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Liver transplantation in patients with incidental hepatocellular carcinoma/cholangiocarcinoma and intrahepatic cholangiocarcinoma： a single-center experience

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hepatobiliary & Pancreatic Diseases International 2017年第3期16卷 264-270页

作者： Mohammed Elshamy Naftali Presser Abdulrahman Y Hammad Daniel J Firl Christopher Coppa John Fung Federico N Aucejo hepatobiliary and Transplant surgery Digestive Disease and Surgery Institute Cleveland Clinic Cleveland OH USA Imaging Institute Cleveland Clinic Cleveland OH USA

BACKGROUND： Reports of fiver transplantation （LT） in patients with mixed hepatocellular carcinoma/cholangiocarcinoma （HCC/CC） and intrahepatic cholangiocarcinoma （ICC） are modest and have been mostly retrospective after pathological categorization in the setting of presumed HCC. Some studies suggest that patients undergoing LT with small and unifocal ICC or mixed HCC/CC can achieve about 40%-60% 5-year post-transplant survival. The study aimed to report our experience in patients undergoing LT with explant pathology revealing HCC/CC and ICC. METHODS： From a prospectively maintained database, we performed cohort analysis. We identified 13 patients who underwent LT with explant pathology revealing HCC/CC or ICC. RESULTS： The observed recurrence rate post-LT was 31% （4/13） and overall survival was 85%, 51%, and 51% at 1, 3 and 5 years, respectively. Disease-free survival was 68%, 51%, and 41% at 1, 3 and 5 years, respectively. In our cohort, four patients would have qualified for exception points based on updated HCC Organ Procurement and Transplantation Network imaging guidelines. CONCLUSIONS： Lesions which lack complete imaging characteristics of HCC may warrant pre-LT biopsy to fully elucidate their pathology. Identified patients with early HCC/CC or ICC may benefit from LT if unresectable. Additionally, incorporating adjunctive perioperative therapies such as in the case of patients undergoing LT with hilar cholangiocarcinoma may improve outcomes but this warrants further investigation.

关键词： mixed hepatocellular carcinoma/ cholangiocarcinoma liver transplantation survival outcomes

Liver transplant oncology:is it time to revisit our ideas?

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hepatobiliary surgery and Nutrition 2021年第6期10卷 864-867页

作者： Ramon Soliva Joan Figueras hepatobiliary and Pancreatic surgery Department of Digestive SurgerySagrat Cor University HospitalBarcelonaSpain

Scarcity of cadaveric liver donors compared with the large number of patients with liver disease has been considered the main obstacle to use liver transplantation(LT)to treat hepatic malignancies and for the development of transplant *** is known that we are experiencing a true paradigm shift in the fundamental problem of transplantology,which is none other than the imbalance between donation and graft implants(1).Because the most common indication of LT in most countries[hepatitis C virus(HCV)cirrhosis]has started to decrease in the waiting lists(2,3).One might think that,for the first time in many years in Western countries,we could find a higher supply of organs than recipients for them.

关键词： organs hepatic Liver

Extrahepatic right hepatic duct diverticulum: a rare entity

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hepatobiliary & Pancreatic Diseases International 2010年第2期9卷 213-215页

作者： Eduardo SM Fernandes Raquel L Bernardo Moacir M Fernandes Rogério MC Araújo Renato Sebbe Asterio Monte JoséF Coelho Antonio AP Souza Joaquim Ribeiro Filho Department of General surgery Section of Hepatobiliary Surgery and TransplantationRio de Janeiro Federal University Department of digestive surgery and Gastroenterology Pio XII General Hospital

BACKGROUND:Douglas described choledochal cysts in 1852 and Todani proposed an anatomy-based classification in 1977. The classification is the most extensively used,but does not include some rare *** present a case of hepatic duct diverticulum,one of the variations,and discuss its diagnosis and treatment. METHODS:A 57-year-old woman presented with upper abdominal pain and discomfort associated with nausea and *** was finally diagnosed with cholelithiasis and right hepatic duct diverticulum. RESULT:The patient underwent resection of the hepatic duct diverticulum and cholecystectomy,and was asymptomatic 26 months after surgery. CONCLUSIONS:Hepatic duct diverticulum is a rare form of choledochal cyst,not included in Todani’s classification. Todani’s classification including this and other uncommon variations of choledochal cysts must be *** best diagnostic imaging methods and treatment for choledochal cysts must be defined.

