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surgical resection versus liver transplantation for hepatocellular carcinoma within the Hangzhou criteria: a preoperative nomogram-guided treatment strategy

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Hepatobiliary & Pancreatic Diseases International 2017年第5期16卷 480-486页

作者： Yang Li Dan-Yun Ruan Chang-Chang Jia Hui Zhao Guo-Ying Wang Yang Yang Nan Jiang Department of Hepatic Surgery and Liver Transplantation Center of the Third Affiliated Hospital Organ Transplantation Institute of Sun Yat-Sen University Organ Transplantation Research Center of Guangdong Province Guangzhou 510630 China Department of Medical Oncology the Third Affiliated Hospital of Sun Yat-Sen University Guangzhou 510630 China Department of Biotherapy the Third Affiliated Hospital of Sun Yat-Sen University Guangzhou 510630 China

BACKGROUND: With the expansion of surgical criteria, the comparative efficacy between surgical resection (SR) and liver transplantation (LT) for hepatocellular carcinoma is inconclusive. This study aimed to develop a prognostic nomogram for predicting recurrence-free survival of hepatocellular carcinoma patients after resection and explored the possibility of using nomogram as treatment algorithm reference. METHODS: From 2003 to 2012, 310 hepatocellular carcinoma patients within Hangzhou criteria undergoing resection or liver transplantation were included. Total tumor volume, albumin level, HBV DNA copies and portal hypertension were included for constructing the nomogram. The resection patients were stratified into low- and high-risk groups by the median nomogram score of 116. Independent risk factors were identified and a visually orientated nomogram was constructed using a Cox proportional hazards model to predict the recurrence risk for SR patients. RESULTS: The low-risk SR group had better outcomes compared with the high-risk SR group (3-year recurrence-free survival rate, 71.1% vs 35.9%; 3-year overall survival rate, 89.8% vs 78.9%, both P0.05). CONCLUSIONS: This nomogram offers individualized recurrence risk evaluation for hepatocellular carcinoma patients within Hangzhou criteria receiving resection. Transplantation should be considered the first-line treatment for high risk patients.

关键词： hepatocellular carcinoma surgical resection liver transplantation nomogram recurrence-free survival

surgical resection of a large hypopharyngeal hemangioma in an adult using neodymium-doped yttrium aluminum garnet laser: A case report

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World Journal of Clinical Cases 2020年第5期8卷 932-938页

作者： Mang Jin Cheng-Yu Wang Yun-Xiang Da Wei Zhu Hui Jiang Department of Otolaryngology Jinshan Hospital Fudan University

BACKGROUND Generally,hemangiomas do not require surgical intervention;however,cases of large hemangiomas,potentially involving the throat and trachea,necessitate surgical therapy.Here,we present a case of hypopharyngeal hemangioma in an adult that was successfully treated with neodymium-doped yttrium aluminum garnet(Nd-YAG)laser.CASE SUMMARY Laryngoscopic examination of a 61-year-old man demonstrated the presence of a large,submucosal vascular lesion that extended into the epiglottis,left arytenoid cartilage,lateral to the aryepiglottic fold,and pyriform sinus.The lesion was resected and photocoagulated with limited hemorrhage using Nd:YAG laser.The hypopharyngeal hemangioma was completely excised.The patient showed no recurrence of hypopharyngeal hemangioma during the 1.5-year follow-up period.CONCLUSION Laser therapy is one of the effective tools for treating hemangiomas with rapid,uncontrolled growth or in functional areas,with few side effects and complications.The present case of a male patient with a large hypopharyngeal hemangioma,treated with YAG laser,demonstrates the efficacy of laser photocoagulation in treating cases of hemangiomas,without the risk of bleeding or airway obstruction.The favorable postoperative outcomes demonstrated by our patient with Nd:YAG laser therapy indicate its consideration in the therapy of similar cases.

