Hepatobiliary Tumors Research Articles

Abstract 199: Regulation of apoptosis in cholangiocarcinoma by miR-106b∼25 cluster

Abstract Introduction: Cholangiocarcinoma (CCA) is a highly lethal hepatobiliary neoplasm with limited therapeutic options. Thus, new therapeutic strategies are needed to advance our treatment armamentarium for this devastating disease. MicroRNAs represent a new class of endogenous nucleic acids regulating development, cell death, and carcinogenesis. Recent studies have indicated that the miR-106b∼25 cluster, which is upregulated in cancer, has potential antiapoptotic properties. Meanwhile, we have demonstrated that Hedgehog (Hh) signaling is activated in CCA and also has a strong antiapoptotic effect. Based on this information, we posited that Hh signaling may regulate mir-106b∼25 expression. Due to the dependence of CCA on antiapoptotic signals, we conducted a study to determine the role of miR-106b∼25 in CCA apoptosis and unveil its regulatory mechanisms. Experimental procedures: Immortalized benign and malignant human cholangiocyte cell lines were used for the experiments. MicroRNA expression was analyzed using real-time quantitative RT-PCR (qRT-PCR) assays. The effect of the microRNAs was studied using Lipofectamine-based transfection with precursor microRNAs or locked-nucleic acid antagonists (LNAs) to respectively potentiate or decrease microRNAs expression. Functional apoptosis studies employed DAPI staining with fluorescent microscopic analysis of nuclear morphology, or biochemical measurement of caspase-3/7 activity. Western blotting and luciferase assays were conducted to identify potential messenger RNA targets. Results: Expression of miR-106b∼25 was enhanced in malignant vs. benign cholangiocyte cell lines. Treatment with the known antagonist of Hh signaling, cyclopamine, resulted in downregulation of the cluster. Because CCA cells express tumor necrosis factor-related apoptosis-inducing ligand (TRAIL) in vivo, we next examined TRAIL-induced apoptosis in CCA cells. TRAIL-mediated apoptosis was attenuated by transfection with miR-25 and enhanced by LNAs. Computational analysis identified the TRAIL death receptor 4 (DR4) as a potential target of this cluster. Indeed, we observed downregulation of DR4 cellular protein levels during overexpression of miR-106b∼25 and upregulation of DR4 upon cluster inhibition with LNAs. The 3’untranslated region (UTR) of the DR4 mRNA was cloned into a luciferase reporter, and the potential direct regulation of DR4 by miR-106b∼25 examined. Indeed, the regulation of DR4 by miR-106b∼25 was confirmed by this luciferase assay demonstrating a direct inhibitory effect of the miR-106b∼25 polycistron on the DR4 3’UTR. Conclusions: The miR-106b∼25 cluster is overexpressed in malignant cholangiocyte cell lines, likely by a Hh signaling pathway. miR-106b∼25 inhibits apoptosis, at least in part, via downregulation of DR4. LNA targeted inhibition of miR-106b∼25 sensitizes CCA cells to apoptosis and may represent a new therapeutic strategy for this cancer. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 102nd Annual Meeting of the American Association for Cancer Research; 2011 Apr 2-6; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2011;71(8 Suppl):Abstract nr 199. doi:10.1158/1538-7445.AM2011-199

Major Liver Resection in Elderly Patients: A Multi-Institutional Analysis

Because of the aging United States population, increase in overall life expectancy, and rising incidence of hepatobiliary tumors, more elderly patients are considered for hepatic resection. The objective of this study was to assess the influence of age on postoperative outcomes after major hepatectomy among a contemporary cohort from 2 high volume centers. Demographics, diagnoses, surgical treatments, and postoperative outcomes of patients who underwent major hepatic resection were reviewed. There were 856 patients who underwent major hepatectomy (resection of 3 or more segments) from 2002 to 2009. Postoperative mortality and morbidity occurred in 53 (6.2%) and 403 (47.1%) patients, respectively. Increasing age was independently associated with postoperative mortality (p = 0.0345). Each 1-year and 10-year increase in age resulted in an odds ratio of mortality after major hepatic resection of 1.036 (95% CI [1.003-1.071]) and 1.426 (95% CI [1.026-1.982]), respectively. This relationship was independent of American Society of Anesthesiology (ASA) score. Increasing age was associated with postoperative sepsis (p = 0.0224, odds ratio for each year 1.025 [range 1.003 to 1.048]) after major hepatic resection, but not overall postoperative morbidity. In the contemporary era, increasing age is independently associated with postoperative mortality after major hepatic resection at high volume academic centers.

