BACKGROUND Endoscopic full-thickness resection(EFTR)is increasingly used for treating gastrointestinal stromal tumors(GISTs)in the stomach.AIM To compare the efficacy,tolerability,and clinical outcomes of EFTR vs surg...BACKGROUND Endoscopic full-thickness resection(EFTR)is increasingly used for treating gastrointestinal stromal tumors(GISTs)in the stomach.AIM To compare the efficacy,tolerability,and clinical outcomes of EFTR vs surgical resection(SR)for gastric GISTs.METHODS We collected clinical data from patients diagnosed with GISTs who underwent either EFTR or SR at our hospital from October 2011 to July 2024.Patients were matched in a 1:1 ratio based on baseline characteristics and tumor clinical-pathological features using propensity score matching.We analyzed perioperative outcomes and follow-up data.The primary outcome measure was progressionfree survival(PFS).RESULTS Out of 912 patients,573 met the inclusion criteria.After matching,each group included 95 patients.The EFTR group demonstrated statistically significant advantages over the SR group in average operative time(P<0.001),length of hospital stay(P<0.001),time to resume liquid diet(P<0.001),incidence of adverse events(P=0.031),and hospitalization costs(P<0.001).The en bloc resection rate was significantly different,with SR group at 100%and EFTR group at 93.7%(P=0.038).The median follow-up was 2451.50 days.Recurrence occurred in 3 patients in the EFTR group and 4 patients in the SR group,with no statistically significant difference(P=1.000).Factors associated with PFS included age,tumor size,high-risk category in the modified National Institutes of Health(NIH)risk score,and resection status.Resection status was identified as an independent prognostic factor for PFS(P=0.0173,hazard ratios=0.0179,95%CI:0.000655-0.491).Notably,there was no statistically significant difference in PFS between the two groups.CONCLUSION This study is a non-inferiority design.The EFTR group significantly outperformed the SR group in terms of operative time,length of hospital stay,time to resume a liquid diet,incidence of adverse events,and hospitalization costs,demonstrating its higher economic efficiency and better tolerability.Additionally,although the en bloc resection rate was lower in the EFTR group compared to the SR group,there were no significant differences in tumor recurrence rates and progression-free survival between the two groups.This study found no statistical difference in the primary endpoint of postoperative recurrence rates between the two groups.However,due to sample size limitations,this result requires further validation in larger-scale studies.The current results should be viewed as exploratory evidence.展开更多
BACKGROUND Thermal ablation(TA),including radiofrequency ablation and microwave ablation,is a commonly used curative treatment for single small hepatocellular carcinoma(sHCC).The relative advantages of TA and surgical...BACKGROUND Thermal ablation(TA),including radiofrequency ablation and microwave ablation,is a commonly used curative treatment for single small hepatocellular carcinoma(sHCC).The relative advantages of TA and surgical resection(SR)in terms of long-term survival remain controversial.AIM To compare their long-term efficacy in this patient population.METHODS This population-based retrospective cohort study included 257 patients who received a first diagnosis of single sHCC and underwent SR or TA from January 2012 to September 2017.The primary endpoints were overall survival(OS)and recurrence-free survival(RFS).RESULTS The average follow-up duration was 11.4 years.The 1-,3-,5-,and 10-year OS rates were 95.8%,86.0%,82.5%,and 74.2%in the SR group vs 97.4%,85.8%,78.6%,and 65.6%in the TA group,with the median OS not yet reached.The 1-,3-,5-,and 10-year RFS rates were 79.8%,59.6%,46.2%,and 24.7%in the SR group vs 83.9%,61.5%,47.9%,and 41.2%in the TA group,with median RFS values of 3.95 and 4.63 years,respectively.No significant differences in OS or RFS were observed overall(OS:P=0.244;RFS:P=0.180),but in patients≤60 years,TA led to a higher RFS than SR(P=0.021).Multivariate analysis identified age,tumor differentiation grade,and Child-Pugh classification as independent risk factors for OS,whereas age and differentiation grade were significant risk factors for RFS.CONCLUSION In patients with single sHCC,SR,and TA offered comparable long-term efficacy.However,TA showed superior RFS in patients≤60 years,suggesting that TA may be a reasonable option for younger patients,pending confirmation by prospective studies.展开更多
Colorectal cancer (CRC) is one of the commonest cancers with 1.2 million new cases diagnosed each year in the world. It remains the fourth most common cause of cancer-related mortality in the world and accounts for &a...Colorectal cancer (CRC) is one of the commonest cancers with 1.2 million new cases diagnosed each year in the world. It remains the fourth most common cause of cancer-related mortality in the world and accounts for > 600000 cancer-related deaths each year. There have been significant advances in treatment of metastatic CRC in last decade or so, due to availability of new active targeted agents and more aggressive approach towards the management of CRC, particularly with liver-only-metastases; however, these drugs work best when combined with conventional chemotherapy agents. Despite these advances, there is a lack of biomarkers to inform us about the accurate management of the patients with metastatic CRC. It is therefore imperative to carefully select the patients with comprehensive multi-disciplinary team input in order to optimise the management of these patients. In this review we will discuss various treatment options available in management of colorectal liver metastases with potential guidance on how and when to choose these options along with consideration on future directions in management of this disease.展开更多
AIM： To evaluate the clinical usefulness of lSF-fluorodeoxyglucose positron emission and computed tomography QSF-FDG PET/CT） in restaging of esophageal cancer after surgical resection and radiotherapy. METHODS： Bet...AIM： To evaluate the clinical usefulness of lSF-fluorodeoxyglucose positron emission and computed tomography QSF-FDG PET/CT） in restaging of esophageal cancer after surgical resection and radiotherapy. METHODS： Between January 2007 and Aug 2008, twenty histopathologically diagnosed esophageal cancer patients underwent 25 PET/CT scans （three patients had two scans and one patient had three scans） for restaging after surgical resection and radiotherapy. The standard reference for tumor recurrence was histopathologic confirmation or clinical follow-up for at least ten months after ^18F-FDG PET/CT examinations. RESULTS： Tumor recurrence was confirmed histopathologically in seven of the 20 patients （35%） and by clinical and radiological follow-up in 13 （65%）. ^18F-FDG PET/CT was positive in 14 patients （68.4%） and negative in six （31.6%）. ^18F-FDG PET/CT was true positive in 11 patients, false positive in three and true negative in six. Overall, the accuracy of ^18F-FDG PET/CT was 85%, negative predictive value （NPV） was 100%, and positive predictive value （PPV） was 78.6%.The three false positive PET/CT findings comprised chronic inflammation of mediastinal lymph nodes （n = 2） and anastomosis inflammation （n = 1）. PET/ CT demonstrated distant metastasis in 10 patients. ^18F-FDG PET/CT imaging-guided salvage treatment in nine patients was performed. Treatment regimens were changed in 12 （60%） patients after introducing ^18F-FDG PET/CT into their conventional post-treatment follow-up program. CONCLUSION： Whole body ^18F-FDG PET/CT is effective in detecting relapse of esophageal cancer after surgical resection and radiotherapy. It could also have important clinical impact on the management of esophageal cancer, influencing both clinical restaging and salvage treatment of patients.展开更多
