1,721,412 research outputs found
Albumin-bilirubin score: an additional tool for the management of patients with hepatocellular carcinoma
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Surgery for hepatocellular carcinoma can provide the same life-expectancy as transplant of that of general population
No full textCure might be achieved by liver resection for hepatocellualr carcinom
Cholangiocarcinoma
No full textCholangiocarcinoma presents a challenge for cancer specialists all over the world. Neoplasia of the biliary tract are rare, accounting for approximately 3% of all gastrointestinal tumours with an incidence of about 3 per 100,000; but rate have been rising rapidly in recent years. Thi cancer is one of the major killes. at the time of diagnosis less than 30% of patients are candidates for complete resection. For unresectable cholangiocarcinomas, median survival is less than 1 year. Given the rarity of the disease, the literature of cholangiocarcinoma is scant. However, the incrising incidence of the highly lethal malignancy should capture the attention of physicians and stimulate further research
Abdominal solid organ transplantation. Immunology, indications, techniques, and early complications
No full textAbdominal solid organ transplantation (SOT) has become treatment of choice for several end-stage chronic disease of liver, kidney and foregut. Improving knowledge in immunology, introduction of new immunosuppressive agents as well as the improvement in surgical techniques have increased the number of potential candidates and outcome. The aim of this book is to focus on main immunological problems of SOT. We will review the indication for liver, kidney and small bowel transplantation, will describe techniques for procurement and transplantation, will emphasize technical, infective and immunological complications and treatments. Special issues will present to elucidate indication and outcome of combined heart-liver, liver-kidney and kidney-pancreas transplantation. With an increasing demand of abdominal SOT, more and more doctors (surgeons, physicians) and scientists, as well as student and nurses are becoming interested in; for them, the book is of value summarizing the knowledge in this field
Diagnostic and Therapeutic Algorithms for Cholangiocarcinoma
No full textCholangiocarcinoa (CC) is a challenging disease, most patients presenting with unresectable tumours at the time of diagnosis. Imaging techniques (US, CT, MRI) and invasive tests (ERC or EUS with brushing and FNA or biopsy US or TC guided) with a pathological confirmation are required to establish a definitive diagnosis of CC. The ultimate curative treatment strategy for CC is surgery. Thus, a multidisciplinary team in a referaal centre should first expolre the surgical option and distinguish resectable from unresectable disease. Secondly, in both situations it is necessary to screen patients with jaundice which may required decompression of the biliary tract with drainage/stent function is essential to minimize the risk of postoperative liver falilure. If future liver failure is suspected, portal vein embolization or an associating liver partition and portal vein ligation for staged hepatectomy should be considered. Surgery could lead to a curative resection and so an adjuvant tharapy may be administered. Otherwise, after a non-curative resection or in unresectable locally advances metastatic or recurrent cholangiocarcinoma first-line chemotherapy is the suggested option, possibly associated with radiotherapy or locoregional treatmens. Whne the disease is no longer controlled by any line of chemotherapy, best supportive care should be suggested
Inframesocolic Approach for Robotic Enucleation of Branch-Duct Intraductal Papillary Mucinous Neoplasm of the Pancreas
No full textBackgroundThe inframesocolic approach to the uncinate process of the pancreas has been rarely described in literature. To the best of our knowledge, no robotic cases have been reported.MethodsThe case of a 74-year-old woman, with a 43-mm branch-duct intraductal papillary mucinous neoplasm with worrisome features within the uncinate process of the pancreas, is described.ResultsAfter diagnostic work-up, due to the uncertain potential of malignancy and the strong motivation of the patient to undergo surgery, we performed a robotic enucleation through an inframesocolic approach. The neoplasm was more than 1 cm from the main pancreatic duct. Final pathological diagnosis revealed a low-grade dysplasia branch-duct intraductal papillary mucinous neoplasm.ConclusionsThe inframesocolic approach could represent an easy way to access the uncinate process of the pancreas, allowing safe limited resection in selected cases such as small branch-duct IPMN or pancreatic neuroendocrine tumors
Liver transplantation for benign hepatic tumors: A systematic review
No full textOrthotopic liver transplantation (OLT) has been performed for several benign hepatic tumors. Most of these diseases are usually managed conservatively, or treated by liver resection. OLT might be required when the lesions are symptomatic, diffuse in hepatic parenchyma, causing life-threatening complications or malignant transformation cannot be ruled out. Polycystic liver disease is the most common indication for OLT. We present a review of transplantable benign hepatic lesions to evaluate the need of OLT for these diseases, to summarize in which OLT is a good therapeutic option, and to show the early and long-term survival which might be expected. Copyright © 2010 S. Karger AG, Basel
Frail patients dropping out of neoadjuvant treatment: what should we do?
