Publications (19)81.95 Total impact
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Article: Repeat endovascular treatment of recurring hepatic artery stenoses in orthotopic liver transplantation.
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ABSTRACT: Hepatic artery stenosis (HAS) is a complication that impacts the results of orthotopic liver transplantation (OLT). Interventional radiological techniques are important therapeutic options for HAS. The aim of this retrospective study was to evaluate the outcome of repeated radiological treatments in recurring HAS after OLT. Of the 941 patients who underwent OLT at our center from January 1998 to September 2010, 48 (5%) were diagnosed with HAS, 37 (77%) of whom underwent transluminal interventional therapy with the placement of an endovascular stent. Success rate, complications, hepatic artery patency and follow-up were reviewed. After stent placement, artery patency was achieved in all patients. Three patients developed complications, including arterial dissection and hematoma. HAS recurrence was observed in 9 patients (24%), and hepatic artery thrombosis (HAT) occurred in 4 (11%). Radiological interventions were repeated 10 times in 8 patients without complications. At a median follow-up of 66 months (range 10-158), hepatic artery patency was observed in 35 cases (94.6%). The 5-year rates for graft and patient survival were 82.3% and 87.7%, respectively. Restenosis may occur in one-third of patients after endovascular treatment for thrombosis and HAS, but the long-term outcomes of iterative radiological treatment for HAS indicate a high rate of success.Transplant International 03/2013; · 2.92 Impact Factor -
Article: Pretransplant fecal carriage of extended-spectrum β-lactamase-producing Enterobacteriaceae and infection after liver transplant, France.
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ABSTRACT: Extended-spectrum β-lactamase-producing Enterobacteriaceae isolates (ESBLE) are emerging pathogens that confer resistance to antimicrobial drugs. We conducted a 10-year study in France (January 2001-April 2010) to investigate the incidence of and risk factors for ESBLE infections after liver transplant. Of 710 transplant patients screened preoperatively for ESBLE fecal carriage, 5.5% had ESBLE infection develop within 4 months after surgery; patients with pretransplant ESBLE fecal carriage were more likely to have infection develop than were noncarriers. Typing showed extensive genetic diversity, with a large predominance of CTX-M enzymes. Independent predictors of ESBLE infection were pretransplant fecal carriage, Model for End Stage Liver Disease score >25, and return to surgery. Our results indicate that the influx of preoperatively acquired ESBLE isolates into the hospital outweighs cross-transmission in the epidemiology of ESBLE infections after liver transplant. Transplant candidates should be systematically screened for carriage, and posttransplant infection in carriers should be treated with carbapenems.Emerging Infectious Diseases 06/2012; 18(6):908-16. · 6.79 Impact Factor -
Article: Liver packing during elective surgery: an option that can be considered.
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ABSTRACT: Packing is a life-saving procedure in patients undergoing emergency surgery for blunt hepatic trauma, especially when massive blood transfusions, acidosis, or hypothermia have resulted in coagulation disorders. The purpose of this study was to apply this concept to the setting of elective liver surgery. Elective packing was performed in 7 patients who had sustained prolonged bleeding mainly related to partial outflow obstruction during the course of liver resection (n = 3) or transplantation (n = 4). At the time of packing, conventional methods of hemostasis had failed and surgery had lasted for 490 (range, 380-695) minutes, blood loss was 5,700 (range, 2,100-13,700) ml, and all patients had coagulation disorders (prothrombin time PT <30%, platelets <45 g/l), hypothermia (body temperature 35.4 °C), acidosis (median blood pH 7.24; serum lactate 6.5 mmol/l) and required catecholamine support. Unpacking was performed after a median of 37 (range, 26-60) hours. At that time, all patients were normothermic, with platelet counts >45 g/l, PT >30%, and restored acid-base balance. Active bleeding had stopped, and secondary fascia closure was feasible. With a minimum follow-up of 6 months, all patients are alive without sequel. Packing is a safe and efficient means to control venous bleeding when conventional methods of hemostasis have failed, knowing that commonly the reason for failure of conventional method of hemostasis is partial outflow obstruction.World Journal of Surgery 05/2011; 35(11):2493-8. · 2.36 Impact Factor -
Article: Early-onset pneumonia after liver transplantation: microbiological findings and therapeutic consequences.
