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Minimally invasive spleen-preserving distal pancreatectomy: Does splenic vessel preservation have better postoperative outcomes? A systematic review and meta-analysis

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Hepatobiliary & Pancreatic Diseases International 2015年第4期14卷 346-353页

作者： Fady Elabbasy Rahul Gadde Mena M Hanna Danny Sleeman Alan Livingstone Danny Yakoub Division of Surgical oncology Department of Surgery Sylvester Comprehensive Cancer Center University of Miami-Miller School of Medicine

BACKGROUND： Minimally invasive spleen-preserving distal pancreatectomy （SPDP） can be performed with either splenic vessel preservation （SVP） or resection [Warshaw procedure （WP）]. The aim of this study was to evaluate the postoperative clinical outcomes of patients undergoing both methods. DATA SOURCES： Database search of PubMed, Embase, Scopus, Cochrane, and Google Scholar was performed （2000-2014）; key bibliographies were reviewed. Qualified studies compar- ing patients undergoing SPDP with either SVP or WP, and as- sessing postoperative complications were included. Calculated pooled risk ratio （RR） with the corresponding 95% confidence interval （CI） by random effects methods were used in the meta-analyses. RESULTS： The search yielded 215 studies, of which only 14 observational studies met our selection criteria. The studies included 943 patients in total; 652 （69%） underwent SVP and 291 （31%） underwent WP. Overall, there was a lower incidence of splenic infarction （RR=0.17; 95% Ch 0.09-0.33; P〈0.001）, gastric varices （RR=0.16; 95% Ch 0.05-0.51; P=0.002）, and intra/postoperative splenectomy （RR=0.20; 95% Ch 0.08-0.49; P〈0.001） in the SVP group. There was no difference in in- cidence of pancreatic fistula （WP vs SVP, 23.6% vs 22.9%;P=0.37）, length of hospital stay, operative time or blood loss. There was moderate cross-study heterogeneity. CONCLUSIONS： SVP is a safe, efficient and feasible technique that may be used to preserve the spleen. WP may be more suit- able for large tumors dose to the splenic hilum or those associ- ated with splenomegaly. Randomized clinical trials are justified to examine the long-term benefits of SVP-SPDP.

关键词： splenic infarction spleen-preserving distal pancreatectomy splenic vessel preservation Warshaw procedure gastric varices

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Hepatocyte growth factor gene therapy prevents radiation-induced liver damage

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World Journal of Gastroenterology 2005年第10期11卷 1496-1502页

作者： Chau-Hua Chi I-Li Liu Wei-Yu Lo Bor-Song Liaw Yu-Shan Wang Kwan-Hwa Chi Institute of Veterinary Science Anawrahta Biotech. Co. Department of Radiation Therapy and oncology

AIM: To transfer human HGF gene into the liver of rats by direct electroporation as a means to prevent radiationinduced liver ***: Rat whole liver irradiation model was accomplished by intra-operative approach. HGF plasmid was injected into liver and transferred by electroporation using a pulse generator. Control rats (n = 8) received electrogene therapy (EGT) vehicle plasmid and another 8rats received HGF-EGT 100 μg 48 h before *** of HGF in liver was examined by RT-PCR and ELISA methods. Apoptosis was determined by TUNEL assay. Histopathology was evaluated 10 wk after whole liver ***: Marked decrease of apoptotic cells and downregulation of transforming growth factor-beta 1 (TGF-β1)mRNA were observed in the HGF-EGT group 2 d after liver irradiation compared to control animals. Less evidence of radiation-induced liver damage was observed morphologically in liver specimen 10 wk after liver irradiation and longer median survival time was observed from HGF-EGT group (14 wk) compared to control rats (5 wk). (P = 0.031).CONCLUSION: For the first time it has been demonstrated that HGF-EGT would prevent liver from radiation-induced liver damage by preventing apoptosis and down-regulation of TGF-β1.

