Conversion managment of colorectal cancer with simultaneous unresectable hepatic metastasis / 中华普通外科杂志

Objective:To investigate the efficacy of different conversion therapies for colorectal cancer with unresectable simultaneous liver metastasis.Methods:A total of 170 patients of colorectal cancer complicated with liver metastasis who were admitted to the First Affiliated Hospital of Nanchang University from Jan 2015 to Dec 2020 were included in the study. Patients were divided into an initial resectable group (42 cases) and an initial non-resectable group (128 cases).Results:There were no significant differences in OS and PFS between patients with CRLM (colorectal cancer with liver metastasis) who were resected initially and those successfully underwent transformation therapy ( P>0.05). The median OS was 36 months in the group with successful transformation, while it was 21 months in the group with simple primary tumor resection and no liver metastasis resection ( P=0.014), HR=0.48 (0.27-0.86). The median PFS was 28 months in the successful conversion group, while it was 10 months in the primary tumor resection only and no liver metastasis resection ( P=0.005), HR=0.43 (0.24-0.77). The OS difference between the group with simple primary tumor resection and no resected liver metastasis and the group with neither primary tumor nor liver metastasis resection was statistically significant: (21 months vs.13 months), HR=0.52 (0.32-0.86) ( P=0.01), while the PFS between the two groups was not statistically significant, ( P>0.05). Conclusions:Chemotherapy combined with targeted therapy has the best effect among the conversion therapies, and can improve the resection rate and survival rate of patients undergoing R 0 surgery. Resection of the primary lesion alone can also prolong the patient's survival.

Propensity score matching analysis on the safety and short-term outcomes of laparoscopic hepatectomy after conversion therapy versus pure laparoscopic hepatectomy / 中华肝胆外科杂志

Objective:To compare the safety and short-term prognosis of laparoscopic hepatectomy after conversion therapy versus pure laparoscopic hepatectomy for patients with hepatocellular carcinoma (HCC).Methods:A total of 740 patients with HCC undergoing laparoscopic hepatectomy at Sun Yat-sen Memorial Hospital of Sun Yat-sen University between January 2019 and December 2022 were screened for study eligibility, among which 433 patients were eligible, including 364 males and 69 females, aged (57.2±11.1) years. Patients who underwent laparoscopic hepatectomy after conversion therapy (including interventional therapy combined with targeted therapy or targeted therapy combined with immunotherapy, etc.) were marked as conversion resection group ( n=36), and those who underwent laparoscopic hepatectomy alone were marked as pure resection group ( n=397). After propensity score matching (PSM), 29 cases in the conversion resection group and pure resection group were finally enrolled. Preoperative (tumor number, maximum tumor diameter, etc.), intraoperative (operation time, intraoperative blood loss, etc.) and postoperative (hospital stay, drainage volume, complications, etc.) data and short-term prognosis were compared between the two groups. Survival curves and rates were analyzed using Kaplan-Meier and log-rank test. Results:The baseline characteristics including the occurrence of liver cirrhosis, the tumor number and maximum diameter showed no significant differences between the two groups after PSM (all P>0.05), indicating comparability. There were no statistical differences between the two groups in terms of operation time, intraoperative blood loss, postoperative hospital stay, postoperative drainage volume etc. (all P>0.05). The incidences of postoperative complications and severe complications (Clavien-Dindo grade ≥Ⅲ) were 34.5% (10/29) and 6.9% (2/29) in pure resection group, and 41.4% (12/29) and 10.3% (3/29) in conversion resection group, respectively, with no significant difference between the two groups (χ 2=0.29, 0, P=0.588, 1.000). The recurrence-free survival rates at 6, 12 and 18 months after surgery were 79.2%, 70.7% and 70.7% in conversion resection group and 86.2%, 82.8% and 79.3% in pure resection group, the overall survival rates at 6, 12, and 18 months after surgery were 96.4%, 89.5%, 74.6% in conversion resection group, and 100.0%, 96.6% and 93.1% in pure resection group, with no significant difference (χ 2=1.90, 1.91, P=0.168, 0.167). Conclusion:Laparoscopic hepatectomy after conversion therapy for initially unresectable HCC has comparable safety and short-term prognosis with the pure laparoscopic hepatectomy.

