ABSTRACT
At present, surgical treatment is the only curative option for gallbladder (GB) cancer. Many efforts therefore have been made to improve resectability and the survival rate. However, GB cancer has a low incidence, and no randomized, controlled trials have been conducted to establish the optimal treatment modalities. The present guidelines include recent recommendations based on current understanding and highlight controversial issues that require further research. For T1a GB cancer, the optimal treatment modality is simple cholecystectomy, which can be carried out as either a laparotomy or a laparoscopic surgery. For T1b GB cancer, either simple or an extended cholecystectomy is appropriate. An extended cholecystectomy is generally recommended for patients with GB cancer at stage T2 or above. In extended cholecystectomy, a wedge resection of the GB bed or a segmentectomy IVb/V can be performed and the optimal extent of lymph node dissection should include the cystic duct lymph node, the common bile duct lymph node, the lymph nodes around the hepatoduodenal ligament (the hepatic artery and portal vein lymph nodes), and the posterior superior pancreaticoduodenal lymph node. Depending on patient status and disease severity, surgeons may decide to perform palliative surgeries.
Subject(s)
Humans , Cholecystectomy, Laparoscopic/methods , Gallbladder Neoplasms/epidemiology , Incidental Findings , Laparotomy , Liver Neoplasms/secondary , Lymph Node Excision/methods , Lymph Nodes/pathology , Lymphatic Metastasis/pathology , Survival RateABSTRACT
BACKGROUNDS/AIMS: Prognostic factors for colorectal cancer with hepatic metastasis are not well-established. We investigated the factors that predicted survival following surgical resection of hepatic metastases in patients with colorectal cancer. METHODS: Fifty-three patients underwent resection of hepatic metastases of colorectal cancer between January 2000 and December 2005, with follow-up periods that ranged from 3 to 119 months. In this retrospective study, the effects of sex, age, type of hepatic resection, T stage and N stage of the primary cancer, number and size of metastatic hepatic tumors, synchronicity or metachronicity of the liver metastases, surgical resection margins, and preoperative carcinoembryonic antigen (CEA) levels on 1-year and 3-year survival were analyzed using the Kaplan-Meier method and the log rank test. RESULTS: Median survival was 39.9 months and the 3-year survival rate was 62.2%. Twenty patients died during the follow-up period of 3 to 119 months (mean, 48.8+/-34.24). In univariate analysis, only the surgical margin of the hepatic metastasis resection correlated significantly with 3-year survival. Sex, age, T stage and N stage of the primary cancer, synchronicity or metachronicity of the metastases, number and size of hepatic metastases, type of hepatic resection and preoperative CEA levels did not predict long-term outcome. CONCLUSIONS: Hepatic resection provides a safe and effective treatment in patients with hepatic metastasis from colorectal cancer. In this study, only the surgical resection margin of the hepatic metastasis of colorectal cancer significantly predicted survival.
Subject(s)
Humans , Carcinoembryonic Antigen , Colorectal Neoplasms , Follow-Up Studies , Liver , Neoplasm Metastasis , Retrospective Studies , Survival RateABSTRACT
A 71-year-old male patient presented with both popliteal mass and calf claudication for 6 years. He had abruptly developed acute pain in both legs and pale skin color after interpersonal conflict. A preoperative computed tomography angiogram checked in another university hospital showed thrombosed popliteal aneurysms with acute leg ischemia in both legs. The left popliteal aneurysm was exposed with a medial approach. A thrombectomy and bypass from the proximal popliteal artery to the distal popliteal artery was done. Unfortunately the leg ischemia did not improve and below knee amputation was necessary. After transfer to Haeundae Paik Hospital, the right popliteal aneurysm was exposed with a posterior approach. After an aneurysmectomy and popliteal-peroneal bypass with peroneal endarterectomy, the leg ischemia completely resolved. He was discharged without complications. Eighteen months has passed since this operation and the patient's graft still has good patency. In the posterior approach to popliteal aneurysm, we found it possible to exposure vessels extensively including the popliteal aneurysm and it is easy to expose the distal artery. So we highly recommend the posterior approach for large popliteal aneurysm and distal artery bypass.
