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Erali RA, Pu T, Vu TM, Mangieri CW, Jee Y, Wise JS, Perry KC, Hsu FC, Levine EA, McNatt MH, Chiba A. Pivotal Role of Genetic Counselors in the Uptake of Germline Genetic Testing in Non-Metastatic Breast Cancer and the Impact of Testing on Surgical Decision Making. Am Surg 2023; 89:5842-5849. [PMID: 37183417 DOI: 10.1177/00031348231175097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
BACKGROUND Genetic testing is increasingly utilized in breast cancer patients; however, testing rates remain low. We aimed to evaluate the rate of genetic testing at a tertiary academic medical center utilizing a multidisciplinary clinic model including genetic counselor. METHODS A single-center retrospective chart review was performed on a cohort of newly diagnosed breast cancer patients from January 2018 through February 2019. Patients were reviewed for genetic screening eligibility, consultation with a genetic counselor, and test results. RESULTS Final analysis included 426 patients. 261 (61.3%) were found to meet National Comprehensive Cancer Network guidelines for genetic testing, of which 178 patient (68.2%) underwent testing and 32 patients (12.3%) declined testing. Of the 165 not eligible for testing, 5 patients were tested. A total of 183 patients underwent testing and 116 (63.4%) had a negative result, 17 (9.3%) were positive for at least one gene mutation and 50 (27.3%) were identified to have a variant of unknown significance (VUS). There was a positive association between those patients who met with a genetic counselor and eligibility for testing (OR 31.1, 95% CI 16.0-60.5). CONCLUSIONS Genetic testing result has become an increasingly important factor when defining optimal surgical treatment for breast cancer patients. Increasing the availability of genetic consultation for breast cancer patients can improve testing rates and patient selection.
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Affiliation(s)
- Richard A Erali
- Division of Surgical Oncology, Department of Surgery, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Tracey Pu
- Department of Surgery, Eastern Virginia Medical School, Norfolk, VA, USA
| | - Thuy M Vu
- Division of Surgical Oncology, Department of Surgery, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Christopher W Mangieri
- Division of Surgical Oncology, Department of Surgery, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Yoonsun Jee
- Division of Surgical Oncology, Department of Surgery, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Jordan S Wise
- Division of Surgical Oncology, Department of Surgery, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Kathleen C Perry
- Division of Surgical Oncology, Department of Surgery, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Fang-Chi Hsu
- Biostatistics and Data Science, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Edward A Levine
- Division of Surgical Oncology, Department of Surgery, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Marissa H McNatt
- Division of Surgical Oncology, Department of Surgery, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Akiko Chiba
- Department of Surgery, Duke University Medical Center, Durham, NC, USA
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Valenzuela CD, Moaven O, Solsky IB, Stauffer JA, Del Piccolo NR, Cheung T, Corvera CU, Wisneski AD, Cha CH, Zarandi NP, Dourado J, Perry KC, Russell G, Shen P. ASO Visual Abstract: Conditional Survival After Hepatectomy for Colorectal Liver Metastasis-Results from the Colorectal Liver Operative Metastasis International Collaborative (COLOMIC). Ann Surg Oncol 2023; 30:3423-3424. [PMID: 36914908 DOI: 10.1245/s10434-023-13286-w] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
Affiliation(s)
- Cristian D Valenzuela
- Division of Surgical Oncology, Comprehensive Cancer Center, Atrium Health Wake Forest Baptist Medical Center, Winston-Salem, NC, USA
| | - Omeed Moaven
- Division of Surgical Oncology, Comprehensive Cancer Center, Atrium Health Wake Forest Baptist Medical Center, Winston-Salem, NC, USA
- Department of Surgical Oncology, Mayo Clinic in Florida, Jacksonville, FL, USA
| | - Ian B Solsky
- Division of Surgical Oncology, Comprehensive Cancer Center, Atrium Health Wake Forest Baptist Medical Center, Winston-Salem, NC, USA
| | - John A Stauffer
- Department of Surgical Oncology, Mayo Clinic in Florida, Jacksonville, FL, USA
| | - Nico R Del Piccolo
- Department of Surgical Oncology, Mayo Clinic in Florida, Jacksonville, FL, USA
| | - Tanto Cheung
- Department of Surgery, University of Hong Kong, Hong Kong, China
| | - Carlos U Corvera
- Department of Hepatobiliary & Pancreatic Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Andrew D Wisneski
- Department of Hepatobiliary & Pancreatic Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Charles H Cha
- Department of Surgery, Yale School of Medicine, New Haven, CT, USA
| | - Nima P Zarandi
- Division of Surgical Oncology, Comprehensive Cancer Center, Atrium Health Wake Forest Baptist Medical Center, Winston-Salem, NC, USA
| | - Justin Dourado
- Division of Surgical Oncology, Comprehensive Cancer Center, Atrium Health Wake Forest Baptist Medical Center, Winston-Salem, NC, USA
| | - Kathleen C Perry
- Division of Surgical Oncology, Comprehensive Cancer Center, Atrium Health Wake Forest Baptist Medical Center, Winston-Salem, NC, USA
| | - Gregory Russell
- Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Perry Shen
- Division of Surgical Oncology, Comprehensive Cancer Center, Atrium Health Wake Forest Baptist Medical Center, Winston-Salem, NC, USA.
