European Journal of Surgical Oncology RSS feed: Current Issue. EJSO - European Journal of Surgical Oncology ("the Journal of Cancer Surgery") is the Official Journal of the European Society of Surgical Oncology and BASO ~ the Association for Cancer Surgery . The EJSO aims to educate and inform about the many subspecialty disciplines of cancer surgery. The EJSO publishes original scientific articles, reviews, clinical trials, and other relevant subject matter. The Journal seeks to capture the interest and attention of its worldwide print and electronic readership through excellence, clarity, simplicity and concise presentation of the written word, figure, table and diagram. The Editors welcome submissions from prospective authors on any subject of relevance to cancer surgical practice. The journal publishes Editorials; Original Articles; specialist and general Review Articles; Educational Articles; and Letters in response to previously published items. Research areas include: epidemiology and preventative aspects of surgical oncology; diagnosis, including imaging; all aspects of cancer therapy, including radiotherapy and chemotherapy; the application of new equipment and procedures to surgical and clinical oncology; methods of assessing the results of treatment, including clinical trials; and of computing and data management in relation to surgical oncology.http://www.ejso.com/?rss=yesElsevier Inc.en © 2009 Published by Elsevier Inc. All rights reserved. European Journal of Surgical Oncology0748-7983363March 2010 © 2009 Published by Elsevier Inc. All rights reserved. healthpermissions@elsevier.comhttp://www.ejso.com/article/PIIS0748798310000132/abstract?rss=yesEditorial Board10.1016/S0748-7983(10)00013-2European Journal of Surgical Oncology 36, 3 (2010)2010-03-01European Journal of Surgical Oncology2010-03-01363S0748-7983(10)X0002-6iihttp://www.ejso.com/article/PIIS0748798309004430/abstract?rss=yesThe multidisciplinary team (MDT) now has a central role in decision making in the management of all cancers in most advanced health systems. The logic of multidisciplinary teamworking in cancer care is persuasive, although the evidence base for a treatment benefit is as yet weak. However, the evolution of the MDT as a clinical management tool is incomplete.Editorial: The multidisciplinary team process: The next stepsDavid Rew10.1016/j.ejso.2009.08.008European Journal of Surgical Oncology 36, 3 (2010)2010-03-01European Journal of Surgical Oncology2010-03-01363S0748-7983(10)X0002-6Editorial221223http://www.ejso.com/article/PIIS074879830900420X/abstract?rss=yesAbstract: Background: The p160 steroid receptor coactivator (SRC) family is critical to the transcriptional activation function of nuclear hormone receptors. A key member of this family is SRC-3, initially found to be amplified and expressed in breast cancer it has subsequent been shown to be expressed in malignant disease arising from a wide range of other organs. An understanding of the potential role of SRC-3 in the pathogenesis and its possible prognostic role in a broad range of tumours will improve our general understanding of carcinogenesis as well as potentially leading to a new prognostic marker as well as new therapeutic targets.Methods: Relevant papers were identified by searching the PubMed and MEDLINE databases for article published until 28th February 2009. Only articles published in English were considered. The search terms included “SRC-3”, “AIB1” in association with the following terms: “human”, “cancer” and “malignant disease”. The search focused on malignant disease arising outside of the mammary gland. Full articles were obtained and references were checked for additional material when appropriate.Results: SRC-3 is amplified and expressed in a wide spectrum of human malignant diseases and appears to be a potential prognostic marker in a number of different tumours.Conclusion: SRC-3 appears to be implicated in the possible risk of developing prostate and ovarian cancer. Its presence appears to be a marker of aggressive disease. Further research is required to determine its predictive and prognostic utility given the relative paucity of studies for each specific malignant disease.The role of steroid receptor coactivator-3 (SRC-3) in human malignant diseaseO. Gojis, B. Rudraraju, C. Alifrangis, J. Krell, P. Libalova, C. Palmieri10.1016/j.ejso.2009.08.002European Journal of Surgical Oncology 36, 3 (2010)2010-03-01European Journal of Surgical Oncology2010-03-01363S0748-7983(10)X0002-6Reviews224229http://www.ejso.com/article/PIIS074879831000003X/abstract?rss=yesAbstract: Aim: To describe systems for capturing and optimising collective knowledge and insight in areas of complexity and uncertainty in surgical oncology, with particular reference