AIM： TO study the proper sites and doses of intraoperative radiotherapy （IORT） for gastric carcinoma and the effects of this treatment. METHODS： A total of 106 patients with stage Ⅰ -Ⅳ gastric carcinoma who rece...AIM： TO study the proper sites and doses of intraoperative radiotherapy （IORT） for gastric carcinoma and the effects of this treatment. METHODS： A total of 106 patients with stage Ⅰ -Ⅳ gastric carcinoma who received D2 or D3 radical operation combined with IORT were analyzed. Sixty-seven patients with gastric cancer of the antrum and body underwent distal gastrectomy. The sites of irradiation were at the celiac artery and hepatoduodenal ligment area. Another 39 patients with carcinoma of the cardia and upper part of the gastric body and whole stomach underwent proximal gastrectomy or total gastrectomy. The sites of irradiation for this group were the upper margin of the pancreas and the regional para-aorta. The therapeutic effects （including survival and complications） of these 106 cases received operation combined with IORT （IORT group） were compared with 441 cases treated during the same time period by a radical operation alone （operation group）. RESULTS： The radiation dose below 30 Gy was safe. The therapeutic method of the operation combined with IORT did not prolong the survival of patients with stage Ⅰ and Ⅳ gastric cancer, but the 5-year survival rates of patients with stage Ⅱ and Ⅲ gastric cancers were significantly improved. The 5-year survival rates of the stages Ⅲ cancer patients receiving D2 resection combined with IORT were markedly improved, while for those receiving D3 radical resection, only the postoperative 3- or 4-year survival rates were improved （P 〈 0.005-0.001）. The 5-year survival rate for those patients was raised only by 4.7% （P 〉 0.05）. CONCLUSION： The 5-year survival rates of patients with stages Ⅱ and Ⅲ gastric carcinoma who received D2 lymphadenectomy combined with IORT were improved, and there was no influence on the postoperative complications and mortality.展开更多
BACKGROUND Surgical resection and radiofrequency ablation(RFA)represent two possible strategy in treatment of hepatocellular carcinoma(HCC)in Milan criteria.AIM To evaluate short-and long-term outcome in elderly patie...BACKGROUND Surgical resection and radiofrequency ablation(RFA)represent two possible strategy in treatment of hepatocellular carcinoma(HCC)in Milan criteria.AIM To evaluate short-and long-term outcome in elderly patients(>70 years)with HCC in Milan criteria,which underwent liver resection(LR)or RFA.METHODS The study included 594 patients with HCC in Milan criteria(429 in LR group and 165 in RFA group)managed in 10 European centers.Statistical analysis was performed using the Kaplan-Meier method before and after propensity score matching(PSM)and Cox regression.RESULTS After PSM,we compared 136 patients in the LR group with 136 patients in the RFA group.Overall survival at 1,3,and 5 years was 91%,80%,and 76%in the LR group and 97%,67%,and 41%in the RFA group respectively(P=0.001).Diseasefree survival at 1,3,and 5 years was 84%,60%and 44%for the LR group,and 63%,36%,and 25%for the RFA group(P=0.001).Postoperative Clavien-Dindo IIIIV complications were lower in the RFA group(1%vs 11%,P=0.001)in association with a shorter length of stay(2 d vs 7 d,P=0.001).In multivariate analysis,Model for End-stage Liver Disease(MELD)score(>10)[odds ratio(OR)=1.89],increased value of international normalized ratio(>1.3)(OR=1.60),treatment with radiofrequency(OR=1.46),and multiple nodules(OR=1.19)were independent predictors of a poor overall survival while a high MELD score(>10)(OR=1.51)and radiofrequency(OR=1.37)were independent factors associated with a higher recurrence rate.CONCLUSION Despite a longer length of stay and a higher rate of severe postoperative complications,surgery provided better results in long-term oncological outcomes as compared to ablation in elderly patients(>70 years)with HCC in Milan criteria.展开更多
AIM:To clarify the benefit of surgical excision for patients with extrahepatic metastases of hepatocellular carcinoma(HCC). METHODS:We retrospectively reviewed the medical records of 140 patients with pathologically p...AIM:To clarify the benefit of surgical excision for patients with extrahepatic metastases of hepatocellular carcinoma(HCC). METHODS:We retrospectively reviewed the medical records of 140 patients with pathologically proven extrahepatic metastases of HCC and evaluated the outcomes of those who had undergone surgical resection(SR)for extrahepatic metastatic lesions.Prognoses made on the basis of extrahepatic metastatic sites were also examined. RESULTS:The survival rates of patients who underwent SR of extrahepatic metastases were significantly better than those of patients who did not receive SR. For the SR group,1-and 3-year survival rates were 24%and 7%,respectively,while for the non-resection group,the survival rates were 8%and 0%,respec- tively(P<0.0001).Survival rates related to metastatic sites were also significantly superior after SR of extrahepatic metastases:median survivals were 32 mo with lung metastasis,10 mo with bone metastasis,6.1 mo with brain metastasis. CONCLUSION:SR can provide survival benefits forpatients with 1 or 2 isolated extrahepatic metastases and who concurrently exhibit good hepatic functional reserve and general performance status as well as successful treatment of intrahepatic HCC.展开更多
Lymph node (LN) metastases from hepatocellular carcinoma (HCC) are considered uncommon. We describe the surgical resection of a solitary para-aortic LN metastasis from HCC. A 65-year-old Japanese man with B-type liver...Lymph node (LN) metastases from hepatocellular carcinoma (HCC) are considered uncommon. We describe the surgical resection of a solitary para-aortic LN metastasis from HCC. A 65-year-old Japanese man with B-type liver cirrhosis was admitted for the evaluation of a liver tumor. He had already undergone radiofrequency ablation, transcatheter arterial chemoembolization, and percutaneous ethanol injection therapy for HCC. Despite treatment, viable regions remained in segments 4 and 8. We performed a right paramedian sectionectomy with partial resection of the left paramedian section of the liver. Six months later, serum concentrations of alpha-fetoprotein (189 ng/mL) and PIVKA-2 (507 mAU/mL) increased. Enhanced com- puted tomography of the abdomen revealed a tumor (20 mm in diameter) on the right side of the abdominal aorta. Fluorine-18 fluorodeoxyglucose positron emission tomography revealed an increased standard uptake value. There was no evidence of recurrence in other regions. Esophagogastroduodenoscopy and colonoscopy revealed no malignant tumor in the gastrointestinal tract. Para-aortic LN metastasis from HCC was thus diagnosed. We performed lymphadenectomy. Histopathological examination revealed that the tumor was largely necrotic, with poorly differentiated HCC on its surface, which confirmed the suspected diagnosis. After 6 mo tumor marker levels were normal, with no evidence of recurrence. Our experience suggests that a solitary para-aortic LN metastasis from HCC can be treated surgically.展开更多
BACKGROUND Surgical resection is the preferred method for patients with complex liver cancer.But the tumor is in a special position, the surgery is highly risky, postoperative complications can easily occur, and the p...BACKGROUND Surgical resection is the preferred method for patients with complex liver cancer.But the tumor is in a special position, the surgery is highly risky, postoperative complications can easily occur, and the prognosis is not ideal.AIM To investigate the effectiveness of surgical resection for complex liver cancer and its influencing factors.METHODS Fifty-seven patients who had complicated liver cancer and underwent surgical resection at our hospital from August 2015 to August 2016 were enrolled in this study. All patients were followed for three years, and their postoperative complications, survival, and factors that impacted their survival were analyzed.RESULTS The total incidence of postoperative complications was 45.61%, and the incidence of pleural effusion was the highest at 28.07%. There were no correlations between the 2-year and 3-year survival rates and sex, age, and Hbs Ag of the patients(P >0.05). In terms of pathological parameters, the 2-year and 3-year survival rates were significantly different according to the presence of a tumor capsule, degree of liver cirrhosis, satellite or focal lesions, hepatic vein thrombosis, portal vein tumor thrombus, and intraoperative blood loss(P < 0.05).CONCLUSIONThe effectiveness of surgical resection for complex hepatocellular carcinoma may be affected by factors such as the presence of a tumor capsule, cirrhosis degree,satellite or focal lesions, hepatic vein embolization, portal vein tumor thrombus,and intraoperative blood loss. Therefore, these factors should be controlled and prevented during surgery to help improve patient survival after surgery.展开更多
