Almog Ben-Yaacov | Semmelweis University (original) (raw)

Papers by Almog Ben-Yaacov

Journal of Gastrointestinal Surgery

Annals of Surgical Oncology

Publisher's Note Springer Nature remains neutral with regard to jurisdictional claims in publishe... more Publisher's Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

European Journal of Surgical Oncology, 2022

INTRODUCTION Multimodal treatment of patients with advanced pelvic malignancies (APM) is challeng... more INTRODUCTION Multimodal treatment of patients with advanced pelvic malignancies (APM) is challenging and surgical expertise is usually concentrated in highly specialised centres. Given significant regional variation in APM surgery, surgical training represents a cornerstone in standardising and future-proofing of this complex therapy. The aim of this study was to describe the availability and current satisfaction levels with surgical training for APM. MATERIAL AND METHODS An online questionnaire was developed and distributed through the Redcap© platform with 32 questions addressing participant and institution demographics, and training in APM surgeries. The survey was electronically disseminated in 2021 to surgical networks across Europe including all specialities treating APM via the European Society of Surgical Oncology (ESSO). All statistical analysis were performed using R. RESULTS The survey received 280 responses from surgeons across 49 countries, representing general surgery (36%), surgical oncology (30%), gynaeoncology (15%), colorectal surgery (14%) and urology (5%). Fifty-three percent of participants report performing >25 APM procedures/year. Respondents were departmental chiefs (12%), consultants (34%), specialist surgeons (40%) and fellows (15%). 34% were happy/very happy with their training with 70% satisfaction about their exposure to surgical procedures. Respondents reported a lack of standardised training (72%), monitoring tools (41%) and mentorship (56%). 57% rated attended courses as useful for training, while 80% rated visiting expert centres as useful. CONCLUSION This study has identified a learning need for improved structured training in APM, with low current satisfaction levels with exposure to APM training. Organisations such as ESSO provide an important platform for visiting expert centres, courses, and structured training.

Annals of Surgical Oncology, 2020

Background. Synchronous peritoneal and liver metastasis in colorectal cancer is a relative contra... more Background. Synchronous peritoneal and liver metastasis in colorectal cancer is a relative contraindication for curative surgery. We aimed to evaluate the safety and oncological outcomes of combined treatment of peritoneal and liver metastasis. Methods. We conducted a retrospective analysis of metastatic colorectal cancer patients from two prospective databases: peritoneal surface malignancy (n = 536) and hepatobiliary (n = 286). We compared 60 patients treated with cytoreduction and hyperthermic intraperitoneal chemotherapy (HIPEC) and hepatectomy; 80 patients treated with cytoreduction and HIPEC only; and 63 patients treated with hepatectomy alone. Results. No differences in demographics were observed between the groups. Median hospital and intensive care unit (ICU) stay was shorter in group C (7 and 1 days, respectively) versus groups A and B (13 and 1 days, and 12 and 1 days, respectively; p \ 0.001). Postoperative complications were not significantly different. Median follow-up was 18.6, 23.1, and 30.6 months for groups A, B, and C, respectively. Estimated 5-year overall survival (OS) was 48.8% (group A), 55.4% (group B), and 60.2% (group C) [p = 0.043 for group A vs. group C], and estimated 5-year disease-free survival (DFS) was 14.2% (group A), 23.0% (group B), and 18.6% (group C). Five-year OS was superior in group C compared with group A (p = 0.043), and DFS was superior in group C compared with groups A and B (p = 0.043 and 0.03, respectively). The peritoneum was the site of first recurrence in groups A and B (23.3% and 32.5%, respectively), and the liver was the site of first recurrence in group C (44.4%). Conclusions. We report favorable perioperative and oncological outcomes in combined cytoreduction/HIPEC and hepatectomy for patients with peritoneal and liver metastasis. Surgical intervention after multidisciplinary discussion should be considered in patients with both peritoneal and hepatic lesions when complete cytoreduction is feasible. Colorectal cancer (CRC) is the third most common cancer worldwide. 1,2 Almost 50% of patients with CRC will develop metastases during the course of their disease. 3 The most common metastatic sites are the regional lymph Mohammad Adileh, Eyal Mor, Arie Ariche, and Aviram Nissan have contributed equally to this work.

