Hepatic Lymph Research Articles

Th2-related cytokines are associated with Fasciola gigantica infection and evasion in the natural host, swamp buffalo

The infection of ruminants by Fasciola spp. always induces a non-protective Th2-type immune response. However, little is known about changes in the local and systemic immune environment during F. gigantica migration in buffalo. In this study, native swamp buffaloes were each infected with 500 viable F. gigantica metacercariae. Mesenteric lymph node (MLN), hepatic lymph node (HLN), spleen, and serum samples were collected from control and infected buffaloes at 3, 10, 28, 42, 70, and 98 days post-infection (DPI). The mRNA expression levels of the Th1- and Th2-related cytokines IL-2, IL-4, IL-5, IL-6, IL-10, IL-12p40, IFN-γ, TNF-α, and CD4 were measured during different infection stages in the MLNs, spleens, and HLNs using quantitative real-time PCR (qRT-PCR). Levels of the specific anti-ESP isotype antibodies IgG, IgG1, and IgG2 were used to reflect changes in humoral immunity. The results of this study indicated that swamp buffaloes were susceptible to F. gigantica infection, and that susceptibility to this infection was closely related to the cytokine environment associated with the Th2-type immune response. The MLNs showed a mixed Th1- and Th2-type immune response during the acute infection stages, after which the production of these cytokines returned to normal. Cytokine expression in the HLNs also expressed a mixed Th1- and Th2-type immune response during the early infection stages. When the infection became chronic, the typical Th2 immune response was induced in the HLNs. At the acute infection stages, the spleen exhibited a Th2 immune response. Nevertheless, cytokines associated with the Th1 and Th2 immune responses were upregulated at 98 DPI. In addition, the total IgG and IgG1 of the parasite-specific antibodies increased. This suggested that the Th2-related cytokines and IgG1 induced by F. gigantica infection might mediate successful F. gigantica infection in the natural host, swamp buffalo.

Laparoscopic liver resection for intrahepatic cholangiocarcinoma

Background: Cholangiocarcinoma is the most common biliary tract malignancy, and the second most common type of primary liver cancer. It is more common in Asia but its incidence in North America is increasing. CCA can be categorized as intrahepatic (iCCA) or extrahepatic (perihilar – pCCA/distal – dCCA). There are three main staging systems: American Joint Committee on Cancer/Union for International Cancer Control (AJCC/UICC); Liver Cancer Study Group of Japan (LCSGJ); and National Cancer Center of Japan (NCCN). Its clinical presentation is unspecific, and it varies depending on tumor location and stage disease. Combined interpretation with different diagnostic modalities is necessary. Methods: A 73-year-old female presented with mild abdominal discomfort and back pain to her primary care physician. Laboratorial exams were requested, and elevated liver enzymes were noted. Abdominal ultrasound was performed that showed left-sided bile duct dilation. Patient underwent an abdominal MRI that identified tortuous and markedly dilated left intrahepatic bile ducts with lobular enhancing intraductal mass with restricted diffusion in the left main hepatic duct measuring approximately 2.3 x 0.9 x 0.8 cm. ERCP with biopsy was made, and a polypoid lesion in the left bile duct was seen. The papillary epithelium was consistent with high-grade dysplasia with possible intraductal papillary neoplasm or cholangiocarcinoma. Laparoscopic surgery was indicated. Patient underwent a cholecystectomy, hepatoduodenal lymphadenectomy, left hepatectomy, and en bloc caudate resection. Results: The Patient was in supine position. General anesthesia was induced. A supraumbilical incision was made. The abdomen was entered without difficulty. Hasson trocar was placed, pneumoperitoneum established. The laparoscope was induced, and the abdomen was explored. The patient had no signs of metastatic or peritoneal disease. The left lobe appeared atrophied, and the right lobe appeared quite hypertrophied. No signs of underlying liver disease. Therefore, 2 additional right-sided 12-mm trocars, an epigastric 5 and a left side 5 trocars were placed. An enlarged hepatic artery lymph node was identified, resected and sent for frozen, it was negative for neoplasia. Cholecystectomy and hepatoduodenal lymphadenectomy were performed. The intrahepatic lesion was resectable, and the caudate lobe appeared potentially involved. It was decided to perform a left hepatectomy with en bloc caudate lobe resection. Specimen was analyzed by Pathology, that confirmed grossly and microscopically widely negative margins. The surface of the liver was cut, and packed with gauze and Surgicel. This was completely dry. There was adequate arterial and portal inflow with biliary drainage to the right lobe of the liver, and no sign of bile leak. Surgicel SNoW and Surgicel gauze were placed against the cut surface of the liver, and closed the specimen extraction site with multiple figure-of-eight 0 Vicryl sutures, and desufflated the abdomen through the trocars, removed the trocars, and closed the 12-mm trocar with a single interrupted 0 Vicryl, and closed the skin with running 4-0 subcuticular stitch and covered with Dermabond. Counts were reported as correct. No complications. No drains. Estimated blood loss was 300 mL. Patient tolerated the surgery well, and was discharged on postoperative day 3. Conclusion: Surgery is the only potentially curative therapeutic option for Cholangiocarcinoma. Minimally invasive approach is challenging, and not widely performed by surgeons. It requires expertise in liver and laparoscopic technique. Despite this, it is feasible, and safe for intrahepatic Cholangiocarcinoma. There are no differences in oncologic outcomes. Blood loss seems to be higher when open surgery is performed, and lymphadenectomy higher in minimally invasive approaches. There are no significant differences between length of hospital stay and complication rates. Laparoscopic liver resection is a treatment modality that should be considered for selected patients with intrahepatic cholangiocarcinoma.

