ObjectiveTo follow-up pain after discharged in patients with liver resection and provide a reference to carry out the continued pain treatment outside the hospital. MethodsPost-discharged pain follow-up in patients with liver resection in our department from December 1, 2014 to April 30, 2015 were conducted, and the pain incidence, characteristics and level on 14 days, 1 month, 2 months, and 3 months after operation were understanded. Results①The pain score of patients on 14 days after operation was 0-3 points, which was mild pain. In 2 months after operation, 24 patients still had pain, the incidence was 20.69% (24/116). In 3 months after operation, the pain incidence was 18.97% (22/116).②There was no significant difference in the pain incidence between men and women in 2 months after operation (P > 0.05). In 3 months after operation, the pain incidence of male and female patients was 13.04% (9/69) and 27.66% (13/47), respectively, the pain incidence of female was significantly higher than men (P < 0.05).③The postoperative pain score and incidence in patients more than 60 years old were lower than that in patients less than 60 years old, but the score and the incidence of postoperative pain in patients with different ages were not statistically significant (P > 0.05).④In chronic pain patients, 81.82% (18/22) were visceral pain, 18.182% (4/22) were skin tingling or numbness. ConclusionWe should focus on the continued pain treatment outside the hospital in patients with hepatic resection, make efforts to alleviate pain, and improve the postoperative quality of life.
ObjectiveTo identify the risk factors of postoperative recurrence and survival for patients with hepatocellular carcinoma within Milan criteria following liver resection. MethodsData of 267 patients with hepatocellular carcinoma within Milan criteria who received liver resection between 2007 and 2013 in our hospital were retrospectively analyzed. ResultsAmong the 267 patients, 123 patients suffered from recurrence and 51 patients died. The mean time to recurrence were (16.9±14.5) months (2.7-75.1 months), whereas the mean time to death were (27.5±16.4) months (6.1-75.4 months). The recurrence-free survival rates in 1-, 3-, and 5-year after operation was 76.8%, 56.3%, and 47.6%, respectively; whereas the overall survival rates in 1-, 3-, and 5-year after operation was 96.6%, 82.5%, and 74.5%, respectively. Multivariate analyses suggested the tumor differentiation, microvascular invasion, and multiple tumors were independent risk factors for postoperative recurrence; whereas the tumor differentiation, positive preoperative HBV-DNA load, and preoperative neutrophil-to-lymphocyte ratio adversely influenced the postoperative survival. ConclusionsFor patients with hepatocellular carcinoma within Milan criteria after liver resection, the tumor differentiation, microvascular invasion, and multiple tumors contribute to postoperative recurrence; whereas the tumor differentiation, positive preoperative HBV-DNA load, and preoperative neutrophil-to-lymphocyte ratio adversely influence the postoperative survival.
ObjectiveTo investigate indications,technical points,and outcomes of laparoscopic liver resection in treatment for hepatic hemangioma. MethodThe clinical data of 78 patients with hepatic hemangioma underwent laparoscopic liver resection in our institute from January 2014 to December 2014 were analyzed retrospectively. ResultsSeventy-seven patients were underwent laparoscopic liver resection successfully,1 patient was conversed to open procedure.Operation method:laparoscopic anatomical liver resections were performed in 35 patients including 23 patients with left lateral segmentectomy,4 patients with left hemihepatectomy,3 patients with right hemihepatectomy,1 patient with Ⅲ segmentectomy,1 patient with Ⅵ segmentectomy,2 patients with Ⅵ and Ⅶ segmentectomy,1 patient with left lateral segmentectomy combined with Ⅵ and Ⅶ segmentectomy.Laparoscopic non-anatomical liver resection were performed in 43 patients.The operation time was (163.6 ±62.3) min,the intraoperative blood loss was (273.6±282.4) mL.No operative death occurred.One patient with postoperative functional bowel obstruction and 3 patients with pleural effusion had been recorded.All the patients recovered well.The postoperative hospital stay was (7.2±2.5) d.The results of postoperative pathology confirmed that all the tumors were hepatic cavernous hemangiomas. ConclusionsLaparoscopic liver resection for hepatic cavernous hemangioma is a safe and feasible method with small trauma,rapid recovery,cosmetic incision.Key of this technology is to strictly select surgical indications,to transect liver parenchyma along right plane,effective control of hepatic blood inflow,and properly management of cutting surface of liver.
