Resection Of Primary Liver Cancer Research Articles

Study on the application of perioperative nutrition management in accelerated rehabilitation surgery in patients with laparoscopic primary liver cancer resection.

Study on the application of perioperative nutrition management in accelerated rehabilitation surgery in patients with laparoscopic primary liver cancer resection.

Clinicopathological features of cholangiolocarcinoma and impact of tumor heterogeneity on prognosis: A single institution retrospective study.

Cholangiolocarcinoma (CLC) is an extremely rare tumor classified as a subtype of small duct-type intrahepatic cholangiocarcinoma (iCCA). There are few detailed reports on CLC and the prognostic impact of tumor heterogeneity is not clear. Between April 2006 and June 2022, of the 774 primary liver cancer resection cases who presented at Kanazawa University Hospital, 14 patients were pathologically diagnosed with CLC through immunohistochemical analysis of their molecular and biological features. Clinicopathological features and prognoses were evaluated retrospectively. Additionally, tumor heterogeneity was assessed and tumors were classified into pure and partial types according to the CLC component proportion in a single tumor. Chronic liver disease was observed in nine patients (64.3%). All tumors were mass-forming, and pathological R0 resection was achieved in 11 patients (78.6%). Tumor heterogeneity was classified as pure in 11 (78.6%) and partial in three (21.4%) patients. The median follow-up was 59.5 months (12-114 months). There was no difference in the 5-year disease-specific survival rates between the pure and partial (90.0% vs. 100.0%; P=0.200) types, but rates were significantly higher in the R0 resection group compared with those in the R1 resection group (100.0% vs. 50.0%; P=0.025). In conclusion, these results suggest that it is important for CLC patients to achieve curative resection, and CLC may have a good prognosis regardless of the proportion of CLC components in a single tumor.

Clinical efficacy of precision liver resection for primary liver cancer.

Precision liver resection is considered the gold standard in liver surgery. Therefore, optimizing the resection of lesions and minimizing unnecessary time of liver ischemia and hypoxia have become focal points. A total of 96 patients with primary liver cancer admitted to Cangzhou People's Hospital from January 2017 and December 2019 were included in this retrospective study, and divided into two groups according to the different surgical treatment, with 50 cases in the control group (conventional hepatic resection) and 46 cases in the observation group (precision liver resection). The surgical indicators, liver function, alpha-fetoprotein (AFP), complications, and three-year follow-up results were analyzed in the two groups. The operation time, intraoperative bleeding, hospital stay, and time of anal venting in the observation group were shorter than those in the control group (P<0.05). One week after surgery, AST, TBiL, ALT, and γ-GT levels decreased in both groups, with more significant decreases in the observation group than those in the control group (P<0.05). PCT and hs-CRP levels in the observation group were significantly lower than those in the control group (P<0.05) observation. The incidences of pleural effusion, bile leak, abdominal infection, pulmonary infection, as well as the total complication rates in the observation group were lower in the observation group than those in the control group (P<0.05). The follow-up data revealed that the observation group exhibited a lower recurrence rate observationand higher survival rate than the control group within 3 years, but these differences were not significant (P>0.05). Precision liver resection can effectively treat primary liver cancer, reduce the incidence of complications, and promote patient recovery after surgery.

Favorable Impact of Serum TERT C228T for Prognosis after Surgical Resection for Liver Cancer

Introduction: Personalized medicine and molecular therapies with the diagnosis of somatic genetic alterations are expected to be developed for liver cancer. Nevertheless, it is unknown whether a mutation in the telomere reverse transcriptase promoter (TERT C228T) in serum cfDNA might be useful for making prognostic predictions after surgical resection for primary liver cancer. Methods: This cohort study retrospectively investigated 111 patients who had undergone surgical resection of liver cancer for the first time. We investigated the differences between clinicopathological features and prognosis according to classification of three tumor markers, including AFP, PIVKAII, and TERT C228T. Results: Multivariate analysis identified etiology (fatty liver disease vs. HBV odds ratio [OR] 6.853) and fibrosis stage (2–4, OR: 0.137) as determinants of TERT C228T-positive liver cancer with normal levels of AFP and PIVKAII (TERT single positive liver cancer). TERT single positive (Yes, OR: 0.301), fibrosis (FIB)-4 index (≥3.25, OR: 2.038), Child-Pugh classification (B, OR: 4.975), and number of tumors (≥2, OR: 4.098) were identified as determinants of the recurrence of liver cancer. TERT single positive (Yes, OR: 3.311), FIB-4 index (≥3.25, OR: 0.433), and number of tumors (≥2, OR: 0.262) were identified as determinants of disease-free survival. Conclusions: Our results highlight the impact of classification of prognostic tumor markers. TERT single positive is one predictor of favorable prognosis after surgical resection for liver cancer.