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Valenzuela CD, Solsky IB, Erali RA, Forsythe SD, Mangieri CW, Mainali BB, Russell G, Perry KC, Votanopoulos KI, Shen P, Levine EA. ASO Visual Abstract: Long-Term Survival in Patients Treated with Cytoreduction and Heated Intraperitoneal Chemotherapy for Peritoneal Mesothelioma at a Single High-Volume Center. Ann Surg Oncol 2023; 30:2676-2677. [PMID: 36823339 DOI: 10.1245/s10434-023-13168-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Affiliation(s)
- Cristian D Valenzuela
- Department of Surgical Oncology, Comprehensive Cancer Center, Atrium Wake Forest Baptist Medical Center, Winston-Salem, NC, USA
| | - Ian B Solsky
- Department of Surgical Oncology, Comprehensive Cancer Center, Atrium Wake Forest Baptist Medical Center, Winston-Salem, NC, USA
| | - Richard A Erali
- Department of Surgical Oncology, Comprehensive Cancer Center, Atrium Wake Forest Baptist Medical Center, Winston-Salem, NC, USA
| | - Steven D Forsythe
- Department of Surgical Oncology, Comprehensive Cancer Center, Atrium Wake Forest Baptist Medical Center, Winston-Salem, NC, USA
| | - Christopher W Mangieri
- Department of Surgical Oncology, Comprehensive Cancer Center, Atrium Wake Forest Baptist Medical Center, Winston-Salem, NC, USA
| | - Bigyan B Mainali
- Department of Surgical Oncology, Comprehensive Cancer Center, Atrium Wake Forest Baptist Medical Center, Winston-Salem, NC, USA
| | - Gregory Russell
- Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Kathleen C Perry
- Department of Surgical Oncology, Comprehensive Cancer Center, Atrium Wake Forest Baptist Medical Center, Winston-Salem, NC, USA
| | - Konstantinos I Votanopoulos
- Department of Surgical Oncology, Comprehensive Cancer Center, Atrium Wake Forest Baptist Medical Center, Winston-Salem, NC, USA
| | - Perry Shen
- Department of Surgical Oncology, Comprehensive Cancer Center, Atrium Wake Forest Baptist Medical Center, Winston-Salem, NC, USA
| | - Edward A Levine
- Department of Surgical Oncology, Comprehensive Cancer Center, Atrium Wake Forest Baptist Medical Center, Winston-Salem, NC, USA.
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Valenzuela CD, Moaven O, Solsky IB, Stauffer JA, Del Piccolo NR, Cheung T, Corvera CU, Wisneski AD, Cha CH, Pourhabibi Zarandi N, Dourado J, Perry KC, Russell G, Shen P. Conditional Survival After Hepatectomy for Colorectal Liver Metastasis: Results from the Colorectal Liver Operative Metastasis International Collaborative (COLOMIC). Ann Surg Oncol 2023; 30:3413-3422. [PMID: 36859704 DOI: 10.1245/s10434-023-13189-w] [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] [Received: 09/15/2022] [Accepted: 01/16/2023] [Indexed: 03/03/2023]
Abstract
INTRODUCTION Complete resection of colorectal liver metastasis (CLM) improves long-term survival in colorectal cancer. However, there is limited recent data on conditional survival (CS) as postoperative survival milestones are achieved post-hepatectomy. METHODS A retrospective analysis was performed on the penta-institutional Colorectal Liver Operative Metastasis International Collaborative (COLOMIC), with 906 consecutive CLM hepatectomy cases. CS was calculated using Bayes' theorem and Kaplan-Meier analysis. Additional CS analyses were performed on additional clinicopathologic risk factors, including colon cancer laterality, KRAS mutation status, and extrahepatic disease. RESULTS The 5-year CS was 40.6%, 45.3%, 52.8%, and 65.3% at 0, 1, 2, and 3 years postoperatively, with significant improvements each year (p < 0.005). CS was not significantly different between right-sided and left-sided colorectal cancers by 3 years postoperatively. Patients with KRAS mutations had worse CS at all timepoints (p < 0.001). Extrahepatic disease was a poor prognostic factor for OS and CS (p < 0.001). However, CS for patients with KRAS mutations or extrahepatic disease improved significantly as 2-year, postoperative survival was achieved (p < 0.05). CONCLUSIONS Five-year CS after hepatectomy for CLM improved with each passing year of survival postoperatively. Although extrahepatic disease and KRAS mutations are poor prognostic factors for OS, these populations still had improved CS after 2 years postoperatively.
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Affiliation(s)
- Cristian D Valenzuela
- Division of Surgical Oncology, Comprehensive Cancer Center, Atrium Health Wake Forest Baptist Medical Center, Winston-Salem, NC, USA
| | - Omeed Moaven
- Division of Surgical Oncology, Comprehensive Cancer Center, Atrium Health Wake Forest Baptist Medical Center, Winston-Salem, NC, USA.,Department of Surgical Oncology, Mayo Clinic in Florida, Jacksonville, FL, USA
| | - Ian B Solsky
- Division of Surgical Oncology, Comprehensive Cancer Center, Atrium Health Wake Forest Baptist Medical Center, Winston-Salem, NC, USA
| | - John A Stauffer
- Department of Surgical Oncology, Mayo Clinic in Florida, Jacksonville, FL, USA
| | - Nico R Del Piccolo
- Department of Surgical Oncology, Mayo Clinic in Florida, Jacksonville, FL, USA
| | - Tanto Cheung
- Department of Surgery, University of Hong Kong, Hong Kong, China
| | - Carlos U Corvera
- Department of Hepatobiliary & Pancreatic Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Andrew D Wisneski
- Department of Hepatobiliary & Pancreatic Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Charles H Cha
- Department of Surgery, Yale School of Medicine, New Haven, CT, USA
| | - Nima Pourhabibi Zarandi
- Division of Surgical Oncology, Comprehensive Cancer Center, Atrium Health Wake Forest Baptist Medical Center, Winston-Salem, NC, USA
| | - Justin Dourado
- Division of Surgical Oncology, Comprehensive Cancer Center, Atrium Health Wake Forest Baptist Medical Center, Winston-Salem, NC, USA
| | - Kathleen C Perry
- Division of Surgical Oncology, Comprehensive Cancer Center, Atrium Health Wake Forest Baptist Medical Center, Winston-Salem, NC, USA
| | - Gregory Russell
- Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Perry Shen
- Division of Surgical Oncology, Comprehensive Cancer Center, Atrium Health Wake Forest Baptist Medical Center, Winston-Salem, NC, USA.
