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1.
Medicine (Baltimore) ; 99(5): e18980, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32000430

RESUMO

RATIONALE: Primary hepatic lymphoma (PHL) is an extremely rare manifestation of extranodal non-Hodgkin lymphoma. There were few cases about PHL in recent years, while cases using positron emission tomography (PET) modalities for both diagnosis and follow-up were even rare. PATIENT CONCERNS: A 29-year-old man complaining of dull epigastric pain for 2 weeks. DIAGNOSIS: The features of liver biopsy and immunohistochemistry were consistent with diffuse large B cell lymphoma. Since there were no other foci of lymphoma on the F-fluoro-2-deoxy-D-glucose (F-FDG) PET/computed tomography (CT) images, the patient was further diagnosed with PHL. INTERVENTIONS: Since the lesions were mainly confined to the right lobe of liver, partial hepatectomy and radiofrequency ablation were performed. Subsequently, 6 cycles of rituximab, cyclophosphamide, adriamycin, vincristine, dexamethasone regimen were performed. OUTCOMES: The patient recovered well postoperatively and was discharged 1 week after surgery. Fortunately, the follow-up F-FDG PET/CT scan 36 months later revealed no abnormal FDG uptake, indicating the absence of relapse. LESSONS: As the superiority in excluding other organ involvement, F-FDG PET/CT should be considered as the preferable imaging modality for the diagnosis and follow-up of PHL. Besides chemotherapy, surgical resection should be considered initially. If radical R0 resection could not be done, partial hepatectomy with radiofrequency ablation may also offer an appropriate alternative treatment.


Assuntos
Neoplasias Hepáticas/diagnóstico por imagem , Linfoma Difuso de Grandes Células B/diagnóstico por imagem , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons/métodos , Adulto , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Ablação por Cateter , Fluordesoxiglucose F18 , Hepatectomia , Humanos , Neoplasias Hepáticas/terapia , Linfoma Difuso de Grandes Células B/terapia , Masculino , Compostos Radiofarmacêuticos
2.
Medicine (Baltimore) ; 99(5): e19076, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32000458

RESUMO

RATIONALE: PMS1 is one of the mismatch repair (MMR) genes with potential crucial roles in carcinogenesis. Very few reports have been identified on germline PMS1 mutations with definite disease phenotype. Here we report a case of hepatocellular carcinoma (HCC) with a novel potential pathogenic germline PMS1 mutation. PATIENT CONCERNS: A 46-year-old Chinese male with Hepatitis B infection history presented a single cancerous nodule (10×12×10 mm) at the left lobe of liver. The nodule was considered malignant by type-B ultrasonic and computed tomography (CT) examinations. DIAGNOSIS AND INTERVENTION: Liver lobectomy was performed to remove the liver cancerous nodule and postoperative TACE was performed for recurrence prevention. Pathological examination on resected tumor tissue confirmed the diagnosis of HCC. Whole-exome sequencing (WES) identified the c.900delT (p.D300fs) heterozygous germline mutation of PMS1, along with 253 nonsynonymous single nucleotide variations (SNVs), 14 Insertion or deletion mutations (INDELs) and 21 genes with copy number variations (CNVs). Three-dimensional prediction of protein tertiary structure suggested that the conformation of the enzyme active site and the ligand binding site might be changed due to the protein truncation. OUTCOMES: The patient was still alive in good condition with no sign of recurrence in 12 months follow-up period. LESSONS: The affected pathways in this case were unique from previously reported HCC patients with no PMS1 germline mutations. The novel PMS1 germline mutation may increase cancer risk. The roles of PMS1 germline mutations in carcinogenesis need further investigation.


Assuntos
Carcinoma Hepatocelular/genética , Mutação da Fase de Leitura , Mutação em Linhagem Germinativa , Neoplasias Hepáticas/genética , Proteínas MutL/genética , Proteínas de Neoplasias/genética , Carcinoma Hepatocelular/diagnóstico por imagem , Carcinoma Hepatocelular/cirurgia , Hepatectomia , Humanos , Neoplasias Hepáticas/diagnóstico por imagem , Neoplasias Hepáticas/cirurgia , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X , Ultrassonografia
3.
Anticancer Res ; 40(1): 401-404, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31892593

RESUMO

BACKGROUND/AIM: Bile leakage after liver surgery is still a problem to be solved. Here, we introduce a simple new technique, the Clip on Staple method, a preventive measure for bile leakage after anatomical liver resection using a stapling device. PATIENTS AND METHODS: Before liver parenchymal transection, the roots of Glissonean pedicles for target segments were dissected and divided using the Endo-GIA™ Tri-Staple™ Curved Tip. After the parenchymal transection was completed, the full length of the stapled stump was reinforced by multiple clips. The DS Titanium Ligation Clip was used as the clipping device. RESULTS: Twenty patients underwent this technique during anatomical liver resections with stapling devices. No patient developed postoperative bile leakage of any grade. There was no reoperation or readmission within 90 days. CONCLUSION: The Clip on Staple method is simple and offers a preventive effect for postoperative bile leakage after anatomical liver resection using stapling devices.


