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Publisher: Springer-Verlag   (Total: 2335 journals)

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Showing 1 - 200 of 2335 Journals sorted alphabetically
3D Research     Hybrid Journal   (Followers: 19, SJR: 0.214, h-index: 10)
4OR: A Quarterly J. of Operations Research     Hybrid Journal   (Followers: 9, SJR: 1.073, h-index: 25)
AAPS J.     Hybrid Journal   (Followers: 16, SJR: 1.192, h-index: 74)
AAPS PharmSciTech     Hybrid Journal   (Followers: 6, SJR: 0.718, h-index: 54)
Abdominal Imaging     Hybrid Journal   (Followers: 16, SJR: 0.723, h-index: 60)
Abhandlungen aus dem Mathematischen Seminar der Universitat Hamburg     Hybrid Journal   (Followers: 2, SJR: 0.447, h-index: 12)
Academic Psychiatry     Full-text available via subscription   (Followers: 22, SJR: 0.492, h-index: 32)
Academic Questions     Hybrid Journal   (Followers: 7, SJR: 0.135, h-index: 6)
Accreditation and Quality Assurance: J. for Quality, Comparability and Reliability in Chemical Measurement     Hybrid Journal   (Followers: 25, SJR: 0.378, h-index: 30)
Acoustical Physics     Hybrid Journal   (Followers: 10, SJR: 0.355, h-index: 20)
Acta Analytica     Hybrid Journal   (Followers: 7, SJR: 0.387, h-index: 6)
Acta Applicandae Mathematicae     Hybrid Journal   (Followers: 1, SJR: 0.624, h-index: 34)
Acta Biotheoretica     Hybrid Journal   (Followers: 5, SJR: 0.419, h-index: 25)
Acta Diabetologica     Hybrid Journal   (Followers: 14, SJR: 1.318, h-index: 46)
Acta Endoscopica     Hybrid Journal   (Followers: 1, SJR: 0.113, h-index: 8)
acta ethologica     Hybrid Journal   (Followers: 4, SJR: 0.465, h-index: 23)
Acta Geochimica     Hybrid Journal   (Followers: 3)
Acta Geodaetica et Geophysica     Hybrid Journal   (Followers: 1, SJR: 0.294, h-index: 13)
Acta Geotechnica     Hybrid Journal   (Followers: 6, SJR: 1.818, h-index: 22)
Acta Informatica     Hybrid Journal   (Followers: 5, SJR: 0.524, h-index: 32)
Acta Mathematica     Hybrid Journal   (Followers: 9, SJR: 8.021, h-index: 47)
Acta Mathematica Hungarica     Hybrid Journal   (Followers: 2, SJR: 0.53, h-index: 29)
Acta Mathematica Sinica, English Series     Hybrid Journal   (Followers: 5, SJR: 0.406, h-index: 30)
Acta Mathematica Vietnamica     Hybrid Journal   (SJR: 0.451, h-index: 5)
Acta Mathematicae Applicatae Sinica, English Series     Hybrid Journal   (SJR: 0.22, h-index: 20)
Acta Mechanica     Hybrid Journal   (Followers: 18, SJR: 0.898, h-index: 52)
Acta Mechanica Sinica     Hybrid Journal   (Followers: 4, SJR: 0.426, h-index: 29)
Acta Metallurgica Sinica (English Letters)     Hybrid Journal   (Followers: 5, SJR: 0.525, h-index: 18)
Acta Meteorologica Sinica     Hybrid Journal   (Followers: 3, SJR: 0.524, h-index: 14)
Acta Neurochirurgica     Hybrid Journal   (Followers: 7, SJR: 0.833, h-index: 73)
Acta Neurologica Belgica     Hybrid Journal   (SJR: 0.348, h-index: 27)
Acta Neuropathologica     Hybrid Journal   (Followers: 3, SJR: 6.61, h-index: 117)
Acta Oceanologica Sinica     Hybrid Journal   (Followers: 3, SJR: 0.295, h-index: 17)
Acta Parasitologica     Hybrid Journal   (Followers: 9, SJR: 0.581, h-index: 28)
Acta Physiologiae Plantarum     Hybrid Journal   (Followers: 2, SJR: 0.551, h-index: 39)
Acta Politica     Hybrid Journal   (Followers: 13, SJR: 0.658, h-index: 20)
adhäsion KLEBEN & DICHTEN     Hybrid Journal   (Followers: 5, SJR: 0.103, h-index: 4)
ADHD Attention Deficit and Hyperactivity Disorders     Hybrid Journal   (Followers: 20, SJR: 0.871, h-index: 15)
Adhesion Adhesives & Sealants     Hybrid Journal   (Followers: 7)
Administration and Policy in Mental Health and Mental Health Services Research     Partially Free   (Followers: 15, SJR: 0.795, h-index: 40)
Adsorption     Hybrid Journal   (Followers: 4, SJR: 0.774, h-index: 52)
Advances in Applied Clifford Algebras     Hybrid Journal   (Followers: 3, SJR: 0.319, h-index: 15)
Advances in Atmospheric Sciences     Hybrid Journal   (Followers: 34, SJR: 0.959, h-index: 44)
Advances in Computational Mathematics     Hybrid Journal   (Followers: 15, SJR: 1.255, h-index: 44)
Advances in Contraception     Hybrid Journal   (Followers: 2)
Advances in Data Analysis and Classification     Hybrid Journal   (Followers: 48, SJR: 1.113, h-index: 14)
Advances in Gerontology     Partially Free   (Followers: 7, SJR: 0.141, h-index: 3)
Advances in Health Sciences Education     Hybrid Journal   (Followers: 23, SJR: 1.397, h-index: 42)
Advances in Manufacturing     Hybrid Journal   (Followers: 3, SJR: 0.2, h-index: 4)
Advances in Polymer Science     Hybrid Journal   (Followers: 40, SJR: 0.637, h-index: 89)
Advances in Therapy     Hybrid Journal   (Followers: 6, SJR: 0.79, h-index: 44)
Aegean Review of the Law of the Sea and Maritime Law     Hybrid Journal   (Followers: 7)
Aequationes Mathematicae     Hybrid Journal   (Followers: 2, SJR: 0.882, h-index: 23)
Aerobiologia     Hybrid Journal   (Followers: 1, SJR: 0.511, h-index: 36)
Aesthetic Plastic Surgery     Hybrid Journal   (Followers: 8, SJR: 0.821, h-index: 49)
African Archaeological Review     Hybrid Journal   (Followers: 14, SJR: 0.612, h-index: 24)
Afrika Matematika     Hybrid Journal   (Followers: 1, SJR: 0.248, h-index: 6)
AGE     Hybrid Journal   (Followers: 7, SJR: 1.358, h-index: 33)
Ageing Intl.     Hybrid Journal   (Followers: 6, SJR: 0.337, h-index: 10)
Aggiornamenti CIO     Hybrid Journal   (Followers: 1)
Aging Clinical and Experimental Research     Hybrid Journal   (Followers: 3, SJR: 0.529, h-index: 55)
Agricultural Research     Hybrid Journal   (Followers: 3)
Agriculture and Human Values     Hybrid Journal   (Followers: 12, SJR: 1.197, h-index: 49)
Agroforestry Systems     Hybrid Journal   (Followers: 20, SJR: 0.64, h-index: 56)
Agronomy for Sustainable Development     Hybrid Journal   (Followers: 10, SJR: 1.732, h-index: 59)
AI & Society     Hybrid Journal   (Followers: 7, SJR: 0.171, h-index: 19)
AIDS and Behavior     Hybrid Journal   (Followers: 13, SJR: 2.006, h-index: 71)
Air Quality, Atmosphere & Health     Hybrid Journal   (Followers: 2, SJR: 0.706, h-index: 19)
Akupunktur & Aurikulomedizin     Full-text available via subscription   (Followers: 1)
Algebra and Logic     Hybrid Journal   (Followers: 2, SJR: 0.566, h-index: 18)
Algebra Universalis     Hybrid Journal   (Followers: 2, SJR: 0.388, h-index: 22)
Algebras and Representation Theory     Hybrid Journal   (SJR: 0.868, h-index: 20)
Algorithmica     Hybrid Journal   (Followers: 7, SJR: 0.898, h-index: 56)
Allergo J.     Full-text available via subscription   (Followers: 1, SJR: 0.183, h-index: 20)
Allergo J. Intl.     Hybrid Journal   (Followers: 2)
Alpine Botany     Hybrid Journal   (Followers: 3, SJR: 0.729, h-index: 20)
ALTEX : Alternatives to Animal Experimentation     Open Access   (Followers: 3, SJR: 1.392, h-index: 32)
AMBIO     Hybrid Journal   (Followers: 14, SJR: 1.094, h-index: 87)
American J. of Cardiovascular Drugs     Hybrid Journal   (Followers: 10, SJR: 0.864, h-index: 39)
American J. of Community Psychology     Hybrid Journal   (Followers: 24, SJR: 1.237, h-index: 83)
American J. of Criminal Justice     Hybrid Journal   (Followers: 5, SJR: 0.634, h-index: 13)
American J. of Cultural Sociology     Hybrid Journal   (Followers: 11, SJR: 0.283, h-index: 3)
American J. of Dance Therapy     Hybrid Journal   (Followers: 4, SJR: 0.175, h-index: 13)
American J. of Potato Research     Hybrid Journal   (Followers: 2, SJR: 0.558, h-index: 35)
American J. of Psychoanalysis     Hybrid Journal   (Followers: 20, SJR: 0.293, h-index: 13)
American Sociologist     Hybrid Journal   (Followers: 10, SJR: 0.18, h-index: 13)
Amino Acids     Hybrid Journal   (Followers: 8, SJR: 1.362, h-index: 83)
AMS Review     Partially Free   (Followers: 4)
Analog Integrated Circuits and Signal Processing     Hybrid Journal   (Followers: 5, SJR: 0.21, h-index: 37)
Analysis and Mathematical Physics     Hybrid Journal   (Followers: 4, SJR: 0.665, h-index: 7)
Analysis in Theory and Applications     Hybrid Journal  
Analysis of Verbal Behavior     Hybrid Journal   (Followers: 4)
Analytical and Bioanalytical Chemistry     Hybrid Journal   (Followers: 32, SJR: 1.096, h-index: 123)
Anatomical Science Intl.     Hybrid Journal   (Followers: 2, SJR: 0.301, h-index: 26)
Angewandte Schmerztherapie und Palliativmedizin     Hybrid Journal  
Angiogenesis     Hybrid Journal   (Followers: 3, SJR: 2.212, h-index: 69)
Animal Cognition     Hybrid Journal   (Followers: 13, SJR: 1.122, h-index: 55)
Annales françaises de médecine d'urgence     Hybrid Journal   (Followers: 1, SJR: 0.156, h-index: 4)
Annales Henri Poincaré     Hybrid Journal   (Followers: 3, SJR: 1.377, h-index: 32)
Annales mathématiques du Québec     Hybrid Journal   (Followers: 4)
