Neoplastic needle track seeding following percutaneous radiofrequency ablation(RFA)of secondary liver tumors is exceedingly rare.Reports on cutaneous tumor seeding after percutaneous RFA for colorectal liver metastasi...Neoplastic needle track seeding following percutaneous radiofrequency ablation(RFA)of secondary liver tumors is exceedingly rare.Reports on cutaneous tumor seeding after percutaneous RFA for colorectal liver metastasis are even rarer in the literature.Here we report a case of a 46-year-old female who developed an ulcerating skin lesion along the needle track of a previous percutaneous RFA site around 6 mo after the procedure.The previous RFA was performed by the LeVeen needle for a secondary liver tumor from a primary rectal cancer.The diagnosis of secondary skin metastasis was confirmed by fine needle aspiration cytology.The lesion was successfully treated with wide local excision.We believe that tumor seeding after percutaneous RFA in our patient was possibly related to its unfavorable subcapsular location and the use of an expansion-type needle.Hence,prophylactic ablation of the needle track should be performed whenever possible.Otherwise,alternative routes of tumor ablation such as laparoscopic or open RFA should be considered.展开更多
We report a rare case of spontaneous liver rupture in a patient with hypereosinophilic syndrome(HES),of which the diagnosis was delayed,resulting in a fatal outcome.The diagnostic criteria and treatment of HES with he...We report a rare case of spontaneous liver rupture in a patient with hypereosinophilic syndrome(HES),of which the diagnosis was delayed,resulting in a fatal outcome.The diagnostic criteria and treatment of HES with hepatic involvement were reviewed.The possible cause of spontaneous liver rupture in HES and its management were also discussed.To our knowledge,this is the fi rst case report of spontaneous liver rupture in HES.We emphasized the need of a high index of suspicion in diagnosing HES,so that early treatment could be initiated.展开更多
Objective:Traditionally,gallbladder is routinely removed during left hepatectomy even if there is no gallbladder pathology.However,adverse consequence after cholecystectomy,though rare,still occa-sionally occurs.This ...Objective:Traditionally,gallbladder is routinely removed during left hepatectomy even if there is no gallbladder pathology.However,adverse consequence after cholecystectomy,though rare,still occa-sionally occurs.This study aims to evaluate the feasibility of gallbladder preservation during robotic left hepatectomy.Methods:All consecutive robotic left hepatectomy cases between December 2010 and January 2022 in Prince of Wales Hospital,the Chinese University of Hong Kong were retrieved from a prospectively collected database.The gallbladder was preserved by moving the liver transection line just away from the gallbladder fossa.Patients were divided into two groups:gallbladder preservation(GBP)and non-gallbladder preservation(NGBP).Operative results and long-term outcomes were compared between these two groups.Results:There were 11 cases in the GBP group and 25 cases in the NGBP group.The two groups were comparable in terms of the patient demographics and disease characteristics.There was no operative mortality.There was no difference between the two groups in operative time(GBP 270 min vs.NGBP 332 min,p=0.132),blood loss(GBP 50 mL vs.NGBP 150 mL,p=0.115)or complication rate(GBP 27.3%vs.NGBP 24.0%,p>0.999).There was also no difference in 5-year overall survival.In the GBP group,no patient developed specific symptoms or complications related to the preserved gallbladder.Follow-up ultrasound or computed tomography revealed a normal appearance of the preserved gallbladders except in one patient who developed a 3-mm gallbladder polyp.On the other hand,one(4%)patient in the NGBP group developed troublesome diarrhoea after surgery.Conclusion:Gallbladder preservation is safe and feasible during robotic left hepatectomy.The preserved gallbladder does not lead to any symptoms,while postcholecystectomy diarrhoea can be avoided.展开更多
