Background
Transanal minimally invasive surgery is a combination of single-port surgery and transanal surgery and was initially developed as a treatment for rectal tumors. Recently, this approach has ...also been used for more advanced or extended pelvic surgery.
Methods
We present a surgical video of combined laparoscopic and transperineal endoscopic total pelvic exenteration performed in a male patient with recurrent rectal cancer and discuss the pros and cons of this approach.
Results
The operating time was 775 min and the operative blood loss was 485 ml. The pathology was recurrent adenocarcinoma invading the prostate and urethra with negative surgical margins. The postoperative course was uneventful except for a urinary tract infection that was treated with antibiotics.
Conclusions
The transanal/perineal endoscopic approach may have some benefits for extended pelvic surgery for recurrent rectal cancer.
The aim of the present study was to clarify differences in node metastasis mode and clinical outcomes based on tumor location in patients with esophageal squamous cell carcinoma (ESCC).
Participants ...comprised 228 patients with ESCC who underwent radical esophagectomy without preoperative supplement therapies. Lymph nodes were harvested from three fields: the neck, thorax, and abdomen. Patients were divided into three groups depending on tumor location upper esophagus (UE), middle esophagus, or lower esophagus (LE) and analyzed clinicopathologically.
The LE group showed significantly more progressive ESCC in terms of tumor invasion (p = 0.025), node metastasis (p = 0.0071), and TNM stage (p = 0.0043). The LE group revealed a tendency to metastasize to extrathoracic (especially abdominal) nodes (p = 0.0008). Recurrent laryngeal node metastasis was increased in the UE group (p = 0.016). However, no prognostic differences were detected between groups according to tumor location. Likewise, subgroup analyses by surgical approach (open thoracotomy vs. thoracoscopy) and cancer stage (stage I/II, III, and IV) did not reveal any significant prognostic impact of tumor location.
Lymphatic spread varied by tumor location, but no prognostic impact of tumor location could be detected in patients with ESCC in spite of surgical approach or cancer stage.
Chemotherapy-induced peripheral neuropathy (CIPN) is an important factor that renders the continuation of chemotherapy difficult. Prevention and treatment of CIPN are indispensable in improving ...patients’ quality of life and promoting the continuation of chemotherapy that may improve survival. Numbness and pain are currently evaluated using subjective methods such as the visual analogue scale (VAS). However, the assessment of pain can vary greatly depending on the mood and physical state of the patient at the time of assessment. In this stage, objective evaluation methods have not been used for evaluations of CIPN in clinical trials because they have not been established as quantified evaluation methods for CIPN yet. A method to quantify CIPN objectively and easily is necessary. The PainVision PS-2100 (PV) is an analytical instrument that was designed to quantitatively and objectively assess sense perception and nociception in patients. The advantage of PV is that it can evaluate pain in a relatively short time, as well as assess pain without causing further pain to patients.
We examined a total of 73 CIPN patients with metastatic CRC received chemotherapy between April 2014 and December 2015 by using VAS, the Functional Assessment of Cancer Therapy/Gynecologic Oncology Group - Neurotoxicity (NTX), the Disk-Criminator™ test, the monofilament test and PV. And then, we evaluated the correlation between subjective and objective evaluation methods or correlation between PV and other objective evaluation methods for CIPN.
The average VAS (hand), VAS (foot) and PV scores of CIPN were 18.4 (range: 0–100), 23.8 (range: 0–100) and 24.7 (range: 0–496), respectively. A strong positive correlation was found between VAS (hand) and VAS (foot) scores (r=0.798). The VAS (hand), VAS (foot), NTX 2, NTX 4 and NTX 8 significantly correlated with PV. PV showed no correlation with a Disk-Criminator™ or the monofilament test used as an objective evaluation.
This is the 1st report regarding the correlation between PV and other objective evaluation methods in CIPN patients. The evaluation of CIPN is complicated because numerous factors are involved. And further research and effort are needed to improve objective evaluation of CIPN by PV.
The authors.
Has not received any funding.
