PRIMARY NEUROENDOCRINE TUMORS OF THE LIVER AND GALLBLADDER

To study Clinco-pathological characters of the neuroendocrine tumors of the liver and gallbladder.MethodsUsing histology,immunohistochemistry and elec-tron microscope,3 cases of liver and gallbladdcr wereinvestigated.The pimary antibodies including anti-chromogranin A,gastrin,serotonin,insulin,somatostatin,gastrin,pancreatic Polypeptide,adreno-corticotropichormone(ACTH)、calcitonin,bombesin,β-humanchorionic gonadotropin(β-HCG)were employed toidentify the property of tumors.ResultsIn one cases tumor of neuroendocrine carcinonma.In the other two cases tumor were typical carcinoid.Inimmunohistochcmistry study,the tumor cells showedpositive reaction to chromagranin A and containedpositive cells ot gastrin,serotonin,insulin and panereaticpolypaptide.Electronmicroscopy showed the cytoplasmcontained dense round granules.ConclusionThe Nuroendocrine tumor of liver and gallbladderis a spectual type neooplasm with character of histology,immunohistochemistry and electron microscopy.Subjeetheadings neuroendocrine t     

LIVER TRANSPLANTATION FOR HEPATIC CANCER

ＬＩＶＥＲＴＲＡＮＳＰＬＡＮＴＡＴＩＯＮＦＯＲＨＥＰＡＴＩＣＣＡＮＣＥＲＸｉａＳｕｉｓｈｅｎｇ夏穗生（ＩｎｓｔｉｔｕｔｅｏｆＯｒｇａｎＴｒａｎｓｐｌａｎｔａｔｉｏｎ，ＴｏｎｇｊｉＭｅｄｉｃａｌＵｎｉｖｅｒｓｉｔｙ，Ｗｕｈａｎ４３００３０）Ａｂｓｔｒａ...     

ALTERNATING CHEMOTHERAPY AND FRACTIONATED RADIOTHERAPY AS A MODALITY FOR THE TREATMENT OF PRIMARY LIVER CANCER

ＡＬＴＥＲＮＡＴＩＮＧＣＨＥＭＯＴＨＥＲＡＰＹＡＮＤＦＲＡＣＴＩＯＮＡＴＥＤＲＡＤＩＯＴＨＥＲＡＰＹＡＳＡＭＯＤＡＬＩＴＹＦＯＲＴＨＥＴＲＥＡＴＭＥＮＴＯＦＰＲＩＭＡＲＹＬＩＶＥＲＣＡＮＣＥＲＬｕＪｉｚｈｅｎ陆继珍ＬｉＢｉｎｇｘｉｎ李炳鑫ＬｉｕＫａｎ...     

BRAIN TUMORS OF THE FIRST YEAR OF LIFE:CLINICAL AND SURGICAL MANAGEMENT

Brain tumors incidence in pediatric age hasbeen estimated between 1.3 to 5% with a relativeincidence of 1.4 to 11% during the first year oflife; the improvement in instrumental deviceshas lead to a relative increase in precocious diag-nosis. The choice to study brain tumors of the firstyear of life as a separate topic from pediatric ageones depends on the observation that these le-sions have peculiar clinical, topographic and tis-sular characteristics. The survival rate of thesepatients is very poor if compared with that found     

THE ROLE OF TARGETING THERAPY IN CYTOREDUCTION AND SEQUENTIAL RESECTION OF UNRESECTABLE HEPATOCELLULAR CARCINOMA

ＴＨＥＲＯＬＥＯＦＴＡＲＧＥＴＩＮＧＴＨＥＲＡＰＹＩＮＣＹＴＯＲＥＤＵＣＴＩＯＮＡＮＤＳＥＱＵＥＮＴＩＡＬＲＥＳＥＣＴＩＯＮＯＦＵＮＲＥＳＥＣＴＡＢＬＥＨＥＰＡＴＯＣＥＬＬＵＬＡＲＣＡＲＣＩＮＯＭＡＴａｎｇＺｈａｏｙｏｕ汤钊猷ＹｕＹｅｑｉｎ余业勤Ｚｈ...     

