The role of hepatic resection in patients with hepatocellular carcinoma (HCC) and invasion of a main portal or hepatic vein branch is controversial. We evaluated the efficacy of hepatic resection and the factors affecting survival after... more
The role of hepatic resection in patients with hepatocellular carcinoma (HCC) and invasion of a main portal or hepatic vein branch is controversial. We evaluated the efficacy of hepatic resection and the factors affecting survival after resection in such patients. The records of 102 patients who underwent resection for HCC with major vascular invasion between 1984 and 1999 were reviewed. Prognostic factors were evaluated by univariate and multivariate analysis. The study included 87 men and 15 women. The median age was 59 years. The perioperative mortality rate was 5.9%. Median survival was 11 months (median follow-up, 93 months). The 1-, 3-, and 5-year survival rates were 45%, 17%, and 10%; the longest-living survivor was still alive at 14.8 years. Absence of moderate to severe fibrosis and absence of high nuclear grade were associated with a better 5-year survival rate (23% vs 5%; P = .001 and 21% vs 9%; P = .04, respectively). On multivariate analysis, moderate to severe fibrosis remained a significant predictor of both short-term (< or = 6 months) and long-term (>6 months) survival ( P < .03 and P < .01, respectively). Hepatic resection for HCC with major vascular invasion is associated with median survival exceeding historical survival in patients not treated surgically. Patients with HCC and major vascular invasion who derive long-term benefit from resection have no or minimal underlying fibrosis.
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Research Interests: Adolescent, Medicine, Multivariate Analysis, Prospective studies, Humans, and 15 moreChild, Female, Male, Hepatocellular Carcinoma, Clinical Sciences, Aged, Middle Aged, Adult, Logistic Models, Multicenter Study, Hepatectomy, Neoplasm staging, Gastrointestinal surgery, Liver neoplasms, and major hepatectomy
The role of surgical resection in patients with large or multinodular hepatocellular carcinoma (HCC) remains unclear. This study evaluated the long-term outcome of patients with hepatic resection for large... more
The role of surgical resection in patients with large or multinodular hepatocellular carcinoma (HCC) remains unclear. This study evaluated the long-term outcome of patients with hepatic resection for large (>5 cm in diameter) or multinodular (more than three nodules) HCC by using a multi-institutional database. The perioperative and long-term outcomes of 404 patients with small HCC (<5 cm in diameter; group 1) were compared with those of 380 patients with large or multinodular HCC (group 2). The prognostic factors in the latter group were analyzed. The postoperative complication rate (27% vs. 23%; P = .16) and hospital mortality rate (2.4% vs. 2.7%; P = .82) were similar between groups. The overall survival rates were significantly higher in group 1 than group 2 (1 year, 88% vs. 74%; 3 years, 76% vs. 50%; 5 years, 58% vs. 39%; P < .001). Among patients in group 2, five independent prognostic factors were identified to be associated with a worse overall survival: namely, symptomatic disease, presence of cirrhosis, multinodular tumor, microvascular tumor invasion, and positive histological margin. Hepatic resection can be safely performed in patients with large or multinodular HCC, with an overall 5-year survival rate of 39%. Symptomatic disease, the presence of cirrhosis, a multinodular tumor, microvascular invasion, and a positive histological margin are independently associated with a less favorable survival outcome.
Research Interests: Gastroenterology, Medicine, Multivariate Analysis, Humans, Internal Medicine, and 15 moreHepatocellular Carcinoma, Aged, Middle Aged, Carcinoma, Neoplasm Invasiveness, Group, Postoperative Complication, Cirrhosis, Hospital Mortality, Overall Survival, Hepatocellular, Large, Perioperative, Hepatectomy, and Liver neoplasms
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Oral Presentatio
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Background Deficiencies in the DNA mismatch repair system cause errors during DNA replication, which in turn give rise to microsatellite instability (MSI). The impact of MSI on survival in metastatic colorectal cancer (mCRC) is unclear.... more
Background Deficiencies in the DNA mismatch repair system cause errors during DNA replication, which in turn give rise to microsatellite instability (MSI). The impact of MSI on survival in metastatic colorectal cancer (mCRC) is unclear. This cohort study aims to investigate the prognostic and predictive value of MSI in mCRC prior to the immune therapy era. Materials and Methods A total of 75 MSI-high (MSI-H) mCRC patients (pts) and 75 matched (age, gender, disease sidedness, metachronous/synchronous) microsatellite-stable (MSS) mCRC pts were identified from 1,268 mCRC pts who had MSI/mismatch repair test results at Mayo Clinic Rochester between January 1992 and July 2016. A retrospective review was conducted by using data from electronic medical records. Statistical analyses utilized the Kaplan-Meier method, log-rank test, and Cox proportional hazards models. Results The MSS group was well matched to the MSI-H group based on age, gender, location, and chronicity of metastatic diseas...
