H.N. Vu

Effects of surgical excision on survival of patients with stage IV breast cancer.

BACKGROUND Non-palliative resection of the primary tumor in stage IV breast cancer is controversial. Our aim was to determine whether surgery improves survival in stage IV patients. METHODS We reviewed records of all stage IV breast cancer patients (1990-2000) at our institution. Data collection included demographics, metastasis sites, treatment, and survival. Survival was compared between metastasis type, hormonal therapy versus no hormonal therapy, chemotherapy versus no chemotherapy, radiation versus no radiation, and surgery versus no surgery. To ascertain local therapy effects while accounting for chemotherapy, we analyzed survival among chemotherapy alone versus chemotherapy with radiation versus chemotherapy with surgery. We also performed multivariate analysis by multiple linear regression. RESULTS Of 157 patients, 58 (37%) had bone-only metastases, 99 (63%) had visceral metastases. Both groups had a 17-mo median survival. Eighty (51%) received hormonal therapy while 77 (49%) did not. Both groups had a 15-mo median survival. Eighty-four (54%) received chemotherapy with a 25-mo median survival versus 8 mo for 73 (46%) not receiving chemotherapy, Wilcoxon (P < 0.0001), and log-rank (P = 0.02). Fifty-eight (37%) received radiation and 99 (63%) did not, with both groups having a 17-mo median survival. Fifty-two (33%) with surgery to the breast primary had a 25-mo median survival, while 105 (67%) without surgery had a 13-mo median survival, Wilcoxon (P = 0.004) and log-rank (P = 0.06). Among patients receiving chemotherapy, 37 with chemotherapy alone had a 21-mo median survival versus 40 mo for the 14 with chemotherapy and radiation and 22 mo for the 33 with chemotherapy and surgery. These differences were not significant by Wilcoxon (P = 0.41) or log-rank (P = 0.36). Multivariate analysis determined chemotherapy as the only factor associated with improved survival (P = 0.02). CONCLUSION Our data, when standardized for chemotherapy, suggests loco-regional therapy does not improve survival.

Factors Affecting Number of Lymph Nodes Harvested in Colorectal Cancer

BACKGROUND Lymph node involvement is a highly important prognostic factor in colorectal cancer staging. Examination of a minimum of 12 nodes is recommended for accurate staging. The purpose of this study was to identify factors affecting the number of lymph nodes harvested in colorectal cancer specimens. MATERIALS AND METHODS Retrospective review of all patients undergoing colectomy for colorectal cancer at our VA hospital from 2002 to 2007 was done. Statistical analysis was done using univariate as well as multivariate analysis. One hundred eighty-three patients were analyzed. RESULTS Average number of nodes retrieved was 14.9 with 92 (51%) containing fewer than 12 lymph nodes. Median number of nodes was 11. The only two factors found to have an effect on nodes harvested were pathologist P<0.05 and surgeon experience P=0.01. Factors not found to have an impact on number of nodes harvested were age of patient, previous operation, T stage of tumor, type of colectomy, bowel prep, laparoscopic versus open technique, or BMI. Multivariate analysis confirmed pathologist and surgeon experience as independent factors associated with number of nodes retrieved P<0.05. CONCLUSIONS Operating surgeon and examining pathologist were the only factors found to have a significant impact on number of nodes harvested. Meticulous dissection both in and outside of the operating room are indicated.

Intraoperative Injection of Radiocolloid for Sentinel Node Biopsy in Breast Cancer

Preoperative injection of radiocolloid for axillary sentinel node biopsy in breast cancer is uncomfortable for patients. This study evaluated the reliability of radiocolloid injection as determined by sentinel node identification rate and positive sentinel node biopsy rate, after the patient has been anesthetized in the operating room as compared with preoperative injection. Methods: After institutional review board approval, a retrospective cohort of patients with breast cancer who underwent sentinel node biopsy from January 2005 through December 2010 was evaluated for analysis. Patients who received intraoperative injection of radiocolloid were compared with those who received their injection preoperatively. Patients with incomplete pathologic staging or having received neoadjuvant chemotherapy were excluded. All patients received radiocolloid injections into the retroareolar tissue; some also received intradermal injection directly over the tumor. All injections contained 37 MBq (1 mCi) in 0.5 mL of filtered (0.22-μm) 99mTc-sulfur colloid. Results: Over the 6-y study period there were 904 sentinel node biopsy procedures, and 165 patients were excluded from analysis. Of the 739 sentinel node biopsies that were analyzed, 647 had preoperative injection of radiocolloid and 92 had intraoperative injection. The overall sentinel lymph node identification rates were similar for the 2 groups: 93.5% for the preoperative injection group and 94.6% for the intraoperative injection group (not statistically significant). The identification rates remained comparable for both groups when analyzed by T stage of the tumor. The average number of sentinel lymph nodes removed was similar between preoperative and intraoperative injection: 2.60 and 2.70 nodes, respectively. The overall rates of positive sentinel nodes were comparable for the 2 groups: 25.6% for the preoperative injection group and 26.4% for the intraoperative injection group (not statistically significant). When analyzed by T stage, the positive sentinel node rates remained similar between the 2 groups. Conclusion: The sentinel lymph node identification rate of 94.6% for the intraoperative injection group was similar to other published sentinel lymph node identification rates (96%–100%). The positive sentinel lymph node rate was also comparable to that of published series. Intraoperative injection of radiocolloid for axillary sentinel node biopsy appears equivalent to preoperative injection and is a less painful experience for breast cancer patients.