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The role of liver transplantation for hilar cholangiocarcinoma

hepatobiliary & Pancreatic Diseases International 2007年第3期6卷 248-253页

作者： Durgatosh Pandey Kang-Hoe Lee Kai-Chah Tan hepatobiliary Surgery & Liver Transplantation Asian Centre for Liver Disease and Transplantation Gleneagles Hospital Singapore

BACKGROUND: Hilar cholangiocarcinoma is a devastating disease. Surgery is the only potentially curative modality. However, the results of surgical resection for hilar cholangiocarcinomas are disappointing. The introduction of liver transplantation for this condition has brought new hope for the management of this disease. The aim of this review is to discuss the role of liver transplantation in this disease. DATA SOURCES: A MEDLINE search was conducted for the articles on liver transplantation for hilar cholangiocarcinoma. Their results have been compiled and compared with the existing literature on resection for this disease. RESULTS: The earlier series on liver transplantation for hilar cholangiocarcinoma were not encouraging because of poor patient selection. The Mayo clinic protocol of neoadjuvant chemoradiation followed by liver transplantation has shown remarkable success (survival at 1-, 3-, and 5-year post-transplantation being 92%, 82%, and 82%, respectively). With better patient selection and integration of neoadjuvant chemoradiation, the long-term survival is superior to that of the patients who undergo resection, as shown by the published literature on resection. The limitations of organ availability can be overcome by the living donor liver transplantation programme. This review article discusses the rationale, pros and cons of liver transplantation vis-à-vis resection for hilar cholangiocarcinoma.CONCLUSIONS: Liver transplantation, especially living donor liver transplantation, is a new and exciting alternative to resection for hilar cholangiocarcinoma. Integration of neoadjuvant chemoradiation has the potential to further improve the curative potential of liver transplantation. The strategy of combining neoadjuvant chemoradiation and liver transplantation brings new hope for the treatment of this difficult disease.

关键词： liver transplantation hilar cholangiocarcinoma neoadjuvant chemoradiation.

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Prognostic Performance of the China Liver Cancer Staging System in Hepatocellular Carcinoma Following Transarterial Chemoembolization

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Journal of clinical and Translational Hepatology 2023年第6期11卷 1321-1328页

作者： Bin-Yan Zhong Jian-Qiang Jiang Jun-Hui Sun Jin-Tao Huang Wei-Dong Wang Qi Wang Wen-Bin Ding Xiao-Li Zhu Cai-Fang Ni Department of Interventional Radiology The First Affiliated Hospital of Soochow UniversitySuzhouJiangsuChina Department of Interventional Therapy Nantong Tumor HospitalNantongJiangsuChina hepatobiliary and Pancreatic Interventional Treatment Center Division of Hepatobiliary and Pancreatic SurgeryThe First Affiliated HospitalZhejiang University School of MedicineHangzhouZhejiangChina Department of Interventional Radiology The Affiliated Wuxi People’s Hospital of Nanjing Medical UniversityWuxiJiangsuChina Department of Interventional Radiology Third Affiliated Hospital of Soochow UniversityChangzhou First HospitalChangzhouJiangsuChina Department of Interventional Radiology Nantong First People’s HospitalNantongJiangsuChina

