• Journal of Digestive Cancer Research
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• v.5 no.1
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• pp.28-31
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• 2017

The number of laparosocpic liver resection performed every years has been increasing. There is a trend than more major hepatectomy and complex liver resection is being reported. However there has been a major obstacles in many centers because open liver resection is still considered as a gold standard and many surgeons are still getting used to the old method of liver resection. To start a new procedure, education and training is essential in order to achieve a good outcome without compromising the safety of the patients. A gradual progression is crucial in order to avoid dreadful complication. The development of the consensus meeting and difficulty score has facility the understanding of safe practice in the development of laparoscopic liver resection. In a long run, development of registry system will improve transparency and safety of this operation.

• Asian Pacific Journal of Cancer Prevention
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• v.16 no.10
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• pp.4451-4456
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• 2015

Background: The aim of our present study was to compare quality of life (QoL) between intermediate-stage (BCLC-B) HCC patients who had undergone either liver resection or transcatheter arterial chemoembolization (TACE). Materials and Methods: A total of 102 intermediate-stage HCC patients participated in our study, including 58 who had undergone liver resection and 44 who had undergone TACE. Baseline demographic characteristics, tumor characteristics, and long-term outcomes, such as tumor recurrence, were compared and analyzed. QoL was assessed using the Short Form (SF)-36 health survey questionnaire with the mental and physical component scales (SF-36 MCS and PCS). This questionnaire was filled out at HCC diagnosis and 1, 3, 6, 12, 24 months after surgery. Results: For the preoperative QoL evaluation, the 8 domains related to QoL were comparable between the two groups. The PCS and MCS scores were significantly decreased in both the TACE and resection groups at1 month after surgery, and this decrease was greater in the resection group. These scores were significantly lower in the resection group compared with the TACE group (P<0.05). However, these differences disappeared at 3 and 6 months following surgery. One year after surgery, the resection group showed much higher PCS scores than the TACE patients (P=0.018), and at 2 years after surgery, the PCS and MCS scores for the resection group were significantly higher than those for the TACE group (P<0.05). Eleven patients (19.0%) in the resection group and 17 (38.6%) in the TACE group suffered HCC recurrence (P<0.05). Univariate and multivariate analyses indicated that tumor recurrence (HR=1.211, 95%CI: 1.086-1.415, P=0.012) was a significant risk factor for poorpostoperative QoL in the HCC patients.Conclusions: Due to its effects on reducing HCC recurrence and improving long-term QoL, liver resection should be the first choice for the treatment of patients with intermediate-stage HCC.

• Journal of Digestive Cancer Research
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• v.4 no.2
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• pp.113-121
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• 2016

Background: We evaluated technique of hepatic resections using suprahilar-extrafascial dissection of Glissonean pedicle with vascular stapling device for pedicle transection with intent to minimize operative time and blood loss. Methods: We analyzed the clinical records of 326 patients who underwent anatomic liver resection by suprahilar-extrafascial pedicle isolation with vascular stapling division technique. Results: The minor liver resections were associated with significantly shorter surgery duration (105.1±21.1 vs. 225.6±75.6) and transection time (40.1±14.5 vs. 96.3±55.2) than major hepatectomies (p<0.0001 for all). The mean blood loss was 350.8±100.5 mL in minor resection and 485.4±250.2 mL in major resection (p=0.001). The mean blood transfusion requirement was 400.8±109.5 mL for minor resections and 550.9±100.0 mL for major hepatectomy (p=0.072). There was no significant difference in morbidity and mortality between groups (p=0.980; p=0.945). Major as well as minor liver resection were oncology superior with no significant difference in the 5-year overall survival rates. Conclusion: Suprahilar-extrafascial dissection of Glissonean pedicle represents an effective and safe technique of liver resection. Presented approach allows early and easy ischemic delineation of appropriate liver territory to be removed with selective inflow vascular control. It is not time consuming and it is very useful in re-resection, as well as oncological reasonable.

