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Repeat hepatectomy for recurrent colorectal liver metastases:A comparative analysis of short-and long-term results

Hepatobiliary & Pancreatic Diseases International 2022年第2期21卷 162-167页

作者： Paulo Figueiredo Costa Fabricio Ferreira Coelho Vagner Birk Jeismann Jaime Arthur Pirola Kruger gilton marques fonsec. Ivan Cecconello Paulo Herman Digestive Surgery Brazilian College of Digestive Surgery(Colégio Brasileiro de Cirurgia Digestiva-CBCD) São PauloBrazil Digestive Surgery Division Department of GastroenterologyUniversity of São Paulo School of MedicineSão PauloBrazil Instituto do Câncer do Estado de São Paulo(ICESP) São PauloBrazil

Background: Liver recurrence after resection of colorectal liver metastases(CRLM) is frequent. Repeat hepatectomy has been shown to have satisfactory perioperative results. However, the long-term outcomes and the benefts for patients with early recurrence have not been clarifed. The aim of this study was to compare the short-and long-term outcomes of patients undergoing single hepatectomy and repeat hepatectomy for CRLM. Additionally, the oncological outcomes of patients with early( ≤ 6 months) and late recurrence who underwent repeat hepatectomy were compared. Methods: Consecutive adult patients undergoing hepatectomy for CRLM between June 20 0 0 and February 2020 were included and divided into two groups: single hepatectomy and repeat hepatectomy. Results: A total of 709 patients were included: 649 in the single hepatectomy group and 60 in the repeat hepatectomy group. Patients in the repeat hepatectomy group underwent more cycles of preoperative chemotherapy [4(3-6) vs. 3(2-4), P = 0.003]. Patients in the single hepatectomy group more frequently underwent major hepatectomies(34.5% vs. 16.7%, P = 0.004) and had a greater number of lesions resected(2.9 ± 3.6 vs. 1.9 ± 1.8, P = 0.011). There was no increase in operative time, estimated blood loss, length of hospital stay, complications, or mortality in the repeat hepatectomy group. There were no differences in overall survival( P = 0.626) and disease-free survival( P = 0.579) between the two groups. Similarly, for patients underwent repeat hepatectomy, no difference was observed between the early and late recurrence groups in terms of overall survival( P = 0.771) or disease-free survival( P = 0.350). Conclusions: Repeat hepatectomy is feasible and safe, with similar short-and long-term outcomes when compared to single hepatectomy. Surgical treatment of early liver recurrence offers similar oncological outcomes to those obtained for late recurrence.

关键词： Colorectal cancer Metastasis Hepatectomy Postoperative complications Survival analysis

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Current status and future perspectives of radiomics in hepatocellular carcinoma

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World Journal of Gastroenterology 2023年第1期29卷 43-60页

作者： Joao Miranda Natally Horvat gilton marques fonsec. Jose de Arimateia Batista Araujo-Filho Maria ClaraFernandes Charlotte Charbel Jayasree Chakraborty Fabricio Ferreira Coelho Cesar Higa Nomura Paulo Herman Department of Radiology University of Sao PauloSao Paulo 05403-010Brazil Department of Radiology Memorial Sloan-Kettering Cancer CenterNew YorkNY 10065United States Department of Gastroenterology University of Sao PauloSao Paulo 05403-000Brazil Department of Radiology Hospital Sirio-LibanesSao Paulo 01308-050Brazil Department of Surgery Memorial Sloan-Kettering Cancer CenterNew YorkNY 10065United States Department of Radiology University of Sao PauloSao Paulo 05403-000Brazil

Given the frequent co-existence of an aggressive tumor and underlying chronic liver disease,the management of hepatocellular carcinoma(HCC)patients requires experienced multidisciplinary team ***,imaging plays a key role in the diagnosis,staging,restaging,and surveillance of ***,imaging assessment of HCC entails the assessment of qualitative characteristics which are prone to inter-reader *** is an emerging field that extracts high-dimensional mineable quantitative features that cannot be assessed visually with the naked eye from medical *** main potential applications of radiomic models in HCC are to predict histology,response to treatment,genetic signature,recurrence,and *** the encouraging results to date,there are challenges and limitations that need to be overcome before radiomics implementation in clinical *** purpose of this article is to review the main concepts and challenges pertaining to radiomics,and to review recent studies and potential applications of radiomics in HCC.

