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Insights on liver-directed surgical innovations, targeted therapies, and immunotherapy for biliary tract cancer: navigating the new European Society for Medical oncology (ESMO) Clinical Practice Guidelines

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Hepatobiliary Surgery and Nutrition 2024年第3期13卷 516-519页

作者： Ajay V.Maker Division of surgical oncology Department of SurgeryUniversity of CaliforniaSan FranciscoCAUSA

Cancers of the bile duct,including gallbladder cancer,extrahepatic cholangiocarcinoma,hilar and intrahepatic cholangiocarcinoma,present a significant treatment *** by their notorious difficulty to diagnose or biopsy,intricate anatomical locations and diverse clinical presentations,these malignancies collectively contribute to a significant burden on global *** epidemiology of bile duct cancers reveals worldwide variations in incidence,prevalence,and mortality rates,emphasizing the need for a nuanced understanding of each subtype and the local environmental *** in early diagnosis further compound the complexity of managing these cancers,often leading to advanced stage at the time of detection and treatment *** remains the cornerstone of curative-intent treatment of bile duct cancers,yet the rate of recurrence and metastases underscores the importance of comprehensive multidisciplinary therapeutic *** randomized clinical trials have been performed;however,they have been challenged by the lack of active agents,a limited number of accrued patients,and a grouping of all patients together regardless of where in the biliary tract the tumor *** has resulted in variations in treatment strategies and multiple treatment options that range from immunotherapy to radiation to hepatic artery infusion therapy(more on this later).A greater understanding of the mutational landscape of biliary tract cancers has resulted in optimism around appropriately targeted agents and combination ***,many of these regimens await robust outcomes data,and it is questionable if they significantly move the needle forward to improve overall *** now,more than ever,there is a need for updated treatment guidelines.

关键词： Gallbladder cancer cholangiocarcinoma guidelines bile duct cancer hepatic artery infusion pump

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Breakthrough therapy for peritoneal carcinomatosis of gastric cancer:Intraperitoneal chemotherapy with taxanes

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World Journal of Gastrointestinal oncology 2015年第11期7卷 285-291页

作者： Hironori Yamaguchi Joji Kitayama Hironori Ishigami Shinsuke Kazama Hiroaki Nozawa Kazushige Kawai Keisuke Hata Tomomichi Kiyomatsu Toshiaki Tanaka Junichiro Tanaka Takeshi Nishikawa Kensuke Otani Koji Yasuda Soichiro Ishihara Eiji Sunami Toshiaki Watanabe Department of surgical oncology the University of Tokyo

The effect of chemotherapy on peritoneal carcinomatosis(PC) of gastric cancer remains ***,the intraperitoneal(IP) administration of taxanes [e.g.,paclitaxel(PTX) and docetaxel(DOC)] during the perioperative period has shown promising ***,we summarized the rationale and methodology for using IP chemotherapy with taxanes and reviewed the clinical *** administered taxanes remain in the IP space at an extremely high concentration for 48-72 *** drug directly infiltrates peritoneal metastatic nodules from the surface and then produces antitumor effects,making it ideal for IP *** are two types of perioperative IP chemotherapy with taxanes: neoadjuvant intraperitoneal and systemic chemotherapy and sequential perioperative intraperitoneal chemotherapy(SPIC).In SPIC,patients receive neoadjuvant IP chemotherapy and the same regimen of IP chemotherapy after cytoreductive surgery(CRS) until disease ***,a taxane dissolved in 500-1000 m L of saline at ordinary temperature is administered through an IP access port on an outpatient *** to phase Ⅰ?studies,the recommended doses(RD) are as follows: IP DOC,45-60 mg/m2; IP PTX [without intravenous(IV) PTX],80 mg/m2; and IP PTX(with IV PTX),20 mg/*** Ⅱ studies have reported a median survival time of 14.4-24.6 mo with a 1-year overall survival of 67%-78%.A phase Ⅲ study comparing S-1 in combination with IP and IV PTX to S-1 with IV cisplatin started in *** prognosis of patients who underwent CRS was better than that of those who did not; however,this was partly due to selection *** several phase Ⅱ studies have shown promising results,a randomized controlled study is needed to validate the effectiveness of IP chemotherapy with taxanes for PC of gastric cancer.

