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Ampullary adenocarcinoma:the current state of adjuvant therapies

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Hepatobiliary surgery and Nutrition 2020年第5期9卷 647-649页

作者： Charles C.Vining Darryl Schuitevoerder Kiran K.Turaga section of general surgery/surgical oncology The University of Chicago MedicineChicagoUSA

Periampullary cancers,including adenocarcinoma from the duodenum,pancreas,bile duct and ampulla,represent a spectrum of malignancies with varying biological behavior and *** particular ampullary adenocarcinoma(AAC)is a rare,poorly understood disease with an incidence of<1/100,000 cases,compromises only 0.2%of gastrointestinal cancers and is frequently grouped together with other periampullary cancers(1).

关键词： adenocarcinoma adjuvant pancreas

Carcinosarcoma of the breast:Facing the challenge of a rare nosologic entity

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World Journal of Clinical Cases 2025年第2期13卷 14-20页

作者： Aikaterini Mastoraki Maria Tsamopoulou Foivos-Konstantinos Stamatis Alexios Strimpakos Ero Mouchtouri Christiana Panagi Evgenia Mela Sotiria Mastoraki Aristotelis Kechagias Dimitrios Schizas Department of surgery National and Kapodistrian University of AthensLaikon General HospitalAthens 11527Greece Department of surgery National and Kapodistrian University of AthensAthens 11527Greece Department of Medical oncology Hygeia HospitalAthens 15123Greece Department of Radiology Henry Dunant Hospital CenterAthens 11526Greece Department of surgery Athens Metropolitan HospitalAthens 15562Greece

Carcinosarcoma(CS),also known as metaplastic breast carcinoma with mesenchymal differentiation,is one of the five distinct subtypes of metaplastic breast *** is considered as a mixed,biphasic neoplasm consisting of a carcinomatous component combined with a malignant nonepithelial element of mesenchymal origin without an intermediate transition *** cellular origin of this neoplasm remains controversial,most researchers declare that neoplastic cells derive from a cellular structure with potential biphasic *** recent research on the therapeutic strategies against CS neoplastic disorders,surgical resection appears the only potentially curative *** CS metastasize by the lymphatic route,axillary assessment with sentinel lymph node biopsy and/or axillary lymph node dissection is always ***,the tumor also presents a hematogenous metastatic pattern including pleural,pulmonary,liver,brain and less commonly bone ***,surgical removal of breast CS does not necessarily ensure patient’s long-term ***,alternative therapies,such as radio-and chemotherapy proved insufficient and 5-year survival rate is ***,there is evidence that following surgery,the combination of radio and chemotherapy is associated with a better prognosis than either treatment *** aim of this review is to evaluate the results of surgical treatment for breast CS with special reference to the extent of its histological *** features,histogenesis,morphological and immunochemical findings are discussed,while the role of current diagnostic and therapeutic management of this aggressive neoplasm is emphasized.

关键词： Carcinosarcoma Breast Diagnostic approach Therapeutic management Prognostic parameters

Colorectal cancer vaccines: Tumor-associated antigens vs neoantigens

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World Journal of Gastroenterology 2018年第48期24卷 5418-5432页

作者： Sandra Wagner Christina S Mullins Michael Linnebacher section of Molecular oncology and Immunotherapy General SurgeryUniversity Medical Center

Therapeutic options for the treatment of colorectal cancer(CRC) are diverse but still not always satisfying. Recent success of immune checkpoint inhibition treatment for the subgroup of CRC patients suffering from hypermutated tumors suggests a permanent role of immune therapy in the clinical management of CRC. Substantial improvement in treatment outcome could be achieved by development of efficient patient-individual CRC vaccination strategies. This mini-review summarizes the current knowledge on the two general classes of targets: tumor-associated antigens(TAAs) and tumorspecific antigens. TAAs like carcinoembryonic antigen and melanoma associated antigen are present in and shared by a subgroup of patients and a variety of clinical studies examined the efficacy of different TAA-derived peptide vaccines. Combinations of several TAAs as the next step and the development of personalized TAA-based peptide vaccines are discussed. Improvements of peptidebased vaccines achievable by adjuvants and immunestimulatory chemotherapeutics are highlighted. Finally, we sum up clinical studies using tumor-specific antigens-in CRC almost exclusively neoantigens-which revealed promising results; particularly no severe adverse events were reported so far. Critical progress for clinical outcomes can be expected by individualizing neoantigen-based peptide vaccines and combining them with immunestimulatory chemotherapeutics and immune checkpoint inhibitors. In light of these data and latest developments, truly personalized neoantigen-based peptide vaccines can be expected to fulfill modern precision medicine's requirements and will manifest as treatment pillar for routine clinical management of CRC.

