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  1. Article ; Online: Principles of Surgical Management of Peritoneal Mesothelioma.

    Steadman, Jessica A / Grotz, Travis E

    Journal of the National Comprehensive Cancer Network : JNCCN

    2023  Volume 21, Issue 9, Page(s) 981–986

    Abstract: Malignant peritoneal mesothelioma (MPeM) is a rare malignancy and represents 5% to 30% of malignant mesothelioma cases. The primary curative therapy for MPeM is radical cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC), ... ...

    Abstract Malignant peritoneal mesothelioma (MPeM) is a rare malignancy and represents 5% to 30% of malignant mesothelioma cases. The primary curative therapy for MPeM is radical cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC), with the strongest predictor of long-term survival being complete cytoreduction. There is a paucity of high-quality evidence available to guide management in MPeM; however, NCCN Guidelines for the management of MPeM were updated this year. In well-selected patients, 5-year overall survival exceeds 65%, but achieving optimal results requires careful preoperative evaluation and expert surgical management. Preoperative patient selection includes histology review and staging with cross-sectional imaging. Ideal candidates for curative intent surgery are those with epithelioid MPeM, a low peritoneal cancer index, and a good performance status. Contraindications to curative intent surgery include the sarcomatoid MPeM, distant metastases, extensive nodal metastases, and extensive small bowel serosal or mesentery involvement not amenable to complete cytoreduction. Those with biphasic histology, bicavitary disease, and metastatic lymphadenopathy may be considered for surgery following response to neoadjuvant therapy. CRS involves resection of all peritoneal disease, the extent of which varies case by case. Key aspects involve careful evaluation of all peritoneal surfaces, complete parietal peritonectomy and omentectomy, and evaluating suspicious abdominal lymph node basins. Once maximum cytoreduction is achieved, HIPEC is performed using a platinum-based perfusate. Postoperative protocols are recommended to optimize recovery and mitigate HIPEC-specific complications, namely chemotherapy-mediated nephrotoxicity and bone marrow suppression.
    MeSH term(s) Humans ; Mesothelioma, Malignant ; Mesothelioma/surgery ; Cytoreduction Surgical Procedures ; Lymph Nodes
    Language English
    Publishing date 2023-09-05
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 2250759-0
    ISSN 1540-1413 ; 1540-1405
    ISSN (online) 1540-1413
    ISSN 1540-1405
    DOI 10.6004/jnccn.2023.7055
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  2. Article ; Online: Omitting hemicolectomy for patients with appendiceal neuroendocrine tumours of 1-2 cm.

    Halfdanarson, Thorvardur R / Grotz, Travis E / Gudmundsdottir, Hallbera / Cleary, Sean P

    The Lancet. Oncology

    2023  Volume 24, Issue 5, Page(s) e189

    MeSH term(s) Humans ; Neuroendocrine Tumors/surgery ; Neuroendocrine Tumors/pathology ; Appendiceal Neoplasms/surgery ; Appendiceal Neoplasms/pathology ; Colectomy/adverse effects ; Patients ; Appendectomy/adverse effects ; Retrospective Studies
    Language English
    Publishing date 2023-05-05
    Publishing country England
    Document type Letter ; Comment
    ZDB-ID 2049730-1
    ISSN 1474-5488 ; 1470-2045
    ISSN (online) 1474-5488
    ISSN 1470-2045
    DOI 10.1016/S1470-2045(23)00122-5
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  3. Article ; Online: Cytoreduction and Hyperthermic Intraperitoneal Paclitaxel and Cisplatin for Gastric Cancer with Peritoneal Metastasis.

    Buckarma, EeeLN / Thiels, Cornelius A / Jin, Zhaohui / Grotz, Travis E

    Annals of surgical oncology

    2023  Volume 31, Issue 1, Page(s) 622–629

    Abstract: Background: Peritoneal metastasis (PM) is the most common site of dissemination of gastric cancer (GC) and is associated with a poor prognosis. Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) for GC with PM remains ... ...

