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  • 1
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    Online Resource
    Phase II study of megestrol acetate in the treatment of hepatocellular carcinoma
    Wiley ; 1997
    In:  Journal of Gastroenterology and Hepatology Vol. 12, No. 4 ( 1997-04), p. 277-281
    Details
    In: Journal of Gastroenterology and Hepatology, Wiley, Vol. 12, No. 4 ( 1997-04), p. 277-281
    Abstract: This is a report of a phase II study of megestrol acetate (160mg/day, orally) in the treatment of hepatocellular carcinoma (HCC). Forty‐six patients with advanced HCC were studied and tumour response, changes in appetite, bodyweight, a feeling of well‐being, survival and toxicity were evaluated. Thirty‐two patients were able to be evaluated for response; there were no complete responders or partial responders. Twelve patients (38%) had stable disease and seven of these patients had a minor response with a median size reduction in the tumour of 18%. Twenty patients (62%) had progressive disease. Five of 24 (21%) patients had a median reduction in α‐fetoprotein levels of 59ng/mL. The overall median survival was 4 months (range 1 week to 27 months). Twenty of 32 (62%) patients had an increased appetite and feeling of well‐being. Fourteen of 22 (64%) patients had a median lean bodyweight gain of 5 kg (range 1–14 kg). Toxicities were minimal. Tests for glucocorticoid receptors were performed in 10 patients. Four of five patients who were positive for glucocorticoid receptors in the tumour had a stable disease and all five patients who were negative for glucocorticoid receptors had progressive disease. Megestrol acetate had no significant effect on the tumour in HCC patients. However, megestrol acetate is useful in the palliative management of HCC patients, with improvements in appetite, bodyweight and a feeling of well‐being with minimal side effects. Some patients had stable disease, a minor reduction of tumour size and a prolonged survival after megestrol acetate treatment and this response may be related to the presence of glucocorticoid receptors in the HCC tumour.
    Type of Medium: Online Resource
    ISSN: 0815-9319 , 1440-1746
    URL: Issue
    URL: Article
    DOI: 10.1111/jgh.1997.12.issue-4
    DOI: 10.1111/j.1440-1746.1997.tb00421.x
    Language: English
    Publisher: Wiley
    Publication Date: 1997
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  • 2
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    Phase II study of flutamide in the treatment of hepatocellular carcinoma
    Wiley ; 1996
    In:  Cancer Vol. 77, No. 4 ( 1996-02-15), p. 635-639
    Details
    In: Cancer, Wiley, Vol. 77, No. 4 ( 1996-02-15), p. 635-639
    Type of Medium: Online Resource
    ISSN: 0008-543X , 1097-0142
    URL: Issue
    URL: Journal
    URL: Article
    DOI: 10.1002/(SICI)1097-0142(19960215)77:4〈〉1.0.CO;2-M
    DOI: 10.1002/(ISSN)1097-0142
    DOI: 10.1002/(SICI)1097-0142(19960215)77:4〈635::AID-CNCR8〉3.0.CO;2-F
    Language: English
    Publisher: Wiley
    Publication Date: 1996
    detail.hit.zdb_id: 1479932-7
    detail.hit.zdb_id: 1429-1
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  • 3
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    Comparison of Resected and Non‐resected Intraductal Papillary Mucinous Neoplasms of the Pancreas
    Wiley ; 2005
    In:  World Journal of Surgery Vol. 29, No. 12 ( 2005-12), p. 1650-1657
    Details
    In: World Journal of Surgery, Wiley, Vol. 29, No. 12 ( 2005-12), p. 1650-1657
    Abstract: By comparing the clinicopathological features and survivals between the resected and non‐resected intraductal papillary mucinous neoplasms (IPMNs) of the pancreas, this study tried to clarify the natural history of IPMNs, to provide a strategy for treatment, and to determine the justification of not performing resection for some patients. A total of 57 patients with IPMN, including 39 resected and 18 non‐resected IPMNs, were recruited for study. Data on demographics, clinical presentations, diagnostic work‐up, treatment modality, clinical course, and outcomes were evaluated and compared between the resected and non‐resected IPMNs. The most common clinical presentation was abdominal pain (57% in total IPMNs, 67% in resected, 33% in non‐resected), followed by body weight loss (32% in total IPMNs, 33% in resected, 28% in non‐resected). The sensitivity in the diagnosis of IPMN was highest by magnetic resonance cholangiopancreatography (MRCP) (88%), followed by endoscopic retrograde cholangiopancreatography (ERCP) (68%), and computed tomography scan (CT scan) (42%) and sonography (10%). The median survival was 21.5 months for patients with resected IPMNs, ranging from 2 to 124 months, and 14 months in non‐resected IPMN patients, ranging from 5.5 to 70 months. There is no significant survival difference between the resected and non‐resected groups, with a 5‐year survival of 69.8% in resected IPMNs and 59.8% in non‐resected IPMNs, P = 0.347. The survival outcome of the unresectable non‐resected IPMNs was much inferior to the resected IPMNs, P = 0.002 and resectable non‐resected IPMNs, P = 0.001. Thus, the prime prognostic factor in predicting the survival outcome of IPMNs is resectability, instead of resection itself. Long‐term survival could also be expected in resectable IPMNs without resection. No resection for the IPMN may be justified for patients with high surgical risks, especially for those who are asymptomatic and very aged.
