Hepatobiliary Pancreat Dis Int

	2017 Vol. 16 No. 3
	Published: 2017-06-15


	pages 225-336
	EDITORIAL META-ANALYSIS REVIEW ARTICLES ORIGINAL ARTICLES/Transplantation ORIGINAL ARTICLES/Liver ORIGINAL ARTICLES/Pancreas LETTERS TO THE EDITOR MEETINGS AND COURSES RELEVANT CONTENT

EDITORIAL

	234	Reichman TW
		Better preoperative planning improves liver resection outcomes
		Since the advent of liver resection as a treatment option for benign and malignant liver diseases, liver resections have continued to become safer with most centers reporting low morbidity and mortality.[1, 2] Gradual improvements in outcomes over the last decade have largely been due to improvement in surgical techniques including the more routine use of laparoscopy and advances in perioperative care.[3] Improvements in abdominal imaging have also lead to better patient selection and improved surgical planning. Despite these advances, there is still a large group of patients that are deemed “technically unresectable” due to anatomical restrictions or incompatible liver volumes. As a community, even in this day and age, we are also still far from achieving zero morbidity and mortality for patients.[4]
		Hepatobiliary Pancreat Dis Int. 2017; 16(3): 234-235 . [Abstract] ( 171 ) [HTML 12KB] [PDF 163KB] ( 712 )

META-ANALYSIS

	236	Jin SF, Fan ZK, Pan L, Jin LM
		Gemcitabine-based combination therapy compared with gemcitabine alone for advanced pancreatic cancer: a meta-analysis of nine randomized controlled trials
		BACKGROUND: Pancreatic cancer is one of the most aggressive malignancies and chemotherapy is an effective strategy for advanced pancreatic cancer. Gemcitabine (GEM) is one of first-line agents. However, GEM-based combination therapy has shown promising efficacy in patients with advanced pancreatic cancer. This meta-analysis aimed to compare the efficacy and safety of GEM-based combination therapy versus GEM alone in the treatment of advanced pancreatic cancer. DATA SOURCES: A comprehensive search of literature was performed using PubMed, EMBASE, Web of Science and Cochrane Central Register of Controlled Trials. A quantitative meta-analysis was performed based on the inclusion criteria from all eligible randomized controlled trials. The outcome indicators included overall survival (OS), 6-month survival, 1-year survival, progression-free survival/time-to-progression (PFS/TTP), and toxicities. RESULTS: A total of nine randomized controlled trials involving 1661 patients were included in this meta-analysis. There was significant improvement in the GEM-based combination therapy with regard to the OS (HR=0.85, 95% CI: 0.76-0.95, P=0.003), PFS (HR=0.76, 95% CI: 0.65-0.90, P=0.002), 6-month survival (RR=1.09, 95% CI: 1.01-1.17, P=0.03), and the overall toxicity (RR=1.68, 95% CI: 1.52-1.86, P<0.01). However, there was no significant difference in the 1-year survival. CONCLUSIONS: GEM-based combination chemotherapy might improve the OS, 6-month survival, and PFS in advanced pancreatic cancer. However, combined therapy also added toxicity.
		Hepatobiliary Pancreat Dis Int. 2017; 16(3): 236-244 . [Abstract] ( 176 ) [HTML 31KB] [PDF 2595KB] ( 864 )