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Background The purpose of this study was to define survival rates in patients with isolated advanced abdominal nodal metastases secondary to colorectal cancer (CRC), treated with curative-intent trimodality therapy. Materials and Methods... more
Background The purpose of this study was to define survival rates in patients with isolated advanced abdominal nodal metastases secondary to colorectal cancer (CRC), treated with curative-intent trimodality therapy. Materials and Methods Sixty-five patients received trimodality therapy, defined as chemotherapy delivered with external beam radiotherapy (EBRT) followed by lymphadenectomy and intraoperative radiotherapy (IORT). Infusional 5-fluorouracil was the most common radiosensitizer used (63%, 41 patients). The median dose of EBRT was 50 Gy, and the median dose of IORT was 12.5 Gy. We evaluated time to distant metastasis, toxicities, local failure within the EBRT field, recurrence within the IORT field, and survival. Results Fifty-two percent of patients were male; patients’ median age was 50.5 years. All patients had an Eastern Cooperative Oncology Group score ≤1. Twenty-nine patients had right-sided colon cancer, 22 had left-sided colon cancer, and 14 had rectal primaries. The ...
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Background BRAF V600E mutations are present in 8%–10% of patients with metastatic colorectal cancer (mCRC) and portend poor prognosis. This study investigated the impact of metastasectomy for patients with BRAF V600E mCRC. Subjects,... more
Background BRAF V600E mutations are present in 8%–10% of patients with metastatic colorectal cancer (mCRC) and portend poor prognosis. This study investigated the impact of metastasectomy for patients with BRAF V600E mCRC. Subjects, Materials, and Methods Using prospective clinical and molecular data, patients with BRAF V600E mCRC were analyzed for clinical characteristics and survival. Statistical analyses utilized the Kaplan-Meier method, log-rank test, and Cox proportional hazard models. Results Fifty-two patients were identified between July 1, 2008, and January 4, 2016. Patient characteristics included median age 65 years, 61% female, Eastern Cooperative Oncology Group performance status ≤1, 71% with right-sided tumors, and 28% with liver-limited metastasis. In the first-line setting, 7% (4/52) received fluorouracil, leucovorin, oxaliplatin, and irinotecan (FOLFOXIRI)/bevacizumab (BEV) and 81% were treated with doublet chemotherapy consisting of fluoropyrimidine, oxaliplatin, a...
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Background Advances in the surgical management of hepatocellular carcinoma (HCC) have expanded the indications for curative hepatectomy, including more extensive liver resections. The purpose of this study was to examine long-term... more
Background Advances in the surgical management of hepatocellular carcinoma (HCC) have expanded the indications for curative hepatectomy, including more extensive liver resections. The purpose of this study was to examine long-term survival trends for patients treated with major hepatectomy for HCC.
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The clinical perspective on hepatic growth is limited. The goal of the present study was to compare hepatic hypertrophy and the kinetic growth rate(KGR) in patients after the ALPPS (Associating Liver Partition with Portal Vein Ligation... more
The clinical perspective on hepatic growth is limited. The goal of the present study was to compare hepatic hypertrophy and the kinetic growth rate(KGR) in patients after the ALPPS (Associating Liver Partition with Portal Vein Ligation for Staged Hepatectomy) procedure, portal vein embolization (PVE) and living donor liver transplantation. Volumetry and KGR of the future liver remnant (FLR) were compared from (15) patients undergoing ALPPS, (53) patients undergoing PVE, (90) recipients of living donor liver grafts and (93) donors of living donor liver grafts. The degree of hypertrophy was significantly greater after ALPPS (84.3 ± 7.8%) than after PVE (36.0 ± 27.2%) (P < 0.001). The KGR was also significantly greater for ALPPS [32.7 ± 13.6 cubic centimetres (cc)/day] (10.8 ± 4.5%/day) compared with PVE (4.4 ± 3.2 cc/day) (0.98 ± 0.75%/day) (P < 0.001). The FLR of living donor donors had the greatest degree of hypertrophy (107.5 ± 39.2%) and was greater than after ALPPS (P = 0.0...
