Prognosis of Concurrent Versus Sequential Chemo-Radiotherapy Induction Followed by Surgical Resection in Patients with Advanced Thymic Epithelial Tumors: A Retrospective Study.

BACKGROUND: This study aimed to evaluate the prognosis of concurrent chemo-radiotherapy (CCRT) versus sequential chemo-radiotherapy (SCRT) induction followed by surgical resection in patients with advanced thymic epithelial tumors (TETs). METHODS: This retrospective study included patients with advanced TETs who underwent CCRT or SCRT induction followed by surgical resection at the Second General Hospital of Guangdong Province between January 2008 and December 2019. The primary outcomes were induction response rate and surgical complete resection rate. The secondary outcomes were surgery combined resection, post-induction T staging, postoperative TNM staging, postoperative pathological tumor regression grade, progression-free survival (PFS) and overall survival (OS), and adverse events (AEs). RESULTS: A total of 31 patients were included, 15 of whom received CCRT and the other 16 SCRT. The induction response rates were 80.0 and 62.5%, respectively, the post-induction step-down rates were 46.7 and 31.3%, respectively, and the post-induction R0 resection rates were 80.0 and 68.8%, respectively, without significant differences between CCRT and SCRT groups (all P > 0.05). The 5-year OS rate was 64.2 and 51.6%, respectively, and PFS was 42.3 and 21.4%, respectively, without significant differences between CCRT and SCRT groups (both P > 0.05). AEs in the hematologic system were significantly higher with CCRT compared with SCRT (P = 0.009). CONCLUSIONS: Patients with advanced TETs might have a good prognosis with both CCRT and SCRT induction therapy, while SCRT induction may result in a lower probability of AEs in the hematologic system.

The efficacy and safety of cold snare versus hot snare polypectomy for endoscopic removal of small colorectal polyps: a systematic review and meta-analysis of randomized controlled trials.

PURPOSE: The optimal technique for removing small colorectal polyps ranging from 5 to 10 mm in size remains uncertain. In order to compare the efficacy and adverse events between cold snare polypectomy (CSP) and hot snare polypectomy (HSP) for removing small polyps, we conducted a systematic review and meta-analysis of available randomized controlled trials. METHODS: We conducted a comprehensive search of MEDLINE, EMBASE, and the Cochrane Library databases from 1998 to May 2023 to identify randomized controlled trials that evaluated the efficacy and safety of cold snare polypectomy (CSP) and hot snare polypectomy (HSP) for resecting small colorectal polyps. The primary outcome measure was the incomplete resection rate (IRR). RESULTS: Seven studies that met our study criteria, with a total of 3178 included polyps, were included in our analysis. The incomplete resection rate (IRR) was found to be significantly higher in the CSP group compared to the HSP group (risk ratio [RR] 1.57 [1.17-2.11], P = 0.003). Although the CSP group had a higher local recurrence rate than the HSP group, the difference was not statistically significant (RR: 3.98 [0.66-23.84], P = 0.13). The polyp retrieval rates were not significantly different between the two groups (RR: 1.00 [0.99-1], P = 0.22). Perforation was not reported or mentioned in any of the seven studies. The overall immediate bleeding rate was significantly higher in the CSP group than the HSP group (RR: 2.26 [1.63-3.14], P < 0.001), but immediate postpolypectomy bleeding requiring additional intervention was similar between the groups (RR: 1.08 [0.54-2.17], P = 0.82). The delayed bleeding rate (RR: 0.83 [0.45-1.55], P = 0.56) and specific polypectomy time (RR: -0.46 [-1.05-0.12], P = 0.12) were also similar between the groups. CONCLUSIONS: The meta-analysis shows a significantly higher IRR for CSP compared with HSP when removing small polyps.

Comparison of complete resection rates in cold snare polypectomy using two different wire diameter snares: A randomized controlled study.

