简介：ＲＥＳＵＬＴＳＯＦ　ＨＥＰＡＴＥＣＴＯＭＹＦＯＲ６００ＣＡＳＥＳＷＩＴＨＰＲＩＭＡＲＹＬＩＶＥＲＣＡＮＣＥＲＬｉＧｕｏｈｕｉ李国辉；ＬｉＪｉｎｑｉｎｇ李锦清；Ｚｈａｎｇｙａｑｉ张亚奇；Ｙｕａｎｙｕｎｆｅｉ元云飞；ＣｈｅｎＭｉｎｓｈａｎ陈敏山；ＧｕｏＲ...

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简介：AIM:ToevaluatetheimpactofadvancedageonoutcomeMETHODS:Twohundredsandelevenpatientsundergonehepatectomy,gastrectomyandpancreatoduodenectomyfromJanuary1998toSeptember2002wereanalyzedretrospectively.Clinicopathologicfeaturesandoperativeoutcomeof83patientsaged65yearsormorewerecomparedwiththatin128youngerpatientsagedlessthan65years.RESULTS:Thenutritionalstate,suchaspre-operationlevelofserumalbuminandhemoglobinintheolderpatientswaspoorerthanthatintheyoungerpatients.Theolderpatientshadhighercomorbiditiesthantheyoungerpatients(48.2%vs15.6%).Nosignificantdifferencewasobservedinpedoperativemortality,andcomplicationratebetweentheolderandyoungerpatients(2.4%vs1.6%and22.9%vs20.3%,respectively).Multivariateanalysisdemonstratedthatpancreatoduodenectomy,hepatectomywithresectionofmorethan2segmentsandcomorbiditieswereindependentpredictorsofpostoperativecomplication,whereasagewasnot(P=0.3172).CONCLUSION:Itissafeforpatientsaged65yearsormoretoundergohepatic,pancreaticandgastricresectionifgreatcareistakenduringperioperativeperiod.

简介：AIM:Todescribeanewclassificationmethodofrighthepatectomyaccordingtothedifferentspecialpositionsoftumors.METHODS:Accordingtopositions,91patientswithmalignanthepatictumorintherightliverlobeweredividedintosixgroups:tumorsintherightposteriorlobeand(or)therightcaudatelobecompressingtherightportalhilum(n=14,15.4%),tumorsintherightliverlobecompressingtheinferiorvenacavaand(or)hepaticveins(n=11,12.9%),tumorsinfiltratingdiaphragmaticmuscle(n=7,7.7%),tumorsinthehepatorenalrecess(infiltratingtherightfattyrenalcapsule,transversecolonandrightadrenalgland,n=8,8.8%),tumorsdeeplylocatednearthevertebralbody(n=3,3.3%),tumorsatothersitesintherightliverlobe(thecontrolgroup,n=48,52.75%).Thevaluesofintraoperativebloodloss(IBL),tumor'smaximcross-sectionarea(TMCSA),andtimeofhepatichilumclamping(THHC)andincidenceofpostoperativecomplicationswerecomparedbetweenfivegroupsoftumorandcontrolgroup,respectively.RESULTS:TheTHHCingroups1-4wassignificantlylongerthanthatinthecontrolgroup,theIBLingroups1-4wassignificantlyhigherthanthatinthecontrolgroup,theTMCSAingroups2-4wassignificantlylargerthanthatinthecontrolgroup,andtheratioofIBL/TMCSAingroup1wassignificantlyhigherthanthatinthecontrolgroup.Therewasnosignificantdifferenceintheindexesbetweengroup5andthecontrolgroup.CONCLUSION:ThesiteoftumoristhekeyfactorthatdeterminesIBL.

