- Abstract: We describe herein the first successful implementation of intraportal stent placement combined with right portal vein embolization as preoperative management against far advanced gallbladder carcinoma. The patient was a 66-year-old woman with obstructive jaundice, in whom computed tomography confirmed that gallbladder carcinoma had invaded the liver and that massive lymph node metastases involved the hepatoduodenal ligament. Portography also revealed severe stenosis of the main portal trunk... Show More
- Abstract: Lactate dehydrogenase (LDH) has been reported to be a sensitive indicator of pancreatic necrosis (PN). In patients with biliary pancreatitis (BP), however, liver enzymes are generally elevated early in the course of the disease because of acute inflammatory liver cell injury caused by ampullary stones impacted during their transpapillary passage. Accordingly, the identification of PN using the initial high LDH activity as an indicator of PN in BP may not be accurate. In patients with ongoing... Show More
- Abstract: Obturator hernia is relatively rare and occurs mostly in elderly, thin, multiparous women. Recent reports have highlighted the importance of pelvic computed tomography (CT) for the preoperative diagnosis. Thirty-six patients with an obturator hernia operated in our hospital were divided retrospectively into two groups (group A: 18 operations from 1973 to 1986, before we used CT; group B: 18 CT cases from 1987 to 1995). Preoperative diagnoses, operative procedures, and postoperative course... Show More
- Abstract: A series of 49 patients with carcinoma of the papilla of Vater treated by pancreaticoduodenectomy with lymph node dissection were subjected to a clinicopathological study, in order to elucidate prognostic factors for the improvement of surgical outcomes. And the appropriate lymph node dissection was evaluated. The cumulative 5-year survival rate was 57.1%. Univariate and multivariate analyses revealed that significant prognostic factor were invasion to the pancreas, invasion to the duodenum,... Show More
- Abstract: The utility of hepatic vein reconstruction following resection of segments VII and VIII plus the right hepatic vein (RHV) is still controversial. The purpose of this study was to investigate the surgical benefits of hepatic vein reconstruction using stapled vascular clips and the draining area of hepatic vein using angiographic computed tomography (CT) to determine strict indications for hepatic vein reconstruction. Five patients underwent RHV reconstruction by external iliac vein graft... Show More
- Abstract: The right umbilical portion (right-sided round ligament) has been discussed as an intrahepatic portal venous anomaly associated with "left-sided gallbladder" in several reports. We treated two patients with right umbilical portion (RUP) associated with cholangiocarcinoma. Left hepatectomies were performed, preserving the residual hepatic blood flow and biliary continuity. From our experience in these patients we propose the presence of anomalous configuration of the intrahepatic biliary... Show More
Article: Four Cases of Pericecal Hernia.
- Abstract: We clinicopathologically studied 19 patients with nonocclusive mesenteric ischemia. 10 men and 9 women aged 48-88 years (mean: 74.6 years). The majority of patients had cardiovascular disease and 6 had collagen disease. Preoperative examination showed no specific findings. The necrotic bowel was resected in all patients, and survival was 78.9%. Histological examination of the straight arteries of the resected bowel revealed arteritis in 3 patients with a history of collagen disease. When... Show More
- Abstract: The incidence of primary duodenal cancer is low among digestive tract cancers, but since it is often diagnosed a few considerable progression, prognosis is poor. We clinicopathologically examined for 20 patients undergoing resection for primary duodenal cancer. Pancreatoduodenectomy numbered 15, partial duodenal excision numbered 3, and pancreatoduodenectomy with preservation of the pyloric ring numbered 2 cases. Mural invasion into the pancreas was observed in 14 cases and metastasis to... Show More
- Abstract: A 70-year-old female was admitted for right hypochondralgia. Blood biochemistry studies revealed evidence of inflammation, liver dysfunction, and jaundice. Abdominal ultrasonography (US) showed gallbladder wall thickening and common bile duct dilatation, suggesting acute cholangitis. Endoscopic retrograde cholangiopancreatography (ERCP) revealed clotted blood in the papillary region, and 3 filling dafects were detected in the common bile duct. An endoscopic nasobiliary drainage (ENBD) tube... Show More
Publications citing this author (1387)
- Lens culinaris agglutinin-reactive AFP (AFP-L3) is a newly developed assay, highly sensitive fraction of AFP (hs-AFP-L3) that has been used as a diagnostic and prognostic marker of HCC. In patients with AFP < 20 ng/mL, measurements of AFP-L3% by the highly sensitive method before treatment was more useful for diagnosis and prognosis of HCC than by the conventional method. Furthermore, since hs-AFP-L3% increases before HCC is detectable by various advanced imaging modalities, this assay may help identify benign liver disease patients with a higher risk of HCC.
