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Minimally invasive liver resection for huge(≥10cm)tumors:an international multicenter matched cohort study with regression discontinuity analyses

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Hepatobiliary surgery and Nutrition 2021年第5期10卷 587-597,I0001-I0003页

作者： Tan-To Cheung Xiaoying Wang Mikhail Efanov Rong Liu David Fuks Gi-Hong Choi Nicholas LSyn Charing CChong Iswanto Sucandy Adrian KHChiow Marco VMarino Mikel Gastaca Jae Hoon Lee TPeter Kingham Mathieu D’Hondt Sung Hoon Choi Robert PSutcliffe Ho-Seong Han Chung Ngai Tang Johann Pratschke Roberto ITroisi Brian KPGoh International Robotic and Laparoscopic Liver Resection Study Group Collaborators department of surgery Queen Mary HospitalThe University of Hong KongHong KongChina department of Liver surgery and Transplantation Liver Cancer InstituteZhongshan HospitalFudan UniversityShanghaiChina department of Hepato-Pancreato-Biliary surgery Moscow Clinical Scientific CenterMoscowRussia Faculty of hepatopancreatobiliary surgery The First Medical Center of Chinese People’s Liberation Army(PLA)General HospitalBeijingChina department of Digestive Oncologic and Metabolic SurgeryInstitute Mutualiste MontsourisUniversite Paris DescartesParisFrance Division of hepatopancreatobiliary surgery Department of SurgerySeverance HospitalYonsei University College of MedicineSeoulKorea department of hepatopancreatobiliary and Transplant surgery Singapore General Hospital and Yong Loo Lin School of MedicineNational University of SingaporeSingaporeSingapore Division of Hepatobiliary and Pancreatic surgery Department of SurgeryPrince of Wales HospitalThe Chinese University of Hong KongNew TerritoriesHong KongChina AdventHealth Tampa Digestive Health InstituteTampaFLUSA hepatopancreatobiliary Unit Department of SurgeryChangi General HospitalSingaporeSingapore General surgery department Azienda Ospedaliera Ospedali Riuniti Villa Sofia-CervelloPalermoItaly Oncologic surgery department P.Giaccone University HospitalPalermoItaly Hepatobiliary surgery and Liver Transplantation Unit Biocruces Bizkaia Health Research InstituteCruces University HospitalUniversity of the Basque CountryBilbaoSpain department of surgery Division of Hepato-Biliary and Pancreatic SurgeryAsan Medical CenterUniversity of Ulsan College of MedicineSeoulKorea department of surgery Memorial Sloan Kettering Cancer CenterNew YorkNew YorkUSA department of Digestive and Hepatobiliary/Pancreatic surgery Groeninge HospitalKortrijkBelgium department of General surgery CHA Bundang Medical CenterCHA University School of MedicineSeongnamKorea department of hepatopancreatobiliary and Liver Transplant surgery University Ho

Background:The application and feasibility of minimally invasive liver resection(MILR)for huge liver tumours(≥10 cm)has not been well ***:Retrospective analysis of data on 6,617 patients who had MILR for liver tumours were gathered from 21 international centers between *** tumors and large tumors were defined as tumors with a size≥10.0 cm and 3.0-9.9 cm based on histology,respectively.1:1 coarsened exact-matching(CEM)and 1:2 Mahalanobis distance-matching(MDM)was performed according to clinically-selected *** discontinuity analyses were performed as an additional line of sensitivity analysis to estimate local treatment effects at the 10-cm tumor size ***:Of 2,890 patients with tumours≥3 cm,there were 205 huge *** 1:1 CEM,174 huge tumors were matched to 174 large tumors;and after 1:2 MDM,190 huge tumours were matched to 380 large *** was significantly and consistently increased intraoperative blood loss,frequency in the application of Pringle maneuver,major morbidity and postoperative stay in the huge tumour group compared to the large tumour group after both 1:1 CEM and 1:2 *** findings were reinforced in RD *** blood transfusion rate and open conversion rate were significantly higher in the huge tumor group after only 1:2 MDM but not 1:1 ***:MILR for huge tumours can be safely performed in expert centers It is an operation with substantial complexity and high technical requirement,with worse perioperative outcomes compared to MILR for large tumors,therefore judicious patient selection is pivotal.

