Laparoscopic hepatectomy versus open hepatectomy for hepatocellular carcinoma in 158 patients: A prospective cohort study

2020 ◽  
Author(s):  
Jiao Yuan ◽  
Li Zeng ◽  
min tian ◽  
Sisi Chen ◽  
Huai yi Yao ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Cohort Study ◽  
Survival Rate ◽  
Liver Cancer ◽  
Laparoscopic Hepatectomy ◽  
Rank Test ◽  
Log Rank Test ◽  
Open Hepatectomy ◽  
Disease Free

Abstract BackgroundHepatocellular carcinoma (HCC) ranks as the fourth most common cancer and the third leading cause of cancer-related mortality worldwide. With the development of minimally invasive surgical techniques, laparoscopic hepatectomy is becoming more prevalent in liver surgery. There are multiple reports to evaluate the safety and feasibility of laparoscopic liver resection. Unfortunately, the jury is still out on whether laparoscopic hepatectomy is better than open hepatectomy. The aim of this study is to compare the perioperative and postoperative long-term outcomes of open hepatectomy and laparoscopic hepatectomy for hepatocellular carcinoma, and to evaluate the safety and efficacy of the two surgical methods for hepatocellular carcinoma.MethodsA prospective cohort study of patients who underwent major hepatectomy for hepatocellular carcinoma between October 2017 and September2018 was performed. And these patients were followed for 24 months after surgery. There are158 patients involved in the present study and they were randomly divided into two groups, LH group (n=60), and OH group (n=98). And all of 158 patients underwent hepatectomy. Continuous data were compared by one-way ANOVA, and categorical data were compared by Fisher’s exact test or the c2 test. Survival curves were calculated by the Kaplan–Meier method and compared using the log-rank test. The study was approved by the ethics committee of Union Hospital. (No. WHUH2018S002) and registered in the International Clinical Trial Registry (No. NCT03585166). Informed consent was signed by all patients.ResultsIncision lengths of LH (5.14±3.11cm) were shorter than OH(20.92±6.44cm), P<0.001. Operating time of LH (398.53±170.51 minutes) were longer than OH(257.74±91.31 minutes), P=0.003. Hospital stay of LH(17.72±5.82 days) were shorter than OH(21.42±8.44 days), P<0.001. The average hospitalization costs of LH group (82741.18±26128.81￥) were significantly less than OH group (94998.75±30499.64￥), p=0.011<0.05. The incidence of total complications was also lower in LH group than in OH group (P<0.001). Postoperatively, the leukocyte was significantly lower at 1st day in LH group (9.79±2.92G/L) than in OH group (12.6±4.85 G/L), p<0.001.The aspartate aminotransferase (AST) was significantly lower at 7th day in LH group (39.25±16.63 U/L) than in OH group (62.49±67.77 U/L), p=0.01<0.05. The albumin was significantly higher at 3rd day in LH group (34.21±3.94 g/L) than in OH group (31.24±5.23 g/L), p<0.001. The albumin was significantly higher at 7th day in LH group (35.26±3.73 g/L) than in OH group (33.31±4.51 g/L), p=0.006<0.05. Direct bilirubin was significantly higher at 1st day in LH group (10.28±10.70 µmol /L) than in OH group (315.03±15.71 µmol /L), p=0.04<0.05. The follow-up time after surgery was 24 months (1-24). The mean follow-up time after surgery was 17.94±9.132. Log rank test was performed to compare overall survival rates between the two groups. There were no statistically significant differences with 2-year survival rate between LH and OH group for liver cancer patients, nor was disease-free survival.ConclusionsLaparoscopic hepatectomy surgery supplied a lower incision lengths, hospital stay and incidence of total complications. Laparoscopic hepatectomy was cheaper the open hepatectomy.There were no statistically significant differences with 2-year survival rate between the two group for liver cancer patients, nor was disease-free survival.

scholarly journals Propranolol Is Associated with Lower Risk of Incidence of Hepatocellular Carcinoma in Patients with Alcoholic Cirrhosis: A Tertiary-Center Study and Indirect Comparison with Meta-Analysis

