1. Management of colorectal liver metastases involves various treatment strategies depending on the extent of disease including primary-first, simultaneous resection, liver-first, and two-stage hepatectomy approaches.
2. The optimal strategy aims to achieve an R0 resection of all metastases while preserving sufficient future liver remnant volume.
3. Preoperative chemotherapy can help downstage initially unresectable disease in select patients, allowing for potentially curative surgery.
- The document summarizes key landmark clinical trials investigating treatments for metastatic gastric cancer.
- The ToGA trial found that adding trastuzumab (Herceptin) to standard chemotherapy (cisplatin and fluoropyrimidine) significantly improved overall survival and progression-free survival in patients with HER2-positive metastatic gastric cancer compared to chemotherapy alone. Median overall survival was 13.8 months with chemotherapy plus trastuzumab versus 11.1 months with chemotherapy alone.
- The REAL-2 trial demonstrated that cisplatin plus capecitabine was as effective as cisplatin plus fluorouracil for advanced gastric cancer, with less toxicity. Cisplatin plus capecitabine has since
The document discusses the role of chemotherapy in carcinoma of the stomach. It outlines several key trials investigating neoadjuvant, adjuvant and perioperative chemotherapy approaches. The MAGIC trial showed significantly improved 5-year survival with perioperative chemotherapy compared to surgery alone. The French FNCLCC trial also demonstrated improved disease-free and overall survival with perioperative chemotherapy. Adjuvant chemoradiation was shown in the INT0116/SWOG 9008 trial to improve 5-year overall and disease-free survival compared to surgery alone. The Japanese S-1 trial found significant benefit in 5-year disease-free and overall survival with adjuvant S-1 chemotherapy compared to observation after surgery.
Métastases Hépatiques : Le Pr Christophe Penna, AP-HP Hôpital de Kremlin-Bicêtre nous donne son point vue de chirurgien colo-réctal sur le traitement à adapter en cas du cancer du colon
Here are the main options for the timing of resection:
- Colon first (staged approach): Resect the primary colon tumor first, followed by chemotherapy, then resect the liver metastases at a later date if the patient responds well to chemotherapy.
- Colon and liver simultaneously: Resect both the primary colon tumor and liver metastases in one surgery. This is typically only done if the tumors are resectable upfront with low risk.
1. Management of colorectal liver metastases involves various treatment strategies depending on the extent of disease including primary-first, simultaneous resection, liver-first, and two-stage hepatectomy approaches.
2. The optimal strategy aims to achieve an R0 resection of all metastases while preserving sufficient future liver remnant volume.
3. Preoperative chemotherapy can help downstage initially unresectable disease in select patients, allowing for potentially curative surgery.
- The document summarizes key landmark clinical trials investigating treatments for metastatic gastric cancer.
- The ToGA trial found that adding trastuzumab (Herceptin) to standard chemotherapy (cisplatin and fluoropyrimidine) significantly improved overall survival and progression-free survival in patients with HER2-positive metastatic gastric cancer compared to chemotherapy alone. Median overall survival was 13.8 months with chemotherapy plus trastuzumab versus 11.1 months with chemotherapy alone.
- The REAL-2 trial demonstrated that cisplatin plus capecitabine was as effective as cisplatin plus fluorouracil for advanced gastric cancer, with less toxicity. Cisplatin plus capecitabine has since
The document discusses the role of chemotherapy in carcinoma of the stomach. It outlines several key trials investigating neoadjuvant, adjuvant and perioperative chemotherapy approaches. The MAGIC trial showed significantly improved 5-year survival with perioperative chemotherapy compared to surgery alone. The French FNCLCC trial also demonstrated improved disease-free and overall survival with perioperative chemotherapy. Adjuvant chemoradiation was shown in the INT0116/SWOG 9008 trial to improve 5-year overall and disease-free survival compared to surgery alone. The Japanese S-1 trial found significant benefit in 5-year disease-free and overall survival with adjuvant S-1 chemotherapy compared to observation after surgery.
Métastases Hépatiques : Le Pr Christophe Penna, AP-HP Hôpital de Kremlin-Bicêtre nous donne son point vue de chirurgien colo-réctal sur le traitement à adapter en cas du cancer du colon
Here are the main options for the timing of resection:
- Colon first (staged approach): Resect the primary colon tumor first, followed by chemotherapy, then resect the liver metastases at a later date if the patient responds well to chemotherapy.
- Colon and liver simultaneously: Resect both the primary colon tumor and liver metastases in one surgery. This is typically only done if the tumors are resectable upfront with low risk.
This document discusses the management of colorectal liver metastases. It addresses topics such as:
- The role of PET-CT scans in assessing resectability and the limited impact they have on surgical management.
- Strategies to improve resectability for patients with multiple or bilobar tumors, including portal vein embolization, portal vein ligation, and ALPPS.
- The importance of volumetric assessment of the future liver remnant using CT or MRI to ensure sufficient functional liver remains post-resection.
- Approaches for synchronous and metachronous colorectal liver metastases, including primary-first, liver-first, and simultaneous resections.
- The role
This document summarizes several landmark trials investigating chemotherapy and radiation therapy approaches for gastric cancer. Key points include:
- Perioperative chemotherapy is now standard for resectable stage II-IV gastric cancer based on trials like MAGIC and FLOT4 showing improved survival.
- FLOT4 established docetaxel-based chemotherapy as the preferred perioperative regimen.
- Adjuvant chemotherapy is recommended after curative surgery without neoadjuvant therapy based on the CLASSIC trial.
- Trials like ARTIST1/2 and CALGB80101 found no benefit to adding adjuvant radiation after D2 lymph node dissection.
- Targeted agents like trastuzumab and ramuc
Perioperative chemotherapy has been shown to improve outcomes for resectable gastric cancer compared to surgery alone. Multiple large randomized controlled trials have found that perioperative chemotherapy results in higher R0 resection rates, improved progression-free survival, and overall survival compared to surgery alone. The addition of preoperative chemoradiotherapy to perioperative chemotherapy did not provide additional benefits in overall survival or progression-free survival compared to perioperative chemotherapy alone in one large trial. Ongoing trials are evaluating whether preoperative chemoradiotherapy can be safely added to improve outcomes further.
1. Neoadjuvant chemoradiotherapy (CTRT) followed by total mesorectal excision (TME) surgery has become the standard of care for locally advanced rectal cancer based on improved local control and survival outcomes compared to surgery or radiotherapy (RT) alone.
2. The addition of chemotherapy to neoadjuvant RT improves pathological complete response rates and local control compared to RT alone, though it also increases toxicity.