关键词： Minimally invasive liver resection(MILR) robotic-assisted liver resection huge tumours hepatocellular carcinoma laparoscopic liver resection

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Quality over quantity:a necessary path for clinical research transformation in China

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Hepatobiliary surgery and Nutrition 2020年第5期9卷 684-686页

作者： Da Xu Bao-Cai Xing Key Laboratory of Carcinogenesis and Translational Research(Ministry of Education/Beijing) Hepatopancreatobiliary Surgery Department IPeking University Cancer Hospital&InstituteBeijingChina

Since the Chinese economic reform in 1978,its medical field has made remarkable progress in the past 40 *** most medical fields,China’s diagnosis and treatment methods are comparable to the international high *** recent years,with the continuous expansion of the medical research team and the improvement of laboratory research equipment and methods,China has achieved some influential and internationally recognized research ***,overall,China still lags behind developed countries in terms of high-level original medical research,especially in high evidence-based medical research(1).

关键词： transformation Quality diagnosis

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Surgical decision-making: can patients benefit?

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Hepatobiliary surgery and Nutrition 2021年第4期10卷 512-514页

作者： Ming Liu Baocai Xing Key Laboratory of Carcinogenesis and Translational Research(Ministry of Education/Beijing) Hepatopancreatobiliary Surgery Department IPeking University Cancer Hospital&InstituteBeijingChina

What is surgery?It is difficult for us to have time to think about this broad question in our busy,day-to-day *** some“super hospitals”,patient admission and surgical operation have even become an“assembly-line”*** a patient successfully recovers from an operation without any postoperative complications,we may be silently proud of our surgical skills.

关键词： operation surgery Surgical

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More precise measurement of irregular splenic volume in cirrhotic patients with portal hypertension

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iLIVER 2023年第2期2卷 109-115页

作者： Xiao Chen Tao Yang Dong Wang Bo Huang Yanlong Cao Jianguo Lu Lei Cai Jikai Yin department of General surgery Tangdu Hospital of the Fourth Military Medical UniversityXi'an 710038China Institute of hepatopancreatobiliary surgery Chongqing General HospitalUniversity of Chinese Academy of SciencesChongqing 404100China

Background and aims:Splenomegaly often occurs in cirrhotic patients with portal hypertension(PHT),and therefore,the efficacy and accuracy of conventional methods for measuring splenic volume are a matter of question in these ***,we developed a novel approach to assess true splenic volume more ***:High-quality thin-slice computed tomography data of 112 cirrhotic patients with PHT were obtained and *** the conventional measurement and a novel formula obtained from 3-dimensional reconstruction software were used to estimate splenic volume,and the accuracy was compared and ***:In PHT patients,the splenic volume calculated using the conventional method was significantly less than that calculated using the 3-dimensional *** found that the splenic volume was significantly positively correlated with splenic indices of length(L),thickness(T),and width(W)and also the diameter of the splenic *** these indices,we propose 2 novel formulas using the software to estimate the splenic volume more accurately:SV=69.686 L+53.077 W+103.525 T+314.510 diameter of splenic vein 2266.209(p<0.01,R^(2)=0.805).And a more practical simplified formula:SV'=0.504× L× W×T+319.762 diameter of splenic vein 81.66(p<0.01,R^(2)=0.784).Conclusion:Although the conventional formula has been widely used for years,it is not suitable for an enlarged *** developed 2 novel formulas for estimating splenic volume from clinical data that were more appropriate for cirrhotic patients with PHT.

关键词： Liver cirrhosis Portal hypertension Splenic volume

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Influence of the adjuvant therapy on the survival of patients with stage Ⅱ pancreatic carcinoma

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Frontiers of Medicine 2010年第4期4卷 430-435页

作者： Xi-Yan WANG Hai-Jun LI Hao WEN Dong YAN Shu-Yong PENG department of hepatopancreatobiliary surgery Affiliated Tumor HospitalXinjiang Medical UniversityUrumqi 830011China department of Hepatobiliary surgery The First Affiliated HospitalXinjiang Medical UniversityUrumqi 830054China department of General surgery Sir Run Run Shaw HospitalCollege of MedicineZhejiang UniversityHangzhou 310016China

