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Vaysse PM, van den Hout MFCM, Engelen SME, Keymeulen KBMI, Bemelmans MHA, Heeren RMA, Olde Damink SWM, Porta Siegel T. Lipid profiling of electrosurgical vapors for real-time assistance of soft tissue sarcoma resection. J Surg Oncol 2024; 129:499-508. [PMID: 38050894 DOI: 10.1002/jso.27502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 10/03/2023] [Accepted: 10/15/2023] [Indexed: 12/07/2023]
Abstract
BACKGROUND Soft tissue sarcomas (STS) constitute a heterogeneous group of rare tumor entities. Treatment relies on challenging patient-tailored surgical resection. Real-time intraoperative lipid profiling of electrosurgical vapors by rapid evaporative ionization mass spectrometry (REIMS) may aid in achieving successful surgical R0 resection (i.e., microscopically negative-tumor margin resection). Here, we evaluate the ex vivo accuracy of REIMS to discriminate and identify various STS from normal surrounding tissue. METHODS Twenty-seven patients undergoing surgery for STS at Maastricht University Medical Center+ were included in the study. Samples of resected STS specimens were collected and analyzed ex vivo using REIMS. Electrosurgical cauterization of tumor and surrounding was generated successively in both cut and coagulation modes. Resected specimens were subsequently processed for gold standard histopathological review. Multivariate statistical analysis (principal component analysis-linear discriminant analysis) and leave-one patient-out cross-validation were employed to compare the classifications predicted by REIMS lipid profiles to the pathology classifications. Electrosurgical vapors produced during sarcoma resection were analyzed in vivo using REIMS. RESULTS In total, 1200 histopathologically-validated ex vivo REIMS lipid profiles were generated from 27 patients. Ex vivo REIMS lipid profiles classified STS and normal tissues with 95.5% accuracy. STS, adipose and muscle tissues were classified with 98.3% accuracy. Well-differentiated liposarcomas and adipose tissues could not be discriminated based on their respective lipid profiles. Distinction of leiomyosarcomas from other STS could be achieved with 96.6% accuracy. In vivo REIMS analyses generated intense mass spectrometric signals. CONCLUSION Lipid profiling by REIMS is able to discriminate and identify STS with high accuracy and therefore constitutes a potential asset to improve surgical resection of STS in the future.
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Affiliation(s)
- Pierre-Maxence Vaysse
- Maastricht MultiModal Molecular Imaging institute (M4i), University of Maastricht, Maastricht, The Netherlands
- Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
- Department of Otorhinolaryngology, Head & Neck Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Mari F C M van den Hout
- Department of Pathology, Maastricht University Medical Center, Maastricht, The Netherlands
- GROW School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Sanne M E Engelen
- Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
- GROW School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
| | | | - Marc H A Bemelmans
- Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
- GROW School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Ron M A Heeren
- Maastricht MultiModal Molecular Imaging institute (M4i), University of Maastricht, Maastricht, The Netherlands
| | - Steven W M Olde Damink
- Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
- Department of General, Visceral and Transplantation Surgery, RWTH University Hospital Aachen, Aachen, Germany
- NUTRIM School of Nutrition and Translational Research in Metabolism Faculty of Health, Maastricht University, Maastricht, The Netherlands
| | - Tiffany Porta Siegel
- Maastricht MultiModal Molecular Imaging institute (M4i), University of Maastricht, Maastricht, The Netherlands
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Kraft A, Moldovan C, Bârcu A, Dumitru R, Croitoru A, Herlea V, Popescu I, Botea F. Salvage Hepatectomy for Giant GIST Liver Metastases Unresponsive to Systemic Therapy-Case Report. Life (Basel) 2023; 13:1681. [PMID: 37629538 PMCID: PMC10456077 DOI: 10.3390/life13081681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 07/21/2023] [Accepted: 08/01/2023] [Indexed: 08/27/2023] Open
Abstract
Therapeutic decision-making for advanced GIST liver metastases is challenging due to limited clinical evidence. This case study aims to demonstrate the survival benefit of resection in non-responsive cases. A 40-year-old male presented with abdominal pain, weight loss, altered general status, massive hepatomegaly, and intermittent melaena. He was diagnosed with stage IV GIST with the primary tumor in the ileal loop and multiple gigantic synchronous bilobar liver metastases. Despite 31 months of tyrosine-kinase inhibitor therapy post-primary tumor resection, the disease remained unresponsive. The patient was admitted to our tertiary center with significant hepatomegaly. A two-stage debulking liver resection was performed after a multidisciplinary team decision. The first operation debulked the left hemiliver through a non-anatomical ultrasound-guided resection of segments 2, 3, and 4. The second operation (7 weeks later) debulked the right hemiliver through a right posterior sectionectomy involving segments 5 and 8. Despite receiving a second line of tyrosine-kinase inhibitor therapy after surgery, the disease progressed both within and outside the liver. However, the patient survived for 55 months, with a postoperative survival benefit of 25 months. In conclusion, this case emphasizes the significant survival benefit achieved through a complex two-stage debulking liver resection for giant liver metastases, even in cases where systemic therapy fails.
