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ASO Author Reflections: Hypertrophic Techniques Have an Impact on the Complexity and Outcomes of Minimally Invasive Major Hepatectomies
No full textLong term central venous access in oncology: Who, why, when?
No full textLong Term Central Venous Catheters (LTCVC) are widely used for administration of chemotherapy, blood products, parenteral nutrition, analgesics, antibiotics. Nevertheless, indications for the placement of LTCVC are not well defined in cancer patients and specific guidelines are still missing, so that the need for placement of an LTCVC is often based on the lack of alternative routes for intravenous treatments secondary to the severe loss of peripheral veins by recurrent and/or prolonged infusion of toxic drugs, such as chemotherapy and parenteral nutrition. This approach is the main factor behind several local complications (phlebitis, extravasation of drugs with ulcers or necrosis, pain) as well as an unacceptable delay in the chemotherapy schedule. The need for an LTCVC has to be considered during the first patient assessment while defining the plan of therapy and placement has to be planned prior to therapy administration. The pre-therapy placement of LTCVC is mandatory if one of the following criteria is present: low availability of peripheral venous accesses, schedules of chemotherapy by continuous infusion or by bolus with vesicant drugs with possible local toxicity with or without extravasation, high-dose chemotherapy, multiple infusion requirements (i.e. chemotherapy plus high volumes of intravenous fluids plus blood products), total parenteral nutrition. Pre-therapy placement of LTCVC is suggested for adjuvant chemotherapy in patients at high risk for early tumour recurrence, low patient compliance to multiple venipunctures, domiciliary treatment. In all other conditions, pre-therapy placement of LTCVC is not indicated but infusion routes should be carefully evaluated during the course of therapy so that the need for an LTCVC may be detected before treatment has to be interrupted for lack of vascular access
Authors' reply: A risk score for predicting perioperative blood transfusion in liver surgery
No full textThe current role of laparoscopic liver resection for the treatment of liver tumors
No full textLaparoscopic liver resection (LLR) represents a natural extension of minimally invasive surgery. Several case-control studies have demonstrated that LLR is safe and feasible in carefully selected patients. LLR is associated with reduced operative blood loss and earlier recovery when compared with open surgery. In addition, oncologic clearance achieved with LLR is comparable to that achieved with open surgery. Improved cosmesis and postoperative patient comfort also argue in favor of LLR compared with open surgery. When considering whether a patient is suitable for LLR, the size and location of the neoplasm must be taken into account. Operator experience must also be considered as LLR is technically demanding and requires experience in conventional hepatobiliary surgery and advanced laparoscopy. The main indication for LLR is limited resection of superficial or peripherally located tumors. In the case of malignant tumors, LLR should be indicated only if a safe and effective oncologic resection can be performed, and the availability of laparoscopy should not change the indications for benign lesions. Ultimately, the future application of LLR will depend on how easily liver surgeons can master the technique and whether the long-term results of LLR can match those achieved with open resection
ElettroChimioTerapia (ECT) sec. Nordenstroem nelle neoplasie pancreatiche: tecnica per l'applicazione perioperatoria
No full textPortal vein graft rectal evacuation after Whipple procedure. The Fabrizio's disease
No full textIn selected cases, pancreatic resections may be performed ''en bloc'' with arterial and/or venous segments, which have to be replaced with autologous or synthetic grafts. Rectal evacuation of portal vein graft following a Whipple procedure is described, being a late graft infection supposed to underlie this event. Portal vein graft rectal evacuation has not previously been reported in the literature and it is worth keeping if in consideration when performing a regional pancreatectomy
Effects of adjuvant therapy on the outcomes of surgical management of extrahepatic billary atresia
No full textUnexpected Findings After Hypertrophic Techniques for Major Minimally Invasive Hepatectomies: Intraoperative Pitfalls and Management Strategies
No full textLaparoscopic hepatic left lateral sectionectomy using the LaparoEndoscopic Single Site approach: evolution of minimally invasive liver surgery
No full textLaparoscopic liver surgery is attracting wider interest for the treatment of benign and malignant neoplasms. Laparoscopy is a safe and feasible approach for lesions located in the left liver lobe. As the emphasis on minimizing the technique continues, single-port access surgery is quickly evolving. We present our initial experience of single-port laparoscopic liver surgery using a LaparoEndoscopic Single Site (LESS) approach with the TriPort System (ASC; Advanced Surgical Concepts, Bray, Ireland) to perform a left lateral sectionectomy via a single supraumbilical incision. The abdomen was approached through a 15 mm supraumbilical incision and a single-port access device was used to perform a left lateral sectionectomy in a patient with a single colorectal metastasis. The total operative time was 145 min, with 50 ml blood loss. Hospital stay was 4 days. Single-port laparoscopic left lateral sectionectomy is a feasible procedure, when performed by experienced laparoscopic surgeons. It has to be determined whether or not this approach would offer benefit to patients, except in terms of cosmesis, compared to standard laparoscopic liver resection
ASO Author Reflections: Minimally Invasive Approach and Oncologic Benefit in Intrahepatic Cholangiocarcinoma (iCCA) With Risk of Very Early Recurrence: Is it Time to Consider Technique as a Key Element of Onco-Surgical Strategy?
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