2014 Vol.26(6)

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Erratum to Significance of the lymph nodes in the 7th station in rational dissection for metastasis of distal gastric cancer with different T categories
2014, 26(6): E22-E22. doi: 10.3978/j.issn.1000-9604.2014.12.07
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New ‘multi-omics’ approach and its contribution to hepatocellular carcinoma in China
Yoshinori Inagaki, Peipei Song, Norihiro Kokudo, Wei Tang
2014, 26(6): 639-640. doi: 10.3978/j.issn.1000-9604.2014.11.07
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Quantitative index calculated by 99mTc-GSA scintigraphy
Morikatsu Yoshida, Shinya Shiraishi, Noriko Tsuda, Fumi Sakamoto, Seiji Tomiguchi, Yasuyuki Yamashita
2014, 26(6): 641-643. doi: 10.3978/j.issn.1000-9604.2014.12.12
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99mTc-galactosyl human serum albumin (GSA) scintigraphy is useful to evaluate hepatic function and hepatic functional reserve. A reliable SPECT and CT integrated system is now commercially available. Using this system, we can obtain 99mTc-GSA SPECT/CT fused imaging with a small registration error. Therefore, the 99mTc-GSA scintigraphy techniques prove more useful in clinical practice than have been previously reported. In the latest Annals of Surgical Oncology on Oct 2014, the uptake index (UI) values calculated from 99mTc-GSA scintigraphy are reported to be useful for predicting the functional reserve of the future remnant liver. In this paper, we describe the usefulness of 99mTc-GSA scintigraphy as well as some cautions that are necessary as regards using the system.
Use of endoscopic ultrasound-based techniques in tumor of the guts and beyond
Chu Pei, Guangqiao Zeng
2014, 26(6): 644-646. doi: 10.3978/j.issn.1000-9604.2014.12.01
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Original Article
Comparison of three mathematical prediction models in patients with a solitary pulmonary nodule
Xuan Zhang, Hong-Hong Yan, Jun-Tao Lin, Ze-Hua Wu, Jia Liu, Xu-Wei Cao, Xue-Ning Yang
2014, 26(6): 647-652. doi: 10.3978/j.issn.1000-9604.2014.11.02
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BackgroundEffective methods for managing patients with solitary pulmonary nodules (SPNs) depend critically on the predictive probability of malignancy.MethodsBetween July 2009 and June 2011, data on gender, age, cancer history, tumor familial history, smoking status, tumor location, nodule size, spiculation, calcification, the tumor border, and the final pathological diagnosis were collected retrospectively from 154 surgical patients with an SPN measuring 3-30 mm. Each final diagnosis was compared with the probability calculated by three predicted models—the Mayo, VA, and Peking University (PU) models. The accuracy of each model was assessed using area under the receiver operating characteristics (ROC) and calibration curves.ResultsThe area under the ROC curve of the PU model [0.800; 95% confidence interval (CI): 0.708-0.891] was higher than that of the Mayo model (0.753; 95% CI: 0.650-0.857) or VA model (0.728; 95% CI: 0.623-0.833); however, this finding was not statistically significant. To varying degrees, calibration curves showed that all three models overestimated malignancy.ConclusionsThe three predicted models have similar accuracy for prediction of SPN malignancy, although the accuracy is not sufficient. For Chinese patients, the PU model may has greater predictive power.
Application of CUSA Excel ultrasonic aspiration system in resection of skull base meningiomas
Hailiang Tang, Haishi Zhang, Qing Xie, Ye Gong, Mingzhe Zheng, Daijun Wang, Hongda Zhu, Xiancheng Chen, Liangfu Zhou
2014, 26(6): 653-657. doi: 10.3978/j.issn.1000-9604.2014.12.10
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BackgroundHere, we introduced our short experience on the application of a new CUSA Excel ultrasonic aspiration system, which was provided by Integra Lifesciences corporation, in skull base meningiomas resection.MethodsTen patients with anterior, middle skull base and sphenoid ridge meningioma were operated using the CUSA Excel ultrasonic aspiration system at the Neurosurgery Department of Shanghai Huashan Hospital from August 2014 to October 2014. There were six male and four female patients, aged from 38 to 61 years old (the mean age was 48.5 years old). Five cases with tumor located at anterior skull base, three cases with tumor on middle skull base, and two cases with tumor on sphenoid ridge.ResultsAll the patents received total resection of meningiomas with the help of this new tool, and the critical brain vessels and nerves were preserved during operations. All the patients recovered well after operation.ConclusionsThis new CUSA Excel ultrasonic aspiration system has the advantage of preserving vital brain arteries and cranial nerves during skull base meningioma resection, which is very important for skull base tumor operations. This key step would ensure a well prognosis for patients. We hope the neurosurgeons would benefit from this kind of technique.
