Hepatobiliary Pancreat Dis Int

	2023 Vol. 22 No. 2
	Published: 2023-04-15


	Pages 111-220
	LETTERS TO THE EDITOR Special issue on clinical and basic research in pancreatic cancer

Special issue on clinical and basic research in pancreatic cancer

	111	Lau WY
		Current controversies and challenges for resection of pancreatic ductal adenocarcinoma in pancreatic head aiming at cure ^Hot!
		Pancreatic ductal adenocarcinoma (PDAC) is a very common but a highly lethal malignancy due to its biological aggressive behavior. PDAC more commonly affects the head than other parts of the pancreas. As PDAC in the head of pancreas is located at an anatomical position with a lot of adjacent vital structures, and the cornerstone of treatment aiming at cure is pancreaticoduodenectomy (PD), only about 20% of patients have resectable disease at the time of clinical presentation [1], with a very low 5-year overall survival of around 20% after surgical resection with curative intent [2].
		Hepatobiliary Pancreat Dis Int. 2023; 22(2): 111-112 . [Abstract] ( 148 ) [HTML 1KB] [PDF 0KB] ( 125 )

	113	Yang Z, Li ZK, Zheng SS
		Laparoscopic pancreaticoduodenectomy: From “standard” to “extended”
		Pancreatic cancer is one of the most desperate malignances worldwide with approximately 470000 deaths per year, and the 5-year survival rate is only 11% [1]. Pancreaticoduodenectomy (PD) is the standard treatment for pancreatic head and periampullary lesions [2]. PD is often either described as “standard PD” or “extended PD” (e.g., “PD with portal vein resection, additional organ resection or arterial resection”) [3].
		Hepatobiliary Pancreat Dis Int. 2023; 22(2): 113-114 . [Abstract] ( 130 ) [HTML 1KB] [PDF 0KB] ( 138 )

	115	Hua J, Shi S, Zhang B, Xu J, Wang W
		Anatomical features and technical difficulties in laparoscopic pancreaticoduodenectomy with various superior mesenteric artery-first approaches
		Laparoscopic pancreaticoduodenectomy (LPD) at its early stage failed to demonstrate the superiority compared with open pancreaticoduodenectomy (OPD) [1]. The well-known randomized trial, LEOPARD-2, was even terminated due to the safety issue [2], but recent researches [3,4 ] revealed that LPD is technically safe and feasible with acceptable rates of morbidity and mortality and therefore, gains popularity recently. The appropriate surgical approaches are of vital importance for performing LPD safely [5]. Artery-first approach in open operation can be now routinely performed laparoscopically [6]. Ma and coworkers [7] in this issue evaluated the safety and feasibility of LPD with major vascular resection using medial approach compared with those of OPD with major vascular resection. Here, we summarized anatomical features and technical difficulties in LPD with various superior mesenteric artery (SMA)-first approaches. These approaches were classified into four categories according to the direction of access to the SMA (anterior or posterior or left or right).
		Hepatobiliary Pancreat Dis Int. 2023; 22(2): 115-118 . [Abstract] ( 126 ) [HTML 1KB] [PDF 0KB] ( 131 )

	119	Hackert T
		Conversion surgery for pancreatic cancer: A future paradigm also for stage IV tumors? ^Hot!
		Pancreatic ductal adenocarcinoma (PDAC) remains still one of the most lethal tumor entities and will be the second leading cause of cancer-related death within the next ten years for both male and female patients. This frustrating development is mainly explained by an increasing incidence and still limited therapeutical success [1,2]. Only about 15%-20% of all patients diagnosed with PDAC qualify for upfront surgery, while in the remaining patients, locally advanced or metastatic tumor stages are found at diagnosis, the largest proportion of these patients presenting with stage IV tumors [3].
		Hepatobiliary Pancreat Dis Int. 2023; 22(2): 119-120 . [Abstract] ( 167 ) [HTML 1KB] [PDF 0KB] ( 159 )