2020 ◽  
Vol 2020 ◽  
pp. 1-7
Author(s):  
Tzu-Hao Li ◽  
Yu-Lien Tsai ◽  
Chien-Fu Hsu ◽  
Chih-Wei Liu ◽  
Chia-Chang Huang ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Meta Analysis ◽  
Indirect Comparison ◽  
Alcoholic Cirrhosis ◽  
Annual Incidence ◽  
Rank Test ◽  
Log Rank Test ◽  
Tertiary Center ◽  
Propranolol Group

Alcoholic cirrhosis (AC) leads to enormous disease burden and occupies a substantial proportion in the etiology of hepatocellular carcinoma (HCC), but scarce attention has been paid to this topic. Besides, propranolol has been reported to decrease the rate of HCC in viral hepatitis. We conducted a retrospective tertiary-center cohort study to identify the HCC incidence in AC patients with or without propranolol. A total of 1,046 AC patients with hospitalization had been screened, and those with regular follow-up for three years or otherwise until the date of malignancy diagnosis without meeting exclusion criteria were enrolled; finally, 23 AC patients with propranolol and 46 AC patients without propranolol were analyzed after twofold propensity-score matching. The cumulative incidence of HCC was lower in the propranolol group (log-rank test, P=0.046). Furthermore, we undertook the meta-analysis of annual incidence of HCC in AC patients, and 1,949 publications were screened, within which eight studies were analyzed; the pooled annual incidence was 2.41%, which was higher than the calculated annual incidence of HCC in our AC cohort with propranolol (1.45%). In conclusion, propranolol is associated with decreased risk of HCC incidence in patients with AC.

Perioperative circulating tumor DNA analysis to predict patient prognosis in liver cancer.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. 4593-4593
Author(s):  
Ledu Zhou ◽  
Ying Xu ◽  
Dong Wang ◽  
Ke Ye ◽  
Liang Xiao ◽  
...  
Keyword(s):  
Liver Cancer ◽  
Survival Time ◽  
Disease Free Survival ◽  
Circulating Tumor Dna ◽  
Rank Test ◽  
Free Survival ◽  
Log Rank Test ◽  
Post Operation ◽  
Disease Free ◽  
Tumor Dna

4593 Background: Resection is a major method for early-stage liver cancer patients. Unfortunately, there still a few patients with post-operation recurrences. Circulating tumor DNA (ctDNA) had been reported as a biomarker in reflecting tumor load and treatment efficacy in some cancer species. Here, we report an application of ctDNA in the perioperative period of liver cancer using targeted sequencing with a 1021-gene panel. Methods: 97 patients diagnosed with liver cancer were enrolled in this study. Postoperative peripheral blood samples were collected within 7 days after surgery and analyzed using hybridization capture based NGS ERSeq method from all patients. Whether a mutant gene was detected in the peripheral blood was defined as ctDNA(+) and ctDNA(-), respectively. Results: Multivariate Cox analysis showed that the post-operation ctDNA was an independent poor prognostic predictor (AFP, RR: 1.0002, 95% Cl: 1.0001-1.0002; ctDNA, RR: 3.738, Cl: 1.872-7.691). 21 patients were ctDNA(+), and all of them had recurrenced (21/21, 100%), while 76 patients were ctDNA(-), and only 12 (12/76, 15.8%) patients had recurrenced. The median disease-free survival time was 5.0 months in ctDNA(+) group and the ctDNA(-) group had not reach the median time (Log-rank test, P < 0.0001). ctDNA combined with AFP would effectively predict the prognosis of patients after surgery. AFP(H) ( > = 400 ng/mL) and ctDNA(+) patients have the worst prognosis and all of the patients had relapsed, while AFP(L) ( < 400 ng/mL) and ctDNA(-) patients had the best prognosis, with less than 20% of patients had relapsed (Log-rank test, P < 0.0001). The median disease-free survival time was 2.0, 6.0 and 7.0 months in ctDNA(+)-AFP(H) (n = 8), ctDNA(-)-AFP(H) (n = 30) and ctDNA(+)-AFP(L) (n = 13) groups, respectively, while ctDNA(-)-AFP(L) group (n = 46) had not reach the median time statistically (Log-rank test, P = 0.0364). Conclusions: In summary, Perioperative ctDNA detection has great potential value clinically, and it also suggests that patients with positive ctDNA after surgery should receive some adjuvant treatments as soon as possible to improve the survival time.

