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Four-year experience with more than 1000 cases of total laparoscopic liver resection in a single center

World Journal of Gastroenterology 2022年第25期28卷 2968-2980页

作者： Xiang Lan Hai-Li Zhang Hua Zhang Yu-Fu Peng Fei Liu Bo Li yong-gang wei Department of Hepatobiliary Surgery The First Affiliated HospitalChongqing Medical UniversityChongqing 400016China Department of Liver Surgery&Liver Transplantation Center Sichuan University West China HospitalChengdu 610041Sichuan ProvinceChina

BACKGROUND Laparoscopic liver resection(LLR)has become a safe surgical procedure that needs additional summarization.AIM To review 4 years of total LLR surgeries,exceeding 1000 cases,which were performed at a single center.METHODS Patients who underwent LLR at West China Hospital of Sichuan University between January 2015 and December 2018 were identified.Surgical details,including the interventional year,category of liver disease,and malignant liver tumors prognosis,were evaluated.The learning curve for LLR was evaluated using the cumulative sum method.The Kaplan-Meier method was used to perform survival analysis.RESULTS Ultimately,1098 patients were identified.Hepatocellular carcinoma(HCC)was the most common disease that led to the need for LLR at the center(n=462,42.08%).The average operation time was 216.94±98.51 min.The conversion rate was 1.82%(20/1098).The complication rate was 9.20%(from grade II to V).The 1-year and 3-year overall survival rates of HCC patients were 89.7%and 81.9%,respectively.The learning curve was grouped into two phases for local resection(cases 1-106 and 107-373),three phases for anatomical segmentectomy(cases 1-44,45-74 and 75-120),and three phases for hemihepatectomy(cases 1-17,18-48 and CONCLUSION LLR may be considered a first-line surgical intervention for liver resection that can be performed safely for a variety of primary,secondary,and recurrent liver tumors and for benign diseases once technical competence is proficiently attained.

关键词： Laparoscopic liver resection Single-center experience Learning curve Liver

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Salvage liver transplantation in the treatment of hepatocellular carcinoma:A Meta-analysis

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World Journal of Gastroenterology 2012年第19期18卷 2415-2422页

作者： Hong-Yu Li yong-gang wei Lv-Nan Yan Bo Li Department of Liver and Vascular Surgery Center of Liver TransplantationWest China HospitalSichuan UniversityChengdu 610041Si-chuan ProvinceChina

AIM:To evaluate survival and recurrence after salvage liver transplantation(SLT) for the treatment of hepatocellular carcinoma(HCC) compared with primary liver transplantation(PLT) using a meta-analysis.METHODS:Literature on SLT versus PLT for the treatment of HCC published between 1966 and July 2011 was retrieved.A meta-analysis was conducted to estimate pooled survival and disease-free rates.A fixed or random-effect model was established to collect the data.RESULTS:The differences in overall survival and disease-free survival rates at 1-year,3-year and 5-year survival rates were not statistically significant between SLT group and PLT group(P > 0.05).After stratifying the various studies by donor source and Milan criteria,we found that:(1) Living donor liver transplantation recipients had significantly higher 1-year survival rate,lower 3-year and 5-year survival rates compared with deceased-donor liver transplantation(DDLT) recipients.And in DDLT recipients they had better 1-year and 5-year disease-free survival rate in SLT group;and(2) No difference was seen in 1-year,3-year and 5-year survival rates between two groups who beyond Milan criteria at the time of liver transplantation.CONCLUSION:SLT can be effectively performed for patients with recurrence or deterioration of liver function after hepatectomy for HCC.It does not increase the perioperative mortality and has a similar long-term survival rates compared to PLT.

关键词：移植治疗 Meta分析肝癌抢救随机效应模型时间标准生存率肝移植

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Risk factors associated with early and late recurrence after curative resection of hepatocellular carcinoma: a single institution's experience with 398 consecutive patients

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Hepatobiliary & Pancreatic Diseases International 2014年第2期13卷 153-161页

作者： Zheng-Gui Du yong-gang wei Ke-Fei Chen Bo Li Department of Liver and Vascular Surgery Liver Transplantation CenterWest China HospitalSichuan University

