BACKGROUND Intrahepatic cholangiocarcinoma(ICC)is the second most common primary liver cancer and is characterized by an aggressive behavior and a dismal prognosis.Radical surgical resection represents the only potent...BACKGROUND Intrahepatic cholangiocarcinoma(ICC)is the second most common primary liver cancer and is characterized by an aggressive behavior and a dismal prognosis.Radical surgical resection represents the only potentially curative treatment.Despite the increasing acceptance of laparoscopic liver resection for surgical treatment of malignant liver diseases,its use for ICC is not commonly performed.In fact,to achieve surgical free margins a major resection and/or vascular and/or biliary reconstructions is often needed,as well as an associated lymph node dissection.AIM To review and summarize the current evidences on the minimally invasive resection of ICC.METHODS A systematic review of the literature based on the criteria predetermined by the investigators was performed from the 1st of January 2009 up to the 1st of January2021 in 4 databases(PubMed,Scopus,Google Scholar,and Cochrane databases).All retrospective and prospective studies reporting on the comparative outcomes of open vs minimally invasive treatment of ICC were included.An evaluation of manuscripts quality was achieved using Methodological Index for Non-Randomized Studies criteria and Newcastle-Ottawa Scale.RESULTS After a systematic search 9 studies fulfilled the inclusion criteria.Among the all 3012 included patients,2450 were operated by an open approach and 562 by a minimally invasive(laparoscopic)approach.Baseline characteristics,tumor characteristics,surgical outcomes and oncological outcomes were collected and analyzed,highlighting values with a statistical significant difference between patients treated with open or laparoscopic approach.Shorter hospital stay and lower intraoperative blood losses were reported by some Authors in minimally invasive surgery,on the contrary,in the open group there was a higher number of lymphadenectomies and a higher percentage of major hepatectomies.CONCLUSION Minimally invasive resection of ICC has some short-term benefits and it is safe and feasible only in selected centers with a high experience in laparoscopic approach for liver surgery.Minimally invasive surgery,actually,was considered mainly in patients with a tumor with a diameter<5 cm,without invasion of main biliary duct or main vessel and no vascular or biliary reconstructions were planned.Further studies are needed to elucidate its impact on long term oncologic outcomes.展开更多
Colorectal cancer(CRC) represents one of the most commonly diagnosed cancers worldwide.It is the second leading cause of cancer death in Western Countries.In the last decade the survival of patients with metastatic CR...Colorectal cancer(CRC) represents one of the most commonly diagnosed cancers worldwide.It is the second leading cause of cancer death in Western Countries.In the last decade the survival of patients with metastatic CRC has improved dramatically.Due to the advent of new drugs(irinotecan and oxaliplatin) and target therapies(i.e.,bevacizumab,cetuximab and panitumab),the median overall survival has risen from about 12 mo in the mid nineties to 30 mo recently.Many questions needing of right collocations and more clearness still exist regarding the prognostic factors and the predictive factors of response to therapy.Despite advances in dosing and scheduling of chemotherapy in both adjuvant and advanced settings,and a greater emphasis on early detection,the outlook still remains poor for most patients.Molecular analyses have shown that the natural history of all CRCs is not the same.Individual patients with same stage tumours may have different long term prognosis and response to therapy.In addition,some prognostic variables are likely to be more important than others.Here we review the role of prognostic factors and predictive factors according to the recently published English literature.展开更多
文摘BACKGROUND Intrahepatic cholangiocarcinoma(ICC)is the second most common primary liver cancer and is characterized by an aggressive behavior and a dismal prognosis.Radical surgical resection represents the only potentially curative treatment.Despite the increasing acceptance of laparoscopic liver resection for surgical treatment of malignant liver diseases,its use for ICC is not commonly performed.In fact,to achieve surgical free margins a major resection and/or vascular and/or biliary reconstructions is often needed,as well as an associated lymph node dissection.AIM To review and summarize the current evidences on the minimally invasive resection of ICC.METHODS A systematic review of the literature based on the criteria predetermined by the investigators was performed from the 1st of January 2009 up to the 1st of January2021 in 4 databases(PubMed,Scopus,Google Scholar,and Cochrane databases).All retrospective and prospective studies reporting on the comparative outcomes of open vs minimally invasive treatment of ICC were included.An evaluation of manuscripts quality was achieved using Methodological Index for Non-Randomized Studies criteria and Newcastle-Ottawa Scale.RESULTS After a systematic search 9 studies fulfilled the inclusion criteria.Among the all 3012 included patients,2450 were operated by an open approach and 562 by a minimally invasive(laparoscopic)approach.Baseline characteristics,tumor characteristics,surgical outcomes and oncological outcomes were collected and analyzed,highlighting values with a statistical significant difference between patients treated with open or laparoscopic approach.Shorter hospital stay and lower intraoperative blood losses were reported by some Authors in minimally invasive surgery,on the contrary,in the open group there was a higher number of lymphadenectomies and a higher percentage of major hepatectomies.CONCLUSION Minimally invasive resection of ICC has some short-term benefits and it is safe and feasible only in selected centers with a high experience in laparoscopic approach for liver surgery.Minimally invasive surgery,actually,was considered mainly in patients with a tumor with a diameter<5 cm,without invasion of main biliary duct or main vessel and no vascular or biliary reconstructions were planned.Further studies are needed to elucidate its impact on long term oncologic outcomes.
文摘Colorectal cancer(CRC) represents one of the most commonly diagnosed cancers worldwide.It is the second leading cause of cancer death in Western Countries.In the last decade the survival of patients with metastatic CRC has improved dramatically.Due to the advent of new drugs(irinotecan and oxaliplatin) and target therapies(i.e.,bevacizumab,cetuximab and panitumab),the median overall survival has risen from about 12 mo in the mid nineties to 30 mo recently.Many questions needing of right collocations and more clearness still exist regarding the prognostic factors and the predictive factors of response to therapy.Despite advances in dosing and scheduling of chemotherapy in both adjuvant and advanced settings,and a greater emphasis on early detection,the outlook still remains poor for most patients.Molecular analyses have shown that the natural history of all CRCs is not the same.Individual patients with same stage tumours may have different long term prognosis and response to therapy.In addition,some prognostic variables are likely to be more important than others.Here we review the role of prognostic factors and predictive factors according to the recently published English literature.
