Hepatectomy Group Research Articles

Dynamic Alterations of Plasma Metabolites in the Progression of Liver Regeneration after Partial Hepatectomy.

To elucidate the dynamic alterations of metabolites in rat plasma during liver regeneration and search for potential biomarkers of liver regeneration, 65 male Sprague-Dawley rats were divided into three groups: 70% partial hepatectomy group (PHx, n = 30), sham-operated group (Sham, n = 30), and pre-PHx group (pre-PHx, n = 5). Rats in the Sham and PHx groups were sacrificed after 30 min (min), 6 h (h), 24, 48, 72, and 168 h of surgery (n = 5 per time point). The gas chromatography-mass spectrometry-based metabolomic approach was used to identify the dynamic metabolites. Liver regeneration in the rats was evidenced by an increase in the liver weight/body weight ratio, expression of proliferating cell nuclear antigen, and yes-associated protein-1. Thirty-four differentially abundant metabolites between the Sham and PHx groups were identified, which were involved in arginine and proline metabolism, aminoacyl-tRNA biosynthesis, and cysteine and methionine metabolism pathways. Of these metabolites, low 1,5-anhydroglucitol may indicate proliferation of liver parenchymal cells during liver regeneration. Thus, a series of metabolic changes occurred with the progression of liver regeneration, and 1,5-anhydroglucitol could function as a novel hallmark of proliferation of liver parenchymal cells.

Resection might be a meaningful choice for hepatocellular carcinoma with portal vein thrombosis: A systematic review and meta-analysis.

Background:According to the Barcelona Clinic Liver Cancer (BCLC) staging system, the presence of portal vein tumor thrombosis (PVTT) is considered to indicate an advanced stage of hepatocellular carcinoma (HCC) with nearly no cure. Hepatic resection and transarterial chemoembolization (TACE) have recently been recommended for treatment of HCC with PVTT.Methods:We conducted a systematic review to compare the overall survival between patients with HCC and PVTT undergoing hepatectomy, TACE or conservative treatment including sorafenib chemotherapy. The PubMed, Web of Science, and Cochrane Library databases were searched. All relevant studies were considered. Hazard ratios with 95% confidence intervals were calculated for comparison of the cumulative overall survival. Ten retrospective studies met the inclusion criteria and were included in the review.Results:Overall survival was not higher in the hepatectomy group than TACE group. But survival rate was higher in hepatectomy group than conservative group. The subgroup analysis demonstrated that hepatectomy was superior in patients without PVTT in the main trunk than in patients with main portal vein invasion. In patients without main PVTT, hepatectomy has showed more benefit than TACE. However, there has been no significant difference between the hepatectomy and TACE groups among patients with main PVTT.Conclusion:For patients with resectable HCC and PVTT, hepatectomy might be more effective in patients without PVTT in the main trunk than TACE or conservative treatment.

Long-term Effects of Repeat Hepatectomy vs Percutaneous Radiofrequency Ablation Among Patients With Recurrent Hepatocellular Carcinoma

Repeat hepatectomy and percutaneous radiofrequency ablation (PRFA) are most commonly used to treat early-stage recurrent hepatocellular carcinoma (RHCC) after initial resection, but previous studies comparing the effectiveness of the 2 treatments have reported conflicting results. To compare the long-term survival outcomes after repeat hepatectomy with those after PRFA among patients with early-stage RHCC. This open-label randomized clinical trial was conducted at the Eastern Hepatobiliary Surgery Hospital and the National Center for Liver Cancer of China. A total of 240 patients with RHCC (with a solitary nodule diameter of ≤5 cm; 3 or fewer nodules, each ≤3 cm in diameter; and no macroscopic vascular invasion or distant metastasis) were randomized 1:1 to receive repeat hepatectomy or PRFA between June 3, 2010, and January 15, 2013. The median (range) follow-up time was 44.3 (4.3-90.6) months (last follow-up, January 15, 2018). Data analysis was conducted from June 15, 2018, to September 28, 2018. Repeat hepatectomy (n = 120) or PRFA (n = 120). The primary outcome was overall survival (OS). Secondary outcomes included repeat recurrence-free survival (rRFS), patterns of repeat recurrence, and therapeutic safety. Among the 240 randomized patients (216 men [90.0%]; median [range] age, 53.0 [24.0-59.0] years), 217 completed the trial. In the intention-to-treat (ITT) population, the 1-year, 3-year, and 5-year OS rates were 92.5% (95% CI, 87.9%-97.3%), 65.8% (95% CI, 57.8%-74.8%), and 43.6% (95% CI, 35.5%-53.5%), respectively, for the repeat hepatectomy group and 87.5% (95% CI, 81.8%-93.6%), 52.5% (95% CI, 44.2%-62.2%), and 38.5% (95% CI, 30.6%-48.4%), respectively, for the PRFA group (P = .17). The corresponding 1-year, 3-year, and 5-year rRFS rates were 85.0% (95% CI, 78.8%-91.6%), 52.4% (95% CI, 44.2%-62.2%), and 36.2% (95% CI, 28.5%-46.0%), respectively, for the repeat hepatectomy group and 74.2% (95% CI, 66.7%-82.4%), 41.7% (95% CI, 33.7%-51.5%), and 30.2% (95% CI, 22.9%-39.8%), respectively, for the PRFA group (P = .09). Percutaneous radiofrequency ablation was associated with a higher incidence of local repeat recurrence (37.8% vs 21.7%, P = .04) and early repeat recurrence than repeat hepatectomy (40.3% vs 23.3%, P = .04). In subgroup analyses, PRFA was associated with worse OS vs repeat hepatectomy among patients with an RHCC nodule diameter greater than 3 cm (hazard ratio, 1.72; 95% CI, 1.05-2.84) or an α fetoprotein level greater than 200 ng/mL (hazard ratio, 1.85; 95% CI, 1.15-2.96). Surgery had a higher complication rate than did ablation (22.4% vs 7.3%, P = .001). No statistically significant difference was observed in survival outcomes after repeat hepatectomy vs PRFA for patients with early-stage RHCC. Repeat hepatectomy may be associated with better local disease control and long-term survival in patients with an RHCC diameter greater than 3 cm or an AFP level greater than 200 ng/mL. ClinicalTrials.gov identifier: NCT00822562.

