Hilar cholangiocarcinoma is a biliary malignancy arising from the perihilar biliary tree,which is associated with poor oncological outcomes due to its aggressive biology,chemo-resistance and insidious onset[1].As stat...Hilar cholangiocarcinoma is a biliary malignancy arising from the perihilar biliary tree,which is associated with poor oncological outcomes due to its aggressive biology,chemo-resistance and insidious onset[1].As stated by Di Martino et al.,the standard of care is radical resection,and during the last decades,there have been great efforts to improve survival of potentially resectable hilar cholangiocarcinoma,with surgery being the treatment associated with longer survival[2].However,radical resection still represents a challenging operation with high risk of intraoperative and postoperative complications.展开更多
Since the 1990 s, many oncological surgery groups around the world started to apply hyperthermic intraperitoneal chemotherapy(HIPEC) to the different peritoneal spread cancers. The rationale of the application of HIPE...Since the 1990 s, many oncological surgery groups around the world started to apply hyperthermic intraperitoneal chemotherapy(HIPEC) to the different peritoneal spread cancers. The rationale of the application of HIPEC after surgery is to complete the cytoreductive procedure. This combined treatment has now been successfully applied to many different intra-abdominal neoplasms. However, the treatment of peritoneal surface malignancies and the administration of HIPEC still lack high graded evidence data, especially in ovarian cancer. Experimental data exists about every step of the treatment of peritoneal spread ovarian cancer but unfortunately they have not yet been translated into phase Ⅲ clinical randomized trials. Moreover, treatment protocols differ between different centers. A systematic review of published randomized trial protocols was performed. HIPEC techniques are miscellaneous and not yet standardized. Well structured phase Ⅲ randomized trials among specialized centers are needed to investi-gate the effi cacy of this therapeutic approach, as well as technical details that may contribute to the standardization of the procedure and limit morbidity and mortality. In particular, new criteria are mandatory to uniformly stage the disease, to objectively evaluate the extension of cytoreduction and consequently the residual disease, to decide the best method of performing hyperthermia and to perfuse drugs. Moreover, pharmacokinetic and pharmacodynamic studies are urgently needed to assess the best type and dose of anticancer drugs.展开更多
Background Endoscopic balloon dilation has been used to treat patients with ga stric outlet obstruction caused by peptic stricture.This study assessed the role of endoscopic balloon dilation in patients with gastric o...Background Endoscopic balloon dilation has been used to treat patients with ga stric outlet obstruction caused by peptic stricture.This study assessed the role of endoscopic balloon dilation in patients with gastric outlet obstruction with or without Helicobacter pylori infection. Methods Consecutive patients seen bet ween January 1996 and September 2001 with benign gastric outlet obstruction (def ined as stenosis preventing the passage of a 9-mm diameter endoscope, vomiting, succussion splash, and recent weight loss) were prospectively studied. Exclusio n criteria were the following: refusal to undergo dilation, and gastric outlet o bstruction because of malignancy. At endoscopy, antral biopsy specimens were obt ained for histopathologic evaluation and for a rapid urease test for Helicobacte r pylori infection.Patients then underwent dilation with through-the-scope bal loons.After balloon dilation, patients with Helicobacter pylori infection were t reated to eradicate the infection. Results Fifty one patients (33 men, 18 women; median age 65 years; IQR 44-79 years) were studied; 33 consented to endoscopic balloon dilation. Symptom resolution occurred in 25 patients (14 Helicobacter p ylori positive, 11 Helicobacter pylori negative).During amedian follow-up of 24 months (IQR 16-40 months), 3 of 14 patients in the Helicobacter pylori positiv e group and 6 of 11 in the Helicobacter pylori negative group developed further ulcer complications (p=0.039). Conclusions After endoscopic dilation for gastric outlet obstruction, eradication of Helicobacter pylori infection is associated with fewer ulcer complications.展开更多
Background and Aims:Increasing utilization of extended criteria donor leads to an increasing rate of early allograft failure after liver transplantation.However,consensus of definition of early allograft failure is la...Background and Aims:Increasing utilization of extended criteria donor leads to an increasing rate of early allograft failure after liver transplantation.However,consensus of definition of early allograft failure is lacking.Methods:A retrospective,multicenter study was performed to validate the Liver Graft Assessment Following Transplantation(L-GrAFT)risk model in a Chinese cohort of 942 adult patients undergoing primary liver transplantation at three Chinese centers.L-GrAFT(L-GrAFT7 and L-GrAFT10)was compared with existing models:the Early Allograft Failure Simplified Estimation(EASE)score,the model of early allograft function(MEAF),and the Early Allograft Dysfunction(EAD)model.Univariate and multivariate logistic regression were used to find risk factors of L-GrAFT high-risk group.Results:L-GrAFT7 had an area under the curve of 0.85 in predicting 90-day graft survival,significantly superior to MEAF[area under the curve(AUC=0.78,p=0.044)]and EAD(AUC=0.78,p=0.006),while there was no statistical significance between the predicting abilities of L-GrAFT7 and EASE(AUC=0.84,p>0.05).Furthermore,L-GrAFT7 maintains good predicting ability in the subgroup of high-donor risk index(DRI)cases(AUC=0.83 vs.MEAF,p=0.007 vs.EAD,p=0.014)and recipients of donors after cardiac death(AUC=0.92 vs.EAD,p<0.001).Through multivariate analysis,pretransplant bilirubin level,units of packed red blood cells,and the DRI score were selected as independent risk factors of a L-GrAFT7 high-risk group.Conclusions:The accuracy of L-GrAFT7 in predicting early allograft failure was validated in a Chinese multicenter cohort,indicating that it has the potential to become an accurate endpoint of clinical practice and transitional study of machine perfusion.展开更多
文摘Hilar cholangiocarcinoma is a biliary malignancy arising from the perihilar biliary tree,which is associated with poor oncological outcomes due to its aggressive biology,chemo-resistance and insidious onset[1].As stated by Di Martino et al.,the standard of care is radical resection,and during the last decades,there have been great efforts to improve survival of potentially resectable hilar cholangiocarcinoma,with surgery being the treatment associated with longer survival[2].However,radical resection still represents a challenging operation with high risk of intraoperative and postoperative complications.
