Search

Background: Bile leakage (BL) is one of the commonest morbidities after hepatic resection for hepatocellular carcinoma (HCC). The current study was conducted to evaluate the incidence and different predictive factors for BL after hepatic resection for HCC, and to evaluate of the impact of BL on the long-term survival outcomes.Methods: We reviewed the patients' data who underwent hepatic resection for HCC during the period between June 2010 and June 2019.Results: A total of 293 patients were included in the study. BL occurred in 17 patients (5.8%). More Child-Pugh class B patients were found in BL group. There were no significant differences between the two groups except for tumor site, macroscopic portal vein invasion, extent of liver resection, Pringle maneuver use, intraoperative blood loss, and transfusions. Longer hospital stay, higher grades of post-hepatectomy liver failure, and abdominal collections were noted in BL group. After median follow-up duration of 17 months (4-110 months), there were no significant differences between BL and non-BL group regarding overall survival (log-rank, p = 0.746) and disease-free survival (log-rank, p = 0.348). In multivariate analysis, Child-Pugh class, macroscopic portal vein invasion, liver resection extent (minor/major), and Pringle's maneuver use were the only significant predictors of BL.Conclusion: BL did not significantly impair the long-term outcomes after hepatic resection for HCC. Child-Pugh class, macroscopic portal vein invasion, liver resection extent (minor/major), and Pringle's maneuver use were the main risk factors of BL in the current study. [ABSTRACT FROM AUTHOR]

Purpose: We aimed to compare the efficacy of hepatic resection and percutaneous ablation for resectable caudate HCC within Milan criteria and to investigate the prognostic factors. Methods: Between August 2006 and August 2020, a total of 67 eligible patients with resectable caudate HCC within Milan criteria in three centers were retrospectively analyzed and divided into hepatic resection group (n = 46) and percutaneous ablation group (n = 21). Recurrence-free survival (RFS) and overall survival (OS) rates were compared between groups of hepatic resection and percutaneous ablation for these resectable caudate HCC patients with Kaplan–Meier curves and log-rank test. Univariable and multivariable Cox regression analyses were performed to identify the prognostic factors of RFS and OS. Results: The 1-, 3-, and 5-year OS rates were 97.6%, 83.6%, and 71.5% for the hepatic resection group, and 89.4%, 58.5%, and 48.8% for the percutaneous ablation group (P = 0.032). The corresponding RFS rates were 77.6%, 47.9%, and 42.6% for the hepatic resection group, and 40.5%, 23.2%, and 15.4% for the percutaneous ablation group (P = 0.010). According to the univariable and multivariable analyses, tumor type (first recurrence) (HR = 3.54; 95%CI, 1.49–8.37; P = 0.004) was a significant independent prognostic factor of RFS for caudate HCC patients after resection or ablation, while total bilirubin (HR = 1.02; 95%CI, 1.01–1.04; P = 0.006) and treatment strategy (HR = 5.97; 95%CI, 1.48–24.12; P = 0.012) were significant independent prognostic factors of OS. Conclusions: Hepatic resection appears to outperform percutaneous ablation for caudate HCC patients within Milan criteria. [ABSTRACT FROM AUTHOR]

Background: Preoperative portal vein embolization (PVE) is utilized to induce growth of the future liver remnant volume (FLRV) among patients at elevated risk of post-hepatectomy liver failure (PHLF).Methods: The American College of Surgery National Surgical Quality Improvement Program (ACS-NSQIP) database was used to compare short-term outcomes of PVE versus non-PVE patients. A propensity score match (PSM) was used to compare short-term outcomes among PVE and non-PVE patients.Results: Among the 11,243 patients included in the study, 462 (4.1%) patients had a PVE. Postoperatively, patients who underwent PVE had a higher incidence of overall (PVE, 44% vs. non-PVE, 23%) and liver-specific complications (biliary leak PVE, 16% vs. non-PVE, 7%; post-hepatectomy liver failure [PHLF] PVE, 17% vs. non-PVE, 5%), as well as a longer length of stay (> 7 days PVE, 39% vs. non-PVE, 22%) compared with the non-PVE group (all p < 0.001). After PSM, no differences in mortality or LOS were observed among PVE and non-PVE patients. PVE patients remained more likely to have a bile leak, organ/surgical-site infection, and PHLF versus non-PVE patients (all p < 0.05).Conclusion: Among patients who underwent PVE before hepatectomy, the risk of postoperative complications was 1.6-fold higher than non-PVE patients. After PSM, PVE patients still had an increased risk of complications. [ABSTRACT FROM AUTHOR]

Purpose: The aims of this study were to clarify the relationship of gait speed, hand grip strength, and skeletal muscle mass with complications after hepatic resection and to identify risk factors for complications in patients who underwent hepatic resection.Methods: We evaluated the risk factors for complications after hepatic resection in 154 consecutive patients. Preoperative factors included gait speed, hand grip strength, and skeletal muscle mass. The gait speed and hand grip strength of patients were measured by physical therapists, and skeletal muscle mass was measured by computed tomography. Multivariate logistic regression analyses using preoperative factors were performed to assess predictors of the development of complications after hepatic resection.Results: Thirty-three patients (21.4%) developed complications after hepatic resection. These patients had a significantly lower serum albumin level (p = 0.015), slower gait speed (p = 0.007), higher rate of hepatic resection ≥ 2 Couinaud segments (p = 0.014), and lower rate of laparoscopic hepatic resection (p = 0.017) than patients without complications. Multivariate analysis revealed that a gait speed ≤ 1.10 m/s and a serum albumin level of ≤ 4.0 g/dl were independent risk factors for complications after hepatic resection.Conclusions: Slow gait speed and low serum albumin level are significant risk factors for complications after hepatic resection. These data will be helpful for perioperative patient management. [ABSTRACT FROM AUTHOR]

