Portion Of Nodes Research Articles

Relationship between the expression of β-glucuronidase mRNA in hepatocellular carcinoma tissue and the clinicopathologic factors

Objective To investigate the relationship between the expression of β-glucuronidase mRNA in hepatocellular carcinoma(HCC)tissue and the clinicopathologic factors.Methods The expressions of β-glucuronidase mRNA in 25 samples of HCC tissue and 10 samples of normal hepatic tissue were detected by RT-PCR,and the relationship between β-glucurenidase mRNA in HCC tissue and clinicopathologic factors was analyzed.Results The expression of β-glucuronidase mRNA in HCC tissue was not influenced by the age of patient,tumor size and alpha-fetoprotein level.The expression of β-glueuronidase mRNA in patients with portal vein tumor thrombus or lymph node metastasis Was significantly higher than those without(t=7.857,9.341,P＜0.05).Conclusions The expression of β-glucuronidase mRNA is closely related to the existence of portal vein tumor thrombus and lymph node metastasis.β-glucuronidase may play a role in the invasion and metastasis of HCC. Key words: Carcinoma,hepatocellular; β-glucuronidase; Pathology,clinical

Roles of Chemokine Receptor 4 (CXCR4) and Chemokine Ligand 12 (CXCL12) in Metastasis of Hepatocellular Carcinoma Cells

Chemokines are involved in human hepatocellular carcinoma (HCC) carcinogenesis. However, the exact mechanism of chemokines in HCC carcinogenesis remains unknown. Here we investigated the roles of chemokine receptor 4 (CXCR4) and chemokine ligand 12 (CXCL12) in the metastasis of HCC. We found that the expression levels of CXCR4 mRNA in HCC tissues, MHCC97 cells, and HUVEC cells were 2.52 +/- 1.13, 2.34 +/- 1.16 and 1.63 +/- 1.26, respectively and that the CXCR4 protein levels were 1.38 +/- 0.13, 1.96 +/- 0.32 and 1.86 +/- 0.21, respectively. In contrast, CXCR4 was not detected in normal hepatic tissues. In 78 HCC patients, we also found that the concentration of CXCL12 in cancerous ascitic fluid was 783-8,364 pg/ml and that CXCL12 mRNA level in HCC metastasis portal lymph nodes was 1.21 +/- 0.87 but undetectable in normal hepatic tissues. Finally we discovered that recombinant human CXCL12 could induce MHCC97 cells and HUVEC cells to migrate with chemotactic indexes (CI) of 3.9 +/- 1.1 and 4.1 +/- 1.6, respectively. Cancerous ascitic fluid could also induce the migration of MHCC97 cells with a CI of 1.9 +/- 0.8. Thus, our data suggest that CXCR4 and CXCL12 may play an important role in the metastasis of HCC by promoting the migration of tumor cells.

CT diagnosis of the carcinoma of bile duct: an analysis of 46 cases

Objective To investigate the CT diagnosis of patients with the carcinoma of bile duct. Methods The data of 46 patients who were treated with surgery, percutaneous puncture biopsy and pathologically confirmed to have the carcinoma of bile duct were collected, and the manifestations of CT plain scanning and dynamic enhancement scanning were retrospectively analyzed. Results The liver CT plain scanning of the carcinoma of intrahepatic bile duct was manifested as similar round and irregular low-density tumor, intrahepatic cholangiectasis was observed in 66.7%, and atrophy of liver lobe was observed in 41.7%; the enhancement scanning was manifested as mild enhancement of peripheral tumor at the arterial phase. The delayed scanning showed that as time elongated, the focus became enhanced gradually, especially that after 9 minutes, the intensities of all the loci were higher than those of normal liver parenchyma. The carcinoma of bile duct at hilus hepatis all displayed as intrahepatic cholangiectasis, and the forms appeared as vine. 21 patients were displayed as soft tissue tumors of hepatic hilar region. Another 3 patients were only displayed as the thickening, stenosis or discontinuation of bile duct wall, and could be accompanied by portal lymph node, the lymph node of posterior abdominal membrane, epoploon metastasis and abdominal dropsy. The carcinoma of extrahepatic biliary duct was manifested as intrahepatic and extrahepatic cholangiectasis, the augmentation of cholecyst, the sudden desection of common bile duct or irregular stenosis of common bile duct. Conclusion CT can clearly display the lesion of the carcinoma of bile duct, the degree of cholangiectasis, and the range of surrounding infiltration, and CT is very significant in detecting the carcinoma of bile duct at early period. Key words: Bile duct neoplasms; Tomography; X-ray computer; Diagnostic imaging

