Malnutrition as an unfavorable prognostic factor after surgical treatment for metastatic colorectal cancer.

<b><br>Introduction:</b> Colorectal cancer (CRC) is the second-leading cause of cancer-related deaths worldwide. Distant metastases are usually located in the liver and are present in 50% of patients.</br> <b><br>Aim:</b> The aim of this study is to evaluate changes in body composition and phase angle before and after surgical treatment of CRC liver metastases, as well as survival time and treatment costs.</br> <b><br>Material and methods:</b> The study included 134 patients who received 174 surgeries for CRC liver metastases. Bioelectrical impedance analysis (BIA) was performed using an AKERN BIA 101 analyzer.</br> <b><br>Results:</b> BIA was performed before and after surgery. The results of tests (total body water content [TBW], body cell mass [BCM], and phase angle) showed a reduction in BCM by 2.21 kg and a statistically significant decrease in phase angle values after surgery (from 5.06 to 4.25 in women and from 5.34 to 4.76 in men). These values are below the reference range for both sexes. There was a correlation between phase angle values and muscle mass, both before (R = 0.528, p<0001) and after surgery (R = 0.634, p<000.1). Preoperative levels of the tumor marker CEA were elevated in more than half of the patients. The median survival time after resection of liver metastases was 37.6 months.</br> <b><br>Discussion:</b> A significant factor that increases complications, mortality, and treatment costs of cancer patients is malnutrition, which could be the earliest symptom of malignant disease.</br> <b><br>Conclusions:</b> Successful treatment of CRC requires the patients to participate in follow-up examinations and to be aware of early signs associated with recurrence (e.g., blood in the stool or weight loss). The patients' nutritional status should be monitored and recorded in a DILO card.</br>.

Simultaneous surgical treatment of hepatocellular carcinoma with tumor thrombus in the inferior vena cava and ischemic heart disease own research and literature review.

<b> Introduction:</b> Hepatocellular carcinoma (HCC) is the third leading cause of cancer-related death worldwide. Tumor penetration into the inferior vena cava/right atrium is rare, as it occurs only in 34% of HCC patients. There are no clear guidelines for the management of this stage of disease. </br></br> <b>Aim:</b> This is a case report of a patient with HCC and tumor thrombus in the inferior vena cava and with advanced coronary artery disease. </br></br> <b> Materials and methods:</b> The patient was qualified for a simultaneous cardiac surgery and liver resection with removal of the tumor thrombus from the inferior vena cava due to a high risk of sudden cardiac death. The first stage involved aortocoronary bypass followed by a right-sided hemihepatectomy with removal of the tumor thrombus from the inferior vena cava (this part of the operation was performed by extracorporeal circulation). The postoperative period was uneventful. Surgical treatment is one of the therapeutic options that offers a chance to radically remove the tumor and extend the patient's life. From a standpoint, these operations are extremely difficult and carry a high risk of perioperative complications (up to 40%). At the same time, the patient is at risk of complications due to cancer, such as pulmonary embolism, tricuspid stenosis, and congestive heart failure, which should be considered when choosing a treatment method. A significant number of patients also suffer from chronic conditions that worsen the prognosis. Cardiac diseases combined with tumor thrombus in the inferior vena cava may cause sudden cardiac death. </br></br> <b>Conclusions:</b> Surgical treatment should be considered in patients with HCC and tumor thrombus in the inferior vena cava, especially in patients with cardiovascular disease burden, as it is not only a chance to prolong life, but also to protect them against life-threatening cardiac complications.

PEComa-A Rare Liver Tumor.

