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Rumpel C, Ann V, Bahri H, Calabi Floody M, Cheik S, Doan TT, Harit A, Janeau JL, Jouquet P, Mora ML, Podwojewski P, Tran TM, Ngo QA, Rossi PL, Sanaullah M. Research for development in the 21st century. Geoderma 2020; 378:114558. [PMID: 32836329 DOI: 10.1016/j.geoderma.2020.114588] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Affiliation(s)
- C Rumpel
- CNRS, IRD, Institute of Ecology and Environmental Sciences - Paris, UMR (CNRS, IRD, INRA, Sorbonne University, UPEC), Paris, France
| | - V Ann
- Institute of Technology of Cambodia, Phnom Penh, Cambodia
| | - H Bahri
- Institut National de Recherches en Génie Rural, Eaux et Forêts, Université de Carthage, Tunisia
| | | | - S Cheik
- Gachamaleh, lot 18, 1095 Djibouti, Djibouti
| | - T T Doan
- Soils and Fertilizers Research Institute, Hanoi, Viet Nam
| | - A Harit
- School of Environmental Sciences, Mahatma Gandhi University, Kottayam, India
| | - J L Janeau
- CNRS, IRD, Institute of Ecology and Environmental Sciences - Paris, UMR (CNRS, IRD, INRA, Sorbonne University, UPEC), Paris, France
| | - P Jouquet
- CNRS, IRD, Institute of Ecology and Environmental Sciences - Paris, UMR (CNRS, IRD, INRA, Sorbonne University, UPEC), Paris, France
| | | | - P Podwojewski
- CNRS, IRD, Institute of Ecology and Environmental Sciences - Paris, UMR (CNRS, IRD, INRA, Sorbonne University, UPEC), Paris, France
| | - T M Tran
- Soils and Fertilizers Research Institute, Hanoi, Viet Nam
| | - Q A Ngo
- Institute of Chemistry, VAST, Hanoi, Viet Nam
| | - P L Rossi
- CNRS, IRD, Institute of Ecology and Environmental Sciences - Paris, UMR (CNRS, IRD, INRA, Sorbonne University, UPEC), Paris, France
| | - M Sanaullah
- Institute of Soil and Environmental Sciences, University of Agriculture, Faisalabad, Pakistan
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Rumpel C, Ann V, Bahri H, Calabi Floody M, Cheik S, Doan TT, Harit A, Janeau JL, Jouquet P, Mora ML, Podwojewski P, Tran TM, Ngo QA, Rossi PL, Sanaullah M. Research for development in the 21st century. Geoderma 2020; 378:114558. [PMID: 32836329 PMCID: PMC7387271 DOI: 10.1016/j.geoderma.2020.114558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- C Rumpel
- CNRS, IRD, Institute of Ecology and Environmental Sciences - Paris, UMR (CNRS, IRD, INRA, Sorbonne University, UPEC), Paris, France
| | - V Ann
- Institute of Technology of Cambodia, Phnom Penh, Cambodia
| | - H Bahri
- Institut National de Recherches en Génie Rural, Eaux et Forêts, Université de Carthage, Tunisia
| | | | - S Cheik
- Gachamaleh, lot 18, 1095 Djibouti, Djibouti
| | - T T Doan
- Soils and Fertilizers Research Institute, Hanoi, Viet Nam
| | - A Harit
- School of Environmental Sciences, Mahatma Gandhi University, Kottayam, India
| | - J L Janeau
- CNRS, IRD, Institute of Ecology and Environmental Sciences - Paris, UMR (CNRS, IRD, INRA, Sorbonne University, UPEC), Paris, France
| | - P Jouquet
- CNRS, IRD, Institute of Ecology and Environmental Sciences - Paris, UMR (CNRS, IRD, INRA, Sorbonne University, UPEC), Paris, France
| | | | - P Podwojewski
- CNRS, IRD, Institute of Ecology and Environmental Sciences - Paris, UMR (CNRS, IRD, INRA, Sorbonne University, UPEC), Paris, France
| | - T M Tran
- Soils and Fertilizers Research Institute, Hanoi, Viet Nam
| | - Q A Ngo
- Institute of Chemistry, VAST, Hanoi, Viet Nam
| | - P L Rossi
- CNRS, IRD, Institute of Ecology and Environmental Sciences - Paris, UMR (CNRS, IRD, INRA, Sorbonne University, UPEC), Paris, France
| | - M Sanaullah
- Institute of Soil and Environmental Sciences, University of Agriculture, Faisalabad, Pakistan
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Farley CR, Perez MC, Soelling SJ, Delman KA, Harit A, Wuthrick EJ, Messina JL, Sondak VK, Zager JS, Lowe MC. Correction to: Merkel Cell Carcinoma Outcomes: Does AJCC8 Underestimate Survival? Ann Surg Oncol 2020; 27:983. [PMID: 32699930 DOI: 10.1245/s10434-020-08871-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
C.R. Farley and M.C. Perez contributed equally to this publication and are co-first authors. J.S. Zager and M.C. Lowe contributed equally to this publication and are co-corresponding authors.
