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1.
Masaji Tani Manabu Kawai Motoki Miyazawa Seiko Hirono Shinomi Ina Ryohei Nishioka Yoichi Fujita Kazuhisa Uchiyama Hiroki Yamaue 《Langenbeck's archives of surgery / Deutsche Gesellschaft fur Chirurgie》2009,394(2):249-253
Background Prognosis of the patients with pancreatic adenocarcinoma is still poor due to a recurrence, and liver metastasis is a distant
metastasis that is foreboded the short survival period.
Methods Between 1999 and 2005, 68 patients for pancreatic adenocarcinoma underwent a pancreaticoduodenectomy (n = 17), a pylorus-preserving pancreaticoduodenectomy (n = 27), distal pancreatectomy (n = 22), or total pancreatectomy (n = 2) with an extensive lymph node dissection.
Results A tumor recurrence occurred to 55 patients (13 of the liver, 21 of the local recurrence, 16 of peritoneal dissemination, three
of the lymph node, and two of lung). The low tumor grade and female demonstrated a risk factor for a liver metastasis (P = 0.043, P = 0.031). A logistic regression analysis demonstrated female (P = 0.02) and low tumor grade (P = 0.04) as independent risk factors for recurrence with liver metastasis. The median survival time (MST) was 13.6 months,
and MST of patients with a liver metastasis as an initial recurrent site was 13.7 months; the liver metastasis as an initial
recurrent site has no impact on the MST after pancreatic resection.
Conclusions We concluded potentially supporting the hypothesis that even patients thought to be at higher risk of liver metastasis may
still be given the chance of resection, considering the satisfying survival. 相似文献
2.
Background We compared outcomes of surgery and radiofrequency thermal ablation (RFA) in patients with metachronous liver metastases.
Methods Between October 1995 and December 2005, 59 patients underwent hepatic resection and 30 underwent RFA for metachronous liver
metastases. Patients with extra-hepatic metastases, those who underwent both types of treatment, and those with synchronous
hepatic metastasis were excluded.
Results The two groups had similar mean age, sex ratio, comorbid medical conditions, primary disease stage, and frequency of solitary
metastases. Preoperative mean serum carcinoembryonic antigen (CEA) level was significantly higher in the RFA group (13.4 ng/mL
vs. 7.7 ng/mL; p = 0.02). Mean diameter of hepatic metastases was significantly greater in the resection than in the RFA group (3.1 cm vs.
2.0 cm; p = 0.001). Recurrence after treatment of metastasis was observed in 18 of 30 (60.0%) RFA and 33 of 59 (56%) resection patients.
Local recurrence at the RFA site was observed in 7 of 30 (23%) patients. Time to recurrence (15 vs. 8 months, p = 0.02) and overall survival (56 vs. 36 months, p = 0.005) were significantly longer in the resection than in the RFA group. In the 69 patients with solitary metastases of
diameter ≤3 cm, time to recurrence (p = 0.004) and overall survival were significantly greater in the resection group.
Conclusions Compared with hepatic resection, RFA for metachronous hepatic metastases from colorectal cancer was associated with higher
local recurrence and shorter recurrence-free and overall survival rates, even in patients with solitary, small (≤3 cm) lesions. 相似文献
3.
Surgical Resection Versus Radiofrequency Ablation in the Treatment of Small Unifocal Hepatocellular Carcinoma 总被引:1,自引:0,他引:1
M. Abu-Hilal J. N. Primrose A. Casaril M. J. W. McPhail N. W. Pearce N. Nicoli 《Journal of gastrointestinal surgery》2008,12(9):1521-1526
Background Hepatocellular carcinoma (HCC) has a high worldwide prevalence and mortality. While surgical resection and transplantation
offers curative potential, donor availability and patient liver status and comorbidities may disallow either. Interventional
radiological techniques such as radiofrequency ablation (RFA) may offer acceptable overall and disease-free survival rates.
Materials and Methods Sixty-eight cirrhotic patients matched for age, sex, tumor size, and Child–Pugh grade with small (1–5 cm) unifocal HCC were
studied retrospectively to find determinants of overall and disease-free survival in those treated with surgical resection
and RFA between 1991 and 2003.
Results Multivariate analysis using Cox proportional regression modeling showed that overall survival was related to tumor recurrence
(p = 0.010), tumor diameter (p = 0.002), and treatment modality (p = 0.014); overall p = 0.008. Recurrence was independently related to the use of RFA over surgery (p = 0.023) on multivariate analysis; overall p = 0.034.
Conclusion Surgical resection offers longer disease-free survival and potentially longer overall survival than RFA in patients with small
unifocal HCC. 相似文献
4.
Survival of Patients with Synchronous and Metachronous Colorectal Liver Metastases—is there a Difference? 总被引:1,自引:0,他引:1
Maximilian Bockhorn Andreja Frilling Nils R. Frühauf Jan Neuhaus Ernesto Molmenti Tanja Trarbach Massimo Malagó Hauke Lang Christoph E. Broelsch 《Journal of gastrointestinal surgery》2008,12(8):1399-1405
Background The aim of this study was to compare outcomes in patients with synchronous and metachronous colorectal liver metastases, with
special emphasis on prognostic determinants.