ANALYSIS OF 26,826 PATIENTS WITH TUMORS IN THE HEAD AND NECK

A series of 26,826 patients with head and neck tumer as confirmed by pathology from January 1970 to December 1989 are analyzed. It accounted for 39. 5% of all the tumors blopsied in the same interval. In this series, 72. 4% was malignant which accounted for 45. 77% of malignant tumors in different parts of the whole body. For benign tumors in the head and neck, the ratio of male to female was 0. 84:1, and for malignant tumors In the head and neck it was 2. 4:1. The most frequently involved site by the malignant tumors were :nasopharynx, mouth, maxillofacial regions, and neck. THe majority (62. 65%) of malignant tumors were located in the nasopharynx which accounted for 28. 68% of all malignanties of which the ratio of mate and female was 3:1, peak age was 41-50 years, 18 of themwas under 10 years of age, the youngest was 1 1/2 years andthe oldest was 84 years old. These data showed that malignant tunors in the head and neck regions, expecially those in the nasopharynx, are common in Guanxi province, Chi     

A STUDY OF THE FORMATION OF LIVER METASTASIS AND ITS MECHANISM USING THE INTRASPLENIC INOCULATION OF CANCER CELLS

In order to establish an animal model with hepatic metastasis intrasplenic inoculation of carcinoma cells from murine uterine cervical carcinoma (U14) was employed. Results showed a high incidence of hepatic metastasis could be obtained through the intrasplenic inoculation of 1 × 106 carcinoma cells. Removal of the primary carcinoma through splenec-tomy at different intervals after intrasplenic inoculation proved that the hepatic metastatic mechanism was not due to mechanical pressure but occurred spontaneously. This experimental model provides a useful means for studying the mechanism and prevention of hepatic metastasis.     

NON-THORACOTOMY ESOPHAGECTOMY FOR CARCINOMA OF THE ESOPHAGUS AND CARDIA

Ｎｏｎｔｈｏｒａｃｏｔｏｍｙｅｓｏｐｈａｇｅｃｔｏｍｙ（ＮＴＥ）ｉｓａｓｅｌｅｃｔｉｖｅｏｐｅｒａｔｉｏｎｆｏｒｃａｒｃｉｎｏｍａｏｆｔｈｅｅｓｏｐｈａｇｕｓａｎｄｃａｒｄｉａ．Ｅｉｇｈｔｅｎｐａｔｉｅｎｔｓｗｉｔｈｃａｒｃｉｎｏｍａｉｎｖｏｌｖｉ...     

A CLINICAL ANALYSIS OF 7878 PATIENTS WITH TUMORS IN THE HEAD AND NECK

7878 patients with tumors in the head and neck were analyzed in a period of twenty years. All the diagnosis were confirmed by pathologic examination. There were 5485 cases (69.62%) of malignant tumors. Nearly an half of malignant tumors were in the nasopharynx (49.32%). Among the malignant tumors of the nasopharynx, 2698 were carcinoma (99.34%) and only 18 (0.66%) sarcoma. Nine of them were under 10 years of age, the youngest patient was 3 years old, and this is rare in our county. The incidence of head and neck tumors was 37.66% and that of the head and neck malignancies was 26.22% of tumors in the whole body. This study indicates that incidence of malignant tumor in head and neck was rather higher, it is worth to improve ths procedure of treatment and prevention.     

THE SIGNIFICANCE OF P53 GENE MUTATIONS AND EXPRESSIONS IN HUMAN COLORECTAL TUMORS

ＴＨＥＳＩＧＮＩＦＩＣＡＮＣＥＯＦＰ５３ＧＥＮＥＭＵＴＡＴＩＯＮＳＡＮＤＥＸＰＲＥＳＳＩＯＮＳＩＮＨＵＭＡＮＣＯＬＯＲＥＣＴＡＬＴＵＭＯＲＳＱｉａｎＨｕａ钱桦；ＹｕＢａｏｍｉｎｇ郁宝铭；ＺｈｏｕＸｉｇｅｎｇ周锡庚；ＷａｎｇＲｕｉｎｉａｎ王瑞年；Ｈｕａ...     

