The technique and results of 29 major hepatic resections using the method of complete vascular isolation and hypothermic perfusion of the liver are reported. The method enables the surgeon to perform otherwise difficult or impossible resections through chilled bloodless hepatic parenchyma. Major intrahepatic vascular structures can thus be recognized and controlled readily under clear vision. Direct neoplastic involvement of, or tumor thrombi in the portal vein, hepatic vein or vena cava, can be successfully dealt with by appropriate surgical measures. The operative mortality was 10.3% for this series which included many tumors previously deemed unresectable. The technical detail and intraoperative physiologic monitoring crucial to success in the use of the method are described. It is hoped that with the widened scope of resectability afforded by this technique, and the use of adjuvant chemotherapy, the currently experienced low cure rates for hepatic cancer can be improved.
Thirty‐eight tumors, or 1.7%, of a series of 2,135 patients with tumors of the major salivary glands, occurred in patients 16 years of age or below. An equal incidence of malignant and benign lesions was noted in this series. Mucoepidermoid carcinoma and benign mixed tumors were the most common tumors encountered. The treatment of choice is subtotal parotidectomy or submaxillary dissection. Further surgery is dependent upon the histologic diagnosis and clinical setting, i.e., the location of the primary tumor and the presence or absence of cervical nodal metastases. The overall determinate 5‐ and 10‐year survival in this series was 96%; for malignant lesions alone, it was 94% and 93%, respectively.
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