Short-term efficacy and safety analysis of TACE combined with TKI and PD-1 inhibitors in the treatment of initially unresectable hepatocellular carcinoma / 中华肝胆外科杂志

Objective:To evaluate the efficacy and safety of transhepatic arterial chemoembolization (TACE) combined with tyrosine kinase inhibitors (TKI) and programmed death-1 (PD-1) inhibitors in the treatment of patients with initially unresectable hepatocellular carcinoma.Methods:The clinical data of 42 patients with initially unresectable hepatocellular carcinoma who were admitted to the Department of Hepatobiliary and Pancreatic Surgery of the First Affiliated Hospital of Zhengzhou University from January 2020 to December 2022 were included. There were 31 males and 11 females, with a median age of 56 years old (range, 45-72 years old). All patients received TACE+ TKI+ PD-1 inhibitor combined treatment. The systemic treatment cycles were calculated by the regimen of immunotherapy. The timing of local treatment depends on tumor size, blood supply and treatment response. Patients were followed up through hospitalization, outpatient visits and telephone review. The Kaplan-Meier curves were obtained for survival analysis.Results:The dosing cycle to achieve optimal imaging response in the patients was 4 (3, 7) [ M( Q1, Q3)], with a systemic treatment time of 141 (65, 194) d [ M( Q1, Q3)] and 2 (1, 3) times [ M( Q1, Q3)] of local treatments. All patients were evaluated by modified response evaluation criteria in solid tumors criteria after treatment, including nine patients with complete response (CR), 21 with partial response, eight with stable disease, and four with progressive disease. Objective response rate and disease control rate were 71.4% (30/42) and 90.5% (38/42), respectively. Treatment-related adverse reactions occurred in 85.7% (36/42) of patients and grade Ⅲ or Ⅳ adverse reactions occurred in 16.7% (7/42). There was no level Ⅳ adverse reactions. All adverse reactions were controlled after dose reduction and symptomatic treatment. Thirteen patients (31.0%, 13/42) redeemed resectable after treatment and underwent radical surgery. Seven patients had pathological CR after surgery. In two patients, the pathological residual cancer tissue was less than 10%. The cumulative overall survival rates of the 42 patients at 6 months, 1 year, 1.5 years after treatment were 100%, 91.7%, and 65.0%, respectively. The postoperative 1-year survival rate of patients undergoing surgery after successful conversion was 83.3%. Conclusion:This study preliminarily showed the safety and efficacy of TACE, TKI, and PD-1 inhibitor combined therapy in patients with initially unresectable hepatocellular carcinoma.

Strategies of conversion therapy for liver carcinoma / 中华肝胆外科杂志

Surgery-led comprehensive treatment is an important consensus in the management of liver carcinoma. Hepatectomy and liver transplantation are the most important means for patients with liver carcinoma to achieve long-term survival. With the development of liver surgery techniques, liver surgery is no longer off-limits. Translational therapy offers the hope of surgical radical treatment for patients with initially unresectable liver carcinoma. This article discusses the conversion therapy for unresectable liver carcinoma with future liver remnant surgery, the downstaging conversion therapy of oncologically unresectable intermediate to advanced liver carcinoma, the timing of surgery after conversion, and safety and efficacy. Prospect for the formation of the standardization of translational therapy for liver carcinoma is made.

