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Introduction: Wilms’ tumour is the most common childhood renal malignancy, with 5–10% of cases presenting bilaterally 1. However, there is currently no consensus between centres on optimal management of bilateral Wilms’ tumours. This is an international multi-centre case series comparing management and outcomes of bilateral Wilms’ tumours between low-income centres (LIC) and high-income centres (HIC). Methods: Patients with bilateral Wilms' tumour were identified from four tertiary referral centres internationally. Data were collected on baseline characteristics, disease status, treatment used and clinical outcomes. Results were compared between individual centres as well as between groups of low-income centres (LIC) and high-income centres (HIC). Results: Data were collected for forty patients. Most patients received preoperative chemotherapy ( n = 38, 95%). The most common surgical procedures were bilateral nephron-sparing surgery ( n = 10, 25%) and nephrectomy with partial nephrectomy ( n = 20, 50%). Ten-year survival after treatment was as follows: LIC's n = 13 (65%); HIC's n = 20 (100%) ( p = 0.01). Discussion: Ten-year survival was significantly higher in HIC's. Our results show this may be caused by patient factors such as later presentation with more advanced disease in low-income centres. This comparative case series is the first to report on a large number of cases from multiple international centres, and to compare key outcomes.

Background This study evaluated the histologic response after preoperative systemic therapy (pST) using the Peritoneal Regression Grading Score (PRGS) and tumor regression grade (TRG) classifications for patients with peritoneal metastases (PM) from colorectal cancer (CRC). Methods Twenty-three patients were selected from a prospective database of 196 patients who underwent CRS followed by HIPEC for synchronous PM from CRC. In all study patients, biopsies of the PM obtained before pST (during the first laparoscopy) and after pST (during cytoreductive surgery) were compared. Results Complete (PRGS 1), Major (PRGS 2), Minor (PRGS 3) and no histological responses (PRGS 4) were obtained in 17,5%, 52% and 13% and 17,5% of patients, respectively. Major (TRG 1–2), partial (TRG3), and no (TRG4-5) histological tumor regression were observed in 61%, 9% and 30% of patients, respectively. Regardless of the classification applied, median OS was significantly higher in patients with a “complete or major” response than in those with a “minor/partial or no” response (54 vs. 26 months, p Conclusions The PRGS and TRG can be used in clinical practice to evaluate the histological response after pST. This study demonstrated that a complete histologic response of PM from CRC can be obtained after pST.

Imaging has a key role in the assessment of paediatric renal tumours, especially when the initial treatment approach is to proceed to standard chemotherapy without histological confirmation. In Europe, according to the International Society of Paediatric Oncology guidelines, core needle biopsy is not routinely done unless the child is older than 10 years. Between age 6 months and 9 years, the child is treated with a standard regimen of preoperative chemotherapy unless there are concerns about non-Wilms' tumour pathology. Atypical imaging findings could therefore stratify a child into a different treatment protocol, and can prompt the need for pretreatment histology. This review details the latest protocols and techniques used in the assessment of paediatric renal tumours. Important imaging findings are discussed, especially the features that might prompt the need for a pretreatment biopsy. Local radiology practices vary, but both MRI and CT are widely used as routine imaging tests for the assessment of paediatric renal tumours in Europe. Advances in imaging technology and MRI sequences are facilitating the development of new techniques, which might increase the utility of imaging in terms of predicting tumour histology and clinical behaviour. Several of these new imaging techniques are outlined here.

Perforation of esophageal cancer solely due to preoperative chemotherapy is extremely rare, but can be associated with pyothorax and can be difficult to treat. Here, we report the case of a successfully treated patient with thoracic esophageal cancer who had esophageal perforation during docetaxel, cisplatin, and 5-fluorouracil chemotherapy. A 73-year-old patient had esophageal perforation on the fourth day of the first docetaxel, cisplatin, 5-fluorouracil cycle. The second docetaxel, cisplatin, 5-fluorouracil cycle was administered after insertion of esophageal stenting and subtotal esophagectomy. Early drainage and stent placement were crucial for achieving infection control and allowing for a subsequent complete resection.