关键词： Taxane Paclitaxel Docetaxel Carcinoma Gastric canc

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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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Precision surgical approach with lymph-node dissection in early gastric cancer

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World Journal of Gastroenterology 2019年第14期25卷 1640-1652页

作者： Shinichi Kinami Naohiko Nakamura Yasuto Tomita Takashi Miyata Hideto Fujita Nobuhiko Ueda Takeo Kosaka Department of surgical oncology Kanazawa Medical University

The gravest prognostic factor in early gastric cancer is lymph-node metastasis,with an incidence of about 10% overall. About two-thirds of early gastric cancer patients can be diagnosed as node-negative prior to treatment based on clinicpathological data. Thus, the tumor can be resected by endoscopic submucosal dissection. In the remaining third, surgical resection is necessary because of the possibility of nodal metastasis. Nevertheless, almost all patients can be cured by gastrectomy with D1+ lymph-node dissection. Laparoscopic or robotic gastrectomy has become widespread in East Asia because perioperative and oncological safety are similar to open surgery. However, after D1+ gastrectomy,functional symptoms may still result. Physicians must strive to minimize postgastrectomy symptoms and optimize long-term quality of life after this *** on the location and size of the primary lesion, preservation of the pylorus or cardia should be considered. In addition, the extent of lymph-node dissection can be individualized, and significant gastric-volume preservation can be achieved if sentinel node biopsy is used to distinguish node-negative *** the surgical treatment for early gastric cancer may be less radical than in the past, the operative method itself seems to be still in transition.

关键词： Stomach neoplasms surgery Gastrectomy methods Recovery of function Sentinel lymph node surgery Gastric cancer

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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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Pancreaticoduodenectomy with combined superior mesenteric vein resection without reconstruction is possible:A case report and review of the literature

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World Journal of Clinical Cases 2018年第8期6卷 214-218页

作者： Lionel Jouffret Theophile Guilbaud Olivier Turrini Jean-Robert Delpero Department of surgical oncology Institut PaoliC almettes

We report the case of a 56-year-old woman with pancreatic adenocarcinoma(PA) discovered during an episode of febrile jaundice. A computed tomography(CT) scan showed a mass in the head of the pancreas with circumferential infiltration of the superior mesenteric vein(SMV) and dilatation of the biliary and pancreatic ducts without metastases. The patient benefited from neoadjuvant chemotherapy(FOLFIRINOX) followed by radio-chemotherapy(45 Gy) and chemotherapy(LV5 FU2). The revaluation CT revealed SMV thrombosis without portal vein(PV) thrombosis. There was no contact of the tumor with the PV. Pancreatoduodenectomy with combined resection of the SMV was performed with no reconstruction of this venous axis after confirmation of adequate PV, splenic, and left gastric venous flow and the absence of bowel ischemia. The pathological diagnosis was p T4 N1 R0 PA. There were no bowel angina issues during the follow-up period. At 15 mo after surgery, the patient died of metastatic recurrence.

关键词： Pancreatic ducts Locally advanced No reconstruction Pancreatic adenocarcinoma Superior mesenteric vein

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Nomograms for colorectal cancer:A systematic review

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World Journal of Gastroenterology 2015年第41期21卷 11877-11886页

作者： Kazushige Kawai Eiji Sunami Hironori Yamaguchi Soichiro Ishihara Shinsuke Kazama Hiroaki Nozawa Keisuke Hata Tomomichi Kiyomatsu Junichiro Tanaka Toshiaki Tanaka Takeshi Nishikawa Joji Kitayama Toshiaki Watanabe Department of surgical oncology Graduate School of Medicinethe University of Tokyo

AIM: To assist in the selection of suitable nomograms for obtaining desired predictions in daily ***: We conducted electronic searches for journal articles on colorectal cancer(CRC)-associated nomograms using the search terms colon/rectal/colorectal/nomogram. Of 174 articles initially found, we retrieved 28 studies in which a nomogram for CRC was ***: We discuss the currently available CRCassociated nomograms, including those that predict the oncological prognosis, the short-term outcome of treatments, such as surgery or neoadjuvant chemoradiotherapy, and the future development of CRC. Developing nomograms always presents a dilemma. On the one hand, the desire to cover as wide a patient range as possible tends to produce nomograms that are too complex and yet have C-indexes that are not sufficiently high. Conversely, confining the target patients might impair the clinical applicability of constructed ***: The information provided in this review should be of use in selecting a nomogram suitable for obtaining desired predictions in daily clinical practice.

关键词： Colon Rectum Nomograms Prognosis Cancer

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Quality assessment of surgery for colorectal cancer:Where do we stand?

