The What, the Why, and the How of Liver Ablations: A Practical Guide for the Medical Oncologist.

Interventional oncology plays a major role within modern oncological patient management. Image-guided thermal ablation has been recognized as a successful local therapeutic option in patients with primary and secondary malignant liver diseases, as also recalled by the recent European Society of Medical Oncology (ESMO) guidelines on colorectal metastases. As image-guided treatments may be as effective as surgery in selected patients with liver lesions, the clinical oncologist should be familiar with the indications, risks, and technical aspects of liver ablation in order to provide their patients with the best outcomes. This article provides a broad overview of the most commonly used ablation techniques and highlights the most relevant technical aspects such as the ideal setting in the operating theatre; which image-guided methods are available, including the growing application of fusion imaging; or contrast-enhanced ultrasound for guiding/monitoring the procedure. A further aim is to expand the knowledge among medical oncologists about liver ablation procedures and to provide insights into the future perspectives of percutaneous minimally invasive procedures in the liver.

Preoperative autologous blood donation and transfusion in dogs undergoing elective surgical oncology procedures with high risk of hemorrhage.

OBJECTIVE: To describe preoperative autologous blood donation (PABD) and transfusion in dogs undergoing elective surgical oncology procedures with a high risk of intraoperative hemorrhage. STUDY DESIGN: Prospective study. ANIMALS: Twelve dogs. METHODS: Dogs undergoing surgical oncology procedures associated with a high risk of hemorrhage were enrolled. Blood was collected a minimum of 6 days before surgery and separated into fresh frozen plasma (FFP) and packed red blood cells (pRBC). Dogs received FFP at the start of surgery and pRBC intraoperatively when hemorrhage ensued. The mean packed cell volume/total solids (PCV/TS) were calculated on the day of PABD preoperatively, immediately postoperatively, and 24 hours after transfusion. The dogs were monitored for transfusion-related adverse reactions, including hyperthermia, hypotension, tachycardia, bradycardia, pale mucous membranes, prolonged capillary refill time, or tachypnea/dyspnea. RESULTS: Dogs enrolled in the study underwent mandibulectomy, maxillectomy, chest wall resection, and liver lobectomy. Ten of the 12 dogs that underwent PABD received autologous transfusion at first signs of hemorrhage intraoperatively. Iatrogenic anemia was noted in two dogs (PCV 30% and 31%). The mean PCV/TS levels on the day of blood collection, preoperatively, immediately postoperatively (after transfusion), and 24 hours posttransfusion were 45.1%/7.1 g/dL, 42.2%/6.73 g/dL, 33.2%/5.42 g/dL, and 36.5%/5.65 g/dL, respectively. No dog developed transfusion-related complications. CONCLUSION: Preoperative autologous blood donation was well tolerated and led to uneventful autologous transfusion in 10 of 12 dogs. CLINICAL SIGNIFICANCE: Preoperative autologous blood donation and autologous transfusion are feasible for dogs undergoing elective surgical procedures with a high risk of hemorrhage.

Evaluación de la disección ganglionar en colectomía oncológica realizada por cirujanos generales / Evaluation of lymph node dissection in oncological colectomy performed by general surgeons

Resumen Introducción: El cáncer colorrectal es la cuarta patología neoplásica en incidencia y mortalidad en Colombia y, aunque hay evidente mejoría en sus desenlaces, este alto volumen hace indispensable la participación integrada de cirujanos colorrectales y cirujanos generales dedicados a esa área de interés. A la fecha es la cirugía el pilar del tratamiento de esta enfermedad, la cual debe ser realizada dentro de unos parámetros que permitan asegurarle al paciente la resección completa de la misma. Uno de estos parámetros incluye un adecuado vaciamiento ganglionar que nos permite evaluar el pronóstico de la enfermedad y la necesidad de terapias complementarias. Objetivo: Evaluar la calidad de la disección ganglionar en la cirugía oncológica colorrectal efectuada por cirujanos generales en dos instituciones de la ciudad de Bogotá. Materiales y Método: Estudio observacional analítico de corte transversal; se analizaron 315 pacientes llevados a cirugía electiva oncológica colorrectal por cirujanos generales en el periodo de 2014 a 2017 en nuestras instituciones. Resultados: La mediana de ganglios linfáticos recuperados fue de 16, el número de ganglios disecados se asoció con localización del tumor (p = 0,002) y la neoadyuvancia (p = 00,001). Sin embargo, no se encontró asociación con el sexo, tipo de abordaje y volumen de sangrado. Conclusiones: Las colectomías realizadas por cirujanos generales mantienen un volumen óptimo en relación a la disección ganglionar sin comprometer el resto de los desenlaces. El número de ganglios linfáticos recuperados se asoció con la localización del tumor y la terapia neoadyuvante.

