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1.
Zhongguo Yi Liao Qi Xie Za Zhi ; 45(2): 176-182, 2021 Apr 08.
Artículo en Chino | MEDLINE | ID: mdl-33825378

RESUMEN

The methods of monitoring the thermal ablation of tumor are compared and analyzed in recent years. The principle method results and insufficient of ultrasound elastography and quantitative ultrasound imaging are discussed. The results show that ultrasonic tissue signature has great development space in the field of real-time monitoring of thermal ablation, but there are still some problems such as insufficient monitoring accuracy difficulty in whole-course monitoring and insufficient in vivo experiments, so it is impossible to realize clinical application. It is necessary to further study the monitoring method which can realize accurate and real-time detection of ablation zone and transition zone and can be easily combined with the existing ultrasonic equipment.


Asunto(s)
Ablación por Catéter , Diagnóstico por Imagen de Elasticidad , Hipertermia Inducida , Neoplasias , Humanos , Hígado/diagnóstico por imagen , Hígado/cirugía , Neoplasias/diagnóstico por imagen , Neoplasias/cirugía , Ultrasonografía
2.
Rev Col Bras Cir ; 48: e20202784, 2021.
Artículo en Inglés, Portugués | MEDLINE | ID: mdl-33787764

RESUMEN

OBJECTIVE: the aim of this study was to identify associated factors with the increased length of hospital stay for patients undergoing surgical treatment for liver trauma, and predictors of mortality as well as the epidemiology of this trauma. METHODS: retrospective study of 191 patients admitted to the Cajuru University Hospital, a reference in the treatment of multiple trauma patients, between 2010 and 2017, with epidemiological, clinicopathological and therapeutic variables analyzed using the STATA version 15.0 program. RESULTS: most of the included patients were men with a mean age of 29 years. Firearm injury represents the most common trauma mechanism. The right hepatic lobe was injured in 51.2% of the cases, and hepatorraphy was the most commonly used surgical correction. The length of hospital stay was an average of 11 (0-78) days and the length of stay in the intensive care unit was 5 (0-52) days. Predictors for longer hospital stay were the mechanisms of trauma, hemodynamic instability at admission, number of associated injuries, degree of liver damage and affected lobe, used surgical technique, presence of complications, need for reoperation and other surgical procedures. Mortality rate was 22.7%. CONCLUSIONS: the study corroborated the epidemiology reported by the literature. Greater severity of liver trauma and associated injuries characterize patients undergoing surgical treatment, who have increased hospital stay due to the penetrating trauma, hemodynamic instability, hepatic packaging, complications and reoperations.


Asunto(s)
Armas de Fuego , Heridas por Arma de Fuego , Adulto , Hospitalización , Humanos , Puntaje de Gravedad del Traumatismo , Tiempo de Internación , Hígado/lesiones , Hígado/cirugía , Masculino , Estudios Retrospectivos , Centros Traumatológicos
3.
Khirurgiia (Mosk) ; (2): 5-13, 2021.
Artículo en Ruso | MEDLINE | ID: mdl-33570348

RESUMEN

OBJECTIVE: To determine the incidence of AS after right lobe living donor liver transplantation with various biliary reconstructions and to identify the predictors of this complication. MATERIAL AND METHODS: A retrospective and prospective analysis included 245 RLLDLTs for the period 2011-2018 at the Burnazjan Federal Medical Biophysical Center. The results of transplantations in 207 patients aged 19-68 years (median 43 years) were assessed. There were 82 men and 125 women. Follow-up period ranged from 10 to 98 months (median 35 months). We analyzed the relationship between surgical characteristics (preoperative data of recipients and donors, graft parameters, technical features of biliary reconstruction and features of post-transplantation period) and incidence of anastomotic strictures. A total of 58 parameters were analyzed. RESULTS: AS occurred in 20 (9.7%) recipients. Median AS-free period was 5 months (range 1-44). In 17 (85%) patients, AC developed within a year after surgery. Cumulative 1-, 2- and 5-year incidence of AS was 8.3%, 8.9%, and 11%, respectively. Significant predictors of AS were impaired arterial blood supply to the graft (HR 7.8, 95% CI 2.3-26.0, p<0.001), biliary leakage ISGLS class B or C (HR 5.0, 95% CI 2.0-12.8, p<0.001), early allograft dysfunction (HR 4.2, 95% CI 1.5-11.6, p=0.006) and female recipient (HR 3.2, 95% CI 1.1-9.9, p=0.04). In our sample, variant biliary anatomy of the graft and recipient liver, as well as technical features of biliary reconstruction did not affect the risk of AS. CONCLUSION: Variant biliary anatomy of potential donor alone should not be considered as a contraindication for organ donation and right liver lobe transplantation. Precise surgical technique, high transplantation activity, as well as experience of reconstructive interventions on the bile ducts during other operations can significantly reduce the incidence of AS after RLLDLT up to 9.7%.