3. For patients who achieve a clinical complete response after neoadjuvant CTRT, a non-operative "watch and wait" approach may be considered given comparable oncologic outcomes when salvage surgery is performed for recurrences.
basic principles of hepatic resection including liver anatomy, segmentation and vascular control techniques. also adjuncts to successful and safe liver resection, blood loss management techniques and more. the aim is to provide guidelines for safe hepatic surgery and apply the recent adjuncts.
1. Pancreatic neuroendocrine tumors (PNETs) are rare, slow-growing neoplasms that originate from cells that produce and secrete hormones.
2. The most common functional PNETs are insulinomas, gastrinomas, glucagonomas, and VIPomas. Non-functional PNETs make up about 75% of cases.
3. Diagnosis involves biochemical testing for hormone levels, imaging such as CT, MRI, and nuclear imaging to locate the primary tumor and metastases, and pathology to determine grade and stage. Endoscopic ultrasound can help locate small tumors.
Neoadjuvant therapy in colorectal carcinomaAnkita Singh
- Several studies have shown that neoadjuvant therapy decreases local recurrence rates in colorectal cancer when compared to surgery alone. One study showed a statistically significant decrease in local recurrence with the addition of chemotherapy to preoperative radiotherapy.
- Evidence indicates that long-course chemoradiotherapy, induction chemotherapy followed by long-course chemoradiotherapy, and short-course radiotherapy are the three accepted neoadjuvant approaches, with long-course chemoradiotherapy being the most commonly used currently. Short-course radiotherapy has also shown non-inferior oncologic outcomes compared to long-course chemoradiotherapy in some studies.
This document discusses the management of gallbladder cancer. It covers diagnosis, staging, and surgical treatment approaches based on tumor stage. For early stage T1a tumors found incidentally after cholecystectomy, simple cholecystectomy may be adequate. For T1b and T2 tumors, radical resection including lymph node dissection is recommended due to higher risk of residual disease and lymph node involvement. For locally advanced T3/T4 or node positive cancers, radical surgery with hepatic resection or multi-organ resection is supported, though morbidity and mortality are high; N2 node involvement carries a poor prognosis. Staging laparoscopy is important to identify unresectable disease not apparent on imaging.
Endoscopic Hemostasis - for Endoscopy NursesJarrod Lee
Endoscopic hemostasis is an important first line treatment modality in bleeding from the gastrointestinal tract. It is also a prerequisite skill for anyone performing therapeutic endoscopy, where bleeding is the most common intra-procedural endoscopic complication. This lecture is aimed at endoscopy nurses assisting the endoscopist, and gives an overview of endoscopic hemostasis in routine endoscopy today.
Complete Mesocolic Excision (CME) is a surgical technique for colon cancer based on Total Mesorectal Excision principles for rectal cancer. CME involves sharp dissection along embryonic planes between the visceral and parietal fascia to remove the colon and intact mesocolon lymphovascular package. Central ligation of supplying vessels also aims to maximize lymph node harvest. A study of over 1,300 colon cancer patients who underwent CME found improved 5-year cancer survival rates and reduced local recurrence compared to previous techniques, correlated with higher lymph node counts. CME principles include producing an intact specimen and maximizing lymph node dissection for improved oncologic outcomes.
Total neoadjuvant therapy for rectal cancer 2016Mohamed Abdulla
1) Total neoadjuvant therapy, consisting of chemotherapy followed by chemoradiation and surgery, may improve outcomes for rectal cancer over the traditional approach.
2) Ongoing clinical trials are investigating selective use of radiation and whether radiation can be omitted from some neoadjuvant regimens based on risk factors and response.
3) Near total neoadjuvant therapy with upfront chemotherapy alone may achieve pathologic complete responses in a third of patients and warrants further exploration as an alternative to traditional chemoradiation.
1) Surgery for hilar cholangiocarcinoma requires complex hepatic resection to obtain clear margins and provides the only chance for cure, though it is associated with significant morbidity and mortality risks.
2) Pre-operative investigations including CT and MRCP are needed to determine the extent of tumor involvement and plan the appropriate type of hepatic resection.
3) The extent of resection is based on the Bismuth-Corlette classification of tumor involvement and may require right, extended right, left, or extended left hepatectomy with possible arterial or portal vein resection.
4) Surgical techniques including inflow control, bile duct division, and vascular reconstruction aim to achieve an R0 resection while preserving adequate
The document discusses the history and evolution of surgical trials for colon cancer. It summarizes several key randomized controlled trials comparing laparoscopic versus open colectomy. The trials demonstrated that laparoscopic colectomy is associated with shorter hospital stays and faster recovery, without increased morbidity or affecting long-term oncologic outcomes. More recent studies also support the complete mesocolic excision technique with central vascular ligation over traditional Japanese D3 surgery for improved lymph node yield and potentially better survival. New technologies like robotic assistance and magnetic endoscopic probes aim to advance minimally invasive colon surgery and cancer screening.
1) Cancers of the gastroesophageal junction are either adenocarcinomas or squamous cell carcinomas. Adenocarcinomas arise from Barrett's esophagus, an abnormal change in the esophageal lining, while squamous cell carcinomas are preceded by dysplasia.
2) Endoscopic ultrasound and diagnostic laparoscopy are used to accurately stage gastroesophageal junction cancers before deciding if the cancer can be surgically removed.
3) The type of surgery performed depends on the location and stage of the cancer, with tumors closer to the stomach treated more like gastric cancers and those higher up treated like esophageal cancers. The goal is to remove the cancer and nearby lymph nodes.
This document discusses strategies for increasing the size of the future liver remnant (FLR) to allow for safer and more extensive liver resections. It covers the history of liver surgery and outlines techniques such as portal vein embolization (PVE) and portal vein ligation (PVL) that can be used preoperatively to promote hypertrophy of the FLR. The optimal size of the FLR is debated but is generally considered to be 20% or more of the total liver volume for a healthy liver and 30-50% for a liver with fibrosis or prior chemotherapy. PVE is the standard approach wherein the portal vein to the side being resected is occluded to divert blood flow to the FLR.
Gestion du petit foie restant: place et résultats des techniques pré-opératoires préventives de l'IHC :
Radiofréquence combinée à la résection - Dr Gabriella PITTAU / Pr Antonio SA CUNHA
This document discusses the management of colorectal liver metastases. It addresses topics such as:
- The role of PET-CT scans in assessing resectability and the limited impact they have on surgical management.