Introduction: Colorectal cancer is the 4th neoplastic disease in terms of incidence and mortality in Colombia, even though the clinical outcomes are improving. The high volume of this patients is requesting the collaboration between colorectal surgeons and general surgeons dedicated to this area of interest. To date is surgery the mainstay of the treatment of this disease which should be carried out within parameters that allow to assure the patient the complete resection of the lesion. One of these parameters includes a suitable lymph node emptying that allows us to evaluate the prognosis of the disease and the need of complementary therapies. Aim: To evaluate the quality of the lymph node dissection in colorectal surgery performed by general surgeons in two academic institutions in Bogota, Colombia. Materials and Method: Transversal cohort in analytical and observational study. We analyzed 315 patients scheduled for elective colorectal surgery by general surgeons in the period from 2014 to 2017 in our institutions. Results: The mean of the lymph node recovered was 16, the number of dissected lymph nodes was associated with the tumor location (p = 0.002), and the neoadjuvant (p = 0.001). However, no association within sex, approach and bleeding was found. Conclusions: The colectomies performed by general surgeons maintain an optimal volume in relation with lymph node dissection without affect the remaining clinical outcomes. The number of lymph nodes recovered is associated with tumor location and neoadjuvant therapy.

Regionalization and Its Alternatives.

This article begins by introducing the historical background surrounding the volume-outcomes relationship literature, particularly in complex cancer surgery. The state of evidence surrounding mortality, as well as other outcomes, in relation to both hospital and surgeon procedure volume is synthesized. Where it is understood, the level of adoption of regionalization of various complex surgeries in the United States is also presented. Various controversies are weighed and discussed. Finally, various models of regionalization and proposed alternatives to regionalization from the peer-reviewed literature are presented.

Animal-Facilitated Therapy Program: Outcomes from Caring Canines, a Program for Patients and Staff on an Inpatient Surgical Oncology Unit

BACKGROUND: Animal-facilitated therapy (AFT) is a complementary medicine intervention. To the authors' knowledge, no study has investigated the benefits of an AFT program in an adult surgical oncology setting. OBJECTIVES: The purpose of this study is to assess the effects of an AFT program on patients and staff on a surgical oncology unit. METHODS: A quasiexperimental design was used for the patient group, and a pre-/post-test design was used for the staff group. The intervention involved the AFT program being fully integrated on a surgical inpatient unit. Outcomes included patient-reported symptoms and quality-of-life (QOL) outcomes for patients, as well as professional QOL for staff. FINDINGS: QOL indicators improved for all patients, and the level of energy at follow-up was significantly higher in the AFT group after adjusting for baseline. For staff, compassion satisfaction was high and burnout was low.

Adjuvant chemoradiotherapy instead of revision radical resection after local excision for high-risk early rectal cancer.

BACKGROUND: After local excision of early rectal cancer, revision radical resection is recommended for patients with high-risk pathologic stage T1 (pT1) or pT2 cancer, but the revision procedure has high morbidity rates. We evaluated the efficacy of adjuvant concurrent chemoradiotherapy (CCRT) for reducing recurrence after local excision in these patients. METHODS: Eighty-three patients with high-risk pT1 or pT2 rectal cancer underwent postoperative adjuvant CCRT after local excision. We defined high-risk features as pT1 having tumor size ≤3 cm, and/or resection margin (RM) ≤3 mm, and/or lymphovascular invasion (LVI), and/or non-full thickness excision such as endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD), or unknown records regarding those features, or pT2 cancer. Radiotherapy was administered with a median dose of 50.4 Gy in 1.8 Gy fraction size over 5-7 weeks. Concurrent 5-fluorouracil and leucovorin were administered for 4 days in the first and fifth weeks of radiotherapy. RESULTS: The median interval between local excision and radiotherapy was 34 (range, 11-104) days. Fifteen patients (18.1 %) had stage pT2 tumors, 22 (26.5 %) had RM of ≥3 mm, and 21 (25.3 %) had tumors of ≥3 cm in size. Thirteen patients (15.7 %) had LVI. Transanal excision was performed in 58 patients (69.9 %) and 25 patients (30.1 %) underwent EMR or ESD. The median follow-up was 61 months. The 5-year overall survival (OS), locoregional relapse-free survival (LRFS), and disease-free survival (DFS) rates for all patients were 94.9, 91.0, and 89.8 %, respectively. Multivariate analysis did not identify any significant factors for OS or LRFS, but the only significant factor affecting DFS was the pT stage (p = 0.027). CONCLUSIONS: In patients with high-risk pT1 rectal cancer, adjuvant CCRT after local excision could be an effective alternative treatment instead of revision radical resection. However, patients with pT2 stage showed inferior DFS compared to pT1.