Surgical management of primary liver cancers during the COVID-19 pandemic: overcoming the dilemma with standardization

BackgroundThe present study evaluates the impact of the pandemic on outcomes after surgical treatment for primary liver cancer in a high-volume hepatopancreatobiliary surgery center. MethodsPatients, who underwent liver resection for primary liver resection between January 2019 and February 2020, comprised pre-pandemic control group. The pandemic period was divided into two timeframes: early pandemic (March 2020–January 2021) and late pandemic (February 2021–December 2021). Liver resections during 2022 were considered as the post-pandemic period. Peri-, and postoperative patient data were gathered from a prospectively maintained database. ResultsTwo-hundred-eighty-one patients underwent liver resection for primary liver cancer. The number of procedures decreased by 37.1% during early phase of pandemic, but then increased by 66.7% during late phase, which was comparable to post-pandemic phase. Postoperative outcomes were similar between four phases. The duration of hospital stay was longer during the late phase, but not significantly different compared to other groups. ConclusionDespite an initial reduction in number of surgeries, COVID-19 pandemic had no negative effect on outcomes of surgical treatment for primary liver cancer. The structured standard operating protocol in a high-volume and highly specialized surgical center can withstand negative effects, a pandemic may have on treatment of patients.

ICG fluorescence imaging technology in laparoscopic liver resection for primary liver cancer: A meta-analysis.

To study the value of ICG molecular fluorescence imaging in laparoscopic hepatectomy for PLC. CNKI, WD, VIP.com, PM, CL and WOS databases were selected to search for literature on precise and traditional hepatectomy for the treatment of PLC. A total of 33 articles were used, including 3987 patients, 2102 in precision and 1885 in traditional. Meta showed that the operation time of precision was longer, while IBV, HS, PLFI, ALT, TBil, ALB, PCR, PROSIM, RMR and 1-year SR had advantages. Hepatectomy with the concept of PS is a safe and effective method of PLC that can reduce the amount of IB, reduce surgery, reduce PC and improve prognosis and quality of life.

Application of liver venous deprivation in secondary hepatic resection of primary liver cancer

Objective: To investigate the efficacy and safety of liver venous deprivation (LVD) before secondary resection of primary liver cancer. Methods: 56 patients with advanced primary liver cancer who were not suitable for primary resection in Liver Surgery Department of Xinxiang Central Hospital from January 2018 to January 2019 were analyzed retrospectively. They were divided into liver vein deprivation group (LVD group: LVD+ PVE, n=26) and portal vein embolization group (PVE group, n=30). The dynamic changes of liver reserve function and future liver remnant volume (FLR-V), R0 resection rate, surgical complications, postoperative recurrence rate and overall survival rate of two groups before and after LVD/PVE were compared. Results: The success rate of puncture and embolization in LVD group and PVE group was 100%. There were no grade Ⅳ complications, and there was no significant difference of grades Ⅰ, Ⅱ and Ⅲ complications between the groups (P=0.808). The FLR-V of LVD group before embolization, 7, 14 and 21 days after embolization was (493.1±25.8), (673.2±56.1), (779.5±81.6) and (853.3±85.2) cm(3), respectively. The FLR-V of PVE group before embolization, 7, 14 and 21 days after embolization were (502.4±20.1), (688.6±43.9), (656.8±73.7) and (563.5±69.1) cm(3), respectively. There was no significant difference in FLR-V between the two groups before and 7 days after embolization (P>0.05). The FLR-V of LVD group was higher than that of PVE group at 14 and 21 days after embolization (P<0.01). The preparation time of LVD group was (20.4±6.3) days, which was shorter than that of PVE group [(31.5±8.8) days, P=0.045]. The rate of secondary hepatectomy was 92.3% (24/26), which was higher than that of PVE group [70.0% (21/30), P=0.036]. The R0 resection rate was 87.5% (21/24), which was higher than that of the PVE group [57.1% (12/21), P=0.022]. However, there were no significant differences in surgical methods, operation time, intraoperative blood loss, Clavien-Dindo complication grade and length of hospital stay between the two groups (P>0.05). After hepatectomy, the median recurrence time and median survival time of LVD group were 12.6 months and 21.3 months, respectively, which were longer than those of PVE group (9.4 months and 13.5 months, respectively, P<0.01). Conclusions: For patients with advanced liver cancer who are not suitable for primary hepatectomy, preoperative LVD can significantly increase FLR-V, improve the resection rate of secondary surgery, shorten the preparation time of two operations, and do not increase surgical complications. Moreover, patients with LVD can improve the R0 resection rate of secondary surgery. The postoperative recurrence time and overall survival rate of patients with LVD are better than those of patients with PVE, and LVD has a good long-term effect.