scholarly journals Handheld Capillary Blood Lactate Analyzer as an Accessible and Cost-Effective Prognostic Tool for the Assessment of Death and Heart Failure Occurrence during Long-Term Follow-Up

2016 ◽  
Vol 2016 ◽  
pp. 1-7 ◽  
Author(s):  
Grzegorz M. Kubiak ◽  
Wojciech Jacheć ◽  
Celina Wojciechowska ◽  
Magdalena Traczewska ◽  
Agnieszka Kolaszko ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Survival Rate ◽  
Capillary Blood ◽  
Rank Test ◽  
Free Survival ◽  
Log Rank Test ◽  
Group I ◽  
Group Ii

Impact of tissue lactate accumulation on prognosis after acute myocardial infarction (AMI) is biased. The study aimed to assess the prognostic role of lactate concentration (LC) in patients with AMI during one year of follow-up. 145 consecutive patients admitted due to AMI were enrolled. The data on the frequency of endpoint occurrence (defined as I, death; II, heart failure (HF); and III, recurrent myocardial infarction (re-MI)) were collected. The patients were divided into group A (LC below the cut-off value) and group B (LC above the cut-off value) for the endpoints according to receiver operating characteristic (ROC) analysis. The cumulative survival rate was 99% in group I-A and 85% in group I-B (p = 0.0004, log-rank test). The HF-free survival rate was 95% in group II-A and 82% in group II-B (p = 0.0095, log-rank test). The re-MI-free survival rate did not differ between groups. A multivariate Cox analysis showed a statistically significant influence of LC on death [Hazard Ratio (HR): 1.41, 95% Confidence Interval (CI) (1.13–1.76), and p = 0.002] and HF [HR: 1.21, 95% CI (1.05–1.4), and p = 0.007] with no impact on re-MI occurrence. LC in capillary blood may be considered a useful prognostic marker of late-onset heart failure and death after AMI.

scholarly journals Robot-assisted minimally invasive thoracolaparoscopic esophagectomy versus open esophagectomy: long-term follow-up of a randomized clinical trial

2020 ◽  
Vol 33 (Supplement_2) ◽  
Author(s):  
Eline M de Groot ◽  
Sylvia van der Horst ◽  
B Feike Kingma ◽  
Lucas Goense ◽  
Pieter C van der Sluis ◽  
...  
Keyword(s):  
Overall Survival ◽  
Disease Free Survival ◽  
Rank Test ◽  
Robot Assisted ◽  
Short Term ◽  
Free Survival ◽  
Log Rank Test ◽  
Disease Free

ABSTRACT Initial results of the ROBOT, which randomized between robot-assisted minimally invasive esophagectomy (RAMIE) and open transthoracic esophagectomy (OTE), showed significantly better short-term postoperative outcomes in favor of RAMIE. However, it is not yet clarified if RAMIE is equivalent to OTE regarding long-term outcomes. The aim of this study was to report the long-term oncological results of the ROBOT trial in terms of survival and disease-free survival. This study is a follow-up study of the ROBOT trial, which was a randomized controlled trial comparing RAMIE to OTE in 112 patients with intrathoracic esophageal cancer. Both the trial protocol and short-term results were previously published. The primary outcome of the current study was 5-year overall survival. Secondary outcomes were disease-free survival and recurrence patterns. Analysis was by intention to treat. During the recruitment period, 109 patients were included in the survival analysis (RAMIE n = 54, OTE n = 55). Majority of patients had clinical stage III or IV (RAMIE 63%, OTE 55%) and received neoadjuvant chemoradiotherapy (80%). Median follow-up was 60 months (range 31–60). The combined 5-year overall survival rates for RAMIE and OTE were 41% (95% CI 27–55) and 40% (95% CI 26–53), respectively (log rank test P = 0.827). The 5-year disease-free survival rate was 42% (95% CI 28–55) in the RAMIE group and 43% (95% CI 29–57) in the OTE group (log rank test P = 0.749). Out of 104 patients, 57 (55%) developed recurrent disease detected at a median of 10 months (range 0–56) after surgery. No statistically difference in recurrence rate nor recurrence pattern was observed between both groups. Overall survival and disease-free survival of RAMIE are comparable to OTE. These results continue to support the use of robotic surgery for esophageal cancer.

