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Ng KKC, Cheng KC, Kung JWC, Ho KM, Lok HT, Fung AKY, Chong CCN, Cheung SYS, Lee KF, Wong J, Lai PBS. Comparison of clinical outcome between laparoscopic and open hepatectomy of high difficulty score for hepatocellular carcinoma: a propensity score analysis. Surg Endosc 2024; 38:857-871. [PMID: 38082015 DOI: 10.1007/s00464-023-10634-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 11/29/2023] [Indexed: 02/02/2024]
Abstract
BACKGROUND Laparoscopic liver resection (LLR) of high difficulty score is technically challenging. There is a lack of clinical evidence to support its applicability in terms of the long-term survival benefits. This study aims to compare clinical outcomes between LLR and the open liver resection of high difficulty score for hepatocellular carcinoma (HCC). MATERIALS AND METHODS From 2010 to 2020, using Iwate criteria, 424 patients underwent liver resection of high difficulty score by the laparoscopic (n = 65) or open (n = 359) approach. Propensity score (PS) matching was performed between the two groups. Short-term and long-term outcomes were compared between PS-matched groups. Univariate and multivariate analyses were performed to identify prognostic factors affecting survival. RESULTS The laparoscopic group had significantly fewer severe complications (3% vs. 10.8%), and shorter median hospital stays (6 days vs. 8 days) than the open group. Meanwhile, the long-term oncological outcomes were comparable between the two groups, in terms of the tumor recurrence rate (40% vs. 46.1%), the 5-year overall survival rate (75.4% vs. 76.2%), and the 5-year recurrence-free survival rate (50.3% vs. 53.5%). The high preoperative serum alpha-fetoprotein level, multiple tumors, and severe postoperative complications were the independent poor prognostic factors associated with worse overall survival. The surgical approach (Laparoscopic vs. Open) did not influence the survival. CONCLUSION LLR of high difficulty score for selected patients with HCC has better short-term outcomes than the open approach. More importantly, it can achieve similar long-term survival outcomes as the open approach.
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Affiliation(s)
- Kelvin K C Ng
- Department of Surgery, The Chinese University of Hong Kong, Hong Kong, Hong Kong.
- Department of Surgery, Prince of Wales Hospital, New Territories, Hong Kong.
- Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, 30 - 32 Ngan Shing Street, New Territories, Hong Kong.
| | - Kai-Chi Cheng
- Department of Surgery, Kwong Wah Hospital, Hong Kong, Hong Kong
| | - Janet W C Kung
- Department of Surgery, Prince of Wales Hospital, New Territories, Hong Kong
| | - Kit-Man Ho
- Department of Surgery, Kwong Wah Hospital, Hong Kong, Hong Kong
| | - Hon-Ting Lok
- Department of Surgery, Prince of Wales Hospital, New Territories, Hong Kong
| | - Andrew K Y Fung
- Department of Surgery, Prince of Wales Hospital, New Territories, Hong Kong
| | - Charing C N Chong
- Department of Surgery, The Chinese University of Hong Kong, Hong Kong, Hong Kong
- Department of Surgery, Prince of Wales Hospital, New Territories, Hong Kong
| | - Sunny Y S Cheung
- Department of Surgery, Prince of Wales Hospital, New Territories, Hong Kong
| | - Kit-Fai Lee
- Department of Surgery, Prince of Wales Hospital, New Territories, Hong Kong
| | - John Wong
- Department of Surgery, Prince of Wales Hospital, New Territories, Hong Kong
| | - Paul B S Lai
- Department of Surgery, The Chinese University of Hong Kong, Hong Kong, Hong Kong
- Department of Surgery, Prince of Wales Hospital, New Territories, Hong Kong
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2
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Eguia E, Baker T, Baker M. Hepatocellular Carcinoma: Surgical Management and Evolving Therapies. Cancer Treat Res 2024; 192:185-206. [PMID: 39212922 DOI: 10.1007/978-3-031-61238-1_10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/04/2024]
Abstract
Hepatocellular carcinoma (HCC) is the fifth most common cancer in men and the eighth most common cancer in women worldwide. It is also the second leading cause of cancer death worldwide, with 780,000 deaths in 2018. Seventy-two percent of HCC cases occur in Asia, 10% in Europe, 8% in Africa, 5% in North America, and 5% in Latin America (Singal et al. in J Hepatol 72(2):250-261, 2020 [1]).
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Affiliation(s)
- Emanuel Eguia
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Talia Baker
- Huntsman Cancer Center, University of Utah Eccles School of Medicine, Salt Lake City, UT, USA
| | - Marshall Baker
- Huntsman Cancer Center, University of Utah Eccles School of Medicine, Salt Lake City, UT, USA.
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3
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Zhuang B, Zhu X, Lin J, Zhang F, Qiao B, Kang J, Xie X, Wei X, Xie X. Radiofrequency ablation induces tumor cell dissemination in a mouse model of hepatocellular carcinoma. Eur Radiol Exp 2023; 7:74. [PMID: 38019353 PMCID: PMC10686970 DOI: 10.1186/s41747-023-00382-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 08/30/2023] [Indexed: 11/30/2023] Open
Abstract
BACKGROUND We tested the hypothesis that radiofrequency ablation (RFA) for hepatocellular carcinoma (HCC) promotes tumor cell release and explored a method for reducing these effects. METHODS A green fluorescent protein-transfected orthotopic HCC model was established in 99 nude mice. In vivo flow cytometry was used to monitor circulating tumor cell (CTC) dynamics. Pulmonary fluorescence imaging and pathology were performed to investigate lung metastases. First, the kinetics of CTCs during the periablation period and the survival rate of CTCs released during RFA were investigated. Next, mice were allocated to controls, sham ablation, or RFA with/without hepatic vessel blocking (ligation of the portal triads) for evaluating the postablation CTC level, lung metastases, and survival over time. Moreover, the kinetics of CTCs, lung metastases, and mice survival were evaluated for RFA with/without ethanol injection. Pathological changes in tumors and surrounding parenchyma after ethanol injection were noted. Statistical analysis included t-test, ANOVA, and Kaplan-Meier survival curves. RESULTS CTC counts were 12.3-fold increased during RFA, and 73.7% of RFA-induced CTCs were viable. Pre-RFA hepatic vessel blocking prevented the increase of peripheral CTCs, reduced the number of lung metastases, and prolonged survival (all p ≤ 0.05). Similarly, pre-RFA ethanol injection remarkably decreased CTC release during RFA and further decreased lung metastases with extended survival (all p ≤ 0.05). Histopathology revealed thrombus formation in blood vessels after ethanol injection, which may clog tumor cell dissemination during RFA. CONCLUSION RFA induces viable tumor cell dissemination, and pre-RFA ethanol injection may provide a prophylactic strategy to reduce this underestimated effect. RELEVANCE STATEMENT RFA for HCC promotes viable tumor cell release during ablation, while ethanol injection can prevent RFA induced tumor cell release. KEY POINTS • RFA induced the release of viable tumor cells during the ablation procedure in an animal model. • Hepatic vessel blocking can suppress tumor cells dissemination during RFA. • Ethanol injection can prevent RFA-induced tumor cell release, presumably because of the formation of thrombosis.
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Affiliation(s)
- Bowen Zhuang
- Department of Medical Ultrasonics, The First Affiliated Hospital of Sun Yat-Sen University, Institute of Diagnostic and Interventional Ultrasound, Guangzhou, 510080, China
| | - Xi Zhu
- Biomedical Engineering Research Center, Kunming Medical University, Kunming, China
| | - Jinhua Lin
- Department of Medical Ultrasonics, The First Affiliated Hospital of Sun Yat-Sen University, Institute of Diagnostic and Interventional Ultrasound, Guangzhou, 510080, China
| | - Fuli Zhang
- Med-X Research Institute and School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Bin Qiao
- Department of Medical Ultrasonics, The First Affiliated Hospital of Sun Yat-Sen University, Institute of Diagnostic and Interventional Ultrasound, Guangzhou, 510080, China
| | - Jihui Kang
- Department of Pathology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Xiaohua Xie
- Department of Medical Ultrasonics, The First Affiliated Hospital of Sun Yat-Sen University, Institute of Diagnostic and Interventional Ultrasound, Guangzhou, 510080, China
| | - Xunbin Wei
- Med-X Research Institute and School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China.
- Biomedical Engineering Department, Peking University, Beijing, 100081, China.
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital & Institute, Beijing, 100142, China.
| | - Xiaoyan Xie
- Department of Medical Ultrasonics, The First Affiliated Hospital of Sun Yat-Sen University, Institute of Diagnostic and Interventional Ultrasound, Guangzhou, 510080, China.
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Mithany RH, Gerges F, Shahid MH, Abdallah S, Manasseh M, Abdelmaseeh M, Abdalla M, Elmahi E. Operative and Hepatic Function Outcomes of Laparoscopic vs. Open Liver Resection: A Systematic Review and Meta-Analysis. Cureus 2023; 15:e47274. [PMID: 37859673 PMCID: PMC10584273 DOI: 10.7759/cureus.47274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/18/2023] [Indexed: 10/21/2023] Open
Abstract
Liver resection is a pivotal treatment for various liver diseases, and the choice between laparoscopic (LR) and open (OR) methods is debatable. This study aims to compare their respective complications and hepatic outcomes comprehensively, providing critical insights to guide clinical decisions and optimize patient results. We conducted a comprehensive review across PubMed, SCOPUS, WOS, and the Cochrane Library until September 2023. Randomized controlled trials (RCTs) comparing laparoscopic (LR) and open (OR) liver resections were included. Data screening, extraction, and quality assessments utilized the Risk of Bias (ROB-2). We conducted our analysis using Review Manager (RevMan 5.4) software, and the data were presented as risk ratios (RR) and mean differences (MD) with 95% confidence intervals (CI). Our comprehensive research yielded 3,192 relevant records, and 9 RCTs were finally included. LR exhibited reduced operative bleeding (MD = -82.87 ml, 95% CI: -132.45 to -33.30, P=0.001) and shorter hospital stays (MD = -2.32 days, 95% CI: -3.65 to -0.98, P=0.0007). The risk of complications was significantly lower in the LR group (RR = 0.57, 95% CI: 0.43-0.76, P<0.0001), especially in Clavian-Dindo classification degree 1 and 2 complications (RR = 0.47, 95% CI: 0.28-0.79, P=0.005). LR patients also had lower postoperative AST levels at one day (MD = -123.16 U/L, 95% CI: -206.08 to -40.24, P=0.004) and three days (MD = -35.95 U/L, 95% CI: -65.83 to -6.06, P=0.02). These findings underscore LR's superiority, emphasizing its potential to significantly enhance patient outcomes, reduce complications, and improve recovery in liver resection procedures.
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Affiliation(s)
- Reda H Mithany
- Laparoscopic Colorectal Surgery, Kingston Hospital National Health Services (NHS) Foundation Trust, Kingston, GBR
| | - Farid Gerges
- General and Emergency Surgery, Kingston Hospital National Health Services (NHS) Foundation Trust, Kingston, GBR
| | | | | | - Mina Manasseh
- General Surgery, Torbay and South Devon National Health Services (NHS) Foundation Trust, Torquay, GBR
| | - Mark Abdelmaseeh
- General Surgery, Faculty of Medicine, Assuit University, Assuit, EGY
| | - Mazin Abdalla
- General Surgery, Kingston Hospital National Health Services (NHS) Foundation Trust, Kingston, GBR
| | - Eiad Elmahi
- General Surgery, Lincoln County Hospital, Lincoln, GBR
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5
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Lei Y, Wang X, Tian Y, Xu R, Pei J, Fu Y, Sun H, Wang Y, Zheng P, Xia F, Wang J. Effect of various hepatectomy procedures on circulating tumor cells in postoperative patients: a case-matched comparative study. Front Med (Lausanne) 2023; 10:1209403. [PMID: 37841010 PMCID: PMC10568028 DOI: 10.3389/fmed.2023.1209403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 09/15/2023] [Indexed: 10/17/2023] Open
Abstract
Background The objective of this study is to elucidate the prevalence of systemic circulating tumor cells (CTCs) prior to and following resection of hepatocellular carcinoma (HCC), and to compare the disparities in postoperative CTCs in terms of quantity and classifications between the open liver resection (OPEN) and laparoscopic liver resection (LAP) cohorts. Patients materials and methods From September 2015 to May 2022, 32 consecutive HCC patients who underwent laparoscopic liver resection at Southwest Hospital were retrospectively enrolled in this study. The clinicopathological data were retrieved from a prospectively collected computer database. Patients in the OPEN group matched at a 1:1 ratio with patients who underwent open liver resection during the study period on age, gender, tumor size, number of tumors, tumor location, hepatitis B surface antigen (HBsAg) positivity, alpha-fetoprotein (AFP) level, TNM and Child-Pugh staging from the database of patients to form the control group. The Can-Patrol CTC enrichment technique was used to enrich and classify CTCS based on epithelial-mesenchymal transformation phenotypes. The endpoint was disease-free survival (DFS), and the Kaplan-Meier method and multiple Cox proportional risk model were used to analyze the influence of clinicopathological factors such as total CTCs and CTC phenotype on prognosis. Results The mean age of the 64 patients with primary liver cancer was 52.92 years (23-71), and 89.1% were male. The postoperative CTC clearance rate was more significant in the OPEN group. The total residual CTC and phenotypic CTC of the LAP group were significantly higher than those of the OPEN group (p = 0.017, 0.012, 0.049, and 0.030, respectively), which may increase the possibility of metastasis (p = 0.042). In Kaplan-Meier analysis, DFS was associated with several clinicopathological risk factors, including Barcelona Clinical Liver Cancer (BCLC) stage, tumor size, and vascular invasion. Of these analyses, BCLC Stage [p = 0.043, HR (95% CI) =2.03(1.022-4.034)], AFP [p = 0.007, HR (95% CI) =1.947 (1.238-3.062)], the number of positive CTCs [p = 0.004, HR (95% CI) =9.607 (2.085-44.269)] and vascular invasion [p = 0.046, HR (95% CI) =0.475 (0.22-1.023)] were significantly associated with DFS. Conclusion In comparison to conventional OPEN technology, LAP technology has the capacity to augment the quantity of epithelial, mixed, and mesenchymal circulating tumor cells (CTCs). Following the surgical procedure, there was a notable increase in the total CTCs, epithelial CTCs, and mixed CTCs within the LAP group, indicating a potential drawback of LAP in facilitating the release of CTCs.