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ABSTRACT: Early-onset hospital-acquired pneumonia (E-HAP) is one of the leading causes of sepsis and mortality after liver transplantation (LT). The appropriate antimicrobial therapy is crucially important for surviving sepsis in this context. The aim of this study was to analyze microbiological findings, associated factors, and optimal antibiotic regimens for E-HAP after LT. Patients demonstrating E-HAP in a single-center cohort of 148 LT recipients were prospectively detected. The diagnosis of pneumonia relied on a combination of supportive clinical findings and a positive culture of a lower respiratory tract sample. E-HAP was considered present if pneumonia occurred within 6 days of intensive care unit (ICU) admission after LT. Twenty-three patients (15.5%) developed E-HAP, which were caused by 36 pathogens (61.1% were gram-negative bacilli, and 33.3% were classified as hospital-acquired). For patients who developed E-HAP, the duration of mechanical ventilation and the ICU stay were significantly longer. Despite a trend toward higher mortality at any time in the E-HAP group, there was no significant difference in mortality between patients with E-HAP and patients without E-HAP. Lactatemia, vasopressor requirements, Simplified Acute Physiology Score II (SAPS II) score on ICU admission, and mechanical ventilation lasting more than 48 hours after LT were associated with E-HAP. Combinations of broad-spectrum β-lactams and aminoglycosides were active against more than 91% of the encountered pathogens. However, antibiotic de-escalation was possible in more than one-third of cases after identification of the pathogens. In conclusion, E-HAP after LT is a severe condition that appears to be influenced by physiological derangements induced by the surgery, such as lactatemia, vasopressor requirements, and mechanical ventilation requirements, as well as the postoperative SAPS II score. At the time of treatment initiation, an antimicrobial regimen usually proposed for late-onset pneumonia should be followed.Liver Transplantation 10/2010; 16(10):1178-85. · 3.39 Impact Factor -
Article: Plasma proteome to look for diagnostic biomarkers of early bacterial sepsis after liver transplantation: a preliminary study.
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ABSTRACT: While outcome continuously improves after liver transplantation, sepsis remains the leading cause of early postoperative mortality. Diagnosis of infections remains particularly difficult in these patients. This study used plasma profiling coupling Proteinchip array with surface-enhanced laser desorption ionization time-of-fly mass spectrometry to search for biomarkers of postoperative sepsis in patients who underwent liver transplantation. Diagnosis of sepsis at day 5 relied on widely accepted clinical signs and positive culture of microbiologic samples. Profiles of day 5 plasma were obtained from SELDI-TOF CM10 chip (BioRad, Marnes-la-Coquette, France) analysis. Mean peak intensity of proteins was compared between septic and nonseptic plasma by U test followed by analysis of the area under the receiver-operating characteristic for the significant peaks. Diagnostic performance of significant proteins was established in a derivation set and in a validation set. In the derivation set of 31 patients with and 30 without infection, 23 plasma protein peaks were differentially expressed between patients with and without sepsis. Combination of five peaks allowed sepsis diagnosis with a positive likelihood ratio of 12.5 and a C-statistics of 0.72, 95% CI 0.57-0.85. In the validation set of 31 patients with infection and 34 without infection, the five peaks were differentially expressed as well and allowed day 5 sepsis diagnosis with a positive likelihood ratio of 5.1 and C-statistics of 0.74 (0.58-0.85). A combination of five plasma protein peaks may provide material for useful diagnostic biomarkers of postoperative sepsis in patients undergoing liver transplantation. However, these proteins remain to be identified.Anesthesiology 03/2010; 112(4):926-35. · 5.36 Impact Factor -
Article: Liver regeneration at day 7 after right hepatectomy: global and segmental volumetric analysis by using CT.
