Mohamed Mortagy

Background: Optimal postoperative follow-up for lung neuroendocrine tumours (L-NET) and surgical resection approaches remain debated. This audit aimed to benchmark long-term outcomes after L-NET surgery at a high-volume centre, identify prognostic factors, and estimate follow-up duration. Methods: This was a retrospective audit of 633 L-NET resections at a high-volume centre (1997–2023). Kaplan-Meier plots for overall survival (OS) were generated. Cox regression was used to identify the factors affecting OS. Expected survival was generated by matching age, sex, and year of surgery to national life tables. Results: Median age was 63 years; 66.8% were female; 78.2% had typical morphology; 78.2% were stage 1; and lobectomy predominated (83.7%). Ten-year OS was 80.4% for all cases and 82.7%, 84.5%, 58.9%, and 67.0% for lobectomy, pneumonectomy, segmentectomy, and wedge resection, respectively. Actual OS overlapped at ~220 months for all cases. Multivariable analysis showed that worse all-cause mortality was associated with advanced age (aHR 1.08) and lymphovascular invasion (aHR 2.38), but not procedure type. Conclusions: This audit provides valuable insights into the benefits and risks of surgery for L-NET at our centre. It identifies risk factors for increased all-cause mortality. It provides data on follow-up, which can inform local case selection, guidelines and policies at our centre.

Neuroendocrine prostate cancer (NEPC) is a rare and aggressive variant of prostate cancer (PC) that can be de novo (d-NEPC) or transform from prior prostate adenocarcinoma (PCa) as treatment-emergent NEPC (t-NEPC). This study aimed to study the clinical characteristics and overall survival (OS) of NEPC using data from the SEER and NCRAS registries and to compare OS of d-NEPC and t-NEPC. A total of 1,465 patients with NEPC were extracted from SEER (n = 990, 2010–2022) and NCRAS (n = 475, 2010–2021). Patients were classified as t-NEPC if preceded by a documented PCa. The primary outcome was OS measured from the date of NEPC diagnosis. Kaplan–Meier analysis, the log-rank test, and Cox regression were performed for SEER, NCRAS, and pooled cohorts. t-NEPC represented 9.9% in NCRAS and 15.2% in SEER. Small cell carcinoma was the most common subtype (80.2% NCRAS, 74.7% SEER). Median time to transformation was 4.63 years in NCRAS and 5 years in SEER. In the pooled cohort, median OS was 9 months for d-NEPC and 7 months for t-NEPC (log-rank P < 0.001). The 60-month OS was 7.9% for d-NEPC and 4.0% for t-NEPC. In the pooled multivariable Cox regression, t-NEPC was independently associated with worse OS (aHR: 1.30, 95% CI: 1.11–1.53, P = 0.001). Data source was not associated with OS (aHR: 1.08, P = 0.206), indicating comparable OS between the USA and England. In this bi-national, population-based study, t-NEPC was associated with worse OS than d-NEPC. OS for NEPC was comparable between the USA and England. These findings support distinguishing d-NEPC from t-NEPC.

Management of appendiceal neuroendocrine tumours (aNET) with a size of 1–2 cm is a topic of debate, with the conflict centred on the potential oncological benefits of right hemicolectomy (RHC) versus appendectomy and the impact of RHC on quality of life. A recent study suggested that RHC may not be needed for certain aNET 1–2 cm in size. A total of 1244 adult patients with aNET 1–2 cm (diagnosed 2012–2022) who underwent appendectomy or RHC were extracted from the Surveillance, Epidemiology, and End Results (SEER) database. Similarly, a total of 270 patients (diagnosed 2012–2021) were extracted from the National Cancer Registration and Analysis Service (NCRAS) database. Kaplan–Meier (KM) plots for overall survival (OS) were generated with log‐rank tests (LR). Univariable and multivariable Cox regression for all‐cause mortality were performed. In the NCRAS cohort, 159 and 111 patients underwent appendectomy and RHC, respectively. The median age was 41 and 51 years for appendectomy and RHC, respectively. Most patients were female (63.7%) and of white race (86.3%). Patients who underwent RHC had a higher proportion of node‐positive disease. In the SEER cohort, 957 and 287 patients underwent appendectomy and RHC, respectively. Median age was 39 and 47 years for appendectomy and RHC, respectively. Most patients were females (65.3%) and of white race (67.7%). Patients who underwent RHC had a higher proportion of node‐positive disease and M1 stage. Sex and race distribution were similar for the two procedures in both NCRAS and SEER. The KM plot for OS in NCRAS ( p = .061) and SEER ( p = .14) showed no statistical difference between appendectomy and RHC. Cox regression for all‐cause mortality showed that there is no statistical difference between appendectomy and RHC in both cohorts after adjusting for other factors, including age and N stage. Cox regression for all‐cause mortality for both cohorts combined showed the same result. Survival of appendectomy is non‐inferior to RHC in the management of aNET 1–2 cm, even in patients with node‐positive disease. These study findings address the gap in current clinical practice guidelines.

