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Objective:To investigate the safety and outcomes of associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) in hepatocellular carcinoma (HCC).Methods:The clinical data of HCC patients who underwent hepatectomy at the University of Hongkong-Shenzhen Hospital from April 2014 to December 2020 were retrospectively analyzed. Of 57 HCC patients who were enrolled, there were 43 males and 14 females, aged (51±14) years old. According to the surgical method, the patients were divided into two groups: patients with pre-operative residual liver volume/standard liver volume <30% who underwent ALPPS procedure by anterior approach formed the study group ( n=20), and patients who underwent right hepatectomy with residual liver volume/standard liver volume ≥35% formed the control group ( n=37). Clinicopathological data and prognosis were reviewed and compared between the two groups. The patients were followed up via outpatient service and telephone. Results:There were more patients with well-moderately differentiated HCC in the study group than in the control group, and the difference was statistically significant ( P<0.05). All patients in the study group successfully completed two-step hepatectomy. Compared with the control group, the operative duration [644(535, 780) vs. 352 (269, 401) min], intraoperative blood loss [1 650 (1 338, 2 200) vs. 650 (500, 925) ml], and proportion of patients requiring blood transfusion (60.0% vs. 29.7%) were increased in the study group. The difference was statistically significant ( P<0.05). There was no significant difference in the incidence of grade III or higher complications between the study group and the control group [30.0% (6/20) vs. 18.9% (7/37), χ 2=0.91, P=0.341]. The 1-, 2- and 3-year overall survival rates were 90.0%, 63.8% and 46.4% respectively, and the corresponding tumor-free survival rates were 53.3%, 35.6%, and 35.6% respectively for the study group. The 1-, 2-, and 3-year overall survival rates were 71.4%, 63.4%, 51.7%, and tumor-free survival rates were 39.0%, 18.5%, 9.3% in the control group respectively. There was no significant difference in the postoperative survival rate and tumor-free survival rate between the two groups ( P>0.05). Conclusion:ALPPS was safe and feasible for treatment of right hepatocellular carcinoma with insufficient residual liver volume, and its survival outcomes was similar with one-stage right hepatectomy for HCC patients.
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Objective:To study the effiacious based on our experience of precise anatomical hemi-hepatectomy strictly guided by the middle hepatic vein (MHV) for regional to treat intrahepatic hepatolithiasis.Methods:A retrospective analysis was conducted on the data of 47 patients with regional hepatolithiasis treated with hemihepatectomy from July 2015 to July 2019 at the Department of Hepatobiliary and Pancreatic Surgery, The University of Hong Kong-Shenzhen Hospital. The study included 15 males and 32 females, aged (42±15) years. The exposure and preservation of the MHV was included in the precision surgery group ( n=26), and failure to fully expose the MHV or damage to the MHV was included in the control group ( n=21). The operation time, intraoperative blood loss and other surgical data and postoperative complications of the two groups were compared. Results:All patients successfully completed the operation. There was no patient who developed liver failure, and no patient died 90 days after the operations. The operation time (5.2±1.8) h and intraoperative blood loss (620.5±450.8) ml of the precision surgery group were not significantly different from those of the control group (4.9±2.3) h and intraoperative blood loss (760.5±540.2) ml ( P>0.05). A total of 19 patients (40.4%) (7 in the precision surgery group and 12 in the control group) developed 36 post operative complications of various types. The postoperative complication rate in the control group was higher than that in the precision surgery group [47.6%(10/21) vs 19.2% (5/26)], the difference was significant ( P<0.05). All 47 patients were followed-up for 6 to 30 months. For postoperative long-term complications: 5 patients in the control group had residual stones, biliary tract infection, liver abscess, and biliary-enteric anastomosis stenosis with recurrence of stones, and only 2 patients in the precision surgery group were found to have residual stones and biliary-enteric anastomotic stenosis. Stone recurrence, (the incidence of long-term complication) in the control group was significantly higher than that in the precision surgery group [23.8% (5/21) vs 7.7% (2/26)], ( P<0.05). Conclusions:Precise anatomical hemi-hepatectomy strictly guided by MHV for regional hepatolithiasis could more fully remove stones and lesions, and reduced the rate of stone recurrence. It was safe and feasible with favorable efficacy.