Clinical efficacy of sequential surgery after immune and targeted therapy in downstaging initially unresectable hepatocellular carcinoma / 中华肝胆外科杂志

Objective:To assess the clinical efficacy of sequential radical surgery after immune and targeted therapy in downstaging patients with initially unresectable hepatocellular carcinoma.Methods:Data were prospectively collected from December 2018 to July 2022 on patients with initially unresectable hepatocellular carcinoma which were downstaged to undergo sequential surgery after treatment with immune and targeted therapy at the Faculty of Hepato-Pancreato-Biliary Surgery, Chinese PLA General Hospital. There were 79 patients, with 69 men and 10 women, aged (53.0±10.9) years, being enrolled into this study. The Kaplan-Meier method was used to calculate the survival rate, and the log-rank test was used for survival rate comparison. Univariate and multivariate Cox regression were used to analyze factors influencing patient prognosis.Results:There were 7 patients (8.9%) with China Liver Cancer Staging (CNLC) Ⅰb, Ⅱa, Ⅱb who had insufficient residual liver volume or tumor rupture before the downstaging therapy, and 38 patients (48.1%) with CNLC Ⅲa and 34 patients (43.0%) with CNLC Ⅲb. These 79 patients underwent R 0 resection after 3-20 cycles (median 5 cycles) of immune and targeted therapy. Based on the modified response evaluation criteria in solid tumor, the results of preoperative imaging assessment were: complete remission in 12 patients (15.2%), partial remission in 50 patients (63.3%), stable disease in 15 patients (19.0%), and disease progression in 2 patients (2.5%). The overall survival rates of patients at 1, 2, and 3 years after diagnosis were 96.1%, 83.5%, and 76.6%; and the recurrence-free survival rates at 1, 2, and 3 years after surgery were 62.1%, 52.9%, and 34.7%, respectively. On multivariate Cox regression analysis, patients with a preoperative alpha-fetoprotein >20 μg/L ( HR=2.816, 95% CI: 1.232-6.432, P=0.014) and a high proportion of pathological residual tumors ( HR=1.015, 95% CI: 1.004-1.026, P=0.006) had a higher risk of postoperative recurrence; and patients with a high proportion of pathological residual tumors ( HR=1.028, 95% CI: 1.007-1.049, P=0.007) and preoperative alpha-fetoprotein >400 μg/L ( HR=4.099, 95% CI: 1.193-14.076, P=0.025) had a higher risk of death. Conclusion:Immunotherapy combined with targeted therapy and sequential surgery for patients with initially unresectable hepatocellular carcinoma provided long-term survival benefits. Elevated preoperative alpha-fetoprotein and a high proportion of pathological residual tumor were independent risk factors for recurrence-free survival and overall survival in this group of patients.

Hot topics in perioperative immune combination therapy for liver cancer / 中华肝胆外科杂志

Most patients with primary hepatocellular carcinoma (HCC) are already in advanced stage when they are diagnosed, with a short survival period and an extremely poor prognosis. HCC seriously threatens the life and health of Chinese people. In recent years, breakthroughs have been made in systemic treatment of HCC, especially in immunotherapy represented by immune checkpoint inhibitors, which has broken the single therapy situation of molecular targeted drugs. And the strategy of immunotherapy combined with anti-angiogenic therapy has shown superiority and profoundly changed the treatment strategy of HCC. This article focuses on several hotspots of immune checkpoint inhibitors combined with anti-angiogenic targeted drugs in the perioperative scenario of HCC, and takes stock of the latest research progress of immunotherapy combined with anti-angiogenic drugs regimens in the perioperative application of HCC.

Clinical efficacy of radical resection of pancreatic cancer after neoadjuvant conversion therapy / 中华消化外科杂志

