The cell cycle is composed of a series of steps which can be negatively or positively regulated by various factors. p53 gene aberrations are common in human malignancies, and recent studies suggest that in cervical carcinoma p53 function is inactivated either by complex formation wilh human papilloma virus (HPV) E6 product or by gene mutation. To study the expression of p53 gene in the cervical cancer and cervical intraepithebal neoplasia, immunohistochemistry for the p53 protein was done in the 47 cases of squamous cell carcinoma, 6 cases of adenocarcinoma and 32 cases of cervical intraepithelial neoplasia. I. The p53 protein was detected in the 31% of cervical intraepithelial neoplasia (10/32 cases). 2. The p53 protein was detected in the 55% of invasive cervical cancer (29/53 cases). 3. By the histologic type of cervieal cancer, the p53 protein was detected in the 57% of squamous cell carcinoma (27/47 cases) and 33% of(2/6 cases) adenocarcinoma. The p53 protein wes more frequently detected in the squamous cell carcinoma than in the adenocarcinoma. 4. By the staging in cervical cancer, the p53 protein was detected in the 31% of stage 0, 50% of Stage Ia, 50% of stage I b, 75% of IIa and 50% of stage II b.
Adenocarcinoma ; Carcinoma, Squamous Cell ; Cell Cycle ; Cervical Intraepithelial Neoplasia ; Genes, p53 ; Humans ; Immunohistochemistry* ; Papilloma ; Uterine Cervical Neoplasms*

BACKGROUND: As the necessity of adult living donor liver transplantation continues to increase, morbidity and mortality of donors has been considered vital. Thus, we performed a sequential analysis of our surgical experience in order to find ways to improve surgical outcomes in right liver donors. METHODS: We performed a retrospective sequential analysis of surgical outcomes of consecutive 245 right liver donors by 50 cases between October 2002 and November 2012. RESULTS: Hospital stay (13.78 to 10.98 days), operation time (432.76 to 389.98 minutes), amount of intra operative bleeding (577.70 to 502.56 mL), and perioperative transfusion rates decreased from the initial 50 cases to the last 45 cases. A total of 96 grade I complications by Clavien-Dindo classification decreased from 26 to 17. Ten and three cases had grade IIIa and IIIb complications, respectively. There were three cases of wound infection, two cases of duodenal ulcer bleeding, one case of pleural effusion, and four cases of bile leakage of grade IIIa complications, and one case of postoperative intestinal obstruction, one case of generalized peritonitis by small bowel perforation, and one case of bile leakage of grade IIIb complications. There was no mortality during the follow-up period. CONCLUSIONS: Although most complications with low-grade severity might be corrected by surgical refinement, efforts to reduce possible moderate to severe complications should be sustained.
Adult* ; Bile ; Classification ; Duodenal Ulcer ; Follow-Up Studies ; Hemorrhage ; Hepatectomy* ; Humans ; Intestinal Obstruction ; Length of Stay ; Liver Transplantation* ; Liver* ; Living Donors ; Mortality ; Peritonitis ; Pleural Effusion ; Retrospective Studies ; Tissue Donors ; Wound Infection

BACKGROUND: To prevent bile duct related complications, exact division of donor bile duct is essential, not only for the recipient, but also for the donor during living donor liver transplantation. Cholangiography has been used for bile duct division during living donor right hemihepatectomy. This study was conducted to determine if bile duct probe could be used to replace cholangiography for bile duct division during living donor right hemihepatectomy. METHODS: Surgical outcomes of 234 donors with right hemihepatectomy and duct to duct biliary anastomosis in living donor liver transplantation between January 2009 and December 2014 were retrospectively analyzed. A total of 85 donors used the bile duct probe for bile duct division during the right hemihepatectomy, whereas 149 donors used cholangiography. All donors underwent preoperative magnetic resonance cholangiopancreatography (MRCP). RESULTS: The expected number of bile duct orifices based on MRCP did not differ significantly from the observed number of bile duct orifices after bile duct division (10 donors and five donors in each group were mismatched, P=0.238). The operation time was 384.7 minutes in the probe group, which was significantly shorter than that of the cholangiography group (400.4 minutes, P=0.041). CONCLUSIONS: Bile duct probing without intraoperative cholangiography might be a feasible procedure for bile duct division during living donor hemihepatectomy.
Bile Ducts* ; Bile* ; Cholangiography ; Cholangiopancreatography, Magnetic Resonance ; Humans ; Liver Transplantation ; Living Donors ; Postoperative Complications ; Retrospective Studies ; Tissue Donors*

