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1.
Combined hepatectomy and hepatic pedicle lymphadenectomy in colorectal liver metastases is justified
Russell Hodgson Harsheet Sethi Andrew H. Ling Peter Lodge 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2017,19(6):525-529
Background
The aim of this study was to describe the outcome of patients with colorectal liver metastases (CRLM) and radiological or clinical evidence of metastatic hepatic lymph node involvement who underwent combined hepatectomy and hepatic pedicle lymphadenectomy.Methods
Retrospective analysis of a prospectively maintained audit of 2082 patients undergoing liver resection for CRLM between 1994 and 2014. Age, type of resection, CT/MRI/PET detection, location, disease recurrence and survival were analysed.Results
Combined hepatectomy and hepatic pedicle lymphadenopathy was performed on 76 patients who met the inclusion criteria. 46% of enlarged lymph nodes were located in the hepatic ligament, with 38% retroportal, 38% common hepatic and 33% coeliac nodes. 50% of lymph node resections were positive for metastatic tumour. Pre-operative CT, MRI and CT/PET failed to detect histologically proven lymph node disease in 25/38 patients. Patients with negative nodal histology had a significant overall (44 vs 20 months, p = 0.008) and disease free (20 vs 11 months, p < 0.001) survival advantage.Conclusion
Combined hepatectomy and lymph node resection for CRLM in the setting of enlarged or suspicious lymphadenopathy is justified as imaging and operative findings are poor guides in determining positive lymph node disease. 相似文献2.
Ville J. Sallinen Tessa Y.S. Le Large Elke Tieftrunk Shamil Galeev Zahar Kovalenko Sven-Petter Haugvik Anne Antila Oskar Franklin Emma Martinez-Moneo Stuart M. Robinson Francesco Panzuto Nicolas Regenet Francesca Muffatti Stefano Partelli Dominik Wiese Philippe Ruszniewski Bertrand Dousset Bjørn Edwin Sebastien Gaujoux 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2018,20(3):251-259
Background
Malignant potential of small (≤20 mm) nonfunctional pancreatic neuroendocrine tumors (sNF-PNET) is difficult to predict and management remain controversial. The aim of this study was to assess the prognosis of sporadic nonmetastatic sNF-PNETs.Methods
Patients were identified from databases of 16 centers. Outcomes and risk factors for recurrence were identified by uni- and multivariate analyses.Results
sNF-PNET was resected in 210 patients, and 66% (n = 138) were asymptomatic. Median age was 60 years, median tumor size was 15 mm, parenchyma-sparing surgery was performed in 42%. Postoperative mortality was 0.5% (n = 1), severe morbidity rate was 14.3% (n = 30), and 14 of 132 patients (10.6%) with harvested lymph nodes had metastatic lymph nodes. Tumor size, presence of biliary or pancreatic duct dilatation, and WHO grade 2–3 were independently associated with recurrence. Patients with tumors sized ≤10 mm were disease free at last follow-up. The 1-, 3- and 5-year disease-free survival rates for patients with tumors sized 11–20 mm on preoperative imaging were 95.1%, 91.0%, and 87.3%, respectively.Conclusions
In sNF-PNETs, the presence of biliary or pancreatic duct dilatation or WHO grade 2–3 advocate for surgical treatment. In the remaining patients, a wait-and-see policy might be considered. 相似文献3.
June S. Peng Ricard Corcelles Kevin Choong Matthew Poturalski Namita Gandhi R. Matthew Walsh Jeffrey M. Hardacre Stacy A. Brethauer Gareth Morris-Stiff 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2018,20(1):34-40
Background
Patients with altered anatomy due to Roux-en-Y gastric bypass (RYGB) present unique diagnostic and therapeutic challenges when they present with periampullary pathology. We describe a series of patients who underwent pancreatoduodenectomy (PD) after gastric surgery with Roux-en-Y reconstruction and review the literature to highlight technical considerations and outcomes.Methods
Patients from two institutions were identified and data regarding preoperative workup, operative conduct, and pathologic and clinical outcomes were collected.Results
Eleven patients were included in the institutional series. At the time of periampullary pathology, the median age was 64 years and time since RYGB was 10 years. Median operative time was 361 minutes, estimated blood loss was 500 mLs, and length of stay was 6 days. Remnant gastrectomy was performed in nine patients and reconstruction was performed using the biliopancreatic limb (BP) without revision of the jejuno-jejunostomy in ten patients. Pathology revealed pancreatic cancer (8), chronic pancreatitis (2), and duodenal cancer (1). Three patients experienced major complications and there were no 90-day mortalities.Conclusion
Pancreatic surgeons will see an increasing number of patients with Roux-en-Y anatomy who will require evaluation and resection for periampullary diseases. For PD after RYGB, we recommend remnant gastrectomy with reconstruction using the BP limb. 相似文献4.