Background: In China, hepatitis B virus (HBV) is an important causative factor of hepatocellular carcinoma (HCC). The contribution and interaction of fibrosis-4 (FIB-4) score and total tumor volume (TTV) in association with HCC recurrence is unknown. A reliable point score based on the FIB-4 score, TTV, and differentiation grade was established to predict the postoperative recurrence of HBV-related HCC patients who underwent hepatic resection (HR).Methods: Three hundred thirty-eight HBV-related HCC patients from three institutions treated by HR were enrolled in this retrospective study. Prognostic factors were also evaluated by univariate and multivariate analysis using Cox's proportional hazards model in the training cohort. The DFT score was established by a Cox regression model and validated in the internal cohort and the external cohorts from the other two institutions.Results: The DFT score differentiated four groups of HBV-related HCC patients (0, 1-2, 3, 4-5 points) with distinct prognosis (median recurrence-free survival (RFS), 72.7 vs. 53.0 vs. 23.2 vs. 5.7 months; P < 0.05). Its predictive accuracy as determined by the area under the receiver operating characteristic curve (AUC) at 1, 3, and 5 years (AUCs 0.7319, 0.7031, and 0.6972) was greater than the other three staging systems for HCC. These findings were supported by the validation cohorts.Conclusions: The DFT model is a reliable and objective model to predict the RFS of HBV-related HCC patients after HR. [ABSTRACT FROM AUTHOR]

Background: Hepatic hemangioma (HH) is the most common benign solid tumor of the liver. The aim of this study is to review our experiences of surgical treatment for giant HH and to show the impact of HH size and type of surgical resection on surgical outcomes.Patients and Methods: This is a retrospective study of the cases who underwent surgery for giant HH during the period from January 2000 to April 2017.Results: Elective surgery was performed for 144 patients who had giant HH. The median diameter of resected HH was 10 cm (5-31 cm). Enucleation was performed for 92 (63.9%) patients and anatomical resection was required in 52 (36.1%) patients. No statistical difference between enucleation and resection as regards intraoperative and postoperative findings. The amount of intraoperative blood loss is significantly more in HH > 10 cm (300 vs. 575 ml, P = 0.007), the need of blood transfusion was significantly more in HH > 10 cm (P = 0.000), and the operation time was significantly longer in HH > 10 cm (120 vs. 180 min, P = 0.000). The size of HH had no significant effect as regards the development of postoperative complications.Conclusion: Giant hemangioma can be treated surgically with low incidence of morbidity and mortality. No statistical difference between enucleation and resection as regards surgical outcomes. In left lobe HH, HH located deeper in posterior hepatic segments and in multiple HH, hepatic resection is preferred. The size of the HH had significant impact intraoperative blood loss and operative time. [ABSTRACT FROM AUTHOR]

Background: Thanks to technical advancement in surgery for hepatocellular carcinoma (HCC), hepatic resection (HR) for elderly HCC patients has become safer. However, elderly patients may have shorter long-term survival after surgery if compared with younger patients because of their expected life span. The aim of the present study was to evaluate clinical outcomes and safety after HR in HCC patients aged >75 years (older) compared with HCC patients aged <75 years (younger).Method: One hundred sixty-eight patients who underwent HR for HCC from 1998 to 2015 in our Center were analyzed using a prospective database. Complications, disease-free survival rates, and cumulative survival rates were compared between the two groups.Results: During the immediate postoperative period, no differences were found about liver-related complications, hospital stay and 90-day mortality. However, older patients had more complications in class II or higher (Clavien classification) (p = 0.017). Although disease-free survival in both groups was similar (p = 0.099), overall survival was worse in the elderly group (p = 0.024). On multivariate analysis, only age ≥75 years was significantly related to overall survival.Conclusion: If elderly patients with liver cirrhosis and HCC are appropriately selected and evaluated, they might have favorable prognoses after HR. [ABSTRACT FROM AUTHOR]

Background: Improvements in liver surgery have led to decreased mortality rates. Symptomatic perihepatic collections (SPHCs) requiring percutaneous drainage remain a significant source of morbidity.Study Design: A single institution's prospectively maintained hepatic resection database was reviewed to identify patients who underwent hepatectomy between January 2004 and February 2012.Results: Data from 2173 hepatectomies performed in 2040 patients were reviewed. Overall, 200 (9%) patients developed an SPHC, the majority non-bilious (75.5%) and infected (54%). Major hepatic resections, larger than median blood loss (≥360 ml), use of surgical drains, and simultaneous performance of a colorectal procedure were associated with an SPHC on multivariate analysis. Non-bilious, non-infected (NBNI) collections were associated with lower white blood cell (WBC) counts, absence of a bilio-enteric anastomosis, use of hepatic arterial infusion pump (HAIP), and presence of metastatic disease, and resolved more frequently with a single interventional radiology (IR) procedure (85 vs. 46.5%, p < 0.001) more quickly (15 vs. 30 days, p = 0.001).Conclusions: SPHCs developed in 9% of patients in a modern series of hepatic resections, and in one third were non-bilious and non-infected. In the era of modern interventional radiology, the need for re-operation for SPHC is exceedingly rare. A significant proportion of minimally symptomatic SPHC patients may not require drainage, and strategies to avoid unnecessary drainage are warranted. [ABSTRACT FROM AUTHOR]

