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Gau RY, Tsai HI, Yu MC, Chan KM, Lee WC, Wang HE, Wang SF, Cheng ML, Chiu CC, Chen HY, Lee CW. Laparoscopic liver resection is associated with less significant muscle loss than the conventional open approach. World J Surg Oncol 2022; 20:385. [PMID: 36464698 PMCID: PMC9721003 DOI: 10.1186/s12957-022-02854-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Accepted: 11/24/2022] [Indexed: 12/07/2022] [Imported: 08/29/2023] Open
Abstract
BACKGROUND Laparoscopic liver resections (LLR) have been shown a treatment approach comparable to open liver resections (OLR) in hepatocellular carcinoma (HCC). However, the influence of procedural type on body composition has not been investigated. The aim of the current study was to compare the degree of skeletal muscle loss between LLR and OLR for HCC. METHODS By using propensity score matching (PSM) analysis, 64 pairs of patients were enrolled. The change of psoas muscle index (PMI) after the operation was compared between the matched patients in the LLR and OLR. Risk factors for significant muscle loss (defined as change in PMI > mean change minus one standard deviation) were further investigated by multivariate analysis. RESULTS Among patients enrolled, there was no significant difference in baseline characteristics between the two groups. The PMI was significantly decreased in the OLR group (P = 0.003). There were also more patients in the OLR group who developed significant muscle loss after the operations (P = 0.008). Multivariate analysis revealed OLR (P = 0.023), type 2 diabetes mellitus, indocyanine green retention rate at 15 min (ICG-15) > 10%, and cancer stage ≧ 3 were independent risk factors for significant muscle loss. In addition, significant muscle loss was associated with early HCC recurrence (P = 0.006). Metabolomic analysis demonstrated that the urea cycle may be decreased in patients with significant muscle loss. CONCLUSION LLR for HCC was associated with less significant muscle loss than OLR. Since significant muscle loss was a predictive factor for early tumor recurrence and associated with impaired liver metabolism, LLR may subsequently result in a more favorable outcome.
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Affiliation(s)
- Ruoh-Yun Gau
- grid.454211.70000 0004 1756 999XDivision of General Surgery, Department of Surgery, Linkou Chang Gung Memorial Hospital, Guishan, Taoyuan, 33305 Taiwan
| | - Hsin-I Tsai
- grid.145695.a0000 0004 1798 0922Graduate Institute of Clinical Medical Sciences, Chang Gung University, Guishan, Taoyuan, Taiwan ,grid.145695.a0000 0004 1798 0922College of Medicine, Chang Gung University, Guishan, Taoyuan, Taiwan ,grid.454211.70000 0004 1756 999XDepartment of Anesthesiology, Linkou Chang Gung Memorial Hospital, Guishan, Taoyuan, Taiwan
| | - Ming-Chin Yu
- grid.454211.70000 0004 1756 999XDepartment of Anesthesiology, Linkou Chang Gung Memorial Hospital, Guishan, Taoyuan, Taiwan ,grid.413801.f0000 0001 0711 0593Division of General Surgery, Department of Surgery, New Taipei Municipal Tu-Cheng Hospital (built and operated by Chang Gung Medical Foundation), Tu-Cheng, New Taipei City, Taiwan
| | - Kun-Ming Chan
- grid.454211.70000 0004 1756 999XDivision of General Surgery, Department of Surgery, Linkou Chang Gung Memorial Hospital, Guishan, Taoyuan, 33305 Taiwan ,grid.145695.a0000 0004 1798 0922College of Medicine, Chang Gung University, Guishan, Taoyuan, Taiwan
| | - Wei-Chen Lee
- grid.454211.70000 0004 1756 999XDivision of General Surgery, Department of Surgery, Linkou Chang Gung Memorial Hospital, Guishan, Taoyuan, 33305 Taiwan ,grid.145695.a0000 0004 1798 0922College of Medicine, Chang Gung University, Guishan, Taoyuan, Taiwan
| | - Haw-En Wang
- grid.454211.70000 0004 1756 999XDepartment of Gastroenterology and Hepatology, Linkou Chang Gung Memorial Hospital, Guishan, Taoyuan, Taiwan
| | - Sheng-Fu Wang
- grid.454211.70000 0004 1756 999XDepartment of Gastroenterology and Hepatology, Linkou Chang Gung Memorial Hospital, Guishan, Taoyuan, Taiwan
| | - Mei-Ling Cheng
- grid.145695.a0000 0004 1798 0922Metabolomics Core Laboratory, Healthy Aging Research Center, Chang Gung University, Guishan, Taoyuan, Taiwan ,grid.145695.a0000 0004 1798 0922Department of Biomedical Sciences, Chang Gung University, Guishan, Taoyuan, Taiwan ,grid.454211.70000 0004 1756 999XClinical Metabolomics Core Laboratory, Linkou Chang Gung Memorial Hospital, Guishan, Taoyuan, Taiwan
| | - Chien-Chih Chiu
- grid.454211.70000 0004 1756 999XDepartment of Nursing, Linkou Chang Gung Memorial Hospital, Guishan, Taoyuan, Taiwan
| | - Hsin-Yi Chen
- grid.145695.a0000 0004 1798 0922College of Medicine, Chang Gung University, Guishan, Taoyuan, Taiwan ,grid.454211.70000 0004 1756 999XDepartment of Nursing, Linkou Chang Gung Memorial Hospital, Guishan, Taoyuan, Taiwan ,grid.454211.70000 0004 1756 999XDepartment of Cancer Center, Linkou Chang Gung Memorial Hospital, Guishan, Taoyuan, Taiwan
| | - Chao-Wei Lee
- grid.454211.70000 0004 1756 999XDivision of General Surgery, Department of Surgery, Linkou Chang Gung Memorial Hospital, Guishan, Taoyuan, 33305 Taiwan ,grid.145695.a0000 0004 1798 0922Graduate Institute of Clinical Medical Sciences, Chang Gung University, Guishan, Taoyuan, Taiwan ,grid.145695.a0000 0004 1798 0922College of Medicine, Chang Gung University, Guishan, Taoyuan, Taiwan
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Chien TP, Huang SF, Chan WH, Pan KT, Yu MC, Lee WC, Tsai HI, Lin PT, Chen HY, Chen JH, Lee CW. The combination of sarcopenia and biochemical factors can predict the survival of hepatocellular carcinoma patients receiving transarterial chemoembolization. Front Oncol 2022; 12:1005571. [PMID: 36248997 PMCID: PMC9554637 DOI: 10.3389/fonc.2022.1005571] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 09/06/2022] [Indexed: 11/13/2022] [Imported: 08/29/2023] Open
Abstract
Background Transarterial chemoembolization(TACE) is the suggested treatment for hepatocellular carcinoma (HCC) not amenable to curative treatments. We investigated the role of sarcopenia on overall survival in HCC patients receiving TACE and proposed a new prognostic scoring system incorporating sarcopenia. Materials and methods We retrospectively analyzed 260 HCC patients who received TACE between 2010 and 2015. Total psoas muscle was measured on a cross-sectional CT image before the first TACE session. Sarcopenia was defined by the pre-determined sex-specific cutoff value. We assessed the impact of sarcopenia and other biochemical factors on the overall survival and compared the new scoring system with other prognostic scoring systems. Results One hundred and thirty patients (50%) were classified as sarcopenia before the first TACE. They were older with a higher male tendency and a significantly lower body mass index (BMI). Cox regression multivariate analysis demonstrated that sarcopenia, multiple tumors, maximal tumor diameter≥ 5cm, major venous thrombosis, sarcopenia, AFP ≥ 200 ng/ml, and albumin<3.5mg/dL were independent poor prognostic factors for overall survival in HCC patients receiving TACE. Our scoring system comprising these factors outperformed other major scoring systems in terms of predicting survival after TACE. Conclusion The current study demonstrated that sarcopenia was an independent prognostic factor for HCC undergoing TACE therapy. Our newly developed scoring system could effectively predict patient survival after TACE. Physicians could, based on the current score model, carefully select candidate patients for TACE treatment in order to optimize their survival. Further studies are warranted to validate our findings.
