Laparoscopic liver surgery. Analysis of a series of 61 patients

AIM: The aim of this paper was to analyze the experience in laparoscopic liver surgery in the Department of General Surgery and Liver Transplantation of the Fundeni Clinical Institute in a six-year interval (1998-2004). METHOD: Sixty-one patients underwent laparoscopic liver surgery in the Department during this period. There were 30 patients with cystic lesions (essential cysts 9, multiple cystic liver disease 2, hydatid cysts 19), 31 patients with solid lesions (hemangiomas 9, benign tumors 3, metastases 6 and primary liver malignancies 13). RESULTS: There was no mortality and the morbidity was 9.83% (6 patients). The mean follow-up was 20 months. There was no recurrence in the cystic lesion patients nor in the patients with malignant lesions who had undergone curative intended operations. CONCLUSION: We are only at the beginning of laparoscopic liver surgery and these results require confirmation in larger series and with a longer follow up. The immediate benefits seem to be those of any miniinvasive surgery: reduced trauma to the abdominal wall, early mobilization, shorter hospital stay, and better cosmetic appearance.     

Progression while Receiving Preoperative Chemotherapy Should Not Be an Absolute Contraindication to Liver Resection for Colorectal Metastases

Purpose

Tumor progression while receiving neoadjuvant chemotherapy (PD) has been associated with poor outcome and is commonly considered a contraindication to liver resection (LR). This study aims to clarify in a large multicenter setting whether PD is always a contraindication to LR.

Methods

Data from the LiverMetSurvey international registry were analyzed. Patients undergoing LR for colorectal metastases without extrahepatic disease after neoadjuvant chemotherapy between 1990 and 2009 were reviewed.

Results

Among 2143 patients, PD occurred in 176 (8.2?%). Risk of progression was increased after 5-FU or irinotecan (22.7?% vs. 6.8?% after other regimens, p?p?p?p?=?0.0006). In the PD group, 3 independent prognostic factors were identified: carcinoembryonic antigen (CEA) ??200?ng/mL (p?=?0.003), >3 metastases (p?=?0.028), and tumor diameter ??50?mm (p?=?0.002). A survival predictive model showed that patients without any risk factors had 5-year survival rates of 53.3?%; good survival results were still observed if metastases were >3 or ??50?mm (29.9 and 19.1?%, respectively). On the contrary, survival was less than 10?% at 3?years in the presence of >1 prognostic factor or CEA of ??200?ng/mL.

Conclusions

PD is a negative prognostic factor, but it is not an absolute contraindication to LR. Patients with PD could be scheduled for LR except for those with >3 metastases and ??50?mm, or CEA ??200?ng/mL in whom further chemotherapy is recommended.     

MicroRNA-21 inhibits Serpini1, a gene with novel tumour suppressive effects in gastric cancer

BackgroundA thorough understanding of gastric cancer at the molecular level is urgently needed. One prominent oncogenic microRNA, miR-21, was previously reported to be upregulated in gastric cancer.MethodsWe performed an unbiased search for downstream messenger RNA targets of miR-21, based on miR-21 dysregulation, by using human tissue specimens and the MKN28 human gastric carcinoma cell line. Molecular techniques include microRNA microarrays, cDNA microarrays, qRT-PCR for miR and mRNA expression, transfection of MKN28 with miR-21 inhibitor or Serpini1 followed by Western blotting, cell cycle analysis by flow cytometry and luciferase reporter assay.ResultsThis search identified Serpini1 as a putative miR-21 target. Luciferase assays demonstrated direct interaction between miR-21 and Serpini1 3′UTR. miR-21 and Serpini1 expression levels were inversely correlated in a subgroup of gastric cancers, suggesting a regulatory mechanism that included both of these molecules. Furthermore, Serpini1 induced growth retardation of MKN28 and induced vigorous G1/S arrest suggesting its potential tumour-suppressive function in the stomach.ConclusionTaken together, these data suggest that in a subgroup of gastric cancers, miR-21 is upregulated, inducing downregulation of Serpini1, which in turn releases the G1–S transition checkpoint, with the end result being increased tumour growth.     

