Decision Regret in Patients with Appendiceal Cancer Undergoing Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy.

BACKGROUND: Decision regret is an emerging patient reported outcome. The aim of this study was to assess the incidence of regret in patients with appendiceal cancer (AC) who underwent cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS-HIPEC). PATIENTS AND METHODS: An anonymous survey was distributed to patients through the Appendix Cancer and Pseudomyxoma Peritonei (ACPMP) Research Foundation. The Decision Regret Scale (DRS) was employed, with DRS > 25 signifying regret. Patient demographics, tumor characteristics, postoperative outcomes, symptoms (FACT-C), and PROMIS-29 quality of life (QoL) scores were compared between patients who regretted or did not regret (NO-REG) the procedure. RESULTS: A total of 122 patients were analyzed. The vast majority had no regret about undergoing CRS-HIPEC (85.2%); 18 patients expressed regret (14.8%). Patients with higher regret had: income ≤ $74,062 (72.2% vs 44.2% NO-REG; p = 0.028), major complications within 30 days of surgery (55.6% vs 15.4% NO-REG; p < 0.001), > 30 days hospital stay (38.9% vs 4.8% NO-REG; p < 0.001), a new ostomy (27.8% vs 7.7% NO-REG; p = 0.03), >1 CRS-HIPEC procedure (56.3% vs 12.6% NO-REG; p < 0.001). Patients with worse FACT-C scores had more regret (p < 0.001). PROMIS-29 QOL scores were universally worse in patients with regret. Multivariable analysis demonstrated > 30 days in the hospital, new ostomy and worse gastrointestinal symptom scores were significantly associated with regret. CONCLUSIONS: The majority of patients with AC undergoing CRS-HIPEC do not regret undergoing the procedure. Lower income, postoperative complications, an ostomy, undergoing > 1 procedure, and with worse long-term gastrointestinal symptoms were associated with increased regret. Targeted perioperative psychological support and symptom management may assist to ameliorate regret.

Comparing Travel Distance to Care and Staging of Parotid Gland Malignancies in South Dakota and Surrounding States.

BACKGROUND: Parotid gland malignancies are difficult to characterize in terms of incidence and risk factors due to their relatively rare occurrence. Common cancers often present more aggressively in rural areas, albeit occurring less frequently. Some previous studies have found increased distance to care has been linked to more advanced malignancies. This study hypothesized decreased access to parotid gland malignancy specialists (otolaryngologists or dermatologists), evaluated as longer travel distances, would be associated with more advanced staging of parotid gland malignancies. METHODS: A retrospective chart review of the Sanford Health system electronic medical record in South Dakota and surrounding states from 2008-2018 was conducted to obtain data of parotid gland malignancies, respective staging, and patient home addresses to assess distance, both driving and straight-line, to the nearest parotid gland malignancy specialist, including outreach clinics. Travel distance was categorized (0-20 miles, 20-40 miles, and 40+ miles) and compared to categorized tumor stage (early 0/I, late II/III/IV) using a Fisher's Exact test. RESULTS: Overall, chart review yielded 134 patients with parotid gland malignancies from 2008-2018 in the Sanford Health system and associated data was gathered. The malignancies were categorically organized as 52.3 percent in early stage (0/I) vs. 47.7 percent in late (II/III/IV). When comparing parotid malignancy stage to driving distance, no significant association was found when outreach clinics were excluded (p=0.938) or included (p=0.327). When comparing parotid malignancy stage to straight-line distance, no significant association was found when outreach clinics were excluded (p=0.801) or included (p=0.874). CONCLUSIONS: Although no association was established between travel distance and parotid gland malignancy staging, further studies are needed to evaluate at population levels the incidence of parotid gland malignancies in rural communities and if there are specific risk factors in these areas for these malignancies which is currently unknown.

Leiomyosarcoma of the inferior vena cava: a case report.

Leiomyosarcoma (LMS) of the inferior vena cava (IVC) is an extremely rare malignancy with <400 cases reported. We present a 42-year-old woman with a 3-day history of vague and non-specific abdominal pain. Examination revealed mild tenderness to the epigastrium and right upper quadrant with no other findings. Abdominal ultrasound was performed, which revealed a large hypoechoic mass overlying the IVC. Abdominal computed tomography (CT) was performed which revealed an 8.9 × 7.9 × 9 cm multilobulated lesion encasing the IVC. A CT-guided biopsy was performed which revealed a primary LMS of the IVC. Surgical en bloc excision was performed with an end-to-end Dacron graft for IVC reconstruction. Histopathology confirmed LMS of the vessel wall with negative surgical margins.

Regio- and Stereospecific C- and O-Allylation of Phenols via π-Allyl Pd Complexes Derived from Allylic Ester Carbonates.

Two complementary strategies have been developed for the C- and O-allylation of phenols via a common π-allyl Pd complex. While O-allylation of phenols by this method is a well-recognized reaction of general utility, the associated para-selective C-allylation reaction is still in its infancy. Cationic π-allyl Pd intermediates, derived from allylic ester carbonates and palladium(0) catalyst, were found to undergo the Friedel-Crafts-type para-selective C-allylations with nine different phenols. Both C- and O-allylated products were obtained in good to excellent yields following a metal-catalyzed regio- and stereospecific substitutive 1,3-transposition. Conditions were also identified that control access to either allylated product. Finally, a study of the equilibrium established between the two allylation products revealed that the O-allylated compound was the kinetic product and the C-allylated compound the thermodynamic product.