BACKGROUND AND AIM: Cold snare polypectomy (CSP) is a standard treatment for small colorectal polyps. This study examined the effect of different snare wire diameters on complete histological resection rate, resection depth, and CSP safety. METHODS: This randomized controlled trial was conducted at two institutions between June 2019 and March 2021. Eligible colorectal polyps (≤10 mm) were randomly assigned in a 1:1 ratio to receive either CSP with a conventional snare made of normal-diameter wire (0.40 mm) or CSP with a dedicated snare made of thin wire (0.23 mm). The primary endpoint was the complete resection rate determined on histological assessment of the resected specimen. RESULTS: In total, 254 lesions in 152 patients were included, with 128 and 126 lesions assigned to the normal-diameter wire snare group and the thin-wire snare group, respectively. No significant differences were observed in patient characteristics between the two groups. The histological complete resection rate was significantly higher in the thin-wire snare group than in the normal-diameter wire snare group (70.0% vs 81.0%, P = 0.04). The normal-diameter wire snare group had significantly more cases of unclear horizontal margin evaluation than the thin-wire snare group (28.1% vs 15.9%, P = 0.02). No significant differences were observed between the two groups in the muscularis mucosa and submucosa of the resected specimens or the thickness of the submucosa in the resected specimens. CONCLUSIONS: CSP with a dedicated thin-wire snare provides more specimens that can be evaluated at the horizontal end and increases the histological complete resection rate.

A Comparison of Incomplete Resection Rate of Large and Small Colorectal Polyps by Cold Snare Polypectomy.

BACKGROUND & AIMS: There are limited data regarding the safety and efficacy of cold snare polypectomy (CSP) for large colorectal polyps. We evaluated factors affecting the clinical outcomes of CSP for polyps between 5 and 15 mm in size. METHODS: This was a prospective single-center observational study involving 1000 patients undergoing colonoscopy. Polyps (5-15 mm) were removed using CSP, and biopsies were taken from the resection margin. The primary outcome was the incomplete resection rate (IRR), and was determined by the presence of residual neoplasia on biopsy. Correlations between IRR and polyp size, morphology, histology, and resection time were assessed by generalized estimating equation model. RESULTS: A total of 440 neoplastic polyps were removed from 261 patients. The overall IRR was 2.27%, 1.98% for small (5-9 mm) vs 3.45% for large (10-15 mm) polyps (P = .411). In univariate analysis, the IRR was more likely to be related to sessile serrated lesions (odds ratio [OR], 6.93; 95% confidence interval [CI], 1.88-25.45; P = .004), piecemeal resection (OR, 11.83; 95% CI, 1.20-116.49; P = .034), and prolonged resection time >60 seconds (OR, 7.56; 95% CI, 1.75-32.69; P = .007). In multivariable regression analysis, sessile serrated lesions (OR, 6.45; 95% CI, 1.48-28.03; P = .013) and resection time (OR, 7.39; 95% CI, 1.48-36.96; P = .015, respectively) were independent risk factors for IRR. Immediate bleeding was more frequent with resection of large polyps (6.90% vs 1.42%; P = .003). No recurrence was seen on follow-up colonoscopy in 37 cases with large polyps. CONCLUSIONS: CSP is safe and effective for removal of colorectal polyps up to 15 mm in size, with a low IRR. (ClinicalTrials.gov; Number: NCT03647176).

A Possible Distinct Molecular Subtype (Quintuple-Wildtype) of Metastatic Colorectal Cancer in First-Line Anti-EGFR Therapy with Cetuximab Plus FOLFIRI - Palliative Precision Therapy and a Multidisciplinary Treatment Approach: Interim Analysis of the IVOPAK II Trial with Early Results.