Knockdown of HMGB1 improves apoptosis and suppresses proliferation and invasion of glioma cells
Jing Zhang, Cang Liu, Ruiguang Hou
2014, 26(6): 658-668. doi: 10.3978/j.issn.1000-9604.2014.12.05
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BackgroundThe purposes of this study were to explore the effects of high mobility group protein box 1 (HMGB1) gene on the growth, proliferation, apoptosis, invasion, and metastasis of glioma cells, with an attempt to provide potential therapeutic targets for the treatment of glioma.MethodsThe expressions of HMGB1 in glioma cells (U251, U-87MG and LN-18) and one control cell line (SVG p12) were detected by real time PCR and Western blotting, respectively. Then, the effects of HMGB1 on the biological behaviors of glioma cells were detected: the expression of HMGB1 in human glioma cell lines U251 and U-87MG were suppressed using RNAi technique, then the influences of HMGB1 on the viability, cycle, apoptosis, and invasion abilities of U251 and U-87MG cells were analyzed using in a Transwell invasion chamber. Also, the effects of HMGB1 on the expressions of cyclin D1, Bax, Bcl-2, and MMP 9 were detected.ResultsAs shown by real-time PCR and Western blotting, the expression of HMGB1 significantly increased in glioma cells (U251, U-87MG, and LN-18) in comparison with the control cell line (SVG p12); the vitality, proliferation and invasive capabilities of U251 and U-87MG cells in the HMGB1 siRNA-transfected group were significantly lower than those in the blank control group and negative control (NC) siRNA group (P<0.05) but showed no significant difference between the blank control group and NC siRNA group. The percentage of apoptotic U251 and U-87MG cells was significantly higher in the HMGB1 siRNA-transfected group than in the blank control group and NC siRNA group (P<0.05) but was similar between the latter two groups. The HMGB1 siRNA-transfected group had significantly lower expression levels of Cyclin D1, Bcl-2, and MMP-9 protein in U251 and U-87MG cells and significantly higher expression of Bax protein than in the blank control group and NC siRNA group (P<0.05); the expression profiles of cyclin D1, Bax, Bcl-2, and MMP 9 showed no significant change in both blank control group and NC siRNA group.ConclusionsHMGB1 gene may promote the proliferation and migration of glioma cells and suppress its effects of apoptosis. Inhibition of the expression of HMGB1 gene can suppress the proliferation and migration of glioma cells and promote their apoptosis. Our observations provided a new target for intervention and treatment of glioma.