Background and Aims:To validate prognostic performance of the China liver cancer(CNLC)staging system as well as to compare these parameters with those of the Barcelona clinic Liver Cancer(BCLC)staging system for Chinese hepatocellular carcinoma(HCC)treated with transarterial chemoembolization(TACE).Methods:This multicenter retrospective study included 1,124 patients with HCC between January 2012 and December 2020 from six Chinese hospitals.Based on overall survival(OS),the prognostic performance outcomes for the CNLC and BCLC staging systems were compared by model discrimination[C statistic and Akaike information criterion(AIC)],monotonicity of the gradient(linear trend chi-square test),homogeneity(likelihood ratio chisquare test),and calibration(calibration plots).A prospective cohort of 44 patients receiving TACE-based therapy included between January 2021 and December 2022 was used to prospectively validate the outcomes.Results:Median OS was 19.1(18.2–20.0)months,with significant differences in OS between stages defined by the CNLC and BCLC observed(p<0.001).The CNLC performed better than the BCLC regarding model discrimination(C-index:0.661 vs.0.644;AIC:10,583.28 vs.10,583.72),model monotonicity of the gradient(linear trend chi-square test:66.107 vs.57.418;p<0.001),model homogeneity(159.2 vs.158.7;p<0.001).Both staging systems had good model calibration.Similar results were observed in the prospective cohort.Conclusions:Combining model discrimination,gradient monotonicity,homogeneity,and calibration,the CNLC performed better than the BCLC for Chinese HCC patients receiving TACE.

关键词： Hepatocellular carcinoma CNLC BCLC TACE

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Pancreatitis in pregnancy: etiology, diagnosis, treatment, and outcomes

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hepatobiliary & Pancreatic Diseases International 2016年第4期15卷 434-438页

作者： Padmavathi Mali Department of Internal Medicine Marshfield Clinic

BACKGROUND：Acute pancreatitis in pregnancy is a rare and dangerous disease.This study aimed to examine the etiology,treatment,and outcomes of pancreatitis in pregnancy.METHOD：A total of 25 pregnant patients diagnosed with pancreatitis during the period of 1994 and 2014 was analyzed retrospectively.RESULTS：The pregnant patients were diagnosed with pancreatitis during a period of 21 years.Most（60%）of the patients were diagnosed with pancreatitis in the third trimester.The mean age of the patients at presentation was 25.7 years,with a mean gestational age of 24.4 weeks.Abdominal pain occurred in most patients and vomiting in one patient was associated hyperemesis gravidarum.The common cause of the disease was gallstone-related（56%）,followed by alcohol-related（16%）,post-ERCP（4%）,hereditary（4%）and undetermined conditions（20%）.The level of triglycerides was minimally high in three patients.ERCP and wire-guided sphincterotomy were performed in 6（43%）of 14 patients with gallstone-related pancreatitis and elevated liver enzymes with no complications.Most（84%）of the patients underwent a full-term,vaginal delivery.There was no difference in either maternal or fetal outcomes after ERCP.CONCLUSIONS：Acute pancreatitis is rare in pregnancy,occurring most commonly in the third trimester,and gallstones are the most common cause.When laparoscopic cholecystectomy is not feasible and a common bile duct stone is highly suspected on imaging,endoscopic sphincterotomy or stenting may help to prevent recurrence and postpone cholecystectomy until after delivery.

关键词： pancreatitis alcoholic pancreatitis pregnancy complications diagnostic imaging

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Selecting an Appropriate Experimental Animal Model for Cholangiocarcinoma Research

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Journal of clinical and Translational Hepatology 2022年第4期10卷 700-710页

作者： Man Li Xueli Zhou Wei Wang Baoan Ji Yu Shao Qianyu Du Jinghao Yao Yan Yang Department of Medical Oncology The First Affiliated Hospital of Bengbu Medical CollegeBengbuAnhuiChina Depart-ment of Cancer Biology Mayo ClinicJacksonvilleFloridaUSA

Cholangiocarcinoma(CCA)is a highly aggressive biliary tree malignancy with intrahepatic and extra-hepatic sub-types that differ in molecular pathogeneses,epidemiology,clinical manifestations,treatment,and prognosis.The over-all prognosis and patient survival remains poor because of lack of early diagnosis and effective treatments.Preclini-cal in vivo studies have become increasingly paramount as they are helpful not only for the study of the fundamental molecular mechanisms of CCA but also for developing novel and effective therapeutic approaches of this fatal cancer.Recent advancements in cell and molecular biology have made it possible to mimic the pathogenicity of human CCA in chemical-mechanical,infection-induced inflammatory,implantation,and genetically engineered animal models.This review is intended to help investigators understand the particular strengths and weaknesses of the currently used in vivo animal models of human CCA and their related mod-eling techniques to aid in the selection of the one that is the best for their research needs.

