The European Organisation for Research and Treatment of Cancer 10981-22023 AMAROS trial evaluated axillary lymph node dissection (ALND) versus axillary radiotherapy (ART) in patients with cT1-2, ...node-negative breast cancer and a positive sentinel node (SN) biopsy. At 5 years, both modalities showed excellent and comparable axillary control, with significantly less morbidity after ART. We now report the preplanned 10-year analysis of the axillary recurrence rate (ARR), overall survival (OS), and disease-free survival (DFS), and an updated 5-year analysis of morbidity and quality of life.
In this open-label multicenter phase III noninferiority trial, 4,806 patients underwent SN biopsy; 1,425 were node-positive and randomly assigned to either ALND (n = 744) or ART (n = 681).
Per intention-to-treat analysis, 10-year ARR cumulative incidence was 0.93% (95% CI, 0.18 to 1.68; seven events) after ALND and 1.82% (95% CI, 0.74 to 2.94; 11 events) after ART (hazard ratio HR, 1.71; 95% CI, 0.67 to 4.39). There were no differences in OS (HR, 1.17; 95% CI, 0.89 to 1.52) or DFS (HR, 1.19; 95% CI, 0.97 to 1.46). ALND was associated with a higher lymphedema rate in updated 5-year analyses (24.5%
11.9%;
< .001). Quality-of-life scales did not differ by treatment through 5 years. Exploratory analysis showed a 10-year cumulative incidence of second primary cancers of 12.1% (95% CI, 9.6 to 14.9) after ART and 8.3% (95% CI, 6.3 to 10.7) after ALND.
This 10-year analysis confirms a low ARR after both ART and ALND with no difference in OS, DFS, and locoregional control. Considering less arm morbidity, ART is preferred over ALND for patients with SN-positive cT1-2 breast cancer.
To assess the impact of a laparoscopic approach on female fecundity in ileoanal pouch surgery.
Restorative proctocolectomy with ileal pouch anal anastomosis (IPAA) is associated with tubal factor ...infertility in female patients. Different studies showed less adhesion formation after laparoscopic colectomy. The relation between laparoscopic pouch surgery and fertility, however, has not been studied so far.
This cross-sectional study was carried out in 3 university hospitals in the Netherlands and in Belgium. Female patients older than 18 years that had IPAA under the age of 41 were eligible for inclusion (n = 179). We sent them a questionnaire addressing medical and fertility history. The primary endpoint was time to first spontaneous pregnancy after IPAA. This study has been registered with ISRCTN.org (ISRCTN85421386).
Of 179 eligible patients, 160 (89%) returned the questionnaire. After IPAA, 50 (31%) patients attempted to conceive. Of these, 23 (46%) had undergone open and 27 (54%) had undergone laparoscopic IPAA. Patient characteristics were similar in both groups. Indications for surgery were ulcerative colitis (UC) in 37 patients, familial adenomatous polyposis (FAP) in 12 patients, and colonic ischemia in 1 patient. A Kaplan-Meier survival function was plotted for time to first spontaneous pregnancy and showed a higher pregnancy rate after laparoscopic IPAA (log-rank, P = 0.023). Similarly, subsequent survival analysis for all patients with UC showed an increased pregnancy rate for the laparoscopic group (log-rank, P = 0.033).
Pregnancy rates are significantly higher after laparoscopic IPAA. This makes the laparoscopic approach the method of choice in young women.
Background
Phyllodes tumors (PTs) are rare tumors of the breast. The current National Comprehensive Cancer Network (NCCN) guidelines recommend excision of benign PTs, accepting close or positive ...margins. Controversy about the optimal treatment for benign PTs remains, especially regarding the preferred margin width after surgical excision and the need for follow-up evaluation.
Methods
A nationwide retrospective study analyzed the Dutch population from 1989 to 2022. All patients with a diagnosis of benign PT were identified through a search in the Dutch nationwide pathology databank (Palga). Information on age, year of diagnosis, size of the primary tumor, surgical treatment, surgical margin status, and local recurrence was collected.
Results
The study enrolled 1908 patients with benign PT. The median age at diagnosis was 43 years (interquartile range IQR, 34–52 years), and the median tumor size was 30 mm (IQR, 19–40 mm). Most of the patients (95%) were treated with breast-conserving surgery (BCS). The overall local recurrence rate was 6.2%, and the median time to local recurrence was 31 months (IQR, 15–61 months). Local recurrence was associated with bilaterality of the tumor (odds ratio OR, 4.91; 95% confidence interval CI, 2.95–28.30) and positive margin status (OR, 2.51; 95% CI 1.36–4.63). The local recurrence rate was 8.9% for the patients with positive excision margins and 4.0% for the patients with negative excision margins. Notably, for 27 patients (22.6%) who experienced a local recurrence, histologic upgrading of the recurrent tumor was reported, 7 (5.9%) of whom had recurrence as malignant lesions.