Expression of VEGFR2 and NRP-1 in non-small cell lung cancer and their clinical significance
Manhua Ding, Liang Liu, Chengxi Hu, Yi Liu, Yun Qiao, Xiaodong Jiang
2014, 26(6): 669-677. doi: 10.3978/j.issn.1000-9604.2014.12.04
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ObjectiveVascular-targeted therapy is gradually becoming more appealing for patients with lung cancer. It is unclear whether vascular endothelial growth factor receptor 2 (VEGFR2) and neuropilin-1 (NRP-1) can be biomarkers for clinical treatment. We aimed to investigate the expression levels of VEGFR2 and NRP-1 in human non-small cell lung cancer (NSCLC) and their clinical significance by observing patient prognosis.MethodsVEGFR2 and NRP-1 were assessed by immunohistochemistry (IHC) in 40 patients with NSCLC and in 10 patients with benign lesions of lung; kinase insert domain receptor (KDR) and NRP-1 copy number gain (CNG) was assessed by fluorescence in situ hybridization (FISH). The distributions of overall survival (OS) and progression-free survival (PFS) were estimated using the Kaplan-Meier method and compared between groups by log-rank test.ResultsRates of positive immunostaining for VEGFR2 and NRP-1 were 58% and 55%, respectively. KDR and NRP-1 CNG (+) were detected in 32.5% and 30% of tumors, respectively. Levels of both VEGFR2 and NRP-1 in lung tumors were significantly different than in the control tissue (χ2=11.22, P=0.001; χ2=9.82, P=0.001, respectively); similar results were obtained using CNGs (χ2=4.39, P=0.036; χ2=3.95, P=0.046, respectively). Statistically significant correlations were observed with histological grade, clinical TNM stage and the lymph node status (P<0.05), but not age, gender or pathology type (P>0.05). VEGFR2 showed a strong correlation with NRP-1 (Rs=0.68, P=0.00); similar results were observed with KDR and NRP-1 CNG (Rs=0.32, P=0.04). Significant differences in OS and PFS were observed between the groups with higher VEGFR2 and NRP-1 and those with lower expression (P<0.05).ConclusionsAccording to these data, VEGFR2 and NRP-1 are highly expressed in NSCLC. We can conclude that they play a key role in NSCLC occurrence, development and metastasis and are associated with patient prognosis (P<0.05 for OS and PFS). This information will be beneficial for clinical anti-angiogenic treatment in NSCLC.
Impact of jejunostomy during esophagectomy for cancer on health related quality of life
Marco Scarpa, Francesco Cavallin, Giulia Noaro, Eleonora Pinto, Rita Alfieri, Matteo Cagol, Carlo Castoro
2014, 26(6): 678-684. doi: 10.3978/j.issn.1000-9604.2014.12.16
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BackgroundThe aim of this study was to evaluate the impact of jejunostomy during esophagectomy for cancer on postoperative health-related quality of life (HRQL).MethodsWe evaluate all consecutive patients who underwent esophagectomy for cancer at the surgical oncology unit of the Veneto Institute of Oncology (IOV-IRCCS) between January 2008 and March 2014. The primary outcome was HRQL, which was assessed using nine scales of EORTC C30 and OES18 questionnaires. General linear models were estimated to evaluate mean score difference (MD) of each selected scale in patients with and without jejunostomy, adjusting for clinically relevant confounders. The secondary outcomes were morbidity, hospital stay, postoperative weight loss and postoperative albumin impairment.ResultsJejunostomy was performed in 40 on 109 patients (41.3%) who participated in quality of life investigation. A clinically and statistically significantly worse eating at admission (P=0.009) became not clinically significant at 3 months after surgery (MD =9.1). Jejunostomy was associated to clinically and statistically significantly poorer emotional function (EF) at 3 months after surgery (MD =−15.6; P=0.04). Hospital stay was longer in jejunostomy group (median, 20 vs. 17 days, P=0.02).ConclusionsIn our series patients who had a jejunostomy during esophagectomy had been selected for their risk for postoperative complication. However, their postoperative outcome was actually similar compared to those without jejunostomy. Nevertheless, jejunostomy was associated to clinically and statistically significantly poorer EF at 3 months after surgery. Therefore, patient candidate to esophagectomy and feeding jejunostomy should receive additional psychological support.
Factors contributing to lymph node occult metastasis in supraglottic laryngeal carcinoma cT2-T4 N0M0 and metastasis predictive equation
Hongzhi Ma, Meng Lian, Ling Feng, Pingdong Li, Lizhen Hou, Xiaohong Chen, Zhigang Huang, Jugao Fang
2014, 26(6): 685-691. doi: 10.3978/j.issn.1000-9604.2014.12.06
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ObjectiveTo investigate factors that contribute to lymph node metastasis (LNM) from clinical cT2-T4 N0M0 (cN0) supraglottic laryngeal carcinoma (SLC), and to predict the risk of occult metastasis before surgery.MethodsA total of 121 patients who received surgery were retrospectively analyzed. Relevant factors regarding cervical LNM were analyzed. Multivariate analyses were conducted to predict the region where the metastasis occurred and prognosis.ResultsThe overall metastatic rate of cN0 SLC was 28.1%. Metastatic rates were 15.4%, 32.5% and 35.7% for T2, T3 and T4, respectively. Metastatic rates for SLC levels II, III and IV were 19.6%, 17.2% and 3.6%, respectively. A regression equation was formulated to predict the probability of metastasis in cN0 SLC as follows: Pn=e(–3.874+0.749T3+1.154T4+1.935P1+1.750P2)/[1+e(–3.874+0.749T3+1.154T4+1.935P1+1.750P2)]. Approximately 0.2% of patients experienced LNM with no recurrence of laryngeal cancer. Comparison of the intergroup survival curves between patients with and without LNM indicated a statistically significant difference (P=0.029).ConclusionsCervical lymph node metastatic rates tended to increase in tandem with T stage in patients with LNM in cN0 SLC, and neck dissection is advised for these patients. Moreover, cervical LNM in cN0 SLC showed a sequential pattern and may be predicted.