All authors have declared no conflicts of interest.
TAS-102 improved overall survival of metastatic colorectal cancer (mCRC) patients with median progression-free survival (PFS) of 2.0 months (RECOURSE trial). Subsequently, the combination of TAS-102 ...and bevacizumab (BV) has been shown to extend median PFS to 3.7 months (C-TASK FORCE). However, this study included patients with 2nd line and 3rd line chemotherapy. Furthermore, combination chemotherapy of TAS-102 plus BV was reportedly associated with grade ≥3 neutropenia in 72% of treated patients. This study was designed for patients being treated as 3rd line chemotherapy to investigate the clinical impact of this combination and whether neutropenia could be suppressed by altering the TAS-102 administration protocol (biweekly method).
This phase II study was conducted in investigator-initiated, open-label, single-arm, multicenter manner in Japan. Eligible patients were 20-80 years old and had to have an ECOG performance status of 0 or 1; had confirmed unresectable mCRC with histologically diagnosed adenocarcinoma; had previously administrated first- and second-line chemotherapy for mCRC and whose tumors were diagnosed as progression of disease (PD). TAS-102 (35mg/ m²) was given orally twice daily on days 1 -5 and 15 -19 in a 4-weeks cycle, and BV (5mg/ kg) was administered by intravenous infusion for 30min in every 2 weeks. The primary endpoint was PFS, and the secondary endpoints were response rate (RR), disease control rate (DCR), overall survival (OS), and safety. This study was registered at the University Hospital Medical Information Network, as UMIN#000030030.
Between January 1, 2018, and March 31, 2019, 45 patients with mCRC were enrolled in this study (median age, 63; male, 51%). The median PFS was 121 days. The RR and DCR were 4.4% and 73.3%, respectively. Grade 3 or higher adverse events were hypertension (20.0%), neutropenia (15.5 %), leukopenia (6.7 %), fatigue (6.7 %), anemia (4.4 %), anorexia (2.2 %), nausea (2.2 %), creatinine increased (2.2 %) and proteinuria (2.2 %). No treatment-related deaths occurred.
Biweekly administration of TAS-102 and BV prevents neutropenia and could be one of the treatment options for 3rd line chemotherapy for mCRC.
UMIN000030030. 2018/March/01.
The authors.
Has not received any funding.
All authors have declared no conflicts of interest.
Patients with colorectal cancer treated with oxaliplatin are at risk of hypersensitivity reactions, with the incidence estimated to be 12%-20%. Coinfusion of dexamethasone and oxaliplatin could ...potentially reduce the incidence of these reactions, but oxaliplatin is reported to be incompatible with alkaline compounds in solution. However, in a previous retrospective study we found that the pH of a solution of dexamethasone and oxaliplatin was less than 7.4, and that hypersensitivity to oxaliplatin could have been prevented by coinfusion of dexamethasone. We aimed to evaluate the effectiveness of coinfusion of dexamethasone and oxaliplatin to prevent oxaliplatin-induced hypersensitivity reactions.
The AVOID trial was a prospective, multicenter, open-label, single-arm Phase II trial conducted from January to September 2013. The study included 73 patients who received capecitabine plus oxaliplatin (XELOX) or XELOX plus bevacizumab therapy for colorectal cancer. In all patients, oxaliplatin was administered in combination with dexamethasone. The primary outcome measure was the presence of hypersensitivity reactions.
Hypersensitivity reactions occurred in three patients (4.1%); all three experienced a cutaneous reaction (grade 1 erythema). None of the 73 patients developed respiratory symptoms, ocular symptoms, or anaphylaxis. Grade 3 or higher hemotoxicity occurred in 13.7% of the patients and grade 3 or higher nonhematological toxicity occurred in 13.7%. The response rate to treatment was 64.4%.
The coinfusion of dexamethasone and oxaliplatin effectively reduced oxaliplatin-induced hypersensitivity reactions in patients with colorectal cancer. This approach should be considered for all patients treated with oxaliplatin, allowing treatment to be completed as planned.
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