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1
Buess, G., B. Mentges, K. Manncke, M. Starlinger, and H. D. Becker. "Minimal invasive surgery in the local treatment of rectal cancer." International Journal of Colorectal Disease 6, no. 2 (May 1991): 77–81. http://dx.doi.org/10.1007/bf00300195.
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Albers, P., S. Schaefers, H. Löhmer, and P. De Geeter. "Minimal invasive perineal radical prostatectomy." Journal of Clinical Oncology 25, no. 18_suppl (June 20, 2007): 15566. http://dx.doi.org/10.1200/jco.2007.25.18_suppl.15566.
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15566 Background: Radical perineal prostatectomy (RPP) has experienced a reappraisal as excellent surgical treatment option for patients with localized prostate cancer which is competing well with the retropubic (RRP), endoscopic and robotic approaches. Herein we report a new and improved minimal invasive technique of an intrafascial, nerve-sparing and seminal vesical sparing RPP. Methods: From July 2003 to July 2006, 507 radical prostatectomies (317 RPP, 190 RRP) have been performed by 3 surgeons. RPP selection criteria: PSA ≤ 10 ng/ml, Gleason sum ≤ 7, volume ≤ 50 ml. A minimal invasive technique (MI-RPP) was used in 146 of 317 RPP (46%) in order to potentially improve on the results of classical RPP. “Minimal invasive” was defined as an approach with reduced mobilisation of the rectum, intended bilateral nerve-sparing with intrafascial preparation and leaving the seminal vesicals in situ. This approach was compared to classical RPP and to RRP. Perioperative and follow-up data using validated questionnaires were centrally registered using an on-line internet-based prostate cancer data bank provided by the Tumorzentrum Berlin. Results: With a median follow-up of 12 months (0–24), the oncological outcome of patients with MI-RPP was not different to RPP or RRP (comparable T-stages). PSA relapse in MI-RPP, RPP, and RRP in pT2R0 was seen in 10.2%, 14.7%, and 9.7% respectively (n.s.). Continence rates (0–1 pad/d) at 4 weeks were 61.7%, 45.0%, and 43.8%, respectively. This improved at 12 months to 96.3%, 85.7%, and 85.6%, respectively (p < 0,023; p < 0,005). MI-RPP, RPP, and RRP showed pT2 in 70.5, 69.6, and 57.3% with R1pT2 in 1.9, 6.7, and 9.2%, resp. Nerve-sparing was performed in 90.4, 62.0, and 57.4% with median OR times of 90, 141, and 163 min. Catheter removal after more than 13 d was seen in 6.6, 13.6, and 33.3%, resp. Conclusions: MI-RPP represents an improved perineal technique regarding intraoperative and postoperative complications maintaining comparable oncological outcome to RPP and RRP. Leaving seminal vesicals in place did not increase PSA relapse rates. Since OR time is significantly less and early recovery is superior, MI-RPP should be the recommended first-line perineal approach to patients with low risk prostate cancer. At the time of the meeting, data of more than 600 patients will be presented. No significant financial relationships to disclose.
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Ghadyalpatil, Nikhil Suresh, Chopra Supriya, Patil Prachi, Dsouza Ashwin, and Saklani Avanish. "Gastrointestinal cancers in India: Treatment perspective." South Asian Journal of Cancer 05, no. 03 (July 2016): 126–36. http://dx.doi.org/10.4103/2278-330x.187585.
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AbstractGI cancer is not one cancer but is a term for the group of cancers that affect the digestive system including gastric cancer (GC), colorectal cancer (CRC), hepatocellular carcinoma (HCC), esophageal cancer (EC), and pancreatic cancer (PC). Overall, the GI cancers are responsible for more cancers and more deaths from cancer than any other organ. 5 year survival of these cancers remains low compared to western world. Unlike the rest of the world where organ based specialities hepatobiliary, pancreatic, colorectal and esophagogastric exist , these cancers are managed in India by either a gastrointestinal surgeons, surgical oncologist, or a general surgeon with varying outcomes.The aim of this review was to collate data on GI cancers in indian continent. In colorectal cancers, data from tertiary care centres identifies the unique problem of mucinous and signet colorectal cancer. Results of rectal cancer resection in terms of technique (intersphincteric resection, extralevator aper, minimal invasive approach ) to be comparable with world literature. However long term outcome and data regarding colon cancers and nationally is needed. Gastric cancer at presentation are advanced and in surgically resected patients, there is need for a trial to compare chemoradiation vs chemotherapy alone to prevent loco regional recurrence. Data on minimal invasive gastric cancer surgery may be sparse for the same reason. Theree is a lot of data on surgical techniques and perioperatve outcomes in pancreatic cancer. There is a high volume of locally advanced gallbladder cancers with efforts on to decide whether neoadjuvant chemotherapy or neoadjuvant chemoradiotherapy is better for down staging. Considering GI cancers, a heterogeneous disease with site specific treatment options and variable outcomes, the overall data and outcomes are extremely variable. Young patients with pathology unique to the Indian subcontinent (for example, signet ring rectal cancer, GBCs) need focussed attention. Solution for such pathology needs to come from the Indian continent itself. Joint efforts to improve outcomes for GI cancer can be integrated under the national cancer grid program.
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Uchikado, Yasuto, Itaru Omoto, Ken Sasaki, Hiroshi Okumura, Yoshiaki Kita, Tetsuhiro Owaki, Yusaku Osako, et al. "PS01.222: HAS A MEDIASTINOSCOPE-ASSISTED ESOPHAGECTOMY CONTRIBUTE TO CURABILITY AND MINIMAL INVASIVE SURGERY?" Diseases of the Esophagus 31, Supplement_1 (September 1, 2018): 113. http://dx.doi.org/10.1093/dote/doy089.ps01.222.
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Abstract Background In a mediastinoscope-assisted esophagectomy, it is unknown whether it contributes to minimally invasive surgery or curability. We examined the outcome of treatment of a mediastinoscope-assisted esophagectomy performed in our hospital. Methods From June 2014 to October 2017, 31 patients underwent a mediastinoscope-assisted esophagectomy. The examined items were clinicopathological factors, preoperative complications, preoperative treatment, bleeding volume, operation time, postoperative complications, and recurrence. Results There were 29 males, 2 females, and the average age 66 years. As preoperative treatment, 12 nontreatment, 4 chemotherapies, and 15 chemoradiotherapy (CRT) were performed. Preoperative complications were found in 27 cases, among which 13 cases were respiratory complications. The percentage of double cancers was also high, 8 cases with synchronous cancer, and 6 cases with metachronous cancer. Gastric cancer accounted for half in synchronous cancer, and in metachronous lung cancer was 4 cases. The reconstructed organs were 29 cases of stomach tube and 2 cases of colon. The reconstruction route was 17 cases in front of the chest wall and the chest wall anterior route was selected for the case of preoperative CRT significantly. The average bleeding volume was 316 ml, and the average operation time was 560 minutes. Pathological tumor depth T0/1a/1b/2/3 were each 2/11/6/7/4 cases. In the postoperative complications, 12 cases of temporary recurrent nephropathy, 5 cases of anastomotic suture failure, 3 cases of pulmonary complications. There were 6 cases (19.3%) of recurrence. Postoperative recurrence was associated with significant pathological tumor depth. Conclusion A mediastinoscope-assisted esophagectomy decreased postoperative pulmonary complications and there were not many recurrences after surgery. It seemed to contribute to minimally invasive surgery and curability. Disclosure All authors have declared no conflicts of interest.
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Nguyen, Thuy Trang, Thi Thuy Dung Nguyen, Qui Thanh Hoai Ta, and Van Giau Vo. "Advances in non and minimal-invasive transcutaneous delivery of immunotherapy for cancer treatment." Biomedicine & Pharmacotherapy 131 (November 2020): 110753. http://dx.doi.org/10.1016/j.biopha.2020.110753.
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Raoof, Mustafa, and Steven A. Curley. "Non-Invasive Radiofrequency-Induced Targeted Hyperthermia for the Treatment of Hepatocellular Carcinoma." International Journal of Hepatology 2011 (2011): 1–6. http://dx.doi.org/10.4061/2011/676957.
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Targeted biological therapies for hepatocellular cancer have shown minimal improvements in median survival. Multiple pathways to oncogenesis leading to rapid development of resistance to such therapies is a concern. Non-invasive radiofrequency field-induced targeted hyperthermia using nanoparticles is a radical departure from conventional modalities. In this paper we underscore the need for innovative strategies for the treatment of hepatocellular cancer, describe the central paradigm of targeted hyperthermia using non-invasive electromagnetic energy, review the process of characterization and modification of nanoparticles for the task, and summarize data from cell-based and animal-based models of hepatocellular cancer treated with non-invasive RF energy. Finally, future strategies and challenges in bringing this modality from bench to clinic are discussed.
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Haga, Norihiro, Toru Ishiguro, Kouki Kuwabara, Kensuke Kumamoto, Youichi Kumagai, Hiroyuki Baba, Keiichiro Ishibashi, and Hideyuki Ishida. "Comparison of Three Different Minimally Invasive Procedures of Distal Gastrectomy for Nonoverweight Patients with T1N0-1 Gastric Cancer." International Surgery 98, no. 3 (August 1, 2013): 259–65. http://dx.doi.org/10.9738/intsurg-d-12-00028.1.
