115 results on '"Hepatectomy statistics & numerical data"'
Search Results
2. Landmark analysis of the risk of recurrence after resection or ablation for HCC: A nationwide study.
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Kraglund F, Skou N, Villadsen GE, and Jepsen P
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- Humans, Male, Female, Denmark epidemiology, Middle Aged, Aged, Catheter Ablation mortality, Risk Assessment, Prognosis, Risk Factors, Liver Neoplasms surgery, Liver Neoplasms mortality, Neoplasm Recurrence, Local, Carcinoma, Hepatocellular surgery, Carcinoma, Hepatocellular mortality, Registries, Hepatectomy statistics & numerical data
- Abstract
Background: The risk of HCC recurrence at particular landmarks since the initial treatment is unknown. With this registry-based study, we aimed to provide a nuanced description of the prognosis following resection or ablation for HCC, including landmark analyses., Methods: Using the Danish nationwide health care registries, we identified all patients who received resection or ablation in 2000-2018 as the first HCC treatment. HCC recurrence was defined as a new HCC treatment > 90 days after the first treatment. We conducted competing risk landmark analyses of the cumulative risk of recurrence and death., Results: Among 4801 patients with HCC, we identified 426 patients who received resection and 544 who received ablation. The 2 treatment cohorts differed in cirrhosis prevalence and tumor stage. The 5-year recurrence risk was 40.7% (95% CI 35.5%-45.8%) following resection and 60.7% (95% CI: 55.9%-65.1%) following ablation. The 1-year recurrence risk decreased over the landmarks from 20.4% (95% CI: 16.6%-24.6%) at the time of resection to 4.7% (95% CI: 0.9%-13.9%) at the 5-year landmark. For ablation, the risk decreased from 36.1% (95% CI: 31.9%-40.4%) at the time of treatment to 5.3% (95% CI: 0.4%-21.4%) at the 5-year landmark. The risk of death without recurrence was stable over the landmarks following both resection and ablation., Conclusions: In conclusion, the risk of recurrence or death following resection or ablation for HCC is high from the treatment date, but the risk of recurrence decreases greatly over the survival landmarks. This information is valuable for clinicians and their patients., (Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American Association for the Study of Liver Diseases.) more...
- Published
- 2024
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3. Development and validation of a gradient boosting machine to predict prognosis after liver resection for intrahepatic cholangiocarcinoma.
- Author
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Ji GW, Jiao CY, Xu ZG, Li XC, Wang K, and Wang XH
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- Aged, Bile Duct Neoplasms pathology, Bile Duct Neoplasms surgery, Cholangiocarcinoma pathology, Cholangiocarcinoma surgery, Female, Hepatectomy statistics & numerical data, Humans, Male, Middle Aged, Retrospective Studies, Risk Assessment, Bile Duct Neoplasms mortality, Cholangiocarcinoma mortality, Machine Learning standards
- Abstract
Background: Accurate prognosis assessment is essential for surgically resected intrahepatic cholangiocarcinoma (ICC) while published prognostic tools are limited by modest performance. We therefore aimed to establish a novel model to predict survival in resected ICC based on readily-available clinical parameters using machine learning technique., Methods: A gradient boosting machine (GBM) was trained and validated to predict the likelihood of cancer-specific survival (CSS) on data from a Chinese hospital-based database using nested cross-validation, and then tested on the Surveillance, Epidemiology, and End Results (SEER) database. The performance of GBM model was compared with that of proposed prognostic score and staging system., Results: A total of 1050 ICC patients (401 from China and 649 from SEER) treated with resection were included. Seven covariates were identified and entered into the GBM model: age, tumor size, tumor number, vascular invasion, number of regional lymph node metastasis, histological grade, and type of surgery. The GBM model predicted CSS with C-Statistics ≥ 0.72 and outperformed proposed prognostic score or system across study cohorts, even in sub-cohort with missing data. Calibration plots of predicted probabilities against observed survival rates indicated excellent concordance. Decision curve analysis demonstrated that the model had high clinical utility. The GBM model was able to stratify 5-year CSS ranging from over 54% in low-risk subset to 0% in high-risk subset., Conclusions: We trained and validated a GBM model that allows a more accurate estimation of patient survival after resection compared with other prognostic indices. Such a model is readily integrated into a decision-support electronic health record system, and may improve therapeutic strategies for patients with resected ICC., (© 2022. The Author(s).) more...
- Published
- 2022
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4. Surgical practice patterns and outcomes in T2 and T3 gallbladder cancer: a population-based study.
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Tharmalingam S, Flemming J, Richardson H, Hurlbut D, Cleary S, and Nanji S
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- Adolescent, Adult, Aged, Aged, 80 and over, Female, Humans, Kaplan-Meier Estimate, Male, Middle Aged, Neoplasm Staging, Ontario, Proportional Hazards Models, Retrospective Studies, Young Adult, Cholecystectomy statistics & numerical data, Gallbladder Neoplasms pathology, Gallbladder Neoplasms surgery, Hepatectomy statistics & numerical data, Outcome and Process Assessment, Health Care statistics & numerical data, Registries
- Abstract
Background: The extent of resection required in advanced gallbladder cancer is controversial. We aimed to describe the management and outcomes in patients with resected stage T2 and T3 gallbladder cancer., Methods: In this population-based study, all T2 and T3 gallbladder cancer cases from Jan. 1, 2002, to Mar. 31, 2012, were identified from the Ontario Cancer Registry; pathology reports were linked and abstracted. The type of resection was classified as extended (cholecystectomy + liver resection, with or without bile duct resection) or simple (cholecystectomy only). We used Kaplan-Meier survival analysis to model time to death and evaluated factors associated with overall survival using the Cox proportional hazards regression model., Results: A total of 370 patients were included, 232 with T2 disease and 138 with T3 disease. The proportions who underwent extended resection were 24.1% (56/232) and 37.0% (51/138), respectively. The unadjusted 5-year overall survival rates for simple and extended resection were 39.7% and 49.5%, respectively, for T2 disease ( p = 0.03), and 13.5% and 22.8%, respectively, for T3 disease ( p = 0.05). In adjusted analysis, extended resection significantly improved overall survival among patients with T2 disease (hazard ratio [HR] 0.51, 95% confidence interval [CI] 0.30-0.97), whereas higher grade of differentiation, presence of lymphovascular invasion and positive lymph nodes led to worse survival. Extended resection was not associated with improved survival in the T3 group; however, in subgroup analysis stratified by lymph node status, a trend toward improved overall survival with extended resection was seen in node-negative patients (HR 0.20, 95% CI 0.03-1.06)., Conclusion: Extended resection improved overall survival in T2 disease regardless of nodal status but appeared most beneficial in node-negative T3 disease. The finding that extended resection was offered only to a small proportion of eligible patients highlights the need for improved knowledge translation at national surgical meetings., Competing Interests: Competing interests: Jennifer Flemming reports consulting fees from Gilead Sciences for participation in an academic conference planning committee. Sean Cleary reports consulting fees from Olympus, Ethicon and Erbe, and honoraria from Ethicon. No other competing interests were declared., (© 2022 CMA Impact Inc. or its licensors.) more...
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- 2022
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5. Resection or ablation versus transarterial therapy for Child-Pugh A patients with a single small hepatocellular carcinoma.
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Suh YJ, Jin YJ, Jeong Y, Shin WY, Lee JM, Cho S, Yu JH, and Lee JW
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- Age Factors, Aged, Carcinoma, Hepatocellular mortality, Carcinoma, Hepatocellular pathology, Carcinoma, Hepatocellular surgery, Chemoembolization, Therapeutic adverse effects, Chemoembolization, Therapeutic methods, Female, Hepatectomy adverse effects, Hepatectomy methods, Humans, Liver Neoplasms mortality, Liver Neoplasms pathology, Liver Neoplasms surgery, Male, Middle Aged, Neoplasm Staging, Propensity Score, Proportional Hazards Models, Radiofrequency Ablation adverse effects, Radiofrequency Ablation methods, Republic of Korea, Retrospective Studies, Survival Rate, Tumor Burden, Carcinoma, Hepatocellular therapy, Chemoembolization, Therapeutic statistics & numerical data, Hepatectomy statistics & numerical data, Liver Neoplasms therapy, Radiofrequency Ablation statistics & numerical data
- Abstract
Abstract: Data from a direct comparison of the long-term survival outcomes of surgical resection (SR) or radiofrequency ablation (RFA) versus transarterial therapy in Child-Turcotte-Pugh (CTP)-class A patients with a single small T1/T2 stage hepatocellular carcinoma (HCC) (≤3 cm) are still lacking. This study retrospectively compared the therapeutic outcomes of these treatment types for CTP-A patients with a single small HCC.Using a nationwide Korean registry, we identified 2314 CTP-A patients with SR (n = 722), RFA (n = 731), or transarterial therapy (n = 861) for a single (≤3 cm) T1/T2 stage HCC from 2008 to 2014. The posttreatment overall survival (OS) of transarterial therapy with either SR or RFA were compared using the Inverse Probability of treatment Weighting (IPW). The median follow-up period was 50 months (range 1-107 months).After IPW, the cumulative OS rates after SR or RFA were significantly higher than those after transarterial therapy in all subjects (all P values < .05). The OS rates after SR or RFA were better than those after transarterial therapy in patients with the hepatitis B or C virus (all P values < .05), and in patients aged <65 years (all P values < .05). The cumulative OSs between RFA and transarterial therapy were statistically comparable in patients with a 2 to 3 cm HCC and aged ≥65 years, respectively. For all subjects, the weighted Cox proportional hazards model using IPW provided the adjusted hazard ratios (95% confidence interval) for the OS after SR versus transarterial therapy and after RFA versus transarterial therapy of 0.42 (0.30-0.60) (P < .001) and 0.78 (0.61-0.99) (P = .044), respectively.In CTP-A patients with a single (≤3 cm) T1/T2 HCC, SR or RFA provides a better OS than transarterial therapy, regardless of the HCC etiology (hepatitis B virus or hepatitis C virus), especially in patients with HCC of <2 cm and aged <65 years., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2021 the Author(s). Published by Wolters Kluwer Health, Inc.) more...
- Published
- 2021
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6. Factors associated with liver cancer prognosis after hepatectomy: A retrospective cohort study.
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Yuan Y, Yang F, Wang Y, and Guo Y
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- Adult, Aged, Biomarkers, Tumor, Comorbidity, Female, Hepatitis B epidemiology, Humans, Liver Function Tests, Liver Neoplasms epidemiology, Logistic Models, Male, Middle Aged, Neoplasm Recurrence, Local, Prognosis, Retrospective Studies, Risk Factors, Hepatectomy statistics & numerical data, Liver Neoplasms mortality, Liver Neoplasms surgery
- Abstract
Abstract: This article was to investigate risk factors influencing liver cancer prognosis after hepatectomy.Patients undergoing hepatectomy after being diagnosed with liver cancer in Zhongshan Hospital Affiliated to Xiamen University were collected in the retrospective cohort study between January 2012 and December 2017, and divided into disease progression and non-progression groups based on their prognostic status. Univariate analysis was performed on the patients' baseline and laboratory test data, with multivariate logistic regression further conducted to investigate the independent risk factors for liver cancer progression after hepatectomy.Among the 288 subjects, 159 had adverse outcomes (death or cancer recurrence). Hepatitis B and high levels of aspartate aminotransferase, gamma-glutamyltransferase, alkaline phosphatase (ALP), direct bilirubin, and total bilirubin as well as low level of lymphocyte (LYM) were found to be associated with disease progression in the univariate analysis, and were introduced into the multivariate logistic regression. The results indicated that patients with high ALP level (odds ratio [OR] = 1.004, 95%CI: 1.002-1.007, P = .003) and with a history of hepatitis B (OR = 2.182, 95%CI: 1.165-4.086, P = .015) had a higher risk of liver cancer progression compared with those of lower ALP level and those without hepatitis B respectively, whereas the elevated level of LYM (OR = 0.710, 95%CI: 0.516-0.978, P = .034) had favorable progression.The elevated ALP level and a history of hepatitis B may increase the risk of death or cancer recurrence, whereas high LYM level may decrease poor progression among liver cancer patients after hepatectomy. More importance should be attached to the improvement of the liver function and treatment of hepatitis B to enable a better outcome for the patients., Competing Interests: The authors have no funding and conflicts of interest to disclose., (Copyright © 2021 the Author(s). Published by Wolters Kluwer Health, Inc.) more...
- Published
- 2021
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7. The predictive value of vessels encapsulating tumor clusters in treatment optimization for recurrent early-stage hepatocellular carcinoma.
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Chen ZY, Guo ZX, Lu LH, Mei J, Lin WP, Li SH, Wei W, and Guo RP
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- Adult, Carcinoma, Hepatocellular blood supply, Carcinoma, Hepatocellular pathology, Carcinoma, Hepatocellular surgery, Disease-Free Survival, Female, Follow-Up Studies, Hepatectomy statistics & numerical data, Humans, Liver blood supply, Liver surgery, Liver Neoplasms blood supply, Liver Neoplasms pathology, Liver Neoplasms surgery, Male, Middle Aged, Neoplasm Recurrence, Local blood supply, Neoplasm Recurrence, Local pathology, Neoplasm Recurrence, Local surgery, Neoplasm Staging, Prognosis, Radiofrequency Ablation statistics & numerical data, Retrospective Studies, Survival Rate, Carcinoma, Hepatocellular mortality, Liver pathology, Liver Neoplasms mortality, Neoplasm Recurrence, Local mortality
- Abstract
Background: The predictive value of vessels encapsulating tumor clusters (VETC) in recurrent early-stage hepatocellular carcinoma (HCC) remains unclear. Therefore, the aim of the present study was to investigate the prognostic significance of VETC in patients with recurrent early-stage HCC after repeat hepatic resection (RHR) or radiofrequency ablation (RFA)., Methods: From December 2005 to December 2016, 138 patients receiving RHR and 188 patients receiving RFA were recruited. VETC was evaluated by immunohistochemical staining for CD34. The survival outcomes of patients with VETC pattern or not were investigated., Results: There was no significant difference between the RHR and RFA groups in disease-free survival (DFS) or overall survival (OS) as determined by the univariate analysis of the whole cohort. In the subgroup analysis of the VETC-positive cohort, the patients in the RHR group showed a longer median DFS time in contrast to those in the RFA group (15.0 vs. 5.0 months, p = 0.001). Similarly, the patients in the RHR group showed a longer median OS time in contrast to those in the RFA group (39.5 vs. 19 months, p = 0.001). In the VETC-negative cohort, no significant differences in DFS and OS rates between the RHR and RFA groups were observed (p > 0.05)., Conclusions: The results of our study suggested that RHR was relatively safe and superior to RFA in improving survival outcomes for recurrent early-stage HCC after initial hepatectomy. Furthermore, the VETC pattern may represent a reliable marker for selecting HCC patients who may benefit from RHR., (© 2021 The Authors. Cancer Medicine published by John Wiley & Sons Ltd.) more...