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ABSTRACT: To evaluate total and segmental liver regeneration by comparing preoperative computed tomographic (CT) volumetry and CT volumetry on postoperative day 7 following right hepatectomy and to study liver regeneration estimated by using CT volumetry in patients with different surgical indications and in whom the middle hepatic vein (MHV) was harvested or not harvested. Local medical ethics committee and state medical board approval and informed consent were obtained. Twenty-seven patients who had undergone right hepatectomy were imaged with multidetector CT preoperatively and at day 7 postoperatively. Fourteen patients (group 1) were living liver donors, including eight in whom the MHV was harvested. Thirteen patients (group 2) underwent right hepatectomy for other indications. Volumetric measurements were performed semiautomatically. Total volumes and segmental volumes were measured for total liver, future liver remnant (FLR), and liver remnant. Total and segmental early regeneration index, defined as [(V(LR) - V(FLR))/V(FLR)] x 100, where V(LR) is volume of the liver remnant and V(FLR) is volume of the FLR, were calculated. Comparisons were performed by using the Mann-Whitney test, and a P value of less than .05 was considered significant. The liver remnant at day 7 showed a 64% increase in volume from the FLR, without a significant difference between groups 1 and 2. In the group with harvesting of MHV, volume and segmental regeneration index were significantly lower than in other patients, for both the caudate lobe (32 and 48 mL, respectively; P = .049) and liver segment IV (Couinaud) (206 and 334 mL, respectively; P = .008). Segmental regeneration of the liver following right hepatectomy varies, depending on whether the MHV was harvested, and seems to be related to hepatic outflow.Radiology 09/2009; 252(2):426-32. · 5.73 Impact Factor -
Article: Living liver donor death related to complications of myeloma.
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ABSTRACT: We report a donor death after right hepatectomy for living donor transplantation due to an undiagnosed myeloma. The 47-year-old donor, who was the 147th case performed in our department, was in excellent health without any abnormalities in the preoperative investigations. Despite an uneventful right hepatectomy without transfusion, the patient developed a partial thrombus of the inferior vena cava with a right proximal pulmonary trunk embolism on postoperative day 6. Subsequently, he developed multiorgan dysfunction leading to a coagulopathy, respiratory distress, and renal failure requiring hemodialysis and mechanical ventilation. This clinical scenario led us to suspect a hematological disorder. Immune electrophoresis showed a monoclonal peak of immunoglobulin G (8.7 g/L), a myelogram revealed an abnormally high level of dystrophic plasmocytes (more than 7%), and biopsies of salivary glands confirmed the diagnosis of immunoglobulin G kappa myeloma. The patient progressively deteriorated because of simultaneous hemorrhagic and infectious pulmonary complications resulting in septic shock. Despite an adequate combination of antimicrobial therapy and pleural drainage, the donor died on postoperative day 57 from multiple organ failure. This unusual cause of donor death after right hepatectomy reinforces the need for an extensive preoperative assessment. We advocate the addition of urinary protein loss and electrophoresis to the standard donor assessment protocol.Liver Transplantation 03/2009; 15(3):326-9. · 3.39 Impact Factor -
Article: Prospective validation of the "fifty-fifty" criteria as an early and accurate predictor of death after liver resection in intensive care unit patients.
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ABSTRACT: Postoperative liver failure after hepatectomy has been identified by the association of prothrombin time <50% and serum bilirubin >50 micromol/L (the "50-50" criteria). Whether these criteria are of prognostic value in a prospective study remains unknown. To determine prospectively the prognostic value of the 50-50 criteria on day 3 and day 5 in intensive care unit (ICU) patients after hepatectomy. From January 2005 to February 2007, among 436 elective liver resections, 99 (23%) consecutive patients aged 58 +/- 17 years were admitted postoperatively in ICU with a mean SAPSII 25 +/- 10. Malignant disease was present in 87 and major resections (< or =3 segments) were performed in 79 (80%) cases. The underlying liver parenchyma was abnormal in 59 (59%) cases including cirrhosis, fibrosis, or steatosis >30% in 19, 23, and 17 patients, respectively. The 50-50 criteria were present on day 3 in 10 patients and on day 5 in 13. Ten patients (10, 6%) died in ICU. Survivors with these criteria were characterized by early aggressive support including reoperation and/or liver assist system. Nonsurvivors were more often cirrhotic, had significantly higher SAPS II and more frequently postoperative prolonged mechanical ventilation. The 50-50 criteria on days 3 and 5 were predictors of death on multivariate analysis [OR (95% CI): 12.7 (2.3-71.4), OR (95% CI): 29.4 (4.9-167), respectively]. After hepatic resection, results of this prospective study validate the 50-50 criteria as a predictive factor of mortality in ICU on both days 3 and 5. These criteria allow an early diagnosis of postoperative liver failure, which may contribute to reduce mortality in ICU patients after hepatectomy.Annals of surgery 01/2009; 249(1):124-8. · 7.90 Impact Factor -
Article: Hypercoagulability after partial liver resection.
