RADPs were equivalent to LDPs in nearly all measures of outcome and safety but significantly reduced the risk of conversion to open resection, despite a statistically greater probability of malignancy in the robotic cohort. We concluded that robotic assistance may broaden indications for minimally invasive pancreatectomy.
Background: The oncological effects of obesity on liver transplant (LT) patients with hepatocellular carcinoma (HCC) remains unclear. We investigated patient overall survival and tested two-way interactions between donor and recipient obesity status. Methods: Using the UNOS database, a total of 8352 LT recipients with HCC were included. Donors and recipients were stratified in normal weight (NW), overweight (OW) and obese (OB). Hazard ratios (HR) for any cause of death and interactions between recipient and donor BMI were estimated by multivariate flexible parametric models. Results: Five-year overall survival was 66% for NW, 67% for OW and 68% for OB recipients. The HRs of death from all causes were 0.96 (95% CI: 0.86-1.08) for OW and 0.93 (95% CI: 0.82-1.05) for OB recipients when compared to NW patients. At multivariate analysis, predictors of inferior survival were recipient age (65 years), donor age (45 years), need for pre-operative dialysis, HCV infection, transplants performed before 2007, and UNOS regions 2,3,9,10, and 11. The lowest adjusted HR was measured for recipients with BMI between 25 and 35 and there were no interactions between recipient and donor BMI. Conclusions: the overall survival of LT recipients with HCC was not affected by donor or recipient obesity.
Background: A systemic inflammatory state is widely considered as a preoperative risk factor for outcomes in solid organ malignancies. Neutrophils have been known to play an important role during early and chronic inflammation. Neutrophil to lymphocyte ratio (NLR) is a wellrecognized sensitive measure of inflammation and high NLR levels have been linked to risk of cancer recurrence. After activation, neutrophils release their DNA into the extracellular space, referred to as neutrophil extracellular traps (NETs). This is a defense mechanism first described to trap and kill bacteria and other pathogens, however has recently been identified in the pathogenesis of inflammatory and malignant diseases. We have recently shown that neutrophil extracellular traps (NETs) play a critical rule and can promote the development and progression of liver metastases after surgical stress in mice. The current study uses a specific neutrophil marker e neutrophil myeloperoxidase (MPO-DNA) as a measure of NET formation. MPO is released into the extracellular space during neutrophil degranulation. We hypothesize that NETs can be utilized as a biomarker determining outcomes after resection of hepatic malignancies. Methods: We selected 103 consecutive patients with Hepatocellular carcinoma (HCC) or Cholangiocarcinoma (CC) who underwent surgery at our institution. Preoperative serum levels were routinely collected for tissue banking. Neutrophil number and MPO-DNA levels were measured pre-surgery. We then performed log rank analysis of recurrence-free survival in patients with high vs low MPO-DNA/NLR. In addition, Pearson correlation of preoperative MPO-DNA and NLR was performed. Results: Pre-therapy MPO-DNA levels are strongly associated with recurrence-free survival in patients undergoing surgery for HCC or CC. Patients with higher pre-therapy MPO-DNA were more likely to have a shorter disease-free survival compared to those with low levels. (HCC: HR: 2.909, 95% CI: 1.607 to 5.264, p<0.0001, CC: HR: 3.221, 95% CI: 1.335 to 7.773 p<0.0093). Median survival for HCC patients with high vs low MPO-DNA was significant with 12.6 vs 25.8 months. Similar Results were obtained in CC patient, high vs low MPO DNA was significant with 13.6 vs 42.9 months. In addition, there is a significant correlation between pre-therapy NLR and MPO-DNA for both HCC and CC (HCC: p<0.0001, R2 = 0.22, CC: p<0.0065, R2 = 0.28) (Figure 1). Conclusion: Neutrophils are an important marker for hepatic cancers after resection. The current study focuses on pre-therapy levels of MPO-DNA as a prognostic marker of
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