Robotic portal lymphadenectomy with segment 4b and 5 resection for gallbladder cancer

Background: Our video describes the use of the da Vinci Surgical System Xi® (Intuitive Surgical, Sunnyvale, CA) to perform a portal lymphadenectomy with resection of segment 4B and 5 of the liver for gallbladder cancer. The patient is a 76 y.o. female who was found to have an incidental pT2pNx gallbladder adenocarcinoma following a laparoscopic cholecystectomy. CT of the chest, abdomen and pelvis were negative for metastasic disease. The procedure was begun with diagnostic laparoscopy which was negative for peritoneal metastasis. Results: The round ligament was taken down using the monopolar scissors and left attached to the under surface of the liver. This was later used as a vascularized pedicle flap to cover the resection bed of the liver at the end of the procedure. Firefly™ fluorescence imaging was used to confirm the junction of the cystic duct stump and the common bile duct. The cystic duct stump was then clipped and divided close to the common bile duct. Intra operative ultrasound was used to identify critical vascular structures and their relationship to the common bile duct and portal lymph nodes. The lymphadenectomy was begun at the lateral aspect of the porta hepatis by incising the peritoneum overlying the porta hepatis and common bile duct. The lateral portal and posterior duodenal lymph nodes were dissected off the common bile duct and portal vein using the mono polar scissors. The lesser omentum was then opened and the hepatic artery lymph nodes were dissected off the hepatic artery. The posterior medial lymph nodes and celiac nodes were also dissected and the specimen was removed en bloc. The EndoWrist® One™ vessel sealer was used to take a wedge of segments 4B and 5 of the liver with a 2 cm margin around the gallbladder fossa. The previously fashioned round ligament flap was then placed into the defect as a vascularized pedicle flap. Final pathology revealed six negative lymph nodes, with a negative cystic duct stump and liver parenchymal margin. The patient’s post-operative course was uneventful and as expected for the procedure.

Identification of reference genes for real-time PCR cytokine gene expression studies in sheep experimentally infected with Fasciola hepatica

The aim of this study was to validate reference genes for gene normalisation using qRT-PCR in hepatic lymph nodes (HLN) and livers from sheep infected with Fasciola hepatica during early and late stages of infection. To this end, a comprehensive statistical approach (RefFinder) encompassing four different methods of analysis (geNorm, BestKeeper, ΔCt method and NormFinder) was used to validate ten candidate reference genes. Stability analysis of gene expression followed by pairwise variation (Vn/Vn + 1) analysis revealed that PGK1, HSP90AA1 and GYPC were the most stable reference genes and suitable for qRT-PCR normalisation in both HLN and liver tissues. These three genes were validated against FoxP3, IL-10, TGF-β, TNF-α and IL-1β genes in the HLN tissue of sheep vaccinated with Cathepsin L1 from F. hepatica and unvaccinated infected and uninfected controls during early stages of infection. In the liver, the three reference genes were validated against TNF-α and IL-1β during chronic stages of infection with F. hepatica and in uninfected controls. Our study is the first to evaluate and validate sheep reference genes in order to provide tools for monitoring cytokines in Fasciola hepatica infected sheep target organs. Our results present an approach to elucidate the role of different cytokines in F. hepatica vaccinated and infected sheep.

