The major symptoms of advanced hepatopancreaticbiliary cancer are biliary obstruction, pain and gastric outlet obstruction(GOO). For obstructive jaundice, surgical treatment should de consider in recurrent stent compl...The major symptoms of advanced hepatopancreaticbiliary cancer are biliary obstruction, pain and gastric outlet obstruction(GOO). For obstructive jaundice, surgical treatment should de consider in recurrent stent complications. The role of surgery for pain relief is marginal nowadays. On the last, there is no consensus for treatment of malignant GOO. Endoscopic duodenal stents are associated with shorter length of stay and faster relief to oral intake with more recurrent symptoms. Surgical gastrojejunostomy shows better long-term results and lower re-intervention rates, but there are limited data about laparoscopic approach. We performed a systematic review of the literature, according PRISMA guidelines, to search for articles on laparoscopic gastrojejunostomy for malignant GOO treatment. We also report our personal series, from 2009 to 2017. A review of the literature suggests that there is no standardized surgical technique either standardized outcomes to report. Most of the studies are case series, so level of evidence is low. Decisionmaking must consider medical condition, nutritional status, quality of life and life expectancy. Evaluation ofthe patient and multidisciplinary expertise are required to select appropriate approach. Given the limited studies and the difficulty to perform prospective controlled trials, no study can answer all the complexities of malignant GOO and more outcome data is needed.展开更多
BACKGROUND A minor subset of primary gastrointestinal stromal tumors(GIST)can also arise outside the gastrointestinal tract,which is known as an extra-GIST(E-GIST).Primary GIST of the liver is an exceptional location....BACKGROUND A minor subset of primary gastrointestinal stromal tumors(GIST)can also arise outside the gastrointestinal tract,which is known as an extra-GIST(E-GIST).Primary GIST of the liver is an exceptional location.AIM To characterize epidemiological,clinical and pathological features and options of treatments.METHODS We performed a systematic review to search for articles on primary hepatic GIST.RESULTS This review shows that right hepatic lobe was the most frequent location.Regarding pathological and immunohistochemical features,mitotic count was≥5/50 High Power Fields in more than 50%;and CD117 was negative in only 1 patient.More than 70%of patients had a lesion with high risk of malignancy.CONCLUSION The diagnosis of E-GIST must be considered in a liver mass.Rendering an accurate diagnosis is a challenge,as well as the confirmation of their primary or metastatic nature.展开更多
文摘The major symptoms of advanced hepatopancreaticbiliary cancer are biliary obstruction, pain and gastric outlet obstruction(GOO). For obstructive jaundice, surgical treatment should de consider in recurrent stent complications. The role of surgery for pain relief is marginal nowadays. On the last, there is no consensus for treatment of malignant GOO. Endoscopic duodenal stents are associated with shorter length of stay and faster relief to oral intake with more recurrent symptoms. Surgical gastrojejunostomy shows better long-term results and lower re-intervention rates, but there are limited data about laparoscopic approach. We performed a systematic review of the literature, according PRISMA guidelines, to search for articles on laparoscopic gastrojejunostomy for malignant GOO treatment. We also report our personal series, from 2009 to 2017. A review of the literature suggests that there is no standardized surgical technique either standardized outcomes to report. Most of the studies are case series, so level of evidence is low. Decisionmaking must consider medical condition, nutritional status, quality of life and life expectancy. Evaluation ofthe patient and multidisciplinary expertise are required to select appropriate approach. Given the limited studies and the difficulty to perform prospective controlled trials, no study can answer all the complexities of malignant GOO and more outcome data is needed.
文摘BACKGROUND A minor subset of primary gastrointestinal stromal tumors(GIST)can also arise outside the gastrointestinal tract,which is known as an extra-GIST(E-GIST).Primary GIST of the liver is an exceptional location.AIM To characterize epidemiological,clinical and pathological features and options of treatments.METHODS We performed a systematic review to search for articles on primary hepatic GIST.RESULTS This review shows that right hepatic lobe was the most frequent location.Regarding pathological and immunohistochemical features,mitotic count was≥5/50 High Power Fields in more than 50%;and CD117 was negative in only 1 patient.More than 70%of patients had a lesion with high risk of malignancy.CONCLUSION The diagnosis of E-GIST must be considered in a liver mass.Rendering an accurate diagnosis is a challenge,as well as the confirmation of their primary or metastatic nature.
