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Risk factors and prognostic factors of local recurrence after radiofrequency ablation of hepatocellular carcinoma.

BACKGROUND Local recurrence rates after radiofrequency ablation (RFA) of hepatocellular carcinoma (HCC) vary from 2% to 36% in the literature. Limited data were available about the prognostic significance of local recurrence. STUDY DESIGN Between April 2001 and March 2006, 273 patients with 357 hepatocellular carcinoma nodules underwent RFA, with radiologically complete tumor ablation after a single session of RFA. The risk factors of local recurrence and its impact on overall survival of patients were analyzed. RESULTS With a median followup period of 24 months, local recurrence occurred in 35 patients (12.8%). By multivariate analysis, tumor size > 2.5 cm was the only independent risk factor for local recurrence. There was no notable difference in overall survival between patients with and without local recurrence. By multivariate analysis, local recurrence more than 12 months after RFA and complete response after additional treatment of local recurrence were associated with better overall survival in patients with local recurrence. CONCLUSIONS This study demonstrated that tumor size > 2.5 cm was the main risk factor for local recurrence after RFA of hepatocellular carcinoma. Our data suggested that additional aggressive treatment of local recurrence aimed at complete tumor response improves overall survival of patients. Late local recurrence was also associated with better prognosis, suggesting different tumor biology between early and late local recurrent tumors after RFA.

Factors predictive of 5-year survival after transarterial chemoembolization for inoperable hepatocellular carcinoma†

Transarterial chemoembolization (TACE) is widely used for unresectable hepatocellular carcinoma (HCC), but the long‐term survival benefit remains unclear.

Improved operative and survival outcomes of surgical treatment for hilar cholangiocarcinoma

The aim of the present study was to assess whether an aggressive surgical approach in the management of patients with hilar cholangiocarcinoma was associated with improved operative and survival outcomes.

The role of hepatic arterial embolization in the treatment of spontaneous rupture of hepatocellular carcinoma.

Thirty-three patients presenting with spontaneous rupture of hepatocellular carcinomas (HCCs) were referred for emergency transcatheter arterial embolization. Blood was present in the ascitic fluid on abdominal paracentesis in all 33 patients. Seventeen patients underwent emergency computed tomography (CT). HCCs were demonstrated on CT in all 17 patients. Blood was detected in the peritoneal cavity or around the liver surface on CT in 15 patients (88.2%), one of whom also had active extravasation of the contrast medium into the peritoneal cavity. Vascular tumours were present in the hepatic angiograms prior to embolization in all 33 patients but extravasation of the contrast medium from the HCC was seen on angiography in only six patients (18.2%). Bleeding from the ruptured HCC was stopped at the end of the procedure in 32 patients who had undergone successful embolization. The overall median survival time was 9 weeks. The median survival time of patients with a serum total bilirubin level of 50 micromol/l or below was 15 weeks, while that of patients with a serum total bilirubin level above 50 micromol/l was only 1 week, the difference being statistically significant. Embolization is therefore the treatment of choice in arresting life-threatening bleeding in ruptured HCC in patients with a serum total bilirubin level of 50 micromol/l or below, but the procedure is rarely effective in prolonging survival in patients with a serum total bilirubin above this critical level.

Efficacy and safety of radiofrequency ablation for perivascular hepatocellular carcinoma without hepatic inflow occlusion

The role of radiofrequency ablation (RFA) for perivascular (up to 5 mm from the major intrahepatic portal vein or hepatic vein branches) hepatocellular carcinoma (HCC) is unclear because of possible incomplete tumour ablation and potential vascular damage. This study aimed to evaluate the safety and efficacy of RFA for perivascular HCC without hepatic inflow occlusion.

Liver transplantation in infants

PURPOSE In view of the earlier reports that children below 1 year of age constitute a high-risk group for liver transplantation, the authors reviewed their experience in performing orthotopic liver transplantation in this age group. METHODS The records of 9 children aged less than 1 year who underwent 6 living-related liver transplants and 3 reduced-size liver transplants between December 1993 and June 1997 were reviewed. RESULTS Five reexplorations were required for 3 children who had 1 or more of the following early complications: bleeding from hepatic vein to inferior vena cava anastomosis (n = 1), right hepatic vein stump bleeding (n = 1), intraabdominal hematoma (n = 2), jejuno-jejunostomy leakage (n = 1), and colonic perforation (n = 1). Late complications include stricture at the biliary-enteric anastomosis requiring percutaneous balloon dilatation (n = 3) and hepatitis of undetermined etiology requiring retransplantation (n = 1). There was no hepatic artery thrombosis despite the small arteries available for anastomosis. Follow-up ranged from 19 to 61 months (mean, 40 months). Patient survival rate was 100%, and graft survival with good liver function was 89%. All living donors, 2 fathers and 4 mothers, are well. CONCLUSIONS Liver transplantation in infants less than 1 year of age is technically demanding but feasible and still can be performed with a good outcome. Age alone (under 1 year) should not be considered as a contraindication for liver transplantation.

Helical computed tomography angiography in the evaluation of Chinese living renal donors

To determine the suitability of helical computed tomography angiography (CTA), recently used in the anatomical evaluation of potential living renal donors (LRDs) in the Caucasian population, for Chinese LRDs.

Pseudo pseudocyst after right lobe live donor liver transplantation.

A 48-year-old man who presented with hepatocellular carcinoma complicating chronic hepatitis B liver cirrhosis underwent right lobe live donor liver transplantation (LDLT). The donor was his wife, who weighed 57.5 kg. The liver graft weighed 660 g, which corresponded to 56% of the recipient’s estimated standard liver weight.1 Single duct-to-duct biliary anastomosis was performed between the donor and the recipient right hepatic duct while the left hepatic duct was closed with 6-O polypropylene (Prolene , Ethicon, Edinburgh, UK). Immunosuppressive induction therapy included two doses of intravenous methylprednisolone and basiliximab (Simulect, Novartis, East Hanover, NJ). Immunosuppression was maintained on low-dose tacrolimus (trough level 5 to 10 ng/ml) and mycophenolate mofetil (1.5 g per day). The postoperative course was uneventful, apart from mild derangement of liver function. Liver biopsy showed nonspecific changes and was not diagnostic of rejection or biliary obstruction. Endoscopic retrograde cholangiopancreatography (ERCP) performed on postoperative day 54 showed mild stenosis of the biliary anastomosis without leakage. There was no significant abdominal pain after the procedure, and the patient was discharged home. The patient was readmitted 6 weeks later with epigastric distension and vomiting. There was no evidence of sepsis. The patient was afebrile, and there was no leukocytosis. There was no abdominal sign to suggest