The clinical application value of TACE combined with SPVE in the treatment of two stage hepatectomy / 中国医师杂志

Objective To investigate the clinical application value of liver transarterial chemoembolization (TACE) combined with selective portal vein embolization (SPVE) in the treatment of two stage hepatectomy.Methods From January 2010 to December 2013,120 patients with liver tumors who were not suitable for one stage hepatectomy admitted to our department were enrolled in this study.Among them,60 (control group) received TACE therapy and 60 (observation group) accepted TACE combined with SPVE treatment.The liver function,liver volume change,the second stage resection,survival rate,complication and adverse reaction were compared between the two groups after treatment,and the application value of the therapy was analyzed.Results All the patients were successfully completed the treatment.The aspartate aminotransferase (AST),alanine aminotransferase (ALT),and total bilirubin (TB) of the two groups were all recovered to the pre-treatment level on the 7th day after treatment,and there was no statistical difference between the two groups (P ＞ 0.05).Except for the 6th months,the survival rates of the observation group in 12th months,18 months and 24 months were all higher than those in the control group.The liver volume of the control group and the observation group increased to varying degrees,and the tumor volume showed varying degrees of atrophy.The residual liver volume (RLV) of the observation group was (527.29 ±58.69) cm3,which was increased and higher than the control group before the treatment (P ＜ 0.05).The implementation rate of the second stage operation was also higher than that of the control group (P ＜ 0.05).There were no serious complications in the two groups,and there was no significant difference between the two groups about adverse reactions (P ＞ 0.05).Conclusions The treatment of TACE combined with SPVE can effectively control tumor growth,increase RLV,so as to improve the resection rate and survival rate of patients with primary hepatectomy who can not undergo primary resection.

Preoperative spleen-liver volume ratio predicts the risk of liver cancer recurrence after hepatectomy / 中国医师杂志

Objective To explore the value of preoperative spleen-liver volume ratio (SLVR) for predicting recurrence of primary liver cancer after hepatectomy.Methods Clinical data of 86 cases of hepatocellular carcinoma undergoing hepatectomy were analyzed retrospectively from January 2009 to December 2014.According to the preoperative SLVR,these patients were divided into two groups:SLVR ＜ 0.8 group (low SLVR group) and SLVR≥0.8 group (high SLVR group).Patients were followed-up until June 2015.Cox ratio risk pattern analysis was used for the recurrent correlative factors.Results The 1-,3-,and 5-year survival rates were 95.5％,88.6％,and 81.8％ in the low SLVR group,and 73.8％,47.6％,and 40.5％ in the high SLVR group,respectively.The difference were statistically significant between two groups (P ＜0.05).Cox regression analysis revealed that SLVR≥0.8,AFP-L3％ ≥10％,the maximum diameter of the tumor ＞ 5 cm,and hepatic or portal vein tumor thrombus were independent predictors of poor disease-free survival after hepatectomy for hepatocellular carcinomas (P ＜ 0.05).Conclusions Preoperative SLVR≥0.8 is an independent adverse predictor of poor disease-free survival.

Ultrasound-guided percutaneous ablation treatment for current hepatoblastoma: initial single-center experience / 中国医师杂志

Objective To summarize the first experience with ultrasound-guided percutaneous ab lation treatment (PAT) for recurrent hepatoblastoma (HB) after liver resection in children.Methods From August 2013 to April 2015,PAT was used to treat 6 children with a total of 9 recurrent HB,including 5 patients with 8 tumors in the liver and 1 patient with 1 tumor in the lung.The mean size of ablated tumors was (1.5 ± 0.8) cm,and the tumor size range was 0.7 cm to 3.1 cm.Results Four patients were performed percutaneous radiofrequency ablation (RFA) for recurrent HB;and 2 patients were performed percutaneous ethanol injection (PEI).Ablation success was achieved in all patients (6/6,100％).The complete ablation rate after the first ablation session was 88.9％ (8/9) on a tumor-by-tumor basis.Only 1 patient developed a fever with temperature ＞ 39 ℃;it was resolved by conservative therapy.During the follow-up period of 5-30 months,3 patients died to tumor progression.The 1-and 2-year overall survival rates after ablation were 83.3％ and 41.7％,respectively.Conclusions PAT is a safe and promising therapy for children with recurrent HB after liver resection,and further investigation in large-scale randomized clinical trials is required to determine its role in the treatment of this disease.