关键词： Yttrium aluminum garnet laser Large Adult surgical resection Hypopharyngeal Hemangioma Case report

surgical resection of adrenal metastasis from primary liver tumors:a report of two cases

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Hepatobiliary & Pancreatic Diseases International 2008年第4期7卷 440-442页

作者： Durgatosh Pandey Kai-Chah Tan Department of surgical Oncology Institute of Medical SciencesBanaras Hindu UniversityVaranasi 221005India Department of Hepatobiliary Surgery and Liver Transplantation Asian Centre for Liver Diseases and Transplantation Gleneagles HospitalSingaporeSingapore

BACKGROUND:Although the treatment of extrahepatic metastases from primary liver tumors is essentially palliative,solitary metastasis from such tumors offers a possibility of cure by surgical resection.The adrenal gland is an uncommon site for metastasis from primary liver tumors. METHOD:We report two cases of adrenalectomy for solitary adrenal metastasis:one from intrahepatic cholangiocarcinoma and the other from hepatocellular carcinoma. RESULTS:The patient with intrahepatic cholangiocar- cinoma had a synchronous adrenal metastasis and underwent simultaneous liver resection and adrenalectomy. However,he developed recurrent disease 17 months following surgery for which he is presently on palliative chemotherapy.The other patient underwent adrenalectomy for adrenal metastasis 3 months following liver transplantation for hepatocellular carcinoma.He is presently alive and disease-free 27 months after adrenalectomy. CONCLUSION:Carefully selected patients with solitary metastasis from primary liver tumors may be considered for resection.

关键词： adrenal metastasis primary liver tumors surgical resection

Personalized treatment of well-differentiated gastric neuroendocrine tumors based on clinicopathological classification and grading:A multicenter retrospective study

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Chinese Medical Journal 2024年第6期137卷 720-728页

作者： Ju Huang Huimin Liu Dekun Yang Tianming Xu Jing Wang Jingnan Li Department of Gastroenterology Peking Union Medical College HospitalChinese Academy of Medical SciencesPeking Union Medical CollegeBeijing 100730China Key Laboratory of Gut Microbiota Translational Medicine Research Chinese Academy of Medical SciencesBeijing 100730China Department of Gastroenterology Affiliated Yantai Yuhuangding Hospital of Qingdao University Medical CollegeYantaiShandong 264000China Department of Gastroenterology Beijing Zhong-Neng-Jian HospitalBeijing 102401China

Background:The incidence of well-differentiated gastric neuroendocrine tumors(G-NET)is increasing annually,and while they have a good prognosis and low mortality rate,their high recurrence rate makes treatment options controversial.This study aims to determine the relationship between individualized treatment plans and the recurrence of G-NET.Methods:We performed a multicenter,retrospective study of 94 patients with highly differentiated G-NET and treated at Peking Union Medical College Hospital,Yantai Yuhuangding Hospital,and Beijing Zhong-Neng-Jian Hospital from November 2015 to September 2023.Risk factors for recurrence of G-NETs were investigated using chi-squared test and multifactorial logistic regression analysis.Results:After a median follow-up of 49 months,the overall recurrence rate among the 94 G-NET patients was 14%(13/94).The recurrence rates of endoscopic mucosal resection(EMR),endoscopic submucosal dissection(ESD),somatostatin analog(SSA)therapy,and surgery were 43%(6/14),10%(5/49),5%(1/22),and 11%(1/9),respectively.Post-treatment recurrence rates were significantly different(P=0.014)among four treatments(EMR,ESD,SSA,and surgery),and further subgroup comparisons revealed lower recurrence rates in the ESD and SSA groups than in the EMR group.From the second month onward,SSA therapy considerably reduced the gastrin levels from 1081.0(571.5,2472.8)pg/mL to 461.5(255.3,795.0)pg/mL(Z=-3.521,P<0.001).Both chi-squared test and multifactorial logistic regression analysis suggested that among the clinicopathological parameters studied,only the pre-treatment gastrin level(P=0.018 and 0.005)and the type of treatment(P=0.014 and 0.017)were significantly associated with G-NET recurrence.Conclusions:Individualized treatment strategies may reduce the risk of relapse after G-NET treatment.Long-term SSA therapy may be a secure and efficacious treatment option for type 1 G-NET with more than six lesions,and it substantially decreases the incidence of post-treatment recurrence.