Annali dell'Universita di Ferrara     Hybrid Journal   (SJR: 0.504, h-index: 14)
Annali di Matematica Pura ed Applicata     Hybrid Journal   (Followers: 1, SJR: 1.167, h-index: 26)
Annals of Behavioral Medicine     Hybrid Journal   (Followers: 10, SJR: 2.112, h-index: 98)
Annals of Biomedical Engineering     Hybrid Journal   (Followers: 18, SJR: 1.182, h-index: 94)
Annals of Combinatorics     Hybrid Journal   (Followers: 3, SJR: 0.849, h-index: 15)
Annals of Data Science     Hybrid Journal   (Followers: 8)
Annals of Dyslexia     Hybrid Journal   (Followers: 9, SJR: 0.857, h-index: 40)
Annals of Finance     Hybrid Journal   (Followers: 26, SJR: 0.686, h-index: 14)
Annals of Forest Science     Hybrid Journal   (Followers: 4, SJR: 0.929, h-index: 57)
Annals of Global Analysis and Geometry     Hybrid Journal   (Followers: 1, SJR: 1.136, h-index: 23)
Annals of Hematology     Hybrid Journal   (Followers: 13, SJR: 1.117, h-index: 62)
Annals of Mathematics and Artificial Intelligence     Hybrid Journal   (Followers: 6, SJR: 0.593, h-index: 42)
Annals of Microbiology     Hybrid Journal   (Followers: 9, SJR: 0.402, h-index: 26)
Annals of Nuclear Medicine     Hybrid Journal   (Followers: 5, SJR: 0.68, h-index: 45)
Annals of Operations Research     Hybrid Journal   (Followers: 8, SJR: 1.186, h-index: 78)
Annals of Regional Science     Hybrid Journal   (Followers: 7, SJR: 0.405, h-index: 42)
Annals of Software Engineering     Hybrid Journal   (Followers: 12)
Annals of Solid and Structural Mechanics     Hybrid Journal   (Followers: 9, SJR: 0.553, h-index: 8)
Annals of Surgical Oncology     Hybrid Journal   (Followers: 11, SJR: 1.902, h-index: 127)
Annals of Telecommunications     Hybrid Journal   (Followers: 7, SJR: 0.315, h-index: 25)
Annals of the Institute of Statistical Mathematics     Hybrid Journal   (Followers: 1, SJR: 0.931, h-index: 31)
Antonie van Leeuwenhoek     Hybrid Journal   (Followers: 5, SJR: 0.992, h-index: 87)
Apidologie     Hybrid Journal   (Followers: 4, SJR: 1.14, h-index: 57)
APOPTOSIS     Hybrid Journal   (Followers: 7, SJR: 1.554, h-index: 87)
Applicable Algebra in Engineering, Communication and Computing     Hybrid Journal   (Followers: 2, SJR: 0.354, h-index: 27)
Applications of Mathematics     Hybrid Journal   (Followers: 1, SJR: 0.274, h-index: 20)
Applied Biochemistry and Biotechnology     Hybrid Journal   (Followers: 45, SJR: 0.575, h-index: 80)
Applied Biochemistry and Microbiology     Hybrid Journal   (Followers: 17, SJR: 0.267, h-index: 26)
Applied Categorical Structures     Hybrid Journal   (Followers: 2, SJR: 0.361, h-index: 21)
Applied Composite Materials     Hybrid Journal   (Followers: 45, SJR: 0.705, h-index: 35)
Applied Entomology and Zoology     Partially Free   (Followers: 2, SJR: 0.554, h-index: 34)
Applied Geomatics     Hybrid Journal   (Followers: 3, SJR: 0.323, h-index: 9)
Applied Geophysics     Hybrid Journal   (Followers: 7, SJR: 0.541, h-index: 13)
Applied Intelligence     Hybrid Journal   (Followers: 13, SJR: 0.777, h-index: 43)
Applied Magnetic Resonance     Hybrid Journal   (Followers: 3, SJR: 0.358, h-index: 34)
Applied Mathematics & Optimization     Hybrid Journal   (Followers: 4, SJR: 0.955, h-index: 33)
Applied Mathematics - A J. of Chinese Universities     Hybrid Journal   (SJR: 0.275, h-index: 8)
Applied Mathematics and Mechanics     Hybrid Journal   (Followers: 4, SJR: 0.37, h-index: 26)
Applied Microbiology and Biotechnology     Hybrid Journal   (Followers: 61, SJR: 1.262, h-index: 161)
Applied Physics A     Hybrid Journal   (Followers: 8, SJR: 0.535, h-index: 121)
Applied Physics B: Lasers and Optics     Hybrid Journal   (Followers: 22, SJR: 0.983, h-index: 104)
Applied Psychophysiology and Biofeedback     Hybrid Journal   (Followers: 5, SJR: 0.677, h-index: 47)
Applied Research in Quality of Life     Hybrid Journal   (Followers: 10, SJR: 0.288, h-index: 15)
Applied Solar Energy     Hybrid Journal   (Followers: 16, SJR: 0.251, h-index: 6)
Applied Spatial Analysis and Policy     Hybrid Journal   (Followers: 4, SJR: 0.351, h-index: 9)
Aquaculture Intl.     Hybrid Journal   (Followers: 21, SJR: 0.613, h-index: 40)
Aquarium Sciences and Conservation     Hybrid Journal   (Followers: 1)
Aquatic Ecology     Hybrid Journal   (Followers: 31, SJR: 0.646, h-index: 44)
Aquatic Geochemistry     Hybrid Journal   (Followers: 3, SJR: 0.764, h-index: 39)
Aquatic Sciences     Hybrid Journal   (Followers: 12, SJR: 1.172, h-index: 53)
Arabian J. for Science and Engineering     Hybrid Journal   (Followers: 5, SJR: 0.345, h-index: 20)
Arabian J. of Geosciences     Hybrid Journal   (Followers: 1, SJR: 0.417, h-index: 16)
Archaeological and Anthropological Sciences     Hybrid Journal   (Followers: 21, SJR: 1.056, h-index: 15)
Archaeologies     Hybrid Journal   (Followers: 12, SJR: 0.397, h-index: 13)
Archiv der Mathematik     Hybrid Journal   (SJR: 0.597, h-index: 29)
Archival Science     Hybrid Journal   (Followers: 51, SJR: 0.804, h-index: 22)
Archive for History of Exact Sciences     Hybrid Journal   (Followers: 7, SJR: 0.28, h-index: 15)
Archive for Mathematical Logic     Hybrid Journal   (Followers: 1, SJR: 0.946, h-index: 23)
Archive for Rational Mechanics and Analysis     Hybrid Journal   (SJR: 4.091, h-index: 66)
Archive of Applied Mechanics     Hybrid Journal   (Followers: 4, SJR: 0.865, h-index: 40)
Archives of Computational Methods in Engineering     Hybrid Journal   (Followers: 4, SJR: 2.841, h-index: 40)
Archives of Dermatological Research     Hybrid Journal   (Followers: 6, SJR: 0.9, h-index: 65)
Archives of Environmental Contamination and Toxicology     Hybrid Journal   (Followers: 10, SJR: 0.846, h-index: 84)
Archives of Gynecology and Obstetrics     Hybrid Journal   (Followers: 16, SJR: 0.695, h-index: 47)
Archives of Microbiology     Hybrid Journal   (Followers: 8, SJR: 0.702, h-index: 85)
Archives of Orthopaedic and Trauma Surgery     Hybrid Journal   (Followers: 8, SJR: 1.039, h-index: 56)
Archives of Osteoporosis     Hybrid Journal   (Followers: 2, SJR: 1.092, h-index: 13)
Archives of Sexual Behavior     Hybrid Journal   (Followers: 9, SJR: 1.198, h-index: 74)
Archives of Toxicology     Hybrid Journal   (Followers: 16, SJR: 1.595, h-index: 76)
Archives of Virology     Hybrid Journal   (Followers: 4, SJR: 1.086, h-index: 90)
Archives of Women's Mental Health     Hybrid Journal   (Followers: 13, SJR: 1.264, h-index: 50)
Archivio di Ortopedia e Reumatologia     Hybrid Journal  
Archivum Immunologiae et Therapiae Experimentalis     Hybrid Journal   (Followers: 2, SJR: 1.2, h-index: 42)
ArgoSpine News & J.     Hybrid Journal   (SJR: 0.102, h-index: 3)
Argumentation     Hybrid Journal   (Followers: 4, SJR: 0.295, h-index: 18)
Arid Ecosystems     Hybrid Journal   (Followers: 3)
Arkiv för Matematik     Hybrid Journal   (SJR: 0.948, h-index: 22)
Arnold Mathematical J.     Hybrid Journal   (Followers: 1)
Arthropod-Plant Interactions     Hybrid Journal   (Followers: 2, SJR: 0.797, h-index: 17)
Arthroskopie     Hybrid Journal   (Followers: 1, SJR: 0.145, h-index: 8)
Artificial Intelligence and Law     Hybrid Journal   (Followers: 8, SJR: 0.288, h-index: 25)
Artificial Intelligence Review     Hybrid Journal   (Followers: 15, SJR: 0.948, h-index: 48)
Artificial Life and Robotics     Hybrid Journal   (Followers: 8, SJR: 0.231, h-index: 14)
Asia Europe J.     Hybrid Journal   (Followers: 4, SJR: 0.247, h-index: 9)
Asia Pacific Education Review     Hybrid Journal   (Followers: 9, SJR: 0.371, h-index: 17)
Asia Pacific J. of Management     Hybrid Journal   (Followers: 11, SJR: 1.676, h-index: 50)
Asia-Pacific Education Researcher     Hybrid Journal   (Followers: 11, SJR: 0.353, h-index: 13)
Asia-Pacific Financial Markets     Hybrid Journal   (Followers: 2, SJR: 0.19, h-index: 15)
Asia-Pacific J. of Atmospheric Sciences     Hybrid Journal   (Followers: 20, SJR: 1.006, h-index: 14)
Asian Business & Management     Hybrid Journal   (Followers: 7, SJR: 0.41, h-index: 10)
Asian J. of Business Ethics     Hybrid Journal   (Followers: 7)
Asian J. of Criminology     Hybrid Journal   (Followers: 5, SJR: 0.263, h-index: 8)
AStA Advances in Statistical Analysis     Hybrid Journal   (Followers: 2, SJR: 0.681, h-index: 15)
AStA Wirtschafts- und Sozialstatistisches Archiv     Hybrid Journal   (Followers: 5, SJR: 0.195, h-index: 5)
ästhetische dermatologie & kosmetologie     Full-text available via subscription  
Astronomy and Astrophysics Review     Hybrid Journal   (Followers: 21, SJR: 4.511, h-index: 44)
Astronomy Letters     Hybrid Journal   (Followers: 19, SJR: 0.58, h-index: 30)
Astronomy Reports     Hybrid Journal   (Followers: 12, SJR: 0.473, h-index: 23)
Astrophysical Bulletin     Hybrid Journal   (Followers: 2, SJR: 0.469, h-index: 11)
Astrophysics     Hybrid Journal   (Followers: 22, SJR: 0.243, h-index: 11)

