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| 1 | Hepatocellular carcinoma: From clinical practice to evidence-based treatment protocols显示文摘Hepatocellular carcinoma(HCC) is one of the major malignant diseases in many healthcare systems. The growing number of new cases diagnosed each year is nearly equal to the number of deaths from this cancer. Worldwide, HCC is a leading cause of cancerrelated deaths, as it is the fifth most common cancer and the third most important cause of cancer related death in men. Among various risk factors the two are prevailing: viral hepatitis, namely chronic hepatitis C virus is a well-established risk factor contributing to the rising incidence of HCC. The epidemic of obesity and the metabolic syndrome, not only in the United States but also in Asia, tend to become the leading cause of the long-term rise in the HCC incidence. Today, the diagnosis of HCC is established within the national surveillance programs in developed countries while the diagnosis of symptomatic, advanced stage disease still remains the characteristic of underdeveloped countries. Although many different staging systems have been developed and evaluated the BarcelonaClinic Liver Cancer staging system has emerged as the most useful to guide HCC treatment. Treatment allocation should be decided by a multidisciplinary board involving hepatologists, pathologists, radiologists, liver surgeons and oncologists guided by personalized-based medicine. This approach is important not only to balance between different oncologic treatments strategies but also due to the complexity of the disease(chronic liver disease and the cancer) and due to the large number of potentially efficient therapies. Careful patient selection and a tailored treatment modality for every patient, either potentially curative(surgical treatment and tumor ablation) or palliative(transarterial therapy, radioembolization and medical treatment, i.e., sorafenib) is mandatory to achieve the best treatment outcome. | Danijel Galun Dragan Basaric Marinko Zuvela Predrag Bulajic Aleksandar Bogdanovic Nemanja Bidzic Miroslav Milicevic | 2015 | World Journal of Hepatology2015，7，20： | 13 |
| 2 | Clinical outcome in patients with hilar malignant strictures type Ⅱ Bismuth-Corlette treated by minimally invasive unilateral versus bilateral endoscopic biliary drainage显示文摘BACKGROUND:Stenting of malignant hilar strictures remains a standard endoscopic treatment in patients with unresectable tumors.The aim of this two-center prospective study was to compare unilateral versus bilateral drainage in hilar malignant stenosis Bismuth-Corlette type II.METHODS:During a 3-year period,a total of 49 patients with hilar tumors(Bismuth-Corlette type II) were referred for endoscopic treatment,following the criteria of unresectability.Ultrasound,computed tomography scan and magnetic resonance cholangiopancreatography(MRCP) were previously performed in all patients in order to facilitate endoscopic retrograde cholangiopancreatography(ERCP).The stricture was first passed by the hydrophilic guide-wire and then contrast medium was injected.Mechanical bile duct dilation was performed,followed by plastic stent placement only in the liver lobe which was previously opacified.The procedures were performed under conscious sedation.The patients were followed up for the next 12 months with a stent exchange every 3 months.Primary outcome was assessed by patient survival in the first 12 months after the procedure.RESULTS:All 49 patients were treated with ERCP while 39(79.59%) had successful stent placement.Among these,32 had hilar cholangiocarcinoma(82%) and 7(18%) had gallbladder cancer.Two groups of patients had Bismuth II strictures:A,21 patients(54%) with unilateral contrast injection and drainage,and B,18(46%) with bilateral contrast injection and drainage.A total of 57 plastic stents were used(10 Fr,89%;11.5 Fr,11%).Group B showed a lower bilirubin level 7 days after the procedure(P=0.008).Early complications were cholangitis(3 patients,2 in group A and 1 in group B) and acute pancreatitis(2 patients,1 each in A and B) with no statistical difference between the groups.Late complications were stent migration(5 patients,1 in A and 4 in B) and stent clogging(6 patients,2 in A and 4 in B) showing a significant difference between the groups(P<0.01).The first stent replacement after 3 months was successful in 87% of patients(four died due to disease progression and one due to cardiopulmonary insufficiency) showing no statistical difference between the groups.At 6 months follow-up,72% patients survived,with no statistical difference between the groups.A final follow-up(12 months) showed the survival rate of 18%(4 patients from group A and 3 from group B)(P>0.05).CONCLUSIONS:A minimally invasive approach,based on the criterion that every bile duct being opacified needs to be drained,is associated with a lower incidence of early complications.Considering that the clinical outcome measured by bilirubin level was lower in patients with bilateral drainage 7 days after the procedure,we assumed that drainage of 50% or more of the liver volume leads to sufficient drainage effectiveness. | Milutin Bulajic Nikola Panic Miodrag Radunovic Radisav Scepanovic Radoslav Perunovic Predrag Stevanovic Tatjana Ille Maurizio Zilli Mirko Bulajic | 2012 | Hepatobiliary & Pancreatic Diseases International2012，11，2： | 8 |
| 3 | Is There any Benefit from Expanding the Criteria for the Resection of Hepatocellular Carcinoma in Cirrhotic Liver? Experience from a Developing Country显示文摘 | Danijel Galun Predrag Bulajic Marinko Zuvela Dragan Basaric Tatjana Ille Miroslav Milicevic | 2012 | World Journal of Surgery2012，，7： | 1 |
| 4 | Is There any Benefit from Expanding the Criteria for the Resection of Hepatocellular Carcinoma in Cirrhotic Liver? Experience from a Developing Country显示文摘 | Danijel Galun Predrag Bulajic Marinko Zuvela Dragan Basaric Tatjana Ille Miroslav Milicevic | 2012 | World Journal of Surgery2012，，7： | 1 |
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