Anemia, Hemolytic ; chemically induced ; therapy ; Female ; Humans ; Paraquat ; poisoning ; Poisoning ; therapy ; Young Adult

Objective Bisegmentectomy Ⅶ-Ⅷ can be an alternative option for the tumor localized in segments Ⅶ and Ⅷ and infiltrating the main trunk of RHV instead of a right hemihepatectomy.This study was to evaluate the safety and practicability of the removal of segments Ⅶ and Ⅷ of the liver with the resection of the main trunk of RHV without vascular reconstruction.Method 13 consecutive patients underwent bisegmentectomy Ⅶ-Ⅷ with the resection of the RHV between Nov.2006 and Dec.2012 at Beijing Cancer Hospital 1st Department.of HPB Surgery.Results Bisegmentectomy Ⅶ-Ⅷ with the resection of the RHV was performed in all 13 patients successfully without the distal vein reconstruction.The duration of the operations was 90-215 min.Mean blood loss was estimated to be 200 ml (100-700 ml).Indications for a bisegmentectomy Ⅶ-Ⅷ included hepatocellular carcinoma in 6 cases,intrahepatic cholangiocarcinoma in one,liver metastasis in 4 and hepatic hemangioma in 2 as confirmed pathologically.All patients recovered without severe complications.The atrophy of segment Ⅵ due to the venous drainage obstacle was observed in 3 patients without the dysfunction of liver postoperatively.Conclusions It is safe and practicable to perform Ⅶ and Ⅷ bisegmentectomy with resection of the right hepatic vein without vascular reconstruction for liver tumors.

Objective To study the survival outcome and the survival-related factors in patients who received liver resection for multiple (≥4) liver metastases of colorectal cancer.Method The results for patients who received partial hepatectomy for four or more colorectal hepatic metastases carried out in the 1 st Department of HPB Surgery,Peking University Cancer Hospital were studied retrospectively.Results Between 2002 and 2013,of 239 patients,60 patients with four or more colorectal hepatic metastases received partial hepatectomy.The median overall survival was 35.2 months and the 5-year survival was 28.2％ (17/60).There were two actuarial 5-year survivors.The median disease-free survival was 6.9 months,with 1 actuarial disease-free survivor at 5 years.There were no perioperative deaths,and the perioperative morbidity was 36.7％ (22/60).Major (hemi-liver or more) liver resection and 7 or more metastases were independently associated with poor survival outcome.Perineural Invasion (T4) of the primary tumor,size of the largest metastasis (≥4 cm),neoadjuvant chemotherapy,and resection of recurrent disease were also associated with survival outcome.Conclusions Long-term survival could be achieved after resection of multiple colorectal liver metastases.Minor resection for multiple colorectal metastases was superior in survival compared with major resection.Additional survival advantage could be achieved by resection of recurrent disease.

Objective To evaluate the correlation between postoperative complications and prognosis after radical hepatic resection for colorectal liver metastasis (CRLM).Methods We retrospectively summarized patients' clinicopathological data and postoperative complications.Postoperative complications were graded using Dindo-Clavien system of classification.Then we investigate the relation between these data and prognosis.Results One hundred and seventy-three patients were recruited.Postoperative complications developed in 59 (34.1％) cases.37 patients had minor complications and 22 patients had major complications.On univariate (x2 =8.106,P =0.004) and multivariate analysis (x2 =8.006,P =0.005),complication was an independent predictor of overall survival (OS).However,in a subgroup of patients with minor compications,morbidity was not associated with a significant reduction in both OS (x2 =3.199,P =0.074) and disease-free survival (x2 =1.313,P =0.252).Conclusions Postoperative complications are an independent factor for long-term outcomes after hepatic resection for CRLM.

