Prognostic value of preoperative systemic immune-inflammation index/albumin for patients with hepatocellular carcinoma undergoing curative resection

BACKGROUND Hepatocellular carcinoma(HCC)is a major factor for cancer-associated mortality globally.Although the systemic immune-inflammation index(SII)and albumin(ALB)show individual prognostic value for various cancers,their combined significance(SII/ALB)in HCC patients undergoing curative hepatectomy is still unknown.It is hypothesized that a higher SII/ALB ratio correlates with poorer outcomes with regard to overall survival(OS)and recurrence-free survival(RFS).AIM To investigate the effect of preoperative SII/ALB in predicting the prognosis of HCC patients undergoing hepatectomy.METHODS Patients who received curative surgery for HCC at a single institution between 2014 and 2019 were retrospectively analyzed.Cox proportional hazards models and Kaplan-Meier curves were utilized to estimate OS and RFS.A nomogram was created using prognostic factors determined by the least absolute shrinkage and selection operator method and analyzed using multivariate Cox regression.This nomogram was assessed internally through the calibration plots,receiver operating characteristic(ROC)analysis,decision curve analysis(DCA)and the concordance index(C-index).RESULTS This study enrolled 1653 HCC patients.Multivariate analyses demonstrated that SII/ALB independently predicted OS[hazard ratio(HR)=1.22,95%CI:1.03-1.46,P=0.025]and RFS(HR=1.19,95%CI:1.03-1.38,P=0.022).Age,alpha-fetoprotein,hepatitis B surface antigen,albumin-bilirubin grade,tumor diameter,portal vein tumor thrombus,tumor number,and SII/ALB were incorporated into the nomogram to predict OS.The nomogram had a C-index of 0.73(95%CI:0.71-0.76)and 0.71(95%CI:0.67-0.74)for the training and validation cohorts,respectively.The area under the ROC curve,DCA and calibration curves demonstrated high accuracy and clinical benefits.CONCLUSION The SII/ALB may independently predict outcomes in HCC patients who receive curative surgical treatment.In addition,the nomogram can be used in HCC treatment decision-making.

Risk factors of poor prognosis and portal vein tumor thrombosis after curative resection of solitary hepatocellular carcinoma

BACKGROUND:Predictors of poor prognosis of solitary hepatocellular carcinoma(SHCC),a subgroup encompassing most patients with the malignancy,are still controversial.Hence,risk factors for portal vein tumor thrombosis(PVTT) in SHCC are obscure.The present study was designed to address this issue.METHOD:Clinicopathological and follow-up data for 156 consecutive patients with SHCC following curative hepatic resection were analyzed using uni-and multi-variate analyses.RESULTS:Univariate analysis showed that PVTT,tumornode-metastasis(TNM) stage,Edmondson-Steiner grade and preoperative serum alpha-fetoprotein(AFP) level were associated with the overall and disease-free survival,whereas tumor size only influenced the overall survival.In multivariate Cox regression tests,Edmondson-Steiner grade and TNM stage were independent prognostic markers for both overall and diseasefree survival.In addition,the Chi-square test showed that AFP level and Edmondson-Steiner grade were correlated with PVTT.Among them,only Edmondson-Steiner grade was shown to be of independent significance for PVTT in multi-variate logistic regression analysis.Additionally,AFP,the sole preoperative factor for PVTT,was not adequately sensitive and specific.CONCLUSIONS:Factors relating to post-surgical prognosis and PVTT in SHCC are all tumor-related.Of these,EdmondsonSteiner grade and TNM stage might be of particular importance in survival analysis.In addition,accurate prediction of PVTT by clinicopathological parameters before surgery remains difficult.