关键词： Well-differentiated G-NET Serum gastrin Personalized treatment Endoscopic submucosal dissection Endoscopic mucosal resection Somatostatin analog therapy surgical resection Recurrence

National guidelines for the diagnosis and treatment of hilar cholangiocarcinoma

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World Journal of Gastroenterology 2024年第9期30卷 1018-1042页

作者： Faisal Saud Dar Zaigham Abbas Irfan Ahmed Muhammad Atique Usman Iqbal Aujla Muhammad Azeemuddin Zeba Aziz Abu Bakar Hafeez Bhatti Tariq Ali Bangash Amna Subhan Butt Osama Tariq Butt Abdul Wahab Dogar Javed Iqbal Farooqi Faisal Hanif Jahanzaib Haider Siraj Haider Syed Mujahid Hassan Adnan Abdul Jabbar Aman Nawaz Khan Muhammad Shoaib Khan Muhammad Yasir Khan Amer Latif Nasir Hassan Luck Ahmad Karim Malik Kamran Rashid Sohail Rashid Mohammad Salih Abdullah Saeed Amjad Salamat Ghias-un-Nabi Tayyab Aasim Yusuf Haseeb Haider Zia Ammara Naveed Department of Hepatopancreatic Biliary Surgery&Liver Transplant Pakistan Kidney and Liver Institute&Research CentreLahore 54000Pakistan Department of Hepatogastroenterology and Liver Transplantation Dr.Ziauddin University HospitalKarachi 75600SindhPakistan University of Aberdeen Aberdeen B243FXUnited Kingdom Department of Pathology Pakistan Kidney and Liver Institute&Research CentreLahore 54000Pakistan Department of Gastroenterology&Hepatology Pakistan Kidney and Liver Institute&Research CentreLahore 54000Pakistan Department of Radiology Aga Khan UniversityKarachi 74800Pakistan Department of Oncology Hameed Latif HospitalLahore 54000Pakistan Division of Hepatopancreatic Biliary Surgery&Liver Transplantation Shifa International HospitalIslamabad 44000Pakistan Department of Hepatopancreatic Biliary Surgery&Liver Transplant Shaikh Zayed Hospital and Post Graduate Medical InstituteLahore 54000Pakistan Department of Medicine Aga Khan University HospitalKarachi 74800Pakistan Department of Liver Transplant Pir Abdul Qadir Shah Jeelani Institute of Medical SciencesGambat 66020Pakistan Department of Medicine&Gastroenterology Lifecare Hospital and Research CentrePeshawar 25000Khyber PakhtunkhwaPakistan Department of Hepatopancreatobiliary&Liver Transplant Bahria International HospitalLahore 54000Pakistan Department of Surgery Hepatopancreatobiliary&Liver TransplantDow University of Health SciencesKarachi 74800Pakistan Department of Gastroenterology Hepatology&NutritionPir Abdul Qadir Shah Jeelani Institute of Medical SciencesGambat 66020Pakistan Department of Oncology Dr.Ziauddin HospitalKarachi 74800Pakistan Department of Radiology Rehman Medical InstitutePeshawar 25000Pakistan Army Liver Transplant Unit Pak Emirates Military HospitalRawalpindi 46000Pakistan Department of Gastroenterology Sindh Institute of Urology and TransplantationKarachi 75500Pakistan Rashid Nursing Home and Cancer Clinic Rashid Nursing Home and Cancer ClinicRawalpindi 46000Pakistan Department of Gastroentero

