Factors affecting operative morbidity and long-term outcomes in patients undergoing surgery for presacral tumours: a multicentric cohort study from the Turkish Collaborative Group for Quality Improvement in Colorectal and Pelvic Surgery.

AIM: Data regarding the operative management of presacral tumours present various dilemmas due to their rarity and heterogeneous nature. The aim of this study was to evaluate the management strategy, factors associated with operative morbidity and long-term postoperative outcomes in a large group of patients undergoing surgery for presacral tumours. METHOD: This study was designed as a multicentre retrospective cohort study. Records of patients who underwent surgery for presacral tumours at 10 tertiary colorectal centres between 1996 and 2017 were evaluated. RESULTS: One hundred and twenty seven patients (44 men) with a mean age of 46 years and body mass index of 27 kg/m2 were included. Fifty eight per cent of the patients had low sacral lesions (below S3). The operative approaches were transabdominal (17%), transsacral (65%) and abdominosacral (17%). The postoperative morbidity was 19%. Thirty per cent of the patients had a malignant tumour. Longer duration of symptoms (p = 0.001), higher American Society of Anesthesiologists score (p = 0.01), abdominosacral operations (p = 0.0001) and presacral tumours located above S3 (p = 0.004) were associated with an increased risk of postoperative morbidity. Overall long-term postoperative recurrence and mortality were 6% and 5%, respectively, within a 3-year mean follow-up period in patients with presacral malignant tumours. CONCLUSION: Reduced physical condition, omission of symptoms prior to surgery, combined resections and high sacral tumours are the risk factors associated with postoperative complications in patients undergoing surgery for presacral tumours. Meticulous planning of the operation and intensified perioperative care may improve the outcomes in high-risk patients.

The association of mucinous histology with clinicopathological characteristics and long-term oncological outcome in patients with colorectal cancer.

BACKGROUND: This study aimed to evaluate clinicopathological characteristics and long-term oncological outcome with respect to mucinous histology of tumor in colorectal cancer (CRC) patients. METHODS: A total of 372 patients who underwent resection surgery due to CRC between March 2006 and March 2019 were included in this retrospective study. Patients were divided into two groups according to degree of mucinous component including mucinous carcinoma group (n=48, ≥50% mucinous component) and non-mucinous carcinoma (n=324, <50% mucinous component) group. Data on patient demographics, tumor characteristics, treatment characteristics, metastasis and recurrence rates, disease free survival (DFS), and overall survival (OS) times were recorded. RESULTS: Mucinous vs. non-mucinous carcinoma was associated with higher rate of T4 stage (p=0.036) and high grade tumors (p=0.001) with extranodal invasion (p=0.019) Both the OS time (75.9±13.1 vs. 110.8±5.6 months, p=0.019) and DFS time (98.5±15.6 vs. 140.5±5.1 months, p=0.003) were significantly shorter in colon cancer patients with vs. without mucinous carcinoma despite their higher likelihood of receiving chemotherapy (89.6 vs. 71.9%, p=0.009). Multivariate analysis revealed presence of perineural invasion (HR 1.865, p=0.002), extranodal invasion (HR 1.869, p=0.009), T4 stage (HR 1.617, p=0.019), and M1 stage tumors (HR 3.643, p<0.001) but not mucinous carcinoma to significantly predict poor survival in CRC patients. CONCLUSION: In conclusion, our findings indicate colorectal tumors with mucinous carcinoma histology to have a more aggressive tumor characteristics and advanced disease stage on admission in CRC patients as well as shorter OS time and DFS time specifically in colon cancer patients despite receiving chemotherapy. KEY WORDS: Chemotherapy, Colorectal cancer, Long-term follow up, Mucinous histology, Survival.

The utility and prognostic value of CA 19-9 and CEA serum markers in the long-term follow up of patients with colorectal cancer. A single-center experience over 13 years.

PURPOSE: To evaluate utility and prognostic value of serum CA 19-9 levels in relation to serum CEA levels in the longterm follow up of patients with colorectal cancer (CRC) METHODS: A total of 315 patients with CRC who were treated over a 13-year period were included in this retrospective study. Data on tumor characteristics, CEA and CA 19-9 levels were recorded. Survival analysis was performed with respect to marker status, while receiver operating characteristics (ROC) curve was plotted to determine the performance of CEA in predicting survival during follow up with calculation of area under curve (AUC) and cut-off value via ROC analysis. RESULTS: Advanced T stage (T3-4, p<0.001), presence of intramural invasion (p=0.019), lymphatic invasion (p=0.003) and larger tumor volume (p=0.02) were associated only with high CEA levels on admission, while poor histological differentiation (p=0.036) was only associated with high CA 19-9 levels on admission. Presence of normal CEA and CA 19-9 levels was associated with the longest survival time (131.6 and 46.8 months, respectively, p<0.001 for each) and 5-year OS rate of 90.5%, while ROC analysis revealed CEA levels >11 (AUC (95% CI): 0.636 (0.580-0.690), p<0.001) to be a potential marker of poor survival with a sensitivity of 75.0% and specificity of 45.9%. CONCLUSION: In conclusion, our findings seem to indicate a weaker poor prognostic value of high CA 19-9 levels when used alone and strongly suggest combined use of CEA and CA 19-9 markers in prognostic assessment and risk-adapted follow-up surveillance in CRC patients. KEY WORDS: CEA, CA 19-9, Colorectal cancer, Prognosis, Survival.

Retroperitoneal cystic lymphangioma: a diagnostic and surgical challenge.

A lymphangioma is a benign proliferation of lymph vessels, producing fluid-filled cysts that result from a blockage of the lymphatic system. The incidence of abdominal lymphangiomas is unknown; however they account for from 3% to 9.2% of all pediatric lymphangiomas, with retroperitoneal lymphangioma representing less than 1% of abdominal lymphangiomas. Due to rarity, preoperative diagnosis is often difficult.

Analysis of prognostic and immunohistochemical factors in gastrointestinal stromal tumors with malignant potential.

The aim of this study was to analyze 37 patients with malignant primary gastrointestinal stromal tumors and to compare the findings and their therapeutic implications with those previously reported. The medical records of 37 patients who were diagnosed and operated on between January 1996 and December 2002 were retrospectively reviewed. The patients' age, tumor size, type of surgery, histologic type, mitotic counts, presence of necrosis, Ki-67 proliferative index, National Institutes of Health 2001 consensus classification, immunohistochemical staining, and recurrence were examined to analyze factors affecting survival. Overall actuarial survival for all patients was 46%. When analyzed by type of resection, the complete resection group (R0 resection) had a mean overall survival of 48.2 +/- 6.18 months compared with the patients with incomplete resection (R1-R2) who survived a mean of 10.8 +/- 3.2 months (P=0.00). Univariate analysis showed development of recurrence (P=0.00), tumor size of 8 cm or greater (P=0.05), Ki-67 proliferative index greater than 0.82 (P=0.0448), desmin staining (P=0.0076), age younger than 49 years (P=0.0009), and incomplete resection (P=0.00) to be significantly correlated with a poor survival. In multivariate analysis, desmin staining (P=0.031), tumor size (P=0.033), age (P=0.01), recurrence (P=0.038), and R0 resection (P=0.02) were significant independent prognostic factors. We recommend that more careful preoperative and more frequent postoperative follow-up examinations be performed for patients with large tumors, age of younger than 49 years, and Ki-67 proliferative index greater than 0.82.