Advantage of autologous blood transfusion in surgery for hepatocellular carcinoma

AIM: To evaluate the significance of autologous blood transfusion (AT) in reducing homologous blood transfusion (HT) in surgery for hepatocellular carcinoma (HCC). METHODS: The proportion of patients who received HT was compared between two groups determined by the time of AT introduction; period A (1991-1994, n = 93) and period B (1995-2000, n = 201). Multivariate logistic regression analysis was performed in order to identify independent significant predictors of the need for HT. We also investigated the impact of AT and HT on long-term postoperative outcome after curative surgery for HCC. RESULTS: The proportion of patients with HT was significantly lower in period B than period A (18.9% vs 60.2%, P < 0.0001). Multivariate logistic regression analysis identified AT administration as a significant independent predictor of the need for HT (P < 0.0001). Disease-free survival in patients with AT was comparable to that without any transfusion. Multivariate analysis identified HT administration as an independent significant factor for poorer disease-free survival (P = 0.0380). CONCLUSION: AT administration significantly decreased the need for HT. Considering the postoperative survival disadvantage of HT, AT administration could improve the long-term outcome of HCC patients.

Sclerosing epithelioid fibrosarcoma of the liver infiltrating the inferior vena cava

Sclerosing epithelioid fibrosarcoma (SEF) is a rare and distinct variant of fibrosarcoma, composed of epithelioid tumor cells arranged in strands, nests, cords, or sheets embedded within a sclerotic collagenous matrix. We report a 39-year-old man with SEF of the liver, which infiltrated the inferior vena cava (IVC). The SEF of the liver was successfully resected, and the infiltrated IVC was also removed together with the liver tumor. Histopathological examination of the tumor showed typical histopathology of SEF. Immunohistochemically, the tumor was positive for vimentin. Recurrence was noted 7 mo after surgery. After chemotherapy, the recurrent tumor was resected surgically, and histopathological examination showed similar findingsto those of the primary tumor. To our knowledge, this is the first report of SEF of the liver with tumor invasion of the IVC.

Fresh frozen plasma transfusion does not affect outcomes following hepatic resection for hepatocellular carcinoma

AIM:To investigate whether fresh frozen plasma (FFP) transfusion affects outcomes following hepatic resection for hepatocellular carcinoma (HCC) in terms of liver function,postoperative complications and cancer prognosis.METHODS:We retrospectively compared the incidence of postoperative complications between 204 patients who underwent hepatectomy for HCC with routine FFP transfusion in an early period (1983-1993,Group A) and 293 with necessity for FFP transfusion during a later period (1998-2006,Group B),and also between two subgroups of Group B [22 patients with FFP transfusion (Group B1) and 275 patients without FFP transfusion (Group B2)].Additionally,only in limited patients in Group B1 and Group B2 with intraoperative blood loss≥ 2000 mL (Group B1 ≥ 2000 mL and Group B2 ≥ 2000 mL),postoperative complications,liver function tests,and cancer prognosis were compared.RESULTS:No mortality was registered in Group B,compared to 8 patients (3.9%) of Group A.The incidence of morbidity in Group B2 [23.2% (64/275)] was not significantly different from Group B1 [40.9% (9/22)] and Group A [27.0% (55/204)].The incidence of complications and postoperative liver function tests were comparable between Group B1 ≥ 2000 mL vs Group B2 ≥ 2000 mL.Postoperative prognosis did not correlate with administration of FFP,but with tumor-related factors.CONCLUSION:The outcome of hepatectomy for HCC is not influenced by FFP transfusion.We suggest FFP transfusion be abandoned in patients who undergo hepatectomy for HCC.

Screening for hilar biliary invasion in ampullary cancer patients

BACKGROUND The treatment for ampullary cancer is pancreatoduodenectomy or local ampullectomy.However,effective methods for the preoperative investigation of hilar biliary invasion in ampullary cancer patients have not yet been identified.AIM To determine the necessity of and an appropriate method for investigating hilar biliary invasion of ampullary cancer.METHODS Among 43 ampullary cancer patients,34 underwent endoscopic treatment(n=9)or surgery(n=25).The use of imaging findings(thickening and enhancement of the bile duct wall on contrast-enhanced computed tomography,irregularity on endoscopic retrograde cholangiography,thickening of the entire bile duct wall on intraductal ultrasonography(IDUS),and partial thickening of the bile duct wall on IDUS)and biliary biopsy results for diagnosing hilar biliary invasion of ampullary cancer was compared.RESULTS Hilar invasion was not observed in every patient.Among the patients who did not undergo biliary stent insertion,the combination of partial thickening of the bile duct wall on IDUS and biliary biopsy results showed the highest accuracy(100%)for diagnosing hilar biliary invasion.However,each imaging method and biliary biopsy yielded some false-positive results.CONCLUSION Although some false-positive results were obtained with each method,the combination of partial thickening of the bile duct wall on IDUS and biliary biopsy results was useful for diagnosing hilar biliary invasion of ampullary cancer.However,hilar invasion of ampullary cancer is rare;therefore,the investigation of hilar biliary invasion of ampullary cancer might be unnecessary.

Solitary mediastinal lymph node recurrence after curative resection of colon cancer

We report two cases of solitary mediastinal lymph node recurrence after colon cancer resection. Both cases had para-aortic lymph node metastasis at the time of initial surgery and received adjuvant chemotherapy for 4 years in case 1 and 18 mo in case 2. The time to recurrence was more than 8 years in both cases. After resection of the recurrent tumor, the patient is doing well with no recurrence for 6 years in case 1 and 4 mo in case 2. Patients should be followed up after colon cancer surgery considering the possibility of solitary mediastinal lymph node recurrence if they had para-aortic node metastasis at the time of initial surgery.