Combined hepatectomy in radical resection for hilar cholangiocarinoma / 中国医师杂志

Objective To evaluate the value of combined hepatectomy in radical resection for hilar cholangiocarinoma. Methods The clinical data and follow-up data of 67 patients of resection for hilar cholangiocarinoma in Henan Tumor Hospital from June 2005 to october 2008 were retrospectively analyzed. Results According to intraoperative exploration situation and bismuth types, tumor resection was combined performed with hepatectomy (n＝38)or non-hepatectomy (n＝29). The rate of R0 resection was 55.3% in hepatectomy group(n＝21) and 34.5% in non-hepatectomy group(n＝10), and the difference was significant（P＝0.024）. The incidence of complications were 39.5% in hepatectomy group(n＝15) and 13.4% in non-hepatectomy group(n＝4), and one patient with liver and kidney failure died in hospital. The 1, 3, 5 years of survival rate were 89.3%,53.6% and 32.1% respectively in R0 group (n＝31) and 69.7%,30% and 10% respectively in R1～R2 group(n＝36), there were significant differences in the postoperative survival rate between both groups（P＝0.018). The 1, 3, 5 years of survival rate were 81.8%,48.5% and 24.2% in hepatectomy group and 75%,32% and 16% in non-hepatectomy group respectively, and the differences were significant（P＝0.037). Conclusions Aggressive resection including combined hepatectomy for hilar cholangiocarcinoma can play an important role for curative effect and long term survival rate.

Combined oxaliplatin with adenosine triphosphate tumor chemosensitivity assay (ATP-TCA) for direction of indiyidual chemotherapy of hepatocellular carcinoma / 中国医师杂志

ObjectiveTo investigate the effectiveness of combined oxaliplatin regimen as adjuvant chemotherapy for hepatocellular carcinoma and to evaluate the efficacy of using adenosine triphosphate tumor chemosensitivity assay (ATP-TCA) for direction of individual chemotherapy.MethodsThe twenty-six patients with primary hepatocellular carcinoma were operated.Specimens were collected and adenosine triphosphate tumor chemosensitivity assay (ATP-TCA) was applied to evaluate the sensitiveness of chemotherapy agent(Adriamycin, Mitomycin, Mitoxantrone, Oxaliplatin, Irinotecan, 5-FU, Gemzar, Carboplatin, Cisplatin, Docetaxel and Etoposide).Sensitive group (SG) was from from 11 patients who were sensitive to oxaliplatin, and control group was from the other 16 patients who were not sensitive to oxaliplatin.All the twenty-six patients received oxaliplatin combined with 5-FU or capecitabine regimen chemotherapy.The effectiveness (CR,PR,SD,PD,ORR,OS and DFS) of the regimen according to RECIST criteria and WHO criteria for anticancer drugs toxicity and efficacy of ATP-TCA were evaluated.ResultsTwenty-six patients were successfully evaluated.In SG, six patients obtained complete remission(CR), three got partial remission(PR), one got stable disease (SD) and one patient got progression disease (PD).While in control group,four patients obtained CR,two patients got PR, five patients got SD and four got PD.No significant differences were found in overall survival (OS, P = 0.1116) and disease-free survival (DFS, P = 0.2328)between sensitive group and control group.But significant differences were found in overall response rate (ORR) (81.8％ vs 40.0％, P =0.0401) between two groups.Common toxicities were as follows:I to Ⅱdegree of myelosuppression was 53.8％, I to Ⅱ degree of gastrointestinal tract response was 50％, I to Ⅱ degree of liver function damage was 57.7％ and I to Ⅱ degree of neuropathy was 23.1％, respectively.Most of these toxicities were tolerable at grade 1 ～ 2.No significant differences were found in the toxicities between two groups.ConclusionsCombined oxaliplatin regimen might be an effective choice for adjuvant chemotherapy for HCC, which has with tolerable systemic toxicity.Application of ATP-TCA system might further improve the efficacy of this regimen by selecting right candidate.

An effect analysis of hemihepatic vascular occlusion and pringle maneuver in Liver cancer operation / 中国医师杂志

Objective To study the application and efficacy of hemihepatie vascular occlusion in HCC resection. Methods 90 ca-ses of HCC patients were roiled in and divided into two groups. Liver resection was performed with Pringle maneuver or hemihepatic vascular occhusion. Ischemia time, operative time, blood loss, postoperative liver function, the occurrence of complications and the recovery of gastro-intestinal function were recorded. The efficacy of the two occlusions was compared. Results There is no significant difference between hemibepatic vascular occlusion and Pringle maneuver in ischemia time, operative time, blood loss (P>0.05). However, there is signifi-cant difference in postoperative liver function, the occurrence of complications and intestinal function recovery time. The former is significant-ly superior to the latter (P<0.05). Conclusions The bemihepatic vascular occlusion and Pringle maneuver occlusion have no difference in ischemia time, operative time and blood loss. But bemihepatic vascular occlusion has less impact on liver function, lower rate of occur-rence of complications and faster recovery speed. Therefore, hemibepatie vascular occlusion is better than Pfingle maneuver occlusion in be-parle inflow occlusion in HCC surgery.