Comparison of pure laparoscopic donor right posterior sectionectomy versus right hemihepatectomy for living donor liver transplantation.

The right posterior section (RPS) graft for living donor liver transplantation is an alternative graft in a live liver donor with insufficient remnant left lobe volume and portal vein anomaly. Although there have been some reports regarding pure laparoscopic donor right posterior sectionectomy (PLDRPS), no study has compared PLDRPS versus pure laparoscopic donor right hemihepatectomy (PLDRH). The aim of our study was to compare the surgical outcomes of PLDRPS versus PLDRH at centers achieving a complete transition from open to laparoscopic approach in liver donor surgery. From March 2019 to March 2022, a total of 351 living donor liver transplantations, including 16 and 335 donors who underwent PLDRPS and PLDRH, respectively, were included in the study. In the donor cohort, there were no significant differences in major complication (≥grade III) rate and comprehensive complication index between the PLDRPS versus PLDRH group (6.3% vs. 4.8%; p = 0.556 and 2.7 ± 8.6 vs.1.7 ± 6.4; p = 0.553). In the recipient cohort, there was a significant difference in major complication (≥grade III) rate (62.5% vs. 35.2%; p = 0.034) but no significant difference in comprehensive complication index (18.3 ± 14.9 vs. 15.2 ± 24.9; p = 0.623) between the PLDRPS and PLDRH groups. PLDRPS in live liver donors with portal vein anomaly and insufficient left lobe was technically feasible and safe with experienced surgeons. The PLDRPS group might be comparable with the PLDRH group based on the surgical outcomes of donors and recipients. However, in terms of recipient outcomes, more careful selection of donors of the RPS graft and further research in a large number of cases are necessary to evaluate the usefulness of PLDRPS.

Optimal maximum duration for delaying salvage operation when recurrence of retroperitoneal liposarcoma is suspected: a single-center study.

BACKGROUND: This study was designed to identify the optimal maximum duration for delaying salvage operation when recurrence of retroperitoneal liposarcoma (LPS) is suspected. METHODS: Patients who underwent salvage operation at Samsung Medical Center for recurrent retroperitoneal LPS from January 2000 to December 2015 were reviewed. The time interval between recurrence and operation for recurrence was divided by 1, 2 or 3 months. A Cox proportional-hazards model was used to analyze factors related to disease-free survival along with recurrence-to-operation interval divided by 1, 2 or 3 months. RESULTS: The 1-, 3-, and 5-year disease-free survival rates were 43.2%, 15.6% and 13.4%, respectively. FNCLCC grade (p = 0.023) and recurrence-to-operation interval divided by 3 months (p = 0.003) were significant factors associated with recurrence. FNCLCC grade 2 (HR 1.940, CI 0.935-4.026, p = 0.238) and grade 3 (HR 4.049, CI 1.767-9.281, p = 0.007) showed increased risk compared to grade 1. Patients who underwent salvage operation more than 3 months after recurrence showed significantly increased risk of recurrence compared to patients within 3 months (HR 2.724, CI 1.391-5.337, p = 0.003). CONCLUSIONS: Based on our analysis of recurrence-free survival, salvage operation can be delayed for less than 3 months when recurrence is suspected. A short-term follow-up imaging study should be performed within this period.

Role and limitation of neoadjuvant hepatic arterial infusion chemotherapy in advanced hepatocelluar carcinoma patients with Child-Pugh class A.