BACKGROUND: With the expansion of surgical criteria, the comparative efficacy between surgical resection (SR) and liver transplantation (LT) for hepatocellular carcinoma is inconclusive. This study aimed to develop a ...BACKGROUND: With the expansion of surgical criteria, the comparative efficacy between surgical resection (SR) and liver transplantation (LT) for hepatocellular carcinoma is inconclusive. This study aimed to develop a prognostic nomogram for predicting recurrence-free survival of hepatocellular carcinoma patients after resection and explored the possibility of using nomogram as treatment algorithm reference. METHODS: From 2003 to 2012, 310 hepatocellular carcinoma patients within Hangzhou criteria undergoing resection or liver transplantation were included. Total tumor volume, albumin level, HBV DNA copies and portal hypertension were included for constructing the nomogram. The resection patients were stratified into low- and high-risk groups by the median nomogram score of 116. Independent risk factors were identified and a visually orientated nomogram was constructed using a Cox proportional hazards model to predict the recurrence risk for SR patients. RESULTS: The low-risk SR group had better outcomes compared with the high-risk SR group (3-year recurrence-free survival rate, 71.1% vs 35.9%; 3-year overall survival rate, 89.8% vs 78.9%, both P<0.001). The high-risk SR group was associated with a worse recurrence-free survival rate but similar overall survival rate compared with the transplantation group (3-year recurrence-free survival rate, 35.9% vs 74.1%, P<0.001; 3-year overall survival rate, 78.9% vs 79.6%, P>0.05). CONCLUSIONS: This nomogram offers individualized recurrence risk evaluation for hepatocellular carcinoma patients within Hangzhou criteria receiving resection. Transplantation should be considered the first-line treatment for high risk patients.展开更多
BACKGROUND Generally,hemangiomas do not require surgical intervention;however,cases of large hemangiomas,potentially involving the throat and trachea,necessitate surgical therapy.Here,we present a case of hypopharynge...BACKGROUND Generally,hemangiomas do not require surgical intervention;however,cases of large hemangiomas,potentially involving the throat and trachea,necessitate surgical therapy.Here,we present a case of hypopharyngeal hemangioma in an adult that was successfully treated with neodymium-doped yttrium aluminum garnet(Nd-YAG)laser.CASE SUMMARY Laryngoscopic examination of a 61-year-old man demonstrated the presence of a large,submucosal vascular lesion that extended into the epiglottis,left arytenoid cartilage,lateral to the aryepiglottic fold,and pyriform sinus.The lesion was resected and photocoagulated with limited hemorrhage using Nd:YAG laser.The hypopharyngeal hemangioma was completely excised.The patient showed no recurrence of hypopharyngeal hemangioma during the 1.5-year follow-up period.CONCLUSION Laser therapy is one of the effective tools for treating hemangiomas with rapid,uncontrolled growth or in functional areas,with few side effects and complications.The present case of a male patient with a large hypopharyngeal hemangioma,treated with YAG laser,demonstrates the efficacy of laser photocoagulation in treating cases of hemangiomas,without the risk of bleeding or airway obstruction.The favorable postoperative outcomes demonstrated by our patient with Nd:YAG laser therapy indicate its consideration in the therapy of similar cases.展开更多
BACKGROUND The anatomical features of the atlantoaxial spine increase the difficulty of complete and safe removal of atlantoaxial intradural extramedullary(IDEM)tumors.Studies concerning surgical interventions via a p...BACKGROUND The anatomical features of the atlantoaxial spine increase the difficulty of complete and safe removal of atlantoaxial intradural extramedullary(IDEM)tumors.Studies concerning surgical interventions via a posterior approach are limited.AIM To investigate the safety and efficacy of atlantoaxial IDEM tumor resection using a one-stage posterior approach.METHODS We retrospectively analyzed clinical databases for one-stage atlantoaxial IDEM tumor resection via a posterior approach between January 2008 and January 2018.The analyzed data included tumor position,histopathological type,pre-and postoperative Japanese Orthopedic Association(JOA)scores and Nurick grades,postoperative complication and recurrence status.RESULTS A total of 13 patients who underwent C1-C2 Laminectomy and/or unilateral facetectomy via the posterior approach were enrolled in the study.In all cases reviewed,total tumor resection and concomitant C1-C2 fusion were achieved.The average follow-up was 35.3±6.9 mo(range,26-49 mo).A statistically significant difference was noted between the preoperative JOA score(11.2±1.1)and the score at the last final follow-up(15.6±1.0)(P<0.05).A statistically significant difference was noted between the preoperative Nurick grade(2.3±0.9)and that at the last follow-up(1.2±0.4)(P<0.05).However,no statistically significant difference was noted between the preoperative and last follow-up C1-2 Cobb angle and C2-7 Cobb angle(P>0.05).No mortalities,severe complications or tumor recurrence were observed during the follow-up period.CONCLUSION Total resection of atlantoaxial IDEM tumors is feasible and effective via a posterior approach.Surgical reconstruction should be considered to avoid iatrogenic kyphosis and improve spinal stability and overall clinical outcomes.展开更多
BACKGROUND:Although the treatment of extrahepatic metastases from primary liver tumors is essentially palliative,solitary metastasis from such tumors offers a possibility of cure by surgical resection.The adrenal glan...BACKGROUND:Although the treatment of extrahepatic metastases from primary liver tumors is essentially palliative,solitary metastasis from such tumors offers a possibility of cure by surgical resection.The adrenal gland is an uncommon site for metastasis from primary liver tumors. METHOD:We report two cases of adrenalectomy for solitary adrenal metastasis:one from intrahepatic cholangiocarcinoma and the other from hepatocellular carcinoma. RESULTS:The patient with intrahepatic cholangiocar- cinoma had a synchronous adrenal metastasis and underwent simultaneous liver resection and adrenalectomy. However,he developed recurrent disease 17 months following surgery for which he is presently on palliative chemotherapy.The other patient underwent adrenalectomy for adrenal metastasis 3 months following liver transplantation for hepatocellular carcinoma.He is presently alive and disease-free 27 months after adrenalectomy. CONCLUSION:Carefully selected patients with solitary metastasis from primary liver tumors may be considered for resection.展开更多
Objective:To analyze the clinical effect of primary small liver cancer under radiofrequency ablation(RFA)and surgical resection(SR)treatment,and to explore the best application timing of the two treatment methods.Meth...Objective:To analyze the clinical effect of primary small liver cancer under radiofrequency ablation(RFA)and surgical resection(SR)treatment,and to explore the best application timing of the two treatment methods.Methods:Randomly controlled clinical trials(RCT)of percutaneous radiofrequency ablation and surgical resection for the treatment of small liver cancer in various databases were searched according to the established search strategy,and Meta data was analyzed based on RevMan5.3 software provided by Cochrane collaborative organization.Results:A total of 10 articles were included in this study,including 1396 patients,699 in the RFA group and 697 in the SR group.Meta-analysis results showed that the two groups had no statistical difference in overall survival rate at 1 and 3 years,1-year disease-free survival rate,and 1-year recurrence rate(P>0.05).The 3-year disease-free survival rate of the RFA group was lower than that of the SR group,and the 3-year recurrence rate was higher than that of the SR group.The higher postoperative complication rate tended to the SR group,and the differences were statistically significant.(P<0.05).Conclusion:For short-term efficacy,radiofrequency ablation and surgical resection show consistency;for long-term efficacy,surgical resection is more effective.展开更多
