Multiple Liver Metastases Research Articles

Nomogram predicted disease free survival for colorectal liver metastasis patients with preoperative chemotherapy followed by hepatic resection

BackgroundHepatic resection is regarded to as a potentially curative option for colorectal cancer liver metastases (CRLM), but it is associated with a high rate of recurrence. The present study intended to establish an effective nomogram to predict disease free survival (DFS) and select candidates of hepatic resection. MethodsThe nomogram was based on a retrospective study on 447 CRLM patients treated with preoperative chemotherapy followed by hepatic resection using a multicentric database between January 1st, 2010 and December 31st, 2017. Results were validated using bootstrap resampling on 117 patients. The predictive accuracy and discriminative ability of the nomogram were determined by concordance index (C-index) and calibration curve. Overall survival, disease free survival, and local recurrence rate for patients with colorectal cancer were measured. ResultsBased on multivariate analysis of the primary cohort, independent factors for DFS included tumor size larger than 5 cm, multiple liver metastases(>1), RAS mutation, primary lymph node metastasis and tumor size increase after preoperative chemotherapy. These five factors were all considered in the nomogram. The C-index of the nomogram for predicting survival was 0.675. With external validation, the C-index of the nomogram for the prediction of the DFS was 0.77, which demonstrated that this model has a good level of discriminative ability. For the 382 patients (66.7%) who developed recurrence, the optimal cutoff point for early recurrence was determined to be 12 months after hepatic resection. ConclusionsThe proposed nomogram demonstrated accurate prognostic prediction of DFS for CRLM patients with preoperative chemotherapy followed by hepatic resection.

Observation of efficacy of paclitaxel with concurrent radiotherapy in the treatment for nasopharyngeal carcinoma patients with liver metastasis

Objective To investigate the efficacy, prognosis and safety of weekly paclitaxel with concurrent radiotherapy in nasopharyngeal carcinoma (NPC) patients with multiple liver metastases. Methods A total of 64 NPC patients with multiple liver metastases in First Affiliated Hospital of Hainan Medical University between January 2016 and January 2018 were recruited and randomly divided into experimental group (n=32) and control group (n=32) by the method of random number table. The patients in the two groups were given palliative radiotherapy with a median dose of 30 Gy. The experimental group used weekly paclitaxel (40 mg/m2) concurrent chemotherapy, cisplatin (40 mg/m2) in the control group. Paclitaxel and cisplatin were used weekly until the end of radiotherapy. The clinical efficacy and adverse effects between the two groups were compared. Results During the follow-up, 1 patient was lost to follow-up in the experimental group, complete remission (CR) in 6 cases (19.4%), partial remission (PR) in 9 cases (29.0%), stable disease (SD) in 7 cases (22.6%) and progressive disease (PD) in 9 cases (29.0%); 2 patients were lost to follow-up in the control group, CR in 4 cases (13.4%), PR in 10 cases (33.3%), SD in 9 cases (30.0%) and PD in 7 cases (23.3%). There was no significant difference between the two groups (Z=-0.060, P=0.952). The effective rates of the experimental group and the control group were 48.4% (15/31) and 46.7% (14/30) respectively, and the difference was not statistically significant (χ2=0.018, P=0.893); the tumor control rates were 71.0% (22/31) and 76.7% (23/30), with no statistically significant difference (χ2=0.256, P=0.613). The median survival time of the experimental group and the control group were 9.4 months and 8.9 months respectively, and the 1-year survival rates were 14.5% and 10.0%, with no significant difference (χ2=1.136, P=0.286). Among the adverse effects, the incidence rates of allergic reaction, neurotoxicity and cardiovascular toxicity in the experimental group were higher than those in the control group [18.8% (6/32) vs. 3.1% (1/32), 28.1% (9/32) vs. 15.6% (5/32), 31.3% (10/32) vs. 15.6% (5/32)], with no significant differences (χ2=2.566, P=0.109; χ2=1.463, P=0.226; χ2=2.177, P=0.140). The incidence rates of granulocyte decline, platelet decline, red blood cell decline, and impaired liver and kidney function in the experimental group were lower than those in the control group [56.3% (18/32) vs. 68.8% (22/32), 12.5% (4/32) vs. 21.9% (7/32), 15.6% (5/32) vs. 25.0% (8/32), 21.9% (7/32) vs. 28.1% (9/32)], with no significant differences (χ2=1.067, P=0.302; χ2=0.988, P=0.320; χ2=0.868, P=0.351; χ2=0.333, P=0.564). The incidence rates of nausea and vomiting was lower than that in the control group [(40.6% (13/32) vs. 78.1% (25/32)], with a significant difference (χ2=9.328, P=0.002). Conclusion Weekly paclitaxel with concurrent radiotherapy has equivalent efficacy to cisplatin and the adverse effects can be tolerated. Key words: Nasopharyngeal neoplasms; Neoplasm metastasis; Radiotherapy; Paclitaxel

