Hong-Jin Kim

Surgical outcomes of hepatocellular carcinoma with bile duct tumor thrombus: a Korean multicenter study.

BackgroundThe long-term outcomes after resection for hepatocellular carcinoma (HCC) with macroscopic bile duct tumor thrombus (BDTT) are unclear. This multicenter study was conducted to determine the prognosis of HCC patients with macroscopic BDTT who underwent resection with curative intent.MethodsOf 4,308 patients with HCC from four Korean institutions, this single-arm retrospective study included 73 patients (1.7xa0%) who underwent resection for HCC with BDTT.ResultsJaundice was also present in 34 patients (46.6xa0%). According to Ueda classification, BDTT was type 2 in 34 cases (46.6xa0%) and type 3 in 39 cases (53.4xa0%). Biliary decompression was performed in 33 patients (45.2xa0%), decreasing the median lowest bilirubin level to 1.4xa0mg/dL before surgery. Systematic hepatectomy was performed in 69 patients (94.5xa0%), and concurrent bile duct resection was performed in 31 patients (42.5xa0%). Surgical curability types were R0 (nxa0=xa057; 78.1xa0%), R1 (nxa0=xa011; 15.1xa0%), and R2 (nxa0=xa05; 6.8xa0%). Patient survival rates were 76.5xa0% at 1xa0year, 41.4xa0% at 3xa0years, 32.0xa0% at 5xa0years, and 17.0xa0% at 10xa0years. Recurrence rates were 42.9xa0% at 1xa0year, 70.6xa0% at 3xa0years, 77.3xa0% at 5xa0years, and 81.1xa0% at 10xa0years. Results of univariate survival analysis showed that maximal tumor size, bile duct resection, and surgical curability were significant risk factors for survival, and surgical curability was a significant risk factor for recurrence. Multivariate analysis did not reveal any independent risk factors.ConclusionsHepatocellular carcinoma patients with BDTT achieved relatively favorable long-term results after resection; therefore extensive surgery should be recommended when complete resection is anticipated.

Determination of Malignant and Invasive Predictors in Branch Duct Type Intraductal Papillary Mucinous Neoplasms of the Pancreas: A Suggested Scoring Formula

Prediction of malignancy or invasiveness of branch duct type intraductal papillary mucinous neoplasm (Br-IPMN) is difficult, and proper treatment strategy has not been well established. The authors investigated the characteristics of Br-IPMN and explored its malignancy or invasiveness predicting factors to suggest a scoring formula for predicting pathologic results. From 1994 to 2008, 237 patients who were diagnosed as Br-IPMN at 11 tertiary referral centers in Korea were retrospectively reviewed. The patients mean age was 63.1 ± 9.2 yr. One hundred ninty-eight (83.5%) patients had nonmalignant IPMN (81 adenoma, 117 borderline atypia), and 39 (16.5%) had malignant IPMN (13 carcinoma in situ, 26 invasive carcinoma). Cyst size and mural nodule were malignancy determining factors by multivariate analysis. Elevated CEA, cyst size and mural nodule were factors determining invasiveness by multivariate analysis. Using the regression coefficient for significant predictors on multivariate analysis, we constructed a malignancy-predicting scoring formula: 22.4 (mural nodule [0 or 1]) + 0.5 (cyst size [mm]). In invasive IPMN, the formula was expressed as invasiveness-predicting score = 36.6 (mural nodule [0 or 1]) + 32.2 (elevated serum CEA [0 or 1]) + 0.6 (cyst size [mm]). Here we present a scoring formula for prediction of malignancy or invasiveness of Br-IPMN which can be used to determine a proper treatment strategy.

The comparison of oncologic and clinical outcomes of laparoscopic liver resection for hepatocellular carcinoma