to the Delphi process and related systems.Methods: Internet search engines (Google, Google Scholar) and four databases (SCOPUS, PubMed, Medline and Embase) were searched to find English language articles on the use of The Delphi Process and related systems in surgical oncology, using a variety of search terms.Findings: There are a number of established systems for co-opting group knowledge and facilitating collective decision-making. These find applications in commerce, industry, government and defence. They have also been applied to problems in surgical oncology, for example using the Delphi process to optimise the management of colorectal cancers and metastases.Conclusions: Collective decision making tools find practical applications in the allocation of resources and in clinical decision making in fields of surgical oncology practice where there is a wide range of evidence and expert opinion. Such methodologies set new standards for the collating of professional expertise and for the writing of “best clinical practice” guidelines in the cancer subspecialities.Collective wisdom and decision making in surgical oncologyN. Robson, D. Rew10.1016/j.ejso.2010.01.002European Journal of Surgical Oncology 36, 3 (2010)2010-03-01European Journal of Surgical Oncology2010-03-01363S0748-7983(10)X0002-6Reviews230236http://www.ejso.com/article/PIIS0748798309004806/abstract?rss=yesAbstract: Aim: The purpose of this study was to analyse the results of preoperative short course radiotherapy in a consecutive, national cohort of patients with rectal cancer.Methods: Through a validated, prospective national database we identified 520 Danish patients who presented with high-risk mobile tumours in the lower two thirds of the rectum and were referred for preoperative radiotherapy with 5 × 5 Gy. The inclusion period was 56 months. Radiotherapy data was retrospectively collected.Results: Of the 520 patients, 514 completed radiotherapy and 506 had surgery. Surgery was considered curative in 439 patients. The 3-year local recurrence rate was 4.0% (95% CI 2.5–6.5%) and the distant recurrence rate at 3 years was 18.7% (95% CI 15.4–22.5%). The 5-year disease free survival rate was 40.2% (95% CI 27.0–53.1%) and overall survival 50.4% (95% CI 36.1–63.1%). Most tumours (61%) were classified as T3 or T4 and 41% of the local recurrences occurred in patients with a fixed tumour at surgery.Conclusion: This study confirms data from randomised studies that the short course 5 × 5 Gy regime is a feasible treatment for locally advanced rectal cancer even when applied in a population outside clinical trials.Clinical outcome in 520 consecutive Danish rectal cancer patients treated with short course preoperative radiotherapyL.H. Jensen, R. Altaf, H. Harling, M. Jensen, S. Laurberg, J.C. Lindegaard, A. Muhic, L. Vestermark, A. Jakobsen, S. Bülow, on behalf of the Danish Colorectal Cancer Group10.1016/j.ejso.2009.10.008European Journal of Surgical Oncology 36, 3 (2010)2010-03-01European Journal of Surgical Oncology2010-03-01363S0748-7983(10)X0002-6Colorectal Cancer237243http://www.ejso.com/article/PIIS0748798309005435/abstract?rss=yesAbstract: Background: Neoadjuvant chemoradiotherapy (CRT) reduces local tumor recurrence in locally advanced rectal cancer (LARC). This phase II study assessed neoadjuvant cetuximab with capecitabine-based CRT in LARC.Methods: Patients with stage II/III LARC received capecitabine 1250 mg/m2 twice daily for 2 weeks followed by intravenous cetuximab 400 mg/m2 at week 3, then weekly intravenous 250 mg/m2 cetuximab plus CRT including capecitabine 825 mg/m2 twice daily (including weekends during radiotherapy) with radiotherapy of 45 Gy (25 × 1.8 Gy), 5 days a week for 5 weeks. Total mesorectal excision was scheduled 4–6 weeks following completion of CRT. The primary endpoint was pathological complete response (pCR).Results: Thirty-seven patients were eligible for safety and efficacy. TMN staging at baseline was: T4N2, 11%; T3N2, 40%; T2N2, 3%; T3N1, 35%; T2N1, 3% and T3N0 8%. The most common adverse events included, grade 1/2 acneiform skin rash (86%), and grade 3 radiodermatitis, (16%), diarrhea (11%) and hypersensitivity (5%). pCR was achieved in 3 patients (8%). Overall-, T- and N-downstaging rates were 73%, 57% and 81% respectively. Total sphincter preservation rate was 76%, and 53% in 17 patients whose tumors were located within 5 cm from the anal verge. Non-fatal perioperative complications occurred in 13 patients (35%) with delayed wound healing occurring in 6 patients (16%). One death was recorded due to sepsis following colonic necrosis.Conclusion: Neoadjuvant cetuximab with capecitabine-based CRT is tolerable in patients with resectable LARC. Whilst the pCR rate was similar to recent reports, a high pathological