Long-term response of metastatic hereditary leiomyomatosis and renal cell carcinoma syndrome associated renal cell carcinoma to bevacizumab plus erlotinib after temsirolimus and axitinib treatment failures

BackgroundHereditary leiomyomatosis and renal cell carcinoma (HLRCC) is a rare hereditary kidney cancer syndrome in which affected individuals are at risk of skin and uterine leiomyomatosis and kidney cancer. HLRCC-associated kidney cancer is a lethal disease with a highly aggressive behavior, and there is no standard treatment option for metastatic disease.Case presentationHere, we report a 29-year-old patient with a locally advanced HLRCC-assiciated RCC. He was administrated temsirolimus initially, then underwent surgical removal of kidney, retroperitoneal lymph nodes, inferior vena cava and tumor thrombi. Unfortunately, multiple liver metastases were confirmed 1 month after surgery, so axitinib was given but failed immediately. We tried bevacizumab plus erlotinib, which achieved long-term good response lasting more than 18 months. He is alive with disease and maintains bevacizumab plus erlotinib treatment.ConclusionThe promising results obtained in this patient suggest that combined bevacizumab plus erlotinib may offer a valid treatment option for advanced HLRCC-associated kidney cancer, even after failures of mTOR inhibitor and/or VEGFR TKI based therapies.

Small intestine neuroendocrine adenocarcinoma with multiple liver metastases and ectopic benign pancreatic tumor in a 24-year-old woman – case report

Abstract : Neuroendocrine tumors represent a varied group of neoplasms which have the potential to produce and secrete a wide range of hormones along with other vasoactive substances.The care of these patients involves several specialties including:surgery, oncology, radiotherapy, interventional radiology and nuclear oncology. Despite this large number of options there is currently no consensus on the optimal sequence of these treatment resources for metastatic patients.We present the case of a 24 year women who was diagnosed with a gastric tumor (could not be biopsied) by imagistics and liver metastatsis. A Pean resection with metastasectomy was done. The histopathology study revealed that the gastric tumor was benign ectopic pancreas tissue and the metastases were actualle of neuroendocrine origin. A somatostatin receptor scintigraphy (OctreoScan) was done which revealed the primary tumor in the ileal mesentery which was resected in a secondary intervention. The patient was started on long acting sandostatin with no recurence.

Evaluation of endoscopic reintervention for self-expandable metallic stent obstruction after stent-in-stent placement for malignant hilar biliary obstruction.

Bilateral self-expandable metallic stent (SEMS) placement is effective for long-term management of unresectable malignant hilar biliary obstruction (UMHBO). However, endoscopic reintervention (ERI) for bilateral SEMSs is not well-studied. This study aimed to evaluate ERI efficacy after stent-in-stent placement. Data of 31 patients who underwent ERI from May 2000 to July 2018 were analyzed. The technical success rate was 80.7% (25/31) and no adverse events occurred. The functional success rate was 100% (25/25). In a multivariate logistic regression analysis, the angle between the bilateral SEMSs (ABBS) >104° (odds ratio 50.49, 95% CI 3.370-2131, P = 0.0039) and overgrowth (odds ratio 25.70, 95% CI 1.121-1234, P = 0.0423) were risk factors for ERI failure. Multiple liver metastases, which sometimes cause overgrowth, were also risk factors. After ERI, some patients underwent additional SEMS (n = 4), plastic stent (n = 14) placement, or internal cleaning of the initial SEMS alone (n = 7). There were no significant intergroup differences in the 50% time to recurrent biliary obstruction. ABBS >104° and overgrowth were risk factors for ERI failure after stent-in-stent placement. In the decision-making process for initial SEMS placement for UMHBO, patient condition should be considered, including the angle between bilateral bile ducts and multiple liver metastases.

