Variaciones anatómicas de la arteria hepática: patrones vasculares observados en 140 hígados de donante cadavérico / Anatomical variations of the hepatic artery: vascular patterns observed in 140 cadaveric donor livers

RESUMEN: El objetivo de este trabajo es analizar las variantes de la arteria hepática observadas en hígados de donantes cadavéricos empleados para trasplante ortotópico de hígado en nuestra población. Se efectuó un estudio retrospectivo de una cohorte de 140 trasplantes entre junio del año 2011 y enero del año 2021. La anatomía vascular arterial de los injertos hepáticos fue clasificada de acuerdo a la descripción de Hiatt. Variante clásica de la arteria hepática - Tipo I: 62 casos (65,7 %). Variante no clásica de la arteria hepática: 48 casos (34,3 %), correspondientes a: Tipo II: 12 casos (8,6 %), Tipo III: 18 casos (12,9 %), Tipo IV: 7 casos (5 %), Tipo V: 10 casos (7,1 %). No se encontró ningún caso de variante Tipo VI. Se halló 1 caso (0,7 %) no descrito en esta clasificación correspondiente a una arteria hepática izquierda accesoria que se originaba de la aorta. El conocimiento preciso de las variaciones más prevalentes, y también de las menos frecuentes, es fundamental para los procedimientos quirúrgicos que se realizan en el abdomen superior.

SUMMARY: The purpose of this article is to analyze the hepatic artery variations observed from the use of cadaveric donor livers for orthotopic transplantation among our population. A retrospective study of a liver transplant cohort including 140 donor livers was conducted between June 2011 and January 2021. The vascular arterial anatomy of the transplanted livers was classified according to Hiatt's classification system. Classic hepatic artery variant: Type I: 62 cases (65.7 %). Non-classic hepatic artery variants: 48 cases (34.3 %), corresponding to: Type II: 12 cases (8.6 %), Type III: 18 cases (12.9 %), Type IV: 7 cases (5 %), Type V: 10 cases (7.1 %). No case of Type VI variant was identified. One case (0.7 %) not included in Hiatt's classification was found, corresponding to an accessory left hepatic artery originating from the aorta. Precise knowledge regarding the most prevalent variations, as well as those that are the least common, is fundamental to upper abdominal surgical procedures.

Cirugía radical en el cáncer de vesícula incidental: valor del hallazgo de enfermedad residual en el estudio histopatológico diferido / Radical surgery for incidental gallbladder cancer: The value of a deferred pathological finding of residual disease

ANTECEDENTES: El tratamiento quirúrgico del cáncer de vesícula continúa siendo controvertido. La extensión de la cirugía radical y su eficacia terapéutica todavía están en debate. OBJETIVO: Valorar la efectividad de la resección radical en el cáncer de vesícula incidental, evaluando la presencia de enfermedad residual en la pieza de resección, los factores asociados y su impacto en la supervivencia alejada. MÉTODO: Se analizó en forma retrospectiva a 43 pacientes adultos con diagnóstico de cáncer incidental de vesícula entre junio de 1999 y junio de 2011. Se incluyeron tumores incidentales con resección R0. Las variables analizadas fueron datos demográficos, características clínicas, estudio histopatológico de la colecistectomía previa, indicación de resección, tipo de resección, morbilidad, mortalidad, estudio histopatológico, presencia de enfermedad residual y supervivencia. Se consideró significativa una p < 0,05. RESULTADOS: Se identificó a 43 pacientes con cáncer incidental de vesícula: 28 pacientes fueron tratados mediante resección, el 78,6% era de sexo femenino, la edad mediana fue de 56 años (rango: 38-78). En todos los pacientes se realizaron resecciones 4b/5, más linfadenectomía, en 6 de 8 casos se realizó la resección de los puertos de laparoscopia. No hubo mortalidad perioperatoria, 25% de morbilidad (71% tipo I). Se identificó enfermedad residual en el estudio histopatológico en el 42% (37% en el hígado), la cual se relacionó con el estadio tumoral (T) (p 0,001) Los pacientes con enfermedad residual presentaron una SG y SLE de 6,5 y 10 meses respectivamente vs 56 meses en aquellos sin enfermedad residual (p 0,001). Los factores independientes relacionados con la supervivencia fueron la presencia de enfermedad residual, el estadio T y el TNM. CONCLUSIÓN: La cirugía radical del cáncer incidental de vesícula es el único procedimiento con intención curativa pero su eficacia depende de la extensión de la enfermedad tumoral hallada durante la resección y en el estudio patológico diferido

