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Hepatobiliary & pancreatic Diseases International 2022年第2期21卷 182-185页

作者： Guo-Ling Lin Min Xiao Li Zhuang Yu Yang Qi-Yong Li Jian-Fang Lu Meng-Xia Li Shu-Sen Zheng division of Hepatobiliary and pancreatic surgery Department of SurgeryShulan(Hangzhou)Hospital Affiliated to Zhejiang Shuren University Shulan International Medical CollegeHangzhouChina division of Hepatobiliary and pancreatic surgery Department of NursingShulan(Hangzhou)Hospital Affiliated to Zhejiang Shuren University Shulan International Medical CollegeHangzhouChina division of Hepatobiliary and pancreatic surgery Department of SurgeryZhejiang University School of MedicineHangzhouChina division of Hepatobiliary and pancreatic surgery Department of SurgeryThe First Affiliated HospitalZhejiang University School of MedicineHangzhouChina

Liver transplantation (LT) is the only way to cure end-stage liver disease with or without tumors in the last few decades [1].However,critical issues such as how to rebuild portal flow in patients with portal vein thrombosis (PVT) or superior mesenteric vein (SMV) thrombosis have been challenging for surgeons.Adequate portal flow is critical in LT because more than 75%of the liver’s blood supply comes from the portal vein and the rest comes from the hepatic artery.PVT is a universal problem in LT.

关键词： anastomosis portal Liver

Prognosis of hepatocellular carcinoma with bile duct tumor thrombus after R0 resection:a matched study

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Hepatobiliary & pancreatic Diseases International 2016年第6期15卷 626-632页

作者： Ding-Ding Wang Li-Qun Wu Zu-Sen Wang division of Hepatobiliary pancreatic surgery The Affiliated Hospital of Qingdao University

BACKGROUND： Hepatocellular carcinoma （HCC） with bile duct tumor thrombus （BDTT） is rare. The present study aimed to determine post-surgical prognoses in HCC patients with BDTT, as outcomes are currently unclear. METHODS： We compared the prognoses of 110 HCC patients without BDTT （group A） to 22 cases with BDTT （group B）. The two groups were matched in age, gender, tumor etiology, size, number, portal vascular invasion, and TNM stage. Additionally, 28 HCC patients with BDTT were analyzed to identify prognostic risk factors. RESULTS： The 1-, 3-, and 5-year overall survival rates were 90.9%, 66.9%, and 55.9% for group A and 81.8%, 50.0%, and 37.5% for group B, respectively. The median survival time in groups A and B was 68.8 and 31.4 months, respectively （P=0.043）. The patients for group B showed higher levels of serum total bilirubin, alanine aminotransferase and gammaglutamyl transferase, a larger hepatectomy range, and a higher rate of anatomical resection. In subgroup analyses of patients with BDTT who underwent R0 resection, TNM stage Ⅲ-Ⅳ was an independent risk factor for overall survival; these patients had worse prognoses than those with TNM stage Ⅰ-Ⅱ after R0 resection （hazard ratio=6.056, P=0.014）. Besides, univariate and multivariate analyses revealed that non-R0 resection and TNM stage Ⅲ-Ⅳ were independent risk factors for both disease-free survival and overall survival of 28 HCC patients with BDTT. The median overall survival time of patients with BDTT who underwent R0 resection was longer than that of patients who did not undergo R0 resection （31.0 vs 4.0 months, P=0.007）.CONCLUSIONS： R0 resection prolonged survival time in HCC patients with BDTT, although prognosis remains poor. For such patients, R0 resection is an important treatment that determines long-term survival.

