1,721,065 research outputs found
Portal vein embolization and cholangiocarcinoma
No full textPreoperative portal vein embolization (PVE) is increasingly used to optimize the volume and function of the future liver remnant (FLR) and to reduce the risk for complications after major hepatectomy for cholangiocarcinoma. In patients with hilarcholangiocarcinoma who are candidates for extended hepatectomy, careful preoperative preparation using biliary drainage, FLRvolumetry, and PVE optimizes the volume and function of the FLR prior to surgery. Appropriate use of PVE has led to improved postoperative outcomes after major hepatectomy for cholangiocarcinoma and oncological outcomes similar to those in patients who undergo resection without PVE. FLRvolumetry is necessary for proper selection of patients for PVE. Analysis of the degree of hypertrophy of the FLR after PVE complements analysis of the pre-PVEFLR volume. FLR degree of hypertrophy and FLR volume are the best predictors of early outcome after major hepatectomy for cholangiocarcinom
Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) for cholangiocarcinoma
No full textTo increase resectability in patients affected by cholangiocarcinoma undergoing major hepatic resection, two methods of portal vein occlusion can be applied: radiological portal vein embolization (PVE) or surgical portal vein ligation (PVL). The rationale behind these approaches is to induce atrophy of the tumor-bearing lobe with subsequent hypertrophy in the contralateral lobe by diverting the portal venous flow into the liver section that is expected to remain. One limiting factor for performing major liver resection is the remaining liver volume (FLR): in the case of normal hepatic function, an FLR of approximately 25% is considered to be sufficient to maintain liver function after resection. A novel concept has recently been described, consisting of 2-staged extended hepatectomy with initial surgical exploration, PVL, and in situ liver splitting (ALPPS) to induce rapid hypertrophy, over a short period of time, of the future liver remnant (FLR) in patients with marginally resectable cholangiocarcinoma. The first step of this novel surgical approach consists of an in situ split liver procedure, with PVL and transection followed by definitive resection 9 days later. In general, it takes 2-6 weeks to achieve sufficient growth of the FLR for curative liver resection after PVE alone. A more rapid increase in FLR volume occurred after ALPPS; this decreased the time to surgery to a mean of 9 days, compared with 21-30 days after PVE. In addition, ALPPS induced an increase in the FLR also after failed PVE, rendering these patients resectable. Moreover, ALPPS involved complete separation of the FLR from the liver lobes to be resected. The accelerated hypertrophy effect observed with ALPPS, as compared to PVL and PVE alone, even with inclusion of segment IV, should be attributed to the "in situ" split procedure. This procedure leads to a complete devascularization of segment IV and also prevents formation of vascular collaterals between the left lateral and the right extended liver lobe. The combination of PVL and the in situ split procedure obviously induces a much stronger stimulus leading to rapid hypertrophy of the FLR
Liver metastases from non-gastrointestinal non-neuroendocrine tumours: review of the literature
No full textLiver resection is integrated in the oncological surgical management of metastatic gastrointestinal and neuroendocrine tumours. However, the good prognosis reached in these cases has not been obtained for metastatic tumours of other histological types. In this review, we analysed the published case reports and series of hepatectomies in patients with metastatic breast cancer, melanoma, sarcoma, genitourinary tumours, pulmonary and adrenocortical tumours. From the reported data the surgical resection of oligometastases yields good results in terms of improved survival, in particular when the disease-free time period is longer than 1 year. Hepatic resection can be a valid surgical strategy to obtain a survival benefit in patients with liver metastases from non-gastrointestinal, non-neuroendocrine tumours. However, a careful patient selection is needed in order to obtain a real survival benefit; patients with a good performance status, with a disease-free period longer than 1 year and with oligometastases may obtain the best advantage from this approach
Surgical treatment for intrahepatic cholangiocarcinoma
No full textIntrahepatic cholangiocarcinoma is an aggressive tumor usually discovered at an advanced stage. Surgical resection is the treatment of choice but less than 50% of patients may receive curative resection. In almost 70% of patients, extended hepatectomy with vascular resection and/or bile duct resection are required to achieve a negative margin. Overall 5-year survival is around 30%. Prognosis is mainly based on tumor factors such as size, number, lymph node or vascular invasion and surgical margin. The main sites of recurrence are the liver, peritoneum and lymph nodes. In patients with liver-only recurrence, re-resection should always be considered.Intrahepatic cholangiocarcinoma is an aggressive tumor usually discovered at an advanced stage. Surgical resection is the treatment of choice but less than 50% of patients may receive curative resection. In almost 70% of patients, extended hepatectomy with vascular resection and/or bile duct resection are required to achieve a negative margin. Overall 5-year survival is around 30%. Prognosis is mainly based on tumor factors such as size, number, lymph node or vascular invasion and surgical margin. The main sites of recurrence are the liver, peritoneum and lymph nodes. In patients with liver-only recurrence, re-resection should always be considered
The role of lymphadenectomy for liver tumors. Further considerations on the appropriateness of treatment strategy
