- Email: [email protected]
Sporadic desmoid tumors of the abdominal wall: Focus on appropriateness of surgery
S4 and PS scale pre- and post-treatment as well as an abdominal contrastenhanced CT scan to evaluate local control of the disease. Main results: 16 patients (9 women and 7 men), with median age of 61 years, underwent laparoscopic MWA using AMICAÒ probe with a mean application energy of 52 W for 7 minutes. Delivery of therapy was confirmed by laparoscopic ultrasonography. All 16 patients demonstrated nonclinically relevant elevation of their amylase and lipase, which peaked at 48 hours and returned to normal at 72 hour post-procedure. 14 patients were discharged on postoperative day 2 showing no complication. Two cases of fistula were treated by percutaneous US-guided drainage. After follow-up, there has been 100% ablation success confirmed by radiology, which showed a remarkable mass reduction and improvement of simptoms. PS was evaluated on a Karnofsky score scale basis. A mean score of 40% was observed on admittance. A second questionnaire on 90 day follow-up showed a notable mean score increase up to 80%. Conclusion: MWA seems to be feasible and safe if used with the correct temperature and at an appropriate distance from vital structures. It appears to have a low rate of morbidity (12.5% of pancreatic fistula). No mortality related to treatment was observed. A remarkable improvement of pain control and PS was observed in 100% of cases. Randomized trials are necessary to determine the true effect size of MWA. http://dx.doi.org/10.1016/j.ejso.2014.10.010
Efficacy of pTACE (DEBIRI) as a neoadjuvant therapy for colorectal liver metastases P. Pilati*, C. Aliberti, M. Zuin, M. Bonjako, S. Bellan, E. Tessari, M. Guido, S. Lonardi, V. Zagonel, D. Nitti Department of Surgery, Oncology and Gastroenterology University of Padova, Padova, Italy * Corresponding author: Pierluigi Pilati, Padova, Italy. E-mail address: [email protected] (P. Pilati) Study objectives: Precision-TACE (pTACE) consists in the administration of embolizing microspheres that permit the controlled release of a drug (Drug Eluting Beads) so as to cause a two fold damage, ischemic and toxic, with a synergistic effect. The slow release increases the efficacy and reduces the toxic effects of the drug. Today, pTACE is used in the therapy of HCC, and for colorectal liver metastases (CLMs) only as a palliative treatment. The introduction of irinotecan (DEBIRI) has greatly improved the prognosis of patients with CLMs when compared to previous formulations. Aliberti (128 patients, mean survival 22e25 months) and Martin (150 patients, mean survival 15e19 months) have the most extensive experience. The aim of this work was to evaluate the efficacy of pTACE (DEBIRI), not only in terms of clinical outcome but also in the real percentage of tumor necrosis this treatment obtains. Material and methods: We studied 6 patients (group A) with liver metastases from colorectal cancer, all with easily resectable lesions (M1a according to Nordlinger’s classification), undergoing loco-regional therapy with neoadjuvant pTACE (DEBIRI) and then liver resection. The efficacy of pTACE was evaluated according to dimensional (RECIST) and morphological criteria: tumor necrosis was quantified in the surgical specimen and a comparison between radiological and histological findings was made. Histological comparison was also made with 15 patients who had undergone neoadjuvant systemic chemotherapy. We compared the perioperative complications of the two groups; finally a survival analysis was made. Main results: All patients had a partial response (PR) according to RECIST criteria and 5 a complete necrosis according to morphological criteria. The histological examination showed 100% of necrosis in 3 patients (see Table 1); the mean necrosis was 88%, much greater than systemic chemotherapy (49%) (p ¼ 0.0076).
