Introduction
The aim of this study was to evaluate the impact of the contouring methods on dose metrics and their predictive value on tumor control and survival, in both situations of pre-treatment ...and post-treatment dosimetry, for patients with advanced HCC treated with SIRT.
Methods
Forty-eight patients who underwent SIRT between 2012 and 2020 were retrospectively included in this study. Target volumes were delineated using two methods: MRI-based contours manually drawn by a radiologist and then registered on SPECT/CT and PET/CT via deformable registration (Pre-C
MRI
and Post-C
MRI
),
99m
Tc-MAA-SPECT and
90
Y-microspheres-PET 10% threshold contouring (Pre-C
SPECT
and Post-C
PET
). The mean absorbed dose (Dm) and the minimal absorbed dose delivered to 70% of the tumor volume (D70) were evaluated with both contouring methods; the tumor-to-normal liver uptake ratio (TNR) was evaluated with MRI-based contours only. Tumor response was assessed using the mRECIST criteria on the follow-up MRIs.
Results
No significant differences were found for Dm and TNR between pre- and post-treatment. TNR evaluated with radiologic contours (Pre-C
MRI
and Post-C
MRI
) were predictive of tumor control at 6 months on pre- and post-treatment dosimetry (OR 5.9 and 7.1, respectively;
p
= 0.02 and 0.01). All dose metrics determined with both methods were predictive of overall survival (OS) on pre-treatment dosimetry, but only Dm with MRI-based contours was predictive of OS on post-treatment images with a median of 23 months for patients with a supramedian Dm versus 14 months for the others (
p
= 0.04).
Conclusion
In advanced HCC treated with SIRT, Dm and TNR determined with radiologic contours were predictive of tumor control and OS. This study shows that a rigorous clinical workflow (radiologic contours + registration on scintigraphic images) is feasible and should be prospectively considered for improving therapeutic strategy.
Purpose
Gastric fistula is a severe complication following sleeve gastrectomy (SG). Chronic gastric fistula can progress to complex anatomical situations, such as esogastro-bronchial and/or ...esogastro-pleural (EGBP) fistulas. We decided to analyze the anatomical characteristics of these EGBP fistulas after SG.
Methods
Our work consisted of an analysis of the clinical, endoscopic, and radiological data of patients treated for EGBP fistulas after SG at the Georges Pompidou European Hospital from May 2009 to November 2017.
Results
A total of 11 patients were retrospectively included with available complete clinical, endoscopic, and radiological data. The origin of the fistula was mostly at the top of the staple line. The fistula’s termination was pleural in 5 patients (45%) and bronchial in 6 (55%). In bronchial fistulas, 2 were proximal and 4 were distal, with the left pulmonary posterolateral segment (S10) being reached in each case. The trans-diaphragmatic passage was through the left cupola in 9 out of 11 patients (82%). In 2 patients, the passage was trans-hiatal (18%). Interestingly, the 2 eso-bronchial fistulas had a trans-hiatal passage with a termination in the proximal bronchus, while the 4 gastro-bronchial fistulas had a trans-diaphragmatic passage with a termination in the distal bronchus. All pleural fistulas were gastric with a trans-diaphragmatic passage.
Conclusions
Esogastro-bronchial and gastro-pleural fistulas after SG originated mostly at the top of the staple line. Eso-bronchial fistulas had a trans-hiatal passage with a proximal bronchial termination, while gastro-bronchial fistulas had a trans-diaphragmatic passage with a distal bronchial termination.
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EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
Liver cancer is the sixth most common cancer in the world and the fourth leading cause of cancer mortality. In unresectable liver cancers, especially hepatocellular carcinoma (HCC), transarterial ...radioembolisation (TARE) can be considered for treatment. TARE treatment involves a contrast-enhanced magnetic resonance imaging (CE-MRI) exam performed beforehand to delineate the liver and tumour(s) in order to perform dosimetry calculation. Due to the significant amount of time and expertise required to perform the delineation process, there is a strong need for automation. Unfortunately, the lack of publicly available CE-MRI datasets with liver tumour annotations has hindered the development of fully automatic solutions for liver and tumour segmentation. The “Tumour and Liver Automatic Segmentation” (ATLAS) dataset that we present consists of 90 liver-focused CE-MRI covering the entire liver of 90 patients with unresectable HCC, along with 90 liver and liver tumour segmentation masks. To the best of our knowledge, the ATLAS dataset is the first public dataset providing CE-MRI of HCC with annotations. The public availability of this dataset should greatly facilitate the development of automated tools designed to optimise the delineation process, which is essential for treatment planning in liver cancer patients.
