EASL-EORTC clinical practice guidelines : management of hepatocellular carcinoma

Bevacizumab plus Irinotecan,Fluorouracil,and Leucovorin for Metastatic Colorectal Cancer

Posthepatectomy liver failure: A definition and grading by the International Study Group of Liver Surgery (ISGLS)

There is still an unresolved paradox with respect to the immunomodulating role of estrogens. On one side, we recognize inhibition of bone resorption and suppression of inflammation in several animal models of chronic inflammatory diseases. On the other hand, we realize the immunosupportive role of estrogens in trauma/sepsis and the proinflammatory effects in some chronic autoimmune diseases in humans. This review examines possible causes for this paradox. This review delineates how the effects of estrogens are dependent on criteria such as: 1) the immune stimulus (foreign antigens or autoantigens) and subsequent antigen-specific immune responses (e.g., T cell inhibited by estrogens vs. activation of B cell); 2) the cell types involved during different phases of the disease; 3) the target organ with its specific microenvironment; 4) timing of 17beta-estradiol administration in relation to the disease course (and the reproductive status of a woman); 5) the concentration of estrogens; 6) the variability in expression of estrogen receptor alpha and beta depending on the microenvironment and the cell type; and 7) intracellular metabolism of estrogens leading to important biologically active metabolites with quite different anti- and proinflammatory function. Also mentioned are systemic supersystems such as the hypothalamic-pituitary-adrenal axis, the sensory nervous system, and the sympathetic nervous system and how they are influenced by estrogens. This review reinforces the concept that estrogens have antiinflammatory but also proinflammatory roles depending on above-mentioned criteria. It also explains that a uniform concept as to the action of estrogens cannot be found for all inflammatory diseases due to the enormous variable responses of immune and repair systems.

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The complex role of estrogens in inflammation

This review is intended to stimulate interest in the effect of increased expression of heme oxygenase-1 (HO-1) protein and increased levels of HO activity on normal and pathological states. The HO system includes the heme catabolic pathway, comprising HO and biliverdin reductase, and the products of heme degradation, carbon monoxide (CO), iron, and biliverdin/bilirubin. The role of the HO system in diabetes, inflammation, heart disease, hypertension, neurological disorders, transplantation, endotoxemia and other pathologies is a burgeoning area of research. This review focuses on the clinical potential of increased levels of HO-1 protein and HO activity to ameliorate tissue injury. The use of pharmacological and genetic probes to manipulate HO, leading to new insights into the complex relationship of the HO system with biological and pathological phenomena under investigation, is reviewed. This information is critical in both drug development and the implementation of clinical approaches to moderate and to alleviate the numerous chronic disorders in humans affected by perturbations in the HO system.

Pharmacological and Clinical Aspects of Heme Oxygenase

A case report of an octogenarian who is alive without any evidence of cancer recurrence more than five years after right hepatopancreatoduodenectomy for hilar cholangiocarcinoma

Background/Aims
Since the usefulness of neoadjuvant chemo(radiation) therapy (NAT) for pancreatic cancer (PC) has been demonstrated, recurrent biliary obstruction (RBO) in patients with PC with a fully covered self-expandable metal stent (FCSEMS) during NAT is expected to increase. This study investigated the impact of sarcopenia on RBO in this setting.


Methods
Patients were divided into normal and low skeletal muscle index (SMI) groups and retrospectively analyzed. Patient characteristics, overall survival (OS), time to RBO (TRBO), stent-related adverse events, and postoperative complications were compared between the two groups. A Cox proportional hazard model was used to identify the risk factors for short TRBO.


Results
A few significant differences were observed in patient characteristics, OS, stent-related adverse events, and postoperative complications between 38 patients in the normal SMI group and 17 in the low SMI group. The median TRBO was not reached in the normal SMI group and was 112 days in the low SMI group (p=0.004). In multivariate analysis, low SMI was the only risk factor for short TRBO, with a hazard ratio of 5.707 (95% confidence interval, 1.148-28.381; p=0.033).


Conclusions
Sarcopenia was identified as an independent risk factor for RBO in patients with PC with FCSEMS during NAT.

Impact of sarcopenia on biliary drainage during neoadjuvant therapy for pancreatic cancer.

We report a case of survival for more than 6 years following left hepatic trisectionectomy and caudate lobectomy with simultaneous resection of the portal vein and right hepatic artery. The patient was a 65-year-old woman admitted to a local hospital with obstructive jaundice. The patient was diagnosed with perihilar cholangiocarcinoma and referred to our hospital. The tumor was located mainly in the left hilar region and occluded the left portal vein; furthermore, it involved the right portal vein and the right hepatic artery. The patient underwent left hepatic trisectionectomy and caudate lobectomy with simultaneous resection of the portal vein and right hepatic artery. The histological findings revealed that the tumor had invaded the portal vein and surrounded the right hepatic artery without any lymph node metastases. Microscopic curative (R0) resection was achieved. The patient is now healthy and still alive 6 years and 6 months after the surgery without any recurrence. Precise preoperative evaluation of the tumor and R0 resection by extended surgery contributed to a satisfactory outcome.

Six-year survival following left hepatic trisectionectomy with simultaneous resection of the portal vein and right hepatic artery for advanced perihilar cholangiocarcinoma without lymph node metastases: report of a case

[Up-to-date surgical treatment for biliary tract cancer].

We previously demonstrated that preoperative poor skeletal muscle mass and poor functional exercise capacity were associated with not only a higher rate of postoperative morbidity and mortality but also worse long-term survival in patients undergoing surgery for HPB malignancies. These results clearly indicate the importance of increasing skeletal muscle mass and improving physical fitness before HPB surgeries for malignancies.

Yukihiro Yokoyama

Papers

A case report of an octogenarian who is alive without any evidence of cancer recurrence more than five years after right hepatopancreatoduodenectomy for hilar cholangiocarcinoma

Impact of sarcopenia on biliary drainage during neoadjuvant therapy for pancreatic cancer.

Six-year survival following left hepatic trisectionectomy with simultaneous resection of the portal vein and right hepatic artery for advanced perihilar cholangiocarcinoma without lymph node metastases: report of a case

[Up-to-date surgical treatment for biliary tract cancer].

ASO Author Reflections: Is It Important to Do Exercise Before Surgery for HPB Malignancy?