Artery Invasion Research Articles

RECURRENT AND MASSIVE HEMOPTYSIS: A CONSEQUENCE OF A RARE ETIOLOGY

SESSION TITLE: Wednesday Fellows Case Report Posters SESSION TYPE: Fellow Case Report Posters PRESENTED ON: 10/23/2019 09:45 AM - 10:45 AM INTRODUCTION: Fibrosing mediastinitis is an inflammatory reaction that results in excessive fibrous tissue formation in the mediastinum. It is usually attributed to histoplasmosis. It may affect the airways, great vessels, and other mediastinal structures secondary to robust inflammatory reaction to fungal antigens including granuloma formation and calcifications. The clinical presentation depends on which mediastinal structures being involved and the extent of the damage. Hemoptysis in fibrosing mediastinitis can be the result of bronchial invasion, necrotizing pneumonia, pulmonary or bronchial venous or arterial invasion. CASE PRESENTATION: 68-year-old Caucasian female with past medical history of chronic sinusitis, paroxysmal atrial fibrillation and fibrosing mediastinitis who presented to the emergency room (ER) complaining of three episodes of hemoptysis for 6 hours. The hemoptysis was estimated to be around 100 ml each time, bright red blood and associated with mild shortness of breath. Initial vitals were 104/54 mm Hg, heart rate of 110 bpm, respiratory rate of 22 cpm and Spo2 95% on 4L nasal cannula. The patient received one unit of PRBC for acute drop in hemoglobin from 14 gm/dl to 11 gm/dl. The patient was admitted to the intensive care unit (ICU) due to a concern of airway compromise and potential need for endotracheal intubation. The patient had episodes of massive hemoptysis over the last year and received corticosteroids intermittently without significant improvement. In the ICU, The clinical condition was relatively stable with normal vital signs yet continued to have hemoptysis. CT scan of the chest revealed mediastinal widening with diffuse calcified lymph nodes, broncholith extending into right main stem bronchus, superior vena cava stent and dilated main pulmonary arteries. Conventional angiography demonstrated dilatation of the two right sided intercostal bronchial trunks and multiple dilated intercostal arteries. Successful embolization of the above-mentioned arteries with microspheres was performed until achieving hemostasis. Subsequently, the patient did not experience further episodes of hemoptysis. The patient was discharged home in a stable clinical condition. DISCUSSION: Recurrent and massive hemoptysis is a consequence of numerous etiologies. We are reporting a rare case of fibrosing mediastinitis that presented as recurrent and massive hemoptysis. Diagnostic approach indicated the involvement of the bronchial and intercostal arteries. The involved vessels were treated successfully by embolization CONCLUSIONS: Recurrent massive hemoptysis is an uncommon clinical feature in these patients and associated with poor prognosis along with other local invasive process by the calcified mediastinal masses. Reference #1: Mediastinal fibrosis complicating histoplasmosis, Loyd JE1, Tillman BF, Atkinson JB, Des Prez RM. Reference #2: Chronic fibrous mediastinitis and superior vena caval obstruction due to histoplasmosis, Dis Chest. 1959 Apr;35(4):364-77. DISCLOSURES: No relevant relationships by Mukhtar Al-Saadi, source=Web Response No relevant relationships by Sai Katta, source=Web Response

EP1.17-23 Omentopexy for Post-Pneumonectomy Bronchopleural Fistula in Patients with Non-Small Cell Lung Cancer After Salvage Radiotherapy

