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1.
Langenbecks Arch Surg ; 394(2): 255-64, 2009 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-18553101

RESUMEN

BACKGROUND: Laparoscopic surgery has gained growing acceptance, but this does not hold for laparoscopic surgery of the liver, above all for patients with hepatocellular carcinoma (HCC) and cirrhosis. This approach mainly includes diagnostic procedures and interstitial therapies. However, we believe there is room for laparoscopic liver resections in well-selected cases. The aim of this study is to assess: (a) the risk of intraoperative bleeding and postoperative complications, (b) the safety and the respect of oncological criteria, and (c) the potential benefit of laparoscopic ultrasound in guiding liver resection. METHODS: A prospective study of laparoscopic liver resections for hepatocellular carcinoma was undertaken in patients with compensated cirrhosis. Hepatic involvement had to be limited and located in the left or peripheral right segments (segments 2-6), and the tumor had to be 5 cm or smaller. Tumor location and its transection margins were defined by laparoscopic ultrasound. RESULTS: From January 1997, 22 out of 250 patients with HCC (9%) underwent laparoscopic liver resections. The mean patient age was 61.4 years (range, 50-79 years). In three patients, conversion to laparotomy was necessary. The laparoscopic resections included five bisegmentectoies (2 and 3), nine segmentectomies, two subsegmentectomies and three nonanatomical resections for extrahepatic growing lesions. The mean operative time, including laparoscopic ultrasonography, was 199 +/- 69 min (median, 220; range, 80-300). Perioperative blood loss was 183 +/- 72 ml (median, 160; range, 80-400 ml). There was no mortality. Postoperative complications occurred in two out of 19 patients: an abdominal wall hematoma occurred in one patient and a bleeding from a trocar access in the other patient requiring a laparoscopic re-exploration. Mean hospital stay of the whole series was 6.5 +/- 4.3 days (median, 5; range, 4-25), while the mean hospital stay of the 19 laparoscopic patients was 5.4 +/- 1 (median, 5; range, 4-8). CONCLUSION: Laparoscopic treatment should be considered in selected patients with HCC and liver cirrhosis in the left lobe or segments 5 and 6 of the liver. It is clear that certain types of laparoscopic resection are feasible and safe when carried out by adequately skilled surgeons with appropriate instruments.


Asunto(s)
Carcinoma Hepatocelular/cirugía , Hepatectomía/métodos , Laparoscopía/métodos , Cirrosis Hepática/cirugía , Neoplasias Hepáticas/cirugía , Adulto , Anciano , Carcinoma Hepatocelular/mortalidad , Supervivencia sin Enfermedad , Estudios de Factibilidad , Femenino , Estudios de Seguimiento , Humanos , Cirrosis Hepática/mortalidad , Neoplasias Hepáticas/mortalidad , Masculino , Persona de Mediana Edad , Recurrencia Local de Neoplasia/mortalidad , Recurrencia Local de Neoplasia/cirugía , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/cirugía , Reoperación
2.
Surg Endosc ; 22(9): 2051-5, 2008 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-18247089

RESUMEN

BACKGROUND: The optimal treatment for hepatocellular carcinoma (HCC) is surgical resection. However, only a small percentage of patients are operative candidates. The authors aimed to assess a novel operative combination of laparoscopic radiofrequency (LRF) with a selective intrahepatic vascular occlusion (SIHVO) to obtain an increased rate of total necrosis and a reduced rate of local HCC recurrences. METHODS: For this study, 37 patients with HCC in liver cirrhosis were submitted to LRF with SIHVO. An LRF was indicated for patients not amenable to liver resection who evidenced at least one of the following criteria: severe impairment of the coagulation tests, large tumors (but <5 cm) or multiple lesions requiring repeated punctures, superficial lesions adjacent to visceral structures, deep-sited lesions with a very difficult or impossible percutaneous approach, and short-term recurrence of HCC after percutaneous loco-regional therapies. RESULTS: Laparoscopic ultrasound identified seven new malignant lesions (19%) undetected by preoperative imaging. There was no operative mortality. Of the 37 patients, 31 experienced no complications (84%). Computed tomography (CT) evaluation 1 month after treatment showed that a complete response with 100% necrosis had been achieved for all the patients (100%). During the follow-up period (mean, 11.8 +/- 8.2 months), new malignant nodules developed in 14 patients (42%), and 36% of these recurrences were located in the same treated segment of the HCC. CONCLUSIONS: The combined LRF and SIHVO procedure proved to be a safe and effective technique at least in the short and mid term. In fact, it permitted the treatment of lesions not treatable using the percutaneous approach with a complete clearance, and it had a low morbidity rate.


