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Background: In this study, we aimed to evaluate the factors that contribute to survival outcomes in patients with thymoma treated with multimodal approaches. Methods: A total of 203 patients (105 males, 98 females; median age: 49 years; range, 17 to 77 years) with Masaoka-Koga Stage II-IV thymoma between January 2002 and December 2018 were retrospectively analyzed. Data including diagnosis of myasthenia gravis, diagnosis of diabetes mellitus, disease stage, histological type of tumor, capsule invasion and surgical margin status, lymphadenectomy, adjuvant radiotherapy or chemotherapy, time from surgery to the first day of adjuvant treatment, length of hospital stay, and overall and disease-free survival rates were recorded. Results: Of the patients, 91 had Stage II, 67 had Stage III, and 45 had Stage IV disease. A total of 123 patients (61%) had myasthenia gravis. Seventy-six patients received adjuvant radiotherapy and 48 patients received either neoadjuvant (n=35) or adjuvant (n=25) chemotherapy. Higher disease stage, presence of R1 resection, and treatment with chemotherapy were significant factors for decreased disease-free survival time. Older age, higher disease stage, longer postoperative hospital stay, chemotherapy, and disease recurrence were effective contributors to decreased overall survival time. Adjuvant radiotherapy had a statistically significant positive effect on overall survival only in patients with completely resected Stage IV disease (five-year overall survival: 94.7% vs. 79.1%, respectively; p=0.015). In the multivariate analysis, older age (hazard ratio: 4.26), higher disease stage (hazard ratio: 2.95), and longer hospitalization time (hazard ratio: 3.81) were significant prognostic factors for overall survival. Patients with local recurrence who underwent complete resection had a survival time comparable to non-recurrent patients (p=0.753). Conclusion: For patients with thymoma, higher disease stage, age ≥50 years, longer hospitalization, and need for chemotherapy are associated with worse survival rates. Adjuvant chemotherapy has a positive impact on Stage IV disease. Resection of recurrent lesions has a valuable impact on survival., Amaç: Bu çalışmada, multimodal yaklaşımlar ile tedavi edilen timoma hastalarının sağkalım sonuçlarına katkıda bulunan faktörler değerlendirildi. Ça¬lış¬ma pla¬nı: Ocak 2002 - Aralık 2018 tarihleri arasında Masaoka-Koga Evre II-IV timomalı toplam 203 hasta (105 erkek, 98 kadın; medyan yaş: 49 yıl; dağılım, 17-77 yıl) retrospektif olarak incelendi. Myastenia gravis tanısı, diabetes mellitus tanısı, hastalık evresi, tümörün histolojik türü, kapsül invazyonu ve cerrahi sınır durumu, lenfadenektomi, adjuvan radyoterapi veya kemoterapi, cerrahiden adjuvan tedavinin ilk gününe kadar geçen süre, hastanede yatış süresi ve genel ve hastalıksız sağkalım oranları kaydedildi. Bulgular: Hastaların 91’inde Evre II, 67’sinde Evre III ve 45’inde Evre IV hastalık izlendi. Toplam 123 hastada (%61) myastenia gravis vardı. Yetmiş altı hastaya adjuvan radyoterapi ve 48 hastaya neoadjuvan (n=35) veya adjuvan (n=25) kemoterapi verildi. Yüksek hastalık evresi, R1 rezeksiyon varlığı ve kemoterapi azalmış hastalıksız sağkalım süresinin anlamlı faktörleriydi. İleri yaş, yüksek hastalık evresi, ameliyat sonrası uzun süreli hastane yatışı, kemoterapi ve hastalık nüksü genel sağkalım süresinin azalmasına katkıda bulunan faktörlerdi. Yalnızca tam rezeke Evre IV hastalığı olan hastalarda, adjuvan radyoterapinin genel sağkalım üzerinde istatistiksel olarak anlamlı bir pozitif etkisi vardı (beş yıllık genel sağkalım: sırasıyla %79.1’e kıyasla %94.7; p=0.015). Çok değişkenli analizde ileri yaş (risk oranı: 4.26), yüksek hastalık evresi (risk oranı: 2.95) ve daha uzun hastanede yatış süresi (risk oranı: 3.81) genel sağkalımın anlamlı prognostik faktörleriydi. Tam rezeksiyon uygulanmış lokal nüks saptanan hastalardaki sağkalım süresi, hiç nüks saptanmayan hastalar ile benzer bulundu (p=0.753). So¬nuç: Timomalı hastalarda yüksek hastalık evresi, ≥50 yaş, daha uzun süreli hastanede yatış ve kemoterapi ihtiyacı, daha kötü sağkalım oranları ile ilişkilidir. Adjuvan radyoterapi, Evre IV hastalık üzerinde olumlu etkiye sahiptir. Tekrarlayan lezyonların rezeksiyonunun sağkalım üzerinde önemli bir etkisi vardır.