Effect of laparoscopic liver resection versus the open technique on hepatocyte regenerating activity in the rat.

Laparoscopic liver resection offers a safe and feasible option primarily for the excision of hepatic neoplasms. Timely recovery of liver volume is a key factor for improving prognosis and post-operative mortality of patients undergone liver resection. The aim of the present study was to compare liver regeneration after laparoscopic over open partial hepatectomy. Wistar rats were subjected to laparoscopic 70% hepatectomy (group LAP-HEP), open 70% hepatectomy (group HEP), sham operation (group Sham) or no intervention (group Control). At various timepoints following operation (1h-2 weeks), the liver was excised to assess relative liver weight, thiobarbituric acid reactive substances (TBARS) levels, mitotic activity, tissue expression of Nuclear Factor-κB (NFκB), Intercellular Adhesion Molecule-1 (ICAM-1) and Vascular Cell Adhesion Molecule-1 (VCAM-1) and the histopathologic profile. No differences were seen in relative liver weight between hepatectomy groups. Mitotic index was increased in all operative study groups, being higher in group LAP-HEP than in group HEP. TBARS levels were higher in group LAP-HEP compared to group HEP. NFκB and VCAM-1 tissue expression scores were increased in all operative study groups with VCAM-1 being higher in group HEP, while ICAM-1 was overexpressed only in hepatectomy groups. Mild histopathologic lesions were noted in hepatectomy groups with the histopathologic score being higher in group HEP (24h). Laparoscopic liver resection enhanced hepatocyte mitotic activity which was accompanied by mild oxidative stress and a less pronounced local inflammatory response and tissue injury to that of the open technique.

Omega-3 polyunsaturated fatty acids prevent progression of liver fibrosis and promote liver regeneration after partial hepatectomy in cirrhotic rats.

To assess the effect of omega-3 polyunsaturated fatty acids (n-3 PUFA) on liver regeneration of rats with liver cirrhosis after hepatectomy and antifibrosis. Omega-3 polyunsaturated fatty acids were intravenously injected in n-3 PUFA group 3 days before the operation to 1 day after partial hepatectomy. 70% hepatectomy was performed in rats, which were subsequently divided into 4 groups, namely normal and hepatectomy group (PH); liver cirrhosis and hepatectomy group (LC+PH); liver cirrhosis, n-3 PUFA (1 mL/kg), and hepatectomy group (LC+n-3 PUFA+PH); liver cirrhosis, n-3 PUFA (2 mL/kg) and hepatectomy group (LC+n-3PUFA*+PH). Body/liver weight ratios, serum parameters, histopathological examination, immunostaining, inflammatory cytokine and quantification of mRNA expression were also investigated. Liver regeneration was significantly delayed compared with PH group 7 days after hepatectomy (PH) in LC+PH group. Besides, liver regeneration of LC+n-3 PUFA*+PH group increased significantly compared with LC+PH group 7 days after PH. In LC+PH group, liver cirrhotic was significantly higher compared with LC+n-3 PUFA+PH group 7 days after PH. In the meantime, liver cirrhosis of LC+n-3 PUFA*+PH group was significantly reduced compared with LC+n-3 PUFA+PH group 7 days after PH. Anti-inflammatory cytokine IL-10 was increased and pro-inflammatory cytokine IL-6 was decreased in LC+n-3 PUFA*+PH group compared with LC+PH group. N-3 PUFA also suppressed increments in mRNA expression for transforming growth factor-β and up-regulated the expression of matrix metalloproteinase-9 and matrix metalloproteinase-1 in the liver. The mentioned results clearly show that n-3 PUFA reduces liver fibrosis and promotes liver regeneration, even under cirrhotic conditions. This could be a potentially useful treatment for liver cirrhosis.

