Surgical Outcomes of Spontaneously Ruptured Hepatocellular Carcinoma.

BACKGROUND: Surgical and oncological outcomes in ruptured hepatocellular carcinoma (HCC) are not well known. The objective of this study was to review and compare survival outcomes and recurrence rates between ruptured and unruptured HCC. METHODS: Data of patients with ruptured HCC who underwent curative surgical resection between January 2000 and December 2016 were retrospectively reviewed. To compare survival outcomes between ruptured and unruptured HCC, 1:2 individual matching was conducted. RESULTS: The 1-, 3-, and 5-year overall survival (OS) rates were 88.8%, 67.0%, and 51.9%, respectively. The 1-, 3-, and 5-year disease-free survival (DFS) rates were 51.7%, 32.8%, and 25.0%, respectively. OS and DFS rates were significantly lower in the ruptured HCC group than the matched unruptured HCC group. HCC recurred in 63 patients (70.8%), 33 (52.4%) of whom presented with both intrahepatic and extrahepatic recurrences. Mean recurrence interval was 12.6 ± 13.8 months. The 1-, 3-, and 5-year survival rates after recurrence were 61.6%, 40.2%, and 33.6%, respectively. Mean survival time after recurrence was 26.4 ± 29.5 months. Incidence of peritoneal seeding (PS) was 18.0%, and eight of them demonstrated solitary lesion. Mean recurrence interval was 5.9 ± 8.2 months. The 1-, 3-, and 5-year OS rates after recurrence were significantly lower in patients with PS (49.7%, 18.7%, and 9.3%, respectively) than in patients without PS. CONCLUSIONS: Hepatectomy in ruptured HCC did show worse survival outcome compared with unruptured HCC and bear a high risk of PS. However, surgical resection combined with transcatheter arterial chemoembolization could help in achieving acceptable oncological outcomes.

Changes in left portal vein diameter in live liver donors after right hemihepatectomy for living donor liver transplantation.

BACKGROUND/AIMS: To evaluate changes in left portal vein(LPV) diameter and its effect on changes of remnant liver volume(RLV) and splenic volume(SV) in live liver donors after right hemihepatectomy. METHODOLOGY: From November 2008 to May 2009, 92 live liver donors were included. On preoperative, postoperative 1-week and 1-month CT, we measured LPV diameters(LPVB, LPV1W, LPV1M), RLVs(RLVB, RLV1W, RLV1M) and SVs(SVB, SV1W, SV1M). Percentage-intervalchanges were analyzed. The relationships between %LPV1W-B and other parameters were evaluated by univariate regression analyses. RESULTS: On postoperative 1-week, LPV1W invariably decreased. However, RLV1W and SV1W increased. %RLVB and %RLV1W-B were significantly associated with %LPV1W-B(P=.016,.011). On postoperative 1-month, mean %LPV1M-1W, %LPV1M-B, %SV1M-1W and %SV1M-B were 108.1±9.8%, 82.9±11.8%, 99.3±11.4% and 146.9±23.0%. Although %RLV1M-B or %RLV1M-1W were not related with %LPV1W-B(P=.034,.401), there were negative correlations between %LPV1W-B and %SV1M-1W or %SV1M-B(P=.004,.007). CONCLUSIONS: LPV diameter mostly decreases following right hemihepatectomy and improves spontaneously. Besides extent of hepatectomy, %LPV1W-B may be another indicator predicting splenic enlargement.

Choledochal cyst and anomalous pancreaticobiliary ductal union in adults: radiological spectrum and complications.

Choledochal cyst and anomalous pancreaticobiliary ductal union (APBDU) are considered to be embryologically related to each other, and their complications are clinically important. This article illustrates the key imaging features of choledochal cysts and APBDU and their various associated abnormalities and complications. Complications of common bile duct are more common in APBDU with choledochal cyst, and complications of gallbladder are more common in APBDU without choledochal cyst.