    Abstract Background: Peritoneal metastasis (PM) is the most common site of dissemination of gastric cancer (GC) and is associated with a poor prognosis. Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) for GC with PM remains controversial due to modest survival and significant morbidity.
    Methods: We conducted a retrospective analysis of patients with GC and PM treated with CRS and HIPEC with cisplatin and paclitaxel for 90 min from June 2019 to December 2022.
    Results: Twenty-two patients were included and received a median of 7 (interquartile range [IQR] 4-8) cycles of neoadjuvant systemic therapy. Seventeen patients (77%) underwent a single neoadjuvant laparoscopic HIPEC, and six (27%) patients received chemoradiation. The median Peritoneal Carcinomatosis Index at the time of CRS was 1 (IQR 0-4), and 21 patients (95%) underwent complete cytoreduction (CC-0). An R0 resection was achieved in 20 (91%) patients, and the median length of stay was 5.5 (IQR 4-7.5) days. There were six (27%) 90-day major complications (Clavien-Dindo grade ≥ 3), one (4%) Common Terminology Classification for Adverse Events (CTCAE) grade 4 cytopenia, and one (4%) acute kidney injury. The rate of anastomotic leak (all grades) was 14%, the 30-day readmission rate was 18%, and the 90-day mortality rate was 0%. At a median follow-up of 24 months, the median progression-free survival (PFS) and overall survival (OS) were not reached. The 1-, 2-, and 3-year PFS rates were 65%, 56%, and 40%, respectively, and the 1-, 2-, and 3-year OS rates were 96%, 78%, and 55%, respectively.
    Conclusions: CRS and HIPEC with paclitaxel and cisplatin is well tolerated and is associated with favorable oncologic and perioperative outcomes.
    MeSH term(s) Humans ; Cisplatin ; Stomach Neoplasms/pathology ; Combined Modality Therapy ; Cytoreduction Surgical Procedures ; Peritoneal Neoplasms/secondary ; Paclitaxel ; Retrospective Studies ; Hyperthermia, Induced ; Antineoplastic Combined Chemotherapy Protocols/therapeutic use ; Survival Rate
    Chemical Substances Cisplatin (Q20Q21Q62J) ; Paclitaxel (P88XT4IS4D)
    Language English
    Publishing date 2023-10-26
    Publishing country United States
    Document type Journal Article
    ZDB-ID 1200469-8
    ISSN 1534-4681 ; 1068-9265
    ISSN (online) 1534-4681
    ISSN 1068-9265
    DOI 10.1245/s10434-023-14379-2
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  4. Article: Advancements and challenges in treating advanced gastric cancer in the West.

    Leiting, Jennifer L / Grotz, Travis E

    World journal of gastrointestinal oncology

    2019  Volume 11, Issue 9, Page(s) 652–664

    Abstract: Gastric cancer is a leading cause of cancer incidence and death worldwide. Patients with advanced gastric cancer benefit from a multi-modality treatment regimen. Sound oncologic resection with negative margins and complete lymphadenectomy plays a crucial ...

    Abstract Gastric cancer is a leading cause of cancer incidence and death worldwide. Patients with advanced gastric cancer benefit from a multi-modality treatment regimen. Sound oncologic resection with negative margins and complete lymphadenectomy plays a crucial role in long-term survival for patients with resectable disease. The utilization of minimally invasive techniques for gastric cancer has been slowly increasing and is proving to be both technically and oncologically safe. Perioperative chemotherapy is the current standard of care for advanced gastric cancer. A variety of chemotherapy regimens have been used with the combination of docetaxel, oxaliplatin, 5-fluorouracil, and leucovorin being the current recommendation given its superior ability to induce a complete pathologic response and prolong survival. The use of radiation has been more controversial with its optimal place in the treatment sequence being unclear. There are current ongoing studies assessing the impact of radiation as an adjunct or in place of chemotherapy. Targeted treatments (
    Language English
    Publishing date 2019-09-17
    Publishing country China
    Document type Journal Article ; Review
    ZDB-ID 2573696-6
    ISSN 1948-5204
    ISSN 1948-5204
    DOI 10.4251/wjgo.v11.i9.652
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  5. Article ; Online: Surgical Management of Metastatic Gastrointestinal Stromal Tumors.

    Yonkus, Jennifer A / Alva-Ruiz, Roberto / Grotz, Travis E

    Current treatment options in oncology

    2021  Volume 22, Issue 5, Page(s) 37

    Abstract: Opinion statement: Treatment with the tyrosine kinase inhibitor (TKI), imatinib is the standard first-line treatment for metastatic gastrointestinal stromal tumors (GISTs). Unfortunately, acquired c-kit mutations cause secondary resistance to imatinib ... ...