PURPOSE: A few studies have been reported on extrahepatic metastasis after curative resection for hepatocellular carcinoma (HCC). We investigated the patterns of extrahepatic recurrence and we identified the risk factors for extrahepatic recurrence after curative resection for HCC. METHODS: We retrospectively reviewed 587 patients who underwent surgical resection with a curative aim from January 1998 to December 2007 in the Yonsei University Health Care System. Among the 571 patients, 291 (51.0%) patients developed recurrence. Sixty five patients initially presented with extrahaptic recurrence. The patients with extrahepatic recurrence were divided into Group A (peritoneal recurrence) and Group B (non-peritoneal extrahepatic recurrence). RESULTS: Group A had higher rates of intraoperative bleeding>1,500 ml and perioperative transfusion too. On the multivariate analysis, perioperative transfusion, satellite nodule and the tumor size were the independent risk factors for Group A. The Edmondson-Steiner grade, satellite nodule and the tumor size were the independent risk factors for Group B. The 1, 3 and 5-year overall survival rates after curative resection for the patients with extrahepatic recurence were 83.1%, 48.9% and 27.4%, respectively. The recurrence patterns and treatment modalities did not affect the overall survival after treatment for extrahepatic recurrence. CONCLUSION: A perioperative transfusion was found to be a different risk factor for peritoneal recurrence, as compared to those risk factors for non-peritoneal extrahepatic recurrence. Therefore, efforts by physicians to decrease intraoperative bleeding may prevent peritoneal recurrence after performing curative resection for HCC.
Carcinoma, Hepatocellular ; Delivery of Health Care ; Hemorrhage ; Humans ; Multivariate Analysis ; Neoplasm Metastasis ; Recurrence ; Retrospective Studies ; Risk Factors ; Survival Rate

BACKGROUNDS/AIMS: Surveillance programs and imaging modality developments have increased the detection rate of small hepatocellular carcinoma (HCC). In particular, liver transplantation produces good results and is now regarded an alternative to liver resection. However, optimal treatment for small HCC is still debated, and thus, the authors designed this study to document clinicopathological characteristics, to identify the prognostic factors of small HCC, and to determine the effectiveness of surgery. METHODS: A total of 507 patients underwent curative liver resection for HCC between January 1996 and August 2006 in our institution. One hundred and thirty four of these patients with a single HCC of less than 3 cm and no gross vascular invasion were enrolled. RESULTS: Major resection was performed in 32 (23.9%) patients; there was no postoperative mortality. Fifty-eight (43.3%) patients experienced recurrence, 53 developed intrahepatic recurrence alone, and 50 (94.3%) of 53 had tumors within the Milan criteria. Five-year disease-free and overall survival rates were 51.0% and 77.3%, respectively. Microscopic vascular invasion, positivity for hepatitis B surface antigen or antibody to hepatitis C, and an indocyanine green retention test at 15 minutes of more than 10% were found to be significantly correlated with disease-free overall survival. A platelet count of less than 100,000/mm3 was the only independent prognostic factors of overall survival identified. CONCLUSIONS: This study showed favorable outcome comparable to the survival after liver transplantation, thus that liver resection appears to be the primary treatment option for small HCC, even in cases with poor prognostic factors.
Carcinoma, Hepatocellular ; Hepatitis B Surface Antigens ; Hepatitis C ; Humans ; Indocyanine Green ; Liver ; Liver Transplantation ; Platelet Count ; Recurrence ; Retention (Psychology) ; Survival Rate

