In the field of hilar cholangiocarcinoma(HCCA) treatment,the value of caudate lobe resection(CLR) has not been fully elucidated.Most scholars advocate that the caudate lobe should be routinely resected.To further inve...In the field of hilar cholangiocarcinoma(HCCA) treatment,the value of caudate lobe resection(CLR) has not been fully elucidated.Most scholars advocate that the caudate lobe should be routinely resected.To further investigate this issue,this study aims to evaluate the impact of CLR on surgical outcomes of HCCA patients who are judged to have no obvious tumor invasion in the caudate lobe.A retrospective analysis was performed on Bismuth type Ⅱ,Ⅲ,or Ⅳ HCCA patients who underwent radical resection between October 2005 and April 2023 at three Chinese medical centers.Patients were divided into the CLR group and the no caudate lobe resection(No-CLR) group according to whether CLR was performed or not.Baseline and tumor characteristics as well as perioperative outcomes were compared between the two groups using propensity score matching(PSM).A total of 397 HCCA patients underwent radical resection and there were 146 patients in each group after PSM.After PSM,the mortality was similar between the two groups.However,patients in the CLR group had a higher incidence of postoperative ascites(43.8% vs 30.1%,P=0.021),liver failure(15.8% vs 6.2%,P=0.014) and intra-abdominal infection(19.2% vs 8.2%,P=0.010).The R0 rate in the CLR group was significantly higher than that in the No-CLR group(88.4% vs 76.0%,P=0.009).Nevertheless,patients undergoing CLR did not show any improvement in overall survival(OS) or recurrence-free survival(RFS).Multivariate analysis showed that CLR was not associated with improved long-term surgical outcomes.The high level of CA19-9 and lower tumor differentiation were associated with worse OS,and adjuvant therapy can significantly improve OS.Lower tumor differentiation and N2 were associated with worse RFS.In summary,there is not yet sufficient evidence to support the routine resection of the caudate lobe during surgery for HCCA.For patients without obvious tumor invasion in the caudate lobe,resection of the lobe should be carefully weighed for its benefits and risks.展开更多
Erratum to:SCIENCE CHINA Life Sciences,Volume 68,Issue 7:2106–2120(2025),https://doi.org/10.1007/s11427-024-2855-x.There is the same error in Figure 5 and Figure 6.The overall number of people in the No-CLR and CLR g...Erratum to:SCIENCE CHINA Life Sciences,Volume 68,Issue 7:2106–2120(2025),https://doi.org/10.1007/s11427-024-2855-x.There is the same error in Figure 5 and Figure 6.The overall number of people in the No-CLR and CLR groups should be“146”and“146”respectively,but we wrote them as“93”and“93”respectively.展开更多
Liver transplantation represents a complex surgical procedure and serves as a curative treatment for patients presenting an acute or chronic end-stage liver disease, or carefully selected liver malignancy. A significa...Liver transplantation represents a complex surgical procedure and serves as a curative treatment for patients presenting an acute or chronic end-stage liver disease, or carefully selected liver malignancy. A significant gap still exists between the number of available donor organs and potential recipients. The use of an otherwise-wasted resected liver lobe from patients with benign liver tumors is a new, albeit small, option to alleviate the allograft shortage. This review provides evidence that resected liver lobes may be used successfully in liver transplantation.展开更多
AIM:To investigate the significance of the surgical approaches in the prognosis of hepatocellular carcinoma(HCC) located in the caudate lobe with a multivariate regression analysis using a Cox proportional hazard mode...AIM:To investigate the significance of the surgical approaches in the prognosis of hepatocellular carcinoma(HCC) located in the caudate lobe with a multivariate regression analysis using a Cox proportional hazard model.METHODS:Thirty-six patients with HCC underwent caudate lobectomy at a single tertiary referral center between January 1995 and June 2010.In this series,left-sided,right-sided and bilateral approaches were used.The outcomes of patients who underwent isolated caudate lobectomy or caudate lobectomy combined with an additional partial hepatectomy were compared.The survival curves of the isolated and combined resection groups were generated by the Kaplan-Meier method and compared by a log-rank test.RESULTS:Sixteen(44.4%) of 36 patients underwent isolated total or partial caudate lobectomy whereas 20(55.6%) received a total or partial caudate lobectomy combined with an additional partial hepatectomy.The median diameter of the tumor was 6.7 cm(range,2.1-15.8 cm).Patients who underwent an isolated caudate lobectomy had significantly longer operative time(240 min vs 170 min),longer length of hospital stay(18 d vs 13 d) and more blood loss(780 mL vs 270 mL) than patients who underwent a combined caudate lobectomy(P < 0.05).There were no perioperative deaths in both groups of patients.The complication rate was higher in the patients who underwent an isolated caudate lobectomy than in those who underwent combined caudate lobectomy(31.3% vs 10.0%,P < 0.05).The 1-,3-and 5-year disease-free survival rates for the isolated caudate lobectomy and the combined caudate lobectomy groups were 54.5%,6.5% and 0% and 85.8%,37.6% and 0%,respectively(P < 0.05).The corresponding overall survival rates were 73.8%,18.5% and 0% and 93.1%,43.6% and 6.7%(P < 0.05).CONCLUSION:The caudate lobectomy combined with an additional partial hepatectomy is preferred because this approach is technically less demanding and offers an adequate surgical margin.展开更多
