Post-operative weight loss affects 3-year survival in patients with gastric adenocarcinoma after gastrectomy and hyperthermic intraperitoneal chemotherapy.

INTRODUCTION: Patients with advanced gastric adenocarcinoma are at high risk of malnutrition. Some patients benefit from total gastrectomy associated with hyperthermic intraperitoneal chemotherapy (HIPEC) with or without cytoreduction surgery (CR) as a curative strategy. The aim of this study was to describe pre- and post-operative nutritional assessments and their impact on survival in these patients. MATERIALS AND METHODS: All patients with advanced gastric adenocarcinoma treated with gastrectomy and HIPEC with or without CR at Lyon University Hospital were retrospectively included from April 2012 to August 2017. Carcinologic data, history of weight, anthropometric measures, nutritional biological markers and CT-scan body composition were collected. RESULTS: 54 patients were included. Malnutrition affected 48.1% before and 64.8% after surgery, and severe malnutrition respectively 11.1% and 20.3%. Pre-operative sarcopenia diagnosed by CT scan was found in 40.7% of the patients while 81.1% of the sarcopenic patients had a normal or high body mass index. A loss of ⩾ 20% of usual weight on discharge was a pejorative factor of survival at 3 years of follow-up (p = 0.0470). Only 14.8% of the patients continued artificial nutrition following discharge but artificial nutrition was resumed in 30.4% of the patients within 4 months after discharge owing to weight loss. CONCLUSIONS: Patients with advanced gastric adenocarcinoma undergoing gastrectomy and HIPEC with or without CR are at high risk of malnutrition. Post-operative weight loss has a pejorative impact on outcome. These patients should be systematically screened for malnutrition with early interventionist nutritional care and close nutritional follow-up.

Etiologies of spontaneous acute intracerebral hemorrhage: A pictorial review.

Spontaneous acute intracerebral hemorrhage (SAIH) is a common and life-threatening condition that affects more than three million patients each year. Of these, one in three patients die within one month of onset and the remaining two in three patients have varying degrees of disability and neurological impairment. The role of radiology is paramount in optimizing patient outcomes by diagnosing SAIH, its potential complications, and the most likely etiology. While the positive diagnosis of SAIH is straightforward, the etiologic diagnosis is broad, covering primary SAIH (hypertension, cerebral amyloid angiopathy) and secondary SAIH (vascular malformations, nonatheromatous vasculopathies, neoplasia, coagulation disorders, toxicants). This pictorial review illustrates the imaging of spontaneous SAIH with an emphasis on etiologic workup.

Safety and Oncologic Outcomes of Percutaneous Cryoablation of Renal Cell Carcinoma Recurrences in the Ipsilateral Kidney Following Partial Nephrectomy.

PURPOSE: To retrospectively investigate the safety and oncological outcomes of cryoablation performed on residual/recurring renal cell carcinoma (RCC) in the ipsilateral kidney following partial nephrectomy (PN). MATERIALS AND METHODS: Data dealing with patients', RCC, procedure (including the length of the hospital stay), and follow-up (technical efficacy [TE], local tumor progression-free survival [LTPFS], disease-free survival [DFS], metastasis-free survival [MFS], cancer-specific survival (CSS), and overall survival [OS]) were retrospectively collected and analyzed. RESULTS: Between January 2008 and November 2020, 21 consecutive patients (17 [81%] men; 4 [19%] women; median age 68 years; range 43-82) underwent cryoablation due to residual/recurring RCC in the PN site (15 patients) or de-novo RCC (6 patients) in the ipsilateral kidney. Median tumor size was 2.2 cm (mean 2.3 cm; range 0.8-4; interquartile range [IQR] 1.9-3). There were two (2/21; 10%) minor self-limiting hemorrhagic complications, both occurring in the group of patients with RCC in the PN site. Median hospital stay was 2 days (mean 2.1; range 1-5; IQR 2-2). TE was 100% (21/21 patients), and 10-year estimates of LTPFS, MFS and DFS were 74.1% (95% confidence intervals [CI] 56.8-96.7%), 36.4% (95% CI 14.2-93.8%), and 43.5% (95% CI 21.9-86.4%), respectively. CSS and OS were 100% at the last available follow-up (median 56 months; mean 67.4; range: 12-147; IQR:34-95). CONCLUSION: Cryoablation in patients with residual/recurring RCC following PN is safe and results in high 10-year estimates of LTPFS.