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Optimizing outcomes for patients with gastric cancer peritoneal carcinomatosis

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World Journal of Gastrointestinal Oncology 2018年第10期10卷 282-289页

作者： Jennifer L Leiting Travis E Grotz division of hepatobiliary and pancreas surgery Mayo Clinic

Peritoneal carcinomatosis (PC) from gastric cancer has traditionally been considered a terminal progression of the disease and is associated with poor survival out-comes. Positive peritoneal cytology similarly worsens the survival of patients with gastric cancer and treatment options for these patients have been limited. Recent ad-vances in multimodality treatment regimens have led to innovative ways to care for and treat patients with this disease burden. One of these advances has been to use neoadjuvant therapy to try and convert patients with positivecytologyorlow-volume PC to negative cytolo-gy with no evidence of active peritoneal *** strategies include the use of neoadjuvant systemic chemotherapy alone,using neoadjuvant laparoscopic heated intraper itoneal chemotherapy(NLHIPEC)after systemic chemotherapy,or using neoadjuvant intra-peritoneal and systemic chemother apy(NIPS)in a bi-dir ectional manner. For patients with higher volume PC,cytoreductive surgery (CRS) and hyperthermic intrape-ritoneal chemotherapy(HIPEC)have been mainstays of treatment. When used together, CRS and HIPEC can improve overall outcomes in properly selected patients,but overall survival outcomes remain unacceptably *** extent of peritoneal disease, commonly measured by the peritoneal carcinomatosis index (PCI), and the com-pleteness of cytor eduction,has been shown to greatly impact outcomes in patients undergoing CRS and *** uses of NLHIPEC and NLHIPEC plus NIPS have both been shown to decrease the PCI and thus increase the opportunity for complete cytoreduction. Newer therapies like pressurized intraperitoneal aerosol chemother apy and immunotherapy, such as catumaxomab, along with improved systemic chemotherapeutic regimens, are being explored with great *** is exciting progress being made in the management of PC from gastric can-cer and its’ treatment is no longer futile.

关键词： Peritoneal carcinomatosis index Peritoneal carcinomatosis Gastric cancer Cytoreductive surgery Heated intraperitoneal chemotherapy Neoadjuvant intraperitoneal and systemic chemotherapy

Therapeutic advances: Single incision laparoscopic hepatopancreatobiliary surgery

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World Journal of Gastroenterology 2014年第39期20卷 14329-14337页

作者： Stephen Kin Yong Chang Kai Yin Lee division of hepatobiliary and pancreas surgery Department of Surgery National University Singapore Hospital

Single-port laparoscopic surgery(SPLS) is proposed to be a step towards minimizing the invasiveness of surgery, and has since gained popularity in several surgical sub-specialties including hepatopancreatobiliary surgery. SPLS has since been applied to cholecystectomy, liver resection as well as pancreatectomy for a multitude of pathologies. Benefits of SPLS over conventional multi-incision laparoscopic surgery include improved cosmesis and potentially post-operative pain at specific time periods and extra-umbilical sites. However, it is also associated with longer operating time, increased rate of complications, and increased rate of port-site hernia. There is no significant difference between length of hospital stay. SPLS has a significant learning curve that affects operating time, rate of conversion and rate of complications. In this article, we review the literature on SPLS in hepatobiliary surgery- cholecystectomy, hepatectomy and pancreatectomy, and offer tips on overcoming potential technical obstacles and minimizing the complications when performing SPLS- surgeon position, position of port and instruments, instrument crossing position, standard hand grip vs reverse hand grip, snooker cue guide position, prevention of incisional hernia. SPLS is a promising direction in laparoscopic surgery, and we recommend step-wise progression of applications of SPLS to various hepatopancreatobiliary surgeries to ensure safe adoption of the surgical technique.

关键词： Single port laparoscopic Cholecystectomy Hepatectomy Pancreatectomy Liver resection

Appropriate treatment strategies improve survival of hepatocellular carcinoma patients with portal vein tumor thrombus

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World Journal of Gastroenterology 2014年第45期20卷 17141-17147页

作者： Jia-Zhou Ye Yong-Quan Zhang Hai-Hong Ye Tao Bai Liang Ma Bang-De Xiang Le-Qun Li Department of hepatobiliary and pancreas surgery Affiliated Tumor Hospital of Guangxi Medical University Department of hepatobiliary and pancreas surgery Affiliated Minzu Hospital of Guangxi Medical University

AIM: To evaluate the survival benefits of different treatment strategies for hepatocellular carcinoma (HCC) patients with portal vein tumor thrombus (PVTT) and to determine the prognosis factors.

