Systemic Sequential Therapy of CisGem, Tislelizumab, and Lenvatinib for Advanced Intrahepatic Cholangiocarcinoma Conversion Therapy

Intrahepatic cholangiocarcinoma (CCA), always diagnosed at an advanced stage in recent years, is of high aggression and poor prognosis. There is no standard treatment beyond first-line chemotherapy and no molecular-targeted agents or immune checkpoint inhibitors approved for advanced intrahepatic CCA. Hence, we firstly report an original therapeutic strategy for a 60-year-old patient diagnosed with intrahepatic CCA categorized as Stage IIIB (T3N1M0) by the American Joint Committee on Cancer staging system. After histopathological examination and next-generation sequencing, the patient was treated with four courses of novel systemic sequential therapy (intravenous gemcitabine 1,000 mg/m2 and cisplatin 25 mg/m2 on days 1 and 8; oral lenvatinib 8 mg/day from days 1 to 21; intravenous tislelizumab 200 mg on day 15). Then, the patient achieved partial response and was operated on right hemihepatectomy, cholecystectomy, and abdominal lymph node dissection. Without any perioperative complications, the patient was discharged from our hospital in perfect condition. Thereafter, the patient continued to use this new regimen 1 month after surgery for adjuvant therapy and was confirmed without recurrence when we followed up. In a word, we found an effective therapeutic regimen for preoperative advanced intrahepatic CCA conversion therapy, which may become a new approach in cancer treatment in the future.

A case of hepatic paragonimiasis was misdiagnosed as hepatocellular carcinoma with rupture and haemorrhage

Paragonimiasis is a disease caused by parasitic infections that mainly involve the lungs. However, it can also produce ectopic infections, such as when the parasites invade the liver, brain and subcutaneous tissue, which then cause different symptoms. This current case report describes a 55-year-old male patient with hepatic paragonimiasis that was misdiagnosed as liver cancer with rupture and haemorrhage. The initial computed tomography findings suggested ruptured liver cancer. The patient underwent laparoscopic right hemihepatectomy. Postoperative pathological analysis resulted in a diagnosis of hepatic paragonimiasis. The patient recovered well postoperatively and was treated with 25 mg/kg praziquantel orally three times a day for 3 days after discharge with good efficacy. In this present case, the rupture and haemorrhage of the liver mass made it difficult for the treating physicians to consider hepatic paragonimiasis, which lead to the initial misdiagnosis of this patient. Although paragonimiasis is very rare, medical staff should be vigilant and have a comprehensive understanding of the different diseases that can cause liver masses so that misdiagnosis can be avoided.

Left-side vs. right-side hepatectomy for hilar cholangiocarcinoma: a meta-analysis

Goals We aim to draw a conclusion which type of hepatectomy could be the priority for hilar cholangiocarcinoma patients. Background Surgery is established as only potentially curative treatment for hilar cholangiocarcinoma. However, whether hepatectomy should be preferred to the left-side hepatectomy, which includes left hemihepatectomy, extended left hemihepatectomy, and left trisectionectomy, or right-side hepatectomy, which represents right hemihepatectomy, extended right hemihepatectomy, and right trisectionectomy, is debated. In this meta-analysis, we evaluated and compared the efficacy and safety of left-side hepatectomy and right-side hepatectomy in patients with hilar cholangiocarcinoma. Study We systematically retrieved the MEDLINE, PubMed, and Cochrane library and related bibliography up to February 2020. The primary outcome is overall survival, and the secondary outcome includes 1-, 3-, and 5-year survival rates, morbidity, mortality, R0 resection rate, and operation time. Based on heterogeneity, fixed-effects model or random-effects models were established through meta-analysis. Results Eleven studies (11 cohort studies, totally 1031 patients) were involved in this study. The overall survival of patients who underwent left-side hepatectomy was comparable to that of patients who underwent right-side hepatectomy (hazard ratio, 1.27 [95% confidence interval, 0.98–1.63]). And there was no significant difference observed in 1-year (relative risk, 1.01 [95% CI, 0.89–1.15]), 3-year (relative risk, 0.94 [95% confidence interval, 0.80–1.11]), and 5-year survival (relative risk, 0.82 [95% confidence interval, 0.67–1.01]) rates between the left-side hepatectomy group and the right-side hepatectomy group. Comparing with the right-side hepatectomy cluster, the hilar cholangiocarcinoma patients in the left-side hepatectomy cluster presented better overall postoperative morbidity (relative risk, 0.82 [95% confidence interval, 0.71–0.96]) and major postoperative morbidity (relative risk, 0.73 [95% confidence interval, 0.56–0.95]). The post-hepatectomy liver failure rate (relative risk, 0.22 [95% confidence interval, 0.09–0.56]) and procedure-related mortality (relative risk, 0.41 [95% confidence interval, 0.23–0.70]) in the left-side hepatectomy group were better than those of the right-side hepatectomy group. Besides, the R0 resection rate was similar between the left-side hepatectomy group and the right-side hepatectomy group (relative risk, 0.95 [95% confidence interval, 0.87–1.03]). And the operation time for the left-side hepatectomy was significantly longer than that for the right-side hepatectomy (mean difference, 38.68 [95% confidence interval, 7.41–69.95]). Conclusion Through meta-analysis, we explored the comparable long-term outcomes and better short-term outcomes in the left-side hepatectomy group as is compared to the right-side hepatectomy group of hilar cholangiocarcinoma patients. In this study, the evidence obtained might indicate that the choice of left-side hepatectomy or right-side hepatectomy depends on the site of hilar cholangiocarcinoma in every patient.

