scholarly journals O-L07 Role of liver resection for metastases from uveal melanoma: Experience from a supra-regional centre, current evidence, and future prospects

2021 ◽  
Vol 108 (Supplement_9) ◽  
Author(s):  
Dharmadev Trivedi ◽  
Natasha Aldulaimi ◽  
Ioannis Karydis ◽  
Matthew Wheater ◽  
Sachin Modi ◽  
...  
Keyword(s):  
Liver Resection ◽  
Uveal Melanoma ◽  
Lead Time ◽  
Treatment Modalities ◽  
Current Evidence ◽  
Survival Outcomes ◽  
Comprehensive Treatment ◽  
Liver Resections ◽  
Radiology Reports ◽  
Novel Treatment

Abstract Background Management of liver metastases from uveal melanoma (LMUM) requires a ‘multi-modal’ approach including surgical resection. This study aimed to evaluate the role, safety, and oncological effectiveness of liver surgery for patients with LMUM in the context multidisciplinary management. A comprehensive treatment pathway developed upon current published evidence, prevalent national guidelines and novel treatment options is presented (Figure 2) Methods Retrospective review of prospectively maintained database between February 2005 to August 2018 was performed using the institutional electronic patient record system from oncology and surgical department. Demographic data, MDT outcome letters, operative records, clinic letters, letters from referring hospitals, discharge summaries, radiology reports, and histology findings were reviewed. Focused literature review was conducted to identify all relevant publications. All advanced statistical analysis was performed using SPSS version 27.0 software (IBM Corp., Armonk, NY, USA). A p-value of < 0.05 was considered to be statistically significant. The work was approved by the institutional clinical governance department (Audit ID 6661). Results 31 patients underwent diagnostic laparoscopy and 17 patients received 19 liver resections locally (Figure 1). 7 major (≥ 3 seg) and 12 minor liver resections (14 laparoscopic) were done without any mortality or major complications. 10/19 (52.6%) were R0 resections. Overall survival positively correlated with the time from UM to LMUM (rs = 0.859, p<0.0001). R0 or R1 resection margin status did not significantly influence survival outcomes (OS 25 Vs 28, p = 0.404; RFS 13 Vs 6 months, p = 0.596), though R1 cohort had longer lead time (100 Vs 24 months, p = 0.0408). Conclusions Liver resection for LMUM is safe, effective and complements multimodal management. Lead time from development of UM to LMUM remains a key factor affecting survival outcomes. As novel treatment modalities for regional and systemic disease control for metastatic uveal melanoma continue to develop, surgical intervention will also continue to evolve as part of the multi-disciplinary management. We emphasise the need for developing a collaborative database at a national and international level. We present an evidence-based, multi-disciplinary management pathway for LMUM patients (Figure 2).

Radiofrequency ablation of colorectal liver metastases

2019 ◽  
Vol 98 (10) ◽  
Keyword(s):  
Radiofrequency Ablation ◽  
Liver Resection ◽  
Liver Metastases ◽  
Colorectal Liver Metastases ◽  
Survival Rates ◽  
Postoperative Mortality ◽  
Disease Free Survival ◽  
Female Ratio ◽  
Liver Resections ◽  
Multi Stage

Introduction: Radical liver resection is the only method for the treatment of patients with colorectal liver metastases (CLM); however, only 20–30% of patients with CLMs can be radically treated. Radiofrequency ablation (RFA) is one of the possible methods of palliative treatment in such patients. Methods: RFA was performed in 381 patients with CLMs between 01 Jan 2001 and 31 Dec 2018. The mean age of the patients was 65.2±8.7 years. The male to female ratio was 2:1. Open laparotomy was done in 238 (62.5%) patients and the CT-navigated transcutaneous approach was used in 143 (37.5%) patients. CLMs <5 cm (usually <3 cm) in diameter were the indication for RFA. We used RFA as the only method in 334 (87.6%) patients; RFA in combination with resection was used in 36 (9.4%), and with multi-stage resection in 11 (3%) patients. We performed RFA in a solitary CLM in 170 (44.6%) patients, and in 2−5 CLMs in 211 (55.6%) patients. We performed computed tomography in each patient 48 hours after procedure. Results: The 30-day postoperative mortality was zero. Complications were present in 4.8% of transcutaneous and in 14.2% of open procedures, respectively, in the 30-day postoperative period. One-, 3-, 5- and 10-year overall survival rates were 94.8, 66.8, 43.9 and 16.6%, respectively, in patients undergoing RFA, and 90.6, 69.1, 52.8 and 39.2%, respectively, in patients with liver resections. Disease free survival was 63.2, 30.1, 18.4 and 13.1%, respectively, in the same patients after RFA, and 71.1, 33.3, 22.8 and 15.5%, respectively, after liver resections. Conclusion: RFA is a palliative thermal ablation method, which is one of therapeutic options in patients with radically non-resectable CLMs. RFA is useful especially in a non-resectable, or resectable (but for the price of large liver resection) solitary CLM <3 cm in diameter and in CLM relapses. RFA is also part of multi-stage liver procedures.

