Temporary stomas after rectal cancer resection; predilection of being permanent and predictors of complications?

Stomas are essential for colorectal surgery and are widely used not only for selected cases for bowel obstructions but also in rectal cancer operations to divert stool away from low rectal anastomosis. On the other hand, complications with stomas/ stomas reversal are not uncommon. In this study, we aimed at studying the frequency and the predictors of temporary stomas being permanent, and the contributing factors of surgical stoma/stoma closure related complications. In our cohort, only about 40% of the patient closed their initially planned temporary stomas. The occurrence of intestinal leak, wound sepsis, or any type of morbidity with 30 days of operation were significant predictors of permanent stomas. In addition, alarmingly although Hartmann's procedure was uncommon in our practice, only 9% of those who underwent Hartmann's have had it reversed. Moreover, the only factor that significantly increased stoma related complications was having an end colostomy. There was a tendency toward late closure of stomas with median 8.2 months, however early closure did not correlate to complications. In conclusion, further studies are needed to delineate the low rate of stoma closure. Patients who develop postoperative complications, even wound sepsis, would be at a higher risk of living with permanent stomas. Hartmann's procedures are commonly associated with stoma problems, and reluctance to reverse the stomas. (AU)

The epidemiological and clinicopathological characteristics of multifocal/multicentric breast cancer in the Egyptian Delta and its impact on management strategies.

BACKGROUND: Multifocal (MFBC)/multicentric (MCBC) breast cancer is being more recognized due to the improved imaging modalities and the greater orientation with this form of breast cancer, however, optimal surgical treatment, still poses a challenge. The standard surgical treatment is mastectomy, however, breast-conserving surgeries (BCS) may be appropriate in certain situations. METHODS: A total of 464 cases of MF/MCBC out of 4798 cases of breast cancer were retrospectively analyzed from the database of the Oncology Center, Mansoura University (OCMU), between January 2008 and December 2019. RESULTS: Radiologic involvement of multiple quadrants was reported in 27.9% by ultrasonography, 19% by mammography, and 59.1% by magnetic resonance imaging. BCS was performed in 32 cases (6.9%) while 432 cases underwent a mastectomy. Postoperative pathology revealed infiltration of other quadrants grossly in 23.5%, and under the microscope in 63.6% of the examined cases. Mean disease-free and overall survival were 95.5 and 164.6 months, respectively. When compared with MFBC, MCBC showed higher pathologic tumor size (p < 0.001), higher stages (p < 0.001), higher recurrence rates (p = 0.006), and lower DFS (P = 0.009) but with similar OS (P = 0.8). CONCLUSION: Mastectomy is still the primary treatment option for MCBC with higher recurrence rates compared with MFBC. However, BCS for properly selected MFBC is considered oncologically safe, following the same rules of breast conservation for unifocal disease.

Prognostic value of androgen receptor expression in different molecular types of breast cancer in women.

BACKGROUND: Breast cancer is a common women's disease. Usually, oestrogen is blamed in the aetiology and correlated with the prognosis; however, androgens are recently raising concern about its role in the breast cancer treatment and prognosis. METHODS: In this study we retrieved archival paraffin blocks of breast cancer patients and stained it for androgen. Thereafter, we compared clinico-epidemiologic parameters, histopathology, neoadjuvant response and recurrence rate and pattern among patients with and without androgen receptor (AR) expression. RESULTS: In total, 119 patients fulfilled enrolment criteria; AR expression were present in 77.3% of the patients. AR expression was associated with less grade III (6.8% versus 36.4%), and less triple negative (6.2% versus 25%), but similar overall recurrence rate (25% versus 22.2%). However, distant recurrence was significantly higher in androgen positive patients (91.3% versus 33.3% of all recurrences). CONCLUSION: Androgen expression appears to be common among breast cancer, but with no clear implication in tumour aggressiveness or effect on the rate of recurrence. However, being commonly associated with distant spread may have an impact on survival of the patients.

The Impact of Narrow and Infiltrated Distal Margin After Proctectomy for Rectal Cancer on Patients' Outcomes: a Systematic Review and Meta-analysis.

Rectal cancer is a common tumor within a difficult anatomic constraint. Total mesorectal excision with longitudinal and circumferential free margins is considered imperative for good prognosis. In this article, the authors systematically reviewed all published literature with specific Mesh terms until the end of year 2019. Thereafter, retrieved articles were assessed using the Newcastle-Ottawa Scale and meta-analysis was conducted comparing local recurrence among 1-cm, 5-mm, and narrow (< 1-mm)/infiltrated margins. Thirty-nine articles were included in the study. Macroscopic distal margin < 1 cm carried a higher incidence of recurrence for those who did not receive neoadjuvant radiation, without affecting neither estimated overall nor disease-free survival. Less than 5-mm margin after radiation therapy is accepted oncologically. Infiltrated margins and narrow margins (< 1 mm) microscopically are associated with higher incidence of local recurrence and shorter overall and disease-free survival. Surgeons should aim at 1-cm safety margin in radiotherapy-naïve patients and microscopic free margin > 1 mm for those who received neoadjuvant therapy. The cost/benefit of reoperation for patients with infiltrated margins is still inadequately studied.

