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Rosen R, Quezada-Diaz FF, Gönen M, Karagkounis G, Widmar M, Wei IH, Smith JJ, Nash GM, Weiser MR, Paty PB, Cercek A, Romesser PB, Sanchez-Vega F, Adileh M, Roth O’Brien D, Hajj C, Williams VM, Shcherba M, Gu P, Crane C, Saltz LB, Garcia Aguilar J, Pappou E. Oncologic Outcomes of Salvage Abdominoperineal Resection for Anal Squamous Cell Carcinoma Initially Managed with Chemoradiation. J Clin Med 2024; 13:2156. [PMID: 38673429 PMCID: PMC11050212 DOI: 10.3390/jcm13082156] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2024] [Revised: 04/01/2024] [Accepted: 04/03/2024] [Indexed: 04/28/2024] Open
Abstract
Background: Abdominoperineal resection (APR) has been advocated for persistent or recurrent disease after failure of chemoradiation (CRT) for anal squamous cell cancer (SCC). Treatment with salvage APR can potentially achieve a cure. This study aimed to analyze oncological outcomes for salvage APR in a recent time period at a comprehensive cancer center. Methods: A retrospective review of all patients who underwent APR for biopsy-proven persistent or recurrent anal SCC between 1 January 2007 and 31 December 2020 was performed. Patients with stage IV disease at the time of initial diagnosis and patients with missing data were excluded. Univariate analysis was used with a chi-square test for categorical variables, and non-parametric tests were used for continuous variables. Kaplan-Meier survival analysis was performed to evaluate disease-specific (DSS), post-APR local recurrence-free (RFS), and disease-free survival (DFS). Results: A total of 96 patients were included in the analysis: 39 (41%) with persistent disease and 57 (59%) with recurrent SCC after chemoradiation had been completed. The median follow-up was 22 months (IQR 11-47). Forty-nine patients (51%) underwent extended APR and/or pelvic exenteration. Eight (8%) patients developed local recurrence, 30 (31%) developed local and distant recurrences, and 16 (17%) developed distant recurrences alone. The 3-year DSS, post-APR local recurrence-free survival, and disease-free survival were 53.8% (95% CI 43.5-66.5%), 54.5% (95% CI 44.4-66.8%), and 26.8% (95% CI 18.6-38.7%), respectively. In multivariate logistic regression analysis, positive microscopic margin (OR 10.0, 95% CI 2.16-46.12, p = 0.003), positive nodes in the surgical specimen (OR 9.19, 95% CI 1.99-42.52, p = 0.005), and lymphovascular invasion (OR 2.61 95% CI 1.05-6.51, p = 0.04) were associated with recurrence of disease. Gender, indication for APR (recurrent vs. persistent disease), HIV status, extent of surgery, or type of reconstruction did not influence survival outcomes. Twenty patients had targeted tumor-sequencing data available. Nine patients had PIK3CA mutations, seven of whom experienced a recurrence. Conclusions: Salvage APR for anal SCC after failed CRT was associated with poor disease-specific survival and low recurrence-free survival. Anal SCC patients undergoing salvage APR should be counseled that microscopic positive margins, positive lymph nodes, or the presence of lymphovascular invasion in the APR specimen are prognosticators for disease relapse. Our results accentuate the necessity for additional treatment strategies for the ongoing treatment challenge of persistent or recurrent anal SCC after failed CRT.
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Affiliation(s)
- Roni Rosen
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA (F.F.Q.-D.); (J.J.S.)
| | - Felipe F. Quezada-Diaz
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA (F.F.Q.-D.); (J.J.S.)
| | - Mithat Gönen
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Georgios Karagkounis
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA (F.F.Q.-D.); (J.J.S.)
| | - Maria Widmar
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA (F.F.Q.-D.); (J.J.S.)
| | - Iris H. Wei
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA (F.F.Q.-D.); (J.J.S.)
| | - J. Joshua Smith
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA (F.F.Q.-D.); (J.J.S.)
| | - Garrett M. Nash
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA (F.F.Q.-D.); (J.J.S.)
| | - Martin R. Weiser
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA (F.F.Q.-D.); (J.J.S.)
| | - Philip B. Paty
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA (F.F.Q.-D.); (J.J.S.)
| | - Andrea Cercek
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA (P.G.)
| | - Paul B. Romesser
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; (P.B.R.)
| | - Francisco Sanchez-Vega
- Department of Computational Oncology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Mohammad Adileh
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA (F.F.Q.-D.); (J.J.S.)
| | - Diana Roth O’Brien
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; (P.B.R.)
| | - Carla Hajj
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; (P.B.R.)
| | - Vonetta M. Williams
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; (P.B.R.)
| | - Marina Shcherba
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA (P.G.)
| | - Ping Gu
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA (P.G.)
| | - Christopher Crane
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; (P.B.R.)
| | - Leonard B. Saltz
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA (P.G.)
| | - Julio Garcia Aguilar
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA (F.F.Q.-D.); (J.J.S.)
| | - Emmanouil Pappou
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA (F.F.Q.-D.); (J.J.S.)
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Ben-Yaacov A, Levine O, Schtrechman G, Adileh M, Beller T, Boursi B, Halpern N, Goldstein A, Ben-Yakov G, Nissan A, Laks S. Extremely high peritoneal cancer index in colorectal peritoneal metastases demonstrates safety and overall survival benefit in selected patients undergoing cytoreductive surgery and heated intraperitoneal chemotherapy. World J Surg 2024; 48:871-878. [PMID: 38686748 DOI: 10.1002/wjs.12080] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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] [Received: 11/23/2023] [Accepted: 12/27/2023] [Indexed: 05/02/2024]
Abstract
BACKGROUND Colorectal peritoneal metastases are a devastating consequence of colorectal cancer (CRC) with extremely poor prognosis. Patients that can undergo complete cytoreduction by cytoreductive surgery and heated intraperitoneal chemotherapy (CRS/HIPEC) have a markedly improved overall survival. Traditionally, patients with extremely high peritoneal cancer index (PCI), PCI >20, are not offered CRS/HIPEC. METHODS We performed a retrospective analysis of our prospectively maintained CRS/HIPEC database and evaluated all patients with CRC peritoneal metastases between 2012 and 2022. We divided the cohorts between those with low operative PCI (PCI<20) and high operative PCI (PCI =>20). We examined demographic, clinicopathologic data, perioperative, and oncological outcomes between the cohorts. RESULTS Of the 691 patients who underwent CRS/HIPEC, 289 were evaluable with CRC metastases, 234 with PCI <20 and 43 with PCI => 20. Median radiologic preoperative and operative PCI was 4 and 10 versus 7 and 24.5 in the low and high PCI cohorts, respectively. Operative time was longer (6 vs. 4 h) and blood loss higher (500 vs. 400 mL) in the high PCI cohort. All other demographic, clinicopathological, and operative characteristics were similar. Median disease free survival (DFS) was longer in the low PCI cohort (11.5 vs. 7 months) but overall survival (OS) showed benefit (41.3 vs. 31.8 months), (p = 0.001 and p = 0.189, respectively), comparatively with an only chemotherapy strategy. CONCLUSIONS Appropriately selected patients with CRC metastases and extremely high PCI demonstrate similar perioperative safety outcomes in experienced tertiary referral centers. Despite a shorter median DFS, these carefully selected patients demonstrated similar median OS.
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Affiliation(s)
- Almog Ben-Yaacov
- Department of General Surgery C and Surgical Oncology, Sheba Medical Center, Ramat Gan, Israel
- Tel-Aviv University, Tel-Aviv, Israel
| | - Olivia Levine
- Department of General Surgery C and Surgical Oncology, Sheba Medical Center, Ramat Gan, Israel
- Tel-Aviv University, Tel-Aviv, Israel
| | - Gal Schtrechman
- Department of General Surgery C and Surgical Oncology, Sheba Medical Center, Ramat Gan, Israel
- Tel-Aviv University, Tel-Aviv, Israel
| | - Mohammad Adileh
- Department of General Surgery C and Surgical Oncology, Sheba Medical Center, Ramat Gan, Israel
- Tel-Aviv University, Tel-Aviv, Israel
| | - Tamar Beller
- Tel-Aviv University, Tel-Aviv, Israel
- Department of Oncology, Sheba Medical Center, Ramat Gan, Israel
| | - Ben Boursi
- Tel-Aviv University, Tel-Aviv, Israel
- Department of Oncology, Sheba Medical Center, Ramat Gan, Israel
| | - Naama Halpern
- Tel-Aviv University, Tel-Aviv, Israel
- Department of Oncology, Sheba Medical Center, Ramat Gan, Israel
| | - Adam Goldstein
- Tel-Aviv University, Tel-Aviv, Israel
- Department of Surgery A, Edith Wolfson Medical Center, Holon, Israel
| | - Gil Ben-Yakov
- Tel-Aviv University, Tel-Aviv, Israel
- Department of Gastroenterology, Edith Wolfson Medical Center, Holon, Israel
| | - Aviram Nissan
- Department of General Surgery C and Surgical Oncology, Sheba Medical Center, Ramat Gan, Israel
- Tel-Aviv University, Tel-Aviv, Israel
| | - Shachar Laks
- Tel-Aviv University, Tel-Aviv, Israel
- Department of Surgery A, Edith Wolfson Medical Center, Holon, Israel
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Benvenisti H, Shiber M, Assaf D, Shovman Y, Laks S, Elbaz N, Mor E, Zippel D, Nissan A, Ben-Yaacov A, Adileh M. Perioperative and Oncological Outcomes of Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy for Peritoneal Metastasis of Rectal Origin. J Gastrointest Surg 2023; 27:2506-2514. [PMID: 37726508 DOI: 10.1007/s11605-023-05833-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 09/07/2023] [Indexed: 09/21/2023]
Abstract
BACKGROUND The peritoneum is a common metastatic site of colorectal cancer (CRC) and associated with worse oncological outcomes. Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) has been shown to improve outcomes in selected patients. Studies have demonstrated significant difference in survival of patients with primary colon and rectal tumors both in local and in metastatic setting; but only few assessed outcomes of CRS/HIPEC for rectal and colon tumors. We studied the perioperative and oncological outcomes of patients undergoing CRS/HIPEC for rectal cancer. METHODS A retrospective analysis of a prospectively maintained database between 2009 and 2021 was performed. RESULTS 199 patients underwent CRS/HIPEC for CRC. 172 patients had primary colon tumors and 27 had primary rectal tumors. Primary rectal location was associated with longer surgery (mean 4.32, hours vs 5.26 h, p = 0.0013), increased blood loss (mean 441cc vs 602cc, p = 0.021), more blood transfusions (mean 0.77 vs 1.37units, p = 0.026) and longer hospitalizations (mean 10 days vs 13 days, p = 0.02). Median disease-free survival (DFS) was shorter in rectal primary group; 7.03 months vs 10.9 months for colon primaries (p = 0.036). Overall survival was not statistically significant; 53.2 months for rectal and 60.8 months for colon primary tumors. Multivariate analysis indicated origin (colon vs rectum) and Peritoneal Cancer Index to be independently associated with DFS. CONCLUSIONS Patients with rectal carcinoma undergoing CRS/HIPEC for peritoneal metastasis had worse peri-operative and oncological outcomes. Overall survival was excellent in both groups. This data may be used for risk stratification when considering CRS/HIPEC for patients with rectal primary.
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Affiliation(s)
- Haggai Benvenisti
- Department of General & Oncological Surgery-Surgery C, The Chaim Sheba Medical Center, Ramat Gan, Israel.
- Sackler School of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel.
| | - Mai Shiber
- Department of General & Oncological Surgery-Surgery C, The Chaim Sheba Medical Center, Ramat Gan, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel
| | - Dan Assaf
- Department of General & Oncological Surgery-Surgery C, The Chaim Sheba Medical Center, Ramat Gan, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel
| | - Yehuda Shovman
- Department of General & Oncological Surgery-Surgery C, The Chaim Sheba Medical Center, Ramat Gan, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel
| | - Shachar Laks
- Department of General & Oncological Surgery-Surgery C, The Chaim Sheba Medical Center, Ramat Gan, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel
| | - Nadav Elbaz
- Department of General & Oncological Surgery-Surgery C, The Chaim Sheba Medical Center, Ramat Gan, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel
| | - Eyal Mor
- Department of General & Oncological Surgery-Surgery C, The Chaim Sheba Medical Center, Ramat Gan, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel
| | - Douglas Zippel
- Department of General & Oncological Surgery-Surgery C, The Chaim Sheba Medical Center, Ramat Gan, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel
| | - Aviram Nissan
- Department of General & Oncological Surgery-Surgery C, The Chaim Sheba Medical Center, Ramat Gan, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel
| | - Almog Ben-Yaacov
- Department of General & Oncological Surgery-Surgery C, The Chaim Sheba Medical Center, Ramat Gan, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel
| | - Mohammad Adileh
- Department of General & Oncological Surgery-Surgery C, The Chaim Sheba Medical Center, Ramat Gan, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel
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4
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Mor E, Schtrechman G, Nizri E, Shimonovitz M, Asher N, Ben-Betzalel G, Grynberg S, Stoff R, Miodovnik M, Adileh M, Ben-Yaacov A, Steinberg Y, Shapira R, Schachter J, Lahat G, Nissan A, Zippel D, Laks S. PET-CT underestimates the true pathological extent of disease at lymphadenectomy for melanoma patients after systemic therapy. Eur J Surg Oncol 2023; 49:106950. [PMID: 37301639 DOI: 10.1016/j.ejso.2023.06.002] [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] [Received: 01/28/2023] [Revised: 05/20/2023] [Accepted: 06/05/2023] [Indexed: 06/12/2023]
Abstract
INTRODUCTION Modern systemic therapy has revolutionized the treatment of melanoma. Currently, patients with clinically involved lymph nodes require lymphadenectomy with associated morbidities. Positron Emission Tomography - Computed Tomography (PET-CT) has demonstrated accuracy in melanoma detection and response to therapy. We aimed to identify whether a PET-CT directed lymphatic resection after systemic therapy is oncologically sound. MATERIALS AND METHODS Retrospective review of patients who underwent lymphadenectomy after systemic therapy for melanoma with a preoperative PET-CT. Examined demographic, clinical, and perioperative parameters including extent of disease, systemic therapy and response, and PET-CT findings compared to pathological outcomes. We compared patients with "as or less than expected" outcomes on pathology against those with "more than expected" pathological outcomes. RESULTS Thirty-nine patients met inclusion criteria. In 28 (71.8%), pathological outcomes were "as or less than expected" by PET-CT, and in 11 (28.2%) pathological outcome were "more than expected". "More than expected" occurred more frequently with advanced disease at presentation with 75% presenting with regional/metastatic disease versus only 42.9% in the "as or less than expected" group (p = 0.015). Poor response to therapy also trended towards the "more than expected" group with only 27.3% favorable response versus 53.6% favorable response in the "as or less than expected" group, not statistically significant. Extent of disease on imaging failed to predict pathological concordance. CONCLUSION PET-CT underestimates pathological extent of disease in the lymphatic basin in 30% of patients after systemic therapy. We failed to identify predictors of more extensive disease and warn against limited PET-CT directed lymphatic resections.