European Journal of Surgical Oncology, 2020

routine haematoxylin-eosin staining. The DMPM exhibits three major histologic subtypes, divided i... more routine haematoxylin-eosin staining. The DMPM exhibits three major histologic subtypes, divided into epithelioid, sarcomatoid, or mixed (biphasic) categories in the updated 2015 World Health Organization classification [15]. A definitive diagnosis of DMPM requires a workup, including immunohistochemistry (IHC). Positive IHC markers are Calretinin (tight junction-associated protein), Cytokeratin 5/6 (intermediate-sized basic keratins), WT-1 (tumour suppressor gene), Podoplanin (transmembrane mucoprotein), and Thrombomodulin (surface glycoprotein involved in the regulation of intravascular coagulation). Negative IHC markers are Claudin 4, TTF-1, and CEA [3]. According to the International Mesothelioma Interest Group (IMIG) 2017 Pathologic Diagnosis Consensus Statement for an accurate diagnosis, an expert second opinion is advised in difficult cases [13]. Recommendation 3 A histological review of the diagnosis of a DMPM by a pathologist with expertise in PSM is mandatory. Level of evidence: A. Strength of recommendation: I. Consensus 27/27 (100%) Recommendation 4 (4.1 to 4.8) The pathologic report must mention the histological subtype, the Ki-67 index and the nodal status (if appropriate). The mention of the sub-classification of epithelioid (tubulopapillary and solid/ deciduoid), the invasiveness, the mitotic rate, the nuclear grade and the nuclear size are optional. 4.1 Histological subtype (epithelioid, biphasic and sarcomatoid) Level of evidence: A. Strength of recommendation: I. Consensus 27/27 (100%) 4.2 Subclassification of epithelioid (tubulopapillary and solid/ deciduoid) Level of evidence: B. Strength of recommendation: II. Consensus 25/27 (92.6%) 4.3 Ki-67 proliferative index Level of evidence: A. Strength of recommendation: I.

International Journal of Surgery Case Reports, 2020

BACKGROUND: Although uncommon, neoplasms of the appendix do exist. The two most common types are ... more BACKGROUND: Although uncommon, neoplasms of the appendix do exist. The two most common types are neuroendocrine tumors and mucinous appendiceal neoplasms. METHODS: In two patients unusual gross and microscopic findings in an appendectomy specimen were recorded. Special immunocytochemistry studies were used to determine the histologic type of the tumors in the appendix. RESULTS: The clinical features and histopathology of two patients who had both a neuroendocrine tumor and a low grade appendiceal mucinous neoplasm in the same appendectomy specimen were described. Possibilities for the causation and treatment of this unusual condition were discussed. The incidence of this double malignancy was estimated at 2.5 in 1000 appendectomy specimens. CONCLUSION: Although extremely unusual, a neuroendocrine tumor and a mucinous appendiceal neoplasm can exist in the same appendix. This condition is reported in two young patients.

The Surgeon, 2018

Background: Cytoreductive surgery and Hyperthermic intra-peritoneal chemotherapy (CRS/ HIPEC) for... more Background: Cytoreductive surgery and Hyperthermic intra-peritoneal chemotherapy (CRS/ HIPEC) for peritoneal surface malignancies is associated with high morbidity. The increased numbers of patients undergoing CRS/HIPEC in recent years mandates risk analysis and quality assurance. However, only scarce data exist regarding causative parameters for readmission. The aim of this study was to assess readmission rates and risk factors associated with readmission. Methods: A retrospective-cohort study including patients from two high-volume centers who underwent CRS/HIPEC surgery between the years 2007e2016 was performed. Patients' demographics, peri-operative data and readmission rates were recorded. Results: 223 patients were included in the study. The 7 and 30-day readmission rates were 3.5% (n ¼ 8) and 11% (n ¼ 25), respectively. Late readmission rates (up to 90 days) were 11% (n ¼ 25). The most common causes of readmission were surgical related infections (35%), small bowel obstruction (17.5%) and dehydration (14%). Post-operative complications were associated with higher readmission rates (p ¼ 0.0001). PCI score was not associated with higher rates of readmission. Conclusion: Readmissions following CRS/HIPEC occur mainly due to infectious complications and dehydrations. Patients following CRS/HIPEC should be discharged after careful investigation to a community based continuing care with access for IV fluid replacement or antibiotics administration when required.

