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1.
Zhang Xingmao Zhou Haitao Liang Jianwei Hou Huirong HU Junjie Zhou Zhixiang 《International journal of colorectal disease》2014,29(9):1119-1124
Purpose
The purposes of this study were to compare the short-term outcomes of natural orifice specimen extraction (NOSE) and laparoscopic-assisted resection for sigmoid colon cancer or rectal cancer and to appraise whether totally laparoscopic resection with NOSE had more advantages compared with conventional laparoscopic-assisted resection.Methods
Sixty-five patients who underwent totally laparoscopic resection with NOSE were assigned to NOSE group, and 132 patients who underwent laparoscopic-assisted resection were assigned to laparoscopic-assisted (LA) group. Data of all 197 cases were reviewed. Short-term outcomes (including operative outcomes, gastrointestinal recovery, hospital stay, and complication) of the two groups were compared.Results
Mean numbers of lymph nodes harvested were 17.0?±?8.3 and 18.9?±?11.6 in NOSE group and LA group, respectively, (P?=?0.248); mean operative times were 111.6?±?25.4 min and 115.3?±?23.0 min in the two groups (P?=?0.384); and the mean blood losses in these two groups were 70.2?±?66.1 ml and 126.3?±?58.6 ml, respectively, (P?0.001). Times to first flatus were 2.7?±?0.8 and 3.4?±?0.9 days (P?0.001), and times to first defecation were 3.3?±?0.6 and 3.9?±?1.1 days (P?=?0.002) in NOSE group and LA group, respectively. Hospital stay in NOSE group were 9.0?±?1.9 and 9.9?±?2.0 days in LA group. Incidences of peri-operative complications were 6.2 and 17.2 % in the two groups, respectively (P?=?0.031).Conclusions
Without compromising oncologic outcome, totally laparoscopic resection with NOSE had more advantages including less blood loss, less pain, faster recovery of intestinal function and shorter hospital stay compared with laparoscopic-assisted resection for selected patients with sigmoid colon cancer or rectal cancer. 相似文献2.
Dae Wook Hwang Ho-Seong Han Yoo-Seok Yoon Jai Young Cho Yujin Kwon Ji Hoon Kim Joon Seong Park Dong Sup Yoon In Seok Choi Keun Soo Ahn Yong Hoon Kim Koo Jeong Kang Young Hoon Kim Young Hoon Roh Chong Woo Chu Hyung Chul Kim Chang Moo Kang Gi Hong Choi Jin Sub Choi Kyung Sik Kim Woo Jung Lee Sung Su Yun Hong Jin Kim Seog Ki Min Hyeon Kook Lee In-Sang Song Kwang-Sik Chun Eung-Ho Cho Sung-Sik Han Sang-Jae Park 《Journal of hepato-biliary-pancreatic sciences》2013,20(2):125-130
Introduction
We report our experience with laparoscopic major liver resection in Korea based on a multicenter retrospective study.Materials and methods
Data from 1,009 laparoscopic liver resections conducted from 2001 to 2011 were retrospectively collected. Twelve tertiary medical centers with specialized hepatic surgeons participated in this study.Results
Among 1,009 laparoscopic liver resections, major liver resections were performed in 265 patients as treatment for hepatocellular carcinoma, metastatic tumor, intrahepatic duct stone, and other conditions. The most frequently performed procedure was left hemihepatectomy (165 patients), followed by right hemihepatectomy (53 patients). Pure laparoscopic procedure was performed in 190 patients including 19 robotic liver resections. Hand-assisted laparoscopic liver resection was performed in three patients and laparoscopy-assisted liver resection in 55 patients. Open conversion was performed in 17 patients (6.4 %). Mean operative time and estimated blood loss in laparoscopic major liver resection was 399.3 ± 169.8 min and 836.0 ± 1223.7 ml, respectively. Intraoperative transfusion was required in 65 patients (24.5 %). Mean postoperative length of stay was 12.3 ± 7.9 days. Postoperative complications were detected in 53 patients (20.0 %), and in-hospital mortality occurred in two patients (0.75 %). Mean number and mean maximal size of resected tumors was 1.22 ± 1.54 and 40.0 ± 27.8 mm, respectively. R0 resection was achieved in 120 patients with hepatic tumor, but R1 resection was performed in eight patients. Mean distance of safe resection margin was 14.6 ± 15.8 mm.Conclusions
Laparoscopic major liver resection has become a reliable option for treatment of liver disease in Korea. 相似文献3.
