AIM: To outline the feasibility, safety, adverse events and early results of endoscopic ultrasound(EUS)-radiofrequency ablation(RFA) in pancreatic neoplasms using a novel probe. METHODS: This is a multi-center, pilot ...AIM: To outline the feasibility, safety, adverse events and early results of endoscopic ultrasound(EUS)-radiofrequency ablation(RFA) in pancreatic neoplasms using a novel probe. METHODS: This is a multi-center, pilot safety feasibility study. The intervention described was radiofrequency ablation(RF) which was applied with an innovative monopolar RF probe(1.2 mm Habib EUS-RFA catheter) placed through a 19 or 22 gauge fine needle aspiration(FNA) needle once FNA was performed in patients with a tumor in the head of the pancreas. The HabibTM EUSRFA is a 1 Fr wire(0.33 mm, 0.013") with a working length of 190 cm, which can be inserted through the biopsy channel of an echoendoscope. RF power is applied to the electrode at the end of the wire to coagulate tissue in the liver and pancreas.RESULTS: Eight patients [median age of 65(range 27-82) years; 7 female and 1 male] were recruited in a prospective multicenter trial. Six had a pancreatic cysticneoplasm(four a mucinous cyst, one had intraductal papillary mucinous neoplasm and one a microcystic adenoma) and two had a neuroendocrine tumors(NET) in the head of pancreas. The mean size of the cystic neoplasm and NET were 36.5 mm(SD ± 17.9 mm) and 27.5 mm(SD ± 17.7 mm) respectively. The EUSRFA was successfully completed in all cases. Among the 6 patients with a cystic neoplasm, post procedure imaging in 3-6 mo showed complete resolution of the cysts in 2 cases, whilst in three more there was a 48.4% reduction [mean pre RF 38.8 mm(SD ± 21.7 mm) vs mean post RF 20 mm(SD ± 17.1 mm)] in size. In regards to the NET patients, there was a change in vascularity and central necrosis after EUS-RFA. No major complications were observed within 48 h of the procedure. Two patients had mild abdominal pain that resolved within 3 d. CONCLUSION: EUS-RFA of pancreatic neoplasms with a novel monopolar RF probe was well tolerated in all cases. Our preliminary data suggest that the procedure is straightforward and safe. The response ranged from complete resolution to a 50% reduction in size.展开更多
Hepatocellular carcinoma(HCC)is the most common primary liver tumor and has been considered a very immunogenic tumor.The treatment with radiofrequency ablation(RFA)has been established as the standard ablative therapy...Hepatocellular carcinoma(HCC)is the most common primary liver tumor and has been considered a very immunogenic tumor.The treatment with radiofrequency ablation(RFA)has been established as the standard ablative therapy for early HCC,and is currently recognized as the main ablative tool for HCC tumors<5 cm in size;however,progression and local recurrence remain the main disadvantages of this approach.To solve this clinical problem,recent efforts were concentrated on multimodal treatment,combining different strategies,including the combination of RFA and immunotherapy.This article reviewed the combination treatment of RFA with immunotherapy and found that this treatment strategy leads to an increased response of anti-tumor T cells,significantly reduces the risk of recurrence and improves survival rates compared to RFA alone.This review highlighted scientific evidence that supports the current recommendations for pre-clinical studies,and discuss the need for further research on this topic.展开更多
Background:There is an ongoing debate on the feasibility,safety,and oncological efficacy of the associating liver partition and portal vein ligation for staged hepatectomy(ALPPS)technique.The aim of this study was to ...Background:There is an ongoing debate on the feasibility,safety,and oncological efficacy of the associating liver partition and portal vein ligation for staged hepatectomy(ALPPS)technique.The aim of this study was to compare ALPPS,two-staged hepatectomy(TSH),and portal vein embolization(PVE)/ligation(PVL)using updated traditional meta-analysis and network meta-analysis(NMA).Data sources:Electronic databases were used in a systematic literature search.Updated traditional