Shuguo Zheng

Feasibility and safety of laparoscopic liver resection for hepatocellular carcinoma with a tumor size of 5-10 cm.

Background Although laparoscopic liver resection has developed rapidly and gained widespread acceptance for the treatment of benign liver diseases and hepatocellular carcinoma with a small tumor size, its usefulness for the treatment of large tumors is less clear, due to concerns about compromising oncological principles and patient safety. The purpose of this study was to explore the safety and feasibility of laparoscopic liver resection for the treatment of hepatocellular carcinoma with a tumor size of 5–10 cm. Methods From March 2007 to December 2011, we performed liver resection in 275 patients with hepatocellular carcinoma with a tumor size of 5–10 cm. Laparoscopic liver resection was performed in 97 patients (Lap-Hx group) and open liver resection was performed in 178 patients (Open-Hx group). Operative time, estimated intraoperative blood loss, blood transfusion rate, and length of postoperative hospital stay were compared between the two groups. Early and intermediate-term postoperative outcomes were also compared. Results Only one liver resection was performed for every patient with HCC in the present study.No operative deaths occurred in either group. Nine of the laparoscopic procedures were converted to open resection (conversion rate 9.28%). There were no significant differences in mean operative time (245±105 min vs 225±112 min; P = .469), mean estimated intraoperative blood loss (460±426 mL vs 454±365 mL; P = .913), or blood transfusion rate (4.6%, 4/88) vs (2.8%, 5/178)(P = .480) between the Lap-Hx and Open-Hx groups. However, postoperative hospital stay was shorter in the Lap-Hx group than the Open-Hx group (8.2±3.6 days vs 13.5±3.8 days; P = .028). There was a lower rate of postoperative complications in the Lap-Hx group than the Open-Hx group (9% vs 30%; P = .001), but there were no severe complications in either group. The median overall follow-up time was 21 months (range 2–50 months) and the median follow-up of time of survivors was 23 months. The median follow-up time was 25 months in the Lap-Hx group and 20 months in the Open-Hx group. The follow-up rate was 95% (84 patients) in the Lap-Hx group and 95% (169 patients) in the Open-Hx group, which was not a significant difference between the two groups (P = .20). Tumor recurrence occurred in 17 patients (20%) in the Lap-Hx group and 35 patients (21%) in the Open-Hx group, which was not a significant difference between the two groups (P = .876). A total of 33 patients (13%) died during the study period, including 12 patients (14%) in the Lap-Hx group and 21 patients (12%) in the Open-Hx group, which was not a significant difference between the two groups (P = .695). There were also no significant differences in the 1-year rates of overall survival (94% vs 95%; P = .942) or disease-free survival (93% vs 92%; P = .941), or the 3-year rates of overall survival (86% vs 88%; P = .879) or disease-free survival (66% vs 67%; P = .931), between the Lap-Hx and Open-Hx groups. Conclusions Laparoscopic liver resection is safe and feasible in patients with hepatocellular carcinoma with a tumor size of 5–10 cm. Laparoscopic liver resection can avoid some of the disadvantages of open resection, and is beneficial in selected patients based on preoperative liver function, tumor size and location.

Laparoscopic hepatectomy with bile duct exploration for the treatment of hepatolithiasis: An experience of 116 cases

BACKGROUND An increasing number of patients with hepatolithiasis were diagnosed at an early stage in China. Laparoscopic surgery has introduced new methods of treating this condition. AIM To investigate the patient selection, operative technique, and efficacy of laparoscopic hepatectomy with bile duct exploration for the treatment of hepatolithiasis. PATIENTS AND METHODS The clinical data of 116 patients who underwent laparoscopic hepatectomy (laparoscopic group) and 78 patients who underwent open hepatectomy (open group) for hepatolithiasis were retrospectively analyzed, and were compared with the recent reports. RESULTS The laparoscopic group had a longer duration of operation (323.3 ± 103.0 min vs. 272.8 ± 66.8 min, p<0.05) and shorter postoperative hospital stay (13.1 ± 5.6 days vs. 16.5 ± 8.4 days, p<0.05) than the open group. There were no significant differences between the two groups in intraoperative blood loss or transfusion rate, postoperative complications, calculus clearance, calculus recurrence, or recurrent cholangitis (p>0.05 for all). Efficacy in the laparoscopic group was similar to that in other recently reported studies. CONCLUSIONS Laparoscopic hepatectomy with bile duct exploration is safe and feasible for early stage localized hepatolithiasis, with an efficacy similar to that of open surgery. Anatomic hepatectomy is important for achieving good therapeutic outcomes.