Background: Hepatectomy is a widely accepted curative treatment for hepatocellular carcinoma (HCC). However, the disease frequently recurs after a curative hepatectomy. The objective of this study is to provide a bett...Background: Hepatectomy is a widely accepted curative treatment for hepatocellular carcinoma (HCC). However, the disease frequently recurs after a curative hepatectomy. The objective of this study is to provide a better understanding of the pattern of disease recurrence and the risk factors involved so as to improve the postoperative surveillance. Methods: A retrospective study for all patients receiving hepatectomy for HCC between 2003 and 2014 was performed. Emphasis was made on the timing and pattern of recurrent disease, and type of treatment given. Results: There were 506 patients in the study. Median follow-up was 43.7 months. The 1-, 3-, 5-, 10-year overall and disease free survival were 89.5%, 74.1%, 63.9%, 49.0% and 69.5%, 54.3%, 43.4%, 30.9%respectively. Recurrent disease occurred in 267 patients, 47.2% occurred within 9 months of hepatectomy and 80.1% recurred only in liver. Median survival was shorter for recurrence occurring within 9 months compared with those occurring between 10 months and 2 years postoperatively (36.2 vs. 65.7 months, P<0.001) whilst less curative treatment was offered for patients with early (within 9 months) intrahepatic alone recurrence (22.2% vs. 51.7%, P<0.01). Multivariate analysis revealed tumor size >3.5 cm and history of rupture were risk factors for recurrence within 9 months. Conclusions: These findings suggest that recurrent diseases are common after curative hepatectomy for HCC and most recurrences occur in the remnant liver. Since almost half of recurrences occurred within first 9 months after hepatectomy, a more stringent postoperative surveillance with target imaging of liver in this period is needed. Early diagnosis of recurrent disease and curative retreatment hopefully can bring about a longer survival.展开更多
Mirizzi syndrome(MS)is a rare complication of gallstone disease in which the common hepatic duct is obstructed by a stone impacted at Hartmann's pouch or cystic duct.
Recovery after traditional open liver resection is greatly hindered by a big upper abdominal incision.This is especially true when the scale of parenchymal liver resection is relatively small,such as wedge resection o...Recovery after traditional open liver resection is greatly hindered by a big upper abdominal incision.This is especially true when the scale of parenchymal liver resection is relatively small,such as wedge resection or left lateral sectionectomy.In such scenarios,the access trauma outweighs the surgical trauma.On the other hand,when the surgical trauma is large,such as major hepatectomy or extended liver resection,the surgical trauma rather than the access trauma determines the postoperative recovery.Thus,minimal access surgery or minimally invasive surgery has come up as a fantastic way to minimize the access trauma and help to speed up recovery and shorten hospital stay(1).展开更多
文摘Neoplastic needle track seeding following percutaneous radiofrequency ablation(RFA)of secondary liver tumors is exceedingly rare.Reports on cutaneous tumor seeding after percutaneous RFA for colorectal liver metastasis are even rarer in the literature.Here we report a case of a 46-year-old female who developed an ulcerating skin lesion along the needle track of a previous percutaneous RFA site around 6 mo after the procedure.The previous RFA was performed by the LeVeen needle for a secondary liver tumor from a primary rectal cancer.The diagnosis of secondary skin metastasis was confirmed by fine needle aspiration cytology.The lesion was successfully treated with wide local excision.We believe that tumor seeding after percutaneous RFA in our patient was possibly related to its unfavorable subcapsular location and the use of an expansion-type needle.Hence,prophylactic ablation of the needle track should be performed whenever possible.Otherwise,alternative routes of tumor ablation such as laparoscopic or open RFA should be considered.
文摘We report a rare case of spontaneous liver rupture in a patient with hypereosinophilic syndrome(HES),of which the diagnosis was delayed,resulting in a fatal outcome.The diagnostic criteria and treatment of HES with hepatic involvement were reviewed.The possible cause of spontaneous liver rupture in HES and its management were also discussed.To our knowledge,this is the fi rst case report of spontaneous liver rupture in HES.We emphasized the need of a high index of suspicion in diagnosing HES,so that early treatment could be initiated.
