Assessing recent recurrence after hepatectomy for hepatitis Brelated hepatocellular carcinoma by a predictive model based on sarcopenia

BACKGROUND Sarcopenia may be associated with hepatocellular carcinoma(HCC)following hepatectomy.But traditional single clinical variables are still insufficient to predict recurrence.We still lack effective prediction models for recent recurrence(time to recurrence<2 years)after hepatectomy for HCC.AIM To establish an interventable prediction model to estimate recurrence-free survival(RFS)after hepatectomy for HCC based on sarcopenia.METHODS We retrospectively analyzed 283 hepatitis B-related HCC patients who underwent curative hepatectomy for the first time,and the skeletal muscle index at the third lumbar spine was measured by preoperative computed tomography.94 of these patients were enrolled for external validation.Cox multivariate analysis was per-formed to identify the risk factors of postoperative recurrence in training cohort.A nomogram model was developed to predict the RFS of HCC patients,and its predictive performance was validated.The predictive efficacy of this model was evaluated using the receiver operating characteristic curve.RESULTS Multivariate analysis showed that sarcopenia[Hazard ratio(HR)=1.767,95%CI:1.166-2.678,P<0.05],alpha-fetoprotein≥40 ng/mL(HR=1.984,95%CI:1.307-3.011,P<0.05),the maximum diameter of tumor>5 cm(HR=2.222,95%CI:1.285-3.842,P<0.05),and hepatitis B virus DNA level≥2000 IU/mL(HR=2.1,95%CI:1.407-3.135,P<0.05)were independent risk factors associated with postoperative recurrence of HCC.Based on the sarcopenia to assess the RFS model of hepatectomy with hepatitis B-related liver cancer disease(SAMD)was established combined with other the above risk factors.The area under the curve of the SAMD model was 0.782(95%CI:0.705-0.858)in the training cohort(sensitivity 81%,specificity 63%)and 0.773(95%CI:0.707-0.838)in the validation cohort.Besides,a SAMD score≥110 was better to distinguish the high-risk group of postoperative recurrence of HCC.CONCLUSION Sarcopenia is associated with recent recurrence after hepatectomy for hepatitis B-related HCC.A nutritional status-based prediction model is first established for postoperative recurrence of hepatitis B-related HCC,which is superior to other models and contributes to prognosis prediction.

Perioperative remedial antiviral therapy in hepatitis B virus-related hepatocellular carcinoma resection:How to achieve a better outcome

BACKGROUND Although the benefits of antiviral therapy for hepatitis B virus(HBV)-related hepatocellular carcinoma(HCC)have been proven,researchers have not con-firmed the differences in patient outcomes between patients who received preoperative antiviral therapy for a period of time(at least 24 wk)and patients who received remedial antiviral therapy just before radical resection for HBV-related HCC.AIM To investigate the efficacy of perioperative remedial antiviral therapy in patients with HBV-related HCC.METHODS A retrospective study of patients who underwent radical resection for HBV-related HCC at the First Affiliated Hospital of Xi’an Jiaotong University from January 2016 to June 2019 was conducted.Considering the history of antiviral therapy,patients were assigned to remedial antiviral therapy and preoperative antiviral therapy groups.RESULTS Kaplan–Meier analysis revealed significant differences in overall survival(P<0.0001)and disease-free survival(P=0.035)between the two groups.Multivariate analysis demonstrated that a history of preoperative antiviral treatment was independently related to improved survival(hazard ratio=0.27;95%confidence interval:0.08-0.88;P=0.030).CONCLUSION In patients with HBV-related HCC,it is ideal to receive preoperative long-term antiviral therapy,which helps patients tolerate more extensive hepatectomy;however,remedial antiviral therapy,which reduces preoperative HBV-DNA levels to less than 4 Log10 copies DNA/mL,can also result in improved outcomes.