Asunto(s)
Conductos Biliares/cirugía , Constricción Patológica , Trasplante de Hígado , Donadores Vivos , Adulto , Anciano , Anastomosis Quirúrgica/efectos adversos , Conductos Biliares/patología , Constricción Patológica/diagnóstico , Constricción Patológica/epidemiología , Constricción Patológica/etiología , Femenino , Humanos , Hígado/cirugía , Trasplante de Hígado/efectos adversos , Trasplante de Hígado/métodos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Estudios Retrospectivos , Adulto Joven
4.
Khirurgiia (Mosk) ; (2): 101-105, 2021.
Artículo en Ruso | MEDLINE | ID: mdl-33570363

RESUMEN

The authors have analyzed the indications and outcomes after ALPPS procedure considering modern literature data devoted to this surgery in pediatric patients. No data on post-resection liver failure, as well as unclear future liver remnant function make it possible to question the feasibility of such procedures in children.


Asunto(s)
Hepatectomía/métodos , Insuficiencia Hepática , Neoplasias Hepáticas , Hígado/patología , Hígado/cirugía , Vena Porta/cirugía , Niño , Hepatectomía/efectos adversos , Insuficiencia Hepática/etiología , Humanos , Ligadura , Neoplasias Hepáticas/cirugía , Tamaño de los Órganos
6.
Medicine (Baltimore) ; 100(6): e24420, 2021 Feb 12.
Artículo en Inglés | MEDLINE | ID: mdl-33578534

RESUMEN

ABSTRACT: Optimal treatment of patients with various types of liver tumors or certain liver diseases frequently demands major liver resection, which remains a clinical challenge especially in children.Eighty seven consecutive pediatric liver resections including 51 (59%) major resections (resection of 3 or more hepatic segments) and 36 (41%) minor resections (resection of 1 or 2 segments) were analyzed. All patients were treated between January 2010 and March 2018. Perioperative outcomes were compared between major and minor hepatic resections.The male to female ratio was 1.72:1. The median age at operation was 20 months (range, 0.33-150 months). There was no significant difference in demographics including age, weight, ASA class, and underlying pathology. The surgical management included functional assessment of the future liver remnant, critical perioperative management, enhanced understanding of hepatic segmental anatomy, and bleeding control, as well as refined surgical techniques. The median estimated blood loss was 40 ml in the minor liver resection group, and 90 ml in major liver resection group (P < .001). Children undergoing major liver resection had a significantly longer median operative time (80 vs 140 minutes), anesthesia time (140 vs 205 minutes), as well as higher median intraoperative total fluid input (255 vs 450 ml) (P < .001 for all). Fourteen (16.1%) patients had postoperative complications. By Clavien-Dindo classification, there were 8 grade I, 4 grade II, and 2 grade III-a complications. There were no significant differences in complication rates between groups (P = .902). Time to clear liquid diet (P = .381) and general diet (P = .473) was not significantly different. There was no difference in hospital length of stay (7 vs 7 days, P = .450). There were no 90-day readmissions or mortalities.Major liver resection in children is not associated with an increased incidence of postoperative complications or prolonged postoperative hospital stay compared to minor liver resection. Techniques employed in this study offered good perioperative outcomes for children undergoing major liver resections.