78-Year-Old Man With Emesis and Jaundice

78-Year-Old Man With Emesis and Jaundice

Preoperative Portal Vein Embolization for Major Liver Resection

Preoperative portal vein embolization (PVE) is used clinically to prevent postoperative liver insufficiency. The current study examined the impact of portal vein embolization on liver resection. A comprehensive Medline search to identify all registered literature in the English language on portal vein embolization. Meta-analysis was performed to assess the result of PVE and its impact on major liver resection. A total of 75 publications met the search criteria but only 37 provided data sufficiently enough for analysis involving 1088 patients. The overall morbidity rate for PVE was 2.2% without mortality. Four weeks following PVE, 85% patients underwent the planned hepatectomy (n = 930). Twenty-three patients had transient liver failure following resection after PVE (2.5%) but 7 patients developed acute liver failure and died (0.8%). The reason for nonresection following PVE (n = 158, 15%) included inadequate hypertrophy of remnant liver (n = 18), severe progression of liver metastasis (n = 43), extrahepatic spread (n = 35), refusal to surgery (n = 1), poor general condition (n = 1), altered treatment to transcatheter artery embolization or chemotherapy (n = 24), complete remission after treatment with 3 cycles of fluoracil and interferon alpha in a patient with hepatocellular carcinoma (n = 1), incomplete pre- or postembolization scanning (n = 8). Of those who underwent laparotomy without resection, (n = 27) reasons included intraoperative finding of peritoneal dissemination (n = 15), portal node metastasis (n = 2), severe invasion of the tumor to the hepatic artery and portal vein (n = 1), and gross tumoral extension precluding curative resection (n = 9). Two techniques were used for portal vein embolization: percutaneous transhepatic portal embolization, (PTPE) and transileocolic portal embolization, (TIPE). The increase in remnant liver volume was much greater in PTPE than TIPE group (11.9% vs. 9.7%; P = 0.00001). However, the proportion of patients who underwent resection following PVE was 97% in TIPE and 88% PTPE, respectively (P = <0.00001). Although there was no significant difference in patients who had major complications post-PVE, the rate for minor complications was significantly higher among patients who had PTPE (53.6% vs. 0%, P = <0.0001). PVE is a safe and effective procedure in inducing liver hypertrophy to prevent postresection liver failure due to insufficient liver remnant.

Loss of p53 and Ink4a/Arf Cooperate in a Cell Autonomous Fashion to Induce Metastasis of Hepatocellular Carcinoma Cells

Hepatocellular carcinoma (HCC) is a leading cause of cancer-related death worldwide. HCC patients frequently present with disease that has metastasized to other regions of the liver, the portal vein, lymph nodes, or lungs, leading to poor prognoses. Therefore, model systems that allow exploration of the molecular mechanisms underlying metastasis in this disease are greatly needed. We describe here a metastatic HCC model generated after the somatic introduction of the mouse polyoma virus middle T antigen to mice with liver-specific deletion of the Trp53 tumor suppressor locus and show the cell autonomous effect of p53 loss of function on HCC metastasis. We additionally find that cholangiocarcinoma also develops in these mice, and some tumors display features of both HCC and cholangiocarcinoma, suggestive of origin from liver progenitor cells. Concomitant loss of the Ink4a/Arf tumor suppressor locus accelerates tumor formation and metastasis, suggesting potential roles for the p16 and p19 tumor suppressors in this process. Significantly, tumor cell lines isolated from tumors lacking both Trp53 and Ink4a/Arf display enhanced invasion activity in vitro relative to those lacking Trp53 alone. Thus, our data illustrate a new model system amenable for the analysis of HCC metastasis.

