Article

Pushing back the frontiers of resectability in liver cancer surgery

HPB and Transplant Unit, St. James's University Hospital, Leeds LS9 7TF, UK.
European journal of surgical oncology: the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology (Impact Factor: 2.89). 04/2008; 34(3):272-80. DOI: 10.1016/j.ejso.2007.07.201
Source: PubMed

ABSTRACT Thanks to advances in surgical technique, anaesthesia and peri-operative care, hepatic resection has evolved from a rare procedure with an associated mortality rate of up to 20% to a routine surgery carried out in high volume liver units with an operative risk of less than 5%. This review concentrates on the techniques employed in radical hepatic resection, considering in particular: (1) The feasibility of extended hepatic parenchymal resections; (2) The treatment of lesions compromising the hepatic in-flow; and (3) The treatment of lesions compromising the hepatic out-flow. We discuss how these aims can be achieved by: minimizing the blood loss; minimizing the remnant liver parenchymal injury; performing an adequate oncological resection; and creating adequate venous out-flow reconstruction, using case series and case histories to illustrate these points.

Download full-text

Full-text

Available from: Mohammad Abu Hilal, Feb 01, 2015
1 Follower
 · 
75 Views
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Liver is common place where the cancer occurs primary as well as secondary. Liver resection as a poten-tially healing method can be performed only in about 20% of patients. Prognosis in group of patients treated non-invasively is bad. Using high frequency thermal ablation which damages the neoplastic tissue in liver may lead to prolongation of life expectancy. The aim of the study was to assess the early results of using the high frequency thermal ablation in patients with primary or secondary cancer. Material and methods. During years of 2001-2007 371 patients underwent the 520 procedures of percutaneous RF thermal ablation under US control. Mean age of patients was 62.47 (19-85 ± 11.63). 175 women and 196 men were treated using this method. Results. There were 10 early complications after thermal ablation (1.92% of procedures, 2.7% of pa-tients). Two of them ended fatal (0.38% of procedures, 0.54% of patients). In seven cases absces forma-tion were observed, one of them was the cause of death due to Clostridium perfingens infection. Choler-rhagia from damaged bile duct in cirrhotic liver caused the peritonitis and subsequent death of patient. Two patients suffered from sub-capsular hematoma of liver. 14 patients also suffered from long lasting pain (more than 14 days). Conclusions. Percutaneous thermal ablation in primary or secondary liver tumors is safe and efficient procedure. Long term follow up will give the knowledge about the real value of the procedure. Liver is the second (after lymph nodes) in frequency of occurrence place of malignant me-tastasis and it is also origin for primary liver tumors (1). Liver resection with margin or its transplan-tation – in the selected cases (HCC, endocrine tumors) is the best method giving the patient a chance for over 5 years survival time (2-7). Patient is suitable for liver surgery if: 1. There is an ability remove all metastatic or primary tumors with one centimeter of he-althy tissue margin (4). 2. Function of the liver is sustained. 3. There is a possibility to treat all extrahepa-tic tumor foci. In case of HCC possibility of liver resection is limited by poor liver function (due to cirrho-sis) and transplantation due to tumor exten-sion (operation only for patients who meets Milano /Mazzaferro/ criteria) and lack of liver donors (5, 8). Less than 20 percent of patients can under-go the liver resection in primary as well as in secondary tumors due to factors presented abo-ve (7-10). Prognosis for the sick with non-resectable primary and secondary tumor is bad. The me-dian survival time for patients with HCC is up to six to eight months in the developed coun-tries. (3, 9, 11). As HCC is mainly growing
    Polish Journal of Surgery 01/2008; 80(8):387-393. DOI:10.2478/v10035-008-0055-9
  • [Show abstract] [Hide abstract]
    ABSTRACT: There is no conclusive answer to the question whether excising gall bladder is helpful to the patient with hepatic cancer. The survival rate of patients with hepatic cancer for more than two years has been increased, and the incidence of complications of cholecystitis and gall stone are relatively higher among these patients, which may seriously complicate treatment of advanced hepatic cancer and decrease quality of life. The researchers conducted a prospective clinical investigation from 2002 to 2006 to assess the clinical significance of preventive cholecystectomy in patients with hepatic cancer. One hundred and eighteen cases of postoperative patients with hepatic cancer, who survived for more than two years, were followed up. Based on whether cholecystectomy was performed, the patients were divided into two groups including 48 cases with cholecystectomy and 70 cases with cholecyst reserved. The two-year morbidity of gall stone and morbidity of pain in the right upper abdomen of cholecyst reservation group were 54.29% and 68.57%, respectively, obviously higher than 0.00% and 20.83% of cholecystectomy group. Mainly for those treated with transcatheter arterial chemo-embolization, the morbidity of gall stone was 86.67% (P < 0.01). Therefore, preventive cholecystectomy is strongly recommended during hepatectomy to decrease the incidence of chronic cholecystitis and gall stone, especially for those whose chemotherapy and embolization will be carried out through hepatic artery and portal vein.
    Frontiers of Medicine in China 06/2008; 2(2):139-142. DOI:10.1007/s11684-008-0026-x
  • [Show abstract] [Hide abstract]
    ABSTRACT: The safety and feasibility of laparoscopic liver resections have recently been confirmed. This has encouraged laparoscopic surgeons to widen the indications and push the boundaries in laparoscopic liver resections. However, a complete laparoscopic two-stage liver resection has not been reported previously. The aim of this work was to assess the feasibility and safety of the two-stage laparoscopic liver resection for metastatic disease. The two-stage laparoscopic liver resection was safely performed in a 58-year-old man with colorectal liver metastasis (one in segment 2/3 and one in the right lobe). A left lateral sectionectomy was first performed, followed by right portal vein embolization 1 week later, and a nonanatomic resection of the right liver was performed after 6 weeks. Laparoscopic liver surgery is gaining popularity and major procedures can now be performed in centers with wide experience. The laparoscopic approach should always be considered for left lateral sectionectomy, and in selected cases, a complete laparoscopic two-stage resection can safely be performed.
    Journal of Laparoendoscopic & Advanced Surgical Techniques 02/2010; 20(1):51-4. DOI:10.1089/lap.2009.0061 · 1.19 Impact Factor
Show more