scholarly journals Surgical liver resection in multimodal therapy of hepatic malignat affections: A 4-year study

2002 ◽  
Vol 10 (1) ◽  
pp. 1-5 ◽  
Author(s):  
Tomas Krejci ◽  
Tomas Skricka ◽  
Milos Ruzicka ◽  
Martin Stracar
Keyword(s):  
Multimodal Therapy ◽  
Postoperative Morbidity ◽  
Radical Resection ◽  
Primary Resection ◽  
Technical Equipment ◽  
Liver Malignancies ◽  
Number Of Patients ◽  
Radiological Methods ◽  
Preoperative Examination ◽  
Metastatic Liver

BACKGROUND: The goal of our study was to evaluate our hitherto 4-year surgical treatment of liver malignancies. METHODS: Our team performed 43 liver resections from 1997 to 2000. Of these, 10 were primary tumours and 33 metastases. The most frequent indication for resection in our sample was for colorectal cancer - in total 27 patients. Metastatic pancreatic cancer or metastases of malignant melanoma account for rarer indications to surgery We considered CT arterioportography (CTAP) as the most significant preoperative examination from all available radiological methods. RESULTS Proper resection of the liver is possible even without special technical equipment. No patient between the ages of 22 - 82 years died in the 30-day postoperative period. Our postoperative morbidity was 18.6%. The most frequent complication was prolonged biliary secretion from drains. In our study, recurrent liver malignancies occurred most frequently within 6 months from the primary resection. CONCLUSION: Radical resection procedure may be facilitated for the greatest number of patients with primary or metastatic liver malignancies by the cohesive cooperation of a number of specialists.

scholarly journals Perioperative hemodynamic optimization: from guidelines to implementation—an experts’ opinion paper

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Jean-Luc Fellahi ◽  
Emmanuel Futier ◽  
Camille Vaisse ◽  
Olivier Collange ◽  
Olivier Huet ◽  
...  
Keyword(s):  
High Risk ◽  
Fluid Therapy ◽  
Postoperative Morbidity ◽  
Large Body ◽  
Surgical Patients ◽  
Cardiac Output Monitoring ◽  
Routine Practice ◽  
Daily Routine ◽  
Hemodynamic Optimization ◽  
Number Of Patients

AbstractDespite a large body of evidence, the implementation of guidelines on hemodynamic optimization and goal-directed therapy remains limited in daily routine practice. To facilitate/accelerate this implementation, a panel of experts in the field proposes an approach based on six relevant questions/answers that are frequently mentioned by clinicians, using a critical appraisal of the literature and a modified Delphi process. The mean arterial pressure is a major determinant of organ perfusion, so that the authors unanimously recommend not to tolerate absolute values below 65 mmHg during surgery to reduce the risk of postoperative organ dysfunction. Despite well-identified limitations, the authors unanimously propose the use of dynamic indices to rationalize fluid therapy in a large number of patients undergoing non-cardiac surgery, pending the implementation of a “validity criteria checklist” before applying volume expansion. The authors recommend with a good agreement mini- or non-invasive stroke volume/cardiac output monitoring in moderate to high-risk surgical patients to optimize fluid therapy on an individual basis and avoid volume overload. The authors propose to use fluids and vasoconstrictors in combination to achieve optimal blood flow and maintain perfusion pressure above the thresholds considered at risk. Although purchase of disposable sensors and stand-alone monitors will result in additional costs, the authors unanimously acknowledge that there are data strongly suggesting this may be counterbalanced by a sustained reduction in postoperative morbidity and hospital lengths of stay. Beside existing guidelines, knowledge and explicit clinical reasoning tools followed by decision algorithms are mandatory to implement individualized hemodynamic optimization strategies and reduce postoperative morbidity and duration of hospital stay in high-risk surgical patients.

