SUMMARYAim: To evaluate adjuvant modalities after curative resection for hepatocellular carcinoma using a metaanalysis of randomized and non-randomized controlled trials. Methods: In a first step, a meta-analysis of randomized controlled trials was carried out. Sensitivity analyses after inclusion of non-randomized controlled trials were performed. Four therapeutic modalities were evaluated: pre-operative transarterial chemotherapy, post-operative transarterial chemotherapy, systemic chemotherapy and a combination of systemic and transarterial chemotherapy. Results: Only post-operative transarterial chemotherapy improved survival significantly at 2 years [difference, 22.8%; confidence interval (CI), 8.6-36.9%; P ¼ 0.002] and 3 years (difference, 27.6%; CI, 8.2-47.1%; P ¼ 0.005), and decreased the probability of no recurrence at 1 year (difference, 28.8%; CI, 16.7-40.8%; P < 0.001), 2 years (difference, 27.6%; CI, 8.2-47.1%; P ¼ 0.005) and 3 years (difference, 28%; CI, 8.2-47.9%; P ¼ 0.006). In a sensitivity analysis after inclusion of non-randomized controlled trials, postoperative transarterial chemotherapy still improved survival at 1 year (difference, 9.6%; CI, 0.8-18.3%; P ¼ 0.03), 2 years (difference, 13.5%; CI, 0.9-26%, P ¼ 0.04) and 3 years (difference, 18%; CI, 7-28.9%; P < 0.001), and decreased the probability of no recurrence at 1 year (difference, 20.3%; CI, 7.7-33%; P ¼ 0.002), 2 years (difference, 35%; CI, 21.4-46.3%; P < 0.001) and 3 years (difference, 34.5%; CI, 18.7-50.3%; P < 0.001). Conclusion: Post-operative transarterial chemotherapy improved survival and decreased the cumulative probability of no recurrence. New randomized controlled trials evaluating this modality are required.

According to the results, the few contraindications of the procedure and its low cost, we confirm that MDS is still the first choice procedure to diagnose lesions located in the axial mediastinum.

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The purpose of this study was to evaluate the results of percutaneous transhepatic management (PTM) of anastomotic biliary strictures (BS). Among 168 liver transplant adult recipients, BS was identified in 30 patients. In 6 patients, narrowing of the anastomosis was found early, and in all cases disappeared spontaneously with prolonged draining of the bile tube. Within a mean time of 14 months after transplantation, 24 patients had symptomatic BSs, revealed by cholestasis (n ‫؍‬ 17) or cholangitis (n ‫؍‬ 7). Twenty-two patients underwent PTM as first treatment of BS (balloon dilatation or stent placement). We evaluated the primary and secondary patency rate of PTM. In 1 patient, PTM failed because the stricture could not be passed with the guide wire, necessitating conversion to a Roux-en-Y choledochojejunostomy (CDJ). Fourteen patients were treated by percutaneous balloon dilatation from which 8 patients (57.2%) were recurrence-free with a mean follow-up of 61 months. One patient with a patent biliary anastomosis underwent retransplantation for acute rejection. Twelve patients received metallic expandable stent placement as their primary treatment (n ‫؍‬ 7) or after failure of balloon dilatation (n ‫؍‬ 5). Recurrent stricture was found in 7 cases (58%) and was treated by PTM (n ‫؍‬ 6) or surgery (n ‫؍‬ 1). The primary patency rate for PTM was 58.8% at 12 months and the secondary patency rate 88.4%, with a mean follow-up of 47 months (median: 44 months). The mortality rate was 3.5% (one death). PTM with balloon dilatation, stent placement, or both, represent a safe method to treat anastomotic BSs after orthotopic liver transplantation (OLT) resulting in a secondary patency rate of 88% at 5 years. (Liver Transpl 2003;9:394-400.) P reviously biliary complications after orthotopic liver transplantation (OLT) have been reported as a perioperative and a middle long-term event in 10% to 40% of patients 1-3 and even nowadays remain an important cause of morbidity after the surgical procedure. 4 Biliary strictures (BS) are reported to occur in 9% to 15% of adult OLT recipients with choledochojejunostomy (CDJ) or choledochocholedochostomy (CDC) and are frequently localized at the anastomosis. 2,5-7 BSs appear also to be a problem in living related liver transplantation. [8][9][10] However, the management of these BSs remains controversial. In a recent survey, 22% of transplant centers in United States reported the use of percutaneous transhepatic management (PTM), whereas 29% chose reoperation and 45% used endoscopic retrograde cholangiography (ERCP). 11 Considering the potential risks of surgical reintervention, we decided in 1990 to treat BSs with PTM as a first approach. The objectives of this retrospective study were to evaluate the longterm outcome and results of systematic PTM for anastomotic BS after OLT. Patients and MethodsBetween July, 1987 and December, 2000, 216 consecutive OLT were performed in our center. To evaluate the middleand long-term outcome of BS, 168 adult patients (85 male and 83 female, age 15 t...