Ji Woong Hwang

Clinical usefulness of portal venous stent in hepatobiliary pancreatic cancers

Treatment options for patients with portal vein (PV) stenosis or occlusion after surgery are limited. The purpose of this study was to investigate the efficacy and safety of PV stent placement in patients with portal vein occlusion or stenosis after radical operation for hepatobiliary pancreatic malignant tumour.

Significance of Radiologic Location and Extent of Portal Venous Involvement on Prognosis After Resection for Pancreatic Adenocarcinoma

Objectives The aim of this study was to determine the prognosis of pancreatic adenocarcinoma patients with portal venous involvement according to its location and extent on radiologic findings. Methods From January 2003 to December 2011, the medical records of 543 patients who had undergone pancreaticoduodenectomy (PD) for pancreas head cancer in Asan Medical Center were retrospectively reviewed. The portal vein (PV) resection (PVR) patients (n = 147) were classified according to the location (NPVC group, without PV confluence invasion; PVC group, with PV confluence invasion) and extent (group A, the tumor surrounded less than two thirds of the vessel perimeter; group B, the tumor extended over two thirds) of venous involvement on radiologic findings. Results The survival rate of the patients who underwent PD with PVR was significantly lower than that of the patients who underwent PD without PVR (P = 0.009). The NPVC group and group A had significantly better prognoses than the PVC group and group B (P = 0.033 and P = 0.005, respectively). Conclusions Pancreatic cancer with venous involvement had different prognoses according to the location and extent of venous involvement. The patients with PV confluence or extensive vein invasion are recommended the neoadjuvant treatments.

What we learned from difficult hepatectomies in patients with advanced hepatic malignancy.

Backgrounds/Aims By reviewing difficult resections for advanced hepatic malignancies, we discuss the effectiveness and extended indications for hepatectomy in such patients. Methods We reviewed 7 patients who underwent extensive surgery between July 2008 and March 2011 for advanced hepatic malignancies. They had stage IV disease, except for in one case that was a stage IIIC (T4N0M0) hepatocellular carcinoma (HCC). Results Patient 1 with intrahepatic cholangiocarcinoma (IHCC) underwent right hemihepatectomy and resection of the bile duct and left portal vein. At 39 months after surgery, she had no recurrence or metastasis. Patient 2 with HCC underwent palliative right trisectionectomy. At 38 months after surgery, he is alive despite residual pulmonary metastases. Patient 3 with HCC invading the hepatic vein and diaphragm underwent right trisectionectomy and caval venoplasty. At 12 months after surgery, he had no recurrence or metastasis. Patient 4, who had 2 large HCCs and pulmonary thromboembolism, underwent a right trisectionectomy. At 7 months after surgery, he had no evidence of recurred HCC. Patient 5, who had IHCC invading her inferior vena cava and main portal vein, underwent preoperative radiotherapy, left hemihepatectomy, and caval resection. At 20 months after surgery, she is well despite a caval thrombus. Patient 6 and 7 underwent repeated surgery due to a recurred IHCC and metastatic colon cancer, respectively. In addition, they are alive during each 20 and 17 months after surgery. Conclusions Despite macroscopic extrahepatic metastases or major vessel involvement, extensive surgery for advanced hepatic malignancy may result in relatively favorable outcomes and be important modality for improving of survival in such patients.