Objective To investigate survival for primary duodenal carcinoma patients after radical resection and identify risk factors associated with overall survival.Methods Data of 51 patients with primary duodenal carcinomas who underwent radical resection between December 2003 and December 2012 at Beijing Cancer Hospital were included.Survival analysis was drawn by Kaplan-Meier method,univariate and multivariate analyses were performed to identify variables associated with survival after resection by COX regression model.Results The median overall survival time was 67 months,and the median disease-free time was 40 months,1-,2-and 3-year overall survival rates were 88％,84％ and 67％,respectively.Multivariate analysis revealed that regional lymph-node positive (P =0.032) and CA199 ＞ 37 U/ml (P =0.037) were independent risk factors of patients' overall survival.Conclusions Radical resection improves survival for primary duodenal carcinoma patients.Regional lymph-node positive and CA199 ＞37 U/ml were the most important risk factors of patients'overall survival.

Objective To analyze the clinical data of patients with post-hepatectomy haemorrhage (PHH) and to discuss the treatment strategies.Method The clinicopathologic data of patients with PHH between 2005-2014 in the HPB Surgery Ward I,Peking University Cancer Hospital,were studied retrospectively.Results In the study period of 10 years,25 of 1 548 patients who underwent hepatectomy suffered from PHH,and 76％ (19/25) of these patients had underlying liver diseases.The common surgical operations followed by PHH were right hemihepatectomy (11/25),and segment Ⅶ/Ⅷ resection (8/25).The median time for PHH to be diagnosed was 27 h,and the median time from diagnosis of postoperative bleeding to reoperation or intervention was 3.5 h.Using the classification of PHH by the International Study Group of Liver Surgery (ISGLS),there were 1 patient in grade A,16 patients in grade B,and 8 patients in grade C.The perioperative mortality of PHH was 8％ (2/25).The most common bleeding site was from the hepatic artery.Conclusions PHH is a serious complication after liver resection,with low occurrence but high mortality.Most patients with PHH can be managed by conservative treatment.Emergency reoperation is required when instability in vital signs appears.Careful evaluation before operation,strict hemostasis during operation,and close monitoring after operation can effectively reduce the incidence and mortality of PHH.

Objective To identify the risk factors associated with overall survival (OS) for patients undergoing partial hepatectomy for colorectal liver metastases,and to assess the predictive values of five published scoring systems in an independent patient cohort for the purpose of external validation.Methods The clinical,pathologic,and complete follow-up data were prospectively collected from 303 consecutive patients who underwent primary hepatic resection for colorectal liver metastases at the Beijing Cancer Hospital from January 2000 to Aug 2014.The predictive values of the Nordlinger score,the Memorial Sloan-Kettering Cancer Center (MSKCC) score,the Iwatsuki score,the Basingstoke index,and the Konopke scoring system were assessed in this patient set.The clinical and pathologic parameters were further analyzed using univariate and multivariate analyses.Results The 1-,3-and 5-year overall survival were 89.2％,50.8％ and 38.6％,respectively.The median survival time was 37 months.Two risk factors were found to be independent predictors of poor overall survival:the N stage of the primary tumor,and a carcinoembyonic antigen level ＞ 30 μg/L.The MSKCC score had the best independent predictive power for survival when compared with the other 4 prognostic systems (C-index:0.903).Conclusion In our patient cohort,the MSKCC score was the best staging system in predicting survival.