Radiological features of follicular dendritic cell tumor of spleen

Objective To summarize the radiological features of follicular dendritic cell tumor of spleen (FDCS). Methods The clinical, radiological and pathological data of 8 patients from November 2011 to November 2017 in 5 hospitals with FDCS confirmed by pathology were retrospectively analyzed. All patients underwent CT examinations including plan and enhanced CT. Three patients underwent additional MRI and two patients underwent PET-CT examinations simultaneously. The imaging features such as location, number, shape, boundary, size, internal structure, density (or signal, 18F-fluorodeoxyglucose uptake), enhancement model and the relationship with surrounding structures were observed and compared with pathological results. Results Of the 8 patients with FDCS, 7 were located in the spleen and 1 was located in the spleen of the ectopic spleen of the pancreas. Seven patients with splenic FDCS underwent splenectomy and 1 patient with pancreatic ectopic spleen FDCS underwent resection of the pancreas. Multiple lesions were detected in 1 case, while single in the others. Tumor was round or oval. The tumors were well-circumscribed and presented as expansive growth. On unenhanced CT, the tumors showed a slightly lower density, and hemorrhage and necrosis could be detected in 6 lesions. Calcification was seen in 1 case, significant necrosis, and cystic change was presented in the pancreatic ectopic spleen FDCS. The solid part presented isointensity or slightly hypointensity on T1WI, and hyperointensity on T2WI. Cystic necrosis areas were hypointensitive on T1WI, and hyperointensitive on T2WI. Spoke-like areas with hypointensity on T1WI and hyperointensity on T2WI were detected in the center of the solid part with the distribution among the substantial degenerative and necrotic regions. PET-CT showed that the 18F-fluorodeoxyglucose was uptaked obviously. The enhancement CT showed that at the arterial phase, the tumors were markedly enhanced and continuously enhanced at portal vein phase and balance phase. Multiple liver metastases were detected in 1 case with huge FDCS. One patient was followed up for 6 years, and gastric lymphoma was detected. The others were followed up for 6 to 53 months, there remained no transfer or recurrence. Conclusions The features of FDCS of spleen mainly manifest as solid or cystic mass with clear solitary sphenoma accompanied by scarring, calcification and hemorrhage. The enhancement mode is persistent enhancement. MRI and PET-CT help to further reflect the tumor pathological basis and biological characteristics. Key words: Splenic neoplasms; Follicular dendritic cell sarcoma; Tomography, X-ray computed; Magnetic resonance imaging

Carcinosarcoma of Vater\u2019s papilla: case report of a rare neoplasm and review of the literature

BackgroundCarcinosarcoma is a rare tumor that includes both carcinoma and sarcoma components. It develops commonly in the female reproductive tract, most often in the uterus. However, as there are a small number of similar cases in the English literature, we would like to present a rare case of a carcinosarcoma in Vater’s papilla.Case presentationA 76-year-old female patient was preoperatively diagnosed with a papillary adenocarcinoma in Vater’s papilla by endoscopic biopsy. The patient underwent subtotal stomach-preserving pancreaticoduodenectomy, and postoperative pathological examination diagnosed the carcinosarcoma. The patient received adjuvant chemotherapy with gemcitabine, but multiple liver metastases were found 3 months after the operation. Though chemotherapy with gemcitabine and cisplatin was introduced, she died owing to tumor progression 7 months after the operation.ConclusionBecause carcinosarcoma of Vater’s papilla is a rare disease, a suitable treatment strategy has been unclear. We also present a review of the English literature regarding carcinosarcoma of Vater’s papilla.

