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Impact of preoperative chemoradiotherapy on survival in patients with resectable pancreatic cancer

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World Journal of Gastroenterology 2007年第21期13卷 2945-2951页

作者： Plvi Vento Harri Mustonen Timo Joensuu Pivi Krkkinen Eero Kivilaakso Tuula Kiviluoto departments of surgery Helsinki University Central HospitalHelsinkiFinland departments of Oncology Helsinki University Central HospitalHelsinkiFinland departments of Pathology Helsinki University Central HospitalHelsinkiFinland

AIM:To explore whether preoperative chemoradiation therapy improves survival of patients with pancreatic cancer undergoing resectional surgery. METHODS:Forty-seven patients with a malignant pancreatic tumor localized in the head or uncinate process of the pancreas underwent radical pancreaticoduodenectomy. Twenty-two received chemoradiation therapy (gemcitabine and radiation dose 50.4 Gy) before surgery (CRR) and 25 patients underwent surgery only (RO). The study was non-randomised. Patients were identified from a prospective database. RESULTS:The median survival time was 30.2 mo in the CRR group and 35.9 mo in the RO group. No statistically significant differences were found in subclasses according to lymph node involvement,TNM stages,tumor size,or perineural invasion. The one,three and five year survival rates were 81%,33% and 33%,respectively,in the CRR group and 72%,47% and 23%,respectively,in the RO group. In ductal adenocarcinoma,the median survival time was 27 mo in the CRR group and 20 mo in the RO group. No statistically significant differences were found in the above subclasses. The one,three and five year survival rates were 79%,21% and 21%,respectively,in the CRR group and 64%,50% and 14%,respectively,in the RO group. The overall hospital mortality rate was 2%. The morbidity rate was 45% in the CRR group and 32% (NS) in the RO group. CONCLUSION:Major multicenter randomized studies are needed to conclusively assess the impact of neoadjuvant treatment in the management of pancreatic cancer.

关键词：胰腺癌化疗外科手术摘除术生存率

Comparison of pancreatic acinar cell carcinoma and adenocarcinoma using multidetector-row computed tomography

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World Journal of Gastroenterology 2013年第34期19卷 5713-5719页

作者： Tatsuaki Sumiyoshi Yasuo Shima Takehiro Okabayashi Akihito Kozuki Toshio Nakamura departments of Gastro-enterological surgery Kochi Health Sciences Center

AIM:To distinguish acinar cell carcinoma(ACC)from pancreatic adenocarcinoma(AC)by comparing their computed tomography ***:Patients with ACC and AC were identified on the basis of results obtained using surgically resected pancreatectomy *** preoperative computer tomographic images of 6 acinar cell carcinoma patients and 67 pancreatic adenocarcinoma patients in 4 phases(non-contrast,arterial,portal venous,and delayed phase)were *** scan delay times were 40,70,and 120 s for each contrast-enhanced *** visual pattern,tomographic attenuation value,and time attenuation curve were assessed and compared between AC and ACC cases using the 2test,Wilcoxon signed-rank test,and Mann Whitney U ***:The adenocarcinomas tended to be hypodense in all 4 *** acinar cell carcinomas also tended to be hypodense in the 3 contrast-enhancedphases,although their computed tomographic attenuation values were ***,5 of the 6 acinar cell carcinomas(83%)were isodense in the non-contrast *** time attenuation curve of the adenocarcinomas showed a gradual increase through the 4 phases,and all adenocarcinomas showed peak enhancement during the delayed *** time attenuation curve of the acinar cell carcinomas showed peak enhancement during the portal venous phase in 4 cases and during the arterial phase in 2 *** of the 6 acinar cell carcinomas showed peak enhancement during the delayed ***:The tumor density in the non-contrast phase and time attenuation curve pattern clearly differ between acinar cell carcinomas and adenocarcinomas,and multidetector-row computed tomography can thus distinguish these tumors.

关键词： pancreatic acinar cell carcinoma pancreatic adenocarcinoma Multidetector-row computed tomography Visual pattern Time attenuation curve

Diabetes: An Accomplice to Cancer

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Journal of Nutritional Oncology 2019年第1期4卷 9-15页

作者： Ting WenGe You XiYu Lu Cai Jiu WeiCui Cancer Center The First Hospital of Jilin University Changchun Jilin 130021 China Department of Hepatobiliary and pancreatic surgery The First Hospital of Jilin University Changchun Jilin 130021 China Pediatric Research Institute Departments of Pediatrics Radiation Oncology Pharmacology and Toxicology University of Louisville Louisville KY 40202 USA

