RESUMO
Perihilar cholangiocarcinoma (pCCA) is an uncommon malignancy with generally poor prognosis. Surgery is the primary curative treatment; however, the perioperative mortality and morbidity rates are high, with a low 5-year survival rate. Use of preoperative prognostic biomarkers to predict survival outcomes after surgery for pCCA are not well-established currently. This systematic review aimed to identify and summarise preoperative biomarkers associated with survival in pCCA, thereby potentially improving treatment decision-making. The Embase, Medline, and Cochrane databases were searched, and a systematic review was performed using the PRISMA guidelines. English-language studies examining the association between serum and/or tissue-derived biomarkers in pCCA and overall and/or disease-free survival were included. Our systematic review identified 64 biomarkers across 48 relevant studies. Raised serum CA19-9, bilirubin, CEA, neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR) and tumour MMP9, and low serum albumin were most associated with poorer survival; however, the cutoff values used widely varied. Several promising molecular markers with prognostic significance were also identified, including tumour HMGA2, MUC5AC/6, IDH1, PIWIL2, and DNA index. In conclusion, several biomarkers have been identified in serum and tumour specimens that prognosticate overall and disease-free survival after pCCA resection. These, however, require external validation in large cohort studies and/or in preoperatively obtained specimens, especially tissue biopsy, to recommend their use.
RESUMO
Conversion to a prepectoral implant pocket is considered the definitive treatment for breast animation after implant-based breast reconstruction. Although subtle movement of implants placed in the prepectoral plane may be noted on clinical examination by experienced surgeons, current data demonstrate complete resolution of animation deformity with prepectoral implant placement. We present the case of a middle-aged women who underwent breast implant pocket conversion from dual-plane to prepectoral plane for treatment of animation deformity. Although her postoperative recovery was unremarkable with initial resolution of animation, recurrent implant animation was evident on 3-month follow-up. Recurrent breast animation after conversion from dual-plane to prepectoral implant pocket is highly unusual and unreported in the current literature. Although revision surgery may identify potential causes, larger-scale research on contributing factors will be valuable in developing strategies to prevent recurrent animation after conversion to a prepectoral implant pocket.