Prospective validation to prevent symptomatic portal vein thrombosis after liver resection.

BACKGROUNDPortal vein thrombosis (PVT) after liver resection is rare but can lead to life-threatening liver failure. This prospective study evaluated patients using contrast-enhanced computed tomography (E-CT) on the first day after liver resection for early PVT detection and management.AIMTo evaluate patients by E-CT on the first day after liver resection for early PVT detection and immediate management.METHODSPatients who underwent liver resection for primary liver cancer from January 2015 were enrolled. E-CT was performed on the first day after surgery in patients undergoing anatomical resection, multiple resections, or with postoperative bile leakage in the high-risk group for PVT. When PVT was detected, anticoagulant therapy including heparin, warfarin, and edoxaban was administered. E-CT was performed monthly until PVT resolved.RESULTSThe overall incidence of PVT was 1.57% (8/508). E-CT was performed on the first day after surgery in 235 consecutive high-risk patients (165 anatomical resections, 74 multiple resections, and 28 bile leakages), with a PVT incidence of 3.4% (8/235). Symptomatic PVT was not observed in the excluded cohort. Multivariate analyses revealed that sectionectomy was the only independent predictor of PVT [odds ratio (OR) = 12.20; 95% confidence interval (CI): 2.22-115.97; P = 0.003]. PVT was found in the umbilical portion of 75.0% (6/8) of patients, and sectionectomy on the left side showed the highest risk of PVT (OR = 14.10; 95%CI: 3.17-62.71; P < 0.0001).CONCLUSIONSectionectomy on the left side should be chosen with caution as it showed the highest risk of PVT. E-CT followed by anticoagulant therapy was effective in managing early-phase PVT for 2 mo without adverse events.

Effect of Intensive Psychological Nursing Intervention on HAMD and SF-36 Scores in Patients with Severe Liver Cancer in ICU.

The aim of the study was to explore the effect of intensive psychological nursing intervention on HAMD and SF-36 scores in patients with severe liver cancer in intensive care unit (ICU). 134 critically ill patients with liver cancer in ICU who underwent resection of primary liver cancer from July 2019 to November 2021 were selected. The patients were randomly divided into control group and study group. The patients in the control group received routine nursing. The patients in the study group received intensive psychological nursing intervention on the basis of routine nursing. Hamilton Anxiety Scale (HAMA), Hamilton Depression Scale (HAMD), and the MOS 36-item short-form health survey (SF-36) scores before and after nursing were compared between the two groups. The satisfaction of the two groups of patients with nursing was counted. The HAMA, HAMD, and SF-36 scores of patients receiving intensive psychological nursing intervention were significantly better than those receiving routine nursing. The nursing satisfaction of patients receiving intensive psychological nursing intervention was significantly higher than that of patients receiving routine nursing. Intensive psychological nursing intervention for patients with severe liver cancer in ICU can significantly reduce HAMD, improve SF-36 score, and patient nursing satisfaction. It is worthy of wide clinical promotion.

Immunoglobulin (Ig) G4-related sclerosing cholangitis in patients resected for presumed perihilar cholangiocarcinoma: a 10-year experience.

