Introduction Patients undergoing pancreaticoduodenectomy for distal cholangiocarcinoma (dCCA) often develop cancer recurrence. Establishing timing, patterns and risk factors for recurrence may help inform surveillance protocol strategies or select patients who could benefit from additional systemic or locoregional therapies. This multicentre retrospective cohort study aimed to determine timing, patterns, and predictive factors of recurrence following pancreaticoduodenectomy for dCCA. Materials and Methods Patients who underwent pancreaticoduodenectomy for dCCA between June 2012 and May 2015 with five years of follow-up were included. The primary outcome was recurrence pattern (none, local-only, distant-only or mixed local/distant). Data were collected on comorbidities, investigations, operation details, complications, histology, adjuvant and palliative therapies, recurrence-free and overall survival. Univariable tests and regression analyses investigated factors associated with recurrence. Results In the cohort of 198 patients, 129 (65%) developed recurrence: 30 (15%) developed local-only recurrence, 44 (22%) developed distant-only recurrence and 55 (28%) developed mixed pattern recurrence. The most common recurrence sites were local (49%), liver (24%) and lung (11%). 94% of patients who developed recurrence did so within three years of surgery. Predictors of recurrence on univariable analysis were cancer stage, R1 resection, lymph node metastases, perineural invasion, microvascular invasion and lymphatic invasion. Predictors of recurrence on multivariable analysis were female sex, venous resection, advancing histological stage and lymphatic invasion. Conclusion Two thirds of patients have cancer recurrence following pancreaticoduodenectomy for dCCA, and most recur within three years of surgery. The commonest sites of recurrence are the pancreatic bed, liver and lung. Multiple histological features are associated with recurrence. 

Patterns, timing and predictors of recurrence following pancreaticoduodenectomy for distal cholangiocarcinoma: An international multicentre retrospective cohort study

The value of serum albumin might be underestimated, especially in cancer patients. We thus aimed to evaluate the association between serum albumin level at hospital admission and clinical outcomes in hospitalized patients with cancer. 

Serum albumin level is associated with mortality and hospital stays: a real-world data analysis

Cirrhosis of the liver, a chronic hepatic condition marked by fibrosis and impaired functionality, poses substantial clinical difficulties worldwide. This comprehensive research review delves deeply into the study of liver cirrhosis, including its etiology, diagnosis, various treatment modalities, and prognosis. Various etiological variables, including conditions such as viral hepatitis, non-alcoholic fatty liver disease, and persistent alcohol consumption, contribute to the expansion of this syndrome via distinct mechanisms. Utilizing advanced methods such as transient elastography is crucial for achieving a precise diagnosis, which depends on a combination of clinical judgment, imaging tests, and histological examination. Various therapeutic approaches may be used based on the harshness of the patients state, including liver transplantation, pharmacotherapy, endoscopic interventions, and modifications in lifestyle. The prediction of the illness is contingent upon the severity of the cirrhosis and the resulting complications. Severe cirrhosis is correlated with an increased likelihood of death, in addition to the development of hepatocellular cancer. Healthcare professionals must collaborate across several disciplines to provide optimal care to their patients. 

Machine Learning Based Liver Cirrhosis Detection Using Different Algorithm : A Review

Multicenter phase I/II trial of gemcitabine, oxaliplatin and nab-paclitaxel as first-line treatment for patients with advanced biliary tract cancer

Induced-volatolomics, a new research field in chemical biology

Sex-related disparities in outcomes of cholangiocarcinoma patients in treatment trials

Objectives: In randomized clinical trials in patients with hepatocellular cancer (HCC), combination therapy with atezolizumab and bevacizumab (Atezo-Bev) prolonged survival, and these treatments have become the standard first-line therapy for advanced HCC. However, clinical trials may not reflect real-life clinical practice due to treatment selection criteria. Thus, our aim was to understand predictors of HCC outcomes with these treatments in a real-world, multicenter setting. Methods: A retrospective review of all patients 18 years of age or older treated for advanced primary liver cancer between February 2020 and August 2022 was conducted to assess the relationship between overall survival and clinical and biochemical variables before or during treatment. Univariate and multivariate Cox regression survival analyses were performed to identify predictors of survival following treatment. Results: One hundred and eleven eligible patients with unresectable HCC received Atezo-Bev over a consecutive 30-month period. Cox regression identified several significant (P<0.05) predictors of survival, including pretreatment albumin (hazard ratios [HR]: 0.2; CI: 0.1-0.4), total bilirubin (HR: 1.3; CI: 1.2-1.5), and international normalized ratio (HR: 5.6; CI: 2.5-12.5). In multivariate analyses, these were significantly associated as predictors of mortality, and patients with pretreatment albumin <3.5 mg/dL had significantly lower survival than those ≥3.5 (153 vs. 522 d, P<0.0001). Conclusions: Pretreatment hypoalbuminemia, high bilirubin, and biochemical tests indicative of hepatic or renal dysfunction can independently predict short-term mortality in advanced HCC patients receiving Atezo-Bev.

Predictors of Survival in Patients With Hepatocellular Cancer Receiving Atezolizumab and Bevacizumab.

Purpose: Surveillance of complications in patients post-lung transplant is routinely achieved by bronchoscopy. There is increasing interest and recognition in analyzing BAL differential cytology to detect allograft dysfunction. However, bronchoscopy is costly and not without risk. Volatile biomarkers released from lung immune and epithelial cells may indicate lung health. We sought to understand if exhaled breath biomarkers could be used as a screening tool for predicting BAL cell differential and allograft dysfunction. 

Utility of Breath Volatomic Analysis in Lung Transplant Recipients

Su1677: THE COST OF HUNGER: FOOD INSECURITY AND DEATHS FROM PRIMARY LIVER CANCERS IN THE UNITED STATES

INTRODUCTION
Biliary stents are used to optimize ductal patency and enable bile flow in the management of obstruction or injury related to biliary tract tumors, strictures, stones, or leaks. Although direct therapeutic applications of biliary stents are less well developed, stents can be used to deliver drugs, radioisotopes, and photodynamic therapy.


AREAS COVERED
This report provides an in-depth overview of the clinical indications, and therapeutic utility of biliary stents. Unique considerations for the design of biliary stents are described. The properties and functionalities of materials used for stents such as metal alloys, plastic polymers, or biodegradable materials are described, and opportunities for design of future stents are outlined. Current and potential applications of stents for therapeutic applications for biliary tract diseases are described.


EXPERT OPINION
Therapeutic biliary stents could be used to minimize inflammation, prevent stricture formation, reduce infections, or provide localized anti-cancer therapy for biliary tract cancers. Stents could be transformed into therapeutic platforms using advanced materials, 3D printing, nanotechnology, and artificial intelligence. Whilst clinical study and validation will be required for adoption, future advances in stent design and materials are expected to expand the use of therapeutic biliary stents for the treatment of biliary tract disorders.

Therapeutic biliary stents: applications and opportunities.

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