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Abstract Laparoscopic-assisted distal gastrectomy has recently come to be a standard procedure for the treatment of early gastric cancer1–5 in select patients. The minimal invasiveness associated with laparoscopic procedures for the resection of gastrointestinal cancer has been repeatedly explained in part by the short incision that is required.6–11 We used two different approaches to perform distal gastrectomies for the resection of gastric cancer as minimally invasive alternatives to a standard laparoscopic approach prior to our surgical team's complete mastery of the skills required for laparoscopic oncological surgery for gastric cancer.9,12 If the minimal invasiveness associated with laparoscopic-assisted gastrectomy can be explained by the small incision, a gastrectomy via a small incision without the use of a pneumoperitoneum may provide a similar outcome in patients. However, to our knowledge, such a comparison has not been previously made. We compared the minimal invasiveness of three different approaches (minilaparotomy, minilaparotomy approach with laparoscopic assistance, and standard laparoscopic-assisted approach) to performing a distal gastrectomy for T1N0-1 gastric cancer in nonoverweight patients (body mass index, ≤25 kg/m2) performed within a limited study period.
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Beets, G. L., L. A. Heijnen, M. Maas, M. H. Martens, D. M. J. Lambregts, R. G. H. Beets-Tan, and J. W. A. Leijtens. "77. Minimal invasive treatment for clinical complete and good responders after chemoradiation for rectal cancer." European Journal of Surgical Oncology 38, no. 9 (September 2012): 755. http://dx.doi.org/10.1016/j.ejso.2012.06.076.
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Peek, M., M. Ahmed, B. Haken ten, and M. Douek. "200. A systematic review of minimal invasive ablative techniques in the treatment of breast cancer." European Journal of Surgical Oncology (EJSO) 40, no. 11 (November 2014): S85. http://dx.doi.org/10.1016/j.ejso.2014.08.195.
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Gennari, Paolo, Michael Gerken, József Mészáros, Monika Klinkhammer-Schalke, Olaf Ortmann, Holm Eggemann, and Atanas Ignatov. "Minimal-invasive or open approach for surgery of early cervical cancer: the treatment center matters." Archives of Gynecology and Obstetrics 304, no. 2 (January 22, 2021): 503–10. http://dx.doi.org/10.1007/s00404-020-05947-y.
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Mann, C., F. Berlth, E. Hadzijusufovic, H. Lang, and P. P. Grimminger. "Minimally invasive esophagectomy: clinical evidence and surgical techniques." Langenbeck's Archives of Surgery 405, no. 8 (October 7, 2020): 1061–67. http://dx.doi.org/10.1007/s00423-020-02003-w.
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Abstract Background Surgical esophagectomy plays a crucial role in the curative and palliative treatment of esophageal cancer. Thereby, minimally invasive esophagectomy (MIE) is increasingly applied all over the world. Combining minimal invasiveness with improved possibilities for meticulous dissection, robot-assisted minimal invasive esophagectomy (RAMIE) has been implemented in many centers. Purpose This review focuses on the development of MIE as well as RAMIE and their value based on evidence in current literature. Conclusion Although MIE and RAMIE are highly complex procedures, they can be performed safely with improved postoperative outcome and equal oncological results compared with open esophagectomy (OE). RAMIE offers additional advantages regarding surgical dissection, lymphadenectomy, and extended indications for advanced tumors.
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Chen, Kevin, Pradeep S. Chauhan, Ramandeep K. Babbra, Wenjia Feng, Nadja Pejovic, Armaan Nallicheri, Peter K. Harris, et al. "Tracking minimal residual disease with urine tumor DNA in muscle-invasive bladder cancer after neoadjuvant chemotherapy." Journal of Clinical Oncology 39, no. 15_suppl (May 20, 2021): e16514-e16514. http://dx.doi.org/10.1200/jco.2021.39.15_suppl.e16514.
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e16514 Background: Standard-of-care for muscle-invasive bladder cancer (MIBC) consists of neoadjuvant chemotherapy (NAC) followed by radical cystectomy. The inability to noninvasively assess minimal residual disease (MRD) after NAC limits our ability to offer bladder-sparing treatment. We perform urine tumor DNA (utDNA) analysis to identify pathologic complete response (pCR) at the time of cystectomy in patients receiving NAC. Methods: We applied CAPP-Seq to urine cell-free DNA samples acquired on the day of radical cystectomy from 19 MIBC patients treated with NAC. utDNA variant-calling was performed without prior tumor mutational knowledge using a panel of 49 consensus driver genes mutated in MIBC. The utDNA level for each patient was represented by the duplex-supported non-silent driver mutation with the highest variant allele fraction (vAF) after removing germline variants. We also serially tracked utDNA variants in two patients before, during, and after NAC. Results: Comparing patients with residual disease detected in their cystectomy specimen ( n = 10) to those who achieved a pCR ( n = 9), median utDNA levels were 2.4% vs. 0%, respectively ( P = 0.006). Using an optimal utDNA threshold to define MRD detection, positive utDNA MRD was highly correlated with the absence of pCR ( P = 0.003). Analysis of two patients’ serial urine samples revealed utDNA dynamics that were consistent with treatment responses in real-time. In one patient who ultimately achieved a pCR, four non-silent driver mutations were detectable pre-NAC, including ERCC2 N238S (7.8% vAF) associated with increased chemosensitivity. One week after starting NAC, ERCC2 N238S increased by 1.6-fold in urine, as did PIK3CA E726K which increased by 8.4-fold. Four weeks post-NAC, however, all mutations previously detected in this patient’s urine became undetectable, consistent with the patient’s pCR and long-term disease-free survival. Conversely, another patient harbored two non-silent driver mutations in PLEKHS1 (1.9% vAF) and KMT2D (4.9% vAF) pre-NAC. One week after starting NAC, both mutations decreased dramatically by 8.0- and 4.3-fold, respectively. By three weeks post-NAC, however, these mutations progressively increased by 5.2-fold on average, which correlated with a lack of pCR as well as post-treatment disease progression. Two newly detected non-silent driver mutations in ARID1A and ERBB2 also emerged on NAC and persisted following completion of chemotherapy , likely reflecting the development of treatment resistance. Conclusions: utDNA MRD after NAC but before radical cystectomy for MIBC correlated significantly with pathologic response, which could help personalize patient selection for bladder-sparing treatments in the future. Serial monitoring of utDNA variants during NAC can reveal dynamic mutational changes that reflect real-time treatment responses as well as ultimate disease-free survival.
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Wei, Shixiong, Shen Ming, and Liu Gang. "Thoracoscopic Lung Cancer Resection with Simultaneous Heart Valve Procedure." Heart Surgery Forum 24, no. 4 (July 27, 2021): E628—E630. http://dx.doi.org/10.1532/hsf.3937.
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Comorbidity of primary lung cancer and heart valve disease, both requiring surgical therapy, characterizes a high-risk group of patients necessitating prompt diagnosis and treatment. Recently, the rate of minimal invasive approach for patients who were not indicated for conventional thoracotomy surgery due to their high-risk status with the procedure has increased as treatment for heart valve disease. We herein report four patients of lung cancer resection with simultaneous valve procedure though thoracoscopic technique [Bablekos 2016].
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Wani, Rauf Ahmad, and Asif Mehraj. "Endoscopic Surgery in Rectal Cancer- A Review." JMS SKIMS 21, no. 1 (December 1, 2018): 3–10. http://dx.doi.org/10.33883/jms.v21i1.333.
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Colorectal cancer is one of the leading causes of cancer-related deaths worldwide. Total mesorectal excision (TME) remains the gold standard treatment for any stage of rectal cancer, especially in more advanced disease, as it effectively treats the mesorectal lymph nodes and reduces recurrence [1]. Minimally invasive abdominal approach has been established to be oncologically safe, feasible and associated with all the advantages of minimal access surgery, however, it has not had a measurable impact on the incidence of postoperative complications, sexual and urinary dysfunction, or quality of life. TME performed either via open, laparoscopic or robotic approach is accompanied by significant morbidity and mortality [2]. In addition, widespread adoption of laparoscopic techniques in colorectal surgery has been limited by the technical complexity and steep learning curve. In an effort to harness the advantages of a minimally invasive approach to benefit patients with colorectal pathology, trans anal natural orifice transluminal endoscopic surgery (NOTES) has been explored, with promising preliminary results, particularly when used for rectal cancer and other benign lesions. NOTES in Rectal lesions can be carried out using Transanal Endoscopic Microsurgery (TEMS) and Transanal Minimal Invasive Surgery (TAMIS), which can be together termed as Transanal endoscopic surgery. JMS 2018;21(1):3-10
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Shen, Lizong, Yiming Huang, Maocai Sun, Hao Xu, Wei Wei, and Wenxi Wu. "Clinicopathological Features Associated with Lymph Node Metastasis in Early Gastric Cancer: Analysis of a Single-Institution Experience in China." Canadian Journal of Gastroenterology 23, no. 5 (2009): 353–56. http://dx.doi.org/10.1155/2009/462678.
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BACKGROUND: An accurate assessment of potential lymph node metastasis is an important issue for the appropriate treatment of early gastric cancer. Minimizing the number of invasive procedures used in cancer therapy is critical for improving the patient’s quality of life.OBJECTIVE: To evaluate the clinicopathological features associated with lymph node metastasis of early gastric cancer in patients from a single institution in China.METHODS: A retrospective review of data from 410 patients surgically treated for early gastric cancer at the First Affiliated Hospital (Nanjing, China) between 1998 and 2007, was conducted. The clinicopathological variables associated with lymph node metastasis were evaluated.RESULTS: Lymph node metastasis was observed in 12.20% of patients. The macroscopic type, tumour size, location in the stomach, depth of gastric carcinoma infiltration, and presence of vascular or lymphatic invasion showed a positive correlation with the incidence of lymph node metastasis by univariate analysis. Multivariate analyses revealed histological classification, macroscopic type, tumour size, depth of gastric carcinoma infiltration, and the presence of vascular or lymphatic invasion to be significantly and independently related to lymph node metastasis. The depth of gastric carcinoma infiltration was the strongest predictive factor for lymph node metastasis. For intramucosal cancer, tumour size was the unique risk factor for lymph node metastasis. For submucosal cancer, histological classification and tumour size were independent risk factors for lymph node metastasis.CONCLUSIONS: Histological classification, macroscopic type, tumour size, depth of gastric carcinoma infiltration, and the presence of vascular or lymphatic invasion are independent risk factors for lymph node metastasis in patients with early gastric cancer in China. Minimal invasive treatment, such as endoscopic mucosal resection, may be possible for highly selected cancers.
