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1.
Hirohisa Okabe Toru Beppu Shigeki Nakagawa Morikatsu Yoshida Hiromitsu Hayashi Toshiro Masuda Katsunori Imai Kosuke Mima Hideyuki Kuroki Hidetoshi Nitta Daisuke Hashimoto Akira Chikamoto Takatoshi Ishiko Masayuki Watanabe Yasuyuki Yamashita Hideo Baba 《Journal of gastrointestinal surgery》2013,17(8):1447-1451
Background
Clinical determinants of liver regeneration induced by portal vein embolization (PVE) and hepatectomy remain unclear. The aims of this study were to investigate how liver regeneration occurs after PVE followed by hepatectomy and to determine which factors strongly promote liver regeneration.Methods
Thirty-six patients who underwent both preoperative PVE and major hepatectomy were enrolled in this study. Percentage of future liver remnant volume before PVE (%FLR-pre) was compared with the remnant liver volume after PVE (%FLR-post-PVE) and on postoperative day 7 after hepatic resection (%FLR-post-HR). Clinical indicators contributing to liver regeneration induced by both PVE and hepatectomy were examined by logistic regression analysis.Results
PVE and hepatectomy caused a two-step regeneration. FLR-pre, FLR-post-PVE, and FLR-post-HR were 448, 579, and 761 cm3, respectively. The %FLR-pre was significantly associated with liver regeneration induced by both PVE and hepatectomy (r?=?0.63, p?<?0.0001). Multiple regression analysis showed that only %FLR-pre was independently correlated with posthepatectomy liver regeneration (p?=?0.027, odds ratio?=?13.8).Conclusion
After PVE and the subsequent hepatectomy, liver regeneration was accomplished in a two-step manner. Liver regeneration was strongly influenced by the %FLR-pre. 相似文献2.
Purpose
To evaluate the safety and efficacy of sequential transcatheter arterial chemoembolization (TACE) and portal vein embolization (PVE) prior to surgery in hepatocellular carcinoma (HCC) patients and to compare the clinical outcome of the combined procedure with that of a matched group of patients undergoing PVE alone.Patients and Methods
From 1997 to 2008, 135 patients with HCC underwent sequential TACE and PVE (n = 71) or PVE alone (n = 64) before right hepatectomy. PVE was performed mean 1.2 months after TACE. In both groups, computed tomography (CT) and liver volumetry were performed before and 2 weeks after PVE to assess degree of left lobe hypertrophy.Results
Baseline patient and tumor characteristics were similar in the two groups. After PVE, the chronological changes of liver enzymes were similar in the two groups. The mean increase in percentage future liver remnant (FLR) volume was higher in the TACE + PVE group (7.3%) than in the PVE-only group (5.8%) (P = 0.035). After surgery, incidence of hepatic failure was higher in the PVE-only group (12%) than in the TACE + PVE (4%) group (P = 0.185). Overall (P = 0.028) and recurrence-free (P = 0.001) survival rates were significantly higher in the TACE + PVE group than in the PVE-only group.Conclusion
Sequential TACE and PVE before surgery is a safe and effective method to increase the rate of hypertrophy of the FLR and leads to longer overall and recurrence-free survival in patients with HCC. 相似文献3.
Suguru Yamashita Kiyoshi Hasegawa Michiro Takahashi Yosuke Inoue Yoshihiro Sakamoto Taku Aoki Yasuhiko Sugawara Norihiro Kokudo 《World journal of surgery》2013,37(3):622-628
Background
Although portal vein embolization (PVE) has been applied for surgical resection of colorectal liver metastases (CLM), the clinical usefulness of liver surgery following PVE for CLM remains unknown.Methods
A total of 115 patients were evaluated retrospectively. Among them, 49 underwent one-stage hepatectomy following PVE (PVE group). The remaining 66 patients underwent at least hemihepatectomy without PVE (non-PVE group). This analysis compared the short- and long-term outcomes between the PVE and non-PVE groups.Results
There were no deaths in either group. Using the Clavien–Dindo classification, the rates of postoperative morbidity ≥ grade 1 were 34.7 % in the PVE group and 25.0 % in the non-PVE group (p = 0.26). The 3-year overall survival rates were 54.6 and 64.5 % in the PVE and non-PVE groups, respectively (p = 0.89). The multivariate analysis the variable performance/nonperformance of PVE was not detected as an independent predictor of poor survival.Conclusions
Our one-stage hepatectomy policy of using PVE provides acceptable morbidity and favorable long-term outcomes. 相似文献4.