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Affiliation(s)
- YongRong Lei
- Key Laboratory of Biorheological Science and Technology (Ministry of Education), College of Bioengineering, Chongqing University, Chongqing, China
- Key Laboratory of Hepatobiliary and Pancreatic Surgery, Institute of Hepatobiliary Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - XiShu Wang
- Key Laboratory of Hepatobiliary and Pancreatic Surgery, Institute of Hepatobiliary Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - YiChen Tian
- Key Laboratory of Biorheological Science and Technology (Ministry of Education), College of Bioengineering, Chongqing University, Chongqing, China
| | - Rong Xu
- Key Laboratory of Biorheological Science and Technology (Ministry of Education), College of Bioengineering, Chongqing University, Chongqing, China
| | - Jun Pei
- Key Laboratory of Hepatobiliary and Pancreatic Surgery, Institute of Hepatobiliary Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - YuNa Fu
- Key Laboratory of Biorheological Science and Technology (Ministry of Education), College of Bioengineering, Chongqing University, Chongqing, China
| | - Heng Sun
- Key Laboratory of Biorheological Science and Technology (Ministry of Education), College of Bioengineering, Chongqing University, Chongqing, China
| | - YaNi Wang
- Key Laboratory of Biorheological Science and Technology (Ministry of Education), College of Bioengineering, Chongqing University, Chongqing, China
| | - Ping Zheng
- Key Laboratory of Hepatobiliary and Pancreatic Surgery, Institute of Hepatobiliary Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Feng Xia
- Key Laboratory of Hepatobiliary and Pancreatic Surgery, Institute of Hepatobiliary Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - JianHua Wang
- Key Laboratory of Biorheological Science and Technology (Ministry of Education), College of Bioengineering, Chongqing University, Chongqing, China
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6
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Nenu I, Toadere TM, Topor I, Țichindeleanu A, Bondor DA, Trella ȘE, Sparchez Z, Filip GA. Interleukin-6 in Hepatocellular Carcinoma: A Dualistic Point of View. Biomedicines 2023; 11:2623. [PMID: 37892997 PMCID: PMC10603956 DOI: 10.3390/biomedicines11102623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 09/14/2023] [Accepted: 09/21/2023] [Indexed: 10/29/2023] Open
Abstract
Hepatocellular Carcinoma (HCC) is a pressing health concern, demanding a deep understanding of various mediators' roles in its development for therapeutic progress. Notably, interleukin-6 (IL-6) has taken center stage in investigations due to its intricate and context-dependent functions. This review delves into the dual nature of IL-6 in HCC, exploring its seemingly contradictory roles as both a promoter and an inhibitor of disease progression. We dissect the pro-tumorigenic effects of IL-6, including its impact on tumor growth, angiogenesis, and metastasis. Concurrently, we examine its anti-tumorigenic attributes, such as its role in immune response activation, cellular senescence induction, and tumor surveillance. Through a comprehensive exploration of the intricate interactions between IL-6 and the tumor microenvironment, this review highlights the need for a nuanced comprehension of IL-6 signaling in HCC. It underscores the importance of tailored therapeutic strategies that consider the dynamic stages and diverse surroundings within the tumor microenvironment. Future research directions aimed at unraveling the multifaceted mechanisms of IL-6 in HCC hold promise for developing more effective treatment strategies and improving patient outcomes.
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Affiliation(s)
- Iuliana Nenu
- Department of Physiology, "Iuliu Hațieganu" University of Medicine and Pharmacy, 400006 Cluj-Napoca, Romania
- Department of Gastroenterology, "Prof. Dr. O. Fodor" Regional Institute of Gastroenterology and Hepatology, 400162 Cluj-Napoca, Romania
| | - Teodora Maria Toadere
- Department of Physiology, "Iuliu Hațieganu" University of Medicine and Pharmacy, 400006 Cluj-Napoca, Romania
| | - Ioan Topor
- Department of Physiology, "Iuliu Hațieganu" University of Medicine and Pharmacy, 400006 Cluj-Napoca, Romania
| | - Andra Țichindeleanu
- Department of Physiology, "Iuliu Hațieganu" University of Medicine and Pharmacy, 400006 Cluj-Napoca, Romania
| | - Daniela Andreea Bondor
- Department of Physiology, "Iuliu Hațieganu" University of Medicine and Pharmacy, 400006 Cluj-Napoca, Romania
| | - Șerban Ellias Trella
- Department of Physiology, "Iuliu Hațieganu" University of Medicine and Pharmacy, 400006 Cluj-Napoca, Romania
| | - Zeno Sparchez
- Department of Gastroenterology, "Prof. Dr. O. Fodor" Regional Institute of Gastroenterology and Hepatology, 400162 Cluj-Napoca, Romania
- Department of Internal Medicine, "Iuliu Hațieganu" University of Medicine and Pharmacy, 400162 Cluj-Napoca, Romania
| | - Gabriela Adriana Filip
- Department of Physiology, "Iuliu Hațieganu" University of Medicine and Pharmacy, 400006 Cluj-Napoca, Romania
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Kabir T, Goh BK. Laparoscopic versus open resection of hepatocellular carcinoma in patients with cirrhosis. Minerva Surg 2023; 78:68-75. [PMID: 36519820 DOI: 10.23736/s2724-5691.22.09729-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Hepatocellular carcinoma (HCC) is the sixth commonest malignancy worldwide, and the fourth-leading cause of cancer related death. Partial liver resection (LR) forms the mainstay of therapy for suitable patients with preserved liver function. In recent years, significant advances in surgical technology, refinement of operative techniques and improvements in peri-operative care have facilitated the widespread adoption of laparoscopic liver resection (LLR) with encouraging outcomes. Liver cirrhosis (LC) is present in up to 80% of patients with HCC, and adds a further dimension of complexity to LR. Cirrhotic patients have a propensity for greater intraoperative blood loss as well as increased postoperative complications such as refractory ascites and posthepatectomy liver failure. Tumor localization within the fibrotic parenchyma is challenging, giving rise to concerns about resection margin status. Patients are also at higher risk of developing metachronous lesions, which affects long-term survival. Presently, the exact role of LLR in HCC patients with underlying LC is not well-defined. Current evidence suggests that LLR offers a multitude of benefits in the short-term such as reduced blood loss and blood transfusion requirements and lower morbidity, when compared to open resection. Oncologic adequacy and long-term survival do not appear to be compromised. Special consideration must be given for LLR in patients with advanced cirrhosis, or those who require extensive major hepatectomies. We present here a brief review of the literature surrounding LLR for HCC on a background of LC.
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Affiliation(s)
- Tousif Kabir
- Department of General Surgery, Sengkang General Hospital, Singapore, Singapore.,Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital and National Cancer Centre, Singapore, Singapore
| | - Brian K Goh
- Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital and National Cancer Centre, Singapore, Singapore - .,Duke National University of Singapore Medical School, Singapore, Singapore
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Jiang S, Yu D, He H, Sun H, Sun Y, Zhou L, Wu Z, Gu Q. Short- and Long-Term Outcomes in Laparoscopic Versus Open Hepatectomy for Hepatocellular Carcinoma in Elderly Patients: A Systematic Review and Meta-Analysis. J Laparoendosc Adv Surg Tech A 2023; 33:321-334. [PMID: 36716177 DOI: 10.1089/lap.2022.0524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Background: Laparoscopic hepatectomy (LH) is considered a safe and feasible treatment for patients with hepatocellular carcinoma (HCC) in recent studies. However, in elderly patients, application of LH still remains controversial, and the outcomes of LH versus open hepatectomy (OH) have not been fully evaluated. Our objective is to compare the short- and long-term outcomes of LH with OH in elderly patients with HCC. Materials and Methods: All studies comparing LH and OH in elderly patients with HCC were systematically searched in the databases of PubMed, EmBase, and Web of Science. Statistical analysis was conducted using Review Manager 5.3 (Cochrane Collaboration, 2014). The last search was performed on March 20, 2022. Short-term outcomes include blood loss, operation time, blood transfusion, overall and major postoperative complications, mortality, hospital stay, tumor size, and surgical margin. Long-term outcomes include 1-, 3-, and 5-year overall survival (OS); 1-, 3-, and 5-year disease-free survival (DFS); and 1-, 3-, and 5-year recurrence-free survival (RFS). Results: Fourteen studies involving 1596 patients were included in this meta-analysis. The short-term outcomes of LH were a shorter postoperative hospital stay and fewer overall and major postoperative complications (all P < .00001). However, there were no significant differences in operation time, blood loss, blood transfusion rate, surgical margin, tumor size, and mortality. For the long-term outcomes, LH is comparable with OH in terms of 1-, 3-, and 5-year OS; 1-, 3-, and 5-year DFS; and 1-, 3-, and 5-year RFS. Conclusions: Compared with OH, LH is a safe and feasible treatment for elderly patients with HCC.
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Affiliation(s)
- Song Jiang
- Department of Hepatobiliary Surgery, Jinshan Branch of Shanghai Sixth People's Hospital, Shanghai, China
| | - Dong Yu
- Department of Hepatobiliary Surgery, Jinshan Branch of Shanghai Sixth People's Hospital, Shanghai, China
| | - Hongwei He
- Department of Hepatobiliary Surgery, Jinshan Branch of Shanghai Sixth People's Hospital, Shanghai, China
| | - Haijian Sun
- Department of Hepatobiliary Surgery, Jinshan Branch of Shanghai Sixth People's Hospital, Shanghai, China
| | - Yan Sun
- Department of Hepatobiliary Surgery, Jinshan Branch of Shanghai Sixth People's Hospital, Shanghai, China
| | - Longxiang Zhou
- Department of Hepatobiliary Surgery, Jinshan Branch of Shanghai Sixth People's Hospital, Shanghai, China
| | - Zhongxin Wu
- Department of Hepatobiliary Surgery, Jinshan Branch of Shanghai Sixth People's Hospital, Shanghai, China
| | - Qiyun Gu
- Department of Hepatobiliary Surgery, Jinshan Branch of Shanghai Sixth People's Hospital, Shanghai, China
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9
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Yang C, Zhang R, Zhu L, Zheng X, Li K, Wang PX. Caudodorsal approach combined with in situ split for laparoscopic right posterior sectionectomy. Surg Endosc 2023; 37:1334-1341. [PMID: 36203107 PMCID: PMC9944372 DOI: 10.1007/s00464-022-09657-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 09/13/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Laparoscopic right posterior sectionectomy (LRPS) was technically challenging and lack of standardization. There were some approaches for LRPS, such as caudal approach and dorsal approach. During our practice, we initiated pure LRPS using the caudodorsal approach with in situ split and present several advantages of this method. METHODS From April 2018 to December 2021, consecutive patients who underwent pure LRPS using the caudodorsal approach with in situ split at our institution entered into this retrospective study. The key point of the caudodorsal approach was that the right hepatic vein was exposed from peripheral branches toward the root and the parenchyma was transected from the dorsal side to ventral side. Specially, the right perihepatic ligaments were not divided to keep the right liver in situ before parenchymal dissection for each case. RESULTS 11 patients underwent pure LRPS using the caudodorsal approach with in situ split. There were 9 hepatocellular carcinoma, 1 sarcomatoid hepatocellular carcinoma, and 1 hepatic hemangioma. Five patients had mild cirrhosis and 1 had moderate cirrhosis. All the procedures were successfully completed laparoscopically. The median operative time was 375 min (range of 290-505 min) and the median blood loss was 300 ml (range of 100-1000 ml). Five patients received perioperative blood transfusion, of which 1 patient received autologous blood transfusion and 2 patients received blood transfusion due to preoperative moderate anemia. No procedure was converted to open surgery. Two patients who suffered from postoperative complications, improved after conservative treatments. The median postoperative stay was 11 days (range of 7-25 days). No postoperative bleeding, hepatic failure, and mortality occurred. CONCLUSION The preliminary clinical effect of the caudodorsal approach with in situ split for LRPS was satisfactory. Our method was feasible and expected to provide ideas for the standardization of LRPS. Further researches are required due to some limitations of this study.
