Oncological features and prognosis of colorectal cancer in human immunodeficiency virus-positive patients: A retrospective study

BACKGROUND Due to the prolonged life expectancy and increased risk of colorectal cancer(CRC)among patients with human immunodeficiency virus(HIV)infection,the prognosis and pathological features of CRC in HIV-positive patients require examination.AIM To compare the differences in oncological features,surgical safety,and prognosis between patients with and without HIV infection who have CRC at the same tumor stage and site.METHODS In this retrospective study,we collected data from HIV-positive and-negative patients who underwent radical resection for CRC.Using random stratified sampling,24 HIV-positive and 363 HIV-negative patients with colorectal adenocarcinoma after radical resection were selected.Using propensity score matching,we selected 72 patients,matched 1:2(HIV-positive:negative=24:48).Differences in basic characteristics,HIV acquisition,perioperative serological indicators,surgical safety,oncological features,and long-term prognosis were compared between the two groups.RESULTS Fewer patients with HIV infection underwent chemotherapy compared to patients without.HIV-positive patients had fewer preoperative and postoperative leukocytes,fewer preoperative lymphocytes,lower carcinoembryonic antigen levels,more intraoperative blood loss,more metastatic lymph nodes,higher node stage,higher tumor node metastasis stage,shorter overall survival,and shorter progression-free survival compared to patients who were HIV-negative.CONCLUSION Compared with CRC patients who are HIV-negative,patients with HIV infection have more metastatic lymph nodes and worse long-term survival after surgery.Standard treatment options for HIV-positive patients with CRC should be explored.

Oncologic outcomes with and without amniotic membranes in robotic-assisted radical prostatectomy:A propensity score matched analysis

Objective:Placement of human placenta derived grafts during robotic-assisted radical prostatectomy(RARP)hastens the return of continence and potency.The long-term impact on the oncologic outcomes remains to be investigated.Our objective was to determine the oncologic outcomes of patients with dehydrated human amnion chorion membrane(dHACM)at RARP compared to a matched cohort.Methods:In a referral centre,from August 2013 to October 2019,599 patients used dHACM in bilateral nerve-sparing RARP.We excluded patients with less than 12 months follow-up,simple prostatectomy,and unilateral nerve-sparing.Patients with dHACM(amnio group)were 529,and were propensity score matched 1:1 to 2465 patients without dHACM(non-amnio group)and a minimum follow-up of 36 months.At the time of RARP,dHACM was placed around the neurovascular bundle in the amnio group.Continuous and categorical variables in matched groups was tested by two-sample Kolmogorov-Smirnov test and Fisher's exact test respectively.Outcomes measured were biochemical recurrence(BCR),adjuvant and salvage therapy rates.Results:Propensity score matching resulted in two groups of 444 patients.Cumulative incidence functions for BCR did not show a difference between the groups(p=0.3).Patients in the non-amnio group required salvage therapy more frequently than the amnio group,particularly after partial nerve-sparing RARP(6.3%vs.2.3%,p=0.001).Limitations are the absence of prospective randomization.Conclusion:The data suggest that using dHACM does not have a negative impact on BCR in patients.Outcomes of cancer specific and overall survival will require follow-up study to increase our understanding of these grafts’impact on prostate cancer biology.

Next Generation Sequencing in Oncological Diagnostics: Hype or Hope?

The understanding of how genetic and epigenetic factors influence tumorigenesis, progression and invasion, is vastly growing since new technologies allow the analysis of the functional genome namely the exome, the transcriptome and the epigenome, besides enabling genome-wide assessment of genetic variations. With the advent of new drugs that are indicated tissue agnostic, depending on certain mutations, there is a growing demand for fast and cost-effective genetic diagnosis. The method in focus that already became an indispensable tool in viral diagnosis is next-generation sequencing (NGS). This approach allows sequencing of literally every DNA molecule in the sample and can either be used to assess numerous genetic markers of one patient at a time, or to assess fewer markers of many patients in parallel, which reduces costs. We submitted 23 samples of different tumor entities to four diagnostic companies with different analysis profiles. The results as disclosed and discussed in this report indicate that so far, the main application of NGS is rather in cancer research than in diagnosis, as none of the reports had a real impact on the therapeutic scheme. We are perfectly aware that such a small cohort cannot be generalized, but considering the costs vs. benefits, NGS should be engaged upon a very stringent evaluation only. However, in cases where obtaining a tissue biopsy is impossible or unfavorable, analysis of liquid biopsy by NGS provides a vital alternative.

