80 research outputs found
Biopsija resektabilnih jetrnih zasevkov raka debelega črevesa in danke
No abstract.Ni abstrakta
Hepatocelični rak - možnost resekcije jeter
Resekcija jeter (RJ) je ostala glavna oblika terapije pri solitarnem hepatoceličnem raku (HCC), pri bolnikih z ohranjeno funkcijsko rezervo jeter in v primernem splošnem stanju. Izpopolnjene slikovne preiskave so pripomogle k boljši izbiri bolnikov. Kirurgija jeter je napredovala: uporabne so številne tehnike transekcije jetrnega tkivadosegljive so različne naprave, ki omogočajo hitrejše in natančnejše operiranje v brezkrvnem operativnem polju. Izboljšana kirurška tehnika, vzdrževanje nizkega centralnega venskega pritiska in napredek pri negi bolnika po operaciji so omogočili, da se je smrtnost po operaciji jeter v izbranih serijah znižala celo do 0%. Barcelona Clinic Liver Cancer (BCLC) klasifikacija poleg zamejitve bolezni, nudi priporočila tudi glede izbora terapije. Kirurško terapijo omejuje zgolj na bolnike z zgodnjim stadijem raka. Namen tega prispevka je raziskati, ali je v sedanjem času mogoče RJ opraviti s sprejemljivimi kratko- in dolgoročnimi rezultati tudi pri bolnikih s takšnim HCC, pri katerem so prisotni številni in veliki tumorji, ki makroskopsko vdirajo v žile.Liver resection (LR) has remained the main form of therapy for solitary hepatocellular cancer (HCC) in patients with preserved functional liver reserves and in good general condition. Advanced imaging has contributed to a better selection of patients. Liver surgery has advanced as there are many techniques of liver tissue transection useful and different instruments are available, which enable faster and more accurate surgery in the bloodless operating field. Improved surgical technique, maintenance of low central venous pressure and advancement in patient postoperative care have provided that mortality rates after liver surgery in selected series lowered as far as to 0%. The Barcelona Clinic Liver Cancer (BCLC) classification apart from disease control also offers recommendations with regard to therapy selection. It limits surgical therapy only to patients with early stage liver cancer. The purpose of this article is to research whether at present time it is perhaps better to perform radioiodine therapy with acceptable short- and long-term results even in patients with HCC, where there are numerous and large tumours present, macroscopically invading the veins
Biopsija resektabilnih jetrnih zasevkov raka debelega črevesa in danke: nepotrebna in nevarna metoda
If in the patient who underwent surgery for colorectal cancer (CC) a newly developed tumour is detected in the liver, it is possible to assume immediately that it is a metastasis. Moreover, it is possible to confirm the diagnosis with 99% probability based on imaging and biochemical screening. Despite this some insist that diagnosis needs to be confirmed with percutaneous core needle biopsy (PCNB). With a review of the literature and an analysis of our series of patients, we will try to show why this procedure is unnecessary and dangerous in patients with resectable liver metastases of CC.Če se pri bolniku, ki je bil operiran zaradi raka debelega črevesa in danke (RDČD), na novo pojavi tumor v jetrih, je mogoče že na podlagi tega sklepati, da gre za zasevek. Še več, diagnozo je mogoče z 99 % verjetnostjo potrditi na podlagi slikovnih in biokemičnih preiskav. Kljub temu nekateri vztrajajo, da je za potrditev diagnoze potrebna perkutana tankoigelna biopsija (PTB). Nepotrebnost in nevarnost tega postopka pri resektabilnih jetrnih zasevkih RDČD bomo poskušali utemeljiti s pregledom literature in analizo naše serije bolnikov
Repeat liver surgeries in the recidive of colorectal cancer metastases - a case study