downstaging rate was achieved.A phase II study of cetuximab, capecitabine and radiotherapy in neoadjuvant treatment of patients with locally advanced resectable rectal cancerV. Velenik, J. Ocvirk, I. Oblak, F. Anderluh10.1016/j.ejso.2009.12.002European Journal of Surgical Oncology 36, 3 (2010)2010-03-01European Journal of Surgical Oncology2010-03-01363S0748-7983(10)X0002-6Colorectal Cancer244250http://www.ejso.com/article/PIIS0748798309004715/abstract?rss=yesAbstract: Aims: The aim of this prospective study is to elucidate feasibility of protocol of neoadjuvant concomitant radiochemotherapy with capecitabine and long course radiotherapy with subsequent laparoscopic rectal resection. We assessed treatment toxicity, downstaging rate, pathological response to the neoadjuvant treatment, surgery complications, rate of conversions and sphincter-preserving surgical procedures, and intraoperative and early postoperative complications too.Methods: We acquired data of 78 patients from 1 January 2005 to 31 December 2007 with a locally advanced rectal cancer in our study. All patients were indicated for the neoadjuvant concomitant chemoradiotherapy due to locally advanced tumor (T3 or T4) or lymph nodes involvement suspicion (N+). Both radiotherapy (to pelvic region) and chemotherapy (capecitabine) were administered. Rectal tumors were localized within 12cm from the anocutaneous verge. The average follow-up time was 23.9 months.Results: All patients completed their treatment according to the planned regimen and dose. The surgery was performed laparoscopicaly within 4–8 weeks following the concomitant chemoradiotherapy – in 17% cases was converted into conventional surgery. Downstaging was achieved in 69% of patients, pathological complete response in 10%, histologically negative lymph nodes were documented in 58% of patients. Grade 3 toxicity of the concomitant chemoradiotherapy was present in 3%; grade 2 in 29% of patients, particularly skin and gastrointestinal form. Intraoperative and early postoperative complications of the surgery were 18%. Re-operation was needed in 5% cases.Conclusions: We demonstrated safety and low toxicity of the concomitant chemoradiotherapy with capecitabine.Neoadjuvant chemoradiotherapy with capecitabine followed by laparoscopic resection in locally advanced tumors of middle and low rectum – Toxicity and complications of the treatmentR. Soumarova, M. Skrovina, J. Bartos, J. Gruna, A. Wendrinski, S. Czudek, R. Kycina, J. Parvez10.1016/j.ejso.2009.10.002European Journal of Surgical Oncology 36, 3 (2010)2010-03-01European Journal of Surgical Oncology2010-03-01363S0748-7983(10)X0002-6Colorectal Cancer251256http://www.ejso.com/article/PIIS0748798309002303/abstract?rss=yesAbstract: Aims: To assess whether combining percutaneous radiofrequency ablation (PRFA) with transcatheter arterial chemoembolization (TACE) was better than PRFA alone for hepatocellular carcinoma (HCC).Materials and methods: One hundered twenty patients (with a solitary HCC≤7.0cm in diameter or multiple HCC (≤3), each ≤3.0cm in diameter) treated with PRFA combined with TACE were compared with 120 well-matched controls selected from a pool of 652 patients who received PRFA alone during the study period.Results: The 1-, 2-, 3-, 5-year overall survival rates for the TACE-PRFA and PRFA groups were 93%, 83%, 75%, 50%, and 89%, 76%, 64%, 42%, respectively (p=.045). Subgroup analyses showed the survival for the TACE-PRFA group was better than the PRFA group for tumors >5.0cm (p=.031) and for multiple tumors (p=.032), but not for tumors ≤5.0cm (p=.319) and for solitary tumor (p=.128). The 1-, 2-, 3-, 5-year progression free survival (PFS) for the TACE-PRFA and PRFA groups was 90%, 76%, 63%, 42%, and 76%, 60%, 47%, 30%, respectively (p=.002). Child-pugh class, Diameter of tumor and hepatitis B surface antigen (HBsAg) were significant prognostic factors.Conclusion: Patients treated with TACE-PRFA had better overall survivals than PRFA alone, but only in a subgroup of patients with tumor >5cm or multiple tumors.A case-control study comparing percutaneous radiofrequency ablation alone or combined with transcatheter arterial chemoembolization for hepatocellular carcinomaZ.-W. Peng, M.-S. Chen, H.-H. Liang, H.-J. Gao, Y.-J. Zhang, J.-Q. Li, Y.