scholarly journals Clinical, surgical, and molecular prognostic factors for survival after spinal sarcoma resection

2016 ◽  
Vol 41 (2) ◽  
pp. E9 ◽  
Author(s):  
Daniel M. Sciubba ◽  
Rafael De la Garza Ramos ◽  
C. Rory Goodwin ◽  
Nancy Abu-Bonsrah ◽  
Ali Bydon ◽  
...  
Keyword(s):  
Local Recurrence ◽  
Recurrence Rate ◽  
Median Survival ◽  
Local Recurrence Rate ◽  
Outcome Measure ◽  
Tumor Biomarker ◽  
High Grade ◽  
Recurrence Rates ◽  
Term Survival ◽  
Spinal Sarcoma

OBJECTIVE The goal of this study was to investigate the local recurrence rate and long-term survival after resection of spinal sarcomas. METHODS A retrospective review of patients who underwent resection of primary or metastatic spinal sarcomas between 1997 and 2015 was performed. Tumors were classified according to the Enneking classification, and resection was categorized as Enneking appropriate (EA) if the specimen margins matched the Enneking recommendation, and as Enneking inappropriate (EI) if they did not match the recommendation. The primary outcome measure for all tumors was overall survival; local recurrence was also an outcome measure for primary sarcomas. The association between clinical, surgical, and molecular (tumor biomarker) factors and outcomes was also investigated. RESULTS A total of 60 patients with spinal sarcoma were included in this study (28 men and 32 women; median age 38 years). There were 52 primary (86.7%) and 8 metastatic sarcomas (13.3%). Thirty-nine tumors (65.0%) were classified as high-grade, and resection was considered EA in 61.7% of all cases (n = 37). The local recurrence rate was 10 of 52 (19.2%) for primary sarcomas; 36.8% for EI resection and 9.1% for EA resection (p = 0.010). Twenty-eight patients (46.7%) died during the follow-up period, and median survival was 26 months. Overall median survival was longer for patients with EA resection (undefined) compared with EI resection (13 months, p < 0.001). After multivariate analysis, EA resection significantly decreased the hazard of local recurrence (HR 0.24, 95% CI 0.06–0.93; p = 0.039). Age 40 years or older (HR 4.23, 95% CI 1.73–10.31; p = 0.002), previous radiation (HR 3.44, 95% CI 1.37–8.63; p = 0.008), and high-grade sarcomas (HR 3.17, 95% CI 1.09–9.23; p = 0.034) were associated with a significantly increased hazard of death, whereas EA resection was associated with a significantly decreased hazard of death (HR 0.22, 95% CI 0.09–0.52; p = 0.001). CONCLUSIONS The findings in the present study suggest that EA resection may be the strongest independent prognostic factor for improved survival in patients with spinal sarcoma. Additionally, patients who underwent EA resection had lower local recurrence rates. Patients 40 years or older, those with a history of previous radiation, and those with high-grade tumors had an increased hazard of mortality in this study.

Surgical management of primary and metastatic sarcoma of the mobile spine

2008 ◽  
Vol 9 (2) ◽  
pp. 120-128 ◽  
Author(s):  
Ganesh Rao ◽  
Dima Suki ◽  
Indro Chakrabarti ◽  
Iman Feiz-Erfan ◽  
Milan G. Mody ◽  
...  
Keyword(s):  
Overall Survival ◽  
Local Recurrence ◽  
Median Survival ◽  
Neurological Function ◽  
High Grade ◽  
Recurrence Rates ◽  
En Bloc ◽  
Study Results ◽  
Mobile Spine ◽  
Metastatic Sarcoma

Object Sarcomas of the spine are a challenging problem due to their frequent and extensive involvement of multiple spinal segments and high recurrence rates. Gross-total resection to negative margins, with preservation of neurological function and palliation of pain, is the surgical goal and may be achieved using either intralesional resection or en bloc excision. The authors report outcomes of surgery for primary and metastatic sarcomas of the mobile spine in a large patient series. Methods A retrospective review of patients undergoing resection for sarcomas of the mobile spine between 1993 and 2005 was undertaken. Sarcomas were classified by histology study results and as either primary or metastatic. Details of the surgical approach, levels of involvement, and operative complications were recorded. Outcome measures included neurological function, palliation of pain, local recurrence, and overall survival. Results Eighty patients underwent 110 resections of either primary or metastatic sarcomas of the mobile spine. Twenty-nine lesions were primary sarcomas (36%) and 51 were metastatic sarcomas (64%). Intralesional resections were performed in 98 surgeries (89%) and en bloc resections were performed in 12 (11%). Median survival from surgery for all patients was 20.6 months. Median survival for patients with a primary sarcoma of the spine was 40.2 months and was 17.3 months for patients with a metastatic sarcoma. Predictors of improved survival included a chondrosarcoma histological type and a better preoperative functional status, whereas osteosarcoma and a high-grade tumor were negative influences on survival. Multivariate analysis showed that only a high-grade tumor was an independent predictor of shorter overall survival. American Spinal Injury Association scale grades were maintained or improved in 97% of patients postoperatively, and there was a significant decrease in pain scores postoperatively. No significant differences in survival or local recurrence rates between intralesional or en bloc resections for either primary or metastatic spine sarcomas were found. Conclusions Surgery for primary or metastatic sarcoma of the spine is associated with an improvement in neurological function and palliation of pain. The results of this study show a significant difference in patient survival for primary versus metastatic spine sarcomas. The results do not show a statistically significant benefit in survival or local recurrence rates for en bloc versus intralesional resections for either metastatic or primary sarcomas of the spine, but this may be due to the small number of patients undergoing en bloc resections.