Is the involvement of the hepatic artery lymph node a poor prognostic factor in pancreatic adenocarcinoma?

Background: The aim of this study was to describe the predictive value of hepatic artery lymph node(HALN) metastasis compared to peripancreatic lymph node (PPLN) in overall survival (OS) and disease-free survival(DFS) of those patients who underwent pancreaticoduodenectomy(PD) for pancreatic adenocarcinoma(PA). Methods: A single-center retrospective study which analyze prospectively those patients who underwent PD for PA between 2003 and 2014.Patients were included if during PD the HALN was submitted for pathologic evaluation and with at least one year of follow-up.Patients were excluded if margins were macroscopically positive.The median follow-up was 21 months. Results: Of the 125 who underwent PD for PA,HALN status was analyzed for 64 patients.HALN was positive in 12 patients(19%),HALN and PPLN were negative in 12 patients(19%) and 40 patients (62%) were HALN-/PPLN+.The OS at 1, 3 and 5 years was:HALN+ group 72%, 9% and 9%; HALN-/PPLN- group 91%, 70%, 47% and HALN-/PPLN+ group 68%,29%,17% respectively (p = 0.015). The DFS at 1,3 and 5 years was:HALN+ group 45%,9% and 0%; HALN-/PPLN- group 81%,38%,38% and HALN-/PPLN+ group 43%,17%,10% respectively(p = 0.05). In multivariable model, the main risk factor for OS and DFS was the PPLN involvement(HR 2.7;CI 1.05-6.93) and the adjuvant chemotherapy the main protective factor(HR 0,13;IC 0,05-0,31). Conclusion: Despite OS as DFS are significantly reduced in patients with positive HALN,multivariate model showed the PPLN status as the main factor of poor prognosis in our series.

Undifferentiated Carcinoma of the Gallbladder: Report of Three Cases

Introduction: Undifferentiated carcinoma (UC) is a rare malignant neoplasm in gallbladder (GB). We report here four cases of UC arising in the GB together with a review of the literature. Method: Between 1994 to 2015, patients with GB cancer who received curative resection were reviewed and we found three UC cases. Result: The first 68-year-old man presented with body weight loss, febril and chilly sensation. Imaging studies revealed an 4.2x2.4-cm fungating mass in the fundus of the GB. Multiple hepatic and para-arotic lymph node metastasis was detected at postoperative 2 months and the patient died at 4 months after surgery. In the second case, a 72-year-old man presented with abdominal pain and febrile sensation. On gross examination, a 15x10-cm tumor was originated from the gallbladder and directly invaded into liver, transverse colon, and omentum. Histological section revealed an UC and hepatic resection margin was involved by the tumor cell. Regional node metastasis was confirmed. Unfortunately, the patient diet at 50 day after surgery due to postoperative sepsis. The third case was a 65-year-old woman who presented with right upper quadrant abdomian pain. The patients was detected multiple hepatic and para-aortic lymph node metastasis at postoperative 2 months after surgery and was treated with systemic chemotherapy, but disease rapidly was progressed and the patient died at 6 months after surgery. Conclusion: Undifferentiated carcinoma of the gallbladder was a rare highly malignant neoplasms. It showed a large tumor pattern with involvement of adjacent organ and the prognosis was very poor.

