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Alaswad M, Otry AA, Alhosainy Z, Elkordy F, Sabbah BN, Arabi TZ, Abdulkader H, Ghanayem OF, Azzam AZ, Amin T. Cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy and intraoperative radiation therapy in the management of gallbladder cancer: a case report. Front Oncol 2024; 14:1361017. [PMID: 38634052 PMCID: PMC11021777 DOI: 10.3389/fonc.2024.1361017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2023] [Accepted: 03/20/2024] [Indexed: 04/19/2024] Open
Abstract
Gallbladder cancer (GBC) is a rare and highly aggressive malignancy, often characterized by nonspecific clinical presentations and late diagnosis, which contribute to its poor prognosis. It is commonly detected at advanced stages, leading to low survival rates. Surgical resection is the primary treatment, with the extent of surgery depending on the T stage of the cancer. In advanced cases, surgery is only considered if it can potentially be curative. Despite various treatment approaches for advanced GBC, survival outcomes remain poor. In our case series, we introduce a novel treatment approach combining cytoreductive surgery, intraoperative radiation therapy, and hyperthermic intraperitoneal chemotherapy. Remarkably, we observed a 100% one-year survival rate, with one patient achieving eight years of disease-free survival without recurrence or metastasis. This aggressive treatment strategy did not lead to increased morbidity or mortality, suggesting its safety and feasibility. However, larger-scale studies are required to draw definitive conclusions.
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Affiliation(s)
- Marwan Alaswad
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | | | - Ziad Alhosainy
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Fadwa Elkordy
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | | | | | | | | | - Ayman Zaki Azzam
- Department of Surgery, Surgical Oncology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
- Department of General Surgery, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Tarek Amin
- Department of Surgery, Surgical Oncology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
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Elashwah A, Alsuhaibani A, Alzahrani A, Azzam AZ, Moftah B, Breakeit M, Hussain M, Mahmood R, ALramahi S, Hassan Z, Amin TM. The Use of Intraoperative Radiation Therapy (IORT) in Multimodality Management of Cancer Patients: a Single Institution Experience. J Gastrointest Cancer 2023; 54:433-441. [PMID: 35290599 DOI: 10.1007/s12029-021-00786-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/06/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND Intraoperative radiation therapy (IORT) is a highly conformal type of radiation therapy given at time of surgery aiming for better tumor local control. It increases the tumor radiation dose without exceeding normal tissues tolerance doses. PURPOSE To assess the feasibility of IORT and short-term toxicities in patients with different cancer sites treated with multidisciplinary protocol including IORT. PATIENTS AND METHODS Medical records of cancer patients who received IORT as a part of their multidisciplinary treatment at King Faisal Specialized Hospital and Research center (KFSH&RC), Riyadh, Saudi Arabia, from January 2013 until December 2017 were retrospectively reviewed. RESULTS A total of 188 patients with 210 IORT applications were analyzed. Twenty-two patients had two applications at the same time. One hundred sixteen patients were males. Median age at time of diagnosis was 49.5 years (19-77). One hundred thirty-four patients had primary, while 54 cases had recurrent disease. Gastroesophageal cancer and soft tissue sarcoma were the most frequent diagnosis in 49 patients followed by colorectal cancer in 35 patients. Major surgeries with curative intent done in 183 patients (97.3%). Hyperthermic intraperitoneal chemotherapy (HIPEC) was performed in 118 (62.8%) patients. The 30-day postoperative mortality rate was 3.2%. Fifty-four (28.7%) patients develop grades III-IV complications according to Clavien-Dindo grading system. CONCLUSION The data presented discusses using of IORT treatment for different malignant tumors as a part of multimodality treatment. IORT seems safe and feasible; however, a longer follow-up period is needed for proper evaluation and to define the role of IORT in a tailored multimodality approach.
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Affiliation(s)
- Ahmed Elashwah
- Section of Radiation Oncology, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia.