European Journal of Surgical Oncology, 2019

Background: 5-flourouracil is widely used in the adjuvant treatment of gastrointestinal cancers, ... more Background: 5-flourouracil is widely used in the adjuvant treatment of gastrointestinal cancers, alone or in combination with other chemotherapeutic agents. During the course of chemotherapy it can induce a wide variety of cardiotoxic events. The aim of our paper is to present a rare case of 5-flourouracil induced arrhythmia in a patient with sigmoid cancer. Materials and methods: We present the case of a 60 year-old patient with medical history of hypertension that was admitted to our department for left lower quadrant abdominal pain and hematochezia lasting for 3 months. Laboratory findings including tumor markers were normal. Colonoscopy found a 2x2 cm tumor in the lower part of the sigmoid colon (biopsies were taken) confirmed by abdominal CT(computerized tomography) scan Results: The patient underwent surgery and left hemicolectomy with side to end anastomosis. The histopathological exam confirmed R0 resection, the excision of 13 lymph nodes and the diagnosis of adenocarcinoma, pT3N0M0 G2, stage IIB. Post-operative the patient developed an anastomotic leak and a second surgery followed with the implementation of a temporary colostomy. Afterwards the patient was scheduled for chemotherapy. After the second dose she developed clinical sings of cardiac insufficiency that were later confirmed by cardiac ultrasound. The 3 year follow-up visit showed disease free survival with the mention that the patient had a cardiac pacemaker for symptomatic bradycardia. Conclusion: We present this case to raise the awareness regarding the possibility of rare chemotherapy related cardiotoxic event such as arrhythmia and to point out the necessity of a multidisciplinary team in the management of patients with neoplasia. Conflict of interest: No conflict of interest.

Worldwide there has been an increase in the overall life expectancy, which has led to an increase... more Worldwide there has been an increase in the overall life expectancy, which has led to an increase in the aging/elderly population. The incidence of cancer has also increased as age is one of the known risk factors and, consequently, the incidence of patients with peritoneal metastases. Elderly patients with PM pose a therapeutic challenge to peritoneal surface oncologists. They can experience a significant prolongation in survival with CRS and HIPEC which needs to be balanced against the risk of increased morbidity. Preoperative evaluation of functional status using scores like the frailty index helps in selecting patients who have the physical reserve to withstand the procedure irrespective of the chronological age. A multidisciplinary evaluation is also needed to select patients who are most likely to derive a benefit, an oncological benefit. Patients with a low PCI and those who undergo complete cytoreduction and have PM from appendiceal primary tumor or peritoneal mesothelioma d...

Annals of Surgical Oncology

Journal of Surgical Research

Annals of Coloproctology, 2021

One of the most common ileostomy-related complications is high output stoma (HOS) which causes si... more One of the most common ileostomy-related complications is high output stoma (HOS) which causes significant fluids and electrolytes disturbances. We aimed to analyze the incidence, severity, and risk factors for readmission for HOS. Methods: We reviewed all patients who underwent loop ileostomy closure in a single institution between 2010 and 2020. Patients that were readmitted for dehydration due to HOS during the time interval between the creation and the closure of the stoma were identified and divided into a study (HOS) group. The remaining patients constructed the control group. Results: A total of 307 patients were included in this study, out of which, 41 patients were readmitted 73 times (23.7% readmission rate) for the HOS group, and the remaining 266 patients constructed the control group. Multivariate analysis identified; advanced American Society of Anesthesiologists (ASA) physical status (PS) classification, elevated baseline creatinine, and open surgery as risk factors for HOS. Renal function worsened among the entire cohort between the construction of the stoma to its closure (mean creatinine of 0.82 vs. 0.96, P < 0.0001). Conclusion: Loop ileostomy formation is associated with a substantial readmission rate for dehydration as a result of HOS, and increasing the risk for renal impairment during the duration of the diversion. We identified advanced ASA PS classification, open surgery, and elevated baseline creatinine as predictors for HOS.