• Asian Pacific Journal of Cancer Prevention
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• v.16 no.4
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• pp.1665-1669
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• 2015

Background: The optimal surgical strategy for the treatment of synchronous resectable gastric cancer liver metastases remains controversial. The aims of this study were to analyze the outcome and overall survival of patients presenting with gastric cancer and liver metastases treated by simultaneous resection. Materials and Methods: Between January 1990 and June 2009, 35 patients diagnosed with synchronous hepatic metastases from gastric carcinoma received simultaneous resection of both primary gastric cancer and synchronous hepatic metastases. The clinicopathologic features and the surgical results of the 35 patients were retrospectively analyzed. Results: The 5-year overall survival rate after surgery was 14.3%. Five patients survived for more than 5 years after surgery. No mortality has occurred within 30 days after resection, although two patients (5.7%) developed complications during the peri-operative course. Univariate analysis revealed that patients with the presence of lymphovascular invasion of the primary tumor, bilateral liver metastasis and multiple liver metastases suffered poor survival. Lymphovascular invasion by the primary lesion and multiple liver metastases were significant prognostic factors that influenced survival in the multivariate analysis (p=0.02, p=0.001, respectively). Conclusions: The presence of lymphovascular invasion of the primary tumor and multiple liver metastases are significant prognostic determinants of survival. Gastric cancer patients without lymphovascular invasion and with a solitary synchronous liver metastasis may be good candidates for hepatic resection. Simultaneous resection of both primary gastric cancer and synchronous hepatic metastases may effectively prolong survival in strictly selected patients.

• Annals of Surgical Treatment and Research
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• v.95 no.5
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• pp.258-266
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• 2018

Purpose: This study analyzes the impact of laparoscopic liver resection on intra-abdominal adhesion. Methods: Patients who underwent salvage liver transplantation after liver resection for hepatocellular carcinoma from January 2012 to October 2017 at our institution were included. Information about the severity of intra-abdominal adhesions was collected from a prospectively maintained database. Intra-abdominal adhesions were graded after the agreement of 2 surgeons who participated in the salvage liver transplantation based on predetermined criteria. Adhesion severity and demographic, operative, and postoperative data were compared between the laparoscopic group and the open group. Multivariate logistic regression was performed to consider potential factors related to severe adhesion during salvage transplantation. Results: Sixty-two patients who underwent salvage liver transplantation after liver resection were included in this study. Among them, 52 patients underwent open surgery, and 10 patients underwent laparoscopy. Adhesion was significantly more severe in the open group than in the laparoscopy group (P = 0.029). A multivariate logistic regression model including potential factors related to severe adhesion showed that laparoscopy (odds ratio, 0.168; 95% confidence interval, 0.029-0.970; P = 0.048) was the only significant factor. Conclusion: Laparoscopic liver resection for hepatocellular carcinoma can minimize intra-abdominal adhesion during salvage liver transplantation.

• Journal of Digestive Cancer Reports
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• v.7 no.2
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• pp.61-64
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• 2019

We report two cases of patients with unresectable pancreatic cancer treated with neoadjuvant chemotherapy and surgical resection. In the first case, main mass was located at the neck of the pancreas, encasing superior mesenteric artery and peritoneal seeding was suspected. In the second case, main mass was located at the body of pancreas and superior mesenteric artery was encased. Both patients received FOLFIRINOX chemotherapy regimen, consisting of 5-FU, folinic acid, irinotecan and oxaliplatin. In both cases, tumor size decreased and vascular involvement regressed in response to chemotherapy. After subsequent chemoradiation therapy, both patients underwent surgical resection with negative resection margin. The pathological stages were ypT1cN0 and ypT1aN0, respectively. Both patients received postoperative adjuvant chemotherapy with 6 cycles of 5-FU/folinic acid and remained without evidence of disease for more than 6 months after the surgery.

• Korean Journal of Clinical Oncology
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• v.14 no.2
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• pp.142-145
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• 2018

Metastases to the liver can be found in various malignancies, most commonly originating from the colon, rectum, pancreas, stomach, esophagus, breast, lung, and melanoma. Surgical resection of liver metastasis is generally considered to be the definitive therapy fore cure. However, many patients are unable to undergo surgical resection due to medical comorbidities or multifocal extent of malignant disease affecting the liver. Among patients not eligible for surgery, other therapies exist for treatment in order to down stage the disease for surgical resection or for palliation. Radioembolization of hepatic metastases has shown to improve outcomes among patients with variety of malignancies including more common malignancies such as colorectal cancer. Yttrium-90 (Y-90) radioembolization has been successfully used in the management of hepatic metastases. A small series of metastatic sarcoma to the liver treated with radioembolization showed a promising response. We report a case of metastatic gastric leiomyosarcoma to the liver treated with Y-90 glass microspheres therapy using the radiation segmentectomy approach, previously described for hepatocellular carcinoma.