Novel treatment opportunities in Graves’ orbitopathy

2014 ◽  
Vol 155 (33) ◽  
pp. 1295-1300
Author(s):  
Annamária Erdei ◽  
Annamária Gazdag ◽  
Miklós Bodor ◽  
Eszter Berta ◽  
Mónika Katkó ◽  
...  
Keyword(s):  
Clinical Experience ◽  
Clinical Course ◽  
Treatment Protocol ◽  
Treatment Modalities ◽  
Graves Disease ◽  
Novel Treatment ◽  
Graves Orbitopathy ◽  
Cd20 Antibody ◽  
Anti Cd20 ◽  
Novel Therapeutic

Graves’ orbitopathy is the most common extrathyroidal manifestation of Graves’ disease. Up to now, curative treatment modalities for the most severe sight-threatening cases have not been developed. Here the authors summarize the treatment protocol of Graves’ orbitopathy and review novel therapeutic options. They review the literature on this topic and present their own clinical experience. The authors point out that anti-CD20 antibody could positively influence the clinical course of Graves’ orbitopathy. Selenium is efficient in mild cases. Further prospective investigations are warranted. Orv. Hetil., 2014, 155(33), 1295–1300.

Treatment Modalities and Survival Outcomes for Sinonasal Diffuse Large B‐Cell Lymphoma

2021 ◽  
Author(s):  
Brandon M. Lehrich ◽  
Arash Abiri ◽  
Khodayar Goshtasbi ◽  
Jack Birkenbeuel ◽  
Tyler M. Yasaka ◽  
...  
Keyword(s):  
B Cell ◽  
Cell Lymphoma ◽  
B Cell Lymphoma ◽  
Treatment Modalities ◽  
Survival Outcomes ◽  
Large B Cell Lymphoma ◽  
Large B Cell

scholarly journals Cannabidiol as a potential treatment for psychosis

2019 ◽  
Vol 9 ◽  
pp. 204512531988191 ◽  
Author(s):  
Cathy Davies ◽  
Sagnik Bhattacharyya
Keyword(s):  
Mechanism Of Action ◽  
Psychotic Disorders ◽  
Dopamine D2 Receptor ◽  
Significant Proportion ◽  
D2 Receptor ◽  
Current Evidence ◽  
Novel Treatment ◽  
D2 Antagonist ◽  
Unique Mechanism ◽  
Preclinical Work

Psychotic disorders such as schizophrenia are heterogeneous and often debilitating conditions that contribute substantially to the global burden of disease. The introduction of dopamine D2 receptor antagonists in the 1950s revolutionised the treatment of psychotic disorders and they remain the mainstay of our treatment arsenal for psychosis. However, traditional antipsychotics are associated with a number of side effects and a significant proportion of patients do not achieve an adequate remission of symptoms. There is therefore a need for novel interventions, particularly those with a non-D2 antagonist mechanism of action. Cannabidiol (CBD), a non-intoxicating constituent of the cannabis plant, has emerged as a potential novel class of antipsychotic with a unique mechanism of action. In this review, we set out the prospects of CBD as a potential novel treatment for psychotic disorders. We first review the evidence from the perspective of preclinical work and human experimental and neuroimaging studies. We then synthesise the current evidence regarding the clinical efficacy of CBD in terms of positive, negative and cognitive symptoms, safety and tolerability, and potential mechanisms by which CBD may have antipsychotic effects.

