How can we treat a patient with liver cirrhosis (hepatitis C virus), hepatocellular carcinoma, and synchronous colon cancer?

INTRODUCTION: The coexistence of liver cirrhosis with hepatocellular carcinoma (HCC) and colon cancer (Ca), which is a rare clinical condition, was treated in a liver transplant recipient. PATIENTS AND METHODS: A 46-year-old man, diagnosed incidentally during an ultrasound (US) examination with a 3.5-cm HCC in segment VII related to chronic hepatitis C virus (HCV), was referred for liver resection. He underwent a laparoscopic protocol evaluation for liver cirrhosis. Liver appearance and biopsy of the left lobe showed Child B/C liver cirrhosis. Because he fulfilled the Milan criteria, we suggested an orthotopic liver transplantation (OLT). During protocol colonoscopy, we discovered an ulcerative sigmoid colon Ca. Three weeks after completing the pre-OLT assessment he underwent an OLT and was discharged home on day 9 on an immunosuppressive regimen of Everolimus, Myfortic, and Prezolone. Two months after transplantation, the patient underwent a sigmoidectomy and for nearly 1 month thereafter received chemotherapy for colon Ca (6 cycles of FOLFOX:Folinic Acid+Fluorouracil+Oxaliplatin). One and a half years after OLT, patient was in good condition but presented with an increased alpha fetoprotein (a-FP) without other findings. A couple of months later we discovered a colon Ca recurrence and 3 small liver metastases. Patient underwent a bowel resection with Hartmann's procedure. Almost immediately after the last operation, he was found to suffer multiple myeloma. He underwent chemotherapy for both malignancies with good responses, but a few months later died of severe sepsis. DISCUSSION: The relevant literature regarding treatment of liver cirrhosis complicated with HCC and synchronous colon Ca reveals poor and controversial outcomes. Our patient underwent chemotherapy immediately after colon resection in the presence of with a good functioning liver. Although his condition was satisfactory after OLT, the optimal treatment of such complicated patients is as yet uncertain.

The cost of cytoreductive surgery and perioperative intraperitoneal chemotherapy in the treatment of peritoneal malignancy in one Greek institute.

PURPOSE: Cytoreductive surgery and perioperative intraperitoneal chemotherapy in the treatment of patients with peritoneal malignancy is expensive. The purpose of this study was to estimate the current cost of cytoreductive surgery combined with perioperative intraperitoneal chemotherapy and identify the most significant related parameters in one center in Greece. METHODS: A retrospective economic study was carried out on 105 patients that underwent 108 cytoreductive operations and hyperthermic intraoperative peritoneal chemotherapy (HIPEC) from 2006-2011 for peritoneal malignancy. The economic cost included the daily cost of hospital bed occupancy, the daily cost of occupancy in the intensive care unit (ICU), the expenditures (materials and drugs), and the preoperative, intraoperative, and postoperative examinations. RESULTS: The mean length of stay in the ICU and the mean hospitalization time was 5 and 23 days, respectively. The hospital mortality and morbidity was 5.6% (6 patients) and 48.17percnt; respectively. The mean cost of treatment was 15677.3±11910.6 euros (range=4258,47-95990,87) per patient. Morbidity (p=0.009), and prolonged stay in the ICU (p<0.001) were the parameters that influenced independently the cost of treatment. CONCLUSION: Cytoreductive surgery combined with perioperative intraperitoneal chemotherapy is an expensive treatment. The economic cost is largely influenced by morbidity and the length of stay in the ICU.