Chen Lin Hongmei Dai Xiafei Hong Haiyu Pang Xianze Wang Peiran Xu Jialin Jiang Wenming Wu Yupei Zhao 《Pancreatology》2018,18(5):608-614
Background
Whether primary tumor resection benefits patients with synchronous multifocal liver metastases from pancreatic neuroendocrine tumors remains controversial. We investigated whether primary tumor resection significantly affects survival in this study.Methods
A retrospective study of patients with synchronous multifocal liver metastases from pancreatic neuroendocrine tumors between 1998 and 2016 was performed. Patient demographics, operation details, adjuvant treatment, and pathological and survival information were collected, and relevant clinical-pathological parameters were assessed in univariate and multivariate survival analyses.Results
Sixty-three patients were included in this study, including 35 who underwent primary tumor resection. The median survival time and 5-year survival rate of this cohort were 50 months and 44.5%, respectively. Median survival time in the resected group was significantly longer at 72 months than that of 32 months in the nonresected group (p?=?0.010). Multivariate analysis showed that primary tumor surgery was a significant independent prognostic factor (HR 0.312, 95% CI: 0.128–0.762, p?=?0.011).Conclusions
Primary tumor resection significantly benefits patients with synchronous multifocal liver metastases from pancreatic neuroendocrine tumors. 相似文献5.
Elena F. Wurster Solveig Tenckhoff Pascal Probst Katrin Jensen Eva Dölger Phillip Knebel Markus K. Diener Markus W. Büchler Alexis Ulrich 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2017,19(6):491-497
Background
Recurrence of colorectal liver metastases after a first hepatectomy is common (4–48% of patients). This review investigates the utility of repeated hepatic resection of colorectal liver metastases.Methods
A systematic search of the literature was performed in the Cochrane Library, MEDLINE, EMBASE, and trial registers. All studies comparing repeated hepatic resection for colorectal liver metastases with patients who underwent only one hepatectomy were eligible. Outcome criteria were safety parameters and survival rates. Data were analyzed using the random-effects model.Results
In eight observational clinical studies, 450 patients with repeated hepatic resection were compared with 2669 single hepatic resections. Morbidity such as hepatic insufficiency (OR [95% CI] 1.46 [0.69; 3.08], p = 0.32) and biliary leakage and fistula (OR [95% CI] 1.22 [0.80; 1.85], p = 0.35) was comparable between the two groups. Mortality (OR [95% CI] 1.13 [0.46; 2.74], p = 0.79) and overall survival (HR [95% CI] 1.00 [0.63; 1.60], p = 0.99) were not significantly different between the two groups.Discussion
Repeated hepatic resection for colorectal liver metastases is safe in selected patients. A prospective, multicenter high-quality trial or register study of repeated hepatic resection will be required to clarify patient-oriented outcomes such as overall survival and quality of life. 相似文献6.