Cerium oxide nanoparticles improve liver regeneration after acetaminophen-induced liver injury and partial hepatectomy in rats

Background and aimsCerium oxide nanoparticles are effective scavengers of reactive oxygen species and have been proposed as a treatment for oxidative stress-related diseases. Consequently, we aimed to investigate the effect of these nanoparticles on hepatic regeneration after liver injury by partial hepatectomy and acetaminophen overdose.MethodsAll the in vitro experiments were performed in HepG2 cells. For the acetaminophen and partial hepatectomy experimental models, male Wistar rats were divided into three groups: (1) nanoparticles group, which received 0.1 mg/kg cerium nanoparticles i.v. twice a week for 2 weeks before 1 g/kg acetaminophen treatment, (2) N-acetyl-cysteine group, which received 300 mg/kg of N-acetyl-cysteine i.p. 1 h after APAP treatment and (3) partial hepatectomy group, which received the same nanoparticles treatment before partial hepatectomy. Each group was matched with vehicle-controlled rats.ResultsIn the partial hepatectomy model, rats treated with cerium oxide nanoparticles showed a significant increase in liver regeneration, compared with control rats. In the acetaminophen experimental model, nanoparticles and N-acetyl-cysteine treatments decreased early liver damage in hepatic tissue. However, only the effect of cerium oxide nanoparticles was associated with a significant increment in hepatocellular proliferation. This treatment also reduced stress markers and increased cell cycle progression in hepatocytes and the activation of the transcription factor NF-κB in vitro and in vivo.ConclusionsOur results demonstrate that the nanomaterial cerium oxide, besides their known antioxidant capacities, can enhance hepatocellular proliferation in experimental models of liver regeneration and drug-induced hepatotoxicity.

Analysis of the curative effect and prognosis factors of surgical treatment for hilar cholangiocarcinoma

Objective To exlore and analyze the curative effect and pognostic factors of surgical treatment for hilar cholangiocarcinoma. Methods The clinical data and prognosis of 92 patients with hilar cholangiocarcinoma admitted to Anhui Provincial Hospital Affiliated to Anhui Medical University from January 2010 to January 2018 were retrospectively analyzed. There were 58 males and 34 females, with an age range of 35-81 years and average age of 61.3 years. Among them, 50 patients underwent radical resection of tumors (radical operation group), and 42 patients were discussed to undergo radical operation before operation, but only palliative resection of tumors or simple biliary drainage (palliative operation group) were performed because of the high location of tumors or distant metastasis during operation. Of the 50 patients who received radical surgery, 27 underwent simple perihepatic portectomy (perihepatic hilar resection group), and 23 underwent combined hepatic lobectomy (extended hepatectomy group). The incidence of perioperative complications, perioperative mortality and long-term survival rate of all patients were collected. The data of clinical cases included in the study were analyzed by univariate and multivariate analysis, and the relationship between perioperative mortality and prognosis survival time was discussed. The measurement data that accord with normal distribution were expressed by (Mean±SD). The comparison between the two groups was performed by t-test, the comparison between multiple groups was performed by one-way ANOVA; Measurement data with non-normal distribution were described as M(P25, P75), and comparison between groups was done using Mann-Whitney U test. The comparison between counting data groups was performed by chi-square test. Results Ninety-two patients included in this study successfully completed the operation. One patient died during the perioperative period, with a mortality rate of 1.09%. The incidence of complications was 35.87%. Biliary tract infection and bile leakage were the most common complications. The incidence of complications was 14.13%(13/92) and 9.78%(9/92) respectively. The survival time of patients in the radical operation group 34.23(13.00, 52.25) months was significantly different from that in the palliative operation group 4.75(2.88, 7.25) months (Z=-6.708, P=0.000). There was no significant difference in the survival time between the extended hepatectomy group 33.87(13.00, 56.00) months and the simple perihepatectomy group 34.54(13.00, 51.00) months (Z=-0.156, P=0.876). Univariate analysis showed that the factors related to the prognosis of hilar cholangiocarcinoma were preoperative history of calculi, tumor size, preoperative highest serum total bilirubin level, preoperative CA19-9 level, surgical modality and tumor differentiation(HR=0.200, 2.692, 2.942, 4.350, 3.740, 0.198; 95%CI: 0.043-0.938, 0.995-7.283, 1.022-8.469, 1.174-16.114, 1.229-11.382, 0.049~0.806, P<0.05). Multivariate analysis showed that tumor size, tumor differentiation and surgical modality were related to hilar cholangiocarcinoma. Surgical prognosis of patients with cholangiocarcinoma was significantly correlated(OR=1.034, 6.444, 12.527; 95%CI: 1.007-1.062, 1.012-41.037, 3.187-49.243, P<0.05). Conclusions Radical resection is an effective way to improve the survival of patients with hilar cholangiocarcinoma. The effective grasp of surgical indications can improve the overall treatment prognosis. Key words: Bile duct neoplasms; Surgical procedures, operative; Prognosis; Treatment outcome; Complications

Prognostic Nutritional Index and Neutrophil-to-Lymphocyte Ratio Are Respectively Associated with Prognosis of Gastric Cancer with Liver Metatasis Undergoing and without Hepatectomy.

