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1.
Clin Mol Hepatol ; 27(4): 564-574, 2021 10.
Article in English | MEDLINE | ID: covidwho-1551487

ABSTRACT

BACKGROUND/AIMS: In July 2017, the Emprint™ next-generation microwave ablation system using thermosphere technology (Covidien, Boulder, CO, USA) was approved for use in Japan. This system can produce a predictable spherical ablation zone at higher temperatures than radiofrequency ablation (RFA). The aim of the present study was to elucidate whether this new microwave thermosphere ablation (MTA) could safely improve outcome compared to RFA, which is the standard of care for small hepatocellular carcinoma (HCC). METHODS: This retrospective study analyzed 513 patients with 630 HCCs (≤3 cm) who were performed by percutaneous RFA (174 patients, 214 HCCs) or MTA (339 patients, 416 HCCs) between January 2016 and March 2020. RESULTS: Median ablation time was significantly shorter for MTA (240 seconds) than for RFA (721 seconds; P<0.001). A significant difference in 3-year local tumor progression rate was evident between the RFA group (22%) and MTA group (8%; P<0.001). Multivariable analysis revealed ablation procedure and tumor diameter as independent factors contributing to local tumor progression (MTA; P<0.001; hazard ratio, 0.565; 95% confidence interval, 0.437-0.731). In patients with primary HCC, a significant difference in overall survival was evident (RFA vs. MTA, 3-year, 77% vs. 95%, P=0.029). Ablation procedure and Child-Pugh score were independent factors contributing to survival. The total complication rate was significantly lower for MTA (8%) than for RFA (14%, P<0.05), particularly for bile duct injury (3% vs. 9%, respectively; P<0.05). CONCLUSION: Next-generation MTA for small HCC could provide safer, more curative treatment in a shorter ablation time than RFA.


Subject(s)
Carcinoma, Hepatocellular , Catheter Ablation , Liver Neoplasms , Radiofrequency Ablation , Carcinoma, Hepatocellular/diagnosis , Carcinoma, Hepatocellular/surgery , Humans , Liver Neoplasms/diagnosis , Liver Neoplasms/surgery , Microwaves , Radiofrequency Ablation/adverse effects , Retrospective Studies , Treatment Outcome
3.
World J Surg Oncol ; 18(1): 264, 2020 Oct 08.
Article in English | MEDLINE | ID: covidwho-1455977

ABSTRACT

BACKGROUND: Approximately 30% of patients with colorectal cancer develop colorectal liver metastases (CRLM). CRLM that become undetectable by imaging after chemotherapy are called disappearing liver metastases (DLM). But a DLM is not necessarily equal to cure. An increasing incidence of patients with DLM provides surgeons with a difficult dilemma: to resect or to not resect the original sites of DLM? The aim of this review was to investigate to what extent a DLM equates a complete response (CR) and to compare outcomes. METHODS: This review was conducted in accordance with the PRISMA guidelines and registered in Prospero (registration number CRD42017070441). Literature search was made in the PubMed and Embase databases. During the process of writing, PubMed was repeatedly searched and reference lists of included studies were screened for additional studies of interest for this review. Results were independently screened by two authors with the Covidence platform. Studies eligible for inclusion were those reporting outcomes of DLM in adult patients undergoing surgery following chemotherapy. RESULTS: Fifteen studies were included with a total of 2955 patients with CRLM. They had 4742 CRLM altogether. Post-chemotherapy, patients presented with 1561 DLM. Patients with one or more DLM ranged from 7 to 48% (median 19%). Median DLM per patient was 3.4 (range 0.4-5.6). Patients were predominantly evaluated by contrast-enhanced computed tomography (CE-CT) before and after chemotherapy, with some exceptions and with addition of magnetic resonance imaging (MRI) in some studies. Intraoperative ultrasound (IOUS) was universally performed in all but two studies. If a DLM remained undetectable by IOUS, this DLM represented a CR in 24-96% (median 77.5%). Further, if a DLM on preoperative CE-CT remained undetectable by additional workup with MRI and CE-IOUS, this DLM was equal to a CR in 75-94% (median 89%). Patients with resected DLM had a longer disease-free survival compared to patients with DLM left in situ but statistically significant differences in overall survival could not be found. CONCLUSION: Combination of CE-CT, MRI, and IOUS showed promising results in accurately identifying DLM with CR. This suggests that leaving DLM in situ could be an alternative to surgical resection when a DLM remains undetectable by MRI and IOUS.