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Affiliation(s)
- Tzu-Ping Chien
- Division of General Surgery, Department of Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Song-Fong Huang
- Division of General Surgery, Department of Surgery, New Taipei Municipal Tu-Cheng Hospital (Built and Operated by Chang Gung Medical Foundation), New Taipei City, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Wen-Hui Chan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Medical Imaging and Intervention, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Kuang-Tse Pan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Medical Imaging and Intervention, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Ming-Chin Yu
- Division of General Surgery, Department of Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
- Division of General Surgery, Department of Surgery, New Taipei Municipal Tu-Cheng Hospital (Built and Operated by Chang Gung Medical Foundation), New Taipei City, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Wei-Chen Lee
- Division of General Surgery, Department of Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Hsin-I Tsai
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Anesthesiology, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
- Graduate Institute of Clinical Medical Sciences, Chang Gung University, Taoyuan, Taiwan
| | - Po-Ting Lin
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Gastroenterology and Hepatology, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Hsing-Yu Chen
- Graduate Institute of Clinical Medical Sciences, Chang Gung University, Taoyuan, Taiwan
- Division of Chinese Internal Medicine, Center for Traditional Chinese Medicine, Taoyuan Chang Gung Memorial Hospital, Taoyuan, Taiwan
- School of Traditional Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Jui-Hsuan Chen
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Nursing, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chao-Wei Lee
- Division of General Surgery, Department of Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Graduate Institute of Clinical Medical Sciences, Chang Gung University, Taoyuan, Taiwan
- *Correspondence: Chao-Wei Lee,
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Tsai HI, Lu YC, Zheng CW, Yu MC, Chou AH, Lee CH, Kou HW, Lin JR, Lai YH, Chang LL, Lee CW. A Retrospective Comparison of Three Patient-Controlled Analgesic Strategies: Intravenous Opioid Analgesia Plus Abdominal Wall Nerve Blocks versus Epidural Analgesia versus Intravenous Opioid Analgesia Alone in Open Liver Surgery. Biomedicines 2022; 10. [PMID: 36289673 DOI: 10.3390/biomedicines10102411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 09/22/2022] [Accepted: 09/23/2022] [Indexed: 11/16/2022] [Imported: 08/29/2023] Open
Abstract
Background: Adequate pain control is of crucial importance to patient recovery and satisfaction following abdominal surgeries. The optimal analgesia regimen remains controversial in liver resections. Methods: Three groups of patients undergoing open hepatectomies were retrospectively analyzed, reviewing intravenous patient-controlled analgesia (IV-PCA) versus IV-PCA in addition to bilateral rectus sheath and subcostal transversus abdominis plane nerve blocks (IV-PCA + NBs) versus patient-controlled thoracic epidural analgesia (TEA). Patient-reported pain scores and clinical data were extracted and correlated with the method of analgesia. Outcomes included total morphine consumption and numerical rating scale (NRS) at rest and on movement over the first three postoperative days, time to remove the nasogastric tube and urinary catheter, time to commence on fluid and soft diet, and length of hospital stay. Results: The TEA group required less morphine over the first three postoperative days than IV-PCA and IV-PCA + NBs groups (9.21 ± 4.91 mg, 83.53 ± 49.51 mg, and 64.17 ± 31.96 mg, respectively, p < 0.001). Even though no statistical difference was demonstrated in NRS scores on the first three postoperative days at rest and on movement, the IV-PCA group showed delayed removal of urinary catheter (removal on postoperative day 4.93 ± 5.08, 3.87 ± 1.31, and 3.70 ± 1.30, respectively) and prolonged length of hospital stay (discharged on postoperative day 12.71 ± 7.26, 11.79 ± 5.71, and 10.02 ± 4.52, respectively) as compared to IV-PCA + NBs and TEA groups. Conclusions: For postoperative pain management, it is expected that the TEA group required the least amount of opioid; however, IV-PCA + NBs and TEA demonstrated comparable postoperative outcomes, namely, the time to remove nasogastric tube/urinary catheter, to start the diet, and the length of hospital stay. IV-PCA with NBs could thus be a reliable analgesic modality for patients undergoing open liver resections.
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Huang CW, Wu TH, Hsu HY, Pan KT, Lee CW, Chong SW, Huang SF, Lin SE, Yu MC, Chen SM. Reappraisal of the Role of Alkaline Phosphatase in Hepatocellular Carcinoma. J Pers Med 2022; 12:jpm12040518. [PMID: 35455635 PMCID: PMC9030712 DOI: 10.3390/jpm12040518] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 03/12/2022] [Accepted: 03/15/2022] [Indexed: 01/27/2023] [Imported: 08/29/2023] Open
Abstract
Background: Alkaline phosphatase (ALP) is a marker of liver function and is associated with biliary tract disease. It was reported as a prognostic factor for hepatocellular carcinoma (HCC). The genetic expression in tumor-tissue microarrays and the perioperative serologic changes in ALP have never been studied for their correlation with HCC prognosis. Methods: The genetic expression of ALP isoforms (placental (ALPP), intestinal (ALPI) and bone/kidney/liver (ALPL)) was analyzed in tumor and non-cancerous areas in 38 patients with HCC after partial hepatectomy. The perioperative change in ALP was further analyzed in a cohort containing 525 patients with HCC to correlate it with oncologic outcomes. A total of 43 HCC patients were enrolled for a volumetry study after major and minor hepatectomy. Results: The genetic expression of the bone/kidney/liver isoform was specifically and significantly higher in non-cancerous areas than in tumors. Patients with HCC with a higher ALP (>81 U/dL) had significantly more major hepatectomies, vascular invasion, and recurrence. Cox regression analysis showed that gender, major hepatectomies, the presence of satellite lesions, higher grades (III or IV) and perioperative changes in liver function tests were independent prognostic factors for recurrence-free survival, and a postoperative increase in the ALP ratio at postoperative day (POD) 7 vs. POD 0 > 1.46 should be emphasized. A liver regeneration rate more than 1.8 and correlation analysis revealed that the ALP level at POD 7 and 30 was significantly higher and correlated with remnant liver growth. Conclusions: This study demonstrated that the perioperative ALP change was an independent prognostic factor for HCC after partial hepatectomies, and the elevation of ALP represented a functional biomarker for the liver but not an HCC biomarker. The higher regeneration capacity was possibly associated with the elevation of ALP after operation.
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Affiliation(s)
- Chun-Wei Huang
- Division of General Surgery, Department of Surgery, New Taipei Municipal Tucheng Hospital (by Chang Gung Medical Foundation, and Chang Gung University and Shen-Ming Chen), New Taipei 23652, Taiwan; (C.-W.H.); (H.-Y.H.); (S.-W.C.); (S.-F.H.)
| | - Tsung-Han Wu
- Department of Surgery, Chang Gung Memorial Hospital, Linkou and Chang-Gung University, Taoyuan 33305, Taiwan; (T.-H.W.); (C.-W.L.)
| | - Heng-Yuan Hsu
- Division of General Surgery, Department of Surgery, New Taipei Municipal Tucheng Hospital (by Chang Gung Medical Foundation, and Chang Gung University and Shen-Ming Chen), New Taipei 23652, Taiwan; (C.-W.H.); (H.-Y.H.); (S.-W.C.); (S.-F.H.)
| | - Kuang-Tse Pan
- Department of Medical Imaging and Intervention, Linkou Chang Gung Memorial Hospital, Taoyuan 33305, Taiwan;
| | - Chao-Wei Lee
- Department of Surgery, Chang Gung Memorial Hospital, Linkou and Chang-Gung University, Taoyuan 33305, Taiwan; (T.-H.W.); (C.-W.L.)
