BackgroundGallbladder cancer (GBC), although infrequent in industrialized countries, has high incidence rates in certain world regions, being a leading cause of death among elderly Chilean women. Surgery is the only effective treatment, and a five-year survival rate of advanced-stage patients is less than 10%. Hence, exploring immunotherapy is relevant, although GBC immunogenicity is poorly understood. This study examined the relationship between the host immune response and GBC patient survival based on the presence of tumor-infiltrating lymphocytes at different disease stages.MethodsTumor tissues from 80 GBC patients were analyzed by immunohistochemistry for the presence of CD3+, CD4+, CD8+, and Foxp3+ T cell populations, and the results were associated with clinical stage and patient survival.ResultsThe majority of tumor samples showed CD3+ T cell infiltration, which correlated with better prognosis, particularly in advanced disease stages. CD8+, but not CD4+, T cell infiltration correlated with improved survival, particularly in advanced disease stages. Interestingly, a < 1 CD4+/CD8+ T cell ratio was related with increased survival. Additionally, the presence of Foxp3+ T cells correlated with decreased patient survival, whereas a ≤ 1 Foxp3+/CD8+ T cell ratio was associated with improved patient survival.ConclusionsDepending on the disease stage, the presence of CD8+ and absence of Foxp3+ T cell populations in tumor tissues correlated with improved GBC patient survival, and thus represent potential markers for prognosis and management of advanced disease, and supports testing of immunotherapy.Electronic supplementary materialThe online version of this article (10.1186/s12885-018-4147-6) contains supplementary material, which is available to authorized users.
Background: Two strategies for same-admission cholecystectomy in mild gallstone pancreatitis (MGP) exist: early surgery (within 48-72 h from admission) and delayed surgery until resolution of symptoms and normalization of pancreatic tests.Methods: This was a single-center, open-label RCT. Patients with MGP according to revised Atlanta classification-2012 and SIRS criteria were randomly assigned to early laparoscopic cholecystectomy (E-LC) within 72 h from admission or delayed laparoscopic cholecystectomy (D-LC). Laparoscopicendoscopic rendezvous was performed when common bile duct stones were found at systematic intraoperative cholangiography. The primary outcome was length of stay (LOS), and the secondary outcomes were complications at 90 days, need for ERCP/choledocolithiasis, conversion, and readmission. One year of follow-up was carried-on.Results: At interim analysis, 52 patients were randomized (26 E-LC, 26 D-LC). E-LC versus D-LC was associated with a significantly shorter LOS (median 58 versus 167 h; P = 0.001). There were no differences in ERCP necessity for choledocolithiasis between the two approaches (E-LC 26.9% versus D-LC 23.1%, P = 1.00). No differences in postoperative complications were found.Conclusions: E-LC approach in patients with MGP significantly reduced LOS and was not associated with clinically relevant postoperative complications.Trial registration: clinicaltrials.gov (NCT02590978).
Introducción: La segmentectomía lateral izquierda es el procedimiento más empleado para la cirugía del donante en trasplante hepático con donante vivo adulto-pediátrico (THDVA-P), y ha demostrado ser seguro y reproducible. Sin embargo, la información aún es escasa respecto al abordaje laparoscópico. El objetivo de este artículo es dar a conocer los resultados postoperatorios de la segmentectomía lateral izquierda laparoscópica (SLI-L) para THDVA-P. Materiales y método: Realizamos un estudio retrospectivo, observacional, de un solo centro, Hospital del Salvador; con vasta experiencia en trasplante hepático y en resecciones hepáticas laparoscópicas. Se ofreció realizar el procedimiento de SLI-L para la cirugía del donante vivo. Se describe la técnica quirúrgica y los resultados postoperatorios de los donantes. Resultados: Entre abril 2015 y enero 2021, 36 pacientes, 25 de ellos hombres, fueron sometidos a SLI-L. El 86% eran madre o padre del receptor, con una mediana de 30 años (19-45). Mediana de tiempo operatorio de 360 min (240-480). Hubo conversión en un caso debido a sangrado venoso de difícil manejo y en dos oportunidades se utilizó técnica mano asistida por la misma causa. Morbilidad Clavien-Dindo III en un paciente debido a fuga biliar precoz, manejada con colangiopancreatografía retrógrada endoscópica exitosamente. La mediana de hospitalización fue de 4 días (3-12) y no hubo mortalidad. Conclusión: La SLI-L ha evolucionado, desde un procedimiento innovador hasta convertirse en el actual procedimiento estándar para THDVA-P. Los buenos resultados en términos de morbimortalidad sugieren que podría ser una técnica segura y reproducible en contextos similares al del centro.
