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Clinicopathological features of the intraductal papillary neoplasms of the intrahepatic bile duct.

Gi Woong JANG ; Shin HWANG ; Yong Joo LEE ; Ki Hun KIM ; Kwang Min PARK ; Chul Soo AHN ; Deok Bog MOON ; Tae Yong HA ; Gi Won SONG ; Dong Hwan JUNG ; Gil Chun PARK ; Sung Gyu LEE

Korean Journal of Hepato-Biliary-Pancreatic Surgery.2012;16(4):138-141. doi:10.14701/kjhbps.2012.16.4.138

BACKGROUNDS/AIMS: This study is intended to investigate the clinicopathological features of the intraductal papillary neoplasms of the intrahepatic bile duct (IPNB), especially focused on malignant changes. METHODS: From the institutional database of liver resection cases (Asan Medical Center, University of Ulsan College of Medicine), 18 patients who met the definition of IPNB were selected. They had undergone liver resection between February 2002 and October 2006; thus, the follow-up period was more than 5 years. RESULTS: Of the 18 patients, 11 patients were male. Their mean age was 61.3+/-6.7 years. There were no differences between the non-malignant and malignant lesions, in the comparison of the CEA levels (5.6+/-2.7 vs.12.6+/-31.1 ng/ml, p=0.439) and the CA19-9 levels (29.2+/-34.7 vs.31.9+/-30.2 ng/ml, p=0.871). The common radiologic findings were: intraductal growing mass in 10; bile duct dilatation in 6; and saccular duct dilatation in 2. Left and right hepatectomies were performed in 15 and 3, respectively. Five patients showed benign lesions of IPNB, and 13 patients revealed malignant lesions of intraductal papillary adnocarcinoma or cholangiocarcinoma. All 4 patients with benign lesions survived for a mean period of 53 months without recurrence. In 13 patients with the malignant lesions, 1-year, 3-year, and 5-year survival rates were 100%, 84.6%, and 59.2%, respectively. CONCLUSIONS: We concluded that intrahepatic IPNB is a rare type of biliary neoplasm which includes a histological spectrum, ranging from benign disease to invasive malignancy. The long-term survival was anticipated after complete curative resection.
Academic Medical Centers ; Bile Ducts ; Bile Ducts, Intrahepatic ; Cholangiocarcinoma ; Dilatation ; Follow-Up Studies ; Hepatectomy ; Humans ; Liver ; Male ; Recurrence ; Survival Rate

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Managements of simple liver cysts: ablation therapy versus cyst unroofing.

Seong Ryong KIM ; Do Sang LEE ; Il Young PARK

Korean Journal of Hepato-Biliary-Pancreatic Surgery.2012;16(4):134-137. doi:10.14701/kjhbps.2012.16.4.134

BACKGROUNDS/AIMS: Simple liver cysts were easily recognizable with the advanced imaging procedures, such as ultrasound and computed tomography scan. A large cyst or significant symptoms were indications for the treatments. Ablation therapy with sclerotic agents was effective, but there were several complications including severe pain. With the surgical cyst unroofing method introduced, we compared the cyst unroofing method and ablation therapy. METHODS: Between March 1997 and May 2011, we performed treatments of simple liver cysts in 27 patients. There were 23 women and 4 men (age range: 42-84 years; mean age: 64 years). The cyst unroofing was undergone with laparoscopic (n=13) and open technique (n=1). The ablation therapy was performed with ethanol (n=13) and acetic acid (n=1). RESULTS: The usual symptoms of the liver cysts were abdominal mass (n=7), indigestion (n=4), abdominal discomfort (n=3), and the increasing size of the cysts (n=4). The mean diameter of the cysts was 10.9 cm. The cyst unroofing method was performed effectively in 14 patients. One patient had bleeding during operation, and was converted to the open technique. One patient had a bile leak from the cyst, but it was successfully closed with the laparoscopic technique. Among the 14 cases with the ablation therapy, there were 4 complications: hematoma (n=1); cyst leaking during aspiration (n=2); acute renal failure (n=1); and death due to acetic acid intoxication (n=1). CONCLUSIONS: Laparoscopic cyst unroofing was more effective and safer in management than the ablation therapy in simple liver cysts.
Acetic Acid ; Acute Kidney Injury ; Bile ; Dyspepsia ; Ethanol ; Female ; Hematoma ; Hemorrhage ; Humans ; Liver ; Male

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Effect of early enteral nutrition after hepatectomy in hepatocellular carcinoma patients.