Gemcitabine cures metastatic hepatic carcinoma and bone metastasis

We report a case of a 59-year-old gentleman who had suffered from low back pain for several months.Abdominal sonogram showed multiple heteroechoic nodules in the bilateral liver and an enlarged pancreatic head.Abdominal computer tomography(CT)favored pancreas head tumor with liver and bone metastasis.Endoscopic retrograde cholangiopancreatography(ERCP)disclosed pancreatic duct invasion over the distal portion of the pancreatic duct with prestenotic dilatation.Liver biopsy showed undifferentiated carcinoma.As suggested by the pathologist,the nasopharyngeal area was checked by the ear,nose and throat doctor,was negative and nasopharyngeal carcinoma was ex-cluded.Therefore,the patient was treated with Gemcitabine(1500 mg/wk),as the suggested treatment schedule,for 24 wk in opioid dependency program.Sequential abdominal CT during follow up showed the disappearance of liver metastasis and shrinkage of the pancreatic tumor.Repeated ERCP after treatment showed re-channelization of the pancreatic duct.During11 years of follow up,5 CT scans disclosed not only the disappearance of the hepatic tumor but also no cancer recurrence.Progressive shrinkage of pancreatic head was also noted.Therefore,we can say this malignant case was cured by monotherapy with gemcitabine.

End-stage liver disease score and future liver remnant volume predict post-hepatectomy liver failure in hepatocellular carcinoma

BACKGROUND Hepatocellular carcinoma(HCC)is the world’s sixth most common malignant tumor and the third cause of cancer death.Although great progress has been made in hepatectomy,it is still associated with a certain degree of risk of posthepatectomy liver failure(PHLF),which extends the length of hospital stay and remains the leading cause of postoperative death.Studies have shown that assessment of hepatic functional reserve before hepatectomy is beneficial for reducing the incidence of PHLF.AIM To assess the value of model for end-stage liver disease(MELD)score combined with standardized future liver remnant(sFLR)volume in predicting PHLF in patients undergoing hepatectomy for HCC.METHODS This study was attended by 238 patients with HCC who underwent hepatectomy between January 2015 and January 2018.Discrimination of sFLR volume,MELD score,and sFLR/MELD ratio to predict PHLF was evaluated according to the area under the receiver operating characteristic curve.RESULTS The patients were divided into two groups according to whether PHLF occurred after hepatectomy.The incidence of PHLF was 8.4%in our research.The incidence of PHLF increased with the decrease in sFLR volume and the increase in MELD score.Both sFLR volume and MELD score were considered independent predictive factors for PHLF.Moreover,the cut-off value of the sFLR/MELD score to predict PHLF was 0.078(P<0.001).This suggests that an sFLR/MELD≥0.078 indicates a higher incidence of PHLF than an sFLR/MELD<0.078.CONCLUSION MELD combined with sFLR is a reliable and effective PHLF predictor,which is superior to MELD score or sFLR volume alone.

Extended central hepatectomy with preservation of segment 6 for patients with centrally located hepatocellular carcinoma

BACKGROUND： In order to preserve functional liver parenchyma, extended central hepatectomy （segments 4, 5, 7 and 8 resection） was proposed for the management of centrally located hepatocellular carcinoma invading the right and middle hepatic veins, reconstructing segment 6 outflow in the absence of the thick inferior right hepatic vein. The present study was to describe our surgical techniques of extended central hepatectomy.METHODS： Between 2008 and 2012, 5 patients with centrally located hepatocellular carcinoma invading or in the vicinity of the right and middle hepatic veins underwent extended central hepatectomy. The thick inferior right hepatic vein was preserved during dissection. Gore-Tex graft was used for segment 6 outflow reconstruction in the absence of the thick inferior right hepatic vein.RESULTS： The mean future remnant liver volume for segments 2 and 3 was 28% versus 45% on segment 6 preservation. The mean tumor diameter was 7.4 cm. The thick inferior right hepatic vein was found in 1 patient. Outflow reconstruction from segment 6 was performed in 4 patients. Postoperative complications included bile leakage （1 patient）, pleural effusion （2） and liver failure （1）. The rate of graft patency was 75%. There was no perioperative mortality.CONCLUSION： Extended central hepatectomy is a safe alternative for extended hepatic resection in selected patients attempting to preserve the functional liver parenchyma.