BACKGROUND: Patients with advanced hepatocellular carcinoma (HCC) have a poor oncologic outcome. In this study, we evaluated the role and limitation of neoadjuvant hepatic arterial infusion chemotherapy (HAIC) in advanced HCC patients with Child-Pugh class A and the efficacy of liver resection subsequent to downstaging after neoadjuvant HAIC. METHODS: In the present retrospective study, 103 patients with advanced HCC, who underwent neoadjuvant HAIC from April 2003 to March 2015 were analyzed. Response to HAIC was evaluated by dividing time period into after 3 cycles and after 6 cycles, each defined as early and late period. Liver resection after neoadjuvant HAIC was offered in patients who were considered as possible candidates for curative resection with tumor-free margin as well as sufficient future liver remnant volume. RESULTS: The median survival time (MST) in all patients was 14 ± 1.7 months. Response rate and disease control rate were 36.3% (37) and 81.4% (83) in early period, respectively, and 26.4% (14) and 47.2% (25), in late period, respectively (P = 0.028). Twelve patients (11.7%) underwent liver resection after neoadjuvant HAIC and the MST was 37 ± 6.6 months. One-, 3-, and 5-year recurrence-free survival after liver resection were 58.3%, 36.5%, and 24.3% respectively. Liver resection was identified as the only independent prognostic factor that associated with overall survival in multivariate analysis (P = 0.002) CONCLUSION: HAIC could be further alternative for the treatment of advanced HCC in patients with good liver function. If liver resection is possible after neoadjuvant HAIC, liver resection would provide better outcomes than HAIC alone.

Laparoscopic Donor Hepatectomy for Adult Living Donor Liver Transplantation Recipients.

Even after 2 decades of experience in laparoscopic hepatectomy, data on purely laparoscopic approach for donor hepatectomy in adult living donor liver transplantation (LDLT) are limited. We report our initial experience of a purely laparoscopic approach for donor hepatectomy for adult recipients to explore its potential application in the management of donors. We did a retrospective data analysis of 54 consecutive patients operated on between May 2013 and February 2015. There were 41 right, 10 extended right, and 3 left hepatectomies. The median operative time was 436 minutes (range 294-684 minutes), and warm ischemia time was 6 minutes (2-12 minutes). Estimated blood loss was 300 mL (10-850 mL), and none of the patients required intraoperative transfusion. Four cases were converted to open laparotomy. The major complication rate was 16.7%, and biliary complication was the most frequent cause. Patients with normal anatomy had a major complication rate of 9.3% as compared with 45.5% in patients with anatomic variations. All patients recovered, and there was no mortality. In conclusion, a purely laparoscopic donor hepatectomy for adult LDLT recipients seems to be a feasible option; with careful patient selection and when performed by experienced surgeons, it may afford results comparable to the open method.

Enhanced effect of human mesenchymal stem cells expressing human TNF-αR-Fc and HO-1 gene on porcine islet xenotransplantation in humanized mice.

BACKGROUND: Porcine islet xenotransplantation is considered an attractive alternative treatment for type 1 diabetes mellitus. However, it is largely limited because of initial rejection due to Instant Blood-Mediated Inflammatory Reaction (IBMIR), oxidative stress, and inflammatory responses. Recently, soluble tumor necrosis factor-ɑ receptor type I (sTNF-αR) and heme oxygenase (HO)-1 genes (HO-1/sTNF-αR) have been shown to improve the viability and functionality of porcine islets after transplantation. METHODS: In this study, genetically modified mesenchymal stem cells (MSCs) expressing the HO-1/sTNF-αR genes (HO-1/sTNF-αR-MSC) were developed using an adenoviral system, and porcine islet viability and function were confirmed by in vitro tests such as GSIS, AO/PI, and the ADP/ATP ratio after coculturing with HO-1/sTNF-αR-MSCs. Subsequently, isolated porcine islets were transplanted underneath the kidney capsule of diabetic humanized mice without MSCs, with MSCs or with HO-1/sTNF-αR-MSCs. RESULTS: According to the results, the HO-1/sTNF-αR-MSC-treated group exhibited improved survival of porcine islets and could reverse hyperglycemia more than porcine islets not treated with MSCs or islets cotransplanted with MSCs. Moreover, the HO-1/sTNF-αR-MSC group maintained its morphological characteristics and the insulin secretion pattern of transplanted porcine islets similar to endogenous islets in immunocompetent humanized mice. CONCLUSIONS: Our results suggest that HO-1/sTNF-αR-MSCs are efficient tools for porcine islet xenotransplantation, and this study may provide basic information for pre-clinical animal models and future clinical trials of porcine islet xenotransplantation.

