Obtaining the basic statistical data on cancer diseases is essential to plan cancer research and to determine the proper tools to use for diagnosing and treating cancer. By using the national wide cancer registry, more accurate data has been collected and more informative cancer-related statistical data can be calculated such as the occurrence rate, the death rate, the survival rate and so on. In Korea, the primary liver cancer registry has been active since 2003, and the clinical data from 10,886 patients has been collected. Unfortunately there are time and security limitations for recording and sharing this data and so a more convenient system is required. Therefore, we have revised the original primary hepatoma cancer registry to give a summary of research itself and an analysis of patients' data for the government's national wide evaluation and management of primary hepatoma.

Acute liver failure (ALF) is sometimes termed fulminant hepatic failure, and this is characterized by rapid deterioration of the liver function, which results in altered mentation and coagulopathy in previously normal individuals. Hepatitis B virus (HBV) infection is the most frequent cause of ALF worldwide. It has been reported that fulminant hepatitis B occurs in approximately 1% of the patients with acute HBV infection and it carries a mortality rate of up to 80% if the patient can not undergo liver transplantation (LT). Since Korea is an HBV-endemic area and most infections occur in infancy or early childhood, chronic HBV infection occupies a large portion of LT. Although ALF due to acute HBV infection is rare in Korea, there is no data on the national incidence of HBV-associated ALF. A single-center report shows that the incidence of HBV-related ALF is decreasing; 71.4% in the 1980s, 30% in the 1990s and 15.8% in 20002. A relevant issue is whether a patient with HBV-associated liver failure and with no prior history of liver disease can enter KONOS status 1 registration. Another issue is how to discern ALF due to acute HBV infection from acute-or-chronic liver failure in hepatitis B patient. A national survey is required to reveal the incidence of HBV-associated ALF.

Hepatitis B virus (HBV)-induced FHF fulminant hepatic failure (FHF) has been a main indication for urgent liver transplantation (LT), and these patients with hepatitis B virus (HBV)-induced FHF have a UNOS status of I. However, HBV-associated FHF has been downgraded to status IIa since late 2007 to eliminate the possibility of confusion between FHF and subacute / acute-or-chronic liver failure. This current study evaluated the influence of this change of the UNOS status on organ allocation by using 4 sets of data (a single-institution study without LT cases, a single-institution study that included LT cases, a single-institution LT study and the nation-wide LT data). During the 12-year experience at Severance Hospital, HBV infection made up 30% of the 60 FHF patients. For the FHF patients, only 28.3% survived without LT. During the 6-year experience at Asan Medical Center, HBV infection made up 15.8% of the 114 FHF patients. Fifteen percent survived without LT, but 86% survived after LT. Only 1 out of the 14 cases of LT was deceased-donor LT. During the 2-year study on urgent LT at Asan Medical Center, there were 578 LT cases, including 520 living-donor LT and 58 deceased-donor LT. Of them, 120 patients (21.7%) had a UNOS status of I or IIa. The patients with HBV made up 17.8% of the status I patients and 80.3% of the status IIa patients. The one-year patient survival was 83.2% following living-donor LT and this was 71.1% following deceased-donor LT. For the nation-wide data for 8 years, 245 patients were allocated for a deceased-donor liver graft as status I (n=85) or IIa (n=160). Of them, 231 grafts were actually implanted. It was estimated that there is a 2.9-times difference in the probability for organ allocation between UNOS status I and IIa. In conclusion, down-grading of HBV-associated FHF from UNOS status I to status IIa would result in a significantly decreased probability to receive deceased-donor liver grafts. Therefore, it is concluded that such down-grading seems to involve unreasonable discrimination, leading to a disadvantage for patients with HBV-associated FHF. To avoid such dilemma for deceased organ allocation, Korea should consider adopting the model for end-stage liver disease (MELD).

Purpose: The aim of this study is to determine whether the serum apolipoprotein A1(apoA1) level, as measured at different time points after hepatectomy and liver transplantation, can predict the synthesis ability of the liver and the nutritional status. We also investigated the usefulness of regions of interest(ROIs) as an indicator of the recovery status of the liver after liver transplantation. Methods: 93 patients (21: laparoscopic cholecystectomy, 53: partial hepatectomy, 19: liver transplantation) were operated on under general anesthesia. The serum levels of apoA1, prealbumin, albumin, aspartate aminotransferase and alanine aminotransferase and the prothrombin time were measured at pre- and post-operation. The liver conditions were a normal liver (50 cases), hepatitis (16 cases) and liver cirrhosis (28 cases). The mean hepatic attenuation was calculated by averaging the ROI values that were obtained at different hepatic segments. Results: The serum apoA1 level was minimally changed during the perioperative period in the laparoscopic cholecystectomy group. Yet in most cases, the serum apoA1 level after partial hepatectomy and liver transplantation was decreased on postoperative days (PODs) 1 and 7, but it nearly recovered to the preoperative level on POD 30. There were significant differences in the values of apoA1 between the normal liver and co-existent liver disease at the various time points. The ROI value after transplantation gradually increased and it reached a normal level by POD 30. Conclusion: The serum apoA1 level can be an indicator of liver's ability to synthesize protein and the nutritional status after partial hepatectomy. In addition, ROIs of the unenhanced CT image can reflect the recovery status of the liver after transplantation.