Hepatectomy with simultaneous resection of portal vein for Bismuth IV perihilar cholangiocarcinoma: a case report

Background: Surgical resection is the only potential treatment choice for patients with cholangiocarcinoma. Portal vein invasion used to be a primary cause of irresectable tumor. Nowadays, portal vein resection and reconstruction has become a routine surgical procedure.Case presentation: A 65-year-old male patient, suffering from jaundice and abnormal liver function was referred to our hospital for intensive examination. Before admission to our center, the patient had been undergoing percutaneous transhepatic cholangial drainage (PTCD) for six days for the palliation of jaundice and liver function. A series of check-ups and examinations resulted in the diagnosis of Bismuth type IV perihilar cholangiocarcinoma. The patient later received right hemihepatectomy and Roux-en-Y choledochojejunostomy. As the portal vein was affected by tumor, it was partially removed and reconstructed. In addition, the portal vein thrombus (PVT) was removed, and a portal vein stent was placed. After surgery, the patient received six courses of chemotherapy. A gemcitabine-based regimen in combination with S-1 were used. Nineteen months after the surgery, the patient is still healthy.Conclusions: This report demonstrates that hepatectomy with simultaneous resection of portal vein for Bismuth type IV perihilar cholangiocarcinoma may contribute to a satisfactory result. Consequently, combined resection and reconstruction is often required when negative pathological resection (R0 resection) is performed.

Delayed Splenic Rupture After a Percutaneous Transsplenic Approach to Treat Portal Vein Occlusion

Purpose: To report a case of delayed splenic rupture after percutaneous transsplenic portal vein stent deployment. Case Report: A 72-year-old male patient presented at a medical center with abdominal pain and reduced liver function according to laboratory tests. Due to a history of right hemihepatectomy and left portal vein occlusion, the percutaneous transhepatic approach was considered inappropriate. Instead, percutaneous transsplenic access was selected as a suitable procedure for portal vein catheterization. Eight days following the procedure, the patient developed abdominal pain, and a computed tomography scan showed a small splenic pseudoaneurysm that was underappreciated at the time. Patient suffered acute splenic rupture 32 days post-procedure. Subsequent embolization was performed, achieving complete hemostasis. Conclusion: The transsplenic approach should be considered when the transhepatic or transjugular approach is unfeasible or difficult to implement. A careful plugging of the puncture tract is necessary to prevent or minimize hemorrhage from the splenic access tract. In addition, careful serial follow-up computed tomography should be used to evaluate the splenic puncture tract.

Left-side vs. right-side hepatectomy for Hilar Cholangiocarcinoma: A meta-analysis

