Surgical vs percutaneous radiofrequency ablation for hepatocellular carcinoma in dangerous locations

AIM:To compare the long-term outcome of percutaneous vs surgical radiofrequency ablation(RFA) for hepatocellular carcinoma(HCC) in dangerous locations.METHODS:One hundred and sixty-two patients with HCC in dangerous locations treated with percutaneous or surgical RFA were enrolled in this study.The patients were divided into percutaneous RFA group and surgical RFA group.After the patients were regularly followed up for a long time,their curative rate,hospital stay time,postoperative complications and 5-year local tumor progression were compared and analyzed.RESULTS:No significant difference was observed in curative rate between the two groups(91.3% vs 96.8%,P = 0.841).The hospital stay time was longer and more analgesics were required while the incidence of bile duct injury and RFA-related hemorrhage was lower in surgical RFA group than in percutaneous RFA group(P < 0.05).The local progression rate of HCC in dangerous locations was significantly lower in surgical RFA group than in percutaneous RFA group(P = 0.05).The relative risk of local tumor progression was 14.315 in percutaneous RFA group.CONCLUSION:The incidence of severe postoperative complications and local tumor progression is lower after surgical RFA than after percutaneous RFA.

Immunotherapy for hepatocellular carcinoma: From basic research to clinical use

Hepatocellular carcinoma(HCC) is a common cancer worldwide with a poor prognosis. Few strategies have been proven efficient in HCC treatment, particularly for those patients not indicated for curative resection or transplantation. Immunotherapy has been developed for decades for cancer control and is attaining more attention as a result of encouraging outcomes of new strategies such as chimeric antigen receptor T cells and immune checkpoint blockade. Right at the front of the new era of immunotherapy, we review the immunotherapy in HCC treatment, from basic research to clinical trials, covering anything from immunomodulators, tumor vaccines and adoptive immunotherapy. The mechanisms, efficacy and safety as well as the approach particulars are unveiled to assist readers to gain a concise but extensive understanding of immunotherapy of HCC.

''Sandwich'' treatment for diospyrobezoar intestinal obstruction: A case report

Intestinal obstruction is a common clinical entity encountered in surgical practice.The objective of this report is to corroborate an atypical scenario of intestinal obstruction in a Chinese patient and to focus on the diagnosis and treatment.A 27-year-old male presented with a history of gastric pain combined with nausea and abdominal distension that had been present for 5 d.The presence of a foreign body was detected by computed tomography and observed as an abnormal density within the stomach.A diospyrobezoar was revealed during gastroscopy,the extraction of which was preventeddue to its size and firmness.An endoscopic holmium laser joined with a snare was used to fragment the obstruction,which was followed by management with a conservative"sandwich"treatment strategy involving intestinal decompression with an ileus tube and Coca-Cola lavage between endoscopic lithotripsy fragmentation procedures.This strategy resulted in the successful removal of the diospyrobezoar along with multiple small bowel obstructions.The patient was discharged after abatement of symptoms.The case presented here demonstrates the implementation of a conservative,yet successful,treatment as an alternative to conventional surgical removal of intestinal obstructions.

Esophago-gastro-duodenoscopy could be an important tool in the diagnostic dilemma inherent in perforated peptic ulcer: A case report

Acute abdomen is a common and sometimes dramatic clinical condition,which can be fatal if diagnosis is not made in time.Perforated peptic ulcer is a cause of an acute abdomen,which can be diagnosed by imaging investigations.However,erect chest X-ray and CT scan may not always establish the diagnosis.Herein we report a case of a patient with acute abdomen,where radiological imaging and CT scan were not able to provide a clear diagnosis.The patient was diagnosed with perforated peptic ulcer by esophago-gastro-duodenoscopy,and underwent laparotomy to repair the anterior wall duodenal perforation with an omental patch.Early endoscopic evaluation seems to be an essential tool for upper gastrointestinal evaluation in acute abdomen cases with inconclusive imaging results.

