1,721,281 research outputs found
ASO Author Reflections: Vascular Resection in Perihilar Cholangiocarcinoma Surgery
No full textvascular resection in hilar cholangiocarcinom
sj-docx-1-tam-10.1177_17588359211033704 – Supplemental material for Circulating TP53 mutations are associated with early tumor progression and poor survival in pancreatic cancer patients treated with FOLFIRINOX
No full textSupplemental material, sj-docx-1-tam-10.1177_17588359211033704 for Circulating TP53 mutations are associated with early tumor progression and poor survival in pancreatic cancer patients treated with FOLFIRINOX by Fleur van der Sijde, Zakia Azmani, Marc G. Besselink, Bert A. Bonsing, Jan Willem B. de Groot, Bas Groot Koerkamp, Brigitte C. M. Haberkorn, Marjolein Y. V. Homs, Wilfred F. J. van IJcken, Quisette P. Janssen, Martijn P. Lolkema, Saskia A. C. Luelmo, Leonie J. M. Mekenkamp, Dana A. M. Mustafa, Ron H. N. van Schaik, Johanna W. Wilmink, Eveline E. Vietsch and Casper H. J. van Eijck in Therapeutic Advances in Medical Oncology</p
ASO Author Reflections:Palliative Therapy Might be an Alternative When the Risks of Surgery for Perihilar Cholangiocarcinoma are High
Full text linkUncertainty in Medical Decision Making: knowing how little you know
Full text linkMaking decisions about the care of individual patients is fundamental to health care. For
each patient, many decisions have to be made. In the emergency room, for example, a
doctor should decide which patient to see first, decide whether an x-ray should be made of
an injured ankle, and decide how this specific ankle fracture of this specific patient should
be treated. Medical training is focused on acquiring the knowledge and experience to make
such decisions. Other factors that are essential for patient care, including empathy and
technical abilities, also involve decision making. For example, in the outpatient clinic, a
trade-off is needed when one patient needs more time and empathy, but the waiting room
is packed and the physician is an hour behind schedule. In the operating room, a surgeon
must decide whether to proceed with a complicated laparoscopic procedure to remove a
gall bladder, to convert to an open procedure, or to ask a more experienced surgeon for
help
Multivariable prediction model for both 90-day mortality and long-term survival for individual patients with perihilar cholangiocarcinoma: does the predicted survival justify the surgical risk?
Full text linkBACKGROUND: The risk of death after surgery for perihilar cholangiocarcinoma is high; nearly one in every five patients dies within 90 days after surgery. When the oncological benefit is limited, a high-risk resection may not be justified. This retrospective cohort study aimed to create two preoperative prognostic models to predict 90-day mortality and overall survival (OS) after major liver resection for perihilar cholangiocarcinoma. METHODS: Separate models were built with factors known before surgery using multivariable regression analysis for 90-day mortality and OS. Patients were categorized in three groups: favourable profile for surgical resection (90-day mortality rate below 10 per cent and predicted OS more than 3 years), unfavourable profile (90-day mortality rate above 25 per cent and/or predicted OS below 1.5 years), and an intermediate group. RESULTS: A total of 1673 patients were included. Independent risk factors for both 90-day mortality and OS included ASA grade III-IV, large tumour diameter, and right-sided hepatectomy. Additional risk factors for 90-day mortality were advanced age and preoperative cholangitis; those for long-term OS were high BMI, preoperative jaundice, Bismuth IV, and hepatic artery involvement. In total, 294 patients (17.6 per cent) had a favourable risk profile for surgery (90-day mortality rate 5.8 per cent and median OS 42 months), 271 patients (16.2 per cent) an unfavourable risk profile (90-day mortality rate 26.8 per cent and median OS 16 months), and 1108 patients (66.2 per cent) an intermediate risk profile (90-day mortality rate 12.5 per cent and median OS 27 months). CONCLUSION: Preoperative risk models for 90-day mortality and OS can help identify patients with resectable perihilar cholangiocarcinoma who are unlikely to benefit from surgical resection. Tailored shared decision-making is particularly essential for the large intermediate group
Timing of Initiation of Palliative Chemotherapy in Asymptomatic Patients with Metastatic Pancreatic Cancer:An International Expert Survey and Case-Vignette Study
