Biomedical subjects

Saboor Khan

Publications and source records attributed to Saboor Khan.

4 recordsLinked to original sources

PubMed2006

Multivariate and univariate analysis of prognostic factors following resection in HCC: the Birmingham experience.

BACKGROUND: The aim of this study was to look into our experience of resection for hepatocellular carcinomas (HCCs) in a tertiary Hepatobiliary and Liver Transplant Unit in the UK. METHODS: A retrospective analysis of our prospective database was carried out. RESULTS: 715 cases of HCC were seen. 100 (13.9%) underwent hepatic resection and 159 (22.2%) orthotopic liver transplant. The 1-, 3- and 5-year overall survival following resection was 75.3, 37.0 and 21.5% respectively. Factors affecting long-term survival included resection margin (p < 0.001), recurrence (p < 0.007), alpha-fetoprotein >50 (p < 0.001) and serum albumin (p < 0.03). On multivariate analysis, recurrence (p < 0.001) and histological grade (p < 0.044) were significant. The 1- and 3-year recurrence rates were 27.3 and 72.5% respectively. Histological grade (p < 0.007), alpha-fetoprotein >50 (p < 0.033), female gender (p < 0.016) and portal vein involvement (p < 0.016) were significant in recurrence. CONCLUSIONS: Resection data from the East may not be comparable to the West owing to the higher transplant activity in the latter. Liver function tests and imaging would be sufficient to assess liver function prior to hepatic resection. HCC with cirrhosis should be assessed by a transplant unit prior to any treatment. The MELD (Model for End-Stage Liver Disease) score would be a valuable preoperative tool in the assessment of cirrhotics.

Adult↗

PubMed2006

Conventional versus piggyback technique of caval implantation; without extra-corporeal veno-venous bypass. A comparative study.

Conventional orthotopic liver transplantation (CON-LT) involves resection of recipient cava, usually with extra-corporeal circulation (veno-venous bypass, VVB), while in the piggyback technique (PC-LT) the cava is preserved. Along with a temporary portacaval shunt (TPCS), better haemodynamic maintenance is purported with PC-LT. A prospective, consecutive series of 384 primary transplants (2000-2003) were analysed, 138 CON-LT (with VVB) and 246 PC-LT (54 without TPCS). Patient/donor characteristics were similar in the two groups. PC-LT required less usage of fresh-frozen plasma and platelets, intensive care stay, number of patients requiring ventilation after day 1 and total days spent on ventilator. The results were not different when comparing, total operating and warm ischaemia time (WIT), red cell usage, requirement for renal support, day 3 serum creatinine and total hospital stay. TPCS had no impact on outcome other than WIT (P = 0.02). Three patients in PC-LT group (three of 246;1.2%) developed caval outflow obstruction (P = 0.02). There was no difference in short- or long-term graft or patient survival. PC-LT has an advantage over CON-LT unsing VVB with respect to intraoperative blood product usage, postoperative ventilation requirement and ITU stay. VVB is no longer required and TPCS may be used selectively in adult transplantation.

Adult↗

PubMed2005

Prognostic potential of hepatocyte volume and cytokine expression in cirrhotic portal hypertension.

BACKGROUND: Differentiating the prognosis of Child-Pugh A and B patients is difficult, particularly following an acute variceal hemorrhage. We have examined the prognostic significance of hepatocyte volume (HV) and the expression of selected cytokines controlling liver repair and regeneration. METHODS: Forty Child-Pugh A and B cirrhotic patients surviving a first acute variceal hemorrhage were recruited prospectively. Hematological, biochemical, neurological, hemodynamic, radio-nuclear and histological assessments were carried out following recovery (at 3 weeks). Fibrosis (%) and HV were calculated using histological morphometry and radio-nuclear liver volume assessment. Immunohistochemistry was used in liver biopsy specimens to assess markers of proliferation (PCNA) and the expression of mitogens (TGF-alpha, TGF-beta(1)) or their receptors (C-met and EGFR). RESULTS: In total, 27 patients died during the follow-up period. HV was predictive of survival in Child-Pugh grade A patients (chi(2) = 10.5, P = 0.0012), but percentage fibrosis and regeneration factor expression were not predictive in either Child-Pugh A or B patients. Cox regression modeling with Child-Pugh grade demonstrated HV to be an independent predictor of survival (chi(2) = 7.1, P = 0.02). CONCLUSIONS: HV predicts survival independently in cirrhotic portal hypertension, and may help to differentiate prognosis in those at the more favorable end of the disease spectrum. Liver cytokine expression 3 weeks following an acute variceal bleed did not appear useful in determining prognosis.

Adult↗

PubMed2002

D2 or not D2? The gastrectomy question.

BACKGROUND: The best reported long-term survival following surgery for gastric cancer is from centers performing radical D2 gastrectomy. Yet comparative studies from European centers report higher rates of postoperative complications following D2 gastrectomy than after the less radical D1 gastrectomy, without any benefit in survival. We aimed to compare the outcome after modified D2 gastrectomy (preserving spleen and pancreas where possible), performed by specialist surgeons, with that after conventional D1 gastrectomy performed by general surgeons for gastric cancer in a large United Kingdom cancer unit. METHODS: Two groups of patients were studied: a historical control group of 245 consecutive patients with gastric cancer, of whom 50 underwent a potentially curative D1 resection (median age, 69 years; 35 males) was compared with 200 consecutive patients, 72 of whom underwent a potentially curative D2 resection (median age, 71 years; 47 males). RESULTS: Among the 122 patients judged to have curable cancers, patients who underwent a D2 gastrectomy had lower operative mortality (8.3% vs 12%; chi(2) = 0.48; P = 0.50) and experienced fewer complications (28% vs 36%; chi(2) = 0.93; P = 0.35) than patients who underwent a D1 gastrectomy. Cumulative survival at 5 years was 56% after D2 resections, compared with 11% after D1 resections ( P < 0.00001). In a multivariate analysis, only the stage of disease (stage I, hazard ratio [HR], 0.068; P = 0.0001; stage II, HR, 0.165; P = 0.001; stage III, HR, 0.428; P = 0.053) and the level of lymphadenectomy (HR, 0.383; P = 0.00001) were independently associated with the duration of survival. CONCLUSION: Modified D2 gastrectomy without pancreatico-splenectomy, performed by specialist surgeons, can improve survival after R0 resections without increasing operative morbidity and mortality, when compared with D1 gastrectomy performed by general surgeons.

Aged↗