Metastases of gastric cancer into the liver – the authors’ own experience and literature review

Introduction. Synchronous metastases of gastric cancer to the liver occur in 3–14% of patients with this cancer, and metachronous lesions in 37% of patients after radical gastrectomy. Liver resections due to metastases of gastric carcinomas represent only 5–9% of resections due to metastases other than colorectal cancer. Until recently, patients with gastric carcinoma metastases to the liver were classified in the IV stage of cancer and the therapy was limited to chemotherapy or palliative treatment only.Material and methods. The paper presents a current review of literature and the authors’ own experience with liver resection due to gastric cancer metastases into this organ. During 34 months, 488 patients with liver metastases were treated in the Department of General, Transplant and Liver Surgery, of the Medical University of Warsaw, in whom 426 surgical procedures were performed (87.3%). The types of surgical procedures are as follows: minor liver resections in 204 patients (47.9%), hemihepatectomies in 102 patients (23.9%), thermoablations in 86 patients (20.2%) and laparotomies in 34 patients (8.0%). Among patients treated for liver metastases there were 4 patients with metastases from gastric cancer (0.8%), which constituted 1% of patients operated on, but 6.8% of patients with liver metastases from organs other than colorectal cancer. The postoperative course and direct results in all patients operated because of gastric cancer metastasesinto the liver were very good.Conclusions. In some patients (single metachronous metastasis, no extrahepatic lesions, no peritoneal lesions, with subsequent chemotherapy) liver resection due to metastases from gastric cancer provides a chance for a longer survival

Przerzuty raka żołądka do wątroby – doświadczenie własne i przegląd piśmiennictwa

Wstęp. Synchroniczne przerzuty raka żołądka do wątroby występują u 3–14% chorych na ten nowotwór, a ogniska metachroniczne – u 37% pacjentów, u których wykonano radykalną gastrektomię. Natomiast resekcje wątroby z powodu przerzutów raków żołądka stanowią zaledwie 5–9% resekcji z powodu przerzutów innych niż raka jelita grubego. Do niedawna chorych z przerzutami raka żołądka do wątroby zaliczano do IV stopnia zaawansowania choroby nowotworowej i terapię ograniczano wyłącznie do leczenia chemicznego lub paliatywnego. Materiał. W pracy przedstawiono aktualny przegląd piśmiennictwa i własne doświadczenie dotyczące resekcji wątroby z powodu przerzutów raka żołądka do tego narządu. W ciągu 34 miesięcy leczono w Klinice Chirurgii Ogólnej, Transplantacyjnej i Wątroby Warszawskiego Uniwersytetu Medycznego 488 chorych z przerzutami do wątroby, u których wykonano 426 zabiegów operacyjnych (87,3%). Rodzaje postępowania operacyjnego przedstawiają się następująco: resekcje wątroby mniejsze – u 204 chorych (47,9%), hemihepatektomie – u 102 chorych (23,9%), termoablacje – u 86 chorych (20,2%) i laparotomie – u 34 chorych (8,0%). Wśród osób leczonych z powodu przerzutów do wątroby było 4 chorych z przerzutami raka żołądka (0,8%), co stanowiło 1% chorych operowanych, ale 6,8% chorych z przerzutami do wątroby z innych narządów niż rak jelita grubego. Przebieg pooperacyjny i bezpośrednie wyniki u wszystkich chorych operowanych z powodu przerzutów raka żołądka do wątroby były bardzo dobre. Wnioski. U niektórych pacjentów (pojedynczy przerzut metachroniczny, bez zmian pozawątrobowych, bez zmian otrzewnowych, z następową chemioterapią) resekcja wątroby z powodu przerzutów raka żołądka daje szanse na dłuższe przeżycie

Cirrhotic Liver of Liver Transplant Recipients Accumulate Silver and Co-Accumulate Copper.

Silver-based materials are widely used in clinical medicine. Furthermore, the usage of silver containing materials and devices is widely recommended and clinically approved. The impact on human health of the increasing use of silver nanoparticles in medical devices remains understudied, even though Ag-containing dressings are known to release silver into the bloodstream. In this study, we detected a widespread and sometimes significant silver accumulation both in healthy and sick liver biopsies, levels being statistically higher in patients with various hepatic pathologies. 28 healthy and 44 cirrhotic liver samples were investigated. The median amount of 0.049 ppm Ag in livers was measured in cirrhotic livers while the median was 0.0016 ppm for healthy livers (a more than 30-fold difference). The mean tissue concentrations of essential metals, Fe and Zn in cirrhotic livers did not differ substantially from healthy livers, while Cu was positively correlated with Ag. The serum levels of gamma-glutamyl transpeptidase (GGTP) was also positively correlated with Ag in cirrhotic livers. The increased Ag accumulation in cirrhotic livers could be a side effect of wide application of silver in clinical settings. As recent studies indicated a significant toxicity of silver nanoparticles for human cells, the above observation could be of high importance for the public health

The Enzymatic Activity of Type 1 Iodothyronine Deiodinase (D1) is Low in Liver Hemangioma: A Preliminary Study