	121	Chierici A, Castaldi A, El Zibawi M, Rosso E, Iannelli A
		How to deal with right hepatic artery coming from the superior mesenteric artery during minimally invasive pancreaticoduodenectomy: A systematic review ^Hot!
		Background: Anatomical variations in the liver arterial supply are quite common and can affect the surgical strategy when performing a minimally invasive pancreaticoduodenectomy (MIPD). Their presence must be preemptively detected to avoid postoperative liver and biliary complications. Data sources: Following the PRISMA guidelines and the Cochrane protocol we conducted a systematic review on the management of an accessory or replaced right hepatic artery (RHA) arising from the superior mesenteric artery when performing an MIPD. Results: Five studies involving 118 patients were included. The most common reported management of the aberrant RHA was conservative (97.0%); however, patients undergoing aberrant RHA division without reconstruction did not develop liver or biliary complications. No differences in postoperative morbidity or long-term oncological related overall survival were reported in all the included studies when comparing MIPD in patients with standard anatomy to those with aberrant RHA. Conclusions: MIPD in patients with aberrant RHA is feasible without increase in morbidity and mortality. As preoperative strategy is crucial, we suggested planning an MIPD with an anomalous RHA focusing on preoperative vascular aberrancy assessment and different strategies to reduce the risk of liver ischemia.
		Hepatobiliary Pancreat Dis Int. 2023; 22(2): 121-127 . [Abstract] ( 135 ) [HTML 1KB] [PDF 0KB] ( 139 )

	128	Jiang XY, Zhu QC, Zhang XJ, Duan T, Feng J, Sui XB, Sun XN, Mou YP
		Roles of lncRNAs in pancreatic ductal adenocarcinoma: Diagnosis, treatment, and the development of drug resistance
		Background: Pancreatic ductal adenocarcinoma (PDAC) is one of the most lethal cancers, primarily due to its late diagnosis, high propensity to metastasis, and the development of resistance to chemo-/radiotherapy. Accumulating evidence suggests that long non-coding RNAs (lncRNAs) are intimately involved in the treatment resistance of pancreatic cancer cells via interacting with critical signaling pathways and may serve as potential diagnostic/prognostic markers or therapeutic targets in PDAC. Data sources: We carried out a systematic review on lncRNAs-based research in the context of pancreatic cancer and presented an overview of the updated information regarding the molecular mechanisms underlying lncRNAs-modulated pancreatic cancer progression and drug resistance, together with their potential value in diagnosis, prognosis, and treatment of PDAC. Literature mining was performed in PubMed with the following keywords: long non-coding RNA, pancreatic ductal adenocarcinoma, pancreatic cancer up to January 2022. Publications relevant to the roles of lncRNAs in diagnosis, prognosis, drug resistance, and therapy of PDAC were collected and systematically reviewed. Results: LncRNAs, such as HOTAIR, HOTTIP, and PVT1, play essential roles in regulating pancreatic cancer cell proliferation, invasion, migration, and drug resistance, thus may serve as potential diagnostic/prognostic markers or therapeutic targets in PDAC. They participate in tumorigenesis mainly by targeting miRNAs, interacting with signaling molecules, and involving in the epithelial-mesenchymal transition process. Conclusions: The functional lncRNAs play essential roles in pancreatic cancer cell proliferation, invasion, migration, and drug resistance and have potential values in diagnosis, prognostic prediction, and treatment of PDAC.
		Hepatobiliary Pancreat Dis Int. 2023; 22(2): 128-139 . [Abstract] ( 120 ) [HTML 1KB] [PDF 0KB] ( 129 )