- Kasr Al-Eini Center of Clinical Oncology (NEMROCK), Cairo University, Cairo, Egypt.
| | | | - Ali Alzahrani
- Department of Surgical Oncology, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
| | - Ayman Zaki Azzam
- Department of Surgical Oncology, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
- Department of General Surgery, Alexandria University, Alexandria, Egypt
| | - Belal Moftah
- King Faisal Specialist Hospital & Research Centre, Department of medical physics, Riyadh, Saudi Arabia
| | - Mohammad Breakeit
- Department of Surgical Oncology, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
| | - Muhammad Hussain
- King Faisal Specialist Hospital & Research Centre, Department of medical physics, Riyadh, Saudi Arabia
| | - Rana Mahmood
- Section of Radiation Oncology, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
| | - Shada ALramahi
- King Faisal Specialist Hospital & Research Centre, Department of medical physics, Riyadh, Saudi Arabia
| | - Zeinab Hassan
- King Faisal Specialist Hospital & Research Centre, Department of medical physics, Riyadh, Saudi Arabia
| | - Tarek Mahmoud Amin
- Department of Surgical Oncology, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
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Aburahmah M, Hijji TM, Saif LT, Kalagi D, Azzam AZ, Amin T. Feasibility of combining oncology surgery with bariatric surgery; a two-patient case series of sleeve gastrectomy with cytoreductive surgery and HIPEC. J Surg Case Rep 2022; 2022:rjab588. [PMID: 35047173 PMCID: PMC8763604 DOI: 10.1093/jscr/rjab588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 12/03/2021] [Indexed: 02/05/2023] Open
Abstract
Patients with an oncologic disease requiring cytoreductive surgery and hyperthermic intraperitoneal chemotherapy may also present with morbid obesity. In some patients, it may be possible to offer bariatric surgery such as sleeve gastrectomy in combination with their cancer resection to treat both diseases concurrently. Two such cases are described where sleeve gastrectomy was done alongside the primary oncologic surgery in the same procedure. Our patients had long-term follow-ups and their overall outcomes were favorable. They achieved remission and acceptable levels of weight loss over their several years of follow-up appointments. The added benefit of bariatric surgery may decrease long-term morbidity and mortality in carefully selected patients. More studies are indicated to fully understand the risks of benefits of this combined procedure in order to offer it on a wider scale.
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Affiliation(s)
- Mohammad Aburahmah
- Surgical Oncology Department, Oncology Center, King Faisal Specialist Hospital and Research Center (KFSH&RC), P. O. Box 3354, Riyadh 11211, Saudi Arabia
| | - Talal M Hijji
- Correspondence address. College of Medicine, Alfaisal University, P.O. Box 50927, Riyadh 11533, Saudi Arabia. Tel: +966 503506541; E-mail:
| | - Lama Tareq Saif
- College of Medicine, Alfaisal University, P.O. Box 50927, Riyadh 11533, Saudi Arabia
| | - Dana Kalagi
- King Faisal Specialist Hospital and Research Center (KFSH&RC), P. O. Box 3354, Riyadh 11211, Saudi Arabia
| | - Ayman Zaki Azzam
- Surgical Oncology Department, Oncology Center, King Faisal Specialist Hospital and Research Center (KFSH&RC), P. O. Box 3354, Riyadh 11211, Saudi Arabia
- General Surgery Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Tarek Amin
- Surgical Oncology Department, Oncology Center, King Faisal Specialist Hospital and Research Center (KFSH&RC), P. O. Box 3354, Riyadh 11211, Saudi Arabia
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Azzam AZ, Al-Hamadah FH, Azzam KA, Amin TM. Mucinous Appendiceal Adenocarcinoma Penetrated the Quadratus Lumborum Muscle Posteriorly and Presented as Gluteal Abscess Managed Aggressively with Drainage Followed by Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy Combined with Intraoperative Radiotherapy. a Case Report and Review of the Literature. Indian J Surg Oncol 2020; 11:128-130. [PMID: 33088148 PMCID: PMC7534762 DOI: 10.1007/s13193-020-01090-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2019] [Accepted: 05/07/2020] [Indexed: 02/05/2023] Open
Abstract
Appendiceal mucinous adenocarcinoma is a term that was given for invasive appendiceal tumors. It is always present with pseudomyxoma peritonei which is a complex disease. These tumors have the tendency to surround the primary tumor then extend primarily and extensively all over the peritoneal cavity as the primary site of metastases. The invasion through the abdominal wall muscles is rare but the penetration and passing through these muscles to the subcutaneous tissue are extremely rare. A 62-year-old male patient known to have pseudomyxoma peritonei presented with gluteal abscess. After 2 weeks from the abscess drainage, the patient underwent cytoreductive surgery (CRS) combined with intraoperative radiotherapy (IORT) and hyperthermic intraperitoneal chemotherapy (HIPEC). He tolerated the operation well and discharged home in a good condition. Even with extensive appendiceal mucinous neoplasms presented with the penetration of the abdominal wall muscles, still aggressive management should be considered.