Katherine T. Ostapoff Emmanuel Gabriel Kristopher Attwood Boris W. Kuvshinoff Steven J. Nurkin Steven N. Hochwald 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2017,19(7):587-594
Background
Current guidelines recommend adjuvant chemotherapy for resected pancreatic adenocarcinoma (PDAC). However, no studies have addressed its survival benefit for stage I patients as they comprise <10% of PDAC.Methods
Using the NCDB 2006–2012, resected PDAC patients with stage I disease who received adjuvant therapy (chemotherapy or chemoradiation) were analyzed. Factors associated with overall survival (OS) were identified.Results
3909 patients with resected stage IA or IB PDAC were identified. Median OS was 60.3 months (mo) for stage IA and 36.9 mo for IB. 45.5% received adjuvant chemotherapy; 19.9% received adjuvant chemoradiation. There was OS benefit for both stage IA/IB patients with adjuvant chemotherapy (HR = 0.73 and 0.76 for IA and IB, respectively, p = 0.002 and <0.001). For patients with Stage IA disease (n = 1,477, 37.8%), age ≥70 (p < 0.001), higher grade (p < 0.001), ≤10 lymph nodes examined (p = 0.008), positive margins (p < 0.001), and receipt of adjuvant chemoradiation (p = 0.002) were associated with worse OS. For stage IB patients (n = 2,432, 62.2%), similar associations were observed with the exception of adjuvant chemoradiation whereby there was no significant association (p = 0.35).Conclusion
Adjuvant chemotherapy was associated with an OS benefit for patients with stage I PDAC; adjuvant chemoradiation was either of no benefit or associated with worse OS. 相似文献7.
David P.J. van Dijk Frans C.H. Bakers Sebastian Sanduleanu Rianne D.W. Vaes Sander S. Rensen Cornelis H.C. Dejong Regina G.H. Beets-Tan Steven W.M. Olde Damink 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2018,20(8):715-720
Background
Myosteatosis, characterized by inter- and intramyocellular fat deposition, is strongly related to poor overall survival after surgery for periampullary cancer. It is commonly assessed by calculating the muscle radiation attenuation on computed tomography (CT) scans. However, since magnetic resonance imaging (MRI) is replacing CT in routine diagnostic work-up, developing methods based on MRI is important. We developed a new method using MRI-muscle signal intensity to assess myosteatosis and compared it with CT-muscle radiation attenuation.Methods
Patients were selected from a prospective cohort of 236 surgical patients with periampullary cancer. The MRI-muscle signal intensity and CT-muscle radiation attenuation were assessed at the level of the third lumbar vertebra and related to survival.Results
Forty-seven patients were included in the study. Inter-observer variability for MRI assessment was low (R2 = 0.94). MRI-muscle signal intensity was associated with short survival: median survival 9.8 (95%-CI: 1.5–18.1) vs. 18.2 (95%-CI: 10.7–25.8) months for high vs. low intensity, respectively (p = 0.038). Similar results were found for CT-muscle radiation attenuation (low vs. high radiation attenuation: 10.8 (95%-CI: 8.5–13.1) vs. 15.9 (95%-CI: 10.2–21.7) months, respectively; p = 0.046). MRI-signal intensity correlated negatively with CT-radiation attenuation (r=?0.614, p < 0.001).Conclusions
Myosteatosis may be adequately assessed using either MRI-muscle signal intensity or CT-muscle radiation attenuation. 相似文献8.
Yanming Zhou Bin Shi Lupeng Wu Xiaoying Si 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2017,19(1):10-15
Background
To assess the published evidence on clinical outcomes following radical antegrade modular pancreatosplenectomy (RAMPS) for adenocarcinoma in the body or tail of the pancreas.Method
PubMed and Chinese Biomedical Literature databases were searched. The results of comparisons between RAMPS and standard retrograde pancreatosplenectomy (SRPS) were analyzed by meta-analytical techniques.Results
The literature search identified 13 observational studies involving 354 patients undergoing RAMPS. The overall morbidity and 30-day mortality was 40% and 0% respectively. The R0 resection rate was 88%; the median number of retrieved lymph nodes was 21; and the median 5-year overall survival rate was 37%. The result of meta-analysis showed that RAMPS was associated with a significantly less intraoperative bleeding [weighted mean difference ?195.2 (95% confidence interval (CI) ?223.27 to ?167.13); P < 0.001], a greater number of retrieved lymph nodes [odds ratio (OR) 6.19 (95% CI 3.72 to 8.67); P < 0.001] and a higher percentage of R0 resection [OR 2.46 (95% CI 1.13 to 5.35); P = 0.02] as compared with SRPS.Conclusion
The current literature provides supportive evidence that RAMPS is a safe and effective procedure for adenocarcinoma in the body or tail of the pancreas, and is oncologically superior to SRPS. 相似文献9.