Laparoscopic Extended Anatomical Resection of Segment 7 by the Caudate Lobe First Approach: a Video Case Report

BackgroundLaparoscopic hepatectomy for segment (S) 7 is classified as one of the most difficult procedures to perform.1 Here, we report a standardized method with the caudate lobe first approach2,3 which may benefit such difficult procedures. MethodsA 76-year-old woman was diagnosed with multiple liver metastases after sigmoid colon cancer resection. Her liver function was normal. Abdominal CT showed multiple small tumors located in S3 (two), S7 (two), and S8 (two). ResultsAfter partial resection of S3, the right lobe was fully mobilized. The caudate lobe was first divided at the midline from the caudal side parallel to the ventral central line of the inferior vena cava, and the caudate process was detached from the posterior Glissonean pedicle. Then, the S7 Glissonean branch was exposed. After transecting it, the demarcation line was secured. The root of the right hepatic vein (RHV) was exposed by further transection of the caudate lobe. The superficial tissue was divided using ultrasonic shears, while the deeper tissue was divided using cavitron ultrasonic surgical aspirator. The main trunk of the RHV was continuously exposed from the caudodorsal side, transecting the S7 branches. Between the exposed main trunk of the RHV and the cutting line in the ventral liver surface, which had been marked on the left of the tumor in the dorsal part of S8, the liver parenchyma was divided, securing the surgical margin for all 4 tumors in S7 and S8. Specimens were placed into a retrieval bag and removed from the umbilicus incision. Operation time was 341 min, and estimated blood loss was 200 g. Metastatic adenocarcinoma was confirmed by postoperative pathological diagnosis. The postoperative course was uneventful. ConclusionsThe caudate lobe first approach in laparoscopic hepatectomy for S7 is feasible and can benefit anatomical resection in such procedures.

Simultaneous surgery for infrahepatic inferior vena cava leiomyosarcoma with multiple liver metastasis

Introduction: Leiomyosarcoma of the inferior vena cava (IVC) is a rarely encountered malignancy originating from the smooth muscle cells of media of IVC, and only a few cases of the resection of IVC leiomyosarcomas with synchronous liver metastases have been reported. We report a simultaneous resection of infrahepatic IVC leiomyosarcoma replaced with polytetrafluoroethylene (PTFE) graft and liver metastasis as volume reduction followed by chemotherapy. Method: A 42-year-old male presented elastic hard abdominal mass in the right upper quadrant. He was diagnosed as leiomyosarcoma 9cm in diameter of infrahepatic IVC with multiple liver metastasis and was referred to our hospital. Via cancer board, resection of the primary lesion and volume reduction hepatectomy for multiple liver metastasis followed by chemotherapy was approved. He underwent tumor involving infrahepatic IVC resection, reconstruction with PTFE graft, and partial hepatectomy of segment 5,7, and 8. Result: The postoperative course of the patient was uneventful and the graft patency was retained by auxiliary with aspirin from postoperative day (POD) 4th. Histopathological examination revealed leiomyosarcoma arising from IVC with high level of Ki-67 index. He discharged on POD 28th and was continuously treated by chemotherapy with adriamycin and ifosfamide followed by eribulin. He was alive with multiple liver metastasis at 9 months after surgery. Conclusion: Although the ideal treatment of choice of IVC leiomyosarcoma with liver metastasis is radical en-bloc excision aimed to obtain a negative resection margin, resection of the primary lesion replaced by PTFE graft and volume reduction hepatectomy followed by chemotherapy may be one alternative option of therapeutic strategies.

A Case of Tumor Lysis Syndrome Induced by Surgery in Colon Cancer with Multiple Liver Metastases

Although tumor lysis syndrome is well described after chemotherapy for non-solid tumors, it is rarely seen or suspected in solid malignancies. Early recognition of this condition is paramount to reduce morbidity and mortality. We report on a case of tumor lysis syndrome induced by surgery in a patient with colon cancer with multiple liver metastases. We also review fifteen cases of diagnosed tumor lysis syndrome accompanying colorectal cancers. Though tumor lysis syndrome is rare in solid tumors, we should realize this possibility in patients with solid tumors of larger volumes, in particular, with enlarged liver metastases.