BACKGROUND: Aortic graft infection is one of the most serious complications of vascular reconstruction with the incidence of 1%. The clinical presentation can vary, which delays the diagnosis. CASE REPORTS: Infections in our patients affected iliac, inguinal region, and retroperitoneum, which are not relatively common sites of graft infection. We present clinical presentation, imaging procedures, and surgical treatment of three patients with unknown cause of late graft infection after 6, 7, and 9 years. CONCLUSION: In our presentations, the etiological factors of the infection are not known, but they suggest that events in the gastrointestinal tract may be related to them. Aggressive surgery should be taken into consideration as a first choice in the similar cases.

We performed an E-survey to evaluate the practice patterns in debulking surgery for advanced ovarian cancer in Asia.We designed a questionnaire, including 50 questions related to debulking surgery for advanced ovarian cancer. The questionnaire was sent to Gynecologic Oncologic Groups in Asia from December 2016 to February 2017.A total of 253 gynecologic oncologists from Japan (58.9%), the Republic of Korea (19%), Taiwan (12.6%), and the other counties including China (7.5%), Malaysia (0.8%), Indonesia (0.8%), and Thailand (0.4%) participated in this E-survey. The median number of debulking surgeries per year was 20, and 46.8% of the respondents preferred1 cm as the criterion for optimal debulking surgery (ODS). The most common barrier and surgical finding precluding ODS were performance status (74.3%) and disease involving the porta hepatis (71.5%). Moreover, 63.2% had a fellowship program, and only 15% or less had opportunities to receive additional training courses in general, thoracic, or urologic surgery. The median percentage of patients receiving neoadjuvant chemotherapy (NAC) was 30%, and the achieved rate of ODS in primary debulking surgery (PDS) and interval debulking surgery (IDS) was 65% and 80%, respectively. Most of the respondents required three to 6 h for PDS (48.6%) and IDS (58.9%). Moreover, more than 50% depended on ultra-radical surgery conducted by specialists.The ODS criteria are relatively lenient with a preference for NAC in 30% of the respondents in Asia. This trend might be associated with the dependence on aggressive surgery performed by specialists.

In recent years, arthroscopic anterior talofibular ligament (ATFL) repair techniques have been increasingly used for chronic ankle instability. Besides permitting the treatment of several comorbidities, arthroscopic techniques are applied to minimize the need for aggressive surgery and improve the assessment of anatomic structures. We describe our surgical technique for all-arthroscopic anatomic ATFL repair using a knotless anchor, which can adjust suture tension under direct visualization using a self-locking mechanism. Thus, this technique diminishes the chance of repaired ligament separation from its attachment by obtaining the desired tension. Moreover, its knotless property allows the avoidance of some complications such as neuritis and pain related to bulky knots., Technique Video Video 1 Arthroscopic demonstration and illustration of arthroscopic anterior talofibular ligament (ATFL) repair. A medial midline portal and an accessory anterolateral portal are used as a viewing portal and working portal, respectively. A Micro SutureLasso (TFCC, Short 70° bend, Arthrex and knotless SutureTak anchor (3.0 12.7 mm; Arthrex) are used for ATFL repair.

Summary The idea that neoplasms grow, becoming unresectable through dissemination, which is initially loco-regional, and systemic only in a later stage, is historically at the basis of the radical surgery – where, by ‘radical’, the old surgery meant the complete removal of the tumor and, in practice, aggressive surgery. Halsted’s “radical mastectomy”, as well as many principles of surgical anatomy of the first decades of the twentieth century, obey to an idea of tumor progression as a linear process taking place in continuity and contiguity, where the various anatomical layers and the peritumoral desmoplastic reaction are mistaken for a wall of defense against the neoplasm’s dissemination, capable of containing and orienting it. However, the investigations of the processes of invasion and metastasis by Rudolf Virchow and Stephel Paget helped to reorient surgical approaches.

As a facial plastic surgeon gains experience, further improvements can be gained with more aggressive surgery, but complications begin to occur when more aggressive measures are undertaken. Therefore, the ideal technique is one that maximizes rejuvenation while minimizing adverse effects. The senior author has found that the aggressive techniques in the region of the neck have improved dramatically the overall initial and long-term results for the neck portion of the rhytidectomy. More aggressive treatment of the midface during the modified deep plane rhytidectomy does not necessarily improve the overall long-term results, however, and can increase the complication rate.