Purpose We evaluate the operative outcome and oncologic outcome of laparoscopic liver resection for hepatocellular carcinoma (HCC), and compare with open liver resection. Methods From January 2004 to December 2012, clinical data of 70 patients who underwent laparoscopic liver resection for HCC (laparoscopic liver resection group, lapa-group) were collected and analyzed retrospectively. Control group (open liver resection group, open-group) were retrospectively matched, and compared with lapa-group. Results Laparoscopic major liver resections were performed in 4 patients. Laparoscopic anatomical resections and nonanatomical resections were performed in 39 patients, and 31 patients, respectively. Mean operative time was shorter in lapa-group (215.5 ± 121.84 minutes vs. 282.30 ± 80.34 minutes, P = 0.001), mean intraoperative transfusion rate and total amount were small in lapa-group (24.28%, 148.57 ± 3,354.98 mL vs. 40.78%, 311.71 ± 477.01 mL). Open conversion occurred in 6 patients (8.57%) because of bleeding, inadequate resection, invisible mass on intraoperative ultrasonography, and tumor rupture. In lapa-group and open-group, 3-year disease-free survival rates were 58.3% ± 0.08%, and 62.6% ± 0.06%, respectively (P = 0.773). In lapa-group and open-group 3-year overall survival rates were 65.3% ± 0.8%, and 65.7% ± 0.6%, respectively (P = 0.610). Conclusion Laparoscopic liver resection for HCC is feasible and safe in a large number of patients, with reasonable operative and oncologic results.

Surgical Strategy for T1 Gallbladder Cancer: A Nationwide Multicenter Survey in South Korea

AbstractBackgroundnThe aim of this study was to investigate the clinical features and clinical outcomes of T1 gallbladder (GB) cancer and to determine an appropriate surgical strategy for T1 GB cancer.MethodsA nationwide multicenter study, in which 16 University Hospitals in Korea participated, was performed from 1995 to 2004. A total of 258 patients, 117 patients with T1a and 141 patients with T1b disease were enrolled. Clinicopathologic findings and long-term follow-up results were analyzed after a consensus meeting of the Korean Pancreas Surgery Club was held.ResultsSimple cholecystectomy was performed in 95 patients (81.2xa0%) with T1a tumor and in 89 patients (63.1xa0%) with T1b tumor (pxa0<xa00.01). Lymph node metastasis was observed in 2.9xa0% of T1a patients and in 9.9xa0% of T1b patients (pxa0=xa00.391). A significant difference in 5-year disease-specific survival (DSS) rates was observed between T1a and T1b patients (96.4 vs 84.8xa0%, respectively, pxa0=xa00.03). However, no significant 5-year DSS rate difference was observed between those who underwent simple cholecystectomy or extended cholecystectomy, regardless of whether lymph node dissection was performed or whether lymph node metastasis was present. There was no significant difference in recurrence-free survival between simple cholecystectomy and extended cholecystectomy.ConclusionsThere was no superiority of extended cholecystectomy over simple cholecystectomy in the aspect of survival and recurrence especially in T1b gallbladder cancer. Furthermore, the effectiveness of regional lymphadenectomy for treatment purpose remains questionable. Therefore, simple cholecystectomy could be recommended as a surgical strategy of T1 gallbladder cancer.The aim of this study was to investigate the clinical features and clinical outcomes of T1 gallbladder (GB) cancer and to determine an appropriate surgical strategy for T1 GB cancer. A nationwide multicenter study, in which 16 University Hospitals in Korea participated, was performed from 1995 to 2004. A total of 258 patients, 117 patients with T1a and 141 patients with T1b disease were enrolled. Clinicopathologic findings and long-term follow-up results were analyzed after a consensus meeting of the Korean Pancreas Surgery Club was held. Simple cholecystectomy was performed in 95 patients (81.2xa0%) with T1a tumor and in 89 patients (63.1xa0%) with T1b tumor (pxa0<xa00.01). Lymph node metastasis was observed in 2.9xa0% of T1a patients and in 9.9xa0% of T1b patients (pxa0=xa00.391). A significant difference in 5-year disease-specific survival (DSS) rates was observed between T1a and T1b patients (96.4 vs 84.8xa0%, respectively, pxa0=xa00.03). However, no significant 5-year DSS rate difference was observed between those who underwent simple cholecystectomy or extended cholecystectomy, regardless of whether lymph node dissection was performed or whether lymph node metastasis was present. There was no significant difference in recurrence-free survival between simple cholecystectomy and extended cholecystectomy. There was no superiority of extended cholecystectomy over simple cholecystectomy in the aspect of survival and recurrence especially in T1b gallbladder cancer. Furthermore, the effectiveness of regional lymphadenectomy for treatment purpose remains questionable. Therefore, simple cholecystectomy could be recommended as a surgical strategy of T1 gallbladder cancer.

Systemic metastasis of hepatocellular carcinoma responsive to multidisciplinary treatment including debulking surgery.

The lung, followed by regional lymph node and bone, is the most common site for extrahepatic metastasis of hepatocellular carcinoma (HCC). Metastatic skin lesion of HCC is rare, and it is a sign of poor prognosis, indicating the strong possibility of metastases in other regions of the body. We report the case of a 52-year-old male with multiple metastases, including skin metastasis of HCC, which were treated with multidisciplinary therapy.