Salvage Living Donor Liver Transplantation for Colorectal Cancer Liver Metastasis: A Case Report

Introduction: Approximately half of the patients with Colorectal cancer (CRC) develop metastases to the liver. Surgical treatment of liver metastases (LM) is the only curative treatment option; however, only 20-40% of patients are candidates for liver resection. In CRC LM cases with unresectable disease, liver transplantation could be a solution with promising results from Norway. Method: Here we present a case with unresectable CRC-LM who developed jaundice and cholangitis and underwent living donor liver transplantation (LDLT) Result: A 42 yo male was referred to our center with cholangitis and jaundice who had multiple percutaneous biliary drainage and endoscopic drainage attempts. The patient was diagnosed with sigmoid colon adeno cancer with multiple liver metastasis 3 years ago and underwent low anterior resection and segment 5 wedge tumor resection (T3N2M1) followed with chemotheraphy (CHT). His LM responded to CHT however recurred after 14 months. He underwent liver resection (18months after initial surgery) followed CHT with capecitabine. He had recurrent liver metastasis for which he underwent portal vein embolization for anatomical resection which was not performed and consecutively transarterial radioembolization. The patient developed jaundice and cholangitis due to biliary compression which required multiple drainage attempts. He went on to have several bouts of cholangitis and severe biliary obstruction requiring multiple admissions and numerous drainage attempts. At referral to our center, his MELD score was 20 (Bil:9.8, INR1.54) and CEA 2737 ng/ml. He had PET scan which showed liver only disease. He had staging laparotomy where 3 hepatoduodenal lymphnodes were negative. After ethical commitee approval, our institutional transplant board decided LDLT. He underwent right lobe living donor liver transplantation and recovered uneventfully and discharged 4 weeks after LDLT. At discharge, his CEA level normalised gradually (53ng/ml) and PET scan was negative. Conclusion: LDLT could be a life saving option for patients with unresectable CRC-LM patients with liver failure.

Long-term Survival of a Patient with Multiple Liver Metastases and Peritoneal Dissemination from Small Bowel Cancer by Postoperative Chemotherapy

Long-term Survival of a Patient with Multiple Liver Metastases and Peritoneal Dissemination from Small Bowel Cancer by Postoperative Chemotherapy

Simultaneous laparoscopic colorectal and hepatic resection for patients with colorectal cancer and synchronous liver metastases: a multicenter series

Background: Laparoscopic resection is considered a viable treatment option for both colorectal cancer and colorectal liver metastases. The aim of this study was to present the results of a multicenter experience with totally laparoscopic simultaneous colorectal and liver resection. Methods: All patients with colorectal liver metastases that underwent simultaneous resection of colorectal primary and liver metastases were selected from a retrospective database containing all laparoscopic liver resections performed in the associated centers. Patient characteristics and perioperative outcomes were reported. Results: Sixty-three patients met the inclusion criteria. The primary tumor was most commonly located in the sigmoid (n=27, 42%). Liver metastases were mostly solitary (n=43, 67%). In most cases (n=54, 86%) a single stage minor liver resection sufficed. A conversion was necessary in 3 patients (5%). Hand-assistance was used in 6 (9%) and robot-assisted surgery was used in 2 (3%) cases. Median operative time was 206 minutes (IQR 170-310) and median blood loss was 200 ml (IQR 100-700). Major postoperative morbidity was 18% (n=11), including anastomic dehiscence 6% (n=4) and 30 day mortality 0%. Conclusion: Simultaneous laparoscopic colorectal and hepatic resection seems an appropriate treatment strategy in selected patients with colorectal cancer and synchronous liver metastases. The current results apply to patients with solitary or multiple small liver metastasis that require a minor liver resection only.

An aggressive surgical approach to rare central biliary invasion of colon cancer

Central biliary metastasis from colorectal cancer (CRC) is a rare manifestation. Given the rarity of the lesion, cases with central biliary metastasis from CRC pose challenges in identifying the proper treatment strategy. We present a case of stage IV CRC with synchronous multiple liver metastases and central biliary invasion. We also conducted a literature search and reviewed the reports on central biliary metastasis of CRC treated by major hepatectomy combined with extrahepatic bile duct resection. The patient underwent colon resection, partial hepatectomy, and transileocecal portal embolization (TIPE) as the first procedure, which was followed by an extended right hepatectomy and extrahepatic bile duct resection. Adjuvant chemotherapy was introduced, and the patient was doing well with no recurrence at 17 months after the first procedure. A liberal radical and aggressive resection in a multimodal treatment strategy could offer a favorable outcome in patients with a rare central biliary manifestation of CRC.

