Surgical resection for hepatocellular carcinoma: a single-centre's one decade of experience

Background and aims

Liver cancer is the third leading cause of global cancer deaths, and hepatocellular carcinoma is its most common type. Liver resection is one of the treatment options for hepatocellular carcinoma (HCC). This study aims to explore our hospital's more than a decade of experience in liver resection for HCC patients.

Methods

This is a retrospective cohort study on HCC patients undergoing resection from 2010 to 2021 in a tertiary-level hospital in Jakarta, Indonesia. Mortality rates were explored as the primary outcome of this study. Statistical analysis was done on possible predictive factors using Pearson's χ2. Survival analysis was done using the Log-Rank test and Cox Regression.

Results

Ninety-one patients were included in this study. The authors found that the postoperative mortality rates were 8.8% (in hospital), 11.5% (30 days), and 24.1% (90 days). Excluding postoperative mortalities, the long-term mortality rates were 44.4% (first year), 58.7% (3 years), and 69.7% (5 years). Cumulatively, the mortality rates were 46.4% (1 year), 68.9% (3 years), 77.8% (5 years), and 67.0% (all time). Significant predictive factors for cumulative 1-year mortality include large tumour diameter [odds ratio (OR) 14.06; 95% CI: 2.59-76.35; comparing <3 cm and >10 cm tumours; P<0.01], positive resection margin (OR 2.86; 1.17-77.0; P=0.02), and tumour differentiation (P=0.01). Multivariate analysis found hazard ratios of 6.35 (2.13-18.93; P<0.01) and 1.81 (1.04-3.14; P=0.04) for tumour diameter and resection margin, respectively.

Conclusion

The mortality rate of HCC patients undergoing resection is still very high. Significant predictive factors for mortality found in this study benefit from earlier diagnosis and treatment; thus, highlighting the importance of HCC surveillance programs.

Characteristics of living liver donors in a national referral hospital in Indonesia: a 13-year experience with living donor liver transplantation

Background

Hepatocellular carcinoma and biliary atresia lead to end-stage liver disease, which requires liver transplantation and is linked to increased mortality. Dr. Cipto Mangunkusumo Hospital is the national referral center in Indonesia and is the only center that routinely performs living donor liver transplantation (LDLT). This study presents the characteristics of living liver donors (LLDs) in Indonesia.

Methods

Using the LDLT registry, we conducted a retrospective analysis of all approved donors from 2010 to 2022. The variables included clinical characteristics of the donors, graft types, and intraoperative and postoperative characteristics.

Results

The LDLT rate has increased from 5.8 to 8.8 procedures/year in the last 8 years. The average age of the 76 LLDs was 31.8 years. They were predominantly female (59%) and lived within a family relationship (90%). Pediatric LDLT was more frequent than adult LDLT (88% vs. 12%, respectively). Most grafts (86%) were obtained by left lateral sectionectomy, with a median ratio of remnant liver volume to total liver volume of 79.5% (range, 47.7%-85.8%) and a mean graft-to-recipient weight ratio of 2.65%±1.21%. The median intensive care unit length of stay (LOS) was 2 days (range, 1-5 days) and the total hospital LOS was 7 days (range, 4-28 days). The complication rate was 23%. No donor mortality was reported.

Conclusions

LDLT in Indonesia has increased over the years. The shortage of donors for adult-to-adult liver transplantation is due to cultural differences and challenges in finding eligible donors. This study aims to explain the eligibility criteria of LLDs and contribute to creating a national policy.

Diagnosis and management of gastric cancer in pregnancy-An evidence-based case report

BACKGROUND

Gastric cancer in pregnancy is a very rare case with an incidence of 0.016% and is mostly detected in a locally advanced or advanced stage due to misinterpretation of non-specific signs and symptoms. Management of gastric cancer in pregnancy should emphasize mother and fetal survival. Currently, there is no diagnostic and management guidance for gastric cancer in pregnancy. The purpose of this study is to ascertain how to diagnose and manage gastric cancer in pregnancy.

METHODS

This study is an evidence-based case report performed in Digestive Division of Department of Surgery in Cipto Mangunkusumo hospital in September-October 2017. Literature search on databases such as Cochrane, PubMed, ScienceDirect, and Scholar Google used keywords like "gastric cancer" AND "pregnant" OR "pregnancy" with inclusion criteria which are systematic review, randomized-clinical trial (RCT), cohort study, case report, or case series, performed in human and published in the last 10 years in English language. Critical appraisal is done according to Oxford Centre For Evidence-Based Medicine 2011. This work is reported in line with the SCARE criteria.

RESULTS

There are 9 case-report studies and 1 case-control study. Radiology examination includes endoscopy, MRI, and CT scan. Management is given according to cancer stage which is; surgery, surgery with adjuvant therapy, and palliative chemotherapy.

CONCLUSION

Radiology examinations with a lower risk of adverse effects are endoscopy and MRI. CT scan may be performed when the benefits exceed the risk. Surgery and chemoradiation have the lowest rate of adverse effects when done in the second and third trimester.