Is anatomical resection necessary for early hepatocellular carcinoma? A single institution retrospective experience.

Aim: The present study aimed to determine whether anatomical resection was necessary for early hepatocellular carcinoma. Methods: A log-rank test or two-stage test was used for univariate analysis. A Cox proportional hazards model was used for multivariable analysis. Results: For patients without microvascular invasion, a resection margin ≥1 cm provided the longest recurrence-free survival time regardless of whether they underwent anatomical resection (p = 0.005) or nonanatomical resection (p = 0.006). For patients with microvascular invasion, anatomical resection combined with a resection margin ≥1 cm provided the longest recurrence-free survival time compared with other treatments (p = 0.001). Conclusion: Anatomical resection was not necessary for patients without microvascular invasion. However, for patients with microvascular invasion, both anatomical resection and a resection margin ≥1 cm were necessary.

Surgical outcomes between patients with and without a cirrhotic liver undergoing laparoscopic liver resection: A meta-analysis.

BACKGROUND: Laparoscopic surgery in patients with liver cirrhosis (CL) is considered to be challenging. Recent studies have shown that laparoscopic liver resection (LLR) is more beneficial of reduced operative stress and postoperative complications in patients with CL. AIM: A meta-analysis was done to review the currently available published data comparing LLR for patients with CL versus those non-cirrhosis of the liver (NCL). METHODS: The electronic databases of PubMed, Wiley, Web of Science, Embase, and the Cochrane Library were searched from date of inception to January 29, 2018. Studies reporting a comparison of outcomes and methods of LLR in CL and NCL groups were included. The studies were evaluated using the modified Newcastle-Ottawa Scale. RESULTS: A total of 1573 patients from six cohort studies were included in final analysis. The CL group had a slightly shorter operative time compared with the NCL group (weighted mean difference [WMD], 18.78min shorter; 95% confidence interval [CI], -43.54-5.98; P=0.14) and delayed hospital stay (WMD, 1.26 days longer; 95% CI, -0.05-2.56; P=0.06). Blood loss, blood transfusion rate, mortality, and conversion rate did not differ significantly between the groups. CONCLUSIONS: LLR is safe and feasible in the CL compared with the NCL groups. Our present review indicates that LLR should be considered when selecting surgery for patients with CL.

High-pitch dual-source CT coronary angiography: analysis of the impact on image quality of altered electrocardiography waves during data acquisition.

Electrocardiography (ECG) "altered waves" sometimes occur during data acquisition when computed tomography coronary angiography (CTCA) is performed with the prospectively ECG-triggered high-pitch (Flash spiral) mode using a second-generation dual-source CT. The aim of this study was to assess the effect of the ECG altered waves on image quality. Seventy-three consecutive patients with stable sinus rhythm ≤ 65 beats per minute were retrospectively enrolled in this study. CTCA was performed using the Flash spiral mode in which the data acquisition was prospectively triggered at 60 % of the R-R interval and completed within one cardiac cycle. The ECG waves before and during data acquisition were analyzed for grouping purposes. Image quality was evaluated using a four-point scale (1 = best, 4 = unevaluatable). Thirty patients (group 1) were found to have ECG altered waves during data acquisition, while 43 patients (group 2) had ECG "stable waves." The altered waves were seen as the baseline drifting; the broad, erected, or inverted P wave or QRS complexes; and a new wave. However, the length of the R-R interval did not change during the data acquisition. There were no significant differences in image quality scores between the two groups on the per-patient (2 ± 0.87 vs. 2.2 ± 0.74, P = 0.273) or per-segment (1.27 ± 0.54 vs. 1.32 ± 0.55, P = 0.577) basis. There were no significant differences in coronary evaluatability as well (per-patient; 93.3 vs. 95.3 %, P = 0.352; per-segment; 99.4 vs. 99.6 %, P = 1.0). CTCA image quality is not affected by ECG altered waves during data acquisition using the Flash spiral mode in low and stable heart rate patients. Thus, the ECG altered waves are considered artifacts.