    Abstract Opinion statement: Treatment with the tyrosine kinase inhibitor (TKI), imatinib is the standard first-line treatment for metastatic gastrointestinal stromal tumors (GISTs). Unfortunately, acquired c-kit mutations cause secondary resistance to imatinib in a median of 18-24 months. Sunitinib and regorafenib are multi-kinase inhibitors that can be used as second-line or third-line therapy in imatinib-resistant or -intolerant GISTs, respectively. Ripretinib (a switch-control tyrosine kinase inhibitor) has recently been approved for fourth-line treatment in metastatic GIST. The TKI avapritinib has been approved for metastatic GIST harboring the imatinib-resistant PDGFRA exon 18 mutation. Although TKI therapies have revolutionized the treatment of metastatic GISTs, they cannot cure metastatic GISTs. Therefore, cytoreductive surgery is of considerable interest and has been accordingly investigated. Retrospective non-randomized studies demonstrated the feasibility and safety of continuous TKI therapy and surgical resection. Most studies demonstrate response to TKI therapy, completeness of resection, extent of disease, and surgical complexity as predictors of outcomes. Most TKIs can be stopped shortly before surgery and restarted shortly after. There is no known survival benefit from debulking operations or R2 resections and this should not be considered. However, debulking/palliative surgery may be necessary for patients with complications of hemorrhage, pain, or intestinal obstruction. SDH-deficient GISTs have an indolent natural history despite metastatic disease and may be another uncommon subgroup that would benefit from surgical debulking (R2 resection). At the time of operation, care should be taken to avoid tumor rupture. After surgical resection, patients should resume tyrosine kinase inhibitor (TKI) therapy as soon as possible and be monitored for disease progression. In all patients with metastatic GIST, the decision to pursue metastasectomy for GIST should be made in a multidisciplinary setting and be individualized according to patient age, comorbidities, functional status, symptoms, mutation status, extent of disease, completeness of resection, TKI response, and goals of the patient.
    MeSH term(s) Antineoplastic Agents/therapeutic use ; Combined Modality Therapy ; Cytoreduction Surgical Procedures ; Gastrointestinal Neoplasms/diagnostic imaging ; Gastrointestinal Neoplasms/drug therapy ; Gastrointestinal Neoplasms/pathology ; Gastrointestinal Neoplasms/surgery ; Gastrointestinal Stromal Tumors/diagnostic imaging ; Gastrointestinal Stromal Tumors/drug therapy ; Gastrointestinal Stromal Tumors/pathology ; Gastrointestinal Stromal Tumors/surgery ; Humans ; Metastasectomy ; Patient Selection ; Preoperative Care ; Protein Kinase Inhibitors/therapeutic use
    Chemical Substances Antineoplastic Agents ; Protein Kinase Inhibitors
    Language English
    Publishing date 2021-03-20
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 2057351-0
    ISSN 1534-6277 ; 1527-2729
    ISSN (online) 1534-6277
    ISSN 1527-2729
    DOI 10.1007/s11864-021-00837-0
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  6. Article ; Online: Gastrointestinal Glomus Tumors: A Single Institution, 20-Year Retrospective Study.

    Zironda, Andrea / Grotz, Travis E / Folpe, Andrew L / Thiels, Cornelius A

    The Journal of surgical research

    2022  Volume 283, Page(s) 982–991

    Abstract: Introduction: Glomus tumors are rare mesenchymal neoplasms composed of cells resembling those of the thermoregulatory glomus body, typically occurring in the skin and superficial soft tissues. Rarely do they occur in the gastrointestinal tract, in ... ...

