Hepatobiliary Pancreat Dis Int

	2019 Vol. 18 No. 3
	Published: 2019-06-15


	Pages 203-302
	EDITORIAL META-ANALYSIS REVIEW ARTICLES ORIGINAL ARTICLES/Transplantation ORIGINAL ARTICLES/Liver ORIGINAL ARTICLES/Biliary ORIGINAL ARTICLES/Pancreas LETTERS TO THE EDITOR VIEWPOINTS

EDITORIAL

	203	Negoi I, Beuran M, Hostiuc S, El-Hussuna A, de-Madaria E
		Platelet-to-lymphocyte ratio and CA19-9 are simple and informative prognostic factors in patients with resected pancreatic cancer
		We read with great interest the paper “Combined preoperative platelet-to-lymphocyte ratio and serum carbohydrate antigen 19-9 level as a prognostic factor in patients with resected pancreatic cancer” published in Hepatobiliary & Pancreatic Diseases International [1] . The authors reviewed the oncological outcomes of 103 patients with pancreaticoduodenectomy, distal pancreatectomy or total pancreatectomy for pancreatic ductal adenocarcinoma (PDAC). They correlated the overall (OS) and disease specific survival (DSS) of these patients with platelet-to-lymphocyte ratio (PLR) and carbohydrate antigen 19-9 (CA19-9) level which were measured within one month prior to surgery. The authors used cutoff values of 129.1 for PLR and 74.0 U/mL for CA19-9. The worst prognosis was found for patients with high PLR and high CA19- 9 (five-year OS = 11.9%, DSS = 16.8%). An intermediate survival for patients with either one of the two factors was decreased (fiveyear OS = 31.9% and DSS = 36.4%), and the best prognosis for patients with low PLR and low CA19-9 (five-year OS = 44.0% and DSS = 47.7%).
		Hepatobiliary Pancreat Dis Int. 2019; 18(3): 203-205 . [Abstract] ( 93 ) [HTML 1KB] [PDF 0KB] ( 164 )

META-ANALYSIS

	206	Yan Y, Zheng DF, Pu JL, Wu ZJ
		Outcomes of adult patients adopting small-for-size grafts in living donor liver transplantation: A systematic review and meta-analysis
		Background: Small-for-size graft (SFSG) has emerged as one of the very contentions in adult-to-adult living donor liver transplantation (LDLT) as a certain graft size is related to recipients’ prognosis. Graft- to-recipient weight ratio (GRWR) ≥0.8% was considered as a threshold to conduct LDLT. However, this also has been challenged over decades as a result of technique refinements. For a better understanding of SFSG in practice, we conducted this meta-analysis to compare the perioperative outcomes and long-term outcomes between patients adopting the grafts with a lower volume (GRWR < 0.8%, SFSG group) and sufficient volume (GRWR ≥0.8%, non-SFSG group) in adult-to-adult LDLT. Data sources: The studies comparing recipients adopting graft with a GRWR < 0.8% and ≥0.8% were searched by three authors independently in PubMed, Web of Science, Embase, the Cochrane Library, MEDLINE and Google Scholar databases until September 2018 and data were analyzed by RevMan 5.3.5. Results: Sixteen studies with a total of 3272 subjects were included in this meta-analysis. In terms of small-for-size syndrome (SFSS), no significant difference was found in subjects enrolled after year 2010 (before 2010, OR = 3.00, 95% CI: 1.69–5.35, P = 0.0002; after 2010, OR = 1.23, 95% CI: 0.79–1.90, P = 0.36; P for interaction: 0.02). There was no significant difference in operative duration, blood loss, cold is- chemia time, biliary complications, acute rejection, postoperative bleeding, hospitalization time, periop- erative mortality, and 1-, 3- and 5-year overall survival rates between two groups. Conclusions: This meta-analysis suggested that adopting SFSG in adult LDLT has comparable outcomes to those with non-SFSG counterparts since 2010.
		Hepatobiliary Pancreat Dis Int. 2019; 18(3): 206-213 . [Abstract] ( 84 ) [HTML 1KB] [PDF 0KB] ( 171 )

