R P DeMatteo

..The pathogenesis of biliary cancers is ill-defined. This study investigates changes in gene expression and copy number in biliary cancers and correlates these changes with anatomical site of origin, histopathology and outcome...

..We present a summary of our experience with these advances...

..Although the efficacy of tyrosine kinase inhibitors in metastatic GIST depends on tumor mutation status, there have been conflicting reports on the prognostic importance of KIT mutation in primary GIST...

..Nearly all tumors have an activating mutation in the KIT or, less often, PDGFRalpha, gene. Therapy with tyrosine kinase inhibitors benefits over 80% of patients with advanced GIST, but most patients eventually develop drug resistance...

..Although STI571 was first applied to GIST only 2 years ago, it has already revolutionized the treatment of patients with metastatic disease and is also currently being tested as an adjuvant therapy after the resection of primary GIST...

..Primary hepatic sarcoma is a rare entity. The objectives of the study were to define treatment and long-term outcome and to identify prognostic factors...

..To analyze resectability and survival in patients with hilar cholangiocarcinoma according to a proposed preoperative staging scheme that fully integrates local, tumor-related factors...

....

..The distinct gene expression profile suggests avenues for investigation of pathogenesis and potential therapeutic strategies...

..The objective of this study was to evaluate outcome of initially unresectable patients who respond to multimodality therapy and undergo resection...

..Although caudate resection of the liver can be performed safely, concomitant major vascular reconstruction substantially increases the mortality of the procedure...

..Our goal was to investigate the spectrum of pathologic response and molecular alterations in a group of GIST patients, clinically defined as having imatinib-stable/imatinib-responsive lesions, who underwent surgical resection...

..Although complete resection improved survival, recurrence was common. The majority of recurrences were local or regional, which may help guide future adjuvant therapy strategies...

..Hepatectomy should be considered when complete gross resection is possible, especially when the time to the development of liver metastasis exceeds 2 years...

..To determine if the degree of blood loss during resection of hepatocellular carcinoma (HCC) is predictive of recurrence and long-term survival...

..Routine sampling of perihepatic lymph nodes will therefore have a low yield in patients without some evidence of disease on preoperative CT or PET scans or at the time of exploration...

..Despite an unknown benefit, hepatic resection is playing an increasing role in patients with extensive disease...

..The advent of STI-571 has markedly altered the clinical approach to GIST. It has proven to be effective in metastatic GIST and is also under investigation as a neoadjuvant and adjuvant therapy...

..Identification of subgroups through clinical features, molecular markers, proteins, or specific tumor properties may also help to individualize treatment...

..Frozen section analysis of bile duct margins is often used to guide the extent of surgical resection for hilar cholangiocarcinoma (HCCA), but the usefulness of this practice is unknown...

..This study was undertaken to reassess the yield of IOUS in light of recent improvements in preoperative staging...

..The role of PET in detecting disease recurrence after resection was also examined...

..CONCLUSIONS: The treatment paradigm for GIST has required the integration of surgery and molecular therapy and this will likely serve as a paradigm for the treatment of other solid tumors as targeted agents are developed...

..A secondary V600E BRAF mutation could represent an alternative mechanism of imatinib resistance. Kinase inhibitors targeting BRAF may be effective therapeutic options in this molecular GIST subset...

..The clinical benefit of sunitinib is genotype-dependent in regards to both primary and secondary mutations, with GIST patients harboring the KIT(AY502-3ins) exon 9 mutation being the most sensitive...

....

....

..The purpose of this study was to compare rates and patterns of disease progression following percutaneous, image-guided radiofrequency ablation (RFA) and nonanatomic wedge resection for solitary colorectal liver metastases...

..The incidence of gallbladder cancer (GBC) in the US is 1.2/100,000. This report examines the patterns of presentation, adjuvant treatment and survival of a large cohort of patients with GBC evaluated at MSKCC over a 10-year period...

..The objective of this study was to evaluate the impact of postoperative morbidity on the long-term outcome after liver resection for MCRC...

..A multidisciplinary treatment approach which combines both medical and surgical modalities may be associated with improved survival...

