Transplantation versus hepatectomy for hepatocellular carcinoma less than 2cm

Xu-Guang Hu,Hee-Jung Wang,Bong-Wan Kim,In-Gyu Kim 한국간담췌외과학회 2016 한국간담췌외과학회 학술대회지 Vol.2016 No.4

Novel Classification for Right Posterior Portal Vein (RPPV) Evaluated by SYNAPSE VINCENT

( Xu-guang Hu ),( Ingyu Kim ),( Sung Yeon Hong ),( Xue-yin Shen ),( Mina Kim ),( Bong-wan Kim ),( Hee-jung Wang ) 대한간학회 2018 춘·추계 학술대회 (KASL) Vol.2018 No.1

Aims: There was no consensus on right posterior section (RPS) graft was a routine option for adult living donor liver transplantation (LDLT). The main reason for it was that the vascular pedicles of the RPS graft which was the second order branches were complicated. And there was no deep and detailed description of the patterns of the 2^nd, 3^rd portal branch in RPS. The present study is an attempt to describe the patterns of the 2^nd, 3^rd portal branch in RPPV. Methods: Between November 2008 and January 2017, a total of 106 preoperative liver multidetector-row computed tomography (MDCT) images were obtained from the donor and the 3D images were reconstructed by SYNAPSE VINCENT medical imaging system. The patterns of the 2^nd, 3^rd portal branch of the RPPV were investigated using SYNAPSE VINCENT medical imaging system. Results: We classified the RPPV into four types. Type A: the RPPV have a common trunk (more than 5mm) with two main 3^rd order branch (36 cases, 34%); Type B: there was no common trunk with two main 2^nd order branch (16 cases, 15%); Type C: there was one major common trunk with multiple 3^rd order branch (48 cases, 45.3%); Type D: the right posterior section have sliding branches to/from anterior portal vein (6 cases, 5.7%). The median length of the type A portal trunk was 12.35mm (range 5.0mm-28.7mm). In the present study, there were 16 cases of right posterior sector (RPS) graft which were selected by volumetry-Based criteria. There was only one RPS graft has multiple portal veins opening. Conclusions: The Couinaud segment was not always supplied with one inflow portal pedicle. In the present study, there were 52 cases (Type A and B, 49%) which one segment has only one inflow portal pedicle. Others, 54 cases which one segment have two or more 3rd inflow portal pedicle. RPPV type C and D could not apply with anatomic segmentectomy, only the systematic resection is possible.

Segmentectomy 8 for Hepatocellular Carcinoma Applied with Synapse Vincent 3D for Preoperative Evaluation

( Xu-guang Hu ),( Hee-jung Wang ),( Bong-wan Kim ),( Sung-yeon Hong ),( Xue-yin Shen ) 대한간학회 2018 춘·추계 학술대회 (KASL) Vol.2018 No.1

Aims: The Glission pedicle of anterior section is complexity and there was no detailed description on patterns of the 3rd order of Glission branch. This presentation is attempt to describe the patterns of the 3rd order of Glission branch in right anterior sectionwith SYNAPSE VINCENT 3D and present two video clip of segmentectomy 8 which applied with SYNAPSE VINCENT 3D for preoperative evaluation. Methods: A total of 106 preoperative multi detector-row computed tomography (MDCT) images were obtained from the donors of adult living donor liver transplantation and the 3D images were reconstructed by SYNAPSE VINCENT medical imaging system. The patterns of the 3rd order of Glission branch in right anterior section were investigated using SYNAPSE VINCENT medical imaging system. Results: After analysis the patterns of the 3rd order of anterior Glission pedicle, we classified the right anterior Glission pedicle into four types. Type A: cranial-caudal type (49 cases, 46.2%); Type B: ventral-dorsal type (14 cases, 13.2%); Type C: Radial type (37 cases, 34.9%); Type D: The right anterior Glission pedicles have sliding branch to/from posterior branch (6 cases, 5.7%). Two video clip of segmentectomy 8 will be shown. The dye injection and Glissionian technique were applied seperatively and the procedure were evaluate by preoperative SYNAPSE VINCENT 3D. Conclusions: The detailed description of the 3rd branch of anterior Glission pedicle enriched our understanding of Couinaud segmental anatomy. Preoperative SYNAPSE VINCENT 3D is helpful for anatomic evaluation of liver resection especially segmentectomy.