Study design We analyzed prospectively collected data on 101 patients with synchronous metastases (group A) who were treated surgically
during the time period from April 1998 to December 2006 in regard to overall and disease-free survival, impact of chemotherapy,
as well as several serum parameters. A group of patients with metachronous colorectal liver metastases (group B) was considered
for baseline comparison.
Results Twenty-three patients in group A received only an explorative laparotomy. Surgical treatment included right hepatectomy (n = 7), left hepatectomy (n = 5), right trisectionectomy (n = 10), left trisectionectomy (n = 1), left lateral resection (n = 11), and sectionectomy (n = 44). Thirty-day mortality was 3%. Morbidity was observed in 10% of the patients. One-, 3-, and 5-year overall survival
rates for synchronous metastases were 86%, 68%, and 47%, respectively. The corresponding rates for metachronous metastases
were 94%, 68%, and 39% (p > 0.05). Disease free survival was 74%, 42%, and 33% in group A versus 84%, 62%, and 13% in group B (p = 0.28). There was no difference in survival between patients receiving neoadjuvant chemotherapy and no chemotherapy (p > 0.05). Out of all serum parameters, carcinoembryonic antigen levels were a negative predictor for overall and disease-free
survival only.
Conclusions Patients with synchronous colorectal liver metastases had a similar 5-year overall and disease-free survival, which corresponds
to patients with metachronous metastases. The impact of neoadjuvant chemotherapy in patients with synchronous metastases needs
to be further clarified. 相似文献
5.
Radiofrequency Ablation vs. Resection for Hepatic Colorectal Metastasis: Therapeutically Equivalent?
Nathaniel P. Reuter Charles E. Woodall Charles R. Scoggins Kelly M. McMasters Robert C. G. Martin 《Journal of gastrointestinal surgery》2009,13(3):486-491
Introduction The role of ablation for hepatic colorectal metastases (HCM) continues to evolve as ablation technology changes and systemic
chemotherapy improves. Our aim was to evaluate the therapeutic efficacy of radiofrequency ablation (RFA) of HCM compared to
surgical resection.
Methods A retrospective review of our 1,105 patient prospective hepatic database from August 1995 to July 2007 identified 192 patients
with only hepatic resection or only ablation for HCM.
Results Patients who underwent RFA were similar to resection patients based on a similar Fong score (1.8 vs. 2.1 p = 0.28), presence of extrahepatic disease (15% vs. 9% p = 0.19), mean number of hepatic lesions (2.8 vs. 2.1 p = 0.14), and prior chemotherapy (67% vs. 60% p = 0.33). Median time to recurrence was shorter with ablation than resection (12.2 vs. 31.1 months; p < 0.001). Recurrence at the ablation–resection site was more common with ablation than resection occurring 17% vs. 2% (p ≤ 0.001) of the time, respectively. Distant recurrence in the liver was also more common with ablation occurring in 33% of
patients vs. 14% for resection (p = 0.002).
Conclusions Surgical resection is associated with a lower chance of recurrence and a longer disease-free interval than RFA and should
remain the treatment of choice in resectable HCM. 相似文献
6.
Srinevas K. Reddy Gloria Broadwater Donna Niedzwiecki Andrew S. Barbas Herbert I. Hurwitz Johanna C. Bendell Michael A. Morse Bryan M. Clary 《Journal of gastrointestinal surgery》2009,13(1):74-84
Background Few studies identifying variables associated with prognosis after resection of colorectal liver metastases (CLM) account for
treatment with multiagent chemotherapy (fluoropyrmidines with irinotecan, oxaliplatin, bevacizumab, and/or cetuximab). The
objective of this retrospective study was to determine the effect of multiagent chemotherapy on long-term survival after resection
of CLM.
Methods Demographics, clinicopathologic tumor characteristics, treatments, and long-term outcomes were reviewed.
Results From 1996 to 2006, 230 patients underwent resection of CLM. Treatment strategies before and after resection included fluoropyrimidine
monotherapy (n = 34 and n = 39), multiagent chemotherapy (n = 81 and n = 73), and observation (n = 115 and n = 118). Prehepatectomy treatment strategy was not associated with overall survival. Actuarial 4-year survival was 63%, 39%,
and 40% for patients treated with multiagent chemotherapy, fluoropyrimidine monotherapy, and observation after hepatectomy,
p = 0.06. Posthepatectomy multiagent chemotherapy (p = 0.04, HR 0.52 [0.27–1.03]), duration of posthepatectomy chemotherapy treatment of 2 months or longer (p = 0.05, HR 0.49 [0.25–0.99]), carcino-embryonic antigen level >10 ng/mL (p = 0.03, HR 2.09, 95% CI [1.32–3.32]), and node positive primary tumor (p = 0.002, HR 1.79 [1.06–3.02]) were associated with overall survival in multivariate analysis.
