Laparoscopic drainage of infected hydatid liver cysts.

From October 1997 until March 1999, we performed this procedure in three patients suffering from suppurated echinococcal liver cyst. Trocar sites are approximately the same to those already known for laparoscopic cholecystectomy. A thoracostomy tube is inserted through the abdominal wall and under direct vision is forced to the projecting part of the cyst for the aspiration of the gross content. The adventitia and thinned out liver are cut with electrocautery and scissors. A large bore fenestrated drainage tube is inserted within the cavity of the cyst and fixed in place. We did not have wound infection in any of the three patients. The average hospital stay was 19 days. No signs of recurrence or any other source of morbidity were apparent within the 18, 14 and 6 months of follow up of the three patients respectively.

Pancreatic resection for pancreatic carcinoma combined with neo- and adjuvant locoregional targeting immuno-chemotherapy--a prospective randomized study.

BACKGROUND/AIMS: The effects on early and late results of combined pancreatic resection with neo- and adjuvant immuno-chemotherapy for patients undergoing pancreatic resection are prospectively evaluated. METHODOLOGY: A group of 26 patients was divided into two groups, which were matched in terms of age-sex ratio, stage of disease, histological diagnosis and mode of pancreatic resection. Group A patients received a multimodality therapy, combining pancreatic resection with neo- and adjuvant locoregional targeting immunochemotherapy. Group B received pancreatic surgery only. RESULTS: For Group A patients (n = 14pts), a complete response was seen in 11 patients with a time interval ranging from 9 to 29 months. In the remaining 3 patients liver secondaries developed 12 months after pancreatic resection in 2 patients and the other patient developed pulmonary metastases 22 months after pancreatic resection. All patients (n = 3pts) are alive, but continue to have the disease. For Group B patients (n = 12pts), a complete response was seen in 3 patients with a survival of 9, 10 and 20 months following pancreatic resection. Six patients died due to locoregional recurrence of the disease, with the survival rate ranging from 7 to 18 months (mean 10 months). Locoregional recurrence was complicated with liver secondaries (n = 3) and with peritoneal dissemination of the disease in a further 3 patients. The remaining 3 patients are alive, but continue to have the disease due to locoregional recurrence. CONCLUSIONS: Patients in whom neo- and adjuvant locoregional immunochemotherapy was carried out in conjunction with pancreatic resection, demonstrated a significantly higher response rate to treatment. Therefore the data collected offers clear evidence, regarding the usefulness, applicability and safety of combined neo- and adjuvant therapy with pancreatic resection. A Multi-modality approach is therefore highly recommended.

Resection of unresectable secondary liver tumors--new frontiers in liver surgery.

BACKGROUND/AIM: Despite remarkable advances in diagnostic and therapeutic techniques for metastatic liver disease, this disease remains a challenge for patients and surgeons. In this study we describe our experience in the management of 21 patients referred for treatment due to metastatic disease, between 1992 and 1997, in Athens, Greece. METHODOLOGY: Patients diagnosed with unresectable liver tumors, received a standard treatment, which included neo-adjuvant locoregional immuno-chemotherapy, surgical resection and adjuvant locoregional immuno-chemotherapy. Twenty days after liver resection a standard protocol of combined locoregional immuno-chemotherapy was administered. The protocol included 10 daily courses of transplenic (5-day) and transtumoral (5-day) immunostimulation using proleukine suspended in lipiodol Urografin emulsion. Five days later a standard dose of chemotherapeutical drugs suspended in lipiodol Urografin were given via the catheter of the hepatic artery. The above mode of adjuvant treatment was continued every 2 months for the first postoperative year and every 3 months for the 2nd and 3rd postoperative years, every 4 months for the 4th and 5th postoperative years. At the end of each treatment a blood test, which included the serum values of the tumors markers and an upper abdominal computer tomography was carried out for each patient. The treatment response was evaluated accordingly, and divided into the following categories: complete response, partial response, stable disease and progressive disease. RESULTS: There was no operative mortality. Sequelae and side effects secondary to treatment were minimal In group A and B of this study a 5-year survival rate of 65% and 20% and an overall response rate of 80% and 68% in the above groups was noted, respectively. CONCLUSION: The mode of management offered satisfactory results regarding quality of postoperative life.

[Indications for prophylactic ovariectomy in patients with colorectal carcinoma]. / Indicazioni all'ovariectomia profilattica nelle pazienti con carcinoma colorettale.

Metastasis of colorectal cancer to the ovaries presents in 2-8% of patients. Prevention of these metastasis with bilateral oophorectomy at the initial operation is quite simple, but nevertheless it produces an early menopause in premenopausal women and may add the morbility of the operation. Prophylactic oophorectomy is evaluated in a prospective study of 130 women that underwent surgery for adenocarcinoma of the large bowel. Forty-four of these patients underwent unilateral (10 patients) or bilateral (34 patients) oophorectomy along with the large bowel resection. Fifty-five women were submitted to colectomy alone, while 31 with or without oophorectomy were lost to the follow-up. Of the 44 women that underwent oophorectomy, 8 were premenopausal, while 36 were postmenopausal. The tumor was situated at the right colon in 5 out of the 44 patients that underwent oophorectomy and at the left colon in the remaining 39. According to Dukes classification, 5 tumors were Dukes A, 22 Dukes B and 17 Dukes C. Two of the 44 patients were found to harbour metastasis to the ovaries (4.5%). One of these patients was premenopausal (12.5%) and 1 was postmenopausal (2.7%). Of the 55 women that underwent colectomy, only one developed metastasis to the ovaries during the follow-up period (1.8%). No metastasis was detected at the resected ovary or at the remaining ovary during the follow-up period, among the patients that underwent unilateral oophorectomy. No complication directly related to the oophorectomy was noted.(ABSTRACT TRUNCATED AT 250 WORDS)