This study investigated the pattern of first recurrence of advanced ovarian cancer before and after the introduction of aggressive surgery. We investigated 291 patients with stage III/IV epithelial ovarian, fallopian tube, and peritoneal cancer. Aggressive surgery including gastrointestinal and upper abdominal surgeries was introduced for advanced ovarian cancer in 2008. The site and time until first recurrence were compared between 70 patients treated without aggressive surgery (2000–2007) and 221 patients who underwent aggressive surgery (2008–2016). The intraperitoneal recurrence rate was significantly lower in patients treated during 2008–2016 than in patients treated during 2000–2007 (55% [82/149] vs. 81% [46/57], p

Lipomas of the oral cavity are uncommon. Here we report a case of 85 year old female presenting with a progressively increasing large growth in the oropharynx which was diagnosed as lipoma on histopathology. The clinicoradiological and histopathological findings are discussed. To the best of our knowledge; this is one of the largest intraoral lipoma reported in India till date. The present case highlights the need to be aware of intraoral lipomas which can present as large growths at this unusual site so as to avoid any unwarranted aggressive surgery.

Introduction and importance Adenocarcinoma of the jejunum is a diagnostic challenge for the physician because of its extreme rareness and the fact that it classically presents with vague clinical symptoms. On the other hand, the Sister Mary Joseph's nodule is a rare clinical sign that refers to umbilical metastasis of an internal malignancy. We here report a rare case of jejunal adenocarcinoma revealed by a Sister Mary Joseph's nodule. Case presentation A 55-year-old man presented with an ulcerated umbilical tumor, which was found to be a secondary lesion of an advanced jejunal adenocarcinoma invading the transverse colon. He underwent surgical resection of the umbilical tumor and the intestinal primitive. Clinical discussion The presence of umbilical metastasis usually represents advanced disease but can be its first manifestation. Gastro-intestinal tract tumors such as jejunal adenocarcinomas and gynecologic malignancies are the most common primary sites. Conclusion Practicians must be aware of clinical implication of Sister Mary Joseph nodule. Aggressive surgery when feasible can be beneficial for survival., Highlights • Secondary umbilical malignancies are known as Sister Mary Joseph's nodule or sign • Small bowel represents only 2% of primary sites. • Differential diagnosis includes primary umbilical malignancy and benign lesions • Sister Mary Joseph's nodule represents advanced disease with an associated poor prognosis. • A combination of aggressive surgery and systemic therapies may result in better survival

The common treatment of epithelial ovarian cancer is aggressive surgery followed by platinum-based cytotoxic chemotherapy. However, residual tumor cells are resistant to chemotherapeutic drugs during postoperative recurrence. The treatment of ovarian cancer requires breakthroughs and advances. In recent years, magnesium alloy has been widely developed as a new biodegradable material because of its great potential in the field of medical devices. From the degradation products of magnesium, biodegradable magnesium implants have great potential in antitumor. According to the disease characteristics of ovarian cancer, we choose it to study the antitumor characteristics of biodegradable magnesium. We tested the anti-ovarian tumor properties of Mg through both in vivo and in vitro experiments. According to the optical in vivo imaging and relative tumor volume statistics of mice, high-purity Mg wires significantly inhibited the growth of SKOV3 cells in vivo. We find that the degradation products of Mg, Mg2+, and H2 significantly inhibit the growth of SKOV3 cells and promote their apoptosis. Our study suggests a good promise for the treatment of ovarian cancer.

Background: Management of type A intramural hematoma (IMH) remains controversial, with opinions divided as to whether patients should be treated with early aggressive surgery or a more conservative approach. The present systematic review aims to evaluate the mortality and morbidities following surgery for type A IMH. Methods: Electronic searches were performed on five databases from dates of inception to December 2018. All studies with surgical outcomes for type A intramural hematoma were identified by two independent researchers and relevant data extracted. Random-effects meta-analysis of proportions or meta-analysis of means were performed to aggregate the data. Survival data were pooled using reconstructed individual patient data derived from Kaplan-Meier curves. Results: Fifteen studies with 744 patients were identified. Ten studies were from Asian countries (73% of patients). Overall mortality was 8.2% [95% confidence interval (CI): 4.6–13.9%]. Mortality from Asian centers was 5.3% (95% CI: 3.6–7.7%) and 18.9% (95% CI: 7.0–40.4%) in Western centers. Postoperative complications were poorly reported and hence not analyzable. Overall pooled survival of 343 patients from four studies at 1-, 2-, 3-, 5-, and 10-year was 91.8%, 90.2%, 89.2%, 87.7%, and 71.1%, respectively. Conclusions: There is an acceptable level of risk of death after surgery for type A IMH, though significant variations exist between results from Asian and Western centers. More detailed studies are required to clarify the controversies surrounding management of type A IMH.