关键词： Cancer vaccines Colorectal neoplasm Immunotherapy Neoplasm antigen tumor-associated antigens tumor-specific antigens Neoantigen(s)

Transhiatal versus transthoracic esophagectomy for esophageal cancer

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World Journal of Gastroenterology 2010年第30期16卷 3804-3810页

作者： J Camilo Barreto Mitchell C Posner section of general surgery and surgical oncology Department of SurgeryUniversity of Chicago Pritzker School of Medicine5841 S. Maryland AveMC 5094ChicagoIL 60637United States

Esophageal cancer continues to represent a formidable challenge for both patients and clinicians. Relative 5-year survival rates for patients have improved over the past three decades, probably linked to a combination of improved surgical outcomes, progress in systemic chemotherapy and radiotherapy, and the increasing acceptance of multimodality treatment. surgical treatment remains a fundamental component of the treatment of localized esophageal adenocarcinoma. Multiple approaches have been described for esophagectomy, which can be thematically grouped under two major categories: either transthoracic or transhiatal. The main controversy rests on whether a more extended resection through thoracotomy provides superior oncological outcomes as opposed to resection with relatively limited morbidity and mortality through a transhiatal approach. After numerous trials have addressed these issues, neither approach has consistently proven to be superior to the other one, and both can provide excellent short-term results in the hands of experienced surgeons. Moreover, the available literature suggests that experience of the surgeonand hospital in the surgical management of esophageal cancer is an important factor for operative morbidity and mortality rates, which could supersede the type of approach selected. Oncological outcomes appear to be similar after both procedures.

关键词： Esophageal cancer Transhiatal esophageal resection Transthoracic esophageal resection

Hepatic metastases from gastric cancer:A surgical perspective

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World Journal of Gastroenterology 2015年第41期21卷 11489-11492页

作者： Guido Alberto Massimo Tiberio Franco Roviello Annibale Donini Giovanni de Manzoni surgical Clinic Department of Clinical and Experimental Sciences University of Brescia surgical oncology Department of Human Pathology and Oncology University of Siena Division of general surgery Department of Surgical SciencesRadiology and DentistryUniversity of Perugia general surgery University of Verona

Management of patients with hepatic metastases as the sole metastatic site at diagnosis of gastric cancer(synchronous setting) or detected during follow-up(metachronous) is controversial. The prevailing attitude in these cases is passive, leading to surgical palliation and, possibly, to chemotherapy. Authors focused this editorial in order to promote a more pragmatic attitude. They stress the importance of recognizing the good candidates to curative surgery of both gastric cancer and hepatic metastases(synchronous setting) or hepatic disease alone(metachronous disease) from those who will not benefit from surgical therapy. In fact, in adequately selected subgroup of patients surgery, especially if integrated in multimodal therapeutic strategies, may achieve unexpected 5-year survival rates, ranging from 10% to 40%. The critical revision of the literature suggests that some simple clinical criteria exist that may be effectively employed in patients selection. These are mainly related to the gastric cancer(factors T, N, G) and to the extent of hepatic involvement(factor H). Upon these criteria it is possible to adequately select about 50% of cases. In the remaining 50% of cases a critical discussion on a case-by-case basis is recommended, considering that among these patients some potential long-survivors exist, that survival is strictly influenced by the ablation of the tumor bulk and by multimodality treatments including chemotherapy and that in expert institutions this kind of surgery is performed with very low mortality and morbidity rates.

关键词： Gastric cancer Hepatic metastases surgical palliat

Dual loop(Roux en Y) reconstruction with isolated gastric limb reduces delayed gastric emptying after pancreatico-duodenectomy

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World Journal of Gastrointestinal surgery 2019年第2期11卷 93-100页

作者： Offir Ben-Ishay Reem Abu Zhaya Yoram Kluger surgical oncology Unit Division of General Surgery Rambam Health Care Campus