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ABSTRACT: One concern of living donor liver transplantation remains the risk of morbidity and/or mortality for the donors, including the risk of postoperative thrombosis. We studied the coagulation changes after partial liver resection in l2 living donors and eight patients with non-malignant hepatic tumors (controls) and searched for potential predictive markers of thrombotic complications. Thrombosis (pulmonary embolism and portal vein thrombosis) developed in two donors and two controls. In donors and controls, we observed an early postoperative decrease in coagulation inhibitors protein C and antithrombin together with an increase in factor VIII and von Willebrand factor, which both persisted when prothrombin time had returned to normal. Dysregulation in the haemostatic system was confirmed by increased prothrombotic markers, with a 10- to 30-fold increase in thrombin-antithrombin complexes and moderate increase(1.5- to 2.0-fold) in sP-Selectin. No difference between donors and controls was observed and the data were pooled for comparison of patients with (n = 4) versus without (n = 16) thrombosis. Thrombin-antithrombin complexes were significantly higher in the thrombosis group, on day 1 (28.8 vs. 13.5 microg/l, p = 0.027) and day 2 (52.3 vs. 9.3 microg/l, p = 0.013). sP-selectin was also significantly higher in the thrombosis group on day 2 (103 vs. 53 ng/ml, p = 0.044) and day 4 (116 vs. 58 ng/ml, p = 0.026) after surgery. Our study indicates that improvement of thromboprophylaxis in partial liver resection is needed. It also suggests that thrombin-antithrombin complexes and sP-selectin could serve as early biological predictors of thrombotic complications in the post-operative period.Thrombosis and Haemostasis 01/2008; 98(6):1252-6. · 5.04 Impact Factor -
Article: Two hundred liver hanging maneuvers for major hepatectomy: a single-center experience.
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ABSTRACT: To establish the indications of the liver hanging maneuver for major hepatectomy. The liver hanging maneuver, which is a technique of passing a tape along the retrohepatic avascular space and suspending the liver during parenchymal transection, facilitates anterior approach of major hepatectomy. However, the feasibility and limits of this maneuver have never been established in patients with different clinical backgrounds. Medical records of 242 consecutive patients considered for major hepatectomy using the hanging maneuver were reviewed. Among 242 patients, 14 patients (6%) were considered to have contraindication for this maneuver preoperatively because of tumor infiltration to anterior surface of retrohepatic inferior vena cava (IVC). It was successful in 201 patients with overall feasibility of 88%. The feasibility increased significantly in the recent years as compared with the initial years (94% in 2003-2005 vs. 76% in 2000-2002, P < 0.0001). Bleeding during the retrohepatic dissection occurred in 5 patients (2%), which was minor due to injury of hepatic capsule in 3 (1%) and major due to injury of short hepatic vein in 2 (1%). In all cases, bleeding stopped spontaneously. The maneuver was abandoned in 27 patients, including 15 related to severe adhesion between liver and IVC. Univariate analysis showed that adhesion between IVC and liver was the only significant negative predictor affecting the feasibility. Cirrhosis, large tumor, preoperative radiologic treatments did not influence on the feasibility. The liver hanging maneuver has 94% feasibility in recent years. Absolute contraindication is tumor infiltration to the retrohepatic avascular space. Adhesion between the IVC and liver has a negative impact of the feasibility. According to this indication, the hanging maneuver is easily achievable without risk of the major bleeding during the retrohepatic dissection.Annals of Surgery 02/2007; 245(1):31-5. · 7.49 Impact Factor -
Article: Respiratory complications: a major concern after right hepatectomy in living liver donors.
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ABSTRACT: One of the main concerns after living donor liver transplantation is the risk of morbidity and/or mortality that it imposes on the donors. Respiratory postoperative complications in living liver donors have already been reported but their frequency seems to be underestimated. We designed a prospective study to evaluate the rate and the nature of postoperative pulmonary complications in 112 consecutive donors. The medical records of the 112 living liver donors operated on at our center from 1998 to 2003 were reviewed and all the cases of respiratory complications were retrieved. Moreover, since 2000, all patients had a computed tomography angiography of the thorax at day 7 on a prospective basis. In all, 112 hepatectomies (44 right and 68 left) for adult-to-adult or adult-to-child liver donation were performed in our center. No postoperative mortality was recorded. Fourteen major respiratory complications developed in of 11 of 112 donors (9.8%), in all cases after right hepatectomy, and included nonsevere pulmonary embolism (n=7), right pleural empyema (n=3), and bacterial pneumonia (n=3). Minor respiratory complications (7.1% of the donors) included iatrogenic pneumothorax (n=3) and pleural effusion requiring thoracocentesis (n=5). Abdominal complications (mainly biliary leak) developed in 10 donors (8.9%), who in the vast majority remained free of pulmonary complications. In our series, pulmonary complications are frequent in living liver donors. These complications are mainly observed after right hepatectomy. The particular prevalence of pulmonary embolism should lead to focus on its early diagnosis and prevention.Transplantation 02/2006; 81(2):181-6. · 4.00 Impact Factor -
Article: A prospective analysis of living-liver donation shows a high rate of adverse events.
