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1.
Chinese Journal of Geriatrics ; (12): 1327-1330, 2020.
Article in Chinese | WPRIM | ID: wpr-869565

ABSTRACT

Objective:To investigate the clinical efficacy of liver resection for colorectal liver metastases(CRLM)in elderly patients and to analyze factors influencing prognosis.Methods:Clinicopathological and follow-up data of 476 CRLM patients undergone liver resection at our department between January 2000 and August 2016 were retrospectively analyzed.Patients were divided into two groups according their ages: the elderly group(n=112, aged 65 years or older)and the young and middle-aged group(n=364, aged less than 65 years). The safety of the surgical treatment and long-term survival were compared between the two groups.Results:The overall postoperative complication rate was 30.3%.There was no significant difference in postoperative complication rates between the elderly group and the young and middle-aged group(32.1% vs. 29.7%, P=0.618). The mortality within 90 days after surgery was 0.9% in the elderly group and 0.5% in the young and middle-aged group( P=0.688). The 5-year survival rates after surgery were similar between the elderly group and the young and middle-aged group(42.4% vs.44.3%, P=0.672). Multivariate analysis revealed that clinical risk score(CRS)≥3 and RAS mutation were independent risk factors for prognosis. Conclusions:Liver resection is safe in carefully selected elderly CRLM patients and can achieve good long-term outcomes.The CRS and RAS genotype can help predict prognosis in elderly CRLM patients.

2.
Chinese Journal of Hepatobiliary Surgery ; (12): 508-513, 2020.
Article in Chinese | WPRIM | ID: wpr-868862

ABSTRACT

Objective:To study the impact of surgical treatment on long-term survival in patients with colorectal cancer liver metastases, and to identify the associated risk factors.Methods:The clinical, pathological, and follow-up data were prospectively collected from 781 consecutive patients who underwent hepatic resection for colorectal liver metastases at Hepatopancreatobiliary Surgery Department Ⅰ, Peking Cancer Hospital from Jan 2000 to Nov 2018. There were 497 males and 284 females. The average age was 56.7 years (range 19 to 83 years). The tumor recurrence and survival outcomes on follow-up were analyzed. Survival curves were plotted using the Kplan-Meier mothod. Parametric survival analysis was used to identify predictors of cancer-specific survival.Results:The 1-, 3-, 5- and 10-year overall survival rates were 91.6%, 57.3%, 45.2% and 27.6%, respectively. The median survival was 46 months. The 1-, 3-, 5- and 10-year disease-free survival rates were 45.3%, 26.0%, 22.9%, and 19.5%, respectively. The median disease-free survival was 11 months. On multivariate analysis, 5 risk factors were found to be independent predictors of poor survival: RAS/BRAF gene mutation ( HR=1.650, 95% CI: 1.302-2.089), right-sided colonic primary ( HR=1.361, 95% CI: 1.151-1.667), node-positive primary ( HR=1.660, 95% CI: 1.284-2.146), largest hepatic tumor ≥3 cm ( HR=1.473, 95% CI: 1.157-1.874), and extrahepatic disease ( HR=1.610, 95% CI: 1.294-2.003). Conclusion:Surgery is the key to long-term survival for patients with liver metastases from colorectal cancer. Right colonic primary, RAS/BRAF gene mutation, primary lymph node metastasis, hepatic metastasis with a maximum diameter ≥3 cm and extrahepatic metastasis were factors associated with poor prognosis.