The Influence of Solar Sintering on Copper Heat Exchanger Parts with Controlled 3D-Printed Morphology

From a scientific point of view, heat transfer is different in solar furnaces compared with classical ones and the influence of direct concentrated solar radiation on sintered parts needs to be studied in detail to determine the feasibility of solar furnaces in manufacturing small workpieces. This study was performed on cylindrical samples with controlled morphology obtained by a powder metallurgy 3D printing technique. All samples were heated with a heating rate of 120 ± 10 °C/minute, with 0, 1, 2, 3, 4 and 5 min holding times at 900 °C and 930 °C. The morphology of the samples was analyzed microscopically, the microhardness was determined before and after sintering, and the results were correlated with the sintering parameters (temperature, heating rate and holding time). The best results were obtained at 930 °C with 5 min holding time from the microhardness value and microstructure point of view.     

Primary prophylaxis of variceal bleeding in cirrhotics awaiting liver transplantation

BACKGROUND/AIMS: To evaluate the efficacy and safety of prophylactic band ligation and propranolol versus propranolol alone for the primary prophylaxis of variceal bleeding in patients with high-risk esophageal varices listed for liver transplantation. METHODOLOGY: Out of 152 cirrhotic patients included on the waiting list between January 2001 and January 2003, high-risk esophageal varices were detected in 72. These patients were randomized to undergo combined therapy or propranolol monotherapy. The actuarial probabilities of bleeding from esophageal varices and bleeding-related death were calculated by Kaplan-Meier method and compared using the log-rank test. RESULTS: Variceal eradication was achieved in 33 patients (91.6%) in 2.5 +/- 1.4 ligation sessions. The mean daily dose of propranolol was 72 +/- 25mg in the propranolol group and 68 +/- 21 mg in the ligation group. Six percent of patients in the ligation group and 31% in the propranolol group had one episode of bleeding during the 18 months of follow-up (p = 0.03). The actuarial probabilities of bleeding-free survival after 18 months of follow-up, in the ligation and monotherapy groups were 96% and, respectively, 69% (p = 0.04). CONCLUSIONS: Endoscopic band ligation associated with propranolol significantly reduces the occurrence of the first episode of variceal bleeding and improves bleeding-related survival in cirrhotics included on the waiting list.     

Prevalence of Nonalcoholic Steatohepatitis Among Patients with Resectable Intrahepatic Cholangiocarcinoma

Background and Aims

The objective of this report was to determine the prevalence of underlying nonalcoholic steatohepatitis in resectable intrahepatic cholangiocarcinoma.

Methods

Demographics, comorbidities, clinicopathologic characteristics, surgical treatments, and outcomes from patients who underwent resection of intrahepatic cholangiocarcinoma at one of eight hepatobiliary centers between 1991 and 2011 were reviewed.

Results

Of 181 patients who underwent resection for intrahepatic cholangiocarcinoma, 31 (17.1 %) had underlying nonalcoholic steatohepatitis. Patients with nonalcoholic steatohepatitis were more likely obese (median body mass index, 30.0 vs. 26.0 kg/m², p?<?0.001) and had higher rates of diabetes mellitus (38.7 vs. 22.0 %, p?=?0.05) and the metabolic syndrome (22.6 vs. 10.0 %, p?=?0.05) compared with those without nonalcoholic steatohepatitis. Presence and severity of hepatic steatosis, lobular inflammation, and hepatocyte ballooning were more common among nonalcoholic steatohepatitis patients (all p?<?0.001). Macrovascular (35.5 vs. 11.3 %, p?=?0.01) and any vascular (48.4 vs. 26.7 %, p?=?0.02) tumor invasion were more common among patients with nonalcoholic steatohepatitis. There were no differences in recurrence-free (median, 17.0 versus 19.4 months, p?=?0.42) or overall (median, 31.5 versus 36.3 months, p?=?0.97) survival after surgical resection between patients with and without nonalcoholic steatohepatitis.

Conclusions

Nonalcoholic steatohepatitis affects up to 20 % of patients with resectable intrahepatic cholangiocarcinoma.