Dong-Hui Xu

Postoperative infection is not uncommon after hepatectomy. This study assessed the effectiveness of preoperative antibiotic prophylaxis in elective hepatectomy in a randomized clinical trial setting. A total of 120 patients who were scheduled to undergo elective hepatectomy were equally randomized to receive either intravenous cefuroxime 1.5 g (group A) or placebo (group B) within 30 min prior to skin incision. Overall, postoperative infection occurred in 26 (21.6 %) of the 120 patients. There was no statistically significant difference between groups A and B in the incidence of overall infection (23.3 vs. 20.0 %, P = 0.658), surgical site infection (13.3 vs. 15 %, P = 0.793), and remote site infection (13.3 vs. 11.7 %, P = 0.783). The use of preoperative antibiotic prophylaxis as a routine practice in patients undergoing elective hepatectomy is unnecessary because it does not reduce the risk of postoperative infectious complications.

Background: Studies investigating the association between Hepatitis B virus (HBV) and hepatitis C virus (HCV) infections and intrahepatic cholangiocarcinoma (ICC) have reported inconsistent findings. We conducted a meta-analysis of epidemiological studies to explore this relationship. Methods: A comprehensive search was conducted to identify the eligible studies of hepatitis infections and ICC risk up to September 2011. Summary odds ratios (OR) with their 95% confidence intervals (95% CI) were calculated with random-effects models using Review Manager version 5.0. Results: Thirteen case–control studies and 3 cohort studies were included in the final analysis. The combined risk estimate of all studies showed statistically significant increased risk of ICC incidence with HBV and HCV infection (OR = 3.17, 95% CI, 1.88-5.34, and OR = 3.42, 95% CI, 1.96-5.99, respectively). For case–control studies alone, the combined OR of infection with HBV and HCV were 2.86 (95% CI, 1.60-5.11) and 3.63 (95% CI, 1.86-7.05), respectively, and for cohort studies alone, the OR of HBV and HCV infection were 5.39 (95% CI, 2.34-12.44) and 2.60 (95% CI, 1.36-4.97), respectively. Conclusions: This study suggests that both HBV and HCV infection are associated with an increased risk of ICC.

Single-incision laparoscopic surgery (SILS) was developed as a novel minimally invasive surgical approach. The aim of this meta-analysis was to compare SILS and conventional laparoscopy (CL) for colorectal diseases with respect to perioperative and oncologic outcomes. An electronic search was performed to retrieve all relevant articles published in the English language between 2008 and 2012 comparing SILS and CL for colorectal diseases. The data were analyzed with fixed-effect or random-effects models using review manager version 5.0. A total of 14 studies (one randomized controlled trial and 13 nonrandomized controlled trials) were found to be eligible and reported on 1,155 subjects, of whom 521 underwent SILS and 634 underwent CL for colorectal diseases. Concerning the perioperative outcomes, no differences were observed in conversion rate, operating time, and postoperative adverse events; however, patients who underwent SILS had lower blood loss, decreased blood transfusion requirement, shorter time to flatus, shorter hospital stay, and smaller incision. Concerning the oncologic outcomes, length of resected specimens, number of harvested lymph nodes, proximal margin, and distal margin, were comparable between two groups. Single-incision laparoscopic surgery (SILS) is a safe, feasible, and oncological efficient alternative to CL for colorectal diseases. Further larger, multi-centred, randomised controlled trial is indicated.

Laparoscopic liver resection (LLR) remains to be established as a safe and effective alternative to open liver resection (OLR) for hepatocellular carcinoma (HCC). The aim of this meta-analysis is to compare laparoscopic versus open resection for HCC with regard to perioperative and oncologic outcomes. A literature search was performed to identify comparative studies reporting outcomes for both laparoscopic and open resection for HCC. Pooled odds ratios (OR) and weighted mean differences (WMD with 95% confidence intervals (95% CI) were calculated using either the fixed effects model or random effects model. Ten nonrandomized controlled studies matched the selection criteria and reported on 494 subjects, of whom 213 underwent LLR and 281 underwent OLR for HCC. Compared with the perioperative results of open surgery, reports on laparoscopic resection indicate potentially favourable outcomes in terms of operative blood loss (WMD: −160.57, 95% CI: −246.49 to −74.66), blood transfusion requirement (OR: 0.39, 95% CI: 0.18 to 0.86), postoperative morbidity (OR: 0.48, 95% CI: 0.29 to 0.78), and length of hospital stay (WMD: −5.53, 95% CI: −7.89 to −3.16). Concerning the oncologic outcomes, there was no difference between groups in surgical margin, overall survival and disease-free survival. LLR for HCC is superior to the OLR in terms of its perioperative results and does not compromise the oncological outcomes. Therefore, LLR may be an alternative choice for treatment of HCC.

Background: There is no clear consensus on the better therapy [radiofrequency ablation (RFA) versus hepatic resection (HR)] for small hepatocellular carcinoma (HCC) eligible for surgical treatments. This study is a meta-analysis of the available evidence. Methods: Systematic review and meta-analysis of trials comparing RFA with HR for small HCC published from 1997 to 2009 in PubMed and Medline. Pooled odds ratios (OR) with 95% confidence intervals (95% CI) were calculated using either the fixed effects model or random effects model. Results: One randomized controlled trial, and 9 nonrandomized controlled trials studies were included in this analysis. These studies included a total of 1411 patients: 744 treated with RFA and 667 treated with HR. The overall survival was significantly higher in patients treated with HR than in those treated with RFA at 3 years (OR: 0.56, 95% CI: 0.44-0.71), and at 5 year (OR: 0.60, 95% CI: 0.36-1.01). RFA has a higher rates of local intrahepatic recurrence compared to HR (OR: 4.50, 95% CI: 2.45-8.27). In the HR group the 1, 3, and 5 years disease -free survival rates were significantly better than in the HR-treated patients (respectively: OR: 0.54, 95% CI: 0.35-0.84; OR: 0.44, 95% CI: 0.28-0.68; OR: 0.64, 95% CI: 0.42-0.99). The postoperative morbidity was higher with HR (OR: 0.29, 95% CI: 0.13-0.65), but no significant differences were found concerning mortality. For tumors ≤ 3 cm HR did not differ significantly from RFA for survival, as reported in three NRCTs . Conclusions: HR was superior to RFA in the treatment of patients with small HCC eligible for surgical treatments, particularly for tumors > 3 cm. However, the findings have to be carefully interpreted due to the lower level of evidence.