-Q. Zhang, W.Y. Lau10.1016/j.ejso.2009.07.007European Journal of Surgical Oncology 36, 3 (2010)2010-03-01European Journal of Surgical Oncology2010-03-01363S0748-7983(10)X0002-6Liver Tumours257263http://www.ejso.com/article/PIIS0748798309004788/abstract?rss=yesAbstract: Background: Microwave ablation is an in situ method of tumour destruction used to treat patients with unresectable liver tumours. A new microwave generator and probe, designed to deliver high energy into solid tumours quickly has been developed at our institution. We report the results of its use in patients with unresectable liver tumours treated by a single surgeon in a single institution.Methods: Thirty-one patients with 89 unresectable liver tumours were recruited into the study and underwent microwave ablation in a single procedure.Results: There were no post-operative complications. At a median of 24 months post ablation, 15 patients were alive with 7 patients disease free. At a median of 26 months, 8 patients were alive with tumour recurrence but only 1 with local recurrence. The remaining 7 patients with recurrence were found to have new disease at locations remote from the ablation site. Fourteen patients died of disease progression at a median survival of 15 months, with only 1 patient with local and remote tumour recurrence. Of the total numbers of tumours treated (n=89), a local tumour recurrence rate of 2% was observed. Overall median survival was 29 months with 3 year survival of 40%.Discussion: Microwave tissue ablation using this novel generator and probe has a low local recurrence and complication rate. Overall survival is comparable to alternative ablation modalities and its ability to treat, even large tumours, with a single insertion of the probe makes it an extremely attractive treatment option.Microwave ablation for unresectable hepatic tumours: Clinical results using a novel microwave probe and generatorN. Bhardwaj, A.D. Strickland, F. Ahmad, M. El-Abassy, B. Morgan, G.S.M. Robertson, D.M. Lloyd10.1016/j.ejso.2009.10.006European Journal of Surgical Oncology 36, 3 (2010)2010-03-01European Journal of Surgical Oncology2010-03-01363S0748-7983(10)X0002-6Liver Tumours264268http://www.ejso.com/article/PIIS0748798309004065/abstract?rss=yesAbstract: Introduction: Liver tumors should be surgically treated whenever possible. In the case of bilobar disease or coexisting liver cirrhosis, surgical options are limited. Radiofrequency ablation (RFA) has been successfully used for irresectable liver tumors. The combination of hepatic resection and RFA extends the feasibility of open surgical procedures in patients with liver metastases and hepatocellular carcinoma (HCC).Patients and methods: RFA was performed with two different monopolar devices using ultrasound guidance. Intraoperative use of RFA for the treatment of liver metastases or HCC was limited to otherwise irresectable tumors during open surgical procedures including hepatic resections. Irresectability was considered if bilobar disease was treated, the functional hepatic reserve was impaired or appraised marginal for allowing further resection.Results: Ten patients with both liver metastases and HCC, and two patients with cholangiocellular carcinoma were treated. Complete initial tumor clearance was achieved in all patients. Two patients of the metastases group and five patients of the HCC group suffered from local recurrence after a median of 12 months (1–26) (local recurrence rate 32%). Five patients of the metastases group and six patients of the HCC group developed recurrent tumors in different areas of the ablation site after a median time of 4 months (2–18) (distant intrahepatic recurrence in 55%). Survival at 31 months was 36%.Conclusion: RFA extends the scope of surgery in some candidates with intraoperatively found irresectability.Results of liver resection in combination with radiofrequency ablation for hepatic malignanciesR.M. Eisele, J. Zhukowa, S. Chopra, S.C. Schmidt, U. Neumann, J. Pratschke, G. Schumacher10.1016/j.ejso.2009.07.188European Journal of Surgical Oncology 36, 3 (2010)2010-03-01European Journal of Surgical Oncology2010-03-01363S0748-7983(10)X0002-6Liver Tumours269274http://www.ejso.com/article/PIIS0748798309004703/abstract?rss=yesAbstract: Background: The objective of this trial was to analyze the clinical patterns and outcome variables of recurrent hepatocellular carcinoma (HCC) in liver transplant patients.Patients and methods: Sixty patients after liver transplantation (LT) for HCC were analyzed. All of them received initially a calcineurin-inhibitor based immunosuppressive regimen. Recurrent HCC was treated by surgical intervention, if eligible, or adjuvant therapies. Furthermore, patients were converted to a Sirolimus (SRL)-based immunosuppressive regimen after tumor relapse. The impact of clinical and histopathological variables on post-recurrence survival was analyzed in uni- and multivariate analysis.Results: Sixteen liver recipients developed HCC recurrence between 4 and 58 months (median: 23 months) post-LT. Sites of first tumor recurrence were lung (n = 5), liver (n = 4), bone (n = 4), cerebrum (n = 1), adrenal gland (n = 1) and peritoneum (n = 1). Seven patients were amenable for surgical resection, while 9 patients