[Show abstract][Hide abstract] ABSTRACT: The liver is a common site of metastases. The most relevant metastatic tumor of the liver to
the surgeon is colorectal cancer because of the well-documented potential for long-term survival
after complete resection. However, a large number of other tumors commonly metastasize
to the liver, including cancers of the upper gastrointestinal system (stomach,
pancreas, biliary), genitourinary system (renal, prostate), neuroendocrine system, breast, eye
(melanoma), skin (melanoma), soft tissue (retroperitoneal sarcoma), and gynecologic system
(ovarian, endometrial, cervix).
The high frequency of liver metastases is caused by:
1. The liver's vast blood supply, which originates from portal and systemic systems.
2. The fenestrations of the hepatic sinusoidal endothelium may facilitate penetration of
malignant cells into the hepatic parenchyma.
3. Humoral factors that promote cell growth and cellular factors, such as adhesion molecules,
favor metastatic spread to the liver.
4. The liver's geographic proximity to other intra-abdominal organs may allow malignant
infiltration by direct extension.
Not so long ago, oncologists were so pessimistic about the appearance of hepatic metastases
that “no treatment” was often the recommendation. Advancing technology and improved
surgical techniques now offer potential therapeutic options for patients with such
lesions. Patient selection is the most important aspect of surgical therapy for metastatic
disease in the liver and clinical follow-up of resected patients has identified those most
and least likely to benefit. Therefore, realistic expectations and honest patient education is
an important aspect of treatment.
[Show abstract][Hide abstract] ABSTRACT: Perioperative outcome of pancreaticoduodenectomy is related to work load volume and to whether the procedure is carried out in a tertiary specialized hepato-pancreatico-biliary (HPB) unit.
To evaluate the perioperative outcome associated with pancreaticoduodenectomy in a newly established HPB unit.
Analysis of 32 patients who underwent pancreaticoduodenectomy (PD) for benign and malignant indications.
Retrospective collection of data on preoperative, intraoperative and postoperative care of all patients undergoing PD.
Thirty-two patients (16 male and 16 female) with a mean age of 59.5±12.7years were analyzed. The overall morbidity rate was high at 53%. The most common complication was wound infection (n=11; 34.4%). Pancreatic and biliary leaks were seen in 5 (15.6%) and 2 (6.2%) cases, respectively, while delayed gastric emptying was recorded in 7 (21.9%). The female sex was not associated with increased morbidity. Presence of co-morbid illness, pylorus-preserving PD, intra-operative blood loss ⩾1L, and perioperative blood transfusion were not associated with significantly increased morbidity. The overall hospital mortality was 3.1% and the cumulative overall (OS) and disease free survival (DFS) at 1year were 80% and 82.3%, respectively. The cumulative overall survival for pancreatic cancer vs ampullary tumor at 1year were 52% vs 80%, respectively.
PD is associated with a low risk of operative death when performed by specialized HPB surgeons even in a tertiary referral hospital. However, the postoperative morbidity rate remains high, mostly due to wound infection. Further improvement by reducing postoperative infection may help curtail the high postoperative morbidity.
Journal of the Egyptian National Cancer Institute 03/2012; 24(1):47-54. DOI:10.1016/j.jnci.2011.12.007
[Show abstract][Hide abstract] ABSTRACT: Since brain-death criteria are not accepted in Egypt, only organs acquired from living donors can be used for transplant. Our objective was to highlight the ethical issues raised by living-donor liver transplant.
The study was conducted by reviewing publications from centers performing living-donor liver transplant in Egypt and by consulting with a group of experts in the fields of liver transplantation, clinical ethics, and religious scholarship.
The first successful living-donor liver transplant in Egypt was performed at the National Liver Institute in 1991; however, this program did not continue because of poor early results. In August 2002, transplants began at Dar-Al-Foaud Hospital; since then, almost 500 cases of living-donor liver transplant have been performed at 9 centers. Although the donor risk is estimated to be low, 2 donors died (0.4%). The ethical principle that best applies to living-donor liver transplant is primum non nocere (first, not to harm), as the donor derives emotional benefit fromdonation and the opportunity to save a life. It is important to stress that the alternative to living-donor liver transplant in Egypt is not deceased-donor liver transplant. There are no doubts that this is a beneficial procedure for the recipient with acceptable risks to the donor.
It is ethically appropriate to perform liver transplant using living donors.
Experimental and clinical transplantation: official journal of the Middle East Society for Organ Transplantation 04/2009; 7(1):18-24. · 0.62 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Aim: Surgical resection is the standard of care for colorectal metastases isolated to the liver. However, only 10–25% are eligible for resection because of extent and location of the disease in the liver or concurrent medical conditions. Several series have shown that radiofrequency ablation (RFA) can result in tumor eradication in properly selected candidates.The purpose of this study was to determine the efficacy of RFA for treatment of such lesions Methods: Thirty patients with documented colorectal liver metastases who met the following criteria were considered for RFA: metastases confined to the liver; judged irresectable due to technical considerations or co-morbidity, number of metastatic deposits no greater than 5; and size less than 10 cm. Results: Median follow-up was 26 (range 9-63) months. Overall 1-and 2-year survival rates were 76 and 61% respectively. Median survival was 32 months. Disease-free survival at 1 year was 35% at 2 years 7%. Six patients developed recurrence at the site of RFA; given that the total number of RFA-treated lesions was 69 the local recurrence rate was 9%. Conclusion: RFA can achieve effective local treatment for patients with colorectal liver metastases who were considered unsuitable for surgical treatment.
Journal of Hepatology 01/2008; 48. DOI:10.1016/S0168-8278(08)60357-8 · 11.34 Impact Factor