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Affiliation(s)
- C R Farley
- Division of Surgical Oncology, Emory University School of Medicine, Atlanta, GA, USA
| | - M C Perez
- Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, FL, USA
| | - S J Soelling
- Division of Surgical Oncology, Emory University School of Medicine, Atlanta, GA, USA
| | - K A Delman
- Division of Surgical Oncology, Emory University School of Medicine, Atlanta, GA, USA.,Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, FL, USA
| | - A Harit
- Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, FL, USA
| | - E J Wuthrick
- Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, FL, USA
| | - J L Messina
- Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, FL, USA
| | - V K Sondak
- Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, FL, USA
| | - J S Zager
- Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, FL, USA.
| | - M C Lowe
- Division of Surgical Oncology, Emory University School of Medicine, Atlanta, GA, USA.
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Farley CR, Perez MC, Soelling SJ, Delman KA, Harit A, Wuthrick EJ, Messina JL, Sondak VK, Zager JS, Lowe MC. Merkel Cell Carcinoma Outcomes: Does AJCC8 Underestimate Survival? Ann Surg Oncol 2020; 27:1978-1985. [PMID: 32103415 DOI: 10.1245/s10434-019-08187-w] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2019] [Indexed: 11/18/2022]
Abstract
INTRODUCTION The eighth edition of the American Joint Committee on Cancer (AJCC8) Staging Manual provides important information for staging and prognostication; however, survival estimates for patients with Stage I-III Merkel cell carcinoma (MCC), a rare disease, may be as practical using data from large-volume centers as that collated for the AJCC analysis. As such, we compared our institutional outcomes to AJCC8. METHODS Patients who presented from 2005 to 2017 with MCC to two high-volume centers were included. Demographics, clinicopathologic characteristics, survival and recurrence data were compiled, and outcomes compared to AJCC8. RESULTS A total of 409 patients were included. Median age was 75 (range 29-98) years, and 68% were male. Median follow-up was 16 months (0-157). Five-year overall survival (OS) was 70%; 5-year disease-specific survival (DSS) was 84%. When stratified by extent of disease, 5-year OS was higher for patients with local disease compared to those with nodal disease (72.6% vs 62.7%, p=0.005). Similarly, patients with local disease had higher 5-year DSS than those with nodal disease (90.1% vs 76.8%, p=0.002). Five-year recurrence-free survival was 59.2% for all patients, 65.0% for local disease and 48.3% for nodal disease (p=0.033). CONCLUSIONS Here, MCC patients with local or nodal disease have substantially higher OS rates than predicted in AJCC8 (5-year: 72.6% vs 50.6%; 62.7% vs 35.4%, respectively). Importantly, 5-year DSS was significantly better than the OS rates reported presently and in AJCC8. As clinicians and patients rely on AJCC to accurately prognosticate and guide treatment decisions, these estimates should be reassessed and updated to more accurately predict survival outcomes.
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Affiliation(s)
- C R Farley
- Division of Surgical Oncology, Emory University School of Medicine, Atlanta, GA, USA.