    Type of Medium: Online Resource
    ISSN: 0364-2313 , 1432-2323
    URL: Article
    DOI: 10.1007/s00268-005-0035-8
    Language: English
    Publisher: Wiley
    Publication Date: 2005
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  • 4
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    A Comparison of Prognosis between Patients with Hepatitis B and C Virus‐related Hepatocellular Carcinoma Undergoing Resection Surgery
    Wiley ; 2011
    In:  World Journal of Surgery Vol. 35, No. 4 ( 2011-04), p. 858-867
    Details
    In: World Journal of Surgery, Wiley, Vol. 35, No. 4 ( 2011-04), p. 858-867
    Abstract: The impact of viral factors on the prognosis of hepatocellular carcinoma (HCC) remains controversial because of heterogeneous populations included in previous reports. This study aims to compare clinicopathologic features and prognoses between patients with hepatitis B‐ and hepatitis C‐related HCC who underwent resection surgery. Methods We enrolled 609 patients with positive serum hepatitis B virus (HBV) surface antigen (HBsAg) and negative serum antibody against hepatitis C virus (anti‐HCV) as the B‐HCC group and 206 patients with negative serum HBsAg and positive anti‐HCV as the C‐HCC group. The overall survival rates and cumulative recurrence rates were compared between these two groups. Results B‐HCC patients were significantly younger, predominantly male, had better liver functional reserve, but more advanced tumor stage than C‐HCC patients. After a median follow‐up period of 40.6 months, 427 patients had died. Furthermore, 501 patients had tumor recurrence after surgery. The postoperative overall survival rates ( p = 0.640) and recurrence rates ( p = 0.387) of the two groups were comparable. However, the overall survival rate was higher in the B‐HCC group than in the C‐HCC group in the cases of transplantable HCC ( p = 0.021) and Barcelona‐Clinic Liver Cancer stage A HCC ( p = 0.040). Conclusions Viral etiologies were not apparent in determining outcomes of HCC patients who underwent resection due to heterogeneous studied populations. In early‐stage HCC, B‐HCC patients had better outcomes than C‐HCC patients did because of better liver reserve and less hepatic inflammation.
    Type of Medium: Online Resource
    ISSN: 0364-2313 , 1432-2323
    URL: Article
    DOI: 10.1007/s00268-010-0928-z
    Language: English
    Publisher: Wiley
    Publication Date: 2011
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    detail.hit.zdb_id: 1463296-2
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  • 5
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    Surgical Mortality, Survival, and Quality of Life after Resection for Gastric Cancer in the Elderly
    Wiley ; 2000
    In:  World Journal of Surgery Vol. 24, No. 4 ( 2000-04), p. 465-472
    Details
    In: World Journal of Surgery, Wiley, Vol. 24, No. 4 ( 2000-04), p. 465-472
    Abstract: Although there were some studies on clinicopathologic characteristics, operative morbidity, and mortality in elderly patients with gastric cancer, no reports have specifically focused on survival and quality of life after resection. A total of 433 patients aged ≥ 65 years (1987–1994) who underwent gastric resection for gastric adenocarcinoma were studied. Two groups were considered: patients aged 65 to 74 years and those 〉 74 years. Most of the patients (78.1%) had advanced diseases, and nearly half (41.3%) had associated chronic disease(s). Resections with curative intention were performed in 362 patients (83.6%). The overall operative morbidity rate was 21.7% and mortality rate 5.1%. Although operative procedures were similar in both groups, patients aged 〉 74 years had a higher mortality rate than those aged 65 to 74 years (10.1% vs. 3.5%; p = 0.034). Age and extent of gastric resection were two independent factors negatively affecting mortality. The cumulative survival rates for patients who underwent curative resection were 86.2%, 72.4%, 67.2%, 62.9%, and 60.0% at 1, 2, 3, 4, and 5 years, respectively. Nearly all patients (96%) after surgery had normal work and daily activities. Some patients appeared to lack energy (16%) or experienced a period of anxiety or depression. There was no statistical difference in survival and quality of life assessed by the Spitzer index after curative resection between the two groups. Therefore resection with curative intention can be performed for the elderly with acceptable morbidity and mortality rates, possible long‐term survival, and good quality of life, but a limited operation should be considered in the very elderly patients.