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Research Interests: Risk assessment, Cancer Control, Medicine, Cryotherapy, Humans, and 15 moreLiver, Female, Male, Prognosis, Risk Assessment, Neuroendocrine Tumor, Cryosurgery, Neuroendocrine Tumors, Postoperative Complications, Clinical Trials as Topic, Hepatectomy, Neoplasm staging, Liver neoplasms, Neoplasm metastasis, and Medical and Health Sciences
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Research Interests: Nonparametric Statistics, Immunohistochemistry, Medicine, Probability, Humans, and 15 moreInternal Medicine, Liver, Female, Male, Liver Transplantation, Netherlands, Clinical Sciences, Middle Aged, Adult, Retrospective Studies, Graft Rejection, Neuroendocrine Tumors, Patient selection, Pancreatic neoplasms, and Liver neoplasms
Research Interests: Medicine, Multivariate Analysis, Humans, Internal Medicine, Female, and 15 moreMale, Hepatocellular Carcinoma, Risk factors, Aged, Middle Aged, Odds ratio, Prognosis, Liver Resection, Risk Factors, Logistic Models, Predictive value of tests, Postoperative Period, Hepatectomy, Cause of death, and Liver neoplasms
Research Interests: Medicine, Hepatitis C, Multivariate Analysis, Liver diseases, Hepatitis B, and 15 moreHumans, Internal Medicine, Female, Male, Hepatocellular Carcinoma, Coinfection, Hepatitis C Virus, Hepatitis, Clinical Sciences, Middle Aged, Hepatic Fibrosis, Hepatitis B virus, Liver Disease, Gastrointestinal surgery, and Liver neoplasms
Research Interests: Adolescent, Medicine, Multivariate Analysis, Prospective studies, Humans, and 15 moreChild, Female, Male, Hepatocellular Carcinoma, Clinical Sciences, Aged, Middle Aged, Adult, Logistic Models, Multicenter Study, Hepatectomy, Neoplasm staging, Gastrointestinal surgery, Liver neoplasms, and major hepatectomy
We thank Dr. Sentilhes and coworkers for their interest in the results from the observational part of the Swedish ICP study, in which we demonstrated that fetal risk correlated with maternal bile acid levels. We stratified a large patient... more
We thank Dr. Sentilhes and coworkers for their interest in the results from the observational part of the Swedish ICP study, in which we demonstrated that fetal risk correlated with maternal bile acid levels. We stratified a large patient material (n 690) of pregnant women with pruritus into three groups: no ICP (serum bile acids 10 mol/ L), mild ICP (10-39 mol/L) and severe ICP ( 40 mol/L). Spontaneous preterm delivery; asphyxial events (operative delivery due to asphyxia, arterial umbilical pH 7.05, or Apgar score 7 at 5 minutes); and meconium staining of amniotic fluid, placenta, and membranes were found to be significantly increased in the group with severe ICP compared with the groups with no ICP and mild ICP. No differences in these variables were detected between the group with no ICP and the group with mild ICP. Furthermore, a higher frequency of intrauterine fetal death (IUFD) in prior pregnancies was reported by women in the group with severe ICP (4.1%) compared with the groups with no ICP (0.6%) and mild ICP (0.8%) (P .001). The rates of IUFD in the group with no ICP and the group with mild ICP did not differ significantly from the overall IUFD rate in Sweden (0.4%). In their comments, our French colleagues referred to the fact that one of our IUFD cases had bile acid levels below 40 mol/L (27 mol/L). This case was a twin pregnancy, in which one fetus died and the other survived. At delivery, a tight knot on the umbilical cord of the dead twin was found. Fetuses in twin pregnancies are indeed exposed to a higher risk, and all cases of IUFD in ICP pregnancies are not necessarily related to the disease. A recent study by Williamson et al.1 investigated fetal outcome in women with ICP, and they reported high fetal complication rates. However, in this study several confounding factors were present. Their patient material was based on a questionnaire survey in women with ICP that were identified by a patient support group. As the authors themselves stated in the article, this fact may indicate that the material was enriched by pregnancies in which complications had occurred. It should be pointed out that induction of labor, especially before term, is associated with an increase of fetal and maternal risk in terms of prolonged labor, higher frequencies of emergency cesarean section, and fetal asphyxia. We agree that the slight increase in risk of respiratory distress syndrome in the neonate is not an important issue when deciding to induce labor. Nevertheless, it should be underlined that inductions of labor should be conducted only in cases in which benefits outweigh risks. Our study proved that fetuses in pregnant women with bile acid levels exceeding 40 mol/L were exposed to an increased risk, and in this group it seems reasonable to propose active management (pharmacological treatment or induction of labor). Because we could not find any increase of fetal risk in our large study population of women with ICP and bile acid levels 10 to 39 mol/L, we cannot find any evidence to support that these women would benefit from routine induction before term. To further address this issue, a randomized study between active and expectant management should be conducted in this specific group.
