Combined hepatocellular carcinoma and cholangiocarcinoma: Debate for the ideal surgical option.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e15644-e15644
Author(s):  
Hardik Satish Chhatrala ◽  
Chintan Shah ◽  
Karthik Kailasam ◽  
Lokesh Yadav ◽  
Sreenivasa Rao Chandana
Keyword(s):  
Hepatocellular Carcinoma ◽  
Surgical Resection ◽  
Survival Benefit ◽  
Total Period ◽  
Transplant Patients ◽  
Kaplan Meier ◽  
Surgical Options ◽  
The Difference ◽  
Better Than ◽  
The Ideal

e15644 Background: Current limited evidence from observational studies suggest lack of survival benefit from liver transplantation (LT) for combined hepatocellular carcinoma with cholangiocarcinoma (cHCC-CC) when compared to surgical resection. This is in contrast to hepatocellular carcinoma (HCC) which has clear survival benefit with LT. We hypothesized that cHCC–CC patients have similar overall survival (OS) after LT compared to resection. Methods: Localized HCC and cHCC–CC patients treated with surgical resection versus transplant were identified in SEER Database (1973–2013). Kaplan-Meier method was used to examine survival with LT versus resection. Results: In the total period between 1973-2013, we identified 9,306 (5496 [59.06%] resection, 3810 [40.94%] transplant) patients with HCC, and 175 (107 [61.14%] resection, 68 [38.85%] transplant) patients with cHCC–CC. 3-year OS of patients undergoing LT remains significantly greater for HCC than for cHCC–CC (80.5% vs 59.9%, P < 0.01). Interesting, for period 2008-13, 3-yr OS for cHCC-CC patients undergoing LT was better than resection, although the difference was not statistically significant (66.4% vs 46.27%, p > 0.10). While there has been improved 3-year and 5-year OS from period 2002-07 to 2008-13 after LT for localized HCC patients (83.6% vs 79.4%, p < 0.002 and 76.4% vs 73.6, p < 0.01, respectively), there has been no significant improvement in 3-year or 5-year survival after for HCC-CC (66.4% vs 65.2%, p < 0.4 and 58.3% vs 55.3%, p > 0.4 respectively). Conclusions: Over the past decade, 3-yr OS of cHCC-CC with LT remains dismal and has not improved. However, LT in patients with localized cHCC–CC may have a potential survival benefit over liver resection, although clearly lower than the survival benefit of LT for HCC. Our results argue for a randomized trial for LT versus resection for localized cHCC-CC patients to obtain better understanding of survival benefit from the two surgical options.

scholarly journals Definite total radical resection in treatment of patients, suffering low-differentiated cancer of the bladder

2020 ◽  
Vol 87 (11-12) ◽  
pp. 76-79
Author(s):  
P. G. Yakovlev
Keyword(s):  
Radical Resection ◽  
Average Period ◽  
Total Resection ◽  
Primary Radical ◽  
Kaplan Meier ◽  
Salvage Resection ◽  
Cancer Of The Bladder ◽  
The Difference ◽  
Better Than

Objective. To determine the operative volume of surgical treatment in total radical resection of the bladder in autonomous regime and to estimate the survival indices in patients with low-differentiated cancer of the bladder depending on time of conduction of radical total resection of the bladder. Materials and methods. Retrospectively 522 histories of the diseases were analyzed in the patients with diagnosis of low-differentiated cancer of the bladder, including 190, in whom radical total resection of the bladder was performed in 1998 - 2016 yrs period. The survival indices were determined. Using Kaplan-Meier method, comparative analysis of the survival indices in patients was done, to whom radical total resection or salvage resection of the bladder performed. Results. Total radical resection of the bladder in autonomous regime was done in 24.7% patients with low-differentiated cancer of the bladder or in 67.9% patients, to whom total resection of the bladder was performed. The indices of total 3-, 5- and 10-yr survival of the patients have constituted 96, 93 and 45%, accordingly. The survival indices in the patients after organ-preserving treatment and further salvage total resection of the bladder for locally progression of cancer were better, than in the patients, to whom the treatment consisted of primary radical total resection of the bladder, but the difference have appeared statistically nonsignificant (p=0.286). Average period between conduction of organ-preserving treatment and salvage total resection of the bladder have constituted 34 mo. Conclusion. Radical total resection of the bladder in autonomous regime constitutes the extended method of treatment of muscularly-invaded low-differentiated cancer of the bladder (performed in 24.7% of all the patients) and guarantees satisfactory late follow-up results while primary or postponed performance.

Embolization versus embolization and systemic therapy in patients with hepatocellular carcinoma and metastatic disease: A retrospective analysis.