This study aimed to investigate the effect of adjuvant therapy on the treatment of stage II pancreatic *** clinical data of 139 cases of stage II pancreatic carcinoma were analyzed *** overall 1-,3-,and 5-year cumulative survival rates of 139 patients were 40%,6%,and 3%,respectively,and the median survival time(MST)was 279 *** MST was 399 days for those with adjuvant therapy,210 days for those without adjuvant therapy,390 days for the radical resection group,270 days for the bypass operation and laparotomy group,and 132 days for the nonsurgical *** adjuvant therapy could not prolong the survival time and decrease the liver metastasis rate of the patients with stage II carcinoma signiﬁcantly in radical resection group(P>0.05).In the bypass operation and laparotomy group and nonsurgical group,the adjuvant therapy could improve the survival of the patients signiﬁcantly(P0.05);or between gemcitabine(GEM)regimen and 5-ﬂuorouracil regimen(P>0.05);or between GEM monotherapy and GEM combined with platinum/capeci-tabine(P>0.05).The proper adjuvant therapy can be suggested according to the general condition of the patients after radical resection for stage II pancreatic *** combined with radiation should be applied actively for the patients whose cancerous tissues were not radically *** clinical efﬁcacy of GEM combined with platinum/capecitabine is relatively better than GEM.

关键词： pancreatic neoplasms neoadjuvant therapy survival

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Superiority of Laparoscopy in the Peritoneal Dialysis Catheter Reset surgery

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Journal of Huazhong University of Science and Technology(Medical Sciences) 2015年第1期35卷 71-75页

作者：陈文莉丁国华郑直刘昌璇 department of Nephrology Renmin Hospital of Wuhan University department of hepatopancreatobiliary surgery Wuhan Central Hospital Tongji Medical College Huazhong University of Science and Technology department of Nephrology Wuhan Central Hospital Tongji Medical College Huazhong University of Science and Technology

Peritoneal dialysis catheter surgery has been used in clinical treatment for nearly 40 years, and open surgery under local anesthesia is the conventional method. However, catheter displacement after open surgery is still the thorny issue during our clinical practice. Then the reset surgery is often required to be taken again. Nowadays, laparoscopic peritoneal dialysis catheter draws our attention due to its advantages of accurate positioning, smaller incision, and less pain, and its clinical application has been limited. While laparoscopic surgery is recognized, there are few relevant studies on whether there is difference during the catheter reset process between the two surgical approaches. In this study, we mainly discussed the rate of secondary catheter migration, the incidence of complications after catheter reset for two surgical approaches and the hospital stay as well as the total clinical cost for the two surgical approaches. In this study, we retrospectively analyzed 25 cases of end-stage renal disease, who received catheterization for peritoneal dialysis and regular peritoneal dialysis in our hospital from March 2010 to December 2013, and had a medical history of catheter migration. We collected the relevant clinical data for all patients. Fifteen patients selected laparoscopic catheter reset, and 10 patients selected the traditional surgical method for catheter reset by themselves. For all patients enrolled, we analyzed the incidence of secondary catheter migration and postoperative complications, hospitalization time, and total cost for different methods of reset. Through the studies above, we found that laparoscopic peritoneal dialysis catheter surgery offered accurate catheter location and a small incision that was easy to heal. Besides, the incidence of postoperative complications for the laparoscopic surgery was lower than that for traditional surgical approach for catheter reset. The average hospitalization time for laparoscopic surgery was shorter

关键词： laparoscope peritoneal dialysis catheter catheter migration

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Effect of IRAK1 on Apoptosis and Necroptosis of Hepatoma Cell Line SK-Hep1

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Chinese Medicine 2019年第1期10卷 19-29页

作者： Zhijia Pan Xiaolei Zhang Changshi Qian Xiaochen Liu Xinglin Jin department of hepatopancreatobiliary surgery Affiliated Hospital of Yanbian University Yanji China