325. Feasibility of a combination of 90Y/177Lu-Radiopeptide Therapy (Peptide Receptor Radionuclide Therapy – PRRT) and External Beam Radiation Therapy (EBRT) in neuroendocrine tumors (NETs)

Purpose PRRT with 90Y-DOTATOC and 177Lu-DOTATATE showed up to 35% objective responses in NETs and acceptable toxicity. Given NET indolent behavior, multiple treatments are sequentially applied; EBRT is proposed frequently as oligometastatic/palliative setting. Our aim was to assess whether the combination of PRRT and EBRT (PRRT + EBRT) arise concerns about tolerability. Methods Over our 807 patients receiving PRRT (1997–2014), 17% underwent also EBRT (14% after PRRT, 3% before PRRT). Among these, 25 patients had dosimetry and clinical data of PRRT + EBRT. The primary NETs were pancreas (12), lung (7), others (6), with multiple metastases in liver (13), bone (10), others (11). EBRT was adjuvant in 18 sites, palliative in 22. Bone metastases were treated with 3D conformal EBRT. Oligometastaseswere treated with image-guided IMRT or stereotactic EBRT, accounting for absorbed doses (AD) from PRRT. AD to Organs At Risk (OARs) and tumours were assessed and toxicity investigated (CTCAE v4). For PRRT, OARs were kidneys and red-marrow; AD to the liver was also evaluated. OARs for EBRT depended on the tumour site. Results The table reports the median value (range) of administered activities and absorbed doses to OARs for the PRRT as well as doses delivered with EBRT. Individual metabolism leaded to large AD variability in PRRT (tumour: 1–42 Gy/GBq, 90Y-DOTATOC; 1–56 Gy/GBq, 177Lu-DOTATATE).No severe red-marrow toxicity was observed (14 patients grade I-II; 3 none); no kidney toxicity was shown but in 1 patient (grade I). Median (range) follow-up was 3.5 (0.2–12.3) years. 7 patients died. Conclusions PRRT and EBRT have different OARs, with the great potential to increase AD to tumours without increasing toxicity, especially in red-marrow and liver. This opens the way to future prospective studies. However, EBRT irradiating liver metastases may (rarely) deliver non-negligible AD to kidneys once summed to AD from PRRT. PRRT + EBRT imposes multidisciplinary dosimetry discussion.

A Recurrent Granulosa Cell Tumor of the Ovary After 20 Years

Adult-type granulosa cell tumors of the ovary are rare tumors. These tumors characteristically have high recurrence rates (10–15%), sometimes many years after the original diagnosis, and so lifelong follow is warranted for these patients. A 52-year-old female presented with a history of hysterectomy with ovarian mass removal 20 yrs back. She presented with huge abdominopelvic mass. Imaging showed abdominopelvic mass (18 × 10 × 24 cm), adherent to large bowel with multiple liver metastases (subcapsular and parenchymal largest 46 × 47 mm). Inhibin B (240 pg/ml) was raised. Exploratory laparotomy followed by ovarian mass removal, bowel resection anastomosis with proximal ileostomy and removal of hepatic metastasis was done. It was a suboptimal surgery, and residual disease was a 2-cm nodule near porta hepatis. Post-surgery inhibin was 70 pg/ml. Postoperatively, she received 6 doses of adjuvant chemotherapy (carboplatin and paclitaxel) and on regular follow-up. Due to high chance of recurrence even years after apparent clinical cure of the primary tumor, lifelong follow-up with clinical examination and tumor markers like inhibin B is required.