BACKGROUND: Surgical treatment of gallbladder cancer is still controversial. The extent of the radical surgery and its therapeutic efficacy continue to be debated. OBJECTIVE: Analyze the efficacy of radical resection in patients with incidental gallbladder cancer evaluating the presence of residual disease in the resection specimen and analyzing the associated factors of survival. METHODS: A retrospective analysis of patients with incidental GC between June 1999 and June 2010 was performed. Incidental (I) tumors were included. Data covering demographic features, clinical characteristics, local pathological stage, histological features and factors for long term survival were analyzed. P < 0.05 were considered significant. RESULTS: A total of 28 patients: 78,6% females. Median age 56 years. All treated by resection of segments 4b/5 and lymphadenectomy. Histological examination revealed residual disease in 42% (37% liver), residual disease was related to tumoral (T) stage (p 0,001). Patients with residual disease presented a DSS and DFS of 10 and 6.5 months respectively vs 56 months in those without residual disease (p 0,001). Variables associated with survival were T stage (P .006), TNM stage (P < .001), and residual disease in the resected specimen (P < .001). CONCLUSIONS: Aggressive re-resection of incidental GC offers the only chance for cure but its efficacy depends on the extent of the disease found at the time of repeated surgery and in the deferred pathological study

[Radical surgery for incidental gallbladder cancer: the value of a deferred pathological finding of residual disease]. / Cirugía radical en el cáncer de vesícula incidental: valor del hallazgo de enfermedad residual en el estudio histopatológico diferido.

BACKGROUND: Surgical treatment of gallbladder cancer is still controversial. The extent of the radical surgery and its therapeutic efficacy continue to be debated. OBJECTIVE: Analyze the efficacy of radical resection in patients with incidental gallbladder cancer evaluating the presence of residual disease in the resection specimen and analyzing the associated factors of survival. METHODS: A retrospective analysis of patients with incidental GC between June 1999 and June 2010 was performed. Incidental (I) tumors were included. Data covering demographic features, clinical characteristics, local pathological stage, histological features and factors for long term survival were analyzed. p< 0.05 were considered significant. RESULTS: A total of 28 patients: 78,6% females. Median age 56 years. All treated by resection of segments 4b/5 and lymphadenectomy. Histological examination revealed residual disease in 42% (37% liver), residual disease was related to tumoral (T) stage (p 0,001). Patients with residual disease presented a DSS and DFS of 10 and 6.5 months respectively vs 56 months in those without residual disease (p 0,001). Variables associated with survival were T stage (P .006), TNM stage (P<.001), and residual disease in the resected specimen (P<.001). CONCLUSIONS: Aggressive re-resection of incidental GC offers the only chance for cure but its efficacy depends on the extent of the disease found at the time of repeated surgery and in the deferred pathological study.

Relevance of residual disease after liver resection for incidental gallbladder cancer.

