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PubMed1999

Diagnostic and therapeutic video-assisted thoracic surgery resection of pulmonary metastases.

BACKGROUND: Appropriateness of video-assisted thoracic surgery (VATS) pulmonary metastasectomy for curative intent has been a controversial topic. We reviewed our experience with VATS wedge resection for peripheral lung metastases to determine the efficacy and potential adverse consequences of this approach for pulmonary metastasectomy. METHODS: One hundred seventy-seven patients underwent VATS resection of pulmonary metastases. Diagnostic resection (VATS-dx) was performed for 78 patients when percutaneous biopsy was unsuccessful or not feasible. Potentially curative resections (VATS-rx) were performed for 99 patients. The histologic findings in this group included colorectal (68), renal (7), sarcoma (6), breast (4), melanoma (3), head/neck (3), lymphoma (2), uterine (1), and "other" (5). The average number of lesions resected was 1.4 (range, 1-7). RESULTS: VATS resection was successfully performed for all VATS-dx and VATS-rx patients. There were no perioperative deaths. Longitudinal follow-up demonstrated a mean survival of 18 months in the VATS-dx group and 28 months in the VATS-rx group. In the VATS-rx group, 37 (37%) of 99 were free of disease, at a mean follow-up interval of 37 months. Of the 57 recurrences, 5% were local, 26% were regional, and 69% were distant. CONCLUSIONS: Results with VATS resection of peripheral pulmonary metastases for diagnostic and potentially curative intentions appear comparable with historical results by "open" thoracotomy. Careful patient selection based on high-resolution helical CT scanning is important to avoid compromise of therapeutic intent. Conversion to thoracotomy is indicated when lesions identified preoperatively are not found or when technical problems encountered may compromise surgical margins when resecting lung metastases for potential cure.

Adult↗
PubMed1999

The role of tumor resection in the treatment of glioblastoma multiforme in adults.

BACKGROUND: The therapeutic impact of tumor resection is poorly defined. Therefore the current study was conducted. METHODS: A retrospective, 2-institutional study was conducted (1991-1994) to compare the treatment results of stereotactic biopsy plus radiation therapy (99 patients; tumor dose: 60 gray [Gy]) with those of surgical resection plus radiation therapy (126 patients; tumor dose: 60 Gy). Only adult patients with supratentorial, lobar located, de novo glioblastoma were included. Survival time was analyzed with the Kaplan-Meier method. Prognostic factors were obtained from the multivariate Cox proportional hazards model. RESULTS: Patients were categorized in the Radiation Therapy Oncology Group (RTOG) Classes IV (46 patients), V (157 patients), and VI (22 patients). The resection group and the biopsy group did not differ in terms of age, pretreatment Karnofsky performance status KPS), gender, duration of symptoms, presenting symptoms, tumor location, tumor size, and the frequency of midline shift. Patients in the biopsy group more often were found to have left-sided tumors (P < 0.001). Transient perioperative morbidity and mortality rates were 1% and 1%, respectively, in the biopsy group and 5% and 1.6%, respectively, in the resection group (P > 0.05). The median survival time was 37 weeks for the resection group and 33 weeks for the biopsy group. The difference was not statistically significant (P = 0.09). The most favorable pretreatment prognostic factor was patient age < 60 years (P < 0.01). Tumor resection was highly effective in patients with midline shift (P < 0.01). In patients without midline shift radiation therapy alone was found to be as effective as tumor resection plus radiation therapy (P = 0.5). Patients with midline shift were more likely to have a worse KPS during the course of primary radiation therapy (P < 0.05). CONCLUSIONS: For RTOG Classes IV-VI patients with moderate mass effect of the tumor, radiation therapy alone is a rational treatment strategy. Tumor resection should be performed in patients with pretreatment midline shift whenever possible.