Fumitoshi Hirokawa Michihiro Hayashi Yoshiharu Miyamoto Mitsuhiro Asakuma Tetsunosuke Shimizu Koji Komeda Yoshihiro Inoue Atsushi Takeshita Yuro Shibayama Kazuhisa Uchiyama 《Journal of gastrointestinal surgery》2013,17(11):1929-1937
Background
The aim of this study was to investigate the clinical characteristics and outcomes of elderly patients (≥70 years old) undergoing curative hepatectomy for hepatocellular carcinoma (HCC).Methods
Clinicopathological data and treatment outcomes in 100 elderly patients (≥70 years old) and 120 control patients (≤70 years old) with HCC who underwent curative hepatectomy between 2000 and 2011 were retrospectively collected and compared.Results
The overall survival rate was similar between the two groups, but the disease-free survival rate was worse in the elderly group when compared with the control group. Prognostic factors for overall and disease-free survival were the same when comparing the two groups. The elderly group had higher rate of females (p?=?0.0230), higher hepatitis C virus infection rate (p?=?0.0090), higher postoperative pulmonary complication rate (p?=?0.0484), lower rate of response to interferon (IFN) therapy (p?=?0.0203) and shorter surgical time (p?=?0.0337) when compared with the control group. The overall recurrence rate was higher in the elderly group than in the control group (p?=?0.0346), but the rate of recurrence within 2 years after the operation was similar when comparing the two groups.Conclusion
The survival of elderly patients with HCC was similar to that of younger patients. However, the disease-free survival was worse in elderly patients than in younger patients. Aggressive antiviral therapy (e.g. IFN therapy) may be necessary to improve the disease-free survival, even in elderly patients. Additionally, clinicians should be aware of the risk of pulmonary complications in elderly patients after hepatectomy. 相似文献5.
Yoon HM Yang HK Lee HJ Park do J Kim HH Lee KU Ahn HS Jo JJ 《Surgical endoscopy》2011,25(6):1761-1765
Background
Several studies have suggested that carbon dioxide (CO2) pneumoperitoneum may have an effect on liver function. This study aimed to compare liver function after laparoscopically assisted distal gastrectomy (LADG) and open distal gastrectomy (ODG) for patients with liver disease.Methods
Between January 2006 and December 2007, the study enrolled 50 patients with EGC and liver disease including 18 liver cirrhosis patients, 3 fatty liver patients (n?=?3), and 29 healthy hepatitis B or C virus carriers. Albumin, total bilirubin, alkaline phosphatase, aspartate aminotransferase, and alanine aminotransferase levels as well as the volume of drainage in the LADG (n?=?18) and ODG (n?=?32) groups were determined to assess liver function.Results
The albumin level on postoperative day 7 was significantly higher in the LADG group (3.5?mg/dl) than in the ODG group (3.1?mg/dl; p?=?0.042), and the volume of drainage on postoperative day 2 was significantly lower in the LADG group (154.3?ml) than in the ODG group (403.1?ml; p?=?0.013). Diuretics were needed by three patients (16.7%) in the LADG group and six patients (18.7%) in the ODG group for control of ascites (p?=?0.587). For the patients with liver cirrhosis, none of the parameters between the two groups were significantly different.Conclusion
For gastric cancer patients with chronic liver disease, LADG can be considered a safe surgical procedure showing surgical outcomes comparable with those for ODG. 相似文献6.