- Strategies to improve resectability for patients with multiple or bilobar tumors, including portal vein embolization, portal vein ligation, and ALPPS.
- The importance of volumetric assessment of the future liver remnant using CT or MRI to ensure sufficient functional liver remains post-resection.
- Approaches for synchronous and metachronous colorectal liver metastases, including primary-first, liver-first, and simultaneous resections.
- The role
This document summarizes several landmark trials investigating chemotherapy and radiation therapy approaches for gastric cancer. Key points include:
- Perioperative chemotherapy is now standard for resectable stage II-IV gastric cancer based on trials like MAGIC and FLOT4 showing improved survival.
- FLOT4 established docetaxel-based chemotherapy as the preferred perioperative regimen.
- Adjuvant chemotherapy is recommended after curative surgery without neoadjuvant therapy based on the CLASSIC trial.
- Trials like ARTIST1/2 and CALGB80101 found no benefit to adding adjuvant radiation after D2 lymph node dissection.
- Targeted agents like trastuzumab and ramuc
Perioperative chemotherapy has been shown to improve outcomes for resectable gastric cancer compared to surgery alone. Multiple large randomized controlled trials have found that perioperative chemotherapy results in higher R0 resection rates, improved progression-free survival, and overall survival compared to surgery alone. The addition of preoperative chemoradiotherapy to perioperative chemotherapy did not provide additional benefits in overall survival or progression-free survival compared to perioperative chemotherapy alone in one large trial. Ongoing trials are evaluating whether preoperative chemoradiotherapy can be safely added to improve outcomes further.
1. Neoadjuvant chemoradiotherapy (CTRT) followed by total mesorectal excision (TME) surgery has become the standard of care for locally advanced rectal cancer based on improved local control and survival outcomes compared to surgery or radiotherapy (RT) alone.
2. The addition of chemotherapy to neoadjuvant RT improves pathological complete response rates and local control compared to RT alone, though it also increases toxicity.
3. For patients who achieve a clinical complete response after neoadjuvant CTRT, a non-operative "watch and wait" approach may be considered given comparable oncologic outcomes when salvage surgery is performed for recurrences.
basic principles of hepatic resection including liver anatomy, segmentation and vascular control techniques. also adjuncts to successful and safe liver resection, blood loss management techniques and more. the aim is to provide guidelines for safe hepatic surgery and apply the recent adjuncts.
1. Pancreatic neuroendocrine tumors (PNETs) are rare, slow-growing neoplasms that originate from cells that produce and secrete hormones.
2. The most common functional PNETs are insulinomas, gastrinomas, glucagonomas, and VIPomas. Non-functional PNETs make up about 75% of cases.
3. Diagnosis involves biochemical testing for hormone levels, imaging such as CT, MRI, and nuclear imaging to locate the primary tumor and metastases, and pathology to determine grade and stage. Endoscopic ultrasound can help locate small tumors.
Neoadjuvant therapy in colorectal carcinomaAnkita Singh
- Several studies have shown that neoadjuvant therapy decreases local recurrence rates in colorectal cancer when compared to surgery alone. One study showed a statistically significant decrease in local recurrence with the addition of chemotherapy to preoperative radiotherapy.
- Evidence indicates that long-course chemoradiotherapy, induction chemotherapy followed by long-course chemoradiotherapy, and short-course radiotherapy are the three accepted neoadjuvant approaches, with long-course chemoradiotherapy being the most commonly used currently. Short-course radiotherapy has also shown non-inferior oncologic outcomes compared to long-course chemoradiotherapy in some studies.
This document discusses the management of gallbladder cancer. It covers diagnosis, staging, and surgical treatment approaches based on tumor stage. For early stage T1a tumors found incidentally after cholecystectomy, simple cholecystectomy may be adequate. For T1b and T2 tumors, radical resection including lymph node dissection is recommended due to higher risk of residual disease and lymph node involvement. For locally advanced T3/T4 or node positive cancers, radical surgery with hepatic resection or multi-organ resection is supported, though morbidity and mortality are high; N2 node involvement carries a poor prognosis. Staging laparoscopy is important to identify unresectable disease not apparent on imaging.
Endoscopic Hemostasis - for Endoscopy NursesJarrod Lee
Endoscopic hemostasis is an important first line treatment modality in bleeding from the gastrointestinal tract. It is also a prerequisite skill for anyone performing therapeutic endoscopy, where bleeding is the most common intra-procedural endoscopic complication. This lecture is aimed at endoscopy nurses assisting the endoscopist, and gives an overview of endoscopic hemostasis in routine endoscopy today.
Complete Mesocolic Excision (CME) is a surgical technique for colon cancer based on Total Mesorectal Excision principles for rectal cancer. CME involves sharp dissection along embryonic planes between the visceral and parietal fascia to remove the colon and intact mesocolon lymphovascular package. Central ligation of supplying vessels also aims to maximize lymph node harvest. A study of over 1,300 colon cancer patients who underwent CME found improved 5-year cancer survival rates and reduced local recurrence compared to previous techniques, correlated with higher lymph node counts. CME principles include producing an intact specimen and maximizing lymph node dissection for improved oncologic outcomes.
Total neoadjuvant therapy for rectal cancer 2016Mohamed Abdulla
1) Total neoadjuvant therapy, consisting of chemotherapy followed by chemoradiation and surgery, may improve outcomes for rectal cancer over the traditional approach.
2) Ongoing clinical trials are investigating selective use of radiation and whether radiation can be omitted from some neoadjuvant regimens based on risk factors and response.
3) Near total neoadjuvant therapy with upfront chemotherapy alone may achieve pathologic complete responses in a third of patients and warrants further exploration as an alternative to traditional chemoradiation.
1) Surgery for hilar cholangiocarcinoma requires complex hepatic resection to obtain clear margins and provides the only chance for cure, though it is associated with significant morbidity and mortality risks.
2) Pre-operative investigations including CT and MRCP are needed to determine the extent of tumor involvement and plan the appropriate type of hepatic resection.
3) The extent of resection is based on the Bismuth-Corlette classification of tumor involvement and may require right, extended right, left, or extended left hepatectomy with possible arterial or portal vein resection.
4) Surgical techniques including inflow control, bile duct division, and vascular reconstruction aim to achieve an R0 resection while preserving adequate
The document discusses the history and evolution of surgical trials for colon cancer. It summarizes several key randomized controlled trials comparing laparoscopic versus open colectomy. The trials demonstrated that laparoscopic colectomy is associated with shorter hospital stays and faster recovery, without increased morbidity or affecting long-term oncologic outcomes. More recent studies also support the complete mesocolic excision technique with central vascular ligation over traditional Japanese D3 surgery for improved lymph node yield and potentially better survival. New technologies like robotic assistance and magnetic endoscopic probes aim to advance minimally invasive colon surgery and cancer screening.