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Valenzuela CD, Solsky IB, Erali RA, Forsythe SD, Mangieri CW, Mainali BB, Russell G, Perry KC, Votanopoulos KI, Shen P, Levine EA. Long-Term Survival in Patients Treated with Cytoreduction and Heated Intraperitoneal Chemotherapy for Peritoneal Mesothelioma at a Single High-Volume Center. Ann Surg Oncol 2023; 30:2666-2675. [PMID: 36754945 DOI: 10.1245/s10434-022-13061-3] [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] [Received: 08/04/2022] [Accepted: 12/26/2022] [Indexed: 02/10/2023]
Abstract
BACKGROUND Malignant peritoneal mesothelioma (MPM) is a rare diagnosis with a dismal prognosis if untreated. Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) is shown to significantly improve survival. Our institution is uniquely positioned to report long-term outcomes in MPM with CRS-HIPEC, due to our robust peritoneal surface disease program existing over the past three decades. METHODS Our prospectively maintained, single-institution database of CRS-HIPEC cases was reviewed, identifying 111 consecutive patients with MPM over 28 years (1993-2021). Prognostic, operative, and pathologic factors were reviewed. Overall survival (OS) and conditional survival (CS) analyses were performed. RESULTS The average age was 55.1 years; 58.6% of patients were male; 17 of 111 patients (15.3%) had a second CRS-HIPEC. At first CRS-HIPEC, the average PCI score was 18.7, and the perfusate drugs were platinum-based (72.1%) and mitomycin C (27.9%). The resection status at first CRS-HIPEC was R2a (46.4%), followed by R0-1 (29.1%), and R2b-c (24.5%). Median OS was 3.3 years for the entire cohort, with 75th and 25th percentiles at 10.7 months and 10.6 years. Median CS was improved if patients survived to the 1-year postoperative mark (4.9 years, p < 0.01) and trended toward further improvement with each passing year. If 3-year postoperative survival was achieved, the median CS improved to 6.1 years. CONCLUSIONS This represents one of the largest and lengthiest, single-center, longitudinal, case series of peritoneal mesothelioma treated with CRS-HIPEC. The OS suggests efficacy for CRS-HIPEC for MPM. Long-term survival improves significantly after patients achieve the 1-year, postoperative mark.
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Affiliation(s)
- Cristian D Valenzuela
- Surgical Oncology, Atrium Health Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC, USA
| | - Ian B Solsky
- Surgical Oncology, Atrium Health Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC, USA
| | - Richard A Erali
- Surgical Oncology, Atrium Health Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC, USA
| | - Steven D Forsythe
- Surgical Oncology, Atrium Health Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC, USA
| | - Christopher W Mangieri
- Surgical Oncology, Atrium Health Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC, USA
| | - Bigyan B Mainali
- Surgical Oncology, Atrium Health Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC, USA
| | - Gregory Russell
- Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Kathleen C Perry
- Surgical Oncology, Atrium Health Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC, USA
| | | | - Perry Shen
- Surgical Oncology, Atrium Health Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC, USA
| | - Edward A Levine
- Surgical Oncology, Atrium Health Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC, USA.
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Valenzuela CD, Moaven O, Gawdi R, Stauffer JA, Del Piccolo NR, Cheung TT, Corvera CU, Wisneski AD, Cha C, Pourhabibi Zarandi N, Dourado J, Perry KC, Russell G, Shen P. Outcomes after repeat hepatectomy for colorectal liver metastases from the colorectal liver operative metastasis international collaborative (COLOMIC). J Surg Oncol 2022; 126:1242-1252. [PMID: 35969175 PMCID: PMC9613625 DOI: 10.1002/jso.27056] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Accepted: 07/28/2022] [Indexed: 01/05/2023]
Abstract
BACKGROUND Resection of colorectal liver metastasis (CLM) is beneficial when feasible. However, the benefit of second hepatectomy for hepatic recurrence in CLM remains unclear. METHODS The Colorectal Liver Operative Metastasis International Collaborative retrospectively examined 1004 CLM cases from 2000 to 2018 from a total of 953 patients. Hepatic recurrence after initial hepatectomy was identified in 218 patients. Kaplan-Meier analysis was performed for overall survival (OS) and recurrence-free survival (RFS). Propensity score matching (PSM) was performed to offset selection bias. Cox proportional-hazards regression was performed to identify risk factors associated with OS. RESULTS A total of 51 patients underwent second hepatectomy. Unadjusted median OS was 60.1 months in repeat-hepatectomy versus 38.3 months in the single-hepatectomy group (p = 0.015). In the PSM population, median OS remained significantly better in the repeat-hepatectomy group (60.1 vs. 33.1 months; p = 0.0023); median RFS was 12.4 months for the repeat-hepatectomy group, versus 9.8 months in the single-hepatectomy group (p = 0.0050). Repeat hepatectomy was associated with lower risk of death (hazard ratio: 0.283; p = 0.000012). Obesity, tobacco use, and high intraoperative blood loss were associated with significant risk of death (p < 0.05). CONCLUSION In CLM with hepatic recurrence, second hepatectomy was beneficial for OS. With PSM, the OS benefit of performing a second hepatectomy remained significant.