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Journal Cover Annals of Surgical Oncology
  [SJR: 1.902]   [H-I: 127]   [11 followers]  Follow
    
   Hybrid Journal Hybrid journal (It can contain Open Access articles)
   ISSN (Print) 1534-4681 - ISSN (Online) 1068-9265
   Published by Springer-Verlag Homepage  [2335 journals]
  • Robotic Hepatectomy: A New Paradigm in the Management of Hepatocellular
           Carcinoma'
    • Authors: Suguru Yamashita; Claudius Conrad
      Pages: 866 - 867
      PubDate: 2017-04-01
      DOI: 10.1245/s10434-016-5639-8
      Issue No: Vol. 24, No. 4 (2017)
       
  • Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemoperfusion in
           Adolescent and Young Adults with Peritoneal Metastases
    • Authors: Mashaal Dhir; Lekshmi Ramalingam; Yongli Shuai; Sam Pakrafter; Heather L. Jones; Melissa E. Hogg; Amer H. Zureikat; Matthew P. Holtzman; Steven A. Ahrendt; Nathan Bahary; James F. Pingpank; Herbert J. Zeh; David L. Bartlett; Haroon A. Choudry
      Pages: 875 - 883
      Abstract: Background Several studies suggest that young patients may derive less oncologic benefit from surgical resection of cancers compared with older patients. We hypothesized that young patients may have worse outcomes following cytoreductive surgery with hyperthermic intraperitoneal chemoperfusion (CRS/HIPEC) for peritoneal metastases. Methods Perioperative and oncologic outcomes in adolescent and young adults (AYA), defined as younger than age 40 years (n = 135), undergoing CRS/HIPEC between 2001 and 2015 were reviewed and compared with middle-aged adults, defined as aged 40–65 years (n = 684). Results The two groups were similar with regards to perioperative characteristics except that AYA were more likely to be symptomatic at presentation (65.2 vs. 50.9%, p = 0.003), had lower Charleson comorbidity index (median 6 vs. 8, p < 0.001), were less likely to receive neoadjuvant chemotherapy (32.8 vs. 42.5%, p = 0.042), and had longer operative times (median 543 vs. 493 min, p = 0.010). Postoperative Clavien–Dindo grade 3–4 morbidity was lower in AYA (17 vs. 26%, p = 0.029), and they required fewer reoperations for complications (3.7 vs. 10.4%, p = 0.014). AYA had longer median overall survival (103.6 vs. 73.2 months, p = 0.053). In a multivariate Cox regression analysis, age was an independent predictor of improved overall survival [hazard ratio 0.705; 0.516–0.963, p = 0.028]. Conclusions Young patients with peritoneal metastases derive similar benefits from CRS/HIPEC as middle-aged patients. Young age should not be a deterrent to consideration of CRS/HIPEC for peritoneal metastases.
      PubDate: 2017-04-01
      DOI: 10.1245/s10434-016-5689-y
      Issue No: Vol. 24, No. 4 (2017)
       
