Hepatobiliary Pancreat Dis Int

	2020 Vol. 19 No. 2
	Published: 2020-04-15


	Pages 101-202
	EDITORIAL REVIEW ARTICLES ORIGINAL ARTICLES/Liver ORIGINAL ARTICLES/Biliary ORIGINAL ARTICLES/Pancreas CLINICAL IMAGE LETTERS TO THE EDITOR

EDITORIAL

	101	Zheng SS, Yang Z, Wu YC
		Liver transplantation for intrahepatic and perihilar cholangiocarcinoma: Current and future
		Cholangiocarcinomas are categorized as intrahepatic cholangiocarcinoma (iCCA), perihilar cholangiocarcinoma (pCCA), and distal cholangiocarcinoma (dCCA) [1]. iCCA and pCCA are the second most common primary hepatobiliary malignant neoplasms [1,2]. Most patients with iCCA and pCCA have asymptomatic clinical course, highly aggressive nature and dismal prognosis [3]. Complete surgical resection offers the best possibility of long-term survival but only a minority of patients are amenable to R0 resection [4]. Tumor involvement of segmental bilateral intrahepatic bile duct, inadequate remnant liver volume or hepatic functional reserve due to underlying chronic liver disease, are key factors limiting the resectability of iCCA and pCCA. Liver transplantation (LT) provides an option for patients with unresectable iCCA and pCCA [4].
		Hepatobiliary Pancreat Dis Int. 2020; 19(2): 101-102 . [Abstract] ( 58 ) [HTML 1KB] [PDF 0KB] ( 95 )

REVIEW ARTICLES

	103	Baltatzis M, Jegatheeswaran S, Siriwardena AK
		Neoadjuvant chemoradiotherapy before resection of perihilar cholangiocarcinoma: A systematic review ^Hot!
		Background: Treatment with neoadjuvant chemoradiotherapy followed by liver transplantation yields promising results in perihilar cholangiocarcinoma (PH-CCA). This study reviews the literature to assess whether there is evidence to justify modern phase II studies of neoadjuvant chemoradiotherapy prior to resection of PH-CCA. Data sources: A systematic review of the literature for reports of patients undergoing resection of PH-CCA after neoadjuvant chemoradiotherapy was performed using MEDLINE and EMBASE databases for the period between 1990 and 2019. The keywords and MeSH headings “hilar cholangiocarcinoma”,“Klatskin”, "chemoradiotherapy” and “chemotherapy” were used. Data were extracted on demographic profile, disease staging, chemoradiotherapy protocols, complications and outcome. Risks of bias were assessed using Cochrane methodology. Results: There were seven reports on this topic, with median recruitment period of 14 (range 4–31) years. The total number of patients in these studies was 87. Interval from completion of neoadjuvant treatment to surgery varied from 3 days to 6 months. Resection was by hepatectomy with three studies reporting an R0 rate of 100%, 24% and 63%, respectively. Three studies reported histopathological evidence of prior treatment response. There were two treatment related deaths at 90 days. Median survival was 19 (95% CI: 9.9–28) months and 5-year survival 20%. Conclusions: There are potential benefits of treatment on both R0 rate and complete response in resected specimens. Scientific equipoise exists in relation to neoadjuvant chemoradiotherapy for PH-CCA.
		Hepatobiliary Pancreat Dis Int. 2020; 19(2): 103-108 . [Abstract] ( 61 ) [HTML 1KB] [PDF 0KB] ( 95 )

	109	Rao BC, Lou JM, Wang WJ, Li A, Cui GY, Yu ZJ, Ren ZG
		Human microbiome is a diagnostic biomarker in hepatocellular carcinoma ^Hot!
		Background: Hepatocellular carcinoma (HCC) is the third leading cause of cancer mortality worldwide. Increasing evidence indicates a close relationship between HCC and the human microbiota. Herein, we reviewed the important potential of the human microbiota as a diagnostic biomarker of HCC. Data sources: Several innovative studies have investigated the characteristics of the gut and oral microbiomes in patients with HCC and proposed that the human microbiome has the potential to be a diagnostic biomarker of HCC. Literature from February 1999 to February 2019 was searched in the PubMed database using the keywords “microbiota” or “microbiome” or “microbe” and “liver cancer”or “hepatocellular carcinoma”, and the results of clinical and experimental studies were analyzed. Results: Specific changes occur in the human microbiome of patients with HCC. Moreover, the gut microbiome and oral microbiome can be used as non-invasive diagnostic biomarkers for HCC. Furthermore, they also have certain diagnostic potential for precancerous diseases of HCC. The diagnostic potential of the blood microbiota and ascites microbiota in HCC will be gradually discovered in the future. Conclusions: The human microbiome is valuable to the diagnosis of HCC and provides a novel strategy for targeted therapy of HCC. The human microbiome may be widely used in the diagnosis, treatment and prognosis for multiple system diseases or cancers in the future.
		Hepatobiliary Pancreat Dis Int. 2020; 19(2): 109-115 . [Abstract] ( 59 ) [HTML 1KB] [PDF 0KB] ( 93 )