Radical Nephrectomy for Primary Retroperitoneal Liposarcoma Near the Kidney has a Beneficial Effect on Disease-Free Survival.

BACKGROUND: The purpose of this study is to analyze the clinical impact of radical nephrectomy on retroperitoneal liposarcoma near the kidney. METHODS: Data of patients who underwent surgery for unilateral primary retroperitoneal liposarcoma near the kidney were retrospectively collected. Patients were divided into four groups according to whether they underwent nephrectomy and combined resection of other organs. Kaplan-Meier survival analysis was used to estimate disease-free survival and overall survival. Multivariable Cox analysis was used to analyze factors related to disease-free survival and overall survival. RESULTS: Nephrectomy (HR = 0.260, CI = 0.078-0.873, p = 0.029) had a beneficial effect on disease-free survival, while interaction model of nephrectomy*other organ resection (HR = 4.655, CI = 1.767-12.263, p = 0.002) showed poor disease-free survival. Other organ resection was not related to disease-free survival (HR = 1.543, CI = 0.146-16.251, p = 0.718). Operation method (p = 0.007) and FNCLCC grade (p < 0.001; G2, HR = 1.833, CI = 0.684-4.915, p = 0.228; G3, HR = 9.190, CI = 3.351-25.199, p < 0.001) were significant factors for disease-free survival. While combined organ resection without nephrectomy group (HR = 1.604, CI = 0.167-15.370, p = 0.682) and radical nephrectomy with combined organ resection group (HR = 1.309, CI = 0.448-3.825, p = 0.622) did not show significant difference in disease-free survival from the mass excision only group, radical nephrectomy without combined organ resection group (HR = 0.279, CI = 0.078-0.991, p = 0.048) showed superior disease-free survival. CONCLUSIONS: Radical nephrectomy of unilateral primary retroperitoneal liposarcoma near the kidney has a beneficial effect on disease-free survival.

Case Report of Kidney Paired Donation (KPD) with Desensitization: the Strategy and Experience of 3-Way KPD in Samsung Medical Center.

As the need for the organ donation increases, strategies to increase kidney transplantation (KT) through expanded living donation have become essential. These include kidney paired donation (KPD) programs and desensitization in incompatible transplantations. KPD enables kidney transplant candidates with incompatible living donors to join a registry with other incompatible pairs in order to find potentially compatible living donor. Positive cross match and ABO incompatible transplantation has been successfully accomplished in selective cases with several pre-conditionings. Patients who are both difficult-to-match due to broad sensitization and hard-to-desensitize because of donor conditions can often be successfully transplanted through a combination of KPD and desensitization. According to the existing data, KPD can increase the number of KTs from living donors with excellent clinical results. This is also a cost-effective treatment as compared with dialysis and desensitization protocols. We carried out 3-way KPD transplantation with one highly sensitized, positive cross match pair and with two ABO incompatible pairs. Herein we report our first successful 3-way KPD transplantation in a single center. To maximize donor-recipient matching and minimize immunologic risk, KPD programs should use proper algorithms with desensitization to identify optimal donor with simultaneous two-, three- or more complex multi-way exchanges.

Short-Term Outcomes of Totally Laparoscopic Central Hepatectomy and Right Anterior Sectionectomy for Centrally Located Tumors: A Case-Matched Study with Propensity Score Matching.