Asunto(s)
Hepatectomía , Hígado/cirugía , Factores de Edad , Niño , Preescolar , Femenino , Hepatectomía/efectos adversos , Hepatectomía/métodos , Humanos , Lactante , Recién Nacido , Cuidados Intraoperatorios , Masculino , Estudios Retrospectivos
7.
Cancer Sci ; 112(3): 1275-1288, 2021 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-33426736

RESUMEN

Hepatocellular carcinoma (HCC) is the second leading cause of cancer-related death. High recurrence rates after curative resection and the lack of specific biomarkers for intrahepatic metastases are major clinical problems. Recently, exosomal microRNAs (miRNAs) have been reported to have a role in the formation of the pre-metastatic niche and as promising biomarkers in patients with malignancy. Here we aimed to clarify the molecular mechanisms of intrahepatic metastasis and to identify a novel biomarker miRNA in patients with HCC. A highly intrahepatic metastatic cell line (HuH-7M) was established by in vivo selection. HuH-7M showed increased proliferative ability and suppression of apoptosis and anoikis. HuH-7M and the parental cell (HuH-7P) showed the similar expression of epithelial-mesenchymal transition markers and cancer stem cell markers. In vivo, mice treated with exosomes derived from HuH-7M showed increased tumorigenesis of liver metastases. Exosomes from HuH-7M downregulated endothelial cell expression of vascular endothelial-cadherin (VE-cadherin) and zonula occludens-1 (ZO-1) in non-cancerous regions of liver and increased the permeability of FITC-dextran through the monolayer of endothelial cells. The miRNAs (miR-638, miR-663a, miR-3648, and miR-4258) could attenuate endothelial junction integrity by inhibiting VE-cadherin and ZO-1 expression. In patients with HCC, higher serum exosomal miR-638 expression was associated with tumor recurrence. In conclusion, the miRNAs secreted from a highly metastatic cancer cell can promote vascular permeability via downregulation of endothelial expression of VE-cadherin and ZO-1. Serum exosomal miR-638 expression holds potential for serving as a significant and independent prognostic marker in HCC.


Asunto(s)
Antígenos CD/genética , Biomarcadores de Tumor/metabolismo , Cadherinas/genética , Carcinoma Hepatocelular/genética , Neoplasias Hepáticas/genética , MicroARNs/metabolismo , Recurrencia Local de Neoplasia/diagnóstico , Proteína de la Zonula Occludens-1/genética , Anciano , Anciano de 80 o más Años , Animales , Biomarcadores de Tumor/sangre , Carcinoma Hepatocelular/sangre , Carcinoma Hepatocelular/mortalidad , Carcinoma Hepatocelular/cirugía , Línea Celular Tumoral , Proliferación Celular/genética , Regulación hacia Abajo , Células Endoteliales/patología , Transición Epitelial-Mesenquimal/genética , Exosomas/metabolismo , Femenino , Regulación Neoplásica de la Expresión Génica , Hepatectomía , Células Endoteliales de la Vena Umbilical Humana , Humanos , Hígado/citología , Hígado/patología , Hígado/cirugía , Neoplasias Hepáticas/sangre , Neoplasias Hepáticas/mortalidad , Neoplasias Hepáticas/cirugía , Masculino , Ratones , Persona de Mediana Edad , Recurrencia Local de Neoplasia/genética , Recurrencia Local de Neoplasia/prevención & control , Periodo Preoperatorio
8.
Z Gastroenterol ; 59(1): 56-62, 2021 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-33429451

RESUMEN

BACKGROUND: Robotic liver surgery is emerging as the future of minimal invasive surgery. The robotic surgical system offers a stable camera platform, elimination of physiologic tremor, augmented surgical dexterity as well as improved ergonomics because of a seated operating position. Due to the theoretical advantages of the robotic assisted system, complex liver surgery might be an especially interesting indication for a robotic approach since it demands delicate tissue dissection, precise intracorporeal suturing as well as difficult parenchymal transection with subsequent need for meticulous hemostasis and biliostasis. MATERIAL AND METHODS: An analysis of English and German literature on open, laparoscopic and robotic liver surgery was performed and this review provides a general overview of the existing literature along with current standards and aims to specifically point out future directions of robotic liver surgery. RESULTS: Robotic liver surgery is safe and feasible compared to open and laparoscopic surgery, with improved short-term postoperative outcomes and at least non-inferior oncological outcomes. CONCLUSION: In complex cases including major hepatectomies, extended hepatectomies with biliary reconstruction and difficult segmentectomies of the posterior-superior segments, robotic surgery appears to emerge as a reasonable alternative to open surgery rather than being an alternative to laparoscopic procedures.