关键词： choledochal cysts hepatic duct diverticulum Todani's classification intrahepatic diverticulum

Complete resection of the gastric antrum decreased incidence and severity of delayed gastric emptying after pancreaticoduodenectomy

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hepatobiliary & Pancreatic Diseases International 2021年第2期20卷 182-189页

作者： Yu-Ling Sun Jian-Jun Gou Kai-Ming Zhang Wen-Qi Li Xiu-Xian Ma Lin Zhou Rong-Tao Zhu Jian Li Institute of hepatobiliary and Pancreatic Diseases Department of Hepatobiliary and Pancreatic Surgerythe First Affiliated Hospital of Zhengzhou UniversityZhengzhou 450052China Department of digestive the First Affiliated Hospital of Zhengzhou UniversityZhengzhou 450052China

Background:Delayed gastric emptying(DGE)is the main complication after pancreaticoduodenectomy(PD),but the mechanism is still *** aim of this study was to elucidate the role of complete resection of the gastric antrum in decreasing incidence and severity of DGE after ***:Sprague-Dawley rats were divided into three groups:expanded resection(ER group),complete resection(CR group),and incomplete resection(IR group)of the gastric *** tension(g)of remnant stomach contraction was *** analyzed the histological morphology of the gastric wall by different excisional methods after distal ***,patients underwent PD at our department between January 2012 and May 2016 were included in the *** cases were divided into IR group and CR group of the gastric antrum,and the clinical data were retrospectively ***:The ex vivo remnant stomachs of CR group exhibited much greater contraction tension than others(P<0.05).The contraction tension of the remnant stomach increased with increasing acetylcholine concentration,while remained stable at the concentration of 10×10^(-5 )mol/***,174 consecutive patients were included and retrospectively analyzed in the *** incidence of DGE was significantly lower(3.5%vs.21.3%,P<0.01)in CR group than in IR *** addition,hematoxylin-eosin staining analyses of the gastric wall confirmed that the number of transected circular smooth muscle bundles were higher in IR group than in CR group(8.24±0.65 vs.3.76±0.70,P<0.05).Conclusions:The complete resection of the gastric antrum is associated with decreased incidence and severity of DGE after *** electrophysiological and physiopathological disorders caused by damage to gastric smooth muscles might be the mechanism underlying DGE.

关键词： Delayed gastric emptying Gastric antrum Gastric electrophysiology Histological morphology Pancreaticoduodenectomy

Relationship between autophagy and perineural invasion, clinicopathological features, and prognosis in pancreatic cancer

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World Journal of Gastroenterology 2017年第40期23卷 7232-7241页

作者： Yan-Hui Yang Jiang-Bo Liu Yang Gui Liang-Liang Lei Shui-Jun Zhang Department of hepatobiliary and Pancreatic surgery the First Affiliated Hospital of Zhengzhou University Department of hepatobiliary surgery First Affiliated Hospital College of Clinical Medicine Henan University of Science and Technology Department of General surgery First Affiliated Hospital College of Clinical Medicine Henan University of Science and Technology Henan Key Laboratory of digestive Organ Transplantation Open and Key Laboratory of Hepatobiliary and Pancreatic Surgery and Digestive Organ Transplantation at Henan Universities Zhengzhou Key Laboratory of Hepatobiliary Pancreatic Diseases and Organ Transplantation

AIM To investigate the relationship between autophagy and perineural invasion(PNI), clinical features, and prognosis in patients with pancreatic cancer. METHODS Clinical and pathological data were retrospectively collected from 109 patients with pancreatic ductal adenocarcinoma who underwent radical resection at the First Affiliated Hospital of Zhengzhou University from January 2011 to August 2016. Expression levels of the autophagy-related protein microtubuleassociated protein 1 A/1 B-light chain 3(LC3) and PNI marker ubiquitin carboxy-terminal hydrolase(UCH) in pancreatic cancer tissues were detected by immunohistochemistry. The correlations among LC3 expression, PNI, and clinical pathological features in pancreatic cancer were analyzed. The patients were followed for further survival analysis. RESULTS In 109 cases of pancreatic cancer, 68.8%(75/109) had evidence of PNI and 61.5%(67/109) had high LC3 expression. PNI was associated with lymph node metastasis, pancreatitis, and CA19-9 levels(P < 0.05). LC3 expression was related to lymph node metastasis(P < 0.05) and was positively correlated with neural invasion(P < 0.05, r = 0.227). Multivariate logistic regression analysis indicated that LC3 expression, lymph node metastasis, pancreatitis, and CA19-9 level were factors that influenced neural invasion, whereas only neural invasion itself was an independent factor for high LC3 expression. Univariate analysis showed that LC3 expression, neural invasion, and CA19-9 level were related to the overall survival of pancreatic cancer patients(P < 0.05). Multivariate COX regression analysis indicated that PNI and LC3 expression were independent risk factors for poor prognosis in pancreatic cancer(P < 0.05). CONCLUSION PNI in patients with pancreatic cancer is positively related to autophagy. Neural invasion and LC3 expression are independent risk factors for pancreatic cancer with a poor prognosis.