BackgroundThis study aimed to investigate the incidence of immunoglobulin (Ig) G4-related sclerosing cholangitis (IgG4-SC) in patients resected for perihilar cholangiocarcinoma (PHC) in a designated hospital from 2010 to 2019. We also aimed to evaluate the diagnostic dilemma of IgG4-SC clinically.MethodsBetween January 2010 and December 2019, all patients who underwent radical resection due to presumed PHC were included. Independent pathologists scored bile duct samples based on the International Consensus Pathology Criteria for IgG4-related Disease (ICPD).ResultsOf the 289 patients who underwent radical resection of primary liver cancer, 26 (9%) were diagnosed as benign, without histological evidence of malignancy, among them, 23 had sclerosing inflammation, 1 had cystadenoma, and 2 had xanthogranulomatous cholangitis. Additionally, 18 had a definitive diagnosis of IgG4-SC. The misdiagnosis rate was 19% (54/289), of which, 26 patients had benign disease, and 28 patients had malignancies.ConclusionsIt is difficult to distinguish IgG-SC from PHC. The misdiagnosis has resulted in a large number of ineffective hepatectomies. Improving the detection rate of serum IgG4 (sIgG4) may therefore avoid misdiagnosis, surgery, and life-threatening complications.

Prevention of postoperative local recurrence by combined radiofrequency ablation of residual liver section during primary liver cancer resection

Prevention of postoperative local recurrence by combined radiofrequency ablation of residual liver section during primary liver cancer resection

Precise Navigation of the Surgical Plane with Intraoperative Real-time Virtual Sonography and 3D Simulation in Liver Resection

The precise intraoperative navigation of the surgical plane remains challenging in liver surgery; however, an innovative imaging technique—real-time virtual sonography (RVS)—may provide a solution. In this modality, preoperative three-dimensional (3D) resection simulation data are transmitted to an RVS workstation and can be used in combination with intraoperative ultrasound to navigate the surgical plane in real time. This paper describes this technique and our experiences in detail. From November 2015 to March 2017, 26 patients with primary liver cancer underwent liver resection under RVS navigation. The operative procedures employed included hemihepatectomy, bisegmentectomy, segmentectomy, and limited resection. RVS was utilized uneventfully and successfully in each operation. The median time required for spatial position registration was 3 (1–12) min, and as the case volume increased, the time required for registration markedly decreased. The surgical plane under RVS navigation was consistent with that of the preoperative plan, and the resection margin was confirmed negative in each case. In conclusion, RVS in combination with 3D simulation is a feasible, safe, and promising technique for the precise intraoperative navigation of liver resection for primary liver cancer. It could be applied to other resectable liver diseases and may be utilized in other centers.

Prevention of venous thromboembolism after resection of primary liver cancer with low molecular weight heparin and its association with P-selectin, lysosomal granule glycoprotein, platelet activating factor and plasma D-dimer.

We aimed at analyzing the efficacy of low molecular heparin in the prevention of venous thromboembolism (VTE) after resection of primary liver cancer and at exploring the correlation of VTE with P-selectin (CD62P), lysosomal granule glycoprotein (CD63), platelet activating factor (PAF) and plasma D-dimer (D-D). A total of 233 patients treated with primary liver cancer resection in our hospital from February 2014 to October 2016 were enrolled in this study. The patients were randomly divided into the observation group (n=117) and the control group (n=116). The observation group received a subcutaneous injection of low molecular weight heparin at 2-7 days after surgery, and the control group was not treated with anticoagulation. The prevalence of VTE and the changes of CD62P, CD63, PAF, and D-D before and after treatment were compared between the two groups. The VTE prevalence after surgery, the changes of CD62P, CD63, PAF, D-D before and after surgery and the correlation of the above indexes with VTE were analyzed. The prevalence of VTE in the observation group was 0.85% (1/117), which was lower than that of the control group (13.79%) (16/116); the difference was statistically significant (p<0.05). There was no significant difference in blood coagulation function between the two groups before and after operation (p>0.05). The CD62P, CD63, PAF, and D-D of the two groups were continuously decreased after the operation, and the serum CD62P, CD63 and plasma D-D of the observation group 6 d and 10 d after operation were lower than that of the control group; the difference was statistically significant (p<0.05). The serum CD62P, CD63 and plasma D-D in the VTE group 6 d and 10 d after operation were lower than those in the non-VTE group; the differences were statistically significant (p<0.05). Low molecular weight heparin can effectively prevent VTE after primary liver cancer resection. Regularly monitoring CD62P, CD63, PAF, and D-D in patients after the operation is pivotal for early diagnosis, evaluation and treatment of VTE.

