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In some patients with colorectal cancer and synchronous liver metastases, chemotherapy and current combinations of chemotherapy allow the size of these metastases to be reduced so that they can be surgically resected. However, in many patients, the initial systematic treatment of the primary tumor is associated with growth of the metastases (which predict the patient's life expectancy). This metastatic growth contraindicates surgical treatment that might otherwise be curative. We report the case of a patient with advanced recto-colonic cancer, which responded well to chemotherapy given as neoadjuvant treatment prior to surgery, in which the hepatic metastases were resected before excision of the primary tumor.

Introduction: Surgical resection is the only available treatment that improves survival in patients with liver metastases from colorectal cancer, particularly when carried out by a multidisciplinary team., Material and Method: We retrospectively analyzed a consecutive series of 116 patients who underwent 138 liver resections (65.4% minor and 35.5% major) for hepatic metastases from colorectal cancer between 1998 and 2004. In 34.5% of the patients, the lesions were synchronous. All patients were individually assessed by a multidisciplinary team. The mean number of metastases removed per patient was 2.43 (range: 1-10). The mean size of the largest tumor per patient was 40 mm (range: 12-90). In 67.3% of the patients, the primary tumor was at an advanced stage (III-IV). In 98% of the patients, the diagnosis was confirmed by helical computed tomography scans/magnetic resonance imaging and intraoperative ultrasonography., Results: Postoperative morbidity was 31.2% and mortality was 2.2%. A mean of 2.7 units of blood was transfused per patient. Overall 5-year survival was 43.2% (median 50 months). Survival rates varied according to whether the patients had < 4 or > or = 4 colorectal liver metastases (50 and 43 months respectively), tumor size (more or less than 5 cm) (60 and 50.6 months respectively) and whether the site was monolobar or bilobar (60 and 43.11 months respectively). In 16 patients, recurrence of liver metastases led to 22 rehepatectomies. Overall 5-year survival was 36.7% (median 60 months) after the first rehepatectomy but was 36 and 12 months respectively after a second or third rehepatectomy., Conclusions: These results confirm that multidisciplinary decisions and interventions by specialist liver surgeons, as in our hospital, reduce postoperative morbidity and mortality and increase survival in patients requiring surgical removal of liver metastases from colorectal cancer.

Caroli's disease consists of a congenital malformation of the intrahepatic bile ducts characterized by saccular, segmental, cystic dilatations giving rise to recurrent cholangitis. The inheritance pattern is unclear and the disease may be associated with other hereditary diseases such as adult polycystic kidney disease. The most effective therapeutic option in symptomatic unilobar Caroli's disease is resection of the affected lobe. In bilobar involvement, liver transplantation should be considered. Due to their rarity, we report three cases of Caroli's disease successfully resolved through lobectomy of the affected lobe: two patients with recurrent cholangitis and one patient with associated adult polycystic kidney disease.

Introduction: Mucin-producing pancreatic tumors account for 1% of all malignant tumors of the pancreas. Notable among these are intraductal papillary mucinous neoplasms of the pancreas, due to their variable clinical behavior, increased frequency, and the controversy surrounding the most suitable treatment and diagnostic methods. The aim of this study was to analyze the clinical presentation, epidemiological and pathological features, diagnostic methods, treatment and survival rates of these tumors., Patients and Method: We performed a prospective review of patients with a diagnosis of intraductal papillary mucinous neoplasm of the pancreas between 1996 and 2001. Demographic and clinical characteristics, diagnostic tests, surgical treatment, tumor characteristics and survival rates were studied., Results: There were 8 patients. The mean age was 65 years. The most common clinical presentation was abdominal pain. The most frequent localization was the pancreatic head. The most common diagnostic methods used were abdominal computed tomography, endoscopic retrograde pancreatography, and serum CA 19.9 levels. Seven patients underwent pancreatic resection and only one patient was not surgically treated. The mean follow-up period was 38 months with a survival rate of 75% and a recurrence rate of 25%., Conclusion: Intraductal papillary mucinous neoplasms of the pancreas generally appear in the sixth decade of life. The most common presenting symptom is abdominal pain. These neoplasms typically occur in the head of the pancreas. The most commonly used diagnostic test is computed tomography and the main treatment is early surgical resection. The prognosis is good after complete resection, with a 5-year survival rate of 60-70%.

Solid-pseudopapillary tumor of pancreas is a very rare neoplasm of low malignant potential and unknown origin. It generally occurs in young women and the prognosis is usually good after complete surgical removal. Two cases of solid pseudopapillary tumor with distinct disease duration are reported.

Objective: The purpose of this study was to evaluate the usefulness of secretin-enhanced MR pancreatography in evaluating morphologic changes and pancreatic function after pancreatoduodenectomy., Subjects and Methods: Twenty patients who underwent pancreatoduodenectomy were evaluated with secretin MR pancreatography. Single-shot fast spin-echo T2-weighted dynamic MR pancreatograms were obtained before and every minute for 10 min after secretin injection. Image analysis included image quality for the visualization of the pancreatic duct and morphologic features of the pancreatic duct (side branches, ductal narrowing, irregular ductal contour, and patency of the anastomotic site). Pancreatic function was assessed using the Van de Kamer method and the fasting blood glucose and oral glucose tolerance tests. Jejunal filling was graded from the lowest amount of filling (grade 1) to normal filling (grade 3) on the last MR pancreatogram., Results: The visualization of the main pancreatic duct was significantly improved with dynamic MR pancreatography (p < 0.05). The anastomotic site was visualized in 14 patients (70%) on MR pancreatography after secretin administration (p < 0.05). No statistically significant improvement in other morphologic data was seen after secretin administration. The sensitivity, specificity, positive predictive value, and negative predictive value of reduced jejunal filling (grade 1) for assessment of reduced pancreatic exocrine function were 92%, 71%, 85%, and 83%, respectively. The relation between reduced jejunal filling (grade 1) and diabetes was statistically significant (p < 0.05)., Conclusion: The administration of secretin improves visualization of the pancreatic ducts and helps in the evaluation of remnant pancreatic function after pancreatoduodenectomy.