Background Hepatic resection is regarded to as a potentially curative option for colorectal cancer liver metastases (CRLM), but it is associated with a high rate of recurrence. The present study intended to establish an effective nomogram to predict disease free survival (DFS) and select candidates of hepatic resection. Methods The nomogram was based on a retrospective study on 447 CRLM patients treated with preoperative chemotherapy followed by hepatic resection using a multicentric database between January 1st, 2010 and December 31st, 2017. Results were validated using bootstrap resampling on 117 patients. The predictive accuracy and discriminative ability of the nomogram were determined by concordance index (C-index) and calibration curve. Overall survival, disease free survival, and local recurrence rate for patients with colorectal cancer were measured. Results Based on multivariate analysis of the primary cohort, independent factors for DFS included tumor size larger than 5 cm, multiple liver metastases(>1), RAS mutation, primary lymph node metastasis and tumor size increase after preoperative chemotherapy. These five factors were all considered in the nomogram. The C-index of the nomogram for predicting survival was 0.675. With external validation, the C-index of the nomogram for the prediction of the DFS was 0.77, which demonstrated that this model has a good level of discriminative ability. For the 382 patients (66.7%) who developed recurrence, the optimal cutoff point for early recurrence was determined to be 12 months after hepatic resection. Conclusions The proposed nomogram demonstrated accurate prognostic prediction of DFS for CRLM patients with preoperative chemotherapy followed by hepatic resection.

Summary: Background/objective: The role of gastrectomy for stage IV gastric cancer (GC) has not yet been established. Thus, we aimed to compare the prognoses of patients with clinical stage IV GC who underwent gastrectomy with and without preoperative chemotherapy after precise recategorization of patients. Methods: We retrospectively reviewed a total of 92 clinical stage IV GC patients who underwent gastrectomy with or without preoperative chemotherapy between 2010 and 2016 at a single institution. Yoshida's classification was used to categorize the patients into the following categories: 1, technically resectable metastasis; 2, marginally resectable metastasis; 3, unresectable peritoneal dissemination; and 4, incurable peritoneal dissemination with distant organ metastasis. Two-year disease-specific survival (DSS) rates were compared between patients who underwent primary surgery and preoperative chemotherapy for each category. Results: The two-year DSS rates of primary surgery vs. preoperative chemotherapy in Categories 1, 2, 3, and 4 (n = 35, 39, 14, and 4, respectively) were 48.6% vs. 41.7% (p = 0.829), 52.6% vs. 40.0% (p = 0.855), 50.0% vs. 75.0% (p = 0.027), and 0% vs. 66.7% (p = 0.083), respectively. Patients in Categories 1 and 2 who underwent preoperative chemotherapy tended to have lower two-year DSS rates (p = 0.911), whereas patients in Categories 3 and 4 had significantly higher two-year DSS rates than those who underwent primary surgery (p = 0.014). Conclusions: Primary surgery may be performed in patients without peritoneal dissemination when GC is technically resectable. However, if peritoneal dissemination is suspected, chemotherapy should be prioritized. Keywords: Carcinomatosis, Chemotherapy, Gastrectomy, Gastric adenocarcinoma

Postoperative complications affect both the short-term and long-term outcomes. The aim of this study was to identify specific prognostic factors among complications after hepatectomy for colorectal liver metastasis (CRLM).Between 2002 and 2014, 427 patients underwent initial hepatectomy for CRLM. The clinicopathological parameters including postoperative complications were evaluated to identify the prognostic factors for the overall (OS) and relapse-free survival (RFS).One hundred and forty-nine patients (34%) developed postoperative complications, including surgical site infection (n = 49, 11.4%), bile leakage (n = 41, 9.6%), posthepatectomy liver failure (PHLF) (n = 26, 6.0%), and pulmonary complication (n = 20, 4.6%). The independent predictors of RFS included primary nodal metastasis, abnormal CA19-9 levels, extrahepatic metastasis, bilateral CRLMs, ≥5 CRLMs, preoperative chemotherapy, lack of adjuvant chemotherapy and PHLF. The 5-year RFS rates in patients with and without PHLF were 8% and 32%, respectively (P 0.001). The independent prognostic factors for OS included primary nodal metastasis, abnormal CA19-9 levels, extrahepatic metastasis, positive surgical margins, preoperative chemotherapy, lack of adjuvant chemotherapy and PHLF. The 5-year OS rates in patients with and without PHLF were 31% and 63%, respectively (P = 0.004).Among the complications, only PHLF was associated with decreased long-term survival after hepatectomy for CRLM as well as tumor-specific prognostic factors.

