1,721,664 research outputs found
Merging epidemiological changes and surveillance data to optimize management of hepatocellular carcinoma
No full textComment on Changing aetiological factors of hepatocellular carcinoma and their potential impact on the effectiveness of surveillance
Impact of severe infections on the outcome of major liver surgery: a pathophysiologic and clinical analysis.
No full textI.F.= 1.088
Although major progress has been achieved, particularly in the field of patient selection and postoperative intensive care, morbidity and mortality rates after major liver surgery are still significant. In fact, the mortality rate in major series reaches 30% of patients undergoing complex liver procedures, mostly related to postoperative septic events. Among these, although extra-abdominal infectious localizations are also frequently reported, intra-abdominal sepsis and abscess formation are probably the most frequent infective clinical presentations. The literature reports that the magnitude of the resection and duration of surgery are associated with a significantly higher postoperative morbidity and mortality rate. Severe postoperative infectious events cause a high proportion of this morbidity and in the presence of a septic evolution of the clinical picture the mortality rises dramatically. Such a tight association between severe infections and mortality after major hepatic surgery gives account to the fundamental role played by the liver in the metabolic homeostasis of the patient and also to the central hepatic function in the immune response to microorganisms of gastroenteric origin. After major liver surgery these central hepatic functions may by significantly impaired, thus leading to higher susceptibility to infections, in particular in the elderly. On these bases the improvement in prophylaxis protocols, in the early diagnosis and in the treatment of these postoperative infectious events can help optimize clinical results after major hepatic surgery
Biological downstaging of intermediate hepatocellular carcinoma in patients treated with sorafenib
No full textRole of temporary portosystemic surgical shunt during liver resection to prevent a post-resection small for size-like syndrome
Full text linkLiver resection stands as the gold-standard therapeutic approach for selected cases of hepatocellular carcinoma (HCC). The extent of resectable parenchyma hinges upon the underlying liver function and its regenerative potential. Consequently, cirrhosis may impede access to potentially curative interventions for HCC arising within this context. Cirrhotic patients undergoing liver resection face heightened susceptibility to post-hepatectomy liver failure (PHLF). The clinical profile of PHLF bears a resemblance to a well-documented syndrome within the liver transplant (LT) domain: Small-for-size syndrome (SFSS), a form of graft failure observed in the postoperative phase following LT with undersized or partial organs. Management of SFSS targets mitigating the overflow syndrome, achievable through diverse portal diversion techniques. Portal vein flow diversion encompasses procedures redirecting a variable proportion of portal vein flow towards systemic circulation. Consequently, derivative procedures aim to directly alleviate portal hypertension. Side-to-side portocaval shunts emerge as the most straightforward and efficacious means of decompressing the portal system. Furthermore, they afford flow calibration to diminish the incidence and severity of steal syndrome and hepatic encephalopathy, without compromising efficacy or hepatic function. Translating insights gleaned from LT complexities involving SFSS to liver resection, strategies involving portal flow diversion warrant consideration in efforts to forestall PHLF. This approach aims to extend the frontiers of liver surgery, broadening access to hepatectomy with curative intent, either as a standalone intervention or as part of a comprehensive treatment regimen where LT serves as a secondary option
Neurocognitive-neurological complications of liver transplantation: a review
No full textNeurological complications are common after liver transplantation (LT) and they are associated with a significant morbidity. Long-term effects of LT on cognitive and psychological outcomes are not clear. The objective of this study was to summarize the present knowledge on the neurological and cognitive complications of LT, resulting from a systematic review of the literature in the last 10 years. Several studies have investigated the incidence and the pathophysiology of neurological complications; in contrast, the knowledge of cognitive and psychological status after LT is poor. Currently, the effect of LT on mental performance is debated. Some studies have shown an improvement of cognitive function after OLTX and, at the same time, a persistence of different cognitive deficits. In addition, the quality of life (QoL) and the psychological status after LT seem to improve but LT recipients have significant deficiencies in most QoL domains. Consequently, future studies are necessary in order to investigate cognitive alterations and QoL in LT recipients
Massive Carbon Dioxide Embolism During Laparoscopic Liver Resection: A Case Report
Full text linkCarbon dioxide embolism during laparoscopic surgery is a serious and life-threatening complication. The overall incidence of embolism during laparoscopic surgery is low (0.15%). Although the potential fatal consequences of this complication are reported in literature, a well-documented report of the effect of massive CO2 embolism during laparoscopic liver resection on cardiovascular, respiratory and encephalographic parameters does not exist. The authors describe a well-documented case of massive carbon dioxide embolism during laparoscopic liver resection suspected by both hemodynamic instability and elevation of EtCO2 and confirmed by arterial blood gas. The surgeon's rapid closure of the vascular breach resulted in an overall improvement of the patient's vital signs without further consequences. Our case report shows the cardiovascular, respiratory and encephalographic effects of a massive carbon dioxide embolism and highlights the importance of a strict cooperation between the surgeon and the anesthesiologist and the importance for a prompt treatment when massive carbon dioxide embolism occurs
Liver transplantation for hepatocellular carcinoma: Are the Milan criteria still valid?