REVIEW ARTICLES

	214	Xiang F, Hu ZM
		Chance and challenge of associating liver partition and portal vein ligation for staged hepatectomy ^Hot!
		Background: The associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) was first performed in 2007. The critical patient selection, timing to perform the second stage operation, and minimally invasive technique are three key factors for patient outcomes. The aim of this review is to summarize published data on these three aspects. Data sources: Studies were identified by searching PubMed for articles published from January 2007 to October 2018, using the keywords “associating liver partition and portal vein ligation for staged hepate- ctomy”or “ALPPS”or “in situ split”. Studies on colorectal liver metastasis (CRLM), perihilar cholangiocar- cinoma (PHC), and hepatocellular carcinoma (HCC) indicated for ALPPS, cutoffvalues to determine the timing of stage 2, as well as modifications of ALPPS were included. Results: The mortality of ALPPS for CRLM is declining, for PHC is high. In patients with HCC, essential hypertrophy makes the ALPPS safer. However, the degrees of fibrosis affect the hypertrophy. The future liver remnant volume is still the gold standard to start the second stage. Hepatobiliary scintigraphy plays an important role in quantitatively assessing liver function, whereas cutoffvalues need to be further calibrated. Less-invasive ALPPS modifications have increased and led to a decreased mortality. Conclusions: ALLPS improved the CRLM outcomes; ALPPS is feasible in patients with PHC after failure of portal vein embolization; ALPPS may be an option for HCC patients with major vascular invasion and thrombosis. The simplified and less-invasive ALPPS is the trend.
		Hepatobiliary Pancreat Dis Int. 2019; 18(3): 214-222 . [Abstract] ( 83 ) [HTML 1KB] [PDF 0KB] ( 168 )

ORIGINAL ARTICLES/Transplantation

	223	Zhang AB, Zhang ZH, Zhang J, Lin BY, Geng L, Yang Z, Feng XN, Zheng SS
		Lower mean platelet volume is a risk indicator of hepatocellular carcinoma recurrence following liver transplantation
		Background: Lower mean platelet volume (MPV) is an indicator of platelet activity in the setting of tumor development. This study was to assess the relationship between preoperative MPV and survival outcomes of patients with hepatocellular carcinoma (HCC) following liver transplantation (LT). Methods: The demographic and clinical characteristics of 304 HCC patients following LT were retrieved from an LT database. All the patients were divided into the normal and lower MPV groups according to the median MPV. The factors were first analyzed using a Kaplan–Meier survival analysis, then the factors with P < 0.10 were selected for multivariate Cox regression analysis and were used to define the independent risk factors for poor prognosis. Results: The 1-, 3-, and 5-year tumor free survival was 95.34%, 74.67% and 69.29% in the normal MPV group, respectively, and 95.40%, 59.97% and 42.94% in the lower MPV group, respectively ( P < 0.01). No significant difference was observed in post-LT complications between the normal and lower MPV groups. Portal vein tumor thrombosis (PVTT) [hazard ratio (HR = 2.24; 95% confidence interval: 1.46–3.43; P < 0.01) and lower MPV (HR = 1.58; 95% confidence interval: 1.05–2.36; P = 0.03) were identified as in- dependent prognostic risk factors for recipient survival. Conclusion: Preoperative lower MPV is a risk indicator of HCC patients survival outcomes after LT.
		Hepatobiliary Pancreat Dis Int. 2019; 18(3): 223-227 . [Abstract] ( 105 ) [HTML 1KB] [PDF 0KB] ( 170 )