Interleukin I receptor associated kinase 1 (IRAK1) is a downstream signal molecule of activated MyD88 recruitment, which can activate Fas associated death domain protein (FADD) to induce apoptosis. IRAK1 can also activate tumor necrosis factor-related factor 6 (TRAF6) and induce the expression of a series of downstream specific genes. IRAK1 is an essential factor in the induction of mitochondrial division and necroptosis. In the current study, RNAi technique was used to silence IRAK1, and the apoptosis and necroptosis rate of SK-Hep1 cells were detected by flow cytometry. The apoptosis and the necroptosis pathway of hepatoma SK-Hep1 cells were blocked separately, and the expressions of FADD, RIP1 and TRAF6 genes were silenced separately. The results showed when the expression of IRAK1 was down-regulated, the apoptosis and necroptosis rate of SK-Hep1 cells were significantly increased. With silenced FADD, RIP1 and TRAF6, respectively, the expression of IRAK1 protein had no significant change. However, the expression of IRAK1 mRNA decreased significantly (p < 0.01) after the silencing of RIP1 and TRAF6 genes, while the IRAK1 mRNA did not change significantly after the silencing of FADD genes;when z-VAD-FMK was interfered, the expression of IRAK1 mRNA decreased significantly after the silencing of TRAF6 genes, while the IRAK1 mRNA did not change significantly after the silencing of FADD and RIP1genes. The study shows that RAK1 gene inhibits apoptosis and necroptosis in SK-Hep1 cells. TRAF6 gene affected the role of IRAK1 in apoptosis and necroptosis, RIP1 gene affected the role of IRAK1 in apoptosis, while FADD gene did not affect the role of IRAK1 in apoptosis and necroptosis.

关键词： IRAK1 Apoptosis Necroptosis FADD RIP1 TRAF6

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TRAF6 Affects RAC1 Expression and Apoptosis in SK-Hep1 Cells

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Chinese Medicine 2018年第4期9卷 179-189页

作者： Shanlei Zhang Changshi Qian Xiaochen Liu Shengjun Piao Xinglin Jin department of hepatopancreatobiliary surgery Affiliated Hospital of Yanbian University Yanji China

RAC1 is a small-molecule G protein that regulates multiple cell cycle, cytoskeletal reorganization, cell migration, and apoptosis. FADD-dependent TRAIL can promote tumor metastasis through RAC1 and PI3K, and down-regulating RAC1 expression can reduce FasL-induced apoptosis. In addition, RIP1 bound to GTP acts as an activating protein for RAC1 and is involved in cytoskeletal reorganization. TRAF6 promotes migration and metastasis by regulating the RAS pathway in tumors. Thus, it is necessary to understand the interaction between RAC1 and TRAF6 as well as FADD and RIP1. In this study, we cultured hepatoma SK-Hep1 cells in vitro, specifically blocked the necroptosis pathway with Nec-1, and silenced FADD, RIP1 and TRAF6 gene expression using RNAi technology. At the same time, the expression of RAC1 was evaluated separately using RT-PCR and Western blot. The hepatoma SK-Hep1 cells survival rate was highest when the concentration of Nec-1 was 60 μM and the concentration of Z-vad-fmk was 20 μM. And the apoptosis rate of the transfected RAC1 siRNA cells was 3.59% compared with transfected siRNA cells 10.01% which was significantly decreased (P < 0.01). RAC1 could promote the occurrence of apoptosis in SK-Hep1 cells. RAC1 expression was suppressed in both protein and gene level in SK-Hep1 cells when the TRAF6 gene was silenced, but there was no significant change in RAC1 gene and protein expression when FADD and RIP1 genes were silenced. TRAF6 affects RAC1 expression and apoptosis in SK-Hep1 cells, while the FADD and RIP1 genes do not affect the role of RAC1. The TRAF6 gene is an important target in liver cancer cells.

关键词： Apoptosis RAC1 TRAF6 FADD RIP1 SK-Hep1 Cells

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Biliary tract intraductal papillary mucinous neoplasm: Report of 19 cases

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World Journal of Gastroenterology 2015年第14期21卷 4261-4267页

作者： Xing Wang Yun-Qiang Cai Yong-Hua Chen Xu-Bao Liu department of hepatopancreatobiliary surgery West China HospitalSichuan University