Assuntos
Bile/metabolismo , Fígado/cirurgia , Instrumentos Cirúrgicos , Grampeamento Cirúrgico , Idoso , Idoso de 80 Anos ou mais , Hepatectomia , Humanos , Processamento de Imagem Assistida por Computador , Pessoa de Meia-Idade , Resultado do Tratamento
4.
Z Gastroenterol ; 58(1): 63-67, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31931542

RESUMO

We report the case of a 65-year-old female patient with hepatic alveolar echinococcosis (AE) caused by Echinococcus multilocularis. This infrequent zoonosis has a considerable morbidity and mortality. The malignant appearing hepatic mass was initially misdiagnosed as cholangiocarcinoma of the right hepatic lobe (segments VII, VIII, and IVa, sized 10.9 cm × 7.6 cm) involving the right and middle hepatic vein and extending close to the left hepatic vein. During exploratory laparotomy, the frozen-section biopsy was indicative of AE (World Health Organization [WHO] classification: stage P3N0M0). Due to the high operative risk, it was decided to pretreat the patient with albendazole as inductive therapy in order to remove the AE secondarily in accordance with the patient's request. After year-long treatment with albendazole (under strict control of the maximum blood levels), a right hemihepatectomy was successfully performed. Postoperative treatment with albendazole had to be stopped prematurely after 11 months due to considerable subjective intolerance and a more-than-tenfold elevation of transaminases despite normal therapeutic albendazole blood levels. A 18F-FDG-PET/CT scan revealed no evidence of AE residues. Conducting follow-up examinations by 18F-FDG-PET/CT scans every 2 years is planned in order to recognize possible recurrence at an early stage.


Assuntos
Albendazol/uso terapêutico , Anti-Helmínticos/uso terapêutico , Equinococose Hepática/terapia , Echinococcus multilocularis/isolamento & purificação , Tomografia por Emissão de Pósitrons/métodos , Idoso , Animais , Equinococose Hepática/diagnóstico por imagem , Equinococose Hepática/parasitologia , Echinococcus multilocularis/efeitos dos fármacos , Feminino , Fluordesoxiglucose F18 , Hepatectomia , Humanos , Recidiva Local de Neoplasia , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Resultado do Tratamento
5.
Zhonghua Wai Ke Za Zhi ; 58(1): 13-16, 2020 Jan 01.
Artigo em Chinês | MEDLINE | ID: mdl-31902163

RESUMO

Large hepatocellular carcinoma (HCC) is one of the most common malignancies and was mistaked as "advanced and unresectable" . Liver resection is still the best curable treatment for HCC.The resection of large HCC is very difficult, which seriously restrict the progress of liver surgery.Our study proved that solitary large HCC (SLHCC) has unique clinicopathological and molecular biological characteristics.No matter how big the tumor size is, it belongs to early stage if there is no vascular invasion.Liver resection should be aggressively recommended for the patients with SLHCC, in which they can obtain good outcome, with 40% 5-year survival rate.We has also defined the borderline resectable hepatocellular carcinoma, and suggested that strictly master and correctly judge the surgical indications, syntheticly evaluate the surgical safety and patient's tolerability for liver resection.After that, with hands of experienced surgeons, liver resection for SLHCC can be safely and reliablely performed.