Jonghwan LEE ; Choon Hyuck David KWON ; Jong Man KIM ; Milljae SHIN ; Jae Won JOH

Korean Journal of Hepato-Biliary-Pancreatic Surgery.2012;16(4):129-133. doi:10.14701/kjhbps.2012.16.4.129

BACKGROUNDS/AIMS: To evaluate the effect of early enteral nutrition after hepatectomy in hepatocellular carcinoma (HCC) patients on postoperative gastrointestinal motility recovery and admission days, liver function and nutrition recovery, and postoperative complication. METHODS: From August 2010 to July 2011, 102 patients with primary HCC underwent hepatectomy. Forty two patients took a sip of water (SOW) at postoperative day (POD)#1, soft blended diet (SBD) at POD#2 (early diet group, ED group), otherwise 60 patients took a SOW at POD#3, SBD at POD#4 (conventional diet group, CD group). Postoperative flatus-pass day, stool-pass day, nausea, vomiting, admission days, immediate postoperative (POD#0) and POD#1, 3, 5, 7 profiles of albumin, prothrombin time (PT) INR, total bilirubin, aspartate aminotransferase (AST), alanine aminotransferase (ALT), white blood cell (WBC), and POD#1, 3, 5, 7 profiles of C-reactive protein (CRP), and postoperative complications cases were compared between ED group and CD group. All clinical data were compared retrospectively. RESULTS: Flatus-pass days (p<0.01), stool-pass days (p<0.01) and postoperative admission days (p=0.012) were shorter in ED group. Total bilirubin levels were higher at POD#0, 1, 3 but lower or similar at POD#5, 7 in ED group. AST, ALT levels were higher at POD#0 but lower at POD#1, 3, 5. There were no significant differences in albumin, PT INR, WBC, CRP and postoperative complication rates. CONCLUSIONS: ED group had no difference in nutritional recovery and postoperative complication rates compared to CD group but it has better gastrointestinal motility recovery, liver function recovery, and shorter postoperative admission days.
Alanine Transaminase ; Aspartate Aminotransferases ; Bilirubin ; C-Reactive Protein ; Carcinoma, Hepatocellular ; Diet ; Enteral Nutrition ; Gastrointestinal Motility ; Hepatectomy ; Humans ; International Normalized Ratio ; Leukocytes ; Liver ; Nausea ; Postoperative Complications ; Prothrombin Time ; Recovery of Function ; Vomiting ; Water

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Bile Duct Cancer afterSubtotal Gastrectomy for Early Gastric Cancer: Report of 2 Cases.

JSeon Mee PARK ; Dong Hee RYU ; Ok Jun LEE ; Rohyun SUNG ; Il Hun BAE ; Jae Woon CHOI

Korean Journal of Hepato-Biliary-Pancreatic Surgery.2008;12(1):86-90.

Patients with early gastric cancer (EGC) may be associated with an increased risk of having a second primary cancer. Metachronous primary malignancies may have an influence on the long term prognosis of these patients. We report here on two cases of bile duct cancer after performing subtotal gastrectomy for EGC. A 59-year-old man underwent pylorus preserving pancreaticoduodenectomy (PPPD) under the diagnosis of bile duct cancer, and this was done 5 years after he had undergone gastrectomy. The pathological specimens were different between the EGC and bile duct cancer according to their morphology and immunohistochemical staining, and this case was determined to be metachronous double cancer. The second case was a 39-year-old man who received PPPD for bile duct cancer 4 years after undergoing gastrectomy. Double primary malignancies of bile duct cancer and gastric cancer are very rare.
Adult ; Bile ; Bile Duct Neoplasms ; Bile Ducts ; Gastrectomy ; Humans ; Middle Aged ; Neoplasms, Second Primary ; Pancreaticoduodenectomy ; Prognosis ; Pylorus ; Stomach Neoplasms

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Analysis of Molecular Cytogenetic Alteration of Pancreatic Cancer Identified by Fluorescent In Situ Hybridization (FISH) and its Clinical Significance.

Yoo Seok YOON ; Dong Soon LEE ; Hyun Chung MIN ; Jin Young JANG ; Seung Eun LEE ; Dae Wook HWANG ; Ho Seong HAN ; Sun Whe KIM

Korean Journal of Hepato-Biliary-Pancreatic Surgery.2008;12(1):75-85.

