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Ni Q, Jia H, Zhang Y, Lu J, Chang H. Treatment and prognosis study of spontaneous rupture hemorrhage in hepatocellular carcinoma: Recommendations for adding the A1 stage to the BCLC staging system. Cancer Med 2024; 13:e6952. [PMID: 38752672 PMCID: PMC11097619 DOI: 10.1002/cam4.6952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 11/10/2023] [Accepted: 01/10/2024] [Indexed: 05/19/2024] Open
Abstract
BACKGROUND The Barcelona Clinic Liver Cancer (BCLC) staging system is an internationally recognized clinical staging system for hepatocellular carcinoma (HCC). However, this staging system does not address the staging and surgical treatment strategies for patients with spontaneous rupture hemorrhage in HCC. In this study, we aimed to investigate the prognosis of patients with BCLC stage A undergoing liver resection for HCC with spontaneous rupture hemorrhage and compare it with the prognosis of patients with BCLC stage A undergoing liver resection without rupture. METHODS Clinical data of 99 patients with HCC who underwent curative liver resection surgery were rigorously followed up and treated at Shandong Provincial Hospital from January 2013 to January 2023. A retrospective cohort study design was used to determine whether the presence of ruptured HCC (rHCC) is a risk factor for recurrence and survival after curative liver resection for HCC. Prognostic comparisons were made between patients with ruptured and non-ruptured BCLC stage A HCC (rHCC and nrHCC, respectively) who underwent curative liver resection. RESULTS rHCC (hazard ratio [HR] = 2.974, [p] = 0.016) and tumor diameter greater than 5 cm (HR = 2.819, p = 0.022) were identified as independent risk factors for overall survival (OS) after curative resection of BCLC stage A HCC. The postoperative OS of the spontaneous rupture in the HCC group (Group I) was shorter than that in the BCLC stage A group (Group II) (p = 0.008). Tumor invasion without penetration of the capsule was determined to be an independent risk factor for recurrence-free survival (RFS) after liver resection for HCC (HR = 2.584, p = 0.002). CONCLUSION HCC with concurrent spontaneous rupture hemorrhage is an independent risk factor for postoperative OS after liver resection. The BCLC stage A1 should be added to complement the current BCLC staging system to provide further guidance for the treatment of patients with spontaneous rupture of HCC.
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Affiliation(s)
- Qingqiang Ni
- Department of Hepatobiliary SurgeryShandong Provincial Hospital Affiliated to Shandong First Medical UniversityJinanShandongChina
| | - Hongtao Jia
- Department of Hepatobiliary SurgeryShandong Provincial Hospital Affiliated to Shandong First Medical UniversityJinanShandongChina
| | - Yazhou Zhang
- Department of PathologyShandong Provincial Hospital Affiliated to Shandong First Medical UniversityJinanShandongChina
| | - Jun Lu
- Department of Hepatobiliary SurgeryShandong Provincial Hospital Affiliated to Shandong First Medical UniversityJinanShandongChina
| | - Hong Chang
- Department of Hepatobiliary SurgeryShandong Provincial Hospital Affiliated to Shandong First Medical UniversityJinanShandongChina
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Chen Y, Guo D, Li X, Xu C, Zhu Q. Predictors of Spontaneous Rupture of Hepatocellular Carcinoma and Clinical Outcomes Following Hepatectomy. Front Oncol 2022; 12:820867. [PMID: 35155255 PMCID: PMC8828539 DOI: 10.3389/fonc.2022.820867] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 01/03/2022] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVE To explore the independent predictive factors of spontaneous tumor rupture (STR) in patients undergoing curative resection of hepatocellular carcinoma (HCC), and to evaluate the impact of STRHCC on long-term survival after hepatectomy. METHODS The clinicopathological parameters of 106 patients with STRHCC and 201 patients with non-ruptured HCC who underwent hepatectomy from January 2007 to November 2011 at the Eastern Hepatobiliary Surgery Hospital and Zhongnan Hospital of Wuhan University were analyzed using propensity score matching (PSM) and a logistic regression model. RESULTS Factors including hypertension, cirrhosis, total bilirubin (TB), tumor size, and ascites were independent predictors of STR. For all 307 HCC patients, the 1-, 3- and 5-year overall survival (OS) rates were 54.0%, 37.3% and 33.8%, respectively. After PSM, the 1-, 3-, and 5-year OS rates in the ruptured group remained significantly lower at 41.5%, 23.5%, and 17.5% when compared with the non-ruptured group at 70.8%, 47.1%, and 37.6%, respectively, while the 1-, 3-, and 5-year disease-free survival (DFS) rates between the groups did not differ significantly (50.4%, 35.1%, 27.1% vs 55.4%, 38.2%, 27.4%). STRHCC was significantly associated with increased risk of OS, but not of shorter DFS. No significant difference in postoperative morbidity or hospital death was observed between the groups. CONCLUSION Factors including hypertension, liver cirrhosis, higher TB levels, tumor size > 5cm, and ascites are significant predictors of STR. The recurrence rate of patients in the ruptured group was significantly higher than that of patients in the non-ruptured group. STR results in poorer OS but not DFS in patients undergoing curative resection for HCC. STRHCC has no impact on postoperative morbidity and mortality after hepatectomy.
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Affiliation(s)
- Yiran Chen
- Department of Hepatobiliary and Pancreatic Surgery, Hubei Provincial Clinical Medicine Research Center for Minimally Invasive Diagnosis and Treatment of Hepatobiliary and Pancreatic Diseases, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Deliang Guo
- Department of Hepatobiliary and Pancreatic Surgery, Hubei Provincial Clinical Medicine Research Center for Minimally Invasive Diagnosis and Treatment of Hepatobiliary and Pancreatic Diseases, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Xinyi Li
- Department of Anesthesiology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Chang Xu
- Second Department of Biliary Surgery, Eastern Hepatobiliary Surgery Hospital of Naval Medical University, Shanghai, China
| | - Qian Zhu
- Department of Hepatobiliary and Pancreatic Surgery, Hubei Provincial Clinical Medicine Research Center for Minimally Invasive Diagnosis and Treatment of Hepatobiliary and Pancreatic Diseases, Zhongnan Hospital of Wuhan University, Wuhan, China
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Huang A, Guo DZ, Wang YP, Fan J, Yang XR, Zhou J. The treatment strategy and outcome for spontaneously ruptured hepatocellular carcinoma: a single-center experience in 239 patients. J Cancer Res Clin Oncol 2022; 148:3203-3214. [PMID: 35118561 DOI: 10.1007/s00432-022-03916-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 01/04/2022] [Indexed: 02/06/2023]
Abstract
PURPOSE There exist no treatment guidelines for spontaneously ruptured hepatocellular carcinoma (srHCC) and its prognosis remains controversial. METHODS Patients were retrospectively enrolled and grouped based on hemodynamics and tumor resectability. The 30-day mortality, 5-year overall survival (OS), progression-free survival (PFS), peritoneal metastasis (PM) and intrahepatic metastasis (IM) rates were compared. RESULTS In general, 239 patients were classified into four groups: patients with stable hemodynamics underwent semi-elective hepatectomy (n = 119), and those with unstable hemodynamics received emergent hepatectomy (n = 17), sequential hemostatic-transcatheter arterial chemoembolization (TACE)/-laparotomy with late hepatectomy (n = 49), or TACE only (n = 54). Hepatectomy was safer and provided better OS and PFS than TACE both before and after propensity score matching. Emergent hepatectomy was associated with higher 30-day mortality (6.2%, P < 0.05) and poorer prognosis whereas semi-elective hepatectomy and sequential treatment had comparable mortality (both 0%) and survival (36.3% vs 45.2%, P > 0.05). Compared with hemostatic TACE in the sequential treatment group, early surgical intervention (semi-elective hepatectomy, emergent hepatectomy, and sequential laparotomy with late hepatectomy) decreased PM (13.6% vs 34.2%, P = 0.003) whereas had higher IM (68.0% vs 50.0%, P = 0.039), but neither procedure had affected OS. In srHCC patients with high risk of recurrence (multiple tumors, micro- and macro-vascular invasion), postoperative adjuvant TACE improved OS. CONCLUSION Hepatectomy could provide better prognosis than TACE for srHCC patients while semi-elective hepatectomy and sequential hemostatic-TACE with staged hepatectomy are viable options for srHCCs with stable and unstable hemodynamics, respectively.