Background Delaying radical cystectomy (RC) after a diagnosis of muscle-invasive bladder cancer (MIBC) has been associated with adverse survival. However, data are lacking regarding the impact of RC delay in patients receiving neoadjuvant chemotherapy (NAC). Objectives To assess whether the time from last cycle of NAC to RC (time to cystectomy, TTC) is associated with survival among MIBC patients. Design, setting, and participants The study cohort comprised 226 patients treated with NAC and RC between 1999 and 2015 for cT2–T4N0M0 bladder cancer. Outcome measurements and statistical analysis Descriptive statistics were used to test the association between TTC and clinicopathologic variables. Overall mortality (OM) and cancer-specific mortality (CSM) were analyzed via Kaplan-Meier estimation according to TTC. We assessed factors associated with OM and CSM using multivariable Cox regression analyses. Results and limitations The median TTC was 7.57 wk (interquartile range 5.2–10.8). Patients with a Charlson comorbidity index (CCI) ≥1 had a longer TTC than those with a score of 10 wk had significantly lower OM-free (p = 0.003) and CSM-free rates (p Conclusions TTC of >10 wk after NAC was associated with adverse survival among patients with MIBC. Patients with a higher CCI were more likely to have prolonged TTC. Patient summary The impact of delaying radical cystectomy in patients who have received neoadjuvant chemotherapy (NAC) is unknown. In this study we assessed whether prolonged time to cystectomy (TTC) after NAC affects survival outcomes in patients with muscle-invasive bladder cancer. We found that TTC of >10 wk was associated with adverse overall survival and cancer-specific survival, and attempts should be made to shorten TTC after preoperative chemotherapy.

International audience; BACKGROUND:Two-stage hepatectomy of bilobar colorectal liver metastases is widely used and shows encouraging survival results. However, the risk of dropout after the first stage remains high and is associated with poor survival. The objective of our study was to evaluate the factors associated with long-term survival based on the pathologic response to preoperative systemic chemotherapy in colorectal liver metastases patients who underwent two-stage hepatectomy.METHODS:The pathologic response to preoperative chemotherapy and its effect on second-stage completion and survival were retrospectively evaluated in 67 patients treated between 2003 and 2013.RESULTS:A total of 56 patients underwent two-stage hepatectomy for initially nonresectable colorectal liver metastases. Chemotherapy was combined with a biotherapy in 32 cases. The tumor regression grade, modified tumor regression grade, and Blazer grade were used to classify patients as responders (tumor regression grade and modified tumor regression grade 1-3, Blazer 0-1) or nonresponders (tumor regression grade and modified tumor regression grade 4-5, Blazer 2) after the first stage. Tumor response in the three classifications was associated with second-stage completion (tumor regression grade 1-3: OR = 4.01, 95% CI: 1.12-14.36, P = .033; modified tumor regression grade 1-3: OR = 3.8, 95% CI: 1.13-12.6, P = .03; Blazer 0-1: OR = 5.45, 95% CI: 1.66-17.85, P = .005). Triple chemotherapy was also associated with responders. The median overall survival of responders was significantly higher (Blazer 0-1: 42.9 months versus Blazer 2: 20.1 months, P = .018; tumor regression grade 1-3: 42.9 months versus tumor regression grade 4-5: 25.1 months, P = .04).CONCLUSION:A pathologic response to chemotherapy is associated with second-stage completion and longer survival. Further studies are needed to achieve the early identification of patients for whom the benefit of the second surgical stage is less straightforward.

Background The survival impact of specific body composition changes during preoperative chemotherapy in patients with colorectal liver metastases undergoing curative-intent surgery remains unclear. This study aimed to determine the impact of changes in body weight and muscle mass during preoperative chemotherapy on survival after hepatectomy in patients with colorectal liver metastases. Methods Consecutive patients with colorectal liver metastases undergoing preoperative chemotherapy and curative hepatectomy during 2009–2013 were retrospectively analyzed. Recurrence-free and overall survival were examined according to body compositions, including muscle mass, as measured by skeletal muscle index (area of muscle [cm2]/square of height [m2]), and body weight before and after preoperative chemotherapy. Results The median follow-up duration in overall 169 patients was 47 months. Skeletal muscle index and body weight changed significantly during chemotherapy (skeletal muscle index: –0.52 cm2/m2, P = .03; body weight: +1.1 kg, P = .002). Patients with major muscle mass loss (≥7%) had significantly shorter median RFS than patients with no or minor muscle mass loss ( Conclusion Major loss of muscle mass but not body weight loss during preoperative chemotherapy is significantly associated with poor recurrence-free survival after hepatectomy in patients with colorectal liver metastases. The mechanisms mediating this association may inform future trials on maintaining muscle mass with dedicated nutrition and exercise programs to improve outcomes.

