Correlation between the survival rate of the patients with synchronous hepatic metastases from gastric carcinoma after surgical resection and patient＇s index

Background Many studies have reported the benefit of hepatic resection for solitary and metachronous metastases from gastric cancer. However, indications and surgical results for synchronous hepatic metastases from gastric carcinoma have not been clearly defined. This study was performed to assess the benefits and limits of simultaneous combined resection of both primary gastric cancer and synchronous hepatic metastases, as well as to identify prognostic factors affecting the survival.

Percutaneous cryosurgery for the treatment of hepatic colorectal metastases

AIM:To determine the safety and efficacy of efficacy of percutaneous cryosurgery for treatment of patients with hepatic colorectal metastases. METHODS: Three hundred and twenty-six patients with non-resectable hepatic colorectal metastases underwent percutaneous cryosurgery under the guidance of ultrasound or CT. Follow-up was 1 mo after cryosurgery and then every 4 mo thereafter by assessment of tumor markers, liver ultrasonography, and abdominal CT. For lesions suspicious of recurrence, a liver biopsy was performed and subsequent repeat cryosurgery was given if histology was positive for cancer. RESULTS: All patients underwent a total of 526 procedures of cryosurgery. There were 151 patients who underwent repeat procedures of cryosurgery for recurrent tumors in the liver and extrahepatic places. At 3 mo after cryosurgery, carcinoembryonic antigen (CEA) levels in 197 (77.5%) patients who had elevated markers before cryosurgery decreased to normal range. Among 280 patients who received CT following-up, cryotreated lesions showed complete response (CR) in 41 patients (14.6%), partial response (PR) in 115 patients (41.1%), stable disease (SD) in 68 patients (24.3%) and progressive disease (PD) in 56 patients (20%). The recurrence rate was 47.2% during a median follow-up of 32 mo (range, 7-61). Sixty one percent of the recurrences were seen in liver only and 13.9% in liver and extrahepatic areas. The recurrence rate at cryotreated site was only 6.4% for all cases. During a median follow-up of 36 mo (7-62 mo), the median survival of all patient was 29 mo (range 3-62 mo). Overall survival was 78%, 62%, 41%, 34% and 23% at 1, 2, 3, 4 and 5 years, respectively, after the treatment. Patients with tumor size less than 3 cm, tumor in right lobe of liver, lower CEA levels (< 100 ng/dL) and post- cryosurgery TACE had higher survival rate. There wasno significant difference in terms of survival based on the number of tumors, pre-cryosurgery chemotherapy and the timing of the development of metastases (synchronous vs metachronous). Patients who underwent 2-3 procedures of cryosurgery had increased survival compared to patients who received cryosurgery once only. There was no intra-cryosurgery mortality. Main adverse effects, such as hepatic bleeding, cryoshock, biliary fistula, liver failure, renal insufficiency and liver abscess were only observed in 0.3%-1.5% of patients. CONCLUSION:Percutaneous cryosurgery was a safe modality for hepatic colorectal metastases. Rather than an alternative to resection, this technique should be regarded as a complement to hepatectomy and as an additional means of achieving tumor eradication when total excision is not possible.

EDGE non-invasive radiosurgery for gastric neuroendocrine hepatic portal lymph node metastases:a case report

Treating metastatic gastric neuroendocrine neoplasms （gNENs） is challenging, especially for those with progressive disease during somatostatin analog processing. In this report, we present a case of a welldifferentiated grade 2, type 3 gNEN with metastatic hepatic portal lymph nodes. EDGE non-invasive radiosurgery （800 cGy x 5 F） was performed to radiate the metastatic hepatic portal lymph nodes. Three months after the hyperfractionated radiotherapy, no signs of metastatic hepatic portal lymph nodes were observed using 8Ga-dotatate positron emission tomography-computed tomography or magnetic resonance imaging. Therefore, EDGE non-invasive radiosurgery could be a potential option for treating local metastatic nodes.

Is there a role for treatment-oriented surgery in liver metastases from gastric cancer?