PEComa (perivascular epithelioid cell tumor) is a rare liver tumor. Decisions regarding patient management are currently based on a few small case series. The aim of this study was to report the clinicopathological features of PEComa in order to provide guidance for management, complemented by our own experience. This retrospective observational study included all patients with PEComa who underwent surgical treatment in two departments between 2002 and 2020. A total of 20 patients were diagnosed with PEComa following histopathological examination. The age of the patients ranged from 21 to 73 years. The majority of patients were women (85%). In most patients, the tumors were incidental. In diagnostic studies, PEComas with high arterial vascularization have been described. Liver resection was the treatment of choice. There was only one postoperative complication. During histopathological evaluation, tumors were composed mostly of epithelioid cells, rarely with spindle cell components, thick-walled vessels, and adipocytes in different proportions. Melanocytic markers (HMB45, MelanA) and at least one smooth muscle marker were expressed in all tumors. Features suggestive of malignancy were found in three cases. In conclusion, PEComa is a rare liver tumor that is usually diagnosed incidentally. In radiological studies, tumors with high arterial vascularization are observed. Liver resection is the treatment of choice.

Performance of initial LI-RADS 2018 treatment response in predicting survival of patients with hepatocellular carcinoma following TACE: a retrospective, single-center cohort study.

PURPOSE: Treatment response following transarterial chemoembolization (TACE) is frequently evaluated with Liver Imaging Reporting and Data System Treatment Response (LR-TR) algorithm, but its association with patients' outcomes is not supported in the literature. The purpose of this study was to provide such data. METHODS: A retrospective analysis of 99 TACE patients with stage A/B hepatocellular carcinoma according to Barcelona-Clinic Liver Cancer staging system was performed. Two radiologists assessed LR-TR, while a third radiologist re-assessed divergent results. Overall survival (OS) and time to disease progression (TTP) were the primary endpoints of the study, while the Cox proportional hazard model was used for outcome analyses. RESULTS: Interobserver agreement was substantial between the two readers with κ = 0.69 (95% CI 0.58-0.81). The median OS in viable, equivocal, and non-viable groups were 27, 27, and 73 months, respectively (p < 0.001). However, after adjustment for confounding factors, there was no significant association between initial viable response and OS (HR 0.98 [95% CI 0.37-2.63], p = 0.97), while equivocal response remained statistically significant (HR 3.52. [95% CI 1.27-9.71], p = 0.015). No significant association was noted when viable and equivocal groups were analyzed in aggregate (HR 1.03 [95% CI 0.4-2.4], p = 0.96). The median TTP did not differ between non-viable and viable groups (23 vs 18 months, respectively; p = 0.98). None of the analyzed predictors was associated with TTP. CONCLUSION: Initial LR-TR response was not an independent predictor for OS nor TTP. The preliminary results suggest the necessity for more aggressive management of equivocal patients.

Assessment of resting energy demand and body composition in oncological patients undergoing partial resections of the liver.

INTRODUCTION: The metabolism of the body is a complicated process. The most important organ of the organism that affects the intensity of changes is the liver. An effective treatment method of primary and metastatic tumours is a partial resection of the organ. The analysis of changes in the body composition of patients undergoing this type of treatment allows identification of problems coexisting with the underlying disease. AIM: To evaluate changes in the parameters of body composition and the amount of resting metabolism. MATERIAL AND METHODS: The study group consisted of 87 patients who underwent resection of changes in the liver or thermoablation of focal lesions during hospitalisation. RESULTS: Analysis of the data showed that the surgical intervention contributes to a statistically significant (p < 0.05) decrease in the value of the phase angle. A significant increase was noted within the extra cellular water content. The amount of resting metabolism in the postoperative period did not differ significantly; however, there was an upward trend in women and a downward trend in men. CONCLUSIONS: Surgical resection of lesions aimed at extending the survival of patients are performed more and more often, while the consequences of these operations are not sufficiently known. The adverse effect of resection treatments on body composition parameters, mainly imaged by decreasing the phase angle value, should be minimised. Effects on metabolism remain ambiguous because no significant changes have been demonstrated in the postoperative period.

Successful Hepatoatrial Anastomosis During a Consecutive Liver Retransplant in the Same Patient Shows Good Long-Term Results: Case Report and 2-Year Follow-Up.