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Fluorouracil/leucovorin as the sole therapy for metastatic colorectal cancer (CRC) provides an overall survival of 8 to 12 months. With an increase in surgical resections of metastatic disease and development of new chemotherapies,... more
Fluorouracil/leucovorin as the sole therapy for metastatic colorectal cancer (CRC) provides an overall survival of 8 to 12 months. With an increase in surgical resections of metastatic disease and development of new chemotherapies, indirect evidence suggests that outcomes for patients are improving in the general population, although the incremental gain has not yet been quantified.
Research Interests: Cancer, Medicine, Colorectal cancer, Multivariate Analysis, Humans, and 15 moreInternal Medicine, Female, Clinical, Male, Clinical oncology, Colectomy, Adenocarcinoma, Metastatic Colorectal Cancer, Colorectal Neoplasms, Combined Modality Therapy, Hepatectomy, Disease Free Survival, Neoplasm staging, Cause of death, and Liver neoplasms
Perihilar cholangiocarcinoma is a complex and devastating disease. Its complexity in part arises from the difficulty of establishing a diagnosis, especially in primary sclerosing cholangitis (PSC) patients. We have found fluorescent in... more
Perihilar cholangiocarcinoma is a complex and devastating disease. Its complexity in part arises from the difficulty of establishing a diagnosis, especially in primary sclerosing cholangitis (PSC) patients. We have found fluorescent in situ hybridization (FISH) of cytologic specimens to be helpful in establishing a diagnosis of cholangiocarcinoma. In particular, FISH polysomy is useful in establishing a diagnosis of this malignancy. Endoscopic ultrasound with fine needle aspirates of regional lymph nodes has high utility in identifying patients who have advanced disease with lymph node metastases. Patients who are resectable by conventional surgical techniques are referred for surgery. However, patients who are not resectable or who have PSC and meet highly selective criteria become eligible for liver transplantation. The protocol employs external beam radiation therapy followed by brachytherapy, and then capecitabine until a staging laparotomy is performed. There is a high dropout ...
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The role of surgical resection in patients with large or multinodular hepatocellular carcinoma (HCC) remains unclear. This study evaluated the long-term outcome of patients with hepatic resection for large... more
The role of surgical resection in patients with large or multinodular hepatocellular carcinoma (HCC) remains unclear. This study evaluated the long-term outcome of patients with hepatic resection for large (&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;5 cm in diameter) or multinodular (more than three nodules) HCC by using a multi-institutional database. The perioperative and long-term outcomes of 404 patients with small HCC (&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;5 cm in diameter; group 1) were compared with those of 380 patients with large or multinodular HCC (group 2). The prognostic factors in the latter group were analyzed. The postoperative complication rate (27% vs. 23%; P = .16) and hospital mortality rate (2.4% vs. 2.7%; P = .82) were similar between groups. The overall survival rates were significantly higher in group 1 than group 2 (1 year, 88% vs. 74%; 3 years, 76% vs. 50%; 5 years, 58% vs. 39%; P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; .001). Among patients in group 2, five independent prognostic factors were identified to be associated with a worse overall survival: namely, symptomatic disease, presence of cirrhosis, multinodular tumor, microvascular tumor invasion, and positive histological margin. Hepatic resection can be safely performed in patients with large or multinodular HCC, with an overall 5-year survival rate of 39%. Symptomatic disease, the presence of cirrhosis, a multinodular tumor, microvascular invasion, and a positive histological margin are independently associated with a less favorable survival outcome.