Major hepatic resection under total vascular exclusion

The major complications associated with liver resection are bleeding, hepatic decompensation and iatrogenic injury to the bile ducts and structures in the porta hepatis during its dissection. Operative blood loss and the amount of intraoperative blood transfusion has been shown repeatedly to be the single most important factor affecting the immediate prognosis of patients undergoing hepatic resection. Massive blood loss associated with the standard techniques of liver resection is frequently c…     

Selective hepatic vascular exclusion and Pringle maneuver: A comparative study in liver resection

Objective

Most liver resections require champing of the hepatic pedicle (Pringle maneuver) to avoid excessive blood loss. But Pringle maneuver cannot control backflow bleeding of the hepatic vein. Resection of liver tumors involving hepatic veins may cause massive hemorrhage or air embolism from injuries of the hepatic vein. Although total hepatic vascular exclusion (THVE) can prevent bleeding of the hepatic vein effectively, it also may result in systemic hemodynamic disturbance because of the clamped inferior vena cava (IVC). SHVE, a new technique, can control the inflow and outflow of the liver without clamping the vena cava. We compared the effects of selective hepatic vascular exclusion (SHVE) and Pringle maneuver in resection of liver tumors involving the junction of the hepatic vein.

Methods

From January 2000 to October 2005, 2100 patients with liver tumors had undergone liver resections in our department. Among them, tumors of 235 cases adhered to or were close to the junction of one or more hepatic veins. Both SHVE and Pringle maneuver were used to control blood loss during hepatectomy. These 235 cases were divided into two groups: Pringle maneuver group (110) from January 2000 to December 2002 and SHVE group (125) from January 2003 to October 2005. Data were analyzed regarding the intraoperative and postoperative courses of the patients. In the SHVE group, total SHVE (clamping the porta hepatis and all major hepatic veins) was used in 69 cases and partial SHVE (clamping the porta hepatic and one or two hepatic veins) in 56 cases. There were three methods in hepatic veins occlusion: ligating with suture, encircling and occluding with tourniquets and clamping with Satinsky clamps.

Results

There was no difference between the two groups regarding the age, gender, tumor size, cirrhosis and HBsAg rate, ischemia time and operating time. Intraoperative blood loss and transfusion requirements were significantly decreased in the SHVE group. Hepatic veins rupture with massive blood loss occurred in 14 and air embolism in three during the tumor resection, but there was no massive blood loss and air embolism in the SHVE group due to hepatic vein occlusion. Postoperative bleeding, reoperation, liver failure and mortality rate were higher, and ICU stay and hospital stay were longer in the Pringle group than those in the SHVE group.

Conclusion

SHVE is much more effective than Pringle maneuver in controlling intraoperative bleeding. It can prevent massive blood loss and air embolism from hepatic veins rupture and can reduce the postoperative complication rate and mortality rate. Clamping the hepatic veins with Satinsky clamps is much safer and easier than ligating with suture and occluding with tourniquets.     

Complex liver resection for hepatic tumours involving the inferior vena cava

Background

Resection of liver tumours with involvement of inferior vena cava (IVC) is considered to have a high surgical risk.

Aim

We retrospectively reviewed 23 patients who underwent hepatectomy with IVC resection in two West-European liver surgery Units.

Methods

The tumours included liver metastases (n = 13), hepatocellular carcinoma (n = 4), intrahepatic cholangiocarcinoma (n = 3), liver haemangioma (n = 1), primary hepatic lymphoma (n = 1) and recurrent right adrenal gland carcinoma (n = 1).

Results

IVC resection was associated with right hepatectomy in 8 cases, extended right hepatectomy in 9 cases, extended left hepatectomy in 3 cases, minor liver resection in 2 cases, and right hepatectomy with nephrectomy in one case. In 16 patients the IVC wall involvement was <30% of its circumference, and a tangential vena cava resection was performed. In 7 patients (30%) with >50% involvement, a caval segment was resected and replaced with a 20 mm ringed polytetrafluoroethylene graft. R0-resection was achieved in all patients. Median intraoperative blood loss was 1.100 ml (range 490–15,000). Fourteen patients were transfused with a median of 3 PRC units per patient (range 1–25). Major complications occurred in 9 patients. Postoperative stay in ICU was 2.3 ± 3.4 days (range 1–14) and hospital stay was 17.3 ± 2.6 days (range 5–62). In 14 patients, final pathology demonstrated microscopic IVC infiltration.