关键词： Cholangiocarcinoma Heterogeneity Animal model Genetically engineered model Cancer cell of origin

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Long-term outcome of patients with chronic pancreatitis treated with micronutrient antioxidant therapy

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hepatobiliary & Pancreatic Diseases International 2017年第2期16卷 209-214页

作者： Sukitha Namal Rupasinghe Ajith K Siriwardena hepatobiliary Surgery Unit Manchester Royal Infirmary Oxford Road Manchester M13 9WL UK

BACKGROUND： Micronutrient antioxidant therapy did not relieve pain in a European randomized trial of patients with chronic pancreatitis without malnutrition. However, intervention was undertaken only for 6 months leaving unanswered the question of whether long-term antioxidant therapy may modulate chronic pancreatitis. The aim of this study is to assess the outcome of long-term use of micronutrient antioxidant therapy in patients with chronic pancreatitis.METHODS： This is a single center clinical cohort report of patients with chronic pancreatitis prescribed micronutrient antioxidant therapy and followed for up to 10 years. Data were collected on demographic detail, clinic pain assessment, insulin requirements, interventions and outcome.RESULTS： A group of 30 patients with a diagnosis of chronic pancreatitis constitute the study population. Median age at time of diagnosis was 40 years（range 14-66）; 19（63%） were male and the median duration of symptoms was 2 years（range 0-18）. Alcohol was the dominant cause in 22（73%） patients and 16（53%） patients were Cambridge stage 1. Twenty-four（80%） patients had pain at presentation. During antioxidant treatment of 4 years（range 1-10）, pain decreased but the proportion with abdominal pain compared to those who were pain-free remained constant（P=0.16; two-way ANOVA with Bonferroni correction）. There was a significant increase in requirement for insulin（P=0.028） with time together with use of both endoscopic and surgical interventions.CONCLUSIONS： This is the first study to report long-term disease-specific outcome in patients with chronic pancreatitis prescribed micronutrient antioxidant therapy. There appears to be no effect of intervention on outcome.

关键词： chronic pancreatitis antioxidant therapy micronutrient Antox outcomes

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clinical application of trans-sinus gastric stent placement and drainage in the management of persistent external pancreatic fistula after minimal access retroperitoneal pancreatic necrosectomy in severe acute pancreatitis patients

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Journal of pancreatology 2022年第4期5卷 146-150页

作者： Yuhui Chen Maosheng Su Xianlei Xin Zhiwei Liu Shouwang Cai Department of General Surgery The First Medical CenterChinese PLA General HospitalBeijingChina Department of hepatobiliary and Pancreatic Surgery The First Medical CenterChinese PLA General HospitalBeijingChina

Background:Persistent external pancreatic fistula(EPF)in patients with pancreatic duct disruption or disconnection can result from minimal access to retroperitoneal pancreatic necrosectomy(MARPN)in severe acute pancreatitis patients,which is a difficult problem for clinicians and requires a long treatment duration.This study aimed to investigate the effectiveness and safety of trans-sinus gastric stent placement and drainage using interventional technology in the management of persistent EPF after MARPN in severe acute pancreatitis.Methods:From August 2018 to December 2020,the data of 9 patients with persistent EPF treated with trans-sinus gastric stent placement and drainage in our hospital were retrospectively collected.The main outcome measures were technical success rate,recurrence rate,new pancreatic fluid collection,morbidity,and mortality.All patients were followed up after the procedure through clinic visits and imaging modalities.Results:The median age of the patients was 46 years(30-61 years).The median persistent EPF duration was 5 months(2-12 months).The median follow-up time was 41 months(range,20-47 months).The median operation time was 48 minutes(range,40-54 minutes),and the technical success rate was 100%.Seven days after treatment,the percutaneous drainage tubes of all patients were removed.Six months after the procedure,2 patients lost the stents,and one of those patients suffered from a pseudocyst,which gradually increased to a maximum diameter of 7 cm over 9 months.Therefore,a double pigtail drainage tube was placed under the guidance of an endoscope.The second of these 2 patients had no recurrence or pseudocyst.Twelve months after the procedure,another 3 patients lost the stents;18 months after the procedure,another 2 patients lost the stents.These patients had no recurrence as well.No other adverse events or deaths occurred during the study period.Conclusion:Trans-sinus tract gastric stent placement and drainage are safe and effective in the treatment of persistent EPF after MARPN in severe

