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Background: Systemic inflammation-related factors, either independently or in combination, are recognized as prognostic factors for various cancers. The ratio of lymphocyte count to C-reactive protein concentration (lymphocyte–CRP ratio; LCR) is a recently identified prognostic marker for several cancers. Here, we examined the prognostic value of the LCR in patients with hepatocellular carcinoma (HCC). Methods: This was a single-center retrospective study of patients who underwent surgical resection for HCC between 2004 and 2017. Patients were divided into high- and low-LCR status groups, and the relationships between LCR status, prognosis, and other clinicopathological characteristics were analyzed. Results: A total of 454 patients with HCC were enrolled and assigned to the high- (n=245) or low- (n=209) LCR groups. Compared with the high-LCR group, patients in the low-LCR group had a significantly lower serum albumin level (median 4.1 vs. 3.9 g/dL, P <0.0001), lower platelet count (median 14.0 vs. 12.0 ×104/μL, P=0.0468), lower prothrombin time (median 93.2 vs. 89.6 %, P=0.0006), and larger tumor size (median 2.3 vs. 2.5 cm, P=0.0056). Patients with low-LCR status had significantly worse outcomes of overall survival and disease-free survival than patients with high-LCR status (P=0.0003 and P=0.0069, respectively). Low-LCR status was significantly associated with worse overall survival in multivariate analysis (hazard ratio 1.57, 95% confidence interval 1.14–2.17, P=0.0058). Conclusions: Low-LCR status may predict worse outcomes in patients with HCC. Measurement of LCR is routine and can easily be applied for risk stratification in the assessment of patients with HCC. [ABSTRACT FROM AUTHOR]

Background: Primary hepatic leiomyosarcoma (PHL) is an extremely rare type of tumor. We herein report a case of a large surgically resected leiomyosarcoma of the liver. Case presentation: A 69-year-old man with a feeling of epigastric compression was referred for examination of an abdominal mass. He had no history of liver disease or alcohol abuse. Liver function tests indicated Child-Pugh class A. Tumor markers were negative. Computed tomography (CT) and magnetic resonance imaging (MRI) revealed a relatively well-contrasted 12 × 11 × 8 cm tumor with well-defined boundary replacing the lateral segment of the liver alongside multiple intrahepatic metastases. Several nodules up to 12 mm were found in both lungs, suggestive of metastasis. SUVmax of the liver mass and lung tumor in positron emission tomography were 10.4 and 1.5, respectively. Hepatocellular carcinoma was primarily suspected. Lateral segmentectomy of the liver was performed to confirm diagnosis and prevent tumor rupture. Macroscopically, the lateral segment of the liver had been replaced by a lobular or multinodular tumor with a maximum diameter of 15 cm. In pathological findings, the tumor consisted of bundle-like proliferation of complicated banding spindle-like cells with clear cytoplasm, accompanied by storiform pattern and compressed blood vessels. Nuclear fission images were observed in 8/10 HPF. Partial necrosis was present, with associated venous invasion and intrahepatic metastasis. Immunohistochemical staining for tumor cells revealed desmin, α-smooth muscle actin (αSMA), and h-caldesmon were all positive, informing a final diagnosis of PHL. The postoperative course was uneventful, and he was discharged on the 12th postoperative day. Conclusions: PHL is a rare malignant disease with relatively poor prognosis. To confirm a diagnosis of PHL, immunohistochemical analysis as well as histopathological findings is important. The preferred treatment is surgical resection, sometimes in combination with adjuvant chemotherapy and radiotherapy. Further studies are needed to elucidate and better understand this uncommon clinical entity. [ABSTRACT FROM AUTHOR]

