Downstaging with Radioembolization or Chemotherapy for Initially Unresectable Intrahepatic Cholangiocarcinoma.

OBJECTIVE: The aim of this retrospective study was to compare the outcomes of patients resected for intrahepatic cholangiocarcinoma (ICC) with upfront surgery or after downstaging treatment. METHODS: All consecutive patients with ICC between January 1997 and November 2017 were included in a single-center database and retrospectively reviewed. Patients were divided into two groups: upfront resection or resection after downstaging using either chemotherapy alone or selective internal radiation therapy (SIRT) combined with chemotherapy. Survival rates of patients who underwent upfront surgery for ICC were compared with those of patients who underwent surgery after downstaging therapy. RESULTS: A total of 169 patients resected for ICC were included: 137 underwent upfront surgery and 32 received downstaging treatment because their tumor was initially unresectable (13 received chemotherapy, 19 received SIRT). Median OS was not different between the two groups: 32.3 months [95% confidence interval (CI) 23.9-40.7] with primary surgery versus 45.9 months (95% CI 32.3-59.4) with downstaging treatment (p = 0.54, log-rank test). In a multivariable Cox regression model, downstaging treatment was not associated with a better or worse prognosis; however, delivery of SIRT as a downstaging treatment was associated with a significant benefit in multivariable analysis (hazard ratio 0.34, 95% CI 0.14-0.84; p = 0.019). CONCLUSIONS: Overall survival of patients resected after downstaging treatment was not different compared with the OS of patients resected upfront. Patients should therefore again be discussed with the surgeon following medical treatment. SIRT may be an efficient neoadjuvant therapy in patients with resectable ICC, in order to improve surgical results.

Bariatric Surgery is feasible in patients with Ehlers-Danlos Syndrome.

BACKGROUND: Ehlers-Danlos syndrome (EDS) is a heterogeneous disease affecting connective tissues. EDS patients have a high susceptibility for developing anastomotic leak after visceral surgery. Although patients with EDS can also develop severe obesity and might be referred to bariatric surgery, there is just 1 case report in the literature regarding the outcomes of bariatric surgery in this specific context. OBJECTIVE: To report the cases of patients with EDS and severe obesity that underwent bariatric surgery. SETTING: Five French hospitals (University Hospital of Nantes, APHP Pitié Salpêtrière Hospital, APHP Bichat Hospital, Clinique St Gregoire Rennes, and Clinique Mutualiste de l'Estuaire St Nazaire). METHODS: We report the cases of 7 patients with EDS and severe obesity who underwent surgery. RESULTS: All patients showed classical postoperative course except for 1 case of excessive bleeding. There was no increased pain, leak, and solid parietal healing was achieved in all patients at 1 month postoperatively. The percent excess weight loss at 1 and 6 months were 13.9 ± 3.8% and 45.3 ± 16%, respectively. CONCLUSION: Our study shows that bariatric surgery is a relevant and apparently safe surgical option to consider in severely obese patients with EDS.