	116	Norton W, Lazaraviciute G, Ramsay G, Kreis I, Ahmed I, Bekheit M
		Current practice of anticoagulant in the treatment of splanchnic vein thrombosis secondary to acute pancreatitis
		Background: Severe acute pancreatitis is a common diagnosis in emergency general surgery and can be a cause of significant morbidity and mortality. A consequence of severe acute pancreatitis is thrombus in the splanchnic veins. These thrombi can potentially lead to bowel ischemia or hepatic failure. However, another complication of severe acute pancreatitis is retroperitoneal bleeding. At this time, it is unclear if treating patients for splanchnic vein thrombosis in the context of severe acute pancreatitis is associated with any outcome benefit. A systematic review might clarify this question. Data sources: A two-fold search strategy (one broad and one precise) looked at all published literature. The review was registered on PROSPERO (ID: CRD42018102705). MEDLINE, EMBASE, PubMed, Cochrane and Web of Science databases were searched and potentially relevant papers were reviewed independently by two researchers. Any disagreement was reviewed by a third independent researcher. Primary outcome was reestablishment of flow in the thrombosed vein versus bleeding complications. Results: Of 1462 papers assessed, a total of 16 papers were eligible for inclusion. There were no randomized controlled trials, 2 were case series, 5 retrospective single-center studies and 9 case reports. There were a total of 198 patients in these studies of whom 92 (46.5%) received anticoagulation therapy. The rates of recanalization of veins in the treated and non-treated groups was 14% and 11% and bleeding complications were 16% and 5%, respectively. However, the included studies were too heterogeneous to undertake a meta-analysis. Conclusions: The systematic review highlights the lack evidence addressing this clinical question. There- fore a randomized controlled trial would be appropriate to undertake.
		Hepatobiliary Pancreat Dis Int. 2020; 19(2): 116-121 . [Abstract] ( 62 ) [HTML 1KB] [PDF 0KB] ( 96 )

ORIGINAL ARTICLES/Liver

	122	Zhou JM, He XG, Wang M, Zhao YM, Shu L, Wang LR, Wang L, Mao AR
		Enhanced recovery after surgery program in the patients undergoing hepatectomy for benign liver lesions
		Background: Enhanced recovery after surgery (ERAS) has shown effectiveness in terms of reducing the hospital stay and cost. However, the benefit of ERAS in patients undergoing hepatectomy for benign liver lesions is still unclear. Methods: ERAS was implemented in our center since March 1st, 2018. From September 2016 to February 2018, 109 patients were enrolled into the control group, and from March 2018 to June 2019, 124 patients were enrolled into the ERAS group. All the indicators related to operation, liver functions, and postoperative outcomes were included in the analysis. Results: The clinicopathologic baselines were similar in these two groups. A significantly higher propor- tion of patients underwent laparoscopic surgery in the ERAS group. On the whole, intraoperative blood loss (10 0.0 0 mL vs . 20 0.0 0 mL, P < 0.0 01), blood transfusion (3.23% vs. 10.09%, P = 0.033), total bilirubin (17.10 μmol/L vs . 21.00 μmol/L, P = 0.041), D -dimer (2.08 μg/mL vs. 2.57 μg/mL, P = 0.031), postoperative hospital stay (5.0 0 d vs. 6.0 0 d, P < 0.0 01), and postoperative morbidity (16.13% vs. 32.11%, P = 0.008) were significantly shorter or less in the ERAS group than those in the control group. After stratified by operation methods, ERAS group showed significantly shorter postoperative hospital stay in both open and laparoscopic operation (both P < 0.001). In patients underwent open surgery, ERAS group demonstrated significantly shorter operative duration (131.76 ±8.75 min vs. 160.73 ±7.23 min, P = 0.016), less intra- operative blood loss (20 0.0 0 mL vs. 450.0 0 mL, P = 0.008) and less postoperative morbidity (16.00% vs. 4 4.4 4%, P = 0.040). Conclusions: ERAS program may be safe and effective for the patients underwent hepatectomy, especially open surgery, for benign liver lesions.
		Hepatobiliary Pancreat Dis Int. 2020; 19(2): 122-128 . [Abstract] ( 55 ) [HTML 1KB] [PDF 0KB] ( 91 )