Objective:To investigate the clinical efficacy of radical resection of pancreatic cancer after neoadjuvant conversion therapy.Methods:The retrospective and descriptive study was conducted. The clinicopathological data of 23 patients who underwent radical resection of pancreatic cancer after neoadjuvant conversion therapy in Nanjing Drum Tower Hospital Affiliated to Nanjing University Medical School from January 2019 to May 2022 were collected. There were 17 males and 6 females, aged 58(range, 33-73)years. After neoadjuvant conversion therapy, the three-dimensional (3D) visualization was used to evaluate and classify tumor vascular invasion, and surgical plan was planned and implemented. Observation indicators: (1) situations of neoadjuvant conversion therapy; (2) surgical situations; (3) postoperative histopathological examination; (4) postoperative recovery; (5) follow-up. Measurement data with normal distribution were represen-ted as Mean± SD, and measurement data with skewed distribution were represented as M(range) or M( Q1, Q3). Count data were described as absolute numbers. Results:(1) Situations of neoadjuvant conversion therapy. All 23 patients received the AG combination chemotherapy (albumin-paclitaxel+gemcitabine), including 14 patients combined with stereotactic body radiation therapy. Of the 23 patients, 22 cases achieved partial response, and 1 case showed stable disease. The CA19-9 of the 23 patients was 85.06(29.74,634.5)U/mL and 13.96(9.74,25.02)U/mL before and after neoadjuvant conversion therapy, respectively. (2) Surgical situations. According to the results of preoperative 3D visualization of tumor vascular invasion, 7 of the 23 patients were evaluated as arterial invasion, 8 cases were evaluated as venous invasion, 5 cases were evaluated as arterial and venous invasion, and there were 3 cases showing negative of vascular invasion. Of the 23 patients, 12 cases underwent pancreaticoduodenectomy, 4 cases underwent radical antegrade modular pancreatosplenectomy, 7 cases underwent total pancreaticoduodenectomy. For vascular reconstruction, there were 10 patients without vascular reconstruction, and there were 13 patients undergoing artificial vascular vein reconstruction. The operation time and volume of intraoperative blood loss of the 23 patients was (524±171)minutes and 1 000(400,1 600)mL, respectively. (3) Postoperative histopathological exami-nation. Results of postoperative histopathological examination in 23 patients showed that there were 2 cases with moderate-well differentiated tumor, 10 cases with moderate differentiated tumor, 7 cases with moderate-poorly differentiated tumor, 2 cases with poorly differentiated tumor, and 2 cases negative of tumor. The number of lymph node dissected in 23 patients was 16±7. There were 5 cases with lymph node metastasis and 18 cases without lymph node metastasis. There were 17 cases with nerve invasion and 6 cases without nerve invasion. All 23 patients were negative of vascular invasion. Of the 23 patients, there were 21 cases with R 0 resection and 2 cases with R 1 resection. For pathological TNM staging, there were 2 cases with 0 stage, 13 cases with Ⅰ stage, 7 cases with Ⅱ stage, and 1 case with Ⅳ stage. For postoperative pathological scoring, there were 2 cases achieved 0 point (complete pathological remission), 16 cases achieved 2 points (partial remission), and 5 cases achieved 3 points (no significant effect). (4) Postoperative recovery. The postoperative duration of hospital stay of 23 patients was 19(14,31)days. There were 17 of 23 patients underwent postoperative complications, including 11 cases with Clavien-Dindo Ⅱ stage complications, 3 cases with Clavien-Dindo Ⅲa stage complications, 1 case with Clavien-Dindo Ⅲb stage complication, 1 case with Clavien-Dindo Ⅳ stage complication, and 1 case with Clavien-Dindo Ⅴ stage complica-tion. (5) Follow-up. There were 22 patients underwent follow-up, with follow-up time as 12(9,23)months. There were 9 patients underwent postoperative recurrence and metastasis, with recurrence and metastasis time as 7.8(range, 6.0-12.0)months. During the follow-up, 15 of the 22 patients survived. Conclusion:Radical resection of pancreatic cancer after neoadjuvant conversion therapy is feasible.

Consideration on hot issues of gastric cancer surgery / 中华消化外科杂志

In China, gastric cancer is the top three malignant tumors with high incidence and mortality, which seriously endangers the lives and health of people. The comprehensive treat-ment based on surgery is still the main treatment for gastric cancer. Through the unremitting efforts and hard works of gastric cancer experts, the treatment effect of gastric cancer in China has made great progress. However, gastric cancer surgery still faces some outstanding problems. How to further improve preoperative accurate diagnosis? How to further rationalize the treatment of early gastric cancer? Where is the future development of minimally invasive techniques for gastric cancer surgery? How to break through the bottleneck of conversion therapy? These are the challenges for gastric cancer surgery. Based on relevant literature and combined with own clinical practice, the author explores the hot issues of gastric cancer surgery.