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Affiliation(s)
- Chongwei Yang
- Department of Hepatobiliary Surgery, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430014 China
| | - Rixin Zhang
- Department of Hepatobiliary Surgery, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430014 China
| | - Ling Zhu
- Department of Hepatobiliary Surgery, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430014, China.
| | - Xiaolin Zheng
- Department of Hepatobiliary Surgery, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430014, China.
| | - Kai Li
- Department of Hepatobiliary Surgery, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430014 China
| | - Pi-Xiao Wang
- Department of Hepatobiliary Surgery, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430014 China
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Kaida T, Hayashi H, Sato H, Kinoshita S, Matsumoto T, Shiraishi Y, Kitano Y, Higashi T, Imai K, Yamashita YI, Baba H. Assessment for the minimal invasiveness of laparoscopic liver resection by interleukin-6 and thrombospondin-1. World J Hepatol 2022; 14:234-243. [PMID: 35126851 PMCID: PMC8790401 DOI: 10.4254/wjh.v14.i1.234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Revised: 06/23/2021] [Accepted: 12/11/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Laparoscopic surgery has been introduced as a minimally invasive technique for the treatment of various field. However, there are few reports that have scientifically investigated the minimally invasive nature of laparoscopic liver resection (LLR).
AIM To investigate whether LLR is scientifically less invasive than open liver resection.
METHODS During December 2011 to April 2015, blood samples were obtained from 30 patients who treated with laparoscopic (n = 10, 33%) or open (n = 20, 67%) partial liver resection for liver tumor. The levels of serum interleukin-6 (IL-6) and plasma thrombospondin-1 (TSP-1) were measured using ELISA kit at four time points including preoperative, immediate after operation, postoperative day 1 (POD1) and POD3. Then, we investigated the impact of the operative approaches during partial hepatectomy on the clinical time course including IL-6 and TSP-1.
RESULTS Serum level of IL-6 on POD1 in laparoscopic hepatectomy was significantly lower than those in open hepatectomy (8.7 vs 30.3 pg/mL, respectively) (P = 0.003). Plasma level of TSP-1 on POD3 in laparoscopic hepatectomy was significantly higher than those in open hepatectomy (1704.0 vs 548.3 ng/mL, respectively) (P = 0.009), and have already recovered to preoperative level in laparoscopic approach. In patients with higher IL-6 Levels on POD1, plasma level of TSP-1 on POD3 was significantly lower than those in patients with lower IL-6 Levels on POD1. Multivariate analysis showed that open approach was the only independent factor related to higher level of IL-6 on POD1 [odds ratio (OR), 7.48; 95% confidence interval (CI): 1.28-63.3; P = 0.02]. Furthermore, the higher level of serum IL-6 on POD1 was significantly associated with lower level of plasm TSP-1 on POD3 (OR, 5.32; 95%CI: 1.08-32.2; P = 0.04) in multivariate analysis.
CONCLUSION In partial hepatectomy, laparoscopic approach might be minimally invasive surgery with less IL-6 production compared to open approach.
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Affiliation(s)
- Takayoshi Kaida
- Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, Kumamoto 860-8556, Japan
| | - Hiromitsu Hayashi
- Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, Kumamoto 860-8556, Japan
| | - Hiroki Sato
- Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, Kumamoto 860-8556, Japan
| | - Shotaro Kinoshita
- Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, Kumamoto 860-8556, Japan
| | - Takashi Matsumoto
- Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, Kumamoto 860-8556, Japan
| | - Yuta Shiraishi
- Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, Kumamoto 860-8556, Japan
| | - Yuki Kitano
- Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, Kumamoto 860-8556, Japan
| | - Takaaki Higashi
- Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, Kumamoto 860-8556, Japan
| | - Katsunori Imai
- Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, Kumamoto 860-8556, Japan
| | - Yo-ichi Yamashita
- Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, Kumamoto 860-8556, Japan
| | - Hideo Baba
- Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, Kumamoto 860-8556, Japan
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11
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Kabir T, Tan ZZ, Syn NL, Wu E, Lin JD, Zhao JJ, Tan AYH, Hui Y, Kam JH, Goh BKP. Laparoscopic versus open resection of hepatocellular carcinoma in patients with cirrhosis: a meta-analysis. Br J Surg 2021; 109:21-29. [PMID: 34757385 DOI: 10.1093/bjs/znab376] [Citation(s) in RCA: 59] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Accepted: 09/29/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND The exact role of laparoscopic liver resection (LLR) in patients with hepatocellular carcinoma (HCC) and underlying liver cirrhosis (LC) is not well defined. In this meta-analysis, both long- and short-term outcomes following LLR versus open liver resection (OLR) were analysed. METHODS PubMed, EMBASE, Scopus and Web of Science databases were searched systematically for randomised controlled trials (RCTs) and propensity-score matched (PSM) studies reporting outcomes of LLR versus OLR of HCC in patients with cirrhosis. Primary outcome was overall survival (OS). This was analysed using one-stage (individual participant data meta-analysis) and two-stage (aggregate data meta-analysis) approaches. Secondary outcomes were operation duration, blood loss, blood transfusion, Pringle manoeuvre utilization, overall and major complications, length of hospital stay (LOHS), 90-day mortality and R0 resection rates. RESULTS Eleven studies comprising 1618 patients (690 LLR versus 928 OLR) were included for analysis. In the one-stage meta-analysis, an approximately 18.7 per cent lower hazard rate (HR) of death in the LLR group (random effects: HR 0.81, 95 per cent confidence interval [C.I.] 0.68 to 0.96; P = 0.018) was observed. Two-stage meta-analysis resulted in a pooled HR of 0.84 (95 per cent C.I. 0.74 to 0.96; P = 0.01) in the overall LLR cohort. This indicated a 16-26 per cent reduction in the HR of death for patients with HCC and cirrhosis who underwent LLR. For secondary outcomes, LLR was associated with less blood loss (mean difference [MD] -99 ml, 95 per cent C.I. -182 to -16 ml), reduced overall complications (odds ratio 0.49, 95 per cent C.I. 0.37 to 0.66) and major complications (odds ratio 0.45, 95 per cent C.I. 0.26 to 0.79), and shorter LOHS (MD -3.22 days, 95 per cent C.I. -4.38 to -2.06 days). CONCLUSION Laparoscopic resection of HCC in patients with cirrhosis is associated with improved survival and perioperative outcomes.
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Affiliation(s)
- Tousif Kabir
- Department of General Surgery, Sengkang General Hospital, Singapore.,Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital, Singapore
| | - Zoe Z Tan
- Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital, Singapore
| | | | - Eric Wu
- Yong Loo Lin School of Medicine, Singapore
| | | | | | - Alvin Y H Tan
- Department of General Surgery, Sengkang General Hospital, Singapore
| | - Yong Hui
- Department of General Surgery, Sengkang General Hospital, Singapore.,Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital, Singapore
| | - Juinn H Kam
- Department of General Surgery, Sengkang General Hospital, Singapore.,Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital, Singapore
| | - Brian K P Goh
- Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital, Singapore.,Duke NUS Medical School, Singapore
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12
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Haney CM, Studier-Fischer A, Probst P, Fan C, Müller PC, Golriz M, Diener MK, Hackert T, Müller-Stich BP, Mehrabi A, Nickel F. A systematic review and meta-analysis of randomized controlled trials comparing laparoscopic and open liver resection. HPB (Oxford) 2021; 23:1467-1481. [PMID: 33820689 DOI: 10.1016/j.hpb.2021.03.006] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 03/04/2021] [Accepted: 03/05/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND/PURPOSE The dissemination of laparoscopic liver resection (LLR) has been based on non-randomized studies and reviews of these. Aim of this study was to evaluate if the randomized evidence comparing LLR to open liver resection (OLR) supports these findings. METHODS A prospectively registered (reviewregistry866) systematic review and meta-analysis following Cochrane and PRISMA guidelines comparing LLR to OLR for benign and malignant diseases was performed via Medline, Web of Science, CENTRAL up to 31.12.2020. The main outcome was postoperative complications. Risk of bias was assessed with the Cochrane Risk of Bias tool 2.0, certainty of evidence was assessed using the GRADE approach. RESULTS The search yielded 2080 results. 13 RCTs assessing mostly minor liver resections with 1457 patients were included. There were reduced odds of experiencing any complication (Odds ratio (OR) [95% confidence interval (CI)]: 0·42 [0·30, 0·58]) and severe complications (OR[CI]: 0·51 [0·31, 0·84]) for patients undergoing LLR. LOS was shorter (Mean difference (MD) [CI]: -2·90 [-3·88, -1·92] days), blood loss was lower (MD: [CI]: -115·41 [-146·08, -84·75] ml), and functional recovery was better for LLR. All other outcomes showed no significant differences. CONCLUSIONS LLR shows significant postoperative benefits. RCTs assessing long-term outcomes and major resections are needed.
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Affiliation(s)
- Caelán M Haney
- Department of General, Visceral, and Transplantation Surgery, University Hospital of Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany
| | - Alexander Studier-Fischer
- Department of General, Visceral, and Transplantation Surgery, University Hospital of Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany
| | - Pascal Probst
- Department of General, Visceral, and Transplantation Surgery, University Hospital of Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany; Study Center of the German Surgical Society, Im Neuenheimer Feld 130, 69120 Heidelberg, Germany
| | - Carolyn Fan
- Department of General, Visceral, and Transplantation Surgery, University Hospital of Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany
| | - Philip C Müller
- Department of Visceral and Transplant Surgery, University Hospital Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
| | - Mohammad Golriz
- Department of General, Visceral, and Transplantation Surgery, University Hospital of Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany
| | - Markus K Diener
- Department of General, Visceral, and Transplantation Surgery, University Hospital of Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany
| | - Thilo Hackert
- Department of General, Visceral, and Transplantation Surgery, University Hospital of Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany
| | - Beat P Müller-Stich
- Department of General, Visceral, and Transplantation Surgery, University Hospital of Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany
| | - Arianeb Mehrabi
- Department of General, Visceral, and Transplantation Surgery, University Hospital of Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany
| | - Felix Nickel
- Department of General, Visceral, and Transplantation Surgery, University Hospital of Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany.
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13
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Zhong Y, Ma T, Qiao T, Hu H, Li Z, Luo K, Wang Y, Tang Q, Wang G, Huang R, Wang X. Role of Phenotypes of Circulating Tumor Cells in the Diagnosis and Treatment of Colorectal Cancer. Cancer Manag Res 2021; 13:7077-7085. [PMID: 34531685 PMCID: PMC8439983 DOI: 10.2147/cmar.s316544] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 08/30/2021] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE To investigate the relationship between circulating tumor cells (CTCs) and their subpopulations and colorectal cancer (CRC). To explore the application of CTCs' numbers and positive rates in the diagnosis and treatment of CRC, and to assess the effect of surgery on CTCs numbers and positivity. METHODS We identified CTCs using the CanPatrol technique after enrollment. Peripheral blood samples were collected from 74 CRC patients before anti-tumor treatment. CTCs can be divided into the following three phenotypes: epithelial CTCs (E-CTCs) (EpCAM+, Vimentin-), mesenchymal CTCs (M-CTCs) (EpCAM-, Vimentin+), and mixed CTCs (E/M-CTCs) (EpCAM+, Vimentin+). CTCs and the proportion of subtypes were statistically compared with clinicopathological characteristics. RESULTS The positive rate of M-CTCs was significantly higher in patients with tumor size ≥5 cm (85.7% vs 49.1%, P = 0.004) and carcinoembryonic antigen (CEA) >5 ng/mL (83.3% vs 51.0% p = 0.024). Moreover, the T stage (T1 0, T2 33.3%, T3 59.4%, T4 100%, p < 0.0005) and TNM stage (stage I 11.8%, stage II 79.2%, stage III 64.3%, stage IV 100%, p < 0.0005) were correlated with the positive rate of M-CTCs. We also found that the proportion of M-CTCs was correlated with the T stage (p < 0.0005) and TNM stage (p=0.0200), but not with the N stage (p=0.6889). In survival analysis, M-CTCs >1 were found associated with worse disease-free survival (p=0.007). After treatment, the number and proportion of CTCs and M-CTCs were significantly reduced. CONCLUSION The positive rate of M-CTCs was associated with tumor size, T stage, TNM stage, vascular invasion, and CEA. As the disease progressed, the proportion of M-CTCs gradually increased, and the survival performance was worse in patients with a high positive rate of M-CTCs.