Transplantation versus Hepatectomy for Hepatocellular Carcinoma 2 cm or Less Than 2 츠

( Xu-guang Hu ),( Hee-jung Wang ),( Bong-wan Kim ),( Mao Wei ),( Sung Yeon Hong ) 대한간학회 2016 춘·추계 학술대회 (KASL) Vol.2016 No.1

Methods: From January 2005 to December 2013, 619 consecutive HCC patients underwent surgical treatment at our hospital. 119 (19.2%) patients, whose diameter of tumor was 2 cm or less than 2 cm, were included and they were divided into two groups by treatment procedure. One group is hepatectomy group (n=79), the other is transplantation group (n=40). The data were retrospective reviewed in this study. Results: The median follow-up period was 40 months. Totally, 30 cases experienced tumor recurrence in the follow-up period, 29 of them came from hepatectomy group, while only one case was from transplantation group. Figure 1 show us the treatment methods for recurrent cases after initial hepatectomy. The 1, 3 and 5-year recurrence free survival rates of hepatectomy group were 85.8%, 69.5% and 51.7%, and those of transplantation group were 97.2%, 97.2% and 97.2%, respectively. (P=0.0001) The 1, 3, and 5-year survival rates of hepatectomy group were 97.5%, 93.4% and 90.8%, and those of transplantation group were 90.0%, 87.3%, and 87.3%, respectively. (p=0.819) Conclusions: Our results show that transplantation could be a radical treatment for 2 cm or less than 2cm HCC.

Surgical treatment for hepatocellular carcinoma with bile duct invasion

Xu-guang Hu,Wei Mao,Sung Yeon Hong,Bong-Wan Kim,Wei-guang Xu,Hee-Jung Wang 대한외과학회 2016 Annals of Surgical Treatment and Research(ASRT) Vol.90 No.3

Purpose: There is still some debate on surgical procedures for hepatocellular carcinoma (HCC) patients with bile duct tumor thrombi (BDTT, Ueda type 3 or 4). What is adequate extent of liver resection for curative treatment? Is extrahepatic bile duct resection mandatory for cure? The aim of this study is to answer these questions. Methods: Between February 1994 and December 2012, 877 consecutive HCC patients underwent hepatic resection at Ajou University Hospital. Thirty HCC patients (3.4%) with BDTT (Ueda type 3 or 4) were retrospective reviewed in this study. Results: In total, 20 patients enrolled in this study were divided into 2 groups: patients who underwent hemihepatectomy with extrahepatic bile duct resection (group 1, n = 10) and with only removal of BDTT (group 2, n = 10). The 1-, 3- and 5-year overall survival rates were 75.0%, 50.0%, and 27.8%, respectively. The 1-, 3-, and 5-year survival rates of group 1 were 100.0%, 80.0%, and 45.7%, and those of group 2 were 50.0%, 20.0%, and 10.0%, respectively (P = 0.014). The 1-, 3-, and 5-year recurrences free survival rates of group 1 were 90.0%, 70.0%, and 42.0%, and those of group 2 were 36.0%, 36.0%, and 0%, respectively (P = 0.014). Thrombectomy and infiltrative growth type (Ig) were found as independent prognostic factors for recurrence free survival by multivariate analysis. Thrombectomy, Ig, and high indocyanine green retention rate at 15 minutes were found as independent prognostic factors for overall survival by multivariate analysis. Conclusion: We suggest that the appropriate surgical procedure for icteric HCC patients should be comprised of ipsilateral hemihepatectomy with caudate lobectomy and extrahepatic bile duct resection.

