Prognostic analysis of 669 liver metastasis of colorectal cancer cases / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To evaluate the relation between different therapy and survival rate of liver metastasis of colorectal cancer (LMCC).</p><p><b>METHODS</b>Clinical data of 669 LMCC patients,collected from Fudan University Zhongshan Hospital from January 2000 to July 2008, were analyzed retrospectively.</p><p><b>RESULTS</b>Of the 669 cases, 379 cases were synchronous liver metastases(SLM) and 290 cases were metachronous liver metastases(MLM). There were no significant differences in age, gender and position of primary tumor between SLM and MLM groups(P>0.05), but as to liver metastasis characteristics(liver lobe involved, focus number and maximal focus diameter) and CEA, CA19-9 before therapy,there were significant differences(P<0.05). Two hundred and fifty-three cases underwent curative hepatic resection, including 123 cases in SLM and 130 cases in MLM. Until October 31, 2008, all the cases were followed up. The median survival time of SLM was(11+/-1) months and of MLM(23+/-2) months(P<0.01). Five-year survival rate of SLM was 6.4% and of MLM 11.4%(P<0.01). As to different treatments, median survival time and 5-year survival rate of curative hepatic resection group were 37 months and 35.6%, and of non-operation groups(i.e. intervention, chemotherapy, radiofrequency therapy and percutaneous ethanol injection) were 5 to 26 months and 0 to 3.6% respectively(P<0.05).</p><p><b>CONCLUSIONS</b>Curative hepatic resection is the first choice of liver metastasis of colorectal cancer, which can improve the survival rate. Resection rate and survival of MLM are better than those of SLM.</p>

Survival of patients with liver metastasis from colorectal cancer by different modes of therapy: a report of 363 cases / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To evaluate the correlation between different therapies and survival of liver metastasis from colorectal cancer ( LMCC) , and to compare the clinical outcome of synchronous liver metastasis (SLM) with that of metachronous liver metastasis (MLM).</p><p><b>METHODS</b>The clinical data of 363 patients with LMCC were retrospectively reviewed with focus on the correlation between different therapy and survival.</p><p><b>RESULTS</b>Of these 363 patients, 160 had SLM and 203 had MLM. Between the SLM and MLM group, there was no significant difference in age, or gender or primary cancer site (P > 0. 05 ), but significant differences were observed in condition of liver metastasis including liver lobe involved, focus number, maximum focus diameters and level of serum CEA and CA199 before therapy(P <0. 05). Ninety-one patients underwent curative hepatic resection, 22 of them in the SLM group and 69 in the MLM group. Mortality rate related to operation was 4. 5% (1/22) in SLM group and 2. 9% (2/69) in MLM group( P < 0.05). All patients were followed until 31/6/2005. The 3-year survival rate was 5. 2% with a median survival time of 10 +/- 1 months for the SLM group, and it wasl6. 4% and 17 +/- 1 months for the MLM group (P<0.01). Regarding to the treatment modalities, the 3-year survival rate was 30. 2% with a median survival time of 26 months for curative hepatic resection group, and it was 0% - 16. 7% and 10 - 17 months for non-operation groups treated by intervention, chemotherapy, radiofrequency therapy, percutaneous ethanol injection and Chinese traditional drugs (P <0. 05, P <0. 01 ).</p><p><b>CONCLUSION</b>Curative hepatic resection is still the first choice for liver metastasis from colorectal cancer improving the survival significantly. Other non-operative methods also can improve phase II resection rate. Metachronous liver metastasis has higher resection rate and better survival than the synchronous liver one.</p>

The interventional management for early hepatic arterial thrombosis after liver transplantation / 介入放射学杂志

Objective To summarize the interventional management for early hepatic arterial thrombosis(HAT)after liver transplantation.Methods 32 patients suspected of HAT or HAS after liver transplantation in 502 cases from April 2001 to September 2006 were done hepatic arterial angiography.Among them,20 patients were confirmed as HAT immediately through hepatic arterial angiography,and were further treated by transarterial thrombolysis,pereutaneous transluminal angioplasty(PTA)and stent-graft placement. Results HAT was identified in 20 patients(3.98%),occurring in the median 4.5 days(2～19 days)after liver transplantation.The sites of all the thrombosis were found at the anastomotic point of the hepatic artery.5 cases were treated by PTA and 3 cases by stent placement during the transarterial thrombolysis.Coil and stent-graft were used in 2 cases with hepatic arterial anastomostic hemorrhage.Hepatic arterial recanalization was obtained in 20 cases.The period of thrombolysis was 2.5 clays(2-11 days).Conclusions Continuous infusion of urokinase through hepatic artery with catheter,PTA and stent placement are effective modalities for hepatic arterial thrombosis after liver transplantation.(J Intervent Radiol,2007,16:799-802)

