Impact of routine preoperative 18 FDG PET/CT on the surgical management of primary colorectal cancer.

OBJECTIVES: Determine the usefulness of [18F]-fluorodeoxyglucose positron emission tomography/computed tomography (18 FDG-PET/CT) in the preoperative setting of colorectal cancer (CRC), assessing its impact on changes in management strategy. METHODS: Retrospective study of CRC patients who underwent preoperative 18 FDG-PET/CT and CT staging scans in a single referral center. The agreement between 18 FDG-PET/CT, contrast-enhanced CT, and colonoscopy for the surgical location was compared using the κ coefficient. Maximum standardized uptake (SUVmax ) value was obtained. Univariate and multivariate analyses were conducted. RESULTS: One hundred ninety-five patients were included. 18 FDG-PET/CT improved tumor localization in 84.6% (165/195) of cases (κ value 0.798, p < 0.001), thus correcting endoscopic errors 69.7% (30/43) of the time. In patients with incomplete colonoscopies, 18 FDG-PET/CT detected synchronous tumors in 2.5% (5/195) patients, overlooked by CT staging scans. Based on extracolonic 18 FDG-uptake, the second primary malignancy was diagnosed in 7(3.6%,7/195) patients and total accuracy for lymph node and distant metastasis was 66.1% and 98.4%, respectively. The treatment plan was altered in 30 (15.4%, 30/196) patients. There was a significant association between the SUVmax and tumor size (odds ratio [OR] 4.254, p = 0.003) and the depth of tumor invasion (OR 1.696, p = 0.026). CONCLUSIONS: Based on its ability to aid in preoperative evaluation and definitively alter surgical treatment planning, 18 FDG-PET/CT should be further evaluated in primary CRC.

A phase II, single-center, double-blind, randomized placebo-controlled trial to explore the efficacy and safety of intravenous melatonin in surgical patients with severe sepsis admitted to the intensive care unit.

To determine whether IV melatonin therapy improves redox status and inflammatory responses in surgical patients with severe sepsis, a unicenter, phase II double-blind, randomized, placebo-controlled trial was carried out. The study included patients with severe sepsis marked by infectious systemic inflammatory response syndrome (SIRS), associated with organ dysfunction, hypoperfusion or hypotension requiring surgical intervention. IV melatonin at a daily dose of 60 mg, which was dissolved in 500 ml of 5% dextrose serum, was continuously administered to the patients for over 30 min starting on the day of the diagnoses during a 5-day period. A total of 14 patients received a placebo treatment and 15 melatonin doses. Redox status decreased in melatonin-treated patients during the 5 days of treatment as compared to the placebo-treated patients. Procalcitonin performed better in the melatonin group, whose neutrophil to lymphocyte ratio was also significantly reduced, resulting in an improved evolution of the disease. Moreover, hospital stays decreased by 19.60% from 26.64 days for the placebo group to 21.42 days for the melatonin group. The placebo group recorded five mortalities, as compared to three for the melatonin group. IV melatonin administration improved the course of the disease in surgical patients with severe sepsis, with no side effects. Additional studies with higher doses of melatonin and a long duration of therapy need to be carried out to assess its clinical use.

Cholangiocarcinoma, 10-Year Survival After Liver Transplantation: A Case Report.

Cholangiocarcinoma is the second most common neoplasm in the liver, with a very poor, short-term prognosis. Today, surgery associated with or without an adjuvant is the only curative treatment. Liver transplantation (LT) is the best treatment for hepatocellular carcinoma tumor. In recent years, treatment of hilar cholangiocarcinoma by LT associated with neoadjuvant therapy has been studied under a criterion. But could it be possible to apply LT like the curative treatment of intrahepatic cholangiocarcinoma (iCC)? Initially the answer is no, but there are different studies about incidental LT in patients with iCC that demonstrate survival over 40% to 50%. In our center, we conducted a review of 468 transplants completed between 2002 and 2018, and we identified 1 case of incidental LT in a patient with iCC with an overall survival of 10 years. Because there is currently an increase in donors owing to the expansion of the criteria, a study to consider extending the criteria of LT to include iCC would be beneficial.