Multiparametric flow cytometric analysis of estrogen receptor: a study on Egyptian breast cancer patients

Precise prognostication of breast cancer based on immunohistochemical features is a challenging assay. Thus, there is a need for more sophisticated prognostic determinants. This work aims to investigate the sensitivity of flow cytometry for the accurate evaluation of steroid receptor positive, tumor cells in formalin-fixed paraffin embedded tissue sections. These sections from forty breast cancer patients were subjected to multiparametric flow cytometric analysis for simultaneous assessment of estrogen receptor and DNA content analysis as well as immunohistochemical staining for steroid receptors. Moreover, tumor markers were estimated in the preoperable sera of these patients. About fifty seven percent of tumors were aneuploid. Seven tumors were interpreted positive for ER by FCM and negative by IHC. Flow cytometric results were confirmed by the traditional prognostic factors. Higher levels of insulin-like growth factor-1 occurred predominantly in aneuploid tumors with lymph nodal metastasis and positively immunostained for both estrogen and progesterone receptors. Multiparametric flow cytometric analysis may allows the detection of specific subset of patients that would otherwise escapes detection

Outcome of surgical management of adenocarcinoma of esophagogastric junction

Adenocarcinoma of the esophagogastric junction [AEG] is a challenging disease for the surgeon. Because of its borderline location, the choice of surgical strategy is controversial. Efforts are currently directed to select patients who may benefit from extensive resection. Therefore, we carried out this prospective study to evaluate the outcome of surgical treatment based on Siewert's classification. From January 2004 to December 2006, 36 patients with AEG underwent resection. The choice of surgical approach was based on the location of the tumor center. The treatment of choice was esophagectomy and proximal gastrectomy for type I tumors and extended gastrectomy and distal esophagectomy for type II and III tumors. The outcome of surgery and prognostic factors were analyzed. Fourteen out of the 36 AEG cases [39%] were diagnosed as having type I tumors, twelve [33%] had type II and 10 [28%] had type Ill AEG tumors. Esophagectomy with proximal gastreetomy was carried out in all patients with type I tumors. Eleven patients with type I tumors underwent transhiatal resection while 3 patients underwent transthoracic resection. All type III tumor patients underwent transabdominal resection by total gastrectomy with transhiatal resection of the distal esophagus. The extent of surgery for type II tumors was the same as type III however, ten patients had a transabdominal resection, while one patient had a thoracotomy and another patient underwent transhiatal esophagectomy. The overall 2-year survival rate was 33.3%. Survival rate was significantly associated with pT stage, pathological node-positive category and tumor stage. Postoperative 30-day mortality and morbidity rates were 30.5%, 36.1%; respectively. Siewert's classification provides a useful tool for selecting the surgical approach but should be tailored to individual patients to achieve R0 resection. Survival is still largely stage dependent and earlier diagnosis holds the key to improve prognosis

Nerve sparing total mesorectal excision for rectal cancer: impact on oncologic results and urogenital functions

The goal of this study was to evaluate the practicability of Total mesorectal excision [TME] and Autonomic nerve preservation [ANP] for patients with rectal cancer, together with their impact on local failure rates and urinary and sexual functions. Surgery for rectal cancer continues to develop towards the ultimate goals of improving local control and overall survival, maintaining quality of life, and preserving sphincter, genitourinary and sexual function. During the planning and conduct of a radical operation for rectal cancer, a number of surgical issues have recently emerged and should be considered. These include: [1] TME; [2] ANP; [3] circumferential resection margin [CRM]; [4] distal resection margin [DRM] and [5] postoperative quality of life. This study was conducted between May 2002 and October 2006 at the department of surgery of the National Cancer Institute and included 50 patients with mid- and low-rectal cancer. Their mean age was 43.7 years. They were 17 males and 33 females. Tumors of the middle 1/3 of the rectum accounted for 54% of cases while those of the lower 1/3 represented 46%. Twenty seven patients had Low anterior resection [LAR] while 23 had Abdomino-perineal resection [APR], all of them with curative intent. These patients were divided into two groups: group A that included 30 patients subjected to subtotal mesorectal excision and that were studied retrospectively and group B that included 20 patients subjected to TME with ANP. Patients were followed up for a period ranging from 6 to 35 months with a median period of 13 months. In group B, median operative duration increased by 45 minutes in LAR and 30 minutes in APR. Blood loss and hospital stay were also higher in group B. Wider CRM and DRM could be achieved in group B. In group A, 20% developed local recurrence of their disease while none of the patients of group B showed recurrence. The postoperative complication rate in group A was 20% whereas in group B it rose to 45%. Postoperatively, 50% of patients in group A and only 15% in group B expressed urinary dysfunction. Abnormal uroflowmetry parameters were found in 33.3% of patients in group A and only 10% of patients in group B. Maintained sexual activity after surgery was noted in only 50% patients in group A while in group B it was maintained in 80% of them. TME with ANP is a tedious procedure requiring painstaking training and it is associated with a higher morbidity rate. Nevertheless the advantages of this technique are so evident as regards the decrease in local recurrence rates and the improvement in voiding and sexual functions that it deserves to be considered as the standard treatment for these tumors