| | - Sio-Wai Chong
- Division of General Surgery, Department of Surgery, New Taipei Municipal Tucheng Hospital (by Chang Gung Medical Foundation, and Chang Gung University and Shen-Ming Chen), New Taipei 23652, Taiwan; (C.-W.H.); (H.-Y.H.); (S.-W.C.); (S.-F.H.)
| | - Song-Fong Huang
- Division of General Surgery, Department of Surgery, New Taipei Municipal Tucheng Hospital (by Chang Gung Medical Foundation, and Chang Gung University and Shen-Ming Chen), New Taipei 23652, Taiwan; (C.-W.H.); (H.-Y.H.); (S.-W.C.); (S.-F.H.)
| | - Sey-En Lin
- Department of Pathology, New Taipei Municipal Tucheng Hospital, New Taipei 23652, Taiwan;
| | - Ming-Chin Yu
- Division of General Surgery, Department of Surgery, New Taipei Municipal Tucheng Hospital (by Chang Gung Medical Foundation, and Chang Gung University and Shen-Ming Chen), New Taipei 23652, Taiwan; (C.-W.H.); (H.-Y.H.); (S.-W.C.); (S.-F.H.)
- Correspondence: (M.-C.Y.); (S.-M.C.)
| | - Shen-Ming Chen
- Department of Chemical Engineering and Biotechnology, National Taipei University of Technology, Taipei 106, Taiwan
- Correspondence: (M.-C.Y.); (S.-M.C.)
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Tsai HI, Lu YC, Kou HW, Hsu HY, Huang SF, Huang CW, Lee CW. The Combination of SOFA Score and Urinary NGAL May Be an Effective Predictor for Ventilator Dependence among Critically Ill Surgical Patients: A Pilot Study. Diagnostics (Basel) 2021; 11:diagnostics11071186. [PMID: 34208828 PMCID: PMC8303699 DOI: 10.3390/diagnostics11071186] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 06/25/2021] [Accepted: 06/25/2021] [Indexed: 01/20/2023] [Imported: 08/29/2023] Open
Abstract
Background: Ventilator dependence (VD) has been considered as a serious complication in critically ill patients in the intensive care unit (ICU). Acute kidney injury (AKI) is associated with VD as a result of lung–kidney interaction. The aim of our study was to investigate novel biomarkers in predicting ventilator dependence in critically ill surgical patients. Methods: Patients who were admitted to surgical ICU were enrolled and their serum and urine samples were collected. Novel biomarkers including gelatinase-associated lipocalin (NGAL), calprotectin, kidney injury molecule-1 (KIM-1), cystatin C, and growth differentiation factor 15 (GDF-15) were analyzed and correlated with clinical outcome. Results: A total of 33 patients were enrolled and analyzed. The majority of them received abdominal surgery prior to ICU admission. Thirteen patients were classified into the VD group, while the remaining 20 were in a non-ventilator dependence group (nVD). Statistical analysis demonstrated that the following were significantly higher in the VD group than in the nVD group: serum NGAL (420.25 ± 45.18 ng/mL vs. 314.68 ± 38.12 ng/mL, p-value 0.036), urinary NGAL (420.87 ± 41.08 ng/mL vs. 250.84 ± 39.45 ng/mL, p-value 0.002), SOFA score (11.3 ± 1.5 vs. 5.6 ± 0.7, p-value 0.001), and APACHE II score (23.2 ± 2.6 vs. 13.6 ± 0.8, p-value 0.001). The area under the ROC curve (AUROC) of urinary NGAL for VD was 0.808. The combination of urinary NGAL and SOFA score could further increase AUROC for VD to 0.835. Conclusions: The current study demonstrated the predictive capability of urinary NGAL for ventilator dependence among critically ill surgical patients. When combined with SOFA score, the predictive ability was further augmented. Further large-scale studies are warranted to validate our findings.
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Affiliation(s)
- Hsin-I Tsai
- Linkou Medical Center, Department of Anesthesiology, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan;
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Yu-Chieh Lu
- Linkou Medical Center, Department of Surgery, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan;
| | - Hao-Wei Kou
- Linkou Medical Center, Division of General Surgery, Department of Surgery, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan;
| | - Heng-Yuan Hsu
- Department of Surgery, New Taipei Municipal Tu-Cheng Hospital (Built and Operated by Chang Gung Medical Foundation), New Taipei City 236017, Taiwan; (H.-Y.H.); (S.-F.H.); (C.-W.H.)
| | - Song-Fong Huang
- Department of Surgery, New Taipei Municipal Tu-Cheng Hospital (Built and Operated by Chang Gung Medical Foundation), New Taipei City 236017, Taiwan; (H.-Y.H.); (S.-F.H.); (C.-W.H.)
| | - Chun-Wei Huang
- Department of Surgery, New Taipei Municipal Tu-Cheng Hospital (Built and Operated by Chang Gung Medical Foundation), New Taipei City 236017, Taiwan; (H.-Y.H.); (S.-F.H.); (C.-W.H.)
| | - Chao-Wei Lee
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
- Linkou Medical Center, Division of General Surgery, Department of Surgery, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan;
- Correspondence: ; Tel.: +886-975366192
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Lee CW, Yu MC, Wang CC, Lee WC, Tsai HI, Kuan FC, Chen CW, Hsieh YC, Chen HY. Liver resection for hepatocellular carcinoma larger than 10 cm: A multi-institution long-term observational study. World J Gastrointest Surg 2021; 13:476-492. [PMID: 34122737 PMCID: PMC8167847 DOI: 10.4240/wjgs.v13.i5.476] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 03/13/2021] [Accepted: 04/28/2021] [Indexed: 02/06/2023] [Imported: 08/29/2023] Open
Abstract
BACKGROUND The treatment of hepatocellular carcinoma (HCC) ≥ 10 cm remains a challenge.
AIM To consolidate the role of surgical resection for HCC larger than 10 cm.
METHODS Eligible HCC patients were identified from the Chang Gung Research Database, the largest multi-institution database, which collected medical records of all patients from Chang Gung Memorial Foundation. The surgical outcome of HCC ≥ 10 cm (L-HCC) was compared to that of HCC < 10 cm (S-HCC) (model 1). The survival of L-HCC after either liver resection or transarterial chemoembolization (TACE) was also analyzed (model 2). The long-term risks of all-cause mortality and recurrence were assessed to consolidate the role of surgery for L-HCC.
RESULTS From January 2004 to July 2015, a total of 32403 HCC patients were identified from the Chang Gung Research Database. Among 3985 patients who received liver resection, 3559 (89.3%) had S-HCC, and 426 had L-HCC. The L-HCC patients had a worse disease-free survival (0.27 for L-HCC vs 0.40 for S-HCC) and overall survival (0.18 for L-HCC vs 0.45 for S-HCC) than the S-HCC after liver resection (both P < 0.001). However, the surgical and long-term outcome of resected L-HCC had improved dramatically in the recent decades. After adjusting for covariates, surgery could provide a better outcome for L-HCC than TACE (adjusted hazard ratio of all-cause mortality: 0.46, 95% confidence interval: 0.38-0.56 for surgery). Subgroup analysis stratified by different stages showed similar trend of survival benefit among L-HCC patients receiving surgery.
CONCLUSION Our study demonstrated an improving surgical outcome for HCC larger than 10 cm. Under selected conditions, surgery is better than TACE in terms of disease control and survival and should be performed. Due to inferior survival, a subclassification within T1 stage should be considered. Future studies are mandatory to confirm our findings.
