Publications by authors named "Julio Garcia Aguilar"

Background: The watch-and-wait strategy provides an opportunity to pursue nonoperative management in rectal cancer patients with clinical complete response after neoadjuvant therapy. The management of those with near-complete response remains controversial.

Objective: We assessed the oncologic outcomes of patients managed by watch-and-wait versus total mesorectal excision according to clinical response to neoadjuvant therapy.

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The management of locally advanced rectal cancer has changed drastically in the last few decades due to improved surgical techniques, development of multimodal treatment approaches and the introduction of a watch and wait (WW) strategy. For patients with a complete response to neoadjuvant treatment, WW offers an opportunity to avoid the morbidity associated with total mesorectal excision in favor of organ preservation. Despite growing interest in WW, prospective data on the safety and efficacy of nonoperative management are limited.

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Background: Appendiceal epithelial tumors are rare and encompass a broad set of adenocarcinoma histologies, including mucinous (mAC), colonic-type (cAC), and goblet cell (GCA) adenocarcinomas. It has previously been reported that nodal disease predicted recurrence in patients with nonmetastatic appendiceal adenocarcinomas, supporting diagnostic laparoscopy with right hemicolectomy for staging and assessment for risk of recurrence. In this update, we sought to identify predictors of nodal disease on initial diagnostic pathology in nonmetastatic adenocarcinomas.

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Background: Surgical site infections (SSIs) are a major driver of morbidity after combined liver and colorectal surgery for metastatic colorectal cancer. Available literature is inadequate to characterize risk factors and benchmarks for quality improvement.

Methods: Consecutive cases of simultaneous liver and colorectal surgery for colorectal adenocarcinoma from November 2013 through September 2022 were reviewed for SSIs per National Surgical Quality Improvement Program (NSQIP) and National Healthcare Safety Network (NHSN) criteria.

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Article Synopsis
  • Patterns of failure and salvage treatment options for anal squamous cell carcinoma (ASCC) post-definitive IMRT were investigated, revealing limited data on patient outcomes after recurrence.
  • A study of 375 ASCC patients showed significant locoregional failure (12%) and distant failure (13%) rates, with 73% progression-free survival and 80% overall survival at six years, emphasizing poorer outcomes for those with locoregional failure.
  • Salvage therapies improved survival chances significantly, with 30% of patients alive after ten years, contrasting sharply with those receiving only chemotherapy or supportive care.
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  • Researchers are merging unstructured patient data with structured health records to create the MSK-CHORD dataset, consisting of varied cancer types from nearly 25,000 patients at Memorial Sloan Kettering Cancer Center.
  • This dataset allows for in-depth analysis of cancer outcomes using advanced techniques like natural language processing, revealing new relationships that smaller datasets may not show.
  • Using MSK-CHORD for machine learning models, findings suggest that incorporating features from these unstructured texts can better predict patient survival than relying solely on genomic data or cancer staging.
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Purpose: The clinical efficacy of total neoadjuvant therapy (TNT) followed by selective nonoperative management (NOM) for locally advanced rectal cancer (LARC) was examined in the Organ Preservation for Rectal Adenocarcinoma (OPRA) trial. We investigated the cost and quality-of-life implications of adopting this treatment approach.

Methods: We analyzed clinical, cost, and quality-of-life outcomes for TNT with selective NOM in comparison with chemoradiotherapy (CRT)-surgery-adjuvant chemotherapy (standard of care [SOC]) using data from OPRA, prospective cohorts, and published studies.

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As cancers progress, they become increasingly aggressive-metastatic tumours are less responsive to first-line therapies than primary tumours, they acquire resistance to successive therapies and eventually cause death. Mutations are largely conserved between primary and metastatic tumours from the same patients, suggesting that non-genetic phenotypic plasticity has a major role in cancer progression and therapy resistance. However, we lack an understanding of metastatic cell states and the mechanisms by which they transition.

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Purpose To develop a radiology-pathology coregistration method for 1:1 automated spatial mapping between preoperative rectal MRI and ex vivo rectal whole-mount histology (WMH). Materials and Methods This retrospective study included consecutive patients with rectal adenocarcinoma who underwent total neoadjuvant therapy followed by total mesorectal excision with preoperative rectal MRI and WMH from January 2019 to January 2022. A gastrointestinal pathologist and a radiologist established three corresponding levels for each patient at rectal MRI and WMH, subsequently delineating external and internal rectal wall contours and the tumor bed at each level and defining eight point-based landmarks.

