OBJECTIVETo compare curative effects of various surgical procedures of bile duct stones.

METHODSTwo thousand nine hundred and fifty-five patients with intrahepatic bile duct lithiasis who had undergone various surgical procedures were analysed with Meta-analysis. Some of these cases were reported in Chinese Medical Journals from January 1990 to March 2001 and others were from Tongji Hospital.

RESULTSThere was a significant difference between curative effects of non-hepatectomy and that of hepatectomy (chi(2) = 62.945, P < 0.01), and the outcomes of hepatectomy were much better than those of non-hepatectomy with OR(S) equalled to 0.303 (0.222 - 0.413). There was not a significant difference between curative effect of interposed jejunum and that of hepatectomy (95% CI of RR from 0.98 to 1.04). All the other operation, effects were worse than hepatectomy (upper limit of 95% CI of RR < 1).

CONCLUSIONSHepatectomy is the most ideal surgery for intrahepatic bile duct stones and operation methods should be diversified since good effect could also be obtained when other operations are performed on suitable cases.

Bile Duct Diseases ; surgery ; Bile Ducts, Intrahepatic ; Choledochostomy ; statistics & numerical data ; Cholelithiasis ; surgery ; Follow-Up Studies ; Hepatectomy ; statistics & numerical data ; Humans ; Treatment Outcome

OBJECTIVETo analyze operative and perioperative factors associated with hepatectomy.

METHODS2008 consecutive patients undergoing hepatectomy from January 1986 to December 2005 at Chinese People's Liberation Army General Hospital were investigated retrospectively according to their medical documentation. Diagnoses were made on basis of pathological results.

RESULTSMalignant and benign liver diseases accounted for 58.5% and 41.2%, respectively. In the former, primary liver cancer accounted for 76.1% and hilar cholangiocarcinoma for 6.7%. Hemangioma (41.7%) and hepatolithiasis (29.6%) were listed in the first two in the latter group with relatively more patient ratios. Isolated caudate lobe resection was performed in 25 patients and micro-wave inline coagulation was induced in 236 cases of liver resection. In all cases, those with blood loss less than 200 ml accounted for 50.5% (1015/2008), whereas those with more than 400 ml accounted for 28.4% (570/2008). In patients performed micro-wave inline coagulation liver resection, those with blood loss less than 200 ml and more than 400 ml accounted for 60.6% (143/236) and 19.9% (47/236), respectively, which differed significantly from the average level (P < 0.05). The postoperative complication incidence was 14.44% for all cases, 12.54% for primary liver cancer, 16.40% for secondary liver cancer, and 16.32% for hepatolithiasis. Complication incidence of primary liver cancer with tumor size smaller than 5 cm was 11.65% and that with tumor larger than 10 cm was 14.69%. There was no significant difference between the two groups. All-case hospital mortality was 0.55% and that for liver malignant disease was 0.60%, hilar cholangiocarcinoma 2.53%.

CONCLUSIONHepatectomy can be performed safely with low mortality and low complication incidence, provided that it is carried out with optimized perioperative management and innovative surgical technique.

Blood Loss, Surgical ; statistics & numerical data ; Female ; Hepatectomy ; methods ; mortality ; statistics & numerical data ; Humans ; Male ; Middle Aged ; Perioperative Care ; Postoperative Complications ; epidemiology ; Retrospective Studies