REVIEW ARTICLES

	245	Khan HA, Ahmad MZ, Khan JA, Arshad MI
		Crosstalk of liver immune cells and cell death mechanisms in different murine models of liver injury and its clinical relevance ^Hot!
		BACKGROUND: Liver inflammation or hepatitis is a result of pluripotent interactions of cell death molecules, cytokines, chemokines and the resident immune cells collectively called as microenvironment. The interplay of these inflammatory mediators and switching of immune responses during hepatotoxic, viral, drug-induced and immune cell-mediated hepatitis decide the fate of liver pathology. The present review aimed to describe the mechanisms of liver injury, its relevance to human liver pathology and insights for the future therapeutic interventions. DATA SOURCES: The data of mouse hepatic models and relevant human liver diseases presented in this review are systematically collected from PubMed, ScienceDirect and the Web of Science databases published in English. RESULTS: The hepatotoxic liver injury in mice induced by the metabolites of CCl4, acetaminophen or alcohol represent necrotic cell death with activation of cytochrome pathway, formation of reactive oxygen species (ROS) and mitochondrial damage. The Fas or TNF-α induced apoptotic liver injury was dependent on activation of caspases, release of cytochrome c and apoptosome formation. The ConA-hepatitis demonstrated the involvement of TRAIL-dependent necrotic/necroptotic cell death with activation of RIPK1/3. The α-GalCer-induced liver injury was mediated by TNF-α. The LPS-induced hepatitis involved TNF-α, Fas/FasL, and perforin/granzyme cell death pathways. The MHV3 or Poly(I:C) induced liver injury was mediated by natural killer cells and TNF-α signaling. The necrotic ischemia-reperfusion liver injury was mediated by hypoxia, ROS, and pro-inflammatory cytokines; however, necroptotic cell death was found in partial hepatectomy. The crucial role of immune cells and cell death mediators in viral hepatitis (HBV, HCV), drug-induced liver injury, non-alcoholic fatty liver disease and alcoholic liver disease in human were discussed. CONCLUSIONS: The mouse animal models of hepatitis provide a parallel approach for the study of human liver pathology. Blocking or stimulating the pathways associated with liver cell death could unveil the novel therapeutic strategies in the management of liver diseases.
		Hepatobiliary Pancreat Dis Int. 2017; 16(3): 245-256 . [Abstract] ( 350 ) [HTML 79KB] [PDF 692KB] ( 864 )

ORIGINAL ARTICLES/Transplantation

	257	Ye YF, Wang W, Wang T, Yu J, Geng L, Yu SF, Yan S, Zheng SS
		Role of [¹⁸F] fludeoxyglucose positron emission tomography in the selection of liver transplantation candidates in patients with hepatocellular carcinoma ^Hot!
		BACKGROUND: The Milan criteria are widely accepted among many centers. However, patients with hepatocellular carcinoma beyond the Milan criteria might still benefit from liver transplantation (LT) when tumor itself is not aggressive. [18F] fluorodeoxyglucose positron emission tomography/computed tomography imaging could provide useful information of tumor behaviors, which is helpful to predict the prognosis for many tumors. METHODS: In order to determine its role in candidate selection for LT, we therefore retrospectively analyzed 103 recipients with preoperative positron emission tomography (PET) findings. RESULTS: Positive PET findings (PET+) were significantly associated with tumor nodule numbers (P=0.013), tumor grade (P=0.025), macro- (P=0.002) and micro-vascular invasion (P=0.002, as well as the Milan criteria (P=0.018). PET+ patients had significantly increased risk of tumor recurrence post-LT compared to PET negative (PET¯) patients (P=0.007). The 1-, 3-, and 5-year overall survival rate of PET¯ patients were 96.0%, 87.2% and 76.2%, compared to 74.7%, 55.4% and 49.9% in PET+ patients, respectively (P<0.05). The 1-, 3-, and 5-year recurrence-free survival rate of PET¯ patients were 91.8%, 81.9% and 76.0%, compared to 70.1%, 39.3% and 21.9% in PET+ patients, respectively (P<0.05). Recipients within the Milan criteria showed comparable 1-, 3-, and 5-year survival rates in comparison with those beyond the Milan criteria with a PET¯ findings (1-, 3-, and 5-year overall survival rates, 97.5%, 83.3%, and 83.3% vs. 90.0%, 80.0%, and 66.7%, P= 0.123; 1-, 3-, and 5-year recurrence-free survival rates, 95.1%, 73.1%, and 73.1% vs 90.0%, 78.8%, and 65.6%, P=0.148). CONCLUSIONS: Certain patients with hepatocellular carcinoma and negative PET findings, who have exceeded the Milan criteria, are also eligible candidates for LT. Preoperative PET/CT imaging is an important marker, which should be incorporated in extended candidate selection criteria for LT.
		Hepatobiliary Pancreat Dis Int. 2017; 16(3): 257-263 . [Abstract] ( 195 ) [HTML 36KB] [PDF 527KB] ( 710 )