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Affiliation(s)
- Eyal Mor
- Sheba Tel Hashomer Medical Center, Department of Surgery C and Surgical Oncology, Ramat Gan, Israel
| | - Gal Schtrechman
- Sheba Tel Hashomer Medical Center, Department of Surgery C and Surgical Oncology, Ramat Gan, Israel
| | - Eran Nizri
- Department of Surgery B, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Michal Shimonovitz
- Department of Surgery B, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Nethanel Asher
- Sheba Tel Hashomer Medical Center, Department of Oncology, Ramat Gan, Israel
| | - Guy Ben-Betzalel
- Sheba Tel Hashomer Medical Center, Department of Oncology, Ramat Gan, Israel
| | - Shirly Grynberg
- Sheba Tel Hashomer Medical Center, Department of Oncology, Ramat Gan, Israel
| | - Ronen Stoff
- Sheba Tel Hashomer Medical Center, Department of Oncology, Ramat Gan, Israel
| | - Mor Miodovnik
- Institute of Oncology, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Mohammad Adileh
- Sheba Tel Hashomer Medical Center, Department of Surgery C and Surgical Oncology, Ramat Gan, Israel
| | - Almog Ben-Yaacov
- Sheba Tel Hashomer Medical Center, Department of Surgery C and Surgical Oncology, Ramat Gan, Israel
| | - Yael Steinberg
- Sheba Tel Hashomer Medical Center, Department of Oncology, Ramat Gan, Israel
| | - Ronnie Shapira
- Sheba Tel Hashomer Medical Center, Department of Oncology, Ramat Gan, Israel
| | - Jacob Schachter
- Sheba Tel Hashomer Medical Center, Department of Oncology, Ramat Gan, Israel
| | - Guy Lahat
- Department of Surgery B, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Aviram Nissan
- Sheba Tel Hashomer Medical Center, Department of Surgery C and Surgical Oncology, Ramat Gan, Israel
| | - Douglas Zippel
- Sheba Tel Hashomer Medical Center, Department of Surgery C and Surgical Oncology, Ramat Gan, Israel
| | - Shachar Laks
- Sheba Tel Hashomer Medical Center, Department of Surgery C and Surgical Oncology, Ramat Gan, Israel.
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5
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Iluz A, Maoz M, Lavi N, Charbit H, Or O, Olshinka N, Demma JA, Adileh M, Wygoda M, Blumenfeld P, Gliner-Ron M, Azraq Y, Moss J, Peretz T, Eden A, Zick A, Lavon I. Rapid Classification of Sarcomas Using Methylation Fingerprint: A Pilot Study. Cancers (Basel) 2023; 15:4168. [PMID: 37627196 PMCID: PMC10453223 DOI: 10.3390/cancers15164168] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 08/14/2023] [Accepted: 08/16/2023] [Indexed: 08/27/2023] Open
Abstract
Sarcoma classification is challenging and can lead to treatment delays. Previous studies used DNA aberrations and machine-learning classifiers based on methylation profiles for diagnosis. We aimed to classify sarcomas by analyzing methylation signatures obtained from low-coverage whole-genome sequencing, which also identifies copy-number alterations. DNA was extracted from 23 suspected sarcoma samples and sequenced on an Oxford Nanopore sequencer. The methylation-based classifier, applied in the nanoDx pipeline, was customized using a reference set based on processed Illumina-based methylation data. Classification analysis utilized the Random Forest algorithm and t-distributed stochastic neighbor embedding, while copy-number alterations were detected using a designated R package. Out of the 23 samples encompassing a restricted range of sarcoma types, 20 were successfully sequenced, but two did not contain tumor tissue, according to the pathologist. Among the 18 tumor samples, 14 were classified as reported in the pathology results. Four classifications were discordant with the pathological report, with one compatible and three showing discrepancies. Improving tissue handling, DNA extraction methods, and detecting point mutations and translocations could enhance accuracy. We envision that rapid, accurate, point-of-care sarcoma classification using nanopore sequencing could be achieved through additional validation in a diverse tumor cohort and the integration of methylation-based classification and other DNA aberrations.
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Affiliation(s)
- Aviel Iluz
- Leslie and Michael Gaffin Center for Neuro-Oncology, Hadassah Medical Center and Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem 9190501, Israel
- Agnes Ginges Center for Human Neurogenetics, Department of Neurology, Hadassah Medical Center and Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem 9190501, Israel
| | - Myriam Maoz
- Oncology Department, Sharett Institute of Oncology, Hadassah Medical Organization and Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem 9190501, Israel
| | - Nir Lavi
- Leslie and Michael Gaffin Center for Neuro-Oncology, Hadassah Medical Center and Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem 9190501, Israel
- Agnes Ginges Center for Human Neurogenetics, Department of Neurology, Hadassah Medical Center and Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem 9190501, Israel
- Department of Military Medicine and “Tzameret”, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem 9190501, Israel
| | - Hanna Charbit
- Leslie and Michael Gaffin Center for Neuro-Oncology, Hadassah Medical Center and Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem 9190501, Israel
- Agnes Ginges Center for Human Neurogenetics, Department of Neurology, Hadassah Medical Center and Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem 9190501, Israel
| | - Omer Or
- Orthopedic Department, Hadassah Medical Organization and Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem 9190501, Israel
| | - Noam Olshinka
- Orthopedic Department, Hadassah Medical Organization and Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem 9190501, Israel
| | - Jonathan Abraham Demma
- Surgical Department, Hadassah Medical Organization and Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem 9190501, Israel
| | - Mohammad Adileh
- Surgical Department, Hadassah Medical Organization and Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem 9190501, Israel
| | - Marc Wygoda
- Radiotherapy Institute, Sharett Institute of Oncology, Hadassah Medical Organization and Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem 9190501, Israel
| | - Philip Blumenfeld
- Radiotherapy Institute, Sharett Institute of Oncology, Hadassah Medical Organization and Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem 9190501, Israel
| | - Masha Gliner-Ron
- Radiology Department, Hadassah Medical Organization and Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem 9190501, Israel
| | - Yusef Azraq
- Radiology Department, Hadassah Medical Organization and Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem 9190501, Israel
| | - Joshua Moss
- Oncology Department, Sharett Institute of Oncology, Hadassah Medical Organization and Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem 9190501, Israel
| | - Tamar Peretz
- Oncology Department, Sharett Institute of Oncology, Hadassah Medical Organization and Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem 9190501, Israel
| | - Amir Eden
- Department of Genetics, The Hebrew University of Jerusalem, Jerusalem 9190501, Israel
| | - Aviad Zick
- Oncology Department, Sharett Institute of Oncology, Hadassah Medical Organization and Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem 9190501, Israel
| | - Iris Lavon
- Leslie and Michael Gaffin Center for Neuro-Oncology, Hadassah Medical Center and Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem 9190501, Israel
- Agnes Ginges Center for Human Neurogenetics, Department of Neurology, Hadassah Medical Center and Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem 9190501, Israel
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6
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Canady J, Murthy SRK, Zhuang T, Gitelis S, Nissan A, Ly L, Jones OZ, Cheng X, Adileh M, Blank AT, Colman MW, Millikan K, O'Donoghue C, Stenson KM, Ohara K, Schtrechman G, Keidar M, Basadonna G. The First Cold Atmospheric Plasma Phase I Clinical Trial for the Treatment of Advanced Solid Tumors: A Novel Treatment Arm for Cancer. Cancers (Basel) 2023; 15:3688. [PMID: 37509349 PMCID: PMC10378184 DOI: 10.3390/cancers15143688] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 07/10/2023] [Accepted: 07/17/2023] [Indexed: 07/30/2023] Open
Abstract
Local regional recurrence (LRR) remains the primary cause of treatment failure in solid tumors despite advancements in cancer therapies. Canady Helios Cold Plasma (CHCP) is a novel Cold Atmospheric Plasma device that generates an Electromagnetic Field and Reactive Oxygen and Nitrogen Species to induce cancer cell death. In the first FDA-approved Phase I trial (March 2020-April 2021), 20 patients with stage IV or recurrent solid tumors underwent surgical resection combined with intra-operative CHCP treatment. Safety was the primary endpoint; secondary endpoints were non-LRR, survival, cancer cell death, and the preservation of surrounding healthy tissue. CHCP did not impact intraoperative physiological data (p > 0.05) or cause any related adverse events. Overall response rates at 26 months for R0 and R0 with microscopic positive margin (R0-MPM) patients were 69% (95% CI, 19-40%) and 100% (95% CI, 100-100.0%), respectively. Survival rates for R0 (n = 7), R0-MPM (n = 5), R1 (n = 6), and R2 (n = 2) patients at 28 months were 86%, 40%, 67%, and 0%, respectively. The cumulative overall survival rate was 24% at 31 months (n = 20, 95% CI, 5.3-100.0). CHCP treatment combined with surgery is safe, selective towards cancer, and demonstrates exceptional LRR control in R0 and R0-MPM patients. (Clinical Trials identifier: NCT04267575).
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Affiliation(s)
- Jerome Canady
- Department of Translational Research, Jerome Canady Research Institute for Advanced Biological and Technological Sciences, Takoma Park, MD 20912, USA
- Department of Mechanical and Aerospace Engineering, The George Washington University, Washington, DC 20052, USA
- Department of Surgery, University of Maryland, Capital Regional Medical Center, Largo, MD 21044, USA
| | - Saravana R K Murthy
- Department of Translational Research, Jerome Canady Research Institute for Advanced Biological and Technological Sciences, Takoma Park, MD 20912, USA
| | - Taisen Zhuang
- Department of Translational Research, Jerome Canady Research Institute for Advanced Biological and Technological Sciences, Takoma Park, MD 20912, USA
| | - Steven Gitelis
- Department of Surgery, Rush University Medical Center, Chicago, IL 60612, USA
| | - Aviram Nissan
- Department of Surgical Oncology/General Surgery, Chaim Sheba Medical Center, Ramat Gan 52621, Israel
| | - Lawan Ly
- Department of Translational Research, Jerome Canady Research Institute for Advanced Biological and Technological Sciences, Takoma Park, MD 20912, USA
| | - Olivia Z Jones
- Department of Translational Research, Jerome Canady Research Institute for Advanced Biological and Technological Sciences, Takoma Park, MD 20912, USA
| | - Xiaoqian Cheng
- Department of Translational Research, Jerome Canady Research Institute for Advanced Biological and Technological Sciences, Takoma Park, MD 20912, USA
| | - Mohammad Adileh
- Department of Surgical Oncology/General Surgery, Chaim Sheba Medical Center, Ramat Gan 52621, Israel
| | - Alan T Blank
- Department of Surgery, Rush University Medical Center, Chicago, IL 60612, USA
| | - Matthew W Colman
- Department of Surgery, Rush University Medical Center, Chicago, IL 60612, USA
| | - Keith Millikan
- Department of Surgery, Rush University Medical Center, Chicago, IL 60612, USA
| | - Cristina O'Donoghue
- Department of Surgery, Rush University Medical Center, Chicago, IL 60612, USA
| | - Kerstin M Stenson
- Department of Surgery, Rush University Medical Center, Chicago, IL 60612, USA
| | - Karen Ohara
- Department of Surgery, Rush University Medical Center, Chicago, IL 60612, USA
| | - Gal Schtrechman
- Department of Surgical Oncology/General Surgery, Chaim Sheba Medical Center, Ramat Gan 52621, Israel
| | - Michael Keidar
- Department of Mechanical and Aerospace Engineering, The George Washington University, Washington, DC 20052, USA
| | - Giacomo Basadonna
- Department of Surgery, University of Massachusetts Chan Medical School, Worcester, MA 01854, USA
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Mor E, Assaf D, Shemla S, Ben-Ami E, Halfon M, Laks S, Perelson D, Zippel D, Ben-Yaacov A, Lawrence Y, Symon Z, Nissan A, Adileh M. IOeRT in retroperitoneal sarcoma: Towards more organ preservation with comparable oncological outcomes. Surg Oncol 2023; 48:101940. [PMID: 37079981 DOI: 10.1016/j.suronc.2023.101940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Revised: 02/25/2023] [Accepted: 03/28/2023] [Indexed: 04/09/2023]
Abstract
BACKGROUND Retroperitoneal sarcomas (RPS) present a surgical challenge with high rates of local recurrence (LR). We investigated the role of intraoperative electron radiotherapy (IOeRT) in reducing LR after surgical resection of RPS. METHODS A retrospective analysis of all patients who underwent surgical resection for RPS between 2014 and 2021 at a tertiary academic referral center (n = 172). Patients included underwent surgical resection of their RPS and received IOeRT (n = 36) and were compared by case control matching to patients with similar tumor characteristics (recurrence status and tumor grade) that did not receive IOeRT (n = 36). RESULTS The median length of hospitalization was 8 days (range, 4-34) in the IOeRT group and 10 days (range, 2-42) in the non-IOeRT group (p = 0.25). The mean operating room (OR) time was 4h (±1.3) and 4h (±1.9) in the IOeRT and non-IOeRT groups respectively, (p = 0.37). Complete resection with R0 margins was achieved in 30 patients (83.3%) and 24 patients (66.6%) in the IOeRT and non-IOeRT groups, respectively (p = 0.1). R1 resection was achieved in 6 patients (16.6%) and 12 patients (33.3%) respectively, (p = 0.1). The resected organ weighted score was significantly different between the groups; score 0 observed in 19 (52.7%) patients in the IOeRT group and 3 (8.3%) in the non-IOeRT group (p < 0.001), score 1 observed in 7 (19.4%) in the IOeRT group and 17 (47.2%) in the non-IOeRT group (p = 0.012). The rate of severe complications (CD score>3) did not differ between the groups, 5 (13.8%) patients in the IOeRT group and 9 (25%) patients in the non-IOeRT group (p = 0.23). No radiation associated complications were noted. The 2-year local recurrence free survival (LRFS) was 75.9% in the IOeRT group and 60.3% in the non-IOeRT group (p = 0.4). The 2-year IOeRT field recurrent free survival (IRFS) was 88.4% in the IOeRT group and 60.3% in the non-IOeRT group (p = 0.04). CONCLUSIONS The use of IOeRT did not increase the rate of surgical complications and was associated with superior local control in the radiation field, improved organ preservation without an impact on overall survival.
