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1.
Arq Bras Cir Dig ; 34(3): e1618, 2022.
Artigo em Inglês, Português | MEDLINE | ID: mdl-35019130

RESUMO

BACKGROUND: Hilar cholangiocarcinoma represents more than half of all cholangiocarcinoma cases, having poor prognosis and presenting a median overall survival after diagnosis of 12-24 months. In patients who have unresectable tumors with a better prognosis, the proposal to perform liver transplantation emerged for expanding the possibility of free margins by performing total hepatectomy. AIM: To provide a Brazilian protocol for liver transplantation in patients with hilar cholangiocarcinoma. METHOD: The protocol was carried out by two Brazilian institutions which perform a large volume of resections and liver transplantations, based on the study carried out at the Mayo Clinic. The elaboration of the protocol was conducted in four stages. RESULT: A protocol proposal for this disease is presented, which needs to be validated for clinical use. CONCLUSION: The development of a liver transplantation protocol for cholangiocarcinoma aims not only to standardize the treatment, but also enable a better assessment of the surgical results in the future.


Assuntos
Neoplasias dos Ductos Biliares , Colangiocarcinoma , Tumor de Klatskin , Transplante de Fígado , Neoplasias dos Ductos Biliares/cirurgia , Ductos Biliares Intra-Hepáticos/cirurgia , Colangiocarcinoma/cirurgia , Hepatectomia , Humanos , Tumor de Klatskin/cirurgia , Estudos Retrospectivos , Resultado do Tratamento
2.
BMC Gastroenterol ; 22(1): 2, 2022 Jan 03.
Artigo em Inglês | MEDLINE | ID: mdl-34979950

RESUMO

BACKGROUND: Undifferentiated embryonal sarcoma of the liver (UESL) is a rare liver tumor accounting for 6-13% of primary liver tumors. Accurate preoperative diagnosis is difficult, with a rather high misdiagnosis rate. Herein, we reported a very large UESL treated with anatomical resection. Our case is amongst the largest pediatric UESLs in the literature. CASE PRESENTATION: Herein, we report a 13-year-old girl presenting with right upper quadrant abdominal pain, postprandial vomiting, and abdominal distention, in which radiographic imaging demonstrated a huge UESL (28 × 20 × 12 cm). The patient was treated with partial hepatectomy and the 5 kg tumor was removed. The patient was discharged in good condition, with no significant complaints in her follow-up. CONCLUSIONS: Although different treatment strategies have been reported for UESL cases, anatomical resection is still the main treatment approach, especially for large tumors.


Assuntos
Neoplasias Hepáticas , Neoplasias Embrionárias de Células Germinativas , Sarcoma , Adolescente , Criança , Feminino , Hepatectomia , Humanos , Neoplasias Hepáticas/diagnóstico por imagem , Neoplasias Hepáticas/cirurgia , Sarcoma/cirurgia
3.
J Coll Physicians Surg Pak ; 32(1): 96-98, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34983156

RESUMO

Single-port laparoscopic liver surgery has become an attractive procedure for many surgeons in order to decrease surgical aggression and the complications related to laparoscopic ports. The aim of this study is to assess the feasibility and efficacy of single-port laparoscopic liver resections in patients with previous upper or lower abdominal surgery. A series of ten patients with history of previous abdominal surgery who underwent single-port laparoscopic surgery for liver metastases, primary liver cancer or benign hepatic tumor, is being presented here. Several clinical and operative parameters were reviewed from a historical database of laparoscopic hepatectomy. Key Words: Laparoscopic liver surgery, Single-port, Previous abdominal surgeries.