Research Interests: Gastroenterology, Medicine, Multivariate Analysis, Humans, Internal Medicine, and 15 moreHepatocellular Carcinoma, Aged, Middle Aged, Carcinoma, Neoplasm Invasiveness, Group, Postoperative Complication, Cirrhosis, Hospital Mortality, Overall Survival, Hepatocellular, Large, Perioperative, Hepatectomy, and Liver neoplasms
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Research Interests: Survival Analysis, Medicine, Humans, Internal Medicine, Liver, and 14 moreFemale, Male, Hepatocellular Carcinoma, Cohort, Risk factors, Middle Aged, Proportional hazards model, Prognosis, Risk Factors, Annals, Proportional Hazards Models, Cohort Studies, Liver neoplasms, and Medical and Health Sciences
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I n this issue of Annals of Surgery, House et al1 from the Memorial Sloan-Kettering Cancer Center report the results of adjuvant hepatic arterial infusional floxuridine (HAI-FUDR) with concurrent modern systemic chemotherapy including... more
I n this issue of Annals of Surgery, House et al1 from the Memorial Sloan-Kettering Cancer Center report the results of adjuvant hepatic arterial infusional floxuridine (HAI-FUDR) with concurrent modern systemic chemotherapy including oxaliplatin or irinotecan in patients after hepatic resection of metastatic colorectal cancer (CRC). The rationale for adjuvant regional chemotherapy is founded on the high frequency of recurrence within the liver after resection of metastases and the confirmed significant response rate of HAI-FUDR compared with nonmodern systemic chemotherapy for hepatic metastases. Previously this center and others have shown benefit for adjuvant HAI-FUDR after hepatic resection of metastatic CRC and prior generation systemic chemotherapy.2–4 Whether the independent impact of regional chemotherapy would persist in patients receiving modern systemic chemotherapy is an important issue and remains unknown. The idee fixe of most surgical and medical oncologists with the improvements in recurrence free and overall survival afforded by modern systemic chemotherapy has diverted study of regional chemotherapy for patients with hepatic metastases. Fortunately, House et al1 from a center widely recognized for their expertise in the management of metastatic CRC have retained interest in the role of adjuvant HAI-FUDR in the modern clinical setting and present noteworthy findings. This retrospective study compared 125 patients who received modern chemotherapy and adjuvant HAI-FUDR with a nonrandomized control group of 125 consecutive patients receiving modern chemotherapy alone after resection of their hepatic metastases during the same time frame. Patient and disease characteristics including clinical risk score were similar between treatment groups except for the significant prevalence of lymph node positive primary CRCs, bilobar metastases, and major hepatectomies in the control group. For the adjuvant HAI-FUDR group, the 5-year diseasespecific survival and liver and overall recurrence-free survival were significantly greater and HAIFUDR was independently associated with improvement in each of these measures of survival. In fact, there was a striking 20% or greater improvement in survival for each measure of survival. Appropriately these authors believe a randomized clinical trial addressing adjuvant HAI-FUDR is justified on the basis of the apparent benefit and limitations of their findings. Is the medical and surgical oncology community up to this challenge? The current standard of care in the perioperative and adjuvant therapy of resected liver metastases has been dominated by systemic chemotherapy after the addition of oxaliplatin and irinotecan to 5-fluorouracil (5-FU) in advanced CRC, almost tripled response rates and more than doubled progression-free survival compared with 5-FU alone.5,6 FOLFOX, a combination of infusional and bolus 5-FU/leucovorin (LV) plus oxaliplatin, and FOLFIRI (5-FU/LV plus irinotecan) have become standard backbones for the addition of targeted agents such as bevacizumab, a monoclonal antibody against vascular endothelial growth factor and cetuximab or panitumumab, both