scholarly journals Prediction of Early Recurrence After R0 Resection for Gallbladder Carcinoma of Stage T1b–T3

2022 ◽  
Vol Volume 14 ◽  
pp. 37-47
Author(s):  
Ding-Zhong Peng ◽  
Gui-Lin Nie ◽  
Bei Li ◽  
Yu-Long Cai ◽  
Jiong Lu ◽  
...  
Keyword(s):  
Gallbladder Carcinoma ◽  
Early Recurrence ◽  
R0 Resection

scholarly journals Are We Sure that Adjuvant Chemotherapy is the Best Approach for Resectable Pancreatic Cancer? Are We in the Era of Neoadjuvant Treatment? A Review of Current Literature

2019 ◽  
Vol 8 (11) ◽  
pp. 1922 ◽  
Author(s):  
Oneda ◽  
Zaniboni
Keyword(s):  
Pancreatic Cancer ◽  
Adjuvant Chemotherapy ◽  
Adjuvant Therapy ◽  
Performance Status ◽  
Neoadjuvant Treatment ◽  
Early Recurrence ◽  
Current Treatment ◽  
R0 Resection ◽  
Resectable Pancreatic Cancer ◽  
Advantages And Disadvantages

The outcome of pancreatic cancer is poor, with a 9% 5-year survival rate. Current treatment recommendations in the 10%–20% of patients who present with resectable disease support upfront resection followed by adjuvant therapy. Until now, only early complete surgical (R0) resection and adjuvant chemotherapy (AC) with either FOLFIRINOX (5-fluorouracil, leucovorin, irinotecan, and oxaliplatin) or nab-paclitaxel plus gemcitabine have been shown to prolong the survival. However, up to 30% of patients do not receive adjuvant therapy because of the development of early recurrence, postoperative complications, comorbidities, and reduced performance status. The aims of neoadjuvant chemotherapy (NAC) are to identify rapidly progressing patients to avoid futile surgery, eliminate micrometastases, increase the feasibility of R0 resection, and ensure the completion of multimodal treatment. Neoadjuvant treatments are effective, but there is no consensus on their use in resectable pancreatic cancer (RPC) because of its lack of a survival benefit over adjuvant therapy. In this review, we analyze the advantages and disadvantages of the two therapeutic approaches in RPC. We need studies that compare the two approaches and can identify the appropriate sequence of adjuvant therapy after neoadjuvant treatment and surgery.

scholarly journals Full-thickness resection device (FTRD) for treatment of upper gastrointestinal tract lesions: the first international experience

2020 ◽  
Vol 08 (10) ◽  
pp. E1291-E1301
Author(s):  
Mouen A. Khashab ◽  
Reem Z. Sharaiha ◽  
Kaveh Hajifathalian ◽  
Yervant Ichkhanian ◽  
Qais Dawod ◽  
...  
Keyword(s):  
Gastrointestinal Tract ◽  
Endoscopic Resection ◽  
Early Recurrence ◽  
Endoscopic Examination ◽  
Upper Gastrointestinal Tract ◽  
R0 Resection ◽  
Full Thickness ◽  
Technical Success Rate ◽  
Average Size ◽  
Upper Gastrointestinal

Abstract Background and study aims The Full-Thickness Resection Device (FTRD) provides a novel treatment option for lesions not amenable to conventional endoscopic resection techniques. There are limited data on the efficacy and safety of FTRD for resection of upper gastrointestinal tract (GIT) lesions. Patients and methods This was an international multicenter retrospective study, including patients who had an endoscopic resection of an upper GIT lesion using the FTRD between January 2017 and February 2019. Results Fifty-six patients from 13 centers were included. The most common lesions were mesenchymal neoplasms (n = 23, 41 %), adenomas (n = 7, 13 %), and hamartomas (n = 6, 11 %). Eighty-four percent of lesions were located in the stomach, and 14 % in the duodenum. The average size of lesions was 14 mm (range 3 to 33 mm). Deployment of the FTRD was technically successful in 93 % of patients (n = 52) leading to complete and partial resection in 43 (77 %) and 9 (16 %) patients, respectively. Overall, the FTRD led to negative histological margins (R0 resection) in 38 (68 %) of patients. A total of 12 (21 %) mild or moderate adverse events (AEs) were reported. Follow-up endoscopy was performed in 31 patients (55 %), on average 88 days after the procedure (IQR 68–138 days). Of these, 30 patients (97 %) did not have any residual or recurrent lesion on endoscopic examination and biopsy, with residual adenoma in one patient (3 %). Conclusions Our results suggest a high technical success rate and an acceptable histologically complete resection rate, with a low risk of AEs and early recurrence for FTRD resection of upper GIT lesions.

