Category Archives: Oncology

Tranexamic Acid Use in Breast Surgery

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“Tranexamic acid (TXA) is an antifibrinolytic agent that competitively inhibits the conversion
of plasminogen to plasmin. TXA is also believed to have an anti-inflammatory effect and may improve platelet function under certain circumstances. TXA has increasingly gained recognition in perioperative use to mitigate the risk of postoperative bleeding. Originating in the field of anesthesiology, TXA is used to control surgical, traumatic, and postpartum hemorrhage. Meanwhile, perioperative TXA administration has been established in orthopedic and cardiothoracic surgery. It is also becoming popular in plastic surgery, especially regarding craniomaxillofacial procedures. Although the evidence on
the use of TXA in breast surgery is improving, its value still needs further investigation.”

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Pembrolizumab for EarlyTriple-Negative Breast Cancer

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“High-risk early triple-negative breast cancer is frequently associated with early recurrence and high mortality. Neo-adjuvant chemotherapy is the preferred treatment approach. In addition to potentially increasing the likelihood of tumor resectability and breast conservation, patients who have a pathological complete response after neoadjuvant therapy have longer event-free survival (defined as the time from randomization to the date of disease progression that precluded definitive surgery, the date of local or distant recurrence or the occurrence of a second primary tumor, or the date of death from any
cause) and overall survival. Accordingly, regulatory guidance supports the use of the pathological complete response as an end point for clinical testing of neoadjuvant treatment in patients with early triple-negative breast cancer.”

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Preoperative Nutrition Status and Postoperative Outcomesin Patients Undergoing Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy

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“Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) is complex surgery to treat peritoneal surface malignancy (PSM). PSM arises from gastrointestinal (GI), gynecological, or primary peritoneal cancers. CRS aims to completely remove macroscopic tumor. In order to achieve complete cytoreduction, multiple abdominal organ resections are often necessary. After cytoreduction, HIPEC is delivered into the abdominal cavity for 30–90 min to treat residual microscopic disease.”
“Malnutrition is prevalent in patients undergoing surgery for abdominopelvic malignancy and is associated with increased morbidity, longer hospital length of stay (LOS), and mortality. Preoperative malnutrition is a risk factor for organ dysfunction, impaired immune function,
wound complications, impaired physical function, and increased LOS. Malnutrition prevalence is documented in up to 67% of patients with ovarian cancer and 30–50% of patients with colorectal cancer.”

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Six versus three years of adjuvant imatinib in patients with localized GIST at high risk of relapse

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“Gastrointestinal stromal tumor (GIST) is the most common sarcoma and also a paradigmatic model for precision medicine in solid tumors, with the tyrosine kinase inhibitor
imatinib as a standard first-line treatment in the advanced phase and as adjuvant treatment in KIT- or PDGFRA-mutated GIST.”
Whether a longer duration of imatinib treatment improves disease-free survival (DFS) has not been explored in a randomized setting. The randomized IMADGIST study was initiated in 2014 with the aim to determine whether the prolongation of adjuvant imatinib during 3 additional years improves the outcome of high-risk GIST patients versus a standard total duration of 3 years as recommended by clinical practice guidelines. The primary endpoint was DFS. We report here the results of this clinical study.”

Figure 2 Disease-free survival in the in the 3-years and 6-years arms. (A) DFS in the entire series; (B) DFS in the stratification subgroup with a risk of relapse of 35%-70%; (C) DFS in the stratification subgroup with a risk of relapse >70%; (D) DFS in the stratification subgroup with a risk of relapse >70%, with (solid lines) or without (dotted lines) tumor rupture. CI, confidence interval; DFS, disease-free survival; Est, estimate; HR, hazard ratio; KM, Kaplan-Meier.
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Survival, Healthcare Utilization, and End-of-life Care among Older Adults with Malignancy-associated Bowel Obstruction

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“Among patients with cancer, the estimated prevalence of malignancy-associated bowel
obstruction (MBO) is 3-15%, including up to 51% in ovarian cancer and up to 28% in
cancers of the gastrointestinal tract. MBO is among the most common palliative
indications for surgical consultation5 and typically signifies a poor prognosis, with mean
survival of 3-8 months in surgical cases and 4-5 weeks in those with inoperable MBO.
Managing the considerable symptom burden associated with MBO frequently
requires hospitalization and contributes to high-intensity healthcare utilization.1, In light
of national efforts to address the poor quality and high cost of care near the end of life, it is
critical to understand the relationship between treatment for complications of terminal
cancer, such as MBO, and end-of-life (EOL) care.”

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Japanese Gastric Cancer Treatment Guidelines 2021

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“The sixth edition of the Japanese Gastric Cancer Treatment Guidelines was completed in July 2021, incorporating new evidence that emerged after publication of the previous edition. It consists of a text-based “Treatments” part and a “Clinical Questions” part including recommendations and explanations for clinical questions. The treatments parts include a comprehensive description regarding surgery, endoscopic resection and chemotherapy for gastric cancer. The clinical question part is based on the literature search and evaluation by an independent systematic review team.”

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Multi-Institutional Analysis of Pancreaticoduodenectomy for Nonfamilial Periampullary Adenoma: A Novel Risk Score to Guide Shared Decision-Making

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“Periampullary adenomas (PA), including both ampullary adenomas (AAs) and duodenal adenomas (DAs), are benign or premalignant mucosal lesions that are either hereditary, most associated with familial adenomatous polyposis (FAP) syndrome, or sporadic, with no known genetic predisposition. In both cases, these uncommon mucosal-based lesions carry malignancy risk and present management dilemmas when not amenable to endoscopic
removal requiring surgical resection. FAP-related PAs are typically large and multifocal and often managed using the Spigelman classification, a point-based system that alerts the clinician of malignancy risk. This classification guides the decision toward continued endoscopic surveillance vs resection vis-à-vis pancreaticoduodenectomy (PD, also known as the “Whipple procedure”). No such scoring system exists for non-FAP-related PAs.”

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