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Manchester, United Kingdom

Lloyd D.M.,Royal Infirmary | Lau K.N.,Carolinas Medical Center | Welsh F.,North Hampshire Hospital | Lee K.-F.,Prince of Wales Hospital | And 4 more authors.
HPB | Year: 2011

Background: Microwave ablation (MWA) is increasingly utilized in the treatment of hepatic tumours. Promising single-centre reports have demonstrated its safety and efficacy, but this modality has not been studied in a prospective, multicentre study. Methods: Eighteen international centres recorded operative and perioperative data for patients undergoing MWA for tumours of any origin in a voluntary Internet-based database. All patients underwent operative MWA using a 2.45-GHz generator with a 5-mm antenna. Results: Of the 140 patients, 114 (81.4%) were treated with MWA alone and 26 (18.6%) were treated with MWA combined with resection. Multiple tumours were treated with MWA in 40.0% of patients. A total of 299 tumours were treated in these 140 patients. The median size of ablated lesions was 2.5 cm (range: 0.5-9.5 cm). Tumours were treated with a median of one application (range: 1-6 applications) for a median of 4 min (range: 0.5-30.0 min). A power setting of 100 W was used in 78.9% of cases. Major morbidity was 8.3% and in-hospital mortality was 1.9%. Conclusions: These multi-institution data demonstrate rapid ablation time and low morbidity and mortality rates in patients undergoing operative MWA with a high rate of multiple ablations and concomitant hepatic resection. Longterm follow-up will be required to determine the efficacy of MWA relative to other forms of ablative therapy. © 2011 International Hepato-Pancreato-Biliary Association. Source

Lendoire J.C.,Liver Transplant Unit | Raffin G.,Liver Transplant Unit | 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. Source

Brais R.J.,Addenbrookes Hospital | Davies S.E.,Addenbrookes Hospital | O'Donovan M.,Addenbrookes Hospital | Simpson B.W.,Addenbrookes Hospital | And 20 more authors.
Pancreatology | Year: 2012

Objective: Current practice to diagnose pancreatic cancer is accomplished by endoscopic ultrasound guided fine needle aspiration (EUSeFNA) using a cytological approach. This method is time consuming and often fails to provide suitable specimens for modern molecular analyses. Here, we compare the cytological approach with direct formalin fixation of pancreatic EUSeFNA micro-cores and evaluate the potential to perform molecular biomarker analysis on these specimen. Methods: 130 specimens obtained by EUSeFNA with a 22G needle were processed by the standard cytological approach and compared to a separate cohort of 130 specimens that were immediately formalin fixed to preserve micro-cores of tissue prior to routine histological processing. Results: We found that direct formalin fixation significantly shortened the time required for diagnosis from 3.6 days to 2.9 days (p < 0.05) by reducing the average time (140 vs 33 min/case) and number of slides (9.65 vs 4.67 slides/case) for histopathological processing. Specificity and sensitivity yielded comparable results between the two approaches (82.3% vs 77% and 90.9% vs 100%). Importantly, EUS eFNA histology preserved the tumour tissue architecture with neoplastic glands embedded in stroma in 67.89% of diagnostic cases compared to 27.55% with the standard cytological approach (p < 0.001). Furthermore, micro-core samples were suitable for molecular studies including the immunohistochemical detection of intranuclear Hes1 in malignant cells, and the laser-capture microdissectionmediated measurement of Gli-1 mRNA in tumour stromal myofibroblasts. Conclusions: Direct formalin fixation of pancreatic EUSeFNA micro-cores demonstrates superiority regarding diagnostic delay, costs, and specimen suitability for molecular studies. We advocate this approach for future investigational trials in pancreatic cancer patients. © 2012, IAP and EPC. Published by Elsevier India, a division of Reed Elsevier India Pvt. Ltd. All rights reserved. Source

Girelli R.,Hepato Pancreato Biliary Unit | Frigerio I.,Hepato Pancreato Biliary Unit | Giardino A.,Hepato Pancreato Biliary Unit | Regi P.,Hepato Pancreato Biliary Unit | And 4 more authors.
Langenbeck's Archives of Surgery | Year: 2013

Background: Stage III pancreatic ductal adenocarcinoma (PDAC) has a poor prognosis, with the results of chemoradiation being disappointing. Radiofrequency is an ablation technique employed in many unresectable solid tumours, but its application to pancreatic cancer is limited. We report our experience of radiofrequency ablation (RFA) with cytoreductive intent in stage III PDAC. Patients and methods: One hundred consecutive patients affected by stage III PDAC received RFA combined with chemoradiotherapy. Follow-up was planned on a 3-month basis including clinical evaluation, serum markers and computed tomography scan or MRI. Short-term outcomes and survival data were evaluated. Results: Forty-eight patients received upfront RFA, and 52 had associated palliative surgery. Abdominal complications occurred in 24 patients, and in 15 cases, they were related to RFA. The mortality rate was 3 %. At a median follow-up of 12 months, 55 patients had died of disease and four patients due to unknown causes. Nineteen patients are alive with disease progression, and 22 are alive and progression free. Conclusions: We presented the broadest experience of RFA in stage III PDAC, focusing on the rationale of its application and considering the advanced stage of disease and the cytoreductive purpose of the procedure. The critical aspects of the technique, along with the unexpected results in efficacy, were discussed. © 2012 Springer-Verlag Berlin Heidelberg. Source

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. Source

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