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Y Y Jan

Publications and source records attributed to Y Y Jan.

At least 37 records · Page 2Linked to original sources
PubMed1998

Hepatocellular carcinoma complicated with coexisting hepatolithiasis: pitfalls in diagnosis and management.

Nineteen patients with hepatocellular carcinoma associated with hepatolithiasis were retrospectively analyzed. Eleven of the 19 patients presented with hepatolithiasis-related biliary infection. Diagnosis was erroneously assumed to be hepatolithiasis alone, liver abscess, or cholangiocarcinoma in five of 11 patients before surgery was attempted. Middle-age, male sex, liver cirrhosis, hepatitis B or C infection, abnormal alpha-fetoprotein, and negative carcinoembryonic antigen raised the suspicion of associated hepatocellular carcinoma rather than cholangiocarcinoma in patients with hepatolithiasis. Antibiotics and nonoperative methods to resolve biliary infection first, followed by hepatectomy, in selected cases, to eradicate hepatocellular carcinoma and hepatolithiasis simultaneously provides the best chance for long-term survival. Otherwise, patients often died of hepatolithiasis-related biliary sepsis rather than hepatocellular carcinoma per se in the long run.

Adult↗
PubMed1998

Hepatocellular carcinoma presenting as pyogenic liver abscess: characteristics, diagnosis, and management.

We performed a 17-year retrospective analysis of 10 cases of hepatocellular carcinoma presenting as pyogenic liver abscess. Spontaneous tumor necrosis and biliary obstruction caused by tumor thrombi, superimposed with bacterial infection, were the two major pathogeneses. Exact diagnosis of the underlying hepatocellular carcinoma was made for five of the 10 patients before management was attempted. Main clinical manifestations included fever, chills, right-upper-quadrant pain, malaise, anorexia, jaundice, and hepatomegaly. Characteristics such as middle age and male sex, seropositivity for hepatitis B and/or hepatitis C, chronic liver disease, unexplained anemia, marked weight loss, and a severely inversed albumin/globulin ratio raise suspicions about the underlying hepatocellular carcinoma. Management strategies included percutaneous drainage (n = 3), surgical drainage (n = 4), and hepatectomy (n = 3) in addition to administration of parenteral antibiotics in all cases. The prognosis was dismal, with a mean survival of 3.5 months (range, 8 days to 6 months).

Adult↗
PubMed1998

Clinical studies of mucin-producing cholangiocellular carcinoma: a study of 22 histopathology-proven cases.

OBJECTIVE: We present the clinical features and outcomes of 22 surgically treated and histopathology-proven cases of mucin-producing cholangiocellular carcinoma (MPCCC). BACKGROUND: Cholangiocellular carcinoma (CCC) is an uncommon malignancy. Unlike hepatocellular carcinoma, it is difficult to set up a high-risk group, and a specific tumor marker has yet to be found. Chronic liver disease is usually not found to be associated with CCC. Information about patients with MPCCC is limited, and the frequency of MPCCC in all patients with CCC has not been reported. METHODS: The clinical features of 22 surgically treated and histopathology-proven cases of MPCCC were reviewed, including morbidity, mortality, and follow-up results. Factors that may influence the outcomes were also analyzed. Clinical features and outcomes of 148 patients with non-mucin-producing cholangiocellular carcinoma (non-MPCCC) were also summarized for comparison. RESULTS: Of 170 cases of CCC, 22 (12.9%) were MPCCC. Imaging studies were important in the differential diagnosis of CCC. Operative findings (e.g., gross appearance of the liver, mucobilia found by common bile duct exploration, choledochoscopic findings, and frozen section) were useful in the diagnosis of MPCCC. Surgical procedures included common bile duct exploration, or hepaticostomy, and intraoperative choledochoscopy in all 22 patients. Hepatic resection was done in 14 of the 22 cases (63.6%). No early surgical mortality was noted. Wound infections (two patients), bile leak (one patient), and intraabdominal abscess (one patient) were the postoperative complications. The 1-, 2-, 3-, 4-, and 5-year survival rates were 86.5%, 68.5%, 59.0%, 38.5%, and 31.0%, respectively. A significant difference in survival pattern was found between the MPCCC and non-MPCCC patient groups. Patients with hepatic resection had a significantly better prognosis than those without resection. Although patients with hepatolithiasis had a better survival pattern than those without hepatolithiasis, the difference was not statistically significant. CONCLUSIONS: We present the clinical features and outcomes of 22 surgically treated and histopathology-proven cases of MPCCC. Patients with hepatic resection were found to have better survival rates.

