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Article ; Online: Inflammation and cancer: What a surgical oncologist should know.

Dupré, Aurélien / Malik, Hassan Z

European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology

2018 Volume 44, Issue 5, Page(s) 566–570

Abstract: Chronic inflammation is an aberrantly prolonged form of a protective response to a loss of tissue homeostasis and it is involved in several steps of the carcinogenesis process. As a result, many cancers are inflammation-related. The systemic inflammatory ...

Abstract	Chronic inflammation is an aberrantly prolonged form of a protective response to a loss of tissue homeostasis and it is involved in several steps of the carcinogenesis process. As a result, many cancers are inflammation-related. The systemic inflammatory response is associated with survival in advanced and localized cancers. Two categories of scores have been proposed to monitor the systemic inflammatory response, those derived from protein measurement and those based on counting inflammatory cells. This review aims to provide a critical appraisal of these 2 categories of surrogate markers. The 3 scale modified Glasgow prognostic score (mGPS) is based on the combination of C-reactive protein and albumin and is graded 0 to 2. It has been validated worldwide showing an independent prognostic value in patients with cancer in a variety of tumour types and tumour stages. Leukocytes-based scores are mainly neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR) and lymphocyte-to-monocyte ratio (LMR). Elevated NLR and/or PLR and lower LMR seem to be associated with decreased survival, but the studies about these markers are very heterogeneous. The main limit is the variety of thresholds used to dichotomize patients, so that reproducibility and reliability of leukocytes-based scores can be questioned. Hence, there is no sufficient evidence to support their use in clinical practice. Comprehensive management of patients with operable and advanced cancer should integrate the host systemic inflammatory response by calculating the mGPS. It could be a helpful tool to tailor patients' management.
MeSH term(s)	Blood Platelets/cytology ; Blood Platelets/immunology ; C-Reactive Protein/immunology ; Humans ; Inflammation/immunology ; Inflammation/metabolism ; Leukocyte Count ; Lymphocyte Count ; Lymphocytes/cytology ; Lymphocytes/immunology ; Monocytes/cytology ; Monocytes/immunology ; Neoplasms/immunology ; Neoplasms/metabolism ; Neutrophils/cytology ; Neutrophils/immunology ; Platelet Count ; Serum Albumin/metabolism ; Surgical Oncology ; Systemic Inflammatory Response Syndrome/immunology
Chemical Substances	Serum Albumin ; C-Reactive Protein (9007-41-4)
Language	English
Publishing date	2018
Publishing country	England
Document type	Journal Article ; Review
ZDB-ID	632519-1
ISSN	1532-2157 ; 0748-7983
ISSN (online)	1532-2157
ISSN	0748-7983
DOI	10.1016/j.ejso.2018.02.209
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Article ; Online: Data driven decision-making for older patients with hepatocellular carcinoma.

Shapey, Iestyn M / Malik, Hassan Z / de Liguori Carino, Nicola

European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology

2020 Volume 47, Issue 3 Pt A, Page(s) 576–582

Abstract: Older age is a risk factor for the development of HCC. However, the treatment options available for older patients with HCC, their safety, efficacy and utility, are poorly understood resulting in challenging decision-making. In this review, we aim to ... ...