Management of Peritoneal Metastases- Cytoreductive Surgery, HIPEC and Beyond, 2017

The liver and the peritoneum are two common sites for metastatic cancer spread. When there is iso... more The liver and the peritoneum are two common sites for metastatic cancer spread. When there is isolated cancer spread to either of these organs, surgical resection of the metastatic disease has led to a significant improvement in the overall and disease-free survival both in selected patients compared to systemic chemotherapy alone which was previously the standard of care. At the same time, it is not uncommon for peritoneal metastases (PM) and liver metastases (LM) to occur synchronously. In patients undergoing resection of LM from various primary sites, chiefly colorectal LM, PM may be an incidental finding during the preoperative workup or during the surgical exploration itself. Similarly, in patients with PM being treated with cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC), one or more LM may be detected on preoperative imaging. Though the presence of two sites of metastases was initially a contraindication for a curative approach at either site...

Annals of Surgical Oncology, 2021

Pathological response ratio to systemic therapy following cytoreductive surgery (CRS) and hyperth... more Pathological response ratio to systemic therapy following cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) correlates with survival. Our study supports utilization of preoperative therapy for better patient selection with potential impact on survival (

Annals of Surgical Oncology, 2021

We would like to thank Wu et al. for their interest in our work and their insightful comments, an... more We would like to thank Wu et al. for their interest in our work and their insightful comments, and we also thank the editors of Annals of Surgical Oncology for an opportunity to reply to their comments. First, we would like to address the issue of completeness of cytoreduction, presence of additional non-peritoneal metastasis, and additional treatment strategies on oncological outcomes. We examined our cohorts of initial and repeat procedures and they were indeed similar in regard to these factors; complete cytoreduction (CC0) was 91.6% and 100% in our initial and repeat cohorts, respectively. In regard to extraperitoneal disease, 21.8% and 16.7% of patients had liver metastasis along with their peritoneal disease in the initial and repeat cohorts, respectively. In terms of preoperative chemotherapy, the groups were again similar, with 91.3% and 100% of patients receiving preoperative chemotherapy in the initial and repeat groups, respectively. Unfortunately, we do not have sufficient data to compare the number of cycles and types of preoperative chemotherapy received. Thus, while we agree that these factors are important in assessing the outcomes of patients after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) for colorectal peritoneal metastasis (CRPM), our groups were sufficiently similar in these regards and we do not believe that this affected our results in a significant manner. In terms of patients with high Peritoneal Cancer Index (PCI), being a peritoneal malignancy center of excellence and quaternary referral center, we are often presented with complex patients with significant disease burden and high PCI. After multidisciplinary tumor board evaluation, some patients with higher PCI (12–20) are offered exploration and potentially CRS/HIPEC. As noted in most large CRS/ HIPEC series, surgical PCI often differs significantly from radiological PCI, and, in appropriate patients where suitable CC0 can still be obtained, we will proceed with treatment and results are favorable. Furthermore, as has been previously described, we often find that clinical operative PCI differs significantly from pathological PCI and those patients may benefit despite high operative PCI. Yet, it is clear from our multivariable analysis that indeed high PCI has a negative prognostic effect on overall survival and should be carefully considered in selection. We believe that the fact that these patients were included, and the data still suggest a positive effect of CRS/HIPEC, only further strengthens our conclusions. Wu et al. expressed interest in the overall survival (OS) of both the isolated and repeat CRS/HIPEC groups, and expressed a desire for more clarification about patient selection. The reason OS was not included in the manuscript is that comparing the OS of a group of patients with initial disease with a very highly selected group of patients, all of whom had already recurred, is an unfair comparison given that the latter group clearly have worse biology. In all isolated CRS/HIPEC, the median OS was 62 months, while in the repeat CRS/HIPEC group, the median OS was 38 months (p = 0.049). A more accurate comparison, which we included, is between the OS in all patients who had a peritoneal-only recurrence and compare those who did versus did not undergo repeat CRS/HIPEC. In this Society of Surgical Oncology 2021

Post-operative femoral neuropathy is a rare condition associated with a variety of surgical proce... more Post-operative femoral neuropathy is a rare condition associated with a variety of surgical procedures including colo-rectal resections, inguinal hernia repair, hysterectomy, cystectomy and hip replacement [2-5,8,9,11,14,18]. The underlying mechanism is yet unknown. It is likely to assume that POFN is associated with compression of the nerve by surgical instruments such as a self-retaining retractor or direct injury to the genito-femoral nerve [3,4,8,11,19,22].