Hitoshi Inagaki Tsuyoshi Kurokawa Tadashi Yokoyama Nobuhiro Ito Yasuhisa Yokoyama Toshiaki Nonami 《Journal of hepato-biliary-pancreatic sciences》2009,16(1):64-68
Background
Although an increasing number of reports and publications have dealt with the laparoscopic approach to liver resection, this procedure remains uncommon, and its feasibility, safety and effectiveness are still not established. There are few reports of the advantages of this approach on postoperative recovery.Methods
From December 1997 to March 2007, laparoscopic hepatic resection were performed in 68 patients.Results
There were 52 malignant tumors (36 hepatocellular carcinomas, three intrahepatic cholangiocarcinomas, one cystadenocarcinoma, liver metastases from ten colorectal carcinomas and two other organs) and 16 benign lesions among our 68 patients. Fifteen patients with hepatocellular carcinoma had cirrhosis. The mean tumor size was 3.1 ± 1.8 cm (range 1.0–14.0 cm), and the tumors were located in every liver segment except segment I. Liver resection was anatomical in 17 patients and consisted of a lobectomy in four patients and a lateral segmentectomy in 13 patients. Non-anatomical resections were performed in 51 patients. The operative time was 214 ± 93 min. Mean blood loss was 393 ± 564 g. A hand-assisted laparoscopic method or mini-laparotomy method was required in 35 patients (51.4%). Operative complications occurred mainly in our early cases and included three patients (4.4%) with operative bleeding, 2 of whom (2.9%) requiring a conversion to open surgery. Postoperative complications occurred in seven patients (10.0%), and two of then eventually required a re-operation. The mean hospital stay was 17 days. There were no complications in the more recent cases.Conclusions
The laparoscopic approach for liver tumors is feasible, if the indication is carefully selected. The safety of this procedure depends on the surgical experience of the surgeon and team and the availability of the necessary technology. 相似文献4.
Junichi Yamanaka Toshihiro Okada Shinichi Saito Yuichi Kondo Yasuhiko Yoshida Kazuhiro Suzumura Tadamichi Hirano Yuji Iimuro Jiro Fujimoto 《Journal of hepato-biliary-pancreatic sciences》2009,16(6):808-815
Background/purpose
Laparoscopic liver resection has not gained wide acceptance compared with other laparoscopic procedures. We evaluated the impact of simulated surgery using data from multidetector CT scanning on planning for laparoscopic hepatectomy.Methods
The hepatectomy simulation system was programmed to perform three-dimensional reconstruction of the vasculature and to calculate the liver resection volume and surgical margin. In 35 patients undergoing laparoscopic hepatectomy or laparoscopy-assisted hepatectomy, the liver resection volume and margin were estimated by simulation preoperatively. Then, the estimated values were compared with the actual resected liver weight and margin.Results
Three-dimensional reconstruction allowed stereoscopic identification of the tumor-bearing portal vein and draining vein. The predicted liver resection volume and margin both showed a significant correlation with the actual values: the mean difference was 21 mL (P < 0.0001) and 1.3 mm (P < 0.01), respectively. Preoperative planning based on simulated resection facilitated laparoscopic mobilization of the liver and mini-laparotomy resection of a large tumor located in the upper right lobe.Conclusions
Three-dimensional simulation of hepatectomy facilitated intraoperative identification of the vascular anatomy, and accurately predicted the resected liver volume and surgical margin. This simulation method should contribute to preoperative planning for safe and curative laparoscopic hepatectomy. 相似文献5.
