Publications by authors named "Tong Kan"

20 Publications

  • Page 1 of 1

The Application and Teaching Value of a Ventricular Septal Defect Canine Model Established by Transcatheter Puncture.

Int Heart J 2021 Mar 17;62(2):367-370. Epub 2021 Mar 17.

Department of Cardiology, Changhai Hospital, The Second Military Medical University.

This study aimed to improve and further explore a ventricular septal defect (VSD) canine model on the basis of the transcatheter puncture method and to evaluate its application and teaching value.In order to lessen the complications of VSD closure, it is necessary to improve the currently available treatment devices using appropriate animal models.In this study, we used 16 healthy adult canines as our models. After anesthesia, the VSD puncture was performed, followed by balloon dilatation of the perforation. VSD was confirmed by angiography. The venous-artery orbit was established, and the VSD was then closed once the catheter and occluder were across the defect.Of the experimental canines, 14 of the 16 canines were successfully modeled, giving a success rate of 87.5%. The canines underwent an immediate creation of a venous-artery orbit for teaching practice and were implanted with an occluder during the procedure. After 4 weeks, 13 canines survived. As per our findings, most VSD types established by the puncture were perimembranous (10 of 13, 77%).The current model has a high success rate. The model can not only avoid the risk of infection and hemodynamic disorders associated with an open thoracotomy, but can also be effectively used in evaluating the impact of occluders. It can also directly measure the parameters of the devices during the procedure, thus having a very high experimental and teaching value.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1536/ihj.20-528DOI Listing
March 2021

Improved Transcatheter aortic valve implantation for aortic regurgitation using a new-type stent: the first preclinical experience.

J Cardiothorac Surg 2020 Sep 29;15(1):276. Epub 2020 Sep 29.

Department of Cardiology, The 903 Hospital of the Chinese People's Liberation Army, No. 40 JiChang Road, Jianggang District, Hangzhou, 310004, Zhejiang Province, China.

Background: In this study, we sought to evaluate the feasibility of improved transcatheter aortic valve implantation (TAVI) in noncalcified aortic valve by using the novel concept of double-layer ChenValve prosthesis. TAVI was initially considered as an alternative treatment for high-risk patients with aortic stenosis. However, non noncalcified aortic valve disease was considered as a contraindication to TAVI.

Methods: ChenValve prosthesis, which consisted of a self-expanding Nitinol ring, a balloon-expandable cobalt-chromium alloy stent and a biological valve, was implanted at the desired position under fluoroscopic guidance in a transapical approach through a 20F sheath in 10 goats. Aortic angiography was performed to measure the diameter of the aotic annulus and assess the performance of the artificial valve. The ultrasound was used to evaluate the regurgitation or paravalvular leakage and trans-prosthetic vascular flow velocity postoperatively. The aortogram and transthoracic echocardiography were applied to observe whether the valve stent was implanted at the desired position.

Results: ChenValve prosthesis was successfully transppical implanted in all animals. The aortogram and transthoracic echocardiography performed immediately after implantation revealed that the valve stent was implanted at the desired position. There was no significant paravalvular leakage, obstruction of coronary artery ostia, stent malpositioning or dislodgement occurred.

Conclusions: This preliminary trial with the novel double-layer ChenValve prosthesis demonstrated the feasibility of improved TAVI in noncalcified aortic valve. The mechanism of Nitinol ring-guided locating the aortic sinus enables us to anatomically correct position the artifact valve. This improved strategy seems to make the TAVI process more safe and repeatable in noncalcified aortic valve.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/s13019-020-01327-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7525934PMC
September 2020

Long-Term Follow-Up of Transthoracic Echocardiography-Guided Transcatheter Closure of Large Atrial Septal Defects (≥ 30 mm) Using the SHSMA Occluder.

Pediatr Cardiol 2020 Apr 1;41(4):716-723. Epub 2020 Feb 1.

Department of Cardiology, Changhai Hospital, Second Military Medical University, 168 Changhai Rd, Shanghai, 200433, China.