Spectrum of lymphnodal involvement following extended cholecystectomy and its correlation with pT stage in carcinoma gall bladder patients

Introduction: The spectrum of lymph nodal involvement following extended cholecystectomy and its correlation with pT Stage in carcinoma gall bladder patients is an area with less reported inspite of its pivotal role in staging and prognosis. Method: A prospective observational study including 57 patients with Carcinoma gall bladder who had undergone extended cholecystectomy with systematic lymphadenectomy between January 2014 to December 2015 in PGIMER, Chandigarh. All the resectable patients underwent standard extended Cholecystectomy with n aim to achieve R0 resections and lymphnodal dissection of cystic, pericholedochal, peripancreactic, periportal, coeliac artery, Common Hepatic Artery, LHA, RHA, Hepato-duodenal lymph nodes were sent separately with main specimen for evaluation. Result: Out of 57 patients, 8 were excluded (5 were xanthogranulomatous cholecystitis, 2 were chronic cholecystitis, 1 was IgG4 related disease). A total of 555 lymph nodes were examined in 49 patients with range of 0 to 26 and median of 11.79.Lymph nodal involvement found in 19 patients(38.7% ) out of 49. Lymph nodal involvement in order of frequency was peripancreatic (n=9/49;18.4%),common hepatic artery(n=7/49;14.3%), periportal(n=7/49;14.3%), hepato-duodenal(n=5/49;10.2%), pericholedochal (n=4/49;8.2%), cystic (n=3/49;6.1%) ,coeliac (n=2/49;4.1%), LHA nodes(1/49;2%) and RHA lymph nodes (1/49;2%). Lymph nodal involvement in our study with respect to tumor staging was, pT1 stage (n=5/49;10.2%) - periportal lymph nodes involved(n=1/5;20%), pT2 stage (n=12/49;24.5%) - pericholedochal (n=3/12;25%), cystic (n=2/12;16.6%) ,peripancreatic (n=2/12;16.6%) ,Common Hepatic Artery nodes (n=1/12;8.3%),periportal(n=1/12;8.3)hepato-duodenal nodes(n=1/12;8.3), pT3 stage tumors(n=32/49;65.3%) - peri-pancreatic(n=7/32;21.9%),Common Hepatic Artery (n=6/32;18.7%), periportal (n=5/32;15.6%),hepato-duodenal(n=4/32;12.5%) ,celiac (n= 2/32 ;6.25%) ,pericholdecochal (n=1/32;3.1%), LHA nodes (n=1/32;3.1%),RHA nodes(n=1/32;3.1%),cystic lymph nodes (n=1/32;3.1%) with p>0.05. Conclusion: Peripancreatic lymph nodes were the most commonly involved irrespective of ‘pT’stage. Our study mandates the role of systemic lymphadenctomy for better tumor clearance and staging even in early carcinoma Gallbladder however its translation in to better survival is yet to be studied.

Colorectal liver metastases and concomitant extrahepatic disease: is resection justified? Single center survival analysis on 84 patients

Background: Limited extrahepatic disease (EHD) in patients with colorectal liver metastases (CRLM) is no longer considered an absolute contraindication to resection. However the impact of the different sites of EHD on survival remains to be defined. Methods: Between 2000 and 2015, 702 patients underwent liver resection for CRLM at our Unit. Of these, 84 patients (11.8%) underwent resection of concomitant EHD and they are the object of our study. Results: Site of EHD was: lung in 27 patients (32.1%), hepatic pedicle lymph nodes (LN) in 38 (44.1%), peritoneum in 18 (19.0%), distant LN (inguinal and aortocaval sites) in 4 (4.8%). Sixty patients (71.4%) underwent preoperative chemotherapy (CT): 5-year overall survival (OS) after resection of CRLM and concomitant EHD was significantly higher in patients with response to CT than that in patients resected with progression (32.4% vs. 14.6%, respectively, p=0.01). Five-year OS of patients resected for liver-only CRLM was not significantly different from that of patients resected for CRLM and concomitant lung metastases (55.3% vs. 39.5%, respectively, p=ns). Resection of concomitant hepatic pedicle LN metastases was associated with a significantly lower 5-year OS (15.0%, p<0.001). Conclusion: In selected patients resection of concomitant lung metastases can be associated with similar OS to that of patients resected for liver-only disease. Presence of hepatic pedicle LN metastases is a poor prognostic factor and resection should be considered in patients showing response to CT.

Is the involvement of the hepatic artery lymph node a poor prognostic factor in pancreatic adenocarcinoma?

Is the involvement of the hepatic artery lymph node a poor prognostic factor in pancreatic adenocarcinoma?