Preoperative chemotherapy or radiotherapy could affect bronchial mucosa blood flow and also the normal healing process of bronchial stump after surgical resection. Otherwise, bronchopleural fistula (BPF) is the worst and time consuming complication in lung cancer surgery. Pneumonectomy is reported as a high risk surgery of BPF. Here, we report our successful treatment experience of BPF using omentum after salvage radiotherapy in NSCLC patient. Retrospective medical chart review A sixty-four years old male patient who had a history of chronic obstructive pulmonary disease diagnosed as squamous carcinoma in left upper lobe, clinical stage of T2aN1M0. Because interlobar artery invasion was suspicious, the patient was treated with radical radiotherapy. After 6600cGy of radiotherapy, the lesion showed marked response. Thus we decided to perform curative surgical resection, pneumonectomy. The patient had discharged in postoperative day 11 and the pathologic report was ypT1aN0M0. But after 1 week from discharge, the patient readmitted and complained of dyspnea and profound sputum. In bronchoscopy, fistula was seen. We performed the second operation. Due to hard fibrosis, direct closure of bronchial stump was not possible. Thus, we covered the stump site with omental flap in multilayers. The patient discharged uneventfully and now in disease free status almost after 2 years from initial operation.View Large Image Figure ViewerDownload Hi-res image Download (PPT) Neoadjuvant radiation therapy and pneumonectomy are risk factors for post-operative BPF. Direct closure with buttressing biocompatible flap is the treatment of choice. But if direct closure is not possible, double-layered omentopexy could be an alternative treatment strategy.

Intra-arterial chemotherapy for advanced pancreatic cancer

Objective. To study effectiveness of intra-arterial chemotherapy in patients with locally advanced and metastatic pancreatic cancer.Material and methods. There were 329 patients who underwent regional chemotherapy in 2000 – 2015 (infusion through celiac trunk – 167, chemoembolization of gastroduodenal artery – 52, combination of these methods – 72, combined chemo-radiotherapy – 38). Locally advanced unresectable pancreatic cancer with arterial invasion (T4 grade) was observed in 198 (60.2%) patients, liver metastases (stage IV) – in 131 (39.8%) patients. Chemoembolization or chemoradiation therapy was performed for patients without distant metastases.Results. The best results for unresectable pancreatic cancer were obtained in 160 patients after chemoembolization combined with infusion. Partial response was obtained in 24.1% of cases compared with 8.9% and 13.4% of cases after infusion or chemoembolization alone. Mean life expectancy was 15.5 months compared with 14.6 and 10.6 months, respectively. Median of life expectancy was 15.6 months compared with 11.7 and 10.8 months, respectively. At the same time, progression of disease was observed in the majority of 131 patients with metastatic cancer. Partial response was noted only in 2.3% of patients only after chemoinfusion. Survival and median survival after chemoinfusion and combination of chemoembolization with chemoinfusion were similar (10.1 (8.3) and 10.9 (7.5) months). Chemoradiotherapy in 4 patients with initially unresectable pancreatic cancer resulted reduction of tumor dimension by 28% (24–32%). Therefore, radical operations were performed later. One-year survival was achieved in 20 (58.8%) out of 34 patients with unresectable pancreatic cancer. Mean life expectancy was 15.4 months (median 13.8 months).Conclusion. Intra-arterial chemotherapy is effective treatment in patients with pancreatic cancer stage III and IV. Combination of celiac axis infusion with arterial embolization, as well as infusion with radiotherapy resulted the best survival. Certain advantage of chemoinfusion was found for liver metastases. The use of new chemotherapy modes for intra-arterial infusion requires further study.

Obestatin activates mitogen-activated protein kinases associated to the obestatin/G-protein coupled receptor 39 signaling pathway in human pancreatic stellate cells

Venous invasion is not included in the pancreatic ductal adenocarcinoma (PDAC) staging, and its correlation with prognosis remains unclear. We evaluated the prognostic impact of radiographic portal/superior mesenteric vein (PV/SMV) invasion, and its possibility of complementing T staging.We identified patients with non-metastatic PDAC using our institutional cohort, and divided them according to PV/SMV invasion at imaging, defined as >180-degree tumor-vessel interface or contour deformity. We conducted Cox proportional hazard regression, and compared survival in the original and 1:1 propensity score matched datasets.We identified 454 patients [PV/SMV(+): 172; PV/SMV(−): 282]. In the multivariate analysis, PV/SMV invasion, age (≥70 years), performance status, tumor size (2–4, >4 cm), lymph nodes >4, and arterial invasion was correlated with prognosis. The PV/SMV(+) group had a shorter overall survival (OS) than the PV/SMV(−) group in the original (14.4 vs. 20.9 months; P < 0.001) and matched datasets (14.3 vs. 17.2 months; P = 0.009). Among patients without arterial invasion (cT1–cT3), the PV/SMV(+) group had a shorter OS (15.9 vs. 21.2 months; P = 0.002). Moreover, their OS did not differ from that of patients with arterial invasion (cT4) (15.9 vs. 14.4 months; P = 0.907). Patients with vessel (artery/vein) invasion had a shorter OS than those without vessel invasion (14.5 vs. 21.2 months; P < 0.001).Radiographic PV/SMV invasion in non-metastatic PDAC was correlated with a poor prognosis. It could identify a group with shorter OS among patients without arterial invasion (cT1–cT3). It is suggested that inclusion of PV/SMV invasion in clinical T4 criteria should be considered.