	129	Li ZH, Xie ZY, Ouyang XX, Huang KZ, Yu XP, Zhao YL, Zhang YH, Zhu DH, Yu J, Li LJ
		Assessment of biological functions for C3A cells interacting with adverse environments of liver failure plasma
		Background: For its better differentiated hepatocyte phenotype, C3A cell line has been utilized in bioartificial liver system. However, up to now, there are only a few of studies working at the metabolic alternations of C3A cells under the culture conditions with liver failure plasma, which mainly focus on carbohydrate metabolism, total protein synthesis and ureagenesis. In this study, we investigated the effects of acute liver failure plasma on the growth and biological functions of C3A cells, especially on CYP450 enzymes. Methods: C3A cells were treated with fresh DMEM medium containing 10% FBS, fresh DMEM medium containing 10% normal plasma and acute liver failure plasma, respectively. After incubation, the C3A cells were assessed for cell viabilities, lactate dehydrogenase leakage, gene transcription, protein levels, albumin secretion, ammonia metabolism and CYP450 enzyme activities. Results: Cell viabilities decreased 15%, and lactate dehydrogenase leakage had 1.3-fold elevation in acute liver failure plasma group. Gene transcription exhibited up-regulation, down-regulation or stability for different hepatic genes. In contrast, protein expression levels for several CYP450 enzymes kept constant, while the CYP450 enzyme activities decreased or remained stable. Albumin secretion reduced about 48%, and ammonia accumulation increased approximately 41%. Conclusions: C3A cells cultured with acute liver failure plasma showed mild inhibition of cell viabilities, reduction of albumin secretion, and increase of ammonia accumulation. Furthermore, CYP450 enzymes demonstrated various alterations on gene transcription, protein expression and enzyme activities.
		Hepatobiliary Pancreat Dis Int. 2020; 19(2): 129-137 . [Abstract] ( 57 ) [HTML 1KB] [PDF 0KB] ( 85 )

ORIGINAL ARTICLES/Biliary

	138	Ge Y, Jeong S, Luo GJ, Ren YB, Zhang BH, Zhang YJ, Shen F, Cheng QB, Sui CJ, Wang HY, Xia Q, Chen L
		Transarterial chemoembolization versus percutaneous microwave coagulation therapy for recurrent unresectable intrahepatic cholangiocarcinoma: Development of a prognostic nomogram ^Hot!
		Background: Transarterial chemoembolization (TACE) and percutaneous microwave coagulation therapy (PMCT) are commonly used to treat intrahepatic recurrent liver cancers. However, there is no informa- tion regarding their effectiveness in patients with recurrent intrahepatic cholangiocarcinoma (ICC) after resection. Methods: A total of 275 patients with localized recurrent ICC who received either TACE ( n = 183) or PMCT ( n = 92) were studied. A propensity score matching analysis was performed to compare prognostic impact of TACE and PMCT. Prognostic factors for TACE and PMCT were identified respectively. Predictive nomograms for each TACE and PMCT were developed using the Cox independent prognostic factors and were validated in independent patient groups by receiver operating characteristic curves and area under curve values. Results: Both TACE and PMCT provided curativeness in partial patients (5-year overall survival: 21.4% and 6.1%, respectively), but TACE provided better survival benefit in both overall patients (hazard ratio [HR] = 0.71; 95% confidence interval [CI]: 0.50–0.97; P = 0.034) and propensity score matching analysis (HR = 0.69; 95% CI: 0.47–0.98; P = 0.041). Independent prognostic factors for TACE were tumor size > 5 cm, poor differentiation, and major resection, whereas poor differentiation, hepatitis B virus infection, cholelithiasis, and lymph node metastasis were identified for PMCT. Both predictive nomograms for TACE and PMCT were validated to be effective with area under curve values of 0.77 and 0.70, respectively. Conclusions: TACE provided better survival benefits compared to PMCT. However, there was a disparity in prognostic factors, suggesting evaluation of the two nomograms may be supportive in modality selection. Further prospective validation studies are required for the results to be applied in clinical medicine.
		Hepatobiliary Pancreat Dis Int. 2020; 19(2): 138-146 . [Abstract] ( 62 ) [HTML 1KB] [PDF 0KB] ( 90 )