Long-term oncologic outcomes of laparoscopic vs open surgery for stages Ⅱ and Ⅲ rectal cancer: A retrospective cohort study

AIM: To evaluate the 5-year survival after laparoscopic surgery vs open surgery for stages Ⅱ and Ⅲ rectal cancer.METHODS:This study enrolled 406 consecutive patients who underwent curative resection for stagesⅡandⅢrectal cancer between January 2000 and December 2009[laparoscopic rectal resection(LRR),n=152;open rectal resection(ORR),n=254].Clinical characteristics,operative outcomes,pathological outcomes,postoperative recovery,and 5-year survival outcomes were compared between the two groups.RESULTS:Most of the clinical characteristics were similar except age(59 years vs 55 years,P=0.033)between the LRR group and ORR group.The proportion of anterior resection was higher in the LRR group than that in the ORR group(81.6%vs 66.1%,P=0.001).The LRR group had less estimated blood loss(50m L vs 200 m L,P<0.001)and a lower rate of blood transfusion(4.6%vs 11.8%,P=0.019)compared to the ORR group.The pathological outcomes of the two groups were comparable.The LRR group was associated with faster recovery of bowel function(2.8 d vs 3.7 d,P<0.001)and shorter postoperative hospital stay(11.7 d vs 13.7 d,P<0.001).The median followup time was 63 mo in the LRR group and 65 mo in the ORR group.As for the survival outcomes,the 5-year local recurrence rate(16.0%vs 16.4%,P=0.753),5-year disease-free survival(DFS)rate(63.0%vs63.1%,P=0.589),and 5-year overall survival(OS)rate(68.1%vs 63.5%,P=0.682)were comparable between the LRR group and the ORR group.Stageby stage,there were also no statistical differences between the LRR group and the ORR group in terms of the 5-year local recurrence rate(stageⅡ:6.3%vs 8.7%,P=0.623;stageⅢ:26.4%vs 23.2%,P=0.747),5-year DFS rate(stageⅡ:77.5%vs 77.6%,P=0.462;stageⅢ:46.5%vs 50.9%,P=0.738),and5-year OS rate(stageⅡ:81.4%vs 74.3%,P=0.242;stageⅢ:53.9%vs 54.1%,P=0.459).CONCLUSION:LRR for stagesⅡandⅢrectal cancer can yield comparable long-term survival while achieving short-term benefits compared to open surgery.

Systematic review of oncological outcomes following laparoscopic vs open total mesorectal excision

AIM: To systematically analyze the randomized trials comparing the oncological and clinical effectiveness of laparoscopic total mesorectal excision(LTME) vs open total mesorectal excision(OTME) in the management of rectal cancer.METHODS: Published randomized, controlled trials comparing the oncological and clinical effectiveness of LTME vs OTME in the management of rectal cancer were retrieved from the standard electronic medical databases. The data of included randomized, controlled trials was extracted and then analyzed according to the principles of meta-analysis using RevMan? statistical software. The combined outcome of the binary variables was expressed as odds ratio(OR) and the combined outcome of the continuous variables waspresented in the form of standardized mean difference(SMD). RESULTS: Data from eleven randomized, controlled trials on 2143 patients were retrieved from the electronic databases. There was a trend towards the higher risk of surgical site infection(OR = 0.66; 95%CI: 0.44-1.00; z = 1.94; P < 0.05), higher risk of incomplete total mesorectal resection(OR = 0.62; 95%CI: 0.43-0.91; z = 2.49; P < 0.01) and prolonged length of hospital stay(SMD,-1.59; 95%CI:-0.86--0.25; z = 4.22; P < 0.00001) following OTME. However, the oncological outcomes like number of harvested lymph nodes, tumour recurrence and risk of positive resection margins were statistically similar in both groups. In addition, the clinical outcomes such as operative complications, anastomotic leak and all-cause mortality were comparable between both approaches of mesorectal excision.CONCLUSION: LTME appears to have clinically and oncologically measurable advantages over OTME in patients with primary rectal cancer in both short term and long term follow ups.

