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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 disease.These 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 low.The 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 HIPEC.The 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 interest.There 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

Radiologic-histological correlation of hepatocellular carcinoma treated via pre-liver transplant locoregional therapies

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hepatobiliary & Pancreatic Diseases International 2013年第1期12卷 34-41页

作者： Galal El-Gazzaz Achuthan Sourianarayanane KV Narayanan Menon Juan Sanabria Koji Hashimoto Cristiano Quintini Dympna Kelly Bijan Eghtesad Charles Miller John Fung Federico Aucejo hepatobiliary & Liver Transplant Surgery Cleveland Clinic Foundation

BACKGROUND:Locoregional therapies(LRTs) are treatments to achieve local control of hepatocellular carcinoma(HCC).Correlation between radiologic response to LRT and degree of induced tumor necrosis is not well understood.The aim of this study was to evaluate different levels of radiologic response after pre-liver transplant(LT) LRT and its correlation with percentage of tumor necrosis on explanted histopathology.METHODS:Institutional Review Board approved LT database was queried for treated HCC in patients undergoing LT.Radiologic response was evaluated to predict tumor necrosis in the explanted liver.Tumor response was evaluated 1 to 3 months after LRT with computed tomography or MRI via Response Evaluation Criteria in Solid Tumors(RECIST),and European Association for the Study of the Liver(EASL) guidelines.LRT was repeated as needed until time of LT.Histological tumor necrosis was graded as complete(100%),partial(50%-99%),or poor(<50%).RESULTS:Between 2002 and 2011,128 patients(97 men and 31 women) received pre-LT LRT including transarterial therapy(93),radiofrequency ablation(20),or combination of both(15).The mean age of the patients was 58±9 years.Their mean follow-up was 35±27 months.The median waitlist time was 55 days.One hundred(78%) patients had HCC within the Milan criteria at the initial radiologic diagnosis.Nineteen(15%) of the patients had complete tumor necrosis on histopathology analysis.Fifty(39%) of the patients exhibited partial necrosis,52(41%) showed poor or no necrosis and 7(5%) showed progressive disease.The overall pre-LT radiologic staging was correlated with explant pathology in 73(57%) of the patients.Underestimated tumor stage was noted in 49(38%) patients,and overestimated tumor stage in 6(5%) patients.The post-LT 3-year overall survival and disease free survival were 82% and 80%,and the rates for complete and partial tumor necrosis were 100% vs 78%(P=0.02) and 100% vs 75%(P=0.03),respectively.CONCLUSIONS:In the current era,interpretation of radiologic response after LRT for HCC doe

关键词： locoregional therapy radiologic response hepatocellular carcinoma

Liver transplantation in patients with incidental hepatocellular carcinoma/cholangiocarcinoma and intrahepatic cholangiocarcinoma： a single-center experience

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hepatobiliary & Pancreatic Diseases International 2017年第3期16卷 264-270页

作者： Mohammed Elshamy Naftali Presser Abdulrahman Y Hammad Daniel J Firl Christopher Coppa John Fung Federico N Aucejo hepatobiliary and Transplant Surgery Digestive Disease and Surgery Institute Cleveland Clinic Cleveland OH USA Imaging Institute Cleveland Clinic Cleveland OH USA

BACKGROUND： Reports of fiver transplantation （LT） in patients with mixed hepatocellular carcinoma/cholangiocarcinoma （HCC/CC） and intrahepatic cholangiocarcinoma （ICC） are modest and have been mostly retrospective after pathological categorization in the setting of presumed HCC. Some studies suggest that patients undergoing LT with small and unifocal ICC or mixed HCC/CC can achieve about 40%-60% 5-year post-transplant survival. The study aimed to report our experience in patients undergoing LT with explant pathology revealing HCC/CC and ICC. METHODS： From a prospectively maintained database, we performed cohort analysis. We identified 13 patients who underwent LT with explant pathology revealing HCC/CC or ICC. RESULTS： The observed recurrence rate post-LT was 31% （4/13） and overall survival was 85%, 51%, and 51% at 1, 3 and 5 years, respectively. Disease-free survival was 68%, 51%, and 41% at 1, 3 and 5 years, respectively. In our cohort, four patients would have qualified for exception points based on updated HCC Organ Procurement and Transplantation Network imaging guidelines. CONCLUSIONS： Lesions which lack complete imaging characteristics of HCC may warrant pre-LT biopsy to fully elucidate their pathology. Identified patients with early HCC/CC or ICC may benefit from LT if unresectable. Additionally, incorporating adjunctive perioperative therapies such as in the case of patients undergoing LT with hilar cholangiocarcinoma may improve outcomes but this warrants further investigation.