Introduction: Previous studies have shown benefit not only from postoperative chemotherapy but also from a short interval to initiation of treatment after resection of primary colorectal cancer. The aim of this study was to determine difference in timing to postoperative chemotherapy for minimally invasive resection (MIR) vs. open resection (OR) of colorectal cancer liver metastases (CRCLM).Methods: This is a retrospective review of 1:1 matched patients undergoing MIR (n = 66) and OR (n = 66) for CRCLM at a single institution.Results: Patients undergoing MIR of CRCLM had significantly shorter length of hospital stay, fewer major complications, and shorter interval to postoperative chemotherapy (median 42 vs. 63 days, p < 0.001). Univariable analysis showed that surgical approach, postoperative complications, blood loss, number of lesions, and length of stay were associated with timing to chemotherapy. On multivariable analysis, surgical approach was still associated with timing to chemotherapy, and postoperative complications resulted in a delay of chemotherapy among patients who underwent OR but not among those who underwent MIR. In addition, worse disease-free survival was seen among patients who received postoperative chemotherapy more than 60 days after surgery.Conclusion: By modifying the deleterious effects of postoperative complications on timing of postoperative chemotherapy, patients undergoing MIR for CRCLM are treated with chemotherapy sooner after surgery compared to those undergoing OR. [ABSTRACT FROM AUTHOR]

Background: Surgical resection is currently indicated for all potentially resectable intrahepatic cholangiocarcinoma (ICC), but the survival outcomes and the prognostic factors have not been well-documented due to its rarity. This study aims to assess these in a large, consecutive series of patients with ICC treated surgically. Methods: A retrospective study was conducted on 1,333 ICC patients undergoing surgery between January 2007 and December 2011. Surgical results and survival were evaluated and compared among different subgroups of patients. Univariate and multivariate analyses were performed to identify prognostic factors. Results: R0, R1, R2 resection and exploratory laparotomy were obtained in 34.8, 44.9, 16.4, and 3.9 % of the patients, respectively. The overall 1-, 3-, and 5-year survival rates for the entire cohort were 58.2, 25.2, and 17.0 %, respectively, with corresponding rates of 79.1, 42.6, and 28.7 % for patients with R0 resection; 60.5, 20.1, and 13.9 % for patients with R1 resection; 20.5, 7.4, and 0 % for patients with R2 resection; and 3.8, 0, and 0 % for patients with an exploratory laparotomy. Independent factors for poor survival included positive resection margin, lymph node metastasis, multiple tumors, vascular invasion, and elevated CA19-9 and/or CEA, whereas hepatitis B virus infection and cirrhosis were independently favorable prognosis indicators. Conclusions: R0 resection offers the best possibility of long-term survival, but the chance of a R0 resection is low when surgery is performed for potential resectable ICC. Further randomized trials are warranted to refine indications for surgery in the management of ICC. [ABSTRACT FROM AUTHOR]

Objective: Advances in multimodality therapy have led to increased survival for patients with metastatic colorectal cancer, but the impact on patients undergoing resection for colorectal liver metastases is unclear. The purpose of this study was to evaluate patterns of treatment for resectable colorectal liver metastases in the USA over the last two decades. Methods: Using the Surveillance, Epidemiology, and End Results-Medicare database, 1,926 patients who underwent hepatic resection for colorectal liver metastasis between 1991 and 2007 were included and divided into two cohorts: period 1 (1991-2000) and period 2 (2001-2007). Demographic data, treatment patterns, and outcomes of the two periods were compared by univariate methods. Multivariable regression models were constructed to predict the use of perioperative chemotherapy, postoperative complications, and 90-day mortality following liver resection. Results: The overall use of perioperative chemotherapy was 33 % and did not differ between periods, but shifted from postoperative to preoperative over time. By multivariable analysis, older age, black race, stage III primary cancer, and metachronous disease were predictive of lesser likelihood of chemotherapy use. The use of preoperative chemotherapy was not associated with any increase in perioperative morbidity or mortality. Conclusions: Despite increased survival and widespread recommendations for the use of multimodality therapy, the overall resection rate and use of perioperative chemotherapy for resectable colorectal liver metastases remain underutilized and have not increased over time. Efforts to investigate barriers to the widespread use of multimodality therapy for these patients are warranted. [ABSTRACT FROM AUTHOR]

Background: The purpose of this study was to compare the clinical and economic outcomes of robotic versus laparoscopic left lateral sectionectomy (LLS). Methods: A retrospective analysis was made comparing robotic ( n = 11) and laparoscopic ( n = 18) LLS performed at the University of Pittsburgh Medical Center between January 2009 and July 2011. Demographic data, operative, and postoperative outcomes were collected. Results: Demographic and tumor characteristics of robotic and laparoscopic LLS were similar. There were also no significant differences in operative outcomes including estimated blood loss and operating room time. Patients undergoing robotic LLS had more admissions to the ICU (46 versus 6 %), increased rate of minor complications (27 versus 0 %), and longer lengths of stay (4 versus 3 days). There were no significant differences in major complication rates or 90-day mortality. The cost of robotic and laparoscopic LLS was not significantly different when only considering direct costs ($5,130 versus $4,408, p = 0.401). However, robotic LLS costs were significantly greater when including indirect costs, which were estimated to be $1,423 per robotic case ($6,553 versus $4,408, p = 0.021). Discussion: Robotic LLS yields slightly inferior clinical outcomes and increased cost compared to the laparoscopic approach. [ABSTRACT FROM AUTHOR]

Background: Hydatid disease is a serious public health problem in endemic areas, and the management is controversial. Operative treatment is generally accepted especially in patients presenting complications. Our policy is to perform radical surgery and, whenever possible, anatomic hepatic resection. The purpose is to report our experience and results in the management of liver hydatid disease. Methods: Between January 1991 and December 2010, 97 patients were referred to our department for surgical treatment of hepatic hydatid cyst. Data were retrospectively reviewed. Patients were divided into three treatment groups: conservative surgery (CS), total pericystectomy (PC), and hepatic resection (HR). The main outcome measures were the mortality, morbidity, and recurrence rate. Results: Median patient age was 45 years (range, 30-56 years). A total of 105 hydatid cysts were treated. Radical surgery was performed in 85 patients: major HR in 43 patients, minor HR in 9, and total PC in 33. CS was performed in 12 cases. There were no postoperative deaths, and the overall morbidity was 20 %. Postoperative morbidity in the HR group was 20 %. Minor (Grade I/II) and major (Grade III/IV) complications were comparable between groups ( p = ns). No statistical difference in duration of hospitalization was observed between the CS and the HR group. One patient in the HR group developed a recurrence. Conclusions: The findings of this study suggest that surgical resection is not associated with much more postoperative and cyst cavity-related complications than the other groups. In addition, there was no mortality and a low recurrence rate. [ABSTRACT FROM AUTHOR]

