ObjectiveTo understand the progress and problems of liver transplantation standard for hepatocellular carcinoma. MethodsThe related articles regarding transplant criteria of hepatocellular carcinoma were reviewed and analyzed. ResultsSince Milan criteria were proposed by Mazzaferro in 1996, a number of criteria were porposed by many transplant centers. These criteria expanded Milan criteria. Compared with Milan criteria, these criteria expanded tumor size and (or) tumor number, or combined with some biological variables, or combined with some immunological variables. However, there are still some issues should be clarified. ConclusionDespite there are many transplant criteria of hepatocellular carcinoma, but a number of issues should be further investigated.
ObjectiveTo analyse the outcomes of patients with Child-Pugh A class cirrhosis and a single hepatocellular carcinoma (HCC) up to 5 cm in diameter who underwent liver transplantation versus resection. MethodsDuring 2007 to 2011, 263 Child-Pugh A class cirrhotic patients with a single HCC up to 5 cm in diameter either underwent liver resection (n=227) or received liver transplantation (n=36) in our centre. Patients and tumour characteristics and outcomes were analysed. ResultsThe 1-, 3-, and 5-year recurrence-free survival rates of patients who received liver transplantation and liver resection were 91.7%, 85.3%, 81.0% and 80.6%, 59.8%, 50.8%, respectively (P=0.003). The 1-, 3-, and 5-year overall survival rates of patients who underwent liver transplantation were 100%, 87.5%, and 83.1% versus 96.9%, 83.8%, and 76.1% for patients received liver resection (P=0.391). The 1-, 3-, and 5-year recurrence-free survival rates for patients with a diameter of HCC < 3 cm underwent liver transplantation were 92.3%, 92.3%, and 92.3% versus 80.2%, 62.5%, and 50.5% for live resection group (P=0.019). The 1-, 3-, and 5-year overall survival rates for patients with a diameter of HCC < 3 cm underwent liver transplantation and liver resection were 100%, 91.7%, 91.7% and 97.7%, 87.5%, 79.5%, respectively (P=0.470). ConclusionsAlthough more recurrences are observed in Child A class cirrhotic patients with a single HCC up to 5 cm in diameter after liver resection, but overall survival rates for patients with a single HCC up to 5 cm in diameter are similar after liver resection and transplantation.
ObjectiveTo investigate the expression of IQ motif-containing GTPase activating protein 1 (IQGAP1) in hepatocellular carcinoma (HCC) tissues, and to analyze the relationship of IQGAP1 and patient's clinical characteristics and prognosis after liver resection. MethodsData of 79 patients who received liver resection between 2007 and 2009 in our hospital were collected. The expression of IQGAP1 was examined by immunohistochemical tests. The clinical characteristics and prognosis were compared. ResultsIQGAP1 was detected in 43 patients (54.4%). Patients with IQGAP1 expression had more poor differentiation and microvascular invasion. The cumulative recurrence-free rate and overall survival rate in 1-, 3-, and 5-year after operation of patients with IQGAP1 expression (cumulative recurrencefree rate:67.4%, 39.5%, and 23.3%; cumulative overall survival rate:97.7%, 71.5%, and 53.3%) were poor than patients without IQGAP1 expression (cumulative recurrence-free rate:100%, 94.4%, and 83.3%; cumulative overall survival rate:1007%, 97.2%, and 88.9%), P < 0.001. ConclusionsHCC patients with IQGAP1 expression had a poor prognosis after liver resection. IQGAP1 may be a prognostic indicator for hepatocellular carcinoma.