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Affiliation(s)
- Yuchen Zhong
- Department of Colorectal Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, 150080, People’s Republic of China
- Department of Colorectal Surgery, The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Hangzhou, Zhejiang, 310002, People’s Republic of China
| | - Tianyi Ma
- Department of Colorectal Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, 150080, People’s Republic of China
| | - Tianyu Qiao
- Department of Colorectal Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, 150080, People’s Republic of China
| | - Hanqing Hu
- Department of Colorectal Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, 150080, People’s Republic of China
| | - Zhengliang Li
- Department of Colorectal Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, 150080, People’s Republic of China
| | - Kangjia Luo
- Department of Colorectal Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, 150080, People’s Republic of China
| | - Yuliuming Wang
- Department of Colorectal Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, 150080, People’s Republic of China
| | - Qingchao Tang
- Department of Colorectal Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, 150080, People’s Republic of China
| | - Guiyu Wang
- Department of Colorectal Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, 150080, People’s Republic of China
- Department of Colorectal Surgery, The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Hangzhou, Zhejiang, 310002, People’s Republic of China
| | - Rui Huang
- Department of Colorectal Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, 150080, People’s Republic of China
| | - Xishan Wang
- Department of Colorectal Surgery, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Science and Peking Union Medical College, National Clinical Research Center for Cancer, Beijing, 100021, People’s Republic of China
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14
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Rocca A, Scacchi A, Cappuccio M, Avella P, Bugiantella W, De Rosa M, Costa G, Polistena A, Codacci-Pisanelli M, Amato B, Carbone F, Ceccarelli G. Robotic surgery for colorectal liver metastases resection: A systematic review. Int J Med Robot 2021; 17:e2330. [PMID: 34498805 DOI: 10.1002/rcs.2330] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 08/10/2021] [Accepted: 09/07/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND The role of robotic surgery for colorectal cancer liver metastases (CRCLMs) has never been investigated in large series. METHODS A systematic literature review was carried out on PubMed and Cochrane libraries. RESULTS We selected nine studies between 2008 and 2021. Two hundred sixty-two patients were included. One hundred thirty-one patients underwent simultaneous resections. The mean blood loss was 309.4 ml (range, 200-450 ml), the mean operative time was 250.5 min (range, 198.5-449.0 min). The mean length of hospital stay was 7.98 days (range, 4.5 to 12 days). The overall postoperative mortality was 0.4%. The overall morbidity rate was 37.0%, Clavien-Dindo grade III-IV complications were 8.4%. The mean 3-year overall survival was 55.25% (range, 44.4-66.1%), the mean 3-year disease free survival was 37% (range, 33.3-41.9%) CONCLUSION: We can conclude that robotic-assisted surgery might be considered as a technical upgrade option for minimally invasive approach to CRCLM resections even for simultaneous operations and challenging cases.
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Affiliation(s)
- Aldo Rocca
- Department of Medicine and Health Sciences "V. Tiberio", University of Molise, Campobasso, Italy
| | - Andrea Scacchi
- Department of Medicine and Health Sciences "V. Tiberio", University of Molise, Campobasso, Italy
| | - Micaela Cappuccio
- Department of Medicine and Health Sciences "V. Tiberio", University of Molise, Campobasso, Italy
| | - Pasquale Avella
- Department of Medicine and Health Sciences "V. Tiberio", University of Molise, Campobasso, Italy
| | - Walter Bugiantella
- General Surgery Department, ASL 2 Umbria, San Giovanni Battista, Foligno, Italy
| | - Michele De Rosa
- General Surgery Department, ASL 2 Umbria, San Giovanni Battista, Foligno, Italy
| | - Gianluca Costa
- Department of Medical and Surgical Sciences and Translational Medicine, Faculty of Medicine and Psychology, St Andrea Hospital, Sapienza University, Rome, Italy
| | - Andrea Polistena
- UOC General Surgery and Laparoscopic Surgery, Department of Surgery "P. Valdoni", Sapienza, University of Study of Rome, University Policlinic Umberto I, Rome, Italy
| | - Massimo Codacci-Pisanelli
- UOC General Surgery and Laparoscopic Surgery, Department of Surgery "P. Valdoni", Sapienza, University of Study of Rome, University Policlinic Umberto I, Rome, Italy
| | - Bruno Amato
- Division of General Surgery, Department of Clinical Medicine and Surgery, School of Medicine, University of Naples "Federico II", Naples, Italy
| | - Fabio Carbone
- Department of Advanced Biomedical Sciences, Università di Napoli - "Federico II", Naples, Italy
| | - Graziano Ceccarelli
- General Surgery Department, ASL 2 Umbria, San Giovanni Battista, Foligno, Italy
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15
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Lopez-Lopez V, Gómez Ruiz A, Pelegrin P, Abellán B, Lopez-Conesa A, Brusadin R, Cayuela V, García A, Robles Campos R. Impact of Immune Response in Short-term and Long-term Outcomes After Minimally Invasive Surgery for Colorectal Liver Metastases: Results From a Randomized Study. Surg Laparosc Endosc Percutan Tech 2021; 31:690-696. [PMID: 34292210 DOI: 10.1097/sle.0000000000000980] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 05/07/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND The potential benefit related to laparoscopic liver surgery (LLS) for colorectal liver metastases outcomes is not well known. MATERIALS AND METHODS Serum cytokines associated with Th1 (tumor necrosis factor-α) and Th2 [interleukin (IL)-10 and IL-6] phenotypes were measured in 36 patients operated on for colorectal liver metastases by open liver surgery (OLS) and LLS. Measurements were performed at 3 time points: 1 day before surgery, day 3 postoperative, and 1 month postoperative. We compared the postoperative inflammatory response influence between LLS and OLS on long-term outcomes. RESULTS In both groups, only IL-6 levels on day 3 postoperative were higher than those measured preoperatively and at 1 month. Comparing the tumor necrosis factor-α levels between the LLS and OLS groups, preoperative (7.28 vs. 2.36), day 3 (7.99 vs. 4.08) and 1 month (7.39 vs. 1.99) postoperative levels were higher in the OLS group (P<0.01, <0.01, and <0.01, respectively). In contrast, IL-10 levels were higher in the LLS group preoperatively (7.51 vs. 4.57) and on day 3 postoperative (13.40 vs. 4.57) (P=0.03 and 0.01, respectively). A cut-off IL-6 level of ≥4.41 in the first month was associated with a higher risk of recurrence (logrank=4.8, P=0.02). CONCLUSIONS Both LLS and OLS induce an initial increase in IL-6 that normalizes one month after surgery, showing a similar pattern. In addition, a cut-off IL-6 value of 4.41 pg/mL was established, with a higher concentration at 1 month postoperative possibly related to a higher risk or recurrence.
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Affiliation(s)
- Victor Lopez-Lopez
- Departments of Surgery
- Biomedical Research Institute of Murcia (IMIB), Clinical University Hospital Virgen de la Arrixaca
| | - Alvaro Gómez Ruiz
- Departments of Surgery
- Biomedical Research Institute of Murcia (IMIB), Clinical University Hospital Virgen de la Arrixaca
| | | | - Beatriz Abellán
- Department of Surgery, Reina Sofía University Hospital, Murcia, Spain
| | - Asunción Lopez-Conesa
- Departments of Surgery
- Biomedical Research Institute of Murcia (IMIB), Clinical University Hospital Virgen de la Arrixaca
| | - Roberto Brusadin
- Departments of Surgery
- Biomedical Research Institute of Murcia (IMIB), Clinical University Hospital Virgen de la Arrixaca
| | - Valentin Cayuela
- Departments of Surgery
- Biomedical Research Institute of Murcia (IMIB), Clinical University Hospital Virgen de la Arrixaca
| | - Ana García
- Inmunology, Virgen de la Arrixaca Clinic and University Hospital, Biomedical Research Institute of Murcia-Virgen de la Arrixaca (IMIB-Arrixaca)
| | - Ricardo Robles Campos
- Departments of Surgery
- Biomedical Research Institute of Murcia (IMIB), Clinical University Hospital Virgen de la Arrixaca
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16
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Tanaka K, Yamasaki M, Sugimura K, Shiraishi O, Motoori M, Hamakawa T, Takeno A, Yamashita K, Makino T, Kimura Y, Miyata H, Hirao M, Eguchi H, Yasuda T, Yano M, Doki Y. Thoracic Duct Resection Has a Favorable Impact on Prognosis by Preventing Hematogenous Spread of Esophageal Cancer Cells: A Multi-institutional Analysis of 2269 Patients. Ann Surg Oncol 2021; 28:4402-4410. [PMID: 33861403 DOI: 10.1245/s10434-021-09962-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 02/19/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND The impact of thoracic duct (TD) resection on prognosis is controversial. This study aimed to examine the impact of TD resection. METHODS In this six-institution, matched-cohort study, 2269 consecutive patients with esophageal squamous cell carcinoma who underwent esophagectomy between 2000 and 2017 were enrolled for analysis of long-term outcomes, including overall survival (OS), disease-free survival (DFS), cause-specific survival (CSS), and recurrence patterns. RESULTS Based on a propensity score, 642 TD-resected and 642 TD-preserved patients with all stages of disease were selected. At 5 years, the TD-resected group had an OS of 57.7%, a DFS of 50.9%, and a CSS of 62.2%. These rates were significantly higher than the corresponding rates of 48.7% (p = 0.0078), 41.0% (p = 0.0297), and 55.3% (p = 0.0473) in the TD-preserved group. The OS in the TD-preserved and TD-resected groups was similar for the patients with cStage 1 or 2 (p = 0.6265), but it was significantly higher in the TD-resected group for the patients with cStage 3 or 4 (p = 0.0052). The incidence of total recurrence did not differ between the two groups. However, the incidence of hematogenous recurrence in the TD-resected group (19.0%) was significantly lower than in the TD-preserved group (26.2%) (p = 0.0021). For cT4a tumors, the incidence of local recurrence in the TD-resected group (2.4%) was significantly lower than in the TD-preserved group (18.4%) (p = 0.0183). CONCLUSIONS Performance of TD resection may help to improve prognosis, especially for patients with advanced esophageal squamous cell carcinoma, by reducing hematogenous and local recurrence. Prospective trials are needed to determine whether prophylactic TD resection has a positive impact on the prognosis of patients with esophageal cancer.