Introduction: The optimal timing of primary and metastatic tumor management in patients with synchronous hepatic colorectal metastases remains controversial. We aimed to compare perioperative outcomes of simultaneous colorectal/liver resection (SCLR) with isolated resections utilizing a national clinical database. Methods: NSQIP data from 2005 to 2009 were examined to construct risk-adjusted generalized linear models and to calculate group-specific predicted estimates. These were used to compare 30-day perioperative outcomes among patients undergoing SCLR with colorectal (CR) and liver resections (LR) only in patients with metastatic colorectal cancer. Results: A total of 3,983 patients were identified, who underwent SCLR (192), LR (1,857), or CR (1,934). Rectal resection was performed in 45 (23.4 %) SCLR patients and 269 (13.9 %) CR patients ( p < 0.001). Major hepatectomy was performed in 69 (35.9 %) SCLR patients and 774 (41.7 %) LR patients ( p = 0.12). Median adjusted operation time (SCLR: 273 min, 95 % CI: 253-295; CR: 172, CI: 168-177; LR: 222, CI: 217-228; p < 0.001) and median adjusted length of hospital stay (SCLR: 9.5 days, CI: 8.8-10.4; CR: 8.1, CI: 7.9-8.3; LR: 6.4, CI: 6.3-6.6; p < 0.001) were longer for SCLR compared to CR and LR. Adjusted predicted risks for at least one postoperative complication were higher in SCLR (36.3 %) than in CR (26.6 %) and LR (19.8 %) ( p < 0.003), mostly due to infectious/cardiopulmonary issues. Discussion: In SCLR patients, the risk of 30-day adverse outcomes is higher, and median operation time as well as length of hospital stay is longer compared to CR and LR patients. However, the expected combined morbidities of staged procedures though likely favor SCLR in carefully selected patients undergoing even complex hepatic and colorectal resections and should be considered. [ABSTRACT FROM AUTHOR]

Background: Diaphragmatic hernia (DH) after hepatic resection (HR) is a rare and not well-described complication. We report our experience with DH following a high volume of HRs in a tertiary center. Methods: Records of patients undergoing major HR for liver tumors between April 1992 and November 2011 were reviewed. The definitive diagnosis of DH was made based on radiologic studies. Primary repair was used for defects <10 cm in size. Transthoracic repair was used in patients with recurrent or complex hernias. Univariate analysis was performed to determine risk factors associated with posthepatectomy DH. Results: DH developed in 10 out of 993 patients (1 %) at a median time interval of 15 months after HR. DH was not associated with old age ( m = 48.5 years), gender (male = 50 %), or high body mass index ( m = 24.5). However, mean tumor size was large ( m = 9.2 cm). The majority of patients presented with symptoms (80 %), small (60 %) and right-sided (80 %) hernias, and underwent elective repair via an abdominal approach (70 %). Large defects (>10 cm; 30 %) were successfully repaired with prosthetic mesh. Increased incidence of DH was associated with diaphragmatic resection at the time of HR (5.4 vs. 0.7 %, p = 0.001). At a median follow-up of 36 months (range, 10-167 months) after hernia repair, recurrence occurred in one patient. Conclusion: Diaphragmatic resection at the time of HR and large tumor size may put patients at risk of developing posthepatectomy DH. Early detection and prompt treatment is associated with low recurrence and offers the advantage of primary repair. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was to investigate the clinical outcomes after surgical treatment of hepatocellular carcinoma (HCC) in the elderly patients compared with younger patients. Methods: Clinicopathological data and treatment outcomes in 61 elderly (≥70 years old) and 90 younger (≤40 years old) patients with HCC who underwent curative liver resection between 2000 and 2010 were retrospectively collected and compared using various parameters. Results: The older HCC group was more likely to have hepatitis C virus and non-B non-C hepatitis virus infection, higher values of indocyanine green retention at 15 min (ICGR), more preoperative comorbidities, and more postoperative complications. There were no significant differences in intraoperative parameters and pathologic features. The recurrence rate, overall survival and disease-free survival rates were similar amongst the two groups. The only independent prognostic factor of overall survival was postoperative complications. Conclusion: Our findings suggest that age by itself does not have an adverse effect on operative outcomes, including long-term prognosis. For young and elderly HCC patients, hepatic resection is a safe and effective treatment. [ABSTRACT FROM AUTHOR]

Background: The present study investigated outcomes following surgical resection of hepatocellular carcinoma (HCC) in nonalcoholic fatty liver disease (NAFLD).Methods: Patients (n = 225) undergoing resection for HCC were divided into three groups: hepatitis C viral group (n = 147), hepatitis B viral group (n = 61), and NAFLD group (n = 17). Clinicopathological characteristics and surgical outcomes were analyzed retrospectively.Results: Patients in the NAFLD group were older (P < 0.001), with a higher body mass index (P < 0.001) and larger tumors (P = 0.002) than patients who were positive for hepatitis viral markers. Eight patients in the NAFLD group were found to have nonalcoholic steatohepatitis (NASH) histologically. Postoperative morbidity and 30-day mortality rates were significantly higher in the NAFLD group (59% and 12%, respectively) than in the hepatitis C viral (31% and 0.7%, respectively) and hepatitis B viral (28% and 3.3%; P = 0.043 and P = 0.016, respectively) groups. All deaths in the NAFLD group were in patients with NASH-related cirrhosis who had undergone right hemihepatectomy. Survival after resection was comparable among the three groups (P = 0.391), but patients with NAFLD showed better disease-free survival on univariate (P = 0.048) and multivariate (P = 0.020) analyses.Conclusions: Surgical resection may provide a survival benefit for patients with NAFLD-related HCC. Patients with NASH-related cirrhosis undergoing major hepatic resection should be treated carefully. [ABSTRACT FROM AUTHOR]