Liver retransplant is the last and only treatment for patients with irreversible graft failure. It is recognized as a high-risk procedure; thus surgical difficulties are multiplied with every successive liver transplant. Liver retransplant is a demanding technical procedure for the surgeon, with no guarantee of postoperative and long-term survival. Here, we report a 29-year-old male patient who underwent a liver transplant in April 2009 due to primary sclerosing cholangitis with overlapping autoimmune hepatitis. The patient underwent liver retransplant in May 2012 due to graft failure. A second liver retransplant was performed in April 2013 using the classical technique. An inflammatory process involving the inferior vena cava and diaphragm forced the surgeon to open the pericardium from the diaphragm and clamp the cuff of the right atrium to perform a hepatoatrial anastomosis of the inferior vena cava. The next steps were performed as for a typical liver transplant. Postoperative stay was free of complications and was not prolonged. Immunosuppression regimen was kept standard. During our follow-up of more than 32 months, the patient continued to show good results. A consecutive hepatectomy in the same recipient is associated with an increased risk of intraoperative complications. When excessive adhesions limit a safe and functioning cavocaval anastomosis, a hepatectomy with the excision of the intrahepatic inferior vena cava and end-to-end anastomosis through a pericardial window for the extension of the recipient's' vena cava cuff are feasible options. We found that a hepatoatrial anastomosis does not impair good overall outcomes and long-term results.

A review of methods for preventing pancreatic fistula after distal pancreatectomy.

Pancreatic fistula is one of the most severe complications after pancreatic surgeries. The risk of pancreatic fistula after distal pancreatectomy is up to 60%. Effective methods to prevent pancreatic fistula are still sought. A unified definition of pancreatic fistula, which was introduced in 2005 by the International Study Group of Pancreatic Surgery (ISGPS), has allowed for an easier diagnosis and determination of fistula severity, as well as for a reliable inter-center comparison of data. Furthermore, a number of publications point out the risk factors of pancreatic fistula, which may be classified into patient-related risk factors, such as MBI, gender, smoking tobacco or pancreatic structure; and surgery-related risk factors, such as blood loss, prolonged surgery and non-underpinning of the major pancreatic duct. The analysis of risk factors and the use of different methods for the prevention of pancreatic fistula, including novel surgical techniques, may reduce both, the formation and severity of fistula. This will, in turn, lead to reduced secondary complications and mortality, as well as a shorter hospital stay. We present a literature review on different strategies used to prevent pancreatic fistula. It seems, however, that multicenter, prospective, randomized studies in two large groups of patients after pancreatectomy are necessary to establish clear recommendations for the preventive management.

Assessment of changes in the body composition in patients qualified for the operational treatment of the primary and metastatic liver tumors with the use of bioelectric impedance.

INTRODUCTION: Resection is an optimal way of treatment of hepatic tumors and metastasis from another organ. The operational injury may influence on patients body composition examined by bioelectrical impedance (BIA). Analysis of parameters may be helpful in identifying early changes indicating of deterioration in nutritional status. THE AIM OF THE STUDY: was to assess changes in body composition of patients before and after resection of liver tumors and potential radiofrequency ablation of lesions. MATERIAL AND METHODS: The study included a group of 50 patients of the Department of General, Gastroenterological and Oncological Surgery, Medical University of Warsaw, who were qualified for radical surgical treatment of tumors within the liver. Data on water content, fat, muscle and cell mass were analyzed. RESULTS: Comparing data obtained from patients before and after intervention in the liver, statistically significant (p <0.05) loss of intracellular water, muscle mass, cell mass, as well as adipose tissue, was demonstrated. The phase angle value in these patients also significantly changed, decreasing by an average of 0.61°. On the other hand, the increase in content was noted in the case of extracellular water. CONCLUSIONS: Surgical intervention within the liver causes noticeable, unfavorable changes in the body composition, as evidenced by the reduction in the value of muscle mass, as well as cellular mass, resulting in a decrease in the phase angle. Bioelectric impedance is a suitable method for assessing changes in body composition of patients undergoing liver resection and is useful in clinical practice. It is advisable to conduct further research in the group of patients undergoing invasive treatment of the liver due to: an increasing number of such operations and centers where this type of surgical intervention is performed.