	228	Schmitz S, Lurje G, Ulmer F, Andert A, Bruners P, Schulze-Hagen M, Neumann U, Schoening W
		Loco-regional hepatocellular carcinoma treatment services as a bridge to liver transplantation ^Hot!
		Background: Liver transplantation remains the main curative treatment option for hepatocellular carcinoma (HCC) patients. In the Eurotransplant area Milan criteria are used to assign priority extra points (exceptional MELD, exMELD) for patients on the waiting list. To prevent patients from tumor progression, loco-regional (neoadjuvant) treatment (LRT) is used. For patients unlikely to timely receive an organ via primary allocation, “extended critera donor (ECD) organs”are used. The present study aimed to investigate the survival after LT with a strategy of minimizing waiting list dropouts by using LRT for bridging and transplanting ECD organs if possible and necessary. Methods: Between October 2010 and May 2015, 50 liver transplants for HCC were included in this retrospective study. Of those, 42 (84%) met the Milan criteria according to the preoperative radiological examination. Forty-one patients (82%) received LRT. The waiting time was analyzed according to LRT. Kaplan-Meier curves with log-rank statistics were used for survival analyses. Results: One- and five-year overall survival within Milan criteria was 94.3% and 83.7% compared with 91.7% and 67.9% beyond Milan criteria, though statistical significance was not reached ( P = 0.487). LRT had no impact on overall survival ( P = 0.629). Median waiting time was shorter if no LRT was performed (4.6 months vs. 1.5 months, P = 0.006) and there were no cases of waiting list dropouts. Using ECD organs had no impact on overall survival ( P = 0.663). Conclusions: Patients with an expected waiting time to transplantation of > 6 months could be success- fully treated with LRT as a bridge to transplant. Overall and disease-free survival for patients within and beyond Milan criteria was comparable and the use of ECD organs in this cohort of HCC patients proved to be a safe option.
		Hepatobiliary Pancreat Dis Int. 2019; 18(3): 228-236 . [Abstract] ( 104 ) [HTML 1KB] [PDF 0KB] ( 165 )

ORIGINAL ARTICLES/Liver

	237	Yan D, Huang YD, Chen YB, Lv T, Gu SL, Li YT, Huang JR, Li LJ
		*Risk factors for Clostridium difficile* infection in cirrhotic patients**
		Background: Cirrhotic patients are susceptible to Clostridium difficile infection (CDI), however, the high risk factors are not clear. The present study aimed to identify the risk factors in cirrhotic patients with CDI. Methods: A total of 526 cirrhotic patients admitted to our hospital between May 2015 and October 2015 were included in this study. Stool samples were collected upon admission for the detection of CDI and toxin. CDI was monitored during the hospital stay. In total, 34 cases showed CDI. Then we analyzed the effects of age, sex, C. difficile colonization (CDC), multiple hospitalization, extended hospital stay, elevation of total bilirubin (TBIL), creatinine (Cr), Child-Pugh grade C, hepatic encephalopathy, hepatorenal syn- drome, upper gastrointestinal hemorrhage, and exposure of antibiotics and proton pump inhibitor (PPI) on the CDI in cirrhotic patients. Results: Patients in the CDI group had more frequent CDC, multiple hospitalization, and extended hospital stay compared to those in the non- C. difficile infection (NCDI) group. Patients in the CDI group had higher TBIL and Cr, and higher frequency of Child-Pugh grade C, hepatic encephalopathy, upper gastrointestinal hemorrhage compared with those in the NCDI group. Multiple logistic regression analysis indicated that age > 60 years (OR = 1.689; 95% CI: 1.135–3.128), multiple hospitalization (OR = 3.346; 95% CI: 1.392–8.043), length of hospital stay > 20 days (OR = 1.564; 95% CI: 1.113–2.563), hypoproteinemia (OR = 4.962; 95% CI: 2.053–11.996), CDC (OR = 18.410; 95% CI: 6.898–49.136), hepatic encephalopathy (OR = 1.357; 95% CI: 1.154–2.368), and exposure of antibiotics (OR = 1.865; 95% CI: 1.213–2.863) and PPI (OR = 3.125; 95% CI: 1.818–7.548) were risk factors of CDI. Conclusions: Age > 60 years, multiple hospitalization, length of hospital stay > 20 days, hypoproteinemia, CDC, hepatic encephalopathy, and exposure of antibiotics and PPI were risk factors for CDI in cirrhotic patients. These may contribute to the early diagnosis and monitoring of CDI in clinical practice.
		Hepatobiliary Pancreat Dis Int. 2019; 18(3): 237-241 . [Abstract] ( 86 ) [HTML 1KB] [PDF 0KB] ( 193 )