Low immediate postoperative platelet count is associated with hepatic insufficiency after hepatectomy

AIM: To investigate the relationship between low immediate postoperative platelet count and perioperative outcome after liver resection in patients with hepatocellular carcinoma(HCC).METHODS: In a cohort of 565 consecutive hepatitis B-related HCC patients who underwent major liver resection, the characteristics and clinical outcomes after liver resection were compared between patients with immediate postoperative platelet count < 100 × 109/L and patients with platelet count ≥ 100 × 109/L. Risk factors for postoperative hepatic insufficiency were evaluated by multivariate analysis.RESULTS: Patients with a low immediate postoperative platelet count(< 100 × 109/L) had more grade Ⅲ-Ⅴ complications(20.5% vs 12.4%, P = 0.016), and higher rates of postoperative liver failure(6.8% vs 2.6%,P = 0.02), hepatic insufficiency(31.5% vs 21.2%, P < 0.001) and mortality(6.8% vs 0.5%, P < 0.001), compared to patients with a platelet count ≥ 100 × 109/L. The alanine aminotransferase levels on postoperative days 3 and 5, and bilirubin on postoperative days 1, 3 and 5 were higher in patients with immediate postoperative low platelet count. Multivariate analysis revealed that immediate postoperative low platelet count, rather than preoperative low platelet count, was a significant independent risk factor for hepatic insufficiency.CONCLUSION: A low immediate postoperative platelet count is an independent risk factor for hepatic insufficiency. Platelets can mediate liver regeneration in the cirrhotic liver.

Impact of antiviral therapy on post-hepatectomy outcome for hepatitis B-related hepatocellular carcinoma

The outcome after curative resection for hepatocellular carcinoma(HCC)remains unsatisfactory due to the high recurrence rate after surgery.In patients with hepatitis B virus(HBV)-related HCC,which is the majority of patients with HCC in Asia,a high viral load is a strong risk factor for HCC recurrence.It is logical to believe that antiviral therapy may improve the postoperative outcome by promoting viral clearance and hepatocyte regeneration,as well as improving residual liver volume in HCC patients with hepatitis B.However,the effect of antiviral therapy on clinical outcomes after liver resection in patients with HBV-related HCC remains to be established.There are two main groups of antiviral treatment for HBV-oral nucleos(t)ide analogues and interferon.Interferon treatment reduces the overall incidence of HBV-related HCC in sustained re-sponders.However,side effects may limit its long-term clinical application.Nucleos(t)ide analogues carry fewer side effects and are potent in terms of viral suppression when compared to interferon and are typically implemented for patients with more advanced liver diseases.They may also improve the outcome after curative resection for HBV-related HCC.There are increasing evidence to suggest that antiviral therapy could suppress HBV,decrease the perioperative reactivation of viral replication,reduce liver injury,preserve the liver function before and after operation,and may lower the risk of HCC recurrence.After all,antiviral therapy may improve the survival after liver resection by reducing recurrence and delaying the liver damage by the virus,resulting in a higher chance of receiving aggressive salvage therapy during HCC recurrence.

Lamivudine treatment enabling right hepatectomy for hepatocellular carcinoma in decompensated cirrhosis

A 69-year-old man was admitted to our hospital in October 2003,for further examination of two liver tumors.He was diagnosed with hepatocellular carcinoma(HCC) arising from decompensated hepatitis B virus(HBV)-related cirrhosis.Long-term lamivudine administration improved liver function dramatically despite repeated treatment for HCC.His Child-Pugh score was 9 points at start of lamivudine treatment,improving to 5 points after 1 year.His indocyanine green at 15 min after injection test score was 48%before lamivudine treat-ment,improving to 22%after 2 years and to 5%after 4 years.Radiofrequency ablation controlled the HCC foci and maintained his liver function.In April 2009,abdominal computed tomography revealed a tumor thrombus in the right portal vein.Since his indocyanine green test results had improved to less than 10%,we performed a right hepatectomy,which was successful.To our knowledge,there have been no documented reports of patients undergoing successful right hepatectomy for HCC arising from decompensated cirrhosis.The findings observed in our patient indicate the importance of nucleoside analogs for treating HBV-related HCC.

