OBJECTIVETo explore the significance of resection margin and tumor number on survival of patients with small liver cancer after hepatectomy.

METHODSWe collected 219 cases with small liver cancer undergoing hepatectomy in Cancer Hospital, Chinese Academy of Medical Sciences between December 2003 to July 2013. The survival rates were compared by log-rank test between two resection margin groups (≥ 1 cm vs. <1 cm), different tumor number groups (single tumor vs. multiple tumors). We also performed a multifactor analysis by Cox model.

RESULTSThe 1-, 3-, 5- and 10- year overall survival rates were 95.9%, 85.3%, 67.8% and 53.3%, respectively, in all patients. The median survival time was 28 months in the group of <1 cm resection margin and 36 months in the group of ≥ 1 cm resection margin (P=0.249). The median survival time was 36 months in the group of single tumor and 26 months in the group of multiple tumors (P=0.448). The multifactor analysis also did not show significant effect of resection margin and tumor number on the patients' survival.

CONCLUSIONSFor small liver cancer, the resection margin of 1 cm might be advised. Increasing resection margin in further could probably not improve therapeutic effect. Standardized operation and combined treatment will decrease the negative influence of multiple tumors on overall survival.

Combined Modality Therapy ; Hepatectomy ; Humans ; Liver Neoplasms ; mortality ; pathology ; surgery ; Survival Rate ; Time Factors

OBJECTIVETo explore the surgical risk, perioperative outcome and the response of patients with hepatocellular carcinoma (HCC) after preoperative transcatheter arterial chemoembolization (TACE).

METHODSA retrospective case-matched study was conducted to compare the characteristics and corresponding measures of patients in the preoperative TACE group and the control group without TACE. A total of 105 patients (82 patients with selective and dynamic region-specific vascular occlusion to perform hepatectomy for patients with complex hepatocellular carcinoma) was included in this study, in which 35 patients underwent TACE therapy, and a 1:2 matched control group of 70 subjects.

RESULTSThe patients of preoperative TACE therapy group had a higher level of γ-glutamyl transpeptidase before operation (119.52±98.83) U/L vs. (67.39±61.25) U/L (P=0.040). The operation time was longer in the TACE group than that in the control group but with a non-significant difference (232.60±95.43) min vs. (218.70±75.13) min (P=0.052). The postoperative recovery of liver function and severe complications in the preoperative TACE group were similar to that in the control group (P>0.05). There were no massive hemorrhage, biliary fistula and 30-d death neither in the treatment group and matched control group.

CONCLUSIONSPreoperative TACE therapy has certain negative effect on liver function. It is preferable to use selective and dynamic region-specific vascular occlusion technique during hepatectomy and combine with reasonable perioperative treatment for this group of patients, that can ensure safety of patients and promote their rapid recovery.

Carcinoma, Hepatocellular ; blood supply ; therapy ; Case-Control Studies ; Chemoembolization, Therapeutic ; adverse effects ; methods ; Hepatectomy ; methods ; Humans ; Liver ; physiopathology ; Liver Neoplasms ; blood supply ; therapy ; Operative Time ; Preoperative Period ; Recovery of Function ; Retrospective Studies ; gamma-Glutamyltransferase ; analysis

OBJECTIVETo investigate the differences between clinicopathological features and prognosis of alpha-fetoprotein (AFP) negative (AFP < 20 ng/ml) and positive (AFP ≥ 20 ng/ml) hepatocellular carcinoma (HCC) patients.

METHODSClinicopathological data of 142 AFP-negative and 109 AFP-positive HCC patients who underwent RO radical hepatectomy in the Cancer Hospital of Chinese Academy of Medical Sciences between January 2006 and December 2011 were retrospectively reviewed and analyzed in this study.

RESULTSCompared with the AFP-negative patients, a higher female to male sex ratio, the later Barcelona Clinic Liver Cancer ( BCLC) stage, more liver capsule invasion and poorer Edmondson-Steiner grade were in the AFP-positive cases (P < 0.05 for all). Furthermore, the 1-, 3-, and 5- year overall survival rates were 94.4%, 82.4% and 61.0% in the AFP-negative group and 87.2%, 61.1% and 40.2%, respectively, in the AFP-positive group (P < 0.001). The multivariate analysis with Cox's proportional hazards model showed that AFP status, tumor size and Edmondson-Steiner grade are independent risk factors for survival of all the patients (P < 0.05) , and large tumor and Edmondson-Steiner grades III/IV are independent risk factors for worse survival in AFP-negative patients (P < 0.05). However, large tumor diameter was proved to be an independent risk factor leading to poor prognosis of AFP-positive cases (P < 0.05).