PURPOSE: Major liver resection and radical lymph node dissection has been accepted as a definite treatment of choice for hilar cholangiocarcinoma (HC). However, the perioperative and survival outcomes of right hemihepatectomy (RH) and left hemihepatectomy (LH) still remain controversial. Thus, this study aimed to compare the surgical and oncological outcomes of RH and LH in HC patients. METHODS: From January 2000 to January 2018, a total of 326 patients underwent surgical resection for HC at Yonsei University College of Medicine in Seoul, Korea. Among the 326 patients, we excluded 130 patients and selected 196 patients, who underwent hemihepatectomy with caudate lobectomy. Among these 196 patients, 114 patients underwent RH, and 82 patients underwent LH. We compared the clinicopathological features as well as the surgical and oncologic outcomes of the RH and LH groups. RESULTS: There were no significant differences in disease-free survival (P = 0.473) or overall survival (P = 0.946) in the RH and LH groups. The LH group had fewer complications compared with the RH group, including postoperative ascites (RH: 15 [13.2%] vs. LH: 3 [3.7%], P = 0.023); however, the LH group had more bile leakage complications (RH: 5 [4.4%] vs. LH: 12 [14.6%], P = 0.012). The average time lag from portal vein embolization to operation was 25.80 ± 12.06 days (n = 45). There was no difference in postoperative liver failure (P = 0.402), although there were significantly more frequent ascites after RH (P = 0.023). CONCLUSION LH might be a good alternative option for the surgical treatment of HC given appropriate tumor location and biliary anatomy indications.

Locally advanced hepatocellular carcinoma (HCC) with portal vein thrombosis carries a 1-year survival rate <10%. Localized concurrent chemoradiotherapy (CCRT), followed by hepatic arterial infusion chemotherapy (HAIC), was recently introduced in this setting. Here, we report our early experience with living donor liver transplantation (LDLT) in such patients after successful down-staging of HCC through CCRT and HAIC. Between December 2011 and September 2012, eight patients with locally advanced HCC at initial diagnosis were given CCRT, followed by HAIC, and underwent LDLT at the Severance Hospital, Seoul, Korea. CCRT [45 Gy over 5 weeks with 5-fluorouracil (5-FU) as HAIC] was followed by HAIC (5-FU/cisplatin combination every 4 weeks for 3-12 months), adjusted for tumor response. Down-staging succeeded in all eight patients, leaving no viable tumor thrombi in major vessels, although three patients first underwent hepatic resections. Due to deteriorating liver function, transplantation was the sole therapeutic option and offered a chance for cure. The 1-year disease-free survival rate was 87.5%. There were three instances of post-transplantation tumor recurrence during follow-up monitoring (median, 17 months; range, 10-22 months), but no deaths occurred. Median survival time from initial diagnosis was 33 months. Four postoperative complications recorded in three patients (anastomotic strictures: portal vein, 2; bile duct, 2) were resolved through radiologic interventions. Using an intensive tumor down-staging protocol of CCRT followed by HAIC, LDLT may be a therapeutic option for selected patients with locally advanced HCC and portal vein tumor thrombosis.
Adult ; Carcinoma, Hepatocellular/complications/drug therapy/surgery/*therapy ; *Chemoradiotherapy ; Cisplatin/therapeutic use ; Disease-Free Survival ; Female ; Fluorouracil/therapeutic use ; Humans ; Liver Neoplasms/complications/drug therapy/surgery/*therapy ; *Liver Transplantation ; *Living Donors ; Male ; Middle Aged ; Neoplasm Recurrence, Local ; *Portal Vein ; Venous Thrombosis/*complications

PURPOSE: Pancreatic ductal adenocarcinoma has the highest incidence between the ages of 60 and 70 years. As the elderly population has been increasing in the last several decades, the proportion of patients older than 70 years of age with resectable pancreatic cancer is expected to increase in our society. This retrospective observation was performed to evaluate surgical value of pancreaticoduodenectomy for the elderly patients with pancreatic ductal adenocarcinoma. MATERIALS AND METHODS: From January 1990 to June 2005, among the patients who underwent pancreaticoduodenectomy for pancreatic ductal adenocarcinoma, the elder patients older than 70 years of age were retrospectively reviewed. Perioperative surgical outcomes, including general clinicopathologic features, morbidity, mortality, and survival outcomes, were investigated based on available medical records. RESULTS: Seventy-seven patients underwent pancreaticoduodenenctomy (PD) for pancreatic ductal adenocarcinoma. Among them, 11 patients (14.3%) were 70 years older. More frequent incidences of morbidity (8 out of 11 vs. 25 out of 65, p=0.049), especially delayed gastric emptying (3 out of 8 vs. 3 out of 66, p=0.035), were observed and overall length of hospital stay was also longer in the elderly (49.2 +/- 13.9 days vs. 36.1 +/- 13.2, p=0.012). However, no significant differences in mortality rate and survival outcomes were noted when comparing with those of the younger patients (p > 0.05). CONCLUSION: We agree with the opinion that age factor can not be absolute contraindication for pancreaticoduodenectomy, however, appropriate preoperative evaluations, proper patient selection considering life expectancy, advanced surgical techniques and detailed perioperative management are mandatory to guarantee the safety of pancreaticoduodenectomy performed in the elderly with pancreatic ductal adenocarcinoma.
Adenocarcinoma/pathology/*surgery ; Aged ; Carcinoma, Pancreatic Ductal/pathology/*surgery ; Female ; Humans ; Male ; Pancreatic Neoplasms/pathology/*surgery ; Pancreaticoduodenectomy/*methods ; Reproducibility of Results ; Retrospective Studies ; Treatment Outcome