Transcatheter closure of large atrial septal defects (ASDs) remains controversial. The aim of this study was to evaluate the feasibility and safety of transthoracic echocardiography (TTE)-guided transcatheter closure of large ASDs. Patients with large secundum ASDs (≥ 30 mm) who underwent device closure were retrospectively reviewed. TTE was performed to guide ASD occluder positioning and assess the immediate and long-term outcomes. A total of 60 patients (median age 43.5 years, range 15-78 years) were enrolled in the study. The median ASD size was 35 mm (range 30-42 mm). Mild to moderate pulmonary hypertension was observed in 36 patients (60%). Thirty-one patients (51.7%) had one short rim, and 18 patients (30.0%) had two deficient rims. Placement of the device was successful in 57 patients (95%), and the median device size was 42 mm (range 40-50 mm). Dislodgement of the device occurred in three patients with two deficient rims: a larger device was redeployed in one case, and two patients required surgical repair. During a median follow-up of 37 months (range 6-83 months), no residual shunts, erosion, or embolization were noted, and pulmonary hypertension resolved in 75% of the patients. Thus t vast majority (95%) of large ASDs can be successfully closed percutaneously using the Chinese-made Shanghai Shape Memory Alloy (SHSMA) occluder under TTE guidance. Long-term follow-up showed that transcatheter closure could become a safe and effective alternative to surgery in select large ASDs.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00246-020-02288-0DOI Listing
April 2020

Sirt3 regulates mitophagy level to promote diabetic corneal epithelial wound healing.

Exp Eye Res 2019 04 19;181:223-231. Epub 2019 Feb 19.

From the Department of Ophthalmology, Fujian Medical University Union Hospital, Fu Zhou, China.

We aim to investigate how Sirt3 (silent mating type information regulation 2 homolog 3) promoting diabetic corneal epithelial wound healing by regulating mitophagy. The effect of HG(High Glucose, 25 mM D-glucose) on Sirt3 and LC3B(light chain 3 beta)which representing of mitophagy were investigated in TKE2 cells (a murine limbal/corneal epithelium-derived progenitor cell line) and corneal epithelium from C57BL/6J-Ins2Akita (Ins2) mice using RT-PCR and Western blotting. How overexpression of Sirt3 promoting diabetic corneal epithelial wound healing was investigated with cell migration assay、immunofluorescence、 immunofluorescence colocalization and corneal injury model. We found that HG reduced the expression of Sirt3 as well the mitophagy both in TKE2 cells and corneas from Ins2 mice. And overexpression of Sirt3 prominently promoted wound healing speed under HG condition via upregulating the level of mitophagy. Mitophagy level was increased dramatically when the Foxo3a (Forkhead box O3)/PINK1(PTEN Induced putative kinase protein 1)-Parkin pathway was activated by Sirt3 overexpression which suggested that the mitophagy was involved in cell injury under HG condition. This study demonstrated the mechanism of Sirt3 regulating mitophagy to promote diabetic corneal epithelial wound healing in vivo and in vitro, which suggested that Sirt3 may positively impact diabetic keratopathy(DK).
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.exer.2019.02.011DOI Listing
April 2019

MiR-34c Participates in Diabetic Corneal Neuropathy Via Regulation of Autophagy.

Invest Ophthalmol Vis Sci 2019 01;60(1):16-25

Department of Ophthalmology, Fujian Medical University Union Hospital, Fu Zhou, China.

Purpose: To investigate the contribution and mechanism of miRNAs and autophagy in diabetic peripheral neuropathy.

Methods: In this study, we used streptozotocin (STZ)-induced type I diabetes C57 mice as animal models, and we detected the expression of miR-34c and autophagic intensity in trigeminal ganglion (TG) tissue. The bioinformatics software was used to predict and analyze the potential targets of miR-34c. Primary trigeminal ganglion neurons were cultured in vitro to investigate the effect of miR-34c on axon growth and survival of TG cells. A corneal epithelial damage-healing model was established on the diabetic mice, then miR-34c antagomir was injected subconjunctivally. The condition of corneal epithelial healing was observed through sodium fluorescein staining, and the peripheral nerve degeneration of the cornea was evaluated by β-tublin corneal nerve staining.

