Outcome analysis of simultaneous liver resection for synchronous liver metastases from colorectal cancer / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To analyze the outcomes of simultaneous liver resection for patients who have primary colorectal cancer with synchronous hepatic metastases to see if there is any advantage for doing so.</p><p><b>METHODS</b>We retrospectively analyzed the medical records (1999 - 2009) of 53 consecutive patients with synchronously recognized primary colorectal carcinoma and hepatic metastases who underwent simultaneous (40 patients) or two-stage (13 patients) colonic and hepatic resections performed at our hospital.</p><p><b>RESULTS</b>There was no thirty-day mortality in both groups. The two groups had significant differences in mean operation duration [(212.9 ± 72.3) min vs. (326.5 ± 140.2) min, P = 0.014], mean blood loss [(337.5 ± 298.0) ml vs. (594.6 ± 430.5) ml, P = 0.020], post-operative hospital stay [(16.2 ± 8.1) day vs. (25.8 ± 8.5) day, P = 0.001]. The incidence rates of post-operative complications were 25.0% (10/40) and 53.8% (7/13), respectively, in the two groups (P = 0.053). The 1-, 3-, 5-year survival rates in the simultaneous resection group were 95.0%, 57.0% and 37.4%, respectively, with a median overall survival of 40.0 months and median disease-free survival of 14.0 months. The 1-, 3-, 5-year survival rates in the two-stage resection group were 92.3%, 58.7% and 36.7%, respectively, with a median overall survival of 38.0 months and median disease-free survival of 13.0 months. There were no significant differences between the two groups in respect of their survivals (P > 0.05).</p><p><b>CONCLUSIONS</b>Simultaneous colectomy and hepatectomy are safe and efficient for colorectal cancer patients who have synchronous colorectal liver metastases, with less complications and blood loss, and shorter hospital stay compared with the two-stage resection.</p>

Application of selective and timely regional hepatic vascular occlusion for resection of large centrally located liver tumors: report of 133 cases / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To improve the resection rate and increase operation safety for large centrally located liver tumors.</p><p><b>METHODS</b>Clinical data from 133 patients with large centrally located liver tumors confirmed by surgery were analyzed retrospectively. Selective and timely regional hepatic vascular occlusion was used during the operation procedure.</p><p><b>RESULTS</b>The resection rate was 100%. Perioperative death occurred in one patient. During operations, Forty-four patients underwent regional hepatic inflow occlusion ranging from 12 to 33 minutes. Twenty-three patients underwent left and right inflow occlusion, respectively, ranging from 8 to 50 minutes. One patient had right half-hepatic vascular exclusion for 40 minutes. The blood loss of 132 patients was (665 ± 424) ml (one patient experienced diffuse blood oozing and died in the next day). Among them, the blood loss of patients with liver cirrhosis was (723 ± 479) ml. On the contrary, those without liver cirrhosis was (458 ± 223) ml (P < 0.01). Liver function in 92.4% (122/132) patients recovered to Child-Pugh A within one week. No liver failure occurred. After operation, 3 patients presented ascites. Among them, two patients had liver cirrhosis and hepatocellular jaundice, one patient was accepted for transcatheter arterial chemoembolization preoperatively. Four patients had biliary fistula, one patient had gastroparesis, one patient had thrombus in the superior mesenteric vein and portal vein, and five patients had right pleural effusion. The 1-, 3- and 5-year survival rates of 112 patients were 89.1%, 57.7% and 36.9%, respectively.</p><p><b>CONCLUSIONS</b>Selective and timely regional hepatic vascular occlusion is useful for the resection of large centrally located liver tumors. This kind of procedure can effectively control the blood loss during the operation and shorten the ischemic reperfusion time, beneficial for protecting the liver cell function. This procedure is a safe hepatic flow occlusion method.</p>