scholarly journals Faktor yang Berpengaruh Terhadap Disease Free Survival dan Overall Survival pada Pasien Kanker Payudara Usia Muda di Kota Padang Tahun 2008 - 2018

2020 ◽  
Vol 9 (1S) ◽  
Author(s):  
Magdi Ayuza ◽  
Wirsma Arif Harahap ◽  
Rony Rustam ◽  
Richvan Dana Nindrea
Keyword(s):  
Overall Survival ◽  
Cohort Study ◽  
Disease Free Survival ◽  
Rank Test ◽  
Free Survival ◽  
Log Rank Test ◽  
Kaplan Meier ◽  
Disease Free ◽  
Data Register

Kanker Payudara (KPD) pada usia muda memiliki keistimewaan karakteristik. Rekurensi KPD dipengaruhi oleh berbagai faktor antara lain faktor klinis, regimen terapi dan biomolekuler dari tumor itu sendiri. Berbagai macam modalitas terapi KPD, namun masih terdapat risiko terjadinya rekurensi terutama pada pasien dewasa muda. Tujuan: Mengetahui faktor-faktor yang mempengaruhi Disease Free Survival (DFS) dan Overall Survival (OS) pada pasien KPD usia muda di Kota Padang. Metode: Penelitian ini menggunakan desain cohort study retrospectif pada pasien KPD usia muda yang telah mendapatkan pengobatan KPD yang memenuhi kriteria inklusi sebanyak 103 sample yang terdapat pada data register KPD PERABOI Padang. Analisis survival menggunakan Kaplan Meier dengan Log Rank Test. Apabila diperoleh nilai p < 0,05, maka terdapat hubungan bermakna. Hasil: Terdapat perbedaan antara setiap faktor klinis, faktor biomolekuler dan faktor terapi dalam hal rata-rata DFS maupun rata-rata OS, namun tidak terdapat pengaruh yang bermakna secara analisis statistik antara faktor terapi (terapi hormon, radioterapi dan terapi target) terhadap DFS dan OS pada pasien kanker payudara usia muda di Kota Padang (p>0,05). Terdapat pengaruh dari pemberian kemoterapi terhadap DFS pada pasien kanker payudara usia muda di Kota Padang (p<0,05). Simpulan: Tidak terdapat hubungan yang bermakna antara faktor klinis dan faktor biomolekuler dengan DFS dan OS, namun terdapat hubungan bermakna antara pemberian kemoterapi dengan DFS dan OS pada penderita KPD usia muda di kota Padang tahun 2008 – 2018.

scholarly journals Factors Determining Survival and Retention among HIV-Infected Children and Adolescents in a Community Home-Based Care and a Facility-Based Family-Centred Approach in Kampala, Uganda: A Cohort Study

ISRN AIDS ◽  
2014 ◽  
Vol 2014 ◽  
pp. 1-13 ◽  
Author(s):  
W. Massavon ◽  
L. Barlow-Mosha ◽  
L. Mugenyi ◽  
W. McFarland ◽  
G. Gray ◽  
...  
Keyword(s):  
Cohort Study ◽  
Children And Adolescents ◽  
Care Delivery ◽  
Rank Test ◽  
Term Survival ◽  
Log Rank Test ◽  
Home Based ◽  
Significant Difference ◽  
Home Based Care

