Malignant pleural effusion (MPE) is an exudative effusion with malignant cells. MPE is a common symptom and accompanying manifestation of metastatic disease. It affects up to 15% of all patients with cancer and is the most common in lung, breast cancer, lymphoma, gynecological malignancies and malignant mesothelioma. In the last year, many studies were performed focusing on the pathophysiological mechanisms of MPE. With the advancement in molecular techniques, the importance of tumor-host cell interactions is becoming more apparent. Additionally, the process of pathogenesis is greatly affected by activating mutations of EGFR, KRAS, PIK3CA, BRAF, MET, EML4/ALK and RET, which correlate with an increased incidence of MPE. Considering all these changes, the authors aim to present a literature review of the newest findings, review of the guidelines and pathophysiological novelties in this field. Review of the just recently, after seven years published, practice guidelines, as well as analysis of more than 70 articles from the Pubmed, Medline databases that were almost exclusively published in indexed journals in the last few years, have relevance and contribute to the better understanding of the presented topic. MPE still presents a severe medical condition in patients with advanced malignancy. Recent findings in the field of pathophysiological mechanisms of MPE emphasize the role of molecular factors and mutations in the dynamics of the disease and its prognosis. Treatment guidelines offer a patient-centric approach with the use of new scoring systems, an out of hospital approach and ultrasound. The current guidelines address multiple areas of interest bring novelties in the form of validated prediction tools and can, based on evidence, improve patient outcomes. However, the role of biomarkers in a clinical setting, possible new treatment modalities and certain specific situations still present a challenge for new research.
Background: The aim of the present study was to determine the correlation between obesity, serum levels of leptin and proximal gastric cancer. Methods: Sixty-four gastric cancer patients operated on with curative intent were included in the study. We determined the correlation between the preoperative serum levels of leptin and the tumor`s location. Results: Serum leptin levels were correlated significantly with the proximal third location (p = 0.04), gastric outlet obstructing tumors (p < 0.0001), CRP levels (p = 0.03) and BMI (p < 0.0001). Patients with high serum levels of leptin had significantly more intestinal types of gastric cancer (p = 0.033) and better differentiation compared to patients with low serum leptin levels (p = 0.009). The linear regression model determined the proximal tumor location (beta: 0.467; p = 0.045), BMI (beta: 0.657; p = 0.001), high preoperative serum albumin (beta: 0.563; p = 0.016) and the presence of pyloric stenosis (beta: 0.525; p = 0.006) as related significantly to serum leptin levels. The Cox proportional hazard model identified age (HR: 0.003; 95%CI: 0-0.794; p = 0.041), preoperative serum levels of leptin (HR: 0.125; 95%CI: 0.018-0.887; p = 0.037) and the number of extracted LNs (HR: 0.001; 95%CI: 0-0.677; p = 0.038) as independent prognostic factors. Conclusions: Serum levels of leptin were significantly elevated in patients with proximal gastric cancer, suggesting that the leptin`s effect might be due to its systemic secretion. This might explain the higher incidence of proximal gastric cancer in obese patients. Elevated serum leptin levels were an independent prognostic factor.
Background In the present paper, we intend to present the shot- and long-term results of omentum-preserving laparoscopic gastric cancer resections with D2 lymphadenectomy in 100 consecutive patients with stages 0-IV and perioperative chemotherapy. Methods The study's primary objectives were the perioperative results, the length of postoperative stay, and the 5-year overall and 5-year disease-specific survival. Results The mean age was 69 ± 11 years; the mean BMI was 26 ± 3 kg/m2. The tumors were primarily located in the middle and distal third of the stomach; 12% were actively bleeding or causing obstruction, necessitating an emergency operation. Perioperative chemotherapy was administered in 46% of the patients. Most patients received a total gastrectomy (52%), and 45% received a distal subtotal gastrectomy. The conversion rate was 16%. Perioperative complications occurred in 20%; the perioperative mortality was 1%. The median hospital stay was eight days. The most common UICC stage was Ia, followed by IIIb. Early gastric cancer was present only in 29% of patients. The 5-year overall and disease-specific survivals were 57.5% and 72.6%, respectively. Conclusion The results from this single high-volume center confirm the safety of laparoscopic omentum-preserving gastrectomy with D2 lymphadenectomy in patients with advanced gastric cancer. The referral of gastric cancer patients to dedicated high-volume centers with specialized laparoscopic surgical teams might lead to similar high-quality results presented in Eastern trials.
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