【Abstract】Objective To investigate whether liver resection for hepatocellular carcinoma (HCC) causes dissemination of liver tumor cells into blood circulation. Methods Fourteen patients with HCC, but without evidences of metastasis, were enrolled for the study. Blood samples of peripheral blood before skin incision and after abdominal wall suture, and of hepatic venous blood and portal venous blood after liver parenchyma dissection, were obtained. AFPmRNA was detected by reverse transcription polymerase chain reaction assays, the change of the level of its expression during operation was assessed by semi-quantitative analysis. Results The rate of its expression before and after operation in peripheral blood, and during operation in portal venous blood and in hepatic venous was 42.9%, 35.7%, 42.9% and 57.1% respectively. There were no differences between them. However, the level of its expression in hepatic venous blood was significantly higher than others (P＜0.05). Conclusion Liver resection for HCC induces releases of cells from the liver, probably including tumor cells, into blood circulation.
Objective?To approach feasibility, safety, and the application range of pure laparoscopic resection （PLR）, hand-assisted laparoscopic resection （HALR）, and robotic liver resection （RLR） in the minimally invasive liver resection （MILR）. Methods?The clinical data of 128 patients underwent MILR in the Surgical Department of the Shanghai Ruijin Hospital from September 2004 to January 2012 were analyzed retrospectively. According to the different methods, the patients were divided into PLR group, HALR group, and RLR group. The intraoperative findings and postoperative recovery of patients in three groups were compared.?Results?There were 82 cases in PLR group, 3 cases of which were transferred to open surgery；the mean operating time was （145.4±54.4） minutes （range：40-290 minutes）；the mean blood loss was （249.3±255.7） ml （range：30-1 500 ml）；abdominal infection was found in 3 cases and biliary fistula in 5 cases after operation, but all recovered after conservative treatment；the mean length of hospital stay was （7.1±3.8） days （range：2-34 days）. There were 35 cases in HALR group, 3 cases of which were transferred to open surgery；the mean operating time was （182.7±59.2） minutes （range：60-300 minutes）；the mean blood loss was （754.3±785.2） ml （range：50-3 000 ml）；abdominal infection was found in 1 case, biliary fistula in 2 cases, and operative incision infection in 2 cases after operation, but all recovered after conservative treatment；the mean length of hospital stay was （15.4±3.7） days （range：12-30 days）. There were 11 cases in RLR group, 2 cases of which were transferred to open surgery； the mean operating time was （129.5±33.5） minutes （range：120-200 minutes）； the mean blood loss was （424.5±657.5） ml （range：50-5 000 ml）； abdominal infection was found in 1 case and biliary fistula in 1 case after operation, but all recovered after conservative treatment； the mean length of hospital stay was （6.4±1.6） days （range：5-9 days）. The operating time （P=0.001） and length of hospital stay （P=0.000） of the RLR group were shortest and the blood loss （P=0.000） of the PLR group was least among three groups. Conclusions?Minimally invasive resection is a safe and feasible. Different surgical procedures should be chosen according to different cases. The robotic liver resection provides new development for treatment of liver tumor.
Objective To approach the clinical effect，feasibility， and advantages and disadvantages of laparoscopic liver resection for liver tumor. Methods The clinical data of 32 patients with liver tumor underwent laparoscopic liver resection from January 2009 to August 2011 in this hospital were analyzed retrospectively. Results The laparoscopic liver resection of 32 patients with liver tumor were performed successfully，including 23 cases of primary liver cancer，5 cases of metastatic liver，3 cases of liver hemangioma，1 case of focal liver nodular hyperplasia. Laparoscopic liver resection included left lateral lobectomy （Ⅱ＋Ⅲ segments） in 17 cases，left internal lobectomy （Ⅳ segment） in 2 cases （left lateral lobe was already removed），left hemihepatectomy （Ⅱ＋Ⅲ＋Ⅳ segments） in 8 cases，Ⅴsegmentectomy in 1 case，and Ⅵ segmentectomy in 1 case，and Ⅲ，Ⅳ，and Ⅴ segments hemihepatectomy in 3 cases. The average operation time of hepatectomy was 75-285 min with an average 215 min. Intraoperative bleeding was 115-760 ml with an average 365 ml. No complications such as bile leakage，hemorrhage，air embolism, and so on happened. The time of gastrointestinal function recovery was 1-3 d. The hospital stay was 5-11 d with an average 6 d. Thirty-one cases were followed-up，the follow-up time was 6-32 months with an average 18 months，except one case was died of tumor recurrence and metastasis in one year after operation，the rest were alive，no tumor recurrence and metastasis happened. Conclusions Laparoscopic liver resection for liver tumor has a small wound，less suffering，quick recovery，which is safe and feasible. The clinical effect is good．
ObjectiveTo summarize the experiences of precise liver resection for giant complex hepatic neoplasm. MethodsFifty-two cases of giant complex hepatic neoplasms were resected using precise liver resection techniques from April 2008 to August 2009. Hepatic functional reserve and liver imaging were evaluated before operation. Appropriate surgical approach, halfhepatic blood flow occlusion, new technique of liver resection, and intraoperative ultrasonography were applied during operation. ResultsThe mean operative time, halfhepatic blood occlusion time, blood loss, recovery of alanine aminotransferase, and total bilirubin were 350 min (210－440 min), 43 min (8－57 min), 370 ml (250－1 150 ml), 10 d (7－14 d), and 4.5 d (3－10 d), respectively. Only 6 patients had mild bile leakage. No liver failure and other major complications emerged, and no death happened. ConclusionPrecise liver resection is a safe and effective approach for giant complex hepatic neoplasm.
