AIM:To compare the long-term outcome of percutaneous vs surgical radiofrequency ablation(RFA) for hepatocellular carcinoma(HCC) in dangerous locations.METHODS:One hundred and sixty-two patients with HCC in dangerous l...AIM:To compare the long-term outcome of percutaneous vs surgical radiofrequency ablation(RFA) for hepatocellular carcinoma(HCC) in dangerous locations.METHODS:One hundred and sixty-two patients with HCC in dangerous locations treated with percutaneous or surgical RFA were enrolled in this study.The patients were divided into percutaneous RFA group and surgical RFA group.After the patients were regularly followed up for a long time,their curative rate,hospital stay time,postoperative complications and 5-year local tumor progression were compared and analyzed.RESULTS:No significant difference was observed in curative rate between the two groups(91.3% vs 96.8%,P = 0.841).The hospital stay time was longer and more analgesics were required while the incidence of bile duct injury and RFA-related hemorrhage was lower in surgical RFA group than in percutaneous RFA group(P < 0.05).The local progression rate of HCC in dangerous locations was significantly lower in surgical RFA group than in percutaneous RFA group(P = 0.05).The relative risk of local tumor progression was 14.315 in percutaneous RFA group.CONCLUSION:The incidence of severe postoperative complications and local tumor progression is lower after surgical RFA than after percutaneous RFA.展开更多
BACKGROUND:An updated definition of early allograft dysfunction(EAD) was recently validated in a multicenter study of 300 deceased donor liver transplant recipients.This analysis did not differentiate between donation...BACKGROUND:An updated definition of early allograft dysfunction(EAD) was recently validated in a multicenter study of 300 deceased donor liver transplant recipients.This analysis did not differentiate between donation after brain death(DBD) and donation after cardiac death(DCD) allograft recipients.METHODS:We reviewed our prospectively entered database for all DBD(n=377) and DCD(n=38) liver transplantations between January 1,2006 and October 30,2011.The incidence of EAD as well as its ability to predict graft failure and survival was compared between DBD and DCD groups.RESULTS:EAD was a valid predictor of both graft and patient survival at six months in DBD allograft recipients,but in DCD allograft recipients there was no significant difference in the rate of graft failure in those with EAD(11.5%) compared with those without EAD(16.7%)(P=0.664) or in the rate of death in recipients with EAD(3.8%) compared with those without EAD(8.3%)(P=0.565).The graft failure rate in the first 6 months in those with international normalized ratio ≥1.6 on day 7 who received a DCD allograft was 37.5% compared with 6.7% for those with international normalized ratio <1.6 on day 7(P=0.022).CONCLUSIONS:The recently validated definition of EAD is a valid predictor of patient and graft survival in recipients of DBD allografts.On initial assessment,it does not appear to be a useful predictor of patient and graft survival in recipients of DCD allografts,however a study with a larger sample size of DCD allografts is needed to confirm these findings.The high ALT/AST levels in most recipients of DCD livers as well as the predisposition to biliary complications and early cholestasis make these parameters as poor predictors of graft failure.An alternative definition of EAD that gives greater weight to the INR on day 7 may be more relevant in this population.展开更多
AIM： To compare the clinical outcome and pathologic features of non-alcoholic steatohepatitis （NASH） patients with hepatocellular carcinoma （HCC） and hepatitic C virus （HCV） patients with HCC （another group in...AIM： To compare the clinical outcome and pathologic features of non-alcoholic steatohepatitis （NASH） patients with hepatocellular carcinoma （HCC） and hepatitic C virus （HCV） patients with HCC （another group in which HCC is commonly seen） undergoing liver transplantation. METHODS： Patients transplanted for HCV and NASH at our institution from January 2000 to April 2011 were analyzed. All explanted liver histology and pre-trans- plant liver biopsies were examined by two specialist liver histopathologists. Patient demographics, disease free survival, explant liver characteristics and HCC features （tumour number, cumulative tumour size, vascular invasion and differentiation） were compared between HCV and NASH liver transplant recipients. RESULTS： A total of 102 patients with NA^SH and 283 patients with HCV were transplanted. The incidence of HCC in NASH transplant recipients was 16.7% （17/102）. The incidence of HCC in HCV transplant recipients was 22.6% （64/283）. Patients with NASH-HCC were statisti- cally older than HCV-HCC patients （P 〈 0.001）. A signif- icantly higher proportion of HCV-HCC patients had vas- cular invasion （23.4% vs 6.4%, P = 0.002） and poorly differentiated HCC （4.7% vs 0%, P 〈 0.001） compared to the NASH-HCC group. A trend of poorer recurrence free survival at 5 years was seen in HCV-HCC patients compared to NASH-HCC who underwent a Liver trans- plantation （P = 0.11）. CONCLUSION： Patients transplanted for NASH-HCC appear to have less aggressive turnout features com- pared to those with HCV-HCC, which likely in part ac- counts for their improved recurrence free survival.展开更多
