Maria Danieli | Università degli Studi di Milano - State University of Milan (Italy) (original) (raw)

Papers by Maria Danieli

Research paper thumbnail of The current role of laparoscopic resection for HCC: a systematic review of past ten years

Translational Gastroenterology and Hepatology, 2018

The use of laparoscopic liver resection (LLR) has progressively spread in the last 10 years. Seve... more The use of laparoscopic liver resection (LLR) has progressively spread in the last 10 years. Several studies have shown the superiority of LLR to open liver resection (OLR) in term of perioperative outcomes. With this review, we aim to systematically assess short-term and long-term major outcomes in patients who underwent LLR for hepatocellular carcinoma (HCC) in order to illustrate the advantages of minimally invasive liver surgery. Through an advanced PubMed research, we selected all retrospective, prospective, and comparative clinical trials reporting short-term and long-term outcomes of any series of patients with diagnosis of HCC who underwent laparoscopic or robotic resection. Reviews, meta-analyses, or case reports were excluded. None of the patients included in this review has received a previous locoregional treatment for the same tumor nor has undergone a laparoscopic-assisted procedure. We considered morbidity and mortality for evaluation of major short-term outcomes, and overall survival (OS) and diseasefree survival (DFS) for evaluation of long-term outcomes. A total of 1,501 patients from 17 retrospective studies were included, 15 studies compare LLR with OLR. Propensity-score matching (PSM) analysis was used in 11 studies (975 patients). The majority of the studies included patients with good liver function and a single HCC. Cirrhosis at pathology ranged from 33% to 100%. Overall mortality and morbidity ranges were 0-2.4% and 4.9-44% respectively, with most of the complications being Clavien-Dindo grade I or II (range: 3.9-23.3% vs. 0-9.52% for Clavien I-II and ≥ III respectively). The median blood loss ranged from 150 to 389 mL; the range of the median duration of surgery was 134-343 minutes. The maximum rate of conversion was 18.2%. The median duration of hospitalization ranged from 4 to 13 days. The ranges of overall survival rates at 1-, 3-and 5-year were 72.8-100%, 60.7-93.5% and 38-89.7% respectively. The ranges of disease free survival rates at 1-, 3-and 5-year were 45.5-91.5%, 20-72.2% and 19-67.8% respectively. The benefits of LLR in term of complication rate, blood loss, and duration of hospital stay make this procedure an advantageous alternative to OLR, especially for cirrhotic patients in whom the use of LLR reduces the risk of post-hepatectomy liver failure. The limits of LLR can be overcome by robotic surgery, which could therefore be preferred. Further benefits of minimally invasive surgery derive from its ability to reduce the formation of adhesions in view of a salvage liver transplant. In conclusion, the results of this review seem to confirm the safety and feasibility of LLR for HCC as well as its superiority to OLR according to perioperative outcomes.

Research paper thumbnail of From a Philosophical Framework to a Valid Prognostic Staging System of the New “Comprehensive Assessment” for Transplantable Hepatocellular Carcinoma

Cancers, 2019

The comprehensive assessment of the transplantable tumor (TT) proposed and included in the last I... more The comprehensive assessment of the transplantable tumor (TT) proposed and included in the last Italian consensus meeting still deserve validation. All consecutive patients with hepatocellular carcinoma (HCC) listed for liver transplant (LT) between January 2005 and December 2015 were post-hoc classified by the tumor/patient stage as assessed at the last re-staging-time (ReS-time) before LT as follow: high-risk-class (HRC) = stages TTDR, TTPR; intermediate-risk-class (IRC) = TT0NT, TTFR, TTUT; low-risk-class (LRC) = TT1, TT0L, TT0C. Of 376 candidates, 330 received LT and 46 dropped-out. Transplanted patients were: HRC for 159 (48.2%); IRC for 63 (19.0%); LRC for 108 (32.7%). Cumulative incidence function (CIF) of tumor recurrence after LT was 21%, 12%, and 8% at 5-years and 27%, 15%, and 12% at 10-years respectively for HRC, IRC, and LRC (P = 0.011). IRC patients had significantly lower CIF of recurrence after LT if transplanted >2-months from ReS-time (28% vs. 3% for <2 and &...