Intraoperative abdominal ultrasound in oncologic imaging

Significant advances in ultrasound technology have created new opportunities for its use in oncologic imaging. The advent of new transducers with focal beam technology and higher frequency has solidified the role of intraoperative sonography (IOUS) as an invaluable imaging modality in oncologic surgery of the liver, kidneys and pancreas. The ability to detect and characterize small lesions and the precise intraoperative localization of such tumors is essential for adequate surgical planning in segmental or lobar hepatic resections, metastasectomy, nephron-sparing surgery, and partial pancreatectomy. Also, diagnostic characterization of small equivocal lesions deemed indeterminate by conventional preoperative imaging such as multidetector computed tomography or magnetic resonance imaging, has become an important application of IOUS. This article will review the current applications of IOUS in the liver, kidneys and pancreas.

Laparoscopic resection of gastrointestinal stromal tumors:Does laparoscopic surgery provide an adequate oncologic resection?

Gastrointestinal stromal tumors (GISTs) are rare tumors of the GI tract.Surgical resection remains the mainstay of non-metastatic disease.However,the ability to provide an adequate oncologic resection using laparoscopic surgery is still an area of debate.This is a thorough review of the current literature,looking particularly at the use of laparoscopic surgery for larger GISTs and the long-term oncologic outcomes compared to the results of open surgery.Laparoscopic resections provide an adequate oncologic result for GISTs of all sizes,including those greater than 5 cm in size.

A matched-pair analysis of laparoscopic versus open pancreaticoduodenectomy: oncological outcomes using Leeds Pathology Protocol

BACKGROUND： Laparoscopic pancreaticoduodenectomy（LPD）is a safe procedure. Oncological safety of LPD is still a matter for debate. This study aimed to compare the oncological outcomes,in terms of adequacy of resection and recurrence rate following LPD and open pancreaticoduodenectomy（OPD）.METHODS： Between November 2005 and April 2009, 12LPDs（9 ampullary and 3 distal common bile duct tumors）were performed. A cohort of 12 OPDs were matched for age,gender, body mass index（BMI） and American Society of Anesthesiologists（ASA） score and tumor site.RESULTS： Mean tumor size LPD vs OPD（19.8 vs 19.2 mm,P=0.870）. R0 resection was achieved in 9 LPD vs 8 OPD（P=1.000）. The mean number of metastatic lymph nodes and total number resected for LPD vs OPD were 1.1 vs 2.1（P=0.140）and 20.7 vs 18.5（P=0.534） respectively. Clavien complications grade I/II（5 vs 8）, III/IV（2 vs 6） and pancreatic leak（2 vs 1）were statistically not significant（LPD vs OPD）. The mean high dependency unit（HDU） stay was longer in OPD（3.7 vs 1.4 days,P〈0.001）. There were 2 recurrences each in LPD and OPD（logrank,P=0.983）. Overall mortality for LPD vs OPD was 3 vs 6（log-rank, P=0.283） and recurrence-related mortality was 2 vs 1.There was one death within 30 days in the OPD group secondary to severe sepsis and none in the LPD group.CONCLUSIONS： Compared to open procedure, LPD achieved a similar rate of R0 resection, lymph node harvest and longterm recurrence for tumors less than 2 cm. Though technically challenging, LPD is safe and does not compromise oncological outcome.

Low-dose computed tomography with 4th-generation iterative reconstruction algorithm in assessment of oncologic patients

