1,720,999 research outputs found
Salvage hepatic resection after incomplete interstitial therapy for primary and secondary liver tumours
No full textBACKGROUND: When the response to percutaneous ablation therapy (PAT) of liver tumours is incomplete, surgery may be undertaken as a salvage therapy. To validate the safety and effectiveness of salvage hepatectomy, patients who had undergone PAT or no treatment before hepatectomy were compared. METHODS:: Of 137 patients who had hepatectomy for primary and secondary tumours, 21 had undergone PAT and 116 had surgery as primary treatment. Tumour features and the incidence of liver cirrhosis were similar in the two groups. RESULTS:: Peroperative mortality and major morbidity rates were zero and 5 per cent (one of 21) respectively among patients who had PAT before surgery, and 0.9 per cent (one of 116) and zero in those who did not. Duration of operation (mean 495 versus 336 min; P < 0.001), clamping time (mean 81 versus 53 min; P < 0.001), blood loss (mean 519 versus 286 ml; P = 0.004), need for blood transfusion (six of 21 patients versus nine of 116; P = 0.001), and rates of thoracophrenolaparotomy (eight of 21 versus 14 of 116; P < 0.001) and resection of other tissues (six of 21 versus nine of 116; P < 0.001) were significantly higher in the PAT group. CONCLUSION:: Hepatectomy after incomplete PAT is safe and effective, but more extensive procedures are necessary. The effect of salvage hepatectomy on long-term outcome is still unclear
Surgical strategy for liver tumors located at the hepato-caval confluence
No full textLiver tumors involving hepatic vein (HV) at caval confluence have been always considered an indication for major hepatectomy and/or HV reconstruction.
However; careful study by means of intraoperative ultrasonography (IOUS) of tumor-vein relations and HV anatomy searching for accessory veins, together with color-Doppler IOUS analysis of portal flow, allows more conservative approaches
also in these patients. Indeed, in our experience, only 12% of patients, who were operated because of liver tumors in contact or in close adjacency with one or more HVs, underwent removal of at least 3 segments: none of them required HV reconstruction, and no hospital mortality was seen. Therefore, IOUS allows
sparing liver parenchyma without tumor recurrence in most patients with tumors involving HV at their caval confluence, avoiding more extended hepatectomies or HV reconstructions. This approach to complex presentations of liver tumors by the use of IOUS-guidance is a further confirmation of the importance of this tool for accomplishing a safe and effective surgical treatment
Bilirubin level fluctuation in drain discharge after hepatectomies justifies long-term drain maintenance
No full textBackground/Aims: Need for abdominal drains after liver resection is debated. However, unrecognized bile leak is relatively frequent: to prevent bile collection we adopted the use of long-term drains. The aim of this study was to validate this policy checking the bilirubin concentration in the drain discharge and serum along the postoperative course. Methodology: A prospective cohort study enrolling 58 consecutive patients with liver tumors was carried out. All patients underwent liver resection and received abdominal drains which were maintained for at least 7 days postoperatively. The bilirubin concentration in serum and drain discharge was sampled on the 3rd, 5th and 7th postoperative days. Results: No postoperative mortality and major morbidity were observed. The bilirubin level in drain discharge was higher on the 5th postoperative day than on the 3rd and 7th postoperative days: difference between the 3rd and 5th postoperative days was significant. No differences were observed among serum bilirubin levels on 3rd, 5th and 7th postoperative days. Conclusions: The bilirubin level in drain discharge increases late in the postoperative course. Therefore, bile leakage should be evaluated between the 5th and 7th postoperative days. The use of long-term drains helps protect against undiscovered collections and thus impacts postoperative course. (copyright) H.G.E. Update Medical Publishing S.A
New technique for defining the right anterior section intraoperatively using ultrasound-guided finger counter-compression
No full textAnatomical segmental and subsegmental resection of the liver for hepatocellular carcinoma: a new approach by means of ultrasound-guided vessel compression
No full textBackground: Anatomic resection is considered the gold standard approach for liver resection in patients with hepatocellular carcinoma. The use of intraoperative ultrasound (IOUS) as guidance is indispensable in this sense but methods available up to now were rather complex and for that reason of limited use. We herein describe a novel technique for the demarcation of the resection area by means of IOUS-guided finger compression to systematically accomplish anatomic segmental and subsegmental resections. Methods: Thirty-three patients met the eligibility criteria. This technique consisted in the demarcation of the resection area by IOUS-guided finger compression of the vascular pedicle feeding the tumor at the level closest to the tumor but oncologically suitable. Median age was 65 years (range, 36-81). There were 25 men and 8 women. Median tumor number was 1 (range, 1-2); median tumor size was 2 cm (range, 1-10). Twenty-five (76%) patients had cirrhosis or chronic hepatitis, and 8 (24%) had steatosis (ClinicalTrials.Gov ID: NCT00829335). Results: Procedure resulted feasible in all eligible patients, and demarcation area was obtained in all patients within 1 minute of bimanual IOUS-guided compression. There was no mortality or major morbidity: only 7 (21%) patients experienced minor morbidity. No blood transfusions were administered. Conclusions: Systematic segmentectomy and subsegmentectomy by IOUS-guided finger compression is a feasible, safe, and effective technique, which could be considered as a simpler alternative to those up to now proposed. Copyrigh
Back-flow bleeding control during resection of right-sided liver tumors by means of ultrasound-guided finger compression of the right hepatic vein at its caval confluence
No full textBackground/Aims: Limiting the backflow bleeding from the hepatic veins is a priority in liver resections. We describe an ultrasound-guided technique for backflow bleeding control from the right hepatic vein (RHV) during right-sided Ever resection.
Methodology: Right surface of the extrahepatic RHV is exposed to allow its compression by surgeon's finger-tips: the effectiveness of finger compression is checked by color-Doppler intraoperative ultrasonography.
Results: This technique was adopted in 47 consecutive patients with tumors located in the right segments and not infiltrating the RHV close to its caval confluence. There was no hospital mortality or major morbidity. Mean blood loss was 310mL, and 4 patients required blood transfusion. The maneuver here described was used 2.3 times per patients, and taping of the RHV was never needed.
Conclusions: The technique here described allows easy and safe control of the RH-V patency without its skeletonization and encirclement
Technical tricks for radical but conservative liver resection. The ultrasound guidance
No full textRate of major resection is still high in most surgical institutions due to fear of incomplete tumor removal: this is in spite mortality and major morbidity of major hepatectomies, particularly in cirrhotic are still not negligible. Intraoperative ultrasonography (IOUS), when used not only for tumor staging but also for resection guidance, minimises the rate of major hepatectomies maintaining treatment radicality. Maintaining this policy, the rate of major resection in our experience is 15% if major hepatectomy is classified as removal of at least 1 sector or 2 adjacent segments, and 5% if we consider major resections only those which include at least 3 segments. This policy has allowed us a safe surgical approach with no mortality and minimal major morbidity and effective local treatment with no tumor relapses at the site of the resection after a mean follow-up of 18 months. Tricks for safe and radical IOUS-guided liver resections are here discussed
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