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Abstract Background Data: Hepatic resection of a large HCC represents a surgical challenge. In patients with large HCC in the right liver, the conventional technique for hepatectomy, i.e., mobilization of the right liver from the retro peritoneum and anterior surface of the inferior vena cava may be difficult because of the tumor volume and local adhesions. Likewise, even if the mobilization can be accomplished, the forceful manipulation of the liver can result in tumor rupture and dissemination of malignant disease. Objective: To report the efficacy of using the anterior approach versus the conventional approach, in surgical resection for large hepatocellular carcinoma (HCC) in terms of surgical and long-term outcomes. Methods: Between 2000 and 2006, 126 consecutive patients who underwent hepatic resection with curative intent for large right HCC ≥7 cm were identified from a prospective database. The 36 patients who had anterior approach were compared with the remaining 90 patients who had conventional approach .Clinicopathological features and surgical results were analyzed and prognostic factors were evaluated by multivariate analysis. Results: There was no significant difference between the 2 groups as regard clinical, laboratory and pathological parameters. The operative results had shown a comparable proportion of patients experienced massive operative blood loss and postoperative complications in the 2 groups. The AA group had a lower recurrence rate (P = 0•015), better disease-free survival (DFS) (P = 0•001) and overall survival than the CA group. Our study identified that AA is prognostic factor of both overall survival and disease-free survival for large HCC ≥7cm. Conclusion: The anterior approach is a safe and effective technique for right hepatic resection for large HCC and achieves more advantageous long survival outcome over the conventional approach.

Abstract Background Data: Hepatic resection of a large HCC represents a surgical challenge. In patients with large HCC in the right liver, the conventional technique for hepatectomy, i.e., mobilization of the right liver from the retro peritoneum and anterior surface of the inferior vena cava may be difficult because of the tumor volume and local adhesions. Likewise, even if the mobilization can be accomplished, the forceful manipulation of the liver can result in tumor rupture and dissemination of malignant disease. Objective: To report the efficacy of using the anterior approach versus the conventional approach, in surgical resection for large hepatocellular carcinoma (HCC) in terms of surgical and long-term outcomes. Methods: Between 2000 and 2006, 126 consecutive patients who underwent hepatic resection with curative intent for large right HCC ≥7 cm were identified from a prospective database. The 36 patients who had anterior approach were compared with the remaining 90 patients who had conventional approach .Clinicopathological features and surgical results were analyzed and prognostic factors were evaluated by multivariate analysis. Results: There was no significant difference between the 2 groups as regard clinical, laboratory and pathological parameters. The operative results had shown a comparable proportion of patients experienced massive operative blood loss and postoperative complications in the 2 groups. The AA group had a lower recurrence rate (P = 0•015), better disease-free survival (DFS) (P = 0•001) and overall survival than the CA group. Our study identified that AA is prognostic factor of both overall survival and disease-free survival for large HCC ≥7cm. Conclusion: The anterior approach is a safe and effective technique for right hepatic resection for large HCC and achieves more advantageous long survival outcome over the conventional approach.

Abstract Background: Hodgkin's lymphoma (HL) is a highly curable malignant disease. Risk-adapted therapy for children with HL is directed toward high survival, minimal toxicity and optimal quality of life. Objectives: To assess the outcome of the HL patients treated with risk-adapted therapy approach at pediatric oncology department in South Egypt Cancer Institute and to assess the prognostic factors of survival in pediatric HL patients. Methods: This prospective study was carried out from January 2009 to January 2014, with median follow up of 36.5 months (range 8-58 months). Thirty four patients were eligible for this study stratified into three risk groups: low risk (LR), intermediate risk (IMR) and high risk (HR). Patients treated with two, four and six cycles respectively of alternating ABVD/COEP chemotherapy followed by involved-field radiation therapy (IFRT): 15 Gy for patients achieved complete response, and 25.5 Gy for those achieved partial response. Results: Six patients were LR, 18 patients were IMR and 10 patients were HR. Six patients had events, progressive disease in 3 patients, relapse in 2 patients, death in one patient due to fever neutropenia. The 3-years overall survival (OS) and event free survival (EFS) rates (± SE) were 91.2% ± 5.3% and 82.3% ± 7.3% respectively. Multivariate analysis revealed "B" symptoms and anemia were the significant independent factors for inferior EFS, however, hypoalbuminemia and anemia were the significant independent factor for lower OS. Conclusion: Risk-adapted combined-modality therapy with ABVD/COEP and involved-field radiation therapy has high efficacy and minimal toxicity in the treatment of pediatric HL.

Abstract Background: Hodgkin's lymphoma (HL) is a highly curable malignant disease. Risk-adapted therapy for children with HL is directed toward high survival, minimal toxicity and optimal quality of life. Objectives: To assess the outcome of the HL patients treated with risk-adapted therapy approach at pediatric oncology department in South Egypt Cancer Institute and to assess the prognostic factors of survival in pediatric HL patients. Methods: This prospective study was carried out from January 2009 to January 2014, with median follow up of 36.5 months (range 8-58 months). Thirty four patients were eligible for this study stratified into three risk groups: low risk (LR), intermediate risk (IMR) and high risk (HR). Patients treated with two, four and six cycles respectively of alternating ABVD/COEP chemotherapy followed by involved-field radiation therapy (IFRT): 15 Gy for patients achieved complete response, and 25.5 Gy for those achieved partial response. Results: Six patients were LR, 18 patients were IMR and 10 patients were HR. Six patients had events, progressive disease in 3 patients, relapse in 2 patients, death in one patient due to fever neutropenia. The 3-years overall survival (OS) and event free survival (EFS) rates (± SE) were 91.2% ± 5.3% and 82.3% ± 7.3% respectively. Multivariate analysis revealed "B" symptoms and anemia were the significant independent factors for inferior EFS, however, hypoalbuminemia and anemia were the significant independent factor for lower OS. Conclusion: Risk-adapted combined-modality therapy with ABVD/COEP and involved-field radiation therapy has high efficacy and minimal toxicity in the treatment of pediatric HL.

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