Hepatitis B virus-related combined hepatocellular-cholangiocarcinoma: clinicopathological and prognostic analysis of 390 cases.

BACKGROUND: The reported treatment outcomes of combined hepatocellular-cholangiocarcinoma (HCC-CC) are inconsistent and the clinicopathological factors influencing treatment outcome remain to be defined. PATIENTS AND METHODS: Patients with hepatitis B virus (HBV)-related HCC-CC undergoing surgical treatment at our institution between January 1997 and September 2010 were retrospectively analyzed. Univariate and multivariate analyses were carried out to identify independent clinicopathological factors affecting surgical outcome. RESULTS: A total of 390 patients with HBV-related HCC-CC were included in this study; there were 328 men and 62 women, with a median age of 49 years (range 21-77 years). Among these patients, 74.4% had underlying liver cirrhosis. The median tumor size was 6.5 cm (range 1.3-33 cm) with 68.7% microvascular invasion and 12.3% lymphatic metastasis. The median survival after surgical resection was 1.68 years and the cumulative survival at 1, 2, 5, and 10 years was 62.1, 46.4, 32, and 25.5%, respectively. The disease-free survival at 1, 2, 5, and 10 years was 36.1, 22.3, 15, and 11.3%, respectively. Independent predictors for decreased survival were male sex, tumor number (≥2), major thrombus, microvascular thrombus, γ-glutamyl transpeptidase (GGT) over 60 U/l, and carbohydrate antigen 19-9 level. Independent negative factors affecting disease-free survival included tumor size (>5 cm), major thrombus, and GGT over 60 U/l. CONCLUSION: Long-term surgical survival of HBV-related HCC-CC seemed to be influenced by sex, tumor-related factors (tumor number, major thrombus, and microvascular thrombus), serum GGT, and carbohydrate antigen 19-9 level. Tumor size, major thrombus, and serum GGT level tended to be associated with disease-free survival.

Vitamin analogues in chemoprevention of hepatocellular carcinoma after resection or ablation--a systematic review and meta-analysis.

OBJECTIVE: While hepatic resection or local ablative therapy may provide a potentially curative treatment for hepatocellular carcinoma (HCC), more than half of these patients develop recurrent HCC within 5 years after treatment. Thus identification of any therapy which can decrease or delay the incidence of recurrence will improve the results of treatment. However, no chemopreventive agent has been approved for HCC. METHODS: A MEDLINE database, Embase, Cancerlit (National Cancer Institute), and CBM (Chinese Biomedical Database) search from 1990 to 2009 was performed to identify relevant articles using the keywords "hepatocellular carcinoma," "vitamin analogue," and "chemoprevention." Additional papers were identified by a manual search of the references from the key articles. The fixed effect model was used for a meta-analysis. RESULTS: Oral administration of acyclic retinoids (vitamin A analogue), and menatetrenone (vitamin K2 analogue) have been tested as chemopreventive agents after hepatic resection or local ablative therapy for HCC. There were one and four randomised, controlled trials (RCTs) which evaluated the efficacy of polyprenoic acid and menatetrenone, respectively. All studies were conducted in Japan. One RCT showed the preventive effect of polyprenoic acid in lowering the incidence of HCC recurrence after hepatic resection or percutaneous ethanol injection, and this effect lasted up to 199 weeks after randomization (or 151 weeks after completion of retinoid administration). Four RCTs evaluated the preventive efficacy of menatetrenone on HCC recurrence after hepatic resection or local ablative therapy. The results of three studies, as well as the meta-analysis of all four studies, showed significantly better tumour recurrence-free survival. The beneficial effect on the overall survival was less definite. CONCLUSION: There is evidence to suggest that chemopreventive therapy after partial hepatectomy or local ablative therapy is beneficial in prolonging disease-free survival, but the evidence is less for an effect on the overall survival. To confirm the beneficial role of vitamin A or K analogues in the chemoprevention of HCC further and larger randomised trials are now required.

Enucleation of liver hemangiomas: is there a difference in surgical outcomes for centrally or peripherally located lesions?

BACKGROUND: Partial hepatectomy for centrally located liver lesions is technically more challenging than that for peripheral lesions. Enucleation of liver hemangiomas is easier and safer than partial hepatectomy. Whether enucleation gives the same surgical outcomes for both centrally and peripherally located hemangiomas is unknown. This study aimed to evaluate the difference in surgical outcomes of enucleation of centrally and peripherally located liver hemangiomas. METHODS: This study used a prospectively maintained database consisting of a consecutive series of patients who underwent enucleation of liver hemangiomas in a tertiary referral center from January 2004 to December 2006. Surgical variables, length of hospital stay, and postsurgical complications were compared between centrally and peripherally located liver hemangiomas. RESULTS: During the study period, 172 patients underwent enucleation of hepatic hemangiomas. The lesions were centrally located in 76 patients (44.2%) and peripherally located in 96 patients (55.8%). The 2 groups were comparable in demographic data and lesion characteristics. There was no hospital mortality. The major complication rates were low in both groups (2.6% vs. 3.1%; P = .848). Enucleation of centrally located liver hemangiomas required significantly longer vascular inflow occlusion time (P <.001), longer operating time (P <.001), and more blood transfusion (P = .001). This group also had a higher volume of blood loss (P = .004) and longer hospital stay (P = .024) than the group with peripherally located liver hemangiomas. CONCLUSIONS: Enucleation is a safe surgery for hemangiomas in any part of the liver, although it is technically more demanding for centrally than peripherally located hemangiomas.

