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Article ; Online: Cumulative Burden of Postoperative Complications in Patients Undergoing Surgery for Primary Retroperitoneal Sarcoma.

Tirotta, Fabio / Parente, Alessandro / Hodson, James / Desai, Anant / Almond, L Max / Ford, Samuel J

2021 Volume 28, Issue 12, Page(s) 7939–7949

Abstract: Background: Correlations between postoperative complications and oncological outcomes have been reported in several malignancies, but their impact in retroperitoneal sarcoma (RPS) is unclear. Our study aimed to evaluate the association between ... ...

Abstract	Background: Correlations between postoperative complications and oncological outcomes have been reported in several malignancies, but their impact in retroperitoneal sarcoma (RPS) is unclear. Our study aimed to evaluate the association between postoperative complications and prognosis in patients with RPS. Methods: Patients undergoing surgery for primary RPS from 2008 to 2019 at a sarcoma center were evaluated. The cumulative burden of postoperative complications was quantified using the Comprehensive Complication Index (CCI), and associations with local recurrence (LR), distant metastases (DM) and overall survival (OS) were assessed. Results: Data were available for 191 patients, of whom 160 (82.9%) developed at least one postoperative complication, with a median CCI of 20.9 (interquartile range 8.7-33.5). After postoperative deaths were excluded (n = 3, 1.6%), the remaining patients were divided into those with a CCI of 0-20.9 (n = 97) and > 20.9 (n = 91). Patients with a CCI >20.9 had significantly shorter OS than those with a CCI of 0-20.9 (43.3% vs. 69.5% at 5 years; p = 0.005), and this difference remained significant after multivariable adjustment for patient- and treatment-related factors [hazard ratio (HR) 2.31, 95% confidence interval (CI) 1.30-4.09; p = 0.004]. However, CCI > 20.9 was not found to be a significant independent predictor of either LR (HR 1.30, 95% CI 0.76-2.23; p = 0.333) or DM (HR 1.08, 95% CI 0.61-1.93; p = 0.786). Conclusion: Increasing complication burden, as quantified by the CCI, is a significant independent predictor of OS; however, there is no evidence of a significant association with either LR or DM, which may be more related to tumor biological factors.
MeSH term(s)	Humans ; Neoplasm Recurrence, Local ; Postoperative Complications/etiology ; Retroperitoneal Neoplasms/surgery ; Retrospective Studies ; Sarcoma/surgery ; Survival Rate
Language	English
Publishing date	2021-05-12
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/s10434-021-10059-1
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Article ; Online: Risk Factors for the Development of Early Recurrence in Patients with Primary Retroperitoneal Sarcoma.

Tirotta, Fabio / Fadel, Michael G / Baia, Marco / Parente, Alessandro / Messina, Valentina / Bassett, Paul / Almond, L Max / Ford, Samuel J / Desai, Anant / van Houdt, Winan J / Strauss, Dirk C

Annals of surgical oncology

2023 Volume 30, Issue 11, Page(s) 6875–6883

Abstract: Background: Disease recurrence after retroperitoneal sarcoma (RPS) surgery is common, and resection may offer no benefit for patients who experience recurrence early. This study examined the incidence of early recurrence (EREC) in RPS patients, and the ... ...