关键词： hepatocellular carcinoma bile duct tumor thrombus prognosis recurrence R0 resection

Acute pancreatitis induced by transarterial chemoembolization:a single-center experience of over 1500 cases

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Hepatobiliary & pancreatic Diseases International 2016年第1期15卷 93-98页

作者： Wong Hoi She Albert CY Chan Tan To Cheung Kenneth SH Chok See Ching Chan Ronnie TP Poon Chung Mau Lo division of Hepatobiliary & pancreatic surgery and Liver Transplantation Department of SurgeryThe University of Hong Kong

BACKGROUND： Acute pancreatitis is a relatively rare but po- tentially lethal complication after transarterial chemotherapy. This study aimed to review the complications such as acute pancreatitis after transarterial chemotherapy with or without embolization for hepatocellular carcinoma. METHODS： A total of 1632 patients with hepatocellular car- cinoma who had undergone transarterial chemoembolization from ]anuary 2000 to February 2014 in a single-center were reviewed retrospectively. We investigated the potential com- plications of transarterial chemoembolization, such as acute pancreatitis and acute pancreatitis-related complications. RESULTS： Of the 1632 patients with hepatocellular carcinoma who had undergone 5434 transarterial chemoembolizations, 1328 were male and 304 female. The median age of these pa- tients was 61 years. Most （79.6%） of the patients suffered from HBV-related hepatoceUular carcinoma. The median tumor size was 5.2 cm. Of the 1632 patients, 145 patients underwent transarterial chemoembolization with doxorubicin elut- ing bead, making up a total of 538 episodes. The remaining patients underwent transarterial chemoembolization with cisplatin. Seven （0.4%） patients suffered from acute pancre- atitis post-chemoembolization. Six patients had chemoembo- lization with doxorubicin and one had chemoembolization with cisplatin. Patients who received doxornbicin eluting bead had a higher risk of acute pancreatitis [6/145 （4.1%） vs 1/1487 （0.1%）, P〈0.0001]. Two patients had anatomical arterial variations. Four patients developed acute pancreatitis- related complications including necrotizing pancreatitis （n=3） and pseudocyst formation （n=1）. All of the 4 patients resolved after the use of antibiotics and other conservative treatment. Three patients had further transarterial chemoembolization without any complication. CONCLUSIONS： Acute pancreatitis after transarterial chemo- embolization could result in serious complications, especially after treatment with doxorubicin eluting bead. Continuation of curr

关键词： transarterial chemoembolization acute pancreatitis hepatocellular carcinoma

Autoimmune pancreatitis with different clinical manifestations and imaging findings:a series of three cases

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Journal of Pancreatology 2023年第2期6卷 82-86页

作者： Changhao Gao Zhiyao Fan Hanxiang Zhan Division of Pancreatic Surgery Department of General SurgeryQilu Hospital of Shandong UniversityJinanShandong ProvinceChina

Autoimmune pancreatitis(AIP)is a rare and emerging immune-mediated pancreatitis.The involvement of the pancreas with lymph-oplasmacytic infiltration and fibrosis on histology is the most common features and has been well studied in the literature.It is characterized by a nonspecific presentation that mimics a malignant process.The purpose of this report is to explore the different clinical and paraclinical aspects of this disease,as well as the challenges posed by its management.The series are made up of three different cases of patients with elevated serum IgG4 levels and pancreatic changes.The first case initially revealed cholestatic jaundice with extrahepatic and intrahepatic cholangitis,and ultrasound reflected multiple occupying changes in the pancreas.The elevated serum IgG4 level was brilliant.Patient improved under the influence of corticosteroids.The second case was clinically asymptomatic,just found weight loss.Magnetic resonance revealed a round mass in the head of the pancreas and was considered as a neuroendocrine tumor.The patient showed slightly elevated serum IgG4 level,but was sensitive to hormone therapy.The third case concerned epigastric pain and enlarged lymph nodes.It was initially diagnosed as pancreatic cancer with distant metastasis,but also finally resolved by corticosteroid treatment.The clinical presentation of AIP is heterogeneous,as evidenced by our three clinical cases.Further observational and interventional studies are needed to better identify and manage this disease.

关键词： Autoimmune pancreatitis Clinical manifestation IgG4 Imaging finding

Is irreversible electroporation safe and effective in the treatment of hepatobiliary and pancreatic cancers?

