Publications by authors named "Vauthey J"
Introduction: Pathway-driven, post-pancreatectomy opioid reduction interventions have proven effective and sustainable and may have a "halo effect" on other major abdominal cancer operations. This study's aim was to analyze the sequential effects of expanding opioid reduction efforts from pancreatectomy on opioids prescribed after hepatectomy.
Methods: This is a retrospective cohort study utilizing data from the electronic health record and a prospective quality improvement database for consecutive hepatectomy patients (09/2016-02/2024).
Purpose: To develop a machine-learning algorithm to improve hepatic resection selection for metastatic colorectal cancer patients by predicting post-PVE outcomes.
Material & Methods: This multicenter retrospective study (2000-2020) included 200 consecutive patients with CRC liver-metastases planned for PVE before surgery. Radiomic features and lab values were collected.
Background: Liver venous deprivation (LVD) is known to induce better future liver remnant (FLR) hypertrophy than portal vein embolization (PVE). The role of LVD, compared with PVE, in inducing FLR hypertrophy and allowing safe hepatectomy for patients with extensive colorectal liver metastases (CLM) and high-risk factors for inadequate hypertrophy remains unclear.
Methods: Patients undergoing LVD (n = 22) were matched to patients undergoing PVE (n = 279) in a 1:3 ratio based on propensity scores, prior to planned hepatectomy for CLM at a single center (1998-2023).
Background: As liver metastasis is the most common cause of mortality in patients with colorectal cancer, studying colorectal cancer liver metastasis (CLM) microenvironment is essential for improved understanding of tumor biology and to identify novel therapeutic targets.
Methods: We used a multiplex immunofluorescence platform to study tumor associated macrophage (TAM) polarization and adaptive T cell subtypes in tumor samples from 105 CLM patients (49 without and 56 with preoperative chemotherapy).
Results: CLM exhibited M2 macrophage polarization, and helper T cells were the prevalent adaptive T cell subtype.
Background: Carcinoembryonic antigen (CEA) levels may vary with administration and discontinuation of pre-hepatectomy chemotherapy in patients undergoing resection of colorectal cancer liver metastases (CLM). The prognostic significance of these changes, termed CEA dynamics, is unclear.
Patients And Methods: Consecutive patients undergoing hepatectomy for CLM (2001-2021) at a comprehensive cancer center were included.
The benefit of resection of liver metastases depends on primary diseases. Neuroendocrine tumors are associated with favorable prognosis after resection of liver metastases. Gastric cancer has worse tumor biology, and resection of gastric liver metastases should be performed in selected patients.
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- Safe and effective liver tissue removal (parenchymal transection) is essential in hepatectomies, and robotic surgery offers various tools and techniques for this purpose.
- Key instruments include the Vessel Sealer Extend, which seals vessels but is less effective on tough livers, and the Synchroseal, which has a more delicate design but can experience efficiency issues due to char buildup.
- Other techniques like the robotic Harmonic Scalpel and ultrasonic aspirators can enhance dissection precision, though they often require skilled assistants, highlighting the importance of combining approaches for optimal results.
Article Synopsis
- The study investigates the effectiveness of radiation therapy (RT) for intrahepatic cholangiocarcinoma (iCCA) and explores a new approach to assess treatment response using quantitative measures rather than traditional size-based methods.
- By analyzing CT scans from 154 patients, researchers found that changes in viable tumor volume after RT are better indicators of overall survival (OS) compared to standard RECIST criteria, with a notable threshold of a 33% reduction in viable volume signaling optimal treatment response.
- The findings highlight the potential for personalized RT approaches based on individual tumor characteristics, suggesting that mathematical models derived from CT imaging can improve patient outcomes by identifying optimal treatment protocols.
Introduction: Cost-effectiveness of Robotic-assisted hepatectomy compared to the open approach is scrutinized. We compared the costs of robotic versus open hepatectomy at a large cancer center.