Neoplasms of the hepatobiliary system: clinical presentation, molecular pathways and diagnostics

Neoplasms of the hepatobiliary system include primary tumors, such as hepatocellular carcinoma and cholangiocarcinoma, and secondary lesions from the metastatic spread of a cancer of nonhepatobiliary origin. Surgical excision remains the mainstay of long-term survival for primary tumors whereas secondary lesions can be treated by multiple modalities, including resection, radiotherapy and radiofrequency ablation. However, diagnosis of hepatobiliary neoplasms often occurs late in the disease process. In this article we will focus on the diagnostic approaches and new molecular diagnostics of primary hepatobiliary cancers and we will discuss how these new developments may impact the detection and management of these recalcitrant cancers.

A Phase I Study of Telomerase-specific Replication Competent Oncolytic Adenovirus (Telomelysin) for Various Solid Tumors

A phase I clinical trial was conducted to determine the clinical safety of Telomelysin, a human telomerase reverse transcriptase (hTERT) promoter driven modified oncolytic adenovirus, in patients with advanced solid tumors. A single intratumoral injection (IT) of Telomelysin was administered to three cohorts of patients (1 x 10(10), 1 x 10(11), 1 x 10(12) viral particles). Safety, response and pharmacodynamics were evaluated. Sixteen patients with a variety of solid tumors were enrolled. IT of Telomelysin was well tolerated at all dose levels. Common grade 1 and 2 toxicities included injection site reactions (pain, induration) and systemic reactions (fever, chills). hTERT expression was demonstrated at biopsy in 9 of 12 patients. Viral DNA was transiently detected in plasma in 13 of 16 patients. Viral DNA was detectable in four patients in plasma or sputum at day 7 and 14 post-treatment despite below detectable levels at 24 h, suggesting viral replication. One patient had a partial response of the injected malignant lesion. Seven patients fulfilled Response Evaluation Criteria in Solid Tumors (RECIST) definition for stable disease at day 56 after treatment. Telomelysin was well tolerated. Evidence of antitumor activity was suggested.

Surgery of hepatobiliary tumors

Surgical R0 resection of primary and secondary hepatobiliary tumors, such as colorectal liver metastases, hepatocellular carcinoma, cholangiocellular carcinoma and gall bladder carcinoma, remains the only potentially curative treatment option. The extent of involvement of lymph node metastases seems to be an independent prognostic factor in these tumors. The prognostic value of a systematic lymph node dissection in hepatobiliary tumors still remains unclear as there is a lack of prospective randomized trials. However, local lymphadenectomy (hepatoduodenal ligament and retropancreaticoduodenal lymph nodes) can be easily performed with low mortality and morbidity rates and may be helpful in better staging of the patients. Further randomized trials are necessary in order to define the relevance of lymph node dissection in hepatobiliary surgery.

CT angiography of the celiac trunk: anatomy, variants and pathologic findings

Celiac trunk variants and pathologies are relatively common occurrences. With the advent of computed tomography (CT) technology, these conditions are being diagnosed with an increased frequency even among asymptomatic patients. CT angiography is used noninvasively for preoperative staging and vascular mapping in patients with pancreatic and hepatobiliary neoplasm. Multidetector-row CT (MDCT) also allows the accurate depiction of the abdominal splanchnic vessels for stenosis, collateral vessels and atherosclerotic plaques. In this study, we describe the normal anatomy and variants of the celiac trunk as well as associated pathologic conditions, such as stenosis, occlusion, aneurysm and median arcuate ligament compression syndrome. The overall aim of this study was to emphasize the clinical importance of these abnormalities.