	140	Zhang XP, Xu S, Zhao ZM, Liu Q, Zhao GD, Hu MG, Tan XL, Liu R
		Robotic pancreaticoduodenectomy for pancreatic ductal adenocarcinoma: Analysis of surgical outcomes and long-term prognosis in a high-volume center ^Hot!
		Background: Robotic pancreaticoduodenectomy (RPD) has been reported to be safe and feasible for patients with pancreatic ductal adenocarcinoma (PDAC) of the pancreatic head. This study aimed to analyze the surgical outcomes and risk factors for poor long-term prognosis of these patients. Methods: Data from patients who underwent RPD for PDAC of pancreatic head were retrospectively analyzed. Multivariate Cox regression analysis was used to seek the independent prognostic factors for overall survival (OS), and an online nomogram calculator was developed based on the independent prognostic factors. Results: Of the 273 patients who met the inclusion criteria, the median operative time was 280.0 minutes, the estimated blood loss was 100.0 mL, the median OS was 23.6 months, and the median recurrence-free survival (RFS) was 14.4 months. Multivariate analysis showed that preoperative carbohydrate antigen 19- 9 (CA19-9) [hazard ratio (HR) = 2.607, 95% confidence interval (CI): 1.560-4.354, P < 0.001], lymph node metastasis (HR = 1.429, 95% CI: 1.005-2.034, P = 0.047), tumor moderately (HR = 3.190, 95% CI: 1.813- 5.614, P < 0.001) or poorly differentiated (HR = 5.114, 95% CI: 2.839-9.212, P < 0.001), and Clavien-Dindo grade ≥III (HR = 1.657, 95% CI: 1.079-2.546, P = 0.021) were independent prognostic factors for OS. The concordance index (C-index) of the nomogram constructed based on the above four independent prognostic factors was 0.685 (95% CI: 0.640-0.729), which was significantly higher than that of the AJCC staging (8th edition): 0.541 (95% CI: 0.493-0.589) ( P < 0.001). Conclusions: This large-scale study indicated that RPD was feasible for PDAC of pancreatic head. Preoperative CA19-9, lymph node metastasis, tumor poorly differentiated, and Clavien-Dindo grade ≥III were independent prognostic factors for OS. The online nomogram calculator could predict the OS of these patients in a simple and convenient manner.
		Hepatobiliary Pancreat Dis Int. 2023; 22(2): 140-146 . [Abstract] ( 152 ) [HTML 1KB] [PDF 0KB] ( 151 )

	147	Ma MJ, Cheng H, Chen YS, Yu XJ, Liu C
		Laparoscopic pancreaticoduodenectomy with portal or superior mesenteric vein resection and reconstruction for pancreatic cancer: A single-center experience ^Hot!
		Background: Open pancreaticoduodenectomy (OPD) with portal or superior mesenteric vein resection and reconstruction has been applied in pancreatic cancer patients with tumor infiltration or adherence. However, it is controversial whether laparoscopic pancreaticoduodenectomy (LPD) with major vascular resection and reconstruction is feasible. This study aimed to evaluate the safety and feasibility of LPD with major vascular resection compared with OPD with major vascular resection. Methods: We reviewed data for all pancreatic cancer patients undergoing LPD or OPD with vascular resection at Department of Pancreatic Surgery, Fudan University Shanghai Cancer Center, between February 2018 and May 2022. We compared the preoperative, intraoperative, and postoperative clinicopathological data of the two groups to conduct a comprehensive evaluation of LPD with major vascular resection. Results: A total of 63 patients underwent pancreaticoduodenectomy (PD) with portal or superior mesenteric vein resection and reconstruction, including 25 LPDs and 38 OPDs. The LPD group had less intraoperative blood loss (200 vs. 400 mL, P < 0.001), lower proportion of intraoperative blood transfusion (16.0% vs. 39.5%, P = 0.047), longer operation time (390 vs. 334 min, P = 0.004) and shorter postoperative hospital stay (11 vs. 14 days, P = 0.005). There was no perioperative death in all patients. There was no significant difference in the incidence of total postoperative complications, grade B/C postoperative pancreatic fistula, delayed gastric emptying and abdominal infection between the two groups. No postpancreatectomy hemorrhage nor bile leakage occurred during perioperative period. There was no significant difference in R0 resection rate and number of lymph nodes harvested between the two groups. Patency of reconstructed vessels in the two groups were 96.0% and 92.1%, respectively ( P = 0.927). Conclusions: LPD with portal or superior mesenteric vein resection and reconstruction was safe, feasible and oncologically acceptable for selected patients with pancreatic cancer, and it can achieve similar or even better perioperative results compared to open approach.
		Hepatobiliary Pancreat Dis Int. 2023; 22(2): 147-153 . [Abstract] ( 165 ) [HTML 1KB] [PDF 0KB] ( 122 )