Long-term outcomes and prognostic analysis of percutaneous radiofrequency ablation in liver metastasis from breast cancer

Objective: To evaluate the long-term efficacy and prognostic factors of ultrasound-guided percutaneous radiofrequency ablation (RFA) for breast cancer liver metastasis (BCLM).Methods: Between 2000 and 2015, 69 patients who underwent ultrasound-guided percutaneous RFA for BCLM and had regular follow-up examinations were included. All patients had undergone resection of the primary breast cancer and had received chemotherapy, endocrine therapy or both after surgery. The sample included two males and 67 females with an average age of 50.3 ± 10.0 years (31–76 y). The mean maximum diameter of metastatic lesions in the liver was 2.9 ± 1.4 cm (1.0–6 cm). Thirty-five patients had a single metastasis, while 34 patients had multiple liver metastases (2–5 lesions). Survival results were generated using Kaplan-Meier estimates and a multivariate analysis was performed using the Cox regression model.Results: In total, 92 RFA sessions were performed and 135 BCLM lesions were treated. Major complications occurred in one of the 92 sessions (1.1%). Technical efficacy was achieved in 92.6% of lesions (125/135 lesions). Local tumor progression occurred in 11.6% (8/69) of patients and new intrahepatic metastasis occurred in 55.1% (38/69) of patients. From the time of initial RFA, the median overall survival was 26 months, and the one-, two-, three- and five -year survival rates were 81.8, 50.1, 25.3 and 11.0%, respectively. Based on the multivariate analysis, the following three factors were identified as independent prognostic factors for overall survival: tumor size (p = .017), positive estrogen receptor status (p = .009) and extrahepatic metastatic disease (p = .001). The median progression-free survival was 24 months, and the one-, two-, three- and five -year survival rates after RFA were 77.4, 47.0, 23.7 and 8.5%, respectively. Additionally, the independent prognostic factors for progression-free survival included tumor size (p = .011), ER positivity (p = .001), margin size (p = .017) and extrahepatic metastatic disease (p < .001).Conclusion: The results of this study showed that RFA is a safe and locally effective method for the treatment of BCLM, especially in patients with lesions measuring less than 3 cm in diameter, a single liver metastasis, positive estrogen receptor status and no extrahepatic metastases. Also, patients with margin size >10 mm had no local tumor progression.

Examination of pancreatic cystic neoplasm except IPMN who underwent surgical resection in our department

Background: These days, detection of cystic neoplasm of the pancreas has been increasing because of improvement for image-diagnosis and substantiality for health examination. We retrospectively analyzed the disease except IPMN in our department. 32 cases were enrolled in this study. Age: 51 years in median (24-80), Gender: 8 men, 23 females, Main lesions in the pancreas were located in head / body / tail; 9 / 10 / 12, The size of tumor: 55 mm in median (8-140). Distant metastases (yes/no) were (3/28). Follow-up period was 55 months (7-130). Results: 1. Symptom were examined in 13 cases, abdominal pain in 11, abdominal discomfort in 2, no symptom in 19. 2. The preoperative diagnosis was pathologically obtained in 4 cases by EUS-FNA, all of those were SPN. 3. Distal pancreatectomy was performed in 18 cases (laparoscopic surgery in 15), pancreaticoduodenectomy in 8, central pancreatectomy in 4, total pancreatectomy in 1. 4. Bleeding volume was 640 ml (0-1510) and operation time was 465 minutes (224 - 844). 5. Discrepancy between preoperative and final diagnosis occurred in 8 cases (26%) Among them, final diagnosis was MCN in 3, epidermoid cyst in 2, SCN, squamoid cyst, hamartoma in 1, respectively. 6. Recurrence and metastasis: LN metastasis occurred in 2 cases (simultaneous in 1 SPN, 3 years after 1 ITN surgery), multiple liver metastasis in 2 (simultaneous and 1 year after operation in SPN). Conclusion: Exact diagnosis for pancreatic cystic disease except IPMN is very important because of that with malignant potential.