J. L. Zhou B. Wu Y. Xiao G. L. Lin W. Z. Wang G. N. Zhang H. Z. Qiu 《Techniques in coloproctology》2014,18(9):825-833
Background
Retrorectal tumors (RTs) are rare in adults. Their surgical excision is often difficult because of their anatomic location. The aim of this study was to evaluate the results of straight laparoscopic resection of RTs in our institution.Methods
Eight patients (six women and two men) with benign RTs were treated by laparoscopic resection in our tertiary care center between September 2012 and June 2013. Exclusion criteria included malignant tumors, lesions with fistula formation, and anterior sacral meningoceles. Clinical data, imaging features, operative details, pathological results, and treatment outcomes were reviewed and analyzed.Results
Eight cases of benign RT with an average diameter of 8.9 ± 1.7 cm were treated by a straight laparoscopic procedure. The mean operative time was 122 ± 36 min, and the average intraoperative blood loss was 46 ± 33 ml. The median postoperative stay was 5 days (range 3–8 days), and all patients were discharged without serious complications. During a median follow-up of 11 months, no tumor recurrence was observed.Conclusions
In our experience, a laparoscopic approach is safe for removing benign tumors in the retrorectal space. This approach may provide access to this difficult-to-reach space and has the advantages of allowing excellent visualization, meticulous dissection, less morbidities, and fast recuperation. 相似文献6.
Shuo Zhang Guan-Qun Chao Men Li Gui-Bao Ni Bin Lv 《Digestive diseases and sciences》2013,58(6):1710-1716
Background and Aims
We aimed to study the feasibility of endoscopic submucosal dissection (ESD) for the removal of gastric muscularis propria tumors and to evaluate the efficacy and safety of ESD for this treatment.Methods
Eighteen patients with gastric SMTs originating from the muscularis propria were treated by ESD between July 2008 and July 2011. Tumor characteristics, complications, en bloc resection rate, and local recurrence rate were evaluated.Results
Among the 18 patients, 11 were women (61.1 %). The median age was 65.3 ± 6.3 years old (range 30–71 years old). Seventeen tumors were resected completely by ESD (success rate 94.4 %). The mean tumor size as determined by endoscopic ultrasound was 2.6 ± 1.2 cm (range 1.0–3.5 cm). The histological diagnosis was gastrointestinal stromal tumor for 13 lesions and leiomyoma for four tumors. The mean operation time was 90 ± 38 min (range 50–120 min), and the average blood loss was 20 ml. Two patients developed perforation, which was closed by endoscopic methods with metallic clips. The tumor was closely adhered to the muscularis propria and was convex to the enterocoelia in one case. No single case had severe complications, such as GI bleeding, peritonitis, or abdominal abscess, and there were no other immediate post-procedure complications.Conclusions
ESD is a safe, effective, well-tolerated, and minimally invasive therapy for the intraluminal SMTs originating from gastric muscularis propria with relatively few complications. Although there is a risk of perforation which has become manageable endoscopically. 相似文献7.
Dechao Jiao Linxue Qian Yanling Zhang Fujun Zhang Chuanxing Li Zilin Huang Liang Zhang Weidong Zhang Peihong Wu Xinwei Han Guangfeng Duan Jianjun Han 《Journal of cancer research and clinical oncology》2010,136(10):1507-1516
Purpose
To evaluate effects of microwave ablation with a 2,450-MHz internally cooled-shaft antenna in animal experiments and in a clinical study.Methods
Microwave ablation was performed using a cooled-shaft antenna in eight in vivo (36 ablations) porcine livers. The coagulation diameters achieved in different microwave ablation parameter groups were compared. Sixty patients (44 men, 16 women; mean age 53 years) with 96, 1–8 cm (mean 3.20 ± 0.17 cm) liver cancers were treated with the same microwave ablation technique. Complete ablation (CA), local tumor progression (LTP) rates and complications were determined.Results
In vivo livers, short axis diameter correlated with the coagulation duration in a sigmoidal curve fashion (60-W group R 2 = 0.76, 80-W group R 2 = 0.87), with a relative plateau achieved within 10 min for power settings of 60 or 80 W. Within 10 min in the 60 and 80-W groups, respectively, 89 and 85.76% of maximum short axis diameter were achieved. CA rates in small (3.0 cm), intermediate (3.1–5.0 cm) and large (5.1–8.0 cm) liver cancers were 96.43% (54/56), 92.31% (24/26) and 78.57% (11/14), respectively. During a mean follow-up period of 17.17 ± 6.52 months, LTP occurred in five (5.21%) treated cancers. There was no significant difference in the CA and LTP rate between the HCC and liver metastasis patient subgroups (P > 0.05).Conclusions
The short axis diameter enlargement has a relative plateau within 10 min by fixing power output to 60 or 80 W, using the 2,450-MHz internally cooled-shaft antenna in vivo porcine livers. Effective local tumor control was achieved during one microwave ablation session. 相似文献8.