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Affiliation(s)
- Koji Tanaka
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Suita City, Osaka, Japan.
| | - Makoto Yamasaki
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Suita City, Osaka, Japan
| | - Keijiro Sugimura
- Department of Digestive Surgery, Osaka International Cancer Institute, Osaka, Japan
| | - Osamu Shiraishi
- Department of Surgery, Kindai University Faculty of Medicine, Osaka, Japan
| | - Masaaki Motoori
- Department of Surgery, Osaka General Medical Center, Osaka, Japan
| | - Takuya Hamakawa
- Department of Surgery, National Hospital Organization Osaka National Hospital, Osaka, Japan
| | - Atsushi Takeno
- Department of Surgery, Kansai Rosai Hospital, Amagasaki, Hyogo, Japan
| | - Kotaro Yamashita
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Suita City, Osaka, Japan
| | - Tomoki Makino
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Suita City, Osaka, Japan
| | - Yutaka Kimura
- Department of Surgery, Kindai University Faculty of Medicine, Osaka, Japan
| | - Hiroshi Miyata
- Department of Digestive Surgery, Osaka International Cancer Institute, Osaka, Japan
| | - Motohiro Hirao
- Department of Surgery, National Hospital Organization Osaka National Hospital, Osaka, Japan
| | - Hidetoshi Eguchi
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Suita City, Osaka, Japan
| | - Takushi Yasuda
- Department of Surgery, Kindai University Faculty of Medicine, Osaka, Japan
| | - Masahiko Yano
- Department of Digestive Surgery, Osaka International Cancer Institute, Osaka, Japan
| | - Yuichiro Doki
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Suita City, Osaka, Japan
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17
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Heinrich S, Lang H. [Evidence of minimally invasive oncological surgery of the liver]. Chirurg 2021; 92:316-325. [PMID: 33449156 DOI: 10.1007/s00104-020-01338-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/14/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND The evidence for minimally invasive surgery (MIS) of the liver has significantly increased with the increasing number of publications on this topic in recent years; however, this technique has not yet gained broad acceptance among surgeons. OBJECTIVE Analysis and presentation of the current literature on MIS of the liver. MATERIAL UND METHODS Structured PubMed literature search and analysis. RESULTS According to the literature, MIS and open liver surgery are equivalent regarding the oncological quality. In addition to parenchyma-preserving resections, major hepatectomies (e.g. hemihepatectomy and sectorectomy), two-stage concepts and re-resections have increasingly been reported. The MIS of the liver is associated with less blood loss and other immunological advantages in addition to a shorter hospital stay. The highest level of evidence has been achieved for colorectal liver metastases for which a systematic review even revealed a survival benefit for patients undergoing MIS surgery. From an oncological perspective, laparoscopic and robotic liver surgery are considered to be equivalent. CONCLUSION According to the current literature MIS of the liver is recommended for the resection of colorectal liver metastases and hepatocellular carcinoma.
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Affiliation(s)
- Stefan Heinrich
- Klinik f. Allgemein‑, Viszeral- und Transplantationschirurgie, Universitätsmedizin Mainz, Langenbeckstraße 1, 55131, Mainz, Deutschland
| | - Hauke Lang
- Klinik f. Allgemein‑, Viszeral- und Transplantationschirurgie, Universitätsmedizin Mainz, Langenbeckstraße 1, 55131, Mainz, Deutschland.
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18
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Zhang H, Guo K, Sun X, Liu Y, Zhong Z, Zhou W, Zeng W, Wang L, Cata JP, Chen W, Miao C. Impact of anesthesia methods on perioperative systemic inflammation and long-term outcomes in patients undergoing surgery for hepatocellular carcinoma: a propensity score-matched analysis. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:49. [PMID: 33553342 PMCID: PMC7859754 DOI: 10.21037/atm-20-3704] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Background Recent studies have shown regional anesthesia might improve the survival of cancer patients. We hypothesized that general-epidural anesthesia (GEA) was associated with longer survival than general anesthesia (GA) in patients undergoing hepatocellular carcinoma (HCC) resections. Methods A retrospective study included patients who received curative resection for HCC between January 2014 to December 2017. Patients were grouped in GEA vs. GA. After propensity score matching, perioperative inflammatory scores were calculated. Grade of postoperative complications, length of stay (LOS), dosage of sufentanil used and times of patients requiring rescue analgesia in both groups were compared for intraoperative and postoperative parameter. Survival curves were constructed from the date of surgery to death, univariable and multivariable Cox regression models were used to compare hazard ratios for death. Results A total of 772 patients were included in the study. With 386 patients in GA group and 386 patients in GEA group. After propensity score matching, the demographic and baseline biomarkers in the two groups were similar. Patients in GEA group showed significantly lower inflammatory scores. Grade of postoperative complications, LOS, opioid use, and times of patients requiring rescue analgesia was significantly lower in the GEA group. The overall survival (OS) and disease-free survival (DFS) rate was significantly lower in the GA group (54.2% vs. 62.3%, 41.2% vs. 52.5%, P<0.001). The multivariate analysis indicated the GA was associated with shorter OS (HR: 1.28, 95% CI: 1.07–2.02, P<0.001) and DFS (HR: 1.06, 95% CI: 1.03–1.71, P<0.001). Conclusions GA combined with epidural anesthesia is associated with lower levels of inflammation, and longer survival in patients undergoing hepatectomy.
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Affiliation(s)
- Hao Zhang
- Department of Anesthesiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Kefang Guo
- Department of Anesthesiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Xingfeng Sun
- Department of Anesthesiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yi Liu
- Department of Anesthesiology, Fudan University Shanghai Cancer Centre, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Ziwen Zhong
- Department of Anesthesiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Wenchang Zhou
- Department of Anesthesiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Weian Zeng
- Department of Anesthesiology, Sun Yat-sen University Cancer Centre, State Key Laboratory of Oncology in South China, Collaborative Innovation Centre for Cancer Medicine, Guangzhou, China
| | - Lu Wang
- Department of Liver Surgery, Shanghai Cancer Center, Shanghai Medical College, Fudan University, Shanghai, China
| | - Juan P Cata
- Department of Anesthesiology and Perioperative Medicine, The University of Texas MD Anderson Cancer Centre, Houston, USA.,Anaesthesiology and Surgical Oncology Research Group, Houston, USA
| | - Wankun Chen
- Department of Anesthesiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Changhong Miao
- Department of Anesthesiology, Zhongshan Hospital, Fudan University, Shanghai, China
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Hornock S, Ellis O, Dilday J, Bader J, Clapp B, Ahnfeldt E. The safety of additional procedures at the time of revisional bariatric surgery. Surg Endosc 2020; 35:3940-3948. [PMID: 32780241 DOI: 10.1007/s00464-020-07856-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 07/28/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND The third most common bariatric operation is revisions of previous bariatric surgeries. Patients may require revisional bariatric surgery for inadequate weight loss or complications. Patients undergoing revisional bariatric surgery may also have other conditions that require surgery. This study evaluates the 30-day postoperative outcomes of patients undergoing revisional bariatric surgery and additional procedures. METHODS A retrospective review of the 2005-2017 ACS NSQIP database identified 7249 patients who underwent revisional bariatric surgery with 3115 (48%) occurring with additional procedures. A 1:1 propensity score matching analysis was completed for 13 patient demographics and comorbidities. Postoperative variables were then analyzed as available in the NSQIP database. Subgroup analyses were completed for those undergoing paraesophageal hernia repair and abdominal wall hernia repair at the time of revisional bariatric surgery. RESULTS The most common bariatric surgery that was converted or revised was the AGB (57%) and the most common additional procedure was paraesophageal hernia repair (n = 181, 15%). When additional procedures were completed at the time of revisional bariatric surgery, overall complications (p < 0.001), major systemic complications (p = 0.009) and mortality/major complications (p = 0.018) were all significantly increased. After matching for operative time, only postoperative sepsis remained significant with additional procedures (p = 0.042). In the subgroup analyses on paraesophageal and abdominal wall hernias there were no differences in postoperative complications after matching for operative time. CONCLUSIONS Additional procedures, including paraesophageal and abdominal wall hernia repairs at the time of revisional bariatric surgery increase postoperative complications. Operative time was longer when additional procedures were performed. Postoperative sepsis was the only complication which remained significant after propensity matching when additional procedures are completed at the time of revisional bariatric surgery.
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Affiliation(s)
- Sasha Hornock
- Department of Surgery, William Beaumont Army Medical Center, 5005 North Piedras Street, El Paso, TX, 79930, USA.
| | - Oriana Ellis
- Department of Surgery, William Beaumont Army Medical Center, 5005 North Piedras Street, El Paso, TX, 79930, USA
| | - Joshua Dilday
- Department of Surgery, William Beaumont Army Medical Center, 5005 North Piedras Street, El Paso, TX, 79930, USA
| | - Julia Bader
- Department of Surgery, William Beaumont Army Medical Center, 5005 North Piedras Street, El Paso, TX, 79930, USA
| | - Benjamin Clapp
- Department of Surgery, Texas Tech Health Sciences Center, El Paso, TX, USA
| | - Eric Ahnfeldt
- Department of Surgery, William Beaumont Army Medical Center, 5005 North Piedras Street, El Paso, TX, 79930, USA
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20
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Oncological Resection for Liver Malignancies: Can the Laparoscopic Approach Provide Benefits? Ann Surg 2020; 275:182-188. [PMID: 32224729 DOI: 10.1097/sla.0000000000003851] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
: Laparoscopic surgery has become an increasingly popular alternative approach to open surgery, resulting in a paradigm shift in liver surgery. Although laparoscopic liver resection (LLR) was initially indicated for small benign and peripheral tumors, at present more than half of LLRs are performed in malignant tumors. Several studies have reported the feasibility of LLR in malignant disease and suggested various short-term benefits compared to open liver resection, including decreased blood loss and postoperative complications and a shorter hospital stay. Although these benefits are important to surgeons, patients, and providers, the main goal of surgery for malignancies is to achieve a maximum oncologic benefit.The relevance of the laparoscopic approach must be assessed in relation to the possibility of respecting basic oncological rules and the expertise of the center. Easy LLRs can be safely performed by most surgeons with minimum expertise in liver surgery and laparoscopy, and can therefore probably provide an oncological benefit. On the other hand, intermediate or difficult LLRs require technical expertise and an oncological benefit can only be achieved in expert centers. Technical standardization is the only way to obtain an oncological benefit with this type of resection, and many problems must still be solved.
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21
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Cao J, Li WD, Zhou R, Shang CZ, Zhang L, Zhang HW, Lau WY, Chen YJ. Totally laparoscopic anatomic S7 segmentectomy using in situ split along the right intersectoral and intersegmental planes. Surg Endosc 2020; 35:174-181. [PMID: 31993823 DOI: 10.1007/s00464-020-07376-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Accepted: 01/06/2020] [Indexed: 01/11/2023]
Abstract
BACKGROUND The traditional open or laparoscopic segmentectomy of liver segment 7 (S7) requires exposing and controlling the root of the right hepatic vein(RHV)after full mobilization and lifting up of the right liver before liver transection. This approach violates the "no-touch" principle for malignant tumors, and makes laparoscopic resection technically challenging. So reports on isolated totally laparoscopic anatomic S7 segmentectomy have rarely been reported. This study describes our experience in laparoscopic anatomic S7 segmentectomy using in situ split along the right intersectoral and intersegmental planes of the liver. To our knowledge, this is the first description of this novel approach. METHODS From September 2017 to May 2019, patients who underwent laparoscopic anatomic S7 segmentectomy for hepatocellular carcinoma at the HPB Surgery Department, Sun Yat-Sen Memorial Hospital entered into this retrospective study. This in situ split approach was designed using main vessels as the plane markers of right intersectoral and intersegmental planes, along which liver transection was carried out. There was no need to mobilize the right liver and control the root of RHV. RESULTS There were 9 women and 15 men. The average diameter of the tumors on preoperative CT/MR was 3.4 cm (range 2-6 cm). All the procedures were successfully carried out laparoscopically. There was no perioperative death. The average operative time was 216.5 min (range 180-310 min). The average blood loss was 320 ml (range 120-620 ml). Pathological study showed all the operations to be R0 resections. CONCLUSION Laparoscopic anatomic S7 segmentectomy using the in situ split approach resulted in R0 liver resection in all our patients with primary liver cancer. The operation was technically feasible and it provided a better view and increased maneuverability in the cramped operative space compared with the traditional open/laparoscopic approach. The approach also better complies with the "no-touch" principle for malignant tumors. Its long-term oncological outcomes require further studies.
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Affiliation(s)
- Jun Cao
- Department of Hepatobiliopancreatic Surgery, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Yanjiangxi road 107#, Guangzhou, China
| | - Wen-da Li
- Department of Hepatobiliopancreatic Surgery, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Yanjiangxi road 107#, Guangzhou, China
| | - Rui Zhou
- Department of Hepatobiliopancreatic Surgery, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Yanjiangxi road 107#, Guangzhou, China
| | - Chang-Zhen Shang
- Department of Hepatobiliopancreatic Surgery, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Yanjiangxi road 107#, Guangzhou, China
| | - Lei Zhang
- Department of Hepatobiliopancreatic Surgery, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Yanjiangxi road 107#, Guangzhou, China
| | - Hong-Wei Zhang
- Department of Hepatobiliopancreatic Surgery, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Yanjiangxi road 107#, Guangzhou, China
| | - Wan Yee Lau
- Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong.
| | - Ya-Jin Chen
- Department of Hepatobiliopancreatic Surgery, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Yanjiangxi road 107#, Guangzhou, China.