	154	Shin D, Kwon J, Lee JH, Park SY, Park Y, Lee W, Song KB, Hwang DW, Kim SC
		Robotic versus laparoscopic distal pancreatectomy for pancreatic ductal adenocarcinoma: A propensity score-matched analysis
		Background: Minimally invasive surgery is becoming increasingly popular in the field of pancreatic surgery. However, there are few studies of robotic distal pancreatectomy (RDP) for pancreatic ductal adenocarcinoma (PDAC). This study aimed to investigate the efficacy and feasibility of RDP for PDAC. Methods: Patients who underwent RDP or laparoscopic distal pancreatectomy (LDP) for PDAC between January 2015 and September 2020 were reviewed. Propensity score matching analyses were performed. Results: Of the 335 patients included in the study, 24 underwent RDP and 311 underwent LDP. A total of 21 RDP patients were matched 1:1 with LDP patients. RDP was associated with longer operative time (209.7 vs. 163.2 min; P = 0.003), lower open conversion rate (0% vs. 4.8%; P < 0.001), higher cost (15 722 vs. 12 699 dollars; P = 0.003), and a higher rate of achievement of an R0 resection margin (90.5% vs. 61.9%; P = 0.042). However, postoperative pancreatic fistula grade B or C showed no significant intergroup difference (9.5% vs. 9.5%). The median disease-free survival (34.5 vs. 17.3 months; P = 0.588) and overall survival (37.7 vs. 21.9 months; P = 0.171) were comparable between the groups. Conclusions: RDP is associated with longer operative time, a higher cost of surgery, and a higher likelihood of achieving R0 margins than LDP.
		Hepatobiliary Pancreat Dis Int. 2023; 22(2): 154-159 . [Abstract] ( 125 ) [HTML 1KB] [PDF 0KB] ( 131 )

	160	Xu S, Zhang XP, Zhao GD, Zou WB, Zhao ZM, Liu Q, Hu MG, Liu R
		Derivation and validation of a preoperative prognostic model for resectable pancreatic ductal adenocarcinoma
		Background: The prognosis of patients with pancreatic ductal adenocarcinoma (PDAC) remains poor even after radical pancreaticoduodenectomy (PD). The study aimed to develop and validate a novel preoperative prognostic model to accurately predict the long-term survival of patients with PDAC. Methods: Patients with PDAC of pancreatic head from Chinese PLA General Hospital were included. The preoperative PDAC model with contour plots was developed using a non-linear model in the training cohort and then tested in the validation cohort. Results: Of 421 patients who met the inclusion criteria, 280 were in the training cohort and 141 in the validation cohort. Contour plots for preoperative PDAC model were established to visually predict the survival probabilities of these patients, based on preoperative carbohydrate antigen 19-9, preoperative fibrinogen to albumin ratio and pain symptoms. This model stratified patients into low- and high-risk groups with distinctly different long-term survival in the training cohort [median overall survival (OS) 32.1 vs. 17.5 months; median recurrence-free survival (RFS) 19.3 vs. 10.0 months, both P < 0.001] and the validation cohort (median OS 28.3 vs. 19.0 months; median RFS 17.5 vs. 11.2 months, both P < 0.001). Time-dependent receiver operating characteristic and decision curve analyses revealed that the model provided higher diagnostic accuracy and superior net benefit compared to other staging systems. Conclusions: This study constructed and validated a novel preoperative prognostic model that can accurately and conveniently predict the long-term survival of patients with resectable PDAC of pancreatic head. Besides, the model can screen high-risk patients with poor prognosis, which may provide references for personal treatment strategies in the future.
		Hepatobiliary Pancreat Dis Int. 2023; 22(2): 160-168 . [Abstract] ( 130 ) [HTML 1KB] [PDF 0KB] ( 120 )

