Value of prognostic scoring systems in the era of multimodal therapy for recurrent colorectal liver metastases.

BACKGROUND: Various predictive scoring systems have been developed to estimate outcomes of patients undergoing surgery for colorectal liver metastases (CRLM). However, data regarding their effectiveness in recurrent CRLM (recCRLM) are very limited. METHODS: Patients who underwent repeat hepatectomy for recCRLM at the University Hospital RWTH Aachen, Germany from 2010 to 2021 were included. Nine predictive scoring systems (Fong's, Nordlinger, Nagashima, RAS mutation, Tumor Burden, GAME, CERR, and Glasgow Prognostic score, Basingstoke Index) were evaluated by likelihood ratio (LR) χ2, linear trend (LT) χ2 and Akaike Information Criterion (AIC) for their predictive value regarding overall survival (OS) and recurrence free survival (RFS). RESULTS: Among 150 patients, median RFS was 9 (2-124) months with a 5-year RFS rate of 10%. Median OS was 39 (4-131) months with a 5-year OS rate of 32%. For RFS and OS, the Nagashima score showed the best prognostic ability (LT χ2 3.00, LR χ2 9.39, AIC 266.66 and LT χ2 2.91, LR χ2 20.91, 290.36). DISCUSSION: The Nagashima score showed the best prognostic stratification to predict recurrence as well as survival, and therefore might be considered when evaluating patients with recCRLM for repeat hepatectomy.

Successful Transplantation of a Liver from a Donor with HELLP Syndrome Undergoing Hypothermic Oxygenated Machine Perfusion (HOPE) Prior to Implantation.

BACKGROUND Liver transplantation (LT) has become the treatment of choice for patients with end-stage liver disease (ESLD). The organ shortage forced clinicians to use livers from donors with certain risk factors, so-called extended-criteria donor (ECD) organs. Hypothermic oxygenated machine perfusion (HOPE) is an alternative to conventional static cold storage and reduces early allograft injury in ECD organs. In this article we present the case of a 45-year-old man with hepatitis B virus (HBV)-associated cirrhosis and hepatocellular carcinoma (HCC) who underwent successful liver transplantation supported by pretransplant hypothermic oxygenated machine perfusion (HOPE) from a 34-year-old extended-criteria donor (ECD) with hemolysis, elevated liver enzymes, and low platelets (HELLP) syndrome. CASE REPORT Liver transplantation was scheduled for a 45-year-old man with hepatocellular carcinoma (HCC) due to hepatitis B virus-induced liver cirrhosis. The organ donor was a 34-year-old woman who had developed intracerebral hemorrhage and brain death due to HELLP syndrome after delivery. Compared to the day of admission to the intensive care unit, a decrease in the donor's transaminases was observed prior to organ procurement. Before transplantation, HOPE was conducted after regular back-table preparation of the graft. LT was performed according to the standard surgical techniques and a standardized immunosuppressive regimen was conducted. In the post-transplant period, transaminases peaked directly after the operation and normalized after 1 week. No major surgical complications occurred. The patient was discharged after a 24-day hospital stay with normal liver function. CONCLUSIONS This case report supports the benefits of using HOPE in ECD organs and it should be considered in livers of donors with HELLP syndrome to improve post-transplant outcome.

Bowel Obstruction Due to Stenotic Sigmoid Colon Cancer in a 32-Year-Old Patient Presenting in the Third Trimester of Pregnancy: A Case Report of an Interval Surgical Approach.

BACKGROUND Colorectal cancer among pregnant women is a rare entity. If colon cancer is suspected during pregnancy, the diagnosis is a therapeutic challenge that should be managed by a multidisciplinary team of specialists. Standardized therapeutic models do not exist. In this article we present a case of a pregnant patient with stenotic sigmoid colon adenocarcinoma. We describe the interdisciplinary treatment and the 2-step surgical approach used during pregnancy. CASE REPORT A 32-year-old women in week 28.8 of pregnancy was admitted to the Department of Gynecology and Obstetrics, meeting the standard pregnancy criteria of constipation. After a week of unsuccessful conservative treatment, the patient underwent magnetic resonance imaging (MRI), which disclosed a stenosed segment in the sigmoid colon. After an emergency colonoscopy with biopsy sampling, histological analysis confirmed sigmoid adenocarcinoma. In a multidisciplinary consultation of specialists, in which neonatological and oncological aspects were considered, a 2-step surgical plan was established. In the first step (gestational week 29.8), a loop transverse colostomy with intestinal decompression was performed. In the second step (gestational week 32.8), an elective primary caesarean section followed by open oncological sigmoid resection was performed. No postoperative complications occurred in either step. The neonate was healthy and had a birth weight appropriate for the gestational age. CONCLUSIONS In cases of colorectal cancer during pregnancy, staged surgical approaches should be considered to reduce maternal and fetal morbidity.