BACKGROUND: Recent advances in technology and accumulation of surgical experience have expanded the indications for laparoscopic liver resection (LLR). However, compared to open liver resection (OLR), the feasibility of laparoscopic anatomical liver resection for centrally located tumor (CLT) has not been clearly established. The aim of our study was to assess the feasibility and safety of laparoscopic anatomical major liver resection for CLT. METHODS: From April 2011 to March 2016, 20 cases of anatomical LLR and 86 cases of OLR for CLTs such as central hepatectomy (CH) and right anterior sectionectomy (RAS) were performed at a single institution. We performed one-to-one propensity score matching and analyzed short-term outcomes between the LLR (n = 20) and OLR (n = 20) groups. RESULTS: Among 20 cases in the LLR group, two cases underwent open conversion due to common bile duct injury and anatomical distortion, respectively. There were no statistically significant difference between the LLR and OLR groups regarding clamping time of the Pringle maneuver (p = 0.502), blood loss (p = 0.746), surgical margin (p = 0.198), or length of hospital stay (p = 0.110). However, surgical time was significantly longer in the LLR group than in the OLR group (388 vs 268 min; p < 0.001). There were no significant differences between the two groups with regard to morbidity rate or mean comprehensive complication index (p = 0.716 and p = 0.819, respectively). CONCLUSION: Total anatomical LLR can be performed safely in selected CLT patients by experienced surgeons. Laparoscopic CH or RAS appears feasible with non-inferior perioperative outcomes compared to OLR.

Comparison of retroperitoneal liposarcoma extending into the inguinal canal and inguinoscrotal liposarcoma.

BACKGROUND: This study was designed to analyze differences between retroperitoneal liposarcoma (RLPS) extending into the inguinal canal and inguinoscrotal liposarcoma. METHODS: We retrospectively reviewed the records for patients who were managed for inguinal liposarcoma at Samsung Medical Center, a tertiary hospital, between January 1998 and December 2016. Patient data on demographics, tumour location, surgery, adjuvant therapy, histology, recurrence and death were collected. We used Mann-Whitney, Fisher exact and Kaplan-Meier log-rank tests to analyze differences between groups. RESULTS: Seven of 179 (3.9%) patients with abdominal liposarcoma had inguinoscrotal liposarcoma, and 6 of 168 (3.6%) patients with RLPS had extension to the inguinal canal. No differences were observed between groups in sex (p > 0.99), mean age (49.7 ± 6.4 yr v. 52.1 ± 12.5 yr, p = 0.37), laterality (p > 0.99) or scrotal involvement (40.0% v. 66.7%, p = 0.57). The RLPS group had significantly larger tumours than the inguinoscrotal group (27.9 ± 6.8 cm v. 7.8 ± 4.2 cm, p = 0.001). Postoperative complications were significantly more common in the RLPS group (n = 4, 83.3%); patients in the inguinoscrotal group experienced no postoperative complications (p = 0.021). Log-rank tests showed that the groups had no statistical differences in disease-free survival (p = 0.94) or overall survival (p = 0.10). However, inoperable disease-free survival was significantly poorer in the RLPS group (p = 0.010). CONCLUSION: Although initial signs and symptoms can be similar, RLPS extending into the inguinal canal was associated with significantly higher morbidity and mortality than inguinoscrotal liposarcoma.

CONTEXTE: Cette étude visait à examiner les différences entre le liposarcome rétropéritonéal s'étendant au canal inguinal et le liposarcome inguino-scrotal. MÉTHODES: Nous avons procédé à une analyse rétrospective des dossiers de patients traités pour un liposarcome inguinal au Samsung Medical Center, un hôpital de soins tertiaires, entre janvier 1998 et décembre 2016. Nous avons recueilli les données des patients en ce qui a trait aux caractéristiques démographiques, au siège de la tumeur, à la chirurgie, au traitement adjuvant, à l'histologie, à la récidive et au décès. Nous avons utilisé le test de Mann-Whitney, la méthode exacte de Fisher et les tests logarithmiques par rangs de Kaplan-Meier pour analyser les différences entre les 2 groupes. RÉSULTATS: Sept des 179 (3,9 %) patients atteints de liposarcome abdominal avaient un liposarcome inguino-scrotal, et 6 des 168 (3,6 %) patients atteints de liposarcome rétropéritonéal présentaient une extension au canal inguinal. Aucune différence n'a été observée entre les groupes pour le sexe (p > 0,99), l'âge moyen (49,7 ± 6,4 ans c. 52,1 ± 12,5 ans, p = 0,37), la latéralité (p > 0,99) ou l'atteinte scrotale (40 % c. 66,7 %, p = 0,57). La taille de la tumeur était significativement plus grande dans le groupe du liposarcome rétropéritonéal que dans celui du liposarcome inguino-scrotal (27,9 ± 6,8 cm c. 7,8 ± 4,2 cm, p = 0,001). De même, les complications postopératoires étaient significativement plus courantes dans le groupe du liposarcome rétropéritonéal (n = 4, 83,3 %), les patients du groupe du liposarcome inguino-scrotal n'en ayant pratiquement pas présenté (p = 0,021). Les tests logarithmiques par rangs ont révélé l'absence de différences statistiques entre les groupes pour la survie sans récidive (p = 0,94) et la survie globale (p = 0,10). Cependant, la survie sans récidive du patient inopérable était significativement plus faible dans le groupe du liposarcome rétropéritonéal (p = 0,010). CONCLUSION: Malgré la similarité des premiers signes et symptômes, le liposarcome rétropéritonéal s'étendant au canal inguinal était associé à des taux de morbidité et de mortalité significativement plus élevés que le liposarcome inguino-scrotal.