Tomimaru Y Eguchi H Marubashi S Wada H Kobayashi S Tanemura M Umeshita K Doki Y Mori M Nagano H 《Digestive diseases and sciences》2012,57(7):1942-1948
Background
Although anatomical resection (AR) is considered better than non-anatomical resection (NAR) for the treatment for hepatocellular carcinoma (HCC), there is only limited evidence in support of this argument.Aim
The aim of this study was to investigate whether AR is superior to NAR regarding postoperative outcomes in patients with small solitary HCC and preserved liver function.Methods
The study subjects were 92 curatively-resected patients with adequate liver function reserve (indocyanine green retention rate at 15 min <15%, prothrombin time >70%, serum albumin >3.5 g/dl) and macroscopically small (≤3.0 cm) solitary HCC without macroscopic vascular invasion; 30 patients underwent AR and 62 patients NAR. Postoperative short-term outcomes including mortality and morbidity and long-term outcomes were compared in the two groups.Results
There was no significant difference in clinicopathological background in the two groups. Although resected liver volume was significantly larger in the AR group than the NAR group (p < 0.0001), no significant differences were detected in the incidence of mortality or morbidity. For long-term outcomes, there were no significant differences between the two groups in disease-free survival or overall survival. Multivariate analysis showed that the extent of surgical procedure was not a significant prognostic factor for disease-free or overall survival.Conclusions
AR of a solitary small HCC did not carry postoperative outcome advantages compared with NAR in patients with preserved liver function. We recommend NAR for hepatic resection of small solitary HCC in patients with preserved liver function. 相似文献9.
Osamu Yamazaki Mitsuharu Matsuyama Katsuhiko Horii Akishige Kanazawa Sadatoshi Shimizu Takahiro Uenishi Masao Ogawa Yutaka Tamamori Shuichi Kawai Kazunori Nakazawa Hiroshi Otani Junya Murase Shinichi Mikami Ikko Higaki Yuichi Arimoto Hiroyuki Hanba 《Journal of hepato-biliary-pancreatic sciences》2010,17(3):349-358
Background/Purpose
Liver resection is a widely preferred treatment modality for hepatocellular carcinomas (HCCs). This study aimed to compare the survival impact of anatomical resection with that of limited resection, in patients with single HCCs no larger than 5 cm in diameter.Methods
A cohort study was carried out on 209 consecutive patients who underwent hepatic resection for a single HCC no larger than 5 cm in diameter between January 1994 and March 2007 at Osaka City General Hospital.Results
The cumulative 5-year overall survival and disease-free survival rates in the anatomical resection group (n = 111) were 71 and 40%, respectively, both of which were significantly better than the 48 and 25% seen in the limited resection group (n = 98) (P = 0.0043 and P = 0.0232, respectively). Better effects of the anatomical resection on both overall and disease-free survival were seen in patients having HCC larger than 2 cm in diameter and in patients with moderately or poorly differentiated HCC. But no significant difference in either overall or disease-free survival was seen between the groups in patients with a HCC 2 cm or less in diameter or in the patients with well-differentiated HCC. Using Cox’s regression model, anatomical resection was confirmed to be an independent favorable factor for both overall and disease-free survival.Conclusions
Anatomical resection is therefore recommended for histologically advanced single HCCs ranging from 2 to 5 cm in diameter. 相似文献10.
Naohiro Nomura Tsutomu Fujii Naohito Kanazumi Shin Takeda Shuji Nomoto Hideki Kasuya Hiroyuki Sugimoto Suguru Yamada Akimasa Nakao 《Journal of hepato-biliary-pancreatic sciences》2009,16(5):639-647
Background and purpose
We present our experience in the treatment of nonfunctioning neuroendocrine pancreatic tumors (NFNPTs) to define the clinical and pathological characteristics and to suggest proper management.Methods
The records of 17 patients with NFNPTs operated on between 1998 and 2008 were retrospectively reviewed, and all tumors were classified clinicopathologically as benign, uncertain, and malignant, based on the World Health Organization (WHO) classification of neuroendocrine tumors.Results
There were four benign, six uncertain, and seven malignant NFNPTs. The most frequent symptoms were abdominal pain (five patients) and obstructive jaundice (one patient). Most of these symptomatic patients had malignant tumors. Mean tumor size of benign, uncertain, and malignant tumors were 1.0 ± 0.3, 3.2 ± 1.6, and 5.3 ± 2.4 cm, respectively. Metastatic lesions of malignant tumors were lymph node (six patients), liver (four patients), and adrenal gland (one patient). Six of seven patients with malignant tumors underwent curative rejection. There were recurrences in four of six patients with curatively rejected malignant tumors. Two patients underwent more rejection, three patients received systemic chemotherapy, and two patients underwent radiofrequency ablation and transcatheter arterial chemoembolization for liver metastases. Survival of patients with malignant tumors was significantly shorter than that of patients with benign and uncertain tumors. However, three patients with malignant tumors had long survival of more than 3 years, even with metastases or recurrences.Conclusions
Aggressive surgical resection should be performed in patients with resectable NFNPTs, even with metastases. Even when a tumor was unresectable or there were recurrences, long-time palliation could be achieved by a multidisciplinary approach. 相似文献11.
