br Treatment Although complete surgical resection

Treatment Although complete surgical resection provides the best outcome and is the ultimate goal of therapy, the addition of chemotherapy has changed treatment from surgery alone to a multimodal approach. Chemotherapy alone, and later with a good surgical technique, has improved survival in patients who in the past had unresectable or metastatic disease by reducing the tumor size and permitting complete tumor resection or transplantation. Our own data (part of the data published) showed that the 3-year survival rate for HB increased from zero to 55% and 91% for the periods 1978–1990, 1991–2001, and 2002–2010, respectively. The recommended algorithm in the management of HB, utilizing a combination of conventional resection, chemotherapy, and transplantation proposed by Tiao et al. However, there are several questionable points in this algorithm. First, what is the definition of a so-called resectable tumor? Second, is getting tissue proof necessary for an unresectable tumor before chemotherapy? Third, is chemotherapy better for difficult but resectable tumors before resection? Fourth, should more cycles of chemotherapy given if the tumor is still considered unresectable after four cycles of chemotherapy? Last, is it gingerol necessary to give two more cycles of chemotherapy after liver transplantation? As to the first controversial point, PRETEXT Stage I tumors are resectable for most surgeons, but resection of Stage II is dependent on the surgeon\'s ability. A unifocal, centrally located tumor in Stage II involving the main hilar structures should be considered unresectable. For Stage III/IV disease, chemotherapy is always recommended prior to any trial of resection. Although complete resection is still possible after chemotherapy if the tumor remains in Stage III/IV, this depends on the surgeon\'s ability, and liver transplantation is recommended for an unresectable Stage III/IV tumor because the outcome of rescue liver transplantation is poor. As for the third point, although some surgeons favor chemotherapy prior to resection even if the tumor is resectable, our personal experience leads us to prefer Tiao et al\'s protocol, although resectability should be very clear. Heroic attempts at partial hepatectomy are discouraged because chemotherapy is effective for downstaging most HBs. For the final point, most transplant surgeons prefer post-transplant chemotherapy, and, in general, this has been tolerated well in most post-transplant patients, although the benefit has not yet been proven, and post-transplant chemotherapy should be tailored to the individual child. Persistence of viable extrahepatic deposits after chemotherapy that are not amenable to surgical resection is the only absolute contraindication for liver transplantation. Macroscopic venous invasion (portal vein, hepatic vein, and vena cava) is not a contraindication if en bloc complete resection can be performed. Patients with incomplete tumor resection after partial hepatectomy or intrahepatic relapse can have so-called rescue liver transplantation, but the survival rate is much lower than in primary liver transplantation. Patients with lung metastasis at presentation should not be excluded from liver transplantation if it clears completely after chemotherapy. Complete eradication of metastatic lesions by chemotherapy and surgical resection of any suspicious remnant is a paramount prerequisite for transplantation.
Introduction Anterior cervical discectomy and fusion (ACDF) has become a common operative procedure for degenerative disc disease and cervical spondylosis associated with radiculopathy or myelopathy. The technique, which uses an anterior iliac bone graft for an anterior interbody fusion, has been the gold standard, with high success rates. However, the harvest of autogenous grafts from the iliac crest is associated with donor-site complications, including persistent donor-site pain, infection, hematoma formation, and iliac crest fractures. Therefore, several graft substitutes, including xenografts, allografts, and artificial bone substitutes, have been developed to overcome these problems.