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Outcomes of curative liver resection for hepatocellular carcinoma in patients with cirrhosis

World Journal of Gastrointestinal Oncology 2021年第5期13卷 424-439页

作者： Omar Elshaarawy Aya Aman Hazem Mohamed Zakaria Talaat Zakareya Asmaa Gomaa esam elshimi Eman Abdelsameea Department of Hepatology Gastroenterology and Liver TransplantationNational Liver InstituteMenoufia UniversityShebine Elkom 32511MenoufiaEgypt Department of Hepatobiliary Pancreatic Surgery National Liver InstituteMenoufia UniversityShebine Elkom 32511MenoufiaEgypt

BACKGROUND Given the poor synthetic function of cirrhotic liver,successful resection for patients with hepatocellular carcinoma(HCC)necessitates the ability to achieve resections with tumor free *** To validate post hepatectomy liver failure score(PHLF),compare it to other established systems and to stratify risks in patients with cirrhosis who underwent curative liver resection for *** Between December 2010 and January 2017,120 patients underwent curative resection for HCC in patients with cirrhosis were included,the pre-operative,operative and post-operative factors were recorded to stratify patients'risks of decompensation,survival,and *** The preoperative model for end-stage liver disease(MELD)score[odds ratio(OR)=2.7,95%CI:1.2-5.7,P=0.013],tumor diameter(OR=5.4,95%CI:2-14.8,P=0.001)and duration of hospital stay(OR=2.5,95%CI:1.5-4.2,P=0.001)were significant independent predictors of hepatic decompensation after *** the preoperative MELD score[hazard ratio(HR)=1.37,95%CI:1.16-1.62,P<0.001]and different grades of PHLF(grade A:HR=2.33,95%CI:0.59-9.24;Grade B:HR=3.15,95%CI:1.11-8.95;Grade C:HR=373.41,95%CI:66.23-2105.43;P<0.001)and HCC recurrence(HR=11.67,95%CI:4.19-32.52,P<0.001)were significant independent predictors for *** Preoperative MELD score and tumor diameter can independently predict hepatic ***,preoperative MELD score,different grades of PHLF and HCC recurrence can precisely predict survival.

关键词： Cirrhosis Liver Resection Scores Hepatocellular carcinoma

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Optimization of biliary drainage in inoperable distal malignant strictures

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World Journal of Gastrointestinal Endoscopy 2020年第9期12卷 285-296页

作者： esam elshimi Wesam Morad Omar Elshaarawy Ahmed Attia Department of Hepatology and Gastroenterology National Liver InstituteMenoufia UniversityShebine Elkom 32111Egypt Department of Epidemiology and Preventive Medicine National Liver InstituteMenoufia UniversityShebine Elkom 32111Egypt

BACKGROUND Given most patients with distal malignant biliary obstruction present in the nonresectable stage,palliative endoscopic biliary drainage with fully covered metal stent(FCMS)or uncovered metal stent(UCMS)is the only available measure to improve patients’quality of *** covered metal stent(HCMS)has been recently introduced *** adverse effects and stent function between FCMS and UCMS have been extensively *** To study the duration of stent patency of HCMS and compare it with FCMS and UCMS to optimize biliary drainage in inoperable patients with distal malignant *** aims in our study included evaluation of patients’survival and the rates of adverse events for each type of *** We studied 210 patients and randomized them into three equal groups;HCMS,FCMS and UCMS were inserted *** Stent occlusion occurred in(18.6%,17.1%and 15.7%in HCMS,FCMS and UCMS groups,respectively,P=0.9).Stent migration occurred only in patients with FCMS(8.6%of patients).Cholangitis and cholecystitis occurred in 11.4%and 5.7%of patients,respectively,in *** growth occurred only in 10 cases among patients with UCMS after a median of 140 d,sludge occurred in nine,seven and one patients in HCMS,FCMS and UCMS,respectively(P=0.04).CONCLUSION Given the prolonged stent functioning time,the use of HCMS is preferred over the use of UCMS and FCMS for optimizing biliary drainage in patients with distal malignant biliary obstruction.

关键词： Obstructive jaundice Endoscopic retrograde cholangio-pancreatography Half covered metal stent Fully covered and uncovered metal stents

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