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Affiliation(s)
- Chao-Wei Lee
- Division of General Surgery, Department of Surgery, Linkou Chang Gung Memorial Hospital, Guishan 333, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Guishan 333, Taoyuan, Taiwan
- Graduate Institute of Clinical Medical Sciences, Chang Gung University, Guishan 333, Taoyuan, Taiwan
| | - Ming-Chin Yu
- Division of General Surgery, Department of Surgery, Linkou Chang Gung Memorial Hospital, Guishan 333, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Guishan 333, Taoyuan, Taiwan
- Graduate Institute of Clinical Medical Sciences, Chang Gung University, Guishan 333, Taoyuan, Taiwan
- Department of Surgery, New Taipei Municipal Tu-Cheng Hospital (Built and Operated by Chang Gung Medical Foundation), Tu-Cheng 236017, New Taipei City, Taiwan
| | - Chih-Chi Wang
- Division of General Surgery, Department of Surgery, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 833, Taiwan
- Division of General Surgery, Department of Surgery, Chiayi Chang Gung Memorial Hospital, Chiayi 613, Taiwan
| | - Wei-Chen Lee
- Division of General Surgery, Department of Surgery, Linkou Chang Gung Memorial Hospital, Guishan 333, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Guishan 333, Taoyuan, Taiwan
| | - Hsin-I Tsai
- College of Medicine, Chang Gung University, Guishan 333, Taoyuan, Taiwan
- Graduate Institute of Clinical Medical Sciences, Chang Gung University, Guishan 333, Taoyuan, Taiwan
- Department of Anesthesiology, Linkou Chang Gung Memorial Hospital, Guishan 333, Taoyuan, Taiwan
| | - Feng-Che Kuan
- Department of Hematology and Oncology, Chiayi Chang Gung Memorial Hospital, Chiayi 613, Taiwan
| | - Chun-Wei Chen
- College of Medicine, Chang Gung University, Guishan 333, Taoyuan, Taiwan
- Department of Gastroenterology and Hepatology, Linkou Chang Gung Memorial Hospital, Guishan 333, Taoyuan, Taiwan
| | - Yi-Chung Hsieh
- College of Medicine, Chang Gung University, Guishan 333, Taoyuan, Taiwan
- Department of Gastroenterology and Hepatology, Linkou Chang Gung Memorial Hospital, Guishan 333, Taoyuan, Taiwan
| | - Hsing-Yu Chen
- Graduate Institute of Clinical Medical Sciences, Chang Gung University, Guishan 333, Taoyuan, Taiwan
- Division of Chinese Internal Medicine, Center for Traditional Chinese Medicine, Taoyuan Chang Gung Memorial Hospital, Guishan 33378, Taoyuan, Taiwan
- School of Traditional Chinese Medicine, College of Medicine, Chang Gung University, Guishan 333, Taoyuan, Taiwan
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Gau RY, Yu MC, Tsai HI, Lee CH, Kuo T, Lee KC, Lee WC, Chan KM, Chiu CC, Lee CW. Laparoscopic Liver Resection Should Be a Standard Procedure for Hepatocellular Carcinoma with Low or Intermediate Difficulty. J Pers Med 2021; 11:266. [PMID: 33918197 DOI: 10.3390/jpm11040266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 03/28/2021] [Accepted: 03/30/2021] [Indexed: 12/24/2022] [Imported: 08/29/2023] Open
Abstract
BACKGROUND To investigate the feasibility of laparoscopic liver resection (LLR) for hepatocellular carcinoma (HCC), we compared the outcome between LLR and conventional open liver resection (OLR) in patient groups with different IWATE criteria difficulty scores (DS). METHODS We retrospectively reviewed 607 primary HCC patients (LLR: 81, OLR: 526) who underwent liver resection in Linkou Chang Gung Memorial hospital from 2012 to 2019. By using 1:1 propensity score-matched (PSM) analysis, their baseline characteristics and the DS stratified by the IWATE criteria were matched between the LLR and OLR. Their perioperative and oncologic outcomes were compared. RESULTS After 1:1 PSM, 146 patients (73 in LLR, 73 in OLR) were analyzed. Among them, 13, 41, 13 and 6 patients were classified as low, intermediate, advanced and expert DS group, respectively. Compared to OLR, the LLR had shorter hospital stay (9.4 vs. 11.5 days, p = 0.071), less occurrence of surgical complications (16.4% vs. 30.1%, p = 0.049), lower rate of hepatic inflow control (42.5% vs. 65.8%, p = 0.005), and longer time of inflow control (70 vs. 51 min, p = 0.022). The disease-free survival (DFS) and overall survivals were comparable between the two groups. While stratified by the DS groups, the LLR tended to have lower complication rate and shorter hospital stay than OLR. The DFS of LLR in the intermediate DS group was superior to that of the OLR (p = 0.020). In the advanced and expert DS groups, there were no significant differences regarding outcomes between the two groups. CONCLUSION We have demonstrated that with sufficient experience and technique, LLR for HCC is feasible and the perioperative outcome is favorable. Based on the current study, we suggest LLR should be a standard procedure for HCC with low or intermediate difficulty. It can provide satisfactory postoperative recovery and comparable oncological outcomes. Further larger scale prospective studies are warranted to validate our findings.
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Tsai HI, Chou TC, Yu MC, Yeh CN, Peng MT, Hsieh CH, Su PJ, Wu CE, Kuo YC, Chiu CC, Lee CW. Purely laparoscopic feeding jejunostomy: a procedure which deserves more attention. BMC Surg 2021; 21:37. [PMID: 33441134 PMCID: PMC7805100 DOI: 10.1186/s12893-021-01050-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 01/04/2021] [Indexed: 01/17/2023] [Imported: 08/29/2023] Open
Abstract
Background Laparoscopic procedure has inherent merits of smaller incisions, better cosmesis, less postoperative pain, and earlier recovery. In the current study, we presented our method of purely laparoscopic feeding jejunostomy and compared its results with that of conventional open approach. Methods We retrospectively reviewed our patients from 2012 to 2019 who had received either laparoscopic jejunostomy (LJ, n = 29) or open ones (OJ, n = 94) in Chang Gung Memorial Hospital, Linkou. Peri-operative data and postoperative outcomes were analyzed. Results In the current study, we employed 3-0 Vicryl, instead of V-loc barbed sutures, for laparoscopic jejunostomy. The mean operative duration of LJ group was about 30 min longer than the OJ group (159 ± 57.2 mins vs 128 ± 34.6 mins; P = 0.001). There were no intraoperative complications reported in both groups. The patients in the LJ group suffered significantly less postoperative pain than in the OJ group (mean NRS 2.03 ± 0.9 vs. 2.79 ± 1.2; P = 0.002). The majority of patients in both groups received early enteral nutrition (< 48 h) after the operation (86.2% vs. 74.5%; P = 0.143). Conclusions Our study demonstrated that purely laparoscopic feeding jejunostomy is a safe and feasible procedure with less postoperative pain and excellent postoperative outcome. It also provides surgeons opportunities to enhance intracorporeal suture techniques.