Results: The expression of miR-34c was significantly increased in TG tissue of type I diabetic mice by real-time PCR. Western blot showed that autophagy-related proteins Atg4B and LC3-II were significantly down-regulated in diabetes TG compared with normal control. Trigeminal neuron immunofluorescence showed that the length of the trigeminal ganglion cell synapses was significantly increased after miR-34c antagomir treatment compared with normal cultures. Subconjunctival injection of miR-34c antagomir can significantly promote corneal epithelium healing of diabetic mice and appreciably promote the regeneration of corneal nerve. At the same time, it can significantly increase the expression of autophagy in TG tissue of type I diabetic mice.

Conclusions: In this study , miR-34c was found to affect the growth of trigeminal sensory neurons and the repair of diabetic corneal nerve endings by acting directly on Atg4B.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1167/iovs.18-24968DOI Listing
January 2019

Inhibition of Fusarium solani Infection in Murine Keratocytes by Lactobacillus salivarius ssp. salivarius JCM1231 Culture Filtrate In Vitro.

Curr Eye Res 2017 10 21;42(10):1339-1347. Epub 2017 Jun 21.

a Department of Ophthalmology , The Eye Center of the First Affiliated Hospital of Fujian Medical University, Fujian Eye Institute , Fuzhou , China.

Purpose: To explore the inhibitory activity of Lactobacillus salivarius ssp. salivarius JCM1231 (L. salivarius JCM1231) culture filtrate against Fusarium solani (F. solani) and its effects on murine keratocytes (MKs) infected with F. solani.

Methods: L. salivarius JCM1231 was cultured in an anaerobic incubator for 24 h, and the L. salivarius culture filtrate (LSCF) was prepared .The antifungal activity of L. salivarius JCM1231 against F. solani was determined with a plate overlay assay, agar diffusion assay, and conidial germination inhibition test. The effects of temperature, pH, and proteolytic enzymes on the antifungal activity of LSCF were detected with microtiter plate-well assay and conidial germination inhibition assay. Furthermore, the effects of LSCF on MKs infected with F. solani were detected. Cell activity and apoptosis were measured using methylthiazoletetrazolium assays and flow cytometry analysis, respectively. The levels of interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) cytokines were measured using real-time polymerase chain reactions and enzyme-linked immunosorbent assays (ELISA), and mycotoxin production was detected with high-performance liquid chromatography tandem mass spectrometry.

Results: Conidial germination and mycelia growth of F. solani were significantly inhibited by LSCF. The antifungal substances produced by L. salivarius JCM1231 were heat unstable, proteinaceous, and sensitive to proteolytic enzymes and were active within a narrow acidic pH range between 2.0 and 4.0. In the presence of 15 µg/ml of LSCF, cell activity was significantly increased, and cell apoptosis, the level of IL-6 and TNF-α expressions, and mycotoxin (zearalenone and fumonisin B1) productions were decreased significantly in MKs infected with F. solani.

Conclusion: L. salivarius JCM1231 culture filtrate can effectively inhibit F. solani growth and protect MKs against F. solani infection.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1080/02713683.2017.1317816DOI Listing
October 2017

Liver-to-spleen ratio as an index of chronic liver diseases and safety of hepatectomy: a pilot study.

World J Surg 2014 Dec;38(12):3186-92

Clinical Center of Liver Disease, Shanghai Public Health Clinical Center, 56 Shuidian Road, Shanghai, China,

Background: Hepatic failure is a main cause of death after hepatectomy. Accurate preoperative evaluation of functional liver reserve is the key to ensure safe resection. Studies have found that the spleen would gradually enlarge as chronic liver disease worsened. This study was designed to determine whether preoperative liver-to-spleen ratio (LSR) would be an indicator to evaluate severity of liver disease and predict safety of hepatectomy.

Methods: The volumes of liver and spleen were evaluated on computed tomography scan in 67 patients who received partial hepatectomy. Preoperative LSR was calculated. Statistical analysis was conducted to examine the relationship between LSR and the degree of chronic liver disease. Ability of LSR to predict the safety of hepatectomy also was evaluated.

Results: LSR had a negative correlation with the degree of chronic liver diseases (r = -0.606, P < 0.0001). LSR = 3.22 was the cutoff point for predicting posthepatectomy complications and inadequacy. AUC, sensitivity, and specificity for predicting posthepatectomy complications and inadequacy respectively were 0.830 (95 % confidence interval [CI] 0.715-0.950, P < 0.0001), 69.6, 93.2 %, and 0.863 (95 % CI 0.777-0.949, P < 0.0001), 68.8, 84.3 %. Multivariate analysis showed that LSR = 3.22 was the factor that affected both posthepatectomy complications and liver inadequacy.