Asunto(s)
Hepatectomía/tendencias , Laparoscopía , Hígado/cirugía , Procedimientos Quirúrgicos Robotizados/normas , Humanos , Estándares de Referencia , Procedimientos Quirúrgicos Robotizados/métodos , Robótica
9.
BMC Surg ; 21(1): 57, 2021 Jan 23.
Artículo en Inglés | MEDLINE | ID: mdl-33485329

RESUMEN

BACKGROUND: To determine the standard remnant liver volume (SRLV) threshold to avoid postoperative hepatic insufficiency inpatients in different stages of hepatic fibrosis who undergo right hemi-hepatectomy. METHODS: Data for 85 patients at our single medical center were analysed prospectively to examine whether the following factors differed significantly between those who experienced postoperative hepatic insufficiency and those who did not: height, prothrombin time, remnant liver volume, SRLV or hepatic fibrosis stage. RESULTS: Logistic regression showed SRLV and hepatic fibrosis stage to be independent risk factors for postoperative hepatic insufficiency. The threshold SRLV for predicting insufficiency was 203.2 ml/m2 across all patients [area under receiver operating characteristic curve (AUC) 0.778, sensitivity 66.67%, specificity 83.64%, p<0.0001), 193.8 ml/m2 for patients with severe hepatic fibrosis (AUC 0.938, sensitivity 91.30%, specificity 85.71%, p<0.0001), and 224.3 ml/m2 for patients with cirrhosis (AUC 0.888, sensitivity 100%, specificity 64.29%, p<0.0001). CONCLUSIONS: Right hemi-hepatectomy may be safer in Chinese patients when the standard remnant liver volume is more than 203.2 ml/m2 in the absence of hepatic fibrosis or cirrhosis, 193.8 ml/m2 in the presence of severe hepatic fibrosis or 224.3 ml/m2 in the presence of cirrhosis.


Asunto(s)
Carcinoma Hepatocelular , Hepatectomía/efectos adversos , Cirrosis Hepática , Neoplasias Hepáticas , Hígado , Adulto , Carcinoma Hepatocelular/diagnóstico por imagen , Carcinoma Hepatocelular/patología , Carcinoma Hepatocelular/cirugía , Simulación por Computador , Femenino , Hepatectomía/métodos , Insuficiencia Hepática/etiología , Insuficiencia Hepática/prevención & control , Humanos , Imagenología Tridimensional , Hígado/diagnóstico por imagen , Hígado/patología , Hígado/cirugía , Cirrosis Hepática/complicaciones , Cirrosis Hepática/diagnóstico por imagen , Cirrosis Hepática/patología , Neoplasias Hepáticas/diagnóstico por imagen , Neoplasias Hepáticas/patología , Neoplasias Hepáticas/cirugía , Masculino , Persona de Mediana Edad , Tamaño de los Órganos , Estudios Prospectivos , Estándares de Referencia , Valores de Referencia , Factores de Riesgo , Tomografía Computarizada por Rayos X
11.
J Clin Gastroenterol ; 55(3): 187-194, 2021 03 01.
Artículo en Inglés | MEDLINE | ID: mdl-33394628

RESUMEN

The coronavirus disease 2019 (COVID-19) pandemic has brought challenges to clinicians caring for patients with chronic liver disease. In the past 6 months, COVID-19 has led to over 150,000 deaths in the United States and over 660,000 deaths around the world. Mounting evidence suggests that chronic liver diseases can have an adverse effect on the clinical outcomes of patients with COVID-19. We present a comprehensive review of the latest literature on preexisting liver diseases and its interrelationship with COVID-19 infection in cirrhosis, hepatocellular carcinoma, nonalcoholic fatty liver disease, autoimmune hepatitis, and viral hepatitis B. As social distancing and telemedicine gain new footing, we synthesize recommendations from 3 major hepatology societies [American Association for the Study of Liver Disease (AASLD), the European Association for the Study of Liver (EASL), and the Asian Pacific Association for the Study of Liver (APASL)] to present the best approaches for caring for patients with liver diseases as well as those requiring liver transplantation.


Asunto(s)
/terapia , Hepatopatías/cirugía , Trasplante de Hígado , Hígado/cirugía , /patogenicidad , /diagnóstico , /virología , Estado de Salud , Interacciones Huésped-Patógeno , Humanos , Huésped Inmunocomprometido , Inmunosupresores/efectos adversos , Hígado/virología , Hepatopatías/diagnóstico , Hepatopatías/mortalidad , Hepatopatías/virología , Trasplante de Hígado/efectos adversos , Trasplante de Hígado/mortalidad , Medición de Riesgo , Factores de Riesgo , Resultado del Tratamiento
12.
Br J Radiol ; 94(1117): 20200415, 2021 Jan 01.
Artículo en Inglés | MEDLINE | ID: mdl-33245679