Conclusions The association of posthepatectomy multiagent chemotherapy with overall survival in this retrospective study indicates the
need for prospective randomized trials comparing multiagent chemotherapy and fluoropyrimidine monotherapy for CLM. 相似文献
7.
Kelvin K. Ng Ronnie T. Poon Chung-Mau Lo Jimmy Yuen Wai Kuen Tso Sheung-Tat Fan 《Journal of gastrointestinal surgery》2008,12(1):183-191
Background Radiofrequency ablation (RFA) is an effective local ablation therapy for hepatocellular carcinoma (HCC) with favorable long-term
outcome. There is no data on the analysis of recurrence pattern and its influence on long-term survival outcome after RFA
in HCC patients.
Aim of Study To evaluate the tumor recurrence pattern and its influence on long-term survival in patients with HCC treated with RFA.
Patients and Methods From April 2001 to January 2005, 209 patients received RFA using internally cooled electrode as the sole treatment modality
for HCC. Among them, 117 patients (56%) had unresectable HCC because of bilobar disease, poor liver function, and/or high
medical risk for resection; whereas 92 patients (44%) underwent RFA as the primary treatment for small resectable HCC. The
ablation procedure was performed through percutaneous (n = 101), laparoscopic (n = 17), or open approaches (n = 91). The tumor recurrence pattern and long-term survival were analyzed. Multivariate analysis was carried out to identify
independent prognostic factors affecting the overall survival of patients.
Results The mortality and morbidity rates were 0.9 and 15.7%, respectively. Complete tumor ablation was achieved in 192 patients (92.7%).
With a median follow-up period of 26 months, local recurrence occurred in 28 patients (14.5%). Same segment and different
segment intrahepatic recurrence occurred in 30 patients (15.6%) and 78 patients (40.6%), respectively. Twenty patients (10.4%)
developed distant extrahepatic metastases. The overall 1-, 3-, and 5-year survival rates were 87.2, 66.6, and 42%, respectively.
Different segment intrahepatic recurrence and distant recurrence after RFA carried significant poor prognostic influence on
overall survival outcome. Using multivariate analysis, Child–Pugh grade (risk ratio [RR] = 2.918, 95% confident interval [CI]
1.704–4.998, p = 0.000), tumor size (RR = 1.231, 95% CI 1.031–1.469, p = 0.021), and pattern of recurrence (risk ratio [RR] = 1.464, 95% CI 1.156–1.987, P = 0.020) were identified as independent prognostic factors for overall survival.
Conclusion The tumor recurrence pattern after RFA carries significant prognostic value in relation to overall survival. Long-term regular
surveillance and aggressive treatment strategy are required for patients with different segment intrahepatic recurrence to
optimize the benefits of RFA. 相似文献
8.
Michelle L. DeOliveira Timothy M. Pawlik Ana L. Gleisner Lia Assumpcaom Gaspar J. Lopes-Filho Michael A. Choti 《Journal of gastrointestinal surgery》2007,11(8):970-976
Survival after resection of colorectal liver metastases has traditionally been associated with clinicopathologic factors.
We sought to investigate whether echogenicity of colorectal liver metastasis as assessed by intraoperative ultrasound (IOUS)
was a prognostic factor after hepatic resection. Prospective data on tumor IOUS appearance were collected in 84 patients who
underwent hepatic resection for colorectal liver metastasis. Images were digitally recorded, blindly reviewed, and scored
for echogenicity (hypo-, iso-, or hyperechoic). The median tumor number was 1 and the median tumor size was 5.0 cm. At the
time of surgery, the IOUS appearance of the colorectal liver metastases were hypoechoic in 35 (41.7%) patients, isoechoic
in 37 (44.0%) patients, and hyperechoic in 12 (14.3%) patients. Traditional clinicopathologic prognostic factors were similarly
distributed among the three echogenicity groups (all p > 0.05). Patients with a hypoechoic lesion had a significantly shorter median survival (30.2 months) compared with patients
who had either an isoechoic (53.2 months) or hyperechoic (42.3 months) lesion (p = 0.005). The 5-year survival after hepatic resection of colorectal liver metastasis was also associated with the echogenic
appearance of the lesion (hypoechoic 14.4 vs isoechoic 37.4 vs hyperechoic 46.2%) (p < 0.05). Intraoperative ultrasound echogenicity should be considered a prognostic factor after hepatic resection of metastatic
colorectal cancer.
This study was presented at the 47th annual meeting of The Society for Surgery of the Alimentary Tract, Los Angeles, CA, USA,
22 May 2006. 相似文献
9.