Background:Hepatocellular carcinoma(HCC)with portal vein invasion(PVI)is considered an advanced stage with a poor prognosis.Although current guidelines recommend systemic treatment for HCC with PVI,surgical resection ...Background:Hepatocellular carcinoma(HCC)with portal vein invasion(PVI)is considered an advanced stage with a poor prognosis.Although current guidelines recommend systemic treatment for HCC with PVI,surgical resection could produce acceptable outcomes in selected patients.This study aimed to identify the clinical significance of surgical resection for HCC with PVI patients using a large-scale nationwide registry.Methods:This retrospective,multicenter,observational cohort analyzed data from the Korean Primary Liver Cancer Registry.A total of 16,781 patients who were newly diagnosed with HCC between 2008 and 2018 were enrolled in this study.Patients with worse Child-Turcotte-Pugh scores(≥7)or performance status(≥2)were excluded.Among them,998 patients who received treatment for HCC with PVI were included in the analysis and were divided into two groups:resection group of 151(15.1%)and palliative group of 847(84.9%)who received transarterial and systemic therapy according to the treatment intent.After matching the number and size of the tumors and model for end-stage liver disease(MELD)score between the groups,the final study cohort for analysis comprised 151(26.6%)patients in the resection group and 417(73.4%)in the palliative group.The primary endpoints were overall survival(OS)and cancer-specific survival(CSS).Results:The number and maximum size of HCC did not differ between the resection and palliative groups after matching[1(range,1-5)vs.1(range,1-6),P=0.11 and 5.5(range,1.2-20.6)vs.6.0(range,1.0-20.5)cm,P=0.24,respectively].Tumor markers,including alpha-fetoprotein(AFP)and protein induced by vitamin K absence or antagonist-II(PIVKA-II),also did not differ between the groups(P=0.29 and P=0.36,respectively).The 5-year OS and CSS rates of the resection and palliative groups were 44.8%and 17.4%(P<0.001)and 47.7%and 18.6%(P<0.001),respectively.Multivariate analysis showed that palliative treatment intent was the most significant risk factor for OS and CSS[odds ratio(OR)=2.24;95%confidence interval(CI):1.66-3.02;P<0.001 and OR=2.29;95%CI:1.68-3.12;P<0.001,respectively].Conclusions:Surgical resection could significantly improve OS and CSS in selected HCC with PVI patients who have preserved liver function and performance status.展开更多
Pancreatic metastasis from a nonpancreatic primary tumor is rare(<2%)(1,2)and has a potentially poor prognosis(3).Melanoma is an aggressive skin malignancy that commonly exhibits distant metastasis and poor overall...Pancreatic metastasis from a nonpancreatic primary tumor is rare(<2%)(1,2)and has a potentially poor prognosis(3).Melanoma is an aggressive skin malignancy that commonly exhibits distant metastasis and poor overall prognosis(4).Isolated pancreatic metastasis from melanoma is even less common and poses significant diagnostic and therapeutic challenges.A retrospective study demonstrated that surgical resection increased the survival of patients with abdominal visceral melanoma metastases(5).However,pancreatic resection of metastatic melanoma is potentially associated with high mortality as experience with this type of surgery is limited(6).Here,we describe a rare case of isolated pancreatic metastatic melanoma treated with pancreatic resection at our hospital,including clinical features,treatment,and follow-up.A review of the related literature is also provided.展开更多
Stage IV pancreatic ductal adenocarcinoma(PDAC)is considered unresectable by the European Society for Medical Oncology(ESMO)-European Society of Digestive Oncology(ESDO)Clinical Practice Guidelines,and treatment for t...Stage IV pancreatic ductal adenocarcinoma(PDAC)is considered unresectable by the European Society for Medical Oncology(ESMO)-European Society of Digestive Oncology(ESDO)Clinical Practice Guidelines,and treatment for these patients,remains mostly palliative(1).In non-metastatic PDAC,and whenever feasible,surgery remains a crucial component,playing a key role in improving survival rates.While the general trend has been to prepare as many patients as possible for surgical intervention,the necessity for proper patient selection has become increasingly evident(2).展开更多
BACKGROUND Colorectal cancer(CRC)frequently metastasizes to the liver,significantly compromising patient survival.While surgical resection improves outcomes for resectable cases,many patients have limited therapeutic ...BACKGROUND Colorectal cancer(CRC)frequently metastasizes to the liver,significantly compromising patient survival.While surgical resection improves outcomes for resectable cases,many patients have limited therapeutic options.AIM To evaluate the role of laparoscopic ultrasound in resection and ablation of colorectal liver metastases(CRLM).METHODS Between June 2018 and June 2020,300 patients with CRC and liver metastases were admitted to our hospital.They were divided into two groups(150 cases each)based on treatment method:The control group(ethoxybenzyl diethylenetriamine penta-acetic acid enhanced magnetic resonance imaging)and the observation group[contrast-enhanced ultrasound with Sonazoid(S-CEUS)].RESULTS The study group demonstrated better efficacy(P<0.05),fewer adverse events(P<0.05),and better survival outcomes compared to the control group(1-year:80%vs 62%;3-year:54%vs 33%;5-year:32%vs 18%;median survival:48 months vs 30 months;hazard ratio=0.63,95%CI:0.48-0.83,P<0.001).Although Karnofsky Performance Status scores improved in both groups,the scores were significantly higher in the observation group(P<0.05).Multivariate analysis confirmed intraoperative S-CEUS and tumor differentiation as independent prognostic factors(P<0.05).CONCLUSION Laparoscopic ultrasound-guided resection/ablation improved outcomes in CRLM,reducing complications and enhancing survival.Intraoperative S-CEUS was an independent prognostic factor,supporting its clinical value.展开更多
BACKGROUND Rectal neuroendocrine tumors(NETs)smaller than 10 mm and well-differentiated tumors are generally considered to have a low risk of lymph node and distant metastasis,making them suitable for endoscopic resec...BACKGROUND Rectal neuroendocrine tumors(NETs)smaller than 10 mm and well-differentiated tumors are generally considered to have a low risk of lymph node and distant metastasis,making them suitable for endoscopic resection.In contrast,tumors≥20 mm in size typically require surgical resection.However,the optimal management of intermediate-sized(10-15 mm)rectal NETs remains controversial.AIM To compare the clinical outcomes of endoscopic resection of rectal NETs<1 cm and those 1-1.5 cm in size.METHODS A retrospective study was conducted on 1056 patients with rectal NETs treated at the Samsung Medical Center between January 2005 and June 2021.After propensity score matching(1:10)for age,sex,and type of endoscopic resection,225 patients with tumors<1 cm in size and 27 patients with tumors 1-1.5 cm in size were analyzed.RESULTS Surgical resection was more frequent in the 1-1.5 cm group(37.2%)than in the<1 cm group(10.7%)(P<0.01).Endoscopic submucosal dissection was also more commonly performed in the 1-1.5 cm group(48.1%vs 18.5%,P<0.01).Negative resection margins were achieved in 97.2%of the patients,with no significant difference between the groups(P=0.22).No lymphovascular invasion was observed.During a median follow-up of 54 months,no recurrence occurred in the 1-1.5 cm group,while one case of metachronous recurrence was noted in the<1 cm group(P=1.00).There was no significant difference in recurrence-free survival(P=0.48).CONCLUSION Endoscopic resection of 1-1.5 cm grade 1 rectal NETs yielded comparable outcomes to those<1 cm in size,suggesting its feasibility as a treatment.展开更多