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- 2021
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8. Significance of liver resection for intermediate stage hepatocellular carcinoma according to subclassification.
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Yamamoto M, Kobayashi T, Hashimoto M, Kuroda S, Kawaoka T, Aikata H, Chayama K, and Ohdan H
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- Adult, Aged, Aged, 80 and over, Carcinoma, Hepatocellular diagnosis, Carcinoma, Hepatocellular mortality, Carcinoma, Hepatocellular pathology, Chemoembolization, Therapeutic methods, Cisplatin administration & dosage, Female, Follow-Up Studies, Humans, Iodized Oil administration & dosage, Kaplan-Meier Estimate, Liver blood supply, Liver drug effects, Liver pathology, Liver surgery, Liver Neoplasms diagnosis, Liver Neoplasms mortality, Liver Neoplasms pathology, Male, Middle Aged, Neoplasm Staging, Prognosis, Retrospective Studies, Risk Assessment methods, Sorafenib administration & dosage, Treatment Outcome, Carcinoma, Hepatocellular therapy, Chemoembolization, Therapeutic statistics & numerical data, Hepatectomy statistics & numerical data, Liver Neoplasms therapy
- Abstract
Background: Patients diagnosed with Barcelona Clinic Liver Cancer (BCLC) intermediate stage hepatocellular carcinoma (HCC) encompass a broad clinical population. Kinki criteria subclassifications have been proposed to better predict prognoses and determine appropriate treatment strategies for these patients. This study validated the prognostic significance within the Kinki criteria substages and analyzed the role of liver resection in patients with intermediate stage HCC., Methods: Patients with intermediate stage HCC (n = 378) were retrospectively subclassified according to the Kinki criteria (B1, n = 123; B2, n = 225; and B3, n = 30). We analyzed the overall survival (OS) and treatment methods., Results: The OS was significantly different between adjacent substages. Patients in substage B1 who underwent liver resection had a significantly better prognosis than those who did not, even after propensity score matching (PSM). Patients in substage B2 who underwent liver resection had a significantly better prognosis than those who did not; however, there was no difference after PSM. There was no difference in prognosis based on treatments among patients in substage B3., Conclusions: The Kinki criteria clearly stratify patients with intermediate stage HCC by prognosis. For substage B1 HCC patients, liver resection provides a better prognosis than other treatment modalities. In patients with substage B2 and B3, an alternative approach is required. more...
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- 2021
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9. Factors predicting long-term outcomes of early-stage hepatocellular carcinoma after primary curative treatment: the role of surgical or nonsurgical methods.
- Author
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Kuo MJ, Mo LR, and Chen CL
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- Aged, Carcinoma, Hepatocellular diagnosis, Carcinoma, Hepatocellular mortality, Carcinoma, Hepatocellular pathology, Disease-Free Survival, Feasibility Studies, Female, Follow-Up Studies, Humans, Liver Neoplasms diagnosis, Liver Neoplasms mortality, Liver Neoplasms pathology, Male, Middle Aged, Neoplasm Recurrence, Local prevention & control, Neoplasm Staging, Prognosis, Retrospective Studies, Risk Assessment methods, Risk Assessment statistics & numerical data, Risk Factors, Time Factors, Carcinoma, Hepatocellular therapy, Chemoembolization, Therapeutic statistics & numerical data, Hepatectomy statistics & numerical data, Liver Neoplasms therapy, Neoplasm Recurrence, Local epidemiology, Radiofrequency Ablation statistics & numerical data
- Abstract
Background: We quantified the elusive effects of putative factors on the clinical course of early hepatocellular carcinoma (HCC) after primary surgical or nonsurgical curative treatment., Methods: Patients with newly diagnosed early HCC who received surgical resection (SR) or percutaneous radiofrequency ablation (RFA) with or without transcatheter arterial chemoembolization (TACE) from January 2003 to December 2016 were enrolled. The cumulative overall survival (OS) and disease-free survival (DFS) rates were compared. A polytomous logistic regression was used to estimate factors for early and late recurrence. Independent predictors of OS were identified using Cox proportional hazard regression., Results: One hundred twenty-five patients underwent SR, and 176 patients underwent RFA, of whom 72 were treated with TACE followed by RFA. Neither match analysis based on propensity score nor multiple adjustment regression yielded a significant difference in DFS and OS between the two groups. Multivariate analysis showed high AFP (> 20 ng/mL), and multinodularity significantly increased risk of early recurrence (< 1 year). In contrast, hepatitis B virus, hepatitis C virus and multinodularity were significantly associated with late recurrence (> 1 year). Multivariate Cox regression with recurrent events as time-varying covariates identified older age (HR = 1.55, 95% CI:1.01-2.36), clinically significant portal hypertension (CSPH) (HR = 1.97, 95% CI:1.26-3.08), early recurrence (HR = 6.62, 95% CI:3.79-11.6) and late recurrence (HR = 3.75, 95% CI:1.99-7.08) as independent risk factors of mortality. A simple risk score showed fair calibration and discrimination in early HCC patients after primary curative treatment. In the Barcelona Clinic Liver Cancer (BCLC) stage A subgroup, SR significantly improved DFS compared to RFA with or without TACE., Conclusion: Host and tumor factors rather than the initial treatment modalities determine the outcomes of early HCC after primary curative treatment. Statistical models based on recurrence types can predict early HCC prognosis but further external validation is necessary. more...
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- 2021
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10. Impact of preoperative TACE on incidences of microvascular invasion and long-term post-hepatectomy survival in hepatocellular carcinoma patients: A propensity score matching analysis.
- Author
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Yang Y, Lin K, Liu L, Qian Y, Yang Y, Yuan S, Zhu P, Huang J, Liu F, Gu F, Fu S, Jiang B, Liu H, Pan Z, Lau WY, and Zhou W
- Subjects
- Adult, Aged, Antineoplastic Combined Chemotherapy Protocols administration & dosage, Carcinoma, Hepatocellular pathology, Carcinoma, Hepatocellular surgery, Disease-Free Survival, Female, Hepatectomy mortality, Hepatectomy statistics & numerical data, Hepatic Artery, Humans, Incidence, Liver Neoplasms pathology, Liver Neoplasms surgery, Male, Microvessels pathology, Middle Aged, Neoplasm Invasiveness, Neoplasm Recurrence, Local mortality, Preoperative Care, Prognosis, Propensity Score, Regression Analysis, Retrospective Studies, Carcinoma, Hepatocellular mortality, Carcinoma, Hepatocellular therapy, Chemoembolization, Therapeutic methods, Chemoembolization, Therapeutic mortality, Chemoembolization, Therapeutic statistics & numerical data, Liver Neoplasms mortality, Liver Neoplasms therapy
- Abstract
Background: To study the influence of preoperative transcatheter arterial chemoembolization (TACE) on the incidence of microvascular invasion (MVI) and long-term survival outcomes in hepatocellular carcinoma (HCC) patients., Methods: Between January 1, 2010 and December 1, 2014, consecutive HCC patients who underwent curative liver resection were enrolled in this study. Univariable and multivariable regression analyses were used to identify independent predictive factors of MVI. Propensity score matching (PSM) was used to compare the incidences of MVI and prognosis between patients who did and did not receive preoperative TACE. Factors associated with Disease-Free Survival (DFS) and Overall survival (OS) were identified using Cox regression analyses., Results: Of 1624 patients, 590 received preoperative TACE. The incidence of MVI was significantly lower in patients with preoperative TACE than those without preoperative TACE (39.15% vs. 45.36%, p = 0.015). After PSM, the incidences of MVI were similar in the two groups (38.85% vs. 41.10%, p = 0.473). Multivariable regression analysis revealed preoperative TACE to have no impact on the incidence of MVI. Before PSM, survival of patients with preoperative TACE was significantly worse than those without preoperative TACE (p = 0.032 for DFS and p = 0.027 for OS). After PSM, the difference became insignificant (p = 0.465 for DFS and p = 0.307 for OS). After adjustment for other prognostic variables in the propensity-matched cohort, preoperative TACE was still found not to be associated with DFS and OS after HCC resection. Both before and after PSM, the prognosis of patients was not significantly different between the two groups for BCLC stages 0, A, and B., Conclusions: Preoperative TACE did not influence the incidence of MVI and prognosis of patients with HCC who underwent 'curative' liver resection., (© 2021 The Authors. Cancer Medicine published by John Wiley & Sons Ltd.) more...
- Published
- 2021
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11. Single-center experience on actual mid-term (≥5 years) and long-term (≥10 years) survival outcome in patients with hepatocellular carcinoma after curative hepatectomy: A bimodal distribution.
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Fung AKY, Cheng NMY, Chong CCN, Lee KF, Wong J, Cheung SYS, Lok HT, Lai PBS, and Ng KKC
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- Adult, Age Factors, Aged, Aged, 80 and over, Carcinoma, Hepatocellular pathology, Disease-Free Survival, Female, Humans, Liver Neoplasms pathology, Male, Middle Aged, Multivariate Analysis, Neoplasm Invasiveness, Neoplasm Recurrence, Local, Postoperative Complications epidemiology, Prognosis, Retrospective Studies, Serum Albumin, Young Adult, Carcinoma, Hepatocellular mortality, Carcinoma, Hepatocellular surgery, Hepatectomy statistics & numerical data, Liver Neoplasms mortality, Liver Neoplasms surgery
- Abstract
Analysis for actual mid-term (≥5 years) and long-term (≥10 years) survivors with hepatocellular carcinoma (HCC) following curative hepatectomy are rarely reported in the literature.This retrospective study aims to study the mid- and long-term survival outcome and associated prognostic factors following curative hepatectomy for HCC in a tertiary referral center.The clinical data of 325 patients who underwent curative hepatectomy for HCC were reviewed. They were stratified into 3 groups for comparison (Group 1, overall survival <5 years; Group 2, overall survival ≥5, and <10 years; Group 3, overall survival ≥10 years). Favorable independent prognostic factors for mid- and long-term survival were analyzed.A bimodal distribution of actual survival outcome was observed, with short-term (<5 years) survival of 52.7% (n = 171), mid-term survival of 18.1% (n = 59), and long-term survival of 29.2% (n = 95). Absence of microvascular invasion (OR 3.690, 95% CI: 1.562-8.695) was independent good prognostic factor for mid-term survival. Regarding long-term overall survival, young age (OR 1.050, 95% CI: 0.920-0.986), ASA grade ≤2 (OR 3.746, 95% CI: 1.325-10.587), high albumin level (OR 1.008, 95% CI: 0.920-0.986), solitary tumor (OR 3.289, 95% CI: 1.149-7.625) and absence of microvascular invasion (OR 4.926, 95% CI: 2.192-11.111) were independent good prognostic factors.Curative hepatectomy results in bimodal actual survival outcome with favorable long-term survival rate of 29.2%. Favorable independent prognostic factors (age, ASA grade, albumin level, tumor number, and microvascular invasion) are identified for overall survival. more...
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- 2020
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12. Comparative clinical outcomes of robot-assisted liver resection versus laparoscopic liver resection: A meta-analysis.
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Zhang L, Yuan Q, Xu Y, and Wang W
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- Blood Loss, Surgical statistics & numerical data, Blood Transfusion statistics & numerical data, Conversion to Open Surgery statistics & numerical data, Hepatectomy economics, Hepatectomy methods, Hepatectomy statistics & numerical data, Humans, Laparoscopy economics, Laparoscopy methods, Laparoscopy statistics & numerical data, Length of Stay statistics & numerical data, Liver Neoplasms economics, Operative Time, Postoperative Complications etiology, Robotic Surgical Procedures economics, Robotic Surgical Procedures methods, Robotic Surgical Procedures statistics & numerical data, Treatment Outcome, Hepatectomy adverse effects, Laparoscopy adverse effects, Liver Neoplasms surgery, Postoperative Complications epidemiology, Robotic Surgical Procedures adverse effects
- Abstract
Background: As an emerging technology, robot-assisted surgical system has some potential merits in many complicated endoscopic procedures compared with laparoscopic surgery. But robot-assisted liver resection is still a controversial problem on its advantages compared with laparoscopic liver resection. We aimed to perform the meta-analysis to assess and compare the clinical outcomes of robot-assisted and laparoscopic liver resection., Methods: We searched PubMed, Cochrane Library, Embase databases, Clinicaltrials, and Opengrey through March 24, 2020, including references of qualifying articles. English-language, original investigations in humans about robot-assisted and laparoscopic hepatectomy were included. Titles, abstracts, and articles were reviewed by at least 2 independent readers. Continuous and dichotomous variables were compared by the weighted mean difference (WMD) and odds ratio (OR), respectively., Results: Of 936 titles identified in our original search, 28 articles met our criteria, involving 3544 patients. Compared with laparoscopy, the robot-assisted groups had longer operative time (WMD: 36.93; 95% CI, 19.74-54.12; P < 0.001), lower conversion rate (OR: 0.63; 95% CI, 0.46-0.87; P = 0.005), higher transfusion rate (WMD: 2.39; 95% CI, 1.51-3.76; P < 0.001) and higher total cost (WMD:0.49; 95% CI, 0.42-0.55; P < 0.001). In addition, the baseline characteristics of patients about largest tumor size was larger (WMD: 0.36; 95% CI, 0.16-0.56; P < 0.001) and malignant lesions rate was higher (WMD: 1.50; 95% CI, 1.21-1.86; P < 0.001) in the robot-assisted versus laparoscopic hepatectomy. The subgroup analysis of minor hepatectomy showed robot-assisted was associated with longer operative time (WMD: 36.00; 95% CI, 12.59-59.41; P = 0.003), longer length of stay (WMD: 0.51; 95% CI, 0.02-1.01; p = 0.04) and higher total cost (WMD: 0.48; 95% CI, 0.25-0.72; P < 0.001) (Table 3); while the subgroup analysis of major hepatectomy showed robot-assisted was associated with lower estimated blood loss (WMD: -122.43; 95% CI, -151.78--93.08; P < 0.001)., Conclusions: Our meta-analysis revealed that robot-assisted was associated with longer operative time, lower conversion rate, higher transfusion rate and total cost, and robot-assisted has certain advantages in major hepatectomy compared with laparoscopic hepatectomy., Competing Interests: The authors have declared that no competing interests exist. more...
- Published
- 2020
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13. Strategies for the delay of surgery in the management of resectable hepatobiliary malignancies during the COVID-19 pandemic.