| | - M C Perez
- Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, FL, USA
| | - S J Soelling
- Division of Surgical Oncology, Emory University School of Medicine, Atlanta, GA, USA
| | - K A Delman
- Division of Surgical Oncology, Emory University School of Medicine, Atlanta, GA, USA.,Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, FL, USA
| | - A Harit
- Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, FL, USA
| | - E J Wuthrick
- Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, FL, USA
| | - J L Messina
- Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, FL, USA
| | - V K Sondak
- Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, FL, USA
| | - J S Zager
- Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, FL, USA
| | - M C Lowe
- Division of Surgical Oncology, Emory University School of Medicine, Atlanta, GA, USA
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Srour MK, Donovan C, Chung A, Harit A, Dadmanesh F, Giuliano AE, Amersi F. Flat epithelial atypia on core needle biopsy does not always mandate excisional biopsy. Breast J 2019; 26:679-684. [DOI: 10.1111/tbj.13507] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 07/16/2019] [Accepted: 07/16/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Marissa K. Srour
- Department of Surgery Cedars‐Sinai Medical Center Los Angeles California
| | - Cory Donovan
- Department of Surgery Cedars‐Sinai Medical Center Los Angeles California
| | - Alice Chung
- Department of Surgery Cedars‐Sinai Medical Center Los Angeles California
| | - Attiya Harit
- Department of Surgery Cedars‐Sinai Medical Center Los Angeles California
| | - Farnaz Dadmanesh
- Department of Pathology Cedars‐Sinai Medical Center Los Angeles California
| | | | - Farin Amersi
- Department of Surgery Cedars‐Sinai Medical Center Los Angeles California
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Talib Z, Amersi F, Harit A, Saleh M. Promoting Breast Cancer Awareness and Clinical Breast Examination in the LMIC: Experiences from Tajikistan, Pakistan and Kenya. Curr Breast Cancer Rep 2019. [DOI: 10.1007/s12609-019-00321-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Manguso N, Nissen N, Hendifar A, Harit A, Mirocha J, Friedman M, Lipshutz HG, Amersi F. Prognostic factors influencing survival in small bowel neuroendocrine tumor with liver metastases. J Surg Oncol 2019; 120:926-931. [PMID: 31396982 DOI: 10.1002/jso.25657] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Accepted: 07/25/2019] [Indexed: 01/13/2023]
Abstract
BACKGROUND Resection of liver metastasis in small bowel neuroendocrine tumors (SBNET) may improve survival, however, factors influencing prognosis are unclear. We evaluated how the extent of resection influences outcomes. METHODS Patients with SBNET with liver metastasis from 1990 to 2013 who underwent resection of the primary tumor were identified. Outcomes among patients undergoing complete resection (CR), partial resection (PR), or no resection (NR) of liver metastases with resection of the primary tumor only were compared. RESULTS One hundred eleven patients met the criteria. The median number of liver lesions was seven and median lesions resected was one. Fifty (45%) patients had NR, 41 (36.9%) underwent CR, and 20 (18.1%) underwent PR. The 5-year overall survival (OS) was 79.4% for NR, 84.7% for PR, and 100% for CR, demonstrating a trend that CR was best, followed by PR then NR (P = .02). 10-year OS showed no significant differences (72.7% NR; 84.7% PR; 82.5% CR; P = .10). Greater than 10 liver lesions (hazard ratio [HR] 3.6; P = 0.04) or receiving chemotherapy (HR 3.7; P = .03) were negative predictors of survival. CONCLUSION The extent of resection of liver disease in SBNET influenced survival at 5 years but not at 10 years. In addition, more than 10 liver lesions and chemotherapy were predictors of mortality.