3.
Chinese Journal of Hepatobiliary Surgery ; (12): 514-517, 2020.
Article in Chinese | WPRIM | ID: wpr-868852

ABSTRACT

Objective:To study the related factors of early recurrence and long-term survival after hepatectomy for patients with colorectal cancer liver metastases (CRLM) with a low-risk on clinical risk score (CRS).Methods:The clinicopathological data of 983 consecutive patients with CRLM who underwent liver resection at Department of Hepatopanereatobiliary Surgery Ⅰ, Peking University Cancer Hospital & Institute between January 2000 and November 2018 were studied retrospectively. A total of 420 patients with a CRS of 0-2 met the inclusion criteria of this study. There were 272 males and 148 females, aged from 21 to 83 years, with a median age 59 years. Univariate and multivariate logistic regression analyses were performed to identify the related factors associated with early recurrence. Survival curves were generated by the Kaplan-Meier method and compared by the log-rank test.Results:Of 420 patients, 272(64.8%) patients developed recurrence, with 163 patients developing early recurrence. Multivariate analysis revealed synchronous liver metastasis ( OR=1.587, 95% CI: 1.021-2.467), number of liver metastases ≥3( OR=1.904, 95% CI: 1.091-3.324) and RAS mutation ( OR=1.774, 95% CI: 1.157-2.270) were independent risk factors of early recurrence. The 5-year overall survival of patients with early recurrence was significantly lower than those with non-early recurrence (33.4% vs 71.1%, P<0.05). For the 163 patients with early recurrence, 41(25.2%) underwent repeat liver resection. When compared with the remaining 122(74.8%) patients who underwent non-resectional treatment, these 41 patients had a significantly higher 5-year overall survival rate (63.5% vs 21.1%, P<0.05). Conclusions:In patients with colorectal cancer liver metastases with a low risk on CRS, the independent risk factors for early recurrence were synchronous liver metastasis, number of liver metastases ≥3, and RAS mutation. Re-resection of early recurrent disease achieved better survival outcomes.

4.
Chinese Journal of General Surgery ; (12): 34-37, 2018.
Article in Chinese | WPRIM | ID: wpr-710491

ABSTRACT

Objective To analyze the effect of tumor number on the survival of patients with colorectal liver metastases (CRLM) undergoing hepatic resection and the definition of oligometastases.Methods Clinicopathological data of patients with colorectal liver-only metastases undergoing liver resection from our database were retrospectively analyzed.Results Of all 377 patients,the median number of hepatic tumor was 2.The 5-year disease free survival rate was 24.1%.The 5-year overall survival rate was 39.8%.Survival of oligometastatic patients was not significantly different from non-oligometastatic patients (x2 =3.037,P =0.081).Survival of patients with 6-10 hepatic tumors was similar to patients with 1-5 tumors.However,survival of patients with more than 10 tumors was significantly worse than patients with liver tumor less than 10(x2 =5.386,P =0.020).In multivariate analysis,number of liver tumor,primary node status,largest hepatic tumor and gender are independent predictors of overall survival.Conclusions The number of liver tumor was an independent predictor of overall survival.The cut-off number of oligometastatic disease should be 10.

5.
China Pharmacy ; (12): 1532-1534, 2017.
Article in Chinese | WPRIM | ID: wpr-513475

ABSTRACT

OBJECTIVE:To investigate the effects of trastuzumab combined with neoadjuvant chemotherapy on clinical effica-cy of breast cancer patients,serum angiogenic factors and apoptosis factors of breast tissue. METHODS:A total of 116 breast can-cer in patients were selected from our hospital during Jan. 2012-Dec. 2014 as research object,and then divided into control group and observation group according to random number table,with 58 cases in each group. Control group was given Carboplatin for in-jection 100 mg(added into 500 mL 5% Glucose injection after diluted into 10 mg/mL),ivgtt,200-400 mg/m2 on the first day of each chemotherapy cycle;Docetaxel injection ivgtt,75 mg/m2 on the first day of each chemotherapy cycle. On the basis of control group,observation group was additionally given Trastuzumab for injection,4 mg/kg in the first week,2 mg/kg in the 2nd-8th week,once a week,ivgtt. A treatment course lasted for 3 weeks,and both groups received 6 courses of treatment. Both groups re-ceived modified radical mastectomy 2 weeks after treatment. The levels of serum angiogenic factors and apoptosis factors of breast tissue were observed in 2 groups before and after treatment. Clinical efficacies and the occurrence of ADR were compared between 2 groups 1 year after treatment. RESULTS:Before treatment,there was no statistical significance in the levels of serum angiogenic factors and apoptosis factors of breast tissue between 2 groups (P>0.05). After treatment,the levels of serum angiogenic factors and apoptosis factors of breast tissue were decreased significantly in 2 groups,and the observation group was significantly lower than the control group,with statistical significance(P0.05). CONCLUSIONS:Trastuzumab combined with neoadjuvant chemotherapy is helpful to improve the therapeutic effect with breast cancer, prevent recnrence,and reduce the expression of serum angiogenic fac-tors and apoptosis factors of breast tissue with good safety.