RESUMEN

OBJECTIVE: To evaluate the use of transarterial chemoembolisation (TACE) combined with microwave ablation (MWA) to treat patients with hepatocellular carcinoma (HCC) and type Ⅱ-Ⅲ portal vein tumour thrombosis (PVTT) intolerant to targeted drug (TG) therapy. METHODS: A total of 18 patients with HCC and type Ⅱ-Ⅲ PVTT intolerant to TG were enrolled between June 2015 and December 2019, who were treated with TACE + MWA (MWA group). 24 patients were treated with TACE + TG (TG group; control cohort). Time to progression and overall survival (OS) were analysed along with the incidence of adverse events. RESULTS: The median follow-up time was 19.0 months (9.0-32.0 months). The median OS was 17.0 months (8.3-29.3 months; MWA group) and 13.5 months (5.5-22.5 months; TG group) and was not significantly different. The 1- and 2 year OS was also comparable (MWA group: 66.7%, 44.4% vs Target group: 41.7%, 29.2%). Time to progression showed no distinct differences (MWA group: 11.5 months; TG group: 9.0 months) between the two groups. Moreover, the incidence of major Grade 3-4 adverse events in the MWA group (5.6%) was similar to those in the TG group (8.3%). CONCLUSION: TACE + MWA and TACE + TG were comparable in their safety and efficacy in patients with HCC, type Ⅱ-Ⅲ PVTT, and intolerance to TG. ADVANCES IN KNOWLEDGE: TACE + MWA can be used as a palliative treatment alternative for TACE + TG in patients with HCC, type Ⅱ-Ⅲ PVTT, and intolerance to TG.


Asunto(s)
Técnicas de Ablación/métodos , Carcinoma Hepatocelular/terapia , Quimioembolización Terapéutica/métodos , Neoplasias Hepáticas/terapia , Vena Porta/patología , Trombosis de la Vena/terapia , Carcinoma Hepatocelular/complicaciones , Carcinoma Hepatocelular/cirugía , Terapia Combinada/métodos , Femenino , Estudios de Seguimiento , Humanos , Hígado/cirugía , Neoplasias Hepáticas/complicaciones , Neoplasias Hepáticas/cirugía , Masculino , Microondas , Persona de Mediana Edad , Estudios Retrospectivos , Resultado del Tratamiento , Trombosis de la Vena/etiología , Trombosis de la Vena/cirugía
13.
Ultrasonics ; 110: 106287, 2021 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-33091652

RESUMEN

In this paper, we proposed ultrasound homodyned K (HK) imaging based on the noise-assisted correlation algorithm (NCA) for monitoring microwave ablation of porcine liver ex vivo. The NCA-based HK (αNCA and kNCA) imaging was compared with NCA-based Nakagami (mNCA) imaging and NCA-based cumulative echo decorrelation (CEDNCA) imaging. Backscattered ultrasound radiofrequency signals of porcine liver ex vivo during and after the heating of microwave ablation were collected (n = 15), which were processed for constructing B-mode imaging, NCA-based HK imaging, NCA-based Nakagami imaging, and NCA-based CED imaging. To quantitatively evaluate the final coagulation zone, the polynomial approximation (PAX) technique was applied. The accuracy of detecting coagulation area with αNCA, kNCA, mNCA, and CEDNCA parametric imaging was evaluated by comparing the PAX imaging with the gross pathology. The receiver operating characteristic (ROC) curve was used to further evaluate the performance of the three quantitative ultrasound imaging methods for detecting the coagulation zone. Experimental results showed that the average accuracies of αNCA, kNCA, mNCA, and CEDNCA parametric imaging combined with PAX imaging were 89.6%, 83.25%, 89.23%, and 91.6%, respectively. The average areas under the ROC curve (AUROCs) of αNCA, kNCA, mNCA, and CEDNCA parametric imaging were 0.83, 0.77, 0.83, and 0.86, respectively. The proposed NCA-based HK imaging may be used as a new method for monitoring microwave ablation.