Won-Suk Lee Min Jung Kim Seong Hyeon Yun Ho-Kyung Chun Woo Yong Lee Sung-Joo Kim Seong-Ho Choi Jin-Seok Heo Jae Won Joh Yong Il Kim 《Langenbeck's archives of surgery / Deutsche Gesellschaft fur Chirurgie》2008,393(1):13-19
Background/aim This study was conducted to devise a prognostic model for patients undergoing simultaneous liver and colorectal resection.
Materials and methods A retrospective analysis was performed on 138 colorectal patients who underwent simultaneous liver and colorectal resection
between September 1994 and September 2005. The primary endpoint of the study was overall survival. Three patients with positive
liver resection margin were excluded from the analysis.
Results At multivariate level, poor prognostic factors were liver resection margin ≤5 mm (P = 0.047; relative risk, 1.684; 95% CI = 1.010–2.809), CEA greater than 5 ng/ml (P = <0.001; relative risk, 2.507; 95% CI = 1.499–4.194), number of liver metastasis > 1 (P = <0.042; relative risk, 1.687; 95% CI = 1.020–2.789), and lymph node ≥ 4 (P = <0.012; relative risk, 1.968; 95% CI = 1.158–3.347). The risk stratification grouping of the 135 patients was performed according to the following criteria: low
risk group, 0–1 factor; intermediate risk group, 2 factors; high-risk group, 3–4 factors. Of 135 patients, 86 patients (63.0%)
were categorized as low-risk group, 36 patients (26.6%) as intermediate risk group, and 14 patients (10.4%) as high-risk group.
Median survival times for low, intermediate, high-risk groups were 68.0, 43.6 (95% CI, 24.7–62.4), and 23.5 months (95% CI,
9.4–31.5), respectively. The high-risk group demonstrated an approximately threefold (relative risk, 3.1; 95% CI, 1.6–6.0)
increased risk of death.
Conclusions A simple risk factor stratification system was proposed to evaluate the chances of cure of patients after simultaneous resection
of liver metastases and primary colorectal carcinoma. The risk factor stratification showed three groups with distinct survival.
The risk stratification may help to predict patient survival after simultaneous liver and colorectal resection. This system
needs further prospective validation. 相似文献
10.
S. W. Cho J. W. Marsh D. A. Geller M. Holtzman H. Zeh III D. L. Bartlett T. C. Gamblin 《Journal of gastrointestinal surgery》2008,12(12):2141-2148
Introduction Leiomyosarcoma of the inferior vena cava (IVC) is a rare tumor for which en bloc resection offers the only chance of cure.
Due to its rarity, however, optimal strategies for the management of the primary tumor and subsequent recurrences are not
well defined.
Methods We performed a retrospective review of patients who underwent surgical resection of IVC leiomyosarcoma. We evaluated clinical
presentations, operative techniques, patterns of recurrence and survival.
Results From 1990 to 2008, nine patients (four females) were identified. Median age was 55 years (40–76). Presentations included abdominal
pain (n = 5), back pain (n = 2), leg swelling (n = 4) and abdominal mass (n = 2). Pre-operative imaging studies showed tumor location to be from the right atrium to renal veins (n = 1), retrohepatic (n = 5), and from hepatic veins to the iliac bifurcations (n = 3). En bloc resection included right nephrectomy (n = 5), right adrenalectomy (n = 4), pancreaticoduodenectomy (n = 1), right hepatic trisectionectomy (n = 1) and right hemicolectomy (n = 1). The IVC was ligated in six patients, and a prosthetic graft was used for IVC reconstruction in three patients. Resection
margins were negative in seven cases. Median length of stay was 12 days (range, 6–22 days). Major morbidity included renal
failure (n = 1) and there was one post-operative mortality. Five patients had leg edema post-operatively, four of whom had IVC ligation.
Median survival was 47 months (range, 1–181 months). Four patients had recurrence and the median time to recurrence was 14 months
(range, 3–25 months). Two patients underwent successful resection of recurrence.
Conclusions Curative resection of IVC leiomyosarcoma can lead to long-term survival. However, recurrence is common, and effective adjuvant
treatments are needed. In selected cases, aggressive surgical treatment of recurrence should be considered.
Presented at the Digestive Disease Week 2008, San Diego, CA, USA, May 2008.
Grant Support: NIH K12 HD 049109 (T.C.G.). 相似文献
11.
Robert M. Eisele Ulf Neumann Peter Neuhaus Guido Schumacher 《World journal of surgery》2009,33(4):804-811
Purpose This study was designed to determine the best approach to radiofrequency ablation (RFA) in the liver.
Methods From a total of 41 procedures, 37 patients with 47 tumors were treated with RFA for metastatic disease. Indications included
colorectal cancer (n = 28, 68%), neuroendocrine tumors (n = 2, 5%), gynecological primaries (n = 4, 10%), pancreatic/duodenal cancer (n = 2, 5%), and miscellaneous entities (n = 5, 12%). Mean follow-up period was 18 (median, 18) months. All ways of approach to RFA were applied: percutaneous was chosen
in 17 (41.5%), laparoscopic and hand-assisted laparoscopic in 5 (12.2%), and open surgical in 19 cases (46.3%), and in 10
cases, RFA was combined with hepatic resection. The average maximum tumor size was 2.3 (range, 0.8–6) cm, and the mean number
of nodules treated per patient in a single session was 1.3 (range, 1–3).