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Affiliation(s)
- Ao Huang
- Department of Liver Surgery and Transplantation; Liver Cancer Institute, Key Laboratory of Carcinogenesis and Cancer Invasion (Fudan University), Ministry of Education; Shanghai Key Laboratory of Organ Transplantation, Zhongshan Hospital, Fudan University, 136 Yi Xue Yuan Road, Shanghai, 200032, China
| | - De-Zhen Guo
- Department of Liver Surgery and Transplantation; Liver Cancer Institute, Key Laboratory of Carcinogenesis and Cancer Invasion (Fudan University), Ministry of Education; Shanghai Key Laboratory of Organ Transplantation, Zhongshan Hospital, Fudan University, 136 Yi Xue Yuan Road, Shanghai, 200032, China
| | - Yu-Peng Wang
- Department of Liver Surgery and Transplantation; Liver Cancer Institute, Key Laboratory of Carcinogenesis and Cancer Invasion (Fudan University), Ministry of Education; Shanghai Key Laboratory of Organ Transplantation, Zhongshan Hospital, Fudan University, 136 Yi Xue Yuan Road, Shanghai, 200032, China
| | - Jia Fan
- Department of Liver Surgery and Transplantation; Liver Cancer Institute, Key Laboratory of Carcinogenesis and Cancer Invasion (Fudan University), Ministry of Education; Shanghai Key Laboratory of Organ Transplantation, Zhongshan Hospital, Fudan University, 136 Yi Xue Yuan Road, Shanghai, 200032, China
- Institute of Biomedical Sciences, Fudan University, Shanghai, 200032, China
| | - Xin-Rong Yang
- Department of Liver Surgery and Transplantation; Liver Cancer Institute, Key Laboratory of Carcinogenesis and Cancer Invasion (Fudan University), Ministry of Education; Shanghai Key Laboratory of Organ Transplantation, Zhongshan Hospital, Fudan University, 136 Yi Xue Yuan Road, Shanghai, 200032, China
| | - Jian Zhou
- Department of Liver Surgery and Transplantation; Liver Cancer Institute, Key Laboratory of Carcinogenesis and Cancer Invasion (Fudan University), Ministry of Education; Shanghai Key Laboratory of Organ Transplantation, Zhongshan Hospital, Fudan University, 136 Yi Xue Yuan Road, Shanghai, 200032, China.
- Institute of Biomedical Sciences, Fudan University, Shanghai, 200032, China.
- State Key Laboratory of Genetic Engineering, Fudan University, Shanghai, 200032, China.
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Matsuoka Y, Taoka R, Xia Z, Sugimoto M, Kakehi Y. Hyperthermic therapy using warm sterile water enhances cytocidal effects on bladder cancer cells. Scand J Urol 2020; 54:65-69. [PMID: 31928301 DOI: 10.1080/21681805.2019.1708967] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Objectives: To investigate whether warm sterile water enhances the cytocidal effect of hypotonic shock on bladder cancer cells that show resistance to sterile water.Methods: Four bladder cancer cell lines of varying grades (T24, RT4, J82, and RT112) were exposed to sterile water, and morphological changes were closely observed under microscopy. Changes in cell membrane integrity and cell viability after water exposure were measured to determine the effects of water-induced hypotonic shock. Additionally, the effects of warm sterile water were analyzed.Results: T24, RT4, and J82 cells started swelling immediately upon exposure to water, followed by rupture within five minutes. RT112 cells demonstrated limited hypotonic swelling with significantly less cell rupture after 10 min. The percentages of viable cells at 10 min were 1.6 ± 0.8%, 3.5 ± 3.5%, 5.0 ± 3.2%, and 22.0 ± 10.3% for T24, RT4, J82, and RT112, respectively. The percentage of viable cells with 48 °C sterile water at one minute was 0% for RT112 cells.Conclusions: These findings support the efficacy of sterile water against bladder cancer cells and reveal that warm sterile water enhances the cytocidal effects of hypotonic shock, potentially avoiding the need for radical surgery.
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Affiliation(s)
- Yuki Matsuoka
- Faculty of Medicine, Department of Urology, Kagawa University, Kagawa, Japan
| | - Rikiya Taoka
- Faculty of Medicine, Department of Urology, Kagawa University, Kagawa, Japan
| | - Zhang Xia
- Faculty of Medicine, Department of Urology, Kagawa University, Kagawa, Japan
| | - Mikio Sugimoto
- Faculty of Medicine, Department of Urology, Kagawa University, Kagawa, Japan
| | - Yoshiyuki Kakehi
- Faculty of Medicine, Department of Urology, Kagawa University, Kagawa, Japan
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Kwak BJ, Park J, Kwon YK, Kwon JH, Yoon YC. Intraoperative radiofrequency ablation and distilled water peritoneal lavage for spontaneously ruptured hepatocellular carcinoma. Ann Surg Treat Res 2019; 97:291-295. [PMID: 31824883 PMCID: PMC6893220 DOI: 10.4174/astr.2019.97.6.291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 10/06/2019] [Accepted: 10/23/2019] [Indexed: 11/30/2022] Open
Abstract
Purpose Spontaneously ruptured hepatocellular carcinoma (srHCC) is known to be a life-threatening complication with poor prognosis. Although there are various treatment modalities, there is no definite treatment guideline. The purpose of this study was to review the surgical outcome and prognosis of srHCC treated with intraoperative radiofrequency ablation (RFA) and distilled water peritoneal lavage (DWPL). Methods From March 2012 to October 2018, 9 patients with srHCC who underwent emergent surgery were reviewed. After hematoma removal, intraoperative RFA and DWPL were applied to all patients. Hepatectomy was performed if necessary. Patients with multiple tumors, distant metastasis, and vascular tumor involvement in radiologic imaging were excluded. Results Six of 9 patients with diameters less than 7 cm were able to obtain hemostasis using RFA alone (RFA group). However, 3 patients with a tumor size of more than 10 cm underwent liver resection because they could not obtain hemostasis with RFA (hepatectomy only group). The RFA group had shorter operation time (148.3 ± 31.7 minutes vs. 251.7 ± 20.2 minutes, P < 0.05) and less red blood cell transfusion (5.8 ± 2.5 packs vs. 24.0 ± 11.5 packs, P < 0.05) than the hepatectomy only group. There was no peritoneal metastasis at long-term follow-up in the RFA group. Five-year recurrence-free survival rate was 0% in both groups. However, 5-year overall survival rate was better in the RFA group (83.3% vs. 0%, P < 0.05). Conclusion Intraoperative RFA and DWPL are easy to perform and theoretically the best methods for managing relatively small srHCC.
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Affiliation(s)
- Bong Jun Kwak
- Division of Hepatobiliary, Pancreas, and Abdominal Organ Transplant, Department of Surgery, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea
| | - Joonseon Park
- Division of Hepatobiliary, Pancreas, and Abdominal Organ Transplant, Department of Surgery, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea
| | - Yong Kyong Kwon
- Division of Hepatobiliary, Pancreas, and Abdominal Organ Transplant, Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Jung Hyun Kwon
- Division of Hepatology, Department of Internal Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Young Chul Yoon
- Division of Hepatobiliary, Pancreas, and Abdominal Organ Transplant, Department of Surgery, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea
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Aseni P, Di Domenico SL, Barbosa F, Rampoldi A, Berry C. Hemoperitoneum in cirrhotic patients in the absence of abdominal trauma. Expert Rev Gastroenterol Hepatol 2019; 13:867-876. [PMID: 31204541 DOI: 10.1080/17474124.2019.1631159] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Introduction: Hemoperitoneum can be a life-threating condition in cirrhotic patients who have a limited compensatory reserve during hemorrhagic shock. We aim to review the literature on the different etiologies associated with non-traumatic hemoperitoneum (NTH), summarizing the most relevant conditions associated with spontaneous and iatrogenic peritoneal and retroperitoneal bleeding that may occur in cirrhotic patients and to illustrate the most relevant diagnostic strategies and optimal management. Area covered: This review encompasses the current literature in hemoperitoneum in cirrhotic patients in the absence of abdominal trauma. Established diagnostic procedures, therapeutic interventions and potential novel targets are reported and discussed. Expert opinion: To ensure the optimal management regardless of the underlying etiology of NTH, the first goal for the clinician is to obtain immediate hemodynamic stabilization with supportive measures and to control the source of bleeding. The latter can be achieved with angiographic embolization, which is usually the first choice, or with open surgery. Other therapeutic options according to specific etiologies include transjugular intrahepatic portosystemic shunt (TIPS), balloon-occluded retrograde transvenous obliteration (BRTO), balloon-occluded anterograde transvenous obliteration (BATO) or intra operative radio frequency (RF).
