scholarly journals Clinical use of molecular targeted agents for primary small bowel adenocarcinoma: A multicenter retrospective cohort study by the Osaka Gut Forum

2017 ◽  
Vol 14 (2) ◽  
pp. 1628-1636 ◽  
Author(s):  
Motohiro Hirao ◽  
Masato Komori ◽  
Tsutomu Nishida ◽  
Hideki Iijima ◽  
Shinjiro Yamaguchi ◽  
...  
Keyword(s):  
Cohort Study ◽  
Small Bowel ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Small Bowel Adenocarcinoma ◽  
Clinical Use ◽  
Targeted Agents ◽  
Molecular Targeted Agents ◽  
Primary Small Bowel

Microsatellite instability and mutations in BRAF and KRAS in small bowel adenocarcinoma.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e15037-e15037
Author(s):  
Vasiliki Michalaki ◽  
Andreas Polydorou ◽  
Theodosios Theodosopoulos ◽  
George Frangulidis ◽  
Nikolaos Dafnios ◽  
...  
Keyword(s):  
Overall Survival ◽  
Small Bowel ◽  
Microsatellite Instability ◽  
Small Bowel Adenocarcinoma ◽  
Targeted Agents ◽  
First Line ◽  
Braf Mutations ◽  
Platinum Based Chemotherapy ◽  
Molecular Targeted Agents ◽  
Line Chemotherapy

e15037 Background: Small-bowel adenocarcinomas (SBAs) are rare cancers with a significantly lower incidence, later stage at diagnosis, and worse overall survival than other intestinal-derived cancers. Activating KRAS and/or BRAF mutations have been identified as predictors of resistance to anti-epidermal growth factor receptor (EGFR) The aim of this study was to perform a comprehensive immunohistochemical.analysis of KRAS, NRAS, V600E BRAF mutations and microsatellite instability using a cohort of surgically resected cases in our institution. Methods: A total of 17 patients (10 males and 7 females; mean age, 56.2 years old; range, 45-75 years old) received chemotherapy due to non-curative tumor resection, unresectable tumor or post-operative recurrence. Twelve patents received fluoropirimidine and oxaliplatin based first line chemotherapy. Molecular targeted agents were administered to 15 patients, for whom it was their first- or second-line therapy. Results: KRAS mutations were found in 7 cases (41%), out of which 5 (29%) were in exons 12/13. BRAFV600E mutation was observed in 1/17 pt. Microsatellite instability was identified in 3/17pt (MSI; 18%), mainly related to a loss of expression of MLH1 protein. Univariate analysis revealed a PS of 0 (P=0.0226) and treatment with platinum-based chemotherapy (P=0.0047) were significant factors for an improved prognosis. Among the 12 patients who received oxaliplatin-based chemotherapy as a first-line chemotherapy, a PS of 0 (P=0.0255) and treatment with anti-EGFR agents (P=0.0127) were significant positive prognostic factors. Toxicities due to the molecular targeted agents were not experienced. The median overall survival time was 14.3 months (range, 3-52 months), the median DFS was 14.2 months and the median OS was 32 months. Conclusions: To date, there is no standard chemotherapy regimen for advanced SBAs and little is known about their molecular characteristics. The results of the present study indicate that oxaliplatin based chemotherapy containing molecular targeted agents is a well-tolerated and effective treatment option for SBA. A better understanding of disease biology may help to identify therapeutic targets and advance precision medicine.

scholarly journals Analysis of a Standardized Technique for Laparoscopic Cuff Closure following 1924 Total Laparoscopic Hysterectomies

2016 ◽  
Vol 2016 ◽  
pp. 1-9 ◽  
Author(s):  
Katherine A. O’Hanlan ◽  
Pamela L. Emeney ◽  
Alfred Peters ◽  
Margaret S. Sten ◽  
Stacey P. McCutcheon ◽  
...  
Keyword(s):  
Tensile Strength ◽  
Cohort Study ◽  
Small Bowel ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Task Force ◽  
Laparoscopic Hysterectomy ◽  
Total Laparoscopic Hysterectomy ◽  
Vaginal Cuff ◽  
Uterosacral Ligaments

Objective. To review the vaginal cuff complications from a large series of total laparoscopic hysterectomies in which the laparoscopic culdotomy closure was highly standardized.Methods. Retrospective cohort study (Canadian Task Force Classification II-3) of consecutive total and radical laparoscopic hysterectomy patients with all culdotomy closures performed laparoscopically was conducted using three guidelines: placement of all sutures 5 mm deep from the vaginal edge with a 5 mm interval, incorporation of the uterosacral ligaments with the pubocervical fascia at each angle, and, whenever possible, suturing the bladder peritoneum over the vaginal cuff edge utilizing two suture types of comparable tensile strength. Four outcomes are reviewed: dehiscence, bleeding, infection, and adhesions.Results. Of 1924 patients undergoing total laparoscopic hysterectomy, 44 patients (2.29%) experienced a vaginal cuff complication, with 19 (0.99%) requiring reoperation. Five patients (0.26%) had dehiscence after sexual penetration on days 30–83, with 3 requiring reoperation. Thirteen patients (0.68%) developed bleeding, with 9 (0.47%) requiring reoperation. Twenty-three (1.20%) patients developed infections, with 4 (0.21%) requiring reoperation. Three patients (0.16%) developed obstructive small bowel adhesions to the cuff requiring laparoscopic lysis.Conclusion. A running 5 mm deep × 5 mm apart culdotomy closure that incorporates the uterosacral ligaments with the pubocervical fascia, with reperitonealization when possible, appears to be associated with few postoperative vaginal cuff complications.

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