	147	Akita M, Ajiki T, Ueno K, Tsugawa D, Tanaka M, Kido M, Toyama H, Fukumoto T
		Benefits and limitations of middle bile duct segmental resection for extrahepatic cholangiocarcinoma
		Background: Pancreaticoduodenectomy (PD) is a standardized strategy for patients with middle and distal bile duct cancers. The aim of this study was to compare clinicopathological features of bile duct segmen- tal resection (BDR) with PD in patients with extrahepatic cholangiocarcinoma. Methods: Consecutive cases with extrahepatic cholangiocarcinoma who underwent BDR ( n = 21) or PD ( n = 84) with achievement of R0 or R1 resection in Kobe University Hospital between January 2000 and December 2016 were enrolled in the present study. Results: Patients who underwent PD were significantly younger than those receiving BDR. The frequency of preoperative jaundice, biliary drainage and cholangitis was not significantly different between the two groups. The duration of surgery was longer and there was more intraoperative bleeding in the PD than in the BDR group (553 vs. 421 min, and 770 vs. 402 mL; both P < 0.01). More major complications ( > Clavien-Dindo IIIa) were observed in the PD group (46% vs. 10%, P < 0.01). Postoperative hospital stay was also longer in that group (30 vs. 19 days, P = 0.02). Pathological assessment revealed that tumors were less advanced in the BDR group but the rate of lymph node metastasis was similar in both groups (33% in BDR and 48% in PD, P = 0.24). The rate of R0 resection was significantly higher in the PD group (80% vs. 38%, P < 0.01). Adjuvant chemotherapy was more frequently administered to patients in the BDR group (62% vs. 38%, P = 0.04). Although 5-year overall survival rates were similar in both groups (44% for BDR and 51% for PD, P = 0.72), in patients with T1 and T2, the BDR group tended to have poorer prognosis (44% vs. 68% at 5-year, P = 0.09). Conclusions: BDR was comparable in prognosis to PD in middle bile duct cancer. Less invasiveness and lower morbidity of BDR justified this technique for selected patients in a poor general condition.
		Hepatobiliary Pancreat Dis Int. 2020; 19(2): 147-152 . [Abstract] ( 73 ) [HTML 1KB] [PDF 0KB] ( 79 )

	153	Choe JW, Kim HJ, Kim JS
		Survival improvement and prognostic factors in recent management of extrahepatic cholangiocarcinoma: A single-center study
		Background: Cholangiocarcinoma was considered as a dismal disease with very poor prognosis until recently. Cholangiocarcinoma is increasingly found due to increased life expectancy. Although surgical and medical management were advanced recently, data on the prognosis, especially extrahepatic cholangiocarcinoma (ECC), were limited. This study aimed to identify clinicopathologic features and prognosis of patients with ECC. Methods: Patients followed up and diagnosed with ECC between January 2014 and December 2016 at a tertiary hospital were included, whereas those with intrahepatic cholangiocarcinoma, gallbladder cancer, and ampullary cancer were excluded. Results: A total of 83 patients were followed after the treatment (49 men and 34 women; median age 73.3 years). Cancer location was classified as distal common bile duct (25 patients), proximal common bile duct (24 patients), common hepatic duct (20 patients), and hilar (14 patients). About 14.5% of patients had history of another malignant neoplasm, and 24.1% patients had chronic illness. Surgical resection was performed in 54 patients (65%) and dysplasia was combined in 63% (34/54). Adjuvant chemotherapy was performed in 54% (29/54), but only 7 underwent palliative chemotherapy in 29 non-surgical patients. The median overall survival in all patients was 30.9 months. In analyzing the treatment modality, median survival of adjuvant chemotherapy, surgery only, palliative chemotherapy, and supportive care groups were 42.9, 30.9, 12.0, and 8.9 months, respectively ( P < 0.05). In the Cox regression analysis of survival, age, surgical resection, chemotherapy, and comorbidity were significant prognostic factors, and the comorbidity was the only significant prognostic factor in the multivariable analysis (hazard ratio [HR] = 2.80; 95% CI: 1.32–5.95; P = 0.007). In a subgroup analysis of surgical patients, the presence of dysplasia was a favorable prognostic factor in the multivariable analysis (HR = 0.29; 95% CI: 0.09–0.91; P = 0.033). Conclusions: The overall survival of patients with ECC was quite high and increased with chemotherapy. Absence of comorbidity, and presence of dysplasia were good prognostic factors.
		Hepatobiliary Pancreat Dis Int. 2020; 19(2): 153-156 . [Abstract] ( 56 ) [HTML 1KB] [PDF 0KB] ( 104 )