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Affiliation(s)
- Cristian D. Valenzuela
- Division of Surgical Oncology, Comprehensive Cancer CenterAtrium Health Wake Forest Baptist Medical CenterWinston‐SalemNorth CarolinaUSA
| | - Omeed Moaven
- Division of Surgical Oncology, Comprehensive Cancer CenterAtrium Health Wake Forest Baptist Medical CenterWinston‐SalemNorth CarolinaUSA
| | - Rohin Gawdi
- Division of Surgical Oncology, Comprehensive Cancer CenterAtrium Health Wake Forest Baptist Medical CenterWinston‐SalemNorth CarolinaUSA
| | - John A. Stauffer
- Department of Surgical OncologyMayo Clinic in FloridaJacksonvilleFloridaUSA
| | | | - Tan To Cheung
- Department of SurgeryUniversity of Hong KongHong KongChina
| | - Carlos U. Corvera
- Department of Hepatobiliary & Pancreatic SurgeryUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - Andrew D. Wisneski
- Department of Hepatobiliary & Pancreatic SurgeryUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - Charles Cha
- Department of SurgeryYale School of MedicineNew HavenConnecticutUSA
| | - Nima Pourhabibi Zarandi
- Division of Surgical Oncology, Comprehensive Cancer CenterAtrium Health Wake Forest Baptist Medical CenterWinston‐SalemNorth CarolinaUSA
| | - Justin Dourado
- Division of Surgical Oncology, Comprehensive Cancer CenterAtrium Health Wake Forest Baptist Medical CenterWinston‐SalemNorth CarolinaUSA
| | - Kathleen C. Perry
- Division of Surgical Oncology, Comprehensive Cancer CenterAtrium Health Wake Forest Baptist Medical CenterWinston‐SalemNorth CarolinaUSA
| | - Gregory Russell
- Department of Biostatistical SciencesWake Forest School of MedicineWinston‐SalemNorth CarolinaUSA
| | - Perry Shen
- Division of Surgical Oncology, Comprehensive Cancer CenterAtrium Health Wake Forest Baptist Medical CenterWinston‐SalemNorth CarolinaUSA
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Valenzuela CD, Moaven O, Gawdi R, Stauffer JA, Del Piccolo NR, Cheung TT, Corvera CU, Wisneski AD, Cha C, Mangieri CW, Zarandi NP, Dourado J, Perry KC, Russell G, Shen P. Association of primary tumor laterality with surgical outcomes for colorectal liver metastases: results from the Colorectal Liver Operative Metastasis International Collaborative (COLOMIC). HPB (Oxford) 2022; 24:1351-1361. [PMID: 35289279 PMCID: PMC9356971 DOI: 10.1016/j.hpb.2022.02.006] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 02/01/2022] [Accepted: 02/16/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Primary laterality of colorectal cancer is thought to be associated with differences in outcomes. Liver metastasis is the most common site of solitary colorectal cancer spread. However, how primary colorectal cancer laterality affects outcomes in colorectal liver metastasis remains unclear. METHODS The Colorectal Liver Operative Metastasis International Collaborative (COLOMIC) of operative hepatectomy cases for colorectal liver metastasis was compiled from five participating institutions. This included consecutive cases from 2000 to 2018 at all sites. A total of 884 patients were included in this study. Univariate, multivariate, and Kaplan-Meier analyses were performed. RESULTS Patients with left-sided versus right-sided cancers had significantly better overall survival: 49.4 vs. 41.8 months (p < 0.05). Patients with KRAS mutations had significantly worse median overall survival compared to KRAS wild-type (43.6 vs 56.1 months; p < 0.001). In left-sided cancers, KRAS mutations were associated with significantly worse median overall survival compared to KRAS wild-type cancers (43.6 vs 56.6 months; p < 0.01). This association was absent in patients with right-sided primary tumors. Multivariate Cox regression analysis revealed different variable sets (non-overlapping) were associated with overall survival, when comparing left-sided and right-sided cancers. CONCLUSION Understanding how primary tumor laterality and related biological aspects affect long-term outcomes can potentially inform treatment decisions for patients with colorectal liver metastases.
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Affiliation(s)
- Cristian D Valenzuela
- Department of Surgical Oncology, Comprehensive Cancer Center, Wake Forest Baptist Medical Center, Winston-Salem, NC, USA
| | - Omeed Moaven
- Department of Surgical Oncology, Comprehensive Cancer Center, Wake Forest Baptist Medical Center, Winston-Salem, NC, USA; Department of Surgical Oncology, Mayo Clinic in Florida, Jacksonville, FL, USA
| | - Rohin Gawdi
- Department of Surgical Oncology, Comprehensive Cancer Center, Wake Forest Baptist Medical Center, Winston-Salem, NC, USA
| | - John A Stauffer
- Department of Surgical Oncology, Mayo Clinic in Florida, Jacksonville, FL, USA
| | - Nico R Del Piccolo
- Department of Surgical Oncology, Mayo Clinic in Florida, Jacksonville, FL, USA
| | - Tan To Cheung
- Department of Surgery, University of Hong Kong, Hong Kong, China
| | - Carlos U Corvera
- Department of Hepatobiliary & Pancreatic Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Andrew D Wisneski
- Department of Hepatobiliary & Pancreatic Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Charles Cha
- Department of Surgery, Yale School of Medicine, New Haven, CT, USA
| | - Christopher W Mangieri
- Department of Surgical Oncology, Comprehensive Cancer Center, Wake Forest Baptist Medical Center, Winston-Salem, NC, USA
| | - Nima P Zarandi
- Department of Surgical Oncology, Comprehensive Cancer Center, Wake Forest Baptist Medical Center, Winston-Salem, NC, USA
| | - Justin Dourado
- Department of Surgical Oncology, Comprehensive Cancer Center, Wake Forest Baptist Medical Center, Winston-Salem, NC, USA
| | - Kathleen C Perry
- Department of Surgical Oncology, Comprehensive Cancer Center, Wake Forest Baptist Medical Center, Winston-Salem, NC, USA
| | - Gregory Russell
- Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Perry Shen
- Department of Surgical Oncology, Comprehensive Cancer Center, Wake Forest Baptist Medical Center, Winston-Salem, NC, USA.