OBJECTIVES: In patients diagnosed with incidental gallbladder cancer (GC), the benefit and optimal extent of further surgery remain unclear. The aims of this study were to analyse outcomes in patients who underwent liver resection following a diagnosis of incidental GC and to determine factors associated with longterm survival. METHODS: A retrospective analysis of patients diagnosed with incidental GC between June 1999 and June 2010 was performed. Data covering demographics, clinical and surgical characteristics and local pathological stage were analysed. RESULTS: A total of 24 patients were identified. All patients underwent a resection of segments IVb and V and lymphadenectomy. Histological examination revealed residual disease in 10 patients, all of whom presented with recurrent disease at 3-12 months. Overall 5-year survival was 53%. Increasing T-stage (P < 0.001), tumour-node-metastasis (TNM) stage (P= 0.003), and the presence of residual tumour in the resected liver (P < 0.001) were all associated with worse survival. CONCLUSIONS: Aggressive re-resection of incidental GC offers the only chance for cure, but its efficacy depends on the extent of disease found at the time of repeat surgery. The presence of residual disease correlated strongly with T-stage and was the most relevant prognostic factor for survival in patients treated with curative resection.

[Study of prognostic factors in the hepatectomy for metastases of colorectal carcinoma--analysis of two scores]. / Estudio de factores pronóstico en resecciones hepáticas por metástasis de carcinoma colorrectal--análisis de dos scores.

BACKGROUND: Resection is the treatment of choice for colorectal cancer liver metastases. OBJECTIVE: This is a retrospective, longitudinal, retrospective analysis of different prognostic factors for survival in a consecutive series of liver resection for metastatic colorectal carcinoma. PATIENTS AND METHODS: Between October 1998 and November 2007, we performed 89 liver resections for colorectal metastases. A retrospective analysis from the liver resection database was performed and the variables analyzed were related to demography, primary tumor and surgical procedure. Survival analysis was performed according to the Fong and Basingstoke scores. RESULTS: The mean age of patients was 60.5 years and 67.4% were men. The primary tumor was localized in the colon in 73% of cases. In 68.5% the metastases were metachronous. The right hemiliver was involved in 46 patients (52%). Major hepatectomy was performed in 36 (40.2%), minor in 55 (59.8%) and combined procedures in 14 (15.7%). Seventy-seven (86.5%) R0 resections were achieved. Morbidity was 32.6%, with no perioperative mortality. Average follow-up was 32.5 months (range 1 to 158 months), with a median of 25.5 months. Median overall survival was 69.7 months and mean disease-free survival 58.7 months. Multivariate analysis found statistical significance for blood product requirement and margin of resection. Thirty-four patients are alive at the end of this study (45.9%). The Basingstoke predictive index for postoperative variables showed significant differences that were not demonstrated by the Fong clinical score on prognostic factors. CONCLUSIONS: The application of Basingstoke predictive index and Fong score with biomarkers may indicate the most appropriate therapeutic strategy in each patient with colorectal liver metastases.

Bile duct cyst type V (Caroli's disease): surgical strategy and results.

BACKGROUND: Caroli's disease (CD) is a benign congenital disorder characterized by segmental cystic dilatation of the intrahepatic biliary ducts. Therapeutic strategy includes medical treatment, percutaneous, endoscopic or surgical drainage of the affected bile ducts, liver resection or transplantation. The aim of this study was to analyse the results and long-term follow-up of a consecutive series of patients who underwent surgical treatment for CD. PATIENTS AND METHODS: Between 1995 and 2005, 10 patients were surgically treated for CD. Variables evaluated were: age, gender, clinical presentation, diagnostic procedures, percutaneous and surgical treatments, histopathological analysis and outcome. RESULTS: The average age of the patients was 45.8 years. Recurrent cholangitis was the main clinical manifestation (70%). In unilateral CD a liver resection was performed in nine patients (left lateral sectionectomy in seven, left hepatectomy in one and right hepatectomy in one). In bilateral disease a cholecystectomy, duct exploration, hepaticojejunostomy and liver biopsy of both lobes were performed. Average follow-up was 60 months. All the patients are alive and free of symptoms without recurrence in the remnant liver. DISCUSSION: Liver resection is the preferred therapeutic option for unilateral CD, demonstrating good results in long-term follow-up. In bilateral disease, hepaticojejunostomy could be considered as an alternative or a previous step to liver transplantation, which still remains the ultimate option.