Annals of Surgical Oncology, 2021

Background Pathological response of colorectal peritoneal metastasis (CRPM) may affect prognosis.... more Background Pathological response of colorectal peritoneal metastasis (CRPM) may affect prognosis. We investigated the relationship between oncological outcomes and pathological response to chemotherapy of CRPM following cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC). Methods We conducted a retrospective analysis of a prospectively maintained Peritoneal Surface Malignancies database between 2015 and 2020. Analysis included patients with CRPM who underwent a CRS/HIPEC procedure ( n = 178). The cohort was divided into three groups according to the response ratio (ratio of tumor-positive specimens to the total number of specimens resected): Group A, complete response; Group B, high response ratio, and Group C, low response ratio. Results The group demographics were similar, but the overall complication rate was higher in Group C (65.2%) compared with Groups A (55%) and B (42.8%) [ p = 0.03]. Survival correlated to response ratio; the estimated median disease-free survival of Group C was 9.1 months (5.97–12.23), 14.9 months (4.72–25.08) for Group B, and was not reached in Group A ( p = 0.001). The estimated median overall survival in Group C was 35 months (26.69–43.31), and was not reached in Groups A and B ( p = 0.001). Conclusions The pathological response ratio to systemic therapy correlates with survival in patients undergoing CRS/HIPEC. This study supports the utilization of preoperative therapy for better patient selection, with a potential impact on survival.

Annals of Surgical Oncology, 2021

Cytoreductive surgery and heated intraperitoneal chemotherapy (CRS/HIPEC) for colorectal cancer p... more Cytoreductive surgery and heated intraperitoneal chemotherapy (CRS/HIPEC) for colorectal cancer peritoneal metastases (CRPM) is associated with improved survival in patients with historically dismal prognosis. Nonetheless, peritoneal recurrences remain common and represent a difficult challenge in these patients' management. Repeat CRS/HIPEC is associated with even greater morbidity and its survival benefit has not yet been clearly demonstrated. We retrospectively reviewed our prospectively maintained database and aimed to assess the safety and oncological efficacy of repeat CRS/HIPEC. Two hundred thirty-two patients underwent an initial CRS/HIPEC, whereas 30 subsequently had repeat CRS/HIPEC for CRPM. Groups were similar in demographics, comorbidities, and peritoneal cancer index (PCI). No significant difference in morbidity, hospital stay, or reoperation rate was noted between initial and repeat procedures. Patients who underwent repeat CRS/HIPEC had a median overall survival of 68 months versus 51 months in patients who did not undergo repeat procedure for their peritoneal recurrence (p = 0.03). Disease-free survival (DFS) in patients after repeat and after initial procedure were similar with median of 9.6 versus 12 months, respectively (p = 0.083). Univariate analysis demonstrated that PCI, DFS, and repeat procedure displayed significant factors on outcomes in patients with peritoneal recurrences, whereas PCI > 16 and DFS remained independent predictors on multivariable analysis. Our analysis, which represents the largest series to date of repeat CRS/HIPEC for CRPM, indicates that this approach as a part of multimodal therapy is both safe and efficacious in appropriately selected patients.

Journal of Gastrointestinal Surgery

Annals of Surgical Oncology

European Journal of Surgical Oncology, 2022

Annals of Surgical Oncology, 2020

European Journal of Surgical Oncology, 2020

International Journal of Surgery Case Reports, 2020

The Surgeon, 2018

European Journal of Surgical Oncology, 2019

Annals of Surgical Oncology

Journal of Surgical Research

Annals of Coloproctology, 2021

Management of Peritoneal Metastases- Cytoreductive Surgery, HIPEC and Beyond, 2017

Annals of Surgical Oncology, 2021