State of the Journal 2010: Managing Growth, Extending Our Reach—Now the Official Journal for the Society of Surgical Oncology and the American Society of Breast Surgeons

We begin this first issue of 2010 by welcoming the 3,000 members of the American Society of Breast Surgeons and assessing the growth of the Annals of Surgical Oncology. The Annals is now the official journal for both the Society of Surgical Oncology and the American Society of Breast Surgeons (ASBS). The ASBS brings with it a membership whose mission aligns nicely with the strategic vision of the Society of Surgical Oncology (SSO) and the Annals. The ASBS will have a special ASO edition to be published in October 2010, which will be a valuable additional resource for both ASBS members and SSO members. The growth of the Annals, both in size and content, has been impressive! Over the last 5 years, submissions and resubmissions of original work have almost tripled (approximately 600 articles submitted in 2005–2006 vs. more than 1600 in 2008–2009). The number of reviewers volunteering their critical expertise to the peer review process grew from 750 in 2006 to over 2000 experts in 2009, with an average number of reviews completed per reviewer declining from 2.5 to 1.6. This growth in the number of peer review experts and the range in their expertise reflects the journal’s continuing expansion of breadth, depth, and range of subject matter. We thank them for their voluntary effort that shapes the scientific excellence of the journal. The Annals now covers 18 content areas, as reflected in the structure of the Editorial Board (Table 1). New additions in 2009 include a section on Colorectal Cancer led by Heidi Nelson, MD, and an expansion of Translational Research to include Biomarkers, led by James Cusack, MD. The journal continues to be especially strong in Hepatobiliary and Pancreatic Tumor papers, now broken into two distinct groups led by Michael Choti, MD, and Andrew Lowy, MD, respectively. Gastrointestinal, Melanoma, and Breast Oncology sections continue to grow as well. Table 1 2009–2010 Editorial Board sections and section editors

In situ hypothermic liver preservation during radical liver resection with major vascular reconstruction

The in situ hypothermic liver preservation technique may allow a more aggressive approach to tumours of the caval confluence and/or all three hepatic veins, which would otherwise be deemed irresectable. All descriptive data regarding patient demographics, operative characteristics, perioperative complications and outcomes of nine patients in whom this technique was used were collected prospectively. Seven patients underwent liver trisegmentectomy and two had primary retrohepatic venal caval resection. Total hepatic vascular occlusion with in situ hypothermic liver preservation was used for venous reconstruction in all patients. The vena cava was reconstructed with prosthetic graft in seven patients. All main hepatic veins were reconstructed in the seven liver resections. In situ hypothermic liver preservation was well tolerated as evidenced by preserved hepatic synthetic function early after operation. One patient died 66 days after surgery. There were two recurrences after a median follow-up of 14 (range 2-33) months; local recurrence was identified in one patient after 4 months and distant metastasis in another after 8 months. The in situ hypothermic liver preservation technique appears to be a useful adjunct to radical hepatobiliary tumour excision procedures that require total hepatic vascular exclusion and major vascular reconstruction.

