Modular multimodal hospital-home chain physical activity rehabilitation programme (3M2H-PARP) in liver cancer: a protocol for a randomised controlled trial.

INTRODUCTION: Patients with liver cancer are susceptible to experiencing a decline in muscle mass and function, which can lead to physical frailty and have a negative impact on prognosis. However, there is currently a lack of physical activity interventions specifically tailored for these patients. Therefore, we have developed a modular multimodal hospital-home chain physical activity rehabilitation programme (3M2H-PARP) designed specifically for patients with liver cancer undergoing transarterial chemoembolisation (TACE). We aim to validate the effectiveness and feasibility of this programme through a randomised controlled trial (RCT). METHODS AND ANALYSIS: 3M2H-PARP RCT will compare a 12-week, modular, multimodal physical activity rehabilitation programme that includes supervised exercise in a hospital setting and self-management exercise at home. The programmes consist of aerobic, resistance, flexibility and balance exercise modules, and standard survivorship care in a cohort of liver cancer survivors who have undergone TACE. The control group will receive standard care. A total of 152 participants will be randomly assigned to either the 3M2H-PARP group or the control group. Assessments will be conducted at three time points: baseline, after completing the intervention and a 24-week follow-up visit. The following variables will be evaluated: liver frailty index, Functional Assessment of Cancer Therapy-Hepatobiliary subscale, Cancer Fatigue Scale, Pittsburgh Sleep Quality Index, Hospital Anxiety and Depression Scale and physical activity level. After the completion of the training programme, semi-structured interviews will be conducted with participants from the 3M2H-PARP group to investigate the programme's impact on their overall well-being. SPSS V.26.0 software will be used for statistical analyses. ETHICS AND DISSEMINATION: Ethical approval has been granted by the Jiangnan University School of Medicine Research Ethics Committee. The findings will be disseminated through publication in a peer-reviewed journal. TRIAL REGISTRATION NUMBER: ChiCTR2300076800.

Rehabilitation strategies following oesophagogastric and Hepatopancreaticobiliary cancer (ReStOre II): a protocol for a randomized controlled trial.

BACKGROUND: Curative treatment for upper gastrointestinal (UGI) and hepatopancreaticobiliary (HPB) cancers, involves complex surgical resection often in combination with neoadjuvant/adjuvant chemo/chemoradiotherapy. With advancing survival rates, there is an emergent cohort of UGI and HPB cancer survivors with physical and nutritional deficits, resultant from both the cancer and its treatments. Therefore, rehabilitation to counteract these impairments is required to maximise health related quality of life (HRQOL) in survivorship. The initial feasibility of a multidisciplinary rehabilitation programme for UGI survivors was established in the Rehabilitation Strategies following Oesophago-gastric Cancer (ReStOre) feasibility study and pilot randomised controlled trial (RCT). ReStOre II will now further investigate the efficacy of that programme as it applies to a wider cohort of UGI and HPB cancer survivors, namely survivors of cancer of the oesophagus, stomach, pancreas, and liver. METHODS: The ReStOre II RCT will compare a 12-week multidisciplinary rehabilitation programme of supervised and self-managed exercise, dietary counselling, and education to standard survivorship care in a cohort of UGI and HPB cancer survivors who are > 3-months post-oesophagectomy/ gastrectomy/ pancreaticoduodenectomy, or major liver resection. One hundred twenty participants (60 per study arm) will be recruited to establish a mean increase in the primary outcome (cardiorespiratory fitness) of 3.5 ml/min/kg with 90% power, 5% significance allowing for 20% drop out. Study outcomes of physical function, body composition, nutritional status, HRQOL, and fatigue will be measured at baseline (T0), post-intervention (T1), and 3-months follow-up (T2). At 1-year follow-up (T3), HRQOL alone will be measured. The impact of ReStOre II on well-being will be examined qualitatively with focus groups/interviews (T1, T2). Bio-samples will be collected from T0-T2 to establish a national UGI and HPB cancer survivorship biobank. The cost effectiveness of ReStOre II will also be analysed. DISCUSSION: This RCT will investigate the efficacy of a 12-week multidisciplinary rehabilitation programme for survivors of UGI and HPB cancer compared to standard survivorship care. If effective, ReStOre II will provide an exemplar model of rehabilitation for UGI and HPB cancer survivors. TRIAL REGISTRATION: The study is registered with ClinicalTrials.gov, registration number: NCT03958019, date registered: 21/05/2019.