Abstract	Older age is a risk factor for the development of HCC. However, the treatment options available for older patients with HCC, their safety, efficacy and utility, are poorly understood resulting in challenging decision-making. In this review, we aim to report the best available evidence to facilitate optimal decision making for older patients with HCC. We report that surgical resection for HCC is equally safe (90-day mortality ~3%) and effective (five-year disease free survival ~40%) for older patients as it is for younger patients. Five-year survival after ablation therapy for HCC is in excess of 50% in older patients, whilst morbidity rates are in the region of 3%. Survival rates of 30% after chemoembolisation reflects its role as a non-curative treatment. Transplantation is an option that may be helpful for a minority of patients, but the high risks of in-hospital mortality and lower likelihood of receiving a transplant should be duly considered before committing to this approach. We therefore advocate an individualised assessment for older patients based on these risk profiles and probabilities of optimal outcomes. In patients with a projected life-span ≥ 3 years, and who have sufficient physiological and functional reserve, surgical resection should be the treatment of choice. Patients with a projected life-span < 3 years are better served with loco-regional therapies, and tumour size, at a threshold of 3 cm, should guide the choice between ablation and chemoembolisation therapies.
MeSH term(s)	Age Factors ; Aged ; Carcinoma, Hepatocellular/mortality ; Carcinoma, Hepatocellular/therapy ; Catheter Ablation ; Chemoembolization, Therapeutic ; Clinical Decision-Making ; Geriatric Assessment ; Hepatectomy ; Hospital Mortality ; Humans ; Liver Neoplasms/mortality ; Liver Neoplasms/therapy ; Liver Transplantation ; Risk Factors ; Survival Rate
Language	English
Publishing date	2020-06-09
Publishing country	England
Document type	Journal Article ; Review
ZDB-ID	632519-1
ISSN	1532-2157 ; 0748-7983
ISSN (online)	1532-2157
ISSN	0748-7983
DOI	10.1016/j.ejso.2020.05.023
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Article ; Online: The case for neo-adjuvant chemotherapy. For.

Malik, Hassan Z

Annals of the Royal College of Surgeons of England

2008 Volume 90, Issue 6, Page(s) 452–454

MeSH term(s)	Antineoplastic Agents/therapeutic use ; Chemotherapy, Adjuvant ; Colorectal Neoplasms ; Humans ; Intraoperative Care/methods ; Liver Neoplasms/drug therapy ; Liver Neoplasms/secondary ; Liver Neoplasms/surgery ; Neoadjuvant Therapy ; Neoplasm Recurrence, Local/prevention & control ; Palliative Care/methods ; Preoperative Care/methods ; Treatment Outcome
Chemical Substances	Antineoplastic Agents
Language	English
Publishing date	2008-09-06
Publishing country	England
Document type	Journal Article
ZDB-ID	80044-2
ISSN	1478-7083 ; 0035-8843
ISSN (online)	1478-7083
ISSN	0035-8843
DOI	10.1308/003588408X321620
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Article ; Online: PINCER (A Platform Study for solId orgaN CancERs): an agile pan-network platform study to deliver high-quality translational research.

Jones, Robert P / Mielgo, Ainhoa / Schmid, Michael / Bury, Danielle / Andrews, Timothy / Burdak-Rothkamm, Susanne / Shackcloth, Michael / J S Cross, Timothy / Fenwick, Stephen / Malik, Hassan Z / Diaz-Nieto, Rafa / Ottensmeier, Christian / Palmer, Daniel H / Vimalachandran, Dale

The British journal of surgery

2023 Volume 110, Issue 9, Page(s) 1108–1111

MeSH term(s)	Humans ; Translational Research, Biomedical ; Neoplasms/genetics ; Neoplasms/therapy
Language	English
Publishing date	2023-08-07
Publishing country	England
Document type	Journal Article
ZDB-ID	2985-3
ISSN	1365-2168 ; 0263-1202 ; 0007-1323 ; 1355-7688
ISSN (online)	1365-2168
ISSN	0263-1202 ; 0007-1323 ; 1355-7688
DOI	10.1093/bjs/znad097
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Article ; Online: Preoperative endoscopic biliary drainage by metal versus plastic stents for resectable perihilar cholangiocarcinoma.

de Jong, David M / Gilbert, Timothy M / Nooijen, Lynn E / Braunwarth, Eva / Ninkovic, Marijana / Primavesi, Florian / Malik, Hassan Z / Stern, Nick / Sturgess, Richard / Erdmann, Joris I / Voermans, Rogier P / Bruno, Marco J / Koerkamp, Bas Groot / van Driel, Lydi M J W

Gastrointestinal endoscopy

2023 Volume 99, Issue 4, Page(s) 566–576.e8

Abstract: Background and aims: Adequate preoperative biliary drainage (PBD) is recommended in most patients with resectable perihilar cholangiocarcinoma (pCCA). Most expert centers use endoscopic plastic stents rather than self-expandable metal stents (SEMSs). In ...