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Affiliation(s)
- Ayman Zaki Azzam
- General Surgery Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt
- Surgical Oncology Department, Oncology Center, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Fatimah Hassan Al-Hamadah
- Surgical Oncology Department, Oncology Center, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | | | - Tarek Mahmoud Amin
- Surgical Oncology Department, Oncology Center, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
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Azzam AZ, Amin TM. Combined Intraoperative Radiotherapy (IORT) and Hyperthermic Intraperitoneal Chemotherapy (HIPEC) with Cytoreduction Surgery (CRS) as a Novel Approach in the Management of Resectable Pancreatic Cancer. Gulf J Oncolog 2020; 1:19-26. [PMID: 32476645 DOI: pmid/32476645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/25/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND Pancreatic cancer is leading cause of cancer related deaths. The prognosis is usually very poor. In spite of the advances in modern surgery, the outcome is still poor. IORT was recently introduced with recorded improvement in both locoregional tumor control and patient survival. Prophylactic HIPEC was introduced during the initial surgery in order to prevent subsequent peritoneal cancer or tumor recurrence which showed some encouraging results. AIM OF WORK Evaluation of the perioperative results of the combination of IORT and HIPEC with CRS as a novel approach in the management of resectable pancreatic cancer. PATIENTS AND METHODS This study was conducted at King Faisal Specialist Hospital and Research Center, Riyadh, Kingdom of Saudi Arabia. Data were collected retrospectively. A total of five patients were included in the study, during the period from November 2017 to August 2018. All surgeries were done by the same surgeon. RESULTS The average age was 51 years (25-63). The patients were two males and three females. All the patients underwent complete surgical resection combined with IORT then HIPEC. All patients were discharged home in good condition. They were regularly followed up without any evidence of local recurrence or metastases. CONCLUSION The combination of IORT and HIPEC with CRS gives the addition of the benefits of each procedure alone without affecting the postoperative morbidity or mortality. This combination appeared to be feasible, safe and well tolerated. However, this need to be applied on a larger number of patients with longer periods of follow-up to reach sound conclusions.