Background: Recently randomized controlled trials have been advocated to compare radiofrequency ablation (RFA) and hepatic resection (HR) in resectable tumours and determine whether differences in observed survivals result from the heterogeneity in previous studies between RFA (treating unresectable lesions) and HR (treating lesions deemed resectable). We reviewed the literature that directly compares the treatments and employed an evidence-based approach to examine the data. Materials and Methods: All studies comparing RFA and HR were included. Primary outcomes were the overall survival (OS) and disease-free survival (DFS) at 3 and 5 years. A subgroup analysis was conducted for solitary or small tumors (<4 cm for colorectal metastases (CRM) or <5 cm for hepatocellular carcinoma (HCC)). Results: Most studies were retrospective. For CRM, HR was markedly superior to RFA in respect of 3- and 5-year OS as well as 5-year DFS including tumours smaller than 4 cm and solitary lesions. For HCC, HR was markedly superior to RFA for 3- and 5-year OS as well as 3-year DFS, and produced a better OS at 3 years for solitary lesions and DFS at 3 years for small tumours. Conclusions: Multiple factors determine outcomes following treatment of liver tumours. Small or solitary lesions seem the most appropriate ones to study as this reduces the number of confounding variables, but even in these cases HR confers a better OS and DFS than RFA for both CRM and HCC. If our data are confirmed it will be important to examine other factors influencing the response. [ABSTRACT FROM AUTHOR]

Background: Lung changes after microwave tissue ablation (MTA) of different volumes of liver were compared with hepatic resection, cryotherapy (CRYO) and radiofrequency ablation (RFA).Methods: Live rats underwent MTA, surgical resection, CRYO or RFA of 15%, 33% and 66% of total hepatic volume and lung samples were collected at the time of death. Lung impairment was assessed directly by examining the tissue specimens for the degree of interstitial pneumonia and by comparing the alveolar thickness in the different groups.Results: All RFA and CRYO rats undergoing 66% of ablations died, but the MTA group had no fatalities. Following 66% RFA or CRYO ablations, the animals had a significantly increased thickness of the alveolar septa compared to 15% or 33% ablations and to 66% ablations in the MTA group.Conclusions: Large volume MTA is associated with a significant reduction in consequent lung damage and is well tolerated compared to RFA and CRYO. [ABSTRACT FROM AUTHOR]

The article discusses a study that examined cases involving surgical management of symptomatic bile duct hamartomas (BDH) diagnosed using magnetic resonance imaging (MRI). The researchers cross-referenced radiology and pathology databases with surgical records and included all cysts with a radiographic diagnosis of BHD in the time under study. Preventing undue complications due to superfluous instrumentation is suggested, as well as avoiding placing drains in the cysts.

Right-sided round ligament (RSRL) is a rare congenital anomaly that is strongly associated with a number of intrahepatic vascular anomalies. Here, we report a 77-year-old male case of hepatolithiasis associated with RSRL for which resection was performed using right hemi-hepatectomy (RHH). Intraoperative ultrasonography revealed that the portal branch of segment 4 ramified from the right anterior portal branch, and the patient was diagnosed as having RSRL. To decide the resection line, the portal branch of segment 4 was punctured and stained with indigo carmine under ultrasonographic guidance, clearly demonstrating the demarcation line between the right and left hemiliver. RHH was then carried out successfully without injuring the portal branch of segment 4. [ABSTRACT FROM AUTHOR]

Introduction: Hemangiopericytoma is an uncommon soft tissue vascular neoplasm. Intraperitoneal hemangiopericytomas such as primary or secondary liver location have been exceptionally described. Its natural history is mostly benign, but recurrences may occur and determining if these late-discovered tumors are distant metastases or synchronous slow and silent-growing locations is sometimes challenging. The histopathological diagnosis and definition of hemangiopericytoma is based on its distinction with solitary fibrous tumors. Liver resection to treat liver hemangiopericytoma seems to be supported by various published experiences.Case Presentation: We herein report the first case of liver metastases from a subcutaneous temporal hemangiopericytoma. The patient was treated by a liver resection. CD34 Immunostaining was negative, but strong expression of Bcl2 and CD99 was found in the neoplastic cells. After 1 year of follow-up, the patient is alive without recurrence.Conclusion: To date, published data, including the case herein reported, support the need for a prolonged follow-up and the role of liver resection to treat liver metastases of hemangiopericytomas. Complete resection of all gross disease appears to be the most significant prognostic factor. [ABSTRACT FROM AUTHOR]

Objective: The objective of the study was to identify patients who may benefit from local treatment in recurrent colorectal liver metastases.Materials and Methods: A total of 51 consecutive patients were treated for hepatic recurrence(s) after an initial partial hepatic resection. Surgery was considered as the primary treatment option for eligible patients. Patients with a small liver remnant after major hepatectomy were treated with radiofrequency ablation (RFA) or stereotactic body radiation therapy (SRx). SRx was given as an outpatient, emerging local treatment option for patients with intra-hepatic recurrences not eligible for surgery or RFA. Partial liver resection was performed in 36 patients (70%), RFA in ten patients (20%), and SRx in five patients (10%).Results: Median hospital stay was 7 (range, 3-62) days with a morbidity of 16% without in-hospital death. None of the patients received adjuvant chemotherapy. There was no difference in recurrence or survival between the three treatment modalities. Overall 5-year survival was 35% with an estimated median survival of 37 months. Patients with a disease-free interval between first hepatectomy and hepatic recurrence less than 6 months did not survive 3 years.Conclusions: Resection, RFA, and SRx can be performed safely in patients with recurrent colorectal liver metastases and offer a survival that seems comparable to primary liver resections of colorectal liver metastases. [ABSTRACT FROM AUTHOR]