AIM To compare radiation dose and image quality of lowdose computed tomography(CT) protocol combined with hybrid-iterative reconstruction algorithm with standarddose CT examinations for follow-up of oncologic patients. METHODS Fifty-one patients with known malignant diseases which underwent, during clinical follow-up, both standarddose and low-dose whole-body CT scans were enrolled. Low-dose CT was performed on 256-row scanner, with 120 kV and automated m A modulation, and iterative reconstruction algorithm. Standard-dose CT was performed on 16-rows scanner, with 120 kV, 200-400 m As(depending on patient weight). We evaluated density values and signal-to-noise ratio, along with image noise(SD), sharpness and diagnostic quality with 4-point scale.RESULTS Density values in liver, spleen and aorta were higher in lowdose images(liver 112.55 HU vs 103.90 HU, P < 0.001), as SD values in liver and spleen(liver 16.81 vs 14.41). Volumetric-Computed-Tomographic-Dose-Index(CTDIvol) and Dose-Length-Product(DLP) were significantly lower in low-dose CT as compared to standard-dose(DLP 1025.6 m Gy*cm vs 1429.2 m Gy*cm, P < 0.001) with overall dose reduction of 28.9%. Qualitative analysis did not reveal significant differences in image noise and diagnostic quality.CONCLUSION Automatic tube-current modulation combined with hybriditerative algorithm allows radiation dose reduction of 28.9% without loss of diagnostic quality, being useful in reducing dose exposure in oncologic patients.

Breast reconstruction:Review of current autologous and implantbased techniques and long-term oncologic outcome

Implant-based reconstruction is the most common method of breast reconstruction.Autologous breast reconstruction is an indispensable option for breast reconstruction demanding keen microsurgical skills and robust anatomical understanding.The reconstructive choice is made by the patient after a discussion with the plastic surgeon covering all the available options.Advantages and disadvantages of each technique along with long-term oncologic outcome are reviewed.

Effectiveness and safety of COVID-19 vaccines in patients with oncological diseases:State-of-the-art

Although the coronavirus disease 2019(COVID-19)pandemic was declared to be no longer“a public health emergency of international concern”with its wide range of clinical manifestations and late complications,severe acute respiratory syndrome coronavirus 2 infection proved to be a serious threat,especially to the elderly and patients with comorbidities.Patients with oncologic diseases are vulnerable to severe infection and death.Indeed,patients with oncohematological diseases have a higher risk of severe COVID-19 and impaired post-vaccination immunity.Unfortunately,cancer patients are usually excluded from vaccine trials and investigations of post-vaccinal immune responses and the effectiveness of the vaccines.We aimed to elucidate to what extent patients with cancer are at increased risk of developing severe COVID-19 and what is their overall case fatality rate.We also present the current concept and evidence on the effectiveness and safety of COVID-19 vaccines,including boosters,in oncology patients.In conclusion,despite the considerably higher mortality in the cancer patient group than the general population,countries with high vaccination rates have demonstrated trends toward improved survival of cancer patients early and late in the pandemic.

Clinical outcomes of cemented distal femur replacements with allpolyethylene tibial components for oncologic indications

BACKGROUND Endoprosthetic distal femoral replacement(DFR)is a well-established salvage procedure following resection of malignant tumors within the distal femur.Use of an all-polyethylene tibial(APT)component is cost-effective and avoids failure due to locking-mechanism issues and backside wear,but limits modularity and the option for late liner exchange.Due to a paucity of literature we sought to answer three questions:(1)What are the most common modes of implant failure for patients undergoing cemented DFR with APT for oncologic indications?(2)What is the survivorship,rate of all-cause reoperation,and rate of revision for aseptic loosening of these implants?And(3)Is there a difference in implant survivorship or patient demographics between cemented DFRs with APT performed as a primary reconstruction vs those performed as a revision procedure?AIM To assess outcomes of cemented DFRs with APT components used for oncologic indications.METHODS After Institutional Review Board approval,a retrospective review of consecutive patients who underwent DFR between December 2000 to September 2020 was performed using a single-institutional database.Inclusion criteria consisted of all patients who underwent DFR with a GMRS®(Global Modular Replacement System,Stryker,Kalamazoo,MI,United States)cemented distal femoral endoprosthesis and APT component for an oncologic indication.Patients undergoing DFR for non-oncologic indications and patients with metal-backed tibial components were excluded.Implant failure was recorded using Henderson's classification and survivorship was reported using a competing risks analysis.RESULTS 55 DFRs(55 patients)with an average age of 50.9±20.7 years and average body mass index of 29.7±8.3 kg/m2 were followed for 38.8±54.9 mo(range 0.2-208.4).Of these,60.0%were female and 52.7%were white.The majority of DFRs with APT in this cohort were indicated for oncologic diagnoses of osteogenic sarcoma(n=22,40.0%),giant cell tumor(n=9,16.4%),and metastatic carcinoma(n=8,14.6%).DFR with APT implantation was performed as a primary procedure in 29 patients(52.7%)and a revision procedure in 26 patients(47.3%).Overall,twenty patients(36.4%)experienced a postoperative complication requiring reoperation.The primary modes of implant failure included Henderson Type 1(soft tissue failure,n=6,10.9%),Type 2(aseptic loosening,n=5,9.1%),and Type 4(infection,n=6,10.9%).There were no significant differences in patient demographics or rates of postoperative complications between the primary procedure and revision procedure subgroups.In total,12 patients(21.8%)required a revision while 20 patients(36.4%)required a reoperation,resulting in three-year cumulative incidences of 24.0%(95%CI 9.9%-41.4%)and 47.2%(95%CI 27.5%-64.5%),respectively.CONCLUSION This study demonstrates modest short-term survivorship following cemented DFR with APT components for oncologic indications.Soft tissue failure and endoprosthetic infection were the most common postoperative complications in our cohort.

