Danny Yakoub

Metastatic gastric cancer (MGC) patients: Can we improve survival by metastasectomy? A systematic review and meta-analysis

Prognosis with current management strategies continues to be dismal in metastatic gastric cancer (MGC) patients. We aimed to evaluate the role of metastasectomy in improving survival.

Minimally invasive spleen-preserving distal pancreatectomy: Does splenic vessel preservation have better postoperative outcomes? A systematic review and meta-analysis

BACKGROUND Minimally invasive spleen-preserving distal pancreatectomy (SPDP) can be performed with either splenic vessel preservation (SVP) or resection [Warshaw procedure (WP)]. The aim of this study was to evaluate the postoperative clinical outcomes of patients undergoing both methods. DATA SOURCES Database search of PubMed, Embase, Scopus, Cochrane, and Google Scholar was performed (2000-2014); key bibliographies were reviewed. Qualified studies comparing patients undergoing SPDP with either SVP or WP, and assessing postoperative complications were included. Calculated pooled risk ratio (RR) with the corresponding 95% confidence interval (CI) by random effects methods were used in the meta-analyses. RESULTS The search yielded 215 studies, of which only 14 observational studies met our selection criteria. The studies included 943 patients in total; 652 (69%) underwent SVP and 291 (31%) underwent WP. Overall, there was a lower incidence of splenic infarction (RR=0.17; 95% CI: 0.09-0.33; P<0.001), gastric varices (RR=0.16; 95% CI: 0.05-0.51; P=0.002), and intra/postoperative splenectomy (RR=0.20; 95% CI: 0.08-0.49; P<0.001) in the SVP group. There was no difference in incidence of pancreatic fistula (WP vs SVP, 23.6% vs 22.9%; P=0.37), length of hospital stay, operative time or blood loss. There was moderate cross-study heterogeneity. CONCLUSIONS SVP is a safe, efficient and feasible technique that may be used to preserve the spleen. WP may be more suitable for large tumors close to the splenic hilum or those associated with splenomegaly. Randomized clinical trials are justified to examine the long-term benefits of SVP-SPDP.

Malignant granular cell tumor of the back: A case report and review of the literature

Malignant granular cell tumors are rare, intensely aggressive entities. This paper presents a case of a large rapidly recurrent malignant granular cell tumor with regional and distal metastases on the back of a 54-year-old Cuban man. The primary tumor recurred within six months of the original wide local excision and with satellite lesions apparent at twelve months, and the mass was diagnosed using the histological criteria established by Fanburg-Smith et al. for malignant granular cell tumors. By fifteen months, right axillary lymphadenopathy, multiple satellite lesions, pulmonary nodules, and distant metastasis in the right thigh were present. At sixteen months, wide local excision of recurrent mass and local satellite masses along with right axillary dissection and placement of Integra with subsequent split-thickness skin graft were performed by surgical oncology and plastic surgery teams. The surgical specimen measured 32.0 × 13.5 × 5.5 cm, containing multiple homogeneous masses with the largest mass 22.0 × 9.0 × 4.6 cm. Following surgery, patient was started on Pazopanib 800 mg/day based on phase III randomized trial data in the treatment of soft tissue sarcomas showing this as a potential novel therapy for malignant granular cell tumors.

Delayed gastric emptying after pylorus preserving pancreaticoduodenectomy--does gastrointestinal reconstruction technique matter?

BACKGROUND The best gastrointestinal reconstruction route after pylorus preserving pancreaticoduodenectomy remains debatable. We aimed to evaluate the incidence of delayed gastric emptying (DGE) after antecolic (AC) and retrocolic (RC) duodenojejunostomy in these patients. DATA SOURCES Studies comparing AC to RC reconstruction after pylorus preserving pancreaticoduodenectomy were identified from literature databases (PubMed, MEDLINE, EMBASE, SCOPUS, and Cochrane). The meta-analysis included 10 studies with a total of 1,067 patients, where 504 patients underwent AC and 563 patients underwent RC reconstruction. The incidence of DGE was significantly lower with AC reconstruction in both randomized controlled trials (risk ratio = .44, confidence interval = .24 to.77, P = .005) and retrospective studies (risk ratio .21, confidence interval .14 to .30, P < .001) with less output and days of nasogastric tube use. AC reconstruction was associated with a decreased length of stay. There was no difference in operative time, blood loss, pancreatic fistula, and abdominal abscess/collections. CONCLUSIONS AC reconstruction seems to be associated with less DGE, with no association with pancreatic fistula or abscess formation.

Factors associated with contralateral preventive mastectomy

Introduction Contralateral prophylactic mastectomy (CPM) is an option for women who wish to reduce their risk of breast cancer or its local recurrence. There is limited data on demographic differences among patients who choose to undergo this procedure. Methods The population-based Florida cancer registry, Florida’s Agency for Health Care Administration data, and US census data were linked and queried for patients diagnosed with invasive breast cancer from 1996 to 2009. The main outcome variable was the rate of CPM. Primary predictors were race, ethnicity, socioeconomic status (SES), marital status and insurance status. Results Our population was 91.1% White and 7.5% Black; 89.1% non-Hispanic and 10.9% Hispanic. Out of 21,608 patients with a single unilateral invasive breast cancer lesion, 837 (3.9%) underwent CPM. Significantly more White than Black (3.9% vs 2.8%; P<0.001) and more Hispanic than non-Hispanic (4.5% vs 3.8%; P=0.0909) underwent CPM. Those in the highest SES category had higher rates of CPM compared to the lowest SES category (5.3% vs 2.9%; P<0.001). In multivariate analyses, Blacks compared to Whites (OR =0.59, 95% CI =0.42–0.83, P=0.002) and uninsured patients compared to privately insured (OR =0.60, 95% CI =0.36–0.98, P=0.043) had significantly less CPM. Conclusion CPM rates were significantly different among patients of different race, socio-economic class, and insurance coverage. This observation is not accounted for by population distribution, incidence or disease stage. More in-depth study of the causes of these disparities in health care choice and delivery is critically needed.

