Management of liver cancer. The Surgeon's point of view.

During the last twenty years, a huge progress has been achieved in the treatment of liver cancer and recent strategies include interventional radiology, chemotherapy regimens and surgery. Meanwhile, Stereotactic Body Radiation Therapy (SRBT) has developed in the treatment of all organs with millimetre accuracy, very few side effects and a high control rate. So, SRBT has become a therapeutic weapon in his own right in liver tumour treatment. Many publications have reported encouraging results in colorectal liver metastasis, hepatocellular carcinoma on cirrhosis and peripheric cholangiocarcinoma. It is important that radiation therapists involve systematic multidisciplinary "liver tumour" meetings to discuss therapeutic indications and initiate treatments quickly.

Other non-surgical treatments for liver cancer.

Interventional radiology plays a major role in the modern management of liver cancers, in primary hepatic malignancies or metastases and in palliative or curative situations. Radiological treatments are divided in two categories based on their approach: endovascular treatment and direct transcapsular access. Endovascular treatments include mainly three applications: transarterial chemoembolization (TACE), transarterial radioembolization (TARE) and portal vein embolization (PVE). TACE and TARE share an endovascular arterial approach, consisting of a selective catheterization of the hepatic artery or its branches. Subsequently, either a chemotherapy (TACE) or radioembolic (TARE) agent is injected in the target vessel to act on the tumor. PVE raises the volume of the future liver remnant in extended hepatectomy by embolizing a portal vein territory which results in hepatic regeneration. Direct transcapsular access treatments involve mainly three techniques: radiofrequency thermal ablation (RFA), microwave thermal ablation (MWA) and percutaneous ethanol injection (PEI). RFA and MWA procedures are almost identical, their clinical applications are similar. A probe is deployed directly into the tumor to generate heat and coagulation necrosis. PEI has known implications based on the chemical toxicity of intra-tumoral injection with highly concentrated alcohol by a thin needle.

Predictive factors and prognosis of microscopic residual disease in non-small-cell lung cancer surgery.

OBJECTIVES: We described patients with microscopic residual disease (R1) operated on for non-small-cell lung cancer (NSCLC) and investigated predictive factors for R1. We also examined prognostic factors for overall survival in these patients. METHODS: From June 2003 to December 2019, a total of 2595 patients benefited from an anatomical resection operation for NSCLC in our department. All preoperative data were prospectively collected in Epithor, the French thoracic surgery national database. All pre-, per- and postoperative care followed the current recommendations. Tumours were classified by experienced pathologists according to the TNM classification and the resection status R. Survival information was collected retrospectively using the French national death register. RESULTS: A total of 94 R1 patients (3.6%) and 2255 R0 patients (86.9%) were identified. R1 patients showed significant differences: They were older (p = 0.02), with a high rate of pneumonectomy(p < 0.001), more squamous cell carcinomas (p < 0.001) and more cases of advanced-stage disease (p < 0.001). We proved that incomplete resection was a poor and independent prognostic factor whereas complete resection had a significant impact on overall survival (HR: 4.66 [3.46-6.27]). Thus, we identified high clinical T status (odds ratio [OR]: 8.82 [5.00-15.56]), high clinical N status (OR: 3.54 [2.13-5.87), squamous cell carcinoma (OR: 3.86 [2.33-6.42]), obesity (OR 1.91 [1.04-3.52]) and low forced expiratory volume in 1 s (OR: 3.62 [1.70-7.68]) as risk factors for R1. No statistical differences were found according to the location of positive resection margin or treatment, whether adjuvant or neoadjuvant. CONCLUSIONS: Incomplete resection was a poor prognostic factor for overall survival of patients operated on for NSCLC, particularly in the advanced stages of the disease. Identification of different predictive factors should help to avoid this situation.subj collection: 152.

Emergency Ravitch Procedure for Inferior Vena Cava Compression After Surgical Scoliosis Correction.

Pectus excavatum is a common chest malformation, classically asymptomatic. The pectus excavatum surgical procedure allows aesthetic correction. Funnel chest is a malformation frequently associated with thoracic scoliosis, especially in Marfan syndrome. Scoliosis is treated with first-line nonsurgical treatment. Second-line treatment consists of a scoliosis operation. In this case report, we present an exceptional emergency indication of funnel chest correction with the Ravitch procedure for a 14-year-old girl who presented with postoperative acute compression of the inferior vena cava due to a surgical scoliosis correction.

Thoracic Damage Control: Let's Think About Intrathoracic Packing.

BACKGROUND In cases of hemorrhagic shock following thoracic trauma, thoracotomy is indicated as primary surgical management, as a chest tube might lead to exsanguination. Thoracic packing is an alternative, particularly in severe injury trauma. CASE REPORT A 48-year-old male was involved in an accident in which 2 cars collided. The patient suffered from right-sided hemothorax due to diaphragm rupture and stripping of the diaphragmatic pillar. A right anterolateral thoracotomy revealed an active bleed due to diaphragmatic pillar stripping and laceration with liver herniation. Right thoracic packing was established to stop the bleeding. CONCLUSIONS The primary objectives of thoracic damage control are to prevent cardiac tamponade, to control intrathoracic bleeding and massive air embolism or bronchopleural fistula, and to allow open cardiac massage. These patients represent challenging cases of both rapid therapeutic decision-making and operative intervention. Thoracic packing is a part of damage control in cases of hemorrhagic shock after thoracic trauma.