The preoperative elevated plasma fibrinogen level is associated with the prognosis of hilar cholangiocarcinoma.

PURPOSE: Elevated fibrinogen (Fbg) levels contribute to tumor progression and metastasis. However, little is known regarding the association of the clinicopathological characteristics and the prognosis of hilar cholangiocarcinoma (HC) with plasma fibrinogen. METHODS: Data on the plasma Fbg levels, clinicopathological characteristics, and overall survival were retrospectively collected. Plasma fibrinogen concentrations over 4.0 g/L were classified as hyperfibrinogen, elevated fibrinogen, or abnormal fibrinogen levels. We then analyzed the relationships among plasma fibrinogen level, clinicopathological features, and patient prognosis. RESULTS: A total of 171 HC patients were included. An elevated plasma fibrinogen level was associated with lymph-node metastasis (P < 0.001), the AJCC stage (P < 0.001), the surgical margin (P = 0.005), and vascular invasion (P = 0.027). Univariate analyses revealed that preoperative plasma fibrinogen (P < 0.001), operative blood loss (P = 0.044), vascular invasion (P < 0.001), CA19-9 (P = 0.003), surgical margin (P < 0.001), T stage (P < 0.001), histologic differentiation (P = 0.007), and lymph-node metastasis (P < 0.001) were associated with OS. The survival time of patients with high Fbg levels was shorter than that of patients with normal fibrinogen levels (P < 0.001). Furthermore, a multivariate analysis showed that fibrinogen was negatively and independently associated with the HC prognosis (P = 0.029). CONCLUSIONS: An elevated plasma Fbg level was associated with lymph-node metastasis, vascular invasion, the surgical margin, and the tumor stage, and the Fbg level might therefore be an independent factor associated with poor outcomes in HC patients.

Prognostic significance of mucinous component in hilar cholangiocarcinoma after curative-intent resection.

BACKGROUND: The presence of mucinous component has been indicated to have a prognostic value in adenocarcinoma. However, little is known regarding the clinicopathological characteristics and prognosis of hilar cholangiocarcinoma (HC) with mucinous component (HCM). METHODS: Between January 1996 and December 2014, a total of 61 HCM patients who underwent curative-intent resection at West China Hospital were retrospectively reviewed. The clinicopathological characteristics and survival of these patients were compared with a large cohort of 217 surgically resected conventional HC patients during the same period. RESULTS: The clinicopathological characteristics of HCM were distinct from conventional HC, including higher CA19-9 levels, larger tumor sizes, less differentiation, and a high frequency of liver parenchyma invasion, portal vein invasion, and lymphovascular invasion. HCM patients showed significantly worse recurrence-free survival (13.4 vs 23.9 months; P = .011) and overall survival (18.2 vs 32.1 months; P = .019) compared with conventional HC patients. Multivariate analysis confirmed liver parenchyma invasion, N stage, surgical margin, and histological grade as independent prognostic factors influencing overall survival in HCM patients. CONCLUSION: HCM showed distinct clinicopathological features, more aggressive biological behaviors, and poor prognosis in comparison with conventional HC. Therefore, the mucinous component is an adverse prognostic factor for HC.

Lymphocyte to monocyte ratio and prognostic nutritional index predict survival outcomes of hepatitis B virus-associated hepatocellular carcinoma patients after curative hepatectomy.

INTRODUCTION: Lymphocytes are an integral part of lymphocyte to monocyte ratio (LMR) and prognostic nutritional index (PNI). Both LMR and PNI which reflect body's inflammatory and nutritional status can be obtained from routine blood and biochemical test conveniently. Little evidence concerning the prognostic value of LMR and PNI in hepatocellular carcinoma (HCC) patients has been published. This study aimed to investigate the prognostic value of LMR and PNI in hepatitis B virals (HBV)-associated HCC patients who underwent curative hepatectomy. METHODS: Between January 2008 and June 2013, 450 surgically treated HCC patients were retrospectively analyzed. Clinicopathological parameters, LMR and PNI were collected and compared. The multivariate analysis was performed to indentify independent prognostic factors. Overall survival (OS) and recurrence-free survival (RFS) rates were also compared. RESULTS: Tumor size, vascular invasion, alpha fetoprotein level, LMR and PNI were independent prognostic factors for OS. Tumor number, tumor size, vascular invasion, LMR and PNI were independent prognostic factors for RFS. Either a high LMR or PNI could predict favorable OS and RFS in surgically treated HCC patients and vice versa. CONCLUSIONS: Both LMR and PNI were significant independent predictors that can predict survival outcomes in HBV-associated HCC patients who received curative hepatectomy. J. Surg. Oncol. 2016;114:202-210. © 2016 Wiley Periodicals, Inc.