文摘Since the 1990 s, many oncological surgery groups around the world started to apply hyperthermic intraperitoneal chemotherapy(HIPEC) to the different peritoneal spread cancers. The rationale of the application of HIPEC after surgery is to complete the cytoreductive procedure. This combined treatment has now been successfully applied to many different intra-abdominal neoplasms. However, the treatment of peritoneal surface malignancies and the administration of HIPEC still lack high graded evidence data, especially in ovarian cancer. Experimental data exists about every step of the treatment of peritoneal spread ovarian cancer but unfortunately they have not yet been translated into phase Ⅲ clinical randomized trials. Moreover, treatment protocols differ between different centers. A systematic review of published randomized trial protocols was performed. HIPEC techniques are miscellaneous and not yet standardized. Well structured phase Ⅲ randomized trials among specialized centers are needed to investi-gate the effi cacy of this therapeutic approach, as well as technical details that may contribute to the standardization of the procedure and limit morbidity and mortality. In particular, new criteria are mandatory to uniformly stage the disease, to objectively evaluate the extension of cytoreduction and consequently the residual disease, to decide the best method of performing hyperthermia and to perfuse drugs. Moreover, pharmacokinetic and pharmacodynamic studies are urgently needed to assess the best type and dose of anticancer drugs.
文摘Background Endoscopic balloon dilation has been used to treat patients with ga stric outlet obstruction caused by peptic stricture.This study assessed the role of endoscopic balloon dilation in patients with gastric outlet obstruction with or without Helicobacter pylori infection. Methods Consecutive patients seen bet ween January 1996 and September 2001 with benign gastric outlet obstruction (def ined as stenosis preventing the passage of a 9-mm diameter endoscope, vomiting, succussion splash, and recent weight loss) were prospectively studied. Exclusio n criteria were the following: refusal to undergo dilation, and gastric outlet o bstruction because of malignancy. At endoscopy, antral biopsy specimens were obt ained for histopathologic evaluation and for a rapid urease test for Helicobacte r pylori infection.Patients then underwent dilation with through-the-scope bal loons.After balloon dilation, patients with Helicobacter pylori infection were t reated to eradicate the infection. Results Fifty one patients (33 men, 18 women; median age 65 years; IQR 44-79 years) were studied; 33 consented to endoscopic balloon dilation. Symptom resolution occurred in 25 patients (14 Helicobacter p ylori positive, 11 Helicobacter pylori negative).During amedian follow-up of 24 months (IQR 16-40 months), 3 of 14 patients in the Helicobacter pylori positiv e group and 6 of 11 in the Helicobacter pylori negative group developed further ulcer complications (p=0.039). Conclusions After endoscopic dilation for gastric outlet obstruction, eradication of Helicobacter pylori infection is associated with fewer ulcer complications.
文摘Background and Aims:Increasing utilization of extended criteria donor leads to an increasing rate of early allograft failure after liver transplantation.However,consensus of definition of early allograft failure is lacking.Methods:A retrospective,multicenter study was performed to validate the Liver Graft Assessment Following Transplantation(L-GrAFT)risk model in a Chinese cohort of 942 adult patients undergoing primary liver transplantation at three Chinese centers.L-GrAFT(L-GrAFT7 and L-GrAFT10)was compared with existing models:the Early Allograft Failure Simplified Estimation(EASE)score,the model of early allograft function(MEAF),and the Early Allograft Dysfunction(EAD)model.Univariate and multivariate logistic regression were used to find risk factors of L-GrAFT high-risk group.Results:L-GrAFT7 had an area under the curve of 0.85 in predicting 90-day graft survival,significantly superior to MEAF[area under the curve(AUC=0.78,p=0.044)]and EAD(AUC=0.78,p=0.006),while there was no statistical significance between the predicting abilities of L-GrAFT7 and EASE(AUC=0.84,p>0.05).Furthermore,L-GrAFT7 maintains good predicting ability in the subgroup of high-donor risk index(DRI)cases(AUC=0.83 vs.MEAF,p=0.007 vs.EAD,p=0.014)and recipients of donors after cardiac death(AUC=0.92 vs.EAD,p<0.001).Through multivariate analysis,pretransplant bilirubin level,units of packed red blood cells,and the DRI score were selected as independent risk factors of a L-GrAFT7 high-risk group.Conclusions:The accuracy of L-GrAFT7 in predicting early allograft failure was validated in a Chinese multicenter cohort,indicating that it has the potential to become an accurate endpoint of clinical practice and transitional study of machine perfusion.