Efficacy of capecitabine-based combination therapy and single-agent capecitabine maintenance therapy in patients with metastatic breast cancer
Huimin Lv, Min Yan, Mengwei Zhang, Limin Niu, Huiai Zeng, Shude Cui
2014, 26(6): 692-697. doi: 10.3978/j.issn.1000-9604.2014.12.13
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ObjectiveThe purpose of this study was to observe the efficacy and toxicities of capecitabine-based chemotherapy and capecitabine monotherapy as maintenance therapy in the treatment of metastatic breast cancer (MBC).Patients and methodsA total of 98 MBC patients were treated with capecitabine combined with vinorelbine (NX).ResultsThe median number of treatment was 6 cycles (1-7 cycles). There were two cases of complete remission (CR), 58 partial remission, 27 stable disease (SD), 11 progression disease. The overall response rate (ORR) (CR + PR) was 61.2%. The clinical benefit rate (CBR) was 75.5%. Fifty of effective patients received with capecitabine monotherapy as maintenance therapy. The ORR (CR + PR) was 4%. The CBR was 48%. The median progression-free survival (PFS) was 12 months. In maintenance therapy or not, the median post metastasis survival rate (MSR) was 63 and 28 months, respectively. In the combination therapy group, the major grade 3/4 toxicities included hand-foot syndrome (3.1%), skin pigmentation (2.0%), diarrhoea and abdominal distension (5.1%), stomatitis (1.0%), and leukopenia (20.4%).ConclusionsCapecitabine-based combination therapy and single-agent capecitabine maintenance therapy were well tolerated and effective to MBC.
Distribution and drug resistance of pathogenic bacteria isolated from cancer hospital in 2013
Linjuan Liu, Qi Li, Qingyun Zhang, Guohong Wang, Guobin Xu, Ji Zhang
2014, 26(6): 698-704. doi: 10.3978/j.issn.1000-9604.2014.12.18
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ObjectiveTo understand distribution and drug resistance of pathogenic bacteria from a specialized cancer hospital in 2013 in order to provide a basis for rational clinical antimicrobial agents.MethodsPathogenic bacteria identification and drug sensitivity tests were performed with a VITEK 2 compact automatic identification system and data were analyzed using WHONET5.6 software.ResultsOf the 1,378 strains tested, 980 were Gram-negative bacilli, accounting for 71.1%, in which Klebsiella pneumonia, Escherichia coli and Pseudomonas aeruginosa were the dominant strains. We found 328 Gram-positive coccus, accounting for 23.8%, in which the amount of Staphylococcus aureus was the highest. We identified 46 fungi, accounting for 4.1%. According to the departmental distribution within the hospital, the surgical departments isolated the major strains, accounting for 49.7%. According to disease types, lung cancer, intestinal cancer and esophagus cancer were the top three, accounting for 20.9%, 17.3% and 14.2%, respectively. No strains were resistant to imipenem, ertapenem or vancomycin.ConclusionsPathogenic bacteria isolated from the specialized cancer hospital have different resistance rates compared to commonly used antimicrobial agents; therefore antimicrobial agents to reduce the morbidity and mortality of infections should be used.