Results Overall survival was 59.5% at 2 years, recurrence-free 2-year survival was 12.6%, local tumor recurrence rate was 34%, and
overall recurrence was 75.6%. Local tumor recurrence and disease-free survival were significantly improved in the open surgically
treated patients compared with the percutaneous treatment group (15.8% [n = 3] vs. 58.8% [n = 10] and 11.5 vs. 7.9 months, p < 0.01 [χ2 test] and p < 0.05 [log-rank test], respectively).
Conclusions Open surgical approach is superior to percutaneous access for RFA in metastatic hepatic disease. 相似文献
12.
Pulitanò C Bodingbauer M Aldrighetti L de Jong MC Castillo F Schulick RD Parks RW Choti MA Wigmore SJ Gruenberger T Pawlik TM 《Annals of surgical oncology》2011,18(5):1380-1388
Background
Hepatic resection for colorectal liver metastasis (CLM) with concomitant extrahepatic disease (EHD) is a controversial topic. We sought to evaluate the long-term outcome of patients undergoing liver resection for CLM in presence of EHD and identify factors associated with prognosis.Methods
From 1996 to 2007, a total of 1629 patients who underwent resection of CLM were identified from an international multi-institutional database. One hundred seventy-one patients (10.4%) underwent resection of EHD. Clinicopathologic and outcome data were collected and analyzed by univariate and multivariate analyses.Results
Median number of treated CLM was 2 (range, 1–18); most patients had solitary EHD (n = 114; 66.6%) a single anatomic site of EHD (n = 153; 89.4%). The 5-year survival for patients with EHD was 26% compared with 58% for those without EHD (P < 0.001). Recurrence was common (84%). Among patients with EHD, R1 margin status, multiple EHD sites, and location of EHD were associated with worse survival (all P < 0.05). Patients with multiple EHD sites or aortocaval lymph node metastasis had a 5-year survival of 14% and 7%, respectively. When survival was stratified by the total number of metastases treated, the presence of EHD still had a prognostic impact, but the relative impact of EHD diminished as the total number of metastases treated increased.Conclusion
Concurrent resection of hepatic and EHD in well-selected patients may provide the possibility of long-term survival. The risk of recurrence, however, remains high, and a worse outcome is associated with both number of metastases and location of EHD. 相似文献13.
Mechteld C. de Jong Skye C. Mayo Carlo Pulitano Serena Lanella Dario Ribero Jennifer Strub Catherine Hubert Jean-François Gigot Richard D. Schulick Michael A. Choti Luca Aldrighetti Gilles Mentha Lorenzo Capussotti Timothy M. Pawlik 《Journal of gastrointestinal surgery》2009,13(12):2141-2151
Introduction
Although 5-year survival approaches 55% following resection of colorectal liver metastasis, most patients develop recurrent disease that is often isolated to the liver. Although repeat curative intent surgery (CIS) is increasingly performed for recurrent colorectal liver metastasis, only small series have been reported. We sought to determine safety and efficacy of repeat CIS for recurrent colorectal liver metastasis as well as determine factors predictive of survival in a large multicenter cohort of patients.Methods
Between 1982 and 2008, 1,706 patients who underwent CIS—defined as curative intent hepatic resection/radiofrequency ablation (RFA)—for colorectal liver metastasis were identified from an international multi-institutional database. Two hundred forty-six (14.4%) patients underwent 301 repeat CIS. Data on clinico-pathologic factors, morbidity, and mortality were collected and analyzed.Results
Following initial CIS, 645 (37.8%) patients had recurrence within the liver. Of these, 246 patients underwent repeat CIS for recurrent disease. The majority had hepatic resection alone as initial therapy (n?=?219; 89.0%). A subset of patients underwent third (n?=?46) or fourth (n?=?9) repeat CIS. Mean interval between surgeries was similar (first → second, 19.1 months; second → third, 21.5 months; third → fourth, 11.3 months; P?=?0.20). Extent of hepatic resection decreased with subsequent CIS (≥hemihepatectomy: first CIS, 30.9% versus second CIS, 21.1% versus third/fourth CIS, 16.4%; P?=?0.004). RFA was utilized in one quarter of patients undergoing repeat CIS (second CIS, 21.1% versus third/fourth CIS, 25.5%). Mortality and morbidity were similar following second, third, and fourth CIS, respectively (all P?>?0.05). Five-year survival was 47.1%, 32.6%, and 23.8% following the first, second, and third CIS, respectively. Presence of extra-hepatic disease was predictive of worse survival (HR?=?2.26, P?=?0.01).Conclusion
Repeat CIS for recurrent colorectal liver metastasis can be performed with low morbidity and near-zero mortality. Patients with no extra-hepatic disease are best candidates for repeat CIS. In these patients, repeat CIS can offer the chance of long-term survival. 相似文献14.