Subject(s)
Aged , Humans , Male , Acute Pain , Amputation, Surgical , Aneurysm , Arterial Occlusive Diseases , Arteries , Endarterectomy , Extremities , Ischemia , Knee , Leg , Popliteal Artery , Skin , Thrombectomy , TransplantsABSTRACT
PURPOSE: Although surgical resection offers patients with HCC the chance of a cure, the post-resection tumor recurrence rate is high, with reported cumulative 5-year tumor recurrence rates ranging from 40 to 70%. The objective of this study was to investigate risk factors for intrahepatic recurrence after resection of hepatocellular carcinoma, especially in patients with hepatitis B virus infection. METHODS: Between January 1999 and December 2003, 59 patients in our Hospital with hepatitis B virus infection underwent liver resection for hepatocellular carcinoma. Clinical, biological, and histopathological characteristics of these patients were collected and tested for their prognostic significance using a Chi-square test and a Student's t-test. Time to recurrence and survival rate were analyzed by the Kaplan-Meier method. RESULTS: Of the 59 patients who underwent liver resection, 24 (41%) experienced intrahepatic recurrence. The 1-, 3-, and 5-year overall survival rates of total enrolled patients were 83%, 63%, and 42%, respectively. The 1-, 3-, and 5-year overall survival rates after recurrence were 87%, 52%, and 20%, respectively. The risk factors for early recurrence were elevated serum aspartate aminotransferase (AST) level (p=0.044) and larger tumor size (p=0.049). For late recurrence, greater tumor size (p=0.039) was the only risk factor. CONCLUSION: Tumor size and serum aspartate aminotransferase are risk factors of intrahepatic recurrence after resection of HCC in patients with chronic hepatitis B virus infection. This finding indicates that patients who have these risk factors should be under more careful supervision and have more aggressive follow-up.
Subject(s)
Humans , Aspartate Aminotransferases , Carcinoma, Hepatocellular , Follow-Up Studies , Hepatitis B virus , Hepatitis B, Chronic , Liver , Organization and Administration , Recurrence , Risk Factors , Survival Rate , VirusesABSTRACT
Cystadenoma of the liver is a rare neoplasm. Although many cystadenomas are asymptomatic, symptoms can include abdominal pain, postprandial epigastric discomfort, and nausea. Dramatic changes in hepatic imaging techniques have been helpful for diagnosing cystic lesions of the liver, such as simple cyst, hydatid cyst, cystadenoma, cystadenocarcinoma, and metastatic neuroendocrine tumors. However, it remains difficult to differentiate cystadenoma from cystadenocarcinoma for multiseptated cystic hepatic lesions with papillary projection on computed tomography (CT) and magnetic resonance imaging (MRI). Here we report the case of a 47-year-old woman with several months of postprandial discomfort and abdominal fullness. CT and MRI revealed multiseptated cystic lesions with papillary excrescences. A left hemihepatectomy was performed. Histology showed a benign mucinous cystic tumor with ovarian-like stroma.
Subject(s)
Female , Humans , Middle Aged , Abdominal Pain , Cystadenocarcinoma , Cystadenoma , Cystadenoma, Mucinous , Cystadenoma, Papillary , Echinococcosis , Liver , Magnetic Resonance Imaging , Mucins , Nausea , Neuroendocrine TumorsABSTRACT
PURPOSE: Gallbladder polyps have malignant potentials and there are no definitive treatment criteria. Therefore, to establish the appropriate treatment for gallbladder polyps, the gross and microscopic appearance of gallbladder polyps were studied and the clinical findings analyzed. METHODS: Between January 1990 and December 1999, 1108 subjects underwent open and laparoscopic cholecystectomy at our institute. Seventy nine subjects, confirmed to have gallbladder polyps by pathology, were analyzed. To establish the surgical indications of polyps with malignancy potential, gender, age, clinical symptoms, polyp size, numbers, shape, coexistence of stones and the pathological findings were analyzed. RESULTS: The mean age of the subjects with benign and malignant polyps were 44.2 and 55.2 years old, respectively (p=0.034). The mean maximum diameter in benign and malignant polyps were 6.4 and 19.8 mm, respectively (p= 0.029). There were single polyps in 52.6 (30/57) and 86.3% (19/22) of the benign and malignant lesions, respectively (p= 0.046). Comparing the clinical symptoms (abdominal discomfort. etc) between the two groups, benign polyps had 26.3% (15/57), malignant polyps had 86.3% (19/22) (p= 0.0032). Cholesterol polyps were found in 29 (36.7%), inflammatory or hyperplastic polyps in 11 (13.9%) adenomas in 17 (21.5%) and adenocarcinomas in 22 (27.9%) cases. There were no differences in the presence of stones or in the shape of the polyps. CONCLUSION: On the basis of our analysis, when the polyp is of the single type, over 15 mm in diameter and the patient was 50 years old or over, surgical intervention should be considered due to the high risk of malignancy. If surgical intervention is not appropriated, a close follow-up is generally recommended to monitor the changes in the polyp size and shape.