Quyen D. Chu Meijiao Zhou Prakash Peddi Kaelen L. Medeiros Gazi B. Zibari Hosein Shokouh-Amiri Xiao-Cheng Wu 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2017,19(12):1046-1057
Introduction
Although a volume-outcome relationship has been well established for pancreatectomy, little is known about differences in mortality by facility type. The objective of this study is to evaluate the impact of facility type on short-term and long-term survival outcomes for patients with pancreatic adenocarcinoma who underwent pancreatectomy and identify determinants of overall survival (OS).Methods
A cohort of 33,382 patients with Stage I–III pancreatic adenocarcinoma diagnosed between 1998 and 2011 were evaluated from the National Cancer Data Base. Clinicopathological, sociodemographic and treatment variables were compared among three facility types where patients received resection: (i) community cancer program (CCP), (ii) comprehensive community cancer program (CCCP), and (iii) academic research program (ARP). 5-year OS was calculated using the Kaplan–Meier method.Results
Despite ARP having significantly higher percentage of poorly differentiated tumors, higher T-stage tumors, more positive lymph nodes, and greater circle distance compared to the other facilities, it had the highest 5-yr OS. The 5-yr OS for CCP, CCCP, and ARP was 11.2%, 13.2%, and 16.6%, respectively (P < 0.0001) and the median survival time (months) was 12.4, 15.6 and 19.1, respectively.Conclusion
Patients receiving pancreatic resection at an ARP yielded a higher 5-year OS compared to CCP or CCCP. 相似文献10.
Valentinus T. Valdimarsson Ingvar Syk Gert Lindell Agneta Norén Bengt Isaksson Per Sandström Magnus Rizell Bjarne Ardnor Christian Sturesson 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2018,20(5):441-447
Background
Patients with synchronous colorectal liver metastases (sCRLM) are increasingly operated with liver resection before resection of the primary cancer. The aim of this study was to compare outcomes in patients following the liver-first strategy and the classical strategy (resection of the bowel first) using prospectively registered data from two nationwide registries.Methods
Clinical, pathological and survival outcomes were compared between the liver-first strategy and the classical strategy (2008–2015). Overall survival was calculated.Results
A total of 623 patients were identified, of which 246 were treated with the liver-first strategy and 377 with the classical strategy. The median follow-up was 40 months. Patients chosen for the classical strategy more often had T4 primary tumours (23% vs 14%, P = 0.012) and node-positive primaries (70 vs 61%, P = 0.015). The liver-first patients had a higher liver tumour burden score (4.1 (2.5–6.3) vs 3.6 (2.2–5.1), P = 0.003). No difference was seen in five-year overall survival between the groups (54% vs 49%, P = 0.344). A majority (59%) of patients with rectal cancer were treated with the liver-first strategy.Conclusion
The liver-first strategy is currently the dominant strategy for sCRLM in patients with rectal cancer in Sweden. No difference in overall survival was noted between strategies. 相似文献11.
Pim B. Olthof Robert J.S. Coelen Jimme K. Wiggers Bas Groot Koerkamp Massimo Malago Roberto Hernandez-Alejandro Stefan A. Topp Marco Vivarelli Luca A. Aldrighetti Ricardo Robles Campos Karl J. Oldhafer William R. Jarnagin Thomas M. van Gulik 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2017,19(5):381-387
Introduction
Resection of perihilar cholangiocarcinoma (PHC) entails high-risk surgery with postoperative mortality reported up to 18%, even in specialized centers. The aim of this study was to compare outcomes of PHC patients who underwent associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) to patients who underwent resection without ALPPS.Methods
All patients who underwent ALPPS for PHC were identified from the international ALPPS registry and matched controls were selected from a standard resection cohort from two centers based on future remnant liver size. Outcomes included morbidity, mortality, and overall survival.Results
ALPPS for PHC was associated with 48% (14/29) 90-day mortality. 90-day mortality was 13% in 257 patients who underwent major liver resection for PHC without ALPPS. The 29 ALPPS patients were matched to 29 patients resected without ALPPS, with similar future liver remnant volume (P = 0.480). Mortality in the matched control group was 24% (P = 0.100) and median OS was 27 months, comparted to 6 months after ALPPS (P = 0.064).Discussion
Outcomes of ALPPS for PHC appear inferior compared to standard extended resections in high-risk patients. Therefore, portal vein embolization should remain the preferred method to increase future remnant liver volume in patients with PHC. ALPPS is not recommended for PHC. 相似文献12.