Highlights • Papillary thyroid cancer with desmoid-type fibromatosis (PTC-DTF) is an uncommon variant of PTC. • The stromal component of the tumor may have an aggressive behavior with risk for local recurrence. • Management of recurrent desmoid-type fibromatosis on the neck can be challenging. • Patients with PTC-DTF need to be monitored carefully after thyroidectomy for local recurrence of the stromal component of the tumor., Introduction Papillary thyroid cancer with desmoid-type fibromatosis (PTC-DTF) is an uncommon tumor characterized by extensive stromal proliferation of fibroblasts and myofibroblasts with a small component of PTC. We report a case of PTC-DTF with infiltration of the mesenchymal component of tumor into perithyroidal muscle and early recurrence of desmoid after thyroidectomy, an outcome previously not reported. Presentation of case A 20-year-old man underwent left hemithyroidectomy for a thyroid nodule. Pathology demonstrated a 4.2 cm tumor with PTC-DTF with the PTC comprising

Introduction. The ability to minimize residual disease during primary cytoreductive surgery is the strongest predictor for improved overall survival in advanced ovarian cancer. But while the probability to achieve a macroscopic complete resection increases if surgery is preceded by neoadjuvant chemotherapy (NACT), survival rates after NACT are similar to those observed after primary surgery. This may suggest that the prognostic effect of residual disease is altered after NACT. More specifically, randomized data suggest that there is no difference between optimal (0.1-1 cm) and suboptimal (>1 cm) cytoreductive surgery after NACT. Therefore, the aim of the current review is to establish the prognostic effect of the amount of residual disease after interval cytoreductive surgery (ICS) on overall survival.Methods. Potential articles for inclusion in the current review were systematically searched through Medline, Embase and Cochrane in September 2017. Median overall survival (mOS) was summarized by the outcome of ICS per study. In addition, mOS was summarized for all studies together stratified by the outcome of ICS, based on the principle of a weighted average.Results. In total, 3677 unique manuscripts were individually screened on title and abstract, which resulted in 11 individual studies that comprised a total of 2178 patients. MOS was 41 months for patients with no residual disease (range 33-54 months), 27 months for patients with 0.1-1 cm of residual disease (range 19-38 months) and 21 months with >1 cm of residual disease (range 14-27 months). Six studies showed significant differences between optimal and suboptimal ICS, while five studies showed no differences.Conclusion. The summary of the currently available literature showed that after NACT, patients with optimal cytoreductive surgery experience lengthened survival compared to patients with suboptimal cytoreductive surgery. Patients with no macroscopic residual disease have, however, the most favorable survival outcomes, similar to what is seen after primary cytoreductive surgery. (C) 2019 Elsevier Inc. All rights reserved.

Maximal aggressive meningioma resection has been suggested to provide the best tumor control rates. However, radical surgery of meningiomas located at the frontal skull base can be accompanied by impairment of adjacent cranial nerve function that negatively affects patients' quality of life. We, therefore, analyzed our institutional database for cases of new cranial nerve deficits and postoperative cerebrospinal fluid (CSF) leakage stratified by the extent of tumor resection.From February 2009 to April 2017, 195 patients underwent resection of frontal skull base meningioma at our institution. Postoperative new deficits of cranial nerve function and CSF leakage were stratified by the resection into Simpson grade I resection with excision of the dural tail as an aggressive surgical approach and Simpson grade II-V resection.Simpson grade I resection was associated with a significantly greater percentage of new cranial nerve deficits immediately after surgery (30%) compared with Simpson grade II (13%; P = 0.007) and Simpson grade II-V (17%; P = 0.035). The differences were greater at the 12-month follow-up point (29% Simpson grade I, 6% Simpson grade II [P0.001]; 10% Simpson grade II-V [P = 0.001]). Postoperative CSF leakage occurred in 10.1% of Simpson grade I versus 2.3% of Simpson grade II resections (P = 0.048). The retreatment rates did not differ between these 2 groups (2.5% vs. 3.4%; P = 1.000).We found high levels of new cranial nerve morbidity and CSF leakage after radical removal of frontal skull base meningiomas that included the adjacent dura. Thus, less aggressive surgery for frontobasal meningioma should be preferred.

The field of melanoma oncology is rapidly evolving with advances in detection, staging and treatment. There is heterogeneity in all stages of melanoma where some patients fare better than others for reasons currently unknown and it is sometimes unclear which patients warrant closer surveillance, multidisciplinary care, increased imaging, more aggressive surgery or adjuvant therapy. Early studies have shown the predictive ability of gene expression profiling (GEP) and institutions that have adopted GEP for melanoma treatment have demonstrated changes in practice patterns and patient management. The goal of this paper is to review the clinical evidence for a new diagnostic test, DecisionDx-Melanoma, the only GEP test for cutaneous melanoma with prospective studies analyzing its utility.