Highlights • Preoperative chemotherapy alone for locally advanced rectal cancer remain unclear. • Neoadjuvant chemotherapy was a promising treatment for unresectable rectal cancer. • Earlier preoperative systemic chemotherapy was assumed to prevent the dissemination., Background In Japan, the significance and efficacy of preoperative chemotherapy alone for locally advanced rectal cancer remain controversial. This case report presents the apparent effectiveness of preoperative FOLFOX plus bevacizumab as shown by pathological complete response (pCR). Additionally, we review the relevant literature and discuss the clinical management of locally advanced rectal cancer with preoperative chemotherapy. Case presentation A 59-year-old male presented with severe constipation, bloody stool and a loss of 10% of his body weight over 3 months. Preoperative examination revealed locally advanced rectal cancer with extensive invasion of the bladder wall and enlarged regional lymph nodes. Thus, this lesion was assigned a preoperative classification of T4bN2bM0 stage IIIC according to the 8th Union for International Cancer Control (UICC) guidelines. Therefore, the patient initially underwent an external loop colostomy of the transverse colon. Next, the patient received chemotherapy including FOLFOX plus bevacizumab. After 12 cycles of chemotherapy, the tumor size was markedly decreased, and all lymph node metastases had disappeared. Therefore, the patient underwent conventional resection of the rectum with D3 lymph node dissection and closure of the colostomy. Histopathological analysis of the resected specimen revealed that all lesions were fibrotic and devoid of any viable cancer cells. Thus, this lesion was assigned a final classification of ypT0N0M0 stage 0. Conclusions We present the rare case of a patient with surgically resected locally advanced rectal cancer who demonstrated an impressive pCR with preoperative chemotherapy, which included FOLFOX plus bevacizumab.

Complete tumor resection of primary malignant liver tumors offers the best chance of survival. However, many of these children may experience anemia and failure to thrive. This study analyzes the association of preoperative anemia and nutritional support with outcomes in children undergoing major resection of primary malignant liver tumors.Using the National Surgical Quality Improvement Program Pediatric database from 2012 to 2015, children undergoing major liver resections for primary malignant hepatic tumors were selected. Patient demographics, comorbidities, and 30-d outcomes were compared with respect to the presence of preoperative anemia and the need for nutritional support. Outcomes included 30-d postoperative complications, perioperative blood transfusions, and hospital readmissions. Propensity score matching was performed to control for significant confounders.One hundred ten children were included, 76 (69.1%) with preoperative anemia, and 36 (32.7%) receiving nutritional support. Anemia was associated with preoperative chemotherapy (P = 0.02) and steroids (P = 0.03). Nutritional support was associated with cardiac (P = 0.01), respiratory (P 0.01), neurologic (P 0.01), and hematologic comorbidities (P = 0.02). There were 20 (18.2%) postoperative complications and 6 (5.5%) hospital readmissions. After propensity score matching, there was no difference in complications between anemic and nonanemic patients (P = 0.13). Preoperative nutritional support was associated with an increased rate of complications (P 0.01). Neither anemia (P = 1.00) nor nutritional support (P = 0.49) were associated with readmissions.The need for nutritional support is common in children undergoing resection of primary malignant hepatic tumors. Anemia was not significantly associated with postoperative complications. In this study, nutritional support was associated with an increased risk of postoperative complications. The need for nutritional support may warrant special attention to the patient's overall conditioning during operative planning.

Background Clinical implication of disappearing liver metastases (DLMs) from colorectal cancer after chemotherapy needs to be reviewed in the era of modern imaging studies. Methods Between 2010 and 2015, 184 patients underwent curative hepatectomy for colorectal liver metastases following preoperative chemotherapy. The sites of metastases detected on pre-chemotherapy CE-CT were examined post-chemotherapy using CE-CT, gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid-enhanced magnetic resonance imaging (EOB-MRI), and contrast-enhanced intraoperative ultrasonography (CE-IOUS). DLMs were defined as tumors that disappeared on CE-CT post chemotherapy. The detection rate of DLMs with EOB-MRI and CE-IOUS were assessed, and the outcome of DLMs resected and those left in place were reviewed. Results A total of 275 DLMs were noted in 59 patients. On EOB-MRI, 71 lesions (26%) were visible and were resected, 92% (65/71) of which contained viable disease. Using CE-IOUS, an additional 94 lesions were identified. A total of 165 DLMs (60%) were identified and resected by sequential use of EOB-MRI and CE-IOUS, 77% (127/165) of which contained viable disease. Of 110 DLMs not identified, 68 were resected, 4% (3/68) of which contained viable disease. Among 42 lesions left in place, 6 (14%) recurred during the median follow-up period of 27 (9–72) months. Discussion EOB-MRI and CE-IOUS exploration identified clinically relevant DLMs containing viable disease with a high level of accuracy.

Background The assessment of colorectal liver metastases (CRLM) after treatment with chemotherapy is challenging due to morphological and/or functional change without changes in size. The aim of this review was to assess the value of FDG-PET, FDG-PET-CT, CT and MRI in predicting response to chemotherapy in CRLM. Methods A systematic review was undertaken based on PRISMA statement. PubMed and Embase were searched up to October 2016 for studies on the accuracy of PET, PET-CT, CT and MRI in predicting RECIST or metabolic response to chemotherapy and/or survival in patients with CRLM. Articles evaluating the assessment of response after chemotherapy were excluded. Results Sixteen studies met the inclusion criteria and were included for further analysis. Study results were available for 6 studies for FDG-PET(-CT), 6 studies for CT and 9 studies for MRI. Generally, features predicting RECIST or metabolic response often predicted shorter survival. The ADC (apparent diffusion coefficient, on MRI) seems to be the most promising predictor of response and survival. In CT-related studies, few attenuation-related parameters and texture features show promising results. In FDG-PET(-CT), findings were ambiguous. Conclusion Radiological data on the prediction of response to chemotherapy for CRLM is relatively sparse and heterogeneous. Despite that, a promising parameter might be ADC. Second, there seems to be a seemingly counterintuitive correlation between parameters that predict a good response and also predict poor survival.