Abstract	Background: Disease recurrence after retroperitoneal sarcoma (RPS) surgery is common, and resection may offer no benefit for patients who experience recurrence early. This study examined the incidence of early recurrence (EREC) in RPS patients, and the association between EREC and prognosis, aiming to identify the factors associated with EREC. Methods: Patients undergoing surgery for primary RPS from 2008 to 2019 at two tertiary RPS centers were analyzed. The study defined EREC as any evidence of local recurrence and/or distant metastases on the CT scan up to 6 months after surgery. Overall survival (OS) was calculated using the Kaplan-Meier method. A multivariable analysis was performed to identify independent predictors of EREC. Results: Of the 692 patients who underwent surgery during the study period, 657 were included in the analysis. Sixty-five of these patients (9.9%; 95% confidence interval [CI], 7.7-12.4%) developed EREC. Five-year OS was 3% for the patients with EREC versus 76% for those without EREC (p < 0.001). Patient characteristics were compared between the EREC and non-EREC patients, and EREC was found to be significantly associated with Eastern Cooperative Oncology Group (ECOG) performance status (p = 0.006), tumor histology (p = 0.002), tumor grading (p < 0.001), radiotherapy (p = 0.04), and postoperative complications measured as a comprehensive complications index value (p = 0.003). However, the only significant independent predictor of EREC in the multivariable analysis was grade 3 tumors, with an odds ratio of 14.8 (95% CI, 4.44-49.2; p < 0.001). Conclusion: Early recurrence is associated with a poor prognosis, and a high tumor grade is an independent predictor for the development of EREC. Patients with EREC may benefit the most from new therapeutic options such as neoadjuvant chemotherapy.
MeSH term(s)	Humans ; Neoplasm Recurrence, Local ; Sarcoma/pathology ; Retroperitoneal Neoplasms/pathology ; Retroperitoneal Space/pathology ; Soft Tissue Neoplasms ; Risk Factors ; Retrospective Studies
Language	English
Publishing date	2023-07-09
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/s10434-023-13754-3
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Article ; Online: Considerations on "Impact of centralisation of services on outcomes in a rare tumour: Retroperitoneal sarcomas".

Tirotta, Fabio / Desai, Anant / Ford, Samuel J / Strauss, Dirk C / Almond, L Max

European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology

2019 Volume 46, Issue 4 Pt A, Page(s) 706–707

MeSH term(s)	Humans ; Retroperitoneal Neoplasms ; Sarcoma ; Soft Tissue Neoplasms
Language	English
Publishing date	2019-10-19
Publishing country	England
Document type	Letter ; Comment
ZDB-ID	632519-1
ISSN	1532-2157 ; 0748-7983
ISSN (online)	1532-2157
ISSN	0748-7983
DOI	10.1016/j.ejso.2019.10.025
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Article ; Online: Advanced endoscopic imaging in Barrett's oesophagus.

Almond, L Max / Barr, Hugh

International journal of surgery (London, England)

2012 Volume 10, Issue 5, Page(s) 236–241

Abstract: Barrett's oesophagus is a metaplastic condition with an inherent risk of progression to adenocarcinoma. It is essential to identify dysplastic changes within Barrett's oesophagus in order to individualise surveillance strategies and establish which ... ...

Abstract	Barrett's oesophagus is a metaplastic condition with an inherent risk of progression to adenocarcinoma. It is essential to identify dysplastic changes within Barrett's oesophagus in order to individualise surveillance strategies and establish which patients warrant endoscopic treatment. There is a trend towards endoscopic resection of focal high-grade dysplasia followed by whole segment ablation. However, endoscopic identification of dysplastic lesions is unreliable and subjective making targeted therapy extremely difficult. In addition, the current practice of taking random quadrantic biopsies may miss dysplastic disease and intramucosal adenocarcinoma. Several advanced endoscopic imaging techniques have been described and tested in clinical trials in an effort to improve the detection of early lesions, although none are routinely used in clinical practice. In this article we will review these techniques and discuss their potential for clinical implementation. We will also discuss the potential benefits of multimodal imaging and highlight several newer techniques which have shown early promise for in vivo diagnosis.
MeSH term(s)	Barrett Esophagus/diagnosis ; Barrett Esophagus/pathology ; Esophagoscopy/methods ; Humans ; Microscopy, Confocal ; Spectrometry, Fluorescence ; Spectrum Analysis, Raman ; Tomography, Optical Coherence
Language	English
Publishing date	2012-04-14
Publishing country	England
Document type	Journal Article ; Review
ZDB-ID	2212038-5
ISSN	1743-9159 ; 1743-9191
ISSN (online)	1743-9159
ISSN	1743-9191
DOI	10.1016/j.ijsu.2012.04.003
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Article ; Online: Association Between Ageing and Short-Term Survival Outcomes in Patients Undergoing Surgery for Primary Retroperitoneal Sarcoma.

Tirotta, Fabio / Fadel, Michael G / Hodson, James / Parente, Alessandro / Wilkerson, Helene / Almond, L Max / Ford, Samuel J / Hayes, Andrew J / Desai, Anant / Strauss, Dirk C

Annals of surgical oncology

2022 Volume 29, Issue 12, Page(s) 7320–7330

Abstract: Background: As the population ages, more elderly patients are receiving surgery for retroperitoneal sarcoma (RPS). However, high-quality data investigating associations between ageing and prognosis are lacking. Our study aimed to investigate whether ... ...

