scholarly journals Staging Laparoscopy in Patients with Intrahepatic Cholangiocarcinoma: Is It Still Useful?

2020 ◽  
Vol 36 (6) ◽  
pp. 501-505
Author(s):  
Lotte C. Franken ◽  
Robert Jan S. Coelen ◽  
Eva Roos ◽  
Joanne Verheij ◽  
Saffire S. Phoa ◽  
...  
Keyword(s):  
Intrahepatic Cholangiocarcinoma ◽  
Locally Advanced ◽  
Distant Metastases ◽  
Staging Laparoscopy ◽  
Preoperative Imaging ◽  
Unresectable Disease ◽  
Advanced Tumor ◽  
Distant Lymph Node Metastasis ◽  
Severe Cirrhosis

<b><i>Background:</i></b> The role of staging laparoscopy in patients with intrahepatic cholangiocarcinoma remains unclear. Despite extensive preoperative imaging, approximately 25% of patients are deemed unresectable at laparotomy due to metastasized disease. The aim of this study was to evaluate the frequency of unresectable disease found at staging laparoscopy and to identify predictors for detecting metastasized intrahepatic cholangiocarcinoma. <b><i>Methods:</i></b> We retrospectively collected records of all patients with intrahepatic cholangiocarcinoma, presenting at our institution from 2008 to 2017. Staging laparoscopy was performed on the suspicion of distant metastases and on indication in larger tumors. The yield and sensitivity of staging laparoscopy was calculated. Reasons for unresectability at staging laparoscopy or laparotomy were recorded. <b><i>Results:</i></b> Among a total of 80 patients with potentially resectable intrahepatic cholangiocarcinoma, 35 patients underwent staging laparoscopy on the suspicion of distant metastases. Unresectable disease was found at staging laparoscopy in 15 patients. Reasons for unresectability were liver metastasis (<i>n</i> = 6), peritoneal metastasis (<i>n</i> = 4), severe cirrhosis (<i>n</i> = 2), locally advanced tumor with satellite lesions (<i>n</i> = 1), and distant lymph node metastasis (<i>n</i> = 2). Considering optimal preoperative imaging, the true yield of staging laparoscopy was 20% (7/35). Two patients did not undergo laparotomy due to progression after staging laparoscopy. Of the remaining 18 patients who underwent laparotomy, 6 patients (30%) had unresectable disease, mostly because of distant metastasis (<i>n</i> = 4). <b><i>Conclusions:</i></b> The role of staging laparoscopy to detect unresectable intrahepatic cholangiocarcinoma is highly dependent on the quality of preoperative imaging. Currently, no accurate selection criteria on imaging exist to select patients with intrahepatic cholangiocarcinoma who potentially benefit from staging laparoscopy.

scholarly journals Use of FOLFIRINOX or Nab-Paclitaxel Plus Gemcitabine for the Treatment of Locally Advanced Pancreatic Adenocarcinoma: A Single Institution Observational Study

Cancers ◽  
2021 ◽  
Vol 13 (19) ◽  
pp. 4939
Author(s):  
Alberto Servetto ◽  
Antonio Santaniello ◽  
Fabiana Napolitano ◽  
Francesca Foschini ◽  
Roberta Marciano ◽  
...  
Keyword(s):  
Median Overall Survival ◽  
Locally Advanced ◽  
Distant Metastases ◽  
Ductal Adenocarcinoma ◽  
Controlled Clinical Trials ◽  
Single Institution ◽  
Locally Advanced Pancreatic Adenocarcinoma ◽  
Grade 3 ◽  
Advanced Pancreatic Adenocarcinoma

Patients with locally advanced (LA) pancreatic ductal adenocarcinoma (PDAC) do not present distant metastases but are not eligible for surgery upfront. Chemotherapy regimens, such as FOLFIRINOX (FFN) or nab-paclitaxel plus gemcitabine (GemNab) in combination with loco-regional treatments are generally used in this setting. However, the best treatment choice is unknown. We retrospectively analyzed the information of 225 patients with stage II–III PDAC treated at our institution between October 2011 and December 2020. A total of 94 patients with LA PDAC who are non-eligible for surgery upfront received neoadjuvant FFN or GemNab. Of the 67 patients receiving FFN, 28 (41.8%) underwent surgery after neoadjuvant therapy. Of the 27 patients treated with GemNab, 6 (22.2%) became eligible for resection. The median overall survival (OS) was 85.1 weeks and 54.3 weeks in the FFN and GemNab groups, respectively (HR = 0.54, p = 0.0109). The median OS was 189.7 weeks and 76.4 weeks in the resected and unresected cohorts, respectively (HR = 0.25, p < 0.0001). Neutropenia (37.3%), anemia (6.0%), and diarrhea (6.0%) in the FFN group and neutropenia (22.2%) and thrombocytopenia (18.5%) in the GemNab groups were the most frequent grade 3–4 side effects. Higher rates of thrombocytosis (p < 0.0001) and peripheral edema (p < 0.0001) were observed in the GemNab group. Our results suggest that the use of FFN is associated with more favorable clinical outcomes than GemNab for patients with LA PDAC. Future randomized and controlled clinical trials are needed to further elucidate the role of these regimens and loco-regional treatments in this setting.