Adenocarcinoma, Mucinous↗
PubMed1998

Weekly 24 h infusion of high-dose 5-fluorouracil and leucovorin in patients with biliary tract carcinomas.

From October 1995 to June 1997, 19 chemotherapy-naive patients with pathology-proven locally advanced or metastatic biliary tract carcinomas (BTC) were enrolled. The regimen consisted of 5-fluorouracil (5-FU) 2600 mg/m2 and leucovorin (LV) 150 mg by weekly 24 h infusion for 6 weeks and followed by a 2 week break. The treatment was terminated if disease progressed, the patient refused or unacceptable toxicity occurred. All patients required a Port-A catheter insertion and were treated at outpatient clinics by portable infusion pumps. There were 12 males and seven females with a median age of 62 years (range 45-77). The primary tumor sites were nine intrahepatic cholangiocarcinomas (CC), three perihilar CC, one distal BTC and six gallbladder cancers. A total of 179 chemotherapy sessions were given with a mean of 9.5 (range 2-18). Eighteen patients were evaluable for response. The response rates were: 33% (six of 18) partial response (PR), 39% (seven of 18) stable disease (SD) and 28% (five of 18) progressive disease (PD). All of the patients were evaluable for toxicity. The most common toxicities were mild fatigue (nine of 19, 47%), loss of appetite (nine of 19, 47%), skin hyperpigmentation (five of 19, 26%) and diarrhea (two of 19, 11%). Only one patient had grade IV myelotoxicity with sepsis but without treatment-related death. The median time to progression was 4 months. The overall median survival time was 7.0 months. The median survival time of the PR was not reached, SD was 8.0 months and PD 3.5 months. In conclusion, weekly high-dose 5-FU with LV by 24 h infusion in an outpatient setting for patients with BTC is effective, only mildly toxic and deserves further study.

Aged↗
PubMed1998

Cholangiocarcinoma presenting as pyogenic liver abscess: is its outcome influenced by concomitant hepatolithiasis?

OBJECTIVE: The etiology of pyogenic liver abscess is changing. Malignant biliary obstruction has emerged as one of the most important causes. We explored the clinical course of pyogenic liver abscess caused by cholangiocarcinoma. METHODS: The medical records of 19 patients with cholangiocarcinoma presenting as pyogenic liver abscess were reviewed. Of them, 57.8% (11 of 19) had concomitant hepatolithiasis. Escherichia coli and Klebsiella pneumoniae were the most common pathogens isolated from aspirates of the abscesses. Eight patients received percutaneous drainage, whereas 11 patients initially underwent surgical drainage because of the presence of ascites or coagulopathy or lack of awareness of the underlying cholangiocarcinoma. RESULTS: Overall, the hospital mortality rate was 36.8% (seven of 19). Patients with hepatolithiasis had a hospital mortality rate of 54.5% (six of 11), compared with 12.5% (one of eight) in those without (p < 0.01). Notably, 84.2% (16 of 19) of the patients died within 6 months after the diagnosis was made. CONCLUSIONS: Cholangiocarcinoma presenting as liver abscess has a dismal prognosis. Concomitant hepatolithiasis worsened the infectious process and adversely affected the survival.

Adult↗
PubMed1998

Prognostic factors in node-negative breast cancer patients: the experience in Taiwan.