关键词： Hepatocyte growth factor HGF Radiation Liver Electroporation Electrogene therapy

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The role of radiotherapy in localised and locally advanced prostate cancer

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Asian Journal of Urology 2019年第2期6卷 153-161页

作者： Michel Bolla Ann Henry Malcom Mason Thomas Wiegel Department of Radiation oncology Grenoble Alpes UniversityGrenobleFrance Department of Clinical oncology St.James’s University HospitalLeedsUK Cardiff University Velindre HospitalWhitchurchUK Department of Radiation oncology University Hospital UlmGermany

For a patient suffering from non-metastatic prostate cancer,the individualized recommendation of radiotherapy has to be the fruit of a multidisciplinary approach in the context of a Tumor Board,to be explained carefully to the patient to obtain his informed *** beam radiotherapy is now delivered by intensity modulated radiotherapy,considered as the gold *** a radiotherapy perspective,low-risk localized prostate cancer is treated by image guided intensity modulated radiotherapy,or brachytherapy if patients meet the required eligibility ***-risk patients may benefit from intensity modulated radiotherapy combined with 4e6 months of androgen deprivation therapy;intensity modulated radiotherapy alone or combined with brachytherapy can be offered to patients unsuitable for androgen deprivation therapy due to co-morbidities or unwilling to accept it to preserve their sexual ***-risk prostate cancer,***-risk localized and locally advanced prostate cancer,requires intensity modulated radiotherapy with long-term(≥2 years)androgen deprivation therapy with luteinizing hormone releasing hormone ***-operative irradiation,either immediate or early deferred,is proposed to patients classified as pT3pN0,based on surgical margins,prostate-specific antigen values and quality of *** the techniques and their degree of sophistication,quality assurance plays a major role in the management of radiotherapy,requiring the involvement of physicians,physicists,dosimetrists,radiation technologists and computer *** patients must be informed about the potential morbidity of radiotherapy and androgen deprivation therapy and followed regularly during and after treatment for tertiary prevention and evaluation.A close cooperation is needed with general practitioners and specialists to prevent and mitigate side effects and maintain quality of life.

关键词： Localized prostate cancer Locally advanced prostate cancer Brachytherapy Intensity modulated radiotherapy Short-term and longterm androgen deprivation therapy

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Selecting the best strategy of treatment in newly diagnosed advanced-stage ovarian cancer patients

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World Journal of Methodology 2015年第4期5卷 196-202页

作者： Lucas Minig Cristina Zorrero Pablo Padilla Iserte Andres Poveda Gynecology Department Clinical Area of Gynecologic Oncology Valencian Institue of Oncology Medical oncology Department Clinical Area of Gynecologic Oncology Valencian Institue of Oncology

Although it is assumed that the combination of chemotherapy and radical surgery should be indicated in all newly diagnosed advanced-stage ovarian cancer patients, one of the main raised questions is how to select the best strategy of initial treatment in this group of patients, neoadjuvant chemotherapy followed by interval debulking surgery or primary debulking surgery followed by adjuvant chemotherapy. The selection criteria to offer one strategy over the other as well as a stepwise patient selection for initial treatment are described. Selecting the best strategy of treatment in newly diagnosed advanced stage ovarian cancer patients is a multifactorial and multidisciplinary decision. Several factors should be taken into consideration:(1) the disease factor, related to the extension and localization of the disease as well as tumor biology;(2) the patient factor, associated with patient age, poor performance status, and co-morbidities; and(3) institutional infrastructure factor, related to the lack of prolonged operative time, an appropriate surgical armamentarium, as well as well-equipped intensive care units with well-trained personnel.

