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Major surgical resection is often the only curative treatment for cholangiocarcinoma. When imaging techniques fail to establish the accurate diagnosis, biopsy of the lesion is unavoidable. However, biopsy is not necessarily required for topography of the cholangiocarcinoma (intrahepatic or extrahepatic). 1) In extrahepatic cholangiocarcinoma (ECC), clinical features and radiological imaging relate to biliary obstruction. Provided that between 8% and 43% of bile duct strictures are not ECC, the lesions mimicking ECC that should be ruled out are gallbladder cancer, Mirizzi syndrome, primary sclerosing cholangitis (PSC), autoimmune pancreatitis and portal biliopathy. Systematic biopsy is usually difficult and has poor sensitivity, but a good knowledge of these mimicking ECC diseases, along with precise analysis of clinical and imaging semiology, may lead to a correct diagnosis without the need for biopsy. 2) Intrahepatic cholangiocarcinoma (ICC) developing in normal liver appears as a hypovascular tumour with fibrotic component and capsular retraction that can be confused with fibrous metastases such as breast and colorectal cancers. The lack of the primary site, a relatively large tumour size and ancillary findings such as bile duct dilatation may provide a clue to the diagnosis. If not, we advocate local resection with lymph node dissection, since ICC is the most likely diagnostis and surgery is the only curative treatment. In the event of adenocarcinoma from unknown primary, surgery is an effective treatment even if prognosis is poor. [ABSTRACT FROM AUTHOR]

Background: Aim of this retrospective study was to compare induction of left liver hypertrophy after right portal vein ligation (PVL) and right portal vein embolization (PVE) before right hepatectomy for liver metastases.Materials and Methods: Between 1998 and 2005, 18 patients underwent a PVE, whereas 17 patients underwent a PVL during a first stage laparotomy.Results: There was no complication related to PVE or PVL. After a similar interval time (7 +/- 3 vs 8 +/- 3 weeks), the increase of the left liver volume was similar between the two groups (35 +/- 38 vs 38 +/- 26%). After PVE and PVL, right hepatectomy was performed in 12 and 14 patients, respectively. Technical difficulties during the right hepatectomy were similar according to duration of procedure (6.4 +/- 1 vs 6.7 +/- 1 h, p = 0.7) and transfusion rates (33 vs 28%, p = 0.7). Mortality was nil in both groups, and morbidity rates were respectively 58% for the PVE group and 36% for the PVL group (p = 0.6).Conclusion: Right PVL and PVE result in a comparable hypertrophy of the left liver. During the first laparotomy of a two-step liver resection, PVL can be efficiently and safely performed. [ABSTRACT FROM AUTHOR]

B Presenter: b Anouk Latenstein MD | Amsterdam UMC B Background: b Total pancreatectomy (TP) is primarily performed in patients with diseases involving the entire pancreas e.g. main duct intraductal papillary neoplasm or pancreatic cancer. Of all patients with at least 30 days or 90 days follow-up, 30-day mortality was 5% (10/210 patients) and 90-day mortality was 9% (17/183). Major postoperative complications and 30-day mortality were still considerable and it might be suggested to perform TP solely in high-volume TP centers. [Extracted from the article]

B Background: b The effect of ALPPS on tumor proliferation, remains a concern. B Results: b Two and three weeks after ALPPS stage 1, PVL or sham surgery, liver MRI showed similar intrahepatic tumor numbers ((p=0.14/0.82), sizes (p=0.45/0.98) and growth kinetics (p=0.58/0.68). [Extracted from the article]

B Methods: b The validation cohort comprised prospectively collected data on donors, recipients, perioperative laboratory values, graft function, complications and survival from 285 liver transplantations between 2008 and 2014. Patients with POD5 platelet counts <60 x10 SP 9 sp /L had higher rates of severe (grade IIIb/IV) complications [27.8% versus 16.8%, odds ratio (OR) 1.9 (95% CI 1.1-3.5), p<0.05] and worse 90-day mortality [6.1% versus 1.3%, OR 5.0 (95% CI 1.0-24.6), p<0.05]. [Extracted from the article]

Objectif de l’étude À côté des traitements de référence (chirurgie, radiofréquence), la radiothérapie induit désormais un taux de stérilisation de 90 % des lésions de moins de 5 cm, et d’environ 80 % des lésions de plus 5 cm, justifiant une comparaison thérapeutique. Matériel et méthode Les dossiers de patients atteints d’un carcinome hépatocellulaire unifocal traité par chémoembolisation (TACE) et irradiation si les patients étaient inéligibles à un traitement de référence, par comparaison à ceux traités par chirurgie, ont été analysés rétrospectivement (analyse statistique : test de Student, analyse uni- et multifactorielle). Résultats Cent-soixante-dix-huit dossiers ont été analysés, 68 associations de radiothérapie et chémoembolisation et 110 chirurgies, chez 78 % d’hommes, d’âge moyen 66 ans (39–89 ans), atteints d’une cirrhose hépatique sous-jacente pour 52 %, d’une tumeur de taille moyenne de 50 mm (16–220 mm), de moins de 50 mm pour 103, avec une durée moyenne du suivi 33 mois. Le taux de réponse complète après l’association de radiothérapie et chémoembolisation était de 92 % si la lésion était de moins de 5 cm contre 80 % sinon. En cas de lésion de moins de 5 cm, l’âge moyen était comparable, la cirrhose hépatique plus fréquente si le patient recevait une association de radiothérapie et chémoembolisation ( p < 0,0001). En analyse unifactorielle, il y avait un impact défavorable de l’association de radiothérapie et chémoembolisation sur la survie globale ( p = 0,01), la survie sans progression ( p = 0,007) et temps jusqu’à progression ( p = 0,04). Aucune différence n’a été observée en analyse multifactorielle (âge de plus de 70 ans, cirrhose, concentration d’albumine de moins de 35 g/L, moins de 100 000 plaquettes). En cas de lésion de plus de 5 cm, si le patient recevait une association de radiothérapie et chémoembolisation, l’âge était plus élevé, la cirrhose significativement plus fréquente ( p = 0,0004). En analyse unifactorielle, les résultats étaient équivalents en termes de temps jusqu’à la progression ( p = 0,99), la survie sans progression ( p = 0,32), il y avait meilleure probabilité de survie globale après chirurgie ( p = 0,0007). En analyse multifactorielle, cette différence de survie globale devenait non significative ( p = 0,19). Conclusion L’analyse de cette cohorte de 178 patients atteints d’un carcinome hépatocellulaire unifocal de score Child A a montré que le taux de réponse complète après l’associations de radiothérapie et chémoembolisation était élevé. Quelle que soit la taille de la lésion, il n’y avait aucune différence en analyse multifactorielle entre les deux traitements. Ces résultats justifient la mise en place d’un essai randomisé comparant l’association de radiothérapie et chémoembolisation et la résection chirurgicale, pour tous les patients, particulièrement en cas de tumeur unique de plus de 5 cm. [ABSTRACT FROM AUTHOR]