Surgical Treatment of Craniopharyngiomas in Adults:Comparison between Primary Surgery and Surgery for Recurrence

Objective Few studies have investigated the differences in outcomes between primary and repeat surgery for a craniopharyngioma in adults.As a result,a treatment concept for adult patients with a craniopharyngioma has not yet been established.The present study aimed to retrospectively analyze adult patients with craniopharyngioma to compare surgical outcomes between primary surgery and surgery for recurrence.Methods The demographic and clinical data of 68 adult patients with craniopharyngioma who had primary surgery(n=50)or surgery for recurrence(n=18)were retrospectively analyzed.In addition,the patients were followed up for an average of 38.6 months(range:1–133 months).Results The cohorts of patients undergoing primary surgery or repeat surgery did not differ preoperatively in terms of demographic data,or radiological tumor features.However,patients with recurrent craniopharyngioma had significantly more pituitary hormone deficits and hypothalamo-pituitary disorders before surgery compared with patients with newly diagnosed craniopharyngioma.The success rate of complete resection in primary surgery was 53.2%.Even after repeat surgery,a satisfactory rate of complete resection of 35.7%was achieved.Operative morbidity was increased neither in patients with repeat surgery compared with those with primary surgery(postoperative bleeding P=0.560;meningitis P=1.000;CSF leak P=0.666;visual disturbance P=0.717)nor in patients with complete resection compared with those with partial resection.We found no difference in recurrence-free survival between initial surgery and repeat surgery(P=0.733).The recurrence rate was significantly lower after complete resection(6.9%)than after partial resection(47.8%;P<0.001).Conclusion Attempting complete resection is justified for not only those with newly diagnosed craniopharyngioma but also for those with recurrent craniopharyngioma.However,the surgeon must settle for less than total resection if postoperative morbidity is anticipated.

Neoadjuvant Chemotherapy Followed by Surgery versus Primary Surgery in Advanced Epithelial Ovarian Cancer: A Review of Outcomes at National Institute of Cancer Research Hospital in Bangladesh

Introduction: This study evaluated the difference in operative and clinical outcomes for patients with advanced ovarian cancer after primary debulking surgery (PDS) versus neoadjuvant chemotherapy (NACT) followed by interval debulking surgery (IDS) in Bangladesh. Methods: Sixty patients with advanced epithelial ovarian cancer presenting to the department of Gynaecological Oncology at the National Institute of Cancer Research and Hospital were prospectively enrolled. Thirty patients underwent primary debulking surgery and thirty patients received NACT followed by IDS. Results: In the PDS and IDS groups respectively, 56.7% and 50% of patients presented with stage IIIC and 67.7% and 56.7% respectively had serious papillary type histopathology. Duration of surgery, amount of blood loss and total hospital stay were significantly lower (p < 0.001) in IDS group than in the PDS group. There was a statistically significant difference in postoperative tumor residuals between IDS and PDS patients. Complete tumor resection (R0) was obtained in 24 (80%) of IDS patients versus 13 (43.3%) PDS patients. In fifteen months of follow-up, 21 (70%) in the PDS group and 5 (16.7%) in the IDS group recurred (p = 0.021). Median progression free survival in PDS patients was twelve months while that of the IDS group was seventeen months. There was one death at 45 days in the PDS group. No other deaths were documented at fifteen months of follow-up. Conclusion: Interval debulking surgery has a more favorable outcome than primary debulking surgery on progression free survival in advanced ovarian cancer patients and permits a less aggressive surgery to be performed in Bangladesh.