Assuntos
Carcinoma Hepatocelular/cirurgia , Hepatectomia/métodos , Neoplasias Hepáticas/cirurgia , Carcinoma Hepatocelular/patologia , Hepatectomia/tendências , Humanos , Neoplasias Hepáticas/patologia
6.
Zhonghua Wai Ke Za Zhi ; 58(1): 17-21, 2020 Jan 01.
Artigo em Chinês | MEDLINE | ID: mdl-31902164

RESUMO

Digital intelligent hepatobiliary surgery has evolved over decades.It has experienced an evolution course from digital virtual human technology to the establishment of a quality-controlled and homogeneous three-dimensional visualization system for precision diagnosis and treatment of diseases, from three-dimensional visualization to the clinical transformation of digital intelligent technology and changes in the diagnosis and treatment model, from empirical diagnosis of diseases to the application of deep learning for the intelligent diagnosis and treatment of diseases, from empirical surgery to real-time multi-modal image guidance during surgery, and from the morphological diagnosis of tumors to accurate diagnosis from molecular imaging.During the whole process, only through continuous innovation in research, theory and technology can the "life" of digital intelligent surgery be endowed with new vitality.In the future, the definition of tumor boundary from the molecular and cellular levels and the early diagnosis and treatment of liver tumor through the functional visualization of key molecules will have significant clinical value for changing the prognosis of liver cancer.In addition, in order to realize intelligent navigation for hepatectomy and break through the technical bottleneck, it is of great clinical significance to develop an intelligent robot real-time navigation hepatectomy system with automatic navigation technology, machine learning intelligent planning technology and multimodal image fusion technology.This provides unprecedented opportunities and challenges for the development of digital intelligent hepatobiliary surgery.


Assuntos
Hepatectomia/métodos , Imagem Tridimensional/métodos , Neoplasias Hepáticas/cirurgia , Inteligência Artificial , Humanos , Neoplasias Hepáticas/diagnóstico por imagem
7.
Medicine (Baltimore) ; 99(1): e18667, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31895832

RESUMO

BACKGROUND: Laparoscopic right hepatectomy (LRH) is one of the most challenging procedures. Right liver resections have been always performed in open procedure and open right hepatectomy (ORH) was initially considered as routine way. Moreover, it is unclear how beneficial the minimally invasive technique is to patients; thus, we conducted a meta-analysis to acquire a more reliable conclusion about the feasibility and safety of LRH compared with ORH. METHODS: We comprehensively searched the electronic databases of PubMed, Embase, and the Cochrane Library using the key words. Meta-analysis was performed using the Review Manager, with results expressed as odds ratio and weighted mean difference with 95% confidence intervals. The fixed-effect model was selected initially if high heterogeneity was not present between the studies; otherwise, the randomized-effect model was used. Subgroup analysis was performed based on different surgical methods of pure laparoscopic operation or hand-assisted operation. RESULTS: Seven studies with 467 patients were included. In the overall analysis, less intraoperative blood loss (MD = -155.17; 95% CI, -238.89, -71.45; P = .0003) and a shorter length of stay (MD = -4.45; 95% CI, -5.84, -3.07; P < .00001) were observed in the LRH group compared to the ORH group. There were fewer overall complications (OR = 0.30; 95% CI, 0.10, 0.90; P = 0.03) and severe complications (OR = 0.24; 95% CI, 0.10, 0.58; P = .002;) in the LRH group than in the ORH group. The disadvantage of LRH was the longer operative time (MD = 49.39; 95% CI, 5.33, 93.45; P = .03). No significant difference was observed between the 2 groups in portal occlusion, rate of R0 resection, transfusion rate, mild complications, and postoperative mortality. In the subgroup analysis, intraoperative blood loss was significantly lower in the pure LRH group and hand-assist LRH group compared with ORH group. Length of stay was shorter by use of pure LRH and hand-assisted LRH manners than ORH. The incidence rate of complications was lower in the pure LRH group than in the ORH group. In contrast, there was no significant difference between hand-assisted LRH group and ORH group. CONCLUSION: Compared to ORH, LRH has short-term surgical advantages and leads to a shorter recovery time in selected patients. We speculate that the operative time of LRH is closer with ORH. Overall, LRH can be considered a feasible choice in routine clinical practice with experienced surgeons, although more evidence is needed to make a definitive conclusion.


Assuntos
Hepatectomia/métodos , Neoplasias Hepáticas/cirurgia , Humanos , Laparoscopia , Complicações Pós-Operatórias
8.
Internist (Berl) ; 61(1): 96-101, 2020 Jan.
Artigo em Alemão | MEDLINE | ID: mdl-31705159

RESUMO

A 46-year-old woman presented with recurrent right upper quadrant pain. Abdominal ultrasound revealed an inhomogeneous liver lesion (4â€¯× 7 cm) with complex echotexture. Since further contrast-enhanced imaging tests were inconclusive and lesion integrity remained unclear, a left hemihepatectomy was performed. Histological examination revealed a hepatic epithelioid angiomyolipoma. Hepatic epithelioid angiomyolipoma is a rare, mostly benign, mesenchymal hepatic tumor, composed of smooth muscle cells, adipose tissue, and blood vessels of varying proportions, and its correct diagnosis remains a clinical challenge.


