Exploration of indication of prophylactic transcatheter arterial chemoembolization on postoperative recurrence of hepatocellular carcinoma / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the efficacy of prophylactic transcatheter arterial chemoembolization (TACE) on postoperative recurrence of hepatocellular carcinoma.</p><p><b>METHODS</b>A retrospective analysis was performed on clinicopathologic data of 260 hepatocellular carcinoma patients who underwent curative hepatectomy in Eastern Hepatobiliary Surgery Hospital, Second Military Medical University from January 2004 to June 2007. Among the 260 patients, 104 underwent postoperative prophylactic TACE and the other 156 were not.</p><p><b>RESULTS</b>The overall survival rates at 1- and 2-years were 84.1% and 70.5% respectively. The overall disease-free survival rates at 1- and 2-years were 69.2% and 58.4% respectively. Of 260 overall patients, the disease-free survival rates at 1- and 2-years were 72.8% and 54.9% respectively in TACE group, and 66.9% and 59.7% respectively in non-TACE group, statistically significant difference of the cumulative disease-free survival rates at 1- and 2-years between TACE group and non-TACE group were not observed (P = 0.145, P = 0.405). Of 62 patients with tumor size >or= 10 cm, the disease-free survival rates at 1- and 2-years were respectively 66.6% and 48.7% in TACE group, and respectively 44.6% and 31.2% years between TACE group and non-TACE group were observed (P = 0.025, P = 0.025). Of 38 patients with vascular tumor thrombi, the disease-free survival rates at 1- and 2-years were respectively 33.0% and 0 in TACE group, and respectively 26.2% and 21.8% in non-TACE group, statistically significant difference of the cumulative disease-free survival rates at 1-years between TACE group and non-TACE group was observed (P = 0.025), and not at 2-years (P = 0.122).</p><p><b>CONCLUSIONS</b>In non-TACE group, statistically significant difference of the cumulative disease-free survival rates at 1- and 2-Prophylactic TACE is preferred for hepatocellular carcinoma patients with high risk factors for recurrence such as tumor size >or= 10 cm and presented vascular tumor thrombi.</p>

Diagnosis and treatment for solitary necrotic nodule of the liver: report of 15 patients / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the diagnostic and therapeutic approach of solitary necrotic nodule of the liver (SNNL).</p><p><b>METHODS</b>Fifteen cases were diagnosed as SNNL from June 1999 to December 2005. The clinical characteristics, imaging findings, diagnosis and treatment were analyzed with related literature retrospectively.</p><p><b>RESULTS</b>The patients manifested abdominal pain and discomfort in 7 cases (46.7%), fever in 1 case (6.7%), debilitation in 1 case (6.7%). Lesions were screened as hypoechogenic patterns in B ultrasound, and CT scan confirmed that the lesion appeared slightly hypodense compared with the normal liver parenchyma without detectable enhanced graphic phases. No significant enhancement was on dynamic magnetic resonance imaging study. All of the nodules demonstrated hypointense and isointense signal relative to parenchyma of liver on both T1 and T2-weighted images. Histologically, the lesion composed mainly of coagulative necrosis with a homogeneous periphery, and the central zone had a rough patchy appearance with cellular debris. The coagulative necrosis was surrounded by a thin boundary of collagen fibers with scanty mononuclear, lymphocyte, plasmocyte inflammatory cells and elastic fibers. Preoperative laboratory examinations showed hepatic function slightly abnormal in 3 patients, and AFP level was normal in all patients. Diagnosis of SNNL was established in 4 cases (26.7%) preoperatively. All patients underwent liver resection with no recurrence within 3 months to 6 years follow-up.</p><p><b>CONCLUSIONS</b>Preoperative diagnosis of SNNL can be established via comprehensive analysis of clinical characteristics and imaging findings. Liver resection is the optimal therapeutic approach.</p>

Lymph node metastasis of patients with intrahepatic cholangiocarcinoma / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the relationship between lymph node metastasis and prognosis in patients of intrahepatic cholangiocarcinoma (ICC).</p><p><b>METHODS</b>A retrospective clinical analysis was made in 132 cases of ICC, who admitted to our hospital from December 1996 to June 2003. Kaplan-meier method was used to calculate their survival rates, chi(2) test to compare the difference of sample rates. Logistic regression analysis was performed to determine the factors influencing lymph node metastasis and log-rank univariate analysis was used to assess the role of lymph node metastasis in the long-survival.</p><p><b>RESULTS</b>Lymph node metastasis in hepatoduodenal ligament could be detected in all 29 preoperative and 48 postoperative lymph metastatic cases, without "jumping-metastasis". Lymph metastasis was one of the major causes of postoperative mortality, and resulted in 36 of 58 followed-up death postoperatively. According to logistic analysis, pathological types of the carcinoma (chi(2) = 4.071, P = 0.044) and periductal-infiltrating tumors (chi(2) = 3.872, P = 0.037) were significant predictors of lymph node metastasis. In all 98 radical resections, 46 cases performed skeletonization of the hepatoduodenal ligament while other 52 cases not. The median survival of the two groups was 20 months and 13 months respectively (chi(2) = 9.82, P < 0.01).</p><p><b>CONCLUSIONS</b>Lymph nodes in the hepatoduodenal ligament may be sentinel nodes for ICC lymph node metastasis. Aggressive treatment of lymph node metastasis in the hepatoduodenal ligament is an important strategy to improve the long-survival of postoperative ICC patients.</p>