ABSTRACT
Ischemia-reperfusion injury (IRI) during liver transplantation has been implicated in the recurrence of hepatocellular carcinoma (HCC). This systematic review aimed to evaluate interventions to reduce IRI during liver transplantation for HCC and their impact on oncologic outcomes. A comprehensive literature search retrieved four retrospective studies involving 938 HCC patients, utilising interventions such as post-operative prostaglandin administration, hypothermic machine perfusion, and normothermic machine perfusion. Overall, treated patients exhibited reduced post-operative hepatocellular injury and inflammation and significantly enhanced recurrence-free survival. Despite these promising results, the impact of these interventions on overall survival remains unclear. This underscores the imperative for further prospective research to comprehensively understand the efficacy of these interventions in HCC patients undergoing transplantation. The findings highlight the potential benefits of these strategies while emphasising the need for continued investigation into their overall impact.
Subject(s)
Carcinoma, Hepatocellular , Liver Neoplasms , Liver Transplantation , Reperfusion Injury , Humans , Reperfusion Injury/prevention & control , Reperfusion Injury/etiology , Liver Transplantation/methods , Carcinoma, Hepatocellular/surgery , Liver Neoplasms/surgery , Treatment Outcome , AllograftsABSTRACT
El uso de la derivación portocava durante el trasplante hepático ortotópico mejora la hemodinámica, puede contribuir a reducir los requerimientos de glóbulos y protege la función renal, aunque incrementa moderadamente el tiempo quirúrgico...
The use of the portocaval shunt during the liver orthotopic transplantation improves the hemodynamics, contributes to reduce the requirements of red blood cells and and protects the renal function, although it moderately increases the surgical time...
Subject(s)
Humans , Male , Female , Adult , Portacaval Shunt, Surgical/methods , Liver Transplantation/pathology , Prospective StudiesABSTRACT
El desarrollo de las técnicas quirúrgicas y los cuidados perioperatorios han permitido un incremento considerable de las resecciones hepáticas. En este estudio se evalúa la experiencia acumulada por el Grupo de Cirugía Hepato-Bilio-Pancreática del Hospital Clinicoquirúrgico "Hermanos Ameijeiras", durante más de 15 años, de exéresis del hígado por cáncer primario o secundario. Se realizó un estudio retrospectivo que incluyó 99 pacientes, a los que les fueron practicados 104 resecciones por cáncer primario o secundario. El estudio comprendió el período entre marzo de 1984 y septiembre del 2001, y recogió información sobre los diagnósticos, las técnicas quirúrgicas aplicadas, las complicaciones y la mortalidad. Se calculó el intervalo libre de enfermedad y la sobrevida acumulada, como evidencia de resultados a largo plazo. Se observó un predominio de las resecciones mayores en el cáncer primario en comparación con las menores en una relación de 2:1, sin embargo, las resecciones menores fueron más frecuentes en la metástasis (1:3). Las complicaciones sépticas tuvieron un peso importante y conllevaron en ocasiones a la relaparotomía; no obstante, fueron los trastornos cardiopulmonares los responsables de la mayoría (37,50(por ciento) de los 8 fallecimientos. El intervalo libre de enfermedad 1, 3 y 5 años fue 62,4 (por ciento), 25,2 (por ciento) y 5,2 (por ciento), respectivamente, mientras que la supervivencia acumulada fue de 77,0, 27,2 y 11,1 (por ciento). Se observaron diferencias significativas entre la supervivencia de los diferentes grupos metastásicos, así entre el cáncer primario y secundario. El grupo ha acumulado una valiosa experiencia en el manejo de este tipo de pacientes, avalado por resultados comparables con otras series internacionales(AU)
The development of the surgical techniques and the perioperative care has made possible a considerable increase of liver resections. In this study, it is evaluated the experience gained by the Group of Hepatobiliary Pancreatic Surgery of "Hermanos Ameijeiras" Clinical and Surgical Hospital for more than 15 years of exeresis of the liver due to primary or secondary cancer. A retrospective study was conducted that included 99 patients who underwent 104 resections due to primary or secondary cancer, from March, 1984, to September, 2001. Information on the diagnoses, the surgical techniques used, complications and mortality, was collected. The disease free inteval (DFI) and the accumulated survival were calculated as an evidence of the long term results. It was observed a predominance of major resections in primary cancer compared with the minor resections at a ratio of 2:1. However, minor resections were less frequent than in the metastasis (1:3). The septic complications were important and led on occasions to relaparatomy; nevertheless, the cardiopulmonary disorders were responsible for most of the 8 deaths (37.50 percent). The DFI at 1, 3 and 5 years was of 62.5 percent, 25.2 percent and 5.2 percent, respectively, whereas the accumulated survival was of 77.0 percent, 27.2 percent and 11.1 percent. Marked differences were observed in the survival of the various metastatic groups, but it was not so between primary and secondary cancer. The Group has gained a valuable experience in the management of this type of patients, supported by the attainment of results comparable with other international series(AU)