	169	He RZ, Zheng JH, Yao HF, Xu DP, Yang MW, Liu DJ, Sun YW, Huo YM
		ADAMTS12 promotes migration and epithelial-mesenchymal transition and predicts poor prognosis for pancreatic cancer
		Background: ADAMTS (a disintegrin and metalloproteinase with thrombospondin-like motifs) family, a group of extracellular multifunctional enzymes, has been proven to play a pivotal role in the tumor. In pancreatic cancer, the role and mechanism of this family remain unclear. The present study aimed to figure out the hub gene of ADAMTSs and explore the exact roles in the prognosis and biological functions in pancreatic ductal adenocarcinoma (PDAC). Methods: We used several databases to analyze the ADAMTS family and then screen out the hub genes. The expression of ADAMTS12 in 106 pairs of PDAC tumors and adjacent normal tissues was examined by immunohistochemistry, and its correlations with clinical parameters were further analyzed. The impacts of ADAMTS12 on the migration of PDAC cells were predicted by gene set enrichment analysis and confirmed by transwell assays. The potential impacts of ADAMTS12 on the epithelial-mesenchymal transition (EMT) were identified by database analysis and experimental proof of real-time quantitative polymerase chain reaction (qPCR) and Western blotting. Results: Our study found that ADAMTS12 was a crucial gene in PDAC, and it was highly expressed in tumor tissues when compared to that in the adjacent tissues. ADATMS12 had predictive value of a poor prognosis for PDAC. The elevation of ADAMTS12 was parallel to the progression of PDAC. Inhibition of ADAMTS12 suppressed the migration of PDAC cells and interfered with the process of EMT. Conclusions: ADAMTS12 is a crucial member of ADAMTSs in PDAC and a predictor of poor prognosis. Additionally, based on its impacts on migration and metastasis in PDAC and the relationship with EMT, ADAMTS12 plays a role of an oncogene in PDAC and may be a promising target for treatment.
		Hepatobiliary Pancreat Dis Int. 2023; 22(2): 169-178 . [Abstract] ( 112 ) [HTML 1KB] [PDF 0KB] ( 127 )

	179	Wang H, Zhou HC, Ren RL, Du SX, Guo ZK, Shen XH
		Apolipoprotein E2 inhibits mitochondrial apoptosis in pancreatic cancer cells through ERK1/2/CREB/BCL-2 signaling ^Hot!
		Background: Apolipoprotein E2 (ApoE2) is a pleiotropic protein that influences several aspects of cancer metabolism and development. Evading apoptosis is a vital factor for facilitating cancer cell growth. However, the role and mechanism of ApoE2 in regulating cell apoptosis of pancreatic cancer remain unclear. Methods: In this study, we firstly detected the mRNA and protein expressions of ApoE2 in PANC-1 and Capan-2 cells by real-time polymerase chain reaction and Western blotting. We then performed TUNEL and flow cytometric analyses to explore the role of recombinant human ApoE2, pCMV6-ApoE2 and siApoE2 in the apoptosis of PANC-1 and Capan-2 cells. Furthermore, we investigated the molecular mechanism through which ApoE2 affected apoptosis in PANC-1 cells using immunofluorescence, immuno-precipitation, Western blotting and co-immunoprecipitation analysis. Results: ApoE2 phosphorylated ERK1/2 and inhibited pancreatic cancer cell apoptosis. In addition, our data showed that ApoE2/ERK1/2 altered the expression and mitochondrial localization of BCL-2 via activating CREB. ApoE2/ERK1/2/CREB also increased the total BCL-2/BAX ratio, inhibited the opening of the mitochondrial permeability transition pore and the depolarization of mitochondrial transmembrane potential, blocked the leakage of cytochrome-c and the formation of the apoptosome, and consequently, suppressed mitochondrial apoptosis. Conclusions: ApoE2 regulates the mitochondrial localization and expression of BCL-2 through the activation of the ERK1/2/CREB signaling cascade to evade the mitochondrial apoptosis of pancreatic cancer cells. ApoE2 may be a distinct prognostic marker and a potential therapeutic target for pancreatic cancer.
		Hepatobiliary Pancreat Dis Int. 2023; 22(2): 179-189 . [Abstract] ( 186 ) [HTML 1KB] [PDF 0KB] ( 146 )

