Minimally invasive versus open living donors right hepatectomy: A systematic review and meta-analysis.

BACKGROUND: Although minimally invasive technology has been widely used in hepatectomy, it remains controversial with regards to liver transplantation, especially in donors right hepatectomy. Herein, we compared the short-term safety and efficacy of minimally invasive donors right hepatectomy (MIDRH) with open donors right hepatectomy (ODRH). METHODS: A systematic literature search was carried out using PubMed, Embase, Web of Science and the Cochrane Library database in order to identify comparison studies of MIDRH and ODRH. Next, we obtained the relevant data, and carried out the meta-analysis. RESULTS: This meta-analysis included 12 studies, which included 1755 cases that underwent donors right hepatectomy. Compared to ODRH, patients that underwent MIDRH had less bleeding (SWD = -0.52, p<0.001), shorter hospital stays (SWD = -0.58, p < 0.001) and lower overall postoperative complications of donors (RR = 0.74, p = 0.008). However, MIDRH was found to be associated with prolonged operative times (SWD = 0.74, p < 0.001), as well as a higher rate of biliary complications in donors (RR = 2.26, p = 0.007) and recipients (RR = 1.69, p < 0.001). There were no statistically significant differences between MIDRH and ODRH in postoperative liver function, rate of major complications and vascular complications of both donors and recipients and overall postoperative complications. DISCUSSION: MIDRH is superior to ODRH with regards to intraoperative bleeding, postoperative hospital stay and overall donor complications. Although biliary-related complications are higher, it is feasible to develop MIDRH in experienced liver transplant centers. However, higher-quality research is still needed for corroboration.

Prevalence of synchronous second primary malignancy: identification using whole body PET/CT imaging.

OBJECTIVE: To describe the prevalence of synchronous second primary malignancy detected by PET/ CT in our clinical practice and its differentiating features from metastatic lesion. METHODS: All PET/CT scans from 1st October 2009 to 30th September 2010 were reviewed. The suspected cases of synchronous second primary malignancy detected by PET/CT were selected, and the histologically confirmed ones were being illustrated. Metachronous second primary cases were excluded. RESULTS: A total of 1522 scans were reviewed. sixty-eight cases were suspected to have a synchronous second primary while 8 were histologically confirmed. Seven (0.4%) of them were malignant and 1 was a benign tumor. These 7 cases were illustrated, and we found a significant difference in SUV(max) values and site of occurrence unusual to metastasis that were the two main radiological features differentiating them from metastatic lesion. CONCLUSION: Synchronous second primary malignancy could be missed without the use of whole body imaging. Its diagnosis is of utmost importance to prevent erroneous upstaging of disease and subsequent palliative treatment instead of curative surgery.

Is lymph node metastasis a common feature of gastrointestinal stromal tumor? PET/CT correlation.

PURPOSE: We investigated the incidence of lymph node metastasis in gastrointestinal stromal tumor (GIST) patients in our PET/CT database. The demographic data and characteristics of the primary tumor were evaluated in GIST patients with or without lymph node metastasis. MATERIALS AND METHODS: We reviewed our PET/CT database from January 1, 2007 to November 30, 2010 by using keyword search, and identified GIST with lymph node metastasis according to our standard of reference. Statistical analysis was conducted between GIST group with or without lymph node metastasis based on the age, sex, primary tumor size, and primary tumor location. RESULTS: A total of 29 GIST patients were found in our database. Six of them had lymph node metastasis, corresponding to 20.7%. When considering only the adult patients, the incidence was 17% (5 out of 28). There were 4 males and 1 female, with the mean age of 66.8 years old, which was 8 years older than the group without lymph node metastasis. Of the 5 adult metastasis patients, 4 had their primary tumor located at very rare sites other than stomach or small bowel. Statistical analysis using Fisher exact test of rare location showed significance between the 2 groups with P = 0.004. The mean size of the primary tumor in the group with lymph node metastasis was 5.2 cm, which was 2.9 cm less than the group without metastasis. No statistical significance was found in age, sex, or size of primary tumor between the 2 groups. CONCLUSION: The incidence of lymph node metastasis in GISTs in our database is 20.7%, which is surprisingly higher than we thought from other previous studies. In contrast to the group without lymph node metastasis, these patients tend to be of older ages and had rare location of the primary tumor. This result supports further study with larger sample size.

Family characteristics and smoking among urban and rural adolescents living in China.

BACKGROUND: Adolescent smoking is a public health concern in China. Although the family is an important social influence in China, few associations among family characteristics and adolescent smoking have been examined using Chinese samples. METHODS: Survey data on psychosocial variables and smoking were collected from a sample of 3629 7th grade adolescents (46% female; 54% male; mean age 12.7 years) in Wuhan, China. For adolescents, past 30-day smoking, family relationships, parents' negative sanctioning of smoking, parents' agreement with smoking, and parents' smoking behaviors are assessed. To account for the clustered data structure, hierarchical logistic regression analyses controlling for demographics (urbanization, age) examined the independent and multivariate effects of family characteristics for each gender. RESULTS: Girls are less likely than boys to report smoking and are more likely to report positive family relationships, and having parents with negative attitudes toward them smoking. Positive family relationships and age were strongly associated with smoking for both genders. No significant differences exist by gender. CONCLUSION: These findings suggest that the quality of family relationships are important for adolescent female and male smoking in China.