18F-fluorodeoxyglucose PET/CT as an independent predictor for patients with hepatocellular carcinoma combined with major portal vein tumor thrombus

Xu-Guang Hu,Xue-Yin Shen,Jin-Niang Nan,In-Gyu Kim,Joon-Kee Yoon,Sung-Yeon Hong,Mi-Na Kim,Bong-Wan Kim,Hee-Jung Wang 대한외과학회 2020 Annals of Surgical Treatment and Research(ASRT) Vol.99 No.1

Purpose: Hepatocellular carcinoma (HCC) patients with major portal vein tumor thrombosis (mPVTT) complications were generally characterized by extremely poor prognoses. The aim of this study was to explore the role of 18F-fluorodeoxyglucose (18F-FDG) PET/CT imaging in predicting HCC complicated by mPVTT. Methods: Five hundred one HCC patients received surgery in our hospital during November 2008 to December 2014, among which 32 patients (6.4%) were diagnosed as HCC complicated by mPVTT. Six cases were excluded for reasons of complex medical conditions, including 2 cases of salvage liver transplantation, 2 cases of re-resection, 1 case of mPVTT combined with inferior vina cava tumor thrombosis, and 1 case of residual portal vein tumor thrombosis. Ultimately, 26 cases were enrolled in this study. The maximal tumor standardized uptake value (SUVmax) was identified as a predictive factor and detected. The univariate and multivariate regression analyses were performed to identify the prognostic factors for recurrence-free survival (RFS) and overall survival (OS) of HCC patients complicated by mPVTT. Results: Our results showed that the median OS was 16 months. The 1-, 3-, and 5-year cumulative OS was 55.6%, 31.7%, and 31.7%, respectively. The multivariate regression analysis revealed that SUVmax ≥ 4.65 was the only independent risk factor for RFS and OS. Conclusion: SUVmax was an independent predictor for RFS and OS of patients suffering from both HCC and mPVTT. L ow SUVmax could serve as an effective factor for selecting candidates with low recurrence risks and for helping with improving patient survival after surgical resection.

Transplantation versus Hepatectomy for Hepatocellular Carcinoma Less than 2 cm: The Experience of Ajou University Hospital

( Xu-guang Hu ),( Ingyu Kim ),( Sung Yeon Hong ),( Mao Wei ),( Bong-wan Kim ),( Hee-jung Wang ) 대한간학회 2016 춘·추계 학술대회 (KASL) Vol.2016 No.1

Aims: Surgical resection has been the treatment of choice for hepatocellular carcinoma (HCC), and the overall survival was satisfied. However, the recurrence is a significant problem. The shortage of organ donors has led to a restricted indication for orthotropic liver transplantation for HCC. The aim of this study was to analyze the results of surgical treatment for HCC (≤2cm). Methods: From January 2005 to December 2013, 619 consecutive HCC patients underwent surgical treatment at our institution. 119 (20.8%) HCC patients who the diameter of tumor was less than 2 cm were retrospective. We excluded one case of incidental HCC and 4 cases hospital motality patients who were received liver transplantation. Finally, 114 HCC patients were enrolled in this study and they were divided into two groups by treatment procedure. One group is hepatectomy group (n=79), the other is transplantation group (n=35). Results: The median follow-up period was 40.5 months. Totally, 30 cases were experience tumor recurrence in the follow-up period, 29 of them were come from hepatectomy group, while only one case was from transplantation group. Figure 1 shows us the Treatment modalities for recurrent cases after initial hepatectomy. The 1, 3 and 5-year recurrence free survival rates of hepatectomy group were 85.8%, 68.3% and 50.9%, and those of transplantation group were 97.1%, 97.1% and 97.1%, respectively. (P=0.000) The 1, 3, and 5-year survival rates of hepatectomy group were 97.5%, 93.4% and 90.8%, and those of transplantation group were 100%, 96.9%, and 96.9%, respectively. (p=0.819) The cutoff value (38.5u/L) of serum ALT was detected by ROC cure (Area under the cure=0.709, P value=0.002) . We divided the hepatectomy group into two sub group: normal and elevated ALT group according the cutoff value. Elevated ALT group have worse disease free survival (P=0.005) and overall survival (p=0.225)(Firgure3). Figure 4 shows us that the overall survival of normal ALT group have a comparable overall survival to transplantation group, whereas the overall survival of elevated ALT group was worse than transplantation group (P=0.034).