ObjectiveTo explore the value liver resection combined with intraoperative radiofrequency ablation during the same period in the treatment of multiple liver cancer. MethodsWe retrospectively analyzed the clinical data of 33 patients with multiple liver cancer treated between January 2005 and April 2013. All the patients were treated by liver resection combined with intraoperative radiofrequency ablation in the same period. There were 91 tumor foci in 33 patients, among which 39 tumor foci were surgically removed, and 52 tumor foci were radiofrequency ablated. Ultrasonography and enhanced CT/MRI were performed for the patients 1 year, 2 years and 3 years after surgery. ResultsNo bleeding or death occurred during the operation. It was observed that the transient liver function was damaged after surgery, but it quickly returned to A level after treatment. All the patients had no perioperative death or other serious complications. Tumor recurrence rate was 16.1% in the first year, 48.4% in the second year and 93.5% in the third year after surgery. ConclusionLiver resection combined with intraoperative radiofrequency ablation for multiple liver cancer in the same period is feasible and safe, without increasing the average length of hospital stay, operative mortality rate and postoperative tumor recurrence rate.
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 explore the clinicopathological characteristics of combined hepatocellular and cholangiocarcinoma (cHCC-CC), and the prognostic factors associated with survival. MethodesThe clinical features of 31 patients with cHCC-CC from 1995 to 2010 in West China Hospital of Sichuan University underwent liver resection were analyzed retrospectively. The prognostic factors were analyzed by using univariate and multivariate analysis. ResultsOf these 31 patients, 25 men and 6 women, with a median age of 58 years, underwent liver resection for cHCC-CC. Twentythree cases (74.2%) showed positive of hepatitis B surface antigen (HBsAg), 13 cases (41.9%) had elevated AFP≥20μg/L, 18 cases (58.1%) with liver cirrhosis, 8 cases (25.8%) showed presence of lymph node metastases. The 1-, 3-, and 5-year overall survival rates of these patients were 61.3%, 32.3%, and 12.9%, respectively. Univariate analysis showed that invasion of portal vein, microscopic tumor thrombi, positive resection margins, and lymph node involvement were significant prognostic factors. Multiple analysis revealed the positive resection margins and lymph node involvement were independent prognostic factors for overall survival. ConclusionsThe prognosis of patients with cHCC-CC is poor. R0 resection is the only available treatment in curing these patients.
ObjectiveTo summary the progress and status of downstaging therapy in treating hepatocellular carcinoma. MethodsThe related literatures were reviewed and analyzed by searching PubMed and MEDLINE. ResultsAlthough the clinical prognosis of advanced hepatocellular carcinoma was poor, the liver resection or liver transplantation after downstaging therapy could significantly improve the prognosis of patients. However, differences were existed if different downstaging therapies and selections of standard were used. ConclusionTo improve the prognosis of patients with advanced hepatocellular carcinoma, the downstaging therapy should be ingeniously selected based on the situation of the patients.
ObjectiveTo observe the impact of antiviral therapy on prognosis in patients after curative resection for hepatitis B virus (HBV)-related hepatocellular carcinoma (HCC). MethodsThe data of 50 patients who had undergone liver resection for HBV-related HCC in our department from August 2008 to June 2012 were retrospectively analyzed. The patients were divided into two groups:21 patients who had not antiviral therapy (untreated group) and 29 patients who received antiviral therapy using nucleotide analogues (antiviral therapy group). ResultsAfter radical resection of HCC, the disease-free survival rate of 1-year, 3-year, and 5-year were 72.4%, 58.6%, and 31.0% in antiviral therapy group and 61.9%, 38.1%, and 14.3% in untreated group, respectively. The overall survival rate of 1-year, 3-year, and 5-year were 86.2%, 68.9%, and 55.2% in antiviral therapy group and 71.4%, 47.6%, and 28.6% in untreated group, respectively. The cumulative disease-free survival rate and overall survival rate of antiviral therapy group were significantly higher than those in the untreated group (P < 0.05). Univariate analysis revealed that the number of tumor, antiviral therapy, and TNM staging were risk factor for tumor-free survival rate, The tumor size, the number of tumor, antiviral therapy, and TNM staging were risk factor for overall survival rate. Multivariate analysis revealed that the number of tumor and TNM staging were independent risk factor for tumor-free survival rate (OR:2.95, 95% CI:1.502-6.114, P < 0.05; OR:4.12, 95% CI:1.972-8.960, P < 0.05), the antiviral therapy and TNM staging were independent risk factor for overall survival rate (OR:3.86, 95% CI:1.745-7.028, P < 0.05; OR:5.17, 95% CI:2.356-11.479, P < 0.05). ConclusionUsing nucleotide analogs antiviral therapy may improve the prognosis after resection of patients with HBV-related HCC.
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.