Yongping Yang Chunping Wang Yinying Lu Wenlin Bai Linjing An Jianhui Qu Xudong Gao Yan Chen Lin Zhou Yu Wu Yongyi Feng Minna Zhang Xiujuan Chang Jiyun Lv 《Journal of hepato-biliary-pancreatic sciences》2012,19(6):674-684
Purpose
To evaluate the efficacy and safety of ultrasound (US)-guided percutaneous argon-helium cryoablation for hepatocellular carcinoma (HCC) and determine appropriate indications.Methods
We reviewed outcomes of 300 HCC patients who underwent US-guided percutaneous cryoablation.Results
Overall, 223 tumors (mean diameter 7.2?±?2.8?cm) in 165 patients were incompletely ablated, while 185 tumors (mean diameter 5.6?±?0.8?cm, P?=?0.0001 vs. incomplete ablation) in 135 patients were completely ablated. Nineteen patients (6.3%) developed serious complications while in hospital, including cryoshock syndrome in six patients, hepatic bleeding in five, stress-induced gastric bleeding in four, liver abscess in one and intestinal fistulas in one. Two patients died because of liver failure. The median follow-up was 36.7?months (range 6–63?months). The local tumor recurrence rate was 31%, and was related to tumor size (P?=?0.029) and tumor location (P?=?0.037). The mean survival duration of patients with early, intermediate and advanced HCC (Barcelona Clinic Liver Cancer staging system) was 45.7?±?3.8, 28.4?±?1.2 and 17.7?±?0.6?months, respectively.Conclusions
US-guided percutaneous cryoablation is a relatively safe and effective therapy for selected HCC patients. 相似文献12.
Sun-pyo Hong Tae Soo Noh Seung-Hwan Moon Young Seok Cho Eun Jeong Lee Joon Young Choi Byung-Tae Kim Kyung-Han Lee 《Digestive diseases and sciences》2014,59(3):607-613
Background
Subjects with fatty liver disease (FLD) can show increased hepatic 2-deoxy-2-(18F)fluoro-d-glucose (FDG) uptake, but the role of hepatic inflammation has not been explored.Aims
We investigated whether hepatic inflammatory response, as implicated by elevated serum markers, is associated with increased liver FDG uptake in FLD.Methods
Liver sonography and FDG positron emission tomography was performed in 331 asymptomatic men with nonalcoholic FLD (NAFLD), 122 with alcoholic FLD (AFLD), and 349 controls. Mean standard uptake value (SUV) of liver FDG uptake was compared to cardiac risk factors and serum markers of liver injury.Results
Hepatic FDG mean SUV was increased in NAFLD (2.40 ± 0.25) and AFLD groups (2.44 ± 0.25) compared to controls (2.28 ± 0.26; both P < 0.001). Both FLD groups also had higher serum γ-glutamylranspeptidase (GGT), triglyceride (TG), hepatic transaminases, and LDL. High GGT and TG levels were independent determinants of increased FDG uptake for both FLD groups. Hepatic mean SUV significantly increased with high compared to low GGT for NAFLD (2.48 ± 0.28 vs. 2.37 ± 0.24), AFLD (2.51 ± 0.27 vs. 2.39 ± 0.23), and control groups (2.39 ± 0.22 vs. 2.26 ± 0.26). High TG increased hepatic mean SUV in AFLD and control groups. Furthermore, serum GGT and TG levels significantly correlated to hepatic mean SUV in all three groups.Conclusions
Hepatic FDG uptake is closely associated with elevated TG and GGT regardless of the presence of FLD. Thus, inflammation response may play a major role in increased hepatic glucose uptake. 相似文献13.