• Asian Pacific Journal of Cancer Prevention
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• v.14 no.12
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• pp.7101-7106
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• 2013

Background: The prognosis of patients with hepatocellular carcinoma (HCC) after curative resection varies greatly. Few studies had investigated the risk factors for early recurrence (recurrence-free time ${\leq}$ 1 year) of hepatitis B virus (HBV)-related HCCs meeting Milan criteria. Methods: A retrospective analysis was performed on the 224 patients with HCC meeting Milan criteria who underwent curative liver resection in our center between February 2007 and March 2012. The overall survival (OS) rate, recurrence-free survival (RFS) rate and risk factors for early recurrence were analyzed. Results: After a median follow-up of 33.3 months, HCC reoccurred in 105 of 224 patients and 32 died during the period. The 1-, 3- and 5-year OS rates were 97.3%, 81.6% and 75.6% respectively, and the 1-, 3- and 5-year RFS rates were 73.2%, 53.7% and 41.6%. Cox regression showed alpha-fetoprotein (AFP) > 800 ng/ml (HR 2.538, 95% CI 1.464-4.401, P=0.001), multiple tumors (HR 2.286, 95% CI 1.123-4.246, P=0.009) and microvascular invasion (HR 2.518, 95% CI 1.475-4.298, P=0.001) to be associated with early recurrence (recurrence-free time ${\leq}$ 1-year) of HCC meeting Milan criteria. Conclusions: AFP > 800 ng/ml, multiple tumors and microvascular invasion are independent risk factors affecting early postoperative recurrence of HCC. In addition resection appears capable of replacing liver transplantation in some situations with safety and a better outcome.

• Journal of Gastric Cancer
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• v.9 no.1
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• pp.14-17
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• 2009

The clinical significance of hepatic resection for gastric metastases is controversial, even though hepatic resection has been widely accepted as a modality for colorectal metastases. Very few patients with gastric hepatic metastases are good candidates for hepatic resection because of multiple bilateral metastases, extrahepatic disease, or advanced cancer progression, such as peritoneal dissemination or extensive lymph node metastases. Therefore, several authors have reported the clinical significance of hepatic resection for gastric metastases in a small number of patients. Considering the present results with previous reports. The number and distribution of tumors in hepatic metastases from gastric cancer was considered based on the present and previous reports. Several authors have reported significantly better survival in patients with metachronous metastasis than in those with synchronous disease. However, metachronous hepatic resection necessitates the dissection of adhesions between the pancreas, liver, and residual stomach to prepare for Pringle's maneuver. Patients with unilobar liver metastasis, and/or metastatic tumors <4 cm in diameter may be good candidates for hepatic resection. Synchronous metastasis is not a contraindication for hepatic resection. Most of the long-term survivors underwent anatomic hepatic resection with a sufficient resection margin. After hepatic resection, the most frequent site of recurrence was the remaining liver, which was associated with a high frequency of mortality within 2 years. A reasonable strategy for improvement in survival would be to prevent recurrence by means of adjuvant chemotherapy and careful follow-up studies.

• Journal of Gastric Cancer
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• v.24 no.2
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• pp.199-209
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• 2024

Purpose: Long-term outcomes of patients with positive lateral margins (pLMs) after endoscopic submucosal dissection (ESD) for early gastric cancer (EGC). This study aimed to evaluate the remnant cancer and survival rates of patients with pLMs compared with those who underwent curative resection. Materials and Methods: A retrospective analysis was performed on consecutive patients with pLMs as the only non-curative factor of expanded indication who underwent ESD for EGC with a follow-up duration of 5 years or more. The rates of remnant cancer, recurrence, and survival were analyzed and compared to those of control patients who underwent curative resection by propensity score matching. Results: Among 3,515 patients treated with ESD between 2005 and 2018, 123 non-curative EGCs were retrospectively analyzed. A total of 108 patients were followed up without endoscopic or surgical resection for 8.2 years. The control group was matched in a 1:1 ratio with patients with EGC who underwent curative resection after ESD. The observation group with pLMs had a higher incidence of remnant cancer (25.9%; 28/108) compared to that in the curative resection group (0/108; P=0.000). The remaining tumors were treated with surgical or endoscopic resection, and no additional recurrences were observed. The overall survival analysis demonstrated no significant difference between the observation and curative resection groups (P=0.577). Conclusions: No difference was observed in the overall survival rate between observation and curative resection groups. Therefore, observation may be a possible option for incomplete ESD with pLMs if continuous follow-up is performed.