Different prognostic factors are associated with early and late intrahepatic recurrence following curative hepatectomy for patients with hepatocellular carcinoma / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate prognostic factors related to early and late intrahepatic recurrences after curative hepatectomy for patients with hepatocellular carcinoma (HCC).</p><p><b>METHODS</b>A retrospective review was conducted on medical records of patients with HCC treated by curative hepatectomy from January 2002 to January 2009. Clinicopathologic data were evaluated for their possible association with postoperative intrahepatic recurrence in univariate and multivariate analysis using Cox proportional hazard model. Recurrence time calculated by Kaplan-Meier method was compared using Log-rank test. Receiver operator characteristic curve (ROC) analysis with calculation of the area under the curve (AUC), sensitivity, and specificity where appropriated and risk stratification were applied to assess predictive ability of prognostic factors.</p><p><b>RESULTS</b>All 101 patients underwent curative hepatectomy. During follow-up period, 75 patients developed postoperative intrahepatic recurrence, among whom, 63 experienced early recurrence (84.0%) and the remaining had late recurrence (16.0%). The 1-, 2-, 3-and 5-year cumulative recurrent rates were 48.5% (49/101), 62.4% (63/101), 70.3% (71/101) and 74.3% (75/101), respectively. Multivariate analysis identified that tumor residual resectional margin, increased BCLC staging and severity of concomitant liver cirrhosis as independent prognostic factors predicting early recurrence while age ≥ 60 years and presence of tumor capsule predicting late recurrence. Cutoff point values (PI ≥ 2.798) predicted early recurrence with AUC 0.897 (95%CI = 0.829 - 0.965), sensitivity 76.6%and specificity 88.9% calculated from ROC. Median recurrent time of early recurrence and late recurrence reached statistically difference after risk stratification, 20.2 months vs. 4.4 months (χ(2) = 29.198, P = 0.000), 46.6 months vs. 28.6 months (Log-rank test, χ(2) = 8.479, P = 0.004), respectively.</p><p><b>CONCLUSIONS</b>Postoperative recurrence for HCC after curative hepatectomy should be differentiated as early recurrence and late recurrence, since each is associated with different risk factors, indicating possible different mechanism responsible for postoperative recurrence. Risk stratification can be used for prediction of different type of recurrence.</p>

Establishment of whole pancreaticoduodenal allotransplantation model with portal venous drainage and enteric drainage in pigs / 南方医科大学学报

<p><b>OBJECTIVE</b>To establish an porcine model of whole pancreaticoduodenal transplantation with portal venous drainage and enteric drainage for ensuring physiologically normal function without hyperinsulinemia and reducing postoperative complications.</p><p><b>METHODS</b>Twenty sichuan native outbreding white pigs weighing 25-30 kg were divided equally into two groups to serve as the donors and recipients. Cooling of the grafts was accomplished with in situ flush with 4 degrees C UW preservation solution via an aortic cannula. A whole pancreatoduodenal graft with the segment of abdominal aorta and the portal vein was harvested from the donor pigs. Type I diabetes model was established by complete removal of the recipient pancreas. The whole pancreatoduodenal graft was preserved and shaped in UW solution, and the subphrenic abdominal aorta of the recipient was joined with the donor abdominal aorta via a side-to-end anastomosis, and venous reflux was reconstructed between the donor portal vein and the recipient superior mesenteric vein. Side-to-side intestinal anastomosis was performed between the donor duodenum and the recipient jejunum.</p><p><b>RESULTS</b>Ten pancreaticoduodenal transplantations (PVE+ED style) were done, and pancreatic graft thrombosis and embolism occurred only in 1 pig 6 days after transplantation.</p><p><b>CONCLUSION</b>The model of whole pancreaticoduodenal transplantation with portal venous drainage and enteric drainage is stable and reliable.</p>