Lymphocyte-to-monocyte ratio predicts survival of patients with hepatocellular carcinoma after curative resection

AIM: To investigate the prognostic value of preoperative lymphocyte-to-monocyte ratio(LMR) in patients with hepatocellular carcinoma(HCC) undergoing curative hepatectomy.METHODS: Clinicopathological data of 210 hepatitis B virus(HBV)-associated HCC patients who were treated by radical hepatic resection between 2003 and 2010 were retrospectively analyzed. None of the patients received any preoperative anticancer therapyor intraoperative radiofrequency ablation. The diagnosis was confirmed by pathological examination after surgery. Absolute peripheral blood lymphocyte and monocyte counts were derived from serum complete blood cell count before surgery,and LMR was calculated by dividing lymphocyte count by monocyte count. The best cutoff was determined by receiver operating characteristics(ROC) curve analysis. Correlations between LMR levels and clinicopathological features were assessed using the χ2 test. Survival outcomes were estimated using the Kaplan-Meier method and compared by the log-rank test. Univariate and multivariate analyses were performed to evaluate the prognostic impact of LMR and other clinicopathological factors on overall survival(OS) and recurrence-free survival(RFS),using the Cox proportional hazards model.RESULTS: The optimal cutoff value of LMR for survival analysis was 3.23,which resulted in the most appropriate sensitivity of 55.3% and specificity of 74.7%,with the area under the curve(AUC) of 0.66(95%CI: 0.593-0.725). All patients were dichotomized into either a low(≤ 3.23) LMR group(n = 66) or a high(> 3.23) LMR group(n = 144). A low preoperative LMR level was significantly correlated with the presence of cirrhosis,elevated levels of total bilirubin and larger tumor size. Patients with a low LMR level had significantly reduced 5-year OS(61.9% vs 83.2%,P < 0.001) and RFS(27.8% vs 47.6%,P = 0.009) compared to those with a high LMR level. Multivariate analyses indicated that a lower LMR level was a significantly independent predictor of inferior OS(P = 0.003) and RFS(P = 0.006). Subgroup analysis indicated that survival outcome was significantly more favorable in cirrhotic patients with LMR > 3.23. However,there were no differences between low and high LMR groups for OS and RFS in non-cirrhotic patients.CONCLUSION: Preoperative LMR was demonstrated for the first time to serve as an independent prognostic factor in HBV-associated HCC patients after curative resection. Prospective studies with larger cohorts for validation are warranted.

Association of HBV DNA replication.with antiviral treatment outcomes in the patients with early-stage HBV-related hepatocellular carcinoma undergoing curative resection

Background:It remains unclear what the antiviral therapy affects disease-free survival(DFS) and overall survival(OS)of patients with hepatitis B virus(HBV)-related hepatocellular carcinoma(HCC) at different tumor stages and baseline HBV DNA levels.In this study,we analyzed the association of antiviral treatment with DFS and OS based on the stratification of baseline HBV DNA load in early-stage(stages Ⅰ and Ⅱ) HCC patients.Methods:We included 445 patients with early-stage HBV-related HCC who underwent curative resection,and then classified them into four subgroups based on baseline HBV DNA load and antiviral therapy stratification.The KaplanMeier and Cox regression analyses were performed to determine the association of clinical characteristics with survival.Results:The median follow-up period was 74 months.For all patients,cumulative OS rates in the antiviral group were significantly higher than those in the non-antiviral group(log-rank test,P = 0.023),whereas no significant differences in DFS rates were observed.High baseline HBV DNA level was a risk factor associated with short DFS and OS in all patients.In patients with baseline HBV DNA levels ≥2000 lU/mL,antiviral treatment was significantly associated with prolonged DFS and OS(log-rank test,P = 0.041 and 0.001,respectively).In patients with HBV DNA levels <2000 lU/mL or undetectable,antiviral treatment did not show a significant benefit in prolonging DFS and OS.Conclusions:High baseline HBV DNA levels are associated with poor prognosis in the patients with early-stage HCC,and the antiviral treatment could generate survival benefits for the patients.Therefore,antiviral treatment should be given for these patients.However,the effect of antiviral treatment on the patients with low viral load remains unclear,and further investigation is warranted.