Clinical Feature and Prognosis of Multiple Primary Malignancies in Patients with HCC Underwent Surgical Resection

( Xu-guang Hu ),( Heejung Wang ),( Bowon Kim ),( Sung-yeon Hong ),( Mina Kim ) 대한간학회 2020 춘·추계 학술대회 (KASL) Vol.2020 No.1

Aims: Multiple primary malignancies are defined as two or more different malignancies detected synchronously or metachronously in different organs of an individual patient. The aim of the present study was to investigate the clinicopathologic features for the HCC patients with multiple primary malignancies. Methods: Between May 1997 and July 2016, 1043 HCC patients had been received radical surgical treatment in our institute. Among them 58 (5.6%) cases were diagnosed with extra-hepatic primary malignancies. The clinicopathologic features including Age, Sex, HBs Ag (positive), HCV Antibody (positive), AFP(more than 400ng/ml), tumor size (more than 5cm), multiple tumor number, microvascular invasion, Edmondson grade (grade 3 and 4), cirrhosis (fibrosis stage 4), AJCC staging for HCC (Stage 1). All the data were retrospectively analyzed form the database of our institute which were prospectively collected. Results: The median follow up time is 53 months in the present study. Of the 58 (5.6%) multiple malignancies patients, 8 were diagnoses synchronously and 50 metachronously; 14 patients’ extra hepatic primary malignancies occurred prior to their HCC diagnoses, and 36 after their HCC diagnoses.The 5 years OS rate for multiple and single primary tumor were 77.8% and 66.9%, respectively (P=0.036). The multiple primary tumor patients have the following clinicopathologic features: older mean age, more patients with non-viral background liver, fewer patients with liver cirrhosis and more patients with AJCC stage I for HCC. Conclusions: The patients with multiple primary tumors have a relatively good prognosis in our institute mostly due to the factors of non-viral background liver and early tumor stage.

The SUV on 18F-FDG-PET/CT imaging as an independent predictor for overall survival and disease free survival after hepatectomy of HCC (less than 5cm)

Xu-Guang Hu,Hee-Jung Wang,Bong-Wan Kim,In-Gyu Kim 한국간담췌외과학회 2016 한국간담췌외과학회 학술대회지 Vol.2016 No.4

Ginsenoside Rh2 reduces depression in offspring of mice with maternal toxoplasma infection during pregnancy by inhibiting microglial activation via the HMGB1/TLR4/NF-kB signaling pathway

Xiang Xu,Yu-Nan Lu,Jia-Hui Cheng,Hui-Wen Lan,Jing-Mei Lu,Guang-Nan Jin,Guang-Hua Xu,Cheng-Hua Jin,Juan Ma,Hu-Nan Piao,Xuejun Jin,Lian-Xun Piao 고려인삼학회 2022 Journal of Ginseng Research Vol.46 No.1

Background: Maternal Toxoplasma gondii (T. gondii) infection during pregnancy has been associated with various mental illnesses in the offspring. Ginsenoside Rh2 (GRh2) is a major bioactive compound obtained from ginseng that has an anti-T. gondii effect and attenuates microglial activation through toll-like receptor 4 (TLR4)/nuclear factor-kappa B (NF-kB) signaling pathway. GRh2 also alleviated tumor-associated or lipopolysaccharide-induced depression. However, the effects and potential mechanisms of GRh2 on depression-like behavior in mouse offspring caused by maternal T. gondii infection during pregnancy have not been investigated. Methods: We examined GRh2 effects on the depression-like behavior in mouse offspring, caused by maternal T. gondii infection during pregnancy, by measuring depression-like behaviors and assaying parameters at the neuronal and molecular level. Results: We showed that GRh2 significantly improved behavioral measures: sucrose consumption, forced swim time and tail suspended immobility time of their offspring. These corresponded with increased tissue concentrations of 5-hydroxytryptamine and dopamine, and attenuated indoleamine 2,3-dioxygenase or enhanced tyrosine hydroxylase expression in the prefrontal cortex. GRh2 ameliorated neuronal damage in the prefrontal cortex. Molecular docking results revealed that GRh2 binds strongly to both TLR4 and high mobility group box 1 (HMGB1). Conclusion: This study demonstrated that GRh2 ameliorated the depression-like behavior in mouse offspring of maternal T. gondii infection during pregnancy by attenuating the excessive activation of microglia and neuroinflammation through the HMGB1/TLR4/NF-kB signaling pathway. It suggests that GRh2 could be considered a potential therapy in preventing and treating psychiatric disorders in the offspring mice of mothers with prenatal exposure to T. gondii infection.