Khalid Khalil Sukhchain Bansal Soofiyah Ayaani James Hodson For Tai Lam Saboor Khan Jawad Ahmad John Isaac Paolo Muiesan Darius Mirza Bobby Dasari Ravi Marudanayagam Robert P. Sutcliffe Gabriele Marangoni Keith J. Roberts 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2018,20(9):848-853
Background
Blood group is reported to have an effect upon survival following pancreatoduodenectomy for pancreatic ductal adenocarcinoma. The effect of blood group is not known, however, among patients with other periampullary cancers. This study sought to review this.Methods
Data were collected for a range of factors and survival outcomes from patients treated at two centres. Those with blood groups B and AB were excluded, due to small numbers. Patient survival was compared between patients with blood groups O and A using multivariable analysis which accounted for confounding factors.Results
Among 431 patients, 235 (54.5%) and 196 (45.5%) were of blood groups A and O respectively. Baseline comparisons found a significant difference in the distribution of tumour types (p = 0.011), with blood group O patients having more ampullary carcinomas (33.2% vs 23.4%) and less pancreatic ductal adenocarcinomas (45.4 vs 61.3%) than group A. On multivariable analysis, after accounting for confounding factors including pathologic variables, survival was found to be significantly shorter in those with blood group A than group O (p = 0.047, HR 1.30 [95%CI: 1.00–1.69]).Conclusions
There is a difference in the distribution of blood groups across the different types of periampullary cancers. Survival is shorter among blood group A patients. 相似文献13.
Ka W. Ma Tan T. Cheung Wong H. She Kenneth S.H. Chok Albert C. Yan Chan Jeff W. Chiu Dai Chung M. Lo 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2018,20(11):1067-1072
Background
Recurrent pyogenic cholangitis (RPC) is a known risk factor for intrahepatic cholangiocarcinoma (ICC), whether it represents a poor prognostic factor remains controversial. The aim of this study was to investigate the post-hepatectomy oncological outcomes of patients with ICC and coexisting RPC.Method
A retrospective analysis with propensity score matching (PSM) was performed for comparison between ICC patient with and without RPC.Results
There were 143 patients with ICC with a median follow-up of 21 months. RPC was diagnosed in 18% of patients. The time from RPC diagnosis to ICC diagnosis was 137(47–481) months. The 3-year disease-free (DFS) and overall survival for the whole population was 34% and 43% respectively. Preoperative child score, elevated carcinoembryonic antigen, presence of microvascular invasion, multiple tumours, presence of postoperative complications and RPC were independent factors for DFS and OS. After PSM, 60 ICC patients who did not have RPC were compared with 20 ICC patients with RPC. Patients with RPC had significantly worse median DFS (10 vs 23 months, P = 0.020) and OS (15 vs 45 months, P = 0.004) when compared to the patients without RPC.Conclusion
RPC represents a poor prognostic factor affecting outcomes after hepatectomy for patients with ICC. 相似文献14.
Yanming Zhou Lupeng Wu Dong Xu Tao Wan Xiaoying Si 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2017,19(9):768-774
Background
Limited data are currently available to address the safety and efficacy of combined resection of the liver and inferior vena cava (IVC) for hepatic malignancies.Methods
A systematic review was performed to identify relevant studies. Pooled individual data were examined for the clinical outcome of combined resection of the liver and IVC for hepatic malignancies.Results
A total of 258 patients were described in 38 articles eligible for inclusion. Resections were performed for colorectal liver metastasis (CLM) [n = 128 (50%)], intrahepatic cholangiocarcinoma (ICC) [n = 51 (20%)], hepatocellular carcinoma (HCC) [n = 48 (19%)], and other pathologies [n = 31 (11%)]. There were 14 (5%) perioperative deaths. The median survival duration was 34 months, and the 1-, 3- and 5-year overall survival (OS) rate was 79%, 46% and 33%, respectively. The 5-year OS rate was 26% for CLM, 37% for ICC, and 30% for HCC.Conclusion
Combined resection of the liver and IVC for hepatic malignancies is safe and applicable, and offers acceptable survival outcomes. 相似文献15.
