ABSTRACT
Objective To investigate the risk factors of spontaneous rupture of BCLC stage A and stage B hepatocellular carcinoma (HCC),and to review the surgical outcomes.Methods From April 2002 to November 2006,89 patients who suffered from spontaneous rupture of HCC of BCLC stage A and stage B were included into this study.A control group of 171 patients was selected by matching the sex,age and BCLC stage.Clinical data and survivals were collected and analysed.Results On multivariate analysis,hypertension (HR 7.38,95％CI:1.91 ～28.58,P＜0.05),cirrhosis (HR6.04,95％ CI:2.83 ～12.88,P ＜ 0.05) and tumor location in segments Ⅱ,Ⅲ,Ⅵ (HR 5.03,95％ CI:2.70 ～ 6.37,P ＜ 0.05) were predictive factors of spontaneous rupture of HCC.In the study group,the median survival and median disease-free survival were 12 months (range,1 ～ 78 months) and 4 months (range,0 ～ 78 months) respectively.The overall survival rates and disease-free survival rates at 1-,3-and 5-year were 66.3％,23.4％,10.1％ and 57.0％,16.8％,4.5％,respectively.Only radical resection remained predictive of overall survival (HR 0.32,95％ CI:0.08 ～ 0.61,P ＜ 0.05) and disease-free survival (HR 0.12,95％ CI:0.01 ～ 0.73,P ＜ 0.05).Conclusions Tumor location,as well as hypertension and cirrhosis were associated with spontaneous rupture of HCC.One-stage hepatic resection should be recommended to patients with ruptured HCC of BCLC stage A and stage B.
ABSTRACT
Objective To investigate the natural history and growth pattern of hepatic hemangioma in adults.Methods From April 2010 to March 2013, adult patients with hepatic hemangioma who had no prior treatment were enrolled.A routine follow-up was performed to observe the natural history and complications of these lesions.Results 236 patients were enrolled in the study.The median size of the hemangiomas was 4.5 cm (range 0.6 ～ 19.2 cm).During a median follow-up of 48 months (range 3 ～ 266 months), the hemangiomas increased in size in 61.0％ of patients, remained stable in size in 23.7％, decreased in size in 8.5％.The peak growth period was in patients ＜ 30 years age (0.46 ± 0.41 cm/year) and the growth rate decreased significantly after 50 years of age (0.21 ±0.40 cm/year).Hemangiomas with a size ＜2.0 cm had the lowest growth rate (0.16 ± 0.42 cm/year).The peak growth rate was in hemangiomas 8.0 ～ 10.0 cm (0.80 ± 0.62 cm/year) , but for hemangiomas ＞ 10.0 cm, the growth rate was only (0.47 ±0.91)cm per year.Only 9 patients had severe symptoms caused by the hemangioma.No patients presented with hemangioma-related complications.Conclusions The majority of hepatic hemangiomas have the tendency to increase in size but they rarely caused complications.All the hemangiomas could be safely managed by observation, and surgery should only be considered in patients with complications.
ABSTRACT
Objective To identify clinicopathologic factors which predict survival following hepatectomy in HBV-related cirrhotic patients with early hepatocellular carcinoma (HCC).Methods A database was used to identify patients with histologically confirmed early HCC (≤5 cm,no nodal involvement,metastases,or major vascular invasion) who underwent surgical resection (excluding ablation or transplantation).Among 20 700 patients with HCC who were diagnosed at the Eastern Hepatobiliary Surgery Hospital from April 2005 to November 2010,537 (2.6％) patients with early HCC were studied retrospectively.Prognostic factors were evaluated using the Kaplan-Meier curves,Cox proportional hazards models and the receiver operating characteristic (ROC) curves.Results The study included 537 patients.The median tumor size was 2.9 cm,and 33％ of patients had tumors ≤2 cm.Most HCC lesions were solitary (63％) and had no evidence of vascular invasion (64％).Following surgery,the overall median and 5-year survival were 45 months and 33％ respectively.After adjusting for demographic factors and histological grade,tumor size ＞2 cm (hazard ratio [HR]:1.56),multifocal tumors (HR:1.34),and vascular invasion (HR:2.03) remained independent predictors of poor survival (all P ＜ 0.05).Based on these findings,a prognostic scoring system was developed that allotted 1 point each for these factors.Patients with early HCC could be stratified into 4 distinct prognostic groups (median and 5-year survival,respectively):0 points (97 months,96％),1 point (85 months,76％),2 points (76 months,54％),3 points (56 months,39％) (P ＜0.01).Conclusions The present study emphasized the importance of pathologic staging even in patients with small HCC.Anatomical resection of HCC should be the preferred surgical procedure in cirrhotic patients.