Surgical resection versus radiofrequency ablation for small hepatocellular carcinomas within the Milan criteria 总被引:2,自引:0,他引:2
Shinichi Ueno Masahiko Sakoda Fumitake Kubo Kiyokazu Hiwatashi Taro Tateno Yoshiro Baba Susumu Hasegawa Hirohito Tsubouchi For The Kagoshima Liver Cancer Study Group 《Journal of Hepato-Biliary-Pancreatic Surgery》2009,16(3):359-366
Background/Purpose It has been reported that hepatic resection may be preferable to other modalities for the treatment of small hepatocellular
carcinomas (HCCs), by contributing to improved overall and disease-free survival. Ablation techniques such as radiofrequency
ablation (RFA) have also been used as therapy for small HCCs; however, few studies have compared the two treatments based
on long-term outcomes. The effectiveness of hepatic resection and RFA for small nodular HCCs within the Milan criteria were
compared.
Methods A retrospective cohort study was performed with 278 consecutive patients who underwent curative hepatic resection (n = 123) or initial RFA percutaneously (n = 110) or surgically (thoracoscopic-, laparoscopic-, and open-approaches; n = 45) for HCC. The selection criteria for treatment were based on uniform criteria. Mortality related to therapy and 3- and
5-year overall and disease-free survivals were analyzed.
Results The model for endstage liver disease (MELD) scores for all patients in the series were less than 13. There were no therapy-related
mortalities in either the hepatic resection or RFA groups. The incidence of death within 1 year after therapy (1.6 and 1.9%,
respectively) was similar in the hepatic resection and RFA groups. The group that underwent hepatic resection showed a trend
towards better survival (P = 0.06) and showed significantly better disease-free survival (P = 0.02) compared with the RFA group, although differences in liver functional reserve existed. The advantage of hepatic resection
was more evident for patients with single tumors and patients with grade A liver damage. In contrast, patients with multinodular
tumors survived longer when treated with RFA, regardless of the grade of liver damage. Further analysis showed that surgical
RFA could potentially have survival benefits similar to those of hepatic resection for single tumors, and that surgical RFA
had the highest efficacy for treating multinodular tumors.
Conclusions In patients with small HCCs within the Milan criteria, hepatic resection should still be employed for those patients with
a single tumor and well-preserved liver function. RFA should be chosen for patients with an unresectable single tumor or those
with multinodular tumors, regardless of the grade of liver damage. In order to increase long-term oncological control, surgical
RFA seems preferable to percutaneous RFA, if the patient’s condition allows them to tolerate surgery. 相似文献
15.
Shin Hwang Sung-Gyu Lee Young-Joo Lee Chul-Soo Ahn Ki-Hun Kim Kwang-Min Park Ki-Myung Moon Deok-Bog Moon Tae-Yong Ha Eun-Sil Yu Ga-Won Choi 《Journal of gastrointestinal surgery》2008,12(4):718-724
Sarcomatous change has been rarely observed in hepatocellular carcinoma (HCC), but it is usually associated with very aggressive
tumor behavior and widespread metastasis. To assess the impact of sarcomatous changes, we analyzed the outcomes of 15 patients
with sarcomatous HCC after resection (n = 11) or liver transplantation (LT) (n = 4). No imaging findings characteristic of sarcomatous changes were observed. According to modified pathological tumor-node
metastasis staging, the HCC lesions were classified as stage II in five patients, stage III in six, stage IVa2 in two, and
stage IVb in one. The Milan criteria were met in 7 of 15 patients, including 3 of 4 in the LT group. R0 resection was achieved
in 9 of 11 resected patients, and their 3-year overall and disease-free survival rates were both 18.2%. In the LT group, 3-year
overall and disease-free survival rates were 37.5 and 25%, respectively. In patients within the Milan criteria, 2-year overall
survival rate was 25% after resection and 33% after LT, showing no prognostic difference. Extrahepatic metastasis as initial
recurrence was detected in 80% after resection and 66.7% after LT. In conclusion, we found that the prognosis of patients
with sarcomatous HCC was very unfavorable after either resection or LT and that, except for liver biopsy, no diagnostic method
could distinguish between sarcomatous and ordinary HCC. Vigorous postoperative systemic surveillance may be helpful for timely
detection and treatment of localized metastases. 相似文献
16.
P. Vogel U. Bolder M. N. Scherer H.-J. Schlitt K.-W. Jauch 《Langenbeck's archives of surgery / Deutsche Gesellschaft fur Chirurgie》2009,394(2):331-337
Background/Aims Soft tissue sarcomas (STS) are rare tumors. General treatment is difficult while multimodality treatment strategies are more
and more common. In these strategies, surgical resection of the primary tumor is essential to achieve local control of the
tumor. In certain cases, complex resections (CR) including multivisceral and/or vascular resection are needed to achieve resection
with tumor-free margins. In this study, we evaluated retrospectively the overall prognosis, morbidity, and mortality of patients
treated for STS at our university hospital.