scholarly journals Analysis of factors associated with local recurrence after endoscopic resection of gastric epithelial dysplasia

2019 ◽  
Author(s):  
Min Kyung Back ◽  
Hee Seok Moon ◽  
In Sun Kwon ◽  
Jae Ho Park ◽  
Ju Seok Kim ◽  
...  
Keyword(s):  
Local Recurrence ◽  
Recurrence Rate ◽  
Local Recurrence Rate ◽  
Complete Resection ◽  
Epithelial Dysplasia ◽  
Resection Rate ◽  
Recurrence Rates ◽  
Factors Associated ◽  
Complete Resection Rate ◽  
Increased Risk

Abstract Background : Endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) are widely used techniques for the treatment of gastric epithelial dysplasia. Previous studies have compared the clinical outcome of endoscopic resection for early gastric cancer, but few studies have focused on gastric dysplasia alone. This study aimed to evaluate the long-term prognosis following endoscopic procedures for gastric epithelial dysplasia, investigate differences in local recurrence rates according to the treatment modality, and identify risk factors associated with local recurrence. Methods : In this retrospective study, local recurrence rates and risk factors associated with local recurrence were compared between 599 patients who underwent EMR and 306 who underwent ESD for gastric epithelial dysplasia from January 2011 to December 2015. Results : The en bloc resection rate (32.2% vs. 100%, p<0.001) and complete resection rate (94.8% vs. 99.0%, p=0.003) were significantly lower in the EMR group than in the ESD group. The local recurrence rate was significantly lower in the ESD group (1.3%) than in the EMR group (4.2%; p=0.026). There was a significantly increased risk of local recurrence, regardless of lesion location or histologic grade, in patients with lesions >2 cm (p=0.002) or red in color (p=0.03). The ESD group had a significantly lower local recurrence rate, with a higher complete resection rate, than that in the EMR group (p<0.05). Conclusions : The complete resection rate was significantly higher, and the local recurrence rate was significantly lower, in patients with gastric epithelial dysplasia treated with ESD. Therefore, ESD should be considered the preferred treatment in patients with lesions >2 cm or showing redness due to an increased risk of local recurrence.

scholarly journals Analysis of factors associated with local recurrence after endoscopic resectionof gastric epithelial dysplasia: A retrospective study

2020 ◽  
Author(s):  
Min Kyung Back ◽  
Hee Seok Moon ◽  
In Sun Kwon ◽  
Jae Ho Park ◽  
Ju Seok Kim ◽  
...  
Keyword(s):  
Local Recurrence ◽  
Recurrence Rate ◽  
Local Recurrence Rate ◽  
Complete Resection ◽  
Epithelial Dysplasia ◽  
Resection Rate ◽  
Recurrence Rates ◽  
Factors Associated ◽  
Complete Resection Rate ◽  
Increased Risk

Abstract Background: Endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) are widely used techniques for the treatment of gastric epithelial dysplasia. Previous studies have compared the clinical outcome of endoscopic resection for early gastric cancer, but few studies have focused on gastric dysplasia alone. This study aimed to evaluate the long-term prognosis following endoscopic procedures for gastric epithelial dysplasia, investigate differences in local recurrence rates according to the treatment modality, and identify risk factors associated with local recurrence. Methods: In this retrospective study, local recurrence rates and risk factors associated with local recurrence were compared between 599 patients who underwent EMR and 306 who underwent ESD for gastric epithelial dysplasia from January 2011 to December 2015.Results: The en bloc resection rate (32.2% vs. 100%, p<0.001) and complete resection rate (94.8% vs. 99.0%, p=0.003) were significantly lower in the EMR group than in the ESD group. The local recurrence rate was significantly lower in the ESD group (1.3%) than in the EMR group (4.2%; p=0.026). There was a significantly increased risk of local recurrence, regardless of lesion location or histologic grade, in patients with lesions >2 cm (p=0.002) or red in color (p=0.03). The ESD group had a significantly lower local recurrence rate, with a higher complete resection rate, than that in the EMR group (p<0.05).Conclusions: The complete resection rate was significantly higher, and the local recurrence rate was significantly lower, in patients with gastric epithelial dysplasia treated with ESD. Therefore, ESD should be considered the preferred treatment in patients with lesions >2 cm or showing redness due to an increased risk of local recurrence.

