Long-term outcomes of combined hepatocellular-cholangiocarcinoma after hepatectomy or liver transplantation: A systematic review and meta-analysis.

BACKGROUND: Combined hepatocellular-cholangiocarcinoma (cHCC-CC) is a rare primary liver malignancy. We conducted a systematic review and meta-analysis to assess the evidence available on the long-term outcomes of cHCC-CC patients after either hepatectomy or liver transplantation (LT). DATA SOURCES: Relevant studies published between January 2000 and January 2018 were identified by searching PubMed and Embase and reviewed systematically. Data were pooled using a random-effects model. RESULTS: A total of 42 observational studies involving 1691 patients (1390 for partial hepatectomy and 301 for LT) were included in the analysis. The median tumor recurrence and 5-year overall survival (OS) rates were 65% (range 38%-100%) and 29% (range 0-63%) after hepatectomy versus 54% (range 14%-93%) and 41% (range 16%-73%) after LT, respectively. Meta-analysis found no significant difference in OS and tumor recurrence between LT and hepatectomy groups. CONCLUSION: Hepatectomy rather than LT should be considered as the prior treatment option for cHCC-CC.

Pancreaticoduodenectomy for locally advanced gastric cancer: Results from a pooled analysis.

Little is known about the clinical outcome of pancreaticoduodenectomy (PD) for locally advanced gastric cancer invading the duodenum and/or pancreas. The aim of this study was to define the clinical outcome and prognostic determinants of PD for locally advanced gastric cancer through a systematic review and pooled analysis of relevant data in the literature. A total of 13 articles involving 69 patients were eligible for inclusion. Postoperative morbidity and mortality were 59.4% and 1.4%, respectively. Overall 5-year survival and median survival were 39.3% and 26 months, respectively. Positive peritoneal lavage cytology represented the only independent prognostic factor for the poor outcome at multivariate analysis (hazard ratio 3.470, 95% confidence interval 1.011-11.909; P = 0.048). In summary, PD is a feasible option for locally advanced gastric cancer invading the duodenum and/or pancreas with an acceptable operative risk and offers survival benefits in selected patients.

A pooled analysis of treatment and prognosis of hepatic angiosarcoma in adults.

BACKGROUND: Hepatic angiosarcoma is a rare malignant vascular tumor presenting unique treatment challenges. The aim of the present study was to determine the treatment and prognosis of this entity. DATA SOURCES: A systematic literature search was conducted using PubMed, Embase and Chinese Biomedical Literature database, to identify articles published from January 1980 to July 2017. Search terms were "hepatic angiosarcoma" and "liver angiosarcoma". Additional articles were retrieved through manual search of bibliographies of the relevant articles. Pooled individual data concerning the prognosis following various therapeutic modalities were analyzed. RESULTS: A total of 75 articles involving 186 patients were eligible for inclusion. The median overall survival (OS) was 8 months, with 1-, 3-, and 5-year OS rates of 36.6%, 22.3%, and 12.0%, respectively. The median OS after partial hepatectomy (n = 86), chemotherapy (n = 36), liver transplantation (n = 17), and supportive care (n = 46) were 15, 10, 5 and 1.3 months, respectively. Small tumor size (<10 cm) was the only significant favorable factor for OS after partial hepatectomy (P = 0.012). CONCLUSIONS: Despite the dismal prognosis, partial hepatectomy could prolong the survival of hepatic angiosarcoma patients, particularly those with tumors <10 cm. Chemotherapy could be an option for unresectable disease. Liver transplantation is not a recommendable option for the management of this malignancy.

Isolated Roux-en-Y reconstruction versus conventional reconstruction after pancreaticoduodenectomy.

BACKGROUND: Pancreatic fistula (PF) is the major cause for morbidity and mortality following pancreaticoduodenectomy. The primary aim of this study was to compare the occurrence rate of postoperative PF between isolated Roux-en-Y reconstruction (RYR) and conventional reconstruction (CR) after pancreaticoduodenectomy. METHODS: Data of 43 patients who underwent RYC were compared with those of a pair-matched equal number of patients undergoing CR. We also performed a meta-analysis of comparative studies of the two procedures. RESULTS: The case-matched analysis showed no significant difference in PF occurrence between RYR and CR groups (23.3% versus 25.6%; P = 0.80). Meta-analysis of 1498 patients further confirmed this finding, showing a pooled odds ratio of 1.14 (95% confidence intervals, 0.82-1.58; P = 0.43). CONCLUSION: The use of RYR for pancreaticojejunostomy does not seem to decrease the occurrence rate of postoperative PF in patients undergoing pancreaticoduodenectomy.

Preoperative administration of bevacizumab is safe for patients with colorectal liver metastases.

AIM: To assess the impact of preoperative neoadjuvant bevacizumab (Bev) on the outcome of patients undergoing resection for colorectal liver metastases (CLM). METHODS: Eligible trials were identified from Medline, Embase, Ovid, and the Cochrane database. The data were analyzed with fixed-effects or random-effects models using Review Manager version 5.0. RESULTS: Thirteen nonrandomized studies with a total of 1431 participants were suitable for meta-analysis. There was no difference in overall morbidity and severe complications between the Bev + group and Bev - group (43.3% vs 36.8%, P = 0.06; 17.1% vs 11.4%, P = 0.07, respectively). Bev-related complications including wound and thromboembolic/bleeding events were also similar in the Bev + and Bev - groups (14.4% vs 8.1%, P = 0.21; 4.1% vs 3.8%, P = 0.98, respectively). The incidence and severity of sinusoidal dilation were lower in patients treated with Bev than in patients treated without Bev (43.3% vs 63.7%, P < 0.001; 16.8% vs 46.5%, P < 0.00, respectively). CONCLUSION: Bev can be safely administered before hepatic resection in patients with CLM, and has a protective effect against hepatic injury in patients treated with oxaliplatin chemotherapy.