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Hepatobiliary & pancreatic Diseases International 2019年第2期18卷 117-124页

作者： Li-Ming Wu Le-Le Zhang Xin-Hua Chen Shu-Sen Zheng division of Hepatobiliary and pancreatic surgery the First Affiliated Hospital Zhejiang University School of Medicine

Background: Irreversible electroporation(IRE) is a novel ablative technique for hepatobiliary and pancreatic cancers. This review summarizes the data regarding the safety and efficacy of IRE in the treatment of hepatobiliary and pancreatic cancers. Data sources: Studies were identified by searching Pub Med and Embase for articles published in English from database inception through July 31, 2017. For inclusion, each clinical study had to report morbidity and survival data on hepatobiliary and pancreatic cancers treated with IRE and contain at least 10 patients. Studies that met these criteria were included for analysis. Two authors assessed each clinical study for data extraction. The controversial parts were resolved through discussion with seniors. Results: A total of 24 clinical studies were included. Fourteen focused on hepatic ablation with IRE comprising 437 patients with 666 lesions of different tumor types. Two patients(0.5%) died after the IRE procedure. Morbidity of hepatic ablation with IRE ranged from 7% to 35%. Most complications were mild. Complete response for hepatic tumors was reported as 57%–97%. Ten studies with 455 patients focused on pancreatic IRE. The overall mortality of IRE in pancreatic cancer was 2%. Overall severe morbidity of IRE in pancreatic cancer ranged from 0 to 20%. The median overall survival after IRE ranged from 7 to 23 months. Patients treated with IRE combined with surgical resection showed a longer overall survival. Conclusions: IRE significantly improves the prognosis of advanced hepatobiliary and pancreatic malignances, and companied with less complications. Hence, IRE is a relatively safe and effective non-thermal ablation strategy and potentially recommended as an option for therapy of patients with hepatobiliary and pancreatic malignances.

关键词： Irreversible electroporation Hepatic cancer pancreatic cancer

Assessment of clinical outcomes of advanced hilar cholangiocarcinoma

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Hepatobiliary & pancreatic Diseases International 2018年第2期17卷 155-162页

作者： Kang-Jie Chen Fu-Chun Yang Yun-Sheng Qin Jing Jin Shu-Sen Zheng division of Hepatobiliary pancreatic surgery First Affiliated Hospital Zhejiang University School of Medicine

Background: Low resectability and poor survival outcome are common for hilar cholangiocarcinoma(HCCA), especially in advanced stages. The present study was to assess the clinical outcome of advanced HCCA, focusing on therapeutic modalities, survival analysis and prognostic assessment.Methods: Clinical data of 176 advanced HCCA patients who had been treated in our hospital between January 2013 and December 2015 were analyzed retrospectively. Prognostic effects of clinicopathological factors were explored by univariate and multivariate analysis. Survival predictors were evaluated by the receiver operating characteristic(ROC) curve.Results: The 3-year overall survival rate was 13% for patients with advanced HCCA. Preoperative total bilirubin(P = 0.009), hepatic artery invasion(P = 0.014) and treatment modalities(P = 0.020) were independent prognostic factors on overall survival. A model combining these independent prognostic factors(area under ROC curve: 0.748; 95% CI: 0.678–0.811; sensitivity: 82.3%, specificity: 53.5%) was highly predictive of tumor death. After R0 resection, the 3-year overall survival was up to 38%. Preoperative total bilirubin was still an independent negative factor, but not for hepatic artery invasion.Conclusions: surgery is still the best treatment for advanced HCCA. Preoperative biliary drainage should be performed in highly-jaundiced patients to improve survival. Prediction of survival is improved significantly by a model that incorporates preoperative total bilirubin, hepatic artery invasion and treatment modalities.

关键词： Hilar cholangiocarcinoma Hepatic artery resection Preoperative biliary drainage Prognostic factors

Controversies regarding and perspectives on clinical utility of biomarkers in hepatocellular carcinoma

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世界胃肠病学杂志：英文版 2016年第1期22卷 262-274页

作者： Pei-Pei Song Ju-Feng Xia Yoshinori Inagaki Kiyoshi Hasegawa Yoshihiro Sakamoto Norihiro Kokudo Wei Tang Hepato-Biliary-pancreatic surgery division Department of SurgeryGraduate School of Medicinethe University of Tokyo

