that has made it evident that appendiceal cancers possess a unique molecular profile, distinct from other gastrointestinal cancers. This review focuses on the epigenetic landscape of epithelial appendiceal cancers and aims to provide a comprehensive overview of the current state of knowledge of epigenetic changes across different appendiceal cancer subtypes, highlighting the challenges as well as the promise of employing epigenetics in the quest for the detection of biomarkers, therapeutic targets, surveillance markers, and predictors of treatment response and survival in epithelial appendiceal neoplasms.

PMID:37566041 | PMC:PMC10417136 | DOI:10.3390/cells12151962

Permalink for 'ASO Visual Abstract: Validation of the AJCC 8th Edition Staging System for Disseminated Appendiceal Cancer Patients Treated with Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy-A Multi-institutional Analysis'

ASO Visual Abstract: Validation of the AJCC 8th Edition Staging System for Disseminated Appendiceal Cancer Patients Treated with Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy-A Multi-institutional Analysis

Fetched: August 12th, 2023, 5:00am GMT by Gopika SenthilKumar

Ann Surg Oncol. 2023 Sep;30(9):5756-5757. doi: 10.1245/s10434-023-13829-1.

NO ABSTRACT

PMID:37423927 | DOI:10.1245/s10434-023-13829-1

Permalink for 'ASO Author Reflections: AJCC 8th Edition Performs Well in Predicting Outcomes Among Patients with Disseminated Appendiceal Cancer Undergoing CRS/HIPEC'

ASO Author Reflections: AJCC 8th Edition Performs Well in Predicting Outcomes Among Patients with Disseminated Appendiceal Cancer Undergoing CRS/HIPEC

Fetched: August 12th, 2023, 5:00am GMT by Gopika SenthilKumar

Ann Surg Oncol. 2023 Sep;30(9):5754-5755. doi: 10.1245/s10434-023-13740-9. Epub 2023 Jun 15.

NO ABSTRACT

PMID:37322281 | DOI:10.1245/s10434-023-13740-9

Evaluating the Surgical Management of Appendiceal Neoplasms Diagnosed following Appendicectomy

Fetched: August 10th, 2023, 5:00am GMT by A H Amir

Ir Med J. 2023 Jun 29;116(6):790.

NO ABSTRACT

PMID:37555426

Permalink for 'Immunoreactivity of HOXB13 in Neuroendocrine Neoplasms Is a Sensitive and Specific Marker of Rectal Well-Differentiated Neuroendocrine Tumors'

Immunoreactivity of HOXB13 in Neuroendocrine Neoplasms Is a Sensitive and Specific Marker of Rectal Well-Differentiated Neuroendocrine Tumors

Fetched: August 9th, 2023, 5:00am GMT by Jiri Soukup

Endocr Pathol. 2023 Sep;34(3):333-341. doi: 10.1007/s12022-023-09779-9. Epub 2023 Aug 8.

ABSTRACT

HoxB13 is a transcription factor involved in defining of posterior endodermal derivatives, including prostate and rectum. While it is used as a marker of prostatic adenocarcinoma, it has not been studied systematically in neuroendocrine neoplasms. Thus, we performed HoxB13 immunohistochemistry in tissue microarrays and the whole sections of 232 neuroendocrine neoplasms. These included 34 paragangliomas (PGs), 20 cauda equina neuroendocrine tumors (CENETs), 123 well-differentiated neuroendocrine tumors (WDNETs), and 55 neuroendocrine carcinomas (NECs). WDNETs were additionally analyzed with SATB2, and colorectal WDNETs with CDX2 and serotonin immunohistochemistry. In total, HoxB13 immunoreactivity was observed in 95% (19/20) CENETs, 10.6% (13/123) WDNETs, and 12.9% (7/54) NECs. No PGs were positive. Large intestine WDNETs expressed HoxB13 in 68.4% (13/19); five negative tumors originated in cecum and one in rectum. In rectum, 92.9% (13/14) WDNETs expressed HoxB13. HoxB13 was 92.9% sensitive and 100% specific, showing 100% positive predictive value for the rectal origin of WDNET. In NECs, HoxB13 was positive in 15.4% (2/13) GIT tumors and 80% (4/5) prostatic NECs, but in none of urinary bladder NECs (0/8). SATB2 was positive in 17.1% (21/123) WDNETs, including 78.9% (15/19) of colorectal WDNETs, 71.4% (5/7) appendiceal WDNETs, and 2.9% (1/34) small intestine WDNETs. All 4 SATB2-negative large bowel tumors originated in the cecum. When both markers combined, HoxB13+/SATB2+ immunoprofile was seen exclusively in rectal WDNETs (positive predictive value 100%), while HoxB13-/SATB2+ immunoprofile was highly suggestive of the appendiceal origin (positive predictive value 71.4%). Therefore, HoxB13 can be useful as an immunohistochemical marker of rectal WDNETs and prostatic NECs.

PMID:37552455 | DOI:10.1007/s12022-023-09779-9

Low incidence of occult colorectal carcinoma in a cohort of 150 consecutive patients with diverticular strictures

Fetched: August 9th, 2023, 5:00am GMT by Tara M Connelly

Surgery. 2023 Sep;174(3):487-491. doi: 10.1016/j.surg.2023.04.017. Epub 2023 Jun 7.

ABSTRACT

BACKGROUND: The symptoms of stricturing diverticulitis can overlap with those of colorectal cancer. Additionally, the stricture itself may mask a "hidden" colorectal cancer. We aimed to describe the demographics, operative details and outcomes, including occult colorectal cancer, in a cohort of consecutive resections for presumed diverticular strictures.

METHODS: In this single-center, retrospective cohort study, all patients undergoing resection for a presumed diverticular stricture between January 2010 and December 2015 were included. Preoperative imaging and colonoscopies were individually reviewed. Only patients with radiographically, endoscopically and/or intraoperatively benign-appearing strictures were included.

RESULTS: One hundred fifty patients (72.7% female, mean age = 70.4 ± 11.8 years, 62.7% elective) were included. Only 34 (22.7%) had a complete preoperative colonoscopy. In 95 (63.6% of cohort) patients, the stricture was non-traversable colonoscopically. Overall, 47 (31.3%) patients did not have complete preoperative imaging or a colonoscopy. In total, 53.3% were open procedures and 62% had non-diverted primary anastomosis. Eleven (14.7%) underwent resection of adjacent organs (5 appendixes/5 right colons/7 fallopian tubes ± ovaries/3 small bowel resections/2 partial cystectomies/1 spleen). The median length of stay was 7 (5, 12.5) days. Only 2 cancers (1.3% of patients) involving the stricture (1 invasive moderately differentiated sigmoid adenocarcinoma/1 lymphoma) were found. Three additional cancers were found in organs involved in the inflammatory process (20% of concomitantly resected organs, 1 ovarian carcinoma/1 leukemia in a lymph node/1 appendiceal tumor).

CONCLUSION: Despite approximately one-third of the cohort not having undergone successful preoperative colonoscopy or imaging, the rate of neoplasia involving diverticular strictures was only 1.3%. A relatively high cancer rate was found in concomitantly resected organs involved in the stricturing process.

PMID:37296056 | DOI:10.1016/j.surg.2023.04.017

Appendiceal cancer showing a submucosal tumor-like morphology in the ascending colon on colonoscopy: a case report

Fetched: August 8th, 2023, 5:01am GMT by Kurodo Koshino

J Surg Case Rep. 2023 Aug 4;2023(8):rjad390. doi: 10.1093/jscr/rjad390. eCollection 2023 Aug.

ABSTRACT

Few reports have described a submucosal tumor (SMT)-like colon tumor together with appendiceal cancer. Moreover, some appendiceal tumors may exhibit a cecal protuberance. Here, we report an uncommon case of appendiceal cancer with an SMT-like tumor, which was a protuberant lesion in the ascending colon. To our knowledge, this is the first report in Japan. Our case was a 50-year-old man with an ascending colon tumor presented at our hospital for further evaluation of this lesion. This was discovered as a cystic lesion near the ascending colon on colonoscopy. Our initial diagnosis was an ascending colon SMT-like tumor, and our treatment strategy was laparoscopic resection. The differential diagnosis was appendiceal cancer or mucocele. Postoperative pathological findings led to a diagnosis of adenocarcinoma of the appendix. The postoperative course was uneventful, and the patient was followed up with computed tomography and blood sampling on an outpatient basis.

PMID:37545788 | PMC:PMC10401314 | DOI:10.1093/jscr/rjad390

Permalink for 'Clinical benefits of FOLFOXIRI combined with bevacizumab for advanced-stage primary signet ring cell carcinoma of the appendix: A case report'

Clinical benefits of FOLFOXIRI combined with bevacizumab for advanced-stage primary signet ring cell carcinoma of the appendix: A case report

Fetched: August 7th, 2023, 5:01am GMT by Nana Huang

Medicine (Baltimore). 2023 Aug 4;102(31):e34412. doi: 10.1097/MD.0000000000034412.

ABSTRACT

RATIONALE: Signet-ring cell carcinoma, which is an infrequent type of colorectal cancer. Abdominal pain is the primary presenting complaint of patients with acute appendicitis. It is difficult to diagnose patients with appendiceal carcinomas accompanying with symptoms of acute appendicitis.

PATIENT CONCERNS: A 33-year-old female patient was admitted to our hospital, with chief complaints of "bilateral pelvic space-occupying lesions for 1 month, aggravated abdominal distension, and she accompanied with diarrhea for 3 days."

DIAGNOSIS: The patient was with primary signet ring cell carcinoma of the appendix, presented with acute appendicitis, as well as bilateral ovarian metastasis and peritoneal implantation metastasis.

INTERVENTIONS: She was then treated with irinotecan, oxaliplatin, calcium folinate, 5-FU combined with bevacizumab, surgical treatment, and postoperative adjuvant treatment with oxaliplatin, capecitabine regimen to consolidate the efficacy.

OUTCOMES: The patient is in good conditions, and postoperative adjuvant chemotherapy is in progress as well.

CONCLUSION: The outcomes highlighted the importance of strict histopathologic assessment for appendiceal adenocarcinoma, and provided new ideas for the diagnosis and treatment of advanced-stage signet ring cell carcinoma of the appendix.

PMID:37543827 | PMC:PMC10402943 | DOI:10.1097/MD.0000000000034412

Appendiceal neuroendocrine neoplasms and resection of the mesoappendix: a retrospective comparative study

Fetched: August 4th, 2023, 5:00am GMT by Ali Sarfarazi

Langenbecks Arch Surg. 2023 Aug 3;408(1):294. doi: 10.1007/s00423-023-03019-8.