Efficacy of Neoadjuvant Chemotherapy in Distal Pancreatectomy with En Bloc Celiac Axis Resection (DP-CAR) for Locally Advanced Pancreatic Cancer

BackgroundsDistal pancreatectomy with en bloc celiac axis resection (DP-CAR) is an extended surgical procedure for patients with locally advanced cancer of the pancreatic body and tail. Recently, the usability of neoadjuvant chemotherapy (NAC) in pancreatic cancer was reported. The purpose of this study was to clarify the impact of NAC on surgical outcomes and prognosis in DP-CAR patients. MethodsThis study retrospectively reviewed 20 consecutive patients who underwent DP-CAR at a single institution. ResultsEleven of 20 patients (55.0%) received NAC. Their first regimens were gemcitabine (GEM) plus nab-PTX (n = 7, 63.6%), GEM plus S-1 (n = 3, 27.3%), and GEM (n = 1, 9.1%). Although two patients converted to a second regimen, none abandoned NAC due to adverse effects or could not undergo a planned procedure for disease progression. There were no significant differences in intraoperative variables, morbidity, including pancreatic fistula and delayed gastric emptying, and mortality between patients with and without NAC; however, patients with NAC had a significantly lower proportion of arterial invasion (p = 0.025), lymphatic invasion (p < 0.0001), and vascular invasion (p = 0.035). There were no significant differences in the induction rate of adjuvant chemotherapy (p = 0.201). The recurrence-free survival and overall survival rates in patients with NAC were significantly higher than in patients without NAC (p = 0.041 and p = 0.018, respectively). ConclusionDP-CAR following NAC was associated with a preferable prognosis and had no negative effect on surgical outcomes. Therefore, NAC in DP-CAR patients might be a beneficial and safe therapeutic strategy.

Preoperative CT findings for prediction of resectability in patients with gallbladder cancer.

To predict residual tumor (R) classification in patients with a surgery for gallbladder (GB) cancer, using preoperative CT. One hundred seventy-three patients with GB cancer who underwent CT and subsequent surgery were included. Two radiologists assessed CT findings, including tumor morphology, location, T stage, adjacent organ invasion, hepatic artery (HA) invasion, portal vein invasion, lymph node metastasis, metastasis, resectability, gallstone, and combined cholecystitis. The R classification was categorized as no residual tumor (R0) and residual tumor (R1 or R2). We analyzed the correlation between CT findings and R classification. We also followed up the patients as long as five years and analyzed the relationship between the R classification and the overall survival (OS). There were 134 patients with R0 and 39 patients with R1/R2. On multivariable analysis, liver invasion (Exp(B) = 3.19, p = 0.010), bile duct invasion (Exp(B) = 3.69, p = 0.031), and HA invasion (Exp(B) = 3.74, p = 0.039) were independent, significant predictors for residual tumor. When two of these three criteria were combined, the accuracy for predicting a positive resection margin was 83.38% with a specificity of 93.28%. The OS and the median patient survival time differed significantly according to the resection margin, i.e., 56.0% and 134.4months in the R0 resection and 5.1% and 10.8months in the R1/R2 resection group (p < 0.001). Preoperative CT findings could aid in planning surgery and determining the resectability using the high-risk findings of residual tumor, including liver invasion, bile duct invasion, and HA invasion. • Liver invasion, bile duct invasion, and HA invasion were significant preoperative CT predictors for residual tumor in GB cancer. • HA invasion showed the highest OR on multivariate analysis and the highest predictor point on a nomogram for predicting a positive resection margin. • Association of two factors can predict positive resection margin with an accuracy of 83.38% and a specificity of 93.28%.

