Comparison of open liver resection and RFA for the treatment of solitary 3-5-cmhepatocellular carcinoma: a retrospective study.

BACKGROUND: The goal of this study was to compare the postoperative results of liver resection and radiofrequency ablation (RFA) for the treatment of small hepatocellular carcinoma (HCC) (3-5 cm). PATIENTS AND METHODS: We retrospectively collected 122 cases of small solitary HCC treated at our center from Jan 2011 to Dec 2015, with diameters in the range of 3-5 cm. According to the treatment program received at our center, the patients were divided into liver resection (72 patients) and RFA (50 patients) groups. RESULT: In comparison with the RFA group, the resection group had a longer operative time, greater intraoperative blood loss (P < 0.01), more hepatic inflow occlusion, and a longer postoperative hospital stay (P < 0.01). The 1-, 3-, and 5-year expected overall survival rates and tumor-free survival rates were comparable between the two groups. Cox regression analysis showed that neither resection nor RFA was a significant risk factor for overall or tumor-free survival in HCC. CONCLUSIONS: For solitary HCC of 3-5 cm in diameter, RFA can achieve better in-hospital clinical results and similar long-term outcomes than resection and can be considered for wide application, especially for central-location cases.

Preoperative transcatheter arterial chemoembolization for resectable hepatocellular carcinoma: a single center analysis.

BACKGROUND AND AIM: The effect of preoperative transcatheter arterial chemoembolization (TACE) on the short- and long-term outcome of resectable hepatocellular carcinoma (HCC) is controversial. We conducted a retrospective evaluation of this aspect using data from our center. MATERIAL AND METHODS: A total of 656 consecutive patients who underwent curative resection of HCC were divided into two groups based on the preoperative TACE: the liver resection (LR) group (405 cases) and the TACE-LR group (183 cases). Overall and disease-free survival curves were constructed using the Kaplan-Meier method and compared with the log-rank test. The significance of differences in survival was tested using a log-rank test. Univariate and multivariate analyses were used to identify the factors that best predicted overall survival or tumor free survival. RESULTS: Although the cost of LR showed no difference between groups, the overall cost was significantly higher in the combined group than in the LR group (P < 0.001). The complication rate after resection was also comparable between the two groups. In regard to long-term outcome, the 1-, 3-, and 5-year overall survival rates were 83.7, 68.9 and 57.5%, respectively, after direct liver resection and 80.9, 65.0 and 54.1%, respectively, after combined TACE and resection (P = 0.739). The 1-, 3-, and 5-year recurrence- free survival rates were also comparable between two groups (P = 0.205). Both univariate analysis and multivariate analysis showed that macro-vascular invasion was the factor that best predicted overall survival or tumor-free survival rate. CONCLUSION: Preoperative TACE has comparable intraoperative and short-term outcomes but more overall cost due to repeated TACE, and the procedure did not significantly improve the overall or tumor-free survival rate. Preoperative TACE should not, therefore, be recommended as a routine procedure before resection for resectable HCCs particularly in cases due to underlying hepatitis B virus (HBV).

Highly selective separation of tetravalent plutonium from complex system with novel phenylpyridine diamide ligands.

In this study, three phenylpyridine diamide ligands, namely, 2,2'-((pyridine-2,6-diylbis(3,1-phenylene))bis(oxy))bis(N,N-diethylacetamide) (PPEA, L1), 2,2'-((pyridine-2,6-diylbis(3,1-phenylene))bis(oxy))bis(N-ethyl-N-phenylacetamide) (PEPA, L2), and 2,2'-(((4-phenylpyridine-2,6-diyl)bis(3,1-phenylene))bis(oxy))bis(N,N-dioctylacetamide) (PPOA, L3), were synthesized and explored for the solvent extraction of Pu(iv) in a HNO3 medium using 1-(trifluoromethyl)-3-nitrobenzene as the diluent. The effects of HNO3 concentration, extractant concentration, and temperature on the Pu(iv) extraction efficiency were studied. All three extractants displayed high selectivity for Pu(iv) over other metals such as U(vi), Np(v), Am(iii), and various fission elements. At 3 M HNO3, the distribution ratio for Pu(iv) reached 27.18, in contrast to 1.11, 0.3, and 0.03 for U(vi), Np(v), Am(iii), respectively. Slope analysis and UV titration revealed the formation of 1 : 1 Pu(NO3)4/ligand complexes during extraction. The extraction reactions had negative Gibbs free energies, indicating the spontaneous nature of Pu(iv) extraction at room temperature. Furthermore, the extractants demonstrated good stripping ability and reusability, and their radiolytic stability was reasonable up to an absorbed dose of 100 kGy, underscoring their potential for practical applications. Overall, this study broadens our understanding of actinide-diamide ligand coordination and actinide chemistry during coordination, paving the way for the design and synthesis of new extractants.

Preoperative adjuvant transarterial chemoembolization cannot improve the long term outcome of radical therapies for hepatocellular carcinoma.