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Papadia, Andrea, Chiara Morosi, Junjie Wang, Maria Luisa Gasparri, Tilman Rau, Fabio Ghezzi, and Michael D. Mueller. "SLN mapping in early-stage cervical cancer as a minimal-invasive triaging tool for multimodal treatment." European Journal of Surgical Oncology 45, no. 4 (April 2019): 679–83. http://dx.doi.org/10.1016/j.ejso.2019.01.184.
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Chen, Kevin, Pradeep S. Chauhan, Ramandeep K. Babbra, Wenjia Feng, Eric H. Kim, Zachary L. Smith, Vivek K. Arora, and Aadel A. Chaudhuri. "00005 Urine tumor DNA detects minimal residual disease in muscle-invasive bladder cancer treated with curative-intent radical cystectomy." Journal of Clinical and Translational Science 5, s1 (March 2021): 113–14. http://dx.doi.org/10.1017/cts.2021.690.
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ABSTRACT IMPACT: Urine tumor DNA non-invasively detects minimal residual disease and infers tumor mutational burden in locally advanced bladder cancer prior to radical cystectomy, which may potentially enable the selection of patients for bladder-sparing treatment or facilitate personalized adjuvant immunotherapy. OBJECTIVES/GOALS: Standard-of-care treatment for muscle-invasive bladder cancer (MIBC) is radical cystectomy. The inability to assess minimal residual disease (MRD) non-invasively limits our ability to offer bladder-sparing treatment. We sought to develop a liquid biopsy solution via urine tumor DNA (utDNA) analysis. METHODS/STUDY POPULATION: We applied uCAPP-Seq, a targeted sequencing method for detecting utDNA, to urine cell-free DNA samples acquired on the day of radical cystectomy from 42 patients with bladder cancer. utDNA variant-calling was performed non-invasively without prior tumor mutational knowledge. The overall utDNA level for each patient was represented by the non-silent mutation with the highest variant allele fraction after removing germline variants. Urine was similarly analyzed from 15 healthy adults. Tumor mutational burden (TMB) was inferred from the number of non-silent mutations detected in urine cell-free DNA by applying a linear relationship derived from TCGA whole exome sequencing of 409 MIBC tumors. RESULTS/ANTICIPATED RESULTS: utDNA levels were significantly higher in patients with residual disease detected in their surgical pathology compared to those who achieved a pathologic complete response (P = 0.002). Using an optimal utDNA threshold to define MRD detection, positive utDNA MRD significantly predicted the absence of pathologic complete response with a sensitivity of 81% and specificity of 81%. Positive utDNA MRD also portended significantly worse progression-free survival (HR = 7.4; P = 0.03) compared to negative utDNA MRD. Furthermore, we applied a linear relationship (Pearson r = 0.84; P < 0.0001) to identify patients with high inferred TMB who may have been candidates for early immune checkpoint blockade. DISCUSSION/SIGNIFICANCE OF FINDINGS: utDNA MRD analysis prior to surgery correlated significantly with pathologic response and progression-free survival, which may help select patients for bladder-sparing treatment. utDNA can also non-invasively infer TMB, which could facilitate personalized adjuvant therapy for patients in the future.
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Pettee, Krista, Kathryn Becker, Arthur Alberts, Kevin Reinard, Jason Schroeder, and Kathryn Eisenmann. "Targeting the mDia Formin-Assembled Cytoskeleton Is an Effective Anti-Invasion Strategy in Adult High-Grade Glioma Patient-Derived Neurospheres." Cancers 11, no. 3 (March 20, 2019): 392. http://dx.doi.org/10.3390/cancers11030392.
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High-grade glioma (HGG, WHO Grade III–IV) accounts for the majority of adult primary malignant brain tumors. Failure of current therapies to target invasive glioma cells partly explains the minimal survival advantages: invasive tumors lack easily-defined surgical margins, and are inherently more chemo- and radioresistant. Much work centers upon Rho GTPase-mediated glioma invasion, yet downstream Rho effector roles are poorly understood and represent potential therapeutic targets. The roles for the mammalian Diaphanous (mDia)-related formin family of Rho effectors have emerged in invasive/metastatic disease. mDias assemble linear F-actin to promote protrusive cytoskeletal structures underlying tumor cell invasion. Small molecule mDia intramimic (IMM) agonists induced mDia functional activities including F-actin polymerization. mDia agonism inhibited polarized migration in Glioblastoma (WHO Grade IV) cells in three-dimensional (3D) in vitro and rat brain slice models. Here, we evaluate whether clinically-relevant high-grade glioma patient-derived neuro-sphere invasion is sensitive to formin agonism. Surgical HGG samples were dissociated, briefly grown as monolayers, and spontaneously formed non-adherent neuro-spheres. IMM treatment dramatically inhibited HGG patient neuro-sphere invasion, both at neuro-sphere embedding and mid-invasion assay, inducing an amoeboid morphology in neuro-sphere edge cells, while inhibiting actin- and tubulin-enriched tumor microtube formation. Thus, mDia agonism effectively disrupts multiple aspects of patient-derived HGG neuro-sphere invasion.
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Lyons, Gray R., Brian J. Schiro, and Govindarajan Narayanan. "Irreversible Electroporation: Expanding the Armamentarium against Pancreatic Cancer." Digestive Disease Interventions 03, no. 02 (June 2019): 138–42. http://dx.doi.org/10.1055/s-0039-1693226.
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AbstractLocally advanced pancreatic cancer is often refractory to conventional therapy, thus warranting new approaches. Irreversible electroporation is an ablative modality that has the potential to deliver targeted anticancer treatment with minimal damage to surrounding structures. Indications for irreversible electroporation in pancreatic cancer patients include palliation for metastatic disease, downstaging for surgery in locally advanced disease, and treatment of local recurrence following operative resection. Benefits of the modality in pancreatic cancer include a minimally invasive approach, precise delivery that minimizes nontarget ablation, and upregulation of anticancer immune response. Early studies have demonstrated an acceptable safety profile for irreversible electroporation; however, more data are needed to define the role of IRE in the treatment algorithm of pancreatic cancer.
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Moati, Emilie, Valerie Taly, Simon Garinet, Audrey Didelot, Julien Taieb, Pierre Laurent-Puig, and Aziz Zaanan. "Role of Circulating Tumor DNA in Gastrointestinal Cancers: Current Knowledge and Perspectives." Cancers 13, no. 19 (September 22, 2021): 4743. http://dx.doi.org/10.3390/cancers13194743.
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Gastrointestinal (GI) cancers are major health burdens worldwide and biomarkers are needed to improve the management of these diseases along their evolution. Circulating tumor DNA (ctDNA) is a promising non-invasive blood and other bodily-fluid-based biomarker in cancer management that can help clinicians in various cases for the detection, diagnosis, prognosis, monitoring and personalization of treatment in digestive oncology. In addition to the well-studied prognostic role of ctDNA, the main real-world applications appear to be the assessment of minimal residual disease to further guide adjuvant therapy and predict relapse, but also the monitoring of clonal evolution to tailor treatments in metastatic setting. Other challenges such as predicting response to treatment including immune checkpoint inhibitors could also be among the potential applications of ctDNA. Although the level of advancement of ctDNA development in the different tumor localizations is still inhomogeneous, it might be now reliable enough to be soon used in clinical routine for colorectal cancers and shows promising results in other GI cancers.
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Reddy, Sanjay S., Elin R. Sigurdson, and Jeffrey M. Farma. "Treatment of colorectal cancers with minimally invasive surgical techniques at a dedicated cancer center." Journal of Clinical Oncology 31, no. 4_suppl (February 1, 2013): 549. http://dx.doi.org/10.1200/jco.2013.31.4_suppl.549.
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549 Background: Laparoscopic (LS) and robotic surgery (RS) for colorectal cancer provides a new perspective of the deep pelvis. Our goal was to identify the role of LS and RS for patients with sigmoid and rectal cancer. Methods: We retrospectively analyzed 53 patients treated from 2007-2012. Resection type, previous surgery, neoadjuvant and adjuvant therapy, timing of surgery, lymph nodes (LN) harvested, estimated blood loss (EBL), operative time (OT), complications, and pathology were reviewed. Results: Of 53 patients, 32 underwent LS, and 18 RS. There were 47 patients with adenocarcinoma, 5 with unresectable polyps and 1 with anal melanoma. 62% of patients underwent a recto-sigmoid resection, 23% rectal, and 8% sigmoid. 32% had prior surgery. Neoadjuvant treatment (NAT) was initiated in 31 patients; 3 received chemotherapy without radiation, and 1 short course radiation. An average of 12.8 and 8.4 LN were harvested in the LS and RS groups respectively, with a mean of 9.9 LN after NAT, and 13.9 without. EBL was 155ml (20-650) with LS and 178ml (25-600) with RS. 3 LS cases were converted to an open procedure. Median OT was 270 and 302 minutes for LS and RS groups. Using the Clavien grading system, 12 patients had grade 1-2 complications, 5 grade 3, and 2 grade 4’s within 30 days. Radial margins were positive in 2 patients; one received NAT for a fungating anal adenocarcinoma, and the other had chemotherapy alone. One patient had a positive proximal margin with no prior therapy. Rate of complete pathological response (pCR) was 35%, and 71% were down staged. The mean interval between completion of NAT and resection was 8 weeks (range 4-12), and surgery to adjuvant therapy was 8 weeks (range 4-22). Conclusions: LS and RS surgery for colorectal cancer can be safely performed in conjunction with neoadjuvant and/or adjuvant chemotherapy. NAT should not preclude adoption of these techniques, as we achieved a 35% pCR with minimal operative morbidity allowing patients to proceed to adjuvant chemotherapy in a timely fashion. [Table: see text]
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Shi, Peina, and Xiaoyun Ding. "Progress on the Prevention of Esophageal Stricture after Endoscopic Submucosal Dissection." Gastroenterology Research and Practice 2018 (2018): 1–8. http://dx.doi.org/10.1155/2018/1696849.