Romain Pommier MD Maxime Ronot MD PhD François Cauchy MD Sébastien Gaujoux MD PhD David Fuks MD PhD Sandrine Faivre MD PhD Jacques Belghiti MD Valérie Vilgrain MD PhD 《Annals of surgical oncology》2014,21(9):3077-3083
Purpose
To compare tumor progression in both embolized and non-embolized liver lobes after portal vein embolization (PVE) in patients with bilobar colorectal liver metastases (CLM), according to the initial response to induction chemotherapy.Methods
From 2002 to 2012, a total of 42 consecutive patients with bilobar CLM initially treated using induction chemotherapy underwent right PVE to achieve adequate future liver remnant volume. Tumoral and liver parenchyma volumes, as well as their volume variations, were measured on computed tomography before and after PVE in both embolized and non-embolized. Patients were classified as fast (≤6 cycles of induction chemotherapy) and slow (>6 cycles) responders.Results
Overall, 432 metastases were analyzed in 42 patients. Patients were slow responders in 29 (69 %) cases. Tumoral volume increased in 29 (69 %) cases in the embolized liver (+48 %; p < 0.0001), and in 28 (66 %) cases in the non-embolized liver (+31 %; p < 0.0001). Fast responders had a tumoral volume decrease in both embolized (?4 %) and non-embolized (?9 %) lobes. On the opposite side, slow responders had tumoral volume increase in both embolized (+79 %) and non-embolized (+32 %) lobes. On multivariate analysis, a ‘slow’ response to induction chemotherapy was the only factor associated with tumoral progression in both embolized (p = 0.0012) and non-embolized (p = 0.001) lobes.Conclusion
Tumor growth after PVE is observed in both embolized and non-embolized liver lobes in most patients but is significantly associated with slow response to induction chemotherapy. 相似文献7.
Hwang S Kim YH Kim DK Ahn CS Moon DB Kim KH Ha TY Song GW Jung DH Kim HR Park GC Namgoong JM Yoon SY Jung SW Park SI Lee SG 《World journal of surgery》2012,36(7):1592-1602
Background
This study was intended to assess the effect of resection of pulmonary metastasis (PM) of hepatocellular carcinoma (HCC) after liver transplantation (LT). No effective treatment modality exists for PM-HCC, and little is known about the posttransplant outcomes of pulmonary metastasectomy (PMT).Methods
Of 587 adult LT recipients diagnosed with HCC, 43 had PM-HCC. We retrospectively compared outcomes in 23 patients who underwent PMT and 20 who did not. PMT was precluded in ten patients in the non-PMT group by multiple (usually ≥5) lung nodules, in nine by lung nodules with concurrent or residual extrapulmonary metastasis, and in one by comorbidity.Results
Of the 23 patients in the PMT group, 14 underwent a single session of PMT, 7 underwent 2 sessions each, and 2 underwent 3 sessions each, for a total of 34 sessions. There were no surgery-related deaths or complications. After first PMT, 41 nodules, each 0.2–2.5 cm in diameter, were observed: 1–5 nodules per patient. Every available treatment was provided to patients with post-PMT recurrence and those in the non-PMT group to control pulmonary and extrapulmonary metastases. Patient survival rates before PM diagnosis did not differ between the two groups (p?=?0.141). However, 2?year post-PM survival rate was significantly greater in the PMT group (30.6% vs. 0%, p?=?0.007), resulting in a significantly greater overall 5?year survival rate (44.7% vs. 12.8%, p?=?0.017). Univariate analysis showed no risk factor significantly associated with patient survival after PMT.Conclusions
PMT should be performed for resectable PM-HCC because it may provide a chance of long-term survival. 相似文献8.
