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PubMedDate not supplied

An 11-year survivor who underwent ten sequential resections of colonic adenocarcinoma metastases.

Hepatectomy is an established treatment for colorectal carcinoma liver metastases. However, the benefit of multiple repeat metastasectomies in the management of colorectal carcinoma patients remains uncertain. We report the case of a 47-year-old man who underwent ten sequential resections of intra- and extrahepatic colonic adenocarcinoma metastases. Metastasectomy procedures in this case included: 6 hepatic resections, 2 pulmonary resections, 1 pulmonary resection combined with wide resection of the abdominal wall, and 1 wide resection of the abdominal wall. The patient finally died, from unresectable metastases to the liver and pancreas, 133 months after the initial hepatectomy. The aggressive multiple repeat metastasectomies may have provided this unusual long-term palliation. Colorectal carcinoma patients with sequential resectable recurrences may be candidates for multiple repeat metastasectomies. Surgeons should pursue resection for colorectal carcinoma metastases, regardless of frequent operations and sites involved, as reliable medical treatment remains unestablished.

Adenocarcinoma↗
PubMed1992

Hepatic resection in patients with cirrhosis and hepatocellular carcinoma.

Hepatic resection can be performed safely in carefully selected patients with cirrhosis. To minimize morbidity and mortality, it is essential to reliably estimate functional hepatic reserve and the extent of tumor before resection is performed. Child's classification is a reliable predictor of long term survival, but a more sensitive measure of hepatic function is needed to predict early morbidity and mortality. Child's classification can also be used to stratify patients and exclude those at high risk from hepatic resection. Promising predictors of operative mortality focus on the mitochondrial function of hepatocytes and include cytochrome a (+a3) contents and the redox tolerance index. Patients with advanced cirrhosis are not candidates for extensive hepatic resection and require careful evaluation before consideration for any hepatic resection. In patients with well-compensated cirrhosis and unifocal tumors, the procedure of choice is an anatomic resection of the tumor. If tumor size and location allows, a segmentectomy offers the best outcome, minimizing postoperative liver dysfunction while offering a long term outcome not dissimilar to a major liver resection. In highly selected patients with incidental tumors, a central tumor and perhaps in patients with multifocal hepatocellular carcinoma, hepatic transplantation may be of benefit. By using the appropriate predictors of hepatic function, refined surgical techniques and optimal postoperative care, a mortality rate of less than 10 per cent is achievable in cirrhotic patients with hepatocellular carcinoma who require resection.

Carcinoma, Hepatocellular↗
PubMed1992

R2 compared with R1 resection for gastric cancer: morbidity and mortality in a prospective, randomised trial.

OBJECTIVE: To compare the postoperative course of patients in the Dutch nationwide randomised trial of R1 (conventional) compared with R2 resection (including extended lymph node dissection) in the treatment of gastric cancer. DESIGN: Prospective randomised controlled trial. SETTING: National multicentre trial with 72 participating hospitals in The Netherlands. SUBJECTS: 192 patients who were operated on between August 1989 and May 1990. INTERVENTIONS: 96 patients were randomised for a R1, and 96 for a R2 resection. MAIN OUTCOME MEASURES: Morbidity and mortality among 131 patients (64 R1 and 67 R2) for whom the resection was performed with curative intent. RESULTS: The groups were comparable for age, sex, type of resection, site of tumour and depth of invasion. Complications developed in 23 R1 (36%) and in 29 R2 patients (43%). Seven patients died in the postoperative period. Median hospital stay was significantly longer after R2 (18 days, range 7-122) than after R1 resection (15 days, range 2-63) (p < 0.05). Morbidity and mortality among the patients whose R2 resection was done by the Japanese instructor (n = 34) did not differ significantly from those among patients operated on by the Dutch supervisors (n = 33), but those operated on by the Japanese instructor stayed in hospital significantly longer (20 compared with 16 days, p < 0.05). CONCLUSIONS: If R2 resections are carried out by properly trained surgeons under supervision, they can be done safely. The reported high morbidity after R2 resection in Western countries seems to result from a lack of proper instruction and quality control.

