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Objective To evaluate preliminarily the clinical efficacy of two types of hepatic inflow occlusion in hepatectomy for hepatocellular carcinoma (HCC). Methods A total of 54 patients with HCC who underwent hepatectomy were divided into two groups; RIP group ( regional ischemic preconditioning with continuous clamping, n = 15) and HHV group( hemi-hepatic vascular inflow occlusion, n = 39 ). HHV was performed by placing a clamp on the right hepatic artery and right portal vein, and was maintained until the liver resection was completed. In the RIP group, HHV was preceded by a 5-min period of ischemia followed by 5 min of reperfusion. The clinical indicators of the two groups were compared. Results The volume of intraoperative blood loss had significant difference between the two groups (P =0.039). One case (6.7% ) in the RIP group and 17 cases (43.6% ) in the HHV group received postoperative blood transfusion, showing a significant difference (P =0.010). No postoperative 30-day mortality happened in all patients. No significant differences were found between the two groups in hospital stay or postoperative morbidity, including hepatic insufficiency, infection, ascites, pleural effusion, cardiopulmonary complications and intestinal ventilation lime ( P > 0. 05 for all). The RIP group had a significantly higher PTA level at postoperative clays 3 and 5 (P < 0.001 ). Although no significant differences were found between the two groups regarding total bilirubin, albumin, prealbumin and aminotransferase (P > 0.05 ) during any postoperative stage, the ALT recovered to normal level in 5 patients (33. 3% ) of the RIP group and only in one case (2.7%) of the HHV group, with a significant difference between the two groups (P =0.006). Conclusion The results of this study indicate that regional ischemic preconditioning may have better hemostatic effect on hepatectomy, can reduce postoperative blood transfusion and promote early recovery of liver function than hemi-hepatic vascular inflow occlusion. [ABSTRACT FROM AUTHOR]

Objective To investigate the differences between clinicopathological features and prognosis of alpha-fetoprotein (AFP) negative (AFP < 20 ng/ml) and positive (AFP ⩾ 20 ng/ml) hepatocellular carcinoma (HGC) patients. Methods clinicopathological data of 142 AFP-negative and 109 AFP-positive HCG patients who underwent R0 radical hepatectomy in the Cancer Hospital of Chinese Academy of Medical Sciences between January 2006 and December 2011 were retrospectively reviewed and analyzed in this study. Results Compared with the AFP-negative patients, a higher female to male sex ratio, the later Barcelona Clinic Liver Cancer (BCLC) stage, more liver capsule invasion and poorer Edmondson-Steiner grade were in the AFP-positive cases (P<0.05 for all). Furthermore, the 1-, 3-, and 5-year overall survival rates were 94.4%, 82.4% and 61.0% in the AFP-negative group and 87.2%, 61.1% and 40.2%, respectively, in the AFP-positive group (P<0.001). The multivariate analysis with Cox's proportional hazards model showed that AFP status, tumor size and Edmondson-Steiner grade are independent risk factors for survival of all the patients (P<0.05) , and large tumor and Edmondson-Steiner grades III/IV are independent risk factors for worse survival in AFP-negative patients (P<0.05). However, large tumor diameter was proved to be an independent risk factor leading to poor prognosis of AFP-positive cases (P<0.05). Conclusion High levels of AFP indicate that the tumors are more malignant and with unfavorable prognosis. [ABSTRACT FROM AUTHOR]