Regardless of the thermal ablation modality used, margins larger than 5 mm are critical for local tumor control, with no LTP noted for margins over 10 mm. Unlike RF ablation, the efficiency of MW ablation was not affected for perivascular tumors.

Objective: To assess the effect of biliary drainage of the future liver remnant (FLR) and to develop a risk score for postoperative mortality after liver resection for perihilar cholangiocarcinoma (PHC). Methods: A consecutive series of 287 patients submitted to major liver resection for presumed PHC between 1997 and 2014 at two Western centers was analyzed; 228 patients (79%) underwent preoperative drainage for jaundice. FLR volumes were calculated with CT volumetry, and completeness of FLR drainage was assessed on imaging. A risk score was developed using multivariable logistic regression with five pre-defined variables. Results: Postoperative mortality at 90-days was 14%. Incomplete FLR drainage was a risk factor only in patients with an FLR volume below 50% (OR 2.8, 95% CI 1.1-7.5). No postoperative mortality was observed in 33 undrained patients with FLR volumes above 50%, including 10 jaundiced patients (median bilirubin level 188 mmol/L). Age,

RLS can be performed for primary hepatobiliary malignancies with long-term oncologic outcomes comparable to published open and laparoscopic data.

The fibrolamellar carcinoma-associated DNAJB1-PRKACA gene fusion transcript RNA codes for the catalytic domain of protein kinase A and, thus, overexpression of Aurora kinase A. • ENMD-2076 showed a favorable toxicity profile. • The limited results, one patient (3%) with a partial response and 57% of patients with stable disease, do not support further evaluation of ENMD-2076 as single agent. • Future studies will depend on the simultaneous targeting approach of DNAJB1-PRKACA and the critical downstream components.

Objective: Microvascular invasion (MVI) is a significant risk factor for early recurrence after resection of hepatocellular carcinoma (HCC). Knowledge of MVI status preoperatively would optimize patient selection for resection or transplant. This study proposes quantitative imaging predictors of MVI. Methods: 121 patients who underwent resection of HCC at 2 institutions from 2003 to 2015 were included in this retrospective study. Patients were included based on the availability of contrast-enhanced CT imaging within 3 months preoperatively. We employed quantitative imaging analysis, including local binary patterns, which utilized regional pixel variations in CT image of tumors to automatically categorize tumor morphology and detect MVI. The analysis was performed on the index tumor, which is the largest tumor, and the analysis was repeated with 10fold cross-validation. Results: Given the diverse morphology of HCC tumors, tumors were first categorized into uniform (n = 40) or heterogeneous (n = 81) groups by two blinded radiologists, and it was validated by quantitative image analysis with area under curve (AUC) 0.94 and accuracy 86%. Thirteen tumors (33%) in the uniform group had MVI whereas 41 (51%) in the heterogeneous group had MVI. Within each group, imaging features measured by local binary patterns were most predictive of MVI by univariate analysis. Local binary patterns predicted MVI with AUC 0.78 and accuracy 75% among uniform tumors and with AUC 0.76 and accuracy 74% among heterogeneous tumors (Figure). Conclusion: Quantitative image analysis is a promising preoperative predictor of MVI. Validation in an external dataset is needed to elucidate the utility of this novel imaging marker.

Background Pancreatic metastases (PM) from renal cell carcinoma (RCC) are uncommon. We herein describe the long-term outcomes associated with pancreatectomy at two academic institutions, with a specific focus on 10-year survival. Methods This investigation was limited to patients undergoing pancreatectomy for PM between 2000 and 2008 at the University of Verona and Memorial Sloan Kettering Cancer Center, allowing a potential for 10 years of surveillance. The probabilities of further RCC recurrence and RCC-related death were estimated using a competing risk analysis (method of Fine and Gray) to account for patients who died of other causes during follow-up. Results The study population consisted of 69 patients, mostly with isolated metachronous PM (77%). The median interval from nephrectomy to pancreatic metastasectomy was 109 months, whereas the median post-pancreatectomy follow-up was 141 months. The 10-year cumulative incidence of new RCC recurrence was 62.7%. In the adjusted analysis, the relative risk of repeated recurrence was significantly higher in PM synchronous to the primary RCC (sHR = 1.27) and in patients receiving extended pancreatectomy (sHR = 3.05). The 10-year cumulative incidence of disease-specific death was 25.5%. The only variable with an influence on disease-specific death was the recurrence-free interval following metastasectomy (sHR = 0.98). In patients with repeated recurrence, the 10-year cumulative incidence of RCC-related death was 35.4%. Conclusion In a selected group of patients followed for a median of 141 months and mostly with isolated metachronous PM, resection was associated with a high possibility of long-term disease control in surgically fit patients with metastases confined to the pancreas.

several guidelines interdict surgery for tumor >5 cm despite its resectability or operability, probably due to lack of published series regarding HCC with large size nodule. Here, the prevalence and management of double extra-large HCC (larger than 15 cm) are reported. Methods: We performed a descriptive retrospective study on patients treated in Cipto Mangunkusumo Hospital from 2010 until 2017. Results: There were 70 cases of HCC, 51 (72.9%) of them are male and the mean age is 51.3 years. The cases are classified into four categories: (1) Double Extra-large (diameter >15 cm), (2) Extra-large (diameter 10-15 cm), (3) Large (diameter 5-< 10 cm), and (4) Small (diameter < 5 cm). There were 22.9%, 14.3%, 25.7% and 37.2% cases in each group, consecutively. Range of diameter was 3 to 25 cm, mostly singular and located on the left liver. Hepatitis B was detected on 90% cases and 9 cases of non-B and C. Mean blood lost was 2000 ml. Overall operative mortality was 18,6%. Each category's mortality was 5.7% (XXL), 10% (XL and L each). The XXL operative mortality were 23.1% compared to 76.9% in the XL and L HCC. Prolonged ascites, pneumonia and relaparotomies occurred as operative morbidity. Range of length of stay was 14 to 44 days. Conclusion: Double Extra-Large HCC were common and not contraindicated for resection.

Background: Thermal ablation is a definitive local treatment for selected colorectal liver metastases (CLM) that can be ablated with adequate margins. A critical limitation has been local tumor progression (LTP). Methods: This prospective, single-group, phase 2 study enrolled patients with CLM < 5 cm in maximum diameter, at a tertiary cancer center between November 2009 and February 2019. Biopsy of the ablation zone center and margin was performed immediately after ablation. Viable tumor in tissue biopsy and ablation margins < 5 mm were assessed as predictors of 12-month LTP. Results: We enrolled 107 patients with 182 CLMs. Mean tumor size was 2.0 (range, 0.6–4.6) cm. Microwave ablation was used in 51% and radiofrequency ablation in 49% of tumors. The 12- and 24-month cumulative incidence of LTP was 22% (95% confidence interval [CI]: 17, 29) and 29% (95% CI: 23, 36), respectively. LTP at 12 months was 7% (95% CI: 3, 14) for the biopsy tumor-negative ablation zone with margins ≥ 5 mm vs. 63% (95% CI: 35, 85) for the biopsy-positive ablation zone with margins < 5 mm (p < 0.001). Conclusions: Biopsy-proven complete tumor ablation with margins of at least 5 mm achieves optimal local tumor control for CLM, regardless of the ablation modality used.