BACKGROUND: Adjuvant chemotherapy has improved the length of disease-free survival and overall survival in node-negative breast cancer patients. It has been a common practice to select only the patients with higher rates of recurrence for adjuvant therapy. Therefore, it is essential to define the risk factors in node-negative breast cancer patients. MATERIALS AND METHODS: Two hundred fifty-five patients with axillary node-negative breast cancers without adjuvant chemotherapy or hormonal therapy at Chang Gung Memorial Hospital between 1981 and 1986 were included in this study. Tissue blocks for DNA flow cytometry study was available in the tumors of 145 patients. RESULTS: The median follow-up period was 121 months and the percentages of patients with 10 years of disease-free survival (DFS) and overall survival (OS) were 75.1% and 82.2%, respectively. The significant poor prognostic factors for 10 years of OS were a tumor size larger than 3 cm, negative estrogen and progesterone receptor status, and having a non-diploid tumor (p value = 0.0176, 0.048 and 0.016, respectively). The patients with frozen section, high mitotic rate, and Scarff-Blood-Richardson (SBR) grade II and III tumors had a worse prognosis than the others, but this trend did not reach statistical significance. The patients with positive estrogen receptor status had a 10-year disease-free rate (DFR) of 94%, and these with tumors less than 2 cm plus SBR grade I had a 10-year DFR of 92%. CONCLUSION: The node-negative breast cancer patients with a low risk of recurrence were those who had estrogen receptor positive, tumor less than 2 cm with SBR grade I, and intraductal carcinomas. Adjuvant chemotherapy would be no benefit for these patients.

Adult↗
PubMed1997

Pancreaticojejunal anastomotic leak after pancreaticoduodenectomy--multivariate analysis of perioperative risk factors.

The records of 131 consecutive patients with periampullary carcinoma who underwent pancreaticoduodenectomy within a 12-year period were reviewed to determine the perioperative risk factors of pancreaticojejunal (PJ) anastomotic leak. Twenty-one PJ leaks were identified, for a frequency of 16% (21 of 131); 19% (4 of 21) of these patients eventually died of PJ leak-related complications. A total of 23 items of perioperative data, presumed as risk factors predisposing to PJ leak, were examined. By univariate analysis, advanced age, prolonged duration of untreated jaundice, deep jaundice, decreased creatinine clearance, increased intraoperative blood loss, and shock during operation were statistically significant. However, by multivariate analysis, only duration of jaundice, creatinine clearance, and intraoperative blood loss turned out to be independent risk factors. Noteworthily, jaundiced patients with impaired creatinine clearance not only had a higher incidence of PJ leak, but were also more liable to experience sepsis and intraabdominal bleeding, which uniformly elicited a grave clinical course. Routine preoperative biliary drainage failed to enhance the security of PJ. Completion pancreatectomy continued to carry a poor prognosis, and should be avoided when possible and replaced by early, aggressive radiologic intervention.

Adult↗
PubMed1997

Prognostic study of gastric cancer without serosal invasion: reevaluation of the definition of early gastric cancer.

BACKGROUND: Early gastric cancer, a term defined by Japanese researchers in the 1960s, is equivalent to pT1 tumor stage regardless of nodal status. Recently, there were suggestions to exclude node-positive pT1 gastric cancer from this entity and to consider node-negative pT2 gastric cancer as early gastric cancer. STUDY DESIGN: A survival analysis was conducted of 294 patients who underwent resection for gastric cancers confined within the gastric wall (pT1, n = 164; pT2, n = 130) between 1986 and 1992. RESULTS: The cumulative 5-year survival rate was 93.5% for pT1 patients and 67.9% for pT2 patients, with an overall survival of 82.5%. There was a significant difference in the 5-year survival rate between node-positive and node-negative pT1 patients (72.8% versus 95.6%; p = 0.0095). The 5-year survival rate of node-negative pT2 patients (80.4%) was significantly worse than that of node-negative pT1 patients (p = 0.011) but was not significantly better than that of node-positive pT1 patients (p = 0.4). If excellent prognosis is a prerequisite for the definition of early gastric cancer, then node-positive pT1 cancer and node-negative pT2 cancer should not be considered early gastric cancer. CONCLUSIONS: In the 1990s, now that new imaging techniques such as endoscopic ultrasonography has been introduced, the preoperative staging of gastric cancer can be made more accurately than in the 1960s, when the term "early gastric cancer" was defined. Because the prognosis of early gastric cancers, if subcategorized by nodal status, is not homogeneously excellent, a reevaluation of the definition of early gastric cancer may be necessary.

