Xin-Da Zhou

The prognostic factor for outcome following second resection for intrahepatic recurrence of hepatocellular carcinoma with a hepatitis B virus infection background

Purpose Second resection has been proved to be a safe and effective treatment for patients with intrahepatic recurrent HCC after primary resection; however, preoperative prognostic factors for outcome following second resection in patients with a hepatitis B virus (HBV) infection background remains to be clarified.Methods Fifty-seven patients with intrahepatic recurrent an HCC and HBV infection background received second resection from 1997 to 2003 in our institute. All of them were negative for anti-hepatitis C virus (HCV) and positive regarding HBV profile. Patient and tumor factors were analyzed.Results At the time of preparing this paper, 31 had re-recurrence and 21patients had died. No postoperative mortality was noted. The 1-, 3-, and 5-year overall survival after second resection were 69.9%, 61.2%, and 30.6%, respectively. Univariate and multivariate analysis showed that vascular invasion and time to recurrence were the independent prognostic factors for overall survival following second resection. The 3- and 4-year overall survival after second resection were 57.7% and 46.6% in patients with the presence of any of two risk factors (n=46), and 100% and 100% in those with absence of both risk factors (n=11, P=0.008).Conclusions Vascular invasion and time to recurrence were the prognostic factors for overall survival following second resection of intrahepatic recurrent HCC.

“Three-Grade Criteria” of radical resection for primary liver cancer

ObjectiveThe present study was designed to develop the “Three-Grade Criteria” for radical resection of primary liver cancer (PLC) and to evaluate its clinical significance.MethodsCriteria for radical resection of PLC were summed up to 3 grades based on criterion development. Grade I: complete removal of all gross tumors with no residual tumor at the excision margin. Grade II: on the basis of Grade I, additional 4 requirements were added: (1) the tumor was not more than two in number; (2) no tumor thrombi in the main trunks or the primary branches of the portal vein, the common hepatic duct or its primary branches, the hepatic veins or the inferior vena cava; (3) no hilar lymph nodes metastases; (4) no extrahepatic metastases. Grade III: in addition to the above criteria, negative postoperative follow-up result including AFP dropping to a normal level (with positive AFP before surgery) within 2 months after operation, and no residual tumor upon diagnostic imaging.The clinical data from 354 patients with PLC who underwent hepatectomy were reviewed retrospectively. Based on the “Three-Grade Criteria” these patients were divided into 6 groups: Grade I radical group, Grade I palliative group, Grade II radical group, Grade II palliative group, Grade III radical group, Grade III palliative group. The survival rate of each group was calculated by the life-table method and the rates compared among the groups.ResultsThe survival rate of patients receiving radical treatment was better than those receiving palliative treatment (P<0.01). Survival improved as more criteria were applied. The 5-year survival rate of the patients in Grade I, II and III who underwent radical resection was 43.2%, 51.2% and 64.4%, respectively (P<0.01).ConclusionThe “Three-Grade Criteria” may be applied for judging the curability of resection therapy for PLC. The stricter the criterion used, the better the survival would be. Adopting high-grade criteria to select cases and guide operations and strengthening postoperative follow-up would improve the results of hepatectomy for PLC.

Ultrastructural observation of liver tissue ablation induced by high-intensity focused ultrasound

AIM To observe the ultrastructural changes of liver tissues on normal rabbit ablated by high-intensity focused ultrasound (HIFU). METHODS A single shot of 1.1 MHz focused ultrasound at an intensity of 500 W/cm(2) with 20-s duration of continuous exposure was applied intraoperatively in normal rabbit livers. Ultrastructural changes of the sonoablated lesion, as viewed by light and electron microscopy, were observed. RESULTS Liver cells at the center of the sonoablated lesion showed irreversible degeneration immediately after HIFU treatment; electron microscopy showed that although the liver cells appeared normal histologically, irregularly shaped cavities of about 0.3-0.5 μm in diameter were present in the cytoplasm. CONCLUSION Thermal damages may be the main mechanism of HIFU-induced ablation of liver tissues besides cavitation effect.