Assuntos
Laparoscopia , Neoplasias Hepáticas , Hepatectomia , Humanos , Neoplasias Hepáticas/cirurgia , Resultado do Tratamento
4.
J Coll Physicians Surg Pak ; 32(1): 105-107, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34983159

RESUMO

Hepatocellular carcinoma (HCC) is the most common primary liver cancer. Hepatectomy and transcatheter arterial chemoembolisation (TACE) are generally accepted methods for the treatment of huge HCCs, but the most appropriate treatment is still controversial. We report a 43-year woman with giant HCC, who successfully underwent surgery. The patient was admitted with persistent right upper abdominal pain and fever. Before operation, we assessed the residual liver function and reserve capacity of the patient, and excluded the relevant surgical contra-indications. The results showed that the patient could tolerate surgical treatment, so we performed HCC resection, and the patient was successfully treated. Individualised treatment should be carried out according to tumor factors, baseline liver function and patient's functional status, so as to maximise the benefit to patients. Key Words: Huge hepatocellular carcinoma, Hepatectomy, TACE.


Assuntos
Carcinoma Hepatocelular , Quimioembolização Terapêutica , Neoplasias Hepáticas , Carcinoma Hepatocelular/cirurgia , Feminino , Hepatectomia , Humanos , Neoplasias Hepáticas/cirurgia , Estudos Retrospectivos
5.
Life Sci ; 289: 120212, 2022 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-34896163

RESUMO

AIMS: Hepatic ischemia reperfusion injury (HIRI) is associated with liver failure after liver transplantation and hepatectomy. Thus, this study aims to explore the effect of conditioned medium from adipose derived stem cells (ADSC-CM) on endoplasmic reticulum stress (ERS) and lipid metabolism after HIRI combined with hepatectomy in miniature pigs. MAIN METHODS: A model of HIRI combined with hepatectomy in miniature pigs was established. The expression of ERS-related proteins and lipid metabolism related genes, as well as triglyceride (TG), total cholesterol (TC), high density lipoprotein (HDL), very low density lipoprotein (VLDL) and acetyl-CoA carboxylase 1 (ACC1) level were measured in liver tissues. KEY FINDINGS: Both ADSCs and ADSC-CM could improve the damage in the ultrastructure of hepatocytes. ADSC-CM significantly decreased the protein expression of GRP78, ATF6, XBP1, p-eIF2α, ATF4, p-JNK and CHOP. Oil red O staining revealed that the degree of hepatocyte steatosis was also significantly reduced after treatment with ADSC-CM. In addition, ADSC-CM remarkably decreased TG, TC, HDL and ACC1 level in liver tissues, while enhanced VLDL content. Finally, SREBP1, SCAP, FASN, ACC1, HMGCR and HMGCS1 mRNA expression was also markedly downregulated in liver tissues. SIGNIFICANCE: Injection of ADSC-CM into the hepatic parenchymal could represent a novel cell-free therapeutic approach to improve HIRI combined with hepatectomy injury. The inhibition of ERS and the improvement of lipid metabolism in the hepatocytes might be a potential mechanism used by ADSC-CM to prevent liver injury from HIRI combined with hepatectomy.


Assuntos
Tecido Adiposo/metabolismo , Estresse do Retículo Endoplasmático , Hepatectomia , Metabolismo dos Lipídeos , Falência Hepática/metabolismo , Transplante de Fígado , Fígado/metabolismo , Células-Tronco Mesenquimais/metabolismo , Traumatismo por Reperfusão/metabolismo , Animais , Meios de Cultivo Condicionados/farmacologia , Falência Hepática/tratamento farmacológico , Traumatismo por Reperfusão/tratamento farmacológico , Suínos , Porco Miniatura
6.
BMC Gastroenterol ; 21(1): 485, 2021 Dec 20.
Artigo em Inglês | MEDLINE | ID: mdl-34930130

RESUMO

BACKGROUND: Mucinous cystic neoplasm of the Liver is rare tumors with malignant potential that occur in the biliary epithelium. Because of its rare presentation, it is often misdiagnosed before surgery. CASE PRESENTATION: A 63-year-old female patient presented with intermittent upper abdominal pain for three months. Laparoscopic hepatectomy of Segment 7 was conducted based on the preoperative diagnosis of space-occupying lesion in the right lobe of the liver. Postoperative pathology showed a low-grade mucinous cystic neoplasm in the right posterior lobe of the liver. The preoperative CA19-9 level was significantly increased while the postoperative CA19-9 returned to the normal range. CONCLUSIONS: The diagnosis of mucinous cystic neoplasm of the liver is closely related to the thickening of the cystic wall or the increase of CA19-9, which has great significance and deserves clinical attention.