关键词： Pancreatic cancer Perineural invasion Autophagy Clinical pathological features Prognosis

Orthotopic liver transplantation as a rescue operation for recurrent hepatocellular carcinoma after partial hepatectomy

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World Journal of Gastroenterology 2008年第27期14卷 4370-4376页

作者： Zhuo Shao Rocio Lopez Bo Shen Guang-Shun Yang Department of Biliary surgery Eastern Hepatobiliary Surgery Hospital Second Military Medical University Shanghai 200438 China digestive Disease Center Cleveland Clinic Cleveland OH 44195 United States

AIM: To compare post-orthotopic liver transplantation (OLT) survival between patients with recurrent hepatocellular carcinoma (HCC) after partial hepatectomy and those who received de novo OLT for HCC and to assess the risk factors associated with post-OLT mortality. METHODS: From July 2003 to August 2005, 77 consecutive HCC patients underwent OLT, including 15 patients with recurrent HCC after partial hepatectomy for tumor resection (the rescue OLT group) and 62 patients with de novo OLT for HCC (the de novo OLT group). Thirty-three demographic, clinical, histological, laboratory, intra-operative and post-operative variables were analyzed. Survival was calculated by the Kaplan- Meier method. Univariable and multivariable analyses were also performed. RESULTS: The median age of the patients was 49.0 years. The median follow-up was 20 mo. Three patients (20.0%) in the rescue OLT group and 15 patients (24.2%) in the de novo OLT group died during the follow-up period (P = 0.73). The 30-day mortality of OLT was 6.7% for the rescue OLT group vs 1.6% for the de novo OLT group (P = 0.27). Cox proportional hazards model showed that pre-OLT hyperbilirubinemia, the requirement of post-OLT transfusion, the size of the tumor, and family history of HCC were significantly associated with a higher hazard for mortality. CONCLUSION: There are no significant differences in survival/mortality rates between OLT as de novo therapy and OLT as a rescue therapy for patients with hcc. Pre-OLT hyperbilirubinemia, post-OLT requirement of transfusion, large tumor size and family history of HCC are associated with a poor survival outcome.

关键词： Orthotopic liver transplantation Liver cancer Resection Recurrence Survival

ASB3 knockdown promotes mitochondrial apoptosis via activating the interdependent cleavage of Beclin1 and caspase-8 in hepatocellular carcinoma

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Science China(Life Sciences) 2019年第12期62卷 1692-1702页

作者： Wenli Zhang Fuchen Liu Zhihui Che Mengmeng Wu Zihui Tang Jie Liu Dongqin Yang Department of digestive Diseases of Huashan Hospital Fudan UniversityShanghai 200040China The Third Department of Hepatic surgery Eastern Hepatobiliary Surgery HospitalSecond Military Medical UniversityShanghai 200438China

Apoptosis and autophagy are distinct cellular processes that can be highly interconnected. The cross talk between the two processes is indispensable in determining the overall cell fate. Although the apoptosis-promoting effect of caspases has been demonstrated, the roles of autophagy-related proteins and even autophagy itself in regulating apoptosis remain poorly understood. In our present study, we found that downregulation of ubiquitin E3 ligase ASB3 led to enhanced mitochondrial apoptosis as well as autophagy, which synergistically promoted cell death in hepatocellular carcinoma(HCC). We observed the activation of caspase-8 and decrease of autophagy protein Beclin1 in apoptotic cells that were depleted of ASB3. Beclin1 was mainly cleaved by activated caspase-8 and active Beclin1 initiated mitochondrial apoptosis via locating its C-terminal fragment to mitochondria. In addition, knocking down of Beclin1 markedly blocked the apoptosis, indicating its essential role in the ***, our study indicated that enhanced autophagy level might be involved in the activation of caspase-8 and promote the apoptosis. Taken together, our results demonstrated that ASB3 can regulate mitochondrial pathway of apoptosis by controlling caspase-8 mediated cleavage of Beclin1 in HCC. Therefore, ASB3 may potentially serve as a novel target for HCC therapy,especially when combined with autophagy agonist.