    Type of Medium: Online Resource
    ISSN: 0364-2313 , 1432-2323
    URL: Article
    DOI: 10.1007/s002689910074
    Language: English
    Publisher: Wiley
    Publication Date: 2000
    detail.hit.zdb_id: 224043-9
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  • 6
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    Surgical Results in Patients with Hepatitis B‐related Hepatocellular Carcinoma and Positive Hepatitis B Early Antigen
    Wiley ; 2000
    In:  World Journal of Surgery Vol. 24, No. 3 ( 2000-03), p. 383-388
    Details
    In: World Journal of Surgery, Wiley, Vol. 24, No. 3 ( 2000-03), p. 383-388
    Abstract: Hepatitis B virus (HBV) infection is the major risk factor in the pathogenesis of hepatocellular carcinoma (HCC). Patients who are positive for hepatitis B early antigen (HBeAg) have active liver disease. The present study aimed to evaluate the possible role of HBeAg in patients with resectable HCC. A series of 249 HCC patients with complete preoperative hepatitis marker who had undergone potentially curative resection were enrolled. Patients with hepatitis C virus infection were excluded. Of these patients, 27 were positive for hepatitis B surface antigen (HBsAg) and HBeAg (group I), 171 were positive for HBsAg and negative for HBeAg (group II), and 51 were negative for hepatitis B markers (group III). The clinicopathologic features and postoperative survivals were compared among the three groups. The prevalence of HBeAg was 10.8%. Group I patients were significantly younger and had worse liver function, smaller tumors, and a higher incidence of liver cirrhosis and chronic active hepatitis than those in groups II and III. No increase in tumor invasiveness was noted in group I patients. The operative morbidity, mortality, and postresection survival were comparable among the three groups. Our findings indicated that HBeAg positivity is not a negative factor for resection in HCC patients and has no significant influence on postresection survival.
    Type of Medium: Online Resource
    ISSN: 0364-2313 , 1432-2323
    URL: Article
    DOI: 10.1007/s002689910061
    Language: English
    Publisher: Wiley
    Publication Date: 2000
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  • 7
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    Higher morbidity and mortality after combined total gastrectomy and pancreaticosplenectomy for gastric cancer
    Wiley ; 2002
    In:  World Journal of Surgery Vol. 26, No. 6 ( 2002-06), p. 678-682
    Details
    In: World Journal of Surgery, Wiley, Vol. 26, No. 6 ( 2002-06), p. 678-682
    Abstract: Se pensó que, para facilitar la disección y extirpación de las adenopatías linfáticas o incluso resecar la parte tumoral que invade el páncreas, podría realizarse, junto con la gastrectomía total, una esplenopancreatectornía, sobre todo en los cánceres gástricos T‐4, Dado que esta teoría no ha demostrado todavía su eficacia por lo que al incremento de la supervivencia se refiere y que en diversos trabajos cursa con alta mortalidad y morbilidad, (no observada sin embargo, en las publicaciones japonesas), tan drástico proceder sigue siendo polémico. Se analiza nuestra experiencia basada en un estudio prospectivo realizado entre 1987 a 1999 sobre la morbilidad y mortalidad registrada en resecciones totales gástricas, completadas o no con esplenopancreatectornía, en pacientes con cáncer gástrico. En total 1,278 pacientes fueron gastrectomizados en nuestro Servicio por cáncer de estómago. De todos ellos 127 fueron sometidos, con fines curativos, a una gastrectomía total con esplenopancreatectornía para