ObjectiveTo investigate the expression of forkhead box A2 (FXOA2) in intrahepatic cholangiocarcinoma (ICC), and to analyze the relationship between expression of FOXA2 and patient's prognosis after liver resection. MethodsData of 85 patients with ICC who underwent liver resection between 2009 and 2013 in our hospital were collected retrospectively. The expression of FOXA2 was examined by immunohistochemical method, and then the relationship between expression of FOXA2 and patient's prognosis/clinical characteristics was expplored. ResultsAmong the 85 patients, low expression of FOXA2 was detected in 50 patients, whereas high expression was observed in 35 patients. More advanced tumor (Ⅲ+Ⅳ staging) was found in patients with low expression of FOXA2 than patients with high expression of FOXA2 (P < 0.050). The median follow-up time was 15-month (3-73 months). During the follow-up period, 65 patients suffered from recurrence, whereas 64 patients died. The multivariate analysis suggested that, postoperative recurrence was associated with low expression of FOXA2, evaluated preoperative CA19-9, and presence of satellite nodes (P < 0.050). Low expression of FOXA2, evaluated preoperative CA19-9, nerves invasion, and presence of satellite nodes were predictive factors for postoperative prognosis (P < 0.050). ConclusionLow expression of FOXA2 was associated with poor prognosis for patients with ICC after liver resection, and FOXA2 may be a prognostic factor for ICC.
ObjectiveTo summarize the definitions, risk factors, and preoperative evaluation methods of posthe-patectomy liver failure. MethodsDomestic and international publications involving posthepatectomy liver failure were retrieved and reviewed. ResultsThere was no uniform definition of posthepatectomy liver failure, however, the most approbatory definitions were "50-50 criteria" and "International Study Group of Liver Surgery (ISGLS) criteria". Risk factors of posthepatectomy liver failure included patient-related factors, liver-related factors, and surgery-related factors, and preoperative evaluation was mainly based on liver function and liver volume. ConclusionPosthepatectomy liver failure is the main cause of postoperative death, sufficient preoperative evaluation and effective measures to decrease intraoperative blood loss and shorten surgery duration are helpful to prevent and (or) reduce posthepatectomy liver failure.
Objective To assess the influence of hepatic artery ligation on survival, hepatocyte apoptosis and regeneration of rats with obstructive jaundice. Methods Eighty adult male Wistar rats were divided into four groups: group A, suffered 70% hepatectomy+hepatic artery ligation+biliary drainage after 3 days of establishing obstructive jaundice model; group B, suffered 70% of hepatectomy+biliary drainage after 3 days of establishing obstructive jaundice model; group C, suffered 70% of hepatectomy+hepatic artery ligation after 3 days of sham operation; group D, suffered 70% of hepatectomy after 3 days of sham operation. Five rats of each group were sacrificed on 1, 2, 3, and 6 days after second operation. Liver function, hepatocyte apoptosis and liver regeneration were detected. Results Postoperative survival rates were not significantly different between group A and group B, similarly between group C and group D (allP＞0.05). There was no significantly different in liver function of group Aversus group B, and group Cversus group D (P＞0.05), but the synthesis of album on 1 d or 3 d after operation were significant difference (group Aversus group B,P＜0.05; group Cversus group D,P＜0.05). Both of the group A, group B and group C had the highest apoptotic index on 1 d after operation, whereas the group D had the lowest hepatic apoptotic index among four group after the surgery. The regeneration indexes were as follow: group D＞group C＞group B＞group A (allP＜0.05). On y 6 d after operation, the regeneration indexes of group A and group B did not increase, while those of group C and group D decreased remarkably. However, the regeneration indexes of four groups were lower than the mean level. Conclusions Hepatic artery ligation will increase hepatocyte apoptosis and weaken liver regeneration. However, for rats with obstructive jaundice, hepatic artery ligation didn't increase the risk of postoperative mortality.
ObjectiveTo investigate the clinical characteristics of primary mass of the hepatoduodenal ligament (HDL) and present some thoughts in the diagnosis and treatment of this disease. MethodsSixteen consecutive patients diagnosed as having a primary mass of the HDL in the West China Hospital of Sichuan University from September 2004 to May 2013 were retrospectively investigated. ResultsThe symptoms and blood testing both lacked specificity. In this group, fourteen patients were examined by ultrasound and fifteen by contrast-enhanced computed tomography, with 3/14 (21.43%) and 5/15(33.33%) respectively defining the location of the lesions and characteristic of benign/malignant. When combining the ultrasound and contrast-enhanced computed tomography, six of twelve(50.00%) defined the location and characteristic of benign/malignant. When combined with contrast-enhanced magnetic resonance, ten of sixteen (62.5%) defined the location and characteristic of benign/malignant. All cases underwent abdominal exploration, 11 cases (68.8%) were porformed mass resected, 2 cases(12.5%) were porformed the simple HDL mass biopsy combined with biliary drainage with T tube, 1 case(6.2%) was porformed drainage for abscess of HDL, and 2 cases(12.5%) were porformed simple frozen biopsy. All cases recovered and discharged. ConclusionsThe diagnosis of a primary mass of the HDL is difficult. The united usage of multiple imageological examinations can increase the accuracy rate of the noninvasive preoperative diagnosis. Surgery and other active treatment can produce good prognosis.