..We conclude that the presence of diabetes is associated with a higher incidence of perioperative mortality. In patients with diabetes mellitus and parenchymal steatosis, major hepatic resection should be undertaken with caution...

..Thermoablation, either cryosurgical ablation (CSA) or radiofrequency ablation (RFA), combined with resection is effective in the treatment of extensive bilobar colorectal metastasis...

..The current study underscores the need for effective adjuvant therapy for patients with HCC treated with partial hepatectomy...

..There was no association between percutaneous transhepatic biliary drainage and peritoneal tumor seeding...

..The pattern of distant spread follows the known patterns of hematogenous dissemination. Complete surgical resection is the cornerstone of treatment for primary GIST and LMS and in selected patients with local and distant recurrence...

..Targeting laparoscopy to patients at high risk for unresectable disease requires consideration of disease-specific factors; however, the surgeons' preoperative impression of resectability is also important...

..Blood conservation methods should be used to avoid transfusion, especially in patents currently requiring limited amounts of transfused blood products...

..Factors associated with the likelihood of subradiographic unresectable disease have not been clearly defined...

..This study analyzes changes in IHC frequency, demographics, and treatment outcome in a consecutive and single institutional cohort...

..Numerous staging systems have been devised for purposes of risk classification; we sought to identify the optimal staging system to predict postoperative survival...

..GISTs showing both NS-G and microtubules were associated with KIT exon 11 genotype and spindle cell morphology. PDGFRA mutated cases were associated with gastric location, predominantly epithelioid morphology and lacked NS-G...

..The indications for surgical treatment of liver metastases are broadening as a variety of novel therapies are being developed, including hepatic artery embolization, hepatic artery infusion of chemotherapy, and radiofrequency ablation...

..The integration of surgery and molecular therapy in GIST will serve as a prototype for the management of other solid tumors for which targeted agents become available...

..To examine the importance of adequate lymph node sampling in staging of extrahepatic bile duct cancer (EHBDCA)...

..We aimed to assess the evolution of the technical approach over time and correlations with morbidity, mortality, and oncologic outcome...

..Minimizing intraoperative blood loss appears to be critical for favorable long-term outcome in patients with large HCC...

..The relative risk of carcinoma in regions remote from the radiographically identified cyst remains poorly defined. This study describes the natural history of IPMN in patients initially selected for resection or surveillance...

..Symptomatic patients with a small FNH or haemangioma can be observed because their symptoms are unlikely to be related to the liver tumour. Percutaneous needle biopsy rarely changes management...

..Add systemic bevacizumab (Bev) to adjuvant hepatic arterial infusion (HAI) plus systemic therapy after liver resection to increase recurrence-free survival (RFS)...

..The rational application of the myriad of therapies to a patient with HCC is designed to maximize both quality of life and survival...

..In patients undergoing hepatic resection, autologous blood transfusion did not demonstrably improve perioperative outcome when compared to a matched cohort of patients receiving a similar number of allogeneic units...

..CT imaging frequently detects subcentimeter pulmonary nodules (SPN) in patients undergoing resection of colorectal cancer liver metastases. Their clinical significance is unknown...

....

..Despite improvements in surgery and chemotherapy, most patients develop recurrence after hepatectomy for metastatic colorectal cancer. Data are lacking on the effect of these patterns on outcome...

..To determine whether histopathologic and immunohistochemical features of tissue adherent to electrodes after radiofrequency (RF) ablation of liver malignancies can help predict local tumor progression (LTP)...

..This study analyzes factors associated with differences in long-term outcomes after hepatic resection for metastatic colorectal cancer over time...

..Major hepatic resections, including major hepatectomy and CBD excision, are appropriate when necessary to clear disease but are not mandatory in all cases...

....

..Diagnosing and treating GIST requires a multidisciplinary approach, given the combination of pathologic and radiographic evaluation, surgical treatment, and oncologic care required to successfully treat patients with GIST...

..To develop 2 instruments that predict the probability of perioperative red blood cell transfusion in patients undergoing elective liver resection for primary and secondary tumors...