2014 ◽  
Vol 32 (3_suppl) ◽  
pp. 363-363 ◽  
Author(s):  
Sunnie Kim ◽  
Karen T. Brown ◽  
Yuman Fong ◽  
Stephen Barnett Solomon ◽  
Joanne F. Chou ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Retrospective Analysis ◽  
Systemic Therapy ◽  
Survival Benefit ◽  
Combined Modality Therapy ◽  
Locally Advanced ◽  
Arterial Embolization ◽  
Combined Modality ◽  
Kaplan Meier

363 Background: Transarterial chemoembolization (TACE) provides a survival benefit in a subset of patients with unresectable hepatocellular carcinoma (HCC). Even though data are lacking, patients with metastatic HCC (mHCC) are sometimes treated with transarterial therapies to address the hepatic disease. Sorafenib is a standard treatment for patients with mHCC. Methods: A retrospective analysis was conducted on patients diagnosed with HCC who had undergone hepatic arterial embolization (HAE) between 2006 and until 2013. Overall survival (OS) was calculated from date of HAE to date of death and estimated by Kaplan Meier Methods. Patients alive at their last follow up date were censored. Results: Of 243 patients who had undergone HAE at MSKCC during the study period, 36 patients had mHCC on initial diagnosis. Of these, 22 received HAE only, while 14 received HAE plus systemic therapy at some time during their whole treatment course. Conclusions: Patients with mHCC who underwent HAE alone had a poor OS. These data suggest that there maybe a survival benefit in patients with mHCC treated with transarterial therapies add to systemic therapy that is given at some time during their whole treatment course. These results contrast with recent data on the use of combined modality in locally advanced disease. Further studies of combined modality therapy in the setting of mHCC may be warranted. [Table: see text]

The role of surgical resection for hepatocellular carcinoma in octogenarians: A population-based analysis.

2014 ◽  
Vol 32 (3_suppl) ◽  
pp. 202-202
Author(s):  
Takintope Akinbiyi ◽  
Atuhani S. Burnett ◽  
Philip Ernst ◽  
Marisa Cevasco ◽  
Donald A. McCain ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Surgical Resection ◽  
Survival Benefit ◽  
The Elderly ◽  
Population Based ◽  
Seer Database ◽  
Significant Difference ◽  
Disease Stages ◽  
The Impact

202 Background: Hepatocellular carcinoma (HCC) is a significant source of morbidity and mortality amongst the elderly population. In appropriately selected patients, surgery is known to confer a survival advantage. Octagenarians, however, given their remaining life expectancy may receive limited benefit from surgery. Nevertheless, insufficient information is available in the literature on the survival benefit of surgery in octagenarians with HCC. Methods: Octogenarians with HCC were selected from the Surveillance, Epidemiology, and End Results (SEER) database between 1998 and 2009. We evaluated patients who underwent surgical resection and those that declined to assess the impact surgery has on overall survival in this population. Results: A total of 8,614 with HCC were identified in the SEER database, of which surgery was recommended for 3,529 (41%). A total of 1,002 patients (28%) underwent surgery and 2,497 (71%) declined. Although there was a trend towards improved survival in the surgery group (7.91 months) vs the non-surgical group (7.03 months), there was no statistically significant difference in survival between the two groups (p = 0.09). Conclusions: Our study demonstrates that octagenarians as a whole do not experience a survival benefit from surgical resection for HCC. Subgroup analysis, however, may ultimately identify benefit in specific disease stages or patients with fewer comorbidities.

The comparisons of the outcomes between surgical resection and proton beam therapy for single primary hepatocellular carcinoma.

2020 ◽  
Vol 38 (4_suppl) ◽  
pp. 482-482
Author(s):  
Shunsuke Tamura ◽  
Yukiyasu Okamura ◽  
Teiichi Sugiura ◽  
Takaaki Ito ◽  
Yusuke Yamamoto ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Proton Beam ◽  
Surgical Resection ◽  
Performance Status ◽  
Proton Beam Therapy ◽  
Primary Hepatocellular Carcinoma ◽  
Free Survival ◽  
Significant Difference ◽  
Clinical Trial Information ◽  
Better Than

