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Non-surgical treatment of hilar cholangiocarcinoma

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World Journal of Gastrointestinal Oncology 2021年第11期13卷 1696-1708页

作者： Riccardo Inchingolo Fabrizio Acquafredda Valentina Ferraro letizia laera Gianmarco Surico Alessia Surgo Alba Fiorentino Stefania Marini Nicola de'Angelis Riccardo Memeo Stavros Spiliopoulos Interventional Radiology Unit "F.Miulli"General Regional HospitalAcquaviva Delle Fonti 70124Italy Unit of Hepato-Pancreatic-Biliary Surgery "F.Miulli"General Regional HospitalAcquaviva Delle Fonti 70021Italy Department of Oncology "F.Miulli"General Regional HospitalAcquaviva Delle Fonti 70021Italy Department of Radiation Oncology "F.Miulli"General Regional HospitalAcquaviva Delle Fonti 70021Italy Department of Radiology "F.Miulli"General Regional HospitalAcquaviva Delle Fonti 70021Italy Unit of Minimally Invasive and Robotic Digestive Surgery "F.Miulli"General Regional HospitalAcquaviva Delle Fonti 70021Italy 2^(nd) Department of Radiology School of MedicineNational and Kapodistrian University of AthensAthens 12461Greece

Cancer of the biliary confluence also known as hilar cholangiocarcinoma(HC)or Klatskin tumor,is a rare type of neoplastic disease constituting approximately 40%-60%of intrahepatic malignancies,and 2% of all *** prognosis is extremely poor and the majority of Klatskin tumors are deemed unresectable upon *** patients with unresectable bile duct cancer die within the first year after diagnosis,due to hepatic failure,and/or infectious complications secondary to biliary *** treatments include surgical resection and liver transplantation in highly selected ***,very few patients are eligible for surgery or transplant at the time of *** patients with unresectable HC,radiotherapy,chemotherapy,photodynamic therapy,and liver-directed minimally invasive procedures such as percutaneous image-guided ablation and intra-arterial chemoembolization are recommended treatment *** review focuses on currently available treatment options for unresectable HC and discusses future perspectives that could optimize outcomes.

关键词： Cholangiocarcinoma Interventional radiology Oncology Liver Radiotherapy Ablation

Current status of non-surgical treatment of locally advanced pancreatic cancer

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World Journal of Gastrointestinal Oncology 2021年第12期13卷 2064-2075页

作者： Stavros Spiliopoulos Maria Teresa Zurlo Annachiara Casella letizia laera Giammarco Surico Alessia Surgo Alba Fiorentino Nicola de'Angelis Roberto Calbi Riccardo Memeo Riccardo Inchingolo 2nd Radiology Department Interventional Radiology UnitNational and Kapodistrian University of AthensAthens 12461Greece Interventional Radiology Unit “F.Miulli”Regional General HospitalAcquaviva delle Fonti 70021Italy Unit of Hepato-Pancreatic-Biliary Surgery “F.Miulli”Regional General HospitalAcquaviva delle Fonti 70021Italy Department of Oncology General Regional Hospital“F.Miulli”Acquaviva delle Fonti 70021Italy Department of Radiation Oncology “F.Miulli”Regional General HospitalAcquaviva delle Fonti 70021Italy Unit of Minimally Invasive and Robotic Digestive Surgery “F.Miulli”Regional General HospitalAcquaviva delle Fonti 70021Italy Department of Radiology General Regional Hospital“F.Miulli”Acquaviva delle Fonti 70021Italy

Pancreatic cancer is the 7th leading cause of death due to cancer in industrializedcountries and the 11th most common cancer globally, with 458918 new cases (2.5%of all cancers) and 432242 deaths (4.5% of all cancer deaths) in 2018. Unfortunately,80% to 90% of the patients present with unresectable disease, and thereported 5-year survival rate range between 10% and 25%, even after successfulresection with tumor-free margins. Systemic chemotherapy, radiotherapy, andminimally invasive image-guided procedures that have emerged over the pastyears, are used for the management of non-operable PC. This review focuses oncurrently available non-surgical options of locally advanced pancreatic cancer.

关键词： Interventional radiology Oncology Radiotherapy Pancreatic cancer Ablation

Current trends and perspectives in interventional radiology for gastrointestinal cancers

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World Journal of Radiology 2021年第10期13卷 314-326页

作者： Elisa Reitano Nicola de'Angelis Giorgio Bianchi letizia laera Stavros Spiliopoulos Roberto Calbi Riccardo Memeo Riccardo Inchingolo Division of General Surgery Department of Translational MedicineUniversity of Eastern PiedmontNovara 28100Italy Unit of Minimally Invasive and Robotic Digestive Surgery "F.Miulli"General Regional HospitalAcquaviva delle Fonti 70021Italy Department of Oncology "F.Miulli"General Regional HospitalAcquaviva delle Fonti 70021Italy 2^(nd) Department of Radiology School of MedicineNational and Kapodistrian University of AthensAthens 12461Greece Department of Radiology "F.Miulli"General Regional HospitalAcquaviva delle Fonti 70124Italy Unit of Hepato-Pancreatic-Biliary Surgery "F.Miulli"General Regional HospitalAcquaviva delle Fonti 70021Italy Interventional Radiology Unit "F.Miulli"General Regional HospitalAcquaviva delle Fonti 70021Italy

Gastrointestinal(GI)cancers often require a multidisciplinary approach involving surgeons,endoscopists,oncologists,and interventional radiologists to diagnose and treat primitive cancers,metastases,and related *** this context,interventional radiology(IR)represents a useful minimally-invasive tool allowing to reach lesions that are not easily approachable with other *** the last years,through the development of new devices,IR has become increasingly relevant in the context of a more comprehensive management of the oncologic *** embolization,ablative techniques,and gene therapy represent useful and innovative IR tools in GI cancer ***,IR can be useful for the management of GI cancer-related complications,such as bleeding,abscesses,GI obstructions,and neurological *** aim of this study is to show the principal IR techniques for the diagnosis and treatment of GI cancers and related complications,as well as to describe the future perspectives of IR in this oncologic field.