Assuntos
Dor Abdominal/etiologia , Angiomiolipoma , Neoplasias Hepáticas , Dor Abdominal/diagnóstico por imagem , Angiomiolipoma/diagnóstico , Angiomiolipoma/patologia , Angiomiolipoma/cirurgia , Biópsia , Feminino , Hepatectomia , Humanos , Fígado/patologia , Neoplasias Hepáticas/diagnóstico , Neoplasias Hepáticas/patologia , Neoplasias Hepáticas/cirurgia , Imagem por Ressonância Magnética , Pessoa de Meia-Idade
9.
J Surg Res ; 245: 500-509, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31446192

RESUMO

BACKGROUND: Abdominal surgery may increase the risk of splanchnic vein thrombosis (SVT). We determined the incidence of SVT after abdominal surgery and identified groups at highest risk. MATERIALS AND METHODS: MEDLINE and Embase were searched for clinical studies evaluating the incidence of postoperative SVT after abdominopelvic surgery. Study selection, data abstraction, and risk of bias assessment were carried out independently by two reviewers. Clinical heterogeneity was explored by subgroup analyses (i.e., type of intra-abdominal procedure and organ group). RESULTS: Of 5549 abstracts screened, 48 were analyzed. Pooled incidence of SVT (n = 50,267) was 2.68% [95% confidence interval (CI), 2.24 to 3.11] (1347 events), I2 = 96%. Pooled incidence of SVT in high-risk procedures were splenectomy with devascularization (24%), hepatectomy in patients with cirrhosis (9%), and pancreatectomy with venous resection (5%). Pooled incidence of symptomatic and asymptomatic SVT was 1.02% (95% CI: 0.97% to 1.07%) and 0.98% (95% CI 0.88% to 1.07%), respectively. Most common causes of SVT-related mortality were irreversible thrombosis, bowel ischemia, liver failure, and gastrointestinal bleed. Most studies included were at a high risk of bias due to lack of prospective data collection and lack of SVT screening for all participants. CONCLUSIONS: Incidence of SVT after abdominal surgery is low but remains a relevant complication. Patients undergoing procedures involving surgical manipulation of the venous system and splenectomy are at the highest risk. Given the life-threatening risks associated with SVT, there is a need for larger prospective studies on the incidence and impact of SVT after abdominal surgery.


Assuntos
Cavidade Abdominal/cirurgia , Complicações Pós-Operatórias/epidemiologia , Circulação Esplâncnica , Trombose Venosa/epidemiologia , Hepatectomia/efeitos adversos , Humanos , Incidência , Pancreatectomia/efeitos adversos , Complicações Pós-Operatórias/etiologia , Fatores de Risco , Esplenectomia/efeitos adversos , Trombose Venosa/etiologia
10.
Br J Radiol ; 93(1105): 20190719, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31670571

RESUMO

OBJECTIVE: To compare therapeutic outcomes between hepatic resection (HR) and radiofrequency ablation (RFA) for small hepatic masses diagnosed as hepatocellular carcinoma (HCC) on pre-treatment imaging study. METHODS: Our institutional review board approved this retrospective study, and informed consent was waived. Patients with a single (≤3 cm) mass diagnosed as HCC on pre-treatment imaging study between January 2008 and December 2009 who underwent HR (n = 145) or RFA (n = 178) were included. Recurrence-free survival (RFS) and overall survival (OS) were assessed. In the HR group, the false-positive rate for imaging diagnosis was calculated. For the RFA group, the local tumor progression rate was calculated. RESULTS: RFS rates at 5 years were 59.3% for the HR group and 32.2% for the RFA group. OS rates at 5 years were 85.4% for the HR group and 76.8% for the RFA group. In the RFA group, cumulative local tumor progression rates were 8.3 and 20.2% at 1 and 3 years. Treatment modality was not an independent prognostic factor for either RFS or OS on multivariate analysis. The false-positive rate for HCC diagnosis based on imaging criteria was 4.8% in the HR group. CONCLUSION: The imaging criteria for diagnosis of HCC have a high positive predictive value. Multivariate analysis showed that RFS and OS rates were not significantly different between HR and RFA for small hepatic masses diagnosed as HCC on pre-treatment imaging. ADVANCES IN KNOWLEDGE: Treatment modality (hepatic resection vs RFA) was not an independent prognostic factor for both RFS and OS for small masses (≤3 cm) diagnosed as hepatocellular carcinoma on pre-treatment imaging.