BACKGROUND Distant metastases are found in approximately 35%of patients with gastric cancer at their first clinical observation,and of these,4%-14%involves the liver.Unfortunately,only 0.4%-2.3%of patients with metastatic gastric cancer are eligible for radical surgery.Although surgical resection for gastric cancer metastases is still debated,there have been changes in recent years,although several clinical issues remain to be defined and that must be taken into account before surgery is proposed.AIM To analyze the clinicopathological factors related to primary gastric tumor and metastases that impact the survival of patients with liver metastatic gastric cancer.METHODS We performed a systematic review of the literature from 2000 to 2018 according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement.The study protocol was based on identifying studies with clearly defined purpose,eligibility criteria,methodological analysis,and patient outcome.RESULTS We selected 47 studies pertaining to the purpose of the review,which involved a total of 2304 patients.Median survival was 7-52.3 mo,median disease-free survival was 4.7-18 mo.The 1-,2-,3-,and 5-year overall survival(OS)was 33%-90.1%,10%-60%,6%-70.4%,and 0%-40.1%,respectively.Only five papers reported the 10-year OS,which was 5.5%–31.5%.The general recurrence rate was between 55.5%and 96%,and that for hepatic recurrence was between 15%and 94%.CONCLUSION Serous infiltration and lymph node involvement of the primary cancer indicate an unfavorable prognosis,while the presence of single metastasis or≤3 metastases associated with a size of<5 cm may be considered data that do not contraindicate liver resection.

Spontaneous hemoperitoneum from hepatic metastatic trophoblastic tumor

Spontaneous hemoperitoneum(SP) is defined as the presence of blood within the peritoneal cavity that is unrelated to trauma.Although there is a vast array of etiologies for SP,primary hepatocellular carcinoma and hepatic adenoma are considered to be the most common causes.Hepatic metastatic tumor associated with spontaneous rupture is rare.SP from hepatic metastatic trophoblastic tumor may initially present with a sudden onset of abdominal pain.Abdominal computed tomography(CT) plays an important role in establishing the diagnosis of SP,indicating its origin and etiology,and determining subsequent management.Herein,we report an uncommon case of hemoperitoneum from spontaneous rupture of a hepatic metastatic trophoblastic tumor in a young female patient.Interestingly,the contrast-enhanced CT findings demonstrated hypervascular hepatic masses with persistent enhancement at all phases,which were completely different from the common appearances of hepatic metastases.For SP resulting from hepatic metastatic tumors,surgical intervention is still the predominant therapeutic method,but the prognosis is very poor.

Positron emission tomography/computer tomography:Challenge to conventional imaging modalities in evaluating primary and metastatic liver malignancies

Computer tomography (CT) and magnetic resonance imaging (MRI),as conventional imaging modalities,are the preferred methodology for tumor,nodal and systemic metastasis (TNM) staging. However,all the noninvasive techniques in current use are not sufficiently able to identify primary tumors and even unable to define the extent of metastatic spread. In addition,relying exclusively on macromorphological characteristics to make a conclusion runs the risk of misdiagnosis due mainly to the intrinsic limitations of the imaging modalities themselves. Solely based on the macromorphological characteristics of cancer,one cannot give an appropriate assessment of the biological characteristics of tumors. Currently,positron emission tomography/computer tomography (PET/CT) are more and more widely available and their application with 18F-fluorodeoxyglucose (18F-FDG) in oncology has become one of the standard imaging modalities in diagnosing and staging of tumors,and monitoring the therapeutic efficacy in hepatic malignancies. Recently,investigators have measured glucose utilization in liver tumors using 18F-FDG,PET and PET/CT in order to establish diagnosis of tumors,assess their biologic characteristics and predict therapeutic effects on hepatic malignancies. PET/ CT with 18F-FDG as a radiotracer may further enhance the hepatic malignancy diagnostic algorithm by accurate diagnosis,staging,restaging and evaluating its biological characteristics,which can benefit the patients suffering from hepatic metastases,hepatocellular carcinoma and cholangiocarcinoma.