Oncological safety of use of ultrasonic activated shears in gastric cancer surgery: Long-term results of randomized controlled trial

Objective： Ultrasonically activated shears （UAS） have been applied in open gastric surgeries with no or little evidence. It was previously reported about the surgical outcome and effectiveness of UAS based on a randomized controlled trial of 256 patients with gastric cancer. We aimed to clarify the long-term oncological safety of the use of UAS in the aspect of overall survival and recurrence.Methods： Gastric cancer patients who underwent gastrectomy with D2 lymph node dissection were enrolled and randomly assigned to either the conventional surgery group （n=125） or the UAS group （n=128）. Survival, recurrence and long-term postoperative complications were compared between the two groups. The median follow-up period was 56 months.Results： Gastric cancer-related death was higher in patients of the UAS group compared with the conventional group （P=0.019）. Overall survival rates stratified by stage were not significantly different between the two groups （P=0.170）. Disease-free survival rates stratified by stage and recurrence-free survival rates of gastric cancer were similar between the conventional group and the UAS group （P=0.313 and 0.199, respectively）. The postoperative complication rate was not significantly different between the groups （P=1.000）. Conclusions： It is suggested that the use of UAS in gastrectomy for gastric cancer showed oncologically acceptable safety compared with conventional electric instruments even in long-term period.

Main Microbial Genres and Its Profile of Resistance and Sensitivity to Antimicrobials Used in the Treatment of Oncological Patients with Febril Neutropenia

Objective: To determine the main microbial genotypes and their antimicrobial resistance and susceptibility profile commonly used in the treatment of oncologic patients with febrile neutropenia, carried out through the review of the clinical histories of the patients’ medical records at the Hospital do Cancer de Muriaé-Fundacao Cristiano Varella. Methods: Quantitative research, determined the susceptibility profile of microorganisms in patients with febrile neutropenia from April 2007 to April 2008 by reviewing clinical histories of patients’ medical records at the referred hospital. Results: Of the total of 8 patients evaluated with Gram-negative microorganisms, 50% of the patients were female and 50% were male. Of the 18 patients evaluated with Gram-positive microorganisms 66% were female and 34% male. Gram-positive bacteria are prevalent and cause around 60% of documented bacteremias, although Gram-negative bacteria are more common in febrile neutropenic patientes. Conclusion: Exaggerated use of antimicrobials in hospitalized patients leads to the suppression of drug-sensitive microorganisms from the intestinal flora and promotes the persistence and growth of resistant bacteria. The antibiotic should be used in a curative manner with other therapeutic measures with the determined bacterial infection.

