[Surgical treatment of liver cancer: experience of the A Coruña UHC (Spain)]. / Tratamiento quirúrgico del hepatocarcinoma: experiencia del CHU A Coruña.

INTRODUCTION: Liver cancer (LC) is one of the most frequent tumours, in which the potentially curative treatment is surgery: partial surgical resection or liver transplant. OBJECTIVES: To determine the morbidity and mortality, survival, and their associated factors in patients with LC, according to the type of surgical treatment: partial surgical resection or liver transplant. MATERIAL AND METHODS: A retrospective, observational follow-up study of LC patients diagnosed and treated from June 1994 to December 2007. A descriptive analysis of the variables was performed, as well as a Kaplan- Meier survival analysis and Cox regression. RESULTS: The incidence of tumour recurrence in the 150 transplant patients was 13.3%, with a survival at 1, 3, and 5 years of 89.3%, 73.1% and 61.4%, respectively. The multivariate analysis showed that only the histological grade/differentiation was an independent risk factor. In the 33 patients with partial surgical resection, the incidence of tumour was 51.5%, with a survival at 1, 3, and 5 years of 90.9%, 60.2%, and 38.6%, respectively. A significantly higher mortality was observed in patients with higher tumour and TNM staging. CONCLUSIONS: The survival throughout follow-up was higher in liver transplant, and tumour recurrence was more frequent in patients with partial surgical resection. The survival results in transplanted patients are consistent with the Spanish and European Liver Transplant Register and with the United Network for Organ Sharing register.

Renal transplantation with venous drainage through the superior mesenteric vein in cases of thrombosis of the inferior vena cava.

Renal transplantation usually is performed by placing the graft in the iliac fossa, anastomosing the renal vein to the iliac vein or, when this is not possible, to the vena cava. When vascular complications occur, particularly on the venous side, the position of the graft may have to be changed. This report describes orthotopic renal grafts and positioning of the organ with anastomosis to the splenic vessels. Venous drainage was established directly into the mesenteric-portal territory, with two cases to the portal vein and one to the inferior mesenteric vein. A new technique for the venous drainage of the renal graft is shown. We have used this model in two cases of infrarenal inferior vena cava thrombosis. The kidney was located in a retroperitoneal position, with venous drainage to the superior mesenteric vein through an orifice in the posterior peritoneum.

Liver transplantation from Maastricht category 2 non-heart-beating donors.

BACKGROUND: The demand for liver transplantation has increasingly exceeded the supply of cadaver donor organs. Non-heart-beating donors (NHBDs) may be an alternative to increase the cadaver donor pool. METHODS: The outcome of 20 liver transplants from Maastricht category 2 NHBDs is compared with 40 liver transplants from heart-beating donors (HBDs). After unsuccessful cardiopulmonary resuscitation (CPR), cardiopulmonary support (CPS) with simultaneous application of chest and abdominal compression (n=6), and cardiopulmonary bypass (CPB; n=14), which was hypothermic (n=7) or normothermic (n=7), were used to preserve the organs from NHBDs. Factors that may influence the outcome of livers from Maastricht category 2 NHBDs were also investigated. RESULTS: With a minimum follow-up of 2 years, actuarial patient and graft survivals with livers from Maastricht category 2 NHBDs were 80% and 55%, respectively. Transplantation of organs from these donors was associated with a significantly higher incidence of primary nonfunction, biliary complications, and more severe initial liver dysfunction compared with livers from HBDs. Graft survival was 83% in livers from NHBDs preserved with CPS and 42% in those maintained with CPB. No graft failed if the duration of warm ischemia did not exceed 130 min with CPR or CPS, and if the period of CPB did not surpass 150 min when this method was used after CPR, regardless if it was hypothermic or normothermic. CONCLUSION: Livers from Maastricht type 2 NHBDs may be used for transplantation if the period of warm ischemia during CPR or CPS does not exceed 130 min. Hypothermic or normothermic CPB after CPR preserves liver viability for an additional 150 min.

The anteromedial thigh flap as a training model of a perforator flap in rat.

BACKGROUND: Perforator flap surgery is a complex surgery that is based on the use of a highly precise microsurgical technique that differs slightly from a conventional free flap, especially the intramuscular dissection of the pedicle. Herein, we report a new model of a perforator flap in rat, the anteromedial thigh flap, as a teaching model of a perforator flap. It is based on a constant musculocutaneous perforator that arises from the muscular vessels for the gracilis muscle. MATERIAL AND METHODS: Twenty Wistar rats were used in this study. In 10 rats, an anatomical study was performed by means of anatomical dissection, Chinese ink injection, and microangiography studies, and in 10 rats, a flap transplantation study was carried out by means of transferring a pedicled perforator flap to the abdomen and monitoring its viability by direct inspection on the seventh day. RESULTS: Anatomical studies revealed a constant perforator that has an average length of pedicle up to 20 mm, an external diameter from 0.2 to 0.3 mm, and supplies blood to an area of approximately 3 x 3 cm of the anteromedial region of the thigh. In the flap studies, all the flaps survived on the seventh day after operation. CONCLUSIONS: The anteromedial thigh perforator flap is a reliable, reproducible inexpensive, replicates the handling of a perforator flap very closely, and has an easy method to record the outcomes by visual inspection, so we think that it is a useful tool as a teaching model for training a perforator flap in the preclinical setting.