Masayuki Okuno Claire Gourmard Takashi Mizuno Kiyohiko Omichi Ching-Wei D. Tzeng Yun Shin Chun Jeffrey E. Lee Jean-Nicolas Vauthey Claudius Conrad 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2018,20(1):57-63
Background
Risk factors for pathological diaphragmatic invasion from colorectal liver metastases (CRLM) and differences in recurrence patterns and survival between patients with true pathological diaphragmatic invasion versus inflammatory adhesions only remain poorly understood. This study aimed at identifying risk factors for and survival impact of pathological diaphragmatic invasion in patients with CRLM.Methods
Patients with CRLM who underwent hepatectomy with or without diaphragmatic resection from 1998 to 2015 were retrospectively analyzed. Recurrence-free survival (RFS), overall survival (OS), and recurrence patterns were examined according to the presence or absence of pathological invasion.Results
Of 1860 patients, 70 underwent hepatectomy with diaphragmatic resection and 1799 had hepatectomy only. Among the patients with gross diaphragmatic involvement, 15 (21%) had pathological invasion, and 55 (79%) had inflammatory adhesion only. Multiple tumors (p = 0.019) and RAS mutation (p = 0.047) were significantly associated with pathological invasion. Pathological invasion was associated with a higher incidence of peritoneal recurrence (33% vs. 11%, p = 0.041), worse median RFS (6 months vs. 11 months, p = 0.21) and OS (26 months vs. 51 months, p = 0.046) compared to inflammatory adhesion.Conclusion
Multiple tumors and RAS mutant were predictors for pathological diaphragmatic invasion, which was associated with a higher incidence of peritoneal recurrence and worse OS. 相似文献16.
Vikram A. Chaudhari Vikas Ostwal Shraddha Patkar Arvind Sahu Anup Toshniwal Anant Ramaswamy Nitin S. Shetty Shailesh V. Shrikhande Mahesh Goel 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2018,20(9):841-847
Background
Studies evaluating neo-adjuvant chemotherapy (NACT) exclusively in gallbladder cancer (GBC) are few and there are no randomized trials on the subject. Locally advanced GBC and indications for NACT in GBC are not yet clearly defined.Methods
We analysed 160 consecutive GBC patients who received NACT based on clinico-radiologic criteria suggesting high-risk disease (TMH Criteria) from January 2010 to February 2016.Results
On initial assessment, 140 (87.5%) patients had T3/T4 disease and 105 (65%) patients were node positive. Response rate and clinical benefit rate was 52.5% and 70% respectively. Sixty six (41.2%) patients could undergo curative intent resection. With a median follow-up of 33 months, the median OS and EFS of the entire cohort were 13 and 8 months respectively. Patient undergoing curative surgery had a statistically superior OS (49 vs. 7 months; p = 0.0001) and EFS (25 months vs. 5 months; p = 0.0001) compared to those who did not.Conclusion
Locally advanced GBC remains a disease with poor prognosis. Chemotherapy with neoadjuvant intent in locally advanced/borderline resectable GBC showed good response rates. This resulted in curative surgical resection or disease stabilisation in significant proportion of patients. Patients who undergo definitive surgery after favourable response to NACT experience good survival. 相似文献17.