Background: Melanoma is the fifth most common cancer in the USA and the UK, with global incidence on the rise. The TNM staging system guides treatment decisions and predicts patients’ outcomes. Objectives: To evaluate the prognostic ability of the eighth edition TNM (TNM-8) staging system to predict overall (OS) and melanoma-specific survival (MSS) in cutaneous malignant melanoma (CMM), and to explore the potential of machine learning (ML) methods to enhance melanoma prognostication. Methods: The records of adult patients diagnosed with CMM from 2018 to 2022 were extracted from the Surveillance, Epidemiology, and End Results (SEER) Program database. TNM-8 was evaluated using Kaplan–Meier plots and OS and MSS probabilities. Fine–Gray competing risk and accelerated failure time (AFT) models evaluated factors affecting MSS and OS, respectively. ML models were used to evaluate the predictive ability of TNM stages for OS and MSS, compared with that of multiple clinically important prognostic variables. Results: Altogether, 111 871 patients with CMM were included in the analysis, with OS and MSS as survival endpoints. Most T (tumour), N (node), M (metastasis) and TNM-8 stage categories had distinct MSS and OS probabilities, except in the N1 and N2 stages at 12 months and in OS for TNM-8 stages 2 and 3 at 12, 36, 48 and 59 months. Fine–Gray and AFT models showed that age, sex, race/origin, tumour site, histological type, ulceration, Breslow thickness, mitotic rate, number of positive lymph nodes and M stage were important prognostic variables for MSS and OS. ML models showed that TNM had a higher predictive prognostic ability for MSS than OS and that including clinically important prognostic variables in addition to TNM stage has higher discriminative prognostic ability for OS and MSS (testing C-indices range 0.84–0.85 and 0.89–0.92, respectively) than using TNM staging alone (testing C-indices range 0.67–0.72 and 0.82–0.87, respectively). Conclusions: This proof-of-concept study demonstrated that although TNM staging retains prognostic value, adding important prognostic variables and using ML could improve prognostication for patients with melanoma. ML could be used to develop interactive clinical decision-support tools to improve the prognostication of individuals with melanoma.

Objective: The time from onset of symptoms of neuroendocrine neoplasia (NEN) to diagnosis ranges between 5 and 7 years. Risk factors associated with this and the difference in overall survival (OS) between routine and emergency presentation (RP and EP) are not known. Design: A retrospective, population-based study. Methods: A retrospective, population-based study of gastroenteropancreatic and lung NEN registered on England’s national cancer between 2012 and 2021. Factors associated with worse OS, or emergency or late presentation (EP or LP), were evaluated using the Kaplan–Meier estimator, Cox and logistic regressions, and machine learning (ML) in two models. Results: A total of 21,345 NEN were included. 20.3% were EP. EP showed worse OS compared to RP. Factors associated with EP were male sex, advanced stage, worse deprivation and NEC. The ML model showed EP related to advanced stage, small intestinal NEN, NEC, advanced age, deprivation and male sex in decreasing order of importance. Factors associated with LP included EP, male sex and NEC. The ML model showed that NEC, small intestinal NEN, advanced age, EP and male sex are associated with LP in decreasing order of importance. Conclusion: EP is associated with poor survival. Addressing the associated factors may aid in timely diagnosis and improved survival.