    Abstract Introduction: Glomus tumors are rare mesenchymal neoplasms composed of cells resembling those of the thermoregulatory glomus body, typically occurring in the skin and superficial soft tissues. Rarely do they occur in the gastrointestinal tract, in particular the stomach, where they have been the subject of case reports and small series. We present our institutional experience with gastrointestinal glomus tumors.
    Methods: A retrospective review of all gastrointestinal glomus tumors was conducted across all three Mayo Clinic sites in Minnesota, Arizona, and Florida from 2001 to 2021. Patient characteristics, pathologic findings, imaging features, operative reports, and clinical outcomes were abstracted. Descriptive statistics were utilized to report outcomes.
    Results: Nine patients with glomus tumors were identified (five men and four women). The median age was 53 [interquartile range (IQR), 44-69] y. Four patients presented with abdominal discomfort, three had anemia or bleeding, and two tumors were incidentally diagnosed. Computed tomography scans identified masses thought to represent gastrointestinal stromal tumors or neuroendocrine tumors in all patients. The tumors were localized to the stomach in all cases, specifically in the gastric antrum. Seven patients underwent preoperative endoscopy, including five with endoscopic ultrasonography. Endoscopic biopsies were interpreted as glomus tumors (n = 3), neuroendocrine tumors (n = 2), and nondiagnostic (n = 2). All patients underwent open (n = 3) or minimally invasive (n = 6) margin-negative resection by wedge resection (n = 5) or distal gastrectomy (n = 4). No nodal metastases were identified radiographically or on pathologic examination. The median tumor size was 2.5 [IQR 1.3-3.4] cm. All tumors showed at least in part typical glomus tumor morphology and smooth muscle actin expression. Aberrant synaptophysin expression was present in the two tumors initially classified as NET. Using the current WHO criteria, tumors were classified as histologically malignant (n = 1) and of "uncertain malignant potential" (n = 8). At a median follow-up of 15 [IQR 1-56] mo, all patients were asymptomatic and without recurrence. Two patients died of unrelated causes. No patients received adjuvant therapies.
    Conclusions: Our 20-year, single institution, 3-site experience with resected gastrointestinal glomus tumors suggests the rarity, predisposition to involve the gastric antrum, and potentially an indolent clinical behavior of many of these tumors. Long-term follow-up is warranted as some previously reported gastric glomus tumors have metastasized, including cases lacking morphologic evidence of malignancy. Surgical resection, with minimally invasive wedge resection alone, is likely sufficient for the management of most gastric glomus tumors.
    MeSH term(s) Female ; Humans ; Male ; Middle Aged ; Gastrointestinal Neoplasms/diagnosis ; Gastrointestinal Neoplasms/surgery ; Gastrointestinal Stromal Tumors/diagnosis ; Gastrointestinal Stromal Tumors/surgery ; Glomus Tumor/diagnosis ; Glomus Tumor/surgery ; Glomus Tumor/pathology ; Neuroendocrine Tumors ; Retrospective Studies ; Stomach Neoplasms/diagnosis ; Stomach Neoplasms/surgery ; Adult ; Aged
    Language English
    Publishing date 2022-12-10
    Publishing country United States
    Document type Journal Article
    ZDB-ID 80170-7
    ISSN 1095-8673 ; 0022-4804
    ISSN (online) 1095-8673
    ISSN 0022-4804
    DOI 10.1016/j.jss.2022.10.070
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  7. Article ; Online: ASO Visual Abstract: Outcomes of Neoadjuvant Chemotherapy for Invasive Intraductal Papillary Mucinous Neoplasm Compared with De Novo Pancreatic Adenocarcinoma.

    Fogliati, Alessandro / Zironda, Andrea / Fiorentini, Guido / Adjei, Stella / Amro, Abdelrahman / Starlinger, Patrick P / Grotz, Travis E / Warner, Susanne G / Smoot, Rory L / Thiels, Cornelius A / Kendrick, Michael L / Cleary, Sean P / Truty, Mark J

    Annals of surgical oncology

    2024  

    Language English
    Publishing date 2024-04-26
    Publishing country United States
    Document type Journal Article
    ZDB-ID 1200469-8
    ISSN 1534-4681 ; 1068-9265
    ISSN (online) 1534-4681
    ISSN 1068-9265
    DOI 10.1245/s10434-024-15016-2
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  8. Article ; Online: Disparities in tyrosine kinase inhibitor use in older patients with gastrointestinal stromal tumors.

    Ho, Thanh P / Dykhoff, Hayley / Sangaralingham, Lindsey R / Siontis, Brittany L / Grotz, Travis E / Okuno, Scott H / Robinson, Steven I

    Journal of geriatric oncology

    2023  Volume 14, Issue 4, Page(s) 101441

    MeSH term(s) Humans ; Aged ; Gastrointestinal Stromal Tumors/drug therapy ; Tyrosine Kinase Inhibitors ; Protein Kinase Inhibitors/therapeutic use ; Imatinib Mesylate/therapeutic use
    Chemical Substances Tyrosine Kinase Inhibitors ; Protein Kinase Inhibitors ; Imatinib Mesylate (8A1O1M485B)
    Language English
    Publishing date 2023-01-28
    Publishing country Netherlands
    Document type Letter ; Research Support, Non-U.S. Gov't
    ZDB-ID 2556813-9
    ISSN 1879-4076 ; 1879-4068
    ISSN (online) 1879-4076
    ISSN 1879-4068
    DOI 10.1016/j.jgo.2023.101441
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  9. Article: Optimizing outcomes for patients with gastric cancer peritoneal carcinomatosis.