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Affiliation(s)
- Hsin-I Tsai
- Department of Anesthesiology, Chang Gung Memorial Hospital, Linkou Medical Center, Guishan, Taoyuan, Taiwan, Republic of China.,College of Medicine, Chang Gung University, Guishan, Taoyuan, Taiwan, Republic of China.,Graduate Institute of Clinical Medical Sciences, Chang Gung University, Guishan, Taoyuan, Taiwan, Republic of China
| | - Ta-Chun Chou
- Department of Surgery, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan, Republic of China
| | - Ming-Chin Yu
- College of Medicine, Chang Gung University, Guishan, Taoyuan, Taiwan, Republic of China.,Graduate Institute of Clinical Medical Sciences, Chang Gung University, Guishan, Taoyuan, Taiwan, Republic of China.,Division of General Surgery, Department of Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, No.5, Fuxing St., Guishan Dist., Taoyuan, 33305, Taiwan, Republic of China.,Department of Surgery, New Taipei Municipal Tu-Cheng Hospital (Built and Operated By Chang Gung Medical Foundation), Tu-Cheng, New Taipei City, Taiwan, Republic of China
| | - Chun-Nan Yeh
- College of Medicine, Chang Gung University, Guishan, Taoyuan, Taiwan, Republic of China.,Division of General Surgery, Department of Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, No.5, Fuxing St., Guishan Dist., Taoyuan, 33305, Taiwan, Republic of China
| | - Meng-Ting Peng
- Department of Hematology-Oncology, Chang Gung Memorial Hospital, Linkou Medical Center, Guishan, Taoyuan, Taiwan, Republic of China
| | - Chia-Hsun Hsieh
- College of Medicine, Chang Gung University, Guishan, Taoyuan, Taiwan, Republic of China.,Department of Hematology-Oncology, Chang Gung Memorial Hospital, Linkou Medical Center, Guishan, Taoyuan, Taiwan, Republic of China.,Division of Hematology and Oncology, Department of Internal Medicine, New Taipei Municipal Tu-Cheng Hospital (Built and Operated by Chang Gung Medical Foundation), Tu-Cheng, New Taipei City, Taiwan, Republic of China
| | - Po-Jung Su
- College of Medicine, Chang Gung University, Guishan, Taoyuan, Taiwan, Republic of China.,Department of Hematology-Oncology, Chang Gung Memorial Hospital, Linkou Medical Center, Guishan, Taoyuan, Taiwan, Republic of China.,Graduate Institute of Data Science, Taipei Medical University, Taipei, Taiwan, Republic of China
| | - Chiao-En Wu
- College of Medicine, Chang Gung University, Guishan, Taoyuan, Taiwan, Republic of China.,Department of Hematology-Oncology, Chang Gung Memorial Hospital, Linkou Medical Center, Guishan, Taoyuan, Taiwan, Republic of China
| | - Yung-Chia Kuo
- College of Medicine, Chang Gung University, Guishan, Taoyuan, Taiwan, Republic of China.,Graduate Institute of Clinical Medical Sciences, Chang Gung University, Guishan, Taoyuan, Taiwan, Republic of China.,Department of Hematology-Oncology, Chang Gung Memorial Hospital, Linkou Medical Center, Guishan, Taoyuan, Taiwan, Republic of China
| | - Chien-Chih Chiu
- Department of Nursing, Chang Gung Memorial Hospital, Linkou Medical Center, Guishan, Taoyuan, Taiwan, Republic of China
| | - Chao-Wei Lee
- College of Medicine, Chang Gung University, Guishan, Taoyuan, Taiwan, Republic of China. .,Graduate Institute of Clinical Medical Sciences, Chang Gung University, Guishan, Taoyuan, Taiwan, Republic of China. .,Division of General Surgery, Department of Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, No.5, Fuxing St., Guishan Dist., Taoyuan, 33305, Taiwan, Republic of China.
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Kou HW, Yu MC, Chong SW, Hsu HY, Chou HH, Lee CW, Chen TC, Huang SF. Successful Localization and Resection of Small Pancreatic Cystic Insulinoma Using Intraoperative Near-Infrared Fluorescence Imaging: A Case Report and Literature Review. Pancreas 2020; 49:1388-92. [PMID: 33122530 DOI: 10.1097/MPA.0000000000001678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022] [Imported: 08/29/2023]
Abstract
Pancreatic cystic insulinoma is an uncommon tumor. Perioperative localization remained challenging if the tumor is atypical with cystic feature or in small size. Near-infrared (NIR) imaging is a technique by injecting fluorescent dye intravenously, which accumulates to the target lesion and creating signal by laser sources. The signal helps surgeons to identify the lesion during operation, but little experience has been reported regarding the use of imaging NIR technique for localizing cystic insulinoma. We present a 29-year-old female patient with a symptomatic pancreatic cystic insulinoma (1.2 cm) as assessed by clinical symptom, laboratory evidence, and magnetic resonance cholangiopancreatography. With an aid of NIR imaging technique, this cystic tumor was localized easily at operation. Also, the fluorescence imaging visualized the tumor part, guided us to identify the safe margin, and preserved the normal pancreatic structure. Pathologic report confirmed that the tumor was a well-differentiated cystic insulinoma. This case demonstrates that pancreatic cystic insulinoma in small size can be intraoperatively localized by NIR imaging, a relatively safe and easy technique.
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Lee CW, Tsai HI, Lee WC, Huang SW, Lin CY, Hsieh YC, Kuo T, Chen CW, Yu MC. Normal Alpha-Fetoprotein Hepatocellular Carcinoma: Are They Really Normal? J Clin Med 2019; 8:E1736. [PMID: 31635078 DOI: 10.3390/jcm8101736] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 10/12/2019] [Accepted: 10/17/2019] [Indexed: 02/07/2023] [Imported: 08/29/2023] Open
Abstract
Introduction: serum alpha-fetoprotein (AFP) was routinely employed as a tumor marker for screening, diagnosis, and treatment follow-up of hepatocellular carcinoma (HCC). However, a substantial proportion of HCC patients had normal AFP level even at an advanced disease status. Few studies to date had tried to explore the nature and behavior of this normal AFP HCC (N-HCC). The purpose of this study was to investigate the clinicopathological characteristics and survival outcome of N-HCC after operation. In addition, potential tumor markers for N-HCC were also sought in an attempt to augment diagnostic ability. Methods: between 2005 and 2015, patients with hepatocellular carcinoma who were treated with hepatectomy in Chang Gung Memorial Hospital Linkou branch were divided into two groups according to their preoperative serum AFP level (<15 ng/mL: NHCC; ≥15 ng/mL: abnormal AFP HCC (A-HCC)). Patient demographic data and clinicopathological variables were collected. Kaplan–Meier and Cox regression multivariate analyses were performed to identify significant risk factors for disease-free survival (DFS) and overall survival (OS) for N-HCC. ELISA and immunohistochemical (IHC) studies were employed to determine the diagnostic accuracy of various tumor markers. Results: a total of 1616 patients (78% male) who underwent liver resection for HCC were included in this study. Of them, 761 patients (47.1%) were N-HCC. N-HCC patients were significantly older with more comorbidities and less hepatitis virus infections. Furthermore, N-HCC had fewer early recurrences (49.6% vs. 60.8%, p < 0.001) and better DFS (44.6 months vs. 23.6 months, p < 0.001) and OS (94.5 months vs. 81.7 months, p < 0.001). Both ELISA and IHC studies demonstrated that glypican-3 (GPC3) would be a promising diagnostic tumor marker for N-HCC. Conclusion: N-HCC patients were significantly older and had less hepatitis virus infections or cirrhosis. Their tumors tended to be smaller, less vascular invaded, and well-differentiated. The carcinogenesis of N-HCC may thus not be identical to that of typical HCC. GPC3 would be a promising tumor marker for diagnosing N-HCC. Further study is warranted to validate our findings.