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Valenzuela CD, Levine EA, Mangieri CW, Gawdi R, Moaven O, Russell G, Lundy ME, Perry KC, Votanopoulos KI, Shen P. Repeat Cytoreductive Surgery with Hyperthermic Intraperitoneal Chemotherapy for Cancers with Peritoneal Metastasis: A 30-year Institutional Experience. Ann Surg Oncol 2022; 29:3436-3445. [PMID: 35286531 PMCID: PMC10088912 DOI: 10.1245/s10434-022-11441-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 10/21/2021] [Accepted: 01/26/2022] [Indexed: 12/25/2022]
Abstract
BACKGROUND Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) improves survival in abdominal cancer patients with metastatic disease limited to the peritoneal cavity. Patients are increasingly being offered repeat CRS-HIPECs for peritoneal recurrence. However, in this rare clinical scenario, the survival benefit of performing repeat CRS-HIPEC operations remains unclear. METHODS A retrospective review of the CRS-HIPEC database at Wake Forest Baptist Medical Center was performed over a 30-year timespan. From 1547 patients with appendix cancers, colorectal cancers, mesotheliomas, and other miscellaneous cancers, 156 received more than one CRS-HIPEC. Kaplan-Meier survival analysis was performed using overall survival (OS) from the time of surgery as the primary endpoint. Multi-variable Cox proportional hazards regression modelling was performed on pertinent clinical variables. RESULTS Patients who received multiple CRS-HIPECs had significantly better median OS (10.7 years) versus those who received one CRS-HIPEC (2.5 years), with appendix cancers faring best (12.9 years). Resection status R2a or better was achieved in 76.4% of repeat CRS-HIPECs. There were no significant changes in complication rates after repeat CRS-HIPEC. On multivariate analysis of repeat CRS-HIPEC, patients with appendix and colorectal cancers, heart disease, and poor functional status were independently associated with poor OS. Factors not independently associated with OS were age, sex, body mass index, race, diabetes, lung disease, smoking history, and systemic chemotherapy between CRS-HIPECs. CONCLUSIONS Performing multiple CRS-HIPEC operations on appropriate surgical candidates may significantly prolong survival. Appendix cancers derived the greatest benefit. Satisfactory resection margins and complication rates are comparable to first cases and achievable in repeat CRS-HIPEC procedures.
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Affiliation(s)
- Cristian D Valenzuela
- Department of Surgical Oncology, Comprehensive Cancer Center, Wake Forest Baptist Medical Center, Winston-Salem, NC, USA
| | - Edward A Levine
- Department of Surgical Oncology, Comprehensive Cancer Center, Wake Forest Baptist Medical Center, Winston-Salem, NC, USA
| | - Christopher W Mangieri
- Department of Surgical Oncology, Comprehensive Cancer Center, Wake Forest Baptist Medical Center, Winston-Salem, NC, USA
| | - Rohin Gawdi
- Department of Surgical Oncology, Comprehensive Cancer Center, Wake Forest Baptist Medical Center, Winston-Salem, NC, USA
| | - Omeed Moaven
- Department of Surgical Oncology, Comprehensive Cancer Center, Wake Forest Baptist Medical Center, Winston-Salem, NC, USA
| | - Gregory Russell
- Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Megan E Lundy
- Department of Surgical Oncology, Comprehensive Cancer Center, Wake Forest Baptist Medical Center, Winston-Salem, NC, USA
| | - Kathleen C Perry
- Department of Surgical Oncology, Comprehensive Cancer Center, Wake Forest Baptist Medical Center, Winston-Salem, NC, USA
| | - Konstantinos I Votanopoulos
- Department of Surgical Oncology, Comprehensive Cancer Center, Wake Forest Baptist Medical Center, Winston-Salem, NC, USA
| | - Perry Shen
- Department of Surgical Oncology, Comprehensive Cancer Center, Wake Forest Baptist Medical Center, Winston-Salem, NC, USA.
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Valenzuela CD, Levine EA, Mangieri CW, Gawdi R, Moaven O, Russell G, Lundy ME, Perry KC, Votanopoulos KI, Shen P. ASO Visual Abstract: Repeat Cytoreductive Surgery with Hyperthermic Intraperitoneal Chemotherapy for Cancers with Peritoneal Metastasis-A 30-year Institutional Experience. Ann Surg Oncol 2022. [PMID: 35254574 DOI: 10.1245/s10434-022-11488-2] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Cristian D Valenzuela
- Department of Surgical Oncology, Comprehensive Cancer Center, Wake Forest Baptist Medical Center, Winston-Salem, NC, USA
| | - Edward A Levine
- Department of Surgical Oncology, Comprehensive Cancer Center, Wake Forest Baptist Medical Center, Winston-Salem, NC, USA
| | - Christopher W Mangieri
- Department of Surgical Oncology, Comprehensive Cancer Center, Wake Forest Baptist Medical Center, Winston-Salem, NC, USA
| | - Rohin Gawdi
- Department of Surgical Oncology, Comprehensive Cancer Center, Wake Forest Baptist Medical Center, Winston-Salem, NC, USA
| | - Omeed Moaven
- Department of Surgical Oncology, Comprehensive Cancer Center, Wake Forest Baptist Medical Center, Winston-Salem, NC, USA
| | - Gregory Russell
- Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Megan E Lundy
- Department of Surgical Oncology, Comprehensive Cancer Center, Wake Forest Baptist Medical Center, Winston-Salem, NC, USA
| | - Kathleen C Perry
- Department of Surgical Oncology, Comprehensive Cancer Center, Wake Forest Baptist Medical Center, Winston-Salem, NC, USA
| | - Konstantinos I Votanopoulos
- Department of Surgical Oncology, Comprehensive Cancer Center, Wake Forest Baptist Medical Center, Winston-Salem, NC, USA
| | - Perry Shen
- Department of Surgical Oncology, Comprehensive Cancer Center, Wake Forest Baptist Medical Center, Winston-Salem, NC, USA.