Comparison of UK and European Association of Urology (EAU) guidelines for kidney cancer management

2017 ◽  
Vol 11 (2) ◽  
pp. 132-138
Author(s):  
David Nicol
Keyword(s):  
Kidney Cancer ◽  
European Association ◽  
Treatment Modalities ◽  
Current Evidence ◽  
Specific Strength ◽  
Cancer Management ◽  
Funding Model ◽  
Cancer Networks ◽  
The Uk ◽  
European Association Of Urology

Clinical practice frequently utilises guidelines on how specific conditions should be managed. For urologists in the UK a range of sources are used as guidelines for the management of kidney cancer. These include documents from national bodies such as the National Institute for Health and Care Excellence (NICE), professional bodies as well as those prepared by individual groups of clinicians within regional cancer networks. In this article the European Association of Urology (EAU) guidelines on renal cell carcinoma are compared to guidelines used in the UK for this disease. Broadly consistent variations exist related to regional practice patterns, funding and the currency of the various guidelines. A specific strength of the EAU guidelines is the regular updating of these allowing incorporation of new evidence. These however do not consider the funding model for healthcare of the UK which dictates the availability of some treatment modalities and thus in some areas are not applicable. Current guidelines for kidney cancer developed within the UK are inconsistent and often outdated in terms of evidence sources. Broader use of the EAU guidelines within the economic restrictions of healthcare in the UK may result in a more consistent practise utilising current evidence sources in the management of kidney cancer.

scholarly journals A multi-disciplinary, multimodal approach for the management of vascular anomalies

2019 ◽  
Vol 36 (ICON-Suppl) ◽  
Author(s):  
Aqsa Mazhar ◽  
Shazia Moosa ◽  
Alizeh Abbas ◽  
Yousuf Mallick ◽  
Lubna Samad
Keyword(s):  
Vascular Anomalies ◽  
Treatment Modalities ◽  
Vascular Tumors ◽  
Comprehensive Treatment ◽  
Multimodal Approach ◽  
Venous Malformations ◽  
Creative Commons ◽  
Special Supplement ◽  
Diagnostic Work

Objective: Vascular anomalies are a diverse group of lesions, ranging from simple to complex, disfiguring anomalies. Our objective was to diagnose and provide comprehensive treatment to patients presenting with vascular anomalies, using a multi-disciplinary approach involving dermatologists, plastic surgeons, radiologists and pediatric surgeons. Methods: Patients presenting with vascular anomalies to The Indus Hospital, Karachi, from January 2017 to March 2019 were enrolled, using a pre-defined questionnaire. Assessment, diagnostic work up, management and clinical and photographic follow up was maintained to monitor outcomes. Results: One hundred eighty seven patients with a mean age of 4.6 years, (females 62%) were enrolled. Diagnoses included vascular tumors (n=89, 47.6%), lymphatic malformations (n=38, 20.3%), capillary malformations (n=19, 10%), venous malformations (n=16, 8.5%), arterio-venous malformations (n=14, 7.5%) and mixed anomalies (n=11, 5.9%). Treatment modalities, in isolation or combination, included oral propranolol, topical timolol, pulsed dye laser and intra-lesional sclerotherapy. Mean follow up was in 7.1 months, with 27 patients achieving treatment completion. 26 children were lost to follow-up. Conclusions: Vascular anomalies have mostly been managed successfully at VAC using single or multimodal treatment. Increasingly complex anomalies can be handled using a multi-disciplinary approach. Establishment of VAC has facilitated many patients who were earlier considered as diagnostic and therapeutic challenges. doi: https://doi.org/10.12669/pjms.36.ICON-Suppl.1710 How to cite this:Mazhar A, Moosa S, Abbas A, Mallick Y, Samad L. A multi-disciplinary, multimodal approach for the management of vascular anomalies. Pak J Med Sci. Special Supplement ICON 2020. 2020;36(1):S14-S19. doi: https://doi.org/10.12669/pjms.36.ICON-Suppl.1710 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

scholarly journals Smoking Behavior and Prognosis After Colorectal Cancer Diagnosis: A Pooled Analysis of 11 Studies

