Thomas Peter Kingham

Objective: Describe the technical complications of hepatic artery infusion pump (HAIP) placement and characterize salvage rates. Summary Background Data: HAIP chemotherapy is an effective tool used in the treatment of hepatic malignancies and has become increasingly adopted at select centers. Much of the safety data is reported from small, newer programs or older, large series. Methods: Retrospective analysis of all patients who underwent HAIP placement at our institution between 2000 and 2022 was conducted. Pump salvage was defined as the ability to receive HAIP chemotherapy after a pump-associated complication. Pump failure was defined as an HAIP-related complication permanently stopping ongoing HAIP chemotherapy. Results: Over the study period, 2935 patients had an HAIP placed for colorectal liver metastases (n=2582, 88%), intrahepatic cholangiocarcinoma (n=294, 10%) or another malignancy (n=59, 2%). Of all patients, 759 (26%) had an HAIP-related complication, with 404/759 (53%) having their pump salvaged. The most common complications were abnormal perfusion (n=360 [12%], 285/360 [79%] salvaged), arterial pseudoaneurysm and/or hemorrhage (n=117 [4%], 7/117 [6%] salvaged), and pump-pocket infection (n=115 [4%], 60/115 [52%] salvaged). The complications with the highest salvage rates were pump-pocket seroma (n=15/16, 94%), pump-flipping (n=41/44, 93%), and pump-pocket hematoma (n=45/49, 92%). Unsalvaged complications were catheter dislodgement from vessel (n=0/47, 0%), catheter erosion into bowel (n=0/25, 0%), and arterial thrombosis (n=0/19, 0%). The cumulative incidence of pump failure at 1 year in patients receiving adjuvant therapy was 6.6%, and 4.5% among those receiving palliative therapy. Conclusions: HAIP-related complications occur in about one quarter of patients, predominantly perfusion and pump-pocket complications. These are salvageable in the majority of cases with multidisciplinary interventions.

Objective: Describe the long-term health-related quality of life (HR-QoL) after curative-intent hepatectomy for high-risk colorectal liver metastases (CRLM). Methods: This prospective study enrolled patients with resectable CRLM with clinical risk score ≥3. European Organization for Research and Treatment of Cancer QLQ-C30, LMC21, and EuroQol EQ-5D-5L were administered at preoperative and postoperative visits, and at 6, 12, 18, 24, and 36 months from hepatectomy, and cancer disease state was recorded. Linear mixed models were used to examine the trajectory of HR-QoL scores. Results: From 297 consented, 146 were evaluable by completing preoperative and postoperative surveys. Median age was 52 years, 42% (n=61) were female, and 70% (n=102) had synchronous CRLM. The QLQ-C30 summary score decreased by −14.6 points (95% CI: −17.2, −12.0) from baseline at the postoperative survey ( P P P P =0.029). Patients with recurrence had similar EQ-VAS scores as baseline at 12 months but remained lower than NED patients at each timepoint after the postoperative survey (all P <0.05). Conclusions: HR-QoL decreases postoperatively before returning to preoperative levels and exceeding it among patients without recurrence. Cancer recurrence significantly influenced HR-QoL.

Survival outcomes for intrahepatic cholangiocarcinoma (IHC) remain poor due to late-stage presentation and limited effective treatment options. Previous st

Although palliative care (PC) is recognized as a component of comprehensive care throughout the life course and universal health coverage, more than 85% of

As with most Sub-Saharan African countries, Nigeria has a rising incidence of cancer, with disproportionate mortality rates. The financial burden of cancer

Background/Objectives: The iBreast Exam (iBE) electronically palpates the breast to identify possible abnormalities. The purpose of this study was to assess iBE feasibility and compare it to Clinical Breast Exam (CBE) for breast lesion detection. Methods: Prospective evaluation of 300 asymptomatic women, ≥18 years old, with CBE, iBE, and mammography was performed. Sensitivity, specificity, positive predictive values (PPV), and negative predictive values (NPV) of iBE and CBE for detecting suspicious breast lesions were calculated using breast imaging as the reference standard. For women with one year follow up, the sensitivity, specificity, PPV, and NPV for cancer detection were calculated. Results: 300 women (mean age 58.9 years) underwent CBE, iBE, and mammography. In 2/300 (0.7%), CBE was positive; in 1/300 (0.3%), iBE was positive; and in 24/300 (8%), screening mammograms were positive. Nine had suspicious imaging findings with biopsy (three malignant and six benign). Of three cancers, all visualized mammographically, CBE and iBE detected an ipsilateral breast abnormality in one woman and missed two cancers ( 0.05). Conclusions: Mammography detected all breast cancers in our cohort and remains the standard of care. iBE is feasible to perform. Our pilot data demonstrates iBE performed similarly to CBE by trained nurse practitioners. Given our small study population, further investigation is warranted into the potential use of iBE where trained healthcare practitioners are not readily available.