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( Liang Lei ),( Xin-fei Xu ),( Jiong-jie Yu ),( Ju-dong Li ),( Zhen-li Li ),( Jun Han ),( Han Zhang ),( Hao Xing ),( Han Wu ),( Ming-da Wang ),( Chao Li ),( Zheng Wang ),( Feng Shen ),( Meng-chao Wu ) 대한간학회 2018 춘·추계 학술대회 (KASL) Vol.2018 No.1
Aims: The prognosis of hepatocellular carcinoma (HCC) with portal vein tumor thrombus (PVTT) is very poor. According to the BCLC treatment recommendations, sorafenib or other palliative treatment (PT) is recommended as the first-line therapy when it happens. In real world, however, a significant number of selected patients with HCC and PVTT suffered from surgical resection (SR). Methods: PubMed, Embase, Medline and Cochrane library were searched for studies comparing SR with PT (including TACE, sorafenib, etc.) for HCC with PVTT, which were published before September 2017. Results: 4,810 patients from 7 studies were enrolled in this meta-analysis, which divided into the SR group (n = 2,344) and the PT group (n = 2476). When compared with the PT group, the pooled hazard ratio (HR) for the 1, 3 and 5-year OS rates of the SR group were 0.56 (95% CI 0.52-0.60, P=0.03), 0.56 (95% CI 0.53-0.59, P<0.001) and 0.55 (95% CI 0.54-0.57, P<0.001). For subgroup analysis, when compared with the mere TACE group, the pooled HR for the 1, 3 and 5-year OS rates of the SR group were 0.54 (95% CI 0.43-0.67, P=0.81), 0.75 (95% CI 0.65-0.87, P=0.25) and 0.76 (95% CI 0.67-0.88, P=0.25). Conclusions: This meta-analysis demonstrated SR had better OS than TACE or other palliative therapy for HCC with PVTT. SR may be suitable as the first-line treatment for selected patients with resectable HCC and removable PVTT.
( Li-yang Sun ),( Jiong-jie Yu ),( Ju-dong Li ),( Xin-fei Xu ),( Jia-he Wang ),( Bing Quan ),( Wen-tao Yan ),( Feng Shen ),( Chao Li ),( Lei Liang ),( Tian Yang ) 대한간학회 2018 춘·추계 학술대회 (KASL) Vol.2018 No.1
Aims: Surgical site infection (SSI) is a common postoperative complication and associated with an increased morbidity, hospital stay, and overall cost. The aim of the present study was to identify risk factors for SSIs after hepatic resection based on a large single-center cohort. Methods: A retrospective study was conducted of 6,132 patients who underwent liver resection without concomitant biliary reconstruction or gastrointestinal procedures between 2014 and 2016 at the largest hepatic center in China. The occurrences of SSI, classified as incisional SSI and organ/space SSI within 30 days after operation were investigated. Patient- and surgical-related risk variables were collected using standardized data collection form. A likelihood ratio forward regression model was used to assess the independent association of risk factors with SSI. Results: SSI developed in 587 patients (9.6%), including superficial/deep incisional SSI in 357 patients (5.8 %), and organ/ space SSI in 304 patients (5.0 %). Multivariate logistic regression analysis showed that obesity, diabetes mellitus, ASA score ≥ 2, liver cirrhosis, re-hepatectomy, hepatoliathiasis, and intraoperative blood transfusion were independent risk factors of overall SSI. However, incisional and organ/space SSI differed from each other with respect to risk factors. Among a variety of risk factors, hepatolithiasis, liver cirrhosis, and intraoperative blood transfusion were consistently associated with both incisional and organ/space SSI. Conclusions: SSI is a common complication after liver resection, and more caution should be taken in patients with hepatolithiasis or liver cirrhosis. Prevention strategies focusing on factors associated with SSI is necessary in order to reduce SSI after liver resection.
( Ju-dong Li ),( Xin-fei Xu ),( Jiong-jie Yu ),( Zhen-li Li ),( Hao Xing ),( Han Wu ),( Han Zhang ),( Chao Li ),( Ming-da Wang ),( Meng-chao Wu ),( Wan-yee Lau ),( Tian Yang ) 대한간학회 2018 춘·추계 학술대회 (KASL) Vol.2018 No.1
Aims: A family history of liver cancer is regarded as a risk factor for hepatocellular carcinoma (HCC) development. We investigated the association between family history and cancer recurrence and survival in patients with hepatitis B virus (HBV)- related HCC. Methods: Patients who underwent curative resection of HBV-related HCC between 2003 and 2013 from a tertiary hepatobiliary center in China were enrolled in this study. A family history was defined as a self-reported history of primary liver cancer in the first-degree relatives. Propensity score matching (PSM) and multivariable Cox-regression analyses were performed to compare the overall survival (OS) and recurrence-free survival (RFS) between patients with and without a family history of liver cancer. Results: Of 1,112 patients, 183 patients (16.5%) had a family history of liver cancer. A family history was not associated with OS and RFS (P=0.994 and 0.428) in the entire cohort. Using PSM, 179 pairs of patients with and without a family history but with comparable baseline characteristics and operative variables were created. A family history was associated with decreased OS and RFS (P=0.042 and 0.006) in the PSM cohort. On multivariable Cox-regression analyses, a family history was significantly associated with decreased OS (HR: 1.574, 95% CI: 1.171-2.116, P=0.003) and RFS (HR: 1.534, 95% CI: 1.176-2.002, P=0.002) after adjusting for other prognostic factors. Conclusions: A family history of liver cancer was associated with decreased OS and RFS rates after curative resection in patients with HBV-related HCC.