A randomized clinical trial of comprehensive education and care program compared to basic care for reducing anxiety and depression and improving quality of life and survival in patients with hepatocellular carcinoma who underwent surgery.

This study aimed to investigate the effect of comprehensive education and care (CEC) program on anxiety, depression, quality of life, and survival in patients with hepatocellular carcinoma (HCC) who underwent surgical resection.Totally 136 patients with HCC who underwent hepatectomy were randomly assigned to CEC group and control group as 1:1 ratio. CEC group received health education, psychological nursing, caring activity, and telephone condolence, whereas control group received basic health education and rehabilitation for 12 months. Anxiety and depression were assessed by Hospital Anxiety and Depression Scale (HADS); quality of life was evaluated using European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (QLQ-C30).HADS-Anxiety (HADS-A) score was decreased at 9 month (M9) and M12, and reduction in HADS-A score (M12-M0) was greater in CEC group compared with control group. At M12, percentage of anxiety patients was less, but anxiety severity was similar in CEC group compared with control group. HADS-Depression (HADS-D) score was decreased at M12, and reduction in HADS-D score (M12-M0) was greater in CEC group compared with control group. At M12, percentage of depression patients were less but depression severity was similar in CEC group compared with control group. In addition, QLQ-C30 global health status and functional score was increased at M12, and score improvement (M12-M0) was greater in CEC group compared with control group. In addition, overall survival was longer in CEC group compared with control group.CEC relieves anxiety and depression, improves quality of life, and prolongs survival in patients with HCC underwent surgical resection.

Enhanced recovery in liver surgery decreases postoperative outpatient use of opioids.

BACKGROUND: Pathways of enhanced recovery in liver surgery decrease inpatient opioid use; however, little data exist regarding their effect on discharge prescriptions and post-discharge opioid intake. METHODS: For consecutive patients undergoing liver resection from 2011-2018, clinicopathologic factors were compared between patients exposed to enhanced recovery vs. traditional care pathways. Multivariable analysis was used to determine factors predictive for traditional opioid use at the first postoperative follow-up. The enhanced recovery in liver surgery protocol included opioid-sparing analgesia, goal-directed fluid therapy, early postoperative feeding, and early ambulation. RESULTS: Of 244 cases, 147 enhanced recovery patients were compared with 97 traditional pathway patients. Enhanced recovery patients were older (median 57 years vs 52 years, P = .031) and more frequently had minimally invasive operations (37% vs 16%, P < .001), with fewer major complications (2% vs 9%, P = .011). Enhanced recovery patients were less likely to be discharged with a prescription for traditional opioids (26% vs 79%, P < .001) and less likely to require opioids at their first postoperative visit (19% vs 61%, P < .001) despite similarly low patient-reported pain scores (median 2/10 both groups, P = .500). On multivariable analysis, the traditional recovery pathway was independently associated with traditional opioid use at the first follow-up (odds ratio 6.4, 95% confidence interval 3.5-12.1; P < .001). CONCLUSION: The implementation of an enhanced recovery in liver surgery pathway with opioid-sparing techniques was associated with decreased postoperative discharge prescriptions for opioids and outpatient opioid use after oncologic liver surgery, while achieving the same level of pain control. For this and other populations at risk of persistent opioid use, enhanced recovery strategies can eliminate excess availability of opioids.

Clinical Benefit of Preoperative Exercise and Nutritional Therapy for Patients Undergoing Hepato-Pancreato-Biliary Surgeries for Malignancy.