Subject(s)
Colorectal Neoplasms , Liver Neoplasms , Adult , Colorectal Neoplasms/diagnostic imaging , Contrast Media , Hepatectomy , Humans , Intraoperative Care , Liver Neoplasms/diagnostic imaging , Liver Neoplasms/surgery , Magnetic Resonance Imaging , Prognosis
5.
Clin Mol Hepatol ; 27(4): 564-574, 2021 10.
Article in English | MEDLINE | ID: covidwho-1456286

ABSTRACT

BACKGROUND/AIMS: In July 2017, the Emprint™ next-generation microwave ablation system using thermosphere technology (Covidien, Boulder, CO, USA) was approved for use in Japan. This system can produce a predictable spherical ablation zone at higher temperatures than radiofrequency ablation (RFA). The aim of the present study was to elucidate whether this new microwave thermosphere ablation (MTA) could safely improve outcome compared to RFA, which is the standard of care for small hepatocellular carcinoma (HCC). METHODS: This retrospective study analyzed 513 patients with 630 HCCs (≤3 cm) who were performed by percutaneous RFA (174 patients, 214 HCCs) or MTA (339 patients, 416 HCCs) between January 2016 and March 2020. RESULTS: Median ablation time was significantly shorter for MTA (240 seconds) than for RFA (721 seconds; P<0.001). A significant difference in 3-year local tumor progression rate was evident between the RFA group (22%) and MTA group (8%; P<0.001). Multivariable analysis revealed ablation procedure and tumor diameter as independent factors contributing to local tumor progression (MTA; P<0.001; hazard ratio, 0.565; 95% confidence interval, 0.437-0.731). In patients with primary HCC, a significant difference in overall survival was evident (RFA vs. MTA, 3-year, 77% vs. 95%, P=0.029). Ablation procedure and Child-Pugh score were independent factors contributing to survival. The total complication rate was significantly lower for MTA (8%) than for RFA (14%, P<0.05), particularly for bile duct injury (3% vs. 9%, respectively; P<0.05). CONCLUSION: Next-generation MTA for small HCC could provide safer, more curative treatment in a shorter ablation time than RFA.


Subject(s)
Carcinoma, Hepatocellular , Catheter Ablation , Liver Neoplasms , Radiofrequency Ablation , Carcinoma, Hepatocellular/diagnosis , Carcinoma, Hepatocellular/surgery , Humans , Liver Neoplasms/diagnosis , Liver Neoplasms/surgery , Microwaves , Radiofrequency Ablation/adverse effects , Retrospective Studies , Treatment Outcome
7.
Clin Transplant ; 35(4): e14246, 2021 04.
Article in English | MEDLINE | ID: covidwho-1069387

ABSTRACT

Adverse clinical outcomes related to SARS-CoV-2 infection among liver transplant (LTx) recipients remain undefined. We performed a meta-analysis to determine the pooled prevalence of outcomes among hospitalized LTx recipients with COVID-19. A database search of literature published between December 1, 2019, and November 20, 2020, was performed per PRISMA guidelines. Twelve studies comprising 517 hospitalized LTx recipients with COVID-19 were analyzed. Common presenting symptoms were fever (71%), cough (62%), dyspnea (48%), and diarrhea (28%). Approximately 77% (95% CI, 61%-93%) of LTx recipients had a history of liver cirrhosis. The most prevalent comorbidities were hypertension (55%), diabetes (45%), and cardiac disease (21%). In-hospital mortality was 20% (95% CI, 13%-28%) and rose to 41% (95% CI, 19%-63%) (P < 0.00) with ICU admission. Additional subgroup analysis demonstrated a higher mortality risk in the elderly (>60-65 years) (OR 4.26; 95% CI, 2.14-8.49). There was no correlation in respect to sex or time since transplant. In summary, LTx recipients with COVID-19 had a high prevalence of dyspnea and gastrointestinal symptoms. In-hospital mortality was comparable to non-transplant populations with similar comorbidities but appeared to be less than what is reported elsewhere for cirrhotic patients (26%-40%). Importantly, the observed high case fatality in the elderly could be due to age-associated comorbidities.