were only suitable for adjuvant treatment (n = 4) or general medical support (n = 5). Median survival rate post-recurrence was 65 months (range: 12–136 months) in patients amenable for surgical therapy, and 5 months (range: 1–52 months) in patients unsuitable for surgical intervention (P = 0.01). Multivariate analysis identified late (>24 months) posttransplant tumor relapse (P = 0.039) and surgical therapy (P = 0.014) as independent predictors of long-term survival after tumor relapse. Five patients are tumour-free alive for a median of 65 months after surgical resection of recurrent HCC and conversion to SRL.Conclusion: Liver transplant patients with HCC recurrence should be treated surgically, if eligible, since this is an independent predictor of long-term survival.Long-term survival after recurrent hepatocellular carcinoma in liver transplant patients: Clinical patterns and outcome variablesA. Kornberg, B. Küpper, A. Tannapfel, K. Katenkamp, K. Thrum, O. Habrecht, J. Wilberg10.1016/j.ejso.2009.10.001European Journal of Surgical Oncology 36, 3 (2010)2010-03-01European Journal of Surgical Oncology2010-03-01363S0748-7983(10)X0002-6Liver Tumours275280http://www.ejso.com/article/PIIS0748798309004971/abstract?rss=yesAbstract: Aims: The objective of this study was to introduce a surgical approach called “extended radical retropubic prostatectomy (ERRP)” developed to reduce positive surgical margin rates in prostate cancer.Methods: Modified surgical procedures in ERRP included apical dissection (division of the dorsal venous complex far distal to the prostatic urethral junction), excision of the bilateral neurovascular bundles (wide resection of structure between the exterior of the urethra and the rectal surface, which contains the neurovascular bundle), perirectal dissection (complete resection of perirectal tissue by dissecting the anterior rectal surface until the muscle layer of the rectum was encountered) and seminal vesicle excision (dissection that leaves seminal vesicles protected by Denonvilliers' fascia with the surrounding fatty and fascial coverings without pulling seminal vesicles from the prostate). This study included 127 consecutive patients who did not request the preservation of potency and underwent ERRP without any neoadjuvant therapies.Results: Median value of preoperative serum prostate specific antigen in 127 patients was 18.1ng/ml. Median operative time and estimated blood loss in these patients were 209min and 744ml, respectively. The pathological stage was diagnosed as pT2, pT3a, pT3b and pT4 in 51, 52, 20 and 4, respectively, while positive surgical margin was detected in 14 of the 127 patients. Furthermore, during the observation period of this study (median, 46 months), biochemical recurrence was detected in 11 of the 127 patients.Conclusions: The ERRP technique could successfully decrease the positive surgical margin rate even in patients with comparatively adverse disease characteristics.Development of “extended radical retropubic prostatectomy”: A surgical technique for improving margin positive rates in prostate cancerH. Miyake, H. Fujimoto, M. Komiyama, M. Fujisawa10.1016/j.ejso.2009.10.013European Journal of Surgical Oncology 36, 3 (2010)2010-03-01European Journal of Surgical Oncology2010-03-01363S0748-7983(10)X0002-6Urological Cancers281286http://www.ejso.com/article/PIIS0748798309004648/abstract?rss=yesAbstract: Aims: To investigate the incidence and long-term effects on kidney function of obstructive and nonobstructive dilatation of the upper urinary tract in patients with ileal neobladder with refluxing ureterointestinal anastomoses.Methods: We retrospectively analyzed a prospectively derived database of 110 patients with bladder cancer and who were treated with an ileal neobladder between 1996 and 2007 using refluxing end-to-side ureterointestinal anastomoses on a short afferent limb. The mean follow up was 65 months. At every follow up visit the patients had an analysis of serum creatinine, urine culture, abdominal CT or ultrasonography, and, if there was dilatation of the upper urinary tract, 99mTc-DTPA renal scintigraphy was requested.Results: In all, 206 renoureteral units were included in the study. Overall, seven had anastomotic stricture and of those, three were symptomatic and were corrected; while four were asymptomatic and of those, only two, with preserved split GFR, were surgically treated, while the remaining two, with a poor split GFR, were followed up. The last 99mTc-DTPA showed a preserved split GFR in the reimplanted units and further split renal function decrease in untreated units. Nonobstructive dilatation of the upper urinary tract, caused by reflux, was diagnosed in 13 units. The dilatation was bilateral in three patients with recurrent