This animal model demonstrates that IRE of the pancreas performed at an optimal voltage is well tolerated, with rapid resolution of pancreatic inflammation and preservation of vascular structures.
The objective of this study was to determine the incidence of multiple primary melanomas (MPM) and other cancers types among patients with melanoma. Factors associated with development of MPM were assessed in a post hoc analysis of the database from a multi-institutional prospective randomized trial of patients with melanoma aged 18 to 70 years with Breslow thickness 1 mm or greater. Disease-free survival (DFS) and overall survival (OS) were evaluated by Kaplan-Meier analysis. Forty-eight (1.9%) of 2506 patients with melanoma developed additional primary melanomas. Median follow-up was 66 months. Except in one patient, the subsequent melanomas were thinner (median, 0.32 mm vs 1.50 mm; P < 0.0001). Compared with patients without MPM, patients with MPM were more likely to be older (median age, 54.5 vs 51.0 years; P = 0.048), to have superficially spreading melanomas (SSM) ( P = 0.025), to have negative sentinel lymph nodes ( P = 0.021), or to lack lymphovascular invasion (LVI) ( P = 0.008) with the initial tumor. On multivariate analysis, age ( P = 0.028), LVI ( P = 0.010), and SSM subtype of the original melanoma ( P = 0.024) were associated with MPM. Patients with MPM and patients with single primary melanoma had similar DFS (5-year DFS 88.7 vs 81.3%, P = 0.380), but patients with MPM had better OS (5-year OS 95.3 vs 80.0%, P = 0.005). Nonmelanoma malignancies occurred in 152 patients (6.1%). Ongoing surveillance of patients with melanoma is important given that a significant number will develop additional melanoma and nonmelanoma tumors. With close follow-up, second primary melanomas are usually detected at an early stage.
Patients undergoing neoadjuvant therapy for esophageal cancer are at a high risk for malnutrition due to the effects of chemoradiation, dysphagia, and malignancy induced cachexia. Preparation for esophagectomy requires careful assessment of nutritional risk and adequate supplementation as indicated. Supplementation via the enteral route is preferred to the parenteral route but requires feeding tube placement. Endoscopically placed silicone stents have also shown promise as a means to alleviate malnutrition and avoid invasive feeding tubes.
Esophageal stenting in the neoadjuvant setting offers improved results compared with feeding tubes both in maintaining preoperative nutrition and in tolerance of neoadjuvant chemoradiotherapy. Future protocols of patients treated with multimodal therapy for cancer of the esophagus should investigate the potential therapeutic benefit of using removable silicone esophageal stents as an alternative to feeding tubes.
Intraoperative autotransfusion can be used safely and effectively for major oncologic procedures. Furthermore, degree of discharge anemia is associated with lower quality of life in patients undergoing oncologic gastrointestinal surgery.
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