Chronic rejection(CR)of liver allografts causes damage to intrahepatic vessels and bile ducts and may lead to graft failure after liver transplantation.Although its prevalence has declined steadily with the introducti...Chronic rejection(CR)of liver allografts causes damage to intrahepatic vessels and bile ducts and may lead to graft failure after liver transplantation.Although its prevalence has declined steadily with the introduction of potent immunosuppressive therapy,CR still represents an important cause of graft injury,which might be irreversible,leading to graft loss requiring re-transplantation.To date,we still do not fully appreciate the mechanisms underlying this process.In addition to T cell-mediated CR,which was initially the only recognized type of CR,recently a new form of liver allograft CR,antibody-mediated CR,has been identified.This has indeed opened an era of thriving research and renewed interest in the field.Liver biopsy is needed for a definitive diagnosis of CR,but current research is aiming to identify new non-invasive tools for predicting patients at risk for CR after liver transplantation.Moreover,the minimization or withdrawal of immunosuppressive therapy might influence the establishment of subclinical CR-related injury,which should not be disregarded.Therapies for CR may only be effective in the“early”phases,and a tailored management of the immunosuppression regimen is essential for preventing irreversible liver damage.Herein,we provide an overview of the current knowledge and research on CR,focusing on early detection,identification of non-invasive biomarkers,immunosuppressive management,re-transplantation and future perspectives of CR.展开更多
Despite being the second most frequent primary liver tumor in humans,early diagnosis and treatment of cholangiocarcinoma(CCA)are still unsatisfactory.In fact,survival after 5 years is expected in less than one fourth ...Despite being the second most frequent primary liver tumor in humans,early diagnosis and treatment of cholangiocarcinoma(CCA)are still unsatisfactory.In fact,survival after 5 years is expected in less than one fourth of patients diagnosed with this disease.Rare incidence,late appearance of symptoms and heterogeneous biology are all factors contributing to our limited knowledge of this cancer and determining its poor prognosis in the clinical setting.Several efforts have been made in the last decades in order to achieve an improved classification/understanding with regard to the diverse CCA forms.Location within the biliary tree has helped to distinguish between intrahepatic,perihilar and distal CCA types.Sequence analysis contributed to identifying several characteristic genetic aberrations in CCA that may also serve as possible targets for therapy.Novel findings are expected to significantly improve the management of this malignancy in the near future.In this changing scenario our review focuses on the current and future strategies for CCA treatment.Both systemic and surgical treatments are discussed in detail.The results of the main studies in this field are reported,together with the ongoing trials.The current findings suggest that an integrated multidisciplinary approach to this malignancy would be helpful to improve its outcome.展开更多
Since the 19th century,appropriate lymphadenectomy has been considered a cornerstone of oncologic surgery and one of the most important prognostic factors.This approach can be applied to any surgery for gastrointestin...Since the 19th century,appropriate lymphadenectomy has been considered a cornerstone of oncologic surgery and one of the most important prognostic factors.This approach can be applied to any surgery for gastrointestinal cancer.During surgery for colon and rectal cancer,an adequate portion of the mesentery is removed together with the segment of bowel affected by the disease.The adequate number of lymph nodes to be removed is standardized and reported by several guidelines.It is mandatory to determine the appropriate extent of lymphadenectomy and to balance its oncological benefits with the increased morbidity associated with its execution in cancer patients.Our review focuses on the concept of“complete mesenteric excision(CME)with central vascular ligation(CVL),”a radical lymphadenectomy for colorectal cancer that has gained increasing interest in recent years.The aim of this study was to evaluate the evolution of this approach over the years,its potential oncologic benefits and potential risks,and the improvements offered by laparoscopic techniques.Theoretical advantages of CME are improved local-relapse rates due to complete removal of the intact mesocolic fascia and improved distance recurrence rates due to ligation of vessels at their origin(CVL)which guarantees removal of a larger number of lymph nodes.The development and worldwide diffusion of laparoscopic techniques minimized postoperative trauma in oncologic surgery,providing the same oncologic results as open surgery.This has been widely applied to colorectal cancer surgery;however,CME entails a technical complexity that can limit its wide minimally-invasive application. This review analyzesresults of these procedures in terms of oncological outcomes, technical feasibilityand complexity, especially within the context of minimally invasive surgery.展开更多