BACKGROUND: The impact of prehabilitation on physical fitness and postoperative course after hepato-pancreato-biliary (HPB) surgeries for malignancy is unknown. The current study aimed to investigate the effect of preoperative exercise and nutritional therapies on nutritional status, physical fitness, and postoperative outcomes of patients undergoing an invasive HPB surgery for malignancy. METHODS: Patients who underwent open abdominal surgeries for HPB malignancies (major hepatectomy, pancreatoduodenectomy, or hepato-pancreatoduodenectomy) between 2016 and 2017 were subjected to prehabilitation. Patients before the introduction of prehabilitation were included as historical control subjects for 1:1 propensity score-matching (no-prehabilitation group). The preoperative nutritional status and postoperative course were compared between the two groups. RESULTS: The prehabilitation group consisted of 76 patients scheduled to undergo HPB surgeries for malignancy. An identical number of patients were selected as the no-prehabilitation group after propensity score-matching. During the waiting period, serum albumin levels were significantly deteriorated in the no-prehabilitation group, whereas this index did not deteriorate or even improved in the prehabilitation group. By performing prehabilitation, a 6-min walk distance and total muscle/fat ratio were significantly increased during the waiting period. Although the overall incidence of postoperative complications did not differ between the two groups, the postoperative hospital stay was shorter in the prehabilitation group than in the no-prehabilitation group (median, 23 vs 30 days; p = 0.045). CONCLUSION: The introduction of prehabilitation prevented nutritional deterioration, improved physical fitness before surgery, and shortened the postoperative hospital stay for the patients undergoing HPB surgeries for malignancy.

Multiple factors affect the regeneration of liver

SUMMARY OBJECTIVE To study factors affecting the liver regeneration after hepatectomy METHODS With 3D reconstitution technology, liver regeneration ability of 117 patients was analysed, and relative factors were studied. RESULTS There was no statistically difference between the volume of simulated liver resection and the actual liver resection. All livers had different degrees of regeneration after surgery. Age, gender and blood indicators had no impact on liver regeneration, while surgery time, intraoperative blood loss, blood flow blocking time and different ways of liver resection had a significant impact on liver regeneration; In addition, the patients' own pathological status, including, hepatitis and liver fibrosis all had a significant impact on liver regeneration. CONCLUSION 3D reconstitution model is a good model to calculate liver volume. Age, gender, blood indicators and biochemistry indicators have no impact on liver regeneration, but surgery indicators and patients' own pathological status have influence on liver regeneration.

RESUMO OBJETIVO Estudar os fatores que afetam a regeneração hepática após hepatectomia. MÉTODOS A capacidade de regeneração hepática de 117 pacientes foi analisada com a tecnologia de reconstituição 3D e foram estudados os fatores relacionados. RESULTADOS Não houve diferença estatística significante entre o volume de ressecção hepática simulada e a ressecção atual. Todos os fígados apresentaram diferentes graus de regeneração após cirurgia. Idade, gênero e indicadores sanguíneos não tiveram impacto na regeneração hepática, enquanto que tempo de cirurgia, perda sanguínea intraoperatória, tempo de bloqueio do fluxo sanguíneo e diferentes formas de ressecção mostraram impacto significante na regeneração do órgão. Além disso, condições patológicas dos pacientes, incluindo hepatite e fibrose hepática, tiveram impacto significante na regeneração hepática. CONCLUSÃO O modelo de reconstituição 3D é um bom modelo para calcular o volume do fígado. Idade, gênero, indicadores sanguíneos e bioquímicos não tiveram impacto na regeneração hepática, mas indicadores operatórios e condição patológica dos pacientes mostraram influência na regeneração do órgão.

Multiple factors affect the regeneration of liver.

OBJECTIVE: To study factors affecting the liver regeneration after hepatectomy. METHODS: With 3D reconstitution technology, liver regeneration ability of 117 patients was analysed, and relative factors were studied. RESULTS: There was no statistically difference between the volume of simulated liver resection and the actual liver resection. All livers had different degrees of regeneration after surgery. Age, gender and blood indicators had no impact on liver regeneration, while surgery time, intraoperative blood loss, blood flow blocking time and different ways of liver resection had a significant impact on liver regeneration; In addition, the patients' own pathological status, including, hepatitis and liver fibrosis all had a significant impact on liver regeneration. CONCLUSION: 3D reconstitution model is a good model to calculate liver volume. Age, gender, blood indicators and biochemistry indicators have no impact on liver regeneration, but surgery indicators and patients' own pathological status have influence on liver regeneration.

Randomized clinical trial on enhanced recovery versus standard care following open liver resection.