Outcome of living donor liver transplantation using right liver allografts with multiple arterial supply.

A right liver graft with multiple hepatic artery (HA) stumps can be found in approximately 5% of living donor liver transplantation (LDLT) using a right lobe graft. From January 2000 to June 2014, 1149 patients underwent LDLT procedures. Thirty patients with LDLT using a right lobe graft with multiple HA stumps and 149 patients with LDLT using a right lobe graft with a single HA stump were enrolled. These patients were divided into 3 groups: single HA (group 1, n = 149), multiple HAs with total reconstruction (group 2, n = 19), and multiple HAs with selective partial reconstruction (group 3, n = 11). Selective partial reconstruction was performed only when pulsatile back-bleeding was confirmed after larger HA reconstruction and sufficient intrahepatic arterial flow was confirmed by Doppler ultrasound (DUS). In group 2, the donor HAs were smaller (P < .001), and HA reconstruction took longer (P < .001). However, there was no significant difference among the groups regarding the arterial complication rate, biliary complication rate, and patient and graft survival. In conclusion, selective partial reconstruction of HA stumps for LDLT using a right lobe graft was feasible when intrahepatic arterial communication was confirmed by pulsatile back-bleeding from the smaller artery and DUS. Liver Transplantation 22 1649-1655 2016 AASLD.

Effect of sham feeding with gum chewing on postoperative ileus after liver transplantation-a randomized controlled trial.

Postoperative ileus (POI) is a common complication after major abdominal surgery. Gum chewing has been shown to stimulate bowel motility and decrease duration of POI after abdominal surgery. We evaluated the effect of gum chewing in reducing the time to first flatus and on oral calorie intake in patients undergoing living or deceased donor liver transplantation. Patients were randomized into the sham feeding group or the control group. The sham feeding group chewed two pieces of xylitol flavored gum for 15 minutes, three times a day after extubation until oral nutrition was tolerated. The control group received the same routine care except for the gum chewing. Fifty-nine patients were randomized into the sham feeding group (n=30) or the control group (n=29). There was no difference in the time to first flatus (72 [66.1-82.9] hours vs 69.0 [57.6-77.2] hours, P=.422). Cumulative energy intake (2.8 [5.8-23.2] % vs 10.0 [8.5-15.9] %, P=.695) and length of intensive care unit stay (4.2 [3.9-5.3] days vs 4.0 [6.7-4.5] days, P=.077) were also similar. In conclusion, sham feeding with gum chewing did not shorten the duration of POI nor facilitate oral intake after liver transplantation. (Clinicaltrials.gov number: NCT 01956643).

Mycobacterium tuberculosis infections in cynomolgus monkey transplant recipients and institution of a screening program for the prevention and control of tuberculosis.