	157	Passeri MJ, Baimas-George MR, Sulzer JK, Iannitti DA, Martinie JB, Baker EH, Ocuin LM, Vrochides D
		Prognostic impact of the Bismuth-Corlette classification: Higher rates of local unresectability in stage IIIb hilar cholangiocarcinoma ^Hot!
		Background: The Bismuth-Corlette (BC) classification is used to categorize hilar cholangiocarcinoma by proximal extension along the biliary tree. As the right hepatic artery crosses just behind the left bile duct, we hypothesized that BC IIIb tumors would have a higher likelihood of local unresectability due to involvement of the contralateral artery. Methods: A retrospective review of a prospectively maintained database identified patients with hilar cholangiocarcinoma taken to the operating room for intended curative resection between April 2008 and September 2016. Cases were assigned BC stages based on preoperative imaging. Results: Sixty-eight patients were included in the study. All underwent staging laparoscopy after which 16 cases were aborted for metastatic disease. Of the remaining 52 cases, 14 cases were explored and aborted for locally advanced disease. Thirty-eight underwent attempt at curative resection. After excluding cases aborted for metastatic disease, the chance of proceeding with resection was 55.6% for BC IIIb staged lesions compared to 80.0% of BC IIIa lesions and to 82.4% for BC I-IIIa staged lesions ( P < 0.05). About 44.4% of BC IIIb lesions were aborted for locally advanced disease versus 17.6% of remaining BC stages. Conclusions: When hilar cholangiocarcinoma is preoperatively staged as BC IIIb, surgeons should antici- pate higher rates of locally unresectable disease, likely involving the right hepatic artery.
		Hepatobiliary Pancreat Dis Int. 2020; 19(2): 157-162 . [Abstract] ( 53 ) [HTML 1KB] [PDF 0KB] ( 90 )

ORIGINAL ARTICLES/Pancreas

	163	Zou SY, Wang WS, Zhan Q, Deng XX, Shen BY
		Higher body mass index deteriorates postoperative outcomes of pancreaticoduodenectomy
		Background: Previous studies presented controversies in impact of body mass index (BMI) on perioper- ative complications in pancreatectomy, and mainly focused on Western population. This study aimed to explore the impact of BMI on perioperative outcomes in Chinese patients undergoing pancreaticoduo- denectomy. Methods: Seven hundred and seven adult patients undergoing open pancreaticoduodenectomy between January 2005 and December 2016 at Ruijin Hospital were studied retrospectively and categorized as obese (BMI ≥25 kg/m 2 ), overweight (BMI ≥23 kg/m 2 and < 25 kg/m 2 ), or normal weight (BMI ≥18.5 kg/m 2 and < 23 kg/m 2 ). Associations of these BMI groups with perioperative outcomes were evaluated. Results: The overweight and obese groups experienced higher risk of clinically related postoperative pan- creatic fistula (CR-POPF) (7.6% vs. 9.9% vs. 17.6%, P = 0.002) and re-operation (1.1% vs. 2.5% vs. 5.1%, P = 0.017), and longer systemic inflammation response syndrome (SIRS) duration [2 (1–9) d vs. 2 (1–7) d vs. 3 (1–10) d, P = 0.003] and postoperative hospital stay [19 (2–84) d vs. 19 (7–158) d vs. 23 (8–121) d, P = 0.023] than the normal weight group did. The multiple logistic regression models showed obese as an independent risk factor for CR-POPF ( P = 0.013). The multiple linear regression analysis confirmed BMI as a predictor for prolonged postoperative hospital stay ( P = 0.005). Conclusions: Higher BMI results in higher morbidity of Chinese patients undergoing open pancreaticoduo- denectomy. Pancreaticoduodenectomy is still a safe surgery procedure for overweight and obese patients, with intensive perioperative management.
		Hepatobiliary Pancreat Dis Int. 2020; 19(2): 163-168 . [Abstract] ( 60 ) [HTML 1KB] [PDF 0KB] ( 92 )