Adult↗
PubMed1999

1998 Distinguished Academician Lecture: hepatic resection--a Western perspective.

During the past two decades, resection of the liver has progressed from a rarely to a commonly performed operation with a low morbidity and mortality. The description of the functional anatomy of the liver was instrumental in the change from non-anatomic to anatomic resections. Major hepatectomies dominated the early experience but segment orientated resections now play a more prominent role. Resections may be performed for a variety of malignant or benign lesions or as an emergency for trauma or other catastrophic event. In the author's institution, 923 liver resections have been performed. The indications for the 825 elective resections were: metastases (46%), primary malignancy (30%) and non-malignant disease (24%). Two-thirds of the 98 emergency hepatectomies were for severe liver trauma. The 30-day mortality was 3.6% for the total series; 2.9% for elective resection, 1.6% for the non-jaundiced patients. In the last 300 elective resections, there has been one postoperative death and the median blood transfusion was zero. The development of innovative graft reduction techniques has made a major contribution to liver transplantation. The lack of suitable whole liver grafts for paediatric recipients was addressed by volume of reduction of adult donor livers so that the left lateral segment could be implanted safely in an infant's abdomen. This technique was the forerunner of split-liver transplantation, auxiliary partial orthotopic transplantation and living-related liver transplantation.

Adult↗
PubMed1997

[Treatment of carinal resections for primary pulmonary carcinoma].

Threeteen patients of lung cancer of center type underwent carinal resections in our department from January 1985 to December 1996. There were 3 patients, T3N2M0 and 10 patients, T4N2M0. Palliative resections were performed for 3 patients and radical resections, for 10 patients. Carinal resection with right pneumonectomy was done in 3 patients, part carinal resection with right pneumonectomy 6 patients, part carinal resection with left pneumonectomy 1 case, and part carinal resection with right sleeve upper and middle lobectomy 3 patients. There were no operative complications and deaths. The 3-year survival rate was 54% and the 5-year survival rates, 30%. One patient has survived for 8 years. The satisfied results of operative therapy were followed when no lymph node metastesis in mediastinum and mass could be resected.

Adenocarcinoma↗
PubMedDate not supplied

Factors influencing bowel function after low anterior resection and sigmoid colectomy.

BACKGROUND/AIMS: The aim of this study was to evaluate the subjective bowel function after low anterior resection and sigmoid colectomy and to clarify the clinicopathologic factors influencing postoperative bowel habits. METHODOLOGY: Eighty-six patients who underwent low anterior resection and sigmoid colectomy replied to the questionnaire which consisted of 8 categories of bowel symptoms. The patients were divided into 2 groups: good bowel function showing less than half of symptoms (< 4) and poor bowel function showing more than half of symptoms (> or = 4). RESULTS: After low anterior resection, patients were often complicated with incomplete evacuation (75%), bowel movement at night (60%), defecation more than twice a day (46%), and soiling (27%). The mean number of defecation/day and frequency of patients with night stools was significantly higher after low anterior resection than sigmoid colectomy (2.81 vs. 2.18, P < 0.05; and 60% vs. 29%, P < 0.05). Poor bowel function after low anterior resection was frequent in patients with high ligation of the inferior mesenteric artery (82%, P < 0.05), injury to the pelvic autonomic nerve (82%, P < 0.05), and blood transfusion; while poor bowel function after sigmoid colectomy was frequent in patients with resected colon measuring 25 cm or more (81%, P < 0.05). CONCLUSIONS: These results indicate that poor bowel function after low anterior resection is associated with high ligation of the inferior mesenteric artery and injury to the pelvic autonomic nerve; while poor bowel function after sigmoid colectomy correlates with length of the resected colon. Less aggressive surgery is needed to preserve good bowel function.

Aged↗
PubMed2000

[Three cases in which CR was obtained in residual metastatic lesions by intrahepatic arterial infusion after resection of hepatic metastases from colorectal carcinoma].