Assuntos
Laparoscopia , Neoplasias , Hepatectomia , Humanos , Fígado , Pessoa de Meia-Idade
7.
World J Surg Oncol ; 19(1): 344, 2021 Dec 12.
Artigo em Inglês | MEDLINE | ID: mdl-34895260

RESUMO

BACKGROUND: This study aimed to establish a radiomics-based nomogram for predicting severe (grade B or C) post-hepatectomy liver failure (PHLF) in patients with huge (≥ 10 cm) hepatocellular carcinoma (HCC). METHODS: One hundred eighty-six patients with huge HCC (training dataset, n = 131 and test dataset, n = 55) that underwent curative hepatic resection were included in this study. The least absolute shrinkage and selection operator (LASSO) approach was applied to develop a radiomics signature for grade B or C PHLF prediction using the training dataset. A multivariable logistic regression model was used by incorporating radiomics signature and other clinical predictors to establish a radiomics nomogram. Decision tree analysis was performed to stratify the risk for severe PHLF. RESULTS: The radiomics signature consisting of nine features predicted severe PHLF with AUCs of 0.766 and 0.745 for the training and test datasets. The radiomics nomogram was generated by integrating the radiomics signature, the extent of resection and the model for end-stage liver disease (MELD) score. The nomogram exhibited satisfactory discrimination ability, with AUCs of 0.842 and 0.863 for the training and test datasets, respectively. Based on decision tree analysis, patients were divided into three risk classes: low-risk patients with radiomics score < -0.247 and MELD score < 10 or radiomics score ≥ - 0.247 but underwent partial resections; intermediate-risk patients with radiomics score < - 0.247 but MELD score ≥10; high-risk patients with radiomics score ≥ - 0.247 and underwent extended resections. CONCLUSIONS: The radiomics nomogram could predict severe PHLF in huge HCC patients. A decision tree may be useful in surgical decision-making for huge HCC hepatectomy.


Assuntos
Carcinoma Hepatocelular , Doença Hepática Terminal , Neoplasias Hepáticas , Carcinoma Hepatocelular/diagnóstico por imagem , Carcinoma Hepatocelular/cirurgia , Hepatectomia , Humanos , Neoplasias Hepáticas/diagnóstico por imagem , Neoplasias Hepáticas/cirurgia , Nomogramas , Prognóstico , Índice de Gravidade de Doença , Tomografia Computadorizada por Raios X
8.
Khirurgiia (Mosk) ; (12): 27-33, 2021.
Artigo em Russo | MEDLINE | ID: mdl-34941206

RESUMO

OBJECTIVE: To analyze the initial data on future liver remnant volume and its function evaluated by 99mTc-Bromesida hepatobiliary scintigraphy in children with liver tumors. MATERIAL AND METHODS: Extended liver resections were performed in 58 patients aged 2 months - 208 months (median 26 months) for various neoplasms. Before hepatectomy, all children underwent contrast-enhanced CT with volumetry and hepatobiliary scintigraphy with 99mTc-Bromezida and subsequent quantitative assessment of its accumulation in the future liver remnant. All consecutive patients eligible for extended liver resection were retrospectively analyzed. RESULTS: The analysis included patients who underwent extended liver resection between June 2017 and March 2021. Among 91 liver resections, 58 (64%) procedures were extended hepatectomies including 2 ALPPS procedures. Median volume of future liver remnant was 44.5% (16.5-91.4), median future liver remnant function - 10.14%/min/m2 (1.8-30). Four patients with adequate liver function had insufficient volume of future liver remnant. Insufficient future liver remnant volume and its appropriate function were observed in 2 patients. Not life-threatening post-resection liver failure developed in 2 patients. CONCLUSION: Evaluation of future liver remnant function is the most sensitive method to predict post-hepatectomy liver failure in children. The cut off value of future liver remnant volume in children is below 25% and probably below 16.5%. Further data collection and research are warranted to determine significant values. These data will contribute to define the new indications for two-staged hepatectomies in children.