Clinical significance of half-hepatic blood flow occlusion technology in patients with hepatocellular carcinoma with cirrhosis

BACKGROUND Most patients with primary hepatocellular carcinoma(HCC)have a history of chronic hepatitis B and usually present with varying degrees of cirrhosis.Owing to the special nature of liver anatomy,the blood vessel wall in the liver parenchyma is thin and prone to bleeding.Heavy bleeding and blood transfusion during hepatectomy are independent risk factors for liver cancer recurrence and death.Various clinical methods have been used to reduce intraoperative bleeding,and the Pringle method is most widely used to prevent blood flow to the liver.AIM To investigate the effect of half-hepatic blood flow occlusion after patients with HCC and cirrhosis undergo hepatectomy.METHODS This retrospective study included 88 patients with HCC and liver cirrhosis who underwent hepatectomy in our hospital from January 2017 to September 2020.Patients were divided into two groups based on the following treatment methods:the research group(n=44),treated with half-hepatic blood flow occlusion technology and the control group(n=44),treated with total hepatic occlusion.Differences in operation procedure,blood transfusion,liver function,tumor markers,serum inflammatory response,and incidence of surgical complications were compared between the groups.RESULTS The operation lasted longer in the research group than in the control group(273.0±24.8 min vs 256.3±28.5 min,P<0.05),and the postoperative anal exhaust time was shorter in the research group than in the control group(50.0±9.7 min vs 55.1±10.4 min,P<0.05).There was no statistically significant difference in incision length,surgical bleeding,portal block time,drainage tube indwelling time,and hospital stay between the research and control groups(P>0.05).Before surgery,there were no significant differences in serum alanine transaminase(ALT),aspartate aminotransferase(AST),total bilirubin,and prealbumin levels between the research and control groups(P>0.05).Conversely,24 and 72 h after the operation the respective serum ALT(378.61±77.49 U/L and 246.13±54.06 U/L)and AST(355.30±69.50 U/L and 223.47±48.64 U/L)levels in the research group were significantly lower(P<0.05)than those in the control group(ALT,430.58±83.67 U/L and 281.35±59.61 U/L;AST,416.49±73.03 U/L and 248.62±50.10 U/L).The operation complication rate did not significantly differ between the research group(15.91%)and the control group(22.73%;P>0.05).CONCLUSION Half-hepatic blood flow occlusion technology is more beneficial than total hepatic occlusion in reducing liver function injury in hepatectomy for patients with HCC and cirrhosis.

Synchronous occurrence of a hepatic myelolipoma and two hepatocellular carcinomas

Myelolipoma is a rare tumor composed of fat and bone marrow components, most of which are located in the adrenal gland. Myelolipoma in the liver is extremely rare. To date, only 10 cases have been reported in the English-language medical literature. In one of these cases, the hepatic myelolipoma was found within a hepatocellular carcinoma(HCC). In the present study, we report the first case of the synchronous occurrence of hepatic myelolipoma and HCCs in different liver sections of one patient, a 26-year-old female who was admitted to our hospital because of a 4-d history of upper abdominal pain. The unenhanced computed tomography(CT) images showed a well-defined lowdensity mass with adipose components in the right liver lobe, 4.2 cm × 4.1 cm in size. Two inhomogeneous low-density masses were found in the left liver lobe, 8.6 cm × 7.7 cm and 2.6 cm × 2.6 cm in size. The masses in both the right and left liver lobes were heterogeneously enhanced in the contrast-enhanced CT images. Based on the results of the imaging examination, the mass in the right liver lobe was preliminarily considered to be a hamartoma, and the two masses in the left liver were preliminarily considered to be HCCs. We performed a right hepatectomy, a left hepatic lobectomy, and a cholecystectomy. Microscopic and immunohistochemical results revealed that the tumor in the right liver lobe was a hepatic myelolipoma, and that the two tumors in the left liver lobe were HCCs.