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Kou HW, Yeh CH, Tsai HI, Hsu CC, Hsieh YC, Chen WT, Cheng HT, Yu MC, Lee CW. Sarcopenia is an effective predictor of difficult-to-wean and mortality among critically ill surgical patients. PLoS One 2019; 14:e0220699. [PMID: 31393937 PMCID: PMC6687130 DOI: 10.1371/journal.pone.0220699] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2019] [Accepted: 07/22/2019] [Indexed: 12/11/2022] [Imported: 08/29/2023] Open
Abstract
BACKGROUND Critically-ill surgical patients are at higher risk for sarcopenia, which is associated with worse survival. Sarcopenia may impair the respiratory musculature, which can subsequently influence the outcome of ventilator weaning. Although there are a variety of weaning parameters predictive of weaning outcomes, none have tried to incorporate "muscle strength" or "sarcopenia". The aim of the current study was to explore the association between sarcopenia and difficult-to-wean (DtW) in critically-ill surgical patients. The influence of sarcopenia on ICU mortality was also analyzed. METHODS Ninety-six patients undergoing mechanical ventilation in the surgical intensive care unit (ICU) were enrolled. Demographic data and weaning parameters were recorded from the prospectively collected database, and the total psoas muscle area (TPA) was determined at the level of the 3rd lumbar vertebra by computed tomography. Sarcopenia was defined by previously established cut-off points and its influence on clinical outcomes was examined. Receiver operating characteristic (ROC) curve analysis was conducted to investigate the predictive capability of TPA and weaning parameters for predicting weaning outcomes. RESULTS The median age of the studied patients was 73 years. Thirty patients (31.3%) were sarcopenic and 30 (31.3%) were defined as DtW. Eighteen patients (18.8%) had ICU mortality. Multivariate logistic regression analyses revealed that sarcopenia was an independent risk factor for DtW and ICU mortality. The area under the ROC curve (AUC) of TPA for predicting successful weaning was 0.727 and 0.720 in female and male patients, respectively. After combining TPA and conventional weaning parameters, the AUC for DtW increased from 0.836 to 0.911 and from 0.835 to 0.922 in female and male patients, respectively. CONCLUSION Sarcopenia is an independent risk factor for DtW and ICU mortality. TPA has predictive value when assessing weaning outcomes and can be used as an effective adjunct predictor along with conventional weaning parameters.
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Affiliation(s)
- Hao-Wei Kou
- Division of General Surgery, Department of Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, Guishan, Taoyuan, Taiwan, Republic of China
| | - Chih-Hua Yeh
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Linkou Medical Center, Guishan, Taoyuan, Taiwan, Republic of China
- College of Medicine, Chang Gung University, Guishan, Taoyuan, Taiwan, Republic of China
| | - Hsin-I Tsai
- College of Medicine, Chang Gung University, Guishan, Taoyuan, Taiwan, Republic of China
- Department of Anesthesiology, Chang Gung Memorial Hospital, Linkou Medical Center, Guishan, Taoyuan, Taiwan, Republic of China
- Graduate Institute of Clinical Medical Sciences, Chang Gung University, Guishan, Taoyuan, Taiwan, Republic of China
| | - Chih-Chieh Hsu
- Division of General Surgery, Department of Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, Guishan, Taoyuan, Taiwan, Republic of China
| | - Yi-Chung Hsieh
- Department of Hepatogastroenterology, Chang Gung Memorial Hospital, Linkou Medical Center, Guishan, Taoyuan, Taiwan, Republic of China
| | - Wei-Ting Chen
- Department of Hepatogastroenterology, Chang Gung Memorial Hospital, Linkou Medical Center, Guishan, Taoyuan, Taiwan, Republic of China
| | - Hao-Tsai Cheng
- College of Medicine, Chang Gung University, Guishan, Taoyuan, Taiwan, Republic of China
- Graduate Institute of Clinical Medical Sciences, Chang Gung University, Guishan, Taoyuan, Taiwan, Republic of China
- Department of Hepatogastroenterology, Chang Gung Memorial Hospital, Linkou Medical Center, Guishan, Taoyuan, Taiwan, Republic of China
| | - Ming-Chin Yu
- Division of General Surgery, Department of Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, Guishan, Taoyuan, Taiwan, Republic of China
- College of Medicine, Chang Gung University, Guishan, Taoyuan, Taiwan, Republic of China
- Graduate Institute of Clinical Medical Sciences, Chang Gung University, Guishan, Taoyuan, Taiwan, Republic of China
- Department of Surgery, Xiamen Chang Gung Hospital, Xiamen, China
| | - Chao-Wei Lee
- Division of General Surgery, Department of Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, Guishan, Taoyuan, Taiwan, Republic of China
- College of Medicine, Chang Gung University, Guishan, Taoyuan, Taiwan, Republic of China
- Graduate Institute of Clinical Medical Sciences, Chang Gung University, Guishan, Taoyuan, Taiwan, Republic of China
- * E-mail:
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Yu MC, Lee CW, Lee YS, Lian JH, Tsai CL, Liu YP, Wu CH, Tsai CN. Prediction of early-stage hepatocellular carcinoma using OncoScan chromosomal copy number aberration data. World J Gastroenterol 2017; 23:7818-7829. [PMID: 29209123 PMCID: PMC5703911 DOI: 10.3748/wjg.v23.i44.7818] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Revised: 10/26/2017] [Accepted: 11/07/2017] [Indexed: 02/06/2023] [Imported: 08/29/2023] Open
Abstract
AIM To identify chromosomal copy number aberrations (CNAs) in early-stage hepatocellular carcinoma (HCC) and analyze whether they are correlated with patient prognosis.
METHODS One hundred and twenty patients with early-stage HCC were enrolled in our study, with the collection of formalin fixed, paraffin-embedded (FFPE) specimens and clinicopathological data. Tumor areas were marked by certified pathologists on a hematoxylin and eosin-stained slide, and cancer and adjacent non-cancerous tissues underwent extraction of DNA, which was analyzed with the Affymetrix OncoScan platform to assess CNAs and loss of heterozygosity (LOH). Ten individuals with nonmalignant disease were used as the control group. Another cohort consisting of 40 patients with stage I/II HCC were enrolled to analyze gene expression and to correlate findings with the OncoScan data.
RESULTS Copy number amplifications occurred at chromosomes 1q21.1-q44 and 8q12.3-24.3 and deletions were found at 4q13.1-q35.2, 8p 23.2-21.1, 16q23.3-24.3, and 17p13.3-12, while LOH commonly occurred at 1p32.3, 3p21.31, 8p23.2-21.1, 16q22.1-24.3, and 17p 13.3-11 in early-stage HCC. Using Cox regression analysis, we also found that a higher percentage of genome change (≥ 60%) was an independent factor for worse prognosis in early-stage HCC (P = 0.031). Among the 875 genes in the OncoScan GeneChip, six were independent predictors of worse disease-free survival, of which three were amplified (MYC, ELAC2, and SYK) and three were deleted (GAK, MECOM, and WRN). Further, patients with HCC who exhibited ≥ 3 CNAs involving these six genes have worse outcomes compared to those who had < 3 CNAs (P < 0.001). Similarly, Asian patients with stage I HCC from The Cancer Genome Atlas harboring CNAs with these genes were also predicted to have poorer outcomes.
CONCLUSION Patients with early-stage HCC and increased genome change or CNAs involving MYC, ELAC2, SYK, GAK, MECOM, or WRN are at risk for poorer outcome after resection.