关键词： Ovarian cancer Advanced stage Primary debulking surgery Neoadjuvant chemotherapy Patients' selection

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Role of radiation therapy in gastric adenocarcinoma

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World Journal of Gastroenterology 2006年第10期12卷 1511-1520页

作者： Lisa Hazard John O'Connor Courtney Scaife Departments of Radiation oncology University of Utah School of Medicine Salt Lake CityUTUnited States Department of Radiation oncology Tulane University New OrleansLAUnited States Departments of Surgery University of Utah School of Medicine Salt Lake CityUTUnited States

Outcomes in patients with gastric cancer in the united States remain disappointing, with a five-year overall survival rate of approximately 23%. Given high rates of local-regional control following surgery, a strong rationale exists for the use of adjuvant radiation therapy. Randomized trials have shown superior local control with adjuvant radiotherapy and improved overall survival with adjuvant chemoradiation. The benefit of adjuvant chemoradiation in patients who have undergone D2 lymph node dissection by an experienced surgeon is not known, and the benefit of adjuvant radiation therapy in addition to adjuvant chemotherapy continues to be defined. In unresectable disease, chemoradiation allows long-term survival in a small number of patients and provides effective palliation. Most trials show a benefit to combined modality therapy compared to chemotherapy or radiation therapy alone. The use of pre-operative, intra-operative, 3D conformal, and intensity modulated radiation therapy in gastric cancer is promising but requires further study. The current article reviews the role of radiation therapy in the treatment of resectable and unresectable gastric carcinoma, focusing on current recommendations in the united States.

关键词： Radiation therapy Gastric cancer Stomach cancer Chemoradiation Adjuvant therapy Neoadjuvant therapy Intra-operative radiation therapy 3D conformal radiation therapy Intensity modulated radiation therapy

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Liver structural transformation after partial hepatectomy and repeated partial hepatectomy in rats: A renewed view on liver regeneration

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World Journal of Gastroenterology 2020年第27期26卷 3899-3916页

作者： Keti Tsomaia Leila Patarashvili Nino Karumidze Irakli Bebiashvili Elza Azmaipharashvili Irina Modebadze Diana Dzidziguri Marom Sareli Sergey Gusev Dimitri Kordzaia Faculty of Medicine Ivane Javakhishvili Tbilisi State UniversityTbilisi 0159Georgia Faculty of Exact and Natural Sciences Ivane Javakhishvili Tbilisi State UniversityTbilisi 0179Georgia Department of Surgical oncology(Surgery C) Chaim Sheba Medical Center at HaShomerTel Aviv 52621Israel Federal Research and Clinical Center of Physical-Chemical Medicine of Federal Medical Biological Agency Moscow 119435Russia Clinical Anatomy and operative Surgery Ivane Javakhishvili Tbilisi State UniversityTbilisi 0159Georgia

BACKGROUND The phenomenon of liver regeneration after partial hepatectomy(PH)is still a subject of considerable interest due to the increasing frequency of half liver transplantation on the one hand,and on the other hand,new surgical approaches which allow removal of massive space-occupying hepatic tumors,which earlier was considered as ***,the mechanisms of liver regeneration are extensively studied after PH but less attention is paid to the architectonics of the regenerated *** of this,the question“How does the structure of regenerated liver differ from normal,regular liver?”has not been fully answered ***,almost without any attention is left the liver's structural transformation after repeated hepatectomy(of the re-regenereted liver).ATM To compare the architectonics of the lobules and circulatory bed of normal,regenerated and re-regenerated *** The livers of 40 adult,male,albino Wistar rats were studied.14 rats were subjected to PH-the 1st study group(SG1);10 rats underwent repeated PH–the 2nd study group(SG2);16 rats were subjected to sham operation-control group(CG);The livers were studied after 9 months from PH,and after 6 months from repeated ***(Schiff reaction for the determination of DNA concentration),histological(H&E,Masson trichrome,CK8 Immunohistochemical marker,transparent slides after Indian Ink injection,),morphometrical(hepatocytes areas,perimeters and ploidy)and Electron Microscopical(Scanning Electron Microscopy of corrosion casts)methods were *** In the SG1 and SG2,the area of hepatocytes and their perimeter are increased compared to the CG(P<0.05).However,the areas and perimeters of the hepatocytes of the SG1 and SG2 groups reveal a lesser *** regenerated(SG1)and re-regenerated(SG2)livers,the hepatocytes form the remodeled lobules,which size(300-1200μm)exceeds the sizes of the lobules from CG(300-600μm).The remodeled lobules(especially the“mega-lobules”with the