PURPOSE: The purposes of this study are to examine the cytogenetic alterations of pancreatic cancer, by using fluorescent in situ hybridization (FISH), to determine thier correlation with the clinico-pathologic prognostic factors and to identify the cytogenetic factors that can predict the prognosis of pancreatic cancer. METHODS: Fresh frozen tissues of pancreatic cancer and normal pancreas that were obtained via pancreatic resection from 20 patients with pancreatic ductal adenocacinoma were analyzed by performing FISH with using locus-specific c-myc, p16, p53 probes and chromosome 18q, 20q probes. We cpmpared the FISH results with the clinico-pathologic prognostic factors. We also examined 16 paraffin-embedded tissues of pancreatic cancer by performing immunohistochemical staining (IHC) with monoclonal antibody to c-myc, p16, p53 and DPC. We then evaluated the correlation between the results of FISH and the results of IHC. RESULTS: At least one alteration of genes or chromosomes was detected in 18 (90.0%) of the 20 pancreatic cancer tissues by FISH, as compared with no alternation in the normal pancreatic tissues: these alteration were an increased copy number of c-myc (66.7%), a decreased copy number of p16 (70.6%), deletion of p53 (100%), loss of chromosome 18q (56.3%) and gain of chromosome 20q (45.0%). IHC demonstrated overexpression of c-myc and p53 in 31.3% and 50.0% of the pancreatic cancer specimens, respectively, and the loss of expressions of p16 and DPC in 25.0% and 93.3% of the pancreatic cancer specimens, respectively. The concordance rate of IHC with FISH was 33.3% to 61.5%. Analysis of the correlation between the cytogenetic changes identified by FISH or IHC and the pathologic prognostic factors showed that only chromosome 20q gain was significantly correlated with the histologic grade (p=0.098) and lymphovascular invasion (p=0.092). However there was no clinical correlation of the cytogenetic changes with respect to recurrence after operation. CONCLUSION: This study confirms that most pancreatic cancers have cytogenetic alternations, as can be determined by FISH. Especially, the correlation between chromosome 20q gain and the prognostic pathologic factors offers the possibility of a new prognostic biologic marker located in chromosome 20q. However, further studies with more cases are needed to clarify the clinical significance of cytogenetic alternations in pancreatic cancer.
Biomarkers ; Coat Protein Complex I ; Cytogenetics ; Humans ; In Situ Hybridization, Fluorescence ; Pancreas ; Pancreatic Ducts ; Pancreatic Neoplasms ; Prognosis ; Recurrence

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Analysis of Clinical Outcome and Prognostic Factors in Patients with Gallbladder Cancer.

Say June KIM ; Dong Goo KIM

Korean Journal of Hepato-Biliary-Pancreatic Surgery.2008;12(1):64-74.

PURPOSE: The aim of the present study was to determine proper treatment strategies to improve the outcome of patients with gallbladder cancer by an analysis of multiple factors affecting tumor recurrence and patient survival. METHODS: Between January 1991 and April 2006, surgery with curative intent was performed on 120 patients with gallbladder cancer. Of 120 cases, 35 patients had findings that precluded any further intervention, and the remaining 85 patients underwent curative resections that included a simple cholecystectomy in 43 cases, a radical cholecystectomy in 32 cases and an extended cholecystectomy in 10 cases. Clinicopathogical data was analyzed. RESULTS: The presence of jaundice at presentation, gross morphology of the tumor, tumor cell differentiation, presence of a lymph node metastasis, lymphatic invasion and direct invasion to other contagious organ(s) and achievement of a tumor-free resection margin were associated with survival. For stage I gallbladder cancer, in only T2 lesions, patients that undergone a simple cholecystectomy had double the rate of recurrence as compared to patients that undergone a radical cholecystectomy (12.5% versus 26.1%; p = .119). For stage II gallbladder cancer, survival and disease-free survival for patients that undergone a radical cholecystectomy were improved as compared to patients that undergone a simple cholecystectomy; survival and disease-free survival was poor for patients that had undergone an extended cholecystectomy, especially in patients that had bile duct invasion (4/5; 80%). For stage III/IV gallbladder cancer, all patients (n = 6) underwent an extended cholecystectomy and half of the patients survived longer than one year. CONCLUSION: Radical cholecystectomy could be a standard procedure for gallbladder cancer in addition to just stage II cancer. An aggressive approach including resecting contagious organ(s) in locally advanced gallbladder cancer could provide a survival benefit without an increase in complications.
Achievement ; Bile Ducts ; Cell Differentiation ; Cholecystectomy ; Disease-Free Survival ; Gallbladder ; Gallbladder Neoplasms ; Humans ; Jaundice ; Lymph Nodes ; Lymphatic Metastasis ; Recurrence

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CT Findings of Acute Gangrenous Cholecystitis.