Background: Effective prognostic models are needed to manage colorectal liver metastasis (CRLM). It is unsolved problerm which is appropriate of surgery first and chemotherapy first. Thus, we developed an algorithm to facilitate treatment based on the standardized uptake value (SUV) from fluorodeoxyglucose-positron emission tomography (FDG-PET). Methods: We retrospectively evaluated 154 patients who underwent surgery for CRLM, including 112 cases that involved primary surgery and 42 cases that involved preoperative chemotherapy before conversion surgery. We evaluated the relationship between the perioperative SUV and postoperative prognosis in the primary surgery cases, as well as the relationship between the SUV change rate (post-chemotherapy SUV / pre-chemotherapy SUV) and prognosis after conversion surgery. Results: In the primary surgery group, recurrence-free survival (RFS) was independently predicted by an SUV of !6.04 (P = 0.042) and !4 liver metastases (P = 0.003). In addition, the combination of an SUV of !6.04 and !4 liver metastase was strongly associated with poor RFS (p < 0.001). In the conversion surgery group, the SUV change rate was associated with tumour size change, CA19-9 change, and pathological response. An SUV change rate of !0.293 was associated with a shorter RFS (P = 0.006) and also independently predicted RFS (P = 0.026). Conclusion:We established a therapeutic algorithm for managing CRLM based on these results (Figure). FDG-PET may be a useful modality for predicting recurrence and prognosis in cases of CRLM, and our algorithm may be useful for managing multiple CRLMs.
papillary mucinous neoplasm (IPMN) involving the entire pancreas. Methods: The patient is a 61-year-old female with a history of stage I endometrial cancer post robotic assisted total hysterectomy and salpingo-oophorectomy who was diagnosed with multifocal IPMN. Endoscopic ultrasound with fine needle aspiration of a complex cyst at the pancreas neck was significant for a CEA of 2080. She is a type 1 diabetic on an insulin pump. Results: A total of 6 robotic ports were placed and the da Vinci Xi robotic system was used with the patient supine. The approach entailed: (i) Diagnostic laparoscopy (ii) Entry into the lessec sac (iii) Division of the short gastric vessels (iv) Exposure and dissection of the inferior pancreas border (v) Dissection and transection of the splenic artery (vi) Mobilization of the spleen (vii) Exposure of the splenic vein-superior mesenteric vein confluence and transection of the splenic vein (viii) Kocher maneuver (ix) Release of the Treitz and transection of proximal jejunum (x) Transection of the distal stomach (xi) Portal lymphadenectomy (xii) Dissection and transection of the gastroduodenal artery (xiii) Hepaticojejunostomy (xiv) Cholecystectomy (xv) Gastrojejunostomy. Conclusion: Robotic total pancreatectomy with splenectomy offers a minimally invasive approach to a major abdominal operation and is feasible in a stepwise, reproducible technique. Objective: The objectives of the video are to describe a minimally invasive technique for pancreatic necrosectomy and determine when pancreatic debridement is necessary over pseudocyst drainage. Methods: Three radially dilating ports were placed through the anterior abdominal wall and through the anterior gastric wall after endoscopic insufflation. A surgical cystgastrostomy was created after removing the previously placed clogged endoscopic stent. Pancreatic debridement was performed through this transgastric approach until the cavity was completely cleared of debris. The gastrotomy sites were closed at the end of the procedure. Results: The patient presented to our institution with severe sepsis three months after initial presentation of necrotizing pancreatitis. He was found to have a clogged stent and infected pancreatic necrosis. He underwent a laparoscopic transgastric necrosectomy for drainage of pus and complete pancreatic debridement. He recovered well and was discharged on postoperative day 4. Conclusion: Laparoscopic transgastric necrosectomy allows for complete debridement with a single definitive operation. MRI is useful in the assessment of solid debris versus fluid in peripancreatic necrotic collections. This approach is an effective strategy for walled-off retrogastric pancreatic necrosis and offers significant benefits in the recovery of these patients to pre-pancreatitis health.V16 Objective: One of the main criticism of laparoscopic liver resection, is that it is difficult, or not possible, to perform liver-sparing resections. The aim of this video is to present short videos where the intrahepatic Glissonian approach was used ...
The impact of primary tumour location (sidedness) in colorectal cancer has been thoroughly investigated in first-lineand palliative chemotherapystudies. While in these patients, right-sided tumours were associated with worse outcome, data on impact of sidedness concerning postoperative long-term survival after resection for colorectal liver metastasis (CRLM) are scarce. Methods: All patients undergoing hepatic resection for newly diagnosed CRLM in two Austrian high-volume centres between 2003e2016 were analysed. Influence of patient, treatment and tumour characteristics on postoperative survival was evaluated. Results: A total of 252 patients (40% female; median 64a) underwent resection with a 90-day-mortality of 1.2% (31% major resections, 55% received preoperative chemotherapy). Primary tumour characteristics were: 25% rightsided, 57% nodal positive. Metastasis characteristics were: synchronous metastasis in 64%, 38% bilobar hepatic
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