Prognostic Significance of Sarcomatous Change in Patients with Hepatocellular Carcinoma After Surgical Resection.

BACKGROUND: Hepatocellular carcinoma (HCC) with sarcomatous change (SC) is a rare malignancy associated with high aggressiveness and poor prognosis; however, its prognostic significance remains unclear. METHODS: From January 1994 to April 2012, surgically resected HCCs with SC (n = 52) at West China Hospital were retrospectively reviewed. HCC with SC was defined as the concomitant presence of the sarcomatous component occupying at least 10 % (but not predominantly) of the HCC-bearing tissue. To validate its prognostic significance, we compared the clinicopathological features and survival rates of these patients with a cohort of 214 randomly selected ordinary HCC patients during the same period. RESULTS: The clinicopathological characteristics of HCC with SC were similar to those of ordinary HCC, with the exception of capsule formation, adjacent organ invasion, lymph node metastasis, and TNM staging. A total of 45 (86.5 %) HCC patients with SC experienced a recurrence, with a median time to recurrence of 6.0 months. Overall survival (OS) rates in the sarcomatous HCC group at 1, 2, and 3 years were 55.8, 25, and 17.3 %, respectively, which were significantly lower than those in the ordinary HCC group (p < 0.001). On multivariable analysis, macrovascular invasion, satellite nodules, and R1/R2 resection were identified as independent risk factors for shorter disease-free survival and OS. CONCLUSIONS: The presence of SC in HCC was uncommon, and was associated with much poorer prognosis than ordinary HCC. Radical resection with negative margin is essential for improving the prognosis. Future prospective studies are warranted to determine if recurrent patients can benefit from postoperative adjuvant therapies.

Selective histology of cholecystectomy specimens--is it justified?

BACKGROUND: Gallbladder cancer (GBC) is rare but the most common malignancy of biliary tract with a dismal prognosis. The early diagnosis and surgical treatment of GBC offers the only chance of long-term survival. Despite advances in radiological imaging, early diagnosis of GBC is still rarely achieved without histopathology. In our hospital, routine histologic examination of all resected gallbladder specimens has been standard practice. This study seeks to define whether selective histologic examination for gallbladder specimens based on preoperative imaging or intraoperative findings is justified. MATERIALS AND METHODS: From September 2008-September 2013, all histopathology reports of gallbladder specimens after elective cholecystectomy were retrospectively analyzed in a single surgical unit. Preoperative imaging, intraoperative findings, and histology notes were analyzed in all cases. RESULTS: Out of 14,369 (60% female and 40% male) patients undergoing cholecystectomy, GBC was found in only 46 cases (0.32%). More than one fifth (10/46) of GBC patients presented with acute cholecutitis (AC). All 10 AC patients coexisted with GBC harbored "significantly inflamed' gallbladders, and about 83.49% AC patients were judged with "significant inflammation." Carcinoma in situ and early GBC (T1a, T1b) accounted for 61% of all cases. Only two patients with Tis and T1a respectively did not show suspicious lesion on preoperative and intraoperative findings, but for the remaining cases (44/46), GBC was suspected either by preoperative imaging and/or intraoperative findings. CONCLUSIONS: Almost all cases of invasive GBC will show macroscopic abnormalities following examination by a simple procedure-a full dissection, inspection, and palpation of the gallbladder. Any patient with early GBCs "missed" on macroscopic examination can still receive the appropriate treatment by the cholecystectomy alone. The gallbladder should be sent for histology only if macroscopic examination raises suspicion. This selective policy is more cost-effective, and does not appear to compromise patients outcome.