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Bennett S, Søreide K, Gholami S, Pessaux P, Teh C, Segelov E, Kennecke H, Prenen H, Myrehaug S, Callegaro D, and Hallet J
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- Betacoronavirus isolation & purification, COVID-19, Coronavirus Infections epidemiology, Coronavirus Infections virology, Humans, Liver Neoplasms virology, Pandemics, Patient Care Management, Pneumonia, Viral epidemiology, Pneumonia, Viral virology, SARS-CoV-2, Coronavirus Infections complications, Hepatectomy statistics & numerical data, Infection Control methods, Liver Neoplasms surgery, Pneumonia, Viral complications, Practice Guidelines as Topic standards, Surgeons standards, Time-to-Treatment statistics & numerical data
- Abstract
Objective: We aimed to review data about delaying strategies for the management of hepatobiliary cancers requiring surgery during the covid-19 pandemic., Background: Given the covid-19 pandemic, many jurisdictions, to spare resources, have limited access to operating rooms for elective surgical activity, including cancer, thus forcing deferral or cancellation of cancer surgeries. Surgery for hepatobiliary cancer is high-risk and particularly resource-intensive. Surgeons must critically appraise which patients will benefit most from surgery and which ones have other therapeutic options to delay surgery. Little guidance is currently available about potential delaying strategies for hepatobiliary cancers when surgery is not possible., Methods: An international multidisciplinary panel reviewed the available literature to summarize data relating to standard-of-care surgical management and possible mitigating strategies to be used as a bridge to surgery for colorectal liver metastases, hepatocellular carcinoma, gallbladder cancer, intrahepatic cholangiocarcinoma, and hilar cholangiocarcinoma., Results: Outcomes of surgery during the covid-19 pandemic are reviewed. Resource requirements are summarized, including logistics and adverse effects profiles for hepatectomy and delaying strategies using systemic, percutaneous and radiation ablative, and liver embolic therapies. For each cancer type, the long-term oncologic outcomes of hepatectomy and the clinical tools that can be used to prognosticate for individual patients are detailed., Conclusions: There are a variety of delaying strategies to consider if availability of operating rooms decreases. This review summarizes available data to provide guidance about possible delaying strategies depending on patient, resource, institution, and systems factors. Multidisciplinary team discussions should be leveraged to consider patient- and tumour-specific information for each individual case., Competing Interests: CONFLICT OF INTEREST DISCLOSURES We have read and understood Current Oncology’s policy on disclosing conflicts of interest, and we declare that we have none., (2020 Multimed Inc.) more...
- Published
- 2020
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14. Systematic failure to operate on colorectal cancer liver metastases in California.
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Raoof M, Jutric Z, Haye S, Ituarte PHG, Zhao B, Singh G, Melstrom L, Warner SG, Clary B, and Fong Y
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- Adolescent, Adult, Black or African American statistics & numerical data, Aged, Aged, 80 and over, California epidemiology, Colorectal Neoplasms epidemiology, Cross-Sectional Studies, Female, Geographic Information Systems, Hepatectomy mortality, Hepatectomy trends, Humans, Incidence, Liver Neoplasms epidemiology, Logistic Models, Male, Middle Aged, Odds Ratio, Registries statistics & numerical data, White People statistics & numerical data, Young Adult, Colorectal Neoplasms pathology, Hepatectomy statistics & numerical data, Liver Neoplasms secondary, Liver Neoplasms surgery
- Abstract
Background: Despite evidence that liver resection improves survival in patients with colorectal cancer liver metastases (CRCLM) and may be potentially curative, there are no population-level data examining utilization and predictors of liver resection in the United States., Methods: This is a population-based cross-sectional study. We abstracted data on patients with synchronous CRCLM using California Cancer Registry from 2000 to 2012 and linked the records to the Office of Statewide Health Planning Inpatient Database. Quantum Geographic Information System (QGIS) was used to map liver resection rates to California counties. Patient- and hospital-level predictors were determined using mixed-effects logistic regression., Results: Of the 24 828 patients diagnosed with stage-IV colorectal cancer, 16 382 (70%) had synchronous CRCLM. Overall liver resection rate for synchronous CRCLM was 10% (county resection rates ranging from 0% to 33%) with no improvement over time. There was no correlation between county incidence of synchronous CRCLM and rate of resection (R
2 = .0005). On multivariable analysis, sociodemographic and treatment-initiating-facility characteristics were independently associated with receipt of liver resection after controlling for patient disease- and comorbidity-related factors. For instance, odds of liver resection decreased in patients with black race (OR 0.75 vs white) and Medicaid insurance (OR 0.62 vs private/PPO); but increased with initial treatment at NCI hospital (OR 1.69 vs Non-NCI hospital), or a high volume (10 + cases/year) (OR 1.40 vs low volume) liver surgery hospital., Conclusion: In this population-based study, only 10% of patients with liver metastases underwent liver resection. Furthermore, the study identifies wide variations and significant population-level disparities in the utilization of liver resection for CRCLM in California., (© 2020 The Authors. Cancer Medicine published by John Wiley & Sons Ltd.) more...- Published
- 2020
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15. In-hospital mortality and failure to rescue following hepatobiliary surgery in Germany - a nationwide analysis.
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Krautz C, Gall C, Gefeller O, Nimptsch U, Mansky T, Brunner M, Weber GF, Grützmann R, and Kersting S
- Subjects
- Aged, Digestive System Diseases surgery, Digestive System Surgical Procedures adverse effects, Digestive System Surgical Procedures mortality, Digestive System Surgical Procedures statistics & numerical data, Female, Germany epidemiology, Hepatectomy statistics & numerical data, Hospitals, High-Volume statistics & numerical data, Hospitals, Low-Volume statistics & numerical data, Humans, Male, Middle Aged, Digestive System Diseases epidemiology, Failure to Rescue, Health Care statistics & numerical data, Hepatectomy adverse effects, Hepatectomy mortality, Hospital Mortality
- Abstract
Background: Recent observational studies on volume-outcome associations in hepatobiliary surgery were not designed to account for the varying extent of hepatobiliary resections and the consequential risk of perioperative morbidity and mortality. Therefore, this study aimed to determine the risk-adjusted in-hospital mortality for minor and major hepatobiliary resections at the national level in Germany and to examine the effect of hospital volume on in-hospital mortality, and failure to rescue., Methods: All inpatient cases of hepatobiliary surgery (n = 31,114) in Germany from 2009 to 2015 were studied using national hospital discharge data. After ranking hospitals according to increasing hospital volumes, five volume categories were established based on all hepatobiliary resections. The association between hospital volume and in-hospital mortality following minor and major hepatobiliary resections was evaluated by multivariable regression methods., Results: Minor hepatobiliary resections were associated with an overall mortality rate of 3.9% and showed no significant volume-outcome associations. In contrast, overall mortality rate of major hepatobiliary resections was 10.3%. In this cohort, risk-adjusted in-hospital mortality following major resections varied widely across hospital volume categories, from 11.4% (95% CI 10.4-12.5) in very low volume hospitals to 7.4% (95% CI 6.6-8.2) in very high volume hospitals (risk-adjusted OR 0.59, 95% CI 0.41-0.54). Moreover, rates of failure to rescue decreased from 29.38% (95% CI 26.7-32.2) in very low volume hospitals to 21.38% (95% CI 19.2-23.8) in very high volume hospitals., Conclusions: In Germany, patients who are undergoing major hepatobiliary resections have improved outcomes, if they are admitted to higher volume hospitals. However, such associations are not evident following minor hepatobiliary resections. Following major hepatobiliary resections, 70-80% of the excess mortality in very low volume hospitals was estimated to be attributable to failure to rescue. more...
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- 2020
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16. Prognoses, outcomes, and clinicopathological characteristics of very elderly patients with hepatocellular carcinoma who underwent hepatectomy.
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Shimada S, Kamiyama T, Orimo T, Nagatsu A, Asahi Y, Sakamoto Y, Kamachi H, and Taketomi A
- Subjects
- Adult, Age Factors, Aged, Aged, 80 and over, Biomarkers, Tumor blood, Carcinoma, Hepatocellular blood, Carcinoma, Hepatocellular mortality, Carcinoma, Hepatocellular pathology, Female, Hepatectomy statistics & numerical data, Humans, Liver Neoplasms blood, Liver Neoplasms mortality, Liver Neoplasms pathology, Male, Middle Aged, Neoplasm Recurrence, Local blood, Neoplasm Recurrence, Local mortality, Neoplasm Recurrence, Local pathology, Neoplasm Recurrence, Local surgery, Neoplasm Staging, Prognosis, Retrospective Studies, Risk Factors, Survival Rate, Treatment Outcome, Carcinoma, Hepatocellular surgery, Liver Neoplasms surgery
- Abstract
Objectives: The aim was to evaluate the prognostic factors, clinicopathological characteristics, and surgical outcomes after hepatectomy in very elderly patients with hepatocellular carcinoma (HCC)., Methods: We analyzed 796 patients with HCC from 2000 to 2017. Patients aged 80 years or older were classified into the very elderly group (group VE; n = 49); patients younger than 80 years old and aged 65 years or older were classified into the elderly group (group E; n = 363), and patients younger than 65 years old were classified into the young group (group Y; n = 384). We investigated the prognoses, clinicopathological characteristics, and surgical outcomes after hepatectomy., Results: The number of surgical procedures and outcomes, including morbidities, was not significantly different. Groups VE, E, and Y showed similar prognoses in terms of both survival and recurrence. In group VE, prothrombin activity (PA) < 80% and PIVKA-II ≥ 400 mAU/ml were unfavorable factors for survival, and PIVKA-II ≥ 400 mAU/ml and the presence of portal venous invasion (PVI), hepatic venous invasion, and fibrosis were unfavorable factors for recurrence. In group E, ChE < 180 IU/l, AFP ≥ 20 ng/ml, tumor size ≥ 10 cm, and the presence of multiple tumors, PVI, and hepatic venous invasion (HVI) were unfavorable factors for survival, and ChE < 180 IU/l, tumor size ≥ 10 cm, and the presence of multiple tumors, PVI, and HVI were unfavorable factors for recurrence. In group Y, AFP ≥ 20 ng/ml, the presence of multiple tumors, poor differentiation, PVI, HVI, and blood loss ≥ 400 ml were unfavorable factors for survival, and PA < 80%, albumin < 3.5 g/dl, AFP ≥ 20 ng/ml, tumor size ≥ 10 cm, and the presence of multiple tumors, poor differentiation, and PVI were unfavorable factors for recurrence., Conclusions: Tumor factors might have limited influence on the prognosis of very elderly patients, and liver function reserve might be important for the long-term survival of very elderly patients. Hepatectomy can be performed safely, even in very elderly patients. Hepatectomy should not be avoided in very elderly patients with HCC if patients have a good general status because these patients have the same prognoses as nonelderly individuals. more...
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- 2020
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17. The efficacy of surgery in advanced hepatocellular carcinoma: a cohort study.
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Chen L, Sun T, Chen S, Ren Y, Yang F, and Zheng C
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- Adult, Aged, Aged, 80 and over, Carcinoma, Hepatocellular pathology, Cohort Studies, Databases, Factual, Female, Hepatectomy statistics & numerical data, Humans, Liver Neoplasms pathology, Male, Middle Aged, Neoplasm Recurrence, Local pathology, Neoplasm Staging, Propensity Score, SEER Program, Survival Rate, Treatment Outcome, Carcinoma, Hepatocellular surgery, Liver Neoplasms surgery, Neoplasm Recurrence, Local surgery
- Abstract
Background: It is still controversial whether hepatocellular carcinoma (HCC) patients with lymph node invasion should receive surgery treatment. This study aimed to evaluate the efficacy of surgery (liver resection and local tumor destruction treatments) in HCC patients with regional lymph node metastasis., Methods: The study utilized data from the Surveillance, Epidemiology, and End Results-18 (SEER-18) cancer registry. Patients for whom the treatment type was not clear or those with distant metastasis or without regional lymph nodule invasion were excluded. For survival analysis, patients with the survival months coded as 0 and 999 were excluded. All 1434 patients were included in the analysis. Among them, 168 patients were treated surgically and the other 1266 received non-surgery therapy. Propensity score matching (PSM) model was used to reduce selection bias., Results: Before PSM, the median overall survival (mOS) and median cancer-specific survival (mCSS) of patients treated surgically were longer than that of receiving non-surgery treatment (mOS 20 months, 95% CI 15.3-24.7 vs. 7 months, 95% CI 6.4-7.6, P < 0.001; mCSS 21 months, 95% CI 115.5-26.5 vs. 6 months, 95% CI 5.3-6.7, P < 0.001). Subgroup analysis found no significant differences in mOS and mCSS between liver resection and non-liver resection surgery cohorts (P = 0.886 and P = 0.813, respectively). Similar results were obtained in the PSM analysis. The mOS and mCSS in the surgery group were longer than those in the non-surgery group (mOS 20 months vs. 7 months, P < 0.001; mCSS 20 months vs. 6 months, P < 0.001). The multivariate analysis documented that surgery was an independent predictor for OS and CSS before and after PSM., Conclusions: HCC patients with invasion of regional lymph nodules may get more survival benefit from surgery than other types of treatment. more...
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- 2020
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18. Accessible laparoscopic liver resection performed in low volume centers: Is it time for democratization?
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Bouras AF, Liddo G, Marx-Deseure A, Leroy A, and Decanter G
- Subjects
- Adult, Aged, Aged, 80 and over, Feasibility Studies, Female, Humans, Male, Middle Aged, Time Factors, Treatment Outcome, Young Adult, Hepatectomy methods, Hepatectomy statistics & numerical data, Hospitals, Low-Volume organization & administration, Laparoscopy, Liver Neoplasms surgery, Procedures and Techniques Utilization statistics & numerical data
- Abstract
Introduction: Laparoscopic liver resection (LLR) has been developed and is daily practiced by many expert teams. However, very few data are available on the experience of low volume centres. The aim of our study was to report and discuss the operative results of LLR performed in three low volume centres., Methods: Records of patients who underwent a LLR in three low volume centres in France between May 2014 and November 2017 were collected. Endpoints studied were indications, intra and postoperative outcomes as well as short-term outcomes., Results: A total of 46 patients (57 specimen resected) underwent a LLR during this period, representing 29.6% of total liver resections. Indications of LLR were benign lesions in 26%, primitive malignant lesions in 32.6% and metastatic tumours in 41.3%. Median size of lesions was 22mm (range 11-100). Most liver resections were non-anatomic (64.7%), while left lateral sectionectomies represented 19.2%. Five patients required conversion and there were at the end 3 specimen with margins inferior to 1mm resected laparoscopically. Postoperative mortality was nil and morbidity rate was 17.3%. Median hospital stay was 6 days (3-15)., Conclusion: Although LLR have gained acceptance in surgeons' arsenal, it remains concentrated in referral centres. Our results suggest the feasibility of LLR in non-academic centres when it comes to small accessible lesions. Further studies would provide data about the long-term safety of this procedure in those centres., (Copyright © 2019 Elsevier Masson SAS. All rights reserved.) more...
