Analysis of perioperative efficacy and safety of cytoreductive surgery in the treatment of colorectal cancer peritoneal metastases / 中华胃肠外科杂志

Objective: To analyzed perioperative safety of cytoreductive surgery (CRS) for patients with colorectal cancer peritoneal metastasis (CRPM) and to construct a predictive model for serious advese events (SAE). Methods: A descriptive case-series study was conducted to retrospectively collect the clinicopathological data and treatment status (operation time, number of organ resection, number of peritoneal resection, and blood loss, etc.) of 100 patients with peritoneal metastases from colorectal cancer or appendix mucinous adenocarcinoma who underwent CRS at the Sixth Affiliated Hospital of Sun Yat-sen University from January 2019 to August 2021. There were 53 males and 47 females. The median age was 52.0 (39.0-61.8) years old. Fifty-two patients had synchronous peritoneal metastasis and 48 had metachronous peritoneal metastasis. Fifty-two patients received preoperative neoadjuvant therapy. Primary tumor was located in the left colon, the right colon and the rectum in 43, 28 and 14 cases, respectively. Fifteen patients had appendix mucinous adenocarcinoma. Measures of skewed distribution are expressed as M (range). Perioperative safety was analyzed, perioperative grade III or higher was defined as SAE. Risk factors associated with the occurrence of SAEs were analyzed using multivariate logistic regression. A nomogram was plotted by R software to predict SAE, the efficacy of which was evaluated using the area under the ROC curve (AUC) and correction curves. Results: The median peritoneal cancer index (PCI) score was 16 (1-39). Sixty-eight (68.0%) patients achieved complete tumor reduction (tumor reduction score: 0-1). Sixty-two patients were treated with intraperitoneal hyperthermic perfusion chemotherapy (HIPEC). Twenty-one (21.0%) patients developed 37 SAEs of grade III-IV, including 2 cases of ureteral injury, 6 cases of perioperative massive hemorrhage or anemia, 7 cases of digestive system, 15 cases of respiratory system, 4 cases of cardiovascular system, 1 case of skin incision dehiscence, and 2 cases of abdominal infection. No grade V SAE was found. Multivariate logistic regression analysis showed that CEA (OR: 8.980, 95%CI: 1.428-56.457, P=0.019), PCI score (OR: 7.924, 95%CI: 1.486-42.259, P=0.015), intraoperative albumin infusion (OR: 48.959, 95%CI: 2.115-1133.289, P=0.015) and total volume of infusion (OR: 24.729, 95%CI: 3.956-154.562, P=0.001) were independent risk factors for perioperative SAE in CRS (all P<0.05). Based on the result of multivariate regression models, a predictive nomogram was constructed. Internal verification showed that the AUC of the nomogram was 0.926 (95%CI: 0.872-0.980), indicating good prediction accuracy and consistency. Conclusions: CRS is a safe and effective method to treat CRPM. Strict screening of patients and perioperative fluid management are important guarantees for reducing the morbidity of SAE.

Carcinoma mucinoso de mama: experiencia de 10 años / Mucinous carcinoma of the breast: ten years experience

El carcinoma mucinoso es un carcinoma ductal invasor de bajo grado de malignidad que se caracteriza por células tumorales inmersas en cúmulos de moco extracelular. Representa el 1% al 7% de todos los cánceres de mama, siendo más frecuente en mujeres mayores. Conocer las características clínicas, factores pronósticos, variedades histológicas, tratamiento aplicado y sobrevida global en pacientes con el diagnóstico de carcinoma mucinoso de mama en el Instituto de Oncología “Dr. Miguel Pérez Carreño”. Estudio descriptivo, transversal, pacientes con el diagnóstico de carcinoma mucinoso de mama vistos entre los años 2002-2011. Se evaluaron las historias clínicas de 17 pacientes, encontrando que el grupo etario más afectado es el de 36-45 años con un 29,4%, la mama con mayor afectación fue la izquierda con un 58,8%, el nódulo palpable fue el síntoma predominante, el cuadrante mayormente afectado fue el súpero externo en un 41,20%, el estadio IIA fue el más frecuente 41,17%, carcinoma mucinoso puro se encontró en 94,11%. El diagnóstico inmunohistoquímico de luminal A fue el de mayor incidencia en 54,54% de los pacientes, 47,05% recibió neoadyuvancia, 76,47% se le practicó una mastectomía radical modificada. 41,7% pacientes presentaron una supervivencia global a los 10 años. Carcinoma mucinoso de mama es una entidad poco frecuente que muestra altas tasas de cura y control con un adecuado tratamiento.

The mucinous carcinoma is invasive ductal carcinoma of low grade malignancy is characterized by tumor cells embedded in extracellular clumps of mucus. They represent 1% to 7% of all breast cancers, are most frequently in older women. Determine the clinical characteristics, prognostic factors, the histological types, the treatment applied and the overall survival in patients with the diagnosis of mucinous carcinoma of breast, viewed at the Oncology Institute “Dr. Miguel Pérez Carreño”. We realized a descriptive study of patients with the diagnosis of mucinous breast carcinoma viewed between the years 2002-2011. We evaluated the medical records of 17 patients and found that the age group most affected is the 36-45 years old with 29.4%, the most affected breast was the left with 58.8%, the palpable nodule was the predominant symptom, the most affected quadrant was the upper outer in a 41.20%, stage IIA was the most predominate, 41.17% pure mucinous carcinoma was found in 94.11%, the immunohistochemistry diagnosis of luminal A was the most prevalent in 54.54% of the patients. 47.05% of all the patients received neoadjuvant treatment, 76.47% were practicing modified radical mastectomy. 41.7% patients had an overall survival at 10 years. The mucinous carcinoma of the breast is a rare entity showing high rates of cure and control with a proper and adequate treatment.