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Valenzuela CD, Mangieri CW, Garland-Kledzik M, Gawdi R, Russell G, Perry KC, Votanopoulos KI, Levine EA, Shen P. Timing of Repeat Cytoreductive Surgery with Hyperthermic Intraperitoneal Chemotherapy for Recurrent Low-Grade Appendiceal Mucinous Neoplasms. Ann Surg Oncol 2022; 29:3422-3431. [PMID: 35254575 PMCID: PMC10085001 DOI: 10.1245/s10434-022-11440-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 01/26/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND Low-grade appendiceal mucinous neoplasm (LAMN) with peritoneal involvement is a common indication for cytoreductive surgery with heated intraperitoneal chemotherapy (CRS/HIPEC). With peritoneal recurrence, patients are increasingly being offered repeat CRS/HIPECs, however optimal timing for a second CRS/HIPEC remains unknown. METHODS A prospectively maintained 30-year database at our high-volume HIPEC center was analyzed retrospectively for patients with LAMNs and peritoneal recurrence receiving one or two CRS/HIPECs. Kaplan-Meier survival analysis, linear regression modeling, and Cox proportional hazards regression analyses were performed. RESULTS Overall, 143 patients with LAMNs who underwent CRS/HIPECs had confirmed postoperative peritoneal recurrence. Of these patients, 85 underwent one CRS/HIPEC and 58 underwent two CRS/HIPECs. The groups had significant differences in age, with younger patients more likely to undergo a second CRS/HIPEC (48.5 vs. 58.0 years; p < 0.001). The median overall survival (OS) for the group undergoing two CRS/HIPECs was approximately four times longer compared with the group undergoing one CRS/HIPEC (227.1 vs. 54.5 months; p < 0.0001). The time from recurrence to the second CRS/HIPEC was not significantly associated with OS from the time of the first operation. Instead, a shorter time between the first CRS/HIPEC and recurrence was significantly associated with shorter OS from the time of the first operation (p = 0.037). CONCLUSION In peritoneal LAMNs with recurrence, receiving two CRS/HIPECs was associated with better OS compared with receiving one CRS/HIPEC. Longer time to recurrence was a good prognostic factor. Delay between recurrence and second CRS/HIPEC had no apparent impact on OS from the first CRS/HIPEC; thus, immediate or delayed reoperative intervention are both reasonable approaches.
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Affiliation(s)
- Cristian D Valenzuela
- Department of Surgical Oncology, Comprehensive Cancer Center, Wake Forest Baptist Medical Center, Winston-Salem, NC, USA
| | - Christopher W Mangieri
- Department of Surgical Oncology, Comprehensive Cancer Center, Wake Forest Baptist Medical Center, Winston-Salem, NC, USA
| | - Mary Garland-Kledzik
- Department of Surgical Oncology, Comprehensive Cancer Center, Wake Forest Baptist Medical Center, Winston-Salem, NC, USA
| | - Rohin Gawdi
- Department of Surgical Oncology, Comprehensive Cancer Center, Wake Forest Baptist Medical Center, Winston-Salem, NC, USA
| | - Gregory Russell
- Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Kathleen C Perry
- Department of Surgical Oncology, Comprehensive Cancer Center, Wake Forest Baptist Medical Center, Winston-Salem, NC, USA
| | - Konstantinos I Votanopoulos
- Department of Surgical Oncology, Comprehensive Cancer Center, Wake Forest Baptist Medical Center, Winston-Salem, NC, USA
| | - Edward A Levine
- Department of Surgical Oncology, Comprehensive Cancer Center, Wake Forest Baptist Medical Center, Winston-Salem, NC, USA
| | - Perry Shen
- Department of Surgical Oncology, Comprehensive Cancer Center, Wake Forest Baptist Medical Center, Winston-Salem, NC, USA.
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Valenzuela CD, Mangieri CW, Garland-Kledzik M, Gawdi R, Russell G, Perry KC, Votanopoulos KI, Levine EA, Shen P. ASO Visual Abstract: Timing of Repeat Cytoreductive Surgery with Hyperthermic Intraperitoneal Chemotherapy for Recurrent Low-Grade Appendiceal Mucinous Neoplasms. Ann Surg Oncol 2022. [DOI: 10.1245/s10434-022-11511-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Moaven O, Su J, Jin G, Votanopoulos KI, Shen P, Mangieri C, O'Neill SS, Perry KC, Levine EA, Miller LD. Clinical Implications of Genetic Signatures in Appendiceal Cancer Patients with Incomplete Cytoreduction/HIPEC. Ann Surg Oncol 2020; 27:5016-5023. [PMID: 32705511 DOI: 10.1245/s10434-020-08841-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Accepted: 06/27/2020] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Clinical decision-making is challenging in patients who undergo cytoreductive surgery/hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) when complete cytoreduction is not feasible. Nevertheless, some patients still benefit with long-term survival after incomplete CRS/HIPEC. There is currently no robust predictive tool that can assist clinical decision-making in this setting. METHODS We quantified gene expression of 79 appendiceal mucinous neoplasms (AMN) from patients with incomplete CRS/HIPEC (R2 resection) using a custom NanoString gene panel. Using our previously defined, prognostic subtype classification algorithm based on signed nonnegative matrix factorization, we classified AMN cases into three molecular subtypes termed: immune enriched (IE), mixed (M), and oncogene enriched (OE). Kaplan-Meier and Cox proportional hazards analyses were used to associate subtypes and individual genes with overall survival (OS). RESULTS Median overall survival (OS) was 7.7 years for IE, 3.6 years for M, and 1.4 years for OE. Compared with IE, OE was associated with significantly lower survival [hazard ratio (HR) 3.64, 95% confidence interval (CI) 1.63-8.13; p = 0.0017]. The differences were observed in both low-grade and high-grade tumors. While only two genes were identified to be associated with OS in low-grade tumors, multiple genes were identified to be associated with OS in high-grade tumors, particularly genes with functions in cell cycle/proliferation, mucin production, immune pathways, and cell adhesion/migration. CONCLUSION Genetic signatures have prognostic value in patients with incomplete cytoreduction and provide valuable information to assist clinical and operative decision-making. Unraveling genetic alterations and involved pathways can direct efforts to design novel therapeutic modalities.
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Affiliation(s)
- Omeed Moaven
- Surgical Oncology Service, Department of General Surgery, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Jing Su
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Guangxu Jin
- Breast Cancer Center of Excellence, Wake Forest Baptist Comprehensive Cancer Center, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Konstantinos I Votanopoulos
- Surgical Oncology Service, Department of General Surgery, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Perry Shen
- Surgical Oncology Service, Department of General Surgery, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Christopher Mangieri
- Surgical Oncology Service, Department of General Surgery, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Stacey S O'Neill
- Department of Pathology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Kathleen C Perry
- Surgical Oncology Service, Department of General Surgery, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Edward A Levine
- Surgical Oncology Service, Department of General Surgery, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Lance D Miller
- Breast Cancer Center of Excellence, Wake Forest Baptist Comprehensive Cancer Center, Wake Forest School of Medicine, Winston-Salem, NC, USA. .,Department of Cancer Biology, Wake Forest School of Medicine, Winston-Salem, NC, 27157, USA.
