1,720,986 research outputs found
Survival benefit della resezione epatica nel colangiocarcinoma intraepatico avanzato: un'analisi dei dati del SEER (Surveillance, Epidemiology, and End Results)
Full text linkBackground:
Liver resection (LR) is the cornerstone in the treatment of Intrahepatic Cholangiocarcinoma (I-CCA). However, it is a controversial solution for advanced lesions not only due to surgical technical aspects but also its survival benefit remains questionable.
Aim of the work:
The aim of this study is to verify the survival benefits of LR in advanced stages of I-CCA based on the 7th and 8th editions of American Joint Committee on Cancer (AJCC) Staging System, and to identify prognostic factors that directly influence patients’ survival after LR.
Methods:
A retrospective cohort study was performed using the Surveillance, Epidemiology, and End Results (SEER) database to identify stage III and IV a of I-CCA patients based on the 7thedition of AJCC (American Joint Committee on Cancer) staging system. 315 patients were enrolled in this study, during the period 2010-2013 and classified into 2 groups; group A includes 154 patients who underwent LR and group B includes 161 patients who did not have LR but received chemotherapy. The selected population has been classified according to the AJCC 8th edition as well. 233 patients out of 315 were enrolled and classified into group A with LR and Group B with CTH. To account for missing data, two sets of analyses were performed for both 7th and 8th editions module; the 1st includes complete cases (CC) data-set and the 2nd is multiple imputation (MI). The patients in group A and B were matched and propensity score (PS) analysis performed for both 7th and 8th editions in both CC and MI data-set. A Cox proportional hazards model were developed using relevant clinic-pathologic variables to determine the prognostic factors.
Results:
In CC/ AJCC 7th edition data set with PS analysis the median survival was 35 months (12.5–57.4) 95% CI, and 1, 2, and 3 years survival rates were 64.3%, 51.1%, and 40.8%. In matched group B, the median survival was 14 months, (9.1–18.8) 95% CI and the 1, 2, and 3years survival rates were 51.6%, 16.4%, and 5.5% for matched group B patients (p=0.007). In CC/AJCC 8th edition with PS analysis the median survival for group A was 17 months (8.1–25.8) 95% CI and 1, 2, and 3 years survival rates were 57.8%, 43.4% and 32.6%. In group B, The median survival was 12 months (8.7–15.2) 95% CI and the 1, 2, and 3 years survival rates were 46.6%, 7.4%, and 3.7% for matched group B patients (p=0.013).
In CC/AJCC 7th edition data-set, poor prognosis has been shown in patients above 65 years old (HR 1.804, 95% CI 1.139 – 2.858, P .012), in multifocal lesion (HR 1.588, 95% CI 0.950- 2.654, P = 0.077) and positive lymph node (HR 1.885, 95% CI 1.012 – 3.513, P = 0.046). After PS analysis in CC/AJCC 7th edition data set poor prognosis has been noticed in patients above 65 years old (HR 2.618, 95% CI 1.501 – 4.569, P = 0.001), Multifocal lesion (HR 1.890, 95% CI 1.083 – 3.298, P = 0.025) and positive lymph node (HR 1.188, 95% CI 0. 0.680 – 2.075, P = 0.546). A survival benefit of liver resection over chemotherapy was confirmed in both data-set (data-set CC AJCC 7^ ed. before PS: HR 0.505 CI 95% 0.313 – 0.814; P = 0.005; after PS: HR 0.567 CI 95% 0.347 – 0.926 P = 0.023).
Conclusion:
LR has showed a significant survival benefit over chemotherapy for I-CCA stage III and IV a of the AJCC 7th edition and some survival benefit also in stage III b of 8th edition.
Poor outcome has been observed in patients >65 years and with multifocal lesions and lymph node metastasis before the performing of PS analysis.
