Author(s) Chandran A.; Bhanji A.; Rao J.
Source British Journal of Oral and Maxillofacial Surgery; Dec 2019; vol. 57 (no. 10)
Introduction/Aims A surgeon's experience undertaking larger case volumes is often linked to better performance. The aim was to assess a single surgeons performance in NMHNSC excisions over five years. We analysed time and case number to reach a consistent competency with regards to excision margins. Materials/Methods Skin pathology data sets were collected retrospectively from 2014 to 2018 The data collected involved a single surgeon operating in multiple hospitals and settings. Information regarding patient demographics, histological features of NMHNSC and excision margins were collected from pathology reports for each operation.

Results/Statistics The results showed from January 2014 to April 2014 there was a 6.8% involved margin rate and a 11.4% close margin rate. This improved with further case volume over the five years. By September2018 to December 2018it was noted that the involved margin rate had reduced to 3.8% and the close margin rate had increased slightly to 13.4%. We present the longitudinal statistics.

​Conclusions/Clinical relevance This study has shown that there appears to be improvement in performance of excisions of NMHNSC as the surgeon gains experience over time to reach a consistent performance. There was a clear initial learning curve to achieve this which took several cases. This likely differs from numbers presented in the literature believed to achieve competency in other bodily surgical procedures.Copyright © 2019

Author(s) Ryan N.A.J.; Crosbie E.J.; Evans D.G.; Glaire M.A.; Blake D. et al.
Source Genetics in Medicine; Oct 2019; vol. 21 (no. 10); p. 2167-2180
Purpose: Endometrial cancer (EC) is often the sentinel cancer in women with Lynch syndrome (LS). However, efforts to implement universal LS screening in EC patients have been hampered by a lack of evidence detailing the proportion of EC patients that would be expected to screen positive for LS.

Method(s): Studies were identified by electronic searches of Medline, Embase, Cochrane CENTRAL and Web of Science. Proportions of test positivity were calculated by random and fixed-effects meta-analysis models. I2 score was used to assess heterogeneity across studies.

​Result(s): Fifty-three studies, including 12,633 EC patients, met the inclusion criteria. The overall proportion of endometrial tumors with microsatellite instability or mismatch repair (MMR) deficiency by immunohistochemistry (IHC) was 0.27 (95% confidence interval [CI] 0.25-0.28, I2: 71%) and 0.26 (95% CI 0.25-0.27, I2: 88%), respectively. Of those women with abnormal tumor testing, 0.29 (95% CI 0.25-0.33, I2: 83%) had LS-associated pathogenic variants on germline testing; therefore around 3% of ECs can be attributed to LS. Preselection of EC cases did increase the proportion of germline LS diagnoses.

Conclusion(s): The current study suggests that prevalence of LS in EC patients is approximately 3%, similar to that of colorectal cancer patients; therefore our data support the implementation of universal EC screening for LS.Copyright © 2019, The Author(s).

Author(s) Doherty D.T.; Coe P.O.; Rimmer L.; Subar D.A.; Lapsia S. et al.
Source Surgical Oncology; Sep 2019; vol. 30 ; p. 147-158
DOI 10.1016/j.suronc.2019.07.007
The prevalence of elevated intra-hepatic fat (IHF) is increasing in the Western world, either alone as hepatic steatosis (HS) or in conjunction with inflammation (steatohepatitis). These changes to the hepatic parenchyma are an independent risk factor for post-operative morbidity following liver resection for colorectal liver metastases (CRLM). As elevated IHF and colorectal malignancy share similar risk factors for development it is unsurprisingly frequent in this cohort. In patients undergoing resection IHF may be elevated due to excess adiposity or its elevation may be induced by neoadjuvant chemotherapy, termed chemotherapy associated steatosis (CAS). Additionally, chemotherapy is implicated in the development of inflammation termed chemotherapy associated steatohepatitis (CASH). Following cessation of chemotherapy, patients awaiting resection have a 4-6 week washout period prior to resection that is a window for prehabilitation prior to surgery. In patients with NAFLD dietary and pharmacological interventions can reduce IHF within this timeframe but this approach to modifying IHF is untested in this population. In this review, the aetiology of CAS and CASH is reviewed with recommendations to identify those at risk. We also focus on the post-chemotherapy washout period, reviewing dietary interventions applied to the metabolic population and suggest this window may be used as an opportunity to optimise IHF with such a regime as part of a pre-operative prehabilitation programme to produce improved patient outcomes.Copyright © 2019 Elsevier Ltd