	169	Lutt F, Ehlers L, Nizze H, Jaster R
		Different characteristics of chronic dibutyltin dichloride-induced pancreatitis and cholangitis in mouse and rat
		Background: Current animal models of chronic pancreatitis (CP) often provide only limited pathophysiological insights since they incompletely reflect the human disease. CP induced by injection of dibutyltin dichloride (DBTC-pancreatitis) shares with human CP the important feature of extended fibrosis and would be an even more attractive model if it could be transferred from rats to mice, as recently suggested in the context of combined ethanol and DBTC application. This study aimed to evaluate the effects of DBTC in pancreas and liver of C57BL/6 mice, a strain commonly used to engineer genetic mouse models. Methods: C57BL/6 mice and Lewis rats were exposed to variable doses of DBTC. After an investigation period of up to 4 weeks, laboratory findings and histopathological changes of pancreas and liver were evaluated. Results: Chronic DBTC-pancreatitis in rats was characterized by acinar cell damage, ductal changes, fibrosis, and inflammatory cell infiltrates. Mice treated with DBTC at 6–8 mg/kg body weight, the standard doses in rats, showed transient increases of lipase activities but no morphological signs of chronic DBTC-pancreatitis 4 weeks after injection of the drug. Increased doses of 10–12 mg/kg DBTC were intolerable due to their high toxicity. In contrast, mice and rats presented with a similar histopathology of the liver that can be characterized as a chronic-proliferative DBTC-cholangitis with predominating damage and proliferation of the small bile ducts as well as secondary portal inflammatory cell infiltrates and a beginning portal fibrosis. Conclusions: The DBTC-model cannot be transferred from rats to C57BL/6 mice with respect to chronic DBTC-pancreatitis, but might be of interest to study DBTC-cholangitis in both species.
		Hepatobiliary Pancreat Dis Int. 2020; 19(2): 169-174 . [Abstract] ( 57 ) [HTML 1KB] [PDF 0KB] ( 87 )

	175	Harricharran T, Ogunwobi OO
		Oxytocin and oxytocin receptor alterations, decreased survival, and increased chemoresistance in patients with pancreatic cancer ^Hot!
		Background: Oxytocin (OXT) and its receptor (OXTR) is associated with cancer. The present study was to investigate the correlation between the genetic expression alterations of OXT and OXTR and the outcomes in patients with pancreatic cancer (PC). Methods: Information regarding OXT and OXTR genetic alterations and changes in gene expression were retrieved from the Cancer Genome Atlas (TCGA) databases and analyzed using the cBioPortal online tool. We assessed the correlation of overall survival and disease/progression-free months to either OXT or OXTR genetic alterations and changes in gene expression using Kaplan-Meier and Cox regression analyses. Quantitative PCR (qPCR) was conducted to assess the mRNA expression levels of OXT and OXTR in human PC cell lines. Results: Five percent of PC cases showed mRNA upregulation in the OXT gene. These PC cases also showed genetic alterations and changes in gene expression of OXTR. The median months of survival and disease-free survival were lower for PC cases with genetic alterations and changes in gene expression in the OXT and OXTR genes as compared to those without such alterations. qPCR data showed that OXT and OXTR mRNA expression were 1-fold and 10-fold higher, respectively in PANC-1 cell lines as compared to L3.6pl cell lines in direct negative correlation with responsiveness to gemcitabine. Conclusions: These data suggest that OXT and OXTR may potentially be important in PC progression, chemoresistance, and patient survival, and potentially could have prognostic and therapeutic implications in a subset of PC patients.
		Hepatobiliary Pancreat Dis Int. 2020; 19(2): 175-180 . [Abstract] ( 59 ) [HTML 1KB] [PDF 0KB] ( 86 )