scholarly journals Surgical Treatment of Intrahepatic Cholangiocarcinoma: Current and Emerging Principles

2020 ◽  
Vol 10 (1) ◽  
pp. 104
Author(s):  
Eliza W. Beal ◽  
Jordan M. Cloyd ◽  
Timothy M. Pawlik
Keyword(s):  
Intrahepatic Cholangiocarcinoma ◽  
Early Stage ◽  
Preoperative Evaluation ◽  
Locally Advanced ◽  
Surgical Techniques ◽  
Future Liver Remnant ◽  
Surgical Morbidity ◽  
Early Stage Disease ◽  
Liver Remnant

Intrahepatic cholangiocarcinoma (ICC) is a rare, aggressive cancer of the biliary tract. It often presents with locally advanced or metastatic disease, but for patients with early-stage disease, surgical resection with negative margins and portahepatis lymphadenectomy is the standard of care. Recent advancements in ICC include refinement of staging, improvement in liver-directed therapies, clarification of the role of adjuvant therapy based on new randomized controlled trials, and advances in minimally invasive liver surgery. In addition, improvements in neoadjuvant strategies and surgical techniques have enabled expanded surgical indications and reduced surgical morbidity and mortality. However, recurrence rates remain high and more effective systemic therapies are still necessary to improve recurrence-free and overall survival. In this review, we focus on current and emerging surgical principals for the management of ICC including preoperative evaluation, current indications for surgery, strategies for future liver remnant augmentation, technical principles, and the role of neoadjuvant and adjuvant therapies.

Intraoperative radiotherapy (IORT) in the era of intensive neoadjuvant chemotherapy and chemoradiotherapy for locally advanced and borderline resectable adenocarcinoma of the pancreas (PDAC).

2016 ◽  
Vol 34 (4_suppl) ◽  
pp. 393-393 ◽  
Author(s):  
Florence K. Keane ◽  
Jennifer Yon-Li Wo ◽  
Cristina Ferrone ◽  
Jeffrey W. Clark ◽  
Lawrence Scott Blaszkowsky ◽  
...  
Keyword(s):  
Frozen Section ◽  
Locally Advanced ◽  
Neoadjuvant Treatment ◽  
Intraoperative Radiotherapy ◽  
Distant Metastases ◽  
Borderline Resectable ◽  
Surgical Exploration ◽  
Positive Margins ◽  
Unresectable Disease ◽  
Significant Difference

393 Background: Improved outcomes with FOLFIRINOX or gemcitabine with nab-paclitaxel in the treatment of metastatic PDAC have prompted incorporation of these regimens into neoadjuvant treatment of PDAC. While some patients are still found to be unresectable after neoadjuvant treatment, others are able to undergo resection. Our aims are to evaluate outcomes and toxicities associated with use of IORT in this setting. Methods: We retrospectively analyzed records of 85 patients with locally advanced/ borderline resectable PDAC who received neoadjuvant treatment with chemotherapy and/or chemoradiotherapy followed by surgical exploration in an IORT-equipped operating suite between 2010-2015. Descriptive statistics were used to compare surgical outcomes. Survival analysis was used to calculate overall survival (OS). Results: Of 85 patients, 49 (57.6%) underwent resection after neoadjuvant treatment, 27 (31.8%) were unresectable, and 9 (10.6%) were found to have distant metastases. 24 of 49 patients who underwent resection received IORT for close/positive margins on intraoperative frozen section. There was no significant difference in operative times, postoperative complications, or operative morbidity in patients who underwent resection and IORT vs those who underwent resection alone. Median OS was 31.1 months in patients who underwent resection alone and 35.1 months in patients who underwent resection and IORT. Despite the increased incidence of close/ positive margins in patients who underwent resection and IORT, the rates of local recurrence were similar to those who underwent resection alone. 26 of 27 patients with unresectable disease upon exploration received IORT. Median OS was 20.5 months. IORT was associated with increased hospital stay (4 vs. 3.5 d), but no significant difference in operative time or morbidity. Conclusions: IORT is not associated with increased toxicity when used in conjunction with resection or surgical exploration after neoadjuvant therapy. IORT resulted in median OS of 35 months for patients with close or positive margins and of 20.5 months for patients with unresectable disease.

scholarly journals A Rare Occurrence of Isolated Brain Metastases from Gastric Cancer

2019 ◽  
Vol 2019 ◽  
pp. 1-5
Author(s):  
Manish M. Karamchandani ◽  
Tej Ganti ◽  
Sunny Jaiswal ◽  
Julian K. Wu ◽  
Muhammad Wasif Saif
Keyword(s):  
Gastric Cancer ◽  
Brain Metastases ◽  
Surgical Resection ◽  
Locally Advanced ◽  
Distant Metastases ◽  
Brain Lesions ◽  
Review Of The Literature ◽  
Advanced Tumor ◽  
Poor Outcomes ◽  
One Year