Background. To clarify the efficacy of hepatectomy for gastric cancer liver metastasis (GCLM) and to investigate the association between prognostic nutrition index (PNI) or neutrophil-to-lymphocyte ratio (NLR) and prognosis of GCLM undergoing or without hepatectomy. Methods. We retrospectively studied 374 patients with GCLM. The ROC curve was used to determine the optimal cut-off of PNI and NLR. Patients were divided into groups based on whether hepatectomy was performed, and survival analysis was conducted before and after grouping. The overall survival (OS) time and 1, 3, 5-year survival rates were also compared. Results. Multivariate analysis of all GCLM patients revealed that hepatectomy (p = 0.001) was an independent prognosis factor. And there were statistical differences in OS and 1, 3, 5-year survival rates (p = 0.001 of all) between hepatectomy group and nonhepatectomy group. Multivariate analysis of GCLM undergoing hepatectomy showed that PNI was an independent prognosis factor (p = 0.001). And there were statistical differences in OS and 1, 3, 5‐year survival rates (p = 0.001p = 0.005, p = 0.001 and p = 0.020, respectively) between high PNI group and low PNI group. Multivariate analysis of GCLM without hepatectomy showed that NLR was an independent prognosis factor (p = 0.001). And there were statistical differences in OS and 1, 3, 5-year survival rates (p = 0.001p = 0.008p = 0.031 and p = 0.026, respectively) between low NLR group and high NLR group. Conclusions. GCLM has a better prognosis with hepatectomy. High preoperative PNI is a benign prognostic predictor for patients undergoing hepatectomy. And high preoperative NLR is an adverse prognostic factor for patients without hepatectomy.

Effectiveness and safety of indocyanine green fluorescence imaging-guided hepatectomy for liver tumors: A systematic review and first meta-analysis.

This meta-analysis was conducted to evaluate the effectiveness and safety of indocyanine green fluorescence imaging-guided hepatectomy(FIGH) for liver tumors. Clinical studies were retrieved from the PubMed, Embase, Cochrane Library, Medline and Web of Science electronic databases. Primary outcomes included operative time, blood loss, blood transfusion, hospital stay, R0 resection, postoperative complications, postoperative mortality and 1-year recurrence rate. Study-specific effect sizes and their 95% confidence intervals (CIs) were combined to calculate the pooled value using a fixed-effects or random-effects model. Six studies comprising 587 patients were included. Major operative time (mean difference [MD] = -55.45; 95% CI = -78.85- -32.05), blood loss (MD = 12.99; 95% CI = 12.00-13.97), hospital stay (rate difference [RD] = -12.61; 95% CI = -15.06- -10.17), and postoperative complications (RD = -0.07; 95% CI = -0.12- -0.01) were all less in the FIGH group than in the traditional hepatectomy(TH) group. No differences were found in blood transfusion, R0 resection or 1-year recurrence rate. No perioperative mortality was observed in either group. Based on current evidence, applying indocyanine green fluorescence imaging technology to accurately diagnose and treat liver tumors can effectively reduce operative time, blood loss, hospital stay and postoperative complications.

A study on the clinical outcomes using different laparoscopic methods to treat hepatic cystic hydatidosis

Objective To study the clinical outcomes using laparoscopic complete dissection of cysts, subtotal cystectomy and partial hepatectomy in the treatment of hepatic cystic echinococcosis. Methods A retrospective study was conducted on 40 patients with hepatic cystic echinococcosis treated by laparoscopic surgery from January 2014 to June 2018 at the First Affiliated Hospital of Xinjiang Medical University. According to the different surgical methods, these patients were divided into three groups: group A (n=14): the laparoscopic complete capsulectomy group, group B (n=14): the laparoscopic subtotal capsulectomy group, group C (n=12): the laparoscopic partial hepatectomy group. The operation time, intraoperative blood loss, time to pass first flatus, duration of drainage tube placement, days of hospitalization after operation, hospitalization expenses, complications of the residual cavity and local recurrence were compared among the 3 groups. Results In this study, all the 40 patients with hepatic cystic hydatidosis were cured, and no death occurred during the perioperative period. The intraoperative blood loss, postoperative duration of drainage tube placement, and hospitalization cost of the three groups were significantly the highest in group C (all P<0.05). The operative time and the time to pass first flatus in group C were both significantly greater than group B (P<0.05). The length of postoperative hospitalization in group A was significantly less than in group C (P<0.05). Postoperative recurrence and complications in group B were significantly worse than those in group A and group C (all P<0.05). Conclusion Laparoscopic complete dissection of the external capsule turned out to be the best laparoscopic treatment of hepatic cystic echinococcosis, followed by laparoscopic partial hepatectomy. Open surgery should be considered in patients with lesions which are evaluated preoperatively to have difficulty in carrying out laparoscopic complete dissection of capsule or partial hepatectomy. Key words: Laparoscopes; Echinococcosis, hepatics; Complete exocystectomy of hepatic hydatid; Hepatic hydatid outer sac subtotal resection; Hepatectomy