UTIs and urosepsis, and the split GFR was bilaterally reduced at diagnosis with a further reduction at the last 99mTc-DTPA. The remaining seven units with sterile urine, showed a preserved split GFR during follow up.Conclusions: All strictures, regardless of their severity, should be immediately corrected. Reflux per se does not provoke renal impairment unless recurrent UTIs and urosepsis are present.Effects on renal function of obstructive and nonobstructive dilatation of the upper urinary tract in ileal neobladders with refluxing ureteroenteric anastomosesR. Minervini, R. Pagni, C. Mariani, A. Morelli, G. Morelli, A. Minervini10.1016/j.ejso.2009.09.003European Journal of Surgical Oncology 36, 3 (2010)2010-03-01European Journal of Surgical Oncology2010-03-01363S0748-7983(10)X0002-6Urological Cancers287291http://www.ejso.com/article/PIIS0748798309005204/abstract?rss=yesAbstract: Aim: To determine the difference in survival after cystectomy between patients presenting with primary muscle infiltrating bladder cancer and patients with progression to muscle infiltration after treatment for initial non-muscle-invasive bladder cancer (NMIBC).Patients and Methods: We retrospectively analyzed the files of 188 patients who underwent cystectomy for transitional cell carcinoma between 1987 and 2005. Two groups were defined: patients presenting with muscle-invasive tumours and those progressing to muscle invasion after initial treatment. This second group was further divided into low-intermediate and high risk according to the EAU grouping for NMIBC.Results: The 5-year disease specific survival (95% confidence intervals) for all patients was 50%(42–59%); 49%(40–60%) in the primary muscle infiltrating group and 52%(37–74%) in the progressive group (p = ns). The 5-year disease specific survival in the progressive group according to EAU risk groups was 75%(58–97%) for the initially diagnosed low-intermediate risk tumours and 35%(17–71%) for the initially diagnosed high-risk tumours (p = 0.015). The percentage of patients with non-locally confined tumours (pT3/4-N0//any pT-N+) was 31%//45% and 24%//46% in the primary muscle infiltrating and progressive group, respectively.Conclusions: Despite close observation of patients treated for non-muscle-invasive bladder cancer, the survival of patients who progress to muscle invasion is not better than survival of patients presenting with primary muscle infiltrating cancer. Patients with high-risk non-invasive tumours (EAU risk-categories) who progress to muscle-invasive disease have a worse prognosis compared to patients with low or intermediate risk tumours.Survival after cystectomy for invasive bladder cancerR.R. de Vries, J.A. Nieuwenhuijzen, A. Vincent, H. van Tinteren, S. Horenblas10.1016/j.ejso.2009.11.012European Journal of Surgical Oncology 36, 3 (2010)2010-03-01European Journal of Surgical Oncology2010-03-01363S0748-7983(10)X0002-6Urological Cancers292297http://www.ejso.com/article/PIIS0748798309002005/abstract?rss=yesAbstract: Objective: To investigate the differences of the amount of paracervical lymphatic structures removed when performing classical type III, modified type II and nerve-sparing radical hysterectomy (RH).Material and methods: Open macroscopic or laparoscopic pelvic dissections in 18 fresh adult female cadavers after lymphatic channels and nodes staining by Lipiodol dye solution injection of the uterine cervix.Results: We distinguished three different lymphatic pathways: 1) the supraureteral paracervical pathway (vascular portion of paracervix-uterine artery and superficial uterine vein), identified in 96% of cases, and removed in all types of RH, 2) the infraureteral paracervical pathway (vascular portion of paracervix-deep uterine vein), identified in 22% of cases, and removed by type III and nerve-sparing RH, and 3) the neural paracervical pathway (nervous portion of paracervix), identified in 7% of cases, and removable only by type III RH. No evidence of stained lymphatic structures running into the vesicouterine and uterosacral ligaments was found.Conclusion: Nerve-sparing RH offers the most effective ratio between oncological safety and surgical-related complications, and would be particularly useful in patients with high risk of paracervical involvement while our results suggest caution in the use of modified type II RH in patients at low-moderate risk of paracervical involvement, unless the use of adjuvant radiotherapy, because of the large amount of potentially lymph-bearing paracervical tissue leaved in situ. Classical type III RH affords the complete resection of all paracervical lymphatic pathways potentially draining the cervix, however this procedure implies a high risk of lesions of the autonomous nerves of pelvic organs.The lymphatic