Subject(s)
COVID-19/epidemiology , Liver Transplantation , Transplant Recipients , Aged , Aged, 80 and over , Carcinoma, Hepatocellular/surgery , Female , Hospitalization , Humans , Liver Neoplasms/surgery , Male , Middle Aged
8.
Curr Oncol ; 27(5): e501-e511, 2020 10.
Article in English | MEDLINE | ID: covidwho-1024675

ABSTRACT

Objective: We aimed to review data about delaying strategies for the management of hepatobiliary cancers requiring surgery during the covid-19 pandemic. Background: Given the covid-19 pandemic, many jurisdictions, to spare resources, have limited access to operating rooms for elective surgical activity, including cancer, thus forcing deferral or cancellation of cancer surgeries. Surgery for hepatobiliary cancer is high-risk and particularly resource-intensive. Surgeons must critically appraise which patients will benefit most from surgery and which ones have other therapeutic options to delay surgery. Little guidance is currently available about potential delaying strategies for hepatobiliary cancers when surgery is not possible. Methods: An international multidisciplinary panel reviewed the available literature to summarize data relating to standard-of-care surgical management and possible mitigating strategies to be used as a bridge to surgery for colorectal liver metastases, hepatocellular carcinoma, gallbladder cancer, intrahepatic cholangiocarcinoma, and hilar cholangiocarcinoma. Results: Outcomes of surgery during the covid-19 pandemic are reviewed. Resource requirements are summarized, including logistics and adverse effects profiles for hepatectomy and delaying strategies using systemic, percutaneous and radiation ablative, and liver embolic therapies. For each cancer type, the long-term oncologic outcomes of hepatectomy and the clinical tools that can be used to prognosticate for individual patients are detailed. Conclusions: There are a variety of delaying strategies to consider if availability of operating rooms decreases. This review summarizes available data to provide guidance about possible delaying strategies depending on patient, resource, institution, and systems factors. Multidisciplinary team discussions should be leveraged to consider patient- and tumour-specific information for each individual case.


Subject(s)
Coronavirus Infections/complications , Hepatectomy/statistics & numerical data , Infection Control/methods , Liver Neoplasms/surgery , Pneumonia, Viral/complications , Practice Guidelines as Topic/standards , Surgeons/standards , Time-to-Treatment/statistics & numerical data , Betacoronavirus/isolation & purification , COVID-19 , Coronavirus Infections/epidemiology , Coronavirus Infections/virology , Humans , Liver Neoplasms/virology , Pandemics , Patient Care Management , Pneumonia, Viral/epidemiology , Pneumonia, Viral/virology , SARS-CoV-2
9.
Pediatr Transplant ; 25(5): e13880, 2021 08.
Article in English | MEDLINE | ID: covidwho-796050

ABSTRACT

We describe the successful pediatric liver transplant for unresectable hepatoblastoma in a 4-year-old male with COVID-19 prior to transplant. The first negative NP swab was documented 1 month after initial diagnosis, when SARS-CoV-2 antibodies were also detected. The patient was actively listed for liver transplant after completing four blocks of a SIOPEL-4 based regimen due to his PRETEXT IV disease which remained unresectable. Following three additional negative NP swabs and resolution of symptoms for 4 weeks, he underwent a whole-organ pediatric liver transplant. COVID-19 positivity determined via NP swab SARS-CoV-2 real-time RT-PCR (Hologic Aptima SARS-CoV-2 RT-PCR assay). IgG and IgM total SARS- CoV-2 antibodies detected by Ortho Clinical Diagnostics VITROS® Immunodiagnostics Products Anti-SARS-CoV-2 Test. Patient received standard prednisone and tacrolimus-based immunosuppression without induction therapy following transplant. Post-transplant course was remarkable for neutropenia and thrombocytopenia, with discharge home on post-transplant day #11. Surveillance tests have remained negative with persistent SARS-CoV-2 IgG antibodies at 6 weeks after transplant. We describe one of the earliest, if not the first case of liver transplant following recent recovery from COVID-19 in a pediatric patient with a lethal malignant liver tumor. A better understanding of how to balance the risk profile of transplant in the setting of COVID-19 with disease progression if transplant is not performed is needed. We followed existing ASTS guidelines to document clearance of the viral infection and resolution of symptoms before transplant. This case highlights that pediatric liver transplantation can be safely performed upon clearance of COVID-19.