	264	Elshamy M, Presser N, Hammad AY, Firl DJ, Coppa C, Fung J, Aucejo FN
		Liver transplantation in patients with incidental hepatocellular carcinoma/cholangiocarcinoma and intrahepatic cholangiocarcinoma: a single-center experience
		BACKGROUND: Reports of liver transplantation (LT) in patients with mixed hepatocellular carcinoma/cholangiocarcinoma (HCC/CC) and intrahepatic cholangiocarcinoma (ICC) are modest and have been mostly retrospective after pathological categorization in the setting of presumed HCC. Some studies suggest that patients undergoing LT with small and unifocal ICC or mixed HCC/CC can achieve about 40%-60% 5-year post-transplant survival. The study aimed to report our experience in patients undergoing LT with explant pathology revealing HCC/CC and ICC. METHODS: From a prospectively maintained database, we performed cohort analysis. We identified 13 patients who underwent LT with explant pathology revealing HCC/CC or ICC. RESULTS: The observed recurrence rate post-LT was 31% (4/13) and overall survival was 85%, 51%, and 51% at 1, 3 and 5 years, respectively. Disease free survival was 68%, 51%, and 41% at 1, 3 and 5 years, respectively. In our cohort, four patients would have qualified for exception points based on updated HCC Organ Procurement and Transplantation Network imaging guidelines. CONCLUSIONS: Lesions which lack complete imaging characteristics of HCC may warrant pre-LT biopsy to fully elucidate their pathology. Identified patients with early HCC/CC or ICC may benefit from LT if unresectable. Additionally, incorporating adjunctive perioperative therapies such as in the case of patients undergoing LT with hilar cholangiocarcinoma may improve outcomes but this warrants further investigation.
		Hepatobiliary Pancreat Dis Int. 2017; 16(3): 264-270 . [Abstract] ( 185 ) [HTML 31KB] [PDF 363KB] ( 620 )

ORIGINAL ARTICLES/Liver

	271	Wang XD, Wang HG, Shi J, Duan WD, Luo Y, Ji WB, Zhang N, Dong JH
		Traditional surgical planning of liver surgery is modified by 3D interactive quantitative surgical planning approach: a single-center experience with 305 patients ^Hot!
		BACKGROUND: Decision making and surgical planning are to achieve the precise balance of maximal removal of target lesion, maximal sparing of functional liver remnant volume, and minimal surgical invasiveness and therefore, crucial in liver surgery. The aim of this prospective study was to validate the accuracy and predictability of 3D interactive quantitative surgical planning approach (IQSP), and to evaluate the impact of IQSP on traditional surgical plans based on 2D images. METHODS: A total of 305 consecutive patients undergoing hepatectomy were included in this study. Surgical plans were created by traditional 2D approach using picture archiving and communication system (PACS) and 3D approach using IQSP respectively by two groups of physicians who did not know the surgical plans of the other group. The two surgical plans were submitted to the chief surgeon for selection before operation. The specimens were weighed. The two surgical plans were compared and analyzed retrospectively based on the operation results. RESULTS: The two surgical plans were successfully developed in all 305 patients and all the 3D IQSP surgical plans were selected as the final decision. Total 278 patients successfully underwent surgery, including 147 uncomplex hepatectomy and 131 complex hepatectomy. Twenty-seven patients were withdrawn from hepatectomy. In the uncomplex group, the two surgical plans were the same in all 147 patients and no statistically significant difference was found among 2D calculated resection volume (2D-RV), 3D IQSP calculated resection volume (IQSP-RV) and the specimen volume. In the complex group, the two surgical plans were different in 49 patients (49/131, 37.4%). According to the significance of differences, the 49 different patients were classified into three grades. No statistically significant difference was found between IQSP-RV and specimen volume. The coincidence rate of territory analysis of IQSP with operation was 92.1% (93/101) for 101 patients of anatomic hepatectomy. CONCLUSIONS: The accuracy and predictability of 3D IQSP were validated. Compared with traditional surgical planning, 3D IQSP can provide more quantitative information of anatomic structure. With the assistance of 3D IQSP, traditional surgical plans were modified to be more radical and safe.
		Hepatobiliary Pancreat Dis Int. 2017; 16(3): 271-278 . [Abstract] ( 260 ) [HTML 42KB] [PDF 586KB] ( 794 )

