The current role of surgery in the treatment of cardiac metastases from malignant melanoma: an educational presentation

Abstract A 71 year-old male with a history of multiple excisions of an initial Clark's level V melanoma of the breast followed by combined radiation and interferon treatment, as well as a recurrence, 3 years later, of a BRAF-positive tumor of the shoulder, with subsequent therapy with dabrafenib and trametinib, presented again with progressive intracardiac masses causing significant right ventricular outflow obstruction. Additionally, the patient complained of dyspnea and fatigue on exertion, thus he was scheduled for surgical resection.

Relationship between BRAFV600E mutation and metastasis after thyroidectomy in papillary thyroid carcinoma with different recurrence risk stratification / 中华核医学与分子影像杂志

Objective@#To investigate the relationship between V-raf murine sarcoma viral oncogene homologue B1 (BRAF)V600E mutation and metastasis after thyroidectomy in papillary thyroid carcinoma (PTC) with different recurrence risk stratification.@*Methods@#From March 2014 to September 2017, 134 PTC patients (45 males, 89 females; age: 16-72 years) who underwent 131I treatment in the Department of Nuclear Medicine of Liaocheng People′s Hospital and had undergone BRAFV600E mutation detection were retrospectively analyzed. The recurrence risk during surgery was divided into 3 levels: low-, medium- and high-risk. Each recurrence risk group was divided into 3 subgroups according to the postoperative follow-up results: non-metastasis group, cervical lymph node metastasis group and pulmonary metastasis group. BRAFV600E mutation rates in different groups were compared (χ2 test).@*Results@#The BRAFV600E mutation rate was 55.22%(74/134) in 134 PTC patients. The mutation rates were not significantly different in the 3 metastasis subgroups for low-risk patients (n=46; χ2=2.39, P>0.05). In medium-risk patients (n=47), the mutation rate in neck lymph node metastasis group (16/19) was higher than that in pulmonary metastasis group (3/8) and non-metastasis group (25.00%, 5/20; χ2 values: 5.89 and 13.75, both P<0.05), while there was no difference between pulmonary metastasis group and non-metastasis group (χ2=0.44, P>0.05). In high risk patients (n=41), the mutation rate in neck lymph node metastasis group (85.00%, 17/20) was higher than that in the pulmonary metastasis group (5/13) and non-metastasis group (1/8; χ2 values: 7.68 and 13.08, both P<0.01), while there was no difference between pulmonary metastasis group and non-metastasis group (χ2=1.64, P>0.05).@*Conclusion@#The BRAFV600E mutation is closely related to neck lymph node metastasis after operation in middle- and high-risk patients with PTC, but it does not significantly increase the probabilities of neck lymph node metastasis in low-risk patients and pulmonary metastasis in low-, medium- and high-risk patients.

De novo malignancies after liver transplantation / 中华普通外科杂志

ObjectiveTo investigate the incidence of de novo malignancies in liver transplantation recipients.MethodsWe retrospectively assessed data of 475 patients undergoing liver transplantation from May 2000 to December 2008. ResultsAmong the 475 recipients followed-up for 6 months at minimum,5 patients developed de novo malignancy and the total incidence rate was 1.1％.The median elapsed time from transplant to the diagnosis of de novo malignancy was 14 months (range 6 to 72).The patients were all males,including one of rectal cancer which was cured by radical resection,2 of hepatocellular carcinoma who died 6 and 14 months respectively after the diagnosis,1 of neuroendocrine carcinoma of the lung dying after 16 months,1 of Bukitt lymphoma who died within 2 months.Conclusions De novo malignancy is an uncommon event in liver transplantation recipients,but the outome is very poor.