MiR-605 represses PSMD10/Gankyrin and inhibits intrahepatic cholangiocarcinoma cell progression.

The aberrant expression of PSMD10 has important functions in various malignancies. This study showed that PSMD10 was highly expressed and inversely correlated with the expression of miR‐605 in intrahepatic cholangiocarcinoma (ICC) specimens. MiR‐605 directly targeted and repressed PSMD10 expression. In addition, over‐expression of miR‐605 inhibited ICC cell progression both in vitro and in vivo. This effect of miR‐605 on ICC cells was similar to that of PSMD10 knock‐down by RNAi. Moreover, restoration of PSMD10 could reverse the phenotypic alteration caused by miR‐605 in ICC cells. These results suggest a new therapeutic strategy in ICC by restoring miR‐605, which is regulated by p53.

Prospective cohort study of laparoscopic and open hepatectomy for hepatocellular carcinoma.

The safety and feasibility of laparoscopic hepatectomy for hepatocellular carcinoma (HCC) with a diameter of 5 cm or less is well recognized. The role of laparoscopy in treating large HCC (5–10 cm) remains controversial. This prospective cohort study was undertaken to assess the short‐ and long‐term outcomes of laparoscopic hepatectomy for large HCC and to compare this approach with open hepatectomy.

Classification and management of hepatolithiasis: A high-volume, single-center's experience

Hepatolithiasis is endemic to East Asia, but immigration from the region means that this rare but emerging disease will pose a therapeutic challenge to doctors in the West as well. Curative management of hepatolithiasis is difficult since its etiology has not been fully elucidated. Hepatectomy is the best approach to treating hepatolithiasis. Here, we propose a novel classification of hepatolithiasis and describe features of each type. We then relate our experience with various forms of hepatectomy to treat different types of hepatolithiasis. Surgery should be indicated for all cases of hepatolithiasis. The proposed classification will help to determine surgical strategies. Better selection of which patients should undergo a hepatectomy will lead to better outcomes.

Trps1 Regulates Biliary Epithelial-Mesenchymal Transition and Has Roles during Biliary Fibrosis in Liver Grafts: A Preliminary Study

Objective To investigate the role(s) of Trps1 in non-anastomotic biliary stricture (NABS) following liver transplantation. Methods Immunohistochemical and histological techniques were used to detect Trps1, E-cadherin, CK19, vimentin, α-SMA, and collagen deposition. Human intrahepatic biliary epithelial cells (HIBECs) were infected with a Trps1 adenovirus, or transfected with Trps1 short-interfering RNAs (siRNAs). Reverse transcription polymerase chain reaction (RT-PCR) assays and western blotting were used to determine expression levels of epithelial and mesenchymal markers, and Trps1 in HIBECs. Results Expression of Trps1 and epithelial markers was down-regulated or absent in NABS liver samples. Mesenchymal markers were seen in biliary epithelial cells (BECs), with collagen deposited around the bile duct. Trps1 expression positively correlated with epithelial markers. Expression of epithelial marker mRNAs and proteins in HIBECs decreased with prolonged cold preservation (CP), while mesenchymal marker expression increased. A 12-h CP period led to increased Trps1 mRNA and protein levels. Expression of E-cadherin was increased in HIBECs following Trps1 adenovirus infection and CP/reperfusion injury (CPRI), with vimentin expression levels reduced and CPRI-mediated epithelial-mesenchymal transition (EMT) inhibited. Transfection of HIBECs with Trps1 siRNAs in conjunction with CPRI revealed that E-cadherin expression was decreased, vimentin expression was increased, and CPRI-mediated EMT was promoted. Conclusion Trps1 is involved in NABS pathogenesis following liver transplantation and negatively correlates with BEC EMT and biliary fibrosis in liver grafts. Trps1 demonstrates antagonistic effects that could reverse EMT.

