RESUMO
BACKGROUND: Repeat transarterial chemoembolisation (rTACE) is often required for hepatocellular carcinoma (HCC) to achieve disease control, however, current practice guidelines regarding treatment allocation vary significantly. This study aims to identify key factors associated with patient survival following rTACE to facilitate treatment allocation and prognostic discussion. METHOD: Patients with HCC undergoing rTACE at six Australian tertiary centers from 2009 to 2014 were included. Variables encompassing clinical, tumour, treatment type and response factors were analysed against the primary outcome of overall survival. Univariate analysis and multivariate Cox regression modelling were used to identify factors pre- and post-TACE therapy significantly associated with survival. RESULTS: Total of 292 consecutive patients underwent rTACE with mainly Child Pugh A cirrhosis (61%) and BCLC stage A (57%) disease. Median overall survival (OS) was 30 months (IQR 15.2-50.2) from initial TACE. On multivariate analysis greater tumour number (p = 0.02), higher serum bilirubin (p = 0.007) post initial TACE, and hepatic decompensation (p = 0.001) post second TACE were associated with reduced survival. Patients with serum AFP ≥ 200 ng/ml following initial TACE had lower survival (p = 0.001), compared to patients with serum AFP level that remained < 200 ng/ml post-initial TACE, with an overall survival of 19.4 months versus 34.7 months (p = 0.0001) respectively. CONCLUSION: Serum AFP level following initial treatment in patients undergoing repeat TACE for HCC is a simple and useful clinical prognostic marker. Moreover, it has the potential to facilitate appropriate patient selection for rTACE particularly when used in conjunction with baseline tumour burden and severity of hepatic dysfunction post-initial TACE.
Assuntos
Carcinoma Hepatocelular/terapia , Quimioembolização Terapêutica/métodos , Neoplasias Hepáticas/terapia , Recidiva Local de Neoplasia/terapia , alfa-Fetoproteínas/análise , Idoso , Austrália/epidemiologia , Carcinoma Hepatocelular/sangue , Carcinoma Hepatocelular/mortalidade , Quimioembolização Terapêutica/efeitos adversos , Feminino , Seguimentos , Humanos , Estimativa de Kaplan-Meier , Neoplasias Hepáticas/sangue , Neoplasias Hepáticas/mortalidade , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/sangue , Recidiva Local de Neoplasia/mortalidade , Seleção de Pacientes , Prognóstico , Retratamento/efeitos adversos , Retratamento/métodos , Estudos Retrospectivos , Resultado do TratamentoRESUMO
INTRODUCTION: Primary endoscopic and percutaneous drainage for pancreatic necrotic collections is increasingly used. We aim to compare the relative effectiveness of both modalities in reducing the duration and severity of illness by measuring their effects on systemic inflammatory response syndrome (SIRS). METHODS: We retrospectively reviewed all cases of endoscopic and percutaneous drainage for pancreatic necrotic collections performed in 2011-2016 at two hospitals. We assessed the post-procedure length of hospital stay, reduction in C-reactive protein levels, resolution of SIRS, the complication rates, and the number of procedures required for resolution. RESULTS: Thirty-two patients were identified and 57 cases (36 endoscopic, 21 percutaneous) were included. There was no significant difference in C-reactive protein reduction between endoscopic and percutaneous drainage (69.5% vs 68.8%, P = 0.224). Resolution of SIRS was defined as the post-procedure normalization of white cell count (endoscopic vs percutaneous: 70.4% vs 64.3%, P = 0.477), temperature (endoscopic vs percutaneous: 93.3% vs 60.0%, P = 0.064), heart rate (endoscopic vs percutaneous: 56.0% vs 11.1%, P = 0.0234), and respiratory rate (endoscopic vs percutaneous: 83.3% vs 0.0%, P = 0.00339). Post-procedure length of hospital stay was 27 days with endoscopic drainage and 46 days with percutaneous drainage (P = 0.0183). CONCLUSION: Endoscopic drainage was associated with a shorter post-procedure length of hospital stay and a greater rate of normalization of SIRS parameters than percutaneous drainage, although only the effects on heart rate and respiratory rate reached statistical significance. Further studies are needed to establish which primary drainage modality is superior for pancreatic necrotic collections.
Assuntos
Drenagem/métodos , Endoscopia/métodos , Pancreatite Necrosante Aguda/cirurgia , Complicações Pós-Operatórias/prevenção & controle , Síndrome de Resposta Inflamatória Sistêmica/prevenção & controle , Idoso , Proteína C-Reativa/metabolismo , Feminino , Humanos , Tempo de Internação , Contagem de Leucócitos , Masculino , Pessoa de Meia-Idade , Pancreatite Necrosante Aguda/sangue , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Síndrome de Resposta Inflamatória Sistêmica/epidemiologia , Resultado do TratamentoAssuntos
Comportamento Cooperativo , Cooperação Internacional , Qualidade da Assistência à Saúde/normas , Radiografia Intervencionista/normas , Radiologia Intervencionista/normas , Certificação/normas , Competência Clínica/normas , Educação de Pós-Graduação em Medicina/normas , Humanos , Radiologia Intervencionista/educaçãoAssuntos
Carcinoma Hepatocelular/cirurgia , Abscesso Hepático/etiologia , Micro-Ondas/efeitos adversos , Administração Intravenosa , Antibacterianos/administração & dosagem , Antibacterianos/uso terapêutico , Síndrome de Budd-Chiari/patologia , Quimioembolização Terapêutica/métodos , Colangiopancreatografia Retrógrada Endoscópica/métodos , Ducto Hepático Comum/lesões , Ducto Hepático Comum/efeitos da radiação , Humanos , Abscesso Hepático/tratamento farmacológico , Abscesso Hepático/cirurgia , Neoplasias Hepáticas/patologia , Neoplasias Hepáticas/cirurgia , Masculino , Micro-Ondas/uso terapêutico , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos/efeitos adversos , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Veia Porta/patologia , Veia Porta/cirurgia , Stents , Resultado do TratamentoRESUMO
High-flow priapism is uncommon particularly in children. While it is a non-emergent condition, delayed management may result in secondary vascular deformities. Embolisation is not commonly offered as first-line management because of the risk of potentially severe ramifications regarding sexual function, particularly with cases of bilateral penile arteriolacunar fistulae. We demonstrate successful application of superselective embolisation technique using absorbable material with no long-term adverse effect on erectile function.