  • Inflammation-Based Prognostic Scores: Utility in Prognostication and
           Patient Selection for Cytoreduction and Perioperative Intraperitoneal
           Chemotherapy in Patients with Peritoneal Metastasis of Colonic Origin
    • Authors: Chukwuemeka Ihemelandu
      Pages: 884 - 889
      Abstract: Background Tumor-associated systemic inflammatory response has been correlated with prognosis. Our aim was to analyze the utility of inflammation-based prognostic scores for prognostication and patient selection for cytoreduction and perioperative intraperitoneal chemotherapy (POIC) in patients diagnosed with peritoneal metastasis of colonic origin. Methods A retrospective analysis of a prospectively maintained database for all patients treated for peritoneal metastasis of colonic origin from February 2001 to April 2015. Inflammation-based prognostic scores including neutrophil–lymphocyte ratio, platelet–lymphocyte ratio (PLR) and Onodera’s prognostic nutritional index (ONI) were calculated. Results Of 123 patients, 70 (56.9%) were men and 53 (43.1%) were women. Mean age at diagnosis was 49.9 years. Significant prognosticators in univariate analysis included intraoperative peritoneal cancer index (p < 0.000), tumor marker CA19-9 (p < 0.000), PLR (p = 0.020), POIC regimen (p < 0.003), and completeness of cytoreduction (p < 0.000). Multivariate Cox analysis identified CA19-9 (hazard ratio [HR] 1.0; 95% confidence interval [CI] 1.00–1.01, p = 0.031), ONI (HR 0.86; 95% CI 0.79–0.94, p < 0.000), PLR (HR 1.0; 95% CI 0.90–1.01, p = 0.041), incompleteness of cytoreduction CC2 and CC3, and mucinous adenocarcinoma histology as significant independent prognosticators. Conclusions The inflammation-based prognostic scores PLR and ONI and tumor marker CA19-9 are significant prognosticators of survival. They are useful in patient selection and prognostication for cytoreductive surgery and POIC in patients with peritoneal carcinomatosis of colonic origin.
      PubDate: 2017-04-01
      DOI: 10.1245/s10434-016-5693-2
      Issue No: Vol. 24, No. 4 (2017)
       
  • Prognostic Factors and Significance of Gastrointestinal Leak After
           Cytoreductive Surgery (CRS) with Heated Intraperitoneal Chemotherapy
           (HIPEC)
    • Authors: Konstantinos Chouliaras; Edward A. Levine; Nora Fino; Perry Shen; Konstantinos I. Votanopoulos
      Pages: 890 - 897
      Abstract: Background Gastrointestinal leak (GIL) after cytoreductive surgery with heated intraperitoneal chemotherapy (CRS/HIPEC) is associated with significant morbidity and mortality. This study aimed to identify GIL prognostic factors and its impact on overall survival. Methods A retrospective analysis of a prospectively maintained database comprising 1270 CRS/HIPEC procedures was performed. Type of GIL, functional and resection status, morbidity, mortality, and survival were reviewed. Results Gastrointestinal leaks were identified in 8.7% (110/1270) of CRS/HIPEC procedures, including 53 anastomotic leaks (4.2%), 53 hollow viscus perforations (4.2%), and four leaks at unknown sites. The multivariate predictors of leak were Eastern Cooperative Oncology Group (ECOG) functional status (ECOG 1 vs. 0: odds ratio [OR] 2.12, p = 0.009; ECOG 2 vs. 0: OR 2.90, p = 0.004), and number of anastomoses (OR 5.34; p < 0.0001). The in-hospital mortality rate for the GIL cohort was 21.8% (24/110), with a 72% (80/110) reoperation rate. The leak cohort had a higher major morbidity rate (88.3 vs. 23.3%; p < 0.0001), a longer hospital stay (39.0 vs. 9.9 days; p < 0.0001), and a longer intensive care unit (ICU) stay (7.7 vs. 1.7 days; p = 0.0003). After surgical mortality was excluded, the overall survival periods for the leak and no-leak patients with complete cytoreduction were respectively 1.5 and 4.98 years (p = 0.0001). Clinically significant decreases in survival were observed for all primary malignancies. Conclusions Gastrointestinal leak after CRS/HIPEC is a source of significant mortality, with a decrease in overall survival even after complete CRS. Preoperative functional status and number of anastomoses are predictors of leak for CRS/HIPEC patients.
      PubDate: 2017-04-01
      DOI: 10.1245/s10434-016-5738-6
      Issue No: Vol. 24, No. 4 (2017)
       
  • Management for Peritoneal Metastasis of Colonic Origin: Role of
           Cytoreductive Surgery and Perioperative Intraperitoneal Chemotherapy: A
           Single Institution’s Experience During Two Decades
    • Authors: Chukwuemeka Ihemelandu; Paul H. Sugarbaker
      Pages: 898 - 905
      Abstract: Background Peritoneal metastasis of colonic origin is associated with a poor prognosis. This study aimed to analyze the clinicopathologic characteristics and prognostic predictors of survival in a cohort of patients treated with cytoreductive surgery (CRS) and perioperative intraperitoneal chemotherapy (POIC) during two decades. Methods A retrospective study analyzed a prospectively maintained database for all patients treated for peritoneal metastasis of a colonic origin (PCC) from January 1990 to April 2015. Results The 318 patients in our study comprised 171 men (53.8%) and 147 women (46.2%). The mean age of the patients at presentation was 50.6 years, (range 18–86 years). Overall survival was 42.5%, median survival and follow-up time was 21.5 and 15.0 months respectively. The 3 and 5 years survival rates were respectively 35 and 25%. The median survival time was 20.6 months for the men and 23.1 months for the women (p = 0.14). The mean intraoperative peritoneal carcinomatosis index (PCI) was 15.2. The patients who had a completeness of cytoreduction (CC) score of 0 or 1 (no residual disease <0.25 mm) had a median survival time of 36.6 months compared with 18.3 months for the patients with a CC-2 score and 7.6 months for the patients with a CC-3 score (p < 0.000). The significant independent predictors of survival in the multivariate analysis were the CC score and elevated tumor makers CA153 and CA125. Conclusion For patients with a limited extent of peritoneal metastases, CC is the most important prognostic variable for improved survival of colon cancer patients with peritoneal metastases.
      PubDate: 2017-04-01
      DOI: 10.1245/s10434-016-5698-x
      Issue No: Vol. 24, No. 4 (2017)
       
