Indocyanine green fluorescence-guided laparoscopic hepatectomy versus conventional laparoscopic hepatectomy for hepatocellular carcinoma: A single-center propensity score matching study.

Background: Indocyanine green fluorescence-guided laparoscopic hepatectomy (ICG-guided LH) is increasingly used for the treatment of hepatocellular carcinoma (HCC). However, whether ICG-guided LH can improve surgical outcomes remains unclear. This study aimed to investigate the short-term outcomes and survival outcomes of ICG-guided LH versus common laparoscopic hepatectomy (CLH) for HCC. Methods: We conducted a retrospective analysis of 104 ICG-guided LH and 158 CLH patients from 2014 to 2020 at our center. To avoid selection bias, 81 ICG-guided LH and 81 CLH cases were analyzed after 1:1 propensity score matching (PSM). The baseline data and results were compared between the two groups. Results: The baseline characteristics of both groups were comparable after matching. There was a significant difference in operative time: longer in the ICG-guided LH group than in the CLH group (p=0.004). However, there was no significant difference in operative time in anatomical resection between the two groups (p=0.987). There was a significant difference in operative time in non-anatomical resection: longer in the ICG-guided LH group than in the CLH group (p=0.001). There were no significant differences in positive surgery margin, blood loss, blood transfusion rate, postoperative complication rate, postoperative length of hospital stay, mortality within 30 days, and mortality within 90 days. The ICG-guided LH group appeared to have a trend towards better overall survival (OS), but there was no significant difference in OS (P=0.168) and recurrence-free survival (RFS) (P=0.322) between the two groups. Conclusions: Although ICG fluorescence-guided LH is a timelier procedure to perform, it is a safe and effective technique with the advantages of intraoperative positioning, low postoperative complication rates, and potential to improve OS.

Influencing factors of indocyanine green fluorescence imaging quality in laparoscopic liver tumor surgery / 中华肝胆外科杂志

Indocyanine green (ICG) fluorescence imaging technology has been applied in laparoscopic surgery. It is possible to highly visualize the tumor cutting edge and liver segment boundary during laparoscopic hepatectomy. Although the application of this technique in liver tumor surgery has become more and more mature, the factors affecting the quality of fluorescence imaging are still not completely clear. In this paper, we analyzed and summarized the effects of different factors such as ICG administration scheme, imaging acquisition, tumor characteristics of patients and preoperative liver function indexes on the quality of intraoperative ICG imaging, in order to provide new ideas and practical experience for clinical practice and research.

Application of indocyanine green fluorescence imaging in laparoscopic hepatectomy / 中华肝胆外科杂志

Minimally invasiveness and accuracy are the aim of modern hepatobiliary surgery.Under the guidance of this concept,laparoscopic hepatectomy turns to be more mature and standardized.However,there are still some limitations for laparoscopy.Indocyanine green fluorescence imaging technique can accurately locate tumors,mapping liver segments,and display biliary tract.It is an effective real-time tool to guide the parenchymal transection accurately during operation.It can also detect small lesions and bile leakage.Indocyanine green fluorescence imaging technique makes up the limitations of laparoscopic surgery,providing better conditions for accurate surgery.In this paper,we summarized the application of indocyanine green fluorescence imaging technique in laparoscopic hepatectomy.

Expression and clinical significance of miR-96-5p in primary hepatocellular carcinoma at early recurrence after radical surgery / 实用医学杂志

Objective To investigate the expression and clinical significance of miR-96-5p in primary hepatocellular carcinoma (HCC) at early recurrence after radical surgery. Methods 61 HCC eryopreservation tissue samples from the liver carcinoma specimens data obtained after radical surgery and banked in our hospital were divided into 2 groups: early recurrence group (33 cases) and non-early recurrence group (28 cases). Aquantitative real-time polymerase chain reaction (qRT-PCR) was performed to detect the expression of miR-96-5p. Results Compared with the non-early recurrence group , the expression of miR-96-5p was observably down-regulated [(0.634 ± 0.783) vs (5.182 ± 11.321), P = 0.043]. The expression of miR-96-5p was correlated to tumor diameter, early recurrence and vascular invasion (P<0.05). Conclusions miR-96-5p are significantly related to early liver cancer recurrence and metastasis. miR-96-5p may be a molecular marker of HCC at early recurrence as well as a target for targeted therapy of liver cancer in future.