关键词： mixed hepatocellular carcinoma/ cholangiocarcinoma liver transplantation survival outcomes

Impact of liver enzymes on SARS-CoV-2 infection and the severity of clinical course of COVID-19

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Liver Research 2021年第1期5卷 21-27页

作者： Fátima Higuera-de la Tijera Alfredo Servín-Caamaño Daniel Reyes-Herrera Argelia Flores-López Enrique J.A.Robiou-Vivero Felipe Martínez-Rivera Victor Galindo-Hernández Oscar Chapa-Azuela Alfonso Chávez-Morales Victor H.Rosales-Salyano Multidisciplinary Team for the Attention and Care of Patients with COVID-19 Hospital General de México Dr.Eduardo LiceagaMexico CityMexico Gastroenterology and Hepatology Department Hospital General de México Dr.Eduardo LiceagaMexico CityMexico Internal Medicine Department Hospital General de México Dr.Eduardo LiceagaMexico CityMexico Hepatobiliary and Pancreatology Clinic Surgery DepartmentHospital General de México Dr.Eduardo LiceagaMexico CityMexico Intensive Care Unit Hospital General de México Dr.Eduardo LiceagaMexico CityMexico

Background and aim Severe acute respiratory syndrome coronavirus 2(SARS-CoV-2),the virus responsible for the current pandemic,can have multi-organ impact.Recent studies show that liver injury could be a manifestation of the disease,and that liver disease could also be related to a worse prognosis.Our aim was to compare the characteristics of patients with severe coronavirus disease 2019(COVID-19)due to SARS-CoV-2 who required intubation versus stable hospitalized patients to identify the early biochemical predictive factors of a severe course of COVID-19 and subsequent requirement for intubation,specifically in Mexican.Methods This was an observational case-control study nested in a cohort study.Complete medical records of patients admitted for confirmed COVID-19 at a tertiary level center in Mexico City were reviewed.clinical and biochemical data were collected,and the characteristics of patients who required invasive mechanical ventilation(IMV)(cases)were compared with stable hospitalized patients without ventilation(controls).Results We evaluated 166 patients with COVID-19 due to SARS-CoV-2 infection;114(68.7%)were men,the mean age was 50.6±13.3 years,and 27(16.3%)required IMV.The comparative analysis between cases and controls showed(respectively)significantly lower blood oxygen saturation(SpO_(2))(73.5±12.0%vs.83.0±6.8%,P<0.0001)and elevated alanine aminotransferase(ALT)(128(14–1123)IU/L vs.33(8–453)IU/L,P=0.003),aspartate aminotransferase(AST)(214(17–1247)vs.44(12–498)IU/L,P=0.001),lactic dehydrogenase(LDH)(764.6±401.9 IU/L vs.461.0±185.6 IU/L,P=0.001),and D-dimer(3463(524–34,227)ng/mL vs.829(152–41,923)ng/mL,P=0.003)concentrations.Patients in the cases group were older(58.6±12.7 years vs.49.1±12.8 years,P=0.001).Multivariate analysis showed that important factors at admission predicting the requirement for IMV during hospitalization for COVID-19 were AST≥250 IU/L(odds ratio(OR)=64.8,95%confidence interval(CI)7.5–560.3,P<0.0001)and D-dimer≥3500 ng/mL(OR=4.1,95%CI 1.2–13.7,P=0.02).Conclusions Our study confi

关键词： Severe acute respiratory syndrome coronavirus 2(SARS-CoV-2) Coronavirus disease 2019(COVID-19) Liver enzymes D-dimer Disease severity Invasive mechanical ventilation(IMV) Multi-organ failure