Perioperative blood glucose management in patients undergoing tumor hepatectomy

Study Objective To determine whether our institutional insulin management (modified Atlanta) protocol is efficient and safe in controlling blood glucose levels in the perioperative period in surgical patients undergoing tumor hepatectomy. Design Retrospective study. Setting Large community hospital. Patients 20 consecutive patients undergoing liver resection for hepatocellular carcinoma, liver metastasis, or other hepatobiliary tumors. Interventions and Measurements All patients continuously received intravenous glucose (5% dextrose in water, one mL/kg/hr); insulin was administered according to a strict algorithm, and dose adjustments were based on measurements of whole-blood glucose intraoperatively at one-hour intervals, and in the intensive care unit (ICU). Lower and upper blood glucose limits were set at 85 mg/dL and 110 mg/dL, respectively, in the operating room (OR). In the ICU, lower and upper limits were 90 mg/dL and 140 mg/dL, respectively. Main Results Intraoperatively, 51.3% of measurements were within the target range. In the ICU, 75.2% of measurements showed a blood glucose level of 90 - 140 mg/dL. Two of 78 (2.6%) and two of 363 (0.5%) measurements had a blood glucose level < 70 mg/dL in the OR and ICU, respectively. The lowest blood glucose levels were 65 mg/dL (OR) and 66 mg/dL (ICU). Conclusions The modified Atlanta protocol is efficient and safe in controlling blood glucose levels in the perioperative period of hepatic tumor resection. Because of decreased insulin needs in the ICU, the use of a more liberal algorithm successfully reduced the risk of hypoglycemia.

Mucobilia: current aspects in the management of a rare cause of malignant biliary obstruction

Mucobilia is a rare pathologic condition characterized by the abnormal secretion and accumulation of abundant mucus within the biliary tree. It is usually seen in association with mucin-producing hepatobiliary and pancreatic tumors. Neoplastic transformation of these tumors can range from low-grade dysplasia to invasive adenocarcinoma. Mucobilia usually presents with signs and symptoms of biliary obstruction, which may span from jaundice to cholangitis with progression to septic complications in severe cases. Occurrence of hepatolithiasis has also been attributed to mucobilia, which raises the concern of an increased risk for the development of cholangiocarcinoma. Precise radiological evaluation and detailed histopathological tissue diagnosis followed by execution of appropriate surgical therapy is vital in the integrated management of mucin-producing biliary neoplasms. This review will address the etiologies and symptomatology of mucobilia as well as discuss current aspects in the management of mucobilia and its causative etiologies.

Rifampicin as an Oral Angiogenesis Inhibitor Targeting Hepatic Cancers

Angiogenesis is an important therapeutic target in cancer, and to fully exploit its therapeutic potential, combination chemotherapeutic/antiangiogenic regimens should be optimized and delivered earlier to more patients. Ideally, this could be done by a single potent oral agent with established safety. Rifampicin, a semisynthetic antibiotic derived from the rifamycins, is one of the most commonly used pharmaceutical compounds worldwide in the treatment of tuberculosis. Here, we present the effects of oral rifampicin on human cancer progression and its antiangiogenic properties, which were comparable to the angiogenesis inhibitor endostatin. Clinically, low-dose p.o. administration of rifampicin to six high-risk patients with hepatitis C virus-related liver cirrhosis resulted in a single occurrence of hepatocellular carcinoma during the follow-up period of 97.3 +/- 29.1 (mean +/- SD) months. Experimentally, rifampicin rapidly and markedly down-regulated the expression of a wide spectrum of angiogenesis-associated genes in growing human microvascular endothelial cells, thereby suppressing endothelial cell proliferation and migration. Rifampicin, at higher concentrations, also directly inhibited the growth of a variety of human cancer cells. P.o. administration of rifampicin significantly inhibited in vivo growth and metastases of subcutaneous human cancer xenografts. Thus, the potent antiangiogenic properties of oral rifampicin therapy were effective in suppressing cancer progression. It provides a promising new addition to antiangiogenic strategies for designing human cancer therapies. Considering the clinical pharmacokinetics of rifampicin, which enters the enterohepatic circulation and undergoes subsequent hepatic accumulation, it may be especially beneficial as an antitumor agent targeting hepatobiliary tumors.