705 SIGNIFICANCE OF CLEAR CIRCUMFERENTIAL RESECTION MARGIN IN ESOPHAGEAL CANCER

2021 ◽  
Vol 34 (Supplement_1) ◽  
Author(s):  
Catherine Cheang ◽  
Pradeep Patil
Keyword(s):  
Esophageal Cancer ◽  
Multimodal Therapy ◽  
Resection Margin ◽  
Locally Advanced ◽  
Radical Resection ◽  
Resection Margins ◽  
R0 Resection ◽  
Term Survival ◽  
R1 Resection

Abstract   Circumferential resection margins (CRM) of an esophagectomy specimen for oesophageal cancer is a key prognostic factor of overall survival (OS). This retrospective study aims to compare OS of post-esophagectomy patients with CRM of >1 mm (R0) and < 1 mm (R1) with further subgroup analysis of locally advanced T3R0 vs T3R1 resection. Methods A total of 110 esophagectomies conducted between 2010 and 2020 were analysed. We recorded R stage based on pathological CRM >1 mm (R0) or < 1 mm (R1). OS was calculated from the day of surgery to day of death or otherwise censored. All patients underwent multimodal therapy including chemotherapy and similar pre-surgical and post-surgical management. 58 of these patients with pT3 stage esophageal cancer (EC) were selected and compared. Statistical analysis was carried out using SPSS. Results Of 110 patients, 78 (71.5%) patients had a R0 resection. Mean OS in R0 resections was 73 months (6 years) compared to 25.2 months (2 years) in R1 resection (p = 0.001). 58 of the 110 patients were pathological stage T3(pT3) despite downstaging with chemotherapy showing the burden of advanced disease. In patients with stage pT3 (n = 58), 32 patients were R0 resections, and 26 patients had R1 resections. Mean OS in T3R0 resections was 51.5 months compared to 28.5 months in T3R1 resection. OS comparison is significant (p = 0.011). Conclusion This study emphasizes the importance of clear CRM in all patients and especially in locally advanced pT3/T4a esophageal cancer in achieving long term survival. Techniques used to ensure a clear CRM such multimodality therapy combined with surgical radical resection concepts such as mesoesophagectomy should be employed.

scholarly journals The Revolution in Indication for Liver Transplantation: Will Liver Metastatic Disease Overcome the End-Stage Liver Disease in the Next Future?

2020 ◽  
Vol 1 (2) ◽  
pp. 111-122
Author(s):  
Tommaso Maria Manzia ◽  
Alessandro Parente ◽  
Roberta Angelico ◽  
Carlo Gazia ◽  
Giuseppe Tisone
Keyword(s):  
Liver Transplantation ◽  
Liver Disease ◽  
Liver Tumors ◽  
Liver Malignancies ◽  
New Concepts ◽  
Innovative Therapies ◽  
Recent Developments ◽  
Underlying Causes ◽  
End Stage ◽  
Metastatic Liver

Indications for liver transplantation (LT) have constantly been evolving during the last few decades due to a better understanding of liver diseases and innovative therapies. Likewise, also the underlying causes of liver disease have changed. In the setting of transplant oncology, recent developments have pushed the boundaries of oncological indications for LT outside hepatocellular carcinoma (HCC), especially for secondary liver tumors, such as neuroendocrine and colorectal cancer. In the next years, as more evidence emerges, LT could become the standard treatment for well-selected metastatic liver tumors. In this manuscript, we review and summarize the available evidence for LT in liver tumors beyond HCC with a focus on metastatic liver malignancies, highlighting the importance of these new concepts for future implications.

Metastatic esophagogastric adenocarcinomas (EGA): Treatment, prognosis, and pretherapeutic selection options.

2014 ◽  
Vol 32 (3_suppl) ◽  
pp. 142-142
Author(s):  
Katja Ott ◽  
Susanne Blank ◽  
Dirk Jaeger ◽  
Wilko Weichert ◽  
Leila Sisic ◽  
...  
Keyword(s):  
Clinical Response ◽  
Multivisceral Resection ◽  
Primary Objective ◽  
Primary Resection ◽  
Published Data ◽  
Number Of Patients ◽  
Tumor Boards ◽  
Treatment Prognosis ◽  
Prospective Database

