Malignant melanoma of the esophagus complicated with poorly differentiated mucinous adenocarcinoma of the stomach: A case report

Analysis of risk factors for infection after percutaneous biliary stenting in patients with cholangiocarcinoma and its impact on prognosis

Background

Cholangiocarcinoma (CCA) may invade the bile duct, causing malignant biliary obstruction, which is mainly treated by percutaneous biliary stenting. Biliary tract infection after stenting is a severe and common complication in the early postoperative period. In this study, we investigated the risk factors predisposing to infection after percutaneous biliary stenting in patients with CCA and its effect on prognosis. Our findings might reference early clinical prevention, diagnosis, and treatment.

Methods

We analyzed retrospective data regarding 337 patients who developed CCA and underwent percutaneous biliary stenting from December 2016 to December 2021. We collected the patients' general characteristics and clinical data utilizing a questionnaire regarding general information designed by the investigator. We performed the t-test and chi-square test to investigate the association between the clinical characteristics and postoperative infection and binary logistic regression to analyze the independent risk factors for patients developing postoperative infections. We used the Cox risk regression to determine each factor's effect on patients' survival status.

Results

Seventy-three cases of postoperative infection occurred in total, with an estimated infection rate of 21.7 %. Logistic regression analysis revealed that age [odds ratio (OR) =1.041, p =0.031], presence of combined gallstones (OR =2.200, p =0.030), stent type (OR =2.607, p =0.003), administration of preoperative prophylactic antibiotics (OR =0.473, p =0.042), presence of intraoperative complications of biliary bleeding (OR =2.452, p =0.017), presence of postoperative biliary pneumoperitoneum (OR =2.355, p =0.013), duration of surgery (OR =1.026, p =0.008), preoperative serum albumin (Alb) (OR =0.946, p =0.005), and preoperative hemoglobin (Hb) (OR =0.964, p =0.014) were the independent factors influencing postoperative infection development. The Cox risk regression analysis showed that infection occurrence was an independent factor influencing patients' survival time (OR =1.041, p =0.031).

Conclusion

Biliary tract infection is the most common complication after biliary interventions, and severe infection may even lead to death. Clinical studies should analyze and evaluate patients' clinical characteristics, perioperative indicators, and relevant serological indicators, identify relevant risk factors, and administer prompt treatment to reduce the chance of infection and improve patients' prognosis. HIPPOKRATIA 2023, 27 (2):89-98.

The Thousand Faces of Malignant Melanoma: A Systematic Review of the Primary Malignant Melanoma of the Esophagus

Primary Malignant Melanoma of the Esophagus (PMME) is an extremely rare cancer of the esophagus, accounting for 0.1−0.8% of all oro-esophageal cancers and <0.05% of all melanoma subtypes, with an estimated incidence of 0.0036 cases per million/year. We conduct a careful analysis of the literature starting from 1906 to the beginning of 2022, searching the PubMed, Science.gov, Scopus and Web of Science (WoS) databases. A total of 457 records were initially identified in the literature search, of which 17 were duplicates. After screening for eligibility and inclusion criteria, 303 publications were ultimately included, related to 347 patients with PMME. PMME represents a very rare entity whose very existence has been the subject of debate for a long time. Over time, an increasing number of cases have been reported in the literature, leading to an increase in knowledge and laying the foundations for a discussion on the treatment of this pathology, which still remains largely represented by surgery. In recent times, the possibility of discovering greater mutations in gene hotspots has made it possible to develop new therapeutic strategies of which nivolumab is an example. Future studies with large case series, with clinicopathological and molecular data, will be necessary to improve the outcome of patients with PMME.

Effect of percutaneous transhepatic cholangial drainag + radiofrequency ablation combined with biliary stent implantation on the liver function of patients with cholangiocarcinoma complicated with malignant obstructive jaundice

OBJECTIVE

To investigate the effect of percutaneous transhepatic cholangial drainage (PTCD) + radiofrequency ablation (RFA) combined with biliary stent implantation on the liver function of patients with cholangiocarcinoma complicated with malignant obstructive jaundice.

METHODS

Retrospective analysis of 120 patients with cholangiocarcinoma complicated with malignant obstructive jaundice were divided into the research group (n=60) and the control group (n=60) according to different treatments. The research group received PTCD + RFA combined with biliary stent implantation, while the control group received only PTCD combined with biliary stent implantation. The changes of liver function indexes before and after treatment, the condition of postoperative jaundice in different periods after operation, toxicity and survival time were observed.

RESULTS

There was no statistically significant difference between the two groups in general data (P>0.05). Before treatment, there was no statistically significant difference between the two groups in albumin (ALB), alkaline phosphatase (ALP), glutamyltranspeptidase (GGT), total bilirubin (TBil) and direct bilirubin (DBil) (all P>0.05). After treatment, the above indicators were all decreased (all P<0.05), and the patient's condition improved, but there was no significant difference between the research group and the control group (P>0.05). There were patients with postoperative jaundice in the two groups at 1 month, 3 months, and 6 months after surgery. The total incidence of postoperative jaundice in the research group and the control group within 6 months was 11.67% and 30.00%, respectively (P<0.05). After treatment, the aftereffects were observed in the research group (15.00%) and the control group (25.00%), including infection, cholangitis, and biliary bleeding, without statistical significance (P>0.05). There was no statistical significant difference in progression-free survival between the two groups (P>0.05), while patients in the research group had higher median survival and 1-year survival rates than those of the control group (both P<0.05).

CONCLUSION

After PTCD + RFA combined with biliary stent implantation was performed on the patients with cholangiocarcinoma complicated with malignant obstructive jaundice, the number of patients with postoperative jaundice at different time points was reduced; 1-year survival rate and median survival were increased; patents' liver function and condition were improved. Thus, this method is worthy of promotion and application.