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- 2020
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19. Survival Outcomes According to Body Mass Index in Hepatocellular Carcinoma Patient: Analysis of Nationwide Cancer Registry Database.
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Cha B, Yu JH, Jin YJ, Suh YJ, and Lee JW
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- Adolescent, Adult, Aged, Aged, 80 and over, Body Mass Index, Carcinoma, Hepatocellular pathology, Carcinoma, Hepatocellular therapy, Catheter Ablation statistics & numerical data, Chemoembolization, Therapeutic statistics & numerical data, Female, Follow-Up Studies, Hepatectomy statistics & numerical data, Humans, Kaplan-Meier Estimate, Male, Middle Aged, Neoplasm Staging, Obesity diagnosis, Overweight diagnosis, Prognosis, Registries statistics & numerical data, Republic of Korea epidemiology, Retrospective Studies, Sex Factors, Thinness diagnosis, Treatment Outcome, Young Adult, Carcinoma, Hepatocellular mortality, Liver Neoplasms mortality, Obesity epidemiology, Overweight epidemiology, Thinness epidemiology
- Abstract
Background and Aims: Body mass index (BMI) is known to be closely related to the prognosis and mortality of various diseases. The aim of our study was to evaluate differences in post-treatment overall survival (OS) according to BMI with hepatocellular carcinoma (HCC) and to understand the meaning of BMI. Among the records of 10,578 HCC patients registered at the Korean Central Cancer Registry from 2008 through 2014, we selected Barcelona Clinic Liver Cancer (BCLC) 0, A, and B staged HCC patients (n = 4,926). HCC patients showed a good prognosis in the order of overweight, normal weight, obesity, and underweight. However, comparing normal-weight (BMI 18.5-24.9 kg/m
2 ) to overweight (BMI 25-29.9 kg/m2 ) after propensity score matching (PSM), there was no significant difference in OS (p = 0.153). Overweight males had a better prognosis than normal-weight males (p = 0.014), but, normal-weight females had a better prognosis than overweight. To determine the gender-specific OS differences, we examined the differences according to the HCC treatment type. In males, overweight patients had better OS after transarterial chemoembolization (TACE) (p = 0.039) than normal-weight, but not after surgical resection (p = 0.618) nor radiofrequency ablation (p = 0.553). However, in females, all of those HCC treatments resulted in significantly better OS in normal-weight patients than overweight. In patients with HCC of BCLC stages 0-B, unlike females, overweight males had a better prognosis than normal-weight, especially among TACE-treated patients. Our results carefully suggest that the meaning of normal BMI in patients with HCC may have gender difference. more...- Published
- 2020
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20. Clinical prediction score for superficial surgical site infections: Real-life data from a retrospective single-centre analysis of 812 hepatectomies.
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Shen J, Ni Z, Qian Y, Wang B, and Zheng S
- Subjects
- Adult, Aged, Aged, 80 and over, China epidemiology, Clinical Decision Rules, Female, Humans, Male, Middle Aged, Multivariate Analysis, ROC Curve, Retrospective Studies, Risk Factors, Hepatectomy adverse effects, Hepatectomy statistics & numerical data, Liver Neoplasms surgery, Risk Assessment methods, Surgical Wound Infection epidemiology, Surgical Wound Infection etiology
- Abstract
Superficial surgical site infections (SSIs) are one of the most common postoperative complications of hepatectomy for liver cancer. The objective of this study is to clarify the risk factors and determine a clinical prediction score for SSIs after partial hepatectomy for malignant tumour. A total of 812 consecutive patients were enrolled who underwent partial hepatectomy for liver malignant tumour from January 2017 to December 2017. Univariate and multivariate analyses were conducted to identify the risk factors for SSIs. Clinical prediction score was then constructed using coefficients of identified significant predictors. Risk stratification was then carried out by receiver operating characteristic curve analysis. Of all the 812 patients, SSIs were observed in 31 (3.82%) patients. A multivariate analysis identified four predictors as independent risk factors for SSIs, which were splenomegaly, perioperative blood transfusion, intensive care unit (ICU) admission, and low postoperative serum albumin concentration (<35 g/L). Clinical prediction score ranged from 0 to 4.6 with its discrimination concordance (C) statistic of 0.70 (95% confidence interval [CI] 0.59, 0.81). Risk stratification classified these patients into low, moderate, and high risk in SSIs. This risk score system may credibly stratify the risk of SSIs with relatively high sensitivity and specificity. Splenomegaly, history of blood transfusion, ICU admission, and postoperative serum albumin concentration less than 35 g/L could be used to predict SSIs with acceptable discrimination. This clinical risk score system may be useful in prediction of SSIs after hepatectomy for malignant tumours., (© 2019 Medicalhelplines.com Inc and John Wiley & Sons Ltd.) more...
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- 2020
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21. Differences in Pathology, Staging, and Treatment between HIV + and Uninfected Patients with Microscopically Confirmed Hepatocellular Carcinoma.
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Torgersen J, Taddei TH, Park LS, Carbonari DM, Kallan MJ, Mitchell Richards K, Zhang X, Jhala D, Bräu N, Homer R, D'Addeo K, Mehta R, Skanderson M, Kidwai-Khan F, Justice AC, and Lo Re V 3rd
- Subjects
- Ablation Techniques statistics & numerical data, Carcinoma, Hepatocellular immunology, Carcinoma, Hepatocellular pathology, Carcinoma, Hepatocellular therapy, Female, HIV Infections complications, HIV Infections immunology, HIV Infections virology, Hepatectomy statistics & numerical data, Hospitals, Veterans statistics & numerical data, Humans, Immunologic Surveillance, Kaplan-Meier Estimate, Liver immunology, Liver surgery, Liver Cirrhosis immunology, Liver Cirrhosis pathology, Liver Cirrhosis therapy, Liver Neoplasms immunology, Liver Neoplasms pathology, Liver Neoplasms therapy, Liver Transplantation statistics & numerical data, Male, Middle Aged, Neoplasm Staging, Retrospective Studies, Risk Factors, Treatment Outcome, United States epidemiology, Carcinoma, Hepatocellular mortality, HIV Infections epidemiology, Liver pathology, Liver Cirrhosis epidemiology, Liver Neoplasms mortality
- Abstract
Background: The incidence of hepatocellular carcinoma (HCC) is substantially higher among HIV-infected (HIV
+ ) than uninfected persons. It remains unclear if HCC in the setting of HIV infection is morphologically distinct or more aggressive., Methods: We evaluated differences in tumor pathology in a cohort of HIV+ and uninfected patients with microscopically confirmed HCC in the Veterans Aging Cohort Study from 2000 to 2015. We reviewed pathology reports and medical records to determine Barcelona Clinic Liver Cancer stage (BCLC), HCC treatment, and survival by HIV status. Multivariable Cox regression was used to determine the hazard ratio [HR; 95% confidence interval (CI)] of death associated with HIV infection after microscopic confirmation., Results: Among 873 patients with HCC (399 HIV+ ), 140 HIV+ and 178 uninfected persons underwent liver tissue sampling and had microscopically confirmed HCC. There were no differences in histologic features of the tumor between HIV+ and uninfected patients, including tumor differentiation (well differentiated, 19% vs. 28%, P = 0.16) and lymphovascular invasion (6% vs. 7%, P = 0.17) or presence of advanced hepatic fibrosis (40% vs. 39%, P = 0.90). There were no differences in BCLC stage ( P = 0.06) or treatment ( P = 0.29) by HIV status. After adjustment for risk factors, risk of death was higher among HIV-infected than uninfected patients (HR = 1.37; 95% CI, 1.02-1.85)., Conclusions: We found no differences in HCC tumor characteristics or background hepatic parenchyma by HIV status, yet HIV was associated with poorer survival. Of note, pathology reports often omitted these characteristics., Impact: Systematic evaluation of HCC pathology by HIV status is needed to understand tumor characteristics associated with improved survival., (©2019 American Association for Cancer Research.) more...- Published
- 2020
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22. Hilar cholangiocarcinoma: Value of high-resolution enhanced magnetic resonance imaging for preoperative evaluation.
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Xin Y, Liu Q, Zhang J, Lu J, Song X, Zhan H, Chen X, Cao Z, Li Y, and Huang Z
- Subjects
- Adult, Aged, Bile Duct Neoplasms pathology, Bile Duct Neoplasms surgery, Cholangiopancreatography, Magnetic Resonance statistics & numerical data, Contrast Media administration & dosage, Feasibility Studies, Female, Hepatic Artery diagnostic imaging, Hepatic Artery pathology, Hepatic Duct, Common blood supply, Hepatic Duct, Common diagnostic imaging, Hepatic Duct, Common pathology, Hepatic Duct, Common surgery, Humans, Klatskin Tumor pathology, Klatskin Tumor surgery, Liver blood supply, Liver diagnostic imaging, Liver pathology, Liver surgery, Male, Middle Aged, Neoplasm Invasiveness diagnosis, Portal Vein diagnostic imaging, Portal Vein pathology, Predictive Value of Tests, Preoperative Care statistics & numerical data, Retrospective Studies, Risk Assessment methods, Bile Duct Neoplasms diagnostic imaging, Cholangiopancreatography, Magnetic Resonance methods, Hepatectomy statistics & numerical data, Klatskin Tumor diagnostic imaging, Preoperative Care methods
- Abstract
Objectives: The objective is to assess the accuracy of high-resolution (HR) enhanced magnetic resonance imaging (MRI) images in the preoperative evaluation of biliary and vascular invasion in hilar cholangiocarcinomas., Methods: This retrospective study included 36 patients with hilar cholangiocarcinoma who underwent enhanced HR-MRI with an effective section thickness of 1.2 mm at 3.0 T before surgery. Combined HR-MRI and magnetic resonance cholangiopancreatography (MRCP) images were compared with MRCP in evaluating the extent of biliary infiltration according to the Bismuth-Corlette classification. To determine the suitable criterion for HR-MRI in predicting vessel invasion, Labeling 180 and 90 of circumferential contact of the tumor with the vessel were used to predict the invasion. The correlation between imaging findings and surgical and histopathological records was statistically analyzed., Results: The accuracy in detecting biliary neoplastic invasion was higher for combined HR-MRI images (97.2%) than MRCP images (86.1%). HR-MRI images increased the accuracy in delineation of the tumor biliary extent (P < 0.05). The accuracy of Labeling 90 (98.6% in portal venous system and 98.0% in hepatic arterial system) was higher than that of Labeling 180 (96.5% in portal venous system and 94.6% in hepatic arterial system). However, there was no significant statistic difference between them (P > 0.05). Interobserver agreement was high with respect to biliary tract, portal venous, and hepatic arterial system involvement., Conclusions: Enhanced HR-MRI images showed excellent capability for assessing tumor extent and vascular invasion in hilar cholangiocarcinomas. More than 90° of circumferential contact of the tumor with the vessel on HR-MRI may be an appropriate criterion for predicting invasion., Competing Interests: None more...
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- 2020
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23. Clinical Analysis of Acinar Cell Carcinoma of the Pancreas: A Single-Center Experience of 45 Consecutive Cases.
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Zhou W, Han X, Fang Y, Han S, Cai Y, Kuang T, Lou W, and Wang D
- Subjects
- Aged, Carcinoma, Acinar Cell mortality, Carcinoma, Acinar Cell secondary, Chemotherapy, Adjuvant statistics & numerical data, Female, Follow-Up Studies, Gastrectomy statistics & numerical data, Hepatectomy statistics & numerical data, Humans, Kaplan-Meier Estimate, Liver Neoplasms mortality, Liver Neoplasms secondary, Male, Middle Aged, Palliative Care statistics & numerical data, Pancreas pathology, Pancreas surgery, Pancreatic Neoplasms mortality, Pancreatic Neoplasms pathology, Retrospective Studies, Survival Rate, Treatment Outcome, Carcinoma, Acinar Cell therapy, Liver Neoplasms therapy, Pancreatectomy statistics & numerical data, Pancreatic Neoplasms therapy, Pancreaticoduodenectomy statistics & numerical data
- Abstract
Backgrounds: Acinar cell carcinoma of the pancreas is a rare malignancy, and its features remain unclear. We aimed to analyze the clinical characteristics, treatment and prognosis of acinar cell carcinoma with our institutional case series., Methods: Patients diagnosed with acinar cell carcinoma in our hospital between 2005 and 2019 were reviewed. Investigations on clinicopathological features, treatment details and long-term survival were performed., Results: A total of 45 pathologically confirmed acinar cell carcinomas were identified. The median age at diagnosis was 58 years with a male-to-female ratio of 3.1:1. There were 24 (53.3%) localized, 5 (11.1%) locally advanced and 16 (35.6%) metastatic cases, with a pancreatic head-to-body/tail ratio of 1:1.4 for all the primary lesions. In the localized group, there were 10 pancreatoduodenectomy, 12 distal pancreatectomy, 1 total pancreatectomy, and 1 distal pancreatectomy combined with proximal gastrectomy. Among the locally advanced and metastatic cases, 13 patients received chemotherapy, 1 received concurrent radiochemotherapy, 1 underwent synchronous resection of primary tumor and liver metastasis, 1 underwent palliative operation, 1 underwent exploratory laparotomy, and 4 required no treatment. The median overall survival of this series was 18.9 months with a 5-year survival rate of 19.6%. Moreover, the resected acinar cell carcinoma patients were associated with prolonged survival compared with the unresected cases (36.6 vs. 8.5 months, P < 0.001)., Conclusions: Surgical resection could improve the long-term survival of acinar cell carcinoma patients, which might also improve the prognosis of selected metastatic cases. Large-scale studies are needed to further clarify the biological behavior and clinical features, and to seek the optimal treatments. more...
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- 2020
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24. Implementation and outcome of minor and major minimally invasive liver surgery in the Netherlands.
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van der Poel MJ, Fichtinger RS, Bemelmans M, Bosscha K, Braat AE, de Boer MT, Dejong CHC, Doornebosch PG, Draaisma WA, Gerhards MF, Gobardhan PD, Gorgec B, Hagendoorn J, Kazemier G, Klaase J, Leclercq WKG, Liem MS, Lips DJ, Marsman HA, Mieog JSD, Molenaar QI, Nieuwenhuijs VB, Nota CL, Patijn GA, Rijken AM, Slooter GD, Stommel MWJ, Swijnenburg RJ, Tanis PJ, Te Riele WW, Terkivatan T, van den Tol PM, van den Boezem PB, van der Hoeven JA, Vermaas M, Abu Hilal M, van Dam RM, and Besselink MG more...
