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Hepatocellular carcinoma with child Pugh-A Cirrhosis treated with stereotactic body radiotherapy

World Journal of Gastrointestinal surgery 2017年第12期9卷 256-263页

作者： Shaakir Hasan Ngoc Thai Tadahiro Uemura Vijay Kudithipudi Paul Renz Stephen Abel Alexander V Kirichenko division of Radiation Oncology Allegheny General Hospital Cancer Institute division of transplant surgery Allegheny General Hospital Cancer Institute

AIM To evaluate the control, survival, and hepatic function for Child Pugh(CP)-A patients after Stereotactic body radiotherapy(SBRT) in hepatocellular carcinoma(HCC).METHODS From 2009 to 2016, 40 patients with Barcelona Liver Clinic(BCLC) stages 0-B HCC and CP-A cirrhosis completed liver SBRT. The mean prescription dose was 45 Gy(40 to 50 Gy in 4-5 fractions). Local relapse, defined as recurrence within the planning target volume was assessed with intravenous multiphase contrast computed tomography or magnetic resonance imaging every 4-6 mo after completion of SBRT. Progression of cirrhosis was evaluated by CP and Model for End Stage Liver Disease scores every 3-4 mo. Toxicities were graded per the Common Terminology Criteria for Adverse Events(v4.03). Median follow-up was 24 mo.RESULTS Forty-nine HCC lesions among 40 patients were analyzed in this IRB approved retrospective study. Median tumor diameter was 3.5 cm(1.5-8.9 cm). Six patients with tumors ≥ 5 cm completed planned selected transarterial chemoembolization(TACE) in combination with SBRT. Eight patients underwent orthotropic live transplant(OLT) with SBRT as a bridging treatment(median time to transplant was 12 mo, range 5 to 23 mo). The Pathologic complete response(PCR) rate in this group was 62.5%. The 2-year in-field local control was 98%(1 failure). Intrahepatic control was 82% and 62% at 1 and 2 years, respectively. Overall survival(OS) was 92% and 60% at 1 and 2 years, with a median survival of 41 mo per Kaplan Meier analysis. At 1 and 2 years, 71% and 61% of patients retained CPA status. Of the patients with intrahepatic failures, 58% developed progressive cirrhosis, compared to 27% with controlled disease(P = 0.06). Survival specific to hepatic failure was 92%, 81%, and 69% at 12, 18, and 24 mo. There was no grade 3 or higher toxicity. On univariate analysis, gross tumor volume(GTV) < 23 cc was associated with freedom from CP progression(P = 0.05), hepatic failure-specific survival(P = 0.02), and trended with OS(P = 0.10).CONCLUSION SBRT is safe

关键词： Stereotactic body radiotherapy Hepatocellular carcinoma Child-Pugh A Cirrhosis Hepatoma Local control Radiotherapy Radiation

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Undifferentiated carcinoma with osteoclast-like giant cells of the pancreas mimicking pancreatic pseudocyst

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Hepatobiliary & Pancreatic Diseases International 2022年第4期21卷 403-405页

作者： Emina Talakic Jasminka Igrec Ann-Katrin Kaufmann-Bühler Elmar Janek Sygulla Stephan Peter Schemmer Michael Fuchsjager division of general Radiology Department of RadiologyMedical University of GrazGrazAustria Diagnostic and Research Institute of Pathology Medical University of GrazGrazAustria general Visceral and Transplant SurgeryDepartment of SurgeryMedical University of GrazGrazAustria

To the Editor:Undifferentiated carcinoma with osteoclast-like giant cells(UCOGC)is one of eight histological subtypes of pancreatic ductal adenocarcinoma(PDAC)according to the 2019 WHO classification[1].It accounts for<1%of exocrine pancreatic carcinomas.This rare variant occurs in slightly younger patients than conventional PDAC,with a slight female predominance(male:female,7:10).

关键词： differentiated pancreas female

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Liver transplantation as an alternative for the treatment of non-resectable liver colorectal cancer: Advancing the therapeutic algorithm

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Hepatobiliary & Pancreatic Diseases International 2024年第2期23卷 154-159页

作者： Badi Rawashdeh Richard Bell Abdul Hakeem Raj Prasad division of transplant surgery Department of General SurgeryMedical College of WisconsinMilwaukeeWI53226USA Leeds Teaching Hospital LeedsUK

Colorectal cancer is a leading cause of cancerrelated mortality,with nearly half of the affected patients developing liver metastases.For three decades,liver resection(LR)has been the primary curative strategy,yet its applicability is limited to about 20%of cases.Liver transplantation(LT)for unresectable metastases was attempted unsuccessfully in the 1990s,with high rates of perioperative death and recurrence.There is now more interest in this strategy due to improvements in systemic therapies and surgical techniques.A significant study conducted by the Oslo group showed that patients receiving liver transplants had a 60%chance of survival after five years.Significantly better results have been achieved by using advanced imaging for risk stratification and further refining selection criteria,especially in the Norvegian SECA trials.This review carefully charts the development and history of LT as a treatment option for colorectal cancer liver metastases.The revolutionary path from the early days of exploratory surgery to the current situation of cautious optimism is traced,highlighting the critical clinical developments and improved patient selection standards that have made LT a potentially curative treatment for such challenging very well selected cases.