Prognostic Factors for Patients after Curative Resection for Proximal Gastric Cancer

The factors influencing the long-term survival of patients with proximal gastric cancer (PGC) after curative resection were investigated. Data from 171 patients who underwent curative resection for PGC were retrospectively analyzed. The patients were grouped according to the clinicopathological factors and operative procedures. The tumor depth (T stage) and lymph node metastasis (pN stage) were graded according to the fifth edition of TNM Staging System published by UICC in 1997. The metastatic lymph node ratio (MLR) was divided into four levels: 0%, 30%. The data of survival rate were analyzed by Kaplan-Meier method (log-rank test) and Cox regression model. The 5-year overall survival rate of 171 patients was 37.32%. The univariate analysis demonstrated that the survival time of the postoperative patients with PGC was related to tumor size (χ2=4.57, P=0.0325), gross type (χ2=21.38, P30% (χ2=13.34, P=0.0003), TNM Ⅲ (χ2=14.05, P=0.0002) or TNM Ⅳ stage (χ2=4.37, P=0.0366); and combining splenectomy was beneficial to the cases of T3 (χ2=5.68, P=0.0171) or MLR >30% (χ2=6.11, P=0.0134). It was concluded that MLR, pN stage, TNM stage, T stage, and gross type had advantages in providing a precise prognostic evaluation for patients undergoing curative resection for PGC, in which MLR was the most valuable index. TG and combining splenectomy were useful to improve the prognosis to patients with PGC of TNM Ⅲ/Ⅲ stage, serosa invasion, or extensive regional lymph node metastasis.

Post-operative albumin-bilirubin grade predicts long-term outcomes among Child–Pugh grade A patients with hepatocellular carcinoma after curative resection

Background: Although Child–Pugh grade A patients with hepatocellular carcinoma(HCC) are candidates for curative resection, some may have a poor prognosis. The albumin-bilirubin(ALBI) grade, a measure of liver function based on albumin and bilirubin, has the potential to detect Child–Pugh grade A HCC patients with poor prognosis. Because components of the ALBI grade can be measured easily even after surgery, we explored the predictive values of ALBI in patient prognosis after HCC resection. Methods: In this retrospective case-control study, we included 136 HCC patients who underwent curative resection between January 2004 and December 2013 at our hospital. ALBI grade was calculated from laboratory data recorded the day before surgery and at post-operative day 5. Results: Pre-and post-operative ALBI grade predicted patients’ long-term outcomes( P = 0.020 and P < 0.001, respectively, for overall survival, and P = 0.012 and P = 0.015, respectively, for recurrence-free survival). Post-operative ALBI grade was associated with patients’ surgical factors of repeated hepatic resection( P = 0.012), intra-operative bleeding( P = 0.006), and surgery duration( P = 0.033). Furthermore, post-operative ALBI grade, rather than pre-operative ALBI grade, was an independent predictive factor of long-term outcome of Child–Pugh grade A patients with HCC. Conclusions: Post-operative ALBI grade is useful to predict the prognosis in patients after HCC resection.

Preoperative serum liver enzyme markers for predicting early recurrence after curative resection of hepatocellular carcinoma

BACKGROUND：Early recurrence of hepatocellular carcinoma（HCC）is associated with worse prognosis after liver resection This study aimed to investigate the prognostic value of com mon liver enzyme markers in HCC early recurrence after cu rative hepatectomy and to establish a simple predictive model for HCC early recurrence.METHODS： A total of 200 patients who had undergone curative resection for HCC were retrospectively analyzed. The patients were divided into early recurrence （within 2 years） and non-early recurrence groups. Demographical characteristics, preopera- tive liver function parameters, surgical factors and tumor related factors of the patients were assessed by univariate analysis to identify potential significant predictors for early recurrence after resection of HCC. Parameters with statisti- cal significance were entered into a Cox proportional hazard model to find independent risk factors. Receiver operating characteristic analysis was done to determine optimal cut-off values and the number of combined factors in multi-factor predictive model. RESULTS： Of 13 potential risk factors for early recurrence identified by univariate analysis, high lactate dehydrogenase （LDH〉206 U/L, HR=1.711, P=0.006）, high aspartate aminotransferase （AST）/alanine aminotransferase （ALT） ratio （AST/ ALT〉0.96, HR=1.769, P=0.006）, elevated alpha-fetoprotein （AFP〉8.6 ng/mL, HR=2.079, P=0.007）, small resection margin （〈1 cm, HR=2.354, P〈0.001） and advanced TNM stage （TNM III-IV, HR=2.164, P〈0.001） were independent risk factors for early recurrence of HCC shown by multivariate analysis. Patients with three or more concurrent independent risk factors had significantly higher risk for early recurrence than those with low risk factors. The sensitivity and specificity of this predictive model are 53.6% and 80.7%, respectively （area under curve=0.741, 95% CI 0.674-0.800, P〈0.0001）. CONCLUSIONS： Preoperative common fiver enzyme markers, LDH and AST/ALT ratio, were independently associated with early recurrence of HCC. The combination of serum liver enzyme markers with AFP, resection margin and TNM stage bet- ter predicted early recurrence of HCC after curative resection in a simple multi-factor model.