BACKGROUND: Tuberculosis is a major health concern in not only humans, but also in non-human primates. In this paper, we report recent cases of Mycobacterium tuberculosis in cynomolgus monkeys from Cambodia used in transplantation research in a Korean facility and describe a program instituted to prevent and control subsequent infections. CASE PRESENTATION: All monkeys were antibody negative for tuberculosis during quarantine; however, suspected tuberculosis gross lesions were observed in two cynomolgus monkeys who underwent allograft kidney transplantation. Lung tissue from one monkey was found to be weakly positive by PCR for detection of M. tuberculosis. After PCR confirmation of tuberculosis, we decided to sacrifice the remaining animals and instituted a program for preventing subsequent infections. During necropsy of the remaining monkeys, two additional suspected tuberculosis cases were observed. A total of four monkeys with nodular lesions in the respiratory tract, suspected to be tuberculosis, demonstrated no clinical signs. Acid-fast bacilli were identified on slides from the lung or liver in all four monkeys. Two of four monkeys tested PCR positive. We decided that new monkeys entering from Cambodia should undergo a single gastric aspiration PCR and tuberculin skin testing (TST) every 2 weeks until four consecutive negatives to detect latent tuberculosis are obtained before starting experiments. Monkeys should then undergo a chest X-ray monthly and TST every 6 months. CONCLUSIONS: Detection of latent tuberculosis by an effective preventive screening program before starting experiments is an essential process to reduce the risk of reactivation of tuberculosis, especially in studies using immunosuppressive drugs. It also serves to protect the health of captive non-human primates, their caretakers and researchers.

Thoracic paravertebral block for nephrectomy: a randomized, controlled, observer-blinded study.

OBJECTIVE: This study evaluated whether adding a preoperative single thoracic paravertebral block (TPVB) to intravenous patient-controlled analgesia (IV PCA) would improve postoperative analgesia compared with using IV PCA alone in patients undergoing nephrectomy. DESIGN: Prospective, randomized, controlled, observer-blinded trial. SETTING: University hospital. SUBJECTS: Thirty-four adult patients undergoing elective open nephrectomy. METHODS: The patients were randomized to receive a TPVB plus IV PCA (group T) or IV PCA alone (group C). A single 18-mL injection of 0.75% ropivacaine was administered preoperatively under ultrasound guidance; fentanyl was used for IV PCA. Each patient's postoperative pain score based on a verbal numerical rating scale, postoperative fentanyl consumption, inspiratory volume by incentive spirometry, and complications were evaluated at 1, 3, 6, 12, and 24 hours after surgery. Changes in heart rate (HR), systolic arterial pressure (SAP), and mean arterial pressure (MAP) were evaluated following skin incision. RESULTS: The postoperative pain score and fentanyl consumption were significantly lower in group T than in group C at all time points up to 24 hours after surgery. The postoperative inspiratory volumes were not significantly different. The changes in HR were similar, while the increases in SAP and MAP after skin incision were lower in group T than in group C. CONCLUSIONS: A preoperative single TPVB improved postoperative analgesia by reducing the postoperative pain score and fentanyl consumption in patients undergoing nephrectomy.

The influence of spinal flexion in the lateral decubitus position on the unilaterality of spinal anesthesia.

BACKGROUND: For unilateral spinal block, local anesthetics should affect the spinal nerves of 1 side. With full flexion of the spine, the sunken cauda equina becomes tightened and is suspended in the middle of the subarachnoid space. We performed this study to assess whether spinal flexion facilitates unilateral spinal anesthesia. METHODS: Hyperbaric bupivacaine (8 mg) was administered at the L3-4 interspace through a 25-gauge Quincke needle at a rate of 0.02 mL/s. Patients were randomly allocated to group F (with full spinal flexion) or group N (the hips and back straightened). After maintaining the lateral position for 15 minutes with or without spinal flexion, patients were gently returned to the supine position. Spinal blockade was assessed by loss of pinprick sensation and the modified Bromage motor scale. RESULTS: While the lateral position was maintained, sensory block was noted on the nondependent side in 14 of 16 patients in group N (87.5%) but only in 1 of 16 patients in group F (6.3%) (P < 0.001). The median level of sensory block in group N was L5 on the nondependent side just before turning to the supine position. When patients were returned to the supine position, sensory blockade on the nondependent side was noted in all group N patients (100%) and 15 group F patients (93.7%). The sensory level on the nondependent side between group N and group F were similar after turning supine. CONCLUSIONS: Strict unilateral sensory block was not achieved even after lateral decubitus positioning with spinal flexion, when 8 mg hyperbaric bupivacaine was administered manually at a conventionally slow rate through a beveled spinal needle. However, maintaining flexion of the spinal column during lateral decubitus positioning altered the initial onset of sensory block with respect to laterality.