关键词： ASB3 apoptosis Beclin1 caspase-8 autophagy liver cancer

Short-term clinical outcomes of laparoscopic vs open rectal excision for rectal cancer: A systematic review and metaanalysis

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World Journal of Gastroenterology 2017年第44期23卷 7906-7916页

作者： Aleix Martínez-Pérez Maria Clotilde Carra Francesco Brunetti Nicola de'Angelis Department of digestive Hepatobiliary Surgery and Liver Transplantation Henri Mondor University Hospital AP-HP Université Paris Est - UPEC Department of General and digestive surgery Hospital Universitario Doctor Peset Rothschild Hospital AP-HP Université Paris VII

AIM To review evidence on the short-term clinical outcomes of laparoscopic(LRR) vs open rectal resection(ORR) for rectal *** A systematic literature search was performed using Cochrane Central Register, MEDLINE, EMBASE, Scopus, Open Grey and Clinical *** register for randomized clinical trials(RCTs) comparing LRR vs ORR for rectal cancer and reporting short-term clinical outcomes. Articles published in English from January 1, 1995 to June, 30 2016 that met the selection criteria were retrieved and reviewed. The Preferred Reporting Items for Systematic reviews and Meta-Analysis(PRISMA) statements checklist for reporting a systematic review was followed. Random-effect models were used to estimate mean differences and risk ratios. The robustness and heterogeneity of the results were explored by performing sensitivity analyses. The pooledeffect was considered significant when P < *** Overall, 14 RCTs were included. No differences were found in postoperative mortality(P = 0.19) and morbidity(P = 0.75) rates. The mean operative time was 36.67 min longer(95%CI: 27.22-46.11, P < 0.00001), the mean estimated blood loss was 88.80 ml lower(95%CI:-117.25 to-60.34, P < 0.00001), and the mean incision length was 11.17 cm smaller(95%CI:-13.88 to-8.47, P < 0.00001) for LRR than ORR. These results were confirmed by sensitivity analyses that focused on the four major RCTs. The mean length of hospital stay was 1.71 d shorter(95%CI:-2.84 to-0.58, P < 0.003) for LRR than ORR. Similarly, bowel recovery(i.e., day of the first bowel movement) was 0.68 d shorter(95%CI:-1.00 to-0.36, P < 0.00001) for LRR. The sensitivity analysis did not confirm a significant difference between LRR and ORR for these latter two parameters. The overall quality of the evidence was rated as high. CONCLUSION LRR is associated with lesser blood loss, smaller incision length, and longer operative times compared to ORR. No differences are observed for postoperative morbidity and mortality.

关键词： Laparoscopic rectal resection Open rectal resection Laparoscopy Rectal cancer Postoperative morbidity Short-term outcomes Systematic review Meta-analysis

Laparoscopic liver resection for colorectal liver metastases—shortand long-term outcomes:A systematic review

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World Journal of Gastrointestinal Oncology 2021年第7期13卷 732-757页

作者： Emily Taillieu Celine De Meyere Frederiek Nuytens Chris Verslype Mathieu D'Hondt Department of digestive and hepatobiliary/Pancreatic surgery AZ GroeningeKortrijk 8500Belgium Department of Gastroenterology and Hepatology KU LeuvenLeuven 3000Belgium

BACKGROUND For well-selected patients and procedures,laparoscopic liver resection(LLR)has become the gold standard for the treatment of colorectal liver metastases(CRLM)when performed in specialized ***,little is currently known concerning patient-related and peri-operative factors that could play a role in survival outcomes associated with LLR for *** To provide an extensive summary of reported outcomes and prognostic factors associated with LLR for *** A systematic search was performed in PubMed,EMBASE,Web of Science and the Cochrane Library using the keywords“colorectal liver metastases”,“laparoscopy”,“liver resection”,“prognostic factors”,“outcomes”and“survival”.Only publications written in English and published until December 2019 were ***,abstracts of which no accompanying full text was published,reviews,case reports,letters,protocols,comments,surveys and animal studies were *** search results were saved to Endnote Online and imported in Rayyan for systematic *** of interest were extracted from the included publications and tabulated for qualitative *** Out of 1064 articles retrieved by means of a systematic and grey literature search,77 were included for qualitative ***-two research papers provided data concerning outcomes of LLR for *** papers were eligible for extraction of data concerning prognostic factors affecting survival *** analysis of the collected data showed that LLR for CRLM is safe,feasible and provides oncological *** research groups have reported on the short-term advantages of LLR compared to open *** obtained results accounted for minor LLR,as well as major LLR,simultaneous laparoscopic colorectal and liver resection,LLR of posterosuperior segments,twostage hepatectomy and repeat LLR for *** research groups so far have studied prognostic factors affecting long-term outcomes of LLR for ***

关键词： Laparoscopic liver resection Colorectal liver metastases Outcomes Prognostic factors Systematic review