There may be a subset of patients with pancreatic metastases who are able to benefit from surgery with respect to improved long-term survival. Symptoms at diagnosis, presentation with primary tumor, surgical resection, and pathologic diagnosis seem to be important prognostic factors.

We concluded that simultaneous colonic and liver resection should be undertaken in selected patients with synchronous colorectal liver resection regardless of the extent of hepatectomy; major liver resection, in fact, seems capable of providing better oncological results, allowing resection of liver micrometastases that, in almost one-third of the patients, are located in the same liver lobe of macroscopic lesions, without increased morbidity rates.

Conventional distal pancreatectomy (cDP) and total pancreatectomy (cTP) also involve removal of the spleen. The spleen, however, is an important organ in the immunologic defense of the host and is worthy of preservation if this can be safely achieved. We performed a spleen-preserving total pancreatectomy (SPTP), with good results, in a Caucasian woman, 66-year-old, affected by pancreatic metastases of renal clear cell carcinoma. This is the first report of a SPTP for pancreatic metastases to our knowledge, and we therefore wish to describe the surgical technique and to suggest the possible indications for this new technique.

An open controlled study was carried out to assess the efficacy and tolerance of a new low molecular weight heparin for the prevention of post-surgical deep vein thrombosis and pulmonary embolism. Forty-five patients undergoing abdominal surgery mainly for neoplasm, gallstones and gastric ulcers were administered 7,500 AXaU of low molecular weight heparin subcutaneously, 2 hours before surgery and once a day for 7 days after. Heparin calcium (15,000 IU subcutaneously per day) was used as a comparison drug in 45 control subjects, matched for age, sex and type of operation. Deep vein thrombosis was identified with clinical parameters, radio-labelled fibrinogen uptake test, echo-doppler and venography; pulmonary embolism with clinical examination, chest X-rays and/or scintigraphy. No episodes of deep vein thrombosis occurred in the low molecular weight heparin-treated patients, whilst there was 1 episode, without pulmonary embolism, in the control group. The consumption of blood and haemoderivatives for transfusions was higher in the heparin calcium group. Only in this group, furthermore, did 5 patients have to suspend antithrombotic treatment due to severe haemorrhages. General tolerance of the two drugs was identical and very good.

Hepatic adenomatosis is a rare benign disease that is more common in young and middle-aged women who are non-steroid dependent; it is usually symptomatic, progressive, and susceptible to hemorrhagic complications. Malignant transformation within adenomas is rare. The management of hepatic adenomatosis remains difficult due to the absence of predictive signs of complications, other than the size of the adenomas. Resective surgery is usually indicated, but liver transplantation could be an indication in highly symptomatic or progressive forms of the disease and represents the treatment of choice in cases of malignant transformation. We report a case of intrahepatic rupture of a caudate lobe adenoma which occurred in an adolescent with hepatic adenomatosis; we also present a brief review of the literature.

Background: Laparoscopic liver resection (LLR) has been reported as safe and effective approach to the management of hepatocarcinoma (HCC). However, in decompensated cirrhosis, studies of long-term outcome about tumor recurrence and patient survival in comparison with other standard treatments are limited. The aim of this study is to analyze the long term outcome of LLR versus transarterial chemoembolization (TACE) for treatment of HCC in Child B patients. Methods: Patients treated with LLR at a single European center were compared with patients treated with TACE included in the ITA.LI.CA database (a national multicenter HCC database). Only patients with same characteristics and adequate follow up were extracted from the database. A propensity score analysis was made matching patients by: age, sex, etiology of liver disease, number of lesions and size of largest nodule. Results: Since 2004 to 2016, 35 patients underwent LLR. Those treated with TACE, identified in the database, were 200. Median overall survival (OS) was not statistically different between groups. After propensity score analysis LLR provided significantly better 3(p=0,05), 5(p=0,04) year survival and OS (p=0,03) than TACE: 44,9months (95% CI:14,9-74,9) versus 18,2 (95% CI:8,4-30,1) respectively. Conclusion: LLR provides significantly better long-term survival than TACE in superselected patients with Child B cirrhosis. Thus, due to its low invasiveness, LLR should be part of multimodal management of HCC even in presence of mild liver function impairment.

No abstract