Histological examination of frozen sections for patients with acute cholecystitis during cholecystectomy.

BACKGROUND: Unexpected gallbladder cancer may present with acute cholecystitis-like manifestations. Some authors recommended that frozen section analysis should be performed during laparoscopic cholecystectomy for all cases of acute cholecystitis. Others advocate selective use of frozen section analysis based on gross examination of the specimen by the surgeon. The aim of the present study was to evaluate whether surgeons could effectively identify suspected gallbladder with macroscopic examination alone. If not, is routine frozen section analysis worth advocating? METHODS: A total of 1162 patients with acute cholecystitis who had undergone simple cholecystectomy in our hospital from February 2009 to February 2014 were enrolled in the study. The data of patients with acute cholecystitis especially those with concurrent gallbladder cancer in terms of clinical characteristics, operative records, frozen section diagnosis and histopathology reports were analyzed. RESULTS: Thirteen patients with acute cholecystitis were found to have concurrent gallbladder cancer, with an incidence of 1.1% in acute cholecystitis. Forty patients with acute cholecystitis were suspected to have gallbladder cancer by macroscopic examination and specimens were taken for frozen section analysis. Six patients with gallbladder cancer were correctly identified by macroscopic examination alone but 7 patients with gallbladder cancer missed, including 3 patients with advanced cancer (2 T3 and 1 T2). Meanwhile, in 6 gallbladder cancer specimens sent for frozen section analysis, 3 early gallbladder cancers (2 Tis and 1 T1a) were missed by frozen section analysis. However, the remaining 3 patients with advanced gallbladder cancers (2 T3 and 1 T2) were correctly diagnosed. CONCLUSIONS: The incidence of comorbidity of gallbladder cancer and acute cholecystitis is higher than that of non-acute cholecystitis. The accurate diagnosis of gallbladder cancer by surgeons is poor and frozen section analysis is necessary.

Percutaneous needle aspiration versus catheter drainage in the management of liver abscess: a systematic review and meta-analysis.

OBJECTIVE: The aim of this study was to compare the effectiveness of percutaneous needle aspiration (PNA) and percutaneous catheter drainage (PCD) in the management of liver abscess. METHODS: Electronic searches (Cochrane Library, MEDLINE, EMBASE, SCIE) were conducted to identify randomized controlled trials (RCTs) comparing PNA and PCD. A meta-analysis was subsequently performed. RESULTS: A total of five RCTs covering 306 patients were included. The meta-analysis showed that outcomes in patients treated with PCD were superior to those in patients treated with PNA in terms of success rate [relative risk (RR): 0.81, 95% confidence interval (CI) 0.66-0.99; P = 0.04], clinical improvement [standardized mean difference (SMD): -0.73, 95% CI 0.36-1.11; P = 0.0001] and days to achieve a 50% reduction in abscess cavity size (SMD: -1.08, 95% CI 0.64-1.53; P < 0.00001). No significant differences were found in duration of hospitalization (mean difference: -0.17, 95% CI -2.10 to 1.75; P = 0.86) or procedure-related complications (RR: 0.50, 95% CI 0.10-2.63; P = 0.41). Days to achieve the total or near total resolution of the abscess cavity and mortality were not calculated because data in the RCTs in the meta-analysis were insufficient. CONCLUSIONS: Both PNA and PCD are safe methods of draining liver abscesses. However, PCD is more effective than PNA because it facilitates a higher success rate, reduces the time required to achieve clinical relief and supports a 50% reduction in abscess cavity size. However, among successfully treated patients, the outcomes of PNA are comparable with those of PCD.

Efficacy of ursodeoxycholic acid as an adjuvant treatment to prevent acute cellular rejection after liver transplantation: a meta-analysis of randomized controlled trials.