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Affiliation(s)
- Ayman Zaki Azzam
- General Surgery Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt
- Surgical Oncology Department, Oncology Center, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Tarek Mahmoud Amin
- Surgical Oncology Department, Oncology Center, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
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Affiliation(s)
- Ayman Zaki Azzam
- General Surgery Department, Faculty of Medicine , Alexandria, Egypt
| | | | | | - Magdy A. Souror
- General Surgery Department, Faculty of Medicine , Alexandria, Egypt
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Azzam AZ, Dababo MA, Azzam KA, Almeshal M, Amin TM. Right Temporal Brain Metastases Arising Three Years after Curative Resection of Gastric Cancer: A Case Report. Gulf J Oncolog 2018; 1:75-77. [PMID: 30344139 DOI: pmid/30344139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/19/2018] [Indexed: 02/08/2023]
Abstract
BACKGROUND Gastric cancer can metastasize to multiple organs but the metastases to brain is very rare. We report a case of recurrent gastric cancer. The only site of recurrence is brain metastases that occurred three years after curative resection. CASE PRESENTATION A 58-year-old male patient who was diagnosed to have gastric cancer. He received neoadjuvant chemotherapy then complete resection. The patient came to the outpatient clinic for regular follow up. After three years from resection the patient complained of headache and seizures. CT scan brain showed right temporal bone localized tumor. Complete resection was done which revealed it is a localized metastases from gastric cancer. CONCLUSION Localized brain metastases from gastric cancer is a rare event. Urgent CT scan must be done if the patient had any neurological complaint. Early diagnosis is the key for the patient management. Rapid treatment can improve the patient general condition and neurological manifestations.
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Affiliation(s)
- Ayman Zaki Azzam
- General Surgery Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt
- Surgical Oncology Department, Oncology Center, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Mohammad Anas Dababo
- Pathology and Laboratory Medicine Department, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Kareem Ayman Azzam
- Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Meshal Almeshal
- Surgical Oncology Department, Oncology Center, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Tarek Mahmoud Amin
- Surgical Oncology Department, Oncology Center, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
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Zaki Azzam A, Alqarni A, Mahmoud Amin T. The role of intraoperative radiotherapy (IORT) in the management of patients with pancreatic and periampullary cancer: A single center experience. J Egypt Natl Canc Inst 2018; 30:77-79. [PMID: 29680448 DOI: 10.1016/j.jnci.2018.03.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Revised: 03/12/2018] [Accepted: 03/24/2018] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND In spite of the advances in modern surgery, the outcome for patients suffering from pancreatic adenocarcinoma or periampullary adenocarcinoma is still bad. Recently, introperative radiotherapy (IORT) was introduced into the multimodality management approach to improve both tumor control and patient' survival. AIM OF WORK To evaluate our initial experience in combined surgical resection and IORT, and to evaluate the feasibility of the application of IORT and its effect on morbidity, mortality and local recurrence. PATIENTS AND METHODS This study was conducted at King Faisal Specialist Hospital and Research Center, Riyadh, Kingdom of Saudi Arabia. Data were collected retrospectively. A total of six patients were included in the study, during the period from November 2013 to April 2017. All surgeries were done by the same surgeon. RESULTS The average age was 60 years (50-71). The patients were four males and two females. Five patients underwent complete surgical resection (pancreaticoduodenectomy) combined with IORT. One patient had locally advanced pancreatic tumor which was beyond surgical resection, for whom surgical bypass was done to overcome the biliary obstruction combined with IORT. Two patients died from disease progression and liver metastases. The remaining four patients survived without any evidence of local recurrence or metastases on follow-up. CONCLUSION Application of IORT is safe and feasible. It can be applied without additional morbidities or mortalities. Although our results are satisfactory, yet they need to be applied on a larger number of patients with longer periods of follow-up to reach sound conclusions.
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Affiliation(s)
- Ayman Zaki Azzam
- General Surgery Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt; Surgical Oncology Department, Oncology Center, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia.
| | - Ahmed Alqarni
- Hepato-biliary Pancreatic Surgery Department, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia.
| | - Tarek Mahmoud Amin
- Surgical Oncology Department, Oncology Center, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia.