Asunto(s)
Carcinoma Hepatocelular/cirugía , Ablación por Catéter/métodos , Laparoscopía/métodos , Neoplasias Hepáticas/cirugía , Escleroterapia/métodos , Ultrasonografía Intervencional/métodos , Anciano , Anciano de 80 o más Años , Carcinoma Hepatocelular/irrigación sanguínea , Carcinoma Hepatocelular/complicaciones , Carcinoma Hepatocelular/diagnóstico por imagen , Carcinoma Hepatocelular/patología , Estudios de Seguimiento , Humanos , Cirrosis Hepática/complicaciones , Neoplasias Hepáticas/irrigación sanguínea , Neoplasias Hepáticas/complicaciones , Neoplasias Hepáticas/diagnóstico por imagen , Neoplasias Hepáticas/patología , Persona de Mediana Edad , Necrosis , Estadificación de Neoplasias , Selección de Paciente , Vena Porta , Escleroterapia/instrumentación , Resultado del Tratamiento , Ultrasonografía Intervencional/instrumentación
3.
Surg Endosc ; 21(2): 181-8, 2007 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-17122984

RESUMEN

BACKGROUND: Laparoscopic surgery has gained growing acceptance, but this does not hold for laparoscopic surgery of the liver. This mainly includes diagnostic procedures, interstitial therapies, and treatment of liver cysts. However, the authors believe there is room for a laparoscopic approach to the liver in selected cases. METHODS: A prospective study of laparoscopic liver resections was undertaken with patients who had preoperative diagnoses of benign lesion and hepatocellular carcinoma with compensated cirrhosis. The inclusion criteria required that hepatic involvement be limited and located in the left or peripheral right segments (segments 2-6), and that the tumor be 5 cm or smaller. The location of the tumor and its transection margin were defined by laparoscopic ultrasound (LUS). RESULTS: From December 1996, 17 (5%) of 313 liver resections were included in the study. There were 5 benign lesions and 12 hepatocellular carcinomas in cirrhotic patients. The mean age of the study patients was 59 years (range, 29-79 years). The LUS evaluation identified the presence of new hepatocellular carcinoma nodules in two patients (17%). The resections included 1 bisegmentectomy, 8 segmentectomies, 3 subsegmentectomies, and 3 nonanatomic resections. The mean operative time, including laparoscopic ultrasonography, was 156 +/- 50 min (median, 150 min; range, 60-250 min), and the perioperative blood loss was 190 +/- 97 ml. There was no mortality. Conversion to laparotomy was necessary for two patients. Postoperative complications were experienced by 3 of 15 patients, all of them cirrhotics. One of the patients had a wall hematoma, and the remaining two patients had bleeding from a trocar access requiring a laparoscopic reexploration. The mean hospital stay for the whole series was 6.9 +/- 4.9 days (median, 6 days; range, 2-25 days) and 5.6 +/-1.4 days (median, 6 days; range, 2-8 days) for the 15 laparoscopic patients. CONCLUSION: Laparoscopic treatment should be considered for selected patients with benign and malignant lesions in the left lobe or frontal segments of the liver. Evaluation by LUS is indispensable to guarantee precise determination of the segmental tumor location and the relationship of the tumor to adjacent vascular or biliary structures, excluding adjacent or adjunctive new lesions. The evolution of laparoscopic hepatectomies probably will depend on the development of new techniques and instrumentations.