Patients/Methods Between 1992 and 2000, 24 of 154 patients with STS received multivisceral resection and four of 154 underwent vascular resection.
To determine the influence of CR on overall prognosis, we compared n = 19 patients after CR with a matched control group after simple tumor resection (SR). To determine surgical morbidity and
mortality the whole study group was used (n = 154, SR n = 126, CR n = 28).
Results The median follow up for all patients was 6.89 years (mean 5.64 years SD 4.3) with no difference between the groups (CR vs
SR: 5.4 SD 4.8 vs 5.9 SD 3.9 years; p = 0.711). Patients receiving CR had a similar overall prognosis (mean survival 9.9 years), morbidity (10.7%) and mortality (0%) compared
to patients with SR (mean survival 8.5 years; morbidity 10.3%; mortality 3.96%).
Conclusions Multivisceral resection and/or vascular resection with tumor-free margins can be achieved with the same overall prognosis,
same morbidity and mortality as SR. This has to be taken into account when evaluating the treatment strategy in patients with
STS. 相似文献
17.
Anastomotic Leakage is Associated with Poor Long-Term Outcome in Patients After Curative Colorectal Resection for Malignancy 总被引:2,自引:0,他引:2
Wai Lun Law Hok Kwok Choi Yee Man Lee Judy W. C. Ho Chi Leung Seto 《Journal of gastrointestinal surgery》2007,11(1):8-15
The impact of anastomotic leakage on long-term outcomes after curative surgery for colorectal cancer has not been well documented.
This study aimed to investigate the effect of anastomotic leakage on survival and tumor recurrence in patients who underwent
curative resection for colorectal cancer. Prospectively collected data of the 1,580 patients (904 men) of a median age of
70 years (range: 24–94), who underwent potentially curative resection for colorectal cancer between 1996 and 2004, were reviewed.
Cancer-specific survival and disease recurrence were analyzed using Kaplan Meier method, and variables were compared with
log rank test. Cox regression model was used in multivariate analysis. The cancer was situated in the colon and the rectum
in 933 and 647 patients, respectively. Anastomotic leakage occurred in 60 patients (clinical leakage: n = 48; radiological leak: n = 12). The leakage rate was significantly higher in patients with surgery for rectal cancer (6.3 vs 2.0%, p < 0.001). The 5-year cancer-specific survivals were 56.9% in those with leakage and 75.9% in those without leakage (p = 0.012). The 5-year systemic recurrence rates were 48.4 and 22.6% in patients with and without anastomotic leak, respectively
(p = 0.001), whereas the 5-year local recurrence rates were 12.9 and 5.7%, respectively (p = 0.009). Anastomotic leakage remained an independent factor associated with a worse cancer-specific survival (p = 0.043, hazard ratio: 1.63, 95% CI: 1.02–2.60) and a higher systemic recurrence rate (hazard ratio: 1.94, 95% CI: 1.23–3.06,
p = 0.004) on multivariate analysis. In rectal cancer, anastomotic leakage was an independent factor for a higher local recurrence
rate (hazard ratio: 2.55, 95% CI: 1.07–6.06, p = 0.034). In conclusion, anastomotic leakage is associated with a poor survival and a higher tumor recurrence rate after
curative resection of colorectal cancer. Efforts should be undertaken to avoid this complication to improve the long-term
outcome.
This work was presented in the plenary session of the 47th Annual Meeting of the Society for Surgery of the Alimentary Tract
at the Digestive Disease Week in Los Angeles on 22 May 2006. 相似文献
18.
The purpose of this study was to compare the outcome, complications and survival of the three most commonly used surgical
reconstructions of the proximal humerus after transarticular tumour resection. Between 1985 and 2005, 38 consecutive proximal
humeral reconstructions using allograft-prosthesis composite (n = 10), osteoarticular allograft (n = 13) or a modular tumour prosthesis (n = 14) were performed in our clinic. The mean follow-up was ten years (1–25). Of these, 27 were disease free at latest follow-up
(mean 16.8 years) and ten had died of disease. The endoprosthetic group presented the smallest complication rate of 21% (n = 1), compared to 40% (n = 4) in the allograft-prosthesis composite and 62% (n = 8) in the osteoarticular allograft group. Only one revision was performed in the endoprosthetic group, in a case of shoulder
instability. Infection after revision (n = 3), pseudoarthrosis (n = 2), fracture of the allograft (n = 3) and shoulder instability (n = 4) were the major complications of allograft use in general. Kaplan-Meier analysis showed a significantly better implant
survival for the endoprosthetic group (log-rank p = 0.002). At final follow-up the Musculoskeletal Tumour Society scores were an average of 72% for the allograft-prosthetic
composite (n = 7, median follow-up 17 years), 76% for the osteoarticular allograft (n = 3, 19 years) and 77% for the endoprosthetic reconstruction (n = 10, 5 years) groups. An endoprosthetic reconstruction after transarticular proximal humeral resection resulted in the lowest
complication rate, highest implant survival and comparable functional results when compared to allograft-prosthesis composite
and osteoarticular allograft use. We believe that the surgical approach that best preserves the abductor mechanism and provides
sufficient surgical exposure for tumour resection contributed to better functional results and glenohumeral stability in the
endoprosthetic group. 相似文献
19.