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Affiliation(s)
- Nicholas Manguso
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California
| | - Nicholas Nissen
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California
| | - Andrew Hendifar
- Division of Hematology and Oncology, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California
| | - Attiya Harit
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California
| | - James Mirocha
- Biostatistics Core, Samuel Oschin Comprehensive Cancer Center, Cedars-Sinai Medical Center, Los Angeles, California
| | - Marc Friedman
- Division of Interventional Radiology, Department of Radiology, Cedars-Sinai Medical Center, Los Angeles, California
| | - H Gabriel Lipshutz
- Division of Interventional Radiology, Department of Radiology, Cedars-Sinai Medical Center, Los Angeles, California
| | - Farin Amersi
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California
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Manguso N, Gangi A, Nissen N, Harit A, Siegel E, Hendifar A, Amersi F. Long-Term Outcomes after Elective versus Emergency Surgery for Small Bowel Neuroendocrine Tumors. Am Surg 2018; 84:1570-1574. [PMID: 30747671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Small bowel neuroendocrine tumors (SBNETs) are often indolent, but occasionally, patients present with acute symptoms requiring emergent operative intervention. Our aim was to determine whether emergency surgery for SBNETs affects long-term outcomes. An institutional database was reviewed to identify patients with SBNET diagnosed between 1990 and 2015. Need for emergency resection (ER) was compared with elective resection (ELR). One hundred and thirty-four patients met inclusion criteria. Median age was 59 years (range, 21-91), and median tumor size was 1.5 cm (range, 0.1-5). Median follow-up time was 5.5 years. One hundred (74.6%) patients had ELR, whereas 34 (25.4%) required ER. ELR had a higher number of lymph nodes resected (median 12.5 vs 8 ER, P = 0.04); however, there was no difference in the number of positive nodes (median 3 vs 2, P = 0.85). There were 45 (33.6%) recurrences (31 [31.0%] ELR vs 14 [41.7%] ER, P = 0.29) and 13 (9.7%) deaths (7 [7.0%] ELR; 6 [17.6%] ER). There was no significant difference in 5-year disease-free survival (ELR 72.6% vs ER 77.9%, P = 0.71) or overall survival (ELR 97.2% vs ER 96.6%, P = 0.81). Although patients undergoing ER have significantly fewer lymph nodes resected, they have comparable recurrence rates and long-term outcomes with those patients undergoing ER.
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Affiliation(s)
- Nicholas Manguso
- Department of Surgery and †Division of Hematology and Oncology, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA
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Manguso N, Gangi A, Nissen N, Harit A, Siegel E, Hendifar A, Amersi F. Long-Term Outcomes after Elective versus Emergency Surgery for Small Bowel Neuroendocrine Tumors. Am Surg 2018. [DOI: 10.1177/000313481808401006] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Small bowel neuroendocrine tumors (SBNETs) are often indolent, but occasionally, patients present with acute symptoms requiring emergent operative intervention. Our aim was to determine whether emergency surgery for SBNETs affects long-term outcomes. An institutional database was reviewed to identify patients with SBNET diagnosed between 1990 and 2015. Need for emergency resection (ER) was compared with elective resection (ELR). One hundred and thirty-four patients met inclusion criteria. Median age was 59 years (range, 21–91), and median tumor size was 1.5 cm (range, 0.1–5). Median follow-up time was 5.5 years. One hundred (74.6%) patients had ELR, whereas 34 (25.4%) required ER. ELR had a higher number of lymph nodes resected (median 12.5 vs 8 ER, P = 0.04); however, there was no difference in the number of positive nodes (median 3 vs 2, P = 0.85). There were 45 (33.6%) recurrences (31 [31.0%] ELR vs 14 [41.7%] ER, P = 0.29) and 13 (9.7%) deaths (7 [7.0%] ELR; 6 [17.6%] ER). There was no significant difference in 5-year disease-free survival (ELR 72.6% vs ER 77.9%, P = 0.71) or overall survival (ELR 97.2% vs ER 96.6%, P = 0.81). Although patients undergoing ER have significantly fewer lymph nodes resected, they have comparable recurrence rates and long-term outcomes with those patients undergoing ER.
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Affiliation(s)
- Nicholas Manguso
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California
| | - Alexandra Gangi
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California
| | - Nicholas Nissen
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California
| | - Attiya Harit
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California
| | - Emily Siegel
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California
| | - Andrew Hendifar
- Division of Hematology and Oncology, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California
| | - Farin Amersi
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California
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Manguso N, Johnson J, Harit A, Nissen N, Mirocha J, Hendifar A, Amersi F. Prognostic Factors Associated with Outcomes in Small Bowel Neuroendocrine Tumors. Am Surg 2017; 83:1174-1178. [PMID: 29391119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Small bowel neuroendocrine tumors (SBNET) account for most gastrointestinal neuroendocrine tumors. Patients often present with late-stage disease; however, there is little information regarding factors that contribute to recurrence. Database review identified 301 patients diagnosed with SBNET between 1990 and 2013. Univariate analysis included patients who underwent complete resection. Survival was estimated by the Kaplan-Meier method. A total of 147 patients met study criteria. Average age was 60 years (range 21-91); 49 per cent were male. Thirty-seven (25.3%) patients had laparoscopic resection, and 29 (19.9%) patients had only small bowel disease, whereas 108 (72.6%) had nodal metastasis. Five-year overall and disease-free survival were 97.5 and 73.5 per cent. Forty-seven (32%) patients had recurrence. The recurrence group was more likely to have an open operation (59.6 vs 32%, P < 0.01), mesenteric invasion, or lymphatic metastasis (87.2 vs 67%, P < 0.01) compared with the no-recurrence group. Cox regression analysis showed that variables associated with recurrence included nodal disease (HR 9.06, P = 0.03), lymphovascular invasion (LVI) (3.95, P < 0.01), perineural invasion (PNI) (3.48, P < 0.01), and mesenteric involvement (3.77, P = 0.03). Patients with SBNET presenting with nodal metastasis, mesenteric involvement, LVI, or PNI have a higher risk of recurrence. Closer surveillance should be considered after operative resection.