The incidence of hepatocellular carcinoma(HCC)has been steadily rising,und-erscoring the need for a clear,stage-specific treatment approach.The Barcelona Clinic Liver Cancer(BCLC)staging system remains the most widely...The incidence of hepatocellular carcinoma(HCC)has been steadily rising,und-erscoring the need for a clear,stage-specific treatment approach.The Barcelona Clinic Liver Cancer(BCLC)staging system remains the most widely used frame-work for classifying HCC and guiding therapy.Among its classifications,the intermediate stage(BCLC-B)encompasses a highly heterogeneous patient popu-lation,with varying degrees of tumor burden and liver function.Traditionally,transarterial chemoembolization has been the standard treatment for this stage,based on earlier evidence.However,recent studies suggest that a subset of BCLC-B patients-particularly those with localized disease-may benefit more from liver resection.This review summarizes current treatment paradigms for BCLC-B HCC,explores emerging subclassifications within this group,and highlights evolving guidelines that support the selective use of surgery in appropriately chosen patients.展开更多
文摘BACKGROUND Endoscopic full-thickness resection(EFTR)is increasingly used for treating gastrointestinal stromal tumors(GISTs)in the stomach.AIM To compare the efficacy,tolerability,and clinical outcomes of EFTR vs surgical resection(SR)for gastric GISTs.METHODS We collected clinical data from patients diagnosed with GISTs who underwent either EFTR or SR at our hospital from October 2011 to July 2024.Patients were matched in a 1:1 ratio based on baseline characteristics and tumor clinical-pathological features using propensity score matching.We analyzed perioperative outcomes and follow-up data.The primary outcome measure was progressionfree survival(PFS).RESULTS Out of 912 patients,573 met the inclusion criteria.After matching,each group included 95 patients.The EFTR group demonstrated statistically significant advantages over the SR group in average operative time(P<0.001),length of hospital stay(P<0.001),time to resume liquid diet(P<0.001),incidence of adverse events(P=0.031),and hospitalization costs(P<0.001).The en bloc resection rate was significantly different,with SR group at 100%and EFTR group at 93.7%(P=0.038).The median follow-up was 2451.50 days.Recurrence occurred in 3 patients in the EFTR group and 4 patients in the SR group,with no statistically significant difference(P=1.000).Factors associated with PFS included age,tumor size,high-risk category in the modified National Institutes of Health(NIH)risk score,and resection status.Resection status was identified as an independent prognostic factor for PFS(P=0.0173,hazard ratios=0.0179,95%CI:0.000655-0.491).Notably,there was no statistically significant difference in PFS between the two groups.CONCLUSION This study is a non-inferiority design.The EFTR group significantly outperformed the SR group in terms of operative time,length of hospital stay,time to resume a liquid diet,incidence of adverse events,and hospitalization costs,demonstrating its higher economic efficiency and better tolerability.Additionally,although the en bloc resection rate was lower in the EFTR group compared to the SR group,there were no significant differences in tumor recurrence rates and progression-free survival between the two groups.This study found no statistical difference in the primary endpoint of postoperative recurrence rates between the two groups.However,due to sample size limitations,this result requires further validation in larger-scale studies.The current results should be viewed as exploratory evidence.
文摘BACKGROUND Thermal ablation(TA),including radiofrequency ablation and microwave ablation,is a commonly used curative treatment for single small hepatocellular carcinoma(sHCC).The relative advantages of TA and surgical resection(SR)in terms of long-term survival remain controversial.AIM To compare their long-term efficacy in this patient population.METHODS This population-based retrospective cohort study included 257 patients who received a first diagnosis of single sHCC and underwent SR or TA from January 2012 to September 2017.The primary endpoints were overall survival(OS)and recurrence-free survival(RFS).RESULTS The average follow-up duration was 11.4 years.The 1-,3-,5-,and 10-year OS rates were 95.8%,86.0%,82.5%,and 74.2%in the SR group vs 97.4%,85.8%,78.6%,and 65.6%in the TA group,with the median OS not yet reached.The 1-,3-,5-,and 10-year RFS rates were 79.8%,59.6%,46.2%,and 24.7%in the SR group vs 83.9%,61.5%,47.9%,and 41.2%in the TA group,with median RFS values of 3.95 and 4.63 years,respectively.No significant differences in OS or RFS were observed overall(OS:P=0.244;RFS:P=0.180),but in patients≤60 years,TA led to a higher RFS than SR(P=0.021).Multivariate analysis identified age,tumor differentiation grade,and Child-Pugh classification as independent risk factors for OS,whereas age and differentiation grade were significant risk factors for RFS.CONCLUSION In patients with single sHCC,SR,and TA offered comparable long-term efficacy.However,TA showed superior RFS in patients≤60 years,suggesting that TA may be a reasonable option for younger patients,pending confirmation by prospective studies.
基金Supported by the National Institute for Health Research(NIHR)Biomedical Research Centre(BRC)at the Royal Marsden NHS Foundation Trust and Institute of Cancer Research and the Robert McAlpine Charity(partly,for Khurum Khan)
文摘Colorectal cancer (CRC) is one of the commonest cancers with 1.2 million new cases diagnosed each year in the world. It remains the fourth most common cause of cancer-related mortality in the world and accounts for > 600000 cancer-related deaths each year. There have been significant advances in treatment of metastatic CRC in last decade or so, due to availability of new active targeted agents and more aggressive approach towards the management of CRC, particularly with liver-only-metastases; however, these drugs work best when combined with conventional chemotherapy agents. Despite these advances, there is a lack of biomarkers to inform us about the accurate management of the patients with metastatic CRC. It is therefore imperative to carefully select the patients with comprehensive multi-disciplinary team input in order to optimise the management of these patients. In this review we will discuss various treatment options available in management of colorectal liver metastases with potential guidance on how and when to choose these options along with consideration on future directions in management of this disease.
文摘AIM： To evaluate the clinical usefulness of lSF-fluorodeoxyglucose positron emission and computed tomography QSF-FDG PET/CT） in restaging of esophageal cancer after surgical resection and radiotherapy. METHODS： Between January 2007 and Aug 2008, twenty histopathologically diagnosed esophageal cancer patients underwent 25 PET/CT scans （three patients had two scans and one patient had three scans） for restaging after surgical resection and radiotherapy. The standard reference for tumor recurrence was histopathologic confirmation or clinical follow-up for at least ten months after ^18F-FDG PET/CT examinations. RESULTS： Tumor recurrence was confirmed histopathologically in seven of the 20 patients （35%） and by clinical and radiological follow-up in 13 （65%）. ^18F-FDG PET/CT was positive in 14 patients （68.4%） and negative in six （31.6%）. ^18F-FDG PET/CT was true positive in 11 patients, false positive in three and true negative in six. Overall, the accuracy of ^18F-FDG PET/CT was 85%, negative predictive value （NPV） was 100%, and positive predictive value （PPV） was 78.6%.The three false positive PET/CT findings comprised chronic inflammation of mediastinal lymph nodes （n = 2） and anastomosis inflammation （n = 1）. PET/ CT demonstrated distant metastasis in 10 patients. ^18F-FDG PET/CT imaging-guided salvage treatment in nine patients was performed. Treatment regimens were changed in 12 （60%） patients after introducing ^18F-FDG PET/CT into their conventional post-treatment follow-up program. CONCLUSION： Whole body ^18F-FDG PET/CT is effective in detecting relapse of esophageal cancer after surgical resection and radiotherapy. It could also have important clinical impact on the management of esophageal cancer, influencing both clinical restaging and salvage treatment of patients.