Advances and challenges of conversion therapy and neoadjuvant therapy in hepatocellular carcinoma / 中华消化外科杂志

Hepatocellular carcinoma (HCC) is characterized by a low resection rate and a high postoperative recurrence rate. Conversion therapy and neoadjuvant therapy are effective stra-tegies to improve the long-term prognosis of patients with HCC. With the clinical application of new technologies and methods and the continuous emergence of new anti-tumor drugs, the conversion therapy and neoadjuvant therapy of HCC have ushered in an unprecedented development. At the same time, they are also facing many new challenges. Based on our own clinical experience and the latest progress in conversion therapy and neoadjuvant therapy of HCC, the authors classify and summarize the selection of treatment strategies and the challenges faced in HCC conversion therapy and neoadjuvant therapy.

LGBTQIA+ rights, mental health systems, and curative violence in India

This commentary examines the space-attitude-administrative complex of mainstream mental health systems with regard to its responses to decriminalisation of non-heteronormative sexual identities. Even though the Supreme Court, in its 2018 order, instructed governments to disseminate its judgment widely, there has been no such attempt till date. None of the government-run mental health institutions has initiated an LGBTQIA+ rights-based awareness campaign on the judgment, considering that lack of awareness about sexualities in itself remains a critical factor for a non-inclusive environment that forces queer individuals to end their lives. That the State did not come up with any awareness campaign as mandated in the landmark judgment reflects an attitude of queerphobia in the State. Drawing on the concept of “biocommunicability”, analysing the public interfaces of state-run mental health institutions, and the responses of mental health systems to the death by suicide of a queer student, I illustrate how mental health institutions function to further anti-LGBTQIA+ sentiments of the state by churning out customer-patients out of structural violence and systemic inequalities, benefitting the mental health economy at the cost of queer citizens on whom curative violence is practised.

Conversion therapy in patients with metastatic gastric cancer / 中华普通外科杂志

Objective:To investigate clinicopathological characteristics and efficacy of conversion therapy in patients with metastatic gastric cancer.Methods:The clinicopathological and follow-up data of metastatic gastric cancer patients at the Department of Gastrointestinal Surgery of Peking University People's Hospital from Jan 2018 to Jun 2021 were retrospectively studied. Multivariate Logistic regression analysis was used to identify independent characteristics for pathological complete response (PCR). The influence of stage of metastatic gastric cancer and pathological response on prognosis were analyzed by Kaplan-Meier curve.Results:A total of 31 patients were enrolled, and 13 tumors located at the cardia or fundus, 8 at body, other 10 at pylorus or antrum . Baseline CT evaluation showed retroperitoneal lymph node metastasis in 10 cases, intraperitoneal metastasis in 10 cases, liver metastasis in 2 cases, adrenal and splenic metastasis in 1 case respectively, and multiple metastasis in 5 cases. After conversion therapy, 8 (26%) cases had pathological T0, 16 cases (52%) had pathological N0 and 7 cases (22%) had pathological complete response. Multivariate Logistic regression analysis showed retroperitoneal lymph node metastasis ( OR: 20.082, 95% CI: 2.141-188.315, P=0.009) was the only independent risk factor of PCR. Meanwhile, Kaplan-Meier curve showed pT0 improved disease-free survival significantly ( P=0.021). Conclusions:Metastatic gastric cancer patients with retroperitoneal lymph node metastasis alone had a tolerable conversion therapy effect. pT0 is a significant factor in improving prognosis.

Prognostic factors affecting the success of conversion chemotherapy in patients with unresectable liver metastases from initially colorectal cancer / 中华胃肠外科杂志