Individual Surgeon Experience Yields Bimodal Effects on Patient Outcomes After Deceased-Donor Liver Transplant: Results of a Quantile Regression for Survival Data.

OBJECTIVES: Data on the relevance of surgeon experience in liver transplant procedures are scarce. In this study, we evaluated the effects of individual surgeon experience on survival outcomes after deceased-donor liver transplant. MATERIALS AND METHODS: In this retrospective analysis of 1193 liver transplant procedures, quantile regression for survival data was performed to assess the effects of surgeon experience. Conditional quantiles of mortality and graft loss were set as primary and secondary outcome measures, respectively, which were categorized as early, midterm, and late. RESULTS: Greater experience of a surgeon performing hepatectomy increased the risk of early mortality (P = .005) and graft loss (P = .025) when the recipient Model for End-Stage Liver Disease was ≤ 25 and the donor Model for End-Stage Liver Disease was ≤ 1600. In conventional transplant procedures, greater experience of surgeon performing hepatectomy additionally increased the risk of midterm mortality (P = .027) and graft loss (P = .046). Conversely, a graft implant procedure performed by a more experienced surgeon was associated with better early, midterm, and late outcomes after conventional transplants (all P < .037) and reduced the risk of early graft loss when the donor Model for End-Stage Liver Disease score was > 1600 (P = .027). CONCLUSIONS: Unexpectedly, individual surgeon experience yields bimodal effects on posttransplant outcomes, dependent on the stage of operation, operative technique, severity of recipient status, and transplant risk profile.

Evolution Of The Results Of 1500 Liver Transplantations Performed In The Department Of General, Transplant And Liver Surgery Medical University Of Warsaw.

UNLABELLED: Liver transplantation is a well-established treatment of patients with end-stage liver disease and selected liver tumors. Remarkable progress has been made over the last years concerning nearly all of its aspects. The aim of this study was to evaluate the evolution of long-term outcomes after liver transplantations performed in the Department of General, Transplant and Liver Surgery (Medical University of Warsaw). MATERIAL AND METHODS: Data of 1500 liver transplantations performed between 1989 and 2014 were retrospectively analyzed. Transplantations were divided into 3 groups: group 1 including first 500 operations, group 2 including subsequent 500, and group 3 comprising the most recent 500. Five year overall and graft survival were set as outcome measures. RESULTS: Increased number of transplantations performed at the site was associated with increased age of the recipients (p<0.001) and donors (p<0.001), increased rate of male recipients (p<0.001), and increased rate of piggyback operations (p<0.001), and decreased MELD (p<0.001), as well as decreased blood (p=0.006) and plasma (p<0.001) transfusions. Overall survival was 71.6% at 5 years in group 1, 74.5% at 5 years in group 2, and 85% at 2.9 years in group 3 (p=0.008). Improvement of overall survival was particularly observed for primary transplantations (p=0.004). Increased graft survival rates did not reach the level of significance (p=0.136). CONCLUSIONS: Long-term outcomes after liver transplantations performed in the Department of General, Transplant and Liver Surgery are comparable to those achieved in the largest transplant centers worldwide and are continuously improving despite increasing recipient age and wider utilization of organs procured from older donors.

Myeloproliferative neoplasms and recurrent thrombotic events in patients undergoing liver transplantation for Budd-Chiari syndrome: a single-center experience.