Postoperative chemoradiation in patients with localized gastric adenocarcinoma: Single center experience.

Background : 5-Flourouracil (FU)-based chemotherapy (CT) and concurrent 45 Gy radiotherapy (RT) is one of the standard postoperative approaches currently used in gastric carcinoma. The high toxicity rates of this treatment leads to interruption of treatment in the majority of patients. In our study, we investigated the rates of toxicity and treatment discontinuation observed during postoperative FU-based chemoradiotherapy (CRT); retrospectively evaluated the effect of CRT and the other prognostic factors on local and distant control and survival. Patients and Methods: A total of 160 patients consisting of 97 total and 63 subtotal gastrectomy receiving postoperative CRT, have been studied retrospectively. Results : Patients who had to discontinue the treatment for a median of 6 (range, 3-13) days experienced toxicity during treatment at a rate of 43%. During the 21 (range, 4-68) months of follow-up local recurrences were observed in 8 (5%) patients and distant recurrences were observed in 41 (25.6%) patients. While the 1-3 year overall survival (OS) rates were 75% and 42%, 13-year disease-free survival (DFS) rates were 63% and 42%, respectively. In the univariate analysis for OS and DFS demonstrated statistical significance for below those 60 years of age, D1-D2 dissection type, negative surgical margin, early treatment beginning, the absence of invasion, and early stage disease. D1D2 dissection type, early treatment begining, age below 60 years and early stage disease significantly improve OS and DFS in multivarite analysis. Conclusions: Survival is worse in patients older than 60 years, had late treatment begining, advanced stage and D0 dissection.

Ocorrência sincrônica de carcinoma mucinoso microinvasivo em mama esquerda e linfoma em axila direita / Synchronous ocurrence of microinvasive mucinous carcinoma in left breast and lymphoma in right axilla

Os linfomas correspondem a 3,5% das neoplasias malignas em mulheres. O carcinoma mucinoso invasivo corresponde entre 2 a 4% dos cânceres mamários. No presente artigo, relata-se o diagnóstico, o tratamento e a evolução de um caso raro de ocorrência sincrônica de carcinoma mucinoso microinvasivo em mama esquerda e linfoma de células B em axila direita.

Lymphomas account for 3.5% of all cancers in women. Invasive mucinous carcinoma accounts from 2 to 4% of breast carcinomas. In this paper, we report the diagnosis, treatment and outcome of a rare case of synchronous occurrence of microinvasive mucinous carcinoma in the left breast, and B-cell lymphoma in the right axilla.

Adenocarcinoma produtor de mucina primário do apêndice: relato de caso e revisäo da literatura / Mucinous adenocarcinoma of appendix: report of case and literature review

Os autores descrevem caso clínico de pacientes com diagnóstico de adenocarcinoma primário de apêncie e revisäo bibliográfica, dando ênfase aos aspectos clínicos, terapêuticos e prognósticos

Tratamento conservador de pseudomixoma peritonial

O pseudomixoma peritoneal e uma entidade clinica rara caracterizada por ascite gelatinosa relacionada com certa frequencia ao adenocarcinoma mucoprodutor do apendice ou ovario, de tratamento eminentimente cirurgico. A evolucao desfavoravel e geralmente devida a obstrucao intestinal causada pelo muco abdominal e complicacoes pos-operatorias. Alternativas terapeuticas nao operatorias poderiam contribuir para diminuir a mortalidade cirurgica. A revisao bibliografica, analisando diversas modalidades terapeuticas foi realizada, estimulando a verificacao do efeito mucolitico da glicose a 2,5 por cento, que no presente caso com pseudomixoma peritoneal e hernia umbilical operado tres comprovou-se de grande eficiencia.

Carcinoma de úraco / Carcinoma of urachus

Os autores apresentam o relato de caso de um paciente portador de Carcinoma de Uraco. Esta rara afecçäo foi obsevada em paciente do sexo masculino, com 30 anos de idade, em que o diagnóstico foi confirmado pela laparotomia e achado histopatológico. Esta patologia tem um prognóstico ruim, mesmo quando tratado com cirurgia radical precoce. Foram relatados cerca de 161 casos na literatura nos últimos anos, somente com cirurgia ou em combinaçäo com Radioterapia, ambos com resultados uniformemente pobres. A taxa de sobrevida em cinco anos é muita baixa (menos de 10 por cento dos casos)

Cáncer del colon en la infancia: presentación de dos casos / Cancer of the colon in childhood: report of 2 cases

Se presentan los hallazgos clínico-patológicos de dos casos de adenocarcinoma de tipo mucinoso, en dos niños. En uno de los casos la evolución ha sido satisfactoria, encontrándose aparentemente libre de la enfermedad, luego de 18 meses de haber sido intervenido. En el otro caso no se tienen datos de su evolución actual. Se revisa la literatura tomando en cuenta las diferentes series de casos registrados en las tres primeras décadas de la vida y se coincide en la baja incidencia de esta neoplasia en niños y adolescentes. Se hacen algunas consideraciones respecto a la clínica, factores epidemiológicos, anatomía-patológica, pronóstico y tratamiento