Arthur J Moser

Background: The impact of altruism on enrollment and longitudinal follow-up among cancer patients participating in clinical research studies remains poorly understood. This systematic review assesses published data reporting altruism as a motivator in cancer research and derives objective definitions of the four subtypes of altruism to permit future investigation in prospective therapeutic and non-therapeutic studies.Method: A qualitative systematic review of altruism and cancer was conducted according PRISMA after a literature search of PubMed, Embase, Cochrane, and PsychINFO databases. Study aims, methodology, outcomes, and conclusions were extracted to perform qualitative analysis of altruistic motivations among cancer research participants. Quality and risk of bias were assessed using the Joanna Briggs Institute (JBI) Critical Appraisal tool for Systematic Reviews Checklist for Qualitative Research. Results: Of 78 full-text manuscripts, fourteen met eligibility criteria for analysis, all of which used semi-structured interviews or questionnaires to study subsets of cancer patients participating in therapeutic clinical trials or non-therapeutic biobanking. Four distinct subtypes of altruism were demonstrated and defined according to an association map having the following four domains: personal benefit, benefit to family (kinship), benefit to others, and social exchange. Conclusion: Different types of altruism among cancer patients were observed both in therapeutic and non-therapeutic studies. Altruism remains as an underrecognized factor that affects clinical research studies.

Treatment burden of robotic gastrectomy for locally advanced gastric cancer (LAGC): a single western experience M. Juanita Rodriguez, Ana Sofia Ore, Khoschy Schawkat, Kevin Kennedy, Andrea Bullock, Douglas K. Pleskow, Jonathan Critchlow, A. James Moser

Widespread application of omic technologies is evolving our understanding of population health and holds promise in providing precise guidance for selection of therapeutic interventions based on patient biology. The opportunity to use hundreds of analytes for diagnostic assessment of human health compared to the current use of 10–20 analytes will provide greater accuracy in deconstructing the complexity of human biology in disease states. Conventional biochemical measurements like cholesterol, creatinine, and urea nitrogen are currently used to assess health status; however, metabolomics captures a comprehensive set of analytes characterizing the human phenotype and its complex metabolic processes in real-time. Unlike conventional clinical analytes, metabolomic profiles are dramatically influenced by demographic and environmental factors that affect the range of normal values and increase the risk of false biomarker discovery. This review addresses the challenges and opportunities created by the evolving field of clinical metabolomics and highlights features of study design and bioinformatics necessary to maximize the utility of metabolomics data across demographic groups.

Robot-assisted enucleation provides the dual benefits of a minimally-invasive technique and pancreatic parenchymal conservation to selected patients with functional pancreatic neuroendocrine tumors (F-pNETs) and serous cystadenomas. Insulinomas, the most common F-pNETs, are ideal candidates for enucleation when <2 cm given the 80% probability of being benign. Current evidence suggests enucleation for the following: benign, isolated lesions with a distance between tumor and main pancreatic duct ≥3 mm (no focal stricture or dilation), insulinomas, gastrinomas <2 cm, and nonfunctional pancreatic neuroendocrine tumors (NF-pNETs) <1–2 cm and low Ki67 mitotic index. Minimally-invasive enucleation is an imaging-dependent procedure that requires recognizable anatomic landmarks for successful completion, including tumor proximity to the pancreatic duct as well as localization relative to major structures such as the gastroduodenal artery, bile duct, and portal vein. Tumor localization often mandates intraoperative ultrasound aided by duplex studies of intratumoral blood flow and frozen section confirmation. Five patients have undergone robot-assisted enucleation at Beth Israel Deaconess Medical Center between January 2014 and January 2017 with median tumor diameter of 1.3 cm (0.9–1.7 cm) located in the pancreatic head [2] and tail [3]. Surgical indications included insulinoma [2] and NF-pNETs [3]. Median operative time was 204 min (range, 137–347 min) and estimated blood loss of 50 mL. There were no conversions to open or transfusions. Robotic enucleation is a safe and feasible technique that allows parenchymal conservation in a minimally-invasive setting, reducing operative time and length of stay with equivalent pathological outcomes compared to open surgery.