Abbas Agaimy Nikolaos Vassos Bruno Märkl Norbert Meidenbauer Jens Köhler Johann Spatz Werner Hohenberger Florian Haller Roland S. Croner Regine Schneider-Stock Klaus Matzel 《International journal of colorectal disease》2013,28(8):1057-1064
Purpose
This study aims to report our multicenter experience with diagnosis, management, and prognosis of anorectal gastrointestinal stromal tumors (GIST).Patients and methods
We retrospectively reviewed cases treated and/or followed up at our institutions in the period 2000–2011.Results
Fifteen patients were identified (eight men and seven women; mean age, 55 years). Presenting symptoms were rectal/perirectal (eight), rectovaginal space (four), or retrovesical/prostatic (three) mass. Primary surgical treatment was local excision (six), deep anterior resection (eight), and palliative diagnostic excision (one). Tumor mean size was 4.8 cm. All but two cases were high risk (Miettinen and Lasota, Semin Diagn Pathol 23:70–83, 2006). R0 resection was achieved in 46 % of cases: one of six local excisions vs. five of seven deep anterior resection (16 vs. 71 %, respectively). All three cases who received total mesorectal excision had R0. Non-R0 status was mainly due to opening of tumor capsule at surgery (Rx). Seven of 14 patients (50 %) developed ≥1 pelvic local recurrences at a mean period of 48.4 months (mean follow-up, 61.6 months). Only two patients developed distant metastasis (adrenal, liver, and peritoneal). Recurrences developed after Rx (three), R1 (two), and unknown R-status (two). Successful mutational analysis in 13 patients revealed KIT mutations in all (10 exon 11, 2 exon 9, and 1 exon 13).Conclusion
Our results confirm the high local recurrence rate of anorectal GISTs (50 %) which correlates with the common practice of suboptimal oncological primary tumor resection (Rx or R1?=?7/13). This uncommon subset of GISTs needs more standardized oncological surgical approach to minimize the propensity for local disease recurrence. 相似文献14.
Jeongmin Choi Sang Gyun Kim Jong Pil Im Joo Sung Kim Hyun Chae Jung 《Digestive diseases and sciences》2013,58(8):2329-2336
Background
Although the accurate estimation of tumor size is essential for proper patient selection for endoscopic resection in early gastric cancer (EGC), no study has been conducted to date on tumor size estimation. We aimed to evaluate the accuracy of endoscopic visual estimation of tumor size of EGC.Methods
In 508 EGC patients that underwent endoscopic resection, endoscopic visual estimations were performed retrospectively by independent two endoscopists using still images. Data were compared with pathologic measurements as gold standard. Inter-observer agreement was determined using the Bland–Altman method and intra-class correlation coefficients (ICC). Measurement discrepancies were presented as differences between measurements.Results
The ICC between the two endoscopists was 0.915 (95 % CI 0.900–0.928). Mean endoscopic estimates for both endoscopists were significantly lower than mean pathologic measurements (1.50 and 1.67 vs. 1.80 cm, P < 0.001). Absolute differences between average endoscopic estimates and pathologic measurements were found to be acceptable in most cases: an absolute difference of <0.4 cm was found for 80 % (404/508) of cases. Bland–Altman plot showed that 94 % of cases lay within the 95 % limits of agreement. Measurement discrepancy was proportional to tumor size and increased for an undifferentiated histology.Conclusions
Endoscopic visual estimations were found to show reliable agreement with pathologic measurement in EGC patients undergoing endoscopic resection, together with good inter-observer agreement. Further prospective study is needed to confirm the validity of this method. 相似文献15.