Laparoscopic versus open two-stage hepatectomy for bilobar colorectal liver metastases: A bi-institutional, propensity score-matched study

BackgroundThe safety and feasibility of laparoscopic, two-stage hepatectomy for bilobar colorectal liver metastases is poorly evaluated. MethodsWe reviewed retrospectively 86 consecutive patients who underwent complete two-stage hepatectomy (left lobe clearance as the first stage and standard/extended right hepatectomy as the second stage) for bilobar colorectal liver metastases between 2007 and 2017 in 2 tertiary centers. Short- and long-term outcomes were compared between laparoscopic and open two-stage hepatectomy before and after propensity score matching. ResultsLaparoscopic two-stage hepatectomy was performed in 38 patients and open two-stage hepatectomy in 48. After propensity score matching, 25 laparoscopic and 25 open patients showed similar preoperative characteristics. For the first stage, a laparoscopic approach was associated with lesser hospital stays (4 vs 7.5 days; P < .001). For the second stage, a laparoscopic approach was associated with less blood loss (250 vs 500 mL; P = .040), less postoperative complications (32% vs 60%; P = .047), lesser hospital stays (9 vs 16 days; P = .013), and earlier administration of chemotherapy (1.6 vs 2 months; P = .039). Overall survival, recurrence-free survival, and liver-recurrence-free survival were comparable between the groups (3-year overall survival: 80% vs 54%; P = .154; 2-year recurrence-free survival: 20% vs 18%; P = .200; 2-year liver-recurrence-free survival: 39% vs 33%; P = .269). Although both groups had comparable recurrence patterns, repeat hepatectomies for recurrence were performed more frequently in the laparoscopic two-stage hepatectomy group (56% vs 0%; P = .006). ConclusionLaparoscopic two-stage hepatectomy for bilobar colorectal liver metastases is safe and feasible with favorable surgical and oncologic outcomes compared to open two-stage hepatectomy.

Application of augmented-reality surgical navigation technology combined with ICG molecular fluorescence imaging in laparoscopic hepatectomy

Objective: To study the application value of augmented-reality (AR) surgical navigation technology combined with indocyanine green (ICG) molecular fluorescence imaging in three-dimensional (3D) laparoscopic hepatectomy. Methods: The clinical data of forty-eight patients who had undergone 3D laparoscopic hepatectomy for hepatocellular carcinoma at First Department of Hepatobiliary Surgery, Zhujiang Hospital, Southern Medical University from January 2018 to April 2019 were retrospectively analyzed.The patients were divided into two groups: the group of 3D laparoscopic hepatectomy navigated by augment reality technology combined with ICG molecular fluorescence imaging (Group A) , and group of conventional 3D laparoscopic hepatectomy (Group B) . Patients in Group A (n=23) underwent 3D laparoscopic hepatectomy using augmented-reality technology combined with ICG molecular fluorescence imaging. In this group, the self-developed three-dimensional laparoscopic augmented-reality surgical navigation system (No. 2018SR840555) was operated to project the preoperative three-dimensional model to the surgical field, and the use of this system in combination with ICG molecular fluorescence imaging navigated laparoscopic hepatectomy. No surgical navigation technology was applied in Group B (n=25) . All patients signed the informed consent, which were in accordance with the requirements of medical ethics (Ethics No.: 2018-GDYK-003) . The preoperative data, surgical indicators and postoperative complications between the two groups were compared and analyzed. Results: The median amount of intraoperative blood loss of Group A was 250 (200) ml (M (Q(R)) ) , which was significantly lower than that of Group B (300 (150) ml) (Z=-2.307, P=0.021) .The transfusion rate of Group A was 13.0% (3/23) , which was significantly lower than that of Group B (40.0%, 10/25) (χ(2)=4.408, P=0.036) .The median postoperative hospitalization time of Group A was 8 (2) d, which was significantly shorter than that of Group B (11 (6.5) d) (Z=-2.694, P=0.007) . There were no serious complications and perioperative death in both groups.The incidence of postoperative complications in Group A was 17.4% (4/23) , which was not significantly different from that in group B (28%, 7/25) (χ(2)=0.763, P=0.382) . Conclusion: Augmented-reality surgical navigation technology combined with ICG molecular fluorescence imaging has better effect in 3D laparoscopic hepatectomy.