ABSTRACT

PURPOSE: Incidental appendiceal neoplasms are identified in approximately 1% of the specimens of suspected appendicitis. The current institutional policy is to perform en bloc mesoappendix resection during routine laparoscopic appendicectomy allowing for staging, reducing the need for oncological right hemicolectomy (ORH). Herein, we review en bloc mesoappendicectomy in clinical practice and its effects on the rate of ORH.

METHODS: We reviewed all cases of appendicectomy performed at the Auckland City Hospital between 1 May 2014 and 31 May 2019. Clinical notes and histopathological reports were reviewed. All neoplasms, surgical techniques and the need for further surgery were analysed.

RESULTS: A total of 2455 appendicectomies were performed with an approximately similar number of procedures between the sexes and an overall median age of 31 years. Overall, 86% (n = 2098) of the specimens included resection of the mesoappendix, and 58 (2.4%) appendiceal neoplasms were identified. Of them, 33 (1.3%) specimens included neuroendocrine appendiceal neoplasms. Eleven (33%) patients with appendiceal neuroendocrine neoplasms were recommended ORH. One of these patients may have avoided additional surgery, whereas 3 (9.1%) patients with tumours of 10-20 mm avoided ORH because their mesoappendix was resected.

CONCLUSION: At our centre, there has been a significant change in the practice of mesoappendix resection, and we support resection of the mesoappendix during appendicectomy. The procedure is technically straightforward and safe, incurs no increases in costs or time, allows for accurate tumour staging and guides decisions regarding further surgical interventions.

PMID:37535180 | DOI:10.1007/s00423-023-03019-8

Discovery of a novel marker for human granulocytes and tissue macrophages: RTL1 revisited

Fetched: August 4th, 2023, 5:00am GMT by Sahar Mortezagholi

Cell Tissue Res. 2023 Oct;394(1):177-188. doi: 10.1007/s00441-023-03817-y. Epub 2023 Aug 3.

ABSTRACT

Here, retrotransposon-like 1 (RTL1) is introduced as a marker for circulating and tissue neutrophils, tissue macrophages, and tumor-associated macrophages (TAM) and neutrophils (TAN). Anti-RTL1 polyclonal and monoclonal antibodies were produced, and their reactivity was examined by Western blotting (WB), ELISA, and immunostaining of human normal and cancer tissues. The reactivity of the anti-RTL1 antibodies with peripheral blood leukocytes and a panel of hematopoietic cell lines was examined. The generated antibodies specifically detected RTL1 in the WB of the placenta and U937 cells. The polyclonal antibody showed excellent reactivity with tissue-resident macrophages, Hofbauer cells, alveolar and splenic macrophages, Kupffer cells, and inflammatory cells in the tonsil, appendix, and gallbladder. In vitro GM-CSF-differentiated macrophages also showed a high level of intracellular RTL1 expression. TAM and TAN also showed excellent reactivity with this antibody. Almost all circulating granulocytes but not lymphocytes or monocytes expressed RTL1 at their surface. Serial sections of the appendix stained with CD15 and RTL1 and placenta stained with CD68 and RTL1 showed a considerable overlap in RTL1 expression in CD15⁺ granulocytes and CD68⁺ macrophages. A small percentage of myelomonocytic cell lines was positive for surface RTL1, while promyelocytic, monocytic, megaloblastic, and lymphoblastic cell lines were negative. Endothelial cells of normal and cancer tissues highly expressed RTL1. RTL1 could be considered a new marker for different normal tissue macrophages, TAM, circulating and tissue neutrophils, and TAN.

PMID:37535101 | DOI:10.1007/s00441-023-03817-y

Permalink for 'Is the measurement of sarcopenia associated with oncological disease in patients undergoing cytoreductive surgery and hyperthermic intraperitoneal chemotherapy?'

Is the measurement of sarcopenia associated with oncological disease in patients undergoing cytoreductive surgery and hyperthermic intraperitoneal chemotherapy?

Fetched: August 2nd, 2023, 5:01am GMT by Adrian Hang Yue Siu

ANZ J Surg. 2023 Sep;93(9):2186-2191. doi: 10.1111/ans.18645. Epub 2023 Jul 31.

ABSTRACT

BACKGROUND: Peritoneal malignancies are challenging cancers to manage. While cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS and HIPEC), may offer a cure, it is a radical procedure associated with significant morbidity. Pre-emptive identification of deconditioned patients for optimization may mitigate surgical risk. However, the difficulty lies in identifying a cost-effective predictive tool. Recently, there has been interest in sarcopenia, which may occur due to malignancy. The purpose of this study was to assess the utility of sarcopenia at predicting post-operative outcomes.

METHODS: A quaternary-centre retrospective study of CRS and HIPEC patients (2017-2020), were conducted to determine the association between pre-operative sarcopenia on oncological (peritoneal carcinomatosis index (PCI)) and surgical outcomes (complications). Sarcopenia from lumbar CT-images were measured using Slice-o-matic™. Statistical differences were analysed using Mann-Whitney U and Chi-squared test.

RESULTS: Cohort analysis (n = 94) found 40% had sarcopenia, majority were female (53.2%), and average age of 55 years. The major pathologies was colorectal cancer (n = 39, 41.5%), appendix adenocarcinoma (n = 21, 22.3%), and pseudomyxoma peritonei (PMP) (n = 19, 20.2%). Sarcopenia was associated with decreased weight, 72.7 versus 82.2 kg (P = 0.014) and shorter survival, 1.4 versus 2.1 years (95% CI, 1.09-3.05, P = 0.032). Median PCI (excluding PMP) was 11 (6-18) and median PCI (only PMP) was 25 (11-32). Post-operatively, sarcopenia patients experienced more complications (72.5% vs. 64.8%, P = 0.001).

CONCLUSION: Pre-emptive identification of sarcopenia may be a useful prognostic indicator and predictor of post-operative outcomes in CRS and HIPEC. For oncological patients, sarcopenia may be an indicator of patients requiring targeted pre-operative rehabilitation, or advanced disease requiring further treatment.

PMID:37525364 | DOI:10.1111/ans.18645

Low grade appendiceal mucinous neoplasm metastatic to the ovary: A case report and intraoperative assessment guide

Fetched: August 1st, 2023, 5:01am GMT by Christine G T Nguyen

Int J Surg Case Rep. 2023 Aug;109:108563. doi: 10.1016/j.ijscr.2023.108563. Epub 2023 Jul 26.

ABSTRACT

INTRODUCTION: Incidence of low grade appendiceal mucinous neoplasm is increasing. Preoperatively, it may present similarly to primary ovarian malignancy. This case report describes a case of presumed ovarian malignancy with final pathologic diagnosis of low grade appendiceal mucinous neoplasm. We also propose several surgical strategies to approach this conundrum.

PRESENTATION OF CASE: A postmenopausal woman with abdominal pain was found to have a 30 cm abdominopelvic mass with elevated CA-125 and CEA presumably a primary ovarian malignancy. During surgical staging, intraoperative findings were notable for an appendiceal mass. Intraoperative surgical oncology consultation recommended appendectomy for diagnostic purposes. Following primary surgery and final pathologic diagnosis, she underwent cytoreductive surgery and hyperthermic intraperitoneal chemotherapy.

DISCUSSION: Low grade appendiceal mucinous neoplasm should be within the differential diagnosis of gynecologic surgeons when presented with a patient with large volume ascites and biopsy of acellular mucin. Intraoperatively, an abnormal appearing appendix with normal appearing gynecologic structures should trigger suspicion for appendiceal rather than ovarian origin. Preoperative symptoms, imaging studies, tumor markers, and frozen section pathology may not be able to differentiate between appendiceal and epithelial ovarian malignancies.

CONCLUSION: A recognition of mucinous material and abnormal appearing appendix should prompt the surgeon to consider performing an appendectomy to obtain primary pathologic diagnosis. A high level of suspicion could better optimize the patient for a joint case with the appropriate surgeons. Given the documented disguise of low grade appendiceal mucinous neoplasm as primary ovarian cancer and its increasing incidence, diagnosis and general understanding of treatment should be understood.

PMID:37524024 | PMC:PMC10400853 | DOI:10.1016/j.ijscr.2023.108563

Permalink for 'Appendectomy and Risk of Advanced Colorectal Neoplasia in Inflammatory Bowel Disease: A Nationwide Population-based Cohort Study'

Appendectomy and Risk of Advanced Colorectal Neoplasia in Inflammatory Bowel Disease: A Nationwide Population-based Cohort Study

Fetched: August 1st, 2023, 5:01am GMT by Anders Mark-Christensen

Inflamm Bowel Dis. 2023 Jul 31:izad141. doi: 10.1093/ibd/izad141. Online ahead of print.

ABSTRACT

BACKGROUND: The aim of this study was to examine the association between appendectomy and advanced colorectal neoplasia (aCRN) in patients with inflammatory bowel disease (IBD).

METHODS: Inflammatory bowel disease patients diagnosed in Denmark in the period 1977 to 2017 were identified from the Danish National Patient Registry. Inflammatory bowel disease patients who underwent appendectomy were matched with up to 10 IBD patients without appendectomy and followed until aCRN, death, or emigration. Absolute risks of aCRN were calculated, treating death and bowel resections as competing risks. Stratified Cox regression was used to calculate adjusted hazard ratios (aHRs) of aCRN, comparing IBD patients with appendectomy to IBD patients without appendectomy.

RESULTS: We identified 3789 IBD patients with appendectomy and 37 676 IBD patients without appendectomy. A total of 573 patients (1.4%) developed aCRN, with an absolute risk of aCRN at 20 years of 4.9% (95% confidence interval [CI], 2.9%-7.7%) for ulcerative colitis (UC) patients with appendectomy after UC diagnosis compared with 2.8% (95% CI, 2.3%-3.3%) for UC patients without appendectomy. Appendectomy after UC was associated with an increased rate of aCRN 5 to 10 years (aHR, 2.5; 95% CI, 1.1-5.5) and 10 to 20 years after appendectomy (aHR, 2.3; 95% CI, 1.0-5.5). Appendectomy prior to UC diagnosis was not associated with an increased rate of aCRN, and Crohn's disease was not associated with the rate of aCRN, regardless of timing or histological diagnosis of the appendix specimen.

CONCLUSIONS: Although appendectomy may have a positive effect on the clinical course of UC, our study suggests that this may come at the expense of a higher risk of aCRN.

PMID:37523678 | DOI:10.1093/ibd/izad141

Permalink for 'Diagnosis of Appendiceal Neuroendocrine Tumors Following Incidental Appendectomy During Benign Gynecologic Laparoscopic Surgeries: A Case Series'

Diagnosis of Appendiceal Neuroendocrine Tumors Following Incidental Appendectomy During Benign Gynecologic Laparoscopic Surgeries: A Case Series

Fetched: August 1st, 2023, 5:01am GMT by Paulina C Altshuler

Cureus. 2023 Jun 29;15(6):e41135. doi: 10.7759/cureus.41135. eCollection 2023 Jun.