Introduction: The role of ablation for hepatic colorectal metastases (HCM) continues to evolve as ablation technology changes and systemic chemotherapy improves. Our aim was to evaluate the therapeutic efficacy of radiofrequency ablation (RFA) of HCM compared to surgical resection.Methods: A retrospective review of our 1,105 patient prospective hepatic database from August 1995 to July 2007 identified 192 patients with only hepatic resection or only ablation for HCM.Results: Patients who underwent RFA were similar to resection patients based on a similar Fong score (1.8 vs. 2.1 p = 0.28), presence of extrahepatic disease (15% vs. 9% p = 0.19), mean number of hepatic lesions (2.8 vs. 2.1 p = 0.14), and prior chemotherapy (67% vs. 60% p = 0.33). Median time to recurrence was shorter with ablation than resection (12.2 vs. 31.1 months; p < 0.001). Recurrence at the ablation-resection site was more common with ablation than resection occurring 17% vs. 2% (p < or = 0.001) of the time, respectively. Distant recurrence in the liver was also more common with ablation occurring in 33% of patients vs. 14% for resection (p = 0.002).Conclusions: Surgical resection is associated with a lower chance of recurrence and a longer disease-free interval than RFA and should remain the treatment of choice in resectable HCM. [ABSTRACT FROM AUTHOR]

Background: Few studies identifying variables associated with prognosis after resection of colorectal liver metastases (CLM) account for treatment with multiagent chemotherapy (fluoropyrmidines with irinotecan, oxaliplatin, bevacizumab, and/or cetuximab). The objective of this retrospective study was to determine the effect of multiagent chemotherapy on long-term survival after resection of CLM.Methods: Demographics, clinicopathologic tumor characteristics, treatments, and long-term outcomes were reviewed.Results: From 1996 to 2006, 230 patients underwent resection of CLM. Treatment strategies before and after resection included fluoropyrimidine monotherapy (n = 34 and n = 39), multiagent chemotherapy (n = 81 and n = 73), and observation (n = 115 and n = 118). Prehepatectomy treatment strategy was not associated with overall survival. Actuarial 4-year survival was 63%, 39%, and 40% for patients treated with multiagent chemotherapy, fluoropyrimidine monotherapy, and observation after hepatectomy, p = 0.06. Posthepatectomy multiagent chemotherapy (p = 0.04, HR 0.52 [0.27-1.03]), duration of posthepatectomy chemotherapy treatment of 2 months or longer (p = 0.05, HR 0.49 [0.25-0.99]), carcino-embryonic antigen level >10 ng/mL (p = 0.03, HR 2.09, 95% CI [1.32-3.32]), and node positive primary tumor (p = 0.002, HR 1.79 [1.06-3.02]) were associated with overall survival in multivariate analysis.Conclusions: The association of posthepatectomy multiagent chemotherapy with overall survival in this retrospective study indicates the need for prospective randomized trials comparing multiagent chemotherapy and fluoropyrimidine monotherapy for CLM. [ABSTRACT FROM AUTHOR]

Introduction: Recently, many surgical procedures have become regionalized in the United States, likely owing to research demonstrating a relationship between volume and outcome. We sought to describe patient characteristics and outcomes according to hospital volume along with patterns of regionalization for hepatic resection in Canada from 1995 to 2004.Methods: Discharge data from all hospitals across Canada except Quebec were obtained from the Canadian Institute for Health Information for 1995-2004. All patients undergoing a hepatic resection were identified using ICD-9 and ICD-10 codes. High-volume hospitals were defined as those performing ten or more procedures per year.Results: A total of 9,912 patients (mean age 59 years) underwent hepatic resection. The proportion of procedures performed at high-volume hospitals increased from 42% in 1995 to 84% in 2004. Overall mortality rate for the study period was 5.0% which decreased over time. Mortality rates were higher at low-volume (6.1%) compared to high-volume centers (4.6%), but this finding was not statistically significant (p = 0.7451). Those factors predictive of mortality in a multivariate analysis included age, gender, year of operation, operative indication, comorbidity score, and admission status.Discussion: Mortality rates have significantly improved. Hospital volume is not a significant predictor of mortality following liver resection in Canada. [ABSTRACT FROM AUTHOR]

Introduction: Literature-based data on mortality after hepatectomy may be misleading, as poor outcomes are less likely to be published. The objective of the current study was to compare published vs public, nationally available mortality rates after hepatic resection.Materials and Methods: A systematic MEDLINE review was conducted to identify reports of hepatectomy outcome between January 1998-December 2004. Data were analyzed to calculate literature-based mortality rate and then compared with population-based mortality rate for hepatectomy using the Nationwide Inpatient Sample (NIS) dataset.Results: Twenty-three publications fulfilled screening criteria. The studies included 7,073 patients who had undergone hepatic resection (46.1% within USA vs 53.9% outside USA). Most patients were male (58.6%) with median age of 56 years. Indications for hepatic resection included hepatocellular carcinoma (47.7%), metastatic disease (34.3%), or other (18.1%). Cirrhosis was present in 23.2% of patients; 46.9% patients underwent either a hemi-hepatectomy or extended resection. The literature-based mortality rate was 3.6% (US centers only, 2.8%). Analysis of NIS revealed 11,429 hepatectomy cases. After controlling for gender, age, extent of hepatectomy, hepatocellular cancer diagnosis, and presence of cirrhosis, the adjusted NIS-based perioperative mortality rate for hepatectomy was 5.6% (95% CI, 5.0-6.2%). The relative mortality after hepatectomy was 1.6-fold higher based on population-based data compared with reports from the literature (P<0.05).Conclusion: Actual population-based mortality rates for major liver resections may be higher than those reported in the literature. Informed consent should reflect actual local and national mortality rates rather than selective reports from the literature. [ABSTRACT FROM AUTHOR]