[Show abstract] [Hide abstract] ABSTRACT: Objective: Using integrated expression analyses of miRs, their mRNA and protein targets and stromal gene expression, we aimed to identify differentially expressed profiles between tumors from YA-BC and MA-BC. Methodology and results: Samples of ER+ invasive ductal breast carcinomas, divided into two groups: YA-BC (35 years or less) or MA-BC (50-65 years) were evaluated. Screening for BRCA1/2 status according to the BOADICEA program indicated low risk of patients being carriers of these mutations. Aggressive characteristics were more evident in YA-BC versus MA-BC. Performing qPCR, we identified eight miRs differentially expressed (miR-9, 18b, 33b, 106a, 106b, 210, 518a-3p and miR-372) between YA-BC and MA-BC tumors with high confidence statement, which were associated with aggressive clinicopathological characteristics. The expression profiles by microarray identified 602 predicted target genes associated to proliferation, cell cycle and development biological functions. Performing RPPA, 24 target proteins differed between both groups and 21 were interconnected within a network protein-protein interactions associated with proliferation, development and metabolism pathways over represented in YA-BC. Combination of eight mRNA targets or the combination of eight target proteins defined indicators able to classify individual samples into YA-BC or MA-BC groups. Fibroblast-enriched stroma expression profile analysis resulted in 308 stromal genes differentially expressed between YA-BC and MA-BC. Conclusion: We defined a set of differentially expressed miRNAs, their mRNAs and protein targets and stromal genes that distinguish early onset from late onset ER positive breast cancers which may be involved with tumor aggressiveness of YA-BC.
- Most of these miRs were previously implicated in regulating pathways involved with BC malignancy. The over expression of miR-9, miR-210, miR-106b, miR-33b, miR-18b was formerly related to poor prognosis, suggesting those miRs as aggressive biomarkers  . The under-expression of miR-372 was related to metastatic tumors, suggesting reduction of miR-372 expression as a poor prognosis biomarker .
- Other mechanisms mediated by sheddase (protease or heparanase) could be responsible of the cleavage of cell surface attached Glypican-3 although further studies are needed to clarify this point. Currently, the mechanism of Glypican-3 shedding into the extracellular space and sera is of general interest, and the possibility of using GPC3 as a serological marker in different cancer types is under investigation . Less is known regarding Glypican-1, which, in our study, showed a very similar expression pattern to that of Notum in late lesions, although some positive staining was also observed in 90% of the analysed ACFs.
[Show abstract] [Hide abstract] ABSTRACT: This study aimed to define the role of combined major hepatectomy and pancreaticoduodenectomy in the surgical management of biliary carcinoma and to identify potential candidates for this aggressive procedure. A retrospective analysis was conducted on 28 patients who underwent a combined major hepatectomy and pancreaticoduodenectomy for extrahepatic cholangiocarcinoma (n = 17) or gallbladder carcinoma (n = 11). Major hepatectomy was defined as hemihepatectomy or more extensive hepatectomy. Altogether, 11 patients underwent a Whipple procedure, and 17 had a pylorus-preserving pancreaticoduodenectomy. The median follow-up time was 169 months. Morbidity and in-hospital mortality were 82% and 21%, respectively. Overall cumulative survival rates after resection were 32% at 2 years and 11% at 5 years (median survival time 9 months). The median survival time was 6 months with a 2-year survival rate of 0% in 11 patients with residual tumor, whereas the median survival time was 26 months with a 5-year survival rate of 18% in 17 patients with no residual tumor (P = 0.0012). Residual tumor status was the only independent prognostic factor of significance (relative risk 4.65; P = 0.003). There were three 5-year survivors (two with diffuse cholangiocarcinoma and one with gallbladder carcinoma with no bile duct involvement) among the patients with no residual tumor. Combined major hepatectomy and pancreaticoduodenectomy provides survival benefit for some patients with locally advanced biliary carcinoma only if potentially curative (R0) resection is feasible. Patients with diffuse cholangiocarcinoma and gallbladder carcinoma with no bile duct involvement are potential candidates for this aggressive procedure.