Research paper thumbnail of ASO Visual Abstract: Refining the Approach to Patients with Primary Soft Tissue Sarcoma of the Extremities and Trunk Wall—Outcome Improvement over Time at a Single Institution

Annals of Surgical Oncology, 2022

The outcome of patients with primary localized adult-type ESTSTS treated at a referral center has... more The outcome of patients with primary localized adult-type ESTSTS treated at a referral center has improved significantly since 2003, possibly thanks to the increased adoption of preoperative treatments and greater availability of medical agents (https://doi.org/10.1245/s10434-021-11 189-2). New treatments are eagerly awaited to further improve outcomes.

Research paper thumbnail of The iGreenGO Study: The Clinical Role of Indocyanine Green Imaging Fluorescence in Modifying the Surgeon’s Conduct During the Surgical Treatment of Advanced Gastric Cancer—Study Protocol for an International Multicenter Prospective Study

Frontiers in Oncology, 2022

BackgroundThe near-infrared/indocyanine green imaging fluorescence (NIR/ICG) technology is showin... more BackgroundThe near-infrared/indocyanine green imaging fluorescence (NIR/ICG) technology is showing promising results in several fields of surgical oncology. The clinical value of NIR/ICG technology in the surgical treatment of advanced gastric cancer (AGC) is not clearly established.MethodsThis is the protocol of the “iGreenGO” (indocyanine Green Gastric Observation) Study, a national prospective multicenter study. Western patients who undergo curative-intent gastrectomy with D2 lymphadenectomy for AGC constitute the study cohort. All the patients undergo preoperative upper gastrointestinal endoscopy for submucosal peritumoral ICG injection at the most 20 h before surgery. Intraoperative endoscopic injection before starting surgical dissection is also allowed. The primary endpoint is the “change in the surgical conduct” (CSC), i.e., the need to perform further dissection after intraoperative NIR/ICG technology activation at the end of D2 lymphadenectomy. Secondary endpoints include ...

Research paper thumbnail of Unplanned Excision of Extremity and Trunk Wall Soft Tissue Sarcoma: To Re-resect or Not to Re-resect?

Annals of Surgical Oncology, 2021

Purpose The need for systematic reexcision in patients who underwent unplanned excision (UE) for ... more Purpose The need for systematic reexcision in patients who underwent unplanned excision (UE) for extremity and superficial trunk soft tissue sarcoma (ESTSTS) has been questioned. We investigated the outcome of patients who underwent reexcision for ESTSTS compared with primarily resected at our institution and the prognostic impact of microscopic residual disease (MR) in the reexcision specimen. Methods Primary ESTSTS patients surgically treated at our institution between 1997 and 2017 were divided in three groups: primarily resected (A), reexcised after macroscopically complete UE (B), and incomplete UE (C). Weighted overall survival (OS), crude cumulative incidence of local relapse (CCI-LR), and distant metastasis (CCI-DM) were calculated and compared. In group B, multivariable models were performed to assess factors associated with the outcomes. Results A total of 1962 patients were identified: 1076, 697 and 189 in groups A, B, and C, respectively. Overall median follow-up was 85 months. Seven-year weighted-OS was 73.8%, 84.1%, and 80.7% ( p < 0.001) for groups A, B, and C respectively. Seven-year CCI-LR and DM were 5.0% and 25.3%, 12.1% and 15.8%, and 13.6% and 29.4% (both p < 0.001) for groups A, B, and C, respectively. At multivariable analysis, the presence MR was associated with LR ( p < 0.001) but not with OS nor CCI-DM. Conclusions UE and the presence of MR at pathology in reexcision specimen are associated to a higher risk of LR but not to a higher risk of DM or lower OS. After macroscopic complete UE, postponing reexcision until a LR occurs may be considered on an individualized basis.