PURPOSE: Although many patients with hepatocellular carcinoma experience recurrence within 2 years after hepatectomy, some patients with T1 and T2 hepatocellular carcinoma show recurrence-free survival for more than 5 years after surgery. This study was designed to analyze the optimal follow-up period on patients with T1 and T2 hepatocellular carcinoma (HCC) showing recurrence-free survival 5 years after surgery. METHODS: One hundred seventy patients underwent hepatectomy from January 1995 to December 1999. Numbers of patients with T1 and T2 HCC were 76 and 73, respectively. The recurrence patterns of patients experiencing recurrence more than 5 years after liver resection were analyzed in aspect of clinicopathological features and follow-up period. RESULTS: Thirteen patients experienced recurrence more than 5 years after surgery. Only age was found as a significant factor for recurrence. Eight patients were checked regularly with 6-month intervals and the others were checked with 12-month or more intervals. The size of the recurrent tumors in the 6-month interval group had a median of 1.1 cm (range, 1 to 4.2 cm) and the size of the recurrent tumors in the 12-month or more interval group had a median of 3 cm (range, 1.6 to 4 cm). The tumor size was significantly smaller in the 6-month interval group. CONCLUSION: Though the patients with early stage HCC showed high overall survival, some patients experienced a late recurrence of more than 5 years after surgery. Patients less than 60 years old with early stage HCC should be checked regularly with 6-month intervals even over 5 years after liver resection.
Carcinoma, Hepatocellular* ; Disease-Free Survival* ; Follow-Up Studies* ; Hepatectomy ; Humans ; Liver* ; Recurrence

PURPOSE: Preformed circulating donor-specific antibodies (DSAs) immunologically challenge vascular endothelium and the bile duct. However, the liver is an immune-tolerant organ and can avoid immunological challenges. This study was undertaken to analyze the effects of DSAs after adult living donor liver transplantation (LDLT). METHODS: We retrospectively reviewed 219 LDLT patients' records treated at our center. RESULTS: Of the 219 patients, 32 (14.6%) were DSA (+) and 187 (85.4%) were DSA (-). Class I DSAs were present in 18 patients, class II in seven patients, and both in seven patients. Seven patients (3.2%) showed DSA to HLA-A, four (1.8%) to HLA-B, seven (3.2%) to HLA-DR, and 14 (6.4%) to two or more HLAs. More DSAs were observed in female recipients than male recipients in the DSA (+) group. The DSA (+) group showed significantly higher levels of class I and II panel reactive antibody (PRA) than did the DSA (-) group. No significant intergroup differences were found between incidences of primary nonfunction, acute rejection, vascular complication, or biliary complication. There were no significant differences in graft survival rates between the two groups. However, the recipients with multiple DSAs tended to have more acute rejection episodes and events of biliary stricture and lower graft survival rates than did patients in the DSA (-) group. CONCLUSION: In LDLT, the presence of multiple DSAs and high PRA seemed to be associated with poor graft outcomes, although our results did not reach statistical significance. Large cohort studies are necessary to clarify the impact of DSA and PRA in LDLT.
Adult ; Antibodies* ; Bile Ducts ; Cohort Studies ; Constriction, Pathologic ; Endothelium, Vascular ; Female ; Graft Survival ; HLA-A Antigens ; HLA-B Antigens ; HLA-DR Antigens ; Humans ; Incidence ; Liver Transplantation ; Liver* ; Living Donors* ; Male ; Retrospective Studies ; Transplantation* ; Transplants