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Mor E, Assaf D, Shemla S, Ben-Ami E, Mor-Hadar D, Halfon M, Laks S, Hazzan D, Perelson D, Zippel D, Ben-Yaacov A, Nissan A, Adileh M. Resection of Recurrent Pelvic Soft Tissue Sarcoma: Is the Risk Worth the Reward? J Surg Res 2023; 283:914-922. [PMID: 36915019 DOI: 10.1016/j.jss.2022.10.026] [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] [Received: 03/23/2022] [Revised: 09/16/2022] [Accepted: 10/16/2022] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Soft tissue sarcomas (STS) of the pelvis present a surgical and oncological challenge. We investigated the outcomes of patients undergoing resection of pelvic sarcomas. METHODS A retrospective analysis of all patients who underwent surgical resection for STS between 2014 and 2021 at a tertiary academic referral center (n = 172). Included all patients with primary or recurrent STS which originated or extended to the pelvic cavity (n = 29). RESULTS The cohort was divided into primary pelvic sarcomas (n = 18) and recurrent pelvic sarcomas (rPS, n = 11). Complete R0/R1 resection was achieved in 26 patients (89.6%). The postoperative complication rate was 48.3%. The rate of major complications was 27.5%. The median time of follow-up from surgery was 12.3 months (range, 0.6-60.3 months). Disease-free survival was superior in the primary pelvic sarcomas group compared to the rPS group (P = 0.002). However, there was no significant difference in overall survival, (P = 0.52). Univariant and multivariant analyses identified rPS group (Hazard Ratio 8.68, P = 0.006) and resection margins (Hazard Ratio 6.29, P = 0.004) to be independently associated with disease-free survival. CONCLUSIONS We have demonstrated that achieving R0/R1 resection is feasible. Oncological outcomes are favorable for primary tumors, whereas recurrent tumors exhibit early recurrences. Consideration of resection of recurrent pelvic STS should involve a careful multidisciplinary evaluation.
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Affiliation(s)
- Eyal Mor
- The Department of General and Oncological Surgery - Surgery C, Sheba Medical Center, Tel Hashomer, Israel; The Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Dan Assaf
- The Department of General and Oncological Surgery - Surgery C, Sheba Medical Center, Tel Hashomer, Israel; The Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shanie Shemla
- The Department of General and Oncological Surgery - Surgery C, Sheba Medical Center, Tel Hashomer, Israel; The Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eytan Ben-Ami
- The Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; The Department of Oncology, Sheba Medical Center, Tel Hashomer, Israel
| | - Danielle Mor-Hadar
- The Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; The Department of Obstetrics and Gynecology, Sheba Medical Center, Tel Hashomer, Israel
| | - Mirit Halfon
- The Department of General and Oncological Surgery - Surgery C, Sheba Medical Center, Tel Hashomer, Israel; The Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shachar Laks
- The Department of General and Oncological Surgery - Surgery C, Sheba Medical Center, Tel Hashomer, Israel; The Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - David Hazzan
- The Department of General and Oncological Surgery - Surgery C, Sheba Medical Center, Tel Hashomer, Israel; The Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Daria Perelson
- The Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; The Department of Anesthesiology, Sheba Medical Center, Tel Hashomer, Israel
| | - Douglas Zippel
- The Department of General and Oncological Surgery - Surgery C, Sheba Medical Center, Tel Hashomer, Israel; The Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Almog Ben-Yaacov
- The Department of General and Oncological Surgery - Surgery C, Sheba Medical Center, Tel Hashomer, Israel; The Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Aviram Nissan
- The Department of General and Oncological Surgery - Surgery C, Sheba Medical Center, Tel Hashomer, Israel; The Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Mohammad Adileh
- The Department of General and Oncological Surgery - Surgery C, Sheba Medical Center, Tel Hashomer, Israel; The Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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Mor E, Assaf D, Laks S, Gilat EK, Hazzan D, Shacham-Shmueli E, Margalit O, Halpern N, Beller T, Boursi B, Purim O, Perelson D, Zippel D, Adileh M, Nissan A, Ben-Yaacov A. Pelvic Peritonectomy Poorly Affects Outcomes in Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy for Colorectal Metastases. J Gastrointest Surg 2023; 27:131-140. [PMID: 36327025 DOI: 10.1007/s11605-022-05501-y] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Accepted: 10/22/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Constraints of pelvic anatomy render complete cytoreduction (CRS) challenging. The aim of this study is to investigate the impact of pelvic peritonectomy during CRS/HIPEC on colorectal peritoneal metastasis (CRPM) patients' outcomes. METHODS This is a retrospective analysis of a prospectively maintained CRS/hyperthermic intraperitoneal chemotherapy (HIPEC) database. The analysis included 217 patients with CRPM who had a CRS/HIPEC between 2014 and 2021. We compared perioperative and oncological outcomes of patients with pelvic peritonectomy (PP) (n = 63) to no pelvic peritonectomy (non-PP) (n = 154). RESULTS No differences in demographics were identified. The peritoneal cancer index (PCI) was higher in the PP group with a median PCI of 12 vs. 6 in the non-PP group (p < 0.001). Operative time was 4.9 vs. 4.3 h in the PP and non-PP groups, respectively (p = 0.63). Median hospitalization was longer in the PP group at 12 vs. 10 days (p = 0.007), and the rate of complications were higher in the PP group at 57.1% vs. 39.6% (p = 0.018). Pelvic peritonectomy was associated with worse disease-free (DFS) and overall survival (OS) with 3-year DFS and OS of 7.3 and 46.3% in the PP group vs. 28.2 and 87.8% in the non-PP group (p = 0.028, p .> 0.001). The univariate OS analysis identified higher PCI (p = 0.05), longer surgery duration (p = 0.02), and pelvic peritonectomy (p < 0.001) with worse OS. Pelvic peritonectomy remained an independent prognostic variable, irrespective of PCI, on the multivariate analysis (p < 0.001). CONCLUSIONS Pelvic peritonectomy at the time of CRS/HIPEC is associated with higher morbidity and worse oncological outcomes. These findings should be taken into consideration in the management of patients with pelvic involvement.
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Affiliation(s)
- Eyal Mor
- Department of General and Oncological Surgery-Surgery C, Sheba Medical Center, Affiliated With the Sackler School of Medicine, Tel Aviv University, Tel Hashomer, Israel
| | - Dan Assaf
- Department of General and Oncological Surgery-Surgery C, Sheba Medical Center, Affiliated With the Sackler School of Medicine, Tel Aviv University, Tel Hashomer, Israel
| | - Shachar Laks
- Department of General and Oncological Surgery-Surgery C, Sheba Medical Center, Affiliated With the Sackler School of Medicine, Tel Aviv University, Tel Hashomer, Israel
| | - Efrat Keren Gilat
- Department of General and Oncological Surgery-Surgery C, Sheba Medical Center, Affiliated With the Sackler School of Medicine, Tel Aviv University, Tel Hashomer, Israel
| | - David Hazzan
- Department of General and Oncological Surgery-Surgery C, Sheba Medical Center, Affiliated With the Sackler School of Medicine, Tel Aviv University, Tel Hashomer, Israel
| | - Einat Shacham-Shmueli
- Department of Oncology, Sheba Medical Center, Affiliated With The Sackler School of Medicine, Tel Aviv, University, Tel Hashomer, Israel
| | - Ofer Margalit
- Department of Oncology, Sheba Medical Center, Affiliated With The Sackler School of Medicine, Tel Aviv, University, Tel Hashomer, Israel
| | - Naama Halpern
- Department of Oncology, Sheba Medical Center, Affiliated With The Sackler School of Medicine, Tel Aviv, University, Tel Hashomer, Israel
| | - Tamar Beller
- Department of Oncology, Sheba Medical Center, Affiliated With The Sackler School of Medicine, Tel Aviv, University, Tel Hashomer, Israel
| | - Ben Boursi
- Department of Oncology, Sheba Medical Center, Affiliated With The Sackler School of Medicine, Tel Aviv, University, Tel Hashomer, Israel
| | - Ofer Purim
- Department of Oncology, Assuta Ashdod Public Hospital, Ashdod, Israel, Affiliated With Faculty of Health and Science, Ben-Gurion University, Beer-Sheba, Israel
| | - Daria Perelson
- Department of Anesthesiology, Sheba Medical Center, Affiliated With Sackler School of Medicine, Tel Aviv University, Tel Hashomer, Israel
| | - Douglas Zippel
- Department of General and Oncological Surgery-Surgery C, Sheba Medical Center, Affiliated With the Sackler School of Medicine, Tel Aviv University, Tel Hashomer, Israel
| | - Mohammad Adileh
- Department of General and Oncological Surgery-Surgery C, Sheba Medical Center, Affiliated With the Sackler School of Medicine, Tel Aviv University, Tel Hashomer, Israel
| | - Aviram Nissan
- Department of General and Oncological Surgery-Surgery C, Sheba Medical Center, Affiliated With the Sackler School of Medicine, Tel Aviv University, Tel Hashomer, Israel
| | - Almog Ben-Yaacov
- Department of General and Oncological Surgery-Surgery C, Sheba Medical Center, Affiliated With the Sackler School of Medicine, Tel Aviv University, Tel Hashomer, Israel.
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Mor E, Shemla S, Assaf D, Laks S, Benvenisti H, Hazzan D, Shiber M, Shacham-Shmueli E, Margalit O, Halpern N, Boursi B, Beller T, Perelson D, Purim O, Zippel D, Ben-Yaacov A, Nissan A, Adileh M. ASO Visual Abstract: Natural History and Management of Small Bowel Obstruction in Patients After Cytoreductive Surgery and Intraperitoneal Chemotherapy. Ann Surg Oncol 2022; 29:8582. [PMID: 35974235 DOI: 10.1245/s10434-022-12422-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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)
- Eyal Mor
- The Department of General and Oncological Surgery - Surgery C, Sheba Medical Center, Tel HaShomer, Israel
- Affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shanie Shemla
- The Department of General and Oncological Surgery - Surgery C, Sheba Medical Center, Tel HaShomer, Israel
- Affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Dan Assaf
- The Department of General and Oncological Surgery - Surgery C, Sheba Medical Center, Tel HaShomer, Israel
- Affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shachar Laks
- The Department of General and Oncological Surgery - Surgery C, Sheba Medical Center, Tel HaShomer, Israel
- Affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Haggai Benvenisti
- The Department of General and Oncological Surgery - Surgery C, Sheba Medical Center, Tel HaShomer, Israel
- Affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - David Hazzan
- The Department of General and Oncological Surgery - Surgery C, Sheba Medical Center, Tel HaShomer, Israel
- Affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Mai Shiber
- The Department of General and Oncological Surgery - Surgery C, Sheba Medical Center, Tel HaShomer, Israel
- Affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Einat Shacham-Shmueli
- Affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- The Department of Oncology, Sheba Medical Center, Tel HaShomer, Israel
| | - Ofer Margalit
- Affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- The Department of Oncology, Sheba Medical Center, Tel HaShomer, Israel
| | - Naama Halpern
- Affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- The Department of Oncology, Sheba Medical Center, Tel HaShomer, Israel
| | - Ben Boursi
- Affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- The Department of Oncology, Sheba Medical Center, Tel HaShomer, Israel
| | - Tamar Beller
- Affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- The Department of Oncology, Sheba Medical Center, Tel HaShomer, Israel
| | - Daria Perelson
- Affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- The Department of Anesthesiology, Sheba Medical Center, Tel HaShomer, Israel
| | - Ofer Purim
- The Department of Oncology, Assuta Ashdod Public Hospital, Ashdod, Israel
- Affiliated with the Faculty of Health and Science, Ben-Gurion University, Beersheba, Israel
| | - Douglas Zippel
- The Department of General and Oncological Surgery - Surgery C, Sheba Medical Center, Tel HaShomer, Israel
- Affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Almog Ben-Yaacov
- The Department of General and Oncological Surgery - Surgery C, Sheba Medical Center, Tel HaShomer, Israel
- Affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Aviram Nissan
- The Department of General and Oncological Surgery - Surgery C, Sheba Medical Center, Tel HaShomer, Israel
- Affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Mohammad Adileh
- The Department of General and Oncological Surgery - Surgery C, Sheba Medical Center, Tel HaShomer, Israel.
- Affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
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Mor E, Laks S, Assaf D, Asher N, Ben-Betzalel G, Grynberg S, Stoff R, Adileh M, Steinberg-Silman Y, Shapira-Frommer R, Schachter J, Nissan A, Zippel D. The increasing role of abdominal metastesectomy for malignant melanoma in the era of modern therapeutics. Surg Oncol 2022; 44:101808. [DOI: 10.1016/j.suronc.2022.101808] [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] [Received: 02/28/2022] [Revised: 05/09/2022] [Accepted: 07/03/2022] [Indexed: 10/17/2022]
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Mor E, Laks S, Nissan A, Adileh M. ASO Author Reflections: Challenges in the Management of Bowel Obstruction after Cytoreductive Surgery and Heated Intraperitoneal Chemotherapy. Ann Surg Oncol 2022; 29:8580-8581. [PMID: 36018523 DOI: 10.1245/s10434-022-12439-7] [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] [Received: 08/05/2022] [Accepted: 08/06/2022] [Indexed: 11/18/2022]
Affiliation(s)
- Eyal Mor
- The Department of General and Oncological Surgery - Surgery C, Sheba Medical Center, Affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Shachar Laks
- The Department of General and Oncological Surgery - Surgery C, Sheba Medical Center, Affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Aviram Nissan
- The Department of General and Oncological Surgery - Surgery C, Sheba Medical Center, Affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Mohammad Adileh
- The Department of General and Oncological Surgery - Surgery C, Sheba Medical Center, Affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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Mor E, Shemla S, Assaf D, Laks S, Benvenisti H, Hazzan D, Shiber M, Shacham-Shmueli E, Margalit O, Halpern N, Boursi B, Beller T, Perelson D, Purim O, Zippel D, Ben-Yaacov A, Nissan A, Adileh M. Natural History and Management of Small-Bowel Obstruction in Patients After Cytoreductive Surgery and Intraperitoneal Chemotherapy. Ann Surg Oncol 2022; 29:8566-8579. [PMID: 35941342 DOI: 10.1245/s10434-022-12370-x] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 07/19/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Small-bowel obstruction (SBO) after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) is a common complication associated with re-admission that may alter patients' outcomes. Our aim was to characterize and investigate the impact of bowel obstruction on patients' prognosis. METHODS This was a retrospective analysis of patients with SBO after CRS/HIPEC (n = 392). We analyzed patients' demographics, operative and perioperative details, SBO re-admission data, and long-term oncological outcomes. RESULTS Out of 366 patients, 73 (19.9%) were re-admitted with SBO. The cause was adhesive in 42 (57.5%) and malignant (MBO) in 31 (42.5%). The median time to obstruction was 7.7 months (range, 0.5-60.9). Surgical intervention was required in 21/73 (28.7%) patients. Obstruction eventually resolved (spontaneous or by surgical intervention) in 56/73 (76.7%) patients. Univariant analysis identified intraperitoneal chemotherapy agents: mitomycin C (MMC) (HR 3.2, p = 0.003), cisplatin (HR 0.3, p = 0.03), and doxorubicin (HR 0.25, p = 0.018) to be associated with obstruction-free survival (OFS). Postoperative complications such as surgical site infection (SSI), (HR 2.2, p = 0.001) and collection (HR 2.07, p = 0.015) were associated with worse OFS. Multivariate analysis maintained MMC (HR 2.9, p = 0.006), SSI (HR 1.19, p = 0.001), and intra-abdominal collection (HR 2.19, p = 0.009) as independently associated with OFS. While disease-free survival was similar between the groups, overall survival (OS) was better in the non-obstruction group compared with the obstruction group (p = 0.03). CONCLUSIONS SBO after CRS/HIPEC is common and complex in management. Although conservative management was successful in most patients, surgery was required more frequently in patients with MBO. Patients with SBO demonstrate decreased survival.