Assuntos
Carcinoma Hepatocelular/diagnóstico por imagem , Carcinoma Hepatocelular/cirurgia , Hepatectomia , Neoplasias Hepáticas/diagnóstico por imagem , Neoplasias Hepáticas/cirurgia , Ablação por Radiofrequência , Biomarcadores Tumorais/sangue , Meios de Contraste , Feminino , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Tomografia Computadorizada por Raios X
11.
Chirurg ; 90(12): 1033-1046, 2019 Dec.
Artigo em Alemão | MEDLINE | ID: mdl-31784769

RESUMO

Benign liver tumors are often detected during routine ultrasound examinations or as an incidental finding in radiological imaging. Only very few benign liver tumors are at risk of becoming malignant. In the majority of cases the differentiation from malignant tumors is currently carried out using imaging procedures. In a few cases of diagnostic uncertainty, a transcutaneous liver biopsy can lead to clarification. If the suspicion of malignancy is substantiated or this cannot be excluded with absolute certainty, the tumor should be removed by partial liver resection.


Assuntos
Hepatopatias , Neoplasias Hepáticas , Biópsia , Diagnóstico Diferencial , Hepatectomia , Humanos , Achados Incidentais , Hepatopatias/diagnóstico , Hepatopatias/terapia , Neoplasias Hepáticas/diagnóstico , Neoplasias Hepáticas/terapia , Ultrassonografia
12.
Nihon Shokakibyo Gakkai Zasshi ; 116(12): 1030-1038, 2019.
Artigo em Japonês | MEDLINE | ID: mdl-31827043

RESUMO

A 77-year-old Japanese man with a gastrointestinal stromal tumor (GIST) had undergone a duodenectomy 11 years prior. At that time, he had an incidentally detected left renal cell carcinoma, for which he underwent a nephrectomy and was followed-up at our institution. Twenty-four months after the nephrectomy, a 13-mm low-density mass was found on abdominal computed tomography (CT). Contrast-enhanced ultrasonography indicated an irregular hyperenhancement in the vascular phase and a defect on the post-vascular image. A tumor biopsy for differential diagnosis revealed that the tumor was a GIST. Since positron emission tomography-CT and capsule endoscopy revealed no evidence of a primary lesion, we performed a partial hepatectomy without adjuvant treatment. Microscopic examination revealed that the tumor consisted of uniform spindle cells with a fascicular growth pattern. Immunohistochemical examination revealed c-kit and CD34 expressions, similar to those found in the resected duodenal GIST specimen 11 years prior. We diagnosed metastatic liver tumor from the duodenal GIST resected 11 years prior. The patient remains alive without disease recurrence 24 months after the hepatectomy. Long-term surveillance is required after resection of a high-risk primary GIST.


Assuntos
Duodeno , Tumores do Estroma Gastrointestinal , Neoplasias Hepáticas , Idoso , Hepatectomia , Humanos , Masculino , Recidiva Local de Neoplasia
13.
Nan Fang Yi Ke Da Xue Xue Bao ; 39(10): 1127-1140, 2019 Oct 30.
Artigo em Chinês | MEDLINE | ID: mdl-31801707

RESUMO

Computer-assisted combined indocyanine green (ICG) molecular fluorescence imaging technology can be used for preoperative planning and intraoperative detection from three-dimensional (3D) morphological anatomy and level of cellular function to guide the anatomical, functional and radical hepatectomy of liver tumor. This technology has received wide acceptance and has shown important diagnostic and therapeutic value. This guideline is intended to standardize the application of computer-assisted combined ICG molecular fluorescence imaging for accurate diagnosis and treatment of liver tumors in the following aspects: (1) the workflow of 3D visualization technology; (2) the mechanism and application flow of ICG molecular fluorescence imaging; (3) clinical application of 3D visualization technology and virtual reality technology; and (4) clinical application of ICG molecular fluorescence imaging. ICG molecular fluorescence imaging can help to define tumor boundary, determine hepatic segment and hepatic lobectomy tangent at the molecular and cellular level, and detect small lesions or metastases. According to the fluorescence signal characteristics of liver tumors and combined with rapid frozen pathological examination during operation, the differentiation degree of liver space-occupying lesions (such as primary liver cancer) can be preliminarily determined, and residual tumors and biliary leakage on the hepatic section can be detected after hepatectomy. Computer-assisted ICG molecular fluorescence imaging in the diagnosis and surgical navigation of liver tumors provides a new approach to digital diagnosis and treatment of liver tumors. With its development in clinical practice and the technological innovation, this technology will be further improved to allow more accurate diagnosis and treatment of liver tumors.