Type 1 iodothyronine deiodinase (D1) is a crucial enzyme which converts the prohormone thyroxine (T4) into active tri-iodothyronine (T3). There has been strong evidence that the metabolism of thyroid hormones is disturbed in some neoplastic tissues such as thyroid, renal, and breast cancer. However, there are few available data about D1 enzyme activity in benign tumors such as hemangioma, which is the most common primary liver tumor. Hence this study aimed to determine the enzymatic activity of D1 in hemangiomas in relation to healthy liver tissue. Seven tumors and healthy control tissues were obtained from patients who had liver resection due to hemangioma. The activity was assessed by measurement of radioactive iodine released by deiodination catalyzed by D1. It was found that D1 activity was significantly lower in the hemagiomas than in the healthy surrounding tissue (p = 0.0017). The results indicated that thyroid hormones play important roles not only in the regulation of cell metabolism, but also in cell growth, division, and apoptosis. The active form T3 acts through its nuclear receptors and influences the up- and down-regulation of target genes. Healthy liver tissue expresses a high level of D1, but disturbed D1 activity may result in changes in the local concentration of T3 which may impair gene transcription. These finding demonstrate a low enzymatic activity of D1 in liver hemangioma and suggest an as yet unknown role of thyroid hormones in this type of benign liver tumor

Actuarial Patency Rates of Hepatico-Jejunal Anastomosis after Repair of Bile Duct Injury at a Reference Center

Background: Bile duct injury complicates patients’ lives, despite the subsequent repair. Repairing the injury must restore continuity of the bile tree and bring the patient into a state of cure referred to as “patency”. Actuarial primary or actuarial secondary patency rates, depending on whether the patient underwent primary or secondary repair of injury, are proposed to be a proper metric in evaluating outcomes. This study was undertaken to assess outcomes of 669 patients with bile duct injuries Strasberg D and E type referred to the department from public surgical wards between 1990 and 2020. In 442 patients, no attempt was made to repair prior to a referral, and in 227 an attempt to repair was made which failed. Methods: Observations were summarized on December 31st, 2020. The retrospective analysis included: primary patency attained (Grade A result), secondary patency attained (Grade C result), patency loss, and actuarial patency rates of the bile tree at 2, 5, and 10 years. Results: Twenty-five (3.7%) patients died after repair surgery. Actuarial patency rates at 2, 5, and 10 years of follow-up were 93%, 88%, and 74% or 86%, 75%, and 55% in patients attaining Grade A and Grade C outcomes, respectively (p < 0.001). Conclusion: Bile duct injury stands out as a surgical challenge, requiring specialized management at a referral center. Improper proceeding after an injury is the factor leading to faster loss of anastomotic patency

Cirrhotic Liver of Liver Transplant Recipients Accumulate Silver and Co-Accumulate Copper

Silver-based materials are widely used in clinical medicine. Furthermore, the usage of silver containing materials and devices is widely recommended and clinically approved. The impact on human health of the increasing use of silver nanoparticles in medical devices remains understudied, even though Ag-containing dressings are known to release silver into the bloodstream. In this study, we detected a widespread and sometimes significant silver accumulation both in healthy and sick liver biopsies, levels being statistically higher in patients with various hepatic pathologies. 28 healthy and 44 cirrhotic liver samples were investigated. The median amount of 0.049 ppm Ag in livers was measured in cirrhotic livers while the median was 0.0016 ppm for healthy livers (a more than 30-fold difference). The mean tissue concentrations of essential metals, Fe and Zn in cirrhotic livers did not differ substantially from healthy livers, while Cu was positively correlated with Ag. The serum levels of gamma-glutamyl transpeptidase (GGTP) was also positively correlated with Ag in cirrhotic livers. The increased Ag accumulation in cirrhotic livers could be a side effect of wide application of silver in clinical settings. As recent studies indicated a significant toxicity of silver nanoparticles for human cells, the above observation could be of high importance for the public health

Goblet cell carcinomas of the appendix: rare but aggressive neoplasms with challenging management

Goblet cell carcinomas (GCC) are a rare, aggressive sub-type of appendiceal tumours with neuroendocrine features, and controversy exists with regards to therapeutic strategy. We undertook a retrospective review of GCC patients surgically treated at two tertiary referral centres. Clinical and histopathological data were extracted from a prospectively maintained database. Survival analyses utilised Kaplan–Meier methodology. Twenty-one patients were identified (9 females). Median age at diagnosis was 55 years (range 32–77). There were 3, 6 and 9 grade 1, 2 and 3 tumours, respectively. One, 10, 5 and 5 patients had stage I, II, III and IV disease at diagnosis, respectively. There were 8, 10 and 3 Tang class A, B and C tumours, respectively. Index operation was appendectomy (n = 12), right hemicolectomy (n = 6) or resections including appendix/right colon, omentum and the gynaecological system (n = 3). Eight patients underwent completion right hemicolectomy. Surgery for recurrence included small bowel resection (n = 2), debulking with peritonectomy and heated intraperitoneal chemotherapy, and hysterectomy and bilateral salpingo-oophorectomy (all n = 1). Median follow-up was 30 months (range 2.5–123). One-, 3- and 5-year OS was 79.4, 60 and 60%, respectively. Mean OS (1-, 3-, and 5-year OS) for Tang class A, B and C tumours were 73.1 months (85.7, 85.7, 51.4%), 83.7 months (all 66.7%) and 28.5 months (66.7, 66.7%, not reached), respectively. Chromogranin A/B and 68Ga-DOTATATE PET/CT were not useful in follow-up, but CEA, CA 19-9, CA 125 and 18F-FDG PET/CT identified tumour recurrence. GCC must be clearly discriminated from relatively indolent appendiceal neuroendocrine neoplasms. 18F-FDG PET/CT and CEA/CA19-9/CA 125 are useful in detecting recurrence of GCC