Consensus is lacking concerning how to manage afferent vessels during hepatectomy, particularly as to the Pringle maneuver vs. selective hemihepatic clamping. Data for 81 hepatocellular carcinoma patients with chronic hepatitis or liver cirrhosis whose liver resection was limited to one section or less, including intraoperative data and postoperative liver function data, were analyzed retrospectively to compare two strategies. No significant differences of intraoperative data or postoperative clinical course were seen between the two groups, even in patients with chronic hepatitis or liver cirrhosis whose postoperative deterioration of liver function could be expected to be more than patients with a normal liver. The difference was evident only in serum alanine aminotransferase level on postoperative day 10 (mean ± SEM, 64.5 ± 5.1 IU in the Pringle group vs. 51.6 ± 4.4 IU in the selective clamping group; P < 0.05). During liver resection limited to one section or less, even with underlying chronic hepatitis or cirrhosis, intermittent use of the Pringle maneuver preserved liver function to the same extent as selective clamping. [Copyright &y& Elsevier]

A prophylactic abdominal drainage catheter is routinely inserted by many surgeons in patients after hepatic resection. Between January 2002 and September 2004, 462 consecutive patients who had undergone hepatic resection using a clamp crushing method by the same surgical team were retrospectively divided into the drainage group (n = 357) and the nondrainage group (n = 105). There was no difference in hospital mortality between the two groups of patients (drainage group, 0.6% vs. nondrainage group, 0%; P = 1.0). However, there was a greater incidence of surgical complications in the drainage group (31.4% vs. 8.6%, P < 0.001), and greater incidence of wound complications and subphrenic complications in the drainage group compared to the nondrainage group (24.4% vs. 4.8%, P < 0.001). In addition, the mean (± SEM) postoperative hospital stay of the drainage group was 13 ± 6.5 days, which was significantly longer than that of the nondrainage group (9.7 ± 3.3 days, P = 0.001). On multivariate analysis, abdominal drainage and intraoperative bleeding were the independent risk factors that were significantly associated with the incidence of drainage-related complications. The results suggested that routine abdominal drainage is unnecessary after hepatic resection when the conventional clamp crushing method is used during parenchyma transection. [Copyright &y& Elsevier]

The goal was to study our experience in the management of a series of patients with a potentially curative subserosal gallbladder cancer who were prospectively treated by the authors. Between April 1988 and July 2004, 139 patients were enrolled in our prospective database. Of the above, 120 were operated on with an open procedure and the rest with laparoscopic surgery. In only eight patients was the diagnosis suspected before the cholecystectomy. The majority of tumors were adenocarcinoma. Six patients had an epidermoid tumor, and one had a carcinosarcoma. Of the patients, 74 underwent reoperation, while in 55 (70.2%) it was possible to perform an extended cholecystectomy with a curative aim. Operative mortality was 0%, and operative morbidity was 16%. Lymph node metastases were found in 10 (18.8%), while in 7 (13.2%) the liver was involved. The overall survival rate was 67.7%, while in those who underwent resection, the survival rate was 77%. Through the use of a multivariate analysis, the presence of lymph node metastasis was found to be an independent factor with respect to prognosis. The feasibility of performing an extended cholecystectomy in patients with gallbladder cancer and invasion of the subserosal layer allows for a good survival rate. The presence of lymph node metastases represents the main poor prognosis factor, and some type of adjuvant therapy should be studied in this particular group. [ABSTRACT FROM AUTHOR]

Hepatic resection for colorectal hepatic metastatic disease has been demonstrated to have a significant outcome benefit for selected patients. Advances in anesthetic and surgical technique have resulted in a significantly reduced morbidity and mortality for this procedure, and this management approach has become widely practiced. This hepatic resection paradigm is also being applied to hepatic metastatic disease of noncolorectal origin. The purpose of this report is to review and summarize the reported literature in order to define if the current data support an indication for hepatic metastasectomy. The specific cancer primaries that this analysis evaluated include breast, melanoma, gynecologic, neuroendocrine, sarcoma, and gastric cancer. Based on the data examined, we propose that although hepatic metastasectomy for noncolorectal cancer may be a promising component of overall oncologic treatment, the role of surgical resection cannot be generalized and at present should be individualized based on the patient''s clinical course and by the biologic behaviors of specific malignancies. [Copyright &y& Elsevier]

Hepatic resection is the most effective therapy for liver metastasis of colorectal carcinoma. To clarify indications for this therapy, the clinicopathologic and follow-up data of 103 consecutive patients who underwent hepatic resection for metastases of colorectal carcinoma were analyzed. Factors influencing overall survival rate were investigated by multivariate analysis. Thereafter, patients who underwent resection were stratified according to the number of independent risk factors present, and their outcomes were compared with those of 14 nonresection patients with fewer than six liver tumors and without extrahepatic metastasis. The overall survival rate of the 103 resection patients was 43.1%. The clinicopathologic factors shown to affect on long-term survival after hepatic resection were the interval between colorectal and hepatic surgery (<12 months), preoperative carcinoembryonic antigen level (≥10 ng/ml), and number of hepatic metastases (four or more). The 5-year overall survival rates were 75.0% with no risk factors (n=16), 53.6% with one risk factor (n=46), 23.0% with two risk factors (n=36), and 0% with three risk factors (n=5). Survival rates did not differ between resection patients with three risk factors and nonresection patients. Therefore, hepatic resection may be appropriate for patients with fewer than three risk factors. [Copyright &y& Elsevier]