	242	Xi ZF, Jeong S, Wang CC, Li HJ, Guo H, Cai J, Li JX, Kong XN, Tong Y, Xia Q
		Expression of IL-26 predicts prognosis of patients with hepatocellular carcinoma after surgical resection
		Background: There is no data regarding prognostic impact of interleukin (IL)-26 on outcomes of patients with hepatocellular carcinoma (HCC). The present study aimed to evaluate the prognostic impact of IL-26 on HCC patients undergoing liver resection. Methods: From 2003 to 2008, 122 patients with HCC who received surgical curative resection were en- rolled. Patients were stratified into IL-26-upper and -lower groups according to the median expression level from immunohistochemical staining of resected specimens. Prognostic impact of IL-26 was estimated using Kaplan–Meier curves. Univariate and multivariate analyses were performed to evaluate time-dependent prognostic impact and independency of IL-26. Demographic and clinical factors that were associated with IL-26 were comprehensively identified. Results: Prognosis of the patients with high level of IL-26 revealed to be significantly unfavorable in both cumulative recurrence-free survival ( P < 0.001) and overall survival ( P = 0.002). Upper expression of IL-26 (HR: 1.643; 95% CI: 1.021 to 2.644; P = 0.041) and microvascular invasion (HR: 3.303; 95% CI: 1.255 to 8.696; P = 0.016) were identified as significant independent prognostic factors for overall survival in the multivariable analysis. Conclusions: IL-26 is a novel prognostic factor for HCC after resection. Evaluation of IL-26 expression may be potentially valuable in clinical therapy when planning individualized follow-up schedule and evaluat- ing candidates for prophylactic adjuvant treatment to prevent recurrence.
		Hepatobiliary Pancreat Dis Int. 2019; 18(3): 242-248 . [Abstract] ( 91 ) [HTML 1KB] [PDF 0KB] ( 194 )

	249	Chan J, Bradshaw L, Houli N, Weinberg L, Perini MV, Fink M, Muralidharan V, Starkey G, Jones R, Wang BZ,
		Outcomes of central hepatectomy versus extended hepatectomy ^Hot!
		Background: Central hepatectomy (CH) is more difficult than extended hepatectomy (EH) and is associated with greater morbidity. In this modern era of liver management with aims to prevent post- hepatectomy liver failure (PHLF), there is a need to assess outcomes of CH as a parenchyma-sparing procedure for centrally located liver tumors. Methods: A total of 178 major liver resections performed by specialist surgeons from two Australian tertiary institutions between June 2009 and March 2017 were reviewed. Eleven patients had CH and 24 had EH over this study period. Indications and perioperative outcomes were compared between the groups. Results: The main indication for performing CH was colorectal liver metastases. There was no perioperative mortality in the CH group and four (16.7%) in the EH group ( P = 0.285). No group differences were found in median operative time [CH vs. EH: 450 min (290–840) vs. 523 min (310–860), P = 0.328], intraop- erative blood loss [850 mL (40 0–150 0) vs. 650 mL (10 0–20 0 0), P = 0.746] or patients requiring intraoper- ative blood transfusion [1 (9.1%) vs. 7 (30.4%), P = 0.227]. There was a trend towards fewer hepatectomy- specific complications in the CH group [3 (27.3%) vs. 13 (54.2%), P = 0.167], including PHLF (CH vs. EH: 0 vs. 29.2%, P = 0.072). Median length of stay was similar between groups [CH vs. EH: 9 days (5–23) vs. 12 days (4–85), P = 0.244]. Conclusions: CH has equivalent postoperative outcomes to EH. There is a trend towards fewer hepatectomy-specific complications, including PHLF. In appropriate patients, CH may be considered as a safe parenchyma-sparing alternative to EH.
		Hepatobiliary Pancreat Dis Int. 2019; 18(3): 249-254 . [Abstract] ( 90 ) [HTML 1KB] [PDF 0KB] ( 169 )