- Subjects
- Aged, Attitude of Health Personnel, Conversion to Open Surgery statistics & numerical data, Female, Humans, Learning Curve, Male, Middle Aged, Netherlands epidemiology, Operative Time, Postoperative Complications epidemiology, Retrospective Studies, Surgeons, Surveys and Questionnaires, Hepatectomy statistics & numerical data, Laparoscopy statistics & numerical data, Liver surgery, Robotic Surgical Procedures statistics & numerical data
- Abstract
Background: While most of the evidence on minimally invasive liver surgery (MILS) is derived from expert centers, nationwide outcomes remain underreported. This study aimed to evaluate the implementation and outcome of MILS on a nationwide scale., Methods: Electronic patient files were reviewed in all Dutch liver surgery centers and all patients undergoing MILS between 2011 and 2016 were selected. Operative outcomes were stratified based on extent of the resection and annual MILS volume., Results: Overall, 6951 liver resections were included, with a median annual volume of 50 resections per center. The overall use of MILS was 13% (n = 916), which varied from 3% to 36% (P < 0.001) between centers. The nationwide use of MILS increased from 6% in 2011 to 23% in 2016 (P < 0.001). Outcomes of minor MILS were comparable with international studies (conversion 0-13%, mortality <1%). In centers which performed ≥20 MILS annually, major MILS was associated with less conversions (14 (11%) versus 41 (30%), P < 0.001), shorter operating time (184 (117-239) versus 200 (139-308) minutes, P = 0.010), and less overall complications (37 (30%) versus 58 (42%), P = 0.040)., Conclusion: The nationwide use of MILS is increasing, although large variation remains between centers. Outcomes of major MILS are better in centers with higher volumes., (Copyright © 2019 International Hepato-Pancreato-Biliary Association Inc. Published by Elsevier Ltd. All rights reserved.) more...
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- 2019
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25. Selection of treatment for hepatic epithelioid hemangioendothelioma: a single-center experience.
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Cao L, Hong J, Zhou L, Ye Y, Liu Y, Yu J, and Zheng S
- Subjects
- Adult, Aged, Biopsy, Fine-Needle, China epidemiology, Female, Follow-Up Studies, Hemangioendothelioma, Epithelioid mortality, Hepatectomy adverse effects, Hepatectomy statistics & numerical data, Humans, Liver pathology, Liver surgery, Liver Neoplasms mortality, Liver Transplantation adverse effects, Liver Transplantation statistics & numerical data, Male, Middle Aged, Neoplasm Recurrence, Local prevention & control, Neoplasm Recurrence, Local therapy, Patient Selection, Prognosis, Radiofrequency Ablation adverse effects, Radiofrequency Ablation statistics & numerical data, Retrospective Studies, Time Factors, Treatment Outcome, Watchful Waiting statistics & numerical data, Clinical Decision-Making, Hemangioendothelioma, Epithelioid therapy, Liver Neoplasms therapy, Neoplasm Recurrence, Local epidemiology
- Abstract
Background: Hepatic epithelioid hemangioendothelioma (HEHE) is a rare angiogenic tumor with no recognized effective treatment. Treatment options used worldwide include liver transplantation (LT), liver resection (LR), radiofrequency ablation (RFA), chemotherapy, and observation. The aim of this study was to describe the efficacy of different treatment options used for HEHE at our center., Methods: The medical charts of 12 patients with HEHE (9 women and 3 men) who were diagnosed and treated at the First Affiliated Hospital of Zhejiang University, China, between January 2011 and December 2017 were retrospectively reviewed., Results: The patients were diagnosed by postoperative histopathology or fine needle aspiration biopsy. Two patients with diffuse lesions received LT and were alive without recurrence at the last follow-up. Three patients received LR as the initial treatment, and all of them developed recurrence during the follow-up period. One patient received RFA and remained free of disease, while the remaining six patients opted for simple observation rather than treatment. One of the patients who received LR passed away because of tumor recurrence within 32 months after surgery; the other patients showed no significant disease activity after treatments for their recurrent lesions. As of April 2018, the mean follow-up duration was 39.6 ± 20.1 months (15-82 months)., Conclusions: There are multiple strategies for HEHE. Considering its indolent course, initial observation for assessment of the lesion behavior may aid in the selection of appropriate treatment. Surgery or LT is suitable for patients with disease progression during the observation period. However, our sample size was small, and further studies are required to gather more information that can aid in optimal treatment selection. more...
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- 2019
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26. Assessment of Outcome of Hepatic Resection for Extremely Elderly Patients With a Hepatic Malignancy.
- Author
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Horiuchi T, Haruki K, Shiba H, Sakamoto T, Saito N, Shirai Y, Iwase R, Fujiwara Y, and Yanaga K
- Subjects
- Age Factors, Aged, Aged, 80 and over, Analysis of Variance, Carcinoma, Hepatocellular mortality, Carcinoma, Hepatocellular pathology, Comorbidity, Disease-Free Survival, Female, Hospital Mortality, Humans, Kaplan-Meier Estimate, Liver Neoplasms mortality, Liver Neoplasms pathology, Liver Neoplasms secondary, Male, Margins of Excision, Postoperative Complications, Survival Analysis, Treatment Outcome, Carcinoma, Hepatocellular surgery, Colorectal Neoplasms pathology, Hepatectomy mortality, Hepatectomy statistics & numerical data, Liver Neoplasms surgery
- Abstract
Background/aim: We aimed to assess surgical outcome and long-term survival after elective hepatic resection for hepatocellular carcinoma (HCC) and colorectal liver metastasis (CRLM) in patients aged 80 years or older., Patients and Methods: This study included 100 patients aged 70 years or older, who underwent hepatic resection for HCC or CRLM between January 2000 and December 2012. Outcomes and clinicopathological data were compared between the elderly (aged 70-79 years; n=84) and extremely elderly groups (aged 80 years or older; n=16)., Results: Incidence of postoperative complications, in-hospital mortality, and postoperative OS in the extremely elderly group were comparable with those of the elderly group. In patients with HCC, the extremely elderly group was associated with shorter DFS (p=0.030) in univariate analysis, while multivariate analysis showed significant and independent factors of cancer recurrence., Conclusion: Hepatic resection for HCC and CRLM in patients aged 80 years and older may be safe and acceptable with appropriate selection. For HCC in patients aged 80 years and older, hepatic resection may be effective when negative surgical margins can be achieved., (Copyright© 2019, International Institute of Anticancer Research (Dr. George J. Delinasios), All rights reserved.) more...
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- 2019
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27. The preoperative platelet to albumin ratio predicts the prognosis of hepatocellular carcinoma patients without portal hypertension after liver resection.
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Li C, Peng W, Zhang XY, Wen TF, and Chen LP
- Subjects
- Adult, Biomarkers blood, Carcinoma, Hepatocellular pathology, Carcinoma, Hepatocellular surgery, Female, Hepatectomy mortality, Hepatectomy statistics & numerical data, Humans, Liver Neoplasms pathology, Liver Neoplasms surgery, Longitudinal Studies, Male, Middle Aged, Neoplasm Recurrence, Local pathology, Predictive Value of Tests, Preoperative Period, Progression-Free Survival, ROC Curve, Albumins metabolism, Blood Platelets metabolism, Carcinoma, Hepatocellular mortality, Liver Neoplasms mortality, Neoplasm Recurrence, Local epidemiology
- Abstract
There is little information concerning the predictive ability of the preoperative platelet to albumin ratio (PAR) in hepatocellular carcinoma (HCC) patients after liver resection. In the current study, we aimed to assess the prognostic power of the PAR in HCC patients without portal hypertension (PH) following liver resection.Approximately 628 patients were included in this study. A receiver operating characteristic (ROC) curve analysis was performed to evaluate the predictive value of the PAR for both recurrence-free survival (RFS) and overall survival (OS). Univariate and multivariate analyses were used to identify the independent risk factors for both RFS and OS.During the follow-up period, 361 patients experienced recurrence, and 217 patients died. ROC curve analysis suggested that the best cut-off value of the PAR for RFS was greater than 4.8. The multivariate analysis revealed that microvascular invasion (MVI), tumor size >5 cm, high aspartate aminotransferase-to-platelet count ratio index (APRI) and high PAR were four independent risk factors for both RFS and OS. Patients with a low PAR had significantly better RFS and OS than those with a high PAR.The PAR may be a useful marker to predict the prognosis of HCC patients after liver resection. HCC patients with a high preoperative PAR had a higher recurrent risk and lower long-term survival rate than those with a low preoperative PAR. more...
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- 2019
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28. The Risk Factors of Postoperative Pressure Ulcer After Liver Resection With Long Surgical Duration: A Retrospective Study.
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Chen HL, Jiang AG, Zhu B, Cai JY, and Song YP
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- Adult, Aged, Electronic Health Records statistics & numerical data, Female, Hepatectomy adverse effects, Humans, Male, Middle Aged, Operative Time, Pressure Ulcer etiology, Retrospective Studies, Blood Loss, Surgical statistics & numerical data, Hepatectomy statistics & numerical data, Postoperative Complications epidemiology, Pressure Ulcer epidemiology
- Abstract
Objective: The aim of this study is to investigate the risk factors of postoperative pressure ulcer (PU) development after liver resection with a long surgical duration., Materials and Methods: A retrospective analysis was performed of patients who underwent a liver resection with a surgical duration greater than 2 hours between January 2015 and December 2016 at a tertiary referral hospital in eastern China. Univariate analysis and multivariate logistic regression were used to analyze the independent risk factors for postoperative PUs., Results: Of the 128 patients included in the study, 11 (8.6%; 95% confidence interval [CI], 4.4%-14.9%) developed a stage 1 PU. Univariate analysis showed albumin on admission, diabetes mellitus complication, length of surgery, and intraoperative blood loss were all significantly different between the developed PU group (n = 11) and no PU group (n = 117; P ⟨ .05). However, multivariate logistic regression showed length of surgery (odds ratio [OR] = 1.026; 95% CI, 1.008-1.146) and intraoperative blood loss (OR = 1.014; 95% CI, 1.009-1.124) as only the independent risk factors for PU development after liver resection with a long surgical duration., Conclusions: These results showed length of surgery and intraoperative blood loss were independent risk factors for PU after liver resection with a long surgical duration. Use of PU prevention strategies are recommended for patients who undergo liver resection with massive intraoperative blood loss and long surgical duration. more...
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- 2019
29. Effective therapeutic options for elderly patients with hepatocellular carcinoma: A nationwide cohort study.
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Shin J, Yu JH, Jin YJ, Suh YJ, Kim DH, Byun S, and Lee JW
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- Age Factors, Aged, Aged, 80 and over, Alcohol Drinking epidemiology, Antineoplastic Agents therapeutic use, Carcinoma, Hepatocellular mortality, Carcinoma, Hepatocellular pathology, Catheter Ablation statistics & numerical data, Chemoembolization, Therapeutic statistics & numerical data, Comorbidity, Female, Health Behavior, Hepatectomy statistics & numerical data, Hepatitis B epidemiology, Hepatitis C epidemiology, Humans, Liver Function Tests, Liver Neoplasms mortality, Liver Neoplasms pathology, Male, Neoplasm Staging, Propensity Score, Registries, Republic of Korea epidemiology, Retrospective Studies, Sex Factors, Socioeconomic Factors, Survival Analysis, Tumor Burden, Carcinoma, Hepatocellular epidemiology, Carcinoma, Hepatocellular therapy, Liver Neoplasms epidemiology, Liver Neoplasms therapy
- Abstract
We evaluated the post-treatment overall survival (OS) of elderly hepatocellular carcinoma (HCC) patients.The archived records of 10,578 HCC patients registered at the Korean Central Cancer Registry from 2008 through 2014 were retrospectively analyzed. In this registry, we selected Barcelona Clinic Liver Cancer (BCLC) 0, A, or B staged HCC patients (n = 4744) treated by surgical resection (SR), local ablation therapy (LAT), or locoregional therapy (LRT). OSs in nonelderly (<70 years) and elderly (≥70 years) patients were compared after propensity score matching (PSM).In BCLC 0-A staged HCC, the cumulative OS rates of elderly patients were poorer than those of nonelderly patients after PSM (P < .001), but not in those with BCLC stage B (P > .05). In BCLC 0-A staged elderly patients, OS after SR was significantly better than after LAT (P = .005) or LRT (P < .001). In BCLC B staged elderly patients, SR achieved better OS than LRT (P = .006). Multivariable analysis showed that LAT (hazard ratio [HR] 1.52, P = .048) or LRT (HR, 2.01, P < .001) as compared with SR, and large (>3 cm) tumor size (HR1.49, P = .018) were poor predictors of OS for elderly patients with BCLC stage 0-A, and that LRT (HR, 2.64, P = .042) was a poor predictor for those with BCLC stage B.SR provided a better OS rate than LAT or LRT in elderly HCC patients with BCLC stage 0-A, than LRT in those with BCLC stage B. SR should be considered the first therapeutic option even in elderly HCC patients with these stages. more...
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- 2019
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30. Advantages of laparoscopic left hemihepatectomy: A meta-analysis.
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Yin X, Luo D, Huang Y, and Huang M
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- Blood Loss, Surgical statistics & numerical data, Blood Transfusion statistics & numerical data, Hepatectomy methods, Humans, Laparoscopy methods, Length of Stay statistics & numerical data, Liver surgery, Liver Diseases blood, Liver Function Tests, Postoperative Complications epidemiology, Postoperative Complications etiology, Postoperative Period, Treatment Outcome, Hepatectomy statistics & numerical data, Laparoscopy statistics & numerical data, Liver Diseases surgery
- Abstract
Background: Laparoscopic left hemihepatectomy (LLH) has been widely accepted as a minimally invasive alternative to open liver surgery. We assessed the benefits and drawbacks of LLH compared with open left hemihepatectomy (OLH) using meta-analysis., Methods: Relevant literature was retrieved using PubMed, Embase, Cochrane, and Ovid Medline databases. Multiple parameters of efficacy and safety were compared between the treatment groups. Results are expressed as odds ratio (OD) or mean difference (MD) with 95% confidence interval (95% CI) for fixed- and random-effects models., Results: The meta-analysis included 13 trials involving 1163 patients. Compared with OLH, LLH significantly reduced intraoperative blood loss (MD, -91.01; 95% CI, -139.12 to -42.89; P = .0002), transfusion requirement (OR, 0.24; 95% CI, 0.11-0.54; P = .0004), time to oral intake (MD, -0.80; 95% CI, -1.27 to -0.33; P = .0008), and hospital stay (MD, -3.94; 95% CI, -4.85 to -3.03; P < .0001). However, operative time; complications rate; and postoperative alanine transferase, albumin, and total bilirubin levels did not differ significantly between the 2 surgical groups (P > .05). For hepatolithiasis treatment, there were no significant differences in operative time, residual stones, stone recurrence, and complications rate between the groups (P > .05), but LLH resulted in lower incisional infection rate (OR, 0.44; 95% CI, 0.22-0.89; P = .02) than OLH. The LLH group demonstrated higher bile leakage rate (OR, 1.79; 95% CI, 1.14-2.81; P = .01) and incurred greater hospital costs (MD, 618.56; 95% CI, 154.47-1082.64; P = .009)., Conclusions: LLH has multiple advantages over OLH and should thus be considered as the first choice for left hemihepatectomy. more...