conseguir una mayor radicalidad tanto en la resección ganglionar como en la infiltración tumoral pancreática. Analizamos: la duración de la operación, estancia hospitalaria, complicaciones postoperatorias y mortalidad; comparando este tratamiento radical, con 201 gastrectomies totales constatamos que: la duración de la intervención (7.91±2.16 vs 6.67±2.01 horas, p 〈 0.001) y la estancia hospitalaria media (24.5 días vs 17, p 〈 0.001) fueron estadísticamente significativas. Igualmente observamos un porcentaje major de complicaciones tales como: absceso intraabdominal, dehiscencia anastomótica, hemorragia postoperatoria, pancreatitis o fístula pancreática, derrame quiloso y complicaciones generales determinantes de inestabilidad de los signos vitales (26.8% vs 11.9%, p =0.001). Sin embargo, la mortalidad no fue significativamente diferente entre ambas intervenciones (6.3% vs 4.8%, p =0.608). Cuando la gastrectomía total se completa con una esplenopancreatectornía, la complicación más frecuente y de fatal evolución fue el absceso intraabdominal. Sin embargo, más del 50% de estas complicaciones se registraron durante las 40 primeras esplenopancreatectomías (1987–1991); tras adquirir una experiencia adecuada en la 87 intervencionas restantes (1991‐) el número total de complicaciones disminuyó (57.5% vs 35.6%, p =0.021); las complicaciones graves fueron menores (40% vs 20.7%, p =0.022) así como la mortalidad (17.5% vs 1.1%, p =0.001). Por tanto, la gastrectomía total asociada a una esplenopancreatectornía puede realizarse, por cirujanos experimentados, con una aceptable morbi‐mortalidad.
    Type of Medium: Online Resource
    ISSN: 0364-2313 , 1432-2323
    URL: Article
    DOI: 10.1007/s00268-001-0289-8
    Language: English
    Publisher: Wiley
    Publication Date: 2002
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  • 8
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    Clinicopathologic Features and Factors Related to Survival of Patients with Small Hepatocellular Carcinoma after Hepatic Resection
    Wiley ; 2003
    In:  World Journal of Surgery Vol. 27, No. 3 ( 2003-03), p. 294-298
    Details
    In: World Journal of Surgery, Wiley, Vol. 27, No. 3 ( 2003-03), p. 294-298
    Abstract: Abstract Hepatic resection for small hepatocellular carcinomas (HCCs) offers patients a chance of cure but is associated with a significant tumor recurrence rate. We characterized 145 resected small HCCs and defined patients who would most benefit from hepatic resection. A retrospective study was conducted of 485 HCC patients who had undergone curative resection. The clinical features and survival rates of patients with HCCs ≤ 3 cm (group 1, n = 145) were compared with those of patients with HCCs 〉 3 cm (group 2, n = 340). Compared with group 2 patients, group 1 had worse liver function, a higher frequency of hepatitis C infection, and a lower α ‐fetoprotein level. The 1‐, 3‐, and 5‐year disease‐free survival rates of group 1 were better than those of group 2 (82%, 59%, and 42% vs. 56%, 39%, and 31%, respectively) ( p 〈 0.001). From the sixth postoperative year onward, the proportions of disease‐free survivors were not significantly different between the two groups (32% vs. 31%). By multivariate analysis, factors influencing small‐HCC patients’ outcomes were tumor centrally located ( p = 0.003), indocyanine green retention rate 〉 10% ( p = 0.017), and albumin level 〈 3.7 g/dl ( p = 0.004). A clinical risk scoring system incorporating these factors correlated closely with the patients’ outcomes and it may be used to select patients who would most benefit from hepatic resection.
