Jun Chul Chung

Overexpression of PD-L1 and PD-L2 Is Associated with Poor Prognosis in Patients with Hepatocellular Carcinoma

Purpose Hepatocellular carcinoma (HCC) is one of the most aggressive malignancies. Recently, the overexpression of programmed cell death 1 (PD-1) and PD-1 ligand 1 (PD-L1) has been shown to correlate with poor prognosis in many cancers. However, the expression of PD-L1 or PD-1 ligand 2 (PD-L2) and clinical outcomes have not been fully investigated in HCC. Materials and Methods Formalin-fixed paraffin-embedded samples were obtained from 85 patients with HCC who underwent surgery. The expression of PD-Ls (PD-L1, PD-L2) was evaluated by immunohistochemical analysis. Results The proportion of high expression groups of PD-L1 and PD-L2 was 27.1% and 23.5%, respectively. Univariate analysis revealed that tumor size (p < 0.001), histological differentiation (p=0.010), PD-L1 expression (p < 0.001), and PD-L2 expression (p=0.039) were significant prognostic factors of overall survival in patients with HCC. Multivariate analysis revealed that overall tumor size (hazard ratio [HR], 4.131; 95% confidence interval [CI], 2.233 to 7.643; p < 0.001 and HR, 3.455; 95% CI, 1.967 to 6.067; p < 0.001) and PD-L1 expression (HR, 5.172; 95% CI, 2.661 to 10.054; p < 0.001 and HR, 3.730; 95% CI, 1.453 to 9.574; p=0.006) were independent prognostic values for overall and disease-free survival. Patients with high expression of PD-Ls had a significantly poorer survival than those with low expression (p < 0.001, p=0.034). Conclusion The overexpression of PD-Ls in HCC patients is correlated with survival and tumor recurrence. Further evaluation of PD-1 and PD-Ls as therapeutic targets and predictive biomarkers for HCC is warranted.

Gallbladder torsion diagnosed by MDCT and MRCP

Gallbladder torsion is an uncommon disease and is treated by emergency surgery. Since its first description by Wendel in 1898, over 500 cases have been reported in the last century [1]. Gallbladder torsion leads to obstruction of biliary drainage and blood flow so that a delay in the diagnosis and treatment may be life-threatening. Although many reports of gallbladder torsion are described preoperative diagnosis remains difficult. We present a case preoperatively diagnosed with multidetector computed tomography (MDCT) and magnetic resonance cholangiopancreatography (MRCP) and successfully treated with laparoscopic cholecystectomy. Especially, preoperative diagnosis of gallbladder torsion by MRCP is the second case since its first report by Usui in 2000 [2]. Also, to our knowledge, this is the first reported case diagnosed by both MDCT and MRCP.

Feasibility and outcomes of laparoscopic enucleation for pancreatic neoplasms

Purpose With the advancement of laparoscopic techniques and instruments, laparoscopic approach for pancreatic lesions has become an increasingly used procedure. But, there are few and limited studies about laparoscopic enuleation (LE) for pancreatic lesions. Therefore, the purpose of this study was to present our experience and to evaluate the clinical outcome of LE for pancreatic benign or borderline malignant tumors. Methods Between May 2005 and December 2011, 11 patients who underwent LE were analyzed. Candidates for LE met the following criteria: benign or borderline malignant pancreatic tumor, no involvement of main pancreatic duct, and outwardly growing tumor with small tumor bed. Results All 11 patients (10 women and 1 man with a mean age of 43.1 ± 11.9 years) who underwent LE were completed laparoscopically without conversion. The mean diameter of tumor was 4.0 ± 3.3 cm and all cases had benign tumors at the final pathologic diagnosis. One patient (9%) developed pancreatic fistula and mean postoperative hospital stay was 5.5 ± 1.7 days. During follow-up period (mean, 44.3 ± 23.9 months), all patients were alive with no recurrence or new onset of diabetes. Conclusion LE is a safe and effective procedure, and should be considered as a treatment option for pancreatic lesions that do not involve the main pancratic duct and have an outgrowing aspect with small tumor bed.

Laparoscopic distal pancreatectomy for benign or borderline malignant pancreatic tumors.

BACKGROUND/AIMS Laparoscopic distal pancreatectomy (LDP) for benign conditions is increasingly performed. But, there are few limited studies about the outcomes of the laparoscopic surgery compared with open surgery. The aim of this study was to evaluate the clinical outcomes of LDP and compare it to that of open distal pancreatectomy (ODP). MATERIALS AND METHODS From July 2007 to February 2012, 60 consecutive patients (41 LDP patients and 19 ODP patients) who underwent elective distal pancreatectomy with an apparent diagnosis of benign or borderline malignant tumor were recruited into the current study. RESULTS There were no significant differences in operation time, transfusion, intravenous patient-controlled analgesia (IV-PCA) duration, pancreatic fistula, mortality, and recurrence between the two groups. Compared to ODP, LDP had lower blood loss (272.7±134.8 vs. 476.9±140.8 ml; p=0.002), shorter time to first flatus (2.4±0.5 vs. 4.0±1.5 days; p=0.003), earlier time to oral intake (3.4±1.6 vs. 5.4±1.9 days; p=0.013), and shorter postoperative hospital stay (9.4±6.9 vs. 17.0±6.7 days; p=0.043). CONCLUSION LDP is a safe procedure and should be considered as a standard treatment option for benign or borderline malignant pancreatic tumors.