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Objective@#To study the application of associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) in hepatocellular carcinoma with mild-to-moderate liver cirrhosis.@*Methods@#There are 14 patients with hepatocellular carcinoma underwent ALPPS at the Department of Hepatobiliary and Pancreatic Surgery, Hong Kong University-Shenzhen Hospital from April 2014 to December 2017. The clinical data was retrospectively studied. The studying objects consisted of 9 males and 5 females, aged from 26 to 71 years old with the average age of 51, all cases were of Child-Pugh grade A. The degree of liver cirrhosis, operation and postoperative complications were analyzed.@*Results@#All 14 patients completed the ALPPS, 1 patient died post stage 2 operation with liver failure. Comparing the groups with no liver cirrhosis (n=4) with the groups of mild liver cirrhosis (n=5) and moderate liver cirrhosis (n=5), the future liver remnant liver volume growth rates were 58%, 46% and 45.6%, respectively. The average operation intervals were 9.0, 11.2 and 12.8 days, respectively. Postoperative complications occurred in 4 patients: 2 patients with liver failure, 1 patient with intestinal obstruction, and 1 patient with hepatic ascites.@*Conclusion@#ALPPS for Child-Pugh grade A, hepatocellular carcinoma with mild-to-moderate liver cirrhosis treatment is safe and feasible.
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Objective To study the value of combination detection of four markers in predicting the early recurrence and metastasis after hepatectomy.Methods Peripheral blood samples were obtained from 40 primary hepatocellular carcinoma and controls,Reverse transcription-polymerase chain reaction (RT-PCR) was used to detect AFP mRNA,h-TERT mRNA,CD44v6 mRNA and MAGE-1 mRNA in PBMC.Results The positive rate of AFP mRNA,h-TERT mRNA,CD44v6 mRNA,MAGE-1 mRNA was 50％,62.5％,55％,37.5％ in PHC patients.The positive expression rate of AFP mRNA and hTERT mRNA were 15％,30％ in patients with chronic active hepatitis,there was significant difference in the positive expression rate of two groups (respectively,~ =6.910,5.640,all P ＜ 0.05).There was no expression of the four markers in peripheral blood of healthy adults.Eight patients showed recurrence or metastasis in 9 PHC patients who has positive expression of the four markers,while none of patients who has no expression of any of four markers showed recurrence or metastasis.The difference among the groups was statistically significant (x2 =9.244,P ＜ 0.01).Conclusions The combinatorial detection of AFP mRNA,h-TERT mRNA,CD44v6 mRNA and MAGE mRNA expression increased the accuracy of predicting recurrence or metastasis of PHC patients in early postoperative phase.
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Objective To study the value of combination detection of four markers in predicting the early recurrence and metastasis after hepatectomy.Methods Peripheral blood samples were obtained from 40 primary hepatocellular carcinoma and controls,Reverse transcription-polymerase chain reaction (RT-PCR) was used to detect AFP mRNA,h-TERT mRNA,CD44v6 mRNA and MAGE-1 mRNA in PBMC.Results The positive rate of AFP mRNA,h-TERT mRNA,CD44v6 mRNA,MAGE-1 mRNA was 50％,62.5％,55％,37.5％ in PHC patients.The positive expression rate of AFP mRNA and hTERT mRNA were 15％,30％ in patients with chronic active hepatitis,there was significant difference in the positive expression rate of two groups (respectively,~ =6.910,5.640,all P ＜ 0.05).There was no expression of the four markers in peripheral blood of healthy adults.Eight patients showed recurrence or metastasis in 9 PHC patients who has positive expression of the four markers,while none of patients who has no expression of any of four markers showed recurrence or metastasis.The difference among the groups was statistically significant (x2 =9.244,P ＜ 0.01).Conclusions The combinatorial detection of AFP mRNA,h-TERT mRNA,CD44v6 mRNA and MAGE mRNA expression increased the accuracy of predicting recurrence or metastasis of PHC patients in early postoperative phase.