ABSTRACT

Gastrointestinal neuroendocrine tumors, although relatively rare, are one of the most common appendiceal neoplasms. Patient symptoms can range from asymptomatic to acute appendicitis, and these tumors are often diagnosed after histopathological evaluation. This case series describes five separate cases of appendiceal neuroendocrine tumors diagnosed by histopathological review following incidental appendectomy during benign gynecologic laparoscopic surgeries at a single multispecialty group. Each case had a preoperative diagnosis of chronic pelvic pain. Intraoperatively, the appendix appeared scarred, adhered, or nodular. Two patients required a right laparoscopic hemicolectomy for the management of the appendiceal neuroendocrine tumor. As a result of these findings, it is recommended that the appendix be routinely evaluated during gynecologic surgeries and, if abnormal in appearance, appendectomy should be performed. Additionally, laparoscopic gynecologic surgeons should receive appendectomy training to aid with the early diagnosis and treatment of appendiceal neuroendocrine tumors.

PMID:37519598 | PMC:PMC10386790 | DOI:10.7759/cureus.41135

Positive Margin for Low-Grade Appendiceal Mucinous Neoplasms (LAMN): To Observe or to Reoperate?

Fetched: July 30th, 2023, 5:00am GMT by Hussein M Hariri

Ann Surg Oncol. 2023 Jul 30. doi: 10.1245/s10434-023-13972-9. Online ahead of print.

NO ABSTRACT

PMID:37516721 | DOI:10.1245/s10434-023-13972-9

Appendiceal Signet Ring Cell Carcinoma: An Atypical Cause of Acute Appendicitis-A Case Study and Review of Current Knowledge

Fetched: July 30th, 2023, 5:00am GMT by Branko Andjelkovic

Diagnostics (Basel). 2023 Jul 13;13(14):2359. doi: 10.3390/diagnostics13142359.

ABSTRACT

Appendiceal signet ring cell carcinoma (ASRCC) is a rare and aggressive form of appendiceal cancer, often presenting with nonspecific symptoms that overlap with acute appendicitis. Early diagnosis and appropriate management are crucial for improving patient outcomes in these rare malignancies. This case report and literature review aims to raise awareness among clinicians about ASRCC of the appendix as a cause of acute appendicitis and highlight the importance of considering this diagnosis in patients with atypical presentations or unexpected histopathological findings. We present a 65-year-old female patient with ASRCC who underwent successful surgical treatment and remains disease-free at the one-year follow-up. It also highlights the necessity of early detection and appropriate treatment in order to improve patient outcomes. In addition, a comprehensive literature review is provided, discussing the clinical presentation, histopathological characteristics, potential pathogenesis, treatment options, and prognosis of ASRCC.

PMID:37510102 | PMC:PMC10378069 | DOI:10.3390/diagnostics13142359

Sixteen Cases of Appendiceal Mucinous Neoplasm

Fetched: July 29th, 2023, 5:00am GMT by Tsutomu Iwata

Gan To Kagaku Ryoho. 2023 Jul;50(7):809-812.

ABSTRACT

Appendiceal mucinous neoplasm is a relatively rare disease. It is classified as mucinous adenocarcinoma(MACA)and low- grade appendiceal mucinous neoplasm(LAMN). We retrospectively evaluated 16 cases of appendiceal mucinous neoplasm (LAMN: 13 cases, MACA: 3 cases)that were surgically resected in our hospital between January 2010 and July 2021. There were 7 men and 9 women, with a median age of 61 years(27-85 years). The most common chief complaint was abdominal pain(12 patients), while 3 cases were incidental findings following medical checkups for other diseases and without a chief complaint. Colonoscopy was performed for 9 cases. Of these, 5 revealed abnormal findings. The preoperative diagnosis was appendicitis in 7 patients and appendiceal tumor in 8 patients. The surgical procedures were planned for 8 cases and performed as emergencies in 8 cases. The procedures included laparoscopic surgery(n=6)and laparotomy(n=10). The resection range included appendectomy(n=9), partial cecal resection(n=4), and ileocecal resection(n=3). Surgical margins were negative in all cases. Metastases were not observed in patients who underwent lymph node dissections (2 patients with MACA and 1 patient with LAMN). The median follow-up was 17 months(1-43 months). Recurrence including peritoneal pseudomyxoma was not detected in any of the patients.

PMID:37496226

Permalink for 'Appendiceal neoplasms in patients treated with antibiotics for acute appendicitis: secondary analysis of the CODA randomized clinical trial'

Appendiceal neoplasms in patients treated with antibiotics for acute appendicitis: secondary analysis of the CODA randomized clinical trial

Fetched: July 28th, 2023, 5:01am GMT by Writing Group for the CODA Collaborative

Br J Surg. 2023 Jul 27:znad240. doi: 10.1093/bjs/znad240. Online ahead of print.

NO ABSTRACT

PMID:37499092 | DOI:10.1093/bjs/znad240

Intraoperative predictors of appendiceal abnormalities in patients with mucinous ovarian neoplasms

Fetched: July 25th, 2023, 5:00am GMT by Melissa Lavecchia

Int J Gynaecol Obstet. 2023 Jul 24. doi: 10.1002/ijgo.15008. Online ahead of print.

ABSTRACT

OBJECTIVE: To evaluate intraoperative factors predicting appendiceal pathology during gynecologic oncology surgery for suspected mucinous ovarian neoplasms.

METHODS: We conducted a retrospective study on 225 patients with mucinous ovarian neoplasms who underwent surgery for an adnexal mass with concurrent appendectomy between 2000 and 2018. Regression analyses were used to evaluate intraoperative factors, such as frozen section of the ovarian mass and surgeon's impression of the appendix in predicting appendiceal pathology.

RESULTS: Most patients (77.8%) had a normal appendix on final pathology. Abnormal appendix cases (n = 26) included: metastasis from high-grade adenocarcinoma of the ovary (n = 1), neuroendocrine tumor of the appendix (n = 4), and low-grade appendiceal mucinous neoplasms (n = 26; 23 associated with a mucinous ovarian adenocarcinoma, 2 with a benign mucinous ovarian cystadenoma, and 1 with a borderline mucinous ovarian tumor). Combining normal intraoperative appearance of the appendix with benign or borderline frozen section yielded a negative predictive value of 85.1%, with 14.9% of patients being misclassified, and 6.0% having a neuroendocrine tumor or low-grade appendiceal neoplasm.

CONCLUSION: Benign or borderline frozen section of an ovarian mucinous neoplasm and normal appearing appendix have limited predictive value for appendiceal pathology. Appendectomy with removal of the mesoappendix should be considered in all cases of mucinous ovarian neoplasm, regardless of intraoperative findings.

PMID:37485684 | DOI:10.1002/ijgo.15008

Permalink for 'Does a Positive Appendiceal Resection Margin in Low-Grade Appendiceal Mucinous Neoplasms, Warrant Additional Surgery? Our Institution Experience and Literature Review'

Does a Positive Appendiceal Resection Margin in Low-Grade Appendiceal Mucinous Neoplasms, Warrant Additional Surgery? Our Institution Experience and Literature Review

Fetched: July 22nd, 2023, 5:00am GMT by Elsayed Ibrahim

Ann Surg Oncol. 2023 Jul 21. doi: 10.1245/s10434-023-13930-5. Online ahead of print.

ABSTRACT

BACKGROUND: Management of low-grade appendiceal mucinous neoplasm (LAMN) with positive resection margin is controversial. Some guidelines recommend surgical reexcision, whereas others recommend a conservative approach. The purpose of our study was to determine whether involvement of the resection margin by LAMN is a risk factor for local recurrence requiring additional surgery.

DESIGN: This is a retrospective study (January 2000-December 2020) of uncomplicated LAMNs with neoplastic epithelium or dissecting mucin at the resection margin. For cases treated with additional surgery, the presence of residual tumor was evaluated. Clinical follow-up was attained in all cases. We also conducted a literature review.

RESULTS: The study investigated 98 patients. Eight with median age of 67 (range: 45-91) years had a LAMN involving the resection margin (8.2%). Five of eight LAMNs (62.5%) with neoplastic epithelium at the margin underwent surgery, and no residual neoplasm was identified. The other three cases were followed conservatively, and no patient developed recurrence (follow-up: 18-69 months with a mean of 45 months). In a review of the literature, we identified 52 LAMNs with positive margin. Although three cases had acellular mucin and one residual LAMN in the reexcision specimen (7.7%), neither of these four cases or any of the other 46 followed conservatively had recurrence of disease.

CONCLUSIONS: These data suggest that for patients with uncomplicated LAMN confined to the appendix, the involvement of the appendiceal margin does not necessary lead to recurrence of LAMN, and a conservative management is a reasonable alternative.

PMID:37477747 | DOI:10.1245/s10434-023-13930-5

Management of Stage III Non-Small-Cell Lung Cancer: ASCO Guideline Rapid Recommendation Update

Fetched: July 21st, 2023, 5:01am GMT by Navneet Singh

J Clin Oncol. 2023 Sep 20;41(27):4430-4432. doi: 10.1200/JCO.23.01261. Epub 2023 Jul 20.

ABSTRACT

ASCO Rapid Recommendations Updates highlight revisions to select ASCO guideline recommendations as a response to the emergence of new and practice-changing data. The rapid updates are supported by an evidence review and follow the guideline development processes outlined in the ASCO Guideline Methodology Manual. The goal of these articles is to disseminate updated recommendations, in a timely manner, to better inform health practitioners and the public on the best available cancer care options. See the Appendix for disclaimers and other important information (Appendix 1 and Appendix 2, online only).

PMID:37471673 | DOI:10.1200/JCO.23.01261

Cancer Cachexia: ASCO Guideline Rapid Recommendation Update

Fetched: July 20th, 2023, 5:00am GMT by Eric J Roeland

J Clin Oncol. 2023 Sep 1;41(25):4178-4179. doi: 10.1200/JCO.23.01280. Epub 2023 Jul 12.

ABSTRACT

ASCO Rapid Recommendations Updates highlight revisions to select ASCO guideline recommendations as a response to the emergence of new and practice-changing data. The rapid updates are supported by an evidence review and follow the guideline development processes outlined in the ASCO Guideline Methodology Manual. The goal of these articles is to disseminate updated recommendations, in a timely manner, to better inform health practitioners and the public on the best available cancer care options. See the Appendix for disclaimers and other important information (Appendix 1 and Appendix 2, online only).