Ken-ichi Okada Toshihide Imaizumi Kenichi Hirabayashi Masahiro Matsuyama Naoki Yazawa Shoichi Dowaki Kosuke Tobita Yasuo Ohtani Yoshiaki Kawaguchi Makiko Tanaka Sadaki Inokuchi Hiroyasu Makuuchi 《Journal of hepato-biliary-pancreatic sciences》2010,17(4):516-522
Background
The surgical decision regarding where to resect the pancreas is an important judgement that is directly linked to the surgical procedure. An appropriate surgical margin to resect intraductal papillary-mucinous neoplasm (IPMN) of the pancreas based on the distance of tumor spread (DTS) in the main pancreatic duct has not been adequately documented. We analyzed the appropriate surgical margin based on the DTS in the main pancreatic duct of IPMN and the positive rate at the pancreatic cut end margin.Methods
Forty patients with main duct- or mixed-type IPMN diagnosed histopathologically who underwent surgery at Tokai University Hospital between 1991 and 2008 were retrospectively analyzed. The resection line was determined to achieve a 2-cm surgical margin in patients with main duct- or mixed-type IPMN and as limited a resection as possible to remove the dilated branch duct in patients with branch duct-type IPMN according to macroscopic type. The dysplastic state of the epithelium was judged as positive for carcinoma in situ (high-grade dysplasia) or adenoma (very low to moderate dysplasia) and judged as negative for hyperplasia or normal.Results
The mean DTS in the main pancreatic duct was 41.6 ± 30.0 mm, and that of the distance of tumor absence was 13.6 ± 12.4 mm. The positive rate at the pancreatic cut end margin in frozen sections was 29.7%. The final positive rate at the pancreatic cut end margin was 26.2%. There has been no evidence of local recurrence in the remnant pancreas. DTS in the main pancreatic duct of IPMN was correlated with the maximum diameter of the duct (R = 0.678).Conclusion
Distance of tumor spread offered important insights about the appropriate site to resect the pancreas and the positive rate at the cut end margin in IPMN. 相似文献16.
Seung Up Kim Sang Hoon Ahn Jun Yong Park Do Young Kim Chae Yoon Chon Jin Sub Choi Kyung Sik Kim Kwang-Hyub Han 《Hepatology International》2008,2(4):471-477
Background
Liver stiffness measurement (LSM) using transient elastography (FibroScan®) reflects the degree of hepatic fibrosis. This prospective study investigated how well LSM predicts the development of hepatic insufficiency after curative liver resection surgery for hepatocellular carcinoma.Methods
The study enrolled 72 consecutive patients who underwent a preoperative LSM to assess the degree of liver fibrosis followed by curative liver resection surgery for hepatocellular carcinoma between July 2006 and December 2007. The primary end point was the development of hepatic insufficiency.Results
The mean age of the patients was 54.9 years. Twenty patients (27.7%) had chronic hepatitis and 52 (72.3%) had cirrhosis (44 and 8 patients showed Child-Pugh class A and B, respectively). The mean LSM was 17.1 kPa. Twelve patients (16.6%) had segmentectomy only, 16 patients (22.2%) had bisegmentectomy, and 44 patients (61.2%) had lobectomy. Nine patients (12.5%) had stage I tumor, 56 (77.7%) had stage II, and 7 (9.8%) had stage III. Univariate and subsequent multivariate analyses revealed that preoperative LSM was the only independent risk factor for predicting the development of postoperative hepatic insufficiency (cutoff, 25.6 kPa; P = 0.001; relative risk, 19.14; 95% confidence interval, 2.71–135.36).Conclusions
LSM is potentially useful to predict the development of postoperative hepatic insufficiency in patients with hepatocellular carcinoma undergoing curative liver resection surgery. 相似文献17.
Xiaohong Chen Boheng Zhang Xin Yin Zhenggang Ren Shuangjian Qiu Jian Zhou 《Journal of cancer research and clinical oncology》2013,139(5):773-781
Purpose
To explore the effect of lipiodolized transarterial chemoembolization (lip-TACE) in hepatocellular carcinoma (HCC) patients at different risk of recurrence after curative resection.Methods
One thousand nine hundred and twenty-four consecutive HCC patients who underwent curative resection were retrospectively analyzed. Patients who underwent resection only were classified into control group, while those received adjuvant lip-TACE were classified into intervention group. Patients were further stratified into 4 groups, that is, tumor ≤5 cm with low or high risk factors, as well as tumor >5 cm with low or high risk factors for recurrence. Tumor number and microscopic tumor thrombus were defined as risk factors for recurrence. The effect of adjuvant lip-TACE on early (<2 year) or late (≥2 year) recurrence was evaluated.Results
There was no significant difference in recurrence curve between intervention group and control group in each stratum. Adjuvant lip-TACE showed an overall survival benefit in patients with tumor >5 cm and presenting high risk factors, mainly for those with time to recurrence (TTR) <2 years after operation. For them, the median survival was 17 months in the intervention group and 11 months in the control group (P = 0.010). For patients who were confirmed to be recurrence-free at 2 years after operation, it had the negative effect for survival (HR = 1.75, P = 0.004).Conclusion
Adjuvant lip-TACE had no preventive effect on recurrence, but may be of benefit to detect early recurrence. 相似文献18.