OBJECTIVE: The study aimed to prospectively evaluate a new molecular biomarker panel (KRAS, NRAS, BRAF, PIK3CA, and ERBB2) for palliative first-line treatment of colorectal cancer (CRC), including a multidisciplinary treatment approach. The rate of secondary metastasis resections was assessed. PATIENTS AND METHODS: A total of 40 patients with definitively nonresectable metastatic CRC were enrolled from 10 centers before the interim analysis (June 2019) of the IVOPAK II trial (Interdisciplinary Care with Quality Control in Palliative Treatment of Colorectal Cancer). After determination of 5 molecular biomarkers in the tumor (KRAS, exons 2-4; NRAS, exons 2-4; BRAF V600E; PIK3CA; and ERBB2), patients in the IVOPAK II study received FOLFIRI plus cetuximab for all-RAS/quintuple-wildtype disease and FOLFIRI plus bevacizumab in the case of RAS mutations. The current article presents the early description of the clinical outcome of the interim analysis of IVOPAK II comparing the all-RAS/quintuple-wildtype and RAS-mutations populations, including a multidisciplinary-treated case report of a quintuple-wildtype patient. RESULTS: The quintuple-wildtype population treated with FOLFIRI plus cetuximab in first-line exhibited a significantly higher response rate and enhanced early tumor shrinkage in the interim analysis than the RAS-mutations population, as well as a high rate of secondary metastatic resections. CONCLUSION: Initial results of this new biomarker panel (quintuple-wildtype) are promising for anti-EGFR therapy with cetuximab plus doublet chemotherapy (FOLFIRI) in first-line treatment of metastatic CRC. These results warrant confirmation with higher case numbers in the IVOPAK II trial.

Endoscopic resection of local recurrences of diminutive polyps by cold forceps polypectomy.

OBJECTIVES: Cold forceps polypectomy (CFP) is an effective treatment for diminutive colorectal polyps. However, polyps occasionally recur, and there is no consensus on their long-term clinical management. Therefore, we investigated the short- and long-term clinical outcomes of re-CFP for recurrent diminutive colorectal polyps. MATERIALS AND METHODS: This was a follow-up of a multicenter, prospective study investigating the clinical outcomes of diminutive colorectal polyps excised by CFP with narrowband imaging-enhanced endoscopy and jumbo forceps. We evaluated short-term outcomes of re-CFP and patients at 1-year follow-up post re-CFP for recurrent colorectal polyps to determine long-term recurrence rates. Additionally, complete resection rates, clinicopathological features, number of forceps bites, and rate of short-term adverse events managed by re-CFP were evaluated. RESULTS: At 1-year follow-up, local recurrence was identified in 18 patients from the original study. The mean size of local recurrent polyps was 1.5 ± 0.6 mm, and all recurrent lesions were < 3 mm. Re-CFP could successfully excise locally recurrent polyps in all cases. All recurrent lesions were low-grade adenomas; no adverse events were reported. Additionally, 16 of 18 patients were evaluated endoscopically at 2-year follow-up; no recurrence was observed. CONCLUSIONS: Recurrent lesions following initial CFP were small and pathologically benign, and re-CFP was an effective treatment.

Resection rate curves by location along the small intestine provide perspectives on characteristics of Crohn's disease.

AIM: Crohn's disease (CD) can affect any part of the gastrointestinal tract; however, the frequency of CD lesions differs by location. This work aimed to examine resection rates by location to clarify locational characteristics of the small intestine in surgical CD cases. METHOD: This was a single-centre retrospective case note review of patients who had undergone resection for CD affecting the small intestine between January 2014 and February 2020. Operative details, including length of the small intestine, location and extent of the resection, identified the pattern of disease. By normalizing these data the resection rate along the length of the intestine was calculated to create resection rate curves. RESULTS: One hundred and twenty six surgical cases were identified. The resection rate curves could be divided into two types: exponential and bimodal. For primary surgery, this depended on whether or not surgery was limited to an ileocolic resection. At subsequent surgery, a previous ileocaecal resection influenced the pattern of disease. The peaks of the bimodal curve were located at the proximal and distal ileum. CONCLUSION: CD patients requiring resection of the small intestine can be divided into terminal ileum type (exponential type) and proximal ileum type (bimodal type). In the future this analytical method may help predict the site of any recurrent disease but also provides a new perspective on the disease.