关键词： Endoscopic technique Interventional technology Persistent external pancreatic fistula Trans-sinus gastric stent placement and drainage

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High prevalence of chronic viral hepatitis B and C in Minnesota Somalis contributes to rising hepatocellular carcinoma incidence

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World Journal of Gastroenterology 2022年第35期28卷 5217-5229页

作者： Essa A Mohamed Nasra H Giama Abubaker O Abdalla Hassan M Shaleh Abdul M Oseini Hamdi A Ali Fowsiyo Ahmed Wesam Taha Hager Ahmed Mohammed Jessica Cvinar Ibrahim A Waaeys Hawa Ali Loretta K Allotey Abdiwahab O Ali Safra A Mohamed William S Harmsen Eimad M Ahmmad Numra A Bajwa Mohamud D Afgarshe Abdirashid M Shire Joyce E Balls-Berry Lewis R Roberts Division of Gastroenterology and Hepatology Mayo ClinicRochesterMN 55905United States Center for clinical and Translational Science Mayo ClinicRochesterMN 55905United States School of Nursing University of MinnesotaMinneapolisMN 55455United States Division of Digestive Diseases Emory School of MedicineAtlantaGA 30322United States Department of Laboratory Medicine and Pathology Mayo ClinicRochesterMN 55905United States Department of Internal Medicine NewYork-Presbyterian QueensFlushingNY 11355United States Department of Pediatrics University of Nevada Las VegasLas VegasNV 89154United States Department of Quantitative Health Sciences Mayo ClinicRochesterMN 55905United States Department of Medicine Gargar Urgent Care and ClinicMinneapolisMN 55406United States Office of the Director Shire ScientificMinneapolisMN 55405United States Department of Neurology Washington University School of Medicine in St LouisSt LouisMO 63130United States Knight Alzheimer Disease Research Center Washington University School of MedicineSt LouisMO 63130United States

BACKGROUND Chronic hepatitis B virus(HBV)and hepatitis C virus(HCV)infections are known risk factors for liver disease,cirrhosis and hepatocellular carcinoma(HCC).There is substantial global variation in HBV and HCV prevalence resulting in variations in cirrhosis and HCC.We previously reported high prevalence of HBV and HCV infections in Somali immigrants seen at an academic medical center in Minnesota.AIM To determine the prevalence of chronic viral hepatitis in Somali immigrants in Minnesota through a community-based screening program.METHODS We conducted a prospective community-based participatory research study in the Somali community in Minnesota in partnership with community advisory boards,community clinics and local mosques between November 2010 and December 2015(data was analyzed in 2020).Serum was tested for hepatitis B surface antigen,hepatitis B core antibody,hepatitis B surface antibody and anti-HCV antibody.RESULTS Of 779 participants,15.4%tested positive for chronic HBV infection,50.2%for prior exposure to HBV and 7.6%for chronic HCV infection.Calculated age-adjusted frequencies in males and females for chronic HBV were 12.5%and 11.6%;for prior exposure to HBV were 44.8%and 41.3%;and for chronic HCV were 6.7%and 5.7%,respectively.Seven participants developed incident HCC during follow up.CONCLUSION Chronic HBV and HCV are major risk factors for liver disease and HCC among Somali immigrants,with prevalence of both infections substantially higher than in the general United States population.Community-based screening is essential for identifying and providing health education and linkage to care for diagnosed patients.