Hepatic resection is still considered the treatment of choice for hepatocellular carcinoma in patients with liver cirrhosis. Radiofrequency ablation is a new emerging modality. The aim of this study was to compare two homogeneous groups of patients who underwent either surgical resection or laparoscopic radiofrequency, analyzing the factors predicting survival and intrahepatic recurrences with use of a multivariate analysis. From February 1997 to April 2003, 98 patients were enrolled in this prospective study. Inclusion criteria were a single nodule of less than 5 cm, Child A-B class of liver function, and no previous treatment: 40 patients were in the surgical group and 58 patients were in the radiofrequency group. The two groups were homogeneous as far as preoperative characteristics were concerned. Operative mortality was zero, and the rates of operative morbidity were similar. Actuarial survival at 4 years was not significantly different (61% after resection and 45% after radiofrequency). There was a significant higher incidence of intrahepatic recurrences after radiofrequency than after resection (53% versus 30%; P=0.018). This was mainly due to local recurrences, whereas those appearing in other liver segments were similar in both groups. A multivariate analysis showed that the significant factors predictive of an intrahepatic recurrence were the level of α-fetoprotein, the etiology of cirrhosis, and the type of the treatment. On the other hand, multivariate analysis of the survival showed that only the level of α-fetoprotein was an independent predictor of survival. The results of our study showed a significant lower incidence of intrahepatic recurrences after resection compared with after radiofrequency. This seems not to significantly influence the overall survival, probably because of a prompt and effective treatment of the recurrences themselves. [Copyright &y& Elsevier]

Several techniques and devices have recently been developed in an effort to allow safer liver resections and avoid intraoperative blood loss. The aim of this study was to analyze our initial experience with hepatic resections using a new water-cooled, high-density, monopolar device—the Tissuelink Monopolar Floating Ball (Tissuelink Medical, Inc., Dover, NH)—in order to avoid bleeding during hepatic surgery. We analyzed patients who underwent hepatic surgery between January and June 2003. Sex, age, type of disease, and type of surgical procedure, in association with the duration of the surgical procedure, blood loss, use of vascular clamping of the liver, length of hospital stay, morbidity, and mortality were analyzed. Seven minor liver resections, two major liver resections, and one total cystopericystectomy were performed with the use of this new device. Average blood loss was 150 ml (range 50 to 300 ml). No vascular clamping was used with the exception of one patient. No deaths were recorded. Morbidity included ascites in one case and pleural effusion in another. In conclusion, the Tissuelink Monopolar Floating Ball permitted excellent coagulation of the cut liver surface, thus avoiding bleeding and vascular clamping. As a result, postoperative morbidity and mortality were low. [Copyright &y& Elsevier]

Diabetes is associated with alterations in liver metabolism and immune response that may influence postoperative recovery and long-term survival after hepatectomy for cancer. Patients with type I or type II diabetes mellitus submitted to a potentially curative hepatic resection for metastatic colorectal cancer were identified from the prospective database, and compared with patients with hepatic colorectal metastases submitted to resection during the same time interval, but without diabetes mellitus. Data on operative morbidity and mortality and long-term survival were analyzed. Between December 1990 and July 1999, a total of 727 patients underwent hepatic resection, 61 of whom (8.1%) had type I and type II diabetes mellitus. Operative mortality in the diabetic patients was significantly greater than in nondiabetic patients (8% vs. 2%, P < 0.02). Among patients with diabetes mellitus, four of the five perioperative deaths were due to liver failure after major hepatic resection (lobectomy or greater). All four of these patients had significant parenchymal abnormality (three with steatosis). Long-term survival was identical to that in nondiabetic control subjects. We conclude that the presence of diabetes is associated with a higher incidence of perioperative mortality. In patients with diabetes mellitus and parenchymal steatosis, major hepatic resection should be undertaken with caution. ( J Gastrointest Surg 2002;6:88–94.) [Copyright &y& Elsevier]

Hepatic resection remains the “gold standard” in the primary management of primary and metastatic tumors to the liver. Advanced surgical techniques along with more modern and sophisticated equipment have led to an increasing number of hepatic resections being performed with a concomitant decrease in morbidity and mortality. We followed prospectively 18 consecutive hepatic resections performed over a period of approximately 2.5 years. The setting was a community teaching hospital with a low volume of referrals for hepatic resection. Sixteen (88%) had metastatic disease and two had primary liver disease. There were four trisegmentectomies, four lobectomies, four segmentectomies, and six large wedge resections. Average estimated blood loss was 608 ml. Seven patients required transfusions. Complications occurred in five patients (27%). In-hospital mortality was 0%. Our experience suggests that liver resections in a low-volume community hospital can be performed safely provided an experienced surgical team with familiarity of advanced surgical techniques and sophisticated equipment used in hepatic resection is readily available. [ABSTRACT FROM AUTHOR]

Hepatic resection results in significant morbidity and mortality primarily related to intraoperatiye blood loss. Intermittent yascular inflow occlusion (VO) and low central venous pressure (CVP) during hepatectomy have been used to reduce blood loss. To determine the benefit or VO and low CVP, we reviewed the outcomes of 168 consecutive patients who underwent liver resection. The results of 78 patients who had undergone hepatic resection between 1993 and 1908 with the use of VO and low CAT (post-VO/CAP) were compared to the previous 90 patients who had undergone hepatcctomy without VO and low CAP (pre-VO/CVP) between 1979 and 1992. Hepatectomies were performed for metastatic disease (65%), hepatoma (20%), and benign minors (15%). Resections included 18 trisegmentectomies, 67 lobectomies, and 83 segmental resections. Patients in both groups were similar with regard to extent of resection. Post-VO/CVP patients had significantly lower median estimated blood loss (725 ml vs. 2300 ml, P <0.001), less postoperative morbidity (10.3% vs. 22.2%, P = 0.038), lower in-hospital mortality (2.6% vs. 10%, P = 0.050), fewer days in the intensive care unit (1.6 ± 0.1 days vs. 5.6 ±1.2 days, P =0.003), and shorter overall length of stay (8.0 ± 0.5 days vs. 15.0 ±1.6 days, P <0.001) than pre-VO/CVT patients. These data suggest that VO and low CAP dunnc liver resection may improve patient outcomes. [ABSTRACT FROM AUTHOR]