Complete remission of hepatocellular carcinoma with portal vein tumor thrombus and lymph node metastases by arterial infusion of 5-fluorouracil and interferon-α combination therapy following hepatic resection

We report two cases of hepatocellular carcinoma (HCC) with portal vein tumor thrombus (PVTT) and lymph node (LN) metastases successfully treated by hepatic arterial infusion of 5-fluorouracil (5-FU) combined with systemic injection of interferon (IFN)-alpha following hepatic resection for the liver tumor. Complete remission was obtained. Case 1 was a 51-year-old man who had HCC in the right lobe of the liver with PVTT and multiple intrahepatic metastases. He also had abdominal and mediastinal LN metastases. Case 2 was a 53-year-old man who had diffuse-type HCC in the right lobe of the liver with PVTT and intrahepatic metastases. A chest computed tomography scan revealed lymph nodes enlarged to 1.0 cm from the mediastinum to the left supraclavicular space. Both patients underwent the hepatectomy to reduce the tumor volumes and remove the PVTT to relieve portal vein obstruction. Following the surgery, the patients underwent IFN-alpha/5-FU combination therapy. Three months after this combined therapy, tumor markers (both alpha-fetoprotein and protein induced by vitamin K absence or antagonist II) returned to the normal range and residual tumors in the liver disappeared. The patients are alive without any recurrence more than 1 year after initial treatment. IFN-alpha/5-FU combined therapy following hepatic resection is a promising modality for the treatment of advanced HCC with LN metastasis.

GALL BLADDER POLYPS IN SCLEROSING CHOLANGITIS: DOES THE 1‐CM RULE APPLY?

Polyps of the gall bladder (PLG) are common findings in radiological investigations of the gall bladder and most are benign although carcinoma of the gall bladder can arise in PLG. In the general population PLG less than 1 cm in diameter are thought to have a low risk of malignancy and can be cautiously observed. All patients undergoing surgical resection for gall bladder cancer were entered into a prospective database. Four patients with primary sclerosing cholangitis (PSC) presenting with gall bladder cancer in a PLG are studied. Four patients (two men; median age 46.5 years, range 37-71 years) presented with PLG and known histories of PSC. All patients were shown to have PLG of size between 7 mm x 8 mm and 25 mm x 14 mm on imaging with no radiological evidence of carcinoma. Tumour markers carcinoembryonic antigen and CA19-9 were within the normal range in all patients. All patients were managed with cholecystectomy. Two patients with T1 tumours remain alive and well at 2 and 4 years post-cholecystectomy. Of the remaining two patients with T2 tumours, one underwent re-resection of the liver bed and portal lymph nodes and remains alive and well at 12 months. The remaining patient developed an abdominal wall recurrence 12 months after cholecystectomy. She has also undergone resection with postoperative radiation therapy and remains well after 12 months of clinical follow up. Gall bladder polyps, which are common and are usually benign in the general population, are often malignant in PSC. Regardless of size, any PLG in a patient with PSC should be considered for cholecystectomy.

Expression and clinical significance of Ephrin-A1 in primary hepatocellular carcinoma

To investigate the expression and clinical significance of Ephrin-A1 mRNA and protein expression level in hepatocellular carcinoma. Reverse transcription polymerase chain reaction (RT-PCR) and immunohistochemistry technique were used to detect the expression of the Ephrin-A1 mRNA and protein of 40 cases of hepatocellular carcinoma and their corresponding para-cancerous tissues and 10 cases of normal liver tissues. The relationships with its clinical pathology characters were analyzed. The mRNA of Ephrin-A1 was expressed in all of the 40 cases of hepatocellular carcinoma and their corresponding para-cancerous tissues and 10 cases of normal liver tissues. Semiquantitative analysis showed that the mRNA expression level of Ephrin-A1 in hepatocellular carcinoma (0.5413 +/- 0.1527) was greater than that in corresponding para-cancerous tissues (0.3895 +/- 0.0549, P < 0.05) and normal liver tissues (0.3770 +/- 0.1055, P < 0.05); but between corresponding para-cancerous tissues (0.3895 +/- 0.0549) and normal liver tissues (0.3770 +/- 0.1055), the mRNA expression level had no significant difference (P > 0.05). The positive rates of Ephrin-A1 protein were 20% (2/10) in normal tissues, 35% (14/40) in para-cancerous tissues and 62% (25/40) in hepatocellular carcinoma tissues, respectively; the protein expression level of Ephrin-A1 was gradually rising (chi(2) = 14.762, P < 0.05). The overexpression of Ephrin-A1 protein was correlated with histological differentiation, tumor thrombi in portal vein and lymph node metastasis (P < 0.05). The overexpression of Ephrin-A1 protein is correlated with histological differentiation, the lymph node metastasis and tumor thrombi in portal vein. It indicates that Ephrin-A1 may play an important role in the malignancy transformation, invasion progression and metastasis of hepatocellular carcinoma.