BACKGROUND Single loop reconstruction(SLR) was routine in our institution for patients undergoing pancreatico-duodenectomy(PD). Roux-en Y reconstruction with an isolated gastric limb(RIGL) recently became the reconstruction of *** To evaluate the impact of RIGL on incidence and severity of delayed gastric emptying(DGE).METHODS This is a single institution, retrospective analysis of patients undergoing PD. All patients undergoing PD from July 2010 through December 2016 were included in the study. Outcome of RIGL were compared to SLR. Primary measure of outcome included incidence and severity of DGE. Secondary measures of outcome were overall complications and postoperative *** One hundred and seventy-nine patients were included in the study. Fifty-two had RIGL, 127 had SLR. Overall complication rate was 40.2%, patients in the RIGL group experienced lower rates of DGE(15.4% vs 59.1%, P = 0.001). Other patient related outcomes were also significantly reduced: day of nasogastric tube removal(3 vs 5, P < 0.001), regain of normal diet(8 vs 9, P < 0.001). On multivariate analysis RIGL was associated independently with reduced rates of DGE(P < 0.001, OR 0.14)CONCLUSION The current study shows that RIGL reduces the rate of DGE after PD. Further prospective randomized controlled trials are required to affirm the current data.

关键词： Pancreaticoduodenectomy Delayed gastric emptying Complications Roux en Y

surgery for metastatic pancreatic neuroendocrine tumors: a narrative review

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Hepatobiliary surgery and Nutrition 2023年第1期12卷 69-83页

作者： Jelani K.Williams Jason L.Schwarz Xavier M.Keutgen Division of general surgery and surgical oncology Department of SurgeryUniversity of Chicago MedicineChicagoILUSA

Background and Objective:Pancreatic neuroendocrine tumors(PanNETs)are derived from the islet cells of the pancreas and have been increasing in *** of these tumors are nonfunctional although some can secrete hormones and lead to hormone-specific clinical *** is the mainstay of treatment for localized tumors,however,surgical resection is controversial in metastatic *** narrative review seeks to summarize the current literature surrounding surgery,specifically in the controversial area of metastatic PanNETs,review current treatment paradigms,and understand the benefits of surgery in this group of ***:Authors searched PubMed using the terms“surgery pancreatic neuroendocrine tumor”,“metastatic neuroendocrine tumor”,and“liver debulking neuroendocrine tumor”from January 1990 to June *** English language publications were *** Content and Findings:There is no consensus among the leading specialty organizations regarding surgery for metastatic *** considering surgery for metastatic PanNETs,tumor grade and morphology,location of the primary tumor,extra-hepatic or extra-abdominal disease,as well as liver tumor burden and metastatic distribution should be *** the liver is the most common site of metastasis and liver failure is the most common cause of death in patients with hepatic metastases,attention is centered here on debulking and other ablative *** transplantation is rarely used for hepatic metastases but could be beneficial in a small subset of *** studies have demonstrated improvement in survival and symptoms after surgery for metastatic disease,but the lack of prospective randomized control trials significantly limits analysis of surgical benefits in patients with metastatic ***:surgery is the standard of care for localized PanNETs,while it remains controversial in metastatic *** studies have shown a survival and symptomatic be

关键词： Pancreatic neuroendocrine tumors(PanNETs) liver tumor burden hepatic metastasis liver debulking DOTATATE

Lymphoepithelial cysts of the pancreas:a management dilemma

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Hepatobiliary & Pancreatic Diseases International 2014年第5期13卷 539-544页

作者： Julie Martin Keith J Roberts Maria Sheridan Gavin A Falk Daniel Joyce R Matthew Walsh Andrew M Smith Gareth Morris-Stiff Departments of Pancreatic surgery St James's University Hospital Departments of Radiology St James's University Hospital Department of general surgery Section of Surgical Oncology/HPB Cleveland Clinic Foundation

Pancreatic lymphoepithelial cysts（LECs） are rare,benign lesions that are typically unexpected post-operative pathological findings. We aimed to review clinical, radiological and pathological features of LECs that may allow their preoperative diagnosis. Histopathology databases of two large pancreatic units were searched to identify LECs and notes reviewed to determine patient demographic details, mode of presentation, investigations, treatment and outcome. Five male and one female patients were identified. Their median age was 60 years. Lesions were identified on computed tomography performed for abdominal pain in two patients, and were incidentally observed in four patients. Five LECs were located in the tail and one in the body of the pancreas, with a median cyst size of 5 cm. Obtaining cyst fluid was difficult and a largely acellular aspirate was yielded. The pre-operative diagnosis was mucinous cystic neoplasm in all patients. This series of patients were treated distal pancreatectomy and splenectomy. A retrospective review of radiological examinations suggested that LECs have a relatively low signal on T2 imaging and a high signal intensity on T1 weighted images. LECs appear more common in elderly males, and are typically incidental, large, unilocular cysts. Close attention to signal intensity on MRI may allow preoperative diagnosis of these lesions.

关键词： lymphoepithelial cyst pancreas

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