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Kumar A, Acharya SK, Singh SP, Arora A, Dhiman RK, Aggarwal R, Anand AC, Bhangui P, Chawla YK, Datta Gupta S, Dixit VK, Duseja A, Kalra N, Kar P, Kulkarni SS, Kumar R, Kumar M, Madhavan R, Mohan Prasad V, Mukund A, Nagral A, Panda D, Paul SB, Rao PN, Rela M, Sahu MK, Saraswat VA, Shah SR, Shalimar, Sharma P, Taneja S, Wadhawan M. 2019 Update of Indian National Association for Study of the Liver Consensus on Prevention, Diagnosis, and Management of Hepatocellular Carcinoma in India: The Puri II Recommendations. J Clin Exp Hepatol 2020; 10:43-80. [PMID: 32025166 PMCID: PMC6995891 DOI: 10.1016/j.jceh.2019.09.007] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 09/15/2019] [Indexed: 01/27/2023] Open
Abstract
Hepatocellular carcinoma (HCC) is one of the major causes of morbidity, mortality, and healthcare expenditure in patients with chronic liver disease in India. The Indian National Association for Study of the Liver (INASL) had published its first guidelines on diagnosis and management of HCC (The Puri Recommendations) in 2014, and these guidelines were very well received by the healthcare community involved in diagnosis and management of HCC in India and neighboring countries. However, since 2014, many new developments have taken place in the field of HCC diagnosis and management, hence INASL endeavored to update its 2014 consensus guidelines. A new Task Force on HCC was constituted that reviewed the previous guidelines as well as the recent developments in various aspects of HCC that needed to be incorporated in the new guidelines. A 2-day round table discussion was held on 5th and 6th May 2018 at Puri, Odisha, to discuss, debate, and finalize the revised consensus statements. Each statement of the guideline was graded according to the Grading of Recommendations Assessment Development and Evaluation system with minor modifications. We present here the 2019 Update of INASL Consensus on Prevention, Diagnosis, and Management of Hepatocellular Carcinoma in India: The Puri-2 Recommendations.
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Key Words
- AFP, alpha-fetoprotein
- AIH, autoimmune hepatitis
- ALT, alanine aminotransferase
- DAA, direct-acting antiviral
- DALY, disability-adjusted life-year
- DNA, deoxyribonucleic acid
- GRADE, Grading of Recommendations Assessment Development and Evaluation
- Gd-BOPTA, gadolinium benzyloxypropionictetraacetate
- Gd-EOB-DTPA, gadolinium ethoxybenzyl diethylenetriamine penta-acetic acid
- HBV, hepatitis B virus
- HBeAg, hepatitis B envelope antigen
- HCC, hepatocellular carcinoma
- HIV, human immunodeficiency virus
- IARC, International Agency for Research on Cancer
- IFN, interferon
- INASL, Indian National Association for Study of the Liver
- MiRNA, micro-RNA
- NAFLD, non-alcoholic fatty liver disease
- NASH, non-alcoholic steatohepatitis
- PIVKA, protein induced by vitamin K absence
- RFA
- RNA, ribonucleic acid
- SVR, sustained virological response
- TACE
- TACE, trans-arterial chemoembolization
- TARE, transarterial radioembolization
- TNF, tumor necrosis factor
- WHO, World Health Organization
- liver cancer
- targeted therapy
- transplant
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Affiliation(s)
- Ashish Kumar
- Institute of Liver Gastroenterology & Pancreatico Biliary Sciences, Sir Ganga Ram Hospital, Rajinder Nagar, New Delhi, 110 060, India
| | - Subrat K. Acharya
- Department of Gastroenterology and Hepatology, KIIT University, Patia, Bhubaneswar, Odisha, 751 024, India
| | - Shivaram P. Singh
- Department of Gastroenterology, SCB Medical College, Cuttack, Dock Road, Manglabag, Cuttack, Odisha, 753 007, India
| | - Anil Arora
- Institute of Liver Gastroenterology & Pancreatico Biliary Sciences, Sir Ganga Ram Hospital, Rajinder Nagar, New Delhi, 110 060, India
| | - Radha K. Dhiman
- Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160 012, India
| | - Rakesh Aggarwal
- Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Raebareli Road, Lucknow, Uttar Pradesh, 226 014, India
| | - Anil C. Anand
- Department of Gastroenterology, Indraprastha Apollo Hospital, Sarita Vihar, New Delhi, 110 076, India
| | - Prashant Bhangui
- Medanta Institute of Liver Transplantation and Regenerative Medicine, Medanta the Medicity, CH Baktawar Singh Road, Sector 38, Gurugram, Haryana, 122 001, India
| | - Yogesh K. Chawla
- Department of Gastroenterology, Kalinga Institute of Medical Sciences (KIMS), Kushabhadra Campus (KIIT Campus-5), Patia, Bhubaneswar, Odisha, 751 024, India
| | - Siddhartha Datta Gupta
- Department of Pathology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110 029, India
| | - Vinod K. Dixit
- Department of Gastroenterology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, 221 005, India
| | - Ajay Duseja
- Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160 012, India
| | - Naveen Kalra
- Department of Radio Diagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, 160 012, India
| | - Premashish Kar
- Department of Gastroenterology and Hepatology, Max Super Speciality Hospital, Vaishali, Ghaziabad, Uttar Pradesh, 201 012, India
| | - Suyash S. Kulkarni
- Division of Interventional Radiology, Tata Memorial Hospital, Dr. E Borges Road, Parel, Mumbai, Maharashtra, 400 012, India
| | - Rakesh Kumar
- Department of Nuclear Medicine, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110 029, India
| | - Manoj Kumar
- Department of Hepatology, Institute of Liver & Biliary Sciences, Sector D-1, Vasant Kunj, New Delhi, 110 070, India
| | - Ram Madhavan
- Department of Radiation Oncology, Amrita Institute of Medical Sciences, Amrita University, Peeliyadu Road, Ponekkara, Edappally, Kochi, Kerala, 682 041, India
| | - V.G. Mohan Prasad
- Department of Gastroenterology, VGM Gastro Centre, 2100, Trichy Road, Rajalakshmi Mills Stop, Singanallur, Coimbatore, Tamil Nadu, 641 005, India
| | - Amar Mukund
- Department of Radiology, Institute of Liver & Biliary Sciences, Sector D-1, Vasant Kunj, New Delhi, 110 070, India
| | - Aabha Nagral
- Department of Gastroenterology, Jaslok Hospital & Research Centre, 15, Dr Deshmukh Marg, Pedder Road, Mumbai, Maharashtra, 400 026, India
| | - Dipanjan Panda
- Department of Oncology, Institutes of Cancer, Indraprastha Apollo Hospital, Sarita Vihar, New Delhi, 110 076, India
| | - Shashi B. Paul
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110 029, India
| | - Padaki N. Rao
- Department of Medical Gastroenterology, Asian Institute of Gastroenterology, No. 6-3-661, Punjagutta Road, Somajiguda, Hyderabad, Telangana, 500 082, India
| | - Mohamed Rela
- The Institute of Liver Disease & Transplantation, Gleneagles Global Health City, 439, Cheran Nagar, Perumbakkam, Chennai, Tamil Nadu, 600 100, India
| | - Manoj K. Sahu
- Department of Medical Gastroenterology, IMS & SUM Hospital, K8 Kalinga Nagar, Shampur, Bhubaneswar, Odisha 751 003, India
| | - Vivek A. Saraswat
- Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Raebareli Road, Lucknow, Uttar Pradesh, 226 014, India
| | - Samir R. Shah
- Department of Gastroenterology, Jaslok Hospital & Research Centre, 15, Dr Deshmukh Marg, Pedder Road, Mumbai, Maharashtra, 400 026, India
| | - Shalimar
- Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110 029, India
| | - Praveen Sharma
- Institute of Liver Gastroenterology & Pancreatico Biliary Sciences, Sir Ganga Ram Hospital, Rajinder Nagar, New Delhi, 110 060, India
| | - Sunil Taneja
- Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160 012, India
| | - Manav Wadhawan
- Liver & Digestive Diseases Institute, Institute of Liver & Digestive Diseases, BLK Super Specialty Hospital, Delhi, 110 005, India
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Liu T, Ma Q, Zhang Y, Wang X, Xu K, Yan K, Dong W, Fan Q, Zhang Y, Qiu X. Self-seeding circulating tumor cells promote the proliferation and metastasis of human osteosarcoma by upregulating interleukin-8. Cell Death Dis 2019; 10:575. [PMID: 31366916 PMCID: PMC6668432 DOI: 10.1038/s41419-019-1795-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Revised: 06/24/2019] [Accepted: 06/27/2019] [Indexed: 01/21/2023]
Abstract
Most circulating tumor cells (CTCs) die during the process of metastasis, but self-seeding CTCs can invade the primary tumor or form clinically meaningful metastases. This study aimed to evaluate the capacity of self-seeding CTCs to promote osteosarcoma growth and lung metastasis and to clarify the specific role of interleukin (IL)-8 in CTC self-seeding. We successfully isolated and cultured self-seeding CTCs through a self-seeding nude mouse model established using green fluorescent protein (GFP)-labeled F5M2 cells and found that self-seeding CTCs exhibit increased cellular proliferation, migration, and invasion in vitro, increased tumor growth and lung metastasis in mice, and increased IL-8 expression. Furthermore, suppressing IL-8 inhibited tumor growth and metastasis and reduced CTC seeding in primary tumors in vitro and in vivo. In osteosarcoma patients, IL-8 levels significantly correlated with the Enneking stage and metastasis. These findings demonstrate that self-seeding osteosarcoma CTCs can promote tumor growth and lung metastasis through IL-8. Their increased metastatic potential and elevated IL-8 expression suggest a novel strategy for future therapeutic interventions to prevent osteosarcoma progression and metastasis.
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Affiliation(s)
- Tao Liu
- State Key Laboratory of Cancer Biology, Biotechnology Center, School of Pharmacy, The Fourth Military Medical University, 169 Changle West Road, Xi'an, 710032, Shanxi, China.,Orthopaedic Oncology Institute, Tangdu Hospital, Fourth Military Medical University, 1 Xinsi Road, Xi'an, 710032, Shanxi, China
| | - Qiong Ma
- Orthopaedic Oncology Institute, Tangdu Hospital, Fourth Military Medical University, 1 Xinsi Road, Xi'an, 710032, Shanxi, China
| | - Yinglong Zhang
- Department of Orthopaedics, First Affiliated Hospital of PLA General Hospital, 100048, Beijing, China
| | - Xin Wang
- Rehabilitation Center of Lintong Sanatorium of PLA, No. 32 Huaqing Road, Lintong District, Xi'an, 710600, Shanxi, China
| | - Kui Xu
- Orthopaedic Oncology Institute, Tangdu Hospital, Fourth Military Medical University, 1 Xinsi Road, Xi'an, 710032, Shanxi, China
| | - Kang Yan
- Orthopaedic Oncology Institute, Tangdu Hospital, Fourth Military Medical University, 1 Xinsi Road, Xi'an, 710032, Shanxi, China
| | - Wengang Dong
- Orthopaedic Oncology Institute, Tangdu Hospital, Fourth Military Medical University, 1 Xinsi Road, Xi'an, 710032, Shanxi, China
| | - Qingyu Fan
- Orthopaedic Oncology Institute, Tangdu Hospital, Fourth Military Medical University, 1 Xinsi Road, Xi'an, 710032, Shanxi, China
| | - Yingqi Zhang
- State Key Laboratory of Cancer Biology, Biotechnology Center, School of Pharmacy, The Fourth Military Medical University, 169 Changle West Road, Xi'an, 710032, Shanxi, China.
| | - Xiuchun Qiu
- Orthopaedic Oncology Institute, Tangdu Hospital, Fourth Military Medical University, 1 Xinsi Road, Xi'an, 710032, Shanxi, China.
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Krzystek-Korpacka M, Zawadzki M, Lewandowska P, Szufnarowski K, Bednarz-Misa I, Jacyna K, Witkiewicz W, Gamian A. Distinct Chemokine Dynamics in Early Postoperative Period after Open and Robotic Colorectal Surgery. J Clin Med 2019; 8:jcm8060879. [PMID: 31248170 PMCID: PMC6616914 DOI: 10.3390/jcm8060879] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Revised: 05/29/2019] [Accepted: 06/17/2019] [Indexed: 01/13/2023] Open
Abstract
Stress response to robot-assisted colorectal surgery is largely unknown. Therefore, we conducted a prospective comparative nonrandomized study evaluating the perioperative dynamics of chemokines: IL-8/CXCL8, MCP-1/CCL2, MIP-1α/CCL3, MIP-1β/CCL4, RANTES/CCL5, and eotaxin-1/CCL11 in 61 colorectal cancer patients following open colorectal surgery (OCS) or robot-assisted surgery (RACS) in reference to clinical data. Postoperative IL-8 and MCP-1 increase was reduced in RACS with a magnitude of blood loss, length of surgery, and concomitant up-regulation of IL-6 and TNFα as its independent predictors. RANTES at 8 h dropped in RACS and RANTES, and MIP1α/β at 24 h were more elevated in RACS than OCS. IL-8 and MCP-1 at 72 h remained higher in patients subsequently developing surgical site infections, in whom a 2.6- and 2.5-fold increase was observed. IL-8 up-regulation at 24 h in patients undergoing open procedure was predictive of anastomotic leak (AL; 94% accuracy). Changes in MCP-1 and RANTES were predictive of delayed restoration of bowel function. Chemokines behave differently depending on procedure. A robot-assisted approach may be beneficial in terms of chemokine dynamics by favoring Th1 immunity and attenuated angiogenic potential and postoperative ileus. Monitoring chemokine dynamics may prove useful for predicting adverse clinical events. Attenuated chemokine up-regulation results from less severe blood loss and diminished inflammatory response.