文摘AIM： TO study the proper sites and doses of intraoperative radiotherapy （IORT） for gastric carcinoma and the effects of this treatment. METHODS： A total of 106 patients with stage Ⅰ -Ⅳ gastric carcinoma who received D2 or D3 radical operation combined with IORT were analyzed. Sixty-seven patients with gastric cancer of the antrum and body underwent distal gastrectomy. The sites of irradiation were at the celiac artery and hepatoduodenal ligment area. Another 39 patients with carcinoma of the cardia and upper part of the gastric body and whole stomach underwent proximal gastrectomy or total gastrectomy. The sites of irradiation for this group were the upper margin of the pancreas and the regional para-aorta. The therapeutic effects （including survival and complications） of these 106 cases received operation combined with IORT （IORT group） were compared with 441 cases treated during the same time period by a radical operation alone （operation group）. RESULTS： The radiation dose below 30 Gy was safe. The therapeutic method of the operation combined with IORT did not prolong the survival of patients with stage Ⅰ and Ⅳ gastric cancer, but the 5-year survival rates of patients with stage Ⅱ and Ⅲ gastric cancers were significantly improved. The 5-year survival rates of the stages Ⅲ cancer patients receiving D2 resection combined with IORT were markedly improved, while for those receiving D3 radical resection, only the postoperative 3- or 4-year survival rates were improved （P 〈 0.005-0.001）. The 5-year survival rate for those patients was raised only by 4.7% （P 〉 0.05）. CONCLUSION： The 5-year survival rates of patients with stages Ⅱ and Ⅲ gastric carcinoma who received D2 lymphadenectomy combined with IORT were improved, and there was no influence on the postoperative complications and mortality.
文摘BACKGROUND Surgical resection and radiofrequency ablation(RFA)represent two possible strategy in treatment of hepatocellular carcinoma(HCC)in Milan criteria.AIM To evaluate short-and long-term outcome in elderly patients(>70 years)with HCC in Milan criteria,which underwent liver resection(LR)or RFA.METHODS The study included 594 patients with HCC in Milan criteria(429 in LR group and 165 in RFA group)managed in 10 European centers.Statistical analysis was performed using the Kaplan-Meier method before and after propensity score matching(PSM)and Cox regression.RESULTS After PSM,we compared 136 patients in the LR group with 136 patients in the RFA group.Overall survival at 1,3,and 5 years was 91%,80%,and 76%in the LR group and 97%,67%,and 41%in the RFA group respectively(P=0.001).Diseasefree survival at 1,3,and 5 years was 84%,60%and 44%for the LR group,and 63%,36%,and 25%for the RFA group(P=0.001).Postoperative Clavien-Dindo IIIIV complications were lower in the RFA group(1%vs 11%,P=0.001)in association with a shorter length of stay(2 d vs 7 d,P=0.001).In multivariate analysis,Model for End-stage Liver Disease(MELD)score(>10)[odds ratio(OR)=1.89],increased value of international normalized ratio(>1.3)(OR=1.60),treatment with radiofrequency(OR=1.46),and multiple nodules(OR=1.19)were independent predictors of a poor overall survival while a high MELD score(>10)(OR=1.51)and radiofrequency(OR=1.37)were independent factors associated with a higher recurrence rate.CONCLUSION Despite a longer length of stay and a higher rate of severe postoperative complications,surgery provided better results in long-term oncological outcomes as compared to ablation in elderly patients(>70 years)with HCC in Milan criteria.
文摘AIM:To clarify the benefit of surgical excision for patients with extrahepatic metastases of hepatocellular carcinoma(HCC). METHODS:We retrospectively reviewed the medical records of 140 patients with pathologically proven extrahepatic metastases of HCC and evaluated the outcomes of those who had undergone surgical resection(SR)for extrahepatic metastatic lesions.Prognoses made on the basis of extrahepatic metastatic sites were also examined. RESULTS:The survival rates of patients who underwent SR of extrahepatic metastases were significantly better than those of patients who did not receive SR. For the SR group,1-and 3-year survival rates were 24%and 7%,respectively,while for the non-resection group,the survival rates were 8%and 0%,respec- tively(P<0.0001).Survival rates related to metastatic sites were also significantly superior after SR of extrahepatic metastases:median survivals were 32 mo with lung metastasis,10 mo with bone metastasis,6.1 mo with brain metastasis. CONCLUSION:SR can provide survival benefits forpatients with 1 or 2 isolated extrahepatic metastases and who concurrently exhibit good hepatic functional reserve and general performance status as well as successful treatment of intrahepatic HCC.
文摘Lymph node (LN) metastases from hepatocellular carcinoma (HCC) are considered uncommon. We describe the surgical resection of a solitary para-aortic LN metastasis from HCC. A 65-year-old Japanese man with B-type liver cirrhosis was admitted for the evaluation of a liver tumor. He had already undergone radiofrequency ablation, transcatheter arterial chemoembolization, and percutaneous ethanol injection therapy for HCC. Despite treatment, viable regions remained in segments 4 and 8. We performed a right paramedian sectionectomy with partial resection of the left paramedian section of the liver. Six months later, serum concentrations of alpha-fetoprotein (189 ng/mL) and PIVKA-2 (507 mAU/mL) increased. Enhanced com- puted tomography of the abdomen revealed a tumor (20 mm in diameter) on the right side of the abdominal aorta. Fluorine-18 fluorodeoxyglucose positron emission tomography revealed an increased standard uptake value. There was no evidence of recurrence in other regions. Esophagogastroduodenoscopy and colonoscopy revealed no malignant tumor in the gastrointestinal tract. Para-aortic LN metastasis from HCC was thus diagnosed. We performed lymphadenectomy. Histopathological examination revealed that the tumor was largely necrotic, with poorly differentiated HCC on its surface, which confirmed the suspected diagnosis. After 6 mo tumor marker levels were normal, with no evidence of recurrence. Our experience suggests that a solitary para-aortic LN metastasis from HCC can be treated surgically.
文摘BACKGROUND Surgical resection is the preferred method for patients with complex liver cancer.But the tumor is in a special position, the surgery is highly risky, postoperative complications can easily occur, and the prognosis is not ideal.AIM To investigate the effectiveness of surgical resection for complex liver cancer and its influencing factors.METHODS Fifty-seven patients who had complicated liver cancer and underwent surgical resection at our hospital from August 2015 to August 2016 were enrolled in this study. All patients were followed for three years, and their postoperative complications, survival, and factors that impacted their survival were analyzed.RESULTS The total incidence of postoperative complications was 45.61%, and the incidence of pleural effusion was the highest at 28.07%. There were no correlations between the 2-year and 3-year survival rates and sex, age, and Hbs Ag of the patients(P >0.05). In terms of pathological parameters, the 2-year and 3-year survival rates were significantly different according to the presence of a tumor capsule, degree of liver cirrhosis, satellite or focal lesions, hepatic vein thrombosis, portal vein tumor thrombus, and intraoperative blood loss(P < 0.05).CONCLUSIONThe effectiveness of surgical resection for complex hepatocellular carcinoma may be affected by factors such as the presence of a tumor capsule, cirrhosis degree,satellite or focal lesions, hepatic vein embolization, portal vein tumor thrombus,and intraoperative blood loss. Therefore, these factors should be controlled and prevented during surgery to help improve patient survival after surgery.