左侧卧位腹腔镜肝右叶部分切除术临床分析

目的探讨左侧卧位腹腔镜肝右叶各肝段部分切除的可行性及疗效。方法回顾性分析右江民族医学院附属医院百东院区2022年5月至2023年4月期间39例行左侧卧位腹腔镜肝右叶部分切除术的病例资料。结果39例中有腹部手术史者13例;肿瘤1个34例,肿瘤2个3例,肿瘤3个2例,肿瘤最大径37.0(24.0,58.0)mm。其中行非解剖性肝切除20例,解剖性肝切除19例;单一肝段切除术28例,两部位肝部分切除术10例,三部位肝部分切除术1例;联合腹腔镜胆囊切除24例;无血流阻断9例,行Pringle法血流阻断30例。平均手术时间(143.5±56.8)min;中位术中出血量100.0(50.0,300.0)mL,4例术中输血(合计29.50 U),无中转开腹。35例放置引流管,引流管留置时间(6.3±3.7)d;术后平均住院时间(10.1±4.0)d,住院总费用(41121.8±18978.3)元。术后23例患者出现少量胸腔积液;1例患者并发急性呼吸窘迫综合征(ARDS)及肝功能不全,经ICU复苏治愈;1例出现少量气胸;无感染、出血、胆漏等并发症发生;无非计划性再次手术发生。所有患者均通过门诊或电话的方式获得随访,所有病例近期无复发。结论左侧卧位行腹腔镜肝右叶部分切除术操作简单,暴露好,手术时间相对较短,出血少。

光谱CT鉴别动脉期高强化肝转移瘤与肝细胞癌的价值

目的探讨双层探测器光谱CT在鉴别动脉期高强化肝转移瘤(APHEHM)和肝细胞癌(HCC)中的价值。方法回顾性收集2021年12月—2023年6月临床或病理确诊的53例动脉期高强化肝脏恶性肿瘤者,将其分为APHEHM组(n=23)和HCC组(n=30),计算光谱参数,包括标准化虚拟单能量图像(VMI)、肿瘤/肝实质的标准化无水碘(NINW-L)、标准化碘密度(NID-L)以及标准化有效原子序数(NZeff-L),并计算肿瘤/腹主动脉的标准化有效原子序数(NZeff-A)。通过受试者工作特征(ROC)曲线和Cohen|d|分析其鉴别效能和临床意义。结果动脉期中APHEHM在以肝实质为对照的40 keV、50 keV、60 keV下的标准化VMI CT值[NCT-L(40keV),NCT-L(50keV),NCT-L(60keV)]、NINW-L、NID-L、NZeff-L以及NZeff-A均小于HCC,差异均具有统计学意义(P<0.05)。动脉期下的NINW-L曲线下面积(AUC)最大,为0.752,以2.985为阈值鉴别两者最佳,敏感度和特异度分别为63.3%、87.0%。结论动脉期下的NCT-L(40keV)、NINW-L和NID-L可作为临床上鉴别APHEHM和HCC的重要指标。

三维重建技术在肝癌腹腔镜肝切除术中的应用体会

目的探讨三维重建技术在肝癌腹腔镜肝切除术中的应用价值。方法收集2019年9月~2022年3月原发性肝癌病人62例,按是否使用三维重建技术分为两组,观察组31例,使用三维重建技术;对照组31例,未使用三维重建技术。术前均完善增强CT扫描。比较两组病人的术中情况(手术时间、术中出血量)、术后情况(术后并发症发生率、术后住院时间)。结果62例病人均顺利完成腹腔镜肝切除术,未出现肝功能衰竭及死亡病例。对于肿瘤位于Ⅱ、Ⅲ肝段病人,对照组与观察组的手术时间、术中出血量、术后住院时间、术后并发症总发生率比较差异无统计学意义(P>0.05);对于肿瘤位于Ⅳ~Ⅵ肝段病人,观察组的手术时间[(211.36±11.22)分钟比(231.69±19.73)分钟]、术中出血量[(274.29±23.84)ml比(306.54±21.05)ml]、术后住院时间[(7.93±1.33)天比(9.62±1.80)天]低于对照组,差异有统计学意义(P<0.05),两组术后并发症总发生率比较差异无统计学意义(P>0.05);对于肿瘤位于Ⅰ、Ⅶ、Ⅷ肝段病人,观察组的手术时间[(165.88±10.60)分钟比(187.30±17.29)分钟]、术中出血量[(271.25±12.17)ml比(308.00±28.21)ml]、术后住院时间[(7.63±0.74)天比(9.30±1.06)天]低于对照组,差异有统计学意义(P<0.05),两组术后并发症总发生率比较差异无统计学意义(P>0.05)。结论三维重建技术可能对复杂的腹腔镜肝癌肝切除术具有指导意义。

Management of centrally located hepatocellular carcinoma:Update 2016

Centrally located hepatocellular carcinoma(HCC)is sited in the central part of the liver and adjacent to main hepatic vascular structures.This special location is associated with an increase in the difficulty of surgery,aggregation of the recurrence disease,and greater challenge in disease management.This review summarizes the evolution of our understanding for centrally located HCC and discusses the development of treatment strategies,surgical approaches and recurrence prevention methods.To improve patient survival,a multi-disciplinary modality is greatly needed throughout the whole treatment period.