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Affiliation(s)
- Paolo Aseni
- Department of Emergency, ASST Grande Ospedale Metropolitano Niguarda , Milan , Italy
| | | | | | | | - Cherisse Berry
- Department of Surgery, Division of Acute Care Surgery, New York University School of Medicine , New York , NY , USA
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Shiozaki A, Yamazato Y, Kosuga T, Kudou M, Shoda K, Arita T, Konishi H, Komatsu S, Kubota T, Fujiwara H, Okamoto K, Marunaka Y, Otsuji E. Effect of low temperature on the regulation of cell volume after hypotonic shock in gastric cancer cells. Int J Oncol 2019; 55:905-914. [PMID: 31432150 DOI: 10.3892/ijo.2019.4853] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 06/20/2019] [Indexed: 11/05/2022] Open
Abstract
Although peritoneal lavage with distilled water performed after surgery prevents peritoneal seeding, cancer cells may avoid rupture under mild hypotonicity through regulatory volume decrease (RVD), which is the homeostatic regulation of ion and water transport. The aim of the present study was to investigate the effect of low temperature on cell volume and cell death under hypoosmolal conditions and determine the underlying molecular mechanisms in gastric cancer (GC). Three human GC cell lines (NUGC4, KATO‑III and MKN45) were exposed to hypotonic solutions, and the effects of low temperature on cell volume and viability were examined. Low temperature‑induced changes in membrane transporters were evaluated, and knockdown and overexpression experiments were conducted to determine their effects on cell volume during hypotonic stimulation. Low temperature (24˚C) during hypotonic stimulation inhibited RVD and enhanced the cytocidal effects on GC cells. The expression of leucine‑rich repeat containing protein A (LRRC8A), a component of a Cl‑ channel, was decreased, and aquaporin 5 (AQP5) expression was increased at low temperatures. LRRC8A knockdown markedly slowed the decrease in cell volume following cell swelling by hypotonic shock. AQP5 overexpression enhanced initial cell swelling after hypotonic shock and increased the final cell volume. These results suggest that a hypotonic solution at low temperature increased initial water influx via activation of AQP5 and decreased Cl‑ efflux via inhibition of LRRC8A. Therefore, low temperature enhanced the hypotonicity‑induced cytocidal effects on GC cells, and these results may contribute to the development of a novel lavage method effective in reducing peritoneal recurrence in GC.
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Affiliation(s)
- Atsushi Shiozaki
- Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kyoto, Kyoto 602‑8566, Japan
| | - Yuzo Yamazato
- Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kyoto, Kyoto 602‑8566, Japan
| | - Toshiyuki Kosuga
- Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kyoto, Kyoto 602‑8566, Japan
| | - Michihiro Kudou
- Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kyoto, Kyoto 602‑8566, Japan
| | - Katsutoshi Shoda
- Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kyoto, Kyoto 602‑8566, Japan
| | - Tomohiro Arita
- Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kyoto, Kyoto 602‑8566, Japan
| | - Hirotaka Konishi
- Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kyoto, Kyoto 602‑8566, Japan
| | - Shuhei Komatsu
- Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kyoto, Kyoto 602‑8566, Japan
| | - Takeshi Kubota
- Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kyoto, Kyoto 602‑8566, Japan
| | - Hitoshi Fujiwara
- Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kyoto, Kyoto 602‑8566, Japan
| | - Kazuma Okamoto
- Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kyoto, Kyoto 602‑8566, Japan
| | - Yoshinori Marunaka
- Department of Molecular Cell Physiology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Kyoto 602‑8566, Japan
| | - Eigo Otsuji
- Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kyoto, Kyoto 602‑8566, Japan
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Sahu SK, Chawla YK, Dhiman RK, Singh V, Duseja A, Taneja S, Kalra N, Gorsi U. Rupture of Hepatocellular Carcinoma: A Review of Literature. J Clin Exp Hepatol 2019; 9:245-256. [PMID: 31024207 PMCID: PMC6476943 DOI: 10.1016/j.jceh.2018.04.002] [Citation(s) in RCA: 81] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Accepted: 04/18/2018] [Indexed: 12/12/2022] Open
Abstract
Approximately 700,000 people die of Hepatocellular Carcinoma (HCC) each year worldwide, making it the third leading cause of cancer related deaths. Rupture is a potentially life-threatening complication of HCC. The incidence of HCC rupture is higher in Asia and Africa than in Europe. In Asia approximately 10% of patients with a diagnosis of HCC die due to rupture each year. Spontaneous rupture is the third most common cause of death due to HCC after tumor progression and liver failure. The diagnosis of rupture in patients without history of cirrhosis or HCC may be difficult. The most common symptom of ruptured HCC is abdominal pain (66-100%). Shock at presentation can be seen in 33-90% of cases; abdominal distension is reported in 33%. Abdominal paracentesis documenting hemoperitoneum is a reliable test to provisionally diagnose rupture of HCC, it can be seen in up to 86% of clinically suspected cases. The diagnoses can be confirmed by computed tomography scan or ultrasonography, or both in 75% of cases. Careful pre-treatment evaluation is essential to decide the best treatment option. Management of ruptured HCC involves multi-disciplinary care where hemostasis remains a primary concern. Earlier studies have reported a mortality rate of 25-75% in the acute phase of ruptured HCC. However, recent studies have reported a significant decrease in the incidence of mortality. There is also a decrease in the incidence of ruptured HCC due to improved surveillance and early detection of HCC. Transarterial Embolization is the least invasive method to effectively induce hemostasis in the acute stage with a success rate of 53-100%. Hepatic resection in the other hand has the advantage of achieving hemostasis and in the same go offers a potentially curative resection in selected patients.
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Affiliation(s)
- Srimanta K. Sahu
- Department of Hepatology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Yogesh K. Chawla
- Department of Hepatology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Radha K. Dhiman
- Department of Hepatology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Virendra Singh
- Department of Hepatology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Ajay Duseja
- Department of Hepatology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Sunil Taneja
- Department of Hepatology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Naveen Kalra
- Department of Radio Diagnosis, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Ujjwal Gorsi
- Department of Radio Diagnosis, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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9
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Ohki A, Abe N, Yoshimoto E, Hashimoto Y, Takeuchi H, Nagao G, Masaki T, Mori T, Ohkura Y, Sugiyama M. Gastric washing by distilled water can reduce free gastric cancer cells exfoliated into the stomach lumen. Gastric Cancer 2018; 21:998-1003. [PMID: 29696405 DOI: 10.1007/s10120-018-0824-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Accepted: 04/04/2018] [Indexed: 02/07/2023]
Abstract
PURPOSE Intragastric free cancer cells in patients with gastric cancer have rarely been studied. The purpose of this study was to investigate the detection rate of intragastric free cancer cells in gastric washes using two types of solutions during endoscopic examination. We further clarified risk factors affecting the presence of exfoliated free cancer cells. METHODS A total of 175 patients with gastric cancer were enrolled. Lactated Ringer's solution (N = 89) or distilled water (DW; N = 86) via endoscopic working channel was sprayed onto the tumor surface, and the resultant fluid was collected for cytological examination. We compared the cancer-cell positivity rate between the two (Ringer and DW) groups. We also tested the correlation between cancer-cell positivity and clinicopathological factors in the Ringer group to identify risk factors for the presence of exfoliated cancer cells. RESULTS The cancer-cell positivity rate was significantly higher in the Ringer group than that in the DW group (58 vs 6%). Cytomorphology in the Ringer group was well maintained, but not in the DW group. The larger tumor size (≥ 20 mm) and positive lymphatic involvement were significant risk factors of exfoliated free cancer cells. CONCLUSIONS Cancer cells can be highly exfoliated from the tumor surface into the gastric lumen by endoscopic irrigation in large gastric cancer with lymphatic involvement. Gastric washing by DW can lead to cytoclasis of free cancer cells; therefore, it may minimize the possibility of cancer-cell seeding in procedures carrying potential risks of tumor-cell seeding upon transluminal communication, such as endoscopic full-thickness resection and laparoscopy-endoscopy cooperative surgery.