Quality of life after curative liver resection: A single center analysis

AIM: To evaluate quality of life (QoL) after curative liver resection and identify variables associated with decreased QoL. METHODS: From October 2001 to July 2004, 323 patients underwent liver resection. At 3-36 mo after discharge, 188 patients were disease free. QoL was assessed using the Short Form (SF)-12 Health Survey with mental and physical component scales (SF-12 MCS and PCS), supplemented with generic questions concerning pain and liver-specific items. RESULTS: Sixty-eight percent (128/188) returned the questionnaire, which was completed in 75% (96/128) of cases. Median SF-12 PCS and MCS were 46.7 (inter- quartile range: 34.2-53.9) and 54.1 (42.8-58.2). Fifty percent were pain free with a median symptom score of 1.75 (1.38-2.13). PCS was higher after major hepatec-tomy [57% (55/96)] compared to minor resection (P = 0.0049), which represented an improved QoL. QoL was not affected by sex but by age compared to the general German population. MCS was higher after liver surgery for metastatic disease [55.9 (47.5-58.8)] compared to primary carcinoma [49.6 (36.5-55.1)] and benign disease [49.2 (37.7-56.3)] (P = 0.0317). There was no correlation between length of postoperative period and QoL. Pain, def iciencies in everyday life and a high symptom score significantly decreased MCS and PCS. CONCLUSION: Most patients were only marginally affected even after major liver resection; however, minor complications were associated with decreased SF-12 MCS and PCS and need careful attention.

Outcomes of curative liver resection for hepatocellular carcinoma in patients with cirrhosis

BACKGROUND Given the poor synthetic function of cirrhotic liver,successful resection for patients with hepatocellular carcinoma(HCC)necessitates the ability to achieve resections with tumor free margins.AIM To validate post hepatectomy liver failure score(PHLF),compare it to other established systems and to stratify risks in patients with cirrhosis who underwent curative liver resection for HCC.METHODS Between December 2010 and January 2017,120 patients underwent curative resection for HCC in patients with cirrhosis were included,the pre-operative,operative and post-operative factors were recorded to stratify patients'risks of decompensation,survival,and PHLF.RESULTS The preoperative model for end-stage liver disease(MELD)score[odds ratio(OR)=2.7,95%CI:1.2-5.7,P=0.013],tumor diameter(OR=5.4,95%CI:2-14.8,P=0.001)and duration of hospital stay(OR=2.5,95%CI:1.5-4.2,P=0.001)were significant independent predictors of hepatic decompensation after resection.While the preoperative MELD score[hazard ratio(HR)=1.37,95%CI:1.16-1.62,P<0.001]and different grades of PHLF(grade A:HR=2.33,95%CI:0.59-9.24;Grade B:HR=3.15,95%CI:1.11-8.95;Grade C:HR=373.41,95%CI:66.23-2105.43;P<0.001)and HCC recurrence(HR=11.67,95%CI:4.19-32.52,P<0.001)were significant independent predictors for survival.CONCLUSION Preoperative MELD score and tumor diameter can independently predict hepatic decompensation.While,preoperative MELD score,different grades of PHLF and HCC recurrence can precisely predict survival.