Assuntos
Verde de Indocianina , Neoplasias Hepáticas/diagnóstico , Neoplasias Hepáticas/cirurgia , Imagem Óptica , Corantes Fluorescentes , Hepatectomia , Humanos
14.
Medicine (Baltimore) ; 98(49): e18176, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31804334

RESUMO

INTRODUCTION: Choice of treatment in patients with symptomatic polycystic liver diseases (PLD) remains controversial. Various surgical procedures aiming at eliminating symptomatic cysts are widely used in mild and advanced PLD patients, but liver transplantation is currently recommended as the only curative treatment especially in severe cases. PATIENT CONCERNS: Case 1: A 51-year-old male was admitted for severe eating disorder and dyspnea for 2 months. He had been diagnosed as PLD, PKD, and hypertension for 9 years, with only antihypertensive drug therapy. No significant family history could be traced.Case 2: A 54-year-old female was admitted to our hospital for ventosity during nearly 5 years. She had been diagnosed as PLD and hypertension for 22 years, for which only aspiration-sclerotherapy therapy was performed for multiple times. Both her mother and sister were diagnosed with PLD previously. DIAGNOSIS: They were diagnosed as PLD by medical history, family history, and computed tomography scan (multiple cysts dispersively presenting in the liver). INTERVENTIONS: The 2 patients underwent hepatectomy with fenestration, and were well recovered with no mortality. OUTCOMES: While case 1 only experienced relief of symptoms, case 2 experienced massive growth of hepatic parenchyma, which indicated positive prognosis and showed the possibility to avoid or at least postpone liver transplantation for a long time, considering the lack of liver parenchyma is one of the main reason for urgency of liver transplantation. CONCLUSION: Here we described subradical polycystic hepatectomy, a special form of hepatectomy with fenestration modified by us, as a safe and effective treatment to potentially achieve long-term effects in PLD patients.


Assuntos
Cistos/cirurgia , Hepatectomia/métodos , Hepatopatias/cirurgia , Cistos/diagnóstico por imagem , Feminino , Humanos , Hepatopatias/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Índice de Gravidade de Doença , Tomografia Computadorizada por Raios X
15.
Medicine (Baltimore) ; 98(49): e18291, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31804374

RESUMO

RATIONALE: Intrahepatic cholangiocarcinoma (ICC) originates from the epithelial cells of the secondary branches that are distant from the intrahepatic bile duct. ICC is a rare pathological type of primary liver cancer, with a high malignancy rate and poor prognosis. However, patients with ICC metastasis to the skull are extremely rarely encountered. Herein, we present a case of a metastatic skull tumor from ICC, along with a literature review. PATIENT CONCERNS: A 50-year-old right-handed man who did not smoke was diagnosed with a poorly differentiated ICC (T2aN0M0) in segment VI of the liver in February 2017. Hepatectomy was performed. The patient then presented with a painful mass in the posterior occipital region with dizziness experienced since 1 month, for which he underwent posterior occipital craniotomy. Postoperative specimens were sent for pathological examination. DIAGNOSES: We diagnosed the patient with a metastatic skull tumor from ICC. INTERVENTIONS: The patient underwent posterior occipital craniotomy and total resection of the tumor. OUTCOMES: The patient received chemotherapy 1 month after surgery, and after 6 months of follow-up, the patient was alive. LESSONS: ICC often shows metastases to the vertebrae. Therefore, physicians should consider the possibility of metastasis in patients with ICC, especially in those who show a painful skull mass of unknown origin; moreover, among patients with vertebral metastasis, physicians should be very vigilant about an occipital mass. We believe that the craniospinal venous system may be the pathway for occipital metastasis in patients with ICC.


