Although the presence of synchronous colorectal liver metastases (CRLM) represents an important prognostic factor for recurrence-free survival (RFS) and overall survival (OS), the definitions of synchronicity are variable in the literature, including metastases at the time of diagnosis, or even before the diagnostic of the primary site of colorectal cancer (CRC), until either six or 12 months after the time of diagnosis, according to the author of each study. Simultaneous approaches to treat CRC and CRLM seem to be safe for patients carefully selected without jeopardizing oncologic outcomes, with similar complication rates, shorter hospital length of stay, and operation times even for major hepatectomies. However, there is no consensus about the optimal timing to approach the primary tumor and CRLM, whether simultaneously or staged, and both performance status and the presence of symptoms play important roles in the treatment sequence, perhaps avoiding two high-risk procedures at the same time.
The presence of synchronous colorectal liver metastases represents an important prognostic factor for recurrence-free survival and overall survival, the definitions of synchronicity are variable in the literature, including metastases at the time of diagnosis, or even before the diagnostic of the primary site of colorectal cancer, and until either six or 12 months after the time of diagnosis, according to the authors of the studies.
Simultaneous approaches to treat colorectal cancer and colorectal liver metastases seem to be safe for patients carefully selected without jeopardizing oncologic outcomes, with similar complication rates, shorter length of stay and operation times even for major hepatectomies. However, there is no consensus about the optimal timing to approach the primary tumor and colorectal liver metastases, whether simultaneously or staged, and both performance status and presence of symptoms play important roles in the treatment sequence, perhaps avoiding two high-risk procedures at the same time
Pancreatic cancer is still a terrifying condition that has a high mortality rate due to its rapid progression and treatment complexity. However, there is still no consensus on what the gold standard of treatment for locally advanced pancreatic cancer (LAPC) is.
The aim of this study was to review the current evidence-based data on treatment strategies for LAPC, comparing pancreatoduodenectomy with vascular reconstruction (PDVR) and chemotherapy alone (CA).
This systematic review was performed according to the PRISMA 2020 guidelines. Overall survival (OS) was the primary endpoint, while progression-free survival (PFS) was the secondary endpoint. The included studies were published between 2013 and 2023.
A total of 16 relevant papers were found in the literature search. The median PFS duration for CA varied from 3.22 to 11.7 months, whereas the median overall survival (mOS) varied from 5.95 to 23.0 months. The mOS ranged from 12.7 to 24.9 months and the median PFS time ranged from 8.5 to 22.5 months for patients submitted to neoadjuvant therapy followed by PDVR.
LAPC presents worse outcomes when patients are submitted to CA with gemcitabine only, or when patients undergo upfront PDVR.
The classification of resectability for pancreatic ductal adenocarcinoma is crucial in guiding treatment strategies. A recent system including anatomic (A), biological (B), and conditional (C) factors has been used to select the patients who underwent pancreatoduodenectomy, and centralization has been associated with low mortality and defined as a critical determinant of surgical outcomes. A comprehensive literature review assessed the impact of incorporating the ABC criteria in patients with pancreatic ductal adenocarcinoma. Incorporating biological and conditional criteria for patients with pancreatic ductal adenocarcinoma could enhance patient stratification accuracy and improve clinical outcomes and survival.
Although the presence of synchronous colorectal liver metastases (CRLM) represents an important prognostic factor for recurrence-free survival (RFS) and overall survival (OS), the definitions of synchronicity are variable in the literature, including metastases at the time of diagnosis, or even before the diagnostic of the primary site of colorectal cancer (CRC), until either six or 12 months after the time of diagnosis, according to the author of each study. Simultaneous approaches to treat CRC and CRLM seem to be safe for patients carefully selected without jeopardizing oncologic outcomes, with similar complication rates, shorter hospital length of stay, and operation times even for major hepatectomies. However, there is no consensus about the optimal timing to approach the primary tumor and CRLM, whether simultaneously or staged, and both performance status and the presence of symptoms play important roles in the treatment sequence, perhaps avoiding two high-risk procedures at the same time.
Knowledge of the cystic artery and its variations is essential to perform safe cholecystectomies. The cystic artery originates from the right hepatic artery, passing posterior to the common hepatic duct, anterior to the cystic duct, and branching into two branches at the neck of the gallbladder. However, variations in position, size, and relationship with adjacent structures are common.
This article presents a literature review regarding cystic artery variations and their frequency during cholecystectomies.
The articles selected for this review were chosen from the PubMed and SciELO databases. The standardized descriptors used were anatomic variation and cholecystectomy. These were chosen using the “Medical Subject Headings” and combined with the Boolean operator AND and the non-standard descriptor cystic artery.
It was found in 54.5% of the studies that the anatomical pattern of the cystic artery was the most frequent type. A different origin from the standard was cited in 63.6% of the articles. Double irrigation of the gallbladder was found in 59.1%. In 36.4%, the cystic artery was anterior to the common hepatic duct or the cystic duct. Cystic arteries outside Calot’s triangle were found in 36.4%. Short cystic arteries were found in 13.6%. The absence or non-identification of the artery was reported in 9.1%.
