BACKGROUND Repeated liver resection is an effective treatment for recurrent hepatocellular carcinoma(HCC).However,few studies have compared the outcome of laparoscopic repeat hepatectomy(LRH)and open repeat hepatectom...BACKGROUND Repeated liver resection is an effective treatment for recurrent hepatocellular carcinoma(HCC).However,few studies have compared the outcome of laparoscopic repeat hepatectomy(LRH)and open repeat hepatectomy(ORH)for recurrent HCC,and few of those have included cirrhotic patients.AIM To compare short-term and long-term outcomes of cirrhotic patients with LRH and ORH for recurrent HCC.METHODS We retrospectively analysed the clinical records retrieved from a prospectively collected database of all patients who underwent hepatectomy for posthepatectomy recurrent HCC at our institute between May 2006 and June 2021.Cases of recurrent HCCs larger than 7 cm were excluded.Patient demographics,operative details,perioperative outcomes,pathologic details,disease-free survival(DFS),and overall survival(OS)data of LRH and ORH were compared.RESULTS Data from 29 patients with LRH and 22 with ORH were compared.The LRH group showed significantly better outcomes for blood loss(median 300 mL vs 750 mL,P=0.013)and length of hospital stay(median 5 d vs 7 d,P=0.003).The 1-,3-and 5-year OS rates in the LRH group were 100.0%,60.0%and 30.0%,respectively;the corresponding rates in the ORH group were 81.8%,36.4%and 18.2%(P=0.336).The 1-,3-and 5-year DFS rates in the LRH group were 68.2%,27.3%and 4.5%,respectively;the corresponding rates in the ORH group were 31.3%,6.3%and 6.3%(P=0.055).There were no significant differences in overall and DFS between the two groups.CONCLUSION Laparoscopic re-resection should be considered for patients presenting with recurrent HCC less than or equal to 7 cm after previous hepatectomy.展开更多
Long-term survival is the most important outcome measurement of a curative oncological treatment.For hepatocellular carcinoma(HCC),the long-term disease-free and overall survival of laparoscopic liver resection(LLR)is...Long-term survival is the most important outcome measurement of a curative oncological treatment.For hepatocellular carcinoma(HCC),the long-term disease-free and overall survival of laparoscopic liver resection(LLR)is shown to be non-inferior to the current standard of open liver resection(OLR).Some studies have reported a superior long-term oncological outcome in LLR when compared to OLR.It has been argued that improvement of visualization and instrumentation and reduced operative blood loss and perioperative blood transfusion may contribute to reduced risk of postoperative tumor recurrence.On the other hand,since most of the comparative studies of the oncological outcomes of LLR and OLR for HCC are non-randomized,it remained inconclusive as to whether LLR confers additional survival benefit compared to OLR.Despite the paucity of level 1 evidence,the practice of LLR for HCC has gained wide-spread acceptance due to the reproducible improvements in the perioperative outcomes and non-inferior oncological outcomes demonstrated by large-scaled,matched comparative studies.Meta-analyses of the outcomes of these studies by multiple systematic reviews have also returned noncontradictory conclusions.On the basis of a theoretical advantage of LLR over OLR in preventing tumor recurrence,the current review aims to dissect from the current meta-analyses and comparative studies any evidence of such superiority.展开更多
BACKGROUND Hepatic resection has become the preferred treatment of choice for colorectal liver metastasis(CLM)patients.AIM To identify the prognostic factors and to formulate a new scoring system for management of CLM...BACKGROUND Hepatic resection has become the preferred treatment of choice for colorectal liver metastasis(CLM)patients.AIM To identify the prognostic factors and to formulate a new scoring system for management of CLM.METHODS Clinicopathologic and long-term survival data were analyzed to identify the significant predictors of survival by univariate and multivariate analyses with the Cox model.A clinical score was constructed based on the analysis results.RESULTS Three factors of worse overall survival were identified in the multivariate analysis.They were number of liver metastases≥5,size of the largest liver lesion≥4 cm,and the presence of nodal metastasis from the primary tumor.These three factors were chosen as criteria for a clinical risk score for overall survival.The clinical score highly correlated with median overall survival and 5-year survival(P=0.002).CONCLUSION Priority over surgical resection should be given to the lowest score groups,and alternative oncological treatment should be considered in patients with the highest score.展开更多