metaanalysis and NMA were performed and compared.Mortality and major morbidity were selected as primary outcomes.Results:Nineteen studies including 1200 patients were selected from the pool of 436 studies.Of these patients,315(31%)and 702(69%)underwent ALPPS and portal vein occlusion(PVO),respectively.Ninetyday mortality based on updated traditional meta-analysis,subgroup analysis of the randomized controlled trials(RCTs),and both Bayesian and frequentist NMA did not demonstrate significant differences between the ALPPS cohort and the PVE,PVL,and TSH cohorts.Moreover,analysis of RCTs did not demonstrate significant differences of major morbidity between the ALPPS and PVO cohorts.The ALPPS cohort demonstrated significantly more favorable outcomes in hypertrophy parameters,time to operation,definitive hepatectomy,and R0 margins rates compared with the PVO cohort.In contrast,1-year disease-free survival was significantly higher in the PVO cohort compared to the ALPPS cohort.Conclusions:This study is the first to use updated traditional meta-analysis and both Bayesian and frequentist NMA and demonstrated no significant differences in 90-day mortality between the ALPPS and other hepatic hypertrophy approaches.Furthermore,two high quality RCTs including 147 patients demonstrated no significant differences in major morbidity between the ALPPS and PVO cohorts.展开更多
AIM:To study costs of laparoscopic and open liver and pancreatic resections,all the compiled data from available observational studies were systematically reviewed.METHODS:A systematic review of the literature was per...AIM:To study costs of laparoscopic and open liver and pancreatic resections,all the compiled data from available observational studies were systematically reviewed.METHODS:A systematic review of the literature was performed using the Medline,Embase,Pub Med,and Cochrane databases to identify all studies published up to 2013 that compared laparoscopic and open liver[laparoscopic hepatic resection(LLR)vs open liver resection(OLR)]and pancreatic[laparoscopic pancreatic resection(LPR)vs open pancreatic resection]resection.The last search was conducted on October 30,2013.RESULTS:Four studies reported that LLR was associated with lower ward stay cost than OLR(2972 USD vs 5291 USD).The costs related to equipment(3345USD vs 2207 USD)and theatre(14538 vs 11406)were reported higher for LLR.The total cost was lower in patients managed by LLR(19269 USD)compared to OLR(23419 USD).Four studies reported that LPR was associated with lower ward stay cost than OLR(6755vs 9826 USD).The costs related to equipment(2496USD vs 1630 USD)and theatre(5563 vs 4444)were reported higher for LPR.The total cost was lower in the LPR(8825 USD)compared to OLR(13380 USD).CONCLUSION:This systematic review support the economic advantage of laparoscopic over open approach to liver and pancreatic resection.展开更多
Haemangiomas are the most common solitary benign neoplasm of the liver with an incidence ranging from 5% to 20%. Although usually small and asymptomatic, they may reach considerable proportions and rarely give rise to...Haemangiomas are the most common solitary benign neoplasm of the liver with an incidence ranging from 5% to 20%. Although usually small and asymptomatic, they may reach considerable proportions and rarely give rise to life-threatening complications. Surgical intervention is required for incapacitating symptoms, established complications, and diagnostic uncertainty. The resection of haemangiomas demands meticulous surgical technique, owing to their high vascularity and the concomitant risk of intra-operative haemorrhage. Laparoscopic resection of giant haemangiomas is even more challenging, and has only been reported twice. We here report the case of a giant 10 cm liver haemangioma which was successfully resected laparoscopically using the laparoscopic HabibTM 4×, a bipolar radiofrequency device, without clamping major vessels and with minimal blood loss. Transfusion of blood or blood products was not required. The patient had an uneventful recovery and was asymptomatic at 7-mo follow-up.展开更多
