Chemotherapy in patients with a solitary colorectal liver metastasis - A nationwide propensity score matched study.

INTRODUCTION: Chemotherapy is widely used as an adjunct to surgery in the treatment of patients with resectable colorectal liver metastases. The aim of this study was to examine whether chemotherapy confers a survival benefit in patients with a solitary colorectal liver metastasis. METHODS: All consecutive patients between 2009 and 2017 in Sweden who were resected for a solitary colorectal liver metastasis were included. Patients treated with chemotherapy were compared with patients who had surgery alone. Unmatched and propensity score matched analyses were performed to compare overall survival, morbidity and mortality. RESULTS: Of 1224 eligible patients, 641 (52.4%) patients had chemotherapy, and 583 (47.6%) had surgery alone. After propensity score matching, two balanced groups with 102 patients in each, were analyzed. There was no difference in readmission within 30-days (p = 0.250), or morbidity, defined as Clavien-Dindo 3a or greater, between the groups (p = 0.761). There were no mortalities within ninety days. Radical resection margins were achieved in 92 (n = 94) per cent in the chemotherapy group, and 77 (n = 78) per cent in the surgery alone group (p = 0.016). Median overall survival was 91 (95% CI 73-109) months in the chemotherapy group, and 78 (95% CI 37-119) months in the surgery-alone group (p = 0.652). CONCLUSION: This nationwide register-based study showed no difference in overall survival between patients treated with chemotherapy compared to surgery alone. Upfront surgery may be advisable in resectable solitary colorectal liver metastasis.

[Limitations of liver resections]. / Limitácie resekcií pecene.

Evaluation of the functional reserve before resectional performance and sufficient rest of liver parenchyma function is essential for the surgeon. From these factors, the decision based on operability, the maximum extent of liver parenchyma resection and the severity of post-operative course. In the period from December 2003 to December 2008, at the Dept of Transplant and Vascular surgery, JLF UK Martin, have been performed 161 resections of the liver in 144 patients, of which 91 large resections performances in the liver (hemihepatektomies or greater performance). Six patients have undergone repeated resection (4.1%), in 11 patients was performed Radio Frequency Ablation due to relaps of the disease (6.1%), and 3 patients were performed two steps resection. Of 91 major resection performance in the liver was 62 (68%) performed by anatomical boundaries of individual segments, in remaining 29 (32%) resections was reflected more to the localization of tumor itself as anatomical subdivision called combined anatomical and non-antomical resection. Radical resection R0 has been achieved in 76% of malignant tumors. In the post-operative course in 17% experienced complications, most often to the hematoma and biloma in place of the resection area, pleural effusion and 8 patients had postoperative liver dysfunction. Of this group, 5 patients had made volumetric examinations, and in all was the volume of residual liver parenchyma < 30% of the total volume of functional liver. Mortality within 30 days of the performance was 1.1%. The survival of patients was affected mainly by extent of resection, histological type of tumor, radicality of resection and necessity of the complex surgical procedures. Based on our evaluation of the results of a group of patients was arranged scheme measures for planning resectional procedures of the liver in our department. These include the adjustment of laboratory parameters, management of jaundice, preference of anatomical resections and volumetric examinations in patients with an estimated loss of more than 60-70% functional parenchyma of liver.

Reactivity of urinary bladder smooth muscle in guinea pigs to acetylcholine and carbachol--participation of acetylcholinesterase.

The authors examined the influence of acetylcholinesterase inhibitor (neostigmine) on the in vitro reactivity of urinary bladder smooth muscle (UBSM) in guinea pigs. The aim of the present study was to determine the participation of pharmacokinetic properties of acetylcholine and carbachol in different UBSM reactivity to these mediators. In vitro method of organ baths was used and reactivity of UBSM strips to cumulative doses of acetylcholine and carbachol was tested before and after the incubation with neostigmine (10(-4) mol.l(-1)). Neostigmine caused a significant increase of UBSM reactivity to acetylcholine. The UBSM reactivity to acetylcholine was significantly higher at concentrations of 10(-5) and 10(-4) mol.l(-1) compared to carbachol at the same concentrations. These findings indicate that in addition to different mediator affinity to muscarinic receptors and to their different intrinsic activity, the pharmacokinetic properties of acetylcholine and carbachol also participate in UBSM reactivity.