Re-excision of anterior margins for breast cancer is associated with a low local recurrence rate

2013 ◽  
Vol 39 (11) ◽  
pp. S66-S67
Author(s):  
Layal El-Asir ◽  
Faizan Jabbar ◽  
George Boundouki ◽  
Clive Griffith ◽  
James Harvey
Keyword(s):  
Breast Cancer ◽  
Local Recurrence ◽  
Recurrence Rate ◽  
Local Recurrence Rate

Do pathological fractures influence survival and local recurrence rate in bony sarcomas?

2007 ◽  
Vol 43 (13) ◽  
pp. 1944-1951 ◽  
Author(s):  
J.A.M. Bramer ◽  
A.A. Abudu ◽  
R.J. Grimer ◽  
S.R. Carter ◽  
R.M. Tillman
Keyword(s):  
Local Recurrence ◽  
Recurrence Rate ◽  
Local Recurrence Rate ◽  
Pathological Fractures

scholarly journals ISR for T1-2 Low Rectal Cancer: A Japanese Approach

2020 ◽  
Vol 33 (06) ◽  
pp. 361-365
Author(s):  
Masaaki Ito
Keyword(s):  
Rectal Cancer ◽  
Local Recurrence ◽  
Recurrence Rate ◽  
Phase Ii ◽  
Local Recurrence Rate ◽  
Anal Verge ◽  
Low Rectal Cancer ◽  
Rectal Cancer Surgery ◽  
Rectal Cancers ◽  
Anal Preservation

AbstractThe evolution over the past 20 years of anal preservation in rectal cancer surgery has been truly remarkable. Intersphincteric resection (ISR) reported by Schiessel in 1994 in Australia has been shown to enable anal preservation even for cancers quite close to the anus. In Japan, ISR via the detachment of the anal canal between the internal and external sphincters and excision of the internal sphincter first began to be practiced in the latter half of 1990. A multicenter Phase II trial of ISR in Japan suggested that 70% of the cases had relatively good function with less than 10 points of Wexner score but around 10% had severe incontinence that would not be improved for long term. The primary end point of the clinical study, 3-year local recurrence rate, was 13.2% across the overall cohort (T1, 0%; T2, 6.9%; and T3, 21.6%). When ISR is performed on T1/T2 rectal cancers, sufficient circumferential resection margin can be obtained even without preoperative chemoradiotherapy, and local recurrence rate was acceptably low. Based on these evidences, ISR is a currently important, standard treatment option among anal-preserving surgeries for T1/T2 low-lying rectal cancers. In Japan, a feasibility study (LapRC trial) of laparoscopic ISR on Stage 0 and Stage 1 low rectal cancer showed excellent outcomes. A prospective Phase II clinical trial targeting low rectal cancers within 5 cm from the anal verge (ultimate trial) is being performed and awaiting the results in near future.

Local recurrence of diminutive colorectal polyps after cold forceps polypectomy with jumbo forceps followed by magnified narrow-band imaging: a multicenter prospective study

Endoscopy ◽  
2019 ◽  
Vol 51 (03) ◽  
pp. 253-260 ◽  
Author(s):  
Toshio Kuwai ◽  
Takuya Yamada ◽  
Tatsuya Toyokawa ◽  
Hiroaki Iwase ◽  
Tomohiro Kudo ◽  
...  
Keyword(s):  
Local Recurrence ◽  
Recurrence Rate ◽  
Local Recurrence Rate ◽  
Narrow Band ◽  
Narrow Band Imaging ◽  
Therapeutic Option ◽  
Colorectal Polyps ◽  
Delayed Bleeding ◽  
Immediate Bleeding

Background Cold polypectomy has been increasingly used to remove diminutive colorectal polyps. We evaluated the local recurrence rate of diminutive polyps at the 1-year follow-up after cold forceps polypectomy (CFP). Methods In a prospective, multicenter, observational cohort study, patients with diminutive colorectal polyps ( ≤ 5 mm) were treated by CFP using jumbo forceps followed by magnified narrow-band imaging (NBI). Patients were assessed for local recurrence at 1-year follow-up. Risk factors associated with local recurrence were analyzed using logistic regression analysis. Results Overall, 955 lesions were resected in 471 patients who completed the 1-year follow-up. The endoscopic complete resection rate was 99.4 %. Immediate and delayed bleeding occurred in 0.8 % and 0.2 % of cases, respectively, with no perforations observed. Local recurrence occurred in 2.1 % of cases at the 1-year follow-up. Univariable analyses indicated that polyps > 3 mm (P < 0.01) and immediate bleeding (P = 0.04) were significantly associated with local recurrence. A trend was observed for patients ≥ 65 years (P = 0.06) and fractional resection (P = 0.09). Multivariable analyses confirmed that lesions > 3 mm were significantly associated with local recurrence (odds ratio 3.4, P = 0.02). Conclusions CFP with jumbo forceps followed by NBI-magnified observation had a low local recurrence rate and is an acceptable therapeutic option for diminutive colorectal polyps. Although we recommend limiting the use of CFP with jumbo forceps to polyps ≤ 3 mm in size, future comparative studies are needed to make recommendations on cold polypectomy using either forceps or snares as the preferred approach for diminutive polyp resection.

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