关键词： Interventional radiology Radiology Colorectal cancer Gastric cancer Malignancy Embolization

Radiofrequency ablation vs surgical resection in elderly patients with hepatocellular carcinoma in Milan criteria

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World Journal of Gastroenterology 2021年第18期27卷 2205-2218页

作者： Maria Conticchio Riccardo Inchingolo Antonella Delvecchio letizia laera Francesca Ratti Maximiliano Gelli Ferdinando Anelli Alexis Laurent Giulio Vitali Paolo Magistri Giacomo Assirati Emanuele Felli Taiga Wakabayashi Patrick Pessaux Tullio Piardi Fabrizio di Benedetto Nicola de'Angelis Javier Briceño AntonioRampoldi RenèAdam Daniel Cherqui Luca Antonio Aldrighetti Riccardo Memeo Departement of Emergency and Trasplantation of Organs General Surgery Unit“M.Rubino”Policlinico di BariBari 70124Italy Interventional Radiology Unit "F.Miulli"General Regional HospitalAcquaviva delle Fonti 70021Italy Department of Emergency and Organ Transplantation General Surgery Unit“M.Rubino”University of BariCeglie Messapica 70124Italy Department of Oncology "F.Miulli"General Regional HospitalAcquaviva delle Fonti 70021Italy Department of Surgery Univ Vita Salute San RaffaeleMilan 20132Italy Department of Visceral and Oncological Surgery Gustave Roussy Cancer Campus Grand ParisVillejuif 94800France Unit of Oncologic and Pancreatic Surgery Hospital University Reina SofíaCordoba 14004Spain Department of Digestive and Hepatobiliary Surgery Henri Mondor University HospitalCreteil 94000France Department of Surgery University of Geneva HospitalsGeneva 44041Switzerland Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit University of Modena and Reggio EmiliaModena 41124Italy Institut de Recherche Contre les Cancers de l'Appareil Digestif Strasbourg 67000France Department of Surgery Keio University School of MedicineShinjuku-ku 160-8582Japan Hepato-Biliary and Pancreatic Surgical Unit Nouvel Hôpital CivilStrasbourg cedex 67091France Department of Hepatobiliary Pancreatic and Digestive SurgeryUniversity Hospital Robert Debréof ReimsReims 51100France Hepatobiliary and Pancreatic Surgery Unit General Surgery DepartementTroyes HospitalTroyes Zip or Postal CodeFrance University of Champagne-Ardenne Reims 51100France Unit of Minimally Invasive and Robotic Digestive Surgery "F.Miulli"General Regional HospitalAcquaviva delle Fonti 70021Italy Department of General and Digestive Surgery Reina Sofia University HospitalCordoba 14004Spain Interventional Radiology Unit Niguarda HospitalMilan 20132Italy 20132 Italy RenèAdam Hepatobiliary Center Hopital Paul BrousseVillejuif 94800France Unit of Hepato-Pancreatic-Biliary Surgery Univ Vita Salute San RaffaeleMilan 20132Italy Uni

BACKGROUND Surgical resection and radiofrequency ablation(RFA)represent two possible strategy in treatment of hepatocellular carcinoma(HCC)in Milan *** To evaluate short-and long-term outcome in elderly patients(>70 years)with HCC in Milan criteria,which underwent liver resection(LR)or *** The study included 594 patients with HCC in Milan criteria(429 in LR group and 165 in RFA group)managed in 10 European *** analysis was performed using the Kaplan-Meier method before and after propensity score matching(PSM)and Cox *** After PSM,we compared 136 patients in the LR group with 136 patients in the RFA *** survival at 1,3,and 5 years was 91%,80%,and 76%in the LR group and 97%,67%,and 41%in the RFA group respectively(P=0.001).Diseasefree survival at 1,3,and 5 years was 84%,60%and 44%for the LR group,and 63%,36%,and 25%for the RFA group(P=0.001).Postoperative Clavien-Dindo IIIIV complications were lower in the RFA group(1%vs 11%,P=0.001)in association with a shorter length of stay(2 d vs 7 d,P=0.001).In multivariate analysis,Model for End-stage Liver Disease(MELD)score(>10)[odds ratio(OR)=1.89],increased value of international normalized ratio(>1.3)(OR=1.60),treatment with radiofrequency(OR=1.46),and multiple nodules(OR=1.19)were independent predictors of a poor overall survival while a high MELD score(>10)(OR=1.51)and radiofrequency(OR=1.37)were independent factors associated with a higher recurrence *** Despite a longer length of stay and a higher rate of severe postoperative complications,surgery provided better results in long-term oncological outcomes as compared to ablation in elderly patients(>70 years)with HCC in Milan criteria.

关键词： Hepatocellular carcinoma Milan criteria Radiofrequency ablation Surgical resection Elderly patients Propensity score matching