RezumatObiectivul acestui studiu este acela de a evalua rezultatele pacienţilor trataţi pentru hepatocarcinom (CHC) într-un centru de Chirurgie Generalã şi Transplant Hepatic. Material şi metode: Acest studiu retrospectiv include 844 pacienţi diagnosticaţi cu CHC şi trataţi chirurgical cu intenţie de radicalitate. Singurele metode de tratament curativ pentru CHC, la ora actualã sunt reprezentate de rezecţia hepaticã (RH) şi transplantul hepatic (TH). Ablaţia tumoralã poate fi indicatã în tratamentul CHC precoce, în cazurile la care rezecţia sau transplantul hepatic nu se pot efectua. La 518 pacienţi s-a practicat rezecţie hepaticã, 162 au beneficiat de transplant hepatic, iar 164 pacienţi au fost trataţi prin distrucţie cu radiofrecvenţã (RFA). 615 pacienţi (73%) au prezentat cirozã hepaticã. Rezultate: Morbiditatea şi mortalitatea înregistrate pentru întreg lotul de pacienţi au fost de 30% şi respectiv 4,3%. Supravieţuirea la 5 ani a fost de 39% cu diferenţe semnificative statistic între pacienţii la care s-a practicat RH comparativ cu cei transplantaţi şi Chirurgia (2017)
Background: Liver resection (LR) is the standard treatment for most focal liver lesions. Intraoperative ultrasound (IOUS) improves their diagnosis and guides the liver resection. The present paper analyses our experience in IOUS guided LR, reviewing the indications, surgical techniques, and the short-term results. Material and Method: 198 LRs guided by IOUS in 186 patients operated in our center between January 2013 and December 2017 were included in a combined prospective and retrospective study. The median age of the patients was 60 years (mean 57, range 16-79), with a male/female ratio of 109/77, and adult/pediatric patient ratio of 185/1. Results: Malignant lesions were the main indication for IOUS guided LR (164 LRs; 82.8%); among these, colorectal liver metastases were the main indication (66 LRs; 33.3%), followed by hepatocellular carcinoma (44 cases, 22.2%). The mean number of tumors was 3 (range 1-16), and the median diameter of the largest tumor was 40 mm (mean 51; range 3-240). IOUS found new lesions in 22.3% of cases operated for liver metastases (46 LRs), and changed the surgical strategy in 41.9% of cases (83 LRs). Major resection rate was 18.2% (36 LRs); anatomical LRs were performed in 18 cases (9.1%). The median operative time was 330 minutes (mean 334; range 90-920). The median blood loss was 700 ml (mean 900; range 250-9500), with a transfusion rate of 54.8% (108 LRs). Overall and major complication rates were 46.5% (92 LRs) and 7.6% (15 LRs), respectively, while the mortality rate was 2% (4 pts). Conclusion: IOUS should be fully integrated in the modern liver surgery, providing improved diagnosis and optimal resection guidance, increasing resectability and surgical safety, with low perioperative morbidity and mortality.
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
Background: Intrahepatic cholangiocarcinoma (ICC) is a rare malignant tumor arising from the epithelial cells of the intrahepatic bile ducts. The aim of the present paper is to report a rare case of centrally located ICC involving the hepatocaval confluence and generating a tumor thrombus in the biliary duct of segment 4 expanding into the left hepatic duct and main common duct, mimicking a type IIIB Klatskin tumor. Case presentation: A 66-year old female presented for epigastric abdominal pain and weight loss, with cytolysis (ALAT= 323 U/l; normal ASAT), high GGT (618 U/L), but normal phosphatase alkaline and bilirubin levels; CA 19-9 was elevated (257 U/mL), while CEA was normal. At dual-phase multi-detector CT and magnetic resonance cholangiopancreatography, a simultaneous ICC and type IIIB perihilar cholangiocarcinoma (Klatskin tumor) were diagnosed. Intraoperatively, the ICC located in segments 1, 4 and 8, infiltrating the left and middle hepatic veins and in contact with the right hepatic vein was confirmed, while the hilar lesion proved to be a bile duct tumor thrombus originating from the ICC. Consequently, a left hepatectomy extended to segments 1 and 8 with hilar approach, with en-bloc resection of main biliary duct, and hilar lymph node dissection was performed. The right hepatic vein and an accessory middle hepatic vein were preserved, accepting 0-mm resection margin at this level. The postoperative outcome was remarkably uneventful. Conclusion: Locally advanced ICC is a challenging presentation for both diagnosis and treatment, for which complex major liver resection is effective when performed in a high volume HPB center.
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