BACKGROUND: Acute cellular rejection (ACR) after liver transplantation (LT) is one of the most common problems faced by transplant recipients in spite of advances in immunosuppressive therapy. Recently, clinical trials reported that ursodeoxycholic acid (UDCA) reduced the incidence of ACR significantly. However, others have shown contradictory conclusion. Therefore, we performed a meta-analysis of rigorous randomized controlled trials (RCTs) to determine the efficacy of UDCA in reducing ACR after LT. DATA SOURCES: All RCTs that evaluated efficacy of UDCA as an adjuvant treatment to prevent ACR after LT were searched from PubMed/MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, ScienceDirect databases and Web of Science (from January 1981 to March 2012). There was no language limitation in these searches. Relevant abstracts of international meetings were also searched. References of each included study were searched manually. RESULTS: A total of 234 patients from four high-quality RCTs (Jadad score 4 to 5) were included in this meta-analysis. Prophylactic use of UDCA did not decrease the incidence of ACR (RR: 0.94, 95% CI: 0.77-1.16, P>0.05), steroid-resistant rejection (RR: 0.77, 95% CI: 0.47-1.27, P>0.05) and the number of patients with the multiple episodes of ACR (RR: 0.60, 95% CI: 0.28-1.30, P>0.05). Different intervention programs (high-dose vs low-dose UDCA; early vs delayed UDCA treatment) also did not alter the outcomes. CONCLUSIONS: UDCA, as an adjuvant treatment, was not able to prevent ACR and steroid-resistant rejection after LT. Further trials should be done to determine whether higher dose of UDCA will be beneficial.

[Risk factors of hepatolithasis-associated intrahepatic cholangiocarcinoma and the value of serum tumor-related makers in its diagnosis].

OBJECTIVE: To explore the risk factors of hepatolithasis-associated intrahepatic cholangiocarcinoma (HICC) and the clinical value of serum tumor-related markers for the detection of HICC. METHODS: Clinical data were collected from 58 patients pathologically diagnosed as HICC between 2005 and 2011 in West China Hospital of Sichuan University and 189 patients diagnosed as hepatolithiasis alone in the same period as matched control group. Logistic regression analysis was used to detect the independent risk factors of HICC and ROCs curve were constructed to assess the diagnostic value of CA199, CEA, GGT and ALP. RESULTS: The patients in both HICC group and control group presented similar clinical symptoms except weight loss. The results of univariate analysis suggested cholangioenterostomy (P < 0.001), early stone removal (OR = 0.001), family history of cancer (P = 0.001) were associated with the incidence of HICC. The results of Multivariate analysis suggested diabetes mellitus (OR = 3.621, 95% CI: 1.333-9.834, P = 0.012), family history of cancer (OR = 16.830, 95% CI: 1.937-146.21, P = 0.010), cholangioenterostomy (OR = 5.115, 95% CI: 1.733-15.098, P = 0.003), early removal of stone (OR = 0.315, 95% CI: 0.128-0.771, P = 0.011) and CA199 > 100 IU/mL (OR = 5.478, 95% CI: 2.539-11.820, P < 0.001) were independent risk factors for hICC. Serum CA199 and CEA level presented low diagnostic accuracy, a combined test (CA199 > 100 IU/mL or CEA > 5 ng/mL) showed better diagnostic performance with a 71.05% of sensitivity and 82.05% of specificity. CONCLUSION: Cholangioenterostomy, diabetes, early and complete stone removal were independent risk factors for hepatolithiasis-associated ICC. A combined test of CA199 and CEA could be an effective detecting tool for HICC.

Fabrication of 3D printed PCL/PEG artificial bile ducts as supportive scaffolds to promote regeneration of extrahepatic bile ducts in a canine biliary defect model.

In this study, a 3D porous poly(ε-caprolactone)/polyethylene glycol (PCL/PEG) composite artificial tubular bile duct was fabricated for extrahepatic bile duct regeneration. PCL/PEG composite scaffolds were fabricated by 3D printing, and the molecular structure, mechanical properties, thermal properties, morphology, and in vitro biocompatibility were characterized for further application as artificial bile ducts. A bile duct defect model was established in beagle dogs for in vivo implantation. The results demonstrated that the implanted PE1 ABD, serving as a supportive scaffold, effectively stimulated the regeneration of a new bile duct comprising CK19-positive and CK7-positive epithelial cells within 30 days. Remarkably, after 8 months, the newly formed bile duct exhibited an epithelial layer resembling the normal structure. Furthermore, the study revealed collagen deposition, biliary muscular formation, and the involvement of microvessels and fibroblasts in the regenerative process. In contrast, the anastomotic area without ABD implantation displayed only partial restoration of the epithelial layer, accompanied by fibroblast proliferation and subsequent bile duct fibrosis. These findings underscore the limited inherent repair capacity of the bile duct and underscore the beneficial role of the PE1 ABD artificial tubular bile duct in promoting biliary regeneration.

