Management of liver metastases of gastrointestinal stromal tumor / 中华胃肠外科杂志

Liver is the most common metastatic site of gastrointestinal stromal tumor(GIST). The recurrence rate is high even after hepatectomy. Although tyrosine kinase inhibitors (TKI) makes the resection feasible for some of the liver metastasis of GIST and significantly increase the overall survival, surgery still can not be substituted. Therefore, it is worth investigating and exploring the most appropriate treatment for the GIST with liver metastasis.

A scoring system to predict ascites after hepatectomy for hepatocellular carcinoma / 中华外科杂志

<p><b>OBJECTIVE</b>To establish a scoring system predicting the ascites postoperatively by analyzing the variant factors associated with massive ascites after hepatectomy in the patients with hepatocellular carcinoma (HCC).</p><p><b>METHODS</b>From January 2005 to January 2010, 324 patients with HCC underwent hepatectomy were analyzed retrospectively. There were 282 male and 42 female, aging from 17 to 84 years (mean age, 54 years). They were divided into two groups according to the volume of ascites. Variant preoperative, intraoperative and postoperative factors were compared and a scoring system was established to predict the postoperative ascites.</p><p><b>RESULTS</b>The univariate analyses revealed that various preoperative factors including prothrombin time, activated partial thromboplastin time, platelet count, albumin, aspartate aminotransferase had significantly difference in the two groups (P < 0.05). The operation time, intraoperative bleeding, hemihepatectomy or extended hemi-hepatectomy and the request of blood and serum transfusion had significantly difference in the two groups (P < 0.05). The multivariate analysis showed that the PLT, AST and the intraoperative plasma transfusion, hemihepatectomy or extended hemi-hepatectomy, the urine output and the drainage in the first postoperative day were independent factors (P < 0.05) for ascites. A scoring system was established based on the analysis. The specificity and the sensitivity were 86.2% and 83.3% respectively.</p><p><b>CONCLUSION</b>Variant factors are associated with postoperative ascites for hepatocellular carcinoma and the scoring system established can predict the ascites after hepatectomy accurately.</p>

Association of hepatitis B virus infection and cirrhosis with liver metastasis in colorectal cancer / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To explore the relationship of hepatitis B virus (HBV) infection and cirrhosis with liver metastasis in colorectal cancer.</p><p><b>METHODS</b>Clinical date of 1176 colorectal cancer patients undergone surgical treatment in the Peking University School of Oncology between January 1999 and August 2004 were analyzed retrospectively to investigate the impact of HBV infection and cirrhosis on the occurrence of liver metastasis and prognosis of patients.</p><p><b>RESULTS</b>The incidence of liver metastasis was 8.8% (10/114) in the HBV infection group and 23.9% (254/1062) in the non-infection group (P<0.01). The 5-year survival rates of these two groups were 54.2% and 60.7% ( P>0.05). The incidence of liver metastasis was 3.8% (1/26) in the cirrhotic group and 22.9% (263/1150) in the non-cirrhotic group (P<0.05). The 5-year survival rates of these two groups were 60.9% and 59.9% ( P>0.05).</p><p><b>CONCLUSION</b>Both hepatitis B virus infection and cirrhosis are associated with less liver metastasis in colorectal cancer, but have no impact on the survival.</p>

Clinicopathological features of solid pseudopapillary tumor of the pancreas / 中国医学科学院学报

<p><b>OBJECTIVE</b>To elucidate the clinicopathological features of solid pseudopapillary tumor (SPT) of the pancreas.</p><p><b>METHODS</b>Eight patients with SPT of the pancreas admitted from August 1996 to March 2005 were retrospectively analyzed.</p><p><b>RESULTS</b>All the 8 patients were female with an average age of 25.3 (13-41) years. The primary clinical manifestations included abdominal mass (n = 3), vague abdominal pain (n = 3), and duodenal obstruction (n = 1). SPT was occasionally found in one patient during physical examination. Six tumors located at the head and the other two in the body and tail of the pancreas. Pancreaticoduodenectomies were performed in 4 patients, tumor enucleations in 2, distal pancreatectomies in 1, and palliative internal drainage with a cystoenterotomy in the other one with an unresectable huge cystic lesion. All patients were alive on an average follow-up of 37.8 (8-103) months.</p><p><b>CONCLUSION</b>SPT occurs mainly in adolescent and young females, and satisfactory outcome may be achieved with active and appropriate surgeries.</p>

