1,721,189 research outputs found
Renewed considerations on the utility (or the futility) of hepatic resections for breast cancer liver metastases
No full textIndication for liver resection (LR) for localized hepatic metastases from breast cancer (BC) is
still a matter of debate. A literature review of recent scientific papers pertaining to hepatectomies for BC
liver metastases (LM). We based our systematic review on case series on literature reviews, comparative
studies and cost-utility analysis which have been selected based on criteria regarding surgery, possible
prognostic factors and evaluation of long-term survival. There is a strong inhomogeneity in the reported
data, with 5-year survivals ranging from 21% to 58%. There is no agreement in the evaluation of prognostic
variables predicting good survival, with the only exception of the time of treatment of the primary BC until
the diagnosis of metastases. Three out of the four comparative studies report better survivals for patients
who underwent a hepatectomy in comparison to those treated with chemotherapy alone, but their strength
in terms of scientific evidence is weak. The only cost utility analysis revealed that 2 out of the 3 scenarios
considered were in favor of the treatment with surgery followed by conventional chemotherapy. There is
no definitive proof on the effectiveness of LRs for BC LM. Surgery can be proposed when it is possible to
perform radical surgery, with R0 margins and saving at least 30% of the liver with its vascular and biliary
connections. Stable skeletal metastases are not a contraindication. The interval between treatment of the
primary location and diagnosis of hepatic metastases is the only prognosis criteria available
A case report of giant hepatic hemangioma spontaneous regression in adult, non-cirrhotic patient and literature review
No full textHepatic hemangiomas (HHs) are defines as “giant” when are larger than 4 cm. The following case is reviewed due its unusual evolution. A case of 64-year-old woman was found at CT scan to have a “giant” HH (>20 cm in diameter). In 2015 (8 years after initial diagnosis), in the absence of treatments, abdominal CT scan highlighted the initial spontaneous regression of the HH, that progressed over time. Management of giant hemangiomas remains debated. Surgery should be restricted to specific situations, depending on growth pattern, symptom persistence, risk of complications and patient anxiety. Usually HHs remain stable in size over time and only a prolonged clinical and radiological follow-up is advised. The commonly known natural history of HHs in non-cirrhotics do not include decrease in size or regression. Clearly documented cases of spontaneous regression of giant HHs in non-cirrhotic adult patients have not yet been reported
Speech disorder related to tacrolimus-induced pontine myelinolysis after orthotopic liver transplantation
No full textWe report a case of speech disorders after tacrolimus treatment and resolution after discontinuatio
Hepatic artery stenosis in liver transplanted patients treated with pegylated Interferon alpha-2b and Ribavirin
No full textNo abstract availabl
Down-staging of hepatocellular carcinoma prior to liver transplantation: the power of selection
No full textNo abstract availabl
Intrahepatic cholangiocarcinoma: primary liver resection and aggressive multimodal treatment of recurrence significantly prolong survival
No full textOBJECTIVE: To evaluate the results of surgical therapy for intrahepatic cholangiocarcinoma (ICC), the incidence and the management of recurrence, and to analyze the change in approach during 2 different periods.
DESIGN: Retrospective study.
PATIENTS AND METHODS: Patient and tumor characteristics, and overall and disease-free survival were analyzed in a series of 72 consecutive patients who underwent hepatic resection for ICC. Several factors likely to influence survival after resection were evaluated. Patients were divided into 2 groups according to the year of operation (before and after 1999). Management of recurrence and survival after recurrence were also analyzed.
RESULTS: The 3- and 5-year overall survival rates were 62% and 48%, whereas the 3- and 5-year disease-free survival rates were 30% and 25%, respectively. The median survival time was 57.1 months. Patient and histologic characteristics before and after 1999 were similar. Survival was significantly better among patients operated after 1999, who were node-negative, did not receive blood transfusion, and underwent adjuvant chemotherapy. The overall recurrence rates before and after 1999 were comparable (66.6% and 50%, P = 0.49). The most frequent site of recurrence was the liver. A significantly large number of patients received treatment for recurrence after 1999 (81.5%) compared with the first period (8.3%). The overall 3-year survival rate after recurrence was 46%. After 1999, there was a significant improvement in 3-year survival after recurrence (56%) compared with patients operated before 1999 (0%, P = 0.004); the median survival time from the diagnosis of recurrence increased from 20 months to 66 months in the second group.
CONCLUSIONS: Although recurrence rate represents a frequent problem in ICC, an aggressive approach to recurrence can significantly prolong survival
Spontaneous mobilization of bone marrow-derived hematopoietic and endothelial progenitor/stem cells after orthotopic liver transplantation
No full textLiver resection with thrombectomy as a treatment of hepatocellular carcinoma with major vascular invasion: results from a retrospective multicentric study
No full textBackground The role of liver resection (LR) of hepatocellular carcinoma with macroscopic vascular thrombosis (MVT) remains controversial. The aim of this study is to evaluate whether the presence of MVT should still be considered a contraindication for LR. Methods Retrospective study was carried out on 62 patients who underwent LR and thrombectomy for hepatocellular carcinoma complicated by MVT. Of the 62 patients, 15 (36.5%) had tumor thrombus (TT) in the peripheral portal vein (Vp1), 5 (12.2%) in second branch (Vp2), and 21 (51.3%) in the first branch/portal vein trunk (Vp3), while on the hepatic/cava vein side, 8 (12.9%) had TT in the main trunk of the hepatic veins (Vv2) and 3 (4.8%) had TT reaching the vena cava/right atrium (Vv3). Results Perioperative major morbidity was 14.5%, while in-hospital mortality was 4.8%. Overall, 1, 3, and 5-year survival rates were 53.3%, 30.1%, and 20%, and disease-free survival rates were 31.7%, 20.8%, and 15.6%, respectively. There were no differences in survival about the MVT localized in Vp1, Vp2, or Vp3 (P =.77), while we found a statistical trend between patients with Vv2 and Vv3 (P =.06). Conclusion Surgical resection seems to be justified in these patients, and the presence of MVT should no longer be considered an absolute contraindication for LR
Post-transplantation lymphoproliferative disorders in liver transplanted patients: a report of four cases
No full textBackground. Posttransplant lymphoproliferative disorders (PTLDs) are an uncommon but important cause of morbidity and mortality in solid organ transplant recipients. They are often the result of Epstein-Barr. virus (EBV)-induced proliferation of B-lymphocytes in the setting of immunosuppression.
Patients and Methods. We retrospectively analyzed four cases of PTLD after liver transplantation. In all patients immunosuppression was reduced and anti-CD20 monoclonal antibody (rituximab) was administered. In two of four patients, EBV viral load was positive in the peripheral blood, and gancyclovir was therefore also prescribed. Chemotherapy (CHOP) was used as a rescue in the event of treatment failure.
Results. Even if no severe adverse events were observed during the treatment period, our treatment approach to PTLD was not effective, and only one patient out of four is still alive.
Conclusions. Well-designed clinical trials are necessary to evaluate the role of this combined approach in the treatment of PTLD in liver transplant recipients
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