Purpose: This study was designed to compare and analyze the complication rates of different anastomotic methods of pancreaticojejunostomy after performing pancreaticoduodenectomies by a single surgeon. Methods: From January 2000 to August 2007, 92 patients underwent pancreaticoduodenectomy at a single institution. According to the texture of the pancreas and pancreatic duct size (below or above 3 mm), the type of pancreaticojejunal anastomosis was selected (either duct-to-mucosa pancreaticojejunostomy or end-to-side pancreaticojejunostomy with polyethylene tube). Results: The pathologic diagnosis of the 92 patients included 81 patients with adenocarcinoma, five with chronic pancreatitis and three with GIST that developed in the duodenum. The adenocarcinomas include 33 distal CBD cancers, 18 pancreatic head cancers, 27 Ampulla of Vater cancers and 6 duodenal cancers. The pancreatic fistula rate was not significantly different between the duct-to-mucosa group and the end-to-side pancreaticojejunostomy group (nine of the 43 patients in the duct-to-mucosa group (20.9%) and six of the 46 patients in the tube insertion group (13.0%) (p=0.4). The rate of pancreatic fistula, as classified by three different consecutive periods (period I: 2000-2003; period II: 2004-2005; period III: 2006-2007), was markedly decreased and there were less complications with increasing experience (period I: 33.3%; II: 7.1%; III: 6.4%) (p=0.001). Conclusion: When performing pancreaticojejunostomy, both the duct-to-mucosa method and the tube insertion method were effective in decreasing the complication rate if the appropriate method was selected according to the texture of the pancreas and the size of pancreatic duct. The surgeon's experience and skill can affect the occurrence of pancreatic fistula after pancreaticojejunostomy. Enough experience is the most important factor to decrease the complication rate after pancreaticoduodenectomy.

Introduction: The prognosis of peri-ampullary cancer is poor because of its low respectability and high recurrence rate. Yet cancer of the Ampulla of Vater(AOV) has a relatively good prognosis. The aim of this study is to investigate the outcomes and to determine the factors that affect the survival rate of patients who underwent curative resection for AOV cancer. Methods: From August 1988 to January 2008, 54 patients underwent curative resection for AOV cancer. We retrospectively reviewed the clinocopathologic data. The median follow up period was 45 months. Results: Twenty-seven pancreaticoduodenectomies (PD) and 27 pyrolus-preserving pancreaticoduodenectomies (PPPD) were performed. There was no hospital mortality, but 25 out of 54 patients (47.3%) experienced postoperative complications. The 5-year overall survival (OS) rate was 53.97% and the 5-year disease free survival (DFS) rate was 51.75%. On multivariate analysis, the variables that affected the overall survival rate and the disease free survival rate was poor histologic differentiation (p<0.001). Conclusions: Although the AOV cancer is one of the periampullary cancers that have a very poor outcome, long-term survival and favorable outcomes can be achieved after a curative resection. In this study, poor-histologic differentiation was the only independent factor for a poor prognosis.

Acinar cell carcinoma (ACC) is a very rare type of pancreatic cancer that makes up less than 1% of all pancreatic cancers. The prognosis of ACC is very poor and the mean survival interval is only 18-19 months. The only effective treatment is currently early radical resection. Materials and methods: To determine ACC's clinical characteristics and the treatment efficacy, we conducted a retrospective chart review to study the clinical characteristics, laboratory findings, pathology and treatment responses of 10 ACC patients among 3042 pancreatic cancer patients who were diagnosed in Severance Hospital and Kangnam Severance Hospital of Yonsei University, College of Medicine from 1988.01.01 to 2008.12.31. Results: The 10 ACC patients were 6 males and 4 females. The mean age of the 10 ACC patients was 53.2 years. The most of the patients (7/10) complained the pain on the epigastric area and there was no jaundice in 8 patients (80%). Unfortunately, regional or distant metastases were founded in 8 patients (80%) at the time of the first diagnosis. The initial mean CA19-9 level was increased to 73.5 U/ml (range: 0.1~350.0 U/ml). Six of 10 patients underwent radical surgery and 4 of 10, including 1 with open and closure, were treated with conservative treatment. The median survival interval was 22.4 months with operative treatment and 1.5 months with conservative treatment. The median overall survival interval was 19.4 months. The median disease free survival was 17 months. The liver was the most common recurrent site (3 cases). Conclusions: An early radical resection is currently the best and only treatment for ACC, but in rare cases, post-operative adjuvant chemotherapy shows hopeful results and so this requires more study.

Paraganglioma is an unusual neoplasm that is embryologically derived from neural crest cells. The most common location of this neoplasm is the adrenal medulla, where these tumors are known as pheochromocytoma. It is extremely rare that paragangliomas occur in the liver. There are only 7 reports of primary hepatic paraganglioma. A 56-year-old man was referred to XX Medical Center. Hypertension was not found. He had suffered from jaundice, headache and weight loss for the 4 previous weeks, but hypertension was not present. The total bilirubin was 7.7 mg/dl and the CA19-9 level was 56.3 U/dl. The tumor was diagnosed as intrahepatic cholangiocarcinoma on the computed tomography image. After biliary drainage via endoscopic nasobiliary drainage, surgical exploration was carried out; right trisectionectomy with caudate lobectomy, portal vein resection and anastomosis were then done. The final pathological diagnosis was primary hepatic malignant paraganglioma of the intrahepatic duct. There has been no evidence of recurrence on the follow up CT images during the 24 month follow up period.