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- 2019
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31. Comparison study between open and laparoscopic liver resection in a Saudi tertiary center.
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Al-Saif FA, Aldekhayel MK, Al-Alem F, Hassanain MM, Mattar RE, and Alsharabi A
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- Adult, Aged, Blood Transfusion statistics & numerical data, Female, Hepatectomy mortality, Humans, Intraoperative Care statistics & numerical data, Laparoscopy mortality, Male, Middle Aged, Morbidity, Operative Time, Retrospective Studies, Saudi Arabia epidemiology, Time Factors, Hepatectomy methods, Hepatectomy statistics & numerical data, Laparoscopy methods, Laparoscopy statistics & numerical data, Tertiary Care Centers statistics & numerical data
- Abstract
Objectives: To compare King Saud University Medical City experience in laparoscopic liver resection with our previously established database for open resections., Methods: A retrospective study was conducted at King Saud University Medical City, Riyadh, Saudi Arabia. All adult patients who underwent liver resection from 2006 to 2017 were included. Patients who had their procedure converted to open were excluded., Results: Among the 111 liver resections included, 22 (19.8%) were performed laparoscopically and 89 (80.1%) were performed using the open technique. Malignancy was the most common indication in both groups (78.5%). The mean operative time was 275 min (SD 92.2) in the laparoscopic group versus 315 min (SD 104.3) in the open group. Intraoperative blood transfusion was required in the laparoscopic (9%) and open groups (31.4%). The morbidity rate was 13.6% in the laparoscopic group and 31.4% in the open group, and the mortality rate was 0% in the laparoscopic group and 5.6% in the open group., Conclusion: Laparoscopic liver resection appears to be a safe technique and can be performed in various benign and malignant cases. more...
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- 2019
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32. Prognostic significance of inflammatory biomarkers in hepatocellular carcinoma following hepatic resection.
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Itoh S, Yugawa K, Shimokawa M, Yoshiya S, Mano Y, Takeishi K, Toshima T, Maehara Y, Mori M, and Yoshizumi T
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- Adult, Aged, Aged, 80 and over, Biomarkers, Tumor blood, Cell Line, Tumor, Female, Humans, Inflammation blood, Male, Middle Aged, Postoperative Complications, Prognosis, Young Adult, Carcinoma, Hepatocellular blood, Carcinoma, Hepatocellular diagnosis, Carcinoma, Hepatocellular epidemiology, Carcinoma, Hepatocellular surgery, Hepatectomy adverse effects, Hepatectomy statistics & numerical data, Liver Neoplasms blood, Liver Neoplasms diagnosis, Liver Neoplasms epidemiology, Liver Neoplasms surgery
- Abstract
Background: Cancer-related inflammation has been correlated with cancer prognosis. This study evaluated inflammatory biomarkers, including neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR) and lymphocyte-to-monocyte ratio (LMR), programmed death ligand (PD-L) 1 expression, and tumour microenvironment in relation to prognosis and clinicopathological features of patients with hepatocellular carcinoma (HCC) undergoing curative hepatic resection., Methods: Patients who had liver resection for HCC in 2000-2011 were analysed. Univariable and multivariable analyses were conducted for overall (OS) and recurrence-free (RFS) survival. Immunohistochemical analyses of PD-L1, CD8 and CD68 expression were performed. HCC cell lines were evaluated for PD-L1 expression. A subgroup analysis was conducted to determine patient features, survival and the tumour microenvironment. Results were validated in a cohort of patients with HCC treated surgically in 2012-2016., Results: Some 281 patients who underwent hepatic resection for HCC were included. Multivariable analysis showed that low LMR was an independent prognostic factor of OS (hazard ratio (HR) 1·59, 95 per cent c.i. 1·00 to 2·41; P = 0·045) and RFS (HR 1·47, 1·05 to 2·04; P = 0·022) after resection. Low preoperative LMR values were correlated with higher α-fetoprotein values ( P < 0·001), larger tumour size ( P < 0·001), and high rates of poor differentiation ( P = 0·035) and liver cirrhosis ( P = 0·008). LMR was significantly lower in PD-L1-positive patients than in those with PD-L1 negativity ( P < 0·001). Results were confirmed in the validation cohort. PD-L1 expression was upregulated in HCC cell lines treated with interferon-γ and co-cultured with THP-1 monocyte cells., Conclusion: LMR is an independent predictor of survival after hepatic resection in patients with HCC. Modulation of the immune checkpoint pathway in the tumour microenvironment is associated with a low LMR. more...
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- 2019
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33. Liver resection and transplantation in Caroli disease and syndrome.
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Fahrner R, Dennler SGC, Dondorf F, Ardelt M, Rauchfuss F, and Settmacher U
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- Bile Duct Neoplasms surgery, Cholangiocarcinoma surgery, Female, Follow-Up Studies, Humans, Liver Cirrhosis surgery, Male, Middle Aged, Retrospective Studies, Symptom Assessment, Syndrome, Time Factors, Treatment Outcome, Caroli Disease surgery, Hepatectomy methods, Hepatectomy statistics & numerical data, Liver Transplantation statistics & numerical data
- Abstract
Introduction: Caroli disease (CD) is a congenital dilatation of the intrahepatic bile ducts. In combination with liver fibrosis or cirrhosis, it is called Caroli syndrome (CS). Infectious complications and intrahepatic cholangiocarcinoma are secondary problems. The aim of this study was to analyse the clinical pattern and outcome in patients with CD/CS who underwent liver surgery., Methods: Between January 2004 and December 2016, 21 patients with CD/CS were treated with liver resection or transplantation (LTX) and post-operative data of patients with CD/CS were retrospectively analysed in a database., Results: Two patients underwent LTX, and 19 patients underwent liver resection due to CD/CS. During follow-up, one patient developed lung cancer nine years after LTX. Patients resected due to CD/CS were predominantly females (74%) with an overall low incidence of co-morbidities. The median post-operative Clavien-Dindo score was 1 (range: 0-3). There was no death during a median follow-up period of over five years. In four patients, cholangiocarcinoma was confirmed. Tumor recurrence was seen in three patients, and was treated with chemotherapy or repeated liver resection., Conclusions: LTX and liver resections due to CD/CS are rare and associated with an acceptable post-operative morbidity and low mortality. Surgical treatment should be performed as early as possible to avoid recurrent episodes of cholangitis or carcinogenesis., (Copyright © 2018 Elsevier Masson SAS. All rights reserved.) more...
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- 2019
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34. Propensity-matched analysis of the influence of perioperative statin therapy on outcomes after liver resection.
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Dasari BVM, Pathanki A, Hodson J, Roberts KJ, Marudanayagam R, Mirza DF, Isaac J, Sutcliffe RP, and Muiesan P
- Subjects
- Aged, Female, Humans, Liver Failure epidemiology, Male, Middle Aged, Perioperative Care, Propensity Score, Retrospective Studies, Treatment Outcome, Hepatectomy adverse effects, Hepatectomy mortality, Hepatectomy statistics & numerical data, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Postoperative Complications epidemiology
- Abstract
Background: Perioperative use of statins is reported to improve postoperative outcomes after cardiac and non-cardiovascular surgery. The aim of this study was to investigate the influence of statins on postoperative outcomes including complications of grade IIIa and above, posthepatectomy liver failure (PHLF), and 90-day mortality rates after liver resection., Methods: Patients who underwent hepatectomy between 2013 and 2017 were reviewed to identify statin users and non-users (controls). Propensity matching was conducted for age, BMI, type of surgery and preoperative co-morbidities to compare subgroups. Univariable and multivariable analyses were performed for the following outcomes: 90-day mortality, significant postoperative complications and PHLF., Results: Of 890 patients who had liver resection during the study period, 162 (18·2 per cent) were taking perioperative statins. Propensity analysis selected two matched groups, each comprising 154 patients. Overall, 81 patients (9·1 per cent) developed complications of grade IIIa or above, and the 90-day mortality rate was 3·4 per cent (30 patients), with no statistically significant difference when the groups were compared before and after matching. The rate of PHLF was significantly lower in patients on perioperative statins than in those not taking statins (10·5 versus 17·3 per cent respectively; P = 0·033); similar results were found after propensity matching (10·4 versus 20·8 per cent respectively; P = 0·026)., Conclusion: The rate of PHLF was significantly lower in patients taking perioperative statins, but there was no statistically significant difference in severe complications and mortality rates. more...
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- 2019
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35. Combined hepatocellular-cholangiocarcinoma: a population level analysis of incidence and mortality trends.
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Wang J, Li E, Yang H, Wu J, Lu HC, Yi C, Lei J, Liao W, and Wu L
- Subjects
- Aged, Bile Duct Neoplasms pathology, Carcinoma, Hepatocellular pathology, Cholangiocarcinoma pathology, Female, Hepatectomy statistics & numerical data, Humans, Incidence, Liver pathology, Liver Neoplasms pathology, Male, Middle Aged, Prognosis, Survival Analysis, United States epidemiology, Bile Duct Neoplasms epidemiology, Carcinoma, Hepatocellular epidemiology, Cholangiocarcinoma epidemiology, Liver Neoplasms epidemiology, Mortality trends, SEER Program statistics & numerical data
- Abstract
Background: The purpose of this study was to explore trends in incidence, incidence-based (IB) mortality, and survival for combined hepatocellular-cholangiocarcinoma (cHCC-CC) utilizing a population-based database to attract people's attention to this disease., Methods: The Surveillance, Epidemiology, and End Results (SEER) database was utilized to investigate the incidence and IB mortality for cHCC-CC from 2000 to 2014. Trends in age-adjusted incidence and IB mortality were characterized by the Joinpoint Regression program. The Kaplan-Meier method and log-rank test were utilized to implement survival analyses. Cox regression was utilized to estimate independent predictors of mortality., Results: The incidence of cHCC-CC was 0.26 per 1,000,000 individuals in 2000 and 0.59 per 1,000,000 individuals in 2014, with an annual percent change (APC) (i.e., the extent of increase in incidence) of 3.84% (95% confidence interval [CI] 1.7-6.1; P < 0.05). The IB mortality also displayed a sustained increase (APC was 4.59%, 95% CI 1.9-7.4; P < 0.05). Compared to patients not undergoing surgery, patients undergoing surgical treatment experienced a significant increase in median survival (3 vs. 28 months; P < 0.001). However, the median survival decreased in patients with tumor size > 5 cm (20 vs. 9 months; P < 0.001). Based on univariate Cox regression analysis, African-American race, distant stage, regionalized stage, tumor size ≥ 5 cm, and no surgery were risk factors for death., Conclusions: We identified an overall steady increase in the incidence of cHCC-CC, which indicates that primary prevention strategies for cHCC-CC have not improved much in recent years and that cHCC-CC needs to be taken seriously. more...
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- 2019
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36. Contemporary practice and short-term outcomes after liver resections in a complete national cohort.
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Lassen K, Nymo LS, Olsen F, Brudvik KW, Fretland ÅA, and Søreide K
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- Aged, Cohort Studies, Female, Hepatectomy statistics & numerical data, Humans, Laparoscopy adverse effects, Laparoscopy statistics & numerical data, Length of Stay, Liver Neoplasms mortality, Liver Neoplasms pathology, Male, Middle Aged, Norway epidemiology, Reoperation, Survival Rate, Treatment Outcome, Hepatectomy adverse effects, Liver Neoplasms surgery, Postoperative Complications epidemiology
- Abstract
Background: Improved outcome after liver resections have been reported in several series, but outcomes from national cohorts are scarce. Our aim was to evaluate nationwide practice and short-term outcomes after liver surgery in a universal healthcare system., Methods: A complete 5-year cohort of all liver resections from the Norwegian Patient Registry (NPR). Short-term outcomes were aggregated length of stay (a-LoS), reoperation and 90-day mortality., Results: Of 2118 liver resections, 605 (28.6%) were major, median age was 65 years and 1184 (55%) were male. Most common indication was metastatic disease (n = 1554; 73.4%) and primary malignancy (n = 328; 15.3%). Laparoscopy was performed in 513 (33.9%) of minor and 37 (6.1%) of major liver resections and increased over time to 39.1% of minor resections in 2016. Median a-LoS was 12 days for major resections, 8 days for open minor and 3 days for laparoscopic minor resections. Reoperation was reported for 159 (7.4%) and 90-day mortality for 44 (2.1%). Primary malignancy, male gender, elderly patients and major resections were associated with poorer outcome., Conclusions: In a national cohort, laparoscopy is used for a substantial proportion of minor resections and was associated with reduced a-LoS. Risk factors for reoperation and mortality were male gender, increased age and major resection for primary malignancy. more...
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- 2019
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37. Comparative efficacy of treatment strategies for hepatocellular carcinoma: systematic review and network meta-analysis.