2021 ◽  
Author(s):  
Elizabeth Alwers ◽  
Prudence R Carr ◽  
Barbara Banbury ◽  
Viola Walter ◽  
Jenny Chang-Claude ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Dose Response ◽  
Smoking Behavior ◽  
Stage I ◽  
Current Evidence ◽  
Survival Outcomes ◽  
Heavy Smoking ◽  
Incidence And Mortality ◽  
Clear Dose Response ◽  
Former Smokers

Abstract Background Smoking has been associated with colorectal cancer (CRC) incidence and mortality in previous studies, but current evidence on smoking in association with survival after CRC diagnosis is limited. Methods We pooled data from 12,345 patients with stage I-IV CRC from 11 epidemiologic studies in the International Survival Analysis in Colorectal Cancer Consortium (ISACC). Cox proportional hazards regression models were used to evaluate the associations of pre-diagnostic smoking behavior with overall, CRC-specific and non-CRC-specific survival. Results Among 12,345 patients with CRC, 4379 (35.5%) died (2515 from CRC), over a median follow-up time of 7.5 years. Smoking was strongly associated with worse survival in stage I-III patients, whereas no association was observed among stage IV patients. Among stage I-III patients, clear dose-response relationships with all survival outcomes were seen for current smokers. For example, current smokers with ≥40 pack-years had statistically significantly worse overall, CRC-specific, and non-CRC-specific survival compared to never smokers (hazard ratio [HR] =1.94, 95% confidence interval [CI] =1.68–2.25; HR = 1.41, 95% CI = 1.12–1.78; and HR = 2.67, 95% CI = 2.19–3.26, respectively). Similar associations with all survival outcomes were observed for former smokers who had quit for less than 10 years, but only a weak association with non-CRC-specific survival was seen among former smokers who had quit for more than 10 years. Conclusions This large consortium of CRC patient studies provides compelling evidence that smoking is strongly associated with worse survival of stage I-III CRC patients in a clear dose-response manner. The detrimental effect of smoking was primarily related to non-colorectal cancer events, but current heavy smoking also showed an association with CRC-specific survival.

EP.TH.1043Outcomes of liver resections by trainee surgeons versus consultant surgeon – a single centre experience

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Umasankar Mathuram Thiyagarajan ◽  
Alaa Al-Mohammad ◽  
Stephanie Goh ◽  
Siong-Seng Liau ◽  
Emmanuel Huguet ◽  
...  
Keyword(s):  
Liver Resection ◽  
Hospital Readmission ◽  
Operative Time ◽  
Bile Leak ◽  
Kidney Injury ◽  
Consultant Surgeon ◽  
Liver Resections ◽  
Trainee Group ◽  
Significant Difference ◽  
Long Term Follow Up

Abstract Introduction Liver resection is a most effective treatment for patients with operable primary or secondary cancer deposits. The role of trainee as a lead surgeon versus consultant surgeon performing liver resections and its impact on surgical outcomes had never been reported. Methods and Materials This study was aimed to assess the liver resection outcomes including operative time, acute kidney injury (AKI), bile leak, sepsis, mortality and hospital readmission within 3 months. A total of 320 liver resections from Addenbookes Hospital at Cambridge between 2015 to 2017 were included in this study. All liver resections were performed under supervision of the consultant surgeon who is either scrubbed or unscrubbed in theatre. Trainee surgeons have performed 116 of 320 as lead surgeon and the consultant surgeons performed the remaining 204. Results The mean operative time was 413±129 versus 383±118 (P = 0.41) minutes in trainee surgeons and consultant surgeons respectively. The incidence of postoperative AKI were similar in between the groups (5/116 versus 11/204;P=0.79). Although the bile leak was numerically high in the trainee group, did not reach statistical difference (13/116 versus 12/204;P=0.12); similar results noted in the incidence of sepsis too (3/116 versus 4/204;P=070). Mortality, hospital readmission at 3 months were (1/204 versus 1/116;P=1) and (2/116 versus 4/204;P=1) respectively. No significant difference was observed. Conclusion Liver resections performed by the trainee surgeons under supervision appeared to be safe without increasing the operative time, morbidity, mortality and hospital readmission at 90 days. Further multicentre prospective study with long-term follow up is recommended.

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