ObjectiveTo analyse the outcomes of patients with Child-Pugh A class cirrhosis and a single hepatocellular carcinoma (HCC) up to 5 cm in diameter who underwent liver transplantation versus resection. MethodsDuring 2007 to 2011, 263 Child-Pugh A class cirrhotic patients with a single HCC up to 5 cm in diameter either underwent liver resection (n=227) or received liver transplantation (n=36) in our centre. Patients and tumour characteristics and outcomes were analysed. ResultsThe 1-, 3-, and 5-year recurrence-free survival rates of patients who received liver transplantation and liver resection were 91.7%, 85.3%, 81.0% and 80.6%, 59.8%, 50.8%, respectively (P=0.003). The 1-, 3-, and 5-year overall survival rates of patients who underwent liver transplantation were 100%, 87.5%, and 83.1% versus 96.9%, 83.8%, and 76.1% for patients received liver resection (P=0.391). The 1-, 3-, and 5-year recurrence-free survival rates for patients with a diameter of HCC < 3 cm underwent liver transplantation were 92.3%, 92.3%, and 92.3% versus 80.2%, 62.5%, and 50.5% for live resection group (P=0.019). The 1-, 3-, and 5-year overall survival rates for patients with a diameter of HCC < 3 cm underwent liver transplantation and liver resection were 100%, 91.7%, 91.7% and 97.7%, 87.5%, 79.5%, respectively (P=0.470). ConclusionsAlthough more recurrences are observed in Child A class cirrhotic patients with a single HCC up to 5 cm in diameter after liver resection, but overall survival rates for patients with a single HCC up to 5 cm in diameter are similar after liver resection and transplantation.
【Abstract】Objective To investigate whether liver resection for hepatocellular carcinoma (HCC) causes dissemination of liver tumor cells into blood circulation. Methods Fourteen patients with HCC, but without evidences of metastasis, were enrolled for the study. Blood samples of peripheral blood before skin incision and after abdominal wall suture, and of hepatic venous blood and portal venous blood after liver parenchyma dissection, were obtained. AFPmRNA was detected by reverse transcription polymerase chain reaction assays, the change of the level of its expression during operation was assessed by semi-quantitative analysis. Results The rate of its expression before and after operation in peripheral blood, and during operation in portal venous blood and in hepatic venous was 42.9%, 35.7%, 42.9% and 57.1% respectively. There were no differences between them. However, the level of its expression in hepatic venous blood was significantly higher than others (P＜0.05). Conclusion Liver resection for HCC induces releases of cells from the liver, probably including tumor cells, into blood circulation.
ObjectiveTo examine long-term survival, morbidity, and mortality following hepatic resection for gastric cancer hepatic metastases and to identify prognostic factors that affect survival. MethodsA systematic literature search of EMbase, PubMed, Web of Science, The Cochrane Library (Issue 2, 2015), CBM, WanFang Data, and CNKI was undertaken for studies that evaluated the role of hepatic resection for gastric cancer hepatic metastases. Two reviewers independently screened studies based on inclusion and exclusion criteria, extracted data, and evaluated risk of bias of included studies. RevMan 5.3 software was used for meta-analysis. ResultsThirty-nine studies were included, of which, eight studies were included in meta-analysis. The median sample size was 21 (range 10 to 64). Procedures were associated with a median 30-day morbidity of 24% (0% to 47%) and mortality of 0% (0% to 30%). The median 1-year, 3-year, and 5-year survival rates were 68%, 31%, and 27%, respectively. Meta-analysis result of 8 cohort studies showed hepatic resection of hepatic metastases was associated with a significantly improved overall survival at 1-year and 2-year follow-up (RR=0.47, 95%CI 0.3 to 0.58, P < 0.000 01; RR=0.70, 95%CI 0.63 to 0.79, P < 0.000 01). ConclusionsPatients with hepatic metastasis from gastric cancer may benefit from hepatic resection. More trials are needed to confirm this finding because of the limited included studies and their low quality.
