Multivisceral resection for gastric cancer: a systematic review

Background: The overall prognosis and survival of patients with advanced gastric cancer is generally poor. One of the most powerful predictors of outcomes in gastric cancer surgery is an R0 resection. However, the extent of the required surgical resection and the additional benefit of multivisceral resection (MVR) are controversial . Methods: Electronic literature searches were conducted using Medline, EMBASE, and the Cochrane Central Register of Controlled Trials from January 1, 1998 to December 31, 2009. All search titles and abstracts were independently rated for relevance by a minimum of two reviewers. Results: Seventeen studies were included in this review. Among the 1343 patients who underwent MVR, overall complication rates ranged from 11.8 to 90.5%. Perioperative mortality was found to be 0-15%. Pathological T4 disease was confirmed in 28.8-89% of patients. R0 resection and extent of nodal involvement were important predictors of survival in patients undergoing MVR. Patient outcomes may also be affected by the number of organs resected. Conclusions: Gastrectomy with MVR can be safely pursued in patients with locally advanced gastric cancer to achieve an R0 resection. MVR may not be beneficial in patients with extensive nodal disease

Defining Surgical Quality in Gastric Cancer: A RAND/UCLA Appropriateness Study

National Health ServiceUniv Toronto, Dept Surg, Toronto, ON, CanadaUniv Toronto, Dept Med, Toronto, ON, CanadaInst Clin Effectiveness Studies, Toronto, ON, CanadaSunnybrook Res Inst, Toronto, ON, CanadaDalhousie Univ, Dept Surg, Halifax, NS B3H 4H2, CanadaUniv Calgary, Dept Surg, Calgary, AB, CanadaMaimonides Hosp, Dept Surg, Brooklyn, NY 11219 USAMem Sloan Kettering Canc Ctr, Dept Surg, New York, NY 10021 USAUniversidade Federal de São Paulo, São Paulo, BrazilBrown Univ, Dept Surg, Providence, RI 02912 USAOhio State Univ, Dept Med, Columbus, OH 43210 USAOhio State Univ, Dept Pharmacol, Columbus, OH 43210 USARoyal Marsden Hosp, Dept Med, Sutton, Surrey, EnglandUniv Texas MD Anderson Canc Ctr, Dept Radiat Oncol, Houston, TX 77030 USAUniv Texas MD Anderson Canc Ctr, Dept Surg Oncol, Houston, TX 77030 USAYonsei Univ, Coll Med, Dept Surg, Seoul, South KoreaUniv Chicago, Dept Surg, Chicago, IL 60637 USACanc Inst Hosp, Dept Surg, Tokyo, JapanLeiden Univ, Med Ctr, Dept Surg, Leiden, NetherlandsUniv Michigan Hlth Syst, Dept Surg, Ann Arbor, MI USAUniversidade Federal de São Paulo, São Paulo, BrazilWeb of Scienc

Multi-Center Analysis of Liver Transplantation for Combined Hepatocellular Carcinoma-Cholangiocarcinoma Liver Tumors.

BACKGROUND: Combined hepatocellular-cholangiocarcinoma liver tumors (cHCC-CCA) with pathologic differentiation of both hepatocellular carcinoma (HCC) and intrahepatic cholangiocarcinoma within the same tumor are not traditionally considered for liver transplantation due to perceived poor outcomes. Published results are from small cohorts and single centers. Through a multi-center collaboration, we performed the largest analysis to date of the utility of liver transplantation for cHCC-CCA. STUDY DESIGN: Liver transplant and resection outcomes for HCC (n=2998) and cHCC-CCA (n=208) were compared in a 12-center retrospective review (2009-2017). Pathology defined tumor type. Tumor burden was based on radiologic Milan criteria at time of diagnosis and applied to cHCC-CCA for uniform analysis. Kaplan-Meier survival curves and log-rank test were used to determine overall survival and disease-free survival. Cox regression was used for multivariate survival analysis. RESULTS: Liver transplant for cHCC-CCA (n=67) and HCC (n=1814) within Milan had no significant difference in overall survival (5-yr cHCC-CCA 70.1%, HCC 73.4%, p=0.806) despite higher cHCC-CCA recurrence rates (23.1% vs 11.5% 5-years, p CONCLUSIONS: Regardless of tumor burden, outcomes following liver transplant are superior to resection for patients with cHCC-CCA. Within Milan criteria, liver transplant for cHCC-CCA and HCC results in similar overall survival justifying consideration of transplantation due to the higher chance of cure with liver transplantation in this traditionally excluded population