Risk factors for local recurrence of middle and lower rectal carcinoma after curative resection

AIM： To explore the risk factors for local recurrence of middle and lower rectal carcinoma after curative resection. METHODS： Specimens of middle and lower rectal carcinoma from 56 patients who received curative resection at the Department of General Surgery of Guangdong Provincial People＇s Hospital were studied. A large slice technique was used to detect mesorectal metastasis and evaluate circumferential resection margin status. The relations between clinicopathologic characteristics, mesorectal metastasis and circumferential resection margin status were identified in patients with local recurrence of middle and lower rectal carcinoma. RESULTS： Local recurrence of middle and lower rectal carcinoma after curative resection occurred in 7 of the 56 patients （12.5%）, and was significantly associated with family history （Х^2= 3.929, P = 0.047）, high CEA level （Х^2 = 4.964, P = 0.026）, cancerous perforation （Х^2 = 8.503, P = 0.004）, tumor differentiation （Х^2 = 9.315, P = 0.009） and vessel cancerous emboli （Х^2 = 11.879, P = 0.001）. In contrast, no significant correlation was found between local recurrence of rectal carcinoma and other variables such as age （Х^2 = 0.506, P = 0.477）, gender （Х^2 = 0.102, Z2 = 0.749）, tumor diameter （Х^2 = 0.421, P = 0.516）,tumor infiltration （Х^2 = 5.052, P = 0.168）, depth of tumor invasion （Х^2 = 4.588, P = 0.101）, lymph node metastases （Х^2 = 3.688, P = 0.055） and TNM staging system （Х^2 = 3.765, P = 0.152）. The local recurrence rate of middle and lower rectal carcinoma was 33.3% （4/12） in patients with positive circumferential resection margin and 6.8% （3/44） in those with negative circumferential resection margin. There was a significant difference between the two groups （Х^2 = 6.061, P = 0.014）. Local recurrence of rectal carcinoma occurred in 6 of 36 patients （16.7%） with mesorectal metastasis, and in 1 of 20 patients （5.0%） without mesorectal metastasis. However, there was no significant difference between the two groups （Х^2 = 1.600, P = 0.206）. CONCLUSION： Family history, high CEA level, cancerous perforation, tumor differentiation, vessel cancerous emboli and circumferential resection margin status are the significant risk factors for local recurrence of middle and lower rectal carcinoma after curative resection. Local recurrence may be more frequent in patients with mesorectal metastasis than in patients without mesorectal metastasis.

Rare primary rectal mucosa-associated lymphoid tissue lymphoma with curative resection by endoscopic submucosal dissection:A case report and review of literature

BACKGROUND Extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue(MALT lymphoma)occurs in approximately 9%of non-Hodgkin B-cell lymphomas.The gastrointestinal tract is the most commonly affected site of the extranodal forms of primary non-Hodgkin’s lymphomas.However,it rarely occurs within the rectum,and at present,there is no consensus on its diagnosis and treatment at this site.CASE SUMMARY We report a rare laterally spreading tumour-like rectal MALT lymphoma case in which the diagnosis and the depth of infiltration were determined by magnifying endoscopy and ultrasonic endoscopy.Then,the lesion was en bloc resected by endoscopic submucosal dissection(ESD)alone.The lesion was confirmed as MALT lymphoma by haematoxylin and eosin staining,immunohistochemical staining and gene arrangement analysis.Surveillance exams have indicated a 2-year disease-free survival for this patient.CONCLUSION We report a rare primary rectal MALT lymphoma that was curable with resection by ESD.ESD is a safe and effective therapeutic option for rectal MALT lymphoma.

The Prognostic and Curative Benefits of Primary Tumor Resection versus No Resection in Stage IV Colorectal Cancer: A Comparative Study

Background: Colorectal cancer (CRC) who is initially diagnosed with single or multiple synchronous distant metastases has an incidence of about 20% of all CRC patients. There is a controversy regarding the role of resection of the primary tumors in those patients. The aim of this study was to explore the prognostic roles and survival advantages of surgical excision of the primary colonic tumor in patients with CRC who are primarily diagnosed with distant metastases. Patients and Methods: We included forty patients who were diagnosed initially with stage IV CRC. We have divided the included patients into two categories the first one included 20 patients that underwent surgical excision of the primary cancer followed by administration of chemotherapy and the remaining 20 patients were initially given chemotherapy without excision of the cancer. We followed patients for 24 months to detect progression, response to chemotherapy, recurrence free survival and overall survival rates. Results: There is statistically significant difference between patients underwent different initial management techniques regarding N stage of the tumor (p = 0.039), response to chemotherapy (p = 0.048), occurrence of relapse (p = 0.022), disease free survival (DFS) (p = 0.027) or overall survival (OS) rates (p = 0.001) (DFS and OS were significantly higher among patients who received initial surgical management. Primary surgical removal of the tumor improved OS rate by 8 months (p = 0.001). Conclusion: Surgical removal of the primary malignancy in mCRC patients before chemotherapy administration improves patients’ survival rates and response to chemotherapy that lead to a better prognosis.

