RESUMO
BACKGROUND/AIMS: To determine the efficacy of portal vein embolization (PVE) against unresectable hepatocellular carcinoma (HCC). METHODOLOGY: We conducted a comparative study using 17 patients with HCC determined to be unresectable and who received a combination of PVE and transarterial chemoembolization (TACE) (PVE group) and 22 HCC patients with tumors in the unilateral lobe, which were treated only with repeated TACE (TACE group) from January 2000 to December 2008. RESULTS: There were no significant differences in background factors except for gender between the two groups. The cumulative intrahepatic recurrence rates in the non-portal-embolized area (in the contralateral lobe for the TACE group) at 1 year and 3 years was 41.1% and 58.8% in the PVE group and 77.3% and 81.8% in the TACE group, respectively. The former was significantly lower (p<0.05). The cumulative overall survival rate at 1 year, 3 and 5 years was 88.2%, 38.2% and 38.2% in the PVE group, and 68.1%, 22.7% and 8.5% in the TACE group, respectively. The former was significantly higher (p<0.05). CONCLUSIONS: Although in patients with unresectable HCC, when HCC is localized in the portal-embolized area, PVE combined with TACE can prevent intrahepatic metastasis to the non-portal-embolized area and improve overall survival.
Assuntos
Carcinoma Hepatocelular/terapia , Embolização Terapêutica , Neoplasias Hepáticas/terapia , Idoso , Idoso de 80 Anos ou mais , Neoplasias Encefálicas/prevenção & controle , Neoplasias Encefálicas/secundário , Carcinoma Hepatocelular/irrigação sanguínea , Carcinoma Hepatocelular/secundário , Quimioembolização Terapêutica , Distribuição de Qui-Quadrado , Contraindicações , Feminino , Hepatectomia , Humanos , Estimativa de Kaplan-Meier , Neoplasias Hepáticas/irrigação sanguínea , Neoplasias Hepáticas/patologia , Neoplasias Pulmonares/prevenção & controle , Neoplasias Pulmonares/secundário , Masculino , Pessoa de Meia-Idade , Taxa de Sobrevida , Fatores de Tempo , Resultado do TratamentoRESUMO
Massive hemorrhage from an adrenocortical carcinoma seldom occurs in the retroperitoneal or abdominal cavity. We report a case of spontaneous rupture of primary adrenocortical carcinoma occurring in an adolescent. A right adrenalectomy with complete removal of the tumor was performed successfully.
Assuntos
Neoplasias do Córtex Suprarrenal/cirurgia , Carcinoma Adrenocortical/cirurgia , Adolescente , Neoplasias do Córtex Suprarrenal/diagnóstico , Adrenalectomia , Carcinoma Adrenocortical/diagnóstico , Feminino , Humanos , Imageamento por Ressonância Magnética , Ruptura EspontâneaRESUMO
A 75-year-old man with right chest pain was diagnosed with primary lung cancer in the right apical portion, and was treated with chemoradiotherapy because of a synchronous left adrenal tumor of 1.6 cm. Since the adrenal tumor did not increase in size for three months and there were no other relapses, the right upper lobectomy of the lung with the excision of the chest wall was performed. Afterward, an enlargement of the left adrenal tumor was encountered; he was admitted to our hospital for an operation. For the metastatic adrenal tumor from lung cancer, we performed a hand-assisted laparoscopic adrenalectomy. He recovered rapidly and returned to the previous hospital in two weeks after the operation. After the first report in 1992, the laparoscopic adrenalectomy has been established as the curative operation to adrenal benign tumor. The indication is being expanded to the malignancy because of the improvement of operation techniques and advancement of the operation equipments. We conclude that the laparoscopic adrenalectomy for malignant tumor is a safe, curative, and clinically useful surgical technique.