Colorectal liver metastases and concomitant extrahepatic disease: is resection justified? Single center survival analysis on 84 patients

Background: Limited extrahepatic disease (EHD) in patients with colorectal liver metastases (CRLM) is no longer considered an absolute contraindication to resection. However the impact of the different sites of EHD on survival remains to be defined. Methods: Between 2000 and 2015, 702 patients underwent liver resection for CRLM at our Unit. Of these, 84 patients (11.8%) underwent resection of concomitant EHD and they are the object of our study. Results: Site of EHD was: lung in 27 patients (32.1%), hepatic pedicle lymph nodes (LN) in 38 (44.1%), peritoneum in 18 (19.0%), distant LN (inguinal and aortocaval sites) in 4 (4.8%). Sixty patients (71.4%) underwent preoperative chemotherapy (CT): 5-year overall survival (OS) after resection of CRLM and concomitant EHD was significantly higher in patients with response to CT than that in patients resected with progression (32.4% vs. 14.6%, respectively, p=0.01). Five-year OS of patients resected for liver-only CRLM was not significantly different from that of patients resected for CRLM and concomitant lung metastases (55.3% vs. 39.5%, respectively, p=ns). Resection of concomitant hepatic pedicle LN metastases was associated with a significantly lower 5-year OS (15.0%, p<0.001). Conclusion: In selected patients resection of concomitant lung metastases can be associated with similar OS to that of patients resected for liver-only disease. Presence of hepatic pedicle LN metastases is a poor prognostic factor and resection should be considered in patients showing response to CT.

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

Abstract 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 well-differentiated grade 2, type 3 gNEN with metastatic hepatic portal lymph nodes. EDGE non-invasive radiosurgery (800 cGy × 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.

Dissection of the hepatic artery lymph node for the preparation of a safe laparoscopic portal-mesenteric venous tunnel

Dissection of the hepatic artery lymph node for the preparation of a safe laparoscopic portal-mesenteric venous tunnel

Abstract 3627: Organ-specific differential responses to immune checkpoint inhibitors in patients with advanced hepatocellular carcinoma

Abstract Background: Immune checkpoints inhibitors (ICIs) such as anti-PD-1/PD-L1 monoclonal antibodies exhibit significant clinical activity in patients with advanced hepatocellular carcinoma (HCC). Immune microenvironments of different organs are often different and may affect the efficacy of immunotherapy. The study explores whether tumor response to ICIs of HCC may vary among different organs. Patients and Methods: We reviewed patients with advanced HCC who had received anti-PD-1, anti-PD-L1, or anti-CTLA-4 therapy, alone or in combination, in 3 medical centers in Taiwan. Patients with measurable diseases were enrolled. An organ-specific response criteria, modified from RECIST 1.1, allowing a maximum of 5 measurable lesions per organ system, was used to evaluate the responses to ICIs for tumors of individual organ system. The organ-specific complete responses (CR), partial responses (PR), stable diseases (SD), or progressive diseases (PD) were determined for individual organ system. Results: A total of 76 patients (Male: Female= 62: 14, median age of 59.1 years) with advanced HCC were enrolled. Among them, 51 (67.1%) and 12 (15.8%) patients had chronic hepatitis B virus or chronic hepatitis C infection. The ICI treatments included anti-PD-1 or anti-PD-L1 alone, anti-CTLA4 alone, and anti-PD-1/PD-L1 plus anti-CTLA4 combination in 59, 1, and 16 patients; 20 and 56 patients had received ICIs as first-line or ≥ 2nd-line therapy. The overall response rate (RR) by RECIST 1.1 was 28.9%. Fifty-nine, 34, 18, and 18 patients who had measurable hepatic tumors, lung, lymph node, and intra-abdomen metastases were subject to organ-specific response evaluation. Organ-specific RRs of hepatic tumors, lung, lymph node, and intra-abdomen metastases, were 23.7, 41.2, 27.8, and 38.9%, respectively. Among 39 patients who had both hepatic and extrahepatic tumors, 16 had significant differential responses between hepatic and extrahepatic tumors: 12 of them had disease control (CR/PR/SD) in extrahepatic tumors and PD in hepatic tumors, and 4 exhibited disease control in hepatic tumors and PD in extrahepatic tumors (p=0.046). Moreover, in 16 patients with only evaluable hepatic tumors and lung metastases, 8 had disease control in lung metastases and PD in hepatic tumors, and none experienced disease control in liver tumors and PD in lung metastases (p=0.005). Conclusions: The hepatic tumors of HCC are less responsive to ICIs than the extrahepatic lesions. Lung metastases show best response to ICIs. The underlying mechanism warrants further investigation. (This work is supported by grants from the Ministry of Science and Technology, Taiwan, MOST 106-2314-B-002-210). Citation Format: Li-Chun Lu, Chiun Hsu, Yu-Yun Shao, Yee Chao, Chia-Jui Yen, I-Lun Shih, Yi-Ping Hung, Chun-Jung Chang, Ying-Chun Shen, Jhe-Cyuan Guo, Tsung-hao Liu, Chih-Hung Hsu, Ann-Lii Cheng. Organ-specific differential responses to immune checkpoint inhibitors in patients with advanced hepatocellular carcinoma [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr 3627.