  • Routine Computer Tomography Imaging for the Detection of Recurrences in
           High-Risk Melanoma Patients
    • Authors: Tristen S. Park; Giao Q. Phan; James C. Yang; Udai Kammula; Marybeth S. Hughes; Kasia Trebska-McGowan; Kathleen E. Morton; Donald E. White; Steven A. Rosenberg; Richard M. Sherry
      Pages: 947 - 951
      Abstract: Background The use of routine CT imaging for surveillance in asymptomatic patients with cutaneous melanoma is controversial. We report our experience using a surveillance strategy that included CT imaging for a cohort of patients with high-risk melanoma. Methods A total of 466 patients with high-risk cutaneous melanoma enrolled in adjuvant immunotherapy trials were followed for tumor progression by physical examination, labs, and CT imaging as defined by protocol. Evaluations were obtained at least every 6 months for year 1, every 6 months for year 2, and then annually for the remainder of the 5-year study. Time to tumor progression, sites of recurrence, and the method of relapse detection were identified. Results The patient cohort consisted of 115 stage II patients, 328 stage III patients, and 23 patients with resected stage IV melanoma. The medium time to progression for the 225 patients who developed tumor progression was 7 months. Tumor progression was detected by patients, physician examination or routine labs, or by CT imaging alone in 27, 14, and 59% of cases respectively. Melanoma recurrences were noted to be locoregional in 36% of cases and systemic in 64% of cases. Thirty percent of patients with locoregional relapse and 75% of patients with systemic relapse were detected solely by CT imaging. Conclusions CT imaging alone detected the majority of sites of disease progression in our patients with high-risk cutaneous melanoma. This disease was not heralded by symptoms, physical examination, or blood work. Although the benefit of the early detection of advanced melanoma is unknown, this experience is relevant because of the rapid development and availability of potentially curative immunotherapies.
      PubDate: 2017-04-01
      DOI: 10.1245/s10434-017-5768-8
      Issue No: Vol. 24, No. 4 (2017)
       
  • Thin Melanoma with Nodal Involvement: Analysis of Demographic, Pathologic,
           and Treatment Factors with Regard to Prognosis
    • Authors: Giorgos Karakousis; Phyllis A. Gimotty; Edmund K. Bartlett; Myung-Shin Sim; Madalyn G. Neuwirth; Douglas Fraker; Brian J. Czerniecki; Mark B. Faries
      Pages: 952 - 959
      Abstract: Background Although only a small proportion of thin melanomas result in lymph node metastasis, the abundance of these lesions results in a relatively large absolute number of patients with a diagnosis of nodal metastases, determined by either sentinel lymph node (SLN) biopsy or clinical nodal recurrence (CNR). Methods Independent cohorts with thin melanoma and either SLN metastasis or CNR were identified at two melanoma referral centers. At both centers, SLN metastasis patients were included. At center 1, the CNR cohort included patients with initial negative clinical nodal evaluation followed by CNR. At center 2, the CNR cohort was restricted to those presenting in the era before the use of SLN biopsy. Uni- and multivariable analyses of melanoma-specific survival (MSS) were performed. Results At center 1, 427 CNR patients were compared with 91 SLN+ patients. The 5- and 10-year survival rates in the SLN group were respectively 88 and 84 % compared with 72 and 49 % in the CNR group (p < 0.0001). The multivariate analysis showed age older than 50 years (hazard ratio [HR] 1.5; 95 % confidence interval [CI] 1.2–1.9), present ulceration (HR 1.9; 95 % CI 1.2–2.9), unknown ulceration (HR 1.6; 95 % CI 1.3–2.1), truncal site (HR 1.6; 95 % CI 1.2–2.2), and CNR (HR 3.3; 95 % CI 1.8–6.0) to be associated significantly with decreased MSS (p < 0.01 for each). The center 2 cohort demonstrated remarkably similar findings, with a 5-year MSS of 88 % in the SLN (n = 29) group and 76 % in the CNR group (n = 39, p = 0.09). Conclusion Patients with nodal metastases from thin melanomas have a substantial risk of melanoma death. This risk is lower among patients whose disease is discovered by SLN biopsy rather than CNR.
      PubDate: 2017-04-01
      DOI: 10.1245/s10434-016-5646-9
      Issue No: Vol. 24, No. 4 (2017)
       
  • Race Is a Risk for Lymph Node Metastasis in Patients With Gastric Cancer
    • Authors: Naruhiko Ikoma; Mariela Blum; Yi-Ju Chiang; Jeannelyn S. Estrella; Sinchita Roy-Chowdhuri; Keith Fournier; Paul Mansfield; Jaffer Ajani; Brian D. Badgwell
      Pages: 960 - 965
      Abstract: Background The frequency of lymph node metastasis in each T stage of gastric cancer has not been as well described for Western populations as it has for Asian populations. This study aimed to determine these frequencies and to investigate risk factors associated with lymph node metastases in a racially diverse U.S. population. Methods A prospectively maintained database of 8260 patients with gastric or gastroesophageal junction adenocarcinoma treated at our institution from 1995 to 2013 was reviewed to identify those who underwent surgical resection without preoperative therapy. Associations between clinicopathologic variables and lymph node metastasis were tested with uni- and multivariate analyses. Results The study identified 218 patients with a pathologic diagnosis of gastric adenocarcinoma who underwent upfront gastrectomy. These study subjects included 115 white (53 %), 19 black (9 %), and 41 Asian (19 %) patients. At least 15 lymph nodes were examined in 148 (68 %) of the patients. The lymph node metastasis rates were 10 % for stage T1a, 34 % for stage T1b, 44 % for stage T2, 73 % for stage T3, and 95 % for stage T4 tumors. Univariate analysis showed that submucosal invasion, race, 15 or more lymph nodes examined, and lymphovascular invasion were associated with lymph node metastasis in T1 and T2 tumors. The multivariate analysis showed all but lymphovascular invasion to be independent risk factors for nodal metastasis. Conclusions The rates of lymph node metastasis observed in this study were higher than those reported in Asian reports. Race was an independent risk factor for lymph node metastasis. Caution is therefore needed when evidence from Asian countries is extrapolated to more racially diverse Western countries.
      PubDate: 2017-04-01
      DOI: 10.1245/s10434-016-5645-x
      Issue No: Vol. 24, No. 4 (2017)
       
  • Prognostic Factors for Locoregional Recurrence in Patients with Thoracic
           Esophageal Squamous Cell Carcinoma Treated with Radical Two-Field Lymph
           Node Dissection: Results from Long-Term Follow-Up
    • Authors: ShiLiang Liu; Simone Anfossi; Bo Qiu; YuZhen Zheng; MuYan Cai; Jia Fu; Hong Yang; Qing Liu; ZhaoLin Chen; JianHua Fu; MengZhong Liu; Jared K. Burks; Steven H. Lin; James Reuben; Hui Liu
      Pages: 966 - 973
      Abstract: Objective To aim of this study was to determine the clinical and biological prognostic factors for locoregional recurrence (LRR) in patients with thoracic esophageal squamous cell carcinoma (ESCC) undergoing radical two-field lymph node dissection (2FLD). Methods A total of 462 patients diagnosed with thoracic ESCC underwent radical esophagectomy between March 2001 and May 2010 at Sun Yat-Sen University Cancer Center. Clinical characteristics, CD44 expression, and tumor-infiltrating lymphocyte (TIL) levels were evaluated in 198 patients who underwent R0 dissection with long-term follow-up. Partial Cox regression analysis with leave-one-out cross-validation was performed to validate the selected risk factors. Results With a median follow-up of 54 months, the 5-year local failure-free survival (LFFS) rate of 198 patients was 62.5%. Multivariate analysis revealed that T stage (p = 0.043), pathological positive tumor above the carina (p = 0.000), CD44 expression level (p = 0.045) and TIL level (p = 0.007) were prognostic factors for LFFS, while the Cox model with risk scores had an area under the curve value of 83.6% for the prediction of 5-year LFFS. The best cut-off value (sum score = 11.19) was used to determine the high- and low-risk groups, with patients at high risk having a significantly shorter 5-year LFFS than patients at low risk (p = 0.000). The LRR pattern revealed significantly high incidences of recurrent disease at the supraclavicular and cervical sites, mediastinum (above the carina), and anastomosis. Conclusions Our predictive model was able to distinguish between patients at high risk for LRR and patients at low risk for LRR. LRR primarily involved the upper thorax and this area must be considered in future study designs for radical trimodality treatment.
      PubDate: 2017-04-01
      DOI: 10.1245/s10434-016-5652-y
      Issue No: Vol. 24, No. 4 (2017)
       