Young Hoon SUL ; In Sang SONG

Korean Journal of Hepato-Biliary-Pancreatic Surgery.2008;12(1):58-63.

PURPOSE: Acute gangrenous cholecystitis (AGC) is a severe advanced form of cholecystitis, and it has a higher morbidity and mortality rate than that that of acute nongangrenous cholecystitis (ANGC). Identifying the CT findings of gangrenous cholecystitis will enable physicians to make an early diagnosis and administer aggressive treatment. METHODS: From January 2005 to October 2007, the CT scans in 277 patients (80 with AGC, 149 with ANGC and 45 with normal gallbladder (NGB)) were retrospectively reviewed by 2 radiologists. We evaluated the findings that included wall thickening (>3mm), distension (transverse diameter > 5cm), gallstones, pericholecystic fluid, pericholecystic inflammation, mural striation, adjacent hepatic enhancement, pericholecystic abscess, an intraluminal membrane, an irregular or absent wall, gas in the wall or lumen, and intraperitoneal fluid. The sensitivity and specificity of the each CT finding for diagnosing AGC were calculated. The dimension and wall thickness of the gallbladder were also measured. RESULTS: The sensitivity, specificity and accuracy of CT for diagnosing AGC were 27%, 94% and 74%, respectively. The findings with the highest specificity for AGC were gas in the wall or lumen (100%), intraluminal membranes (99.5%), pericholecystic abscess (99.5%), an irregular or absent wall (98.5%), adjacent hepatic enhancement (97.9%), intraperitoneal fluid (96.9%), pericholecystitic fluid (95.6%), and mural striation (93.8%). The difference of the mean gallbladder wall thickness between the groups was statistically significant. CONCLUSION: These specific CT findings, including the GB wall thickness, will assist clinicians in making an earlier and more exact diagnosis of gangrenous cholecystitis
Abscess ; Cholecystitis ; Early Diagnosis ; Gallbladder ; Gallstones ; Humans ; Inflammation ; Membranes ; Retrospective Studies ; Sensitivity and Specificity

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Continuous Peritransplant Assessment of Consciousness using Bispectral Index Monitoring for Patients with Fulminant Hepatic Failure.

Jeong Ik PARK ; Shin HWANG ; Sung Gyu LEE ; Gyu Sam HWANG ; Ki Hun KIM ; Chul Soo AHN ; Deok bog MOON ; Tae Yong HA ; Gi Won SONG ; Dong Hwan JUNG ; Je Ho RYU ; Hyo Jun LEE ; Sung Moon JEONG ; Suk Kyung HONG

Korean Journal of Hepato-Biliary-Pancreatic Surgery.2008;12(1):51-57.

PURPOSE: Deterioration of consciousness is the most critical problem in patients with fulminant hepatic failure (FHF). Electroencephalography (EEG) is a standard procedure to determine the brain activity in unconscious patients. The bispectral (BIS) index derived from EEG was primarily developed to monitor the depth of unconsciousness. METHODS: A prospective study was performed to assess the clinical utility of peritransplant BIS monitoring in 11 fulminant hepatic failure (FHF) patients who were undergoing emergency living donor liver transplantation (LT) with using a right liver graft. All the patients recovered their consciousness after LT. RESULTS: There was a significant correlation between the BIS index values and the derived GCS score (r2=0.634, p <0.001). Timing of eye opening to voice command matched the BIS index value of 64+/-9.5, which was after 14+/-9.4 hours passing BIS index of 50. All the patients with endotracheal intubation during the early posttransplant period showed progressive increase of their BIS index, which appeared slightly earlier and more evident than the rise of derived GCS scores. CONCLUSION: BIS monitoring is a noninvasive, simple and easy-to-interpret method and it also appears to be a useful to assess and predict the recovery of a patient's consciousness level after LT. Therefore, we concluded that BIS monitoring can be an indispensable component of the peritransplant intensive care for patients with FHF and who require emergency LT.
Brain ; Consciousness ; Consciousness Monitors ; Electroencephalography ; Emergencies ; Eye ; Humans ; Critical Care ; Intubation, Intratracheal ; Liver ; Liver Failure, Acute ; Liver Transplantation ; Living Donors ; Organothiophosphorus Compounds ; Prospective Studies ; Transplants ; Unconscious (Psychology) ; Voice

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Portal Vein Anastomosis with using Growth Factor for Preventing Stricture and Thrombosis following Auxiliary Partial Liver Transplantation in Rat..