Mechteld C. de Jong Rianne C.J. Beckers Victor van Woerden Julie M.L. Sijmons Marc H.A. Bemelmans Ronald M. van Dam Cornelis H.C. Dejong 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2018,20(7):631-640
Background
The feasibility of the liver-first approach for synchronous colorectal liver metastases (CRLM) has been established. We sought to assess the short-term and long-term outcomes for these patients.Methods
Outcomes of patients who underwent a liver-first approach for CRLM between 2005 and 2015 were retrospectively evaluated from a prospective database.Results
Of the 92 patients planned to undergo the liver-first strategy, the paradigm could be completed in 76.1%. Patients with concurrent extrahepatic disease failed significantly more often in completing the protocol (67% versus 21%; p = 0.03). Postoperative morbidity and mortality were 31.5% and 3.3% following liver resection and 30.9% and 0% after colorectal surgery. Of the 70 patients in whom the paradigm was completed, 36 patients (51.4%) developed recurrent disease after a median interval of 20.9 months. The median overall survival on an intention-to-treat basis was 33.1 months (3- and 5-year overall survival: 48.5% and 33.1%). Patients who were not able to complete their therapeutic paradigm had a significantly worse overall outcome (p = 0.03).Conclusion
The liver-first approach is feasible with acceptable perioperative morbidity and mortality rates. Despite the considerable overall-survival-benefit, recurrence rates remain high. Future research should focus on providing selection tools to enable the optimal treatment sequence for each patient with synchronous CRLM. 相似文献18.
Clinicopathological features and prognosis of advanced biliary carcinoma centered in the cystic duct
Yoshitsugu Nakanishi Takahiro Tsuchikawa Keisuke Okamura Toru Nakamura Takehiro Noji Toshimichi Asano Kimitaka Tanaka Toshiaki Shichinohe Tomoko Mitsuhashi Satoshi Hirano 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2018,20(1):28-33
Background
Whether to classify “advanced (subserosal layer or greater invasion)” biliary carcinoma centered in the cystic duct (BCCD) as gallbladder carcinoma (GBC) or perihilar cholangiocarcinoma (PHCC) remains unclear.Methods
The clinicopathological features and overall survival (OS) of patients with advanced BCCD were examined through a comparison with those of patients with advanced PHCC and with GBC.Results
290 patients were classified as 199 PHCC, 44 GBC, and 47 BCCD. Patients with BCCD (median, 23 months) had significantly worse OS than those with PHCC (44 months, p = 0.030). OS of patients with BCCD, all of whom were classified as pT3 or pT4 by the American Joint Committee on Cancer (AJCC) classification of GBC, was similar to 27 patients with pT3 or pT4 GBC (23 months, p = 0.840). When the patients with BCCD were classified by the AJCC classification of PHCC, 36 were classified as pT2. OS among the patients with BCCD classified as pT2 by the PHCC classification (29 months) was significantly worse than that among patients classified as pT2 PHCC (48 months, p = 0.040).Conclusion
These findings suggest that advanced BCCD is appropriately classified as a subtype of GBC because it can grow through the serosa. 相似文献19.
David G. Brauer Ryan C. Fields Benjamin R. Tan M.B. Majella Doyle Chet W. Hammill William G. Hawkins Graham A. Colditz William C. Chapman 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2018,20(5):470-476
Background
Lymph node (LN) status is an important predictor of overall survival for resected IHCC, yet guidelines for the extent of LN dissection are not evidence-based. We evaluated whether the number of LNs resected at the time of surgery is associated with overall survival for IHCC.Methods
Patients undergoing curative-intent (R0 or R1) resection for IHCC between 2004 and 2012 were identified within the US National Cancer Database. LN thresholds were evaluated using maximal chi-square testing and five-year overall survival was modeled using Kaplan–Meier and Cox regressions.Results
57% (n = 1,132) of 2,000 patients had one or more LNs resected and pathologically examined. In the 631 patients undergoing R0 resection with pN0 disease, maximal chi-square testing identified ≥3 LNs as the threshold most closely associated with overall survival. Only 39% of resections reached this threshold. On multivariable survival analysis, no threshold of LNs was associated with overall survival, including ≥3 LNs (p = 0.186) and the current American Joint Committee on Cancer recommendation of ≥6 LNs (p = 0.318).Conclusion
In determining the extent of lymphadenectomy at the time of curative-intent resection for IHCC, surgeons should carefully consider the prognostic yield in the absence of overall survival benefit. 相似文献20.
Laëtitia Courtin-Tanguy Olivier Turrini Damien Bergeat Stéphanie Truant Benjamin Darnis Jean R. Delpero Jean Y. Mabrut Nicolas Regenet Laurent Sulpice 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2018,20(5):405-410