BACKGROUND: Budd-Chiari syndrome is a heterogeneous disease. The role of liver transplantation as a treatment option has been discussed since 1976. Many cases are related to underlying myeloproliferative neoplasms associated with prothrombotic propensity. The aim of this study was to evaluate the long-term clinical outcome after liver transplantation for Budd-Chiari syndrome at our center, with special emphasis on recurrent thrombosis and underlying myeloproliferative disorders. MATERIAL/METHODS: A medical records search revealed 25 patients transplanted at our center for Budd-Chiari syndrome between 2000 and 2009. Indications for transplantation were complications of end-stage liver disease or acute liver failure. RESULTS: Ten patients were men (40.0%). Median age of recipients at transplantation was 29.0 (17-51) years. Eighteen patients (72%) had evidence of myeloproliferation, 1 had paroxysmal nocturnal hemoglobinuria, and 6 had idiopathic disease. In 55.5% of cases eventually diagnosed with myeloproliferative neoplasms, Budd-Chiari syndrome was their initial presentation. All patients were maintained on long-term post-transplant anticoagulation protocol. The median follow-up time was 58.8 months. Four patients (16%) died during follow-up. Acute graft rejection occurred in 16% of cases. During the observation period, 5 patients had recurrent thrombotic events. The 5-year patient and graft survival rate was 84%. No case of transformation to acute leukemia was seen. CONCLUSIONS: Our data show satisfactory long-term survival of patients and grafts in the study group. Occult course of myeloproliferative neoplasms is frequent in this population and exceeds 50%. We observed recurrent thrombosis in 20% of recipients.

Neoadjuvant imatinib in locally advanced gastrointestinal stromal tumors (GIST): the EORTC STBSG experience.

BACKGROUND: Preoperative imatinib therapy of locally advanced GIST may facilitate resection and decrease morbidity of the procedure. METHODS: We have pooled databases from 10 EORTC STBSG sarcoma centers and analyzed disease-free survival (DFS) and disease-specific survival (DSS) in 161 patients with locally advanced, nonmetastatic GISTs who received neoadjuvant imatinib. OS was calculated from start of imatinib therapy for locally advanced disease until death or last follow-up (FU) after resection of the GIST. DFS was calculated from date of resection to date of disease recurrence or last FU. Median FU time was 46 months. RESULTS: The primary tumor was located in the stomach (55%), followed by rectum (20%), duodenum (10%), ileum/jejunum/other (11%), and esophagus (3%). The tumor resection after preoperative imatinib (median time on therapy, 40 weeks) was R0 in 83%. Only two patients have demonstrated disease progression during neoadjuvant therapy. Five-year DSS/DFS rates were 95/65%, respectively, median OS was 104 months, and median DFS was not reached. There were 56% of patients who continued imatinib after resection. Thirty-seven GIST recurrences were diagnosed (only 5 local relapses). The most common mutations affected exon 11 KIT (65%). Poorer DFS was related to primary tumor location in small bowel and lack of postoperative therapy with imatinib. CONCLUSIONS: Our analysis comprising the largest group of GIST patients treated with neoadjuvant imatinib in routine practice indicates excellent long-term results of combined therapy in locally advanced GISTs.

Results of liver transplantation in the Department of General, Transplant and Liver Surgery at the Medical University of Warsaw in patients with chronic hepatitis B and C viruses infection.