  • Standard Clinical Protocol for Bidirectional Hyperthermic Intraperitoneal
           Chemotherapy (HIPEC): Systemic Leucovorin, 5-Fluorouracil, and Heated
           Intraperitoneal Oxaliplatin in a Chloride-Containing Carrier Solution
    • Authors: Akash M. Mehta; Alwin D. R. Huitema; Jacobus W. A. Burger; Alexandra R. M. Brandt-Kerkhof; Sander F. van den Heuvel; Victor J. Verwaal
      Pages: 990 - 997
      Abstract: Background Intraperitoneal chemotherapy has an established role in the treatment of selected patients with colorectal peritoneal metastases. Oxaliplatin is highly suitable as a chemotherapeutic agent for hyperthermic intraperitoneal chemotherapy (HIPEC), but its use to date has been limited because of the morbidity caused by severe electrolyte and glycemic imbalances associated with 5% glucose as its carrier solution. This report provides an overview of the development, rationale, and application of intraperitoneal chemotherapy and the use of various drugs and carrier solutions. A novel, evidence-based protocol for bidirectional oxaliplatin-based HIPEC in a physiologic carrier solution (Dianeal PD4 dextrose 1.36%) is presented, and its impact on electrolyte and glucose levels is demonstrated. Methods After implementation of the new protocol, the serum electrolyte (sodium, potassium, and chloride) levels, glucose levels, and intravenous insulin requirements were intensively measured in eight consecutive cases immediately before HIPEC (T = 0), immediately after HIPEC (T = 30), 1 h after HIPEC (T = 60), and 3 h after HIPEC (T = 180). Results The median sodium levels were 140 mmol/L at T = 0, 138 mmol/L at T = 30, 140 mmol/L at T = 60, and 140 mmol/L at T = 180. The respective median potassium levels were 4.6, 4.2, 3.7, and 3.9 mmol/L, and the respective median chloride levels were 112, 111, 111, and 112 mmol/L. The respective median glucose levels were 9, 11.5, 10.7, and 8.6 mmol/L. The median insulin requirements were respectively 0.5, 1.5, 1.2, and 0 U/h. None of the patients were diabetic. Conclusion Using a novel protocol for bidirectional oxaliplatin-based HIPEC in Dianeal instead of 5% glucose, the observed fluctuations in this study were minimal and not clinically relevant compared with historical values for electrolyte and glycemic changes using 5% glucose as a HIPEC carrier solution. This novel protocol leads to only minimal and clinically irrelevant electrolyte and glycemic disturbances, and its adoption as the standard protocol for oxaliplatin-based HIPEC should be considered.
      PubDate: 2017-04-01
      DOI: 10.1245/s10434-016-5665-6
      Issue No: Vol. 24, No. 4 (2017)
       
  • Surgeon’s Experience Overrides the Effect of Hospital Volume for
           Postoperative Outcomes of Laparoscopic Surgery in Gastric Cancer:
           Multi-institutional Study
    • Authors: Han Hong Lee; Sang-Yong Son; Ju Hee Lee; Min Gyu Kim; Hoon Hur; Do Joong Park
      Pages: 1010 - 1017
      Abstract: Background Hospital volume is known to be a crucial factor in reducing postoperative morbidity and mortality in laparoscopic gastrectomy for gastric cancer. However, it is unclear whether surgeon’s individual experience can overcome the effect of hospital volume. Methods Clinicopathologic data of initial 50 laparoscopic gastrectomy cases were collected from six gastric cancer surgeons. Half of the six surgeons worked in high-volume centers, and the other half worked in low-volume hospitals. Perioperative outcomes were compared between the high-volume centers and the low-volume hospitals. Results Three low-volume hospitals in this study contained significantly more male and older patients with a higher American Society of Anesthesiologists score than high-volume centers. Although high- and low-volume hospitals mainly used laparoscopy-assisted and totally laparoscopic approach, respectively, there were no differences between the two groups in the extent of resection, operating time, estimated blood loss, and number of collected lymph nodes. Postoperative recovery such as duration to soft diet and hospital stay did not differ between the high- and the low-volume hospitals. No significant difference was found in postoperative morbidities by Clavien–Dindo classification. There was no mortality reported in both groups of the enrolled hospitals. Conclusions Hospital volume is not a decisive factor in affecting postoperative morbidity and mortality for well-trained beginners in laparoscopic surgery for gastric cancer.
      PubDate: 2017-04-01
      DOI: 10.1245/s10434-016-5672-7
      Issue No: Vol. 24, No. 4 (2017)
       
  • An Isoperistaltic Jejunum-Later-Cut Overlap Method for Esophagojejunostomy
           Anastomosis After Totally Laparoscopic Total Gastrectomy: A Safe and
           Feasible Technique
    • Authors: Chang-Ming Huang; Ze-Ning Huang; Chao-Hui Zheng; Ping Li; Jian-Wei Xie; Jia-Bin Wang; Jian-Xian Lin; Jun Lu; Qi-Yue Chen; Long-Long Cao; Mi Lin; Ru-Hong Tu
      Pages: 1019 - 1020
      Abstract: Background Intracorporeal anastomosis after totally laparoscopic total gastrectomy (TLTG) has been increasingly applied. 1–7 We assessed the intracorporeal isoperistaltic jejunum-later-cut overlap method (IJOM) for esophagojejunostomy anastomosis (EA). Methods From January to June 2014, a total of 19 patients with resectable gastric cancer (cT1–T4aNOM0) underwent TLTG. IJOM was performed by creating side-to-side stapled anastomosis through enterotomies proximal to the left esophageal resection margin and on the antimesenteric jejunal border, 30 cm distal to the Trietz ligament. Conjoined enterotomies were sutured closed. The IJOM reduces jejunal motion and controls the EA direction. The biliary jejunal limb was transected ≤5 cm proximal to anastomosis, and a gastrografin esophagram was performed 5–7 days after the operation to diagnose anastomotic leakage. Follow-ups were performed every 3 months from the date of surgery to last follow-up by esophagram or computed tomography. Results For the 19 patients, the esophagojejunostomy time was 26 min, and blood loss was 50 ml (interquartile ranges [IQRs] 22–31 and 50–60, respectively). There were no conversions to open surgery. Liquid intake and soft diet were initiated on days 4 and 7, respectively, for 37 and 53% of patients (n = 7 and 10; IQRs 4–5 and 7–8, respectively). One patient with abdominal infection had delayed oral intake (day 11). Hospitalization duration was 12 days (IQR 11–16), and no patients experienced anastomosis-related complications (i.e. anastomotic leakage, stricture, hemorrhage, dysphagia, or dilation) or recurrence at anastomosis during follow-up (19 months; IQR 18–20). Conclusions IJOM for EA after TLTG is feasible. These early results do not reveal a high complication rate but additional outcome monitoring is needed.
      PubDate: 2017-04-01
      DOI: 10.1245/s10434-016-5658-5
      Issue No: Vol. 24, No. 4 (2017)
       
  • Impact of Skeletal Muscle Mass, Muscle Quality, and Visceral Adiposity on
           Outcomes Following Resection of Intrahepatic Cholangiocarcinoma
    • Authors: Shinya Okumura; Toshimi Kaido; Yuhei Hamaguchi; Atsushi Kobayashi; Hisaya Shirai; Yasuhiro Fujimoto; Taku Iida; Shintaro Yagi; Kojiro Taura; Etsuro Hatano; Hideaki Okajima; Shinji Uemoto
      Pages: 1037 - 1045
      Abstract: Background Decrease in skeletal muscle mass and function, known as sarcopenia, is associated with poor prognosis. Visceral fat accumulation also is related to mortality. This study investigated the impact of preoperative skeletal muscle mass, muscle quality, and visceral adiposity on outcomes in patients undergoing resection of intrahepatic cholangiocarcinoma (ICC). Methods A retrospective analysis was performed of 109 patients undergoing resections of ICC between January 2004 and April 2015. Skeletal muscle mass [skeletal muscle index (SMI)], skeletal muscle quality [muscle attenuation (MA)], and visceral adiposity [visceral to subcutaneous adipose tissue area ratio (VSR)] were measured on preoperative computed tomography images. The impacts of these parameters on outcomes after ICC resections were analyzed. Results The overall survival rates were significantly lower in patients with low SMI (P = 0.002), low MA (P = 0.032), and high VSR (P = 0.026) compared with patients with high SMI, high MA, and low VSR, respectively. With multivariate analyses, in patients with stage I–III, low SMI (hazard ratio (HR) 3.29, P = 0.003) and low MA (HR 2.86, P = 0.010) were revealed as independent significant risk factors for mortality. In patients with stage IV, none of these parameters was identified as risk factors, with only the absence of adjuvant chemotherapy identified as an independent risk factor for mortality (HR 5.92, P = 0.001). Conclusions Although stage was the most important factor, low skeletal muscle mass and quality were closely related to mortality after resection of ICC in patients with stage I–III.
      PubDate: 2017-04-01
      DOI: 10.1245/s10434-016-5668-3
      Issue No: Vol. 24, No. 4 (2017)
       