RAS mutations are associated with limited overall survival after resection of colorectal liver metastases. Our aim was to determine criteria for considering hepatectomy for patients with RAS mutant colorectal liver metastases.Of 1,163 patients who underwent liver resection for colorectal liver metastases during 2005-2014, all patients operated on with curative intent who had known RAS mutation status were included. Factors associated with overall survival were determined using multivariate analysis.A total of 524 patients met the inclusion criteria; 212 (40%) had mutated RAS. Mutations were located on codon 12 in 128 patients (60%) and codon 13 in 29 (14%). At median follow-up of 38 months, median overall survival was 72.6 months for wild-type RAS and 50.9 months for mutated RAS (P .001). Median overall survival for patients with codon 12 and 13 mutations was 51.9 and 50.9 months, respectively (P = .839), significantly worse than for patients with wild-type RAS (P = .005, and P = .038 for codon 12 and 13, respectively). For patients with RAS mutation, factors associated independently with worse overall survival were node-positive primary tumor, tumor3 cm, and7 cycles of preoperative chemotherapy. Major and 2-stage hepatectomy were not associated independently with overall survival. Median overall survival was 57, 41, and 21.5 months for patients with 1, 2, and 3 risk factors, respectively. There were no 4-year survivors in the highest-risk group.Patients with multiple risk factors had poor overall survival after curative resection of RAS mutant colorectal liver metastases. For such patients, hepatectomy may be ill advised, and alternative therapies or further systemic therapy should be considered.

Despite an impressive increase in survival rate over the past decades, there is still a need to improve the survival of specific subgroups of Wilms tumor (anaplastic, metastatic, and bilateral) and to decrease the late effects of treatment in terms of renal function and heart toxicity. We aim to explore new areas of improvement, from diagnosis to treatment: in the field of radiology the increased use of MRI and exploration of its diffusion-weighted imaging capabilities to predict WT histology at diagnosis and for preoperative assessment; in biology the emergence of new biomarkers that could be integrated into the decision-making process; and surgical techniques with more accurate indication of nephron-sparing surgery that is no longer reserved for bilateral WT and the minimally invasive approach. The long-term outcome of patients with WT should thus be a strong indicator of the improvement in adapting and personalizing the treatment to each individual.

The main goal of preoperative chemotherapy is to reduce the size of the tumor and allow conservative treatment. Neoadjuvant treatment can affect axillary status with a downstaging in one third of the cases. For these patients, the benefit of axillary node dissection is questioned and the sentinel node biopsy (SLNB) seems to be a relevant option. However, the timing of performing SLNB is still debated especially for clinical negative patients with negative axillary ultrasound before preoperative chemotherapy. For axillary positive nodes proved by biopsy/cytology before preoperative chemotherapy, SLNB can be an option if there is a good clinical and radiological response.

We present the case of a 3-year-old female patient diagnosed with stage V bilateral nephroblastoma with predominant blastemal component. The treatment protocol included preoperative chemotherapy, left partial nephrectomy, and postoperative chemotherapy. After full recovery, partial right nephrectomy was performed, combined with left radical nephrectomy due to the suspicion of a local subcapsular recurrence. A small remaining tumoral lesion was treated by percutaneous microwave ablation with favorable postoperative recovery. Nephroblastoma raises a challenging diagnostic and treatment protocol, requiring a multimodal and multidisciplinary approach of the pediatric patient.

Background This study was performed to evaluate variables that affect the use of mastectomy and lumpectomy in an underinsured population. Methods A retrospective review of all patients who underwent breast cancer operations from July 2001 to February 2011 at a safety net hospital was performed. Univariate and multivariate analyses were performed to identify variables, which were associated with the type of operation. Results Of the 412 patients, 81% of the patients were underinsured or uninsured. Most patients (58%) presented with clinical stage 2A/B disease. Mastectomy was performed in 37% of patients and lumpectomy in 63%. In multivariate analysis, clinical tumor size ( P = .035) and pathologic stage ( P = .003) remained associated with mastectomy, while use of preoperative chemotherapy ( P = .004) and type of surgeon ( P = .001) was associated with lumpectomy. Conclusions Most patients underwent lumpectomy despite later stage at presentation. Preoperative chemotherapy was associated with increased likelihood of lumpectomy.