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ABSTRACT: Donor risk is the main obstacle in the development of living-donor liver transplantation in Western countries. The knowledge of a wide and uneven range of donor morbidity has come mainly from various retrospective analyses of complications in the literature. Donor outcomes have not been prospectively analyzed. From 1995, the intra- and postoperative courses of 127 living-donor hepatectomies were prospectively analyzed and recorded. All adverse events were classified and stratified according to the extent of surgery, including 45 left-lateral sectionectomies (LLS); 25 left hepatectomies (LH), and 57 right hepatectomies (RH). There was no donor death. The overall rate of significant complications was 20%, ranging from 8% after LH to 32% after RH. The overall incidences of surgical complications, reoperations, and hospital readmissions were 8%, 3%, and 5%, respectively. However, the prospective accumulation of all adverse events revealed an overall postoperative morbidity of 51%, ranging from 32% after LH to 66% after RH. In conclusion the incidence of postoperative adverse events after living donation is nearly 50% as revealed by prospective screening. These results allow more accurate information for potential donors. This study confirms that right hepatectomy carries three times higher risk of morbidity as compared to left-sided resections, leading to reappraisal of the use of left grafts in adults.Journal of Hepato-Biliary-Pancreatic Surgery 02/2006; 13(2):117-22. · 1.60 Impact Factor -
Article: Role of replicative senescence in the progression of fibrosis in hepatitis C virus (HCV) recurrence after liver transplantation.
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ABSTRACT: Although hepatitis C virus (HCV) recurrence is almost universal after orthotopic liver transplantation (OLT), the impact of viral infection on liver graft is highly variable and difficult to predict. Because of the possible relationship between replicative senescence (RS) and the accelerated development of liver fibrosis, we aimed to assess the potential role of RS in the severity of HCV-related chronic hepatitis recurrence after OLT. One hundred three liver biopsies from 56 patients receiving transplants for HCV-related cirrhosis were studied, including 30 revascularization biopsies and 52 and 21 biopsies performed during and beyond the first year of OLT, respectively. The presence of senescent cells in liver grafts was assessed by the senescence-associated beta-galactosidase (SA-beta-Gal) staining method. Chronic hepatitis was defined by fibrosis stage and necrotico-inflammatory activity grade using the METAVIR score. A total of 34 of the 103 (33%) frozen liver biopsies displayed SA-beta-Gal-positive cells, including 6 (20%) of the revascularization biopsies, 14 (34%) of the biopsies performed within the first year, and 10 (46%) of the biopsies performed beyond 1 year of follow-up. The presence of senescent cells in revascularization biopsies was significantly associated with the degree of ischemic necrosis at time of OLT (P = 0.01) and hepatitis C recurrence in the first year after OLT (P = 0.05). Furthermore, the presence of RS in the biopsy performed within the first year was associated with further development of fibrosis (P = 0.05). These data show that RS has a significant impact upon the course of liver transplantation, especially in the long-term progression of fibrosis observed in HCV-infected patients.Transplantation 07/2004; 77(11):1755-60. · 4.00 Impact Factor -
Article: Direct bile duct visualization during the preparation of split livers.
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ABSTRACT: The split-liver technique is an important means to alleviating donor shortage. Its development is, at least in part, hindered by the risk of biliary complications, particularly when splitting is performed ex situ. We present a simple technique aimed at improving the identification of the biliary anatomy at the hilar level and the safety of the procedure.Liver Transplantation 06/2004; 10(5):703-5. · 3.39 Impact Factor -
Article: Underestimation of the influence of satellite nodules as a risk factor for post-transplantation recurrence in patients with small hepatocellular carcinoma.