Prognostic significance of osteopontin in hepatitis B virus-related hepatocellular carcinoma

Background and aims Osteopontin (OPN) is known to be associated with metastasis in many types of cancers. Since OPN is a highly phosphorylated and glycosylated protein, the modification after transcription is very important to its function. In hepatocellular carcinoma (HCC), the elevated expression of OPN at mRNA levels and its relationship with metastasis and poorer prognosis of the patients have been reported. However, the prognostic impact of OPN at protein levels on the patients with hepatitis B virus (HBV)-related HCC after hepatectomy is still limited. Patients and methods The expression of OPN was examined at protein level by using immunohistochemistry in 72 patients who underwent hepatectomy for HBV-related HCC, and its prognostic significance in disease-free and overall survival of the patients was also analyzed by log-rank test and multivariate Cox regression analyses. Results Thirty-nine of 72 (54.17%) HBV-related HCC specimens were positive for OPN with cytoplasmic staining. OPN was highly expressed in the specimens with capsular infiltration compared to those without ( P < 0.05), and also was significantly related with portal vein invasion ( P < 0.01) and lymph node invasion ( P < 0.01). The mean disease-free survival (DFS) was only 13.55 ± 14.77 months when the HBV-related HCC specimens highly expressed OPN compared to 36.00 ± 18.68 months for those with low expression ( P < 0.001). The overall survival (OS) of the patients was 18.63 ± 17.28 months when the HCC over-expressed OPN compared to 42.59 ± 16.85 months for HCC with the low expressed OPN ( P < 0.001). Multivariate analysis showed that OPN over-expression was the strongest independent adverse prognostic factor for both DFS ( P = 0.01) and OS ( P = 0.014). Conclusions OPN over-expression was closely related to capsular infiltration, venous invasion, lymph node metastasis, and also with worse prognosis, suggesting that OPN might be deemed as a useful molecular marker for predicting the prognosis of HCC.

Hepatic metastasectomy following FOLFOX therapy in patients with colorectal metastases

13523 Background: Advances in systemic therapy for metastatic colon cancer may render patients (pts) candidates for hepatic metastasectomy (HM) with curative intent. We retrospectively reviewed our experience with HM following oxaliplatin chemotherapy. Methods: Pts were identified from the records of 5 surgeons who performed HM at two institutions. Pts were included if FOLFOX (bolus 5-FU/leucovorin d1 or d 1 + 2, followed by 46 hour 5-FU infusion; oxaliplatin 85–130mg/m2 d 1 q 14 d) chemotherapy had been given for &gt; 1 cycle prior to HM and complete resection of hepatic metastases was achieved. Data on radiographic (RECIST) and pathologic response and outcome were collected. Pathologic complete response (pCR) was defined as no residual cancer. Near pCR was defined as residual mucin in the liver, without residual cancer cells, or necrosis with atypical glands. Results: Thirty-six pts were identified. Males 21/36, median age 55 (range 37–77), rectum/rectosigmoid primary 5 (13.9%), adenocarcinoma 100%, synchronous metastases or metastases within 6 months (m) of primary diagnosis 24/32 (75%), median cycles of FOLFOX = 7 (range 2 to &gt;30), bevacizumab (B) 9 (25%). Mean number of hepatic lesions pre-chemotherapy 1.9 (range 1–7), tumor size 1 to &gt;10cm. Radiographic responses to pre-operative FOLFOX included partial response (PR) 9/30 (30%), CR 2/30 (6.7%), progressive disease 3/30 (10%), stable disease 16/30 (53.5%). Operations included right (R) hepatectomy 12, extended (ext) R hepatectomy 3, partial R hepatectomy 2, left (L) hepatectomy 3, partial L hepatectomy 1, ext L hepatectomy 1, trisegmentectomy 2, caudate lobectomy 1, multiple wedge resections ± radiofrequency ablation 7. pCR 2 (5.6%); near pCR 3 (8.3%). At a median follow up of 12.9 m from HM, 9/36 (25%) recurred; liver only (3), portal lymph nodes (1), other extrahepatic sites (5). One pt died at 18.3 m. Conclusions: HM after FOLFOX chemotherapy, with or without B, results in a high progression-free and overall survival at 12.9 m. This retrospectively identified population included pts with conventionally adverse prognostic features including rectal cancers, synchronous metastases, large lesions and/or high lesion number. Prospective studies of the utility of pre-HM chemotherapy are warranted. [Table: see text]