Conclusions
This nationwide series of 1908 patients showed a low local recurrence rate of 6.2% for benign PT, with higher recurrence rates following positive margins.
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EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
Background
The aim of this study was to determine whether the need for adhesiolysis during completion proctectomy (CP) with ileopouch anal anastomosis (IPAA) is influenced by the surgical approach of ...the initial emergency colectomy for ulcerative colitis and the hospital setting.
Methods
One hundred consecutive patients who underwent CP with IPAA in our center between January 1999 and April 2010 were included. Emergency colectomy had been performed laparoscopically in 30 of 52 patients at the Academic Medical Center Amsterdam and in 6 of 48 patients at referring hospitals. Case files of these patients were retrospectively reviewed.
Results
Significantly more extensive adhesiolysis was performed after open compared to laparoscopic colectomy (47 vs. 6%,
P
< 0.001). In univariate analysis, emergency colectomy at a referring hospital was also predictive for adhesiolysis (
P
= 0.003), but the open approach for the initial colectomy was the only independent predictive factor for the need for adhesiolysis (
P
< 0.001) in a multivariable ordinal logistic regression analysis. Operating time of CP was significantly longer when limited 18 (95% CI = 0–36) min or extensive 55 (35–75) min adhesiolysis had to be performed. The interval to CP was longer after open colectomy and after colectomy performed at a referring hospital. Significantly more incisional hernia corrections during CP were performed after open emergency colectomy (14 vs. 0%,
P
= 0.024). Overall morbidity and postoperative hospital stay of CP were not related to the surgical approach or the hospital setting of the emergency colectomy.
Conclusion
Laparoscopic as opposed to open emergency colectomy is associated with less adhesiolysis, fewer incisional hernias, and a shorter interval to completion proctectomy.
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EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
Background:
Anastomotic leakage is a major complication after restorative proctocolectomy with ileal pouch-anal anastomosis IPAA. Identification of patients at high risk of leakage may influence ...surgical decision making. The aim of this study was to identify risk factors associated with anastomotic leakage after restorative proctocolectomy with IPAA.
Methods:
Between September 1990 and January 2015, patients who underwent IPAA for inflammatory bowel disease IBD were identified from prospectively maintained databases of three tertiary referral centres. Retrospective chart review identified additional data on demographic and surgical variables. Multivariable regression models were developed to identify risk factors for anastomotic leakage. Separate analyses were performed for type of procedure.
Results:
A total of 640 patients 56.9% male were included, with a median age of 38 years interquartile range 29–48; 96 15.0% patients developed anastomotic leakage. Multivariable regression analysis demonstrated that being overweight (body mass index BMI > 25, (odds ratio OR 1.92; 95% confidence interval CI 1.15 – 3.18), and American Society of Anesthesiologists classification ASA score > 2 OR 1.91; 95% CI 1.03 – 3.54 were independent risk factors for anastomotic leakage in patients who underwent a completion proctectomy. A disease course of > 5 years OR 2.34; 95% CI 1.42 – 3.87 and concurrent combination of anti-tumour necrosis factor TNF and steroids OR 6.40; 95% CI 1.76 – 23.20 were independent risk factors for anastomotic leakage in patients who underwent a proctocolectomy and IPAA.
Conclusions:
Independent risk factors for anastomotic leakage in IBD patients undergoing IPAA are BMI >25, ASA score >2, disease course > 5 years, and concurrent steroid and anti-TNF treatment, with a different risk profile for one-stage proctocolectomy and completion proctectomy procedures.
This study aims to evaluate the response to and surgical benefits of neoadjuvant endocrine therapy (NET) in ER+/HER2-breast cancer patients who are clinically high risk, but genomic low risk ...according to the 70-gene signature (MammaPrint).
Patients with ER+/HER2-invasive breast cancer with a clinical high risk according to MINDACT, who had a genomic low risk according to the 70-gene signature and were treated with NET between 2015 and 2023 in our center, were retrospectively analyzed. RECIST 1.1 criteria were used to assess radiological response using MRI or ultrasound. Surgical specimens were evaluated to assess pathological response. Two breast cancer surgeons independently scored the eligibility of breast conserving therapy (BCS) pre- and post- NET.
