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( Oleksandr Korshak ),( Nellya Ablaeva ),( Olha Sokolova ),( Andrii Zhylenko ),( Denis Fedorov ),( Oleksandr Hrinenko ),( Oleksandr Ostapyshen ),( Maria Stassiuk ),( Vadim Kondratiuk ),( Andriy Husiev 대한간학회 2020 춘·추계 학술대회 (KASL) Vol.2020 No.1
Aims: Portal vein embolization(PVE) provokes cancer progression. Our aim was to develop method of future liver remnant(- FLR) augmentation that not only enable local tumor control but possible enable anticancer In Situ immunization during FLR regeneration. Methods: 3 initially unresectable patients due to small FLR with advanced hepatocellular carcinoma(HCC) and liver cirrhosis were treated. Selective transarterial chemoembolization with doxorubicin 50mg and short term biodegradable starch microspheres( DSM-TACE), into tumor bearing liver to be resected, was simultaneously followed by PVE of latter. Upon completion of PVE selective intratumoral immunotherapy(HIT-IT) with atezolizumab 1200mg into restored after DSM-TACE tumor arterial feeders (for selective connection with PD-L1 ligands located on tumor cells but not on normal human tissues) was done. DSM-TACE and HIT-IT was repeated one more time in all patients after postzenith decrease of T-cytotoxic cells level in peripheral blood had started. Anticancer immune response was investigated by comparison of Initial histopathology specimen with specimen obtained just before second DSM-TACE+HIT IT and finaly with specimen of resected tumor bearing liver. Latter were analysed along with peripheral blood flow cytometry. Results: Predominantly T and NK cells response was obtained. All patients had successfully underwent extended liver resection upon sufficient FLR regeneration. In all 3 cases we had achieved effective local tumor control via total or subtotal HCC necrosis, even more, in 1(33%) case planned amount of liver resection was decreased due to achieved tumor downsizing. There were no procedure related severe morbidity or Immune-related adverse events (irAEs). Also there were no postresectional liver failure. Conclusions: Herein we had proposed new aggressive but safe method of FLR augmentation for patients with HCC and liver cirrhosis that could not only potentially preclude drop out of patients during anticipated prolonged waiting period of FLR augmentation but also possible improves long-term outcomes by means of tumor downsizing and HCC immunoscore conversion.
Safety and Reasonability of Liver Resection for Intrahepatic Cholangiocarcinoma in Elderly Patients
( Andrii Zhylenko ),( Oleksandr Hrinenko ),( Oleksandr Korshak ),( Oleksii Popov ),( Andrii Husiev ) 대한간학회 2020 춘·추계 학술대회 (KASL) Vol.2020 No.1
Aims: The incidence of intrahepatic cholangiocarcinoma (ICC) in elderly patients is increasing worldwide. Little is known regarding postoperative outcomes in elderly patients undergoing liver resection for ICC. Methods: 84 patients undergoing liver resection for ICC between 2004 and 2018 were identified. Perioperative characteristics, postoperative morbidity, mortality and survival were compared between elderly (>60 years, group 1, n=31) and non-elderly (<60 years, group 2, n=53) patients. Results: Gender (P =0,34) and body mass index distribution (P =0,61), duration of stay (P =0,071) were comparable between groups. Surgical characteristics and pathologic data we present in table 1. Incidence of surgical site infections (19,3% vs 18,8%, P =0,95), posthepatectomy liver failure (18,6% vs 22,6%, P =0,47), reoperation (9,6% vs 9,4%, P =0,97) and clinically relevant complications (29,1% vs 32,1%, P =0,77) were comparable between the different age groups. 3-year OS (29.1% vs 32,5%, P =0,06) and DFS (16,5% vs 18.4%, P =0,004) were comparable between the elderly and non-elderly patients. Conclusions: Liver resection for ICC in elderly patients can obtain acceptable perioperative morbidity rates with a chance of long-term survival.