Antiviral effects of hepatitis B virus S gene-specific anti-gene locked nucleic acid in transgenic mice

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World Journal of clinical Cases 2018年第8期6卷 183-191页

作者： Shu-Rong Xiao Gui-Dan Xu Wu-Jun Wei Bin Peng Yi-Bin Deng Department of Medical Laboratory Science the Affiliated Hospital of Youjiang Medical College for Nationalities Department of hepatobiliary Disease Center Guangxi Clinic Medicine Research

AIM To assess the antiviral effects of hepatitis B virus(HBV) S gene-specific anti-gene locked nucleic acid(LNA) in transgenic mice.METHODS Thirty HBV transgenic mice were acclimatized to laboratory conditions and positive for serum HBV surface antigen(HBs Ag) and HBV DNA, were randomly divided into 5 groups(n = 7), including negative control(blank control, unrelated sequence control), positive control(lamivudine, anti-sense-LNA), and anti-gene-LNA experimental group. LNA was injected into transgenic mice by tail vein while lamivudine was administeredby gavage. Serum HBV DNA and HBs Ag levels were determined by fluorescence-based PCR and enzymelinked immune sorbent assay, respectively. HBV S gene expression amounts were assessed by reverse transcription polymerase chain reaction. Positive rates of HBsA g in liver cells were evaluated immunohistochemistry.RESULTS Average rate reductions of HBs Ag after treatment on the 3 rd, 5 th, and 7 th days were 32.34%, 45.96%, and 59.15%, respectively. The inhibitory effect of antigene-LNA on serum HBs Ag peaked on day 7, with statistically significant differences compared with pretreatment(0.96 ± 0.18 vs 2.35 ± 0.33, P < 0.05) and control values(P < 0.05 for all). Average reduction rates of HBV DNA on the 3 rd, 5 th, and 7 th days were 38.55%, 50.95%, and 62.26%, respectively. This inhibitory effect peaked on the 7 th day after treatment with anti-gene-LNA, with statistically significant differences compared with pre-treatment(4.17 ± 1.29 vs 11.05 ± 1.25, P < 0.05) and control values(P < 0.05 for all). The mR NA levels of the HBV S gene(P < 0.05 for all) and rates of HBsA g positive liver cells(P < 0.05 for all) were significantly reduced compared with the control groups. Liver and kidney function, and histology showed no abnormalities. CONCLUSION Anti-gene-LNA targeting the S gene of HBV displays strong inhibitory effects on HBV in transgenic mice, providing theoretical and experimental bases for gene therapy in HBV.

关键词： Anti-gene therapy Hepatitis B virus Locked nucleic acid Hepatitis B Transgenic mice Anti-sensetherapy

A retrospective study of the occurrence of ischemic-type biliary lesions post liver transplantation

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Science China(Life Sciences) 2016年第5期59卷 529-531页

作者： Rui Shi Ya-Min Zhang Yong-Lin Deng Hong Zheng Cheng Pan Zhong-Yang Shen Tianjin Key Laboratory of Organ Transplantation Department of Hepatobiliary Surgery First Center Hospital Clinic Institute Tianjin Medical University

Dear Editors,Ischemic-type biliary lesions(ITBLs)significantly reduce patient and graft survival rates.Research data regarding the causes of ITBL are rare.ITBLs is an important cause of post liver transplantation graft loss and patient death.The exact cause of this type of biliary complication remains unclear.To establish strategies for ITBL treatment or prevention,the risk factors of ITBL must be elucidated.The objective of this single-center retrospective study was to investigate the risk factors of ITBL in orthotopic liver transplantation(OLT)patients.

关键词：肝移植胆道病变血型预防方法风险因素危险因素存活率

Synchronous colorectal liver metastases:therapeutic considerations

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hepatobiliary Surgery and Nutrition 2021年第5期10卷 711-713页

作者： Michael R.Driedger Sean P.Cleary David M.Nagorney Division of hepatobiliary and Pancreatic Surgery Atrium HealthCharlotteNCUSA Division of hepatobiliary and Pancreatic Surgery Mayo ClinicRochesterMNUSA

More than 50%of patients will develop colorectal cancer(CRC)liver metastases(CRCLM)during the course of their disease,while 15-25%of patients will have metastatic disease present at the time of initial diagnosis.Resection of CRCLM is possible in approximately one-in-four patients and 5-year overall survival(OS)rates have improved to nearly 60%in selected patients who undergo resection.