A rare etiology of post-endoscopic retrograde cholangiopancreatography pneumoperitoneum

Major complications of endoscopic retrograde cholangiopancreatography (ERCP) include pancreatitis, hemorrhage, cholangitis, and duodenal perforation. The occurrence of free air in the peritoneal cavity post- ERCP is a rare event (< 1%), which is usually the result of duodenal or ductal perforation related to therapeutic ERCP with sphincterotomy. We describe for the first time a different aetiology of pneumoperitoneum, in an 84-year-old woman with pancreatic cancer and a large hepatic metastasis, after ERCP with common bile duct stent deployment. Our patient developed, pneumoperitoneum due to air leakage from rupture of intrahepatic bile ducts and Glisson’s capsule in the area of a peripheral large hepatic metastasis. The potential mechanism underlying this complication might be post- ERCP pneumobilia and increased pressure of intrahepatic bile ducts leading to rupture of intrahepatic bile ducts in the liver metastatic mass owing to neoplastic tissue friability. This case indicates the need for close clinical and radiological observation of patients with hepatic masses (primary or metastatic) subjected to ERCP. In such patients, avoidance of excessive air insufflation during ERCP and/or placement of a nasogastric tube for bowel decompression immediately after ERCP might be a reasonable strategy to prevent such unusual complications.

An uncommon cause of gastro-duodenal ulceration

Gastrointestinal ulcers occur frequently and are mainly caused by H pylori infection. In this report, we present a rare case of gastro-duodenal ulcer following selective internal radiation therapy (SIRT). SIRT is a palliative treatment for unresectable liver tumours. During SIRT, 90Y-microspheres are infused into the hepatic artery. Pre- treatment evaluation for the presence of arterial shunts to neighbouring organs should be determined in order to avoid complications of SIRT.

Calcitonin-negative neuroendocrine tumor of the thyroid with metastasis to liver-rare presentation of an unusual tumor: A case report and review of literature

BACKGROUND Neuroendocrine tumors mainly occur in the stomach,intestine,pancreas,and lung and are rarely detected in the thyroid.Thyroid neuroendocrine tumors,designated medullary thyroid carcinoma,generally present with elevated calcitonin.Calcitonin-negative neuroendocrine tumors of the thyroid are extremely rare.CASE SUMMARY Here,we present a case report of a 56-year-old female patient with a neck pain complaint.Total thyroidectomy was conducted after comprehensive evaluation,and diagnosis was confirmed as calcitonin-negative neuroendocrine tumor of the thyroid.Two months later,liver metastasis was detected,and transcatheter arterial chemoembolization was subsequently performed to control growth.However,the curative effect was unsatisfactory and multiple intrahepatic metastases occurred after 3 mo.CONCLUSION Owing to the rarity of this disease,no clear guidelines are available for treatment.In addition to reporting this rare case,we have reviewed and summarized associated medical literature with an aim to provide a comprehensive reference platform for subsequent research.

Acquired hepatocerebral degeneration in a metastatic neuroendocrine tumor long-term survivor——an update on neuroendocrine neoplasm’s treatment:A case report

BACKGROUND Metastatic small bowel low-grade neuroendocrine tumors(NETs)have a good prognosis.Surgery is the only curative treatment;however,this may induce advanced liver disease,particularly in long-term survivor patients.Acquired hepatocerebral degeneration or Parkinsonism in cirrhosis is characterized by rapidly progressive extrapyramidal symptoms in patients with advanced liver disease.CASE SUMMARY A 70-year-old man presented to the emergency department with diminished consciousness and disorientation,and was diagnosed with hepatic encephalopathy.The patient was diagnosed in 1993 with a metastatic small bowel NET,for which he twice underwent hepatic surgery,with metastatic resection in 1993 and a right hepatectomy in 2002 to remove two hepatic metastases.In 2003,the patient started first-line chemotherapy and in 2004 started the first of three consecutive biological treatments,followed by radio-molecular therapy,achieving stable disease for 14 years.Disease progression was identified and he underwent an endoscopic retrograde cholangiopancreatography.However,in 2019 advanced liver disease was identified.We diagnosed the development of acquired hepatocerebral degeneration,an unusual long-term side effect after multiple hepatic procedures.CONCLUSION The importance of regular and ongoing surveillance in long-term NET survivors who undergo hepatic procedures should be integrated into the therapeutic management plan,as some of these negative outcomes could be prevented.