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Affiliation(s)
- Atsuko Ohki
- Department of Surgery, Kyorin University School of Medicine, 6-20-2 Shinkawa, Mitaka, Tokyo, 181-8611, Japan.
| | - Nobutsugu Abe
- Department of Surgery, Kyorin University School of Medicine, 6-20-2 Shinkawa, Mitaka, Tokyo, 181-8611, Japan
| | - Eri Yoshimoto
- Department of Surgery, Kyorin University School of Medicine, 6-20-2 Shinkawa, Mitaka, Tokyo, 181-8611, Japan
| | - Yoshikazu Hashimoto
- Department of Surgery, Kyorin University School of Medicine, 6-20-2 Shinkawa, Mitaka, Tokyo, 181-8611, Japan
| | - Hirohisa Takeuchi
- Department of Surgery, Kyorin University School of Medicine, 6-20-2 Shinkawa, Mitaka, Tokyo, 181-8611, Japan
| | - Gen Nagao
- Department of Surgery, Kyorin University School of Medicine, 6-20-2 Shinkawa, Mitaka, Tokyo, 181-8611, Japan
| | - Tadahiko Masaki
- Department of Surgery, Kyorin University School of Medicine, 6-20-2 Shinkawa, Mitaka, Tokyo, 181-8611, Japan
| | - Toshiyuki Mori
- Department of Surgery, Kyorin University School of Medicine, 6-20-2 Shinkawa, Mitaka, Tokyo, 181-8611, Japan
| | - Yasuo Ohkura
- Pathology and Cytology Center, PCL JAPAN, 1361-1 Matoba, Kawagoe, Saitama, 350-1101, Japan
| | - Masanori Sugiyama
- Department of Surgery, Kyorin University School of Medicine, 6-20-2 Shinkawa, Mitaka, Tokyo, 181-8611, Japan
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10
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Successful robotic extirpation of diaphragmatic seeding of hepatocellular carcinoma after previous rupture. J Robot Surg 2018; 13:525-528. [PMID: 30269251 DOI: 10.1007/s11701-018-0880-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Accepted: 09/21/2018] [Indexed: 10/28/2022]
Abstract
A 51-year-old man who was a hepatitis B carrier presented with ruptured hepatocellular carcinoma (HCC). Hepatic arterial embolization was performed for control of bleeding which was followed by staged open left lateral sectionectomy for tumor removal. Pathology confirmed a 3.5 cm ruptured subcapsular HCC in a cirrhotic liver with clear resection margin. However, the alpha-fetoprotein (AFP) increased from 14 to 72 µg/L after 7 months. A 1.7 × 0.8 cm nodule at left subdiaphragmatic region abutting on the spleen but no intrahepatic lesion was seen on computed tomography (CT). Dual tracer positron emission tomography suggested the nodule was a HCC seeding with no other recurrent tumor noted. Robotic exploration was offered to patient with the possibility of splenectomy. During operation, the nodule was adherent to the diaphragm with no splenic involvement. The lesion was locally excised. The diaphragmatic defect was closed with non-absorbable suture. Recovery was uneventful and the patient was discharged on postoperative day 4. Pathology confirmed HCC cells infiltrating to skeletal muscle and fibrous tissue. The resection margin was clear. Post-operatively AFP normalised. Serial abdominal CT and ultrasound revealed no evidence of recurrent disease. Patient had a disease-free survival of 47 months after excision of tumor seeding.
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Liu J, Zhu Q, Li Y, Qiao GL, Xu C, Guo DL, Tang J, Duan R. Microvascular invasion and positive HB e antigen are associated with poorer survival after hepatectomy of early hepatocellular carcinoma: A retrospective cohort study. Clin Res Hepatol Gastroenterol 2018; 42:330-338. [PMID: 29551612 DOI: 10.1016/j.clinre.2018.02.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2017] [Revised: 01/31/2018] [Accepted: 02/05/2018] [Indexed: 02/04/2023]
Abstract
BACKGROUND We aimed to identify the independent predictive factors of microvascular invasion (MVI) for curative resection of HCC and to investigate the impacts of MVI and HBeAg on long-term recurrence and survival after resection. METHODS The clinicopathological parameters of 237 patients with HCC with MVI who underwent hepatic resection from April 2005 to November 2010 were investigated. Clinical features and factors associated with the clinical outcomes of 386 patients with HCC without MVI were used for comparison. RESULTS Multivariate stepwise logistic regression analysis revealed that alpha-fetoprotein level>100μg/L, positive HBeAg, and tumour size were independent prognostic factors in patients with HCC with MVI. The overall survival (OS) of patients in the HCC with MVI group was significantly poorer compared with the HCC without MVI group (P<0.001). However, patients with HCC without MVI group exhibited a significantly better recurrence-free survival rate (RFS) (P<0.001). While the HCC with positive HBeAg group exhibited significantly lower OS compared with the HCC with negative HBeAg group (P=0.007). CONCLUSIONS AFP level>100μg/L, positive HBeAg, and tumour size>2cm are independent indicators of poorer prognosis for HCC with MVI. The present study confirmed that microvascular invasion itself had a negative impact on patient survival; moreover, HBeAg was an independent risk factor influencing OS, while not RFS of patients with HCC underwent hepatectomy. It is important to predict the presence of MVI before hepatic resection to determine treatment strategies.
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Affiliation(s)
- Jian Liu
- Department of general surgery, Jingmen First People's hospital, 67 Xiangshan avenue, 448000 Jingmen, Hubei Province, China
| | - Qian Zhu
- Department of general surgery, Jingmen First People's hospital, 67 Xiangshan avenue, 448000 Jingmen, Hubei Province, China.
| | - Yun Li
- Department of general surgery, Jingmen First People's hospital, 67 Xiangshan avenue, 448000 Jingmen, Hubei Province, China
| | - Guo-Liang Qiao
- Department of medical oncology, capital medical university cancer center, Beijing Shijitan hospital, 100038 Beijing, China
| | - Chang Xu
- Second department of biliary surgery, eastern hepatobiliary surgery hospital, second military medical university, 200438 Shanghai, China
| | - De-Liang Guo
- Department of general surgery, Jingmen First People's hospital, 67 Xiangshan avenue, 448000 Jingmen, Hubei Province, China
| | - Jie Tang
- Department of general surgery, Jingmen First People's hospital, 67 Xiangshan avenue, 448000 Jingmen, Hubei Province, China
| | - Rui Duan
- Department of general surgery, Jingmen First People's hospital, 67 Xiangshan avenue, 448000 Jingmen, Hubei Province, China
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Moris D, Chakedis J, Sun SH, Spolverato G, Tsilimigras DI, Ntanasis-Stathopoulos I, Spartalis E, Pawlik TM. Management, outcomes, and prognostic factors of ruptured hepatocellular carcinoma: A systematic review. J Surg Oncol 2017; 117:341-353. [DOI: 10.1002/jso.24869] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Accepted: 09/12/2017] [Indexed: 12/15/2022]
Affiliation(s)
- Demetrios Moris
- Department of Surgery; The Ohio State University Wexner Medical Center and James Cancer Hospital and Solove Research Institute; Columbus Ohio
| | - Jeffery Chakedis
- Department of Surgery; The Ohio State University Wexner Medical Center and James Cancer Hospital and Solove Research Institute; Columbus Ohio
| | - Steven H. Sun
- Department of Surgery; The Ohio State University Wexner Medical Center and James Cancer Hospital and Solove Research Institute; Columbus Ohio
| | - Gaya Spolverato
- Department of Surgery; The Ohio State University Wexner Medical Center and James Cancer Hospital and Solove Research Institute; Columbus Ohio
| | - Diamantis I. Tsilimigras
- Department of Therapeutics; Alexandra General Hospital; National and Kapodistrian University of Athens; Athens Greece
| | - Ioannis Ntanasis-Stathopoulos
- Department of Therapeutics; Alexandra General Hospital; National and Kapodistrian University of Athens; Athens Greece
| | - Eleftherios Spartalis
- Laboratory of Experimental Surgery and Surgical Research; National and Kapodistrian University of Athens; Athens Greece
| | - Timothy M. Pawlik
- Department of Surgery; The Ohio State University Wexner Medical Center and James Cancer Hospital and Solove Research Institute; Columbus Ohio
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Zhu Q, Qiao GL, Xu C, Guo DL, Tang J, Duan R, Li Y. Partial hepatectomy for spontaneous tumor rupture in patients with hepatocellular carcinoma: a retrospective cohort study. Cancer Manag Res 2017; 9:525-537. [PMID: 29089785 PMCID: PMC5655153 DOI: 10.2147/cmar.s146708] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND The impact of ruptured hepatocellular carcinoma (HCC) on a patients outcome after hepatic resection remains insufficient. We aimed to identify the independent predictive factors of spontaneous tumor rupture (STR) for curative resection of HCC and to investigate the impact of STR of HCC on long-term survival after resection. PATIENTS AND METHODS The clinicopathological parameters of 106 patients with ruptured HCC and 201 patients with non-ruptured HCC who underwent hepatic resection from 2007 to 2011 were investigated. Clinical features and factors associated with the clinical outcomes were compared between both groups. RESULTS Of 774 HCC patients who underwent surgical resection, 106 (13.7%) had tumor rupture. Multivariate stepwise logistic regression analysis revealed hypertension, liver cirrhosis, total bilirubin (TB), tumor size and ascites to be independent prognostic factors for patients with ruptured HCC. The overall survival (OS) of patients in the ruptured HCC group was significantly poorer compared with those in the non-ruptured HCC group. The 1-, 3- and 5-year OS rates were 77.7%, 56.9% and 41.6%, respectively, in the non-ruptured HCC group and 37.7%, 19.7%, 14.%, respectively, in the ruptured HCC group (P<0.001). Similar OS rates were found in patients with non-ruptured and ruptured HCC; patients in the non-ruptured HCC group had a significantly better recurrence-free survival (RFS) rate compared with those in the ruptured group (P=0.016). CONCLUSION The presence of hypertension, liver cirrhosis, higher TB levels, tumor size >5 cm and ascites are the independent indicators of poorer prognosis for patients undergoing hepatic resection after ruptured HCC. The present study confirmed that tumor rupture itself had a negative impact on patient survival, but hepatic resection, when technically feasible, is safe and appropriate in selected patients and can result in OS and RFS rates comparable to that of patients with non-ruptured HCC.
