Therapeutic Value of Sentinel Lymph Node Biopsy in Patients With Melanoma: A Randomized Clinical Trial.

Importance: Sentinel lymph node (SLN) biopsy is a standard staging procedure for cutaneous melanoma. Regional disease control is a clinically important therapeutic goal of surgical intervention, including nodal surgery.

Objective: To determine how frequently SLN biopsy without completion lymph node dissection (CLND) results in long-term regional nodal disease control in patients with SLN metastases.

Hepatic lobe torsion: A rare disease necessitating surgical management.

Background: Accessory liver lobes and other congenital liver abnormalities are rare and most often asymptomatic. However, these abnormalities can result in liver torsion, requiring surgical resection.

Case Report: We report a case of a 72-year-old woman with hepatic lobe torsion.

GIST identified during bariatric surgery: to treat or not to treat?

Background: Gastrointestinal stromal tumors (GIST) are rare GI tumors that compose 1% of GI tumors. With the rise in obesity, bariatric surgery is becoming an increasingly common procedure and the incidental GISTs in this population have been noted more often than in the general population.

Objective: We evaluated and characterized the incidental GISTs in our bariatric surgical population.

Head and neck cancer PEG site metastases: Association with PEG placement method.

Background: Many patients with head and neck cancer (HNC) will require feeding tube placement for nutritional support using percutaneous endoscopic gastrostomy (PEG) tube. Rarely, HNC metastases have been reported at the PEG site, a morbidity associated with a poor outcome.

Methods: Along with a case report, an evaluation of PEG placement methods with metastases from the literature was completed along with a statistical analysis of the literature to determine PEG site metastases and method of placement correlations.

Predictive genetic profiles for regional lymph node metastasis in primary cutaneous melanoma: a case-matched pilot study.

Melanoma confers an estimated lifetime risk of one in 50 for 2016. Clinicopathologic staging and sentinel lymph node biopsy (SLNB) have been the standard of care for T2 and T3 lesions. Molecular biomarkers identified in the primary lesion suggestive of metastatic potential may offer a more conclusive prognosis of these lesions.

Completion Dissection or Observation for Sentinel-Node Metastasis in Melanoma.

Background: Sentinel-lymph-node biopsy is associated with increased melanoma-specific survival (i.e., survival until death from melanoma) among patients with node-positive intermediate-thickness melanomas (1.

Management of periampullary adenocarcinoma by pancreaticoduodenectomy at a regional teaching hospital.

Background: Periampullary adenocarcinoma (PA) includes: pancreatic, duodenal and ampullary adenocarcinoma; and cholangiocarcinoma. Pancreaticoduodenectomy (PD) is required for cure of PA. Previous studies demonstrated the likelihood of cure increases when a microscopically negative (R0) margin is achieved.

Videoscopic inguinal lymphadenectomy in malignant melanoma: safe in pregnancy?

Lymphadenectomy is the standard of care for metastatic melanoma in the inguinal lymph node basin. Historically, open surgery was the only treatment option. However, in recent years, videoscopic inguinal lymphadenectomy (VIL) has become a popular approach as it offers a minimally invasive alternative, provides similar oncologic control and reduces wound complications.

What is the risk of diagnostic endoscopic retrograde cholangiopancreatography before cholecystectomy?

Many surgeons prefer to perform endoscopic retrograde cholangiopancreatography (ERCP) before cholecystectomy, specifically in patients at significant risk of having biliary pathology. However, a preoperative diagnostic ERCP, without the use of an endoscopic ultrasound or magnetic retrograde cholangiopancreatoscopy, remains controversial. This is the result of the risk of either performing an unnecessary procedure and/or the development of post-ERCP pancreatitis (PEP).

Differential lymph node retrieval in rectal cancer: associated factors and effect on survival.

Background: Recent publications have identified positive associations between numbers of lymph nodes pathologically examined and five-year overall survival (5-yr OS) in colon cancer. However, focused examinations of relationships between survival of rectal cancer and lymph node counts are less common. We conducted a single institution, retrospective review of rectal cancer resections to determine whether lymph node counts correlated with 5-yr OS and to explore the relationship between lymph node counts and various clinical and pathologic factors.

Histology, not lymph node involvement, predicts long-term survival in bronchopulmonary carcinoids.

Recently, the incidence of bronchopulmonary carcinoid has increased substantially, whereas survival associated with both subtypes has declined. We reviewed our experience with bronchopulmonary carcinoid to identify factors associated with long-term survival. We reviewed our cancer registry from 1985 to 2009 for all patients undergoing surgical resection for bronchopulmonary carcinoid.

Neuroendocrine tumors of the rectum: a 10-year review of management.