1) Cancers of the gastroesophageal junction are either adenocarcinomas or squamous cell carcinomas. Adenocarcinomas arise from Barrett's esophagus, an abnormal change in the esophageal lining, while squamous cell carcinomas are preceded by dysplasia.
2) Endoscopic ultrasound and diagnostic laparoscopy are used to accurately stage gastroesophageal junction cancers before deciding if the cancer can be surgically removed.
3) The type of surgery performed depends on the location and stage of the cancer, with tumors closer to the stomach treated more like gastric cancers and those higher up treated like esophageal cancers. The goal is to remove the cancer and nearby lymph nodes.
This document discusses strategies for increasing the size of the future liver remnant (FLR) to allow for safer and more extensive liver resections. It covers the history of liver surgery and outlines techniques such as portal vein embolization (PVE) and portal vein ligation (PVL) that can be used preoperatively to promote hypertrophy of the FLR. The optimal size of the FLR is debated but is generally considered to be 20% or more of the total liver volume for a healthy liver and 30-50% for a liver with fibrosis or prior chemotherapy. PVE is the standard approach wherein the portal vein to the side being resected is occluded to divert blood flow to the FLR.
Gestion du petit foie restant: place et résultats des techniques pré-opératoires préventives de l'IHC :
Radiofréquence combinée à la résection - Dr Gabriella PITTAU / Pr Antonio SA CUNHA
This document discusses several tools for evaluating liver function and predicting postoperative outcomes following hepatic resection. It mentions several studies that found:
- Remnant liver volume/body weight ratio (RLV/BWR) of less than 0.5% was a risk factor for hepatic dysfunction after right trisectionectomy.
- Only a hepatic venous pressure gradient greater than 10 mmHg was a significant risk factor for decompensated cirrhosis after surgery in univariate analysis.
- Indocyanine green retention rate at 15 minutes was significantly higher in patients who died compared to survivors following hepatic resection.
- A posthepatectomy portal vein pressure over 22.5 mmHg was an independent predictor of liver failure and mortality
Carcinome hépatocellulaire (CHC). Conférence du Dr Eric Vibert (Chirurgien, AP-HP Hôpital Paul Brousse, Villejuif, France) aux Journées de Chirurgie hépato-biliaire, Juin 2014, Paris.
This document discusses the impact of underlying liver disease on postoperative liver failure after surgery. It covers cirrhosis, chemotherapy-induced liver toxicity, and cholestasis.
For cirrhosis, it recommends patient selection based on Child-Pugh and MELD scores. It suggests limiting major resections to Child A patients without varices or thrombocytopenia. Portal vein embolization can help optimize liver remnant volume.
For chemotherapy-induced toxicity, it warns of increased morbidity from extensive preoperative chemo (>6 cycles) due to sinusoidal injuries. Optimization may include stopping bevacizumab.
For cholestasis, it recommends optimizing patients preoperatively with endoscopic
This document discusses the results of liver resection versus liver transplantation for hepatocellular carcinoma. It summarizes various studies comparing outcomes such as overall survival and disease-free survival between the two treatments. The document concludes that liver transplantation provides better long-term and disease-free outcomes overall, though liver resection may be comparable for very small solitary tumors. It also notes that salvage transplantation after resection is not ideal since many patients are ineligible after recurrence. When transplant organ availability is limited, it argues hepatocellular carcinoma patients should not be excluded if their survival benefit from transplantation would be similar to those with end-stage liver disease.
Chirurgie du cholangiocarcinome hilaire. Conférence du Dr Oriana Ciacio ( Chirurgienne, AP-HP Hôpital Paul Brousse, Villejuif, France) aux Journées de Chirurgie Hépato-Biliaire (juin 2014, Paris)
Traitement de la fistule biliaire après hépatectomie - Technique chirurgical et résultats. Conférence du Professeur Denis Castaing (Chirurgien Chef de service, AP-HP Hôpital Paul Brousse, Villejuif, France) aux Journées de Chirurgie Hépato-Biliaire, Juin 2014, Paris.
Imagerie du cholangiocarcinome du hile. Conférence du le Pr Maïté Lewin (Radiologue, AP-HP Hôpital Paul Brousse, Villejuif, France) aux Journées de Chirurgie hépato-biliaire (Juin 2014, Paris).
Conférence du Dr. Maximiliano GELLI (Chirurgien hépatique, AP-HP Hôpital Paul Brousse, Villejuif, France) aux Journées de Chirurgie Hépato-Biliaire, juin 2014, Paris.
This document summarizes research on diagnosis and treatment strategies for esophageal cancer. The study analyzed data from 515 patients who underwent radical surgery. Key findings include:
- The 5-year survival rate was 48.8%, influenced by factors like tumor stage, grade, adjuvant therapy, and blood test results.
- Neural network analysis correctly predicted 5-year survival 100% of the time based on ratios of blood cells to cancer cells, tumor stage, grade, and other factors.
- Optimal diagnosis and treatment requires early detection, experienced surgeons, aggressive surgery with lymph node dissection, precise prediction modeling, and adjuvant therapy for higher-risk patients.
The document discusses classification and surgical treatment options for extrahepatic bile duct cancer. It examines preoperative biliary drainage and portal embolization. Surgical techniques discussed include laparoscopy, posterior approach, tumor resection, hepatectomy, and caudate lobe resection. Operative procedures and mortality are analyzed according to tumor location, TNM classification, and staging. Long-term survival outcomes are presented for different patient groups and surgical approaches.
This study analyzed data from 788 gastric cancer patients who underwent radical surgery between 1975-2019 to determine optimal diagnosis and treatment strategies. Several factors were found to significantly impact 5-year survival rates based on multivariate analysis, including: 1) the transition from early to invasive cancer stages; 2) the transition from N0 to N1-2 node stages; and 3) ratios of cancer cells to other blood cell types. Neural network modeling correctly predicted 5-year survival 100% of the time based on these and other factors. The study concludes that screening and early detection, experienced surgeons, aggressive surgery, precise prediction, and adjuvant chemotherapy can optimize outcomes for gastric cancer patients.
