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Dr Harsh Shah - GI & HPB Oncosurgeon in Ahmeadbad
Dr Harsh Shah - GI & HPB Oncosurgeon in Ahmeadbad

Dr Harsh Shah

Predictive Factors for Better Outcomes in Peritoneal Metastasis of Gastric Cancer

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A new study has identified significant predictive factors for patients with peritoneal metastasis of gastric cancer (PMGC) who underwent aggressive treatment strategies. The study focused on patients who received a combination of cytoreductive surgery (C-CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) after responding to induction chemotherapy.

Key findings include:

Patients with a Ki-67 index lower than 10 had significantly better recurrence-free and overall survival.
Limited lymph node involvement (LNI < 2) and smaller omental lesion size (< 0.5 cm) were associated with improved outcomes.
The study retrospectively examined 62 patients and found that those with these favorable parameters had a higher likelihood of long-term survival. Cox regression analysis further confirmed that decreased Ki-67 expression and minimal lymph node involvement were independent factors for better prognosis.

These results underscore the importance of thorough preoperative assessment to identify patients who are likely to benefit most from an aggressive multimodal treatment approach. This approach includes initial induction chemotherapy, followed by surgery and HIPEC, and aims to maximize survival outcomes.

For detailed insights, read the full study here.

New Insights in Treating Malignant Peritoneal Mesothelioma

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Malignant peritoneal mesothelioma (MPeM) is a rare and aggressive cancer of the abdominal lining. A recent multi-center study has shed light on the effectiveness of various treatments for this condition. The study divided patients into two groups: those who underwent cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) and those who could not undergo curative surgery.

The CRS-HIPEC group showed significantly better outcomes, with a median overall survival (OS) of 44.6 months compared to 12.6 months for non-surgical treatments. This combination therapy is particularly beneficial for patients who can achieve complete or near-complete tumor resection. Factors such as low completeness of cytoreduction (CC) scores and low peritoneal cancer index (PCI) scores were associated with better survival rates.

For patients who are not surgical candidates, chemotherapy remains the primary treatment option. The platinum-pemetrexed regimen is particularly effective, with patients showing improved progression-free survival (PFS) and OS compared to other treatments.

The study underscores the importance of personalized treatment plans based on the patient’s specific condition and prognosis. It also highlights the role of experienced surgical centers in achieving optimal outcomes. Continuous advancements in surgical techniques and chemotherapy regimens are improving survival rates for MPeM patients.

For detailed information, read the full study here.
https://link.springer.com/article/10.1245/s10434-024-15506-3

Management of T1 Colon Cancer: Insights from Denmark

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In Denmark, the management of T1 colon cancer emphasizes the importance of complete endoscopic resection (R0 resection) with clear horizontal and vertical margins, and no lymphovascular invasion. This approach is designed to ensure that the histopathology can accurately confirm the absence of high-risk features, minimizing the need for additional surgeries. The key focus is on obtaining a sufficient amount of submucosal tissue during the resection for better diagnostic accuracy. These practices help enhance patient outcomes by reducing the likelihood of recurrence and the necessity for further invasive procedures.

URL: https://doi.org/10.1097/SLA.0000000000006355

Enhancing Quality of Life in Hepatocellular Carcinoma: Insights from the HIMALAYA Study

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The Phase III HIMALAYA study provides new insights into the management of unresectable hepatocellular carcinoma (uHCC), highlighting the benefits of the Single Tremelimumab Regular Interval Durvalumab (STRIDE) regimen over sorafenib. This study involved 1,171 patients who were evaluated for patient-reported outcomes (PROs), including global health status, quality of life (QoL), and symptom burden.

The STRIDE regimen significantly extended the time to deterioration in global health status, physical functioning, and various symptoms compared to sorafenib. Patients on STRIDE and Durvalumab also had a higher likelihood of clinically meaningful improvements in QoL, role functioning, and symptom management.

These findings suggest that STRIDE not only improves overall survival but also enhances the quality of life for patients with uHCC, making it a compelling frontline treatment option. General practitioners should consider these benefits when discussing treatment plans with patients, as improving QoL is crucial in managing advanced cancers.

The comprehensive assessment of PROs and high compliance rates in the HIMALAYA study reinforce the robustness of these results, ensuring that the benefits observed are representative of a diverse patient population.

URL: https://doi.org/10.1200/JCO.23.01462

Palliative Surgery Outcomes in Gastroesophageal Junction and Gastric Cancer

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A recent study highlights the positive outcomes of palliative surgery in patients with advanced gastroesophageal junction or gastric cancer. Over 80% of patients undergoing palliative surgery reported significant symptom improvement. Notably, a better performance status was linked to greater improvements, suggesting that the overall health condition of patients plays a crucial role in their response to surgery.

General practitioners should consider the benefits of palliative surgery when managing patients with advanced gastroesophageal junction or gastric cancer, especially for those with relatively good performance status. These findings can help guide discussions about palliative care options and improve patient quality of life by focusing on symptom relief.

For more comprehensive insights, access the full study here: https://doi.org/10.1245/s10434-024-15534-z

Long-Term Outcomes of Minimally Invasive Surgery for Ileal Neuroendocrine Tumors

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A recent study evaluated the long-term survival outcomes of minimally invasive surgery (MIS) compared to open surgery for ileal neuroendocrine tumors (i-NETs). The findings suggest that MIS, using a hand-access port device, offers similar short- and long-term oncological outcomes as open surgery.

In the study, 168 patients were divided into MIS and open surgery groups. The MIS group showed fewer complications and shorter hospital stays. Open surgery was primarily used for cases requiring extensive mesenteric mass resection or concurrent liver surgery. Both surgical approaches provided comparable overall survival rates, with no significant differences after propensity score matching.

These results support the use of MIS as an effective alternative to open surgery for i-NETs, particularly in cases without bulky mesenteric involvement.

URL: https://doi.org/10.1245/s10434-024-15468-6

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Dr Harsh Shah - GI & HPB Oncosurgeon in Ahmeadbad
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