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Affiliation(s)
| | - Marek Zawadzki
- Department of Oncological Surgery, Regional Specialist Hospital, 51-124 Wroclaw, Poland.
| | - Paulina Lewandowska
- Department of Medical Biochemistry, Wroclaw Medical University, 50-368 Wroclaw, Poland.
| | | | - Iwona Bednarz-Misa
- Department of Medical Biochemistry, Wroclaw Medical University, 50-368 Wroclaw, Poland.
| | - Krzysztof Jacyna
- Department of Oncological Surgery, Regional Specialist Hospital, 51-124 Wroclaw, Poland.
| | - Wojciech Witkiewicz
- Department of Oncological Surgery, Regional Specialist Hospital, 51-124 Wroclaw, Poland.
- Research and Development Centre at Regional Specialist Hospital, 51-124 Wroclaw, Poland.
| | - Andrzej Gamian
- Department of Medical Biochemistry, Wroclaw Medical University, 50-368 Wroclaw, Poland.
- Laboratory of Medical Microbiology, Ludwik Hirszfeld Institute of Immunology and Experimental Therapy, Polish Academy of Sciences, 53-114 Wroclaw, Poland.
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25
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Zhang L, Ren L, Shan K, Guo X, Wang J, Cui B, An J. Serum Inflammatory Cytokines Comparison in Gastric Cancer Therapy. Open Med (Wars) 2019; 14:300-306. [PMID: 30931396 PMCID: PMC6434663 DOI: 10.1515/med-2019-0027] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Accepted: 11/19/2018] [Indexed: 01/22/2023] Open
Abstract
To compare serum inflammatory cytokines between laparoscopic-assisted and open radical gastrectomy in the perioperative period, 80 cases of advanced gastric cancer were chosen for the study. They were divided into laparoscopy group (40 cases) and abdominal open surgery group (40 cases), performed laparoscopic-assisted radical gastrostomy and conventional open radical gastrectomy, respectively. Serum Heme oxygenase-1 (HO-1), TNF-α, IL-6 and CRP were measured by ELISA on preoperative day 1, post-operative day 1 and post-operative day3. Serum HO-1, TNF-α, IL-6 and CRP had no significant difference between the laparoscopy group and the open group on pre-operative day 1. Serum HO-1, IL-6 and CRP of the laparoscopy group were significantly lower than that of the open group on post-operative day 1 and day 3 except for Serum TNF-α which had no significant difference. Laparoscopic-assisted radical gastrectomy was minimally invasive compared with conventional open radical gastrectomy in advanced gastric cancer patients.
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Affiliation(s)
- Li Zhang
- Department of general surgery, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong, 250021, China
| | - Lehao Ren
- Department of general surgery, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong, 250021, China
| | - Keshu Shan
- Department of general surgery, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong, 250021, China
| | - Xiaobo Guo
- Department of general surgery, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong, 250021, China
| | - Jinshen Wang
- Department of general surgery, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong, 250021, China
| | - Bin Cui
- Department of general surgery, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong, 250021, China
| | - Jie An
- Department of Pharmacology, Shandong University School of Medicine, 44 Wenhua Xi Road, Jinan, Shandong, 250012 P.R. China
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Levy MJ, Kipp BR, Milosevic D, Schneider AR, Voss JS, Avula R, Kerr SE, Henry MR, Highsmith E, Liu MC, Gleeson FC. Analysis of Cell-Free DNA to Assess Risk of Tumoremia Following Endoscopic Ultrasound Fine-Needle Aspiration of Pancreatic Adenocarcinomas. Clin Gastroenterol Hepatol 2018. [PMID: 29526691 DOI: 10.1016/j.cgh.2018.02.048] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Cellular and nuclear material from tumors disseminates into the bloodstream (tumoremia), but it is not clear whether medical procedures cause release of this material or contribute to formation of metastases. We performed a prospective study of blood samples from patients with pancreatic adenocarcinoma (PDAC) to determine whether endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) associates with markers of tumoremia. METHODS We obtained peripheral blood from 104 patients (35 with PDAC) before and after EUS-FNA of primary tumors; blood samples from 69 healthy individuals were used as controls. Plasma concentrations of cell-free DNA (cfDNA) were measured, and cfDNA and primary tumor samples were analyzed to detect activating mutations in KRAS. Potential development of tumoremia was defined by an increase in cfDNA of 2-fold or more, and/or detection of mutant KRAS in samples collected after FNA from patients whose blood samples did not contain detectable mutant KRAS before FNA. RESULTS Peripheral blood concentrations of cfDNA were 1200 ng/ml (500-3300 ng/ml) before FNA vs 1400 ng/ml (900-4000 ng/ml) after FNA (P = .391). Tumoremia was detected in 10/35 patients (28.6%): 7 patients had a ≥2-fold increase in cfDNA concentration (20.6%) and 3 patients had circulating tumor DNA with KRAS mutations after FNA that were not detected before FNA (8.8%). New distant metastases were detected in 1.3 ± 0.82 patients with tumoremia vs 0.64 ± 0.81 without (P = .0375). Overall mortality did not differ significantly between patients with tumoremia (10/10 deaths, 100%) vs those without (19/25 deaths, 76%) nor did survival times of deceased patients (13.3 months for patients with tumoremia; range, 5.8-14.9 months vs 11.1 months for patients without tumoremia; range, 5.5-14.5 months). However, 6 patients without tumoremia were alive at a mean 23.9 months after EUS-FNA (range, 19.9-25 months after EUS-FNA) vs none of the patients with tumoremia. CONCLUSION In patients with PDAC, EUS-FNA associates with increased plasma concentration of cfDNA and increased detection of mutant KRAS after the procedure (markers of tumoremia and possible new distant metastasis). Although levels of cfDNA and activating mutations in KRAS are logical markers of tumoremia, they may not serve as the ideal biomarkers of this process. These findings are preliminary and do not indicate a need to modify current practice, yet further studies are needed.
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Affiliation(s)
- Michael J Levy
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota.
| | - Benjamin R Kipp
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
| | - Dragana Milosevic
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
| | - Amber R Schneider
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
| | - Jesse S Voss
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
| | - Rajeswari Avula
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
| | - Sarah E Kerr
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
| | - Michael R Henry
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
| | - Edward Highsmith
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
| | - Minetta C Liu
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota; Division of Medical Oncology, Mayo Clinic, Rochester, Minnesota
| | - Ferga C Gleeson
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota
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Heinrich S, Tripke V, Huber T, Mittler J, Lang H. A Match-Pair Analysis of Open Versus Laparoscopic Liver Surgery. JSLS 2018; 21:JSLS.2017.00061. [PMID: 29326529 PMCID: PMC5743215 DOI: 10.4293/jsls.2017.00061] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Background and Objectives: In addition to general advantages of laparoscopic over open surgery, such as better cosmesis and faster recovery, laparoscopic liver surgery offers specific advantages. Improved liver function and potentially earlier postoperative oncologic treatment are suggested by the literature as benefits of laparoscopic over open liver surgery. The purpose of this analysis was to analyze the outcomes of laparoscopic liver surgery in our department. Methods: All laparoscopic liver resections (LLRs) performed from January 2011 through July 2016 were identified from the institutional database and matched 1:2 to open liver resections (OLRs). Data were analyzed regarding perioperative outcome, and significance was set at P < .05. Results: Of 1525 liver resections, 120 patients were included in this analysis. Forty resections were performed laparoscopically. Patients in the LLR group more often had benign tumors. No patient died after LLR, but 2 required conversion to open surgery (5%) because of bleeding. Blood loss (200 vs 500 mL, P < .001) was less and hospital stay (6 vs. 7 days, P = .001) shorter after LLR. Iwate score, operating time, and the size of the resection margins did not differ between the groups. Iwate score correlated with operative time (P = .027). Conclusions: Laparoscopic liver surgery was safe, and several advantages over open surgery were confirmed in our series.
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Affiliation(s)
- Stefan Heinrich
- Department of General, Visceral, and Transplantation Surgery, University Hospital of Mainz, Germany
| | - Verena Tripke
- Department of General, Visceral, and Transplantation Surgery, University Hospital of Mainz, Germany
| | - Tobias Huber
- Department of General, Visceral, and Transplantation Surgery, University Hospital of Mainz, Germany
| | - Jens Mittler
- Department of General, Visceral, and Transplantation Surgery, University Hospital of Mainz, Germany
| | - Hauke Lang
- Department of General, Visceral, and Transplantation Surgery, University Hospital of Mainz, Germany
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Katt ME, Wong AD, Searson PC. Dissemination from a Solid Tumor: Examining the Multiple Parallel Pathways. Trends Cancer 2018; 4:20-37. [PMID: 29413419 PMCID: PMC5806201 DOI: 10.1016/j.trecan.2017.12.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Revised: 12/04/2017] [Accepted: 12/05/2017] [Indexed: 12/23/2022]
Abstract
Metastasis can be generalized as a linear sequence of events whereby halting one or more steps in the cascade may reduce tumor cell dissemination and ultimately improve patient outcomes. However, metastasis is a complex process with multiple parallel mechanisms of dissemination. Clinical strategies focus on removing the primary tumor and/or treating distant metastases through chemo- or immunotherapies. Successful strategies for blocking metastasis will need to address the parallel mechanisms of dissemination and identify common bottlenecks. Here, we review the current understanding of common dissemination pathways for tumors. Understanding the complexities of metastasis will guide the design of new therapies that halt dissemination.
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Affiliation(s)
- Moriah E Katt
- Institute for Nanobiotechnology, 100 Croft Hall, Johns Hopkins University, Baltimore, MD 21218, USA; Department of Materials Science and Engineering, Johns Hopkins University, Baltimore, MD 21218, USA; These authors contributed equally
| | - Andrew D Wong
- Institute for Nanobiotechnology, 100 Croft Hall, Johns Hopkins University, Baltimore, MD 21218, USA; Department of Materials Science and Engineering, Johns Hopkins University, Baltimore, MD 21218, USA; These authors contributed equally
| | - Peter C Searson
- Institute for Nanobiotechnology, 100 Croft Hall, Johns Hopkins University, Baltimore, MD 21218, USA; Department of Materials Science and Engineering, Johns Hopkins University, Baltimore, MD 21218, USA; Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD 21231, USA.
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Anterior Approach to Improve the Prognosis in HCC Patients Via Decreasing Dissemination of EpCAM + Circulating Tumor Cells. J Gastrointest Surg 2017; 21:1112-1120. [PMID: 28378318 DOI: 10.1007/s11605-017-3410-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Accepted: 03/23/2017] [Indexed: 01/31/2023]
Abstract
BACKGROUND It is supposed that the improvement of prognosis in hepatocellular carcinoma (HCC) patient by anterior approach for liver resection was related to the decreasing hematogenic dissemination of circulating cancer cells. METHODS The EpCAM+ circulating tumor cells (CTCs) were detected in HCC patients having liver resection with either anterior approach (AA) or conventional approach (CA). The relation of CTCs to the 2-year recurrence and survival after surgery was investigated. RESULTS Overall, patients with ≥3.5 CTCs had much higher recurrence rate than those with <3.5 CTCs (62.0 vs. 18.0%, P = 0.001). Less CTCs were detected in AA group than that in CA group (mean, 2.1 vs. 3.0; median, 1.2 vs. 3.5; all P = 0.001). The 2-year recurrence rate in AA group was much lower than in CA group (27.1 vs. 44.9%, P = 0.009). The 2-year survival rate in AA group was much higher than in CA group (83.3 vs. 66.7%, P = 0.001). The CTCs in >5 cm AA group were much less than that in >5 cm CA group (3.7 vs. 2.4, P = 0.002). Moreover, the 2-year recurrence rate in >5 cm AA group was much lower than that in >5 cm CA group (29.2 vs. 54.7%, P = 0.001). Also, the 2-year survival rates in >5 cm AA group were much higher than that in >5 cm CA group (72.9 vs. 49.1%, P = 0.01). By multivariate analysis, CA is one of the independent risk factors for poor prognosis in HCC patients after liver resection. CONCLUSIONS Like the liver-directed therapies, AA can reduce the dissemination of CTCs, especially in patients with large-size HCC (>5 cm) and successively improve the early prognosis.