	279	Kobayashi T, Aikata H, Kobayashi T, Ohdan H, Arihiro K, Chayama K
		Patients with early recurrence of hepatocellular carcinoma have poor prognosis
		BACKGROUND: Early recurrence (ER) after hepatic resection (HR) is a poor prognostic factor for patients with hepatocellular carcinoma (HCC). This study aimed to identify the clinicopathological features, outcomes, and risk factors for ER after HR for small HCC in order to clarify the reasons why ER is a worse recurrence pattern. METHODS: We retrospectively examined 130 patients who underwent HR for small HCC (≤30 mm). Recurrence was classified into ER (<2 years) and late recurrence (LR) (≥2 years). The clinicopathological features, outcomes, and risk factors for ER were analyzed by multivariate analysis. RESULTS: ER was observed in 39 patients (30.0%). The survival rate of the ER group was significantly lower than that of the LR group (P<0.005), and ER was an independent prognostic factor for poor survival (P=0.0001). The ER group had a significantly higher frequency (P=0.0039) and shorter interval (P=0.027) of development to carcinoma beyond the Milan criteria (DBMC) compared with the LR group, and ER was an independent risk factor for DBMC (P<0.0001). Multi-nodularity, non-simple nodular type, and microvascular invasion were independent predictors for ER (P=0.012, 0.010, and 0.019, respectively). CONCLUSIONS: ER was a highly malignant recurrence pattern associated with DBMC and subsequent poor survival after HR for small HCC. Multi-nodularity, non-simple nodular type, and microvascular invasion predict ER, and taking these factors into consideration may be useful for the decision of the treatment strategy for small HCC after HR.
		Hepatobiliary Pancreat Dis Int. 2017; 16(3): 279-288 . [Abstract] ( 243 ) [HTML 47KB] [PDF 718KB] ( 664 )

	289	Tsiakalos A, Voumvas T, Psarris A, Oikonomou CK, Ziogas DC, Ketikoglou I, Hatzis G, Sipsas NV
		Circulating autoantibodies to endogenous erythropoietin are associated with chronic hepatitis C virus infection-related anemia
		BACKGROUND: Chronic hepatitis C virus (HCV) infection is associated with autoimmune phenomena and is often complicated by anemia. Circulating autoantibodies to endogenous erythropoietin (anti-EPO) have been detected in patients with chronic viral infections and were correlated to anemia. The present study aimed to determine anti-EPO prevalence in patients with chronic HCV infection and investigate its possible association with anemia. METHODS: Ninety-three consecutive patients (62 males and 31 females) with chronic HCV infection, who had never received antiviral therapy or recombinant EPO, were enrolled in the study. Circulating anti-EPO were detected in the serum by using an ELISA assay. Quantitative determination of serum EPO levels was done by radioimmunoassay. HCV RNA viral load measurement and genotype sequencing were also performed. RESULTS: Circulating anti-EPO were detected in 10.8% of HCV-infected patients and the prevalence of anti-EPO was significantly higher in patients with anemia (19.4% vs 5.3%, P=0.040) compared to that in those without anemia. Compared to anti-EPO negative cases, anti-EPO positive patients had higher frequency of anemia (70.0% vs 34.9%, P=0.030), lower EPO concentrations (median 16.35 vs 30.65 mU/mL, P=0.005), and higher HCV RNA viral load (median 891.5×103 vs 367.5×103 IU/mL, P=0.016). In multivariate regression analysis the presence of anti-EPO remained an independent predictor of anemia (adjusted OR: 14.303, 95% CI: 1.417-36.580, P=0.024). EPO response to anemia was less prominent among anti-EPO positive patients (P=0.001). CONCLUSIONS: Circulating anti-EPO are detected in a significant proportion of treatment-naïve HCV-infected patients and are independently associated with anemia, suggesting a further implication of autoimmunity in the pathophysiology of HCV-related anemia.
		Hepatobiliary Pancreat Dis Int. 2017; 16(3): 289-295 . [Abstract] ( 277 ) [HTML 40KB] [PDF 426KB] ( 847 )