We report three cases in which CR was maintained after infusion (WHF) was performed for residual metastatic lesions following resection of hepatic metastases from colorectal cancer. (Case 1) A 55-year-old female with sigmoidal cancer and hepatic metastases, H2 (4 lesions). Right lobectomy and partial resection of the left lobe were performed. On the third month following surgery, CT showed two lesions in the lateral segment of the left lobe, and WHF was then begun. One month after the start of infusion, the lesions calcified and following that, disappeared. Infusion was performed for 12 months and the total amount of 5-FU was 52.8 g. Eight years and nine months following surgery, the patient is currently alive and without recurrence. (Case 2) A 65-year-old male with rectal cancer and hepatic metastases, H3 (6 lesions). Four lesions were removed by hepatic resection; however, 2 deep lesions in S4 and S5 were left unresected. WHF was begun one month following surgery, following which the lesions were undetectable by either CT or US. Infusion was performed for 18 months and the total amount of 5-FU was 81 g. Two years and ten months after surgery an isolated lung metastasis was discovered in the right lung and a thoracoscopic partial resection was performed. Eight years and four months following the original surgery and five years and four months following the lung operation the patient is alive and without recurrence. (Case 3) A 55-year-old male with rectal cancer and subsequently discovered hepatic metastases, H3 (5 lesions). Resection of the lateral segment and a partial resection of the right lobe were performed; however, one deep lesion in S7 was left unresected. WHF was begun on the 10th day following surgery. At about eight months there was a change in shape and shrinkage of the lesion. Infusion was performed for 11 months and the total amount of 5-FU was 48 g. Ten months following surgery, CT showed a new lesion in S7 and a partial resection was performed. Intraoperative US confirmed the disappearance of the previous residual lesion in S7. One year and one month following the original surgery, the patient is alive and without recurrence. From these results, it is suggested that with postoperative WHF it is possible to obtain a complete cure in cases of colorectal cancer with hepatic metastases without the resection of all lesions. (*WHF: 5-FU 1,000 mg/m2/5 hrs/week).

Aged↗
PubMed2000

[Videocardioscopy: a new way to assess resectability of cT4 lung cancer by vascular invasion].

OBJECTIVES: To demonstrate the usefulness of intrapericardial inspection of pulmonary vessels by video assisted thoracoscopy (VAT), for determining whether suspicion indicated by computed axial tomography (CAT) or magnetic resonance (MR) scanning is justified or not. PATIENTS AND METHOD: Since 1993 we have used exploratory VAT for final staging and assessment of lung cancer resectability. Intrapericardial vascular exploration (IVE) is a complementary method of assessing resectability in cT4 cases. We have performed 20 IVE among 460 VAT when intrapericardial involvement of pulmonary vessels has been suspected (19 men, 1 woman, mean age 64.6 years, range 50-77). VAT demonstrated invasion for 11 patients with previous suspicion based on hilar and vascular invasion shown by CAT scan; in 9 others such involvement was found during IVE for assessing resectability. VAT-IVE was performed through three or sometimes four entrance approaches, from which intrapericardial vessels were explored easily. RESULTS: Five cases were non-resectable: four due to invasion of the pulmonary artery to its point of origin and one due to extensive invasion of pulmonary veins and the left auricle. The remaining 15 cases were resectable and lesions were removed by posterolateral thoracotomy with intrapericardial dissection and ligature of the vessels. Five had been considered non-resectable by teams at other hospitals where they were classified as advanced cT4 cancers after imaging. The mean duration of IVE was 23 minutes (range 16 to 33); mean postprocedural stay was 48 h in non-resected patients, who were sent for neoadjuvant therapy on the third day. These patients, who underwent only IVE, had no complications and there were no deaths, with five unnecessary thoracotomies avoided. CONCLUSIONS: IVE allows correct staging of the T parameter in patients for whom T4 classification is suspected, avoiding unnecessary thoracotomies in non-resectable cases and allowing for surgical removal in cases where CAT or MR imaging results are unclear.