CONCLUSIONHigh levels of AFP indicate that the tumors are more malignant and with unfavorable prognosis.

Asian Continental Ancestry Group ; Carcinoma, Hepatocellular ; chemistry ; mortality ; pathology ; surgery ; Female ; Hepatectomy ; Humans ; Liver Neoplasms ; chemistry ; mortality ; pathology ; surgery ; Male ; Multivariate Analysis ; Prognosis ; Proportional Hazards Models ; Retrospective Studies ; Risk Factors ; Survival Rate ; alpha-Fetoproteins ; analysis

OBJECTIVETo evaluate preliminarily the clinical efficacy of two types of hepatic inflow occlusion in hepatectomy for hepatocellular carcinoma (HCC).

METHODSA total of 54 patients with HCC who underwent hepatectomy were divided into two groups: RIP group (regional ischemic preconditioning with continuous clamping, n=15) and HHV group (hemi-hepatic vascular inflow occlusion, n=39). HHV was performed by placing a clamp on the right hepatic artery and right portal vein, and was maintained until the liver resection was completed. In the RIP group, HHV was preceded by a 5-min period of ischemia followed by 5 min of reperfusion. The clinical indicators of the two groups were compared.

RESULTSThe volume of intraoperative blood loss had significant difference between the two groups (P=0.039). One case (6.7%) in the RIP group and 17 cases (43.6%) in the HHV group received postoperative blood transfusion, showing a significant difference (P=0.010). No postoperative 30-day mortality happened in all patients. No significant differences were found between the two groups in hospital stay or postoperative morbidity, including hepatic insufficiency, infection, ascites, pleural effusion, cardiopulmonary complications and intestinal ventilation time (P>0.05 for all).The RIP group had a significantly higher PTA level at postoperative days 3 and 5 (P<0.001). Although no significant differences were found between the two groups regarding total bilirubin, albumin, prealbumin and aminotransferase (P>0.05) during any postoperative stage, the ALT recovered to normal level in 5 patients (33.3%) of the RIP group and only in one case (2.7%) of the HHV group, with a significant difference between the two groups (P=0.006).

CONCLUSIONThe results of this study indicate that regional ischemic preconditioning may have better hemostatic effect on hepatectomy, can reduce postoperative blood transfusion and promote early recovery of liver function than hemi-hepatic vascular inflow occlusion.

Ascites ; Bilirubin ; Blood Loss, Surgical ; Blood Transfusion ; Carcinoma, Hepatocellular ; surgery ; Constriction ; Hepatectomy ; Hepatic Artery ; Humans ; Ischemic Preconditioning ; Length of Stay ; Liver Neoplasms ; surgery ; Portal Vein ; Postoperative Period

Objective To evaluate preliminarily the clinical efficacy of two types of hepatic inflow occlusion in hepatectomy for hepatocellular carcinoma ( HCC) .Methods A total of 54 patients with HCC who underwent hepatectomy were divided into two groups:RIP group ( regional ischemic preconditioning with continuous clamping,n=15) and HHV group(hemi-hepatic vascular inflow occlusion, n=39).HHV was performed by placing a clamp on the right hepatic artery and right portal vein, and was maintained until the liver resection was completed.In the RIP group, HHV was preceded by a 5-min period of ischemia followed by 5 min of reperfusion.The clinical indicators of the two groups were compared.Results The volume of intraoperative blood loss had significant difference between the two groups (P=0.039).One case (6.7%) in the RIP group and 17 cases ( 43.6%) in the HHV group received postoperative blood transfusion, showing a significant difference (P=0.010).No postoperative 30-day mortality happened in all patients. No significant differences were found between the two groups in hospital stay or postoperative morbidity, including hepatic insufficiency, infection, ascites, pleural effusion, cardiopulmonary complications and intestinal ventilation time ( P >0.05 for all).The RIP group had a significantly higher PTA level at postoperative days 3 and 5 (P<0.001).Although no significant differences were found between the two groups regarding total bilirubin, albumin, prealbumin and aminotransferase ( P >0.05 ) during any postoperative stage, the ALT recovered to normal level in 5 patients (33.3%) of the RIP group and only in one case (2.7%) of the HHV group, with a significant difference between the two groups (P=0.006). Conclusion The results of this study indicate that regional ischemic preconditioning may have better hemostatic effect on hepatectomy, can reduce postoperative blood transfusion and promote early recovery of liver function than hemi-hepatic vascular inflow occlusion.