Subject(s)
COVID-19/therapy , Hepatoblastoma/surgery , Liver Neoplasms/surgery , Liver Transplantation/methods , COVID-19/complications , COVID-19 Testing , Child, Preschool , Disease Progression , Hepatoblastoma/complications , Humans , Immunoglobulin G , Immunoglobulin M , Immunosuppressive Agents/administration & dosage , Liver Neoplasms/complications , Male , Neutropenia/complications , Prednisone/administration & dosage , Tacrolimus/administration & dosage , Thrombocytopenia/complications , Treatment Outcome
11.
J Laparoendosc Adv Surg Tech A ; 31(3): 266-272, 2021 Mar.
Article in English | MEDLINE | ID: covidwho-720927

ABSTRACT

Background: COVID-19 pandemic rendered the surgical approach as well as the surgical indication very complex due to the outstanding consumption of public health system' resources, especially in the intensive care subdivision. A multidisciplinary team-based strategy is necessary to adapt guidelines and medical practices to the actual situation. The aim of this study is to evaluate the changes in the therapeutic algorithm in a small group of patients with hepatocellular carcinoma (HCC) enlisted for surgery during the COVID-19 outbreak. Materials and Methods: A multidisciplinary strategy has been adopted to allocate HCC patients to a treatment that permitted to reduce the risk of complications and the hospital stay, thus preventing contamination by the virus. Nasopharyngeal swab and a chest radiograph were performed in all patients within 48 hours before the surgical procedure: in the suspected cases with negative COVID tests, we prudently postponed surgery and repeated the diagnostic tests after 15 days. Results: During the emergency state, 11 HCC patients were treated (8 laparoscopic ablations and 3 hepatic resections). We reported only 1 postoperative complication (hemothorax) and 1 death during the follow-up for COVID pneumonia. Comparing our performances with those in the same time frame in the past 4 years, we treated a similar number of HCC patients, obtaining a decrease in operative timing (P = .0409) and hospital stay (P = .0412) (Fig. 2b) with similar rates of immediate postoperative complications, without ICU admissions. Conclusions: An adapted algorithm for the treatment of HCC to COVID outbreak permitted to manage safely these patients by identifying those most at risk of evolution of the neoplastic disease.


Subject(s)
COVID-19/epidemiology , Carcinoma, Hepatocellular/surgery , Disease Management , Guideline Adherence , Hepatectomy/methods , Laparoscopy/methods , Liver Neoplasms/surgery , Aged , Aged, 80 and over , Carcinoma, Hepatocellular/epidemiology , Comorbidity , Female , Humans , Length of Stay , Liver Neoplasms/epidemiology , Male , Middle Aged , Operative Time , Pandemics , SARS-CoV-2
14.
HPB (Oxford) ; 22(8): 1128-1134, 2020 08.
Article in English | MEDLINE | ID: covidwho-592305