关键词： Partial hepatectomy Repeated hepatectomy Liver regeneration Liver reregeneration Hepatocytes hypertrophy Remodeling Ploidy Corrosion casts

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Comparison of open and closed hyperthermic intraperitoneal chemotherapy: Results from the united States hyperthermic intraperitoneal chemotherapy collaborative

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World Journal of Gastrointestinal oncology 2020年第7期12卷 756-767页

作者： Jennifer L Leiting Jordan M Cloyd Ahmed Ahmed Keith Fournier Andrew J Lee Sophie Dessureault Seth Felder Jula Veerapong Joel M Baumgartner Callisia Clarke Harveshp Mogal Charles A Staley Mohammad Y Zaidi Sameer H Patel Syed A Ahmad Ryan J Hendrix Laura Lambert Daniel E Abbott Courtney Pokrzywa Mustafa Raoof Christopher J LaRocca Fabian M Johnston Jonathan Greer Travis E Grotz Division of Hepatobiliary and Pancreas Surgery Mayo ClinicRochesterMN 55901United States Division of Surgical oncology Department of SurgeryThe Ohio State University Wexner Medical CenterColumbusOH 43210United States Department of Surgical oncology University of Texas MD Anderson Cancer CenterHoustonTX 77030United States Department of Gastrointestinal oncology Moffitt Cancer CenterDepartment of Oncologic SciencesMorsani College of MedicineTampaFL 33612United States Division of Surgical oncology Department of SurgeryUniversity of CaliforniaSan DiegoCA 92093United States Division of Surgical oncology Department of SurgeryMedical College of WisconsinMilwaukeeWI 53226United States Division of Surgical oncology Winship Cancer InstituteEmory UniversityAtlantaGA 30322United States Department of Surgery University of Cincinnati College of MedicineCincinnatiOH 45267United States Division of Surgical oncology Department of SurgeryUniversity of Massachusetts Medical SchoolWorcesterMA 01655United States Peritoneal Surface Malignancy Program Section of Surgical oncology Huntsman Cancer InstituteUniversity of UtahSalt Lake CityUT 84112United States Division of Surgical oncology Department of SurgeryUniversity of WisconsinMadisonWI 53792United States Christopher La Rocca Division of Surgical OncologyDepartment of SurgeryCity of Hope National Medical CenterDuarteCA 91010United States Department of Surgery Johns Hopkins UniversityBaltimoreMD 21287United States

BACKGROUND Cytoreductive surgery(CRS)with hyperthermic intraperitoneal chemotherapy(HIPEC)for peritoneal carcinomatosis can be performed in two ways:Open or closed abdominal *** To evaluate the impact of HIPEC method on post-operative and long-term survival *** Patients undergoing CRS with HIPEC from 2000-2017 were identified in the united States HIPEC collaborative ***-operative,recurrence,and overall survival outcomes were compared between those who received open vs closed *** Of the 1812 patients undergoing curative-intent CRS and HIPEC,372(21%)patients underwent open HIPEC and 1440(79%)underwent closed *** was no difference in re-operation or severe complications between the two *** HIPEC had higher rates of 90-d readmission while open HIPEC had a higher rate of 90-d *** multi-variable analysis,closed HIPEC technique was not a significant predictor for overall survival(hazards ratio:0.75,95%confidence interval:0.51-1.10,P=0.14)or recurrence-free survival(hazards ratio:1.39,95%confidence interval:1.00-1.93,P=0.05)in the entire *** findings remained consistent in the appendiceal and the colorectal *** In this multi-institutional analysis,the HIPEC method was not independently associated with relevant post-operative or long-term *** technique may be left to the discretion of the operating surgeon.