This 35-year-old female patient presented with dyspnea and weakness for 19 days following a wound infection. Imaging showed a right ventricular thrombus (RVT) measuring 4cm, right ventricular dilation, and right ventricular dysfunction consistent with pulmonary embolism (PE). Laboratory tests were notable for a D-dimer of 4000. Treatment included unfractionated heparin infusion, antibiotics, and oxygen. The RVT size decreased over subsequent days with treatment. Optimal treatment of intracardiac thrombi is unclear but includes surgical embolectomy, thrombolysis, catheter removal, or anticoagulation. Mortality remains high regardless of the therapeutic approach chosen.
This study analyzed 10-year survival rates of 551 esophageal cancer patients who underwent radical surgery. The 10-year survival rate was 45.9%, while factors like early cancer stage, lower N stage, higher ratios of healthy to cancer cells, and adjuvant chemoimmunoradiotherapy significantly improved survival. Neural network analysis revealed that phase transition from N0 to N1-2, ratios of healthy to cancer cells, and early vs invasive cancer stage were the top predictors of 10-year survival.
2021 lung presentation pro or contra moscouGeorgesNOEL3
1) For operable stage III NSCLC patients with resectable tumors, preoperative chemoradiotherapy followed by surgery may improve survival outcomes compared to surgery or chemoradiotherapy alone.
2) For stage III NSCLC patients with N2 nodal involvement who have undergone complete resection, postoperative radiotherapy does not provide a survival benefit and can increase toxicity.
3) For unresectable locally advanced stage III NSCLC patients, concurrent chemoradiotherapy improves survival compared to radiotherapy alone and should be the standard of care. Adding consolidation immunotherapy after chemoradiotherapy may provide additional benefits.
Recent evidence for mechanical thrombolysisDr Vipul Gupta
1. The document summarizes key findings from recent endovascular thrombectomy trials for acute ischemic stroke. It found that stent retrievers significantly improved rates of revascularization and functional independence compared to standard medical care.
2. Time to treatment is critical, with most trials requiring treatment initiation within 6 hours of symptom onset. Advanced imaging helped select patients most likely to benefit.
3. The trials established endovascular thrombectomy using stent retrievers as the standard of care for appropriately selected stroke patients with large vessel occlusions. This represents a major advance in acute stroke treatment.
- The document examines pathological characteristics and clinical outcomes of laparoscopic transhiatal esophagectomy or open esophagectomy for pT1 esophageal adenocarcinoma.
- It found that 66% of patients with pT1 adenocarcinoma had characteristics like lymphovascular invasion or multifocal carcinoma that would make them inappropriate candidates for endoscopic mucosal resection (EMR) alone.
- EMR should be reserved for highly selected pT1 adenocarcinoma patients, as esophagectomy had a small but definite risk of recurrent disease, but provided similar lymph node retrieval and no evidence of oncological detriment from the laparoscopic approach.
1) The study analyzed survival rates for 556 patients who underwent radical surgery for esophageal cancer between 1975-2022.
2) Multivariate analysis found that 5-year survival significantly depended on factors like the transition from early to invasive cancer, lymph node status (N0-N1-2), cell ratio factors, adjuvant treatment, and tumor location.
3) Neural network modeling correctly predicted 5-year survival in 100% of cases based on factors like early vs. invasive cancer, healthy to cancer cell ratios, and lymph node status.
1) The study analyzed survival rates for 556 patients who underwent radical surgery for esophageal cancer between 1975-2022.
2) Multivariate analysis found that 5-year survival significantly depended on factors like the transition from early to invasive cancer, lymph node status (N0-N12), blood cell ratios, and adjuvant chemoradiotherapy.
3) Neural network modeling correctly predicted 5-year survival in 100% of cases based on factors like early vs. invasive cancer, blood cell counts, and lymph node status.
This document summarizes information from a presentation on surgery for early-stage hepatocellular carcinoma (HCC). It discusses outcomes of liver resection for HCC tumors under 2 cm, including a 98% rate of complete radiological necrosis. It also examines factors like tumor size and number, presence of satellite nodules or cirrhosis that affect risk of recurrence. Additionally, it evaluates tools like indocyanine green retention at 15 minutes to assess liver functional reserve and risk of post-operative liver failure. The conclusion is that liver resection can cure early HCC when the patient has sufficient liver function and the surgery contains an adequate safety margin.
OBJECTIVE: 5-survival (5YS) and life span after radical surgery for non-small cell lung cancer (LC) pa¬tients (LCP) (T1-4N0-2M0) was analyzed.
METHODS: We analyzed data of 771 consecutive LCP (age=57.6±8.3 years; tumor size=4.1±2.4 cm) radically operated and monitored in 1985-2022 (m=662, f=109; upper lobectomies=278, lower lobectomies=178, middle lobectomies=18, bilobectomies=42, pneumonectomies=255, mediastinal lymph node dissection=771; combined procedures with resection of trachea, carina, atrium, aorta, VCS, vena azygos, pericardium, liver, diaphragm, ribs, esophagus=194; only surgery-S=620, adjuvant chemoimmunoradiotherapy-AT=151: CAV/gemzar + cisplatin + thymalin/taktivin + radiotherapy 45-50Gy; T1=322, T2=255, T3=133, T4=61; N0=518, N1=131, N2=122, M0=771; G1=195, G2=243, G3=333; squamous=418, adenocarcinoma=303, large cell=50; early LC=215, invasive LC=556; right LC=413, left LC=358; central=291; peripheral=480. Variables selected for study were input levels of 45 blood parameters, sex, age, TNMG, cell type, tumor size. Regression modeling, clustering, SEPATH, Monte Carlo, bootstrap and neural networks computing were used to determine significant dependence.
RESULTS: Overall life span (LS) was 2240.9±1748.8 days and cumulative 5-year survival (5YS) reached 73%, 10 years – 64.2%, 20 years – 43%. 503 LCP lived more than 5 years (LS=3126.6±1536 days), 145 LCP – more than 10 years (LS=5068.5±1513.2 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (77.7% vs.63.4%, P=0.00001 by log-rank test). AT significantly improved 5YS (64.4% vs. 34.8%) (P=0.00003 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.035). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), eosinophils/CC (4), erythrocytes/CC (5),healthy cells/CC (6), segmented neutrophils/CC (7), lymphocytes/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data.
OBJECTIVE: 5-survival (5YS) and life span after radical surgery for non-small cell lung cancer (LC) pa¬tients (LCP) (T1-4N0-2M0) was analyzed.