文摘Objective:Traditionally,gallbladder is routinely removed during left hepatectomy even if there is no gallbladder pathology.However,adverse consequence after cholecystectomy,though rare,still occa-sionally occurs.This study aims to evaluate the feasibility of gallbladder preservation during robotic left hepatectomy.Methods:All consecutive robotic left hepatectomy cases between December 2010 and January 2022 in Prince of Wales Hospital,the Chinese University of Hong Kong were retrieved from a prospectively collected database.The gallbladder was preserved by moving the liver transection line just away from the gallbladder fossa.Patients were divided into two groups:gallbladder preservation(GBP)and non-gallbladder preservation(NGBP).Operative results and long-term outcomes were compared between these two groups.Results:There were 11 cases in the GBP group and 25 cases in the NGBP group.The two groups were comparable in terms of the patient demographics and disease characteristics.There was no operative mortality.There was no difference between the two groups in operative time(GBP 270 min vs.NGBP 332 min,p=0.132),blood loss(GBP 50 mL vs.NGBP 150 mL,p=0.115)or complication rate(GBP 27.3%vs.NGBP 24.0%,p>0.999).There was also no difference in 5-year overall survival.In the GBP group,no patient developed specific symptoms or complications related to the preserved gallbladder.Follow-up ultrasound or computed tomography revealed a normal appearance of the preserved gallbladders except in one patient who developed a 3-mm gallbladder polyp.On the other hand,one(4%)patient in the NGBP group developed troublesome diarrhoea after surgery.Conclusion:Gallbladder preservation is safe and feasible during robotic left hepatectomy.The preserved gallbladder does not lead to any symptoms,while postcholecystectomy diarrhoea can be avoided.
文摘Background: Hepatectomy is a widely accepted curative treatment for hepatocellular carcinoma (HCC). However, the disease frequently recurs after a curative hepatectomy. The objective of this study is to provide a better understanding of the pattern of disease recurrence and the risk factors involved so as to improve the postoperative surveillance. Methods: A retrospective study for all patients receiving hepatectomy for HCC between 2003 and 2014 was performed. Emphasis was made on the timing and pattern of recurrent disease, and type of treatment given. Results: There were 506 patients in the study. Median follow-up was 43.7 months. The 1-, 3-, 5-, 10-year overall and disease free survival were 89.5%, 74.1%, 63.9%, 49.0% and 69.5%, 54.3%, 43.4%, 30.9%respectively. Recurrent disease occurred in 267 patients, 47.2% occurred within 9 months of hepatectomy and 80.1% recurred only in liver. Median survival was shorter for recurrence occurring within 9 months compared with those occurring between 10 months and 2 years postoperatively (36.2 vs. 65.7 months, P<0.001) whilst less curative treatment was offered for patients with early (within 9 months) intrahepatic alone recurrence (22.2% vs. 51.7%, P<0.01). Multivariate analysis revealed tumor size >3.5 cm and history of rupture were risk factors for recurrence within 9 months. Conclusions: These findings suggest that recurrent diseases are common after curative hepatectomy for HCC and most recurrences occur in the remnant liver. Since almost half of recurrences occurred within first 9 months after hepatectomy, a more stringent postoperative surveillance with target imaging of liver in this period is needed. Early diagnosis of recurrent disease and curative retreatment hopefully can bring about a longer survival.
文摘Mirizzi syndrome(MS)is a rare complication of gallstone disease in which the common hepatic duct is obstructed by a stone impacted at Hartmann's pouch or cystic duct.
文摘Recovery after traditional open liver resection is greatly hindered by a big upper abdominal incision.This is especially true when the scale of parenchymal liver resection is relatively small,such as wedge resection or left lateral sectionectomy.In such scenarios,the access trauma outweighs the surgical trauma.On the other hand,when the surgical trauma is large,such as major hepatectomy or extended liver resection,the surgical trauma rather than the access trauma determines the postoperative recovery.Thus,minimal access surgery or minimally invasive surgery has come up as a fantastic way to minimize the access trauma and help to speed up recovery and shorten hospital stay(1).