Application of timely regional vascular occlusion in primary liver cancer resection

Objective To study the application effects of timely regional vascular occlusion in primary liver cancer (PLC) surgery. Methods Eighty-eight patients with PLC who underwent surgery in the Department of General Surgery of Yan′an University Affiliated Hospital from January 2014 to December 2016 were selected for prospective study, and they were divided into the experimental group and the control group by the random number table method, 44 cases of each group. In the experimental group, the blood supply was blocked with timely regional vascular occlusion while in the control group, the blood supply was blocked with half hepatic vascular occlusion. The occurrence of postoperative complications, and surgical indexes (surgical time, intraoperative blood loss, the time of hepatic portal occlusion, blood transfusion volume, abdominal drainage volume and hospital stay), levels of alanine aminotransferase, albumin and total bilirubin, levels of CD3+ , CD4+ , CD8+ and CD4+ /CD8+ , effective rate, control rate, and clinical efficacy were compared between the two groups. Measurement data with normal distribution were represented as ±s and analyzed using the independent-sample t test between the two groups; within the groups, paired t-tests were used. Comparison of count data were represented as n(%), and analyzed using the chi-square test. Results The intraoperative blood loss, time of hepatic portal occlusion, blood transfusion volume and hospital stay of the experimental group were (331.48±30.65) ml, (14.78±2.27) min, (132.61±13.87) ml, (9.29±1.19) d, and the control group were (500.61±50.62) ml, (23.96±2.89) min, (305.76±30.64) ml, (12.10±1.22) d, with statistically significant differences in above indexes between the two groups (all P 0.05). After surgery, the levels of alanine aminotransferase, total bilirubin and albumin of the experimental group were (54.86±5.61) U/L, (20.65±2.32) U/L, (41.95±4.32) ng/ml, and the control group were (120.75±13.03) U/L, (35.42±3.21) U/L, (70.25±7.45) ng/ml, with statistically significant differences in above indexes between the two groups (all P 0.05). Conclusions The application of timely regional vascular occlusion in PLC surgery can reduce the intraoperative blood loss, the time of hepatic portal occlusion, blood transfusion volume and hospital stay, improve the immune level and liver function. And there is no difference in response rate and control rate compared with half hepatic vascular occlusion, therefore it is worthy of clinical application. Key words: Liver neoplasms; Liver function tests; Timely regional vascular occlusion; Primary liver cancer

Long-Term Survival and Prognostic Factors of Pulmonary Metastasectomy in Liver Cancer: A Systematic Review and Meta-Analysis.

Lung is the most common extrahepatic metastatic organ of liver cancer. Surgical resection is a common local treatment for pulmonary metastasis. But the long-term prognosis of pulmonary metastasectomy varies greatly due to the small sample size and different results of previous studies. Therefore, we conducted this meta-analysis to evaluate the combined 5-year overall survival (OS) rate and prognostic factors after pulmonary metastasectomy in liver cancer. Key words such as liver cancer pulmonary metastasis and metastasectomy were retrieved firstly in PubMed, Cochrane Library, Embase and Chinese Wanfang databases. Eligible studies were identified by manual searches. Each included study should report 5-year OS rate and/or prognostic factors of pulmonary metastasectomy. Newcastle-Ottawa Scale was used for quality assessment, and heterogeneity was estimated by I2. We calculated the combined 5-year survival rates and determined the prognostic factors for OS by the hazard ratios (HR) and number of events. Seventeen cohort studies with a total of 513 patients were included in this meta-analysis. The combined 5-year survival rates after pulmonary metastasectomy were 33% [95% confidence interval (95% CI) 29-37%]. The poor prognostic factors were disease-free interval (DFI)<12months (HR=2.421 95% CI 1.384 4.236) and existence of cirrhosis (HR=1.936 95% CI 1.031 3.636). The 5-year OS rate of patients with pulmonary metastasectomy after resection of primary liver cancer is 33%. DFI<12months and existence of cirrhosis are probably poor prognostic factors.

