Background Laparoscopic treatment for gallbladder cancer (GBC) has long been contraindicated, but few studies have demonstrated the oncologic outcomes of this treatment. The purpose of this study was ...to evaluate long-term survival after intended laparoscopic surgery for early-stage GBC based on our 10 years of experience. Study Design Between May 2004 and April 2014, eighty-three patients suspected of having early-stage GBC with no evidence of liver invasion were enrolled in the prospective protocol for laparoscopic surgery. Data for 45 of these patients with pathologically proven GBC were analyzed to determine the safety and oncologic outcomes of a laparoscopic approach to GBC. Twenty-six patients whose postoperative follow-up exceeded 5 years were investigated to determine the 5-year actual survival outcomes. Results Extended cholecystectomy, including laparoscopic lymphadenectomy, was performed in 32 patients and simple cholecystectomy in 13 patients. The T stages based on final pathologic results were Tis (n = 2), T1a (n = 10), T1b (n = 8), and T2 (n = 25). After a median follow-up of 60 months after surgery, recurrence was detected in 4 patients as distant metastases. There was no local recurrence around the gallbladder bed or lymphadenectomy. Disease-specific 5-year survival rate of the 45 patients was 94.2%. Disease-specific actual survival rate of 26 patients whose postoperative follow-up period exceeded 5 years was 92.3% at 5 years. Conclusions The favorable long-term oncologic results shown in this study confirm the oncologic safety of laparoscopic cholecystectomy, including laparoscopic lymphadenectomy in selected patients with GBC.
Background
To investigate whether preoperative malnutrition in patients who underwent curative pancreaticoduodenectomy (PD) in pancreatic head cancer correlated with short‐term outcomes.
Methods
This ...study was a retrospective review of medical records from January 2004 to December 2018. Preoperative malnutrition was defined as body mass index (BMI) <18.5 kg/m2, or hypoalbuminemia with serum albumin level < 3.5 g/dL within 30 days before surgery.
Results
Of the 289 eligible patients, 60 patients (20.7%) were classified as the malnutrition group. The estimated blood loss (EBL, mL) (964.1 ± 879.7 vs 597.7 ± 501.7, P = .044) and transfusion rate (51.7% vs 18.8%, P < .001) was significantly higher in the malnutrition group than no‐malnutrition group. The hospital stay (days) (20.5 ± 12.2 vs 18.1 ± 13.6, P = .05) was significantly longer in the malnutrition group. The open conversion rate (45.4% vs 6.67%, P < .001) and major complication rate (36.7% vs 21.8%, P = .032) was significantly higher in the malnutrition group. In multivariate analysis, preoperative malnutrition was found to be the predictor of postoperative complication (HR 1.971 95% confidence interval 1.071‐3.624, P = .029).
Conclusion
Preoperative malnutrition in patients who underwent curative PD for pancreatic head cancer is associated with adverse short‐term outcomes.
Highlight
No study has been reported on the association between preoperative malnutrition and surgical outcomes in pancreatic cancer. Among patients who underwent curative pancreaticoduodenectomy, Lee and colleagues revealed that those with preoperative malnutrition had increased blood loss, open conversion rates, hospital stay, and complication rates compared with those without preoperative malnutrition.
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FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK
There is a recently proposed subtype of hepatocellular carcinoma (HCC) that is histologically similar to usual HCC, but characterized by the expression of “stemness”‐related markers. A large‐scale ...study on two different cohorts of HCCs was performed to investigate the clinicopathologic features and epithelial‐mesenchymal transition (EMT)‐related protein expression status of this subtype of HCCs. The expression status of stemness‐related (e.g., keratin 19 K19, cluster of differentiation CD133, epithelial cell adhesion molecule EpCAM, and c‐kit) and EMT‐related markers (e.g., snail, S100A4, urokinase plasminogen activator receptor uPAR, ezrin, vimentin, E‐cadherin, and matrix metalloproteinase MMP2) were examined using tissue microarrays from cohort 1 HCCs (n = 137). K19 protein expression in cohort 2 HCCs (n = 237) was correlated with the clinicopathologic parameters and messenger RNA (mRNA) levels of K19, uPAR, VIL2, Snail, Slug, and Twist. K19, EpCAM, c‐kit, and CD133 positivity were observed in 18.2%, 35.0%, 34.3%, and 24.8%, respectively. K19 was most frequently expressed in combination with at least one other stemness‐related marker (92.0%). K19‐positive HCCs demonstrated more frequent major vessel invasion and increased tumor size, compared to K19‐negative HCCs (P < 0.05). K19 was most significantly associated with EMT‐related protein expression (e.g., vimentin, S100A4, uPAR, and ezrin) (P < 0.05) and a poor prognosis (overall survival: P = 0.018; disease‐free survival: P = 0.007) in cohort 1. In cohort 2, HCCs with high K19 mRNA levels demonstrated higher mRNA levels of Snail, uPAR, and MMP2 (P < 0.05). K19‐positive HCCs demonstrated more frequent microvascular invasion, fibrous stroma, and less tumor‐capsule formation, compared to K19‐negative HCCs (P < 0.05). K19 expression was a significant independent predictive factor of poor disease‐free survival (P = 0.032). Conclusion: K19 was well correlated with clinicopathologic features of tumor aggressiveness, compared to other stemness‐related proteins. K19‐positive HCCs showed significantly increased EMT‐related protein and mRNA expression, suggesting that they may acquire more invasive characteristics, compared to K19‐negative HCCs through the up‐regulation of EMT‐associated genes. (HEPATOLOGY 2011;)
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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK
The lack of association between serum testosterone levels and symptoms suggestive of hypogonadism is a significant barrier in the determination of late-onset hypogonadism (LOH) in men. This study ...explored whether testosterone levels increase after morning awakening, likewise the cortisol awakening response (CAR) in the hypothalamic-pituitary-adrenal (HPA) axis, and whether testosterone levels during the post-awakening period are associated with age and symptoms suggestive of late-onset hypogonadism (LOH) in men.