	296	Asgarshirazi M, Shariat M, Sheikh M
		Comparison of efficacy of folic acid and silymarin in the management of antiepileptic drug induced liver injury: a randomized clinical trial
		BACKGROUND: Liver injury associated with antiepileptic drugs accounts for a large proportion of drug-induced liver injuries (DILI) in children. Although withdrawal of the causative agent is the only proved treatment for DILI, in some clinical situations it is not possible. Recent studies have reported promising results of using hepatoprotective drugs with antioxidant actions for the management of DILI. This study aimed to evaluate the efficacy of folic acid versus silymarin treatment in relation to decreasing liver enzymes in patients with DILI due to antiepileptic therapy. METHODS: This randomized, open-label, clinical trial evaluated 55 children with epilepsy who were on antiepileptic treatment and experienced DILI. The children were randomized to receive either silymarin (5 mg/kg per day) or folic acid (1 mg per day) for one month and were followed up for three months. RESULTS: Liver enzymes significantly decreased in both groups. The decrease trend in alanine aminotransferase (ALT) and aspartate aminotransferase (AST) were stronger in the folic acid group compared to silymarin group (P=0.04 and P=0.007, respectively). At the end of the study patients in the folic acid group had significantly lower ALT (P=0.04), AST (P=0.02), and gamma-glutamyl transferase (GGT) (P<0.001) levels and also higher percentage of normal ALT (30.7% vs 3.4%, P=0.009) and AST (42.3% vs 0%, P<0.001), and GGT (23.1% vs 0%, P=0.008) values compared to the patients in the silymarin group. No rebound elevations in ALT, AST and GGT levels or adverse reactions were noted in neither of the study groups. CONCLUSION: Although both treatments were safe and effective in decreasing liver enzymes, folic acid seems to be superior to silymarin in the management of DILI.
		Hepatobiliary Pancreat Dis Int. 2017; 16(3): 296-302 . [Abstract] ( 265 ) [HTML 40KB] [PDF 550KB] ( 987 )

	303	Jia GS, Feng GL, Li JP, Xu HL, Wang H, Cheng YP, Yan LL, Jiang HJ
		Using receiver operating characteristic curves to evaluate the diagnostic value of the combination of multislice spiral CT and alpha-fetoprotein levels for small hepatocellular carcinoma in cirrhotic patients
		BACKGROUND: The various combination of multiphase enhancement multislice spiral CT (MSCT) makes the diagnosis of a small hepatocellular carcinoma (sHCC) on the background of liver cirrhosis possible. This study was to explore whether the combination of MSCT enhancement scan and alpha-fetoprotein (AFP) level could increase the diagnostic efficiency for sHCC. METHODS: This study included 35 sHCC patients and 52 cirrhotic patients without image evidence of HCC as a control group. The diagnoses were made by three radiologists employing a 5-point rating scale, with postoperative pathologic results as the gold standard. Receiver operating characteristic (ROC) curve analysis was performed to evaluate the diagnostic value of the three MSCT combination modes (arterial phase+portal-venous phase, arterial phase+delayed phase, arterial phase+portal-venous phase+delayed phase) and AFP levels for sHCC on the background of liver cirrhosis. RESULTS: The area under ROC curve (AUC), sensitivity, and specificity of the combination of arterial phase+portal-venous phase+delayed phase were 0.93, 93%, and 82%, respectively. The average AUC of the arterial phase+portal-venous phase+delayed phase combination was significantly greater than that of the arterial phase+portal-venous phase (AUC=0.84, P=0.01) and arterial phase+delayed phase (AUC=0.85, P=0.03). Arterial phase+portal-venous phase had a smaller AUC (0.84) than arterial phase+delayed phase (0.85), but the difference was insignificant (P=0.15). After combining MSCT enhancement scan with AFP, the AUC, sensitivity, and specificity were 0.95, 94%, and 83%, respectively, indicating a greatly increased diagnostic efficiency for sHCC. CONCLUSIONS: The combination of AFP and 3 phases MSCT enhancement scan could increase the diagnostic efficiency for sHCC on the background of liver cirrhosis. The application of ROC curve analysis has provided a new method and reference in HCC diagnosis.
		Hepatobiliary Pancreat Dis Int. 2017; 16(3): 303-309 . [Abstract] ( 166 ) [HTML 40KB] [PDF 378KB] ( 611 )