    Type of Medium: Online Resource
    ISSN: 0364-2313 , 1432-2323
    URL: Article
    DOI: 10.1007/s00268-002-6539-6
    Language: English
    Publisher: Wiley
    Publication Date: 2003
    detail.hit.zdb_id: 224043-9
    detail.hit.zdb_id: 1463296-2
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  • 9
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    Incidence and Factors Associated with Recurrence Patterns after Intended Curative Surgery for Gastric Cancer
    Wiley ; 2003
    In:  World Journal of Surgery Vol. 27, No. 2 ( 2003-02), p. 153-158
    Details
    In: World Journal of Surgery, Wiley, Vol. 27, No. 2 ( 2003-02), p. 153-158
    Abstract: Abstract Recurrence after curative resection for gastric cancer remains high. We examined its incidence and factors related to recurrence pattern, while trying to avoid the interaction of various factors. A total of 611 gastric cancer patients after resection for curative intent (1988–1995) were analyzed. The result showed that 245 patients had recurrence (40.1%). Cumulative recurrence rates were 53.5%, 80%, 89.0%, 94.7%, 96.3%, 98%, and 99.5% at 1, 2, 3, 4, 5, 6, and 7 years, respectively. Over half of patients with recurrence (123; 50.2%) had an initial single recurrence. Taking single and multiple recurrence together, most recurrences (213; 86.9%) were distant metastases, 110 recurrences (44.9%) were local relapses, and 78 recurrences (49.8%) were both local and distant. Among the distant metastases, 131 patients (53.5%) had peritoneal dissemination, 106 patients (43.3%) had hematogenous metastases, and 70 patients (28.6%) had distant lymphatic spread. Scirrhous‐type stromal reaction, serosa invasion, and female gender were factors negatively related to peritoneal recurrence. Medullary‐type stromal reaction and male gender showed a preference for locoregional recurrence, and expanding growth tumor commonly led to hematogenous metastasis. Patients who had paraaortic lymph node metastasis were at high risk of developing distant lymphatic recurrence. It is conceivable that the patterns of recurrence and the times to recurrence provide a biological basis for clinical monitoring of patients with the aim of modifying therapeutic modalities.
    Type of Medium: Online Resource
    ISSN: 0364-2313 , 1432-2323
    URL: Article
    DOI: 10.1007/s00268-002-6279-7
    Language: English
    Publisher: Wiley
    Publication Date: 2003
    detail.hit.zdb_id: 224043-9
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  • 10
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    Evaluation of Effect of Hemihepatic Vascular Occlusion and the Pringle Maneuver during Hepatic Resection for Patients with Hepatocellular Carcinoma and Impaired Liver Function
    Wiley ; 2005
    In:  World Journal of Surgery Vol. 29, No. 11 ( 2005-11), p. 1374-1383
    Details
    In: World Journal of Surgery, Wiley, Vol. 29, No. 11 ( 2005-11), p. 1374-1383
    Abstract: Reducing blood loss during resection of hepatocellular carcinoma (HCC) in patients with impaired liver function is important. This study evaluated the effect and safety of inflow occlusion (hemihepatic vascular occlusion and the Pringle maneuver) in reducing blood loss during hepatectomy. A total of 120 HCC patients with impaired liver function (with a preoperative indocyanine green retention rate at 15 minutes 〉 10%) who underwent hepatectomy were included in this retrospective study. Patients were divided into three groups, no‐occlusion (n = 30), hemihepatic vascular occlusion (n = 49), and Pringle maneuver (n = 41). There was one hospital death in each group. Of all three groups, 50 patients (41.7%) had blood loss less than 1000 ml. The three groups were similar in terms of clinocopathological features. All patients underwent minor resection. Blood loss was significantly greater in the no‐occlusion group; there was no difference between the hemihepatic group and the Pringle group. Multivariate analysis revealed that risk factors related to blood loss included no inflow occlusion [odds ratios (ORs), 2.93; 95% confidence intervals (CIs) 1.13–7.59], tumor centrally located (ORs, 3.85; 95% CIs, 1.50–9.90), serum albumin level 〈 3.5 gm/dl (ORs, 5.15; 95% CIs, 1.20–22.07), and serum alanine aminotransferase 〉 120 U/l (ORs, 3.58; 95% CIs, 1.19–10.80). For patients with occlusion time ≥ 45 minutes, postoperative serum total bilirubin and aspartate aminotransferase levels in the Pringle group were significantly higher than those in the hemihepatic and no‐occlusion groups ( P 〈 0.05). In HCC patients with impaired liver function undergoing hepatectomy, both hemihepatic vascular occlusion and the Pringle maneuver are safe and effective in reducing blood loss. Patients subjected to hemihepatic vascular occlusion responded better than those subjected to the Pringle maneuver in terms of earlier recovery of postoperative liver function, especially when occlusion time was ≥ 45 minutes.
    Type of Medium: Online Resource
    ISSN: 0364-2313 , 1432-2323
    URL: Article
    DOI: 10.1007/s00268-005-7766-4
    Language: English
    Publisher: Wiley
    Publication Date: 2005
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