METHODS: We analyzed data of 771 consecutive LCP (age=57.6±8.3 years; tumor size=4.1±2.4 cm) radically operated and monitored in 1985-2022 (m=662, f=109; upper lobectomies=278, lower lobectomies=178, middle lobectomies=18, bilobectomies=42, pneumonectomies=255, mediastinal lymph node dissection=771; combined procedures with resection of trachea, carina, atrium, aorta, VCS, vena azygos, pericardium, liver, diaphragm, ribs, esophagus=194; only surgery-S=620, adjuvant chemoimmunoradiotherapy-AT=151: CAV/gemzar + cisplatin + thymalin/taktivin + radiotherapy 45-50Gy; T1=322, T2=255, T3=133, T4=61; N0=518, N1=131, N2=122, M0=771; G1=195, G2=243, G3=333; squamous=418, adenocarcinoma=303, large cell=50; early LC=215, invasive LC=556; right LC=413, left LC=358; central=291; peripheral=480. Variables selected for study were input levels of 45 blood parameters, sex, age, TNMG, cell type, tumor size. Regression modeling, clustering, SEPATH, Monte Carlo, bootstrap and neural networks computing were used to determine significant dependence.
RESULTS: Overall life span (LS) was 2240.9±1748.8 days and cumulative 5-year survival (5YS) reached 73%, 10 years – 64.2%, 20 years – 43%. 503 LCP lived more than 5 years (LS=3126.6±1536 days), 145 LCP – more than 10 years (LS=5068.5±1513.2 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (77.7% vs.63.4%, P=0.00001 by log-rank test). AT significantly improved 5YS (64.4% vs. 34.8%) (P=0.00003 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.035). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), eosinophils/CC (4), erythrocytes/CC (5),healthy cells/CC (6), segmented neutrophils/CC (7), lymphocytes/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data.
OBJECTIVE: 5-survival (5YS) and life span after radical surgery for non-small cell lung cancer (LC) pa¬tients (LCP) (T1-4N0-2M0) was analyzed.
METHODS: We analyzed data of 771 consecutive LCP (age=57.6±8.3 years; tumor size=4.1±2.4 cm) radically operated and monitored in 1985-2022 (m=662, f=109; upper lobectomies=278, lower lobectomies=178, middle lobectomies=18, bilobectomies=42, pneumonectomies=255, mediastinal lymph node dissection=771; combined procedures with resection of trachea, carina, atrium, aorta, VCS, vena azygos, pericardium, liver, diaphragm, ribs, esophagus=194; only surgery-S=620, adjuvant chemoimmunoradiotherapy-AT=151: CAV/gemzar + cisplatin + thymalin/taktivin + radiotherapy 45-50Gy; T1=322, T2=255, T3=133, T4=61; N0=518, N1=131, N2=122, M0=771; G1=195, G2=243, G3=333; squamous=418, adenocarcinoma=303, large cell=50; early LC=215, invasive LC=556; right LC=413, left LC=358; central=291; peripheral=480. Variables selected for study were input levels of 45 blood parameters, sex, age, TNMG, cell type, tumor size. Regression modeling, clustering, SEPATH, Monte Carlo, bootstrap and neural networks computing were used to determine significant dependence.
RESULTS: Overall life span (LS) was 2240.9±1748.8 days and cumulative 5-year survival (5YS) reached 73%, 10 years – 64.2%, 20 years – 43%. 503 LCP lived more than 5 years (LS=3126.6±1536 days), 145 LCP – more than 10 years (LS=5068.5±1513.2 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (77.7% vs.63.4%, P=0.00001 by log-rank test). AT significantly improved 5YS (64.4% vs. 34.8%) (P=0.00003 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.035). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), eosinophils/CC (4), erythrocytes/CC (5),healthy cells/CC (6), segmented neutrophils/CC (7), lymphocytes/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: PT early-invasive cancer; PT N0--N12; cell ratio factors; blood cell circuit; biochemical factors; hemostasis system; AT; LC characteristics; surgery type; anthropometric data.
1) A 23-year old patient presented with thrombotic microangiopathy and was diagnosed with severe refractory thrombotic thrombocytopenic purpura (TTP).
2) The patient required intubation and intensive care due to neurological dysfunction, cardiac issues, and acute kidney injury.
3) Treatment included prolonged daily plasma exchange, immunosuppression, rituximab, caplacizumab, methylprednisolone, and bortezomib.
4) It took over 3 weeks but the patient's condition eventually stabilized and thrombocytopenia resolved, allowing discharge from the intensive care unit.
- The document discusses treatment options for locally advanced non-small cell lung cancer (NSCLC), including chemoradiation therapy.
- A large phase III trial (RTOG 0617) found that high-dose radiation therapy (74 Gy) was associated with higher mortality and more severe adverse events compared to standard-dose radiation therapy (60 Gy) when combined with chemotherapy.
- Another study (START) evaluated the immunotherapy drug tecemotide as consolidation therapy after chemoradiation for stage III NSCLC but did not meet its primary endpoint of improved overall survival, though a subgroup analysis found a survival benefit in patients who received concurrent chemoradiation.
Positron emission tomography (PET) provides functional imaging of the body with high sensitivity and specificity. Common PET radiotracers include [F-18] FDG for glucose metabolism and tumor imaging. PET is useful for diagnosing cancer, staging and re-staging, detecting treatment response, and localizing unknown primary tumors. It has applications in lung cancer, colorectal cancer, lymphoma, and other cancers. PET imaging improves over other modalities in detecting metastatic disease and is useful for treatment planning and monitoring.
Similar to Hepatectomie en 2 temps - Pr René Adam (20)
1. Hypothermic perfusion of the liver during hepatic resection allows for safer total vascular exclusion of over 60 minutes by decreasing metabolic needs and improving hemodynamic tolerance.
2. Hypothermic perfusion can be performed in situ, without dividing the portal triad, or ex situ after dividing the portal triad. Veno-venous bypass is often used to avoid hemodynamic instability during long periods of vascular exclusion.
3. Preliminary experience with 77 cases of hepatic resection using hypothermic perfusion and vascular exclusion showed lower mortality and morbidity compared to standard surgery. Independent predictors of mortality were identified to help patient selection.
This document summarizes research on applications of microtechnology and bioengineering in liver modeling and transplantation. It discusses topics like micropatterning co-cultures, encapsulation, bioartificial and transplantable engineered livers, and using microfluidics and biomaterials for drug screening and disease modeling. Specific techniques covered include differentiating stem cells into liver cells, constructing 3D liver organoids, developing liver-on-chip devices, and applying organoids to study bile acid recycling and treat cholangiopathy. The overall goal is to build functional artificial livers through multidisciplinary approaches like microengineering, stem cell differentiation, organoid development, and organ-chip systems.