PMID:37467399 | DOI:10.1200/JCO.23.01280

Delayed perforation after endoscopic resection of a Peutz-Jeghers-type polyp arising from an inverted appendix

Fetched: July 20th, 2023, 5:00am GMT by Tomoya Ueda

Dig Endosc. 2023 Sep;35(6):793. doi: 10.1111/den.14639. Epub 2023 Aug 15.

NO ABSTRACT

PMID:37467374 | DOI:10.1111/den.14639

A case of ovarian carcinosarcoma with a germline pathogenic variant of BRCA2 involving a perforated appendix with an abscess

Fetched: July 19th, 2023, 5:00am GMT by Ayaka Saito

J Obstet Gynaecol Res. 2023 Jul 18. doi: 10.1111/jog.15736. Online ahead of print.

ABSTRACT

We report a case of rare and aggressive ovarian carcinosarcoma with a germline pathogenic BRCA2 variant. A patient with a history of breast cancer who developed an inflammatory ovarian tumor with peritonitis carcinomatosis involving the appendix suffered from cachexia. Following three cycles of weekly paclitaxel and carboplatin chemotherapy, emergency surgery was required owing to sepsis. Bilateral salpingo-oophorectomy, total hysterectomy, appendectomy, and small intestine adhesiolysis were performed. Histologically, the tumor comprised an admixture of carcinomatous and sarcomatous components, with involvement of the appendix, which had caused perforation and abscess formation. The final diagnosis was ovarian carcinosarcoma with a germline pathogenic BRCA2 variant, c.658_659del (p.Val220fs). The patient responded completely to adjuvant chemotherapy. A combination of chemotherapy and surgery might be beneficial to patients with ovarian carcinosarcoma and germline pathogenic BRCA2 variants with a poor general condition. This is the first report of ovarian carcinosarcoma with a germline pathogenic BRCA2 variant that responded favorably to chemotherapy.

PMID:37461372 | DOI:10.1111/jog.15736

The Impact of Germline Alterations in Appendiceal Adenocarcinoma

Fetched: July 18th, 2023, 5:01am GMT by Michael B Foote

Clin Cancer Res. 2023 Jul 14;29(14):2631-2637. doi: 10.1158/1078-0432.CCR-22-3956.

ABSTRACT

PURPOSE: More than 10% of assessed patients with appendiceal adenocarcinoma have a pathogenic (P) or likely pathogenic (LP) germline variant, including genes implicated in heritable gastrointestinal cancer syndromes, such as Lynch syndrome. We defined the clinical and molecular impact of heritable alterations in appendiceal adenocarcinoma to evaluate the need for dedicated appendiceal screening and prevention strategies in patients with LP/P germline variants.

EXPERIMENTAL DESIGN: We performed an integrated germline and somatic molecular analysis for patients with confirmed appendiceal adenocarcinoma. Patients underwent paired tumor-normal sequencing for up to 90 hereditary cancer risk genes and 505 genes for somatic mutation profiling. We defined the cooccurrence of LP/P germline variants and second-hit pathogenic somatic alterations. The associations between germline variants and patient clinicopathologic features were also evaluated.

RESULTS: Twenty-five of 237 patients (10.5%) carried pathogenic or likely pathogenic germline variants in cancer susceptibility genes. Clinicopathologic characteristics and appendiceal adenocarcinoma-specific survival were similar in patients with or without germline variants. Most (92%, N = 23/25) patients with germline variants demonstrated no second-hit somatic alterations, including loss of heterozygosity. Two patients with a germline APC I1307K low-penetrance founder variant exhibited secondary somatic pathogenic alterations in APC. However, only one patient tumor exhibited APC-mediated WNT signaling dysregulation: a plausible consequence of multiple somatic APC mutations with no germline variant contribution. Four patients had germline variants in PMS2 or MSH2 associated with Lynch syndrome, yet their cancers were microsatellite-stable.

CONCLUSIONS: Germline variants are likely incidental without a contributory driver role in appendiceal adenocarcinoma. Appendiceal adenocarcinoma screening in patients with germline variants is not clearly merited.

PMID:37289003 | DOI:10.1158/1078-0432.CCR-22-3956

A Phase 1 Study of Cytokine-induced Memory-like (CIML) NK Cells With Venetoclax as Consolidation Therapy in AML

Posted: December 1st, 2023, 3:00am GMT

Conditions: Acute Myeloid Leukemia; Acute Myeloid Leukemia Recurrent; Leukemia; Leukemia, Myeloid
Interventions: Biological: Cytokine-Induced Memory-like Natural Killer Cells; Biological: Interleukin-2; Drug: Venetoclax
Sponsors: Dana-Farber Cancer Institute; The Leukemia and Lymphoma Society
Not yet recruiting

Evaluate the Efficacy and Safety of Edoxaban on Prevention of Catheter-related Thrombosis (CRT) in Cancer Patients

Posted: November 29th, 2023, 3:00am GMT

Conditions: Thrombosis, Venous; Cancer; Catheter Complications
Interventions: Drug: Edoxaban
Sponsors: Cancer Institute and Hospital, Chinese Academy of Medical Sciences
Not yet recruiting

Permalink for 'Cytokine-induced Memory-like Natural Killer Cell Therapy After Hematopoietic Stem Cell Transplantation for Eradication of Measurable Residual Disease, a Phase I/Ib Clinical Trial'

Cytokine-induced Memory-like Natural Killer Cell Therapy After Hematopoietic Stem Cell Transplantation for Eradication of Measurable Residual Disease, a Phase I/Ib Clinical Trial

Posted: November 20th, 2023, 3:00am GMT

Conditions: Acute Myeloid Leukemia; Leukemia; Leukemia, Myeloid; Myelodysplastic Syndromes; Myeloproliferative Neoplasm; Myeloproliferative Disorders
Interventions: Biological: Cytokine Induced Memory-like Natural Killer Cells; Biological: Interleukin-2
Sponsors: Dana-Farber Cancer Institute
Not yet recruiting

Study of RMC-6291 in Combination With RMC-6236 in Participants With Advanced KRAS G12C Mutant Solid Tumors

Posted: November 13th, 2023, 3:00am GMT

Conditions: Non-Small Cell Lung Cancer (NSCLC) Colorectal Cancer (CRC) Pancreatic Ductal Adenocarcinoma Advanced Solid Tumors
Interventions: Drug: Assigned interventions
Sponsors: Revolution Medicines, Inc.
Not yet recruiting

Locally ablatIVe thErapy for oLigo-progressive gastrOintestiNal maliGnancies (LIVELONG)

Posted: October 26th, 2023, 2:00am GMT

Conditions: Esophageal Cancer; Small Bowel Cancer; Gastroesophageal-junction Cancer; Gastric Cancer; Colorectal Cancer; Appendiceal Cancer; Biliary Cancer; Gall Bladder Cancer; Intrahepatic Cholangiocarcinoma; Extrahepatic Cholangiocarcinoma; Oligoprogressive
Interventions: Device: Ablative local therapy
Sponsors: University of California, Davis; National Cancer Institute (NCI)
Recruiting

Appendectomy and Colorectal Cancer

Posted: October 19th, 2023, 2:00am GMT

Conditions: Colorectal Cancer; Appendicitis
Sponsors: Chinese University of Hong Kong
Active, not recruiting

Feasibility of the Maastro Applicator in Rectal Cancer

Posted: October 18th, 2023, 2:00am GMT

Conditions: Rectal Cancer; Feasibility; Toxicity; Quality of Life; Radiation Toxicity; Radiation Proctitis; Brachytherapy; Complete Response
Interventions: Device: Maastro applicator
Sponsors: Maastricht Radiation Oncology; Varian Medical Systems
Not yet recruiting

Permalink for 'Prospective Clinical Validation of Next Generation Sequencing (NGS) and Patient-Derived Tumor Organoids (PDO) Guided Therapy in Patients With Advanced/ Inoperable Solid Tumors'

Prospective Clinical Validation of Next Generation Sequencing (NGS) and Patient-Derived Tumor Organoids (PDO) Guided Therapy in Patients With Advanced/ Inoperable Solid Tumors

Posted: October 11th, 2023, 2:00am GMT

Conditions: Hepatocellular Carcinoma; Colorectal Cancer
Interventions: Other: Patient-Derived Tumor Organoids
Sponsors: Chinese University of Hong Kong
Not yet recruiting

Individual Food Preferences for the Mediterranean Diet in Cancer Patients

Posted: September 28th, 2023, 2:00am GMT

Conditions: Neoplasms
Interventions: Other: Self-questionnaire; Other: Self-questionnaire; Other: Self-questionnaire; Other: Self-questionnaire; Other: Self-questionnaire; Other: Self-questionnaire; Other: Self-questionnaire; Other: Self-questionnaire; Other: Self-questionnaire; Other: Self-questionnaire; Other: Self-questionnaire; Other: Self-questionnaire
Sponsors: Centre Antoine Lacassagne; University of Lyon; University of Firenze and Siena, Napoli, Italy
Recruiting

$Permalink for 'Safety and Efficacy of CD19 Targeted CAR-T Therapy for Refractory Autoimmune Disease'$

Safety and Efficacy of CD19 Targeted CAR-T Therapy for Refractory Autoimmune Disease

Posted: September 27th, 2023, 2:00am GMT

Conditions: SLE (Systemic Lupus); Sjogren's Syndrome; Systemic Scleroderma; Dermatomyositis; Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis
Interventions: Biological: CD19 targeted CAR-T cells
Sponsors: Chongqing Precision Biotech Co., Ltd
Recruiting

$Permalink for 'Mezigdomide Plus Ixazomib and Dexamethasone for Relapsed and Refractory Multiple Myeloma'$

Mezigdomide Plus Ixazomib and Dexamethasone for Relapsed and Refractory Multiple Myeloma

Posted: September 22nd, 2023, 2:00am GMT

Conditions: Relapsed and Refractory Multiple Myeloma
Interventions: Drug: Mezigdomide; Drug: Ixazomib; Drug: Dexamethasone
Sponsors: Kathleen Dorritie; Bristol-Myers Squibb
Not yet recruiting

Safety and Efficacy of NEO212 in Patients With Astrocytoma IDH-mutant, Glioblastoma IDH-wildtype or Brain Metastasis