Neoadjuvant chemotherapy with gemcitabine plus cisplatin followed by radical liver resection versus immediate radical liver resection alone with or without adjuvant chemotherapy in incidentally detected gallbladder carcinoma after simple cholecystectomy or in front of radical resection of BTC (ICC/ECC): A phase III study utilizing the German Registry of Incidental Gallbladder Carcinoma Platform (GR)—The AIO/CALGP/ACO-GAIN-Trial.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. TPS4653-TPS4653
Author(s):  
Thorsten Oliver Goetze ◽  
Ulli Simone Bankstahl ◽  
Sven A. Lang ◽  
Steffen Heeg ◽  
Wolf Otto Bechstein ◽  
...  
Keyword(s):  
Liver Resection ◽  
Adjuvant Chemotherapy ◽  
Gallbladder Carcinoma ◽  
Radical Resection ◽  
Phase Iii ◽  
R0 Resection ◽  
Extrahepatic Cholangiocarcinoma ◽  
Simple Cholecystectomy ◽  
Post Surgery ◽  
Phase Iii Study

TPS4653 Background: Currently, complete surgical resection represents the only potentially curative treatment option for Biliary Tract Cancer (BTC) including Gallbladder Cancer (GBC). Even after curative resection, 5-year OS is only 20–40%. GBC is relatively rare, but still the fifth most common neoplasm of the digestive tract and even the most frequent cancer of the biliary system. Gallbladder carcinoma is suspected preoperatively in only 30% of all pts, while the majority of cases are discovered incidentally by the pathologist after cholecystectomy for a benign indication. For improving curative rates in BTC and GBC, early systemic therapy combined with radical resection seems to be a promising approach. The earliest moment to apply chemotherapy would be in front of radical surgery. Encouraging results of neoadjuvant/perioperative concepts in other malignancies provide an additional rationale to use this treatment in the early phase of GBC management and even in intrahepatic and extrahepatic cholangiocarcinoma. Especially because data regarding pure adjuvant chemotherapy in BTC`s are conflicting. Methods: This is a multicenter, randomized, controlled, open-label phase III study including pts with incidentally discovered GBCs after simple cholecystectomy in front of radical liver resection and pts with resectable/borderline resectable cholangiocarcinomas (ICC/ECC) scheduled to receive perioperative chemotherapy (Gemcitabine + Cisplatin 3 cycles pre- and post-surgery) or surgery alone followed by a therapy of investigator’s choice. Primary endpoint is OS; secondary endpoints are PFS, R0-resection rate, toxicity, perioperative morbidity, mortality and QoL. A total of N=333 patients with GBC or BTC will be included. Recruitment has just started; first patient in was on December 6, 2020. EudraCT number: 2017-004444-38. Clinical trial information: NCT03673072 .

UNDIFFERENTIATED ENDOMETRIAL SARCOMA: THERAPEUTIC CHALLENGES DESPITE GOOD SURGICAL RESECTION

2021 ◽  
pp. 60-61
Author(s):  
JC Sharma ◽  
Anupma Anupma ◽  
Basanti Mazumdar ◽  
Dhruba Banik ◽  
Avir Sarkar
Keyword(s):  
Endometrial Stromal Sarcoma ◽  
Total Abdominal Hysterectomy ◽  
Abdominal Hysterectomy ◽  
Early Recurrence ◽  
Tumour Cells ◽  
R0 Resection ◽  
High Grade ◽  
Undifferentiated Sarcoma ◽  
Endometrial Sarcoma ◽  
Undifferentiated Endometrial Sarcoma

Undifferentiated endometrial sarcoma is a rare uterine malignancy of mesodermal origin. Only a few cases have been reported in literature. Herein, we describe a 56-year old woman who presented with post-menopausal bleeding of a short duration. Endometrial curettings were suggestive of undifferentiated sarcoma. Computed tomography showed an enlarged uterus with welldened mass in the endometrial cavity extending down to the cervix. A total abdominal hysterectomy, bilateral salpingo-oophorectomy, bilateral pelvic and para-aortic lymphadenectomy and omental biopsies were taken. Histological examination revealed a tumour with a permeative growth pattern composed of uniformly high grade round tumour cells with high mitotic activity. However, there was no lymphovascular space invasion. Tumour cells were strongly positive for CD10 signifying high grade endometrial stromal sarcoma (HG-ESS). Post R0 resection, patient is now receiving adjuvant chemotherapy. However, it is seen that most patients have early recurrence following even R0 resection.

