Minggen Hu

Outcomes of open versus laparoscopic procedure for synchronous radical resection of liver metastatic colorectal cancer: a comparative study.

Background: The laparoscopic resection of colorectal cancer (CRC) along with synchronous liver metastases has been attempted and reported in multiple single series. In this study, we aimed to examine the feasibility, procedural safety, and oncological integrity of 1-stage totally laparoscopic procedure for the radical resection of liver metastatic CRC in a head-to-head comparison with the 1-stage open procedure simultaneously. Methods: The patients who underwent selective 1-stage concomitant resection of CRC and synchronous liver metastases between January 2004 and December 2008 (laparoscopy group, n=13) were retrospectively enrolled in the study. Patients receiving open 1-stage resection (laparotomy group) were retrospectively included at the ratio of 1:1 (n=13 out of 71), matching the laparoscopy group in sex, age, body mass index, site and stage of primary tumor, location and size of liver metastases, and adjuvant therapies. Results: All the thirteen 1-stage laparoscopic procedures were successfully completed, without conversion to open procedure or additional incision. The operative duration of laparoscopic procedure was shorter than that of open procedure (313±44 vs. 350±46 min, P<0.05). The volume of blood loss was comparable between the 2 groups (259±111 vs. 273±95 mL, P>0.05). Patients undergoing laparoscopic procedure resumed off-bed activities, bowel movement, and oral intake earlier than those undergoing open procedure, and also had a shorter hospitalization stay (8.5±1.9 vs. 11.2±1.8 d, P<0.05). Only 1 clinically significant adverse event occurred in a patient who developed bile leak after the laparoscopic resection. The 1-, 3-, and 5-year survival rates were comparable between the 2 groups (P>0.05). Conclusions: One-stage synchronous laparoscopic resection of liver metastatic CRC is a feasible, effective, and safe modality in specifically indicated patients, both accelerating postoperative recovery and shortening hospitalization time.

SOX10 is a novel oncogene in hepatocellular carcinoma through Wnt/β-catenin/TCF4 cascade

SOX (high mobility group) genes play an important role in a number of developmental processes. Potential roles of SOXs have been demonstrated in various neoplastic tissues as tumor suppressors or promoters depending on tumor status and types. The aim of this study was to investigate the function role of SOXs in the human hepatocellular carcinoma (HCC). The gene expression changes of SOXs in HCC tissues compared with those in noncancerous hepatic tissues were detected using real-time quantitative reverse transcriptase polymerase chain reaction (QRT-PCR) analysis and immunohistochemistry. In addition, we identified the gene SOX10 that was significantly upregulated in HCC by QRT-PCR analysis and immunohistochemistry. Furthermore, we discovered that SOX10 promoted cancer cell proliferation in vitro, and SOX10 expression correlated with elevated β-catenin levels in HCC, and β-catenin function was required for SOX10’s oncogenic effects. Mechanistically, SOX10 facilitates TCF4 to bind to β-catenin and form a stable SOX10/TCF4/β-catenin complex and trans-activate its downstream target gene. SOX10 mutations that disrupt the SOX10-β-catenin interaction partially prevent its function in tumor cells. All in all, SOX10 is a commonly activated tumor promoter that activates Wnt/β-catenin signaling in cancer cells of HCC.

Retroperitoneal laparoscopic hepatectomy: a novel approach.

Purpose: Retroperitoneal laparoscopic surgery has been widely used for kidney and adrenal gland resection. However, there have not been any reports of laparoscopic hepatectomy performed using a retroperitoneal approach. Herein, we report on a successful case of laparoscopic hepatectomy using a retroperitoneal approach. Further, we discuss the key technical points, feasibility, and indications of this method. Methods: A 48-year-old male patient with multiple hepatic metastases of the left lateral and right posterior segments of the liver following radical colon carcinoma resection underwent laparoscopic partial hepatectomy of the right posterior segment using a retroperitoneal approach, followed by laparoscopic hepatic left-lateral segmentectomy using a transabdominal approach. Results: The operation time was 120 minutes and the blood loss volume was 150 mL. The patient was discharged at nine days post-surgery. There were no complications, including hemorrhage and bile leakage. Conclusions: The results of this case study provide evidence that a retroperitoneal approach is a novel, rapid, and safe method for laparoscopic hepatectomy that can be applied to the partial resection of small and superficial tumors of the right posterior segment of the liver.