482 Background: There are many treatment choices for hepatocellular carcinoma (HCC). Proton beam therapy (PBT) is considered a treatment option for HCC. The purpose of this study was to compare surgical resection (SR) and PBT in order to clarify the prognostic factors for operable HCC based on a single institution’s database. Methods: Patients with single primary nodular HCC ≤ 100 mm without vessel invasion on pretreatment imaging were divided into the SR group and PBT group. In the PBT group, the patients with unresectable HCC due to their liver function and/or performance status (PS) were excluded. Results: There were 314 and 31 patients who underwent SR and PBT, respectively. The median survival time in the SR group was significantly better than in the PBT group (104.1 vs. 64.6 months, p = 0.008). Regarding the relapse-free survival (RFS), there was no significant difference between the SR and PBT groups (33.8 vs. 14.0 months, p = 0.099). Conclusions: In RFS, the PBT group and the SR group were comparable. However, the PBT group was significantly worse than SR group in overall survival. SR may therefore be favorable as an initial treatment for HCC compared to PBT. Clinical trial information: 1856.

scholarly journals The Relation Between Histological, Tumor-Biological and Clinical Parameters in Deep and Superficial Leiomyosarcoma and Leiomyoma

Sarcoma ◽  
2002 ◽  
Vol 6 (3) ◽  
pp. 105-110 ◽  
Author(s):  
Justin Pijpe ◽  
Gerben H. Torn Broers ◽  
Boudewijn E.Ch. Plaat ◽  
M. Hundeiker ◽  
F. Otto ◽  
...  
Keyword(s):  
Metastatic Potential ◽  
Rank Test ◽  
Biological Behaviour ◽  
Ki 67 ◽  
Proliferation Markers ◽  
Log Rank Test ◽  
Kaplan Meier ◽  
Size Grade ◽  
The Difference ◽  
Better Than

Purpose: Leiomyosarcomas (LMS) of deep and superficial tissues were examined to identify prognostic markers explaining their different biological behaviour and to define differences between cutaneous and subcutaneous LMS. LMS and leiomyomas (LM) of the skin were compared to and consistent differences that could aid in the (sometimes difficult) diagnosis.Patients: Material was obtained from 27 patients with a deep LMS, 14 with a superficial LMS, and 21 with a LM.Methods: Proliferation markers (mitotic and Ki-67 indices), DNA ploidy, size, grade, and the amount of apoptosis were studied. Statistical analysis was performed and survival curves were constructed by the Kaplan-Meier method and compared by the log-rank test.Results: Superficial LMS were smaller than deep LMS (p < 0.05), and the overall survival of patients with a superficial LMS was better than with a deep LMS (p < 0.05).Within the group of superficial LMS only entirely subcutaneous, and not cutaneous tumors metastasized.No differences were found in the other examined parameters. Proliferation and apoptotic indices were significantly higher in superficial LMS compared to superficial LM.Discussion: The difference in clinical outcome between patients with a superficial and deep LMS, seems to be related to site and size.The metastatic potential of subcutaneous LMS, however, seems to be related to location alone and not to size.The amount of apoptosis and proliferation can be used as additional criteria in the differentiation between superficial LMS and LM.

scholarly journals Selecting the ideal adjuvant to improve neuraxial and regional analgesia: A narrative review

2020 ◽  
Vol 24 (6) ◽  
Author(s):  
Dmytriiev Dmytro ◽  
Nazarchuk Oleksandr ◽  
Dmytriiev Kostiantyn ◽  
Lysak Evgenii ◽  
Zaletska Olesya
Keyword(s):  
Local Anesthetics ◽  
Sensory Block ◽  
Narrative Review ◽  
Regional Analgesia ◽  
Effect Duration ◽  
The Difference ◽  
Time To Onset ◽  
Crucial Part ◽  
Better Than ◽  
The Ideal

Introduction: The aim of this review was to systematize known facts about the effects of adjuvants to local anesthetics for neuraxial and regional analgesia in order to determine the adjuvant with the best effect among all others. More precisely to consider the time to onset, the strength of the effect, duration of the motor and sensory block and some additional effects such as ‘marker of intravascular injection’, safety and toxicity profile. We aimed to find an ideal adjuvant which has all these properties to a good degree. Methodology: For this narrative review we searched the information in Medline, PubMed, Scopus, and Embase databases. 105 articles were identified regarding the topic, published since 1989 to 2020. Data from 105 articles about adjuvants to local anesthetics was analyzed and synthesized in this review. Results: Regional methods of analgesia are becoming a crucial part of anesthesiologists’ practice and the knowledge about adjuvants is developing alongside with it, so there are more and more studies devoted to it. All of them try to find the “ideal” adjuvant, having sufficient necessary effects, but we think that due to the difference in various classes of adjuvants, some may be better than others. However, use of combination of adjuvants is not desirable at all times. Conclusion: A variety of adjuvants to local anesthetics are available now, yet the data about most of them remains inconclusive, so more studies are required to found out the best adjuvants with the most desirable profile and the least adverse effects Key words: Local anesthetic; Adjuvants; Pain management; Regional anesthesia. Citation: Dmytro D, Oleksandr N, Kostiantyn D, Evgenii L, Olesya Z. Selecting the ideal adjuvant to improve neuraxial and regional analgesia: A narrative review. Anaesth. pain intensive care 2020;24(6):---; DOI: 10.35975/apic.v24i6.1209 Received: 24 March 2020, Reviewed: 23 April, 25 June 2020, Revised: 18 October 2020, Accepted: 27 October 2020

scholarly journals Age independent survival benefit for patients with hepatocellular carcinoma (HCC) without metastases at diagnosis: a population-based study