6.
Chinese Journal of General Surgery ; (12): 565-568, 2016.
Article in Chinese | WPRIM | ID: wpr-497053

ABSTRACT

Objective To investigate survival for primary duodenal carcinoma patients after radical resection and identify risk factors associated with overall survival.Methods Data of 51 patients with primary duodenal carcinomas who underwent radical resection between December 2003 and December 2012 at Beijing Cancer Hospital were included.Survival analysis was drawn by Kaplan-Meier method,univariate and multivariate analyses were performed to identify variables associated with survival after resection by COX regression model.Results The median overall survival time was 67 months,and the median disease-free time was 40 months,1-,2-and 3-year overall survival rates were 88%,84% and 67%,respectively.Multivariate analysis revealed that regional lymph-node positive (P =0.032) and CA199 > 37 U/ml (P =0.037) were independent risk factors of patients' overall survival.Conclusions Radical resection improves survival for primary duodenal carcinoma patients.Regional lymph-node positive and CA199 >37 U/ml were the most important risk factors of patients'overall survival.

7.
Chinese Journal of Hepatobiliary Surgery ; (12): 231-235, 2016.
Article in Chinese | WPRIM | ID: wpr-488610

ABSTRACT

Objective To analyze the clinical data of patients with post-hepatectomy haemorrhage (PHH) and to discuss the treatment strategies.Method The clinicopathologic data of patients with PHH between 2005-2014 in the HPB Surgery Ward I,Peking University Cancer Hospital,were studied retrospectively.Results In the study period of 10 years,25 of 1 548 patients who underwent hepatectomy suffered from PHH,and 76% (19/25) of these patients had underlying liver diseases.The common surgical operations followed by PHH were right hemihepatectomy (11/25),and segment Ⅶ/Ⅷ resection (8/25).The median time for PHH to be diagnosed was 27 h,and the median time from diagnosis of postoperative bleeding to reoperation or intervention was 3.5 h.Using the classification of PHH by the International Study Group of Liver Surgery (ISGLS),there were 1 patient in grade A,16 patients in grade B,and 8 patients in grade C.The perioperative mortality of PHH was 8% (2/25).The most common bleeding site was from the hepatic artery.Conclusions PHH is a serious complication after liver resection,with low occurrence but high mortality.Most patients with PHH can be managed by conservative treatment.Emergency reoperation is required when instability in vital signs appears.Careful evaluation before operation,strict hemostasis during operation,and close monitoring after operation can effectively reduce the incidence and mortality of PHH.

8.
Chinese Journal of Gastrointestinal Surgery ; (12): 1098-1101, 2015.
Article in Chinese | WPRIM | ID: wpr-353767

ABSTRACT

<p><b>OBJECTIVE</b>To explore the role of repeat liver resection in colorectal liver metastasis (CRLM) with early recurrence and to analyze the risk factors of early recurrence.</p><p><b>METHODS</b>Clinicopathological and follow-up data of 303 CRLM patients undergoing liver resection in our department between January 2000 and August 2014 were analyzed retrospectively. The 5-year overall survivals between early recurrence(within postoperative 1 year) and non-early recurrence were compared. The impact of repeat liver resection on 5-year survival of early recurrence was analyzed. Clinicopathological features which might be associated with early recurrence were investigated using univariate and multivariate analyses.</p><p><b>RESULTS</b>Among 303 patients, 192(63.4%) patients had recurrence, including 145 patients of early recurrence and 47 of non-early recurrence. The 5-year overall survival of early recurrence patients was significantly lower compared with non-early recurrence ones(16.0% vs. 63.9%, P=0.000). Among 145 early recurrence patients, 80 were evaluated as resectable, of whom 22 received repeat liver resection. Compared with other 58 patients receiving conservative treatment, above 22 patients receiving repeat liver resection had a significantly higher 5-year overall survival(27.1% vs. 0%, P=0.033). Multivariate analysis revealed T-stage of primary tumor, lymph node metastasis, and larger size(> 5 cm) of metastatic liver focus were independent risk factors of early recurrence, and good efficacy of neo-adjuvant chemotherapy was independent protective factor of early recurrence(all P<0.05). Repeat liver resection was associated with better long-term survival.</p><p><b>CONCLUSIONS</b>The prognosis of early recurrence after liver resection in CRLM patients is poor, while repeat resection for resectable lesions in recurrence patients can obviously prolong the survival. For those with late T-stage, lymph node metastasis, and larger metastatic liver focus, actively preoperative neo-adjuvant chemotherapy should be considered.</p>