Impact of affected lymph nodes on long-term outcome after surgical therapy of alveolar echinococcosis.

Alveolar echinococcosis (AE) is a life-threatening helminthic disease. In humans, AE mostly affects the liver; the regional hepatic lymph nodes may be involved, indicating dissemination of AE from the liver. To achieve complete removal of the disease, enlarged hepatic lymph nodes may be resected during surgical treatment. We evaluated the frequency of affected lymph nodes by conventional microscopic and immunohistochemical analyses including detection of small particles of Echinococcus multilocularis (spem). Furthermore, we analyzed the association of resection of enlarged and affected lymph nodes with long-term outcome after surgical therapy of patients who underwent surgery with curative intent. We identified 43 patients who underwent hepatic surgery with curative intent with lymph node resection for AE. We analyzed the cohort for the manifestation of the parasite in the resected lymph nodes by conventional histology and by immunohistochemistry and compared these data with the further course of AE. Microscopically infected lymph nodes (laminar layer visible) were found in 7 out of these 43 patients (16%). In more than three quarters (25/32) of all specimens investigated, lymph nodes showed spems when stained with antibody against Em2G11, a monoclonal antibody specific for the Em2 antigen of the Echinococcus multilocularis metacestode. Most frequently, lymph nodes were resected due to enlargement. The median size of microscopically affected lymph nodes was 2cm (range, 1.2 to 2.5cm), the median size of immunohistochemically and non-affected lymph nodes was 1.3cm each (range, "small" to 2.3 or 2.5cm, respectively). Median follow-up was 8years for all patients, 5years for patients with lymph node resection, and 4years for patients with infested lymph nodes. Overall, recurrent disease was seen in ten patients (10/109; 9%) after a median period of 1.5years (range, 4months to 4years). None of the seven patients with conventionally microscopically affected lymph nodes suffered from recurrent disease. One patient with negative resected nodes and one patient with spems showed recurrent disease after 4 and 35months, respectively. Lymph node involvement in AE is frequent, particularly when evaluated by immunohistochemical examination of lymph nodes with the monoclonal antibody Em2G11. Affected lymph nodes tend to be larger in size. Lymph node involvement is not associated with recurrent disease and therefore warrants further analysis of the biological significance of lymph node involvement.

Synaptotagmin XIII expression and peritoneal metastasis in gastric cancer.

Peritoneal metastasis is a frequent cause of death in patients with gastric cancer. The aim of this study was to identify molecules responsible for mediating peritoneal metastasis of gastric cancer. Transcriptome and bioinformatics analyses were conducted to identify molecules associated with peritoneal metastasis. The therapeutic effects of intraperitoneally administered small interfering (si) RNA were evaluated using mouse xenograft models. Expression of mRNA and protein was determined in gastric tissues from patients with gastric cancer. Synaptotagmin XIII (SYT13) was expressed at significantly higher levels in patients with peritoneal recurrence, but not in those with hepatic or distant lymph node recurrence. Inhibition of SYT13 expression in a gastric cancer cell line transfected with SYT13-specific siRNA (siSYT13) was associated with decreased invasion and migration ability of the cells, but not with proliferation and apoptosis. Intraperitoneal administration of siSYT13 significantly inhibited the growth of peritoneal nodules and prolonged survival in mice. In an analysis of 200 patients with gastric cancer, SYT13 expression in primary gastric cancer tissues was significantly greater in patients with peritoneal recurrence or metastasis. A high level of SYT13 expression in primary gastric cancer tissues was an independent risk factor for peritoneal recurrence. SYT13 expression in gastric cancer is associated with perioneal metatases and is a potential target for treatment.