Asunto(s)
Hepatectomía/métodos , Laparoscopía/métodos , Hepatopatías/diagnóstico por imagen , Hepatopatías/cirugía , Monitoreo Intraoperatorio/métodos , Ultrasonografía Doppler/métodos , Adulto , Anciano , Estudios de Cohortes , Femenino , Estudios de Seguimiento , Hepatectomía/efectos adversos , Humanos , Laparoscopía/efectos adversos , Hepatopatías/patología , Pruebas de Función Hepática , Neoplasias Hepáticas/mortalidad , Neoplasias Hepáticas/patología , Neoplasias Hepáticas/cirugía , Masculino , Persona de Mediana Edad , Procedimientos Quirúrgicos Mínimamente Invasivos/métodos , Complicaciones Posoperatorias/epidemiología , Estudios Prospectivos , Medición de Riesgo , Índice de Severidad de la Enfermedad , Tasa de Supervivencia , Resultado del Tratamiento
4.
Surg Endosc ; 15(12): 1456-8, 2001 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-11965465

RESUMEN

BACKGROUND: The surgical management of primary hyperparathyroidism is changing both in terms of the extent of cervical exploration and in technique. There are many new mini-invasive procedures for neck surgery. We describe our preliminary experience with a technique that combines two mini-invasive procedures--radio-guided and video-assisted parathyroidectomy. METHODS: Six consecutive patients with no recurrent or persistent primary hyperparathyroidism, no previous cervical operations, and no thyroid pathologies were selected to undergo radio-guided video-assisted parathyroidectomy. RESULTS: One case was converted. There was no morbidity or mortality in the postoperative period. Six parathyroids were removed; the histological diagnosis was adenoma in all cases. All patients were discharged on the 1st postoperative day. Calcium serum levels normalized in all cases, with only one case of transient postoperative hypocalcemia. All patients were normocalcemic after 6 months. CONCLUSION: Radio-guided video-assisted parathyroidectomy is feasible in selected patients. However, longer follow-up and more cases are necessary before this procedure can be applied routinely.


Asunto(s)
Paratiroidectomía/métodos , Cirugía Asistida por Video/métodos , Adenoma/cirugía , Adulto , Anciano , Endoscopía/métodos , Femenino , Humanos , Hiperparatiroidismo/cirugía , Hiperparatiroidismo Secundario/cirugía , Masculino , Persona de Mediana Edad , Neoplasias de las Paratiroides/cirugía , Paratiroidectomía/instrumentación , Radiofármacos , Tecnecio Tc 99m Sestamibi
6.
G Chir ; 12(1-2): 31-3, 1991.
Artículo en Italiano | MEDLINE | ID: mdl-1867970

RESUMEN

Intestinal endometriosis is a rare lesion characterized by a difficult differential diagnosis with other intestinal diseases. The authors report the case of a woman suffering from endometriosis involving the distal ileal loop.


Asunto(s)
Endometriosis/diagnóstico , Neoplasias del Íleon/diagnóstico , Colectomía , Diagnóstico Diferencial , Endometriosis/patología , Endometriosis/cirugía , Femenino , Humanos , Neoplasias del Íleon/patología , Neoplasias del Íleon/cirugía , Íleon/patología , Íleon/cirugía , Persona de Mediana Edad
8.
G Chir ; 14(6): 299-300, 1993 Jul.
Artículo en Italiano | MEDLINE | ID: mdl-8398620

RESUMEN

Diverticulosis of the vermiform appendix, either single or multiple, congenital or acquired, is rather infrequent and usually asymptomatic. However, it may be complicated by flogosis configuring an acute abdomen hardly recognizable from an acute appendicitis not related to the diverticular disease. The Authors report a case of acute appendicular diverticulitis surgically treated. A brief review of the literature is also reported.


Asunto(s)
Abdomen Agudo/etiología , Apéndice , Diverticulitis/complicaciones , Adulto , Enfermedades del Ciego/complicaciones , Humanos , Masculino
9.
G Chir ; 12(6-7): 379-83, 1991.
Artículo en Italiano | MEDLINE | ID: mdl-1751326

RESUMEN

The authors discuss about the different surgical approaches in the management of primary intrahepatic stones, conforming their experience to literature reports. In the future they hope for a more conservative treatment on the basis of the good results obtained with percutaneous transhepatic fiber cholangioscopy (P.T.C.S.) and ultrasonographic extra-body lithotripsy recently adopted in the clinical practice.