Adenocarcinoma↗
PubMed1992

Modified anoabdominal rectal resection and colonic J-pouch anal anastomosis for lower rectal carcinoma: preliminary report.

BACKGROUND: There has recently been increasing interest in coloanal reconstruction after proctectomy for low rectal carcinoma. We describe here our pilot experience with seven patients undergoing modified anoabdominal resection of the rectum and a colonic J-pouch anal anastomosis. METHODS: The procedure varied according to the extent of internal anal sphincter (IAS) resection (type a, partial resection of the upper IAS; type b, circumferential resection of the upper IAS; type c, partial preservation of the lower IAS; and type d, total resection of the IAS). RESULTS: None of the patients had incontinence, but preservation of the lower half of the IAS (types a and b) showed functional superiority over more extensive IAS resection (types c and d). Only patients who underwent types c and d resection needed medications to reduce stool frequency. CONCLUSIONS: Our results suggest that the lower half of the IAS has a more important role than the upper half in the control of defecation. Total resection of the IAS did not sacrifice continence, but preservation of at least the lower IAS resulted in a better quality of life. Careful patient selection is needed when considering the use of these procedures for tumors in the lowest part of the rectum.

Adenocarcinoma↗
PubMed2003

[An inquiry into blood loss in laparoscopic liver resections].

OBJECTIVE: To investigate the potential causes and preventive measures for blood loss in laparoscopic liver resection. METHODS: The candidates for laparoscopic liver resections were 21 patients with liver lesions, including 13 patients with primary liver cancer, 2 patients with liver abscess, 3 patients with liver hemangioma, 1 patient with hepatic cellular adenoma, 1 patient with hepatic focal nodular hyperplasia, and 1 patient with infected liver cyst. They were classified as Child A in 16 and B in 5 patients. RESULTS: Twenty-one patients with liver lesions underwent 23 laparoscopic resections uneventfully. Operating procedures included partial liver resection in 12 patients, segment IV in 1 case and anatomical left liver resections in 8 patients. Operation duration was 80 - 320 (mean 193.8 +/- 78.3) minutes. The blood loss in operation was 100 - 1000 (mean 333.1 +/- 291.4) ml. The postoperative hospital stay averaged 6.3 +/- 1.5 days, which was markedly shortened in comparison to conventional laparotomy liver resections. In addition, there was no complication in this series. CONCLUSIONS: Based on these preliminary results, occlusion of hepatic vessels with clamp is very important for partial liver resection. The key technique is to control the blood loss in operation. We conclude that laparoscopic liver resection is a prospective minimally invasive technique. These experiences suggest that laparoscopic procedures could be employed both in the treatment of benign and malignant tumors in selected cases.

Adult↗
PubMed1992

Prospective study of aggressive resection of metastatic pancreatic endocrine tumors.

BACKGROUND: Because metastatic pancreatic endocrine tumors (MPET) have a poor prognosis, 17 patients with potentially resectable MPET were prospectively studied to define the efficacy of aggressive resection. METHODS: Patients underwent resection when the full extent of MPET was deemed operable after imaging studies were obtained. Two patients underwent three reoperations for recurrent tumor. RESULTS: MPET were completely excised in 16 of 20 cases by major resections of liver, viscera, and nodes, with no operative mortality. Survival was 87% at 2 years and 79% at 5 years with mean follow-up of 3.2 years. Median imaging disease-free interval was 1.8 years, and four of 17 patients remain biochemically cured. After aggressive resection patients with MPET limited in extent had higher survival than patients with extensive MPET (p < 0.019). In a nonrandomized cohort of 25 patients with inoperable tumor, survival was 60% at 2 years and 28% at 5 years. CONCLUSIONS: In select patients MPET can be resected safely with a favorable outcome; most patients will experience recurrence, but some may be cured. Resection of extensive MPET does not appear to improve survival. Resection of limited MPET should be considered as life-extending and potentially curative therapy.