Worldwide, cancer and diabetes are two major chronic diseases that have great impacts on human health. Clinical and basic research studies have shown that diabetes, especially type 2 diabetes mellitus (T2DM), can promote the incidence and development of colon, pancreatic, breast, liver and bladder cancers. Hyperglycemia, chronic inflammation and abnormal metabolism are considered to be major risk factors involved in the development of cancer. Notably, some treatments used for diabetes, such as maintenance of a healthy diet and the use of hypoglycemic drugs to control blood glucose levels, may decrease the risk of cancer. On the other hand, metabolic disorders and the organ damage caused by cancer can also promote or accelerate the progression of diabetes. By reviewing the relevant literature, we found that diabetes can promote the occurrence and development of some cancers, and cancer can, in turn, influence diabetes. We herein discuss and summarize the mechanisms underlying the relationship between diabetes and cancer and the new therapeutic strategies based on this relationship.

关键词： Cancer Diabetes Epidemiology Abnormal metabolism Therapy Targeted drug

Clinical significance of isolated biliary candidiasis in patients with unresectable cholangiocarcinoma

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Hepatobiliary & pancreatic Diseases International 2016年第5期15卷 533-539页

作者： In-Ho Kim Jae-Ki Choi Dong-Gun Lee In Seok Lee Tae Ho Hong Young Kyoung You Ho Jong Chun Myung Ah Lee departments of Internal Medicine Division of Medical 0ncologySeoul St. Mary’s Hospital The Catholic University of Korea Seoul Korea departments of Internal Medicine Division of Infectious Diseases Bucheon St. Mary’s Hospital The Catholic University of Korea Seoul Korea Division of Infectious Diseases Seoul St. Mary’s Hospital The Catholic University of Korea Seoul Korea Division of Gastroenterology Seoul St. Mary’s Hospital The Catholic University of Korea Seoul Korea Department of surgery Seoul St. Mary’s Hospital The Catholic University of Korea Seoul Korea Department of Radiology Seoul St. Mary’s Hospital The Catholic University of Korea Seoul Korea Department of Hepato-Biliary-pancreatic Cancer Center Seoul St. Mary’s Hospital The Catholic University of Korea Seoul Korea

BACKGROUND: The frequency of isolated biliary candidiasis is increasing in cancer patients. The clinical signiifcance of isolated biliary candidiasis remains unclear. We analyzed the risk factors of biliary candidiasis and outcomes of the patients with unresectable cholangiocarcinoma after percutaneous transhepatic biliary drainage (PTBD). METHODS: Among 430 patients who underwent PTBD between January 2012 and March 2015, 121 patients had unresectable cholangiocarcinoma. Bile and blood samples were collected for consecutive fungal culture. RESULTS: The study cohort included 49 women and 72 men with a median age of 71 years. Multivariate analysis showed that cancer progression (P=0.013), concurrent presence of another microorganism (P=0.010), and previous long-term (>7 days) antibiotic use (P=0.011) were potential risk factors of biliary candidiasis. Chemotherapy was not associated with overall biliary candidiasis (P=0.196), but was signiifcantly related to repeated biliary candidiasis (P=0.011). Patients with isolated biliary candidiasis showed remarkably reduced survival compared with those without (median overall sur-vival (OS): 32 vs 62 days,P=0.011)Subgroup analysis was also performed. Patients with repeated candidiasis had markedly decreased survival compared with those with transient candi-diasis (median OS: 30 vs 49 days,P=0.046). Biliary candidiasis was identiifed as a poor prognostic factor by univariate and multivariate analyses (P=0.033). Four cases of repeated can-didiasis (4/19, 21%) showedCandida species in consecutive blood culture until the end of the study, but others showed no candidemia. CONCLUSIONS: Isolated biliary candidiasis may be associ-ated with poor prognosis in patients with unresectable chol-angiocarcinoma. Especially, repeated biliary candidiasis may have the possibility of progression to candidemia. We suggest that biliary dilatation treatment or antifungal agents might be helpful for patients with biliary candidiasis.

关键词： biliary candidiasis biliary obstruction cholangiocarcinoma percutaneous transhepatic biliary drainage

Versatility and viability of hepatic venoplasty in live donor liver transplantation using the right lobe with the middle hepatic vein

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Hepatobiliary & pancreatic Diseases International 2005年第4期4卷 618-621页

作者： See-Ching Chan Chung-Mau Lo Chi-Leung Liu Yik Wong Sheung-Tat Fan Centre for the Study of Liver Disease and Departments of Surgery The University of Hong KongPokfulamHong KongChina Radiology The University of Hong Kong PokfulamHong KongPokfulamHong KongChina

Including the middle hepatic vein in the right lobe liver graft has the advantage of providing direct venous drainage of the right anterior segment. To allow unimpeded passage of blood flow, we previously designed venoplasty of the middle and right hepatic veins. We found that venoplasty is also feasible when the inferior right hepatic vein is near to the right hepatic vein, or when multiple segment 8 hepatic vein orifices are exposed adjacent to the middle hepatic vein at the graft transection surface. By joining the hepatic vein orifices into a single opening, the anastomosis into the inferior vena cava is much facilitated. The technique is simple, yet versatile , and able to cope with variation of the configurations of the hepatic vein.