Laparoscopic vs. open cholecystectomy for cirrhotic patients: a systematic review and meta-analysis.

BACKGROUND/AIMS: To compare the safety and effectiveness of laparoscopic cholecystectomy (LC) versus open cholecystectomy (OC) for cirrhotic patients. METHODOLOGY: The Cochrane Library, MEDLINE, Science Citation Index Expanded, EMBASE and CBM (Chinese Biomedical Database) were searched until August 2011 to indentify relevant and eligible studies. RESULTS: Twenty three articles with 1316 cirrhotic patients were included. All patients were allocated to the LC group (n=694) or the OC group (n=622). They were primarily in Child-Pugh class A (n=957, 72.7%) and class B (n=343, 26.1%). Meta-analysis of 5 randomized controlled trials (n=284) indicated LC group was associated with the following advantages: significant lower surgery-related morbidity, less postoperative complications (e.g. incision hernia, wound infection), shorter hospital stay and less loss of blood. There were no significant differences in the intra-hospital mortality and total operative time between the two groups. Meta-analysis of 19 non-randomized studies (n=1082) showed similar results in favour of LC group. In addition, it showed significant lower intra-hospital mortality and less total operative time in the LC group than the OC group. CONCLUSIONS: LC is safe and offers various significant benefits over OC. Thus, it should be recommended for compensated cirrhotic patients.

Efficacy of ondansetron vs. metoclopramide in prophylaxis of postoperative nausea and vomiting after laparoscopic cholecystectomy: a systematic review and meta-analysis.

BACKGROUND/AIMS: The incidence of postoperative nausea and vomiting is truly high after laparoscopic cholecystectomy. Ondansetron and metoclopramide may be effective in preventing it. Our aim was to estimate the efficacy of ondansetron vs. metoclopramide in preventing postoperative nausea and vomiting after laparoscopic cholecystectomy. METHODOLOGY: We searched MEDLINE (PubMed), Cochrane Central Register of Controlled Trials (CENTRAL), Science Citation Index Expanded, EMBASE etc. to obtain relevant randomized controlled trials until October 2011. Two authors independently assessed the trials for inclusion and extracted the data. The odds ratio (OR) for dichotomous data was used with 95% confidence intervals (CI). Sensitivity and subgroup analysis were performed, if necessary. RESULTS: The total incidence of postoperative nausea and vomiting within 24 hours after laparoscopic cholecystectomy was 31% (74 of 235) in the ondansetron group and 56% (127 of 225) in the metoclopramide group (OR=0.33, 95%CI=0.22-0.49, p<0.00001, 12=49%). The total incidences of nausea and vomiting were lower in the ondansetron group (OR=0.28, 95%CI=0.15-0.54, p=0.0002, I²=0%) and (OR=0.31, 95%CI=0.17-0.55, p<0.0001, I²=0%), respectively. CONCLUSIONS: Based on the evidence, ondansetron has a better effect than metoclopramide for preventing postoperative nausea and vomiting after laparoscopic cholecystectomy. If we ignore the price factor, ondansetron is recommended for adhibition.

The impact of glucocorticoids for cirrhosis patients performed major liver resection: a retrospective control study.