关键词： Viral hepatitis Liver disease Community engagement African Immigrant health

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Postoperative adjuvant transarterial chemoembolization for multinodular hepatocellular carcinoma within the Barcelona clinic Liver Cancer early stage and microvascular invasion

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hepatobiliary Surgery and Nutrition 2018年第6期7卷 418-428页

作者： Han Wang Peng-Cheng Du Meng-Chao Wu Wen-Ming Cong Department of Pathology Eastern Hepatobiliary Surgery HospitalThe Second Military Medical UniversityYangpuShanghai 200438China Key Laboratory of Signaling Regulation and Targeting Therapy of Liver Cancer(Second Military Medical University)Ministry of Education YangpuShanghai 200438China Shanghai Key Laboratory of hepatobiliary Tumor Biology(Eastern hepatobiliary Surgery Hospital) YangpuShanghai 200438China Department of Vascular Surgery Changhai Hospital5Department of SurgeryEastern Hepatobiliary Surgery HospitalThe Second Military Medical UniversityYangpuShanghai 200433China

Background:The survival benefit of postoperative adjuvant transcatheter arterial chemoembolization(PA-TACE)remained controversial.We aimed to investigate the prognosis effect of PA-TACE on the Barcelona clinic Liver Cancer(BCLC)early stage multinodular hepatocellular carcinoma(MHCC)patients with/without microvascular invasion(MVI).Methods:Two hundred and seventy-one patients from January 2010 to December 2014 undergoing curative hepatectomy were included in this study.Disease-free survival(DFS)rates and overall survival(OS)rates as well as prognostic factors were analyzed by the Kaplan-Meier method,the log-rank test and the Cox proportional hazard model.Results:Thirty-four point four percent(44/128)MVI positive and 55.2%(79/143)MVI negative patients underwent PA-TACE.Multivariate analysis revealed that HBV DNA load>103 copy/Ml,>three tumors,MVI,and without PA-TACE were independent risk factors for poor DFS.Higher alkaline phosphatase(ALP),three tumors,MVI,and without PA-TACE were independent risk factors for poor OS.Both DFS and OS were significantly improved in patients with MVI who received PA-TACE as compared to those who underwent hepatic resection alone(5-year DFS,26.3%vs.20.7%,P=0.038;5-year OS,73.6%vs.47.7%,P=0.005).No differences were noted in DFS and OS among MVI negative patients with or without PA-TACE(5-year DFS,33.7%vs.33.0%,P=0.471;5-year OS,84.1%vs.80.3%,P=0.523).Early recurrence was more likely to occur in patients without PA-TACE(P=0.001).Conclusions:PA-TACE was a safe intervention and could effectively prevent tumor recurrence and improve the survival of the BCLC early stage MHCC patients with MVI.

关键词： Hepatocellular carcinoma(HCC) microvascular invasion(MVI) clonal origin postoperative adjuvant transcatheter arterial chemoembolization(PA-TACE)

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血清白蛋白水平预测肝门部胆管癌患者的生存

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Gastroenterology Report 2017年第1期5卷 62-66,I0003页

作者： Abhijeet Waghray Anastasia Sobotka Carlos Romero Marrero Bassam Estfan Federico Aucejo KV Narayanan Menon Department of Medicine MetroHealth Medical CenterClevelandOHUSA Department of Gastroenterology and Hepatology Cleveland Clinic FoundationClevelandOHUSA Department of hepatobiliary and Transplant Surgery Cleveland Clinic FoundationClevelandOHUSA

