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  • ISSN: 2373-938X
    Early Online
    Volume 5, Issue 2
    Mini Review
    S. Jarboui*, H Triki, H Abouda, Z. Bokal, and N. Bel Hadj Yahya
    Anastomotic leak (AL) after colorectal surgery is a catastrophic complication. It results in increased rates of morbidity, mortality, and depletion in healthcare resources. Anastomotic leaks still occur despite many advances in surgery and the efforts established for diagnosis, management and treatment. Despite the gravity of the complication and potential sequelae, data regarding risk factors and optimal perioperative management of ALs are relatively poor. The lack of a universal definition for AL contributes to the complexity of managing this complication. For treatment options, no firm evidence is available, between repair and saving of the anastomosis or anastomotical breakdown and definitive colostomy.
    In this review, we examine the most common risk factors and their prevalence, preventive measures, diagnostic modalities, and treatment patterns for leak management.
    Case Report
    Menna A. Fouda*, Fawzy Z. Sherif, Amr A. Ghannam, and Safinaz H. Al-shorbagy
    Purpose: To evaluate the prognostic effect of breast cancer subtypes on local relapse rates, distant metastases, and survival in women underwent breast conservative surgery for early stages breast cancer.
    Patients and methods: Data of 100 patients affected by early stage breast cancer and treated with breast-conserving therapy were reviewed. Patients were grouped, based on the basis of receptor status and HER-2 status, patients were grouped, as: luminal A (ER + and/or PR+, Ki67 low and HER2-), luminal B (ER + and/or PR+, Ki67 high and/or HER2+), HER2-positive (ER-, PR- and HER2+) and triple negative (ER-, PR, HER2-). Distribution of variables among subtypes was evaluated with Pearson’s test. Survival rates were calculated with life tables; Cox regression stepwise method was used to identify predictive variables of survival.
    Results: Median age was (range 18-50) and median follow up time of 40 months (range 36.83-43.17). Breast cancer specific survival and distant metastases rates were different among breast cancer subtypes (both outcomes P= 0.001) , there was significant difference regarding local relapse rates (P= 0.002 ). Axillary nodes status (P= 0.007), adjuvant therapy (P= <0.001) and breast cancer subtypes resulted prognostic factors of breast cancer specific survival; axillary node status (P= 0.007) and breast cancer subtypes had an impact on distant metastases.
    Conclusions: In our study, breast cancer subtype seems a prognostic factor of breast cancer specific survival and distant metastases rates & of local relapse rate. Patients could be submitted to conservative surgery, if feasible, but considering the differences in survivals, patients with worse prognosis should receive more aggressive adjuvant treatment.
    Research Article
    Francesca Vignolo Lutati, Cecilia Bracco, Anna Allavena, Paola Ogliara, Guido C. Casalis Cavalchini, Giorgia Mandrile, Daniela F. Giachino, and Barbara Pasini*
    Although approximately 20% of breast cancer cases have a positive family history for the disease, less than 25% of familial cases carry an identified germline mutation in the “high risk” susceptibility genes, BRCA1, BRCA2 and TP53, or in the so called “moderate penetrance” susceptibility genes such as ATM, CHEK2, PALB2, SLX4, BRIP1, BARD1, MRE11A, RAD50 and NBN. These genes are involved in pathways related to DNA repair thus suggesting that a failure in maintaining genome integrity can increase breast cancer risk. Moreover, tumours with impaired DNA repair through homologous recombination as those occurring in BRCA1 or BRCA2 mutation carriers seem particularly sensitive to PARP inhibitors thus underlining the need of a better knowledge of the mechanisms promoting cancer development. With the aim to identify additional breast/ovarian cancer susceptibility genes belonging to the homologous recombination pathway, we focus our attention on SHFM1DSS1, a three exons gene on chromosome 7q encoding a highly conserved protein interacting with the longest region of evolutionary conservation of BRCA2. SHFM1DSS1 analysis in a consecutive series of 944 cases previously screened for BRCA1 and BRCA2 mutations led to the identification of a non-sense germline mutation in a family with four cases of female breast cancer diagnosed between 43 and 77 years. The mutation was absent in 548 healthy controls. Although rare in the Italian population, SHFM1DSS1 germline mutations can potentially increase the risk of breast cancer thus extending the list of cancer susceptibility genes to be considered for testing.
    Michael Chuong, Elizabeth T. Chang, Eun Yong Choi, Javed Mahmood, Rena G Lapidus, Eduardo Davila and France Carrier*
    Radiotherapy (RT) has long been known to be immunogenic. Mounting preclinical data demonstrate a synergistic anti-tumor effect when RT is used in combination with immune check point inhibitors (ICI). However, it is unclear how to best integrate RT with an ICI (i.e. dose fractionation, sequence, etc.). Here we explored the concept that RT delivered as an in situ tumor vaccine sequentially to separate tumors over time might stimulate more potent and rapid antitumor immune response than RT delivered to only one tumor. In essence, radiation to a second tumor could be likened to giving a vaccine “booster shot”. Mice bearing pancreatic tumors in three different sites were injected with anti-PD-L1 antibody and exposed to three daily consecutive fractions of 4 Gy each at one or two sites with a one week interval. Our data indicate that delivering an RT to one tumor followed by an RT “booster shot” to a second tumor, compared to treating only one tumor with RT, significantly reduced tumor growth at a third non-irradiated site. This abscopal effect to the non-irradiated site was observed earlier (day 9) in mice that received RT to two tumors versusa single tumor (day 17). Decreased growth of the non-irradiated tumor correlated with a transient increase of the CD4/CD8 ratio in the tumor, increase myeloid-derived suppressor cells and tumor associated macrophages in the draining lymph nodes. These data warrant further exploration of sequentially treating multiple lesions with RT and ICI with the intent of generating a robust anti-tumor immune response.
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