Our aim was to retrospectively assess the diagnostic performance from combined positron emission tomography/computed tomography (PET/CT) and magnetic resonance imaging (MRI) for the detection of bone marrow invasion of the mandible or maxilla in patients with oral cavity squamous cell carcinoma (OCSCC). A total of 114 patients with OCSCC, arising from or abutting the upper or lower alveolar ridge, underwent staging PET/CT and MRI studies before surgery. The possibility of bone marrow invasion on PET/CT and MRI was graded retrospectively on a 5-point score. Histopathology was taken as the reference standard. Sensitivity, specificity, predictive values and likelihood ratios were calculated. Clinical factors affecting the performance, like tumor origin and dentate status were also explored. PET/CT was found to be more specific than MRI (83% vs. 61%, respectively, p=0.0015) but less sensitive (78% vs. 97%, respectively, p=0.0391). Dentate status and tumor origin affected the diagnostic performance of PET/CT. In patients with positive MRI, sensitivity and specificity of PET/CT were 78% and 100% in dentate patients with alveolar ridge tumors, 75% and 80% in dentate patient with buccal tumors, 90% and 33% in edentulous patients with alveolar ridge tumors and 0% and 63% for edentulous patients with buccal tumors, respectively. PET/CT is more specific than MRI and can be used to complement the role of MRI. A negative MRI result can confidently exclude the presence of bone marrow invasion, while in patients with positive MRI findings, a negative PET/CT may be useful to rule out bone marrow invasion in dentate patients.

OBJECTIVES: We sought to determine potential prognostic value of total lesion glycolysis (TLG) calculated from combined positron emission tomography/computed tomography (PET/CT) in patients with oral cavity squamous cell carcinoma (OSCC). MATERIALS AND METHODS: We prospectively studied 126 patients with OSCC who underwent PET/CT before definitive treatment by radical surgery. The metabolic tumor volume (MTV) was calculated for the primary tumor according to an absolute standardized uptake value (SUV) of 3. TLG was calculated as MTV × the average SUV. The nodal SUVmax was also recorded. The median value of SUVmax and TLG were used to divide the patients into two categories (high and low). Patients were followed up until death or for at least 24 months from their surgery. Disease-free (DFS) and disease-specific survivals (DSS) were the main outcome measures. RESULTS: The median TLG of the primary tumor ((T)TLG) was 71.4, and the median nodal SUVmax ((N)SUV) was 7.5. Patients with high (T)TLG (≥ median) had a 2-year DFS of 52% whereas the DFS was 74% for those with a low (T)TLG (P=0.007); the 2-year-DSS rates were 53% vs. 84%, respectively (P0.001). Similarly, patients with high (N)SUVmax (≥ median) had a 2-year DFS of 42% vs. 70% for patients with a low (N)SUVmax (P=0.001); the 2-year-DSS rates were 39% vs. 78%, respectively (P0.001). In multivariate analyses, (T)TLG, (N)SUVmax, and pathological nodal status were independent prognostic factors for the 2-year DSS. A 3-point prognostic scoring system was formulated based on the presence or absence of the independent factors. Patients with positive neck nodes, high (N)SUVmax, and high (T)TLG (score 3) had a 32-fold higher risk of cancer death compared with those lacking such risk factors (2-year-DSS=26% vs. 97%, P0.001). CONCLUSION: Primary tumor TLG is an independent prognostic factor for cancer control and survival in patients with OSCC. A prognostic scoring system that includes primary tumor TLG, nodal SUVmax, and pathological neck status may be useful for risk stratification in this group of patients.

