Clinical study of 169 patients with hepatic angiomyolipoma / 中华外科杂志

<p><b>OBJECTIVE</b>To review and investigate the optimal preoperative diagnostic means and treatment principles of hepatic angiomyolipoma (HAML).</p><p><b>METHODS</b>The clinical features, treatment, prognostic and follow-up data of 169 HAML patients treated between January 1992 and May 2010 were retrospectively analyzed. The median age of the patients, including 46 male and 123 female (male/female, 1/2.7), was 45 years (range, 17 - 73 years). The mean case history was 0.54 year with a range of 2 d to 16 years.</p><p><b>RESULTS</b>Among the 169 patients, 149 patients (88.2%) had a solitary tumor and 96 patients (56.8%) were detected in the right lobe. The overall preoperative diagnostic rate was 13.6% and 119 patients (70.4%) were misdiagnosed as hepatocellular carcinoma or hepatic cavernous hemangioma. The diagnostic accuracy of MRI is higher than CT in distinguishing the nature of the tumor (χ² = 5.508, P = 0.019). One hundred and sixty-eight patients received surgical resection and one received percutaneous microwave coagulation therapy. One patient occurred postoperative hemorrhage and 3 patients developed hydrothorax. The postoperative mortality and recurrence for all the patients were 0. Postoperative pathology confirmed the diagnosis of hepatic angiomyolipoma. Follow-up study showed a benign course and no signs of recurrence.</p><p><b>CONCLUSIONS</b>MRI is the main diagnostic means of HAML. Treatment strategies of HAML depends largely on tumor size, location and growth rate. Surgical management is suggested to patients with the following criteria: (1) tumor size greater than 5 cm; (2) with clinical symptoms; (3) faster tumor growth; (4) the tumor located at 1, 4, 5, 8 segments of liver.</p>

Gastric cancer surgery and its hazards: post operative infection is the most important complication.

BACKGROUND/AIMS: To evaluate early surgical outcome and analyze postoperative complications of gastric cancer surgery, on the basis of standard auditing system. METHODOLOGY: 357 patients who underwent operations for gastric cancer were included in this study. We applied POSSUM (Physiological and Operative Severity Score for the enumeration of Morbidity and mortality) system to predict morbidity. The observed to estimated morbidity ratio (O: E) was calculated to give risk adjusted morbidity. All the complications were stratified according to its severity and analyzed separately. RESULTS: Observed morbidity was not significantly different from predicted value, the O: E ratio was 1.01. Overall, 137 patients were observed to have postop complications (including 5 death); infection was the main complication which complicated about 17 per cent patients and occupying 44 per cent of all complications. Pulmonary infection rate was on the top. CONCLUSIONS: Post operative complication is higher in gastric cancer surgery. POSSUM system along with stratification of complications is a reliable algorithm in surgical audit to analyze various complications. Postoperative infection is the culprit of various complications. Postoperative infection especially the pulmo-nary infection stands on the top of all complications. More prospective study including basic researches is necessary to explore the etiology of different compilations.

Role of post-operative transcatheter arterial chemoembolization in hepatocellular carcinoma with different pathological characteristics / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the efficacy of transcatheter arterial chemoembolization (TACE) on postoperative recurrence of hepatocellular carcinoma.</p><p><b>METHODS</b>A total of consecutive 823 patients with hepatocellular carcinoma from October 1996 to September 2001 were included in this study. All patients underwent curative liver resection and 126 patients (15.3%) received TACE post operation. The effects of postoperative TACE on the recurrence of hepatocellular carcinoma with different pathological characteristics such as tumor size, tumor capsule, number of nodules, vascular invasion and surgical margin was analyzed.</p><p><b>RESULTS</b>Postoperative TACE had not decreased the recurrence rate in patients with a tumor diameter less than 3 cm. Postoperative TACE increased the disease-free survival for patients with tumor diameter of 3 - 10 cm, positive in alpha fetoprotein (AFP), presented vascular invasion or patients with tumor diameter larger than 10 cm, positive in AFP, multi-nodular, presented vascular invasion, resection margin less than 1 cm.</p><p><b>CONCLUSIONS</b>Postoperative TACE can decrease recurrence rate and prolong the survival of hepatocellular carcinoma patients with high risk factors for recurrence.</p>