Number of positive lymph nodes and lymphatic invasion are significant prognostic factors after pancreaticoduodenectomy for distal cholangiocarcinoma.

Background: Early recurrence of distal cholangiocarcinoma (DCC) may result in a poorer prognosis. This study aimed to evaluate the clinicopathological factors that predict survival and recurrence in patients with DCC.Methods: Fifty-five patients with DCC who underwent pancreaticoduodenectomy between 2005 and 2015 were studied retrospectively. The following clinicopathological parameters were analyzed as predictors of disease-free survival (DFS) and overall survival (OS): sex, age, body mass index, presence of biliary tract decompression, macroscopic type, histological type, tumor size, TNM classification, lymph node metastasis ratio, number of positive lymph nodes (PLNs), lymphatic invasion, venous invasion, perineural invasion, proximal bile duct margin, dissected margin, portal system invasion, arterial system invasion, stage, and residual tumor.Results: Univariate analysis showed that contiguous extension of the primary tumor, PLN, lymphatic invasion, venous invasion, perineural invasion, and stage were significant prognostic factors for DFS and OS. Multivariate analysis revealed that PLN and lymphatic invasion were prognostic for DFS and OS (P<0.001). Significant differences in OS and DFS were found in analyses stratified by PLN (0, 1, 2 vs ≥3) and lymphatic invasion (0 vs 1, 2, 3).Conclusion: Among the clinicopathological parameters analyzed, PLN and lymphatic invasion were confirmed as prognostic factors for DCC.

A case report: unmasking a singular culprit for cardiogenic shock: looking beyond the coronary tree.

BackgroundCardiogenic shock remains challenging in its therapy and aetiology.Case summaryA 74-year-old woman admitted for cardiogenic shock requiring mechanical ventilation and high-dose inotropics and vasopressors with an electrocardiogram showing left ventricular (LV) lateral wall ischaemia had diffuse coronary artery disease but TIMI III flow in the coronary tree. An echocardiogram showed a suspicious mass invading the left ventricle and computed tomography scan revealed an advanced lung cancer with LV wall and pulmonary artery invasion as the cardiogenic shock cause.DiscussionWhen managing cardiogenic shock, it is important to consider different and not obvious diagnosis. A high level of clinical suspicion and multimodality imaging assessment was very important in the present case to attain the diagnosis.

Two cases of recurrent nasopharyngeal carcinoma accompanied with internal carotid artery invasion and mouth opening restriction

报道安徽医科大学第一附属医院治疗2例伴张口受限复发性鼻咽癌患者的过程。病例1张口受限，反复鼻腔大出血，CT血管造影显示鼻咽颅底颈内动脉呈环形狭窄；病例2术前张口受限，头痛难以忍受，强力要求手术不愿行进一步检查。对于病例1，手术时首先行颈总动脉结扎，再采用下唇正中切开下颌骨升支切除，切除累及颈内动脉鼻咽复发肿瘤，创面用帽状筋膜修复。对于病例2，直接采用下唇正中切开下颌骨升支切除，解剖鼻咽颅底颈内动脉，最大限度切除复发灶，创面用帽状筋膜修复。2例手术均顺利完成，术后未见严重并发症，生活质量明显改善。.