Asunto(s)
Técnicas de Ablación , Hígado/diagnóstico por imagen , Hígado/cirugía , Microondas/uso terapéutico , Ultrasonografía/métodos , Algoritmos , Animales , Procesamiento de Imagen Asistido por Computador , Técnicas In Vitro , Porcinos
14.
Br J Radiol ; 94(1118): 20200163, 2021 Feb 01.
Artículo en Inglés | MEDLINE | ID: mdl-33353395

RESUMEN

OBJECTIVE: This study aimed to develop a predictive risk model for post-ablation hemobilia. METHODS: This was a retrospective, multicenter, matched case-control study. The case group comprised patients with hepatocellular carcinoma who developed post-ablation hemobilia (n = 21); the control group (n = 63) comprised patients with hepatocellular carcinoma but no post-ablation hemobilia; for each case, we included three controls matched for age, sex, platelet count, year of ablation therapy, and center. Univariate and multivariate regression analyses were performed to identify the risk factors for hemobilia. A risk score model was developed based on adjusted odds ratios (ORs). RESULTS: The independent risk factors for occurrence of post-ablation hemobilia were maximum tumor diameter >47 mm [OR = 5.983, 95% CI (1.134-31.551)] and minimum distance from the applicator to the portal trunk ≤8 mm [OR = 4.821, 95% CI (1.225-18.975)]. The risk model was developed using the adjusted ORs; thus a score of 6 was assigned to the former and a score of 5 for the latter. The area under the curve of this risk model was 0.76. Significant hemodynamic instability and inaccurate embolization might increase the risk of recurrence of hemobilia. CONCLUSION: Tumor size >47 mm and distance of the applicator from the portal trunk ≤8 mm are independent risk factors for hemobilia. A predictive risk model for post-ablation hemobilia was developed using these risk factors. ADVANCES IN KNOWLEDGE: This is the first study that developed a risk score model of post-ablation hemobilia. Risk factors of the recurrence of post-ablation hemobilia were also been identified.


Asunto(s)
Carcinoma Hepatocelular/patología , Carcinoma Hepatocelular/cirugía , Ablación por Catéter/métodos , Hemobilia/diagnóstico , Neoplasias Hepáticas/patología , Neoplasias Hepáticas/cirugía , Carcinoma Hepatocelular/diagnóstico por imagen , Estudios de Casos y Controles , Femenino , Humanos , Hígado/diagnóstico por imagen , Hígado/patología , Hígado/cirugía , Neoplasias Hepáticas/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Modelos Teóricos , Valor Predictivo de las Pruebas , Estudios Retrospectivos , Medición de Riesgo , Factores de Riesgo , Tomografía Computarizada por Rayos X/métodos , Resultado del Tratamiento , Carga Tumoral
15.
PLoS One ; 15(12): e0243539, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33315924

RESUMEN

BACKGROUND: Sex differences are becoming of rising interest in many fields of medicine. It remains unknown whether sex has a role in postoperative and long-term outcome after hepatic resection (HR). The aim of this study was to investigate sex differences in disease presentation, surgical and oncological outcome after curative HR. METHODS: Retrospective analysis of 1010 patients who underwent HR between 2005 and 2018 at two tertiary hospitals in Austria. Demographics and survival data were obtained from a prospectively maintained database. Univariate analysis was used to identify sex differences for the entire cohort and for sub-cohorts. Disease-free- and overall survival was assessed by the Kaplan-Meier estimate and results were compared by log-rank tests. RESULTS: 436 females and 574 males were analyzed. Women were younger (p<0.001), had less liver cirrhosis (p<0.001), cardiac comorbidities (p<0.001), diabetes (28 (p<0.001) and obesity (p<0.001). Type of HR and surgical management did not vary by sex. Ninety-day morbidity (p = 0.179) and -mortality (p = 0.888) were comparable. In patients with malignant disease, no differences in disease-free- and overall survival was observed, neither for the entire cohort nor for the subgroups according to tumor entity or type of resection. Only in HCC patients, females showed an inferior OS (p = 0.029). CONCLUSION: This study delivers new insights on the impact of sex differences in liver surgery. Despite the fact that male patients have a higher incidence of preoperative morbidities, we did not observe specific disparities in terms of immediate postoperative as well as long term oncological outcome between sexes.