- Thus, the involvement of such vital arteries must be assessed meticulously during the operation before starting a resection [36, 46]. Any involvement of the hepatic arteries to be preserved and/or the superior mesenteric artery should exclude the choice of combined major hepatectomy and PD because reconstruction of such vital arteries provides little survival benefit for patients with histologically verified invasion of these ves- sels [8, 37]. The main limitation of the current study is that it is a retrospective analysis of a small number of patients.
[Show abstract] [Hide abstract] ABSTRACT: Background: Hypovascular nodules often occur together with hypervascular hepatocellular carcinoma (HCC). However, it remains controversial whether hypovascular nodules associated with hypervascular HCC have any prognostic value. This study evaluated the prognostic impact of hypovascular nodules co-existing with hypervascular HCC as diagnosed by computed tomography during arterial portography (CTAP) and computed tomography during hepatic arteriography (CTHA), which can sensitively capture the dynamic changes in blood flow through the portal vein and hepatic artery in patients with early stage HCC. Methods: A total of 152 patients with hypervascular HCC (? 30 mm, ? 3 nodules), who underwent initial local ablation, were analyzed retrospectively. All patients received CTAP and CTHA prior to treatment. Overall survival (OS) was compared among group A (hypervascular HCC only, 107 patients) and group B (hypovascular nodules and hypervascular HCC, 45 patients). Results: Among all hypovascular nodules, 81% (46 of 57) developed hypervascularization within the follow-up period. The 1- and 2-year hypervascularization rates were 17% and 51%, respectively. OS was significantly longer for group A than for group B (P < 0.001). A Cox proportional-hazards model identified the presence of hypovascular nodules concurrent with hypervascular HCC as an independent poor prognostic factor. Conclusion: The prognosis of hypervascular HCC patients with hypovascular nodules detected during CTAP and CTHA is poor. Clinical HCC categories seem to be dissimilar between patients with and without hypovascular nodules.
- These results were similar to hypervascularization of hypovascular nodules in our study, although there was the limitation that hypervascularization was diagnosed not with only CTAP/CTHA but also other modalities Impact of Hypovascular Nodules in HCC such as dynamic CT or dynamic MRI. Toyoda et al found that non-hypervascular hypointense nodules are a risk factor for recurrence of HCC after hepatectomy, mainly due to multicentric recurrence . Furthermore, patients with non-hypervascular hypointense nodules are at a high risk for HCC development at any site in the liver .
[Show abstract] [Hide abstract] ABSTRACT: The histidine-rich calcium binding protein (HRC) is a regulator of Ca2+-homeostasis. Herein, we found that HRC was frequently upregulated in human hepatocellular carcinoma (HCC) tissues, and its expression was correlated with tumor size and metastasis. Moreover, HRC expression was positively related to the metastatic potential of HCC cell lines. Knockdown of HRC suppressed cell invasion and migration in vitro, whereas ectopic expression of HRC resulted in increased cell invasion and migration in vitro and intrahepatic and lung metastasis in vivo. Interestingly, the pro-invasion and pro-migration effects of HRC were associated with focal adhesion turnover, which was a consequence of FAK phosphorylation. Further experiments showed that HRC induced phospho-FAK, focal adhesion turnover and cell migration through Ca2+/CaM singaling. We found that HRC increased [Ca2+]i by inhibiting the expression of SERCA2. In addition, upregulation of HRC in HCC was attributed to SATB1, which is known to promote HCC metastasis. Ectopic expression of SATB1 enhanced HRC gene transcription by activating AP-1 in mainly a JNK-dependent manner. Our findings highlight HRC as a potential therapeutic target for HCC treatment.