基金supported by grants from the National Natural Science Foundation of China(81572368)Guangdong Natural Science Foundation(2016A030313278)+1 种基金Science and Technology Planning Project of Guangdong Province,China(2014A020212084)National Natural Science Youth Foundation of China(81600505)
文摘BACKGROUND: With the expansion of surgical criteria, the comparative efficacy between surgical resection (SR) and liver transplantation (LT) for hepatocellular carcinoma is inconclusive. This study aimed to develop a prognostic nomogram for predicting recurrence-free survival of hepatocellular carcinoma patients after resection and explored the possibility of using nomogram as treatment algorithm reference. METHODS: From 2003 to 2012, 310 hepatocellular carcinoma patients within Hangzhou criteria undergoing resection or liver transplantation were included. Total tumor volume, albumin level, HBV DNA copies and portal hypertension were included for constructing the nomogram. The resection patients were stratified into low- and high-risk groups by the median nomogram score of 116. Independent risk factors were identified and a visually orientated nomogram was constructed using a Cox proportional hazards model to predict the recurrence risk for SR patients. RESULTS: The low-risk SR group had better outcomes compared with the high-risk SR group (3-year recurrence-free survival rate, 71.1% vs 35.9%; 3-year overall survival rate, 89.8% vs 78.9%, both P<0.001). The high-risk SR group was associated with a worse recurrence-free survival rate but similar overall survival rate compared with the transplantation group (3-year recurrence-free survival rate, 35.9% vs 74.1%, P<0.001; 3-year overall survival rate, 78.9% vs 79.6%, P>0.05). CONCLUSIONS: This nomogram offers individualized recurrence risk evaluation for hepatocellular carcinoma patients within Hangzhou criteria receiving resection. Transplantation should be considered the first-line treatment for high risk patients.
基金Supported by the Jinshan Hospital Qihang Plan,No.2018-JSYYQH-02
文摘BACKGROUND Generally,hemangiomas do not require surgical intervention;however,cases of large hemangiomas,potentially involving the throat and trachea,necessitate surgical therapy.Here,we present a case of hypopharyngeal hemangioma in an adult that was successfully treated with neodymium-doped yttrium aluminum garnet(Nd-YAG)laser.CASE SUMMARY Laryngoscopic examination of a 61-year-old man demonstrated the presence of a large,submucosal vascular lesion that extended into the epiglottis,left arytenoid cartilage,lateral to the aryepiglottic fold,and pyriform sinus.The lesion was resected and photocoagulated with limited hemorrhage using Nd:YAG laser.The hypopharyngeal hemangioma was completely excised.The patient showed no recurrence of hypopharyngeal hemangioma during the 1.5-year follow-up period.CONCLUSION Laser therapy is one of the effective tools for treating hemangiomas with rapid,uncontrolled growth or in functional areas,with few side effects and complications.The present case of a male patient with a large hypopharyngeal hemangioma,treated with YAG laser,demonstrates the efficacy of laser photocoagulation in treating cases of hemangiomas,without the risk of bleeding or airway obstruction.The favorable postoperative outcomes demonstrated by our patient with Nd:YAG laser therapy indicate its consideration in the therapy of similar cases.
基金the National Natural Science Foundation of China,No.81860406Guangxi Natural Science Foundation,No.2018GXNSFAA281127Medical Excellence Award Funded by the Creative Research Development Grant from The First Affiliated Hospital of Guangxi Medical University.
文摘BACKGROUND The anatomical features of the atlantoaxial spine increase the difficulty of complete and safe removal of atlantoaxial intradural extramedullary(IDEM)tumors.Studies concerning surgical interventions via a posterior approach are limited.AIM To investigate the safety and efficacy of atlantoaxial IDEM tumor resection using a one-stage posterior approach.METHODS We retrospectively analyzed clinical databases for one-stage atlantoaxial IDEM tumor resection via a posterior approach between January 2008 and January 2018.The analyzed data included tumor position,histopathological type,pre-and postoperative Japanese Orthopedic Association(JOA)scores and Nurick grades,postoperative complication and recurrence status.RESULTS A total of 13 patients who underwent C1-C2 Laminectomy and/or unilateral facetectomy via the posterior approach were enrolled in the study.In all cases reviewed,total tumor resection and concomitant C1-C2 fusion were achieved.The average follow-up was 35.3±6.9 mo(range,26-49 mo).A statistically significant difference was noted between the preoperative JOA score(11.2±1.1)and the score at the last final follow-up(15.6±1.0)(P<0.05).A statistically significant difference was noted between the preoperative Nurick grade(2.3±0.9)and that at the last follow-up(1.2±0.4)(P<0.05).However,no statistically significant difference was noted between the preoperative and last follow-up C1-2 Cobb angle and C2-7 Cobb angle(P>0.05).No mortalities,severe complications or tumor recurrence were observed during the follow-up period.CONCLUSION Total resection of atlantoaxial IDEM tumors is feasible and effective via a posterior approach.Surgical reconstruction should be considered to avoid iatrogenic kyphosis and improve spinal stability and overall clinical outcomes.
文摘BACKGROUND:Although the treatment of extrahepatic metastases from primary liver tumors is essentially palliative,solitary metastasis from such tumors offers a possibility of cure by surgical resection.The adrenal gland is an uncommon site for metastasis from primary liver tumors. METHOD:We report two cases of adrenalectomy for solitary adrenal metastasis:one from intrahepatic cholangiocarcinoma and the other from hepatocellular carcinoma. RESULTS:The patient with intrahepatic cholangiocar- cinoma had a synchronous adrenal metastasis and underwent simultaneous liver resection and adrenalectomy. However,he developed recurrent disease 17 months following surgery for which he is presently on palliative chemotherapy.The other patient underwent adrenalectomy for adrenal metastasis 3 months following liver transplantation for hepatocellular carcinoma.He is presently alive and disease-free 27 months after adrenalectomy. CONCLUSION:Carefully selected patients with solitary metastasis from primary liver tumors may be considered for resection.
文摘Objective:To analyze the clinical effect of primary small liver cancer under radiofrequency ablation(RFA)and surgical resection(SR)treatment,and to explore the best application timing of the two treatment methods.Methods:Randomly controlled clinical trials(RCT)of percutaneous radiofrequency ablation and surgical resection for the treatment of small liver cancer in various databases were searched according to the established search strategy,and Meta data was analyzed based on RevMan5.3 software provided by Cochrane collaborative organization.Results:A total of 10 articles were included in this study,including 1396 patients,699 in the RFA group and 697 in the SR group.Meta-analysis results showed that the two groups had no statistical difference in overall survival rate at 1 and 3 years,1-year disease-free survival rate,and 1-year recurrence rate(P>0.05).The 3-year disease-free survival rate of the RFA group was lower than that of the SR group,and the 3-year recurrence rate was higher than that of the SR group.The higher postoperative complication rate tended to the SR group,and the differences were statistically significant.(P<0.05).Conclusion:For short-term efficacy,radiofrequency ablation and surgical resection show consistency;for long-term efficacy,surgical resection is more effective.