Posted: September 21st, 2023, 2:00am GMT

Conditions: Diffuse Astrocytoma, IDH-Mutant; Glioblastoma, IDH-wildtype; Brain Metastases, Adult; Cervical Cancer; Colorectal Cancer; Esophageal Cancer; Esophageal Squamous Cell Carcinoma; Gastric Cancer; Gastroesophageal Junction Adenocarcinoma; Head and Neck Squamous Cell Carcinoma; Melanoma; Merkel Cell Carcinoma; Microsatellite Instability-High Solid Malignant Tumor; Mismatch Repair Deficient Solid Malignant Tumor; Microsatellite Instability-High Colorectal Cancer; Mismatch Repair Deficient Colorectal Cancer; Non-small Cell Lung Cancer; Renal Cell Carcinoma; Small Cell Lung Cancer; Squamous Cell Carcinoma; Urothelial Carcinoma
Interventions: Drug: NEO212 Oral Capsule; Drug: Ipilimumab; Drug: Pembrolizumab; Drug: Nivolumab; Drug: Regorafenib; Drug: Carboplatin; Drug: Paclitaxel; Drug: FOLFIRI Protocol; Drug: Bevacizumab
Sponsors: Neonc Technologies, Inc.
Not yet recruiting

Analysis of the Toxicity and Efficacy of Daily 1 vs 2 Beam Proton Therapy

Posted: September 8th, 2023, 2:00am GMT

Conditions: Chordoma; Chondrosarcoma; Ewing Sarcoma; Osteosarcoma
Interventions: Radiation: Proteus ONE one daily beam; Radiation: Proteus ONE two daily beam
Sponsors: Centre Antoine Lacassagne
Recruiting

A Master Protocol (LY900023) That Includes Several Clinical Trials of Drugs for Children and Young Adults With Cancer

Posted: August 21st, 2023, 2:00am GMT

Conditions: Neoplasms; Child; Adolescent
Interventions: Drug: Ramucirumab; Drug: Cyclophosphamide; Drug: Vinorelbine; Drug: Gemcitabine; Drug: Docetaxel; Drug: Abemaciclib; Drug: Irinotecan; Drug: Temozolomide
Sponsors: Eli Lilly and Company
Recruiting

The Remote Study: Investigating the Effects or Online Exercise on Quality of Life in Men With Prostate Cancer

Posted: August 14th, 2023, 2:00pm GMT

Condition: Prostate Cancer
Intervention: Behavioral: Exercise
Sponsors: University of Surrey; Royal Surrey County Hospital NHS Foundation Trust
Not yet recruiting

Permalink for 'Evaluation of Subcutaneous Immunoglobulin Product Cutaquig in Terms of Safety and Efficacy in the Treatment of Patients With Primary Immunodeficiencies'

Evaluation of Subcutaneous Immunoglobulin Product Cutaquig in Terms of Safety and Efficacy in the Treatment of Patients With Primary Immunodeficiencies

Posted: August 10th, 2023, 2:00pm GMT

Condition: Primary Immunodeficiency Diseases (PID)
Intervention: Drug: Cutaquig
Sponsor: Federal Research Institute of Pediatric Hematology, Oncology and Immunology
Recruiting

Value of Right-sided Hemicolectomy for Chldren With High-risk Neuroendocrine Tumors of the Appendix

Posted: June 26th, 2023, 2:00pm GMT

Conditions: Neoplasms; Appendix Cancer
Intervention:
Sponsor: Academisch Medisch Centrum - Universiteit van Amsterdam (AMC-UvA)
Recruiting

A Multi-Centre, Single-arm, Observational Study of EVUSHELD in China

Posted: June 26th, 2023, 2:00am GMT

Conditions: COVID-19
Sponsors: AstraZeneca
Completed

Enhanced Clinical Decisions for Management of Benign Prostatic Hyperplasia Using Patient-Reported Outcomes

Posted: June 12th, 2023, 2:00am GMT

Conditions: Benign Prostatic Hyperplasia
Interventions: Other: Medical Management; Other: Surgical Management
Sponsors: Northwestern University; NorthShore University HealthSystem; Arbor Research Collaborative for Health
Recruiting

A Study of Adalimumab on Inflammatory Mediators Following a Systemic Endotoxin Challenge

Posted: June 1st, 2023, 2:00am GMT

Conditions: Healthy
Interventions: Drug: Adalimumab; Drug: Lipopolysaccharide (LPS)
Sponsors: Janssen Research & Development, LLC
Completed

The Active Surveillance Study

Posted: April 12th, 2023, 2:00pm GMT

Conditions: Prostate Cancer
Interventions: Other: Active Surveillance
Sponsors: Institute of Cancer Research, United Kingdom; Royal Marsden NHS Foundation Trust
Recruiting

HYPNONAG : Therapeutic Communication Versus Traditional Method for Naso-gastric Intubation in Haematology

Posted: March 30th, 2023, 2:00am GMT

Conditions: Aplasia; Chemotherapy Effect
Interventions: Other: Standard intubation; Other: Hypnosis
Sponsors: Rennes University Hospital
Not yet recruiting

Epcoritamab and Rituximab for First-line Follicular Lymphoma

Posted: March 24th, 2023, 2:00pm GMT

Conditions: Follicular Lymphoma; Low Grade Non-Hodgkin's Lymphoma, Adult
Interventions: Drug: Epcoritamab; Drug: Rituximab
Sponsors: Reid Merryman, MD; Genmab; AbbVie
Recruiting

Glofit and Obin in Follicular Lymphoma and Marginal Zone Lymphoma

Posted: March 24th, 2023, 2:00pm GMT

Conditions: Follicular Lymphoma; Marginal Zone Lymphoma; Indolent Non-hodgkin Lymphoma
Interventions: Drug: Obinutuzumab; Drug: Glofitamab
Sponsors: Reid Merryman, MD; Genentech, Inc.
Recruiting

Individualized Dose Escalation of 5-FU for Gastrointestinal Cancer

Posted: March 22nd, 2023, 2:00pm GMT

Conditions: Colorectal Cancer; Esophagus Cancer; Appendix Cancer; Small Bowel Cancer; Ampullary Cancer
Intervention: Other: FOX dose-escalation algorithm
Sponsor: Dartmouth-Hitchcock Medical Center
Recruiting

DETERMINE Trial Treatment Arm 5: Vemurafenib in Combination With Cobimetinib in Adult Patients With BRAF Positive Cancers.

Posted: March 14th, 2023, 2:00pm GMT

Conditions: Solid Tumor; Haematological Malignancy; Melanoma; Thyroid Cancer, Papillary; Ovarian Neoplasms; Colorectal Neoplasms; Laryngeal Neoplasms; Carcinoma, Non-Small-Cell Lung; Glioma; Multiple Myeloma; Erdheim-Chester Disease; Thyroid Carcinoma, Anaplastic
Interventions: Drug: Vemurafenib; Drug: Cobimetinib
Sponsors: Cancer Research UK; University of Manchester; University of Birmingham; Royal Marsden NHS Foundation Trust; Hoffmann-La Roche
Recruiting

Gastrointestinal Stimulation as a Treatment of Postoperative Ileus Following Extensive Surgery

Posted: March 2nd, 2023, 3:00pm GMT

Conditions: Postoperative Ileus; Bowel Paralysis
Intervention: Device: Gastric electric pacemaker
Sponsors: University of Aarhus; Danish Cancer Society
Recruiting

Impact of a Physical Activity Intervention With Motivational Support From Peers for Prostate Cancer Patients

Posted: February 22nd, 2023, 3:00am GMT

Conditions: Prostate Cancer
Interventions: Behavioral: Acti-Pair program
Sponsors: Centre Hospitalier Universitaire de Saint Etienne; Sport Health Center of Auvergne-Rhône Alpes; INSERM, SAINBIOSE U1059; INSERM, CIC1408; INSERM ECEVE 1123; Ministry of Health, France
Recruiting

Surgery Induced Trauma After Total Versus Medial Unicompartmental Knee Arthroplasty (SITA)

Posted: February 21st, 2023, 3:00am GMT

Conditions: Knee Osteoarthritis; Arthritis; Surgery; Total Knee Arthroplasty; Unicompartmental Knee Arthroplasty
Interventions: Procedure: Total Knee Arthroplasty (TKA); Procedure: Unicompartmental Knee Arthroplasty (UKA)
Sponsors: Hvidovre University Hospital; Frederiksberg University Hospital; Parker Research Institute
Recruiting

A Phase 1 Study of SAIL66 in Patients With CLDN6-positive Locally Advanced or Metastatic Solid Tumors

Posted: February 21st, 2023, 3:00am GMT

Conditions: Solid Tumor
Interventions: Drug: SAIL66; Drug: Tocilizumab
Sponsors: Chugai Pharmaceutical
Recruiting

Genetics of Appendix Cancer Study

Posted: February 20th, 2023, 3:00pm GMT

Conditions: Appendix Cancer; Appendiceal Cancer; Appendiceal Neoplasms; Appendiceal Mucinous Neoplasm; Appendiceal Adenocarcinoma; Appendiceal Carcinoid Tumor; Appendiceal Neoplasm Malignant Secondary; Appendix Adenocarcinoma; Appendix Mucinous Neoplasm; Appendix Tumor; Appendix Cancer Metastatic; Appendix NET; Low-Grade Appendix Mucinous Neoplasm; High Grade Appendix Mucinous Neoplasm; High Grade Appendix Mucinous Adenocarcinoma
Interventions: Genetic: Genetic profiling; Other: Retrospective tissue procurement
Sponsor: Andreana Holowatyj, PhD, MSCI
Recruiting

Permalink for 'DETERMINE (Determining Extended Therapeutic Indications for Existing Drugs in Rare Molecularly Defined Indications Using a National Evaluation Platform Trial) - Master Screening Protocol'

DETERMINE (Determining Extended Therapeutic Indications for Existing Drugs in Rare Molecularly Defined Indications Using a National Evaluation Platform Trial) - Master Screening Protocol

Posted: February 10th, 2023, 3:00pm GMT

Conditions: Solid Tumor; Haematological Malignancy
Interventions: Drug: Alectinib; Drug: Atezolizumab; Drug: Entrectinib; Drug: Trastuzumab in combination with pertuzumab; Drug: Vemurafenib in combination with cobimetinib
Sponsors: Cancer Research UK; University of Manchester; University of Birmingham; Royal Marsden NHS Foundation Trust; Hoffmann-La Roche
Recruiting

ETHAN - ET for Male BC

Posted: August 15th, 2022, 2:00am GMT

Conditions: Male Breast Cancer; Hormone Receptor-positive Breast Cancer; Hormone Receptor Negative Breast Carcinoma
Interventions: Drug: Tamoxifen; Drug: Anastrozole; Drug: Degarelix; Drug: Abemaciclib
Sponsors: Jose Pablo Leone; Eli Lilly and Company; Translational Breast Cancer Research Consortium (TBCRC)
Recruiting

Mass Response of Tumor Cells as a Biomarker for Rapid Therapy Guidance (TraveraRTGx)