Purpose To investigate the prognostic significance of standardized uptake value (SUV) of metastatic neck lymph nodes measured on FDG PET/CT in patients with stage IV oro/hypopharyngeal cancers treated by definitive chemoradiotherapy (CCRT). Methods Retrospective analysis of 65 patients with clinically N+ stage IV SCC of the oro/hypopharyngeal squamous cell carcinoma (SCC) who underwent FDG PET/CT scans for primary staging. Follow-up continued till death or at least 24 months from the start of treatment. The primary study endpoint was neck control (NC). The log-rank test and Cox proportional hazard analysis were used to identify significant prognostic factors. Results The 3-year NC rate was 53%. In univariate analysis, N3 status and nodal SUV ≥ 9.8 were significantly associated with reduced NC. In multivariable analyses, nodal SUV retained its independent prognostic significance as a predictor of NC. Lymph node stage was an independent predictor of disease specific survival (DSS). A prognostic scoring system was constructed as follows: score 0 = N0-N2 and nodal SUV 9.8; score 1 = N3 or nodal SUV ≥ 9.8; and score 2 = N3 and nodal SUV ≥ 9.8. Patients with a score of 2 showed the worst NC (hazard ratio [HR], 95% confidence interval [CI]= 10.5, 3.3-33.1; P 0.001) and the lowest DSS (HR, 95% CI = 6.4, 2.2-18.7; P = 0.001). Conclusion The combination of high nodal SUV and N3 neck disease identifies a subgroup of high-risk stage IV oro/hypopharyngeal SCC patients. Further prospective studies are warranted to validate this finding.

This commentary addresses strengths and weaknesses of the clinical trial study protocol designed by Liu et al., in particular with regard of the methodology, taking into consideration the commentary article "Assessing surgical methods for treatment of cubital tunnel syndrome - which is the best?" Our commentary emphasizes the importance of adjustment for known prognostic covariates, such as duration of symptoms and advanced age that have been negatively correlated with outcomes in previous studies. Subgroup analysis for the treatment groups of interest, namely moderate and severe cubital tunnel syndrome, which have previously shown conflicting differences in efficacy of surgical options is highly recommended. Intention-to-treat analysis is a preferable approach for the evaluation of primary outcome measures to lessen the bias. Use of well-validated composite outcome measure is strongly encouraged.

Background: Seroma formation after breast surgery could result in significant morbidity and subsequent delay to commence the adjuvant therapy. A prospective randomized study was done to assess the effect of obliterating the axillary dead space by sutures with Flap fixation after Breast cancer surgery either by Modified Radical Mastectomy (MRM) or Conservative Breast Surgery (CBS) prospectively. In addition, Factors predicting the formation of seroma were analyzed and reported. Methods: A total of 164 patients diagnosed as Breast cancer, they were randomized to have the post mastectomy dead space obliterated (intervention group) or standard wound closure (control group) following either MRM or CBS. Those had immediate reconstruction were excluded from the study. Drains were routinely left in place until the preceding 48-hour output was 30 milliliters/day. The duration of the drains left in place and the incidence of seroma formation were reported. A multivariate analysis for the potential factors associated with seroma formation was done. Results: Fifty -eight (n=58) patients were assigned to the treatment group and 106 (n=106) to the control group. MRM was performed on 105 patients (64%) and CBS on 59 (36%). Ten of the 58 patients (17.2%) in the intervention group developed a seroma in comparison to 33 of the 106 control patients (31.1%) (P=0.03). There was a significant reduction in the duration of suction drain in situ with obliteration of the dead space (P=0.001). No statistically significant differences were observed between intervention and control groups with respect to patient and pathological parameters or the incidence of other wound complications. Multivariate analysis revealed that Significant risk factors for seroma formation were Diabetes Mellitus (DM) (P=0.01), neoadjuvant CTH (P=0.019), number of retrieved L node (P=0.019), and dead space obliteration (P=0.04). Conclusion: On multivariate analysis, the most significant factors affecting seroma formation were DM, neoadjuvant CTH, number of retrieved L node and Dead Space Obliteration. Dead Space Obliteration following breast cancer surgery is a simple technique that reduces the time of suction tubal drainage, and incidence of seroma formation.

