Ryan C. Fields

Recurrence after complete resection and selective use of adjuvant therapy for stage I through III Merkel cell carcinoma.

Merkel cell carcinoma (MCC) is a rare cutaneous neuroendocrine neoplasm whose natural history is poorly understood. Here, the authors describe their experience with a large cohort of patients who were treated at a single institution to describe patterns of recurrence after curative therapy.

Up and down or side to side? A systematic review and meta-analysis examining the impact of incision on outcomes after abdominal surgery

BACKGROUND The aim of this study was to examine whether midline, paramedian, or transverse incisions offer potential advantages for abdominal surgery. DATA SOURCES We searched MEDLINE, Embase, Web of Science, and The Cochrane Central Register of Controlled Trials from 1966 to 2009 for randomized controlled trials comparing incision choice. METHODS We systematically assessed trials for eligibility and validity and extracted data in duplicate. We pooled data using a random-effects model. RESULTS Twenty-four studies were included. Transverse incisions required less narcotics than midline incisions (weighted mean difference = 23.4 mg morphine; 95% confidence interval [CI], 6.9 to 39.9) and resulted in a smaller change in the forced expiratory volume in 1 second on postoperative day 1 (weighted mean difference = -6.94%; 95% CI, -10.74 to -3.13). Midline incisions resulted in higher hernia rates compared with both transverse incisions (relative risk = 1.77; 95% CI, 1.09 to 2.87) and paramedian incisions (relative risk = 3.41; 95% CI, 1.02 to 11.45). CONCLUSIONS Both transverse and paramedian incisions are associated with a lower hernia rate than midline incisions and should be considered when exposure is equivalent.

Comparison of 18F-FDG PET/CT and 111In pentetreotide scan for detection of Merkel cell carcinoma.

Background Merkel cell carcinoma (MCC) is a rare cutaneous neuroendocrine neoplasm with propensity for nodal metastases. A few reports have presented imaging results with FDG PET/CT or 111In- pentetreotide (OctreoScan, OCT) indicating a higher sensitivity for FDG than OCT, but no reports have directly compared FDG to OCT in the same patients. We reviewed our experience in a limited number of patients who underwent both procedures. Methods Patients with MCC who had FDG PET and OCT between 2000 and 2010 in our center were retrospectively reviewed. Patients were included if they had FDG PET/CT and OCT scan within a 2-month interval. For each eligible patient, we compared all abnormal lesions identified on either scan. The findings were verified by pathology or other imaging techniques up to a 4-month follow-up. Results A total of 9 patients met the selection criteria with 10 dual scans (1 was scanned twice). Three patients had no documented sites of disease at the time of imaging. One patient had negative findings on both FDG and OCT initially, but 1 year later developed FDG-positive OCT-negative disease. Five patients had metastatic disease at the time of imaging: 2 were negative on OCT and positive on FDG; the other 3 were positive on both scans but had more lesions on FDG. Conclusions Our data on a small number of patients are in agreement with prior individual FDG or OCT reports and suggest that, overall, FDG PET/CT detects more MCC lesions and upgrades MCC stage compared with the OCT scan. Importantly, there were no lesions identified by OCT that were missed by PET. Thus, given the added resolution and sensitivity of PET, the use of OCT in MCC in the modern era is of limited value and it remains to be seen whether newer 68Ga-labeled somatostatin analogs will perform better than OCT.

Selective radiotherapy for the treatment of head and neck Merkel cell carcinoma.

The role of radiotherapy (RT) in the management of Merkel cell carcinoma (MCC) is controversial. The authors of this report evaluated the rates and patterns of failure in a selected group of patients who underwent RT for MCC of the head and neck (HN).