Posted: July 18th, 2022, 2:00pm GMT

Conditions: Pleural Effusion, Malignant; Ascites, Malignant; Carcinoma; Carcinoma, Hepatocellular; Carcinoma, Renal Cell; Carcinoma, Renal; Carcinoma, Small Cell; Carcinoma, Non-Small-Cell Lung; Carcinoma, Pancreatic Ductal; Carcinoma, Neuroendocrine; Carcinoma, Thymic; Carcinoma, Pancreatic; Carcinoma Breast; Carcinoma, Ovarian; Carcinoma Bladder; Carcinoma of Unknown Primary; Carcinoma of the Head and Neck; Carcinoma of the Oropharynx; Carcinoma of the Larynx; Carcinoma of the Bladder; Carcinoma of Esophagus; Carcinoma of the Nasopharynx; Carcinoma of the Penis; Carcinoma of the Cervix; Carcinoma of the Anus; Carcinoma of the Vulva; Carcinoma of the Appendix; Carcinoma of the Oral Cavity; Cholangiocarcinoma; Melanoma; Mesothelioma; Pancreatic Cancer
Intervention:
Sponsors: Travera Inc; xCures
Recruiting

Fedratinib in Combination With Nivolumab

Posted: May 26th, 2022, 2:00am GMT

Conditions: Primary Myelofibrosis; Secondary Myelofibrosis
Interventions: Drug: Fedratinib Oral Capsule [Inrebic]; Drug: Nivolumab
Sponsors: Institut für Klinische Krebsforschung IKF GmbH at Krankenhaus Nordwest; Prof. F. Heidel, University Medicine Greifswald; Celgene International II S.á.r.l.
Recruiting

Molecular Characterisation of Appendiceal Cancer

Posted: May 6th, 2022, 2:00pm GMT

Conditions: Appendiceal Cancer
Interventions: Other: Retrospective tissue sample analysis
Sponsors: The Christie NHS Foundation Trust; University of Manchester
Not yet recruiting

Appendectomy vs. Symptomatic Treatment in Uncomplicated Acute Appendicitis Among Pediatric Patients

Posted: March 21st, 2022, 2:00am GMT

Conditions: Appendicitis
Interventions: Procedure: appendectomy
Sponsors: Helsinki University Central Hospital; Turku University Hospital; Tampere University Hospital; Kuopio University Hospital; Oulu University Hospital
Recruiting

Permalink for 'Efficacy and Safety of Generic Imatinib (Carcemia®) Compared to Glivec® in Real-Life Management of Chronic Phase of Chronic Myeloid Leukemia'

Efficacy and Safety of Generic Imatinib (Carcemia®) Compared to Glivec® in Real-Life Management of Chronic Phase of Chronic Myeloid Leukemia

Posted: March 16th, 2022, 2:00am GMT

Conditions: Chronic Myeloid Leukemia
Interventions: Drug: Carcemia; Drug: Glivec
Sponsors: Hikma Pharmaceuticals LLC
Recruiting

Intraperitoneal Aerosolized Nanoliposomal Irinotecan (Nal-IRI) in Peritoneal Carcinomatosis From Gastrointestinal Cancer

Posted: March 14th, 2022, 2:00pm GMT

Conditions: Peritoneal Carcinomatosis; Peritoneal Metastases; Colorectal Cancer; Small Bowel Cancer; Appendix Cancer; Gastric Cancer; Pancreatic Cancer; Bile Duct Cancer
Intervention: Drug: PIPAC with Nal-IRI
Sponsors: University Hospital, Ghent; Kom Op Tegen Kanker; University Ghent
Recruiting

Tissue Procurement and Natural History Study of Neuroendocrine Neoplasms (NENs) Including Adrenocortical Carcinoma (ACC)

Posted: February 14th, 2022, 3:00pm GMT

Conditions: Neuroendocrine Tumors; Carcinoma, Neuroendocrine
Sponsors: National Cancer Institute (NCI)
Recruiting

JAB-21822 in Combination With Cetuximab in Patients With Advanced CRC and Other Solid Tumors With KRAS G12C Mutation

Posted: January 18th, 2022, 3:00pm GMT

Conditions: Advanced Colorectal Cancer; Small Intestinal Cancer; Appendiceal Cancer
Interventions: Drug: JAB-21822; Drug: Cetuximab
Sponsor: Jacobio Pharmaceuticals Co., Ltd.
Recruiting

Two-Session Couples Class to Improve Relationship Health

Posted: August 30th, 2021, 2:00am GMT

Conditions: Stress
Interventions: Behavioral: Mindfulness Compassion (MC); Behavioral: Mindfulness Gratitude (MG); Behavioral: Mindfulness Value-Based Living (MV)
Sponsors: Sam Houston State University
Terminated

Permalink for 'A Study to Learn About the Study Medicine (Called Ontorpacept or TTI-621) Given Alone and in Combination With Doxorubicin in People With Leiomyosarcoma'

A Study to Learn About the Study Medicine (Called Ontorpacept or TTI-621) Given Alone and in Combination With Doxorubicin in People With Leiomyosarcoma

Posted: August 9th, 2021, 2:00am GMT

Conditions: Leiomyosarcoma
Interventions: Drug: Ontorpacept (TTI-621); Drug: Doxorubicin
Sponsors: Pfizer
Active, not recruiting

Defining the Clinical Potential of Mass Response as a Biomarker for Patient Tumor Sensitivity to Drugs

Posted: August 2nd, 2021, 2:00pm GMT

Conditions: Stage III Breast Cancer; Stage IV Breast Cancer; Stage III Lung Cancer; Stage IV Lung Cancer; AML; Multiple Myeloma in Relapse; Carcinoma; Carcinoma, Pancreatic; Carcinoma of Lung; Carcinoma, Non-Small-Cell Lung; Carcinoma Breast; Carcinoma Prostate; Carcinoma, Hepatocellular; Carcinoma, Renal Cell; Carcinoma, Neuroendocrine; Carcinoma, Small Cell Lung; Carcinoma, Ovarian; Carcinoma Bladder; Carcinoma of Esophagus; Carcinoma Cervix; Carcinoma, Thymic; Carcinoma, Ductal; Carcinoma of the Head and Neck; Carcinoma of the Lip; Carcinoma of the Oral Cavity; Carcinoma of Unknown Primary; Carcinoma of the Skin; Carcinoma of the Anus; Carcinoma of the Larynx; Carcinoma of the Penis; Carcinoma of the Oropharynx; Carcinoma of the Appendix; Carcinoma of the Paranasal Sinus; Carcinoma of the Vulva; Malignant Pleural Effusion; Malignant Ascites; Mesothelioma; Cholangiocarcinoma
Intervention:
Sponsor: Travera Inc
Not yet recruiting

Peritoneal Carcinomatosis Leveraging ctDNA Guided Treatment in GI Cancer Study (PERICLES Study)

Posted: June 18th, 2021, 2:00pm GMT

Conditions: Appendix Carcinoma by AJCC V8 Stage; Colorectal Carcinoma by AJCC V8 Stage; Digestive System Neoplasm; Esophageal Carcinoma by AJCC V8 Stage; Gastric Carcinoma by AJCC V8 Stage; Liver and Intrahepatic Bile Duct Carcinoma; Peritoneal Carcinomatosis
Interventions: Procedure: Biospecimen Collection - blood and tissue sample collection; Other: Electronic Health Record Review
Sponsors: Rutgers, The State University of New Jersey; National Cancer Institute (NCI)
Recruiting

Virtual Reality for GI Cancer Pain to Improve Patient Reported Outcomes

Posted: June 1st, 2021, 2:00pm GMT

Conditions: Cancer Pain; Visceral Pain; Gastrointestinal Neoplasms; Cancer of Gastrointestinal Tract; Small Intestine Cancer; Pancreas Cancer; Liver Cancer; Colon Cancer; Biliary Tract Cancer; Stomach Cancer; Rectum Cancer; Peritoneal Cancer; Gastrointestinal Cancer Metastatic; Gastrointestinal Cancers - Anus; Gastrointestinal Cancers - Stomach; Gastrointestinal Cancers - Colorectal; Gastrointestinal Cancers - Small Intestine; Small Intestine Cancer Stage III; Small Intestine Cancer Stage IV; Small Intestine Cancer, Recurrent; Pancreas Cancer, Stage III; Pancreas Cancer, Stage IV; Pancreas Cancer, Metastatic; Pancreas Cancer, Recurrent; Liver Cancer Stage IIIa; Liver Cancer Stage IIIb; Liver Cancer Stage IIIc; Liver Cancer Stage IV; Colon Cancer Stage III; Colon Cancer Stage IV; Stomach Cancer Stage III; Stomach Cancer Stage IV; Stomach Cancer Recurrent; Rectum Cancer, Recurrent; Gastrointestinal Cancers - Liver; Anal Cancer; Anal Cancer Stage III; Anal Cancer Stage IV; Anal Cancer Recurrent; Anal Cancer Metastatic; Anal Cancer, Stage IIIA; Anal Cancer, Stage IIIB; Appendix Cancer; Ampullary Cancer; Bile Duct Cancer; Bile Duct Cancer Stage III; Bile Duct Cancer Stage IV; Bile Duct Cancer Stage IVA; Bile Duct Cancer Stage IVB; Bile Duct Cancer Recurrent; Carcinoid Tumor; Carcinoid Tumor of Pancreas; Carcinoid Tumor of Large Intestine; Carcinoid Tumor of GI System; Carcinoid Tumor of Colon; Carcinoid Tumor of Liver; Carcinoid Tumor of Cecum; Carcinoid Tumor of Ileum; Carcinoid Tumor of Rectum; Carcinoid Tumor of the Small Bowel; Carcinoid Tumor of the Stomach; Large Intestine Cancer; Esophagus Cancer; Esophagus Cancer, Stage III; Esophagus Cancer, Stage IV; Esophagus Cancer, Recurrent; Gallbladder Cancer; Gallbladder Cancer Stage III; Gallbladder Cancer Stage IV; Gastric (Stomach) Cancer; Neuroendocrine Tumor; Peritoneum Cancer; Rectal Cancer; Esophagus Cancer, Stage I; Esophagus Cancer, Stage II; Gallbladder Cancer Stage I; Gallbladder Cancer Stage II; Bile Duct Cancer Stage I; Bile Duct Cancer Stage II
Intervention: Device: PICO G2 4k
Sponsors: Cedars-Sinai Medical Center; National Cancer Institute (NCI)
Recruiting

$Permalink for 'Study of CBX-12 in Subjects With Advanced or Metastatic Refractory Solid Tumors'$

Study of CBX-12 in Subjects With Advanced or Metastatic Refractory Solid Tumors

Posted: May 26th, 2021, 2:00pm GMT

Conditions: Solid Tumor, Adult; Epithelial Ovarian Cancer; Small Cell Lung Carcinoma; Breast Cancer; Colorectal Cancer; Pancreas Cancer; Appendix Cancer; Non-small Cell Lung Cancer; Gastric Cancer; Esophagus Cancer; Urothelial Carcinoma; Sarcoma
Intervention: Drug: CBX-12
Sponsor: Cybrexa Therapeutics
Recruiting