ORIGINAL ARTICLES/Pancreas

	310	Sun YL, Zhao YL, Li WQ, Zhu RT, Wang WJ, Li J, Huang S, Ma XX
		Total closure of pancreatic section for end-to-side pancreaticojejunostomy decreases incidence of pancreatic fistula in pancreaticoduodenectomy
		BACKGROUND: Postoperative pancreatic fistula (POPF) is a serious complication and results in prolonged hospitalization and high mortality. The present study aimed to evaluate the safety and effectiveness of total closure of pancreatic section for end-to-side pancreaticojejunostomy in pancreaticoduodenectomy (PD). METHODS: This was a prospective randomized clinical trial comparing the outcomes of PD between patients who underwent total closure of pancreatic section for end-to-side pancreaticojejunostomy (Group A) vs those who underwent conventional pancreaticojejunostomy (Group B). The primary endpoint was the incidence of pancreatic fistula. Secondary endpoints were morbidity and mortality rates. RESULTS: One hundred twenty-three patients were included in this study. The POPF rate was significantly lower in Group A than that in Group B (4.8% vs 16.7%, P<0.05). About 38.3% patients in Group B developed one or more complications; this rate was 14.3% in Group A (P<0.01). The wound/abdominal infection rate was also much higher in Group B than that in Group A (20.0% vs 6.3%, P<0.05). Furthermore, the average hospital stays of the two groups were 18 days in Group A, and 24 days in Group B, respectively (P<0.001). However, there was no difference in the probability of mortality, biliary leakage, delayed gastric emptying, and pulmonary infection between the two groups. CONCLUSION: Total closure of pancreatic section for end-to-side pancreaticojejunostomy is a safe and effective method for pancreaticojejunostomy in PD.
		Hepatobiliary Pancreat Dis Int. 2017; 16(3): 310-314 . [Abstract] ( 224 ) [HTML 31KB] [PDF 428KB] ( 710 )

	315	Fancellu A, Ginesu GC, Feo CF, Cossu ML, Puledda M, Pinna A, Porcu A
		Pancreatic head excavation for tissue diagnosis may reduce unnecessary pancreaticoduodenectomies in the setting of chronic pancreatitis ^Hot!
		BACKGROUND: The necessity to obtain a tissue diagnosis of cancer prior to pancreatic surgery still remains an open debate. In fact, a non-negligible percentage of patients undergoing pancreaticoduodenectomy (PD) for suspected cancer has a benign lesion at final histology. We describe an approach for patients with diagnostic uncertainty between cancer and chronic pancreatitis, with the aim of minimizing the incidence of PD for suspicious malignancy finally diagnosed as benign disease. METHODS: Eighty-eight patients (85.4%) with a clinicoradiological picture highly suggestive for malignancy received formal PD (group 1). Fifteen patients (14.6%) in whom preoperative diagnosis was uncertain between pancreatic cancer and chronic pancreatitis underwent pancreatic head excavation (PHEX) for intraoperative tissue diagnosis (group 2): those diagnosed as having cancer received PD, whereas those with chronic pancreatitis received pancreaticojejunostomy (PJ). RESULTS: No patient received PD for benign disease. All patients in group 1 had adenocarcinoma on final histology. Eight patients of group 2 (53.3%) received PD after intraoperative diagnosis of cancer, whereas 7 (46.7%) received PJ because no malignancy was found at introperative frozen sections. No signs of cancer were encountered in patients receiving PHEX and PJ after a median follow-up of 42 months. Overall survival did not differ between patients receiving PD for cancer in the group 1 and those receiving PD for cancer after PHEX in the group 2 (P=0.509). CONCLUSION: Although the described technique has been used in a very selected group of patients, our results suggest that PHEX for tissue diagnosis may reduce rates of unnecessary PD, when the preoperative diagnosis is uncertain between cancer and chronic pancreatitis.
		Hepatobiliary Pancreat Dis Int. 2017; 16(3): 315-322 . [Abstract] ( 199 ) [HTML 47KB] [PDF 618KB] ( 679 )

