Abstract:
OBJECTIVE:To determine the long-term results of liver transplantation for hepatocellular carcinoma (HCC) measuring 5 cm or larger treated in a multimodality adjuvant protocol. SUMMARY BACKGROUND DATA:Transplant has been established as a viable treatment of HCC measuring less than 5 cm, but the results for larger tumors have been disappointing. Several studies have shown promising preliminary results when combining transplant with preoperative transarterial chemoembolization and/or perioperative systemic chemotherapy in the treatment of advanced HCC that is not amenable to resection. However, follow-up in the studies has been limited and the number of patients has been small. METHODS:Beginning in October 1991, all patients with unresectable HCC measuring 5 cm or larger, as measured by computed tomography, were considered for enrollment in the authors' multimodality protocol. Entry criteria required that all patients be free of extrahepatic disease based on computed tomography scans of the chest and abdomen and bone scan and have a patent main portal vein and major hepatic veins on duplex ultrasonography. Patients received subselective arterial chemoembolization with mitomycin C, doxorubicin, and cisplatin at the time of diagnosis, repeated as necessary based on tumor response. Patients received a single systemic intraoperative dose of doxorubicin (10 mg/m(2)) before revascularization of the new liver and systemic doxorubicin (50 mg/m(2)) every 3 weeks as tolerated, for a total of six cycles, beginning on the sixth postoperative week. RESULTS:Eighty patients were enrolled; 37 were eventually excluded, due mainly to disease progression while on the waiting list, and 43 underwent liver transplant. Mean pathologic tumor diameter was 5.8 +/- 2.7 cm. Median follow-up of surviving transplanted patients was 55.1 +/- 24.9 months. There were two (4.7%) perioperative deaths. Median overall survival was significantly longer in transplanted patients (49.9 +/- 10.42 months) than in those who were excluded (6.83 +/- 1.34 months). Overall and recurrence-free survival rates in transplanted patients at 5 years were 44% and 48%, respectively. A tumor size larger than 7 cm and the presence of vascular invasion correlated significantly with recurrence. Recurrence-free survival at 5 years was significantly higher for the 32 patients with tumors measuring 5 to 7 cm (55%) than the 12 patients with tumors larger than 7 cm (34%). CONCLUSIONS:A significant proportion of patients with HCC measuring 5 cm or larger can achieve long-term survival after liver transplantation in the context of multimodal adjuvant therapy. Patients with tumors measuring 5 to 7 cm have significantly longer recurrence-free survival compared with those with larger tumors.
journal_name
Ann Surgjournal_title
Annals of surgeryauthors
Roayaie S,Frischer JS,Emre SH,Fishbein TM,Sheiner PA,Sung M,Miller CM,Schwartz MEdoi
10.1097/00000658-200204000-00012subject
Has Abstractpub_date
2002-04-01 00:00:00pages
533-9issue
4eissn
0003-4932issn
1528-1140journal_volume
235pub_type
临床试验,杂志文章abstract::Two hundred thirty-four patients with extensive ulcerative colitis from the city of Göteborg, Sweden have been followed up and the cumulative risk of development of cancer of the large bowel was estimated. These patients constitute all persons in this region who developed an extensive ulcerative colitis between 1951 a...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-197812000-00018
更新日期:1978-12-01 00:00:00
abstract:OBJECTIVE:To prospectively characterize changes in body weight, satiety, and postprandial gut hormone profiles following esophagectomy. BACKGROUND:With improved oncologic outcomes in esophageal cancer, there is an increasing focus on functional status and health-related quality of life in survivorship. Early satiety a...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0000000000001918
更新日期:2017-07-01 00:00:00
abstract:OBJECTIVE:To evaluate recent surgical strategy for hilar cholangiocarcinoma (HC) of the left-side predominance. BACKGROUND:When employing left hemihepatectomy (LH) for HC, vasculobiliary anatomy of the right liver often makes it difficult to achieve a tumor-free margin of the right posterior sectional bile duct (RPSBD...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0000000000000584
更新日期:2014-06-01 00:00:00
abstract:BACKGROUND:The presence and number of nodal metastasis significantly impact colon cancer prognosis. Similarly, the number of resected/evaluated nodes impacts staging accuracy. This ratio of metastatic to examined nodes or lymph node ratio (LNR) may have independent prognostic value in colon carcinoma. PURPOSE:: To eva...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0b013e3181ffa780
更新日期:2011-01-01 00:00:00
abstract::One hundred and forty patients with an intractable ascites complicating a chronic liver disease received a peritoneovenous shunt (PVS) using the LeVeen valve. Operative mortality was ten per cent but was 25% in patients with severe liver failure. Intraoperative drainage of ascites sharply decreased postoperative compl...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-198504000-00014
更新日期:1985-04-01 00:00:00
abstract:BACKGROUND:Acute abdominal pain is the most common indication for surgical admission. Nonspecific abdominal pain (NSAP) may account for up to 40% of cases. There has been no published prospective study in which adult patients presenting with acute abdominal pain are investigated for celiac disease. AIMS:We aimed to as...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/01.sla.0000171301.35513.cf
更新日期:2005-08-01 00:00:00
abstract:OBJECTIVE:To determine if the extent of lymphadenectomy (number of recovered lymph nodes) was associated with long-term outcome in patients operated on for stage B and C colon cancer. SUMMARY BACKGROUND DATA:Lymphatic spreading is the main prognostic indicator in colon cancer patients, although the optimal extent of l...