Hannes P. Neeff Oliver Drognitz Philipp Holzner Andrea Klock Peter Bronsert Ulrich T. Hopt Frank Makowiec 《International journal of colorectal disease》2013,28(8):1135-1141
Introduction
Although advances in multimodal treatment have led to prolongation of survival in patients after resection of colorectal liver metastasis (CRC-LM), most patients develop recurrence, which is often confined to the liver. Repeat hepatic resection (RHR) may prolong survival or even provide cure in selected patients. We evaluated the perioperative and long-term outcomes after RHR for CRC-LM in a single institution series.Patients and methods
Since 1999, 92 repeat hepatic resections (63 % wedge/segmental, 37 % hemihepatectomy or greater) for recurrent CRC-LM were performed in 80 patients. Median interval from initial liver resection to first RHR was 1.25 years. Any kind of chemotherapy (CTx) had been given in 88 % before RHR. Neoadjuvant CTx was given in 38 %.Results
Hepatic margin-negative resection was achieved in 79 %. Mortality was 3.8 %. Overall complication rates were 53 %, including infection (17 %), operative re-intervention (12 %), and hepatic failure (5.4 %). Overall 5-year survival after first RHR was 50.3 %. Univariately, primary tumor stage, the extent of liver resection, postoperative complications, and the overall resection margin correlated with survival. By multivariate analysis, primary T stage, size of metastasis, and overall R0 resection influenced survival. Survival was not independently influenced by hepatic resection margins or (neoadjuvant) CTx.Conclusions
Repeat hepatic resection for recurrent CRC-LM can be performed with low mortality and acceptable morbidity. Survival after repeat hepatic resection in this selected group of patients is encouraging and comparable to results after first liver resections. 相似文献19.
Robert J. Wong James Wantuck Antonia Valenzuela Aijaz Ahmed Clark Bonham Amy Gallo Marc L. Melcher Glen Lutchman Waldo Concepcion Carlos Esquivel Gabriel Garcia Tami Daugherty Mindie H. Nguyen 《Digestive diseases and sciences》2014,59(1):183-191
Background
Hepatocellular carcinoma (HCC) is a leading cause of mortality worldwide. Existing studies comparing outcomes after liver transplantation (LT) versus surgical resection among transplant-eligible patients are conflicting.Aim
The purpose of this study was to compare long-term survival between consecutive transplant-eligible HCC patients treated with resection versus LT.Methods
The present retrospective matched case cohort study compares long-term survival outcomes between consecutive transplant-eligible HCC patients treated with resection versus LT using intention-to-treat (ITT) and as-treated models. Resection patients were matched to LT patients by age, sex, and etiology of HCC in a 1:2 ratio.Results
The study included 171 patients (57 resection and 114 LT). Resection patients had greater post-treatment tumor recurrence (43.9 vs. 12.9 %, p < 0.001) compared to LT patients. In the as-treated model of the pre-model for end stage liver disease (MELD) era, LT patients had significantly better 5-year survival compared to resection patients (100 vs. 69.5 %, p = 0.04), but no difference was seen in the ITT model. In the multivariate Cox proportional hazards model, inclusive of age, sex, ethnicity, tumor stage, and MELD era (pre-MELD vs. post-MELD), treatment with resection was an independent predictor of poorer survival (HR 2.72; 95 % CI, 1.08–6.86).Conclusion
Transplant-eligible HCC patients who received LT had significantly better survival than those treated with resection, suggesting that patients who can successfully remain on LT listing and actually undergo LT have better outcomes. 相似文献20.
Stefano Trastulli Jacopo Desiderio Federico Farinacci Francesco Ricci Chiara Listorti Roberto Cirocchi Carlo Boselli Giuseppe Noya Amilcare Parisi 《International journal of colorectal disease》2013,28(6):807-814