Fas-670 A/G polymorphism predicts prognosis of hepatocellular carcinoma after curative resection in Chinese Han population

Background:Apoptosis,also called programmed cell death,is a genetically controlled process against hyperproliferation and malignancy.The Fas-Fas ligand(FasL)system is considered a major pathway for apoptosis in cells and tissues.Thus,this study aimed to investigate whether single nucleotide polymor-phisms(SNPs)in Fas and FasL gene may have effects on the recurrence and survival of patients with hepatocellular carcinoma(HCC)after curative hepatectomy.Methods:We investigated the relationship between Fas rs1800682,rs2234767 and FasL rs763110 poly-morphisms and recurrence-free survival(RFS)as well as overall survival(OS)in 117 Chinese Han patients with HCC who underwent hepatectomy.Results:In Kaplan-Meier survival analysis,only Fas rs1800682(-670 A/G)was associated with RFS and OS.Compared with AA genotype,the AG/GG genotype was significantly associated with better RFS(P=0.008)and OS(P=0.020).Moreover,multivariate Cox regression analysis showed that Fas rs1800682 remained as a significant independent predictor of RFS for HCC patients with hepatectomy[AG/GG vs.AA:adjusted hazard ratio=0.464,95%confidence interval:0.275-0.782,P=0.004],but was not an independent predictor of OS(P=0.395).Conclusions:This study demonstrated that Fas-670 G allele may play a protective role in the recurrence and survival of HCC patients with hepatectomy.Furthermore,Fas rs1800682 polymorphism might be a promising biomarker for HCC patients after hepatectomy.

Metabolic imaging for guidance of curative treatment of isolated pelvic implantation metastasis after resection of spontaneously ruptured hepatocellular carcinoma: A case report

Spontaneous rupture of hepatocellular carcinoma(HCC) is a life-threatening complication and its prognosis is significantly poor because of the high recurrence rate after initial hepatectomy. Resection of isolated extrahepatic metastasis of HCC has been advocated to obtain a possibility of long-term survival. However, it is a challenge for clinicians to detect implantation metastasis of spontaneously ruptured HCC. Accurate re-staging plays the most important role in making a decision on isolated metastasis resection. 18F-fluorodeoxyglucose(18F-FDG) positron emission tomography/computed tomography(PET/CT) is useful in detecting intraabdominal implantation metastasis from a variety of malignancies and shows superior accuracy to conventional imaging modalities in determining the location of metastasis. We present one patient with a new isolated pelvic implantation metastasis detected by 18F-FDG PET/CT and pathologically confirmed by PET/CT-guided percutaneous biopsy, who had a history of resection of spontaneously ruptured HCC two years ago. The patient's condition was stable at the 6-mo follow-up after resection of the isolated pelvic metastasis.

Comparative Analysis on the Curative Effect of Endoscopic Submucosal Dissection and Mucosal Resection in the Treatment of Gastric Neuroendocrine Tumor

Objective:To study the therapeutic effect of endoscopic submucosal dissection and mucosal resection on gastric neuroendocrine tumor.Methods:A hundred patients with gastric neuroendocrine tumor that were treated in the Affiliated Hospital of Chifeng University from January 2016 to May 2021 were randomly selected for this research.They were divided into two groups,which were the control group(endoscopic mucosal resection)and the study group(endoscopic submucosal dissection),by the digital table method.The curative effects of the two groups were observed and compared.Results:Before operation,there were no significant differences in serum CgA,TNF-α,and IL-6 between the two groups,p>0.05.After surgical treatment,the operation time and hospital stay of the patients in the study group were shorter than those in the control group,the amount of surgical bleeding was also less compared to the control group,and the complete tumor resection rate was higher than that in the control group(p<0.05);the levels of IL-6 and CgA of the study group were lower than those in the control group,while the levels of TNF-α were higher than those of the control group,p<0.05;the postoperative complication rate of the study group was lower than that of the reference group(p<0.05).Conclusion:Endoscopic submucosal dissection is more effective for gastric neuroendocrine tumors.The resection rate of the tumor is high,and the operation risk is low.