文摘BACKGROUND Repeated liver resection is an effective treatment for recurrent hepatocellular carcinoma(HCC).However,few studies have compared the outcome of laparoscopic repeat hepatectomy(LRH)and open repeat hepatectomy(ORH)for recurrent HCC,and few of those have included cirrhotic patients.AIM To compare short-term and long-term outcomes of cirrhotic patients with LRH and ORH for recurrent HCC.METHODS We retrospectively analysed the clinical records retrieved from a prospectively collected database of all patients who underwent hepatectomy for posthepatectomy recurrent HCC at our institute between May 2006 and June 2021.Cases of recurrent HCCs larger than 7 cm were excluded.Patient demographics,operative details,perioperative outcomes,pathologic details,disease-free survival(DFS),and overall survival(OS)data of LRH and ORH were compared.RESULTS Data from 29 patients with LRH and 22 with ORH were compared.The LRH group showed significantly better outcomes for blood loss(median 300 mL vs 750 mL,P=0.013)and length of hospital stay(median 5 d vs 7 d,P=0.003).The 1-,3-and 5-year OS rates in the LRH group were 100.0%,60.0%and 30.0%,respectively;the corresponding rates in the ORH group were 81.8%,36.4%and 18.2%(P=0.336).The 1-,3-and 5-year DFS rates in the LRH group were 68.2%,27.3%and 4.5%,respectively;the corresponding rates in the ORH group were 31.3%,6.3%and 6.3%(P=0.055).There were no significant differences in overall and DFS between the two groups.CONCLUSION Laparoscopic re-resection should be considered for patients presenting with recurrent HCC less than or equal to 7 cm after previous hepatectomy.
文摘Long-term survival is the most important outcome measurement of a curative oncological treatment.For hepatocellular carcinoma(HCC),the long-term disease-free and overall survival of laparoscopic liver resection(LLR)is shown to be non-inferior to the current standard of open liver resection(OLR).Some studies have reported a superior long-term oncological outcome in LLR when compared to OLR.It has been argued that improvement of visualization and instrumentation and reduced operative blood loss and perioperative blood transfusion may contribute to reduced risk of postoperative tumor recurrence.On the other hand,since most of the comparative studies of the oncological outcomes of LLR and OLR for HCC are non-randomized,it remained inconclusive as to whether LLR confers additional survival benefit compared to OLR.Despite the paucity of level 1 evidence,the practice of LLR for HCC has gained wide-spread acceptance due to the reproducible improvements in the perioperative outcomes and non-inferior oncological outcomes demonstrated by large-scaled,matched comparative studies.Meta-analyses of the outcomes of these studies by multiple systematic reviews have also returned noncontradictory conclusions.On the basis of a theoretical advantage of LLR over OLR in preventing tumor recurrence,the current review aims to dissect from the current meta-analyses and comparative studies any evidence of such superiority.
文摘BACKGROUND Hepatic resection has become the preferred treatment of choice for colorectal liver metastasis(CLM)patients.AIM To identify the prognostic factors and to formulate a new scoring system for management of CLM.METHODS Clinicopathologic and long-term survival data were analyzed to identify the significant predictors of survival by univariate and multivariate analyses with the Cox model.A clinical score was constructed based on the analysis results.RESULTS Three factors of worse overall survival were identified in the multivariate analysis.They were number of liver metastases≥5,size of the largest liver lesion≥4 cm,and the presence of nodal metastasis from the primary tumor.These three factors were chosen as criteria for a clinical risk score for overall survival.The clinical score highly correlated with median overall survival and 5-year survival(P=0.002).CONCLUSION Priority over surgical resection should be given to the lowest score groups,and alternative oncological treatment should be considered in patients with the highest score.