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Endoscopic submucosal dissection (ESD) has been widely accepted as an effective, minimally invasive treatment for superficial esophageal cancers. However, esophageal stricture often occurs in patients with large mucosal defects after ESD. In this review, we discuss various approaches recently researched to prevent esophageal strictures after ESD. These approaches can be classified as pharmacological treatments, esophageal stent treatments, and tissue engineering approaches. Most of the preventive approaches still have their limitations and require further research. With the improvement of current therapies, ESD can be more widely utilized as a minimally invasive treatment with minimal complications.
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D'Hont, C., M. Lantsoght, and P. Van Erps. "846 High intensity focused ultrasound: Minimal invasive transrectal treatment for localized prostate cancer. 2.5 years — 250 patients." European Urology Supplements 3, no. 2 (February 2004): 214. http://dx.doi.org/10.1016/s1569-9056(04)90838-x.
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Pignata, G., M. Barone, M. Stefanoni, and U. Bracale. "Long-term results of laparoscopic treatment for advanced rectal cancer." Acta chirurgica Iugoslavica 55, no. 3 (2008): 31–37. http://dx.doi.org/10.2298/aci0803031p.
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Backgraound. The management of advanced rectal cancer has changed into a multidisciplinary treatment model. Only limited randomized data are available for patients with rectal cancer treated laparoscopically. Aim. We report a multimodal treatment of advanced rectal cancer: preoperative oncological treatment, use of endoscopic stent (for malignant obstruction), minimal invasive treatment. Methods. The Authors reported a series of 45 laparoscopic rectal resections for adenocarcinoma, some of them with malignant obstruction. Long term oncological results were reviewed. Results. The 30-day mortality was 2.2%. Of 45 adenocarcinoma, 4 cases were obstructed. Successful stent positioning was obtained in all patients and treated with radiochemiotherapy before laparoscopic resection. The 5-year global survival rate (including stage IV) was 62.2%; for stage II was 77.9% and 53.8% for stage III. Conclusion. This study indicates that laparoscopy for advanced rectal cancer have good long-term results. In high and middle rectal malignant obstructions, we considered the use of stents to be useful.
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Ivanova, Viktoria A., Ekaterina V. Verenikina, Vera P. Nikitina, Oksana E. Zhenilo, and Anna Yu Ardzha. "Photodynamic therapy for preinvasive vaginal cancer." Journal of Clinical Oncology 39, no. 15_suppl (May 20, 2021): 5592. http://dx.doi.org/10.1200/jco.2021.39.15_suppl.5592.
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5592 Background: Photodynamic therapy (PDT) is an effective method for the treatment of various cancers resulting in apoptosis, autophagy and ischemic necrosis of irradiated tissues. The purpose of the study was to analyze the efficacy of PDT for pre-invasive vaginal cancer treatment. Methods: PDT results were studied in 20 patients aged 32-65 years with verified pre-invasive vaginal cancer. All patients received PDT with the Latus diode laser and Photolon or Photolan photosensitizers. The effect was evaluated with extended colposcopy. The criteria for efficiency included normalization of the colposcopic picture and the absence of atypical cells. The sizes of the irradiation fields varied from 1.5 to 2 cm, the number of fields - from 1 to 4, the power density - from 0.1 to 0.17 W/cm2, the light dose - from 40 to 100 J/cm2. The duration of a PDT session varied from 10 to 30 min, depending on the number of irradiation fields. The irradiation field necessarily included an area of normal tissue 3-5 mm surrounding the lesion. 4 to 6 sessions were required to restore the normal layer of stratified squamous epithelium. The antitumor efficacy of PDT was evaluated based on the results of visual observation of changes in the area of the treated pathological foci and information on the presence or absence of clinical symptoms of the disease 1 and 3 months after the treatment (WHO criteria). Results: Complete regression was registered in 100% of patients after 3 months. Repeated courses of PDT were required in cases with a wide spread of pathological foci and the impossibility of their simultaneous irradiation. At follow-up after 1 month, 3 of 20 patients (15%) showed local foci of atypical changes in the epithelium managed with repeated PDT courses. In 6 months, stable remission of the disease clinical symptoms in the treated pathological foci was registered. The results of the cytological study performed 3 months after PDT were normal in 100% patients; no negative changes were registered 6 and 12 months after PDT. Conclusions: The results of PDT in the treatment of patients with pre-invasive vaginal cancer demonstrated its high therapeutic efficacy and a minimal number of adverse reactions, which allows recommending PDT in the treatment of pre-invasive vaginal cancer.
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R. Mokoena, Dimakatso, Blassan P. George, and Heidi Abrahamse. "Enhancing Breast Cancer Treatment Using a Combination of Cannabidiol and Gold Nanoparticles for Photodynamic Therapy." International Journal of Molecular Sciences 20, no. 19 (September 26, 2019): 4771. http://dx.doi.org/10.3390/ijms20194771.
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Indisputably, cancer is a global crisis that requires immediate intervention. Despite the use of conventional treatments over the past decades, it is acceptable to admit that these are expensive, invasive, associated with many side effects and, therefore, a reduced quality of life. One of the most possible solutions to this could be the use of gold nanoparticle (AuNP) conjugated photodynamic therapy (PDT) in combination with cannabidiol (CBD), a Cannabis derivative from the Cannabis sativa. Since the use of Cannabis has always been associated with recreation and psychoactive qualities, the positive effects of Cannabis or its derivatives on cancer treatment have been misunderstood and hence misinterpreted. On the other hand, AuNP-PDT is the most favoured form of treatment for cancer, due to its augmented specificity and minimal risk of side effects compared to conventional treatments. However, its use requires the consideration of several physical, biologic, pharmacologic and immunological factors, which may hinder its effectiveness if not taken into consideration. In this review, the role of gold nanoparticle mediated PDT combined with CBD treatment on breast cancer cells will be deliberated.
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Boese, Axel, Alexander Wagner, Michael Friebe, Uwe Bernd Liehr, and Jakob Johann Wendler. "Endoscopic filter fluorometer for emission detection of Protoporphyrin IX and its direct precursors in PDT and PDD." Current Directions in Biomedical Engineering 6, no. 3 (September 1, 2020): 587–90. http://dx.doi.org/10.1515/cdbme-2020-3150.
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AbstractPhotodynamic therapy (PDT) is a potential option for treatment of cancer since it can be performed non- invasive for superficial cancers or minimal-invasive with low traumatization. But PDT is intrinsically inefficient due to the complex accumulation of the photosensitizing drug inside the tumor and the processes of heme syntheses to create the needed cell killing components. To optimize the outcome of PDT and increase acceptance as viable option it is necessary to predict the optimal time for the start of the treatment based on measurable precursors. A former cell study proposed a new filter fluorometer in a complex and sensitive setup. In this work we now designed and tested a simplified system that can be used in combination with standard endoscopic imaging systems. This system will be used as base to prove viability of this approach for a future clinical study.
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Yang, Yang, Wei Yin, Nan Li, Wensheng Xu, Fei Ma, Xiaosong Chen, Wen-Ming Cao, et al. "Development of a plasma cell-free DNA chromosome instabilities assay for early cancer detection and treatment response monitoring of multiple tumor types." Journal of Clinical Oncology 37, no. 15_suppl (May 20, 2019): e13072-e13072. http://dx.doi.org/10.1200/jco.2019.37.15_suppl.e13072.
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e13072 Background: Tumor cells keep shedding DNA into blood stream. Here we present a retrospective study to investigate the potential of CIN in plasma cell-free DNA (cfDNA) as a minimal-invasive biomarker for early cancer detection and cancer treatment responses monitoring. Methods: To characterization cfDNA CIN, 160 plasma samples from non-cancer individuals and 569 from cancer patients, including tumors from the brain, respiratory tract, gastrointestinal tract, urinary tract, liver, gallbladder, female reproductive system, prostate, breast and sarcoma. cfDNA was extracted and sent to low-coverage whole genome sequencing by the Illumina X10, followed by CIN analyses by a customized workflow Ultrasensitive Chromosomal Instability Detector (UCAD). Results: In non-cancer individuals, increased CIN in cfDNA was found associated with active EBV infections(P<0.01) and HBV infection (P=0.042). No statistical significances were found for the other parameters, including age, hypertension, diabetes, chronic kidney diseases, family history of cancer and etc. cfDNA CIN increased along with the development of lung cancer lesions, from adenocarcinoma in-situ, minimal invasive adenocarcinoma, invasive adenocarcinoma (P=0.034) to relapsed cancer (P<0.01). The sensitivity of early lung cancer detection was 30.7%, 37.5%, 45.5%, 50.0% and 98.1% for AIS, MIA, IAC, SCC and relapsed lung cancer, at a specificity of 75%. cfDNA CIN levels did not show statistical differences regarding metastases sites. cfDNA CIN were further increased in relapsed breast cancer (P<0.01). The sensitivity of relapsed breast cancer detection was 73.3%, 94.4%, 89.6% and 80.0% for HER2+, Luminal A, Luminal B and triple negative breast cancer, at a specificity of 90%. In primary liver cancer, cfDNA CIN decreased after curative therapies, including R0 resections and liver transplant. R0 resections showed similar performance as compared to liver transplant (P=0.35) in terms of cfDNA CIN decreasing. Furthermore, cfDNA CIN was higher in patients after R0 resections (P=0.003) and liver transplant (P=0.03) than that of HBV-positive cancer-free patients, indicating the potential risk of disease relapses. For advanced stage patients, continuously increasing cfDNA CIN level was found associated with worse survival, and a decreasing trend predicting better prognosis vice versa. Conclusions: Plasma cfDNA CIN analysis might be a useful tool for cancer management.