A consensus meeting of national experts from all major national hepatobiliary centres in the country was held on May 26,2023,at the Pakistan Kidney and Liver Institute&Research Centre(PKLI&RC)after initial consultations with the experts.The Pakistan Society for the Study of Liver Diseases(PSSLD)and PKLI&RC jointly organised this meeting.This effort was based on a comprehensive literature review to establish national practice guidelines for hilar cholangiocarcinoma(hCCA).The consensus was that hCCA is a complex disease and requires a multidisciplinary team approach to best manage these patients.This coordinated effort can minimise delays and give patients a chance for curative treatment and effective palliation.The diagnostic and staging workup includes high-quality computed tomography,magnetic resonance imaging,and magnetic resonance cholangiopancreato-graphy.Brush cytology or biopsy utilizing endoscopic retrograde cholangiopancreatography is a mainstay for diagnosis.However,histopathologic confirmation is not always required before resection.Endoscopic ultrasound with fine needle aspiration of regional lymph nodes and positron emission tomography scan are valuable adjuncts for staging.The only curative treatment is the surgical resection of the biliary tree based on the Bismuth-Corlette classification.Selected patients with unresectable hCCA can be considered for liver transplantation.Adjuvant chemotherapy should be offered to patients with a high risk of recurrence.The use of preoperative biliary drainage and the need for portal vein embolisation should be based on local multidisciplinary discussions.Patients with acute cholangitis can be drained with endoscopic or percutaneous biliary drainage.Palliative chemotherapy with cisplatin and gemcitabine has shown improved survival in patients with irresectable and recurrent hCCA.

关键词： Hilar cholangiocarcinoma Bismuth-Corlette classification Memorial Sloan Kettering Cancer Centre Staging Preoperative biliary drainage Portal vein embolisation surgical resection Hepatectomy

surgical resection for pulmonary recurrence of esophageal cancer after curative esophagectomy

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Journal of Cancer Metastasis and Treatment 2021年第1期7卷 412-421页

作者： Masaru Morita Manabu Yamamoto Yuichiro Nakashima Keiichi Shiokawa Yuki Shin Yoshiaki Fujimoto Tomonori Nakanoko Hideo Uehara Masahiko Sugiyama Mitsuhiko Ota Yohei Mano Keishi Sugimachi Tatsuro Okamoto Yasushi Toh Department of Gastroenterological Surgery National Hospital Organization Kyushu Cancer CenterFukuoka 811-1395Japan Department of Hepatobiliary-Pancreatic Surgery National Hospital Organization Kyushu Cancer CenterFukuoka 811-1395Japan Department of Thoracic Oncology National Hospital Organization Kyushu Cancer CenterFukuoka 811-1395Japan.

Aim:To clarify the significance of surgical resection for pulmonary recurrence after curative esophagectomy for esophageal cancer.Methods:Clinical details,such as the recurrence site,timing,and contents of therapies for recurrence,and the prognosis,were examined in 14 patients who underwent surgical resection for pulmonary recurrence that developed after curative esophagectomy.Results:The median disease-free interval after esophagectomy was 17.2 months.Two patients underwent pulmonary resection two times,and in one patient,three times.All pulmonary resections were performed when other extra-pulmonary recurrences had been controlled,and R0 resection was achieved.Chemotherapy and/or radiotherapy were additionally performed for pulmonary metastasis in 13 patients.The median survival time after initial pulmonary resection was 45.5 months,and the 1-,3-,and 5-year overall survival rates were 93%,68%,and 43%,respectively.The 5-year overall survival rate after initial pulmonary resection was 13%in patients with Stage III or IV esophageal cancer and 100%in those with Stage I or II disease(P=0.010).The rate was 56%in patients with tumorssurgical resection along with systemic therapy is a promising treatment strategy for pulmonary recurrence after curative esophagectomy when it is solitary and localized.Clinical factors,such as the esophageal cancer stage and the size of the pulmonary metastasis,are useful for deciding on the surgical indication.