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Affiliation(s)
- Qian Zhu
- Department of Hepatobiliary and Pancreatic Surgery, Jingmen First People's Hospital, Jingmen, Hubei Province
| | - Guo-Liang Qiao
- Department of Medical Oncology, Capital Medical University Cancer Center, Beijing Shijitan Hospital, Beijing
| | - Chang Xu
- Second Department of Biliary Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China
| | - De-Liang Guo
- Department of Hepatobiliary and Pancreatic Surgery, Jingmen First People's Hospital, Jingmen, Hubei Province
| | - Jie Tang
- Department of Hepatobiliary and Pancreatic Surgery, Jingmen First People's Hospital, Jingmen, Hubei Province
| | - Rui Duan
- Department of Hepatobiliary and Pancreatic Surgery, Jingmen First People's Hospital, Jingmen, Hubei Province
| | - Yun Li
- Department of Hepatobiliary and Pancreatic Surgery, Jingmen First People's Hospital, Jingmen, Hubei Province
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Gabriel E, Singla S, Kim M, Fisher D, Powers C, Visioni A, Attwood K, Skitzki J. Water lavage as an adjunct to cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS-HIPEC). Am J Surg 2017. [PMID: 28622839 DOI: 10.1016/j.amjsurg.2017.05.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Water lavage (WL) during gastrointestinal cancer surgery has osmotically mediated lytic effects on tumor cells. We investigated the safety and efficacy of WL with CRS-HIPEC. METHODS This is a retrospective review, 1/2003-7/2014, of a single institution experience with CRS-HIPEC comparing patients who had WL (WL+) to those who did not (WL-). RESULTS Of 157 CRS-HIPECs, 16 (10.2%) were WL+. WL+ had more PCI scores >20 compared to WL- (56.3% vs 19.4%, respectively, p = 0.003); however, the completeness of cytoreduction (CC) was similar. There were no differences in hospital length of stay or post-operative complications. The average POD 1 sodium (Na) level was statistically lower in the WL+ group (133.6 ± 2.5 vs 135.5 ± 3.2 mEq/L, p = 0.023); however, the average Na at discharge for each group was 140 mEq/L. There were no differences in 3-year OS (3WL+:0.63 vs WL-:0.68, p = 0.97) or RFS (WL+:0.32 vs WL-:0.39, p = 0.47). A subset analysis for patients with PCI >20 showed no difference between groups. CONCLUSIONS WL offers a low cost, safe and theoretically efficacious method of tumor cell lysis for peritoneal malignancy.
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Affiliation(s)
- Emmanuel Gabriel
- Department of Surgical Oncology, Roswell Park Cancer Institute, Buffalo, NY, USA
| | - Smit Singla
- Department of Surgical Oncology, Roswell Park Cancer Institute, Buffalo, NY, USA
| | - Minhyung Kim
- Department of Immunology, Roswell Park Cancer Institute, Buffalo, NY, USA
| | - Daniel Fisher
- Department of Immunology, Roswell Park Cancer Institute, Buffalo, NY, USA
| | - Colin Powers
- Department of Immunology, Roswell Park Cancer Institute, Buffalo, NY, USA
| | - Anthony Visioni
- Department of Surgical Oncology, Roswell Park Cancer Institute, Buffalo, NY, USA
| | - Kristopher Attwood
- Department of Biostatistics, Roswell Park Cancer Institute, Buffalo, NY, USA
| | - Joseph Skitzki
- Department of Surgical Oncology, Roswell Park Cancer Institute, Buffalo, NY, USA.
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Shiozaki A, Ichikawa D, Kosuga T, Marunaka Y, Otsuji E. Regulation of osmolality for cancer treatment. J Physiol Sci 2017; 67:353-360. [PMID: 28185236 PMCID: PMC10716996 DOI: 10.1007/s12576-017-0528-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Accepted: 01/23/2017] [Indexed: 02/08/2023]
Abstract
Disseminated metastasis is associated with a poor prognosis, and its management in the peritoneal or pleural cavity is crucial in the treatment of cancer. Recent studies show that ion and water transporters play important roles in fundamental cellular functions, including the regulation of cell volume that would be involved in the cancer process. Here, we review the evidence for hypotonic treatments of cancer and evaluate the potential of the cellular physiological approach in clinical management. The regulation of extracellular osmolality is a promising method, with several studies demonstrating the cytocidal effects of hypotonic solution on cancer cells. Peritoneal lavage with distilled water (DW) during surgery is reported to improve the survival rate of patients with spontaneously ruptured hepatocellular carcinoma. The in vitro studies included in this review also indicate the cytocidal effects of hypotonic shock on esophageal, gastric, colonic, pancreatic, and liver cancer cells with several unique methods and apparatuses, such as a differential interference contrast microscope connected to a digital video camera, a high-resolution flow cytometer and re-incubation analysis. The in vivo studies demonstrate the safeness of a peritoneal injection of DW into mice and indicate that the development of dissemination nodules can be prevented by the pre-incubation of cancer cells with DW or the peritoneal injection of DW. We also demonstrate that the blockade of Cl- channels/transporters enhances the cytocidal effects of hypotonic shock by inhibiting regulatory volume decrease in various cancer cells. A deeper understanding of molecular mechanisms may lead to the discovery of these cellular physiological approaches as a novel therapeutic strategy for disseminated metastasis.
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Affiliation(s)
- Atsushi Shiozaki
- Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, Kyoto, 602-8566, Japan.
| | - Daisuke Ichikawa
- Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Toshiyuki Kosuga
- Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Yoshinori Marunaka
- Department of Molecular Cell Physiology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, Kyoto, 602-8566, Japan.
- Department of Bio-Ionomics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, Kyoto, 602-8566, Japan.
- Japan Institute for Food Education and Health, St. Agnes' University, Kyoto, 602-8013, Japan.
| | - Eigo Otsuji
- Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, Kyoto, 602-8566, Japan
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16
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Ou D, Yang H, Zeng Z, Luo Y, Yang L. Comparison of the prognostic influence of emergency hepatectomy and staged hepatectomy in patients with ruptured hepatocellular carcinoma. Dig Liver Dis 2016; 48:934-9. [PMID: 27263055 DOI: 10.1016/j.dld.2016.04.016] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Revised: 04/14/2016] [Accepted: 04/20/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND Spontaneous hepatocellular carcinoma (HCC) rupture is a fatal complication of primary liver cancer and is associated with poor surgical outcomes. Whether emergency hepatectomy or staged hepatectomy should be performed in the situations of a spontaneous rupture for resectable HCC need to be investigated. METHODS Between January 2005 and December 2014, 131 patients with HCC ruptures received emergency or staged hepatectomy in our hospital and were included in this study. We retrospectively compared the postoperative morbidity and mortality, overall survival (OS), and disease-free survival (DFS) of patients who received emergency or staged hepatectomies. Independent prognostic predictors were identified using the Cox multivariate regression analysis. RESULTS Emergency hepatectomy could be performed for successful surgical hemostasis and radical tumor resection. However, the in-hospital mortality rate was 11.0%, which correlated with INR, liver function, shock, blood transfusion, and aggressive treatment by emergency hepatectomy (P<0.05). Conversely, the 1-, 3-, and 5-year overall survival rates of ruptured HCC patients with staged hepatectomy were 82.8%, 55.2%, and 41.4%; and the disease-free survival rates were 70.7%, 44.8%, and 27.6%, respectively. The overall survival and disease-free survival of staged hepatectomy group were longer than that of emergency hepatectomy group (P=0.034, P=0.019). Multivariable analyses of HCC ruptures patients indicated that tumor sizes more than 10cm and multiple-nodule tumors were independent predictors of poor long-term survival. CONCLUSIONS Though they carry some risk, emergency hepatectomy is still an important means of treatment for spontaneous HCC ruptures. For resectable HCC ruptures, emergency hepatectomy or staged hepatectomy are life-saving procedures, and efficient therapeutic methods. After the initial hemostasis, staged liver resection can often help patients achieve better long-term survival than emergency hepatectomy.