关键词： venoplasty live donor liver transplantation

Primary hepatic solitary fibrous tumor with histologically benign and malignant areas

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Hepatobiliary & pancreatic Diseases International 2015年第6期14卷 665-668页

作者： Anna Silvanto Nariman D Karanjia Izhar N Bagwan departments of Histopathology Royal Surrey County Hospital General Sugery Royal Surrey County Hospital

Extrapleural solitary fibrous tumor （SFT） is an uncommon mesenchymal neoplasm, presenting most commonly in the intrathoracic sites but which has been reported at nu- merous extrathoracic locations. The majority of intra-thoracic SFTs are benign, but 10%-15% behave aggressively. We report a case of primary hepatic SFT with histologically benign and ma- lignant areas. A 65-year-old man underwent an abdominal CT scan following a cerebrovascular accident, which demonstrated a sharply demarcated large liver mass with a heterogenous enhancing area and occupying most of the left lobe of the liver. Histological examination following a hemihepatectomy showed an SFT with morphological patterns ranging from benign to malignant areas, including pleomorphism, increased cellularity, herringbone pattern, necrosis and a raised mitotic count. On review of the literature, only an occasional case report with malignant areas in a hepatic SFT was identified. This case highlights that SFT should be included in the differential diagnosis of a hepatic spindle cell lesion, and that on rare occasions, malignant areas can occur in this already uncommon neoplasm.

关键词： liver tumors malignant (non-HCC) liver surgery pathological changes

Clinicopathological and prognostic implications of endoglin (CD105) expression in hepatocellular carcinoma and its adjacent non-tumorous liver

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World Journal of Gastroenterology 2005年第2期11卷 176-181页

作者： Joanna W.Ho Ronnie T.Poon Chris K.Sun Sheung-Tat Fan Centre tor the Study of Liver Disease and Departments of Surgery and PathologyThe University of Hong KongPokfulam Hong Kong China

AIM: The expression pattern of endoglin (CD105) in hepatocellular carcinoma (HCC) has not been reported so far. We hypothesized that CD105 could differentially highlight a subset of microvessels in HCC, and intratumoral microvessel density (IMVD) by CD105 immunostaining (IMVD-CD105) could provide better prognostic information than IMVD by CD34 immunostaining (IMVD-CD34).METHODS: Paraffin blocks of tumor and adjacent nontumorous liver tissues from 86 patients who underwent curative resection of HCC were used for this study. Serial sections were stained for CD105 and CD34, respectively,to highlight the microvessels. IMVD was counted according to a standard ***: In the HCC tissues, CD105 was either negatively or positively stained only in a subset of microvessels. In contrast, CD34 showed positive and more extensive microvessel staining in all cases examined. However, in the adjacent non-tumorous liver sections, CD105 showed a diffuse pattern of microvessel staining in 20 of 86 cases,while CD34 showed negative or only focal staining of the sinusoids around portal area. Correlation with clinicopathological data demonstrated that lower scores of IMVD-CD105 were found in larger sized tumors [mean 41.4/0.74 mm2 (＞5 cm tumor) vs 65.9/0.74 mm2(≤ 5 cm tumor), P = 0.043] and more aggressive tumors,as indicated by venous infiltration [36.8/0.74 mm2 (present)vs 64.2/0.74 mm2 (absent), P = 0.020], microsatellite nodules [35.1/0.74 mm2 (present) vs 65.9/0.74 mm2(absent), P = 0.012], and advanced TNM tumor stage [38.8/0.74 mm2 (stage 3 or 4) vs 68.3/0.74 mm2 (stage 1or 2), P = 0.014]. No prognostic significance was observed when median values were used as cut-off points using either IMVD-CD105 or IMVD-CD34. However, the presence of the diffuse pattern of CD105 expression in the adjacent non-tumorous liver tissues predicted a poorer disease-free survival (median 8.6 vs 21.5 mo, P = 0.026).CONCLUSION: Our data demonstrate that a lower IMVDCD105 is associated with larger

关键词：临床病理学内分泌 CD105 基因表达肝细胞癌肿瘤肝癌 HCC

Intraoperative radiofrequency ablation with or without tumorectomy for hepatocellular carcinoma in locations difficult for a percutaneous approach

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Hepatobiliary & pancreatic Diseases International 2009年第6期8卷 591-596页