Objective: To investigate the factors affecting the success of conversion therapy in patients with initially unresectable colorectal cancer liver metastases (CRLM) in order to provide evidence-based medical evidence for formulating individualized treatment strategies for patients. Methods: A retrospective case-control study was used in this study. Clinical data of 232 patients with initially unresectable CRLM receiving first-line systemic treatment in Sun Yat-sen University Cancer Center from January 2013 to January 2020 were collected, including 98 patients of successful conversion and 134 patients of failed conversion as control. Conversion therapy scheme: 38 patients received FOLFOXIRI regimen chemotherapy (irinotecan, oxaliplatin, calcium folinate and fluorouracil), 152 patients received FOLFOX regimen (oxaliplatin, calcium folinate and fluorouracil), 19 patients received FOLRIRI regimen (irinotecan, calcium folinate and fluorouracil), 23 patients received systemic chemotherapy combined with fluorouridine hepatic artery infusion chemotherapy; 168 patients received targeted therapy, including 68 of bevacizumab and 100 of cetuximab. Logistics analysis was used to compare the factors affecting the success of conversion therapy. The Kaplan-Meier method was used to calculate progression-free survival (PFS), and the Log-rank test was used for survival comparison. Results: Among 232 patients, 98 patients had successful conversions and 134 patients had failed conversions with a successful conversion rate of 42.2%, meanwhile 30 patients underwent simple hepatectomy and 68 underwent hepatectomy combined with intraoperative radiofrequency ablation. After first-line chemotherapy, 111 patients (47.8%) were partial remission, 57 patients (24.6%) were stable disease, and 64 patients (27.6%) were progression disease. During the median follow-up of 18.8 (1.0-87.9) months, 148 patients were dead or with tumor progression. The median PFS time of patients with successful conversion was longer than that of patients with failed conversion (31.0 months vs. 9.9 months, P<0.001). Univariate analysis found that the bilobar distribution of liver tumors (P=0.003), elevated baseline carcinoembryonic antigen (CEA) levels (P=0.024), tumor invasion of the portal vein (P=0.001), number of metastatic tumor>8 (P<0.001), non-FOLFOXIRI (P=0.005), and no targeted therapy (P=0.038) were high risk factors for the failed conversion therapy. The results of multivariate logistics analysis indicated that the number of metastatic tumor >8 (OR=2.422, 95%CI: 1.291-4.544, P=0.006), portal vein invasion (OR=2.727, 95%CI: 1.237-4.170, P=0.008) were the independent risk factors for failed conversion therapy, while FOLFOXIRI regimen (OR=0.300, 95%CI: 0.135-0.666, P=0.003) and targeted drugs (OR=0.411, 95%CI: 0.209-0.809, P=0.010) were independent protective factors for successful conversion therapy. Conclusions: The number of metastatic tumor and portal vein invasion are key factors that affect the outcomes of conversion therapy for initially unresectable CRLM. If a patient can tolerate chemotherapy, a combination program of three-drug and targeted therapy is preferred for the active conversion therapy.

Perioperative immunotherapy for hepatocellular carcinoma / 临床肝胆病杂志

Hepatocellular carcinoma (HCC) greatly threatens the life and health of Chinese people. Most patients with HCC are already in the advanced stage when attending the hospital and are not eligible for radical treatment, and patients in the early stage of HCC who are eligible for radical treatment still face a high risk of recurrence after surgery. In recent years, immunotherapy based on immune checkpoint inhibitors (ICIs) has made great progress in the treatment of advanced HCC, and perioperative immunotherapy for HCC is attracting more and more attention. Immunotherapy in the perioperative period of HCC can improve the feasibility of hepatectomy, reduce the recurrence rate after hepatectomy, and prolong the survival of patients. This article discusses the application of ICIs-based immunotherapy in the perioperative period of HCC and the issues that need to be considered, so as to provide new ideas for perioperative immunotherapy for HCC.