ABSTRACT

BACKGROUND: The extent of the COVID-19 pandemic and the resulting response has varied globally. The European and African Hepato-Pancreato-Biliary Association (E-AHPBA), the premier representative body for practicing HPB surgeons in Europe and Africa, conducted this survey to assess the impact of COVID-19 on HPB surgery. METHODS: An online survey was disseminated to all E-AHPBA members to assess the effects of the pandemic on unit capacity, management of HPB cancers, use of COVID-19 screening and other aspects of service delivery. RESULTS: Overall, 145 (25%) members responded. Most units, particularly in COVID-high countries (>100,000 cases) reported insufficient critical care capacity and reduced HPB operating sessions compared to COVID-low countries. Delayed access to cancer surgery necessitated alternatives including increased neoadjuvant chemotherapy for pancreatic cancer and colorectal liver metastases, and locoregional treatments for hepatocellular carcinoma. Other aspects of service delivery including COVID-19 screening and personal protective equipment varied between units and countries. CONCLUSION: This study demonstrates that the COVID-19 pandemic has had a profound adverse impact on the delivery of HPB cancer care across the continents of Europe and Africa. The findings illustrate the need for safe resumption of cancer surgery in a "new" normal world with screening of patients and staff for COVID-19.


Subject(s)
Betacoronavirus , Biliary Tract Neoplasms/surgery , Coronavirus Infections/complications , Digestive System Surgical Procedures/methods , Liver Neoplasms/surgery , Pancreatic Neoplasms/surgery , Pneumonia, Viral/complications , Africa/epidemiology , Biliary Tract Neoplasms/complications , COVID-19 , Coronavirus Infections/epidemiology , Cross-Sectional Studies , Delivery of Health Care/methods , Europe/epidemiology , Female , Humans , Liver Neoplasms/complications , Male , Pancreatic Neoplasms/complications , Pandemics , Pneumonia, Viral/epidemiology , SARS-CoV-2 , Societies, Medical
15.
Zhonghua Zhong Liu Za Zhi ; 42(3): 187-191, 2020 Mar 23.
Article in Chinese | MEDLINE | ID: covidwho-590726

ABSTRACT

Objective: From December 2019, the new coronavirus pneumonia (COVID-19) broke out in Wuhan, Hubei, and spread rapidly to the nationwide. On January 20, 2020, the National Health Committee classified COVID-19 pneumonia as one of B class infectious diseases and treated it as class A infectious disease. During the epidemic period, the routine diagnosis and treatment of tumor patients was affected with varying degrees. In this special period, we performed the superiority of the multi-disciplinary team of diagnosis and treatment, achieved accurate diagnosis and treatment of patients with hepatobiliary malignant tumors, provided support for these patients with limited medical resources, and helped them to survive during the epidemic period.On the basis of fully understanding the new coronavirus pneumonia, the treatment strategy should be changed timely during the epidemic, and more appropriate treatment methods should be adopted to minimize the adverse effect of the epidemic on tumor treatment.


Subject(s)
Coronavirus Infections/prevention & control , Coronavirus , Cross Infection/prevention & control , Liver Neoplasms/surgery , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Betacoronavirus , Biliary Tract Neoplasms/diagnosis , COVID-19 , China , Communicable Disease Control/methods , Coronavirus/pathogenicity , Coronavirus Infections/epidemiology , Disease Outbreaks , Humans , Immunocompromised Host , Liver Neoplasms/diagnosis , Patient Care Planning , Pneumonia, Viral/epidemiology , Risk , SARS-CoV-2
17.
Am J Transplant ; 20(7): 1916-1921, 2020 07.
Article in English | MEDLINE | ID: covidwho-210165

ABSTRACT

Over 1 000 000 cases of coronavirus disease 2019 (COVID-19) have been confirmed since the worldwide outbreak began. Not enough data on infected solid organ transplant (SOT) recipients are available, especially data about the management of immunosuppressants. We report two cases of COVID-19 in two transplant recipients, with different treatments and prognoses. The first patient received liver transplantation due to hepatitis B virus-related hepatocellular carcinoma and was confirmed to have COVID-19 9 days later. Following a treatment regimen consisting of discontinued immunosuppressant use and low-dose methylprednisolone-based therapy, the patient developed acute rejection but eventually recovered. The other patient had undergone a renal transplant from a living-related donor 17 years ago, and was admitted to the hospital because of persistent fever. This patient was also diagnosed with COVID-19. His treatment regimen consisted of reduced immunosuppressant use. No signs of rejection were observed during the regimen. In the end, the patient successfully recovered from COVID-19. These effectively treated cases can provide a basis for immunosuppressant management of COVID-19-positive SOT recipients.