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Affiliation(s)
- Dipeng Ou
- Department of Geriatric Surgery, Xiangya Hospital, Central South University, Changsha 410008, Hunan, China.
| | - Hao Yang
- Department of Geriatric Surgery, Xiangya Hospital, Central South University, Changsha 410008, Hunan, China.
| | - Zhijun Zeng
- Department of Geriatric Surgery, Xiangya Hospital, Central South University, Changsha 410008, Hunan, China.
| | - Yijiang Luo
- Department of Geriatric Surgery, Xiangya Hospital, Central South University, Changsha 410008, Hunan, China
| | - Lianyue Yang
- Department of Surgery, Xiangya Hospital, Central South University, Changsha 410008, Hunan, China.
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17
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Yoshida H, Mamada Y, Taniai N, Uchida E. Spontaneous ruptured hepatocellular carcinoma. Hepatol Res 2016; 46:13-21. [PMID: 25631290 DOI: 10.1111/hepr.12498] [Citation(s) in RCA: 86] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Revised: 01/23/2015] [Accepted: 01/26/2015] [Indexed: 02/08/2023]
Abstract
The incidence of hepatocellular carcinoma (HCC) is rising worldwide. Spontaneous rupture of HCC occasionally occurs, and ruptured HCC with intraperitoneal hemorrhage is potentially life-threatening. The most common symptom of ruptured HCC is acute abdominal pain. The tumor size in ruptured HCC is significantly greater than that in non-ruptured HCC, and HCC protrudes beyond the original liver margin. In the acute phase, hemostasis is the primary concern and tumor treatment is secondary. Transcatheter arterial embolization (TAE) can effectively induce hemostasis. The hemostatic success rate of TAE ranges 53-100%. A one-stage surgical operation is a treatment modality for selected patients. Conservative treatment is usually given to patients in a moribund state with inoperable tumors and thus has poor outcomes. Patients with severe ruptures of advanced HCC and poor liver function have high mortality rates. Liver failure occurs in 12-42% of patients during the acute phase. In the stable phase, tumor treatment, such as transarterial chemoembolization or hepatic resection should be concerned. The combination of acute hemorrhage and cancer in patients with ruptured HCC requires a two-step therapeutic approach. TAE followed by elective hepatectomy is considered an effective strategy for patients with ruptured HCC.
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Affiliation(s)
- Hiroshi Yoshida
- Department of Surgery, Nippon Medical School Tama Nagayama Hospital, Tokyo, Japan
| | | | | | - Eiji Uchida
- Department of Surgery, Nippon Medical School, Tokyo, Japan
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18
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Taoka R, Williams SB, Ho PL, Kamat AM. In-vitro cytocidal effect of water on bladder cancer cells: The potential role for intraperitoneal lavage during radical cystectomy. Can Urol Assoc J 2015; 9:E109-13. [PMID: 25844095 DOI: 10.5489/cuaj.2435] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION We investigate the cytocidal effect of water on bladder cancer cells. Intraperitoneal lavage with sterile water is sometimes used during radical cystectomy to lyse cancer cells that might have escaped the surgical specimen. The efficacy of this approach at the cellular level is unknown. METHODS Three bladder cancer cell lines of varying grade, RT4, TCCSUP and T24 were exposed to sterile water, and morphological changes were closely observed under microscopy. Changes of cell membrane integrity, cell viability, and cell number of re-incubated cells after water exposure were measured to determine water induced hypotonic shock. RESULTS The low-grade RT4 cells started swelling immediately upon exposure to water followed by rupture within 3 minutes. The higher grade TCCSUP and T24 cells demonstrated limited hypotonic swelling with significantly less cell rupture after 10 minutes. The damage to cell membrane of RT4 cells was evident at 1 minute; only 10.0% of cells were intact at 10 minutes. On the other hand, 41.9% and 77.8% of TCCSUP and T24 cells were intact at 10 minutes, respectively. Percentage of viable cells at 10 minutes was 2.1 ± 2.3%, 2.3 ± 0.4%, and 16.1 ± 0.6% for RT4, TCCSUP, and T24, respectively. CONCLUSIONS Cytocidal effect of hypotonic shock can be achieved, to varying degrees, by exposing bladder cancer cells to water for at least 10 minutes. This in vitro study may have bearing on the effects seen with intraperitoneal lavage using sterile water during radical cystectomy.
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Affiliation(s)
- Rikiya Taoka
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Stephen B Williams
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Philip L Ho
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Ashish M Kamat
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX
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Schwarz RE. Current status of management of malignant disease: current management of gastric cancer. J Gastrointest Surg 2015; 19:782-8. [PMID: 25591828 DOI: 10.1007/s11605-014-2707-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Accepted: 11/14/2014] [Indexed: 02/07/2023]
Abstract
Despite a continually decreasing incidence trend, gastric cancer remains a high-risk malignancy. Symptoms are often unspecific, and upper gastrointestinal endoscopy is the key modality for diagnosing early and intermediate-stage disease. Surgeons play a critical role in guiding and managing multiple aspects of gastric cancer diagnosis and care. Potentially curable gastric adenocarcinoma has to be free of distant metastasis and should be staged through endoscopic ultrasound and computed tomography. Early (T1N0) gastric cancer can be considered for endosopic mucosal resection or submucosal dissection. All other M0 stage groups should be evaluated for preoperative chemotherapy or chemoradiation followed by resection through a multidisciplinary approach. Laparoscopic staging, complete (R0) resection, and extended lymphadenectomy (D2 dissection) are critical operative components that optimize curability during gastrectomy. The morbidity potential after gastrectomy remains high; splenectomy and distal pancreatectomy should be avoided if possible to minimize postoperative complications. Laparoscopic gastric cancer resections are increasingly pursued and have not shown disadvantages to open gastrectomy as long as oncologic principles are followed. For the palliation of specific symptoms in patients with incurable gastric cancer, operative interventions should be applied selectively if less invasive modalities are insufficient and only if a meaningful benefit can be expected from a resection or bypass procedure. Prophylactic total gastrectomy should be considered for individuals at risk for hereditary diffuse-type gastric cancer through germline E-cadherin gene mutations. Surgeons engaging in gastric cancer care are expected to provide specialty expertise in order to plan and deliver appropriate care, minimize postoperative morbidity, and optimize resulting survival.
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Affiliation(s)
- Roderich E Schwarz
- Department of Surgery (RES), Indiana University School of Medicine, South Bend, IU Health Goshen Center for Cancer Care, 200 High Park Avenue, Goshen, IN, 46526, USA,
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Efficacy of a hypotonic treatment for peritoneal dissemination from gastric cancer cells: an in vivo evaluation. BIOMED RESEARCH INTERNATIONAL 2014; 2014:707089. [PMID: 25093178 PMCID: PMC4100448 DOI: 10.1155/2014/707089] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/13/2014] [Accepted: 06/13/2014] [Indexed: 01/05/2023]
Abstract
The aim of the present study was to determine the efficacy of a hypotonic treatment for peritoneal dissemination from gastric cancer cells using an in vivo model. We firstly evaluated the toxicity of a peritoneal injection of distilled water (DW) (2 mL for 3 days) in mice. Macroscopic and microscopic examinations revealed that the peritoneal injection of DW did not severely damage the abdominal organs of these mice. MKN45 gastric cancer cells preincubated with NaCl buffer or DW for 20 minutes in vitro were then intraperitoneally injected into nude mice, and the development of dissemination nodules was analyzed. The total number, weight, and volume of the dissemination nodules were significantly decreased by the DW preincubation. We then determined whether the peritoneal injection of DW inhibited the establishment of peritoneal dissemination. After a peritoneal injection of MKN45 cells into nude mice, NaCl buffer or DW was injected into the abdominal cavity for 3 days. The total volume of dissemination nodules was significantly lower in DW-injected mice than in NaCl-injected mice. In conclusion, we demonstrated the safeness of a peritoneal injection of DW. Furthermore, the development of dissemination nodules from gastric cancer cells was prevented by a preincubation with or peritoneal injection of DW.