Context Although most sellar lesions are related to pituitary adenomas, the region gives rise to a variety of neoplasms that can be associated with substantial morbidity and/or mortality. Design Information from reviews and guidelines of relevant societies dealing with such neoplasms, as well as articles that have provided new developments that made important contributions to their pathogenesis and treatment up to 2018, were obtained: public indexes such as PubMed/MEDLINE were used with the relevant search items. Results Sellar neoplasms have a worse outcome than pituitary adenomas that is related not only to their natural history but also to side effects of therapies and evolving endocrine and/or hypothalamic deficiencies. Recent imaging advances have established the radiological fingerprint of some of these neoplasms, and several chromosomal aberrations have also been identified. Although established approaches along with new surgical and radiotherapeutic approaches remain the main treatment modalities, recent evidence has provided insight into their molecular pathogenesis involving, other than chemotherapy, treatments with targeted agents as in gliomas and craniopharyngiomas bearing BRAF mutations. Development of predictive markers of recurrences may also identify high-risk patients, including proliferative markers and expression of the progesterone receptor in meningiomas, and lead to less aggressive surgery. Owing to the rarity and complexity of these neoplasms, patients should be managed in dedicated centers. Conclusions The diagnosis and management of sellar neoplasms necessitate a multidisciplinary approach. Following evolving recent advances in their diagnosis and therapy, such a multidisciplinary approach needs to be extended to establish evidence-based diagnostic and management plans.

New concepts had to be developed since the progress in diagnostic methods, tumor characterization and progress in treatment delivery (more aggressive surgery and radiotherapy) made possible new approaches for locally advanced breast cancer. The process of remodeling is now a reality and the local cure of locally advanced tumor by only high dose radiotherapy is now possible. Based on modern irradiation techniques as IMRT, VMAT or Tomotherapy, target volume conformal dose distributions delivered to complex targets made possible the "remodeling" process at the soft and/or bone tissue. We present from our own experience clinical cases of "remodeling" at the level of chest wall and bone metastases at the spine and pelvic bone.

Liver resection for colorectal metastases is affected by a non-negligible recurrence rate. The earlier the recurrence, the worse the prognosis. We analyzed an unexplored topic, i.e., the incidence, predictive factors, and prognostic impact of very early recurrence (≤ 3 months after hepatectomy). All consecutive liver resections for colorectal metastases performed between 2004 and 2017 were retrospectively reviewed. Inclusion criteria were available recurrence status at 3 months after resection and follow-up ≥ 12 months. Overall, 484 patients were analyzed; 56 (11.6%) had very early recurrence. Independent predictors were number of metastases (very early recurrence in 3.7% of patients with solitary metastasis, 8.1% of those with 2–9 metastases; 20.0% of those with 10–14 metastases; 44.4% of those with ≥ 15 metastases, p

A case of a 46-year-old woman with disease relapse and surgical intervention with a transverse rectus abdominalis muscle flap (TRAM) of the chest wall is reported. Long-term survival (64 months) following aggressive surgery was succeeded.

Endometriosis is a complex chronic inflammatory condition that can create a multitude of bothersome painful symptoms for women. Bowel endometriosis is often misdiagnosed or overlooked leading to years of suffering for many women. The surgical management of bowel endometriosis varies based on extent of disease as well as surgeon experience. Surgical treatment for bowel endometriosis is complex and a variety of intraoperative and postoperative complications must be considered. Two significant postoperative complications for bowel endometriosis include anastomotic leak and fistula formation. There is continued debate regarding the appropriate surgical treatment for bowel endometriosis. Aggressive surgery with segmental bowel resection is being utilized more cautiously, with an increase in less aggressive shaving or disc excision techniques. Historic beliefs regarding the limitations of shaving and disc excision are being challenged, and with a reduction in morbidity these less aggressive techniques are winning favor among gynecologic surgeons. Shaving, discoid excision, and segmental bowel resection are all feasible surgical management options for bowel endometriosis. Segmental resection is associated with the highest rates of both anastomotic leak and fistula formation, while shaving is associated with the lowest.

Gliomas are one of the most common brain tumors occurring in children and adults. Gliomas are primary, diffusely infiltrating brain tumors. There are few effective therapies for these type of cancer, and patients with malignant glioma fare poorly, even after aggressive surgery, chemo- and radiotherapy.

Hutch diverticulum is a congenital diverticulum of the urinary bladder, reported infrequently in children and rare amongst adults. We present a 60-year-old male patient with bilateral Hutch diverticula, detected incidentally during an abdominal ultrasound examination performed for blunt abdominal trauma. This rare case highlights an unusual incidental presentation and opportunity to learn how to differentiate it from acquired bladder diverticula. The available treatment options are also discussed varying from simple follow-up to aggressive surgery.