简介：Objective:ToassesstheeffectofantiviraltherapyforhepatitisBvirus(HBV)-relatedhepatocellularcarcinoma(HCC)afterradicalhepatectomy.Methods:Atotalof478HBV-relatedHCCpatientstreatedbyradicalhepatectomywereretrospectivelycollected.Patientsinthetreatmentgroup(n=141)receivedpostoperativelamivudinetreatment(100mg/d),whereaspatientsinthecontrolgroup(n=337)didnot.Recurrence-freesurvival(RFS)rates,overallsurvival(OS)rates,treatmentsforrecurrentHCCandcauseofdeathwerecomparedbetweenthetwogroups.Propensityscorematching(PSM)analysiswasalsoconductedtoreduceconfoundingbiasbetweenthetwogroups.Results:The1-,3-,and5-yearRFSratesdidn’tsignificantlydifferbetweenthetwogroups(P=0.778);however,the1-,3-,and5-yearOSratesinthetreatmentgroupweresignificantlyhigherthanthoseinthecontrolgroup(P=0.002).Similarresultswereobservedinthematcheddata.SubgroupanalysisshowedthatantiviraltreatmentconferredasignificantsurvivalbenefitforBarcelonaClinicalLiverCancerstageA/Bpatients.FollowingHCCrecurrence,morepeopleinthetreatmentgroupwereabletochoosecurativetreatmentsthanthoseinthecontrolgroup(P=0.031).Forcauseofdeath,fewerpeopleinthetreatmentgroupdiedofliverfailurethanthoseinthecontrolgroup(P=0.041).Conclusion:PostoperativeantiviraltherapyincreaseschancesofreceivingcurativetreatmentsforrecurrentHCCandpreventsdeathbecauseofliverfailure,therebysignificantlyprolongingOS,especiallyinearly-orintermedian-stagetumors.

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简介：瞄准：评估与hemihepatic经历hepatectomy的病人的临床的结果脉管的吸藏(HHO)与全部的肝的流入吸藏(THO)相比。方法：比较hemihepatic的使随机化的控制试用(RCT)脉管的吸藏和全部的肝的流入吸藏被系统的文学搜索包括。二个作者独立地为包括估计了试用并且提取了数据。元分析被进行基于aspartateaminotransferase(著名计算机生产厂商)和丙氨酸aminotransferase(中高音)的层次估计血损失，输送要求，和肝损害。固定效果模型或随机的效果模型被使用。结果：包括338个病人的四RCT满足了predened包括标准。167个病人的一个总数与THO被对待并且171与HHO。著名计算机生产厂商的元分析与加权的吝啬的差别(WMD)在THO组在手术后的白天铺平1显示的高水平342.27；95%信心间隔(CI)217.28-467.26；P=0.00001；I2=16%。元分析没在血损失上显示出THO组和HHO组之间的重要差别，输送要求，死亡，病态，操作时间，ischemic持续时间，医院停留，在手术后的白天的中高音层次1，3和7并且在手术后的白天的著名计算机生产厂商层次3和7。结论：Hemihepatic脉管的吸藏不把令人满意的利益提供给经历肝的切除术的病人。然而，他们在肝切除术以后有更少的肝损害。

简介：Theabilitytomodulatethefutureliverremnant(FLR)isakeycomponentofmodernoncologichepatobiliarysurgerypracticeandhasextendedsurgicalcandidacyforpatientswhomayhavebeenpreviouslythoughtunabletosurviveliverresection.MultipletechniqueshavebeendevelopedtoaugmenttheFLRincludingportalveinembolization(PVE),associatingliverpartitionandportalveinligation(ALPPS),andtherecentlyreportedtranshepaticlivervenousdeprivation(LVD).PVEisawell-establishedmeanstoimprovethesafetyofliverresectionbyredirectingbloodflowtotheFLRinanefforttoselectivelyhypertrophyandultimatelyimprovefunctionalreserveoftheFLR.ThisarticlediscussesthecurrentpracticeofPVEwithfocusonsummarizingthelargenumberofpublishedreportsfromwhichoutcomesbasedpracticeshavebeendeveloped.BothtechnicalaspectsofPVEincludingvolumetry,approaches,andembolizationagents;andclinicalaspectsofPVEincludingdatasupportingindications,anditsroleinconjunctionwithchemotherapyandtransarterialembolizationwillbehighlighted.PVEremainsanimportantaspectofoncologiccare;inlargepartduetothesubstantialfoundationofinformationavailabledemonstratingitsclearclinicalbenefitforhepaticresectioncandidateswithsmallanticipatedFLRs.