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Li W, Zhou X, Huang Z, Zhang K, Luo X, Zhong J, Chen Y. Short-term and long-term outcomes of laparoscopic hepatectomy, microwave ablation, and open hepatectomy for small hepatocellular carcinoma: a 5-year experience in a single center. Hepatol Res 2017; 47:650-657. [PMID: 27487979 DOI: 10.1111/hepr.12785] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Revised: 06/28/2016] [Accepted: 07/26/2016] [Indexed: 12/12/2022]
Abstract
AIM Laparoscopic hepatectomy (LH), microwave ablation (MWA), and open hepatectomy (OH) are three widely used methods to treat small hepatocellular carcinoma (HCC). However, few studies have compared the short- and long-term outcomes of these three treatments. The aim of this study was to investigate their effectiveness. METHODS The data were reviewed from 280 patients with HCCs measuring ≤3 cm (Barcelona Clinic Liver Cancer stage 0 or A) who received LH (n = 133), OH (n = 87), or MWA (n = 60) in our research center from 2005 to 2010. Short-term outcomes included intraoperative blood loss, operation time, and length of hospital stay. The disease-free survival and overall survival rates were analyzed as long-term outcomes. RESULTS The patients in the MWA and LH groups showed better short-term outcomes compared with those in the OH group. There were no significant differences in overall survival rates among the three treatments. The LH group showed significantly lower recurrence rates than the MWA group (P = 0.0146). CONCLUSIONS Laparoscopic hepatectomy may be a better option for patients with small HCC located on the liver surface and left lateral lobe. The short-term outcome of MWA is promising, although the high risk of local recurrence after the operation should be considered when planning treatment.
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Affiliation(s)
- Wenda Li
- Department of Hepatobiliary Surgery, The Sun Yat-sen memorial Hospital of Sun Yat-sen University, Guangzhou, China
| | - Xue Zhou
- Department of Anesthesiology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Zejian Huang
- Department of Hepatobiliary Surgery, The Sun Yat-sen memorial Hospital of Sun Yat-sen University, Guangzhou, China
| | - Kelin Zhang
- Department of Surgical Intensive Care Unit, The Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, China
| | - Xuan Luo
- Department of Hepatobiliary Surgery, The Sun Yat-sen memorial Hospital of Sun Yat-sen University, Guangzhou, China
| | - Jinyi Zhong
- Department of Hepatobiliary Surgery, The Sun Yat-sen memorial Hospital of Sun Yat-sen University, Guangzhou, China
| | - Yajin Chen
- Department of Hepatobiliary Surgery, The Sun Yat-sen memorial Hospital of Sun Yat-sen University, Guangzhou, China
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Future Perspectives of ERAS: A Narrative Review on the New Applications of an Established Approach. Surg Res Pract 2016; 2016:3561249. [PMID: 27504486 PMCID: PMC4967675 DOI: 10.1155/2016/3561249] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Accepted: 06/14/2016] [Indexed: 02/07/2023] Open
Abstract
ERAS approach (Enhanced Recovery After Surgery) is a multimodal, perioperative pathway designed to achieve early recovery after surgery. ERAS has shown documented efficacy in elective surgery, and the concept of "multimodal" and "multidisciplinary" approach seems still to be of higher importance than each single item within ERAS protocols. New perspectives include the use of ERAS in emergency surgery, where efficacy and safety on outcome have been documented, and flexibility of traditional items may add benefits for traditionally high-risk patients. Obstetric surgery, as well, may open wide horizons for future research, since extremely poor data are currently available, and ERAS benefits may translate even on the baby. Finally, the concept of "outcome" may be extended when considering the specific setting of cancer surgery, in which variables like cancer recurrence, early access to adjuvant therapies, and, finally, long-term survival are as important as the reduced perioperative complications. In this perspective, different items within ERAS protocols should be reinterpreted and eventually integrated towards "protective" techniques, to develop cancer-specific ERAS approaches keeping pace with the specific aims of oncologic surgery.
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Abstract
PURPOSE Laparoscopy for colorectal cancer resection bares early post-operative advantages and results in equal oncologic long-term outcome. However, data on laparoscopic right hemi-colectomy is scarce. Aim of the present study was to analyze a well selected collective of patients with right-sided colon cancer treated open and laparoscopically with regard to peri-operative and long-term outcome. METHODS We analyzed all patients who underwent right-sided hemi-colectomy for colon cancer between January 1996 and March 2013. Data was extracted from our prospective database. Inclusion criteria were tumor localization in the ascending colon, oncologic resection, histology of an adenocarcinoma, tumors UICC I-III, and R0 resection. Exclusion criteria were multiple malignancies including colon, emergency operation, adenoma or pT0 status, and UICC IV. For the matched pairs approach between patients undergoing laparoscopic (LAP) or open (OPEN) surgery, the parameters age, UICC stage, tumor grading, and sex were applied. RESULTS A total of 188 patients was included in the analysis with n = 94 in both the LAP and the OPEN group. Some peri-operative results demonstrated advantages for laparoscopy including median return to liquid (p < 0.0001) and solid diet (p = 0.008), median length of ICU stay (p < 0.0001), and median length of hospital stay (p = 0.022). No significant differences were revealed for complication rates, rates of anastomotic leakage, or 30-day mortality. Lymph node yield was identical. Also, no differences in oncologic long-term outcome were detected. Rates for local recurrence were 4.3 and 2.0 %. CONCLUSION This matched pairs analysis verifies peri-operative advantages of laparoscopy explicitly for the sub-group of CRC patients undergoing right-sided hemi-colectomy in comparison to open surgery while demonstrating equivalent oncologic long-term results.
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Gallotta V, Nero C, Lodoli C, Chiantera V, Pacelli F, Fagotti A, Costantini B, Scambia G. Laparoscopic Splenectomy for Secondary Cytoreduction in Ovarian Cancer Patients With Localized Spleen Recurrence: Feasibility and Technique. J Minim Invasive Gynecol 2016; 23:425-8. [DOI: 10.1016/j.jmig.2016.01.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2015] [Revised: 01/04/2016] [Accepted: 01/05/2016] [Indexed: 11/16/2022]
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Lin S, Xu Y, Gan Z, Han K, Hu H, Yao Y, Huang M, Min D. Monitoring cancer stem cells: insights into clinical oncology. Onco Targets Ther 2016; 9:731-40. [PMID: 26929644 PMCID: PMC4755432 DOI: 10.2147/ott.s96645] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Cancer stem cells (CSCs) are a small, characteristically distinctive subset of tumor cells responsible for tumor initiation and progression. Several treatment modalities, such as surgery, glycolytic inhibition, driving CSC proliferation, immunotherapy, and hypofractionated radiotherapy, may have the potential to eradicate CSCs. We propose that monitoring CSCs is important in clinical oncology as CSC populations may reflect true treatment response and assist with managing treatment strategies, such as defining optimal chemotherapy cycles, permitting pretreatment cancer surveillance, conducting a comprehensive treatment plan, modifying radiation treatment, and deploying rechallenge chemotherapy. Then, we describe methods for monitoring CSCs.
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Affiliation(s)
- ShuChen Lin
- Department of Oncology, Shanghai Sixth People's Hospital East Campus, Shanghai Jiao Tong University, People's Republic of China
| | - YingChun Xu
- Department of Oncology, Renji Hospital, Shanghai Jiao Tong University, People's Republic of China
| | - ZhiHua Gan
- Department of Oncology, Shanghai Sixth People's Hospital East Campus, Shanghai Jiao Tong University, People's Republic of China
| | - Kun Han
- Department of Oncology, Shanghai Sixth People's Hospital East Campus, Shanghai Jiao Tong University, People's Republic of China
| | - HaiYan Hu
- Department of Oncology, The Sixth People's Hospital, Shanghai Jiao Tong University, People's Republic of China
| | - Yang Yao
- Department of Oncology, The Sixth People's Hospital, Shanghai Jiao Tong University, People's Republic of China
| | - MingZhu Huang
- Department of Medical Oncology, Cancer Hospital of Fudan University, Shanghai, People's Republic of China
| | - DaLiu Min
- Department of Oncology, Shanghai Sixth People's Hospital East Campus, Shanghai Jiao Tong University, People's Republic of China
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Gallotta V, Ghezzi F, Vizza E, Fagotti A, Ceccaroni M, Fanfani F, Chiantera V, Ercoli A, Rossitto C, Conte C, Uccella S, Corrado G, Scambia G, Ferrandina G. Laparoscopic Management of Ovarian Cancer Patients With Localized Carcinomatosis and Lymph Node Metastases: Results of a Retrospective Multi-institutional Series. J Minim Invasive Gynecol 2016; 23:590-6. [PMID: 26872630 DOI: 10.1016/j.jmig.2016.01.029] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Revised: 01/28/2016] [Accepted: 01/29/2016] [Indexed: 02/02/2023]
Abstract
STUDY OBJECTIVE To investigate the feasibility and safety of laparoscopic cytoreduction in ovarian cancer patients with localized carcinomatosis or lymph node involvement. DESIGN Retrospective cohort study (Canadian Task Force classification II-2). SETTING Multi-institutional study performed in 6 referral gynecologic oncology units. PATIENTS Between June 2005 and December 2014, preoperatively presumed early-stage ovarian cancer patients, who accidentally revealed localized carcinomatosis or lymph node involvement at laparoscopic evaluation or at postoperative pathological examination managed by the laparoscopic approach. INTERVENTIONS All patients with limited carcinomatosis and/or lymph node metastases underwent complete laparoscopic cytoreduction. MEASUREMENTS AND RESULTS Sixty-nine patients were included in the analysis. Twenty-eight (40.6%) patients were staged III C because they had lymph node metastases. Pelvic lymphadenectomy was performed in 75.4% of cases, whereas aortic lymphadenectomy was performed in 79.7% of cases. Lymph node metastases were found in pelvic and aortic regions in 11 and 13 patients, respectively, whereas 4 patients had lymph node metastases in both regions. Twelve (17.4%) patients underwent complete pelvic peritonectomy because of the presence of nodules localized in several pelvic region sites. As of May 2015, the median follow-up was 35 months, and the median disease-free survival was 29 months. The 2-year disease-free survival rate was 77.1%, whereas the 2-year overall survival rate was 90.6%. The median time to recurrence was 26 months (range, 6 -55 months); 15 (21.7%) patients developed recurrence. CONCLUSION The present study shows the technical and clinical feasibility of laparoscopic cytoreduction in ovarian cancer patients with limited carcinomatosis or lymph node involvement.
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Affiliation(s)
- Valerio Gallotta
- Gynecologic Oncology Unit, Catholic University of the Sacred Heart, Rome, Italy.
| | - Fabio Ghezzi
- Department of Obstetrics and Gynecology, University of Insubria, Del Ponte Hospital, Varese, Italy
| | - Enrico Vizza
- Department of Oncological Surgery, Gynecologic Oncologic Unit, "Regina Elena" National Cancer Institute, Rome, Italy
| | - Anna Fagotti
- Gynecologic Oncology Unit, Catholic University of the Sacred Heart, Rome, Italy
| | - Marcello Ceccaroni
- Department of Obstetrics and Gynecology, Gynecologic Oncology and Minimally-Invasive Pelvic Surgery, Sacred Heart Hospital, Negrar, Verona, Italy
| | - Francesco Fanfani
- Gynecologic Oncology Unit, Catholic University of the Sacred Heart, Rome, Italy
| | - Vito Chiantera
- Gynecologic Oncology Unit, Fondazione "Giovanni Paolo II", Campobasso, Italy
| | - Alfredo Ercoli
- Department of Obstetrics and Gynecology Abano Terme Hospital, Padova, Italy
| | - Cristiano Rossitto
- Gynecologic Oncology Unit, Catholic University of the Sacred Heart, Rome, Italy
| | - Carmine Conte
- Gynecologic Oncology Unit, Catholic University of the Sacred Heart, Rome, Italy
| | - Stefano Uccella
- Department of Obstetrics and Gynecology, University of Insubria, Del Ponte Hospital, Varese, Italy
| | - Giacomo Corrado
- Department of Oncological Surgery, Gynecologic Oncologic Unit, "Regina Elena" National Cancer Institute, Rome, Italy
| | - Giovanni Scambia
- Gynecologic Oncology Unit, Catholic University of the Sacred Heart, Rome, Italy
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