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Moaven O, Perry KC, Votanopoulos KI, Shen P, Levine EA. ASO Author Reflections: Patient-Reported Outcomes of Mucinous Appendiceal Cancer Improve with Oxaliplatin HIPEC. Ann Surg Oncol 2019; 27:781-782. [PMID: 31720929 DOI: 10.1245/s10434-019-08066-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Indexed: 11/18/2022]
Affiliation(s)
- Omeed Moaven
- Department of Surgery, Wake Forest Baptist Medical Center, Winston Salem, NC, USA
| | - Kathleen C Perry
- Department of Surgery, Wake Forest Baptist Medical Center, Winston Salem, NC, USA
| | | | - Perry Shen
- Department of Surgery, Wake Forest Baptist Medical Center, Winston Salem, NC, USA
| | - Edward A Levine
- Department of Surgery, Wake Forest Baptist Medical Center, Winston Salem, NC, USA.
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Enomoto LM, Choudry MH, Bartlett DL, Totin L, Mann GN, Skitzki JJ, Perry KC, Votanopoulos KI, Levine EA, Shen P. Outcomes After Adjuvant Hyperthermic Intraperitoneal Chemotherapy for High-Risk Primary Appendiceal Neoplasms After Complete Resection. Ann Surg Oncol 2019; 27:107-114. [DOI: 10.1245/s10434-019-07634-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Indexed: 12/27/2022]
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Ali YM, Sweeney J, Shen P, Votanopoulos KI, McQuellon R, Duckworth K, Perry KC, Russell G, Levine EA. Effect of Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy on Quality of Life in Patients with Peritoneal Mesothelioma. Ann Surg Oncol 2019; 27:117-123. [PMID: 31069554 DOI: 10.1245/s10434-019-07425-5] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Indexed: 01/26/2023]
Abstract
INTRODUCTION Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC) is an accepted treatment for peritoneal mesothelioma. In this study, we evaluated QOL after HIPEC for peritoneal mesothelioma. METHODS This was a prospective study performed after HIPEC for peritoneal mesothelioma between 2002 and 2015. Patients completed QOL surveys, including the Short Form-36 (SF-36), Functional Assessment of Cancer Therapy + Colon (FACT-C), Brief Pain Inventory (BPI), and Center for Epidemiologic Studies Depression Scale (CES-D) preoperatively and at 3, 6, 12, and 24 months postoperatively. RESULTS Overall, 46 patients underwent HIPEC for peritoneal mesothelioma and completed QOL surveys. Mean age was 52.8 ± 13.8 years and 52% were male. Good preoperative functional status was 70%. Median survival was 3.4 years, and 1, 3, and 5-year survivals were 77.4, 55.2, and 36.5%, respectively. CES-D score decreased at 3 months postoperatively, but increased at 24 months (p = 0.014); SF-36 physical functioning scale decreased at 3 months but returned to baseline at 12 months (p = 0.0045); and the general health scale decreased at 3 months, then improved by 6 months (p = 0.0034). Emotional well-being (p = 0.0051), role limitations due to emotional problems (p = 0.0006), social functioning (p = 0.0022), BPI (p = 0.025), least pain (p = 0.045), and worst pain (p < 0.0001) improved. FACT-C physical well-being decreased at 3 months but returned to baseline at 6 months (p = 0.020), and total FACT-C score improved at 6 months (p = 0.052). CONCLUSION QOL returned to baseline or improved from baseline between 3 months and 1 year following surgery. Despite the risks associated with this operation, patients may tolerate HIPEC well and have good overall QOL postoperatively.
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Affiliation(s)
- Yasmin M Ali
- Surgical Oncology Service, Department of General Surgery, Wake Forest University, Winston-Salem, NC, USA
| | - Joseph Sweeney
- Surgical Oncology Service, Department of General Surgery, Wake Forest University, Winston-Salem, NC, USA
| | - Perry Shen
- Surgical Oncology Service, Department of General Surgery, Wake Forest University, Winston-Salem, NC, USA
| | | | - Richard McQuellon
- Surgical Oncology Service, Department of General Surgery, Wake Forest University, Winston-Salem, NC, USA
| | - Katie Duckworth
- Surgical Oncology Service, Department of General Surgery, Wake Forest University, Winston-Salem, NC, USA
| | - Kathleen C Perry
- Surgical Oncology Service, Department of General Surgery, Wake Forest University, Winston-Salem, NC, USA
| | - Greg Russell
- Surgical Oncology Service, Department of General Surgery, Wake Forest University, Winston-Salem, NC, USA
| | - Edward A Levine
- Surgical Oncology Service, Department of General Surgery, Wake Forest University, Winston-Salem, NC, USA.
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Merrill A, Garland MM, Howard-Mcnatt M, Isnassuos M, Perry KC, Levine EA. What is the Utility of Routine Complete Blood Count, Liver Function Tests, and Chest X-ray in the Evaluation of Patients with Clinically Node-Negative Breast Cancer? Am Surg 2019. [DOI: 10.1177/000313481908500114] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
National Comprehensive Cancer Network guidelines suggest a selective workup of early-stage breast cancer with complete blood count (CBC) and liver function tests (LFTs) and no longer recommend chest X-ray (CXR) to screen for occult metastasis. We evaluated the utility of routine preoperative screening tests in patients with clinically node-negative (cN0) breast cancer. We identified 1611 patients with cN0 breast cancer treated at our institution between October 1998 and December 2015; 94.4 per cent of the patients underwent at least one preoperative screening test: 90.8 per cent CBC, 89.4 per cent LFTs, and 63.6 per cent CXR. Thirty-six per cent of CBCs, 13.1 per cent of LFTs, and 6.7 per cent of CXRs were abnormal. Abnormalities led to 17 CTscans, and one found an occult metastasis. Eleven patients (0.7%) were diagnosed with metastatic disease post-operatively, but only half had abnormal preoperative screening tests. Positive predictive values of preoperative CBC, LFTs, and CXR for occult metastasis are 1.3 per cent, 1.1 per cent, and 1.5 per cent, respectively. Preoperative screening in cN0 breast cancer is of low yield. Even when abnormalities are found, metastasis is present in less than 1 per cent of patients, and a normal study does not rule out metastasis. Routine preoperative determination is not warranted, and staging studies should be limited to patients with signs or symptoms.