BACKGROUND: Surgical resection is an important curative treatment for hepatocellular carcinoma (HCC); however, some patients experience an unexpected recurrence even after hepatectomy. The present study aimed to investigate risk factors and predictive criteria for early and late recurrence of HCC after resection.METHODS: A retrospective analysis of 398 Chinese patients who received curative resection for HCC was conducted. Patients were divided into three groups: without recurrence, early recurrence and late recurrence. Prognostic factors and predictive criteria for early and late recurrence were statistically analyzed. RESULTS: The cumulative recurrence-free survival rates at1, 2, 3, 4, and 5 years were 75.5%, 58.2%, 54.1%, 40.5%, and28.7%, respectively. The distribution of the time to recurrence suggested that recurrence could be divided into early phase(before 2 years; n=164) and late phase (after 2 years; n=83)Cox’s multivariate proportional hazard model analysis revealed that multiplicity of tumors (P=0.004) and venous infiltration(P=0.002) were independent risk factors associated with early recurrence. In contrast, indocyanine green retention rate at 15minutes (P=0.007), serum albumin level (P=0.045), and HBeAg status ( =0.028) proved to be significant independent adverse prognostic factors for late recurrence. Patients with at least 1of the 2 early recurrence risk factors (multiplicity of tumors ≥2and venous infiltration) or with 2 or more late recurrence risk factors are often susceptible to recurrence (P=1.36e-4 and 1.0e-6respectively).CONCLUSIONS: Early and late recurrences correlate with different risk factors and predictive criteria. Early recurrence primarily results from intrahepatic metastases, while late recurrence may be multicentric in origin.

关键词： hepatocellular carcinoma intrahepatic recurrence hepatectomy risk factors prognosis

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Selective oxidation of methane and carbon deposition over Fe_2O_3/Ce_(1-x)Zr_xO_2 oxides

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Rare Metals 2014年第2期33卷 230-238页

作者： Xiu-Li Sang Kong-Zhai Li Hua Wang yong-gang wei Quality Development Institute Kunming University of Science and Technology Engineering Research Center of Metallurgical Energy Conservation and Emission Reduction Ministry of EducationKunming University of Science and Technology

A series of Fe2O3/Al2O3, Fe2O3/CeO2, Ce0.7Zr0.3O2, and Fe2O3/Ce1-xZrxO2（x = 0.1–0.4） oxides was prepared and their physicochemical features were investigated by X-ray diffraction（XRD）, transmission electron microscope（TEM）, and H2-temperature-programmed reduction（H2-TPR） techniques. The gas–solid reactions between these oxides and methane for syngas generation as well as the catalytic performance for selective oxidation of carbon deposition in O2-enriched atmosphere were investigated in detail. The results show that the samples with the presence of Fe2O3show much higher activity for methane oxidation compared with the Ce0.7Zr0.3O2solid solution,while the CeO2-contained samples represent higher CO selectively in methane oxidation than the Fe2O3/Al2O3sample. This suggests that the iron species should be the active sites for methane activation, and the cerium oxides provide the oxygen source for the selective oxidation of the activated methane to syngas during the reaction between methane and Fe2O3/Ce0.7Zr0.3O2. For the oxidation process of the carbon deposition, the CeO2-containing samples show much higher CO selectivity than the Fe2O3/Al2O3sample, which indicates that the cerium species should play a very important role in catalyzing the carbon selective oxidation to CO. The presence of the Ce–Zr–O solid solution could induce the growth direction of the carbonfilament, resulting in a loose contact between the carbon filament and the catalyst. This results in abundant exposed active sites for catalyzing carbon oxidation, strongly improving the oxidation rate of the carbon deposition over this sample. In addition, the Fe2O3/Ce0.7Zr0.3O2also represents much higher selectivity（ca. 97 %） for the conversion of carbon to CO than the Fe2O3/CeO2sample, which can be attributed to the higher concentration of reduced cerium sites on this sample. The increase of the Zr content in the Fe2O3/Ce1-xZrxO2samples could improve the reactivity of the materials for methane oxidation, but it also reduces the selectivity for CO formation

关键词： Methane Carbon deposition Gas–solid reaction Selective oxidation of carbon Fe2O3/Ce1-xZrxO2 catalysts

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Mesohepatectomy versus extended hemihepatectomy for centrally located hepatocellular carcinoma

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Hepatobiliary & Pancreatic Diseases International 2014年第3期13卷 264-270页

作者： Xi Chen Bo Li wei He yong-gang wei Zheng-Gui Du Li Jiang Department of Liver Surgery and Liver Transplantation Center West China Hospital Sichuan University