Conclusions

In selected patients with malignant involvement of the liver and IVC, surgical resection en bloc with IVC is the only possibility to achieve R0 resection, with acceptable mortality and morbidity, in units specialized in liver surgery.     

选择性出入肝血流阻断在肝脏巨大肿瘤切除术中的应用

目的 探讨选择性出入肝血流阻断(SHVE)在肝脏巨大肿瘤切除术中应用的优势.方法 回顾性分析29例施行肝脏巨大肿瘤切除术患者的临床资料,随机分为SHVE组(15例)和第一肝门阻断组[(Pringle组),14例],比较两组患者的术中肝血流阻断时间、肝切除范围、出血量、术后肝功能恢复情况、术后2 d平均腹腔引流量以及并发症发生率等指标.结果 两组患者的性别、年龄、肿瘤大小、术中肝血流阻断时间以及肝切除范围的差异均无统计学意义(P＞0.05).SHVE组患者的术中出血量为(282.1±286.5)ml,明显少于Pringle组[(721.5±512.1)ml,P＜0.05].SHVE组患者术后第1、3、7天血清前白蛋白含量明显高于Pringle组(P＜0.05),血清谷丙转氨酶和总胆红素含量明显低于Pringle组(P＜0.05).SHVE组患者术后2 d平均引流量为(189.4±103.5)ml,明显少于Pringle组[(249.5±108.7)ml,P＜0.05].Pringle组有1例发生肝功能衰竭,SHVE组无一例发生肝功能衰竭.Pringle组有4例发生肝静脉损伤,3例发生肝静脉破裂大出血,1例发生空气栓塞;SHVE组虽有5例发生肝静脉损伤,但无一例发生肝静脉破裂大出血或空气栓塞.结论 SHVE术可以提高肝脏巨大肿瘤切除患者对手术的耐受性,是合理安全的肝脏手术术式.     

Results of liver resection in combination with radiofrequency ablation for hepatic malignancies

Introduction

Liver tumors should be surgically treated whenever possible. In the case of bilobar disease or coexisting liver cirrhosis, surgical options are limited. Radiofrequency ablation (RFA) has been successfully used for irresectable liver tumors. The combination of hepatic resection and RFA extends the feasibility of open surgical procedures in patients with liver metastases and hepatocellular carcinoma (HCC).

Patients and methods

RFA was performed with two different monopolar devices using ultrasound guidance. Intraoperative use of RFA for the treatment of liver metastases or HCC was limited to otherwise irresectable tumors during open surgical procedures including hepatic resections. Irresectability was considered if bilobar disease was treated, the functional hepatic reserve was impaired or appraised marginal for allowing further resection.

Results

Ten patients with both liver metastases and HCC, and two patients with cholangiocellular carcinoma were treated. Complete initial tumor clearance was achieved in all patients. Two patients of the metastases group and five patients of the HCC group suffered from local recurrence after a median of 12 months (1–26) (local recurrence rate 32%). Five patients of the metastases group and six patients of the HCC group developed recurrent tumors in different areas of the ablation site after a median time of 4 months (2–18) (distant intrahepatic recurrence in 55%). Survival at 31 months was 36%.

Conclusion

RFA extends the scope of surgery in some candidates with intraoperatively found irresectability.     

Total vascular exclusion for liver resections: Pros and cons

Dramatic improvements in morbidity and mortality rates following liver resections have been reported in the past decade. Consequently, the indications for hepatectomy are becoming more liberal. Many techniques of liver resection with or without vascular clamping have been reported with excellent clinical results. Total vascular exclusion (TVE) of the liver during parenchymal transection has been advocated susceptible to increase the resectability of tumors that might not be safely approached by other techniques. Cirrhotic livers are probably more vulnerable to ischemic injury related to TVE than normal livers. The indications and technical and metabolic aspects of the technique are reviewed. J. Surg. Oncol. 1999;72:50–56. © 1999 Wiley-Liss, Inc.     

A prospective randomized controlled trial to compare two methods of selective hepatic vascular exclusion in partial hepatectomy

Background and aim

Selective hepatic vascular exclusion (SHVE) has not been widely used because of difficulty in extrahepatic isolation of hepatic veins. This study aims to compare the results of SHVE using tourniquets or Satinsky clamps on major hepatic veins in partial hepatectomy for liver tumors involving the roots of hepatic veins.