关键词： Mucinous appendiceal carcinoma Cytoreductive surgery Multi-institutional

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Adjuvant therapy for gastric cancer:Current and future directions

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World Journal of Gastroenterology 2014年第38期20卷 13718-13727页

作者： Marcus Foo Trevor Leong Division of Radiation oncology and Cancer Imaging and Cancer Imaging Peter MacCallum Cancer Centre University of Melbourne

The management of gastric cancer continues to evolve. Whilst surgery alone is effective when tumours present early,a large proportion of patients are diagnosed with loco-regionally advanced disease,resulting in high locoregional and distant relapse rates,with subsequent poor survival. Early attempts at improving outcomes following resection were disappointing;however,randomized trials have now established either post-operative chemoradiotherapy(INT0116) or peri-operative chemotherapy as standard adjuvant therapies in the Western world. There remain,however,significant differences in the approach to management between the West and East. In Asia,where there is the highest incidence of gastric cancer,extended resection followed by adjuvant chemotherapy represents the standard of care. This review discusses current standard adjuvant therapy in gastric adenocarcinoma,as well as recent and ongoing trials investigating novel(neo)adjuvant approaches,which hope to build on the successes of previous studies.

关键词： Adjuvant Gastric Stomach Cancer Chemoradiation Chemoradiotherapy Chemotherapy Peri-operative Neo-adjuvant

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VATS Right Upper Lobe Anterior Segmentectomy in Post Left Pneumonectomy: Technique

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中国肺癌杂志 2020年第8期23卷 730-732页

作者： Balasubramanian VENKITARAMAN Jichen QU Lei JIANG Department of Surgical oncology Thoracic Oncology DivisionSri Ramachandra Institute of Higher Education and ResearchChennaiIndia Department of Thoracic Surgery Shanghai Pulmonary Disease HospitalTongii University School of MedicineShanghai 200433China

Lung resection following pneumonectomy for recurrent lung cancer is a challenging ***-operative airway management and choice of surgical procedure are issues to be addressed by both the anesthesiologists and thoracic *** hereby report a case of anterior segmentectomy of the right upper for recurrent lung cancer,in a patient who had previously underwent pneumonectomy for primary lung cancer one year earlier.A modified conventional tracheal intubation and unique surgical techniques were applied for video-assisted thoracoscopic surgery(VATS)anterior segmentectomy of the right upper lobe in a patient with a notable mediastinal shift(following contralateral pneumonectomy),resulting in a good recovery and clinical *** clinical experience is summarized in detail in this article.

关键词： Post pneumonectomy surgery Video-assisted thoracoscopic surgery Resurgery in pneumonectomy Lung cancer surgery

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Up-to-date intraoperative computer assisted solutions for liver surgery

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World Journal of Gastrointestinal Surgery 2019年第1期11卷 1-10页

作者： Apollon Zygomalas Ioannis Kehagias Surgical oncology OLYMPION General Clinic of Patras Department of Surgery University Hospital of Patras

Computer assisted surgical planning allowed for a better selection of patients,evaluation of operative strategy, appropriate volumetric measurements,identification of anatomical risks, definition of tumour resection margins and choice of surgical approach in liver oncologic resections and living donor liver transplantations. Although preoperative computer surgical analysis has been widely used in daily clinical practice, intraoperative computer assisted solutions for risk analysis and navigation in liver surgery are not widely available or still under clinical evaluation. Computer science technology can efficiently assist modern surgeons during complex liver operations, mainly by providing image guidance with individualized 2 D images and 3 D models of the various anatomical and pathological structures of interest. Intraoperative computer assisted liver surgery is particularly useful in complex parenchyma-sparing hepatectomies, for intraoperative risk analysis and for the effective treatment of colorectal metastases after neoadjuvant therapy or when they are multiple. In laparoscopic liver surgery, intraoperative computer aid is definitively more important as, apart from a restricted field of view, there is also loss of the fine haptic feedback. Intraoperative computer assisted developments face challenges that prevent their application in daily clinical practice. There is a vast variety of studies regarding intraoperative computer assisted liver surgery but there are no clear objective measurements in order to compare them and select the most effective solutions. An overview of up-to-date intraoperative computer assisted solutions for liver surgery will be discussed.

关键词： Computer assisted surgery Liver Intraoperative 3D models Navigation Image guidance Augmented reality Hepatic surgery Hepatectomy

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