	190	Revskij D, Runst J, Umstatter C, Ehlers L, Rohde S, Zechner D, Bastian M, Muller-Hilke B, Fuellen G, Henze L, Murua Escobar H, Junghanss C, Kowald A, Walter U, Kohling R, Wolkenhauer O, Jaster R
		Uncoupling protein 2 deficiency of non-cancerous tissues inhibits the progression of pancreatic cancer in mice
		Background: Pancreatic ductal adenocarcinoma (PDAC) is a disease of the elderly mostly because its development from preneoplastic lesions depends on the accumulation of gene mutations and epigenetic alterations over time. How aging of non-cancerous tissues of the host affects tumor progression, however, remains largely unknown. Methods: We took advantage of a model of accelerated aging, uncoupling protein 2-deficient ( Ucp2 knockout, Ucp2 KO) mice, to investigate the growth of orthotopically transplanted Ucp2 wild-type (WT) PDAC cells (cell lines Panc02 and 6606PDA) in vivo and to study strain-dependent differences of the PDAC microenvironment. Results: Measurements of tumor weights and quantification of proliferating cells indicated a significant growth advantage of Panc02 and 6606PDA cells in WT mice compared to Ucp2 KO mice. In tumors in the knockout strain, higher levels of interferon-γ mRNA despite similar numbers of tumor-infiltrating T cells were observed. 6606PDA cells triggered a stronger stromal reaction in Ucp2 KO mice than in WT animals. Accordingly, pancreatic stellate cells from Ucp2 KO mice proliferated at a higher rate than cells of the WT strain when they were incubated with conditioned media from PDAC cells. Conclusions: Ucp2 modulates PDAC microenvironment in a way that favors tumor progression and implicates an altered stromal response as one of the underlying mechanisms.
		Hepatobiliary Pancreat Dis Int. 2023; 22(2): 190-199 . [Abstract] ( 127 ) [HTML 1KB] [PDF 0KB] ( 127 )

LETTERS TO THE EDITOR

	200	Pan LY, Hu XM, Han P, Yang DF
		Des-gamma-carboxy prothrombin is a promising biomarker of hepatocellular carcinoma and a predictor of complications in patients with chronic liver diseases
		Although des-gamma-carboxy prothrombin (DCP) is considered a complementary biomarker to alpha-fetoprotein (AFP) in the diagnosis of hepatocellular carcinoma (HCC), its cut-off value has not been recommended in any guideline. This study aimed to explore the diagnostic efficacy of DCP on HCC.
		Hepatobiliary Pancreat Dis Int. 2023; 22(2): 200-204 . [Abstract] ( 106 ) [HTML 1KB] [PDF 0KB] ( 127 )

	205	Zhao XD, Ye J, Sun YK, Liang JF, Hu L, Chang AC, Du LZ, Li HM, Shu Q, Chen X, Tan LH
		Hypoxic hepatitis in children after cardiac surgery
		Hypoxic hepatitis (HH), also known as ischemic hepatitis or shock liver, is a liver injury characterized by necrosis of centrilobular hepatocytes with a rapid increase in serum aminotransferase levels. The incidence rate of HH among patients in the intensive care unit (ICU) was found to be 0.9%-11.9% [1]. Occurrence of HH appears to have a significant impact on the clinical outcome. The 30-day mortality rate in critically ill patients who developed HH has been reported to be over 50% [1,2]. Nevertheless, raised aminotransferase levels are still not given sufficient consideration in the clinical context. The high incidence and the strong prognostic impact of HH on ICU survival encourage research to recognize its occurrence as early as possible [3].
		Hepatobiliary Pancreat Dis Int. 2023; 22(2): 205-209 . [Abstract] ( 119 ) [HTML 1KB] [PDF 0KB] ( 139 )