Relationship between clinicopathologic characteristics and prognosis of patients with lymph node metastasis of primary liver cancer

Objective To investigate the clinicopathologic characteristics and prognosis of patients with lymph node metastasis of primary liver cancer. Methods The clinical data of 236 patients who underwent radical resection of primary liver cancer at the First Affiliated Hospital of Medical College of Xi'an Jiaotong University from August 2000 to August 2011 were retrospective analyzed. The clinicopathologic factors affecting survival time of patients with liver cancer, gender, age, pathological classification, histological grade, cirrhosis, alanine transami nase (ALT) , aspartate transaminase (AST) , alkaline phosphatase (ALP) , glutamyl-transpeptidase (GGT) , alpha-fetoprotein (AFP) , hepatitis, hepatic lobe distribution, tumor diameter, gross type, tumor number, satellite lesions, capsule integrity, liver capsule local invasion, vascular thrombosis, TNM stage and lymph node metastasis were analyzed. The patients received serum AFP and B ultrasound reexaminations every 3 months after operation and chest X-ray film every 6 months. The recurrence of liver cancer in suspected patients were confirmed by abdomen CT scan and/ or digital subtraction angiography (DSA) . The ultrasound-guided puncture histopatho-logical examination was done if necessary. The follow-up was done till 30, December 2013 or death. The survival time was calculated from operation date to death or the end of follow-up. The measurement data with normal distribution were presented as ±s and analyzed usingt test, and the count data were analyzed using chi-square test or Fisher exact probability. The survival curve was drawn by Kaplan Meier method, and the survival rate was analyzed using the Log rank test. The univariate analysis and multivariate analysis were done using the one-way ANOVA and COX regression model. Results Of 236 patients with primary liver cancer, there were 23 patients with lymph node metastasis and 213 patients without lymph node metastasis. The incidences of lymph node metastasis in patients with hepatocellular carcinoma, cholangiocarcinoma and hepatocellular cholangiocarcinoma were 7. 93%(13/ 164) , 15. 00% (9/ 60) and 8. 33% (1/ 12) , respectively. The lymph node metastasis which located in hepa-toduodenal ligament, hepatic pedicle, pancreatic and multiple locations were in 10, 6, 4 and 3 patients, respectively. Univariate analysis showed that the pathological classification, level of ALP, hepatitis, TNM stage, lymph node metastasis were risk factors affecting the prognosis of patients (F =3. 386, 4. 064, 2. 857, 22. 988, 4. 087, P 120 U/ L, TNM stage Ⅲ and positive lymph node metastasis were independent risk factors affecting the prognosis of patients (HR = 1. 533, 1. 592, 2. 032, 4. 086, 95% confidence interval: 1. 008-2. 331, 1. 019-2. 489, 1. 214-3. 399, 1. 996-8. 363, P 0.05) . Conclusions The hepatocellular carcinoma, ALP >120 U/ L, TNM stage Ⅲ and positive lymph node metastasis are independent risk factors affecting the prognosis of patients with primary liver cancer, and lymph node metastasis is closely related to liver lobe distribution of tumor, satellite lesions and partial liver capsule invasion. There is different in the prognosis of patients with positive lymph node metastasis and different pathological classification of primary liver cancer. Key words: Liver neoplasms; Pathology, clinical; Lymph node metastasis; Prognosis

Study on the application of value of digital medical technology in the operation on primary liver cancer

To study the clinical application of digital medical in the operation on primary liver cancer. The patients (n=11) with primary hepatic carcinoma treated between February and July 2008, including 9 cases of hepatocellular carcinoma, 2 cases of cholangiocellular carcinoma, were scanned using 64 slices helicon computerized tomography (CT) and the datasets was collected. Segment and three-dimensional (3D) reconstruction of the CT image was carried out by the medical image processing system which was developed. And the 3D moulds were imported to the FreeForm Modeling System for smoothing. Then the hepatectomy in treatment of hepatoma and implanting of catheter were simulated with the force-feedback equipment (PHANToM). Finally, 3D models and results of simulation surgery were used for choosing mode of operation and comparing with the findings during the operation. The reconstructed models were true to life, and their spatial disposition and correlation were shown clearly; Blood supply of primary liver cancer could be seen easily. In the simulation surgery system, the process of virtual partial hepatectomy and implanting of catheter using simulation scalpel and catheter on 3D moulds with PHANToM was consistent with the clinical course of surgery. Life-like could be felt and power feeling can be touched during simulation operation. Digital medical benefited knowing the relationship between primary liver cancer and the intrahepatic pipe. It gave an advantage to complete primary liver cancer resection with more liver volume remained. It can improve the surgical effect and decrease the surgical risk and reduce the complication through demonstrating visualized operation before surgery.