Permalink for 'A Modified Dose of Rabbit Anti-thymocyte Globulin (rATG) in Children and Adults Receiving Treatment to Help Prepare Their Bodies for a Bone Marrow Transplant'

A Modified Dose of Rabbit Anti-thymocyte Globulin (rATG) in Children and Adults Receiving Treatment to Help Prepare Their Bodies for a Bone Marrow Transplant

Posted: May 4th, 2021, 2:00pm GMT

Conditions: Acute Myeloid Leukemia (AML); Acute Lymphoid Leukemia (ALL); Myelodysplastic Syndromes (MDS)
Interventions: Other: Personalized rATG (P-rATG); Radiation: Hyper fractionated total body irradiation; Drug: Thiotepa; Drug: Cyclophosphamide; Drug: GCSF; Drug: Busulfan; Drug: Melphalan; Drug: Fludarabine
Sponsors: Memorial Sloan Kettering Cancer Center
Recruiting

Flat Dose vs. Weight-based IP Chemotherapy for CRS/HIPEC

Posted: March 3rd, 2021, 3:00pm GMT

Condition: Peritoneal Carcinomatosis
Interventions: Drug: Mitomycin C, flat dose 40 mg; Drug: Mitomycin C, weight-based dose 12.5 mg/m2
Sponsor: Prakash Pandalai
Recruiting

Refining Local-Regional Therapy for IBC

Posted: November 19th, 2020, 3:00pm GMT

Conditions: Breast Cancer; Inflammatory Breast Cancer; Sentinel Lymph Node
Intervention: Procedure: Lymphoscintigraphy
Sponsor: Dana-Farber Cancer Institute
Recruiting

Permalink for 'A Single Arm Phase II Study of ADjuvant Endocrine Therapy, Pertuzumab, and Trastuzumab for Patients With Anatomic Stage I Hormone Receptor-positive, HER2-positive Breast Cancer'

A Single Arm Phase II Study of ADjuvant Endocrine Therapy, Pertuzumab, and Trastuzumab for Patients With Anatomic Stage I Hormone Receptor-positive, HER2-positive Breast Cancer

Posted: September 30th, 2020, 2:00am GMT

Conditions: HER2-positive Breast Cancer; Invasive Carcinoma of the Breast; Breast Cancer; Node Negative Breast Cancer; Micrometastasis Breast Cancer; Hormone Receptor Positive Breast Cancer
Interventions: Combination Product: Pertuzumab+TRASTUZUMAB; Drug: ADJUVANT ENDOCRINE THERAPY
Sponsors: Dana-Farber Cancer Institute; Genentech, Inc.
Recruiting

Permalink for 'Oral Cryotherapy Plus Acupressure and Acupuncture Versus Oral Cryotherapy for Decreasing Chemotherapy-Induced Peripheral Neuropathy From Oxaliplatin-Based Chemotherapy in Patients With Gastrointestinal Cancer'

Oral Cryotherapy Plus Acupressure and Acupuncture Versus Oral Cryotherapy for Decreasing Chemotherapy-Induced Peripheral Neuropathy From Oxaliplatin-Based Chemotherapy in Patients With Gastrointestinal Cancer

Posted: August 10th, 2020, 2:00pm GMT

Conditions: Appendix Carcinoma; Colon Carcinoma; Esophageal Carcinoma; Gastric Carcinoma; Liver and Intrahepatic Bile Duct Carcinoma; Malignant Digestive System Neoplasm; Pancreatic Carcinoma; Rectal Carcinoma; Small Intestinal Carcinoma; Anal Carcinoma; Digestive System Carcinoma; Digestive System Neuroendocrine Tumor; Pancreatic Neuroendocrine Tumor
Interventions: Procedure: Acupuncture Therapy; Procedure: Acupressure Therapy; Procedure: Oral Cryotherapy; Other: Questionnaire Administration; Other: Quality-of-Life Assessment
Sponsors: University of Washington; National Cancer Institute (NCI); The Safeway Foundation
Recruiting

Autologous Stem Cell Transplant Followed by Polatuzumab Vedotin in Patients With B-cell Non-Hodgkin and Hodgkin Lymphoma

Posted: July 29th, 2020, 2:00am GMT

Conditions: B-cell Lymphoma; Burkitt Lymphoma; Diffuse Large B Cell Lymphoma; Follicular Lymphoma; Mantle Cell Lymphoma; Marginal Zone Lymphoma; Transformed Non-Hodgkin Lymphoma; Richter Syndrome; Hodgkin Lymphoma
Interventions: Drug: Polatuzumab vedotin
Sponsors: New York Medical College
Recruiting

Communication Training for Cancer Patients, Their Caregivers, and Their Doctors

Posted: July 21st, 2020, 2:00pm GMT

Condition: Communication and Illness Understanding
Intervention:
Sponsor: Memorial Sloan Kettering Cancer Center
Recruiting

Permalink for 'A Study of Fedratinib in Japanese Subjects With DIPSS (Dynamic International Prognostic Scoring System)- Intermediate or High-risk Primary Myelofibrosis (PMF), Post-polycythemia Vera Myelofibrosis (Post-PV MF), or Post-essential Thrombocythemia Myelofibr'

A Study of Fedratinib in Japanese Subjects With DIPSS (Dynamic International Prognostic Scoring System)- Intermediate or High-risk Primary Myelofibrosis (PMF), Post-polycythemia Vera Myelofibrosis (Post-PV MF), or Post-essential Thrombocythemia Myelofibr

Posted: June 25th, 2020, 2:00am GMT

Conditions: Primary Myelofibrosis
Interventions: Drug: Fedratinib
Sponsors: Celgene
Active, not recruiting

Afatinib in Advanced NRG1-Rearranged Malignancies

Posted: June 1st, 2020, 2:00pm GMT

Condition: Metastatic and Locally Advanced NRG1-rearranged Malignancies
Intervention: Drug: Afatinib 40 MG
Sponsors: German Cancer Research Center; German Consortium for Translational Cancer Research
Recruiting

Bosutinib in Pediatric Patients With Newly Diagnosed Chronic Phase or Resistant/Intolerant Ph + Chronic Myeloid Leukemia

Posted: February 6th, 2020, 3:00am GMT

Conditions: Philadelphia Chromosome Positive CML; Accelerated Phase Chronic Myelogenous Leukemia; Blastic Phase Chronic Myelogenous Leukemia; Chronic Phase Chronic Myelogenous Leukemia
Interventions: Drug: Bosutinib
Sponsors: Children's Oncology Group; Erasmus Medical Center; Dutch Childhood Oncology Group; Innovative Therapies for Children with Cancer; Pfizer
Active, not recruiting

Y90 Radiation Segmentectomy vs SBRT for HCC

Posted: January 22nd, 2020, 3:00am GMT

Conditions: Hepatocellular Carcinoma (HCC)
Interventions: Radiation: Yttrium-90 Radiation Segmentectomy; Radiation: Stereotactic Body Radiation Therapy
Sponsors: Indiana University
Terminated

Operative Versus Non-Operative Management for Appendicitis With Abscess or Phlegmon

Posted: November 19th, 2019, 3:00am GMT

Conditions: Appendicitis
Interventions: Procedure: Operative management; Other: Drainage or antibiotics
Sponsors: Yale University
Recruiting

Permalink for 'A Study of the Safety and Efficacy of Risankizumab in Adult Participants With Plaque Psoriasis Who Have Had a Suboptimal Response to Secukinumab or Ixekizumab'

A Study of the Safety and Efficacy of Risankizumab in Adult Participants With Plaque Psoriasis Who Have Had a Suboptimal Response to Secukinumab or Ixekizumab

Posted: September 25th, 2019, 2:00am GMT

Conditions: Plaque Psoriasis
Interventions: Drug: Risankizumab
Sponsors: AbbVie
Completed

Topical Tazarotene Vs Placebo In Hand-Foot-Skin Reactions

Posted: August 28th, 2019, 2:00am GMT

Conditions: Solid Tumor; Hand-Foot Skin Reaction (HFSR)
Interventions: Drug: Topical Tazarotene; Other: Placebo
Sponsors: Dana-Farber Cancer Institute; Bayer
Terminated

The Registry of Oncology Outcomes Associated With Testing and Treatment

Posted: July 22nd, 2019, 2:00am GMT

Conditions: Adenocarcinoma; Adenocystic Carcinoma; Anal Cancer; Appendix Cancer; Brain Tumor; Glioblastoma; Astrocytoma; Bile Duct Cancer; Cholangiocarcinoma; Bladder Cancer; Bone Cancer; Synovial Sarcoma; Chondrosarcoma; Liposarcoma; Sarcoma, Kaposi; Sarcoma,Soft Tissue; Sarcoma; Osteosarcoma; CNS Cancer; Brain Stem Neoplasms; Breast Cancer; Cervical Cancer; Colorectal Cancer; Rectal Cancer; Colon Cancer; Esophageal Cancer; Esophagus Cancer; Cancer of Colon; Pancreatic Cancer; Cancer of Pancreas; Testis Cancer; Testicular Cancer; Ureter Cancer; Renal Cell Carcinoma; Kidney Cancer; Gestational Trophoblastic Tumor; Head and Neck Neoplasms; Parotid Tumor; Larynx Cancer; Tongue Cancer; Pharynx Cancer; Salivary Gland Cancer; Acute Myeloid Leukemia; Chronic Myeloid Leukemia; Acute Lymphoblastic Leukemia; Multiple Myeloma; Non Hodgkin Lymphoma; Carcinoid Tumor; Lung Cancer; Neuroendocrine Tumors; Mesothelioma; Thyroid Cancer; Parathyroid Neoplasms; Adrenal Cancer; Small Bowel Cancer; Stomach Cancer; Liver Cancer; Hepatic Cancer; Melanoma; Skin Cancer; Unknown Primary Tumors; Uterine Cancer; Fallopian Tube Cancer; Ovarian Cancer; Prostate Cancer; Vaginal Cancer; Penile Cancer; Vulvar Cancer; Waldenstrom Macroglobulinemia; Cancer, Advanced; Thymus Cancer; Nasopharyngeal Carcinoma; Multiple Endocrine Neoplasia; Pheochromocytoma; Small Cell Carcinoma; Pulmonary Carcinoma
Interventions: Diagnostic Test: Biomarker Testing (L); Drug: Systemic Treatment (T); Other: Patient Reported Outcomes (P)
Sponsors: Taproot Health
Recruiting

Permalink for 'Daratumumab-bortezomib-dexamethasone (Dara-VCd) vs Bortezomib-Thalidomide-Dexamethasone (VTd), Then Maintenance With Ixazomib (IXA) or IXA-Dara'