Endovascular treatment of splenomesenteric-portal vein thromboses during orthotopic liver transplantation.

Extensive splanchnic venous thrombosis in patients undergoing orthotopic liver transplantation (OLT) continues to have a substantial impact on surgical complexity and perioperative morbidity and mortality rates. This report presents an experience in eight patients with splanchnic venous thrombosis treated by means of splanchnic vessel recanalization, primary stent placement, and closure of spontaneous competitive shunts during OLT. In all cases, portal perfusion in the allograft was adequate, portal hypertension was solved, and no complications were observed. None of the patients died during surgery or follow-up. The results reported here need to be confirmed in future studies.

Auxiliary liver transplantation with portal arterialization in the rat: description of a new model.

In recent years, portal arterialization has been used in liver transplantation to increase the portal flow, as a solution for singular technical problems. We have developed a new auxiliary liver transplantation model in the rat with portal arterialization, so the native hepatic hilium remains untouched, consisting on a graft with a previous 70% hepatectomy. It is sited on the right renal bed, joining the infrahepatic inferior vena cava (IVC) of the graft with the recipient IVC. With an abdominal aortic graft, we connect the recipient aorta with the portal vein from the auxiliary liver. All the animals survived at the seventh day. No thrombosis was seen in any graft and an important rejection was observed in all the fields. We have developed a new experimental model of an auxiliary liver with portal arterialization, avoiding the utilisation of the native hepatic hilium, necessary for the possible recovering of the proper liver in the case of a reversible fulminant hepatitis.

Tratamiento quirúrgico del hepatocarcinoma: experiencia del CHU A Coruña / Surgical treatment of liver cancer: experience of the A Coruña UHC (Spain)

Introducción El hepatocarcinoma (HCC) es uno de los tumores más frecuentes, y su tratamiento potencialmente curativo es la cirugía: resección quirúrgica parcial o trasplante hepático. Objetivos Determinar la morbimortalidad, la supervivencia y sus factores asociados en pacientes con HCC según tipo de tratamiento quirúrgico: trasplante hepático o resección quirúrgica parcial. Material y métodos Estudio observacional de seguimiento retrospectivo de HCC diagnosticados y tratados de junio de 1994 a diciembre de 2007. Se realiza un análisis descriptivo de las variables, análisis de supervivencia Kaplan-Meier y regresión de Cox. Resultados En los 150 pacientes trasplantados, la incidencia de recidiva tumoral es del 13,3%, con supervivencias a 1, 3 y 5 años del 89,3, el 73,1 y el 61,4% respectivamente; el análisis multivariable demuestra que sólo el grado de diferenciación histológica es factor de riesgo independiente. En los 33 pacientes con resección quirúrgica parcial, la incidencia de recidiva tumoral fue del 51,5%, con supervivencias a 1, 3 y 5 años del 90,9, el 60,2 y el 38,6%. Se evidencia una mortalidad significativamente mayor en pacientes con estadio tumoral y TNM superiores. Conclusiones La supervivencia en el seguimiento es mayor con trasplante hepático y la recidiva tumoral es más frecuente en pacientes con resección quirúrgica parcial. Los resultados de supervivencia en pacientes trasplantados coinciden con el Registro Español y Europeo de Trasplante Hepático y el registro de la United Network for Organ Sharing (AU)

Introduction: Liver cancer (LC) is one of the most frequent tumours, in which the potentiallycurative treatment is surgery: partial surgical resection or liver transplant. Objectives: To determine the morbidity and mortality, survival, and their associated factors in patients with LC, according to the type of surgical treatment: partial surgical resection orliver transplant. Material and methods: A retrospective, observational follow-up study of LC patients diagnosedand treated from June 1994 to December 2007. A descriptive analysis of the variableswas performed, as well as a Kaplan- Meier survival analysis and Cox regression. Results: The incidence of tumour recurrence in the 150 transplant patients was 13.3%, with asurvival at 1, 3, and 5 years of 89.3%, 73.1% and 61.4%, respectively. The multivariate analysis showed that only the histological grade/differentiation was an independent risk factor. Inthe 33 patients with partial surgical resection, the incidence of tumour was 51.5%, with asurvival at 1, 3, and 5 years of 90.9%, 60.2%, and 38.6%, respectively. A significantly highermortality was observed in patients with higher tumour and TNM staging. Conclusions: The survival throughout follow-up was higher in liver transplant, and tumourrecurrence was more frequent in patients with partial surgical resection. The survivalresults in transplanted patients are consistent with the Spanish and European LiverTransplant Register and with the United Network for Organ Sharing register (AU)

Donantes a corazón parado incontrolados o categorías I y II de Maastricht. Resultados / No disponible

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