Techniques of radiofrequency ablation for unresectable primary liver cancer and outcome evaluation

Objective To summarize the experience in treatment of unresectable primary liver cancer (PLC) with radiofrequency ablation (RFA) and evaluate the outcome. Methods Over a 3-year period, 49 consecutive patients with solitary or muhinodular PLC (Child-Pugh class A or B) under-went RFA. Histopathologic types were of hepatocellular carcinoma in 43 cases and of cholangio-carci-noma in 6. The tumor size was 1.5-- 10. 0 cm. RFA was performed by a RITA expandable electrode device(RF-1500) followed by TACE administration 3-4 weeks later. Local efficacy was evaluated with computed tomography (CT) performed at an average of 4 weeks after RFA treatment and then during follow-up. Results There were no severe complications after RFA in all the patients. The total 1, 2 and 3-year survival rates were 77.5%, 56.5% and 44.0%, respectively. Tumors no more than 5cm in diameter could be ablated inside out. The 1, 2 and 3-year survival rates were 100%, 79.6%, 61.9%, respectively. The treatment response of RFA was assessed as curative ablation (complete tumor ablation with 0.5-1 cm ablative margin) in 19 cases, sub-curative ablation (complete tumor ablation with less than 0.5 cm ablative margin) in 9 cases,non-curative (noncomplete) ablation in 21 cases. The 2-year survival rate was 85.7 %, 60.0% and 24.3%, respectively, in patients with differ-ent types of response. Conelusion RFA has similar effect as resection of PLC on small tumors. The classification method for the evaluation of RFA display the results in 3 grades, and it is useful for the selection of adjuvant therapy. Key words: Carcinoma,hepatoeellular; Radiofrequency ablation; Survival rate; Treatment outcome

Precautions in caudate lobe resection: Report of 11 cases

To find the precautions against the safety in caudate lobe resection. The clinical data obtained from 11 cases of primary liver cancer in caudate lobe who received hepatectomy successfully were retrospectively analyzed. Four safe procedures were used in resection of primary liver cancer in caudate lobe: (1) selection of appropriate skin incision to obtain excellent exposure of operative field; (2) adequate mobilization of the liver to allow the liver to be displaced upwards to the left or to the right; (3) preparatory placement of tapes for total hepatic vascular exclusion, so that this procedure could be used to control the fatal bleeding of the liver when necessary; (4) selection of the ideal route for hepatectomy based on the condition of the tumor and the combined removal of multiple lobes if necessary. Among the 11 cases, simple occlusion of vessels of porta hepatis was used in caudate lobectomy for 6 cases, while in the other cases, the vessels were intermittently occluded several times or total hepatic vascular isolation was used in the caudate lobectomy. Combined partial right hepatectomy was done for 3 cases, combined left lateral lobectomy for 2 cases and caudate lobectomy alone for 6 cases. Operation was successful for all the 11 cases. Intermittent inflow occlusion was performed for all patients for 15 min at 5-min intervals. Blockade was performed twice in 3 patients and total hepatic vascular exclusion was performed in one of the three patients. Blockade was performed three times in one patient, including a total hepatic vascular exclusion. Total hepatic vascular exclusion was performed only in one patient. The mean blood loss was 300 mL. Ascites and pleural effusion occurred in 4 patients, jaundice in 1 patient. Six patients died of tumor recurrence in 6, 11, 12, 13, 15, 19 mo after operation, respectively. The other 5 patients have survived more than 16 mo since the operation. Caudate lobectomy for liver cancer in candate lobe can be safely performed with the above procedures.

“Three-Grade Criteria” of radical resection for primary liver cancer

Objective The present study was designed to develop the “Three-Grade Criteria” for radical resection of primary liver cancer (PLC) and to evaluate its clinical significance.