Methods

Between June 2008 and March 2012, a randomized controlled trial was performed on patients undergoing liver resection to compare selective hepatic vascular exclusion using tourniquets or Satinsky clamps in partial hepatectomy. In the tourniquet group, the hepatic veins were completely isolated and occluded with tourniquets. In the Satinsky clamp group, the hepatic veins were dissected on the anterior and side walls only and they were clamped directly by Satinsky clamps.

Results

The time for dissecting hepatic veins was significantly shorter in the Satinsky clamp group (7.5 ± 6.6 min vs 21.3 ± 7.4 min) than the tourniquet group. In the tourniquet group, 5 hepatic veins could not be completely isolated and encircled. In 4 additional patients the hepatic vein was slightly torn during dissection. These 9 patients received successful occlusion using Satinsky clamps. In the Satinsky group, all occlusion of the hepatic vein was successful. There was a significant difference in the success rate in hepatic vein occlusion using the Satinsky and the tourniquet groups 60/60 vs 51/60, P = 0.0018.

Conclusions

Both techniques of hepatic vein occlusion were safe and efficacious. As the use of Satinsky clamps is safer, easier and took less time, it is recommended.     

经右侧入路解剖第三肝门法切除肝尾叶癌

肝尾叶癌手术难度大,风险高.我院采用经右侧入路解剖第三肝门法,为2例肝尾叶癌患者成功实施了肝尾叶肝癌切除术,现将结果报告如下……     

Combined liver and inferior vena cava resection for hepatic malignancy

OBJECTIVE: The experience from a single center, in combined liver and inferior vena cava (IVC) resection for liver tumors, is presented. METHODS: Twelve patients underwent a combined liver resection with IVC replacement. The median age was 45 years (range 35-67 years). Resections were carried out for hepatocellular carcinoma (n = 4), colorectal metastases (n = 6), and cholangiocarcinoma (n = 2). Liver resections included eight right lobectomies and four left trisegmentectomies. The IVC was reconstructed with ringed Gore-Tex tube graft. RESULTS: No perioperative deaths were reported. The median operative blood transfusion requirement was 2 units (range 0-12 units) and the median operative time was 5 hr. Median hospital stay was 10 days (range 8-25 days). Three patients had evidence of postoperative liver failure, resolved with supportive management. Two patients developed bile leaks, resolved conservatively. With a median follow up of 24 months, all vascular reconstructions were patent and no evidence of graft infection was documented. CONCLUSIONS: Aggressive surgical management of liver tumors, offer the only hope for cure or palliation. We suggest that liver resection with vena cava replacement may be performed safely, with acceptable morbidity, by specialized surgical teams.     

Primary malignant vascular tumors of the liver in children: Angiosarcoma and epithelioid hemangioendothelioma

Primary malignant vascular neoplasms of the liver, angiosarcoma and epithelioid hemangioendothelioma, are extremely rare entities in the pediatric population. International Society for the Study of Vascular Anomalies classification system is recommended for the pathologic diagnosis of hepatic vascular lesions in this age group. In this article, we highlight the clinicopathologic characteristics of hepatic angiosarcoma and epithelioid hemangioendothelioma in the pediatric population. Hepatic angiosarcoma in children shows a slight female predominance with an average age of 40 mo at diagnosis. The distinct histologic features include whorls of atypical spindled cells and eosinophilic globules, in addition to the general findings of angiosarcoma. Histologic diagnosis of pediatric hepatic angiosarcoma is not always straightforward, and the diagnostic challenges are discussed in the article. Hepatic epithelioid hemangioendothelioma also demonstrates a female predominance, but is more commonly identified in adolescents (median age at diagnosis: 12 years). Histologically, the lesion is characterized by epithelioid cells and occasional intracytoplasmic lumina with a background of fibromyxoid stroma. While WWTR1-CAMTA1 and YAP1-TFE3 fusions have been associated with epithelioid hemangioendothelioma, there are currently no known signature genetic alterations seen in pediatric hepatic angiosarcoma. Advancement in molecular pathology, particularly for pediatric hepatic angiosarcoma, is necessary for a better understanding of the disease biology, diagnosis, and development of targeted therapies.