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HPB Surgery
Published in Tjun Tang, Elizabeth O'Riordan, Stewart Walsh, Cracking the Intercollegiate General Surgery FRCS Viva, 2020
London Lucien Ooi Peng Jin, Teo Jin Yao
The patient has no other metastases. Are his multiple liver lesions a contraindication to surgery?Liver-only metastasis is no longer a contraindication to surgery. Poor prognostic indicators for liver metastases are related to timing of occurrence, tumour size and number (tumour burden), bilobar nature and the potential operability.Current guidelines dictate that as long as an R0-resection can be achieved, leaving enough functional remnant liver volume, liver resection should be performed for liver-only metastases. In situations, where the residual liver remnant is deemed to be inadequate, various techniques can be employed including staged resections, portal vein embolisation for liver hypertrophy, or combined resection with ablation techniques.Neoadjuvant chemotherapy is also an important consideration to increase operability in those deemed borderline resectable.
Liver and spleen metastases
Published in Anju Sahdev, Sarah J. Vinnicombe, Husband & Reznek's Imaging in Oncology, 2020
Wolfgang Schima, Helmut Kopf, Claus Kölblinger
Early detection and correct characterization of liver metastases is of importance in patients with malignancies with regard to staging, prognosis, and further patient management. In general, the presence of liver metastases indicates non-resectability of the primary tumour for oncological reasons and chemotherapy is the treatment of choice. Resection of solitary liver metastases has been shown to improve patient survival. The 5-year survival rates following surgery typically range between 25% and 40% compared to 0%–10% in patients treated conservatively (2–5).
The Pancreas and the Periampullary Area
Published in E. George Elias, CRC Handbook of Surgical Oncology, 2020
All the endocrine tumors of the pancreas arise from the islet cells which have multiple potentials. Such tumors can be in the form of benign adenomas, multiple adenomas, hyperplasia, or malignant tumors. All the malignant tumors have a tendency to metastasize to the regional lymph nodes then to the liver. These tumors may give various symptoms; however, these symptoms may overlap one another. This is because some of these tumors produce more than one peptide, or more than one tumor is found in a single patient, similar to the multiple endocrine syndromes. Once the patient presents with symptoms, and the physician suspects one of these tumors, a blood level determination is pathognomonic. The availability of radioimmune assays has been of great help in establishing the diagnosis. Table 3 outlines the six well-known pancreatic islet cell tumors and summarizes the cell of origin, the most common site of these tumors, their malignant potential, their presenting symptoms, and the pathogenesis of each of them. Once the blood test(s) has confirmed the presence of the peptide or the hormone, the anatomical location of the tumor is to be determined. Overall, the most important diagnostic approach is arteriography. This usually shows tumor flush and exact location in the pancreas. If this is unsuccessful, the second approach will be transhepatic selective venous catheterization for sampling for the peptides. The use of CT scanning, ultrasonography, and duodenoscopy with retrograde cannulation of the bile and pancreatic ducts is of minimal use. CT scanning can be of great help in identifying liver metastasis.
Evaluation of the safety and efficacy of ultrasound-guided percutaneous radiofrequency ablation for hepatocellular carcinoma and liver metastases adjacent to the gallbladder
Published in International Journal of Hyperthermia, 2023
Yuanfeng Meng, Binbin Jiang, Kun Yan, Song Wang, Zhongyi Zhang, Luzeng Chen, Wei Wu, Wei Yang
This study was performed in accordance with the principles outlined in the Declaration of Helsinki. The institutional review board of the hospital approved this study (2015KT27), and the requirement for informed consent was waived owing to its retrospective nature. Between March 2011 and June 2019, the medical records of 1543 patients (2156 lesions) with HCC and liver metastases treated with ultrasound guided RFA at our hospital were retrospectively analyzed. The diagnosis of HCC was made based on the needle biopsy results or the noninvasive diagnostic criteria defined in the Asia–Pacific clinical practice guidelines on managing hepatocellular carcinoma (2017 update) [20]. Liver metastases were diagnosed based on clinical findings, enhanced computed tomography (CT), and magnetic resonance imaging (MRI).
Ultrasound-guided percutaneous radiofrequency ablation in treatment of neuroendocrine tumor liver metastases：a single-center experience
Published in International Journal of Hyperthermia, 2022
Jingzhi Huang, Baoxian Liu, Manxia Lin, Xiaoer Zhang, Yanling Zheng, Xiaoyan Xie, Ming Xu, Xiaohua Xie
Due to the heterogeneous primary tumors in this study, patients received RFA for NETLM had absolutely different treatment outcomes. For the patients with Ki-67 < 5%, the median PFS was 22.0 months, while for those with Ki-67 ≥ 5%, the median PFS was only 3.5 months (p<.001). Patients with Ki-67 ≥ 5% had much shorter period of PFS. Similarly, in the study performed by Genc et al., it found that patients with a Ki-67 rate higher than 5% after curative resection of pancreatic NET had higher risk of recurrence [30]. However, the OS was not significantly different between patients with Ki-67 < 5% and those with Ki-67 ≥ 5% in our study. But Sartori et al. reported that patients with Ki-67 ≤ 7% had better survival outcome than those with Ki-67 > 7% [31]. The difference may due to small samples and shorter follow-up of our study. Since Ki-67 is well known as a reliable prognostic predictor, patients with less aggressive tumors can have better tumor control. Nevertheless, 4 patients were found to have higher pathologic grade of liver metastases than the primary tumor. Timucin et al. found that a high Ki-67 index of metastases was the most significant predictor of decreased survival [13]. However, Perrodin, S. F. et al reported that the survival was not influenced by the grade of liver metastases, or a change in liver metastases grade compared to the grade of the primary tumor [27]. More studies are required to further clarify the relationship between the pathologic grade of liver metastases and the outcome of survival.
Variation of NK, NKT, CD4+ T, CD8+ T cells, and IL-17A by CalliSpheres® microspheres-transarterial chemoembolization in refractory liver metastases patients
Published in Scandinavian Journal of Clinical and Laboratory Investigation, 2022
Guangsheng Zhao, Mei Bi, Song Liu, Jian Ma, Fang Xu, Ying Liu, Fei Gao, Ying Yu, Jun Zhou, Zhuo Feng, Jianlin Wu
Liver is a common site of metastases in solid tumors [1,2]. The occurrence of liver metastases is far more than that of primary liver cancer, which is responsible for most tumor-related deaths [1–3]. In recent years, oligo liver metastasis is potentially curable; however, the treatment is limited for patients with refractory liver metastases whose tumor either is unresectable or progresses after treatment [4,5]. Currently, CalliSpheres® microspheres-transarterial chemoembolization (CSM-TACE) is effective and safe in treating refractory liver metastases, which is partly because CalliSpheres® presents impressive characteristics (including continuous chemotherapeutic drug-releasing property, great drug-loading ability, etc.) [6–8]. However, the survival profile of patients with refractory liver metastases after CSM-TACE is still unfavorable, with the median overall survival ranging from 20 months to 28 months [7–9]. Importantly, it has been reported that the immune environment plays an important role in the management of liver cancer [10]. Thus, the understanding of the variation of the immune environment by CSM-TACE might further help to improve the management of patients with refractory liver metastases.