Identification of microRNA-217 targeted gene ANLN in pancreatic cancer PANC1 cells / 中华胰腺病杂志

Objective To identify the miR-217 targeted gene ANLN by experiment.Methods Bioinformatic algorithms were used to predict the potential targets of miR-217.Then,ANLN binding with miR217 and mutant ANLN (mutANLN) sequence were designed and synthesized,and their amplified fragments were inserted into plasmid psiCHECK-2,and recombinant plasmid psiCHECK-2-ANLN and psiCHECK-2-mutANLN were reconstructed.The two recombinant plasmids were co-transfected into pancreatic cancer cell line PANC1 with miR-217,miR-217 inhibitor,NC,NC inhibitor by liposome,respectively.Dual luciferase reporter system was used to determine the luciferase activity,and Western blot was used to measure the expression of ANLN protein.Results The luciferase activities of psiCHECK-2-ANLN,psiCHECK-2-ANLN +miR-217,psiCHECK-2ANLN + miR-217 inhibitor,psiCHECK-2ANLN + NC,psiCHECK-2-ANLN + NC inhibitor were 2.221 ± 0.188,0.769 ± 0.061,3.764 ± 0.371,2.265 ± 0.201,2.242 ± 0.018,and the difference among these groups was statistically significant (F =77.405,P ＜0.001),but the difference among psiCHECK-2ANLN group,psiCHECK-2-ANLN + NC group and psiCHECK-2-ANLN + NC inhibitor group was not statistically significant.However,luciferase activities of psiCHECK-2-ANLN + miR-217 group were significantly decreased when compared with other 3 groups,and luciferase activity of psiCHECK-2-ANLN +miR-217 inhibitor group were significantly increased when compared with other 4 groups (all P ＜0.001).Luciferase activities of groups transfected with psiCHECK-2-mutANLN was not significantly different (P =0.053).The expression of ANLN protein in PANC1 with psiCHECK-2-ANLN + miR-217 co-transfection was significantly down-regulated when compared with that with psiCHECK-2-ANLN transfection alone.Conclusions ANLN is one of the direct target genes of miR-217 in PANC1 cells.

Research on the safety and effectiveness of transumbilical single port laparoscopic cholecystectomy / 南方医科大学学报

<p><b>OBJECTIVE</b>To evaluate the safety and effectiveness of transumbilical single port laparoscopic cholecystectomy (TSPLC).</p><p><b>METHODS</b>A retrospective analysis was conducted for the 141 patients, who received TSPLC by DR. Jian in our hospital since April 2011 to October 2012, and the operative and postoperative effects of these patients were evaluated by comparing with that of the conventional laparoscopic cholecystectomy (CLC).</p><p><b>RESULTS</b>In the total of 141 TSPLC cases that included in the study, 3 cases converted to CLC. 2 cases converted to open cholecystectomy. Additionally, 1 case was diagnosed as an unexplained bowel perforation after operation, fat liquefaction occurred in 2 patients. When comparing with these cases to 306 CLC patients, there was no obvious statistical difference in the terms of patients age, gender, BMI and abdominal surgery history (P>0.05). Meanwhile, There were similar effects of the two groups of patients on the operation time (28.5∓19.3 min vs 33.4∓14.2 min, P=0.001), estimate blood loss (6.4∓18.9 ml vs 9.8∓20.6 ml, P=0.06), the time needed for closing abdomen (5.1∓3.8 min vs 5.8∓4.3 min, P=0.06) and postoperative complications (3/141 vs 5/306, P=1.00). However, the TSPLC group was superior to CLC group in the terms of the conversion rate (2/141 vs 25/306,P=0.001), and postoperative hospitalization (1.2∓1.4 d vs 2.6∓1.7 d,P<0.01), meanwhile, TSPLC was also superior to LC on the satisfactory degree of operative effect through the one week follow-up (8.5∓1.1 vs 7.9∓0.7, P<0.01).</p><p><b>CONCLUSIONS</b>TSPLC is both safer and more effective than that of CLC, and thus it is worth adopting in selected hospitals.</p>

Application of three-dimensional visualization technology for laparoscopic resection of cystic carcinoma in the pancreatic body and tail / 南方医科大学学报

