Comparison of survival outcomes after anatomical resection and non-anatomical resection in patients with hepatocellular carcinoma

Seheon Kim,Seokwhan Kim,Insang Song,Kwangsik Chun 한국간담췌외과학회 2015 한국간담췌외과학회지 Vol.19 No.4

Backgrounds/Aims: Liver resection is a curative procedure performed worldwide for hepatocellular carcinoma (HCC). Deciding on the appropriate resection range for postoperative hepatic function preservation is an important surgical consideration. This study compares survival outcomes of HCC patients who underwent anatomical or non-anatomical resection, to determine which offers the best clinical survival benefit. Methods: One hundred and thirty-one patients underwent liver resection with HCC, between January 2007 and February 2015, and were divided into two groups: those who underwent anatomical liver resection (n=88) and those who underwent non-anatomical liver resection (n=43). Kaplan-Meier survival analysis and Cox regressions were used to compare the disease-free survival (DFS) and overall survival (OS) rates between the groups. Results: The mean follow-up periods were 27 and 40 months in the anatomical and non-anatomical groups, respectively (p=0.229). The 3- and 5-year DFS rates were 70% and 60% in the anatomical group and 62% and 48% in the non-anatomical group, respectively. The 3 and 5-year OS rates were 94% and 78% in the anatomical group, and 86% and 80% in the non-anatomical group, respectively. The anatomical group tended to show better outcomes, but the findings were not significant. However, a relative risk of OS between the anatomical and non-anatomical group was 0.234 (95% CI, 0.061-0.896; p=0.034), which is statistically significant. Conclusions: Although statistical significance was not detected in survival curves, anatomical resection showed better results. In this respect, anatomical resection is more likely to perform in HCC patients with preserve liver function than non-anatomical resection.

다발성 간세포암 환자에서 다발 부위 간절제 또는 고주파 치료를 병합한 간절제술 후 장기 성적

조민수(Min Soo Cho),최기홍(Gi Hong Choi),김동현(Dong Hyun Kim),강창무(Chang Moo Kang),최진섭(Jin Sub Choi),박영년(Young Nyun Park),이우정(Woo Jung Lee) 한국간담췌외과학회 2009 한국간담췌외과학회지 Vol.13 No.4

Purpose: Hepatic resection is the standard treatment for hepatocellular carcinoma (HCC). In some patients with multiple HCC, one-block resection is not feasible due to either the tumor location or the underlying liver function. In this study, we attempted to compare the outcomes of multiple - site resection or combined resection and radiofrequency ablation with those of one-block resection in patients with multiple HCC. Methods: We retrospectively reviewed 507 patients who underwent surgical resection. Among 507 patients who received surgical treatment with potentially curative aim from January 1996 to August 2006 in Yonsei University Health System, 58 patients had a radiologically detected multiple HCC. Patients with multiple HCC were divided into: group A, patients treated with one-block resection (n=40) and group B, patients with multiple-site resection or combined resection and RFA (n=18). Results: The 1-, 3- and 5-year overall survival rates for patients with single and multiple HCC were 90.2%, 76.2% and 66.7% and 82.7%, 61.4% and 37.9%, respectively (p<0.001). In group B, 6 patients received multiple-site resection and 12 patients underwent combined resection and RFA. The clinicopathological variables were not significantly different between the two groups except the distribution of multiple tumors. The postoperative complication rates for group A and B were 32.5% and 33.3%, respectively. The 1-, 3- and 5-year disease-free survival rates for group A and B were 53.0%, 27.6% and 24.1% and 18.3%, 24.1% and 18.3%, respectively (p=0.386). The overall survival rates were also not significantly different between the two group (80.0%, 59.6%, and 36.9% for group A and 88.9%, 65.7% and 39.4% for group B, p=0.528). The multivariate analysis revealed that Edmondsons-Steiner grade (III-IV) and Indocyanine green retention rate at 15 minutes (ICG R15) >10% were adverse prognostic factors for overall survival. Conclusion: Active treatments including multiple-site resection and combined resection and RFA showed similar treatment outcomes compared with one-block resection in patients with multiple HCC.