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ABSTRACT: Liver transplantation offers good results in patients with small hepatocellular carcinoma. However, 3 to 15% of patients still have recurrence, suggesting that factors other than the size and number of nodules are implicated. The aim of our study was to identify predictive factors of recurrence in patients with small hepatocellular carcinoma. Seventy consecutive patients fulfilling Milano criteria and who were transplanted for hepatocellular carcinoma were studied. Forty-six patients had pretransplantation adjuvant local therapy. The size and number of tumors, the clinical and biological characteristics of the patients were recorded before liver transplantation, and histological analysis was performed on the explanted liver. Overall survival rates at 1 and 3 years were 81% and 66%, respectively. Recurrence-free survival rates at 1 and 3 years were 80% and 65%, respectively. Seven patients had tumor recurrence with 1- and 3-year recurrence rates of 5% and 10%, respectively. Satellite nodules on the explanted liver were the only statistically significant predictor of recurrence (P=.0003). None of the patients who did not have satellite nodules had recurrence. There was a significant correlation between satellite nodules and microvascular invasion. Patients with pretransplantation adjuvant therapy had significantly more tumor necrosis, but did not have less satellite nodules. In conclusion, microscopic satellite nodules are a significant predictive factor of tumor recurrence in patients transplanted for small hepatocellular carcinoma.Liver Transplantation 03/2004; 10(2 Suppl 1):S86-90. · 3.39 Impact Factor -
Article: Harvesting the middle hepatic vein with a right hepatectomy does not increase the risk for the donor.
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ABSTRACT: The harvesting of the middle hepatic vein (MHV) with a right hepatectomy for living-donor liver transplantation allows an optimal venous drainage for the recipient but can also have adverse effects for the donor. This study compares morbidity, early liver function, and volume regeneration in 2 groups of donors who underwent right hepatectomy with (MHV+, n = 21) or without (MHV-, n = 20) MHV harvesting during 2 successive periods. The operative time was 401 +/- 60 minutes in the MHV+ group compared with 392 +/- 63 minutes in the MHV- group, and the transection time was 152 +/- 53 minutes in the MHV+ group compared with 131 +/- 30 minutes in the MHV- group (not significant). Blood loss in the MHV+ group was 773 +/- 343 mL compared with 613 +/- 361 mL in the MHV- group (not significant). The graft weight and remnant liver volume ratio were similar in the MHV+ and MHV- groups (763 +/- 200 gm vs. 832 +/- 156 gm and 42% +/- 9.5% vs. 43% +/- 8.3%, respectively). Postoperative biologic liver function tests showed that prothrombin time (PT) ratio on postoperative days 1 and 3 were significantly lower in the MHV+ group compared with the MHV- group (53% vs. 65% and 63% vs. 72%, respectively, P <.05). There were no differences in postoperative alanine aminotransferase and aspartate aminotransferase peak levels between the MHV+ and MHV- groups (319 +/- 198 IU /L vs. 310 +/- 110 IU /L and 317 +/- 226 IU /L vs. 296 +/- 125 IU /L, respectively). Bilirubin maximal blood level was similar in the 2 groups (32 +/- 17 micromol/L in the MHV+ group vs. 43 +/- 16 micromol/L in the MHV- group, P <.05). No donor died. The overall morbidity was lower in the MHV+ group compared with the MHV- group (36% vs. 55%; P >.05, not significant). The donor's remnant liver volume regeneration, evaluated by computed tomography (CT) volumetric study on day 7, was similar in the 2 groups (97% +/- 29% in the MHV+ group and 103% +/- 39% in the MHV- group, P >.05). The results of this comparative study show that right hepatectomy with the MHV neither affects morbidity nor impairs early liver function and regeneration in donors.Liver Transplantation 01/2004; 10(1):71-6. · 3.39 Impact Factor -
Article: Resection prior to liver transplantation for hepatocellular carcinoma.