- Collectively, these results indicated that HRC participated in the pro-metastasis function of SATB1 in HCC. To address the molecule mechanism of SATB1- mediated HRC expression, we investigated MAPKs and Akt signal pathways, which are two main pathways in HCC [23, 24]. Prominent changes in the levels of phosphorylated JNK, c-Jun, MEK1/2 and ERK1/2 were
[Show abstract] [Hide abstract] ABSTRACT: Background The prognosis of advanced hepatocellular carcinoma (HCC) is dismal, underscoring the need for novel effective treatments. The α1,6-fucosyltransferase (fucosyltransferase 8, FUT8) has been reported to accelerate malignant potential in HCC. Our study aimed to investigate the regulation of FUT8 expression by p53 and develop a novel therapeutic strategy for targeting HCC cells using L-fucose-mediated drug delivery. Methods Binding sites for p53 were searched for within the FUT8 promoter region. FUT8 expression was assessed by immunoblotting. Chromatin immunoprecipitation (ChIP) assays were performed to analyze p53 binding to the FUT8 promoter. The delivery of Cy5.5-encapsulated L-fucose-liposomes (Fuc-Lip-Cy5.5) to a Lens Culinaris agglutinin-reactive fraction of α-fetoprotein (AFP-L3)-expressing HCC cells was analyzed by flow cytometry. The induction of FUT8 by histone deacetylase inhibitor (HDACi) -inducing acetylated -p53 was evaluated by immunoblotting. Flow cytometric analysis was performed to assess whether the activation of p53 by HDACi affected the uptake of Fuc-Lip-Cy5.5 by HCC cells. The cytotoxicity of an L-fucose-bound liposome carrying sorafenib (Fuc-Lip-sorafenib) with HDACi was assessed in vivo and in vitro. Results The knock down of p53 with siRNA led to decreased FUT8 expression. ChIP assays revealed p53 binds to the FUT8 promoter region. Flow cytometric analyses demonstrated the specific uptake of Fuc-Lip-Cy5.5 into AFP-L3-expressing HCC cells in a p53- and FUT8-dependent manner. HDACi upregulated the uptake of Fuc-Lip-Cy5.5 by HCC cells by increasing FUT8 via acetylated -p53. The addition of a HDACi increased apoptosis induced by Fuc-Lip-sorafenib in HCC cells. Conclusions Our findings reveal that FUT8 is a p53 target gene and suggest that p53 activated by HDACi induces Fuc-Lip-sorafenib uptake by HCC cells, highlighting this pathway as a promising therapeutic intervention for HCC.
- Thus, a combination strategy using HDACi and Fuc-Lip to encapsulate anticancer drugs could be a promising novel strategy for HCC treatment. In HCC patients, the positivity of AFP-L3 is around 20–30%; AFP-L3 correlates with poor differentiation, indicating that AFP-L3 may have a prognostic value.On the other hand, p53 is mutated in 25% of HCC patients. We demonstrated that AFP-L3 levels were higher in HCC patients with tumors expressing wt -p53 compared to those with tumors showing mutant -p53.
[Show abstract] [Hide abstract] ABSTRACT: We herein describe the case of a 70-year-old female patient diagnosed with pancreatic carcinoma. An abdominal enhanced computed tomography scan revealed a poorly enhanced mass (17 mm × 15 mm in size) in the pancreatic head. Magnetic resonance cholangiopancreatography revealed stenosis of the main pancreatic and common bile ducts caused by a mass-neighboring cyst. Based on these findings, we performed subtotal stomach-preserving pancreaticoduodenectomy. The patient demonstrated a good postoperative course, and was discharged from our hospital in remission 49 days after the surgery. Pathological findings confirmed that it was anaplastic pancreas carcinoma (giant cell type). After the surgery, we performed S-1 adjuvant chemotherapy 100 mg/day for four weeks, repeated similarly every six weeks for a total of four courses. We have followed this case for over 2 years so far with adjuvant chemotherapy, and no recurrence or metastasis has been revealed. Adjuvant chemotherapy with S-1 in patients with resected anaplastic carcinoma of the pancreas is also recommended as a result of Japan Adjuvant Study Group of Pancreatic Cancer 01(JASPAC-01) like the ordinary pancreatic ductal carcinomas. There is a possibility to achieve long-term survival in cases in which multidisciplinary treatment such as a curative resection and adjuvant chemotherapy are performed.
