Excisional surgery for cancer cure: therapy at a cost

Coffey, J. Calvin; Wang, J H; Smith, Myles; Bouchier‐Hayes, David; Cotter, Thomas G.; Redmond, H. P.

doi:10.1016/s1470-2045(03)01282-8

Cited by 317 publications

(249 citation statements)

References 63 publications

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“…Activated macrophages, fibroblasts, smooth muscle cells and keratinocytes release them along with other inflammatory cytokines. In the experimental setting, TNFa acts as a tumourigenic agent and tumour promoter (Coffey et al, 2003). Various other mechanisms explain how other factors like VEGF, PDGF and interleukins influence tumour growth (Dvorak, 1986;Dvorak et al, 1995;Abramovich et al, 1999;Balkwill and Mantovani, 2001;Coussens and Werb, 2002;Chang et al, 2005).…”

Section: Discussionmentioning

confidence: 99%

Postoperative wound complications and systemic recurrence in breast cancer

et al. 2007

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Many factors involved in wound healing can stimulate tumour growth in the experimental setting. This study examined the relationship between wound complications and the development of systemic recurrence after treatment of primary breast cancer. One thousand and sixty-five patients diagnosed with operable primary invasive breast cancer between 1994 and 2001 were assessed for development of systemic recurrence according to whether or not a wound complication occurred after surgery, with a median follow-up of 54 months (range 15-119). There were 93 wound complications (9%). There was a statistically significant greater risk of developing systemic recurrence in patients with wound problems than those without (hazard ratio (HR) 2.87; 95% CI: 1.97, 4.18; Po0.0001). This remained in a multivariate analysis after adjustment for case mix variables, including Nottingham Prognostic Index (NPI) and oestrogenprogesterone receptor status (HR: 2.52; 95% CI: 1.69, 3.77; Po0.0001). In the good prognostic NPI group, 4 out of 27 patients (15%) with wound problems vs 11 out of 334 (3%) without wound problems developed systemic recurrence. The corresponding figures were 10 out of 35 (29%) vs 48 out of 412 (12 %) in the moderate prognostic group and 18 out of 29 (62%) vs 75 out of 199 (38%) in the poor prognostic group. In 29 patients NPI could not be calculated. Smokers at the time of diagnosis were more likely to develop metastatic disease than the non-smokers (HR: 1.50; 95% CI: 1.04, 2.15; P ¼ 0.03) after adjustment for other factors. The results suggest that patients with wound complications at primary surgery have increased rates of systemic recurrence of breast cancer.

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Section: Discussionmentioning

confidence: 99%

Postoperative wound complications and systemic recurrence in breast cancer

et al. 2007

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“…The perioperative period has long been recognized as a vulnerable time frame during which tumour progression and metastasis is often accelerated (Coffey et al, 2003). Indeed, some small and retrospective trials have demonstrated improved patient survival and disease-free intervals when regional anaesthesia was used for cancer surgery (Schlagenhauff et al, 2000;Exadaktylos et al, 2006).…”

Section: Perioperative Epigenetics and Tumour Recurrencementioning

confidence: 99%

Epigenetics in the perioperative period

Lirk

Fiegl

Weber

et al. 2015

British J Pharmacology

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The perioperative period is characterized by profound changes in the body's homoeostatic processes. This review seeks to address whether epigenetic mechanisms may influence an individual's reaction to surgery and anaesthesia. Evidence from animal and human studies suggests that epigenetic mechanisms can explain many facets of susceptibility to acute and chronic pain, making them potential therapeutic targets. Modern pain management is still based upon opiates, and both the developmental expression of opioid receptors and opioid-induced hyperalgesia have been linked to epigenetic mechanisms. In general, opiates seem to increase global DNA methylation levels. This is in contrast to local anaesthetics, which have been ascribed a global demethylating effect. Even though no direct investigations have been carried out, the potential influence of epigenetics on the inflammatory response that follows surgery seems a promising area for research. There is a considerable body of evidence that supports the involvement of epigenetics in the complex process of wound healing. Epigenetics is an important emerging research topic in perioperative medicine, with a huge potential to positively influence patient outcome. LINKED ARTICLESThis article is part of a themed section on Epigenetics and Therapy. To view the other articles in this section visit http://dx

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“…Surgical intervention has been suspected to promote cancer growth since ancient times but has received little attention from clinicians 17. Upfront primary tumor resection significantly increases the risk of progression for synchronous colorectal liver metastases as confirmed in a multivariate analysis 18, 19.…”

Section: Discussionmentioning

confidence: 93%

Phase II study on early start of chemotherapy after excising primary colorectal cancer with distant metastases (Pearl Star 02)

Yoshida

Aisu

Kojima

et al. 2017

Annals of Gastroent Surgery

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Initiating chemotherapy usually requires a delay of more than 4 weeks after surgically resecting colorectal cancer. However, there is little evidence regarding the required delay interval. We have previously reported a pilot study to determine the safety and feasibility of early initiation of chemotherapy after resecting primary colorectal cancer with distant metastases. We aimed to determine the safety and efficacy of early initiation of chemotherapy after resecting colorectal cancer with distant metastases.This phase II study (trial number UMIN000006310) was a prospective, single‐arm trial. A total of 20 patients (men, 15 and women, 5) were enrolled. They underwent XELOX therapy (130 mg/m2 oxaliplatin on day 1+1000 mg/m2 capecitabine twice daily on days 1‐4) on postoperative day 7 and XELOX+bevacizumab (7.5 mg/kg bevacizumab on day 1) after the second chemotherapy cycle.Baseline characteristics included a median age of 64 (range, 43‐72) years. Surgical procedures included right hemicolectomy in six patients, sigmoidectomy in three, anterior resection in five, and Hartmann procedure in six. All patients started chemotherapy on postoperative day 7. Median progression‐free survival was 14.9 months; overall response rate was 80%. Disease control rate was 100%. Grade 3 or higher hemotoxicity and grade 3 or higher non‐hematological toxicity was noted in 5.0% and 25.0% of patients, respectively. Postoperative complications were observed in two patients (superficial incisional surgical site infection and ileus).Early initiation of chemotherapy after surgery is feasible. These findings suggest future changes of the start time of chemotherapy after surgery.

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Excisional surgery for cancer cure: therapy at a cost

Cited by 317 publications

References 63 publications

Postoperative wound complications and systemic recurrence in breast cancer

Postoperative wound complications and systemic recurrence in breast cancer

Epigenetics in the perioperative period

Phase II study on early start of chemotherapy after excising primary colorectal cancer with distant metastases (Pearl Star 02)

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