This paper reports twelve patients underwent repeat hepatic resection because of the recurrence of hepatocellular carcinomas after primary resection. The indication of reoperation, selection of incision, difficults encountered in the operation and the treatment after operation are discussed. The authors believe that the second operation is technically more difficult than the first one, some troubles my be happened during the operation and put forward some ways to deal with this situations.
【Abstract】Objective To investigate the MR imaging （MRI） appearances of postoperative residual liver after hepatic resection for hepatocellular carcinoma (HCC) and the MRI features of tumor recurrences.Methods Twenty patients with previous surgical resection of HCC underwent MR examination of upper abdomen for routine follow-up study or due to clinical suspicion of tumor recurrence. MRI protocol included T1W axial unenhanced images and Gadoliniumenhanced sequences, Gadolinium-enhanced VIBE sequence, unenhanced T2W axial images and coronal TrueFisp sequence.Results Thirteen patients showed normal edge of surgical resection, while 6 patients demonstrated MR signs of incision edge recurrence of HCC and 1 patient was suspicious of tumor recurrence at the incision edge. Among the 20 patients, 12 had MRI features of tumor recurrence of the residual liver, including invasion of left, right and common hepatic ducts 3 cases. Three patients had metastatic lymphadenopathy in portal hepatis, portacaval space and retroperitoneal space. Two patients showed extensive tumor implantation of peritoneum and mesentery. Conclusion MRI is effective in differentiating normal surgical incision edge of residual liver from tumor recurrence. It is also very useful for the early detection of intrahepatic and extrahepatic tumor lesions.
ObjectiveTo evaluate the methodological quality and impacts on outcomes for systematic reviews (SRs) of radiofrequency ablation (RFA) versus hepatic resection (HR) for early hepatocellular carcinoma (HCC). MethodsWe comprehensively searched six databases and five official websites for health technology assessment (HTA), to collect HTAs, SRs, or meta-analyses from inception to Nov. 11th, 2012. The Overview Quality Assessment Questionnaire (OQAQ) was applied for quality assessment of included studies, the tools recommended by the Cochrane Collaboration was applied for quality assessment for randomized controlled trials (RCTs), and the modified MINORS score was applied to assess non-randomized controlled trials (NRCTs). The odds ratios (ORs) and 95% confidence intervals (CIs) were integrated using Stata 10.0 software. ResultsOne HTA, 3 SRs and 15 meta-analyses were included in total. The mean OQAQ score was 3.3 with 95%CI 2.6 to 4.1. Only five (26.3%) SRs were assessed as good quality. Seven studies misused statistical models, and 3 of them changed outcome direction after modification. Five studies (5/19) included retrospective controlled studies as RCTs. A total of 39 primary studies referenced by SRs were included, of which, 3 RCTs were levelled grade B, 35 NRCTs were of moderate quality, with an estimated mean MINORS score of 15.0 (totally, scored 18) with 95%CI 14.6 to 15.4, and only 13 studies (37.1%) scored more than 16. Seventeen primary studies (43.6%) did not meet inclusion criteria of the SRs, of which, 9 (23.1%) studies were mixed with other effective interventions in both groups (TACE, PEI, etc.). Four studies included patients with non-primary HCC. ConclusionCurrently, the overall quality of HTAs, SRs and meta-analyses about comparing the effects between RFA and HR for early HCC is fairly poor (high heterogeneity exists, and the evidence level is low. Physicians should apply the evidence with caution in clinical practice.