Analysis of surgical treatment of 30 cases of small hepatocellular carcinoma in special position / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To investigate the resection technique for small hepatocellular carcinoma (SHCC) in special sites and discuss their outcome.</p><p><b>METHODS</b>Clinicopathological data of 30 patients with SHCC in special sites undergone liver resection were reviewed. There were 29 cases of hepatocellular carcinoma and 1 case of cholangiocarcinoma, confirmed by pathology. The tumor was close to the first porta hepatis in 8 cases, colse to the second porta hepatis in 15 cases, and close to the third porta hepatis in 7 cases. Twenty-five patients had one lesion, 4 patients had two and the other had three. The tumor diameter was (2.7 ± 1.2) cm.</p><p><b>RESULTS</b>No perioperative death occurred. The operation time was (279 ± 101) min, the mean intraoperative blood loss was 566 ml, and the postoperative hospitalization was (10.5 ± 2.7) days. The 1- and 3-year survival rates were 100% and 83.3%, respectively, and the 1- and 3-year disease free survival rates were 85.0% and 41.3%, respectively.</p><p><b>CONCLUSION</b>Although the surgery for SHCC in special sites is quite difficult and risky, surgical treatment is still safe with good perioperative management and is an effective treatment of SHCC in special sites.</p>

Characterization of hormone receptor status in 5758 Chinese females with breast cancer / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To analyze the characteristics of hormone receptor status in Chinese females with breast cancer.</p><p><b>METHODS</b>The clinicopathological data of 5758 female breast cancer patients surgically treated in our breast cancer center from Jan. 1997 to Oct. 2008 were retrospectively analyzed.</p><p><b>RESULTS</b>The positive rates of estrogen receptor (ER) and progesterone receptor (PR) were 64.1% and 70.2%, respectively. The ER positive rate was significantly higher in elderly, post-menopausal females with a smaller tumor and well-differentiated histology (P < 0.05), while the PR positive rate was significantly correlated with only histological differentiation and tumor size (P < 0.05). The ER and PR positive rates were significantly higher in the patients with lymph node metastasis than that in those without (P < 0.05). Multivariate analysis showed that the histological differentiation, T stage, N stage and menopause status were significantly correlated with ER positive rate, while histological differentiation, T stage and N stage were significantly correlated with PR positive rate.</p><p><b>CONCLUSION</b>Our results show that the ER positive rate of breast cancer in Chinese women is lower than that in western high incidence areas. The ER positive rate is significantly correlated with age, histological differentiation, tumor size, and menopause status. The PR positive rate is correlated only with histological differentiation and tumor size. Interestingly, the ER and PR positive rates are significantly higher in the patients with axillary lymph node metastases than that in those without. However, further study is needed to verify this special phenomenon.</p>

Risk factors and surgical treatment of recurrent gastrointestinal stromal tumor in the rectum / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate the risk factors and surgical treatment of recurrent gastrointestinal stromal tumors in the rectum.</p><p><b>METHODS</b>The clinical data of 24 cases,admitted to our hospital, were analyzed retrospectively. The possible risk factors were tested by chi(2)-test. The resectable rate and recurrent rate of recurrent cases were compared with the first-treated cases.</p><p><b>RESULTS</b>The tumors with biggest diameter >or=3 cm and high invasive risk had higher recurrent rates (chi(2)=4.874, P=0.027, chi(2)=6.659, P=0.010). The resectable rate of recurrent gastrointestinal stromal tumors in rectum was 64.3% (9/14), which was significantly lower than that of first-treated ones (23/24) (chi(2)=6.618, P=0.010). There was no significant difference of recurrent rate between the recurrent group and the first-treated group (chi(2)=1.459, P>0.05).</p><p><b>CONCLUSIONS</b>The size and invasive risk of tumor are associated with the recurrent rate of gastrointestinal stromal tumors in rectum. The resectable rate of recurrent gastrointestinal stromal tumors in rectum is significantly lower than that of first-treated ones, but recurrent rates are similar in the 2 groups.</p>