Conclusions: Preoperative LSR score correlated well with the degree of chronic liver diseases, and it probably help us to improve the safety of hepatectomy.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00268-014-2717-6DOI Listing
December 2014

TGF-β upregulates miR-182 expression to promote gallbladder cancer metastasis by targeting CADM1.

Mol Biosyst 2014 Mar 21;10(3):679-85. Epub 2014 Jan 21.

The Second Department of Biliary Tract Surgery, Eastern Hepatobiliary Surgery Hospital, The Second Military Medicine University, 225 Changhai Road, Shanghai 200438, China.

Unlabelled: Transforming growth factor β (TGF-β) plays important roles in tumor metastasis by regulating miRNAs expression. miR-182 is an important molecule in the regulation of cancer progression. The aim of the study is to assess the role of miR-182 in TGF-β-induced cancer metastasis. In the present study, we found that miR-182 levels are significantly upregulated in GBC tissues compared with normal controls, and miR-182 expression is remarkably increased in primary tumors that subsequently metastasized, when compared to those primary tumors that did not metastasize. TGF-β induces miR-182 expression in GBC cells, and overexpression of miR-182 promotes GBC cell migration and invasion, whereas miR-182 inhibition suppresses TGF-β-induced cancer cell migration and invasion. The blockage of miR-182 by a specific inhibitor effectively inhibits pulmonary metastases in vivo. We further identified that the cell adhesion molecule1 (CADM1) is a new target gene of miR-182. miR-182 negatively regulates CADM1 expression in vitro and in vivo. Importantly, re-expression of CADM1 in GBC cells partially abrogates miR-182-induced cell invasion.

Conclusions: miR-182 is an important mediator of GBC metastasis, thus offering a new target for the development of therapeutic agents against GBC.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1039/c3mb70479cDOI Listing
March 2014

miR-204 inhibits epithelial to mesenchymal transition by targeting slug in intrahepatic cholangiocarcinoma cells.

Cell Physiol Biochem 2013 22;32(5):1331-41. Epub 2013 Nov 22.

The Second Department of Biliary Tract Surgery, Eastern Hepatobiliary Surgery Hospital, The Second Military Medical University, Shanghai, China.

Background/aims: MicroRNAs (miRNAs) play critical roles during carcinogenesis and cancer progression. Down-regulation of miR-204 has been frequently observed in various cancers. In this study, we investigated the roles and mechanisms of miR-204 in human intrahepatic cholangiocarcinoma (ICC).

Methods: The relative expression of miR-204 in ICC tissues and cell lines was monitored by qRT-PCR. Effects of miR-204 were studied in human ICC cell lines HuH28 and HuCCT1, and cells were analyzed for proliferation, migration and invasion. Expression levels of miR-204 target gene Slug and EMT markers (E-cadherin and vimentin) in ICC cell lines and tissues were measured by qRT-PCR, western blotting and immunofluorescence.

Results: miR-204 was frequently downregulated in human ICC, and the low-level expression of miR-204 was significantly associated with lymph node metastasis. Overexpression of miR-204 dramatically suppressed ICC cell migration and invasion, as well as the epithelial-mesenchymal transition process (EMT). Slug was identified as a direct target of miR-204, and its downregulation by miR-204 in HuH28 cells reversed EMT, as shown by the increased expression of the epithelial marker E-cadherin and decreased expression of the mesenchymal marker vimentin.

Conclusion: These findings suggest that miR-204 plays negative roles in the invasive and/or metastatic potential of ICC, and that its suppressive effects are mediated by repressing Slug expression.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1159/000354531DOI Listing
August 2014

Bevacizumab attenuates hepatic fibrosis in rats by inhibiting activation of hepatic stellate cells.

PLoS One 2013 30;8(8):e73492. Epub 2013 Aug 30.

Department of Special Treatment, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China ; Department of Hepatobiliary Surgery, Shuguang Hospital, Shanghai, China.