- It might result in a better prognosis to perform further S-1 based chemotherapy or postoperative chemoradiation strategies undergoing curative-intent resection of pancreatic cancer . We hope to further evaluate the randomized trial such as JASPAC-01  in the future. There is a possibility to achieve longterm survival in cases in which multidisciplinary treatment such as a curative resection and adjuvant chemotherapy are performed.
[Show abstract] [Hide abstract] ABSTRACT: Background: Surveillance for hepatocellular carcinoma (HCC) has level I evidence among patients with hepatitis B but only level II evidence in patients with cirrhosis. This lack of randomized data has spurred questions regarding the utility of HCC surveillance in this patient population; however, lack of randomized data does not equate to a lack of data supporting the efficacy of surveillance. The aim of our study was to determine the effect of HCC surveillance on early stage tumor detection, receipt of curative therapy, and overall survival in patients with cirrhosis. Methods and findings: We performed a systematic literature review using Medline from January 1990 through January 2014 and a search of national meeting abstracts from 2009-2012. Two investigators identified studies that reported rates of early stage tumor detection, curative treatment receipt, or survival, stratified by HCC surveillance status, among patients with cirrhosis. Both investigators independently extracted data on patient populations, study methods, and results using standardized forms. Pooled odds ratios, according to HCC surveillance status, were calculated for each outcome using the DerSimonian and Laird method for a random effects model. We identified 47 studies with 15,158 patients, of whom 6,284 (41.4%) had HCC detected by surveillance. HCC surveillance was associated with improved early stage detection (odds ratio [OR] 2.08, 95% CI 1.80-2.37) and curative treatment rates (OR 2.24, 95% CI 1.99-2.52). HCC surveillance was associated with significantly prolonged survival (OR 1.90, 95% CI 1.67-2.17), which remained significant in the subset of studies adjusting for lead-time bias. Limitations of current data included many studies having insufficient duration of follow-up to assess survival and the majority not adjusting for liver function or lead-time bias. Conclusions: HCC surveillance is associated with significant improvements in early tumor detection, receipt of curative therapy, and overall survival in patients with cirrhosis. Please see later in the article for the Editors' Summary.
- In the seven studies with more than 10% Child Pugh C patients, the 3-year survival rates were only 49.8% (795 of 1,597 patients) and 22.0% (311 of 1,411 patients), respectively [19,25,40,44,47,54,61]. Finally, we evaluated survival according to study quality, with high-quality studies defined as those with a score of 7–9 [27,34,40,44,49,51,53,55,58,62] and >low-quality studies defined as those with scores less than 7 <citref rids=ref19 ref22 ref25 ref35 ref38 ref39 ref43 ref47 ref52 ref54 ref59 ref61">17,19,22,25,35,38,39,43,47,52,54,59,61]. with incidentally discovered tumors (p,0.001) or the 9-month median survival among patients who presented symptomatically (p,0.001)
- Emergency surgery can thus be avoided. An indwelling urinary catheter is also effective for preventing recurrence, and an increase in the frequency of conservative treatment is anticipated . HBO (2.5 atm, 84 min, 8 -20 sessions) has been attracting attention as a method for treating spontaneous rupture of the urinary bladder.
[Show abstract] [Hide abstract] ABSTRACT: Tumor-associated macrophages (TAMs), the most abundant infiltrating immune cells in tumor microenvironment, have distinct functions in hepatocellular carcinoma (HCC) progression. CD68+ TAMs represent multiple polarized immune cells mainly containing CD86+ antitumoral M1 macrophages and CD206+ protumoral M2 macrophages. TAMs expression and density were assessed by immunohistochemical staining of CD68, CD86, and CD206 in tissue microarrays from 253 HCC patients. Clinicopathologic features and prognostic value of these markers were evaluated. We found that CD68+ TAMs were not associated with clinicopathologic characteristics and prognosis in HCC. Low presence of CD86+ TAMs and high presence of CD206+ TAMs were markedly correlated with aggressive tumor phenotypes, such as multiple tumor number and advanced tumor-node-metastasis (TNM) stage; and were associated with poor overall survival (OS) (p = 0.027 and p = 0.024, respectively) and increased time to recurrence (TTR) (p = 0.037 and p = 0.031, respectively). In addition, combined analysis of CD86 and CD206 provided a better indicator for OS (p = 0.011) and TTR (p = 0.024) in HCC than individual analysis of CD86 and CD206. Moreover, CD86+/CD206+ TAMs predictive model also had significant prognosis value in _-fetoprotein (AFP)-negative patients (OS: p = 0.002, TTR: p = 0.005). Thus, these results suggest that combined analysis of immune biomarkers CD86 and CD206 could be a promising HCC prognostic biomarker.
