Enhanced recovery after surgery (ERAS) has shown effectiveness in terms of reducing the hospital stay and cost associated with open liver resection. However, the benefit of ERAS in patients undergoing laparoscopic liver resection is still unclear, and clinical studies on this topic are limited.The ERAS program for laparoscopic liver resection was used in a group of 80 patients (ERAS group). The results were compared with those in a control group of 107 patients. All patients underwent laparoscopic liver resection. The primary endpoints were the postoperative hospital stay, defined as the number of days from surgery to discharge, and the hospitalization expense. The secondary endpoints were resumption of oral intake, readmissions, and complications.The median postoperative hospital stay was 6.2 ± 2.6 days in the ERAS group, which was significantly shorter than that in the control group (9.9 ± 5.9 d; P < 0.001). The hospitalization cost was $6871 ± 2571 in the ERAS group and $7948 ± 3630 in the control group (P = 0.020). The morbidity rate was 22.5% (18 of 80 patients) in the ERAS group and 43.9% (47 of 107 patients) in the control group (P = 0.002). There were no significant differences the in rate of readmission between the 2 groups.Enhanced recovery after surgery for laparoscopic liver resection is safe and effective. Patients in the ERPS group had a shorter hospital stay, fewer complications, and lower hospital costs.
In terms of the feasibility and safety, this study showed that ALPPS in the treatment of hepatocellular carcinoma with insufficient future liver remnant might be a double-edged sword, and careful patients selected was proposed. Too small of FLR/SLV, less than 30%, is not recommended for ALPPS in liver with cirrhosis.
Background & Aims
Immune checkpoint inhibitors (ICIs) improve the survival of patients with advanced tumors. However, immune-related adverse events limit the use of ICIs. Although liver toxicity has been concerned gradually, little is known about bile duct injury associated with ICIs. Hence, this review aims to describe clinicopathological features, imaging, and management of immune-mediated cholangitis (IMC) induced by ICIs.
Methods
We retrieved the literature from the PubMed database for case reports and series of IMC induced by ICIs. IMC was then classified as small-ducts type, large-ducts type and mixed type. Biochemical parameters, pathological characteristics, imaging features, treatment and response were evaluated and compared among three patterns.
Results
Fifty-three cases of IMC were enrolled. The median values of alkaline phosphatase and alanine transaminase of IMC were 1328 and 156 IU/L. The ALP level of the large-ducts type was higher than that of the small-ducts type (P = 0.021). The main pathological characteristics of small-ducts cholangitis were portal inflammation, bile duct injury and ductular reaction. The imaging features of large-duct cholangitis were bile duct dilatation, stenosis and bile duct wall thickening and irregularity. Forty-eight (90%) cases received immunosuppression therapy. Biliary enzymes reduced in 79% of cases receiving immunosuppression therapy, but only 8.5% of cases returned to normal. It took a long time for biliary enzymes to recover.
Conclusions
The clinicians should be aware of the possibility of IMC if the biliary enzymes increase significantly after the use of ICIs. The liver function can be improved partially by immunosuppressive therapy in the majority of IMC.
Background
Several studies have investigated the effect of non–vitamin K antagonist oral anticoagulants (
NOAC
s) in atrial fibrillation (
AF
) patients with cancer, but the results remain controversial. Therefore, we conducted a meta‐analysis to compare the efficacy and safety of
NOAC
s versus warfarin in this population.
Methods and Results
We systematically searched the PubMed and Embase databases until February 16, 2019 for studies comparing the effect of
NOAC
s with warfarin in
AF
patients with cancer. Risk ratios (
RR
s) with 95%
CI
s were extracted and pooled by a random‐effects model. Five studies involving 8908
NOAC
s and 12 440 warfarin users were included. There were no significant associations between cancer status and risks of stroke or systemic embolism, major bleeding, or death in
AF
patients. Compared with warfarin,
NOAC
s were associated with decreased risks of stroke or systemic embolism (
RR
, 0.52; 95%
CI
, 0.28–0.99), venous thromboembolism (
RR
, 0.37, 95%
CI
, 0.22–0.63), and intracranial or gastrointestinal bleeding (
RR
, 0.65; 95%
CI
, 0.42–0.98) and with borderline significant reductions in ischemic stroke (
RR
, 0.63; 95%
CI
, 0.40–1.00) and major bleeding (
RR
, 0.73; 95%
CI
, 0.53–1.00). In addition, risks of efficacy and safety outcomes of
NOAC
s versus warfarin were similar between
AF
patients with and without cancer.
Conclusions
In patients with
AF
and cancer, compared with warfarin,
NOAC
s had lower or similar rates of thromboembolic and bleeding events and posed a reduced risk of venous thromboembolism.
Most breast cancer survivors receiving chemotherapy have severe cognitive impairment, often referred to as “chemobrain.” Polydatin (PLD) is known to have many biological activities. Thus, this study aimed to determine whether symptoms of chemobrain can be prevented or relieved by PLD. The chemobrain models were established by intraperitoneal injection of doxorubicin (DOX, 2 mg/kg) in rats once a week for 4 weeks (DOX group and DOX+PLD group). In the PLD group and DOX+PLD group, PLD (50 mg/kg) was administered orally to rats every day. We found that PLD treatment significantly protected against DOX-induced learning and memory impairment, restored hippocampal histopathological architecture. Furthermore, PLD suppressed DOX-induced oxidative stress through up-regulating Nrf2, inhibited inflammatory response by activating the NF-κB pathway, and reduced hippocampal apoptosis. Therefore, the present study indicated that PLD offered neuroprotection against DOX-induced chemobrain. PLD may assist in preventing chemobrain after chemotherapy in patients with cancers.
This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
BackgroundAlthough the transcatheter arterial chemoembolization (TACE) was demonstrated to be an alternative treatment of hepatocellular carcinoma with favorable oncological effect, the benefit of postoperative adjuvant TACE was still controversial. The aim of this study was to evaluate the effect of postoperative TACE in hepatocellular carcinoma.ResultsThe 1, 3, and 5–year overall and disease–free survival rates were comparable between Surgery+TACE and Surgery groups. In subgroup analysis, tumor size (≥ 5 cm) was detrimental to disease–free survival (p = 0.028) and an inferior tendency of overall survival was presented. Besides, repeated TACE for patients contributed to a poor disease–free survival (p = 0.005). While, postoperative adjuvant TACE improved the overall survival in patients with high preoperative alpha–fetoprotein or positive pathologically (p = 0.039 and p = 0.045).Materials and MethodsThe data were collected from consecutive patients between January 2010 and September 2014. After propensity score matching, baseline characteristics, overall and disease–free survival were compared between two groups. Subsequently, univariate and subgroup analysis were carried on.ConclusionsOur study indicated that single postoperative adjuvant TACE was beneficial for selected patients of stage I with tumor less than 5 cm, or high preoperative alpha–fetoprotein in serum or positive of alpha–fetoprotein pathologically.
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