..We postulated that adjuvant treatment with imatinib would improve recurrence-free survival compared with placebo after resection of localised, primary gastrointestinal stromal tumour...

..We tested the hypothesis that the gene expression profile in GISTs might be related to KIT genotype and possibly to other clinicopathological factors...

..That acquired resistance to imatinib in GIST commonly occurs via secondary gene mutation in the KIT kinase domain has implications for strategies to delay or prevent imatinib resistance and to employ newer targeted therapies...

..Based on our experience and a review of the published reports, we summarize the clinical and pathologic features of hepatic follicular dendritic cell sarcoma and its surgical management...

..Circulating angiogenic factors in patients with colorectal cancer liver metastases may promote tumor growth and contribute to liver regeneration after partial hepatectomy...

..This clinicopathologic study characterizes differences in cell cycle-regulatory protein expression across the spectrum of BTA...

..Perioperative bev is now commonly used in patients undergoing hepatic resection. Little is known, however, about the safety of perioperative bev use in the setting of hepatic resection...

..The current study compares outcome after resection of papillary hilar cholangiocarcinoma to that of the more common nodular-sclerosing subtype...

..Steatosis alone should not preclude aggressive hepatic resection for neoplasms when indicated; however, patients with marked steatosis undergoing large resections should still be approached with due caution...

..To analyze the impact of margin width on long-term outcome after hepatic resection for colorectal metastasis...

..The impact of KIT mutation in other regions, such as the extracellular or kinase domains, is not well-defined and fewer than 30 cases have been published to date...

..Resection should be considered the standard therapy for patients with HCC who have adequate liver reserve...

..There is now sufficient follow-up on a significant number of patients to address the curative intent of resecting CLM...

..The technique promotes tumor clearance while con-serving uninvolved parenchyma...

..In vitro experiments confirmed that monocyte suppression was mediated by neutrophil-derived IL-10. Thus, during septic peritonitis, neutrophils suppress peritoneal inflammatory monocytes through IL-10 and are dispensable for survival...

..Consequently, guidelines for treatment remain unclear. Current pathologic classification systems do not permit meaningful discrimination of hepatic neuroendocrine neoplasms...

..This study uses standard pathologic analysis and immunohistochemistry (IHC) to determine the impact of occult metastatic disease to perihepatic LN in patients with colorectal cancer undergoing hepatectomy...

..It is not clear which events are critical in tumor initiation versus tumor progression. RNA expression arrays and proteomics hold promise to provide further clues about this common and complex cancer...

..Preoperative assessment of future liver volume remaining distinguishes which patients undergoing liver resection will most likely benefit from preoperative liver enhancement techniques such as portal vein embolization...

..Transfusion of fresh frozen plasma (FFP) might be required after major hepatectomy because of blood loss or coagulopathy, but there are no standard criteria for the use of FFP in this setting...

..The yield of laparoscopy increases with increasing CRS. Preventing celiotomy with laparoscopy is associated with a decreased length of hospital stay and earlier initiation of postoperative chemotherapy...

....

..These tumors have a relatively indolent tumor biology, and late recurrences are common. Repeat resections for recurrence should be considered given the lack of other effective treatment options...

..These data have critical implications for investigating the immunologic mechanisms of experimental models that utilize gene transfer...

..All patients with potentially resectable primary gallbladder cancer and patients with T2/T3 hilar cholangiocarcinoma should undergo staging laparoscopy before surgical exploration...

..To assess the nature of changes in the field of hepatic resectional surgery and their impact on perioperative outcome...

..But the benefits of resection and appropriate selection criteria in patients who develop both hepatic and pulmonary metastases are ill defined...

..The results are essential to advance our understanding of GIST biology and determine the therapeutic value and limitations of STI571. ..

..We expect the findings to be important for immunologic conditions of the liver that include autoimmunity, infection, transplantation, and cancer. ..

..The results will further define GIST biology and be applicable to other diseases treated with molecular agents. ..

....

..Our investigations will be useful in identifying new therapies to treat ischemia reperfusion injury that occurs in humans. ..