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Objective To investigate the safety,feasibility and effectivity of laparoscopic left hemihepatectomy for left hepatolithiasis.Methods From Jan.2005 to Dec.2013,36 patients with left hepatolithiasis underwent laparoscopic left hemihepatectomy (group LH),in comparison with 39 other patients who underwent conventional open left hemihepatectomy (group OH).The blood supply to left liver was dissected and cut off first.The liver parenchyma was transected and the left hepatic vein was dissected and clamped.Intraoperative choledochoscopy was carried out through the stump of left bile duct,laparoscopic choledocholithotomy and T-tube drainage were carried out when stones were found in the common or right bile duct.Blood loss,rate of residual stone,complication rate between the two groups were compared.Results The success rate of operation was 100％.Compared with group OH,group LH had shorter postoperative hospitalization,less incision infection and fewer analgesia needed(t =3.75,x2 =4.11,x2 =22.12,P ＜0.05).There was no statistical difference for blood loss,rate of transfusion,and postoperative complications such as bile leakage,pleural effusion,ascites,residual stones (t =0.66,x2 =0.70,x2 =0.01,x2 =0.52,x2 =0.01,x2 =0.28,x2 =0.01,P ＞ 0.05).Conclusions Laparoscopic left hemihepatectomy is safe,feasible,and effective for hepatolithiasis of the left liver lobe.
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Objective To evaluate the feasibility,safety,post-operative short and long-term outcomes of laparoscopic-assisted D2 radical distal gastrectomy in treating advanced gastric carcinoma without serosal invasion.Method From May 2007 to May 2013,54 cases of advanced gastric antral cancer without serosal invasion underwent laparoscopic-assisted D2 radical distal gastrectomy (laparoscopic group),54 demographically and pathologically-matched cases undergoing open surgery served as control.The surgical risk,post-operative recovery and follow-up results were compared.Result Surgery was successful in all patients.The mean operation time in laparoscopic group and open group was (168 ± 31) mins and (157 ±20) min respectively,the difference was significant (t =2.237,P =0.027) ; Intra-operative blood loss was (151 ± 56) ml and (213 ± 86) ml (t =4.45,P =0) ; Post-operative intestinal function recovery time was (2.7 ± 0.7) d and (3.4 ± 0.5) d (t =5.4,P =0) ; Lymph node dissection number was (26.4 ± 4.2) and (24.8 ±5.2) (t =1.769,P=0.08).Post-operative complication rate was 4％ and 11％ (P =0.142).There was no perioperative mortality in either group.Post-operative pathological stage of Ⅰ B,Ⅱ A,Ⅱ B,ⅢA was 8,17,24,5 cases in laparoscopic group and 9,14,23,8 cases in open surgery group.108 cases were followed up from 7 to 79 months.In laparoscopic group,8 cases had local recurrence or distal mestastasis,and 4 cases died from tumor; In open group,9 cases had local recurrence or distal mestastasis,and 6 cases died from tumor.Conclusions Laparoscopic-assisted D2 radical distal gastrectomy in treating advanced gastric cancer without serosal invasion is feasible,safe and advantageous in minimal invasion and rapid recovery,with good short and long-term outcomes.
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Objective To study the influence of laparoscopic gastric surgery on the gut barrier function (GBF).Methods There were 64 gastric cancer patients undergoing respectively laparoscopic radical procedures (32 cases) and open gastric surgery (32 cases).Blood was drawn on day one before surgery,day 1,day 3 and day 7 after the surgery for the measurement of plasma D-lacate and plasma diamine oxidase activity by using ultraviolet spectrophotometry.Results There was no statistical difference among demographic,clinicopathological characterastics between the two groups (P ＞ 0.05).The difference on the operative time,blood loss and the time starting to take food after the surgery was significant between the two groups,P ＜ 0.05.The differences of plasma D-lacate level and the diamine oxidase (DAO) on perioperatively respective all time points were not significant between the two groups,P ＞ 0.05.Conclusion Laparoscopic radical gastrectomy is comparable to open procedures in causing damage to patient's gut barrier functions.