关键词： Hepatocellular carcinoma Portal vein tumor thrombosis Conservative treatment Transarterial chemoembolization Surgical resection Postoperative transarterial chemoembolization

Chimeric antigen receptor-engineered T-cell therapy for liver cancer

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hepatobiliary & Pancreatic Diseases International 2018年第4期17卷 301-309页

作者： Yang Chen Chang-Yong E Zhi-Wen Gong Shui Liu Zhen-Xiao Wang Yong-Sheng Yang Xue-Wen Zhang Department of hepatobiliary and pancreas surgery the Second Hospital of Jilin University Department of hepatobiliary and Pancreatic surgery China-Japan Union Hospital of Jilin University

Background: Chimeric antigen receptor-engineered T-cell(CAR-T) therapy is a newly developed immunotherapy used in the treatment of cancers. Because CAR-T therapy has shown great success in treating CD19-positive hematological malignancies, its application has been explored in the treatment of solid tumors, such as liver cancer. In this review, we discuss the immune characteristics of liver cancer, the obstacles encountered during the application of CAR-T therapy, and preclinical and clinical progress in the use of CAR-T therapy in patients with liver *** sources: The data on CAR-T therapy related to liver cancers were collected by searching Pub Med and the Web of Science databases prior to December 2017 with the keywords "chimeric antigen receptor","CAR-T", "liver cancer", "hepatocellular carcinoma", and "solid tumor". Additional articles were identified by manual search of references found in the primary articles. The data for clinical trials were collected by searching Clinical ***: The liver has a tolerogenic nature in the intrahepatic milieu and its tumor microenvironment significantly affects tumor progression. The obstacles that reduce the efficacy of CAR-T therapy in solid tumors include a lack of specific tumor antigens, limited trafficking and penetration of CAR-T cells to tumor sites, and an immunosuppressive tumor microenvironment. To overcome these obstacles, several strategies have emerged. In addition, several strategies have been developed to manage the side effects of CAR-T, including enhancing the selectivity of CARs and controlling CAR-T activity. To date, no clinical trials of CAR-T therapy against HCC have been completed. However, preclinical studies in vitro and in vivo have shown potent antitumor efficacy. Glypican-3, mucin-1, epithelial cell adhesion molecule, carcinoembryonic antigen, and other targets are currently being ***: The application of CAR-T therapy for liver cancer is just beginning to be expl

关键词： Liver cancer Chimeric antigen receptor-engineered T-cell therapy Immunotherapy Tumor-associated antigen

Clinical advantages of single port laparoscopic hepatectomy

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World Journal of Gastroenterology 2018年第3期24卷 379-386页

作者： Jae Hyun Han Young Kyoung You Ho Joong Choi Tae Ho Hong Dong Goo Kim division of hepatobiliary-pancreas surgery and Liver Transplantation Department of SurgerySeoul St.Mary’s HospitalCollege of MedicineThe Catholic University of Korea

AIM To evaluate the clinical advantages of single-port laparoscopic hepatectomy(SPLH) compare to multiport laparoscopic hepatectomy(MPLH).METHODS We retrospectively reviewed the medical records of 246 patients who underwent laparoscopic liver resection between January 2008 and December 2015 at our hospital. We divided the surgical technique into two groups; SPLH and MPLH. We performed laparoscopic liver resection for both benign and malignant disease. Major hepatectomy such as right and left hepatectomy was also done with sufficient disease-free margin. The operative time, the volume of blood loss, transfusion rate, and the conversion rate to MPLH or open surgery was evaluated. The post-operative parameters included the meal start date after operation, the number of postoperative days spent in the hospital, and surgical complications was also *** Of the 246 patients, 155 patients underwent SPLH and 91 patients underwent MPLH. Conversion rate was 22.6% in SPLH and 19.8% in MPLH(P = 0.358). We performed major hepatectomy, which was defined as resection of more than 2 sections, in 13.5% of patients in the SPLH group and in 13.3% of patients in the MPLH group(P = 0.962). Mean operative timewas 136.9 ± 89.2 min in the SPLH group and 231.2 ± 149.7 min in the MPLH group(P < 0.001). The amount of blood loss was 385.1 ± 409.3 m L in the SPLH group and 559.9 ± 624.9 m L in the MPLH group(P = 0.016). The safety resection margin did not show a significant difference(0.84 ± 0.84 cm in SPLH vs 1.04 ± 1.22 cm in MPLH, P = 0.704). Enteral feeding was started earlier in the SPLH group(1.06 ± 0.27 d after operation) than in the MPLH group(1.63 ± 1.27 d)(P < 0.001). The mean hospital stay after operation was non-significantly shorter in the SPLH group than in the MPLH group(7.82 ± 2.79 d vs 7.97 ± 3.69 d, P = 0.744). The complication rate was not significantly different(P = 0.397) and there was no major perioperative complication or mortality case in both groups. CONCLUS