Surgery for metastases for esophageal-gastric cancer in the real world: Data from the AGAMENON national registry

IntroductionThe effect of surgery for metastases in patients with esophagogastric cancer is unknown, given the lack of randomized clinical trials; likewise, the criteria for selecting eligible patients remain to be determined. MethodsThis registry evaluates the results of patients with advanced adenocarcinoma of the stomach, distal esophagus, or gastro-esophageal junction from 32 centers. To assess selection criteria and prognostic factors, a state arrival extended Markov proportional hazards (PH) model was used. Results1792 subjects were analyzed, 5% of whom (n = 92) underwent surgery for metastasis. The most common surgeries were peritoneal (29%), hepatic (24%), and distant lymph nodes (11%). Subjects chosen for metastasectomy had higher survival rates, HR 0.34 (95% CI, 0.06–0.80, p = 0.021). Patients who underwent surgery had a mOS since metastasectomy of 16.7 months (95% CI, 12.5–22.4). The 1- and 3-year relapse rates following R0 resection were 58% and 65%, respectively. Median time since R0 metastasectomy until relapse was 8.4 months (95% CI, 7.6–23.7). The 3-year OS after surgery was 30.6% (95% CI, 19.3–40.4). Duration of chemotherapy prior to surgery (months) increased mortality (HR 1.04 [95% CI, 1.01–1.07]), p = 0.009. The only significant interaction involved the use of anti-HER2 therapy. ConclusionThe AGAMENON registry suggests that subjects with limited metastatic disease, selected on a clinical basis, can benefit from early surgeries. Prospective trials are needed to confirm these data.

Computed tomographic appearance of abdominal lymph nodes in healthy cats.

BackgroundComputed tomography (CT) is commonly used in veterinary medicine and plays an important role in disease identification and cancer staging. Identification of abnormal abdominal lymph nodes is important for clinical, therapeutic, and prognostic decision making. No published study describes the CT appearance of abdominal lymph nodes in healthy cats.Hypothesis/ObjectivesAll abdominal lymph centers will be identified on CT with the majority of lymph nodes being elongated and homogenously contrast enhancing.AnimalsSixteen healthy cats without clinical or biochemical evidence of disease.MethodsPrecontrast and postcontrast CT images of sedated healthy cats were used to identify the presence and descriptive characteristics of intra‐abdominal lymph nodes. These assessments then were compared with patient characteristics to identify possible correlations.ResultsAbdominal lymph nodes were readily identified on CT with caudal mesenteric, colic, hepatic, inguinal, and pancreaticoduodenal lymph nodes identified in 16/16 cats. Lymph node size and shape varied among lymph centers with nearly all lymph nodes homogeneously contrast enhancing in 515/525. Significant negative correlations were identified between age and length (P = .0166) and width (P = .0387) of abdominal lymph nodes as well as age and number of sacral lymph nodes (P = .0493). Intranodal fat was present in 18/525 lymph nodes.Conclusions and Clinical ImportanceCT readily permitted identification and characterization of feline abdominal lymph nodes. This study provides subjective and objective data on the CT characteristics of abdominal lymph nodes in 16 healthy cats, with younger cats having larger abdominal lymph nodes and a higher number of sacral lymph nodes.