Significance of Hepatectomy in Patients Diagnosed With T2 Gallbladder Cancer.

A radical surgery is mandatory for advanced gallbladder cancer. However, the appropriate surgical procedure for T2 gallbladder cancer remains controversial because of the difficulty associated with accurate preoperative diagnosis. The aims of the study were to analyze the clinicopathologic features of patients diagnosed with T2 gallbladder cancer and to identify the survival benefit of hepatectomy for such cases. Eighty-four patients, who were diagnosed with pT2 gallbladder cancer from January 1995 to December 2012, were included in this study. Patients were divided into nonhepatectomy and hepatectomy groups. Partial hepatectomies were performed in 36 of 84 patients (42.9%). A significant difference in age was observed between the nonhepatectomy and hepatectomy groups (P=0.027). However, no significant differences were observed in sex, tumor size, or pathologic outcome between the 2 groups. No significant difference in survival rate was observed between the 2 groups (5-year survival rate, 60.4% vs. 66.6%). Of the 23 patients who underwent cholecystectomy, 11 (47.8%) were treated with extended surgery as a second operation with curative intent. No remnant tumor was detected at the hepatectomy site in any patient. However, the second operation revealed lymph node metastasis in 2 patients (18.2%). In terms of recurrence, 8 patients (34.7%) had hepatic metastasis. However, the metastatic tumor was away from the resection margin. No significant difference in survival rate was found between the peritoneal and the hepatic side groups (5-year survival rate, 62.5% vs. 73.0%). Hepatectomy is not associated with a better survival rate after surgery for T2 gallbladder cancer. Moreover, no recurrence near the gallbladder fossa is observed. In case of T2 gallbladder cancer confirmed by first operation, however, a second operation should be recommended on the basis of accurate nodal staging and additional therapy.

Extensive Hepatectomy as an Alternative to Liver Transplant in Advanced Hepatoblastoma: A New Protocol Used in a Pediatric Liver Transplantation Center

BackgroundSurgery is a key factor in the treatment of hepatoblastoma, but choosing between an aggressive resection and liver transplant may be an extremely difficult task. The aim of this study was to describe the outcomes of patients with advanced hepatoblastoma: pretreatment extent of disease (PRETEXT)/post-treatment extent of disease (POST-TEXT) III and IV undergoing aggressive resections or living donor liver transplant in cases involving the entire liver. Based on this experience, a new protocol for the treatment of these patients was proposed. MethodsA retrospective study included patients with advanced hepatoblastoma (POST-TEXT III and IV) who were referred for a liver transplant from 2010 to 2017. ResultsA total of 24 children were included: 13 (54.2%) were male, with a median age at diagnosis of 42 months (range, 15–120 months), and a history of prematurity was identified in 20.8% of the patients. Ten cases (41.7%) were staged as PRETEXT/POST-TEXT III, and 12 cases (50.0%) were staged as PRETEXT/POST-TEXT IV. Two patients were referred after posthepatectomy recurrence. Five patients underwent a liver transplant, with recurrence and death in 2 patients (40.0%) within a mean period of 6 months. In the extensive hepatectomy group, there was recurrence in 6 patients (31.6%), with disease-free outcomes and overall survival in 63.2% and 94.7% of patients, respectively. ConclusionIn cases of advanced hepatoblastoma, an extensive surgical approach is a valuable option. The fact that the team was fully prepared to proceed with living donor liver transplant allowed the surgeon to be more aggressive and to switch to transplantation when resection was not possible.

Complication Rates for Pediatric Hepatectomy and Nephrectomy: A Comparison of NSQIP-P, PHIS, and KID

