Fang Hq

Strategy for the surgical management of insulinomas: analysis of 52 cases.

Aim: The goal of this retrospective study was to analyze the strategy for the surgical management of insulinomas. Methods: From May 2000 to October 2006, the medical records of 52 patients with insulinomas were retrospectively studied. Results: All tumors were localized precisely by imaging techniques combined with intraoperative palpation. Forty-eight patients with benign lesions underwent surgical treatment: 41 patients open and 7 patients laparoscopic procedures. Four patients with malignant insulinomas underwent tumor resection; 3 of them underwent metastatic lesion and/or lymph node dissection. There were no discrepancies regarding operation time, blood loss, and complication rate between open enucleation and laparoscopic surgery. The mean hospital stay was 11.8 ± 3.4 days after laparoscopic surgery, shorter than the 17.0 ± 6.0 days after the open approach. Twenty-two complications occurred in 17 patients (32%) following resection. On follow-up, 86% of the patients were free from symptoms, and surgical cure was achieved in 95% of the patients with benign insulinomas. Conclusions: The choice of the surgical strategy for the treatment of pancreatic insulinomas depends on size and location of the tumor and the risk of malignancy. The optimal surgical procedure is key to prevent postoperative complications. The laparoscopic approach is safe and feasible for patients with benign tumors located in body or tail of the pancreas.

Radiofrequency ablation for liver metastasis from gastric cancer

AIMS Several studies have reported the benefit of hepatic resection for metastatic tumor from gastric cancer. However, the value of treatment with radiofrequency ablation (RFA) has not been clearly defined. METHODS Between Jan 2002 and Dec 2007, 21 patients with primary gastric cancer were diagnosed with synchronous or metachronous liver metastases. All patients were treated with RFA, and the complication, survival, and recurrence rates were assessed. RESULTS The postoperative complication rate was 5% (1/21), with no mortality. The median actuarial survival time was 14 months. The 1-yr, 2-yr, 3-yr, and 5-yr survival rates after RFA were 70%, 11%, 5%, and 3%, respectively. With a median follow-up time of 19 months, local recurrence at the RFA site was 19% (4/21). Solitary metastasis had significantly longer survival than multiple lesions after RFA (22 vs 10 months, P = 0.004). CONCLUSIONS RFA provides a minimally invasive and safe modality of treatment patients with liver metastasis from gastric cancer. Patients with solitary liver lesion were considered appropriate candidates for RFA.

Percutaneous radiofrequency ablation for liver tumors: Is it safer and more effective in low-risk areas than in high-risk areas?

Aim:  To evaluate the feasibility and safety of ultrasound‐guided radiofrequency ablation (RFA) of hepatic tumors in high‐risk areas (in caudate lobe, adjacent to the hilum, capsular surface, gallbladder or diaphragm) in comparison with those in low‐risk areas.

Advantage of sorafenib combined with radiofrequency ablation for treatment of hepatocellular carcinoma.

Background Hepatocellular carcinoma (HCC) is a leading cause of death worldwide. Among the surgical and nonsurgical treatments available, radiofrequency ablation (RFA) and sorafenib have been shown to have efficacy. There is little evidence whether combination of these therapies would have additional benefits. Methods In a mouse model of HCC, effects of sorafenib were determined by tumor size, RFA-induced necrosis area (triphenyltetrazolium chloride staining), microvascular density (MVD; 4’,6-diamidino-2-phenylindole and anti-CD31 antibody staining), and tumor perfusion (magnetic resonance imaging). Results The RFA-induced necrosis area was 80.98 ± 9.14 and 69.49 ± 7.46 mm2 in mice administered 80 and 40 mg/kg sorafenib, respectively, but only 57.29 ± 3.39 mm2 in controls. Sorafenib also reduced tumor volume and enhanced RFA-induced tumor destruction in a dose-dependent manner, and reduced both MVD and tumor perfusion. Conclusions The results of our study suggest a potential role for combining RFA with sorafenib for treatment of HCC. Sorafenib could enhance RFA efficiency, possibly through its angiogenesis suppressive effects.