CLINICAL IMAGE

	181	Yang Z, Abdrakhimov B, Wang S, Xie QF, Zhuang L, Zheng SS
		Liver transplantation in a patient with massive polycystic liver disease
		Polycystic liver disease (PLD) is a genetic disorder [1] that is diagnosed by presence of multiple hepatic cysts. Clinical manifestations of PLD are related to the size of hepatic cysts and associated complications. In the early stage, PLD rarely causes any symptoms. However, patients with advanced stage PLD have a variety of clinical manifestations and complications due to severe hepatomegaly. They include abdominal pain, abdominal distension, dyspepsia, ascites and many others that may result from compression of adjacent tissue or organ failure [2,3]. Surgical treatment of PLD includes: aspiration with or without sclerotherapy, cyst fenestration, hepatectomy and liver transplantation. Despite some researchers have concluded that cyst fenestration or hepatectomy is effective in treatment of PLD [4–6], the only curative surgical option in severe patients is liver transplantation [7,8]. All other types of surgeries present a great challenge to a surgeon, having little or no effect when cysts are diffuse, or even contraindicated due to possibility of life-threatening complications arising during or after the procedure. Herein, we report a case of 51-year-old male diagnosed with massive PLD complicated by abdominal adhesion, liver cirrhosis, splanchnic varices and ascites that successfully underwent liver transplantation.
		Hepatobiliary Pancreat Dis Int. 2020; 19(2): 181-183 . [Abstract] ( 52 ) [HTML 1KB] [PDF 0KB] ( 98 )

	184	Orlando G, Lai Q, Lerut J
		Composite hepatocellular and hemangiosarcomatous tumor: The prognosis is determined by the sarcomatous component
		Nowadays, mixed liver tumors are more frequently diagnosed due to better imaging, advanced immunohistochemistry (IHC) staining techniques and better knowledge of hepatic tumorigenesis [1–3]. Such tumors represent a mosaic of components with distinct histogenesis and carcinogenic pathways. As their occurrence in the liver is very rare, their behavior and natural history are difficult to determine, and their management remains empirical. An uncommon case of a composite tumor harboring hepatocellular carcinoma (HCC) and hepatic hemangiosarcoma (HHS) components in a liver transplant (LT) recipient is reported herein.
		Hepatobiliary Pancreat Dis Int. 2020; 19(2): 184-186 . [Abstract] ( 68 ) [HTML 1KB] [PDF 0KB] ( 89 )

	187	Li T, Liu C, He JT, Sui KD, Zhang ZB, Hong D, Su HY, Shao HB
		Portal stent with endovascular brachytherapy improves the efficacy of TACE for hepatocellular carcinoma with main portal vein tumor thrombus
		Hepatocellular carcinoma (HCC) with portal vein tumor thrombus (PVTT) yields poor prognosis with a median overall survival (OS) of 2.7–4 months [1]. Once PVTT develops in the main portal vein, the sudden appearance of portal hypertension often leads to fatal complications, including esophagogastric variceal hemorrhage, refractory ascites, and liver failure. Transarterial chemoembolization (TACE) has been recommended for advanced HCC patients by China Liver Cancer Group due to its benefit of OS compared with using sorafenib alone [2]. For the treatment of PVTT, portal stent with endovascular iodine-125 brachytherapy (PSEIB) was recently reported to be effective because it relieved portal hypertension rapidly and controlled PVTT effectively with an improved OS of 9.3–12.5 months [3,4]. The combination of PSEIB and TACE had been applied in some studies [3,4]. Nevertheless, these studies failed to demonstrate the effect of PSEIB on TACE results. Herein we aimed to present a case how PSEIB improves the efficacy of TACE for HCC patients with main PVTT.
		Hepatobiliary Pancreat Dis Int. 2020; 19(2): 187-190 . [Abstract] ( 57 ) [HTML 1KB] [PDF 0KB] ( 95 )