antibodies against the epidermal growth factor receptor. The high activity of these modern systemic chemotherapy regimens suggested that they should significantly increase survival when translated to an adjuvant setting. Unfortunately, the results of large adjuvant phase III trials have largely been disappointing. In stage III colon cancer, only oxaliplatin-fluoropyrimidine combinations have consistently improved disease-free (DFS) and overall survival.7,8 Adjuvant FOLFIRI, on the other contrary, was not superior to 5-FU/LV,9 and the addition of bevacizumab or cetuximab to FOLFOX did not improve DFS over FOLFOX alone.9,10,11 Equally disappointing results have emerged in the adjuvant treatment of resected stage IV CRC. Postresection FOLFIRI did not improve outcomes compared with 5-FU/LV,12 perioperative FOLFOX was found to be superior to surgery alone in terms of DFS , but not in overall survival.13 Still based on the results of this European phase III trial, perior postoperative FOLFOX has become the standard of care in the medical management of resectable stage IV CRC. The ongoing phase III National Surgical Adjuvant Breast and Bowel Project (NSABP)-led US Intergroup trial (NSABP C-11) builds on these data by comparing perioperative versus postoperative FOLFOX in the
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Hepatocellular carcinoma (HCC) is a major cause of cancer-related death worldwide. In select patients, surgical treatment in the form of either resection or transplantation offers a curative option. The aims of this review are to (1)... more
Hepatocellular carcinoma (HCC) is a major cause of cancer-related death worldwide. In select patients, surgical treatment in the form of either resection or transplantation offers a curative option. The aims of this review are to (1) review the current American Association for the Study of Liver Diseases/European Association for the Study of the Liver guidelines on the surgical management of HCC and (2) review the proposed changes to these guidelines and analyze the strength of evidence underlying these proposals. Three authors identified the most relevant publications in the literature on liver resection and transplantation for HCC and analyzed the strength of evidence according to the Grading of Recommendations Assessment, Development and Evaluation (GRADE) classification. In the United States, the liver allocation system provides priority for liver transplantation to patients with HCC within the Milan criteria. Current evidence suggests that liver transplantation may also be indi...
Research Interests: Cancer Control, Medicine, Humans, Liver Cirrhosis, Female, and 15 moreMale, Hepatocellular Carcinoma, Aged, Middle Aged, Adult, Age Factors, Partial Hepatectomy, Liver Resection, Liver Disease, Lymph Node, Mortality rate, Hepatectomy, Liver neoplasms, Pharmacology and pharmaceutical sciences, and multivariate analyses
Optimal management of patients with intrahepatic cholangiocarcinoma (ICCA) and elevated CA19-9 remains undefined. We hypothesized CA19-9 elevation above normal indicates aggressive biology and that inclusion of CA19-9 would improve... more
Optimal management of patients with intrahepatic cholangiocarcinoma (ICCA) and elevated CA19-9 remains undefined. We hypothesized CA19-9 elevation above normal indicates aggressive biology and that inclusion of CA19-9 would improve staging discrimination. The National Cancer Data Base (NCDB-2010-2012) was reviewed for patients with ICCA and reported CA19-9. Patients were stratified by CA19-9 above/below normal reference range. Unadjusted Kaplan-Meier and adjusted Cox-proportional-hazards analysis of overall survival (OS) were performed. A total of 2,816 patients were included: 938 (33.3%) normal; 1,878 (66.7%) elevated CA19-9 levels. Demographic/pathologic and chemotherapy/radiation were similar between groups, but patients with elevated CA19-9 had more nodal metastases and less likely to undergo resection. Among elevated-CA19-9 patients, stage-specific survival was decreased in all stages. Resected patients with CA19-9 elevation had similar peri-operative outcomes but decreased lon...