Asunto(s)
Cálculos/cirugía , Hepatectomía , Hepatopatías/cirugía , Hígado/cirugía , Adulto , Cálculos/diagnóstico , Drenaje , Humanos , Hígado/diagnóstico por imagen , Hepatopatías/diagnóstico , Masculino , Radiografía , Ultrasonografía
10.
G Chir ; 13(11-12): 539-41, 1992.
Artículo en Italiano | MEDLINE | ID: mdl-1292562

RESUMEN

The authors review their experience in the surgical management of rectal cancer. They analyze rectal malignancies and their recurrences from natural history to surgical strategies and survival rates. In particular, the need to perform extended operations in order to offer patients a better prognosis is discussed.


Asunto(s)
Carcinoma/cirugía , Recurrencia Local de Neoplasia/cirugía , Neoplasias del Recto/cirugía , Recto/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Carcinoma/mortalidad , Carcinoma/patología , Femenino , Humanos , Escisión del Ganglio Linfático , Metástasis Linfática , Masculino , Persona de Mediana Edad , Recurrencia Local de Neoplasia/mortalidad , Recurrencia Local de Neoplasia/patología , Estadificación de Neoplasias , Pronóstico , Neoplasias del Recto/mortalidad , Neoplasias del Recto/patología
11.
G Chir ; 13(10): 471-2, 1992 Oct.
Artículo en Italiano | MEDLINE | ID: mdl-1467146

RESUMEN

Multiple bile duct hamartomatosis of the liver or so-called von Meyenburg's syndrome, is an infrequent disease related to a dysembryogenic error. The authors discuss clinical features, diagnostic methods and possible related pathologies. Data reported in the literature are also received.


Asunto(s)
Neoplasias de los Conductos Biliares/patología , Síndrome de Hamartoma Múltiple/patología , Anciano , Conductos Biliares/patología , Femenino , Humanos , Masculino , Persona de Mediana Edad
12.
G Chir ; 13(1-2): 20-2, 1992.
Artículo en Italiano | MEDLINE | ID: mdl-1581160

RESUMEN

Intestinal artery aneurysms are a rare clinical condition, usually asymptomatic. However, sometimes they occur as vascular emergency, with a mortality rate of about 75%. Therefore, their occasional diagnosis should be carefully considered as an indication for elective surgery. The authors report their experience in the surgical management of 3 cases of intestinal artery aneurysms respectively involving the splenic, the gastroduodenal and the inferior mesenteric artery. A review of the literature is also presented.


Asunto(s)
Aneurisma/diagnóstico por imagen , Aneurisma de la Aorta/diagnóstico por imagen , Arteria Hepática , Anciano , Anciano de 80 o más Años , Aneurisma/cirugía , Aorta Abdominal/diagnóstico por imagen , Aorta Abdominal/cirugía , Aneurisma de la Aorta/cirugía , Arteria Hepática/diagnóstico por imagen , Arteria Hepática/cirugía , Humanos , Masculino , Persona de Mediana Edad , Radiografía
13.
Eur J Surg Oncol ; 39(8): 850-7, 2013 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-23726257

RESUMEN

BACKGROUND AND AIMS: The aim was to externally validate the capability of a simplified Barcelona Clinic Liver Cancer (s-BCLC) staging system in allocating patients to hepatic resection (HR) and the effect on survival: S-BCLC was defined by only 2 groups: AA included BCLC A1 + A2 classes with alpha-fetoprotein (AFP) ≤ 20 ng/ml and AB included A1 + A2 with AFP > 20 ng/ml plus A3 + A4 subgroups. METHODS: This study compared a training group (TG) with hepatocellular carcinoma (HCC) submitted to hepatic resection (HR) in Milan with another group of patients, the validation group (VG) in Creteil. All patients underwent ultrasound-guided anatomical resection (<3 segments). RESULTS: Overall survival got worse from A1 to A4 (p = 0.0271) in TG (n = 132), as well as in VG (n = 100) (p = 0.0044) with a more important overlapping of each curves. According s-BCLC classification, the survival curves of TG (p = 0.0001) and VG (p = 0.0250) showed a definitive separation in two different staging groups. The s-BCLC provided the best predictive accuracy and it also presented the highest separability index and C-statistics in both TG and VG. On the other hand, in the evaluation of discriminatory ability for death, measured by ROC curve areas, the s-BCLC system gave better results than the others. CONCLUSION: This experience stressed the high value of BCLC system in staging of HCC, but the s-BCLC system seems to be more useful for therapeutic decision making.