Extrahepatic recurrence after curative resection of hepatocellular cancer / 中华普通外科杂志

Objective To investigate the risk factors of extrahepatie recurrences after curative resection of primary hepatocellular carcinoma (HCC). Methods Clinicopathologic data of 238 curative resected cases of primary HCC were retrospectively reviewed for parameters affecting postoperative extrahepatic recurrences. Results During a median follow-up of 34 months (7 - 78 months), extrahepatic recurrences were observed in 32 out of 238 patients (13.4%). According to univariate analysis, the risk factors for extrahepatic recurrences were preoperative serum a-fetoprotein (AFP) level of > 1000 ng/ml,aspartate aminotransferase level of > 50 IU/L, presence of hepatic vein invasion, neighboring organ invasion, tumor satellites, and lack of tumor capsule formation. Preoperative serum AFP levels of > 1000 ng/ml, hepatic vein invasion, neighboring organ invasion proved to be independent risk factors by multivariate analysis. Conclusions Extrahepatic recurrences after curative resection of HCC was found to be related to preoperative serum AFP level of > 1000 ng/ml, hepatic vein invasion, and neighboring organ invasion.

Late local-regional recurrence of nasopharyngeal carcinoma after conventional radiotherapy / 中华放射肿瘤学杂志

Objective To investigate the local-regional recurrence of nasopharyngeal carcinoma (NPC) 5 years after conventional radiotherapy and its prognosis.Methods From August 1989 to Decem ber 1999,1384 patients with newly histo-pathologicatly diagnosed NPC were treated with conventional radia tion.350 out of 1277 followed-up patients were diagnosed as local-regional failure.The intervals between completion of radiation and tumor relapse ranged from 6 months to 171 months.There were 62 patients with local-regional recurrence 5 years after the radiotherapy,including 41 in nasopharynx,19 in neck and 2 in na sopharynx and neck simultaneously.Thirty-seven patients with late local-regional recurrence received a sec ond course conventional radiotherapy.Results The median survival time was 44 months(95% CI = 30.4 -57.6) of patients with re-irradiation comparing with 14 months (95% CI = 7.1-20.8) of those without. The 5 year survival rate after re-irradiation was 42%.Conclusions Local-regional recurrence of nasopha ryngeal carcinoma can oeoure 5 years after radiotherapy.Second course converntional radiotherapy possesses good results.

Clinical research of intraperitoneal ehemohyperthermia with NRL-002 double RF tumor hyperthermia system on recurrent ovarian cancer / 肿瘤研究与临床

Objective To study the efficacy of intraperitoneal chemohyperthermia with Double RF Tumor Hyperthermia System on recurrent ovarian cancer. Methods 22 cases of advanced recurrent ovarian cancer were infused with hot NS and DDP and VP16 in abdominal cavity, NRL-002 double RF Tumor Hyportherrnia System was applied to heat the abdominal part for 60-120 minutes. RF hyperthermia was given twice per week and chemotherapy once per week. Results The overall response rate (CR+PR) was 63.6%. The serum CA125 ratio was decreased significantly. The level of CD4/CD5 and NK cells was higher than that of pretherapy after management. The clinical beneficial response(CBR) was 81.8%. The median TIP and MST were 7.8 mouth and 18.5 month. Conclusion Intraperitoneal ehemohyporthermia with NRL-002 Double RF Tumor Hyperthermia System was an effective way to treat advanced recurrent ovarian cancer. It Can also improve life quality of patients with mild adverse effect and recommended to be applied clinically.

Analysis of the prognostic factors affecting postoperative recurrence and progression in patients with superficial bladder transitional cell carcinoma / 中国基层医药

Objective To evaluate the prognostic factors affecting postoperative recurrence and progression in patients with superficial bladder transitional cell carcinoma(SBTCC). Methods From 2000 to 2004,150 patients with SBTCC were treated, of which 120 patients were followed up. The possible prognostic factors including clinical and pathological figures were analyzed by Cox's proportional hazard model in these patients. Results The mean fol-low-up period was 84.7 months. The recurrence rates at 3-year,5-year were 27.5% and 36.7% respectively. The main variables affecting recurrence were histological grades,tumor stage,tumor number and recurring tumor,and the first three were the independent risk factors. The progression rotes at 3-year,5-year were 9. 2% and 17.5%. The main variables affecting progression were histological grade,tumor stage, tumor number and recurring tumor, and the first one was the independent risk factor. Conclusion The main variables affecting progression were histological grade, tumor stage,tumor number and recurring tumor,and the first one were the independent risk factor.