Combinations of transarterial chemoembolization (TACE) and radical therapies (pretransplantation, resection and radiofrequency ablation) for hepatocellular carcinoma (HCC) have been reported as controversial issues in recent years. A consecutive sample of 1560 patients with Barcelona Clinic Liver Cancer (BCLC) stage A/B HCC who underwent solitary Radiofrequency ablation (RFA), resection or liver transplantation (LT) or adjuvant pre-operative TACE were included. The 1-, 3- and 5-year overall survival rates and tumor-free survival rates were comparable between the solitary radical therapy group and TACE combined group in the whole group and in each of the subgroups (RFA, resection and LT) (P > 0.05). In the subgroup analysis, according to BCLC stage A or B, the advantages of adjuvant TACE were also not observed (P > 0.05). A Neutrophil-lymphocyte ratio (NLR) more than 4, multiple tumor targets, BCLC stage B, and poor histological grade were significant contributors to the overall and tumor-free survival rates. In conclusions, our results indicated that preoperative adjuvant TACE did not prolong long-term overall or tumor-free survival, but LT should nevertheless be considered the first choice for BCLC stage A or B HCC patients. Radical therapies should be performed very carefully in BCLC stage B HCC patients.

Bilateral transformational thoracolumbar interbody fusion for the treatment of giant central thoracolumbar junction disc herniation: A prospective clinical and radiological study.

STUDY DESIGN: Clinical and radiological assessment of prospective single-center data. BACKGROUND: The optimal treatment strategy for giant central thoracolumbar junction disc herniation (TLDH) remains controversial. OBJECTIVE: This study aimed to report the clinical and radiological results of bilateral transformational thoracolumbar interbody fusion (bilateral TTIF) to treat giant central TLDH. METHODS: Seventeen consecutive patients with giant central TLDH underwent bilateral TTIF from January 2014 to June 2014 and were followed for 9-15 months. Clinical and radiological data were prospectively examined, including operative time, blood loss, pre- and postoperative American Spinal Injury Association (ASIA) score for sensory and motor function, visual analog scale (VAS) and Oswestry Disability Index (ODI) scores, fusion rate, extent of decompression, rate of instrumentation failure, and complications. RESULTS: The average time of surgery was 160 ± 37 min, and blood loss was 884 ± 197 ml. The ASIA sensory and motor scores improved from 72.76 ± 3.36 to 90.71 ± 2.54 and from 68.47 ± 4.7 to 88.0 ± 3.2, respectively. VAS for back pain and ODI decreased from 6.65 ± 1.93 to 2.23 ± 0.56 and from 42.82 ± 5.08 to 11.3 ± 2.3, respectively. Canal encroachment improved from 50.3 ± 6.6% to 2 ± 0.3% at the last follow-up. Surgery complications were seen in 5 patients (29%), who experienced intraoperative dural tear and cerebrospinal fluid leak. There were no other major complications at the last follow-up. CONCLUSIONS: Bilateral TTIF produced satisfactory outcomes and may be one of the surgical treatments of choice for myelopathy due to giant central TLDH.

Ex vivo liver resection followed by autotransplantation to a patient with advanced alveolar echinococcosis with a replacement of the retrohepatic inferior vena cava using autogenous vein grafting: a case report and literature review.

Alveolar echinococcosis (AE) of the liver is a rare disease. In advanced cases of this parasitic disease, the inferior vena cava (IVC) can be invaded; in these cases, the optimal treatment is liver transplantation and replacement of the IVC. Considering the donor shortage and the drawbacks of immunosuppressive therapy, ex vivo liver resection followed by autotransplantation may be the first choice for these patients. We report the first case of advanced AE successfully treated by an ex vivo liver resection, followed by autotransplantation with a replacement of the retrohepatic IVC using autogenous vein grafting. This graft included the following regions: the bilateral great saphenous vein, part of the retrohepatic inferior vena and the middle hepatic vein with no invasion, the inferior mesenteric vein, and part of the side wall of the infrahepatic vena cava. This patient had an uneventful postoperative recovery; currently, she has been enjoying a normal life and is 12 months postoperative with no immunosuppressive therapy or AE recurrence.In conclusion, ex vivo liver resection followed by autotransplantation with a replacement of the retrohepatic IVC using autogenous vein grafting might be a useful surgical practice for advanced AE.

Barcelona clinic liver cancer stage B hepatocellular carcinoma: transarterial chemoembolization or hepatic resection?

According to the Barcelona Clinic Liver Cancer (BCLC) guidelines, transarterial chemoembolization (TACE) is recommended for BCLC stage B hepatocellular carcinoma (HCC). However, an investigation of the use of resection for BCLC stage B is needed. Therefore, we compared the efficacy and safety of hepatic resection (HR) with that of TACE in treating intermediate HCC.We retrospectively enrolled 923 patients with BCLC stage B HCC who underwent TACE (490 cases) or HR (433 cases). The baseline characteristics, postoperative recoveries, and long-term overall survival rates of the patients in these 2 groups were compared. Subgroup analyses and comparisons were also performed between the 2 groups.The baseline demographic and tumor characteristics, in-hospital mortality rate, and 30-day mortality rate were comparable between the 2 groups. However, the patients in the resection group suffered from more serious complications compared with those in the TACE group (11.1% vs 4.7%, respectively, P < 0.01) as well as longer hospital stays (P < 0.05). The resection patients had significantly better overall survival rates than the TACE patients (P < 0.01). In the TACE group, patients with Lipiodol retention showed much higher 1-, 3-, and 5-year overall survival rates than those in the noncompact Lipiodol retention group (P < 0.01). Subgroup analyses revealed that patients with 1 to 3 tumor targets showed much better 1-, 3-, and 5-year overall survival rates in the resection group (P < 0.01), but no difference was observed for the patients with >3 targets.Our clinical analysis suggests that patients with BCLC stage B HCC should be recommended for resection when 1 to 3 targets are present, whereas TACE should be recommended when >3 targets are present.