Myunghee YOON

Korean Journal of Hepato-Biliary-Pancreatic Surgery.2008;12(1):46-50.

PURPOSE: To overcome donor shortage, reduced-size liver transplantation, split-liver transplantation and partial liver transplantation from living donors for children are frequently used all over the world. Despite the difficulties of adequate volume reduction and the age difference between the donor and the recipent, all these techniques also share the problem of size mismatch between the vessels of the adult liver and those of the pediatric recipient. Portal vein reconstruction in a crucial factor for a successful transplantation because it allows blood flow to the liver graft, which ends the ischemic period for the graft, as well as the anhepatic period for the recipient. METHODS: In Group I (n=10, no growth factor), a partial liver of Sprague-Dawley(SD) rat was transplanted heterotopically, via microsurgical technique, to a SD rat with performing end-to-end portal vein anastomosis without applying growth factor to the suture of the portal vein. In Group II (n=10, 50-60% growth factor), a partial liver of a SD rat was transplanted heterotopically to a SD rat, via microsurgical technique, with applying growth factor to 50-60% of the diameter of the portal vein. In Group III (n=10, 80-100% growth factor), the portal vein was anastomosed, via microsurgical technique, with using growth factor to 80-100% of the diameter of the portal vein. RESULTS: In Group II, only one case has portal vein stenosis on the postoperative 14th day following portal vein anastomosis with growth factor. In Group I, 3 cases showed portal vein stenosis on the postoperative 7th day, and 5 cases showed portal vein thrombosis on the postoperative 14th day. In Group III, 6 cases died due to bleeding after declamping of the portal vein anastomosis with using 80-100% growth factor on the diameter and 1 case has portal vein thrombosis on the postoperative 14th day. CONCLUSION: Several surgical factors might have an important role in preventing vascular stenosis and thrombosis, and especially when transplanting a technical-variant liver graft like a reduced-size or split liver graft. To overcome the small caliber of the portal vein and the difference in caliber between the donor and recipient vessels, the growth-factor suture technique having 50-60% of one diameter might be helpful because it allows for expansion along the suture line and it also prevents a purse-string effect.
Adult ; Animals ; Child ; Constriction, Pathologic ; Hemorrhage ; Humans ; Liver ; Liver Transplantation ; Living Donors ; Portal Vein ; Rats ; Suture Techniques ; Sutures ; Thrombosis ; Tissue Donors ; Transplants

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Ampulla of Vater Cancer in a Patient with Double Common Bile Duct.

Jae Im LEE ; Kyong Hwa JUN ; Yong Sung WON ; Hyung Min CHIN ; Hyun Jin KIM ; Woo Bae PARK

Korean Journal of Hepato-Biliary-Pancreatic Surgery.2005;9(3):189-191.

Of the various anomalies of the biliary system, a double common bile duct (DCBD) is extremely rare. According to a report by Boyden, the first case of DCBD was reported by Vesalius in 1543, with few additional case reports since 1986. Cancer and Anomalous pancreatobiliary ductal union (APBDU) are the two of the most serious concomitant conditions. A 69-year-old female was admitted to our hospital with the complaint of jaundice. An abdominal computed tomography and percutaneous transhepatic cholangiography revealed a mass lesion at the distal common bile duct. The patient underwent Whipple's operation, and the operative finding showed a septum in the common bile duct, with a DCBD opening as a single duct into the ampulla of Vater. A histological examination showed an adenocarcinoma in the ampulla of Vater. Herein, a case of the ampulla of Vater cancer in a patient with a double common bile duct is reported, with a review of the literature.
Adenocarcinoma ; Aged ; Ampulla of Vater* ; Biliary Tract ; Cholangiography ; Common Bile Duct Neoplasms ; Common Bile Duct* ; Female ; Humans ; Jaundice

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