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Affiliation(s)
- Nicholas Manguso
- Division of Surgical Oncology, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
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Manguso N, Johnson J, Harit A, Nissen N, Mirocha J, Hendifar A, Amersi F. Prognostic Factors Associated with Outcomes in Small Bowel Neuroendocrine Tumors. Am Surg 2017. [DOI: 10.1177/000313481708301033] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Small bowel neuroendocrine tumors (SBNET) account for most gastrointestinal neuroendocrine tumors. Patients often present with late-stage disease; however, there is little information regarding factors that contribute to recurrence. Database review identified 301 patients diagnosed with SBNET between 1990 and 2013. Univariate analysis included patients who underwent complete resection. Survival was estimated by the Kaplan–Meier method. A total of 147 patients met study criteria. Average age was 60 years (range 21–91); 49 per cent were male. Thirty-seven (25.3%) patients had laparoscopic resection, and 29 (19.9%) patients had only small bowel disease, whereas 108 (72.6%) had nodal metastasis. Five-year overall and disease-free survival were 97.5 and 73.5 per cent. Forty-seven (32%) patients had recurrence. The recurrence group was more likely to have an open operation (59.6 vs 32%, P < 0.01), mesenteric invasion, or lymphatic metastasis (87.2 vs 67%, P < 0.01) compared with the no-recurrence group. Cox regression analysis showed that variables associated with recurrence included nodal disease (HR 9.06, P = 0.03), lymphovascular invasion (LVI) (3.95, P < 0.01), perineural invasion (PNI) (3.48, P < 0.01), and mesenteric involvement (3.77, P = 0.03). Patients with SBNET presenting with nodal metastasis, mesenteric involvement, LVI, or PNI have a higher risk of recurrence. Closer surveillance should be considered after operative resection.
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Affiliation(s)
- Nicholas Manguso
- Division of Surgical Oncology, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Jeffrey Johnson
- Division of Surgical Oncology, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Attiya Harit
- Division of Surgical Oncology, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Nicholas Nissen
- Division of Surgical Oncology, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA
| | - James Mirocha
- Division of Surgical Oncology, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Andrew Hendifar
- Division of Hematology Oncology, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Farin Amersi
- Division of Surgical Oncology, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA
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Manguso N, Gangi A, Johnson J, Harit A, Nissen N, Jamil L, Lo S, Wachsman A, Hendifar A, Amersi F. The role of pre-operative imaging and double balloon enteroscopy in the surgical management of small bowel neuroendocrine tumors: Is it necessary? J Surg Oncol 2017; 117:207-212. [PMID: 28940412 DOI: 10.1002/jso.24825] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Accepted: 08/11/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND OBJECTIVES Pre-operative localization of small bowel neuroendocrine tumors (SBNET) is important for operative planning. The aim was to determine the effectiveness of pre-operative imaging and double-balloon enteroscopy (DBE) in identifying extent of disease. METHODS Database review identified 85 patients with primary SBNET between 2006 and 2013. Analysis included patients who underwent imaging, endoscopy, and surgery at our institution. RESULTS Average age was 60.7 years. Sixty-six (77.1%) patients had a primary NET in the ileum. Seventy-two patients (67.3%) underwent CT, 47 (46.7%) had MRI, 44 (46.7%) had somatostatin receptor imaging (SRI), and 41 (39.3%) underwent DBE. The sensitivity of each in identifying the NET was 59.7% for CT, 54% for MRI, 56% for SRI, and 88.1% for DBE. Eighteen (21.2%) patients had primary tumors not identified on imaging. Of these 18, 13 underwent DBE, and 12 of 13 (92.3%) DBEs identified the primary lesion. DBE was significantly better at identifying the primary NET than CT, MRI or SRI (P = 0.004, 0.007, and 0.012). CONCLUSIONS Most SBNETs are identified with a combination of imaging modalities. In those with unidentified primary tumors after imaging, DBE should be considered as it may provide valuable information as to the location of the primary tumor.