Biology Dictates Prognosis Following Resection of Gallbladder Carcinoma: Sometimes Less is More

In this issue of Annals of Surgical Oncology, D’Angelica and colleagues from the Memorial Sloan–Kettering Cancer Center report data on the importance of extent of resection for gallbladder adenocarcinoma. The analyses reveal that extensive resections for gallbladder cancer are associated with increased morbidity, but not survival. These findings have important implications as some investigators have in the past advocated extended operations that combine major hepatic resection and routine common bile duct resection with reconstructive hepaticojejunostomy to improve longterm survival. Prognosis following surgery for gallbladder adenocarcinoma can vary dramatically, with 5-year survival rates ranging from 10% to 90%. As noted by the authors in their current report, outcome following surgery depends not only on the extent of the curative resection, but more importantly, on the stage of disease. D’Angelica and colleagues reaffirm the basic oncologic tenet that tumor biology—not extent of resection—is the dominate factor that dictates survival. Whether to perform empirically a nonanatomical resection or an anatomical resection for hepatobiliary malignancies of the liver has been controversial. Although some studies have reported that the performance of an anatomical resection improves tumor clearance and outcome, other reports have not demonstrated a benefit for anatomic or ‘‘extended’’ resections. In general, most surgeons have begun to advocate a more parenchymalsparing approach to resection of hepatobiliary tumors that still maintains a negative margin. In support of this, our group previously reported that the extent of hepatectomy for gallbladder carcinoma was not associated with prognosis. D’Angelica similarly noted that patients who underwent a major hepatectomy had a 5-year actuarial survival comparable to those patients who did not undergo major hepatic resection. However, unlike D’Angelica et al., we previously reported that, rather than extent of hepatic resection, surgical margin status was a key determinant of outcome. Specifically, R1/R2 margin status was associated with significantly worse long-term outcome. The failure of the current authors to find margin status to be a significant prognostic factor may be due to the laudatory fact that only nine patients in the series had a positive resection margin. As such, analyses involving margin status may have been underpowered. Regardless, we agree whole-heartedly with our colleagues that rather than dogmatically adhering to an extended versus nonextended surgical resection approach, the surgeon’s goal should be to resect all disease with negative histologic margins. Similar to the extent of hepatic resection, the wholesale adoption of a more extensive approach to the common bile duct may also be unwarranted. While some surgeons have advocated routine resection of the common bile duct at the time of curative resection and portal lymphadenectomy, other investigators have questioned this approach. The study by D’Angelica et al., as well as others, now provide data to show that routine bile duct excision is not necessarily associated with improved overall survival. The notion that resection of the common bile duct may facilitate a more thorough lymphadenectomy also has been questioned. As noted in the D’Angelica report, lymph node counts were similar regardless of whether a common bile duct resection had been performed. It is important to note that, while routine common bile duct resection was not associated with survival or lymph node yield, it was associated with increased morbidity. In fact, D’Angelica et al. noted a 33% incidence of grade 3/4 morbidity in the group of patients who underwent bile duct excision and reconstruction. Citing similar data showing no improvement in long-term survival, as well as the increased risk of Society of Surgical Oncology 2009

