Jack P. Silva

Overall survival after resection of retroperitoneal sarcoma at academic cancer centers versus community cancer centers: An analysis of the National Cancer Data Base

Background Operative resection remains the definitive curative therapy for retroperitoneal sarcoma. Data published recently show a correlation between improved outcomes for complex oncologic operations and treatment at academic centers. For large retroperitoneal sarcomas, operative resection can be complex and require multidisciplinary care. We hypothesized that survival rates vary between type of treating center for patients undergoing resection for retroperitoneal sarcoma. Methods Patients with stage I to III nonmetastatic retroperitoneal sarcomas who underwent operative resection were identified from the National Cancer Database during the years 2004–2013. Treating centers were categorized as academic cancer centers or community cancer centers. Overall survival was analyzed by log‐rank test and graphed using Kaplan‐Meier method. Results A total of 2,762 patients were identified. A majority of patients (59.4%, n = 1,642) underwent resection at an academic cancer centers. Median age at diagnosis was 63 years old. Neoadjuvant radiotherapy was more common at academic cancer centers, while adjuvant radiotherapy was more common at community cancer centers. Improved overall survival was seen at academic cancer centers across all stages compared with community cancer centers (P = .014) but, after multivariable Cox regression analysis, was not a significant independent predictor of survival (hazard ratio = 0.91, 95% confidence interval, 0.79–1.04, P = .171). Academic cancer centers exhibited a greater rate of R0 resection (55.9% vs 47.0%, P < .001) and a lesser odds of positive margins (odds ratio 0.83, 95% confidence interval, 0.69–0.99, P = .044) after multivariable logistic regression. Conclusion Resection for retroperitoneal sarcoma performed at academic cancer centers was an independent predictor of margin‐negative resection but was not a statistically significant factor for survival. This observation suggests that site of care may contribute to some aspect of improved oncologic resection for retroperitoneal sarcoma.

The prognostic utility of baseline alpha‐fetoprotein for hepatocellular carcinoma patients

Alpha‐fetoprotein (AFP) has a valuable role in postoperative surveillance for hepatocellular carcinoma (HCC) recurrence. The utility of pretreatment or baseline AFP remains controversial. The present study hypothesized that elevated baseline AFP levels are associated with worse overall survival in HCC patients.

The effect of prior upper abdominal surgery on outcomes after liver transplantation for hepatocellular carcinoma: An analysis of the database of the organ procurement transplant network

Objectives: Orthotopic liver transplantation (OLT) is the preferred treatment for hepatocellular carcinoma (HCC) in select patients. Many patients listed for OLT have a history of prior upper abdominal surgery (UAS). Repeat abdominal surgery increases operative complexity and may cause a greater incidence of complication. This study sought to compare outcomes after liver transplantation for patients with and without prior UAS. Methods: Adult HCC patients undergoing OLT were identified using the database from the Organ Procurement and Transplantation Network (1987–2015). Patients were separated by presence of prior UAS into 2 propensity‐matched cohorts. Overall survival (OS) and graft survival (GS) were analyzed by log‐rank test and graphed using Kaplan‐Meier method. Recipient and donor demographic and clinical characteristics were also studied using Cox regression models. Results: A total of 15,043 patients were identified, of whom 6,205 had prior UAS (41.2%). After 1:1 propensity score matching, cohorts (UAS versus no UAS) contained 4,669 patients. UAS patients experienced shorter GS (122 months vs 129 months; P < .001) and shorter OS (130 months vs 141 months; P < .001). Median duration of stay for both cohorts was 8 days. Multivariate Cox regression models revealed that prior UAS was associated with an increased hazard ratio (HR) for GS (HR 1.14; 95% confidence interval (CI) 1.06–1.22; P < .001) and OS (HR 1.14; 95% CI 1.06–1.23; P < .001). Conclusion: Prior UAS is an independent negative predictor of GS and OS after OLT for HCC. OLT performed in patients with UAS remains a well‐tolerated and effective treatment for select HCC patients but may alter expected outcomes and influence follow‐up protocols.

Regional Therapies for Hepatic Adenoma

Hepatic adenomas (HAs) are a rare and benign disease primarily affecting a young and otherwise healthy patient population, but the risk of hemorrhage and malignant transformation makes identification and treatment crucial. HAs may present with abdominal pain, but are most often discovered incidentally. Accurate diagnosis of HA is important to properly risk stratify patients. Cross-sectional imaging can often diagnose HA and distinguish it from FNH without the need for core needle biopsy. The most important characteristics guiding treatment of HA are the tumor size, anatomic location, and the patient’s gender. Any patient presenting with an HA-associated hemorrhage or rupture should be treated emergently with hepatic artery embolization to stabilize the patient, and resection should be strongly considered.

Ablation approach for primary liver tumors: Peri-operative outcomes

Ablation is a common treatment modality for malignant primary liver tumors(PLTs), outcomes following laparoscopic (LA) versus open ablation (OA) are ill‐defined. This project compares peri‐procedural outcomes of LA versus OA for PLTs.