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Affiliation(s)
- Nicholas Manguso
- Department of Surgery, Division of Surgical Oncology and Hepatobiliary Surgery, Cedars-Sinai Medical Center, Los Angeles, California
| | - Alexandra Gangi
- Department of Surgery, Division of Surgical Oncology and Hepatobiliary Surgery, Cedars-Sinai Medical Center, Los Angeles, California
| | - Jeffrey Johnson
- Department of Surgery, Division of Surgical Oncology and Hepatobiliary Surgery, Cedars-Sinai Medical Center, Los Angeles, California
| | - Attiya Harit
- Department of Surgery, Division of Surgical Oncology and Hepatobiliary Surgery, Cedars-Sinai Medical Center, Los Angeles, California
| | - Nicholas Nissen
- Department of Surgery, Division of Surgical Oncology and Hepatobiliary Surgery, Cedars-Sinai Medical Center, Los Angeles, California
| | - Laith Jamil
- Department of Gastroenterology, Cedars-Sinai Medical Center, Los Angeles, California
| | - Simon Lo
- Department of Gastroenterology, Cedars-Sinai Medical Center, Los Angeles, California
| | - Ashley Wachsman
- Department of Radiology, Cedars-Sinai Medical Center, Los Angeles, California
| | - Andrew Hendifar
- Department of Internal Medicine, Division of Hematology and Oncology, Cedars-Sinai Medical Center, Los Angeles, California
| | - Farin Amersi
- Department of Surgery, Division of Surgical Oncology and Hepatobiliary Surgery, Cedars-Sinai Medical Center, Los Angeles, California
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Manguso N, Harit A, Nissen NN, Mirocha J, Hendifar AE, Amersi FF. Prognostic factors influencing survival in small bowel neuroendocrine tumors with liver metastasis. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.e15688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e15688 Background: Management of liver metastasis in patients with small bowel neuroendocrine tumors (SBNET) remains unclear. Complete surgical resection improves long term survival however factors that influence overall prognosis are not clear. Methods: Database review identified 301 patients diagnosed with SBNET from 1990 to 2013. Only patients with known liver metastasis who underwent resection of the primary tumor were included. Outcomes among patients who underwent complete surgical resection, incomplete debulking of liver metastasis, and resection of the primary tumor alone were compared. The Kaplan-Meier method was used for survival estimates and Cox regression was used to identify predictors of death. Results: 111 patients met study criteria. Median age was 59 years (range 16-80); 49% were male. The terminal ileum (47/111, 42%) was the most common primary tumor location. The median number of liver lesions was 8.5 (range 1-31) and median lesions resected was 1 (range 0-31). In addition to resection of the primary tumor, 36 patients (32%) had no liver resection (NR), 41 (36.9%) had complete resection of liver disease (R0) and 34 (30%) had incomplete resection of liver metastasis (R1). 58 patients (36%) had one or more wedge resections, 12 (10.8%) underwent segmentectomy and 5 (4.5%) had a lobectomy. 33 (29.7%) patients underwent post-operative chemoembolization, 25 (22.5%) had radioembolization and 23 (20.7%) had radiofrequency ablation. The R1 group differed from the R0 group in median size of primary tumor (2.5 cm R1 vs 1.6 cm R0, p = 0.05) and median number of positive lymph nodes (5.0 R1 vs 3.0 R0, p = 0.05). The 5-year OS was 80.9%, 81.1% and 100% for NR, R1 and R0 groups respectively (p = 0.01). 10-year OS did not differ between groups (72.8% NR vs 81.1% R1vs 82.5% NR, p = 0.31). Cox regression showed post-operative administration of chemotherapy (HR = 3.68, p < 0.01) and higher tumor grade (HR = 18.4, p = 0.02) increased risk of death. Conclusions: In patients with SBNET with liver metastasis, higher tumor grade and post-operative chemotherapy increased risk of death. However, resection of the primary tumor along with liver metastasis improves the 5-year OS with complete cytoreduction providing the most benefit.
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