Importance of low preoperative platelet count in selecting patients for resection of hepatocellular carcinoma: a multi-institutional analysis.

Background: Low platelet count is a marker of portal hypertension but is not routinely included in the standard preoperative evaluation of patients with hepatocellular carcinoma (HCC) because it pertains to liver function (Child/model for end-stage liver disease [MELD] score) and tumor burden (Milan criteria). We hypothesized that low platelet count would be independently associated with increased perioperative morbidity and mortality after resection.

Study Design: Patients treated with liver resection for HCC between January 2000 and January 2010 at 3 institutions were eligible.

A prospective phase II evaluation of esophageal stenting for neoadjuvant therapy for esophageal cancer: optimal performance and surgical safety.

Background: Many surgeons are reluctant to use esophageal stents during neoadjuvant therapy for esophageal cancer because of concerns about nutritional status, stent-related complications, or added difficulties during esophagogastrectomy. We hypothesized that esophageal stenting during neoadjuvant therapy allows for optimal nutritional intake without adversely affecting perioperative outcomes.

Study Design: This study is a prospective, dual-institution, single-arm, phase II evaluation of esophageal cancer patients undergoing neoadjuvant therapy before resection.

Imaged guided transarterial chemoembolization with drug-eluting beads loaded with doxorubicin (DEBDOX) for hepatic metastases from melanoma: early outcomes from a multi-institutional registry.

Patients with unresectable hepatic metastases from melanoma present a difficult clinical challenge due to lack of locoregional control and poor response to systemic chemotherapy. This study aims to examine the early outcomes of the novel treatment of unresectable hepatic metastases from melanoma with drug-eluting beads loaded with doxorubicin (DEBDOX) delivered via image guided transarterial chemoembolization. A multicenter prospective open registry of hepatic-directed therapy with drug-eluting beads was reviewed.

Prognostic significance of tumor infiltrating lymphocytes in melanoma.

The prognostic significance of tumor infiltrating lymphocyte (TIL) response in cutaneous melanoma is controversial. This analysis of data from a prospective, randomized trial included patients with cutaneous melanoma > or = 1.0 mm Breslow thickness who underwent wide local excision and sentinel lymph node (SLN) biopsy.

Medically managed hypercholesterolemia and insulin-dependent diabetes mellitus preoperatively predicts poor survival after surgery for pancreatic cancer.

Introduction: Although patients with pancreatic ductal adenocarcinoma (PDAC) frequently require medications to treat pre-existing conditions, the impact of these treatments on outcomes post-resection is unknown. The purpose of this study was to determine the impact of preoperative medications on overall survival after pancreatic resection.

Methods: Multi-institutional data on preoperative medications and outcomes in patients undergoing resection for PDAC were analyzed.

Hepatectomy after hepatic arterial therapy with either yttrium-90 or drug-eluting bead chemotherapy: is it safe?

Background: The use of hepatic arterial therapy (HAT) with either yttrium-90 or drug-eluting bead therapy for initially unresectable hepatic malignancies has risen significantly. The safety of hepatic resection after hepatic arterial therapy (HAT) is not established.

Objective: The present study evaluates the safety profile for hepatic resection after HAT.

Phase II comparison study of intraoperative autotransfusion for major oncologic procedures.

Background: Intraoperative autotransfusion (IOAT) has been avoided in oncologic surgery because of possible tumor cell dissemination. Through a prior Phase I study, we demonstrated that malignant cells are not present in blood filtered for IOAT. We hypothesized that autotransfusion could be safely used for patients undergoing major oncologic procedures and reduce the need for allogeneic blood.

The lower incidence of melanoma in women may be related to increased preventative behaviors.

Background: Men have a higher lifetime incidence of melanoma than women.

Methods: Data from the 2005 Health Interview Survey were analyzed for sex differences in response to sun exposure and reported preventive measures among adults.

Results: There were 31,428 people surveyed representing the US population.

Does mitotic rate predict sentinel lymph node metastasis or survival in patients with intermediate and thick melanoma?

Background: The significance of mitotic rate (MR) in melanoma remains controversial.

Methods: In this retrospective analysis of a prospective randomized trial that included patients with melanoma of 1.0 mm or greater, all patients underwent wide excision and sentinel node (sentinel lymph node [SLN]) biopsy.

Bile cultures: a guide to infectious complications after pancreaticoduodenectomy.

Background: The aim of this study was to evaluate the utility of intraoperative bile cultures on the outcome of patients undergoing pancreaticoduodenectomy.

Study Design: A review of a hepato-pancreato-biliary database was performed to identify all patients who had a pancreaticoduodenectomy from 1/1998 to 8/2008.

Results: Two hundred twenty-eight patients were evaluated, with preoperative biliary stenting performed in 129 out of 229 patients (57%), with 63/129(49%) had bile cultures taken intraoperatively, 39/129(30%) having positive bile cultures.

Is prior cholecystectomy associated with decreased survival in patients with resectable pancreatic adenocarcinoma following pancreaticoduodenectomy?

Background: Patients with pancreatic cancer who present with biliary symptoms may undergo cholecystectomy and thus delay cancer diagnosis. We hypothesized that prior cholecystectomy leads to decreased overall survival in patients with pancreatic adenocarcinoma.

Methods: Retrospective study of hepatobiliary database.