关键词： Hepatectomy Laparoscopy Minimally invasive surgery Treatment outcome Feasibility study

Advances in managing hepatocellular carcinoma

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Frontiers of Medicine 2014年第2期8卷 175-189页

作者： Marielle Reataza David K. Imagawa University of California lrvine Medical Center Orange CA 92868 USA division of hepatobiliary and pancreas surgery Department of Surgery University of California Irvine Medical Center Orange CA 92868 USA

Multiple modalities for treatment of hepatocellular carcinoma are available, depending on tumor size and number. Surgical resection remains the gold standard, so long as the residual liver function reserve is sufficient. In patients with advanced cirrhosis, liver transplantation is the preferred option, as these patients may not have adequate hepatic reserve after resection. Salvage liver transplantation has also become an option for a select few patients who recur after surgical resection. Ablative techniques have been used for palliation as well as to either completely destroy the tumor, act as an adjunct to resection, or downstage the tumor to meet Milan criteria such that a patient may be a candidate for liver transplantation. Radiofrequency ablation, microwave ablation, chemoembolization, radioembolization, and irreversible electroporation have all been used in this capacity. Currently, sorafenib is the only US Food and Drug Administration-approved chemotherapeutic for hepatocellular carcinoma. The efficacy of sorafenib, in combination with other agents, transarterial chemoembolization, and surgical resection is currently being investigated. Sunitinib and brivanib, tyrosine kinase inhibitors, have failed as potential first- or second-line options for chemotherapy. Bevacizumab in combination with erlotinib is also currently being studied. Final analysis for ramucirumab and axitinib are pending. Tivantinib, a selective mesenchymai-epithelial transition factor （MET） inhibitor, is also undergoing clinical trials for efficacy in MET- high tumors. This review serves to emphasize the current and new technologies emerging in the treatment of hepatoeellular carcinoma.

关键词： hepatocellular carcinoma radiofrequency ablation microwave ablation chemoembolization radioembolization sorafenib irreversible electroporation

Clinical outcome in patients with hepatocellular carcinoma after living-donor liver transplantation

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World Journal of Gastroenterology 2013年第29期19卷 4737-4744页

作者： Ho Joong Choi Dong Goo Kim Gun Hyung Na Jae Hyun Han Tae Ho Hong Young Kyoung You hepatobiliary-pancreas surgery and Liver Transplantation division Department of Surgery Seoul St. Mary's Hospital The Catholic University of Korea Seoul 137-701 South Korea

AIM: To investigate risk factors for hepatocellular carcinoma (HCC) recurrence after living donor liver transplantation (LDLT) and efficacy of various criteria. METHODS: From October 2000 to November 2011, 233 adult patients underwent LDLT for HCC at our institution. After excluding nine postoperative mortality cases, we analyzed retrospectively 224 patients. To identify risk factors for recurrence, we evaluated recurrence, disease-free survival (DFS) rate, survival rate, and various other factors which are based on the characteristics of both the patient and tumor. Additionally, we developed our own criteria based on our data. Next, we compared our selection criteria with various tumor-grading scales, such as the Milan criteria, University of California, San Francisco (UCSF) criteria, TNM stage, Barcelona Clinic Liver Cancer (BCLC) stage and Cancer of the Liver Italian Program (CLIP) scoring system. The median follow up was 68 (6-139) ***: In 224 patients who received LDLT for HCC, 37 (16.5%) experienced tumor recurrence during the follow-up period. The 5-year DFS and overall survival rates after LDLT in all patients with HCC were 80.9% and 76.4%, respectively. On multivariate analysis, the tumor diameter {5 cm; P < 0.001; exponentiation of the B coefficient [Exp(B)], 11.89; 95%CI: 3.784-37.368} and alpha fetoprotein level [AFP, 100 ng/mL; P = 0.021; Exp(B), 2.892; 95%CI: 1.172-7.132] had significant influences on HCC recurrence after LDLT. Therefore, these two factors were included in our criteria. Based on these data, we set our selection criteria as a tumor diameter ≤ 5 cm and AFP ≤ 100 ng/mL. Within our new criteria (140/214, 65.4%), the 5-year DFS and overall survival rates were 88.6% and 81.8%, respectively. Our criteria (P = 0.001), Milan criteria (P = 0.009), and UCSF criteria (P = 0.001) showed a significant difference in DFS rate. And our criteria (P = 0.006) and UCSF criteria (P = 0.009) showed a significant difference in overall survival rate. Bu

关键词： Hepatocellular carcinoma Living donor liver transplantation Selection criteria Milan criteria University of California, San Francisco criteria Barcelona Clinic Liver Cancer Cancer of the Liver Italian Program