Background: Gallbladder cancer (GBC) represents the most common and aggressive biliary tract cancer with overall 5-year survival being only 5%–10%. Survival following resection, especially in early stages, has shown some improvement due to advances in surgical treatment. Advanced stages, however, continue to have dismal outcome. Complete surgical resection offers the only chance for cure, which extended from simple cholecystectomy to major hepatectomy or enbloc resection of adjacent organs. The aim of this study was to examine the predictors of longterm survival in patients with gall bladder cancer. Methods: We retrospectively evaluated 38 patients who underwent curative (R0) resection for GBC between January 2001 and December 2010 in Surgical Oncology Department, South Egypt Cancer Institute, Assiut University, Egypt. Surgical procedures included simple cholecystectomy (10.5%), radical cholecystectomy (75.4%), bile duct resection (33.8), and right hepatectomy (7.8%). Adjacent organ resection was performed in (23.4%), duodenal sleeve resection (10.4%), segmental colectomy (5.2%), segmental gastrectomy (2.6%), Hepatopancreatico-duodenectomy (5.3 %). Adjuvant chemotherapy was given for (68.4%) of patients and adjuvant radiotherapy for (36.8%) of patients. Median follow up period of the patients was 38 months (0.5-69 months). Results: The median disease free survival (DFS) for GBC patients was 38 months. Univariate analysis revealed that patient’s age, comorbidities, weight loss, jaundice, tumor differentiation, organ invasion, lymph node metastasis, perineural invasion, tumor stage and chemotherapy were associated with the patient’s survival. Of these, weight loss, jaundice, lymph node metastasis and tumor stage were found to influence the overall survival on the multivariate Cox Hazard Regression analysis. First year overall survival estimate was 86.84% ±5.5%, 2nd year = 71.05% ± 7.4%, Third year 60.53% ± 7.9% fifth year =15.79% ± 5.9%. Conclusion: Curative surgical resection remains the only effective approach for treatment of GBC. This study confirms that jaundice, weight loss and aggressive tumor (advanced stage and regional lymph nodes metastasis) are predictors of poor prognosis.

Background: Gallbladder cancer (GBC) represents the most common and aggressive biliary tract cancer with overall 5-year survival being only 5%–10%. Survival following resection, especially in early stages, has shown some improvement due to advances in surgical treatment. Advanced stages, however, continue to have dismal outcome. Complete surgical resection offers the only chance for cure, which extended from simple cholecystectomy to major hepatectomy or enbloc resection of adjacent organs. The aim of this study was to examine the predictors of longterm survival in patients with gall bladder cancer. Methods: We retrospectively evaluated 38 patients who underwent curative (R0) resection for GBC between January 2001 and December 2010 in Surgical Oncology Department, South Egypt Cancer Institute, Assiut University, Egypt. Surgical procedures included simple cholecystectomy (10.5%), radical cholecystectomy (75.4%), bile duct resection (33.8), and right hepatectomy (7.8%). Adjacent organ resection was performed in (23.4%), duodenal sleeve resection (10.4%), segmental colectomy (5.2%), segmental gastrectomy (2.6%), Hepatopancreatico-duodenectomy (5.3 %). Adjuvant chemotherapy was given for (68.4%) of patients and adjuvant radiotherapy for (36.8%) of patients. Median follow up period of the patients was 38 months (0.5-69 months). Results: The median disease free survival (DFS) for GBC patients was 38 months. Univariate analysis revealed that patient’s age, comorbidities, weight loss, jaundice, tumor differentiation, organ invasion, lymph node metastasis, perineural invasion, tumor stage and chemotherapy were associated with the patient’s survival. Of these, weight loss, jaundice, lymph node metastasis and tumor stage were found to influence the overall survival on the multivariate Cox Hazard Regression analysis. First year overall survival estimate was 86.84% ±5.5%, 2nd year = 71.05% ± 7.4%, Third year 60.53% ± 7.9% fifth year =15.79% ± 5.9%. Conclusion: Curative surgical resection remains the only effective approach for treatment of GBC. This study confirms that jaundice, weight loss and aggressive tumor (advanced stage and regional lymph nodes metastasis) are predictors of poor prognosis.