Angiogenesis is a fundamental part of the response to tissue injury, which is involved in the development of hepatic fibrosis. Vascular endothelial growth factor plays an important role in angiogenesis. The expression of VEGF is increased during hepatic fibrogenesis and correlates with the micro-vessel density. In this study, we investigated the effects of bevacizumab, an anti-angiogenetic drug, on the formation of hepatic fibrosis. We found that bevacizumab could attenuate the development of hepatic fibrosis and contribute to the protection of liver function. Bevacizumab was also found to downregulate the expression α-SMA and TGF-β1, which have been reported to be profibrogenic genes in vivo. We also observed that the expression of VEGF increased significantly during the development of hepatic fibrosis and CCl4 was found to induce hepatocytes to secrete VEGF, which led to the activation and proliferation of HSCs. Bevacizumab was also found to block the effects of the hepatocytes on the activation and proliferation of HSCs. Our results suggest that bevacizumab might alleviate liver fibrosis by blocking the effect of VEGF on HSCs. Bevacizumab might be suitable as a potential agent for hepatic fibrosis therapy.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0073492PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3758295PMC
April 2014

Infrahepatic inferior vena cava clamping in hepatectomy for tumors involving hepatocaval confluence.

Asian J Surg 2013 Jul 16;36(3):111-5. Epub 2013 Mar 16.

Department of Special Treatment and Liver Transplantation, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China.

Background: Massive hemorrhage and the need for blood transfusion carry a high rate of morbidity and mortality after hepatectomy. The aim of this study was to evaluate the safety and potential benefit of infrahepatic inferior vena cava (IVC) clamping in hepatectomy for tumors involving hepatocaval confluence.

Methods: We conducted a retrospective analysis of 113 consecutive patients who underwent hepatectomy with infrahepatic IVC clamping (n = 60, Group A) and without infrahepatic IVC clamping (n = 53, Group B) as the initial treatment for tumors involving hepatocaval confluence.

Results: In Group A, central venous pressure reduced from 7.6 ± 3.2 to 4.4 ± 2.7 cm H₂O (p < 0.001). Patients in Group A experienced less blood loss (477.3 ± 340.3 vs. 794.5 ± 602.7 mL, p = 0.001), fewer blood transfusion requirements (8.3% vs. 22.6%, p = 0.034), lower postoperative complications (40% vs. 60.4%, p = 0.031), and shorter hospital stay (10.7 ± 2.2 vs. 12.9 ± 4.8 days, p = 0.008) than those in Group B.

Conclusion: Infrahepatic IVC clamping is generally effective and safe in controlling bleeding during hepatectomy for tumors involving hepatocaval confluence.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.asjsur.2013.01.002DOI Listing
July 2013

Results of en bloc resection for hepatocellular carcinoma extending to adjacent organs.

Can J Surg 2012 Aug;55(4):222-6

Department of Hepato-Biliary-Pancreato-Vascular Surgery, First Affiliated Hospital of Xiamen University, Xiamen, China.

Background: To curatively resect hepatocellular carcinoma (HCC) with adjacent organ extension, the combined resection of these organs is inevitable. We analyzed the safety and effectiveness of en bloc resection for HCC extending to adjacent organs.

Methods: From December 2002 to May 2006, we compared the surgical outcomes of patients with HCC extending to adjacent organs with those of closely matched, randomly selected patients with HCC without adjacent organ extension.

Results: We included 42 patients whose HCC extended to adjacent organs and 126 patients whose HCC did not extend to adjacent organs. There was no significant difference in survival, operative morbidity or mortality between the groups. In patients with HCC extending to adjacent organs, histopathological examination of the specimen revealed true tumour invasion in 13 and adhesion in 29 patients. Those with tumour invasion were more likely to have a high incidence of capsule infiltration, microvascular invasion and early intrahepatic recurrence (≤ 1 yr after hepatectomy). The 5-year overall survival of patients with tumour invasion was 11.5%, whereas that of patients with tumour adhesion was 38.1% (p = 0.033).

Conclusion: En bloc resection is a safe and effective therapy for HCC extending to adjacent organs. Tumour invasion to adjacent organs exhibits a more aggressive clinical behaviour and is associated with worse survival than tumour adhesion.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1503/cjs.028410DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3404140PMC
August 2012

Safety and efficacy of trisectionectomy for hepatocellular carcinoma.