关键词： Esophageal cancer pulmonary metastasis recurrence surgical resection

Transcatheter arterial chemoembolization followed by surgical resection for hepatocellular carcinoma: a focus on its controversies and screening of patients most likely to benefit

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Chinese Medical Journal 2021年第19期134卷 2275-2286页

作者： Zhan-Qi Wei Yue-Wei Zhang School of Medicine Tsinghua UniversityHaidian DistrictBeijing 100084China Beijing Tsinghua Changgung Hospital School of Clinical MedicineTsinghua UniversityBeijing 102218China

surgical resection(SR)is recommended as a radical procedure in the treatment of hepatocellular carcinoma(HCC).However,postoperative recurrence negatively affects the long-term efficacy of SR,and preoperative adjuvant therapy has therefore become a research hotspot.Some clinicians adopt transcatheter arterial chemoembolization(TACE)as a preoperative adjuvant therapy in patients undergoing SR to increase the resection rate,reduce tumor recurrence,and improve the prognosis.However,the findings of the most relevant studies remain controversial.Some studies have confirmed that preoperative TACE cannot improve the long-term survival rate of patients with HCC and might even negatively affect the resection rate.Which factors influence the efficacy of preoperative TACE combined with SR is a topic worthy of investigation.In this review,existing clinical studies were analyzed with a particular focus on several topics:screening of the subgroups of patients most likely to benefit from preoperative TACE,exploration of the optimal treatment regimen of preoperative TACE,and determination of the extent of tumor necrosis as the deciding prognostic factor.

关键词： Hepatocellular carcinoma surgical resection Transcatheter arterial chemoembolization Adjuvant therapy

Clinical strategies for differentiating IgG4-related cholecystitis from gallbladder carcinoma to avoid unnecessary surgical resection

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Science China(Life Sciences) 2020年第5期63卷 764-770页

作者： Rui Zhang Hao-Ming Lin Zhao-Xi Cai Su-Juan Du Hong Zeng Lei-Bo Xu Jie Wang Chao Liu Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation and Department of Biliary-Pancreas Surgery Sun Yat-sen Memorial HospitalSunYat-sen UniversityGuangzhou 510120China Department of Radiology Sun Yat-sen Memorial HospitalSun Yat-sen UniversityGuangzhou 510120China Department of Anesthesia Sun Yat-sen Memorial HospitalSun Yat-sen UniversityGuangzhou 510120China Department of Pathology Sun Yat-sen Memorial HospitalSun Yat-sen UniversityGuangzhou 510120China

Immunoglobulin G4(IgG4)-related cholecystitis(IgG4-C)is often difficult to distinguish from gallbladder carcinoma(GBC).This study aimed to determine a practical strategy for differentiating between IgG4-C and GBC to avoid unnecessary surgical resection.The expression of IgG4 in the gallbladder was detected by immunohistochemistry.The clinicopathological and radiological characteristics of IgG4-C patients and GBC patients were analyzed retrospectively.Immunohistochemistry revealed that IgG4 was upregulated in the plasma cells of IgG4-C tissues.The median serum total bilirubin levels were significantly higher in the patients with IgG4-C than in those with GBC(45.8μmol L^-1 vs.29.9μmol L^-1).The serumγ-GGT levels were higher in IgG4-C patients than in GBC patients,whereas the serum levels of CA125 were significantly higher in GBC patients than in IgG4-C patients.The imaging scans were helpful for differentiating IgG4-C from GBC based on the presence of a layered pattern and Rokitansky-Aschoff sinuses in the gallbladder wall.There were no statistically significant differences in age,presence of abdominal pain,level of emaciation between the two groups.Our study demonstrated that the combination of imaging with serum total bilirubin,γ-GGTand CA125 levels can offer added preoperative diagnostic value and reduce the rate of IgG4-C misdiagnosis.

关键词： clinical strategies IgG4-cholecystitis gallbladder carcinoma surgical resection

Radiofrequency ablation vs surgical resection in elderly patients with hepatocellular carcinoma in Milan criteria

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World Journal of Gastroenterology 2021年第18期27卷 2205-2218页