Primary hepatic neuroendocrine carcinoma: report of two cases and literature review

BackgroundPrimary hepatic neuroendocrine carcinoma (PHNEC) is extremely rare. The diagnosis of PHNEC remains challenging—partly due to its rarity, and partly due to its lack of unique clinical features. Available treatment options for PHNEC include surgical resection of the liver tumor(s), radiotherapy, liver transplant, transcatheter arterial chemoembolization (TACE), and administration of somatostatin analogues.Case presentationWe report two male PHNEC cases and discuss the diagnosis and treatment options. Both cases presented with abdominal pain; case two also presented with symptoms of jaundice. The initial diagnosis for both cases was poorly differentiated grade 3 small-cell neuroendocrine carcinoma, based on imaging characteristics and the pathology of liver biopsies. Final diagnoses of PHNEC were arrived at by ruling out non-hepatic origins. Case one presented with a large tumor in the right liver lobe, and the patient was treated with TACE. Case two presented with tumors in both liver lobes, invasions into the left branch of hepatic portal vein, and metastasis in the hepatic hilar lymph node. This patient was ineligible for TACE and was allergic to the somatostatin analogue octreotide. This limited treatment options to supportive therapies such as albumin supplementation for liver protection. Patient one and two died at 61 and 109 days, respectively, following initial hospital admission.ConclusionsWe diagnosed both cases with poorly differentiated grade 3 small-cell PHNEC through imaging characteristics, immunohistochemical staining of liver biopsies, and examinations to eliminate non-hepatic origins. Neither TACE nor liver protection appeared to significantly extend survival time of the two patients, suggesting these treatments may be inadequate to improve survival of patients with poorly differentiated grade 3 small-cell PHNEC. The prognosis of poorly differentiated grade 3 small-cell PHNEC is poor due to limited and ineffective treatment options.

AB009. 93. Minimally invasive oesophagectomy

: Ivor-Lewis oesophagectomy is the standard treatment for resectable oesophageal carcinoma, although it is associated with significant postoperative morbidity and mortality. Minimally invasive oesophagectomy (MIO) is increasingly adopted as the preferred surgical approach in order to decrease perioperative morbidity and facilitate earlier functional recovery. (I) stage I: with the surgeon on the right and the assistant on the left a 5-port technique is used to perform a laparoscopic gastric mobilisation with an en bloc lymphadenectomy of the common hepatic, left gastric and splenic artery lymph node stations. The stomach is fully mobilized with preservation of the right gastroepiploic arcade. After full mobilisation of the stomach a 3.5–4 cm gastric conduit is fashioned by sequential firing of an EndoGIA 4.8-mm stapler. The gastric conduit is then sutured to the transected stomach for retrieval later in the chest. A Heineke-Mikulicz pyloroplasty is fashioned in selected cases. Using a seldinger technique a 9-Fr feeding jejunostomy is inserted into the jejunum and secured to the anterior abdominal wall with a purse-string suture. (II) Stage II: a 5-post thoracoscopy is performed in the left lateral decubitus position. The oesophagus is fully mobilized to the thoracic inlet and an en bloc lymphadenectomy is performed of the paraesophageal, subcarinal, right and left bronchial and lower paratracheal lymph node stations. The 9th intercostal port site is converted to a 3–4 cm mini-thoracotomy. A 28 mm circular anvil is placed in the proximal oesophagus and secured with a purse-string suture. A gastrotomy is made in the tip of the gastric conduit through which an EEA circular stapler is inserted. An esophagogastric end-to-side anastomosis is fashioned and the redundant fundal tissue excised with a linear stapler. A 16 French chest tube is placed prior to closure of the wounds. MIO has been successfully implemented in the Mercy University Hospital with a median length of stay of 8 days and an in-hospital mortality of 3.5%.

Risk prediction and impaired tactile sensory perception among cancer patients during chemotherapy.

ABSTRACTObjectives:to estimate the prevalence of impaired tactile sensory perception, identify risk factors, and establish a risk prediction model among adult patients receiving antineoplastic chemotherapy. Method:historical cohort study based on information obtained from the medical files of 127 patients cared for in the cancer unit of a private hospital in a city in Minas Gerais, Brazil. Data were analyzed using descriptive and bivariate statistics, with survival and multivariate analysis by Cox regression. Results:57% of the 127 patients included in the study developed impaired tactile sensory perception. The independent variables that caused significant impact, together with time elapsed from the beginning of treatment up to the onset of the condition, were: bone, hepatic and regional lymph node metastases; alcoholism; palliative chemotherapy; and discomfort in lower limbs. Conclusion:impaired tactile sensory perception was common among adult patients during chemotherapy, indicating the need to implement interventions designed for early identification and treatment of this condition.