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Azzam AZ, Alyahya ZA, Wusaibie AAA, Amin TM. Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in the management of pseudomyxoma peritonei: A single-center experience. Indian J Gastroenterol 2017; 36:452-458. [PMID: 29185227 DOI: 10.1007/s12664-017-0799-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Accepted: 11/05/2017] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Pseudomyxoma peritonei (PMP) results from perforated appendiceal tumors. It is usually diagnosed preoperatively by imaging. Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC), although aggressive long procedure with high complications rate, was considered the optimal treatment. This study is aiming to study the role of CRS and HIPEC in the management of PMP and assess the outcome. METHODS This is a retrospective study which was conducted at King Faisal Hospital and Research Center, a tertiary care hospital during the period from November 2008 to June 2016. Approval of the Research Advisory Council was obtained. Forty-one procedures of CRS and HIPEC were performed in 38 patients. Using the open abdomen technique, CRS was performed using standard peritonectomy procedures and visceral resections directed toward the complete elimination of tumors from abdominopelvic cavity. HIPEC was performed using mitomycin C in a dose of 30 mg/m2 and allowed to circulate in abdominopelvic cavity for 90 min at 41.0 to 42.2 °C. RESULTS Forty-one procedures were performed in 38 patients. Three procedures were done as repeat CRS and HIPEC. No perioperative mortality. Cystoscopy and bilateral ureteric stents in 35 procedures (85.5%). Hospital stay (range 9-85 days) average is 21 days. Follow up period is 1-84 months, and median follow up is 54 months. Five-year survival rate is 92%. Median 5-year disease-free survival rate is 60%. Two patients died during the follow up period by septic shock and one patient died from disease progression. CONCLUSION CRS and HIPEC is well-tolerated and feasible management for PMP.
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Affiliation(s)
- Ayman Zaki Azzam
- General Surgery Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt.
- Surgical Oncology Department, Oncology Center, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia.
| | - Zyad Adil Alyahya
- General Surgery Department, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Ahmed Abbas Al Wusaibie
- General Surgery Department, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Tarek Mahmoud Amin
- Surgical Oncology Department, Oncology Center, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
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Azzam AZ, Tanaka K. Biliary complications after living donor liver transplantation: A retrospective analysis of the Kyoto experience 1999-2004. Indian J Gastroenterol 2017; 36:296-304. [PMID: 28744748 DOI: 10.1007/s12664-017-0771-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2017] [Accepted: 07/02/2017] [Indexed: 02/05/2023]
Abstract
BACKGROUND AND AIM In living donor liver transplantation (LDLT), biliary complications continue to be the most frequent cause of morbidity and may contribute to mortality of recipients although there are advances in surgical techniques. This study will evaluate retrospectively the short-term and long-term management of biliary complications. METHODS During the period from May 1999, to May 2004, 505 patients underwent 518 LDLT in the Department of Liver Transplantation and Immunology, Kyoto University Hospital, Japan. The data was collected and analyzed retrospectively. RESULTS The recipients were 261 males (50.4%) and 257 females (49.6%). Biliary complications were reported in 202/518 patients (39.0%), included; biliary leakage in 79/518 (15.4%) patients, leakage followed by biloma in 13/518 (2.5%) patients, leakage followed by stricture in 9/518 (1.8%) patients, and biliary strictures in 101/518 (19.3%) patients. Proper management of the biliary complications resulted in a significant (p value 0.002) success rate of 96.5% compared to the failure rate which was 3.5%. CONCLUSION Careful preoperative evaluation and the proper intraoperative techniques in biliary reconstruction decrease biliary complications. Early diagnosis and proper management of biliary complications can decrease their effect on both the patient and the graft survival over the long period of follow up.
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Affiliation(s)
- Ayman Zaki Azzam
- General Surgery Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt.
| | - Koichi Tanaka
- Kobe International Frontier, Medical Center Medical Corporation, Kobe, Japan
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Abstract
Hepatocellular carcinoma (HCC) is one of the most common cancers worldwide and has a poor prognosis if untreated. It is ranked the third among the causes of cancer-related death. There are multiple etiologic factors that can lead to HCC. Screening for early HCC is challenging due to the lack of well specific biomarkers. However, early diagnosis through successful screening is very important to provide cure rate. Liver transplantation (LT) did not gain wide acceptance until the mid-1980s, after the effective immunosuppression with cyclosporine became available. Orthotopic LT is the best therapeutic option for early, unresectable HCC. It is limited by both, graft shortage and the need for appropriate patient selection. It provides both, the removal of tumor and the remaining cirrhotic liver. In Milan, a prospective cohort study defined restrictive selection criteria known as Milan criteria (MC) that led to superior survival for transplant patients in comparison with any other previous experience with transplantation or other options for HCC. When transplantation occurs within the established MC, the outcomes are similar to those for nonmalignant liver disease after transplantation. The shortage of organs from deceased donors has led to the problems of long waiting times and dropouts. This has led to the adoption of extended criteria by many centers. Several measures have been taken to solve these problems including prioritization of patients with HCC, use of pretransplant adjuvant treatment, and living donor LT.