Assuntos
Colangiocarcinoma/patologia , Neoplasias Cranianas/secundário , Quimioterapia Adjuvante , Colangiocarcinoma/cirurgia , Craniotomia , Hepatectomia , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias Cranianas/cirurgia
16.
Medicine (Baltimore) ; 98(49): e18307, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31804378

RESUMO

Only a few high-volume centers have reported the efficacy of laparoscopic liver resection (LLR) for patients with intrahepatic cholangiocarcinoma (ICC). The minimally invasive approach is still controversial for ICC, especially when dealing with large (≥5 cm) or multiple (≥2) ICCs.Patients with large and multiple ICCs who underwent LLR or open hepatectomy (OH) between January 2012 and June 2017 were included. Furthermore, 1:2 propensity score matching (PSM) was performed between the LLR group and the OH group. Short- and long-term outcomes were compared between the different techniques.After PSM, LLR resulted in significantly longer operation time (median 225 minutes vs 190 minutes, P = .006) and pringle maneuver time (median 50 minutes vs 32.5 minutes, P = .001). There was no statistically significant difference in postoperative hospital stay between the different approaches (median 6 days vs 7 days, P = .092). The grade III/IV complication rates were comparable between the groups (5.6% vs 11.1%, P = .868). In the PSM subset, there was no significant difference in terms of overall survival (P = .645) or disease-free survival (P = .827) between patients in the LLR group and in the OH group.The present study showed that patients who underwent LLR for large or multiple ICCs could obtain similar short- and long-term outcomes compared with those who underwent OH, and lymph node dissection (LND) was technically difficult but feasible during LLR.


Assuntos
Neoplasias dos Ductos Biliares/cirurgia , Colangiocarcinoma/cirurgia , Hepatectomia/métodos , Laparoscopia/métodos , Feminino , Humanos , Excisão de Linfonodo , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Complicações Pós-Operatórias , Pontuação de Propensão
17.
Rozhl Chir ; 98(10): 394-398, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31842568

RESUMO

Treatment of metastatic rectal cancer and liver metastases continues to pose a major challenge. Synchronous liver metastases are present in up to one fifth of patients diagnosed with rectal carcinoma. Multidisciplinary cooperation is essential for determination of the consequent diagnostic and therapeutic plan. Only tight collaboration of experts from different medical fields allows for optimal timing of various medical procedures leading to a maximal benefit for the patient. Given the complexity of the problem, different specific methods and combinations thereof are applied in the course of the therapy, making the design of straightforward guidelines impossible. Since open surgery is complicated by the vastly distant locations of the rectum and liver, minimally invasive approach brings more perspectives in simultaneous surgery. A novel possibility of robotic and/or laparoscopic surgery performed by two teams is currently being developed. Despite the progress in surgical technology, optimal strategy has not yet been established.


Assuntos
Neoplasias Hepáticas/secundário , Neoplasias Hepáticas/cirurgia , Neoplasias Retais/patologia , Neoplasias Retais/cirurgia , Hepatectomia/métodos , Humanos , Laparoscopia , Fígado/cirurgia , Neoplasias Primárias Múltiplas , Equipe de Assistência ao Paciente , Protectomia/métodos , Reto/cirurgia , Procedimentos Cirúrgicos Robóticos
18.
Rozhl Chir ; 98(10): 408-413, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31842571

RESUMO

INTRODUCTION: Surgical resection is the method of choice in treating liver malignancies. In patients who are not suitable for radical surgical treatment, the radiotherapeutic system Cyberknife® is a viable treatment option. The aim of this study is to compare short- and long-term results of both treatment methods. METHODS: A retrospective analysis of prospectively collected data was performed, focused on patients undergoing treatment of liver malignancies either by surgical resection or by the Cyberknife® system from 2013 to 2016. Only patients treated using a single treatment method were included in the study. RESULTS: A total of 260 patients were analysed; 142 were treated by performing surgical resection and the remaining 118 using Cyberknife® radiotherapy. Median survival was 30.65 months for the surgical resection and 22.93 for the Cyberknife® therapy; median overall survival was 27.63 months. Three-year cumulative survival was 47.4% for the resection and 19.9% for radiotherapy. Kaplan-Meier analysis did not demonstrate a statistically significant difference in disease-specific survival between both groups (p=0.082, CI 95%). Results limited only to colorectal liver metastases showed a statistically significant difference in disease-specific survival (p=0.031, CI 95%). CONCLUSIONS: Results of this study show statistically indifferent overall disease-specific survival of both groups. However, the significant difference in 3-year survival still indicates a predominant position of surgery in the diagnostic and therapeutic management of patients with liver malignancies. Nevertheless, Cyberknife® radiotherapy may actually represent a viable treatment alternative, particularly in patients unable to undergo surgical resection, although a longer follow-up period is necessary to obtain more robust results.