Intraperitoneal hemorrhage during and after percutaneous radiofrequency ablation of hepatic tumors: reasons and management / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Intraperitoneal hemorrhage is one of the most common complications of radiofrequency (RF) ablation of hepatic tumors. This study was designed to investigate the reason and management of intraperitoneal hemorrhage occurred during or after percutaneous RF ablation of hepatic tumors.</p><p><b>METHODS</b>Three hundred and fifty-six patients with hepatic tumors have been treated at 592 procedures of ultrasound guided RF ablation. Intraperitoneal hemorrhage occurred in 5 patients (0.8%). The reasons and management of intraperitoneal hemorrhage in these 5 cases were retrospectively analyzed.</p><p><b>RESULTS</b>Two patients with liver metastasis and one hepatocellular carcinoma (HCC) patient suffered from hemorrhage during the RF treatment. Two patients with recurrent HCC after surgery developed hemorrhage 20 minutes or 4 hours after RF treatment. One case of hemorrhage was due to the inappropriate electrode positioning induced liver laceration while treating a 1 cm liver metastasis near the liver capsule. One was due to the injury of a small vessel by the RF needle in another liver metastasis patient. Three cases were due to tumor rupture with two cases induced by cough or position change after treating large protruding HCC lesions. Four (80%) of the 5 cases of hemorrhage were rapidly identified by ultrasound. The causes and sites of bleeding during the RF treatment in three cases were confirmed through ultrasound, which were successfully treated using RF coagulation to achieve hemostasis of the bleeding site. Two patients with post-ablation hemorrhage recovered in one hour and 24 hours, respectively after given blood transfusion and other conservative measures. No surgical intervention was required. Two patients died of wide spread metastasis 23 - 36 months afterwards and the other three patients have lived for 18 - 25 months to date.</p><p><b>CONCLUSIONS</b>It is important to perform close monitoring during and after RF ablation in order to identify intraperitoneal hemorrhage in time. RF ablation of the bleeding sites was a simple and effective management when the bleeding site could be confirmed by ultrasound. The hemorrhage due to the rupture of large and protruding liver tumors could be serious and should be considered as contraindication for RF treatment.</p>

Impact of spiral CT cholangiography on suspected obstructive jaundice / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To study spiral CT cholangiography (SCTC) before treatment in patients with obstructive jaundice due to unknown cause.</p><p><b>METHODS</b>Between October 1998 and November 2000, a total of 59 patients with obstructive jaundice of unknown cause were examined by two-phase enhanced spiral CT (eSCT). Twenty-nine of these cases were excluded because they had had T-Bil of > 34 micromol/L so that their biliary duct system could not have been visualized. The remaining 30 patients were 17 male and 13 female with an age range of 31 - 76 years (mean 56.6). Pathologically, the lesion was proven to be carcinoma of pancreatic head (n = 9), Vater's ampulla carcinoma (n = 4), extrahepatic or hilar cholangiocarcinoma (n = 13), hepatocellular carcinoma (n = 1), chronic pancreatitis (n = 1) and cholelithiasis (n = 2). SCTC was performed through intravenous injection of 20 ml 50% Cholografin within 20 min before eSCT. SCTC was undertaken with parameters of a slice thickness of 2 - 3 mm, a table feed of 3 - 5 mm, a gantry time of 0.75 sec, a reconstruction interval of 1 - 2 mm, a pitch of 1.1 - 1.2, a voltage of 120 kV, a current of 220 - 240 mA, a matrix of 512 x 512 and a scan range from the level above hepatic hilum to the third segment of duodenum within 60 - 105 min following the injection. Both reconstructed SCTC source images and later eSCT scans were considered as axial CT (ACT). Multiplanar reconstruction (MPR) was obtained immediately on the operator console. 3D imaging adopted in our study was volume rendering technology (VRT) that was processed on the Siemens 3D Virtuoso workstation within 30 min. Opacification of biliary tree (OBT) analyzed by Grades 1 to 5 and image quality (IQ) assessed by 4 scales as excellent, good, fair and poor were investigated in ACT, MPR and VRT, respectively. The correlation between total OBT, which was the highest among the 3 image methods in the same case, and T-Bil, D-Bil, ALT, severity of the biliary obstruction (SBO) as well as level of the obstruction was analyzed.</p><p><b>RESULTS</b>In OBT, no statistically significant difference was found in the five grades by the three imaging techniques (P > 0.05), the distribution of percentages being 0, 0, 13.3%, 30.0% and 56.7% in ACT, 0, 6.7%, 20.0%, 30.0% and 43.3% in MPR and 0, 0, 13.3%, 40.0% and 46.7% in VRT. The evident correlation between total OBT and D-Bil (r(s) = -0.719), ALT (r(s) = -0.544) and SBO (r(s) = 0.650) was showed. In IQ, only a statistical significance existed between ACT and MPR (P = 0.034), having the scales "excellent to poor" in percentages of 93.3%, 6.7%, 0 and 0 for ACT, 66.7%, 30.0%, 3.3% and 0 for MPR and 70.0%, 23.3%, 6.7% and 0 for VRT, respectively.</p><p><b>CONCLUSION</b>According to our study, spiral CT cholangiography is very useful for the evaluation of selected patients with suspected obstructive jaundice before treatment.</p>

Expression of wild type and variant estrogen receptors in human hepatocellular carcinoma / 北京大学学报(医学版)

Objective:To investigate the expression of wild type estrogen receptor(wER)and the ex-on-5 deleted ER(variant ER,vER)in human hepatocellular carcinoma(HCC)samples,and thereafteranalyze the possibility of HCC treatment by endocrine therapy.Methods:The mRNA expressions of wERand vER were analysed from 28 cases of HCC by RT-PCR.The expression of ER at the protein level wasdetected by immunohistochemistry(IHC).Results:IHC results showed that 39.3% of the HCC speci-mens expressed ER.The mRNA of wER was detected in 89.3%(25/28)of the HCC specimens whilethat of vER was detected in 96.4%(27/28).Twenty four out of 28 HCC cases(85.7%)expressedboth wER and vER.One out of 28 patients(3.5%)expressed only wER whereas 3 patients out of 28(10.7%)expressed vER only.Conclusion:Ninety six percent(27/28)of the HCC patients expressedvER,which suggests that the expression of vER is an important event in the development of HCC.