Coronavirus disease 2019 (COVID-19) or severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), a novel coronavirus strain disease, has recently emerged in China and rapidly spread worldwide. ...This novel strain is highly transmittable and severe disease has been reported in up to 16% of hospitalized cases. More than 600,000 cases have been confirmed and the number of deaths is constantly increasing. COVID-19 hospitalized patients, especially those suffering from severe respiratory or systemic manifestations, fall under the spectrum of the acutely ill medical population, which is at increased venous thromboembolism risk. Thrombotic complications seem to emerge as an important issue in patients infected with COVID-19. Preliminary reports on COVID-19 patients’ clinical and laboratory findings include thrombocytopenia, elevated D-dimer, prolonged prothrombin time, and disseminated intravascular coagulation. As the pandemic is spreading and the whole picture is yet unknown, we highlight the importance of coagulation disorders in COVID-19 infected patients and review relevant data of previous coronavirus epidemics caused by the severe acute respiratory syndrome coronavirus 1 (SARS-CoV-1) and the Middle East Respiratory Syndrome coronavirus (MERS-CoV).
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Background
Immune checkpoints inhibitors (ICIs) have emerged as a treatment option for several malignancies. Nivolumab, pembrolizumab, nivolumab plus ipilimumab, and atezolizumab plus bevacizumab ...have been approved for the management of advanced‐stage hepatocellular carcinoma (HCC). We aimed to systematically review the literature and summarize the characteristics and outcomes of patients with HCC treated with ICIs.
Methods
A systematic literature search of PubMed, the Cochrane Library, and ClinicalTrials.gov was performed according to the PRISMA statement (end of search date: November 7, 2020). Quality of evidence assessment was also performed.
Results
Sixty‐three articles including 2,402 patients were analyzed, 2,376 of whom received ICIs for unresectable HCC. Response to ICIs could be evaluated in 2,116 patients; the overall objective response rate (ORR) and disease control rate (DCR) were 22.7% and 60.7%, respectively, and the mean overall survival (OS) was 15.8 months. The ORR, DCR, and OS for nivolumab (n = 846) were 19.7%, 51.1%, and 18.7 months, respectively; for pembrolizumab (n = 435) they were 20.7%, 64.6% and 13.3 months, respectively. The combination of atezolizumab/bevacizumab (n = 460) demonstrated an ORR and DCR of 30% and 77%, respectively. The overall rate of treatment discontinuation because of adverse events was 14.9%. Fifteen patients received ICIs in the liver transplant (LT) setting (one pre‐LT for bridging, 14 for post‐LT recurrence); fatal graft rejection was reported in 40.0% (n = 6/15) and mortality in 80.0% (n = 12/15).
Conclusion
ICIs are safe and effective against unresectable HCC, but caution is warranted regarding their use in the LT setting because of the high graft rejection rate.
Implications for Practice
This systematic review pooled the outcomes from studies reporting on the use of immune checkpoint inhibitors (ICIs) for the management of 2,402 patients with advanced‐stage hepatocellular carcinoma (HCC), 2,376 of whom had unresectable HCC. The objective response rate and disease control rate were 22.7% and 60.7%, respectively, and the mean overall survival was 15.8 months. The overall rate of treatment discontinuation because of adverse events was 14.9%. Fifteen patients received ICIs in the liver transplant (LT) setting (one pre‐LT for bridging, 14 for post‐LT recurrence). Six of these patients experienced graft rejection (40.0%).
Favorable initial survival outcomes of immune checkpoint inhibitor (ICI) treatment have led to broader use as first‐ or second‐line options in patients with unresectable hepatocellular carcinoma (HCC). This article summarizes the available data on characteristics and outcomes of patients with HCC treated with ICIs.
Pancreatic neuroendocrine tumors (PNETs) arise from endocrine pancreatic cells and comprise 3-5% of pancreatic cancers. Surgical resection is the only potentially curative option for PNETs. Surgical ...candidates should be carefully selected according to tumor functionality, size, location, grade, and stage. Current guidelines state that patients with neuroendocrine carcinoma may not be surgical candidates due to aggressive tumor behavior and poor prognosis, while in cases of PNET with unresectable metastatic disease, resection may be of benefit in certain patients. The current guidelines recommend resection of any size of functional PNETs and of non-functional PNETs >2 cm. Watchful waiting is recommended for patients with non-functional PNETs <1 cm. Further evidence is needed to determine whether surgery for non-functional PNETs of 1-2 cm would be of benefit or if surgery should be individualized. This review aimed to discuss the current literature on the management of PNETs and highlight the utility of surgery in treatment.
