Outcomes after resection of synchronous or metachronous hepatic and pulmonary colorectal metastases.

Background: Surgical resection of isolated hepatic or pulmonary colorectal metastases prolongs survival in selected patients. But the benefits of resection and appropriate selection criteria in patients who develop both hepatic and pulmonary metastases are ill defined.

Study Design: Data were prospectively collected from 131 patients with colorectal cancer who underwent resection of both hepatic and pulmonary metastases over a 20-year period.

The use of imaging in the diagnosis and staging of hepatobiliary malignancies.

This review addresses the optimal use of imaging in the diagnosis, staging, and treatment planning of patients with hepatobiliary neoplasms. We focus on primary liver cancers, including hepatocellular carcinoma and intrahepatic cholangiocarcinoma as well as extrahepatic biliary tract malignancies, including hilar cholangiocarcinoma and gallbladder cancer. In each section, we provide an overview of the staging requirements for each disease followed by a discussion of various imaging modalities that can be used to optimally stage the disease and plan therapy.

Fate of the remnant pancreas after resection of noninvasive intraductal papillary mucinous neoplasm.

Background: The risk of local recurrence in the pancreatic remnant after resection of noninvasive intraductal papillary mucinous neoplasm (IPMN) is not well defined.

Study Design: We performed a retrospective review of a prospectively maintained pancreatic resection database that identified 78 patients who underwent resection for noninvasive IPMN between 1983 and 2006. Local recurrence was determined radiographically and confirmed either pathologically or clinically.

Adjuvant chemotherapy improves survival after resection of hepatic colorectal metastases: analysis of data from two continents.

Background: In the US, systemic chemotherapy is often administered after liver resection for hepatic colorectal metastases, even though no clinical trials data directly support this practice. The bias in America for chemotherapeutic treatment has made studies difficult. Until recently, no well accepted staging systems existed to categorize these patients with liver metastases, who have greatly varied prognoses.

Rates and patterns of recurrence for percutaneous radiofrequency ablation and open wedge resection for solitary colorectal liver metastasis.

Introduction: The purpose of this study was to compare rates and patterns of disease progression following percutaneous, image-guided radiofrequency ablation (RFA) and nonanatomic wedge resection for solitary colorectal liver metastases.

Methods: We identified 30 patients who underwent nonanatomic wedge resection for solitary liver metastases and 22 patients who underwent percutaneous RFA because of prior major hepatectomy (50%), major medical comorbidities (41%), or relative unresectability (9%). Serial imaging studies were retrospectively reviewed for evidence of local tumor progression.

Cytokine-secreting herpes viral mutants effectively treat tumor in a murine metastatic colorectal liver model by oncolytic and T-cell-dependent mechanisms.

In this model of hepatic micrometastases, the antitumor efficacy and role of the T-cell and natural killer (NK) cell populations were studied for oncolytic herpes simplex virus type-1 (HSV-1) viral mutants containing the granulocyte-monocyte colony stimulating factor (GM-CSF (NV1034)) or interluken-12 (IL-12 (NV1042)) cytokine genes. These were compared to saline and control virus (NV1023) in vitro and in vivo. HSV-1 mutants were assessed for cytotoxicity, replication and cytokine expression in CT-26 cells.

Use of an oncolytic virus secreting GM-CSF as combined oncolytic and immunotherapy for treatment of colorectal and hepatic adenocarcinomas.

Background: Oncolytic cancer therapy using herpes simplex viruses (HSV) that have direct tumoricidal effects and cancer immunotherapy using the cytokine granulocyte-macrophage colony-stimulating factor (GM-CSF) have each been effective in preclinical testing. NV1034 is a multimutated oncolytic HSV carrying the gene for murine GM-CSF that attempts to combine these 2 anticancer strategies. The purpose of this study was to compare NV1034 to NV1023, the parent HSV mutants lacking GM-CSF, to determine if such combined oncolytic and immunotherapy using a single vector has advantages over oncolytic therapy alone.

Management of primary liver sarcomas.

Background: Primary hepatic sarcoma is a rare entity. The objectives of the study were to define treatment and long-term outcome and to identify prognostic factors.

Methods: Between January 1981 and December 2004, 30 patients with primary sarcoma of the liver and 5 patients with primary carcinosarcoma of the liver were treated.

Outcome after hepatectomy for multiple (four or more) colorectal metastases in the era of effective chemotherapy.

Background: Hepatic resection is generally accepted as the only potential for long-term survival in patients with colorectal metastases confined to the liver. Despite an unknown benefit, hepatic resection is playing an increasing role in patients with extensive disease.

Methods: A retrospective review of a prospectively maintained hepatobiliary surgical database was carried out.

The utility of F-18 fluorodeoxyglucose whole body PET imaging for determining malignancy in cystic lesions of the pancreas.

Previous studies have suggested that whole body positron-emission tomography (PET) can distinguish between benign and malignant cysts of the pancreas. Patients were identified (n = 68) who had undergone whole body PET imaging for a cystic lesion of the pancreas between Jan. 1997 and May 2005.

Lack of evidence for increased operative morbidity after hepatectomy with perioperative use of bevacizumab: a matched case-control study.

Background: Bevacizumab (bev) is a humanized monoclonal antibody that targets vascular endothelial growth factor (VEGF). Perioperative bev is now commonly used in patients undergoing hepatic resection. Little is known, however, about the safety of perioperative bev use in the setting of hepatic resection.

Differential diagnosis of proximal biliary obstruction.