Metabolic and bariatric surgery (MBS) is widely considered the most effective option for treating obesity, a chronic, relapsing, and progressive disease. Recently, the American Society of Metabolic ...and Bariatric Surgery (ASMBS) and the International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) issued new guidelines on the indications for MBS, which have superseded the previous 1991 National Institutes of Health guidelines. The aim of this study is to establish the first set of consensus guidelines for selecting procedures in Class I and II obesity, using an Expert Modified Delphi Method. In this study, 78 experienced bariatric surgeons from 32 countries participated in a two-round Modified Delphi consensus voting process. The threshold for consensus was set at an agreement or disagreement of ≥ 70.0% among the experts. The experts reached a consensus on 54 statements. The committee of experts reached a consensus that MBS is a cost-effective treatment option for Class II obesity and for patients with Class I obesity who have not achieved significant weight loss through non-surgical methods. MBS was also considered suitable for patients with Type 2 diabetes mellitus (T2DM) and a body mass index (BMI) of 30 kg/m
or higher. The committee identified intra-gastric balloon (IGB) as a treatment option for patients with class I obesity and endoscopic sleeve gastroplasty (ESG) as an option for patients with class I and II obesity, as well as for patients with T2DM and a BMI of ≥ 30 kg/m
. Sleeve gastrectomy (1) and Roux-en-Y gastric bypass (RYGB) were also recognized as viable treatment options for these patient groups. The committee also agreed that one anastomosis gastric bypass (OAGB) is a suitable option for patients with Class II obesity and T2DM, regardless of the presence or severity of obesity-related medical problems. The recommendations for selecting procedures in Class I and II obesity, developed through an Expert Modified Delphi Consensus, suggest that the use of standard primary bariatric endoscopic (IGB, ESG) and surgical procedures (SG, RYGB, OAGB) are acceptable in these patient groups, as consensus was reached regarding these procedures. However, randomized controlled trials are still needed in Class I and II Obesity to identify the best treatment approach for these patients in the future.
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IZUM, KILJ, NUK, PILJ, PNG, SAZU, UL, UM, UPUK
Systematic studies of postoperative outcome of bariatric surgery provide information on the predictors of success. Surgeon's and institution experience and patient's behavior after surgery are key ...determinant of success or failure. Data on clinical trials generally reflect the experience of skilled obesity surgery centers. Little is known about the current practice at a nationwide level. The present study was realized in the frame of a national survey on medical and surgical practices conducted by the public health insurance system. The objective was to analyze systematically and prospectively the outcome of all bariatric surgery procedures consecutively performed in a given period, as registered by the French National Medical Insurance Service. This study at a nationwide level focused on predictive factors of success and analyzed how the experience of the centers relates to the patients' outcomes at 1 and 2 years after surgery.
This study examined prospectively the 2-year predictors of success of all consecutive 1236 bariatric operations performed at a nationwide level. Most (87.3%) were laparoscopic adjustable gastric banding (LAGB), so that the non-LAGB were eliminated from the study. Data were collected independently by consultants of the French National Medical Insurance Service: characteristics of the patients, evolution of body mass index (BMI), physical activity and comorbidities, changes in behavior, complications, reoperations. Information was available on the activity of the surgical teams. Excess weight loss (EWL) >50% was considered a "success," and EWL <50% "not a success." A backstep logistic regression (likelihood ratio test) was used to determine predictive factors.