Since laparoscopic liver resection was first introduced in 2001, Korean surgeons have chosen a laparoscopic procedure as one of the treatment options for benign or malignant liver disease. We distributed and analyzed a nationwide questionnaire to members of the Korean Laparoscopic Liver Surgery Study Group (KLLSG) in order to evaluate the current status of laparoscopic liver resection in Korea. Questionnaires were sent to 24 centers of KLLSG. The questionnaire consisted of operative procedure, histological diagnosis of liver lesions, indications for resection, causes of conversion to open surgery, and postoperative outcomes. A laparoscopic liver resection was performed in 416 patients from 2001 to 2008. Of 416 patients, 59.6% had malignant tumors, and 40.4% had benign diseases. A total laparoscopic approach was performed in 88.7%. Anatomical laparoscopic liver resection was more commonly performed than non-anatomical resection (59.9% vs 40.1%). The anatomical laparoscopic liver resection procedures consisted of a left lateral sectionectomy (29.3%), left hemihepatectomy (19.2%), right hemihepatectomy (6%), right posterior sectionectomy (4.3%), central bisectionectomy (0.5%), and caudate lobectomy (0.5%). Laparoscopy-related serious complications occurred in 12 (2.8%) patients. The present study findings provide data in terms of indication, type and method of liver resection, and current status of laparoscopic liver resection in Korea.
*Hepatectomy/statistics & numerical data ; Humans ; *Laparoscopy/statistics & numerical data ; Liver/*surgery ; Liver Diseases/pathology/surgery ; Liver Neoplasms/pathology/surgery ; Postoperative Complications/epidemiology ; Questionnaires ; Republic of Korea

OBJECTIVETo evaluate the correlation between overweight and postoperative complications and prognosis after radical hepatectomy for colorectal liver metastasis (CRLM).

METHODSA total of 192 patients who underwent hepatectomy for colorectal liver metastases between January 2000 and March 2012 were eligible for the study. We retrospectively summarized their clinicopathological data, BMI index and postoperative complications, and investigated the relation between these data and complications and prognosis.

RESULTSOf the 192 patients, 109 cases were classified as overweight with a BMI ≥24 and 83 patients were classified as non-overweight with a BMI <24. Seventy-five complications occurred in 68 of the 192 patients (35.4%) who underwent hepatectomy. Surgical complications (P=0.428), operation time (P=0.837), and blood loss (P=0.272) were not statistically significantly associated with BMI. 173 patients were included to analyze the influence of overweight on oncologic outcome. The median survival for the overweight patients was 59 months, while that of non-overweight patients was 31 months (P=0.016). The overweight patients had a longer OS assessed by both univariate analysis (P=0.016) and multivariate analysis (P=0.031). However, no statistical differences in disease-free survival (DFS) were detected between the overweight and non-overweight groups (P=0.058).

CONCLUSIONSOverweight is not independently associated with an increasing complication rate. BMI does not significantly affect the CRLM-DFS, and high BMI patients might have a better overall survival.

Colorectal Neoplasms ; epidemiology ; surgery ; Disease-Free Survival ; Hepatectomy ; statistics & numerical data ; Humans ; Liver Neoplasms ; epidemiology ; secondary ; surgery ; Overweight ; Postoperative Complications ; epidemiology ; Prognosis ; Retrospective Studies ; Survival Rate

This study was undertaken to analyze and evaluate the diagnosis and principal treatment methods for congenital choledochal cyst, focusing on various surgical procedures and clinical outcome. A comprehensive, retrospective study was conducted on 72 adult patients who presented with choledochal cyst from 1985 to 2002. Surgical procedures were cyst excision with hepaticojejunostomy in 25 cases for type I or type IV-B, extrahepatic cyst excision with hepaticojejunostomy in 8 cases for type IV-A, extrahepatic cyst excision with modified hepaticojejunostomy in 2 cases for type IV-B, non-cyst excision with or without hepaticojejunostomy in 27 cases for types I, II, IV-A, IV-B. The early postoperative morbidity and mortality rate were 16.1% (9/62) and 6.5% (4/62) respectively, and the complication rate related to surgical procedure was 30.6% (19/62). The incidence of cholangiocarcinoma with non-cyst excision or non-operated congenital choledochal cyst was 10.8% (4/37). One patient died of primary hepatocellular carcinoma after cyst excision with hepatojejunostomy. In conclusion, our results showed that complete exci-sion of choledochal cyst for types I, II, and IV-B and complete excision of extra-hepatic choledochal cyst from the hepatic hilum in type IV-A with hepaticojejunostomy or modified hepaticojejunostomy are the treatment of choice for choledochal cyst in adult patients.
Academic Medical Centers/trends ; Adolescent ; Adult ; Choledochal Cyst/*epidemiology/*surgery ; Female ; Hepatectomy/*methods/*statistics & numerical data ; Humans ; Jejunostomy/*methods/*statistics & numerical data ; Korea/epidemiology ; Male ; Middle Aged ; Postoperative Complications/*epidemiology ; Retrospective Studies ; Treatment Outcome

OBJECTIVETo evaluate the effects of acute normovolemic hemodilution (ANH) combined with controlled hypotension on reducing heterogeneous transfusion and safety during liver tumorectomy.