Pancreatic cancer surgery with vascular resection: current concepts and perspectives

Abstract Pancreatic cancer is a devastating disease and resection at an early disease stage is the best chance of cure. Less than 20% of all patients present with a resectable tumor, while another 20% to 30% have locally advanced pancreatic cancer and the majority of the patient suffer from metastatic disease. Recently, it has been recognized that there is a 4th group of patients with so-called borderline resectable disease. Here, the tumor approaches or infiltrates the vascular axis (superior mesenteric vein/portal vein and/or superior mesenteric/hepatic artery/celiac trunk). While a large number of tumors with suspected venous infiltration can be resected with concomitant venous resection and reconstruction, arterial infiltration has been considered a contraindication to resection. Neoadjuvant treatment with combination chemotherapy protocols with or without radiotherapy has allowed for higher resection rates even in patients with arterial invasion. Here, we review the contemporary literature on extensive pancreatic cancer surgery with vascular resection and reconstruction.

Biological and conditional factors should be included when defining criteria for resectability for patients with pancreatic cancer

BackgroundThis study aimed to evaluate novel resectability criteria for pancreatic ductal adenocarcinoma (PDAC) proposed by the International Association of Pancreatology (IAP) by comparing them with the National Comprehensive Cancer Network (NCCN) guidelines. Methods369 patients who underwent upfront surgery for PDAC were retrospectively analyzed. Overall survival (OS) of each group as defined by either of the guidelines were compared and preoperative prognostic factors for OS were identified. ResultsBased on the IAP-criteria, 157 patients were classified as resectable (R), 192 as borderline resectable (BR) and 20 as unresectable (UR), with the median survival time (MST) of 40 months, 17 and 11, respectively. In contrast to the NCCN-criteria, BR demonstrated significantly better OS than UR (P = 0.023) under the IAP-criteria. Performance status ≥2 (hazard ratio [HR]: 2.47, P = 0.014) and lymph node metastasis suspected by imaging (HR: 1.55, P = 0.003) were identified as independent prognostic factors by the multivariate analysis along with portal or arterial invasion, while carbohydrate antigen 19-9 ≥ 500 U/ml was not (HR: 1.23, P = 0.190). ConclusionThe IAP-criteria, which includes biological and conditional factors, resulted in superior separation of survival curves stratified by the resectablity when compared with the NCCN-criteria.

Analysis of prognostic factors in the surgical treatment of hilar cholangiocarcinoma

Objective To analyze the prognostic factors in the surgical treatment of hilar cholangiocarcinoma. Methods The retrospective case-control study was conducted. The clinicopathological data of 93 patients [61 males and 32 females, age (64±8)years with the range of 43-84 years] with hilar cholangiocarcinoma who underwent surgical treatments in the General Hospital of the Northern Theater from January 2010 to December 2017 were collected. According to preoperative different staging and intraoperative exploration of hilar cholangiocarcinoma, corresponding operations were performed. Observation indicators: (1) surgical treatment situations; (2) tumor typing, staging and degree of differentiation: ① tumor typing and staging, ② degree of tumor differentiation; (3) follow-up situations; (4) analysis of prognostic factors: ①univariate analysis, ②multivariate analysis; (5) subgroup analysis. Follow-up using outpatient examination and telephone interview was performed to detect survival time and survival rate of patients up to December 31, 2017. Kaplan-Meier method was used to calculate survival time and survival rate and to draw survival curves. Survival situations were analyzed by Log-rank test. The univariate analysis and multivariate analysis were performed using the Log-rank test and COX proportional hazard model respectively. Results (1) Surgical treatment situations: 93 patients underwent surgical treatments, including 51 undergoing radical resection, 23 undergoing palliative resection, 16 undergoing internal biliary drainage or external drainage, 3 undergoing abdominal laparotomy and intraoperative biopsy. (2) Tumor typing, staging and degree of differentiation. ① Tumor typing and staging: of the 93 patients with hilar cholangiocarcinoma, Bismuth-Corlette type Ⅰ, Ⅱ, Ⅲa, Ⅲb and Ⅳ were detected in 26, 22 , 9, 18 and 18 patients. TNM stage Ⅰ, Ⅱ, Ⅲ and Ⅳ were detected in 7, 34, 22 and 30 patients, Mayo Clinic stage 1, 2, 3, 4 were detected in 20, 19, 51 and 3 patients. ② Degree of tumor differentiation: results of pathological examination showed 16 of 93 patients with highly differentiated adenocarcinoma, 35 with moderately differentiated adenocarcinoma, 37 with poorly differentiated adenocarcinoma, 4 with mucinous adenocarcinoma and 1 with papillary adenocarcinoma. (3) Follow-up situations: 93 patients were followed up for 6-36 months, with a median time of 24 months. The survival time of 93 patients was (21.4±2.1)months and the 1-, 2-, 3-year overall survival rates were 62.2%, 34.9% and 17.1%, respectively. (4) Analysis of prognostic factors: ① results of univariate analysis showed that preoperative level of TBil, preoperative level of CA19-9, preoperative level of CA24-2, surgical methods, lymph node metastasis, vascular invasion, TNM staging, Mayo Clinic staging, degree of tumor differentiation were related factors affecting prognosis of patients with hilar cholangiocarcinoma (χ2=6.321, 7.357, 6.590, 22.088, 11.173, 22.914, 23.326, 25.966, 39.512, P 0.05). Of the 35 patients with vascular invasion, the overall survival time was (7.0±2.0)months and 1-, 2-, 3-year survival rates were 14.5%, 7.3%, 0 respectively in 18 with portal vein invasion only, (10.0±2.1)months and 37.5%, 18.8%, and 18.8% respectively in 8 with hepatic artery invasion, showing no statistically significant difference between the two groups (χ2=0.905, P>0.05). Conclusions Preoperative level of TBil, preoperative level of CA19-9, surgical procedures, vascular invasion and degree of tumor differentiation are independent prognostic factors for patients with hilar cholangiocarcinoma. Radical resection can prolong the survival time of patients compared with other surgical treatments. Key words: Hilar cholangiocarcinoma; Surgical procedures, operative; Tumor typing; Tumor staging; Degree of tumor differentiation; Prognosis analysis