BACKGROUND: Enhanced recovery programmes (ERPs) have been shown to reduce length of hospital stay (LOS) and complications in colorectal surgery. Whether ERPs have the same benefits in open liver resection surgery is unclear, and randomized clinical trials are lacking. METHODS: Consecutive patients scheduled for open liver resection were randomized to an ERP group or standard care. Primary endpoints were time until medically fit for discharge (MFD) and LOS. Secondary endpoints were postoperative morbidity, pain scores, readmission rate, mortality, quality of life (QoL) and patient satisfaction. ERP elements included greater preoperative education, preoperative oral carbohydrate loading, postoperative goal-directed fluid therapy, early mobilization and physiotherapy. Both groups received standardized anaesthesia with epidural analgesia. RESULTS: The analysis included 46 patients in the ERP group and 45 in the standard care group. Median MFD time was reduced in the ERP group (3 days versus 6 days with standard care; P < 0·001), as was LOS (4 days versus 7 days; P < 0·001). The ERP significantly reduced the rate of medical complications (7 versus 27 per cent; P = 0·020), but not surgical complications (15 versus 11 per cent; P = 0·612), readmissions (4 versus 0 per cent; P = 0·153) or mortality (both 2 per cent; P = 0·987). QoL over 28 days was significantly better in the ERP group (P = 0·002). There was no difference in patient satisfaction. CONCLUSION: ERPs for open liver resection surgery are safe and effective. Patients treated in the ERP recovered faster, were discharged sooner, and had fewer medical-related complications and improved QoL. REGISTRATION NUMBER: ISRCTN03274575 (http://www.controlled-trials.com).

Treatment outcome for patients with primary NSCLC and synchronous solitary metastasis.

INTRODUCTION: Non-small cell lung cancer (NSCLC) patients with synchronous solitary metastasis were generally considered as stage IV and believed to be incurable. Recently, growing evidence has indicated that surgical treatment may provide these patients with a survival benefit. The aim of this study was to retrospectively analyze the effectiveness of different treatments for primary tumors and solitary metastases. MATERIALS AND METHODS: Patients older than 18 years with histologically confirmed stage IV NSCLC and a confirmed synchronous solitary metastasis that diagnosed within 2 months of primary NSCLC. Patients with uncontrolled massive pleural effusion were excluded. Between February 2002 and October 2010, 213 patients were considered eligible and enrolled in this cohort. RESULTS: The median survival time (MST) for the 213 patients was 12.6 months. Forty-five patients received primary pulmonary tumor surgery in the entire cohort. The MSTs of patients who received primary tumor resection and those who did not were 31.8 and 11.4 months (p < 0.01). The MST of the patients with solitary brain metastasis was 12.3 months. Forty-one patients who received brain surgical treatment or SRS had a MST of 15.4 months and others who only received WBRT had a MST of 11.5 months (p = 0.002). Gender, the stage of the primary tumor, PS and whether the primary tumor was removed all affected prognosis independently. CONCLUSIONS: Aggressive local and metastasis treatments could lead to better clinical outcomes and thus provide an option for clinicians in the future management of patients with NSCLC and synchronous solitary metastasis.

A home-based exercise program to improve function, fatigue, and sleep quality in patients with Stage IV lung and colorectal cancer: a randomized controlled trial.

CONTEXT: Exercise benefits patients with cancer, but studies of home-based approaches, particularly among those with Stage IV disease, remain small and exploratory. OBJECTIVES: To conduct an adequately powered trial of a home-based exercise intervention that can be facilely integrated into established delivery and reimbursement structures. METHODS: Sixty-six adults with Stage IV lung or colorectal cancer were randomized, in an eight-week trial, to usual care or incremental walking and home-based strength training. The exercising participants were instructed during a single physiotherapy visit and subsequently exercised four days or more per week; training and step-count goals were advanced during bimonthly telephone calls. The primary outcome measure was mobility assessed with the Ambulatory Post Acute Care Basic Mobility Short Form. Secondary outcomes included ratings of pain and sleep quality as well as the ability to perform daily activities (Ambulatory Post Acute Care Daily Activities Short Form), quality of life (Functional Assessment of Cancer Therapy-General), and fatigue (Functional Assessment of Cancer Therapy-Fatigue). RESULTS: Three participants dropped out and seven died (five in the intervention and two in the control group, P=0.28). At Week 8, the intervention group reported improved mobility (P=0.01), fatigue (P=0.02), and sleep quality (P=0.05) compared with the usual care group, but did not differ on the other measures. CONCLUSION: A home-based exercise program seems capable of improving the mobility, fatigue, and sleep quality of patients with Stage IV lung and colorectal cancer.