Yun-Hsuan Lee Chia-Yang Hsu Yi-Hsiang Huang Chien-Wei Su Han-Chieh Lin Cheng-Yuan Hsia Teh-Ia Huo 《Journal of gastrointestinal surgery》2013,17(4):730-738
Background/Aims
Serum α-fetoprotein (AFP) and total tumor volume (TTV) are important factors linked with post-operative tumor recurrence in hepatocellular carcinoma (HCC) patients. We investigated the role of a new prognostic marker, AFP-to-TTV ratio, in predicting HCC recurrence.Methods
A total of 655 HCC patients undergoing resection were analyzed.Results
In the multivariate logistic model, serum AFP level [odds ratio (OR) 32.459, p?=?0.012] and TTV (OR 0.006, p?=?0.01) were independently associated with a higher AFT/TTV ratio. The 1-, 3-, and 5-year tumor recurrence rates were 29 %, 55 %, and 68 %, respectively. In the Cox proportional hazards model, alcoholism (hazard ratio [HR], 1.354, p?=?0.028), international normalized ratio of prothrombin time ≥1.01 (HR, 1.349, p?<?0.001), multiple nodules (HR, 1.381, p?=?0.004), main tumor diameter ≥4?cm (HR, 1.535, p?=?0.001), macrovascular invasion (HR, 1.362, p?=?0.016), and AFP/TTV ratio ≥1.5 (HR, 1.49, p?<?0.001) were independently associated with tumor recurrence. In subgroup analysis, a higher AFP/TTV ratio was significantly associated with tumor recurrence in patients characterized by macrovascular invasion, TTV?≥?40 cm3, or main tumor diameter ≥4cm (all p?=?0.001).Conclusion
The AFP/TTV ratio, a newly proposed marker for predicting post-operative tumor recurrence in HCC, is a feasible surrogate and may be useful in selecting super-high-risk patients for tumor recurrence. 相似文献9.
Chuan Li Wen-Jiang Zhu Tian-Fu Wen Yan Dai Lu-Nan Yan Bo Li Jia-Yin Yang Wen-Tao Wang Ming-Qing Xu 《Journal of gastrointestinal surgery》2014,18(8):1469-1476
Objective
This study aims to analyze the outcomes of patients with Child-Pugh A class cirrhosis and a single hepatocellular carcinoma (HCC) up to 5 cm in diameter who underwent liver transplantation vs. resection.Methods
During 2007 to 2012, 282 Child-Pugh A cirrhotic patients with a single HCC up to 5 cm in diameter either underwent liver resection (N?=?243) or received liver transplantation (N?=?39) at our center. Patient and tumor characteristics and outcomes were analyzed.Results
Patients who underwent liver transplantation had a better recurrence-free survival (RFS) vs. those who underwent liver resection. However, the 5-year survival rates after these two treatments were comparable. Similar results were observed when we analyzed patients with a HCC less than 3 cm, and for patients with portal hypertension. In the multivariate analysis, tumor differentiation, difference of primary treatment, and presence of microvascular invasion were associated with postoperative recurrence. However, only differentiation negatively impacted overall survival after operation.Conclusion
Although more recurrences were observed in Child A cirrhotic patients with a single HCC up to 5 cm after liver resection, liver resection offers a similar 5-year survival to liver transplantation, even for patients with portal hypertension. 相似文献10.
Hung-Hsu Hung Hao-Jan Lei Gar-Yang Chau Chien-Wei Su Cheng-Yuan Hsia Wei-Yu Kao Wing-Yiu Lui Wen-Chieh Wu Han-Chieh Lin Jaw-Ching Wu 《Journal of gastrointestinal surgery》2013,17(4):702-711
Aims
This study aims to evaluate the risk factors for tumor recurrence beyond the Milan criteria (MC) for patients with hepatocellular carcinoma (HCC) after surgical resection (SR) in which salvage liver transplantation is relatively contraindicated.Methods
A total of 447 patients who underwent SR for HCC were enrolled consecutively. Among them, 248 and 199 patients were within the Milan criteria and beyond the Milan criteria (BMC group), respectively. Overall survival, recurrence, and disease-free survival were analyzed by multivariate analysis.Results
After a median follow-up of 34.4 months, 130 patients died. Microvascular invasion, higher Edmondson stage of tumor cell differentiation, BMC group, and no anti-viral therapy were associated with poor overall survival. Multi-nodularity, higher Edmondson stage, BMC group, and no anti-viral therapy were independent risk factors for tumor recurrence, while BMC group and no anti-viral therapy were independent risk factors for disease-free survival. The Milan criteria, multi-nodularity, and microvascular invasion were used to stratify the patients into low-, medium-, and high-risk groups for tumor recurrence outside the MC and showed statistical significance (low vs. medium, p?=?0.011; low vs. high, p?<?0.001; medium vs. high, p?=?0.009).Conclusions
The combination of the MC, multi-nodularity, and microvascular invasion predict the post-operative recurrence of HCC and may provide a roadmap for further treatment. 相似文献11.