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ABSTRACT: To evaluate the feasibility and postoperative course of liver transplantation (LT) in cirrhotic patients who underwent liver resection prior to LT for HCC. Although LT provides longer survival than liver resection for treatment of small HCCs, donor shortage and long LT wait time may argue against LT. The feasibility and survival following LT after hepatic resection have not been previously examined. Between 1991 and 2001, among 107 patients who underwent LT for HCC, 88 met Mazzafero's criteria upon pathologic analysis of the explant. Of these, 70 underwent primary liver transplantation (PLT) and 18 liver resection prior to secondary liver transplantation (SLT) for recurrence (n = 11), deterioration of liver function (n = 4), or high risk for recurrence (n = 3). Perioperative and postoperative factors and long-term survival were compared. Comparison of PLT and SLT groups at the time of LT revealed similar median age (53 vs. 55 years), sex, and etiology of liver disease (alcohol/viral B/C/other). In the SLT group, the mean time between liver resection and listing for LT was 20 months (range 1-84 months). Overall time on LT waiting list of the two groups was similar (3 vs. 5 months). Pathologic analysis after LT revealed similar tumor size (2.2 vs. 2.3 cm) and number (1.6 vs. 1.7). Perioperative and postoperative courses were not different in terms of operative time (551 vs. 530 minutes), blood loss (1191 vs. 1282 mL), transfusion (3 vs. 2 units), ICU (9 vs. 10 days) or hospital stay (32 vs. 31 days), morbidity (51% vs. 56%) or 30-day mortality (5.7% vs. 5.6%). During a median follow-up of 32 months (3 to 158 months), 3 patients recurred after PLT and one after SLT. After transplantation, 3- and 5-year overall survivals were not different between groups (82 vs. 82% and 59 vs. 61%). In selected patients, liver resection prior to transplantation does not increase the morbidity or impair long-term survival following LT. Therefore, liver resection prior to transplantation can be integrated in the treatment strategy for HCC.Annals of Surgery 01/2004; 238(6):885-92; discussion 892-3. · 7.49 Impact Factor -
Article: Extent of liver resection influences the outcome in patients with cirrhosis and small hepatocellular carcinoma.
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ABSTRACT: The long-term outcome after resection of hepatocellular carcinoma (HCC) is influenced by parameters related to the tumor and the underlying liver disease. However, the extent of the resection, which can be limited or anatomical (including the tumor and its portal territory), is controversial. Among 64 Child-Pugh A patients with cirrhosis who underwent curative liver resection for small HCC (< or = 4 cm) between 1990 and 1996, 34 patients underwent limited resection with a margin width of at least 1 cm, and 30 patients underwent anatomic resection of at least 1 liver segment with complete removal of the portal area containing the tumor. The 2 groups were comparable in terms of epidemiologic and pathologic parameters. The major end points were: (1) in-hospital mortality and morbidity; (2) overall and disease-free survival; and (3) rate and topography of recurrence. The 30-day mortality (6% vs 7%) and morbidity (52% vs 47%) rates after limited and anatomic liver resection were not statistically different. The 5- and 8-year overall survival rates after limited versus anatomic resection were, respectively, 35% versus 54% (P <.05) and 6% versus 45% (P <.05). The 5- and 8-year disease-free survival rates were, respectively, 26% versus 45% and 0% versus 21% (P <.05). Local recurrence was more frequently observed after limited resections than after anatomic resections (50% vs 10%, P <.05). In patients with cirrhosis and a small HCC, anatomic resection achieves better disease-free survival than limited resection without increasing the postoperative risk. Therefore, anatomical resection should be the treatment of choice and considered as the reference surgical treatment compared with other treatments.Surgery 03/2002; 131(3):311-7. · 3.10 Impact Factor -
Article: Hepatocellular-cholangiocarcinoma: helical computed tomography findings in 30 patients.
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ABSTRACT: To report the helical multiphasic computed tomography (CT) findings in 30 patients with hepatocellular-cholangiocarcinoma. We evaluated age, gender, tumor risk factors, serum tumor markers, symptoms, and tumor morphology and enhancement on helical multiphasic CT in 30 patients. Twenty-six of 30 patients (86%) were men. Patients had an age range of 27-78 years (mean = 58 years). Abdominal signs or symptoms were present in 21 of 30 patients, and 25 of 30 (83%) had chronic liver disease. Helical CT demonstrated a well-defined tumor in all patients with signs of malignancy such as hepatic hypervascularity (63%), biliary obstruction (17%), satellite lesions (40%), and lymphadenopathy (27%). Portions of the tumor were hyperattenuated on arterial-phase imaging and hypoattenuated on all other phases, whereas other portions showed delayed persistent enhancement, sometimes (27%) with hepatic capsular retraction, findings that have been reported to be characteristic of hepatocellular carcinoma and cholangiocarcinoma, respectively. The diagnosis of hepatocellular-cholangiocarcinoma should be considered when a hepatic tumor has CT features of both hepatocellular carcinoma and cholangiocarcinoma. Radiologists should be aware of this tumor type so that the biopsy is performed properly to allow sufficient tissue sampling.Journal of Computer Assisted Tomography 27(2):117-24. · 1.22 Impact Factor
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