背景与目的:肝门部胆管癌是一种极具威胁的恶性肿瘤,其发生率随地域及其他危险因素的不同而有所差异,其快速进展的疾病特点及难以早期诊断的现状使相当数量的患者无法得到根治性治疗。本研究的目的是明确影响肝门部胆管癌患者总体生存... 详细信息

背景与目的:肝门部胆管癌是一种极具威胁的恶性肿瘤,其发生率随地域及其他危险因素的不同而有所差异,其快速进展的疾病特点及难以早期诊断的现状使相当数量的患者无法得到根治性治疗。本研究的目的是明确影响肝门部胆管癌患者总体生存的预后因素。方法:收集2003-2013年间经组织学证实的成人肝门部胆管癌患者,评估其预后影响因素,评估变量包括入院时人口学资料、实验室指标、症状及影像学特征。结果:116例经病理诊断的肝门部胆管癌患者纳入研究。血清白蛋白>3.0 g/dL(P3.0 g/dL是一项独立的预后保护因素(HR=0.31,95%CI:0.14~0.70),可以得到44周的生存获益。结论:本研究是目前对于肝门部胆管癌预后因素的最大宗病例分析。血清白蛋白>3.0 g/dL是一项独立的预后指标,可以显著延长生存期。

关键词：肝门部胆管癌预后因素生存白蛋白

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Inhalation of hydrogen gas reduces liver injury during major hepatotectomy in swine

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World Journal of Gastroenterology 2012年第37期18卷 5197-5204页

作者： Lei Xiang Jing-Wang Tan Li-Jie Huang Lin Jia Ya-Qian Liu Yu-Qiong Zhao Kai Wang Jia-Hong Dong Animal Experiment Centers PLA General Hospital Beijing 100853 China Institute of hepatobiliary Surgery PLA General Hospital Beijing 100853 China

AIM:To study the effect of H2 gas on liver injury in massive hepatectomy using the Intermittent Pringle maneuver in swine. METHODS:Male Bama pigs (n = 14) treated with ketamine hydrochloride and Sumianxin Ⅱ as induction drugs followed by inhalation anesthesia with 2% isoflurane, underwent 70% hepatotectomy with loss of bleeding less than 50 mL, and with hepatic pedicle occlusion for 20 min, were divided into two groups:Hydrogen-group (n = 7), the pigs with inhalation of 2% hydrogen by the tracheal intubation during major hepatotectomy; Contrast-group (n = 7), underwent 70% hepatotectomy without inhalation of hydrogen. Hemo-dynamic changes and plasma concentrations of alanine aminotransferase (ALT), aspartate aminotransferase (AST), hyaluronic acid (HA), tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), and malondialdehyde (MDA) in liver tissue were measured at pre-operation, post-hepatotectomy (PH) 1 h and 3 h. The apoptosis and proliferating cell nuclear antigen (PCNA) expression in liver remnant were evaluated at PH 3 h. Thenwe compared the two groups by these marks to evaluate the effect of the hydrogen in the liver injury during major hepatotectomy with the Pringle Maneuver in the swine. RESULTS: There were no significant differences in body weight, blood loss and removal liver weight between the two groups. There was no significant difference in changes of portal vein pressure between two groups at pre-operation, PH 30 min, but in hydrogen gas treated-group it slightly decrease and lower than its in Contrast-group at PH 3 h, although there were no significant difference (P = 0.655). ALT and AST in Hydrogen-group was significantly lower comparing to Contrast-group (P = 0.036, P = 0.011, vs P = 0.032, P = 0.013) at PH 1 h and 3 h, although the two groups all increased. The MDA level increased between the two group at PH 1 h and 3 h. In the hydrogen gas treated-group, the MDA level was not significantly significant at pre-operation and significantly low at PH 1 h and 3 h comparing to Contrast-group (P = 0.

关键词：氢气处理肝脏损伤增殖细胞核抗原脱氧核糖核苷酸猪肿瘤坏死因子白细胞介素6 细胞凋亡

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