Asunto(s)
Neoplasias Hepáticas/patología , Hígado/cirugía , Factores Sexuales , Adulto , Anciano , Anciano de 80 o más Años , Carcinoma Hepatocelular/patología , Estudios de Cohortes , Supervivencia sin Enfermedad , Femenino , Hepatectomía/métodos , Humanos , Estimación de Kaplan-Meier , Hígado/patología , Cirrosis Hepática/patología , Masculino , Persona de Mediana Edad , Recurrencia Local de Neoplasia/patología , Complicaciones Posoperatorias/epidemiología , Estudios Retrospectivos , Factores de Riesgo , Resultado del Tratamiento
16.
Zhonghua Wai Ke Za Zhi ; 58(11): 835-840, 2020 Nov 01.
Artículo en Chino | MEDLINE | ID: mdl-33120445

RESUMEN

Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) can speed up the regeneration of future liver remnant (FLR) in short period of time, and offer a chance for surgical resection for patients without sufficient FLR. However, ALPPS still remains controversy due to its high perioperative morbidity and mortality, as well as the uncertain long-term oncological benefits. How to solve these problems is the key to ensure the safety of surgery.This article focus on the indication selection, liver function reserve evaluation and timing to perform the second stage surgery, surgical mode evolution and comparison with portal venous embolization/portal venous ligation+two-stage hepatectomy.


Asunto(s)
Hepatectomía , Neoplasias Hepáticas , Hígado/cirugía , Vena Porta/cirugía , Embolización Terapéutica , Hepatectomía/métodos , Humanos , Ligadura , Hígado/anatomía & histología , Hígado/fisiología , Neoplasias Hepáticas/cirugía , Regeneración Hepática , Resultado del Tratamiento
17.
Anticancer Res ; 40(11): 6465-6471, 2020 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-33109585

RESUMEN

AIM: To assess the utility of the perioperative use of direct oral anticoagulants for patients with hepatocellular carcinoma (HCC) with cancer-associated thrombosis. CASE REPORT: An 83-year-old woman was admitted with a solitary HCC (10-cm diameter), as well as with multiple sites of venous thromboembolism and macroscopic portal vein tumor thrombosis. She had appropriate liver function without viral hepatitis, triple-positive tumor markers, and secondary polycythemia. Edoxaban at 30 mg was initiated 10 days before surgery to remove HCC. Complete remission of the pulmonary embolism and stability of the deep vein thrombosis and massive superior mesenteric vein thrombosis were recognized preoperatively. An extended left hepatectomy was successfully performed. To avoid hemorrhage complications, we used intravenous administration of nafamostat mesylate for 2 days, thereafter we restarted edoxaban. Superior mesenteric vein thrombosis resolved 5 months after surgery. CONCLUSION: Perioperative oral administration of edoxaban was useful in multidisciplinary treatment for a patient with advanced HCC with cancer-associated thrombosis.


Asunto(s)
Carcinoma Hepatocelular/cirugía , Neoplasias Hepáticas/cirugía , Hígado/cirugía , Trombosis/tratamiento farmacológico , Anciano de 80 o más Años , Anticoagulantes/administración & dosificación , Carcinoma Hepatocelular/tratamiento farmacológico , Carcinoma Hepatocelular/patología , Femenino , Humanos , Hígado/efectos de los fármacos , Hígado/patología , Neoplasias Hepáticas/tratamiento farmacológico , Neoplasias Hepáticas/patología , Trombosis/complicaciones , Trombosis/patología , Trombosis/cirugía
18.
Anticancer Res ; 40(11): 6545-6550, 2020 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-33109596

RESUMEN

BACKGROUND/AIM: To evaluate the complication rates and risk factors associated with transumbilical wounds and investigate the usefulness of an incision for organ removal in laparoscopic hepatectomy (Lap-H). PATIENTS AND METHODS: We enrolled 42 patients who underwent Lap-H excluding a small partial resection in our hospital between 2013 and 2018. The occurrences of superficial surgical site infection (SSI) and transumbilical port-site incisional hernia were recorded. RESULTS: SSI was not observed, and hernia occurred in 3 patients (7.14%). Univariate analysis revealed that body mass index (BMI) (p=0.004) was significantly associated with the risk of hernia formation. CONCLUSION: High BMI is a risk factor for hernia formation in patients undergoing Lap-H with transumbilical incision; hence, wound closure should be performed carefully. The construction of the transumbilical wound for organ removal was feasible with rationality, with no need to create a new wound.