Eddie K. Abdalla Dario Ribero Timothy M. Pawlik Daria Zorzi Steven A. Curley Andrea Muratore Axel Andres Gilles Mentha Lorenzo Capussotti Jean-Nicolas Vauthey 《Journal of gastrointestinal surgery》2007,11(1):66-72
Purpose: To examine clinical features and outcome of patients who underwent hepatic resection for colorectal liver metastases (LM)
involving the caudate lobe.
Patients and Methods: Consecutive patients who underwent hepatic resection for LM from May 1990 to September 2004 were analyzed from a multicenter
database. Demographics, operative data, pathologic margin status, recurrence, and survival were analyzed.
Results: Of 580 patients, 40 (7%) had LM involving the caudate. Six had isolated caudate LM and 34 had LM involving the caudate plus
one or more other hepatic segments. Patients with caudate LM were more likely to have synchronous primary colorectal cancer
(63% vs. 36%; P = 0.01), multiple LM (70% vs. 51%; P = 0.02) and required extended hepatic resection more often than patients with non-caudate LM (60% vs. 18%; P < 0.001). Only four patients with caudate LM underwent a vascular resection; three at first operation, one after recurrence
of a resected caudate tumor. All had primary repair (vena cava, n = 3; portal vein, n = 1). Perioperative complications (43% vs. 28%) and 60-day operative mortality (0% vs. 1%) were similar (caudate vs. non-caudate
LM, both P > 0.05). Pathological margins were positive in 15 (38%) patients with caudate LM and in 43 (8%) with non-caudate LM (P < 0.001). At a median follow-up of 40 months, 25 (64%) patients with caudate LM recurred compared with 219 (40%) patients
with non-caudate LM (P = 0.01). Patients with caudate LM were more likely to have intrahepatic disease as a component of recurrence (caudate: 51%
vs. non-caudate: 25%; P = 0.001). No patient recurred on the vena cava or portal vein. Patients with caudate LM had shorter 5-year disease-free and
overall survival than patients with non-caudate LM (disease-free: 24% vs. 44%; P = 0.02; overall: 41% vs. 58%; P = 0.02).
Conclusions: Patients who undergo hepatic resection for caudate LM often present with multiple hepatic tumors and tumors in proximity to
the major hepatic veins. Extended hepatectomy is required in the majority, although vascular resection is not frequently necessary;
when performed, primary repair is usually possible. Despite resection in this population of patients with multiple and bilateral
tumors, and despite close-margin and positive-margin resection in a significant proportion, recurrence on the portal vein
or vena cava was not observed, and long-term survival is accomplished (41% 5-year overall survival).
These data were presented at the American Hepato-Pancreato-Biliary Association 2006 Annual Meeting, Miami, Florida, March
12, 2006. 相似文献
20.
Darren R. Carpizo PhD Chandrakanth Are MD William Jarnagin MD Ronald DeMatteo MD Yuman Fong MD Mithat Gönen PhD Leslie Blumgart MD Michael D’Angelica MD 《Annals of surgical oncology》2009,16(8):2138-2146
Background Surgical resection for patients with hepatic and extrahepatic (EHD) colorectal metastases is controversial. We analyzed our
experience with hepatic resection in patients with concomitant EHD. The aims were to characterize survival, recurrence rates,
and factors associated with outcome.
Methods From 1992 to 2007, 1,369 patients underwent resection of hepatic colorectal metastases, of whom 127 (9%) had concurrent resection
of EHD. Survival and recurrence were compared between patients with and without EHD. Survival data were stratified by site
of metastatic involvement. Variables potentially associated with survival were analyzed in univariate and multivariate analyses.
Results Median follow-up was 24 months (range 3–152 months). The 3- and 5-year survival for patients with concomitant EHD were 47%
and 26%, respectively, compared with 67% and 49%, for those without EHD (P < 0.001). Among the patients with EHD, multivariate analysis identified higher clinical risk score, incomplete resection
of all EHD, EHD detected intraoperatively, and having received neoadjuvant chemotherapy to be independently associated with
a worse survival. Patients with portal lymph node metastases had worse survival than those with lung or ovarian metastases.
Among patients who had a complete resection of all disease, 95% recurred.
Conclusion Concurrent resection of hepatic and EHD in well-selected patients is associated with a possibility of long-term survival.
The presence of limited and resectable EHD should not be an absolute contraindication to resection. The site of EHD and the
nearly universal recurrence rate must be taken into consideration. 相似文献