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Lymphoepithelioma-like hepatocellular carcinoma: Case report and review of the literature

World Journal of Gastroenterology 2015年第36期21卷 10468-10474页

作者： Andrea Cacciato Insilla Pinuccia Faviana Luca Emanuele Pollina Paolo De Simone Laura Coletti Franco Filipponi Daniela Campani Department of surgical MedicalMolecular Pathology and Critical AreaDivision of Surgical PathologyUniversity Hospital of Pisa Department of surgical MedicalMolecular Pathology and Critical AreaDivision of Liver Surgery and TransplantationUniversity Hospital of Pisa

Lymphoepithelioma-like hepatocellular carcinoma(LELHCC) is a rare form of undifferentiated carcinoma of the liver characterized by the presence of an abundant lymphoid infiltrate. Here,a case of LEL-HCC is described. An 81-year-old woman with a chronic hepatitis C infection was referred to the general surgery department of our hospital in August 2013 with a diagnosis of HCC. A past ultrasound examination had revealed a 60 mm-diameter nodular lesion in the third segment of the liver. After a needle biopsy,the lesion was diagnosed as HCC. The patient underwent surgery with a liver segmentectomy. Two additional nodes on the gastric wall were detected during the surgical operation. The histology of the removed specimen showed a poorly differentiated HCC with significant lymphoid stroma. Immunohistochemical studies revealed that the epithelial component was reactive for CK CAM5.2,CK8,CK18,CEA(polyclonal) and was focally positive for hepar-1 and that the lymphoid infiltrate was positive for CD3,CD4 and CD8. The tumor cells were negative for Epstein-Barr virus. The gastric nodes were ultimately determined to be two small gastrointestinal stromal tumors(GISTs).The synchronous occurrence of HCC and GIST is another very uncommon finding rarely described in the literature. Here,we report the clinicopathological features of our case,along with a review of the few cases present in the literature.

关键词： Lymphoepithelioma Lymphoepithelioma-like Hepatocel

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Current treatment options for colon cancer peritoneal carcinomatosis

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World Journal of Gastroenterology 2014年第35期20卷 12493-12500页

作者： Tomoyoshi Aoyagi Krista P Terracina Ali Raza Kazuaki Takabe division of surgical Oncology Department of SurgeryVirginia Commonwealth University School of Medicine division of surgical Oncology Department of SurgeryVirginia Commonwealth University School of MedicineRichmond

Peritoneal carcinomatosis(PC),the dissemination of cancer cells throughout the lining of the abdominal cavity,is the second most common presentation of colon cancer distant *** remarkable advances in cytotoxic chemotherapy and targeted therapy for colon cancer over the last 15 years,it has been repeatedly shown that these therapies remain ineffective for colon cancer ***,there has been a rapid accumulation of reports that cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy(CRS-HIPEC) prolongs the life of colon cancer PC ***,we will review the clinical presentation,the mechanisms of disease progression,and current treatment options for colon cancer PC,with a focus on the benefits and limitations of CRSHIPEC.

关键词： Cancer Colorectal Carcinomatosis Peritoneal Hyperthermic intraperitoneal chemotherapy Intraperitoneal chemotherapy Cytoreductive surgery Mechanism

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Post-operative albumin-bilirubin grade predicts long-term outcomes among Child–Pugh grade A patients with hepatocellular carcinoma after curative resection

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Hepatobiliary & Pancreatic Diseases International 2018年第6期17卷 502-509页

作者： Masataka Amisaki Ei Uchinaka Masaki Morimoto Naruo Tokuyasu Teruhisa Sakamoto Soichiro Honjo Hiroaki Saito Yoshiyuki Fujiwara division of surgical Oncology Department of Surgery School of Medicine Tottori University Faculty of Medicine

Background: Although Child–Pugh grade A patients with hepatocellular carcinoma(HCC) are candidates for curative resection, some may have a poor prognosis. The albumin-bilirubin(ALBI) grade, a measure of liver function based on albumin and bilirubin, has the potential to detect Child–Pugh grade A HCC patients with poor prognosis. Because components of the ALBI grade can be measured easily even after surgery, we explored the predictive values of ALBI in patient prognosis after HCC resection. Methods: In this retrospective case-control study, we included 136 HCC patients who underwent curative resection between January 2004 and December 2013 at our hospital. ALBI grade was calculated from laboratory data recorded the day before surgery and at post-operative day 5. Results: Pre-and post-operative ALBI grade predicted patients’ long-term outcomes( P = 0.020 and P surgical factors of repeated hepatic resection( P = 0.012), intra-operative bleeding( P = 0.006), and surgery duration( P = 0.033). Furthermore, post-operative ALBI grade, rather than pre-operative ALBI grade, was an independent predictive factor of long-term outcome of Child–Pugh grade A patients with HCC. Conclusions: Post-operative ALBI grade is useful to predict the prognosis in patients after HCC resection.