Extracorporeal membrane oxygenation for repair of tracheal injury during transhiatal esophagectomy

Extracorporeal Membrane Oxygenation (ECMO) for repair of tracheal injury during transhiatal esophagectomy Tracheal injury is a rare but potentially fatal complication of esophagectomies requiring prompt recognition and treatment. We describe a case of tracheal injury recognized in the operative period of an open transhiatal esophagectomy for squamous cell carcinoma of the mid to distal esophagus. When injury was discovered, attempts to improve oxygenation and ventilation by conventional methods were unsuccessful. Therefore, peripheral ECMO was used to support oxygenation during the tracheal defect repair. The use of ECMO for the repair of a tracheal injury during esophagectomy is very uncommon but, in our case, provided adequate oxygenation and ventilation while the surgeon repaired the injury and the patient was able to be promptly weaned from ECMO support and extubated not long after.

Tracheobronchial injury in the setting of an esophagectomy for cancer: Postoperative discovery a bad omen

A tracheobronchial injury is an uncommon complication of an esophagectomy. Differences in outcomes may exist for patients with injuries detected intraoperatively and postoperatively.

Distal pancreatectomy for benign and low grade malignant tumors: Short-term postoperative outcomes of spleen preservation—A systematic review and update meta-analysis

The value of spleen preservation with distal pancreatectomy (DP) for benign and low grade malignant tumors remains unclear. The aim of this study was to evaluate the short‐term postoperative clinical outcomes in patients undergoing DP with splenectomy (DPS) or spleen preservation (SPDP).

Successful Treatment of Primary Cutaneous Mucormycosis Complicating Anti-TNF Therapy with a Combination of Surgical Debridement and Oral Posaconazole.

Lipid formulations of amphotericin B remain the first-line antifungal therapy for invasive mucormycosis. Posaconazole is an alternative for salvage therapy, but its use as primary therapy is not recommended due to the paucity of clinical data. Here we describe the case of a 57-year-old diabetic woman receiving etanercept and prednisone for the treatment of psoriatic arthritis who developed primary cutaneous mucormycosis after a minor gardening injury. Infection was successfully treated with aggressive surgical debridement followed by a 6-week course of the new delayed-release tablet formulation of posaconazole and temporary withholding of anti-TNF treatment. Primary antifungal therapy with posaconazole can be considered in selected cases of cutaneous mucormycosis.

Abstract 1840: Metabolomic profiling of gastrointestinal stromal tumor (GIST) T1 cell lines in response to imatinib therapy

Background: There is a growing need for novel drugs to treat drug resistant GIST. The aim of this study was to evaluate chronological metabolic changes in GIST cells treated with imatinib mesylate. Methods: Human GIST T1 cells were incubated with imatinib 0.5 mM. Metabolomic profiling was performed in extracted cell pellets at 12, 24 and 48 hours, after viability and cell counting was done, and compared with controls via acquisition of 1 H-NMR spectra using a 500MHz spectrometer equipped with a 5mm TCI 500S2 H-C/N-D-05 Z cryoprobe head at 298 K. Standard, one-dimensional NOESYpr1D pre-saturation pulse program was used. Spectra were further processed in an NMR suite processor; Partial Least Squares Discriminant Analysis (PLS-DA) model was used for characterization of chronological biochemical differences. Results: By 48 hours of exposure of cells to imatinib, glucose initially increased then significantly decreased with gradual decrease of lactate production and minimal changes in pyruvate and succinate denoting shifting from cytosolic to mitochondrial glycolysis, this was echoed with consumption of glutamine and glutamate. Glutathione and cell membrane phospholipids as phosphocholine gradually decreased by a factor of 1.6 for each, suggesting inhibited growth and invasiveness. Aspartate, myo-inositol, glycerophosphocholine and taurine gradually increased by a factor of 1.6, 1.7, 2.6 and 1.3, respectively. Tyrosine, valine and leucine showed minimal changes. Cell viability was directly correlated to changes in choline, creatine phosphate, myo-inositol and taurine (Pearson9s R >0.65). PLS-DA model suggested that changes in myoinositol, glycerophosphocholine, glutamate, aspartate, phosphcholine and glutathione were the metabolites mostly influencing the differential chronological global metabolic profiles of the cells with continued exposure to imatinib (R 2 X = 0.76, R 2 Y = 0.60, Q 2 (cum) = 0.20). Conclusion: Metabolomic profiling of GIST cells exposed to signal transduction modulators supplements molecular findings and provides further mechanistic insights into longitudinal changes of the mitochondrial and glycolytic pathways of oncogenesis, it can potentially provide novel as well as complementary therapeutic targets. Citation Format: Vered Marks, Gregory Tiesi, Ana Paz Mejia, Jonathan Trent, Jamie Walls, Alan Livingstone, Danny Yakoub. Metabolomic profiling of gastrointestinal stromal tumor (GIST) T1 cell lines in response to imatinib therapy. [abstract]. In: Proceedings of the 106th Annual Meeting of the American Association for Cancer Research; 2015 Apr 18-22; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Res 2015;75(15 Suppl):Abstract nr 1840. doi:10.1158/1538-7445.AM2015-1840