scholarly journals BRAZILIAN CONSENSUS ON INCIDENTAL GALLBLADDER CARCINOMA

2020 ◽  
Vol 33 (1) ◽  
Author(s):  
Felipe Jose F COIMBRA ◽  
Orlando Jorge M TORRES ◽  
Ruslan ALIKHANOV ◽  
Anil AGARWAL ◽  
Patrick PESSAUX ◽  
...  
Keyword(s):  
Lymph Node ◽  
Minimally Invasive ◽  
Gallbladder Cancer ◽  
Gallbladder Carcinoma ◽  
Preoperative Evaluation ◽  
Lymph Node Biopsy ◽  
R0 Resection ◽  
Final Report ◽  
Incidental Gallbladder Cancer ◽  
Agreement Assessment

ABSTRACT Background: Incidental gallbladder cancer is defined as a cancer discovered by histological examination after cholecystectomy. It is a potentially curable disease. However, some questions related to their management remain controversial and a defined strategy is associated with better prognosis. Aim: To develop the first evidence-based consensus for management of patients with incidental gallbladder cancer in Brazil. Methods: Sixteen questions were selected, and 36 Brazilian and International members were included to the answer them. The statements were based on current evident literature. The final report was sent to the members of the panel for agreement assessment. Results: Intraoperative evaluation of the specimen, use of retrieval bags and routine histopathology is recommended. Complete preoperative evaluation is necessary and the reoperation should be performed once final staging is available. Evaluation of the cystic duct margin and routine 16b1 lymph node biopsy is recommended. Chemotherapy should be considered and chemoradiation therapy if microscopically positive surgical margins. Port site should be resected exceptionally. Staging laparoscopy before reoperation is recommended, but minimally invasive radical approach only in specialized minimally invasive hepatopancreatobiliary centers. The extent of liver resection is acceptable if R0 resection is achieved. Standard lymph node dissection is required for T2 tumors and above, but common bile duct resection is not recommended routinely. Conclusions: It was possible to prepare safe recommendations as guidance for incidental gallbladder carcinoma, addressing the most frequent topics of everyday work of digestive and general surgeons.

scholarly journals Effect of preoperative jaundice on long-term prognosis of gallbladder carcinoma with radical resection

2020 ◽  
Author(s):  
xinwei yang ◽  
Chen Jun-yi ◽  
Wen Zhi-jian ◽  
Li Yu-long ◽  
Wang Fei-yu ◽  
...  
Keyword(s):  
Gallbladder Carcinoma ◽  
Tumor Invasion ◽  
Radical Resection ◽  
Clinicopathological Parameters ◽  
R0 Resection ◽  
Independent Factor ◽  
Term Survival ◽  
Long Term Prognosis ◽  
Hepatic Invasion

Abstract Purposes This study was designed to evaluate the long-term prognostic value of preoperative jaundice and explore which clinicopathological factor significantly influencing the long-term prognosis of gallbladder carcinoma (GBC) after radical resection (R0). Methods A total of 267 GBC patients who underwent R0 resection between January 2004 and December 2014 were enrolled, including 54 patients with preoperative jaundice and 213 patients without jaundice. The clinicopathological parameters between the two groups were compared, and the correlation between preoperative jaundice and the long-term prognosis was furtherly analyzed. Results Unilateral and multivariate analyses of 267 GBC patients showed that the depth of tumor invasion (pT stage), lymphatic metastasis, and hepatic invasion were independent prognostic factors. In terms of the 54 GBC patients with preoperative jaundice, univariate and multivariate analysis showed that only pT stage was an independent factor for prognosis. Furthermore, the intraoperative blood transfusion and pT stage were significant different between long-term survival (survival for more than 3 years) and those who died within 3 years (P<0.05). Conclusion Preoperative jaundice was not the independent factor affecting the poor long-term prognosis of gallbladder carcinoma after R0 resection. The pT stage was the only long-term prognostic factor in all GBC patients with and without preoperative jaundice.