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World Journal of Gastrointestinal Surgery 2024年第4期16卷 982-987页

作者： Stefan Morarasu Cristian Livadaru Gabriel-Mihail Dimofte The Second Department of surgical oncology Regional Institute of OncologyIasi 707483Romania

Quality assurance in surgery has been one of the most important topics of debate among colorectal surgeons in the past *** has produced new surgical standards that led in part to the impressive oncological outcomes we see in many units *** mesorectal excision,complete mesocolic excision(CME),and the Japanese D3 lymphadenectomy are now benchmark techniques embraced by many surgeons and widely recommended by surgical ***,there are still ongoing discrepancies in outcomes largely based on surgeon *** is one of the main reasons why many countries have shifted colorectal cancer surgery only to high volume *** markers of surgical quality is thus a perquisite to ensure that standards and oncological outcomes are met at an institutional *** the evolution of CME surgery,various quality markers have been described,mostly based on measurements on the surgical specimen and lymph node yield,while others have proposed radiological markers(*** stumps)measured on postoperative scans as part of the routine cancer *** is no ideal marker;however,taken together and assembled into a new score or set of criteria may become a future point of reference for reporting outcomes of colorectal cancer surgery in research studies and defining subspecialization requirements both at an individual and hospital level.

关键词： Colorectal cancer Colon surgery Arterial stump Complete mesocolic excision surgical quality

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RETROSPECTIVE ANALYSIS OF PULMONARY SARCOMA AND BLASTOMA WITH REVIEW OF LITERATURES

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Chinese Journal of Cancer Research 2003年第1期15卷 68-71页

作者：陈晋峰张力建刘静贤 Department of surgical oncology Department of Pathology Peking University School of Oncology

Objective: To explore the clinical characteristics,diagnosis and treatment of pulmonary sarcoma andblastoma. Methods: Seven cases of pulmonary sarcoma(including 1 case of pulmonary carcinosarcoma, 1 case ofpulmonary malignant fibroneuroma, 1 case of pulmonarymalignant fibrous tissue tumor and 1 case of pulmonaryblastoma from August 1995 to June 2002 in our hospital) were retrospectively summarized the histologicalcharacteristics, clinical features, diagnosis and treatment. Results: Pulmonary sarcoma and blastoma both are raremalignant tumors and can be easily misdiagnosed ormistreated. The main symptoms of both diseases are cough and expectoration. X ray or CT shows node or focus in *** both are diagnosed by histological pathology. Because the symptoms of these diseases are not typical, it is difficultfor patients to be diagnosed without pathologyConclusion: These two kinds of diseases are often easy to be misdiagnosed. Early diagnosis and treatment are importantto improve the efficiency of treatment. surgical resection is the best method of treatment, and it is important to combine with chemotherapy and radiation treatment.

关键词： Pulmonary sarcoma Pulmonary blastomaDiagnosis Surgery

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PROGNOSTIC VALUE OF VEGF EXPRESSION IN PRIMARY ESOPHAGEAL SQUAMOUS CELL CARCINOMA

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Chinese Journal of Cancer Research 2004年第2期16卷 85-89页

作者：徐卫国杨国利ボ立新谢玉泉张力建 Department of surgical oncology Peking University School of Oncology Beijing 100036

To study the expression of vascular endothelial growth factor (VEGF) and microvessel density (MVD) in esophageal squamous cell carcinoma (ESCC) and clarify the association of VEGF expression with the angiogenesis and prognostic value of this disease. Methods: Eighty-two cases with primary ESCC treated with radical operation in Department of Surgery from Jan 1981 through May 1994 were enrolled. VEGF expression and MVD value were examined by immunohistochemical staining, the streptavidin-biotin peroxidase complex method (SP method), using anti-VEGF polyclonal antibody and anti-Factor-VIII antibody, respectively. We also analyzed the relationship between VEGF expression and MVD value and postoperative survival rate of patients. Results: Of the 82 cases, 63.4% cases showed positive for VEGF in tumor cells and the median of MVD in tumor was 37 (9-150)·mm-2. There was a close correlation between MVD and VEGF (P=0.001). The 5-year survival rate of patients with low and high MVD was 34.1% and 12.2%, respectively. The 5-year survival rate was 46.7% in patients with VEGF-negative tumor and 11.5% in patients with VEGF-positive tumor. These differences were statistically significant (P=0.017 and P<0.001, respectively). Conclusion: In ESCC, angiogenesis is mediated mainly by VEGF and VEGF may be associated with tumor progression and increased malignancy via angiogenesis.

关键词： Esophageal Squamous cell Carcinoma Angiogenesis factor Biosynthesis Neovascularization Prognosis

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