Andrea Gardini

The authors wish to make the following corrections to this paper

The aim of the study was to evaluate the safety and efficacy of a new chemo-radiotherapy regimen for patients with locally advanced pancreatic cancer (LAPC). Patients were treated as follows: gemcitabine 1000 mg/m² on day 1, and oxaliplatin 100 mg/m² on day 2, every two weeks (GEMOX regimen) for 4 cycles, 15 days off, hypofractionated radiotherapy (35 Gy in 7 fractions in 9 consecutive days), 15 days off, 4 additional cycles of GEMOX, restaging. From April 2011 to August 2016, a total of 42 patients with non resectable LAPC were enrolled. Median age was 67 years (range 41–75). Radiotherapy was well tolerated and the most frequently encountered adverse events were mild to moderate nausea and vomiting, abdominal pain and fatigue. In total, 9 patients underwent surgical laparotomy (5 radical pancreatic resection 1 thermoablation and 3 explorative laparotomy), 1 patient became operable but refused surgery. The overall resectability rate was 25%, while the R0 resection rate was 12.5%. At a median follow-up of 50 months, the median progression-free survival and overall survival were 9.3 (95% CI 6.2–14.9) and 15.8 (95% CI 8.2–23.4) months, respectively. The results demonstrate the feasibility of a new chemo-radiotherapy regimen as a potential treatment for unresectable LAPC.

Advanced unresectable gastric cancer has a dismal prognosis. The aim of this study was to evaluate the short- and long-term outcomes of patients who underwent induction chemotherapy ± gastrectomy for advanced gastric cancer. All patients referred to our center with a clinical diagnosis of unresectable locally advanced or stage IV gastric adenocarcinoma between April 2005 and August 2016 were included in the study. Cox regression was performed to find independent prognostic factor among the considered variable. The cohort included 73 patients: 16 had best supportive care, 35 chemotherapy alone and 22 chemotherapy plus radical surgery. Thirty-three patients underwent surgery after chemotherapy. Twenty-two patients had R0 surgery, while the remaining 11 had only an exploratory procedure. Nine patients (40.9%) underwent gastrectomy plus hyperthermic intraperitoneal chemotherapy. Three patients out of 22 developed postoperative complications with a Clavien-Dindo grade above 2. Median survival was 50 months for patients who had chemotherapy plus surgery while it was 14 and 3 for those who had chemotherapy alone and best supportive care, respectively (p < 0.0001). Cox regression analysis performed on the whole cohort identified only radical conversion surgery as an independent factor positively associated with survival (HR 0.12, 95% CI 0.05-0.29, p < 0.0001). Conversion gastrectomy, when R0 could be achieved, is associated with long survivals and it is the most important prognostic factor in patients with advanced gastric cancer. Further studies are needed to define the ideal patient who can really benefit from this treatment.

Although the ideal management of cholecysto-choledocholitiasis is controversial, the two-stage approach, namely the common bile duct (CBD) clearance through endoscopic retrograde cholangiopancreatography (ERCP) followed by laparoscopic cholecystectomy, remains the standard way of management. However, whenever feasible, the one-stage approach, using the so-called “laparoendoscopic rendezvous” (LERV) technique, offers some advantages, mainly reducing the hospital stay and the risk of post-ERCP pancreatitis. The aim of this study was to evaluate the safety and the efficacy of the one-stage approach, and to compare our results with data from available large studies.

E15684 Background: In 2015 we published a paper where we have assessed the outcome of patient with HCC treated with metformin(M)and sorafenib(S). The data show that the concomitant use of S and m was associated with a lower PFS and OS respect for patients receiving S alone. The aim of this study was to validate the prognostic significance of m in patients with HCC treated with S. Methods: 280 patients with HCC consecutively treated with S twice daily between March 2008 and August 2016 were included in the study. Patients who had been taking insulin (I) for at least 5 years at the time of the HCC diagnosis were considered “ patients with diabetes treated with I,” whereas those who had been on m at for at least 5 years when HCC was diagnosed were considered “ patients with diabetes treated with M.” Results: In patients treated chronically with m the treatment with S was associated with a median PFS of 1.9 months (95% CI 1.8-2.3) compared to 3.7 months (95% CI 3.1-4.6) for patients without DM2 and compared to 8.4 months (95% CI 5.3-11.4) for patients treatment chronically with I (P < 0.0001). In patients treated chronically with m the treatment with sorafenib was associated with a median OS of 6.6 months (95% CI 4.6-8.7) compared to 10.8 months (95% CI 9.0-13.1) for patients without DM2 and compared to 16.6 months (95% CI 14.5-25.5) for patients treatment chronically with I (P = 0.0001). Metformin effects on clinical outcome were also investigated in relation to ORR. Patients treated chronically with metformin showed a higher percentage of progression at the first CT re-evaluation than those patients treatment with I and patients without DM2 (75.8% vs. 14.7% vs 38,8%, respectively). Considering the overall population, the risk of progression, was higher in DM2 patients taking m compared with patients without DM2 (HR = 1.91, 95% CI 1.28-2.8,). Regarding the risk of survival, similar results were observed (HR = 1.70, 95% CI 1.14-2.55). Conclusions: These results confirm an increased tumor aggressiveness and resistance to S in patients treated with m cronicaly.Molecular alterations in transporter genes or transcription factors involved in m molecular action and pharmacokinetics could contribute to a different response to these drugs combination.

Background: Pulmonary carcinoids (PCs) are classified according to 2004 WHO criteria as typical (TC) or atypical (AC). Data on palliative treatment are extrapolated from studies of mixed populations. Over the past few years SSAs have been assessed in gastroenteopancreatic neuroendocrine tumors but trials are lacking on PCs. The aim of this study was to retrospectively evaluate the efficacy of SSAs in metastatic PCs and to define prognostic factors.