The incidence of cavitary lung adenocarcinoma has recently increased; despite this, little is known about its clinical features and prognosis. We, therefore, evaluated the clinicopathologic features and prognosis of this malignancy.Between 1998 and 2007, 2,316 patients without preoperative chemotherapy or radiation therapy underwent surgical resection for primary lung adenocarcinoma. Among these cases, 143 (6.2%) were diagnosed as having cavitary adenocarcinoma based on high-resolution computed tomography scans and were enrolled in our study.Cavitary adenocarcinoma occurred more frequently in patients who were male (p0.001); who had a smoking history (p0.001), larger tumor size (p0.001), a tumor in the lower lobe (p0.001), lymph node metastasis (p = 0.02), advanced tumor stage (p = 0.04), postoperative recurrence (p0.01), and a papillary (p = 0.02) or solid predominant tumor pattern (p0.01); and who had vascular (p0.001), lymphatic (p = 0.04), or pleural invasion (p0.01). Kaplan-Meier analysis revealed that the overall and recurrence-free survival of patients with cavitary adenocarcinoma was significantly shorter than that of patients with noncavitary adenocarcinoma (p 0.001). Multivariate analysis revealed that cavity formation was an independent prognostic factor in adenocarcinoma (p = 0.028).Cavitary adenocarcinoma has worse prognostic clinicopathologic characteristics than noncavitary adenocarcinoma. Based on this finding, cavitary and noncavitary adenocarcinoma tumors should be considered separate entities.

Highlights • A case showed perforation of gastric intramural metastasis from esophageal cancer. • Rapid tumor regression by preoperative chemotherapy may cause the perforation. • Minimally invasive curative resection was achieved by a two-step operation., Introduction Perforation of intramural metastasis to the stomach (IMS) from esophageal cancer during chemotherapy has not been reported. Presentation of case A 68-year-old male consulted our hospital due to appetite loss. He was diagnosed with advanced esophageal squamous cell carcinoma in the lower thoracic esophagus along with a large IMS in the upper stomach. The patient received preoperative chemotherapy of docetaxel, cisplatin, and 5-fluorouracil (DCF). During the second cycle of DCF, he had upper abdominal pain and was diagnosed with gastric perforation. Omental implantation repair for the perforation, peritoneal drainage, tube-gastrostomy, and tube-jejunostomy were performed. At 24 days after emergency surgery, he underwent thoracoscopic radical esophagectomy with total gastrectomy and reconstruction with colonic interposition. Pathological findings in the esophagus demonstrated complete replacement of the tumor by fibrosis. The gastric tumor was replaced by scar tissue with multinucleated giant cells along with a small amount of viable cancer cells. The patient was alive and healthy at 14 months after the radical operation, without tumor recurrence. Discussion The gastric perforation occurred due to rapid regression of the IMS which had involved the whole gastric wall before chemotherapy. Close monitoring to detect rapid tumor shrinkage during chemotherapy in patients with IMS may be warranted. A two-step operation was proposed to achieve safe curative treatment in patients with perforation of IMS during preoperative chemotherapy. Conclusion We describe the first reported case of a patient with esophageal squamous cell carcinoma who showed perforation of IMS during preoperative chemotherapy.

We report the case of a 44-year-old woman with Masaoka stage IV, World Health Organization type B1 thymoma associated with pure red cell aplasia, thrombocytopenia, and myasthenia gravis, which occurred during preoperative chemotherapy with high-dose methylprednisolone. Noninvasive positive-pressure ventilation, intravenous immunoglobulin infusion, and methylprednisolone pulse therapy were performed for the myasthenic crisis. Disseminated thymoma was markedly reduced after these treatments, and macroscopic complete resection was performed after achieving control of pure red cell aplasia, myasthenia gravis, and thrombocytopenia using cyclosporine A. Chemotherapy, including high-dose methylprednisolone, may carry a risk of myasthenic crisis, although the regimen is effective against lymphocyte-rich thymoma.

To compare surgical complication rates after immediate nephrectomy versus delayed nephrectomy following preoperative chemotherapy in children with non-metastatic Wilms' tumour enrolled in UKW3, both in randomised patients and in those for whom the treatment approach was defined by parental or physician choice.Records for all patients enrolled into UKW3 were reviewed. Any record of tumour rupture or surgical complication was extracted and comparisons made between the two treatment strategies in both populations of randomised and non-randomised patients.Of 525 children enrolled, 205 patients were randomised to either immediate nephrectomy (n=103) or pre-operative chemotherapy followed by delayed nephrectomy (n=102). Of the 320 children not randomised, data were available on 189 cases treated with immediate nephrectomy and 103 treated with pre-operative chemotherapy. There were significantly fewer surgical complications in randomised children given pre-operative chemotherapy before surgery compared to children undergoing immediate nephrectomy (1% vs. 20.4%, P0.001); this difference was most marked for tumour rupture (0% vs. 14.6%, P0.001).Delayed nephrectomy for Wilms' tumour, preceded by pre-operative chemotherapy was associated with fewer surgical complications compared with immediate nephrectomy.