Outcome of curative resection for perihilar cholangiocarcinoma in Northeast Thailand

AIM: To examine survival outcomes of perihilar cholangiocarcinoma(PCCA) resection including mortality, morbidity and prognostic factors. METHODS: Multivariate analyses were carried out based on the survival data of all patients with histologically confirmed PCCA who underwent curative resection at Srinagarind Hospital from January 2006 to December 2011. RESULTS: There were 29(19%) cases of intrahepatic CCA that involved hilar and 124(81%) with hilar bileduct cancer. R0 resection was carried out on 66(43.1%) patients of whom 50(32.7%) also had lymph node metastasis. The other patients underwent R1 resection. The overall 5-year survival rate was 20.6%(95%CI: 13.8-28.4) and median survival time was 19.9 mo. Postoperative mortality was 2%, and 30% of patients had complications. Patients without lymph node metastasis were 60% less likely to die than those with metastasis. Achieving R0 led to a 58% reduction in the chance of mortality as compared to R1. CONCLUSION: To achieve a better survival outcome, focus should center on performing radical surgery and detection of patients with early stage cancer.

Rare long-term survivors of pancreatic adenocarcinoma without curative resection

Long-term outcome data in pancreatic adenocarcinoma are predominantly based on surgical series, as resection is currently considered essential for longterm survival. In contrast, five-year survival in nonresected patients has rarely been reported. In this report, we examined the incidence and natural history of ≥ 5-year survivors with non-resected pancreatic adenocarcinoma. All patients with pancreatic adenocarcinoma who received oncologic therapy alone without surgery at our institution between 1995 and 2009 were identified. Non-resected ≥ 5-year survivors represented 2%(11/544) of all non-resected patients undergoing treatment for pancreatic adenocarcinoma, and 11%(11/98) of ≥ 5-year survivors. Nine patients had localized tumor and 2 metastatic disease at initial diagnosis. Disease progression occurred in 6 patients, and the local tumor bed was the most common site of progression. Six patients suffered from significant morbidities including recurrent cholangitis, second malignancy, malnutrition and bowel perforation. A rare subset of patients with pancreatic cancer achieve longterm survival without resection. Despite prolonged survival, morbidities unrelated to the primary cancer were frequently encountered and a close follow-up is warranted in these patients. Factors such as tumor biology and host immunity may play a key role in disease progression and survival.

Laparoscopic liver resection utilizing the ventral avascular area of the inferior vena cava:A retrospective cohort study

BACKGROUND Laparoscopic liver resection(LLR)can be challenging due to the difficulty of establishing a retrohepatic tunnel under laparoscopy.Dissecting the third hepatic hilum before parenchymal transection often leads to significant liver mobilization,tumor compression,and bleeding from the short hepatic veins(SHVs).This study introduces a novel technique utilizing the ventral avascular area of the inferior vena cava(IVC),allowing SHVs to be addressed after parenchymal transection,thereby reducing surgical complexity and improving outcomes in in situ LLR.AIM To introduce and evaluate a novel LLR technique using the ventral avascular area of the IVC and compare its short-term outcomes with conventional methods.METHODS The clinical cohort data of patients with pathologically confirmed hepatocellular carcinoma or intrahepatic cholangiocarcinoma who underwent conventional LLR and novel LLR between July 2021 and July 2023 at the First Affiliated Hospital of Chongqing Medical University were retrospectively analyzed.In novel LLR,we initially separated the caudate lobe from the IVC using dissecting forceps along the ventral avascular area of the IVC.Then,we transected the parenchyma of the left and right caudate lobes from the caudal side to the cephalic side using the avascular area as a marker.Subsequently,we addressed the SHVs and finally dissected the root of the right hepatic vein or left hepatic vein.The short-term postoperative outcomes and oncological results of the two approaches were evaluated and compared.RESULTS A total of 256 patients were included,with 150(58.59%)undergoing conventional LLR and 106(41.41%)undergoing novel LLR.The novel technique resulted in significantly larger tumor resections(6.47±2.96 cm vs 4.01±2.33 cm,P<0.001),shorter operative times(199.57±60.37 minutes vs 262.33±83.90 minutes,P<0.001),less intraoperative blood loss(206.92±37.09 mL vs 363.34±131.27 mL,P<0.001),and greater resection volume(345.11±31.40 mL vs 264.38±31.98 mL,P<0.001)compared to conventional LLR.CONCLUSION This novel technique enhances liver resection outcomes by reducing intraoperative complications such as bleeding and tumor compression.It facilitates a safer,in situ removal of complex liver tumors,even in challenging anatomical locations.Compared to conventional methods,this technique offers significant advantages,including reduced operative time,blood loss,and improved overall surgical efficiency.