Significance of neoadjuvant therapy for borderline resectable pancreatic cancer: a multicenter retrospective study.

Neoadjuvant therapy (NAT) is increasingly used to improve the prognosis of patients with borderline resectable pancreatic cancer (BRPC) albeit with little evidence of its advantage over upfront surgical resection. We analyzed the prognostic impact of NAT on patients with BRPC in a multicenter retrospective study. Medical data of 165 consecutive patients who underwent treatment for BRPC between January 2010 and December 2014 were collected from ten institutions. We defined BRPC according to the National Comprehensive Cancer Network guidelines, and subclassified patients according to venous invasion alone (BR-PV) and arterial invasion (BR-A). The rates of NAT administration and resection were 35% and 79%, respectively. There were no significant differences in resection rates and prognoses between patients in the BR-PV and BR-A subgroups. NAT did not have a significant impact on prognosis according to intention-to-treat analysis. However, in patients who underwent surgical resection, NAT was independently associated with longer overall survival (OS). The median OS of patients who underwent resection after NAT (53.7months) was significantly longer than that of patients who underwent upfront (17.8months) or no resection (14.9months). The rates of superior mesenteric or portal vein invasion, lymphatic invasion, venous invasion, and lymph node metastasis were significantly lower in patients who underwent resection after NAT than in those who underwent upfront resection despite similar baseline clinical profiles. Resection after NAT in patients with BRPC is associated with longer OS and lower rates of both invasion to the surrounding tissues and lymph node metastasis.

Pancreatoduodenectomy En Bloc With Vascular Resections in Borderline Resectable Pancreatic Cancer.

Pancreatic cancer remains asymptomatic for a long period of time, being frequently diagnosed when vascular invasion is already present. Such cases are widely known as borderline lesions. The aim of this study was to identify the effectiveness of vascular resection in this subgroup of patients. Fifteen such cases were submitted to surgery with curative intent. Eight cases were diagnosed with borderline resectable lesions with portal vein invasion and were submitted to per primam resection and seven cases were initially diagnosed with arterial invasion and had been initially submitted to neoadjuvant chemotherapy followed by resection. In all cases portal vein resection was needed while in other four cases association of superior mesenteric artery resection was performed. Postoperatively, five patients developed complications requiring reoperation, three of whom died at the end of the first postoperative month. The histopathological studies confirmed the completeness of resection in all cases. Vascular resections in pancreatic cancer resections remain demanding procedures, and are reserved for cases in which a radical resection is feasible.