Canine oral papillary squamous cell carcinoma (COPSCC) is a rare neoplasm and although locally invasive it carries a favourable prognosis following wide surgical excision. Radiotherapy has been reported to be effective as an adjunct treatment to surgery. However, limited information is available on the role of radiotherapy as single treatment. This single‐institution retrospective study describes a series of 10 dogs diagnosed with macroscopic COPSCC that were treated with definitive‐intent radiotherapy (DRT) as a monotherapy. These dogs had a median age of 4 years (range: 0.4‐9.6 years). The tumour was located in the rostral oral cavity in all cases with a median tumour size of 2.5 cm (range: 0.8‐6.8 cm). No local or distant metastases were identified. All dogs were treated with electron beam DRT (>32Gy, 10‐16 daily fractions of 3.2Gy). The median follow‐up time was 961 days (range: 333‐3.498 days) with nine dogs achieving a complete response and one dog a partial response. The dog with the partial response developed disease progression at 228 days after initiation of radiotherapy. Two dogs died from non‐tumour‐related causes. The remaining seven dogs were still alive and in complete remission at the time of last follow‐up. Median progression‐free survival time and median survival time were not reached. DRT was generally well tolerated, but all dogs experienced self‐limiting acute radiation mucositis (grade 2‐3) and/or dermatitis (grade 1). No late radiation toxicity was observed. Macroscopic COPSCC appears to be a radiosensitive tumour that can be successfully treated with DRT eliminating the need for aggressive surgery in advanced cases.

BACKGROUND: Odontogenic myxoma (OM) is a rare neoplasm, which originates from odontogenic ectomesenchyme. There is no study in the literature that analyses the best standards for OM diagnosis and how the treatment modalities may influence the recurrence rates.OBJECTIVE: To evaluate the best standards for odontogenic myxoma (OM) diagnosis and treatment, and how these may influence the recurrence rates.STUDY DESIGN: Two independent researchers performed a systematic review in many databases. Fifty-two eligible studies were included for qualitative analysis. Bias analysis was conducted according to Oxford Centre for Evidence-Based Medicine.RESULTS: A total of 1363 OM cases were reported on, and female gender with average age of 27 years is the most common patient profile. Conventional microscopic findings were observed in 93.43% of the reported cases. In 57.49% of the cases, multilocular radiographic appearance was present, followed by unilocular appearance (32.87%). Posterior mandible was the site with the major prevalence, while surgical resection was the most common treatment modality, followed by enucleation. Recurrence rates for both treatment modalities were approximately close (13.04% and 25.0%, respectively).CONCLUSION: The correct diagnosis of OM relies on the association of clinical, radiographic and microscopic findings. About imaging examinations, panoramic radiography and computed tomography are sufficient for the evaluation of OM. Recurrence rates were closely among the two most used surgery treatments. So according to some clinical-radiological aspects, conservative surgery may be preferred than aggressive surgery modalities.

Dynamic contrast-enhanced (DCE) MRI is increasingly used to stage and evaluate rectal cancer extent in vivo in order to plan and target interventions for locally advanced tumors. The major clinical challenge faced with rectal cancers today is to personalize interventions through early identification of patients will benefit from neoadjuvant chemoradiation (nCRT) alone and who will benefit from aggressive surgery (with adjuvant radiation) instead; via baseline imaging. In this study, we evaluated texture kinetic features of rectal tumors using baseline DCE MRI scans, in order to predict pathologic tumor stage regression in response to nCRT. Our texture kinetics approach utilized a combination of texture features (from multiple DCE uptake phases) and polynomial curve fitting to uniquely quantify spatiotemporal patterns of lesion texture during contrast uptake and diffusion that were different between responders and non-responders to nCRT. We utilized a cohort of 48 rectal cancer patients for whom pre-nCRT 3 T DCE MRI was available, including pre-, early-, and delayed-enhancement phases. All DCE MRI phases were processed for motion and spatial alignment artifacts via rigid co-registration, and the tumor ROI on all 3 contrast phases was normalized with respect to non-enhancing muscle. 191 texture features were extracted from each of 3 contrast phases separately, following which each feature was plotted with respect to time to yield a feature enhancement curve. Polynomial fitting was applied to each feature enhancement curve to result in a vector of coefficients which was considered the texture kinetic representation of that feature. All 191 features were evaluated in terms of their texture kinetic representation as well as the raw feature enhancement, for predicting pathologically regressed tumor stages (ypT0-2) from non-regressed tumors (ypT3-4) via a cross-validated QDA classifier. Texture kinetics of gradient XY enhancement yielded the best overall AUC=0:762±0:053, which was significantly higher than any feature enhancement representation (best AUC=0:696±0:050). Texture kinetic representations also outperformed their corresponding raw feature enhancement representations in 54.5% of the features compared, and performed significantly worse in only 13% of the comparisons. Non-invasive guidance of interventions in rectal cancers could therefore be enhanced through the use of texture kinetic features from DCE MRI, which may better characterize spatiotemporal differences between responders and non-responders on baseline imaging.

