ABSTRACT
Backg round: Transar terial chemoembolization (TACE) is the prefer red treatment for patients with intermediate-stage hepatocellular carcinoma (HCC) without portal vein tumor thrombosis (PVTT). However, select patients with advanced HCC and with PVTT have shown improved survival with TACE. This study was undertaken to evaluate the outcome of TACE in patients with HCC beyond Barcelona-Clinic Liver Cancer- B (BCLC - B) and those with HCC and PVTT. Methods: Patients with unresectable HCC, subjected to TACE were included. HCC patients with PVTT involving main portal vein and, poor performance status were excluded from the study. Patients were stratified according to performance status, alpha feto protein (AFP) values, and up-to-seven criteria. Individually and using various combinations, the influence of these variables on survival was also estimated. Results: A total of 50 patients were included in the study. PVTT was present in 12 patients. Clinically, significant liver failure was observed in two patients. The average overall survival of patients beyond BCLC-B following TACE was 13 months. Survival was not influenced by tumor invasion into the portal vein. Patients with higher AFP levels had comparable survival provided their tumor load was satisfying up-to-seven criteria. Conclusion: We conclude that TACE could improve survival in selective HCC patients beyond BCLC-B and with PVTT not extending to the main portal vein
ABSTRACT
Background: Only a few studies address the financial impact of the management of bile duct injuries (BDI). This study was aimed to assess the cost of BDI sustained during cholecystectomy. Methods: Patients who underwent surgical repair for post cholecystectomy BDI and due for routine follow up between August 2006 and September 2007 were called for an interview. Results: 47 patients were interviewed. There were 39 (83%) women and 8 (17%) men. The median direct cost was US$ 1626 (451-11,009); ` 73,983 (20,521-500,910). The median indirect cost was US$ 312 (26-2,708); ` 14,196 (1,183-123,214). Total median cost was US$ 2,045 (488- 12,369); ` 93,046 (22,204-562,790). The median total costs of management of BDI was 9.98 times the costs of a cholecystectomy at our centre (US$ 205); (` 9,328) and was 8.41 times the median monthly income of the patients (US$ 243); (` 11,057). Conclusions: Our results will help the hospital administrators and the insurance agencies to calculate and revise the packages and premium for cholecystectomy so that the extra cost of a possible BDI is evenly distributed.