Surgical Outcomes of Laparoscopic versus Open Hepatectomy for Left Hepatocellular Carcinoma: Propensity Score Analyses Using Retrospective Japanese and Korean Individual Patient Data.

Introduction: This study aimed to compare the prognostic impact of laparoscopic left hepatectomy (LLH) with that of open left hepatectomy (OLH) on patient survival after resection of left hepatocellular carcinoma (HCC). Methods: Among the 953 patients who received initial treatment for primary HCC that was resectable by either LLH or OLH from 2013 to 2017 in Japan and Korea, 146 patients underwent LLH and 807 underwent OLH. The inverse probability of treatment weighting approach based on propensity scoring was used to address the potential selection bias inherent in the recurrence and survival outcomes between the LLH and OLH groups. Results: The occurrence rate of postoperative complications and hepatic decompensation was significantly lower in the LLH group than in the OLH group. Recurrence-free survival (RFS) was better in the LLH group than in the OLH group (hazard ratio, 1.33; 95% confidence interval, 1.03-1.71; p = 0.029), whereas overall survival (OS) was not significantly different. Subgroup analyses of RFS and OS revealed an almost consistent trend in favor of LLH over OLH. In patients with tumor sizes of ≥4.0 cm or those with single tumors, both RFS and OS were significantly better in the LLH group than in the OLH group. Conclusions: LLH decreases the risk of tumor recurrence and improves OS in patients with primary HCC located in the left liver.

Effects of supervised exercise on aerobic capacity and quality of life in patients with chronic liver disease and patients who underwent liver transplantation: a systematic review and meta-analysis.

Chronic liver disease and liver transplantation are risk factors for poor physical health and quality of life. This meta-analysis aimed to examine whether supervised exercise improves the physical health and quality of life in patients with chronic liver disease and liver transplant. Articles were searched in four databases (MEDLINE, Cochrane, Embase, and the Web of Science) from 1 January 1990 to 6 July 2021. Studies that assessed the change in aerobic capacity and quality of life following supervised exercise in patients with chronic liver disease or in those who had undergone liver transplantation were included in this meta-analysis. The two independent reviewers extracted data and the methodological quality of the included studies was assessed by the Cochrane Handbook for Systematic Reviews of Interventions. The extracted data were statistically analyzed using review management software (RevMan 5.3). The meta-analysis included 11 studies, comprising 159 patients. We observed that aerobic capacity measured as VO2 peak and 6-min walking test improved in patients with chronic liver disease and liver transplant after supervised exercise. Among the parameters of Short-form-36 (SF-36) used for measuring the quality of life, only physical functioning improved after supervised exercise. The other parameters of SF-36 including role-physical, bodily pain, general health, vitality, social functioning, role-emotional, and mental health were not significantly improved after supervised exercise. Supervised exercise seems essential for patients with chronic liver disease and liver transplant. It was found to be helpful in enhancing the aerobic capacity and physical function in these patients.

Factors influencing patterns of recurrence following pancreaticoduodenectomy for patients with distal bile duct cancer and ampulla of Vater cancer.