Biliary cystadenoma mimicking hydatid cyst

Sir, Biliary cystadenomas are rare hepatobiliary cystic tumors, more common in women. We report one such tumor that presented with obstructive jaundice and mimicked a hydatid cyst of the common bile duct (CBD). Cystadenoma was diagnosed only after biopsy but, due to wide excision, there was no residual or recurrent tumor. Biliary cystadenomas are rare cystic tumors that arise in the liver or less frequently in the extrahepatic biliary system. They are more common in middle-aged women, their most favored site being the right hepatic lobe. It is extremely rare for an intrahepatic cystadenoma to extend into the CBD. Less than 10 cases have been reported in the medical literature.[1] Presentation is frequently nonspecific: Patients may complain of abdominal pain, anorexia and nausea. Liver function tests are frequently abnormal and extrahepatic lesions tend to present with obstructive jaundice. A 20-year-old female was admitted with a 10-day history of jaundice and a 3-day history of increasing right upper quadrant colicky pain. She had also experienced previous intermittent episodes of jaundice. Liver function tests were abnormal on admission, with a serum bilirubin of 4.8 mg/dL and alkaline phosphatase of 22 KAU. An ultrasound scan revealed multiple coiled ascaris in the CBD, seen as bunches and also appearing calcified. Intrahepatic ducts and CBD were dilatated (16 mm). Periportal lymphadenopathy was present. There was a diagnostic dilemma with which an exploration was undertaken. At laparotomy, there were multiple cysts filling up the CBD and a perop diagnosis of hydatid disease was made. Excision of the cyst [Figure 1] with removal of an enlarged regional lymph node was performed and a T-tube was left in situ. Figure 1 Excised cystadenoma Histology showed the tissue to be cystadenoma. The patient had a smooth postoperative course with T-tube removal performed on the 14th postop day. She was discharged and closely followed-up. Biliary cystadenomas are rare and their similarity to hydatid disease can make them difficult to diagnose. The radiological appearance of biliary cystadenomas is quite specific. Ultrasound may show an anechogenic mass with internal septations that are highly echogenic, which, in our case, led us to think of it as calcified ascaris. Computed tomography helps with the finding of a smooth thick-walled cyst with fine internal septae,[2] but it could not be performed in this case due to financial constraints. At laparotomy, these lesions can be difficult to localize as they are usually soft, difficult to palpate and pose minimal or no resistance to biliary probes. Therefore, the use of intraoperative choledochoscopy and cholangiography[3] has been advocated. In 1892, the first case of successful resection for a biliary cystadenoma was reported.[4] Since this time several treatment strategies have been suggested: Simple enucleation, local excision either with a cuff of bile duct or liver and radical excision, including hemihepatectomy if appropriate. However, these tumors have a low malignant potential and unless excised completely, tend to reoccur. The largest reported series of 15 cases is by Lewis et al., who concluded that while formal lobar resection is frequently carried out, local complete excision is just as effective provided the neoplasm is entirely removed and is associated with low rates of morbidity.[5] In developing countries, a wide local excision with regular follow-up would be more appropriate considering the limited availability of adequate back up for a more radical procedure at most of the centers.

Mimics of Cholangiocarcinoma: Spectrum of Disease

Cholangiocarcinoma is the second most common primary malignant hepatobiliary neoplasm, accounting for approximately 15% of liver cancers. Diagnosis of cholangiocarcinoma is challenging and the prognosis is uniformly poor, with recurrence rates of 60%-90% after surgical resection. A wide spectrum of neoplastic and nonneoplastic conditions of the biliary tract may masquerade as cholangiocarcinoma, adding to the complexity of management in patients suspected to have cholangiocarcinoma. Mimics of cholangiocarcinoma constitute a heterogeneous group of entities that includes primary sclerosing cholangitis, recurrent pyogenic cholangitis, acquired immunodeficiency syndrome cholangiopathy, autoimmune pancreatitis, inflammatory pseudotumor, Mirizzi syndrome, xanthogranulomatous cholangitis, sarcoidosis, chemotherapy-induced sclerosis, hepatocellular carcinoma, metastases, melanoma, lymphoma, leukemia, and carcinoid tumors. These entities demonstrate characteristic histomorphology and variable clinicobiologic behaviors. The imaging findings of these disparate entities are protean and may be indistinguishable from those of cholangiocarcinoma. In most cases, a definitive diagnosis can be established only with histopathologic examination of a biopsy specimen.

Quality of life after liver resection for hepatobiliary malignancies

Few prospective longitudinal studies have used a validated quality of life (QOL) instrument in patients undergoing liver resection for hepatobiliary malignancy. Patients undergoing liver resection for hepatobiliary tumours in a 1-year period were enrolled. The cancer-specific European Organization for Research and Treatment of Cancer core questionnaire (EORTC QLQ-C30) was completed before operation, and at 6, 12 and 36-48 months after surgery. QOL over time was analysed in relation to several clinical factors. A total of 103 patients were enrolled. Patient compliance was at least 75 per cent at all stages. Most functional scales and the global QOL scale showed a non-significant trend towards deterioration at 6 months and a return to preoperative level at 12 months. Physical functioning and dyspnoea deteriorated significantly at 6 months (P = 0.020 and P = 0.004 respectively) and did not recover by 12 months (P = 0.002 and P < 0.001 respectively). Pain and fatigue showed clinically significant deterioration over 12 months, which was not statistically significant. Survivors without recurrence at 36-48 months showed better QOL than those with recurrent disease. Major liver resection is associated with acceptable QOL outcomes, and QOL continues to improve in the long term in those without recurrence.