Intersphincteric Resection Is the Optimal Procedure for Very Low Rectal Cancer: Techniques, Morbidity, Oncologic and Functional Outcomes

Background: The intersphincteric resection the most extreme form of a sphincter-preserving alternative for the abdominoperineal resection. Aim of the Work: We investigated oncological, functional outcomes and morbidity after ISR. Methods: This retrospective study included 164 patients who underwent ISR with between 2010 and 2015, Male 56.1%, Female 43.9%, with a median age was 54.5 years, Median follow-up time was of 48 months, Average surgical time was 230 min, Median blood loss was 700 mL and median hospital stay was nine days. Mean tumour size was34 mm. The surgical procedure through a laparotomy (72.6%), laparoscopically (27.4%). Neoadjuvant radiotherapy 89.6% {long-course radiotherapy 74.4%, short-course radiotherapy 15.2%}, neoadjuvant chemotherapy 28.7% and adjuvant chemotherapy 70.1%. Colonic J-pouch 16.5%, Transverse coloplasty 15.9%, a side-to-end anastomosis 26.8% and straight coloanal anastomosis 40.9%. Partial-ISR 36.6%, subtotal-ISR 37.2%, total-ISR 26.2%, diverting ileostomy 6.7%. Results: Operative mortality 1.2%, morbidity 14.6% (anastomotic leakage 3.7%, anastomotic stenosis 1.8%, a recto-vaginal fistula 2.4% bowel obstruction 3%, surgical site infection 3%. Respiratory tract infection 1.2%, local 7.9%, distant recurrence 15.2%, 5-year overall 79.8%, disease-free survival 75.8%, R0 resection 95.1%. Pathologic complete response 11%. Circumferential margin involvement 2.4%. Median number of lymph nodes 17. Mean distal margin20 mm, after 12 months Median Wexner score 6. Incontinence for (flatus 11%, liquid 4.9%, solid 4.3%). Median bowel motions in a 24-h were 3. Faecal urgency 17.7%. Stool fragmentation 18.9%. Difficult evacuation 17.7%, lifestyle alteration 14.6%. Difficulty Feces/flatus discrimination 43.3%. Nocturnal soiling in 17.1%. Daytime soiling 11%. Pad wearing 23.8%. Anti-diarrhoea medication loperamide 14%. Conclusion: ISR is a feasible surgical procedure for low rectal cancer. Oncologic and functional, outcomes after are acceptable.

Application of quantitative imaging in oncologic management

Medical imaging, such as computed tomography （CT）, magnetic resonance imaging （MRI） and positron emissiontomography （PET）, plays a vital role for the decision-making in oncologic management. In clinical practice, imaging-derivedtumor metrics are routinely applied in oncologic management as an imaging biomarker. For example, the ResponseEvaluation Criteria in Solid Tumors （RECIST） are commonly used for tumor treatment response evaluation based on thedynamic changes in tumor size. However, the current cross-sectional images are interpreted qualitatively for lesioncharacterization, treatment response evaluation and prognostic prediction by highly trained radiologists, which hasincreasingly apparent limitations. Therefore, there is a demanding shift toward more quantitative imaging interpretation.

Rehabilitation of Oncological Amputee Patients

Peripheral vascular disease is the main reason for lower limb amputation, mostly present in old persons. The number of lower limb amputations due to cancer is small, but affects all age groups. Surgery is the primary （main） treatment for most bone tumors, the main goal is to remove all of the tumor. Sometimes limb amputation is the only possible solution, resulting in severe impairment of body function and activity limitations. The final goal of rehabilitation is to enable patients to re-integrate to the highest possible level into their previous social life and work. The article presents the functional outcome of patients with lower limb amputation due to oncological disease--cancer of bone or soft tissue admitted for rehabilitation to the University Rehabilitation Institute So^a in the period from 2002 to 2012. During this period 67 amputees were admitted and 60 of them were fitted with appropriate lower limb prosthesis. Younger age and transtibial level of amputation were of better functional outcome than in transfemoral or hip disarticulation amputees.

