Prognostic factors after curative resection hepatocellular carcinoma and the surgeon's role

PURPOSE: Patient, surgical, and tumor factors affect the outcome after surgical resection for hepatocellular carcinoma (HCC). The surgical factors are only modifiable by the surgeon. We reviewed our experience with curative resection for HCC in terms of surgical factors. METHODS: After analyses of the prospectively collected clinical data of 256 consecutive patients undergoing surgical resection for HCC, prognostic factors for disease-free survival (DFS) and overall survival (OS) were identified; all patients were stratified by tumor diameters > or 5 cm. CONCLUSION: Tumor recurrence after liver resection for HCC depends on tumor status, bleeding, and transfusions, which subsequently lead to poor patient survival. Surgeons can help improve the prognosis of patients by minimizing blood loss and transfusion, particularly in patients with larger tumors.

ERCC1 Can Be a Prognostic Factor in Hilar Cholangiocarcinoma and Extrahepatic Bile Duct Cancer, But Not in Intrahepatic Cholangiocarcinoma / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: There are three types of bile duct cancer, intrahepatic cholangiocarcinoma (ICC), hilar cholangiocarcinoma (HC), and extrahepatic cholangiocarcinoma (EHC). Despite different clinical presentation, the same protocol has been used in treatment of patients with these cancers. We analyzed clinicopathologic findings and protein expression in order to investigate the difference and the specific prognostic factors among these three types of cancers. MATERIALS AND METHODS: We conducted a retrospective review of 104 patients diagnosed with bile duct cancer at Seoul St. Mary's Hospital between January 1994 and May 2004. We performed immunohistochemical staining for p53, cyclin D1, thymidine phosphorylase, survivin, and excision repair cross-complementing group 1 (ERCC1). RESULTS: Of the 104 patients, EHC was most common (44.2%). In pathologic findings, perineural invasion was significantly less common in ICC. Overall survival was similar among the three types of cancer. Lymph node invasion, lymphatic, and venous invasion showed a significant association with survival outcome in ICC, however, the differentiation of histologic grade had prognostic significance in HC and EHC. No difference in protein expression was observed among these types of cancer, however, ERCC1 showed a significant association with survival outcome in HC and EHC, not in ICC. CONCLUSION: Based on our data, ICC showed different characteristics and prognostic factors, separate from the other two types of bile duct cancer. Conduct of further studies with a large sample size is required in order to confirm these data.

Apoptosis and Cell Proliferation in Gastric Adenoma and Adenocarcinoma

PURPOSE: Cancer is a genetic disease caused by alterations in key regulators of cell growth and cell turnover. We investigated apoptotic cell death and cell proliferation in gastric adenomas and adenocarcinomas. MATERIALS AND METHODS: The TdT-mediated dUTP-biotin nick end labelling (TUNEL) method and immunohistochemistry for Ki-67 were performed, using paraffin-embedded tissues of 41 gastric adenomas and 100 gastric adenocarcinomas. These results were compared with histopathologic parameters. RESULTS: The Ki-67 labelling index was higher in adenocarcinomas than in adenomas and the apoptotic index was higher in adenomas than in adenocarcinomas. There were no significant difference between the apoptotic index/Ki-67 labelling index and clinicopathological parameters. CONCLUSION: We propose that cell proliferation is more closely associated with gastric adenocarcinomas than apoptosis is, but that neither has any clinical significance as a prognostic factor in gastric adenocarcinomas.

Insulinoma of the Pancreas

PURPOSE: Insulinomas are a rare disease, which can be cured by surgical management if diagnosed early. However, diagnosis and localization are difficult, due to their small size and varied clinical manifestations. We analyzed the clinicopathological features, diagnosis and surgical management of insulinomas. METHODS: We retrospectively analyzed 12 insulinoma patients who had undergone pancreatic surgery, between 1988 and 2001, at the Department of Surgery, College of Medicine, The Catholic University of Korea. RESULTS: The male to female ratio of the insulinoma patients was 1: 1 with a mean age of 37.9 years, ranging from 20 to 65. The clinical manifestations were loss of consciousness, weakness, confusion and dizziness, and all the patients had findings compatible with Whipple's triad. The median duration of symptoms before surgery was 16.8 months, ranging from 1 to 48 months. Hyperinsulinemic hypoglycemia was confirmed, during prolonged fasting, when the concomitant fasting blood sugar level was 42.4mg/dl and insulin level was 25.2 microU/ml (8.1~61.8 microU/ml). The insulinoma can be localized in 11 patients (91.7%) preoperatively. For the preoperative localization, a transhepatic portal vein sample (THPVS), selective angiography and a CT scan were good diagnostic methods. Intraoperative ultrasonography was the most useful localization tool during the operation. For treating the insulinoma, an enucleation, a distal pancreatectomy, and a pylorus preserving pancreaticoduodenectomy were performed in 5, 6 and 1 patients, respectively. An enucleation case was diagnosed as nesidioblastosis after surgery, thus needing a near total pancreatectomy. One patient with a multiple endocrine neoplasia (MEN), subtype I, needed a thyroidectomy and an adrenalectomy. All cases were single, benign tumors within the pancreas. The symptoms of hypoglycemia and the laboratory values were normal in all patients after surgery. CONCLUSION: We experienced 12 insulinoma patients, where preoperative suspicions, proper utilization of diagnostic tools, and prudent intraoperative diagnostic procedures enhanced the diagnostic accuracy of the insulinoma, and led to better treatment strategies.

Clinical Analysis of the Patients with Choledochal Cyst: A Comparison between Children and Adults / 한국간담췌외과학회지

BACKGROUN/AIMS: We performed this study to review and compare the clinical characteristics of choledochal cyst between children and adults. METHODS: We reviewed medical records of patients with choldochal cyst who underwent surgical treatment between January 1984 and December 1996. We analyzed clinical symptoms, laboratory data and procedures. To compare clinical characteristics, patients under age 15 were grouped as children and the others were as adults. RESULTS: Sixty-eight patients, 21 children and 47 adults, underwent surgical treatment, Female predominance is common in both group. Abdominal pain was the most frequent symptom in both groups. Abdominal mass and jaundice were observed more frquently in children. Fever and chilling is more common in adults. The combined disease were more common in adults. Two adult patients had combined malignant diseases, cholangiocarcinoma and pancreas adenocarcinoma respectively. According to Todani's classsification, the most common type was type I in both group. The most common surgical procedure is cyst excision and hepaticojejunostomy in both groups. CONCLUSION: There was no significant difference in choledochal cysts between child and adults clinically. But combined diseases were common in adults, early detection and early surgry will be needed in this disease.