Adolescent↗
PubMed1997

Role of hepatic resection in surgery for bilateral intrahepatic stones.

BACKGROUND: Hepatic resection is the treatment of choice for unilateral intrahepatic stones. The availability of the flexible choledochoscope has greatly changed the management of intrahepatic stones. Little has been reported regarding hepatic resection for bilateral intrahepatic stones. METHODS: Fifty-nine (15.1 per cent) of 392 patients with bilateral intrahepatic stones underwent hepatic resection. The indications and results were reported. Surgical outcome and long-term follow-up were analysed, and results were compared with those in patients not undergoing hepatectomy. RESULTS: Fifty-nine patients underwent hepatic resection because of destruction of the left liver by repeated infection (n = 40), multiple cholangitic liver abscesses (n = 18) or associated intrahepatic cholangiocarcinoma (n = 1). The hospital mortality rate was 1.7 per cent. The majority of complications were wound infection (9 per cent), haematobilia (5 per cent) and biliary fistula (3 per cent). The incidence of residual stones after surgery was 60 per cent. One year after postoperative choledochoscopic stone extraction, the rate of complete stone clearance was 84 per cent. In patients who did not have hepatectomy the respective rates were 90.1 and 52.9 per cent. The recurrence rate for stones in the hepatectomy and no-hepatectomy groups was 12 and 33.0 per cent respectively. CONCLUSIONS: Compared with patients not undergoing hepatectomy, those having hepatic resection had similar operative risks, fewer residual stones and a low incidence of recurrent stones (P < 0.05).

Adult↗
PubMed1996

Primary carcinoma of the gallbladder in Taiwan.

To define more precisely the prognostic index for patients with primary carcinoma of the gallbladder in Taiwan, we retrospectively reviewed the data of 74 patients with gallbladder carcinoma treated over a period of 15 years, from 1979 to 1993. Of these patients, 75% had Nevin stage V gallbladder cancer. The most common presenting complaint was abdominal pain, followed by jaundice, fever, and nausea and vomiting. Accurate preoperative diagnosis was made in 29.7% of the patients. Ultrasonography and computed tomography had a diagnostic accuracy of 34.0% and 40.9%, respectively. The most common histologic type was adenocarcinoma. Liver was the organ most commonly invaded (51.9%) by direct extension and/or metastases, followed by regional lymph nodes (38.5%). The overall 5-year survival rate was 4.1%. Age, sex, white cell count, hemoglobulin, SGOT, SGPT, total bilirubin, alkaline phosphatase, and cholelithiasis were not significant prognostic factors. Patients with cancers confined in the gallbladder wall (stages I, II, III) had a better (P < 0.05) cumulative survival rate than did those with regional lymph nodes and distant metastases. Cholecystectomy or extended surgery had a better survival rate than did palliative surgery, but there was no significant difference between cholecystectomy and extended surgery. High index of suspicion of the disease and earlier surgical treatment may improve patient survival.

Adult↗
PubMed1996

Surgical treatment of hepatolithiasis: long-term results.