Retroperitoneoscopic Anatomical Necrosectomy A Modified Single-Stage Video-Assisted Retroperitoneal Approach for Treatment of Infected Necrotizing Pancreatitis

Background. Video-assisted retroperitoneal necrosectomy is a minimally invasive surgical technique for the treatment of severe acute pancreatitis. This study evaluated the safety and feasibility of a modified single-stage video-assisted retroperitoneal necrosectomy, retroperitoneoscopic anatomical necrosectomy (REAN). Methods. Between September 2010 and May 2012, a total of 17 patients with infected necrotizing pancreatitis underwent REAN. The surgical procedures were similar to retroperitoneoscopic pancreatectomy, in which 3 trocars are utilized. Briefly, the perirenal space was entered through the posterior pararenal space. Dissection proceeded from posterior to anterior direction to expose the dorsal side of the perirenal fascia. This was opened to reach the anterior perirenal space, where the peripancreatic abscess was located. Necrotic tissue was then debrided and catheter drainage was performed in a single stage. Results. Operating time ranged from 45 to 100 minutes with minimal blood loss. All patients recovered except for one who died. Major perisurgical complications included peritoneal injury (1 patient), splenic vein injury (1 patient), retroperitoneal infection with paralytic ileus (1 patient), hydrothorax and atelectasis (2 patients), and subcutaneous cellulitis beneath the incision (3 patients). Two patients required additional percutaneous catheter drainage, and 1 patient required a laparotomy to debride the remaining necrotic tissue. Postoperative hospital stay ranged from 21 to 64 days. Conclusions. This study demonstrates that REAN, a modified single-stage video-assisted retroperitoneal approach, was safe and feasible for the treatment of infected necrotizing pancreatitis. The advantages of this procedure include direct access with shorter operating time, complete necrotic tissue debridement, easy hemostasis, simple manipulation, and easy drainage.

Lithotomy Using Cholangioscopy via the Left Hepatic Duct Orifice Versus the Common Bile Duct in Laparoscopic Treatment of Left-Sided Hepatolithiasis: A Comparative Study

OBJECTIVE Laparoscopic hepatectomy is widely used in the surgical treatment of left-sided hepatolithiasis (LSH). Lithotomy using a cholangioscope usually is required for the treatment of concurrent right-sided hepatolithiasis or choledocholithiasis. The primary objective of this study was to evaluate the effectiveness and safety of gallstone elimination using cholangioscopy through the left hepatic duct (LHD) orifice versus the common bile duct (CBD). PATIENTS AND METHODS Eligible LSH patients (n=41) were scheduled for laparoscopic left lateral segmentectomy or left hemihepatectomy with intraoperative biliary exploration using cholangioscopy through the LHD orifice (LHD group, n=23) or the CBD (CBD group, n=18) at the discretion of patients. Laparoscopic T-tube insertion was performed in selected patients. Patients were regularly followed up at monthly intervals or more frequently in the presence of any symptom. The primary outcome measures included overall operative time, duration of the cholangioscopy procedure, volume of blood loss, length of hospital stay, and frequency of procedure-related complications. RESULTS The two groups were comparable in sex, age, symptoms, site of lesion, and gallstone comorbidities (P>.05). Of the 18 patients in the CBD group, 12 (66.7%) patients had a T-tube inserted in contrast to 1 (4.5%) patient in the LHD group. The two groups were comparable in cholangioscopy duration and volume of blood loss (P>.05), whereas the LHD group had a significantly shorter operative time than the CBD group (221.4 ± 58.6 minutes versus 171.2 ± 63.5 minutes; P<.05). The postoperative duration of hospitalization was significantly shorter in the LHD group than in the CBD group (7.5 ± 2.2 days versus 4.2 ± 1.9 days; P<.05). No patient showed any recurrence of gallstones or cholangitis during the follow-up period. CONCLUSIONS As an effective and safe technique that is comparable to choledochotomy, LHD cholangioscopy is a preferred alternative to choledochotomy in the laparoscopic treatment of LSH because it offers patients shorter operative duration and length of hospitalization.

Single-port Retroperitoneoscopic Pancreatectomy Preliminary Results From the First 3 Patients

To date, single-port laparoscopic pancreatic surgery has been rarely reported. This study aimed to evaluate the feasibility and safety of single-port retroperitoneoscopic pancreatectomy based on the first 3 cases in a single center. Three patients with suspected lesions in the distal pancreas underwent single-port retroperitoneoscopic pancreatectomy using a conventional retroperitoneoscopic pancreatectomy approach. All operations were successfully completed utilizing a single port. Operating times were 50, 90, and 150 minutes for the 3 cases. There were no complications, and all patients were discharged within 7 days after surgery. In conclusion, for selected patients, single-port retroperitoneoscopy can be safely utilized for pancreatectomy.