​Author(s) Clarke N.W.; Hoyle A.; Ali A.; Ingleby F.C.; Amos C.L. et al.
Source Annals of oncology : official journal of the European Society for Medical Oncology; Sep 2019
DOI 10.1093/annonc/mdz396
BACKGROUND: STAMPEDE has previously reported that the use of upfront docetaxel improved overall survival (OS) for metastatic hormone naive prostate cancer patients starting long-term androgen deprivation therapy. We report on long-term outcomes stratified by metastatic burden for M1 patients.

METHOD(S): We randomly allocated patients in 2:1 ratio to standard-of-care (SOC; control group) or SOC+docetaxel. Metastatic disease burden was categorised using retrospectively-collected baseline staging scans where available. Analysis used Cox regression models, adjusted for stratification factors, with emphasis on restricted mean survival time where hazards were non-proportional.

RESULT(S): Between 05 October 2005 and 31 March 2013, 1086 M1 patients were randomised to receive SOC (n=724) or SOC+docetaxel (n=362). Metastatic burden was assessable for 830/1086 (76%) patients; 362 (44%) had low and 468 (56%) high metastatic burden. Median follow-up was 78.2months. There were 494 deaths on SOC (41% more than the previous report). There was good evidence of benefit of docetaxel over SOC on OS (HR=0.81, 95% CI 0.69-0.95, P=0.009) with no evidence of heterogeneity of docetaxel effect between metastatic burden sub-groups (interaction P=0.827). Analysis of other outcomes found evidence of benefit for docetaxel over SOC in failure-free survival (HR=0.66, 95% CI 0.57-0.76, P<0.001) and progression-free survival (HR=0.69, 95% CI 0.59-0.81, P<0.001) with no evidence of heterogeneity of docetaxel effect between metastatic burden sub-groups (interaction P>0.5 in each case). There was no evidence that docetaxel resulted in late toxicity compared with SOC: after 1year, G3-5 toxicity was reported for 28% SOC and 27% docetaxel (in patients still on follow-up at 1year without prior progression).

​CONCLUSION(S): The clinically significant benefit in survival for upfront docetaxel persists at longer follow-up, with no evidence that benefit differed by metastatic burden. We advocate that upfront docetaxel is considered for metastatic hormone naive prostate cancer patients regardless of metastatic burden.Copyright © The Author(s) 2019. Published by Oxford University Press on behalf of the European Society for Medical Oncology.

• Available in full text at Annals of oncology : official journal of the European Society for Medical Oncology from Unpaywall

​Author(s): Doherty D.T.; Coe P.O.; Rimmer L.; Subar D.A.; Lapsia S.; Krige A.
Source: Surgical Oncology; 2019
Publication Date: 2019
Publication Type(s): Review
Available  at Surgical Oncology -  from ClinicalKey
Abstract:The prevalence of elevated intra-hepatic fat (IHF) is increasing in the Western world, either alone as hepatic steatosis (HS) or in conjunction with inflammation (steatohepatitis). These changes to the hepatic parenchyma are an independent risk factor for post-operative morbidity following liver resection for colorectal liver metastases (CRLM). 

​Author(s): Parker C.C.; Dearnaley D.P.; James N.D.; Brawley C.D.; Ritchie A.W.S.; Gilson C.; Langley R.E.; Millman R.; Amos C.L.; Parmar M.K.B.; Sydes M.R.; Clarke N.W.; Hoyle A.P.; Ali A.; Tran A.T.H.; Attard G.; Chowdhury S.; Cross W.; Gillessen S.; Jones R.J.; Russell J.M.; Malik Z.I.; Eswar C.; Mason M.D.; Matheson D.; Thalmann G.N.; Alonzi R.; Bahl A.; Birtle A.; Din O.; Douis H.; Gale J.; Gannon M.R.; Jonnada S.; Khaksar S.; Lester J.F.; O'Sullivan J.M.; Parikh O.A.; Pedley I.D.; Pudney D.M.; Sheehan D.J.; Srihari N.N.
Source: The Lancet; Dec 2018; vol. 392 (no. 10162); p. 2353-2366
Publication Date: Dec 2018
Publication Type(s): Article
PubMedID: 30355464
Abstract:Background: Based on previous findings, we hypothesised that radiotherapy to the prostate would improve overall survival in men with metastatic prostate cancer, and that the benefit would be greatest in patients with a low metastatic burden. We aimed to compare standard of care for metastatic prostate cancer, with and without radiotherapy. Method(s): We did a randomised controlled phase 3 trial at 117 hospitals in Switzerland and the UK. Eligible patients had newly diagnosed metastatic prostate cancer. 