Hepatocellular carcinoma(HCC)is the fifth most common neoplasm in the world,closely correlated with viral hepatitis and liver cirrhosis.The vast majority of HCC patients present at a late stage and are unsuitable for ...Hepatocellular carcinoma(HCC)is the fifth most common neoplasm in the world,closely correlated with viral hepatitis and liver cirrhosis.The vast majority of HCC patients present at a late stage and are unsuitable for surgery due to limited liver functional reserve.Tumors can involve major vessels or hilar structures,necessitating major liver resection and/or rendering liver resection unfeasible.A series of new technologies have been developed to optimise HCC management.Stem cell therapy improves impaired liver functional reserve prior to liver resection.Intravascular radiofrequency ablation recanalises the portal vein invaded by tumour thrombus and endobiliary radiofrequency ablation restores and extends biliary patency of the bile duct invaded by malignancy.Laparoscopic radiofrequency assisted liver resection minimizes blood loss and avoids liver warm ischemia,while increasing parenchymal sparing.These benefits combined maximize the safety of liver resection.展开更多
文摘AIM: To outline the feasibility, safety, adverse events and early results of endoscopic ultrasound(EUS)-radiofrequency ablation(RFA) in pancreatic neoplasms using a novel probe. METHODS: This is a multi-center, pilot safety feasibility study. The intervention described was radiofrequency ablation(RF) which was applied with an innovative monopolar RF probe(1.2 mm Habib EUS-RFA catheter) placed through a 19 or 22 gauge fine needle aspiration(FNA) needle once FNA was performed in patients with a tumor in the head of the pancreas. The HabibTM EUSRFA is a 1 Fr wire(0.33 mm, 0.013") with a working length of 190 cm, which can be inserted through the biopsy channel of an echoendoscope. RF power is applied to the electrode at the end of the wire to coagulate tissue in the liver and pancreas.RESULTS: Eight patients [median age of 65(range 27-82) years; 7 female and 1 male] were recruited in a prospective multicenter trial. Six had a pancreatic cysticneoplasm(four a mucinous cyst, one had intraductal papillary mucinous neoplasm and one a microcystic adenoma) and two had a neuroendocrine tumors(NET) in the head of pancreas. The mean size of the cystic neoplasm and NET were 36.5 mm(SD ± 17.9 mm) and 27.5 mm(SD ± 17.7 mm) respectively. The EUSRFA was successfully completed in all cases. Among the 6 patients with a cystic neoplasm, post procedure imaging in 3-6 mo showed complete resolution of the cysts in 2 cases, whilst in three more there was a 48.4% reduction [mean pre RF 38.8 mm(SD ± 21.7 mm) vs mean post RF 20 mm(SD ± 17.1 mm)] in size. In regards to the NET patients, there was a change in vascularity and central necrosis after EUS-RFA. No major complications were observed within 48 h of the procedure. Two patients had mild abdominal pain that resolved within 3 d. CONCLUSION: EUS-RFA of pancreatic neoplasms with a novel monopolar RF probe was well tolerated in all cases. Our preliminary data suggest that the procedure is straightforward and safe. The response ranged from complete resolution to a 50% reduction in size.
文摘Hepatocellular carcinoma(HCC)is the most common primary liver tumor and has been considered a very immunogenic tumor.The treatment with radiofrequency ablation(RFA)has been established as the standard ablative therapy for early HCC,and is currently recognized as the main ablative tool for HCC tumors<5 cm in size;however,progression and local recurrence remain the main disadvantages of this approach.To solve this clinical problem,recent efforts were concentrated on multimodal treatment,combining different strategies,including the combination of RFA and immunotherapy.This article reviewed the combination treatment of RFA with immunotherapy and found that this treatment strategy leads to an increased response of anti-tumor T cells,significantly reduces the risk of recurrence and improves survival rates compared to RFA alone.This review highlighted scientific evidence that supports the current recommendations for pre-clinical studies,and discuss the need for further research on this topic.