METHODSThirty patients undergoing elective liver tumorectomy were randomly divided into 3 groups (10 each), namely ANH group (group A), ANH combined with controlled hypotension group (group B) and control group (group C). All the patients were anesthetized via endotracheal intubation. Before the operation, ANH was performed in groups A and B after anesthesia induction, and controlled hypotension was initiated in group B during tumorectomy. Blood transfusion and fluid infusion were carried out routinely in group C. Hb and Hct were measured before operation, after ANH, and immediately, 1 day and 7 days after the operation. The difference in intraoperative blood loss and heterogeneous blood transfusion volume in the 3 groups was observed.

RESULTSIn group A, heterogeneous blood transfusion was avoided in 6 cases and but given in the other cases for an average of 400 ml. In group C, every patient received heterogeneous blood transfusion (664.8-/+248.1 ml), but none of the patients received heterogeneous blood in group B. The difference in transfusion volume between the 3 groups was significant (P<0.01). Hemodynamics was basically stable during operation in the 3 groups.

CONCLUSIONANH combined with controlled hypotension is safe and effective for decreasing and even avoiding homologous blood transfusion in liver tumorectomy.

Adult ; Aged ; Blood Loss, Surgical ; prevention & control ; Blood Transfusion ; statistics & numerical data ; Combined Modality Therapy ; Female ; Hemodilution ; methods ; Hepatectomy ; methods ; Humans ; Hypotension, Controlled ; methods ; Isotonic Solutions ; Liver Neoplasms ; surgery ; Male ; Middle Aged ; Postoperative Complications ; prevention & control ; Treatment Outcome

OBJECTIVETo evaluate the combinated transcatheter hepatic artery chemoembolization (TACE) and analyse the factors affecting prognosis in patients with primary hepatic carcinoma.

METHODS141 consecutive patients with primary hepatic carcinoma were treated, including 125 men and 16 women (mean age, 52 years; age range, 21 - 76 years). Combinated TACE procedures included TACE, TACE followed by surgical resection, TACE and percutaneous ethanol injection (PEI) and transcatheter hepatic artery infusion (TAI). The factors included sex, age, ALT, AFP, HBsAg, liver function (Child's system), the way of treatment, tumor size and number, serum albumin, portal cancerous thrombus, pathological type of tumors, and HBeAg. The Cox's regression analysis model was used to analyse the factors affecting the prognosis. P < 0.05 means statistically significant difference.

RESULTSThe total median survival time was 19 months and mean survival time 23.59 months. The total survival rates of 1, 2, 3, 5 years were 63.9%, 44.5%, 25.8% and 7.4%, respectively. Multivariable analysis revealed significant prognostic factors as follows: age, liver function, the way of treatment, portal cancerous thrombus and pathological types of tumors (chi2 = 45.993, P = 0.0001).

CONCLUSIONThe combinated TACE procedure is safe and effective. In this study, 5 factors directly influencing the prognosis are age, liver function, portal cancerous thrombus and pathological types of tumors are risk prognostic factors, and the way of treatment is a protective factor (chi2 = 45.993, chi2 = 0.0001).

Acetaldehyde ; administration & dosage ; Adult ; Age Factors ; Aged ; Antineoplastic Combined Chemotherapy Protocols ; therapeutic use ; Carcinoma, Hepatocellular ; pathology ; surgery ; therapy ; Chemoembolization, Therapeutic ; Combined Modality Therapy ; statistics & numerical data ; Female ; Follow-Up Studies ; Hepatectomy ; methods ; Humans ; Infusions, Intra-Arterial ; Injections, Intradermal ; Liver Neoplasms ; pathology ; surgery ; therapy ; Male ; Middle Aged ; Neoplastic Cells, Circulating ; pathology ; Portal Vein ; Prognosis ; Proportional Hazards Models ; Survival Analysis