위선종과 조기위암에서 내시경 점막절제술의 연구 -완전절제율에 영향을 미치는 인자와 점막 절제술 전후의 조직학적 차이-

고강훈 ( Kang Hun Koh ),정혜진 ( Hey Jin Jung ),김상욱 ( Sang Wook Kim ) 전북대학교 의과학연구소 2007 全北醫大論文集 Vol.31 No.1

Objectives: The endoscopic mucosal resection of gastric adenomas or early gastric cancers is now widely accepted as a useful radical treatment method. We studied that the rate of successful treatment by the endoscopic mucosal resection of gastric adenomas or early gastric cancers and the factors related to the rate of the complete resection. Methods: We analysed, retrospectively, 118 lesions in 114 patients diagnosed early gastric cancer or gastric adenoma at the Chonbuk National University Hospital from January, 2005 to June, 2006. Of the 118 lesions, there were 107 adenomas and 11 early gastric cancers. We tried to follow up the lesions of resection by the endoscopic biopsy later. Results: The lesions were diagnosed 107 adenomas, 6 early gastric cancers type IIa, 5 type IIb, and the rate of complete resection was 85%(91), 84%(5), 80%(4), each. The sites of the lesions were divided antrum, angle, body, pylorus and each 60 cases, 14 cases, 42 cases, 2cases was reported. The rate of complete resection for the site was each 83%(50), 85%(12), 81%(34), 100%(2). The size of the lesions was divided ≤10 mm, 11~15 mm, 16~20 mm, 21~25 mm, 26~30 mm, ≥31 mm and each 14 cases, 21 cases, 41 cases, 6 cases, 31 cases, 5 cases were reported. The rate of complete resection for the size was each 86%, 86%, 90%, 100%, 71%, 60%. Of the 14 cases which were diagnosed as high grade dysplastic adenoma, early gastric cancer was diagnosed in 4 cases after the biopsy by endoscopic mucosal resection. Conclusion : We concluded that the site, size and the other factors of the lesions were related to the rate of complete resection after endoscopic mucosal resection, and the abnormal gastric mucosal lesions should be diagnosed with the biopsy by endoscopic mucosal resection.

조기 위암의 내시경 치료 후 불완전 절제 시의 대책

공은정,방창석 대한의사협회 2022 대한의사협회지 Vol.65 No.5

Background: Endoscopic resection is indicated for early or superficial gastrointestinal neoplasms with a negligible risk of lymph node metastasis. This procedure could preserve the organ while allowing en bloc resection of tumors, irrespective of the size and location of the lesion. Histological evaluation of the resected specimen determines whether curative resection, which implies a favorable long-term outcome, was achieved. If the resected specimen reveals non-curative, additional treatment is necessary as it is strongly associated with recurrence. Current Concepts: Surgical resection is recommended after non-curative resection of gastrointestinal neoplasms. However, rather than surgical resection, additional endoscopic treatment can be recommended if non-curative resection is solely because of the positive involvement at the horizontal resection margin without any other findings compatible with the non-curative resection criteria. Discussion and Conclusion: Adopting precise indications of endoscopic resection is important to reduce the risk of non-curative resection. If curative resection is not achieved after endoscopic resection, additional treatment should be considered to prevent local recurrence as well as lymph node metastasis.