Number of positive lymph nodes and lymphatic invasion are significant prognostic factors for distal cholangiocarcinoma

Introduction: Early recurrence of distal cholangiocarcinoma (DCC) may Result in a poorer prognosis. This study aimed to evaluate the clinicopathological factors that predict survival and recurrence in patients with DCC. Method: Fifty-five patients with DCC who underwent pancreaticoduodenectomy between 2005 and 2015 were studied retrospectively. The following clinicopathological parameters were analyzed as predictors of disease-free survival (DFS) and overall survival (OS): sex, age, body mass index, presence of biliary tract decompression, macroscopic type, histological type, tumor size, TNM classification, lymph node metastasis ratio, number of positive lymph nodes (PLN), lymphatic invasion, venous invasion, perineural invasion, proximal bile duct margin, dissected margin, portal system invasion, arterial system invasion, stage, and residual tumor. Result: Univariate analysis showed that contiguous extension of the primary tumor, PLN, lymphatic invasion, venous invasion, perineural invasion, and stage were significant prognostic factors for DFS and OS. Multivariate analysis revealed that PLN and lymphatic invasion were prognostic for DFS and OS (p<0.001). Significant differences in OS and DFS were found in analyses stratified by PLN (0, 1, 2 vs. ≥3) and lymphatic invasion (0 vs. 1, 2, 3). Conclusion: Among the clinicopathological parameters analyzed, PLN, and lymphatic invasion were confirmed as prognostic factors for DCC.

Results of portal vein and hepatic artery resection for surgical treatment of Klatskin tumor

Background: Portal vein invasion is most often cause of portal vein resection and reconstruction combine with hepatectomy for surgical treatment of Klatskin tumor at nowadays. The reported rate of morbidity and mortality still high (more then 10%). 5-year survival is possible. Special complexity is represented by cases with a tumor invasion of a portal vein and a hepatic artery. Results of combine resection portal vein and hepatic artery still controversial. Methods: The aim of this study to observe results of surgical treatment of Klatskin tumor with portal vein and hepatic artery invasion. Between 2002 and 2016 major and extended resections of the liver to 183 patients with Klatskin tumor was made. Results: 183 patients underwent resection for pCCA. Median age was 61,2 ±/12 years. More than in 45 % of cases there was a necessity of a separate drainage of three sections of a liver. A liver resection carried out at level of bilirubin of a blood not above 60 mcmol/l. From 183 patients in 96 cases have executed a resection of a portal vein with the subsequent reconstruction. At 13 patients it is made hepatoduodenoligamentectomy with resection and reconstruction of portal vein and hepatic artery. The postoperative mortality has made 9,3 %, 5-year survival rate – 18,8 %. Conclusion: Aggressive surgical treatment for cholangiocarcinoma the confluence of bile duct with portal vein resection can be performed safely with acceptable mortality and long-term survival rate.

Relationship between serum MMP-9 level and prognosis after radical resection for Hilar cholangiocarcinoma patients.

Purpose: To analyze the preoperative serum matrix metalloproteinase-9 (MMP-9) levels and prognosis of patients with hilar cholangiocarcinoma (HC) undergoing radical resection. Methods: Preoperative serum MMP-9 levels in patients with HC undergoing radical resection were detected by enzyme-linked immunosorbent assay (ELISA). The ROC curve assay was used to analyze the preoperative serum MMP-9 level to determine the most valuable cut-off point. The relationship between MMP-9 and clinicopathological features of HC patients was analyzed. Kaplan-Meier method was used to analyze the prognostic factors, and COX regression model was used to analyze the independent risk factors affecting prognosis. Results: Preoperative serum MMP-9 levels were significantly elevated in the death patients compared with the survival patients. The most valuable cut-off point for preoperative serum MMP-9 for prognosis was 201.93 ng/mL. Preoperative serum MMP-9 was associated with Bismuth-Corlette classification) and lymph node metastasis. Kaplan-Meier analysis showed that MMP-9, Bismuth-Corlette classification, Lymph node metastasis, Portal vein invasion, Hepatic artery invasion, Liver invasion, Incised margin, and Preoperative biliary drainage were related to prognosis. Cox regression model confirmed that hepatic artery invasion, liver invasion, incised margin, and MMP-9 have the potential to independence predicate prognosis in HC patients. Conclusion: Preoperative serum MMP-9 has high predictive value for prognosis and is an independent influencing factor for the prognosis of patients with hilar cholangiocarcinoma.