Aged↗
PubMed2001

[Carinal resection for bronchogenic carcinoma].

The purpose of this study was to evaluate the results of carinal resection for bronchogenic carcinoma in our institute. From 1981 to 1999, 24 carinal resection were performed for squamous cell carcinoma (n = 19), adenoid cystic carcinoma (n = 2), small cell carcinoma (n = 1), adenocarcinoma (n = 1), and mucoepidermoid carcinoma (n = 1). Nineteen underwent sleeve pneumonectomy, 2 had carinal resection without lung resection, 2 had carinal resection with right middle and lower lobectomy, and 1 had wedge pneumonectomy. In the patients with sleeve or wedge pneumonectomy, there were 5 operative death and 3 patients had survived for more than 3 years. Two patients with low-grade malignant tumors underwent carinal resection without lung resection and survived more than 10 years. We believe that limited carinal resection for low-grade malignant tumors are safe and valuable procedure. Careful selection of patients with sleeve or wedge pneumonectomy is mandatory.

Adult↗
PubMed2001

[Significance of liver resection for multiple hepatic metastases from colorectal cancer].

In colorectal cancer, liver metastasis is the most common and most important prognostic factor. To elucidate the significance of liver resection, we examined 72 cases (H2: 29 cases, H3: 43 cases). The 3-year survival rate for H2 and H3 patients was 71.5% and 4.5%, respectively. The liver resection rate in H2 and H3 patients was 58.6% (17/29) and 16.3% (7/43), respectively. In H2 patients the 3-year survival rate of those with liver resection and non-resection was 71.3% and 9.2%, respectively (p < 0.001). However, in H3 patients the 3-year survival rate in liver resection and non-resection patients was 80.0% and 43.9%, respectively (not significant). Many therapies, such as liver resection, hepatic arterial infusion, and systemic chemotherapy, were attempted for patients with hepatic metastases. Our data show that liver resection can prolong the survival of H2 patients only. On the other hand, hepatic arterial infusion therapy prolongs the survival of H3 patients only. Systemic chemotherapy does not prolong the survival of either H2 or H3 patients.

Adult↗
PubMed2001

[Indications for combined resection and reconstruction of the hepatic artery in biliary tract carcinoma].

More than 10 years have passed since hepatic artery resection was first performed for the treatment of biliary tract cancer. The safety of this procedure has been established with the introduction of the microsurgery technique. However, the benefits of and indications for this treatment have not yet been clarified. Twenty-three patients underwent vascular resection (portal vein in 7, portal vein + hepatic artery in 9, hepatic artery in 7) among 114 resected patients with biliary tract cancer in our institution. The right hepatic artery was reconstructed by end-to-end anastomosis in most cases. The curative resection rate was 88.9% in hilar bile duct cancer. However, it was less than 50% in other carcinomas. Cumulative 5-year survival rates of vascular resection patients with hilar bile duct cancer, lower bile duct cancer, gallbladder cancer, and cholangiocarcinoma were 14.8%, 25%, 0%, and 0%, respectively. On the other hand, the rates were 38.9%, 0%, 0%, and 0%, in the stage III + IV patients who did not undergo vascular resection. The longest survival period among patients with hilar bile duct cancer and lower bile duct cancer was 85 months and 65 months, respectively, whereas it was 15 months in gallbladder cancer and 20 months in cholangiocarcinoma patients. No hilar bile duct cancer patient who survived for more than 3 years had lymph node metastasis. The longest surviving cholangiocarcinoma patient has received adjuvant chemotherapy consisting of 5-fluorouracil and cisplatin. It is concluded that patients with hilar bile duct cancer are good candidates for vascular resection. Adjuvant chemotherapy should be administered to gallbladder cancer and cholangiocarcinoma patients, because vascular resection alone does not result in prolongation of life in these patients.

Aged↗
PubMed2001

Radical resection improves survival for patients with pT2 gallbladder carcinoma.