Full text linkBackground: The use of imaging, in general, and during follow-up after resection of pancreatic cancer, is increasing. Consequently, the number of asymptomatic patients diagnosed with metastatic pancreatic cancer (mPDAC) is increasing. In these patients, palliative systemic therapy is the only tumor-directed treatment option; hence, it is often immediately initiated. However, delaying therapy in asymptomatic palliative patients may preserve quality of life and avoid therapy-related toxicity, but the impact on survival is unknown. This study aimed to gain insight into the current perspectives and clinical decision=making of experts regarding the timing of treatment initiation of patients with asymptomatic mPDAC. Methods: An online survey (13 questions, 9 case-vignettes) was sent to all first and last authors of published clinical trials on mPDAC over the past 10 years and medical oncologists of the Dutch Pancreatic Cancer Group. Inter-rater variability was determined using the Kappa Light test. Differences in the preferred timing of treatment initiation among countries, continents, and years of experience were analyzed using Fisher’s exact test.Results: Overall, 78 of 291 (27%) medical oncologists from 15 countries responded (62% from Europe, 23% from North America, and 15% from Asia–Pacific). The majority of respondents (63%) preferred the immediate initiation of chemotherapy following diagnosis. In 3/9 case-vignettes, delayed treatment was favored in specific clinical contexts (i.e., patient with only one small lung metastasis, significant comorbidities, and higher age). A significant degree of inter-rater variability was present within 7/9 case-vignettes. The recommended timing of treatment initiation differed between continents for 2/9 case-vignettes (22%), in 7/9 (77.9%) comparing the Netherlands with other countries, and based on years of experience for 5/9 (56%). Conclusions: Although the response rate was limited, in asymptomatic patients with mPDAC, immediate treatment is most often preferred. Delaying treatment until symptoms occur is considered in patients with limited metastatic disease, more comorbidities, and higher age.</p
Author response to: Comment on: Multivariable prediction model for both 90-day mortality and long-term survival for individual patients with perihilar cholangiocarcinoma: does the predicted survival justify the surgical risk?
Full text linkTailored care in resectable perihilar cholangiocarcinoma
Full text linkSurgical resection of perihilar cholangiocarcinoma offers a distinct benefit in long-term survival, but it is a complex procedure. The tumour may extend into segmental branches of the bile ducts, or involve the portal vein and/or hepatic artery. Curative-intent resection requires a combined extrahepatic bile duct and partial liver resection, sometimes including a portal vein resection and reconstruction. These extended procedures are associated with a high risk of postoperative mortality, even more so because many patients present with obstructive jaundice. Selecting the optimal treatment in patients with perihilar cholangiocarcinoma is a trade-off between opportunities for long-term survival against the danger of procedural risks: surgery offers a chance for long-term survival or cure, but perioperative complications may cause abrupt death. This thesis aimed to provide recommendations and clinical decision rules for tailored care in patients with resectable perihilar cholangiocarcinoma
Operative and Oncological Outcomes of Vascular Resection and Reconstruction for Perihilar Cholangiocarcinoma
No full textBackground. Hepatectomy with associated vascular resection and reconstruction (VR) is an option to increase the number of patients with locally advanced perihilar cholangiocarcinoma (pCCA) eligible for radical-intent surgery. Objectives. This study aimed to assess the safety and oncological outcomes of VR in pCCA patients. Methods. Patients who underwent surgery for pCCA at 10 western centers were retrospectively reviewed and divided according to the performance of the VR. Primary outcomes were major morbidity, vascular morbidity, 90-day mortality, and overall survival (OS). Results. A total of 1054 patients were included, of whom 259 (24.6%) underwent VR. Of these 259 patients, 199 (76.8 %) underwent portal vein reconstruction (PVR) only and 60 (23.2%) underwent hepatic artery reconstruction (HAR) with or without PVR. VR patients were younger (66 vs. 68 years; p = 0.011) and more frequently had Bismuth type 4 tumors (31.3% vs. 22.9%; p = 0.008). They more frequently underwent portal vein embolization (32.0% vs. 17.6%; p < 0.001), biliary drainage (84.9% vs. 77.3%; p = 0.008), and extended hepatectomy (56.8% vs. 37.1%; p < 0.001), with longer operative times (539 vs. 479 min; p < 0.001) and higher blood loss (1300 vs. 700 mL; p < 0.001). Positive resection margins were observed more frequently (45.7% vs. 35.2%; p = 0.003). Major complications (51.4% vs. 41.0%; p = 0.004), vascular complications (19.7% vs. 3.3%; p < 0.001), and mortality (16.2% vs. 10.6%; p = 0.02) were higher in VR patients. Median OS was 28.0 months for patients without VR versus 22.8 months for patients with VR (p = 0.18). Conclusions. Liver resection and VR in patients with locally advanced pCCA are associated with increased major and vascular morbidity but offer similar survival as patients not undergoing VR; therefore, VR should be considered in selected patients
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