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Hepatocellular carcinoma mainly develops in a cirrhotic liver; in the majority of the patients chronic hepatitis or cirrhosis are virus-related and/or postalcoholic. Liver resection is the gold standard treatment when there is no multifocality of the tumor and liver disease is not advanced (patients with Child-Pugh A score, or B in selected cases). In our experience the presence of vascular invasion and satellite nodules is clearly related to a decreased rate of disease-free survival and a higher percentage of intrahepatic recurrence.

At the present, surgical treatment still represents the only chance of cure for liver metastases from colorectal cancer. Moreover in the last years the new chemotherapic adjuvant and neoadjuvant regimens and the use of radioablative techniques as radiofrequency have improved resectability and even survival. Besides, iterative surgery seems to show more and more encouraging results in terms of disease-free and overall survival, sometimes even in patients already resected for extrahepatic disease. The golden rule is in fact to try to perform every time an R0 resection, with no macro- and possibly microresidual disease.

Only recently, in our laboratory of experimental surgery, we started with a protocol for orthotopic liver transplantation (OLT) in a pig model. This was felt as mandatory for experimental purposes as well as for future clinical applications at our center. We report herein our own experience with 41 OLTx. Intraoperative "lethal" complications occurred in up to 32% (14/41) whereas postoperative complications occurred in the remainders at different intervals of time with a maximum survival of 30 days. No attention was paid to prevent rejection-infection episodes. The main cause of death was the primary non-function (PNF) or dis-function (PDF) manifested either intra or postoperatively in 16 out the 41 OLTx (39%). Intraoperative technical errors accounted for up to 9% (4/41 OLTx). Acute hemorrhage gastritis and gastric perforations occurred postoperatively in 6 animals (14%) and represent one of the peculiar aspects of OLT in pig model.

Restorative proctocolectomy with ileal-anal anastomosis can induce a duodenal stenosis due to the compression between superior mesenteric artery (SMA) and aorta when the ileum is pulled-down to the anus stretching the SMA. This situation may require prolonged nasogastric intubation or even surgery. In our experience this occurred in 10% of pts. Aiming to avoid this complication we have performed an intestinal derotation just before ileal-anal anastomosis abolishing any possibility of duodenal compression. Comparing this latter group of patients to those who didn't receive intestinal derotation, we observed a significant reduction of nasogastric tube drainage and of the nasogastric intubation time. We think that intestinal derotation could be effective in preventing SMA syndrome after restorative proctocolectomy and ileal-anal anastomosis.