Background: The management of hepatocellular carcinoma (HCC) in patients with concomitant esophageal varices (EV) remains controversial. We assessed the surgical outcome of hepatectomy and aimed to clarify the indications and management of HCC in patients with concomitant EV. Methods: We retrospectively enrolled 502 patients with HCC (100 with and 402 without EV), who underwent curative hepatectomy. We analyzed the prognostic outcomes and risk factors for EV bleeding after hepatectomy. Results: Overall survival (OS) was significantly lower in HCC patients with EV than in those without EV ( p = 0.003), although recurrence-free survival was similar in both groups. Multivariate analysis showed that indocyanine green retention test at 15 min (ICGR) >17 % ( p = 0.007) and α-fetoprotein >12.5 ng/ml ( p = 0.003) was independent predictors of poorer OS. Among patients with EV who underwent hepatectomy, multivariate analysis identified ICGR >17 % ( p = 0.03) as the only independent predictor of poorer OS. There was no significant difference in OS between HCC patients with EV and ICGR ≤17.0 % and HCC patients without EV. Ten patients experienced EV bleeding after hepatectomy. Multivariate analysis showed that preoperative endoscopic findings of blue color EV ( p = 0.008) and red color sign ( p = 0.0005) were independent predictors of EV bleeding in patients with HCC after hepatectomy. Conclusions: These results suggest that HCC patients with EV and ICGR ≤17 % may be suitable for surgery, but patients with preoperative endoscopic blue color EV and red color sign need to be managed appropriately. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the effectiveness of using soft coagulation followed by the application of polyglycolic acid (PGA) felt and fibrin glue to prevent pancreatic fistula (PF) after distal pancreatectomy (DP). Methods: A soft coagulation system was applied on the cut surface of the pancreas after ligating the main pancreatic duct, followed by the application of layers of PGA felt and fibrin glue on the layers, to prevent the development of a PF after DP. Results: This technique was applied in nine patients, with mean drain amylase levels of 372 ± 296, 185 ± 209, 54 ± 40, and 47 ± 34 IU/l on days 1, 3, 5, and 7, respectively, after DP. Only one patient (11.1%) showed a Grade A PF on day 3 after surgery; none of the other patients developed a fistula. Conclusions: This technique is an effective prophylactic measure to prevent the development of a PF after DP. [ABSTRACT FROM AUTHOR]

Introduction: Although antegrade en bloc distal pancreatectomy is appropriate for invasive distal pancreatic malignancies, this technique is not easy to perform because the end-point of deep vertical resections cannot be controlled. This report describes the usefulness of the application of hanging maneuver in performing the radical surgery.Methods: A tape for guidance is passed in a space behind the bundles of the left celiac and mesenteric plexus, followed by sagittal resection of the distal pancreas exposing the root of the celiac artery and superior mesenteric artery. After dividing the pancreas down to the level of the roots of the celiac and superior arteries, the distal pancreas is dissected from the retroperitoneum in medial to lateral fashion.Results: This technique was applied in six patients with distal pancreas malignancies, without any positive cancer cells at the resected margin. The mean tumor size was 3.0±0.9 cm. The mean duration of surgery and intraoperative blood loss were 258±71 min and 226±240 ml, respectively.Conclusion: Antegrade en bloc distal pancreatectomy with plexus hanging maneuver is an appropriate technique for treating distal pancreatic malignancies. [ABSTRACT FROM AUTHOR]

As minimally invasive treatments for liver cancers, percutaneous ablation therapies represent a valid alternative to liver resections, especially in patients with poor liver function. Recently, image-guided surgical and interventional procedures using open magnetic resonance imaging (MRI) have been introduced. We performed percutaneous ablation therapy for 51 nodules of liver cancer in 34 patients using a navigation system based on open MRI. During the ablation therapy, the ultrasonography (US) probe, needle, and tumor were displayed on the MR image. Immediately after the procedure, the therapeutic effect was evaluated by open MRI. In all cases, percutaneous puncture into the tumors was successful, even in the case of tumor undetectable by US. Mean fiducial registration error was approximately 3 mm. MR images captured after the procedure clearly demonstrated the ablated area. No mortality or major complications occurred, except for mild hemorrhage, pyrexia, and ascites. We developed a novel navigation system integrating US and MR images using open MRI for percutaneous ablation therapy of liver cancers. The presented system allows a safe and accurate approach to liver cancers, especially certain tumors that cannot be adequately visualized by US, and an evaluation of therapeutic results immediately after the procedures. [ABSTRACT FROM AUTHOR]