Asunto(s)
Hepatectomía , Neoplasias Hepáticas/cirugía , Hígado/cirugía , Ombligo/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Hernia/fisiopatología , Humanos , Laparoscopía , Hígado/patología , Neoplasias Hepáticas/fisiopatología , Masculino , Persona de Mediana Edad , Factores de Riesgo , Infección de la Herida Quirúrgica/fisiopatología , Ombligo/fisiopatología
19.
PLoS One ; 15(9): e0239857, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32986787

RESUMEN

OBJECTIVE: The outcomes of children with Choledochal cyst who undergo laparoscopic cyst excision and Roux-en-Y hepaticojejunostomy versus open cyst excision and Roux-en-Y hepaticojejunostomy have not been adequately compared. We conducted a systematic review and meta-analysis to gain further insight into the efficacy and safety of laparoscopic excision in children with choledochal cysts. METHODS: A systematic search of PubMed, Embase, Cochrane Central Register, and ClinicalTrials.gov databases from January 1973 to January 31, 2020 was performed utilizing the PRISMA guidelines. Short-term, long-term and total postoperative complications were the primary endpoint measurements, whereas intraoperative outcomes and other postoperative outcomes were the secondary endpoints. RESULTS: The final analysis included 14 retrospective cohorts comprising 1767 patients. There were no significant differences in the patients' short-term postoperative complications (RR = -1.08; 95% CI = -1.72 to -0.67) between the 2 approaches. However, improvements in long-term (RR = 0.09; 95% CI = 0.01 to 0.18) and total postoperative complications (RR = -0.29; 95% CI = -0.40 to -0.21), estimated intraoperative blood loss and transfusion, time of initial feeding, and length of hospital stay were observed in patients who underwent laparoscopic excision when compared to those who underwent open surgery. CONCLUSIONS: Laparoscopic cyst excision and Roux-en-Y hepaticojejunostomy provides similar or even improved intraoperative, postoperative outcomes when compared to open excision for children with Choledochal cyst.


Asunto(s)
Procedimientos Quirúrgicos del Sistema Biliar/efectos adversos , Procedimientos Quirúrgicos del Sistema Biliar/métodos , Quiste del Colédoco/cirugía , Laparoscopía/efectos adversos , Laparoscopía/métodos , Adolescente , Anastomosis en-Y de Roux , Niño , Preescolar , Femenino , Humanos , Lactante , Recién Nacido , Yeyuno/cirugía , Tiempo de Internación , Hígado/cirugía , Masculino , Complicaciones Posoperatorias , Estudios Retrospectivos , Resultado del Tratamiento
20.
Nat Commun ; 11(1): 4383, 2020 09 01.
Artículo en Inglés | MEDLINE | ID: mdl-32873799

RESUMEN

Mongolia has the highest incidence of hepatocellular carcinoma (HCC) in the world, but its causative factors and underlying tumor biology remain unknown. Here, we describe molecular characteristics of HCC from 76 Mongolian patients by whole-exome and transcriptome sequencing. We present a comprehensive analysis of mutational signatures, driver genes, and molecular subtypes of Mongolian HCC compared to 373 HCC patients of different races and ethnicities and diverse etiologies. Mongolian HCC consists of prognostic molecular subtypes similar to those found in patients from other areas of Asia, Europe, and North America, as well as other unique subtypes, suggesting the presence of distinct etiologies linked to Mongolian patients. In addition to common driver mutations (TP53, CTNNB1) frequently found in pan-cancer analysis, Mongolian HCC exhibits unique drivers (most notably GTF2IRD2B, PNRC2, and SPTA1), the latter of which is associated with hepatitis D viral infection. These results suggest the existence of new molecular mechanisms at play in Mongolian hepatocarcinogenesis.


Asunto(s)
Biomarcadores de Tumor/genética , Carcinoma Hepatocelular/genética , Regulación Neoplásica de la Expresión Génica , Hepatitis D/genética , Neoplasias Hepáticas/genética , Anciano , Carcinogénesis/genética , Carcinoma Hepatocelular/epidemiología , Carcinoma Hepatocelular/cirugía , Carcinoma Hepatocelular/virología , Análisis Mutacional de ADN , Femenino , Perfilación de la Expresión Génica , Hepatectomía , Hepatitis D/epidemiología , Hepatitis D/cirugía , Hepatitis D/virología , Virus de la Hepatitis Delta/aislamiento & purificación , Humanos , Incidencia , Hígado/patología , Hígado/cirugía , Hígado/virología , Neoplasias Hepáticas/epidemiología , Neoplasias Hepáticas/cirugía , Neoplasias Hepáticas/virología , Masculino , Persona de Mediana Edad , Mongolia/epidemiología , Mutación , Pronóstico , Secuenciación del Exoma Completo
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