The purpose of the study was to improve treatment outcomes for patients with inoperable colorectal liver metastases using the combination of chemoembilization of the hepatic artery and radiofrequency ablation.Material and methods. Treatment outcomes of 60 patients with methachronic unresectable liver metastases from colorectal cancer were analyzed. Eligibility criteria were as follows: absence of extrahepatic metastases, size of metastases from 3 to 5 cm, and inability to perform resection. All patients were divided into two groups. Group I included 30 patients who received combination of regional chemotherapy and radiofrequency ablation. Group II (the control group) consisted of 30 patients who received radiofrequency ablation only.Results. Post-embolization and post-ablation syndromes were observed in both groups of patients. Rightsided hydrothorax (Clavien-Dindo grade II) was found in 4 out of 60 patients (2 patients in Group I and 2 patients in Group II). One-, two- and three-year disease-free survival rates in Group I patients were 96.6 %, 76.6 % and 53.3 %, respectively. The corresponding rates in the control group patients were 90.0 %, 53.6 % and 30.0 %, respectively (p=0.049). The overall one-, two-and three-year survival rates in Group I patients were 100 %, 90 % and 63.3 %, respectively. The corresponding rates in the control group patients were 100 %, 70 % and 50.0 %, respectively (p=0.202).Conclusion. The combination of regional chemotherapy and radiofrequency ablation led to the improvement in overall and disease-free survival rates.
In a retrospective study, a comparative analysis of treatment of 509 patients with acute obstructive colonic obstruction, tumor genesis, which are made of different kinds of surgery (n=384) and stenting of the tumor stricture self-expanding metal stents (n=79). For statistical comparison of results concluded that the endoscopic stenting accompanied by fewer complications, a low mortality, reduces hospitalization time as compared to conventional operations. Stenting may be applicable for continuous decompression in patients with malignant strictures as the final treatment, as well as to the time of decompression in potentially resectable patients as the first stage of treatment («bridge to surgery»). In a retrospective study evaluated the results of clinical observation 509 patients from 2010 to October 2016 were carried out surgery for malignant obstruction of the colon. The first group included 79 patients who performed endoscopic stenting. These patients are the main group. A control group, consisting of two sub-groups, made up of 384 patients whom underwent surgery were performed. First subset patients (330 patients) performed a resection of the left colon departments to form a single-barrel colostomy (Hartmann type of operation), right-sided hemicolectomy with the formation ileotransverzoanastomosis; the second subgroup (54 patients) were formed colonies or ileostomy due to hemodynamic instability and/or the presence of unresectable tumors. We describe the results of the comparison of colorectal stenting and colostomy. The conclusion about the prospects of the use of colorectal stenting in patients with acute colonic obstruction obstructive tumor genesis.
Human epidermal growth factor receptor HER2, a proto-oncogene involved in the proliferation and differentiation signaling pathway. The overexpression and amplification of the HER2 gene and their significance have been studied in breast cancer. Data on HER2 over expression in gastric cancer vary widely, and the value is presented by inconsistent disparate data. The interpretation of HER2 in gastric cancer differs from the evaluation in breast cancer. The purpose of this review is to summarize current data on the evaluation of HER2 in gastric cancer for the selection of targeted therapy. The search in modern databases of medical literature was carried out, more than 100 modern literary sources on the above-mentioned topic were studied and analyzed in detail and carefully. The most significant data on the evaluation of HER2 expression in gastric cancer and its prognostic and predictive value were selected and presented. Selected options evaluate the expression of HER2 receptor in operating and biopsy material of stomach cancer. Comparative data on the use of different antibody clones to solve the above problem are presented. The most frequent and important errors and possible interpretation disorders in the expression of HER2 in gastric cancer are analyzed. The use of transtuzumab for targeted therapy in gastric cancer makes it mandatory to test surgical and biopsy samples of gastric cancer to assess their expression of HER2. The development of various methods and the progress of molecular biology, however, the main role of the immunohistochemical method in solving this problem still left. Gastric cancer needs a single accessible standardized system for evaluating HER2 expression, and, most importantly, expert level interpretation of these results.
Objectives: Bronchobiliary fistula is an abnormal communication between the biliary tree and airway. It presents with cough and bilioptysis. This article is to demonstrate the usefulness of HIDA scan in diagnosing bronchobiliary fistula. Methods: The study was between May 2013 and August 2015.Case 1: A 39 year male admitted with bilioptysis. He had earlier undergone PCD followed by laparotomy for ruptured liver abscess 2 years back. Within a month, relaparotomy was done with external drainage and cholecystostomy. Since he developed external biliary fistula then treated with fistulojejunostomy in 3rd surgery. Then patient developed bronchobiliary fistula which was demonstrated by HIDA scan and not by MRCP. He was then treated with ERCP and biliary stenting. Bilioptysis stopped in 10 days.Case 2: A 35 year male, hilar cholangiocarcinoma with liver metastasis admitted with bilioptysis for 20 days. He had undergone palliative PTBD with stent internalisation 4 months back. The bronchobiliary fistula was then demonstrated by HIDA scan. He was treated with ERCP and biliary stenting. The bilioptysis stopped in 7 days results in both the patients MRCP failed to diagnose the fistulous communication which are well diagnosed with HIDA scan. Conclusion: Bronchobiliary fistula has to be suspected in patients with bilioptysis who have undergone hepatobiliary intervention. Diagnosing fistula may be difficult with MRCP and other imaging modalities. But with HIDA scan it is possible to diagnose the bronchobiliary fistula as is evident from these cases, which will be helpful for the management.
Неоадъювантная химиотерапия является стандартом лечения многих опухолей, в особенности желудочно-кишечного тракта. Данный подход имеет много потенциальных преимуществ, включая регресс опухоли, раннее начало лечения микрометастазов, а также возможность оценивать биологию опухоли, тем самым персонализируя подход к лечению. В настоящее время неоадъювантная химиотерапия не является стандартом лечения местно-распространенного рака ободочной кишки, что связано с неточностью предоперационного стадирования, возможностью прогрессирования опухоли, а также отсутствием достаточного количества рандомизированных клинических исследований.
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