ObjectiveThis clinical study evaluated the results of and defined the indications for laparoscopic fenestration of symptomatic nonparasitic hepatic cysts, either solitary or diffuse. Summary Background DataDifferent surgical treatments have been proposed for highly symptomatic hepatic cysts: enucleation, fenestration, hepatic resection, and liver transplantation. The advent of laparoscopic surgery has given new opportunities but, at the same time, has increased the uncertainties concerning the proper management of these patients. MethodsEight patients with solitary cysts and nine with polycystic liver and kidney disease (PLD) were seen during a period of 2 years. After a careful review of the symptoms, 6 patients were excluded from surgical treatment and 11 (4 solitary cysts and 7 PLD) were treated by laparoscopic fenestration. Postoperative morbidity and mortality rates, hospital stay, and clinical early and late results were evaluated. ResultsIn the solitary cyst group, there was no surgical morbidity or deaths, and a complete regression of symptoms occurred in all patients. No recurrences were observed. In the PLD group, two patients had to be converted to laparotomic fenestration (28%). There were no deaths, and the surgical morbidity was limited to two cases of postoperative ascites. Symptomatic relief was obtained in 80% of patients, but the symptoms recurred in 60%. A subgroup of PLD at high risk for recurrence was identified. ConclusionsThe best indications for laparoscopic fenestration seem to be solitary cyst and PLD characterized by large cysts mainly located on the liver surface (type 1), whereas PLD characterized by numerous small cysts all over the liver (type 2) should be considered a contraindication to laparoscopic fenestration. 157

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In a group of 396 patients who had chemoembolization for hepatocellular carcinoma (HCC) between 1984 and 1991, 67 underwent surgery (segmentaryhbsegmentary resections: 3 1 ; or transplantation: 36). Morbidity was limited to hepatic insufficiency (seven), arterial thrombosis (two), vasculitis (five), cholecystitis (two), and hepatic abscess (one). Perioperative mortality was 5.5% for transplantation and 6.7% for resection.Histological examination of resected specimens showed a total or subtotal tumor necrosis in 58% of the cases, and a necrosis beween 50% and 80% in another 18%. Data on recurrence and long-term survival are not significant if retrospectively compared with non-chemoembolized surgically treated patients.Chemoembolization is known to be an effective palliative treatment of HCC. Its role in the preoperative setting is substained by a 58% of total or subtotal histological necrosis. A multicentric prospective trial to evaluate the role of preoperative chemoembolization for long-term survival and recurrence of HCC is advocated. 0 1993 Wiley-Liss, Inc.

The topic chosen by the Board of the Italian Society of Surgery for the 2013 annual Consensus Conference was gastric cancer. With this purpose, under the direction of 2 chairmen, 36 experts nominated by the Regional Societies of Surgery and by the Italian Research Group for Gastric Cancer (GIRCG) participated in an experts consensus exercise, preceded by a questionnaire and mainly held by telematic vote, in accordance with the rules of the Delphi method. The results of this Consensus Conference, presented to the 115th National Congress of the Italian Society of Surgery, and approved in plenary session, are reported in the present paper.

Abstract. Gastric cancer is one of the most common and lethal malignancies worldwide. Bone metastases in gastric cancer are less common than in other solid tumors, but when they occur the prognosis is generally poor. Increased osteoclastogenesis and osteoclast activity are common features in bone metastases caused by different osteotropic cancer. We investigated osteoclastogenesis and its mechanisms in gastric cancer by enrolling 31 newly diagnosed gastric cancer patients and 45 healthy controls. We studied in vitro osteoclastogenesis in the peripheral blood mononuclear cell cultures of patients and controls, showing spontaneous osteoclastogenesis for half of the patients. This osteoclastogenesis was RANKL-and TNF-α-independent. We analyzed primary tumor and bone metastatic tissues of gastric cancer for the expression of genes involved in osteoclastogenesis. The expression of transforming growth factor-β (TGF-β), osteoprotegerin (OPG), IL-7 and dickkopf-1 (DKK-1) was higher in primary tumors than in bone metastases. RANKL was not detectable in primary tumor or in bone metastatic tissue. The serum RANKL level was significantly higher in healthy controls than in patients, and it was not related to osteoclastogenesis, thereby suggesting that RANKL is not involved in the bone metastatic mechanisms in gastric cancer. We hypothesized a role of RANKL in angiogenesis, thus we compared the serum levels of RANKL to those of VEGF, since VEGF is directly related to angiogenesis. Different from RANKL, the VEGF serum levels were higher in gastric patients than in controls, suggesting a block of the angiogenesis inhibition due to RANKL. RANKL and VEGF serum levels were not predictive of overall survival in our cohort of gastric patients.