关键词： Prognosis Hepatic resection Albumin Bilirubin

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Prognostic value of postoperative complication for early recurrence after curative resection of hepatocellular carcinoma

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Hepatobiliary & Pancreatic Diseases International 2018年第4期17卷 323-329页

作者： Masataka Amisaki Hiroaki Saito Naruo Tokuyasu Teruhisa Sakamoto Soichiro Honjo Yoshiyuki Fujiwara division of surgical Oncology Department of SurgerySchool of MedicineTottori University Faculty of Medicine

Background: Postoperative complications may adversely affect oncological outcomes. The aim of this study was to evaluate the impact of postoperative complications on early-phase recurrence after curative resection for hepatocellular carcinoma(HCC).Methods: We included 145 HCC patients who underwent initial and curative resection between January2004 and December 2013. Postoperative complications of grade III or higher based on Clavien–Dindo classification were defined as clinically relevant postoperative complications. Recurrence within two years after hepatectomy was defined as early-phase ***: Thirty-eight patients(26%) developed postoperative complications. The only predictive factor for postoperative complication was longer operative duration(P = 0.037). The disease-specific survival rate of patients with complication was lower than that of patients without complications(P = 0.015). Earlyphase recurrence was observed in 20/38(53%) patients who suffered postoperative complications and36/107(34%) patients with no complications, which was statistically significant(P = 0.039). Multivariate analysis identified four factors contributing to early-phase recurrence: high serum AFP level(P = 0.042),multiple tumors(P < 0.001), poor differentiation(P = 0.036) and presence of postoperative complication(P = 0.039).Conclusions: Postoperative complication is an independent prognostic factor for early-phase recurrence after curative resection of HCC. Close observation of patients with postoperative complications may be a necessary treatment strategy for HCC.

关键词： Neoplasm metastasis Complications Risk factors Hepatocellular carcinoma

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Minimally invasive surgical approach to pancreatic malignancies

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World Journal of Gastrointestinal Oncology 2015年第12期7卷 411-421页

作者： Lapo Bencini Mario Annecchiarico Marco Farsi Ilenia Bartolini Vita Mirasolo Francesco Guerra Andrea Coratti Department of Oncology Division of Surgical Oncology and Robotics Careggi University Hospital

Pancreatic surgery for malignancy is recognized as challenging for the surgeons and risky for the patientsdue to consistent perioperative morbidity and mortality. Furthermore, the oncological long-term results are largely disappointing, even for those patients who experience an uneventfully hospital stay. Nevertheless, surgery still remains the cornerstone of a multidisciplinary treatment for pancreatic cancer. In order to maximize the benefits of surgery, the advent of both laparoscopy and robotics has led many surgeons to treat pancreatic cancers with these new methodologies. The reduction of postoperative complications, length of hospital stay and pain, together with a shorter interval between surgery and the beginning of adjuvant chemotherapy, represent the potential advantages over conventional surgery. Lastly, a better cosmetic result, although not crucial in any cancerous patient, could also play a role by improving overall well-being and patient self-perception. The laparoscopic approach to pancreatic surgery is, however, difficult in inexperienced hands and requires a dedicated training in both advanced laparoscopy and pancreatic surgery. The recent large diffusion of the da Vinci® robotic platform seems to facilitate many of the technical maneuvers, such as anastomotic biliary and pancreatic reconstructions, accurate lymphadenectomy, and vascular sutures. The two main pancreatic operations, distal pancreatectomy and pancreaticoduodenectomy, are approachable by a minimally invasive path, but more limited interventions such as enucleation are also feasible. Nevertheless, a word of caution should be taken into account when considering the increasing costs of these newest technologies because the main concerns regarding these are the maintenance of all oncological standards and the lack of long-term follow-up. The purpose of this review is to examine the evidence for the use of minimally invasive surgery in pancreatic cancer(and less aggressive tumors), w

关键词： Pancreatic cancer Pancreatic adenocarcinoma Neuroe

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Combined preoperative platelet-to-lymphocyte ratio and serum carbohydrate antigen 19–9 level as a prognostic factor in patients with resected pancreatic cancer