INTRODUCTION: Cirrhosis related to hepatitis C virus (HCV) and hepatitis B virus (HBV) infection is the most frequent indication for liver transplantation worldwide. Progress in prophylaxis of posttransplant HBV recurrence has led to major improvements in long-term outcomes of patients after liver transplantation. Conversely, impaired posttransplant survival of patients with HCV infection was reported in several studies, mainly due to recurrence of viral infection. The purpose of this study was to compare long-term results of liver transplantation between patients with HBV monoinfection, HCV monoinfection and HBV/HCV coinfection. MATERIAL AND METHODS: A total of 1090 liver transplantations were performed in the Department of General, Transplant and Liver Surgery in cooperation with the Department of Immunology, Internal Medicine, and Transplantology at the Transplantation Institute Medical University of Warsaw between December 1994 and May 2012. After exclusion of patients with cirrhosis of non-viral etiology, patients with malignant tumors, and patients with acute liver failure, the final study cohort comprised 209 patients with HBV (HBV+/HCV- subgroup; n = 56) or HCV (HBV-/HCV+ subgroup; n = 119) monoinfection or HBV/HCV coinfection (HBV+/HCV+; n = 34). These subgroups of patients were compared in terms of long-term results of transplantations, defined by 5-year patient and 5-year graft survival estimates. RESULTS: Overall and graft survival rates after 5-years for the whole study cohort were 74.5% and 72.6%, respectively. Five-year overall survival was 70.4% for patients within the HBV+/HCV- subgroup, 77.8% for patients within the HBV-/HCV+ subgroup, and 68.5% for patients within the HBV+/HCV+ subgroup. The corresponding rates of graft survival were 67.0%, 76.3%, and 68.5% for patients within the HBV+/HCV-, HBV-/ HCV+, and HBV+/HCV+ subgroups, respectively. Observed differences were non-significant, both in terms of overall (p = 0.472) and graft (p = 0.461) survival rates. CONCLUSIONS: Both overall and graft survival rates after liver transplantations performed in the Department of General, Transplant and Liver Surgery in cooperation with the Department of Immunology, Internal Medicine, and Transplantology at the Transplantation Institute Medical University of Warsaw in patients with HBV and HCV infection are comparable to those reported by other European and American centers. In contrast to other studies, obtained results do not confirm the negative impact of HCV infection on long-term outcomes of patients.

1000 liver transplantations at the Department of General, Transplant and Liver Surgery, Medical University of Warsaw--analysis of indications and results.

THE AIM OF THE STUDY: was to analyze indications and results of the first one thousand liver transplantations at Chair and Clinic of General, Transplantation and Liver Surgery, Medical University of Warsaw. MATERIAL AND METHODS: Data from 1000 transplantations (944 patients) performed at Chair and Clinic of General, Transplantation and Liver Surgery between 1994 and 2011 were analyzed retrospectively. These included 943 first transplantations and 55 retransplantations and 2 re-retransplantations. Frequency of particular indications for first transplantation and retransplantations was established. Perioperative mortality was defined as death within 30 days after the transplantation. Kaplan-Meier survival analysis was used to estimate 5-year patient and graft survival. RESULTS: The most common indications for first transplantation included: liver failure caused by hepatitis C infection (27.8%) and hepatitis B infection (18%) and alcoholic liver disease (17.7%). Early (< 6 months) and late (> 6 months) retransplantations were dominated by hepatic artery thrombosis (54.3%) and recurrence of the underlying disease (45%). Perioperative mortality rate was 8.9% for first transplantations and 34.5% for retransplantations. Five-year patient and graft survival rate was 74.3% and 71%, respectively, after first transplantations and 54.7% and 52.9%, respectively, after retransplantations. CONCLUSIONS: Development of liver transplantation program provided more than 1000 transplantations and excellent long-term results. Liver failure caused by hepatitis C and B infections remains the most common cause of liver transplantation and structure of other indications is consistent with European data.

Transjugular Intrahepatic Porto-Caval Shunt (TIPS) in treatment of portal hypertension in liver transplant recipiens.

BACKGROUND: TIPS, as non-operative treatment of portal hypertension allows for safe awaiting liver transplantation for patients otherwise at high risk of hemorrhage from oesophageal varices veins. When endoscopic treatment fails, TIPS is a plausible and less hazardous alternative for surgical porto-systemic shunts. It is of particular importance in patients with liver failure and unacceptable operative risk (group C in Child-Pugh classification). MATERIAL/METHODS: TIPS was done in 96 patients aged 16-68 years (average 52 years). According to Child-Pugh classification, which documents a stage of liver failure, 60 patients (62%) were in group B, and 36 (38%) in group C. Patients from group C are in most severe condition and at highest operative risk. Postalcoholic and postinflammatory liver cirrhosis is a main cause of portal hypertension. RESULTS: TIPS was done in 26 patients expecting liver transplantation. Twenty patients had subsequently undergone liver transplantation while remaining 6 are still on the waiting list. In 15 patients stenosis of the shunt was observed within a year. Stenosis was then treated with intervention radiology and implantation of supplemental stents. CONCLUSIONS: TIPS as a non-operative option for treatment of portal hypertension gives a patient an opportunity to await liver transplantation with maximum possible safety. Considering these facts, TIPS is called a bridge to liver transplantation.