Adult↗
PubMed1992

Abdominosacral resection for midrectal cancer.

Abdominosacral resection is the most reliable radical sphincter-saving operation for midrectal cancers which are too low for anterior resection. The posterior incision provides maximum exposure for wide resection of the tumor, a measured distal margin, and an accurate anastomosis. The procedure can be carried out consistently to the pelvic floor without disrupting the anal sphincters and their innervation. Sphincter function is consistently preserved. Mortality rate is no higher than for other radical rectal resections. Morbidity can be limited by the selective use of protective colostomy. The use of mechanical retractors and the end-to-end stapler facilitates the operation and should encourage its wider application. The transsacral approach allows mobilization of the rectum to the levators in every case, and resection is limited only by the distance of the tumor from the sphincter, and not by poor exposure due to obesity or a narrow pelvis. In the treatment of 926 consecutive patients with rectal cancer, sphincter-saving resection was possible in 79%. In our experience, abdominosacral resection extends the range of sphincter-saving resection beyond that which is possible by the abdominal approach alone, with no compromise in safety and no increased risk of local recurrence or death from cancer.

Abdomen↗
PubMed2004

[Esophageal resections and plastics].

UNLABELLED: The aim was to evaluate interim results of surgery and plastics for esophageal diseases. From March 2002 to August 2003, 31 patients underwent esophageal resections in the Department of Thoracic Surgery of Klaipeda Hospital. The following operations were performed: 10 patients (32.3%) had transthoracic resections, 10 patients (32.3%) - transhiatal resections, 2 patients (6.5%) - Lewis type, 5 patients (16.1%) - Garlock type and 4 patients (12.9%) - first step of Thoreck type operations. Twenty-five patients (80.6%) underwent surgery due to cancer, 3 patients (9.7%) due to esophagus perforation, 1 patient (3.2%) due to peptic stricture, 1 patient (3.2%) due to post-burn stricture, and 1 patient (3.2%) due to gastric necrosis. In 7 cases (22.6%) combined esophageal resections were performed: 2 patients (6.5%) with lung segmentectomies, 2 patients (6.5%) with liver metastasis resections, 1 patient (3.25%) with right lower lobectomy, and 2 patients (6.5%) with proximal gastric metastasis resection. In 58% of patients we observed postoperative complications; lethal outcome was present in 5 patients (16.1%). CONCLUSIONS: Subtotal esophageal resection with gastric pipe reconstruction and two-level lymphadenectomies are sufficient radical treatment in cancer patients. Postoperative mortality (16.1%) after 31 resections depends on stage of disease, performance status, comorbidity, surgeon experience and type of operation.

Esophageal Diseases↗
PubMed2004

Impact of age on the outcome of liver resections.

The purpose of this study was to evaluate the influence of age on the outcome of liver resections. One hundred five consecutive hepatic resections were divided into two groups: > or = 65 years old [old group (O-group)] and < 65 years old [young group (Y-group)]. The two groups were first compared to evaluate the distribution of the variables potentially affecting the postoperative course, including primary diagnosis, concomitant diseases, previous upper abdominal surgery, type of operation (major or minor resection), associated procedures, presence and length of portal clamping, intraoperative blood losses and transfusions, and length of operation. The outcome of hepatic resections in the two groups was comparatively evaluated in terms of postoperative mortality, morbidity, transfusions, and length of postoperative hospitalization. The Y-group included 61 resections in 60 patients, mean age 52 +/- 10 years (mean +/- SD), range 23-64 years, whereas the O-group included 44 resections in 43 patients, mean age 71 +/- 4 years (mean +/- SD ), range 65-82 years. The O-group included more hepatocellular carcinomas (45.4% vs 18.0%, P = 0.002) and chronic liver diseases (40.9% vs 18.7%, P = 0.017); the median length of operation was slightly higher in the Y-group (300 minutes vs 270 minutes, P = 0.003). Both O-group and Y-group were comparable (P = n.s.) when evaluated for all other listed variables. As far as concerns the outcome of hepatic resections in the two groups, the length of postoperative hospitalization was identical (median 9 days, 5-60 days), whereas transfusions of packed red cells (O-group vs Y-group: 25.0% vs 16.3%, P = 0.30) or fresh frozen plasma (O-group vs Y-group: 13.6% vs 6.5%, P = 0.053) were not statistically different. Postoperative mortality included one case among young patients whereas no deaths were recorded among elderly patients. Postoperative morbidity was higher in Y-group than in O-group (31.5% vs 20.5%, P = 0.59). The age factor does not negatively affect the outcome of liver resections.