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Tian G, Yang S, Yuan J, Threapleton D, Zhao Q, Chen F, Cao H, Jiang T, and Li L
- Subjects
- Humans, Combined Modality Therapy, Disease-Free Survival, Neoplasm Staging, Treatment Outcome, Network Meta-Analysis, Carcinoma, Hepatocellular therapy, Catheter Ablation statistics & numerical data, Chemoembolization, Therapeutic statistics & numerical data, Ethanol therapeutic use, Hepatectomy statistics & numerical data, Liver Neoplasms therapy
- Abstract
Objective: Hepatocellular carcinoma (HCC) is the third leading cause of cancer death worldwide. We conducted network meta-regression within a Bayesian framework to compare and rank different treatment strategies for HCC through direct and indirect evidence from international studies., Methods and Analyses: We pooled the OR for 1-year, 3-year and 5-year overall survival, based on lesions of size ˂ 3 cm, 3-5 cm and ≤5 cm, using five therapeutic options including resection (RES), radiofrequency ablation (RFA), microwave ablation (MWA), transcatheter arterial chemoembolisation (TACE) plus RFA (TR) and percutaneous ethanol injection (PEI)., Results: We identified 74 studies, including 26 944 patients. After adjustment for study design, and in the full sample of studies, the treatments were ranked in order of greatest to least benefit as follows for 5 year survival: (1) RES, (2) TR, (3) RFA, (4) MWA and (5) PEI. The ranks were similar for 1- and 3-year survival, with RES and TR being the highest ranking treatments. In both smaller (<3 cm) and larger tumours (3-5 cm), RES and TR were also the two highest ranking treatments. There was little evidence of inconsistency between direct and indirect evidence., Conclusion: The comparison of different treatment strategies for HCC indicated that RES is associated with longer survival. However, many of the between-treatment comparisons were not statistically significant and, for now, selection of strategies for treatment will depend on patient and disease characteristics. Additionally, much of the evidence was provided by non-randomised studies and knowledge gaps still exist. More head-to-head comparisons between both RES and TR, or other approaches, will be necessary to confirm these findings., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2018. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.) more...
- Published
- 2018
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38. Assessment of the Surveillance Interval at 1 Year after Curative Treatment in Hepatocellular Carcinoma: Risk Stratification.
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Lee M, Chang Y, Oh S, Cho YY, Jung DE, Kim HH, Nam JY, Cho H, Cho EJ, Lee JH, Yu SJ, Yi NJ, Lee KW, Lee DH, Lee JM, Yoon JH, Suh KS, and Kim YJ
- Subjects
- Aged, Carcinoma, Hepatocellular diagnosis, Female, Hepatectomy statistics & numerical data, Humans, Liver Neoplasms diagnosis, Male, Middle Aged, Propensity Score, Proportional Hazards Models, Radiofrequency Ablation statistics & numerical data, Retrospective Studies, Risk Assessment methods, Carcinoma, Hepatocellular surgery, Liver Neoplasms surgery, Neoplasm Recurrence, Local diagnosis, Population Surveillance methods, Time Factors
- Abstract
Background/aims: Guidelines recommend surveillance for hepatocellular carcinoma (HCC) recurrence at 3-month intervals during the first year after curative treatment and 6-month intervals thereafter in all patients. This strategy does not reflect individual risk of recurrence. We aimed to stratify risk of recurrence to optimize surveillance intervals 1 year after treatment., Methods: We retrospectively analyzed 1,316 HCC patients treated with resection/radiofrequency ablation at Barcelona Clinic Liver Cancer stage 0/A. In patients without 1-year recurrence under 3-monthly surveillance, a new model for recurrence was developed using backward elimination methods: training (n=582)/validation cohorts (n=291). Overall survival (OS) according to risk stratified by the new model was compared according to surveillance intervals: 3-monthly versus 6-monthly (n=401) after lead time bias correction and propensity-score matching analyses., Results: Among patients without 1-year recurrence, age and international normalized ratio values were significant factors for recurrence (hazard ratio [HR], 1.03; 95% confidence interval [CI], 1.00 to 1.03; p=0.009 and HR, 5.63; 95% CI, 2.24 to 14.18; p<0.001; respectively). High-risk patients stratified by the new model showed significantly higher recurrence rates than low-risk patients in the validation cohort (HR, 1.73; 95% CI, 1.18 to 2.53; p=0.005). After propensity-score matching between the 3-monthly and 6-monthly surveillance groups, OS in high-risk patients under 3-monthly surveillance was significantly higher than that under 6-monthly surveillance (p=0.04); however, OS in low-risk patients under 3-monthly surveillance was not significantly different from that under 6-monthly surveillance (p=0.17)., Conclusions: In high-risk patients, 3-monthly surveillance can prolong survival compared to 6-monthly surveillance. However, in low-risk patients, 3-monthly surveillance might not be beneficial for survival compared to 6-monthly surveillance. more...
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- 2018
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39. Primary hepatic neuroendocrine neoplasm: Long-time surgical outcome and prognosis.
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Shi C, Zhao Q, Dai B, Xie F, and Yang J
- Subjects
- Adult, Aged, Aged, 80 and over, Antigens, Tumor-Associated, Carbohydrate blood, Female, Humans, Liver Neoplasms mortality, Liver Neoplasms pathology, Male, Middle Aged, Neoplasm Grading, Neoplasm Recurrence, Local, Neuroendocrine Tumors mortality, Neuroendocrine Tumors pathology, Operative Time, Prognosis, Retrospective Studies, Risk Factors, Survival Rate, Hepatectomy methods, Hepatectomy statistics & numerical data, Liver Neoplasms surgery, Neuroendocrine Tumors surgery
- Abstract
Primary hepatic neuroendocrine neoplasms (PHNENs) represent a kind of rare liver tumor and its clinical features and prognosis remain unclear. This study aims to reveal the long-term therapeutic outcome of PHNEN and to present its prognostic feature.A retrospective designed, single-center study containing 22 patients with PHNENs receiving surgical resections was done. Clinical data were reviewed and long-term follow-up was updated. Survival analysis was tried to find the prognostic factors.Nine patients recurred (recurrence rate = 40.9%) and 6 patients died on the disease. The actual 1-, 3-, and 5-year recurrence-free survival rate were 86.4%, 63.6%, and 52.9%, respectively. The 1-, 3-, and 5-year overall survival rate were 95.5%, 81.8%, and 64.7%, respectively. Median overall survival for group G1, G2, and G3 were 69, 67, and 42 months, respectively.Patients with PHNEN can have a long survival after radical surgical resection, especially when the tumor proliferative grade exhibits lower (G1/2). more...
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- 2018
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40. LIVER RESECTION IN BRAZIL: A NATIONAL SURVEY.
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Fonseca GM, Jeismann VB, Kruger JAP, Coelho FF, Montagnini AL, and Herman P
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- Brazil, Health Care Surveys, Hepatectomy methods, Humans, Surveys and Questionnaires, Hepatectomy statistics & numerical data
- Abstract
Background: Liver surgery has developed significantly in the past decades. In Brazil, the interest on it has grown significantly, but there is no study regarding its clinical practice. Despite intrinsic limitations, surveys are well suited to descriptive studies and allow understanding the current scenario., Aim: To provide an overview on the current spread of liver surgery in Brazil, focusing on groups´ profile, operative techniques and availability of resources., Method: From May to November 2016, was conducted a national survey about liver surgery profile in Brazil composed by 28 questions concerning surgical team characteristics, technical preferences, surgical volume, results and available institutional resources. The survey was sent by e-mail to 84 liver surgery team leaders from different centers including all regions of the country., Results: Forty-three study participants (51.2%), from all Brazilian regions, responded the survey. Most centers have residency/fellowship programs (86%), perform and do laparoscopic procedures (91%); however, laparoscopy is still responsible for a little amount of surgeries (1-9% of laparoscopic procedures over all liver resections in 39.5% of groups). Only seven centers (16.3%) perform more than 50 liver resections/year. Postoperative mortality rate is between 1-3% in 55% of the centers., Conclusion: This is the first depiction of liver surgery in Brazil. It showed a surgical practice aligned with worldwide excellence centers, concentrated on hospitals dedicated to academic practice. more...
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- 2018
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41. Utility of Routine Gall Bladder Histopathology after Living Donor Hepatectomy in Liver Transplantation.
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Bhatti ABH, Haq IU, Ahmed IN, Bilal R, and Dar FS
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- Adolescent, Adult, Female, Hepatectomy statistics & numerical data, Humans, Male, Middle Aged, Tomography, X-Ray Computed, Gallbladder pathology, Hepatectomy methods, Liver pathology, Liver Transplantation methods, Living Donors, Tissue and Organ Harvesting methods
- Abstract
Intraoperative cholangiogram with cholecystectomy is a routinely performed procedure in living donor liver transplantation (LDLT).The objective of this study was to determine the frequency of gall bladder pathology in healthy living donors and whether routine histopathology can be omitted. This was a retrospective review of 366 donors who underwent donor hepatectomy between 2012 and 2016. Primary outcome of interest was frequency of abnormal histopathology findings in removed gall bladder specimen; and if their distribution was different with respect to gender, age and BMI. Male to female ratio was 2.1:1. Median age was 26 (18-50) years. Median BMI was 23.9 (15.7-35) Kg/m2. The most common finding was chronic cholecystitis in 189 (51.6%). Gall bladder pathology was more frequently seen in donors with BMI >25 Kg/m2, i.e. 69.3 % versus 30.7% (p<0.001). Due to high frequency of abnormal findings, gall bladder should be sent routinely for histopathology in healthy liver donors after cholecystectomy. more...
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- 2018
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42. Major hepatectomies in liver cystic echinococcosis: A bi-centric experience. Retrospective cohort study.
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Ramia JM, Serrablo A, Serradilla M, Lopez-Marcano A, de la Plaza R, and Palomares A
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- Adult, Aged, Animals, Cysts parasitology, Cysts pathology, Echinococcosis, Hepatic complications, Echinococcosis, Hepatic pathology, Feasibility Studies, Female, Humans, Length of Stay, Male, Middle Aged, Morbidity, Retrospective Studies, Treatment Outcome, Cysts surgery, Echinococcosis, Hepatic surgery, Hepatectomy statistics & numerical data
- Abstract
Surgical treatment of liver cystic echinococcosis (LCE) could be conservative or radical. Radical surgery includes liver resection, but usually are minor hepatectomy in favourable segments. Experience in major hepatectomy (MH) for LCE is limited., Methods: Retrospective study., Period: January 2007-December 2014., Inclusion Criteria: liver infestation with Echinococcus granulosus causing active or complicated cysts. Epidemiological, clinical, radiological and surgical data were studied., Results: 145 patients underwent surgery for LCE. MH was performed in 49 patients (34%) with 81 cysts. 51% of patients were women. Mean age: 56 years. Sixteen patients (32.7%) had recurrent disease. The mean diameter cyst was 9.9 cm. The MH performed were right hepatectomy (n = 15), left hepatectomy (6) and others (n = 28). The reason for MH was occupation of the entire lobe (14), severe vascular or biliary involvement (17), or a combination of the two (18). Major morbidity (Clavien III-V) was 26%. Mortality was 2%. Mean hospital stay: 15.3 days. At follow-up (mean: 31 months) the rate of liver recurrence after MH was 0%., Conclusions: MH is feasible in LCE, with a major morbidity rate of (26%), and zero recurrence. Indications of MH are occupation of an entire lobe, extreme biliary or vascular involvement or recurrent cysts., (Copyright © 2018. Published by Elsevier Ltd.) more...
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- 2018
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43. 42,573 cases of hepatectomy in China: a multicenter retrospective investigation.
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Zhang B, Zhang B, Zhang Z, Huang Z, Chen Y, Chen M, Bie P, Peng B, Wu L, Wang Z, Li B, Fan J, Qin L, Chen P, Liu J, Tang Z, Niu J, Yin X, Li D, He S, Jiang B, Mao Y, Zhou W, and Chen X
- Subjects
- Adult, Aged, Carcinoma, Hepatocellular pathology, Carcinoma, Hepatocellular physiopathology, China epidemiology, Female, Hepatectomy adverse effects, Hepatitis, Viral, Human complications, Humans, Liver Neoplasms pathology, Liver Neoplasms physiopathology, Male, Middle Aged, Postoperative Complications diagnosis, Postoperative Complications mortality, Prognosis, Retrospective Studies, Risk Factors, Survival Analysis, alpha-Fetoproteins analysis, Carcinoma, Hepatocellular epidemiology, Carcinoma, Hepatocellular surgery, Hepatectomy statistics & numerical data, Liver Neoplasms epidemiology, Liver Neoplasms surgery
- Abstract
Hepatectomy is currently routinely performed in most hospitals in China. China owns the largest population of liver diseases and the biggest number of liver resection cases. A nationwide multicenter retrospective investigation involving 112 hospitals was performed, and focused on liver resection for patients with hepatocellular carcinoma (HCC). 42,573 cases of hepatectomy were enrolled, and 18,275 valid cases of liver resection for HCC patients were selected for statistical analysis. The epidemiology of HCC, distribution of hepatectomy, postoperative complications and prognosis were finally analyzed. In the 18,275 HCC patients, 81% had hepatitis B virus infection and 10% had hepatitis C virus infection. 38% of the HCC patients had normal Alphafetoprotein (AFP) level, and other 35% had an AFP level lower than 400 ng mL
-1 . In the study period, 97% of the hepatectomy for HCC were treated with open surgery, and 23.81% had vascular exclusion techniques. The operation time was (191.7±105.6) min, the blood loss was (546.0±562.8) mL, and blood transfusion was (543.0±1,035.2) mL. The median survival for HCC patients was 631 days, with 1-, 3-, and 5-year overall survival of 73.2%, 28.8% and 19.6%, respectively. Liver cirrhosis, multiple nodules, tumor thrombosis and high AFP level were risk factors that affect postoperative survival. more...- Published
- 2018
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44. Intraoperative cell salvage with autologous transfusion in elective right or repeat hepatectomy: a propensity-score-matched case-control analysis.
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Zacharias T, Ahlschwede E, Dufour N, Romain F, and Theissen-Laval O
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- Aged, Aged, 80 and over, Case-Control Studies, Elective Surgical Procedures statistics & numerical data, Female, Hepatectomy methods, Humans, Male, Middle Aged, Operative Blood Salvage instrumentation, Propensity Score, Retrospective Studies, Blood Loss, Surgical statistics & numerical data, Blood Transfusion, Autologous statistics & numerical data, Erythrocyte Transfusion statistics & numerical data, Hepatectomy statistics & numerical data, Liver Diseases surgery, Operative Blood Salvage statistics & numerical data, Outcome Assessment, Health Care statistics & numerical data
- Abstract
Background: Liver resection may be associated with substantial blood loss, and cell saver use has been recommended for patients at high risk. We performed a study to compare the allogenic erythrocyte transfusion rate after liver resection between patients who had intraoperative cell salvage with a cell saver device versus patients who did not. Our hypothesis was that cell salvage with autologous transfusion would reduce the allogenic blood transfusion rate., Methods: Cell salvage was used selectively in patients at high risk for intraoperative blood loss based on preoperatively known predictors: right and repeat hepatectomy. Patients who underwent elective right or repeat hepatectomy between Nov. 9, 2007, and Jan. 27, 2016 were considered for the study. Data were retrieved from a liver resection database and were analyzed retrospectively. Patients with cell saver use (since January 2013) constituted the experimental group, and those without cell salvage (2007-2012), the control group. To reduce selection bias, we matched propensity scores. The primary outcome was the allogenic blood transfusion rate within 90 days postoperatively. Secondary outcomes were the number of transfused erythrocyte units, and rates of overall and infectious complications., Results: Ninety-six patients were included in the study, 41 in the cell saver group and 55 in the control group. Of the 96, 64 (67%) could be matched, 32 in either group. The 2 groups were balanced for demographic and clinical variables. The allogenic blood transfusion rate was 28% (95% confidence interval [CI] 12.5%-43.7%) in the cell saver group versus 72% (95% CI 56.3%-87.5%) in the control group ( p < 0.001). The overall and infectious complication rates were not significantly different between the 2 groups., Conclusion: Intraoperative cell salvage with autologous transfusion in elective right or repeat hepatectomy reduced the allogenic blood transfusion rate. more...