journal_title:Annals of surgery
pub_type: 杂志文章,多中心研究
doi:10.1097/00000658-200204000-00002
更新日期:2002-04-01 00:00:00
abstract::Analysis of experience with chronic bleeding peptic ulcer in 504 patients, admitted from 1960 to 1971, shows a hospital mortality of 12%. This retrospective review suggested that early endoscopic diagnosis, adequate resuscitation and a policy of early selective surgery was necessary if mortality was to be reduced. Wit...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-198401000-00008
更新日期:1984-01-01 00:00:00
abstract:OBJECTIVE:To investigate long-term outcomes of locally advanced rectal cancer (LARC) patients with postchemoradiotherapy (post-CRT) pathologic complete response of primary tumor (ypT0) and determine prognostic significance of post-CRT pathologic nodal (ypN) status. BACKGROUND:LARC patients with post-CRT pathologic com...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0b013e3181f3f1b1
更新日期:2010-12-01 00:00:00
abstract::The etiology and mechanisms by which severe trauma or sepsis induce hepatic failure are unknown. Previously we showed that Kupffer cells (KC), the fixed macrophages of the liver, induce a profound decrease in hepatocyte (HC) total-protein synthesis when exposed to endotoxin. Furthermore we demonstrated that endotoxin-...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-199010000-00009
更新日期:1990-10-01 00:00:00
abstract:OBJECTIVES:The aim of this study was to investigate the effect of pylorus resection on postoperative delayed gastric emptying (DGE) after partial pancreatoduodenectomy (PD). BACKGROUND:PD is the standard treatment for tumors of the pancreatic head. Preservation of the pylorus has been widely accepted as standard proce...
journal_title:Annals of surgery
pub_type: 杂志文章,随机对照试验
doi:10.1097/SLA.0000000000002480
更新日期:2018-06-01 00:00:00
abstract::The aim of this study was to define the post-traumatic changes in body fluid compartments and to evaluate the effect of plasma colloid osmotic pressure (COP) on the partitioning of body fluid between these compartments. Forty-two measurements of plasma volume (green dye), extracellular volume (bromine), and total body...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-198909000-00015
更新日期:1989-09-01 00:00:00
abstract:OBJECTIVE:The authors assess the effect of surgical margin width on recurrence rates after intestinal resection of Crohn's Disease (CD). BACKGROUND:The optimal width of margins when resecting DC of the small bowel is controversial. Most studies have been retrospective and have had conflicting results. METHODS:Patient...
journal_title:Annals of surgery
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1097/00000658-199610000-00014
更新日期:1996-10-01 00:00:00
abstract:OBJECTIVE:To study the incidence of gastroesophageal reflux (GER)related complications after correction of esophageal atresia (EA). SUMMARY BACKGROUND DATA:The association of EA and GER in children is well known. However, little is known about the prevalence of GER and its potential complications in adults who have un...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/01.sla.0000094303.07910.05
更新日期:2003-11-01 00:00:00
abstract::Previous reports suggest the value of renal decapsulation in the prevention of renal failure after acute ischemia. It has been suggested that this response is due to a release of "compartmental" pressure resulting in increased blood flow to the decapsulated kidney. Ten dogs were evaluated following 90 minutes of renal...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-198004000-00011
更新日期:1980-04-01 00:00:00
abstract::A prospective (Part I) and a retrospective (Part II) study were used to determine the safety and efficacy of corticosteroids in the treatment of septic shock. In Part I, 172 consecutive patients in septic shock admitted over an 8-year period were treated with either steroid or saline: 43 received dexamethasone (DMP), ...