Results of liver transplantation for hepatocellular cancer.

BACKGROUND: Liver transplantation (LTx) for hepatocellular carcinoma (HCC) in cirrhotic liver is nowadays generally accepted treatment modality. AIM OF STUDY: Overview of the indications and results of the LTx in the patients with HCC, the first one performed in 2001. MATERIAL/METHODS: Among 357 adult liver transplant recipients in the period 1994-04.2005, in 26 (7%) the indication was HCC (16 men: 10 women, age 20-65, mean 46.5 years). HCC developed in cirrhotic liver in 25 pts. 12 (48%) were Child C, 10 (30%)--Child B and 3 (12%)--Child A patients. As underlying disease in 2 patients (8%) was alcoholic cirrhosis, in 7 (28%)--HBV cirrhosis, in 12 (48%)--HCV cirrhosis and in 4 (16%)--HBV/HCV cirrhosis. Milano criteria were met in 20 patients (77%). The mean waiting list time was 2.9 months (range 1-6 months). Seven patients underwent liver resection and 1 transarterial chemoembolization prior to LTx. 11 patients (42%) were operated on with use of veno-venous bypass, in 15 patients (58%) the piggy back technique was applied. Rapamycine based immunosuppression was preferred in post-LTx treatment. RESULTS: Operative mortality was 0.4 patients required relaparotomy for intraperitoneal bleeding. 21 patients (81%) are alive in good general condition, 19--free of the disease. 5 patients died 7-28 months after LTx (mean 16.7). The mean survival time is 20 months (range 1-38). CONCLUSIONS: Liver transplantation is safe and effective method of treatment of the selected patients with HCC in cirrhotic liver. Further investigations concerning the precise indications, timing of the transplantation and adjuvant treatment are necessary.

Different factors are responsible for predicting relapses after primary tumors resection and for imatinib treatment outcomes in gastrointestinal stromal tumors.

BACKGROUND: The development of accurate diagnostic methods in gastrointestinal stromal tumors (GISTs) and the introduction of imatinib (IM) therapy has focused attention on the factors influencing the prognosis of patients with primary lesions as well as of patients with advanced disease treated with imatinib. MATERIAL/METHODS: The clinico-pathological and genetic factors influencing disease-free survival (DFS) in 335 patients with primary CD117-immunopositive tumors (group A; calculated from primary tumor resection) and progression-free survival (PFS) in 232 metastatic/unresectable GIST patients treated with IM (group B; calculated from the start of imatinib therapy) were analyzed. RESULTS: In group A, statistically significant factors negatively influencing DFS(five-year DFS: 38%), both in univariate and multivariate analysis, were: primary tumor size >5 cm, mitotic index >5/50 HPF (high-power fields), male gender, primary tumor R1 resection or tumor rupture, non-gastric primary tumor localization. In group B, five factors negatively affecting PFS (three-year PFS: 54%) were identified, which were statistically significant both in univariate and multivariate analyses: WHO performance status >/=2, tumor genotype indicating other than exon 11 KIT mutation, high baseline pre-IM granulocyte count, mitotic index >10/50 HPF, and age <45 years at diagnosis. CONCLUSIONS: Different sets of independent biological and pathological prognostic factors were identified for the assessment of the natural course of primary GIST and for the prediction of PFS during IM therapy for advanced GIST.

Prevention of hepatitis B recurrence after liver transplantation using lamivudine and hepatitis B immune globulin.