Advances in preoperative treatment of colorectal cancer / 中华消化外科杂志

Preoperative treatment of colorectal cancer includes neoadjuvant therapy for initial resectable patients and conversion therapy for initial unresectable patients. In locally advanced rectal cancer, on the basis of neoadjuvant chemoradiotherapy or radiotherapy, increasing the intensity of concurrent chemotherapy, or raising postoperative adjuvant chemotherapy before surgery, or combining with immunotherapy can increase pathological downstaging, contribute to organ preservation, and improve survival of patients. In locally advanced colon cancer, neoadjuvant chemotherapy can improve surgical outcomes. In patients with resectable colorectal liver metastases, neoadjuvant chemotherapy is recommended in patients with unfavorable prognostic factors, but it remains controversial whether it should be combined with targeted therapy. However, in patients with initially unresectable colorectal liver metastases, under the guidance of molecular typing, chemotherapy, especially triple-drug chemotherapy, combined with targeted therapy, is expected to achieve higher objective response rate and convertible rate, thus accepting surgical resection, which improves long-term survival. In addition, for the patients with mismatch repair deficient/micro-satellite instability-high metastatic colorectal cancer, programmed death-1 monoclonal antibody (mAb) and/or cytotoxic T lymphocyte-associated antigen-4 mAb have become the standard first-line treatment option.

Radical hepatectomy in patients with initially unresectable liver cancer after conversion therapy / 中华普通外科杂志

Objective:To explore the clinical efficacy of radical surgery after successful conversion therapy for liver cancer.Methods:We retrospectively analyzed the clinical data of 10 patients with liver cancer who underwent successful conversion therapy and subsequent radical surgery in Peking University People's Hospital from Nov 2019 to Dec 2021.Results:The median age of the 10 patients was 64 (51.25,68.50) years. The median number of conversion therapy cycles was 11 (4.75,25.00). No serious adverse reactions were found in the patients during conversion therapy. After conversion therapy, 8 patients underwent partial hepatectomy, and 2 patients underwent radiofrequency ablation. Postoperative complications occurred in 4 patients. All complications were classified as Clavien-Dindo grade Ⅰ or Ⅱ. The median follow-up time was 13 (9.75,49.75) weeks. Three patients had tumor recurrence after surgery. Among the patients with tumor recurrence, 1 patient died of liver failure.Conclusions:Conversion therapy is an effective treatment for patients with clinically unresectable liver cancer. The incidence of serious adverse reactions in conversion therapy for liver cancer is low. The radical surgery can be safely performed in patients with good general condition and liver function. Radical surgery after conversion therapy can prolong the survival time of patients for unresectable liver cancer.

Clinical efficacy of immunotherapy plus targeted therapy combined with local treatment for unresectable hepatocellular carcinoma / 中华消化外科杂志

Immunotherapy combined with targeted therapy can benefit the survival of patients with unresectable hepatocellular carcinoma. Atezolizumab combined with bevacizumab has achieved remarkable efficacy in patients with advanced hepatocellular carcinoma, but the efficacy of conversion therapy in patients with unresectable hepatocellular carcinoma still needs more evidences. The authors report the clinical efficacy of a case of unresectable hepatocellular carcinoma with hepatitis B virus related liver cirrhosis who was treated with immunotherapy plus targeted therapy combined with local treatment. Results show a good effect in patient without tumor recurrence after postoperative 9 months.

Clinical efficacy of hepatic arterial infusion chemotherapy combined with atelizumab plus bevacizumab on first line treatment of advanced hepatocellular carcinoma / 中华消化外科杂志

The treatment of advanced hepatocellular carcinoma (HCC) is limited and the prognosis is poor, which seriously endangers the public health. Results of clinical trials have confirmed the validity of atelizumab plus bevacizumab in patients with advanced HCC. The authors introduce the clinical experience of a patient with stage Ⅲa HCC undergoing local therapy of hepatic artery chemoembolization, and combined with atelizumab plus bevacizumab. The results show that patient with successfully transformational therapy, and receiving surgical resection with a good clinical effect.

Safety and efficacy of a treatment protocol in converting initially unresectable to resectable hepatocellular carcinoma / 中华肝胆外科杂志