Variations of the cystic artery are common and are frequently reported. One aspect of a safe cholecystectomy is anatomical knowledge and its possible variations. Thus, surgeons must be familiar with this point in order to reduce vascular and biliary injuries.
Deaths related to colorectal cancer are generally associated with its metastases that affect the liver (50%) through the hematogenous route. Approximately 20-25% of these patients already have synchronous metastases in the liver at the time of primary tumor diagnosis. In others, liver metastases will occur during the course of the disease and are called metachronous. Metachronous metastases are believed to have a better prognosis; however, 20-25% of metastatic cases can be resected during the course of the disease. There is a lack of consensus on the diagnostic time interval for metastases to be considered metachronous in the consulted literature. Surgical treatment of metastases and lymph nodes is indicated, and extrahepatic neoplastic disease must be carefully evaluated. Liver transplantation can benefit the patient, should be evaluated, and is indicated in some special situations.
Colorectal cancer (CRC) is a common disease, with incidence in Brazil of 45,630 new cases per 100,000 inhabitants between 2023-2025. Risk factors for CRC can be evaluated between environmental and hereditary and their mode of presentation are classified as sporadic, inherited and familial. Sporadic disease is characterized by the absence of a family history and accounts for approximately 70% of all colorectal cancers, being more common over 50 years of age, with dietary and environmental factors implicated in its pathogenesis. Sporadic disease is characterized by the absence of a family history and accounts for approximately 70% of all colorectal cancers, being more common over 50 years of age, with dietary and environmental factors implicated in its pathogenesis. The percentage of patients with a true hereditary genetic predisposition is less than 10%, and these are related to the presence or absence of colonic polyps as an important manifestation of the disease. Non-polyposis diseases are known as hereditary non-polypomatous colorectal cancer (HNPCC) or Lynch syndrome, and polyposis diseases are familial adenomatous polyposis (FAP), MUTYH-associated polyposis (MAP), and hamartomatous polyposis syndromes (e.g., Peutz-Jeghers, juvenile polyposis, phosphatase and tensin homologue - PTEN, Cowden syndrome). These diseases are linked to a high risk of developing cancer. With the development of treatments in metastatic disease and the use of targeted therapies and their biomarkers, it was possible to evaluate them within clinical studies both in the primary tumor and in the correspondence of metastases.
Liver metastases from melanomas, sarcomas, and renal tumors are less frequent. Treatment and prognosis will depend on whether they are isolated or multiple, size and location, the presence or absence of extrahepatic neoplastic disease, age, stage of the initial disease, initial treatments instituted, time of evolution, and clinical condition of the patient. Recently, a high number of oncological therapies including monotherapy or in combination, neoadjuvants or adjuvants, and immuno-oncological treatments have been developed and tested, increasing disease-free time and survival.
Complete removal of metastatic disease and maintenance of an adequate liver remnant remains the only treatment option with curative intent concerning colorectal liver metastases. Surgery impacts on the long-term prognosis and complications adversely affect oncological results. The actual morbidity involving this scenario is debatable and estimated to be ranging from 15% to 50%. Postoperative complications eventually lead to an increase in both mortality rates and tumor recurrence. Biliary fistula and liver failure are the leading complications following liver resection to metastatic colorectal cancer. Prophylactic drainage does not prevent fistulas or hemorrhage. Drainage along with endoscopic intervention and/or surgery may be necessary for grade B and C fistulas. Liver failure is a potentially lethal complication with few therapeutic options. Patient selection and preoperative care are crucial for its prevention.
One anastomosis gastric bypass (OAGB) has gained prominence in the search for better results in bariatric surgery. However, its efficacy and safety compared to Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) remain ill-defined.
To compare the efficacy and safety of OAGB relative to RYGB and SG in the treatment of obesity.
We systematically searched PubMed, EMBASE, Cochrane Library, Lilacs, and Google Scholar databases for randomized controlled trials comparing OAGB with RYGB or SG in the surgical approach to obesity. We pooled outcomes for body mass index, percentage of excess weight loss, type-2 diabetes mellitus remission, complications, and gastroesophageal reflux disease. Statistical analyses were performed with R software (version 4.2.3).
Data on 854 patients were extracted from 11 randomized controlled trials, of which 422 (49.4%) were submitted to OAGB with mean follow-up ranging from six months to five years. The meta-analysis revealed a significantly higher percentage of excess weight loss at 1-year follow-up and a significantly lower body mass index at 5-year follow-up in OAGB patients. Conversely, rates of type-2 diabetes mellitus remission, complications, and gastroesophageal reflux disease were not significantly different between groups. The overall quality of evidence was considered very low.
Our results corroborate the comparable efficacy of OAGB in relation to RYGB and SG in the treatment of obesity, maintaining no significant differences in type-2 diabetes mellitus remission, complications, and gastroesophageal reflux disease rates.
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