	191	Ogura T, Nishioka N, Higuchi K
		Lumen-apposing metal stent deployment for walled-off necrosis using semi-free hand technique from the intestine
		Lumen-apposing metal stent (LAMS) deployment under endoscopic ultrasonography (EUS) guidance has been used for walled-off necrosis (WON) [1] . Recently, LAMS with electrocautery enhanced delivery system has been developed. One of the advantages of this stent is that the stent can be delivered without any dilation devices. However, to prevent stent migration into the intestinal lumen, it is important that stent delivery system should be inserted within the WON. When the diameter of WON is not large enough to insert stent delivery system, contralateral wall of WON may be injured. To prevent this adverse event, guidewire insertion may be useful after puncturing. In addition, according to the recent reports [2–4] , EUS-guided LAMS placement for WON drainage has been performed. We herein described a case of LAMS deployment from the second part of the duodenum using semi-free hand technique.
		Hepatobiliary Pancreat Dis Int. 2020; 19(2): 191-193 . [Abstract] ( 63 ) [HTML 1KB] [PDF 0KB] ( 86 )

LETTERS TO THE EDITOR

	194	Lainas P, Rodda GA,Rafek G,Millereux M,Dammaro C,Trouiller P, Maitre S, Dagher I
		Lifesaving transarterial embolization using absorbable gelatin sponge particles for massive bleeding of ruptured metastatic hepatic melanoma
		Melanoma is an aggressive malignant tumor that arises from melanocytic cells. It usually originates from the epithelial tissues of the skin, retina and anorectal canal. Melanoma is characterized by early metastases, even from thin primary tumors. The most common sites of distant metastasis are: skin, lung, brain, liver, bone and intestine. Liver involvement occurs in 14% to 20% of cases [1] , but the diagnosis is usually performed incidentally on imaging studies, since these lesions are seldom symptomatic. Rarely, metastatic hepatic melanoma can manifest as an acute condition of massive bleeding due to spontaneous rupture of one or more hepatic lesions, with disastrous outcomes for patients in most cases. In the current literature, very few cases of spontaneous rupture of metastatic hepatic melanoma have been reported, all with fatal outcomes [2–5] . Indeed, when such a condition occurs, prompt management and bleeding control strategies are essential for long-term survival of these patients.
		Hepatobiliary Pancreat Dis Int. 2020; 19(2): 194-196 . [Abstract] ( 65 ) [HTML 1KB] [PDF 0KB] ( 82 )

	197	Chen MT, Zhou YQ, Wu TY, Cheng DX, Li G, Zhan RY
		Rare giant asymptomatic skull metastasis from intrahepatic cholangiocarcinoma
		Skull metastases are common cranial tumors in adults. Breast cancer, lung cancer, prostate cancer and malignant lymphoma are the most common types of primary tumor. Skull metastases are often asymptomatic; however, they can also cause local pain and cranial nerve palsies, and even severe disability due to compression of the dural sinuses [1] . In these cases, surgery is necessary to improve the patients’ quality of life, especially relieving the mass effect of skull metastasis. Skull metastases from less common malignant tumors such as intrahepatic cholangiocarcinoma (ICC) have rarely been described [2–6] , and its treatment still remained a big challenge for all neurosurgeons. Here, we present an asymptomatic case of giant skull metastases from ICC treated with complete resection and chemotherapy.
		Hepatobiliary Pancreat Dis Int. 2020; 19(2): 197-199 . [Abstract] ( 55 ) [HTML 1KB] [PDF 0KB] ( 89 )

	200	Wang H, Zhang BB, Wang SF, Zhong JJ, Zheng JM, Han H
		Pancreatic schwannoma: Imaging features and pathological findings
		Schwannoma is an infrequent tumor originating from Schwann cells of the peripheral nerve sheath and was first reported as a true neoplasm originating from Schwann cells in 1910 [1] . The majority of schwannomas are detected as a solitary tumor from the peripheral nerves of the face, neck, trunk, extremities, or retroperitoneal region. Based on a previous study [2] , merely 3% of schwannomas are retroperitoneal, accounting for approximately 4% of all retroperitoneal tumors. Furthermore, pancreatic schwannomas that stem from either parasympathetic or sympathetic fibers of the pancreas are especially rare. Schwannomas are generally encapsulated, and over 90% are benign [3] . Considering its benign biological behavior, it is essential to accurately diagnose schwannomas in order to apply reasonable surgical methods and postoperative surveillance. Herein, we report four cases of pancreatic schwannoma in our center to update the data on the clinicopathological traits about this type of tumor.
		Hepatobiliary Pancreat Dis Int. 2020; 19(2): 200-202 . [Abstract] ( 60 ) [HTML 1KB] [PDF 0KB] ( 86 )

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