  • Laparoscopic Glissonean Pedicle Transection (Takasaki) for Negative
           Fluorescent Counterstaining of Segment 6
    • Authors: Takashi Mizuno; Rahul Sheth; Masakazu Yamamoto; Hyun Seon C. Kang; Suguru Yamashita; Thomas A. Aloia; Yun Shin Chun; Jeffrey E. Lee; Jean-Nicolas Vauthey; C. Conrad
      Pages: 1046 - 1047
      Abstract: Background The portal pedicles are wrapped in connective tissue known as the Walaeus sheath, which abut Laennec’s capsule covering the liver parenchyma. Precise knowledge of this anatomic relationship allows for dissection of this interspace and early control of the segmental portal pedicle (Glissonean pedicle transection method [GPTM], Takasaki approach). 1,2 Subsequent systemic administration of indocyanine green (ICG) leads to negative counterstaining of the segment to be resected. Patient The patient was a 60-year-old healthy woman with invasive lobular breast cancer, grade 2, which was estrogen receptor-positive (ER +), progesterone receptor-positive (PR +), human epidermal growth factor-negative (HER2–), Ki-67 80%, and cT2N0M1. A synchronous solitary liver metastasis between segments 6 and 7 was diagnosed. After treatment with letrozole and palbociclib for 1 year had achieved stable disease, the patient was considered for liver metastasectomy. 3,4 Methods After an intraoperative ultrasound, the patient was placed in the French position, 5 and the gallbladder was disconnected from the cystic duct for exposure of the hepatoduodenal ligament. The hilar plate was lowered, and the portal pedicle of segment 6 was dissected out using the GPTM approach. After test-clamping, an appropriate demarcation was observed, and ICG was administered systemically. This led to negative counterstaining of segment 6 and allowed for precise anatomic dissection under near-infrared vision. Conclusions Laparoscopic application of GPTM facilitates anatomically precise liver resection through early pedicle control. Negative counterstaining using ICG under near-infrared vision leads to visual enhancement of the anatomically precise borders. They typically do not follow straight lines and are therefore difficult to dissect precisely. Counterstaining with ICG shows patient-specific anatomic variations that would be a challenge to determine, especially laparoscopically.
      PubDate: 2017-04-01
      DOI: 10.1245/s10434-016-5721-2
      Issue No: Vol. 24, No. 4 (2017)
       
  • Chemotherapy Significantly Improves Survival for Patients with T1c-T2N0M0
           Medullary Breast Cancer: 3739 Cases From the National Cancer Data Base
    • Authors: Alina M. Mateo; Todd A. Pezzi; Mark Sundermeyer; Cynthia A. Kelley; V. Suzanne Klimberg; Christopher M. Pezzi
      Pages: 1050 - 1056
      Abstract: Background Medullary breast cancer (MBC) is a rare tumor associated with a better prognosis compared with other breast cancers. The role of adjuvant chemotherapy has not been extensively studied. Methods Female patients with invasive MBC reported to the National Cancer Data Base from 2004 to 2012 were analyzed. Overall survival (OS) and treatment were studied using the Kaplan–Meier method and the Cox proportional hazard model. Patients who had node-negative (N0), non-metastatic (M0) tumors 10 to 50 mm in size (T1cN0M0 and T2N0M0) treated with and without chemotherapy were analyzed using propensity score matching. Results Of 3739 patients with MBC, 2642 (71%) had T1b-T2N0M0 disease treated with and without chemotherapy. Multivariable analysis showed that for all MBC patients, the significant predictors of OS were age older than 65 years, one or more comorbidities, tumor larger than 2 cm, positive nodes, distant metastasis, and treatment with chemotherapy or radiation therapy. Patients with T1cN0M0 and T2N0M0 had improved OS if they received chemotherapy (p < 0.0005). Patients with T1bN0M0 who received chemotherapy did not show better OS than those who did not. Patients with T1c-T2N0M0 were then matched by propensity score based on age, presence of comorbidities, tumor size, and treatment methods used. After matching, the group receiving chemotherapy showed an improved OS (hazard ratio [HR], 0.40; 95% confidence interval [CI], 0.26–0.62; p < 0.0005) compared to the group that did not receive chemotherapy. Conclusions For patients with T1c-T2N0M0 MBC, chemotherapy significantly improves OS.
      PubDate: 2017-04-01
      DOI: 10.1245/s10434-016-5649-6
      Issue No: Vol. 24, No. 4 (2017)
       
  • Survival Outcome and Risk of Metachronous Colorectal Cancer After Surgery
           in Lynch Syndrome
    • Authors: Tae Jun Kim; Eun Ran Kim; Sung Noh Hong; Young-Ho Kim; Jung Wook Huh; Yoon Ah Park; Yong Beom Cho; Seong Hyeon Yun; Hee Cheol Kim; Woo Yong Lee; Kiyoun Kim; Kyunga Kim; Dong Kyung Chang
      Pages: 1085 - 1092
      Abstract: Background The survival benefit of extensive colectomy is controversial in Lynch syndrome, and risk factors for metachronous colorectal cancer (CRC) after segmental colectomy are unclear. Objective The aim of this study was to investigate the survival outcome and risk of metachronous CRC after surgery in Lynch syndrome patients diagnosed with their first CRC. Methods Overall, 106 patients with Lynch syndrome who underwent surgery for CRC were included in the study. The demographics, genotype, clinicopathological characteristics of the index CRC, and follow-up data were reviewed from a single-institution Lynch syndrome database. Results Of 30 patients who underwent extensive surgery, no metachronous CRC was developed during a mean follow-up of 68.1 months. Of 76 patients who underwent segmental colectomy, 13 (17.1 %) developed metachronous CRC during a mean follow-up of 77.2 months. The cumulative risk of metachronous CRC was 8.4 % at 5 years and 20.4 % at 10 years after segmental colectomy. No difference in overall and CRC-specific survival was observed between segmental colectomy and extensive colectomy (p = 0.277 and p = 0.659, respectively). A 25 cm or longer resection of bowel decreased the risk of metachronous CRC after segmental colectomy compared with less extensive resection (hazard ratio 0.10, 95 % confidence interval 0.01–0.86). Annual surveillance colonoscopy did not decrease the risk of metachronous CRC compared with less frequent surveillance colonoscopy. Although not statistically significant, none of the MSH6 gene mutation carriers were diagnosed with metachronous CRC. Conclusions Although no survival benefit was identified, surgeons and patients might consider extensive colectomy to prevent metachronous CRC in Lynch syndrome patients regardless of their clinicopathological characteristics.
      PubDate: 2017-04-01
      DOI: 10.1245/s10434-016-5633-1
      Issue No: Vol. 24, No. 4 (2017)
       