Results of portal vein and hepatic artery resection for surgical treatment of Klatskin tumor

Background: Portal vein invasion is most often cause of portal vein resection and reconstruction combine with hepatectomy for surgical treatment of Klatskin tumor at nowadays. The reported rate of morbidity and mortality still high (more then 10%). 5-year survival is possible. Special complexity is represented by cases with a tumor invasion of a portal vein and a hepatic artery. Results of combine resection portal vein and hepatic artery still controversial. Methods: The aim of this study to observe results of surgical treatment of Klatskin tumor with portal vein and hepatic artery invasion. Between 2002 and 2016 major and extended resections of the liver to 183 patients with Klatskin tumor was made. Results: 183 patients underwent resection for pCCA. Median age was 61,2 ±/12 years. More than in 45 % of cases there was a necessity of a separate drainage of three sections of a liver. A liver resection carried out at level of bilirubin of a blood not above 60 mcmol/l. From 183 patients in 96 cases have executed a resection of a portal vein with the subsequent reconstruction. At 13 patients it is made hepatoduodenoligamentectomy with resection and reconstruction of portal vein and hepatic artery. The postoperative mortality has made 9,3 %, 5-year survival rate – 18,8 %. Conclusion: Aggressive surgical treatment for cholangiocarcinoma the confluence of bile duct with portal vein resection can be performed safely with acceptable mortality and long-term survival rate.

Experience of using MRT imaging in specifying diagnosis of obstructive diseases of the biliopancreatoduodenal zone.

The article presents the experience of surgical treatment of 12 patients with pancreatic cancer who were treated at the clinic of the Department of Surgery No. 2 of the ONMEDU during 2017. As a preoperative diagnosis, an MRI scan was performed in these patients. In general, the intraoperative size of the tumor was not significantly different from MRI - sizes: the medians of their differences were only + 5.5 mm and + 3.5 mm for the average and maximum MRT sizes. The calculated sensitivity and specificity of the method of MRTand CT in the assessment of artery invasion was 83.3% and 71.4% respectively, in the assessment of vein invasion - up to 50.0% and 42.9%, respectively. The combination of MRI and CT with intravenous contrast is the best option for planning surgical tactics today.

Update on giant cell arteritis.

Giant cell arteritis (GCA) is a challenging condition to manage because of the potential for acute irreversible vision loss and corticosteroid-related morbidity. Recent developments offer the potential to improve both the assessment and treatment of patients. Vascular imaging is increasingly being used in the diagnostic algorithm for GCA. Results from recent vascular ultrasound and high-resolution cranial MRI studies have led some groups to suggest forgoing temporal artery biopsy (TAB) in selected patients. The treatment armamentarium has been enhanced with the addition of Tocilizumab, a monoclonal antibody that inhibits IL-6 and has been shown to be effective in sustaining glucocorticoid-free remission out to 52 weeks. New publications have provided guidance in how clinicians can interpret minimally inflamed biopsies and navigate the controversy about what role, if any, varicella zoster virus may play in the pathophysiology of GCA. Basic science developments have improved our understanding of the immunopathology of GCA including the role of Th1 and Th17 lymphocytes and mechanisms of arterial wall lymphocyte invasion. There have been significant recent advances in GCA, particularly in relation to imaging and treatment options. Longer term outcome data will help clarify how best to utilize them in routine clinical practice.