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Il’in, A. A., A. S. Khadzhimba, S. Ya Maksimov, I. V. Sobolev, E. A. Vyshinskaya, and S. Kh Kaitova. "Minimal vulvar cancer: a literature review and own observations." Tumors of female reproductive system 14, no. 3 (October 16, 2018): 64–70. http://dx.doi.org/10.17650/1994-4098-2018-14-3-64-70.
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Organ-sparing surgeries for vulvar cancer (VC) include wide excision of perineal tissues or hemivulvectomy. The advances in the treatment of VC reduce the risk of complications in patients with somatic pathology and preserve reproductive function in young patients with minimal risk of disease recurrence. The development of new approaches to VC therapy based on currently accepted clinical and morphological criteria will help to improve treatment outcomes.Materials and methods.We retrospectively analyzed the data on 252 patients with VC. Of them, 58 participants had stage I VC, 103 had stage II VC, 79 had stage III VC, and 12 had stage IV VC. The majority of patients (n = 152) underwent vulvectomy; 100 patients underwent extended vulvectomy.Results.Tumor size and depth of invasion are independent prognostic factors determining overall patient survival. The overall survival rate in patients with tumors of 1.5 cm or smaller was 91.7 %, whereas in patients with tumors >2 cm the overall survival rate was 62.2 %. Thefive-year survival rate was 53.9 % in individuals with tumor invasion >1 cm and 84.6 % in individuals with tumor invasion <0.5 cm.Conclusion.We have developed the criteria for minimal vulvar cancer: tumors <2 cm, tumor invasion <5 mm, tumors located outside theclitoris, no tumor emboli in the vessels, no multifocal growth.
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Ördek, Eser, Mehmet Kolu, Mehmet Demir, Eyyup Sabri Pelit, and Halil Çiftçi. "Transcatheter bilateral superselective arterial embolization, a minimally invasive method for persistent hematuria in elderly and comorbid patients with bladder and prostate cancer." Yeni Üroloji Dergisi 16, no. 16-2 (June 29, 2021): 171–77. http://dx.doi.org/10.33719/yud.2021;16-2-841651.
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Objective: In this article, we aimed to share our experience with superselective vesical and prostatic artery embolization applied by transarterial microcatheter method as a treatment option for recurrent resistant hematuria due to bladder and prostate cancer in elderly and comorbid patients. Materials and Methods: Bilateral transarterial microcatheter method was used for superselective vesical or prostatic artery embolization in 10 patients whose follow-up treatment was continued in our clinic with macroscopic hematuria due to bladder and prostate cancer diagnoses and could not be treated with other palliative and radical surgical methods due to comorbidity and high surgical operative risk. Before and after embolization treatment; hemoglobin (Hb) and hematocrit (Hct) values of the patients, the amount of transfusion of blood and blood products, postoperative complications, urethral foley catheter removal times and patient satisfaction were evaluated. The patients were followed up with controls intermittently for an average of 15 months. Results: The mean age of the patients included in the study was 77.5 (69-86) years. The average hemoglobin value before and after the embolization procedure was 8,16 mg/dL and 9,48 mg/dL, respectively. The average hematocrit value before and after the embolization procedure was 25,5 and 30,4 , respectively. The average amount of blood products (erythrocyte suspension) transfusion was 2.1 (1-3) units before the procedure, and there was no need for blood transfusion in the follow-up after the procedure. The urethral catheters of all patients were removed on the 5th day (3-7 days) after the urine color became completely clear. There were no major complications, recurrent urethral catheterization or mortality, morbidity related to the treatment after the embolization procedure. Conclusion: Superselective vesical and prostatic artery embolization treatment applied by transarterial microcatheter method is an effective and reliable alternative in the case of resistant hematuria due to bladder or prostate cancer that cannot be controlled with other palliative methods due to the high risk of anesthesia in elderly patients with comorbidities. Keywords: persistent hematuria, bladder cancer, superselective vesical artery embolization
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Hébert-Croteau, Nicole, Jacques Brisson, Jean Latreille, Gilles Gariépy, Caty Blanchette, and Luc Deschênes. "Time Trends in Systemic Adjuvant Treatment for Node-Negative Breast Cancer." Journal of Clinical Oncology 17, no. 5 (May 1999): 1458. http://dx.doi.org/10.1200/jco.1999.17.5.1458.
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PURPOSE: We conducted a population-based study in Quebec, Canada, to assess longitudinal changes in systemic adjuvant therapy for node-negative breast cancer. MATERIALS AND METHODS: A stratified random sample was selected among women with newly diagnosed node-negative breast cancer in 1988, 1991, and 1993. Information on the patient, her tumor, source of care, and treatment was abstracted from medical charts. Patients were classified as being at minimal, moderate, or high risk of recurrence on the basis of criteria proposed at the 4th International Conference on Adjuvant Therapy of Primary Breast Cancer (St. Gallen, Switzerland, 1992), and systemic adjuvant treatment received was dichotomized as being consistent or not consistent with consensus recommendations. RESULTS: Overall, 1,578 cases of invasive breast carcinoma were reviewed. The proportion of patients who were given hormonal or cytotoxic treatment increased from 51.7% to 73.1% from 1988 to 1993. Virtually all women at minimal risk were treated in 1991 and 1993 according to the consensus statement. The proportions of women so treated were 75.0% and 65.4% in the moderate- and high-risk categories, respectively, in 1991. In 1993, these proportions were 71.4% and 67.0%, respectively. Omission of chemotherapy, especially in high-risk women with estrogen receptor–negative tumors who were 50 to 69 years of age, was the most frequent inconsistency with guidelines. CONCLUSION: Systemic adjuvant therapy for node-negative breast cancer has gained acceptance. Better understanding of the decision-making process, of the perception of the risks and benefits involved, and of the impact of alternative strategies for the dissemination of consensus recommendations are needed to promote the use of chemotherapy in specific categories of women who are at high risk of recurrence.
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Melo, Antonio Marlos Duarte de, Messias Silvano Da Silva Filho, Bárbara Torquato Alves, Kevellyn Cruz Aguilera, Ana Maria Correia Alencar, Ana Maria Lima Carneiro de Andrade, Daniel Gonçalves Leite, and Ricardo Souto Quidute. "THE INNOVATIONS, ADVANCES AND OUTLOOKS OF LIQUID BIOPSY IN ONCOLOGY: A LITERATURE REVIEW." Amadeus International Multidisciplinary Journal 2, no. 4 (July 6, 2018): 117–28. http://dx.doi.org/10.14295/aimj.v2i4.38.
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Studies on the biology of cancer are multiplying and have been giving significant repercussions on the care of cancer patients, and there is a growing need to evaluate the biology of the tumor. Conventional tissue biopsies currently represent the gold standard in the diagnosis of cancer, but they are not suitable for serial analysis because of the need for invasive procedures, besides being able to present a high risk of life and also impossibility of reaching surgical in some tumors. To solve this obstacle, the use of the Liquid Biopsy, which analyzes the presence of biomarkers released by cancer cells, such as circulating tumor cells (CTCs), tumor cell DNA (ctDNA) and exosomes is being discussed. These techniques are non-invasive or minimally invasive and collect their samples from peripheral blood, plasma and serum, urine, saliva and cerebrospinal fluid (CSF). As they are already being used in the treatment of several histopathological types of cancer, these new techniques generally represent a revolution in the understanding of early diagnosis, choice of personalized treatment, follow-up of the treatment response in real time, detection of minimal residual disease and prognosis for malignant neoplasms. The objective of this study was to present a literature review to clarify the fundamental molecular and clinical aspects involved in this revolutionary diagnostic technique by extracting the data from the sample. Keywords: Liquid Biopsy. Oncology.: literature review
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Barzilai, Ori, Mark H. Bilsky, and Ilya Laufer. "The Role of Minimal Access Surgery in the Treatment of Spinal Metastatic Tumors." Global Spine Journal 10, no. 2_suppl (April 2020): 79S—87S. http://dx.doi.org/10.1177/2192568219895265.