文摘Chronic rejection(CR)of liver allografts causes damage to intrahepatic vessels and bile ducts and may lead to graft failure after liver transplantation.Although its prevalence has declined steadily with the introduction of potent immunosuppressive therapy,CR still represents an important cause of graft injury,which might be irreversible,leading to graft loss requiring re-transplantation.To date,we still do not fully appreciate the mechanisms underlying this process.In addition to T cell-mediated CR,which was initially the only recognized type of CR,recently a new form of liver allograft CR,antibody-mediated CR,has been identified.This has indeed opened an era of thriving research and renewed interest in the field.Liver biopsy is needed for a definitive diagnosis of CR,but current research is aiming to identify new non-invasive tools for predicting patients at risk for CR after liver transplantation.Moreover,the minimization or withdrawal of immunosuppressive therapy might influence the establishment of subclinical CR-related injury,which should not be disregarded.Therapies for CR may only be effective in the“early”phases,and a tailored management of the immunosuppression regimen is essential for preventing irreversible liver damage.Herein,we provide an overview of the current knowledge and research on CR,focusing on early detection,identification of non-invasive biomarkers,immunosuppressive management,re-transplantation and future perspectives of CR.
文摘Despite being the second most frequent primary liver tumor in humans,early diagnosis and treatment of cholangiocarcinoma(CCA)are still unsatisfactory.In fact,survival after 5 years is expected in less than one fourth of patients diagnosed with this disease.Rare incidence,late appearance of symptoms and heterogeneous biology are all factors contributing to our limited knowledge of this cancer and determining its poor prognosis in the clinical setting.Several efforts have been made in the last decades in order to achieve an improved classification/understanding with regard to the diverse CCA forms.Location within the biliary tree has helped to distinguish between intrahepatic,perihilar and distal CCA types.Sequence analysis contributed to identifying several characteristic genetic aberrations in CCA that may also serve as possible targets for therapy.Novel findings are expected to significantly improve the management of this malignancy in the near future.In this changing scenario our review focuses on the current and future strategies for CCA treatment.Both systemic and surgical treatments are discussed in detail.The results of the main studies in this field are reported,together with the ongoing trials.The current findings suggest that an integrated multidisciplinary approach to this malignancy would be helpful to improve its outcome.
文摘Since the 19th century,appropriate lymphadenectomy has been considered a cornerstone of oncologic surgery and one of the most important prognostic factors.This approach can be applied to any surgery for gastrointestinal cancer.During surgery for colon and rectal cancer,an adequate portion of the mesentery is removed together with the segment of bowel affected by the disease.The adequate number of lymph nodes to be removed is standardized and reported by several guidelines.It is mandatory to determine the appropriate extent of lymphadenectomy and to balance its oncological benefits with the increased morbidity associated with its execution in cancer patients.Our review focuses on the concept of“complete mesenteric excision(CME)with central vascular ligation(CVL),”a radical lymphadenectomy for colorectal cancer that has gained increasing interest in recent years.The aim of this study was to evaluate the evolution of this approach over the years,its potential oncologic benefits and potential risks,and the improvements offered by laparoscopic techniques.Theoretical advantages of CME are improved local-relapse rates due to complete removal of the intact mesocolic fascia and improved distance recurrence rates due to ligation of vessels at their origin(CVL)which guarantees removal of a larger number of lymph nodes.The development and worldwide diffusion of laparoscopic techniques minimized postoperative trauma in oncologic surgery,providing the same oncologic results as open surgery.This has been widely applied to colorectal cancer surgery;however,CME entails a technical complexity that can limit its wide minimally-invasive application. This review analyzesresults of these procedures in terms of oncological outcomes, technical feasibilityand complexity, especially within the context of minimally invasive surgery.