	255	Qiang GH, Wang ZX, Ji AL, Wu JY, Cao Y, Zhang G, Zhang YY, Jiang CP
		Sphingosine kinase 1 knockout alleviates hepatic ischemia/reperfusion injury by attenuating inflammation and oxidative stress in mice
		Background: Hepatic ischemia/reperfusion (I/R) injury remains a significant problem in clinical practice. Sphingosine kinase 1 (SphK1) phosphorylates sphingosine to sphingosine-1-phosphate (S1P) which par- ticipates in multiple bioactive processes. However, little is known about the role of SphK1 in hepatic I/R injury. This study aimed to investigate the effect of SphK1 knockout on liver I/R injury and to explore underlying mechanisms. Methods: SphK1 knockout and wild type mice were subjected to 70% partial hepatic I/R. Serum alanine aminotransferase was determined to indicate the degree of liver damage. Hematoxylin-eosin stain- ing and TUNEL assay were used to assess histological changes and hepatocellular apoptosis, respectively. Immunohistochemistry was performed to detect the expression and translocation of phosphorylated p65 and signal transducer and activator of transcription 3 (STAT3). Western blotting was used to determine the expression of S1P receptor 1 (S1PR1), phosphorylated p65 and STAT3. Real-time PCR was used to demonstrate the changes of proinflammatory cytokines. Oxidative stress markers were also determined through biochemical assays. Results: SphK1 knockout significantly ameliorated I/R-induced liver damage, mitigated liver tissue necro- sis and apoptosis compared with wild type control. I/R associated inflammation was alleviated in SphK1 knockout mice as demonstrated by attenuated expression of S1PR1 and reduced phosphorylation of nu- clear factor kappa B p65 and STAT3. The proinflammatory cytokines interleukin-1β, interleukin-6 and tumor necrosis factor- αwere also inhibited by SphK1 genetic deletion. The oxidative stress markers were lower in SphK1 knockout mice after I/R injury than wild type mice. Conclusions: Knockout of SphK1 significantly alleviated damage after hepatic I/R injury, possibly through inhibiting inflammation and oxidative stress. SphK1 may be a novel and potent target in clinical practice in I/R-related liver injury.
		Hepatobiliary Pancreat Dis Int. 2019; 18(3): 255-265 . [Abstract] ( 93 ) [HTML 1KB] [PDF 0KB] ( 199 )

	266	Dai YW, Zhu LX, Zhang Y, Wang SH, Chen K, Jiang TT, Xu XL, Geng XP
		Au@SiO2@CuInS2–ZnS/Anti-AFP fluorescent probe improves HCC cell labeling
		Background: Clear tumor imaging is essential to the resection of hepatocellular carcinoma (HCC). This study aimed to create a novel biological probe to improve the HCC imaging. Methods: Au nano-flower particles and CuInS2–ZnS core-shell quantum dots were synthesized by hydrothermal method. Au was coated with porous SiO 2 and combined with anti-AFP antibody. HCC cell line HepG2 was used to evaluate the targeting efficacy of the probe, while flow cytometry and MTT assay were used to detect the cytotoxicity and bio-compatibility of the probe. Probes were subcutaneously injected to nude mice to explore light intensity and tissue penetration. Results: The fluorescence stability of the probe was maintained 100% for 24 h, and the brightness value was 4 times stronger than that of the corresponding CuInS2–ZnS quantum dot. In the targeting experiment, the labeled HepG2 emitted yellow fluorescence. In the cytotoxicity experiments, MTT and flow cytometry results showed that the bio-compatibility of the probe was fine, the inhibition rate of HepG2 cell with 60% Cu-QDs/Anti-AFP probe and Au-QDs/Anti-AFP probe solution for 48 h were significantly different (86.3% ± 7.0% vs . 4.9% ± 1.3%, t = 19.745, P < 0.05), and the apoptosis rates were 83.3% ± 5.1% vs. 4.4% ± 0.8% ( P < 0.001). In the animal experiment, the luminescence of the novel probe can penetrate the abdominal tissues of a mouse, stronger than that of CuInS2–ZnS quantum dot. Conclusions: The Au@SiO2@CuInS2–ZnS/Anti-AFP probe can targetedly recognize and label HepG2 cells with good bio-compatibility and no toxicity, and the strong tissue penetrability of luminescence may be helpful to surgeons.
		Hepatobiliary Pancreat Dis Int. 2019; 18(3): 266-272 . [Abstract] ( 88 ) [HTML 1KB] [PDF 0KB] ( 151 )

