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Objective:To study the risk factors of very early recurrence (VER, within 3 months) after R 0 resection of hepatocellular carcinoma (HCC), and to establish a predictive model. Methods:Of 427 HCC patients [with 368 males, 59 females, aged (52.7±12.1) years] who developed early recurrence (within 2 years) after R 0 resection from January to December 2008 at Zhongshan Hospital, Fudan University were enrolled in the test cohort. Another 590 patients [with 525 males, 65 females, aged (54.7±11.0) years] who underwent R 0 resection from January to June 2009 were enrolled in the validation cohort. Risk factors were investigated and a predictive model was established. Results:In the test cohort, 126 patients (29.5%) developed VER and their survival outcomes were extremely poor. Serum α-fetoprotein (AFP) level >827 μg/L, multiple tumors, microvascular invasion (MVI) and tumor number were independent risk factors for VER. A new predictive model (0.809·AFP+ 1.262·tumor number+ 0.983·MVI) was established by logistic regression in predicting VER after surgery. The receiver operating characteristic curve showed that the area under the curve (AUC) in predicting VER was 0.722 (95% CI: 0.669-0.774, P<0.001). In the validation cohort, the AUC of this model was 0.785 (95% CI: 0.715-0.855, P<0.001). Conclusions:A high AFP level, multiple tumors, and MVI were independent risk factors for VER of HCC after R 0 resection. The prediction model consisting of these three factors demonstrated robustness and it has the potential in clinical application.
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Objective To study the clinical impact of microvascular invasion (MVI) on patients with intrahepatic cholangiocarcinoma (ICC) after R0 resections.Methods The clinicopathological data of 359 patients with ICC who underwent R0 resection in the Zhongshan Hospital,Fudan University between January 2000 and December 2008 were retrospectively studied.Univariate analysis and multivariate analysis were carried out to study factors related to postoperative survival outcomes and recurrence.The impact of MVI on patients with ICC after R0 resection was studied.Results The incidence of MVI was 13.6％ in the study cohort.MVI was correlated with HBV infection (P ＜ 0.05),liver cirrhosis (P ＜ 0.05) and tumor differentiation (P ＜ 0.05).The 1-,3-,5-year overall survival (OS) between the MVI positive and negative groups were 50.0％,20.9％,12.2％ and 63.9％,33.1％,22.0％ respectively (P ＜ 0.05),and the median survival time was 13 months and 18.5 months (P ＜0.05).The 1-,3-,5-year recurrence free survival (RFS) rates between the MVI positive and negative groups were 29.7％,12.7％,8.5％ and 50.6％,26.9％,18.4％,respectively (P ＜0.05),and the median recurrence free survival time was 8 months and 12.5 months (P ＜ 0.05).Multivariate analysis showed that MVI was an independent risk factor affecting recurrence after R0 resection (HR 1.852,95％ CI:1.075 ～ 3.195,P ＜ 0.05).Conclusions The occurrence of MVI in ICC patients was associated with hepatitis B infection.MVI was an independent risk factor affecting recurrence in ICC patients after R0 resection.However,it was not an independent risk factor of overall survival in patients after R0 resection.The clinical impact of MVI on patients with ICC was not as strong as for hepatocellular carcinoma.
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Objective To investigate the feasibility and safty of indocyanine green (ICG) fluorescence staining by laparoscopic ultrasound and three-dimensional (3D) visualization guided portal branch puncture approach in anatomical segmentectomy.Methods The retrospective cross-sectional study was conducted.The clinical data of 26 patients who underwent anatomical segmentectomy using ICG fluorescence staining by laparoscopic ultrasound and 3D visualization guided portal branch puncture approach in the Zhongshan Hospital of Fudan University between December 2016 and April 2018 were collected.The preoperative 3D visualization reconstruction and areas of portal branch perfusion were analyzed,laparoscopic ultrasound localization was intraoperatively applied to tumor and portal vein of targeted hepatic segment,and then portal branch puncture and staining were done under laparoscopic ultrasound and 3D visualization,finally laparoscopic anatomical segmentectomy was performed.Observation indicators:(1) intraoperative situations:success rate of portal vein puncture,targeted hepatic segment,effect of ICG fluorescence staining,intraoperative complications,operation time,volume of intraoperative blood loss,blood transfusion,conversion to open surgery,tumor diameter,the minimum resection margin to tumor;(2) postoperative situations:postoperative complications (Clavien-Dindo classification as a criteria) and duration of hospital stay;(3) follow-up situations:cases with follow-up,follow-up time and postoperative tumor recurrence.Follow-up using outpatient examination and telephone interview was performed to detect postoperative tumor recurrence up to April 2018.Measurement data with normal distribution and count data were respectively described as average (range) and percentage.Results (1) Intraoperative situations:a success rate of laparoscopic ultrasound and 3D visualization guided portal branch puncture in 26 patients was 100.0％ (26/26),and punctures in S8,S7,S2,S3,S6,S5 and S4 of the liver were respectively performed to 7,6,4,3,3,2 and 1 patients.Of 26 patients,22 achieved expected effect of ICG fluorescence staining,with a statisfaction of 84.6％ (22/26) and 4 failed to get expected effect,including 2 with uneven dying,1 with staining-uncovered partial areas of targeted liver segment and 1 with adjacent hepatic segmental staining induced to unclear boundary.All the 26 patients were not complicated with ICG injection induced to allergy.Average operation time and volume of intraoperative blood loss were 184 minutes (range,60-315 minutes) and 97 mL (range,10-400 mL),without intraoperative blood transfusion and conversion to open surgery.Average tumor diameter and average minimum resection margin to tumor in 26 patients were respectively 3.2 cm (range,1.2-10.0 cm) and 1.5 cm (range,0.4-3.0 cm).(2) Postoperative situations:of 26 patients,2 with grade Ⅰ-Ⅱ of Clavien-Dindo classification were improved by drug treatments (1 with deep venous thrombosis of the lower extremities and 1 with pleural effusion),no patient had grade Ⅲ and above complications,and there was no bile leakage,infection and hepatic dysfunction.Average duration of hospital stay in 26 patients was 6.9 days (range,5.0-14.0 days).(3) Follow-up situations:26 patients were followed up for 0.3-17.0 months,with a median time of 6.0 months.During the follow-up,1 patient with hepatocellular carcinoma had adrenal metastasis and 25 had tumor-free survival.Conclusion Laparoscopic anatomical segmentectomy with ICG fluorescence staining by laparoscopic ultrasound and 3D visualization guided portal branch puncture approaeh is safe and feasible,especially suitable in posterosuperior liver segments.