No full textPerioperative oncological treatment is currently the gold standard approach in Europe for Advanced Gastric Cancer patients. Unfortunately, patients dropping out due to worsening conditions has been frequently observed, but these data are seldomly considered and reported. To analyze frequency and propose solutions to support these patients, we reconsidered our results from the GASTRODOC randomized trial performed by [blinded for reviewers] and GIRCG on 91 patients. Thirty-four patients (37.4%) suspended chemotherapy and five (5.4%) did not reach surgery. Ten patients (11%) presented unacceptable toxicity related to gastrointestinal symptoms, six ended the treatment for investigator decision and six for progression, five patients withdrew their consent, five patients were excluded because of surgical complications and long hospitalization, and two patients died. Even though not significant, survival rates for patients who interrupted treatment in the whole trial were lower (5-year OS completed 64.6 vs. interrupted 41.8 p 0.07). Promptness in giving patient support for gastrointestinal symptoms, careful evaluation of anemia and patient nutritional status, and psychological programs from the beginning of the oncologic treatment may improve the final results
Gastric splenosis mimicking a gastrointestinal stromal tumor: A case report
Full text linkIntramural gastric nodules are rare but all differential diagnoses must always be considered. If feasible, a preoperative fine needle aspiration can help the surgeon in selecting the best treatment option. Splenosis is uncommon in the general population but it must be considered in each patient with a history of splenectomy (especially after trauma). In this specific cluster it is reasonable to insist on ruling out splenosis even making a second histologic sampling after a first failur
Anatomic Laparoscopic Liver Resection in the Scenario of the Hepatocellular Carcinoma: A Systematic Review and Meta-Analysis
No full textAim:To assess the impact of the laparoscopic anatomic resections (LARs) on hepatocellular carcinoma (HCC) patients, analyzing the pooled short- and long-term outcomes of this technique and comparing it with the standard open approach [open anatomic resections (OAR)]. Material and Methods:A systematic literature search was performed in PubMed, Embase, and Scopus for studies published between 2010 and 2020 concerning LAR for HCC. Results:After screening 311 articles, 10 studies with a total of 398 patients who underwent LAR for HCC were included. The pooled cohort included mostly male (76.6%), Child A (98.2%), with hepatitis B virus (HBV)-related disease (60.5%). The pooled conversion rate was 7.3%. The pooled overall complication rate was 10.2 with a mortality rate of 1.0%. In the pooled analyses of only comparative studies, LAR group included 378 versus 455 in OAR. Operative time was longer in the LAR group (329 minutes versus 248;P = .001). Blood loss (179 versus 331 mL;P = .018) was lower in the LAR group. The pooled mean length of hospital stay was 8.4 days in LARs and 11.3 in OARs (P = .002). The pooled rate of postoperative complications was higher in the OAR group (25.3 versus 13.8;P = .009), while mortality rates were similar. The LAR group had a pooled 3- and 5-year overall survival of 90.1 and 81.9 versus 83.5 and 80.7 of the OARs (P > .05), respectively. Conclusions:In conclusion, the LAR for HCC is safe and associated with decreased blood loss and length of hospital stay. Survival rates are comparable with those of the conventional open approach
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