ORIGINAL ARTICLES/Biliary

	273	Qu JW, Xin C, Wang GY, Yuan ZQ, Li KW
		Feasibility and safety of single-incision laparoscopic cholecystectomy versus conventional laparoscopic cholecystectomy in an ambulatory setting
		Background: Single-incision laparoscopic surgery has emerged as an alternative to conventional laparoscopic cholecystectomy (LC) in the clinical setting. Limited information is available on the possibility of performing single-incision laparoscopic surgery as an ambulatory procedure. This study aimed to determine the feasibility and safety of single-incision laparoscopic cholecystectomy (SILC) versus conventional LC in an ambulatory setting. Methods: Ninety-one patients were randomized to SILC ( n = 49) or LC ( n = 42). The success rate, operative duration, blood loss, hospital stay, gallbladder perforation, drainage, delayed discharge, readmission, total cost, complications, pain score, vomiting, and cosmetic satisfaction of the two groups were then compared. Results: There were significant differences in the operative time (46.89 ± 10.03 min in SILC vs. 37.24 ± 10.23 min in LC; P < 0.001). As compared with LC, SILC was associated with lower total costs (8012.28 ± 752.67 RMB vs. 10258.91 ± 1087.63 RMB; P < 0.001) and better cosmetic satisfaction (4.94 ± 0.24 vs. 4.74 ± 0.54; P = 0.031). There were no significant differences between-group in terms of general data, success rate, blood loss, hospital stay, gallbladder perforation, drainage, delayed discharge, readmission, complications, pain score, and vomiting ( P > 0.05). Conclusions: Ambulatory SILC is safe and feasible for selected patients. The advantages of SILC as compared with LC are improved cosmetic satisfaction and lower total costs.
		Hepatobiliary Pancreat Dis Int. 2019; 18(3): 273-277 . [Abstract] ( 95 ) [HTML 1KB] [PDF 0KB] ( 152 )

ORIGINAL ARTICLES/Pancreas

	278	Sakamoto T, Saito H, Amisaki M, Tokuyasu N, Honjo S, Fujiwara Y
		Combined preoperative platelet-to-lymphocyte ratio and serum carbohydrate antigen 19–9 level as a prognostic factor in patients with resected pancreatic cancer ^Hot!
		Background: Carbohydrate antigen 19–9 (CA19-9) is the most frequently used tumor marker and serves as a prognostic indicator in patients with pancreatic cancer (PC). The platelet-to-lymphocyte ratio (PLR) is thought to be an inflammation-related serum marker. An elevated PLR represents increased inflammatory status and is associated with poor prognosis in patients with various cancers including PC. Methods: This study involved 103 patients with a histopathological diagnosis of pancreatic ductal ade- nocarcinoma who underwent pancreatectomy. The patients were assessed to determine the prognostic significance of the combination of the PLR and CA19-9 level. Results: Based on the receiver operating characteristic analysis results, the patients were divided into PLR High (PLR ≥129.1) and PLR Low (PLR <129.1)groupsand into CA19-9 High (CA19-9 ≥74.0 U/mL) and CA19-9 Low (CA19-9 < 74.0 U/mL) groups. The cumulative 5-year overall survival (OS) and disease-specific survival (DSS) rates significantly differed by both the PLR (PLR High group: 19.5% and 22.9%; PLR Low group: 39.1% and 45.9%) and CA19-9 (CA19-9 High group: 19.1% and 25.6%; CA19-9 Low group: 41.0% and 41.0%). We then divided the patients into Groups A (PLR Low /CA19-9 Low ), B (PLR Low /CA19-9 High or PLR High /CA19-9 Low ), and C (PLR High /CA19-9 High ). The cumulative 5-year OS rates in Groups A, B, and C were 44.0%, 31.9%, and 11.9%, respectively ( P = 0.002). The cumulative 5-year DSS rates in Groups A, B, and C were 47.7%, 36.4%, and 16.8%, respectively ( P = 0.002). Multivariate analysis revealed that the combination of the PLR and CA19-9 was an independent prognostic factor in patients with resected PC. Conclusions: The combination of the PLR and CA19-9 is useful for predicting the prognosis of patients with resected PC.
		Hepatobiliary Pancreat Dis Int. 2019; 18(3): 278-284 . [Abstract] ( 94 ) [HTML 1KB] [PDF 0KB] ( 179 )

VIEWPOINTS

	285	Hori T, Aisu Y, Yamamoto M, Yasukawa D, Iida T, Yagi S, Taniguchi K, Uemoto S
		Laparoscopic approach for choledochojejunostomy
		Laparoscopic hepatobiliary and pancreatic (HBP) surgery has been developed slowly because of technical challenges and a protracted learning curve with the exception of laparoscopic cholecystectomy [1] . Surgical treatments for benign diseases of the extrahepatic bile duct (EHBD) are classified according to their therapeutic purpose as lithotomy (i.e., choledocholithotomy) or diversion (i.e., choledochojejunostomy) [2] . General surgeons do not perform these surgeries laparoscopically because they require advanced skills and anatomical precision [3,4] . The basic skills required for laparotomy are clearly different from those used in laparoscopic procedures. Notably, experience alone is not enough to ensure successful performance of laparoscopic surgeries [1] .
		Hepatobiliary Pancreat Dis Int. 2019; 18(3): 285-288 . [Abstract] ( 90 ) [HTML 1KB] [PDF 0KB] ( 161 )