Efficacy of third-line pemetrexed monotherapy versus pemetrexed combination with bevacizumab in patients with advanced EGFR mutation-positive lung adenocarcinoma
Cheng-Zhi Zhou, Yin-Yin Qin, Zhan-Hong Xie, Jie-Xia Zhang, Ming Ou-Yang, Shi-Yue Li, Rong-Chang Chen
2014, 26(6): 705-710. doi: 10.3978/j.issn.1000-9604.2014.12.19
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ObjectiveThe purposes of this study were to observe the effects of different treatment strategies, including third-line pemetrexed alone versus its combination with bevacizumab, in patients with advanced epidermal growth factor receptor (EGFR) mutation-positive lung adenocarcinoma, and to analyze the effects of the different medication orders of first- and second-line drugs on third-line efficacy.Patients and methodsOne hundred and sixteen cases of patients with EGFR-positive lung adenocarcinoma who had received third-line pemetrexed alone or in combination with bevacizumab between March 2010 and March 2014 at Guangzhou Institute of Respiratory Diseases, the First Affiliated Hospital of Guangzhou Medical University were analyzed retrospectively. Additionally, all the patients were treated with first-line gemcitabine and cisplatin (GP) chemotherapy and second-line EGFR tyrosine kinase inhibitor (TKI) or with first-line EGFR-TKI and second-line GP chemotherapy.ResultsThe median survival of 61 cases with third-line pemetrexed monotherapy was 36.22 months, the median survival time of 55 cases with third-line pemetrexed plus bevacizumab was 38.76 months, and there was a significant difference in survival time between the two groups (P=0.04). Subgroup analysis revealed that among the 55 cases with third-line bevacizumab plus pemetrexed treatment, the median survival of 29 patients with first-line GP and second-line EGFR-TKI was 42.80 months, while the median survival of 26 patients with first-line EGFR-TKI and second-line GP was only 34.46 months; additionally, there was a significant difference in the survival time between the two subgroups (P=0.001). Among 61 cases with third-line pemetrexed treatment, the median survival of 34 patients with first-line GP and second-line EGFR-TKI was 38.72 months, while the median survival of 27 patients with first-line EGFR-TKI and second-line GP was only 32.94 months; the survival time of the two subgroups was significantly different (P=0.001).ConclusionsRegardless of the order of the first- and second-line chemotherapy and TKI therapy, the pemetrexed plus bevacizumab regimen was superior to the pemetrexed monotherapy as the third-line therapy in patients with advanced EGFR-positive lung adenocarcinoma. However, this strategy is worth further investigation in prospective studies.
Brief Communication
Downregulation of serum miR-17 and miR-106b levels in gastric cancer and benign gastric diseases
Qinghai Zeng, Cuihong Jin, Wenhang Chen, Fang Xia, Qi Wang, Fan Fan, Juan Du, Yihang Guo, Changwei Lin, Kaiyan Yang, Jingjing Li, Xiaowei Peng, Xiaorong Li, Ke Cao
2014, 26(6): 711-716. doi: 10.3978/j.issn.1000-9604.2014.12.03
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Altered microRNA (miRNA) associated with gastric cancer (GC) development and miR-17 and miR-106b were differentially expressed in GC tissues. This study detected serum levels of miR-17 and miR-106b expression in GC, benign gastric disease (BGD) and healthy controls to assess them as tumor markers for GC. Serum samples from 40 GC, 32 BGD (10 gastric ulcer, 14 gastric polyps, and 8 gastric ulcer with polyps) and 36 healthy individuals were subjected to quantitative reverse transcription polymerase chain reaction (qRT-PCR) analysis of miR-17 and miR-106b expression. The data showed that the serum levels of miR-17 and miR-106b were significantly reduced in healthy individuals and BGD patients compared to GC patients. There was a significant association of miR-17 and miR-106b expression with age, but not with other clinicopathological features, such as gender, tumor differentiation, stage and lymphatic metastasis. Further analysis showed that, in discriminating GC patients from healthy controls, miR-17 could yield a receiver-operating characteristic (ROC) area under the curve (AUC) of 0.879 with 80.6% sensitivity and 87.5% specificity and miR-106b could yield an AUC of 0.856 with 75.0% sensitivity and 92.5% specificity. The combined AUC of miR-17 and miR-106b was 0.913 with 83.3% sensitivity and 87.5% specificity. Collectively, these data suggest that detection of serum miR-17 and miR-106b levels should be further evaluated as novel non-invasive biomarkers in early GC detection and surveillance of disease progression.