Abstract	Background and aims: Adequate preoperative biliary drainage (PBD) is recommended in most patients with resectable perihilar cholangiocarcinoma (pCCA). Most expert centers use endoscopic plastic stents rather than self-expandable metal stents (SEMSs). In the palliative setting, however, use of SEMSs has shown longer patency and superior survival. The aim of this retrospective study was to compare stent dysfunction of SEMSs versus plastic stents for PBD in resectable pCCA patients. Methods: In this multicenter international retrospective cohort study, patients with potentially resectable pCCAs who underwent initial endoscopic PBD from 2010 to 2020 were included. Stent failure was a composite end point of cholangitis or reintervention due to adverse events or insufficient PBD. Other adverse events, surgical outcomes, and survival were recorded. Propensity score matching (PSM) was performed on several baseline characteristics. Results: A total of 474 patients had successful stent placement, of whom 61 received SEMSs and 413 plastic stents. PSM (1:1) resulted in 2 groups of 59 patients each. Stent failure occurred significantly less in the SEMSs group (31% vs 64%; P < .001). Besides less cholangitis after SEMSs placement (15% vs 31%; P = .012), other PBD-related adverse events did not differ. The number of patients undergoing surgical resection was not significantly different (46% vs 49%; P = .71). Complete intraoperative SEMSs removal was successful and without adverse events in all patients. Conclusions: Stent failure was lower in patients with SEMSs as PBD compared with plastic stents in patients with resectable pCCA. Removal during surgery was quite feasible. Surgical outcomes were similar.
MeSH term(s)	Humans ; Retrospective Studies ; Klatskin Tumor/surgery ; Klatskin Tumor/etiology ; Stents/adverse effects ; Self Expandable Metallic Stents/adverse effects ; Cholangiocarcinoma/surgery ; Cholangiopancreatography, Endoscopic Retrograde ; Drainage/methods ; Cholangitis/etiology ; Bile Duct Neoplasms/surgery ; Bile Ducts, Intrahepatic ; Cholestasis/etiology ; Treatment Outcome
Language	English
Publishing date	2023-10-20
Publishing country	United States
Document type	Multicenter Study ; Journal Article
ZDB-ID	391583-9
ISSN	1097-6779 ; 0016-5107
ISSN (online)	1097-6779
ISSN	0016-5107
DOI	10.1016/j.gie.2023.10.041
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Zs.MO 519: Show issues

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Article ; Online: Long-term morbidity after surgery for perihilar cholangiocarcinoma: A cohort study.

Gilbert, Timothy M / Hackett, James / Holt, Lauren / Bird, Nicholas / Quinn, Marc / Gordon-Weeks, Alex / Diaz-Nieto, Rafael / Fenwick, Stephen W / Malik, Hassan Z / Jones, Robert P

Surgical oncology

2022 Volume 45, Page(s) 101875

Abstract: Background: Surgery for perihilar cholangiocarcinoma (pCCA) offers the only possibility of long-term survival, but remains a formidable undertaking. Traditionally, 90-day post-operative complications and death are used to define operative risk. However, ...