Research paper thumbnail of ASO Author Reflections: Outcome Improvement Over Time in Extremity and Trunk Wall Soft Tissue Sarcomas: To Whom the Merit?

Annals of Surgical Oncology, 2022

Research paper thumbnail of Refining the Approach to Patients with Primary Soft Tissue Sarcoma of the Extremities and Trunk Wall: Outcome Improvement Over Time at a Single Institution

Annals of Surgical Oncology, 2022

The improved outcome of extremity soft tissue sarcoma patients surgically treated until 2007 at t... more The improved outcome of extremity soft tissue sarcoma patients surgically treated until 2007 at the authors’ institution was previously reported. This study updates the analysis at a later follow-up and extends the patients’ cohort to assess changes in outcomes over time for extremity and superficial trunk soft tissue sarcoma (ESTSTS) treated at a single referral center. All consecutive patients with primary localized adult-type ESTSTS surgically treated at the authors’ institution between 1987 and 2017 were included and divided into group 1 (1987–2002) and group 2 (2003–2017) according to primary surgery year. Crude cumulative incidence (CCI) of sarcoma-specific mortality (SSM), local recurrence (LR), and distant metastases (DM) were calculated in a competing-risks framework. DM-free survival (DMFS) and post-DM survival were also assessed. The study identified 2382 patients. The median follow-up was 104 months (range, 63–127 months), and the post-DM follow-up was 76 months (range, 37–126 months). Since 2003, an increased adoption of preoperative treatments was observed: the use of chemotherapy, radiotherapy and combined chemoradiotherapy went from 10.5% to 23.7%, from 1.7% to 17.8%, and from 1% to 11.8% respectively. This change in treatment strategies was associated to an improvement in CCI-SSM (27.8% vs 19.5%; P < 0.001), CCI-LR (14.1 vs 7.5%; P < 0.001), DMFS (57.9% vs 65.8%; P = 0.004), and post-DM (12.2% vs 20.1%; P = 0.012), but not in CCI-DM. Increased adoption of preoperative treatments and greater availability of medical agents in the recent years were associated to better outcomes. New treatments are eagerly awaited for further improvement of outcome for ESTSTS patients because no major changes have been observed since 2003.

Research paper thumbnail of ASO Author Reflections: Reexcision after Macroscopically Complete Unplanned Excision in Extremity and Trunk Wall Soft Tissue Sarcoma: Is Less More?

Several studies have shown that reexcision (RE) after unplanned excision (UE) of extremity and tr... more Several studies have shown that reexcision (RE) after unplanned excision (UE) of extremity and trunk wall soft tissue sarcoma (ETSTS) was able to offset the negative prognostic impact of an unplanned procedure. As a result, RE was long considered a standard procedure for every patient who had undergone UE. However, none of these studies distinguished between macroscopically incomplete and complete UE. Of note, in at least half of the patients, no residual tumor was found in the RE specimen. In addition, the causative relationships between local relapse (LR) and the incidence of distant metastases (DM), and the prognostic significance of microscopic residual disease (MR?) in the RE specimen are still debated. On these grounds, the need for systematic reexcision (RE) in ETSTS patients who undergo macroscopically complete UE is being questioned.

Research paper thumbnail of Laparoscopic Modified Blumgart Anastomosis with a Newly Manufactured and Customized Double Needle Suture

Research paper thumbnail of The prognostic impact of unplanned excision in primary STS of the extremities and trunk wall: Is re-excision always mandatory?