We describe factors determining retention and survival among HIV-infected children and adolescents engaged in two health care delivery models in Kampala, Uganda: one is a community home-based care (CHBC) and the other is a facility-based family-centred approach (FBFCA). This retrospective cohort study reviewed records from children aged from 0 to 18 years engaged in the two models from 2003 to 2010 focussing on retention/loss to follow-up, mortality, use of antiretroviral therapy (ART), and clinical characteristics. Kaplan Meier survival curves with log rank tests were used to describe and compare retention and survival. Overall, 1,623 children were included, 90.0% (1460/1623) from the CHBC. Children completed an average of 4.2 years of follow-up (maximum 7.7 years). Median age was 53 (IQR: 11–109) months at enrolment. In the CHBC, retention differed significantly between patients on ART and those not (log-rank test, adjusted, P<0.001). Comparing ART patients in both models, there was no significant difference in long-term survival (log-rank test, P=0.308, adjusted, P=0.489), while retention was higher in the CHBC: 94.8% versus 84.7% in the FBFCA (log-rank test, P<0.001, adjusted P=0.006). Irrespective of model of care, children receiving ART had better retention in care and survival.

scholarly journals Systolic thickening fraction of inerventricular septum as a predictor of superresponse to cardiac resyncronisation therapy - concept of a helical ventriсular band

2020 ◽  
Vol 27 (1) ◽  
pp. 40-46
Author(s):  
N. E. Shirokov ◽  
V. A. Kuznetsov ◽  
A. M. Soldatova ◽  
D. V. Krinochkin
Keyword(s):  
Survival Rate ◽  
Interventricular Septum ◽  
Rank Test ◽  
Systolic Volume ◽  
Log Rank Test ◽  
Systolic Thickening ◽  
Group I ◽  
End Systolic Volume ◽  
Apical Loop

Aim: to assess morpho-functional properties of left ventricle (LV) in patients with superresponse (SR) to CRT using the helical ventriсular band concept (HVB).Materials and methods: 56 patients were examined (mean age 54.0±9.9 years) at baseline and during follow-up visit: 48.8±25.6 months. Patients were divided into groups: I group (n=34) with decrease of LV end-systolic volume (ESV) ≥30% (superresponders) and II group (n=22) - decrease of LV ESV ˂30% (nonsuperresponders).Results: apical loop descendens segment (DS) and ascendens segment (AS) of HVB were evaluated according to the concept of F. Torrent-Guasp et al. According to the logistic regression mechanical interventricular delay (MID) (OR 1.072, 95% CI 1.017-1.131; p=0.01) and systolic thickening fraction (STF) of interventricular septum (IVS) DS (OR 0.944, 95% CI 0.895 - 0.995; p = 0.033) had an independent relationship with CRT SR. According to the ROC analysis the sensitivity and specificity of this model were 72.7% and 66.7% (AUC=0.769; р=0.001). AS STF of IVS was higher in SR (22.5 [0.0;40.0]% и 0.0 [0.0;25.0]%; р=0.005). The survival rate in group I was 85.1%, in group II was 63.6% (Log-Rank test p=0.019).Conclusion: SR is associated with a higher AS STF of IVS, higher MID, also with a higher survival rate.

Colorectal Liver Metastases - Does the Number of Lesions Determine the Sensibility of Resection?

Swiss Surgery ◽  
2000 ◽  
Vol 6 (1) ◽  
pp. 6-10
Author(s):  
Knoefel ◽  
Brunken ◽  
Neumann ◽  
Gundlach ◽  
Rogiers ◽  
...  
Keyword(s):  
Liver Metastases ◽  
Colorectal Liver Metastases ◽  
Rank Test ◽  
Log Rank Test ◽  
Kaplan Meier ◽  
Chirurgische Entfernung