ABSTRACTS There were no adverse effects to loco-regional therapy while peri-operative complications were similar to literature. In the pTACE group we observed a better disease free survival (15 vs 5 months). Conclusion: DEBIRI is an extremely effective therapy since we observed better results when compared to standard neoadjuvant systemic chemotherapy. We used pTACE (DEBIRI) in easily resectable patients only to evaluate its real efficacy; the next step will be the evaluation of its use in combination with systemic chemotherapy for potentially resectable lesions. http://dx.doi.org/10.1016/j.ejso.2014.10.011
Sporadic desmoid tumors of the abdominal wall: Focus on appropriateness of surgery C. Mussi, P.F. Bagnoli*, G. Pietropaolo, F. Cananzi, O. Nucca, V. Quagliuolo Milano, Italy * Corresponding author: Pietro Francesco Bagnoli, Milano, Italy. E-mail address: [email protected] (P.F. Bagnoli) Study objectives: Treatment of desmoid tumors is complex and challenging. Many different therapeutic approaches can be used and combined during the unforeseeable history of this enigmatic disease. Surgery was for a long time the mainstay of treatment for primary tumors but recently its role has been questioned in favour of a frontline “wait and see” policy and medical treatments. Currently, many referral centers advise against a frontline surgical approach. Nevertheless the best timing for surgery has not been clearly established yet. The abdominal wall is a common site of origin of sporadic desmoid and is usually associated to favourable tumor behaviour. The disease in this site often affects young females in the fertility age. This makes the treatment more complex. We analysed the results of surgery in this specific site Material and methods: Data from 36 patients (pts) affected by sporadic desmoid tumors of the abdominal wall, treated at our Centre between January 2000 and September 2013, were retrieved. Thirty-four pts presented with primary lesions, 2 with recurrent tumors. Perioperative complications were classified according to the Common Terminology Criteria for Adverse Events Main results: Male: female ratio was 2:34 Median age was 38 years. Thirty-three patients underwent surgery, 32 in upfront. Thirty-one pts required plastic reconstruction with a mesh. Median hospital stay was 5 days. Three pts had grade 2 surgical complications. Three patients (9%) developed local recurrence after surgical treatment at our institutions. They were treated with surgery again. One, a male, had a further recurrence and started medical treatment with tamoxifen. He reached stable disease (SD). None died of disease. Three pts delivered a child after surgery (1 vaginal, 2 cesarean). Four patients followed a wait and see policy as front-line approach. We observed 2 progressions, 1 SD, 1 complete regression of the tumor Conclusion: Desmoid tumors of the abdominal wall have a favourable prognosis. In this specific anatomic site, surgery is safe, it achieves long term good local control in the majority of pts and remains in the armamentarium of the leading therapeutic options for pts who progress after a wait and see approach and for women who are looking for pregnancy http://dx.doi.org/10.1016/j.ejso.2014.10.012
Two hundred consecutive patients treated with radiofrequency ablation for stage III pancreatic cancer: Results from a single institution A. Giardino1,*, R. Girelli1, I. Frigerio1, P. Regi1, F. Scopelliti1, A. Borin1, C. Bassi2, P. Pederzoli1 1 Chirurgia Pancreatica, Casa di Cura Pederzoli, Peschiera del Garda, VR, Italy
Efficacy of pTACE (DEBIRI) as a neoadjuvant therapy for colorectal liver metastases P. Pilati*, C. Aliberti, M. Zuin, M. Bonjako, S. Bellan, E. Tessari, M. Guido, S. Lonardi, V. Zagonel, D. Nitti Department of Surgery, Oncology and Gastroenterology University of Padova, Padova, Italy * Corresponding author: Pierluigi Pilati, Padova, Italy. E-mail address: [email protected] (P. Pilati) Study objectives: Precision-TACE (pTACE) consists in the administration of embolizing microspheres that permit the controlled release of a drug (Drug Eluting Beads) so as to cause a two fold damage, ischemic and toxic, with a synergistic effect. The slow release increases the efficacy and reduces the toxic effects of the drug. Today, pTACE is used in the therapy of HCC, and for colorectal liver metastases (CLMs) only as a palliative treatment. The introduction of irinotecan (DEBIRI) has greatly improved the prognosis of patients with CLMs when compared to previous formulations. Aliberti (128 patients, mean survival 22e25 months) and Martin (150 patients, mean survival 15e19 months) have the most extensive experience. The aim of this work was to evaluate the efficacy of pTACE (DEBIRI), not only in terms of clinical outcome but also in the real percentage of tumor necrosis this treatment obtains. Material and methods: We studied 6 patients (group A) with liver metastases from colorectal cancer, all with easily resectable lesions (M1a according to Nordlinger’s classification), undergoing loco-regional therapy with neoadjuvant pTACE (DEBIRI) and then liver resection. The efficacy of pTACE was evaluated according to dimensional (RECIST) and morphological criteria: tumor necrosis was quantified in the surgical specimen and a comparison between radiological and histological findings was made. Histological comparison was also made with 15 patients who had undergone neoadjuvant systemic chemotherapy. We compared the perioperative complications of the two groups; finally a survival analysis was made. Main results: All patients had a partial response (PR) according to RECIST criteria and 5 a complete necrosis according to morphological criteria. The histological examination showed 100% of necrosis in 3 patients (see Table 1); the mean necrosis was 88%, much greater than systemic chemotherapy (49%) (p ¼ 0.0076).