Objective:To study the safety and efficacy of a treatment protocol using immune checkpoint inhibitors (ICIs) and antiangiogenic targeted drugs (AATDs) in converting 41 patients with initially unresectable to resectable hepatocellular carcinoma (HCC).Methods:The data of 41 patients with initially unresectable HCC treated with immunotherapy combined with targeted therapy from December 2018 to April 2021 in Chinese PLA General Hospital were analysed. There were 34 males and 7 females, aged (51.8±10.7) years. The clinical characteristics, conversion to resectable HCC, adverse drug reactions, surgical data and postoperative complications were analysed. Patients were followed-up by outpatients clinics or telephone calls.Results:There were 5 patients with Chinese Liver Cancer Staging (CNLC)-Ⅰb, 4 with CNLC-Ⅱ, 28 with CNLC-Ⅲa and 4 with CNLC-Ⅲb before the treatment protocol. Among them, 28 patients had portal vein tumor thrombosis (PVTT) and 4 had retroperitoneal lymph node metastases. All patients had a mean tumor diameter of (9.16±4.43) cm before and (6.49±4.69) cm after the treatment protocol. The latter was based on the last assessment before hepatectomy. The efficacy of the treatment protocol in converting unresectable to resectable HCC was assessed by the modified Response Evaluation Criteria in Solid Tumors after 3-15 cycles (median dose cycles, 5) of protocal therapy: 15 patients achieved a complete response; 15 patients achieved a partial response; 6 patients had a stable disease, and 5 patients had a progressive disease. 21 patients (51.2%) experienced adverse reactions associated with drug treatment, which resolved with symptomatic treatment or brief discontinuation of the therapy. All patients underwent successful hepatectomy. Postoperative complications of grade Ⅱ or higher occurred in 9 patients (22.0%). The cumulative overall survival rates at 6 months, 1 year and 2 years from diagnosis were 100.0%, 92.6% and 64.7% respectively. The cumulative overall survival rates at 6 months, 1 year and 2 years after surgery were 95.1%, 74.7% and 60.8%, and the recurrence-free survival rates at 6 months, 1 year and 2 years after surgery were 87.8%, 56.7% and 48.6%, respectively.Conclusions:This study provided preliminary evidences that surgical resection after immunotherapy combined with targeted therapy in patients with initially unresectable HCC was safe and efficacious.

Will salvage surgery after conversion of initially unresectable to resectable hepatocellular carcinoma become a treatment option in this era of precision medicine? / 中华肝胆外科杂志

Hepatocellular carcinoma (HCC) is common in China. Most patients are at advanced stages of HCC at diagnosis, with short survival outcomes and poor prognosis. It is a major disease that seriously affects the health of many people. In recent years, the medical community has attempted to prolong survival and improve quality of life of patients by using multidisciplinary treatments. Immune checkpoint inhibitors, when combined with antiangiogenic targeted drugs, have achieved encouraging results in treatment of advanced hepatocellular carcinoma. This paper focuses on the issues of using salvage surgery after conversion of initially unresectable to resectable HCC by immune checkpoint inhibitors combined with antiangiogenic targeted drugs in treatment of advanced hepatocellular carcinoma, and makes a prediction on the prospect of this therapy protocol in treatment of these patients.

Strategies of neoadjuvant and conversion therapy for gastroenteropancreatic neuroendocrine neoplasms / 中华消化外科杂志

Gastroenteropancreatic neuroendocrine neoplasms (GEP-NENs) refer to a group of relatively rare and heterogeneous tumors. The treatment and prognosis are distinct for GEP-NENs of different genetic phenotypes, differentiation degree, pathological categories, staging and grading, clinical characteristics. Neoadjuvant therapy is becoming increasingly accepted in the compre-hensive treatment of GEP-NENs. More and more researches show that neoadjuvant therapy contri-butes to improve R 0 resection rate and eliminate metastasis of malignancies. However, the value of neoadjuvant therapy and whether it improves overall survival of GEP-NENs patients remain contro-versial. The principle of neoadjuvant therapy is to bring survival benefits for selective patients treated by optimal therapy at appropriate time. It is important to master certain degrees for above event nodes. Whether the neoadjuvant /conversion therapy serve as castle in the air or Noah's ark for GEP-NENs requires prospective randomized controlled tests to answer. Combined with guidelines at home and abroad, the authors systematically review the evidence based medicines on neoadju-vant and conversion therapy for GEP-NENs, demonstrate relative research progress, carry an indepth discussion on hot and difficult subjects and controversial issues, aiming to provide references for individualized, precised and standardized comprehensive treatment of GEP-NENs.