Osteosarcoma shows a high propensity to metastasize to the lung. Pulmonary metastases occur in approximately 40% of patients with osteosarcoma during the course of their disease, and the lung is the only site of metastatic disease in the majority of these cases. Chemotherapy continues to be the standard treatment for metastatic sarcoma, but when it is the only treatment modality, it still results in poor survival rates. In order to improve the outcome, a combination of chemotherapy followed by surgical resection of the metastases has been advocated for selected cases. Substantial evidence documents the potential benefit of pulmonary metastasectomy in osteosarcoma, resulting, in various series, in a 5-year overall survival of 30-40%. Aggressive surgery in combination with chemotherapy appears to be justified for metastatic osteosarcoma in selected patients, and it is associated with acceptable morbidity. Synchronous metastases, a short interval from diagnosis to presentation of pulmonary metastasis, a higher number (>4) of metastases, bilateral and central location, pleural infiltration, poor response to preoperative chemotherapy and concurrent (resectable) extra-pulmonary disease have all been associated with a less favorable outcome. Complete surgical resection is essential for giving a chance of long-term survival. Lateral thoracotomy with salvage of as much lung parenchyma as possible is the procedure of choice. Repeat surgery for re-recurrences is feasible and beneficial, resulting in prolonged survival in a number of cases.

Clinicians struggle with limited efficacy and durability of standard treatments when treating patients with Dupuytren disease diathesis. Alternative treatments such as low-dose radiation therapy in early phase of disease, supplemental pharmacotherapy with anti-inflammatory and/or anti-mitotic drugs, as well as other pharmacologic targets, and more aggressive surgery such as dermofasciectomy all have been reported with variable success or with serious side effects that hamper their standard use. This article gives an overview of the available literature.

Background Glioblastoma has in last 20 years seen the steady increase of incidence, which is most prominent in the group of older patients. These older than 70 years have significantly poorer prognosis than other patients and are considered a distinct group of glioblastoma patients. Modified prognostic factors are being used in these patients and this information is lately supplemented with the genetic and epigenetic information on tumour. The therapy is now often tailored accordingly. The aim of our study was to analyse the current treatment of the glioblastoma patients over 70 years of age to determine the impact of clinical prognostic factors. Patients and methods Among patients treated at the Institute of Oncology Ljubljana between 1997 and 2015, we found that 207 were older than 70 years. We analysed their survival, clinical prognostic factors (age, performance status) treatment modalities (extent of surgery, radiation dose, chemotherapy). Results Median survival of patients older than 70 years was 5.3 months which was statistically significant inferior to the survival of younger patients (p < 0.001). The clinical prognostic factors that influenced survival the most were performance status (p < 0.001), extent of surgical resection (p < 0.001), addition of temozolomide (p < 0.001) and addition of radiotherapy (p = 0.006). Patients receiving concomitant radiochemotherapy with temozolomide followed by adjuvant temozolomide, had same median survival as patients receiving adjuvant temozolomide after completion of radiotherapy. Conclusions The increase of the number of older patients with glioblastoma corresponds to the increase in the life expectancy but in Slovenia also to the increased availability of diagnostic procedures. Clinical prognostic markers are helpful in decision on the aggressiveness of treatment. Radiotherapy and temozolomide have the biggest impact on survival, but the radiotherapy dose seems to be of secondary importance. In selected patients, chemotherapy alone might be sufficient to achieve an optimal effect. Patients that were fitter, had more aggressive surgery, and received temozolomide fared the best. The scheduling of the temozolomide seems to have limited impact on survival as in our study, there was no difference weather patients received temozolomide concomitant with radiotherapy or after the radiotherapy. Thus far, our findings corroborate the usefulness of recursive partitioning analysis (RPA) classes in clinical decisions.

There are several low-grade pancreatic tumors whose biology permits the use of aggressive surgery to achieve a curative resection. Tumors that are deemed unresectable by conventional techniques due to mesenteric vessel involvement may benefit from ex vivo tumor resection and autotransplantation to allow complete resection while minimizing ischemic organ injury. Despite the excellent oncologic outcomes when used for these neoplasms, the procedure carries substantial morbidity and a high complication rate. But for patients who were otherwise offered total enterectomy and allotransplantation or told that their tumor was unresectable, ex vivo resection may offer them a hope for cure.

