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Novel preoperative strategies to improve hepatocellular carcinoma resectability

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Hepatobiliary Surgery and Nutrition 2023年第1期12卷 140-141页

作者： Francisco Tustumi fabricio ferreira coelho Paulo Herman Department of Gastroenterology Universidade de São PauloSao PauloBrazil Department of Surgery Hospital Israelita Albert EinsteinSao PauloBrazil

Peng et al.(1)performed a pretty interesting article,reporting the proposal of a new strategy to improve resectability for hepatocellular carcinoma(HCC).Their findings are *** strategies to improve liver resection are methods for promoting future liver remnant(FLR)growth in a timely manner before cancer *** main strategies are portal vein embolization(PVE)and associating liver partition and portal vein ligation for staged hepatectomy(ALPPS).

关键词： hepatocellular liver

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

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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 Fonseca 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

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 Fonseca 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

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 Fonseca 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

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 Fonseca 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： Chemotherapy Gemcitabine Oxaliplatin Hepatectomy Hepatic veins Fibrolamellar hepatocellular carcinoma

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 fonseca 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

Communicating with the non-dominant hemisphere:Implications for neurological rehabilitation

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Neural Regeneration Research 2013年第13期8卷 1236-1246页

作者： fabricio ferreira de Oliveira Sheilla de Medeiros Correia Marin Paulo Henrique ferreira Bertolucci Department of Neurology and Neurosurgery Escola Paulista de Medicina Federal University of So Paulo (UNIFESP) So Paulo SP

Aphasic syndromes usually result from injuries to the dominant hemisphere of the brain. Despite the fact that localization of language functions shows little interindividual variability, several brain areas are simultaneously activated when language tasks are undertaken. Mechanisms of language recovery after brain injury to the dominant hemisphere seem to be relatively stereotyped, including activations of perilesional areas in the acute phase and of homologues of language areas in the non-dominant hemisphere in the subacute phase, later returning to dominant hemisphere activation in the chronic phase. Plasticity mechanisms reopen the critical period of language development, more specifically in what leads to disinhibition of the non-dominant hemisphere when brain lesions affect the dominant hemisphere. The non-dominant hemisphere plays an important role during recovery from aphasia, but currently available rehabilitation therapies have shown limited results for efficient language improvement. Large-scale randomized controlled trials that evaluate well-defined interventions in patients with aphasia are needed for stimulation of neuroplasticity mechanisms that enhance the role of the non-dominant hemisphere for language recovery. Ineffective treatment approaches should be replaced by more promising ones and the latter should be evaluated for proper application. The data generated by such studies could substantiate evidence-based rehabilitation strategies for patients with aphasia.

关键词： neural regeneration reviews linguistics aphasia language speech non-dominant hemisphere disability evaluation prognosis cerebrum function grants-supported paper neuroregeneration

Discovery of the marine Eocene in the northern South China Sea

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National Science Review 2019年第5期6卷 881-886页

作者： Zhimin Jian Haiyan Jin Michael A Kaminski fabricio ferreira Baohua Li Pai-Sen Yu State Key Laboratory of Marine Geology Tongji University Geosciences Department King Fahd University of Petroleum and Minerals Institute for Geosciences Universidade Federal Fluminense Nanjing Institute of Geology and Paleontology Chinese Academy of Sciences Applied Research Laboratories(NARLabs) Taiwan Ocean Research Institute(TORI)

The nature of the Eocene stratigraphy of the South China Sea (SCS) has been a mystery for *** the southern SCS, the Eocene system with marine deposits is often considered as representing part of the ‘Proto-South Chin... 详细信息

关键词： SCS Sr Discovery of the marine Eocene in the northern South China Sea China

Liver resection for the treatment of post-cholecystectomy biliary stricture with vascular injury

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World Journal of Gastroenterology 2015年第7期21卷 2102-2107页

作者： Marcos V Perini Paulo Herman Andre L Montagnini Jose Jukemura fabricio F coelho Jaime A Kruger Telesforo Bacchella Ivan Cecconello Digestive Surgery Division Depar-tment of Gastroenterology University of Sao Paulo Medical School

AIM:To report experience with liver resection in a select group of patients with postoperative biliary stricture associated with vascular ***:From a prospective database of patients treated for benign biliary strictures at our hospital,cases that underwent liver resections were *** cases were referred after one or more attempts to repair bile duct injuries following cholecystectomy(open or laparoscopic).Liver resection was indicated in patients with Strasberg E3/E4(hilar stricture)bile duct lesions associated with vascular damage(arterial and/or portal),ipsilateral liver atrophy/abscess,recurrent attacks of cholangitis,and failure of previous ***:Of 148 patients treated for benign biliary strictures,nine(6.1%)underwent liver resection;eight women and one man with a mean age of 38.6 *** patients had previously been submitted to open cholecystectomy and three to laparoscopic *** mean number of surgical procedures before definitive treatment was *** patients had Strasberg E3/E4injuries,and vascular injury was present in all *** patients underwent right hepatectomy and one underwent left lateral sectionectomy without *** time of follow up was 69.1 mo and after longterm follow up,eight patients are ***:Liver resection is a good therapeutic option for patients with complex postoperative biliary stricture and vascular injury presenting with liver atrophy/abscess in which previous hepaticojejunostomy has failed.

关键词： Abscess Atrophy Benign Bile ducts Cholecystectomy