Abstract	Background: Surgery for perihilar cholangiocarcinoma (pCCA) offers the only possibility of long-term survival, but remains a formidable undertaking. Traditionally, 90-day post-operative complications and death are used to define operative risk. However, there is concern that this metric may not accurately capture long-term morbidity after such complex surgery. Methods: A retrospective review of a prospective database of patients undergoing surgery for pCCA at a Western centre between January 2009-2020. Results: Eighty-five patients underwent surgical resection for pCCA with a median overall survival of 36.3 months. Post-op (<90day) morbidity rates were high with 46% of patients developing a major complication (Clavien-Dindo grade 3-4). Post-op mortality rate was 13%. In total 38% (28/74) of patients experienced at least 1 episode of delayed morbidity (>90-days of surgery) resulting in 53 separate admissions with a median LOS of 7 days (IQR 2-15). These episodes were predominately secondary to biliary obstruction with the majority requiring radiological intervention (Clavien-Dindo grade 3). The development of long-term morbidity was associated with increased recurrence rates and correlated with poorer OS (27.6 months vs. 65.7 months HR 2.2 CI 1.63-2.77). Conclusions: Routinely cited 90-day morbidity and mortality does not accurately capture the patient morbidity experienced following surgery for pCCA. Surgery clearly offers a survival benefit and should be pursued in selected patients, but they must be fully counselled on the potential for long-term morbidity before embarking on this strategy.
MeSH term(s)	Humans ; Klatskin Tumor/surgery ; Cohort Studies ; Morbidity ; Cholestasis ; Bile Duct Neoplasms/surgery
Language	English
Publishing date	2022-10-26
Publishing country	Netherlands
Document type	Journal Article
ZDB-ID	1107810-8
ISSN	1879-3320 ; 0960-7404
ISSN (online)	1879-3320
ISSN	0960-7404
DOI	10.1016/j.suronc.2022.101875
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Article ; Online: Surgical management of suspected gallbladder cancer: The role of intraoperative frozen section for diagnostic confirmation.

Chan, Benjamin K Y / Carrion-Alvarez, Lucia / Telfer, Rebecca / Rehman, Adeeb H / Bird, Nicholas / Mann, Kulbir / Jones, Robert P / Malik, Hassan Z / Fenwick, Stephen W / Diaz-Nieto, Rafael

Journal of surgical oncology

2021 Volume 125, Issue 3, Page(s) 399–404

Abstract: Background: Preoperative diagnosis for suspected gallbladder cancers is challenging, with a risk of overtreating benign disease, for example, xanthogranulomatous cholecystitis, with radical cholecystectomies. We retrospectively evaluated the surgeon's ... ...

Abstract	Background: Preoperative diagnosis for suspected gallbladder cancers is challenging, with a risk of overtreating benign disease, for example, xanthogranulomatous cholecystitis, with radical cholecystectomies. We retrospectively evaluated the surgeon's intraoperative assessment alone, and with the addition of intraoperative frozen sections, for suspected gallbladder cancers from a tertiary hepatobiliary multidisciplinary team (MDT). Methods: MDT patients with complex gallbladder disease were included. Collated data included demographics, MDT discussion, operative details, and patient outcomes. Results: A total of 454 patients with complex gallbladder disease were reviewed, 48 (10.6%) were offered radical surgery for suspected cancer. Twenty-five underwent frozen section that led to radical surgery in 6 (25%). All frozen sections were congruent with final histopathology but doubled the operating time (p < 0.0001). Both the surgeon's subjective and additional frozen section's objective assessment, allowed for de-escalation of unnecessary radical surgery, comparing favourably to a 13.0% cancer diagnosis among radical surgery historically. Conclusions: The MDT process was highly sensitive in identifying gallbladder cancers but lacked specificity. The surgeon's intraoperative assessment is paramount in suspected cancers, and deescalated unnecessary radical surgery. Intraoperative frozen section was a safe and viable adjunct at a cost of resources and operative time.
MeSH term(s)	Aged ; Carcinoma/mortality ; Carcinoma/pathology ; Carcinoma/surgery ; Cholecystectomy ; Female ; Frozen Sections ; Gallbladder Neoplasms/mortality ; Gallbladder Neoplasms/pathology ; Gallbladder Neoplasms/surgery ; Humans ; Lymphoma/mortality ; Lymphoma/pathology ; Lymphoma/surgery ; Male ; Melanoma/mortality ; Melanoma/pathology ; Melanoma/surgery ; Middle Aged ; Neoplasm Staging ; Operative Time ; Retrospective Studies ; Sensitivity and Specificity ; Survival Rate
Language	English
Publishing date	2021-10-24
Publishing country	United States
Document type	Journal Article
ZDB-ID	82063-5
ISSN	1096-9098 ; 0022-4790
ISSN (online)	1096-9098
ISSN	0022-4790
DOI	10.1002/jso.26726
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Zs.A 706: Show issues