Objective To investigate the differences between clinicopathological features and prognosis of alpha-fetoprotein ( AFP ) negative ( AFP<20 ng/ml ) and positive ( AFP≥20 ng/ml ) hepatocellular carcinoma ( HCC) patients.Methods Clinicopathological data of 142 AFP-negative and 109 AFP-positive HCC patients who underwent R0 radical hepatectomy in the Cancer Hospital of Chinese Academy of Medical Sciences between January 2006 and December 2011 were retrospectively reviewed and analyzed in this study.Results Compared with the AFP-negative patients, a higher female to male sex ratio, the later Barcelona Clinic Liver Cancer ( BCLC ) stage, more liver capsule invasion and poorer Edmondson-Steiner grade were in the AFP-positive cases (P<0.05 for all).Furthermore, the 1-, 3-, and 5-year overall survival rates were 94.4%, 82.4%and 61.0%in the AFP-negative group and 87.2%, 61.1%and 40.2%, respectively, in the AFP-positive group ( P<0.001 ) .The multivariate analysis with Cox′s proportional hazards model showed that AFP status, tumor size and Edmondson-Steiner grade are independent risk factors for survival of all the patients ( P<0.05) , and large tumor and Edmondson-Steiner gradesⅢ/Ⅳare independent risk factors for worse survival in AFP-negative patients ( P<0.05) .However, large tumor diameter was proved to be an independent risk factor leading to poor prognosis of AFP-positive cases (P<0.05).Conclusion High levels of AFP indicate that the tumors are more malignant and with unfavorable prognosis.

Objective To explore the surgical risk, perioperative outcome and the response of patients with hepatocellular carcinoma ( HCC ) after preoperative transcatheter arterial chemoembolization ( TACE) . Methods A retrospective case?matched study was conducted to compare the characteristics and corresponding measures of patients in the preoperative TACE group and the control group without TACE. A total of 105 patients ( 82 patients with selective and dynamic region?specific vascular occlusion to perform hepatectomy for patients with complex hepatocellular carcinoma) was included in this study, in which 35 patients underwent TACE therapy, and a 1 ∶ 2 matched control group of 70 subjects. Results The patients of preoperative TACE therapy group had a higher level of γ?glutamyl transpeptidase before operation (119.52± 98.83)U/L vs. (67.39±61.25) U/L (P=0.040). The operation time was longer in the TACE group than that in the control group but with a non?significant difference (232.60±95.43) min vs. (218.70±75.13) min ( P=0.052) . The postoperative recovery of liver function and severe complications in the preoperative TACE group were similar to that in the control group ( P>0.05) . There were no massive hemorrhage, biliary fistula and 30?d death neither in the treatment group and matched control group. Conclusions Preoperative TACE therapy has certain negative effect on liver function. It is preferable to use selective and dynamic region?specific vascular occlusion technique during hepatectomy and combine with reasonable perioperative treatment for this group of patients, that can ensure safety of patients and promote their rapid recovery.

