Extra-gastrointestinal stromal tumor of the pancreas: A case report.

INTRODUCTION: Gastrointestinal stromal tumors (GIST) represent the most common mesenchymal tumors of the gastrointestinal tract. In rare cases, these tumors do not develop in the gastrointestinal tract and are defined as extra-gastro-intestinal stromal tumors (EGISTs). Pancreatic EGIST is extremely rare. We reported a case of EGIST of the pancreas in a 53-year-old patient. PRESENTATION OF CASE: A 53-year-old man presented with chronic epigastralgia. An enhanced CT scan showed a solido-cystic tumor of the pancreatic body-tail. The patient underwent a laparotomy. Cytology fine needle aspiration did not find any tumor cells. Enucleation was performed. Histopathology and immunohistochemical examination confirmed the diagnosis of EGIST (CD117 +, Dog-1 +) with a high risk of malignancy. The patient received adjuvant therapy. There was no evidence of disease recurrence after 8 months of follow-up. CLINICAL DISCUSSION: We reported a rare case of a pancreatic EGIST. Enucleation was performed permitting to avoid distal pancreatectomy and thus decreasing morbidity rates. The clinical presentation is not specific and it depends on the location and the size of the tumor. CT scan shows hypervascular tumors with no regional lymph nodes metastasis but is not accurate in assessing diagnosis. Whenever possible, enucleation should be performed. This tumor should be considered in the differential diagnoses of pancreatic neoplasms. CONCLUSION: Pancreatic stromal tumor is extremely rare. There are no specific clinical and radiologic findings. A careful decision should be made after a discussion in a multidisciplinary coordination meeting. Surgical resection is the cornerstone of the treatment. Whenever possible, enucleation is sufficient.

5-mFI is more accurate than ASA score in predicting postoperative mortality in rectal cancer: A case series of 109 patients.

Introduction: The aim of this study was to compare the accuracy of 5-mFI (modified frailty index) to ASA score (American Society of Anesthesiologists score) in predicting postoperative mortality in patients with rectal cancer. Materials and methods: The ability of each parameter to predict postoperative mortality was attested in 2 ways: Area under the curve (AUC) was determined using ROC curves analysis. A comparison of AUC was performed using Delong test and Henley-McNeil test.-Multivariate analysis to determine the weight of each variable in predicting postoperative mortality. Results: The records of 109 patients undergoing surgical resection, for curative intent, for rectal cancer, were analyzed. Nine patients died during the 30-day postoperative period (8.25%). The optimum cutoff for 5-mFI to predict mortality using the ROC analysis was 1.5. The AUC at the cut-off point was 0.93. The optimum cutoff for ASA score to predict mortality was 1.5 and the AUC at the cut-off point was 0.81. The AUC of 5-mFI was significantly higher than the AUC of ASA score (p < 0.0001 using Delong test and p = 0.0024 using Hanley and McNeil test).On univariate analysis, predictive factors of mortality were: age (p = 0.002), ASA score≥2 (p = 0.0001) and 5-mFI≥2 (p = 0.0001). On multivariate analysis, 5-mFI≥2 was the only factor significantly associated with increased odds of postoperative mortality (OR = 1.73; 95% CI 1.05-2.01). Conclusion: 5-mFI was more accurate than ASA score in predicting postoperative mortality in patients with rectal cancer.

[Predictive factors of maintain of employment and return to work after cancer]. / Facteurs prédictifs de maintien en emploi et de retour au travail après un cancer.

BACKGROUND: Return-to-work after cancer depends on several factors related to the disease but also other socio-professional factors. The primary aim of this study was to identify socio-demographic, disease related and professional factors influencing the return-to-work process. METHODS: It was a prospective and descriptive study reporting the return-to-work process in 89 cancer patients, in a professional activity age, who had cancer treatment and a follow up in the Oncology department in Tahar Maamouri Teaching Hospital of Nabeul, between September 2015 to December 2019. RESULTS: Our study included 89 patients. Mean age was 45 years±8. The population was predominantly feminine (59 %). They were employees in 45 % of cases. Private professional sectors included 60 % of all patients. An open-ended contract was performed in 87 % of cases. Most frequent primary tumors were breast tumors (45 %) and colon tumors (20 %). Thirty-four patients went back to work after recovery. Seventy-nine percent of them were female patients and 70 % had breast cancer. Predictive factors identified in univariate statistical analysis and correlated to return-to-work were gender (P=0.002), occupation (P<10-3), initial duration off sick (P=0.015), fitting out measures at work (P=0.01), primary tumor origin (P=0.01), disease stage (P=0.037), treatment (P=0.014) and disease outcome after treatment (P=0.024). CONCLUSION: Our study underlined a need to create a pluridisciplinary platform unifying collaborators among oncologists and occupational health professionals in order to enhance professional reintegration process and to hold patient's professional equilibrium after cancer recovery.