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Wang X, Sun K, Tan Y, Wu S, Zhang J. Efficacy and safety of selenium nanoparticles administered intraperitoneally for the prevention of growth of cancer cells in the peritoneal cavity. Free Radic Biol Med 2014; 72:1-10. [PMID: 24727439 DOI: 10.1016/j.freeradbiomed.2014.04.003] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2014] [Revised: 04/02/2014] [Accepted: 04/03/2014] [Indexed: 12/01/2022]
Abstract
Peritoneal implantation of cancer cells, particularly postoperative seeding metastasis, frequently occurs in patients with primary tumors in the stomach, colon, liver, and ovary. Peritoneal carcinomatosis is associated with poor prognosis. In this work, we evaluated the prophylactic effect of intraperitoneal administration of selenium (Se), an essential trace element and a putative chemopreventive agent, on peritoneal implantation of cancer cells. Elemental Se nanoparticles were injected into the abdominal cavity of mice, into which highly malignant H22 hepatocarcinoma cells had previously been inoculated. Se concentrations in the cancer cells and tissues, as well as the efficacy of proliferation inhibition and safety, were evaluated. Se was mainly concentrated in cancer cells compared to Se retention in normal tissues, showing at least an order of magnitude difference between the drug target cells (the H22 cells) and the well-recognized toxicity target of Se (the liver). Such a favorable selective distribution resulted in strong proliferation suppression without perceived host toxicity. The mechanism of action of the Se nanoparticle-triggered cytotoxicity was associated with Se-mediated production of reactive oxygen species, which impaired the glutathione and thioredoxin systems. Our results suggest that intraperitoneal administration of Se is a safe and effective means of preventing growth of cancer cells in the peritoneal cavity for the above-mentioned high-risk populations.
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Affiliation(s)
- Xin Wang
- School of Tea and Food Science, Anhui Agricultural University, Hefei 230036, Anhui, People's Republic of China
| | - Kang Sun
- School of Tea and Food Science, Anhui Agricultural University, Hefei 230036, Anhui, People's Republic of China
| | - Yanping Tan
- School of Tea and Food Science, Anhui Agricultural University, Hefei 230036, Anhui, People's Republic of China
| | - Shanshan Wu
- School of Tea and Food Science, Anhui Agricultural University, Hefei 230036, Anhui, People's Republic of China
| | - Jinsong Zhang
- School of Tea and Food Science, Anhui Agricultural University, Hefei 230036, Anhui, People's Republic of China.
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Abstract
Liver tumors bleed rarely; management has changed radically during the last 20years, advancing from emergency surgery with poor results to multidisciplinary management. The first steps are the diagnosis and control of bleeding. Abdominopelvic CT scan should be performed as soon as patient hemodynamics allow. When active bleeding is visualized, arterial embolization, targeted as selectively as possible, is preferable to surgery, which should be reserved for severe hemodynamic instability or failure of interventional radiology. When surgery is unavoidable, abbreviated laparotomy (damage control) with perihepatic packing is recommended. The second step is determination of the etiology and treatment of the underlying tumor. Adenoma and hepatocellular carcinoma (HCC) are the two most frequently encountered tumors in this context. Liver MRI after control of the bleeding episode generally leads to the diagnosis although sometimes the analysis can be difficult because of the hematoma. Prompt resection is indicated for HCC, atypical adenoma or lesions at risk for degeneration to hepatocellular carcinoma. For adenoma with no suspicion of malignancy, it is best to wait for the hematoma to resorb completely before undertaking appropriate therapy.
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Affiliation(s)
- B Darnis
- Service de chirurgie générale et digestive, transplantation hépatique et intestinale, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, 103, Grande Rue de la Croix-Rousse, 69004 Lyon, France.
| | - A Rode
- Service de radiologie, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, 103, Grande Rue de la Croix-Rousse, 69004 Lyon, France
| | - K Mohkam
- Service de chirurgie générale et digestive, transplantation hépatique et intestinale, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, 103, Grande Rue de la Croix-Rousse, 69004 Lyon, France
| | - C Ducerf
- Service de chirurgie générale et digestive, transplantation hépatique et intestinale, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, 103, Grande Rue de la Croix-Rousse, 69004 Lyon, France
| | - J-Y Mabrut
- Service de chirurgie générale et digestive, transplantation hépatique et intestinale, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, 103, Grande Rue de la Croix-Rousse, 69004 Lyon, France
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Grivas N, Hastazeris K, Kafarakis V, Tsimaris I, Aspiotis S, Stratis A, Stavropoulos NE. Efficacy of Postoperative Bladder Irrigation with Water for Injection in Reducing Recurrence Rates of Non Muscle Invasive Bladder Cancer. Asian Pac J Cancer Prev 2014; 15:2263-6. [DOI: 10.7314/apjcp.2014.15.5.2263] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Yang T, Sun YF, Zhang J, Lau WY, Lai ECH, Lu JH, Shen F, Wu MC. Partial hepatectomy for ruptured hepatocellular carcinoma. Br J Surg 2013; 100:1071-9. [PMID: 23754648 DOI: 10.1002/bjs.9167] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/11/2013] [Indexed: 12/28/2022]
Abstract
BACKGROUND Improvements in surgical technique and perioperative care have made partial hepatectomy a safe and effective treatment for hepatocellular carcinoma (HCC), even in the event of spontaneous HCC rupture. METHODS A consecutive cohort of patients who underwent partial hepatectomy for HCC between 2000 and 2009 was divided into a ruptured group and a non-ruptured group. Patients with ruptured HCC were further divided into emergency and staged hepatectomy subgroups. Mortality and morbidity, overall survival and recurrence-free survival (RFS) were compared. Prognostic factors for overall survival and RFS were identified by univariable and multivariable analyses. RESULTS A total of 1233 patients underwent partial hepatectomy for HCC, of whom 143 had a ruptured tumour. The morbidity and mortality rates were similar in the ruptured and non-ruptured groups, as well as in the emergency and staged subgroups. In univariable analyses, overall survival and RFS were lower in the ruptured group than in the non-ruptured group (both P < 0·001), and also in the emergency subgroup compared with the staged subgroup (P = 0·016 and P = 0·025 respectively). In multivariable analysis, spontaneous rupture independently predicted poor overall survival after hepatectomy (hazard ratio 1·54, 95 per cent confidence interval 1·24 to 1·93) and RFS (HR 1·75, 1·39 to 2·22). Overall survival and RFS after hepatectomy for ruptured HCC in the emergency and staged subgroups were not significantly different in multivariable analyses. CONCLUSION Spontaneous rupture predicted poor long-term survival after hepatectomy for HCC, but surgical treatment seems possible, safe and appropriate in selected patients.
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Affiliation(s)
- T Yang
- Department of Hepatic Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China
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25
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The potential role and mechanisms of distilled water-induced hypotonic shock on malignant cells. J Surg Res 2013; 181:67-8. [DOI: 10.1016/j.jss.2012.01.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2011] [Revised: 12/31/2011] [Accepted: 01/05/2012] [Indexed: 11/18/2022]
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26
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Nako Y, Shiozaki A, Ichikawa D, Komatsu S, Konishi H, Iitaka D, Ishii H, Ikoma H, Kubota T, Fujiwara H, Okamoto K, Ochiai T, Nakahari T, Marunaka Y, Otsuji E. Enhancement of the cytocidal effects of hypotonic solution using a chloride channel blocker in pancreatic cancer cells. Pancreatology 2012; 12:440-8. [PMID: 23127534 DOI: 10.1016/j.pan.2012.08.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2012] [Revised: 07/17/2012] [Accepted: 08/07/2012] [Indexed: 12/11/2022]
Abstract
BACKGROUND Tumor cells exfoliated during surgery for pancreatic cancer can cause peritoneal recurrence. Peritoneal lavage with distilled water has been performed during surgery, but there have been no systematic studies for its efficacy and no experimental data demonstrating the cytocidal effects of distilled water on pancreatic cancer cells. This study investigated the cytocidal effects of hypotonic shock and enhancement using chloride channel blocker in pancreatic cancer cells. METHODS Three human pancreatic cancer cell lines, KP4-1, PK-1, and PK45-H, were exposed to distilled water, and the resultant morphological changes were observed under a differential interference contrast microscope connected to a high-speed video camera. Analysis of cell volume changes was performed using a high-resolution flow cytometer. To investigate the cytocidal effects of water, re-incubation of cells was performed after exposure to hypotonic solution. Additionally, the effects of 5-nitro-2-(3-phenylpropylamino)-benzoic acid (NPPB), a Cl(-) channel blocker, on cells during exposure to hypotonic solution were analyzed. RESULTS Video recordings demonstrated that hypotonic shock induced cell swelling followed by cell rupture. Measurement of cell volume changes indicated that severe hypotonicity increased broken fragments of cancer cells within 5 min. Re-incubation experiments demonstrated the cytocidal effects of hypotonic shock. In all cell lines, treatment with NPPB increased cell volume by inhibiting regulatory volume decreases, which are observed during hypotonic shock, and enhanced the cytocidal effects of hypotonic solution. CONCLUSIONS These findings support the efficacy of peritoneal lavage with distilled water for pancreatic cancer and suggest that regulation of Cl(-) transport enhances the cytocidal effects of hypotonic shock.