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Hepatobiliary & Pancreatic Diseases International 2019年第3期18卷 278-284页

作者： Teruhisa Sakamoto Hiroaki Saito Masataka Amisaki Naruo Tokuyasu Soichiro Honjo Yoshiyuki Fujiwara division of surgical Oncology Department of Surgery School of Medicine Tottori University Faculty of Medicine

Background: Carbohydrate antigen 19–9(CA19-9) is the most frequently used tumor marker and serves as a prognostic indicator in patients with pancreatic cancer(PC). The platelet-to-lymphocyte ratio(PLR) is thought to be an inflammation-related serum marker. An elevated PLR represents increased inflammatory status and is associated with poor prognosis in patients with various cancers including PC. Methods: This study involved 103 patients with a histopathological diagnosis of pancreatic ductal adenocarcinoma who underwent pancreatectomy. The patients were assessed to determine the prognostic significance of the combination of the PLR and CA19-9 level. Results: Based on the receiver operating characteristic analysis results, the patients were divided into PLR H igh(PLR ≥ 129.1) andPLRLow(PLR < 129.1) groups and into CA19-9High(CA19-9 ≥ 74.0 U/mL) and CA19-9Low(CA19-9 < 74.0 U/mL) groups. The cumulative 5-year overall survival(OS) and disease-specific survival(DSS) rates significantly differed by both the PLR(PLR H igh group: 19.5% and 22.9%;PLRLow group: 39.1% and 45.9%) and CA19-9(CA19-9 H igh group: 19.1% and 25.6%;CA19-9Low group: 41.0% and 41.0%). We then divided the patients into Groups A(PLR L ow/CA19-9Low), B(PLR Low/CA19-9High or PLRHigh/CA19-9Low), and C(PLR H igh/CA19-9High). The cumulative 5-year OS rates in Groups A, B, and C were 44.0%, 31.9%, and 11.9%, respectively( P = 0.002). The cumulative 5-year DSS rates in Groups A, B, and C were 47.7%, 36.4%, and 16.8%, respectively( P = 0.002). Multivariate analysis revealed that the combination of the PLR and CA19-9 was an independent prognostic factor in patients with resected PC. Conclusions: The combination of the PLR and CA19-9 is useful for predicting the prognosis of patients with resected PC.

关键词： CA19-9 Pancreatic cancer Platelet-to-lymphocyte ratio Prognosis

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Neoadjuvant therapy for pancreas cancer: Past lessons and future therapies

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World Journal of Gastroenterology 2014年第42期20卷 15564-15579页

作者： Jeffrey M Sutton Daniel E Abbott Department of Surgery Division of Surgical Oncology University of Cincinnati Medical Center

Pancreatic adenocarcinoma remains a most deadly malignancy, with an overall 5-year survival of 5%. A subset of patients will be diagnosed with potentially resectable disease, and while complete surgical resection provides the only chance at cure, data from trials of postoperative chemoradiation and/or chemotherapy demonstrate a modest survival advantage over those patients who undergo resection alone. As such, most practitioners believe that completion of multimodality therapy is the optimal treatment. However, the sequence of surgery, chemotherapy and radiation therapy is frequently debated, as patients may benefit from a neoadjuvant approach by initiating chemotherapy and/or chemoradiation prior to resection. Here we review the rationale for neoadjuvant therapy, which includes a higher rate of completion of multimodality therapy, minimizing the risk of unnecessary surgical resection for patients who develop early metastatic disease, improved surgical outcomes and the potential for longer overall survival. However, there are no prospective, randomized studies of the neoadjuvant approach compared to a surgeryfirst strategy; the established and ongoing investigations of neoadjuvant therapy for pancreatic cancer are discussed in detail. Lastly, as the future of therapeutic regimens is likely to entail patient-specific genetic and molecular analyses, and the treatment that is best applied based on those data, a review of clinically relevant biomarkers in pancreatic cancer is also presented.