LETTERS TO THE EDITOR

	323	Yin BL, Fu XD
		A clinical analysis of acute pancreatitis in pregnancy
		To the Editor: Acute pancreatitis in pregnancy (APIP) is one of the acute abdomen in pregnancy. Once the disease deteriorated rapidly, it could be a serious threat to gravida and fetus. Although the incidence of APIP has been gradually increasing due to the life style change,[1] it is still a rare disease and the mechanism is not clear. Patients with APIP were often misdiagnosed and not managed properly.[2]
		Hepatobiliary Pancreat Dis Int. 2017; 16(3): 323-325 . [Abstract] ( 228 ) [HTML 16KB] [PDF 200KB] ( 774 )

	326	Peng B, She XG, Cheng K, Liu H, Niu Y, Ming YZ
		Orthotopic liver transplantation from a donor with Schistosoma japonicum
		To the Editor: Despite of the rapid increase of donation after cardiac death (DCD) in China, the shortage of organs continues to be a major problem. Every organ procured is so valuable that it should never be discarded easily, especially a liver that could save a patient’s life in an emergency. This leads to the use of grafts from donors with unrecognized and unusual diseases, including schistosomiasis.[1] Here, we reported a case of orthotopic liver transplantation (OLT) from a donor with Schistosoma japonicum to a patient with end-stage cirrhosis due to HBV infection.
		Hepatobiliary Pancreat Dis Int. 2017; 16(3): 326-328 . [Abstract] ( 169 ) [HTML 16KB] [PDF 368KB] ( 588 )

	329	Tsang J, Chan A, Chok K, Tsang F, Lo CM
		Combined cavo-atrial thrombectomy and hepatectomy in hepatocellular carcinoma
		*To the Editor:* Hepatocellular carcinoma (HCC) remains one of the commonest cancers worldwide especially in hepatitis B endemic regions. Its aggressive behavior is characterised by the natural history of increasing size, a tendency for vascular invasion into the hepatic veins and portal veins. Further growth into the inferior vena cava (IVC) and right atrium (RA) is an infrequent finding but signifies a pre-terminal event with a dismal prognosis. The reported incidence is 3%-4%.[1] Patients are at high-risk of pulmonary embolism and systemic metastasis. Surgical resection with thrombectomy offers the only chance of tumor clearance and cure. The available evidence for surgery, however, is limited with only small case series and individual case reports published.[1-4] We describe a case of HCC with IVC and RA tumor thrombus successfully treated with combined cavo-atrial thrombectomy under cardiopulmonary bypass (CPB) and hepatectomy.
		Hepatobiliary Pancreat Dis Int. 2017; 16(3): 329-333 . [Abstract] ( 271 ) [HTML 24KB] [PDF 320KB] ( 780 )

MEETINGS AND COURSES

	334
		Meetings and courses

		Hepatobiliary Pancreat Dis Int. 2017; 16(3): 334-335 . [Abstract] ( 130 ) [HTML 1KB] [PDF 166KB] ( 540 )

RELEVANT CONTENT

	336
		Relevant content--Liver Cancer (Vol. 6, No. 2, 2017)

		Hepatobiliary Pancreat Dis Int. 2017; 16(3): 336-336 . [Abstract] ( 132 ) [HTML 1KB] [PDF 233KB] ( 341 )

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