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Study Design: Literature review. Objective: To provide an overview of the recent advances in minimal access surgery (MAS) for spinal metastases. Methods: Literature review. Results: Experience gained from MAS in the trauma, degenerative and deformity settings has paved the road for MAS techniques for spinal cancer. Current MAS techniques for the treatment of spinal metastases include percutaneous instrumentation, mini-open approaches for decompression and tumor resection with or without tubular/expandable retractors and thoracoscopy/endoscopy. Cancer care requires a multidisciplinary effort and adherence to treatment algorithms facilitates decision making, ultimately improving patient outcomes. Specific algorithms exist to help guide decisions for MAS for extradural spinal metastases. One major paradigm shift has been the implementation of percutaneous stabilization for treatment of neoplastic spinal instability. Percutaneous stabilization can be enhanced with cement augmentation for increased durability and pain palliation. Unlike osteoporotic fractures, kyphoplasty and vertebroplasty are known to be effective therapies for symptomatic pathologic compression fractures as supported by high level evidence. The integration of systemic body radiation therapy for spinal metastases has eliminated the need for aggressive tumor resection allowing implementation of MAS epidural tumor decompression via tubular or expandable retractors and preliminary data exist regarding laser interstitial thermal therapy and radiofrequency ablation for tumor control. Neuronavigation and robotic systems offer increased precision, facilitating the role of MAS for spinal metastases. Conclusions: MAS has a significant role in the treatment of spinal metastases. This review highlights the current utilization of minimally invasive surgical strategies for treatment of spinal metastases.
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Sharabi, Shirley, David Last, Dianne Daniels, Itzik Cooper, Yael Bresler, and Yael Mardor. "EXTH-14. PULSED ELECTRIC FIELDS FOR THE TREATMENT OF BRAIN TUMORS." Neuro-Oncology 21, Supplement_6 (November 2019): vi85. http://dx.doi.org/10.1093/neuonc/noz175.348.
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Abstract When high pulsed electric fields (PEFs) are applied to the brain electroporation occurs. Depending on the electric fields strength, irreversible electroporation, inducing necrotic cell death or reversible electroporation, inducing BBB disruption may occur. We have developed a unique minimally-invasive setup for treating brain tumors employing a single insulated intracranial electrode with an exposed tip placed within the tumor and an external surface electrode. This unique setup, termed point-source electroporation, provides intratumoral irreversible-electroporation (inducing necrosis) with surrounding reversible BBB disruption, enabling efficient delivery of systemically administered drugs into the infiltrating zone. Treatment duration is 1–2 min. An efficacy study conducted with 120 glioma-bearing rats resulted in suppressed tumor growth rates in the electroporation+Cisplatin group (1.1±0.1) relative to growth rates in the control group (5.2±1.0), p< 0.047, and in the Cisplatin-only group p< 0.012 (3.92±1.0) (Welch’s F(2,12.73)=10.84; p< 0.002; ω2=0.28). Kaplan-Meir analysis revealed that electroporation+Cisplatin prolonged survival significantly (χ2=7.54; p< 0.006). Immunofluorescence analysis revealed significant infiltration of peripheral macrophages and CD8+ cells in the residual tumor. A finite elements simulation demonstrated the feasibility for obtaining clinically-relevant treatment volumes (~6cm diameter) using a single 3mm (diameter) intracranial catheter. Additionally, we discovered that low PEFs, an order of magnitude lower than electroporation threshold, can also transiently disrupt the BBB by a different mechanism, enabling penetration of both small (Gd/NaF) and large (Evans blue bound to serum albumin) molecules and immune cells, non-invasively. The extent of BBB disruption, measured in mice using delayed-contrast MRI, was found to be linearly dependent both on the electric field strength (r2=0.9,p< 0.03) and on the number of applied pulses (r2=0.94,p< 0.003). These results demonstrate the feasibly of applying combined systemic chemotherapy with point-source electroporation, a minimal-invasive/rapid treatment of PEFs, for obtaining significant antineoplastic effects. Furthermore, low PEFs may be applied non-invasively, rapidly and repeatedly for obtaining reversible BBB disruption.
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Sanderink, W. B. G., M. Caballo, L. J. A. Strobbe, P. Bult, W. Vreuls, D. J. Venderink, I. Sechopoulos, N. Karssemeijer, and R. M. Mann. "Reliability of MRI tumor size measurements for minimal invasive treatment selection in small breast cancers." European Journal of Surgical Oncology 46, no. 8 (August 2020): 1463–70. http://dx.doi.org/10.1016/j.ejso.2020.04.038.
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Nordentoft, Iver, Emil Christensen, Karin Birkenkamp-Demtröder, Sunil Deochand, Dillon Maloney, Tomer Lauterman, Kristofer Patel, et al. "Genome-wide circulating tumor DNA monitoring for bladder cancer treatment management and organ preservation." Journal of Clinical Oncology 39, no. 15_suppl (May 20, 2021): e16527-e16527. http://dx.doi.org/10.1200/jco.2021.39.15_suppl.e16527.
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e16527 Background: Bladder cancer (BC) is the 9th most commonly diagnosed cancer worldwide and each year responsible for 165,000 deaths. Neoadjuvant combination chemotherapy, followed by radical cystectomy, is used for the management of localized muscle-invasive bladder cancer. One of the critical challenges in this therapeutic regimen is monitoring the tumor load to assess therapeutic efficacy – this is typically performed by assessing pathological downstaging in the cystectomy specimen. A high frequency of patients presents with T0N0 at cystectomy (no indication of residual disease), and consequently, it is vital to investigate organ preservation approaches to identify those patients who may qualify for bladder preservation. For precision oncology, we need to develop quantitative and non-invasive diagnostic methodologies to help the oncologist tailor the treatments to individual patients and monitor them for further clinical decision-making. Methods: Cell-free DNA (cfDNA) mutation detection has shown significant promise in its ability to monitor minimal residual disease and disease relapse by detection of cancer mutations in the peripheral blood. However, the combination of low tumor fraction and limited input material obtained from a typical plasma sample restricts the probability of detecting low metastatic burden in cfDNA through current deep targeted sequencing methods. Results: Here we present results from applying whole-genome sequencing (WGS) of cfDNA. We integrate a genome-wide mutation and copy number monitoring approach coupled with advanced signal processing and Artificial Intelligence (AI) for measuring the tumor load from low-input blood samples (̃1mL of plasma) with ultra-sensitive detection. The increased sensitivity allowed clinical detection of tumor fraction down to 8*10-5 and recurrence detection sensitivity achieving > 65% at the first two months post-surgery. The WGS cfDNA approach is being evaluated on a patient cohort of more than 50 bladder cancer patients with longitudinal plasma sampling during neoadjuvant chemotherapy (response measure), pre-cystectomy (complete response measure), and post-surgery (relapse monitoring). Conclusions: The results indicate the clinical potential of genome-wide mutation integration as an ultra-sensitive, non-invasive diagnostic method for bladder cancer clinical management and bladder organ preservation.
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Radosa, Julia Caroline, Pauline Mertke, Christoph Georg Radosa, Sara Brucker, Florin Andrei Taran, Stefan Kommoss, Uwe Ulrich, et al. "Accuracy of primary laparoscopic staging in patients with early ovarian malignancies: A retrospective multicenter study." Journal of Clinical Oncology 37, no. 15_suppl (May 20, 2019): e17052-e17052. http://dx.doi.org/10.1200/jco.2019.37.15_suppl.e17052.
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e17052 Background: Early ovarian malignancies (eOM) are often diagnosed incidentally in the course of diagnostic minimal invasive surgery or laparoscopy for preoperative suspected benign indications. To what extent initial minimal-invasive staging matches final FIGO stage following definite surgery is controversially discussed and current literature on this question is sparse. The aim of this study was to assess accuracy of laparoscopic staging of eOM with regard to final FIGO stage. Methods: We retrospectively identified all patients treated for eOM between 01/2000 and 10/2018. Participating sites were Gynecologic comprehensive cancer centers with great expertise in minimal invasive surgery. Inclusion criteria were no preoperative suspicion of advanced malignancy, initial staging laparoscopy, completion of surgical treatment via laparotomy and complete follow-up data. Clinical data and outcomes were abstracted from the medical record. Rate of upstaging and distinct causes were assessed and initial and definite FIGO stage and 3-year disease free (DFS) and overall survival (OS) were compared with regard to the incidence of upstaging. Results: 107 patients with eOM were included in the final analysis. In 72 (67 %) patients primary laparoscopic staging was concordant with final staging. 35 (33 %) cases were upstaged after the second operation. Regarding the cause for upstaging 4 (11 %) were upstaged because of infiltration of the contralateral ovarian capsule, 16 (46 %) because of peritoneal infiltrates and in 15 (43 %) patients an iatrogenic rupture of the ovarian tumor occurred during laparotomy. 21 (60 %) cases were upstaged within FIGO stage I and 14 (40 %) cases from stage I to II. Comparison of 3-year DFS and OS showed no differences regarding upstaging. Conclusions: In this population of patients with eOM, staging laparoscopy performed by specialized laparoscopic oncologic surgeons showed a sufficient accuracy with no case of upstaging to advanced FIGO stages. Regarding oncologic safety laparoscopic staging showed no impact on 3-year DFS and OS.
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Adhikari, Manish, Vikas Soni, Simonyan Hayk, Colin Young, Jonathan Sherman, and Michael Keidar. "INNV-13. SYNERGISTIC EFFECT OF COLD ATMOSPHERIC PLASMA IN COMBINATION WITH TEMOZOLOMIDE TO TREAT GLIOBLASTOMA IN A NON-INVASIVE MOUSE XENOGRAFT MODEL." Neuro-Oncology 22, Supplement_2 (November 2020): ii119. http://dx.doi.org/10.1093/neuonc/noaa215.496.