Daratumumab-bortezomib-dexamethasone (Dara-VCd) vs Bortezomib-Thalidomide-Dexamethasone (VTd), Then Maintenance With Ixazomib (IXA) or IXA-Dara

Posted: April 1st, 2019, 2:00am GMT

Conditions: Multiple Myeloma
Interventions: Drug: Daratumumab plus Velcade Cyclophosphamide Dexamethasone; Drug: Velcade Thalidomide Dexamethasone
Sponsors: European Myeloma Network; EMN Research Italy
Active, not recruiting

Comparing Distress Screening + Consultation With Enhanced Usual Care for Caregivers of Cancer Patients

Posted: February 27th, 2019, 3:00am GMT

Conditions: Cancer Caregivers
Interventions: Behavioral: Baseline questionnaire; Behavioral: NCCN Problem List; Behavioral: FACT-GP; Behavioral: HADS; Behavioral: CSS-CG
Sponsors: Memorial Sloan Kettering Cancer Center; University of Virginia
Active, not recruiting

Green Exercise for Cancer - Creating Opportunities for Survivors

Posted: February 25th, 2019, 3:00am GMT

Conditions: Childhood Cancer; Hematoietic Cell Transplant
Interventions: Behavioral: Outdoor Exercise; Behavioral: Indoor Exercise
Sponsors: University of Minnesota
Recruiting

Study of the Effects of Pre-surgical Aerobic Exercise on Patients With Solid Tumors

Posted: January 23rd, 2019, 3:00pm GMT

Conditions: Preoperative Aerobic Training; Solid Tumors
Interventions: Behavioral: treadmill walking (Proof-of-Concept); Behavioral: treadmill walking Dose-Finding / Escalation
Sponsors: Memorial Sloan Kettering Cancer Center
Active, not recruiting

Radical Resection and HIPEC for Recurrent Retroperitoneal Sarcoma

Posted: January 3rd, 2019, 3:00am GMT

Conditions: Retroperitoneal Sarcoma
Interventions: Drug: Doxorubicin
Sponsors: National Cancer Centre, Singapore
Active, not recruiting

Permalink for 'Nivolumab, BMS-936558 in Combination With Relatlimab, BMS-986016 in Patients With Metastatic Melanoma Naïve to Prior Immunotherapy in the Metastatic Setting'

Nivolumab, BMS-936558 in Combination With Relatlimab, BMS-986016 in Patients With Metastatic Melanoma Naïve to Prior Immunotherapy in the Metastatic Setting

Posted: November 16th, 2018, 3:00am GMT

Conditions: Melanoma
Interventions: Drug: Relatlimab; Drug: Nivolumab; Drug: Relatlimab + Nivolumab
Sponsors: John Kirkwood; Bristol-Myers Squibb
Active, not recruiting

A Study of Carboplatin and Paclitaxel Chemotherapy With Nivolumab With or Without Ipilimumab in Patients With Ovarian Cancer

Posted: August 10th, 2017, 2:00am GMT

Conditions: High Grade Serous Ovarian; Fallopian Tube; Primary Peritoneal Cancer
Interventions: Drug: Carboplatin and Paclitaxel; Drug: Nivolumab; Procedure: Cytoreductive surgery; Drug: Ipilimumab
Sponsors: Memorial Sloan Kettering Cancer Center; Bristol-Myers Squibb
Active, not recruiting

Watch and Wait as Treatment for Patients With Rectal Cancer

Posted: April 24th, 2017, 2:00am GMT

Conditions: Rectal Neoplasms
Interventions: Procedure: endoscopy; Procedure: Surgery; Device: MRI
Sponsors: Sahlgrenska University Hospital, Sweden; Karolinska Institutet
Recruiting

Atezolizumab and Bevacizumab in Treating Patients With Rare Solid Tumors

Posted: March 8th, 2017, 3:00am GMT

Conditions: Appendix Adenocarcinoma; Human Papillomavirus-Related Anal Squamous Cell Carcinoma; Human Papillomavirus-Related Cervical Squamous Cell Carcinoma; Human Papillomavirus-Related Squamous Cell Carcinoma of the Penis; Human Papillomavirus-Related Vulvar Squamous Cell Carcinoma; Neuroendocrine Carcinoma; Pancreatic Neuroendocrine Tumor; Recurrent Merkel Cell Carcinoma; Recurrent Nasopharynx Carcinoma; Recurrent Peritoneal Malignant Mesothelioma; Recurrent Pleural Malignant Mesothelioma; Stage III Merkel Cell Carcinoma AJCC v7; Stage III Nasopharyngeal Carcinoma AJCC v7; Stage III Pleural Malignant Mesothelioma AJCC v7; Stage IV Merkel Cell Carcinoma AJCC v7; Stage IV Nasopharyngeal Carcinoma AJCC v7; Stage IV Pleural Malignant Mesothelioma AJCC v7; Stage IVA Nasopharyngeal Carcinoma AJCC v7; Stage IVB Nasopharyngeal Carcinoma AJCC v7; Stage IVC Nasopharyngeal Carcinoma AJCC v7; Vaginal Squamous Cell Carcinoma, Not Otherwise Specified
Interventions: Drug: Atezolizumab; Biological: Bevacizumab; Other: Laboratory Biomarker Analysis; Other: Pharmacological Study
Sponsors: M.D. Anderson Cancer Center; National Cancer Institute (NCI)
Active, not recruiting

Exercise Testing for Early Stage Breast Cancer Patients Receiving Radiation Treatment

Posted: July 18th, 2016, 2:00am GMT

Conditions: Breast Cancer; Fatigue
Interventions: Behavioral: FACIT-Fatigue 52-point questionnaire
Sponsors: Memorial Sloan Kettering Cancer Center
Active, not recruiting

Administration of T Lymphocytes for Prevention of Relapse of Lymphomas

Posted: January 26th, 2016, 3:00am GMT

Conditions: Hodgkin Disease; Lymphoma; Lymphoma, Non-Hodgkin; Immune System Diseases; Immunoproliferative Disorders; Lymphatic Diseases; Lymphoproliferative Disorders; Neoplasms; Neoplasms by Histologic Type
Interventions: Drug: ATLCAR.CD30 cells
Sponsors: UNC Lineberger Comprehensive Cancer Center; National Heart, Lung, and Blood Institute (NHLBI)
Active, not recruiting

A Study of Tazemetostat in Adult Participants With Soft Tissue Sarcoma

Posted: November 11th, 2015, 3:00am GMT

Conditions: Malignant Rhabdoid Tumors (MRT); Rhabdoid Tumors of the Kidney (RTK); Atypical Teratoid Rhabdoid Tumors (ATRT); Selected Tumors With Rhabdoid Features; Synovial Sarcoma; INI1-negative Tumors; Malignant Rhabdoid Tumor of Ovary; Renal Medullary Carcinoma; Epithelioid Sarcoma; Poorly Differentiated Chordoma (or Other Chordoma With Sponsor Approval); Any Solid Tumor With an EZH2 GOF Mutation
Interventions: Drug: Tazemetostat
Sponsors: Epizyme, Inc.
Active, not recruiting

Gastrointestinal Microbiome Study of Appendiceal Cancer

Posted: November 6th, 2015, 3:00pm GMT

Conditions: Pseudomyxoma Peritonei; Appendiceal Neoplasm; Cancer, Appendiceal
Interventions: Other: Bio-specimen collection; Other: Questionnaire
Sponsors: Mercy Medical Center; University of California, San Diego
Recruiting

18F-MFBG Imaging for Evaluation of Neuroendocrine Malignancies

Posted: January 28th, 2015, 3:00pm GMT

Condition: Neuroendocrine Tumors
Interventions: Radiation: 18F-MFBG (meta-fluoro benzylguanidine); Device: Positron emission tomography (PET) imaging; Other: Blood draws
Sponsor: Memorial Sloan Kettering Cancer Center
Recruiting

Development of Psychotherapeutic Interventions for Parents Who Lost a Child

Posted: June 3rd, 2014, 2:00am GMT

Conditions: Parents Who Have Lost a Child
Interventions: Behavioral: Meaning-Centered Grief Therapy (MCGT); Behavioral: Supportive Psychotherapy (SP); Behavioral: questionnaires assessments
Sponsors: Memorial Sloan Kettering Cancer Center; University of Memphis; University of Hawaii; Adelphi University; Weill Medical College of Cornell University; University of Southern California; The New School for Social Research; Monash University
Active, not recruiting

Electronic Skin Surface Brachytherapy for Cutaneous Basal Cell and Squamous Cell Carcinoma

Posted: May 6th, 2014, 2:00am GMT

Conditions: Cutaneous Basal Cell; Squamous Cell Carcinoma
Interventions: Radiation: Electronic Skin Surface Brachytherapy; Behavioral: Quality of life assessment
Sponsors: Memorial Sloan Kettering Cancer Center; Lynn Cancer Institute
Active, not recruiting

Permalink for 'Crossover Trial of Systemic Chemotherapy in Patients With Metastatic Well-Differentiated Mucinous Appendiceal Adenocarcinomas With Pseudomyxoma Peritonei'

Crossover Trial of Systemic Chemotherapy in Patients With Metastatic Well-Differentiated Mucinous Appendiceal Adenocarcinomas With Pseudomyxoma Peritonei

Posted: September 20th, 2013, 2:00am GMT

Conditions: Gastrointestinal Neoplasms
Interventions: Behavioral: Questionnaire
Sponsors: M.D. Anderson Cancer Center
Active, not recruiting

Prospective Ascertainment for Late Effects Among Survivors of Cancer, Tumor, or a Related Illness

Posted: August 17th, 2012, 2:00am GMT

Conditions: Pediatric or Young Adult Cancer Survivors
Interventions: Genetic: Family History Questionnaire (FHQ); Genetic: Salvia sample; Other: Blood sample
Sponsors: Memorial Sloan Kettering Cancer Center
Active, not recruiting

Permalink for 'Serum Biomarkers to Characterize the Effects of Therapy on Ovarian Reserve in Premenopausal Women With Early-stage Breast Cancer or BRCA Mutations'

Serum Biomarkers to Characterize the Effects of Therapy on Ovarian Reserve in Premenopausal Women With Early-stage Breast Cancer or BRCA Mutations

Posted: January 15th, 2009, 3:00pm GMT

Condition: Breast Cancer
Intervention: Other: Blood draw and questionnaires
Sponsors: Memorial Sloan Kettering Cancer Center; Yale University; New York Presbyterian Hospital; Weill Medical College of Cornell University
Recruiting

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Rare Cancer News & Clinical Trials » Appendix Cancer

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Appendix Cancer (281 unread)

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