Abstract	Background: As the population ages, more elderly patients are receiving surgery for retroperitoneal sarcoma (RPS). However, high-quality data investigating associations between ageing and prognosis are lacking. Our study aimed to investigate whether ageing is associated with inferior short-term survival outcomes after RPS surgery. Patients and methods: Patients undergoing surgery for primary RPS between 2008 and 2019 at two tertiary sarcoma centres were analysed. The primary outcome was 1-year mortality, and the primary explanatory variable was patient age, classified as: < 55, 55-64, 65-74 or 75+ years. Results: The 692 patients undergoing surgery (mean age 60.8 ± 13.8 years) had a 1-year mortality rate of 9.4%, which differed significantly by age (p < 0.001), with rates of 7.2%, 6.9%, 8.7% and 22.8% for the < 55, 55-64, 65-74 and 75+ years groups, respectively. The distribution of causes of death also differed significantly by age (p = 0.023), with 22% and 28% of deaths in the 65-74 and 75+ years groups caused by post-operative complications, versus none in the < 55 and 55-64 years groups. On multivariable analysis, age of 75+ years (versus < 55 years) was a significant independent predictor of 1-year mortality [odds ratio (OR) 7.05, 95% confidence interval (CI) 2.63-18.9, p < 0.001]; no significant increase in risk was observed in the 55-64 (OR 0.72, 95% CI 0.28-1.87) or 65-74 (OR 0.89, 95% CI 0.37-2.15) years groups. Conclusions: Post-operative complications are an important cause of deaths in elderly patients. These findings are relevant to decision-making and counselling when surgery is considered for patients with RPS.
MeSH term(s)	Aged ; Aging ; Humans ; Middle Aged ; Postoperative Complications/mortality ; Retroperitoneal Neoplasms/mortality ; Retroperitoneal Neoplasms/surgery ; Sarcoma/mortality ; Sarcoma/surgery ; Survival Rate
Language	English
Publishing date	2022-07-19
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/s10434-022-12231-7
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Article ; Online: Improved Biopsy Accuracy in Retroperitoneal Dedifferentiated Liposarcoma.

Tirotta, Fabio / Morosi, Carlo / Hodson, James / Desai, Anant / Barisella, Marta / Ford, Samuel J / Gronchi, Alessandro / Almond, L Max / Fiore, Marco

Annals of surgical oncology

2020 Volume 27, Issue 11, Page(s) 4574–4581

Abstract: Background: Biopsy sensitivity in retroperitoneal dedifferentiated liposarcoma (DDLPS) is variable. Patients with grade 3 DDLPS face a significant risk of metastatic disease and may potentially benefit from neoadjuvant therapy, making highly accurate ... ...

Abstract	Background: Biopsy sensitivity in retroperitoneal dedifferentiated liposarcoma (DDLPS) is variable. Patients with grade 3 DDLPS face a significant risk of metastatic disease and may potentially benefit from neoadjuvant therapy, making highly accurate pretherapy diagnosis essential. Our study aimed to establish whether diagnostic sensitivity could be improved by targeting solid areas of tumor on percutaneous biopsy. Methods: Between 2016 and 2019, data on patients with suspected primary retroperitoneal sarcoma who underwent a biopsy were collected, and diagnostic accuracy was calculated. These data were compared with our previously reported series from 2005 to 2016. For DDLPS tumors, comparisons were then made between biopsies that targeted the solid component and those that did not. Results: Data were available for 121 patients in the current series and 238 from the previous study. The proportion of biopsies returning a histological subtype concordant with postoperative pathology was 83% in the current series, marking a significant improvement over our previous study (67%, p = 0.001). For diagnosis of DDLPS, biopsy sensitivity improved from 40 to 74% (p < 0.001), with an increase from 13 to 50% (p = 0.006) where grade 3 DDLPS was treated as a separate disease. Within the current series, targeted biopsy yielded a sensitivity of 100% for identifying DDLPS, compared with 10% in nontargeted biopsy (p < 0.001). Conclusion: Systematic targeting of solid areas of tumor within suspected retroperitoneal liposarcoma has improved sensitivity for detection of both DDLPS and grade 3 DDLPS on biopsy. This approach minimizes the risk of underdiagnosis of patients with DDLPS who could benefit from neoadjuvant chemotherapy.
MeSH term(s)	Biopsy ; Cell Dedifferentiation ; Humans ; Liposarcoma/pathology ; Liposarcoma/surgery ; Retroperitoneal Neoplasms/pathology ; Retroperitoneal Neoplasms/surgery ; Retrospective Studies
Language	English
Publishing date	2020-05-04
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/s10434-020-08519-1
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Article ; Online: Neoadjuvant and adjuvant strategies in retroperitoneal sarcoma.