Neuroendocrine tumors of the rectum constitute approximately 19 per cent of gastrointestinal neuroendocrine tumors (NETs). The histologic characteristics of the tumor seem to be an indicative prognostic factor. Optimal treatment of NETS of the rectum has been widely debated, but more recent studies suggest that treatment depends upon the size.

The use of sentinel lymph node biopsy in ductal carcinoma in situ.

Although ductal carcinoma in situ (DCIS) does not require axillary evaluation, controversy exists regarding the use of sentinel lymph node biopsy (SLNB) in patients with DCIS diagnosed by core needle biopsy (CNB). Advocates of concomitant SLNB and lumpectomy cite the low morbidity of SLNB, the high rate of invasive ductal carcinoma in resected specimens, and the positive nodes found in 1 to 2 per cent of patients with resected DCIS despite finding no invasive component. Opponents of this practice cite the complication risk and the improbability of clinically significant axillary recurrence.

Combined treatment of dendritoma vaccine and low-dose interleukin-2 in stage IV renal cell carcinoma patients induced clinical response: A pilot study.

Vaccination using dendritic/tumor cell hybrids represents a novel and promising cancer immunotherapy. We have developed a technology that can instantly purify the hybrids (dendritomas) from the fusion mixture of dendritic cells (DCs) and tumor cells. Our animal studies and a phase I study of stage IV melanoma patients demonstrated that dendritoma vaccination could be conducted without major toxicity and induced tumor cell-specific immunological and clinical responses.

Differential expression of prognostic factors and effect on survival in young (< or =40) breast cancer patients: a case-control study.

The belief that young women develop more aggressive forms of breast cancer than other women is controversial. The purpose of this study was to determine if women 40 years of age and under with breast cancer have more negative prognostic indicators and a higher 5-year mortality than those women over 40 years of age. From January 1998-December 2002, all women with breast cancer were identified from our tumor registry.

Treatment and outcomes of melanoma with a Breslow's depth greater than or equal to one millimeter in a regional teaching hospital.

Local control and regional lymph node evaluation are the primary treatment goals for cutaneous primary melanoma. Historically, primary lesions were excised with large 3- to 5-cm radial margins. Recent clinical trials have suggested that similar survival and recurrence rates can be achieved with smaller margins of excision.

Sentinel node in the era of neoadjuvant therapy and locally advanced breast cancer.

The most important determinant of prognosis for patients with breast cancer is the status of the axillary lymph nodes. Axillary lymph node dissection (ALND) has been performed for over a century to stage the cancer, achieve regional control, and perhaps improve survival. In accordance with tradition, ALND has been performed on all patients with the diagnosis of invasive breast cancer.

Differential expression of thymidylate synthase in colorectal tumors and matched lymph nodes: impact on adjuvant treatment.

Although the expression of thymidylate synthase (TS) in metastatic colorectal cancer (CRC) may be a better predictor of response to 5-fluorouracil chemotherapy than TS expression in primary CRC, this enzyme has not been well studied in tumor-draining regional lymph nodes. We retrospectively examined TS expression in 12 primary CRC lesions (pT3) and matched sentinel lymph nodes. Of the 8 primary tumors that were TS-positive, 50 per cent (4/8) had tumor-positive lymph nodes and 50 per cent (4/8) had tumor-negative nodes.

Lymphatic mapping and sentinel node analysis to optimize laparoscopic resection and staging of colorectal cancer: an update.

Background: Laparoscopic colectomy for colorectal cancer (CRC) has been criticized because of the potential for inadequate nodal dissection and incomplete staging. Lymphatic mapping (LM) and sentinel lymph node (SLN) analysis can improve the accuracy of staging in open colectomy, but its utility during laparoscopic colectomy is unknown.

Methods: Between 1996 and 2002, 30 patients with clinically localized colorectal neoplasms or premalignant polyps underwent subserosal or submucosal injection of isosulfan blue dye via a colonoscope, via a percutaneously inserted spinal needle, or through a hand port.

Colorectal carcinoma nodal staging. Frequency and nature of cytokeratin-positive cells in sentinel and nonsentinel lymph nodes.

Context: Nodal staging accuracy is important for prognosis and selection of patients for chemotherapy. Sentinel lymph node (SLN) mapping improves staging accuracy in breast cancer and melanoma and is being investigated for colorectal carcinoma.

Objective: To assess pathologic aspects of SLN staging for colon cancer.

Combination probe and dye-directed lymphatic mapping detects micrometastases in early colorectal cancer.

Nodal metastasis is the single most important prognostic factor in early colorectal cancer (CRC). Lymphatic mapping can identify sentinel nodes for focused histopathologic examination and thereby improve the nodal staging of CRC; however, the optimal technique for identifying sentinel nodes in CRC is unclear. We hypothesized that a combination of radiotracer and blue dye would more accurately identify tumor-positive sentinel nodes than blue dye alone.