Expressing the Surgery First Position on Treatment of Synchronous Colorectal Metastases in the Asymptomatic Patient

The patient is asymptomatic with synchronous hepatic metastases from a colorectal primary tumor. The options for treatment would be to resect the colorectal primary tumor and treat the liver metastases or to give chemotherapy first and then see if resection is feasible. The ultimate goal of every cancer surgeon is to cure the patient. For the vast majority of patients with metastatic disease, this is impossible. In those situations, surgery must be used as a palliative tool; thus, extirpative surgery is generally not needed in the asymptomatic patient, especially with the advent of new chemotherapy agents that have such good response rates in patients with colorectal cancer. However, in the patient with synchronous liver metastases only, there remains a chance for cure, and that chance should always be pursued. New data about hepatic artery infusions in the face of unresectable liver metastases show extremely high response rates in the liver and make the chance of converting patients disease into resectable lesions a possible reality. Thus, in a patient who is capable of undergoing surgery and who has a primary colorectal cancer and liver metastases only, the best treatment would be a resection of the primary cancer and placement of a hepatic artery infusion pump for unresectable disease or resection of the liver metastases and placement of a hepatic artery infusion pump. Treatment with systemic chemotherapy before surgery would not help the situation and may allow potentially curable disease to become too large for resection. Synchronous hepatic metastases from colorectal primary tumors occur in approximately 20% of patients with colorectal cancer. The question of operability of the hepatic lesions does not hinge on whether or not the metastases are synchronous. Because patients with synchronous disease can also have 5-year survivals of >25%, they should not be excluded from hepatic resection. The important factors for assessing whether colorectal metastases are resectable have been assessed by two groups with large retrospective studies. Both of these groups were addressing patients with metastases confined to the liver, and thus patients with portal lymph nodes involved with tumor, with carcinomatosis, or with lung or other organ metastases were not considered good candidates for hepatic resection. One of the systems was developed by Dr. Yuman Fong at Memorial Sloan-Kettering Cancer Center and included five clinical criteria. They were (1) the nodal status of the primary tumor, (2) the disease-free interval from the time of the primary operation to discovery of liver metastases (£12 or >12 months), (3) more than one tumor, (4) a preoperative carcinoembryonic antigen level >200 ng/mL, and (5) largest tumor >5 cm. Each negative criterion was assigned one point, and the 5-year survivals were calculated. For patients with a score of 0, the 5-year survival was 60%, compared with 14% for those with Received July 27, 2005; accepted October 24, 2005; published online January 16, 2006. Address correspondence and reprint requests to: M. Margaret Kemeny, MD, FACS; E-mail: kemenym@nychhc.org

Metastatic Colorectal Carcinoma: Pushing the Surgical Envelope of Cure

Over the last 25 years, surgical resection for hepatic colorectal metastases (HCM) has progressed through various phases of enthusiasm. In the 1980s, considerable cynicism existed, and William Silen stated that ‘‘hepatic resection for metastases from colorectal carcinoma is of dubious value’’ and suggested that the benefit was primarily due to the natural history of the disease. 1 Those who supported surgical resection proposed a very cautious approach with eligible candidates limited to ‘‘only highly selected young patients with a solitary lesion...’’ The multi-institutional collective series reported by Hughes et al. 2 established that hepatic resection for HCM altered the natural history of the disease and provided a 5year actuarial survival of 33%. In historical series of unresected patients, the reported median survival is 6 to 9 months, with very few survivors at 5 years and none recorded at 10 years. In contrast, studies of hepatic resection with long-term follow-up have demonstrated a 10-year survival rate of 22% to 24%, 3 and several authors have reported survival periods of longer than 20 years after hepatic resection. Despite the lack of a confirmatory prospective randomized trial, surgical resection for HCM has become the standard approach. However, such a curative approach can be offered to only 10% to 15% of patients with colorectal cancer, because it has traditionally been contraindicated in the presence of extrahepatic disease, particularly portal lymph node metastases. 2 Bilobar, multiple, and/or large metasta