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Abu-Zaid A, Azzam AZ, AlOmar O, Salem H, Amin T, Al-Badawi IA. Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for managing peritoneal carcinomatosis from endometrial carcinoma: a single-center experience of 6 cases. Ann Saudi Med 2014; 34:159-66. [PMID: 24894786 PMCID: PMC6074854 DOI: 10.5144/0256-4947.2014.159] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Endometrial carcinoma is the most common gynecologic malignancy worldwide. Prognosis of patients with peritoneal carcinomatosis (PC) from endometrial carcinoma is deadly, with an estimated median survival not exceeding 12 months. The objective of this study was to report our experience with cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) for managing PC from primary and recurrent endometrial carcinoma. DESIGN AND SETTINGS A retrospective analysis of 6 patients with PC arising from endometrial cancer, who were managed with CRS and HIPEC at our referral tertiary care center, from November 2010 to August 2013. MATERIALS AND METHODS Six patients underwent CRS and HIPEC. CRS was performed using standard peritonectomy procedures and visceral resections directed toward the complete elimination of tumors from ab.dominopelvic cavity. HIPEC was performed with cisplatin (50 mg/m2) and doxorubicin (15 mg/m2) and allowed to circulate in abdominopelvic cavity for 90 minutes at 41.0 to 42.2°C. RESULTS Two patients with primary endometrial carcinoma and 4 patients with recurrent endometrial carcino.ma confined to peritoneal cavity were studied. Complete cytoreduction (CC-0) was achieved in 5 patients. The International Federation of Gynecology and Obstetrics (FIGO) stages and histopathological types were as follows: IB endometrioid adenocarcinomas (n=1), IC mesonephric carcinomas (n=1), IIIA endometrioid adenocarcino.mas (n=2), IIIA papillary serous carcinomas (n=1), and IIIC clear-cell carcinomas (n=1). Anastomotic leak (grade I) was the most commonly encountered postoperative complication. Two patients developed grade IV compli.cations due to septicemia and pulmonary embolism. No intraoperative mortality occurred. Postoperatively, all patients received chemotherapy (carboplatin and paclitaxel). In 1 patient, the clear-cell carcinoma histologic lesion relapsed within 6 months; the metastases spread to hepatic, pelvic, and mesenteric lymph nodes, and the patient died 5 months later. One patient with cytoreduction completeness of CC-2 developed hepatic metastases within 3 months and is still alive at a follow-up up 6 months. Remaining patients (n=4) are alive and disease free without evidence of recurrence of follow-ups at 35, 34, 19, and 7 months. CONCLUSION CRS and HIPEC are well-tolerated and feasibly promising management modalities in PC from primary and recurrent endometrial carcinoma. Further research is needed for in-depth analysis.