9.
Chinese Journal of Oncology ; (12): 913-916, 2015.
Article in Chinese | WPRIM | ID: wpr-304476

ABSTRACT

<p><b>OBJECTIVE</b>To validate the prognostic significance of Clinical Risk Score (CRS) system proposed by Fong et al. after hepatectomy of liver metastasis from colorectal cancer.</p><p><b>METHODS</b>The clinicopathological data were collected retrospectively from 294 patients with hepatic metastases from colorectal cancer who received liver resection between January 2000 and August 2014 in Peking University Cancer Hospital. Routine follow-up was done by outpatient interview or telephone. Statistical analysis was conducted to compare the survival of different CRS patients.</p><p><b>RESULTS</b>After a median follow-up of 19 months (2-129 months) for all the 294 patients, the median overall survival and disease-free survival were 35 months and 11 months, respectively. The postoperative 1-, 3- and 5-year overall survival rates were 89.0%, 49.0%, and 35.7%, and the disease-free survival rates were 47.2%, 22.2%, and 18.2%, respectively. For the six different groups with CRS of 0, 1, 2, 3, 4, 5 accordingly, the median overall survival was 64, 59, 33, 35, 17 and 15 months, respectively, showing a significant difference (P=0.002), and the median disease-free survival was 16, 19, 13, 10, 4 and 6 months, respectively, showing also a significant difference (P<0.001). For patients whose CRS were 0-2 and 3-5, the median overall survival was 44 and 33 months, respectively, with a significant difference between them (P=0.022), and the median disease-free survival was 15 and 8 months, respectively, with also a significant difference (P<0.001).</p><p><b>CONCLUSION</b>This CRS system may predict the prognosis for patients with hepatic metastasis from colorectal cancer after hepatectomy, therefore to provide useful reference for making treatment plan for those patients.</p>


Subject(s)
Humans , Colorectal Neoplasms , Disease-Free Survival , Follow-Up Studies , Hepatectomy , Liver Neoplasms , Mortality , General Surgery , Prognosis , Retrospective Studies , Risk Assessment , Survival Rate , Time Factors , Treatment Outcome
10.
Chinese Journal of Gastrointestinal Surgery ; (12): 680-683, 2015.
Article in Chinese | WPRIM | ID: wpr-260286

ABSTRACT

<p><b>OBJECTIVE</b>To evaluate the effect of hepatitis on surgical treatment and prognosis of colorectal liver metastasis(CRLM).</p><p><b>METHODS</b>A retrospective study of medical records of all the patients undergoing operation with colorectal liver metastasis in Peking University Hepatobiliary pancreatic Surgery Ward I from November 2007 to January 2013 was conducted. A total of 175 patients were eligible and divided into two groups: with hepatitis (n=16) or without hepatitis (n=159).</p><p><b>RESULTS</b>Preoperative liver function was similar in these two groups. There were no significant differences in preoperative serum albumin, total bilirubin and prothrombin time between two groups (all P>0.05), except for lower blood platelet in hepatitis group after operation. Major hepatectomy was performed in 37.5% (6/16) and 22.0% (15/159) of two groups respectively (P>0.05). There were also no significant differences in operation time, blood loss, surgical complications and drainage volume (all P>0.05). The median overall survival time was 46 months in hepatitis group and 33 months in non-hepatitis group, and the median disease free time was 8 months in hepatitis group and 10 months in non-hepatitis group (all P>0.05).</p><p><b>CONCLUSION</b>CRLM patients concomitant with hepatitis have adequate liver reserve function for major hepatic resection and have similar prognosis of patients without hepatitis.</p>


Subject(s)
Humans , Colorectal Neoplasms , Drainage , Hepatectomy , Hepatitis , Liver Neoplasms , Operative Time , Prognosis , Retrospective Studies
11.
Chinese Journal of Clinical Oncology ; (24): 1056-1062, 2015.
Article in Chinese | WPRIM | ID: wpr-479499