The prevalence of hepatocellular carcinoma(HCC)worldwide parallels that of persistent infection with the hepatitis B virus(HBV)and/or hepatitis C virus(HCV).According to recommendations by the World Health Organization guidelines for HBV/HCV,alpha-fetoprotein(AFP)testing and abdominal ultrasound should be performed in routine surveillance of HCC every 6 mo for high-risk patients.These examinations have also been recommended worldwide by many other HCC guidelines over the past few decades.In recent years,however,the role of AFP in HCC surveillance and diagnosis has diminished due to advances in imaging modalities.AFP was excluded from the surveillance and/or diagnostic criteria in the HCC guidelines published by the American Association for the Study of Liver Diseases in 2010,the European Association for the Study of the Liver in 2012,and the National Comprehensive Cancer Network in 2014.Other biomarkers,including the Lens culinaris agglutinin-reactive fraction of AFP(AFP-L3),des-γ-carboxyprothrombin,Dickkopf-1,midkine,and micro RNA,are being studied in this regard.Furthermore,increasing attention has focused on the clinical utility of biomarkers as pre-treatment predictors for tumor recurrence and as post-treatment monitors.Serum and tissue-based biomarkers and genomics may aid in the diagnosis of HCC,determination of patient prognosis,and selection of appropriate treatment.However,further studies are needed to better characterize the accuracy and potential role of these approaches in clinical practice.

关键词： Hepatocellular carcinoma Biomarker Guideline Surveillance Diagnosis Prognosis

Laparoscopic extended right hepatectomy for posterior and completely caudate massive liver tumor (with videos)

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Hepatobiliary & pancreatic Diseases International 2023年第3期22卷 326-330页

作者： Liang Chen Lu-Zheng Liu Jia-Cheng Chen Da-Feng Xu Cheng Chen Shi-Xun Lin Xiang-Xiang Luo Jin-Cai Wu division of Hepatobiliary pancreatic surgery Hainan Affiliated Hospital of Hainan Medical University(Hainan General Hospital)Haikou 570311China

To the Editor:Liver tumor may occur in any hepatic segment or lobe,and thus the liver resection is individualized as per the location and size of the tumor.In addition,the resection of the posterior and caudate lobes of the liver is especially difficult amongst all types of hepatectomy.Kawaguchi et al.believed that the laparoscopic resection of right posterior liver lobe was a difficult surgical procedure[1].

关键词： hepatectomy liver

Added value of indocyanine green fluorescence imaging in liver surgery

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Hepatobiliary & pancreatic Diseases International 2022年第4期21卷 310-317页

作者： Nobuyuki Takemura Kyoji Ito Fuyuki Inagaki Fuminori Mihara Norihiro Kokudo Department of surgery Hepato-Biliary Pancreatic Surgery DivisionNational Center for Global Health and Medicine1-21-1 ToyamaShinjyuku-kuTokyo162-8655Japan

Recently,indocyanine green(ICG)fluorescence imaging has been widely used as a substitute for cholangiography in hepatobiliary surgery,to detect hepatic tumors,for accurate anatomical hepatectomy,and to increase the safety and accuracy of minimally invasive(laparoscopic and robotic)hepatectomy.The clinical relevance of this method has been increasing gradually,as new procedures develop in this field.Various important roles and the latest added value of ICG fluorescence imaging in liver surgery are discussed in this report.

关键词： Florescence imaging Indocyanine green Hepatocellular carcinoma Colorectal metastasis Hepatectomy Minimally invasive surgery

Postoperative outcomes after open splenectomy versus laparoscopic splenectomy in cirrhotic patients:a meta-analysis

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Hepatobiliary & pancreatic Diseases International 2016年第1期15卷 14-20页

作者： Khaled Al-raimi Shu-Sen Zheng division of Hepatobiliary pancreatic surgery First Affiliated HospitalZhejiang University School of Medicine

BACKGROUND： Laparoscopic splenectomy is considered the gold standard for resecting normal-to-moderately bigger spleens in benign conditions, and in addition could be tried for patients with malignant splenic disorders. However, the safety of laparoscopic splenectomy in patients with hyper- splenism is not well-known. This study aimed to investigate the efficacy and safety of laparoscopic splenectomy for pa- tients with hypersplenism secondary to liver cirrhosis by com- paring with the open splenectomy.

关键词： open splenectomy laparoscopic splenectomy cirrhosis