Objective:To compare the safety and long-term survival of patients with synchronous rectal cancer liver metastasis, who received either simultaneous or staged resection to treat primary tumor and liver metastases. Methods:Clinicopathologic and peri-operative data were collected retrospectively from 54 patients with synchronous rectal cancer liver metastasis, who received both prima-ry and liver resections between January 2000 and April 2015 at Peking University Cancer Hospital. Routine follow-up was conducted. The safety and long-term survival of 19 patients who underwent simultaneous resection were compared with those of 35 patients who received staged resection. Results:The clinicopathologic data between the two groups were comparable. Postoperative Clavien-Dindo grades 1, 2, 3, and 4 complications were 10.5%(2/19), 31.6%(6/19), 5.3%(1/19), and 10.5%(2/19) for the simultaneous group, respec-tively, and 8.6%(3/35), 17.1%(6/35), 25.7%(9/35), and 0%(0/35) for the staged group correspondingly, which were not significantly different (P=0.093). However, the median postoperative hospital stay of the simultaneous group was significantly shorter than that of the staged group (14 days versus 25 days, P<0.001). The median postoperative overall survival (OS) and disease-free survival (DFS) be-tween these groups were not significantly different [not reached versus 39 months for OS, respectively (P=0.649);10 months versus 10 months for DFS, respectively (P=0.827)]. Conclusion:The postoperative complications in simultaneous resection group were not sig-nificantly increased compared with those in staged resection group for synchronous rectal cancer liver metastasis. The long-term results among the groups were similar.

OBJECTIVETo investigate the functional reconstruction technique for partial lower lip defects.

METHODS7 patients with lower lip cancer (3 cases of basal cell carcinoma, 2 cases squamous cell carcinoma and 2 cases papillary carcinoma) underwent excision. The full-thickness lower lip defects were one-third to two-third of the total lower lip length. All the defects were reconstructed with V-Y island advancement flaps based on the mental neurovascular bundle.

RESULTSThere was no flap loss. No recurrence was observed during the follow-up period of 3 months to one year. Both the aesthetic appearance, muscle function and sensation of the reconstructed lower lip were satisfactory.

CONCLUSIONSMental neurovascular V-Y island advancement flap is an ideal method for functional repair of partial lower lip defect.

Aged ; Carcinoma, Basal Cell ; surgery ; Chin ; innervation ; Female ; Humans ; Lip ; injuries ; Lip Neoplasms ; surgery ; Male ; Middle Aged ; Reconstructive Surgical Procedures ; methods ; Surgical Flaps ; blood supply

OBJECTIVETo evaluate the effect of endoscopic resection and traditional procedure in the management of sinonasal inverted papilloma with a staging system based on endoscopic examination of the nasal cavity and computed tomography (CT) scan evaluation.

METHODSTwo hundred and twenty-two patients with sinonasal inverted papilloma treated surgically were retrospectively reviewed. There were 23 cases in stage I; 119 cases in stage II; 65 cases in stage III and 15 cases in stage IV. Among these patients, 122 cases were treated endoscopically; 100 cases were treated by traditional surgical techniques, including 56 cases with lateral rhinotomy; 27 cases with intranasal approach and 15 cases with Caldwell-Luc technique.

RESULTSThe inverted papilloma was removed completely and no serious complications were encountered by all four kinds of techniques used. With an average follow-up of 3. 8 years, the recurrence rate for endoscopic group was 14.8% (18/122, four patients were in group I; nine in group II; four in group III; and one patient in group IV. No recurrence was found in group III who underwent endoscopic excision combined with Caldwell-Luc procedure. The recurrence rate for lateral rhinotomy group was 33. 9% (19/56, one patients in group I; six in group II; nine in group III; three in group IV). The recurrence rate for intranasal approach group was 51.9% (14/27, two patients were in group I; ten in group II; and two in group III). The recurrence rate for Caldwell-Luc procedure group was 29.4% (5/17, all in group II and group III). Regardless of approaches, patients who had primary resection had a recurrence of 26. 8%, whereas those with secondary resection had a recurrence of 20. 9% (P = 0.39).

CONCLUSIONSThe endoscopic surgical technique was proved to be a better method for treating sinonasal inverted papilloma in stage I and stage II. Better results for patients in stage III would be achieved by combining endoscopic technique with Caldwell-Luc procedure. As to patients with stage IV, radical external approaches should be considered.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Endoscopy ; Female ; Humans ; Male ; Middle Aged ; Otorhinolaryngologic Surgical Procedures ; Papilloma, Inverted ; surgery ; Paranasal Sinus Neoplasms ; surgery ; Retrospective Studies ; Treatment Outcome ; Young Adult