BackgroundThree large national data sets are commonly used to assess operative outcomes in pediatric surgery; National Surgical Quality Improvement Program Pediatric (NSQIP-P), Pediatric Health Information System (PHIS), and Kids' Inpatient Data set (KID). Hepatectomy and nephrectomy are rare pediatric surgical procedures, which may benefit from large administrative data sets for the assessment of short-term complications. Materials and methodsA retrospective review of NSQIP-P (2012-2015), KID (2012), and PHIS (2012-2015) was performed for hepatectomy or nephrectomy cases for children aged 0 to 18 y. Thirty-day perioperative outcomes were collected, analyzed, and compared across data sets and surgical cohorts. ResultsRates of surgical site infection, wound dehiscence, central line infection, sepsis, and venous thromboembolism were similar across NSQIP-P, PHIS, and KID in both cohorts. Rates of pneumonia and renal insufficiency were higher in PHIS and KID versus NSQIP-P in both cohorts. Blood transfusions in NSQIP-P were higher than PHIS and KID in the hepatectomy group (50.9% versus 43.0% versus 32.4%, P < 0.001), but similar across data sets in the nephrectomy cohorts (12.0% versus 14.0% versus 13.0%, P = 0.15). PHIS reported higher readmission rates than NSQIP-P for both the hepatectomy (56.5% versus 17.9%, P < 0.001) and nephrectomy (32.6% versus 7.6%,P < 0.001) cohorts. Thirty-day mortality rates were similar between NSQIP-P and PHIS, but higher in KID as compared with NSQIP-P for hepatectomy (6.4% versus 0.4%, P < 0.001) and nephrectomy (2.0% versus 0.3%, P < 0.001) cases. ConclusionsAdministrative data sets provide large sample sizes for the study of low-volume procedures in children, but there are significant variations in the reported rates of perioperative outcomes between NSQIP-P, PHIS, and KID. Therefore, surgical outcomes should be interpreted within the context of the strengths and limitations of each data set.

Spontaneous rupture of hepatocellular carcinoma: Optimal timing of partial hepatectomy

BackgroundPartial hepatectomy has been used to treat patients with resectable hepatocellular carcinoma (HCC) which spontaneously ruptured. It is still controversial as to whether emergency partial hepatectomy (EmPH) should be carried out at the time of rupture, or the patients should initially be managed by operative or non-operative treatment to stop the bleeding, followed by staged early or delayed partial hepatectomy when the patient's condition becomes stable. MethodsConsecutive 10-year patients with ruptured HCC managed at our center were included in this study. Patients who underwent partial hepatectomy were further subdivided into the EmPH group, the staged early partial hepatectomy (SEPH) group, and the staged delayed partial hepatectomy (SDPH) group. Univariate and multivariate analyses of factors affecting overall survival(OS) were conducted before and after propensity score matching analyses amongst the included patients. OS, postoperative mortality, recurrence free survival (RFS), and peritoneal metastatic rates were compared. The risk factors of peritoneal metastases were determined using the COX regression analysis. ResultsThe 130 patients who underwent partial hepatectomy were subdivided into the EmPH group (surgery at the time of rupture, n = 30), the SEPH group (surgery ≤ 8 days of rupture, n = 67), and the SDPH group (surgery > 8 days of rupture, n = 33). The remaining 86 patients underwent non-surgical treatment. Partial hepatectomy was an independent predictor of better OS (HR 2.792, P < 0.001). For resectable HCC, the 30-day mortality, OS, and RFS were similar between the EmPH group, and the staged partial hepatectomy (SPH) group which included the patients who underwent SEPH and SDPH. The SEPH group had significantly better OS and RFS. Multivariate COX regression analysis demonstrated that SDPH was strongly associated with postoperative peritoneal dissemination (OR 28.775, P = 0.003). ConclusionPartial hepatectomy provided significantly better survival than non-surgical treatment for patients who presented with ruptured HCC. Early partial hepatectomy within 8 days of rupture which included EmPH (carefully selected) and SEPH, resulted in significantly less patients with peritoneal dissemination and better long-term survival outcomes (especially RFS) than SDPH.

Mitogen Inducible Gene-6 Is a Prognostic Marker for Patients with Colorectal Liver Metastases

PURPOSE: Prognostic schemes that rely on clinical variables to predict outcome after resection of colorectal metastases remain imperfect. We hypothesized that molecular markers can improve the accuracy of prognostic schemes. METHODS: We screened the transcriptome of matched colorectal liver metastases (CRCLM) and primary tumors from 42 patients with unresected CRCLM to identify differentially expressed genes. Among the differentially expressed genes identified, we looked for associations between expression and time to disease progression or overall survival. To validate such associations, mRNA levels of the candidate genes were assayed by qRT-PCR from CRCLM in 56 additional patients who underwent hepatectomy. RESULTS: Seven candidate genes were selected for validation based on their differential expression between metastases and primary tumors and a correlation between expression and surgical outcome: lumican; tissue inhibitor metalloproteinase 1; basic helix-loop-helix domain containing class B2; fibronectin; transmembrane 4 superfamily member 1; mitogen inducible gene 6 (MIG-6); and serpine 2. In the hepatectomy group, only MIG-6 expression was predictive of poor survival after hepatectomy. Quantitative PCR of MIG-6 mRNA was performed on 25 additional hepatectomy patients to determine if MIG-6 expression could substratify patients beyond the clinical risk score. Patients within defined clinical risk score categories were effectively substratified into distinct groups by relative MIG-6 expression. CONCLUSIONS: MIG-6 expression is inversely associated with survival after hepatectomy and may be used to improve traditional prognostic schemes that rely on clinicopathologic data such as the Clinical Risk Score.

Repeat hepatectomy for recurred colorectal liver metastasis: is it justified?