TNM classification for perihilar cholangiocarcinoma: comparison between 5th and 6th editions of the AJCC/UICC staging system

A few investigators have evaluated the TNM classification for perihilar cholangiocarcinoma. The new sixth edition of the American Joint Committee on Cancer (AJCC)/Internal Union Against Cancer (UICC) staging system focuses on vascular invasion and regional lymph node metastasis. For 166 patients with perihilar cholangiocarcinoma undergoing R0 resection, survival curves stratified according to TNM classifications were compared between fifth and sixth editions. The previous T3 now is divided into T3 and T4. Most new pT4 patients had invasion of the portal bifurcation; their survival was poorer than that for new pT3 patients. The 5-, 10-, and 15-year survival rates were worse in the previous stage III than in the previous stage IVA, although the difference fell short of significance. The previous stage IVA (T3 Any NM0) is divided into new stages: IIA (T3N0M0), IIB (T1-3N1M0), and III (T4 Any NM0). All patients in stage III had invasion of the portal bifurcation. Survival was similar between stages IA, IB, and IIA, while patients with T4N0M0 tumors survived longer than those with T4N1M0 tumors and similarly to those with stage IIB tumors. The sixth edition provided improved prediction of survival in patients with perihilar cholangiocarcinoma; for still better prediction, cancer invasion of the portal bifurcation and regional lymph node metastasis should be weighted equally.

Gallbladder Cancer

intervention was wrong in 62% of their patients. In 50% of the patients, the initial diagnosis was a benign biliary disorder such as biliary colic (24%), acute colicystitis (12%), or choledocholithiasis (5%). In another 12% of patients, the gallbladder cancer was confused with a perihilar cholangiocarcinoma. As a result, 31% of the patients underwent a cholecystectomy prior to referral, and of the 51 patients who were explored, 50% had a biliary stent placed prior to surgery. These observations document that gallbladder cancer is difficult to diagnose and that treatment at a referral center is frequently complicated by prior interventions. Dixon et al 1 achieved their excellent results with the infrequent use (5%) of staging laparoscopy, an aggressive approach to liver (45%) and bile duct (30%) resection, a modest portal lymph node dissection, rare (2%) pancreatoduodenectomy, and the occasional use of primarily palliative chemotherapy (17%) and radiation therapy (5%). While most hepatobiliary surgeons agree with the philosophic concept of an “aggressive approach,” considerable controversy exists with respect to the most appropriate pre-, intra-, and postoperative management. Thus, the remaining question in the management of patients with gallbladder cancer is exactly what constitutes an “aggressive approach”? Ongoing advances in computed tomography and magnetic resonance imaging have helped with preoperative staging and the decision to explore the patient. 2 The presence of major vascular encasement or metastases should lead to a nonoperative approach. However, approximately two thirds of patients with T-3 and 80% of patients with T-4 gallbladder cancers will have liver and/or peritoneal mestastases. 3 Thus, the yield of staging laparoscopy is very high in patients with larger gallbladder cancers, and frequent employment of this procedure will often establish a tissue diagnosis and avoid an unnecessary operation.