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Abstract INTRODUCTION A primary limitation in anti-cancer therapy is the resistance of cancer cells to chemotherapeutic drugs. However, combination therapy may be an effective approach for reducing drug derived toxicity and evading drug resistance, resulting in improved clinical treatment of cancer. Our prior work demonstrated effective treatment of glioblastoma (GBM) with cold atmospheric plasma (CAP) technology with minimal effect to normal cells. Consequently, CAP may serve as a strong candidate for combination therapy with the classical antineoplastic alkylating agent Temozolomide (TMZ) to treat GBM. OBJECTIVES To determine the in vivo co-efficacy of CAP and TMZ to “sensitize” GBM. METHODS An in vivo study was performed using the CAP jet device (He-gas) to determine the effect of combined CAP–TMZ treatment. U87MG-luc glioblastoma cells were implanted intracranially in athymic nude NU(NCr)-Foxn1nu/immunodeficient mice. He-CAP (or control He alone) was non-invasively applied over the skin for 60sec to developed tumors on the first day of the treatment followed with 6.5 mg/kg TMZ or vehicle control treatment for 5 days for two weeks (n=5/group). In vivo bioluminescence imaging was used to monitor tumor volume on the 6th, 9th and 13th treatment day. RESULTS In vivo bioluminescence imaging revealed a marked 8.0±3.2 fold increase in tumor volume in control animals (He-vehicle). Treatment with He-TMZ (6.7±2.5 fold) or CAP-vehicle (4.8±1.7 fold) in isolation had minimal effect in preventing tumor growth. However, combined CAP-TMZ co-treatment virtually prevented increases in tumor volume over 2 weeks (1.8±0.2 fold). CONCLUSIONS Collectively, these findings indicate an effective synergistic treatment method for GBM combining CAP with TMZ. Future investigations look to incorporate radiation into the treatment regimen as well as primary GBM cell models.
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Lopez Penha, T. R., E. M. Heuts, S. Tuinder, R. van der Hulst, and M. F. von Meyenfeldt. "An algorithm for screening and treatment of breast cancer-related lymphedema." Journal of Clinical Oncology 29, no. 27_suppl (September 20, 2011): 256. http://dx.doi.org/10.1200/jco.2011.29.27_suppl.256.
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256 Background: Currently, there is no clear-cut regimen for the treatment of breast cancer related lymphedema. There is evidence advocating both conservative and micro surgical therapy, with treatment effectiveness being dependent on the lymphedema stage. We propose a multidisciplinary screening program with the aim of preventing breast cancer related lymphedema progression and ensure disease regression by early identification and treatment initiation. This approach would ultimately reduce the negative functional, psychosocial and cosmetic consequences resulting from (chronic) lymphedema. Methods: All women with early stage breast cancer are included in this screening program. We use preoperative and sequential postoperative bilateral upper limb circumference measurements and patient perception to identify lymphedema. A difference of > 2cm between post-operative and baseline circumference and patient perception of (refractory) swelling constitutes a diagnosis of lymphedema. Upon lymphedema diagnosis, patients are referred to a lymph therapist for initiation of conservative therapy in the form of complex decongestive physiotherapy. Therapy effect is evaluated after 1 month. In case of unsatisfactory symptom or limb circumference reduction, the patient is considered for surgical treatment. A plastic surgeon evaluates the possibility of microsurgical lymph vessel repair in the form of lymphatic-venous anastomoses or lymphatic-venous-lymphatic anastomoses. This minimal invasive surgery can improve lymph flow in the affected limb. If despite this, symptom improvement and patient satisfaction remains minimal, autologous lymph node transplantation is considered. Results: The aimed outcome parameters are 1) limb circumference reduction, 2) perceived symptom improvement: (refractory) swelling, 3) quality of life improvement, 4) limb range of motion improvement, 5) strength and sensory improvement, 6) restoration/improvement of lymph flow visualized by lymphoscintigraphy. Conclusions: A structured approach for a multidisciplinary treatment of breast cancer related lymphedema is proposed to reduce the negative functional, psychosocial and cosmetic consequences resulting from (chronic) lymphedema.
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Molinari, Chiara, Giorgia Marisi, Alessandro Passardi, Laura Matteucci, Giulia De Maio, and Paola Ulivi. "Heterogeneity in Colorectal Cancer: A Challenge for Personalized Medicine?" International Journal of Molecular Sciences 19, no. 12 (November 23, 2018): 3733. http://dx.doi.org/10.3390/ijms19123733.
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High inter-patient variability and high spatial heterogeneity are features of colorectal cancer (CRC). This may influence the molecular characterization of tumor tissue, now mandatory for patients with metastatic CRC who are candidates for treatment with an anti-EGFR mAb, as false-negative results can occur, leading to non optimal therapy. Moreover, temporal molecular heterogeneity during treatment is known to influence the response to therapy and prognosis. We present a literature overview of advances made in characterizing molecular heterogeneity in CRC, underlining that the analysis of liquid biopsy could represent an efficient non-invasive tool to overcome the problem. We believe that understanding CRC heterogeneity is fundamental for a more accurate diagnosis, for selecting the best targets to ensure prolonged antitumor response, and for monitoring minimal residual disease and the onset of resistance to therapy, all essential components of successful personalized treatment.
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Randall, James Michael, Mark G. Erlander, Cecile Rose T. Vibat, Saege Hancock, Vlada Melnikova, Ezra E. W. Cohen, Scott Michael Lippman, Razelle Kurzrock, and Hatim Husain. "Non-Invasive Monitoring of Urinary KRAS Circulating Tumor DNA for Treatment Response and Minimal Residual Disease in Patients with Lung Adenocarcinoma." Journal of Clinical Oncology 33, no. 15_suppl (May 20, 2015): e19092-e19092. http://dx.doi.org/10.1200/jco.2015.33.15_suppl.e19092.
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Volos, Liliya, and Andrew Dudash. "CLINICAL AND MORPHOLOGICAL FEATURES OF LUMINAL A SUBTYPE OF INVASIVE DUCTAL BREAST CANCER." Scientific Journal of Polonia University 43, no. 6 (June 18, 2021): 293–306. http://dx.doi.org/10.23856/4338.
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The aim of this article was to study clinical and morphological features of luminal A subtype of breast cancer to assess its relationship with disease progression. Methods: This study included 79 patients with luminal A subtype of breast cancer who treatment in 2017 at the Lviv State Oncological Regional Treatment and Diagnostic Center. The Luminal A subtype was identified by immunohistochemistry (IHC) as ER+, PR+/-, HER2- and Ki-67 less than 20 percent on surgically resected breast cancer tissue. Results: The mean age of patients was 60,41±12,25 (range, 32–85 years), 26 (32,9%) were under 55 years. Nottingham Histologic Grade distribution was as follows: G1 – 10 (12,66%), G2 – 56 (70,88%), and G3 – 13 (16,46%) cases. Clinical stage II – 35 (44,3%) and III – 31 (39,24%) was observed. Menopausal status was in 67,1% of cases. Morphological analysis of the tumor tissue showed that except alveolar structures, there were trabecular, solid, tubular structures and separately located groups of tumor cells. The stromal component of the tumor was weak or moderate, most tumors showed minimal or marked inflammatory infiltration and low proliferative activity. Conclusions: To predict the probability of lymphogenic metastasis should be considered: menstrual function, histologic grade, the presence of alveolar structures in the infiltrative component, the different types of structures in the infiltrative component, hyalinosis in the stroma of the tumor node and inflammatory infiltration of tumor.
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Nabavizadeh, Reza, Benjamin Petrinec, Andrea Necchi, Igor Tsaur, Maarten Albersen, and Viraj Master. "Utility of Minimally Invasive Technology for Inguinal Lymph Node Dissection in Penile Cancer." Journal of Clinical Medicine 9, no. 8 (August 3, 2020): 2501. http://dx.doi.org/10.3390/jcm9082501.
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Our aim is to review the benefits as well as techniques, surgical outcomes, and complications of minimally invasive inguinal lymph node dissection (ILND) for penile cancer. The PubMed, Wiley Online Library, and Science Direct databases were reviewed in March 2020 for relevant studies limited to those published in English and within 2000–2020. Thirty-one articles describing minimally invasive ILND were identified for review. ILND has an important role in both staging and treatment of penile cancer. Minimally invasive technologies have been utilized to perform ILND in penile cancer patients with non-palpable inguinal lymph nodes and intermediate to high-risk primary tumors or patients with unilateral palpable non-fixed inguinal lymph nodes measuring less than 4 cm, including videoscopic endoscopic inguinal lymphadenectomy (VEIL) and robotic videoscopic endoscopic inguinal lymphadenectomy (RVEIL). Current data suggest that VEIL and RVEIL are feasible and safe with minimal intra-operative complications. Perhaps the strongest appeal for the use of minimally-invasive approaches is their faster post-operative recovery and less post-operative complications. As a result, patients can tolerate this procedure better and surgeons can offer surgery to patients who otherwise would not be a candidate or personally willing to undergo surgery. When compared to open technique, VEIL and RVEIL have similar dissected nodal count, a surrogate metric for oncological adequacy, and a none-inferior inguinal recurrence rate. Larger randomized studies are encouraged to investigate long-term outcome and survival rates using these minimally-invasive techniques for ILND.
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Herbreteau, Guillaume, Sandrine Charpentier, Audrey Vallée, and Marc G. Denis. "Use of circulating tumoral DNA to guide treatment for metastatic melanoma." Pharmacogenomics 20, no. 18 (December 2019): 1259–70. http://dx.doi.org/10.2217/pgs-2019-0097.