Die komplette chirurgische Entfernung von Lebermetastasen bietet Patienten nach kolorektalem Karzinom die einzige kurative Chance. Es gibt jedoch eine, anscheinend unbegrenzte, Anzahl an Parametern, die die Prognose dieser Patienten bestimmen und damit den Sinn dieser Therapie vorhersagen können. Zu den am häufigsten diskutierten und am einfachsten zu bestimmenden Parametern gehört die Anzahl der Metastasen. Ziel dieser Studie war es daher die Wertigkeit dieses Parameters in der Literatur zu reflektieren und unsere eigenen Patientendaten zu evaluieren. Insgesamt konnte von 302 Patienten ein komplettes Follow-up erhoben werden. Die gebildeten Patientengruppen wurden mit Hilfe einer Kaplan Meier Analyse und konsekutivem log rank Test untersucht. Die Literatur wurde bis Dezember 1998 revidiert. Die Anzahl der Metastasen bestätigte sich als ein prognostisches Kriterium. Lagen drei oder mehr Metastasen vor, so war nicht nur die Wahrscheinlichkeit einer R0 Resektion deutlich geringer (17.8% versus 67.2%) sondern auch das Überleben der Patienten nach einer R0 Resektion tendenziell unwahrscheinlicher. Das 5-Jahres Überleben betrug bei > 2 Metastasen 9% bei > 2 Metastasen 36%. Das 10-Jahres Überleben beträgt bislang bei > 2 Metastasen 0% bei > 2 Metastasen 18% (p < 0.07). Die Anzahl der Metastasen spielt in der Prognose der Patienten mit kolorektalen Lebermetastasen eine Rolle. Selbst bei mehr als vier Metastasen ist jedoch gelegentlich eine R0 Resektion möglich. In diesen Fällen kann der Patient auch langfristig von einer Operation profitieren. Das wichtigere Kriterium einer onkologisch sinnvollen Resektabilität ist die Frage ob technisch und funktionell eine R0 Resektion durchführbar ist. Ist das der Fall, so sollte auch einem Patienten mit mehreren Metastasen die einzige kurative Chance einer Resektion nicht vorenthalten bleiben.

scholarly journals Complex multimorbidity and mortality in Japan: a prospective propensity-matched cohort study

BMJ Open ◽  
2021 ◽  
Vol 11 (8) ◽  
pp. e046749
Author(s):  
Daisuke Kato ◽  
Ichiro Kawachi ◽  
Junko Saito ◽  
Naoki Kondo
Keyword(s):  
Older Adults ◽  
Cohort Study ◽  
Health Behaviours ◽  
Evaluation Study ◽  
Rank Test ◽  
Baseline Survey ◽  
Similar Degree ◽  
Matched Cohort ◽  
Log Rank Test ◽  
Prediction Of Mortality

ObjectivesThere are limitations to defining multimorbidity (MM) based on a simple count of diseases. To address these limitations, the concept of complex MM (CMM) focuses on how many body systems are affected in a single patient, rather than counting comorbid conditions. This study compared the prediction of mortality among older Japanese adults between CMM and conventional MM.DesignA population-based prospective cohort study.SettingThe Japan Gerontological Evaluation Study, a nationwide longitudinal cohort study, which ran from 2010 to 2016.ParticipantsFunctionally independent individuals who were older than 65 and had complete illness data at the time of baseline survey were eligible.Outcomes measureCMM was defined as the coexistence of 3 or more body system disorders at baseline. We calculated the propensity for each individual to develop CMM based on a wide array of characteristics, including socioeconomic status and health behaviours. Individuals with and without CMM were then matched on their propensity scores before we estimated overall survival using a log-rank test.ResultsOur 6-year follow-up included 38 889 older adults: 20 233 (52.0%) and 7565 (19.5%) adults with MM and CMM, respectively. In the MM-matched cohort (n=15 666 pairs), the presence of MM was significantly associated with increased mortality (HR 1.07; 95% CI 1.01 to 1.14; p=0.02 by the log-rank test). A similar mortality association was found in the CMM-matched cohort (n=7524 pairs, HR, 1.07; 95% CI 0.99 to 1.16; p=0.08 by the log-rank test).ConclusionThis is the first study to report the association between CMM and mortality among older adults in Japan. MM and CMM predict mortality in older adults to a similar degree. This finding needs to be replicated with more precision in larger samples.

Sign in / Sign up

Export Citation Format

Share Document