Objective To evaluate preliminarily the clinical efficacy of two types of hepatic inflow occlusion in hepatectomy for hepatocellular carcinoma ( HCC) .Methods A total of 54 patients with HCC who underwent hepatectomy were divided into two groups:RIP group ( regional ischemic preconditioning with continuous clamping,n=15) and HHV group(hemi-hepatic vascular inflow occlusion, n=39).HHV was performed by placing a clamp on the right hepatic artery and right portal vein, and was maintained until the liver resection was completed.In the RIP group, HHV was preceded by a 5-min period of ischemia followed by 5 min of reperfusion.The clinical indicators of the two groups were compared.Results The volume of intraoperative blood loss had significant difference between the two groups (P=0.039).One case (6.7%) in the RIP group and 17 cases ( 43.6%) in the HHV group received postoperative blood transfusion, showing a significant difference (P=0.010).No postoperative 30-day mortality happened in all patients. No significant differences were found between the two groups in hospital stay or postoperative morbidity, including hepatic insufficiency, infection, ascites, pleural effusion, cardiopulmonary complications and intestinal ventilation time ( P >0.05 for all).The RIP group had a significantly higher PTA level at postoperative days 3 and 5 (P<0.001).Although no significant differences were found between the two groups regarding total bilirubin, albumin, prealbumin and aminotransferase ( P >0.05 ) during any postoperative stage, the ALT recovered to normal level in 5 patients (33.3%) of the RIP group and only in one case (2.7%) of the HHV group, with a significant difference between the two groups (P=0.006). Conclusion The results of this study indicate that regional ischemic preconditioning may have better hemostatic effect on hepatectomy, can reduce postoperative blood transfusion and promote early recovery of liver function than hemi-hepatic vascular inflow occlusion.

Objective To investigate the differences between clinicopathological features and prognosis of alpha-fetoprotein ( AFP ) negative ( AFP<20 ng/ml ) and positive ( AFP≥20 ng/ml ) hepatocellular carcinoma ( HCC) patients.Methods Clinicopathological data of 142 AFP-negative and 109 AFP-positive HCC patients who underwent R0 radical hepatectomy in the Cancer Hospital of Chinese Academy of Medical Sciences between January 2006 and December 2011 were retrospectively reviewed and analyzed in this study.Results Compared with the AFP-negative patients, a higher female to male sex ratio, the later Barcelona Clinic Liver Cancer ( BCLC ) stage, more liver capsule invasion and poorer Edmondson-Steiner grade were in the AFP-positive cases (P<0.05 for all).Furthermore, the 1-, 3-, and 5-year overall survival rates were 94.4%, 82.4%and 61.0%in the AFP-negative group and 87.2%, 61.1%and 40.2%, respectively, in the AFP-positive group ( P<0.001 ) .The multivariate analysis with Cox′s proportional hazards model showed that AFP status, tumor size and Edmondson-Steiner grade are independent risk factors for survival of all the patients ( P<0.05) , and large tumor and Edmondson-Steiner gradesⅢ/Ⅳare independent risk factors for worse survival in AFP-negative patients ( P<0.05) .However, large tumor diameter was proved to be an independent risk factor leading to poor prognosis of AFP-positive cases (P<0.05).Conclusion High levels of AFP indicate that the tumors are more malignant and with unfavorable prognosis.

Objective To explore the surgical risk, perioperative outcome and the response of patients with hepatocellular carcinoma ( HCC ) after preoperative transcatheter arterial chemoembolization ( TACE) . Methods A retrospective case?matched study was conducted to compare the characteristics and corresponding measures of patients in the preoperative TACE group and the control group without TACE. A total of 105 patients ( 82 patients with selective and dynamic region?specific vascular occlusion to perform hepatectomy for patients with complex hepatocellular carcinoma) was included in this study, in which 35 patients underwent TACE therapy, and a 1 ∶ 2 matched control group of 70 subjects. Results The patients of preoperative TACE therapy group had a higher level of γ?glutamyl transpeptidase before operation (119.52± 98.83)U/L vs. (67.39±61.25) U/L (P=0.040). The operation time was longer in the TACE group than that in the control group but with a non?significant difference (232.60±95.43) min vs. (218.70±75.13) min ( P=0.052) . The postoperative recovery of liver function and severe complications in the preoperative TACE group were similar to that in the control group ( P>0.05) . There were no massive hemorrhage, biliary fistula and 30?d death neither in the treatment group and matched control group. Conclusions Preoperative TACE therapy has certain negative effect on liver function. It is preferable to use selective and dynamic region?specific vascular occlusion technique during hepatectomy and combine with reasonable perioperative treatment for this group of patients, that can ensure safety of patients and promote their rapid recovery.