Is portal venous outflow better than systemic venous outflow in small bowel transplantation? Experimental study in syngeneic rats

Background/Purpose Blood drainage of the graft into the recipient portal vein reestablishes the physiological venous outflow after small bowel transplantation (SBT). However, although this approach is likely beneficial for the host, it may be technically more demanding making portocaval venous drainage the preferred arrangement during human SBT. The aim of this study was to examine in a syngeneic model of SBT the possible benefits of portoportal anastomosis (PPA) vs portocaval anastomosis (PCA) in terms of body and organ weights and bacterial translocation. Methods Syngeneic SBT was carried out in 25 Brown-Norway male rats weighing 249 ± 17.5 g using either PPA (n = 13) or PCA (n = 12). Half the animals in each group were killed, respectively, on postoperative day 2 or 7. Liver, spleen, and lungs were weighed and under sterile conditions the regional lymph nodes were excised. The nodes and venous samples from the cava and portal veins were cultured for aerobes and anaerobes. Bacterial components were detected in blood by polymerase chain reaction. The findings in both groups were compared by χ 2 or Mann-Whitney U tests. Results Mean postoperative body weight change was −3.6% ± 1.5% in PPA and −6.0% ± 1.2% in PCA animals (ns) on day 2 and −6.5% ± 2.6% and −8.0% ± 5.0% (ns) on day 7. Liver, spleen, and lung weights were not significantly different between both groups on either end point. Gram-negative enteric bacteria were found in 3 of 7 PCA animals and 2 of 6 PPA animals at day 2 (ns) and in 1 of 6 and 4 of 6 on day 7 (ns). Aerobic gram-positive bacteria were found in 1 of 7 and 1 of 6 (ns), 3 of 6 and 3 of 6 (ns), respectively, in the 4 groups. Most positive cultures corresponded to portal blood and lymph node samples. There were no anaerobic growths. Conclusions - No body or organ weight change suggesting significant functional advantages of one technical alternative over the other could be demonstrated. - Bacterial translocation in the absence of rejection was frequent after SBT independently of the variety of venous outflow used. No difference in bacterial translocation between both anastomosis could be demonstrated. - Orthotopic venous drainage did not seem to be advantageous in the present experimental setting.

Incidentally discovered gallbladder cancer: role of cryotherapy.

Carcinoma of the gallbladder is the most common malignancy of the biliary tree. There is no standard surgical approach to the treatment of gallbladder cancer. Extended cholecystectomy with partial or complete hepatic lobectomy has resulted in high morbidity and poor long-term survival. This report describes cryotherapy of the gallbladder fossa as an alternative to liver resection in the treatment of gallbladder cancer. A group of patients underwent cryotherapy to the gallbladder fossa for local control of gallbladder cancer. Portal lymph node dissection was performed at the same time and patients with positive lymph nodes received post-operative chemotherapy and radiation; negative node patients were observed. Seven patients underwent surgery. Gallbladder cancer had been incidentally found in all patients. Median hospital stay was 4 days. Five patients had positive nodes. Complications included biliary stricture, pleural effusion, congestive heart failure exacerbation, and pulmonary embolus. Mean disease-free survival for patients with T2 tumors was 11.7 months. Mean disease-free survival for patients with T3 tumors was 16.3 months. Mean disease-free survival for lymph node positive patients was 14.8 months compared to 13 months for node negative patients. No local recurrences have been detected in the gallbladder fossa. This study suggests cryotherapy to the gallbladder fossa done concomitantly with portal lymph node dissection may represent a safe and effective alternative to hepatic resection in the treatment of gallbladder cancer.

Individualizse the treatment of liver metastases from colorectal cancer using RAND appropriateness method: Oncosurge decision model. Results of a consensus detecting from the international taskforce group

3595 Background: Less than 20% of patients with colorectal liver metastases (CLM) are suitable for liver resection with curative intent. Recent studies suggested that the use of oxaliplatin based neoadjuvant chemotherapy may increase this figure to 30–40% of all patients. However, there is no consensus that determine which patients might benefit from such chemotherapy and subsequently have the chance of coming to curative liver surgery. It will be many years before clinical trials addressing this question are able to report. The aim of this project was to create a therapeutic decision model using the RAND Appropriateness Method. Methods: Following a comprehensive literature review, an international panel of liver surgeons, oncologists and radiologists (16 in total) provided both quantitative and qualitative expressions of opinion concerning the resectability of CLM. During 2 panel meetings a consensus was detected regarding specific patient characteristics in decision making for CLM resection. These characteristics are: contraindications; primary tumour characteristics and CLM characteristics. All characteristics were applied to appropriateness relating to resection and chemotherapy. The appropriateness of each therapeutic decision was assessed by the panel for all possible patient scenarios. Results: Consensus was agreed that features which totally pre-clude consideration for resection included not-treatable extra-hepatic disease, unfit for surgery, CLM involvement of >70% liver or 6 segments. Optimal type (5FU/LV, oxaliplatin, irinotecan) and sequences of chemotherapy pre and post resectability were evaluated. Other specific data relating to CLM (number and size of mets, resection margin, portal nodes) will be presented. Conclusions: This validated decision model tool would help healthcare providers to analyse the appropriateness of liver resection alone or in association with optimal chemotherapeutic sequence based upon individual patient and tumour characteristics. This tool will be available on academic website. Author Disclosure Employment or Leadership Consultant or Advisory Stock Ownership Honoraria Research Funding Expert Testimony Other Remuneration Sanofi-Synthelabo Evidis Sarl; Pfizer; Sanofi-Synthelabo Pfizer; Sanofi-Synthelabo Sanofi-Synthelabo Sanofi-Synthelabo