<p><b>OBJECTIVE</b>To study the application of three-dimensional visualization technology for laparoscopic resection of cystic carcinoma in the pancreatic body and tail.</p><p><b>METHODS</b>Six cases of cystic carcinoma in the pancreatic body and tail treated between Nov, 2009 and Mar, 2011 were retrospectively analyzed. The original image data of 64-slice spiral CT were collected and using adaptive region growing algorithm, the serial CT images were segmented and automatically extracted to obtain the 3-dimensional reconstruction images with customized image manipulation software. The specific surgical approach (the trocar position) and surgical procedure were planned based on the reconstructed mode.</p><p><b>RESULTS</b>The reconstructed 3-dimensional model clearly displayed cystic carcinoma in the pancreatic body and tail and the adjacent organs, showing distinct relationship between the cystoma and the splenic artery and vein. All the patients successfully underwent laparoscopic resection of the pancreatic body and tail without perioperative death. The spleen was preserved in 5 cases and removed in 1 case due to mucinous cystadenocarcinoma. The overall rate of pancreatic fistulae was 33.3% without incidences of postoperative hemorrhage. The average hospital stay of the patients was 12 days.</p><p><b>CONCLUSION</b>Three-dimensional reconstruction based on pancreatic CT data provides valuable assistance for laparoscopic resection of cystic carcinoma in the pancreatic body and tail.</p>

Expression of miR-216a in pancreatic cancer and its clinical significance / 南方医科大学学报

<p><b>OBJECTIVE</b>To explore the clinical significance of miRNA-216a expression in pancreatic cancer.</p><p><b>METHODS</b>Fourteen patients with pancreatic cancer undergoing pancreaticoduodenectomy and 6 patients with benign pancreas lesions were examined for miR-216a expressions in the tumor or lesion tissues using Agilent Human miRNA Microarray (V12.0). The relationship between miR-216a expressions and the clinicopathological features of the patients was analyzed.</p><p><b>RESULTS</b>The expression of miRNA-216a was significantly lower in pancreatic cancer than in benign pancreas lesions (P=0.000). The expression of miRNA-216a was significantly correlated with the T stage of the tumor (P=0.002), but not with the patients' age, gender, smoking status, tumor stage, lymph node metastases, distant metastasis, tumor differentiation, nerve invasion, vessel invasion or serum CA19-9 level (P>0.05).</p><p><b>CONCLUSIONS</b>The down-regulated expression of miR-216a in pancreatic cancer suggests the involvement of miR-216a in the tumorigenesis and development of pancreatic cancer. miR-216a may potentially serve as a novel tumor marker and also a prognostic factor for pancreatic cancer.</p>

Surgical management and prognostic factors of hilar cholangiocarcinoma: experience with 115 cases in China.

BACKGROUND: Hilar cholangiocarcinoma (or Klatskin tumor) is a rare condition, accounting for less than 1% of all cancers. This study was designed to assess the surgical and postsurgical management of affected patients, including the postoperative chemotherapy, and an analysis to determine prognostic factors for postoperative morbidity and mortality. METHODS: A retrospective review of 115 consecutive cases treated with resection between January 1990 and January 2004 at a single university medical center in southern China was carried out. Clinicopathological data were analyzed and univariate and multivariate analyses against outcome was employed to determine the prognostic significance of a variety of factors including excision margin characteristics, status of metastases, tumor type, histological differentiation, lymph node characteristics, and postoperative therapy. RESULTS: Median survival time of patients treated with resection and anastomosis with postoperative chemotherapy was 41 months compared with 36 months for patients who did not receive chemotherapy postoperatively. Factors correlating with shorter survival were positive excision margin, metastasis, adenoacanthoma-type tumor, poor or unknown histological differentiation, and positive lymph nodes. In addition, postoperative chemotherapy improved survival. Patients treated with chemotherapy postoperatively had a survival of 43.15 +/- 21.02 months, which was significantly longer than the survival of patients who received no postoperatively chemotherapy (36.97 +/- 15.99 months; P < 0.05). CONCLUSION: Resection with anastomosis and postoperative chemotherapy results in longer survival time compared with no chemotherapy postoperatively. Positive excision margins, metastases, adenoacanthoma-type tumor, poor or unknown histological differentiation, and positive lymph nodes correlate with shorter survival.

Controlled study on different hepatic blood flow occlusion in hepatectomy / 中国普通外科杂志

Objective To evaluate the indications of different hepatic blood flow occlusion in hepatectomy of cancer patients. Methods One hundred and fifty-six patients admitted between 1991-2001 underwent hepatectomy with hepatic blood flow occlusion in different ways, among them 48 cases underwent hepatic segmentectomy with segmental portal vein occlusion by a balloon catheter, 71 cases underwent hepatectomy with porta hepatis occlusion by Pringle method, 37 cases treated by hemihepatectomy or partial hepatectomy with hemihepatic occlusion. Results Intraoperative blood loss in patients using balloon catheter was smaller and postoperative liver function recovered faster compared with other ways of blood flow occlusion. Conclusion The preliminary result shows that hepatic segmentectomy with segmental portal vein occlusion by a balloon catheter is safe and useful technique for hepatectomy.