- Still worse, there is no reliable biomarker to differentiate the prognosis of AFP -HCC patients. To test the prognostic value of TAMs marker in AFP − patients (cut-off point 20 ng/mL) [17,18], 99 patients were selected from as the abovementioned cohort. In this AFP − cohort, patients with CD86 low and CD206 high status had the worse OS and TTR (OS: 40.5 months, p =0.002, TTR: 32.6 months, p = 0.005, Figure 5A,B) compared with three other groups (Group I, CD86 high but CD206 low , OS: 57.1 months, TTR: 54.1 months; Group II, CD86 low and CD206 low , OS: 54.8 months, TTR: 48.8 months; Group III, CD86 high but CD206 high , OS: 52.8 months, TTR: 37.4 months).
[Show abstract] [Hide abstract] ABSTRACT: Background There have been few studies on the impact of viral etiology on the prognosis in patients with hepatocellular carcinoma (HCC). The aim of this study was to evaluate the clinical characteristics and survival of patients with viral hepatitis-associated HCC (V-HCC), compared to patients with HCC of non-hepatitis B, non-hepatitis C (NBNC-HCC) etiology. Methods We performed a retrospective analysis of all patients with HCC treated at our comprehensive cancer center from 2000 through 2014. Patients were divided into two groups according to their viral hepatitis status. Presentation patterns, treatments, and survival data were analyzed. Results We evaluated 366 patients: 233 patients (63.7%) had V-HCC while 133 (36.3%) patients had NBNC-HCC. V-HCC patients were younger (P<0.0001) and more likely to be male (P=0.001). Decompensated cirrhosis was more prevalent in V-HCC patients (P=0.01). There was no difference in the resectability rate or disease stage. In patients with resectable disease, those with V-HCC were less likely to undergo hepatectomy (23.7% vs. 38%; P=0.04) for more advanced liver disease. The estimated median survival for V-HCC was 13 months compared to 16 months in NBNCHCC patients (P=0.57). On multivariate analysis, disease stage (P<0.0001) and Child-Pugh class (P<0.0001) were independent factors affecting survival, but viral status was not (P=0.75). Conclusion Despite presenting with more advanced cirrhosis and being less likely to undergo surgery, V-HCC patients had similar survival to patients with NBNC-HCC. Keywords Hepatocellular carcinoma, survival, viral hepatitis Ann Gastroenterol 2017; 30 (1): 101-105
- Th e younger age of patients in the V-HCC group, as well as the higher incidence of decompensated cirrhosis compared to the NBNC-HCC group, suggest a faster progression of liver disease with viral hepatitis. Th e majority of studies comparing the prognosis of HCC according to viral status come from Japan, where hepatitis C is the predominant causative agent [7,17,18]. Akahoshi et al showed that the cause of cirrhosis was an independent factor in determining survival. In their study, while NBNC-HCC patients presented more commonly with advanced disease, stage-stratifi ed comparisons found that NBNC-HCC patients fared better than those with V-HCC .
[Show abstract] [Hide abstract] ABSTRACT: Cyanoacrylates are a group of fast-acting adhesives. They form low viscosity liquids in the monomer state and instantly polymerize to become adhesive upon contact with ionic substances. Since the 1950s, they have been used around the world for industrial and household purposes. N-butyl cyanoacrylate (NBCA) is a cyanoacrylate that is commonly used for medical care, and the closure of skin wounds with NBCA has been found to promote hemostasis. However, in Japan, the intravascular injection of NBCA is considered to be off-label use, except during the treatment of gastric varices under endoscopy. The use of NBCA in embolotherapy is considered when the target vessels cannot be cannulated superselectively, for vascular diseases that require long segments of the target vessel to be embolized, or for patients in a hypocoagulable state. NBCA-based embolotherapy can be used to treat vascular malformations, acute hemorrhaging, tumors, and venous disease. The complications associated with NBCA-based embolotherapy include tissue ischemia, hemorrhaging, systemic or local reactions, and catheter adhesion to blood vessels. NBCA is mixed with Lipiodol to make it radiopaque and to adjust its polymerization time. Since there are various technical aspects to performing NBCA-based embolotherapy safely, it should be carried out by, or with the assistance of, proficient interventional radiologists.