Background: Obstruction at the hepatic duct confluence is generally due to hilar cholangiocarcinoma (HCCA). However, in up to 15% of patients, hilar obstruction could be due to alternative diagnoses other than HCCA. The aim of this study was to determine preoperative criteria that could differentiate HCCA from the alternative diagnoses.

A selective approach to the resection of cystic lesions of the pancreas: results from 539 consecutive patients.

Objective: To define a group of patients with pancreatic cysts who do not require resection.

Summary Background Data: The increased use of cross-sectional imaging has resulted in an increased identification of small, asymptomatic pancreatic cysts. Data have not been available to determine which lesions should be resected.

The addition of extensive upper abdominal surgery to achieve optimal cytoreduction improves survival in patients with stages IIIC-IV epithelial ovarian cancer.

Objectives: To determine the survival impact of adding extensive upper abdominal surgical cytoreduction to standard surgical techniques for advanced ovarian cancer.

Methods: The records of all patients with stages IIIC-IV epithelial ovarian cancer who underwent primary surgery at our institution from 1998 to 2003 were reviewed. The cohort was divided into 3 groups.

Perihepatic lymph node assessment in patients undergoing partial hepatectomy for malignancy.

Objective: To assess the value of preoperative imaging studies and the intraoperative assessment of perihepatic lymph nodes in patients undergoing partial hepatectomy for malignancy.

Summary Background Data: Perihepatic lymph node status is an important prognostic factor for patients undergoing hepatic resection for 1(o) and metastatic cancer. The value of preoperative imaging studies and intraoperative assessment of perihepatic nodes is unknown.

Incidence and management of pleural effusions after diaphragm peritonectomy or resection for advanced mullerian cancer.

Objectives: Diaphragm peritonectomy or resection is an effective way to cytoreduce diaphragm disease but frequently results in sympathetic pleural effusions. Our objective was to determine the incidence and management of effusions that developed after diaphragm surgery in patients with advanced mullerian cancer.

Methods: We reviewed the records of all patients with stage IIIC-IV epithelial ovarian, fallopian tube, or peritoneal cancer who had diaphragm peritonectomy or resection as part of optimal primary cytoreduction at our institution from 2000-2003.

En bloc resection of diaphragm with lung for recurrent ovarian cancer: a case report.

Introduction: Multiple series have demonstrated the feasibility of full-thickness diaphragm resection for ovarian cancer metastatic to the diaphragm. However, direct extension of tumor into the lung is sometimes encountered, and successful resection of this type of implant has not been previously described in the gynecologic oncology literature.

Case Report: We present the first case of en bloc full-thickness diaphragm resection including a portion of lung tissue using the EndoGIA stapler with primary diaphragmatic closure.

Recurrent invasive intraductal papillary mucinous carcinoma of the pancreas mimicking pott disease: review of the literature.

Specific information regarding intraductal papillary mucinous neoplasm (IPMN) recurrence is limited because most series are small and the follow-up interval is short. We report an unusual case of cancer recurrence in an 86-year-old woman who had undergone a pancreaticoduodenectomy for a large IPMN in the head of the pancreas. Final pathological evaluation of the resected pancreas found a component of in situ and invasive ductal adenocarcinoma without lymph node involvement.

Differential cell cycle-regulatory protein expression in biliary tract adenocarcinoma: correlation with anatomic site, pathologic variables, and clinical outcome.

Purpose: Biliary tract adenocarcinomas (BTAs), although anatomically related, arise through ill-defined and possibly different location-related pathogenetic pathways. This clinicopathologic study characterizes differences in cell cycle-regulatory protein expression across the spectrum of BTA.

Methods: Tissue microarrays were prepared from paraffin-embedded surgical specimens with triplicate cores of BTA and benign tissue.

Outcome of patients with fibrolamellar hepatocellular carcinoma.

Background: Fibrolamellar hepatocellular carcinoma (FL-HCC) is a rare variant of hepatocellular carcinoma, has distinct pathologic features, and typically occurs in young patients without underlying hepatitis or cirrhosis.

Methods: Forty-one patients with the pathologic diagnosis of FL-HCC evaluated at our institution between 1986 and 2003 were identified from a prospective database.

Results: Median age of all patients was 27 years.

Profile of plasma angiogenic factors before and after hepatectomy for colorectal cancer liver metastases.

Background: Circulating angiogenic factors in patients with colorectal cancer liver metastases may promote tumor growth and contribute to liver regeneration after partial hepatectomy.

Methods: We analyzed blood samples from 26 patients with colorectal cancer liver metastases before and after liver resection and used samples from 20 healthy controls as a reference. Plasma levels of vascular endothelial growth factor (VEGF), basic fibroblast growth factor (bFGF), epidermal growth factor (EGF), and hepatocyte growth factor (HGF) were measured, and levels were correlated with recurrence.

Optimal abdominal incision for partial hepatectomy: increased late complications with Mercedes-type incisions compared to extended right subcostal incisions.

Introduction: The optimal abdominal incision for partial hepatectomy has not been established.

Methods: A prospective hepatobiliary surgery database was retrospective reviewed. Patients with Mercedes and extended right subcostal (ERSC) incisions were identified and compared.

Laparoscopic and hand-assisted laparoscopic splenectomy for recurrent and persistent ovarian cancer.

Objective: Prolonged survival in patients with recurrent ovarian cancer isolated to the spleen has been demonstrated after successful splenectomy. The purpose of this study was to report the outcomes of a series of patients who underwent splenectomy for persistent or recurrent ovarian cancer via laparoscopy or hand-assisted laparoscopy.

Methods: We reviewed the charts of all patients who underwent laparoscopic or hand-assisted laparoscopic splenectomy for presumed persistent or recurrent ovarian cancer.