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Objective:To evaluate the clinical value of lymph node dissection (LND) for intrahepatic cholangiocarcinoma (ICC) after surgical resection.Methods:A retrospective study was conducted on the clinical data of 156 patients who underwent surgery for ICC in Eastern Hepatobiliary Surgery Hospital of Naval Military Medical University from November 2010 to December 2017, including 94 males and 62 females, aged (60.0±9.5) years. Curative surgery was performed in 114 cases. Of 64 cases were in stage Ⅰ according to American Joint Committee on Cancer (AJCC), including 38 cases of non-lymph node dissection (NLND) and 26 cases of LND; 21 cases were in AJCC stage Ⅱ, including 11 cases of NLND and 10 cases of LND; 22 cases were in AJCC stage Ⅲb, including 14 cases of LND and 8 cases of lymph node resection (LNR); 5 cases were in AJCC stage Ⅲa, 2 cases were in AJCC stage Ⅳ. Univariate and multivariate Cox regression analysis were used for the risk factors of ICC prognosis. The log-rank test compared the survival rates of the two groups.Results:Cox multivariate analysis indicated that lymph node metastasis was independent risk factors for prognosis in patients with ICC ( HR=1.96, 95% CI: 1.09-3.55, P=0.026). A total of 114 patients were included in the curative surgery group. The 1-, 3-, and 5-year overall survival (OS) rates of the negative lymph node group ( n=91) were 65.9%, 47.3% and 35.6%, respectively, which were significantly better than those of the positive lymph node group ( n=23) who had 1-, 3-, 5-year OS rates of 56.5%, 17.7% and 0, respectively (χ 2=8.11, P=0.004 ). In stage Ⅰ and Ⅱ patients, there were no significant differences in 1-, 3-, 5-year OS rates between the NLND group and the LND group (both P>0.05 ). In stage Ⅲb patients, the LND group had 1-, 3-, 5-year OS rates of 71.4%, 29.8% and 0, respectively, significantly better than those of the LNR group who had 1-, 3-, 5-year OS rates of 37.5%, 0 and 0, respectively (χ 2=6.45, P=0.011). Conclusions:Lymph node metastasis is an independent risk factor affecting the prognosis of ICC. Lymph node dissection should be performed cautiously in ICC with AJCC stage Ⅰ and Ⅱ, while routine lymph node dissection is recommended in ICC with AJCC stage Ⅲb.
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Objective To study the clinical features and treatment results of hepatic epithelioid hemangioendothelioma (HEHE).Methods A retrospective study was conducted on 26 patients with HEHE who were diagnosed and treated at the Eastern Hepatobiliary Surgical Hospital in Shanghai from November 2003 to December 2015.Results The main clinical manifestations of these 26 patients included abdominal pain (13),dizziness (1),anorexia (1),the other 11 patients were asymptomatic.Ultrasound test revealed mixed echogenicity in 17 patients (17/25,68.0％).CT study showed hypointensity lesions in 10 patients (10/12,83.3％).MRI scans identified T1WI hypointense signals in 12 patients (12/14,85.7％) and T2WI hyperintense signals in 11 patients (11/14,78.6％).Platelet distribution width (PDW) assay indicated 18 patients ＜ 15.5 fl (18/22,81.8％),P ＜0.05.all the patients performed tumor makers test,including AFP,CEA,CA19-9.Slightly elevation of CA19-9 was merely identified in one patient.All the patients were confirmed CD34 positive through immunohistochemistry stains.The 1,3,5-year survival rates of these patients were 87.7％,57.0％,43.4％,respectively.Median survival was 61 months.Conclusions HEHE should be considered based on the suggestive imaging findings for the patients with negative tumor markers after exclusion of hemangioma.PDW assay may have a key role in HEHE diagnosis.
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Objective To evaluate embedding 5-FU microparticles during operation after hepatectomy for small hepatocellular carcinoma to prevent recurrence. Methods A retrospective analysis on 184 patients was done.All patients received liver resection for HCC from 2007 Mar.to 2008 Mar.In 90 cases,5-FU releasing microparticles were embeded on liver cutting surface after the tumor was resected (group A).94 cases in which no micropaticles were given served as controls (group B).All patients had a single tumor( ≤5 cm) without visible vessel invasion. Results The postoperative disease-free survival ( DFS),and median period of DFS of group A vs.group B was 43 months vs 35 months.Postoperative DFS rates of 1-,2-and 3-year were 86％,76％ ％ and 64％ respectively in A group,while they were 77％,61％and 49％ respectively in B group ( x2 =4.77,P ＜ 0.05 ).In two groups the liver and kidney main function index( TB,ALB,ALT,BUN,Scr)on day 7 and postoperative complications were not statistically different (P ＞ 0.05 ). Conclusions Embeding 5-FU microparticle after hepatectomy for HCC could increase the postoperative DFS rates,and patients do not suffer from significant liver and kidney malfunctions.
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Objective To explore the clinical features, treatment and prognosis of intrabepatic biliary cystadenocarcinoma (IBC). Methods We retrospectively analyzed clinical data of 17 patients with pathologically confirmed IBC, treated between January 2002 and September 2007. Results Of the 17 patients, 4 were men and 13 were women, with a mean age of 49.3 years (range 45 -68). Serum level of AFP was normal in all patients. CA19-9 was abnormally elevated in only two patients and the other two had abnormal serum level of CEA. Seven cases underwent radical resection, 7 underwent complete tumor resection combined with removal of tumor thrombi in the bile duct, 3 received palliative surgery. On histopathological examination, 10 were biliary cystadenocarcinoma,2 were biliary cystadenoma with partial eanceration,2 were papillary cystadenocarcinoma,2 were mutinous papillary cystadenocarcinoma and 1 was of mixed cystadenocarcinoma and hepatocellular carcinoma. According to tumor differentiation, the number of well, moderate and poor-differentiated group was 7, 3 and 7 cases respectively. The medality of surgery (β= - 0.692, P = 0.01) and tumor differentiation (β = - 2.041, P = 0.007) effected the prognosis significantly. Conclusions IBC occurs mainly in elderly women. CA19-9 examination does not help in the establishment of diagnosis of IBC. The occurrence of tumor thrombosis in common bile duct doesn't necessarily indicate poor prognosis, hence a IBC patient will still have a satisfactory prognosis should the primary tumor be completely resected and tumor thrombi removed.