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Affiliation(s)
- Eyal Mor
- The Department of General and Oncological Surgery - Surgery C, Sheba Medical Center, Affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Hashomer, Israel
| | - Shanie Shemla
- The Department of General and Oncological Surgery - Surgery C, Sheba Medical Center, Affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Hashomer, Israel
| | - Dan Assaf
- The Department of General and Oncological Surgery - Surgery C, Sheba Medical Center, Affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Hashomer, Israel
| | - Shachar Laks
- The Department of General and Oncological Surgery - Surgery C, Sheba Medical Center, Affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Hashomer, Israel
| | - Haggai Benvenisti
- The Department of General and Oncological Surgery - Surgery C, Sheba Medical Center, Affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Hashomer, Israel
| | - David Hazzan
- The Department of General and Oncological Surgery - Surgery C, Sheba Medical Center, Affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Hashomer, Israel
| | - Mai Shiber
- The Department of General and Oncological Surgery - Surgery C, Sheba Medical Center, Affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Hashomer, Israel
| | - Einat Shacham-Shmueli
- The Department of Oncology, Sheba Medical Center, Affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Hashomer, Israel
| | - Ofer Margalit
- The Department of Oncology, Sheba Medical Center, Affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Hashomer, Israel
| | - Naama Halpern
- The Department of Oncology, Sheba Medical Center, Affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Hashomer, Israel
| | - Ben Boursi
- The Department of Oncology, Sheba Medical Center, Affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Hashomer, Israel
| | - Tamar Beller
- The Department of Oncology, Sheba Medical Center, Affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Hashomer, Israel
| | - Daria Perelson
- The Department of Anesthesiology, Sheba Medical Center, Affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Hashomer, Israel
| | - Ofer Purim
- The Department of Oncology, Assuta Ashdod Public Hospital, Affiliated with the Faculty of Health and Science, Ben-Gurion University, Beer-Sheba, Israel, Ashdod, Israel
| | - Douglas Zippel
- The Department of General and Oncological Surgery - Surgery C, Sheba Medical Center, Affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Hashomer, Israel
| | - Almog Ben-Yaacov
- The Department of General and Oncological Surgery - Surgery C, Sheba Medical Center, Affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Hashomer, Israel
| | - Aviram Nissan
- The Department of General and Oncological Surgery - Surgery C, Sheba Medical Center, Affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Hashomer, Israel
| | - Mohammad Adileh
- The Department of General and Oncological Surgery - Surgery C, Sheba Medical Center, Affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Hashomer, Israel.
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Laks S, Bilik A, Schtrechman G, Adileh M, Mor E, Boursi B, Halpern N, Margalit O, Shacham-Shmueli E, Nissan A, Ben-Yaacov A. Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy in Elderly is Safe and Effective. J Surg Res 2022; 279:739-747. [PMID: 35940050 DOI: 10.1016/j.jss.2022.06.057] [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] [Received: 03/06/2022] [Revised: 06/22/2022] [Accepted: 06/30/2022] [Indexed: 11/18/2022]
Abstract
INTRODUCTION An increasing proportion of elderly patients (EP) are undergoing Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy (CRS/HIPEC). They have increased comorbidities and perioperative risk. Current literature is deficient in describing the outcomes of EP undergoing CRS/HIPEC. MATERIALS AND METHODS A retrospective review of our prospectively maintained CRS/HIPEC database analyzed perioperative and oncological outcomes of EP (>70 y) compared to younger patients (YP) (<60 y). RESULTS Of 500 CRS/HIPEC patients, 62 EP and 210 YP were included. Median age was 73 y in EP and 46 y in YP. Demographic, clinical, operative, and perioperative outcomes were similar between groups. American Society of Anesthesiologists > 3 was more prevalent in the EP with 88.2% versus 54.8% in the YP (P < 0.001). Comorbidities were higher in the EP with 87.1% versus 39.0% in the YP (P < 0.001). Peritoneal Cancer Index score was similar with a median of 9. All postoperative and severe complications were similar with 55.2% and 17.1% in the YP and 64.5% and 21.0% in the EP (P = 0.242; P = 0.448). Postoperative mortality was similar with 1.5% in the YP and 5.0% in the EP (P = 0.134). In colorectal primary patients, median overall and disease-free survival was 61.8 and 12.9 mo in the YP and 64.6 and 11.3 mo in the EP (P = 0.363; P = 0.845). CONCLUSIONS Despite a significant age difference, increased comorbidities, worse American Society of Anesthesiologists, and similar Peritoneal Cancer Index burden, we found no significant differences in perioperative complications or oncological benefit in elderly CRS/HIPEC patients. EP appear to have similar perioperative and oncological outcomes as YP.
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Affiliation(s)
- Shachar Laks
- Department of General Surgery C and Surgical Oncology, Sheba Medical Center, Affiliated with Tel-Aviv University, Sackler School of Medicine, Ramat Gan, Israel.
| | - Alona Bilik
- Department of General Surgery C and Surgical Oncology, Sheba Medical Center, Affiliated with Tel-Aviv University, Sackler School of Medicine, Ramat Gan, Israel
| | - Gal Schtrechman
- Department of General Surgery C and Surgical Oncology, Sheba Medical Center, Affiliated with Tel-Aviv University, Sackler School of Medicine, Ramat Gan, Israel
| | - Mohammad Adileh
- Department of General Surgery C and Surgical Oncology, Sheba Medical Center, Affiliated with Tel-Aviv University, Sackler School of Medicine, Ramat Gan, Israel
| | - Eyal Mor
- Department of General Surgery C and Surgical Oncology, Sheba Medical Center, Affiliated with Tel-Aviv University, Sackler School of Medicine, Ramat Gan, Israel
| | - Ben Boursi
- Department of Oncology, Sheba Medical Center, Affiliated with Tel-Aviv University, Sackler School of Medicine, Ramat Gan, Israel
| | - Naama Halpern
- Department of Oncology, Sheba Medical Center, Affiliated with Tel-Aviv University, Sackler School of Medicine, Ramat Gan, Israel
| | - Ofer Margalit
- Department of Oncology, Sheba Medical Center, Affiliated with Tel-Aviv University, Sackler School of Medicine, Ramat Gan, Israel
| | - Einat Shacham-Shmueli
- Department of Oncology, Sheba Medical Center, Affiliated with Tel-Aviv University, Sackler School of Medicine, Ramat Gan, Israel
| | - Aviram Nissan
- Department of General Surgery C and Surgical Oncology, Sheba Medical Center, Affiliated with Tel-Aviv University, Sackler School of Medicine, Ramat Gan, Israel
| | - Almog Ben-Yaacov
- Department of General Surgery C and Surgical Oncology, Sheba Medical Center, Affiliated with Tel-Aviv University, Sackler School of Medicine, Ramat Gan, Israel
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15
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Pantelis A, Ben-Yaacov A, Adileh M, Schtrechman G, Shacham-Shmueli E, Boursi B, Margalit O, Halpern N, Mor E, Assaf D, Maximiliano K, Nissan A, Laks S. Outcomes of Stable Lung Colorectal Metastases on Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy. J Gastrointest Surg 2022; 26:1724-1731. [PMID: 35768716 DOI: 10.1007/s11605-022-05390-1] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 04/30/2022] [Indexed: 01/31/2023]
Abstract
BACKGROUND Cytoreductive surgery (CRS) and heated intraperitoneal chemotherapy (HIPEC) have demonstrated benefit in patients with colorectal peritoneal metastases (CRPM). Traditionally, extraperitoneal disease is considered a contraindication to CRS/HIPEC. Stable lung metastases in patients with colorectal cancer often have an indolent course, while the presence of untreated peritoneal metastases poorly affects short-term survival. We sought to evaluate the outcomes of patients undergoing CRS/HIPEC for peritoneal disease with known stable lung metastases. METHODS We retrospectively reviewed our prospectively maintained CRS/HIPEC database. In 2017, we adopted a policy of considering patients with stable lung metastases for CRS/HIPEC as part of multidisciplinary treatment. We compared the oncologic outcome and safety of CRS/HIPEC with peritoneal only (PM) against patients with peritoneal and lung metastases (PLM). RESULTS Our database includes 570 patients with CRS/HIPEC of which 174 with CRPM that underwent CRS/HIPEC, 18 with preoperatively diagnosed peritoneal and lung metastases. The demographics of the PM and PLM group were similar with the exception of operative time that was longer in the PLM group. Median PCI of the cohort was 7, similar in both groups (p = 0.89). Three-year overall survival (OS) of PLM patients was 68%, compared to 71% in PM (p = 0.277). Three-year progression-free survival (PFS) rate was 20% in PLM and 23% in PM (p = 0.688). CONCLUSIONS Presence of stable lung metastases from colorectal cancer in patients with CRPM does not appear to affect the outcomes of CRS/HIPEC. Patients with stable lung disease should be considered for CRS/HIPEC after multidisciplinary discussion.
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Affiliation(s)
- Arnos Pantelis
- The Department of General and Oncological Surgery - Surgery C, Sheba Medical Center, Affiliated With the Sackler School of Medicine, Tel Aviv University, 52621, Tel Hashomer, Israel
| | - Almog Ben-Yaacov
- The Department of General and Oncological Surgery - Surgery C, Sheba Medical Center, Affiliated With the Sackler School of Medicine, Tel Aviv University, 52621, Tel Hashomer, Israel
| | - Mohammad Adileh
- The Department of General and Oncological Surgery - Surgery C, Sheba Medical Center, Affiliated With the Sackler School of Medicine, Tel Aviv University, 52621, Tel Hashomer, Israel
| | - Gal Schtrechman
- The Department of General and Oncological Surgery - Surgery C, Sheba Medical Center, Affiliated With the Sackler School of Medicine, Tel Aviv University, 52621, Tel Hashomer, Israel
| | - Einat Shacham-Shmueli
- The Department of Oncology, Sheba Medical Center, Affiliated With the Sackler School of Medicine, Tel Aviv University, Tel Hashomer, Israel
| | - Ben Boursi
- The Department of Oncology, Sheba Medical Center, Affiliated With the Sackler School of Medicine, Tel Aviv University, Tel Hashomer, Israel
| | - Ofer Margalit
- The Department of Oncology, Sheba Medical Center, Affiliated With the Sackler School of Medicine, Tel Aviv University, Tel Hashomer, Israel
| | - Naama Halpern
- The Department of Oncology, Sheba Medical Center, Affiliated With the Sackler School of Medicine, Tel Aviv University, Tel Hashomer, Israel
| | - Eyal Mor
- The Department of General and Oncological Surgery - Surgery C, Sheba Medical Center, Affiliated With the Sackler School of Medicine, Tel Aviv University, 52621, Tel Hashomer, Israel
| | - Dan Assaf
- The Department of General and Oncological Surgery - Surgery C, Sheba Medical Center, Affiliated With the Sackler School of Medicine, Tel Aviv University, 52621, Tel Hashomer, Israel
| | - Klug Maximiliano
- The Department of Radiology - Sheba Medical Center, Affiliated With the Sackler School of Medicine, Tel Aviv University, Tel Hashomer, Israel
| | - Aviram Nissan
- The Department of General and Oncological Surgery - Surgery C, Sheba Medical Center, Affiliated With the Sackler School of Medicine, Tel Aviv University, 52621, Tel Hashomer, Israel
| | - Shachar Laks
- The Department of General and Oncological Surgery - Surgery C, Sheba Medical Center, Affiliated With the Sackler School of Medicine, Tel Aviv University, 52621, Tel Hashomer, Israel.
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16
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Hsu KS, Adileh M, Martin ML, Makarov V, Chen J, Wu C, Bodo S, Klingler S, Sauvé CEG, Szeglin BC, Smith JJ, Fuks Z, Riaz N, Chan TA, Nishimura M, Paty PB, Kolesnick R. Colorectal cancer develops inherent radiosensitivity that can be predicted using patient-derived organoids. Cancer Res 2022; 82:2298-2312. [PMID: 35472075 DOI: 10.1158/0008-5472.can-21-4128] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 02/21/2022] [Accepted: 04/22/2022] [Indexed: 11/16/2022]
Abstract
Identifying colorectal cancer patient populations responsive to chemotherapy or chemoradiation therapy before surgery remains a challenge. Recently validated mouse protocols for organoid irradiation employ the single hit multi-target (SHMT) algorithm, which yields a single value, the D0, as a measure of inherent tissue radiosensitivity. Here we translate these protocols to human tissue to evaluate radioresponsiveness of patient-derived organoids (PDOs) generated from normal human intestines and rectal tumors of patients undergoing neoadjuvant therapy. While PDOs from adenomas with a logarithmically-expanded Lgr5+-intestinal stem cell population retain the radioresistant phenotype of normal colorectal PDOs, malignant transformation yields PDOs from a large patient subpopulation displaying marked radiosensitivity due to reduced homologous recombination-mediated DNA repair. A proof-of-principle pilot clinical trial demonstrated that rectal cancer patient responses to neoadjuvant chemoradiation, including complete response, correlate closely with their PDO D0 values. Overall, upon transformation to colorectal adenocarcinoma, broad radiation sensitivity occurs in a large subset of patients that can be identified using SHMT analysis of PDO radiation responses.
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Affiliation(s)
- Kuo-Shun Hsu
- Memorial Sloan Kettering Cancer Center, New York City, United States
| | - Mohammad Adileh
- Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | | | - Vladimir Makarov
- Memorial Sloan Kettering Cancer Center, Cleveland, OH, United States
| | - Jiapeng Chen
- Memorial Sloan Kettering Cancer Center, Manhattan, New York, United States
| | - Chao Wu
- Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Sahra Bodo
- Memorial Sloan Kettering Cancer Center, New York, New York, United States
| | - Stefan Klingler
- Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | | | - Bryan C Szeglin
- Albert Einstein College of Medicine, Bronx, NY, United States
| | - J Joshua Smith
- Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Zvi Fuks
- Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Nadeem Riaz
- Memorial Sloan Kettering Cancer Center, Manhattan, New York, United States
| | | | - Makoto Nishimura
- Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Philip B Paty
- Memorial Sloan Kettering Cancer Center, New York, NY, United States
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17
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Klingler S, Hsu KS, Hua G, Martin ML, Adileh M, Baslan T, Zhang Z, Paty PB, Fuks Z, Brown AM, Kolesnick R. Disruption of the crypt niche promotes outgrowth of mutated colorectal tumor stem cells. JCI Insight 2022; 7:153793. [PMID: 35260534 PMCID: PMC8983138 DOI: 10.1172/jci.insight.153793] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 08/09/2021] [Accepted: 01/26/2022] [Indexed: 12/14/2022] Open
Abstract
Recent data establish a logarithmic expansion of leucine rich repeat containing G protein coupled receptor 5–positive (Lgr5+) colonic epithelial stem cells (CESCs) in human colorectal cancer (CRC). Complementary studies using the murine 2-stage azoxymethane–dextran sulfate sodium (AOM-DSS) colitis-associated tumor model indicate early acquisition of Wnt pathway mutations drives CESC expansion during adenoma progression. Here, subdivision of the AOM-DSS model into in vivo and in vitro stages revealed DSS induced physical separation of CESCs from stem cell niche cells and basal lamina, a source of Wnt signals, within hours, disabling the stem cell program. While AOM delivery in vivo under non-adenoma-forming conditions yielded phenotypically normal mucosa and organoids derived thereof, niche injury ex vivo by progressive DSS dose escalation facilitated outgrowth of Wnt-independent dysplastic organoids. These organoids contained 10-fold increased Lgr5+ CESCs with gain-of-function Wnt mutations orthologous to human CRC driver mutations. We posit CRC originates by niche injury–induced outgrowth of normally suppressed mutated stem cells, consistent with models of adaptive oncogenesis.