Liver resection in hepatitis B related-hepatocellular carcinoma: Clinical outcomes and safety in elderly patients

AIM:To compare the morbidity and mortality in young and elderly hepatocellular carcinoma(HCC)patients undergoing liver resection.METHODS:We retrospectively enrolled 1543 consecutive hepatitis B(HBV)-related HCC patients undergoing elective hepatic resection in our cohort,including 207elderly patients(≥65 years)and 1336 younger patients(<65 years).Patient characteristics and clinical outcomes after liver resection were compared between the two groups.RESULTS:Elderly patients had more preoperative comorbidities and lower alanine aminotransferase and aspartate aminotransferase levels.Positive rates for hepatitis B surface antigen(P<0.001),hepatitis B e antigen(P<0.001)and HBV DNA(P=0.017)were more common in younger patients.Overall complications and their severity classified using the Clavien system were similarin the two groups(33.3%vs 29.6%,P=0.271).Elderly patients had a higher rate of postoperative cardiovascular complications(3.9%vs 0.6%,P=0.001),neurological complications(2.9%vs 0.4%,P<0.001)and mortality(3.4%vs 1.2%,P=0.035),and had more hospital stay requirement(13 d vs 12 d,P<0.001)and more intensive care unit stay(36.7%vs 27.8%,P=0.008)compared with younger patients.However,postoperative hepatic insufficiency was more common in the younger group(7.7%vs 3.4%,P=0.024).CONCLUSION:Hepatectomy can be safely performed in elderly patients.Age should not be regarded as a contraindication to liver resection with expected higher complication and mortality rates.

Value of radiofrequency ablation in the treatment of hepatocellular carcinoma

Hepatocellular carcinoma(HCC)is a malignant disease that substantially affects public health worldwide.It is especially prevalent in east Asia and sub-Saharan Africa,where the main etiology is the endemic status of chronic hepatitis B.Effective treatments with curative intent for early HCC include liver transplantation,liver resection(LR),and radiofrequency ablation(RFA).RFA has become the most widely used local thermal ablation method in recent years because of its technical ease,safety,satisfactory local tumor control,and minimally invasive nature.This technique has also emerged as an important treatment strategy for HCC in recent years.RFA,liver transplantation,and hepatectomy can be complementary to one another in the treatment of HCC,and the outcome benefits have been demonstrated by numerous clinical studies.As a pretransplantation bridge therapy,RFA extends the average waiting time without increasing the risk of dropout or death.In contrast to LR,RFA causes almost no intraabdominal adhesion,thus producing favorable conditions for subsequent liver transplantation.Many studieshave demonstrated mutual interactions between RFA and hepatectomy,effectively expanding the operative indications for patients with HCC and enhancing the efficacy of these approaches.However,treated tumor tissue remains within the body after RFA,and residual tumors or satellite nodules can limit the effectiveness of this treatment.Therefore,future research should focus on this issue.

Solitary hepatic lymphangioma mimicking liver malignancy: A case report and literature review