A prospective RCT is needed for better understanding predictors of survival and to establish evidence based algorithmic approach in IC management
La letteratura e le altre arti : atti del convegno annuale dell'Associazione di Teoria e studi di letteratura straniera comparata : L'Aquila, febbraio 2004
No full textRole of temporary portosystemic surgical shunt during liver resection to prevent a post-resection small for size-like syndrome
Full text linkLiver resection stands as the gold-standard therapeutic approach for selected cases of hepatocellular carcinoma (HCC). The extent of resectable parenchyma hinges upon the underlying liver function and its regenerative potential. Consequently, cirrhosis may impede access to potentially curative interventions for HCC arising within this context. Cirrhotic patients undergoing liver resection face heightened susceptibility to post-hepatectomy liver failure (PHLF). The clinical profile of PHLF bears a resemblance to a well-documented syndrome within the liver transplant (LT) domain: Small-for-size syndrome (SFSS), a form of graft failure observed in the postoperative phase following LT with undersized or partial organs. Management of SFSS targets mitigating the overflow syndrome, achievable through diverse portal diversion techniques. Portal vein flow diversion encompasses procedures redirecting a variable proportion of portal vein flow towards systemic circulation. Consequently, derivative procedures aim to directly alleviate portal hypertension. Side-to-side portocaval shunts emerge as the most straightforward and efficacious means of decompressing the portal system. Furthermore, they afford flow calibration to diminish the incidence and severity of steal syndrome and hepatic encephalopathy, without compromising efficacy or hepatic function. Translating insights gleaned from LT complexities involving SFSS to liver resection, strategies involving portal flow diversion warrant consideration in efforts to forestall PHLF. This approach aims to extend the frontiers of liver surgery, broadening access to hepatectomy with curative intent, either as a standalone intervention or as part of a comprehensive treatment regimen where LT serves as a secondary option
Liver transplantation for hepatocellular carcinoma through the lens of transplant benefit
No full textPrediction of hepatocellular carcinoma biological behavior in patient selection for liver transplantation
No full textMorphological criteria have always been considered the benchmark for selecting hepatocellular carcinoma (HCC) patients for liver transplantation (LT). These criteria, which are often inappropriate to express the tumor's biological behavior and aggressiveness, offer only a static view of the disease burden and are frequently unable to correctly stratify the tumor recurrence risk after LT. Alpha-fetoprotein (AFP) and its progression as well as AFP-mRNA, AFP-L3%, des-γ-carboxyprothrombin, inflammatory markers and other serological tests appear to be correlated with post-transplant outcomes. Several other markers for patient selection including functional imaging studies such as (18)F-FDG-PET imaging, histological evaluation of tumor grade, tissue-specific biomarkers, and molecular signatures have been outlined in the literature. HCC growth rate and response to pre-transplant therapies can further contribute to the transplant evaluation process of HCC patients. While AFP, its progression, and HCC response to pre-transplant therapy have already been used as a part of an integrated prognostic model for selecting patients, the utility of other markers in the transplant setting is still under investigation. This article intends to review the data in the literature concerning predictors that could be included in an integrated LT selection model and to evaluate the importance of biological aggressiveness in the evaluation process of these patients
Totally Laparoscopic Microwave Ablation and Portal Vein Ligation for Staged Hepatectomy : A New Minimally Invasive Two-Stage Hepatectomy.
No full textAbstract
BACKGROUND:
Laparoscopic microwave ablation and portal vein ligation for staged hepatectomy (LAPS) is a new technique with a first laparoscopic step available in cases of unresectable right liver masses and inadequate future liver remnant (FLR).
METHODS:
In Step 1, laparoscopic right portal vein occlusion is performed with microwave ablation on the future transection plane and in the FLR. Step 2 consists of a totally laparoscopic right trisectionectomy.
RESULTS:
Duration of the Step 1 operation was 170 min, without the need for blood transfusions and intensive care unit admission. The postoperative liver volumetric computed tomography scan was performed on postoperative day 9 and revealed a satisfactory left hepatic hypertrophy (FLR 666 cm3; FLR to body weight ratio 0.96; FLR increase 90.4 %; daily FLR hypertrophy 35 cm3/day). Duration of the Step 2 operation was 630 min (liver transection time 240 min). Blood loss was 700 cc, with no need for transfusion. The specimen was extracted through a 10-cm Pfannenstiel incision, and pathology revealed a tumor-free resection margin (R0). The patient was discharged on postoperative day 7 without complications (total hospital stay for Step 1 + Step 2: 10 days).
CONCLUSIONS:
Totally LAPS is a technically feasible and safe procedure. It could provide benefit in selected patients with primarily non-resectable liver cancer, making extreme liver surgery easy and safe in well-selected patients
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
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