Segmental duodenectomy with duodenojejunostomy of gastrointestinal stromal tumor involving the duodenum

Duodenal gastrointestinal stromal tumors (GISTs) are uncommon and a relatively small subset of GISTs whose optimal surgical procedure has not been well defined. Because submucosal spread and local lymph node involvement is infrequent in GISTs, wide margins with routine lymph node dissection may not be required. Various techniques of limited resection for duodenal GISTs have been described depending on the site and the size of the tumors. In this study, we report two cases of GIST involving the third and fourth portion of the duodenum successfully treated by segmental duodenectomy with end-to-end duodenojejunostomy. This technique should be considered as a treatment option for GIST located at the third and fourth portion of the duodenum.

Long-term results of oncoplastic breast surgery with latissimus dorsi flap reconstruction: a pilot study of the objective cosmetic results and patient reported outcome

Purpose The goal of oncoplastic breast surgery is to restore the appearance of the breast and improve patient satisfaction. Thus, the assessment of cosmetic results and patient-reported outcomes (PROs) using appropriately constructed and validated instruments is essential. The aim of the present study was to assess the long-term objective cosmetic results and corresponding PROs after oncoplastic breast surgery. Methods Cosmetic results were assessed by the patients, a medical panel, and a computer program (BCCT.core). PROs were assessed using BREAST-Q, a questionnaire that measures the perception of patients having breast surgery. The cosmetic results and PROs were analyzed in patients who underwent quadrantectomy and partial breast reconstruction utilizing the latissimus dorsi flap. Results The mean duration of the follow-up period was 91.6 months (range, 33.3–171.0 months), and mean age of the patients was 51 years old (range, 33–72 years). The mean tumor size was 2.1 cm (range, 0.9–5.5 cm). There was fair agreement between the medical panel and BCCT.core score (K = 0.32, P < 0.001), and a statistically significant correlation between the BCCT.core score and medical panel cosmetic results was identified (r = 0.606, P < 0.001). A better BCCT.core result was related to a higher PRO of each BREAST-Q domain—satisfaction with breasts (R2 = 0.070, P = 0.039), satisfaction with outcome (R2 = 0.087, P = 0.021), psychosocial well-being (R2 = 0.085, P = 0.023), sexual well-being (R2 = 0.082, P = 0.029), and satisfaction with information (R2 = 0.064, P = 0.049). Conclusion Our long-term results of oncoplastic surgery achieved a high level of patient satisfaction with good cosmetic results. The medical panel and BCCT.core results correlated well with the PROs of the patients using valid, reliable, and procedure-specific measures.

Astrocyte elevated gene-1 overexpression in hepatocellular carcinoma: an independent prognostic factor

Purpose Astrocyte elevated gene-1 (AEG-1) plays important roles in tumorigenesis such as proliferation, invasion, metastasis, angiogenesis, and chemoresistance. We examined the expression of AEG-1 in patients with hepatocellular carcinoma (HCC). Methods Eighty-five samples were collected from patients with HCC who underwent surgery and were histopathologically confirmed to have HCC. Two independent pathologists, experienced in evaluating immunohistochemistry and blinded to the clinical outcomes of the patients, reviewed all samples. They determined AEG-1 expression semiquantitatively by assessing the percentage of positively stained immunoreactive cells and staining intensity. Clinicopathological data were analyzed in association with prognosis. Results The association was estimated by univariate and multivariate analyses with Cox regression. Tumor size (hazard ratio [HR], 2.285; 95% confidence interval [CI], 1.175-4.447; P = 0.015), microvascular invasion (HR, 6.754; 95% CI, 1.631-27.965; P = 0.008), and AEG-1 expression (HR, 4.756; 95% CI, 1.697-13.329; P = 0.003) were independent prognostic factors for overall survival. Those for disease-free survival rate were tumor size (HR, 2.245; 95% CI, 1.282-3.933; P = 0.005) and AEG-1 expression (HR, 1.916; 95% CI, 1.035-3.545; P = 0.038). The cumulative 5-year survival and recurrence rates were 89.2% and 50.0% in the low-expressing group and 24.5% and 82.4% in the high-expressing group, respectively. Conclusion The results suggest that AEG-1 overexpression could serve as a valuable prognostic marker in patients with HCC.