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- 2018
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45. Outcome of hepatic resection: First five-year experience in elderly and younger patients.
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Bulathsinhala BKS, Tillekaratne MSB, Gunatilleke MB, Niriella MA, Wijegunawardena DGA, and Siriwardana RC
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- Aged, Female, Humans, Male, Middle Aged, Sri Lanka, Treatment Outcome, Age Factors, Hepatectomy statistics & numerical data, Liver Diseases surgery
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- 2018
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46. Reappraisal of primary hepatic lymphoma: Is surgical resection underestimated?
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Cesaretti M, Loustau M, Robba C, Senescende L, and Zarzavadjian Le Bian A
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- Adolescent, Adult, Aged, Aged, 80 and over, Female, Humans, Liver Neoplasms pathology, Lymphoma, Large B-Cell, Diffuse pathology, Male, Middle Aged, Retrospective Studies, Survival Analysis, Treatment Outcome, Young Adult, Hepatectomy statistics & numerical data, Liver Neoplasms epidemiology, Liver Neoplasms surgery, Lymphoma, Large B-Cell, Diffuse epidemiology, Lymphoma, Large B-Cell, Diffuse surgery
- Abstract
Primary hepatic lymphoma (PHL) is defined as a lympho-proliferative disorder limited to the liver without any involvement of the spleen, lymph nodes, bone marrow or blood. Diffuse large B-cell lymphoma (DLBCL) is the most common histological type counting more than 60-80% of all PHL. Usually, it occurs in middle-aged men with aspecific symptoms and diagnosis is confirmed by histopathology. In order to expand current knowledge and to investigate an optimal therapeutic strategy, a systematic review of literature was conducted in February 2016. A total of 274 articles were retrieved, and after exclusion, 55 were retained, reporting 147 cases of PHL. Patients were mainly men (64.9%) with a median age at diagnosis of 57 years (range: 17-92) and right hepatic lobe involvement (69.6%). Among the 147 patients, 9% received no therapy while 77% underwent treatment including chemotherapy, surgery and radiotherapy in 64%, 26% and 1% of cases, respectively. Mean follow-up was 22.6 months (range: 0.2-360). Overall mortality was 29.2% with a 90-day mortality of 26%. Risk factors for increased mortality include; bilobar lesions (p = 0.001), right lobe localisation (p = 0.003) and non-surgical approach or the absence of any treatment (p = 0.001). A trend towards favourable outcomes for young patients (mean = 50.4 years) with a large liver lesion was achieved by surgical management of PHL but this did not achieve statistical significance. Statistical analysis indicates that in cases of resectable disease, an aggressive surgical approach in selected patients leads to increase long-term survival. Thus, two hypotheses should be assessed in further randomized studies: 1°) resectable PHL is a less severe form or 2°) hepatectomy is an effective treatment for PHL., (Copyright © 2018 Elsevier B.V. All rights reserved.) more...
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- 2018
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47. Salvage liver transplantation or repeat hepatectomy for recurrent hepatocellular carcinoma: An intent-to-treat analysis.
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Lim C, Shinkawa H, Hasegawa K, Bhangui P, Salloum C, Gomez Gavara C, Lahat E, Omichi K, Arita J, Sakamoto Y, Compagnon P, Feray C, Kokudo N, and Azoulay D
- Subjects
- Aged, Carcinoma, Hepatocellular complications, Disease-Free Survival, Female, Follow-Up Studies, Hepatectomy methods, Hepatectomy statistics & numerical data, Humans, Intention to Treat Analysis, Liver Cirrhosis complications, Liver Neoplasms complications, Liver Neoplasms mortality, Liver Neoplasms pathology, Liver Transplantation methods, Male, Middle Aged, Neoplasm Recurrence, Local mortality, Neoplasm Recurrence, Local pathology, Reoperation statistics & numerical data, Retrospective Studies, Salvage Therapy methods, Survival Rate, Treatment Outcome, Carcinoma, Hepatocellular surgery, Liver Cirrhosis surgery, Liver Neoplasms surgery, Liver Transplantation statistics & numerical data, Neoplasm Recurrence, Local surgery, Salvage Therapy statistics & numerical data
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The salvage liver transplantation (LT) strategy was conceived for initially resectable and transplantable hepatocellular carcinoma (HCC) to obviate upfront transplantation, with salvage LT in the case of recurrence. The longterm outcomes of a second resection for recurrent HCC have improved. The aim of this study was to perform an intention-to-treat analysis of overall survival (OS) comparing these 2 strategies for initially resectable and transplantable recurrent HCC. From 1994 to 2011, 391 patients with HCC who underwent salvage LT (n = 77) or a second resection (n = 314) were analyzed. Of 77 patients in the salvage LT group, 21 presented with resectable and transplantable recurrent HCC and 18 underwent transplantation. Of 314 patients in the second resection group, 81 presented with resectable and transplantable recurrent HCC and 81 underwent a second resection. The 5-year intention-to-treat OS rates, calculated from the time of primary hepatectomy, were comparable between the 2 strategies (72% for salvage transplantation versus 77% for second resection; P = 0.57). In patients who completed the salvage LT or second resection procedure, the 5-year OS rates, calculated from the time of the second surgery, were comparable between the 2 strategies (71% versus 71%; P = 0.99). The 5-year disease-free survival (DFS) rates were 72% following transplantation and 18% following the second resection (P < 0.001). Similar results were observed after propensity score matching. In conclusion, although the 5-year OS rates were similar in the salvage LT and second resection groups, the salvage LT strategy still achieves better DFS. Second resection for recurrent HCC might be considered to be the best alternative option to LT in the current organ shortage. Liver Transplantation 23 1553-1563 2017 AASLD., (© 2017 by the American Association for the Study of Liver Diseases.) more...
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- 2017
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48. Anatomic isolated caudate lobectomy: Is it possible to establish a standard surgical flow?
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Jin Y, Wang L, Yu YQ, Zhou DE, Liu DR, Yang JJ, Peng SY, and Li JT
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- Adult, Aged, Blood Loss, Surgical statistics & numerical data, Carcinoma, Hepatocellular diagnostic imaging, Carcinoma, Hepatocellular mortality, Carcinoma, Hepatocellular pathology, Female, Hepatectomy adverse effects, Hepatectomy standards, Hepatectomy statistics & numerical data, Humans, Length of Stay statistics & numerical data, Liver diagnostic imaging, Liver pathology, Liver surgery, Liver Neoplasms diagnostic imaging, Liver Neoplasms mortality, Liver Neoplasms pathology, Magnetic Resonance Imaging, Male, Middle Aged, Operative Time, Postoperative Complications etiology, Survival Rate, Treatment Outcome, Carcinoma, Hepatocellular surgery, Hepatectomy methods, Liver Neoplasms surgery, Postoperative Complications epidemiology
- Abstract
Aim: To establish the surgical flow for anatomic isolated caudate lobe resection., Methods: The study was approved by the ethics committee of the Second Affiliated Hospital Zhejiang University School of Medicine (SAHZU). From April 2004 to July 2014, 20 patients were enrolled who underwent anatomic isolated caudate lobectomy at SAHZU. Clinical and postoperative pathological data were analyzed., Results: Of the total 20 cases, 4 received isolated complete caudate lobectomy (20%) and 16 received isolated partial caudate lobectomy (80%). There were 4 cases with the left approach (4/20, 20%), 6 cases with the right approach (6/20, 30%), 7 cases with the bilateral combined approach (7/20, 35%), 3 cases with the anterior approach (3/20, 15%), and the hanging maneuver was also combined in 2 cases. The median tumor size was 5.5 cm (2-12 cm). The median intra-operative blood loss was 600 mL (200-5700 mL). The median intra-operative blood transfusion volume was 250 mL (0-2400 mL). The median operation time was 255 min (110-510 min). The median post-operative hospital stay was 14 d (7-30 d). The 1- and 3-year survival rates for malignant tumor were 88.9% and 49.4%, respectively., Conclusion: Caudate lobectomy was a challenging procedure. It was demonstrated that anatomic isolated caudate lobectomy can be done safely and effectively., Competing Interests: Conflict-of-interest statement: We declare that we have no conflict of interest related to this work. more...
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- 2017
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49. Pre-S deletions of hepatitis B virus predict recurrence of hepatocellular carcinoma after curative resection.
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Li-Shuai Q, Yu-Yan C, Hai-Feng Z, Jin-Xia L, and Cui-Hua L
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- Adult, Aged, China epidemiology, Cohort Studies, DNA, Viral isolation & purification, Female, Humans, Male, Middle Aged, Prognosis, Retrospective Studies, Sequence Deletion genetics, Statistics as Topic, Survival Analysis, Carcinoma, Hepatocellular complications, Carcinoma, Hepatocellular pathology, Carcinoma, Hepatocellular physiopathology, Carcinoma, Hepatocellular surgery, Hepatectomy methods, Hepatectomy statistics & numerical data, Hepatitis B complications, Hepatitis B diagnosis, Hepatitis B virology, Hepatitis B virus genetics, Hepatitis B virus pathogenicity, Liver Neoplasms complications, Liver Neoplasms pathology, Liver Neoplasms physiopathology, Liver Neoplasms surgery, Neoplasm Recurrence, Local mortality, Neoplasm Recurrence, Local virology
- Abstract
The relationship between hepatitis B virus (HBV) and the prognosis of hepatocellular carcinoma (HCC) after surgery remains uncertain. A retrospective cohort study was performed to evaluate the impact of pre-S deletions, T1762/A1764, and A1896 mutations on prognosis of HCC after curative resection. A total of 113 patients with positive serum HBV DNA (>200 IU/mL) who had underwent curative resection of pathologically proven HCC were recruited to determine the risk factors affecting the prognosis.The median follow-up time was 36.5 months and recurrence was detected in 67 patients (59.3%). The cumulative recurrence rates and overall survival rates at 1-, 3-, and 5-year after curative resection were 18.0%, 49.7%, 70.3%, and 93.7%, 61.0%, 42.5%, respectively. Patients with pre-S deletions showed significantly higher recurrence rates compared with those with wild type infection (HR: 1.822, P = .018), but not related with a significantly poor survival (HR: 1.388, P = .235). Subgroup analysis indicated that the patients with type III deletion had significant higher tumor recurrence rates than other deletion types (HR: 2.211, 95% confidence intervals [CI]: 1.008-4.846, P = .048). Multivariate analysis revealed that pre-S deletion, tumor size >3 cm in diameter, and the presence of microvascular invasion were independent risk factors for tumor recurrence. HBV pre-S deletions were found to be clustered primarily in the 5' end of pre-S2 region and were more often found between amino acids 120 and 142 of the pre-S2 domain. The domains most frequently potentially involved were the transactivator domain in pre-S2 and polymerized human serum albumin binding site.Our cohort showed that pre-S deletions at the time of resection could predict tumor recurrence in HCC patients after curative resection. more...
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- 2017
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50. The Impact of a Hepatobiliary Multidisciplinary Team Assessment in Patients with Colorectal Cancer Liver Metastases: A Population-Based Study.
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Engstrand J, Kartalis N, Strömberg C, Broberg M, Stillström A, Lekberg T, Jonas E, Freedman J, and Nilsson H
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- Adult, Aged, Aged, 80 and over, Colorectal Neoplasms diagnosis, Colorectal Neoplasms mortality, Colorectal Neoplasms pathology, Female, Follow-Up Studies, Hepatectomy standards, Humans, Liver pathology, Liver surgery, Liver Neoplasms diagnosis, Liver Neoplasms mortality, Liver Neoplasms secondary, Male, Middle Aged, Odds Ratio, Patient Care Team standards, Practice Guidelines as Topic, Referral and Consultation standards, Retrospective Studies, Colorectal Neoplasms surgery, Hepatectomy statistics & numerical data, Liver Neoplasms surgery, Patient Care Team statistics & numerical data, Referral and Consultation statistics & numerical data
- Abstract
Background: Assessing patients with colorectal cancer liver metastases (CRCLM) by a liver multidisciplinary team (MDT) results in higher resection rates and improved survival. The aim of this study was to evaluate the potentially improved resection rate in a defined cohort if all patients with CRCLM were evaluated by a liver MDT., Patients and Methods: A retrospective analysis of patients diagnosed with colorectal cancer during 2008 in the greater Stockholm region was conducted. All patients with liver metastases (LM), detected during 5-year follow-up, were re-evaluated at a fictive liver MDT in which previous imaging studies, tumor characteristics, medical history, and patients' own treatment preferences were presented. Treatment decisions for each patient were compared to the original management. Odds ratios (ORs) and 95% confidence intervals were estimated for factors associated with referral to the liver MDT., Results: Of 272 patients diagnosed with LM, 102 patients were discussed at an original liver MDT and 69 patients were eventually resected. At the fictive liver MDT, a further 22 patients were considered as resectable/potentially resectable, none previously assessed by a hepatobiliary surgeon. Factors influencing referral to liver MDT were age (OR 3.12, 1.72-5.65), American Society of Anaesthesiologists (ASA) score (OR 0.34, 0.18-0.63; ASA 2 vs. ASA 3), and number of LM (OR 0.10, 0.04-0.22; 1-5 LM vs. >10 LM), while gender ( p = .194) and treatment at a teaching hospital ( p = .838) were not., Conclusion: A meaningful number of patients with liver metastases are not managed according to best available evidence and the potential for higher resection rates is substantial., Implications for Practice: Patients with liver metastatic colorectal cancer who are assessed at a hepatobiliary multidisciplinary meeting achieve higher resection rates and improved survival. Unfortunately, patients who may benefit from resection are not always properly referred. In this study, the potential improved resection rate was assessed by re-evaluating all patients with liver metastases from a population-based cohort, including patients with extrahepatic metastases and accounting for comorbidity and patients' own preferences towards treatment. An additional 12.9% of the patients were found to be potentially resectable. The results highlight the importance of all patients being evaluated in the setting of a hepatobiliary multidisciplinary meeting., Competing Interests: Disclosures of potential conflicts of interest may be found at the end of this article., (© AlphaMed Press 2017.) more...
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- 2017
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