Adjuvant Chemotherapy for Stage II and III Colon Cancer Following Complete Resection: A Cancer Care Ontario Systematic Review.

The objective of this systematic review was to provide current evidence regarding the use of adjuvant systemic chemotherapy for stage II and III colon cancer following curative intent surgery. MEDLINE and EMBASE databases and proceedings of American Society for Clinical Oncology and European Society of Medical Oncology/European Cancer Congress were searched through to August 2015. Systematic reviews (with or without meta-analyses) and randomised controlled trials were included. Patients with completely resected stage III colon cancer have an overall survival benefit from adjuvant chemotherapy. Combination chemotherapy (5-fluorouracil/leucovorin/oxaliplatin or capecitabine/oxaliplatin) provides a larger benefit than monotherapy but with additional toxicity. For stage II colon cancer, a clear overall survival benefit has not been shown. However, based on the subgroup analysis available, patients with high-risk stage II disease may benefit from adjuvant chemotherapy. Patients younger than 70 years of age may derive greater disease-free survival and overall survival benefit from adjuvant chemotherapy (in combination with oxaliplatin) compared with those older than 70 years. Stage II patients with microsatellite instability may have an overall survival detriment if given adjuvant chemotherapy.

Patient-centered quality of life measures after alloplastic temporomandibular joint replacement surgery.

The purpose of this study was to evaluate patient-reported outcome measures of quality of life (QoL) for patients with end-stage temporomandibular joint (TMJ) disease who have undergone TMJ prosthetic replacement. The records of 36 patients who had undergone alloplastic total joint replacement procedures were analyzed. Patients were treated using either TMJ Concepts or Biomet/Lorenz prosthetics. Patients were asked to complete a 12-item TMJ-S-QoL survey, which encompassed questions pertaining to pain, speech, chewing function, and various aspects of social life and mental health. The questions were answered on a 5-point scale. Data were analyzed using the Wilcoxon signed-rank test. Among the 36 patients (six male and 30 female), 18 responded to the survey. Markers of QoL after surgery were compared to the preoperative period. Significant improvements were reported for pain (94.4% of patients), chewing (83.3% of patients), speech (55.6% of patients), anxiety (72.2% of patients), activity (66.7% of patients), recreation (61.1% of patients), and mood (66.7% of patients) (all P<0.05). TMJ prosthetic replacement significantly enhanced QoL among patients suffering from chronic pain, limited range of motion, anxiety, impaired speech, and chewing due to end-stage TMJ disease in this sample of surgical patients.

The neutrophil-to-lymphocyte ratio predicts major perioperative complications in patients undergoing colorectal surgery.

AIM: The objective of the study was to evaluate the association between the neutrophil-to-lymphocyte ratio (NLR) and the occurrence of perioperative complications in patients undergoing colorectal surgery. METHOD: A retrospective cohort study was conducted of patients who underwent resection for suspected or confirmed colorectal cancer from 2004 to 2012. Patient cohorts with a high vs low NLR were defined by receiver operating characteristic curve analysis. Univariate and multivariate logistic regression was used to determine whether patients with elevated NLR were more likely to suffer perioperative complications. RESULTS: In all, 583 patients were included. A preoperative NLR greater than or equal to 2.3 was significantly associated with a major perioperative complication (OR 2.52, 95% CI 1.26-5.01). On multivariate analysis, a high NLR (OR 2.25, 95% CI 1.12-4.52) and Charlson Comorbidity Index ≥ 3 (OR 4.55, 95% CI 2.17-9.56) were significantly related to major morbidity. No relationships were found between an elevated preoperative NLR and complication type, although there was a trend towards the occurrence of anastomotic leakage. CONCLUSION: Preoperative NLR ≥ 2.3 may be a risk factor for major surgical complications following colorectal resection. Further study is needed to validate this threshold and evaluate the clinical implications of these findings.

Adjuvant systemic chemotherapy for stages II and III colon cancer after complete resection: a clinical practice guideline.

BACKGROUND: Updated practice guidelines on adjuvant chemotherapy for completely resected colon cancer are lacking. In 2008, Cancer Care Ontario's Program in Evidence-Based Care developed a guideline on adjuvant therapy for stages ii and iii colon cancer. With newer regimens being assessed in this patient population and older agents being either abandoned because of non-effectiveness or replaced by agents that are more efficacious, a full update of the original guideline was undertaken. METHODS: Literature searches (January 1987 to August 2015) of medline, embase, and the Cochrane Library were conducted; in addition, abstracts from the American Society of Clinical Oncology, the European Society for Medical Oncology, and the European Cancer Congress were reviewed (the latter for January 2007 to August 2015). A practice guideline was drafted that was then scrutinized by internal and external reviewers whose comments were incorporated into the final guideline. RESULTS: Twenty-six unique reports of eighteen randomized controlled trials and thirteen unique reports of twelve meta-analyses or pooled analyses were included in the evidence base. The 5 recommendations developed included 3 for stage ii colon cancer and 2 for stage iii colon cancer. CONCLUSIONS: Patients with completely resected stage iii colon cancer should be offered adjuvant 5-fluorouracil (5fu)-based chemotherapy with or without oxaliplatin (based on definitive data for improvements in survival and disease-free survival). Patients with resected stage ii colon cancer without "high-risk" features should not receive adjuvant chemotherapy. For patients with "high-risk" features, 5fu-based chemotherapy with or without oxaliplatin should be offered, although no clinical trials have been conducted to conclusively demonstrate the same benefits seen in stage iii colon cancer.

Long-term outcome of stenting as a bridge to surgery for acute left-sided malignant colonic obstruction.