miR-124 targets GATA6 to suppress cholangiocarcinoma cell invasion and metastasis

BackgroundOur previous study showed that GATA6 plays important roles in cholangiocarcinoma (CCA) cell invasion and metastasis. However, the regulation mechanism of GATA6 in CCA is not clear. In this study, we studied the potential function of miR-124 in CCA and the mechanism of GATA6 regulation.MethodsThe expression levels of miR-124 and GATA6 in cancerous tissues from 57 CCA patients was detected by RT-PCR and IHC. The impact of miR-124 on GATA6 expression in CCA cells was evaluated using cell transfection, xenotransplantation into nude mice and a luciferase reporter assay.ResultsmiR-124 was decreased in 57 cancerous tissue samples compared with 38 matched paracancerous samples. The miR-124 level was inversely associated with lymph node involvement and distant metastasis. miR-124 significantly inhibited invasion and migration of CCA cells in vitro. Furthermore, miR-124 inhibited CCA cell metastasis in nude mice. miR-124 inhibited the luciferase activity of reporter genes containing the wild-type GATA6 3′-UTR, which was abrogated by mutation of the binding site. The protein levels of GATA6 were negatively regulated by miR-124. miR-124 expression was inversely associated with GATA6 in 57 cancerous samples. The miR-124-induced suppression of CCA invasion was abrogated by remedial expression of GATA6. GATA6 expression was decreased by miR-124 overexpression in liver masses from nude mice.ConclusionsOur data suggested that miR-124 decreases GATA6 expression by targeting its 3′-UTR, which in turn inhibits CCA invasion and metastasis.

Des-γ-Carboxyprothrombin Plasma Level in Diagnosis of Hepatocellular Carcinoma in a Chinese Population Undergoing Surgery

Background The usefulness of Des-γ-carboxyprothrombin (DCP) has been indicated in areas where hepatitis C virus is prevalent. DCP has yet to be used in China. The aim of this study was to evaluate the usefulness of DCP in Chinese patients with hepatocellular carcinoma (HCC) predominantly caused by hepatitis B. Material/Methods 329 subjects with HCC and 371 subjects without HCC that all underwent surgery were consecutively enrolled. Serum AFP and plasma DCP levels in all subjects and 153 healthy volunteers were measured and analyzed. Results Of 329 subjects with HCC, 258 (78.4%) were HBsAg positive. The median level of plasma DCP was 853.72 mAU/mL in subjects with HCC, 26.43 mAU/mL in subjects without HCC, and 29.91 m AU/mL in healthy volunteers. A cut-off DCP value of 87 mAU/mL yielded the optimal sensitivity of 74.80% and a specificity of 83.33% for differentiating subjects with HCC from subjects without HCC. The combination of AFP of 21.33 ng/mL and DCP of 87 mAU/mL had a sensitivity of 82.60% for tumors no larger than 2 cm, as well as a sensitivity of 90% for tumors larger than 5 cm. Conclusions The combination of DCP and AFP yielded great improvement in sensitivity in differentiating subjects with HCC from subjects without HCC. These two markers may be incorporated in the protocol for surveillance and diagnosis of HCC in the high-risk Chinese population.

Laparoscopic anatomical segmentectomy of liver segments VII and VIII with the hepatic veins exposed from the head side (with videos).

The reported protocol was difficult to expose the hepatic veins for laparoscopic anatomical hepatectomy of segments VII and VIII. We introduce a new, convenient, applicable approach with the hepatic vein exposed from the head side.

Laparoscopic Extraction of a Hepatic Fish Bone Mimicking a Liver Mass After Gastric Perforation

Approximately 29 % of foreign-body perforations occur in the anus or distal rectum, and the remaining 71 % of perforations were intra-abdominal [1]. Asymptomatic perforation of the gastrointestinal tract (GIT) with subsequent penetration into solid organ(s) is rare [2, 3]. Penetration of the foreign body into solid organ(s) results in severe consequences such as liver abscess [4], pancreatic abscess [5], and even death [6]. We present a case of successful management with laparoscopy for fish bone penetrating the liver parenchyma after perforating the GIT and mimicking a liver mass.