No full textAbstract: Liver transplantation (LT) offers excellent results for candidates with hepatocellular carcinoma (HCC) selected according to the Milan criteria. A selection strategy exclusively based on the Milan criteria, however, maintains a dangerous risk of prognostic inaccuracy due to the intrinsic diagnostic limitations of imaging procedures and to the surrogate nature of size and number of tumors with respect to more direct markers of biological aggressiveness like tumor grade, and vascular invasion. Moreover, the use of Milan criteria as dropout criteria seems to overestimate the risk of tumor biological progression before LT.
The basis for allocation of donor liver to patients with HCC will undoubtedly evolve over coming years beyond the simple across-the-board application of Milan criteria taking into account the following key concepts: (1) a reliable prognostic staging system for HCC will help to optimize allocation of the various therapeutic alternatives to HCC patients; (2) new molecular biomarkers may improve the prognostic accuracy of selection criteria for LT; (3) aggressive multimodality nectadjuvant therapy can downstage HCC and limit tumor progression before LT, and treatment response may inform about tumor biology; and (4) Prioritization of HCC patients for LT should take into account not only tumor characteristics, but also response to nectadjuvant therapy, time on the waiting list, and the suitability of alternative donor sources including split/living donor LT, and marginal livers. (c) 2007 Published by Elsevier Ltd
NAFLD: a multi-faceted morbid spectrum with uncertain diagnosis and complicated management
No full textNon-alcoholic steatohepatitis (NASH) can be considered the pandemic of these times, because of its global diffusion alongside obesity, diabetes, and metabolic dysfunction. It is a disease that often poses many difficulties, since making an early diagnosis is often impossible since specific diagnostic tests and criteria are missing: so, it needs a high degree of suspicion. Most of the times the evolution to its more severe and terminal step, NASH cirrhosis, is unavoidable and so are the social pressure on health system and economic consequences it brings back. The aim of this article is to provide a review of the literature about both non-alcoholic fatty liver disease (NAFLD) and NASH, thus structuring a wide, comprehensive, 360-degree work with a focus on all major aspects of NAFLD, spanning from diagnosis, physiopathology and its repercussions on liver transplantation. Moreover, we also focus on patients related issues both in pre-and post-transplant management (when these patients are listed for liver transplant). NAFLD and NASH are a contemporary plague, and an exhaustive knowledge of the problem throughout all its aspects is necessary in order to lower economic weight that metabolic issues bring back and to have an open view to possible solutions to all management issues that NASH patients have and that are often prohibitive to a definitive cure (for example cardiovascular risk in patients otherwise eligible to liver transplantation). We aim to offer a complete view on the actual knowledge about NAFLD and NASH, by an extensive review of the literature. (Cite this article as: Di Renzo C, Vitale A, D'Amico F, Cillo U. NAFLD: a multi-faceted morbid spectrum with uncertain diagnosis and complicated management. Minerva Surg 2021;76:450-66. DOI: 10.23736/S2724-5691.21.08729-0
A NEW ALLOCATION MODEL FOR LIVER TRANSPLANTATION COMBINING URGENCY BASED PRIORITIZATION WITH DONOR-RECIPIENT MATCHING: A PROSPECTIVE CONTROLLED STUDY
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