关键词： colorectal metastases patients

Interleukin-22 contributes to liver regeneration in micewith concanavalin A-induced hepatitis after hepatectomy

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World Journal of Gastroenterology 2016年第6期22卷 2081-2091页

作者： Ya-Min Zhang Zi-Rong Liu Zi-Lin Cui Chao Yang Long Yang Yang Li Zhong-Yang Shen Department of hepatobiliary Surgery First Central HospitalTianjin 300192China First Central clinic of Tianjin Medical University Tianjin 300192China

AIM: To investigate the therapeutic effects and mechanisms of interleukin(IL)-22 in liver regeneration in mice with concanavalin A(Con A)-induced liver injury following 70% hepatectomy.METHODS: Mice were injected intravenously with Con A at 10 μg/g body weight 4 d before 70% hepatectomy to create a hepatitis model, and recombinant IL-22 was injected at 0.125 μg/g body weight 30 min prior to 70% hepatectomy to create a therapy model. Control animals received an intravenous injection of an identical volume of normal saline.RESULTS: IL-22 treatment prior to 70% hepatectomy performed under general anesthesia resulted in reductions in the biochemical and histological evidence of liver injury, earlier proliferating cell nuclear antigen expression and accelerated recovery of liver mass. IL-22 pretreatment also significantly induced signal transducer and activator of transcription factor 3(STAT3) activation and increased the expression of a variety of mitogenic proteins, such as Cyclin D1. Furthermore, alpha fetal protein m RNA expression was significantly elevated after IL-22 treatment.CONCLUSION: In this study, we demonstrated that IL-22 is a survival factor for hepatocytes and prevents and repairs liver injury by enhancing pro-growth pathways via STAT3 activation. Treatment with IL-22 protein may represent a novel therapeutic strategy for preventing liver injury in patients with liver disease who have undergone hepatectomy.

关键词： Interleukin-22 Concanavalin A Partialhepatectomy Liver regeneration

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血清白蛋白水平预测肝门部胆管癌患者的生存

Gastroenterology Report 2017年第1期5卷 62-66,I0003页

作者： Abhijeet Waghray Anastasia Sobotka Carlos Romero Marrero Bassam Estfan Federico Aucejo KV Narayanan Menon Department of Medicine MetroHealth Medical CenterClevelandOHUSA Department of Gastroenterology and Hepatology Cleveland Clinic FoundationClevelandOHUSA Department of hepatobiliary and Transplant Surgery Cleveland Clinic FoundationClevelandOHUSA

背景与目的:肝门部胆管癌是一种极具威胁的恶性肿瘤,其发生率随地域及其他危险因素的不同而有所差异,其快速进展的疾病特点及难以早期诊断的现状使相当数量的患者无法得到根治性治疗。本研究的目的是明确影响肝门部胆管癌患者总体生存... 详细信息

背景与目的:肝门部胆管癌是一种极具威胁的恶性肿瘤,其发生率随地域及其他危险因素的不同而有所差异,其快速进展的疾病特点及难以早期诊断的现状使相当数量的患者无法得到根治性治疗。本研究的目的是明确影响肝门部胆管癌患者总体生存的预后因素。方法:收集2003-2013年间经组织学证实的成人肝门部胆管癌患者,评估其预后影响因素,评估变量包括入院时人口学资料、实验室指标、症状及影像学特征。结果:116例经病理诊断的肝门部胆管癌患者纳入研究。血清白蛋白>3.0 g/dL(P3.0 g/dL是一项独立的预后保护因素(HR=0.31,95%CI:0.14~0.70),可以得到44周的生存获益。结论:本研究是目前对于肝门部胆管癌预后因素的最大宗病例分析。血清白蛋白>3.0 g/dL是一项独立的预后指标,可以显著延长生存期。

关键词：肝门部胆管癌预后因素生存白蛋白