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Affiliation(s)
- Ming-Chin Yu
- Department of Surgery, Chang Gung Memorial Hospital, Taoyuan 33305, Taiwan
- Department of Surgery, Xiamen Chang Gung Hospital, Xiamen 361028, China
| | - Chao-Wei Lee
- Department of Surgery, Chang Gung Memorial Hospital, Taoyuan 33305, Taiwan
- Graduate Institute of Clinical Medical Sciences, Chang Gung University, Taoyuan 33302, Taiwan
| | - Yun-Shien Lee
- Genomic Medicine Core Laboratory, Chang Gung Memorial Hospital, Taoyuan 33305, Taiwan
- Department of Biotechnology, Ming-Chuan University, Taoyuan 33348, Taiwan
| | - Jang-Hau Lian
- Genomic Medicine Core Laboratory, Chang Gung Memorial Hospital, Taoyuan 33305, Taiwan
| | - Chia-Lung Tsai
- Genomic Medicine Core Laboratory, Chang Gung Memorial Hospital, Taoyuan 33305, Taiwan
| | - Yi-Ping Liu
- Department of Surgery, Chang Gung Memorial Hospital, Taoyuan 33305, Taiwan
| | - Chun-Hsing Wu
- Department of Surgery, Chang Gung Memorial Hospital, Taoyuan 33305, Taiwan
| | - Chi-Neu Tsai
- Graduate Institute of Clinical Medical Sciences, Chang Gung University, Taoyuan 33302, Taiwan
- Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan 33305, Taiwan
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Hsu HY, Yu MC, Lee CW, Tsai HI, Sung CM, Chen CW, Huang SW, Lin CY, Jeng WJ, Lee WC, Chen MF. RAM score is an effective predictor for early mortality and recurrence after hepatectomy for hepatocellular carcinoma. BMC Cancer 2017; 17:742. [PMID: 29121890 PMCID: PMC5680811 DOI: 10.1186/s12885-017-3748-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Accepted: 11/01/2017] [Indexed: 02/08/2023] [Imported: 08/29/2023] Open
Abstract
Background Liver resection had been regarded as a standard treatment for primary hepatocellular carcinoma (HCC). However, early mortality and recurrence after surgery were still of major concern. RAM (Risk Assessment for early Mortality) scoring system is a newly developed tool for assessing early mortality after hepatectomy for HCC. In this study, we compared RAM scoring system with ALBI and MELD scores for their capability of predicting short-term outcome. Methods We retrospectively reviewed patients with hepatocellular carcinoma who were treated with hepatectomy at Chang Gung Memorial Hospital between 1986 and 2015. Their clinical characteristics and perioperative variables were collected. We applied RAM, albumin-bilirubin (ALBI), and model for end-stage liver disease (MELD) scoring systems to predict early mortality and early recurrence in HCC patients after surgery. We investigated the discriminative power of each scoring system by receiver operating characteristic (ROC) curve and area under the ROC curve (AUC). Results A total of 1935 patients (78% male) who underwent liver resection for HCC were included in this study. The median follow-up period was 41.9 months. One hundred and forty-nine patients (7.7%) died within 6 months after hepatectomy (early mortality). All the three scoring systems were effective predictor for early mortality, with higher score indicating higher risk of early mortality (AUC of RAM = 0.723, p < 0.001; AUC of ALBI = 0.682, p < 0.001; AUC of MELD = 0.590, p = 0.002). Cox regression multivariate analysis demonstrated that the RAM class was the most significant independent predictor of early mortality after surgery, while MELD grade failed to discriminatively predict early mortality. In addition to early mortality, the RAM score was also predictive of early recurrence in HCC after surgery. Conclusions This study demonstrated that RAM score is an effective and user-friendly bedside scoring system to predict early mortality and early recurrence after hepatectomy for HCC. In addition, the predictive capability of RAM score is superior to ALBI and MELD scores. Further study is warranted to validate our findings.
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Affiliation(s)
- Heng-Yuan Hsu
- Department of Surgery, Chang Gung Memorial Hospital, No. 5, Fuxing St., Guishan Dist., Taoyuan, 333, Taiwan, Republic of China
| | - Ming-Chin Yu
- Department of Surgery, Chang Gung Memorial Hospital, No. 5, Fuxing St., Guishan Dist., Taoyuan, 333, Taiwan, Republic of China.,College of Medicine, Chang Gung University, Taoyuan, Taiwan, Republic of China
| | - Chao-Wei Lee
- Department of Surgery, Chang Gung Memorial Hospital, No. 5, Fuxing St., Guishan Dist., Taoyuan, 333, Taiwan, Republic of China. .,College of Medicine, Chang Gung University, Taoyuan, Taiwan, Republic of China. .,Graduate Institute of Clinical Medical Sciences, Chang Gung University, Taoyuan, Taiwan, Republic of China.
| | - Hsin-I Tsai
- Graduate Institute of Clinical Medical Sciences, Chang Gung University, Taoyuan, Taiwan, Republic of China.,Department of Anesthesiology, Chang Gung Memorial Hospital, No. 5, Fuxing St., Guishan Dist., Taoyuan, 333, Taiwan, Republic of China
| | - Chang-Mu Sung
- Graduate Institute of Clinical Medical Sciences, Chang Gung University, Taoyuan, Taiwan, Republic of China.,Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, No. 5, Fuxing St., Guishan Dist., Taoyuan, 333, Taiwan, Republic of China
| | - Chun-Wei Chen
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, No. 5, Fuxing St., Guishan Dist., Taoyuan, 333, Taiwan, Republic of China
| | - Shu-Wei Huang
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, No. 5, Fuxing St., Guishan Dist., Taoyuan, 333, Taiwan, Republic of China
| | - Cheng-Yu Lin
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, No. 5, Fuxing St., Guishan Dist., Taoyuan, 333, Taiwan, Republic of China
| | - Wen-Juei Jeng
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, No. 5, Fuxing St., Guishan Dist., Taoyuan, 333, Taiwan, Republic of China
| | - Wei-Chen Lee
- Department of Surgery, Chang Gung Memorial Hospital, No. 5, Fuxing St., Guishan Dist., Taoyuan, 333, Taiwan, Republic of China
| | - Miin-Fu Chen
- Department of Surgery, Chang Gung Memorial Hospital, No. 5, Fuxing St., Guishan Dist., Taoyuan, 333, Taiwan, Republic of China.,College of Medicine, Chang Gung University, Taoyuan, Taiwan, Republic of China
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Huang SF, Kuo IM, Lee CW, Pan KT, Chen TC, Lin CJ, Hwang TL, Yu MC. Comparison study of gastrinomas between gastric and non-gastric origins. World J Surg Oncol 2015; 13:202. [PMID: 26077245 PMCID: PMC4478711 DOI: 10.1186/s12957-015-0614-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Accepted: 05/28/2015] [Indexed: 12/17/2022] [Imported: 08/29/2023] Open
Abstract
BACKGROUND Gastrinomas are one of the neuroendocrine tumors with potential distant metastasis. Most gastrinomas are originated from pancreas and duodenum, but those of gastric origin have been much less reported. The aim of the study is to compare gastrinomas of gastric and non-gastric origins. METHODS Four hundred twenty-four patients with neuroendocrine tumor by histological proof in Chang Gung Memorial Hospital, Linkou branch in the past 10 years were included. A total of 109 (25.7 %) cases were identified of upper gastrointestinal origins, of which 20 (18.3 %) were proven gastrinomas. The clinical characteristics were collected and analyzed retrospectively. RESULTS In our study, 21 tumors of the 20 cases were identified by pathologic proof, 11 (55 %) had resection or endoscopic mucosa resection, 9 of gastric origins, 9 of duodenal origins, 2 of pancreatic origins, and 1 of hepatic origins. One case had multiple lesions. Patients with gastric gastrinomas had older age, higher levels of gastrin, seemingly smaller tumor size (p = 0.024, 0.030, and 0.065, respectively), and usually lower grade in differentiation (p = 0.035). Though gastric gastrinomas had a high recurrent rate (80 %), the lymph node and liver involvement was less common. Gastrinomas with liver involvement/metastasis had a high mortality rate where 80 % died of liver dysfunction. CONCLUSIONS Gastrinomas originating from stomach had higher gastrin level and lower tumor grading and presented at older age. The long-term outcome was probably better than non-gastric origin because of lower grading and less lymph node and liver involvement.