  • Incidence, Patterns, and Predictors of Locoregional Recurrence in Colon
           Cancer
    • Authors: David Liska; Luca Stocchi; Georgios Karagkounis; Faisal Elagili; David W. Dietz; Matthew F. Kalady; Hermann Kessler; Feza H. Remzi; James Church
      Pages: 1093 - 1099
      Abstract: Background Locoregional recurrence (LR) in colon cancer is uncommon but often incurable, while the factors associated with it are unclear. The purpose of this study was to identify patterns and predictors of LR after curative resection for colon cancer. Methods All patients who underwent colon cancer resection with curative intent between 1994 and 2008 at a tertiary referral center were identified from a prospectively maintained institutional database. The association of LR with clinicopathologic and treatment characteristics was determined using univariable and multivariable analyses. Results A total of 1397 patients were included with a median follow-up of 7.8 years; 635 (45%) were female, and the median age was 69 years. LR was detected in 61 (4.4%) patients. Median time to LR was 21 months. On multivariable analysis, the independent predictors of LR were disease stage [hazard ratio (HR) for Stage II 4.6, 95% confidence interval (CI) 1.05–19.9, HR for Stage III 10.8, 95% CI 2.6–45.8], bowel obstruction (HR 3.8, 95% CI 1.9–7.4), margin involvement (HR 4.1, 95% CI 1.9–8.6), lymphovascular invasion (HR 1.9, 95% CI 1.06–3.5), and local tumor invasion (fixation to another structure, perforation, or presence of associated fistula, HR 2.2, 95% CI 1.1–4.5). Adjuvant chemotherapy was not associated with reduced LR in patients with either Stage II or Stage III tumors. Conclusions Adherence to oncologic surgical principles in colon cancer resection results in low rates of LR, which is associated with tumor-dependent factors. Recognition of these factors can help to determine appropriate postoperative surveillance.
      PubDate: 2017-04-01
      DOI: 10.1245/s10434-016-5643-z
      Issue No: Vol. 24, No. 4 (2017)
       
  • Survival Analysis and Risk for Progression of Intraductal Papillary
           Mucinous Neoplasia of the Pancreas (IPMN) Under Surveillance: A
           Single-Institution Experience
    • Authors: Marco Del Chiaro; Zeeshan Ateeb; Marcus Reuterwall Hansson; Elena Rangelova; Ralf Segersvärd; Nikolaos Kartalis; Christoph Ansorge; Matthias J. Löhr; Urban Arnelo; Caroline Verbeke
      Pages: 1120 - 1126
      Abstract: Purpose While surveillance of the majority of patients with IPMN is considered best practice, consensus regarding the duration of follow-up is lacking. This study assessed the survival rate and risk for progression of IPMN under surveillance. Methods All patients diagnosed with and surveyed for IPMN between January 2008 and December 2013 were identified and assigned to two groups: patients without indication for surgery (Group 1), and patients whose IPMN required surgery but were inoperable for general reasons (Group 2). Disease progression and survival data were compared between both groups. Results In total 503 patients were identified, of whom 444 (88.3%) were followed up. Group 1 included 395 patients, and Group 2 had 49. In Group 1, IPMN-specific 1-, 5-, and 10-year survival rates were 100, 100, and 94.2%, respectively. Four patients died of associated or concomitant pancreatic cancer, and 230 patients (58.2%) experienced disease progression. The 1-, 4-, 10-year cumulative risk for progression and for surgery was 11.2, 70.6, 97.5, and 2.9, 26.2, 72.1%, respectively. In Group 2, the 1-, 5-, 10-year IPMN-specific survival rate was 90.7, 74.8, and 74.8%, respectively. Conclusions This study confirmed the safety of surveillance for patients with IPMN who do not require surgery. However, the risk for disease progression and for surgery increases significantly over time. The study results support International and European guidelines not to discontinue IPMN surveillance and validate the European recommendation to intensify follow-up after 5 years. The fairly good prognosis of patients whose IPMN requires surgery but cannot undergo resection suggests a relatively indolent disease biology.
      PubDate: 2017-04-01
      DOI: 10.1245/s10434-016-5661-x
      Issue No: Vol. 24, No. 4 (2017)
       
  • Pancreatic Duct Involvement in Well-Differentiated Neuroendocrine Tumors
           is an Independent Poor Prognostic Factor
    • Authors: Yoshihide Nanno; Ippei Matsumoto; Yoh Zen; Kyoko Otani; Jun Uemura; Hirochika Toyama; Sadaki Asari; Tadahiro Goto; Tetsuo Ajiki; Keiichi Okano; Yasuyuki Suzuki; Yoshifumi Takeyama; Takumi Fukumoto; Yonson Ku
      Pages: 1127 - 1133
      Abstract: Background The biological behavior of well-differentiated neuroendocrine tumors of the pancreas (PNETs) is difficult to predict. This study was designed to determine whether involvement of the main pancreatic duct (MPD) serves as a poor prognostic factor for PNETs. Methods The involvement of the MPD in PNETs was defined as ductal stenosis inside the tumor mass associated with distal MPDs more than twofold larger in diameter than the proximal ducts. We examined the correlation between MPD involvement and other clinicopathological parameters, including nodal metastasis and recurrence-free survival, in 101 patients treated consecutively at three referral centers in Japan. All patients underwent surgical resection. Results MPD involvement was observed in 13 of the 101 cases (13%) and was associated with multiple unfavorable clinicopathological features (e.g., larger tumor size, higher histological grade, more frequent nodal metastasis, and higher recurrence rates). Patients with MPD involvement also showed significantly worse recurrence-free survival than did those without ductal involvement (P < 0.001), with a 5 years recurrence-free rate of 41%. On multivariate analysis, MPD involvement was significantly associated with nodal metastasis [odds ratio (OR) 16; 95% confidence interval (CI) 3.8–89; P < 0.001] and recurrence (OR 8.0; 95% CI 1.7–46; P = 0.009). The radiology–pathology correlation revealed that stenosis of the MPD was due to periductal and/or intraductal tumor invasion. Cases with MPD involvement had microscopic venous invasion (P = 0.010) and perineural infiltration (P = 0.002) more frequently than did those with no ductal infiltration. Conclusions MPD involvement in PNETs may serve as an imaging sign indicating an aggressive clinical course.
      PubDate: 2017-04-01
      DOI: 10.1245/s10434-016-5663-8
      Issue No: Vol. 24, No. 4 (2017)
       
  • Long-Term Impact of Postoperative Complications on Cancer Recurrence
           Following Lung Cancer Surgery
    • Authors: Takashi Nojiri; Toshimitsu Hamasaki; Masayoshi Inoue; Yasushi Shintani; Yukiyasu Takeuchi; Hajime Maeda; Meinoshin Okumura
      Pages: 1135 - 1142
      Abstract: Background Postoperative complications are associated with poor cancer-specific survival in various types of cancer surgery. Recent studies suggest that systemic inflammation induced by surgical trauma can accelerate the adhesion of circulating tumor cells to the vascular endothelium of distant organs, resulting in early cancer recurrence. We investigated the impact of postoperative cardiopulmonary complications on cancer recurrence following lung cancer surgery. Methods From a prospective database of 675 consecutive patients who underwent curative surgery for lung cancer between 2007 and 2012, the incidence of postoperative cardiopulmonary complications, white blood cell counts, and C-reactive protein levels were evaluated in the acute phase after surgery. Four patients had both cardiovascular and respiratory complications. The remaining 671 patients were divided into 3 groups: patients without cardiopulmonary complications; those with cardiovascular complications; and those with respiratory complications. The incidence of cancer recurrence was compared among the three groups. Results Postoperative cardiovascular or respiratory complications were identified in 94 (14%) or 25 (4%) patients, respectively. Postoperative white blood cell counts and C-reactive protein levels were significantly higher in those with postoperative respiratory complications than in those without. There was a significantly higher incidence of cancer recurrence in those with postoperative respiratory complications than in those without (48.0 vs. 16.8%; p < 0.0001). Multiple regression analysis adjusted for age, sex, and pathological staging showed that the incidence of postoperative respiratory complications was a significant predictor of cancer recurrence. Conclusions The presence of respiratory complications following lung cancer surgery was a significant predictor of cancer recurrence.
      PubDate: 2017-04-01
      DOI: 10.1245/s10434-016-5655-8
      Issue No: Vol. 24, No. 4 (2017)
       
 
 
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