ABSTRACT
Objective To investigate the appropriate cutoff point of CA19-9 in prognosis and to determine other potential prognostic factors which may affect survival of patients with hilar cholangiocarcinoma (HC) after radical surgery.Methods 168 patients who had undergone radical surgery for hilar cholangiocarcinoma with R0 and R1 resection were selected for the study.Categorized versions were used in univariate model to determine the appropriate cutoff point of CA19-9.CA19-9 and other clinicopathologic factors were analyzed for their influence on survival using multivariate methods.Results The strongest univariate predictor among the categorized preoperative CA19-9 measures was CA19-9 of less than 150 IU/L (P ＜0.001).On univariate analysis,age,differentiation,tumor size,Bismuth-Corlette classification,portal vein invasion,lymph node metastasis,hepatic artery invasion,liver invasion,preoperative biliary drainage,resection margin and preoperative CA19-9 levels were identified as significant prognostic factors.On multivariable analysis,lymph node metastasis,resection margin and preoperative CA19-9 levels were independent prognostic factors of survival.Conclusions A raised preoperative CA19-9 level was an independent prognostic factor of survival for hilar cholangiocarcinoma.The most discriminative cutoff point of CA19-9 for prognosis was at 150 kU/L.
ABSTRACT
Objective To determine the risk factors of ruptured hepatocellular carcinoma (HCC) and to study the prognostic factors of long-term survival.Methods Of the 4209 patients with HCC diagnosed and treated at the Eastern Hepatobiliary Surgery Hospital from Apr 2002 to Nov 2006,200 patients (4.8％) presented with ruptured HCC.These patients were studied retrospectively and the results of treatment were evaluated and compared with a randomly selected group of 202 patients who had no history of rupture and were treated during the study period.Results On multivariate logistic regression analysis,co-existing hypertension and cirrhosis,tumor size ＞5 cm,vascular thrombus and extrahepatic invasion were predictors of spontaneous rupture of HCC.For the 200 patients with spontaneous rupture of HCC,105 patients underwent elective one stage hepatic resection,33 received transcatheter arterial chemoembolization (TACE),and 62 were treated conservatively.The median survival time (MST) for patients with spontaneous rupture of HCC was 6 months (range,1-72 months),and the overall survival rates at 1-,3-and 5-year were 32.5％,10％ and 4％,respectively.The MST was 12 months (range,1-72 months) in the surgical group,4 months (range,1-30 months) in the TACE group and 1 month (range,0-19 months) in the conservative group.The 1-,3-and 5-year overall survival rates in patients with ruptured HCC who received partial hepatectomy were 57.1 ％,19.0％ and 7.6％,respectively,compared with 77.1％,59.8％ and 41.2％ in 98 patients who underwent partial hepatectomy for HCC without rupture (P＜0.001).Conclusions For patients with HCC who had underlying of hypertension and cirrhosis,extrahepatic invasion and tumor size ＞5 cm,there was a high propensity to rupture.Prolonged survival could be achieved in selected patients who received one-stage partial hepatectomy,although the survival results were inferior to the patients had no rupture.
ABSTRACT
Objective To study the outcomes of partial hepatectomy in patients with liver metastases from breast cancer.Methods The data of 47 patients who underwent partial hepatectomy for liver metastases from breast cancer between 2000 and 2009 were studied.The relationship between the clinical features and outcomes were analyzed retrospectively.Results The mortality of surgery was 0％.The 1-,3-,and 5-year survival rates for these 47 patients were 74.5％,42.5％ and 17.0％ respectively.The median survival was 29 months.Patients with less than 3 metastatic nodules survived longer than those with more than 3 metastatic nodules.The 1-,3-,and 5-year survival rates were 86.7％,53.3％,23.3 ％ versus 52.8％,23.5％,5.9 ％,and the mean survival was 79.4 months versus 34.6 months (P=0.001),respectively.Patients without local lymph node metastases had longer survival than those with local lymph nodes metastases.The 1-,3-,and 5-year survival rates were 82.3％,50.0％,23.5％ versus 53.8％,23.1 ％,0％,and the mean survival was 71.9 mouths versus 28.6 months (P＝0.002),respectively.There was no relationship between survival and tumor differ entiation,expression of ER,PR and Her 2.Conclusion Surgical treatment was safe for patients with liver metastases from breast cancer.The long-term survival was better for patients with liver metastases with less than 3 nodules compared to those with more than 3 nodules.The survival was poorer in patients with local lymph node metastases than those without lymph node metastases.
