The influence of viral hepatitis status on long-term HCC outcome in patients with non-cirrhotic livers.

AIM: To evaluate the influence of viral hepatitis status on the long-term outcome of patients with hepatocellular carcinoma (HCC) in non-cirrhotic livers. PATIENTS AND METHODS: Two hundred and seventy-nine patients diagnosed with HCC underwent liver resection. Histologic examination of the resected liver confirmed the absence of cirrhosis in 145 patients. Clinical characteristics and surgical outcome were compared between patients with HCC derived from non-cirrhotic liver with (n=111) and without (n=34) viral hepatitis. RESULTS: One-, three- and five-year disease-specific survival rates in patients without viral markers (97.0%, 93.9% and 88.1%, respectively) were significantly higher than in patients with positive viral markers (97.2%, 81.0% and 62.3%, respectively) (p=0.0151). The five-year remnant liver recurrence-free survival rate in patients with negative viral markers (64.1%) was significantly higher than in patients with viral markers (44.9%) (p=0.0412). CONCLUSION: Hepatic resection is beneficial for HCC in non-cirrhotic livers patients without viral hepatitis.

Validity of hepatic resection of colorectal liver metastases in the elderly (75 years and older).

AIM: To evaluate the validity of surgical therapy for colorectal liver metastases in the elderly patients. PATIENTS AND METHODS: Between 1992 and 2004, 401 patients were diagnosed as having liver metastases from colorectal cancer. These comprised 64 patients aged 75 years or older and 337 patients aged less than 75 years. RESULTS: Two hundred and thirty-two patients (57.9%) underwent potentially curative hepatic resection. Postoperative complications occurred in 29.6% of the older patients and in 23.4% of the younger patients. Mortality was 0% in the older group and 0.5% in the younger group. The overall 5-year survival rates of the older and younger group were 33.2% and 47.9%, respectively (p < 0.01). The proportion of patients who died of other diseases was significantly higher in the older (11.1%) than the younger group (2.0%) (p = 0.04). CONCLUSION: Age cannot be regarded as a medical contraindication for hepatic resection of colorectal liver metastases.

Expression of dihydropyrimidine dehydrogenase, thymidylate synthase, p53 and p21 in metastatic liver tumor from colorectal cancer after 5-fluorouracil-based chemotherapy.

BACKGROUND: The expression of genes thought to be related to 5-FU chemosensitivity has been extensively investigated. However, little data is available on the expression patterns of these genes after chemotherapy. PATIENTS AND METHODS: We investigated the expression of four genes, DPD, TS, p53 and p21, in the metastatic liver lesions obtained from colorectal cancer patients who had been treated with hepatic arterial infusions of 5-fluorouracil(5-FU)-based chemotherapy. RESULTS: Expression of DPD, TS and p53 in the metastatic liver lesions was significantly higher in the chemotherapy-response group than in the no response group. In the response group, viable cancer cell nests were seen in confined spaces surrounded by fibrous tissue. It was of interest that these cancer cells in the response group showed conspicuous immunoreactivity of DPD, TS and p53. CONCLUSION: An analysis of genes involved in 5-FU sensitivity revealed that surviving tumor cells exhibited resistance characteristics, indicating that the chemotherapy regimen should be altered, even in partially responding cases, unless the response is pathologically complete.

Outcome of total pelvic exenteration for locally recurrent rectal cancer.

BACKGROUND/AIMS: Local recurrence occurs in 10 to 30% of patients with rectal cancer following curative resection. However treatment of choice remains controversial. We assessed the results of total pelvic exenteration for locally recurrent cancer of the rectum retrospectively. METHODOLOGY: We reviewed medical charts of 45 patients with rectal cancer who underwent curative total pelvic exenteration for local recurrence. The cause of recurrence was classified into four groups: anastomotic, surgical cut-end, implantation, and lymphatic based on pathologic findings and computed tomography. Long-term survival was correlated with clinicopathologic variables. RESULTS: Postoperative morbidity was 77.8% and in-hospital death occurred in 13.3% of patients. The overall 5-year survival rate was 14.1%. The 5-year survival rates stratified according to the expectation of curability were 31.6% for absolutely curative resection, 7.8% for relatively curative resection, and 0% for non-curative resection. Multivariate analysis revealed that the disease-free interval was the only independent prognostic factor. There was no benefit from perioperative radiation or intraoperative continuous pelvic peritoneal perfusion of the pelvis. CONCLUSIONS: Total pelvic exenteration for local recurrence of rectal cancer can achieve long-term survival when curative resection is possible and the disease-free interval is long.

Extended abdominoperineal resection with partial prostatectomy for T3 rectal cancer.

BACKGROUND/AIMS: To describe and discuss extended abdominoperineal resection with partial prostatectomy using the ultrasonic harmonic scalpel as an alternative to total pelvic exenteration in lower rectal T3 cancer contiguous with the prostate. METHODOLOGY: Extended abdominoperineal resection with partial prostatectomy was performed in 4 patients with lower rectal clinical stage T3 cancer contiguous with the prostate using the ultrasonic harmonic scalpel. The ultrasonic harmonic scalpel permitted en bloc dissection of the rectum and the posterior part of the prostate, removing all tumor and disruption of the normal urinary stream. RESULTS: Blood loss ranged from 600 to 2500 mL. The final pathologic stage was T2 in 1, T3 in 2 and T4 in 1 patient, and the surgical margins were clear in all patients. Urethral injury occurred in 1 patient, and 2 patients had postoperative urinary dysfunction. No patients required a urinary stoma or suffered recurrence. CONCLUSIONS: Extended abdominoperineal resection with partial prostatectomy using the ultrasonic harmonic scalpel is an attractive alternative to total pelvic exenteration for patients with lower rectal T3 cancer contiguous with the prostate.

Outcome of total pelvic exenteration for primary rectal cancer.

PURPOSE: This retrospective study identifies the clinicopathologic factors (age, gender, size of tumor, location, tumor stage, lymph node metastasis, histologic differentiation, and adjuvant therapies) that are useful in predicting long-term survival in patients undergoing total pelvic exenteration for advanced primary rectal cancer. METHODS: We reviewed the medical records of 71 patients with stage T3 or T4 primary rectal cancer who underwent a curative total pelvic exenteration. The effects of various clinical variables on long-term survival were analyzed. RESULTS: The postoperative mortality, hospital death, and morbidity rates were 1.4, 4.2, and 66.2 percent, respectively. The overall five-year survival rate after total pelvic exenteration was 54.1 percent. The five-year survival rate was 65.7 percent for patients with T3 lesions and 39 percent for patients with T4 lesions. A univariate analysis showed that postoperative survival was affected by age, tumor stage, and lymph node metastasis, while a multivariate analysis showed that age and lymph node metastasis were independent prognostic factors. CONCLUSION: Total pelvic exenteration may enable long-term survival in younger patients with stage T3 or T4 primary rectal cancer and little or no lymph node metastasis.