- As for vital organ ischemia induced via collateral channels, unintended embolization of the anterior spinal artery by NBCA after its migration through the intercostal and lumber arteries has been reported [110, 144]. The following complications of NBCA have also been reported: brain infarcts [10, 29, 42, 46, 62, 74, 79, 84, 91, 92, 94, 96, 97, 101–107, 114, 127, 161, 172, 184], visual disturbance [29, 36, 89, 101, 102, 104, 106] , ophthalmo- myelitis , spinal paralysis [110, 150], pulmonary embolism [16, 26, 28, 30, 76, 82, 85, 93, 101, 102, 109, 141, 170], intestinal ischemia [54, 67, 68, 73, 87, 98, 99, 153, 155, 164, 182], acute cholecystitis [169, 177], hepatic artery obstruction [49, 159, 181], splenic infarction [113, 167], renal infarction [39, 51, 117], soft tissue injury [88, 95, 103, 104, 116, 142, 145], and peripheral nerve disorders [88, 142, 182]. (2) Hemorrhaging [10, 42, 46, 60, 62, 74, 92–94, 96, 107, 160, 170].
[Show abstract] [Hide abstract] ABSTRACT: Hepatocellular carcinoma (HCC) is a major health concern worldwide. The prediction of prognosis of HCC is complex compared with most solid tumors, because it depends on the tumor burden in addition to patient’s underlying liver disease and liver functional reserve. Therefore, staging systems based on both tumor factors and host factors such as liver function have been required to accurately classify HCC patients undergoing various therapeutic options. Although many staging systems and scoring systems have been established and refined in many countries, however, there is currently no globally accepted system for assessing HCC patients, due to heterogeneity of the extent of tumor extension and underlying liver disease. In this review, we focus on the currently available staging systems for assessing the prognosis of HCC, their uses, limitations, and future prospects.
- Usefulness of the staging systems will also differ depending on the distribution of patients with HCC according to the period. As mentioned above, Toyoda et al.  reported that the CLIP staging systems proved to be more suitable before 1990, however, the JIS system was the most suitable after 1990, when early detection and early treatment of HCC became common. When early detection of HCCs becomes more common in many countries, it could lead to the predominance of early-stage HCC patients and Japanese staging systems such as the JIS and the JIS family may become more suitable over the world.
[Show abstract] [Hide abstract] ABSTRACT: Fernmetastasen treten bei 40–60 % aller Patienten mit kolorektalem Karzinom auf. In 80 % der Fälle handelt es sich hierbei primär um Lebermetastasen. Bei 30 % der Patienten ist die Leber auf lange Zeit einziger Metastasierungsort. Bei 15–25 % der Patienten sind Lebermetastasen bereits synchron mit dem Primärtumor manifest. Der Verlauf bei Patienten mit Lebermetastasen kann hinsichtlich ihrer überlebenszeit stark variieren. Die Langzeitprognose wird neben dem Ausmaß des Leberbefalls und eventuell weiterer Metastasierungslokalisationen wesentlich von den therapeutischen Möglichkeiten beeinflusst. Unter Zuhilfenahme multimodaler Therapieoptionen ist die chirurgische Therapie von Lebermetastasen zu einem wichtigen Bestandteil der Behandlung geworden (Sperti et al., 2006).
- Die Re-Resektion kann mit der gleichen Sicherheit und mit vergleichbaren 5-Jahres- Überlebensraten durchgeführt werden wie die primäre Metastasenresektion . Die 5-Jahres-Überlebensraten liegen hier zwischen 23 und 49 %193194195196197198199200201202203204205206207208209210211. Auch nach Drittresektion kann ein 5-Jahres-Überleben von 32 % und ein krankheitsfreies Überleben von 17 % erreicht werden  .
Shizuoka Cancer CenterSizuoka, Shizuoka, Japan