ANZ J Surg 2011 Dec 7;81(12):895-9. Epub 2011 Jan 7.

Department of Hepato-Biliary-Pancreato-Vascular Surgery, The First Affiliated Hospital of Xiamen University, China.

Background: Right or left trisectionectomy represents the most extensive and difficult type of hepatic resection, and carries an unfavourably high morbidity and mortality. This retrospective study aimed to evaluate the safety and efficacy of trisectionectomy for hepatocellular carcinoma (HCC).

Methods: From January 2000 to December 2008, 35 patients with HCC were treated with trisectionectomy. The treatment outcomes of these patients were retrospectively analysed.

Results: Twenty-three right and 12 left trisectionectomies were performed. The overall operative morbidity and mortality were 42.8% (n= 15) and 2.8% (n= 1), respectively. The 1-, 3-, and 5-year overall survival rates were 82.9%, 51.4% and 23.8%, while the 1-, 3- and 5-year disease-free survival rates were 71.4%, 42.9% and 12.9%, respectively.

Conclusions: With careful patient selection and meticulous surgical technique, trisectionectomy can be performed safely and is associated with long-term survival in a subset of patients with HCC.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/j.1445-2197.2010.05605.xDOI Listing
December 2011

A let-7/Fas double-negative feedback loop regulates human colon carcinoma cells sensitivity to Fas-related apoptosis.

Biochem Biophys Res Commun 2011 May 21;408(3):494-9. Epub 2011 Apr 21.

The Department of Special Treatment, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, No. 225, Changhai Road, Shanghai 200438, China.

Interferon-γ (IFN-γ) is considered essential for the regulation of anti-tumor reactions as it sensitizes Fas-related apoptosis in HT29 cells, but the mechanism is unclear. In the current study, our data demonstrated that IFN-γ stimulation and Fas activation suppressed Dicer processing and let-7 microRNA biogenesis, while let-7 microRNA strongly inhibited Fas expression by directly targeting Fas mRNA. Accordingly, our results indicate that Fas and let-7 microRNAs form a double-negative feedback loop in IFN-γ and Fas induced apoptosis in colon carcinoma cell line HT29, which may be an important synergistic mechanism in anti-tumor immune response. We also found that a let-7 microRNA inhibitor increased Fas expression and sensitized cells to Fas-related apoptosis, which may have future implications in colon carcinoma therapy.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.bbrc.2011.04.074DOI Listing
May 2011

Intraductal papillary mucinous neoplasms of the pancreas--predictors of malignancy.

Hepatogastroenterology 2010 May-Jun;57(99-100):635-9

Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China.

Background/aims: Preoperative determination of malignancy in Intraductal Papillary Mucinous Neoplasms (IPMN) remains problematic. The aim of this study was to review our experience with surgical resection for IPMN and to identify the clinicopathological features that predicted malignancy in IPMN.

Methodology: Forty patients who underwent pancreatic resection for IPMN at a single tertiary center between January 1996 and March 2008 were retrospectively analyzed.

Results: Thirteen patients (32.5%) had adenomas, 4 (10%) borderline IPMN, 18 (45%) carcinoma in situ, and 5 (12.5%) invasive carcinoma. Patients with benign IPMN had 1-, 3-, and 5-year overall survival rates of 100%, 94.1%, and 88.2%, respectively and 1-, 3-, and 5-year disease-free survival rates of 100%, 94.1%, and 88.2%, respectively. Patients with malignant IPMN had 1-, 3-, and 5-year overall survival rates of 100%, 65.2%, and 56.5%, respectively and 1-, 3-, and 5-year disease-free survival rates of 91.3%, 47.8%, and 43.5% respectively. After a median follow-up of 39 months (range, 9 - 89) months, there were 5 patients with disease recurrences (12.5%) in patients with IPMN with invasive carcinoma after operation. Abdominal pain, jaundice, main-duct or mixed type, tumor size, mural nodule and size of mural nodule, were predictive of malignant IPMN by univariate analysis, and size of mural nodule was identified as the only independent predictive factor for malignancy.

