Introduction: Hyperthermic Isolated Limb Perfusion (HILP) is a surgical procedure for the regional delivery of heat and high doses of chemotherapy and biologic agents to the extremity. The procedure is employed as a limb salvage technique for locally advanced primary malignancies or recurrent cancers that are unresectable and confined to the extremity

Methods: From 1987-2016, 247 patients with unresectable recurrent melanoma (95%), sarcoma or Merkel Cell Carcinoma underwent HILP for limb salvage of the affected extremity after staging was negative for Stage IV disease and disease was confirmed to be confined to the extremity.

Results: All patients had limb salvage with this protocol. All patients were clinically negative in their regional basin at the time of perfusion, although 40% of the patients had evidence of regional nodal disease following nodal dissections. Immediate responses (within 3 months) on the extremity to the HILP were as follows: complete response (CR) of 66%, partial response (PR) of 20%, 10% stable disease and 4% progressive disease. With a mean follow-up period of 5 years, 61.5% of the patients have recurred with 68.4% of the recurrences being systemic, 21% regional nodal, 7.2% in-transit and 3.3% local-regional soft tissue.

Conclusions: HILP is an effective strategy for limb salvage in patients with unresectable, locally advanced cancers confined to the extremity. The treatment was associated with a high rate of complete responses on the extremity. Most patients recurred with distant metastases emphasizing the need for better systemic therapies for these malignancies.

Synopsis: Patients with recurrent, unresectable melanoma, other cutaneous malignancies and sarcoma confined to an extremity are problematic for clinicians since recurrence rates show that most will have occult systemic disease. An aggressive amputation approach does not make sense and the fact that these patients have active disease makes them ineligible for approved adjuvant therapies. In addition since their clinically apparent active disease is confined to the local/regional soft tissues making them Stage 3 disease, they are not eligible for Stage IV protocols. In these situations Hyperthermic Isolated Limb Perfusion (HILP) effectively treats the extremity with high response rates and a 100% limb salvage rate.

Introduction: Gallbladder carcinoma is the most frequent tumor of the bile system and has a poor prognosis. The main proportion of tumors diagnosed coincidentally after gallbladder removal for various reasons. In these cases, an incomplete removal of the tumors occurs frequently. The adequate treatment of these patients is still under discussion. We present our experience with different procedures.

Patients and Methods: Between 1990 and 2015, we identified 20 patients which were presented at our University Hospital after incomplete removal of gallbladder cancer (R1, R2, RX) as incidental findings after cholecystectomy. The prospectively collected data including surgery, adjuvant treatment, histopathological examinations of the specimens and follow-up data were analyzed retrospectively.

Results: The median age of patients was 72 years (range 47-89 years), 90 % (18/20) were female. The median follow-up period was 10 months (range 0-109 months). The median survival of all patients was 11 months (95 % confidence interval: 5-17 months). The median survival of patients who received staged surgery and chemo radiation after incomplete gallbladder removal was significantly increased (median 32 months; range 4-109 months) vs. patients who received chemo radiation without surgery (median 13 months; range 8-51 months) or chemotherapy alone (median 2.5 months (range 0-40 months)) (p = 0.005).

Discussion: There is no standardized treatment for residual tumor after incomplete gallbladder cancer resection. Our data demonstrate that staged surgery with prior chemo radiation may improve patient´s outcome. Surgery can be performed with low morbidity and mortality.