RESUMEN
BACKGROUND: Limited evidence exists to guide the management of patients with liver metastases from squamous cell carcinoma (SCC). The aim of this retrospective multicentre cohort study was to describe patterns of disease recurrence after liver resection/ablation for SCC liver metastases and factors associated with recurrence-free survival (RFS) and overall survival (OS). METHOD: Members of the European-African Hepato-Pancreato-Biliary Association were invited to include all consecutive patients undergoing liver resection/ablation for SCC liver metastases between 2002 and 2019. Patient, tumour and perioperative characteristics were analysed with regard to RFS and OS. RESULTS: Among the 102 patients included from 24 European centres, 56 patients had anal cancer, and 46 patients had SCC from other origin. RFS in patients with anal cancer and non-anal cancer was 16 and 9 months, respectively (P = 0.134). A positive resection margin significantly influenced RFS for both anal cancer and non-anal cancer liver metastases (hazard ratio 6.82, 95 per cent c.i. 2.40 to 19.35, for the entire cohort). Median survival duration and 5-year OS rate among patients with anal cancer and non-anal cancer were 50 months and 45 per cent and 21 months and 25 per cent, respectively. For the entire cohort, only non-radical resection was associated with worse overall survival (hazard ratio 3.21, 95 per cent c.i. 1.24 to 8.30). CONCLUSION: Liver resection/ablation of liver metastases from SCC can result in long-term survival. Survival was superior in treated patients with liver metastases from anal versus non-anal cancer. A negative resection margin is paramount for acceptable outcome.
Asunto(s)
Carcinoma de Células Escamosas , Neoplasias Hepáticas , Carcinoma de Células Escamosas/cirugía , Estudios de Cohortes , Humanos , Neoplasias Hepáticas/cirugía , Recurrencia Local de Neoplasia/cirugía , Estudios RetrospectivosRESUMEN
BACKGROUND: The extent of liver resection for tumours is limited by the expected functional reserve of the future liver remnant (FRL), so hypertrophy may be induced by portal vein embolization (PVE), taking 6 weeks or longer for growth. This study assessed the hypothesis that simultaneous embolization of portal and hepatic veins (PVE/HVE) accelerates hypertrophy and improves resectability. METHODS: All centres of the international DRAGON trials study collaborative were asked to provide data on patients who had PVE/HVE or PVE on 2016-2019 (more than 5 PVE/HVE procedures was a requirement). Liver volumetry was performed using OsiriX MD software. Multivariable analysis was performed for the endpoints of resectability rate, FLR hypertrophy and major complications using receiver operating characteristic (ROC) statistics, regression, and Kaplan-Meier analysis. RESULTS: In total, 39 patients had undergone PVE/HVE and 160 had PVE alone. The PVE/HVE group had better hypertrophy than the PVE group (59 versus 48 per cent respectively; P = 0.020) and resectability (90 versus 68 per cent; P = 0.007). Major complications (26 versus 34 per cent; P = 0.550) and 90-day mortality (3 versus 16 per cent respectively, P = 0.065) were comparable. Multivariable analysis confirmed that these effects were independent of confounders. CONCLUSION: PVE/HVE achieved better FLR hypertrophy and resectability than PVE in this collaborative experience.
Asunto(s)
Embolización Terapéutica/métodos , Hepatectomía/métodos , Neoplasias Hepáticas/terapia , Cuidados Preoperatorios/métodos , Anciano , Femenino , Estudios de Seguimiento , Venas Hepáticas , Humanos , Regeneración Hepática , Masculino , Persona de Mediana Edad , Vena Porta , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
El adenoma quístico paratiroideo es una entidad poco frecuente (<0,01% de las masas cervicales) que cursa con hiperparatiroidismo primario en un 9% de los casos. La gammagrafía de paratiroides es fundamental para su diagnóstico y no es frecuente un resultado falso negativo. El uso de equipos híbridos SPECT/TC permite establecer un diagnóstico de localización más preciso. El tratamiento en casos funcionales es finalmente quirúrgico. Se presenta el caso de una mujer de 64 años diagnosticada de hiperparatiroidismo con adenoma quístico paratiroideo y gammagrafía negativa (AU)
Cystic parathyroid adenoma is a rare disease (<0.01% of all cervical masses) that associates primary hyperparathyroidism in 9% of cases. Parathyroid scintigraphy is essential for its diagnosis with uncommon false negative results. Hybrid SPECT/CT equipments allow a more accurate diagnosis. Functional cystic parathyroid adenomas are surgically treated. A case of a 64-year-old woman with diagnoses of hyperparathyroidism and a cystic parathyroid adenoma without uptake in scintigraphy is described (AU)
Asunto(s)
Humanos , Femenino , Persona de Mediana Edad , Adenoma , Neoplasias de las Paratiroides , Hiperparatiroidismo Primario/complicaciones , Hiperparatiroidismo Primario , Cintigrafía , Tecnecio Tc 99m Sestamibi/análisis , Tomografía Computarizada de Emisión de Fotón Único/métodos , Reacciones Falso Negativas , Pertecnetato de Sodio Tc 99m/análisis , Patología/tendencias , Adenoma/cirugíaRESUMEN
Cystic parathyroid adenoma is a rare disease (<0.01% of all cervical masses) that associates primary hyperparathyroidism in 9% of cases. Parathyroid scintigraphy is essential for its diagnosis with uncommon false negative results. Hybrid SPECT/CT equipments allow a more accurate diagnosis. Functional cystic parathyroid adenomas are surgically treated. A case of a 64-year-old woman with diagnoses of hyperparathyroidism and a cystic parathyroid adenoma without uptake in scintigraphy is described.