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Affiliation(s)
- Stefan Klingler
- Laboratory of Signal Transduction, Sloan Kettering Institute, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Kuo-Shun Hsu
- Laboratory of Signal Transduction, Sloan Kettering Institute, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Guoqiang Hua
- Institute of Radiation Medicine, Fudan University, Shanghai, China
| | - Maria Laura Martin
- Laboratory of Signal Transduction, Sloan Kettering Institute, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Mohammad Adileh
- Laboratory of Signal Transduction, Sloan Kettering Institute, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | | | | | | | - Zvi Fuks
- Department of Radiation Oncology, and
| | - Anthony Mc Brown
- Department of Cell & Developmental Biology, Weill Cornell Medicine, New York, New York, USA
| | - Richard Kolesnick
- Laboratory of Signal Transduction, Sloan Kettering Institute, Memorial Sloan Kettering Cancer Center, New York, New York, USA
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18
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Assaf D, Mor E, Laks S, Zohar N, Benvenisti H, Hazzan D, Segev L, Akopyan OK, Shacham-Shmueli E, Margalit O, Halpern N, Boursi B, Ben-Yaacov A, Nissan A, Adileh M. The pattern of peritoneal colorectal metastasis predicts survival after cytoreductive surgery and hyperthermic intra-peritoneal chemotherapy. Eur J Surg Oncol 2021; 48:197-203. [PMID: 34489120 DOI: 10.1016/j.ejso.2021.08.023] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 07/13/2021] [Accepted: 08/20/2021] [Indexed: 10/20/2022] Open
Abstract
BACKGROUND Peritoneal cancer index (PCI) has been used reliably to prognosticate patients with peritoneal metastasis, however, it fails to describe the patterns of peritoneal spread and to correlate these patterns to survival outcomes. We aim to define the scattered peritoneal spread (SPS) as a pattern associated with worse survival in colorectal peritoneal metastasis. METHODS A retrospective analysis of metastatic colorectal cancer patients from a prospectively maintained database of peritoneal surface malignances (n = 280) between 2015 and 2020. SPS was defined by the presence of at least two distant and non-contiguous PCI regions. We compared patients with SPS (n = 73) and clustered peritoneal spread (CPS) (n = 88) for demographics, perioperative and survival outcomes. RESULTS No difference in demographics or post-operative course was noted between the groups. The median follow-up was 15.4 months (0.4-70.8 months). Worse disease-free survival (DFS) in the SPS group with an estimated median of 8.2 months compared to 22.5 months in the CPS spread group, (p = 0.001). The estimated median overall survival (OS) for SPS group was 35.7 months whereas in the CPS group the median was not reached (p = 0.025). The same effect of SPS was preserved even after stratification of PCI. CONCLUSIONS We defined and described the association of the peritoneal spread pattern to survival outcomes. SPS patients exhibit worse DFS and OS independent of the PCI level. Integration of malignant spread pattern into prognostication models along with PCI may aid in predicting oncological outcomes.
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Affiliation(s)
- Dan Assaf
- The Department of General and Oncological Surgery - Surgery C Sheba Medical Center, Tel Hashomer, (Affyliated with the Sackler School of Medicine, Tel Aviv University), Israel; The Sheba Talpiot Medical Leadership Program, Israel.
| | - Eyal Mor
- The Department of General and Oncological Surgery - Surgery C Sheba Medical Center, Tel Hashomer, (Affyliated with the Sackler School of Medicine, Tel Aviv University), Israel
| | - Shachar Laks
- The Department of General and Oncological Surgery - Surgery C Sheba Medical Center, Tel Hashomer, (Affyliated with the Sackler School of Medicine, Tel Aviv University), Israel
| | - Nitzan Zohar
- The Department of General and Oncological Surgery - Surgery C Sheba Medical Center, Tel Hashomer, (Affyliated with the Sackler School of Medicine, Tel Aviv University), Israel
| | - Haggai Benvenisti
- The Department of General and Oncological Surgery - Surgery C Sheba Medical Center, Tel Hashomer, (Affyliated with the Sackler School of Medicine, Tel Aviv University), Israel
| | - David Hazzan
- The Department of General and Oncological Surgery - Surgery C Sheba Medical Center, Tel Hashomer, (Affyliated with the Sackler School of Medicine, Tel Aviv University), Israel
| | - Lior Segev
- The Department of General and Oncological Surgery - Surgery C Sheba Medical Center, Tel Hashomer, (Affyliated with the Sackler School of Medicine, Tel Aviv University), Israel
| | - Olga Klebanov Akopyan
- The Department of General and Oncological Surgery - Surgery C Sheba Medical Center, Tel Hashomer, (Affyliated with the Sackler School of Medicine, Tel Aviv University), Israel
| | - Einat Shacham-Shmueli
- The Department of Oncology Sheba Medical Center, Tel Hashomer, (Affyliated with the Sackler School of Medicine, Tel Aviv University), Israel
| | - Ofer Margalit
- The Department of Oncology Sheba Medical Center, Tel Hashomer, (Affyliated with the Sackler School of Medicine, Tel Aviv University), Israel
| | - Naama Halpern
- The Department of Oncology Sheba Medical Center, Tel Hashomer, (Affyliated with the Sackler School of Medicine, Tel Aviv University), Israel
| | - Ben Boursi
- The Department of Oncology Sheba Medical Center, Tel Hashomer, (Affyliated with the Sackler School of Medicine, Tel Aviv University), Israel
| | - Almog Ben-Yaacov
- The Department of General and Oncological Surgery - Surgery C Sheba Medical Center, Tel Hashomer, (Affyliated with the Sackler School of Medicine, Tel Aviv University), Israel
| | - Aviram Nissan
- The Department of General and Oncological Surgery - Surgery C Sheba Medical Center, Tel Hashomer, (Affyliated with the Sackler School of Medicine, Tel Aviv University), Israel
| | - Mohammad Adileh
- The Department of General and Oncological Surgery - Surgery C Sheba Medical Center, Tel Hashomer, (Affyliated with the Sackler School of Medicine, Tel Aviv University), Israel
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19
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Abstract
Background: Deloyers procedure enables anastomosis of the ascending colon to the rectum following extended resections that prevent usual fashion anastomosis. During the procedure, the right colon is completely mobilized and counterclockwise rotated to allow tension free and well-vascularized anastomosis while preserving the ileocecal valve. The purpose of this manuscript is to report our experience with laparoscopic Deloyers procedure in a hostile abdomen due to adhesions from previous surgeries. Methods: We report the outcomes and our technique of laparoscopic Deloyers procedure in three patients. All patients had a surgical complication necessitating the creation of end colostomy with a short colonic remnant. The bowel status prevented restoration of continuity by the common colorectal anastomosis and laparoscopic Deloyers was elected. Results: The procedure was successful in all patients, with no intra-operative complication and average surgery duration of three hours. Patients had uneventful postoperative recovery with only one case of minor complication and an adequate functional outcome. Conclusion: Laparoscopic Deloyers is safe and allows the restoration of bowel continuity with preservation of ileocecal valve and good functional outcome even in hostile abdomen.
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Affiliation(s)
- Joseph Dux
- Department of General and Oncological Surgery-Surgery C, Sheba Medical Center, Tel Hashomer, Israel
| | - Ephraim Katz
- Department of General and Oncological Surgery-Surgery C, Sheba Medical Center, Tel Hashomer, Israel
| | - Mohammad Adileh
- Department of General and Oncological Surgery-Surgery C, Sheba Medical Center, Tel Hashomer, Israel
| | - Lior Segev
- Department of General and Oncological Surgery-Surgery C, Sheba Medical Center, Tel Hashomer, Israel
| | - David Hazzan
- Department of General and Oncological Surgery-Surgery C, Sheba Medical Center, Tel Hashomer, Israel
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20
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Mor E, Assaf D, Laks S, Benvenisti H, Schtrechman G, Hazzan D, Segev L, Yaka R, Shacham-Shmueli E, Margalit O, Halpern N, Perelson D, Monica-Inda K, Ben-Yaacov A, Nissan A, Adileh M. ASO Visual Abstract: Ratio of Pathological Response to Preoperative Chemotherapy in Patients Undergoing Complete Cytoreduction and Hyperthermic Intraperitoneal Chemotherapy for Metastatic Colorectal Cancer Correlates with Survival. Ann Surg Oncol 2021. [PMID: 34283314 DOI: 10.1245/s10434-021-10410-6] [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)
- Eyal Mor
- The Department of General and Oncological Surgery - Surgery C Sheba Medical Center, Tel Hashomer, Affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Dan Assaf
- The Department of General and Oncological Surgery - Surgery C Sheba Medical Center, Tel Hashomer, Affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shachar Laks
- The Department of General and Oncological Surgery - Surgery C Sheba Medical Center, Tel Hashomer, Affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Haggai Benvenisti
- The Department of General and Oncological Surgery - Surgery C Sheba Medical Center, Tel Hashomer, Affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Gal Schtrechman
- The Department of General and Oncological Surgery - Surgery C Sheba Medical Center, Tel Hashomer, Affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - David Hazzan
- The Department of General and Oncological Surgery - Surgery C Sheba Medical Center, Tel Hashomer, Affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Lior Segev
- The Department of General and Oncological Surgery - Surgery C Sheba Medical Center, Tel Hashomer, Affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ronel Yaka
- The Department of General and Oncological Surgery - Surgery C Sheba Medical Center, Tel Hashomer, Affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Einat Shacham-Shmueli
- The Department of Oncology, Sheba Medical Center, Tel Hashomer, Affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ofer Margalit
- The Department of Oncology, Sheba Medical Center, Tel Hashomer, Affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Naama Halpern
- The Department of Oncology, Sheba Medical Center, Tel Hashomer, Affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Daria Perelson
- The Department of Anesthesiology, Sheba Medical Center, Tel Hashomer, Affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Kaufmann Monica-Inda
- The Department of Phatology, Sheba Medical Center, Tel Hashomer, Affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Almog Ben-Yaacov
- The Department of General and Oncological Surgery - Surgery C Sheba Medical Center, Tel Hashomer, Affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Aviram Nissan
- The Department of General and Oncological Surgery - Surgery C Sheba Medical Center, Tel Hashomer, Affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Mohammad Adileh
- The Department of General and Oncological Surgery - Surgery C Sheba Medical Center, Tel Hashomer, Affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
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21
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Mor E, Assaf D, Laks S, Benvenisti H, Schtrechman G, Hazzan D, Segev L, Yaka R, Shacham-Shmueli E, Margalit O, Halpern N, Perelson D, Kaufmann MI, Ben-Yaacov A, Nissan A, Adileh M. Ratio of Pathological Response to Preoperative Chemotherapy in Patients Undergoing Complete Cytoreduction and Hyperthermic Intraperitoneal Chemotherapy for Metastatic Colorectal Cancer Correlates with Survival. Ann Surg Oncol 2021; 28:9138-9147. [PMID: 34232423 DOI: 10.1245/s10434-021-10367-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 06/04/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND Pathological response of colorectal peritoneal metastasis (CRPM) may affect prognosis. We investigated the relationship between oncological outcomes and pathological response to chemotherapy of CRPM following cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC). METHODS We conducted a retrospective analysis of a prospectively maintained Peritoneal Surface Malignancies database between 2015 and 2020. Analysis included patients with CRPM who underwent a CRS/HIPEC procedure (n = 178). The cohort was divided into three groups according to the response ratio (ratio of tumor-positive specimens to the total number of specimens resected): Group A, complete response; Group B, high response ratio, and Group C, low response ratio. RESULTS The group demographics were similar, but the overall complication rate was higher in Group C (65.2%) compared with Groups A (55%) and B (42.8%) [p = 0.03]. Survival correlated to response ratio; the estimated median disease-free survival of Group C was 9.1 months (5.97-12.23), 14.9 months (4.72-25.08) for Group B, and was not reached in Group A (p = 0.001). The estimated median overall survival in Group C was 35 months (26.69-43.31), and was not reached in Groups A and B (p = 0.001). CONCLUSIONS The pathological response ratio to systemic therapy correlates with survival in patients undergoing CRS/HIPEC. This study supports the utilization of preoperative therapy for better patient selection, with a potential impact on survival.
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Affiliation(s)
- Eyal Mor
- The Department of General and Oncological Surgery, Surgery C Sheba Medical Center, Affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Hashomer, Israel
| | - Dan Assaf
- The Department of General and Oncological Surgery, Surgery C Sheba Medical Center, Affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Hashomer, Israel
| | - Shachar Laks
- The Department of General and Oncological Surgery, Surgery C Sheba Medical Center, Affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Hashomer, Israel
| | - Haggai Benvenisti
- The Department of General and Oncological Surgery, Surgery C Sheba Medical Center, Affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Hashomer, Israel
| | - Gal Schtrechman
- The Department of General and Oncological Surgery, Surgery C Sheba Medical Center, Affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Hashomer, Israel
| | - David Hazzan
- The Department of General and Oncological Surgery, Surgery C Sheba Medical Center, Affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Hashomer, Israel
| | - Lior Segev
- The Department of General and Oncological Surgery, Surgery C Sheba Medical Center, Affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Hashomer, Israel
| | - Ronel Yaka
- The Department of General and Oncological Surgery, Surgery C Sheba Medical Center, Affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Hashomer, Israel
| | - Einat Shacham-Shmueli
- The Department of Oncology, Sheba Medical Center, Affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Hashomer, Israel
| | - Ofer Margalit
- The Department of Oncology, Sheba Medical Center, Affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Hashomer, Israel
| | - Naama Halpern
- The Department of Oncology, Sheba Medical Center, Affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Hashomer, Israel
| | - Daria Perelson
- The Department of Anesthesiology, Sheba Medical Center, Affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Hashomer, Israel
| | - Monica-Inda Kaufmann
- The Department of Pathology, Sheba Medical Center, Affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Hashomer, Israel
| | - Almog Ben-Yaacov
- The Department of General and Oncological Surgery, Surgery C Sheba Medical Center, Affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Hashomer, Israel
| | - Aviram Nissan
- The Department of General and Oncological Surgery, Surgery C Sheba Medical Center, Affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Hashomer, Israel
| | - Mohammad Adileh
- The Department of General and Oncological Surgery, Surgery C Sheba Medical Center, Affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Hashomer, Israel.
