The prognosis of patients with metastatic colorectal cancer(m CRC) remain poor despite the impressive improvement of treatments observed over the last 20 years that led to an increase in median overall survival from 6...The prognosis of patients with metastatic colorectal cancer(m CRC) remain poor despite the impressive improvement of treatments observed over the last 20 years that led to an increase in median overall survival from 6 mo, with the only best supportive care, to approximately 30 mo with the introduction of active chemotherapy drugs and targeted agents. The monoclonal antibodies(mo Abs) cetuximab and panitumumab, directed against the epidermal growth factor receptor(EGFR), undoubtedly represent a major step forward in the treatment of m CRC, given the relevant efficacy in terms of progression-free survival, overall survival, response rate, and quality of life observed in several phase Ⅲ clinical trials among different lines of treatment. However, the anti-EGFR mo Abs were shown only to be effective in a subset of patients. For instance, KRAS and NRAS mutations have been identified as biomarkers of resistance to these drugs, improving the selection of patients who might derive a benefit from these treatments. Nevertheless, several other alterations might affect the response to these drugs, and unfortunately, even the responders eventually become resistant by developing secondary(or acquired) resistance in approximately 13-18 mo. Several studies highlighted that the landscape of responsible alterations of both primary and acquired resistance to anti-EGFR drugs biochemically converge into MEK-ERK and PIK3CA-AKT pathways. In this review, we describe the currently known mechanisms of primary and acquired resistance to anti-EGFR mo Abs together with the various strategies evaluated to prevent, overcame or revert them.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
Aim:This paper reported the experience of one center on repeat laparoscopic liver surgery for metastasis and hepatocellular carcinoma(HCC)with a review of the literature.Methods:This retrospective study included 24 pa...Aim:This paper reported the experience of one center on repeat laparoscopic liver surgery for metastasis and hepatocellular carcinoma(HCC)with a review of the literature.Methods:This retrospective study included 24 patients who underwent laparoscopic re-intervention(hepatic resection and radiofrequency ablation)for recurrent HCC in cirrhosis(n=17)and for recurrent malignant metastases(n=7)after a previous open or laparoscopic procedure.Patients were divided into two groups according to the fi rst surgical approach.Group 1 underwent open resection and laparoscopic procedure(7 patients),and Group 2 underwent laparoscopic resection and laparoscopic procedure(17 patients).Results:Mean operative time for re-intervention was signifi cantly longer for Group 1(220.14±80.06 min)than for Group 2(150±56.18 min;P=0.001),whereas the mean blood loss and mean hospital stay were comparable in both groups.According to Dindo-Clavien classifi cation,overall morbidity ranged between Grade I and IIIa and was similar in both groups.Conclusion:This study suggests that repeat laparoscopic surgery for recurrent hepatic malignant diseases in selected patients is a feasible and safe procedure with good short-term outcomes,but further prospective studies are needed to support these results.展开更多
文摘The prognosis of patients with metastatic colorectal cancer(m CRC) remain poor despite the impressive improvement of treatments observed over the last 20 years that led to an increase in median overall survival from 6 mo, with the only best supportive care, to approximately 30 mo with the introduction of active chemotherapy drugs and targeted agents. The monoclonal antibodies(mo Abs) cetuximab and panitumumab, directed against the epidermal growth factor receptor(EGFR), undoubtedly represent a major step forward in the treatment of m CRC, given the relevant efficacy in terms of progression-free survival, overall survival, response rate, and quality of life observed in several phase Ⅲ clinical trials among different lines of treatment. However, the anti-EGFR mo Abs were shown only to be effective in a subset of patients. For instance, KRAS and NRAS mutations have been identified as biomarkers of resistance to these drugs, improving the selection of patients who might derive a benefit from these treatments. Nevertheless, several other alterations might affect the response to these drugs, and unfortunately, even the responders eventually become resistant by developing secondary(or acquired) resistance in approximately 13-18 mo. Several studies highlighted that the landscape of responsible alterations of both primary and acquired resistance to anti-EGFR drugs biochemically converge into MEK-ERK and PIK3CA-AKT pathways. In this review, we describe the currently known mechanisms of primary and acquired resistance to anti-EGFR mo Abs together with the various strategies evaluated to prevent, overcame or revert them.
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Aim:This paper reported the experience of one center on repeat laparoscopic liver surgery for metastasis and hepatocellular carcinoma(HCC)with a review of the literature.Methods:This retrospective study included 24 patients who underwent laparoscopic re-intervention(hepatic resection and radiofrequency ablation)for recurrent HCC in cirrhosis(n=17)and for recurrent malignant metastases(n=7)after a previous open or laparoscopic procedure.Patients were divided into two groups according to the fi rst surgical approach.Group 1 underwent open resection and laparoscopic procedure(7 patients),and Group 2 underwent laparoscopic resection and laparoscopic procedure(17 patients).Results:Mean operative time for re-intervention was signifi cantly longer for Group 1(220.14±80.06 min)than for Group 2(150±56.18 min;P=0.001),whereas the mean blood loss and mean hospital stay were comparable in both groups.According to Dindo-Clavien classifi cation,overall morbidity ranged between Grade I and IIIa and was similar in both groups.Conclusion:This study suggests that repeat laparoscopic surgery for recurrent hepatic malignant diseases in selected patients is a feasible and safe procedure with good short-term outcomes,but further prospective studies are needed to support these results.