	210	Kim HJ, Paik KY
		Xanthogranulomatous cholecystitis managed by laparotomy may go through troublesome clinical course: Reflection of severe inflammation
		Xanthogranulomatous cholecystitis (XGC) is an uncommon inflammatory disease of the gallbladder, and its incidence is reported to be 1.3%-5.2% [1] . XGC is diagnosed by histopathological examination, characterized by severe inflammatory destruction followed by a granulomatous reaction, marked proliferative fibrosis, and infiltration of inflammatory cells [2]. Despite being a benign disease, XGC can exhibit aggressive behavior by extending the range of inflammation to neighboring organs, resulting in adhesions, perforation, abscess formation, and fistulous communication with the bowel [3]. Therefore, it is very difficult to distinguish XGC from gallbladder cancer based on preoperative images and clinical representation. It is usually not possible to diagnose XGC before surgery. The ambiguity of the diagnosis and its inherent invasive nature make it difficult to determine the method of operation. If the diagnosis of XGC is clear, the definite treatment is simple cholecystectomy with or without combined resection of the involved organ [4,5]. However, the involvement of multiple organs makes the surgery difficult and requires a radial operation. Several reports do not recommend the laparoscopic approach because of the high conversion rate of up to 80%, prolonged operative time, and high complication rate. Whereas, there are a few studies on the clinical outcomes of the open radical approach [2,4,6]. This study focused on different surgical types for XGC under different clinical outcomes according to different surgical types, which may reflect the invasiveness of XGC.
		Hepatobiliary Pancreat Dis Int. 2023; 22(2): 210-212 . [Abstract] ( 120 ) [HTML 1KB] [PDF 0KB] ( 123 )

	213	Cheng J, Hong DF, Zhang CW, Fan XM, Luo ZY, YaoWF, Jin LM
		Transcatheter arterial chemoembolization after percutaneous microwave ablation and portal vein embolization for advanced hepatocellular carcinoma
		Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) promotes the future liver remnant (FLR) rapid proliferation in the short term, which in turn provides an opportunity for radical surgical resection to hepatocellular carcinoma (HCC) for patients with insufficient FLR [1,2]. However, the HCC patients with cirrhosis have slow compensatory hyperplasia of the FLR, and hence, some patients cannot tolerate second-stage hepatectomy due to insufficient growth of FLR or liver dysfunction after first-stage ALPPS [3]. The perioperative mortality and complication rates of traditional ALPPS are high [4]. Conversely, percutaneous microwave ablation liver partition and portal vein embolization (PALPP) avoids the first step of abdominal surgery with low risk and is minimally invasive [5]. It provides a safe opportunity of secondary salvage treatment for HCC patients who cannot tolerate second-stage hepatectomy because of insufficient compensatory hyperplasia of FLR or severe cirrhosis. In this study, we presented the clinical data of transcatheter arterial chemoembolization (TACE) combined with PALPP in a patient with advanced HCC and cirrhosis and assessed the clinical effect over a 47-month follow-up.
		Hepatobiliary Pancreat Dis Int. 2023; 22(2): 213-216 . [Abstract] ( 124 ) [HTML 1KB] [PDF 0KB] ( 120 )

	217	Shen ZH, Yuan WB, Yan Q, Mao J, Zhang Q
		An accidental gallbladder schwannoma misdiagnosis as malignant cancer
		Schwannomas are mainly benign neurogenic tumors originating from the Schwann cells in peripheral nerves sheaths and occur in patients at any age and in every location [1,2 ]. The most common occurring sites of schwannomas are the head, neck and extremities [3]. In the abdominal cavity, the most frequently involved sites are the retroperitoneum and stomach [4]. Schwannomas in the gallbladder are uncommon and rarely have been reported in the literature. Due to the lack of specific clinical experience, schwannomas in the gallbladder are almost indistinguishable from malignant tumors and hard to make an accurate preoperative diagnosis. We herein report a case of gallbladder schwannoma, which was misdiagnosed as cancer before operation.
		Hepatobiliary Pancreat Dis Int. 2023; 22(2): 217-220 . [Abstract] ( 118 ) [HTML 1KB] [PDF 0KB] ( 113 )

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