Goals: We aim to draw a conclusion which type of hepatectomy could be the priority for hilar cholangiocarcinoma patients.Background: Surgery is established as only potentially curative treatment for hilar cholangiocarcinoma. However, whether hepatectomy should be preferred to the left-side hepatectomy, which includes left hemihepatectomy, extended left hemihepatectomy and left trisectionectomy, or right-side hepatectomy, which represents right hemihepatectomy, extended right hemihepatectomy and right trisectionectomy, is debated. In this meta-analysis, we evaluated and compared the efficacy and safety of left-side hepatectomy and right-side hepatectomy in patients with hilar cholangiocarcinoma.Study: We systematically retrieved the MEDLINE, PubMed and Cochrane library and related bibliography up to February 2020. The primary outcome is overall survival, and secondary outcomes include 1-, 3-, and 5-Year survival rates, morbidity, mortality, R0 resection rate and operation time. Based on heterogeneity, fixed-effects model or random-effects models were established through meta-analysis.Results: Eleven studies (11 cohort studies, totally 1031 patients) were involved in this study. The overall survival of patients underwent left-side hepatectomy was comparable to that of patients underwent right-side hepatectomy (hazard ratio, 1.27 [95% confidence interval, 0.98-1.63]). And there was no significant difference observed in 1-year (relative risk, 1.01 [95% CI, 0.89-1.15]), 3-year (relative risk, 0.94 [95% confidence interval, 0.80-1.11]), and 5-year survival (relative risk, 0.82 [95% confidence interval, 0.67-1.01]) rates between left-side hepatectomy group and the right-side hepatectomy group. Comparing with right-side hepatectomy cluster, the hilar cholangiocarcinoma patients in left-side hepatectomy cluster presented better overall postoperative morbidity (relative risk, 0.82 [95% confidence interval, 0.71-0.96]) and major postoperative morbidity (relative risk, 0.73 [95% confidence interval, 0.56-0.95]). The post-hepatectomy liver failure rate (relative risk, 0.22 [95% confidence interval, 0.09-0.56]) and procedure-related mortality (relative risk, 0.41 [95% confidence interval, 0.23-0.70]) in left-side hepatectomy group was better than that of right-side hepatectomy group. Besides, the R0 resection rate was similar between left-side hepatectomy group and right-side hepatectomy group (relative risk, 0.95 [95% confidence interval, 0.87-1.03]). And the operation time for left-side hepatectomy were significantly longer than those for right-side hepatectomy (mean difference, 38.68 [95% confidence interval, 7.41-69.95]).Conclusion: Through meta-analysis, we explored the comparable long-term outcomes and better short-term outcomes in left-side hepatectomy group as is compared to right-side hepatectomy group of hilar cholangiocarcinoma patients. In this study, the evidence obtained might indicate that the choice of left-side hepatectomy or right-side hepatectomy had better depend on the site of hilar cholangiocarcinoma in every patient.

Left-Side vs. Right-Side Hepatectomy for Hilar Cholangiocarcinoma: A Meta-Analysis

Goals: We aim to draw a conclusion which side of hepatectomy could be the priority for hilar cholangiocarcinoma patients.Background: Surgery is established as only potentially curative treatment for hilar cholangiocarcinoma. However, whether hepatectomy should be preferred to the left-side hepatectomy, which contains left hemihepatectomy, extended left hemihepatectomy and left trisectionectomy, or right-side hepatectomy, which represents right hemihepatectomy, extended right hemihepatectomy and right trisectionectomy, is debated. In this meta-analysis, we evaluated and compared the efficacy and safety of left-side hepatectomy and right-side hepatectomy in patients with hilar cholangiocarcinoma.Study: We systematically retrieved the MEDLINE, PubMed and Cochrane library and related bibliography up to February 2020. The primary outcome is overall survival, and secondary outcomes include 1-, 3-, and 5-Year survival rates, morbidity, mortality, R0 resection rate and operation time. Based on heterogeneity, fixed-effects model or random-effects models were established through meta-analysis.Results: Eleven studies (11 cohort studies, totally 1031 patients) were involved in this study. The overall survival of patients underwent left-side hepatectomy was comparable to that of patients underwent right-side hepatectomy (hazard ratio, 1.27 [95% confidence interval, 0.98-1.63]). And there was no significant difference observed in 1-year (relative risk, 1.01 [95% CI, 0.89-1.15]), 3-year (relative risk, 0.94 [95% confidence interval, 0.80-1.11]), and 5-year survival (relative risk, 0.82 [95% confidence interval, 0.67-1.01]) rates between left-side hepatectomy group and the right-side hepatectomy group. Comparing with right-side hepatectomy cluster, the hilar cholangiocarcinoma patients in left-side hepatectomy cluster presented better overall postoperative morbidity (relative risk, 0.82 [95% confidence interval, 0.71-0.96]) and major postoperative morbidity (relative risk, 0.73 [95% confidence interval, 0.56-0.95]). The post-hepatectomy liver failure rate (relative risk, 0.22 [95% confidence interval, 0.09-0.56]) and procedure-related mortality (relative risk, 0.41 [95% confidence interval, 0.23-0.70]) in left-side hepatectomy group was better than that of right-side hepatectomy group. Besides, the R0 resection rate was similar between left-side hepatectomy group and right-side hepatectomy group (relative risk, 0.95 [95% confidence interval, 0.87-1.03]). And the operation time for left-side hepatectomy were significantly longer than those for right-side hepatectomy (mean difference, 38.68 [95% confidence interval, 7.41-69.95]).Conclusion: Through meta-analysis, we explored the comparable long-term outcomes and better short-term outcomes in left-side hepatectomy group as is compared to right-side hepatectomy group of hilar cholangiocarcinoma patients. In this study, the evidence obtained might indicate that the choice of left-side hepatectomy or right-side hepatectomy had better depend on the specific situation of every patients of hilar cholangiocarcinoma.