Adult↗
PubMed2004

[Complications of hepatic resection surgery: a 12-month experience in a high case-load specialized center].

BACKGROUND: Surgical treatment indications in benign and malignant hepatic tumors changed in last 20 years. Total number of hepatic resections increased in reference centers. OBJECTIVE: To evaluate complications after hepatic resections in a specific center, during a 12 months period. METHODS: Between January 2001 and January 2002, 80 patients with hepatic resection were analyzed. Mean age 55 years (r:14-79). Female: 55%. We analyze: tumor specifications, hepatic resection performed, transfusions, vascular clamping, operative time, associated procedures, length of hospital stage, postoperative complications and mortality. RESULTS: 61 patients (76.2%) were treated because of malignant pathology and 19 for benign. In 30 patients (37.5%) was made major resections and minor in 50 (62.5%). 16 patients (20%) required blood transfusions. Vascular intermittent clamping was used in 66 patients (82.5%). Associated procedures were made in 46 patients (58%). Mean operative time was 200'. Mean hospital stage: 6 days (r:3-12). Morbidity: 15 patients (18.7%). Complications were significantly higher in patients with: major hepatic resections (p: 0.002); primary hepatic tumors (p: 0.01); mean operative time more than 200' (p: 0.00007). Mortality associated with the procedure: 0%. CONCLUSIONS: 1-Hepatic resections performed in high volume centers have a low complication risk and almost with no mortality. 2-Major hepatic resection, primary malignant tumors and mean operative time more than 200', were risk factors associated with postoperative complications.

Adolescent↗
PubMedDate not supplied

Hepatic resection induces a shift in the Th 1/2 balance toward Th 2 and produces hypermetabolic and hyperhemodynamic states.

BACKGROUND/AIMS: Recent studies have shown that the type 1/2 T-helper (Th 1/2) cell balance is shifted toward a Th 2-type immune response not only by malignancy but also by surgical stress. The present study evaluated surgical stress as a result of liver surgery in comparison with that of other major abdominal surgeries. Immune, metabolic and circulatory responses to surgery were measured for determination of surgical stress. METHODOLOGY: Eighty-five patients who underwent abdominal surgeries were divided into three groups: hepatic resection (n=17), gastric resection (n=38), colorectal resection (n= 30). Blood sampling was performed before surgery, and on postoperative days (POD) 2 and 14. The Th 1/2 helper T cell balance was determined by flow cytometric analysis of interferon-gamma and interleukin-4 expression. Energy expenditure was measured by indirect calorimetry, and hemodynamics was studied using pulse dye densitometry until POD 14. RESULTS: Following surgery Th 1/2 ratios decreased significantly. Additionally, the Th 1/2 balance in patients with hepatic resection on POD 2 was significantly lower than that of patients with other major surgeries. However, on POD 14 there were no significant differences among the three groups. Resting energy expenditure and cardiac index on postoperative days 1 and 3 in patients with hepatic resection increased significantly above levels in the other surgical groups. Conversely, blood volume in the hepatic resection patients was significantly lower than that of other patients until POD 3. Ten patients who developed postoperative complications had significantly lower Th 1/2 ratios and more hypermetabolism. CONCLUSIONS: This study reveals that hepatic resection induces a more marked shift toward a Th 2 helper T cell response and significantly more hypermetabolism than other major surgeries. A distinct pattern of Th 1/2 ratio changes during the early phase of the postoperative course in hepatic resection may be related to changes in metabolism and circulation. Therefore, determination of Th 1/2 balance may be of help in evaluating different surgical procedures, and management of energy intake and circulatory management may be cautiously determined based on the shift in Th 1/2 balance.