Pri polovici bolnikov z rakom debelega črevesa in danke se lahko pojavijo zasevki v jetrih. Multidisciplinarna obravnava predstavlja temelj uspešnega zdravljenja, resekcija jeter pa je edina potencialno kurativna oblika terapije. Kljub uspešni operaciji pa se lahko jetrni zasevki kasneje ponovijo. Tudi v takšnem primeru je smiselno znova začeti zdravljenje, ki zajema kombinacijo kemoterapije, tarčnih zdravil in načrtovanja ponovnih jetrnih resekcij. Nekateri bolniki živijo brez ponovitve obolenja več let po začetku zdravljenja.Half of colorectal cancer patients may develop liver metastases. Multidisciplinary management is the basis for successful treatment, and liver resection represents the only potentially curative form of therapy. Despite a successful surgery, liver metastases may later recur. In such cases, it is wise to restart treatment with a combination of chemotherapy and target drugs, and to plan repeat liver resections. After the treatment, some patients can live for years without disease recurrence
Ponovne operacije jeter pri recidivu zasevkov raka debelega črevesa in danke: prikaz primera
Half of colorectal cancer patients may develop liver metastases. Multidisciplinary management is the basis for successful treatment, and liver resection represents the only potentially curative form of therapy. Despite a successful surgery, liver metastases may later recur. In such cases, it is wise to restart treatment with a combination of chemotherapy and target drugs, and to plan repeat liver resections. After the treatment, some patients can live for years without disease recurrence.Pri polovici bolnikov z rakom debelega črevesa in danke se lahko pojavijo zasevki v jetrih. Multidisciplinarna obravnava predstavlja temelj uspešnega zdravljenja, resekcija jeter pa je edina potencialno kurativna oblika terapije. Kljub uspešni operaciji pa se lahko jetrni zasevki kasneje ponovijo. Tudi v takšnem primeru je smiselno znova začeti zdravljenje, ki zajema kombinacijo kemoterapije, tarčnih zdravil in načrtovanja ponovnih jetrnih resekcij. Nekateri bolniki živijo brez ponovitve obolenja več let po začetku zdravljenja
Biopsy of resectable liver metastases of colorectal cancer – an unnecessary and dangerous method
Če se pri bolniku, ki je bil operiran zaradi raka debelega črevesa in danke (RDČD), na novo pojavi tumor v jetrih, je mogoče že na podlagi tega sklepati, da gre za zasevek. Še več, diagnozo je mogoče z 99 % verjetnostjo potrditi na podlagi slikovnih in biokemičnih preiskav. Kljub temu nekateri vztrajajo, da je za potrditev diagnoze potrebna perkutana tankoigelna biopsija (PTB). Nepotrebnost in nevarnost tega postopka pri resektabilnih jetrnih zasevkih RDČD bomo poskušali utemeljiti s pregledom literature in analizo naše serije bolnikov.If in the patient who underwent surgery for colorectal cancer (CC) a newly developed tumour is detected in the liver, it is possible to assume immediately that it is a metastasis. Moreover, it is possible to confirm the diagnosis with 99% probability based on imaging and biochemical screening. Despite this some insist that diagnosis needs to be confirmed with percutaneous core needle biopsy (PCNB). With a review of the literature and an analysis of our series of patients, we will try to show why this procedure is unnecessary and dangerous in patients with resectable liver metastases of CC
Results of surgical treatment of resectable liver metastases in colorectal cancer at the University Clinical Centre Maribor
Izhodišča: Pri bolnikih z jetrnimi metastazami (JM) pri kolorektalnem raku (KRR) le kirurško zdravljenje, sedaj pogosto kombinirano z drugimi načini zdravljenja, nudi možnost dolgotrajnejšega preživetja ali pa celo upanje na ozdravitev. Namen raziskave je prikaz možnosti multimodalnega načina zdravljenja in ocenitev rezultatov takšnega zdravljenja JM pri KRR pri naših bolnikih. Metode: V obdobju od 1. julija 1997 do 31. decembra 2011 je bilo opravljenih 377 jetrnih operacij pri 281 bolnikih z metastazami KRR (178 moški, 103 ženskepovprečna starost 63,3 letarazpon 27 do 85 let). Rezultati: Od skupno 377 operacij zaradi JM KRR je bila 324-krat opravljena resekcija jeter, od tega pri 28 bolnikih kombinirana z RFA. 235 (79,4 %) je bilo R0 resekcij, 54 (18,2 %) je bilo R1 in 7 (2,4 %) R2 resekcij. Skupno 53 posegi so bile RFA JM. Pri 113 bolnikih so bile JM ugotovljene sinhrono ob ugotovitvi KRR, pri 168 pa je šlo za metahrone JM. 145 bolnikov je imelo unilobarne, 136 pa bilobarne metastaze. Povprečno je bilo 2,9 jetrnih metastaz, povprečna velikost metastaz pa je bila 4,3 cm. Pri 46 bolnikih je bilo obolenje prisotno tudi zunaj jeter. 131 bolnikov je pred jetrno operacijo prejemalo neoadjuvantno kemoterapijo. 