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Surgical treatment of hepatocellular carcinoma: Evidence-based outcomes

World Journal of Gastroenterology 2008年第5期14卷 685-692页

作者： shintaro yamazaki Tadatoshi Takayama Department of Digestive Surgery Nihon University School of Medicine Tokyo 173-8610 Japan

Surgeons may be severely criticized from the perspective of evidence-based medicine because the majority of surgical publications appear not to be convincing. In the top nine surgical journals in 1996, half of the 175 publications refer to pilot studies lacking a control group, 18% to animal experiments, and only 5% to randomized controlled trials (RCT). There are five levels of clinical evidence:level 1 (randomized controlled trial), level 2 (prospective concurrent cohort study), level 3 (retrospective historical cohort study), level 4 (pre-post study), and level 5 (case report). Recently, a Japanese evidence-based guideline for the surgical treatment of hepatocellular carcinoma (HCC) was made by a committee (Chairman, Professor Makuuchi and five members). We searched the literature using the Medline Dialog System with four Keywords:HCC, surgery, English papers, in the last 20 years. A total of 915 publications were identified systematically reviewed. At the first selection (in which surgery-dominant papers were selected), 478 papers survived. In the second selection (clearly concluded papers), 181 papers survived. In the final selection (clinically significant papers), 100 papers survived. The evidence level of the 100 surviving papers is shown here:level-1 papers (13%), level-2 papers (11%), level-3 papers (52%), and level-4 papers (24%);therefore, there were 24% prospective papers and 76% retrospective papers. Here, we present a part of the guideline on the five main surgical issues:indication to operation, operative procedure, peri-operative care, prognostic factor, and post-operative adjuvant therapy.

关键词： Indication to operation Hepatocellular carcinoma Operative procedure Peri-operative care Prognostic factors

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Prospective validation to prevent symptomatic portal vein thrombosis after liver resection

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World Journal of Hepatology 2022年第5期14卷 1016-1024页

作者： Nao Yoshida shintaro yamazaki Moriguchi Masamichi Yukiyasu Okamura Tadatoshi Takayama Department of Digestive Surgery Nihon University School of MedicineTokyo 1738610Japan

BACKGROUND Portal vein thrombosis(PVT)after liver resection is rare but can lead to lifethreatening liver *** prospective study evaluated patients using contrastenhanced computed tomography(E-CT)on the first day after liver resection for early PVT detection and *** To evaluate patients by E-CT on the first day after liver resection for early PVT detection and immediate *** Patients who underwent liver resection for primary liver cancer from January 2015 were enrolled.E-CT was performed on the first day after surgery in patients undergoing anatomical resection,multiple resections,or with postoperative bile leakage in the high-risk group for *** PVT was detected,anticoagulant therapy including heparin,warfarin,and edoxaban was administered.E-CT was performed monthly until PVT *** The overall incidence of PVT was 1.57%(8/508).E-CT was performed on the first day after surgery in 235 consecutive high-risk patients(165 anatomical resections,74 multiple resections,and 28 bile leakages),with a PVT incidence of 3.4%(8/235).Symptomatic PVT was not observed in the excluded *** analyses revealed that sectionectomy was the only independent predictor of PVT[odds ratio(OR)=12.20;95%confidence interval(CI):2.22-115.97;P=0.003].PVT was found in the umbilical portion of 75.0%(6/8)of patients,and sectionectomy on the left side showed the highest risk of PVT(OR=14.10;95%CI:3.17-62.71;P<0.0001).CONCLUSION Sectionectomy on the left side should be chosen with caution as it showed the highest risk of PVT.E-CT followed by anticoagulant therapy was effective in managing early-phase PVT for 2 mo without adverse events.

关键词： Portal vein thrombosis Liver resection Anatomical resection Anticoagulant therapy Hepatocellular carcinoma Umbilical potion

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