Illness experience in patients with hepatocellular carcinoma: an interpretative phenomenological analysis study.

AIMS: Hepatocellular carcinoma (HCC) is common in Asia and has implications for compromised health-related quality of life. We report a qualitative study to explore the impact of HCC on patients' lives and the adjustment process. METHODS: Thirty-three adult patients with HCC in Taiwan (age from 31 to 76 years) took part in a semistructured interview. The interview guide included illness experience, strategies used to deal with the disease, and any significant concerns in their current life. Data were analyzed using interpretative phenomenological analysis. RESULTS: Three main themes were identified. These included: (a) the impact of disease: HCC was associated with physical symptoms and psychosocial stress, as well as positive changes; (b) illness perceptions: patients perceived HCC as a long-term and chronic disease that could not be cured but might be controlled; and (c) coping strategies: these included focusing on managing HCC and its symptoms, emotional responses, and leading a normal life. CONCLUSION: Patients' physical condition, their illness perceptions, and coping strategies all contributed to their disease adjustment. Our results suggest that patients in Taiwan are as keen for information about their disease as described in Western cultures. Cross-cultural work is needed to enhance our understanding about how the social or cultural contexts shape individuals coping with cancer.

National trends in discharge disposition after hepatic resection for malignancy.

BACKGROUND: There is a paucity of data on the trends in discharge disposition for patients undergoing hepatic resection for malignancy. AIM: To analyse the national trends in discharge disposition after hepatic resection for malignancy. METHODS: The National Inpatient Sample (NIS) database was queried (1993 to 2005) to identify patients that underwent hepatic resection for malignancy and analyse the discharge status (home, home health or rehabilitation/skilled facility). RESULTS: A weighted total of 74,520 patients underwent hepatic resection of whom, 53,770 patients had a principal diagnosis of malignancy. The overall mortality improved from 6.3% to 3.4%. After excluding patients that died in the post-operative period and those with incomplete discharge status, 45,583 patients were included. The proportion of patients that had acute care needs preventing them from being discharged home without assistance increased from 10.9% in 1993 to 19.5% in 2005. While there was an increase in the number of patients discharged to home health care during this time (8.9% to 13.8%), there was a larger increase in the proportion of patients that were discharged to a rehabilitation or skilled nursing facility (2% to 5.7%). Despite a decrease in the mortality rates, there was no improvement in rate of patients discharged home without assistance over the period of the study. CONCLUSIONS: The results of the present study demonstrate that after hepatic resection, a significant proportion of patients will need assistance upon discharge. This information needs to be included in patient counselling during pre-operative risk and benefit assessment.

[Case report: the practical use of the self-care deficit nursing theory for a patient with a neuroendocrine cancer of the duodenum]. / Fallstudie: Praktische Anwendung der Selbstpflegedefizit-Theorie bei einem Patienten mit neuroendokrinem Karzinom des Duodenums.

This case describes the nursing care of a 66-year-old electively admitted patient who came to hospital for the treatment of a hepatic secondary neuroendocrine duodenum cancer. A typical liver resection with duodeno-pancreatectomy and sigmaresection was performed. Complications led to more than ten re-laparatomies with resection of the stomach and oesophagus. It was necessary to perform blind occlusion of the jejunum and the disposition of an oesophagus stoma. A diabetes mellitus was caused by the total resection of the pancreas. Mister B. got a percutaneous endoscope jejunostomy but it could not be used because of a new small intestine fistula into the abdominal cavity wherefore a port was implanted. The following different conceptions of the self-care deficit theory have been used to describe and analyse the patient situation as follows: Basic conditioning factors, self-care requisites, therapeutic self-care demands, self-care competence. The future self-management capabilities consist of the following: Care of the oesophagus stoma, care of the percutaneous endoscope jejunostomy, management of the diabetes mellitus, coping with the changed self-image, coping with the restriction of movement and with the needed prophylaxis. Support was given by the transfer of knowledge to the patient. Instructions were given during realisations of new activities and development of skills. It was evaluated if the patient is capable to reflect his actions and to assess if he is able to react on deviations from the normal standards in a correct and appropriate way. After dismissal it was secured by phone call that the patient successfully manages the new self-care demands independently.