Mee Joo Kang Jin-Young Jang Wooil Kwon Jae Woo Park Ye Rim Chang Sun-Whe Kim 《Journal of gastrointestinal surgery》2013,17(9):1592-1599
Background and Aim
The clinical usefulness of portal vein embolization (PVE) for Klatskin tumor is not well established. The authors explored the change in liver volume and function before and after major hepatectomy and evaluated the effect of PVE.Methods
Thirty-three consecutive patients who underwent right hepatectomy with an initial future liver remnant (FLR)?≤?30 % for Klatskin tumors at Seoul National University Hospital were included.Results
Eleven patients underwent PVE, and eight patients received right trisectionectomy. PVE induced a mean FLR increase of 19.3 % after a mean of 15.8 days. At postoperative month 1, liver volume and liver hypertrophy ratio was comparable between PVE and no-PVE group. For patients with an initial FLR?≤?20 %, postoperative liver hypertrophy rate of PVE group was comparable to no-PVE group. Liver function tests were not affected by PVE or the initial FLR. Postoperative liver hypertrophy ratio was negatively correlated with the initial FLR (hypertrophy ratio (%)?=?326.7–0.4×initial FLR (ml), P?=?0.001). There was no severe PVE-related morbidity, and postoperative morbidity rate was comparable in PVE and no-PVE group.Conclusion
The postoperative liver hypertrophy ratio, final liver volume, or liver function tests were not affected by PVE. Postoperative liver hypertrophy was related to the initial FLR. 相似文献12.
Mamoru Uemura MD PhD Yo Sasaki MD PhD Terumasa Yamada MD PhD Kunihito Gotoh MD PhD Hidetoshi Eguchi MD PhD Masahiko Yano MD PhD Hiroaki Ohigashi MD PhD Osamu Ishikawa MD PhD Shingi Imaoka MD PhD 《Annals of surgical oncology》2014,21(5):1719-1725
Background
Hepatocellular carcinoma (HCC) is the seventh most common cancer and the third leading cause of cancer deaths worldwide. Hepatitis C virus (HCV) infection is a major risk factor for HCC recurrence after curative resection. This study evaluated anti-HCV antibody (Ab) titer as a prognostic indicator of HCC recurrence after curative hepatic resection.Methods
A total of 82 patients with HCC (anti-HCV Ab positive and hepatitis B surface antigen negative) who underwent curative hepatic resection were evaluated. Anti-HCV Ab titers were measured using a third-generation enzyme immunoassay, and patients were divided into high (n = 41) and low (n = 41) titer groups to compare their clinicopathological characteristics and disease-free survival. Univariate and multivariate analyses were conducted to identify risk factors for early or late recurrence.Results
Multivariate analysis showed that anti-HCV Ab titer and vascular invasion were independent prognostic factors of disease-free survival [odds ratio (OR) 1.9, p = 0.03, and OR 1.8, p = 0.04, respectively]. Subgroup analysis identified only vascular invasion as an independent prognostic factor for early recurrences that were considered residual intrahepatic metastases. Subgroup analysis identified anti-HCV Ab titer and fibrosis grade as independent prognostic factors of late recurrences that were considered to be metachronous multicentric liver carcinogenesis (OR 4.8, p = 0.04, and OR 5.2, p = 0.03, respectively).Discussion
Anti-HCV Ab titer is a predictive factor for HCC recurrence, especially the risk of late recurrence due to multicentric carcinogenesis. Prevention of liver carcinogenesis after hepatic resection for HCC might be appropriate for patients with high anti-HCV Ab titers. 相似文献13.