关键词： Pancreatic cancer Neoadjuvant therapy Chemotherapy Chemoradiation Biomarkers

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Current guidelines for the management of non-alcoholic fatty liver disease:A systematic review with comparative analysis

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World Journal of Gastroenterology 2018年第30期24卷 3361-3373页

作者： Simona Leoni Francesco Tovoli Lucia Napoli Ilaria Serio Silvia Ferri Luigi Bolondi Department of Medical and surgical Sciences (DIMEC) Division of Internal MedicineUniversity of Bologna

The current epidemic of non-alcoholic fatty liver disease(NAFLD) is reshaping the field of hepatology all around the *** widespread diffusion of metabolic risk factors such as obesity,type2-diabetes mellitus,and dyslipidemia has led to a worldwide diffusion of *** parallel to the increased availability of effective anti-viral agents,NAFLD is rapidly becoming the most common cause of chronic liver disease in Western Countries,and a similar trend is expected in Eastern Countries in the next *** epidemic and its consequences have prompted experts from all over the word in identifying effective strategies for the diagnosis,management,and treatment of *** scientific societies from Europe,America,and Asia-Pacific regions have proposed guidelines based on the most recent evidence about *** guidelines are consistent with the key elements in the management of NAFLD,but still,show significant difference about some critical *** reviewed the current literature in English language to identify the most recent scientific guidelines about NAFLD with the aim to find and critically analyse the main *** distinguished guidelines from 5 different scientific societies whose reputation is worldwide recognised and who are representative of the clinical practice in different geographical *** were noted in: the definition of NAFLD,the opportunity of NAFLD screening in high-risk patients,the noninvasive test proposed for the diagnosis of NAFLD and the identification of NAFLD patients with advanced fibrosis,in the follow-up protocols and,finally,in the treatment strategy(especially in the proposed pharmacological management).These difference have been discussed in the light of the possible evolution of the scenario ofNAFLD in the next years.

关键词： Non-alcoholic fatty liver disease Metformin Liver steatosis Liver biopsy Non-invasive diagnosis Pioglitazone Clinical guidelines

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Update on Liver Failure Following Hepatic Resection: Strategies for Prediction and Avoidance of Post-operative Liver Insufficiency

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Journal of Clinical and Translational Hepatology 2018年第1期6卷 97-104页

作者： Amir A. Rahnemai-Azar Jordan M. Cloyd Sharon M. Weber Mary Dillhoff Carl Schmidt Emily R. Winslow Timothy M. Pawlik Department of Surgery Division of Surgical OncologyUniversity of Wisconsin HospitalMadisonWIUSA Department of Surgery Division of Surgical OncologyThe Ohio State University Wexner Medical CenterColumbusOHUSA Department of Surgery Division of Surgical OncologyThe Ohio State University Wexner Medical CenterColumbusOH 43210USA

Liver resection is increasingly used for a variety of benign and malignant *** advances in preoperative selection,surgical technique and perioperative management,posthepatectomy liver failure(PHLF)is still a leading cause of morbidity and mortality following liver *** the devastating physiological consequences of PHLF and the lack of effective treatment options,identifying risk factors and preventative strategies for PHLF is *** the past,a major limitation to conducting high quality research on risk factors and prevention strategies for PHLF has been the absence of a standardized *** this article,we describe relevant definitions for PHLF,discuss risk factors and prediction models,and review advances in liver assessment tools and PHLF prevention strategies.

关键词： Complication Hepatectomy Liver failure Liver resection Prevention Risk models

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Laparoscopic approach to gastrointestinal malignancies: Toward the future with caution

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World Journal of Gastroenterology 2014年第7期20卷 1777-1789页

作者： Lapo Bencini Marco Bernini Marco Farsi division of surgical Oncology Department of OncologyCareggi University Hospital50134 FlorenceItaly

After the rapid acceptance of laparoscopy to manage multiple benign diseases arising from gastrointestinal districts,some surgeons started to treat malignancies by the same ***,if the limits of laparoscopy for benign diseases are mainly represented by technical issues,oncologic outcomes remain the foundation of any procedures to cure *** patients represent an important group with peculiar aspects including reduced survival expectancy,worsened quality of life due to surgery itself and adjuvant therapies,and challenging psychological *** these issues could,potentially,receive a better management with a laparoscopic surgical *** order to confirm such aspects,similarly to testing the newest weapons(surgical or pharmacologic)against cancer,long-term follow-up is always recommendable to assess the real benefits in terms of overall survival,cancer-free survival and quality of ***,it seems of crucial importance that surgeons will be correctly trained in specific oncologic principles of surgical oncology as well as in modern miniinvasive ***,laparoscopic treatment of gastrointestinal malignancies requires more caution and deep analysis of published evidences,as compared to those achieved for inflammatory bowel diseases,gastroesophageal reflux disease or diverticular *** review tries to examine the evidence available to date for the use of laparoscopy and robotics in malignancies arising from the gastrointestinal district.

关键词： Gastrointestinal cancer Laparoscopic Oncology Laparoscopic surgery Robotic surgery surgical outcomes Oncologic outcomes

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