Recently introduced in the treatment algorithms and guidelines for the treatment of ulcerative colitis,biological therapy is an effective treatment option for patients with an acute severe flare not responsive to conv...Recently introduced in the treatment algorithms and guidelines for the treatment of ulcerative colitis,biological therapy is an effective treatment option for patients with an acute severe flare not responsive to conventional treatments and for patients with steroid dependent disease.The reduction in hospitalization and surgical intervention for patients affected by ulcerative colitis after the introduction of biologic treatment remains to be proven.Furthermore,these agents seem to be associated with increase in cost of treatment and risk for serious postoperative complications.Restorative proctocolectomy with ileal pouch-anal anastomosis is the surgical treatment of choice in ulcerative colitis patients.Surgery is traditionally recommended as salvage therapy when medical management fails,and,despite advances in medical therapy,colectomy rates remain unchanged between 20% and 30%.To overcome the reported increase in postoperative complications in patients on biologic therapies,several surgical strategies have been developed to maintain long-term pouch failure rate around 10%,as previously reported.Surgical staging along with the development of minimally invasive surgery are among the most promising advances in this field.展开更多
Gastric carcinoma is one of the most frequent malignancies in the world and its clinical behavior especially depends on the metastatic potential of the tumor.In particular,lymphatic metastasis is one of the main predi...Gastric carcinoma is one of the most frequent malignancies in the world and its clinical behavior especially depends on the metastatic potential of the tumor.In particular,lymphatic metastasis is one of the main predictors of tumor recurrence and survival,and current pathological staging systems reflect the concept that lymphatic spread is the most relevant prognostic factor in patients undergoing curative resection.This is compounded by the observation that two-thirds of gastric cancer in the Western world presents at an advanced stage,with lymph node metastasis at diagnosis.All current therapeutic efforts in gastric cancer are directed toward individualization of therapeutic protocols,tailoring the extent of resection and the administration of preoperative and postoperative treatment.The goals of all these strategies are to improve prognosis towards the achievement of a curative resection(R0 resection) with minimal morbidity and mortality,and better postoperative quality of life.展开更多
Combined hepatic artery infusion (HAI) and systemic chemotherapy have demonstrated its clinical efficacy inprolonging overall survival in unresectable intrahepatic cholangiocarcinoma and as a conversion to treatmentst...Combined hepatic artery infusion (HAI) and systemic chemotherapy have demonstrated its clinical efficacy inprolonging overall survival in unresectable intrahepatic cholangiocarcinoma and as a conversion to treatmentstrategy in a small proportion of patients. The utilization of HAI chemotherapy is restricted by the scarcity ofsurgeons and oncologists who are well-experienced in its use. This represents a significant drawback of thistreatment method. In recent years, a solid push to expand its use, mainly in the United States and recently also inEurope, has been made possible by the HAI Consortium Research Network. Results of ongoing Clinical Trials areeagerly awaited to give the basis for further expansion of this technique and oncological treatment outside ofhistorically established centers. In this technical note review, we aim to give a brief historical description of theorigins and evolution of intra-arterial chemotherapy for unresectable intrahepatic cholangiocarcinoma. We will,therefore, discuss the surgical technique by providing some tips and tricks without neglecting the difficulties thatmay be encountered.展开更多
文摘Recently introduced in the treatment algorithms and guidelines for the treatment of ulcerative colitis,biological therapy is an effective treatment option for patients with an acute severe flare not responsive to conventional treatments and for patients with steroid dependent disease.The reduction in hospitalization and surgical intervention for patients affected by ulcerative colitis after the introduction of biologic treatment remains to be proven.Furthermore,these agents seem to be associated with increase in cost of treatment and risk for serious postoperative complications.Restorative proctocolectomy with ileal pouch-anal anastomosis is the surgical treatment of choice in ulcerative colitis patients.Surgery is traditionally recommended as salvage therapy when medical management fails,and,despite advances in medical therapy,colectomy rates remain unchanged between 20% and 30%.To overcome the reported increase in postoperative complications in patients on biologic therapies,several surgical strategies have been developed to maintain long-term pouch failure rate around 10%,as previously reported.Surgical staging along with the development of minimally invasive surgery are among the most promising advances in this field.
文摘Gastric carcinoma is one of the most frequent malignancies in the world and its clinical behavior especially depends on the metastatic potential of the tumor.In particular,lymphatic metastasis is one of the main predictors of tumor recurrence and survival,and current pathological staging systems reflect the concept that lymphatic spread is the most relevant prognostic factor in patients undergoing curative resection.This is compounded by the observation that two-thirds of gastric cancer in the Western world presents at an advanced stage,with lymph node metastasis at diagnosis.All current therapeutic efforts in gastric cancer are directed toward individualization of therapeutic protocols,tailoring the extent of resection and the administration of preoperative and postoperative treatment.The goals of all these strategies are to improve prognosis towards the achievement of a curative resection(R0 resection) with minimal morbidity and mortality,and better postoperative quality of life.
文摘Combined hepatic artery infusion (HAI) and systemic chemotherapy have demonstrated its clinical efficacy inprolonging overall survival in unresectable intrahepatic cholangiocarcinoma and as a conversion to treatmentstrategy in a small proportion of patients. The utilization of HAI chemotherapy is restricted by the scarcity ofsurgeons and oncologists who are well-experienced in its use. This represents a significant drawback of thistreatment method. In recent years, a solid push to expand its use, mainly in the United States and recently also inEurope, has been made possible by the HAI Consortium Research Network. Results of ongoing Clinical Trials areeagerly awaited to give the basis for further expansion of this technique and oncological treatment outside ofhistorically established centers. In this technical note review, we aim to give a brief historical description of theorigins and evolution of intra-arterial chemotherapy for unresectable intrahepatic cholangiocarcinoma. We will,therefore, discuss the surgical technique by providing some tips and tricks without neglecting the difficulties thatmay be encountered.