Methods: Patients undergoing hepatectomy (1/2019-2/2022) were collected from a prospectively maintained database and 1:1 propensity score matched for 61 robotic and 61 open hepatectomy patients by complexity, tumor diagnosis, and age >65.
In patients with hepatocellular carcinoma (HCC), liver resection is potentially curative. Nevertheless, post-operative recurrence is common, occurring in up to 70% of patients. Factors traditionally recognized to predict recurrence and survival after liver resection for HCC include pathologic factors (i.
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- Traditional guidelines recommend preserving 700 cc of liver during radiation treatment to minimize the risk of liver failure, but this study explores using SPECT imaging to better identify and protect functional liver tissue in patients with diminished liver volume from previous treatments.
- The phase I trial involved 12 patients with colorectal liver metastases, all having received prior chemotherapy, and assessed safety by monitoring for toxicities after high-dose liver-directed radiotherapy.
- Results showed that incorporating SPECT imaging allowed for safe administration of higher radiation doses without dose-limiting toxicities, achieving a 57% in-field control rate and a 73% overall survival rate after one year.
Article Synopsis
- - The study compares manual liver volumetry on CT images to two software programs, SYNAPSE and syngo.via, in 30 patients who had right hepatectomy, focusing on accuracy, time efficiency, and learning curves.
- - Results showed that the manual method produced lower future liver remnant (FLR) measurements and was less reproducible compared to the software methods, with SYNAPSE being the quickest.
- - The findings suggest that using three-dimensional simulation software improves liver volumetry efficiency and accuracy, aiding less experienced physicians in learning the process more effectively.
Article Synopsis
- * Different types of stem cells, such as mesenchymal stem cells and hematopoietic stem cells, have been used in studies to enhance liver growth and have shown promising results in both animal models and initial clinical trials.
- * While PVESA appears to be safe and potentially more effective than standard methods, further research is needed to refine stem cell selection and treatment techniques, as well as to conduct larger clinical studies to better understand its benefits and mechanisms.
Background: Postoperative hepatic insufficiency (PHI) is the most feared complication after hepatectomy. Volume of the future liver remnant (FLR) is one objectively measurable indicator to identify patients at risk of PHI. In this review, we summarized the development and rationale for the use of liver volumetry and liver-regenerative interventions and highlighted emerging tools that could yield new advancements in liver volumetry.
View Article and Find Full Text PDFWe aimed to evaluate the practice and the associated outcomes of surgical treatment for young-onset colorectal cancer (YOCRC) patients presenting with synchronous liver metastases. The study cohort was divided into two groups according to surgery date: 131 patients in the early era (EE, 1998-2011) and 179 in the contemporary era (CE, 2012-2020). The CE had a higher rate of node-positive primary tumors, higher carcinoembryonic antigen level, and lower rate of RAS/BRAF mutations.
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- CT hepatic arteriography (CTHA) is very effective at detecting colorectal liver metastases (CLMs) but struggles with specificity for small, incidental lesions due to pseudolesions and ambiguous imaging signatures.
- A study involving 22 patients highlighted the identification of incidental ring-hyperenhancing liver micronodules (RHLMs) during CTHA, revealing that 41.7% of CTHA images contained these nodules, with many subsequently confirmed as CLMs.
- The research suggests that RHLMs detected in CTHA may serve as an early indicator for small CLMs, which could help in improving the accuracy of liver ablation procedures.
Background: Distinguishing malignant from benign causes of obstruction at the liver hilum can pose a diagnostic dilemma. This study aimed to determine factors that predict benign causes of hilar obstruction and long-term outcomes after resection.
Methods: Consecutive patients who underwent surgery for hilar obstruction at a single institution between 1997 and 2022 were retrospectively analyzed.
Background: Accurate prognostic stratification of hepatocellular carcinoma (HCC) is vital for clinical trial enrollment and treatment allocation. Multiple scoring systems have been created to predict patient survival, but no standardized scoring systems account for radiologic tumor features. We sought to create a generalizable scoring system for HCC which incorporates standardized radiologic tumor features and more accurately predicts overall survival (OS) than established systems.
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