This phase 2 clinical trial evaluated the safety and efficacy of bepirovirsen, an antisense oligonucleotide, for the treatment of chronic hepatitis B. The trial involved 31 participants with chronic hepatitis B who received subcutaneous injections of bepirovirsen or placebo. Treatment with bepirovirsen was found to be generally safe and well tolerated, with mostly mild to moderate adverse events. Bepirovirsen treatment resulted in transient increases in liver enzymes in some participants. Additionally, reductions in hepatitis B surface antigen levels were observed in participants receiving bepirovirsen compared to placebo, suggesting antiviral activity. This trial provides initial evidence supporting further evaluation of bepirovirsen for the treatment of chronic hepatitis
More from Centre Hepato-Biliaire / AP-HP Hopital Paul Brousse (20)
CLASSIFICATION OF H1 ANTIHISTAMINICS-
FIRST GENERATION ANTIHISTAMINICS-
1)HIGHLY SEDATIVE-DIPHENHYDRAMINE,DIMENHYDRINATE,PROMETHAZINE,HYDROXYZINE 2)MODERATELY SEDATIVE- PHENARIMINE,CYPROHEPTADINE, MECLIZINE,CINNARIZINE
3)MILD SEDATIVE-CHLORPHENIRAMINE,DEXCHLORPHENIRAMINE
TRIPROLIDINE,CLEMASTINE
SECOND GENERATION ANTIHISTAMINICS-FEXOFENADINE,
LORATADINE,DESLORATADINE,CETIRIZINE,LEVOCETIRIZINE,
AZELASTINE,MIZOLASTINE,EBASTINE,RUPATADINE. Mechanism of action of 2nd generation antihistaminics-
These drugs competitively antagonize actions of
histamine at the H1 receptors.
Pharmacological actions-
Antagonism of histamine-The H1 antagonists effectively block histamine induced bronchoconstriction, contraction of intestinal and other smooth muscle and triple response especially wheal, flare and itch. Constriction of larger blood vessel by histamine is also antagonized.
2) Antiallergic actions-Many manifestations of immediate hypersensitivity (type I reactions)are suppressed. Urticaria, itching and angioedema are well controlled.3) CNS action-The older antihistamines produce variable degree of CNS depression.But in case of 2nd gen antihistaminics there is less CNS depressant property as these cross BBB to significantly lesser extent.
4) Anticholinergic action- many H1 blockers
in addition antagonize muscarinic actions of ACh. BUT IN 2ND gen histaminics there is Higher H1 selectivitiy : no anticholinergic side effects
Applications of NMR in Protein Structure Prediction.pptxAnagha R Anil
This presentation explores the pivotal role of Nuclear Magnetic Resonance (NMR) spectroscopy in predicting protein structures. It delves into the methodologies, advancements, and applications of NMR in determining the three-dimensional configurations of proteins, which is crucial for understanding their function and interactions.
Storyboard on Acne-Innovative Learning-M. pharm. (2nd sem.) CosmeticsMuskanShingari
Acne is a common skin condition that occurs when hair follicles become clogged with oil and dead skin cells. It typically manifests as pimples, blackheads, or whiteheads, often on the face, chest, shoulders, or back. Acne can range from mild to severe and may cause emotional distress and scarring in some cases.
**Causes:**
1. **Excess Oil Production:** Hormonal changes during adolescence or certain times in adulthood can increase sebum (oil) production, leading to clogged pores.
2. **Clogged Pores:** When dead skin cells and oil block hair follicles, bacteria (usually Propionibacterium acnes) can thrive, causing inflammation and acne lesions.
3. **Hormonal Factors:** Fluctuations in hormone levels, such as during puberty, menstrual cycles, pregnancy, or certain medical conditions, can contribute to acne.
4. **Genetics:** A family history of acne can increase the likelihood of developing the condition.
**Types of Acne:**
- **Whiteheads:** Closed plugged pores.
- **Blackheads:** Open plugged pores with a dark surface.
- **Papules:** Small red, tender bumps.
- **Pustules:** Pimples with pus at their tips.
- **Nodules:** Large, solid, painful lumps beneath the surface.
- **Cysts:** Painful, pus-filled lumps beneath the surface that can cause scarring.
**Treatment:**
Treatment depends on the severity and type of acne but may include:
- **Topical Treatments:** Such as benzoyl peroxide, salicylic acid, or retinoids to reduce bacteria and unclog pores.
- **Oral Medications:** Antibiotics or oral contraceptives for hormonal acne.
- **Procedures:** Such as chemical peels, extraction of comedones, or light therapy for more severe cases.
**Prevention and Management:**
- **Cleanse:** Regularly wash skin with a gentle cleanser.
- **Moisturize:** Use non-comedogenic moisturizers to keep skin hydrated without clogging pores.
- **Avoid Irritants:** Such as harsh cosmetics or excessive scrubbing.
- **Sun Protection:** Use sunscreen to prevent exacerbation of acne scars and inflammation.
Acne treatment can take time, and consistency in skincare routines and treatments is crucial. Consulting a dermatologist can help tailor a treatment plan that suits individual needs and reduces the risk of scarring or long-term skin damage.
Can Traditional Chinese Medicine Treat Blocked Fallopian Tubes.pptxFFragrant
There are many traditional Chinese medicine therapies to treat blocked fallopian tubes. And herbal medicine Fuyan Pill is one of the more effective choices.
Osvaldo Bernardo Muchanga-GASTROINTESTINAL INFECTIONS AND GASTRITIS-2024.pdfOsvaldo Bernardo Muchanga
GASTROINTESTINAL INFECTIONS AND GASTRITIS
Osvaldo Bernardo Muchanga
Gastrointestinal Infections
GASTROINTESTINAL INFECTIONS result from the ingestion of pathogens that cause infections at the level of this tract, generally being transmitted by food, water and hands contaminated by microorganisms such as E. coli, Salmonella, Shigella, Vibrio cholerae, Campylobacter, Staphylococcus, Rotavirus among others that are generally contained in feces, thus configuring a FECAL-ORAL type of transmission.
Among the factors that lead to the occurrence of gastrointestinal infections are the hygienic and sanitary deficiencies that characterize our markets and other places where raw or cooked food is sold, poor environmental sanitation in communities, deficiencies in water treatment (or in the process of its plumbing), risky hygienic-sanitary habits (not washing hands after major and/or minor needs), among others.
These are generally consequences (signs and symptoms) resulting from gastrointestinal infections: diarrhea, vomiting, fever and malaise, among others.