No full textOBJECTIVE: To evaluate the role of regional lymphadenectomy in patients with liver tumors. BACKGROUND: Lymph node status is 1 of the most important prognostic factors in oncologic surgery; however, the role of lymph node dissection remains unclear for hepatic tumors. METHODS: A total of 120 consecutive patients undergoing liver resections for primary and secondary hepatic tumors were prospectively enrolled in the study. "Regional" lymphadenectomy was carried out routinely after specimen removal. Incidence, site, and influence on survival of node metastases were analyzed. RESULTS: Only 1 postoperative complication (intra-abdominal bleeding) was related to lymph node excision. Median number of dissected nodes was 6.8 +/- 3.6. Periportal, pericholedochal, and common hepatic artery stations were always removed. Lymph node metastases were found in 17 (16.5%) patients. The percentage rises to 20.3% when considering only noncirrhotic patients. The incidence of lymph node metastases was 7.5% for hepatocellular carcinoma, 14% for colorectal metastases, 40% for noncolorectal metastases, and 40% for intrahepatic cholangiocarcinoma (P < 0.002). Median survival time was 486 +/- 93.2 days among all patients with node metastases and 725 +/- 29.7 among patients without node metastases. The 2-year survival was 37.1% and 86.7%, in the 2 groups (P < 0.05). The 2-year recurrence rate was 77.6% and 45.3%, respectively (P < 0.05). CONCLUSIONS: Regional lymphadenectomy is a safe procedure after liver resection, and it should be routinely applied in patients with primary and secondary hepatic tumors, particularly in those without chronic disease. A careful evaluation of node status is nevertheless advisable also in patients with hepatocellular carcinoma on cirrhosis
Liver transplantation for hepatic tumors: A systematic review
No full textImprovements in the medical and pharmacological management of liver transplantation (LT) recipients have led to a better long-term outcome and extension of the indications for this procedure. Liver tumors are relevant to LT; however, the use of LT to treat malignancies remains a debated issue because the high risk of recurrence. In this review we considered LT for hepatocellular carcinoma (HCC), cholangiocarcinoma (CCA), liver metastases (LM) and other rare tumors. We reviewed the literature, focusing on the past 10 years. The highly selected Milan criteria of LT for HCC (single nodule < 5 cm or up to 3 nodules < 3 cm) have been recently extended by a group from the University of S. Francisco (1 lesion < 6.5 cm or up to 3 lesions < 4.5 cm) with satisfying results in terms of recurrence-free survival and the "up-to-seven criteria". Moreover, using these criteria, other transplant groups have recently developed downstaging protocols, including surgical or loco-regional treatments of HCC, which have increased the post-operative survival of recipients. CCA may be treated by LT in patients who cannot undergo liver resection because of underlying liver disease or for anatomical technical challenges. A well-defined protocol of chemoirradiation and staging laparotomy before LT has been developed by the Mayo Clinic, which has resulted in long term disease-free survival comparable to other indications. LT for LM has also been investigated by multicenter studies. It offers a real benefit for metastases from neuroendocrine tumors that are well differentiated and when a major extrahepatic resection is not required. If LT is an option in these selected cases, liver metastases from colorectal cancer is still a borderline indication because data concerning the disease-free survival are still lacking. Hepatoblastoma and hemangioendothelioma represent rare primary tumors for which LT is often the only possible and effective cure because of the frequent multifocal, intrahepatic nature of the disease. LT is a very promising procedure for both primary and secondary liver malignancies; however, it needs an accurate evaluation of the costs and benefits for each indication to balance the chances of cure with actual organ availability
Liver and Vena Cava En Bloc Resection for an Invasive Leiomyosarcoma Causing Budd-Chiari Syndrome, Under Veno-Venous Bypass and Liver Hypothermic Perfusion : Liver Hypothermic Perfusion and Veno-Venous Bypass for Inferior Vena Cava Leiomyosarcoma
No full textBackground. Leiomyosarcoma of vascular origin is a rare tumor, occurring mainly in the inferior vena cava (IVC). When involving the hepatic vein confluence, it often causes Budd–Chiari syndrome, and IVC removal with a complex hepatectomy is required (Mingoli in J Am Coll Surg 211:145–146, 2010; Griffin in J Surg Oncol 34:53–60, 1987; Heaney in Ann Surg 163:237–241, 1966; Fortner in
Ann Surg 180:644–652, 1974).
Methods. A 57-year-old male, without previous oncological history, presented with Budd–Chiari syndrome due to a leiomyosarcoma extending to the supra-diaphragmatic IVC and involving the right and middle hepatic veins. The patient did not receive neoadjuvant treatment.
Results. A femoral to superior vena cava veno-venous bypass was inserted, and both a median sternotomy and phreno-laparotomy with right subcostal extension were performed. A hemi-portocaval shunt was created between the right portal branch and the IVC, while a catheter was connected to the left portal branch for cold perfusion. Under extracorporeal circulation, the IVC was sectioned
after infrahepatic and supra-diaphragmatic cross-clamping. The left liver was flushed with Celsior solution and packed with ice. A right trisectionectomy extended to the caudate lobe with en bloc vena cava removal was performed. The IVC was replaced by a cryopreserved aortic homograft, to which the stump of the left hepatic vein was anastomosed. Bypass duration, warm and cold liver ischemia, and operation time were 280 min, 8 min, 112 min, and 11 h, respectively. Duct-to-duct biliary anastomosis tutored by aT-tube was performed, and the patient was discharged on postoperative day 29, without major complications. After 16 months free of disease, the patient developed bilateral lung metastases. After 4 years the patient is still alive and receiving systemic chemotherapy.
Conclusions. Leiomyosarcoma of the IVC involving the hepatic veins can be treated with extended hepatectomy and removal of the IVC through extracorporeal circulation
Minimally invasive adrenalectomy for incidentally discovered cavernous hemangioma
No full textin pres
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
- …