Prognosis of hepatocellular carcinoma with bile duct tumor thrombus after R0 resection:a matched study

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hepatobiliary & Pancreatic Diseases International 2016年第6期15卷 626-632页

作者： Ding-Ding Wang Li-Qun Wu Zu-Sen Wang division of hepatobiliary Pancreatic surgery The Affiliated Hospital of Qingdao University

BACKGROUND： Hepatocellular carcinoma （HCC） with bile duct tumor thrombus （BDTT） is rare. The present study aimed to determine post-surgical prognoses in HCC patients with BDTT, as outcomes are currently unclear. METHODS： We compared the prognoses of 110 HCC patients without BDTT （group A） to 22 cases with BDTT （group B）. The two groups were matched in age, gender, tumor etiology, size, number, portal vascular invasion, and TNM stage. Additionally, 28 HCC patients with BDTT were analyzed to identify prognostic risk factors. RESULTS： The 1-, 3-, and 5-year overall survival rates were 90.9%, 66.9%, and 55.9% for group A and 81.8%, 50.0%, and 37.5% for group B, respectively. The median survival time in groups A and B was 68.8 and 31.4 months, respectively （P=0.043）. The patients for group B showed higher levels of serum total bilirubin, alanine aminotransferase and gammaglutamyl transferase, a larger hepatectomy range, and a higher rate of anatomical resection. In subgroup analyses of patients with BDTT who underwent R0 resection, TNM stage Ⅲ-Ⅳ was an independent risk factor for overall survival; these patients had worse prognoses than those with TNM stage Ⅰ-Ⅱ after R0 resection （hazard ratio=6.056, P=0.014）. Besides, univariate and multivariate analyses revealed that non-R0 resection and TNM stage Ⅲ-Ⅳ were independent risk factors for both disease-free survival and overall survival of 28 HCC patients with BDTT. The median overall survival time of patients with BDTT who underwent R0 resection was longer than that of patients who did not undergo R0 resection （31.0 vs 4.0 months, P=0.007）.CONCLUSIONS： R0 resection prolonged survival time in HCC patients with BDTT, although prognosis remains poor. For such patients, R0 resection is an important treatment that determines long-term survival.

关键词： hepatocellular carcinoma bile duct tumor thrombus prognosis recurrence R0 resection

Acute pancreatitis induced by transarterial chemoembolization:a single-center experience of over 1500 cases

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hepatobiliary & Pancreatic Diseases International 2016年第1期15卷 93-98页

作者： Wong Hoi She Albert CY Chan Tan To Cheung Kenneth SH Chok See Ching Chan Ronnie TP Poon Chung Mau Lo division of hepatobiliary & Pancreatic surgery and Liver Transplantation Department of SurgeryThe University of Hong Kong

BACKGROUND： Acute pancreatitis is a relatively rare but po- tentially lethal complication after transarterial chemotherapy. This study aimed to review the complications such as acute pancreatitis after transarterial chemotherapy with or without embolization for hepatocellular carcinoma. METHODS： A total of 1632 patients with hepatocellular car- cinoma who had undergone transarterial chemoembolization from ]anuary 2000 to February 2014 in a single-center were reviewed retrospectively. We investigated the potential com- plications of transarterial chemoembolization, such as acute pancreatitis and acute pancreatitis-related complications. RESULTS： Of the 1632 patients with hepatocellular carcinoma who had undergone 5434 transarterial chemoembolizations, 1328 were male and 304 female. The median age of these pa- tients was 61 years. Most （79.6%） of the patients suffered from HBV-related hepatoceUular carcinoma. The median tumor size was 5.2 cm. Of the 1632 patients, 145 patients underwent transarterial chemoembolization with doxorubicin elut- ing bead, making up a total of 538 episodes. The remaining patients underwent transarterial chemoembolization with cisplatin. Seven （0.4%） patients suffered from acute pancre- atitis post-chemoembolization. Six patients had chemoembo- lization with doxorubicin and one had chemoembolization with cisplatin. Patients who received doxornbicin eluting bead had a higher risk of acute pancreatitis [6/145 （4.1%） vs 1/1487 （0.1%）, P〈0.0001]. Two patients had anatomical arterial variations. Four patients developed acute pancreatitis- related complications including necrotizing pancreatitis （n=3） and pseudocyst formation （n=1）. All of the 4 patients resolved after the use of antibiotics and other conservative treatment. Three patients had further transarterial chemoembolization without any complication. CONCLUSIONS： Acute pancreatitis after transarterial chemo- embolization could result in serious complications, especially after treatment wit

关键词： transarterial chemoembolization acute pancreatitis hepatocellular carcinoma