Almond, L Max / Gronchi, Alessandro / Strauss, Dirk / Jafri, Mariam / Ford, Samuel / Desai, Anant

European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology

2018 Volume 44, Issue 5, Page(s) 571–579

Abstract: Extended surgery remains the mainstay of treatment in retroperitoneal sarcoma, although conflicting data exist on the benefit of neoadjuvant and adjuvant therapies, particularly with regard to tumour grade and histological type. Experience of ... ...

Abstract	Extended surgery remains the mainstay of treatment in retroperitoneal sarcoma, although conflicting data exist on the benefit of neoadjuvant and adjuvant therapies, particularly with regard to tumour grade and histological type. Experience of radiotherapy and chemotherapy in extremity soft tissue sarcoma can inform treatment strategies, however these data cannot be universally extrapolated to the retroperitoneum where disease biology and anatomical considerations are different. The present review sets a historical context before discussing recent evidence and on-going multi-centre trials in retroperitoneal sarcoma. Promising data on histologically- and molecularly-targeted chemotherapy are discussed and the need for centralisation of retroperitoneal sarcoma services in order to facilitate large international collaborative trials is emphasised.
MeSH term(s)	Chemotherapy, Adjuvant ; Humans ; Neoadjuvant Therapy ; Radiotherapy, Adjuvant ; Retroperitoneal Neoplasms/therapy ; Sarcoma/therapy
Language	English
Publishing date	2018
Publishing country	England
Document type	Journal Article ; Review
ZDB-ID	632519-1
ISSN	1532-2157 ; 0748-7983
ISSN (online)	1532-2157
ISSN	0748-7983
DOI	10.1016/j.ejso.2018.02.001
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Zs.MO 549: Show issues

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Article ; Online: Strategies for the prevention of oesophageal adenocarcinoma.

Almond, L Max / Old, Oliver / Barr, Hugh

International journal of surgery (London, England)

2014 Volume 12, Issue 9, Page(s) 931–935

Abstract: The incidence of oesophageal adenocarcinoma has increased by 500% over the past 30 years [1]. Improved understanding of the mechanisms of neoplastic progression provides an opportunity to reverse this trend. A thorough review of emerging strategies ... ...

Abstract	The incidence of oesophageal adenocarcinoma has increased by 500% over the past 30 years [1]. Improved understanding of the mechanisms of neoplastic progression provides an opportunity to reverse this trend. A thorough review of emerging strategies aiming to prevent the formation of oesophageal malignancy is presented. These include dietary modification, chemoprevention, early endoscopic identification and treatment of premalignant disease, and the potential for a non-endoscopic screening test. Oesophageal adenocarcinoma has become a major public health problem in the West and it is essential that clinicians are fully informed of risk reduction strategies so that they can be actively promoted in the community.
MeSH term(s)	Adenocarcinoma/prevention & control ; Anti-Inflammatory Agents, Non-Steroidal/therapeutic use ; Barrett Esophagus/diagnosis ; Barrett Esophagus/therapy ; Diet ; Endoscopy ; Enzyme Inhibitors/therapeutic use ; Esophageal Neoplasms/prevention & control ; Humans ; Precancerous Conditions/diagnosis ; Precancerous Conditions/therapy
Chemical Substances	Anti-Inflammatory Agents, Non-Steroidal ; Enzyme Inhibitors
Language	English
Publishing date	2014-08-01
Publishing country	England
Document type	Journal Article ; Review
ZDB-ID	2212038-5
ISSN	1743-9159 ; 1743-9191
ISSN (online)	1743-9159
ISSN	1743-9191
DOI	10.1016/j.ijsu.2014.07.273
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Article ; Online: Biphasic malignant tumours of the abdominal cavity.