Asunto(s)
Carcinoma Hepatocelular/mortalidad , Carcinoma Hepatocelular/patología , Hepatectomía/mortalidad , Neoplasias Hepáticas/mortalidad , Neoplasias Hepáticas/patología , alfa-Fetoproteínas/metabolismo , Adulto , Anciano , Análisis de Varianza , Biomarcadores de Tumor/metabolismo , Carcinoma Hepatocelular/cirugía , Bases de Datos Factuales , Supervivencia sin Enfermedad , Detección Precoz del Cáncer , Femenino , Estudios de Seguimiento , Hepatectomía/métodos , Humanos , Italia , Neoplasias Hepáticas/cirugía , Masculino , Persona de Mediana Edad , Invasividad Neoplásica/patología , Estadificación de Neoplasias , Valor Predictivo de las Pruebas , Modelos de Riesgos Proporcionales , Estudios Prospectivos , Curva ROC , Medición de Riesgo , Estadísticas no Paramétricas , Análisis de Supervivencia
14.
J Ultrasound ; 13(4): 150-7, 2010 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-23396628

RESUMEN

INTRODUCTION: Hepatocellular carcinoma (HCC) is associated with a high incidence of postoperative recurrence, despite high rates of complete necrosis with radiofrequency ablation (RFA) and curative hepatic resections (HR). The aim of this study was to identify intraoperative ultrasound patterns observed during HR or RFA that predicting intrahepatic HCC recurrence. MATERIALS AND METHODS: From January 1997 through August 2008, we treated 377 patients with HCC (158 with HR and 219 with surgical RFA). All patients underwent intraoperative ultrasound (IOUS) examination. Primary HCCs was classified according to diameter, HCC pattern (nodular or infiltrative), echogenicity (hyper- or hypo-), echotexture (homogeneous or inhomogeneous), capsular invasion, mosaic pattern, nodule-in-nodule appearance, and infiltration of portal vessels. Number of HCC nodules was also considered. Comparisons between the groups of possible factors for intrahepatic recurrence of treated tumors were performed using the Kaplan-Meier method and compared using the log-rank test. RESULTS: Patients were followed for 9-127 months (median: 18.6 months), and intrahepatic recurrence was observed in 198 (52.5%). In 138 patients (36.5%), recurrences were located in different segments with respect to the primary tumor. In 60 HCC tumors (16%), local recurrences were found in the same segment as the primary tumor. At univariate analysis, primary HCC echogenicity and mosaic pattern were the only factors not significant associated with intrahepatic recurrences. CONCLUSION: IOUS is an accurate staging tool for use during "surgical" resection or RFA. This study shows that IOUS patterns can also be used to estimate the risk of post-treatment HCC recurrence. In patients at high risk for this outcome, closer follow-up and use of adjuvant therapies could be useful.

18.
HPB (Oxford) ; 6(1): 52-4, 2004.
Artículo en Inglés | MEDLINE | ID: mdl-18333049

RESUMEN

BACKGROUND: Hepatobiliary cystadenoma is a rare tumour that can be clinically 'silent' and only discovered as an incidental finding on ultrasonography (US). It can also be symptomatic with abdominal pain and jaundice or develop internal bleeding and (exceptionally) malignant degeneration. Therefore the treatment of choice is liver resection. CASE OUTLINE: A 77-year-old woman was admitted with mild jaundice and right hypochondrial pain. For 7 years she had been known to have a silent liver lesion, always considered to be a simple cyst on US. US and CT scan revealed a multi-septate mass involving segments IV, V and VIII of the liver, with thick walls, no calcifications and no contrast enhancement. US-guided aspiration showed the presence of old blood-stained material. The patient was operated with a suspected diagnosis of bleeding into a simple cyst. A Lin fenestration was performed with wide excision of the anterior wall of the cyst. Pathological examination demonstrated a mucinous hepatobiliary cystadenoma. The postoperative course was uneventful, and follow-up at 2 years confirmed no recurrence. DISCUSSION: Imaging will normally help to distinguish the occasional hepatobiliary cystadenoma from the common simple cyst. Otherwise, when a complication occurs, preoperative differentiation may become impossible, and requires histological examination of the cyst after surgical removal.

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