Conclusions: The optimal management of IPMN remains controversial and should be individualized based on the balance between risk and benefit.
View Article and Find Full Text PDF

Download full-text PDF

Source
September 2010

Prognostic factors in the surgical treatment of caudate lobe hepatocellular carcinoma.

World J Gastroenterol 2010 Mar;16(9):1123-8

Department of Special Treatment and Liver Transplantation, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai 200438, China.

Aim: To evaluate the short- and long-term outcomes of liver resection for caudate lobe hepatocellular carcinoma (HCC).

Methods: We retrospectively analyzed 114 consecutive patients with HCC, originating from the caudate lobe, who underwent resection between January 2001 and January 2007. Univariate and multivariate analyses were performed on several clinicopathologic variables to determine the factors affecting long-term outcome and intrahepatic recurrence.

Results: Overall mortality and morbidity were 0% and 18%, respectively. After a median follow-up of 31 mo (interquartile range, 11-66 mo), tumor recurrence had occurred in 76 patients (66.7%). The 1-, 3-, and 5-year disease-free survival rates were 65.7%, 38.1%, and 18.4%, respectively. The 1-, 3-, and 5-year overall survival rates were 76.1%, 54.7%, and 31.8%, respectively. Univariate analysis showed that subsegmental location of the tumor (45.7% vs 16.2%, P = 0.01), liver cirrhosis (12.3% vs 47.9%, P = 0.03), surgical margin (18.5% vs 54.6%, P = 0.04), vascular invasion (37.9% vs 23.2%, P = 0.04) and extended caudate resection (42.1% vs 15.4%, P = 0.04) were related to poorer long-term survival. Multivariate analysis showed that only subsegmental location of the tumor, liver cirrhosis and surgical margin were significant independent prognostic factors.

Conclusion: Hepatectomy was an effective treatment for HCC in the caudate lobe. The subsegmental location of the tumor, liver cirrhosis and surgical margin affected long-term survival.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2835791PMC
http://dx.doi.org/10.3748/wjg.v16.i9.1123DOI Listing
March 2010

Risk factors for early recurrence of small hepatocellular carcinoma after curative resection.

Hepatobiliary Pancreat Dis Int 2010 Feb;9(1):33-7

Department of Hepato-Biliary-Pancreato-Vascular Surgery, First Xiamen Hospital, Fujian Medical University, Xiamen 361003, China.

Background: Poorer prognosis is seen in patients with hepatocellular carcinoma (HCC) after curative hepatic resection with early recurrence (1 year). This study aimed to identify risk factors for postoperative early recurrence of small HCC (
Methods: The study population consisted of 158 patients who underwent curative resection for small HCC between January 2002 and July 2004. Risk factors for early recurrence were analyzed.

Results: Thirty-three (20.8%) patients developed early recurrence after surgery. Univariate analysis showed the following significant risk factors for early recurrence in small HCC: serum alpha-fetoprotein (AFP) level >100 ng/ml, lack of tumor capsule formation, microscopic vascular invasion, high Edmonson-Steiner grades, and cytokeratin-19 (CK-19) expression (P<0.05). Multivariate stepwise logistic regression analysis showed that serum AFP level >100 ng/ml (odds ratio 2.561, 95% confidence interval 1.057 to 6.206, P=0.037) and microscopic vascular invasion (odds ratio 4.549, 95% confidence interval 1.865 to 11.097, P=0.001) were independent factors.

Conclusions: Postoperative early recurrence is related to serum AFP level >100 ng/ml and microscopic vascular invasion in patients with small HCC. Adjuvant therapy and careful follow-up are required for patients with these risk factors.
View Article and Find Full Text PDF

Download full-text PDF

Source
February 2010

Clinicopathological and prognostic analysis of 429 patients with intrahepatic cholangiocarcinoma.

World J Gastroenterol 2009 Dec;15(47):5976-82

Department of Special Treatment, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, 225 Changhai Road, Shanghai 200438, China.

Aim: To understand the clinicopathological characteristics and treatment selections and improve survival and provide valuable information for patients with intrahepatic cholangiocarcinoma (ICC).

Methods: We retrospectively evaluated 5311 liver cancer patients who received resection between October 1999 and December 2003. Of these, 429 (8.1%) patients were diagnosed with ICC, and their clinicopathological, surgical, and survival characteristics were analyzed.