Laparoscopic liver resection for hepatocellular carcinoma: review of current status

Despite initial skepticism of laparoscopic liver resection (LLR) due to fears of uncontrolled bleeding, margin involvement resulting from a lack of palpation of laparoscopy, and a steep learning curve, LLR has progressively developed over the past two decades. Through a review of the literature, we compare perioperative and oncologic outcomes of laparoscopic and open liver resection (OLR) for hepatocellular patients, and assess current indications and limitations of laparoscopic liver surgery. Although randomized control trials have not been reported, other data indicate the safety and better short-term outcomes of LLR compared to OLR for hepatocellular carcinoma (HCC) without compromising oncologic outcomes including resection margin status and long-term survival. Moreover, LLR is associated with reduced postoperative ascites and a lower incidence of liver failure for HCC patients with liver cirrhosis (LC) and facilitates subsequent repeat surgery by reducing operation time due to minimal adhesion formation. Major hepatectomies and resections of unfavorable locations in classic indication are expected to benefit from this approach, overcoming the current limitations.

Laparoscopic resection for hepatocellular carcinoma: comparison between Middle Eastern and Western experience.

Laparoscopic liver resection (LLR) for hepatocellular carcinoma (HCC) is increasing in this era of minimal invasive liver surgery. LLR for HCC is currently known to be a safer procedure than it was before because of technical advances and improvement in postoperative patient management and remains the first-line treatment for HCC in compensated cirrhosis in many centers. n nWe have the chance of analyzing the paper about the comparison between Middle Eastern and Western experience for LLR as treatment of HCC.

Two-dimensional autofocus technique for stepped-frequency ISAR imaging

A new ISAR autofocus method based on the subarray averaging concept is developed to compensate for the phase errors along down-range dimension. The results in this paper show that the ISAR autofocus based on the subarray averaging concept makes it possible to reconstruct high quality ISAR images even though a target moves with very high speed, and a stepped-frequency signal with low PRF is used.

Surgical Strategy for T2 Gallbladder Cancer: Nationwide Multicenter Survey in Korea

Background Although all guidelines suggest that T2 gallbladder (GB) cancer should be treated by extended cholecystectomy (ECx), high-level scientific evidence is lacking because there has been no randomized controlled trial on GB cancer. Methods A nationwide multicenter study between 2000 and 2009 from 14 university hospitals enrolled a total of 410 patients with T2 GB cancer. The clinicopathologic findings and long-term follow-up results were analyzed after consensus meeting of Korean Pancreas Surgery Club. Results The 5-year cumulative survival rate (5YSR) for the patients who underwent curative resection was 61.2%. ECx group showed significantly better 5YSR than simple cholecystectomy (SCx) group (65.4% vs. 54.0%, P = 0.016). For N0 patients, there was no significant difference in 5YSR between SCx and ECx groups (68.7% vs. 73.6%, P = 0.173). Systemic recurrence was more common than locoregional recurrence (78.5% vs. 21.5%). Elevation of cancer antigen 19-9 level preoperatively and lymph node (LN) metastasis were significantly poor prognostic factors in a multivariate analysis. Conclusion ECx including wedge resection of GB bed should be recommended for T2 GB cancer. Because systemic recurrence was more common and recurrence occurred more frequently in patients with LN metastasis, postoperative adjuvant therapy should be considered especially for the patients with LN metastasis.

Highlights of the Third Expert Forum of Asia-Pacific Laparoscopic Hepatectomy; Endoscopic and Laparoscopic Surgeons of Asia (ELSA) Visionary Summit 2017

The application of laparoscopy for liver surgery is rapidly increasing and the past few years have demonstrated a shift in paradigm with a trend towards more extended and complex resections. The development of instruments and technical refinements with the effective use of magnified caudal laparoscopic views have contributed to the ability to overcome the limitation of laparoscopic liver resection. The Endoscopic and Laparoscopic Surgeons of Asia (ELSA) Visionary Summit 2017 and the 3rd Expert Forum of Asia-Pacific Laparoscopic Hepatectomy organized hepatobiliary pancreatic sessions in order to exchange surgical tips and tricks and discuss the current status and future perspectives of laparoscopic hepatectomy. This report summarizes the oral presentations given at the 3rd Expert Forum of Asia-Pacific Laparoscopic Hepatectomy.