drainage of the uterine cervix in adult fresh cadavers: Anatomy and surgical implicationsA. Ercoli, V. Delmas, V. Iannone, A. Fagotti, F. Fanfani, G. Corrado, G. Ferrandina, G. Scambia10.1016/j.ejso.2009.06.009European Journal of Surgical Oncology 36, 3 (2010)2010-03-01European Journal of Surgical Oncology2010-03-01363S0748-7983(10)X0002-6Gynaecological Cancer298303http://www.ejso.com/article/PIIS0748798309004417/abstract?rss=yesAbstract: Objectives: To study the feasibility, morbidity and outcome of cervical cancer patients treated with laparoscopic assisted radical vaginal hysterectomy (LARVH).Methods: The study group included 53 women with cervical cancer (stage-Ib). They included women undergoing LARVH at the joint cancer-centres between 1994 and 2002. Data was collected on operating-time, nodal-yield, hospital-stay, complications recurrence rate and survival rate. The group was followed up until 2006.Results: Of 53 women who were selected for LARVH, in 2 women LARVH was abandoned when nodes were positive at frozen section. The median age was 42 years while the operating-time was 210min with a nodal-yield of 23 and a hospital-stay of 5 days. Final histology revealed 10 women with lympho-vascular invasion, 1 nodal metastases and invasion of parametrium/vagina in 2 women. 7 received adjuvant radiotherapy. 3 had chemo-radiation. Complications included voiding difficulty (6), urinary tract infection (5), pyrexia (4), haemorrhage (2), pain (1), port-site haematoma (1) and nerve injury (1). Late complications included lymphoedema (4), urinary incontinence (4), voiding-problems (2), lymphocyst (1), venous-thrombosis (1) and rectocele (1). The median follow-up was 41 months. 4 women had recurrence, of which 3 women died. The five-year survival was 89%.Conclusions: Vaginal radical hysterectomy with laparoscopic pelvic lymphadenectomy is feasible and safe with regards to mortality and has low morbidity.Laparoscopic assisted radical vaginal hysterectomy for cervical carcinoma: Morbidity and long-term follow-upG. Mehra, A. Weekes, P. VanTrappen, D. Visvanathan, A. Jeyarajah10.1016/j.ejso.2009.08.009European Journal of Surgical Oncology 36, 3 (2010)2010-03-01European Journal of Surgical Oncology2010-03-01363S0748-7983(10)X0002-6Gynaecological Cancer304308http://www.ejso.com/article/PIIS0748798309002017/abstract?rss=yesAbstract: Aims: This study is the first to evaluate the clinical and treatment-related risk factors for perioperative toxicity and mortality in patients with peritoneal recurrence that underwent iterative cytoreductive surgery (CRS) with or without perioperative intraperitoneal chemotherapy (PIC). The aim is to improve patient selection.Methods: Fifty-seven consecutive iterative CRS procedures were performed in 40 patients between June 2000 and September 2008. Forty-seven patients were administered PIC. Adverse events were rated from grades I to V with increasing severity. Grade I toxicity was self limiting; grade II required medical intervention; grade III required an invasive intervention; grade IV required returning to intensive care unit or operating theatre; and grade V resulted in patient death during hospital stay. Risk factors for grades III and IV/V toxicity were determined.Results: The mortality rate was 2%. The grades III and IV/V toxicity rate was 18% and 19%, respectively. A peritoneal cancer index ≥16 (p=0.020), operation length ≥9h (p=0.045), number of peritonectomy procedures ≥2 (p=0.045) and a suboptimal cytoreduction (p=0.031) were the risk factors for grade IV/V toxicity.Conclusions: Iterative CRS and PIC procedures have an acceptable rate of perioperative toxicity in carefully selected patients. Patients with high tumour burden requiring extensive surgical dissection are at highest risk of a severe adverse event. Thorough preoperative evaluation of patients is necessary to improve both perioperative and postoperative outcomes.Critical assessment of preoperative and operative risk factors for complications after iterative peritonectomy proceduresA. Saxena, T.D. Yan, D.L. Morris10.1016/j.ejso.2009.06.008European Journal of Surgical Oncology 36, 3 (2010)2010-03-01European Journal of Surgical Oncology2010-03-01363S0748-7983(10)X0002-6Peritoneal Carcinomatosis309314http://www.ejso.com/article/PIIS0748798309004624/abstract?rss=yesAbstract: Introduction: For pseudomyxoma peritonei (PMP), survival depends on pathological grade and completeness of cytoreductive surgery. The aim of the study was to assess the ability of preoperative 18F-FDG PET to determine these 2 prognosis indicators.Material and methods: In this prospective single centre study, all patients presenting with PMP were included. They underwent a preoperative 18F-FDG PET with a double radiological evaluation and an