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Article ; Online: Higher Postoperative Mortality and Inferior Survival After Right-Sided Liver Resection for Perihilar Cholangiocarcinoma: Left-Sided Resection is Preferred When Possible.

Olthof, Pim B / Erdmann, Joris I / Alikhanov, Ruslan / Charco, Ramón / Guglielmi, Alfredo / Hagendoorn, Jeroen / Hakeem, Abdul / Hoogwater, Frederik J H / Jarnagin, William R / Kazemier, Geert / Lang, Hauke / Maithel, Shishir K / Malago, Massimo / Malik, Hassan Z / Nadalin, Silvio / Neumann, Ulf / Olde Damink, Steven W M / Pratschke, Johann / Ratti, Francesca /

Ravaioli, Matteo / Roberts, Keith J / Schadde, Erik / Schnitzbauer, Andreas A / Sparrelid, Ernesto / Topal, Baki / Troisi, Roberto I / Groot Koerkamp, Bas

Annals of surgical oncology

2024

Abstract: Background: A right- or left-sided liver resection can be considered in about half of patients with perihilar cholangiocarcinoma (pCCA), depending on tumor location and vascular involvement. This study compared postoperative mortality and long-term ... ...

Abstract	Background: A right- or left-sided liver resection can be considered in about half of patients with perihilar cholangiocarcinoma (pCCA), depending on tumor location and vascular involvement. This study compared postoperative mortality and long-term survival of right- versus left-sided liver resections for pCCA. Methods: Patients who underwent major liver resection for pCCA at 25 Western centers were stratified according to the type of hepatectomy-left, extended left, right, and extended right. The primary outcomes were 90-day mortality and overall survival (OS). Results: Between 2000 and 2022, 1701 patients underwent major liver resection for pCCA. The 90-day mortality was 9% after left-sided and 18% after right-sided liver resection (p < 0.001). The 90-day mortality rates were 8% (44/540) after left, 11% (29/276) after extended left, 17% (51/309) after right, and 19% (108/576) after extended right hepatectomy (p < 0.001). Median OS was 30 months (95% confidence interval [CI] 27-34) after left and 23 months (95% CI 20-25) after right liver resection (p < 0.001), and 33 months (95% CI 28-38), 27 months (95% CI 23-32), 25 months (95% CI 21-30), and 21 months (95% CI 18-24) after left, extended left, right, and extended right hepatectomy, respectively (p < 0.001). A left-sided resection was an independent favorable prognostic factor for both 90-day mortality and OS compared with right-sided resection, with similar results after excluding 90-day fatalities. Conclusions: A left or extended left hepatectomy is associated with a lower 90-day mortality and superior OS compared with an (extended) right hepatectomy for pCCA. When both a left and right liver resection are feasible, a left-sided liver resection is preferred.
Language	English
Publishing date	2024-03-12
Publishing country	United States
Document type	Journal Article
ZDB-ID	1200469-8
ISSN	1534-4681 ; 1068-9265
ISSN (online)	1534-4681
ISSN	1068-9265
DOI	10.1245/s10434-024-15115-0
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Article ; Online: Preoperative Leucocyte-Based Inflammatory Scores in Patients with Colorectal Liver Metastases: Can We Count on Them?