ABSTRACT
Objective To evaluate the safety and feasibility of hepatectomy for huge focal nodu-lar hyperplasia of the liver. Methods The clinical data of 29 cases of huge FNH of the liver with an average diameter of 12.5 cm (10-26 cm) who were admitted to our hospital from 1996 to 2007 were retrospectively analyzed. Lesions protruded from the liver in 26 cases, compressed extrahepatic organs in 10 and adjoined or compressed hepatic hila in 19. Results All the lesions were successfully resected without operative death. The mean intraopreative blood loss was 747 ml (100-4000 ml). The first he-patic portal blocking was performed in 27 cases and the mean blocking time was 26 min (13-78 min).Among 19 cases of huge FNH involving hepatic hila, the mean intraopreative blood loss was 1011 ml,the mean blocking time 30 min and the liver cross-section was not completely sutured in 7 of these ca-ses. The intraoperative hemorrhea occurred in 7 and postoperative biliary fistula in 1. Twenty-seven cases were followed up for a median of 46 months (4-132 months) with no recurrence and the longest survival time had reached to 11 years. Conclusion Hepatectomy is a safe and feasible means for huge focal nodular hyperplasia of the liver. For those involving hepatic hila, distinguishing between the le-sion and intrahepatic vessels, performing resection closely around the lesion and dealing with the liver cross-section properly may be helpful to reduce the surgical complications.
ABSTRACT
Objective To investigate the lymph node micrometastasis and its clinicopathologic features on 5-year disease free survival rate for patients with pT1-3N0 gastric cancer.Methods One hundred and twenty patients with stage pT1-3N0 gastric tumors were included,and 2 106 lymph nodes were harvested and examined in all the specimens.There were 9-28 lymph nodes with average 18 lymph nodes from each patient.All the lymph nodes were negative by HE staining.The CK20 expression of lymph nodes was tested by immunohistochemistry.The relationships between clinicopathologic features or CK positive expression and 5-year disease free survival were analyzed.Results The positive expression rate of CK20 was 9.07%(191/2 106)in lymph nodes and 26.67%(32/120)in patients with pT1-3N0 gastric cancer by immunohistochemistry.Eleven cases were with micriometastasis,21 cases were isolated tumor cells(ITC).The average postoperative follow-up was 66.35(range 24-121)months.Five-year disease free survival rates were 87.4%,78.3%,and 40.9% for the lymph node negative,ITC,and micrometastasis groups,respectively.Five-year disease free survival rate in the micrometastasis group was lower than that in the lymph node negative group(P=0.000)and ITC group(P=0.046).However,there was no significant difference between the lymph node negative group and ITC group(P=0.253).Multivariate analysis identified tumor diameter(P=0.011),depth of tumor invasion(P=0.043),and lymphatic vessel invasion(P=0.002)were related with CK20 positive expression.There was no significant relationship between the pathologic parameters and the 5-year disease free survival rates.Lymph node micrometastasis of gastric cancer was detected in 11 patients who should belong to stage pN1(Mi),the restage rate was 9.17%.While the lymph node negative(88 patients)and ITC(21 patients)were recorded pN0(i-)and pN0(i+),respectively,and were not recommended restage(stage pN0).Conclusion Patients with stage pT1-3N0 gastric cancer and micrometastasis in lymph node are with high-risk and low 5-year disease free survival rate,for whom adjuvant therapies may be justified and effective.
ABSTRACT
Objective To explore the safe technique of caudate lobectomy for liver cancer in candafe lobe(LCCL).Methods The clinical data of 11 cases of primary liver cancer in caudate lobe who received hepatectomy successfully were retrospectively analyzed. four procedures were used in the operations:(1)selection of appropriate skin incision, so as to obtain excellent exposure of operative field;(2)adequate mobilization of the liver to allow the liver to be displaced upwards to the left or to the right;(3)preparatory placement of tapes for total hepatic vascular isolation,so that this procedure can be used when necessary;(4)selection of the ideal route for hepatectomy based on the condition of the tumor and, if necessary, the combined removal of multiple lobes. Among the 11 cases, simple occlusion of vessels of porta hepatis was used for candate lobectomy in 6 cases, while, in the other cases, the vessels were intermittently occluded several times or total hepatic vlascular isolation was used for the caudate lobectomy. combined partial right hepatectomy was done in 2 cases, combined left lateral lobectomy in 3 cases and caudate lobectomy alone in 6 cases.Results Operation was smooth and successful in all of the 11 cases, and there was no mortality. Conclusions Caudate lobectomy for LCCL can be safely performed when the above procedures are used.