125Ⅰ prevents local cancer recurrence after hepatectomy / 中华普通外科杂志

Objective To investigate the therapeutic effectiveness of residue liver embedding of iodine-125 on recurrence after hepatectomy in hepatocellular carcinoma patients. Methods In this study, 85 cases with resectable hepatocellular carcinoma were collected and divided into two groups randomly: intrahepatic embedding of iodine-125 group and control group. The serum values of T lymphocyte phenotypes (CD3 + CD4 + ,CD8 +), NK cells,TB IL, ALT, AST, AFP and MMP-9 were measured in all patients 1 day before and 7, 30 days after the operation respectively; B ultrasonic and CT were used to detect for intrahepatic dissemination and recurrence of HCC after hepateetomy. All patients were followed-up from 16 to 55 months (average 35.4 months). Results Surgery were successful in all cases. There were no difference in T lymphocyte phenotypes, NK cells, TBIL, ALT and AST between the two groups (P＞0.05). The serum values of AFP and MMP-9 were much lower in the intrahepatic embedding of iodine-125 group than the control group(P<0.05). In iodine-125 embedding group, the 0.5-, 1-year recurrent rates were 2.3%、6.9%, respectively, compared with 14.2% and 26.1%, respectively, in control group (all P<0.05). Conclusions Intrahepatic embedding of iodine-125 in HCC patients after hepatectomy decreases values of AFP, MMP-9 and local cancer recurrence rate in HCC patients after hepatectomy.

Covered Self-Expandable Metallic Stent Placement for a Post-operative Malignant Anastomotic Stricture Secondary to Recurrent Gastric Cancer

PURPOSE: To evaluate the technical feasibility and clinical effectiveness of stent placement for the treatment of a post-operative malignant anastomotic stricture secondary to recurrent gastric cancer. MATERIALS AND METHODS: Under fluoroscopic guidance, one or two covered stents were placed in 20 consecutive patients (age range, 44-75 years) with an anastomotic stricture due to a recurrent gastric malignancy. Before stent placement, all patients had severe nausea and recurrent vomiting after ingestion. RESULTS: Stent placement was technically successful for all patients, and no procedural complications occurred. After stent placement, 18 of 20 (90.0%) patients were able to ingest at least a liquid diet and had a markedly decreased incidence of vomiting. During the follow-up of 2-116 weeks (mean, 25.5 weeks), stent migration occurred in two patients (10.0%) on one day after the procedure. All patients with stent migration were treated successfully by means of placing a second stent. Three patients showed a recurrence of the stricture due to tumor overgrowth; two of the patients were treated with coaxial placement of a second stent. Another patient refused additional management. CONCLUSION: Covered self-expandable metallic stent placement seems to be technically feasible and effective for palliative treatment of a post-operative malignant anastomotic stricture secondary to recurrent gastric cancer.

The cause,prevention and treatment strategy of local recurrence after operation for rectal carcinoma / 中国普通外科杂志

Objective To discuss the causes,the methods of intraoperative prevention and treatment of local recurrence in patients after operation for rectal carcinoma.Methods Fifty-two re-operated patients with local recurrence of rectal carcinoma were analyzed retrospectively.Results In these 52 patients,there were 14 patients with perianus and pelvic cavity recurrence,31 patients with stoma recurrence,4patients with vaginal wall recurrence,2 patients with prostate gland recurrence and 1 patient with implantation in the incision of abdominal wall.Among them,36 patients underwent radical operation,13 patients had palliative resection and 3 patients were treated by enterostomy.The median survival time for the groups who underwent radical(operation) and palliative resection was 33.5(12~80) months and 12(3~23) months respectively.(Conclusions) Patients with local recurrence of rectal cancer should still be given aggressive operative(treatment).Radical resection of the lesions and formal radical lymphadenectomy can prolong patient survival time and improve quality of life.