Testosterone and cortisol levels were determined in saliva samples collected immediately upon awakening and 30 and 60 min after awakening, and scores of the Aging Males' Symptoms (AMS) questionnaire were obtained from 225 healthy adult men.
A typical CAR (an increase in cortisol level ≥ 2.5 nmol/L above individual baseline) was observed in 155 participants (the subgroup exhibiting typical CAR). In the subgroup exhibiting CAR, testosterone levels sharply increased during the post-awakening period, showing a significant negative correlation with age, total AMS score, and the scores of 11 items on the somatic, psychological, and sexual AMS subscales. Of these items, three sexual items (AMS items #15-17) were correlated with age. Meanwhile, there was no notable increase in testosterone levels and no significant correlation of testosterone levels with age and AMS score in the subgroup exhibiting no typical CAR (
= 70).
The results indicate that the hypothalamus-pituitary-gonad (HPG) axis responds to morning awakening, and determining testosterone levels during the post-awakening period in men with typical CAR may be useful for assessing HPG axis function and LOH.
The characteristics of bioliquid produced through the hydrothermal carbonization (HTC) of wood wastes and the effects of recirculation on hydrochar production were analyzed. The organic acids and ...total organic carbon of bioliquid increased with progressive recirculation, whereas intermediate byproducts decreased. Hydrochar production by bioliquid recirculation increased mass yield, carbon content, caloric value, and energy yield of the former, while improving its quality as a solid refuse fuel. We concluded that bioliquid recirculation promoted HTC, as demonstrated by Fourier-transform infrared spectroscopy. Furthermore, contrary to predictions, a relatively constant quantity of bioliquid was generated in each step, indicating that its continuous reuse is feasible. Therefore, bioliquid recirculation can improve hydrochar production while simultaneously mitigating the environmental impact of wastewater generation. This method should be considered an important strategy toward the implementation of carbon-neutrality goals.
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IZUM, KILJ, NUK, PILJ, PNG, SAZU, UL, UM, UPUK
Achieving textbook outcomes (TOs) improves the short-term and long-term performance of a hospital. Our objective was to assess TOs in the laparoscopic liver resection (LLR) of tumors in the PS ...(posterosuperior) section of the liver and identify the impact of the learning curve. We conducted a retrospective cohort study analyzing patients who underwent LLR for lesions located in the PS segments. Patients were divided into a TO and no-TO group. TOs were defined as negative margins, no transfusion, no readmission, no major complications, no 30-day mortality, and a length of stay ≤ 50th percentile. Patients' outcomes were assessed in two study periods before and after 2015. TOs were achieved in 47.6% (
= 117). In multivariable analysis, obesity (
= 0.001), shorter operation time (
< 0.001), less blood loss (
< 0.001), normal albumin (
= 0.003), and minor resection (
= 0.046) were significantly associated with achieving TOs. Although the 5-year recurrence-free survival rate (
= 0.096) was not significantly different, the 5-year overall survival rate was significantly greater in the TO group (
= 0.001). Body mass index > 25 kg/m
(
= 0.020), age > 65 years (
= 0.049), and achievement of TOs (
= 0.024) were independently associated with survival. The proportion of patients who achieved a TO was higher after 2015 than before 2015 (52.3% vs. 36.1%;
= 0.022). TOs are important markers not only for assessing hospital and surgeon performance but also as predictors of overall survival. As the number of surgeons who achieve the learning curve increases, the number of patients with TOs will gradually increase with a subsequent improvement in overall survival.