Aged↗
PubMedDate not supplied

Change in alpha glutathione s-transferase levels during liver resection.

BACKGROUND/AIMS: Alpha-glutathione s-transferase (GST) is a 50,000-kDa cytosol protein of the hepatocytes. It comprises 5% of the soluble protein of hepatocytes and is readily released in response to injury. Its half-life time is 60 minutes (AST: 47 hrs, ALT: 22 hrs). The aim of this study is to clarify the usefulness of GST measurement during liver resection. We obtained data from 26 patients undergoing liver resection and compared GST levels with AST and ALT levels. METHODOLOGY: Patients included 15 hepatocellular carcinoma, 5 cholangiocellular carcinoma and 6 metastatic cancers (4: colon, 2: stomach). We performed lobectomy for 11, segmentectomy for 5 and partial resection for 10 patients. From these patients, blood samples were collected before surgery, beginning of resection, end of resection, 15, 30, 60 min after resection, end of surgery, 1, 3, 6, 12, 24 hr after operation and 2, 3, 4, 5, 6, 7, 10, 14 postoperative days (POD). GST (Biotrin, Ireland) levels in the serum samples were determined by an ELISA. We also measured AST, ALT levels from the same set of samples. RESULTS: At the end of resection, GST showed highest level and quickly decreased at 1 hr after operation. On the other hand, AST and ALT showed peak levels at 12 hr after operation. CONCLUSIONS: Our findings suggest that perioperative GST measurement may be a sensitive and useful marker to evaluate liver function after liver resection.

Adult↗
PubMed2005

[Photodynamic diagnosis and fluorescence-guided resection of malignant gliomas: a report of 15 cases].

OBJECTIVE: To study the usefulness of the intraoperative photodynamic diagnosis (PDD) and fluorescence-guided resection of malignant gliomas. METHODS: Fifteen consecutive patients with malignant gliomas received doses of hematoporphyrin derivative (HPD, 2 mg/kg body weight) 48 hours before induction of anesthesia. After the tumors recognized by bare eyes they were removed routinely. The fluorescence around 690 nm excited by laser beam (wavelength 632.5 nm) was detected by laser electronic spectrum analyzer and then fluorescing tissue was removed whenever it was considered safel. Tissue samples derived from the walls of tumor cavities after resection and PDD were sent for histological examination. Compared with the result of the histological examination, the sensitivity and specificity of PDD were calculated and recorded. Early postoperative MRI or CT were done to determine the extend of the resection of the tumors. Surgical mortality and morbidity were also recorded. RESULTS: Intraoperatively, in all of 15 cases tumor areas with HPD fluorescence could be recognized by laser electronic spectrum analyzer. On the basis of 106 tissue samples derived from 15 tumors, a sensitivity of 90.6%, a specificity of 96.8% and an accuracy of 94.3% of PDD were achieved. In 2 cases the resection of residual tumor were performed after finding left tumors by PDD. Complete resection of contrast-enhancing tumor was accomplished in 9 patients (60%). Residual intraoperative tissue fluorescence left unresected for safety reasons predicted residual enhancement on MR images in 5 of the 6 remaining patients. No perioperative deaths and one case of morbidity were encountered. CONCLUSIONS: Intraoperative photodynamic diagnosis following resection of malignant gliomas can detect residual tumor tissue with high accuracy. Photodynamic diagnosis and fluorescence-guided resection of malignant gliomas have a positive role in improving the radicality of malignant glioma resection.

