AIM To compare survival and recurrence after laparoscopic liver resection(LLR) and laparoscopic radiofrequency ablation(LRFA) for the treatment of small hepatocellular carcinoma(HCC).METHODS Between June 1, 2005 and N...AIM To compare survival and recurrence after laparoscopic liver resection(LLR) and laparoscopic radiofrequency ablation(LRFA) for the treatment of small hepatocellular carcinoma(HCC).METHODS Between June 1, 2005 and November 30, 2010, 46 patients(62.26 ± 8.55 years old; female/male: 12/34) treated for small HCC were enrolled following strict criteria. Patients with better liver function and larger tumors were referred for LLR(n = 24), while those with poorer liver function and multiple tumors were referred for LRFA(n = 22), and they were then followed for similar durations(44.74 ± 21.3 mo for LLR vs 40.27 ± 30.8 mo for LRFA). RESULTS The LLR and LRFA groups were homogeneous with regard to age, sex, etiology of liver cirrhosis, and AFP levels. The overall survival(OS) and disease-free survival(DFS) probability was 0.354 and 0.260, respectively. A significantly higher OS was observed in the LLR group(LLR: 0.442; LRFA: 0.261; P = 0.048), whereas no statistical difference was found for DFS(LLR: 0.206; LRFA: 0.286; P = 0.205). In the LRFA group was treated a greater number of nodules(LLR: 1.41 ± 0.77; LRFA: 2.72 ± 1.54; P < 0.001). Cox regression analysis found the number of intraoperative HCC nodules as the unique variable statistically significant for OS(hazard ratio: 2.225; P < 0.001). The rank-hazard plot showed a steeper increase of relative hazard for intraoperative nodules > 2.CONCLUSION Our preliminary results confirm the superiority of hepatic resection on thermoablation in the treatment of small HCC in selected patients, when both approaches are made laparoscopically. LLR showed better results compared to LRFA in terms of OS. These data need to be confirmed by further studies on a larger number of patients.展开更多
Split liver transplantation for two adults offers a valuable opportunity to expand the donor pool for adult recipients.However,its application is mainly hampered by the physiological limits of these partial grafts.Sma...Split liver transplantation for two adults offers a valuable opportunity to expand the donor pool for adult recipients.However,its application is mainly hampered by the physiological limits of these partial grafts.Small for size syndrome is a major concern during transplantation with partial graft and different techniques have been developed in living donor liver transplantation to prevent the graft dysfunction.Herein,we report the first application of synergic approaches to optimise the hepatic hemodynamic in a split liver graft for two adults. A Caucasian woman underwent liver transplantation for alcoholic cirrhosis(MELD 21)with a full right liver graft (S5-S8)without middle hepatic vein.Minor and accessory inferior hepatic veins were preserved by splitting the vena cava;V5 and V8 were anastomosed with a donor venous iliac patch.After implantation,a 16G catheter was advanced in the main portal trunk.Inflow modulation was achieved by splenic artery ligation.Intraportal infusion of PGE1 was started intraoperatively and discontinued after 5 d.Graft function was immediate withnormalization of liver test after 7 d.Nineteen months after transplantation,liver function is normal and graft volume is 110%of the recipient standard liver volume. Optimisation of the venous outflow,inflow modulation and intraportal infusion of PGE1 may represent a valuable synergic strategy to prevent the graft dysfunction and it may increase the safety of split liver graft for two adults.展开更多
文摘AIM To compare survival and recurrence after laparoscopic liver resection(LLR) and laparoscopic radiofrequency ablation(LRFA) for the treatment of small hepatocellular carcinoma(HCC).METHODS Between June 1, 2005 and November 30, 2010, 46 patients(62.26 ± 8.55 years old; female/male: 12/34) treated for small HCC were enrolled following strict criteria. Patients with better liver function and larger tumors were referred for LLR(n = 24), while those with poorer liver function and multiple tumors were referred for LRFA(n = 22), and they were then followed for similar durations(44.74 ± 21.3 mo for LLR vs 40.27 ± 30.8 mo for LRFA). RESULTS The LLR and LRFA groups were homogeneous with regard to age, sex, etiology of liver cirrhosis, and AFP levels. The overall survival(OS) and disease-free survival(DFS) probability was 0.354 and 0.260, respectively. A significantly higher OS was observed in the LLR group(LLR: 0.442; LRFA: 0.261; P = 0.048), whereas no statistical difference was found for DFS(LLR: 0.206; LRFA: 0.286; P = 0.205). In the LRFA group was treated a greater number of nodules(LLR: 1.41 ± 0.77; LRFA: 2.72 ± 1.54; P < 0.001). Cox regression analysis found the number of intraoperative HCC nodules as the unique variable statistically significant for OS(hazard ratio: 2.225; P < 0.001). The rank-hazard plot showed a steeper increase of relative hazard for intraoperative nodules > 2.CONCLUSION Our preliminary results confirm the superiority of hepatic resection on thermoablation in the treatment of small HCC in selected patients, when both approaches are made laparoscopically. LLR showed better results compared to LRFA in terms of OS. These data need to be confirmed by further studies on a larger number of patients.
文摘Split liver transplantation for two adults offers a valuable opportunity to expand the donor pool for adult recipients.However,its application is mainly hampered by the physiological limits of these partial grafts.Small for size syndrome is a major concern during transplantation with partial graft and different techniques have been developed in living donor liver transplantation to prevent the graft dysfunction.Herein,we report the first application of synergic approaches to optimise the hepatic hemodynamic in a split liver graft for two adults. A Caucasian woman underwent liver transplantation for alcoholic cirrhosis(MELD 21)with a full right liver graft (S5-S8)without middle hepatic vein.Minor and accessory inferior hepatic veins were preserved by splitting the vena cava;V5 and V8 were anastomosed with a donor venous iliac patch.After implantation,a 16G catheter was advanced in the main portal trunk.Inflow modulation was achieved by splenic artery ligation.Intraportal infusion of PGE1 was started intraoperatively and discontinued after 5 d.Graft function was immediate withnormalization of liver test after 7 d.Nineteen months after transplantation,liver function is normal and graft volume is 110%of the recipient standard liver volume. Optimisation of the venous outflow,inflow modulation and intraportal infusion of PGE1 may represent a valuable synergic strategy to prevent the graft dysfunction and it may increase the safety of split liver graft for two adults.