142 Background: Nowadays an increasing number of patients (pts.) with metastatic disease (MD) are discussed in interdisciplinary tumor boards. Preliminary results of the FLOT-3 study suggest a benefit for pts. with limited MD after resection compared to pts. with chemotherapy (CTx) only. Own published data suggest that a subgroup of pts. may benefit from surgery (ESJO, 2013). Primary objective of this retrospective explorative study was the outcome of pts. with resected metastatic EGA and the evaluation of our preoperative prognosis score (PPS) in a larger patients`series. Methods: From 2001-2012 123/800 EGA were classified as cM1 either confirmed intraoperatively as pM1 or confirmed by imaging during follow-up. Response evaluation was performed clinically by endoscopy and CT-scan, histopathologically by the Becker regression score. The PPS for pts. treated with CTx contains grading, clinical response and presumed R-category. Analysis was performed retrospectively from a prospective database. Results: M1 sites (70 AEG, 53 gastric cancer): 27 liver, 43 distant lymph nodes, 16 peritoneum, 10 lung, 6 others, 21 multiple. 11 (9%) were only explored, the rest resected. 49/112 (40%) had multivisceral resections. 63/112 (56%) were completely resected (R0). 72 had preoperative CTx, 51 primary resection. 26 (21%) were classified as clinical responder, 16 (13%) as histopathological responder, 30 (42%) as subgroup with improved prognosis by the PPS. The median survival was 20.0 months (m.). Survival was significantly increased by resection, a complete resection and a preoperative CTx (primary resection: 11m., after CTx: 30 m.)(all p=0.001), but not by multivisceral resection, number or type of metastases or localization of the primary tumor. In pts. who had preoperative CTx, clinical response and the PPS (21 m. versus 66 m., p=0.005) significantly influenced survival. In R0 pts. preoperative CTx (p=0.03), clinical response and the PPS remained prognostic (both p=0.001). Conclusions: A primary resection without preoperative CTx is not appropriate for metastatic EGA. Subgroups of pts. with limited metastatic spread may be selected for surgery using the PPS. Prospective randomized studies are required.

Postoperative Morbidity After Radical Resection of Primary Retroperitoneal Sarcoma

2018 ◽  
Vol 267 (5) ◽  
pp. 959-964 ◽  
Author(s):  
Andrea J. MacNeill ◽  
Alessandro Gronchi ◽  
Rosalba Miceli ◽  
Sylvie Bonvalot ◽  
Carol J. Swallow ◽  
...  
Keyword(s):  
Postoperative Morbidity ◽  
Radical Resection ◽  
Retroperitoneal Sarcoma ◽  
Primary Retroperitoneal

scholarly journals Can We Consider the Possibility of Transurethral Resection of the Prostate (TURP) Becoming Another Gateway to the Focal Therapy of Localized Prostate Cancer?

2020 ◽  
Vol 3 (2) ◽  
pp. e22-e30
Author(s):  
Masaru Morita ◽  
Akira Morita ◽  
Takeshi Matsuura
Keyword(s):  
Prostate Cancer ◽  
Transurethral Resection ◽  
Risk Group ◽  
Radical Resection ◽  
Focal Therapy ◽  
Localized Prostate Cancer ◽  
Transurethral Resection Of Prostate ◽  
Low Grade ◽  
Psa Testing ◽  
Number Of Patients

Background and ObjectivesMinimally invasive methods are expected to avoid the risk of overtreatment and overtreatment of radical therapy to manage the increased number of patients with low-volume, low-grade localized prostate cancer. Based on our experience of radical transurethral resection of prostate cancer (TURPCa) as a radical treatment, we studied the efficacy and safety of focal TURPCa as a focal therapy for patients with localized prostate cancer. Materials and MethodsWe performed focal TURPCa in 49 patients during the period from July 2007 to August 2016 and followed them with prostate-specific antigen (PSA) testing for the mean period of 68.0 months. We selected the patient as a candidate for the study if the biopsy revealed that cancer foci were limited in one lobe, or the foci were several or less even found in both lobes. Standard TURP was followed by further resection and fulguration of the peripheral zone where cancer was considered to exist. We selected one of our three methods of focal TURPCa as follows: one lobe radical TURPCa, radical resection of the affected lobe with unaffected lobe being resected less vigorously; nerve-sparing radical TURPCa, radical resection of both lobes except for the posterolateral part of the prostate; target radical TURPCa, radical resection of the cancer focus and the surrounding prostate when the target is suggested single. ResultsTwelve patients were in the low-risk group (D’Amico), 29 in the intermediate-risk group, and 8 in the high-risk group. Pathological stages were as follows: pT0, three cases; pT2a-b, 17 cases; pT2c, 29 cases. The preoperative PSA of 6.15±2.73 ng/mL (mean±SD) dropped to 0.172±0.283 ng/mL postoperatively. PSA failure occurred in only two patients (4.1%). Incontinence did not develop and erectile function was preserved in eight (44.4%) of the 18 potent patients. The most frequent complication was bladder neck contracture (20.4%). Other complications included acute epididymitis (8.1%), bladder tamponade (2.0%). No patients died of prostate cancer. ConclusionsThough the final assessment of efficacy will require long-term follow-up results with more cases, we may think focal TURPCa can be another treatment option as a focal therapy for localized prostate cancer.