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Objective To evaluate the feasibility,safety and outcome of laparoscopic total mesorectal excision with sphincter preservation in the treatment of low rectal cancer.Methods From April 2004 to April 2007,laparoscopic total mesorectal excision with sphincter preservation for low rectal carcinoma was performed in 25 cases.The intraoperative risk.recovery,short-term and oncological outcomes of these patients were compared with 25 cases of conventional Dixon's operation.The controls,matched for age,sex,mass margin distance from the anus,Dukes stage,were selected from conventional Dixon's operations performed at the same period as laparoscopic group.T test and Chi-square test were used.Results Laparoscopic procedure was successful in 24 cases while one was converted to Bacon operation.The mean operation time(197±36)min in laparoscopic group was significantly longer than those(172±51)min in open group(t=2.12,P=0.04).The mean operative blood loss was(157±105)ml in laparoscopic group and(304±237)ml in open group(t=-2.95,P=0.01).No significant differences were detected between two groups in specimen length and number of lymph nodes excised.The bowel function was restored earlier in laparoseopic group than that in open group.The overall morbidity rates were 16%and 28%,and the local recurrence rates were 8%and 4%in the two groups respectively.Conclusion Laparoscopic total mesorectal excision is a feasible,safe,minimally invasive technique for rectal cancer.which provides better short-term outcomes and similar oncological outcomes compared with the traditional open procedure.
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Objective To determine the expression of E-cadherin-catenins complex(E-cad,?-cat,?-cat and ?-cat) in early gastric cancer and their relationships with biological characteristics of early gastric cancer by evaluating the invasion and the lymph nodes metastasis of eraly gastric cancer(ECG).Methods 53 cases of EGC,who accepted radical operations from January 1997 to December 2000 in Sir Run Show Hospital were included in this study.According to the invasion depth and lymph nodes metastasis,they were divided into different sub-groups for discussion.Also the normal gastric mucosa of 10 cases with extra-gastric disease were selected as control group.Results All four proteins(E-cad,?-cat,?-cat and ?-cat) were normally expressed in control group.In early gastric cancer,the abnormal expression rates of E-cad,?-cat,?-cat and ?-cat were 64.2%,69.8%,66% and 73.6%,respectively.In the sub-group of mucosal invasion,the abnormal expression rates were 61%(14/23),65.2%(15/23),47.8%(11/23) and 56.5%(13/23),respectively.But in the sub-group of submucosal invasion,the abnormal expression rates were 66.7%(20/30),73.3(22/30)%,80%(24/30) and 86.7%(26/30),respectively.In sub-group of no lymph node metastasis,the abnormal expression rates were 61.4%(27/44),65.9%(29/44),63.6%(28/44) and 70%(31/44) respectively.In sub-group of lymph node metastasis,the abnormal expression rates were 77.8%(7/9),88.9%(8/9),77.8%(7/9) and 88.9%(8/9) respectively.Abnormal expression of ?-cat and ?-cat had significantly difference between the sub-group of mucosal invasion and the submucosal invasion(P
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Objective To investigate whether routine exposure recurrent laryngeal nerves(RLN) during the procedure of thyreoidectomy would prevent permanent nerves injuries caused by thyroid surgery.Methods 1523 patients with thyroid disease underwent thyreoidectomy from January 1980 to December 2004.Routine exposure of RLN during the procedure of thyreoidectomy were in 274 cases(group 1) and not in 1249 cases(group 2),the incidence rates of temporary RLN injuries and permanent RLN injures were compared in these groups.Results 3 cases(3/274,1.1%) occurred permanent RLN injuries in group 1 and 47 cases(47/1249,3.8%) occurred RLN injuries in group 2.The incidence rate of permanent RLN injuries in group 1 was lower than that in group 2(P0.05) in these groups.Conclusion Exposure recurrent RLN during the procedure of thyreoidectomy can effectively prevent permanent nerves injuries caused by thyroid surgery.