Effect of Sarcopenia on the Prognosis of Clinical Outcomes in Patients With Hepatocellular Carcinoma After Hepatic Resection.

BACKGROUND: We aimed to study the prognostic impact of sarcopenia on overall survival (OS), disease-free survival (DFS), and postoperative outcomes among patients with Hepatocellular carcinoma (HCC) who underwent curative hepatic resection. METHODS: Data were collected retrospectively from patients with HCC underwent curative hepatic resection and preoperative abdominal computed tomography (CT) at our institution between January 2010 and December 2020. Sarcopenia was evaluated by the skeletal muscle mass at the inferior direction of the third-lumbar-vertebra (L3) cross-sectional area based on preoperative CT imaging using software analysis. Cutoff values for skeletal muscle index (SMI) were 43.75 and 41.10 cm2/m2 for males and females. The patients were classified into sarcopenia and nonsarcopenia groups. The association between preoperative sarcopenia and clinicopathological factors, impact of sarcopenia on survival, and postoperative outcomes were analyzed. RESULTS: Sarcopenia was present in 39 of 83 (47.0%) patients who underwent curative hepatic resection for HCC and was significantly correlated with lower SMI, lower serum albumin levels, higher intraoperative blood loss, higher postoperative complications, and longer hospital stay. The 5-year OS was significantly lower in sarcopenic patients than in nonsarcopenic patients (58.2% vs 83.6%; P = .006), but the 5-year DFS was not significantly different between the 2 groups. Multivariate analysis revealed that sarcopenia was a significant risk factor for poor OS (HR 4.728; 95% CI, 1.458-15.329; P = .010). CONCLUSION: Sarcopenia was identified as a prognostic factor for poor OS after hepatic resection, and major postoperative complications were more frequent in sarcopenia. Early sarcopenia detection and management may improve OS and clinical outcomes in postoperative HCC.

Acute cholangitis caused by a huge hepatic simple cyst: a case report.

Simple hepatic cysts are usually asymptomatic and rarely cause complications. Among the rare complications of liver cysts, intracystic hemorrhage is one of the most frequent, and can result in a rapid increase in cyst size. Some simple hepatic cysts may be large and can present with pressure effects, such as abdominal discomfort or obstructive jaundice. A 68-year-old female with a simple huge hepatic cyst was scheduled elective laparoscopic fenestration in 6 weeks. Before the operation, she developed acute cholangitis, resulting from an acute increase in cyst size due to intracystic hemorrhage. Upon open fenestration, 6.1 L of chocolate-like fluid was drained. A huge simple hepatic cyst complicated by intracystic hemorrhage resulted in an acute increase in cyst size. Distortion of the extrahepatic bile duct by the cyst obstructed the bile flow. Acute cholangitis was eventually developed.

Analysis of preoperative risk factors for early recurrence after curative pancreatoduodenectomy for resectable pancreatic adenocarcinoma.

Objectives: To investigate the risk factors for early recurrence after curative pancreatoduodenectomy for resectable pancreatic ductal adenocarcinoma. Methods: All data were retrospectively collected from patients with resectable pancreatic ductal adenocarcinoma who had undergone pancreatoduodenectomy at the Department of Surgery, Phramongkutklao Hospital, from January 2015 to December 2020. The preoperative and perioperative risk factors were included into the analysis. Results: In total, 34 patients were included in the study. The median time for recurrence and median survival time were 17 and 20 months, respectively. The 1, 3, and 5 year disease-free survival rates were 59.6%, 23.87%, and 23.87%, respectively, while the 1, 3, and 5 year overall survival rates were 81%, 24.7%, and 12.4%, respectively. Seventeen patients (50%) from a total of 34 patients had recurrence, and ten patients (29.41%) had recurrence within 12 months. The independent preoperative risk factor associated with adverse disease-free survival was tumor size > 4 cm (hazard ratio [HR], 14.34, p=0.022). The perioperative risk factors associated with adverse disease-free survival were pathological lymphovascular invasion (HR, 4.31; p=0.048) and non-hepatopancreatobiliary surgeon (HR, 5.9; p=0.022). Risk factors associated with poor overall survival were microscopical margin positive (R1) resection (HR, 3.68; p=0.019) and non-hepatopancreatobiliary surgeon (HR, 3.45; p=0.031). Conclusions: Tumor size > 4 cm from the preoperative imaging study was a poor prognostic factor for early recurrence after curative pancreatoduodenectomy for resectable pancreatic adenocarcinoma indicated that they may have radiological occult metastasis, thus, staging laparoscopy may reduce the number of unnecessary laparotomies and avoid missing radiologically negative metastases.

Choledochal cysts type VI: biliary cyst of the cystic duct with connecting to right anterior sectoral bile duct: a case report.

Type VI choledochal cysts or cystic duct dilatation cysts are a relatively new and rare condition. We report the case of a 35-year-old man who presented with a history of recurrent episodes of epigastrium pain. Magnetic resonance cholangiography revealed a cyst lodged between the cystic duct and the right anterior sectoral bile duct. He underwent a laparoscopic right anterior sectorectomy with cholecystectomy. Pathological examination revealed a cyst with a fibrous wall, dense chronic inflammatory infiltration, lined by columnar epithelium. Due to its rarity, the diagnosis is often made intraoperatively. The treatment of cystic duct cysts includes cholecystectomy, complete cyst excision, recontinuity of the common bile duct. Type VI choledochal cysts are extremely rare. Preoperative diagnosis, using either magnetic resonance cholangiopancreatography or endoscopic retrograde cholangiopancreatography, is vital to prevent postoperative complications. Treatment of this type of cysts includes cholecystectomy and complete cyst excision and biliary-enteric reconstruction if necessary.