Background Initial complete resection is a powerful prognostic indicator of survival in thymic epithelial tumors (TETs), but is obviously related to tumor stage. Here, we report the results of a prospective study of neoadjuvant docetaxel/cisplatin in locally advanced TETs. Methods Patients with histologically proven, Masaoka stage III/IV TETs at presentation were enrolled in this open-label, phase II, nonrandomized study. Patients received docetaxel 75 mg/m 2 I.V, followed by cisplatin 75 mg/m 2 I.V on day 1 of every 3-week cycle. After three cycles, surgical resection was performed if the tumor was considered resectable. Results From March 2007 to July 2011, 27 patients were enrolled in the trial. Masaoka stage at presentation was III ( n = 8; 29.6%), IVA ( n = 17; 63.0%), and IVB ( n = 2; 7.4%). Histologic types were nine thymomas (33.3%) and 18 thymic carcinomas (66.7%). After completion of neoadjuvant chemotherapy, 17 patients (63.0%) achieved partial response and 10 (37.0%) had stable disease. Nineteen patients (70.4%) underwent surgery and eight did not because of surgeons' decision ( n = 5), patient refusal ( n = 2), or decision to undergo radiation therapy instead ( n = 1). Fifteen among the 19 patients achieved complete resection (78.9%), which yields 55.6% of complete resection rate with intent-to-treat analysis. The most common side effects of severity greater than grade 3 were neutropenia and diarrhea. With a median follow-up of 42.6 months, 4-year overall survival, and progression-free survival in all patients was 79.4 and 40.6%, respectively. Conclusion Neoadjuvant docetaxel/cisplatin is both feasible and well tolerated, and potentially improves surgical resectability in patients with advanced TETs.

Limb preservation is now the standard method of treatment for most bone sarcomas. Limb-salvage operations have been shown to have similar recurrence rates to amputation. A recent study by Schrager et al. of pediatric patients with ES and OS showed a 35% greater mortality rate with amputation compared with limb salvage. The success of limb salvage is the result of several advances in the evaluation, diagnosis, and treatment of pediatric bone sarcomas. These include imaging modalities such as magnetic resonance imaging that allow for precise mapping of the tumor, effective chemotherapy, and reconstructive options that allow for a functional limb. Treatment typically includes preoperative chemotherapy, surgical resection with or without reconstruction, and postoperative chemotherapy.

Background Twenty five percent of women with breast cancer who undergo preoperative chemotherapy do not have axillary metastases. These patients need to withstand sentinel lymph node biopsy (SLNB). The optimal timing of SLNB in patients with neoadjuvant chemotherapy has not yet been defined. Methods We systematically reviewed the literature for studies concerning the efficacy of sentinel lymph node biopsy before neoadjeuvant chemotherapy. A literature search was performed for the years 1993 through 2011 using the databases MEDLINE and EMBASE. Data that assessed the reliability of sentinel lymph node biopsy before chemotherapy were collected. Results We identified 10 high-quality studies from 387 papers, which are analyzed further in this review. The identification rates reported ranged from 97% to 100%. The sensitivities of sentinel lymph node biopsy were 100%, and the false negative rates were 0%. Use an isotope combined with blue dye was associated with a higher probability of identification than that of using an isotope or blue dye alone (99.5% vs 98.5%). Only two studies compared data based on different timing for the sentinel lymph node biopsy. They achieved a lower false negative rate (0% vs 15.8%) and higher success rate (100% vs 81%) in patients with sentinel lymph node biopsy prior to neoadjuvant chemotherapy. Conclusion Sentinel lymph node biopsy prior to chemotherapy potentially gives a more accurate evaluation of axillary status, because it is unaffected by any previous therapeutic intervention.

Background Although use of preoperative chemotherapy for breast cancer is increasing, resultant changes in breast architecture have not been described. The purpose of this study was to examine breast architecture changes in response to chemotherapy by the placement of 4 peripheral clips. Methods In a prospective case-series of breast cancer patients selected to undergo preoperative chemotherapy, 4 clips were placed peripherally to each mass using sonographic guidance. Mammograms documented tumor size and clip locations both before chemotherapy and after chemotherapy. Percentage reduction in area was calculated based on the tumor dimensions and distances between clips. Results In 16 participants, 87.5% of lesions had a significant response to chemotherapy. Changes in clip measurements varied widely from significant reduction to significant increase and did not correlate with changes in tumor size. The Pearson correlation coefficient comparing changes in tumor size and clip measurements was .036 ( P = .895). Conclusions There was no correlation between reduction in tumor size and change in clip measurements. Further research should be conducted using noncompression breast imaging modalities to eliminate possible distortion caused by mammographic compression.