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The management of metastatic cutaneous melanoma is conditioned by the identification of BRAF-activating mutations in tumor DNA. Tumor genotyping is usually performed on DNA extracted from tissue samples. However, these invasive samples are rarely repeated during follow-up, and their analysis requires a sample pre-treatment which may take several weeks. Circulating tumor DNA (ctDNA), released into blood by cancer cells, is a good alternative to tissue sampling. ctDNA is not subject to tumor heterogeneity, and can be analyzed rapidly, making possible the detection of mutations in emergency or in patients whose tumor cannot be sampled. ctDNA can also be analyzed repeatedly during follow-up, for postresection minimal residual disease assessment, for therapeutic response monitoring and for early relapse detection.
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Wentao, L., and N. Toleska Dimitrovska. "EP1.18-31 Miniport Video-Assisted Thoracic Surgery Technique - A New Minimal Invasive Approach for Treatment of Lung Cancer: Case Report." Journal of Thoracic Oncology 14, no. 10 (October 2019): S1107. http://dx.doi.org/10.1016/j.jtho.2019.08.2511.
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Hanekamp, Eline E., Liesbeth M. Kühne, J. Anton Grootegoed, Curt W. Burger, and Leen J. Blok. "Progesterone receptor A and B expression and progestagen treatment in growth and spread of endometrial cancer cells in nude mice." Endocrine-Related Cancer 11, no. 4 (December 2004): 831–41. http://dx.doi.org/10.1677/erc.1.00844.
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In endometrial cancer, decreased expression of progesterone receptor (PR) isotypes A and B (PRA and PRB) is a feature of poorly differentiated tumours. In distant metastases, PRB is the predominantly expressed isotype and endometrial cancer cells that express PRB have been observed to be more invasive. Furthermore, PRB-associated in vitro invasion is markedly inhibited by progestagens. In the present study, ovariectomized mice were injected intraperitoneally with Ishikawa endometrial cancer cells that express only PRA, only PRB, both PRA and PRB, or no PR. Half of the mice were substituted with medroxyprogesterone acetate (MPA). After ten weeks, growth and spread of the cancer cells were examined macroscopically, microscopically, and by PCR detection. Without MPA substitution, cells that express only PRB were found to be the most proliferative and migrative, while cells that express only PRA, both receptor isotypes, or no PR, showed minimal growth and spread. MPA appeared to inhibit growth and spread of PR-positive cells. Surprisingly, when mice that were inoculated with PR-negative cells were substituted with MPA, this resulted in massive abdominal tumour growth. These results provide further evidence that over-expression of PRB in endometrial cancer contributes to the development of a more aggressive phenotype. MPA inhibits tumour growth and spread of PR-positive cells, but can also have an indirectly stimulating effect on PR-negative tumour cells, probably through a host-mediated response.
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Piper, Charlotte, Robin Epplen, Thomas van Erps, David J. K. P. Pfister, Daniel Porres, and Axel Heidenreich. "Palliative transurethral resection in men with castration-resistant prostate cancer (CRPC): Minimally invasive procedure with minimal morbidity?" Journal of Clinical Oncology 30, no. 5_suppl (February 10, 2012): 233. http://dx.doi.org/10.1200/jco.2012.30.5_suppl.233.
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233 Background: About 20 to 30% of men with CRPC with a prostate in situ will develop subvesical obstruction due to locally progressing prostate cancer with time. Treatment options include palliative TURP, urinary diversion by transurethral or suprapubic catheters. There are only few reports critically evaluating the outcome of palliative TURP and the development of associated symptoms of locally progressing CRPC. Methods: We retrospectively reviewed all patients who underwent palliative TURP for locally advanced CRPC with regard to the functional and oncological outcome. In addition, we analysed the frequency of complications associated with locally advanced (LA) CRPC. Patient with incidental prostate cancer were excluded from the analysis. Results: Between 2004–2010 a total of 83 patients were identified. The mean age of the patients was 76 (60–91) years. Mean PSA at time of TURP was 78 (1–253) ng/ml. Initial therapy included androgen deprivation monotherapy in 67.8%, radiation therapy in 28.6% and active surveillance in 3.4%.The mean size of the prostate was 40 (15–130) ml, the mean resected prostate weight was 18.6 (2–56) g. The mean Gleason score was 8.3 (6–10). The indication for palliative TURP was subvesical obstruction with a postvoid residual urine > 100ml in 68.8 %, recurrent gross hematuria in 13.2% and acute urinary retention in 18.1%. 19 (2.9%) pts demonstrated uni- or bilateral upper urinary tract obstruction necessitating drainage by endoluminal stenting or percutaneous nephrostomy. The mean catheterization time was 3.4 (2–6) days; postoperative complications developed in 15 (18.1%) pts and included: urinary retention in 2 pts, intravesical blood clots in 3 pts, permanent suprapubic catheter in 3 pts, stress urinary incontinence in 2 pts and re-do TURP in 3 pts. Perioperative mortality was 0% and after a mean follow-up of 3.6 years, 27 (32.5%) pts had died due to prostate cancer. Conclusions: Palliative TURP in men with LA-CRPC is fairly safe, but side effects are higher compared to conventional TURP. Due to a high frequency of involvement, the upper urinary tract has to be screened prior to palliative TURP.
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Hart, M. R., A. M. Steely, T. A. James, and L. E. McCahill. "Patient factors influencing choice for mastectomy." Journal of Clinical Oncology 29, no. 27_suppl (September 20, 2011): 264. http://dx.doi.org/10.1200/jco.2011.29.27_suppl.264.
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264 Background: The process of shared decision-making in the surgical management of breast cancer is complex. Many women eligible for breast conservation therapy (BCT) still choose total mastectomy (TM), and little is known about the factors responsible for their decision. We conducted a pilot, qualitative study in order to determine factors influencing the selection of TM over BCT, and to improve our understanding of patient’s concerns and priorities in their decision-making process for breast cancer surgery. Methods: Data were collected from a four-year, prospective Breast Cancer Surgical Quality Database. Study participants included female patients with invasive carcinoma who, despite being eligible for BCT, elected to undergo TM. Eligibility criteria included women with no contraindications to BCT, tumor size <2cm, and no evidence of extensive microcalcifications. Patients with tumor recurrence, multicentric disease, scleroderma, and lupus were excluded. Patients were contacted by phone and administered a survey designed to elicit the specific factors affecting their decision to undergo TM. Results: Out of 670 patients treated for IDC/ILC between 2003 and 2007, 12 met eligibility criteria and were subsequently interviewed. 10 patients identified fear of recurrence as the prevailing factor in their decision to undergo TM, and 5 patients identified availability of breast reconstruction as a moderate to strong influence in their decision to undergo TM. Time away from work and transportation during radiation therapy had minimal or no influence. Conclusions: Our results indicate that patients with small, invasive breast cancers who chose TM for their surgical treatment, despite being eligible for BCT, were primarily influenced by fear of recurrence. These decision factors persisted despite treatment at a multidisciplinary center, where patients are informed of equivalent survival and minimal difference in recurrence with appropriate BCT. These results highlight the need for further assessment of patient education and comprehension, as well as greater awareness of emotional factors which may influence a patient’s decision regarding the surgical management of her breast cancer.
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Parisi, Alessandro, Giampiero Porzio, Fanny Pulcini, Katia Cannita, Corrado Ficorella, Vincenzo Mattei, and Simona Delle Monache. "What Is Known about Theragnostic Strategies in Colorectal Cancer." Biomedicines 9, no. 2 (February 1, 2021): 140. http://dx.doi.org/10.3390/biomedicines9020140.
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Despite the paradigmatic shift occurred in recent years for defined molecular subtypes in the metastatic setting treatment, colorectal cancer (CRC) still remains an incurable disease in most of the cases. Therefore, there is an urgent need for new tools and biomarkers for both early tumor diagnosis and to improve personalized treatment. Thus, liquid biopsy has emerged as a minimally invasive tool that is capable of detecting genomic alterations from primary or metastatic tumors, allowing the prognostic stratification of patients, the detection of the minimal residual disease after surgical or systemic treatments, the monitoring of therapeutic response, and the development of resistance, establishing an opportunity for early intervention before imaging detection or worsening of clinical symptoms. On the other hand, preclinical and clinical evidence demonstrated the role of gut microbiota dysbiosis in promoting inflammatory responses and cancer initiation. Altered gut microbiota is associated with resistance to chemo drugs and immune checkpoint inhibitors, whereas the use of microbe-targeted therapies including antibiotics, pre-probiotics, and fecal microbiota transplantation can restore response to anticancer drugs, promote immune response, and therefore support current treatment strategies in CRC. In this review, we aim to summarize preclinical and clinical evidence for the utilization of liquid biopsy and gut microbiota in CRC.
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Horst, Vernon D., Hetal D. Patel, and Stan C. Hewlett. "Robotic Transhiatal Esophagectomy in a Community Hospital: Evolution of Technique." American Surgeon 82, no. 8 (August 2016): 730–32. http://dx.doi.org/10.1177/000313481608200832.
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Esophageal cancer is an uncommon but highly lethal disease. Surgical resection is the gold standard of treatment for early-stage disease. Traditional surgical approach entailed significant convalescence, hospital stay, and morbidity and mortality. Transhiatal esophagectomy (THE) involves blind dissection of the esophagus with minimal mediastinal lymphadenectomy. Integration of robotic surgery is an alternate platform for minimally invasive approach while maintaining safety and following oncologic principles. We review our technique for minimally invasive THE using robotic technology, demonstrating the safety and efficacy of robotic technology surgery. We present a retrospective review of a single surgeon's data of patients treated with robotic-assisted THE, with a chart review to evaluate pathology, adequacy of surgical resection, nodal harvest, and perioperative course. Robotic THE (rTHE) shows promise as a valid option for esophageal resection, including premalignant and advanced stages of cancer. Adequate transhiatal mediastinal nodal resection can be performed with the robot.