Efficacy-cost analysis of endoscopic mucosal resection and cold snare polypectomy:A propensity score matching analysis

BACKGROUND Although substantial evidence supports the advantages of cold snare polypectomy(CSP)in terms of polypectomy efficacy and reduced postoperative adverse events,few studies have examined the cost differences between CSP and traditional endoscopic mucosal resection(EMR)for the treatment of intestinal polyps.AIM To compare the efficacy-cost of EMR and CSP in the treatment of intestinal polyps.METHODS A total of 100 patients with intestinal polyps were included in the retrospective data of our hospital from April 2022 to May 2023.According to the treatment methods,they were divided into EMR(n=46)group and CSP(n=54)group.The baseline data of the two groups were balanced by 1:1 propensity score matching(PSM),and the cost-effectiveness analysis was performed on the two groups after matching.The recurrence rate of the two groups of patients was followed up for 1 year,and they were divided into recurrence group and non-recurrence group according to whether they recurred.Multivariate logistic regression analysis was used to screen out the influencing factors affecting the recurrence of intestinal polyps after endoscopic resection.RESULTS Significant disparities were observed in the number of polyps and smoking background between the two groups before PSM(P<0.05).Following PSM,the number of polyps and smoking history were well balanced between the EMR and CSP groups.The direct cost incurred by the CSP group was markedly higher than that incurred by the EMR group.Concurrently,the cost-effectiveness ratio in the CSP group was substantially reduced when juxtaposed with that in the EMR group(P<0.05).Upon completion of the 1-year follow-up,the rate of recurrence after endoscopic intestinal polypectomy was 38.00%.Multivariate methods revealed that age≥60 years,male sex,number of polyps≥3,and pathological type of adenoma were risk factors for recurrence after endoscopic intestinal polypectomy(all P<0.05).CONCLUSION CSP was more cost-effective for the treatment of intestinal polyps.An age≥60 years,male sex,having a number of polyps≥3,and pathological type of adenoma are independent influencing factors for recurrence.

Harnessing the prognostic power of preoperative systemic immuneinflammation index/albumin ratio in hepatocellular carcinoma resection

The recent study by Chen et al,published in the World Journal of Gastroenterology,introduces a groundbreaking assessment tool-the preoperative systemic immuneinflammation index/albumin(SII/ALB)ratio-for patients with hepatocellular carcinoma(HCC)undergoing curative resection.This study not only establishes the independent prognostic significance of the SII/ALB ratio but also incorporates it into a predictive nomogram,enhancing its utility for clinical decision-making.The SII/ALB ratio,by integrating inflammatory and nutritional biomarkers,offers a novel lens through which the prognosis of HCC patients can be viewed,suggesting a more tailored approach to patient management.The development of the nomogram,validated for its accuracy in predicting patient outcomes,marks a pivotal advance,potentially guiding surgical decisions and postoperative care.However,the study's focus on a single-center cohort prompts the need for validation in a broader,more diverse patient population to ensure its applicability across various clinical settings.Moreover,longitudinal studies could elucidate the dynamic changes in SII/ALB post-surgery,offering insights into its potential as a continuous monitor for recurrence and long-term survival.This abstract aim to underscore the critical findings of Chen et al's study while calling for further research to explore the full potential of the SII/ALB ratio in the global management of hepatocellular carcinoma.