Objective: We have recently reported that colorectal cancer liver metastases have three different histological growth patterns (HGPs) (desmoplastic, replacement and pushing) and that patients with predominantly desmoplastic lesions have a better prognosis after resection than replacement HGPs. It is also known that a portion of metastases progress after portal vein embolization (PVE) and may decrease the resectability rate. Our aim was to determine if a particular HGP was associated with progression seen after PVE. Methods: Between 2008 and 2015, patients who underwent PVE and resection and had the appropriate imaging available were included. CT-Scan tumor volumes were measured for lesions before and after PVE and pathologists blinded to the clinical data performed HGP scoring on the H&E stained slides derived from the resected specimens. Results: Forty-eight patients with 178 lesions were included. Ninety-eight lesions progressed (PD) and 80 were stable (SD) after PVE. In the PD group, lesions were predominantly of replacement pattern (95.0% (IQ range 73.8e100.0) vs. 5.0% (0.0e10.0) desmoplastic, p < 0.001). In the SD group, lesions were predominantly desmoplastic (95.0% (5.0e 100.0) vs. replacement 0.0% (0.0e83.8)%, p < 0.001). In patients with two-stage resections with PD, the predominant pattern was replacement in both first and second stage surgeries (87.5% (47.5e96.3) and 90.0% (82.7e95.0) respectively), whereas in patients with two-stage resections with SD, the predominant pattern was desmoplastic in both the first and second stage surgeries (97.5% (20.0e100.0) and 97.5% (50.0e100.0) respectively). Conclusion: HGP of liver metastases are associated with disease progression post PVE. Non-invasive methods that could identify growth patterns are needed to optimize patient stratification.
A model of the accumulation and depletion capacitance for a bottom gate top contact (BGTC) thin film transistors (TFT) with an etch stop layer (ESL) was presented. The model, which includes the parasitic capacitance due to device layout, was verified by comparison of measured data and modeled data for TFTs of various dimensions. Good agreement was seen between measured and modeled data, where the model underestimated the capacitance by 2% to 7%, depending on the device dimensions. The impact of the parasitic capacitance on estimates of the Debye length (λD ) are discussed and it is demonstrated that the relative error in the λD estimates is directly proportional to the ratio of the parasitic capacitance over the measured capacitance (CPAR/CM). The relative error was shown to increase as the ratio increases, leading to a larger underestimation of the λD. It was concluded that the parasitic capacitance to measured capacitance should be minimized for devices that are used for extraction of physical parameters from C‐V data. This is especially important in the case where the λD is a critical parameter in the optimization of TFT performance.
This project was designed to critically assess the outcomes of hand-assisted laparoscopic minimallyinvasive hepatectomy for malignancy. Methods: Eighty-two consecutive patients undergoing minimally invasive hepatectomy for malignancy were assessed for intraoperative, pathological, mid-term complications and long-term oncologic outcomes. The median age was 59 years (range: 24e79 yrs), 54% were male, and the median BMI was 27.1 (IQR: 24.2e31.8). Sixty-eight patients (83%) had hand-assisted resection (Gelport, Applied Medical) via an 8 cm port/extraction incision (36 subcostal/32 midline) and 14 (17%) were totally laparoscopic. Histologies included colorectal metastases (55%), HCC (17%), NET metastases (6%), and other malignancy (22%) with 45% treated with preoperative chemotherapy. Results: Median operative time was 200 minutes (IQR: 155e244 min) and median EBL was 88cc (IQR: 50e 150cc) with no perioperative transfusions. There was one conversion to open surgery for extensive portal inflammation after PVE. Six patients (9%) in the hand-assisted group had small occult tumors identified by palpation and resected, none of which were detectable on imaging or ultrasound. Postoperatively, there were 11 patients (13%) with minor complications, no major complications, no reoperations, 4 readmissions (5%) and no 90-day mortalities. 95% of resections were R0 with no intrahepatic recurrence in the four R1 cases. With a median follow-up of 18 months, the 3-year RFS was 58% with 68% of patients without disease and the 3-year OS was 82%. Conclusion: Compared to historical totally laparoscopic hepatectomy outcomes with a pfannenstiel extraction incision, upper abdominal hand-assisted laparoscopic hepatectomy is safer, more efficient, and better able to identify small occult lesions, while providing excellent oncologic outcomes.
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