Background:Preoperative patient selection in Associating Liver Partition and Portal vein ligation for Staged hepatectomy(ALPPS)is not always reliable with currently available scores,particularly in patients with prima...Background:Preoperative patient selection in Associating Liver Partition and Portal vein ligation for Staged hepatectomy(ALPPS)is not always reliable with currently available scores,particularly in patients with primary liver tumor.This study aims to(I)to determine whether comorbidities and patients characteristics are a risk factor in ALPPS and(II)to create a score predicting 90-day mortality preoperatively.Methods:Thirteen high-volume centers participated in this retrospective multicentric study.A risk analysis based on patient characteristics,underlying disease and procedure type was performed to identify risk factors and model the Comprehensive ALPPS Preoperative Risk Assessment(CAPRA)score.A nonparametric receiver operating characteristic analysis was performed to estimate the predictive ability of our score against the Charlson Comorbidity Index(CCI),the age-adjusted CCI(aCCI),the ALPPS risk score before Stage 1(ALPPS-RS1)and Stage 2(ALPPS-RS2).The model was internally validated applying bootstrapping.Results:A total of 451 patients were included.Mortality was 14.4%.The CAPRA score is calculated based on the following formula:(0.1×age)−(2×BSA)+1(in the presence of primary liver tumor)+1(in the presence of severe cardiovascular disease)+2(in the presence of moderate or severe diabetes)+2(in the presence of renal disease)+2(if classic ALPPS is planned).The predictive ability was 0.837 for the CAPRA score,0.443 for CCI,0.519 for aCCI,0.693 for ALPPS-RS1 and 0.807 for ALPPS-RS2.After 1,000 cycles of bootstrapping the C statistic was 0.793.The accuracy plot revealed a cut-off for optimal prediction of postoperative mortality of 4.70.Conclusions:Comorbidities play an important role in ALPPS and should be carefully considered when planning the procedure.By assessing the patient’s preoperative condition in relation to ALPPS,the CAPRA score has a very good ability to predict postoperative mortality.展开更多
Associated liver partition and portal vein ligation for staged hepatectomy(ALPPS)is an established resection strategy well into its teenage years.After initial controversy,it has proven to be an effective and safe app...Associated liver partition and portal vein ligation for staged hepatectomy(ALPPS)is an established resection strategy well into its teenage years.After initial controversy,it has proven to be an effective and safe approach for primary unresectable liver remnant anatomy in high volume centers(1-5).ALPPS involves portal vein ligation and parenchymal split to obtain rapid,enhanced hypertrophy of the future liver remnant and resection during second stage of the operation(6).This allows for resection with liver remnants as small as 20%of original volume(7,8).It is the most rapid tool in achieving hypertrophy compared to other modalities(9-11).Nevertheless,ALPPS remains a contentious topic in the HPB literature(12-15).We believe that ALPPS is an excellent option for highly selected patients with expanded indications,especially when conducted by experienced surgical teams(5,16).展开更多
Adenocarcinoma of the colon and rectum(CRC)is the second leading cause of cancer-related mortality.Surgical resection of disease offers the best long-term survival.Unfortunately,>50%of patients have liver metastase...Adenocarcinoma of the colon and rectum(CRC)is the second leading cause of cancer-related mortality.Surgical resection of disease offers the best long-term survival.Unfortunately,>50%of patients have liver metastases at the time of diagnosis,or develop colorectal cancer liver metastases(CRLM)subsequent to treatment of primary disease.Metastasectomy of CRLM has proven to extend survival.展开更多
Colorectal cancer(CRC)is the second leading cause of cancer related mortality,though improvements in CRC screening,systemic and local treatment,and surgical technique have steadily won victories in the battle against ...Colorectal cancer(CRC)is the second leading cause of cancer related mortality,though improvements in CRC screening,systemic and local treatment,and surgical technique have steadily won victories in the battle against CRC,and the rate of mortality from CRC is steadily declining(1).However,perhaps no clinical-oncologic scenario is as unstandardized as the management of colorectal-liver metastases(CRLM)and their evaluation for consideration of resectability.展开更多