Adult↗
PubMedDate not supplied

Hepatocellular carcinoma confined to Couinaud segment VIII: experience with extensive or limited resection.

BACKGROUND/AIMS: Surgical treatment of hepatocellular carcinoma (HCC) confined to Couinaud segment VIII has been regarded as difficult. This study evaluates surgical and oncological results after extensive or limited resection of the tumor(s). METHODOLOGY: Of the 399 HCC patients that underwent hepatic resection, 36 patients had the tumor(s) confined to segment VIII. These 36 patients were divided into group 1 (extensive resection) (n=15) (three right hepatectomies, 12 anterior segmentectomies) and group 2 (limited resection) (n=21) (11 subsegmentectomies, 10 wedge resections). Data were collected prospectively and analyzed retrospectively. RESULTS: Hospital mortality and morbidity were 0% and 20% in group 1, 9.5%, and 38% in group 2 (P>0.05). Group 1 patients had larger tumor (4.0cm vs. 2.8cm; P=0.01), heavier resected specimen (380g vs. 118g; P<0.01), and a higher incidence of wide surgical margin (> or =1cm) (67% vs. 29%; P=0.041) than those in group 2. The percentage of patients in whom the a-fetoprotein levels returned to the normal range after resection was higher in group 1 (75.0%, 6 of 8 patients) than in group 2 (26.7%, 4 of 15 patients) (P=0.037). The 1-, 3-, and 5-year disease-free survival in group 1 (93%, 79% and 52%) were significantly better than those of group 2 (67%, 38% and 22%) (P=0.021). CONCLUSIONS: In selected patients, extensive resection of HCC located in segment VIII correlates with better survival.

Aged↗
PubMed2005

Risk factors for postoperative complications after liver resection.

BACKGROUND: Liver resection is still a complicated operation with a high risk of postoperative morbidity. This study was undertaken to analyze the risk factors for postoperative complications after liver resection. METHODS: From 2001 to 2004, a total of 146 patients underwent liver resection for malignant or benign lesions. Postoperative complications after the resection were classified as surgical and medical, their incidences were analyzed retrospectively. The risk factors for both surgical and medical complications were analyzed. To increase the safety of liver resection, surgical techniques were modified after April 2003, including control of inflow or outflow and intra-operative test with methylene blue. RESULTS: Before April 2003, a series of 58 patients received liver resection. Modified surgical techniques were used in liver resections for 88 patients after April 2003. A total of 36 patients (24.7%) had postoperative complications. Surgical and medical complications occurred in 24 and 13 patients respectively (One patient had both surgical and medical complications). Perioperative blood transfusion was related to a higher risk of surgical complications (P < 0.05). Patients with diabetes mellitus were associated with a higher risk of medical complications (P < 0.05). Surgical complications and postoperative hospitalization were decreased after the use of modified surgical techniques (P < 0.05). CONCLUSION: Postoperative surgical complications can be decreased by modified surgical techniques, and careful selection of patients for liver resection may help to decrease postoperative medical complications also.

Adult↗
PubMed2005

Resection arthrodesis of the knee for osteosarcoma: an alternative when mobile joint reconstruction is not feasible.