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Affiliation(s)
| | | | | | | | | | - Ismail A Al-Badawi
- Dr. Ismail A. Al-Badawi, MBC 52 Department of Obstetrics and Gynecology,, PO Box 3354, King Faisal Specialist Hospital and Research Centre,, Riyadh 11211, Saudi Arabia, T: +966-11- 442-7392, F: +966-11-442-7393,
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Abstract
BACKGROUND/AIMS Vascular complications after liver transplantation remain a major source of morbidity and mortality for recipients especially those receiving LDLT owing to the complex vascular reconstruction. METHODOLOGY During the period from May 1999 to May 2004, 518 LDLT were performed in the Department of Liver Transplantation and Immunology, Kyoto University Hospital, Japan. RESULTS The recipients were 261 males and 257 females. Pediatric cases were 230. The indications were cholestatic diseases in 42.5%, chronic hepatocellular diseases (CHD) in 13.3%, HCC in 18.5%, other tumors in 2.7% and others in 23%. Small for- size grafts in 4.8%, accepted size grafts in 16.0%, optimum size grafts in 74.5% and large-for-size grafts in 4.6%. Vascular complications occurred during hospital stay in 6.4%, within 3 months from discharge in 2.5% and after 3 months from discharge in 6.0%. The success rate of the management of HAT was 83.3%, portal vein complications was 97.6% and hepatic vein complications was 84.6%. CONCLUSIONS Careful preoperative evaluation and the proper intraoperative techniques in vascular reconstruction prevent vascular complications. Intraoperative microsurgical technique for hepatic artery reconstruction decreases hepatic artery complications. Routine post transplant Doppler examination should be performed at least twice a day for the first week after the operation. Immediate surgical intervention is required for acute vascular complications, whereas late complications may be treated by balloon angioplasty and endoluminal stent to avoid late complications and even mortality.
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Affiliation(s)
- Ayman Zaki Azzam
- Department of General Surgery, Alexandria University, Alexandria, Egypt.
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Azzam AZ, Hegab B, Khalaf H, Al Bahili H, Mohammed H, Kamel Y, Abaalkhail F, Al-hamoudi W, Al Sofayan M, Al Sebayel M. Liver transplantation in patients with hepatocellular carcinoma: a single-center experience. EXP CLIN TRANSPLANT 2011; 9:323-8. [PMID: 21967259 DOI: pmid/21967259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVES Liver transplantation has become one of the best treatment options for early hepatocellular carcinoma in cirrhosis. We sought to study the results of liver transplantation in patients with hepatocellular carcinoma and to evaluate the outcome of the patients. MATERIALS AND METHODS The medical records of 256 recipients who underwent a liver transplantation from April 2001 to January 2010 were reviewed. One hundred seventy-six patients received their livers from deceased donors, and 80 received their livers from living donors. Fifty-two patients underwent liver transplantation for hepatocellular carcinoma. RESULTS From April 2001 until now, 52 patients (20.3%) underwent liver transplantation for hepatocellular carcinoma. Eighteen patients (34.6%) were performed from living-related donors, and 34 (65.4%) were from deceased donors. The patients were 37 males and 15 females (median, 55 years old; age range, 5 through 68 years). Model for end-stage liver disease score ranged from 6 to 40 with a median of 14. All patients were within the Milan criteria by the preoperative evaluation. Hospital stay ranged from 6 to 338 days with a median 14 days. Operating time ranged from 4 to 15 hours with a median 7.5 hours. Blood transfusion ranged from 0 to 19 units median 5 units. Thirty-four complications occurred in 23 patients (44.2%). Recurrence of hepatocellular carcinoma in 7 patients (13.5%), of which recurrent cholangiocarcinoma was diagnosed in 3 (5.7%), accidentally discovered in the explant. One deceased donor had hepatitis B core antibody positive. One explant showed macrovascular invasion. Sixteen patients died, 7 of 52 (13.5%) from hepatocellular carcinoma recurrence, including the 3 cases of accidental discovery of cholangiocarcinoma (5.7%). CONCLUSIONS Apart from the common complications that can occur with any transplantation, liver transplantation remains the most-promising solution for patients with hepatocellular carcinoma among the available ones, and represents a cornerstone in managing hepatocellular carcinoma. It is the only acceptable option for complete eradication of both the disease and the predisposing factor.
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Affiliation(s)
- Ayman Zaki Azzam
- Liver Transplantation and Hepatobiliary-Pancreatic Surgery Department, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia.
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