Gut ◽  
2019 ◽  
Vol 69 (1) ◽  
pp. 168-176 ◽  
Author(s):  
Enrico N De Toni ◽  
Anne Schlesinger-Raab ◽  
Martin Fuchs ◽  
Wolfgang Schepp ◽  
Ursula Ehmer ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Real World ◽  
Survival Benefit ◽  
Treatment Options ◽  
Relative Survival ◽  
Population Based ◽  
Real World Data ◽  
Cancer Specific Survival ◽  
Kaplan Meier ◽  
German Region

ObjectiveHepatocellular carcinoma (HCC) is a major cause of death worldwide and its incidence is expected to increase globally. Aim of this study was to assess whether the implementation of screening policies and the improvement of treatment options translated into a real-world survival benefit in HCC patients.Design4078 patients diagnosed with HCC between 1998 and 2016 from the Munich Cancer Registry were analysed. Tumour characteristics and outcome were analysed by time period and according to age and presence of metastases at diagnosis. Overall survival (OS) was analysed using Kaplan-Meier method and relative survival (RS) was computed for cancer-specific survival. Cox proportional hazard models were conducted to control for prognostic variables.ResultsWhile incidence of HCC remained substantially stable, tumours were diagnosed at increasingly earlier stages, although the median age at diagnosis increased. The 3 years RS in HCC improved from 19.8% in 1998–2002, 22.4% in 2003–2007, 30.6% in 2008–2012 up to 31.0% in 2013–2016. Median OS increased from 6 months in 1998–2002 to 12 months in 2008–2016. However, analysis according to the metastatic status showed that survival improved only in patients without metastases at diagnosis whereas the prognosis of patients with metastatic disease remained unchanged.ConclusionThese real-world data show that, in contrast to the current assumptions, the incidence of HCC did not increase in a representative German region. Earlier diagnosis, likely related to the implementation of screening programmes, translated into an increasing employment of effective therapeutic options and a clear survival benefit in patients without metastases at diagnosis, irrespective of age.

scholarly journals Medical Management of Hepatocellular Carcinoma

2017 ◽  
Vol 13 (6) ◽  
pp. 356-364 ◽  
Author(s):  
Nicole E. Rich ◽  
Adam C. Yopp ◽  
Amit G. Singal
Keyword(s):  
Hepatocellular Carcinoma ◽  
Surgical Resection ◽  
Survival Benefit ◽  
Early Stage ◽  
Performance Status ◽  
Poor Performance Status ◽  
Recurrence Rates ◽  
Ablative Therapies ◽  
Therapeutic Decisions ◽  
Systemic Therapies

Hepatocellular carcinoma (HCC) typically occurs in patients with advanced liver disease, so therapeutic decisions must account for the degree of underlying liver dysfunction and patient performance status in addition to tumor burden. Curative treatment options, including liver transplantation, surgical resection, and local ablative therapies, offer 5-year survival rates exceeding 60% but are restricted to patients with early-stage HCC. Surgical resection and local ablative therapies are also limited by high recurrence rates, highlighting a need for adjuvant and/or neoadjuvant therapies. A majority of patients with HCC are diagnosed beyond an early stage, when the tumor is no longer amenable to curative options. For patients with liver-localized HCC in whom curative options are not possible, transarterial therapies, either chemoembolization or radioembolization, can prolong survival but are rarely curative. Sorafenib and regorafenib are the only approved first-line and second-line systemic therapies, respectively, with a survival benefit for patients with advanced HCC; however, the benefit is primarily observed in patients with intact liver function and good performance status. There are several ongoing phase II and III trials evaluating novel systemic therapies, including immunotherapies. Patients with poor performance status or severe hepatic dysfunction do not derive any survival benefit from HCC-directed therapy and have a median survival of approximately 6 months. These patients should be treated with best supportive care, with a focus on maximizing quality of life. Multidisciplinary care has been shown to improve appropriateness of treatment decisions and overall survival and should be considered standard of care for patients with HCC.

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