The EORTC QLQ-C30 and QLQ-CR29 may play a complementary role to LARS score in evaluating the quality of life for patients following laparoscopic and robotic rectal cancer surgery

Objective:To analyze whether the European Organisation for Treatment and Research of Cancer(EORTC)Quality of Life Questionnaires(QLQ-C30 and QLQ-CR29)complement the low anterior resection of rectum syndrome(LARS)score in evaluating the quality of life of patients who underwent laparoscopic or robotic rectal cancer surgery.Methods:Initially,335 patients who underwent laparoscopic or robotic rectal cancer surgery were randomly selected at Sir Run Run Shaw Hospital,Zhejiang University School of Medicine from June 2013 to September 2020.All the patients took the questionnaires of LARS score,QLQ-C30 and QLQ-CR29.Totally,questionnaires filled out by 224 patients were qualified after screening.Patients were divided into three groups according to LARS score:No LARS group(score 0-20),minor LARS group(score 21-29)and major LARS group(score 30-42).The scores of QLQ-C30 as well as QLQ-CR29 among the three groups were compared.Results:Major,minor and no LARS groups had 140 cases,40 cases and 44 cases respectively.In the scales of QLQ-C30,significant differences were discovered in global quality of life,physical function,role function,emotional function,cognitive function,social function,fatigue,pain,dyspnea,sleep disturbance,constipation and diarrhea between the no and major LARS groups(p<0.05).While the differences were only found in global quality of life and diarrhea between the minor and major LARS groups(p<0.05).In QLQ-CR29,scales of urinary frequency,blood and mucus in stool,body image,flatulence,fecal incontinence,sore skin,stool frequency,embarrassment,impotence,abdominal pain,buttock pain,bloating,dry mouth,hair loss,taste,anxiety and weight,had significant differences between the no and major LARS groups(p<0.05).Only six scales,ie blood and mucus in stool,flatulence,fecal incontinence,stool frequency,embarrassment and dysuria had significant differences between the minor and major LARS groups(p<0.05).Conclusion:For patients following laparoscopic or robotic low anal sphincter preserving surgery,LARS score,QLQ-C30 and QLQ-CR29 scores are consistent in overall trends.To guide disease evaluation and individualized treatment,as well as to evaluate efficacy,we suggest getting pre-and post-operative LARS scores incorporating QLQ-C30 and QLQ-CR29 scores as a comprehensive evaluation system.

Risk factors for incomplete polyp resection during colonoscopy

Colonoscopic polypectomy is extremely effective in protecting against colorectal cancers,and recognition of adenomas by colonoscopy is of paramount importance in preventing colorectal cancer(CRC)and CRC-associated mortality.Incomplete polyp resection(IPR)occurs routinely in medical practice following polypectomy.We conducted a comprehensive literature search to identify studies that reported on the potential risk factors for IPR using MEDLINE,EMBASE,and PubMed.Publication time was limited between January 2004 and July 2021.Our search revealed assessments of the position,morphology,and histologic variation of the polypsdas well as the relevant skills that may interfere with IPR.The included studies showed that colonic polyps with a diameter>20 mm and proximal in location should be dealt with cautiously.For smaller polyps,cold-snare polypectomy appeared to be the most effective method used to accomplish comprehensive polyp removal.In addition,endoscopist experience in narrow-band imaging in polyp detection were also associated with IPR.Therefore,polypectomy should be performed cautiously if the polyp growth is expected to be cancerous and situated in the proximal portion of the colon or rectum,and modalities should be standardized so as to lower the potential risk for IPR.

Synchronous intraoperative radiofrequency ablation for multiple liver metastasis and resection of giant solid pseudopapillary tumors of the pancreas

The solid pseudopapillary tumors of the pancreas （SPTP） are rare tumors, which are commonly found in adolescent women. Radical surgical resection of the primary tumor or metastases is the standard treatment for SPTP and could achieve long-term survival. We reported a case of a 20-year-old female with multiple liver metastases of SPTP, and performed surgical resection for primary tumor 14 cm in diameter and 2 major liver metastases （both 5 cm in diameter）, radiofrequency ablation （RFA） for small lesions and one major liver metastase 6 cm in diameter successfully. No evidence of recurrence in situ or in the liver was found by computed tomography （CT） scan 3 months after the operation. RFA is a safe and effective treatment for unresectable multiple liver metastases of SPTP.