ABSTRACTS There were no adverse effects to loco-regional therapy while peri-operative complications were similar to literature. In the pTACE group we observed a better disease free survival (15 vs 5 months). Conclusion: DEBIRI is an extremely effective therapy since we observed better results when compared to standard neoadjuvant systemic chemotherapy. We used pTACE (DEBIRI) in easily resectable patients only to evaluate its real efficacy; the next step will be the evaluation of its use in combination with systemic chemotherapy for potentially resectable lesions. http://dx.doi.org/10.1016/j.ejso.2014.10.011
Sporadic desmoid tumors of the abdominal wall: Focus on appropriateness of surgery C. Mussi, P.F. Bagnoli*, G. Pietropaolo, F. Cananzi, O. Nucca, V. Quagliuolo Milano, Italy * Corresponding author: Pietro Francesco Bagnoli, Milano, Italy. E-mail address: [email protected] (P.F. Bagnoli) Study objectives: Treatment of desmoid tumors is complex and challenging. Many different therapeutic approaches can be used and combined during the unforeseeable history of this enigmatic disease. Surgery was for a long time the mainstay of treatment for primary tumors but recently its role has been questioned in favour of a frontline “wait and see” policy and medical treatments. Currently, many referral centers advise against a frontline surgical approach. Nevertheless the best timing for surgery has not been clearly established yet. The abdominal wall is a common site of origin of sporadic desmoid and is usually associated to favourable tumor behaviour. The disease in this site often affects young females in the fertility age. This makes the treatment more complex. We analysed the results of surgery in this specific site Material and methods: Data from 36 patients (pts) affected by sporadic desmoid tumors of the abdominal wall, treated at our Centre between January 2000 and September 2013, were retrieved. Thirty-four pts presented with primary lesions, 2 with recurrent tumors. Perioperative complications were classified according to the Common Terminology Criteria for Adverse Events Main results: Male: female ratio was 2:34 Median age was 38 years. Thirty-three patients underwent surgery, 32 in upfront. Thirty-one pts required plastic reconstruction with a mesh. Median hospital stay was 5 days. Three pts had grade 2 surgical complications. Three patients (9%) developed local recurrence after surgical treatment at our institutions. They were treated with surgery again. One, a male, had a further recurrence and started medical treatment with tamoxifen. He reached stable disease (SD). None died of disease. Three pts delivered a child after surgery (1 vaginal, 2 cesarean). Four patients followed a wait and see policy as front-line approach. We observed 2 progressions, 1 SD, 1 complete regression of the tumor Conclusion: Desmoid tumors of the abdominal wall have a favourable prognosis. In this specific anatomic site, surgery is safe, it achieves long term good local control in the majority of pts and remains in the armamentarium of the leading therapeutic options for pts who progress after a wait and see approach and for women who are looking for pregnancy http://dx.doi.org/10.1016/j.ejso.2014.10.012
Two hundred consecutive patients treated with radiofrequency ablation for stage III pancreatic cancer: Results from a single institution A. Giardino1,*, R. Girelli1, I. Frigerio1, P. Regi1, F. Scopelliti1, A. Borin1, C. Bassi2, P. Pederzoli1 1 Chirurgia Pancreatica, Casa di Cura Pederzoli, Peschiera del Garda, VR, Italy