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IZUM, KILJ, NUK, PILJ, PNG, SAZU, UL, UM, UPUK
According to recent international consensus conferences, pure laparoscopic donor hepatectomy (PLDH), particularly right and left hepatectomies, is not yet considered a standard practice because ...studies remain limited. Thus, we present the outcomes of more than 500 PLDH patients, mostly receiving a right hepatectomy. To our knowledge, this is the largest study to date on PLDH. Data from all living liver donors who underwent PLDH at 5 centers in Korea until June 2018 were retrospectively analyzed. The outcomes of both donors and recipients were included. Pearson correlation analysis was used to explore the relationship between the duration of surgery and cumulative experience at each center, which reflects the learning curve. Overall, 545 PLDH cases were analyzed, including 481 right hepatectomies, 25 left hepatectomies, and 39 left lateral sectionectomies (LLS). The open conversion was necessary for 10 (1.8%) donors, and none of the donors died or experienced irreversible disability. Notably, there were 25 (4.6%) patients with major complications (higher than Clavien‐Dindo grade 3). All centers except one showed a significant decrease in surgery duration as the number of cases accumulated. Regarding recipient outcomes, there were 110 cases (20.2%) of early major complications and 177 cases (32.5%) of late major complications. This study shows the early and late postoperative outcomes of 545 donors and corresponding recipients, including 481 right hepatectomies and 25 left hepatectomies, from 5 experienced centers. Although the results are comparable to those of previously reported open donor hepatectomy series, further studies are needed to consider PLDH a new standard practice.
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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK
To assess the relationship between computed tomographic (CT) indexes and histologically measured pancreatic fat in surgical specimens and to evaluate patients with impaired glucose metabolism in a ...clinical setting.
This retrospective study was institutional review board approved and informed consent was waived. The hospital database was searched for records from November 2008 to April 2009, and 62 patients (42 men and 20 women; mean age, 61.4 years; age range, 21-81 years) who underwent CT within 1 month before pancreatectomy were identified. The histologic pancreatic fat fraction (area ratio of fat to total tissue times 100%) was measured in nontumorous pancreatic tissue. Attenuation was measured in three regions of interest in the pancreas and the spleen on nonenhanced CT images. The difference between pancreatic and splenic attenuation and the pancreas-to-spleen attenuation ratio were calculated. Visceral fat area at the level of the umbilicus was measured on the CT images. Spearman correlation coefficients (ρ) were calculated to examine the correlation between the CT indexes or visceral fat area and the histologic pancreatic fat fraction. A multivariate logistic regression model was used to determine whether CT attenuation indexes and patient age, sex, and visceral fat correlated with impaired glucose metabolism (ie, impaired glucose tolerance, impaired fasting glucose, or presence of diabetes).
The histologic pancreatic fat fraction ranged from 0% to 65.3% and was significantly correlated with the difference between pancreatic and splenic attenuation (ρ = -0.622, P < .01) and the pancreas-to-spleen attenuation ratio (ρ = -0.616, P < .01). The visceral fat area was not correlated with the histologic pancreatic fat fraction (ρ = 0.09, P = .50). The CT attenuation indexes were significant and independent variables predictive of impaired glucose metabolism after adjusting for age, sex, and visceral fat.
Pancreatic fat can be quantified by using CT, and CT attenuation indexes that are applied to the quantification of pancreatic fat are significantly associated with clinical assessment of impaired glucose metabolism.
Background Laparoscopic liver resection is an attractive option for treating liver tumors. Laparoscopic liver resection is more difficult for hepatocellular carcinomas located in the posterosuperior ...segments than for hepatocellular carcinomas in the anterolateral segments. We compared perioperative and long-term outcomes between laparoscopic liver resection for hepatocellular carcinomas located in the posterosuperior and anterolateral segments. Methods We retrospectively reviewed the clinical data for 230 patients who underwent laparoscopic liver resection for hepatocellular carcinomas between September 2003 and July 2014. Of these, 116 patients were selected by case-matched analysis using age, sex, tumor number and size, Child-Pugh class, and extent of liver resection. Patients were classified into 2 groups according to tumor location: the anterolateral group ( n = 58) and the posterosuperior group ( n = 58). Results Operation time (355 minutes vs 212 minutes, P < .005), intraoperative blood loss (600 mL vs 410 mL, P < .001), and hospital stay (8.5 days vs 7 days, P = .040) were significantly greater in the posterosuperior group than in the anterolateral group. The open conversion (13.8% vs 10.3%, P = .777), postoperative complication (17.2% vs 10.3%, P = .420), 5-year overall survival (88.5% vs 85.7%, P = .370), and 5-year, recurrence-free survival (47.6% vs 40.9%, P = .678) rates were not significantly different between the posterosuperior and anterolateral groups. Conclusion Although laparoscopic liver resection is more difficult for hepatocellular carcinomas located in the posterosuperior segment, there were no differences in the short- and long-term outcomes between the posterosuperior and anterolateral groups. The perceived impact of tumor location on patient outcomes could be overcome by experience and technical improvements.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK, ZRSKP
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