Subject(s)
Humans , Middle Aged , Adenocarcinoma , Adenoma , Cholecystectomy , Cholecystectomy, Laparoscopic , Cholesterol , Follow-Up Studies , Gallbladder Neoplasms , Gallbladder , Pathology , PolypsABSTRACT
The uterus is an unusual site for metastasis from an extrapelvic neoplasm. Metastasis of gastric cancer to the uterus is rare. We experienced a patient who underwent a gastrectomy and chemotherapy due to gastric cancer and who subsequently suffered a solitary metastatic adenocarcinoma of the uterus from the primary gastric cancer. Similar to Krukenberg tumors of the ovary, lymphatic dissemination is regarded as the route of metastasis from the stomach to the uterine. We report this case with a brief review of literature.
Subject(s)
Female , Humans , Adenocarcinoma , Drug Therapy , Gastrectomy , Krukenberg Tumor , Neoplasm Metastasis , Ovary , Stomach , Stomach Neoplasms , UterusABSTRACT
The uterus is an unusual site for metastasis from an extrapelvic neoplasm. Metastasis of gastric cancer to the uterus is rare. We experienced a patient who underwent a gastrectomy and chemotherapy due to gastric cancer and who subsequently suffered a solitary metastatic adenocarcinoma of the uterus from the primary gastric cancer. Similar to Krukenberg tumors of the ovary, lymphatic dissemination is regarded as the route of metastasis from the stomach to the uterine. We report this case with a brief review of literature.
Subject(s)
Female , Humans , Adenocarcinoma , Drug Therapy , Gastrectomy , Krukenberg Tumor , Neoplasm Metastasis , Ovary , Stomach , Stomach Neoplasms , UterusABSTRACT
We report a case of intussusception of the cecum and appendix arising in pericecal endometriosis that are mistaken as a cecal tumor preoperatively. At the other OBGY clinic, the 1st lapalotomy was performed for management of leiomyoma but pelvic organs were adhesion severely and palpation mass in the cecum and appendix. The patient was transfer to our hospital for evaluation and treatment of mass. We investigated to intestine closely and diagnosis was cecal tumor colonoscopically. Total hystrectomy and iliocecectomy was performed successfully and discovered intussusception of the cecum and appendix due to endometriosis mistaken as a cecal tumor in operative field. Postoperatively, this case was diagnosed in pericecal endometriosis histologically.
Subject(s)
Female , Humans , Appendix , Cecum , Diagnosis , Endometriosis , Intestines , Intussusception , Leiomyoma , PalpationABSTRACT
BACKGROUND/AIMS: Transcatheter arterial chemoembolization (TACE) is the one of effective methods which treat hepatocellular carcinoma (HCC) in patients who have unresectable tumors or poor liver function. The aim of this study is to evaluate the histologic necrosis rate of hepatocellular carcinoma (HCC) treated with TACE. METHODS: From 1997 to 2001, 77 patients diagnosed as a HCC with percutaneous needle biposy underwent hepatic resection, who had been treated with properative TACE. Complete necrosis rate of tumor was studied by histologic examination of resected specimens. RESULTS: A complete necrosis rate was demonstrated in 31.2% (24/77). A mean size of completely necrotized tumors was 2.8 cm, incompletely necrotized tumor size was 4.8 cm. Lymph node metastasis of 77 hepatocellular carcinoma cases was shown in 5.2% (4/77). Of 24 cases with a complete necrotized tumor, lymph node metastasis was found in one case. CONCLUSION: This study indicates the effectiveness of TACE on the destruction of HCC. However, the presence of viable residual tumors strongly argues for the necessity of surgical resection whenever it is possible.