关键词： Radiomics Hepatocellular carcinoma Texture analysis Radiology

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Biliary tract schwannoma:A rare cause of obstructive jaundice in a young patient

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World Journal of Gastroenterology 2012年第37期18卷 5305-5308页

作者： gilton marques fonsec. André Luis Montagnini Manoel de Souza Rocha Rosely Antunes Patzina Mário Vinícius Angelete Alvarez Bernardes Ivan Cecconello José Jukemura Digestive Surgery Division Department of GastroenterologySchool of MedicineUniversity of So Paulo

Schwannoma is a tumor derived from Schwann cells which usually arises in the upper extremities, trunk, head and neck, retroperitoneum, mediastinum, pelvis, and peritoneum. However, it can arise in the gastro-intestinal tract, including biliary tract. We present a 24-year-old male patient with obstructive jaundice, whose investigation with computed tomography abdomen showed focal wall thickening in the common hepatic duct, difficult to differentiate with hilar adenocarcinoma. He was diagnosed intraoperatively schwannoma of common bile duct and treated with local resection. The patient recovered well without signs of recurrence of the lesion after 12 mo. We also reviewed the common bile duct schwannoma related in the literature and evaluated the difficulty in pre and intraoperative differential diagnosis with adenocarcinoma hilar. Resection is the treatment of choice for such cases and the tumordid not recur in any of the resected cases.

关键词：神经黄疸阻性患者原因雪旺氏细胞 CT检查手术切除

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Surgical treatment of fibrolamellar hepatocellular carcinoma:an underestimated malignant tumor?

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Hepatobiliary & Pancreatic Diseases International 2014年第6期13卷 618-621页

作者： Paulo Herman Aline Lopes Chagas Marcos Vinicius Perini Fabricio Ferreira Coelho gilton marques fonsec. Venancio Avancini Ferreira Alves Flair José Carrilho Ivan Cecconello Digestive Surgery Division Department of GastroenterologyUniversity of Sao Paulo School of MedicineAvenida Doutor Enéas de Carvalho Aguiar255Instituto Central9°andarSala 9074CEP:05403-900Cerqueira Cesar-Sao PauloSPBrazil Digestive Surgery Division Department of GastroenterologyUniversity of Sao Paulo School of MedicineAvenida Doutor Enéas de Carvalho Aguiar255Instituto Central9°andarSala 9074CEP:05403-900Cerqueira Cesar-Sao PauloSPBrazil Department of Pathology University of Sao Paulo School of MedicineAvenida Doutor Enéas de Carvalho Aguiar255Instituto Central9°andarSala 9074CEP:05403-900Cerqueira Cesar-Sao PauloSPBrazil Digestive Surgery Division Department of GastroenterologyUniversity of Sao Paulo School of MedicineAvenida Doutor Enéas de Carvalho Aguiar255Instituto Central9°andarSala 9074CEP:05403-900Cerqueira Cesar-Sao PauloSPBrazil

BACKGROUND： Fibrolamellar hepatocellular carcinoma （FLHCC） is a rare disease with an indolent behavior. Its prognosis is better than that of patients with hepatocellular carcinoma. The authors present their experience with resection of FLHCC. METHODS： Twenty-one patients with FLHCC were treated at our institution between 1990 and 2012. Of these patients, 14 were subjected to resection of the tumor. Patient demographics, medical history, results of imaging studies and laboratory tests, surgical data, and pathologic findings were evaluated. RESULTS： The median age of the patients at the diagnosis of the tumor was 20 years and 14 patients were female. None of the patients had tumor-associated chronic liver disease or cirrhosis. The mean tumor size was 12.8 cm （range 6-19） and 18 patients had a single liver nodule. Fourteen patients were subjected to hepatectomy and six of them had lymph node metastases resected. Pathologic evaluation revealed that 5 （35.7%） patients had major vascular invasion. Tumor recurrence was seen in 8 patients （66.7%）, during a follow-up. The median survival time for patients who were subjected to resection was 36 months. The 5-year overall survival rate and disease free survival rate were 28.0% and 8.5%, respectively. Univariate analysis showed that vascular invasion was the only variable associated with the disease free survival ***： Despite an aggressive treatment, patients with FLHCC presented unexpected low survival rates. It seems that an underestimated malignant behavior is attributed to this disease, and that the forms of adjuvant treatment should be urgently evaluated.

关键词： fibrolamellar hepatocellular carcinoma hepatectomy hepatocellular carcinoma lymph node excision survival

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The Knowledge and Participation of the Father in Breast Feeding, Salvador, Brazil

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Open Journal of Obstetrics and Gynecology 2016年第10期6卷 559-571页

作者： Fernanda Tourinho Lima Andréa Canário Santana gilton marques dos Santos Tatiane Falcão dos S. Albergaria Luciana Rodrigues Silva Universidade Federal da Bahia Salvador Brazil

The most fundamental influence in the breastfeeding process is the father’s support. The mother feels safer in breastfeeding when she has her partner’s support and a more active and effective participation. This study aimed at evaluating the father’s knowledge about breastfeeding in a quantitative approach through a transversal cohort study, interviewing 78 fathers in a public maternity in Salvador. The average age of the interviewees was 29.9 years and 53.8% had an incomplete fundamental schooling. Regarding knowledge of the subject, 10.3% believed that breastfeeding can be substituted. All fathers interviewed answered that they support breastfeeding for their children and believe in its benefits;39.7% reported that their opinion could interfere their partner’s decision to prolong the process. Moreover, 69.2% of the males attended their partner’s antenatal meetings, and of these, over a third had no intervention on the subject. Of all the participants, 80.8% confirmed that they had participated in the breastfeeding process and emphasized their gratification during this phase. About the paternal opinion, 39.7% believed that there is a degree of influence over the partner’s decision to breastfeed, and for that reason 50% told the mother their opinion. The study widened the knowledge about the role of the father in breastfeeding, ratifying the importance of their support towards the mother in this process, ultimately contributing to improving the practice and benefiting the mother-child relationship. Therefore, we conclude that those interviewed have some knowledge about breastfeeding, recognize its importance during the process and would like to know more.