scholarly journals Postoperative Morbidity and Failure to Rescue in Surgery for Gastric Cancer: A Single Center Retrospective Cohort Study of 1107 Patients from 1972 to 2014

Cancers ◽  
2020 ◽  
Vol 12 (7) ◽  
pp. 1953
Author(s):  
Christian Galata ◽  
Ulrich Ronellenfitsch ◽  
Susanne Blank ◽  
Christoph Reißfelder ◽  
Julia Hardt
Keyword(s):  
Gastric Cancer ◽  
Surgical Complications ◽  
Postoperative Morbidity ◽  
Postoperative Mortality ◽  
Radical Resection ◽  
Failure To Rescue ◽  
Surgical Morbidity ◽  
Significant Difference ◽  
Lethal Complications ◽  
Early Cohort

Background: The aim of this study was to evaluate postoperative morbidity, mortality, and failure to rescue following complications after radical resection for gastric cancer. Methods: A retrospective analysis of the surgical database of patients with gastroesophageal malignancies at our institution was performed. All consecutive patients undergoing R0 gastrectomy for pT1–4 M0 gastric adenocarcinoma between October 1972 and February 2014 were eligible for this analysis. Patients were divided into two groups according to the date of surgery: an early cohort operated on from 1972–1992 and a late cohort operated on from 1993–2014. Both groups were compared regarding patient characteristics and surgical outcomes. Results: A total of 1107 patients were included. Postoperative mortality was more than twice as high in patients operated on from 1972–1992 compared to patients operated on from 1993–2014 (6.8% vs. 3.2%, p = 0.017). Between both groups, no significant difference in failure to rescue after major surgical complications was observed (20.8% vs. 20.5%, p = 1.000). Failure to rescue after other surgical and non-surgical complications was 37.8% in the early cohort compared to 3.2% in the late cohort (p < 0.001). Non-surgical complications accounted for 71.2% of lethal complications between 1972 and 1992, but only for 18.2% of lethal complications between 1993 and 2014 (p = 0.002). Conclusion: In the course of four decades, postoperative mortality after radical resection for gastric cancer has more than halved. In this cohort, the reason for this decrease was reduced mortality due to non-surgical complications. Major surgical morbidity after gastrectomy remains challenging.

Clival chordomas: clinical management, results, and complications in 71 patients

2010 ◽  
Vol 113 (5) ◽  
pp. 1059-1071 ◽  
Author(s):  
Chandranath Sen ◽  
Aymara I. Triana ◽  
Niklas Berglind ◽  
James Godbold ◽  
Raj K. Shrivastava
Keyword(s):  
Skull Base ◽  
Proton Beam ◽  
Positive Impact ◽  
Tumor Resection ◽  
Radical Resection ◽  
Surgical Approaches ◽  
Malignant Neoplasms ◽  
Radical Excision ◽  
Number Of Patients ◽  
Csf Leakage

Object Chordomas are rare malignant neoplasms arising predominantly at the sacrum and skull base. They are uniformly lethal unless treated with aggressive resection and proton beam irradiation. The authors present results of the surgical management of a large number of patients with clivus chordomas. Factors that influence the surgeon's ability to achieve radical tumor resection are also evaluated. Methods Between 1991 and 2005, 71 patients with clivus chordomas underwent surgery. The average follow-up was 66 months (median 60 months, range 3–189 months). Sixty-five patients had complete records that were analyzed in the present report. Thirty-five percent of them had undergone surgery before being treated by the authors. They were evaluated with MR imaging and CT scanning and underwent surgery utilizing a variety of skull base techniques aimed at achieving radical excision. Many also underwent postoperative radiation, usually in the form of proton beam therapy. The patients were followed up with serial imaging at regular intervals as well as with neurological evaluation. Results Radical tumor resection was achieved in 58% of the group. The overall 5-year survival rate was 75%. Radical resection had a positive impact on survival. The ability to achieve radical resection was dependent on the preoperative tumor volume and the number of anatomical areas involved by the tumor. Cranial nerve impairment and CSF leakage were the most frequent postoperative complications. Conclusions Radical excision is the ideal surgical goal in the treatment of clival chordomas and can be achieved with reasonable risks. Several different surgical approaches may be necessary to accomplish this.

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