Background. Gastric cancer is the fourth most common cancer worldwide and the second most common cause of cancer-related death. The majority of newly diagnosed gastric cancer cases present either as locally advanced tumor growth or with distant metastases.Case Report. Here, we describe a case of isolated brain metastases in a male patient with gastric cancer. Initially, our patient presented with dysphagia and was diagnosed with gastric cancer after a thorough evaluation. One year after chemotherapy and surgical resection of his gastric cancer, he presented with headaches, nausea, dizziness, and photophobia. Further evaluation of these symptoms led to the discovery of three metastatic brain lesions without evidence of extracranial metastases.Conclusions. Our review of the literature has found that such cases are rare. Additionally, our review of the literature demonstrates the poor outcomes associated with metastatic brain lesions from gastric cancer and highlights the importance of surgical resection in increasing overall survival time.

scholarly journals The role of down staging treatment in the management of locally advanced intrahepatic cholangiocarcinoma: Review of literature and pooled analysis

2020 ◽  
Vol 24 (1) ◽  
pp. 6 ◽  
Author(s):  
Sivesh Kamarajah ◽  
Francesco Giovinazzo ◽  
Keith J. Roberts ◽  
Pankaj Punia ◽  
Robert P. Sutcliffe ◽  
...  
Keyword(s):  
Intrahepatic Cholangiocarcinoma ◽  
Locally Advanced ◽  
Pooled Analysis ◽  
Review Of Literature

scholarly journals Extracorporeal Partial Nephrectomy with Orthotopic Autotransplantation under Pharmaco-Cold Ischaemia for Cancer of a Single Kidney: A Case Report

2020 ◽  
Vol 13 (3) ◽  
pp. 1202-1208
Author(s):  
Tatiana Baitman ◽  
Irina Miroshkina ◽  
Alexander Gritskevich ◽  
Alexander Teplov ◽  
Andrey Zotikov ◽  
...  
Keyword(s):  
Inferior Vena ◽  
Advanced Disease ◽  
Locally Advanced ◽  
Vena Cava ◽  
Distant Metastases ◽  
Cancer Specific Survival ◽  
Nephron Sparing ◽  
Radical Method ◽  
Single Kidney

Up to 10% of patients with renal cell carcinoma (RCC) have locally advanced disease with venous tumour thrombosis involving the inferior vena cava (IVC). 30–50% of them present with synchronous metastatic disease. Surgical treatment remains the only potentially radical method for patients suffering from RCC and IVC tumour thrombosis without distant metastases. Five-year cancer-specific survival for such patients is 40–60%. The role of surgery in the treatment of RCC is significant, even if only cytoreductive operation is possible. Nephron-sparing surgery (NSS) is reasonably preferable for patients suffering from single kidney RCC, but it is not always radical enough. Extracorporeal approach allows to perform a radical dissection of the tumour in special complicated cases, but it is seldom used because of technical difficulties. We present a case of successful NSS by extracorporeal approach in our modification for RCC with IVC tumour thrombosis.

scholarly journals The Role of Surgical Resection and Liver Transplantation for the Treatment of Intrahepatic Cholangiocarcinoma

2021 ◽  
Vol 10 (11) ◽  
pp. 2428
Author(s):  
Guergana Panayotova ◽  
Jarot Guerra ◽  
James V. Guarrera ◽  
Keri E. Lunsford
Keyword(s):  
Liver Transplantation ◽  
Surgical Resection ◽  
Intrahepatic Cholangiocarcinoma ◽  
Locally Advanced ◽  
Tumor Biology ◽  
Future Liver Remnant ◽  
Patient Treatment ◽  
Term Survival ◽  
Liver Remnant

Intrahepatic cholangiocarcinoma (iCCA) is a rare and complex malignancy of the biliary epithelium. Due to its silent presentation, patients are frequently diagnosed late in their disease course, resulting in poor overall survival. Advances in molecular profiling and targeted therapies have improved medical management, but long-term survival is rarely seen with medical therapy alone. Surgical resection offers a survival advantage, but negative oncologic margins are difficult to achieve, recurrence rates are high, and the need for adequate future liver remnant limits the extent of resection. Advances in neoadjuvant and adjuvant treatments have broadened patient treatment options, and these agents are undergoing active investigation, especially in the setting of advanced, initially unresectable disease. For those who are not able to undergo resection, liver transplantation is emerging as a potential curative therapy in certain cases. Patient selection, favorable tumor biology, and a protocolized, multidisciplinary approach are ultimately necessary for best patient outcomes. This review will discuss the current surgical management of locally advanced, liver-limited intrahepatic cholangiocarcinoma as well as the role of liver transplantation for select patients with background liver disease.

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