BACKGROUND: Patients undergoing liver transplantation (ltx) for hepatitis B-related liver disease are prone to recurrence. Historically, ltx has been associated with aggressive reinfection and poor survival results. The mainstay of prophylaxis has been passive immunotherapy with hepatitis B immune globulin(HBIG). Antiviral prophylaxis with lamivudine appears to reduce hepatitis B virus (HBV)infection after liver transplantation. However, HBV recurrence remains common. This study retrospectively evaluated a single center's experience with cohort of patients who underwent ltx for HBV-related chronic and acute liver disease. We examined the effect of a combined of intravenous HBIG and lamivudine viral prophylactic therapy on HBV recurrence and the outcome of ltx. MATERIAL/METHODS: Eighteen patients underwent transplantation for HBV liver disease at our center. Before ltx all patients were HBsAg positive and 3 were HBV DNA positive. HBV recurrence was defined by HBsAg seropositivity after ltx. HBIG monotherapy was used in 2 (15%) patients, lamivudine monotherapy in 4 (31%), and lamivudine and HBIG combination in 7 (54%). Hepatocellular carcinoma was present in 1 patients. Maintenance immunosuppression regimens consisted of either a cyclosporine- or tacrolimus-based drug regimen. RESULTS: Overall 1-year and 3-years patient survival rates were 60% and 60%, respectively, and 1-year and 3-years graft survival was 60% and 60% respectively. Among 7 patients receiving receiving combination HBIG and lamivudine, one patient died. He was retransplanted 9 months after first transplantation secondary to biliary complication caused by late hepatic artery thrombosis. Of the 6 surviving patients, 4 patients currently have normal allograft function. Allograft dysfunction developed in two patients because of ischemic biliary strictures. Among seven patients, who received HBIG and lamivudine, one did not receive proper administration of the prophylactic regimen and graft became infected. Serologic HBV recurrence was diagnosed after 9 months after transplantation. CONCLUSIONS: Liver transplantation for HBV under combination viral prophylaxis results in good survival rates. A good outcome is possible after liver transplantation for HBV liver disease using HBIG dosed by pharmacokinetic parameters in combination with lamivudine. Viral prophylactic therapy has effectively reduced HBV recurrence and prolonged survival outcome.

Surgical treatment of patients with initially inoperable and/or metastatic gastrointestinal stromal tumors (GIST) during therapy with imatinib mesylate.

BACKGROUND: The aim of the study was to analyze the surgical possibilities of unresectable and/or metastatic GIST CD117(+) patients during imatinib treatment. METHODS: We analyzed the results of surgery in 141 patients treated with imatinib for initially inoperable and/or metastatic GIST CD117(+). Median follow-up time was 12 months (range: 3-26). RESULTS: Surgery was performed as subsequent treatment in 24 patients (Group I, 17%) for resection of residual disease after complete/partial response and lack of further response to imatinib and as salvage therapy in eight patients (Group II, 6%), who progressed on initially successful imatinib therapy. In Group I, the viable GIST cells were not detected histologically in only three resection specimens. The first five patients in Group I did not receive imatinib further and we observed four recurrences. In next 19 patients, continuing imatinib after surgery, we observed only one relapse. In Group II, we continued imatinib therapy after high-risk surgical procedures, but in five patients we observed subsequent progression. CONCLUSIONS: Surgical removal of residual disease during imatinib treatment may allow for complete remission in selected GIST patients after response to therapy, theoretically prolonging durable remission, but it is necessary to continue imatinib for its maintenance.

[Antioxidant status of patients with primary colorectal cancer and liver metastases of colorectal cancer]. / Potencjal antyoksydacyjny u chorych na pierwotnego raka jelita grubego oraz z przerzutami z raka jelita grubego do watroby.

In the present work we examined selected parameters of antioxidant status in patients with primary colorectal cancer and liver metastasis of colorectal cancer. Total antioxidant status (TAS), activity of superoxide dismutase (SOD) and catalase (CAT) were examined in colorectal primary cancer, liver metastasis of colorectal cancer and in blood serum of patients before and after surgery. It was found that patients have disordered function of the the antioxidant system. This is demonstrated by decreased TAS and changes in the activity of SOD and CAT, both in tumor tissue and blood serum.