PET/CT for evaluation of hepatobiliary and pancreatic tumors

PET/CT技术是近年来肿瘤诊断与病情程度判断最精确的功能影像学检查方法,在美国,该技术在肺癌的临床实践中发挥了极大的作用.消化系统肿瘤是我国目前发病率最高的恶性肿瘤,有关PET/CT在消化系统肿瘤诊断与病情程度判断中价值的初步研究结果令人鼓舞,其临床应用潜力备受关注。

Biliary tract cancers: From pathogenesis to endoscopic treatment

Cholangiocarcinoma is the second most common hepatobiliary tumour. Even if it is a rare tumour, its incidence is increasing over these last decades, probably due in part to a better knowledge of the disease and to an improvement of the diagnosis. Accurate diagnosis and staging are key steps to determine the appropriate treatment. The only curative treatment of this cancer is surgical resection. To date, no neoadjuvant or adjuvant treatments have ever proved any survival benefit, and are not recommended outside clinical trials. Liver transplantation (with or without neoadjuvant treatment) can be an option for highly selected cases. Unfortunately, these tumours are generally diagnosed at an advanced stage or are unresectable. For most of these patients, palliative therapeutic options exist and are in further development, based on multimodal promising combinations including chemotherapy, targeted agents, radiation, endoscopic stenting and photodynamic treatment.

Radiofrequency Ablation Versus Resection for Resectable Colorectal Liver Metastases: Time for a Randomized Trial?

Radiofrequency Ablation Versus Resection for Resectable Colorectal Liver Metastases: Time for a Randomized Trial?

CT Angiography for Delineation of Celiac and Superior Mesenteric Artery Variants in Patients Undergoing Hepatobiliary and Pancreatic Surgery

The objective of our study was to determine the frequency of different arterial variants identified at abdominal CT angiography (CTA) performed before pancreatic and hepatobiliary surgery. Variant hepatic and celiac arterial anatomy is common. CTA can be used to identify common and uncommon variants that are important for the surgical management of patients with pancreatic and hepatobiliary neoplasms.

Adult liver abscess: characteristics of patients living in rural north-eastern Taiwan

This study aimed to analyse the characteristics of adult liver abscess (LA) patients living in rural townships of Taiwan. We retrospectively screened the electronic admission records of a rural community hospital located in north-eastern Taiwan from 1 April, 2002 to 30 April, 2006. Relevant data, including subjects' basic characteristics, laboratory findings and infectious microorganisms, were extracted. Fifty-six subjects (mean age: 66.1 +/- 15.9 years; range: 23-94 years) were enrolled; one patient had an amoebic LA and 55 had pyogenic LA. Five subjects died in hospital. Overall, 80.5% of patients complained of having a fever, 87.5% had single abscess, 71.4% had right hepatic lobe involvement and 58.9% underwent invasive drainage. Most subjects (66.1%) did not have diabetes mellitus, 94.6% did not have a hepato-biliary tumour, 73.2% did not have gallstones, 78.6% did not have hepatitis and 87.5% did not have prior hepato-biliary surgery. Klebsiella pneumoniae was the most common infecting microorganism. Previous hepato-biliary surgery and serum creatinine >2.0 mg/dl were significantly more common in patients >or=65 years of age (p = 0.031). Diabetes mellitus was more common in female subjects (p = 0.021). Invasive drainage and single abscess were not significantly correlated to prognosis. Adult LA patients living in rural north-eastern Taiwan have different characteristics than patients living in urban areas. Geriatric LA patients should be managed cautiously because of the possibility of renal insufficiency or previous hepato-biliary surgery. Female LA patients should be evaluated for the presence of diabetes mellitus.