Subject(s)
Coronavirus Infections/complications , Coronavirus Infections/therapy , Immunosuppressive Agents/therapeutic use , Organ Transplantation , Pneumonia, Viral/complications , Pneumonia, Viral/therapy , Transplant Recipients , Adult , Betacoronavirus , COVID-19 , Carcinoma, Hepatocellular/complications , Carcinoma, Hepatocellular/surgery , Hepatitis B/complications , Hepatitis B/surgery , Hepatitis B virus , Humans , Kidney Failure, Chronic/complications , Kidney Failure, Chronic/surgery , Kidney Transplantation , Liver Neoplasms/complications , Liver Neoplasms/surgery , Liver Transplantation , Male , Methylprednisolone/administration & dosage , Middle Aged , Pandemics , Prognosis , SARS-CoV-2 , Treatment Outcome
18.
Am J Transplant ; 20(8): 2254-2259, 2020 08.
Article in English | MEDLINE | ID: covidwho-155106

ABSTRACT

The novel coronavirus disease 2019 (COVID-19) is a highly infectious and rapidly spreading disease. There are limited published data on the epidemiology and outcomes of COVID-19 infection among organ transplant recipients. After initial flulike symptoms, progression to an inflammatory phase may occur, characterized by cytokine release rapidly leading to respiratory and multiorgan failure. We report the clinical course and management of a liver transplant recipient on hemodialysis, who presented with COVID-19 pneumonia, and despite completing a 5-day course of hydroxychloroquine, later developed marked inflammatory manifestations with rapid improvement after administration of off-label, single-dose tocilizumab. We also highlight the role of lung ultrasonography in early diagnosis of the inflammatory phase of COVID-19. Future investigation of the effects of immunomodulators among transplant recipients with COVID-19 infection will be important.


Subject(s)
Antibodies, Monoclonal, Humanized/therapeutic use , Coronavirus Infections/complications , Liver Transplantation , Pneumonia, Viral/complications , Renal Dialysis , Transplant Recipients , COVID-19 , Carcinoma, Hepatocellular/complications , Carcinoma, Hepatocellular/surgery , Coronavirus Infections/drug therapy , Hepatitis C/complications , Hepatitis C/surgery , Humans , Hydroxychloroquine/therapeutic use , Inflammation , Liver Cirrhosis/complications , Liver Cirrhosis/surgery , Liver Neoplasms/complications , Liver Neoplasms/surgery , Male , Middle Aged , Pandemics , Pneumonia, Viral/drug therapy , Reoperation , Treatment Outcome
20.
Am J Transplant ; 20(7): 1907-1910, 2020 07.
Article in English | MEDLINE | ID: covidwho-47494

ABSTRACT

Liver injury is common in patients with COVID-19, but little is known about its clinical presentation and severity in the context of liver transplant. We describe a case of COVID-19 in a patient who underwent transplant 3 years ago for hepatocellular carcinoma. The patient came to clinic with symptoms of respiratory disease; pharyngeal swabs for severe acute respiratory syndrome coronavirus 2 were positive. His disease progressed rapidly from mild to critical illness and was complicated by several nosocomial infections and multiorgan failure. Despite multiple invasive procedures and rescue therapies, he died from the disease. The management of COVID-19 in the posttransplant setting presents complex challenges, emphasizing the importance of strict prevention strategies.


Subject(s)
Carcinoma, Hepatocellular/complications , Coronavirus Infections/complications , End Stage Liver Disease/complications , Hepatitis B/complications , Liver Neoplasms/complications , Liver Transplantation , Pneumonia, Viral/complications , Betacoronavirus , COVID-19 , Carcinoma, Hepatocellular/surgery , Coronavirus Infections/therapy , Cross Infection/complications , End Stage Liver Disease/surgery , Fatal Outcome , Hepatitis B/surgery , Humans , Immunocompromised Host , Immunosuppressive Agents/therapeutic use , Liver Neoplasms/surgery , Male , Middle Aged , Pandemics , Pneumonia, Viral/therapy , Postoperative Complications , Radiography, Thoracic , SARS-CoV-2 , Tomography, X-Ray Computed , Transplant Recipients , Treatment Outcome
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