Hepatocellular carcinoma associated with membranous obstruction of the inferior vena cava: incidence, characteristics, and risk factors and clinical efficacy of TACE.

PURPOSE: To analyze the characteristics associated with membranous obstruction of the inferior vena cava (MOVC)-associated hepatocellular carcinoma (HCC) and to evaluate the clinical efficacy of transcatheter arterial chemoembolization (TACE). MATERIALS AND METHODS: This retrospective study was approved by an institutional review board, and informed consent was waived. Ninety-eight patients (mean age, 48.5 years +/- 12.9 [standard deviation]) with MOVC were retrospectively evaluated. The diagnosis of Budd-Chiari syndrome was confirmed with results from Doppler ultrasonography, computed tomography, magnetic resonance imaging, and/or inferior venacavography. The cumulative incidences of HCC and the patient survival period were calculated by using the Kaplan-Meier method. Factors associated with the development of HCC were evaluated by using multivariate Cox regression analysis. RESULTS: Among 98 patients with MOVC, liver nodules were detected in 37 patients (38%), 23 of whom had HCC associated with MOVC and 14 of whom had benign nodules. The cumulative incidence of HCC at 1, 5, and 10 years was 7.3%, 13.5%, and 31.8%, respectively. Female sex was the only significant factor associated with the development of HCC (odds ratio, 6.02; P <.001). HCC was of the single nodular type and of peripheral location. Among 23 patients with HCC, 20 patients were treated with only TACE and three with liver transplantation after TACE. After TACE, 14 (61%) of the study patients had a complete response, and survival rates at 1, 2, 3, 4, and 5 years were 90%, 85%, 61%, 61%, and 46%, respectively. CONCLUSION: The incidence of HCC in patients with MOVC was similar to that found in other studies. TACE resulted in an effective tumor response for HCC and seemed to be effective in prolonging patient survival. Female sex was the only significant factor associated with the development of HCC. A single nodular tumor with a peripheral location appears to have a higher probability of HCC.

[Palliative rehabilitation of two patients with terminal stage cancer: a visit to patient's home and the provision of advice by a nurse and rehabilitation staff members before discharge--from physical therapist's perspective].

We report two patients with terminal stage cancer who spent some days at their home after a physical therapist, occupational therapist, nurse, and medical social worker all visited the patients' homes and advised the patients' family in regard to the appropriate care before the patients were discharged as a strategy for palliative rehabilitation. Case 1: A patient suffering from terminal stage cancer was bed-ridden because of a pathological fracture of the femur. After palliative rehabilitation, the patient was able to get out of the bed and improved her daily living activity level through physical therapy. She spent some days at home according to the results of the pre-discharge home visit guidance to her family. Case 2: A patient suffering from terminal stage cancer manifested symptoms of fatigue and generalized muscular weakness. After palliative rehabilitation, her muscle strength and physical endurance were improved by physical therapy and adjustment of the bed height. Because she was eager to go home, we took her to her home before being discharged, and she was able to spend a few hours at home. Pre-discharge home visit guidance by a nurse and rehabilitation staff members to the patient' s family in regard to appropriate home care may therefore be a good means of satisfying such patients' desire to see their home once more and thereby improve their quality of life.

Health-related quality of life: return to baseline after major and minor liver resection.

BACKGROUND: Assessment of quality of life (QOL) after a major operation has become increasingly pertinent to patient care and may be as important as long-term survival in cancer patients. No current study has evaluated the long-term quality-of-life effects or the time to return to baseline quality of life in oncology patients undergoing hepatic resection for cancer. Thus, the aim of our study was to evaluate that the time to return to baseline QOL after major and minor hepatectomy is similar to other major abdominal operations. METHODS: A prospective study of 32 patients with malignant liver tumors completed the FACT-Hep, FACT-FHSI-8, EORTC QLQ-C30, Profile of Mood States, EORTC QLQ-Pan26, and Global Rating Scale at the time of consent, discharge, first postoperative visit, 6 weeks, 3 months, 6 months, and 12 months. RESULTS: Twenty-four patients underwent major (>2 segments) and 8 minor hepatectomy. Patients who underwent major hepatectomy demonstrated a significant loss in FACT-physical and functional scores at first postoperative visit and 6 weeks (P = .04) with return to baseline at 3 months. Similar nadir in all quality-of-life assessment scores were observed for POMS, EORTC QLQ-C30, FHSI-8, and certain global rating scales at 6 weeks, with a return to baseline at 3 months. For minor hepatectomy, the nadir for most quality-of-life scores occurred at the first postoperative visit with a return to baseline at 6 weeks. CONCLUSION: Patients undergoing major hepatectomy return to their baseline quality of life at 3 months with a progressive and sustained increase in physical, emotional, and global rating scale at 6 months. This study is the first one to demonstrate that major hepatectomy can be performed with short-term adverse QOL effects and long-term improvements in overall QOL.