文摘AIM:To compare the long-term outcome of percutaneous vs surgical radiofrequency ablation(RFA) for hepatocellular carcinoma(HCC) in dangerous locations.METHODS:One hundred and sixty-two patients with HCC in dangerous locations treated with percutaneous or surgical RFA were enrolled in this study.The patients were divided into percutaneous RFA group and surgical RFA group.After the patients were regularly followed up for a long time,their curative rate,hospital stay time,postoperative complications and 5-year local tumor progression were compared and analyzed.RESULTS:No significant difference was observed in curative rate between the two groups(91.3% vs 96.8%,P = 0.841).The hospital stay time was longer and more analgesics were required while the incidence of bile duct injury and RFA-related hemorrhage was lower in surgical RFA group than in percutaneous RFA group(P < 0.05).The local progression rate of HCC in dangerous locations was significantly lower in surgical RFA group than in percutaneous RFA group(P = 0.05).The relative risk of local tumor progression was 14.315 in percutaneous RFA group.CONCLUSION:The incidence of severe postoperative complications and local tumor progression is lower after surgical RFA than after percutaneous RFA.
文摘BACKGROUND:An updated definition of early allograft dysfunction(EAD) was recently validated in a multicenter study of 300 deceased donor liver transplant recipients.This analysis did not differentiate between donation after brain death(DBD) and donation after cardiac death(DCD) allograft recipients.METHODS:We reviewed our prospectively entered database for all DBD(n=377) and DCD(n=38) liver transplantations between January 1,2006 and October 30,2011.The incidence of EAD as well as its ability to predict graft failure and survival was compared between DBD and DCD groups.RESULTS:EAD was a valid predictor of both graft and patient survival at six months in DBD allograft recipients,but in DCD allograft recipients there was no significant difference in the rate of graft failure in those with EAD(11.5%) compared with those without EAD(16.7%)(P=0.664) or in the rate of death in recipients with EAD(3.8%) compared with those without EAD(8.3%)(P=0.565).The graft failure rate in the first 6 months in those with international normalized ratio ≥1.6 on day 7 who received a DCD allograft was 37.5% compared with 6.7% for those with international normalized ratio <1.6 on day 7(P=0.022).CONCLUSIONS:The recently validated definition of EAD is a valid predictor of patient and graft survival in recipients of DBD allografts.On initial assessment,it does not appear to be a useful predictor of patient and graft survival in recipients of DCD allografts,however a study with a larger sample size of DCD allografts is needed to confirm these findings.The high ALT/AST levels in most recipients of DCD livers as well as the predisposition to biliary complications and early cholestasis make these parameters as poor predictors of graft failure.An alternative definition of EAD that gives greater weight to the INR on day 7 may be more relevant in this population.
文摘AIM： To compare the clinical outcome and pathologic features of non-alcoholic steatohepatitis （NASH） patients with hepatocellular carcinoma （HCC） and hepatitic C virus （HCV） patients with HCC （another group in which HCC is commonly seen） undergoing liver transplantation. METHODS： Patients transplanted for HCV and NASH at our institution from January 2000 to April 2011 were analyzed. All explanted liver histology and pre-trans- plant liver biopsies were examined by two specialist liver histopathologists. Patient demographics, disease free survival, explant liver characteristics and HCC features （tumour number, cumulative tumour size, vascular invasion and differentiation） were compared between HCV and NASH liver transplant recipients. RESULTS： A total of 102 patients with NA^SH and 283 patients with HCV were transplanted. The incidence of HCC in NASH transplant recipients was 16.7% （17/102）. The incidence of HCC in HCV transplant recipients was 22.6% （64/283）. Patients with NASH-HCC were statisti- cally older than HCV-HCC patients （P 〈 0.001）. A signif- icantly higher proportion of HCV-HCC patients had vas- cular invasion （23.4% vs 6.4%, P = 0.002） and poorly differentiated HCC （4.7% vs 0%, P 〈 0.001） compared to the NASH-HCC group. A trend of poorer recurrence free survival at 5 years was seen in HCV-HCC patients compared to NASH-HCC who underwent a Liver trans- plantation （P = 0.11）. CONCLUSION： Patients transplanted for NASH-HCC appear to have less aggressive turnout features com- pared to those with HCV-HCC, which likely in part ac- counts for their improved recurrence free survival.