ABSTRACT

Objective:To compare the safety and long-term survival of patients with synchronous rectal cancer liver metastasis, who received either simultaneous or staged resection to treat primary tumor and liver metastases. Methods:Clinicopathologic and peri-operative data were collected retrospectively from 54 patients with synchronous rectal cancer liver metastasis, who received both prima-ry and liver resections between January 2000 and April 2015 at Peking University Cancer Hospital. Routine follow-up was conducted. The safety and long-term survival of 19 patients who underwent simultaneous resection were compared with those of 35 patients who received staged resection. Results:The clinicopathologic data between the two groups were comparable. Postoperative Clavien-Dindo grades 1, 2, 3, and 4 complications were 10.5%(2/19), 31.6%(6/19), 5.3%(1/19), and 10.5%(2/19) for the simultaneous group, respec-tively, and 8.6%(3/35), 17.1%(6/35), 25.7%(9/35), and 0%(0/35) for the staged group correspondingly, which were not significantly different (P=0.093). However, the median postoperative hospital stay of the simultaneous group was significantly shorter than that of the staged group (14 days versus 25 days, P<0.001). The median postoperative overall survival (OS) and disease-free survival (DFS) be-tween these groups were not significantly different [not reached versus 39 months for OS, respectively (P=0.649);10 months versus 10 months for DFS, respectively (P=0.827)]. Conclusion:The postoperative complications in simultaneous resection group were not sig-nificantly increased compared with those in staged resection group for synchronous rectal cancer liver metastasis. The long-term results among the groups were similar.

12.
Chinese Journal of Hepatobiliary Surgery ; (12): 388-392, 2015.
Article in Chinese | WPRIM | ID: wpr-474702

ABSTRACT

Objective To identify the risk factors associated with overall survival (OS) for patients undergoing partial hepatectomy for colorectal liver metastases,and to assess the predictive values of five published scoring systems in an independent patient cohort for the purpose of external validation.Methods The clinical,pathologic,and complete follow-up data were prospectively collected from 303 consecutive patients who underwent primary hepatic resection for colorectal liver metastases at the Beijing Cancer Hospital from January 2000 to Aug 2014.The predictive values of the Nordlinger score,the Memorial Sloan-Kettering Cancer Center (MSKCC) score,the Iwatsuki score,the Basingstoke index,and the Konopke scoring system were assessed in this patient set.The clinical and pathologic parameters were further analyzed using univariate and multivariate analyses.Results The 1-,3-and 5-year overall survival were 89.2%,50.8% and 38.6%,respectively.The median survival time was 37 months.Two risk factors were found to be independent predictors of poor overall survival:the N stage of the primary tumor,and a carcinoembyonic antigen level > 30 μg/L.The MSKCC score had the best independent predictive power for survival when compared with the other 4 prognostic systems (C-index:0.903).Conclusion In our patient cohort,the MSKCC score was the best staging system in predicting survival.

13.
Chinese Journal of General Surgery ; (12): 42-45, 2015.
Article in Chinese | WPRIM | ID: wpr-468822

ABSTRACT

Objective To evaluate the correlation between postoperative complications and prognosis after radical hepatic resection for colorectal liver metastasis (CRLM).Methods We retrospectively summarized patients' clinicopathological data and postoperative complications.Postoperative complications were graded using Dindo-Clavien system of classification.Then we investigate the relation between these data and prognosis.Results One hundred and seventy-three patients were recruited.Postoperative complications developed in 59 (34.1%) cases.37 patients had minor complications and 22 patients had major complications.On univariate (x2 =8.106,P =0.004) and multivariate analysis (x2 =8.006,P =0.005),complication was an independent predictor of overall survival (OS).However,in a subgroup of patients with minor compications,morbidity was not associated with a significant reduction in both OS (x2 =3.199,P =0.074) and disease-free survival (x2 =1.313,P =0.252).Conclusions Postoperative complications are an independent factor for long-term outcomes after hepatic resection for CRLM.