文摘Background:There is an ongoing debate on the feasibility,safety,and oncological efficacy of the associating liver partition and portal vein ligation for staged hepatectomy(ALPPS)technique.The aim of this study was to compare ALPPS,two-staged hepatectomy(TSH),and portal vein embolization(PVE)/ligation(PVL)using updated traditional meta-analysis and network meta-analysis(NMA).Data sources:Electronic databases were used in a systematic literature search.Updated traditional metaanalysis and NMA were performed and compared.Mortality and major morbidity were selected as primary outcomes.Results:Nineteen studies including 1200 patients were selected from the pool of 436 studies.Of these patients,315(31%)and 702(69%)underwent ALPPS and portal vein occlusion(PVO),respectively.Ninetyday mortality based on updated traditional meta-analysis,subgroup analysis of the randomized controlled trials(RCTs),and both Bayesian and frequentist NMA did not demonstrate significant differences between the ALPPS cohort and the PVE,PVL,and TSH cohorts.Moreover,analysis of RCTs did not demonstrate significant differences of major morbidity between the ALPPS and PVO cohorts.The ALPPS cohort demonstrated significantly more favorable outcomes in hypertrophy parameters,time to operation,definitive hepatectomy,and R0 margins rates compared with the PVO cohort.In contrast,1-year disease-free survival was significantly higher in the PVO cohort compared to the ALPPS cohort.Conclusions:This study is the first to use updated traditional meta-analysis and both Bayesian and frequentist NMA and demonstrated no significant differences in 90-day mortality between the ALPPS and other hepatic hypertrophy approaches.Furthermore,two high quality RCTs including 147 patients demonstrated no significant differences in major morbidity between the ALPPS and PVO cohorts.
文摘AIM:To study costs of laparoscopic and open liver and pancreatic resections,all the compiled data from available observational studies were systematically reviewed.METHODS:A systematic review of the literature was performed using the Medline,Embase,Pub Med,and Cochrane databases to identify all studies published up to 2013 that compared laparoscopic and open liver[laparoscopic hepatic resection(LLR)vs open liver resection(OLR)]and pancreatic[laparoscopic pancreatic resection(LPR)vs open pancreatic resection]resection.The last search was conducted on October 30,2013.RESULTS:Four studies reported that LLR was associated with lower ward stay cost than OLR(2972 USD vs 5291 USD).The costs related to equipment(3345USD vs 2207 USD)and theatre(14538 vs 11406)were reported higher for LLR.The total cost was lower in patients managed by LLR(19269 USD)compared to OLR(23419 USD).Four studies reported that LPR was associated with lower ward stay cost than OLR(6755vs 9826 USD).The costs related to equipment(2496USD vs 1630 USD)and theatre(5563 vs 4444)were reported higher for LPR.The total cost was lower in the LPR(8825 USD)compared to OLR(13380 USD).CONCLUSION:This systematic review support the economic advantage of laparoscopic over open approach to liver and pancreatic resection.
文摘Haemangiomas are the most common solitary benign neoplasm of the liver with an incidence ranging from 5% to 20%. Although usually small and asymptomatic, they may reach considerable proportions and rarely give rise to life-threatening complications. Surgical intervention is required for incapacitating symptoms, established complications, and diagnostic uncertainty. The resection of haemangiomas demands meticulous surgical technique, owing to their high vascularity and the concomitant risk of intra-operative haemorrhage. Laparoscopic resection of giant haemangiomas is even more challenging, and has only been reported twice. We here report the case of a giant 10 cm liver haemangioma which was successfully resected laparoscopically using the laparoscopic HabibTM 4×, a bipolar radiofrequency device, without clamping major vessels and with minimal blood loss. Transfusion of blood or blood products was not required. The patient had an uneventful recovery and was asymptomatic at 7-mo follow-up.
文摘Hepatocellular carcinoma(HCC)is the fifth most common neoplasm in the world,closely correlated with viral hepatitis and liver cirrhosis.The vast majority of HCC patients present at a late stage and are unsuitable for surgery due to limited liver functional reserve.Tumors can involve major vessels or hilar structures,necessitating major liver resection and/or rendering liver resection unfeasible.A series of new technologies have been developed to optimise HCC management.Stem cell therapy improves impaired liver functional reserve prior to liver resection.Intravascular radiofrequency ablation recanalises the portal vein invaded by tumour thrombus and endobiliary radiofrequency ablation restores and extends biliary patency of the bile duct invaded by malignancy.Laparoscopic radiofrequency assisted liver resection minimizes blood loss and avoids liver warm ischemia,while increasing parenchymal sparing.These benefits combined maximize the safety of liver resection.
