Surgical outcome of hepatocellular carcinoma patients with biliary tumor thrombi

<p>Abstract</p> <p>Background</p> <p>To investigate the surgical outcome of hepatocellular carcinoma (HCC) patients with biliary tumor thrombi (BTT).</p> <p>Methods</p> <p>Surgical outcome of 27 HCC patients with BTT (group I) were compared with randomly selected HCC patients without BTT (group II; n = 270).</p> <p>Results</p> <p>One patient in group I died of hepatic failure within 30 days after resection. The 1-, 3- and 5-year cumulative survival rates of group I were 70.3%, 25.9%, and 7.4%, respectively; these were significantly lower than those of group II (90.6%, 54.0%, and 37.7%) (<it>P <</it>0.001). The rates of early recurrence (≤ 1 year) after resection were significantly higher in group I than group II (70.3% vs. 34.8%) (<it>P </it>< 0.001).</p> <p>Conclusion</p> <p>HCC patients with BTT had a worse prognosis after resection than those without BTT. Resection should be considered for these tumors given the lack of effective alternative therapies.</p

Repeat hepatectomy for recurrent hepatocellular carcinoma: a local experience and a systematic review

Background: This study aimed to assess the efficacy and safety of repeat hepatectomy for recurrent hepatocellular carcinoma (HCC). Methods: Thirty-seven patients who underwent a curative repeat hepatectomy in our hospital were retrospectively studied. An extensive database literature search was performed to obtain for all relevant studies. Results: In our series, there were no perioperative deaths during repeat hepatectomy for recurrent HCC. Patients survival after repeat hepatectomy were similar to 429 patients undergoing initial hepatectomy. A computerized search of the Medline and PubMed databases found 29 retrospective studies providing relevant data in 1149 patients were included for appraisal and data extraction. After the repeat hepatectomy, postoperative morbidity ranged from 6.2% to 68.2% with a median per cohort of 23.5 per cent. There were 7 perioperative deaths (0.7 per cent of 993 for whom mortality data were provided). The overall median survival ranged from 21 to 61.5 months, with 1 -, 3 -, and 5-year survival of 69.0% to 100%, 21.0% to 87.0%, and 25.0% to 87.0%, respectively. Conclusions: Repeat hepatectomy can be performed safely and is associated with long-term survival in a subset of patients with recurrent HCC. However, the findings have to be carefully interpreted due to the lower level of evidence. A randomized controlled study is needed to compare repeat hepatectomy and other modalities for recurrent HCC

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

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. 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. 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. Infrahepatic IVC clamping is generally effective and safe in controlling bleeding during hepatectomy for tumors involving hepatocaval confluence

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

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

Numerical Study on Particulate Fouling Characteristics of Flue with a Particulate Fouling Model Considering Deposition and Removal Mechanisms

Due to a large amount of particulate matter in industrial flue gas, the formation of particulate deposits on the flue wall will increase the instability of equipment operation, which needs to be solved urgently. In this paper, a numerical investigation on the characteristics of particulate deposition and removal in the furnace flue was carried out for waste heat and energy recovery. This research adopted a comprehensive fouling model combined with the discrete phase model (DPM) which was performed by the CFD framework and extended by user-defined functions (UDFs). Firstly, the particulate deposition and removal algorithms were proposed to develop the judgment criterion of particle fouling based on the Grant and Tabakoff particle–wall rebound model and the Johnson–Kendall–Roberts (JKR) theory. This model not only considered the particles transport, sticking, rebound, and removal behaviors, but also analyzed the deposition occurring through the multiple impactions of particles with the flue wall. Then, the influence of furnace gas velocity, particle concentration, and inflection angle α of the tee section on the particulate fouling were predicted. The results show that the furnace gas velocity, particle concentration, and flue structure have significant effects on particle fouling and distribution, and the particle fouling mainly occurs in the blind elbow section and the tee sections of the flue. In addition, the fouling mass of particles decreases with an increasing furnace gas velocity and the decrease in particle concentration. Lastly, the fouling mass of particles decreases with the increase in the inflection angle α of the tee section, and the location of particle fouling gradually transfers from the blind elbow section to the tee section

Comparative Investigation of Axial Bearing Performance and Mechanism of Continuous Flight Auger Pile in Weathered Granitic Soils

Axial bearing performance and mechanism of continuous flight auger (CFA) pile in weathered granitic soils, i.e., a widespread special soil in South China, were investigated by field test in this study. Load–settlement responses of four CFA piles were examined, and evolutions of shaft/base resistances were captured by ultra-weak fiber Bragg gratings (UWFBG) with a reflectivity ≤−40 dB. Performances of CFA piles were compared with those of a slurry displacement (SD) pile at the same site, thirteen pretensioned spun high-strength concrete (PHC) piles in the literature and empirical data in design code. Test results show that the ultimate bearing capacity of the CFA pile is highest among different pile types, and typically is twice that of the SD pile. Again, CFA pile produces the highest shaft resistances at 140 kPa and 153 kPa in two weathered granitic soils, while the base resistance of 3080 kPa is between those of the SD pile and the PHC pile. By field excavation, the superior mechanism of the CFA pile is suggested to avoid the formation of in-between bentonite layers and prevent preferential baseflow along fissures, both of which can weaken the soil–pile interface. Overall, this study provides fundamental data through UWFBG and explanations based on field observations which underpin the need for developing a design code specified for CFA piles in South China

Numerical Study on Particulate Fouling Characteristics of Flue with a Particulate Fouling Model Considering Deposition and Removal Mechanisms

Due to a large amount of particulate matter in industrial flue gas, the formation of particulate deposits on the flue wall will increase the instability of equipment operation, which needs to be solved urgently. In this paper, a numerical investigation on the characteristics of particulate deposition and removal in the furnace flue was carried out for waste heat and energy recovery. This research adopted a comprehensive fouling model combined with the discrete phase model (DPM) which was performed by the CFD framework and extended by user-defined functions (UDFs). Firstly, the particulate deposition and removal algorithms were proposed to develop the judgment criterion of particle fouling based on the Grant and Tabakoff particle&ndash;wall rebound model and the Johnson&ndash;Kendall&ndash;Roberts (JKR) theory. This model not only considered the particles transport, sticking, rebound, and removal behaviors, but also analyzed the deposition occurring through the multiple impactions of particles with the flue wall. Then, the influence of furnace gas velocity, particle concentration, and inflection angle &alpha; of the tee section on the particulate fouling were predicted. The results show that the furnace gas velocity, particle concentration, and flue structure have significant effects on particle fouling and distribution, and the particle fouling mainly occurs in the blind elbow section and the tee sections of the flue. In addition, the fouling mass of particles decreases with an increasing furnace gas velocity and the decrease in particle concentration. Lastly, the fouling mass of particles decreases with the increase in the inflection angle &alpha; of the tee section, and the location of particle fouling gradually transfers from the blind elbow section to the tee section

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

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. Copyright (C) 2013, Asian Surgical Association. Published by Elsevier Taiwan LLC. All rights reserved

Safety and efficacy of trisectionectomy for hepatocellular carcinoma

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