No abstract

Percutaneous needle biopsies are frequently used to evaluate focal lesions of the liver. Needle-tract implantation of hepatocellular cancer has been described in case reports, but the true risk for this problem has not been clearly defined. We retrospectively reviewed 91 cases of hepatocellular cancer during a 4-year period from 1994 to 1997. Data on diagnostic studies, therapy, and outcome were noted. Of 91 patients with hepatocellular cancer, 59 patients underwent percutaneous needle biopsy as part of their diagnostic workup for a liver mass. Three patients (5.1%) were identified with needle-tract implantation of tumor. Two patients required en bloc chest wall resections for implantation of hepatocellular cancer in the soft tissues and rib area. The third patient, who also received percutaneous ethanol injection of his tumor, required a thoracotomy and lung resection for implanted hepatocellular cancer. Percutaneous needle biopsy of suspicious hepatic lesions should not be performed indiscriminately because there is a significant risk for needle-tract implantation. These biopsies should be reserved for those lesions in which no definitive surgical intervention is planned and pathological confirmation is necessary for a nonsurgical therapy. Copyright 2000 by the American Association for the Study of Liver DiseasesF ocal lesions of the liver often present challenging diagnostic and management problems. Incidental detection of hepatic lesions by the increasing use of modern imaging techniques further complicates the problem. The diagnostic armamentarium used to evaluate these lesions has been enhanced with the advent of computed tomographic (CT) scan and ultrasound-guided needle biopsy.Although percutaneous needle biopsy of the liver has been shown to be a generally safe procedure, serious complications have been reported. Complications include hemorrhage, biliary leak, pneumothorax, intrahepatic hematomas, diagnostic error, and needletract seeding. 1 Needle-tract seeding has been reported previously with a low incidence of 0.005% (3 of 63,108 cases). This study included, however, a large series of biopsies of many different organs (liver, pancreas, lymph nodes, kidney, spleen, and adrenal gland) performed for a variety of reasons, both neoplastic and nonneoplastic. 2 Several cases showing seeding of hepatocellular carcinoma during percutaneous procedures have been documented at our institution and have prompted closer scrutiny of this problem. MethodsAll patients referred to our group of surgeons with hepatocellular carcinoma over the 5-year period between January 1993 and December 1997 were the subjects of this study. Records were retrospectively reviewed for diagnostic studies, procedures performed, pathological examination, and outcome. Ninety-one patients with hepatocellular carcinoma were identified, and patterns of recurrence were noted. Three documented cases of needle-tract seeding were found and form the basis of this report. ResultsDuring the 5-year study period between January 1993 and December 1997, ...

No abstract

No abstract

No abstract

It is difficult to estimate the total cost of ESLD; however, in evaluating inpatient costs, we see that it is expensive and significant amounts are spent on patients who die. Further study is necessary to determine which factors can optimize the cost of ESLD.

No abstract

Hepatocellular cancer (HCC) is increasing in incidence and liver transplant (LT) is likely the best treatment for long-term survival and decreased recurrence in those with localized disease. Optimal treatment for HCC is limited by advanced stage at presentation and available donors. We retrospectively reviewed 232 cases of HCC from 1993 to 2002 referred to our medical center, which also has the only transplant program in the state. Demographic data, risk factors, stage, previous treatment, candidacy for LT, and outcome were noted. Stage distribution was as follows: stage I - nine patients, II - 115 patients, III - 31 patients, and IV - 76 patients. Mean age was 61.1 yr and 62 patients were over the age of 70 yr. Thirty-five patients (15.1%) were offered LT evaluation. Nineteen patients (8.2%) eventually underwent LT, five are currently on a transplant waiting list, three were on a list but removed due to death or progression of disease, six were evaluated but not listed, and two refused evaluation. Five patients were transplanted because implementation of the Model of End-stage Liver Disease (MELD) system for organ allocation. Of 19 patients who underwent LT, 14 are still alive 3-52 months post-transplant, three developed recurrent HCC, and two died of lung cancer. Although LT may be the best treatment for HCC, a relatively small number of patients (15%) will qualify for this therapy. About half of those who qualify will actually undergo LT. This further emphasizes the need for other strategies such as vaccination, chemoprevention, and early detection to improve survival from HCC.