Introduction: The use of telemedicine for treatment of coronavirus disease 2019 (COVID-19) infection has been effective in lowering the risk of infection and relieving strain on the healthcare system. This study aimed to describe the clinical characteristics of COVID-19 cases, their follow-up, risk factors of disease severity, and predictors of hospital admission while using telemedicine. Methodology: The study included 611 Egyptian patients with mild and moderate COVID-19 disease. The patients were isolated at home and monitored daily. Results: Based on the World Health Organization classification, 79% of studied patients had mild illness while 20.5% had moderate illness. The initial symptoms included cough (51.7%), fever (50.8%), fatigue (45.9%), sore throat (41.1%), dyspnea (35.2%), and headache (34%); 25.2% patients had prolonged symptoms (≥ 21 days). Dyspnea was the most frequent (15.5%) long-term symptom. Age, co-existing diabetes, and COVID-19 infection with moderate severity, were associated with the need for hospitalization. We compared patients with COVID-19 infection who required hospital admission (n = 37) versus patients who continued in home isolation (n = 574). High neutrophil/lymphocyte ratio, transaminases, and ferritin significantly correlated with the need for hospitalization. 18.9% of the patients who required hospital admission had diabetes. Multivariate analysis described age and diabetes as independent predictors of disease severity. Age and high neutrophil/lymphocyte ratio were independent predictors of hospital admission. Conclusions: Telemedicine is effective in-home management of mild/moderate COVID-19 patients, which may ease the pressure on the healthcare system, even beyond the pandemic.

Introduction: Right hemicolectomy (RHC) remains the treatment standard for goblet cell adenocarcinoma (GCA), despite limited evidence supporting survival benefit. This study aims to explore factors influencing surgical management and survival outcomes among patients treated with RHC or appendicectomy using NCRAS (UK) and SEER (USA) data. Methods: A retrospective analysis was conducted using 998 (NCRAS) and 1703 (SEER) cases. Factors influencing procedure type were explored using logistic regression analyses. Overall survival (OS) probabilities and Kaplan–Meier (KM) plots were generated using KM analysis and the log-rank test compared survival between groups. Cox regression analyses were performed to assess hazard ratios. Results: The NCRAS analysis revealed that age and regional stage disease were determinants of undergoing RHC, with all age groups showing similar odds of receiving RHC, excluding the 75+ age group. The SEER analysis revealed tumour size > 2 cm, and receipt of chemotherapy were determinants of undergoing RHC, unlike the distant stage, which was associated with appendicectomy. Surgery type was not a significant predictor of OS in both analyses. In NCRAS, age and stage were significant predictors of OS. In SEER, age, stage, and Black race were significant predictors of worse OS. Conclusions: The study shows variations in the surgical management of GCA, with limited evidence to support a widespread recommendation for RHC.

Background: Neuroendocrine neoplasms (NENs) are increasing in incidence globally. Previous analysis of the UK cancer database (National Cancer Registration and Analysis Service (NCRAS)) showed a notable female survival advantage in most tumour sites. This study aims to compare NCRAS to the Surveillance, Epidemiology, and End Results Program (SEER) to validate these results using the same statistical methods. Methods: A total of 14,834 and 108,399 patients with NENs were extracted from NCRAS and SEER, respectively. Sixty-months survival for both males and females for each anatomical site of NENs were calculated using restricted mean survival time (RMST) and Kaplan–Meier Survival estimates. The sixty-month RMST female survival advantage (FSA) was calculated. Results: FSA was similar in NCRAS and SEER. The highest FSA occurred in lung and stomach NENs. Conclusions: The data from SEER confirm the findings published by NCRAS. Female survival advantage remains unexplained.

Endoscopic submucosal dissection (ESD) is a well-established, minimally invasive treatment for superficial neoplasms of the gastrointestinal tract. The universal adoption of ESD has been limited by its slow learning curve, long procedure times, and high risk of complications. One technical challenge is the lack of a second hand that can provide traction, as in conventional surgery. Reliable tissue retraction that exposes the submucosal plane of dissection would allow for safer and more efficient dissection. Magnetic anchor guided endoscopic submucosal dissection (MAG-ESD) has potential benefits compared to other current traction methods. MAG-ESD offers dynamic tissue retraction independent of the endoscope mimicking a surgeon’s “second hand”. Two types of magnets can be used: electromagnets and permanent magnets. In this article we review the MAG-ESD technology, published work and studies of magnets in ESD. We also review the use of magnetic anchor guidance systems in natural orifice transluminal endoscopic surgery and the idea of magnetic non-contact retraction using surface ferromagentization. We discuss the current limitations, the future potential of MAG-ESD and the developments needed for adoption of this technology.