The purpose of this study was to assess the postoperative morbidity of patients ≥75 years with non-small cell lung cancer (NSCLC) who underwent neoadjuvant chemotherapy, comparing them to younger patients.We performed a case-control study over a 5-year period using Epithor, the French Society of Thoracic and Cardiovascular Surgery database, including to date more than 160,000 procedures from 103 institutions. We collected prospectively the data concerning 1510 patients with NSCLC who underwent preoperative chemotherapy, from January 2005 to December 2009. In order to compare patients with similar characteristics, we matched the 81 patients ≥75 to 81 controls (75) for gender, American Society of Anesthesia (ASA) score, Performance Status (PS), Forced Expiratory Volume (FEV1) and histological subtype of the tumor. The patients of the control group were randomized within the 1429 patients75 included. Lung cancer surgical treatment, post-operative morbidity and mortality rates, and length of stay (LOS) were compared between the two age groups.There was no significant difference in type of resection between the two groups (p=0.07): pneumonectomy 15% (n=12) for patients ≥75 vs 28% (n=23) for younger patients, lobectomy 65% (n=53) vs 54% (n=44), bilobectomy 14% (n=11) vs 6% (n=5) and sub-lobar resection 4% (n=3) for the two groups. There was no significant difference in type of mediastinal lymphadenectomy (p=0.48) between the two age groups. Elderly patients presented a more important number of postoperative complications (p=0.04) and these ones were more severe (p=0.03). There was no significant difference in postoperative mortality with 30-day mortality: 4.9%, n=4, versus 2.5%, n=2, (p=0.83); 60-day mortality: 6.2%, n=5, versus 2.5%, n=2, (p=0.61); and 90-day mortality was the same. Hospital LOS was longer for the elderly (14.9 days, CI95%[12.5;17.4] vs 11.9 days, CI95%[10.7;13.3], p0.001).Postoperative morbidity after neoadjuvant chemotherapy is more important in elderly patients. These data should be taken into account when considering the interest of preoperative treatment in elderly patients with resectable NSCLC.

Background Neoadjuvant chemotherapy is gaining acceptance as an option for breast cancer treatment, particularly in young women. These women may seek immediate breast reconstruction after mastectomy even though it is not known whether such preoperative chemotherapy may be detrimental to post-reconstruction wound healing. Therefore, we set out to assess the influence of neoadjuvant chemotherapy for invasive breast cancer on the short-term complications after skin sparing mastectomy and immediate prosthetic reconstruction. Methodology The short-term surgical outcome of 48 immediate breast reconstructions in 37 women treated with neoadjuvant chemotherapy from 2006 through 2009 was prospectively compared to that of 215 immediate reconstructions in 176 women who were operated in the same period without neoadjuvant chemotherapy. Results The overall rate of short-term postoperative complications was significantly less among neoadjuvantly treated women (15% vs. 29%; p = 0.042) but this did not result in a reduction of loss of prostheses (8% vs. 11%; p = 0.566). Conclusion Because neoadjuvant chemotherapy is not associated with an increase in short-term complications after skin sparing mastectomy and immediate prosthetic reconstruction in patients with invasive breast cancer, such combined surgical therapy may be offered as treatment option for this particular group of patients also.

Background The aim of this study was to evaluate the accuracy of a magnetic resonance imaging (MRI) marking technique with a drape-type thermoplastic shell for planning breast-conserving surgery (BCS). Methods A prospective review was performed on 35 consecutive patients who underwent MRI in the supine position and used the specified MRI marking technique. Eleven cases underwent pre-operative chemotherapy and 24 cases did not. After immobilizing the breast mound with a drape-type thermoplastic shell, patients underwent MRI, and the location of the lesion was marked on the shell. Resection lines were dyed blue by indigo carmine, which was pushed through the pores of the shell. Specimens obtained during BCS were sliced into 5-mm contiguous sections, and the margin was assessed for each specimen. Cancer foci less than 5 mm from the margin were classified as positive. Results Of 35 patients, 33 were included in the analysis; 2 were excluded due to a lack of effect of pre-operative chemotherapy. Of these 33 patients, 25 (75.8%) had negative margins and 7 (21.2%) had positive margins. Conclusions Our MRI marking technique may be useful for evaluating the extent of tumors that were determined by MRI alone. Long-term outcomes of this technique should be evaluated further.