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Affiliation(s)
- Alin Kraft
- Department of General Surgery, “Regina Maria” Military Emergency Hospital, 500007 Brașov, Romania;
| | - Cosmin Moldovan
- Department of General Surgery, Witting Clinical Hospital, 010243 Bucharest, Romania
- Department of Medical-Clinical Disciplines, Faculty of Medicine, “Titu Maiorescu” University of Bucharest, 031593 Bucharest, Romania; (A.C.); (V.H.); (I.P.); (F.B.)
| | - Alexandru Bârcu
- Doctoral School in Medicine, “Titu Maiorescu” University, 040441 Bucharest, Romania;
| | - Radu Dumitru
- Department of Radiology and Medical Imaging, “Fundeni” Clinical Institute, 050474 Bucharest, Romania;
| | - Adina Croitoru
- Department of Medical-Clinical Disciplines, Faculty of Medicine, “Titu Maiorescu” University of Bucharest, 031593 Bucharest, Romania; (A.C.); (V.H.); (I.P.); (F.B.)
- Department of Oncology, “Fundeni” Clinical Institute, 022328 Bucharest, Romania
| | - Vlad Herlea
- Department of Medical-Clinical Disciplines, Faculty of Medicine, “Titu Maiorescu” University of Bucharest, 031593 Bucharest, Romania; (A.C.); (V.H.); (I.P.); (F.B.)
- Department of Pathology, “Fundeni” Clinical Institute, 022328 Bucharest, Romania
| | - Irinel Popescu
- Department of Medical-Clinical Disciplines, Faculty of Medicine, “Titu Maiorescu” University of Bucharest, 031593 Bucharest, Romania; (A.C.); (V.H.); (I.P.); (F.B.)
- “Dan Setlacec” Center for General Surgery and Liver Transplant, “Fundeni” Clinical Institute, 022328 Bucharest, Romania
| | - Florin Botea
- Department of Medical-Clinical Disciplines, Faculty of Medicine, “Titu Maiorescu” University of Bucharest, 031593 Bucharest, Romania; (A.C.); (V.H.); (I.P.); (F.B.)
- “Dan Setlacec” Center for General Surgery and Liver Transplant, “Fundeni” Clinical Institute, 022328 Bucharest, Romania
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Senapathi H, Morada A, Perry M, Bertram C, Yeung E, Sultany M, Bertsch D, Cagir B. Prognostic Factors in Gastrointestinal Leiomyosarcomas: An Analysis Using the Surveillance, Epidemiology, and End Results (SEER) Database. Cureus 2021; 13:e19447. [PMID: 34926025 PMCID: PMC8654067 DOI: 10.7759/cureus.19447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/10/2021] [Indexed: 11/05/2022] Open
Abstract
Background Gastrointestinal leiomyosarcomas (LMSs) from intramural smooth muscle are extremely rare, with limited literature. This paper evaluates the epidemiology and survival and prognostic factors in LMSs of the gastrointestinal tract. Methods Clinical data from the Surveillance, Epidemiology and End Results (SEER) 18 registry from 2001 to 2016 with additional treatment fields were compared between primary tumor sites using the chi-squared test for categorical variables and ANOVA for continuous variables. A five-year survival rate analysis was performed for overall and cancer-specific survival. Hazard ratios (HRs) were calculated using univariate and multivariate Cox proportional models using the variables age group, tumor location, grade, stage, surgery, and chemotherapy. Results We identified a total of 523 patients diagnosed with LMSs of the gastrointestinal tract. The median age of diagnosis was 66 years, with no significant difference between tumor sites for age, sex, and race. The five-year overall survival was 77.3%, and the cancer-specific survival was 90.3%. In the multivariate analysis, grade and stage of tumor were the only factors significantly affecting survival in this cohort. Conclusion While surgical status significantly affected survival in the univariate analysis, when adjusted for other factors, the HR for death was not significantly different by surgical therapy. Grade 3 tumors and tumors with distant metastasis at diagnosis were associated with worse survival among these patients.
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Affiliation(s)
| | - Anthony Morada
- Surgery, Geisinger Commonwealth School of Medicine, Scranton, USA
| | - Morgan Perry
- Biomedical Research, Guthrie Robert Packer Hospital, Sayre, USA
| | | | - Enoch Yeung
- Surgery, Guthrie Robert Packer Hospital, Sayre, USA
| | | | - David Bertsch
- Surgical Oncology, Guthrie Robert Packer Hospital, Sayre, USA
| | - Burt Cagir
- Colorectal Surgery, Guthrie Robert Packer Hospital, Sayre, USA
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Small bowel sarcoma: Tumor biology and advances in therapeutics. Surg Oncol 2015; 24:136-44. [DOI: 10.1016/j.suronc.2015.08.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Revised: 07/17/2015] [Accepted: 08/04/2015] [Indexed: 12/26/2022]
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