Acute Pulmonary Embolism Caused by Local Resection of Choroidal Melanoma

Uveal melanoma is the most malignancy in adults, with 6-7 cases/million people.^-~j common primary ocular an annual incidence of The choroid is the most common site of involvement occurring in more than 90% patients.TM We conducted a retrospective study for uveal melanoma at Yongren Eye Center from 1997 to 201 I. A total of 682 cases of uveal melanoma were recorded. Among them, 176 （25.8%） cases received local resection surgery. Most of them survived after surgery and had good recovery. However, life-threatening complication of acute pulmonary embolism （APE） occurred in 3 choroidal melanoma patients shortly after surgery. Till now, to the best of our knowledge, there are few reports of severe postsurgical complications of choroidal melanoma.

Clinical observation of local resection or enucleation for uveal melanoma

Backround Local resection is an effective method for treating the uveal melanoma. The aim of this study is to evaluate the survival and clinical outcomes of patients with uveal melanoma treated by local resection or enucleation. Methods Totally, 167 consecutive patients with uveal melanoma were recruited for the study, of whom 57 patients were treated with local resection and 110 patients were treated with enucleation. The main outcome was measured by the visual acuity, local recurrence, eye retention, metastases, and melanoma-related mortality. Results There were statistically significant differences in the largest basal diameter of the tumor （t=-3.441）, the tumor thickness （t=-4.140）, the ciliary body infiltration （X2=8.391）, and the duration of follow-up （Z=3.995） between the two groups （P 〈0.05）. The univariate survival analysis showed that the method of treatment was not significantly associated with metastases. The Cox proportion hazard analysis showed that the risk factors for metastasis involved the age at the time of diagnosis （RR=1.752, 95% CI 1.066- 2.880, P=0.027）, the largest basal diameter of the tumor （RR=3.508, 95% CI 1.934-6.336, P=0.000）, and the histological type （RR=2.444, 95% CI 1.106-5.877, P=0.046）. The 5-year metastases rate was 18.60% for the group with local resection and 27.81% for enucleation （X2=1.214, P 〉0.05）; the 5-year melanoma-related mortality was 16.27% for the group with local resection and 25.33% for enucleation （X2=1.304, P 〉0.05）. The 5-year local tumor recurrence rate was 29.50% and the 5-year accumulated eye retention rate was 69.00% after local resection. The visual acuity which light perception or better of 60 months after local resection was observed in 25 （92.60%） among persons retaining eye. Conclusions The survival outcomes of the patients with local resection were not worse than that of the patients with enucleation, and local resection could make the patient retain eye and partial visual functions. Hence, local resection may be an effective method for patients with uveal melanoma eligible for operation.

THE FACTORS AND TREATMENT OF LOCAL RECURRENCE AFTER RADICAL RESECTION RESERVING THE ANUS IN THE PATIENTS WITH RECTAL CANCER

Of seventy-one patients with rectal cancer after radical resection retaining the anus, 15 developed local recurrence with a recurrence rate of 21.1%. Local recurrence was correlated with improper safety margin from the lower edge of cancer to the anal end. There was statistical significant difference between 3 cm or more and 2 cm or less. The local recurrence was also related to the pathologic stage, histologic differentiation and implant of free cancer cells. It is suggested that the surgical indication of saving the anus be strict and without stretching, the safety margin from the lower edge of cancer to the anal end should not be less than 2 cm in early rectal cancer and not less than 4 cm in advanced lesions. During the operation, no touching tumor technique, thorough rinsing of the peritoneal cavity and pre- or post-operative radiotherapy are important for prevention of local recurrence. Early local recurrent rectal cancer can be detected by periodic examinations.

Clinical evidence of neoadjuvant immunotherapy for resectable locally advanced esophageal carcinoma:A systematic review

Background:Immune checkpoint inhibitors(ICIs)as the neoadjuvant therapy for resectable locally advanced esophageal carcinoma(rlaEC)remains challenging given the poor reports of efficacy and safety.This study aimed to summarize reliable evidence for the preoperative neoadjuvant immunotherapy of rlaEc by analyzing all the published clinical trials on the ICIs as the neoadjuvant therapy for rlaEC.Methods:PubMed,Cochrane Library,Embase and ClinicalTrials.gov were searched from inception until June 1st,2023,for available reports to perform a meta-analysis.The primary endpoints were RO resection,objective response rate(ORR),pathological complete response(pCR)and major pathological response(MPR),as well as treatment-related adverse events(AEs)and postoperative complications.The Stata 14.0 software was employed to estimate pooled effect size.Results:A total of 18 single-arm clinical trials involving 625 patients met the inclusion criteria.Meta-analysis showed that,among these patients with rlaEC,the pooled R0 resection rate was 97.0%(95%CI:94.0%-99.0%),the p0oled ORR was 70.0%(95%CI:64.0%-76.0%),the p0oled pCR and MPR rate were 34.0%(95%CI:29.0%-39.0%)and 56.0%(95%CI:47.0%-65.0%)respectively.The incidence of main treatment-related AEs and postoperative complications was about 6%-45% and 8%-19% respectively.Conclusions:Patients with rlaEC were tolerated to neoadjuvant immunotherapy and it might be beneficial to improve efficacy.But this meta-analysis had limitations and the conclusions still needed to be validated by more rigorous phase II randomized controlled clinical trials.

Clinical characteristics and treatment of neurofibroma of the choroid

Background Neurofibroma is a kind of benign neoplasm that derives from nervous tissues. Though this tumor is the most common types in the peripheral nervous system, it is rarely seen in the choroid and easy to be misdiagnosed of choroidal melanoma. The aim of this study was to review the clinical features of neurofibroma of the choroid in the Chinese race. Methods A retrospective case series design was used. Two male and one female patients diagnosed with choroidal neurofibroma in Beijing Tongren Eye Center were included in this study. The clinical histories were abstracted from the patients＇ medical records. Routine eye examinations including visual acuity, intraocular pressure, slit lamp and ophthalmoscope were performed. Auxiliary examinations included fluorescein fundus angiography （FFA）, AB-ultrasound scan, color doppler imaging （CDI）, and magnetic resonance imaging （MRI）. Local resection of the tumors was performed and the specimens underwent pathological examinations. Results The tumors were of yellow-pink color with pigmentation on the surface. CDI showed arterial blood signals in the tumor and MRI showed high-intensity in the Tl-weighted image and a slightly increased intensity in the T2-weighted image. FFA and indocyaninegreen angiography demonstrated the tumors were of hypofluorescence at early stage and hyperfluorescence with prominent leakage at late stage. The pathological examination confirmed the tumors were choroidal neurofibroma. After 5-10-year follow-up, there were no recurrences of the tumors and the retinas were well attached. Conclusions Choroidal neurofibroma is difficult to be diagnosed clinically and pathological confirmation is important. These tumors can be managed conservatively by local resection.