Epirubicin in the treatment of malignant obstructive jaundice / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To evaluate the safety and efficiency of epirubicin in the treatment of malignant obstructive jaundice (MOJ).</p><p><b>METHODS</b>Thirty-nine patients with diagnosis of MOJ, whose serum total bilirubin (TB) had not dropped to normal level after stent placement or percutaneous transhepatic biliary drainage, received trans-arterial chemoembolization (TACE). During TACE, epirubicin emulsion containing pharmorubicin at dose of 30 mg/m(2) was used. The toxicity and hepatic injury was observed according to WHO anticancer drug toxicity criterion and Child-Pugh classification criterion, respectively. The time of jaundice recurrence and survival were also observed during follow-up.</p><p><b>RESULTS</b>Median total serum bilirubin in 39 patients was 72.7 micromol/L (range: 52.1 - 91.4 micromol/L) before TACE. The dose of pharmorubicin was 40 - 60 mg with a median of 55.0 mg and the amount of lipiodol was 2 - 25 ml. Decrease in white blood cell count was observed: grade I in 41.0% of patients, grade II in 35.9% and grade III - IV in 15.4%. Grade III - IV nausea and vomiting developed in 100% of the patients. Hepatic injury became aggravated in 8 from A to B class patients, in one from A to C class, and in 3 from B to C class according to Child-Pugh classification criterion. No cardiac toxicity was observed in this series. The median survival time was 6.0 months with a range of 2 to 72 months. Jaundice recurred in 19 patients (48.7%) with a medium jaundice recurrence time of 9.0 months (range: 2 - 20 months).</p><p><b>CONCLUSION</b>Epirubicin-lipiodol emulsion at a dose of 30 mg/m(2) is safe and efficient in the management of patients with malignant obstructive jaundice with total serum bilirubin between 51 and 100 micromol/L after biliary drainage.</p>

Clinical analysis of 56 cases of primary liver cancer of over 5 years survival after comprehensive interventional therapy / 介入放射学杂志

Objective To analyze the key factors on long-term effect for comprehensive interventional therapy of primary liver cancer.Methods The clinical data,therapeutic protocols and follow-up of 56 patients with primary liver cancer survived for more than 5 years after comprehensive interventional therapy were analyzed retrospectively.Results Before TACE,20 patients were in clinical stageⅠ,35 were in stageⅡand one was in stageⅢ,including hepatic function of grade A(36 cases),grade B(20 cases),and grade C (0 case).The tumor patterns were consisted of mononodular type(32 cases),multinodular type(24 cases),and diffuse type(0 cases).The diameter of tumor demonstrated less than 3 cm(10 cases),3-5 cm(20 cases), 5-10 cm(19 cases)and more than 10 cm(7 cases).Thirty-three cases(58.9%)were treated by only TACE for the original lesions,while 23 cases(41.1%)were treated by TACE combined other treatment including TACE combined PEt(11 cases),TACE combined RFA(4 eases),TACE combined radiotherapy(one case),and TACE combinedⅡ-staged resection(7 cases).During follow-up,24 patients with hepatic recurrence and 17 cases of distal metastasis were treated by TACE and other anti-tumor treatment.Complications after interventional therapy in 20 cases were also treated.All cases survived for more than 5 years after interventional therapy including 3 more than 10 years.Conclusions Tumor factors,liver function, standardized TACE,combination of TACE with other anti-tumor therapy,treatment of hepatic recurrence and distal metastasis and complications are the key points to improve the long-term survival rate for primary liver cancer treated by comprehensive interventional therapy.

The portal venous pressure change due to metallic stents implanted into portal veins in HCC patients / 介入放射学杂志

Objective To research the change of the portal venous pressure after the stents implanted into portal vein in HCC.Methods Twelve HCC patients receiving portal venous stem embolization were included in this study.The portal venous pressures were recorded before varices embolized(P1),after embolized(P2)and after stents implanted(P3),respectively.Four groups were formed according to the pressures within portal vein stem(PV),portal vein branch without tumor invasion(PVB),splenic vein(SV) and superior mesenteric vein(SMV).Results In PV group,P1 was(45:17?2.25)cm H20,and P2 was (48.33?2.20)cm H_2O,P＜0.05,P3 was(39.33?2.44)em H_2O,thus P＜0.05 in comparing with P2.for PVB group,P1 was(38.08?2.97)cm H_2O,and P2 was(38.83?2.94)cm H_2O,P＞0.05,P3 was(37.41?2.37)cm H_2O,comparing with P2,P＞0.05.In SV group,P1 was(44.67?2.13)cm H_2O,and P2 was(48.17?2.20)cm H_2O,P＜0.05,P3 was(41.67?2.20)cm H_2O,comparing with P2,P＜0.05.Finally,the SMV group,P1 was(45.25?2.21 )cm H_2O,P2 was(48.42?2.19)cm H_2O,P＜0.05,P3 was(41.25?2.24)cm H_2O, in comparison with P2,P＜0.05.Conclusions In portal vein stem embolization,portal venous pressure would be higher after varices embolized,but lower after stents placement.

Stenting in malignant obstruction of inferior vena cava caused by hepatic carcinoma / 介入放射学杂志

Objective To evaluate the effectiveness of endovascular deployment of metallic Z-type self- expandable stents in treating the patients with inferior vena eava(IVC)obstruction caused by hepatic malignant tumour.Methods One hundred and fifty six patients with IVC obstruction due to malignant compression were enrolled.Venography was performed via femoral vein before and after metallic Z-type self-expandable stent deployment across the stenotic segment of IVC.The diameter of stenotic segment,collateral vessels,venous pressures and the scores of patients IVC syndrome were compared before and after stent placement.Results One hundred and seventy nine stents were implanted in 156 patients successfully.The average obstructive length of IVC was(6.1?2.2)cm.The pressure gradient of stenotie segments of IVC declined from(2.1?0.5)kPa to (0.5?0.11)kPa.The diameters of stenotic segment of IVC increased from(0.33?0.11 )cm to(1.6?0.4) cm.After operations,the main clinical symptoms and physical signs relieved quickly.During 2～24 month follow-up,the pateney of IVC stents reached 86.7%.Conclusion Endovascular deployment of metallic Z-type self-expandable stent is an effective palliative treatment for patients with malignant obstruction of IVC.