Of 72 included patients, 23 were premenopausal (100% started with tamoxifen of which 4 also received OFS) and 49 were postmenopausal (98% started with an aromatase inhibitor). Overall, 8 (11%) showed radiological complete response. Only 1 (1.4%) patient had a pathological complete response (RCB-0) and 68 (94.4%) had a pathological partial response (RCB-1 or RCB-2). Among the 26 patients initially considered for mastectomy, 14 (53.8%) underwent successful BCS. In all 20 clinical node-positive patients, a marked axillary lymph node was removed to assess response. Four out of 20 (20%) patients had a pathological complete response of the axilla.
The study showed that a subgroup of patients with a clinical high risk and a genomic low risk ER+/HER2-breast cancer benefits from NET resulting in BCS instead of a mastectomy. Additionally, NET may enable de-escalation in axillary treatment.
•Population: ER+/HER2-breast cancer treated with neoadjuvant endocrine therapy.•Inclusion criteria: clinical high risk & low-risk 70-gene signature.•Conversion to breast-conserving surgery in 53.8%.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
The aim of our study is to analyze patterns in treatment and outcome in a population-based series of patients with borderline and malignant phyllodes tumors (PT).
Data on all patients with a ...borderline or malignant PT (1989–2020) were extracted from the Netherlands Cancer Registry and the Dutch nationwide pathology databank (Palga) and retrospectively analyzed.
We included 921 patients (borderline PT n = 452 and malignant PT n = 469). Borderline PT patients more often had breast-conserving surgery (BCS) as final surgery (81 vs. 46%). BCS rates for borderline PT increased over time (OR 1.08 per year, 95%CI 1.04 - 1.13, P < 0.001). In malignant PT adjuvant radiotherapy was given in 14.7%; this rate increased over time (OR 1.07 per year, 95%CI 1.02 – 1.13, P = 0.012). Local recurrence rate (5-year estimate of cumulative incidence) was 8.7% (95%CI 6.0–11.4) for borderline PT and 11.7% (95%CI 8.6–14.8) for malignant PT (P = 0.187) and was related to tumor size ≥ 20 mm (HR 10.6 (95%CI 1.5–76.8) and positive margin (HR 3.0 (95%CI 1.6–5.6), p < 0.001), but not to negative margin width (HR 1.3 ( 95%CI 0.7–2.3), p = 0.350)). Distant metastasis occurred only in malignant PT with a 5-year cumulative incidence of 4.7% (95%CI 3.3 – 6.1).
This population-based series showed an increase in BCS in borderline PT and an increase in adjuvant radiotherapy in malignant PT over time. We identified malignant PT, BCS, larger tumor size and positive final margins as possible risk factors for local recurrence. Small but negative margins can be accepted.
•Increased breast conserving surgery rates over time for borderline phyllodes tumors.•Increased radiotherapy rates over time for malignant PT.•Malignant phyllodes tumor and tumor size ≥ 20 mm elevate local recurrence risk.•Surgical risk factors: Breast-conserving surgery and final positive margins.•Small but negative margins can be accepted.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Background In colorectal cancer (CRC), colonoscopic tattooing is performed to mark the tumor site before laparoscopic surgery. Objective To determine whether colonoscopic tattooing can be used to ...refine staging accuracy by increasing the lymph node (LN) yield per specimen and to determine its accuracy as a sentinel LN procedure. Design Retrospective, case-control study. All LNs were microscopically examined for the presence of carbon particles. Setting A university hospital and a teaching hospital. Patients A consecutive series of 95 tattooed patients who had surgery for CRC between 2005 and 2009. A series of 210 non-tattooed patients who had surgery in the same time period served as controls. Main Outcome Measurements Total number of LNs retrieved, detection rate, and sensitivity of tattooing as a sentinel node procedure. Results A higher LN yield was observed in patients with preoperative tattooing, median (interquartile range) 15 (10-20) versus 12 (9-16), ( P = .014). In multivariable analysis, the presence of carbon-containing LNs was an independent predictive factor for a higher LN yield ( P = .002). The detection rate was 71%, with a median of 5 carbon-containing LNs per specimen. If preoperative tattooing was used for sentinel node mapping, the overall accuracy of predicting LN status was 94%. In the 24 N1 cases, there were 4 false-negative procedures (sensitivity 83%). Limitations Retrospective series. Conclusion After tattooing of CRC, the LN yield was higher than in a control group, and it could be used as a sentinel node procedure with acceptable accuracy rates. Because LN yield and sentinel node mapping are associated with improved diagnostic accuracy of LN involvement, preoperative tattooing can refine staging.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
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