Robot-assisted minimally invasive esophagectomy (RAMIE) was introduced as a further development of the conventional minimally invasive esophagectomy, aiming to further improve the high morbidity and ...mortality associated with open esophagectomy. We aimed to compare the outcomes between RAMIE and open esophagectomy, which remains a popular approach for resectable esophageal cancer. Ten studies meeting our inclusion criteria were identified, including five retrospective cohort, four prospective cohort, and one randomized controlled trial. RAMIE was associated with significantly lower rates of overall pulmonary complications (odds ratio (OR): 0.38, 95% confidence interval (CI): 0.26, 0.56), pneumonia (OR: 0.39, 95% CI: 0.26, 0.57), atrial fibrillation (OR: 0.53, 95% CI: 0.29, 0.98), and wound infections (OR: 0.20, 95% CI: 0.07, 0.57) and resulted in less blood loss (weighted mean difference (WMD): −187.08 mL, 95% CI: −283.81, −90.35) and shorter hospital stays (WMD: −9.22 days, 95% CI: −14.39, −4.06) but longer operative times (WMD: 69.45 min, 95% CI: 34.39, 104.42). No other statistically significant difference was observed regarding surgical and short-term oncological outcomes. Similar findings were observed when comparing totally robotic procedures only to OE. RAMIE is a safe and feasible procedure, resulting in decreased cardiopulmonary morbidity, wound infections, blood loss, and shorter hospital stays compared to open esophagectomy.
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IZUM, KILJ, NUK, PILJ, PNG, SAZU, UL, UM, UPUK
BACKGROUND:Intrahepatic cholangiocarcinoma (iCCA) is a contraindication to liver transplantation (LT) in most centers worldwide. Therefore, only a few such cases have been performed in each ...individual center and the need for a systematic review and meta-analysis to cumulatively pool these results is apparent.
METHODS:A systematic literature review was conducted using the MEDLINE and Cochrane Library databases according to the PRISMA statement (end-of-search dateMay 29, 2020). Meta-analyses of proportions were conducted to pool the overall survival (OS), recurrence-free survival (RFS), and overall recurrence rates using the random-effects model. Meta-regression was utilized to examine cirrhosis and incidental diagnosis as confounders on OS and RFS.
RESULTS:Eighteen studies comprising 355 patients and a registry study of 385 patients were included. The pooled 1-, 3-, and 5-year OS rates were 75% (95%CI64%-84%), 56% (95%CI46%-67%), and 42% (95%CI29%-55%), respectively. The pooled 1-, 3-, and 5-year RFS rates were 70% (95%CI63%-75%), 49% (95%CI41%-57%), and 38% (95%CI27%-50%), respectively. Cirrhosis was positively associated with RFS, while incidental diagnosis was not. Neither cirrhosis nor incidental diagnosis were associated with OS. The pooled overall recurrence rate was 43% (95%CI33%-53%) over a mean follow-up of 40.6±37.7 months. Patients with very early (single ≤ 2 cm) iCCA exhibited superior pooled 5-year RFS (67%, 95%CI47%-86%) versus advanced iCCA (34%, 95%CI23%-46%).
CONCLUSIONS:Cirrhotics with very early iCCA or carefully selected patients with advanced iCCA after neoadjuvant therapy may benefit from LT under research protocols.
Background
The implementation of the laparoscopic and robotic approaches for major hepatectomy (LMH and RMH) was slower than that for minor hepatectomy, but has significantly increased over the past ...years. The role or advantages of RMH remains controversial, and we aimed to compare the peri-/postoperative outcomes of LMH versus RMH.