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Enhanced recovery pathways (ERP) have not been widely implemented for hepatic surgery. The aim of this study was to evaluate the safety of an ERP for patients undergoing open hepatic resection. A single-surgeon, retrospective... more
Enhanced recovery pathways (ERP) have not been widely implemented for hepatic surgery. The aim of this study was to evaluate the safety of an ERP for patients undergoing open hepatic resection. A single-surgeon, retrospective observational cohort study was performed comparing the clinical outcomes of patients undergoing open hepatic resection treated before and after implementation of an ERP. Morbidity, mortality, and length of hospital stay (LOS) were compared between pre-ERP and ERP groups. 126 patients (pre-ERP n = 73, ERP n = 53) were identified for the study. Patient characteristics and operative details were similar between groups. Overall complication rate was similar between pre-ERP and ERP groups (37% vs. 28%, p = 0.343). Before and after pathway implementation, the median LOS was similar, 5 (IQR 4-7) vs. 5 (IQR 4-6) days, p = 0.708. After adjusting for age, type of liver resection, and ASA, the ERP group had no increased risk of major complication (OR 0.38, 95% CI 0.14-1.0...
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Intrahepatic cholangiocarcinoma (ICC) is the second most common primary tumor of the liver. To further define its clinicopathology and surgical management, we reviewed our experience. Clinical presentations of 32 patients with ICC was... more
Intrahepatic cholangiocarcinoma (ICC) is the second most common primary tumor of the liver. To further define its clinicopathology and surgical management, we reviewed our experience. Clinical presentations of 32 patients with ICC was similar to that with hepatocellular carcinoma. Jaundice occurred in only 27 percent. ICC was unresectable due to advanced disease stage in 81 percent. Six patients had curative resections with two 5 year disease free survivors. Underlying liver disease was associated with ICC in 34 percent of patients.
Research Interests: Medicine, Humans, Female, Male, Aged, and 6 moreMiddle Aged, HPB SURGERY, Adult, Survival Rate, Neoplasm staging, and Liver neoplasms
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Research Interests: Clinical Sciences and hpb
Research Interests: Palliative Care, Risk assessment, Medicine, Humans, Female, and 15 moreMale, Liver Transplantation, Clinical Sciences, Aged, Middle Aged, Adult, Retrospective Studies, Chi Square Distribution, Risk Assessment, Antineoplastic Agents, Proportional Hazards Models, hpb, Hepatectomy, Disease Free Survival, and Liver neoplasms
Research Interests: Risk assessment, Humans, Female, Male, Risk factors, and 15 moreClinical Sciences, Minnesota, Aged, Middle Aged, Adult, Time Factors, Odds ratio, Retrospective Studies, Risk Factors, Risk Assessment, Proportional Hazards Models, Pancreaticoduodenectomy, Logistic Models, Gastrointestinal Stromal Tumors, and hpb
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Research Interests: Cancer Control, Humans, Liver Cirrhosis, Female, Male, and 14 moreHepatocellular Carcinoma, Aged, Middle Aged, Adult, Survival Rate, Retrospective Studies, Prognosis, Age Factors, Mortality rate, Liver Tumor, Surgical Treatment, Hepatectomy, Liver neoplasms, and Pharmacology and pharmaceutical sciences
... Correspondence: Michael L. Kendrick, MD, Department of Surgery, Mayo Clinic, 200 First St SW, Rochester, MN 55905 (kendrick.michael{at}mayo.edu). Accepted for Publication: February 10, 2009. Author Contributions: Study concept and... more
... Correspondence: Michael L. Kendrick, MD, Department of Surgery, Mayo Clinic, 200 First St SW, Rochester, MN 55905 (kendrick.michael{at}mayo.edu). Accepted for Publication: February 10, 2009. Author Contributions: Study concept and design: Kendrick. ...
Results. Resection was performed for liver metastases from genitourinary primary tumors (n = 34), soft tissue primary tumors (n = 41), and metastases from other primary cancers (n = 21). Extent of liver resection included wedge (n = 32),... more
Results. Resection was performed for liver metastases from genitourinary primary tumors (n = 34), soft tissue primary tumors (n = 41), and metastases from other primary cancers (n = 21). Extent of liver resection included wedge (n = 32), lobectomy (n = 44), and extended ...