​Author(s): Ryan N.A.J.; Crosbie E.J.; Evans D.G.; Blake D.; Cabrera-Dandy M.; Glaire M.A.
Source: Systematic Reviews; Aug 2018; vol. 7 (no. 1)
Publication Date: Aug 2018
Publication Type(s): Article
Available  at Systematic reviews -  from BioMed Central
Abstract:Background: Lynch syndrome is the most common inherited cancer syndrome, which predisposes individuals to a number of different cancers, principally colorectal and endometrial cancer. The early diagnosis of Lynch syndrome enables colorectal surveillance, which has been shown to save lives through the detection and removal of premalignant polyps and earlier detection of invasive disease. Endometrial cancer, which is often the sentinel cancer in women, provides an opportunity to diagnose Lynch syndrome and thus enable colorectal surveillance as well as the cascade testing for Lynch syndrome in other family members. These potential benefits have led to a call for the universal screening of women with endometrial cancer for Lynch syndrome, a practice that is now commonplace in colorectal cancer. Healthcare providers and clinicians are however restricted by insufficient knowledge about the prevalence of Lynch syndrome in women with endometrial cancer, with estimates varying as widely as 1-10%. The aim of this study is to perform a systematic review with a meta-analysis of the current literature base in order to estimate the prevalence of Lynch syndrome among women with endometrial cancer to inform this discussion. 
Database: EMBASE

​Author(s): Lucente, Ermelinda; Liu, Hongguang; Liu, Yang; Hu, Xiang; Lacivita, Enza; Leopoldo, Marcello; Cheng, Zhen
Source: Bioconjugate chemistry; May 2018; vol. 29 (no. 5); p. 1595-1604
Publication Date: May 2018
Publication Type(s): Journal Article
PubMedID: 29587479
Abstract:Bombesin receptor 2 (BB2) and integrin αvβ3 receptor are privileged targets for molecular imaging of cancer because of their overexpression in a number of tumor tissues. The most recent developments in heterodimer-based radiopharmaceuticals concern BB2- and integrin αvβ3-targeting compounds, consisting of bombesin (BBN) and cyclic arginine-glycine-aspartic acid peptides (RGD), connected through short length linkers. 

​Author(s): Topps A.R.; Barr S.P.; Pikoulas P.; Maxwell A.J.; Pritchard S.A.
Source: Annals of Surgical Oncology; Oct 2017 ; p. 1-6
Publication Date: Oct 2017
Publication Type(s): Article In Press
Abstract:Background: Pre-operative ultrasound-guided needle sampling (UNS) of abnormal axillary lymph nodes in breast cancer can identify patients with axillary metastases and therefore rationalize patient care and inform decision-making. To obtain tissue diagnosis, UNS can be performed by either fine needle aspiration (FNA) or core needle biopsy (CNB). However, few studies have compared the sensitivity of these techniques and the majority show no difference. Methods: All node-positive patients (those with micro- and macrometastases but not isolated tumor cells) treated at a tertiary referral center between January 2012 and December 2015 were retrospectively identified from pathology records. The result of the first axillary UNS performed on each patient was compared with postoperative histopathology results. The UNS method used was according to individual radiologist preference. Results: A total of 215 patients underwent FNA (1 patient had bilateral breast cancer and underwent bilateral FNA), and 92 underwent CNB. Sensitivity of CNB was significantly higher than FNA (83.7 vs. 69.0%, P = 0.008). The false-negative rate in the FNA group was therefore higher than in the CNB group by a factor of 2.5. There was no difference in inadequacy rate between the two techniques. There were no complications in the FNA group, and only one hematoma (which did not require operative intervention) in the CNB group. Conclusions: CNB is safe and should be the preferred technique for UNS to improve sensitivity.Copyright © 2017 Society of Surgical Oncology
Database: EMBASE