A path for diagnosis and therapy of colon cancer: a continuous quality improvement
Jacopo Giuliani, Marina Marzola
2014, 26(6): 717-723. doi: 10.3978/j.issn.1000-9604.2014.12.08
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ObjectivePrognosis of colorectal cancer strongly depends on stage at diagnosis, which can be cured in most cases at an early stage. The results were supported by different screening programmes. Few data concerning analysis of different phases of Colorectal Cancer Program were reported in literature. The aim of this study is to analyze “step by step”, from a longitudinal type, the Colorectal Cancer Program, active at our Institution, verifying compliance with standards of care.MethodsWe compared two different populations during the same period: patients referring to our Clinical Oncology Unit coming from Regional Colorectal Cancer Screening Program and the other population that was not in any Colorectal Cancer Program.ResultsConsidering patients from the Regional Colorectal Cancer Screening Program (19 patients, corresponding to 24.0% of the general case study), 3 (15.8%) were deceased and 16 (84.2%) were alive without evidence of the disease (NED). Concerning patients that are not coming from Regional Colorectal Cancer Screening Program (61 patients, corresponding to 76.0% of the general case study), 9 (14.8%) were deceased, 43 (70.5%) were NED, 8 (13.1%) were alive with metastases and 1 (1.6%) was lost during follow-up (PFU).ConclusionsOn the basis of this experience, we concluded for high-quality care for both populations. Any critical point should be carefully analyzed in order to implement quality of care.
Endoscopic ultrasonography: an advancing option with duality in both diagnosis and treatment of gastrointestinal oncology
Fenglin Chen
2014, 26(6): 724-729. doi: 10.3978/j.issn.1000-9604.2014.12.14
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Since their introduction into the clinical practices in 1980s, techniques of endoscopic ultrasonography (EUS) have been rapidly developing and are now in widespread use in gastrointestinal oncology. Evolving from the classical option, EUS today has been much innovated with addition of a variety of novel ideation which makes it a powerful tool with encouraging duality for both diagnostic and therapeutic purposes. There is a dire need for physicians in this field to understand the status quo of EUS as related to the management and detection of gastrointestinal tumors, which is globally reviewed in this paper.
Next generation sequencing, inter-tumor heterogeneity and prognosis of hepatitis B related hepatocellular carcinoma
Jean-Charles Nault
2014, 26(6): 730-731. doi: 10.3978/j.issn.1000-9604.2014.12.11
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Endobronchial ultrasound-guided transbronchial needle aspiration: unraveling myths of mass in the chest
Rui Wang, Guangqiao Zeng
2014, 26(6): 732-734. doi: 10.3978/j.issn.1000-9604.2014.12.02
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Surgical Technique
Laparoscopic left liver lobectomy for hepatocellular carcinoma in a cirrhotic patient: a video report
Giovanni Battista Levi Sandri, Giovanni Vennarecci, Roberto Santoro, Pasquale Lepiane, Marco Colasanti, Giuseppe Maria Ettorre
2014, 26(6): 735-736. doi: 10.3978/j.issn.1000-9604.2014.11.08
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We present a video case of a 51-year-old man admitted to our surgical and liver transplantation unit for hepatocellular cancer (HCC). Patient has a HCV cirrhosis with portal hypertension and esophageal varices F1. Child Pugh score was B7 and model of end staged liver disease (MELD) was 11. Body mass index (BMI) was 26.7 and ASA score was 2. No previous abdominal surgery. According with our multidisciplinary group we suggest a laparoscopic left lobectomy for the patient. Pringle manoeuvre was not performed. Operation time was 193 min and blood loss estimation was 100 cc. No transfusion was required. Post-operative course was uneventful, grade I of Clavien-Dindo Classification. Patient was discharged in day 8. In our experience laparoscopic resection in cirrhotic liver should be performed in selected patients and in an experienced team.
Meet the Professor
Professor Malcolm Mason: what could we do against cancer?
Eunice X. Xu, Yongshi Jiang
2014, 26(6): 737-739. doi: 10.3978/j.issn.1000-9604.2014.11.06
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