European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology
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Anastomotic leakage (AL) is a serious complication after low anterior resection (LAR) with total mesorectal excision (TME) for rectal cancer. Whether the Enhanced Recovery After Surgery (ERAS)-protocol influences the risk of short-term morbidity in relation to the use of a diverting stoma is unclear. ⋯ A diverting stoma did not affect postoperative morbidity in this large cohort of patients undergoing LAR within an ERAS program. However, the routine use of a diverting stoma could be expected to delay postoperative recovery.
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The type of a biomarker - whether it is prognostic or predictive - is frequently not known, although such information is crucial for assessing the clinical value of a marker. In order to evaluate the type of marker TP53 is, we identified a cohort of 76 patients with colorectal liver metastases (CLM), homogeneously staged as resectable, who had been treated either with or without fluorouracil-based neoadjuvant chemotherapy. The TP53 genotype was assessed retrospectively from paraffin-embedded, diagnostic tumour biopsies using a standardised, p53 gene-specific sequencing protocol (mark53(®) kit). ⋯ In patients treated with surgery alone, a mutated TP53 did not have a negative effect on survival (P = 0.54). A mutated TP53 status independently predicted survival disadvantage in CLM patients in the presence, but not in the absence, of neoadjuvant chemotherapy. Our data suggest that TP53 might be a pure predictive marker.
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Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) can be complicated by pulmonary emboli (PE). Patients are at high risk due to surgery, underlying malignancy, immobility and indwelling lines. ⋯ Body temperature is the only statistically significant clinical finding observed with PE. We recommend a standardised investigative approach consisting of troponin, ECG and CXR. PE in CRS-HIPEC does not cause significant cardio-respiratory dysfunction, or escalation of care. PE rates are higher than other major surgeries, thus we propose a trial with increased chemical prophylaxis in CRS-HIPEC patients.
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The role of SC before CRS/HIPEC for patients with PMCA is unclear. This study explores the effect of SC prior to CRS/HIPEC on overall survival (OS) in patients with PMCA. ⋯ Preoperative SC could improve the prognosis of patients with high-grade PMCA with SRC histology.
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Multicenter Study
Treatment patterns of elderly breast cancer patients at two Canadian cancer centres.
Treatment of breast cancer in elderly women is limited by declining functional status and life expectancy. The impact of providing less aggressive treatment remains controversial. This study assessed the treatment patterns of elderly breast cancer patients. ⋯ Women ≥80 y received less aggressive treatment than younger women and had less favourable DFS and OS. Until age-specific recommendations are available physicians must use clinical judgement and assess the tumour biology with the patient's comorbidties to make the best choice.