Constantinos Nastos Konstantinos Kalimeris Nikolaos Papoutsidakis George Defterevos Agathi Pafiti Helen Kalogeropoulou Loukia Zerva Tzortzis Nomikos Georgia Kostopanagiotou Vasillios Smyrniotis Nikolaos Arkadopoulos 《Journal of gastrointestinal surgery》2011,15(5):809-817
Background
This study aims to evaluate whether injury of gut mucosa in a porcine model of post-hepatectomy liver dysfunction can be prevented using antioxidant treatment with desferrioxamine.Methods
Post-hepatectomy liver failure was induced in pigs combining major (70%) liver resection and ischemia/reperfusion injury. An ischemic period of 150 minutes, was followed by reperfusion for 24 h. Animals were randomly divided into a control group (n?=?6) and a desferrioxamine group (DFX, n?=?6). DFX animals were treated with continuous IV infusion of desferrioxamine 100 mg/kg. Intestinal mucosal injury (IMI), bacterial and endotoxin translocation (BT) were evaluated in all animals. Intestinal mucosa was also evaluated for oxidative markers.Results
DFX animals had significantly lower IMI score (3.3?±?1.2 vs. 1.8?±?0.9, p?<?0.05), decreased BT in the portal circulation at 0 and 12 h of reperfusion (p?=?0.007 and p?=?0.008, respectively), decreased portal endotoxin levels at 6 (p?=?0.006) and 24 h (p?=?0.004), decreased systemic endotoxin levels (p?=?0.01) at 24 h compared to controls. Also, 24 h post-reperfusion mucosal malondialdehyde and protein carbonyls were decreased in DFX animals compared to controls (4.1?±?1.2 vs. 2.5?±?1.2, p?=?0.05 and 0.5?±?0.1 vs. 0.4?±?0.1, p?=?0.04 respectively).Conclusion
Desferrioxamine seems to attenuate mucosal injury from post-hepatectomy liver dysfunction possibly through blockage of iron-catalyzed oxidative reactions. 相似文献14.
Atiq Rahman M. Mura Assifi Felipe E. Pedroso Warren R. Maley Juan E. Sola Harish Lavu Jordan M. Winter Charles J. Yeo Leonidas G. Koniaris 《Journal of gastrointestinal surgery》2012,16(10):1897-1909
Background
Whether liver resection or liver transplantation is optimal therapy for patients with hepatocellular carcinoma (HCC) remains undefined. A meta-analysis was conducted to answer this question.Study Design
This study performed a systematic review of the published literature between January 2000 and April 2012.Results
Nine retrospective studies, totaling 2,279 patients (989 resected and 1,290 transplanted), met the selection criteria. Older patients with larger tumors and less severe cirrhosis were identified in the resection group. At 1?year, resection demonstrated significantly higher overall [odds ratio (OR)?=?1.54; 95?% confidence interval (CI), 1.19?C1.98; p?=?0.001], but equivalent disease-free survival (OR?=?0.93; 95?% CI, 0.53?C1.63; p?=?0.80). At 5?years, there was no difference in overall survival (OR?=?0.86; 95?% CI, 0.61?C1.21; p?=?0.38), but a higher disease-free survival in transplanted patients was observed (OR?=?0.39; 95?% CI, 0.24?C0.63; p?<?0.001). When limiting our analysis to studies conducted in an intent-to-treat fashion, there was no difference in 5?year overall survival (OR?=?1.18; 95?% CI, 0.92?C1.51; p?=?0.19), but a significantly higher disease-free survival (OR?=?0.76; 95?% CI, 0.57?C1.00; p?=?0.05) in transplanted patients. At 10?years, transplantation had higher overall and disease-free survival rates.Conclusion
Liver transplantation in patients with HCC results in increased late disease-free and overall survival when compared with liver resection. Nonetheless, the benefit of liver transplantation is offset by higher short-term mortality, donor organ availability, and long transplant wait times associated with more patient deaths. Understanding these differences in survival is helpful in guiding treatment. However, a properly controlled prospective trial is needed to define how best to treat HCC patients who are candidates for either therapy. 相似文献15.