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Affiliation(s)
- Song-Fong Huang
- Department of Surgery, Chang Gung Memorial Hospital, 5, Fu-Shin Street, Kweishan, Taoyuan, 333, Taiwan.
| | - I-Ming Kuo
- Department of Surgery, Chang Gung Memorial Hospital, 5, Fu-Shin Street, Kweishan, Taoyuan, 333, Taiwan.
| | - Chao-Wei Lee
- Department of Surgery, Chang Gung Memorial Hospital, 5, Fu-Shin Street, Kweishan, Taoyuan, 333, Taiwan.
| | - Kuang-Tse Pan
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, 5, Fu-Shin Street, Kweishan, Taoyuan, 333, Taiwan.
| | - Tse-Ching Chen
- Department of Pathology, Chang Gung Memorial Hospital, 5, Fu-Shin Street, Kweishan, Taoyuan, 333, Taiwan.
| | - Chun-Jung Lin
- Department of General Gastroenterology, Chang Gung Memorial Hospital, 5, Fu-Shin Street, Kweishan, Taoyuan, 333, Taiwan.
| | - Tsann-Long Hwang
- Department of Surgery, Chang Gung Memorial Hospital, 5, Fu-Shin Street, Kweishan, Taoyuan, 333, Taiwan.
| | - Ming-Chin Yu
- Department of Surgery, Chang Gung Memorial Hospital, 5, Fu-Shin Street, Kweishan, Taoyuan, 333, Taiwan.
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Lee CW, Tsai HI, Lin YS, Wu TH, Yu MC, Chen MF. Intrahepatic biliary mucinous cystic neoplasms: clinicoradiological characteristics and surgical results. BMC Gastroenterol 2015; 15:67. [PMID: 26058559 PMCID: PMC4460858 DOI: 10.1186/s12876-015-0293-3] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Accepted: 05/22/2015] [Indexed: 12/20/2022] [Imported: 08/29/2023] Open
Abstract
Background Intrahepatic biliary mucinous cystic neoplasms are rare hepatic tumors and account for less than 5% of intrahepatic cystic lesions. Accurate preoperative diagnosis is difficult and the outcome differs among various treatment modalities.The aim of this study is to investigate the clinico-radiological characteristics of intrahepatic biliary mucinous cystic neoplasms and to establish eligible diagnostic and treatment suggestions. Methods Nineteen patients with intrahepatic biliary cystadenomas and two patients with biliary cystadenocarcinomas were retrospectively reviewed. Their clinico-radiological variables and survival outcome were analyzed. Results Of the 19 patients with biliary cystadenoma, 16 (84.2 %) were female. 11 (57.9 %) patients had symptoms before operation with the most common presenting symptom being abdominal pain. Among the patients with available data, serum and cystic fluid CA 19–9 levels were invariably elevated and the CA 19–9 level in the cystic fluid was significantly higher than that in the serum. Loculations (84.2 %) and septations (63.2 %) were the most common radiologic findings. For treatment, 11 (57.9 %) patients received radical resection by either enucleation or hepatic resection, while the remaining 8 (42.1 %) patients underwent only fenestration of liver cysts. Radical resection provided a significantly better clinical outcome than fenestration in terms of tumor recurrence (p = 0.018). The only two male patients with biliary cystadenocarcinoma received radical hepatic resection and achieved a disease-free survival of 16.5 months and 33 months, respectively. Conclusion Intrahepatic biliary mucinous cystic neoplasms are rare and preoperative diagnosis is difficult. Internal septations and loculations on radiologic examinations should raise some suspicion of this diagnosis. Complete tumor excision is the standard treatment that may provide patients with better long term results after the operation.
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Affiliation(s)
- Chao-Wei Lee
- Department of Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan. .,Chang Gung University, Kwei-Shan Tao-Yuan, Taiwan.
| | - Hsin-I Tsai
- Department Anesthesiology, Chang Gung Memorial Hospital, Linkou, Taiwan.
| | - Yann-Sheng Lin
- Department of Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan.
| | - Tsung-Han Wu
- Department of Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan.
| | - Ming-Chin Yu
- Department of Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan. .,Chang Gung University, Kwei-Shan Tao-Yuan, Taiwan.
| | - Miin-Fu Chen
- Department of Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan. .,Chang Gung University, Kwei-Shan Tao-Yuan, Taiwan.
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Lee SC, Huang SS, Lee CW, Fung CP, Lee N, Shieh WB, Siu LK. Comparative antimicrobial susceptibility of aerobic and facultative bacteria from community-acquired bacteremia to ertapenem in Taiwan. BMC Infect Dis 2007; 7:79. [PMID: 17640342 PMCID: PMC1971056 DOI: 10.1186/1471-2334-7-79] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2006] [Accepted: 07/17/2007] [Indexed: 11/23/2022] [Imported: 08/29/2023] Open
Abstract
Background Ertapenem is a once-a-day carbapenem and has excellent activity against many gram-positive and gram-negative aerobic, facultative, and anaerobic bacteria. The susceptibility of isolates of community-acquired bacteremia to ertapenem has not been reported yet. The present study assesses the in vitro activity of ertapenem against aerobic and facultative bacterial pathogens isolated from patients with community-acquired bacteremia by determining and comparing the MICs of cefepime, cefoxitin, ceftazidime, ceftriaxone, ertapenem, piperacillin, piperacillin-tazobactam, ciprofloxacin, amikacin and gentamicin. The prevalence of extended broad spectrum β-lactamases (ESBL) producing strains of community-acquired bacteremia and their susceptibility to these antibiotics are investigated. Methods Aerobic and facultative bacteria isolated from blood obtained from hospitalized patients with community-acquired bacteremia within 48 hours of admission between August 1, 2004 and September 30, 2004 in Chang Gung Memorial Hospital at Keelung, Taiwan, were identified using standard procedures. Antimicrobial susceptibility was evaluated by Etest according to the standard guidelines provided by the manufacturer and document M100-S16 Performance Standards of the Clinical Laboratory of Standard Institute. Antimicrobial agents including cefepime, cefoxitin, ceftazidime, ceftriaxone, ertapenem, piperacillin, piperacillin-tazobactam, ciprofloxacin, amikacin and gentamicin were used against the bacterial isolates to test their MICs as determined by Etest. For Staphylococcus aureus isolates, MICs of oxacillin were also tested by Etest to differentiate oxacillin-sensitive and oxacillin-resistant S. aureus. Results Ertapenem was highly active in vitro against many aerobic and facultative bacterial pathogens commonly recovered from patients with community-acquired bacteremia (128/159, 80.5 %). Ertapenem had more potent activity than ceftriaxone, piperacillin-tazobactam, or ciprofloxacin against oxacillin-susceptible S. aureus (17/17, 100%)and was more active than any of these agents against enterobacteriaceae (82/82, 100%). Conclusion Based on the microbiology pattern of community-acquired bacteremia, initial empiric treatment that requires coverage of a broad spectrum of both gram-negative and gram-positive aerobic bacteria, such as ertapenem, may be justified in moderately severe cases of community-acquired bacteremia in non-immunocompromised hosts.
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Affiliation(s)
- Sai-Cheong Lee
- Division of Infectious Diseases, Chang Gung Memorial Hospital, Keelung, Taiwan, Republic of China
- Chang Gung Institute of Technology, Kwei-Shan Tao-Yuan,, Taiwan, Republic of China
| | - Shie-Shian Huang
- Division of Infectious Diseases, Chang Gung Memorial Hospital, Keelung, Taiwan, Republic of China
- Chang Gung Institute of Technology, Kwei-Shan Tao-Yuan,, Taiwan, Republic of China
| | - Chao-Wei Lee
- Department of Surgery, Chang Gung Memorial Hospital, Keelung, Taiwan, Republic of China
| | - Chang-Phone Fung
- Division of Infectious Diseases, Veterans General Hospital, Taipei, Taiwan, Republic of China
- National Yang-Ming University, Taipei, Taiwan, Republic of China
| | - Ning Lee
- Department of Pathology, Chang Gung Memorial Hospital, Keelung, Taiwan, Republic of China
| | - Wen-Bin Shieh
- Department of Chest, Chang Gung Memorial Hospital, Keelung, Taiwan, Republic of China
- Chang Gung University, Kwei-Shan Tao-Yuan,, Taiwan, Republic of China
| | - LK Siu
- Division of Clinical Research, National Health Research Institute, Miaoli County,, Taiwan, Republic of China
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