BACKGROUND Hepatic lymphangioma,a malformation of the liver lymphatic system,is a rare benign neoplasm and usually coexists with other visceral lymphangiomas.Solitary hepatic lymphangioma is much more rarely seen and could cause a clinical misinterpretation as malignancy.CASE SUMMARY A 50-year-old woman with a liver mass of approximately 3.5 cm was initially diagnosed with hepatocellular carcinoma given the risk factors for liver cancer that she presented with,including Schistosome japonicum infection and jaundice,and also together with imaging results,which showed the mass enhanced quickly in the arterial phase and faded fast in the venous phase.The patient did not have the surgery first but received three rounds of transarterial chemoembolization because of her anxiety and fears for operation.Finally,the patient underwent laparoscopic liver segment 4b resection and cholecystectomy and was discharged from the hospital only 10 d after the operation.The pathological examination indicated the mass as hepatic lymphangioma.The patient has been followed up for 30 mo without recurrence.To raise the awareness of this misdiagnosed case and to better diagnose and treat this rare disease in future,we reviewed the published literature of solitary hepatic lymphangioma for its clinical symptoms,imaging presentation,operative techniques,histology features and prognosis.CONCLUSION Solitary hepatic lymphangioma mimicking malignancy makes diagnosis difficult.Complete surgical resection is the first choice to treat solitary hepatic lymphangioma.

Cryoablation combined with radiotherapy for hepatic malignancy:Five case reports

BACKGROUND The survival of patients treated with monotherapy for hepatic malignancies is not ideal.A comprehensive program of cryoablation combined with radiotherapy for the treatment of hepatic malignancies results in less trauma to the patients.It may provide an option for the treatment of patients with advanced hepatic malignancies.CASE SUMMARY We reported 5 cases of advanced-stage hepatic malignancies treated in our hospital from 2017-2018,including 3 cases of primary hepatocellular carcinoma and 2 cases of metastatic hepatic carcinoma.They first received cryoablation therapy on their liver lesions.The procedure consisted of 2 freeze-thaw cycles,and for each session,the duration of freezing was 13-15 min,and the natural rewarming period was 2-8 min.Depending on the tumor size,the appropriate cryoprobes were selected to achieve complete tumor ablation to the greatest extent possible.After cryoablation surgery,intensity-modulated radiotherapy(IMRT)for liver lesions was performed,and the radiotherapy regimen was 5400 cGy/18f and 300 cGy/f.None of the 5 patients had adverse events above grade II,and their quality of life was significantly improved.Among them,4 patients were free of disease progression in the liver lesions under local control,and their survival was prolonged;3 patients are still alive.CONCLUSION Our clinical practice demonstrated that cryoablation combined with IMRT could be implemented safely.The definitive efficacy for hepatic malignancies needs to be confirmed in larger-size sample prospective studies.

Downstaging and resection after neoadjuvant therapy for fibrolamellar hepatocellular carcinoma

Fibrolamellar hepatocellular carcinoma(FLHCC) is a rare malignant liver neoplasm, commonly observed in adolescents and young adults of both genders. The disease is more common in Caucasians and in patients without a prior history of liver disease. The best treat-ment option is a surgical resection associated with liver hilum lymph node dissection. However, there is no established systemic drug treatment for patients with locally advanced or metastatic disease. We report on a patient with advanced FLHCC, initially considered un-resectable due to invasion of the right and the middle hepatic veins and circumferential involvement of the left hepatic vein. Following the treatment with gem-citabine-oxaliplatin systemic chemotherapy, the patient exhibited a significant tumor reduction. As a result, a complete resection was performed with an extended right hepatectomy associated with a partial resection of the inferior vena cava, a wedge resection in segment 2, and lymphadenectomy of the hepatic hilum. The case was unusual due to the significant tumor downstaging with gemcitabine-oxaliplatin, potentially enabling cura-tive resection. More studies are needed to confirm the efficacy of the systemic drug treatment for FLHCC.

Timing of antiviral therapy in patients with hepatitis B virus related hepatocellular carcinoma undergoing hepatectomy

Globally,hepatocellular carcinoma(HCC)is among the most prevalent and deadly cancers.Hepatitis B virus(HBV)infection is an important etiology and disease progression factor for HCC.Hepatectomy is a widely accepted curative treatment for HCC,but the long-term survival rate is still unsatisfactory due to the high recurrence rate after resection.Preoperative or postoperative antiviral therapy plays an important role in improving the prognosis for HBV-related HCC patients who underwent hepatectomy.However,many patients miss out on the chance to receive long-term preoperative antiviral medication because their HBV and HCC infections are discovered concurrently,necessitating the start of remedial antiviral therapy in the perioperative phase.Therefore,it is of great value to know when antiviral therapy is more appropriate and whether perioperative rescue antiviral therapy can achieve the effect of preoperative long-term antiviral therapy.