BACKGROUND: Extended hemihepatectomy is usually recommended to treat large centrally located hepatocellular carcinoma (HCC). However, the morbidity and mortality are high because of the postoperative liver failure. Mesohepatectomy is seldom used because of its technical complexity This study aimed to evaluate the short-term and long-term curative effect of mesohepatectomy. METHODS: From January 2002 to September 2008, a total of 198 consecutive patients with centrally located HCC underwent hepatectomy in our department. According to the surgical procedures, they were divided into mesohepatectomy (group M, n=118), extended right hemihepatectomy (group RE, n=47) and extended left hemihepatectomy (group LE, n=33) groups. The surgical techniques, clinical pathological characteristics and outcomes were compared between group M, group RE and group LE. RESULTS: The operative time of group M was significantly longer than that of the other two groups (P0.05). The morbidity rate in group M was significantly lower than that in group RE (37.3% vs 55.3%, P=0.034), but not in group LE (37.3% vs 24.2%, P=0.163). The biliary leakage tended to be more common in group M (10.2%, P>0.05). The incidence of postoperative liver failure in group M was significantly lower than that in group RE (1.7% vs 10.6%, P=0.032), but not in group LE (1.7% vs 6.1%, P=0.208). The 1-, 3- and 5-year tumor-free survival rates and the overall survival rates after mesohepatectomy were 53.4%, 30.5% and 16.9% and 67.8%, 45.5% and 28.9%, respectively. CONCLUSIONS: Mesohepatectomy is a safe and effective technique for centrally located HCC patients. Compared with extended right hemihepatectomy, mesohepatectomy can ret

关键词： hepatocellular carcinoma mesohepatectomy extended hemihepatectomy complication survival

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Cost-effectiveness analysis of transcatheter arterial chemoembolization with or without sorafenib for the treatment of unresectable hepatocellular carcinoma

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Hepatobiliary & Pancreatic Diseases International 2017年第5期16卷 493-498页

作者： Rong-Ce Zhao Jing Zhou yong-gang wei Fei Liu Ke-Fei Chen Qiu Li Bo Li Department of Liver Surgery and Liver Transplantation Center West China Hospital Sichuan University Chengdu 610041 China Department of Medical Oncology Cancer Center State Key Laboratory of BiotherapyWest China Hospital Sichuan University Chengdu 610041 China

BACKGROUND: Transcatheter arterial chemoembolization(TACE) and TACE in combination with sorafenib(TACEsorafenib) have shown a significant survival benefit for the treatment of unresectable hepatocellular carcinoma(HCC). Adopting either as a first-line therapy carries major cost and resource implications. The objective of this study was to estimate the relative cost-effectiveness of TACE against TACE-sorafenib for unresectable HCC using a decision analytic model.METHODS: A Markov cohort model was developed to compare TACE and TACE-sorafenib. Transition probabilities and utilities were obtained from systematic literature reviews, and costs were obtained from West China Hospital, Sichuan University, China. Survival benefits were reported in quality-adjusted life-years(QALYs). The incremental cost-effectiveness ratio(ICER) was calculated. Sensitive analysis was performed by varying potentially modifiable parameters of the model.RESULTS: The base-case analysis showed that TACE cost $26 951 and yielded survival of 0.71 QALYs, and TACE-sorafenib cost $44 542 and yielded survival of 1.02 QALYs in the entire treatment. The ICER of TACE-sorafenib versus TACE was $56 745 per QALY gained, which was above threshold for cost-effectiveness in China. Sensitivity analysis revealed that the major driver of ICER was the cost post TACE-sorafenib therapy with stable state.CONCLUSION: TACE is a more cost-effective strategy than TACE-sorafenib for the treatment of unresectable HCC.

关键词： hepatocellular carcinoma transcatheter arterial chemoembolization TACE in combination with sorafenib cost-effectiveness

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Adult-to-adult living donor liver transplantation for acute liver failure in China

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World Journal of Gastroenterology 2012年第48期18卷 7234-7241页

作者： Ding Yuan Fei Liu yong-gang wei Bo Li Lv-Nan Yan Tian-Fu Wen Ji-Chun Zhao yong Zeng Ke-Fei Chen Department of Liver and Vascular Surgery and Liver Transplantation Center of West China Hospital Sichuan University Department of Hepatopancreatobiliary Surgery of West China Hospital Sichuan University

AIM:To investigate the long-term outcome of recipients and donors of adult-to-adult living-donor liver transplantation(AALDLT) for acute liver failure(ALF).METHODS:Between January 2005 and March 2010,170 living donor liver transplantations were performed at West China Hospital of Sichuan University.All living liver donor was voluntary and provided informed consent.Twenty ALF patients underwent AALDLT for rapid deterioration of liver function.ALF was defined based on the criteria of the American Association for the Study of Liver Diseases,including evidence of coagulation abnormality [international normalized ratio(INR) ≥ 1.5] and degree of mental alteration without pre-ex-isting cirrhosis and with an illness of weight was 623.3 ± 111.3 g,which corresponded to graft-torecipient weight ratio of 0.95% ± 0.14%.The segment Ⅴor Ⅷ hepatic vein was reconstructed in 11 right-lobe grafts.The 1-year and 3-year recipient's survival and graft survival rates were 65%(13 of 20).Postoperative results of total bilirubin,INR and creatinine showed obvious improvements in the survived patients.However,the creatinine level of the deaths was increased postoperatively and became more aggravated compared with the level of the survived recipients.Multivariate analysis

关键词：肝功能衰竭移植治疗中国西部活体成人急性等待时间国际标准化

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Reply to: The letter to the editor "Laparoscopic liver resection for malignancies confined to Couinaud's segment VII in the robotic surgery era" by Zizzo et al.