Successful treatment of liver metastases arising from early gastric cancer achieved clinical complete response by nivolumab

BackgroundAlthough a recent randomized clinical trial has demonstrated that the objective response rate to nivolumab for metastatic gastric cancer was 11.2%, there was no patients confirmed complete response. Herein, we report on a case of liver metastasis arising from early gastric cancer in which a complete clinical response was achieved to nivolumab as third-line therapy.Case presentationA 77-year-old man was referred to Kochi Medical School Hospital for the treatment of liver metastases from gastric cancer. The patient had undergone laparoscopic total gastrectomy with regional lymph node dissection 30 months prior for early gastric cancer, with a final diagnosis of T1N0M0, stage IA. The patient developed solitary splenic metastasis measuring 42 mm 28 months later and underwent splenectomy because there was no evidence of further metastatic lesions in any other organ. The patient was treated with S-1 plus oxaliplatin based on negative immunohistochemical staining of the resected specimens for human epidermal growth factor receptor 2 (HER2). Four months after the splenectomy, the patient developed multiple liver metastases and was treated with ramucirumab plus paclitaxel. Because of disease progression, the patient was administered 3 mg/kg, i.v., nivolumab every 2 weeks. After 4 cycles of systemic treatment using nivolumab, abdominal computed tomography revealed marked shrinkage of the liver metastases. After 12 cycles of nivolumab, the liver metastases had disappeared completely. The patient did not develop any adverse reactions, including immune-reactive adverse events, during treatment. The patient continues to receive nivolumab, and there is no evidence of disease recurrence in the 8-month period since starting nivolumab.ConclusionsTo the best of our knowledge, this is the first case report in the English literature of a gastric cancer patient achieving a complete clinical response to nivolumab, and highlights the potential for successful treatment of metastatic gastric cancer using nivolumab.

Application value of π-shaped Roux-en-Y esophagojejunostomy in totally laparoscopic total gastrectomy

Objective To investigate the application value of π-shaped esophagojejunostomy in totally laparoscopic total gastrectomy. Methods The retrospective and descriptive study was conducted. The clinicopathological data of 3 patients who underwent totally laparoscopic total gastrectomy in the Beijing Friendship Hospital of Capital Medical University between October 2016 and March 2017 were collected. Patients received π-shaped Roux-en-Y esophagojejunostomy. Patients who were diagnosed with Ⅱ and above stages by pathological examination underwent postoperative adjuvant chemotherapy with oxaliplatin + tegafur gimeracil oteracil. Observation indicators: (1) surgical and postoperative recovery situations; (2) follow-up and survival situations. The follow-up using outpatient examination and telephone interview was performed to detect postoperative adjuvant therapy and survival up to March 2018. Results (1) Surgical and postoperative recovery situations: 3 patients underwent successfully totally laparoscopic total gastrectomy, and π-shaped Roux-en-Y esophagojejunostomy was also performed. Case 1 had injury of spleen vessel when No 11p lymph nodes were dissected and then received successful hemostasis, and case 2 and 3 didn′t have complication. Operation time, digestive tract reconstruction time, volume of intraoperative blood loss, time to anal exsufflation and postoperative drainage-tube removal time of case 1, 2 and 3 were respectively 376 minutes, 290 minutes, 284 minutes and 26 minutes, 30 minutes, 24 minutes and 500 mL, 100 mL, 200 mL and 2 days, 3 days, 3 days and 4 days, 4 days, 5 days. Case 3 with left pleural effusion was cured by puncture and drainage treating, and case 1 and 2 didn′t have complication. Three patients were not complicated with anastomotic stoma-related complicaions. Results of postoperative pathological examination: number of lymph node dissected and TNM staging of case 1, 2 and 3 were respectively 20, 17, 20 and T1aN0M0 staging, T3N3M0 staging, T1bN0M0 staging. Duration of hospital stay in case 1, 2 and 3 was respectively 7 days, 8 days and 11 days. (2) Follow-up and survival situations: 3 patients were followed up, and follow-up time of case 1, 2 and 3 was respectively 18 months, 16 months, 12 months. During the follow-up, case 2 received postoperative adjuvant therapy, and then underwent palliative treatment of Paclitaxel and Xeloda after the case was rechecked out multiple liver metastases at postoperative month 12. Case 1 and 3 had disease-free survival. Conclusion The π-Shaped esophagojejunostomy is safe and feasible for totally laparoscopic total gastrectomy, and it can be used as an alternative to digestive tract reconstruction. Key words: Gastric neoplasms; Total gastrectomy; Digestive tract reconstruction; Esophagojejunostomy; Laparoscopy