Short-Term Surgical Outcomes of Standard and Lateral Video Endoscopic Inguinal Lymphadenectomy: A Multinational Retrospective Study.

Background: Video endoscopic inguinal lymphadenectomy (VEIL) is a minimally invasive technique that gives superior surgical outcomes than open inguinal lymphadenectomy (IL) for treating lymph node metastasis in penile, vulvar, and skin cancers. This study compared surgical outcomes obtained with two different approaches of VEIL, standard VEIL and lateral VEIL (L-VEIL), in cancer patients. Methods: Sixty-two patients who underwent standard VEIL (n = 15) or L-VEIL (n = 47) for treatment of lymph node metastasis were evaluated retrospectively from three centers in Brazil, Egypt, and India. Primary endpoint analyzed was conversion rate to open IL in the two groups, and the secondary endpoints included operative time, estimated blood loss, nodal yield, nodal positivity, postoperative drain duration, and postoperative complications. Results: The conversion rate to open IL was higher in L-VEIL compared with VEIL group (2% vs. 0%). Significantly lesser blood loss was reported with L-VEIL compared with VEIL (mean difference: 3.63 mL; P = .01). Postoperative drain duration was significantly lower with L-VEIL (-4.34 days; P < .05) than VEIL. The L-VEIL group had a higher number of lymph nodes without infiltration (mean difference: -0.48; P = .02). Operative time, nodal yield, nodal positivity, and hospitalization duration were similar in both groups. Postoperative complications were higher in the L-VEIL versus VEIL group (35 vs. 11 cases). Lymphedema events were significantly higher with L-VEIL in comparison with VEIL (38.8% vs. 16.7%; P = .03). Among patients with penile cancer, no significant difference was observed in outcomes obtained with VEIL and L-VEIL. Conclusion: As L-VEIL and VEIL approaches lead to comparable surgical outcomes, surgeons may choose either of these as per their convenience.

Significance of Omental Infiltration in Gastric Cancer Patients: a Retrospective Cohort Study.

BACKGROUND: Stomach cancer is a curative disease in early stages. The optimal extent and approach for gastric resection are still evolving. PATIENTS AND METHODS: In this study, we examined the value, as well as, the predictors of omental disease spread, retrospectively, in a group of patients with gastric cancer who attended the Oncology Center, Mansoura University, in the period between January 2006 and April 2017. RESULTS: Nodal metastasis, especially heavy disease (N2 and beyond), and advanced stage are predictors of the presence of omental disease. However, neither overall nor disease-free survival is affected by omental infiltration. CONCLUSION: Omental resection will continue being an integral part of gastric resection, but the level of omental cutting needs further studies.

Clinico-epidemiologic criteria and predictors of survival of rectal cancer among Egyptians in Delta region / Critérios clínico-epidemiológicos e preditores de sobrevida do câncer retalentre egípcios na região do Delta

Abstract Background Colorectal cancer represents a global health problem. Rectal cancer in particular is increasing and is believed to carry a unique epidemiologic and prognostic criteria. Method We herein study retrospectively the data of 245 patients from a tertiary center in Egypt. Clinico-epidemiologic criteria and predictors of survival are analyzed. Results The disease affects younger population without sex predilection. Prognosis is affected by age, nodal status, metastasis, and bowel obstruction. Conclusion Rectal cancer has unique criteria in the Egyptian population. A national population based registry is recommended to delineate the nature of the disease in Egypt.

Resumo Introdução O câncer colorretal é um problema de saúde global. A incidência de câncer retal, em particular, está aumentando; acredita-se que esta neoplasia apresente critérios epidemiológicos e prognósticos únicos. Métodos O presente estudo avaliou retrospectivamente os dados de 245 pacientes de um centro terciário no Egito. Critérios clínico-epidemiológicos e preditores de sobrevida foram analisados. Resultados A doença afeta a população mais jovem, sem predileção por sexo. O prognóstico é afetado pela idade, estado nodal, metástase e obstrução intestinal. Conclusão O câncer retal apresenta critérios únicos na população egípcia. Recomenda-se um registro nacional de base populacional para delinear a natureza da doença no Egito.

Oophorectomy as a Hormonal Ablation Therapy in Metastatic and Recurrent Breast Cancer: Current Indications and Results.

Breast cancer is the commonest malignancy affecting females. Hormone-positive cancers carry a better prognosis. Many adjuvant and palliative endocrine therapies are in use, including surgical ablation. We retrospectively studied seventy-four patients who did bilateral salpingo-oophorectomy (BSO)/bilateral oophorectomy (BO) for factors affecting survival and prognosis. BSO was superior in overall and progression-free survival. Incidental ovarian metastasis carried a grave prognosis. Surgical hormonal ablation is a viable option with laparoscopic BSO as the approach of choice.