BACKGROUND/AIMS: Research on the influence of pre-operation usage of steroids for liver cirrhosis patients performed major liver resection (=3 segments). METHODOLOGY: In total, 741 cirrhosis patients who underwent major hepatectomy (>3 segments) in our medical center were selected for the study. One hundred and five out of 741 patients used 500 mg methylprednisolone between half an hour and one hour before operation and were enrolled in the steroids group. The other 636 patients without steroid injection were assigned in the control group. Our analysis compared the data of bilirubin, ALT, AST, postoperative PT, complications, mortality, IL-6, average length of hospitalization and the like. RESULTS: Blood sample test showed level of bilirubin and aspartate aminotransferase (AST) and alanine aminotransferase (ALT) and prothrombin time (PT), IL-6 were significantly lower in the steroids group than the control group in the postoperative days. There were no differences of mortality, morbidity and length of stay between the two groups. CONCLUSIONS: Methylprednisolone used in preoperative period could degrade the bilirubin and IL-6 level safely and effectively after operation but does not reduce the mortality and the average hospital stay for liver sclerotic patients with normal liver function with slight side effects; it may have positive clinical effects for marginal liver patients.

Organ fibrosis inhibited by blocking transforming growth factor-ß signaling via peroxisome proliferator-activated receptor γ agonists.

BACKGROUND: Organ fibrosis has been viewed as one of the major medical problems, which can lead to progressive dysfunction of the liver, lung, kidney, skin, heart, and eventually death of patients. Fibrosis is initiated by a variety of pathological, physiological, biochemical, and physical factors. Regardless of their different etiologies, they all share a common pathogenetic process: excessive activation of the key profibrotic cytokine, transforming growth factor-beta (TGF-beta). Peroxisome proliferator-activated receptor gamma (PPARgamma), a ligand-activated transcription factor of the nuclear receptor superfamily, has received particular attention in recent years, because the activation of PPARgamma by both natural and synthetic agonists could effectively inhibit TGF-beta-induced profibrotic effects in many organs. DATA SOURCES: The English-language medical databases, PubMed, Elsevier and SpringerLink were searched for articles on PPARgamma, TGF-beta, and fibrosis, and related topics. RESULTS: TGF-beta is recognized as a key profibrotic cytokine. Excessive activation of TGF-beta increases synthesis of extracellular matrix proteins and decreases their degradation, associated with a gradual destruction of normal tissue architecture and function, whereas PPARgamma agonists inhibit TGF-beta signal transduction and are effective antifibrogenic agents in many organs including the liver, lung, kidney, skin and heart. CONCLUSIONS: The main antifibrotic activity of PPARgamma agonists is to suppress the TGF-beta signaling pathway by so-called PPARgamma-dependent effect. In addition, PPARgamma agonists, especially 15d-PGJ2, also exert potentially antifibrotic activity independent of PPARgamma activation. TGF-beta1/Smads signaling not only plays many essential roles in multiple developmental processes, but also forms cross-talk networks with other signal pathways, and their inhibition by PPARgamma agonists certainly affects the cytokine networks and causes non-suspected side-effects. Anti-TGF-beta therapies with PPARgamma agonists may have to be carefully tailored to be tissue- and target gene-specific to minimize side-effects, indicating a great challenge to the medical research at present.

Prediction of Early Recurrence After R0 Resection for Gallbladder Carcinoma of Stage T1b-T3.

PURPOSE: The time-to-tumor recurrence can predict the prognosis of hepatobiliary cancers following curative-intent resection. Therefore, for patients with gallbladder carcinoma (GBC) of stage T1b-T3 who had undergone R0 resection, we investigated the risk factors for early recurrence of GBC and their prognosis. PATIENTS AND METHODS: A total of 260 patients with GBC with T1b-T3 disease and an R0 margin were identified. Their clinicopathologic characteristics, perioperative details and prognostic data were reviewed. Survival analyses were carried out using the Kaplan-Meier method. Logistic regression models were used to identify the risk factors for early recurrence. RESULTS: The optimal cutoff for early recurrence was 29 months. Early recurrence tended to result in relapse far from the primary tumor, and such patients tended to have significantly worse overall survival. Multivariate analysis revealed that T3 disease, N1/N2 stage, poor differentiation of tumor, and lymphovascular invasion (LI) were associated with a greater risk of early recurrence. Patients diagnosed as having GBC incidentally and who had the risk factors of early recurrence were more likely to benefit from re-resection 2-4 weeks after a cholecystectomy. CONCLUSION: T3 stage, N1-N2 stage, poor differentiation, and LI were independent risk factors associated with early recurrence for patients with GBC with stage T1b-T3 disease after R0 resection.