	289	Xu G, Yang HY, Xu HF
		Prediction of microvascular invasion in hepatocellular carcinoma with preoperative imaging radiomic analysis: Is it ready for prime time?
		Microvascular invasion (MVI), also known as microvascular tumor embolism, refers to the cancer cell nest in vessels lined with endothelial cells. MVI may be found in the small branches of the portal vein and hepatic vein. Occasionally, MVI may also exist in the hepatic artery, bile duct and lymphatic vessels. The incidence of MVI in hepatocellular carcinoma (HCC) patients ranges from 15% to 57.1%, and MVI can predict the risks of tumor recurrence and long-term survival after surgery [1,2] . However, MVI is different from macrovascular invasion, and MVI cannot be preoperatively diagnosed by imaging. Due to the heterogeneity of HCC and the limited amount of tissue obtained by biopsy, clinicians cannot accurately assess the MVI status of HCC [3] and therefore, the identification of MVI is still based on histopathological examination of resected surgical specimens. Owing to its late postoperative diagnosis, MVI has limited usefulness in current clinical practice. An accurate preoperative evaluation method for MVI can provide an effective basis for individualized treatment plans for each patient. Currently, the preoperative assessment of MVI in HCC with non-invasive methods has become a hot topic.
		Hepatobiliary Pancreat Dis Int. 2019; 18(3): 289-290 . [Abstract] ( 90 ) [HTML 1KB] [PDF 0KB] ( 170 )

LETTERS TO THE EDITOR

	291	Colombi D, Aragona G, Bodini FC, Zangrandi A, Morelli N, Michieletti E
		SpyGlass percutaneous transhepatic cholangioscopy-guided diagnosis of adenocarcinoma of the ampullary region in a patient with bariatric biliopancreatic diversion
		The definition of biliary stricture in patients with post-surgical biliary or enteric anatomy is challenging, due to limitations in accessing biliary system with a peroral approach. In these cases, percutaneous route is an option to obtain diagnosis and to steer patients’ therapy [1] . However, cytologic findings obtained from bile and biliary brushing during percutaneous transhepatic cholangiography (PTC) demonstrated low sensitivity (43%) and high rate of inadequate specimens (21%) [2] . Nevertheless, cholangioscopy can be performed through percutaneous transhepatic access to obtain endoscopic visualization of the biliary tract and to guide tissue sampling with biopsy forceps [1,3] . Here, we report the diagnosis of adenocarcinoma of the ampullary region achieved at surgical specimen after endoscopic biopsy of dysplastic adenomatous alterations at the distal common bile duct obtained through percutaneous transhepatic cholangioscopy (PTCS) in a patient affected by worsening jaundice with previous bariatric biliopancreatic diversion.
		Hepatobiliary Pancreat Dis Int. 2019; 18(3): 291-293 . [Abstract] ( 84 ) [HTML 1KB] [PDF 0KB] ( 198 )

	294	Xu DL, Wu YQ, Xin C, Zhou QF, Chen ML, Yan HJ
		Simple cholangitis induces extremely and recurrently elevated serum carbohydrate antigen 19-9 level
		The carbohydrate antigen 19-9 (CA19-9) is a tumor maker which is usually used in biliary and pancreatic malignancies [1] . However, the specificity of CA19-9 can be reduced by biliary inflammation and other benign diseases [2] . Generally, the level of CA19-9 in benign diseases is less than 100 U/mL, whereas the serum level of CA19-9 can rise to 500 U/mL or even higher than 1000 U/mL in some cases with chronic pancreatitis [3] . Marrelli et al. [4] reported that CA19-9 may be elevated in 61% of benign cases. Moreover, the level of CA19-9 may rise to over 10 0 0 U/mL in patients with choledocholithiasis. Sheen-Chen et al. [5] reported a case of acute cholangitis with extremely elevated serum CA19-9 (5673.8 U/mL). After one month of treatment, the level of CA19-9 returned to normal (10.4 U/mL). We reported here a patient with simple cholangitis who had recurrent elevations of CA19-9 which is rare in previous studies.
		Hepatobiliary Pancreat Dis Int. 2019; 18(3): 294-295 . [Abstract] ( 90 ) [HTML 1KB] [PDF 0KB] ( 153 )