BACKGROUND: Hepatolithiasis is a common disease in East Asia and is prevalent in Taiwan. Surgical and nonsurgical procedures for management of hepatolithiasis have been discussed, but long-term follow-up results of surgical treatment of hepatolithiasis are rarely reported. METHODS: We conducted a retrospective study of case records of patients with hepatolithiasis who underwent surgical or nonsurgical percutaneous transhepatic cholangioscopy treatment. Of 614 patients with hepatolithiasis seen between January 1984 and December 1988, 427 underwent follow-up after surgical (380) or percutaneous transhepatic cholangioscopy (47) treatment for 4 to 10 years and constituted the basis of this study. RESULTS: Long-term results of 427 patients with hepatolithiasis after surgical and nonsurgical treatment within 4 to 10 years of follow-up were recurrent stone rate 29.6% (105 of 355), repeated operation 18.7% (80 of 427), secondary biliary cirrhosis 6.8% (29 of 427), late development of cholangiocarcinoma 2.8% (12 of 427), and mortality rate 10.3% (44 of 427). The patients with hepatectomy had a better quality of life (symptom-free) with a lower recurrent stone rate (9.5%), lower mortality rate (2.1%), and lower incidence of secondary biliary cirrhosis (2.1%) and cholangiocarcinoma (0%) than did the nonhepatectomy group (p < 0.01). The patients without residual stones after choledochoscopy had a better quality of life than did the residual stone group (p < 0.01). CONCLUSIONS: Long-term follow-up study of hepatolithiasis after surgical treatment revealed a high recurrent stone rate (29.6%) that required repeated surgery and a high mortality rate (10.3%) resulting from repeated cholangitis, secondary biliary cirrhosis, and late development of cholangiocarcinoma. Patients who received hepatectomy or without residual stones after choledochoscopy had a good prognosis and quality of life.

Adolescent↗
PubMed1995

Percutaneous trans-hepatic cholangioscopic lithotomy for hepatolithiasis: long-term results.

A prospective study was undertaken to evaluate the long-term results of percutaneous trans-hepatic cholangioscopic lithotomy in 48 patients with hepatolithiasis during a 4- to 10-year follow-up period. Complete clearance of the intrahepatic stones was achieved in 40 patients (83.3%). In these 40 patients, long-term results during the follow-up period were as follows: free of symptoms and without evidence of recurrent stones, 22 patients (55%); free of symptoms with recurrent stones, 2 patients; recurrent stones with cholangitis, 14 patients (35%); symptoms of cholangitis without evidence of recurrent stones, 2 patients. Of those patients with recurrent stones, secondary biliary cirrhosis developed in 1, and in 9 of the patients in whom secondary cholangitis developed, subsequent laparotomy or percutaneous drainage was required. Three of the 40 patients (7.5%) died within the 4- to 10-year follow-up period. The procedural failure rate in terms of stone retention was 20.5% for patients with bile duct strictures. No stones were retained in patients without strictures. The postprocedural rate of stone recurrence for patients with bile duct strictures was 51.6%; no recurrence was seen in patients without strictures.

Adult↗
PubMed1995

Primary carcinoma of the gallbladder associated with anomalous pancreaticobiliary ductal junction.

Anomalous pancreaticobiliary ductal junction (APBDJ) is a rare anomaly but is a risk factor for primary carcinoma of the gallbladder. To define the relationship between APBDJ and gallbladder carcinoma, we retrospectively reviewed data of 57 patients with gallbladder carcinoma. Of these patients, 25 had undergone endoscopic retrograde cholangiopancreaticography (ERCP) and four (16%) exhibited APBDJ. The age of those patients with APBDJ was 58.0 +/- 8.6 years and that of the patients without APBDJ was 59.2 +/- 3.1 years. Two (50.0%) of the APBDJ patients had gallstones and 47.6% of the patients without APBDJ had gallstones. The mean length of the common channel was 30 mm (range 22-38). The mode of ductal junction was three pancreatic-biliary types and one biliary-pancreatic type. One patient had an associated choledochal cyst. All the four patients with APBDJ had advanced gallbladder cancers. Consideration of gallbladder carcinoma in the patients with APBDJ may improve early detection and their survival rate.

Adenocarcinoma↗
PubMed1995

Clinical experience with hepatic resection for ruptured hepatocellular carcinoma.

