The very late observation of an hydatid cyst of the liver, after clinical or fortuitous signs (intraoperative, ultrasound, CT) is a highly underestimated possibility. From 4 cases of hydatid cysts of the liver which were removed 10 to 22 year after a pulmonary hydatidosis, any possibility of parasitic reinfestation during this time being excluded, the authors propose a physiopathological explanation to an often very long clinical latency period of the liver hydatidosis. Indeed the pulmonary location of the hydatid disease means that the hepatic filter did not properly operate or was bypassed, but it does not exclude a simultaneous intrahepatic graft. The literature study shows a 4 to 8.4% rate of concomitant liver-lung location according to the statistical data provided by thoracic and digestive surgery departments. The percentage reaches 25% when ultrasounds and abdominal computed tomography are systematically used. The rapid growth of the hydatid cyst in the lung can be explained by the low resistance of the lung parenchyma and vasculo-bronchial structure to the intracystic pressure, whereas in the liver, the hydatid cyst growing is stopped by a dense parenchyma and the hepatobiliary capsules. When fissuring or large opening in the biliary tract occurs the intracystic pressure drops, the pericyst becomes sclerotic, calcified. The combination of these different factors all the more contributes to the cyst involution since it presents a central topography.

Adult↗

PubMedDate not supplied

[Surgical possibilities in the treatment of hepatic metastases].

314 patients with liver metastases were admitted to the Department of Surgery. University of Angers, from 1963 to 1983. The primary sites include tumors of the colon and rectum (129 patients), pancreas (74 patients), stomach (51 patients), extrahepatic bile ducts (38 patients), esophagus (7 patients), small intestine (4 patients), ovaries (4 patients), kidney (3 patients) and 4 malignant melanomas. Surgical management of liver metastases was hepatectomy (23 cases) or wedge resection (4 cases) when metastases were solitary or multiple but unilateral, selective (2 patients), total (4 patients), temporary (4 patients), desarterialization or regional intraarterial chimiotherapy (12 patients) were performed for non resectable metastases. Most of the resections (22 cases) were done for apparently solitary metastases from colorectal cancer, while a palliative treatment was utilized for some hypervascular deposits from renal, ovarian and endocrine primary tumors. The operative mortality rate was 4 per cent (2 of 49 patients): one right, and one left hepatectomies. Nine patients survived more than 2 years after liver resection, two lived more than 4 years; the longest survival (62 months) occurred after plurisegmentectomies for carcinoid metastases. The results of palliative surgery were deceptive, 14 patients died within one year, 2 patients survived 2 years, and 1 patient had a 68 months survival after liver desarterialization for carcinoid metastases. We conclude that an agressive surgical approach in the treatment of solitary or multiple resectable liver metastases is based upon several tenets. The primary tumor, when the site is the colon or the rectum preferendly must be well differentiated, Dukes B class, especially with no evidence of extrahepatic metastases.(ABSTRACT TRUNCATED AT 250 WORDS)

Antineoplastic Agents↗

PubMedDate not supplied

[Obstruction of the extrahepatic bile ducts by tumor debris and/or clots in primary cancer of the liver. Diagnostic and therapeutic problems. Apropos of 9 personal cases and review of the literature].

The onset of jaundice in patients with primary liver cancer is sometimes caused by intra ductal biliary system tumor casts, free floating debris or hemobilia. The diagnosis of this complication is now possible by E.R.C.P. or P.T.C. We report 9 cases of unrecognized primary liver tumor revealed by intra biliary system migration of tumor casts or free floating debris. In three patients the diagnosis was operative, but for the last six cases the E.R.C.P. data in addition with U.S., C.A.T. Scan and/or hepatic angiography were helpful in determining the nature of the hepatic and biliary changes, the operability (size, location, extent). A curative surgery was not indicated in our 8 operated patients: liver resection and biliary decompression. With the palliative procedures, bilio enteric by pass (2 cases) T tube (1 case) trans hepatic uni or bilateral tubes. The survey was not longer than 11 months. Three patients died in post operative course. Only 56 patients among 117 observations of the literature have been operated: 10 liver resections including the main hepatic junction in two cases were performed with one hospital death, two patients were alive over 2 years with recurrence and three patients were disease free with a follow up less than one year. The operative mortality with palliative procedures was 34.4%; the one-two years survival was 23%; the two longest survivors lived 41 and 61 months.

Adenoma, Bile Duct↗

PubMedDate not supplied