PurposeLiver resection is considered the only curative treatment modality for colorectal liver metastasis. The recurrence rate after hepatectomy is >50%. Two or more hepatectomies are applied to treat recurred metastases. We assessed the efficiency and feasibility of repeat hepatectomy and analyzed the prognostic factors after a repeat hepatectomy.MethodsIn total, 248 patients were diagnosed with recurred liver metastasis between January 2003 and May 2016. Second and third hepatectomies were performed in 70 and 7 patients, respectively. The other 171 patients did not undergo a repeat hepatectomy. Clinical features were collected from the medical records. We analyzed survival rates of the repeat hepatectomy group and the nonrepeat hepatectomy group. We also investigated factors affecting overall and disease-free survival of patients who received a repeat hepatectomy using univariate and multivariate analyses.ResultsMedian overall survival was significantly higher in the repeat hepatectomy group than in the nonrepeat group (83.0 months vs. 25.0 months, P < 0.001). The morbidity and mortality rates of repeat hepatectomy were 9.1% and 0%, respectively. Median overall and disease-free survival of the repeat hepatectomy group were 62.0 and 51.0 months, respectively. The number of recurred tumors was the only significant factor for disease-free survival (P = 0.029). None of the factors affected overall survival.ConclusionRepeat hepatectomy is necessary, effective, and safe for treating recurred colorectal liver metastasis. Repeat hepatectomy can be considered in patients with fewer than three recurred metastatic tumors.

Staged partial hepatectomy versus transarterial chemoembolization for the treatment of spontaneous hepatocellular carcinoma rupture: a multicenter analysis in Korea.

PurposeThe aim of this study was to identify the prognostic factors and compare the long-term outcomes of staged hepatectomy and transarterial chemoembolization (TACE) for patients with spontaneous rupture of hepatocellular carcinoma (HCC).MethodsThis study is a multicenter, retrospective analysis of patients with newly diagnosed ruptured HCC. To compare overall survival between staged hepatectomy group and TACE alone group, we performed propensity score-matching to adjust for significant differences in patient characteristics. To identify prognostic factors, the clinical characteristics at the time of diagnosis of tumor rupture were investigated using Cox-regression analysis.ResultsFrom 2000 to 2014, 172 consecutive patients with newly diagnosed ruptured HCC were treated in 6 Korean centers. One hundred seventeen patients with Child-Pugh class A disease were identified; of which 112 were initially treated with transcatheter arterial embolization (TAE) for hemostasis and five underwent emergency surgery for bleeder ligation. Of the 112 patients treated with TAE, 44 underwent staged hepatectomy, 61 received TACE alone, and 7 received conservative treatment after TAE. Those that underwent staged hepatectomy had significantly higher overall survival than those that underwent TACE alone before matching (P < 0.001) and after propensity score-matching (P = 0.006). Multivariate analysis showed that type of treatment, presence of portal vein thrombosis, pretreatment transfusion >1,200 mL, and tumor size >5 cm were associated with poor overall survival.ConclusionStaged hepatectomy may offer better long-term survival than TACE alone for spontaneous rupture of HCC. Staged hepatectomy should be considered in spontaneous rupture of HCC with resectable tumor and preserved liver function.

Perihilar Hepatectomy for Hepatolithiasis with Compressed Hilar Bile Duct Induced by Perihilar Hyperplasia of Liver

Background: Stone recurrence is a major problem limiting the effects of surgical treatment for hepatolithiasis. It was showed that hyperplasia of perihilar liver may compress the hepatic portal and cause deficient bile flow because of compressed hilar bile duct, thereby leading to the formation of bile stasis and precipitating stone recurrence. This retrospective study aimed to evaluate the efficiency of perihilar hepatectomy for hepatolithiasis with compressed hilar bile duct induced by perihilar hyperplasia of liver. Methods: 135 patients with compressed hilar bile duct induced by hypertrophied perihilar liver were included in this study from January 2011 to July 2016. Among these patients, 77 underwent conventional operation procedure (control group) and 58 underwent conventional operation procedure added by perihilar hepatectomy (perihilar hepatectomy group). Clinical data containing preoperative data, intraoperative data, operation complications, and short-term and long-term outcomes were collected. Results: The demographic and disease-related characteristics of the two groups were comparable. The two groups were not remarkably different in operation-related characteristics. The incidence of bile leakage in the perihilar hepatectomy group was substantially higher than that in the control group. Other postoperative complications were not remarkably different between the two groups. In the long-term postoperative follow-up period, the incidence of the recurrence of stones and cholangitis in the control group was considerably higher than that in the perihilar hepatectomy group. Conclusions: Based on conventional operation procedure, additional perihilar hepatectomy is a reliable intervention with definite clinical effects for hepatolithiasis with compressed hilar bile duct induced by hypertrophied perihilar liver.