Reductive surgery plus percutaneous isolated hepatic perfusion for multiple advanced XXXX .

@entity1 @entity632 @entity96 @entity5 @entity1578 @entity157
OBJECTIVE: To evaluate the efficacy of a novel 2-stage treatment with reductive surgery plus percutaneous isolated hepatic perfusion (PIHP) for @entity157 ( @entity157 ), which was previously unresectable. SUMMARY BACKGROUND DATA: Surgical resection is the treatment of choice for @entity157 , but the majority of @entity1 with advanced @entity157 are not suitable candidates. PIHP is a minimally invasive surgery that allows high-dose regional chemotherapy of the liver, and our phase II studies have shown its profound efficacy for the local control of advanced @entity157 . METHODS: Twenty-five @entity1 with multiple advanced @entity157 were enrolled in this prospective study. In the first stage, all @entity1 underwent reductive hepatectomy: major hepatectomy in 13 @entity1 and segmentectomy or less in 12. In 2 @entity1 with subsegmentectomy, the retropancreatic and periportal metastatic lymph nodes were synchronously resected. Regardless of the type of hepatectomy, all @entity1 routinely underwent cholecystectomy, and ligations of the right gastric artery and arterial collaterals of the remnant liver to increase the safety and efficacy of PIHP. In the second stage, PIHP with @entity632 60-120 mg/m2/treatment was planned for a period of 1 to 3 months after surgery. RESULTS: Of 25 enrolled @entity1 , 22 successfully underwent PIHP an average of 1.8 times for the local control of residual @entity96 . In the remaining 3 @entity1 , PIHP was abandoned because 2 had rapid disease progression and 1 had @entity1578 after surgery. In 22 @entity1 with the 2-stage treatment, 19 (86%) had objective @entity5 control (10 complete remissions and 9 partial responses with a median response duration of 16 months). The actuarial survival rate of all 25 @entity1 was 42% at 5 years. CONCLUSIONS: Reductive surgery plus PIHP produced a strong antitumoral effect on multiple advanced @entity157 , when liver function allows this concentrated treatment approach, and offers long-term survival in a subset of @entity1 who were previously deemed to have unresectable disease.
