Vascular resection for intrahepatic cholangiocarcinoma: Current considerations

Intrahepatic cholangiocarcinoma (iCCA) accounts for approximately 10% of all primary liver cancers. Surgery is the only potentially curative treatment, even in cases of macrovascular invasion. Since resection offers the only curative chance, even extended liver resection combined with complex vascular or biliary reconstruction of the surrounding organs seems justified to achieve complete tumour removal. In selected cases, the major vascular resection is the only change to try getting the cure. The best results are achieved by the referral centre with a wide experience in complex liver surgery, such as ALPPS procedure, IVC resection, and ante-situ and ex-situ resections. However, despite aggressive surgery, tumour recurrence occurs frequently and long-term oncological results are very poor. This suggests that significant progress in prognosis cannot be expected by surgery alone. Instead, multimodal treatment including neoadjuvant chemotherapy, radiotherapy, and subsequent adjuvant treatment for iCCA seem to be necessary to improve results. © 2021 by the authors. Licensee MDPI, Basel, Switzerland

Vascular resection in perihilar cholangiocarcinoma

Among the cholangiocarcinomas, the most common type is perihilar (phCC), accounting for approximately 60% of cases, after which are the distal and then intrahepatic forms. There is no staging system that allows for a comparison of all series and extraction of conclusions that increase the long-term survival rate of this dismal disease. The extension of the resection, which theoretically depends on the type of phCC, is not a closed subject. As surgery is the only known way to achieve a cure, many aggressive approaches have been adopted. Despite extended liver resections and even vascular resections, margins are positive in around one third of patients. In the past two decades, with advances in diagnostic and surgical techniques, surgical outcomes and survival rates have gradually improved, although variability is the rule, with morbidity and mortality rates ranging from 14% to 76% and from 0% to 19%, respectively. Extended hepatectomies and portal vein resection, or even right hepatic artery reconstruction for the left side tumors are frequently needed. Salvage procedures when arterial reconstruction is not feasible, as well as hepatopancreatoduodenectomy, are still under evaluation too. In this article, we discuss the aggressive surgical approach to phCC focused on vascular resection. Disparate results on the surgical treatment of phCC made it impossible to reach clear-cut conclusions. © 2021 by the authors. Licensee MDPI, Basel, Switzerland

Associating Liver Partition and Portal Vein Ligation for Staged Hepatectomy (ALPPS) procedure for colorectal liver metastasis

Since first described, Associating Liver Partition and Portal Vein Ligation for Staged Hepatectomy (ALPPS) has garnered boisterous praise and fervent criticism. Its rapid adoption and employment for a variety of indications resulted in high perioperative morbidity and mortality. However recent risk stratification, refinement of technique to reduce the impact of stage I and progression along the learning curve have resulted in improved outcomes. The first randomized trial comparing ALPPS to two stage hepatectomy (TSH) for colorectal liver metastases (CRLM) was recently published demonstrating comparable perioperative morbidity and mortality with improved resectability and survival following ALPPS. In this review, as ALPPS enters the thirteenth year since conception, the current status of this contentious two stage technique is presented and best practices for deployment in the treatment of CRLM is codified

On parton distributions in a photon gas

In some cases it may be useful to know parton distributions in a photon gas. This may be relevant, e.g., for the analysis of interactions of high energy cosmic ray particles with the cosmic microwave background radiation. The latter can be considered as a gas of photons with an almost perfect blackbody spectrum. An approach to finding such parton distributions is described. The survival probability of ultra-high energy neutrinos traveling through this radiation is calculated.Comment: 5 pages, 4 figures, EPJ style files. Some changes in the text. Two new sections discussing ultra-high energy neutrino damping in the cosmic microwave background radiation are include

Crystal structure of solid Oxygen at high pressure and low temperature

Results of X-ray diffraction experiments on solid oxygen at low temperature and at pressures up to 10 GPa are presented.A careful sample preparation and annealing around 240 K allowed to obtain very good diffraction patterns in the orthorhombic delta-phase. This phase is stable at low temperature, in contrast to some recent data [Y. Akahama et al., Phys. Rev. B64, 054105 (2001)], and transforms with decreasing pressure into a monoclinic phase, which is identified as the low pressure alpha-phase. The discontinuous change of the lattice parameters, and the observed metastability of the alpha-phase increasing pressure suggest that the transition is of the first order.Comment: 4 pages with three figure

Transverse Λ0\Lambda^0 polarization in inclusive quasi-real photoproduction: quark scattering model

The transverse polarization of $\Lambda^0$ hyperons produced in the inclusive $ep$ reaction at the 27.6 GeV beam energy is assumed to appear mostly via scattering of the strange quark in a color field. Results of application of such an idea to the preliminary data of HERMES are presented. Contributions of $\Sigma^0$, $\Xi$, and $\Sigma^*$ resonances to the polarization are taken into account.Comment: 5 pages, 5 figures, corrected according to version accepted by Physics of Atomic Nucle

Transverse Λ0\Lambda^0 polarization in inclusive quasi-real photoproduction at the current fragmentation

It is shown that the recent HERMES data on the transverse $\Lambda^0$ polarization in the inclusive quasi-real photoproduction at $x_F>0$ can be accommodated by the strange quark scattering model. Relations with the quark recombination approach are discussed.Comment: 5 pages, 3 figures, accepted by Eur. Phys. J.