基金The study was approved by Independent Ethics Committee(IEC)of Tübingen University Hospital(No.030/2019A)and informed。
文摘Background:Preoperative patient selection in Associating Liver Partition and Portal vein ligation for Staged hepatectomy(ALPPS)is not always reliable with currently available scores,particularly in patients with primary liver tumor.This study aims to(I)to determine whether comorbidities and patients characteristics are a risk factor in ALPPS and(II)to create a score predicting 90-day mortality preoperatively.Methods:Thirteen high-volume centers participated in this retrospective multicentric study.A risk analysis based on patient characteristics,underlying disease and procedure type was performed to identify risk factors and model the Comprehensive ALPPS Preoperative Risk Assessment(CAPRA)score.A nonparametric receiver operating characteristic analysis was performed to estimate the predictive ability of our score against the Charlson Comorbidity Index(CCI),the age-adjusted CCI(aCCI),the ALPPS risk score before Stage 1(ALPPS-RS1)and Stage 2(ALPPS-RS2).The model was internally validated applying bootstrapping.Results:A total of 451 patients were included.Mortality was 14.4%.The CAPRA score is calculated based on the following formula:(0.1×age)−(2×BSA)+1(in the presence of primary liver tumor)+1(in the presence of severe cardiovascular disease)+2(in the presence of moderate or severe diabetes)+2(in the presence of renal disease)+2(if classic ALPPS is planned).The predictive ability was 0.837 for the CAPRA score,0.443 for CCI,0.519 for aCCI,0.693 for ALPPS-RS1 and 0.807 for ALPPS-RS2.After 1,000 cycles of bootstrapping the C statistic was 0.793.The accuracy plot revealed a cut-off for optimal prediction of postoperative mortality of 4.70.Conclusions:Comorbidities play an important role in ALPPS and should be carefully considered when planning the procedure.By assessing the patient’s preoperative condition in relation to ALPPS,the CAPRA score has a very good ability to predict postoperative mortality.
文摘Associated liver partition and portal vein ligation for staged hepatectomy(ALPPS)is an established resection strategy well into its teenage years.After initial controversy,it has proven to be an effective and safe approach for primary unresectable liver remnant anatomy in high volume centers(1-5).ALPPS involves portal vein ligation and parenchymal split to obtain rapid,enhanced hypertrophy of the future liver remnant and resection during second stage of the operation(6).This allows for resection with liver remnants as small as 20%of original volume(7,8).It is the most rapid tool in achieving hypertrophy compared to other modalities(9-11).Nevertheless,ALPPS remains a contentious topic in the HPB literature(12-15).We believe that ALPPS is an excellent option for highly selected patients with expanded indications,especially when conducted by experienced surgical teams(5,16).
文摘Adenocarcinoma of the colon and rectum(CRC)is the second leading cause of cancer-related mortality.Surgical resection of disease offers the best long-term survival.Unfortunately,>50%of patients have liver metastases at the time of diagnosis,or develop colorectal cancer liver metastases(CRLM)subsequent to treatment of primary disease.Metastasectomy of CRLM has proven to extend survival.
文摘Colorectal cancer(CRC)is the second leading cause of cancer related mortality,though improvements in CRC screening,systemic and local treatment,and surgical technique have steadily won victories in the battle against CRC,and the rate of mortality from CRC is steadily declining(1).However,perhaps no clinical-oncologic scenario is as unstandardized as the management of colorectal-liver metastases(CRLM)and their evaluation for consideration of resectability.