Dupré, Aurélien / Jones, Robert P / Diaz-Nieto, Rafael / Fenwick, Stephen W / Poston, Graeme J / Malik, Hassan Z

World journal of surgery

2019 Volume 43, Issue 5, Page(s) 1351–1359

Abstract: Background: Neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR) and lymphocyte-to-monocyte ratio (LMR) have been identified as potential prognostic factors for overall survival (OS) in primary colorectal cancer, and there is a ... ...

Abstract	Background: Neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR) and lymphocyte-to-monocyte ratio (LMR) have been identified as potential prognostic factors for overall survival (OS) in primary colorectal cancer, and there is a growing interest in their use in colorectal liver metastases (CLMs). However, optimal cut-off values for these ratios have not been defined by making comparison between series difficult. This study aimed to confirm the prognostic value of inflammatory scores in patients undergoing resection for CLM. Methods: We retrospectively analysed data from 376 consecutive patients who underwent liver surgery for CLM between June 2010 and August 2015. We assessed the reproducibility of previously published ratios and determined new cut-off values using the Cut-off Finder web-based tool. Relations between cut-off values and OS were analysed with Kaplan-Meier log-rank survival analysis and multivariate Cox models. Results: Three hundred and forty-three patients had full preoperative blood tests for calculation of NLR, PLR and LMR. The number of cut-off values which showed a significant discrimination for OS was 49/249 (19.7%) for NLR, 28/316 (8.9%) for PLR and 22/214 (10.3%) for LMR, all with a scattered nonlinear distribution. Conclusions: This study showed that inflammatory scores expressed as ratios do not seem to be consistently reliable prognostic markers in patients with resectable CLM.
MeSH term(s)	Aged ; Colorectal Neoplasms/blood ; Colorectal Neoplasms/mortality ; Colorectal Neoplasms/pathology ; Colorectal Neoplasms/surgery ; Female ; Humans ; Leukocytes ; Liver Neoplasms/secondary ; Male ; Middle Aged ; Proportional Hazards Models ; Reproducibility of Results ; Retrospective Studies
Language	English
Publishing date	2019-01-23
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	224043-9
ISSN	1432-2323 ; 0364-2313
ISSN (online)	1432-2323
ISSN	0364-2313
DOI	10.1007/s00268-019-04914-2
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Article ; Online: British Society of Gastroenterology guidelines for the diagnosis and management of cholangiocarcinoma.

Gut

2023 Volume 73, Issue 1, Page(s) 16–46

Abstract: These guidelines for the diagnosis and management of cholangiocarcinoma (CCA) were commissioned by the British Society of Gastroenterology liver section. The guideline writing committee included a multidisciplinary team of experts from various ... ...

Abstract	These guidelines for the diagnosis and management of cholangiocarcinoma (CCA) were commissioned by the British Society of Gastroenterology liver section. The guideline writing committee included a multidisciplinary team of experts from various specialties involved in the management of CCA, as well as patient/public representatives from AMMF (the Cholangiocarcinoma Charity) and PSC Support. Quality of evidence is presented using the Appraisal of Guidelines for Research and Evaluation (AGREE II) format. The recommendations arising are to be used as guidance rather than as a strict protocol-based reference, as the management of patients with CCA is often complex and always requires individual patient-centred considerations.
MeSH term(s)	Humans ; Gastroenterology ; Cholangiocarcinoma/diagnosis ; Cholangiocarcinoma/therapy ; Bile Duct Neoplasms/diagnosis ; Bile Duct Neoplasms/therapy ; Bile Ducts, Intrahepatic
Language	English
Publishing date	2023-12-07
Publishing country	England
Document type	Journal Article
ZDB-ID	80128-8
ISSN	1468-3288 ; 0017-5749
ISSN (online)	1468-3288
ISSN	0017-5749
DOI	10.1136/gutjnl-2023-330029
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