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22
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Bhatt A, Rousset P, Baratti D, Biacchi D, Benzerdjeb N, H J T de Hingh I, Deraco M, Gushchin V, Kammar P, Labow D, Levine E, Moran B, Mohamed F, Morris D, Mehta S, Nissan A, Alyami M, Adileh M, Barat S, Ben Yacov A, Campbell K, Cummins-Perry K, Cortes-Guiral D, Cohen N, Parikh L, Alammari S, Bashanfer G, Alshukami A, Kundalia K, Goswami G, de Vlasakker VV, Sittig M, Sammartino P, Sardi A, Villeneuve L, Turaga K, Yonemura Y, Glehen O. Patterns of peritoneal dissemination and response to systemic chemotherapy in common and rare peritoneal tumours treated by cytoreductive surgery: study protocol of a prospective, multicentre, observational study. BMJ Open 2021; 11:e046819. [PMID: 34226220 PMCID: PMC8258594 DOI: 10.1136/bmjopen-2020-046819] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 06/18/2021] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION Despite optimal patient selection and surgical effort, recurrence is seen in over 70% of patients undergoing cytoreductive surgery (CRS) for peritoneal metastases (PM). Apart from the Peritoneal Cancer Index (PCI), completeness of cytoreduction and tumour grade, there are other factors like disease distribution in the peritoneal cavity, pathological response to systemic chemotherapy (SC), lymph node metastases and morphology of PM which may have prognostic value. One reason for the underutilisation of these factors is that they are known only after surgery. Identifying clinical predictors, specifically radiological predictors, could lead to better utilisation of these factors in clinical decision making and the extent of peritoneal resection performed for different tumours. This study aims to study these factors, their impact on survival and identify clinical and radiological predictors. METHODS AND ANALYSIS There is no therapeutic intervention in the study. All patients with biopsy-proven PM from colorectal, appendiceal, gastric and ovarian cancer and peritoneal mesothelioma undergoing CRS will be included. The demographic, clinical, radiological, surgical and pathological details will be collected according to a prespecified format that includes details regarding distribution of disease, morphology of PM, regional node involvement and pathological response to SC. In addition to the absolute value of PCI, the structures bearing the largest tumour nodules and a description of the morphology in each region will be recorded. A correlation between the surgical, radiological and pathological findings will be performed and the impact of these potential prognostic factors on progression-free and overall survival determined. The practices pertaining to radiological and pathological reporting at different centres will be studied. ETHICS AND DISSEMINATION The study protocol has been approved by the Zydus Hospital ethics committee (27 July, 2020) and Lyon-Sud ethics committee (A15-128). TRIAL REGISTRATION NUMBER CTRI/2020/09/027709; Pre-results.
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Affiliation(s)
- Aditi Bhatt
- Surgical Oncology, Zydus Hospital, Ahmedabad, India
| | - Pascal Rousset
- Radiology, Centre Hospitalier Lyon-Sud, Pierre-Benite, France
| | - Dario Baratti
- Surgical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | | | | | | | - Marcello Deraco
- Surgical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Vadim Gushchin
- Surgical Oncology, Mercy Medical Center, Baltimore, Maryland, USA
| | | | - Daniel Labow
- Surgical Oncology, Mount Sinai Medical Center, New York City, New York, USA
| | - Edward Levine
- Surgery, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina, USA
| | - Brendan Moran
- Peritoneal malignancy unit, Basingstoke and North Hampshire NHS Foundation Trust, Basingstoke, UK
| | - Faheez Mohamed
- Peritoneal malignancy unit, Basingstoke and North Hampshire NHS Foundation Trust, Winchester, UK
| | - David Morris
- Peritonectomy Unit, University of New South Wales, Sydney, New South Wales, Australia
| | - Sanket Mehta
- Surgical Oncology, Saifee Hospital, Mumbai, India
| | - Aviram Nissan
- Surgical Oncology, Sheba Medical Center, Tel Hashomer, Israel
| | - Mohammad Alyami
- Surgical Oncology, King Khaled Hospital, Najran, Saudi Arabia
| | - Mohammad Adileh
- Surgical Oncology, Sheba Medical Center, Tel Hashomer, Israel
| | - Shoma Barat
- Surgical Oncology, St. George Hospital, Sydney, New South Wales, Australia
| | - Almog Ben Yacov
- Surgical Oncology, Sheba Medical Center, Tel Hashomer, Israel
| | - Kurtis Campbell
- Surgical Oncology, Mercy Medical Center, Baltimore, Maryland, USA
| | | | | | - Noah Cohen
- Surgical Oncology, Mount Sinai Medical Center, New York City, New York, USA
| | | | - Samer Alammari
- Surgical Oncology, King Khaled Hospital, Najran, Saudi Arabia
| | | | | | - Kaushal Kundalia
- Surgical Oncology, Basingstoke and North Hampshire NHS Foundation Trust, Winchester, UK
| | | | | | - Michelle Sittig
- Surgical Oncology, Mercy Medical Center, Baltimore, Maryland, USA
| | | | - Armando Sardi
- Surgical Oncology, Mercy Medical Center, Baltimore, Maryland, USA
| | | | - Kiran Turaga
- Surgical Oncology, University of Chicago Pritzker School of Medicine, Chicago, Illinois, USA
| | - Yutaka Yonemura
- Surgical Oncology, Kishiwada Tokushukai Hospital, Kishiwada, Japan
| | - Olivier Glehen
- Surgical Oncology, Centre Hospitalier Lyon-Sud, Pierre-Benite, France
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Mor E, Laks S, Nissan A, Adileh M. ASO Author Reflections: Pathologic Response Ratio (PRR) in CRS and HIPEC for Peritoneal Metastasis from Colorectal Cancer. Ann Surg Oncol 2021; 28:9148-9149. [PMID: 34180017 DOI: 10.1245/s10434-021-10369-4] [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] [Received: 06/15/2021] [Accepted: 06/17/2021] [Indexed: 11/18/2022]
Affiliation(s)
- Eyal Mor
- The Department of General and Oncological Surgery - Surgery C, Sheba Medical Center, Affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Shachar Laks
- The Department of General and Oncological Surgery - Surgery C, Sheba Medical Center, Affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Aviram Nissan
- The Department of General and Oncological Surgery - Surgery C, Sheba Medical Center, Affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Mohammad Adileh
- The Department of General and Oncological Surgery - Surgery C, Sheba Medical Center, Affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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Ben-Yaacov A, Laks S, Goldenshluger M, Nevo Y, Mor E, Schtrechman G, Margalit O, Boursi B, Shacham-Shmueli E, Halpern N, Purim O, Hazzan D, Segev L, Zippel D, Adileh M, Nissan A. Impact of "critical lesions" on outcomes following cytoreductive surgery and hyperthermic intra-peritoneal chemotherapy. Eur J Surg Oncol 2021; 47:2933-2938. [PMID: 34088586 DOI: 10.1016/j.ejso.2021.05.022] [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] [Received: 03/17/2021] [Revised: 04/19/2021] [Accepted: 05/07/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Peritoneal Cancer Index (PCI) and complete cytoreduction are the best outcome predictors following cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC). Lesions in critical areas, regardless of PCI, complicate surgery and impact oncological outcomes. We prospectively defined "Critical lesions" (CL) as penetrating the hepatic hilum, diaphragm at hepatic outflow, major blood vessels, pancreas, or urinary tract. METHODS Retrospective analysis of a prospective database of 352 CRS + HIPEC patients from 2015 to 2019. Excluded patients with aborted/redo operation (n = 112), or incomplete data (n = 19). Patients categorized by CL status and compared: operative time, estimated blood loss (EBL), PCI, transfusions, hospital stay, post-operative complications and mortality, overall survival (OS) and disease-free survival (DFS). RESULTS Included 221 patients (78 CL; 143 no-CL). No difference in patients' characteristics: age, BMI, gender or co-morbidities noted. Operative time longer (5.3 h vs 4.3 h, p < 0.01), EBL higher (769 ml vs 405 ml, p < 0.01), transfusions higher (1.9 vs 0.7 Units, p < 0.001) and PCI higher (15.5 vs 9.5, p < 0.01) in CL. No difference in major complications. Postoperative complications, CL, OR-time and transfusions were predictive of OS in univariate analysis, while only complications remained on multivariate analysis. Median follow up of 21.4 months, 3-year DFS/OS was 22% vs 30% (p < 0.037) and 73% vs 87% (p < 0.014) in CL and non-CL, respectively. Despite CL complete resection, 17/38 patients (44.7%) that recurred had recurrence at previous CL site. CONCLUSIONS Critical lesions complicate surgery and may be associated with poor oncological outcomes with high local recurrence rate, despite no significant difference in complications. Utilizing adjuvant or intra-operative radiation may be beneficial.
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Affiliation(s)
- A Ben-Yaacov
- Department of General and Oncological Surgery- Surgery C, The Chaim Sheba Medical Center, Tel Hashomer, Israel; Sackler School of Medicine, Tel-Aviv University, Israel.
| | - S Laks
- Department of General and Oncological Surgery- Surgery C, The Chaim Sheba Medical Center, Tel Hashomer, Israel; Sackler School of Medicine, Tel-Aviv University, Israel
| | - M Goldenshluger
- Department of General and Oncological Surgery- Surgery C, The Chaim Sheba Medical Center, Tel Hashomer, Israel; Sackler School of Medicine, Tel-Aviv University, Israel
| | - Y Nevo
- Department of General and Oncological Surgery- Surgery C, The Chaim Sheba Medical Center, Tel Hashomer, Israel; Sackler School of Medicine, Tel-Aviv University, Israel
| | - E Mor
- Department of General and Oncological Surgery- Surgery C, The Chaim Sheba Medical Center, Tel Hashomer, Israel; Sackler School of Medicine, Tel-Aviv University, Israel
| | - G Schtrechman
- Department of General and Oncological Surgery- Surgery C, The Chaim Sheba Medical Center, Tel Hashomer, Israel; Sackler School of Medicine, Tel-Aviv University, Israel
| | - O Margalit
- Sackler School of Medicine, Tel-Aviv University, Israel; Gastrointestinal Malignancies Unit at the Institution of Oncology, The Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - B Boursi
- Sackler School of Medicine, Tel-Aviv University, Israel; Gastrointestinal Malignancies Unit at the Institution of Oncology, The Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - E Shacham-Shmueli
- Sackler School of Medicine, Tel-Aviv University, Israel; Gastrointestinal Malignancies Unit at the Institution of Oncology, The Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - N Halpern
- Sackler School of Medicine, Tel-Aviv University, Israel; Gastrointestinal Malignancies Unit at the Institution of Oncology, The Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - O Purim
- Gastrointestinal Malignancy Service at Assuta Samson Hospital, Ashdod, Israel
| | - D Hazzan
- Department of General and Oncological Surgery- Surgery C, The Chaim Sheba Medical Center, Tel Hashomer, Israel; Sackler School of Medicine, Tel-Aviv University, Israel
| | - L Segev
- Department of General and Oncological Surgery- Surgery C, The Chaim Sheba Medical Center, Tel Hashomer, Israel; Sackler School of Medicine, Tel-Aviv University, Israel
| | - D Zippel
- Department of General and Oncological Surgery- Surgery C, The Chaim Sheba Medical Center, Tel Hashomer, Israel; Sackler School of Medicine, Tel-Aviv University, Israel
| | - M Adileh
- Department of General and Oncological Surgery- Surgery C, The Chaim Sheba Medical Center, Tel Hashomer, Israel; Sackler School of Medicine, Tel-Aviv University, Israel
| | - A Nissan
- Department of General and Oncological Surgery- Surgery C, The Chaim Sheba Medical Center, Tel Hashomer, Israel; Sackler School of Medicine, Tel-Aviv University, Israel
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Segev L, Assaf D, Elbaz N, Schtrechman G, Westrich G, Adileh M, Nissan A, Goitein D. Outcomes of diverting loop ileostomy reversal in the elderly: a case-control study. ANZ J Surg 2021; 91:E382-E388. [PMID: 33870605 DOI: 10.1111/ans.16871] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 01/02/2021] [Revised: 03/28/2021] [Accepted: 04/04/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND Although diverting loop ileostomy (DLI) reversal is considered to be a relatively simple procedure, it is not immune from major morbidity. We aimed to compare outcomes of DLI reversal between elderly and non-elderly patients. METHODS Retrospective review of all patients who underwent DLI reversal at a single tertiary medical centre between 2010 and 2020. The elderly group consisted of patients 70 or older compared to a control group of those younger than 70 years. RESULTS During the study period, 307 patients underwent DLI reversal. Of these, 76 patients were in the elderly group (mean age 75.6) and 231 in the control group (mean age 55.3). The groups were comparable in terms of mean time interval between the creation of the ileostomy and reversal (242 versus 255 days, respectively, P = 0.5), choice between stapled and hand-sewn anastomoses (97.4% stapled anastomosis versus 93.1%, P = 0.086), median post-operative length of stay (5 days in both, P = 0.086), rates of post-operative complications (26.3% versus 26.8%, P = 0.99), severe complications (5.3% versus 6.9%, P = 0.81) and 30-day readmission rates (13.2% versus 10.8%, P = 0.58). Multivariate analysis found the time interval between the creation of the stoma and its reversal to be the only significant risk factor for major post-operative morbidity. Age was not found to be correlated with post-operative morbidity. CONCLUSION The outcomes of loop ileostomy reversal in elderly patients are similar to non-elderly patients. Efforts should be made to decrease the time interval between the creation of the stoma and its reversal as this is a significant risk factor for major post-operative morbidity.