Factors related to pleural effusion following hepatectomy for primary liver cancer.

BACKGROUND: Pleural effusion frequently complicates hepatectomy and multiple factors contribute to its development following hepatectomy for primary liver cancer. The purpose of this study was to evaluate these factors. METHODS: From March 2003 to May 2005, 228 consecutive patients with primary liver cancer underwent hepatectomy in our department were evaluated retrospectively to identify factors related to postoperative pleural effusion. RESULTS: Among the 228 patients, postoperative pleural effusions arose in 58 (25.4%). Univariate analysis showed significant differences in postoperative ascites, subphrenic collection, Pringle manoeuvre length, drainage amount on postoperative day 1, albumin level on postoperative day 7, alanine aminotransferase (ALT) level on postoperative days 1 and 3, prealbumin level on postoperative days 3 and 7, and tumor size (P<0.05). Ordinal regression analysis revealed that subphrenic collection, drainage on postoperative day 1 and ALT plus prealbumin on postoperative days 1 and 3 were statistically significantly related to postoperative pleural effusion (P<0.05). CONCLUSION: Subphrenic collection and operative injury to the liver appeared to be significantly related to pleural effusion after hepatectomy for primary liver cancer.

Clinicopathologic features, diagnosis and surgical treatment of intrahepatic cholangiocarcinoma in 104 patients.

BACKGROUND: The outcome of surgical treatment of patients with intrahepatic cholangiocarcinoma (ICC) is poor. This study was designed to analyze the relationship between clinicopathologic features and the survival time after operation. METHODS: The operation was performed in 104 patients with mass-forming type ICC at our hospital between November 1996 and May 2000. Seventy-nine patients (76.0%) were followed up successfully. Sixteen clinicopathological variables including age, sex, history of chronic liver disease, HBsAg, operation, adjuvant therapy, ascites, lymph node metastasis, invasion of adjacent organs, tumor size, necrosis of tumor, envelope, intrahepatic metastasis, International Union Against Cancer (UICC) TNM staging, histology, and cirrhosis were selected for univariate and multivariate analyses to evaluate their influence on the prognosis. RESULTS: The accumulative 1-, 3-, 5-year survival rates of the 79 patients were 49.4%, 17.3%, 9.6% respectively. Univariate analysis revealed that sex (P=0.0221), HBsAg (P=0.0115), operation (P=0.0042), adjuvant therapy (P=0.0389), ascites (P=0.0001), invasion (P=0.0220), intrahepatic metastasis (P=0.0000) and TNM stage (P=0.0001) were related to survival time. Multivariate analysis revealed that HBsAg, ascites and TNM stage were significantly related to prognosis. CONCLUSION: Early diagnosis and treatment and major hepatectomy are essential to improving the results of surgical treatment of ICC patients.

Surgical excision of giant primary carcinoma in the medial liver lobe.

OBJECTIVE: To assess the techniques for surgical excision of giant primary carcinoma in the medial liver lobe. METHODS: Operative managements, complications and their causes during and after resection of giant carcinoma in the medial liver lobe were analyzed retrospectively in 166 cases treated from October 1996 through December 2001. RESULTS: Of the 166 patients, 123 (74.1 %) underwent tumor resection and 43 (25.9 %) regular lobectomy, including left trilobectomy (8, 4.8 %), medial lobectomy (21, 12.7 %), right anterior lobectomy (11, 6.6 %), and hemihepatectomy (3, 1.8 %). All patients were subjected to surgery with intermittent interruption of the first porta hepatis under normothermia. The total interruption time was 7-68 minutes and average time was 24.5 minutes. The maximum single interruption time was 41 minutes. Intraoperative blood loss was 50-4000 ml, averaging 726 ml. The maximum blood transfusion was 5200 ml, averaging was 811 ml, and transfusion was not needed in 54 patients. Postoperative complications occurred in 9 patients (5.4%), of whom, 2 (1.2%) died of liver failure and acute respiratory distress syndrome respectively. CONCLUSIONS: An adequate reserve of liver function is a prerequisite for a smooth recovery after operation. Careful intraoperative management is crucial to decrease postoperative complications.

E-selectin and its ligand-sLeX in the metastasis of hepatocellular carcinoma.

OBJECTIVE: To study the significance of E-selectin and its ligand-sLeX in the metastasis of hepatocellular carcinoma (HCC). METHODS: Flow cytometry and immunohistochemistry were used to detect the expression of E-selectin and its ligand-sLeX in both HCC cell lines and human HCC tissues. RESULTS: The positive rate of E-selectin in vascular endothelial cells adjacent to cancer was 67.9% (19/28). The expression of E-selectin in tumors accompanied with emboli or satellite foci was significantly higher than that in tumors without emboli or satellite foci (P<0.05), and it was not related to tumor size, tumor capsule, AFP content, and the degree of differentiation. The positive expression of sLeX in SMMU-7721, PLF/PRF/5 and HepGII cell lines was 7.03%, 63.35% and 97.29% respectively. The positive cells of sLeX mainly distributed in the margin of tumor tissues. The positive expression of sLeX in HCC cells in emboli or invasive tumor tissues was much higher than in Primary foci. CONCLUSION: E-selectin and its ligand-sLeX are closely correlated with the metastasis of HCC.