Journal of Clinical Oncology, 2020

e23557 Background: To investigate the outcome of patients affected by soft tissue sarcomas (STS) ... more e23557 Background: To investigate the outcome of patients affected by soft tissue sarcomas (STS) of the extremities and trunk wall who underwent unplanned excision (UE) and the prognostic impact of microscopic residual tumor at re-excision. Methods: All consecutive patients affected by primary STS of the extremity and trunk wall operated at Fondazione IRCCS Istituto Nazionale dei Tumori from Jan 1997 to Dec 2017 were included and divided in 3 groups: patients primarily resected at our institution (group A), patients undergoing re-excision after macroscopically complete UE (group B) and patients undergoing completion resection after macroscopically incomplete UE (group C). Inverse probability treatment weighted overall survival (OS), crude cumulative incidence of local relapse (CCI-LR) and of distant metastasis (CCI-DM) were calculated and compared. Histological subgroup curves were drawn and multivariable models were performed in group B. Results: 1965 patients were identified; 1079...

Research paper thumbnail of How to treat liposarcomas located in retroperitoneum

European Journal of Surgical Oncology

Research paper thumbnail of Refining the approach to patients with primary soft tissue sarcoma of the extremities and trunk wall (ESTSTS): Outcome improvement over 30 years at a single institution

Journal of Clinical Oncology, 2021

e23548 Background: In 2011 we reported the improved outcome of ESTS pts treated between 1987 and ... more e23548 Background: In 2011 we reported the improved outcome of ESTS pts treated between 1987 and 2007 at Istituto Nazionale Tumori (INT), Milan (Italy). We updated the analysis at a later follow-up (FU) to assess possible changes in survival of ESTSTS. Outcomes according to histology were also explored. Methods: Pts with primary localized adult-type ESTSTS surgically treated at INT between 1987 and 2017 were retrospectively reviewed and divided into 6 groups according to the date of primary surgery. Crude cumulative incidence (CCI) of sarcoma-specific mortality (SSM), local relapse (LR), distant metastases (DMs) were calculated for each group in a competing risks framework. DM free survival (DMFS) was calculated for each group taking into account all DMs (occurred as first or later). PostDM survival and all outcomes according to histology were calculated before and after 2002. Results: 2384 pts were included. At a 104-mo m-FU, median post-DM FU was 76 mos. Clinicopathologic characte...

Research paper thumbnail of The current role of laparoscopic resection for HCC: a systematic review of past ten years

Translational Gastroenterology and Hepatology, 2018

The use of laparoscopic liver resection (LLR) has progressively spread in the last 10 years. Seve... more The use of laparoscopic liver resection (LLR) has progressively spread in the last 10 years. Several studies have shown the superiority of LLR to open liver resection (OLR) in term of perioperative outcomes. With this review, we aim to systematically assess short-term and long-term major outcomes in patients who underwent LLR for hepatocellular carcinoma (HCC) in order to illustrate the advantages of minimally invasive liver surgery. Through an advanced PubMed research, we selected all retrospective, prospective, and comparative clinical trials reporting short-term and long-term outcomes of any series of patients with diagnosis of HCC who underwent laparoscopic or robotic resection. Reviews, meta-analyses, or case reports were excluded. None of the patients included in this review has received a previous locoregional treatment for the same tumor nor has undergone a laparoscopic-assisted procedure. We considered morbidity and mortality for evaluation of major short-term outcomes, and overall survival (OS) and diseasefree survival (DFS) for evaluation of long-term outcomes. A total of 1,501 patients from 17 retrospective studies were included, 15 studies compare LLR with OLR. Propensity-score matching (PSM) analysis was used in 11 studies (975 patients). The majority of the studies included patients with good liver function and a single HCC. Cirrhosis at pathology ranged from 33% to 100%. Overall mortality and morbidity ranges were 0-2.4% and 4.9-44% respectively, with most of the complications being Clavien-Dindo grade I or II (range: 3.9-23.3% vs. 0-9.52% for Clavien I-II and ≥ III respectively). The median blood loss ranged from 150 to 389 mL; the range of the median duration of surgery was 134-343 minutes. The maximum rate of conversion was 18.2%. The median duration of hospitalization ranged from 4 to 13 days. The ranges of overall survival rates at 1-, 3-and 5-year were 72.8-100%, 60.7-93.5% and 38-89.7% respectively. The ranges of disease free survival rates at 1-, 3-and 5-year were 45.5-91.5%, 20-72.2% and 19-67.8% respectively. The benefits of LLR in term of complication rate, blood loss, and duration of hospital stay make this procedure an advantageous alternative to OLR, especially for cirrhotic patients in whom the use of LLR reduces the risk of post-hepatectomy liver failure. The limits of LLR can be overcome by robotic surgery, which could therefore be preferred. Further benefits of minimally invasive surgery derive from its ability to reduce the formation of adhesions in view of a salvage liver transplant. In conclusion, the results of this review seem to confirm the safety and feasibility of LLR for HCC as well as its superiority to OLR according to perioperative outcomes.

