1,721,484 research outputs found
The multiple aspects of liver transplantation for hepatocellular carcinoma: comments on the recommendations from the consensus conference
No full textHepatocellular carcinoma (HCC) is a recognized indication for liver transplantation (LT) as it can at the same time provide a radical oncological resection and prevent its recurrence treating the hepatic disease. However the shortage of donors and the long time on waiting list forces the hepatologists and transplant surgeons to adopt bridging locoregional treatments to prevent the drop out and to perform downstaging treatments to offer a chance of radical intervention to more patients. The therapeutical strategies for patients suffering from HCC are various and different choices should be considered according to each patient's clinical situation according to prognostic and staging systems. Recently recommendations have been published on Lancet Oncology about this topic. These guidelines are very helpful in choosing among the different therapeutic options and in the management of patients in waiting list. Here we briefly summarize and comment the main features covered in the recommendations
Reply to "hepatic venous pressure gradient for preoperative assessment of patients with resectable hepatocellular carcinoma: A comment for moving forward"
No full textN
Why is pancreatic adenocarcinoma not screened for earlier?
No full textWhy is pancreatic adenocarcinoma not screened for earlier
Can Positive Resection Margin of Intra-hepatic Cholangiocarcinoma Still Provide a Survival Benefit over Systemic Chemotherapy?
No full textN
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
Comment on: 'Long-term impact of liver function on curative therapy for hepatocellular carcinoma: Application of the ALBI grade'
No full textN
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
- …