Radical resection (wedge resection of the gallbladder bed and dissection of the hepatoduodenal ligament, portal, and celiac lymph nodes) has been reported to improve survival from pathologic T2 gallbladder carcinoma (pT2 GBCa; invasion through the muscularis without perforation of the serosa). We report our experience and the outcome of patients with pT2 GBCa. Between 1989 and 2000 at Vanderbilt University Medical Center ten patients were found to have pT2 disease after cholecystectomy. The patients had an average age of 64+/-13 years and underwent either radical resection (n = 5) or no further surgical therapy (n = 5). Of the patients who underwent cholecystectomy only, one (20%) is still alive at 27 months and four (80%) died of recurrent GBCa between 6.5 and 21 months. For the patients who underwent radical resection all five are alive at 15 to 83 months with no recurrence. The proportion of patients surviving pT2 GBCa after radical resection was significantly greater than with cholecystectomy alone (P < 0.05). The difference in length of survival between the two groups was also significant (P < 0.05). Morbidity after radical resection was low (pancreatic leak in one patient), and there were no operative mortalities. Radical resection significantly improved survival over cholecystectomy alone for patients with pT2 GBCa. The procedure has low morbidity and mortality rates. Therefore a radical resection operation is indicated for patients with pT2 GBCa.

Adenocarcinoma↗
PubMed1999

[Study of recurrence and metastasis after radical resection of carcinoma of the lung].

OBJECTIVE: To study the characteristics of recurrence and metastasis following radical resection of carcinoma of the lung. METHODS: A total of 1,229 cases of radically resected lung cancer was statistically analyzed using STATA software. The survival rate was estimated using life table method. Comparisons of survival in each group were made according to the log rank test. The differences in rate between groups was assessed by chi 2 test. RESULTS: Recurrence rate was found higher in squamous-cell carcinoma than in adenocarcinoma. It was also higher in sleeve resection and partial resection than in other resection modes (P < 0.05). The rate of lymph node metastasis was higher in adenocarcinomas than in squamous-cell carcinoma (P < 0.05). Lung, bone, brain, liver, subcutis, and adrenal glands were the common resorts of metastasis, in decreasing order of frequency. Metastatic rate was the lowest in squamous-cell carcinoma. Active therapy can still improve the survival even when recurrence and metastasis occurred. CONCLUSION: It is recommended to avoid partial resection for the invaded adjacent lobe whenever patient's condition can stand multilobectomy. It is necessary to assure resection margin length when sleeve resection is performed in order to reduce recurrence. Active therapy can improve survival of patients with recurrence and metastasis.

Adenocarcinoma↗
PubMedDate not supplied

Ultrasound-guided liver resections for hepatocellular carcinoma.

Imaging-guided interventional procedures have modified the approach to hepatocellular carcinoma including the surgical one. In fact, liver resections can be carried out with no mortality even if cirrhosis is associated, combining the needs for oncological radicality and liver parenchyma sparing mainly because of the extensive use of intraoperative ultrasonography either for tumor staging or resection-guidance. The aid of intraoperative ultrasonography is therefore optimizing the balance between the oncological radicality and the sparing of the highest amount of functioning liver parenchyma. Intraoperative ultrasonography allows the accomplishment of anatomical resections otherwise not possible such as the systematic segmentectomy. This is of crucial importance if taking into account that anatomical resections seem able to provide better prognosis than the non-anatomical one. However, if non-anatomical resection is carried out intraoperative ultrasonography guidance allows a better tumor clearance. Precise definition of hepatic vein anatomy and association with color Doppler enables hepatectomies otherwise not possible, expanding the indication at surgical resection. In conclusion, we can affirm that liver resection is an imaging-guided procedure and as every interventional imaging-guided procedure, its features are the highest therapeutic efficacy combined with the minimal invasiveness. Then, with the intraoperative ultrasonography guidance liver resection remains the treatment of choice of hepatocellular carcinoma.