Resultados a corto y largo plazo de la resección hepática por hepatocarcinoma: análisis de 232 resecciones consecutivas / Short and long-term results of liver resection for hepatocarcinoma in peru: a peruvian single center experience on 232 cases

ANTECEDENTES: Para evaluar la morbilidad, mortalidad post operatoria sobrevida yrecurrencia luego de las resecciones hepáticas por carcinoma hepatocelular (HCC) se realizóun análisis en 232 pacientes consecutivos con HCC resecados entre enero de 1990 y Diciembredel 2006 en el departamento de abdomen del Instituto de Enfermedades Neoplasicas (INEN).METODOS:La sobrevida global y libre de enfermedad fue calculada por el metodo deKaplan-Meier, los factores pronósticos fueron evaluados utilizando análisis univariadoy multivariado (Cox).RESULTADOS.- La media de edad fue 36 años, 44.2 tuvieron infección por virus de lahepatitis, solo el 16.3 por ciento tuvo cirrosis. La media de AFP fue de 5,467 ng/ml. la medianadel tamaño del HCC fue 15 cms.La mayoría de pacientes tuvo una resección hepática mayor (74.2 por ciento tuvo 4 o mássegmentos resecados).La morbilidad y mortalidad post operatoria fue de 13.7 ciento y 5.3 por ciento respectivamente. Despuésde una media de seguimiento de 40 meses el 53.3% de los pacientes presentó recurrencia.La sobrevida global a 1, 3 y 5 años fue de 66.5 por ciento , 38.7 por ciento y 26.7 por ciento respectivamente. Lasobrevida libre de enfermedad a 1, 3 y 5 años fue de 53.7 por ciento , 27.6 por ciento y 19.9 por ciento .En análisis multivariado, la presencia de múltiples nódulos (p<0.000), la cirrosis (p<0.001)y la invasión vascular macroscopica (p<0.001) fueron factores independientes asociadosa una pobre sobrevida.CONCLUSION: La resección quirúrgica es el tratamiento de elección para elhepatocarcinoma y puede realizarse en el Departamento de Abdomen del INEN con bajamorbi-mortalidad y adecuada sobrevida.

BACKGROUND: To evaluate the short and long term outcome of liver resections for hepatocellular carcinoma a retrospective analysis was performed on 232 consecutive patients with hepatocellular carcinoma resected between January 1990 and December 2006 at the Department of Abdomen of the Instituto de Enfermedades Neoplasicas of Lima Peru. METHODS: Disease-free survival (DFS) and overall survival (OS) were determined by Kaplan- Meier method, Prognostic factors were evaluated using univariate and multivariate analysis RESULTS: The median age was 36 years. 44.2% were associated with hepatitis B, only16.3% had cirrhosis. The median size of the tumors was 15 cm. The median value of AFP was 5,467 ng/ml. The majority of patients underwent a major hepatectomy (74.2 % hadfour or more segments resected)Overall morbidity and mortality were 13.7% and 5.3% respectively. After a median followup of 40 months, tumour recurrence appeared in 53.3% of the patients. The 1, 3, and 5 year overall survival rates were 66.5%, 38.7% and 26.7%respectively. The 1, 3, and 5year disease-free survival rates were 53.7%, 27.6%, and 19.9%. On multivariate analysis, presence of multiple nodules (p<0.000), cirrhosis (p=0.001), and macroscopic vascularinvasion (p=0.001) were found to be independent prognostic factors related to a worse long-term survival.CONCLUSIONS: Surgical resection is the optimal therapy for large HCC and can be safely performed with a reasonable long-term survival.