Results: Upper abdominal discomfort or pain (65.0%), no symptoms (12.1%), and hypodynamia (8.2%) were the major causes for medical attention. Laboratory tests showed 198 (46.4%) patients were HBsAg positive, 90 (21.3%) had alpha-fetoprotein > 20 microg/L, 50 (11.9%) carcinoembryonic antigen > 10 microg/L, and 242 (57.5%) carbohydrate antigen 19-9 (CA19-9) > 37 U/mL. Survival data was available for 329 (76.7%) patients and their mean survival time was 12.4 mo. The overall survival of the patients with R0, R1 resection and punching exploration were 18.3, 6.6 and 5.6 mo, respectively. Additionally, CA19-9 > 37 U/mL was associated with lymph node metastases, but inversely associated with cirrhosis. Multivariate analysis indicated that radical resection, lymph node metastases, macroscopic tumor thrombi and size, and CA19-9 were associated with prognosis.

Conclusion: Surgical radical resection is still the most effective means to cure ICC. Certain laboratory tests (such as CA19-9) can effectively predict the survival of the patients with ICC.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2795186PMC
http://dx.doi.org/10.3748/wjg.15.5976DOI Listing
December 2009

[Study of bloodless hepatectomy under occlusion of total hemi-hepatic vessel].

Zhonghua Wai Ke Za Zhi 2007 Feb;45(3):186-8

Department of Special Treatment, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai 200438, China.

Objective: To explore the preliminary clinical evaluation of hepatectomy with total hemi-hepatic vascular exclusion.

Methods: Twenty-eight patients with primary liver cancer were divided into two groups of hepatectomy with total hemi-hepatic vascular exclusion (group A) and total hepatic inflow occlusion (group B). The time of hepatic vascular control, intraoperative blood loss, volume of removed liver, postoperative liver function recovery and complications were compared between the two groups.

Results: The intraoperative blood loss in group A was (296 +/- 240) ml, which was less significantly than that in group B [(582 +/- 497) ml] (P<0.05). The serum pre-albumin levels on the day 1, 3 and 7 after operation in group A were (164 +/- 39) mg/L, (111 +/- 17) mg/L and (104 +/- 23) mg/L, which were higher significantly than that in group B [(134 +/- 34) mg/L, (90 +/- 22) mg/L and (82 +/- 35) mg/L] (P<0.05). While the time of hepatic vascular control and volume of lost liver were no difference between the groups (P>0.05). There were no significant difference in other items between the groups.

Conclusions: Intraoperative blood loss and liver damage of hepatectomy under the total hemi-hepatic vascular exclusion could be less than that under the other methods of vascular occlusion. It could be worth improving and applying further.
View Article and Find Full Text PDF

Download full-text PDF

Source
February 2007

Hepatectomy in the treatment of very big primary liver cancer: report of 86 cases.

Hepatobiliary Pancreat Dis Int 2002 Feb;1(1):42-5

Easten Hospital of Hepatobiliary Surgery, Second Military Medical University, Shanghai 200433 China.

Objective: To study the indications for resection of very big primary liver cancer and the operative results.

Methods: From January 1985 to June 1996, 86 patients with very big primary liver cancer (>/= 15 cm in diameter) underwent hepatectomy in our hospital. The volume of bleeding and blood transfusion was recorded during the operation. After the operation, the draining quantity from their abdominal cavities, and the days of transfusion and hospitalization were recorded. The occurrence of complications and survival time of the patient were followed up.

Results: The postoperative mortality was 3.48% and the occurrence rate of complications was 31.40%, which was significantly correlated with preoperative lower level of serum albumin or the elevated gamma-globulin level and the amount of resected liver tissue. But their liver function before operation was fairly good, the 1-, 3-and 5-year survival rates after hepatectomy were 58.2%, 35.7% and 17.64%.

Conclusions: patients with very big primary liver cancer, should be subjected to hepatectomy if their liver function before operation are normal and the margins are distinct between the tumor and liver tissues. After the operation, other treatments are suitable for good effects.
View Article and Find Full Text PDF

Download full-text PDF

Source
February 2002