The impact of interval between surgery and postoperative radiotherapy in major salivary gland carcinoma

Background:Radiotherapy following primary operation is strongly recommended for salivary gland carcinomas(SGCs)with adverse features.The interval between surgery and the initiation of radiotherapy(SRT)varied and a prolonged SRT may cause failure of cancer treatment.However,the association of SRT with survival is unclear in major SGCs.Methods:This retrospective study included a total of 346 patients who underwent radiotherapy after the pri-mary operation from Fudan University Shanghai Cancer Center from 2005 to 2020.The best cutoffvalue of the SRT was determined by the maximum log-rank statistic method.The primary endpoint of the study was over-all survival(OS).Correlations between variables and OS were conducted by the univariable analysis using the Log-rank method,and a multivariate Cox proportional hazards regression was performed to identify the indepen-dent prognostic factors associated with OS.The estimated survival rates were captured using the Kaplan-Meier method.Results:With a median follow-up time of 70.31 months,the estimated 5-year OS,LRFS,and DMFS were 83.3%,80.1%,and 75.9%,respectively.The cutoffvalue for SRT was 8.5 weeks,while age,T stage,N stage,perineural invasion(PNI),pathological aggression,chemotherapy,and SRT were associated with OS in the univariable analysis.The Cox regression analysis demonstrated that older age(P<0.001),T3-4 tumors(P=0.007),positive N stage(P<0.001),pathological aggression(P=0.014),and longer SRT(P=0.009)were independent prognostic factors for major SGCs.Using the stratification model,we observed that delay in the SRT was associated with worse OS(P=0.006)in the high-risk group,whereas no significant difference was observed in the low-risk subgroup(P=0.61).Conclusions:The delay in the initiation of postoperative radiotherapy may be a prognostic factor for patients with major SGCs.It was suggested that radiotherapy should be delivered within 8.5 weeks following the operation,especially for patients with≥2 risk factors,including older age,high pathological aggression,T3-4 tumors,and positive N stage.

Prognostic value of primary tumor surgery in seminoma patients with distant metastasis at diagnosis:a population-based study

The aims of this study were to determine the prog no stic value of primary tumor surgery and identify optimal can didates for such surgery among patients with semi noma and dista nt metastasis at diag no sis.We ide ntified 521 patients with seminoma and distant metastasis at diagnosis between 2004 and 2014 from the Surveillanee,Epidemiology,and End Results database.Among these patients,434 had undergone surgery,whereas 87 had not.The prognostic value of primary tumor surgery was assessed by Kaplan-Meier methods,log-rank analyses,and multivariate Cox's proportional hazards model.Survival curves and forest plots were also plotted.Survival analysis indicated that patients who underwent surgery had a better 5-year overall survival and cancer-specific survival tha n those who did not.Multivariate analyses dem on strated that primary tumor surgery is an in depende nt prog no stic factor for overall survival and cancer-specific survival,along with age at diagnosis,Mstage,and marital status.In addition,primary tumor surgery still had con siderable prog no stic value in the subgroup of patie nts with lymph node metastasis.Further,forest plots demonstrated that patie nts with Mia stage,N1 or N2-3 stage,and a youn ger age at diagnosis(<60 years)may ben efit from primary tumor surgery.In con elusion,our findings indicate that primary tumor surgery is correlated with improved survival in patients with seminoma and distant metastasis.Furthermore,primary tumor surgery is an independent prognostic indicator for patients with seminoma and distant metastasis.

Risk factors of major intraoperative blood loss at primary debulking surgery for ovarian cancer

Objective:The goal of this study was to find the risk factors for major intraoperative blood loss(MBL)of pr imary debulking surgery(PDS)for ovarian cancer.Methods:Patients wi th ovarian cancer who underwent PDS in our hospital,from 2010 to 2017,were enrolled.The association between risk factors and MBL was modeled with the use of logisde regr ession.Receiver operating characteristic(ROC)curve analysis was used to determine the predictive value of the logi stic regression model.Results:A total of 346 padients met the inclusion criteria.There were 150 patients with MBL.Tumor stage 3/4(P<0.001),American Society of Aneshesiologists(ASA)score 23(P=0.044),ascites volume≥500 ml(P=0.002),radical or ultra radical surgery(P=0.002),and diabetes(P=0.035)were independent risk factors for MBL in patients with ovarian cancer.The logistic regression combined model of these five factors is more reliable in the prediction of MBL with an area under the ROC curve of 0.729 than the tumor stage(ROC curve=0.645)and surgical complexity(ROC curve=0.568).Conclusion:In padients with ovarian cancer,five risk factors for major intraoperative bleeding were identified.Planned surgical procedures and preoperative risk factors can be used to predict perioperative blood requir ements.