14.
Chinese Journal of Oncology ; (12): 200-203, 2015.
Article in Chinese | WPRIM | ID: wpr-248383

ABSTRACT

<p><b>OBJECTIVE</b>To evaluate the correlation between overweight and postoperative complications and prognosis after radical hepatectomy for colorectal liver metastasis (CRLM).</p><p><b>METHODS</b>A total of 192 patients who underwent hepatectomy for colorectal liver metastases between January 2000 and March 2012 were eligible for the study. We retrospectively summarized their clinicopathological data, BMI index and postoperative complications, and investigated the relation between these data and complications and prognosis.</p><p><b>RESULTS</b>Of the 192 patients, 109 cases were classified as overweight with a BMI ≥24 and 83 patients were classified as non-overweight with a BMI <24. Seventy-five complications occurred in 68 of the 192 patients (35.4%) who underwent hepatectomy. Surgical complications (P=0.428), operation time (P=0.837), and blood loss (P=0.272) were not statistically significantly associated with BMI. 173 patients were included to analyze the influence of overweight on oncologic outcome. The median survival for the overweight patients was 59 months, while that of non-overweight patients was 31 months (P=0.016). The overweight patients had a longer OS assessed by both univariate analysis (P=0.016) and multivariate analysis (P=0.031). However, no statistical differences in disease-free survival (DFS) were detected between the overweight and non-overweight groups (P=0.058).</p><p><b>CONCLUSIONS</b>Overweight is not independently associated with an increasing complication rate. BMI does not significantly affect the CRLM-DFS, and high BMI patients might have a better overall survival.</p>


Subject(s)
Humans , Colorectal Neoplasms , Epidemiology , General Surgery , Disease-Free Survival , Hepatectomy , Liver Neoplasms , Epidemiology , General Surgery , Overweight , Postoperative Complications , Epidemiology , Prognosis , Retrospective Studies , Survival Rate
15.
Chinese Journal of Surgery ; (12): 171-174, 2014.
Article in Chinese | WPRIM | ID: wpr-314739

ABSTRACT

<p><b>OBJECTIVE</b>To identify risk factors associated with overall survival (OS) for patients undergoing primary hepatic resection for metastatic colorectal cancer.</p><p><b>METHODS</b>The clinical and pathological data were prospectively collected from 191 consecutive patients undergoing primary hepatic resection for colorectal liver metastases from January 2000 to August 2012. The survival curve was drawn by Kaplan-Meier method, and the survival rates were analyzed by Log-rank test. Parametric survival analysis was used to identify predictors of cancer-specific survival.</p><p><b>RESULTS</b>The 5-year overall survival were 38.4% and median survival time was 33 months; 5-year disease-free survival were 23.6%, and the median disease-free survival time was 10.0 months. 5-years survival rate was significantly lower in patients with synchronal metastasis than in patients with heterochronia metastasis (27.4% vs. 51.8%, χ(2) = 6.527, P < 0.05). In overall survival, univariate analysis found 7 risk factors: gender (χ(2) = 5.219), N stage of the primary tumor (χ(2) = 5.591), bilobar metastases (χ(2) = 4.269), number of metastases ≥ 2 (χ(2) = 5.051), disease-free interval ≥ 6 months (χ(2) = 6.527), carcinoembyonic antigen level ≥ 30 µg/L (χ(2) = 4.454), and extrahepatic disease (χ(2) = 5.158). On multivariate analysis, 3 risk factors were found to be independent predictors of poor survival: N stage of the primary tumor (RR = 2.198, 95%CI: 1.146-4.216), disease-free interval ≥ 6 months (RR = 1.840, 95%CI: 1.139-2.973), carcinoembyonic antigen level ≥ 30 µg/L(RR = 1.854, 95%CI: 1.056-3.255).</p><p><b>CONCLUSIONS</b>Resection of liver metastases provides good long-term cancer-specific survival benefit. N stage of the primary tumor, disease-free interval, carcinoembyonic antigen level are important prognostic factors for colorectal liver metastasis.</p>


Subject(s)
Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Young Adult , Carcinoembryonic Antigen , Blood , Colorectal Neoplasms , Pathology , Disease-Free Survival , Follow-Up Studies , Kaplan-Meier Estimate , Liver , General Surgery , Liver Neoplasms , General Surgery , Prognosis , Risk Factors , Survival Rate
16.
Chinese Journal of General Surgery ; (12): 181-184, 2014.
Article in Chinese | WPRIM | ID: wpr-443438

