Background and ObjectivesThe roles of microRNA(miR)‐106b‐5p in hepatocellular carcinoma (HCC) remain unclear. We aimed here to investigate the clinical significance of miR‐106b‐5p expression in HCC and its underlying mechanisms.MethodsExpression levels of miR‐106b‐5p in 108 HCC clinical samples by quantitative real‐time reverse transcription PCR. Associations of miR‐106b‐5p expression with various clinicopathological features and patients' prognosis were evaluated by Chi‐square test, Kaplan‐Meier, and Cox proportional regression analyses, respectively. The target gene of miR‐106b‐5p and their functions in HCC cells were investigated by luciferase reporter, CCK‐8, and Transwell Matrigel invasion assays.ResultsmiR‐106b‐5p expression was markedly higher in HCC tissues than in noncancerous adjacent liver tissues (P < .001). miR‐106b‐5p upregulation was significantly associated with advanced TNM stage (P = .02), short recurrence‐free (P = .005), and overall (P = .001) survivals. Importantly, miR‐106b‐5p expression was an independent predictor of poor prognosis (P < .05). RUNX3 was identified as a direct target gene of miR‐106b‐5p in HCC cells. Functionally, miR‐106b‐5p upregulation promoted the viability and invasion of HCC cells, while enforced RUNX3 expression reversed the oncogenic effects of miR‐106b‐5p overexpression.ConclusionsmiR‐106b‐5p may serve as a potent prognostic marker for tumor recurrence and survival of HCC patients. miR‐106b‐5p may exert an oncogenic role in HCC via regulating its target gene RUNX3.
Objectives: To evaluate comparative outcomes of routine abdominal drainage (RAD) and non-routine abdominal drainage (NRAD) during elective hepatic resection for hepatic neoplasms. Materials and Methods: We systematically searched MEDLINE, EMBASE, The Cochrane Library, Web of Science. The searching phrases included “liver resection,” “hepatic resection,” “hepatectomy,” “abdominal drainage,” “surgical drainage,” “prophylactic drainage,” “intraperitoneal drainage,” “drainage tube,” “hepatectomy,” “abdominal drainage” and “drainage tube.” Two independent reviewers critically screened literature, extracted data and assessed the risk of bias. Post-operative morbidity and mortality were the outcome parameters. Combined overall effect sizes were calculated using fixed-effect or random-effect model. Results: We have identified 9 RCTs and 3 comparative studies reporting total of 5726 patients undergoing elective hepatectomy under RAD (n = 3084) or NRAD (NRAD group, n = 2642). RAD was associated with significantly higher overall complication rate [odds risk = 1.79, 95% CI (1.10, 2.93), P = .02] and biliary leakage rate [odds risk = 2.41, 95% CI (1.48, 3.91), P = .0004] compared with NRAD. Moreover, it significantly increased hospital stays [mean difference = 0.95, 95% CI (0.02, 1.87), P = .04] compared with NRAD. RAD showed no difference regarding intra-abdominal hemorrhage, wound complications, liver failure, subphrenic complications, pulmonary complications, infectious complications, reoperation and mortality compared with NRAD. Conclusions: Although routine abdominal drainage may help surgeons to observe post-operative complication, it seems to be associated with increased post-operative morbidity and longer hospital stays. Non-routine abdominal drainage may be an appropriate option in selected patients undergoing hepatic resection. Higher level of evidence is needed.
We report the first documented case of leiomyosarcoma at zone II-III of inferior vena cava with thrombi in three hepatic veins undergoing ex vivo liver resection and autotransplantation (ELRA) and hepatic veins thrombectomy. A 33-year-old female patient presented with abdominal distention and lower extremities edema. Abdominal wall varicosis and shifting dullness were positive on physical examination. Her liver function was classified as Child-Pugh B and a solid tumor at retro-hepatic vena cava extending to right atrium with thrombi in three hepatic veins were confirmed. The diagnosis of leiomyosarcoma with Budd-Chiari syndrome was highly suspected with preoperative ultrasound, echocardiogram, CT scan, and three-dimensional reconstruction. A zone II-III leiomyosarcoma of IVC origin was confirmed at surgery and ex vivo liver resection and autotransplantation, and hepatic vein thrombectomy with atrial reconstruction were performed under cardiopulmonary bypass (CPB). Operative time, anhepatic time, and CPB time were 12 h, 128 min, and 84 min, respectively. The patients experienced post-operative liver dysfunction and was cured with conservative therapy. Hepatic recurrence two years after surgery was managed with radiofrequency. The patient was alive with liver metastasis three years after surgery. Despite being regarded as an extremely aggressive procedure, ELRA could be considered in the treatment of advanced leiomyosarcoma with Budd-Chiari syndrome and hepatic vein thrombi.
Objectives: The clinical safety, efficacy and feasibility of laparoscopic appendectomy (LA) compared with open appendectomy (OA) in pregnancy are still controversial. Herein, we are aiming to compare the clinical outcomes of LA and OA in patients with acute appendicitis during their pregnancy.Materials and Methods: This was a systematic review and metaanalysis of studies comparing laparoscopic and OA in pregnancy identifying using PubMed, Web of science, Embase, The Cochrane Library, Ovid and Scopus. Two independent reviewers extracted data on surgical complication, fetal loss, preterm delivery, hospital stay, Apgar score in both groups.Results: Twenty-seven studies with total of 6497 patients (4464 in open and 2031 in laparoscopic group) were included. LA was associated with lower rate of wound infection [odds risk (OR) = 3.13, 95% confidence interval (CI): 1.77-5.56, P < 0.0001] overall complications (OR = 2.15, 95% CI: 1.47-3.14, P < 0.0001) and shorter hospitalization (mean difference = 0.72, 95% CI: 0.43-1.02, P < 0.00001) compared with open group. LA was in a lower risk for 5-minute Apgar score (mean difference = 0.09, 95% CI: 0.02-0.17, P = 0.01) group than open group. No difference was found regarding preterm delivery between 2 groups. LA was associated with higher fetal loss (OR = 0.57, 95% CI: 0.41-0.79, P = 0.0007) compared with open surgery. However, laparoscopy was not associated with increased fetal loss after 2010 (OR = 0.74, 95% CI: 0.44-1.24, P = 0.26) compared with open group.Conclusions: LA in pregnancy seems to be feasible with acceptable outcome, especially in patients with early and mid-trimester period, with sophisticated hands and experienced centers.
Rationale: Hepatocellular with tumor thrombi extending into 3 hepatic veins (HVs) and right atrium presents as a real clinical challenge. We report the first documented case of surgical resection of an advanced hepatocellular carcinoma (HCC) with extensive invasion to distal stomach, atrium and hepatic vasculatures. Patient concerns: We present a case of 48-years old man with abdominal mass accompanying shortness of breath after activities. Diagnoses: Preoperative examination revealed giant HCC with tumor thrombi extending into portal vein, HVs, inferior vena cava, and atrium. Interventions: Distal stomach involvement was confirmed at surgery and, distal gastrectomy, atrial reconstruction and ante-situm liver resection and autotransplantation under cardio-pulmonary bypass were performed. Outcomes: The operation time was 490 minutes, extracorporeal circulation time 124 minutes, and anhepatic time 40 minutes. Postoperative follow-up revealed normal hepatic and cardiac function with no sign of recurrence. Lessons: This case illustrates that the extensive invasion of HCC to major vasculature and adjacent organs may not necessarily preclude the liver autotransplantation with multi-visceral resection as the treatment option of extremely advanced HCC patients.
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