Klatskin tumor 106예의 수술 후 생존분석

최영길,최창수,전진호,백낙환 인제대학교 백병원 2002 仁濟醫學 Vol.23 No.1S

■ Objectives Until recently resection of Klatskin tumor was uncommon, with the prognosis being notoriously poor. The authors adopted a radical surgery aimed at cure since 1988. This review summarized our experience with resections for Klatskin tumor and estimated the long-term outcome and predictive factors for survival over the past 14 years. ■ Methods and materials A retrospective analysis was undertaken in 106 patients with Klatskin tumor between 1988 and 2001. A surgical resection was performed in 76 patients; 48 patients underwent hilar resection with regional lymph-node dissection, and 28 patients had combined liver resection. The postoperative survival rates and significant prognostic factors were assessed. ■ Results A potentially curative resection was achieved in 33 patients. Curative resection rate was higher in patients with liver resection. There were two operative deachs after resection(mortality; 3%). The overall 5-year survival rate after radical resection was 27%. Eleven patients survived for more than five years. The median survival period of patients undergoing a palliative procedure was six months. The survival was superior in patients with a curative resection(p<0.05) and in those with early TNM stages(p<0.01). Depth of tumor invasion, lymph-node metastasis, perineural invasion, preoperative serum bilirubin level, and curability of surgical procedures were significant prognostic factors on multivariate analysis. ■ Conclusions Longterm survivals can be achieved by a radical resection with acceptable surgical risks. Increment of curative resection rate by an extended procedure including liver resection is mandatory for further improvement of the treatment outcomes.

간절제를 병용실시한 Klatskin 담관암 50예의 단기치료성적

이승규,이영주,박광민,전훈배,최건무,김명환,이성구,성규보,황신 大韓消化器病學會 1997 大韓消化器病學會誌 Vol.30 No.3

Cold Allodynia after C2 Root Resection in Sprague-Dawley Rats

Chung, Daeyeong,Cho, Dae-Chul,Park, Seong-Hyun,Kim, Kyoung-Tae,Sung, Joo-Kyung,Jeon, Younghoon The Korean Neurosurgical Society 2018 Journal of Korean neurosurgical society Vol.61 No.2

Objective : The purpose of this study was to evaluate pain-related behaviors after bilateral C2 root resection and change in pain patterns in the suboccipital region in rats. Methods : Male Sprague-Dawley rats were randomly assigned to three groups (n=25/group); $n{\ddot{a}}ive$, sham, and C2 resection. Three, 7, 10, and 14 days after surgery, cold allodynia was assessed using $20{\mu}L$ of 99.7% acetone. c-Fos and c-Jun were immunohistochemically stained to evaluate activation of dorsal horn gray matter in C2 segments of the spinal cord 2 hours, 1 day, 7 days, and 14 days after surgery. Results : Three days after surgery, the response to acetone in the sham group was significantly greater than in the $n{\ddot{a}}ive$ group, and this significant difference between the $n{\ddot{a}}ive$ and sham groups was maintained throughout the experimental period (p<0.05 at 3, 7, 10, and 14 days). Seven, 10, and 14 days after surgery, the C2 root resection group exhibited a significantly greater response to acetone than the $n{\ddot{a}}ive$ group (p<0.05), and both the sham and C2 resection groups exhibited significantly greater responses to acetone compared with 3 days after surgery. No significant difference in cold allodynia was observed between the sham and C2 root resection groups throughout the experimental period. Two hours after surgery, both the sham and C2 root resection groups exhibited significant increases in c-Fos- and c-Jun-positive neurons compared with the naive group (p=0.0021 and p=0.0358 for the sham group, and p=0.0135 and p=0.014 for the C2 root resection group, respectively). One day after surgery, both the sham and C2 root resection groups exhibited significant decreases in c-Fos -positive neurons compared with two hours after surgery (p=0.0169 and p=0.0123, respectively), and these significant decreases in c-Fos immunoreactivity were maintained in both the sham and C2 root resection groups 7 and 14 days after surgery. The sham and C2 root resection groups presented a tendency toward a decrease in c-Jun-positive neurons 1, 7, and 14 days after surgery, but the decrease did not reach statistical significance. Conclusion : We found no significant difference in cold allodynia and the early expression of c-Fos and c-Jun between the sham and C2 resection groups. Our results may support the routine resection of the C2 nerve root for posterior C1-2 fusion, but, further studies are needed.