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Affiliation(s)
- Lior Segev
- Department of General and Oncological Surgery - Surgery C, The Chaim Sheba Medical Center, Ramat Gan, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Dan Assaf
- Department of General and Oncological Surgery - Surgery C, The Chaim Sheba Medical Center, Ramat Gan, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Nadav Elbaz
- Department of General and Oncological Surgery - Surgery C, The Chaim Sheba Medical Center, Ramat Gan, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Gal Schtrechman
- Department of General and Oncological Surgery - Surgery C, The Chaim Sheba Medical Center, Ramat Gan, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Gal Westrich
- Department of General and Oncological Surgery - Surgery C, The Chaim Sheba Medical Center, Ramat Gan, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Mohammad Adileh
- Department of General and Oncological Surgery - Surgery C, The Chaim Sheba Medical Center, Ramat Gan, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Aviram Nissan
- Department of General and Oncological Surgery - Surgery C, The Chaim Sheba Medical Center, Ramat Gan, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - David Goitein
- Department of General and Oncological Surgery - Surgery C, The Chaim Sheba Medical Center, Ramat Gan, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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26
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Laks S, Ben-Yaacov A, Adileh M, Nissan A. Authors' Reply to Wu et al. "Comment on: Repeat Cytoreductive Surgery and Intraperitoneal Chemotherapy for Colorectal Cancer Peritoneal Recurrences is Safe and Efficacious". Ann Surg Oncol 2021; 28:815-816. [PMID: 33813670 DOI: 10.1245/s10434-021-09933-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 03/17/2021] [Indexed: 11/18/2022]
Affiliation(s)
- Shachar Laks
- Department of General and Oncological Surgery - Surgery C, Chaim Sheba Medical Center, Affiliated with Sackler School of Medicine, Tel Aviv University, Ramat Gan, Israel.
| | - Almog Ben-Yaacov
- Department of General and Oncological Surgery - Surgery C, Chaim Sheba Medical Center, Affiliated with Sackler School of Medicine, Tel Aviv University, Ramat Gan, Israel
| | - Mohammad Adileh
- Department of General and Oncological Surgery - Surgery C, Chaim Sheba Medical Center, Affiliated with Sackler School of Medicine, Tel Aviv University, Ramat Gan, Israel
| | - Aviram Nissan
- Department of General and Oncological Surgery - Surgery C, Chaim Sheba Medical Center, Affiliated with Sackler School of Medicine, Tel Aviv University, Ramat Gan, Israel
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Adileh M, Laks S, Ben-Yaakov A, Nissan A. Response to: Concurrent or Sequential? A Curative Approach to Colorectal Liver and Peritoneal Metastasis Treatment is Possible. Ann Surg Oncol 2021; 28:808-809. [PMID: 33638040 DOI: 10.1245/s10434-021-09756-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 02/08/2021] [Indexed: 11/18/2022]
Affiliation(s)
- Mohammad Adileh
- Department of General and Oncological Surgery, Sheba Medical Center, Ramat-Gan, Israel
| | - Shachar Laks
- Department of General and Oncological Surgery, Sheba Medical Center, Ramat-Gan, Israel
| | - Almog Ben-Yaakov
- Department of General and Oncological Surgery, Sheba Medical Center, Ramat-Gan, Israel
| | - Aviram Nissan
- Department of General and Oncological Surgery, Sheba Medical Center, Ramat-Gan, Israel.
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28
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Laks S, Adileh M, Ben-Yaacov A, Nissan A. ASO Author Reflections: If Once Is Good, Is Twice Just as Good? A critical evaluation of Repeat CRS-HIPEC for Colorectal Peritoneal Metastases. Ann Surg Oncol 2021; 28:5339-5340. [PMID: 33604829 DOI: 10.1245/s10434-021-09704-6] [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] [Received: 01/27/2021] [Accepted: 01/27/2021] [Indexed: 11/18/2022]
Affiliation(s)
- S Laks
- Department of General and Oncological Surgery - Surgery C, Chaim Sheba Medical Center, Ramat Gan, Israel.
| | - M Adileh
- Department of General and Oncological Surgery - Surgery C, Chaim Sheba Medical Center, Ramat Gan, Israel
| | - A Ben-Yaacov
- Department of General and Oncological Surgery - Surgery C, Chaim Sheba Medical Center, Ramat Gan, Israel
| | - A Nissan
- Department of General and Oncological Surgery - Surgery C, Chaim Sheba Medical Center, Ramat Gan, Israel
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29
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Laks S, Schtrechman G, Adileh M, Ben-Yaacov A, Purim O, Ivanov V, Aderka D, Shacham-Shmueli E, Halpern N, Goren S, Perelson D, Nissan A. Repeat Cytoreductive Surgery and Intraperitoneal Chemotherapy for Colorectal Cancer Peritoneal Recurrences is Safe and Efficacious. Ann Surg Oncol 2021; 28:5330-5338. [PMID: 33591479 DOI: 10.1245/s10434-021-09684-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 01/22/2021] [Indexed: 01/19/2023]
Abstract
BACKGROUND Cytoreductive surgery and heated intraperitoneal chemotherapy (CRS/HIPEC) for colorectal cancer peritoneal metastases (CRPM) is associated with improved survival in patients with historically dismal prognosis. Nonetheless, peritoneal recurrences remain common and represent a difficult challenge in these patients' management. Repeat CRS/HIPEC is associated with even greater morbidity and its survival benefit has not yet been clearly demonstrated. METHODS We retrospectively reviewed our prospectively maintained database and aimed to assess the safety and oncological efficacy of repeat CRS/HIPEC. RESULTS Two hundred thirty-two patients underwent an initial CRS/HIPEC, whereas 30 subsequently had repeat CRS/HIPEC for CRPM. Groups were similar in demographics, comorbidities, and peritoneal cancer index (PCI). No significant difference in morbidity, hospital stay, or reoperation rate was noted between initial and repeat procedures. Patients who underwent repeat CRS/HIPEC had a median overall survival of 68 months versus 51 months in patients who did not undergo repeat procedure for their peritoneal recurrence (p = 0.03). Disease-free survival (DFS) in patients after repeat and after initial procedure were similar with median of 9.6 versus 12 months, respectively (p = 0.083). Univariate analysis demonstrated that PCI, DFS, and repeat procedure displayed significant factors on outcomes in patients with peritoneal recurrences, whereas PCI > 16 and DFS remained independent predictors on multivariable analysis. CONCLUSIONS Our analysis, which represents the largest series to date of repeat CRS/HIPEC for CRPM, indicates that this approach as a part of multimodal therapy is both safe and efficacious in appropriately selected patients.
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Affiliation(s)
- Shachar Laks
- Department of General and Oncological Surgery - Surgery C, Sheba Tel Hashomer Medical Center, The Chaim Sheba Medical Center, Ramat Gan, Israel. .,Affiliated with the Sackler School of Medicine, Tel Aviv University, Ramat Gan, Israel.
| | - Gal Schtrechman
- Department of General and Oncological Surgery - Surgery C, Sheba Tel Hashomer Medical Center, The Chaim Sheba Medical Center, Ramat Gan, Israel.,Affiliated with the Sackler School of Medicine, Tel Aviv University, Ramat Gan, Israel
| | - Mohammad Adileh
- Department of General and Oncological Surgery - Surgery C, Sheba Tel Hashomer Medical Center, The Chaim Sheba Medical Center, Ramat Gan, Israel.,Affiliated with the Sackler School of Medicine, Tel Aviv University, Ramat Gan, Israel
| | - Almog Ben-Yaacov
- Department of General and Oncological Surgery - Surgery C, Sheba Tel Hashomer Medical Center, The Chaim Sheba Medical Center, Ramat Gan, Israel.,Affiliated with the Sackler School of Medicine, Tel Aviv University, Ramat Gan, Israel
| | - Ofer Purim
- Department of Oncology, Assuta Samson Hospital, Ashdod, Israel
| | - Vyacheslav Ivanov
- Department of General and Oncological Surgery - Surgery C, Sheba Tel Hashomer Medical Center, The Chaim Sheba Medical Center, Ramat Gan, Israel.,Affiliated with the Sackler School of Medicine, Tel Aviv University, Ramat Gan, Israel
| | - Dan Aderka
- Affiliated with the Sackler School of Medicine, Tel Aviv University, Ramat Gan, Israel.,Department of Oncology, Chaim Sheba Medical Center, Ramat Gan, Israel
| | - Einat Shacham-Shmueli
- Affiliated with the Sackler School of Medicine, Tel Aviv University, Ramat Gan, Israel.,Department of Oncology, Chaim Sheba Medical Center, Ramat Gan, Israel
| | - Naama Halpern
- Affiliated with the Sackler School of Medicine, Tel Aviv University, Ramat Gan, Israel.,Department of Oncology, Chaim Sheba Medical Center, Ramat Gan, Israel
| | - Shani Goren
- Department of General and Oncological Surgery - Surgery C, Sheba Tel Hashomer Medical Center, The Chaim Sheba Medical Center, Ramat Gan, Israel.,Affiliated with the Sackler School of Medicine, Tel Aviv University, Ramat Gan, Israel
| | - Daria Perelson
- Department of Anesthesiology, Chaim Sheba Medical Center, Ramat Gan, Israel
| | - Aviram Nissan
- Department of General and Oncological Surgery - Surgery C, Sheba Tel Hashomer Medical Center, The Chaim Sheba Medical Center, Ramat Gan, Israel.,Affiliated with the Sackler School of Medicine, Tel Aviv University, Ramat Gan, Israel
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30
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Adileh M, Yuval JB, Walch HS, Chatila WK, Yaeger R, Garcia-Aguilar J, Schultz N, Paty PB, Cercek A, Nash GM. Correction to: Primary Tumor Location and Outcomes After Cytoreductive Surgery and Intraperitoneal Chemotherapy for Peritoneal Metastases of Colorectal Origin. Ann Surg Oncol 2020; 27:987. [PMID: 33001300 DOI: 10.1245/s10434-020-09191-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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
In the original article there is a reference missing, in addition to its citations in the text. The reference is as follows.
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Affiliation(s)
- Mohammad Adileh
- Colorectal Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jonathan B Yuval
- Colorectal Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Henry S Walch
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Marie-Josée and Henry R. Kravis Center for Molecular Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Walid K Chatila
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Marie-Josée and Henry R. Kravis Center for Molecular Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Tri-Institutional Program in Computational Biology and Medicine, New York, NY, USA
| | - Rona Yaeger
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Julio Garcia-Aguilar
- Colorectal Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Nikolaus Schultz
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Marie-Josée and Henry R. Kravis Center for Molecular Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Philip B Paty
- Colorectal Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Andrea Cercek
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Garrett M Nash
- Colorectal Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
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31
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Mor E, Adileh M, Ariche A, Nissan A. ASO Author Reflections: Synchronous Liver and Peritoneal Metastasis From Colorectal Cancer. Ann Surg Oncol 2020; 28:3330-3331. [PMID: 33005991 DOI: 10.1245/s10434-020-09186-y] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 09/17/2020] [Indexed: 12/22/2022]
Affiliation(s)
- Eyal Mor
- Department of General and Oncological Surgery-Surgery C, Sheba Medical Center, Affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Hashomer, Israel.
| | - Mohammad Adileh
- Department of General and Oncological Surgery-Surgery C, Sheba Medical Center, Affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Hashomer, Israel
| | - Arie Ariche
- Department of Surgery, Hadassah-Hebrew University Medical Center Mount Scopus, Jerusalem, Israel
| | - Aviram Nissan
- Department of General and Oncological Surgery-Surgery C, Sheba Medical Center, Affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Hashomer, Israel
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Adileh M, Mor E, Assaf D, Benvenisti H, Laks S, Ben-Yaacov A, Schtrechman G, Hazzan D, Shacham-Shmueli E, Margalit O, Halpern N, Aderka D, Perelson D, Ariche A, Nissan A. Perioperative and Oncological Outcomes of Combined Hepatectomy with Complete Cytoreduction and Hyperthermic Intraperitoneal Chemotherapy for Metastatic Colorectal Cancer. Ann Surg Oncol 2020; 28:3320-3329. [PMID: 32968959 DOI: 10.1245/s10434-020-09165-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 08/31/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Synchronous peritoneal and liver metastasis in colorectal cancer is a relative contraindication for curative surgery. We aimed to evaluate the safety and oncological outcomes of combined treatment of peritoneal and liver metastasis. METHODS We conducted a retrospective analysis of metastatic colorectal cancer patients from two prospective databases: peritoneal surface malignancy (n = 536) and hepatobiliary (n = 286). We compared 60 patients treated with cytoreduction and hyperthermic intraperitoneal chemotherapy (HIPEC) and hepatectomy; 80 patients treated with cytoreduction and HIPEC only; and 63 patients treated with hepatectomy alone. RESULTS No differences in demographics were observed between the groups. Median hospital and intensive care unit (ICU) stay was shorter in group C (7 and 1 days, respectively) versus groups A and B (13 and 1 days, and 12 and 1 days, respectively; p < 0.001). Postoperative complications were not significantly different. Median follow-up was 18.6, 23.1, and 30.6 months for groups A, B, and C, respectively. Estimated 5-year overall survival (OS) was 48.8% (group A), 55.4% (group B), and 60.2% (group C) [p = 0.043 for group A vs. group C], and estimated 5-year disease-free survival (DFS) was 14.2% (group A), 23.0% (group B), and 18.6% (group C). Five-year OS was superior in group C compared with group A (p = 0.043), and DFS was superior in group C compared with groups A and B (p = 0.043 and 0.03, respectively). The peritoneum was the site of first recurrence in groups A and B (23.3% and 32.5%, respectively), and the liver was the site of first recurrence in group C (44.4%). CONCLUSIONS We report favorable perioperative and oncological outcomes in combined cytoreduction/HIPEC and hepatectomy for patients with peritoneal and liver metastasis. Surgical intervention after multidisciplinary discussion should be considered in patients with both peritoneal and hepatic lesions when complete cytoreduction is feasible.
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Affiliation(s)
- Mohammad Adileh
- The Department of General and Oncological Surgery - Surgery C, Sheba Medical Center, Affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Hashomer, Israel
| | - Eyal Mor
- The Department of General and Oncological Surgery - Surgery C, Sheba Medical Center, Affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Hashomer, Israel
| | - Dan Assaf
- The Department of General and Oncological Surgery - Surgery C, Sheba Medical Center, Affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Hashomer, Israel
| | - Haggai Benvenisti
- The Department of General and Oncological Surgery - Surgery C, Sheba Medical Center, Affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Hashomer, Israel
| | - Shachar Laks
- The Department of General and Oncological Surgery - Surgery C, Sheba Medical Center, Affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Hashomer, Israel
| | - Almog Ben-Yaacov
- The Department of General and Oncological Surgery - Surgery C, Sheba Medical Center, Affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Hashomer, Israel
| | - Gal Schtrechman
- The Department of General and Oncological Surgery - Surgery C, Sheba Medical Center, Affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Hashomer, Israel
| | - David Hazzan
- The Department of General and Oncological Surgery - Surgery C, Sheba Medical Center, Affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Hashomer, Israel
| | - Einat Shacham-Shmueli
- The Department of Oncology, Sheba Medical Center, Affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Hashomer, Israel
| | - Ofer Margalit
- The Department of Oncology, Sheba Medical Center, Affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Hashomer, Israel
| | - Naama Halpern
- The Department of Oncology, Sheba Medical Center, Affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Hashomer, Israel
| | - Dan Aderka
- The Department of Oncology, Sheba Medical Center, Affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Hashomer, Israel
| | - Daria Perelson
- The Department of Anesthesiology, Sheba Medical Center, Affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Hashomer, Israel
| | - Arie Ariche
- The Department of Surgery, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Aviram Nissan
- The Department of General and Oncological Surgery - Surgery C, Sheba Medical Center, Affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Hashomer, Israel.