AIM: To gain a better understanding of biliary tract intraductal papillary mucinous neoplasm(BT-IPMN).METHODS: From January 2000 to December 2013, 19cases of BT-IPMN were retrospectively identified from a total of 343 biliary tract tumors resected in our single *** characteristics, clinical data, pathology, surgical strategies, and long-term follow-up were ***: The mean age of the 19 BT-IPMN cases was 53.8 years(range: 25-74 years).The most common symptom was abdominal pain(15/19; 78.9%), followed by jaundice(7/19; 36.8%).Cholangitis was associated with most(16/19; 84.2%) of the BT-IPMN *** visible mucin was detected in all 19 patients, based on original surgical *** most common abnormal preoperative imaging findings for BT-IPMN were bile duct dilation(19/19; 100%) and intraluminal masses(10/19; 52.6%).Thirteen(68.4%) cases involved the intrahepatic bile duct and *** performed left hepatectomy in 11/19(57.9%), right hepatectomy in 2/19(10.5%), bile duct resection in 4/19(21.1%), and pancreatoduodenectomy in 1/19(5.3%) ***(5.3%) patient was biopsied and received a choledochojejunostomy because of multiple tumors involving the right extrahepatic and left intrahepatic bile *** showed malignancy in 10/19(52.6%) *** overall median survival was 68 *** benign cases showed a non-significant trend towards improved survival compared to malignant cases(68 mo vs 48 mo, P = 0.347).The patient without tumor resection died of liver failure 22 mo after palliative ***: BT-IPMN is a rare biliary *** resection of the tumor is associated with good survival, even in patients with malignant disease.

关键词： Biliary tract Cystic tumor Intraductal papillary m

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Systematic review of the outcomes of surgical resection for intermediate and advanced Barcelona Clinic Liver Cancer stage hepatocellular carcinoma:A critical appraisal of the evidence

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World Journal of Hepatology 2018年第6期10卷 433-447页

作者： Ye Xin Koh Hwee Leong Tan Weng Kit Lye Juinn Huar Kam Adrian Kah Heng Chiow Siong San Tan Su Pin Choo Alexander Yaw Fui Chung Brian Kim Poh Goh department of hepatopancreatobiliary and Transplant surgery Singapore General HospitalSingapore 169608Singapore Center for Quantitative Medicine Duke-NUS Graduate Medical SchoolSingapore 169857Singapore department of General surgery Hepatopancreatobiliary ServiceChangi General HospitalSingapore 529889Singapore department of Medical Oncology National Cancer Centre SingaporeSingapore 169610Singapore Duke-NUS Graduate Medical School Singapore 169857Singapore

AIM To perform a systematic review to determine the survival outcomes after curative resection of intermediate and advanced hepatocellular carcinomas(HCC).METHODS A systematic review of the published literature was performed using the PubM ed database from 1 st January 1999 to 31 st Dec 2014 to identify studies that reported outcomes of liver resection as the primary curative treatment for Barcelona Clinic Liver Cancer(BCLC) stage B or C HCC. The primary end point was to determine the overall survival(OS) and disease free survival(DFS) of liver resection of HCC in BCLC stage B or C in patients with adequate liver reserve(i.e., Child's A or B status). The secondary end points were to assess the morbidity and mortality of liver resection in large HCC(defined as lesions larger than 10 cm in diameter) and to compare the OS and DFS after surgical resection of solitary vs multifocal *** We identified 74 articles which met the inclusion criteria and were analyzed in this systematic review. Analysis of the resection outcomes of the included studies were grouped according to(1) BCLC stage B or C HCC,(2) Size of HCC and(3) multifocal tumors. The median 5-year OS of BCLC stage B was 38.7%(range 10.0-57.0); while the median 5-year OS of BCLC stage C was 20.0%(range 0.0-42.0). The collective median 5-year OS of both stages was 27.9%(0.0-57.0). In examining the morbidity and mortality following liver resection in large HCC, the pooled RR for morbidity [RR(95%CI) = 1.00(0.76-1.31)] and mortality [RR(95%CI) = 1.15(0.73-1.80)] were not significant. Within the spectrum of BCLC B and C lesions, tumors greater than 10 cm were reported to have median 5-year OS of 33.0% and multifocal lesions 54.0%.CONCLUSION Indication for surgical resection should be extended to BCLC stage B lesions in selected patients. Further studies are needed to stratify stage C lesions for resection.

关键词： Barcelona Clinic Liver Cancer Hepatocellular carcinoma Hepatectomy Milan criteria

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