作者： Maria Conticchio Riccardo Inchingolo Antonella Delvecchio Letizia Laera Francesca Ratti Maximiliano Gelli Ferdinando Anelli Alexis Laurent Giulio Vitali Paolo Magistri Giacomo Assirati Emanuele Felli Taiga Wakabayashi Patrick Pessaux Tullio Piardi Fabrizio di Benedetto Nicola de'Angelis Javier Briceño AntonioRampoldi RenèAdam Daniel Cherqui Luca Antonio Aldrighetti Riccardo Memeo Departement of Emergency and Trasplantation of Organs General Surgery Unit“M.Rubino”Policlinico di BariBari 70124Italy Interventional Radiology Unit "F.Miulli"General Regional HospitalAcquaviva delle Fonti 70021Italy Department of Emergency and Organ Transplantation General Surgery Unit“M.Rubino”University of BariCeglie Messapica 70124Italy Department of Oncology "F.Miulli"General Regional HospitalAcquaviva delle Fonti 70021Italy Department of Surgery Univ Vita Salute San RaffaeleMilan 20132Italy Department of Visceral and Oncological Surgery Gustave Roussy Cancer Campus Grand ParisVillejuif 94800France Unit of Oncologic and Pancreatic Surgery Hospital University Reina SofíaCordoba 14004Spain Department of Digestive and Hepatobiliary Surgery Henri Mondor University HospitalCreteil 94000France Department of Surgery University of Geneva HospitalsGeneva 44041Switzerland Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit University of Modena and Reggio EmiliaModena 41124Italy Institut de Recherche Contre les Cancers de l'Appareil Digestif Strasbourg 67000France Department of Surgery Keio University School of MedicineShinjuku-ku 160-8582Japan Hepato-Biliary and Pancreatic surgical Unit Nouvel Hôpital CivilStrasbourg cedex 67091France Department of Hepatobiliary Pancreatic and Digestive SurgeryUniversity Hospital Robert Debréof ReimsReims 51100France Hepatobiliary and Pancreatic Surgery Unit General Surgery DepartementTroyes HospitalTroyes Zip or Postal CodeFrance University of Champagne-Ardenne Reims 51100France Unit of Minimally Invasive and Robotic Digestive Surgery "F.Miulli"General Regional HospitalAcquaviva delle Fonti 70021Italy Department of General and Digestive Surgery Reina Sofia University HospitalCordoba 14004Spain Interventional Radiology Unit Niguarda HospitalMilan 20132Italy 20132 Italy RenèAdam Hepatobiliary Center Hopital Paul BrousseVillejuif 94800France Unit of Hepato-Pancreatic-Biliary Surgery Univ Vita Salute San RaffaeleMilan 20132Italy Uni

BACKGROUND surgical resection and radiofrequency ablation(RFA)represent two possible strategy in treatment of hepatocellular carcinoma(HCC)in Milan criteria.AIM To evaluate short-and long-term outcome in elderly patients(>70 years)with HCC in Milan criteria,which underwent liver resection(LR)or RFA.METHODS The study included 594 patients with HCC in Milan criteria(429 in LR group and 165 in RFA group)managed in 10 European centers.Statistical analysis was performed using the Kaplan-Meier method before and after propensity score matching(PSM)and Cox regression.RESULTS After PSM,we compared 136 patients in the LR group with 136 patients in the RFA group.Overall survival at 1,3,and 5 years was 91%,80%,and 76%in the LR group and 97%,67%,and 41%in the RFA group respectively(P=0.001).Diseasefree survival at 1,3,and 5 years was 84%,60%and 44%for the LR group,and 63%,36%,and 25%for the RFA group(P=0.001).Postoperative Clavien-Dindo IIIIV complications were lower in the RFA group(1%vs 11%,P=0.001)in association with a shorter length of stay(2 d vs 7 d,P=0.001).In multivariate analysis,Model for End-stage Liver Disease(MELD)score(>10)[odds ratio(OR)=1.89],increased value of international normalized ratio(>1.3)(OR=1.60),treatment with radiofrequency(OR=1.46),and multiple nodules(OR=1.19)were independent predictors of a poor overall survival while a high MELD score(>10)(OR=1.51)and radiofrequency(OR=1.37)were independent factors associated with a higher recurrence rate.CONCLUSION Despite a longer length of stay and a higher rate of severe postoperative complications,surgery provided better results in long-term oncological outcomes as compared to ablation in elderly patients(>70 years)with HCC in Milan criteria.

关键词： Hepatocellular carcinoma Milan criteria Radiofrequency ablation surgical resection Elderly patients Propensity score matching