Viganò L Russolillo N Ferrero A Langella S Sperti E Capussotti L 《Annals of surgical oncology》2012,19(6):2035-2044
Background
Liver resection (LR) is the only potentially curative treatment of colorectal liver metastases (CRLM). Its outcome over the past 2 decades was studied using actual 5-year survival rates.Methods
Data of 393 consecutive patients who underwent LR for CRLM at Mauriziano Umberto I (Turin) until June 2005 were analyzed. Excluding R2 resections (n?=?4) or incomplete 5-year follow-up (n?=?13), 376 patients were divided according to LR date into groups A (before 1995: 90 patients), B (1995?C2000: 94 patients), C (2001?C2005: 192).Results
Group C presented increased multiple and bilobar metastases compared with combined group A and B (C vs AB: 54.7% vs 40.2%, P?=?0.005; 28.1% vs 19.0%, P?=?0.038, respectively), decreased metastases diameter (C vs AB: 32 vs 40?mm, P?=?0.0001). The 5-year overall survival, calculated excluding 4 operative mortalities (group AB), increased over the years (A, 20.5%; B, 32.6%; C, 46.4%; P?0.0001). Early recurrences (1?year) were not decreased, extrahepatic recurrences even increased (C vs AB: 17.2% vs 8.6%, P?=?0.015). Recurrence-free 5-year survival improved (C vs AB: 23.4% vs 13.9%, P?=?0.019) linked to decreased liver recurrences (C vs AB: 26.8% vs 37.4%, P?=?0.023). Resection rate (59% overall for liver recurrence) increased along with 5-year survival after recurrence (A, 4.0%; B, 14.2%; C, 21.4%; P?0.0001). Survival improvement was confirmed for multiple (P?=?0.003) and synchronous metastases (P?=?0.008), N+ tumors (P?=?0.005), and in patients without chemotherapy (P?=?0.001).Conclusions
Long-term outcome of LR for CRLM improved over 20?years, even in patients with negative prognostic factors, linked to hepatic recurrences reduction and increased survival after recurrence. 相似文献16.
Ahmed El-Gendi Mohamed El-Shafei Fatma Abdel-Aziz Essam Bedewy 《Journal of gastrointestinal surgery》2013,17(4):712-718
Background
Radiofrequency ablation (RFA) was initially started by radiologists as a percutaneous treatment, but surgeons started to use RFA by surgical approach for patients with tumors at locations difficult for the percutaneous procedure. The aim was to evaluate the results of intraoperative RFA for small hepatocellular carcinomas (HCCs) (<3 cm) in locations difficult for a percutaneous approach.Methods
Two hundred forty-seven patients with small solitary HCC (<3 cm) were treated; 196 via percutaneous RFA while 51 patients presented at sites not amenable for percutaneous route. Twenty-seven out of 51 patients underwent surgical resection, while 24/51 patients underwent intraoperative RFA.Results
The location and depth of the tumor from the liver capsule was the only significant factors in the choice of the surgeon between resection and RFA. RFA was successful in all tumors (complete ablation rate of 100 %). In the surgery group, all patients achieved R0 resection. Complication rate was comparable (p?=?1.0). After a median follow-up of 37 months (range, 10–45 months), no tumors showed neither local progression nor local recurrence and no significant difference was observed between two groups as regards early recurrence and number of de novo lesions (p?=?0.49). One-year and 3-year survival rates were 93 % and 81 %, respectively, in the resection group comparable to the corresponding rates of 92 % and 74 % in the RFA group (p?=?0.9).Conclusion
For small HCC in locations difficult for a percutaneous approach, intraoperative RFA can be an alternative option for deep-seated tumors necessitating more than one segmentectomy achieving similar tumor control, and overall and disease-free survival. 相似文献17.
Nir Lubezky Evan Winograd Michael Papoulas Guy Lahat Einat Shacham-Shmueli Ravit Geva Richard Nakache Joseph Klausner Menahem Ben-Haim 《Journal of gastrointestinal surgery》2013,17(3):527-532
Purpose
Bevacizumab has been shown to increase progression free and overall survival in patients with metastatic colorectal cancer. Neoadjuvant bevacizumab is commonly used in patients undergoing liver resection. Our purpose was to evaluate whether bevacizumab is associated with increased rate of perioperative complications in patients undergoing hepatic resection for colorectal liver metastases (CRLM).Methods
Retrospective analysis of patients undergoing hepatic resection for CRLM who received chemotherapy and bevacizumab (group 1, n?=?134), or chemotherapy alone (group 2, n?=?57). We compared demographics, surgical characteristics, and perioperative course.Results
Perioperative complications developed in 35 % of patients in group 1, and 47 % in group 2 (p?=?0.11). Of those complications, 15 (11.2 %) in group 1, and 5 (8.8 %) in group 2 were considered major (p?=?0.617). Four patients, all of whom received preoperative bevacizumab, developed enteric leaks following combined liver and bowel resection. The rate of anastomotic leak in group 1 was 10 %, compared with 0 in group 2, p?=?0.56.Conclusion
Neoadjuvant chemotherapy along with bevacizumab was not associated with an increased risk of postoperative complications after hepatic resection. Possible association of increased morbidity with simultaneous bowel and liver resections following bevacizumab administration was found and we recommend avoiding such treatment combination. 相似文献18.