BACKGROUND: Wide resection and mobile joint reconstruction are preferable for treating an osteosarcoma around the knee. In certain situations, resection arthrodesis or an amputation is suggested. METHODS: During the past decade, 86 patients with an osteosarcoma around the knee were treated surgically in our institution. Wide resection and endoprosthetic reconstruction were performed in 35 patients, resection arthrodesis was performed in 36 patients, and an amputation was performed in 15 patients. The oncological and functional results were compared. Special attention was paid to the indications, techniques, and complications of patients receiving resection arthrodesis. RESULTS: Extensive tumor involvement was the main reason, followed by inappropriate previous treatment, for precluding mobile joint reconstruction. The local recurrence rates were similar among the 3 groups (11.4% for the endoprosthetic group, 11.1% for the arthrodesis group, and 6.7% for the amputation group). The 5-year survival rate was 39% for the arthrodesis group, which was significantly lower than that of the endoprosthetic group (60%, p = 0.040), although it was higher than that of the amputation group (13%, p = 0.056). Major complications were found in 7 patients receiving resection arthrodesis (7/24, 29%), and these included nonunion, infection, and allograft fracture. Functional results for the arthrodesis patients were inferior to those of the endoprosthetic patients, but most patients were grateful for preservation of the limb despite certain handicaps. CONCLUSIONS: The importance of early and proper planning of treatment cannot be over-stressed when treating osteosarcomas. Resection arthrodesis offers a durable reconstruction alternative to amputation in a special group of patients when extensive resection precludes mobile joint reconstruction.

Adolescent↗
PubMed2005

[Prognostic analysis of surgical resection for patients with liver metastases from gastric cancer].

OBJECTIVE: To assess the indication and efficacy of surgical treatment for patients with hepatic metastases from gastric cancer. METHODS: Clinical data of 43 patients with hepatic metastases from gastric cancer undergoing surgery from September 1995 to May 2002 were analyzed retrospectively. RESULTS: No relationships were found between the number of hepatic metastases and patient's gender, age, tumor invasion depth, lymphatic node metastases and differentiation P> 0.05. All of 43 patients underwent surgery. Four cases undergoing hepatic resection for metachronous hepatic metastases had a higher survival rate than those who had curative resections for synchronous hepatic metastases (median survival 35 months vs. 10 months) (P=0.0233). 39 patients had synchronous hepatic metastases, of whom 32 patients received gastric resection only and 7 patients received both gastric and hepatic resections, there was significant difference of median survival between synchronous group and metachronous group(median survival 6.0 vs. median survival 10.0 months)(P=0.2799). There was significant difference of the postoperative survival rate among H (1) (7.5 months), H (2) (6 months) and H (3) (4 months) in the patients with palliative gastric resections (P=0.0007). CONCLUSION: Hepatic resection for metachronous hepatic metastases from gastric cancer has a better prognosis. Resections of gastric and hepatic lesions at the same time may not benefit the patients with liver metastases from gastric cancer. H(3) is not feasible for palliative gastric resections.

Hepatectomy↗
PubMed2006

[Segmental and bisegmental resections of liver in a treatment of malignant neoplasms].

UNLABELLED: The news in understanding intrahepatal anatomy, such as radiology contemporary technology making easier segmental and bisegmental access to hepatal resection. This access comprises resection of isolated anatomical segments or a sector of liver which is depends of magnitude of intrahepatal pathological process. After segmental or bisegmental resection of liver, patients were analysed in the period from 15 and 30 days after the operation. Analysis of patients from this period comprise: localisation of tumour in relation on segments, liver test and follow up, technique of resection, intraoperative stream, the period of operation, blood follow up through v. portae, blood loss and quantitative and qualitative analysis of postoperative complications. RESULTS: between January 2000 and March 2005, sixty two subject were analysed that have been operated on our clinic (segmental or bisegmental resection), because of the metastatic process of liver and hepatocellular carcinoma of liver (HCC). Hospital mortality was 2.1%, with most often mortality in patients with HCC and cirrhosis of liver. High of morbidity from this period were 19,8%. Need for transfusion of blood (fresh erythrocytes) were 1,2 +/- 0,5 U. Patients with HCC had more needs from blood transfusions contrary patients without HCC; 2,9 +/- 1,4 contrary 0,7 +/- 0,28 U (p<0,05). Recidivism of malignant process in hepatal margin were 2,7%. CONCLUSION: Segmental hepatal resection is very accurate technique which makes possible complete resection of tumour and in the same time preservation of healthy liver parenchyma. Segmental hepatal resection is especially useful for patients with HCC and patients with recidivism or progress of primary process.

Carcinoma, Hepatocellular↗