Reactive lymphoid hyperplasia of the liver mimicking hepatocellular carcinoma: a case report.

Reactive lymphoid hyperplasia (RLH) of the liver is an extremely rare benign lesion, which is often misdiagnosed as a malignant liver tumour. We present the case of a 69-year-old man with an incidental liver tumour revealed on the ultrasonography of the kidney-urinary bladder system for benign prostatic hyperplasia. Hepatocyte-specific contrast (gadoxetate disodium) magnetic resonance imaging revealed a round 6-mm lesion, which was hypointense on T1-weighted images, slightly hyperintense on T2-weighted images and highly intense on diffusion-weighted images. Other findings included arterial hyperintensity, venous and delayed hypointensity and a defect in liver segment 6. The patient was diagnosed with hepatocellular carcinoma; laparoscopic partial hepatectomy was performed. Intraoperatively, a 7-mm greyish white solid nodule was observed. In conclusion, it may be difficult to distinguish RLH from other malignant liver tumours. However, it should be considered as a differential diagnosis for small liver lesions in young, female patients without liver cirrhosis.

The optimal extent of surgery in T2 gallbladder cancer and the need for hepatectomy: A meta-analysis.

Extensive surgery is the mainstay treatment for gallbladder cancer and offers a long-term survival benefits to the patients. However, the optimal extent of surgery remains debatable. We aimed to perform a meta-analysis of hepatectomy and no hepatectomy approaches in patients with T2 gallbladder cancer. We searched the following electronic databases for systematic literature: PubMed, Google Scholar, and the Cochrane Library. We selected studies that compared patients with T2 gallbladder cancer who underwent hepatectomy with those who did not. While the long-term overall survival (OS) and disease-free survival (DFS) were the primary outcomes, perioperative morbidity and mortality were the secondary outcome. We analysed over 18 studies with 4,587 patients. Of the total patients, 1,683 and 1,303 patients underwent hepatectomy and no hepatectomy, respectively. The meta-analysis revealed no significant difference between the hepatectomy and no hepatectomy groups, in terms of the overall morbidity (risk ratio [RR] = 1.85, 95% confidence interval [CI] = 0.66-5.20) and 30-day mortality (RR = 0.9, 95% CI = 0.1-8.2). The results were comparable in terms of the OS (RR = 0.76, 95% CI = 0.57-1.01), (HR = 0.74, 95% CI = 0.49-1.12), and DFS (RR = 0.99, 95% CI = 0.88-1.11). In conclusion, the perioperative and long-term outcomes of hepatectomy and no hepatectomy approaches were comparable. Hepatectomy may not be required in T2 gall bladder cancer if the preoperative evaluation confirms the depth of the tumour in the perimuscular connective tissue and the intraoperative frozen sections confirm microscopic negative margins. Likewise, for those whom gall bladder cancer was diagnosed from the pathological report after simple cholecystectomy, further hepatectomy may not necessary.

Utility of preoperative imaging in evaluating colorectal liver metastases declines over time.

OBJECTIVES: Reports on the sensitivity and accuracy of contrast-enhanced helical computed tomography (HCT) in the preoperative evaluation of colorectal liver metastases (CLM) have been conflicting. Few studies have controlled for and reported on the time interval between HCT and eventual surgery. METHODS: A multi-institution, retrospective review of consecutive patients who underwent hepatic resection for CLM from January 1999 to September 2004 was conducted. Data regarding lesion characteristics and resectability were extracted from radiology reports, operative findings and histopathological records. Findings in HCT were evaluated according to their sensitivity for detecting CLM and ability to predict resectability. RESULTS: A total of 217 consecutive patients who underwent hepatic resection for CLM were identified. The overall sensitivity of HCT for detection of CLM was 83.2%. Prolonged time between imaging and surgery was a negative predictor for HCT sensitivity in univariate and multivariate analysis (P < 0.001). In predicting resectability, preoperative HCT was accurate 77.0% of the time. The time interval to surgery was negatively correlated with HCT prediction accuracy in univariate and multivariate analyses (P < 0.001). CONCLUSIONS: The utility of HCT as a preoperative tool to evaluate CLM is inversely proportional to the time interval between imaging and surgery. This may explain conflicting reports of the accuracy of HCT in the current literature.

A randomized controlled trial to improve lymph node assessment in stage II colon cancer.

HYPOTHESIS: Physicians seem to learn best from their peers, yet the impact of opinion leaders on physician behavior is unclear. Because colon cancer staging has been identified as being suboptimal in Ontario, Canada, we sought to evaluate the influence of expert and local opinion leaders for colon cancer on optimizing colon cancer lymph node assessment. DESIGN, SETTING, PARTICIPANTS: A cluster-randomized trial including all hospitals in Ontario that identified a local opinion leader with intervention between January 5 and June 17, 2004. INTERVENTION: All 42 centers received a standardized lecture about colon cancer lymph node assessment delivered by an expert opinion leader in colon cancer. The 21 intervention hospitals also received academic detailing of a local opinion leader by the expert opinion leader and a toolkit. MAIN OUTCOME MEASURES: Mean number of lymph nodes assessed in patients with stage II colon cancer and the proportion of cases staged with a minimum of 12 lymph nodes before and after a standardized lecture were assessed. RESULTS: Patient demographic and tumor factors were similar in both groups before and after the standardized lecture. Lymph node assessment significantly improved after the standardized lecture at intervention and control sites (P < .001). No additional benefit of academic detailing and toolkit provision in the intervention was demonstrated. CONCLUSIONS: In-person provision of information by an expert opinion leader in colon cancer may stimulate performance regarding lymph node assessment for colon cancer. Academic detailing of a local opinion leader did not further improve lymph node assessment.