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Affiliation(s)
- Ameliay Merrill
- From the Surgical Oncology Service, Department of General Surgery, Wake Forest University, Winston-Salem, North Carolina
| | - Mary M. Garland
- From the Surgical Oncology Service, Department of General Surgery, Wake Forest University, Winston-Salem, North Carolina
| | - Marissa Howard-Mcnatt
- From the Surgical Oncology Service, Department of General Surgery, Wake Forest University, Winston-Salem, North Carolina
| | - Mena Isnassuos
- From the Surgical Oncology Service, Department of General Surgery, Wake Forest University, Winston-Salem, North Carolina
| | - Kathleen C. Perry
- From the Surgical Oncology Service, Department of General Surgery, Wake Forest University, Winston-Salem, North Carolina
| | - Edward A. Levine
- From the Surgical Oncology Service, Department of General Surgery, Wake Forest University, Winston-Salem, North Carolina
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Merrill AY, Garland MM, Howard-McNatt M, Isnassuos M, Perry KC, Levine EA. What Is the Utility of Routine Complete Blood Count, Liver Function Tests, and Chest X-ray in the Evaluation of Patients with Clinically Node-Negative Breast Cancer? Am Surg 2019; 85:29-33. [PMID: 30760341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
National Comprehensive Cancer Network guidelines suggest a selective workup of early-stage breast cancer with complete blood count (CBC) and liver function tests (LFTs) and no longer recommend chest X-ray (CXR) to screen for occult metastasis. We evaluated the utility of routine preoperative screening tests in patients with clinically node-negative (cN0) breast cancer. We identified 1611 patients with cN0 breast cancer treated at our institution between October 1998 and December 2015; 94.4 per cent of the patients underwent at least one preoperative screening test: 90.8 per cent CBC, 89.4 per cent LFTs, and 63.6 per cent CXR. Thirty-six per cent of CBCs, 13.1 per cent of LFTs, and 6.7 per cent of CXRs were abnormal. Abnormalities led to 17 CT scans, and one found an occult metastasis. Eleven patients (0.7%) were diagnosed with metastatic disease postoperatively, but only half had abnormal preoperative screening tests. Positive predictive values of preoperative CBC, LFTs, and CXR for occult metastasis are 1.3 per cent, 1.1 per cent, and 1.5 per cent, respectively. Preoperative screening in cN0 breast cancer is of low yield. Even when abnormalities are found, metastasis is present in less than 1 per cent of patients, and a normal study does not rule out metastasis. Routine preoperative determination is not warranted, and staging studies should be limited to patients with signs or symptoms.
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de Pomerai DI, Ip WK, McLaughlin M, Perry KC. Expression in non-lens tissues of an enzyme activity related to the ‘lens-specific’ protein, delta crystallin. Development 1991; 111:181-90. [PMID: 2015793 DOI: 10.1242/dev.111.1.181] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
When chick embryo neutral retina (NR) cells are cultured for long periods in vitro, they undergo extensive transdifferentiation into lens and express the lens protein, delta crystallin. We now demonstrate that this process is accompanied by a change in the chromatin conformation of the delta-gene locus from DNAase1-resistant to DNAase1-sensitive in the nuclei of most cells. Transcripts hybridising to a delta probe are also much more prevalent among the in vitro transcription products from lens or transdifferentiated NR culture nuclei, as compared to nuclei from fresh NR tissue. Published evidence indicates that the chick delta 1 crystallin gene encodes the major structural protein of embryonic lens fibres, whereas the closely related delta 2 gene may encode the urea-cycle enzyme argininosuccinate lyase (ASL). Our present data lends further support to this view. Both immunodetectable delta-related protein(s) and ASL activity are present in fresh embryonic NR tissue, as well as in mouse and Rana liver, and in Rana lens. Our polyclonal anti-delta antibody also cross-reacts with a major constituent of commercial bovine ASL, of the same molecular size as chick delta crystallin. Immunoselection studies suggest that the ASL activity in chick embryonic NR is conferred mainly by the delta-related protein band. So-called ‘ectopic’ expression of delta crystallin in embryonic NR (and other tissues) may thus involve the delta 2/ASL gene, and could reflect some metabolic requirement for ASL activity.
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Abstract
The notes of 134 consecutive patients undergoing bladder neck incision (BNI) were analysed retrospectively. Details of pre-operative symptoms and the short-term results of the operation were studied, as well as the need for reoperation. Long-term results of the operation were not available in 100 patients and a questionnaire was sent to them asking for details of their present symptoms. This produced results on the long-term follow-up of 107 patients with a mean follow-up of 31 months (range 18-48); 86% of patients showed an improvement in symptoms in the short term whilst 68% maintained a subjective improvement in symptoms in the long term. Further surgery was required in 18 patients (13%). Possible reasons for this are discussed.
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Affiliation(s)
- B Waymont
- Department of Urology, District General Hospital, Eastbourne
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Abstract
In a prospective study of 100 patients undergoing transurethral resection, changes in serum sodium were estimated during the per-operative and post-operative periods. The weight of prostate resected and the volume of irrigant fluid used influenced the changes in serum sodium. In 93 patients these changes were not statistically significant. In only seven patients were significant falls in serum sodium recorded, in one case to a level of 103 mmol/l. All seven exhibited the clinical features of the transurethral syndrome and there was one post-operative death which we attributed to it. The TUR syndrome undoubtedly exists and its incidence in this series was 7%. Its pathogenesis and clinical management are discussed.
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