16-krat je bila za povečanje preostanka jeter opravljena portalna embolizacija, 10-krat pa ligatura desne veje vene porte. Simultana resekcija jeter je bila narejena pri 41 bolnikih. Pri prvi operaciji je bila opravljena resekcija jeter pri 252 bolnikih. Pri 239 bolnikih je bila narejena samo resekcija jeter, pri 23 bolnikih pa je bila resekcija kombinirana še z radiofrekventno ablacijo JM (RFA). Od 239 resekcij JM brez dodatne RFA je bilo 198 (83 %) resekcij R0, 36 (15 %) R1, 5 (2 %) pa R2 resekcij. Pri 29 bolnikih je bila narejena samo RFA JM (20-krat odprta RFA, 9-krat perkutana RFA). Zaradi ponovitve obolenja smo operirali 73 bolnikov, pri katerih smo opravili 96 posegov (1 do 6 na bolnika). Upoštevajoč vse opravljene operacije (377) je bila skupna pooperacijska obolevnost 25,5 %, 30-dnevna umrljivost pa je bila 1,9 %. Pričakovano 5-letno preživetje pri bolnikih z R0 resekcijo JM in brez zunaj jetrnega obolenja je bilo 38,3 % (mediano preživetje: 43 mesecev). Zaključki: Resekcije jeter so varne (morbiditeta: 25,5 %30 mortaliteta: 1,9 pri R0 resekcijah), glede na pričakovano dolgoročno preživetje (5-letno 38,3 %, mediana 43 mesecev) pa trenutno predstavljajo najučinkovitejši način zdravljenja bolnikov z metastazami KRR. Poudarjen je pomen multidisciplinarnega pristopa in multimodalnega zdravljenja bolnikov z metastazami KRRBackground: Only surgical treatment in patients with liver metastases (LM) in colorectal cancer (CC), which is nowadays often combined with other forms of treatment, offers the possibility of long-term survival or even hope of a cure. The aim of this study is to present the possibilities of multimodal treatment and to assess the results of such treatment of LM in CC in our patients. Methods: In the period from 1 July 1997 to 31 December 2011, a total of 377 liver surgeries were performed in 281 patients with metastases of CC (107 men, 103 womenmean age 63.3 yearsspan of 27 to 85 years). Results: Of 377 surgeries for LM of CC, liver resection was performed 324 times, and in 28 of those patients in combination with RFA. 235 (79.4%) were R0 resections, 54 (18.2%) were R1 and 7 (2.4% were R2 resections. A total of 53 procedures were RFA of LM. In 113 patients, LM were diagnosed synchronously with CC, and 168 men had metachronous LM. Unilobar metastases were found in 145 patients, and 136 had bilobar metastases. On average, there were 2.9 liver metastases with an average size of 4.3 cm. In 46 patients, the disease was present also outside the liver. Prior to liver surgery, 131 patients underwent neoadjuvant chemotherapy. In 16 cases, portal embolisation was performed to increase the residual liver volume, and ligature of the right branch of the vena porta was performed 10 times. Simultaneous liver resection was performed in 41 patients. At the first surgery, liver resection was performed in 252 patients. Liver resection alone was performed in 239 patients, whereas in 23 patients, it was combined with radiofrequency ablation of LM (RFA). Of 239 LM resections without additional RFA, 198 (83%) were R0 resections, 36 (15%) were R1 and 5 (2%) were R2 resections. In 29 patients, only RFA of LM was performed (open RFA 20 times, percutaneous RFA 9 times). Surgery for disease recurrences was performed on 73 patients, who underwent 96 procedures (1 to 6 per patient). Considering all surgeries (377), the total post-operative incidence was 25.5%, and 30-day morbidity was 1.9%. The expected 5-year survival in patients with R0 resection of LM and no disease outside the liver was 38.3% (median survival: 43 months Conclusions: Liver resections are safe (morbidity: 25.5%30-day morbidity: 1.9% in R0 resections). Considering the expected long-term survival (5-year of 38.8%, median of 43 months), they currently represent the most effective method for the treatment patients with metastases of CC. The focus is on the importance of a multidisciplinary approach and multi modal treatment of patients with metastases of CC
Laparoscopic versus open liver resection for intrahepatic cholangiocarcinoma: a multicenter propensity score-matched study
Background: The role of laparoscopy in the treatment of intrahepatic cholangiocarcinoma (ICC)
remains unclear. This multicenter study examined the outcomes of laparoscopic liver resection for ICC.