Relationship between pancreaticobiliary maljunction and gallbladder carcinoma: meta-analysis.

BACKGROUND: Reports on the relationship between pancreaticobiliary maljunction (PBM) and gallbladder carcinoma (GBC) are conflicting. The frequency of PBM in GBC patients and the clinical features of GBC patients with PBM vary in different studies. DATA SOURCES: English-language articles describing the association between PBM and GBC were searched in the PubMed and Web of Science databases. Nine case-control studies fulfilled the inclusion criteria and addressed the relevant clinical questions of this analysis. Data were extracted independently by two reviewers using a predefined spreadsheet. RESULTS: The incidence of PBM was higher in GBC patients than in controls (10.60% vs 1.76%, OR: 7.41, 95% CI: 5.03 to 10.87, P<0.00001). The proportion of female patients with PBM was 1.96-fold higher than in GBC patients without PBM (80.5% vs 62.9%, OR: 1.96, 95% CI: 1.09 to 3.52, P=0.12). GBC patients with PBM were 10 years younger than those without PBM (SMD: -9.90, 95% CI: -11.70 to -8.10, P<0.00001). And a difference in the incidence of associated gallstone was found between GBC patients with and without PBM (10.8% vs 54.3%, OR: 0.09, 95% CI: 0.05 to 0.17, P<0.00001). Among the GBC patients with PBM, associated congenital dilatation of the common bile duct was present with a higher incidence ranging from 52.2% to 85.7%, and 70.0%-85.7% of them belonged to the P-C type of PBM (the main pancreatic duct enters the common bile duct). No substantial heterogeneity was found and no evidence of publication bias was observed. CONCLUSIONS: PBM is a high-risk factor for developing GBC, especially the P-C type of PBM without congenital dilatation of the common bile duct. To prevent GBC, laparoscopic cholecystectomy is highly recommended for PBM patients without congenital dilatation of the common bile duct, especially relatively young female patients without gallstones.

Postsurgical radiotherapy in stage IIIB gallbladder cancer patients with one to three lymph nodes metastases: A propensity score matching analysis.

BACKGROUND: The effect of postsurgical radiotherapy (PSRT) among T1-3 gallbladder cancer (GBC) patients with one to three lymph node metastases remains controversial. The aim of this study was to assess the impact of PSRT on gallbladder cancer-specific survival (GBCSS) in patients with stage IIIB. METHODS: The data of GBC patients were obtained from the American Surveillance, Epidemiology, and End Results (SEER) Data resources between 2004 and 2015. Then, a 1:1 propensity score matching (PSM) method was performed. GBCSS was compared among all patients. Subgroup analysis was conducted to identify patients who would benefit from PSRT. RESULTS: 726 AJCC (8th edition) stage IIIB GBC patients were included. PSRT failed to improve GBCSS (p = 0.168). Male sex, tumor size ≥ 4 cm and absence of chemotherapy were independent negative prognostic factors. No significant survival benefit from PSRT was found in any subgroup. CONCLUSIONS: PSRT provides no survival benefit for IIIB GBC.

[Experimental study on selective hepatic lobectomy using nitinol alloy net blocker of biliary intrahepatic duct].

OBJECTIVE: To investigate the feasibility and possible mechanism of non traditional hepatic lobectomy using nitinol alloy net blocker of biliary intrahepatic duct. METHODS: Biliary intrahepatic ducts of the experimental pigs were blocked with and without dissepiment blockers. The histological changes and expressions of TGF-betal and TIMP-1 in the livers were compared. RESULTS: Blockage of biliary intrahepatic duct using nitinol alloy net blocker without dissepiment resulted in obvious atrophy of the focus liver. The mean weight and size of the focus liver was only 1/4 of the controls (P < 0.05), with liver cells almost completely taken by collagen fibers. Higher expressions of TGF-beta1 and TIMP-1 were found in the group without dissepiment than in the group with dissepiments (P < 0.05). CONCLUSION: Using nitinol alloy net blocker for selective hepatic lobectomy is as effective as traditional hepatic lobectomy. It may offer a new way for treating intrahepatic bile duct stones.