Almond, L Max / Warfield, Adrian T / Desai, Anant / Gourevitch, David / Ford, Samuel J

International journal of clinical oncology

2017 Volume 22, Issue 4, Page(s) 635–640

Abstract: Carcinosarcomas (CS) are uncommon, highly aggressive, biphasic tumours consisting of both sarcomatous and carcinomatous elements. They appear to originate from a common cell of origin, either via transformation from a single premature precursor or ... ...

Abstract	Carcinosarcomas (CS) are uncommon, highly aggressive, biphasic tumours consisting of both sarcomatous and carcinomatous elements. They appear to originate from a common cell of origin, either via transformation from a single premature precursor or conversion of a mature epithelial cell through an epithelial-mesenchymal transition. CS should be considered a unique cancer subtype with cells typically displaying diffuse mitotic activity and widespread atypical mitoses predisposing to early metastasis and a tendency to local recurrence following resection. This review addresses the pathophysiology of CS and discusses its presentation, natural history and management at a variety of sites within the abdominal cavity and retroperitoneum.
MeSH term(s)	Abdominal Cavity/pathology ; Abdominal Neoplasms/pathology ; Abdominal Neoplasms/therapy ; Carcinoma, Renal Cell/epidemiology ; Carcinoma, Renal Cell/physiopathology ; Carcinoma, Renal Cell/therapy ; Carcinosarcoma/pathology ; Carcinosarcoma/therapy ; Epithelial-Mesenchymal Transition ; Female ; Humans ; Kidney Neoplasms/epidemiology ; Kidney Neoplasms/physiopathology ; Kidney Neoplasms/therapy ; Ovarian Neoplasms/epidemiology ; Ovarian Neoplasms/physiopathology ; Ovarian Neoplasms/therapy ; Sarcoma/pathology ; Sarcoma/therapy ; Uterine Neoplasms/epidemiology ; Uterine Neoplasms/physiopathology ; Uterine Neoplasms/therapy
Language	English
Publishing date	2017-08
Publishing country	Japan
Document type	Journal Article ; Review
ZDB-ID	1400227-9
ISSN	1437-7772 ; 1341-9625
ISSN (online)	1437-7772
ISSN	1341-9625
DOI	10.1007/s10147-017-1153-7
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Article ; Online: Myeloid Sarcoma: Presentation, Diagnosis, and Treatment.

Almond, L Max / Charalampakis, Maria / Ford, Samuel J / Gourevitch, David / Desai, Anant

Clinical lymphoma, myeloma & leukemia

2017 Volume 17, Issue 5, Page(s) 263–267

Abstract: Myeloid sarcoma is an extramedullary tumor of immature granulocytic cells. It is a rare condition, most often associated with acute myeloid leukemia (AML), although in some rare cases it may present in nonleukemic patients. It should therefore be ... ...

Abstract	Myeloid sarcoma is an extramedullary tumor of immature granulocytic cells. It is a rare condition, most often associated with acute myeloid leukemia (AML), although in some rare cases it may present in nonleukemic patients. It should therefore be considered as a differential diagnosis of any atypical cellular infiltrate. It may occur at any site, leading to very varied clinical presentations. Diagnosis is challenging and relies on a high index of suspicion as well as radiology, histology, immunophenotyping, and molecular analyses, which also are essential for risk stratification and treatment planning. Systemic chemotherapy using AML-like regimens should be commenced early, even in nonleukemic disease. Surgery and/or radiotherapy may be indicated for symptomatic lesions or tumors causing local organ dysfunction or obstruction. Allogeneic hematopoietic stem cell transplantation has demonstrated promising results, particularly in patients who achieved complete remission with AML-induction protocols, and recent advances in genetic profiling may enable the development of novel targeted therapies. Prospective multicenter controlled trials are required to further refine management decisions and investigate the role of novel targeted therapies.
Language	English
Publishing date	2017-05
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	2540992-X
ISSN	2152-2669 ; 2152-2650
ISSN (online)	2152-2669
ISSN	2152-2650
DOI	10.1016/j.clml.2017.02.027
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