The treatment consists of replacing lost liquids and electrolytes (drinking drinking water and other recommended liquids, including consumption of juicy fruits such as papayas, apples, pears, among others that contain water in their composition).
To prevent this, it is necessary to promote health education, improve the hygienic-sanitary conditions of markets and communities in general as a way of promoting, preserving and prolonging PUBLIC HEALTH.
Gastritis and Gastric Health
Gastric Health is one of the most relevant concerns in human health, with gastrointestinal infections being among the main illnesses that affect humans.
Among gastric problems, we have GASTRITIS AND GASTRIC ULCERS as the main public health problems. Gastritis and gastric ulcers normally result from inflammation and corrosion of the walls of the stomach (gastric mucosa) and are generally associated (caused) by the bacterium Helicobacter pylor, which, according to the literature, this bacterium settles on these walls (of the stomach) and starts to release urease that ends up altering the normal pH of the stomach (acid), which leads to inflammation and corrosion of the mucous membranes and consequent gastritis or ulcers, respectively.
In addition to bacterial infections, gastritis and gastric ulcers are associated with several factors, with emphasis on prolonged fasting, chemical substances including drugs, alcohol, foods with strong seasonings including chilli, which ends up causing inflammation of the stomach walls and/or corrosion. of the same, resulting in the appearance of wounds and consequent gastritis or ulcers, respectively.
Among patients with gastritis and/or ulcers, one of the dilemmas is associated with the foods to consume in order to minimize the sensation of pain and discomfort.
Fexofenadine is sold under the brand name Allegra.
It is a selective peripheral H1 blocker. It is classified as a second-generation antihistamine because it is less able to pass the blood–brain barrier and causes lesser sedation, as compared to first-generation antihistamines.
It is on the World Health Organization's List of Essential Medicines. Fexofenadine has been manufactured in generic form since 2011.
TEST BANK For Brunner and Suddarth's Textbook of Medical-Surgical Nursing, 14...Donc Test
TEST BANK For Brunner and Suddarth's Textbook of Medical-Surgical Nursing, 14th Edition (Hinkle, 2017) Verified Chapter's 1 - 73 Complete.pdf
TEST BANK For Brunner and Suddarth's Textbook of Medical-Surgical Nursing, 14th Edition (Hinkle, 2017) Verified Chapter's 1 - 73 Complete.pdf
TEST BANK For Brunner and Suddarth's Textbook of Medical-Surgical Nursing, 14th Edition (Hinkle, 2017) Verified Chapter's 1 - 73 Complete.pdf
Nutritional deficiency Disorder are problems in india.
It is very important to learn about Indian child's nutritional parameters as well the Disease related to alteration in their Nutrition.
1. Two-Stage Hepatectomy
vs ALPPS for
Unresectable Metastases
R Adam,
K Imai, C Castro, MA Allard,
E Vibert, A Sa Cunha, D
Cherqui, H Baba, D Castaing
Hôpital Paul Brousse, Villejuif, France
Université Paris-Sud, France
2. Multi Unilobar Multi Bilobar Multi Bilobar
Remnant Liver <30% ≤3 nod. ≤30 mm >3 nod. >30 mm
Hepatectomy +
Local Ablation
2-Stage
Hepatectomy
Portal Vein
Embolization
Two-Stage Hepatectomy: Patient Selection
Standard 2-Stage ALPPS
3. Portal vein
ligation
Tumorectomy
of liver remnant
Hypertrophy of
liver remnant
Stage 1 Stage 2
>30% of
total liver
4-8 weeks
Removal of the
deportalized lobe
Portal vein
embolization
Clavien et al. Strategies for safer liver surgery. NEJM, 2017
The Selective Staged method…
Two-stage Hepatectomy
Exclusion Pts
in progression
4.
5. Portal vein
ligation
Tumorectomy
of liver remnant
Hypertrophy of
liver remnant
Stage 1 Stage 2
>30% of
total liver
9 days
Removal of the
deportalized lobe
Portal vein
embolization
Clavien et al. Strategies for safer liver surgery. NEJM, 2017
The fast-surgery method…: ALPPS
6. Present status
• Higher feasibility of complete resection with ALPPS
• Faster hypertrophy rate of liver remnant
Are the oncological results better than conventional
2-stage ?
Pending question
7. Results: flow chart
January 2000 – June 2014
248 Pts Resected of CLM at Paul Brousse Hospital
56 Two stage hepatectomy (23%)
TSH (N = 41)
15 Failure
(36%)
26 Complete
(64%)
ALPPS (N = 17)
8. Patient Selection
• Two-stage hepatectomy and ALPPS : indicated in
patients with bilobar colorectal liver metastases not
resectable by a single-stage hepatectomy with or without
portal vein embolization or local ablation therapy.
• ALPPS was favoured in patients with an estimated
smaller liver remnant volume irrespective of other tumour
or patient characteristics
9. Male 65 yrs
Synchronous Bilateral Irresectable LMCCR
FOLFOX AVASTIN 6 Courses
ACE 228 --- 83
FLR: 313cc ( < 0.5% ratio to Body weight)
10. Methods
• Between January 2010 and June 2014,
• 58 consecutive patients who underwent either
ALPPS (n=17) or two-stage hepatectomy (n=41)
for colorectal liver metastases were enrolled in
the study.
• Short-term and oncological outcomes were
compared.
11. Methods: ALPPS or TSH?
Bilobar multiple CLM
Unresectable with a single hepatectomy
even with portal vein embolization
Estimated small remnant liver
(requiring right hepatetomy
extended to segment IV)
ALPPS or Two stage hepatectomy?
Possibility to spare
segment IV
12. Methods: Techniques for ALPPS
• Clairance of future remnant liver
• Portal vein embolization
• Parenchymal transection
12 days later….
Right hepatectomy extended to segment IV
1st stage
22. Cohort updated to 24 pts:
Months
OSprobability
0 12 24 36 48
0.00.20.40.60.81.0
41 35 18 9 3 Two stage
24 13 3 ALPPS
P = 0.005
MS : 28.9 mo
MS : Not reached
Two stage
ALPPS
23. Conclusions
• Despite a higher feasibility (100% vs 63%)
• …the absence of 90 day-mortality and a
comparable morbidity
• Survival of ALPPS group was lower than TSH,
in intention to treat (42 vs 77 % at 2 years)
• DFS was similar with however a higher
proportion of liver recurrences (100 vs 53%) and
a lower use of repeat surgery .
24. Summary
The higher feasibility rate of ALPPS did not seem
to translate into a better oncological outcome
compared to two-stage hepatectomy.