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  • Total mesorectal excision with intersphincteric resection and handsewn coloanal anastomosis (ISR-CAA) is considered safe for patients with distal rectal cancer, but the outcomes for those not qualifying for a watch-and-wait strategy have yet to be studied.
  • A retrospective analysis compared ISR-CAA with abdominoperineal resection (APR) in patients who received neoadjuvant therapy, showing similar tumor characteristics but differing local recurrence rates.
  • Results revealed a lower 5-year local recurrence-free survival rate for ISR-CAA (79%) compared to APR (93%), while disease-free survival rates were similar for both groups.
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  • The discovery of "mismatch repair proficient (MMRp)-crypt foci" in a patient with constitutional MMR deficiency presents new insights into tumor development in Lynch syndrome (LS).
  • The study found MMRp crypts in both non-cancerous and cancerous intestinal tissues, highlighting the unique genetic behavior of MSH6 in tumor formation.
  • These findings emphasize the need for careful diagnostic practices when using MMR immunohistochemistry, as the presence of MMRp crypts could lead to misdiagnosis in individuals with CMMRD.
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Background: Prospective randomized trials have not yet identified baseline features predictive of organ preservation in locally advanced rectal cancers treated with total neoadjuvant therapy and a selective watch-and-wait strategy.

Methods: This was a secondary analysis of the OPRA trial, which randomized patients with stage II-III rectal adenocarcinoma to receive either induction or consolidation total neoadjuvant therapy. Patients were recommended for total mesorectal excision, or watch and wait based on clinical response at 8 ± 4 weeks after completing treatment.

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Background MRI plays a crucial role in restaging locally advanced rectal cancer treated with total neoadjuvant therapy (TNT); however, prospective studies have not evaluated its ability to accurately select patients for nonoperative management. Purpose To evaluate the ability of restaging MRI to predict oncologic outcomes and identify imaging features associated with residual disease (RD) after TNT. Materials and Methods This was a secondary analysis of the Organ Preservation in Rectal Adenocarcinoma (OPRA) trial, which randomized participants from April 2014 to March 2020 with stages II or III rectal adenocarcinoma to undergo either induction or consolidation TNT.

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In colorectal carcinoma (CRC), tumor deposits (TDs) are described as macroscopic/microscopic nests/nodules in the lymph drainage area discontinuous with the primary mass, without identifiable lymph node (LN) tissue, and not confined to vascular or perineural spaces. A TD is categorized as pN1C only when no bona fide LN metastasis exists. However, there has been an ongoing debate on whether TDs should be counted as LNs.

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Background: Total neoadjuvant therapy (TNT) has been used for patients with locally advanced rectal cancer. The optimal sequence of chemoradiotherapy (CRT) and chemotherapy (CT) is a matter of debate.

Methods: We performed a pooled analysis of the CAO/ARO/AIO-12 and OPRA multicenter, randomized phase 2 trials to identify patient subsets that could benefit from one TNT sequence over the other regarding disease-free survival (DFS).

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  • Adenosquamous carcinoma (ASC) is a rare and severe form of colon cancer that often presents at more advanced stages compared to common adenocarcinomas, resulting in worse outcomes.
  • A study reviewed 13 cases of colonic ASC from 2000 to 2020, revealing that most patients were diagnosed at Stage III or IV, with a median age of 48.7 years and a high recurrence rate (53.8%).
  • The overall five-year survival rate for these patients was found to be only 38.5%, highlighting the need for further research to understand and improve management strategies.
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Purpose: Outcome for patients with nonmetastatic, microsatellite instability (MSI) colon cancer is favorable: however, high-risk cohorts exist. This study was aimed at developing and validating a nomogram model to predict freedom from recurrence (FFR) for patients with resected MSI colon cancer.

Patients And Methods: Data from patients who underwent curative resection of stage I, II, or III MSI colon cancer in 2014-2021 (model training cohort, 384 patients, 33 events; median follow-up, 38.

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  • * The design of a new NCI-sponsored randomized trial aims to determine the best chemotherapy regimen for patients who achieve a clinical complete response (cCR) after TNT, potentially allowing for a "watch and wait" strategy instead of immediate surgery.
  • * The trial will enroll up to 760 patients with specific LARC criteria and will evaluate the effectiveness of long-course chemoradiation followed by different consolidation chemotherapy regimens, with patient outcomes being monitored over time.
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Purpose: To systematically review and meta-analyze the prognostic significance of lateral lymph node metastasis (LLNM) on pretreatment MRI in patients with rectal cancer who undergo neoadjuvant chemoradiation followed by curative surgical resection without lateral lymph node dissection (LLND).

Methods: We searched the MEDLINE and EMBASE databases until September 27, 2023, utilizing the following search terms: (rectal OR rectum OR colorectal) AND (lateral OR sidewall) AND (lymph OR node). The QUIPS tool was employed to evaluate methodological quality.

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