Hepatic resection for isolated breast cancer liver metastasis

Jae Bong Choi,Hyung Il Seo,Sung Pil Yun,Young Lae Jung,Seok Won Lee,Young Tae Bae,Suk Kim 대한종양외과학회 2017 Korean Journal of Clinical Oncology Vol.13 No.2

Purpose: The objective of this study was to investigate the outcomes of selected patients with breast cancer liver metastases (BCLM) without extrahepatic metastases after hepatic resection. Methods: Patients whose imaging findings did not show extrahepatic disease were selected for hepatic resection. If R0 resection was available and the operative risk was low in preoperative tests, the patients underwent surgery. Results: Between 2011 and 2014, six patients underwent hepatic resection for BCLM. All patients received hepatic resection to achieve an R0 resection. The time interval between initial detection of breast cancer and that of liver metastases in the patients, excluding one patient with synchronous metastases, was 55.2 months. Major liver resection was performed in four patients. Differences were observed in the hormone receptor status between the primary breast tumor and liver metastases; however, no difference was observed in the human epidermal growth factor receptor 2 status. The 1-year and 3-year overall survival rates after hepatic resection were 100% and 83.3%, respectively. The 1-year and 3-year disease free survival rates after hepatic resection were 66.7% and 50.0%, respectively. Conclusion: Curative resection may be considered as one of the multimodality treatments for BCLM. It shows benefit in selected patients; its selection criteria needs to be investigated.

Liver resection for hepatocellular carcinoma

Ho Hyun Kim,Eun Kyu Park,Jin Shick Seoung,Young Hoe Hur,Yang Seok Koh,Jung Chul Kim,Chol Kyoon Cho,Hyun Jong Kim 대한외과학회 2011 Annals of Surgical Treatment and Research(ASRT) Vol.80 No.6

Purpose: To analyze the outcomes of laparoscopic liver resection compared with open liver resection in patients with hepatocellular carcinoma (HCC). Methods: Between July 2005 and December 2009, 26 consecutive patients with HCC underwent a pure laparoscopic liver resection, and data from this group (laparoscopic liver resection group, L-group) were compared with a retrospective control group of 29 patients who underwent open liver resection for HCC (open liver resection group, O-group) during the same period. The two groups were matched in terms of demographic data, tumor size, degree of liver cirrhosis, American Society of Anesthesiology score, type of resection, and tumor location. Results: Median operation time and the amount of intraoperative packed red blood cell transfusion in the L-group were 147.5 minutes and 0.35 units, respectively. The L-group revealed a shorter operation time (147.5 vs. 220.0 minutes, P = 0.031) than the O-group. No difference in perioperative morbidity or mortality rates was observed (3.8, 0 vs. 24.1%, 0%; P = 0.054, non-specific, respectively); the L-group was associated with a shorter hospital stay than the O-group (11.08 vs. 16.07 days, P = 0.034). After a mean follow-up of 23.9 months (range, 0.7 to 59.4 months), the 1-year disease-free survival rate was 84.6% in the L-group and 82.8% in the O-group (P = 0.673). Conclusion: Laparoscopic liver resection for HCC is feasible and safe in selected patients and can produce good surgical results with a shorter postoperative hospital stay and similar outcomes in terms of perioperative morbidity, mortality, and disease-free survival than open resection.

Hepatic resection for isolated stomach cancer liver metastases: A single-center experience

Hyunyou Kim,Hyung-Il Seo 대한종양외과학회 2019 Korean Journal of Clinical Oncology Vol.15 No.2

Purpose: The objective of this study was to investigate the outcomes of selected patients with stomach cancer liver metastasis (SCLM) without extrahepatic metastases after hepatic resection. Methods: Patients whose imaging results did not detect extrahepatic disease were selected for hepatic resection. If R0 resection was possible and if the operative risk was low in the preoperative tests, the patients underwent hepatic resection. Results: Between 2011 and 2016, seven patients underwent hepatic resection for SCLM. All patients received hepatic resection to achieve an R0 resection. Minor liver resection was performed in all patients. Two patients showed long-term survival with a single lesion and human epidermal growth factor receptor 2 (HER2)-negative tumor. The 5-year overall survival and disease-free survival rates after hepatic resection were 38.1% and 28.6%, respectively. Conclusion: Hepatic resection for isolated SCLM may be considered as a multimodality treatment. However, it has only limited benefits in select patients. It has long-term survival benefit in patients with single metastases and HER2-negative hormonal status.