The Rationality of Resectional Surgery and Palliative Interventions in the Management of Patients with Gallbladder Cancer

2015 ◽  
Vol 81 (6) ◽  
pp. 591-599 ◽  
Author(s):  
Metin Ercan ◽  
Erdal B. Bostanci ◽  
Tebessum Cakir ◽  
Kerem Karaman ◽  
Ilter Ozer ◽  
...  
Keyword(s):  
Survival Rate ◽  
Gallbladder Carcinoma ◽  
Stage Iv ◽  
Stage I ◽  
Stage Ii ◽  
Survival Period ◽  
R0 Resection ◽  
Resection Rate ◽  
Stage Iv Disease

The aim of the present study was to evaluate in a retrospective manner, the survival period and survival rate according to stages and groups after R0, R1, R2 resections and palliative interventions. Between 2003 and 2012, 67 patients diagnosed with gallbladder carcinoma were retrospectively analyzed. Patient demographics, the survival period, and survival rate according to stages and groups after R0, R1, R2 resections and palliative interventions were retrospectively analyzed. Sixty-seven patients were diagnosed with gallbladder carcinoma. Thirty-eight patients (56.7%) were female and 29 patients (43.3%) were male. The median survival period was significantly longer in stage II and III diseases than in stage IV disease ( P < 0.001). The R0, R1, and R2 resection rates in patients who underwent surgery with curative intent were 67.7, 19.4, and 12.9 per cent, respectively. The R0 resection rate according to the tumor stages was 100 per cent for stage I, 87.5 per cent for stage II, 66.7 per cent for stage III, and 42.8 per cent for stage IV disease. The median follow-up period was six months (eight days to 36 months). During this follow-up period, 53 patients (79.1%) died. In conclusion, R0 resection rate decreases when tumor stage increases. The highest survival rates after R0 resection are achieved in patients with stage I, II, and III diseases. Radical surgery has no benefit over palliative surgery for stage IV disease in terms of survival.

Perioperative chemotherapy with gemcitabine plus cisplatin followed by radical liver resection versus immediate radical liver resection alone in gallbladder carcinoma or in front of radical resection in BTC: The phase III GAIN trial.

2021 ◽  
Vol 39 (3_suppl) ◽  
pp. TPS353-TPS353
Author(s):  
Thorsten Oliver Goetze ◽  
Sylvie Lorenzen ◽  
Ulli Simone Bankstahl ◽  
Sven A. Lang ◽  
Uwe A Wittel ◽  
...  
Keyword(s):  
Liver Resection ◽  
Gallbladder Carcinoma ◽  
Radical Surgery ◽  
Neoadjuvant Treatment ◽  
Radical Resection ◽  
Phase Iii ◽  
R0 Resection ◽  
Extrahepatic Cholangiocarcinoma ◽  
Borderline Resectable ◽  
Post Surgery

TPS353 Background: Radical surgical resection represents the only potentially curative treatment option for Biliary Tract Cancer (BTC) and Gallbladder Carcinoma (GBC). Nevertheless, 5-year OS is only 20–40% after curatively intended resection. GBC is the fifth most common neoplasm of the digestive tract and even the most frequent cancer of the biliary system. The majority of gallbladder carcinoma cases are discovered incidentally by the pathologist after cholecystectomy for a benign indication, so called incidental gallbladder carcinomas. For improving curative rates in BTC and GBC, early systemic therapy combined with radical resection seems to be a promising approach. The earliest moment to apply chemotherapy would be in front of radical surgery. Encouraging results of neoadjuvant/perioperative concepts in other malignancies provide an additional rationale to use this treatment in the early phase management of GBC and intrahepatic as well extrahepatic cholangiocarcinoma, especially because data regarding pure adjuvant chemotherapy in BTC`s are currently conflicting. Methods: GAIN is a multicenter, randomized, controlled, open-label phase III trial, including pts with GBCs in front of radical liver resection and pts with resectable/borderline resectable intra- and extrahepatic cholangiocarcinomas (ICC/ECC). Pts. are randomized to either neoadjuvant systemic chemotherapy (Gemcitabine + Cisplatin 3 cycles pre- and post-surgery) followed by radical surgery or to direct surgery without neoadjuvant treatment. Primary endpoint is OS; secondary endpoints are PFS, R0-resection rate, toxicity, perioperative morbidity, mortality and QoL. A total of N = 333 patients with GBC or BTC will be included. Recruitment has just started; first patient in was on December 6th, 2019. Clinical trial information: NCT03673072.

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