关键词： Liver transplantation Colorectal cancer liver metastases Non-resectable liver metastases

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Echinococcus granulosus:A novel parenchymal sparing surgical treatment

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Hepatobiliary & Pancreatic Diseases International 2020年第4期19卷 390-393页

作者： Daniela Kniepeiss Emina Talakic Peter Schemmer general Visceral and Transplant SurgeryDepartment of SurgeryMedical University GrazAuenbruggerplatz 298036 GrazAustria division of general Radiology Department of RadiologyMedical University of GrazAuenbruggerplatz 208036 GrazAustria

Human echinococcosis is a zoonosis caused by Echinococcus(E.)tapeworms.There are different species,but E.granulosus and E.multilocularis have clinical relevance causing cystic and alveolar echinococcosis,respectively.Cystic echinococcosis(CE)is defined as presence of one or more hydatid cysts,most frequently in the liver and the lungs,less usual in the kidneys,bones,spleen,pancreas,heart or brain.The location,the number and size of the cysts determine the severity of the disease[1].

关键词： Echinococcus spleen clinical

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Xanthogranulomatous cholecystitis mimicking gallbladder cancer and causing obstructive cholestasis

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Hepatobiliary & Pancreatic Diseases International 2012年第5期11卷 549-552页

作者： Paulo N Martins Patricia Sheiner Marcelo Facciuto Department of surgery Transplant DivisionMassachusetts General HospitalHarvard Medical School Department of surgery Division of Hepatobiliary Surgery and TransplantationNew York Medical College division of transplantation Mount Sinai Hospital

BACKGROUND: Xanthogranulomatous cholecystitis (XGC) is a destructive inflammatory disease of the gallbladder that can mimic gallbladder carcinoma. METHODS: We present the case of a 35-year-old Hispanic male complaining of right upper quadrant pain and jaundice for 2 months prior to admission. He denied a history of fever, nausea/ vomiting, and weight loss. The past medical history was relevant only for diabetes. He had no previous history of jaundice or previous operations. RESULTS: CA19-9 was slightly elevated (52 U/mL). Abdominal ultrasonography showed an irregular thickening of the gallbladder wall and no gallstones were detected. CT scan also revealed an irregular thickening of the wall of the gallbladder body suggestive of malignancy. At laparotomy, the mass was adherent to the duodenum and colon, and although the frozen section biopsy was negative, the intraoperative findings were suggestive of malignancy, and the patient underwent left liver trisegmentectomy, resection of the common bile duct and Roux-en-Y hepaticojejunostomy. Pathological examination unexpectedly revealed XGC without malignancy. CONCLUSIONS: Preoperative and intraoperative differential diagnosis of XGC from gallbladder carcinoma remains a challenge when it is associated with inflammatory involvement of surrounding tissues. Since gallbladder carcinoma and XGC may coexist, radical resection is justified when malignancy cannot be completely ruled out.

关键词： xanthogranulomatous cholecystitis gallbladder cancer obstructive cholestasis

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A comparative study of pancreas transplantation between type 1 and 2 diabetes mellitus

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Hepatobiliary surgery and Nutrition 2021年第4期10卷 443-453页

作者： Bor-Shiuan Shyr Bor-Uei Shyr Shih-Chin Chen Che-Chuan Loong Yi-Ming Shyr Shin-E Wang division of general surgery Department of SurgeryTaipei Veterans General Hospitaland National Yang Ming UniversityTaipei division of transplant surgery Department of SurgeryTaipei Veterans General Hospitaland National Yang Ming UniversityTaipei

Background:Pancreas transplantation remains the best long-term treatment option to achieve physiological euglycemia and insulin independence in patients with labile diabetes mellitus(DM).It is widely accepted as an optimal procedure for type 1 DM(T1DM),but its application in type 2 DM(T2DM)is not unanimously acknowledged.Methods:In total,146 diabetes patients undergoing pancreas transplantation were included in this study.Clinical data and outcomes were compared between the T1DM and T2DM groups.Results:Majority(93%)of the pancreas transplantations in T2DM were for uremic recipients.Complications occurred in 106(73%)patients,including 70(48%)with early complications before discharge and 79(54%)with late complications during follow-up period.Overall,rejection of pancreas graft occurred in 37(25%)patients.Total rejection rate in T2DM recipients was significantly lower than that in T1DM.The short-and long-term outcomes for endocrine function in terms of fasting blood sugar and hemoglobin A1c levels and graft survival rates are comparable between the T2DM and T1DM groups.Conclusions:T2DM is not inferior to T1DM after pancreas transplantation in terms of surgical risks,immunological and endocrine outcomes,and graft survival rates.Therefore,pancreas transplantation could be an effective option to treat selected uremic T2DM patients without significant insulin resistance.