Research paper thumbnail of From a Philosophical Framework to a Valid Prognostic Staging System of the New “Comprehensive Assessment” for Transplantable Hepatocellular Carcinoma

Cancers, 2019

The comprehensive assessment of the transplantable tumor (TT) proposed and included in the last I... more The comprehensive assessment of the transplantable tumor (TT) proposed and included in the last Italian consensus meeting still deserve validation. All consecutive patients with hepatocellular carcinoma (HCC) listed for liver transplant (LT) between January 2005 and December 2015 were post-hoc classified by the tumor/patient stage as assessed at the last re-staging-time (ReS-time) before LT as follow: high-risk-class (HRC) = stages TTDR, TTPR; intermediate-risk-class (IRC) = TT0NT, TTFR, TTUT; low-risk-class (LRC) = TT1, TT0L, TT0C. Of 376 candidates, 330 received LT and 46 dropped-out. Transplanted patients were: HRC for 159 (48.2%); IRC for 63 (19.0%); LRC for 108 (32.7%). Cumulative incidence function (CIF) of tumor recurrence after LT was 21%, 12%, and 8% at 5-years and 27%, 15%, and 12% at 10-years respectively for HRC, IRC, and LRC (P = 0.011). IRC patients had significantly lower CIF of recurrence after LT if transplanted >2-months from ReS-time (28% vs. 3% for <2 and &...

Research paper thumbnail of ASO Visual Abstract: Refining the Approach to Patients with Primary Soft Tissue Sarcoma of the Extremities and Trunk Wall—Outcome Improvement over Time at a Single Institution

Annals of Surgical Oncology, 2022

The outcome of patients with primary localized adult-type ESTSTS treated at a referral center has... more The outcome of patients with primary localized adult-type ESTSTS treated at a referral center has improved significantly since 2003, possibly thanks to the increased adoption of preoperative treatments and greater availability of medical agents (https://doi.org/10.1245/s10434-021-11 189-2). New treatments are eagerly awaited to further improve outcomes.

Research paper thumbnail of The iGreenGO Study: The Clinical Role of Indocyanine Green Imaging Fluorescence in Modifying the Surgeon’s Conduct During the Surgical Treatment of Advanced Gastric Cancer—Study Protocol for an International Multicenter Prospective Study

Frontiers in Oncology, 2022

BackgroundThe near-infrared/indocyanine green imaging fluorescence (NIR/ICG) technology is showin... more BackgroundThe near-infrared/indocyanine green imaging fluorescence (NIR/ICG) technology is showing promising results in several fields of surgical oncology. The clinical value of NIR/ICG technology in the surgical treatment of advanced gastric cancer (AGC) is not clearly established.MethodsThis is the protocol of the “iGreenGO” (indocyanine Green Gastric Observation) Study, a national prospective multicenter study. Western patients who undergo curative-intent gastrectomy with D2 lymphadenectomy for AGC constitute the study cohort. All the patients undergo preoperative upper gastrointestinal endoscopy for submucosal peritumoral ICG injection at the most 20 h before surgery. Intraoperative endoscopic injection before starting surgical dissection is also allowed. The primary endpoint is the “change in the surgical conduct” (CSC), i.e., the need to perform further dissection after intraoperative NIR/ICG technology activation at the end of D2 lymphadenectomy. Secondary endpoints include ...