journal_title:Annals of surgery
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1097/00000658-197609000-00011
更新日期:1976-09-01 00:00:00
abstract:OBJECTIVE:Metabolic activity of transformed human liver (Hep G2) cells and primary rat hepatocytes were compared during in vitro application of a gel entrapment bioartificial liver. BACKGROUND:Clinical trials of bioartificial liver devices containing either transformed liver cells or primary hepatocytes have been init...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:
更新日期:1994-07-01 00:00:00
abstract::The abilities of polymorphonuclear leukocytes (PMN) and pulmonary alveolar macrophages (PAM), to demonstrate chemotaxis, phagocytosis, and superoxide release after bile duct ligation in the rat were investigated to determine the effect of cholestasis on nonspecific cellular immune mechanisms. Chemotactic response to C...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-198711000-00004
更新日期:1987-11-01 00:00:00
abstract::Eighty-nine grafts of expanded microporous polytetrafluoroethylene (PTFE) with a diameter of 4 mm, were placed in the carotid and femoral arteries of dogs. The animals were sacrificed at varying intervals beginning three days after operation. Four animals remain alive with patent grafts 10 months post-operatively. Twe...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-197508000-00010
更新日期:1975-08-01 00:00:00
abstract::Cyclosporine has been used as primary immunosuppression in renal allograft recipients in our unit for the past decade. The overall clinical experience and long-term effects of the agent are reviewed. There were 461 consecutive recipients of kidney grafts; 379 received grafts from cadaver donors (CAD) and 82 from livin...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-199107000-00007
更新日期:1991-07-01 00:00:00
abstract:OBJECTIVE:To determine the effects of recombinant human insulin-like growth factor-1 (IGF-1) complexed with its principal binding protein, IGFBP-3, on skeletal muscle metabolism in severely burned children. SUMMARY BACKGROUND DATA:Severe burns are associated with a persistent hypermetabolic response characterized by h...
journal_title:Annals of surgery
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1097/00000658-199905000-00014
更新日期:1999-05-01 00:00:00
abstract:OBJECTIVE:To investigate potential impacts of restructuring general surgery training on colorectal (CR) surgery recruitment and expertise. SUMMARY BACKGROUND DATA:In response to the American Surgical Association Blue Ribbon Committee report on surgical education (2004), the American Board of Colon and Rectal Surgery, ...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0b013e3181ad64f1
更新日期:2009-07-01 00:00:00
abstract::The subcutaneous administration of insulin did not induce a significant effect on oxidative phosphorylation of the mitochondria from normal rat liver. However, in rats subjected to ligation of a branch of portal vein, the phosphorylative activity of the mitochondria from the ligated lobe deprived of portal blood fell ...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-197411000-00002
更新日期:1974-11-01 00:00:00
abstract:OBJECTIVE:To assess the efficacy of adjunctive IPC to standard prophylaxis of postoperative VTE in patients at extremely high-risk. SUMMARY OF BACKGROUND DATA:The standard prophylaxis for postoperative VTE is insufficient in extremely high-risk patients. It is unclear whether an adjunctive use of IPC would result in a...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0000000000004556
更新日期:2020-11-12 00:00:00
abstract:OBJECTIVE:Regional circulatory changes in intestinal mucosa were evaluated after the onset of septic shock and the effect of nitric oxide (NO) inhibition on mucosal blood flow was investigated at different locations along the intestine. SUMMARY BACKGROUND DATA:The response of intestinal blood flow to different physiol...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-199801000-00018
更新日期:1998-01-01 00:00:00
abstract::Desmoid tumors are locally invasive, nonmetastasizing fibrous tumors most frequently seen in patients with familial polyposis coli (FPC). Of 325 patients with FPC treated at the Cleveland Clinic, 29 (8.9%) were found to have a total of 36 desmoid tumors. These tumors occur in young patients (mean age: 29.8 years), par...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-198607000-00014
更新日期:1986-07-01 00:00:00
abstract:OBJECTIVE:To determine whether the immune system limits or improves the therapeutic efficacy of an adenovirus vector expressing the herpes simplex thymidine kinase (HSVtk) gene in a subcutaneous tumor model. BACKGROUND DATA:Enhanced immune reactions against tumors may be therapeutically useful. However, recent studies...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-199509000-00008
更新日期:1995-09-01 00:00:00
abstract::Twenty-four patients with intra-peritoneal infections were studied sequentially to evaluate neutrophil chemotaxis, spontaneous migration, and chemiluminescence. In six patients, infection was due to spontaneous disease processes and 18 others, infection was a sequel of intra-abdominal operation. In the patients studie...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-198107000-00003
更新日期:1981-07-01 00:00:00
abstract::Twelve patients with anal incontinence due to neurologic disease or failure of previous incontinence surgery underwent implantation of an artificial anal sphincter. The system used was a modification of the AMS 800 artificial urinary sphincter. In two patients, infection necessitated removal of the system, and in four...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-199204000-00013
更新日期:1992-04-01 00:00:00
abstract:OBJECTIVE:The aim of this study is to assess CT-PET and endoscopic assessment postneoadjuvant chemoradiotherapy (nCRT) in predicting complete pathologic response (pCR) in locally advanced esophageal cancer (LAEC). DESIGN:A prospective cohort study. BACKGROUND:nCRT is increasingly standard of care in LAEC, with pCR a ...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0000000000001902
更新日期:2016-11-01 00:00:00