Subject(s)
Humans , Carcinoma, Hepatocellular , Liver , Lymph Nodes , Necrosis , Needles , Neoplasm Metastasis , Neoplasm, ResidualABSTRACT
There has been numerous experimental liver transplantation models in the rodent : orthotopic versus hetrerotopic; whole liver versus partial liver; microvascular suture versus cuff method in technical aspects. Several simplified modifications were introduced for experimental liver transplantation for improving animal-survival rate. Liver transplantation without arterial reconstruction, the cuff tchnique or stent method were the examples of simplifing modification. In practice, complications related to biliary reconstruction are frequent causes of intraabdominal infection in our rat liver transplantation. Here we propose using simple liver transplantation model of partial heterotopic liver transplantation without artery and bile duct reconstruction in the studies which need only observation of immediate graft survival or very short-term follow-up. Here we examined the serial histologic changes of auxiliary liver grafts without biliary reconstruction during short period after transplantation. Until 7 days of transplantation, bile duct proliferation was confined in the portal area of grafts and did not distort the lobular structure. Early graft-survival and rapid immunologic response might be evaluated by this easy transplantation model.
Subject(s)
Animals , Rats , Arteries , Bile Ducts , Bile , Graft Survival , Intraabdominal Infections , Liver Transplantation , Liver , Rodentia , Stents , Sutures , TransplantsABSTRACT
There has been numerous experimental liver transplantation models in the rodent : orthotopic versus hetrerotopic; whole liver versus partial liver; microvascular suture versus cuff method in technical aspects. Several simplified modifications were introduced for experimental liver transplantation for improving animal-survival rate. Liver transplantation without arterial reconstruction, the cuff tchnique or stent method were the examples of simplifing modification. In practice, complications related to biliary reconstruction are frequent causes of intraabdominal infection in our rat liver transplantation. Here we propose using simple liver transplantation model of partial heterotopic liver transplantation without artery and bile duct reconstruction in the studies which need only observation of immediate graft survival or very short-term follow-up. Here we examined the serial histologic changes of auxiliary liver grafts without biliary reconstruction during short period after transplantation. Until 7 days of transplantation, bile duct proliferation was confined in the portal area of grafts and did not distort the lobular structure. Early graft-survival and rapid immunologic response might be evaluated by this easy transplantation model.
Subject(s)
Animals , Rats , Arteries , Bile Ducts , Bile , Graft Survival , Intraabdominal Infections , Liver Transplantation , Liver , Rodentia , Stents , Sutures , TransplantsABSTRACT
We report a premature neonate who suffered from bronchial foreign body. The neonate was delivered at 34 weeks of gestational age, 1,850 g of birth weight, through Cesarean section. After birth the baby showed respiratory distress and received surfactant therapy on the first hospital day. After extubation on the 10th hospital day, the baby experienced 2 episodes of pneumonia in the right upper lung field. On the 27th day after birth, a chest X-ray revealed a feeding tube-shaped foreign body which was located from right main bronchus to trachea, about 4.5 cm long and 2.0 mm wide. The patient was too small to remove the foreign body by even the smallest-diametered fibroptic bronchoscopy. We rotated the baby to a nearly 90 degree head-down position and percussed on the back. After confirming the movement of foreign body in to the trachea, we intubated 3.0 Fr. endotracheal tube under fluoroscopic observation. We found that a tip of foreign body was inserted into the ET tube innerside. We sucked out the foreign body by mechanical suction with central-holed rubber suction tip. Forced expiration with cough reflex and intubation with mechanical suction allowed for the successful removal of the foreign body.