关键词： Father Breastfeeding Knowledge

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Downstaging and resection after neoadjuvant therapy for fibrolamellar hepatocellular carcinoma

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World Journal of Gastrointestinal Surgery 2014年第6期6卷 107-111页

作者： gilton marques fonsec. Antonio Drauzio Varella Fabricio Ferreira Coelho Emerson Shigueaki Abe Rodrigo Blanco Dumarco Paulo Herman Digestive Surgery Division Department of Gastroenterology University of So Paulo School of Medicine Avenida Doutor Enéas de Carvalho Aguiar 255 Instituto Central 05403-900 So Paulo Brazil Clinical Oncologist Hospital Sírio-Libanês 01308-050 So Paulo Brazil

Fibrolamellar hepatocellular carcinoma(FLHCC) is a rare malignant liver neoplasm, commonly observed in adolescents and young adults of both genders. The disease is more common in Caucasians and in patients without a prior history of liver disease. The best treat-ment option is a surgical resection associated with liver hilum lymph node dissection. However, there is no established systemic drug treatment for patients with locally advanced or metastatic disease. We report on a patient with advanced FLHCC, initially considered un-resectable due to invasion of the right and the middle hepatic veins and circumferential involvement of the left hepatic vein. Following the treatment with gem-citabine-oxaliplatin systemic chemotherapy, the patient exhibited a significant tumor reduction. As a result, a complete resection was performed with an extended right hepatectomy associated with a partial resection of the inferior vena cava, a wedge resection in segment 2, and lymphadenectomy of the hepatic hilum. The case was unusual due to the significant tumor downstaging with gemcitabine-oxaliplatin, potentially enabling cura-tive resection. More studies are needed to confirm the efficacy of the systemic drug treatment for FLHCC.

关键词：化疗 Gemcitabine Oxaliplatin Hepatectomy 肝的静脉 Fibrolamellar hepatocellular 癌

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Laparoscopic liver resection:Experience based guidelines

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World Journal of Gastrointestinal Surgery 2016年第1期8卷 5-26页

作者： fabricio ferreira coelho jaime arthur pirola kruger gilton marques fonsec. raphael leonardo cunha araújo vagner birk jeismann marcos vinícius perini renato micelli lupinacci ivan cecconello paulo herman liver surgery unit department of gastroenterologyuniversity of sao paulo medical schoolSao PauloCEP 05403-900Brazil austin health Department of SurgeryUniversity of MelbourneHeidelbergVIC 3084Australia service de chirurgie digestive viscérale et endocrinienne groupe hospitalier diaconesses-croix saint simon75020 ParisFrance

Laparoscopic liver resection(LLR) has been progressively developed along the past two decades. Despite initial skepticism, improved operative results made laparoscopic approach incorporated to surgical practice and operations increased in frequency and complexity. Evidence supporting LLR comes from case-series, comparative studies and meta-analysis. Despite lack of level 1 evidence, the body of literature is stronger and existing data confirms the safety, feasibility and benefits of laparoscopic approach when compared to open resection. Indications for LLR do not differ from those for open surgery. They include benign and malignant(both primary and metastatic) tumors and living donor liver harvesting. Currently, resection of lesions located on anterolateral segments and left lateral sectionectomy are performed systematically by laparoscopy in hepatobiliary specialized centers. Resection of lesions located on posterosuperior segments(1, 4a, 7, 8) and major liver resections were shown to be feasible but remain technically demanding procedures, which should be reserved to experienced surgeons. Hand-assisted and laparoscopy-assisted procedures appeared to increase the indications of minimally invasive liver surgery and are useful strategies applied to difficult and major resections. LLR proved to be safe for malignant lesions and offers some short-term advantages over open resection. Oncological results including resection margin status and long-term survival were not inferior to open resection. At present, surgical community expects high quality studies to base the already perceived better outcomes achieved by laparoscopy in major centers' practice. Continuous surgical training, as well as new technologies should augment the application of lap-aroscopic liver surgery. Future applicability of new technologies such as robot assistance and image-guided surgery is still under investigation.

关键词： Minimally invasive surgery Laparoscopicsurgery Hand-assisted laparoscopy Liver neoplasm Liver cirrhosis Living donor Liver Hepatectomy Livertransplantation

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