Precision hepatic arterial irinotecan therapy in the treatment of unresectable intrahepatic cholangiocellular carcinoma: optimal tolerance and prolonged overall survival.

Background: Unresectable intrahepatic cholangiocellular carcinoma (ICC) carries a poor prognosis, and there are few chemotherapeutic treatments to prolong survival. The purpose of this study was to assess the efficacy of drug-eluting bead (DEB) therapy by transarterial infusion for unresectable ICC.

Methods: A prospective multicenter study of ICC patients who received hepatic arterial DEB therapy.

Hepatectomy is superior to thermal ablation for patients with a solitary colorectal liver metastasis.

Introduction: Hepatic resection is the mainstay of treatment for solitary colorectal liver metastases (mCRC); however, some patients are not ideal candidates. The aim of this study was to compare outcomes for patients with solitary mCRC who underwent resection or ablation.

Methods: A retrospective review of a hepatobiliary database identified patients with solitary mCRC.

Surveillance after surgical treatment of melanoma: futility of routine chest radiography.

Background: Current recommendations by the National Comprehensive Cancer Network and other groups suggest that follow-up of cutaneous melanoma may include chest radiography (CXR) at 6- to 12-month intervals. The aim of this study was to determine the clinical efficacy of routine CXR for recurrence surveillance in melanoma.

Methods: Post hoc analysis was performed on data from a prospective, randomized, multi-institutional study on melanoma ≥1.

Ulceration as a predictive marker for response to adjuvant interferon therapy in melanoma.

Objective: This analysis was performed to investigate the hypothesis that ulceration predicts improved response to adjuvant interferon (IFN) therapy.

Summary Background Data: Several studies have demonstrated that adjuvant therapy for high-risk melanoma patients with IFN alfa-2b improves disease-free survival (DFS), although the impact on overall survival (OS) is controversial. Recent data have suggested that IFN therapy may preferentially benefit patients with ulcerated primary melanomas.

Second primary melanomas: incidence and outcome.

The objective of this study was to determine the incidence of multiple primary melanomas (MPM) and other cancers types among patients with melanoma. Factors associated with development of MPM were assessed in a post hoc analysis of the database from a multi-institutional prospective randomized trial of patients with melanoma aged 18 to 70 years with Breslow thickness 1 mm or greater. Disease-free survival (DFS) and overall survival (OS) were evaluated by Kaplan-Meier analysis.

The prognostic significance of nonsentinel lymph node metastasis in melanoma.

Background: We hypothesized that metastasis beyond the sentinel lymph nodes (SLN) to the nonsentinel nodes (NSN) is an important predictor of survival.

Materials And Methods: Analysis was performed of a prospective multi-institutional study that included patients with melanoma ≥ 1.0 mm in Breslow thickness.

Prognostic information from sentinel lymph node biopsy in patients with thick melanoma.

Hypothesis: Sentinel lymph node (SLN) biopsy provides valuable prognostic information for patients with thick (T4) melanoma.

Design: Post hoc analysis of data from a prospective, randomized trial.

Setting: Academic and private hospitals.

Prior biliary tree instrumentation does not preclude hepatic arterial therapy for malignancy.

Hepatic arterial therapy (HAT) has become an accepted alternative for patients with unresectable hepatic malignancies. HAT has an acceptable toxicity profile, yet its safety for use in patients who have undergone significant biliary manipulation is undocumented. A retrospective review identified 18 consecutive patients with unresectable hepatic malignancies who had undergone significant prior biliary tree manipulation.

Adenovirus-mediated expression of truncated E2F-1 suppresses tumor growth in vitro and in vivo.

Background: Adenovirus (Ad)-mediated E2F-1 gene transfer induces apoptosis in cancer cells in vitro and in vivo, but clinical application of E2F-1 in cancer gene therapy remains controversial because of the oncogenic potential of E2F-1. This barrier can be circumvented by using the truncated form of the E2F-1 gene (E2Ftr) (amino acids 1 through 375), which lacks the E2F-1 transactivation domain and cell cycle-promoting effects.

Methods: The authors constructed 3 adenoviral vectors that expressed E2Ftr under regulation of the tetracycline (Tet)-off system (AdTet-E2Ftr1, AdTet-E2Ftr2, and AdTet-E2Ftr3).

A multicenter analysis of distal pancreatectomy for adenocarcinoma: is laparoscopic resection appropriate?

Background: As compared with open distal pancreatectomy (ODP), laparoscopic distal pancreatectomy (LDP) affords improved perioperative outcomes. The role of LDP for patients with pancreatic ductal adenocarcinoma (PDAC) is not defined.

Study Design: Records from patients undergoing distal pancreatectomy (DP) for PDAC from 2000 to 2008 from 9 academic medical centers were reviewed.

Laparoscopic hepatic lobectomy: advantages of a minimally invasive approach.

Background: As compared with open hepatic lobectomy (OHL), laparoscopic hepatic lobectomy (LHL) carries a substantial learning curve and potential for improved perioperative outcomes. The purpose of this analysis was to compare the outcomes of patients undergoing LHL with those of patients undergoing OHL.

Methods: Analysis of a 1,545-patient prospective hepato-pancreatico-biliary database from January 2000 to June 2009 identified 450 hepatic lobectomy patients, in whom 90 were LHL.