    Leiting, Jennifer L / Grotz, Travis E

    World journal of gastrointestinal oncology

    2018  Volume 10, Issue 10, Page(s) 282–289

    Abstract: Peritoneal carcinomatosis (PC) from gastric cancer has traditionally been considered a terminal progression of the disease and is associated with poor survival outcomes. Positive peritoneal cytology similarly worsens the survival of patients with gastric ...

    Abstract Peritoneal carcinomatosis (PC) from gastric cancer has traditionally been considered a terminal progression of the disease and is associated with poor survival outcomes. Positive peritoneal cytology similarly worsens the survival of patients with gastric cancer and treatment options for these patients have been limited. Recent advances in multimodality treatment regimens have led to innovative ways to care for and treat patients with this disease burden. One of these advances has been to use neoadjuvant therapy to try and convert patients with positive cytology or low-volume PC to negative cytology with no evidence of active peritoneal disease. These strategies include the use of neoadjuvant systemic chemotherapy alone, using neoadjuvant laparoscopic heated intraperitoneal chemotherapy (NLHIPEC) after systemic chemotherapy, or using neoadjuvant intraperitoneal and systemic chemotherapy (NIPS) in a bidirectional manner. For patients with higher volume PC, cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) have been mainstays of treatment. When used together, CRS and HIPEC can improve overall outcomes in properly selected patients, but overall survival outcomes remain unacceptably low. The extent of peritoneal disease, commonly measured by the peritoneal carcinomatosis index (PCI), and the completeness of cytoreduction, has been shown to greatly impact outcomes in patients undergoing CRS and HIPEC. The uses of NLHIPEC and NLHIPEC plus NIPS have both been shown to decrease the PCI and thus increase the opportunity for complete cytoreduction. Newer therapies like pressurized intraperitoneal aerosol chemotherapy and immunotherapy, such as catumaxomab, along with improved systemic chemotherapeutic regimens, are being explored with great interest. There is exciting progress being made in the management of PC from gastric cancer and its' treatment is no longer futile.
    Language English
    Publishing date 2018-10-15
    Publishing country China
    Document type Editorial
    ZDB-ID 2573696-6
    ISSN 1948-5204
    ISSN 1948-5204
    DOI 10.4251/wjgo.v10.i10.282
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  10. Article ; Online: Can cryptogenic multifocal ulcerous stenosing enteritis (CMUSE) be diagnosed in a patient with non-steroidal anti-inflammatory drug exposure?

    Osman, Karim T / Maselli, Daniel B / Mounajjed, Taofic M / Grotz, Travis E

    BMJ case reports

    2021  Volume 14, Issue 2

    Abstract: The differential diagnosis for ulcerating small bowel strictures is extensive and includes exposure to non-steroidal anti-inflammatory drugs (NSAIDs), Crohn's disease, infections, gastrointestinal lymphoma and vasculopathy. It also encompasses the ... ...

    Abstract The differential diagnosis for ulcerating small bowel strictures is extensive and includes exposure to non-steroidal anti-inflammatory drugs (NSAIDs), Crohn's disease, infections, gastrointestinal lymphoma and vasculopathy. It also encompasses the exceptionally rare and poorly understood diagnosis of cryptogenic multifocal ulcerative stenosing enterocolitis (CMUSE), often a diagnosis of exclusion and considerable difficulty. We present a case of persistent proximal jejunal ulcerating stenoses in a 75-year-old Caucasian man, which continued despite cessation of NSAIDs. After extensive clinical, radiographic, laboratory and ultimately surgical pathological appraisal-as well as failure to improve with both misoprostol and budesonide-he was diagnosed with CMUSE and managed with limited small bowel resection. In the presentation of this case, we aim to underscore the diagnostic challenges that clinicians face in differentiating CMUSE from other more common diagnoses, particularly NSAIDs-induced enteropathy.
    MeSH term(s) Abdominal Pain/etiology ; Aged ; Anti-Inflammatory Agents, Non-Steroidal ; Anti-Ulcer Agents/therapeutic use ; Constriction, Pathologic ; Diagnosis, Differential ; Enteritis/diagnosis ; Humans ; Intestinal Obstruction/diagnosis ; Intestine, Small/pathology ; Male ; Misoprostol/therapeutic use ; Tomography, X-Ray Computed ; Ulcer/diagnosis
    Chemical Substances Anti-Inflammatory Agents, Non-Steroidal ; Anti-Ulcer Agents ; Misoprostol (0E43V0BB57)
    Language English
    Publishing date 2021-02-04
    Publishing country England
    Document type Case Reports ; Journal Article
    ISSN 1757-790X
    ISSN (online) 1757-790X
    DOI 10.1136/bcr-2020-238160
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