	296	Chen SA, Feng ZN, Li S, Zhang YC, Sun XL, Liu ZH, Liu MN, Jin SZ
		EUS-guided gallbladder polyp resection: A new method for treatment of gallbladder polyps
		The gallbladder polyp detection rate has been increasing due to the growing use of abdominal imaging technology and the incidence of gallbladder polyps, occurring in 5%−10% of the global adult population [1]. Gallbladder polyps can be divided into true polyps and pseudo polyps, and the latter are more common. Pseudo polyps have no malignant potential. In contrast, true polyps can be benign or malignant, with the most common being adenomas and adenocarcinomas [2]. Prognosis worsens when the gallbladder polyp size is greater than 9 mm and/or the patient’s age is over 52 years. Invasion of the surface of the liver or gallbladder wall thickening of more than 5 mm is considered the main factor promoting the risk of malignant transformation [3]. In addition, a recent study has confirmed the association between gallbladder polyps and colorectal adenomas or adenocarcinomas [4]. Currently, the main treatment methods of gallbladder polyps include conservative therapy and surgical resection. Conservative therapies include anti-inflammatory and cholestatic drugs; albeit not a cure, these treatments relieve symptoms. Surgical treatment involves conventional surgical cholecystectomy and laparoscopic cholecystectomy. Although surgical resection can be curative, there are many shortcomings, including trauma, slow recovery, high cost and complications such as bile leakage, pneumoperitoneum, and bleeding. Therefore, a new method for the treatment of gallbladder polyps is necessary.
		Hepatobiliary Pancreat Dis Int. 2019; 18(3): 296-297 . [Abstract] ( 82 ) [HTML 1KB] [PDF 0KB] ( 148 )

	298	Mao JX, Teng F, Liu C, Yuan H, Dong JY, Fu H, Ding GS, Guo WY
		Immunometabolic inflammation and hepatocellular carcinoma
		Inflammation-cancer transformation and metabolomics are hot topics in hepatocellular carcinoma (HCC). Cancer-related inflammation and anti-cancer immunity co-exist in cancer progression and the microenvironmental conditions dictate the direction [1]. Recently, a study published in CA Cancer J Clin [2] revealed the correlation between excess body weight and increased incidence of tumors. In excess body weight related tumors, the cases of liver cancer ranked first in males and the fourth in females [2], and more direct evidence indicated that non-alcoholic fatty liver disease (NAFLD) and metabolic syndrome are important risk factors of HCC, in addition to hepatitis C/B virus and alcoholic liver disease [3,4]. The crosstalk between immunity and metabolism during the oncogenesis and progression of HCC remains uncertain and deserves further exploration.
		Hepatobiliary Pancreat Dis Int. 2019; 18(3): 298-300 . [Abstract] ( 96 ) [HTML 1KB] [PDF 0KB] ( 175 )

	301	Yan WT, Quan B, Yu JJ, Yang T
		Should we invariably follow the current guidelines to treat our HCC patients?
		We read with great interest the article by Dr. Vitale et al. [1] , which developed an ITA.LI.CA scoring system to improve the prognostic utility for patients with re-staging hepatocellular carcinoma (HCC) before additional therapies. We appreciate the authors’ work and believe that the study has important value in guiding reasonable treatments for HCC. Herein, we would like to raise the following comments.
		Hepatobiliary Pancreat Dis Int. 2019; 18(3): 301-302 . [Abstract] ( 94 ) [HTML 1KB] [PDF 0KB] ( 167 )

Forgot your password?

Enter your e-mail address to receive an e-mail with your account information.

Submission Guidance

Top cited articles

- Most Cited Hepatobiliary & Pancreatic Diseases International Articles

- Most Downloaded Hepatobiliary & Pancreatic Diseases International Articles

more>>

Top downloaded articles

more>>

Services

Web feed

hbpdint@126.com

hbpdje@zju.edu.cn

Copyright © Official Publication of First Affiliated Hospital
Official Publication of First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
浙ICP备05050873号-1