Statistical analysis showed significant differences in EWL with the following data: age <40 years (P < 0.01), initial BMI <50 kg/m (P < 0.001), experience of the surgeon(s) >2 procedures per week (P < 0.01), recovery of physical activity (P < 0.001), and change in eating habits (P < 0.001). Compared with 15- to 39-year-old patients, 40- to 49-year-old patients have a 1.5 higher risk not to have a success after surgery and over 50-year-old patients a 1.8 higher risk. Morbidly obese patients (40 < BMI < 49) had a 2.6 times higher risk not to have a success than patients with severe obesity (35 < BMI < 39). Superobese patients (BMI >50) had a 5.4 times higher risk not to succeed than patients with severe obesity. Being operated by a team with a surgical activity over 15 bariatric procedures/2 months doubles the chance of a successful operation when compared with patients operated by surgical teams having only performed 1 or 2 bariatric procedures. Patients who had not recovered or increased their physical activity after operation had a 2.3 times higher risk not to have a success than those who did. Patients who had not changed their eating habits had a 2.2 times higher risk not to have a success than those who did.
This nationwide survey shows that the best profile for a success after gastric banding is a patient <40 years, with an initial BMI <50 kg/m, willing to change his eating habits and to recover or increase his physical activity after surgery and who has been operated by a team usually performing >2 bariatric procedures per week. This study emphasizes that obesity surgery requires a significant experience of the surgical team and a multidisciplinary approach to improve behavioral changes.
We aimed to establish a payer-perspective cost-effectiveness and budget impact (BI) model of adjustable gastric banding (AGB) and gastric bypass (GBP) vs conventional treatment (CT) in patients with ...BMI > or =35 kg/m(2) and type-2 diabetes T2DM, in Germany, UK and France.
Clinical evidence was obtained from literature and patient-reported EQ-5D scores given BMI and T2DM status from HODaR. Resource utilization data in AGB, GBP and CT were obtained from quoted publications so as to reflect practice in 2005. CT in each country was based on descriptions in HTA reports or based on co-authors' experience of current practice. Unit costs were obtained from published sources when available, or from co-authors' institutions. A deterministic algorithm with cost and utility discounting, enabled selection of inputs independently throughout the time scope for each of the 3 treatments, and included mean BMI, amounts of resources and unit costs.
The base case time-scope was 5 years, and the annual discount rate for utilities and costs was 3.5%. Compared to CT, GBP yielded +80.8 kg/m(2).years, +2.6 T2DM-free-years and +1.34 QALYs. AGB yielded +57.8 kg/m(2).years, +2.5 T2DM-free-years and +1.03 QALYs. In Germany and France, both GBP and AGB yielded a cost decrease, and were thus dominant in terms of ICER compared to CT. In the UK, GBP and AGB yielded a cost increase, but were cost-effective.
In patients with T2DM and BMI > or =35 kg/m(2), AGB and GBP are effective at 5-year follow-up in cost-saving in Germany and France, and are cost-effective in the UK with a moderate BI vs CT.
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EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
Leakage after one-anastomosis gastric bypass (OAGB) is fortunately rare (<1%), but it remains the most severe complication. Few published data exist on this specific issue.
To analyze the results ...from patients who presented with acute intra-abdominal sepsis (AIAS) caused by leakage after OAGB.
A university public hospital in France.
Between October 2006 and February 2016, 17 consecutive patients with a diagnosis of AIAS caused by leakage after OAGB were included. Preoperative characteristics, clinical symptoms, radiologic findings, management, morbidity, and mortality were assessed.
All 17 patients were included in the study. There were 4 men (23.5%), the median age was 48 years, and median preoperative body mass index (BMI) was 51 kg/m
. The most frequent clinical sign was tachycardia (65%). An oral contrast computed tomography scan was performed in 15 patients (88%) and showed a diagnosis of AIAS in 93% of cases. The median time between OAGB and leak diagnosis was 4 days. A gastrojejunal anastomosis (GJA) leak was the most frequent origin (41%). Sixteen patients (94%) were managed surgically (laparotomy n = 11, laparoscopy n = 5) and one medically. There were no deaths. The overall morbidity rate was 47% (major = 41%). Six patients underwent an emergency conversion into Roux-en-Y gastric bypass (RYGB) (in cases of GJA, gastric-tube, and biliary-limb leakages) and were compared to 6 patients who did not undergo conversion but who could have benefited. We observed a tendency toward a reduced overall morbidity rate (16.7% versus 83.3%, P = .08) and shorter lengths of stay in the "conversion to RYGB" group.
The management of AIAS caused by leakage after OAGB was safe, effective, and mostly surgical. Emergency conversion to RYGB in cases of GJA, gastric-tube, or biliary-limb perforation was feasible and safe.
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