Research paper thumbnail of Unplanned Excision of Extremity and Trunk Wall Soft Tissue Sarcoma: To Re-resect or Not to Re-resect?

Annals of Surgical Oncology, 2021

Purpose The need for systematic reexcision in patients who underwent unplanned excision (UE) for ... more Purpose The need for systematic reexcision in patients who underwent unplanned excision (UE) for extremity and superficial trunk soft tissue sarcoma (ESTSTS) has been questioned. We investigated the outcome of patients who underwent reexcision for ESTSTS compared with primarily resected at our institution and the prognostic impact of microscopic residual disease (MR) in the reexcision specimen. Methods Primary ESTSTS patients surgically treated at our institution between 1997 and 2017 were divided in three groups: primarily resected (A), reexcised after macroscopically complete UE (B), and incomplete UE (C). Weighted overall survival (OS), crude cumulative incidence of local relapse (CCI-LR), and distant metastasis (CCI-DM) were calculated and compared. In group B, multivariable models were performed to assess factors associated with the outcomes. Results A total of 1962 patients were identified: 1076, 697 and 189 in groups A, B, and C, respectively. Overall median follow-up was 85 months. Seven-year weighted-OS was 73.8%, 84.1%, and 80.7% ( p < 0.001) for groups A, B, and C respectively. Seven-year CCI-LR and DM were 5.0% and 25.3%, 12.1% and 15.8%, and 13.6% and 29.4% (both p < 0.001) for groups A, B, and C, respectively. At multivariable analysis, the presence MR was associated with LR ( p < 0.001) but not with OS nor CCI-DM. Conclusions UE and the presence of MR at pathology in reexcision specimen are associated to a higher risk of LR but not to a higher risk of DM or lower OS. After macroscopic complete UE, postponing reexcision until a LR occurs may be considered on an individualized basis.

Research paper thumbnail of ASO Author Reflections: Outcome Improvement Over Time in Extremity and Trunk Wall Soft Tissue Sarcomas: To Whom the Merit?

Annals of Surgical Oncology, 2022

Research paper thumbnail of Refining the Approach to Patients with Primary Soft Tissue Sarcoma of the Extremities and Trunk Wall: Outcome Improvement Over Time at a Single Institution

Annals of Surgical Oncology, 2022

The improved outcome of extremity soft tissue sarcoma patients surgically treated until 2007 at t... more The improved outcome of extremity soft tissue sarcoma patients surgically treated until 2007 at the authors’ institution was previously reported. This study updates the analysis at a later follow-up and extends the patients’ cohort to assess changes in outcomes over time for extremity and superficial trunk soft tissue sarcoma (ESTSTS) treated at a single referral center. All consecutive patients with primary localized adult-type ESTSTS surgically treated at the authors’ institution between 1987 and 2017 were included and divided into group 1 (1987–2002) and group 2 (2003–2017) according to primary surgery year. Crude cumulative incidence (CCI) of sarcoma-specific mortality (SSM), local recurrence (LR), and distant metastases (DM) were calculated in a competing-risks framework. DM-free survival (DMFS) and post-DM survival were also assessed. The study identified 2382 patients. The median follow-up was 104 months (range, 63–127 months), and the post-DM follow-up was 76 months (range, 37–126 months). Since 2003, an increased adoption of preoperative treatments was observed: the use of chemotherapy, radiotherapy and combined chemoradiotherapy went from 10.5% to 23.7%, from 1.7% to 17.8%, and from 1% to 11.8% respectively. This change in treatment strategies was associated to an improvement in CCI-SSM (27.8% vs 19.5%; P < 0.001), CCI-LR (14.1 vs 7.5%; P < 0.001), DMFS (57.9% vs 65.8%; P = 0.004), and post-DM (12.2% vs 20.1%; P = 0.012), but not in CCI-DM. Increased adoption of preoperative treatments and greater availability of medical agents in the recent years were associated to better outcomes. New treatments are eagerly awaited for further improvement of outcome for ESTSTS patients because no major changes have been observed since 2003.