文摘Background:Hepatocellular carcinoma(HCC)with portal vein invasion(PVI)is considered an advanced stage with a poor prognosis.Although current guidelines recommend systemic treatment for HCC with PVI,surgical resection could produce acceptable outcomes in selected patients.This study aimed to identify the clinical significance of surgical resection for HCC with PVI patients using a large-scale nationwide registry.Methods:This retrospective,multicenter,observational cohort analyzed data from the Korean Primary Liver Cancer Registry.A total of 16,781 patients who were newly diagnosed with HCC between 2008 and 2018 were enrolled in this study.Patients with worse Child-Turcotte-Pugh scores(≥7)or performance status(≥2)were excluded.Among them,998 patients who received treatment for HCC with PVI were included in the analysis and were divided into two groups:resection group of 151(15.1%)and palliative group of 847(84.9%)who received transarterial and systemic therapy according to the treatment intent.After matching the number and size of the tumors and model for end-stage liver disease(MELD)score between the groups,the final study cohort for analysis comprised 151(26.6%)patients in the resection group and 417(73.4%)in the palliative group.The primary endpoints were overall survival(OS)and cancer-specific survival(CSS).Results:The number and maximum size of HCC did not differ between the resection and palliative groups after matching[1(range,1-5)vs.1(range,1-6),P=0.11 and 5.5(range,1.2-20.6)vs.6.0(range,1.0-20.5)cm,P=0.24,respectively].Tumor markers,including alpha-fetoprotein(AFP)and protein induced by vitamin K absence or antagonist-II(PIVKA-II),also did not differ between the groups(P=0.29 and P=0.36,respectively).The 5-year OS and CSS rates of the resection and palliative groups were 44.8%and 17.4%(P<0.001)and 47.7%and 18.6%(P<0.001),respectively.Multivariate analysis showed that palliative treatment intent was the most significant risk factor for OS and CSS[odds ratio(OR)=2.24;95%confidence interval(CI):1.66-3.02;P<0.001 and OR=2.29;95%CI:1.68-3.12;P<0.001,respectively].Conclusions:Surgical resection could significantly improve OS and CSS in selected HCC with PVI patients who have preserved liver function and performance status.
文摘Pancreatic metastasis from a nonpancreatic primary tumor is rare(<2%)(1,2)and has a potentially poor prognosis(3).Melanoma is an aggressive skin malignancy that commonly exhibits distant metastasis and poor overall prognosis(4).Isolated pancreatic metastasis from melanoma is even less common and poses significant diagnostic and therapeutic challenges.A retrospective study demonstrated that surgical resection increased the survival of patients with abdominal visceral melanoma metastases(5).However,pancreatic resection of metastatic melanoma is potentially associated with high mortality as experience with this type of surgery is limited(6).Here,we describe a rare case of isolated pancreatic metastatic melanoma treated with pancreatic resection at our hospital,including clinical features,treatment,and follow-up.A review of the related literature is also provided.
基金funded by Bengt Ihre fellowship research grant(to R.V.),Cancerforkningsfonden i Norrland/Lions,Cancerforskningsfond(Nos.AMP 21-1058 and LP 24-2376,to R.V.)Centrala(No.ALF RV-980274,to R.V.).
文摘Stage IV pancreatic ductal adenocarcinoma(PDAC)is considered unresectable by the European Society for Medical Oncology(ESMO)-European Society of Digestive Oncology(ESDO)Clinical Practice Guidelines,and treatment for these patients,remains mostly palliative(1).In non-metastatic PDAC,and whenever feasible,surgery remains a crucial component,playing a key role in improving survival rates.While the general trend has been to prepare as many patients as possible for surgical intervention,the necessity for proper patient selection has become increasingly evident(2).
基金Supported by National Clinical Key Specialty Major Research Project of Hunan Provincial Health Commission in 2023,No.Z2023165.
文摘BACKGROUND Colorectal cancer(CRC)frequently metastasizes to the liver,significantly compromising patient survival.While surgical resection improves outcomes for resectable cases,many patients have limited therapeutic options.AIM To evaluate the role of laparoscopic ultrasound in resection and ablation of colorectal liver metastases(CRLM).METHODS Between June 2018 and June 2020,300 patients with CRC and liver metastases were admitted to our hospital.They were divided into two groups(150 cases each)based on treatment method:The control group(ethoxybenzyl diethylenetriamine penta-acetic acid enhanced magnetic resonance imaging)and the observation group[contrast-enhanced ultrasound with Sonazoid(S-CEUS)].RESULTS The study group demonstrated better efficacy(P<0.05),fewer adverse events(P<0.05),and better survival outcomes compared to the control group(1-year:80%vs 62%;3-year:54%vs 33%;5-year:32%vs 18%;median survival:48 months vs 30 months;hazard ratio=0.63,95%CI:0.48-0.83,P<0.001).Although Karnofsky Performance Status scores improved in both groups,the scores were significantly higher in the observation group(P<0.05).Multivariate analysis confirmed intraoperative S-CEUS and tumor differentiation as independent prognostic factors(P<0.05).CONCLUSION Laparoscopic ultrasound-guided resection/ablation improved outcomes in CRLM,reducing complications and enhancing survival.Intraoperative S-CEUS was an independent prognostic factor,supporting its clinical value.
文摘BACKGROUND Rectal neuroendocrine tumors(NETs)smaller than 10 mm and well-differentiated tumors are generally considered to have a low risk of lymph node and distant metastasis,making them suitable for endoscopic resection.In contrast,tumors≥20 mm in size typically require surgical resection.However,the optimal management of intermediate-sized(10-15 mm)rectal NETs remains controversial.AIM To compare the clinical outcomes of endoscopic resection of rectal NETs<1 cm and those 1-1.5 cm in size.METHODS A retrospective study was conducted on 1056 patients with rectal NETs treated at the Samsung Medical Center between January 2005 and June 2021.After propensity score matching(1:10)for age,sex,and type of endoscopic resection,225 patients with tumors<1 cm in size and 27 patients with tumors 1-1.5 cm in size were analyzed.RESULTS Surgical resection was more frequent in the 1-1.5 cm group(37.2%)than in the<1 cm group(10.7%)(P<0.01).Endoscopic submucosal dissection was also more commonly performed in the 1-1.5 cm group(48.1%vs 18.5%,P<0.01).Negative resection margins were achieved in 97.2%of the patients,with no significant difference between the groups(P=0.22).No lymphovascular invasion was observed.During a median follow-up of 54 months,no recurrence occurred in the 1-1.5 cm group,while one case of metachronous recurrence was noted in the<1 cm group(P=1.00).There was no significant difference in recurrence-free survival(P=0.48).CONCLUSION Endoscopic resection of 1-1.5 cm grade 1 rectal NETs yielded comparable outcomes to those<1 cm in size,suggesting its feasibility as a treatment.
文摘The incidence of hepatocellular carcinoma(HCC)has been steadily rising,und-erscoring the need for a clear,stage-specific treatment approach.The Barcelona Clinic Liver Cancer(BCLC)staging system remains the most widely used frame-work for classifying HCC and guiding therapy.Among its classifications,the intermediate stage(BCLC-B)encompasses a highly heterogeneous patient popu-lation,with varying degrees of tumor burden and liver function.Traditionally,transarterial chemoembolization has been the standard treatment for this stage,based on earlier evidence.However,recent studies suggest that a subset of BCLC-B patients-particularly those with localized disease-may benefit more from liver resection.This review summarizes current treatment paradigms for BCLC-B HCC,explores emerging subclassifications within this group,and highlights evolving guidelines that support the selective use of surgery in appropriately chosen patients.