ObjectiveTo investigate the effectiveness of rotation-embedding technology for treatment of moderate to severe inverted nipples. MethodsBetween March 2012 and March 2014, 24 patients (39 nipples) with moderate to severe inverted nipples were treated using rotation-embedding technology. The age ranged from 28 to 42 years (mean, 32 years). The bilateral nipples involved in 15 cases, unilateral nipple in 9 cases, including 30 moderate inverted nipples, 9 severe inverted nipples. The first time operation was performed in the other patients except 1 patient who had received corrective operation of bilateral nipples. ResultsThe operation was successfully performed in all patients; primary healing of incision was obtained; no swollen, bleeding, dehiscence, or blood flow obstacle occurred. All patients were followed up 5-24 months (mean, 12 months). The shapes of nipples were satisfactory; bilateral nipples were symmetrical basically; no nipple inversion recurred, and the nipple skins had good sensation. ConclusionUsing rotation-embedding technology can correct moderate to severe inverted nipples effectively.
ObjectiveTo discussion the indications and contradictions of associating liver partition and potal vein ligation for staged hepatectomy (ALPPS) for primary hepatocellular carcinoma patients. MethodsThe date of 15 patients underwent the ALPPS in West China Hospital between Augst, 2014 and March, 2015 were retrospectively analyzed. The efficacy of the treatment was evaluated by blood test, the volume of residual liver growth, and postoperative follow-up. ResultsFourteen cases underwent the complete ALPPS, 1 case lost because it couldn't match the standard for the second step. The median increase in the future liver remnant(FLR) volume was 205.5 cm3[(-7.92)-270.6 cm3] and the median rate of FLR increase was 56.5%[(-1.89%)-134.74%]. One case died in the perioperative period for the liver failure, 2 cases was found recurrence or metastasis and died in 3 and 4 months after operation, respectively. One case's AFP was found rising but no iconography evidence for recurrence. One case with tumor survival about 4 moths. The remaining 10 patients were alive without recurrence and metastasis. ConclusionsALPPS is a feasible strategy in patients with cirrhosis and can improve the resectability of hepatocellular carcinoma to provide a chance of a cure to those who would not otherwise be able to receive surgery. And we put out an indications and contradictions for ALPPS tentatively.
ObjectiveTo identify the risk factors of postoperative recurrence and survival for patients with hepatocellular carcinoma within Milan criteria following liver resection. MethodsData of 267 patients with hepatocellular carcinoma within Milan criteria who received liver resection between 2007 and 2013 in our hospital were retrospectively analyzed. ResultsAmong the 267 patients, 123 patients suffered from recurrence and 51 patients died. The mean time to recurrence were (16.9±14.5) months (2.7-75.1 months), whereas the mean time to death were (27.5±16.4) months (6.1-75.4 months). The recurrence-free survival rates in 1-, 3-, and 5-year after operation was 76.8%, 56.3%, and 47.6%, respectively; whereas the overall survival rates in 1-, 3-, and 5-year after operation was 96.6%, 82.5%, and 74.5%, respectively. Multivariate analyses suggested the tumor differentiation, microvascular invasion, and multiple tumors were independent risk factors for postoperative recurrence; whereas the tumor differentiation, positive preoperative HBV-DNA load, and preoperative neutrophil-to-lymphocyte ratio adversely influenced the postoperative survival. ConclusionsFor patients with hepatocellular carcinoma within Milan criteria after liver resection, the tumor differentiation, microvascular invasion, and multiple tumors contribute to postoperative recurrence; whereas the tumor differentiation, positive preoperative HBV-DNA load, and preoperative neutrophil-to-lymphocyte ratio adversely influence the postoperative survival.