Frigerio I.,Hepato Pancreato Biliary Unit |
Frigerio I.,University of Verona |
Girelli R.,Hepato Pancreato Biliary Unit |
Giardino A.,Hepato Pancreato Biliary Unit |
And 3 more authors.
Journal of Hepato-Biliary-Pancreatic Sciences | Year: 2013
Background: Neo-adjuvant chemotherapy (CHT) has gained increasing importance in resectable and borderline resectable pancreatic cancer leading to a better performing surgery when we look at negative resection margins and selection of patients with less aggressive disease. We apply this principle to patients with Stage III (LAC) pancreatic cancer undergoing RFA and try to select patients who may benefit from a local treatment. Methods: All patients affected by LAC were treated with RFA for a stable disease after a short CHT. Postoperative morbidity and mortality were evaluated together with overall survival (OS) and disease specific survival (DSS). Results: We consecutively treated 57 patients affected by LAC. Median duration of CHT before RFA was 5 months. The postoperative mortality rate was zero. Overall morbidity was 14 % with RFA-related morbidity of 3.5 %. The OS and DSS were 19 months and when compared to a similar population who received RFA as up front treatment, there was no difference. Conclusions: Our results do not support the adoption of a short CHT as a way to identify patients to treat with RFA with the most benefit. Based on this and by knowing the role of immune modulation after RFA and its specific involvement in pancreatic carcinoma, we can propose RFA as upfront treatment. © 2013 Japanese Society of Hepato-Biliary-Pancreatic Surgery and Springer Japan.
Lendoire J.C.,Hospital Dr Cosme Argerich |
Raffin G.,Hospital Dr Cosme Argerich |
Grondona J.,UNACIR HPB |
Bracco R.,UNACIR HPB |
And 6 more authors.
Journal of Gastrointestinal Surgery | Year: 2011
Background: Caroli's disease (CD) management is still controversial. Aim: The purpose of this study is to report the most frequent clinical features, treatment options, and outcome obtained after surgical management of CD. Methods: A voluntary survey was conducted. Demographic, clinical, surgical, and pathological variables were analyzed. Results: Six centers included 24 patients having received surgical treatment from 1991 to 2009. Seventeen (70. 8%) patients were female, with average age of 48. 7 years old (20-71), and 95. 5% were symptomatic. There was left hemiliver involvement in 75% of the patients. Surgical procedures included nine left lateral sectionectomies, eight left hepatectomies, and four right hepatectomies for those with hemiliver disease, while for patients with bilateral disease, one right hepatectomy and two Roux-en-Y hepaticojejunostomies were performed. The average length of hospitalization was 7 days. For perioperative complications (25%), three patients presented minor complications (types 1-2), while major complications occurred in three patients (type 3a). No mortality was reported. After a median follow-up of 166 months, all patients are alive and free of symptoms. CD diagnosis was confirmed by histology. Congenital hepatic fibrosis was present in two patients (8. 3%) and cholangiocarcinoma in one (4. 2%). Conclusions: CD in Argentina is more common in females with left hemiliver involvement. Surgical resection is the best curative option in unilateral disease, providing long-term survival free of symptoms and complications. In selected cases of bilateral disease without parenchymal involvement, hepaticojejunostomy should be proposed. However, a close follow-up is mandatory because patients might progress and a transplant should be indicated. © 2011 The Society for Surgery of the Alimentary Tract.