Body Weights and Measures↗
PubMed2002

Pancreatic resection for locally advanced primary and metastatic nonpancreatic neoplasms.

We conducted a retrospective review of our single-institution experience with pancreas resection for locally advanced primary malignancy or metastases from other organs. From January 1989 through April 2001 35 patients underwent pancreatic resection for locally advanced primary (17) and recurrent nonpancreatic (18) tumors. Patient records were examined for recurrence and survival. Seventeen patients with locally advanced primary tumors presented with pancreatic extension either into the head/body (six) or tail (11). Pancreatic resections were completed as en bloc procedures with the primary disease of stomach (five), colon (four), sarcoma (five), adrenal gland (one), or spleen (one). Procedures performed included pancreaticoduodenectomy for proximal lesions and distal pancreatectomy for disease limited to the pancreatic tail. Median overall survival was 56 months. Fourteen of 17 patients remain alive: three with disease and 11 without evidence of recurrence. Eighteen patients presented with recurrent tumor from a previously resected right upper quadrant tumor (nine) or metastases from an intra-abdominal source (nine). The primary source was colon (eight), biliary (three), sarcoma (three), melanoma (two), ovary (one), and unknown primary (one). Patients underwent pancreaticoduodenectomy, distal pancreatectomy, or resection of residual pancreas. Overall median survival was 46 months. In this group of 18 patients there was no increased survival in those patients with a time to recurrence from their primary tumor resection greater than 2 years. We conclude that pancreatic resection for locally advanced nonpancreatic or recurrent intra-abdominal malignancies is possible in properly selected patients. The ability to obtain disease-free margins through en bloc resection is a key component of therapy.

Abdominal Neoplasms↗
PubMedDate not supplied

Prognostic factors of intrahepatic cholangiocarcinoma after hepatic resection: univariate and multivariate analysis.

BACKGROUND/AIMS: Intrahepatic cholangiocarcinoma is clinicopathologically distinct from hepatocellular carcinoma and hilar cholangiocarcinoma, and the prognostic factors after hepatic resection of these rare tumors are not well documented. The aim of this study was to evaluate prognostic factors of intrahepatic cholangiocarcinoma after hepatic resection. METHODOLOGY: We retrospectively studied 20 consecutive patients with intrahepatic cholangiocarcinoma who underwent hepatectomy over a 15-year period from 1984 to 1998. Fifteen prognostic factors were evaluated for their association with overall and disease-free survivals in univariate and multivariate analysis (Cox's proportional hazards model). RESULTS: Eighty percent of the resected patients had major hepatectomy. Operative morbidity and mortality rates were 30% and 0%, respectively. Four patients (20%) survived more than 5 years without recurrence after hepatic resection. The 1-year, 3-year, and 5-year overall or disease-free survival rate after hepatic resection were 56.0% or 49.5%, 43.8% or 43.3%, and 43.8% or 37.3%, respectively. Univariate analysis showed young age and periductal invasion tumor or the presence of vascular invasion, lymphatic invasion, and lymph node metastasis as significant poor prognostic predictors contributing overall and disease-free survivals. Multivariate analysis revealed only lymph node metastasis as an independent prognostic factor affecting disease-free survival. During the same time, 17 unresectable patients were treated by intrahepatic arterial infusion chemotherapy (12), systemic chemotherapy (4), or radiation (1). Median overall survival time in resected patients (16 months) was significantly better than in unresectable patients (5 months) (P = 0.005). CONCLUSIONS: Hepatic resection remains to be the best current therapeutic option. The prognosis after hepatic resection for intrahepatic cholangiocarcinoma was determined by lymph node metastasis. New adjuvant chemotherapy after surgery is imperative for such patients.

Aged↗
PubMed2002

[Resection made possible following hepatic arterial infusion in 2 cases of hepatic metastases from colorectal cancer].