Methods
A systematic literature review was conducted using the MEDLINE and Cochrane Library databases according to the PRISMA guidelines (end-of-search date: March 16th, 2020). Only comparative studies (LMH vs. RMH) reporting on outcomes of interest were included. Meta-analysis was performed using the random-effects model when substantial heterogeneity was encountered; otherwise, the fixed-effects model was implemented. Quality of evidence assessment was performed using the Newcastle–Ottawa Scale.
Results
Seven retrospective cohort studies comparing LMH (
n
= 300) versus RMH (
n
= 225) were identified. No significant difference was observed between LMH and RMH regarding overall complications odds ratio (OR) 1.42, 95% confidence interval (CI) 0.90–2.23;
p
= 0.13, severe complications (Clavien-Dindo grade ≥ 3) risk difference (RD) 0.01, 95% CI − 0.03 to 0.05;
p
= 0.72, and overall mortality (RD 0.00, 95% CI − 0.02 to 0.03;
p
= 0.73). The two approaches were also equivalent regarding conversion to open hepatectomy (RD 0.03, 95% CI − 0.01 to 0.08;
p
= 0.15), margin-positive resection (OR 1.34, 95% CI 0.51–3.52;
p
= 0.55), and transfusion rate (RD − 0.03, 95% CI − 0.16 to 0.11;
p
= 0.67). No significant difference was observed for LMH versus RMH regarding blood loss standardized mean difference (SMD) 0.27, 95% CI − 0.24 to 0.77;
p
= 0.30), operative time (SMD − 0.08, 95% CI − 0.51 to 0.34;
p
= 0.70), and length of stay (SMD 0.13, 95% CI − 0.58 to 0.84;
p
= 0.72).
Conclusion
LMH and RMH have equivalent peri-/postoperative outcomes when performed in select patients and high-volume centers.
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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 transplantation (LT) has gained interest in the treatment of unresectable colorectal liver metastases (CRLM) over the last two decades. Despite the initial poor outcomes, recent reports from ...countries with graft abundance have provided further insights in the potential of LT as a treatment for unresectable CRLM.
A systematic literature search was conducted in the MEDLINE (PubMed), Embase, Scopus, Cochrane Library, Google Scholar, Virtual Health Library, Clinicaltrials.gov, and Web of Science databases (end-of-search date: January 27th, 2020) to identify relevant studies. Pooled overall and recurrence-free survival analysis at 6 months, 1, 2, 3, and 5 years was conducted with the Kaplan-Meier (Product Limit) method.
Eighteen studies comprising 110 patients were included. The population consisted of 59.8% males with a mean age of 52.3 ± 9.3 years. CRLM diagnosis was synchronous in 83%, while 99% received chemotherapy, and 39% received liver resection prior to LT. The mean time from primary tumor resection to LT was 39.5 ± 32.5 months, the mean post-LT follow-up was 32.1 ± 22.2 months, and the mean time to recurrence was 15.0 ± 11.3 months. The pooled 6-month, 1-, 2-, 3-, and 5-year overall survival rates were 95.7% (95%CI: 89.1%–98.4%), 88.1% (95%CI: 79.6%–93.2%), 74.6% (95%CI: 64.2%–82.3%), 58.4% (95%CI: 47.2%–62.0%), and 50.5% (95%CI: 39.0%–61.0%), respectively. The pooled 6-months, 1-, 2-, 3-, and 5-year recurrence-free survival rates were 77.2% (95%CI: 67.2%–84.5%), 59.9% (95%CI: 49.0%–69.2%), 42.4% (95%CI: 31.8%–52.6%), 30.7% (95%CI: 20.9%–41.1%), and 25.6% (95%CI: 16.2%–36.0%), respectively.
LT should be considered in patients with unresectable liver-only CRLM under strict selection criteria and only under well-designed research protocols. Ongoing studies are expected to further elucidate the indications and prognosis of patients undergoing LT for unresectable CRLM.
•Liver transplantation has gained interest in the treatment of unresectable colorectal liver metastases over the last decades.•The 5-year overall and recurrence-free survival are 50.5% and 25.6%, or 65.8% and 25.6% after 2005, respectively.•Liver transplantation should be considered for unresectable liver-only colorectal metastases under research protocols.•Ongoing trials will improve the criteria and outcomes of liver transplantation for unresectable colorectal liver metastases.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
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