Expression of Ku86 and Presence of Ku86 Antibody as Biomarkers of Hepatitis B Virus Related Hepatocellular Carcinoma

BackgroundHepatocellular carcinoma (HCC) is a common disease and the third leading cause of cancer-related deaths worldwide. Level of the 82-kDa ATP-dependent DNA helicase II (Ku86) increases in some tumors, but its clinical use as a marker for HCC is rare.AimsTo examine the relationship between increases in Ku86 and the development of hepatitis B virus (HBV)-related HCC to define the relationship between Ku86 and HCC.MethodsExpression of Ku86 in tumor tissue, para-tumor tissue, and normal tissue was examined by immunohistochemistry, and Ku86 antibody titers in patient serum collected pre- and post-operatively were measured by ELISA. Long-term survival of the patients was also monitored.ResultsKu86 staining in tumors was much stronger than in para-tumor and normal tissues. The expression of Ku86 was related to the tumor size, TNM stage, and tumor differentiation but not to gender, age, Child–Pugh score, tumor number, or α-fetoprotein levels. The long-term survival of patients with low Ku86 expression was longer. Patients with HCC had higher pre-operative Ku86 antibody levels. After surgical intervention, Ku86 antibody levels in patients with HCC declined significantly. Survival analysis showed that double-positive patients had the lowest survival rate, double-negative patients had the highest. Receiver operating characteristic curve analysis showed no significant difference between the AFP and Ku86 antibody. Multivariate analysis showed that Ku86 protein and Ku86 antibodies were independent prognostic factors of overall survival.ConclusionsKu86 and Ku86 antibodies are promising tumor markers for early detection and prognosis prediction of HBV-related HCC.

MicroRNA-4656 is a prognostic factor and tumor suppressor in human pancreatic cancer through a downstream target of TrkA

In the present study, we investigated the expression profile and functional mechanism of microRNA‐4656 in human pancreatic cancer (PC).

Robot-assisted Retrohepatic Inferior Vena Cava Thrombectomy: First or Second Porta Hepatis as an Important Boundary Landmark

BACKGROUND Robot-assisted retrohepatic inferior vena cava (IVC) thrombectomy (RA-R-IVCTE) has been reported only for limited series. OBJECTIVE To describe in detail the techniques for RA-R-IVCTE with regard to the relationship of a proximal thrombus to either the first porta hepatis (FPH) or second porta hepatis (SPH). DESIGN, SETTING, AND PARTICIPANTS From May 2013 to July 2016, 22 patients with R-IVC tumor thrombi were admitted to our hospital. SURGICAL PROCEDURE RA-R-IVCTE was performed using the Rummel tourniquet technique. For a proximal thrombus inferior to the FPH, we ligated some short hepatic veins (SHVs; typically 1-3). For a thrombus between the FPH and SPH, we mobilized the right lobe of the liver from the IVC by ligating additional SHVs. For a thrombus near or above the SPH but below the diaphragm, we mobilized both the right and left lobes of the liver to obtain high proximal control of the suprahepatic and infradiaphragmatic IVC, and simultaneously clamped the FPH. MEASUREMENTS Detailed techniques were described for various scenarios and perioperative outcomes were recorded. RESULTS AND LIMITATIONS The median operation time was 285min (interquartile range [IQR] 191-390). Intraoperative estimated blood loss was 1350ml (IQR 1000-2075ml). Some 63.6% of patients required an intraoperative blood transfusion and 68% were transferred to the intensive care unit after surgery. Grade IV complications developed in five cases. Vascular injuries (4 cases) were treated with intraoperative endoscopic sutures. An intestinal fistula was found on postoperative day 7 in one case; treatment with gastrointestinal decompression and drainage resolved the condition by 1 mo. CONCLUSIONS Even though the risks involved are high, RA-R-IVCTE is feasible for selected patients. The FPH/SPH is an important boundary landmark for RA-R-IVCTE. The location of proximal IVC tumor thrombi in relation to the FPH or SPH should determine the technique used. PATIENT SUMMARY Robot-assisted thrombectomy for retrohepatic inferior vena cava tumor thrombus is feasible in selected patients.

An Improved Surgical Technique for Pure Laparoscopic Left Hemihepatectomy: Ten Years Experience in a Tertiary Center

Abstract Background: This study details our experience with an improved surgical technique involving the hepatic pedicle during laparoscopic left hemihepatectomy (LLH). Methods: We describe an improved laparoscopic technique to extraparenchymally divide the left hepatic pedicle. A retrospective analysis of all of the patients who underwent laparoscopic liver procedures between 2002 and 2012 was conducted. The patients were divided into two groups, an early LLH group (ELLH group) and a recent LLH group (RLLH group), based on the surgical approach used for the left hepatic pedicle. Results: A total of 72 cases of LLH (26 ELLH and 46 RLLH) were identified. The RLLH group exhibited a shorter median operative time, median length of hospital stay, and lower median blood loss compared to the ELLH group (182, 162.5–223.7 versus 232.5, 200–357.5 minutes, P < .01; 5, 4.2–7 versus 7, 6–8.7 days, P < .05; 150, 100–257.5 versus 300, 200–337.5 mL, P < .05, respectively). No perioperative mortality was observed. Conclusions: This study confirms that our improved surgical technique for LLH is practical, safe, and effective. The main advantage of this method compared to other techniques is the possibility of attaining rapid and precise control of vascular inflow, thus facilitating LLH.