​Author(s): Sharma V.; Junejo M.; Mitchell P.J.
Source: Colorectal Disease; Oct 2017; vol. 19 ; p. 39
Publication Date: Oct 2017
Publication Type(s): Conference Abstract
Available  at Colorectal Disease -  from Wiley Online Library Medicine and Nursing Collection 2018 - NHS
Abstract:Purpose: A malignant polyp is a retrospective diagnosis of an endoscopically excised polyp with positive histological finding of malignancy. ACPGBI guidelines (2013) recommend follow-up endoscopy at 3 months. Our primary aim was to assess concordance with these guidelines, with the secondary aim to assess early recurrence. Methods: Retrospective analysis of all malignant polyps treated endoscopically between April 2012 and April 2015 within a regional cancer network. Results: 177 patients were identified of whom 37 underwent surgery. 140 patients underwent endoscopic surveillance with recurrence in 5 patients. Median age of observed patients was 68.5 years. 93.6% of polyps were located in the rectum or sigmoid (n = 67 and 64 respectively). Median size of excised polyps was 15 mm. Endoscopic surveillance within three months was undertaken in 86 patients (61.4%) and within six months in 116 patients (82.9%). By 12 months 125 patients (89.3%) had undergone endoscopic surveillance. 3/86 (3.5%) patients having 3-month surveillance had endoscopic abnormality which resulted in surgical intervention. Positive residual disease was identified in 2 out of these 3 patients. 3 recurrences were identified late (>3 months) with two on cross sectional imaging (6 and 12 months respectively), and one on endoscopy at 12 months. A normal endoscopy at 3 months provided a negative predictive value of 96.4% for disease recurrence. Conclusion: A normal endoscopy at three months excluded the risk of recurrence/ residual disease for the vast majority of patients, however less than 2/3 patients with malignant polyps are appropriately followed up with a three-month endoscopy as per the ACPGBI guidelines.
Database: EMBASE

Author(s): Athanasiou, Christos; Robinson, Jonathan; Yiasemidou, Marina; Lockwood, Sonia; Markides, Georgios A

Source: International journal of surgery (London, England); Mar 2017

Publication Type(s): Journal Article Review

Abstract:
BACKGROUND
Transverse colon malignancies have been excluded from all randomized controlled trials comparing laparoscopic against open colectomies, potentially due to the advanced laparoscopic skills required for dissecting around the middle colic vessels and the associated morbidity. Concerns have been expressed that the laparospopic approach may compromise the oncological clearance in transverse colon cancer. This study aimed to comprehensively compare the laparoscopic (LPA) to the open (OPA) approach by performing a meta-analysis of long and short term outcomes.METHODSMedline, Embase, Cochrane library, Scopus and Web of Knowledge databases were interrogated. Selected studies were critically appraised and the short-term morbidity and long term oncological outcomes were meta-analyzed. Sensitivity analysis according to the quality of the study, type of procedure (laparoscopic vs laparoscopically assisted) and level of lymphadenectomy was performed. Statistical heterogeneity and publication bias were also investigated.

RESULTS
Eleven case control trials (1415 patients) were included in the study. There was no difference between the LPA and the OPA in overall survival [Hazard Ratio (HR)=0.83 (0.56, 1.22); P=0.34], disease free survival (p=0.20), local recurrence (p=0.81) or distant metastases (p=0.24). LPA was found to have longer operative time [Weighted mean difference (WMD)=45.00 (29.48, 60.52);P<0.00001] with earlier establishment of oral intake [WMD=-1.68 (-1.84, -1.53);P<0.00001] and shorter hospital stay [WMD =-2.94 (-4.27, -1.62);P=0.0001]. No difference was found in relation to anastomotic leakage (p=0.39), intra-abdominal abscess (p=0.25), lymph nodes harvested (p=0.17).CONCLUSIONSLPA seems to be safe with equivalent oncological outcomes to OPA and better short term outcomes in selected patient populations. High quality Randomized control trials are required to further investigate the role of laparoscopy in transverse colon cancer.
​
Database: Medline

Author(s): Nightingale, J.M.; Murphy, F.; Eaton, C.; Borgen, R.

Source: Radiography; Feb 2017; vol. 23 (no. 1); p. 38-47

Publication Date: Feb 2017

Publication Type(s): Academic Journal
​
Database: CINAHL