作者： Hyung Ook Kim Seung Kwon Kim Byung Ho Son Chang Hak Yoo Hyun Pyo Hong Yong Kyun Cho Byung Ik Kim departments of surgery Kangbuk Samsung Hospital Sungkyunkwan University School of Medicine Radiology Kangbuk Samsung Hospital Sungkyunkwan University School of Medicine Division of Interventional Radiology Mallinckrodt Institute of RadiologyWashington University School of Medicine Internal Medicine Kangbuk Samsung Hospital Sungkyunkwan University School of Medicine

BACKGROUND:Although hepatic resection is widely accepted as a proper modality for treating hepatocellular carcinoma(HCC),a majority of patients are unable to undergo surgical resection due to various tumor and patient *** ablation(RFA)has mostly been used as a therapeutic alternative to resection for treating *** objective of this study was to evaluate the results of intraoperative RFA for HCCs in locations difficult for a percutaneous ***:Eight patients(male,seven;age,49-67 years) with 8 HCCs in difficult locations were treated by intraoperative *** of the patients had local tumor progression after initial transarterial chemoembolization or ultrasound(US)guided percutaneous *** locations of the tumors were hepatic dome in six patients,posterior subcapsule in one,and caudate lobe in *** tumor size was 2.0 to 6.4 cm(mean,3.9 cm).Intraoperative RFA was performed at the tumor itself and an anticipated resection line under US guidance with 3 cm monopolar single or clustered internally cooled *** resection was performed in six *** month later,treatment response was assessed by contrast material-enhanced computed tomography(CT).CT studies were performed every 2 or 3 months after ***:RFA was technically successful in all tumors,and the contrast-enhanced CT images acquired one month later showed complete disappearance of tumor *** pneumothorax *** a median follow-up of 18 months(range,6-30 months),no tumors showed local *** the follow-up period,four new recurrent tumors were observed in three *** patients were alive at the time of this report and the other four died of hepatorenal syndrome,liver failure,and progression of new recurrent ***:Intraoperative RFA with tumor resection can be an alterative treatment option for HCC in locations difficult for a percutaneous approach.

关键词： hepatocellular carcinoma radiofrequency ablation intraoperative

Reduction effect of bacterial counts by preoperative saline lavage of the stomach in performing laparoscopic and endoscopic cooperative surgery

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World Journal of Gastroenterology 2014年第42期20卷 15763-15770页

作者： Hirohito Mori Hideki Kobara Takaaki Tsushimi Shintaro Fujihara Noriko Nishiyama Tae Matsunaga Maki Ayaki Tatsuo Yachida Joji Tani Hisaaki Miyoshi Asahiro Morishita Tsutomu Masaki departments of Gastroenterology and Neurology Facultyof Medicine Kagawa University Department of Gastroenterological surgery Ehime Rosai Hospital

AIM:To investigate the effects of gastric lavage with2000 mL of saline in laparoscopic and endoscopic cooperative ***:Twenty two patients who were diagnosed with a gastric gastrointestinal stromal tumor were *** former term,irrigations of the stomach were conducted whenever it was necessary,not systematically(Non systemic lavage group).In latter term,the stomach was thoroughly cleaned with 2000 mL of saline using an endoscope with a water jet,and Duodenal balloon occlusion was conducted to prevent refluxedbile and pancreatic juice(Systemic lavage+balloon occlusion group).The gastric wall was sprayed with 20mL of distilled water,and 20 mL of gastric juice was collected in a sterile tube and submitted for culture.20mL of ascites was also collected from the laparoscopic ports and submitted for *** compared WBC,CRP,BT between two groups,and verify the reduction effect of bacterial counts in Systemic lavage+balloon occlusion ***:WBC count before,1 d after,and 3 d after laparoscopic and endoscopic cooperative surgery(LECS)were 5060(95%CI:4250-9640),12140(6050-14110),and 6910(5320-12520)in Non systemic lavage group,4400(3660-7620),8910(6480-10980),and 5950(4840-7860)in Systemic lavage+balloon occlusion *** differences between two groups at the day after LECS(P=0.029)and the 3 d after LECS(P=0.042).CRP levels in Non systemic lavage group and in Systemic lavage+balloon occlusion group were significantly different at the day after LECS(P=0.005)and the 3 d after LECS(P=0.028).BTs(℃)in Non systemic lavage group and in Systemic lavage+balloon occlusion group were also significantly different at the day after LECS(P=0.004)and the 3 d after LECS(P=0.006).In a logarithmic comparison,bacterial load before gastric lavage,after lavage,and ascites culture were 6.08(95%CI:4.04-6.97),0.48(0-0.85),and 0.21(0-0.56).The bacterial counts before and after gastric lavage were significantly suppressed(P=0.007),but no significant difference betw

关键词： Laparoscopic and endoscopic cooperative surgery Sy