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Hepatobiliary Surgery and Nutrition 2019年第4期8卷 445-446页

作者： Ning-Yuan Wen yong-gang wei Fei Liu Hai-Li Zhang Department of Liver Surgery Liver Transplantation Center West China Hospital of Sichuan University Chengdu 610041 China

We would like to thank you and other reviewers for reading our papers and sharing valuable comments. We are also appreciative of your conscientiousness and broad knowledge on relevant research fields. Recent advances in robotic hepatectomy (RH) were briefly summarized in your letter, especially its non-inferiority compared with the conventional laparoscopic liver resection (LLR). Here, we would like to address several points relevant to the comments.

关键词： resection letter surgery

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Feasibility of using marginal liver grafts in living donor liver transplantation

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World Journal of Gastroenterology 2018年第23期24卷 2441-2456页

作者： Xiang Lan Hua Zhang Hong-Yu Li Ke-Fei Chen Fei Liu yong-gang wei Bo Li Department of Liver Surgery and Liver Transplantation Center West China Hospital of Sichuan University Department of Pancreatic Surgery West China Hospital of Sichuan University

Liver transplantation(LT) is one of the most effective treatments for end-stage liver disease caused by related risk factors when liver resection is contraindicated. Additionally,despite the decrease in the prevalence of hepatitis B virus(HBV) over the past two decades,the absolute number of HBs Ag-positive people has increased,leading to an increase in HBV-related liver cirrhosis and hepatocellular carcinoma. Consequently,a large demand exists for LT. While the wait time for patients on the donor list is,to some degree,shorter due to the development of living donor liver transplantation(LDLT),there is still a shortage of liver grafts. Furthermore,recipients often suffer from emergent conditions,such as liver dysfunction or even hepatic encephalopathy,which can lead to a limited choice in grafts. To expand the pool of available liver grafts,one option is the use of organs that were previously considered "unusable" by many,which are often labeled "marginal" organs. Many previous studies have reported on the possibilities of using marginal grafts in orthotopic LT; however,there is still a lack of discussion on this topic,especially regarding the feasibility of using marginal grafts in LDLT. Therefore,the present review aimed to summarize the feasibility of using marginal liver grafts for LDLT and discuss the possibility of expanding the application of these grafts.

关键词： Marginal liver grafts Living donor liver transplantation Liver transplant waiting lists Small-forsize grafts Older donors ABO-incompatible Steatosis Chronic hepatitis

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Combined hepatectomy and radiofrequency ablation versus TACE in improving survival of patients with unresectable BCLC stage B HCC

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Hepatobiliary & Pancreatic Diseases International 2016年第4期15卷 378-385页

作者： Yi-Fu Hou yong-gang wei Jia-Yin Yang Tian-Fu Wen Ming-Qing Xu Lu-Nan Yan Bo Li Department of Hepatic Surgery West China HospitalSichuan University

BACKGROUND： Combined hepatectomy and radiofrequency ablation（RFA） provides an additional treatment for patients with Barcelona Clinic Liver Cancer（BCLC） stage B hepatocellular carcinoma（HCC） who are conventionally deemed unresectable. This study aimed to analyze the outcome of this combination therapy by comparing it with transarterial chemoembolization（TACE）. METHODS： We retrospectively reviewed 51 patients with unresectable BCLC stage B HCC who had received the combination therapy. We compared the survival of these patients with that of 102 patients in the TACE group（control）. Prognostic factors associated with worse survival in the combination group were analyzed.RESULTS： No differences in tumor status and liver function were observed between the TACE group and combination group. The median survival time for the combination group and TACE group was 38（6-54） and 17（3-48） months, respectively（P〈0.001）. The combination group required longer hospitalization than the TACE group [8（5-14） days vs 4（2-9） days,P〈0.001]. More than two ablations decreased the survival rate in the combination group. CONCLUSIONS： Combined hepatectomy and RFA yielded a better long-term outcome than TACE in patients with unresectable BCLC stage B HCC. Patients with a limited ablated size（≤2 cm）, a limited number of ablations（≤2）, and adequate surgical margin should be considered candidates for combination therapy.

关键词： hepatocellular carcinoma hepatectomy radiofrequency ablation transarterial chemoembolization Barcelona Clinic Liver Cancer system

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