Dai Hoon Han

Comparison of Anatomic and Non-anatomic Hepatic Resection for Hepatocellular Carcinoma

The aim of the present study was to compare the prognostic impact of anatomic resection (AR) versus non‐anatomic resection (NAR) on patient survival after resection of a single hepatocellular carcinoma (HCC).

Impact of Braun anastomosis on reducing delayed gastric emptying following pancreaticoduodenectomy: a prospective, randomized controlled trial

The present study investigates the clinical impact of Braun anastomosis on delayed gastric emptying (DGE) after pylorus‐preserving pancreaticoduodenectomy (PPPD).

Clinical Significance of Lactate Clearance for the Development of Early Allograft Dysfunction and Short-Term Prognosis in Deceased Donor Liver Transplantation

Purpose This retrospective study evaluated lactate clearance (LC) as a predictor of early allograft dysfunction (EAD) and short-term outcomes in patients receiving deceased donor liver transplantation. Methods We performed a retrospective analysis for 181 consecutive deceased donor liver transplantation from January 2011 to May 2016. LCs were calculated at 6, 12, 18 and 24 hours after reperfusion (LC6, LC12, LC18 and LC24). Results Of 181 transplant recipients, 44 (24.3%) developed EAD and had lower LCs than those who did not develop EAD. A receiver operating characteristic analysis showed that LC determined at 6 hours showed the highest area under curve value of 0.828 (95% confidence interval [CI]: 0.755–0.990) for predicting the development of EAD at a cutoff value of 25.8% with 76.7% sensitivity and 77.9% specificity. LC values that fell below the cutoff values were significantly associated with EAD in a multivariate analysis, with values at 6 hours having the highest adjusted odds ratio (11.891, 95% CI: 4.469–31.639). In-hospital and 6-month mortalities were higher in patients with LC values below the cutoffs compared with those above the cutoff values at each time point. Conclusions LC calculated shortly after reperfusion of an allograft is significantly discriminative for the development of EAD and is associated with short-term prognosis after deceased donor liver transplantation. Figure. No caption available. Figure. No caption available.

Patient Selection by Tumor Markers in Liver Transplantation for Advanced Hepatocellular Carcinoma

Although far advanced hepatocellular carcinoma (HCC) is generally considered a contraindication for liver transplantation (LT), biologically favorable tumors among them could show acceptable results. However, it is still unclear which tumors can be treated with LT. Data were collected on adult patients who underwent LT for HCC beyond the Milan criteria in 8 Korean LT centers between January 2000 and June 2013. Far advanced HCC was defined as HCC with the largest tumor ≥ 10 cm, 10 or more tumor nodules, or accompanying macrovascular invasion. A total of 688 patients, including 169 with far advanced HCC, were enrolled in this study. The 5‐year overall and recurrence‐free survival rates were 60.4% and 55.1%, respectively, for all patients but only 28.7% and 24.8%, respectively, for patients with far advanced HCC (P < 0.001). Both preoperative alpha‐fetoprotein (AFP) and protein induced by vitamin K absence or antagonist II (PIVKA‐II) were significant risk factors for HCC recurrence after LT. In particular, AFP + PIVKA‐II combined was a better predictor than either marker alone. Of all far advanced HCC patients with available AFP and PIVKA‐II levels, 45 (30.8%) had low AFP + PIVKA‐II (≤300) and their 5‐year overall and recurrence‐free survival rate were 47.8% and 53.4%, respectively, which were acceptable and significantly superior to those of patients with AFP (ng/mL) + PIVKA‐II (nAU/mL) > 300 (21.0% and 10.8%, respectively; P < 0.001). In conclusion, patients with favorable HCC had acceptable outcomes after LT even when their tumors were extremely advanced. AFP + PIVKA‐II gave reliable information about the tumor biology of far advanced HCC. Liver Transplantation 00 000–000 2018 AASLD.

A missing link between RON expression and oncological outcomes in resected left-sided pancreatic cancer

Alteration and activation of recepteur dorigine nantais (RON) expression is known to be associated with cancer progression and decreased survival in various types of human cancer, including pancreatic cancer. Therefore, in the present study, RON expression levels were determined in resected left-sided pancreatic cancer to evaluate the potential oncological role of RON in the clinical setting of distal pancreatic cancer. From January 2005 to December 2011, a total of 57 patients underwent radical distal pancreatectomy for left-sided pancreatic cancer. Ductal adenocarcinoma was confirmed in all patients. Among these patients, 17 patients who received preoperative neoadjuvant treatment and 7 patients without available paraffin-embedded tissue blocks were excluded from the present study. RON expression in a the pancreatic cancer cell lines ASPC-1, BxPC-3, MiaPaCa-3 and Panc-1, as well as in resected left-sided pancreatic cancer specimens was determined by Western blot analysis. RON and vascular endothelial growth factor (VEGF) overexpression in resected left-sided pancreatic cancer was also evaluated by immunohistochemistry using pre-diluted anti-RON and anti-VEGF antibodies. An association was identified between the oncological outcome and RON overexpression. Increased levels of RON expression were observed in two pancreatic cancer cell lines, AsPC-1 and BxPC-3. RON overexpression was detected in specimens from 15/33 patients (45.5%) using immunohistochemistry. No significant association was identified between RON overexpression and VEGF overexpression (25.5 vs. 87.9%; P=0.667). No significant differences in disease-free survival or disease-specific survival associated with RON overexpression were identified. Although the results of previous studies have suggested that RON is a potential target for the treatment of pancreatic cancer, in the present study no association between RON overexpression and any adverse oncological effect was identified.