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Yuval JB, Adileh M, Cercek A, Nash GM. ASO Author Reflections: Tumor Sidedness in CRS/IPC. Ann Surg Oncol 2020; 27:907-908. [PMID: 32845418 DOI: 10.1245/s10434-020-09054-9] [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] [Received: 08/03/2020] [Accepted: 08/15/2020] [Indexed: 11/18/2022]
Affiliation(s)
- Jonathan B Yuval
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, USA
| | - Mohammad Adileh
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, USA
| | - Andrea Cercek
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, USA
| | - Garrett M Nash
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, USA.
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Adileh M, Yuval JB, Walch HS, Chatila WK, Yaeger R, Garcia-Aguilar J, Schultz N, Paty PB, Cercek A, Nash GM. Primary Tumor Location and Outcomes After Cytoreductive Surgery and Intraperitoneal Chemotherapy for Peritoneal Metastases of Colorectal Origin. Ann Surg Oncol 2020; 28:1109-1117. [PMID: 32844293 DOI: 10.1245/s10434-020-08993-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Accepted: 07/21/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND The aim of this study is to evaluate outcomes in patients with peritoneal metastasis of colorectal cancer (pmCRC) who underwent cytoreductive surgery and intraperitoneal chemotherapy (CRS/IPC) in relation to the location of the primary tumor. Regional therapy, including cytoreductive surgery and intraperitoneal chemotherapy, has been associated with improved survival in patients with pmCRC. Location of the primary tumor has been shown to be prognostic in patients with metastasis. PATIENTS AND METHODS A retrospective review was performed for all patients who underwent complete cytoreduction and intraperitoneal chemotherapy from 2010 to 2017, examining patient and tumor characteristics, overall and recurrence-free survival, recurrence patterns, and tumor mutational profiles. RESULTS Ninety-three patients were included in the study: 49 (53%) with a right-sided and 44 (47%) with a left-sided primary tumor. Patients with a right-sided tumor had significantly shorter recurrence-free survival (median, 6.3 months; 95% CI, 4.7-8.1 months vs 12.3 months; 95% CI, 3.6-21.7 months; P = 0.02) and overall survival (median, 36.6 months; 95% CI, 26.4-46.9 months vs 83.3 months; 95% CI 44.2-122.4 months; P = 0.03). BRAF and KRAS mutations were more frequent in right-sided tumors, and APC and TP53 mutations were more frequent in left-sided tumors, which were more chromosomally instable. BRAF mutations were associated with early recurrence. CONCLUSIONS Tumor sidedness is a predictor of oncological outcomes after CRS/IPC. Tumor sidedness and molecular characteristics should be considered when counseling patients regarding expected outcomes and when selecting or stratifying pmCRC patients for clinical trials of regional therapy.
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Affiliation(s)
- Mohammad Adileh
- Colorectal Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jonathan B Yuval
- Colorectal Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Henry S Walch
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Marie-Josée and Henry R. Kravis Center for Molecular Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Walid K Chatila
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Marie-Josée and Henry R. Kravis Center for Molecular Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Tri-Institutional Program in Computational Biology and Medicine, New York, NY, USA
| | - Rona Yaeger
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Julio Garcia-Aguilar
- Colorectal Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Nikolaus Schultz
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Marie-Josée and Henry R. Kravis Center for Molecular Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Philip B Paty
- Colorectal Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Andrea Cercek
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Garrett M Nash
- Colorectal Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
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35
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Martin ML, Adileh M, Hsu KS, Hua G, Lee SG, Li C, Fuller JD, Rotolo JA, Bodo S, Klingler S, Haimovitz-Friedman A, Deasy JO, Fuks Z, Paty PB, Kolesnick RN. Organoids Reveal That Inherent Radiosensitivity of Small and Large Intestinal Stem Cells Determines Organ Sensitivity. Cancer Res 2019; 80:1219-1227. [PMID: 31690670 DOI: 10.1158/0008-5472.can-19-0312] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 09/03/2019] [Accepted: 10/29/2019] [Indexed: 12/31/2022]
Abstract
Tissue survival responses to ionizing radiation are nonlinear with dose, rather yielding tissue-specific descending curves that impede straightforward analysis of biologic effects. Apoptotic cell death often occurs at low doses, while at clinically relevant intermediate doses, double-strand break misrepair yields mitotic death that determines outcome. As researchers frequently use a single low dose for experimentation, such strategies may inaccurately depict inherent tissue responses. Cutting edge radiobiology has adopted full dose survival profiling and devised mathematical algorithms to fit curves to observed data to generate highly reproducible numerical data that accurately define clinically relevant inherent radiosensitivities. Here, we established a protocol for irradiating organoids that delivers radiation profiles simulating the organ of origin. This technique yielded highly similar dose-survival curves of small and large intestinal crypts in vivo and their cognate organoids analyzed by the single-hit multi-target (SHMT) algorithm, outcomes reflecting the inherent radiation profile of their respective Lgr5+ stem cell populations. As this technological advance is quantitative, it will be useful for accurate evaluation of intestinal (patho)physiology and drug screening. SIGNIFICANCE: These findings establish standards for irradiating organoids that deliver radiation profiles that phenocopy the organ of origin.See related commentary by Muschel et al., p. 927.
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Affiliation(s)
- Maria Laura Martin
- Laboratory of Signal Transduction, Memorial Sloan Kettering Cancer Center, New York, New York.,Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Mohammad Adileh
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Kuo-Shun Hsu
- Laboratory of Signal Transduction, Memorial Sloan Kettering Cancer Center, New York, New York.,Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Guoqiang Hua
- Institute of Radiation Medicine, Fudan University, Shanghai, China
| | - Sang Gyu Lee
- Laboratory of Signal Transduction, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Christy Li
- Laboratory of Signal Transduction, Memorial Sloan Kettering Cancer Center, New York, New York
| | - John D Fuller
- Laboratory of Signal Transduction, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Jimmy A Rotolo
- Laboratory of Signal Transduction, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Sahra Bodo
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Stefan Klingler
- Laboratory of Signal Transduction, Memorial Sloan Kettering Cancer Center, New York, New York.,Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | | | - Joseph O Deasy
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Zvi Fuks
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Philip B Paty
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Richard N Kolesnick
- Laboratory of Signal Transduction, Memorial Sloan Kettering Cancer Center, New York, New York.
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Ganesh K, Wu C, O'Rourke KP, Szeglin BC, Zheng Y, Sauvé CEG, Adileh M, Wasserman I, Marco MR, Kim AS, Shady M, Sanchez-Vega F, Karthaus WR, Won HH, Choi SH, Pelossof R, Barlas A, Ntiamoah P, Pappou E, Elghouayel A, Strong JS, Chen CT, Harris JW, Weiser MR, Nash GM, Guillem JG, Wei IH, Kolesnick RN, Veeraraghavan H, Ortiz EJ, Petkovska I, Cercek A, Manova-Todorova KO, Saltz LB, Lavery JA, DeMatteo RP, Massagué J, Paty PB, Yaeger R, Chen X, Patil S, Clevers H, Berger MF, Lowe SW, Shia J, Romesser PB, Dow LE, Garcia-Aguilar J, Sawyers CL, Smith JJ. A rectal cancer organoid platform to study individual responses to chemoradiation. Nat Med 2019; 25:1607-1614. [PMID: 31591597 PMCID: PMC7385919 DOI: 10.1038/s41591-019-0584-2] [Citation(s) in RCA: 278] [Impact Index Per Article: 55.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Accepted: 08/15/2019] [Indexed: 12/22/2022]
Abstract
Rectal cancer (RC) is a challenging disease to treat that requires chemotherapy, radiation and surgery to optimize outcomes for individual patients. No accurate model of RC exists to answer fundamental research questions relevant to patients. We established a biorepository of 65 patient-derived RC organoid cultures (tumoroids) from patients with primary, metastatic or recurrent disease. RC tumoroids retained molecular features of the tumors from which they were derived, and their ex vivo responses to clinically relevant chemotherapy and radiation treatment correlated with the clinical responses noted in individual patients' tumors. Upon engraftment into murine rectal mucosa, human RC tumoroids gave rise to invasive RC followed by metastasis to lung and liver. Importantly, engrafted tumors displayed the heterogenous sensitivity to chemotherapy observed clinically. Thus, the biology and drug sensitivity of RC clinical isolates can be efficiently interrogated using an organoid-based, ex vivo platform coupled with in vivo endoluminal propagation in animals.
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Affiliation(s)
- Karuna Ganesh
- Molecular Pharmacology Program, Sloan Kettering Institute, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Gastrointestinal Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Chao Wu
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Colorectal Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Kevin P O'Rourke
- Cancer Biology and Genetics Program, Sloan Kettering Institute, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Weill Cornell Medicine/Rockefeller University/Sloan Kettering Tri-Institutional MD-PhD Program, New York, NY, USA
| | - Bryan C Szeglin
- Colorectal Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Albert Einstein College of Medicine, Bronx, NY, USA
| | - Youyun Zheng
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Marie-Josée and Henry R. Kravis Center for Molecular Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Mohammad Adileh
- Colorectal Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Isaac Wasserman
- Colorectal Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Michael R Marco
- Colorectal Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Amanda S Kim
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Maha Shady
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Marie-Josée and Henry R. Kravis Center for Molecular Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Francisco Sanchez-Vega
- Colorectal Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Computational Oncology Service, Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Wouter R Karthaus
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Helen H Won
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Marie-Josée and Henry R. Kravis Center for Molecular Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Seo-Hyun Choi
- Colorectal Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Raphael Pelossof
- Colorectal Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Afsar Barlas
- Molecular Cytology Core Facility, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Peter Ntiamoah
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Emmanouil Pappou
- Colorectal Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Arthur Elghouayel
- Colorectal Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - James S Strong
- Colorectal Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Chin-Tung Chen
- Colorectal Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jennifer W Harris
- Colorectal Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Martin R Weiser
- Colorectal Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Garrett M Nash
- Colorectal Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jose G Guillem
- Colorectal Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Iris H Wei
- Colorectal Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Richard N Kolesnick
- Molecular Pharmacology Program, Sloan Kettering Institute, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Harini Veeraraghavan
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Eduardo J Ortiz
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Iva Petkovska
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Andrea Cercek
- Gastrointestinal Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Leonard B Saltz
- Gastrointestinal Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jessica A Lavery
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Ronald P DeMatteo
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Joan Massagué
- Cancer Biology and Genetics Program, Sloan Kettering Institute, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Philip B Paty
- Colorectal Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Rona Yaeger
- Gastrointestinal Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Xi Chen
- Department of Public Health Sciences, Sylvestor Comprehensive Cancer Center, Miami, FL, USA
| | - Sujata Patil
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Hans Clevers
- Hubrecht Institute, Royal Netherlands Academy of Arts and Sciences, University of Medical Center, Utrecht, The Netherlands
| | - Michael F Berger
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Marie-Josée and Henry R. Kravis Center for Molecular Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Scott W Lowe
- Cancer Biology and Genetics Program, Sloan Kettering Institute, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jinru Shia
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Gastrointestinal Pathology, Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Paul B Romesser
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Lukas E Dow
- Sandra and Edward Meyer Cancer Center, Departments of Medicine and Biochemistry, Weill Cornell Medicine, Weill Cornell Graduate School of Medical Sciences, New York, NY, USA
| | - Julio Garcia-Aguilar
- Colorectal Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Charles L Sawyers
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
| | - J Joshua Smith
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
- Colorectal Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
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Ben-Yaacov A, Zendel A, Adileh M, Shapiro R, Aderka D, Shacham-Shmueli E, Beny A, A. arishe, Nissan A. Perioperative and long-term results of cytoreductive surgery with hyperthermic intraperitoneal chemotherapy and synchronous liver metastases resection. Eur J Surg Oncol 2019. [DOI: 10.1016/j.ejso.2018.10.448] [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: 11/29/2022] Open
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38
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Martin ML, Zeng Z, Adileh M, Jacobo A, Li C, Vakiani E, Hua G, Zhang L, Haimovitz-Friedman A, Fuks Z, Kolesnick R, Paty PB. Logarithmic expansion of LGR5 + cells in human colorectal cancer. Cell Signal 2017; 42:97-105. [PMID: 28958617 DOI: 10.1016/j.cellsig.2017.09.018] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [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: 07/28/2017] [Accepted: 09/23/2017] [Indexed: 12/17/2022]
Abstract
Stem cells of the small and large intestine are marked by expression of the Wnt target gene LGR5, a leucine-rich-repeat-containing G protein-coupled receptor. Previous studies reported increased expression of LGR5 in human colorectal cancer (CRC) compared to normal tissue either by immunohistochemistry or in situ hybridization (ISH). However, as these studies were semi-quantitative they did not provide a numerical estimate of the magnitude of this effect. While we confirm that LGR5+ cells are exclusively located at the base of normal human small and large intestinal crypts, representing approximately 6% of total crypt cells, we show this cell population is 10-fold expanded in all grades of CRC, representing as much as 70% of the cells of tumor crypt-like structures. This expansion of the LGR5 compartment coincides with maintenance of crypt-like glandular structure (adenomas, and well and moderately differentiated adenocarcinomas), and is reduced in poorly differentiated CRC, where crypt-like glandular architecture is lost, accompanied by reduced epithelial terminal differentiation. Altogether these results indicate that LGR5+ cell expansion is a hallmark of CRC tumorigenesis occurring during progression to adenoma, supporting CRC as a stem cell disease with implications for CRC therapy.
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Affiliation(s)
- Maria Laura Martin
- Laboratory of Signal Transduction, Memorial Sloan-Kettering Cancer Center, New York, NY 10065, USA; Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY 10065, USA
| | - Zhaoshi Zeng
- Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY 10065, USA
| | - Mohammad Adileh
- Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY 10065, USA
| | - Adrian Jacobo
- Howard Hughes Medical Institute, Laboratory of Sensory Neuroscience, The Rockefeller University, 1230 York Avenue, New York, NY 10065, USA
| | - Christy Li
- Laboratory of Signal Transduction, Memorial Sloan-Kettering Cancer Center, New York, NY 10065, USA
| | - Efsevia Vakiani
- Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY 10065, USA
| | - Guoqiang Hua
- Laboratory of Signal Transduction, Memorial Sloan-Kettering Cancer Center, New York, NY 10065, USA; Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY 10065, USA
| | - Lixing Zhang
- Laboratory of Signal Transduction, Memorial Sloan-Kettering Cancer Center, New York, NY 10065, USA; School of Life Sciences and Biotechnology, Shanghai Jiaotong University, Shanghai 200030, China
| | | | - Zvi Fuks
- Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY 10065, USA
| | - Richard Kolesnick
- Laboratory of Signal Transduction, Memorial Sloan-Kettering Cancer Center, New York, NY 10065, USA.
| | - Philip B Paty
- Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY 10065, USA.
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Dux J, Rayman S, Shachar Y, Adileh M, Shapiro R, Zippel D, Ben-Yaakov A, Shacham-Shmueli E, Aderka D, Venturero M, Nissan A. 709. Metastases to surgical scars from primary operation for intraabdominal malignancies, revisited during secondary cytoreductive surgery for recurrent peritoneal disease. Eur J Surg Oncol 2016. [DOI: 10.1016/j.ejso.2016.06.367] [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: 11/30/2022] Open
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