Background: Radiofrequency ablation (RFA) is a widely used percutaneous local ablation technique for the treatment of hepatocellular carcinoma (HCC). Yet the optimal treatment for marginal recurrence after RFA is not established, and the role of salvage hepatectomy is still unclear. Methods: A retrospective analysis was performed on 60 patients who underwent salvage hepatectomy (SH) for recurrent HCC after RFA between January 2004 and August 2022 at a single tertiary referral center. Short-term and long-term outcomes were compared to a matched control group (n = 60) of patients who underwent primary hepatectomy (PH) as initial treatment during the same period. Results: The two groups showed no statistically significant difference in operative extent, operation time, and intraoperative blood loss. Postoperative morbidity rates were similar, and there was no postoperative mortality in either group. After intention-to-treat analysis, recurrence rates were significantly higher in the SH group for both local recurrence (36 [60.0%] vs. 14 [23.3%], p < 0.001) and systemic recurrence (22 [36.7%] vs. 3 [5.0%], p < 0.001). The 1-, 3-, and 5-year DFS rates were significantly worse in the SH group compared to the PH group (83.1% vs. 94.5%, 46.9% vs. 70.4%, and 26.2% vs. 66.9%, respectively; p < 0.001). Cancer-related death showed higher incidence in the SH group (13 [21.7%] vs. 4 [6.7%], p = 0.018). However, the difference in 1-, 3-, and 5-year overall survival rates between the two groups was not statistically significant (93.0% vs. 98.1%, 81.9% vs. 95.8%, and 78.0% vs. 92.2%, respectively; p = 0.091). Conclusions: Salvage hepatectomy is an acceptable treatment option for recurrence after RFA with short-term outcomes comparable to primary resection. However, treatment should be planned carefully, because recurrent HCC after RFA exhibits more aggressive behavior.
Background: To compare the outcomes of major laparoscopic liver resection (LLR) and open liver resection (OLR) for hepatocellular carcinoma (HCC) with two methods. Methods: We retrospectively reviewed a data of 177 patients who underwent major liver resection for HCC (LLR; n = 67 vs. OLR; n = 110). We performed 1:1 propensity score matching (PSM) between two groups and matched 65 patients for both groups. Another comparison was done with already published article as a benchmark after applying similar inclusion and exclusion criteria (LLR; n = 30 vs. OLR; n = 34). Results: After PSM, there were no significant differences in blood loss (1,407.2 ± 2,322.7 vs. 1,071.5 ± 1,160.6 mL; p = 0.299), and transfusion rate (32.2% vs. 32.0%; p = 0.574) between two groups. The mean operative time was significantly longer in LLR than in the OLR group (418.7 ± 172 vs. 335.1 ± 121.6 min; p = 0.002). Complication rate (21.5% vs. 33.8%; p = 0.085) was similar and the mean hospital stay was shorter in the LLR than in the OLR group (11.4 ± 8.5 vs. 17.6 ± 21.4 days; p = 0.009). After benchmarking method, there were no significant differences in between two groups in terms of blood loss (780 ± 822 vs. 947 ± 660.5 mL; p = 0.382), transfusion rate (30.0 vs. 32.4%; p = 0.528), hospital stay (9 ± 3.7 vs. 10.4 ± 3.59 days; p = 0.119), and complication rate (10.0% vs. 20.6%; p = 0.208). Operation time (395 ± 166.6 vs. 296 ± 68.3 min; p = 0.002) was significantly longer in the LLR than in the OLR group. Benchmarking method showed significant loss of number of patients analysed, but results were quite similar to PSM method. Conclusions: Both methods showed that major LLR was safe compared to major OLR. Benchmarking method can be easily used to compare with data of other published article.
Background: Although various pathologic grading systems evaluating tumor response to neoadjuvant therapy (NAT) in pancreatic ductal adenocarcinoma (PDAC) exist, their prognostic value to predict recurrence after surgery has not been validated in. This study aimed to show that microscopic tumor mapping in post-NAT specimens could predict postoperative oncologic outcomes. Methods: Among patients who underwent pancreaticoduodenectomy after NAT for PDAC between 2019 and 2021, 44 pathological responders with College of American Pathologists (CAP) scores 1 or 2 were prospectively enrolled. Microscopic mapping was performed to identify residual tumor loci within the macroscopic tumor bed using 4 mm 2 -sized pixels. Patients were divided into large extent (LE, n = 22) and small extent (SE, n = 22) groups with a cutoff value of 300 mm 2 . Survival outcomes were compared between the two groups, and the diagnostic performance of microscopic tumor mapping was evaluated with receiver operating (ROC) curves. Results: Recurrence and cancer-related mortality rates were significantly higher in the LE group (18.2% vs. 50.0%, p = 0.026; 0 vs. 18.2%, p = 0.001). 1-year and 3-year disease-free survival rates were significantly lower in the LE group compared to the SE group (95.5% vs. 54.5% and 80.4% vs. 50.0%, respectively; p = 0.010). When ROC curves were compared, the area under curve (AUC) was 0.759 for pathologic response measured by microscopic tumor mapping, which was higher compared to the CAP score (AUC 0.586). Conclusions: Evaluation of residual tumor in post-NAT specimens by microscopic tumor mapping is a significant predictor for early recurrence after surgery, with better performance in predicting recurrence compared to the CAP score.
Background: High visceral to subcutaneous adipose tissue area ratio (VSR) has been reported to be a useful predictor of poor prognosis in various type of cancer. However, the clinical significant of high VSR in pancreatic ductal adenocarcinoma (PDAC) is less wellknown. This study aimed to evaluate the relationship between the high VSR and the prognosis of PDAC Methods: A total of 404 patients who underwent upfront surgery for PDAC from 2004 to 2020 were included in a single center, retrospective study. Visceral fat area (VFA) and subcutaneous fat area (SFA) were measured using the three-dimensional image analysis system. According to VSR (VFA/SFA) with a cut-off value of 0.5, the patients were divided into low VSR (n = 142) and high VSR (n = 262) groups. Perioperative outcomes and survival outcomes were compared between the two groups. Results: There are no significant differences in operative and pathological outcomes between low VSR and high VSR groups. The high VSR group had similar 5-year recurrence-free survival to the low VSR group (31.6% vs. 28.9%, p = 0.542), but had significantly lower 5-year overall survival than the low VSR group (35.3% vs. 21.0%, p = 0.004). In the high VSR group, a significant number of patients died from worsening of comorbidities rather than cancer progression. Conclusions: High VSR was associated with decreased survival related to worsening of comorbidities in patients with PDAC. Future studies should be conducted to investigate whether exercise and nutritional interventions for patients with high VSR can prolong the overall survival in patients with resected pancreatic cancer.
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