Backgrounds/Aims: Pancreaticoduodenectomy (PD) is a standard surgical procedure for patients with periampullary cancer. During the follow-up period after PD, recurrence can be observed in various places with different prognosis. The aim of this study was to clarify the pattern of recurrence and factors affecting the survival of patients with periampullary cancer. Methods: Overall, 88 patients who received PD for distal common bile duct cancer or ampulla of Vater cancer were finally included and their clinical characteristics were analyzed. Patients were divided into three groups: recurrence-free (RF) group, an isolated locoregional recurrence (LR) group, and a distant metastasis (DM) group. Prognostic factors affecting recurrence in each group were analyzed and a survival analysis was performed. Results: Perineural invasion (PNI), T stage, and lymphovascular invasion (LVI) were significant risk factors for LR and PNI, lymph node metastasis, LVI, and T stage were associated with DM group compared to RF group in univariate analysis, respectively. N stage and PNI were significant risk factors (p = 0.046, p = 0.041) in overall survival of the LR and the DM groups. There was no significant difference in 5-year overall survival between the LR and DM groups. Conclusions: T stage was a significant risk factor of LR, while PNI was a significant risk factor of DM. There was no significant difference in overall survival depending on the site of recurrence.

Postoperative Health Status and Quality of Life After Pure Laparoscopic Donor Hepatectomy for Living Donor Liver Transplantation.

BACKGROUND Laparoscopic donor hepatectomy (LDH) for living donor liver transplantation has been performed in several specialized institutes. Surgical outcomes of LDH have shown comparable results to open donor hepatectomy (ODH), but the quality of life (QOL) after LDH is not known. This prospective questionnaire-based study was performed to assess health status and QOL of live liver donors before and after donor hepatectomy (DH). MATERIAL AND METHODS From May 2017 to February 2020, questionnaire items such as the Enhanced Recovery after Surgery mobility scale (EMS), Body Image Questionnaire, and EQ-5D-3L were examined up to 1 year after DH to respectively evaluate postoperative recovery, body image satisfaction, and health status. RESULTS During the study period, 45 laparoscopic DH (LDH) donors and 2 open DH (ODH) donors were finally fully evaluated. The LDH group had a significantly higher mean EMS than ODH on postoperative day (POD) 5, and 7 (P=0.011, and P=0.004, respectively). Body image scores of the LDH group were significantly higher than that of the ODH group at 1 month after DH (17.8 vs 15.0, P=0.017). There were 45 LDH donors who recovered to preoperative values at 6 months and 1 month after DH, with no statistically significant difference in EQ-5D-3L index value and visual analogue scale (P=0.059 and P=0.217, respectively). CONCLUSIONS Within 1 month after DH, LDH donors showed faster mobility recovery and body image satisfaction to the level of preoperative status than ODH. LDH donors recovered to preoperative health status within 6 months, in accordance with previous studies of ODH donors.

Optimal allogeneic islet dose for transplantation in insulin-dependent diabetic Macaca fascicularis monkeys.

Many groups are working to improve the results of clinical allogeneic islet transplantation in a primate model. However, few studies have focused on the optimal islet dose for achieving normal glycemia without exogenous insulin after transplantation in primate models or on the relationship between rejection and islet amyloid polypeptide (IAPP) expression. We evaluated the dose (10,000, 20,000, and > 25,000 islet equivalents (IEQ)/kg) needed to achieve normal glycemia without exogenous insulin after transplantation using eleven cynomolgus monkeys, and we analyzed the characteristics exhibited in the islets after transplantation. 10,000 IEQ/kg (N = 2) failed to control blood glucose level, despite injection with the highest dose of exogenous insulin, and 20,000 IEQ/kg group (N = 5) achieved unstable control, with a high insulin requirement. However, 25,000 IEQ/kg (N = 4) achieved normal glycemia without exogenous insulin and maintained it for more than 60 days. Immunohistochemistry results from staining islets found in liver biopsies indicated that as the number of transplanted islets decreased, the amount of IAPP accumulation within the islets increased, which accelerated CD3+ T cell infiltration. In conclusion, the optimal transplantation dose for achieving a normal glycemia without exogenous insulin in our cynomolgus monkey model was > 25,000 IEQ/kg, and the accumulation of IAPP early after transplantation, which depends on the transplanted islet dose, can be considered one factor in rejection.