Hepatic resection in stage IV colorectal cancer: prognostic predictors of outcome.

Hepatic resection has been proposed as an effective way to treat metastatic colorectal carcinoma. The aim of the study was to determine if contemporary resection of intestinal primary tumor and hepatic metastases is effective in the treatment of patients with metastases that are recognized at the initial clinical presentation of the primary tumor. In a retrospective study, univariate and multivariate models were used to analyze the effect of patient demographics, tumor characteristics, and treatment factors on early and long-term outcome of patients submitted to synchronous intestinal and hepatic resection for colorectal liver metastases. From 1988 to 1999, 78 patients underwent surgical resection of primary colorectal tumor and hepatic metastases with curative intent. Criteria for study recruitment included primary tumor controllable, no extrahepatic disease detectable, and negative surgical margins of hepatic resection. The univariate analysis disclosed as adverse predictors of the long-term outcome the numbers of metastases (</=3; >3), pre-operative CEA value >100 ng/ml, resection margin <10 mm, and portal nodal status. Multivariate analysis confirmed number of metastases, resection margin and portal nodal status as independent predictors. Our findings confirm hepatic resection as an effective procedure when undertaking combined bowel and hepatic resection. The applicability and the outcome of this surgical strategy is definitively influenced by the chance of a radical resection of the primary tumor, the number of hepatic metastases, resection margin wider than 1 cm, positive portal nodes, and the absence of any extrahepatic metastatic disease.

Critical assessment of the methods used for detection of bacterial translocation.

Bacterial translocation (BT) can be demonstrated by blood and lymph node cultures and also by polymerase chain reaction (PCR) detection of DNA of enteric bacteria. Aiming at investigating BT after gastrointestinal operations we assessed it on two endpoints after ischemia-reperfusion (IR) or sham operation (SO). 2 groups of 200-g Brown Norway male rats were treated as follows: SO animals ( n=12) had laparotomy alone and IR animals ( n=12) had successively 15 min clamping of the portal vein and the mesenteric artery. Half the animals in each group were killed on postoperative (p.o.) day 2 the other half on p.o. day 7. Under sterile conditions regional lymph nodes and vena cava and portal vein blood samples were recovered and cultured for aerobes and anaerobes. Escherichia coli beta-galactosidase DNA was assessed in blood samples by PCR. The findings in the two groups were compared by means of chi(2) tests. Post-hepatic (peripheral blood) BT was detected by cultures of gram-negative bacteria in 16% and 0% of SO and IR animals, respectively, on p.o. day 2 and in 16% and 50% on p.o. day 7. These differences were not significant (ns). E. coli DNA was found in one SO rat. Pre-hepatic BT (portal blood and/or lymph nodes) of gram-negative bacteria was found in 16% and 33%, respectively, on day 2 and in 16% and 16% on day 7 (ns). However, if gram-positive cultures were taken into account, the figures were 66% and 66% on day 2 and 66% and 83% on day 7 (ns). No anaerobes could be cultured. (1) BT is frequent in surgically manipulated animals. (2) To limit the assessment of BT to Enterobacteriaceae is probably misleading, since consistent amounts of gram-positive bacteria are found in the pre-hepatic territory. (3) PCR tests limited to E. coli DNA alone are likely incomplete. (4) Short periods of vascular clamping do not increase BT on the two endpoints selected in comparison with SO animals.