Background: Gallbladder cancer (GBC) represents the most common and aggressive biliary tract cancer with overall 5-year survival being only 5%–10%. Survival following resection, especially in early stages, has shown some improvement due to advances in surgical treatment. Advanced stages, however, continue to have dismal outcome. Complete surgical resection offers the only chance for cure, which extended from simple cholecystectomy to major hepatectomy or enbloc resection of adjacent organs. The aim of this study was to examine the predictors of longterm survival in patients with gall bladder cancer. Methods: We retrospectively evaluated 38 patients who underwent curative (R0) resection for GBC between January 2001 and December 2010 in Surgical Oncology Department, South Egypt Cancer Institute, Assiut University, Egypt. Surgical procedures included simple cholecystectomy (10.5%), radical cholecystectomy (75.4%), bile duct resection (33.8), and right hepatectomy (7.8%). Adjacent organ resection was performed in (23.4%), duodenal sleeve resection (10.4%), segmental colectomy (5.2%), segmental gastrectomy (2.6%), Hepatopancreatico-duodenectomy (5.3 %). Adjuvant chemotherapy was given for (68.4%) of patients and adjuvant radiotherapy for (36.8%) of patients. Median follow up period of the patients was 38 months (0.5-69 months). Results: The median disease free survival (DFS) for GBC patients was 38 months. Univariate analysis revealed that patient’s age, comorbidities, weight loss, jaundice, tumor differentiation, organ invasion, lymph node metastasis, perineural invasion, tumor stage and chemotherapy were associated with the patient’s survival. Of these, weight loss, jaundice, lymph node metastasis and tumor stage were found to influence the overall survival on the multivariate Cox Hazard Regression analysis. First year overall survival estimate was 86.84% ±5.5%, 2nd year = 71.05% ± 7.4%, Third year 60.53% ± 7.9% fifth year =15.79% ± 5.9%. Conclusion: Curative surgical resection remains the only effective approach for treatment of GBC. This study confirms that jaundice, weight loss and aggressive tumor (advanced stage and regional lymph nodes metastasis) are predictors of poor prognosis.

Background: Gallbladder cancer (GBC) represents the most common and aggressive biliary tract cancer with overall 5-year survival being only 5%–10%. Survival following resection, especially in early stages, has shown some improvement due to advances in surgical treatment. Advanced stages, however, continue to have dismal outcome. Complete surgical resection offers the only chance for cure, which extended from simple cholecystectomy to major hepatectomy or enbloc resection of adjacent organs. The aim of this study was to examine the predictors of longterm survival in patients with gall bladder cancer. Methods: We retrospectively evaluated 38 patients who underwent curative (R0) resection for GBC between January 2001 and December 2010 in Surgical Oncology Department, South Egypt Cancer Institute, Assiut University, Egypt. Surgical procedures included simple cholecystectomy (10.5%), radical cholecystectomy (75.4%), bile duct resection (33.8), and right hepatectomy (7.8%). Adjacent organ resection was performed in (23.4%), duodenal sleeve resection (10.4%), segmental colectomy (5.2%), segmental gastrectomy (2.6%), Hepatopancreatico-duodenectomy (5.3 %). Adjuvant chemotherapy was given for (68.4%) of patients and adjuvant radiotherapy for (36.8%) of patients. Median follow up period of the patients was 38 months (0.5-69 months). Results: The median disease free survival (DFS) for GBC patients was 38 months. Univariate analysis revealed that patient’s age, comorbidities, weight loss, jaundice, tumor differentiation, organ invasion, lymph node metastasis, perineural invasion, tumor stage and chemotherapy were associated with the patient’s survival. Of these, weight loss, jaundice, lymph node metastasis and tumor stage were found to influence the overall survival on the multivariate Cox Hazard Regression analysis. First year overall survival estimate was 86.84% ±5.5%, 2nd year = 71.05% ± 7.4%, Third year 60.53% ± 7.9% fifth year =15.79% ± 5.9%. Conclusion: Curative surgical resection remains the only effective approach for treatment of GBC. This study confirms that jaundice, weight loss and aggressive tumor (advanced stage and regional lymph nodes metastasis) are predictors of poor prognosis.

Purpose In this study, we aim to report the efficacy of using the anterior approach (AA) versus the conventional approach (CA), in surgical resection for large hepatocellular carcinoma (HCC) (≥7 cm) of the right hepatic lobe in terms of surgical and long-term outcomes. Materials and Methods Between 2000 and 2006, 138 consecutive patients who underwent hepatic resection with curative intent for large right lobe HCC ≥7 cm were identified from a retrospective database. The 40 patients who had AA were compared with the remaining 98 patients who had CA. Clinicopathological features and surgical results were analyzed and prognostic factors were evaluated by multivariate analysis. Results There was no significant difference between the two groups as regards clinical, laboratory, and pathological parameters. The operative results had shown a comparable proportion of patients who experienced massive operative blood loss and postoperative complications in the two groups. The AA group had a lower recurrence rate (P = 0·015), better diseasefree survival (DFS) (P = 0·001), and overall survival than the CA group. Our study identified that AA is a prognostic factor of both overall survival and disease-free survival for large HCC ≥7 cm. Conclusion The AA is a safe and effective technique for right hepatic resection for large HCC and achieves more advantageous long survival outcome over the CA.