Methods: Patients with ICC who had undergone laparoscopic or open liver resection between 2012
and 2019 at four European expert centers were included in the study. Laparoscopic and open
approaches were compared in terms of surgical and oncological outcomes. Propensity score matching
was used for minimizing treatment selection bias and adjusting for confounders (age, ASA grade,
tumor size, location, number of tumors and underlying liver disease).
Results: Of 136 patients, 50 (36.7%) underwent laparoscopic resection, whereas 86 (63.3%) had open surgery. Median tumor size was larger (73.6 vs 55.1 mm, p¼ 0.01) and the incidence of bi-lobar tumors was
higher (36.6 vs 6%, p< 0.01) in patients undergoing open surgery. After propensity score matching baseline characteristics were comparable although open surgery was associated with a larger fraction of major
liver resections (74 vs 38%, p< 0.01), lymphadenectomy (60 vs 20%, p< 0.01) and longer operative time
(294 vs 209 min, p< 0.01). Tumor characteristics were similar. Laparoscopic resection resulted in less complications (30 vs 52%, p¼ 0.025), fewer reoperations (4 vs 16%, p¼ 0.046) and shorter hospital stay (5 vs
8 days, p< 0.01). No differences were found in terms of recurrence, recurrence-free and overall survival.
Conclusion: Laparoscopic resection seems to be associated with improved short-term and with similar
long-term outcomes compared with open surgery in patients with ICC. However, possible selection criteria for laparoscopic surgery are yet to be defined
Outcomes and risk score for distal pancreatectomy with celiac axis resection (DP-CAR) : an international multicenter analysis
Background: Distal pancreatectomy with celiac axis resection (DP-CAR) is a treatment option for selected patients with pancreatic cancer involving the celiac axis. A recent multicenter European study reported a 90-day mortality rate of 16%, highlighting the importance of patient selection. The authors constructed a risk score to predict 90-day mortality and assessed oncologic outcomes.
Methods: This multicenter retrospective cohort study investigated patients undergoing DP-CAR at 20 European centers from 12 countries (model design 2000-2016) and three very-high-volume international centers in the United States and Japan (model validation 2004-2017). The area under receiver operator curve (AUC) and calibration plots were used for validation of the 90-day mortality risk model. Secondary outcomes included resection margin status, adjuvant therapy, and survival.
Results: For 191 DP-CAR patients, the 90-day mortality rate was 5.5% (95 confidence interval [CI], 2.2-11%) at 5 high-volume (1 DP-CAR/year) and 18% (95 CI, 9-30%) at 18 low-volume DP-CAR centers (P=0.015). A risk score with age, sex, body mass index (BMI), American Society of Anesthesiologists (ASA) score, multivisceral resection, open versus minimally invasive surgery, and low- versus high-volume center performed well in both the design and validation cohorts (AUC, 0.79 vs 0.74; P=0.642). For 174 patients with pancreatic ductal adenocarcinoma, the R0 resection rate was 60%, neoadjuvant and adjuvant therapies were applied for respectively 69% and 67% of the patients, and the median overall survival period was 19months (95 CI, 15-25months).
Conclusions: When performed for selected patients at high-volume centers, DP-CAR is associated with acceptable 90-day mortality and overall survival. The authors propose a 90-day mortality risk score to improve patient selection and outcomes, with DP-CAR volume as the dominant predictor
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