Assuntos
Hepatectomia , Neoplasias Hepáticas/radioterapia , Neoplasias Hepáticas/cirurgia , Radiocirurgia , Humanos , Estimativa de Kaplan-Meier , Neoplasias Hepáticas/mortalidade , Estudos Retrospectivos , Resultado do Tratamento
19.
Zhong Nan Da Xue Xue Bao Yi Xue Ban ; 44(10): 1163-1168, 2019 Oct 28.
Artigo em Chinês | MEDLINE | ID: mdl-31857511

RESUMO

OBJECTIVE: To observe the safety and impact on the short-term prognosis for patients of stroke volume variation (SVV) goal-directed fluid therapy (GDFT) in laparoscopic precision hepatectomy.
 Methods: A total of 120 patients (18-65 years old) undergoing laparoscopic precision hepatectomy were randomly divided into the fluid therapy group (group S) guided by SVV and the fluid therapy group (group C) guided by central venous pressure group (CVP), with 60 cases in each group. Mean arterial pressure (MAP) and heart rate (HR) were recorded at the following time: at home calm (T0), the operation started (T1), began to cut the liver (T2), the hepatectomy was acheived (T3), and in the end (T4). The lactic acid was measured at T0 to T4 and 1 day after surgery (T5). The amount of blood loss, urine output and fluid supplement, the incidence of intraoperative hypotension, and the use of neophryn were recorded. The recovery of liver function, Hb, and so on were also recorded.
 Results: Compared with the group C, the number of hypotension cases, the amount of blood loss and the amount of neophryn in the group S were decreased during the operation (P<0.05), while the lactic acid values in the group S were not significantly increased than those in the group C at T3 and T4 (P<0.05) and the elevation of AST, ALT, DBIL and TBIL in the group S was significantly decreased than those in the group C at 1 and 2 d after the operation (P<0.05). Hb and Hct in the group S were higher than those in the group C at 1 d after the surgery (P<0.05). Compared with the group C, the postoperative exhaust time and hospitalization time were shortened in the group S (P<0.05), and the infection rate and ICU admission rate were decreased in the group S (P<0.05).
 Conclusion: SVV-guided GDFT in laparoscopic precise hepatectomy is safe and effective. It reduces intraoperative blood loss and benefits the short-term prognosis of patients after operations. High SVV value (13%-17%) is adopted at the liver resection stage, and SVV value with 8%-12% at the end of trans-section may be used as one of intraoperative liquid therapy in laparoscopic precise hepatectomy.


Assuntos
Hepatectomia , Laparoscopia , Adolescente , Adulto , Idoso , Pressão Venosa Central , Hidratação , Humanos , Pessoa de Meia-Idade , Volume Sistólico , Adulto Jovem
20.
Medicine (Baltimore) ; 98(50): e18278, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31852101

RESUMO

RATIONALE: Primary hepatic neuroendocrine tumors (PHNET) are extremely rare, which makes it difficult for doctors not deeply to be aware of their imaging and pathological characteristics. Therefore, it is challenging to diagnose PHNET accurately without biopsy or surgical excision. The purpose of this study is PATIENT CONCERNS:: A 52-year-old male patient came to our outpatient department with intermittent upper abdominal pain. DIAGNOSES: PHNET. INTERVENTIONS: Biochemical examination and imaging examination were performed prior to operation. Liver tumors were removed by ultrasound scalpel under laparoscopy. Pathology examination of liver tumors was performed after operation. Symptomatic supportive treatment was performed after operation as well, including anti-inflammation and rehydration. OUTCOMES: The results of biochemical examination were generally normal. The results of MRI showed low signal on T1WI, slightly high signal on T2WI/FS and DWI manifestation of high signal. Immunohistochemistry (IHC) showed that synaptophysin (Syn) was positive, CD56 was positive, chromaffin A (CgA) was positive, and Ki-67 was 15%. The patient was generally in good condition and no discomfort or recurrence was reported during 15 months of follow-up. LESSONS: The incidence of PHNET is extremely low. Sometimes the patient has no cirrhosis or hepatitis, and alpha-fetoprotein is not high, but imaging examination shows solid occupation and clear boundaries of the liver tumor, for which doctors should consider the primary liver nerve tumor. The diagnosis of PHNET depends on pathological characteristics. Surgical excision is the main method to treat the disease.


Assuntos
Hepatectomia/métodos , Neoplasias Hepáticas/diagnóstico , Fígado/diagnóstico por imagem , Tumores Neuroendócrinos/diagnóstico , Biópsia , Diagnóstico Diferencial , Seguimentos , Humanos , Neoplasias Hepáticas/cirurgia , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Tumores Neuroendócrinos/cirurgia , Tomografia Computadorizada por Raios X , Ultrassonografia
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