ABSTRACT

Objective Bisegmentectomy Ⅶ-Ⅷ can be an alternative option for the tumor localized in segments Ⅶ and Ⅷ and infiltrating the main trunk of RHV instead of a right hemihepatectomy.This study was to evaluate the safety and practicability of the removal of segments Ⅶ and Ⅷ of the liver with the resection of the main trunk of RHV without vascular reconstruction.Method 13 consecutive patients underwent bisegmentectomy Ⅶ-Ⅷ with the resection of the RHV between Nov.2006 and Dec.2012 at Beijing Cancer Hospital 1st Department.of HPB Surgery.Results Bisegmentectomy Ⅶ-Ⅷ with the resection of the RHV was performed in all 13 patients successfully without the distal vein reconstruction.The duration of the operations was 90-215 min.Mean blood loss was estimated to be 200 ml (100-700 ml).Indications for a bisegmentectomy Ⅶ-Ⅷ included hepatocellular carcinoma in 6 cases,intrahepatic cholangiocarcinoma in one,liver metastasis in 4 and hepatic hemangioma in 2 as confirmed pathologically.All patients recovered without severe complications.The atrophy of segment Ⅵ due to the venous drainage obstacle was observed in 3 patients without the dysfunction of liver postoperatively.Conclusions It is safe and practicable to perform Ⅶ and Ⅷ bisegmentectomy with resection of the right hepatic vein without vascular reconstruction for liver tumors.

17.
Chinese Journal of Hepatobiliary Surgery ; (12): 195-200, 2014.
Article in Chinese | WPRIM | ID: wpr-445106

ABSTRACT

Objective To study the survival outcome and the survival-related factors in patients who received liver resection for multiple (≥4) liver metastases of colorectal cancer.Method The results for patients who received partial hepatectomy for four or more colorectal hepatic metastases carried out in the 1 st Department of HPB Surgery,Peking University Cancer Hospital were studied retrospectively.Results Between 2002 and 2013,of 239 patients,60 patients with four or more colorectal hepatic metastases received partial hepatectomy.The median overall survival was 35.2 months and the 5-year survival was 28.2% (17/60).There were two actuarial 5-year survivors.The median disease-free survival was 6.9 months,with 1 actuarial disease-free survivor at 5 years.There were no perioperative deaths,and the perioperative morbidity was 36.7% (22/60).Major (hemi-liver or more) liver resection and 7 or more metastases were independently associated with poor survival outcome.Perineural Invasion (T4) of the primary tumor,size of the largest metastasis (≥4 cm),neoadjuvant chemotherapy,and resection of recurrent disease were also associated with survival outcome.Conclusions Long-term survival could be achieved after resection of multiple colorectal liver metastases.Minor resection for multiple colorectal metastases was superior in survival compared with major resection.Additional survival advantage could be achieved by resection of recurrent disease.

18.
Chinese Journal of Gastrointestinal Surgery ; (12): 1009-1013, 2014.
Article in Chinese | WPRIM | ID: wpr-254372

ABSTRACT

<p><b>OBJECTIVE</b>To compare the short- and long-term outcomes of patients with synchronous colorectal liver metastases receiving either simultaneous or staged hepatectomy.</p><p><b>METHODS</b>Clinical and follow-up data of 64 patients with synchronous colorectal liver metastasis who underwent either simultaneous or staged hepatectomy between January 2003 and December 2011 in our hospital were reviewed retrospectively. Among them 20 patients underwent simultaneous resection of colorectal cancer and liver metastasis(simultaneous group) and 44 patients underwent staged operations(staged group).</p><p><b>RESULTS</b>The Clavien-Dindo grade 1, 2, 3 complication rates in simultaneous group were 10.0%, 15.0% and 15.0% respectively, and were staged group 13.6%, 13.6% and 22.7% respectively in staged group, and the difference was not statistically significant(P>0.05). The 1-, 2- and 3-year overall survival rates in simultaneous group were 85.0%, 59.6% and 37.2% respectively, compared with 90.9%, 68.2% and 47.1% in staged group, and the difference was not statistically significant(P>0.05). The median disease-free survival time in simultaneous group was 6 months versus 7 months in the staged group, which was comparable(P>0.05). Multivariate analysis revealed that positive primary lymph-node(P=0.020), prehepatectomy CEA>20 μg/L(P=0.017) were independent risk factors of overall survival, and having the opportunity to receive local radical therapy combined with chemotherapy after recurrence was a protective factor(P=0.001), while the timing of resection (simultaneous or staged strategy) did not reach statistical significance according to overall survival(P>0.05).</p><p><b>CONCLUSIONS</b>For synchronous colorectal liver metastasis there are no significant differences in postoperative complication rate and long-term survival between curative simultaneous and staged resection.</p>


Subject(s)
Humans , Colorectal Neoplasms , Pathology , Disease-Free Survival , Hepatectomy , Liver Neoplasms , General Surgery , Neoplasm Recurrence, Local , Postoperative Complications , Retrospective Studies , Survival Rate
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