关键词： Type 2 diabetes mellitus(T2DM) pancreas transplantation

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A liver donor with double hepatic artery aneurysm: a saved graft

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Hepatobiliary & Pancreatic Diseases International 2015年第4期14卷 443-445页

作者： Vincenzo Tondolo Alberto Manzoni Fausto Zamboni division of general surgery and transplantation Department of Surgery Brotzu Hospital

The shortage of organs and the increasing median age of deceased donors for orthotropic liver transplantation stimulate transplant centres to accept grafts that otherwise would have been discarded due to severe vascular abnormali- ties. We encountered a donor with two arterial aneurysms and a left accessory hepatic artery： an arterial aneurysm of the common hepatic artery and a left accessory hepatic artery arising from a second aneurysm of the left gastric artery （Mi- chels type V）. A complex reconstruction was created to trans- plant the liver. Multiple arterial anastomosis was made and the hepatic inflow of the transplanted liver restored. Although the procedure increased the risk of hepatic artery thrombosis, one more organ supposed to be discarded was saved.

关键词： liver transplantation anastomosis anatomy hepatic aneurysm arterial reconstruction

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Normothermic Ex-vivo Liver Perfusion and the Clinical Implications for Liver transplantation

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Journal of Clinical and Translational Hepatology 2018年第3期6卷 276-282页

作者： Clifford Akateh Eliza W.Beal Bryan A.Whitson Sylvester M.Black general and Gastrointestinal surgery Department of SurgeryThe Ohio State University Wexner Medical CenterColumbusOhioUSA division of Cardiac surgery Department of SurgeryThe Ohio State University Wexner Medical CenterColumbusOhioUSA division of transplant surgery Department of SurgeryThe Ohio State University Wexner Medical CenterColumbusOhioUSA

Despite significant improvements in outcomes after liver trans-plantation,many patients continue to die on the waiting list,while awaiting an available organ for transplantation.Organ shortage is not only due to an inadequate number of available organs,but also the inability to adequately assess and evaluate these organs prior to transplantation.Over the last few decades,ex-vivo perfusion of the liver has emerged as a useful technique for both improved organ preservation and assessment of organs prior to transplantation.Large animal studies have shown the superiority of ex-vivo perfusion over cold static storage.However,these studies have not,necessa-rily,been translatable to human livers.Small animal studies have been essential in understanding and improving this tech-nology.Similarly,these results have yet to be translated into clinical use.A few Phase 1 clinical trials have shown promise and confirmed the viability of this technology.However,more robust studies are needed before ex-vivo liver perfusion can be widely accepted as the new clinical standard of organ preser-vation.Here,we aimed to review al relevant large and smal animal research,as well as human liver studies on normother-mic ex-vivo perfusion,and to identify areas of deficiency and opportunities for future research endeavors.

关键词： Liver transplantation Ex-vivo perfusion

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Liver transplantation for unresectable colorectal metastasis:a new hope

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Hepatobiliary surgery and Nutrition 2020年第5期9卷 665-668页

作者： Andre Gorgen Tommy Ivanics Gonzalo Sapisochin Multi-Organ transplant Program Division of General SurgeryUniversity Health NetworkToronto General HospitalTorontoCanada

Despite recent advances in medical and surgical treatments,surgical resection remains the only curative option for patients with colorectal liver metastasis(CRLM).Unfortunately,only a minority of patients with CRLM are candidates for liver resection.The 5-year survival of patients with liver-only disease and deemed unresectable is difficult to quantify but likely ranges around 5 to 10%.Since 2013,a few studies have shown that liver transplantation(LT)is feasible for selected patients with unresectable CRLM(1,2).Recently,the Oslo University Hospital LT group has published their latest results with modified selection criteria and should be congratulated for their efforts.Nevertheless,the evidence available is still developing.For example,currently,there is a lack of robust evidence supporting the widespread use of LT for CRLM outside Norway,a particular region in terms of graft scarcity.

关键词： metastasis colorectal likely

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Downstaging strategies for unresectable hepatocellular carcinoma

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World Journal of Gastroenterology 2024年第20期30卷 2731-2733页

作者： Georgia Sofia Karachaliou Nikolaos Dimitrokallis Dimitrios P Moris division of Gastroenterology Department of MedicineDuke University Medical CenterDurhamNC 27710United States First Department of surgery&Organ transplant Unit Evangelismos General HospitalAthens 10676Greece Department of surgery Duke University Medical CenterDurhamNC 27710United States

A significant number of patients with hepatocellular carcinoma(HCC)are usually diagnosed in advanced stages,that leads to inability to achieve cure.Palliative options are focusing on downstaging a locally advanced disease.It is wellsupported in the literature that patients with HCC who undergo successful conversion therapy followed by curative-intent surgery may achieve a significant survival benefit compared to those who receive chemotherapy alone or those who are successfully downstaged with conversion therapy but not treated with surgery.Hepatic artery infusion chemotherapy can be a potential downstaging strategy,since recent studies have demonstrated excellent outcomes in patients with colorectal liver metastatic disease as well as primary liver malignancies.

关键词： Unresectable hepatocellular carcinoma Hepatic arterial infusion chemotherapy Downstaging Hepatocellular carcinoma

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