Hepatocellular carcinoma (HCC) is the third most common cancer in the digestive system based on survey of domestic cancer incidence, and the ratio of elderly aged 65 or older is expected to rise steadily, leading to a higher incidence of total hepatocellular carcinoma. The most important thing in treating these older patients with HCC is to assess the benefits and risks of the treatment in advance. In other words, the benefit of treatment should be greater than the reduction of survival period or maladjustment due to treatment. Based on these perspectives, we examined how the detailed treatment of hepatocellular carcinoma differs from that of general treatment in elderly patients. In conclusion, older age was not a definite prognostic factor of survival risk-benefit comparison in the most treatment modalities. However it should be carefully considered and approached about possible complications in treating HCC in elderly patients.
Aged ; Aging ; Carcinoma, Hepatocellular ; Digestive System ; Humans ; Incidence ; Risk Assessment

Laparoscopic pancreatoduodenectomy (LPD) in pancreatic cancer is primarily criticized for its technical and oncological safety. Although solid evidence has not yet been established, many institutions are performing LPD for pancreatic cancer patients, with continuous efforts to ensure oncologic safety. In this video, we demonstrated a case of standard LPD combined with vascular resection in pancreatic cancer.

ICG is widely applied in real-time imaging during abdominal surgery, plastic surgery, as well as oncologic staging and treatment. A twenty-eight year-old female patient was found to have a 4.5 cm solid pseudopapillary neoplasm in the tail of the pancreas. Under ICG-fluorescent pancreatic perfusion-guidance, we easily defined the margin of the pancreatic tumor and secured the resection margin when performing laparoscopic distal pancreatosplenectomy in the patient. No clinically relevant complications, including postoperative pancreatic fistula, were noted. Intravenous ICG can be very easily and quickly detected in the pancreas under near infrared light. This enhanced vision gives strong contrast to the organ compared to a necrotic tumor with poor blood perfusion, such as solid pseudopapillary neoplasm. Based on our current experience, ICG pancreatic perfusion-guided determination of appropriate resection margin is useful and feasible during pancreaticoduodenectomy.
Female ; Fluorescent Dyes ; Humans ; Indocyanine Green ; Pancreas* ; Pancreatectomy ; Pancreatic Fistula ; Pancreaticoduodenectomy ; Perfusion ; Surgery, Plastic ; Tail

Laparoscopic pancreatoduodenectomy (LPD) in pancreatic cancer is primarily criticized for its technical and oncological safety. Although solid evidence has not yet been established, many institutions are performing LPD for pancreatic cancer patients, with continuous efforts to ensure oncologic safety. In this video, we demonstrated a case of standard LPD combined with vascular resection in pancreatic cancer.

Background: /Aim: Gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid-enhanced magnetic resonance imaging (EOBMRI) further enhances the identification of additional hepatic nodules compared with computed tomography (CT) alone; however, the optimal treatment for such additional nodules remains unclear. We investigated the long-term oncological effect of aggressive treatment strategies for additional lesions identified using EOB-MRI in patients with hepatocellular carcinoma (HCC). Methods: Data from 522 patients diagnosed with solitary HCC using CT between January 2008 and December 2012 were retrospectively reviewed. Propensity score-matched (PSM) analysis was used to compare the oncologic outcomes between patients with solitary HCC and those with additional nodules on EOB-MRI after aggressive treatment (resection or radiofrequency ablation [RFA]). Results: Among the 383 patients included, 59 had additional nodules identified using EOB-MRI. Compared with patients with solitary HCC, those with additional nodules on EOB-MRI had elevated total bilirubin, aspartate transaminase, and alanine transaminase; had a lower platelet count, higher MELD score, and highly associated with liver cirrhosis (P<0.05). Regarding long-term outcomes, 59 patients with solitary HCC and those with additional nodules after PSM were compared. Disease-free survival (DFS) and overall survival (OS) were comparable between the two groups (DFS, 60.4 vs. 44.3 months, P=0.071; OS, 82.8 vs. 84.8 months, P=0.986). Conclusion The aggressive treatment approach, either resection or RFA, for patients with additional nodules identified on EOBMRI was associated with long-term survival comparable with that for solitary HCC. However, further studies are required to confirm these findings.

PURPOSE: Unplanned conversion is sometimes necessary during minimally invasive liver resection (MILR) of hepatocellular carcinoma (HCC). The aims of this study were to compare surgical outcomes of planned MILR and unplanned conversion and to investigate the risk factors after unplanned conversion. METHODS: We retrospectively analyzed 286 patients who underwent MILR with HCC from January 2006 to December 2017. All patients were divided into a MILR group and an unplanned conversion group. The clinicopathologic characteristics and outcomes were compared between the 2 groups. In addition, surgical outcomes in the conversion group were compared with the planned open surgery group (n = 505). Risk factors for unplanned conversion were analyzed. RESULTS: Of the 286 patients who underwent MILR, 18 patients (6.7%) had unplanned conversion during surgery. The unplanned conversion group showed statistically more blood loss, higher transfusion rate and postoperative complication rate, and longer hospital stay compared to the MILR group, whereas no such difference was observed in comparison with the planned open surgery group. There were no significant differences in overall and disease-free survival among 3 groups. The right-sided sectionectomy (right anterior and posterior sectionectomy), central bisectionectomy and tumor size were risk factors of unplanned conversion. CONCLUSION Unplanned conversion during MILR for HCC was associated with poor perioperative outcomes, but it did not affect long-term oncologic outcomes in our study. In addition, when planning right-sided sectionectomy or central bisectionectomy for a large tumor (more than 5 cm), we should recommend open surgery or MILR with an informed consent for unplanned open conversions.

PURPOSE: The aim of this study was to assess the feasibility and safety of laparoscopic resection following the insertion of self-expanding metallic stents (SEMS) for the treatment of obstructing left-sided colon cancer. METHODS: Between October 2006 and December 2012, laparoscopic resection following SEMS insertion was performed in 54 patients with obstructing left-sided colon cancer. RESULTS: All 54 procedures were technically successful without the need for conversion to open surgery. The median interval from SEMS insertion to laparoscopic surgery was 9 days (range, 3-41 days). The median surgery time was 200 minutes (range, 57-444 minutes), and estimated blood loss was 50 mL (range, 10-3,500 mL). The median time to soft diet was 4 days (range, 2-8 days) and possible length of stay (hypothetical length of stay according to the discharge criteria) was 7 days (range, 4-22 days). The median total number of lymph nodes harvested was 23 (range, 8-71) and loop ileostomy was performed in 2 patients (4%). Six patients (11%) developed postoperative complications: 2 patients with anastomotic leakages, 1 with bladder leakage, and 3 with ileus. There was no mortality within 30 days. CONCLUSION: The present study shows that the presence of a SEMS does not compromise the laparoscopic approach. Laparoscopic resection following stent insertion for obstructing left-sided colon cancer could be performed with a favorable safety profile and short-term outcome. Large-scale comparative studies with long-term follow-up are needed to demonstrate a significant benefit of this approach.
Anastomotic Leak ; Colon* ; Colonic Neoplasms* ; Conversion to Open Surgery ; Diet ; Humans ; Ileostomy ; Ileus ; Laparoscopy ; Length of Stay ; Lymph Nodes ; Mortality ; Postoperative Complications ; Stents* ; Urinary Bladder