Simple parameters predicting extrahepatic recurrence after curative hepatectomy for hepatocellular carcinoma.

Extrahepatic recurrence (EHR) after curative hepatectomy for hepatocellular carcinoma (HCC) is associated with a poor prognosis. We investigated the features of EHR and identified its predictive factors. This retrospective study included 398 treatment-naive patients who underwent curative hepatectomy for HCC at two tertiary hospitals. Multivariate Cox-regression analysis was performed to identify the variables associated with EHR. EHR was diagnosed in 94 patients (23.6%) over a median follow-up period of 5.92 years, most commonly in the lungs (42.6%). The 5-/10-year cumulative rates of HCC recurrence and EHR were 63.0%/75.6% and 18.1%/35.0%, respectively. The median time to EHR was 2.06 years. Intrahepatic HCC recurrence was not observed in 38.3% of patients on EHR diagnosis. On multivariate analysis, pathologic modified Union for International Cancer Control stage (III, IVa), surgical margin involvement, tumor necrosis, sum of tumor size > 7 cm, and macrovascular invasion were predictive factors of EHR. Four risk levels and their respective EHR rates were defined as follows: very low risk, 1-/5-year, 3.1%/11.6%; low risk, 1-/5-year, 12.0%/27.7%; intermediate risk, 1-/5-year, 36.3%/60.9%; and high risk, 1-year, 100.0%. Our predictive model clarifies the clinical course of EHR and could improve the follow-up strategy to improve outcomes.

Are Urologists Performing Semi-rigid Ureteroscopic Lithotripsy Safe From Radiation Exposure? A Guidance to Reduce the Radiation Dose.

OBJECTIVE: To measure radiation exposure of urologists during ureteroscopic (URS) lithotripsy, and hence estimating the number of procedures that can be performed safely considering the annually permissible radiation dose, and to identify influential variables. MATERIALS AND METHODS: The radiation exposure dose was measured at the neck, chest, arm, and hands of a single urologist who performed 49 URS lithotripsies. The number of annually performed URS lithotripsies was estimated based on the annual permissible occupational exposure radiation dose guidelines. The fluoroscopy screening time, tube voltage, and tube current were evaluated to determine their correlation with operative time, position, size, and Hounsfield unit (HU) values of the ureteral stones, and patients' body mass index (BMI). RESULTS: Our findings showed that 45 URS lithotripsies can be safely performed without a whole-body apron vs 1725 cases with one; considering the permissible dose for the hands, 448 cases without radiation protection were possible. Significant correlations were observed between operative time and fluoroscopy screening time (P < .001), ureteral calculi location and fluoroscopy screening time (P = .027), HU value and fluoroscopy screening time (P = .016), HU value and operative time (P = .041), and tube current and patients' BMI (P = .009). CONCLUSION: Considering radiation exposure risk, protective gear is necessary to ensure safety and efficacy of URS lithotripsy. Efforts to reduce radiation dose before and during surgery are required when ureteral calculi are in upper locations or have large HU, or the patient has a high BMI.