BACKGROUND: International best-practice guidelines recommend completion thyroidectomy and radioiodine remnant ablation (RRA) for patients with differentiated thyroid cancer (DTC) > 4 cm or with specific risk factors. Patients with DTC < 1 cm without risk factors are recommended for lobectomy alone. Indications for aggressive surgery and RRA are less clearly defined for tumours measuring 1–4 cm. A personalised approach to decision-making is recommended. OBJECTIVES: This study assesses therapeutic approaches to DTC as compared to the current British Thyroid Association (BTA) clinical practice guidelines. We ascertained the effect of equivocal guidance in the 1–4 cm tumour cohort on contemporary practice patterns. METHODS: Data were obtained from a prospectively maintained thyroid cancer database of patients treated for DTC in a tertiary referral centre at the University Hospital Galway. Consecutive patients attending a dedicated thyroid cancer clinic between August 2014 and August 2017 were included. Clinicopathological characteristics and management strategies were assessed. RESULTS: Ninety-four percent (n = 168/178) of patients were surgically managed in adherence with guidelines. A minority (n = 10) received surgery not aligned with guidelines. Ninety-seven percent (n = 172/178) of RRA treatment decisions were in accordance with guidelines. The BTA guidelines recommended a personalised decision-making approach for 18.0% (n = 32) and 44.9% (n = 80) of surgery and RRA treatment decisions, respectively. The more aggressive, treatment-driven approach was typically favoured by the multidisciplinary team, with 97% (n = 31/32) undergoing completion thyroidectomy and 100% (n = 80) proceeding to RRA. CONCLUSIONS: Management of DTC at our institution closely adheres to contemporary clinical practice guidelines. The finding of more aggressive management in those requiring a personalised decision-making approach highlights the requirement for improved risk stratification in this cohort to ratio­nalise management strategies.

Highlights • In case of cholangiocarcinoma invading hilar vessels, adequate simulations and expert skills are required to achieve R0 resection., Introduction The present case report demonstrated the successfully radical operation (R0) for the highly advanced cholangiocarcinoma involving hilar hepatic arteries and portal vein, The careful preoperative diagnosis to define the adequate resection area and the expert operation was achieved without postoperative severe complications. Presentation of case A 55-year-old male was admitted to our hospital with obstructive jaundice, and the perihilar cholangiocarcinoma (PC) was found. At the time of finding PC, enhanced computed tomography showed the widely extension and involved the surrounding right hepatic artery (RHA) and bilateral portal veins (PV). According to extension of PC, left trisectionectomy combined resection of RHA and PV trunk was scheduled. By supporting plastic surgeon’s procedure, the scheduled R0 operation could be achieved and the patient was discharged without any severe complication but delayed intrahepatic abscess formation. After abscess drainage, he could immediately recovered and tumor relapse was not observed for a couple of months. By carefully preoperative examination, a complicated operation was successfully completed. Discussion The major hepatectomy with arterio-portal resections and anastomosis for advanced has been challenged at the high-volume center and the improvement of survival seemed to be obtained and, however, operative risk is still remained. This operation could be achieved by the expert surgeons under precise planning or management. Conclusion The role of HBP surgeons is to challenge aggressive surgery even for patients with highly advanced local extension of PC.

Despite aggressive surgery, radiotherapy, and chemotherapy, malignant gliomas remain uniformly fatal. To progress, these tumors stimulate the formation of new blood vessels through processes driven primarily by angiogenesis factors. However, the resulting vessels are structurally and functionally abnormal and contribute to a hostile microenvironment that is highly selective for a more malignant phenotype with increased morbidity and mortality. Emerging preclinical and clinical data indicate that antiangiogenesis therapies are potentially effective regarding glioblastoma, and can transiently normalize tumor vessels. This creates a window of opportunity for optimally combining chemotherapeutics and radiation.

Intrahepatic cholangiocarcinoma (iCCA) accounts for approximately 10% of all primary liver cancers. Surgery is the only potentially curative treatment, even in cases of macrovascular invasion. Since resection offers the only curative chance, even extended liver resection combined with complex vascular or biliary reconstruction of the surrounding organs seems justified to achieve complete tumour removal. In selected cases, the major vascular resection is the only change to try getting the cure. The best results are achieved by the referral centre with a wide experience in complex liver surgery, such as ALPPS procedure, IVC resection, and ante-situ and ex-situ resections. However, despite aggressive surgery, tumour recurrence occurs frequently and long-term oncological results are very poor. This suggests that significant progress in prognosis cannot be expected by surgery alone. Instead, multimodal treatment including neoadjuvant chemotherapy, radiotherapy, and subsequent adjuvant treatment for iCCA seem to be necessary to improve results.

Background Osteoblastomas are a type of primary osseous neoplasm that exhibit a proclivity for the spine, primarily the posterior elements. While generally considered benign, some variants of osteoblastoma exhibit aggressive growth with lytic osseous destruction and soft tissue invasion, with some recurring after initial treatment. Given their proximity to vital structures and potential for rapid growth, these tumors are often managed with aggressive surgery, with en-bloc resection preferred. Methods Here we describe our osteotomy technique for resecting en bloc a posterolateral thoracic osteoblastoma causing rapidly progressive myelopathy in a 17-year-old male. Results Successful treatment of osteoblastoma in a 17-year-old male demonstrates the efficacy of our laminopedicular osteotomy technique in treating 1 instance of a rapidly presenting spinal tumor. Conclusions This case bolsters the growing body of literature that favors the outcomes of a more conservative approach to en-bloc resection of spinal tumors.