AIM: This study aimed to evaluate both the short- and long-term outcomes associated with colonic stenting as a bridge to surgery in patients with obstructing adenocarcinoma of the colon. METHOD: Patients with potentially curable acute left-sided colonic obstruction treated with stenting as a bridge to surgery (n = 28) or with emergency surgical resection (n = 39) from January 1998 to December 2008 were identified from a prospectively maintained database. Short-term data on postoperative mortality, morbidity, necessity of intensive care and length of hospital stay were compared. Overall survival and disease-free survival were also analysed. RESULTS: Patients in the two study arms had similar demographic profiles. Those receiving preoperative stenting had a higher likelihood of a laparoscopic resection (P < 0.001). The emergency surgery group had a higher rate of postoperative complications (P = 0.024), rate of intensive care unit admission (P = 0.013) and longer total length of hospital stay (9 vs 12 days, P = 0.001). With a median follow-up of 26.5 and 31.3 months for the stenting and surgical resection groups, there was no difference in overall and disease-free survival (overall survival 30 vs 31 months, P = 0.858; disease-free survival 13 vs 12 months, P = 0.989). There was no difference in the rate of systemic recurrence (8 vs 13, P = 0.991). CONCLUSION: Stenting as a bridge to surgery is a safe strategy for acute left-sided colonic obstruction with improved short-term outcome and comparable long-term oncological results.

Pseudoaneurysm of the external carotid artery secondary to subcondylar fracture.

Arterial pseudoaneurysms are rare in oral and maxillofacial surgery, but when they occur, quick recognition and management is necessary to avoid devastating consequences. The authors report a case of a pseudoaneurysm of the external carotid artery that developed after open reduction and internal fixation of a mandibular condyle fracture.

The efficacy of bioresorbable fixation in the repair of mandibular fractures: an animal study.

PURPOSE: The efficacy of bioresorbable fixation has recently been described in the treatment of cranial vault deformities and in midfacial trauma. However, little to no data exist regarding its use in load-bearing areas. The purpose of this study is to analyze and compare the treatment of mandibular fractures by using a bioresorbable fixation system with a conventional titanium system in a canine model. MATERIALS AND METHODS: Four adult beagles constituted the experimental group (A), and 2 beagles constituted the control group (B). Both groups underwent extraoral iatrogenic left mandibular angle osteotomies/fractures and open reduction and internal fixation by use of a bioresorbable fixation system (A) or a titanium fixation system (B). All operated animals were allowed to function immediately. Lateral skull radiographs were obtained preoperatively, immediately postoperatively after reduction, and at 3- and 6-month intervals. Preoperative and 6-month follow-up bite registrations were taken. At the 3-month interval, 1 animal from the experimental group was killed, and at 6 months the remaining animals were killed for morphologic, radiographic, and histologic analysis of the fractured interface and screw sites. RESULTS: Morphologically, in the bioresorbable group, there was no clinical evidence of 1) intraoral/ extraoral incisional dehiscence of wound infection; 2) deviation of the occlusion from maximum intercuspation; 3) intraoral/extraoral palpability of the device; 4) mobility of the fractured segments on manual manipulation; or 5) malunion as visualized at the time of sacrifice. All bioresorbable plates were clinically absent after 6 months and associated with adequate fixation and healing. Adequate restoration of function was achieved in both groups, with all of the animals showing weight gain. Radiographically, good alignment of the inferior border was seen, and histologically bony union was apparent in all specimens. CONCLUSIONS: This bioresorbable fixation system is effective in the treatment of mandibular angle fractures in a dog model, despite being placed in a load-bearing region.

Infantile hemangioma of the accessory parotid gland.

Parotid gland tumors, especially those of the accessory parotid gland, are rare in infancy. Although infantile hemangiomas have been frequently reported as a cause of parotid gland tumors, their association with the accessory parotid gland has not been reported. This article describes the presentation of a hemangioma of the accessory parotid gland in an infant. Review of the literature and treatment methods are discussed.

Diamond fraise technique for dermal grafts in temporomandibular disk reconstruction.

Dermal grafts have been described for a variety of applications, including preprosthetic surgery, reconstructive surgery, and temporomandibular joint surgery. Several reports have described the procedural techniques for acquiring a dermal graft. The surgical technique for harvesting a dermal graft with the use of the dermabrading diamond fraise bur is described. The use of the diamond fraise bur offers many unique surgical advantages: it allows minimal damage to the dermal layer; the healing surface is smooth, cosmetic, homogenous, and devoid of scratches or debris; an adequate graft of uniform thickness is obtained; the technique allows access to a variety of donor sites; and minimal patient postoperative donor site morbidity. The use of this technique provides a simple, cosmetic approach to obtaining an adequate dermal graft for temporomandibular joint reconstructive procedures, while minimizing the potential complications associated with other commonly used techniques.

Early experience with biodegradable fixation for congenital pediatric craniofacial surgery.

We describe early experience using a polymeric bioresorbable bone fixation system in a consecutive series of eight pediatric patients for the correction of craniofacial malformations. Indications for surgical treatment included craniosynostosis (7) and encephalocele (1). All patients underwent bifrontal craniotomies with cranial vault or orbital reconstruction or both. Segments were then stabilized using bioresorbable fixation systems. Patients were evaluated pre- and postoperatively clinically and with radiographs and photographs. Mean follow-up was 4.5 months, with a minimum follow-up of 3 months. In seven of eight patients, there was no incidence of infection, extrusion, exposure, erythema, instability of the advanced segments, relapse, hematoma, seroma formation, or adverse inflammatory reaction. One patient experienced difficulty with respect to system imperfections (i.e., drill holes after tapping were too large for screws). This study demonstrated the efficacy of bioresorbable plates and screws for the growing pediatric craniofacial patient; excellent short-term results were achieved. Prospective studies and longer longitudinal follow-up of larger numbers of patients are desirable to confirm these findings.