ObjectiveTo explore the value liver resection combined with intraoperative radiofrequency ablation during the same period in the treatment of multiple liver cancer. MethodsWe retrospectively analyzed the clinical data of 33 patients with multiple liver cancer treated between January 2005 and April 2013. All the patients were treated by liver resection combined with intraoperative radiofrequency ablation in the same period. There were 91 tumor foci in 33 patients, among which 39 tumor foci were surgically removed, and 52 tumor foci were radiofrequency ablated. Ultrasonography and enhanced CT/MRI were performed for the patients 1 year, 2 years and 3 years after surgery. ResultsNo bleeding or death occurred during the operation. It was observed that the transient liver function was damaged after surgery, but it quickly returned to A level after treatment. All the patients had no perioperative death or other serious complications. Tumor recurrence rate was 16.1% in the first year, 48.4% in the second year and 93.5% in the third year after surgery. ConclusionLiver resection combined with intraoperative radiofrequency ablation for multiple liver cancer in the same period is feasible and safe, without increasing the average length of hospital stay, operative mortality rate and postoperative tumor recurrence rate.
ObjectiveTo summary the progress and status of downstaging therapy in treating hepatocellular carcinoma. MethodsThe related literatures were reviewed and analyzed by searching PubMed and MEDLINE. ResultsAlthough the clinical prognosis of advanced hepatocellular carcinoma was poor, the liver resection or liver transplantation after downstaging therapy could significantly improve the prognosis of patients. However, differences were existed if different downstaging therapies and selections of standard were used. ConclusionTo improve the prognosis of patients with advanced hepatocellular carcinoma, the downstaging therapy should be ingeniously selected based on the situation of the patients.
ObjectiveTo investigate the expression of IQ motif-containing GTPase activating protein 1 (IQGAP1) in hepatocellular carcinoma (HCC) tissues, and to analyze the relationship of IQGAP1 and patient's clinical characteristics and prognosis after liver resection. MethodsData of 79 patients who received liver resection between 2007 and 2009 in our hospital were collected. The expression of IQGAP1 was examined by immunohistochemical tests. The clinical characteristics and prognosis were compared. ResultsIQGAP1 was detected in 43 patients (54.4%). Patients with IQGAP1 expression had more poor differentiation and microvascular invasion. The cumulative recurrence-free rate and overall survival rate in 1-, 3-, and 5-year after operation of patients with IQGAP1 expression (cumulative recurrencefree rate:67.4%, 39.5%, and 23.3%; cumulative overall survival rate:97.7%, 71.5%, and 53.3%) were poor than patients without IQGAP1 expression (cumulative recurrence-free rate:100%, 94.4%, and 83.3%; cumulative overall survival rate:1007%, 97.2%, and 88.9%), P < 0.001. ConclusionsHCC patients with IQGAP1 expression had a poor prognosis after liver resection. IQGAP1 may be a prognostic indicator for hepatocellular carcinoma.
ObjectiveTo summarize the experiences of precise liver resection for giant complex hepatic neoplasm. MethodsFifty-two cases of giant complex hepatic neoplasms were resected using precise liver resection techniques from April 2008 to August 2009. Hepatic functional reserve and liver imaging were evaluated before operation. Appropriate surgical approach, halfhepatic blood flow occlusion, new technique of liver resection, and intraoperative ultrasonography were applied during operation. ResultsThe mean operative time, halfhepatic blood occlusion time, blood loss, recovery of alanine aminotransferase, and total bilirubin were 350 min (210－440 min), 43 min (8－57 min), 370 ml (250－1 150 ml), 10 d (7－14 d), and 4.5 d (3－10 d), respectively. Only 6 patients had mild bile leakage. No liver failure and other major complications emerged, and no death happened. ConclusionPrecise liver resection is a safe and effective approach for giant complex hepatic neoplasm.