基金supported by the National Natural Science Foundation of China (81902839)the Hubei Provincial Department of Science and Technology Rolling Project for Base and Platform Development (CXPTZX005)+1 种基金the Project for Enhancing the Diagnosis and Treatment Capabilities of Malignant Tumors (EXZL-GX-024)the Consulting Research Project of the Wuhan Branch of the Hubei Institute for Strategic Studies in Engineering and Technology Development,Chinese Academy of Engineering,2021 (HB2021C13)。
文摘In the field of hilar cholangiocarcinoma(HCCA) treatment,the value of caudate lobe resection(CLR) has not been fully elucidated.Most scholars advocate that the caudate lobe should be routinely resected.To further investigate this issue,this study aims to evaluate the impact of CLR on surgical outcomes of HCCA patients who are judged to have no obvious tumor invasion in the caudate lobe.A retrospective analysis was performed on Bismuth type Ⅱ,Ⅲ,or Ⅳ HCCA patients who underwent radical resection between October 2005 and April 2023 at three Chinese medical centers.Patients were divided into the CLR group and the no caudate lobe resection(No-CLR) group according to whether CLR was performed or not.Baseline and tumor characteristics as well as perioperative outcomes were compared between the two groups using propensity score matching(PSM).A total of 397 HCCA patients underwent radical resection and there were 146 patients in each group after PSM.After PSM,the mortality was similar between the two groups.However,patients in the CLR group had a higher incidence of postoperative ascites(43.8% vs 30.1%,P=0.021),liver failure(15.8% vs 6.2%,P=0.014) and intra-abdominal infection(19.2% vs 8.2%,P=0.010).The R0 rate in the CLR group was significantly higher than that in the No-CLR group(88.4% vs 76.0%,P=0.009).Nevertheless,patients undergoing CLR did not show any improvement in overall survival(OS) or recurrence-free survival(RFS).Multivariate analysis showed that CLR was not associated with improved long-term surgical outcomes.The high level of CA19-9 and lower tumor differentiation were associated with worse OS,and adjuvant therapy can significantly improve OS.Lower tumor differentiation and N2 were associated with worse RFS.In summary,there is not yet sufficient evidence to support the routine resection of the caudate lobe during surgery for HCCA.For patients without obvious tumor invasion in the caudate lobe,resection of the lobe should be carefully weighed for its benefits and risks.
文摘Erratum to:SCIENCE CHINA Life Sciences,Volume 68,Issue 7:2106–2120(2025),https://doi.org/10.1007/s11427-024-2855-x.There is the same error in Figure 5 and Figure 6.The overall number of people in the No-CLR and CLR groups should be“146”and“146”respectively,but we wrote them as“93”and“93”respectively.
基金supported by grants from the National Natural Science Foundation of China (82150 0 04)the National Municipal Key Clinical Specialtythe Clinical Research Project for Major Diseases in Municipal Hospitals (SHDC2020CR1022B)。
文摘Liver transplantation represents a complex surgical procedure and serves as a curative treatment for patients presenting an acute or chronic end-stage liver disease, or carefully selected liver malignancy. A significant gap still exists between the number of available donor organs and potential recipients. The use of an otherwise-wasted resected liver lobe from patients with benign liver tumors is a new, albeit small, option to alleviate the allograft shortage. This review provides evidence that resected liver lobes may be used successfully in liver transplantation.
文摘AIM:To investigate the significance of the surgical approaches in the prognosis of hepatocellular carcinoma(HCC) located in the caudate lobe with a multivariate regression analysis using a Cox proportional hazard model.METHODS:Thirty-six patients with HCC underwent caudate lobectomy at a single tertiary referral center between January 1995 and June 2010.In this series,left-sided,right-sided and bilateral approaches were used.The outcomes of patients who underwent isolated caudate lobectomy or caudate lobectomy combined with an additional partial hepatectomy were compared.The survival curves of the isolated and combined resection groups were generated by the Kaplan-Meier method and compared by a log-rank test.RESULTS:Sixteen(44.4%) of 36 patients underwent isolated total or partial caudate lobectomy whereas 20(55.6%) received a total or partial caudate lobectomy combined with an additional partial hepatectomy.The median diameter of the tumor was 6.7 cm(range,2.1-15.8 cm).Patients who underwent an isolated caudate lobectomy had significantly longer operative time(240 min vs 170 min),longer length of hospital stay(18 d vs 13 d) and more blood loss(780 mL vs 270 mL) than patients who underwent a combined caudate lobectomy(P < 0.05).There were no perioperative deaths in both groups of patients.The complication rate was higher in the patients who underwent an isolated caudate lobectomy than in those who underwent combined caudate lobectomy(31.3% vs 10.0%,P < 0.05).The 1-,3-and 5-year disease-free survival rates for the isolated caudate lobectomy and the combined caudate lobectomy groups were 54.5%,6.5% and 0% and 85.8%,37.6% and 0%,respectively(P < 0.05).The corresponding overall survival rates were 73.8%,18.5% and 0% and 93.1%,43.6% and 6.7%(P < 0.05).CONCLUSION:The caudate lobectomy combined with an additional partial hepatectomy is preferred because this approach is technically less demanding and offers an adequate surgical margin.