Louise Barbier MD David Fuks MD PhD Patrick Pessaux MD PhD Fabrice Muscari MD Yves-Patrice Le Treut MD Sandrine Faivre MD PhD Jacques Belghiti MD 《Annals of surgical oncology》2013,20(11):3603-3609
Background
Liver resection can be considered in some hepatocellular carcinoma (HCC) patients who received sorafenib. The lack of clinical data about safety of resection after sorafenib treatment led us to assess its potential impact on perioperative course in a multicentric study.Methods
From 2008 to 2011, a total of 23 HCC patients who underwent liver resection after treatment with sorafenib (sorafenib group) were compared with 46 HCC patients (control group) matched for age, gender, underlying liver disease, tumor characteristics and type of resection. Patients received sorafenib for a median duration of 1 (range 0.2–11) months and drug was interrupted at least 7 days before surgery. End points were intraoperative (operative time, vascular clamping, blood loss and transfusion), and postoperative outcomes focusing on recovery of liver function.Results
In the sorafenib group, HCC was developed on F4 cirrhosis in 48 % and the rate of major resection was 44 %. Surgical procedure duration (280 vs. 240 min), transfusion rate (26 vs. 15 %), blood loss (400 vs. 300 mL) and vascular clamping (70 vs. 74 %) were similar in the two groups. Mortality was zero in the sorafenib group and one (2.1 %) in the control group (p = 1.000). The incidence of postoperative complications was 44 % in the sorafenib group and 59 % in the control group (p = 0.307). Recovery of liver function was similar in the two groups in terms of prothrombin time (90 vs. 81 %, p = 0.429) and bilirubin level (16 vs. 24 μmol/L, p = 102) at postoperative day 5.Conclusions
No adverse effect of preoperative administration of sorafenib was observed during and immediately after liver resection for HCC. 相似文献19.
Madziarska K Weyde W Krajewska M Zukowska Szczechowska E Gosek K Penar J Klak R Golebiowski T Kozyra C Klinger M 《International urology and nephrology》2012,44(3):955-961
Purpose
To assess factors influencing the long-term survival of elderly dialysis patients.Methods
The study group consisted of 51 prevalent dialysis patients aged over 70?years (32 F and 19?M, all caucasians), who had been on a chronic hemodialysis (27) or peritoneal dialysis program (24) for at least 2?months; median age was 77?years, median time on dialysis before inclusion was 16?months, and median residual diuresis was 600?ml. The patients were prospectively followed up to 4?years, and an analysis of factors affecting survival was performed.Results
Thirteen patients from the initial cohort of 51 (25.5?%) survived the whole 48-month observation period: 10 HD patients (37?%) and 3 PD patients (12.5?%). Annual mortality rate was 28.2?%: 37.4?% on PD vs. 20.9?% on HD. The dialysis modality had a significant impact on patients?? survival (p?=?0.049; Cox F-test). The independent mortality risk factors in the Cox proportional hazard regression model were higher plasma pro-atrial natriuretic peptide (pro-ANP) (p?=?0.006), lower residual diuresis (p?=?0.048), and lower systolic blood pressure (BP) value (p?=?0.039).Conclusions
Paramount for the survival of the elderly on dialysis is adequate extracellular volume control. Residual renal function is a protective factor for the survival of elderly HD patients. This observation is novel, not previously reported in an elderly dialysis population. 相似文献20.