A prospective randomized study comparing jumbo biopsy forceps to cold snare for the resection of diminutive colorectal polyps.

BACKGROUND AND AIMS: The quality of colonoscopy is essential for successful colon cancer screening. Inadequate polypectomy technique can contribute to incomplete polypectomy. The primary outcome of this study was to compare the incomplete resection rate (IRR) for cold jumbo forceps polypectomy (JFP) and cold snare polypectomy (CSP). Secondary outcomes were to compare the rates of tissue retrieval and rates of procedure-related complications. METHODS: This prospective randomized parallel-group study assigned patients undergoing colonoscopy to jumbo biopsy forceps polypectomy (JFP) or cold snare polypectomy (CSP) for polyps ≤ 6 mm in size. After polyp removal was complete, the base of the polypectomy site was biopsied to evaluate for the presence of residual polyp tissue. RESULTS: The resection quality was evaluated in 151 patients with 261 polyps ≤ 6 mm. The IRR was 9.6% (25/261) for all polyps, 11.1% (16/144) for JFP, and 7.7% (9/117) for CSP (P = 0.41). Failure of tissue retrieval was noted in 0/144 (0%) of JFP and 5/117 (4.3%) of CSP (P = 0.02). There were no procedure-related complications in either group. CONCLUSION: Colon polyps are incompletely resected in a small but potentially significant percentage of cases. IRR are similar with the use of cold jumbo forceps and cold snare. Use of cold jumbo forceps may result in more successful tissue retrieval as compared to cold snare.

Impact of increased resection rates and a liver parenchyma sparing strategy on long-term survival after surgery for colorectal liver metastases. A population-based study.

Background and aims: Expanded criteria for resection of colorectal liver metastases (CRLM) have led to a more aggressive surgical attitude. The aim is to evaluate any impact of expanded criteria on perioperative mortality and long-term survival. Materials and methods: A population based study from 2001 to 2015 for patients undergoing surgery for CRLM. The cohort was divided into three 5-year periods. Results: A total of 341 patients underwent resection of CRLM. Relative to the number of colorectal primaries, patients resected for CRLM increased from 82/2520 (3.3%) in 2001-2005 to 151/3071 (4.9%) in 2011-2015 (p = .007). The proportion of patients who underwent formal resections declined from 62% to 21%. There was a substantial increase in resections of synchronous liver metastases, portal vein embolizations, two-stage resections, and the share of octogenarians who underwent resection. The proportion of patients undergoing reresections of new liver recurrences increased from 6% to 24%. The 90-d postoperative mortality for 2001-2005, 2006-2010, and 2011-2015 were 7.9%, 0.8%, and 2.0%, respectively. The median overall survival was 47 months during the two first periods, for the last period not reached. The 5-year overall survival remained at 40% from 2001 to 2010, and estimated at 55.2% from 2011 to 2015. The 5-year disease-free survival was well above 30%. The 5-year overall survival following liver reresection was 52.6%. Conclusion: Postoperative mortality remained at approximately 2%, and the 5-year overall survival at 40% in the first 10 years, but increased to 55% in the last 5 years under study, despite a marked increase in resection rates.

Comparison of neoadjuvant chemoradiotherapy and neoadjuvant chemotherapy for esophageal cancer: a meta-analysis.

Aim: To compare the clinical efficacy of neoadjuvant chemoradiotherapy (nCRT) and neoadjuvant chemotherapy (nCT) for esophageal cancer. Methods: Randomized controlled trials reporting on the comparison of nCRT and nCT for esophageal cancer were identified. Results: Three eligible randomized controlled trials were identified and included with a total of 375 patients (189 nCRT, 186 nCT). Outcomes showed that compared with nCT group, R0 resection and pathologic complete response (pCR) rates were significantly increased in nCRT group. However, no significant difference was seen in 3- and 5-year progression-free survival or 3- and 5-year overall survival. Conclusion: The addition of radiotherapy to neoadjuvant chemotherapy results in higher R0 resection rate and pCR rate, without significantly impacting survival.