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Affiliation(s)
- Yoshito Nako
- Department of Surgery, Division of Digestive Surgery, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kajii-cho, Kamigyo-ku, Kyoto, Japan
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Tsakok T, Tsakok M, Damji C, Watson R. Washout after lobectomy: is water more effective than normal saline in preventing local recurrence? Interact Cardiovasc Thorac Surg 2011; 14:200-4. [PMID: 22159256 DOI: 10.1093/icvts/ivr078] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
A best evidence topic in thoracic surgery was written according to a structured protocol. The question addressed was: 'is water washout more effective than normal saline washout after lobectomy in preventing local recurrence?' Altogether more than 48 papers were found using the reported search, of which nine represented the best evidence to answer the clinical question. The authors, journal, date, country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. Tumour cell 'spillage' after cancer resection is linked to a worse prognosis, so washout to minimize contamination is an established surgical technique. While the mechanical effects of lavage are well validated, the differential cytocidal effects of water versus saline as irrigation fluids are not. There are currently no studies addressing this issue in the thoracic surgery setting, after lung cancer lobectomy. However, the majority of relevant papers describe the use of basic in vitro methods and animal models to produce data that can conceivably be extrapolated to the clinical question in hand. The number of studies is small, and some have technical limitations. While two of the better-designed experiments suggest that water exerts a superior cytocidal effect on tumour cells, data from other studies are somewhat unimpressive, with two studies reporting that water washout controls tumour growth to a lesser extent than saline. This, together with the complete paucity of clinical trials on the subject, leads us to conclude that water is unlikely to represent a superior irrigation fluid in lung cancer patients after lobectomy.
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Affiliation(s)
- Teresa Tsakok
- Academic Foundation Programme, Guy's and St Thomas' NHS Foundation Trust, Great Maze Pond, London, UK.
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Iitaka D, Shiozaki A, Ichikawa D, Kosuga T, Komatsu S, Okamoto K, Fujiwara H, Ishii H, Nakahari T, Marunaka Y, Otsuji E. Blockade of chloride ion transport enhances the cytocidal effect of hypotonic solution in gastric cancer cells. J Surg Res 2011; 176:524-34. [PMID: 22261593 DOI: 10.1016/j.jss.2011.10.039] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2011] [Revised: 10/12/2011] [Accepted: 10/26/2011] [Indexed: 12/15/2022]
Abstract
BACKGROUND Cancer cells that are exfoliated into the peritoneal cavity during surgery are viable and have the potential to produce peritoneal recurrence. Although peritoneal lavage with distilled water is applied in some cancer surgeries to kill tumor cells, there is no consensus regarding the optimal methodology and its effects. METHODS Three human gastric cancer cell lines, MKN28, MKN45, and Kato-III, were exposed to distilled water, and the resultant morphologic changes were observed using a microscope. Analysis of cell volume changes was performed using a flow cytometer. To investigate the cytocidal effects of the water, re-incubation of the cells was performed after exposing them to hypotonic solution. Additionally, the effects of 5-nitro-2-3-phenylpropylamino)-benzoic acid (NPPB), a Cl(-) channel blocker, and R(+)-[(dihydroindenyl)oxy] alkanoic acid (DIOA), a blocker of the K(+)/Cl(-) co-transporter, on the cells during their exposure to hypotonic solution were analyzed. RESULTS After the cells had been exposed to the distilled water, a rapid increase in cell volume occurred followed by cell rupture. In the MKN45 and Kato-III cells, treatment with NPPB increased cell volume by inhibiting regulatory volume decrease and enhanced the cytocidal effects of the hypotonic solution, whereas no such effects were observed in the MKN28 cells. On the other hand, treatment of the MKN28 cells with DIOA inhibited RVD and enhanced the cytocidal effects of hypotonic shock. CONCLUSION These findings support the efficacy of peritoneal lavage with distilled water during surgery for gastric cancer and suggest that the regulation of Cl(-) transport enhances the cytocidal effects of hypotonic shock.
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Affiliation(s)
- Daisuke Iitaka
- Department of Surgery, Division of Digestive Surgery, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
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Ito F, Camoriano M, Seshadri M, Evans SS, Kane JM, Skitzki JJ. Water: a simple solution for tumor spillage. Ann Surg Oncol 2011; 18:2357-63. [PMID: 21301970 DOI: 10.1245/s10434-011-1588-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2010] [Indexed: 11/18/2022]
Abstract
BACKGROUND Although often proposed as a means to reduce the harmful consequences of tumor spill, water lavage has yet to be systematically evaluated in relevant in vitro and in vivo models. This study evaluates the mechanisms and utility of a single water lavage to improve the sequelae of tumor spill during laparotomy. METHODS Murine colorectal tumor cell susceptibility to water-induced osmotic lysis was characterized in vitro. A reproducible model of tumor spill was established to recapitulate water or saline lavage during laparotomy. Analyses of tumor volumes calculated from noninvasive imaging were performed. The tumor volumes and survival of mice treated with water, normal saline, or sham laparotomy were assessed. RESULTS Significant osmotic lysis of cultured murine colorectal cancer cells was observed after a brief exposure to water. Compared to saline or sham laparotomy, water lavage demonstrated superior clinical outcomes with a decrease in tumor burden and concomitant improvement in survival. CONCLUSIONS The use of water lavage during oncologic surgeries to reduce the sequelae of tumor spill is justified and strongly supported by our study. Data from our study raise several concerns regarding the mechanisms and efficacy of saline lavage. Clinically, the use of water lavage during laparotomy would be anticipated to reduce peritoneal disease burden with minimal toxicity or cost.
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Affiliation(s)
- Fumito Ito
- Department of Surgical Oncology, Roswell Park Cancer Institute, Buffalo, NY, USA
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van den Tillaart SAHM, Busard MPH, Trimbos JBMZ. The use of distilled water in the achievement of local hemostasis during surgery. ACTA ACUST UNITED AC 2009; 6:255-259. [PMID: 20234842 PMCID: PMC2837248 DOI: 10.1007/s10397-008-0464-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2008] [Accepted: 12/29/2008] [Indexed: 11/30/2022]
Abstract
Distilled water is used worldwide to check on hemostasis at the end of pelvic oncological operations. Nevertheless, reports about this method are lacking. The aim of this study was to explain the method and to discuss possible side effects. After the addition of distilled water to the surgically exposed pelvis, rapid lysis of erythrocytes results in a transparent fluid in which a small source of bleeding is easily recognizable. A possible side effect of the lavage might be contribution to the formation of peritoneal adhesions by confusing the abdominal defence system. Systemic side effects are not to be expected. Although tumour cells might suffer from hypotonic distilled water lavage, the current use of distilled water at the end of surgery is probably not effective to lyse tumour cells. Our findings support the ongoing use of distilled water lavage to achieve hemostasis after extensive pelvic surgery.
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Affiliation(s)
- S. A. H. M. van den Tillaart
- Department of Gynaecology K6-P, Leiden University Medical Center, P.O. Box 9600, 2300 RC Leiden, The Netherlands
| | - M. P. H. Busard
- Department of Gynaecology K6-P, Leiden University Medical Center, P.O. Box 9600, 2300 RC Leiden, The Netherlands
| | - J. B. M. Z. Trimbos
- Department of Gynaecology K6-P, Leiden University Medical Center, P.O. Box 9600, 2300 RC Leiden, The Netherlands
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31
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Spontaneous rupture of primary hepatocellular carcinoma: Experience of emergency laparotomy over a 16-year period. ACTA ACUST UNITED AC 2007. [DOI: 10.1007/s11805-007-0322-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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