Of 66 examples of hepatic metastases from colorectal cancer, 30 cases in which resection was performed had 3- and 5-year cumulative survival rates of 66.7% and 56.8%, while in 36 cases in which resection was not possible, the percentages were 8.7% and 2.9%, respectively. In two of the latter cases, resection was possible following WHF (5-FU 1,000 mg/m2 5 h qw). Case 1: A 58-year-old male, with rectal cancer and multiple metastases (H3, synchronous). Arterial infusion was performed 21 times, with the total volume of 5-FU administered being 31.5 g. The size of the lesions was reduced and hepatic resection was performed. The patient later died due to local recurrence and intra-abdominal lymph node metastases. He had survived 2 years and 11 months following hepatic resection and was free from recurrence of hepatic metastases. Case 2: An 82-year-old female, with cancer of the ascending colon, sigmoidal colon and multiple hepatic metastases (H3, metachronous). Arterial infusion was performed 16 times, with the total amount of 5-FU administered being 20 g. A lowering of CEA levels and reduction of tumor size were achieved, and hepatic resection was performed. Seven months following hepatic resection, CEA levels are normal and no distant metastases or recurrence in the residual liver have been found: possibly a complete cure. Even among cases of unresectable hepatic metastases from colorectal cancer, there are some in which resection is possible following hepatic arterial infusion chemotherapy, with the possibility of complete cure.

Aged↗
PubMed2002

[Hepatic resections for hepatocellular carcinoma and cirrhosis].

Liver resection in a patient with cirrhosis carries increased risk. The purposes of this study were to review the results of cirrhotic liver resection in the past decade and to propose strategies for low morbidity and mortality. From January 1991 to December 2000 73 patients with primary liver cancer (PLC) were operated and identified in a retrospective database. Twenty five (34%) patients had underlying cirrhosis: 14--Child A and 11--Child B. There were 18 male and 7 female with mean age 60.9 +/- 9.2 (from 44 to 78). There were 16 (64%) resections: 11--stage Child A and 5--stage Child B. Major resections were 7 and minor--9. Eight patients received hemotransfusion--mean 939.13 ml (370-2000 ml). Four patients (25%) died of the hepatic resection--by the 30-th day. Seven patients had postoperative complications. 4 patients developed liver failure. Major resections had 42.86% mortality, minor resections--11.11%. Hepatic resection is potentially curative therapy for HCC and cirrhosis especially in Child A. Child B produce high rate of postoperative morbidity and mortality.

Adult↗
PubMed2003

Resection of central hepatic malignant lesions.

Tumors within the central hepatic region can be managed by various operative techniques. The aim of hepatic resection should be to render the patient free of disease while limiting the excision of functioning parenchyma. Technical feasibility, improved anatomical understanding, and advanced support services have enabled access to lesions previously considered unresectable. Various surgical options and outcomes from a single surgeon's experience are presented. Thirty-three patients underwent surgical resection for central hepatic lesions adjacent to the anterior hilar plate from 1980 to 2001. The mean patient age was 55.7 years (range 34-82). The mean lesion size was 7.7 cm (2-21). Malignant lesions were most commonly encountered in segments IV and V (43%). The most common resection performed was a central hepatic resection (55%) followed by right trisegmentectomy (27%). Resections were primarily performed for metastatic colon cancer (48%), cholangiocarcinoma (25%), and hepatocellular carcinoma (15%). The 5-year survival was 45 per cent for metastatic colon cancer, 20 per cent for cholangiocarcinoma, and 66 per cent for hepatocellular carcinoma. The overall morbidity was 43 per cent, and there was a single mortality. The size, location, and extension of hepatic tumors are important factors that may predict the extent of hepatic resection. Small centrally located focal lesions are amenable to central hepatic resection with biliary reconstitution hence limiting extensive resections. Valuable 5-year patient survival and a low mortality rate were achieved.

Adult↗