简介：Objective:Spontaneoushepatocellularcarcinoma(HCC)rupturecanbefatal,andhepaticresectioncouldachieveafavorablelong-termsurvivalamongallstrategiesoftumorrupture.However,thereisnoavailableprognosticscoringsystemforpatientswithrupturedHCCwhounderwentpartialhepatectomy.Methods:FromJanuary2005toMay2015,129patientswithspontaneousHCCruptureunderwentpartialhepatectomy.Preoperativeclinicaldatawerecollectedandanalyzed.Independentriskfactorsaffectingoverallsurvival(OS)wereusedtodevelopthenewscoringsystem.Harrell'sCstatistics,Akaikeinformationcriterion(AIC),therelativelikelihood,andtheloglikelihoodratiowerecalculatedtomeasurethehomogeneityanddiscriminatoryabilityofaprognosticsystem.Results:InthemultivariableCoxregressionanalysis,threefactors,includingtumorsize,preoperativeα-fetoproteinlevel,andalkalinephosphataselevel,werechosenforthenewtumor-associatedantigen(TAA)prognosticscoringsystem.The1-yearOSrateswere88.1%,43.2%,and30.2%forTAAscoresof0-5points(low-riskgroup),6-9points(moderate-riskgroup),and10-13points(high-riskgroup),respectively.TheTAAscoringsystemhadsuperiorhomogeneityanddiscriminatoryability(Harrell'sCstatistics,0.693vs.0.627and0.634;AIC,794.79vs.817.23and820.16;relativelikelihood,both<0.001;andloglikelihoodratio,45.21vs.22.77and21.84)thantheBarcelonaClinicLiverCancerstagingsystemandtheCanceroftheLiverItalianPrograminpredictingOS.Similarresultswerefoundwhilepredictingdisease-freesurvival(DFS).Conclusions:ThenewprognosticscoringsystemissimpleandeffectiveinpredictingbothOSandDFSofpatientswithspontaneousrupturedHCC.

简介：AbstractBackground:Hepatectomy for hepatocellular carcinoma (HCC) beyond the Milan criteria is shown to be beneficial. However, a high rate of post-operative HCC recurrence hinders the long-term survival of the patients. This study aimed to investigate and compare the impacts of tenofovir (TDF) and entecavir (ETV) on the recurrence of hepatitis B viral (HBV)-related HCC beyond the Milan criteria.Methods:Data pertaining to 1532 patients who underwent hepatectomy and received antiviral therapy between January 2014 and January 2019 were collected from five centers. Recurrence-free survival (RFS) analysis was performed using the Kaplan-Meier method. Cox proportional hazards regression analysis was performed to determine prognostic factors for HCC recurrence.Results:The analysis incorporates 595 HBV-related HCC patients. The overall 5-year RFS was 21.3%. Among them, 533 and 62 patients received ETV and TDF treatment, respectively. The 1-, 3-, and 5-year RFS rates were 46.3%, 27.4%, and 19.6%, respectively, in the ETV group compared with 65.1%, 41.8%, and 37.2%, respectively, in the TDF group (P < 0.001). Multivariate analysis showed that TDF treatment (hazard ratio [HR]: 0.604, P = 0.005), cirrhosis (HR: 1.557, P = 0.004), tumor size (HR: 1.037, P = 0.008), microvascular invasion (MVI) (HR: 1.403, P = 0.002), portal vein tumor thrombus (PVTT) (HR: 1.358, P = 0.012), capsular invasion (HR: 1.228, P= 0.040), and creatinine levels (CREA) (HR: 0.993, P = 0.031) were statistically significant prognostic factors associated with RFS.Conclusions:Patients with HCC beyond the Milan criteria exhibited a high rate of HCC recurrence after hepatectomy. Compared to the ETV therapy, TDF administration significantly lowered the risk of HCC recurrence.