Emergency Digestive Oncological Surgery in Yaounde (Cameroon): Indications and Short-Term Results

Background: Data on emergency digestive oncology surgery are limited in Cameroon. The aim of this work was to give the short-term results of emergency digestive carcinological surgery in our context. Patients and Methods: We conducted a descriptive and analytical observational study with retrospective data collection in four reference hospitals in the city of Yaoundé. Files of patients who had emergency digestive oncological surgery, for an acute complication, from January 1, 2016 to December 31, 2020, were included. The outcomes of the patients in the 30 days following the surgery had to be known. Results: We collected 41 patients, representing 20% of the digestive oncological surgery activity. Their average age was 51.76 ± 16.59 years with a male predominance (63.4%). The cancer complication was inaugural in 27 patients. The main tumor sites were colic (56.1%), rectal (19.5%), and gastric (9.7%). The indications for surgery were: acute bowel obstruction (60.9%), acute generalized peritonitis (29.3%), and gastrointestinal bleeding (4.9%). The tumor was diagnosed intraoperatively in 10 patients (24.4%). The main operative procedures were left colectomy (21.9%) and Hartmann’s intervention (19.5%). The morbidity and mortality rates were 60.9% and 43.9%, respectively. Preoperative anemia (p = 0.019), peritonitis as indication for surgery (p = 0.039) and TNM stage 4 (p = 0.015) were identified as associated with an increased risk of death. Conclusion: In our context, one-fifth of digestive oncological surgery is done urgently in front of an acute complication which is inaugural for cancer in nearly two-thirds of patients. Postoperative morbidity and mortality are significant.

Postoperative morbidity adversely impacts oncological prognosis after curative resection for hilar cholangiocarcinoma

BACKGROUND Postoperative morbidity after curative resection for hilar cholangiocarcinoma(HCCA)is common;however,whether it has an impact on oncological prognosis is unknown.AIM To evaluate the influence of postoperative morbidity on tumor recurrence and mortality after curative resection for HCCA.METHODS Patients with recently diagnosed HCCA who had undergone curative resection between January 2010 and December 2017 at The First Affiliated Hospital of Army Medical University in China were enrolled.The independent risk factors for morbidity in the 30 d after surgery were investigated,and links between postoperative morbidity and patient characteristics and outcomes were assessed.Postoperative morbidities were divided into five grades based on the Clavien-Dindo classification,and major morbidities were defined as Clavien-Dindo≥3.Univariate and multivariate Cox regression analyses were used to evaluate the risk factors for recurrence-free survival(RFS)and overall survival(OS).RESULTS Postoperative morbidity occurred in 146 out of 239 patients(61.1%).Multivariate logistic regression revealed that cirrhosis, intraoperative blood loss > 500 mL, diabetes mellitus,and obesity were independent risk factors. Postoperative morbidity was associated with decreasedOS and RFS (OS: 18.0 mo vs 31.0 mo, respectively, P = 0.003;RFS: 16.0 mo vs 26.0 mo, respectively,P = 0.002). Multivariate Cox regression analysis indicated that postoperative morbidity wasindependently associated with decreased OS [hazard ratios (HR): 1.557, 95% confidence interval(CI): 1.119-2.167, P = 0.009] and RFS (HR: 1.535, 95%CI: 1.117-2.108, P = 0.008). Moreover, majormorbidity was independently associated with decreased OS (HR: 2.175;95%CI: 1.470-3.216, P <0.001) and RFS (HR: 2.054;95%CI: 1.400-3.014, P < 0.001) after curative resection for HCCA.CONCLUSIONPostoperative morbidity (especially major morbidity) may be an independent risk factor forunfavorable prognosis in HCCA patients following curative resection.

Heating Preciosity—Trends in Modern Oncological Hyperthermia

The use of hyperthermia as a treatment in oncology is a common topic for debate. Some researchers expect a breakthrough in oncological treatments with hyperthermia, whereas others have disregarded the method. Serious questions concerning hyperthermia have arisen. Should homogeneous (isothermal) or heterogeneous (selective) heating being used? When we use selective heating (heterogeneity), should the entire tumour be targeted or should the malignant cells be individually selected? Does the mechanism involve thermal cell death or thermally-assisted cell death? Is the goal necrosis or apoptosis? Is hyperthermia safe as a monotherapy or does it have to be combined with conventional treatments? When the selection is local, how do we act on disseminated cells that represent a high risk of life threatening metastases? When local heating is the focus, how should it be carried out with measured and controlled? Our objective is to show how precise, selective heat transfer is necessary to remove malignant cells and, consequently, how hyperthermia as part of the immune-oncology can change the game in this promising field of oncological therapies.