Research paper thumbnail of ASO Author Reflections: Reexcision after Macroscopically Complete Unplanned Excision in Extremity and Trunk Wall Soft Tissue Sarcoma: Is Less More?

Several studies have shown that reexcision (RE) after unplanned excision (UE) of extremity and tr... more Several studies have shown that reexcision (RE) after unplanned excision (UE) of extremity and trunk wall soft tissue sarcoma (ETSTS) was able to offset the negative prognostic impact of an unplanned procedure. As a result, RE was long considered a standard procedure for every patient who had undergone UE. However, none of these studies distinguished between macroscopically incomplete and complete UE. Of note, in at least half of the patients, no residual tumor was found in the RE specimen. In addition, the causative relationships between local relapse (LR) and the incidence of distant metastases (DM), and the prognostic significance of microscopic residual disease (MR?) in the RE specimen are still debated. On these grounds, the need for systematic reexcision (RE) in ETSTS patients who undergo macroscopically complete UE is being questioned.

Research paper thumbnail of Laparoscopic Modified Blumgart Anastomosis with a Newly Manufactured and Customized Double Needle Suture

Research paper thumbnail of The prognostic impact of unplanned excision in primary STS of the extremities and trunk wall: Is re-excision always mandatory?

Journal of Clinical Oncology, 2020

e23557 Background: To investigate the outcome of patients affected by soft tissue sarcomas (STS) ... more e23557 Background: To investigate the outcome of patients affected by soft tissue sarcomas (STS) of the extremities and trunk wall who underwent unplanned excision (UE) and the prognostic impact of microscopic residual tumor at re-excision. Methods: All consecutive patients affected by primary STS of the extremity and trunk wall operated at Fondazione IRCCS Istituto Nazionale dei Tumori from Jan 1997 to Dec 2017 were included and divided in 3 groups: patients primarily resected at our institution (group A), patients undergoing re-excision after macroscopically complete UE (group B) and patients undergoing completion resection after macroscopically incomplete UE (group C). Inverse probability treatment weighted overall survival (OS), crude cumulative incidence of local relapse (CCI-LR) and of distant metastasis (CCI-DM) were calculated and compared. Histological subgroup curves were drawn and multivariable models were performed in group B. Results: 1965 patients were identified; 1079...

Research paper thumbnail of How to treat liposarcomas located in retroperitoneum

European Journal of Surgical Oncology

Research paper thumbnail of Refining the approach to patients with primary soft tissue sarcoma of the extremities and trunk wall (ESTSTS): Outcome improvement over 30 years at a single institution

Journal of Clinical Oncology, 2021

e23548 Background: In 2011 we reported the improved outcome of ESTS pts treated between 1987 and ... more e23548 Background: In 2011 we reported the improved outcome of ESTS pts treated between 1987 and 2007 at Istituto Nazionale Tumori (INT), Milan (Italy). We updated the analysis at a later follow-up (FU) to assess possible changes in survival of ESTSTS. Outcomes according to histology were also explored. Methods: Pts with primary localized adult-type ESTSTS surgically treated at INT between 1987 and 2017 were retrospectively reviewed and divided into 6 groups according to the date of primary surgery. Crude cumulative incidence (CCI) of sarcoma-specific mortality (SSM), local relapse (LR), distant metastases (DMs) were calculated for each group in a competing risks framework. DM free survival (DMFS) was calculated for each group taking into account all DMs (occurred as first or later). PostDM survival and all outcomes according to histology were calculated before and after 2002. Results: 2384 pts were included. At a 104-mo m-FU, median post-DM FU was 76 mos. Clinicopathologic characte...