The Nobel Prize in Physiology or Medicine 2018 was awarded jointly to James P. Allison and Tasuku Honjo "for their discovery of cancer therapy by inhibition of negative immune regulation". A number of therapeutic approaches are available for cancer treatment, including surgery, radiation, and other strategies, some of which have been awarded previous Nobel Prizes. These include methods for hormone treatment for prostate cancer (Huggins, 1966), chemotherapy (Elion and Hitchins, 1988), and bone marrow transplantation for leukemia (Thomas, 1990). Many scientists engaged in intense basic research and uncovered fundamental mechanisms regulating immunity and also showed how the immune system can recognize cancer cells. T-cells were shown to have receptors that bind to structures recognized as non-self and such interactions trigger the immune system to engage in defense. However, additional proteins acting as T-cell accelerators are also required to trigger a full-blown immune response. Many scientists contributed to this important basic research and identifi ed other proteins that function as brakes on the T-cells, inhibiting immune activation. This intricate balance between the accelerators and inhibitors is essential for a tight control. New strategy was developed into a therapy for humans. Promising results soon emerged from several groups, and in 2010 an important clinical study showed striking effects in patients with advanced melanoma. In several patients, signs of remaining cancer disappeared. The results were dramatic, leading to long-term remission and possible cure in several patients with metastatic cancer, a condition that had previously been considered essentially untreatable. Such remarkable results had never been seen in this patient group before (Fig. 2, Ref. 12). Text in PDF www.elis.sk.

BackgroundLimited data are available on the importance of routine lymphadenectomy of the hepatoduodenal ligament in the treatment of liver metastasis from colorectal cancer in the literature.MethodsA single center retrospective cohort study was conducted to evaluate morbidity and long-term survival in patients who had undergone selective versus routine lymphadenectomy during surgery for colorectal liver metastasis. From January 2006 to December 2009, eighty-one patients undergoing radical resection due to liver metastasis from colorectal cancer were included. The combination of two surgical teams with different approaches to hepatoduodenal ligament lymphadenectomy at our institution allowed us to select two cohorts of patients undergoing selective or routine lymphadenectomy.ResultsNo significant differences between the cohorts were found in age, American Society of Anesthesiology score or Fong’s prognostic criteria. Patients with pN+ disease had significantly inferior survival compared to patients with pN0 disease (hazard ratio [HR] = 6.33, 95% CI 2.16–18.57, p = 0.0001). No significant difference in postoperative morbidity was observed in the group undergoing routine opposed to selective lymphadenectomy (13.63% vs. 8.69%, p = 0.36). There was no difference in long-term survival between the groups (HR = 0.90, 95% CI 0.52–1.58, p = 0.70). There were also no significant differences in the subgroup of patients with pN0 stage (HR = 1.17, 95% CI 0.6–2.11, p = 0.60).ConclusionsThese data suggest that there is no survival benefit from the use of routine lymphadenectomy during surgery for colorectal liver metastasis, but these data should be confirmed in a prospective randomized study.

BACKGROUND: The most serious problem in surgical treatment of gastric cancer includes the area of resection and the extent of lymphadenectomy. The extent of gastric resection is determined by the extent of tumor affection. The aim of radical surgical intervention is to achieve microscopically clear resection line, since R0 resection is the main criterion for the patient´s prognosis. Curative surgical resection for gastric cancer includes the lymph nodes dissection. In the treatment of gastric cancer, there are two views on the importance of lymphadenectomy. The Far East considers that operation improves the survival and the Europe considers that surgery is not curative, but it determines the staging and prognosis. There is also a difference in staging systems. The one from East is importance based on the anatomical location of affected lymph nodes, the second from Europe is based on the number of positive lymph nodes. MATERIALS AND METHODS: This work is a retrospective observational study. In the study cohort, comparing the survival of patients according to different classifi cation systems, depending on the N-stage of disease, 119 patients with gastric adenocarcinoma in clinical stage I to III, i.e. without metastasis, who underwent a radical surgical resection with D2 lymphadenectomy, were enrolled. For the evaluation of the survival versus the time after operation, we used Kaplan-Meier method. To evaluate the correlation between the survival rate and the explanatory variables, Cox regression and Kendall correlation coeffi cient were used. RESULTS: The median survival, according to different classifi cation systems, depending on the N-stage of the disease, was signifi cantly correlated with the survival for the 6th and 7th editions of TNM classifi cation system for the Japanese classifi cation system, for N-ratio classifi cation system). The new fi nding was differentiation of patients in groups N1 vs N2 under the 6th TNM classifi cation (HR=0.910249), also a little differentiation in groups N1 vs N2 according to the classifi cation of N-ratio (HR=0.8750926) and equally a poor differentiation in the survival in groups N2 vs N3 according to the 7th TNM classifi cation (HR = 0.881797). The strongest correlation reached the Japanese classifi cation system, but not signifi cantly different from the 6th TNM classifi cation system. In the 7th edition of TNM classifi cation system, we then found the weakest correlation with the survival time, but not signifi cantly different from the previous two. CONCLUSION: Our retrospective study confi rmed the strongest correlation between the patient´s prognosis and the anatomic localization of the affected lymph nodes. This correlation was not statistically signifi cant compared to the correlation between patient´s prognosis and the number of positive lymph nodes. It leads us to the conclusion that both classifi cation systems are comparable and the difference is statistically insignifi cant (Tab. 4, Fig. 8, Ref. 16).

Although venous resection in pancreatic cancer is widely used method, recently published data about its safety and survival benefit showed conflicting results. A retrospective case matched study was performed to compare the results of patients who underwent venous resection to those with no venous resection during radical surgery in pancreatic cancer.From January 2010 to December 2015, 297 pancreatic resections due to pancreatic tumor were performed in the National Cancer Institute (NCI). Fifty-three patients with venous resection were identified and enrolled into the study and matched with 66 patients without vascular resection during radical resection of pancreatic head/body cancer. Both groups matched for age, ASA score, need for preoperative biliary drainage and clinical staging of the tumor. Morbidity was determined according Clavien and Dindo classification [1] and was similar in both groups of patients (p = 0.48). Thirty day postoperative mortality was also equal in both groups 5.6 vs 4.5% (p > 0.99) and long term survival was with no significant difference. Median overall survival was 18.8 vs 20.7 months (p = 0.33) for patients with/without venous resection.Therefore we consider venous resection in pancreatic cancer safe procedure with equal morbidity and perioperative mortality as in patients with no need for vascular resection and with the same long term survival if R0 resection is achieved.

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