explorative laparotomy with the objective of optimal cytoreduction followed by a hyperthermic intra-operative intraperitoneal chemotherapy (HIPEC). Patients with non resectable disease underwent debulking surgery without HIPEC. The Completeness of Cytoreduction was assessed by CC score.Results: Thirty-four patients were included. PET scanning was positive for 19 patients with grade II (hybrid form) or III (Peritoneal Mucinous Carcinomatosis) and for 2 patients with grade I (disseminated peritoneal adenomucinosis), and negative for 3 patients with grade II - III and for 10 patients with grade I. PET scanning was positive for 6 patients with CC score 2 - 3 and for 16 patients with CC score 0, and negative for 2 patients with CC score 2 - 3 and for 10 patients with CC score 0. The 18F-FDG PET interpretation distinguished 2 patients groups (grade I and grade II - III) with a sensitivity of 90% and a specificity of 77%. Moreover, probability of complete cytoreduction when PET was negative was over 80%.Conclusion: Preoperative 18F-FDG PET may predict pathological grade and completeness of cytoreduction which are the two main prognostic factors in patients with PMP.Pseudomyxoma Peritonei: Role of 18F-FDG PET in preoperative evaluation of pathological grade and potential for complete cytoreductionG. Passot, O. Glehen, O. Pellet, S. Isaac, C. Tychyj, F. Mohamed, F. Giammarile, F.N. Gilly, E. Cotte10.1016/j.ejso.2009.09.001European Journal of Surgical Oncology 36, 3 (2010)2010-03-01European Journal of Surgical Oncology2010-03-01363S0748-7983(10)X0002-6Peritoneal Carcinomatosis315323http://www.ejso.com/article/PIIS0748798309005186/abstract?rss=yesAbstract: Background: Hyperthermic intraperitoneal chemotherapy (HIPEC) is a complex, expensive and time-consuming procedure. Despite its good results in the treatment of peritoneal carcinomatosis, these factors have precluded the wider use of this procedure around the world. We hypothesized that HIPEC could be performed by heating the liquid within the abdomen and thus avoiding the need for an external heating circuit and a pump. The aim of this study was to assess the feasibility and safety of an internal heating device for hyperthermic intraperitoneal chemotherapy in an experimental model.Methods: Four large-white pigs underwent one-hour open intraperitoneal hyperthermia with closed abdomen using this new device. Constant stirring of the liquid around the viscera was performed in the first three animals, but not in the fourth one. At the end of the procedure, all of the viscera were carefully examined to look for thermal injury. Any lesion or doubtful area was removed and sent to pathologic examination.Results: No adverse events occurred during surgery in any of the animals. A temperature of 42°C was reached in an average time of 14min and maintained homogeneously between 42°C and 43°C for one hour. No visceral injury was detected in the first three animals. Three foci of thermal injury to the mucosa were detected in the absence of stirring (fourth animal).Conclusion: Heating the solution within the abdomen during hyperthermic intraperitoneal chemotherapy is feasible, safe and achieves perfect thermal homogeneity. This device provides a time-saving inexpensive way to perform intraperitoneal hyperthermic chemotherapy.Using a heating cable within the abdomen to make hyperthermic intraperitoneal chemotherapy easier: Feasibility and safety study in a pig modelP. Ortega-Deballon, O. Facy, G. Magnin, F. Piard, B. Chauffert, P. Rat10.1016/j.ejso.2009.11.010European Journal of Surgical Oncology 36, 3 (2010)2010-03-01European Journal of Surgical Oncology2010-03-01363S0748-7983(10)X0002-6Peritoneal Carcinomatosis324328http://www.ejso.com/article/PIIS0748798309004363/abstract?rss=yesWe read with interest the article by Lordan et al. on the effect of multidisciplinary teams (MDTs) on outcome in colorectal liver metastases (CLM). We are firm believers in the MDT process for all malignancies, however, we are uncertain as to whether the data presented actually confirms the role of the MDT in the context of liver hepatobilairy surgery and think that in its current form may indeed suggest that specific HPB MDTs are not required.HPB multidisciplinary teamsG.J. Morris-Stiff, S. Farid, K.R. Prasad10.1016/j.ejso.2009.08.004European Journal of Surgical Oncology 36, 3 (2010)2010-03-01European Journal of Surgical Oncology2010-03-01363S0748-7983(10)X0002-6Correspondence329330http://www.ejso.com/article/PIIS0748798310000168/abstract?rss=yes7th European Breast Cancer Conference 24–27 March 2010, Barcelona, SpainCalendar of Events 201010.1016/S0748-7983(10)00016-8European Journal of Surgical Oncology 36, 3 (2010)2010-03-01European Journal of Surgical Oncology2010-03-01363S0748-7983(10)X0002-6II