BACKGROUND: Spontaneous rupture of a hepatocellular carcinoma (HCC) is an uncommon but fatal complication of this disease. Surgical treatment is aimed at controlling the intraperitoneal hemorrhage, which has been achieved by hepatectomy, hepatic arterial ligation, packing and suturing. However, hemostasis obtained by hepatic arterial ligation, packing and suturing is not particularly effective, and the rebleeding rate is high. Information on hepatectomy for ruptured HCC is sparse, and we therefore reviewed our experience with hepatic resection for this potentially fatal complication. METHOD: The clinicopathological features of 23 patients with ruptured HCC who underwent hepatectomy during the past 15 years were reviewed. Morbidity, mortality and survival rates were analyzed. RESULTS: Effective hemo-stasis was achieved by hepatectomy. Indications for operative treatment were acute abdomen necessitating immediate laparotomy in 12, and spontaneous hemoperitoneum in 11. Types of hepatectomy included left hemihepatectomy in 3, lateral segmentectomy in 6 and local excision in 14. Liver cirrhosis was the concomitant disease in 13 (56.5%). Hospital mortality rate was 4.3%. 1, 2, 3, and 5 year survival rates were 60%, 52%, 40.5% and 26.5%, respectively. CONCLUSIONS: Hepatic resection is the treatment of choice for ruptured HCC. Long-term survival can be observed in a few patients without recurrence.

Adolescent↗
PubMed1995

Combined laparoscopic hysterectomy and cholecystectomy--a case report.

We present the first recorded case which received a combined laparoscopic hysterectomy, right salpingo-oophorectomy and cholecystectomy during one anesthetic period in Taiwan. This procedure was done to treat the coexisting benign lesions of the uterus, ovary, and the gall bladder. Postoperative pathological diagnoses was myoma, an ovarian hemorrhagic corpus leutum cyst, cholelithiasis, and cholecystitis. Estimated blood loss was less than 150 ml for the combined procedure. With the total operation time being 135 minutes. The patient recovered soon and could take a regular diet and walk without assistance 20 hours after operation. She discharged 4 days later and returned to work 5 days after discharge. We think for well trained laparoscopists, a cross-specialty cooperation between a gynecologist and a general surgeon to treat coexisting lesions of the uterus and the gall bladder is a safe, feasible, and beneficial procedure.

Cholecystectomy, Laparoscopic↗
PubMed1994

Obstructive jaundice secondary to ruptured hepatocellular carcinoma into the common bile duct. Surgical experiences of 20 cases.

BACKGROUND: Hepatocellular carcinoma (HCC) presenting as obstructive jaundice caused by floating tumor debris in common bile duct is rare. Taiwan has a high incidence of HCC and cirrhosis. The authors report their clinical experiences and evaluate the results of different treatment modalities for this disease. METHODS: A retrospective study was undertaken to review 20 patients with obstructive jaundice secondary to ruptured HCC into common bile duct during the 12 years period. RESULTS: All patients on initial examination had recurrent episodic jaundice or cholangitis. Jaundice was relieved by nonsurgical, percutaneous transhepatic biliary stenting in 4 patients and surgical intubation with T-tube drainage in 16. Types of treatment for those who were treated nonsurgically were percutaneous transhepatic biliary stenting in two patients, followed by transcatheter hepatic arterial embolization in another two patients. For the 16 patients who were treated surgically, the types of treatment were T-tube or Y-tube drainage in 11, T-tube drainage followed by hepatic resection in 2, T-tube drainage and hepatic arterial ligation in 1, and T-tube drainage followed by transcatheter hepatic arterial embolization in the other 2. Liver cirrhosis was the associated disease in 12 (75%). Four patients (20%) died in the hospital. The mean survival time for 12 patients with only surgical or nonsurgical biliary stenting was 3.9 months. For the three patients with percutaneous hepatic arterial embolization, the mean survival time was 8.0 months. Two patients who had undergone hepatic resection had a better postoperative survival time, with one surviving for more than 5 years. CONCLUSION: Clinical features, types of management, operative findings, and survival in 20 patients with HCC obstructing the common bile duct by tumor thrombi were reviewed. Not all patients with this disease were terminally ill. With proper management, good palliation and occasional cure are possible.

Adult↗