Assuntos
Neoplasias Hepáticas , Fígado/fisiologia , Criança , Pré-Escolar , Hepatectomia , Humanos , Lactente , Fígado/diagnóstico por imagem , Fígado/cirurgia , Falência Hepática , Neoplasias Hepáticas/diagnóstico por imagem , Neoplasias Hepáticas/cirurgia , Veia Porta , Estudos Retrospectivos
9.
JSLS ; 25(4)2021.
Artigo em Inglês | MEDLINE | ID: mdl-34949907

RESUMO

Background and Objectives: The scope of laparoscopic surgery has expanded to encompass hepatic resections, specifically hepatic hemangioma. The most serious intraoperative complication is bleeding, often requiring laparotomy. Because risk factors associated with such massive blood loss have not been well evaluated, the intent of this retrospective study was to analyze these risk factors associated with laparoscopic resection of hepatic hemangiomas. Methods: From June 1, 2011 to January 31, 2021, 140 consecutive patients underwent laparoscopic surgery for hepatic hemangioma in our hospital. According to quantity of intraoperative blood loss, they were divided into massive (≥ 800 ml) and minor blood loss (< 800 ml) groups. Perioperative data were analyzed by univariate and multivariate analyses with logistic regression to identify the risk factors for potential massive blood loss during laparoscopic resection. Results: There were 24 and 116 patients in the massive and minor blood loss groups, respectively. Of four risk factors significantly associated with massive blood loss by univariate logistic regression analysis (location of hemangioma in the liver, postcaval or hepatic venous compression, hilar compression, and body mass index exceeding 28) the multifactorial logistic model identified only location in the liver of the hemangioma as statistically (P = 0.012) associated with intraoperative massive blood loss. Conclusions: Location of the hepatic hemangioma was the single statistically significant risk factor for massive blood loss during laparoscopic surgery for hepatic hemangioma. Of particular importance, location in Couinaud liver segments I, IVa, VII, and VIII necessitates precautions to mitigate the risk of massive blood loss.


Assuntos
Perda Sanguínea Cirúrgica , Hemangioma , Hepatectomia , Laparoscopia , Neoplasias Hepáticas , Hemangioma/cirurgia , Hepatectomia/efeitos adversos , Humanos , Laparoscopia/efeitos adversos , Neoplasias Hepáticas/cirurgia , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento
10.
Arq Gastroenterol ; 58(4): 514-519, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34909859

RESUMO

BACKGROUND: Robotic surgery has gained growing acceptance in recent years, expanding to liver resection. OBJECTIVE: The aim of this paper is to report the experience with our first fifty robotic liver resections. METHODS: This was a single-cohort, retrospective study. From May 2018 to December 2020, 50 consecutive patients underwent robotic liver resection in a single center. All patients with indication for minimally invasive liver resection underwent robotic hepatectomy. The indication for the use of minimally invasive technique followed practical guidelines based on the second international laparoscopic liver consensus conference. RESULTS: The proportion of robotic liver resection was 58.8% of all liver resections. Thirty women and 20 men with median age of 61 years underwent robotic liver resection. Forty-two patients were operated on for malignant diseases. Major liver resection was performed in 16 (32%) patients. Intrahepatic Glissonian approach was used in 28 patients for anatomical resection. In sixteen patients, the robotic liver resection was a redo hepatectomy. In 10 patients, previous liver resection was an open resection and in six it was minimally invasive resection. Simultaneous colon resection was done in three patients. One patient was converted to open resection. Two patients received blood transfusion. Four (8%) patients presented postoperative complications. No 90-day mortality was observed. CONCLUSION: The use of the robot for liver surgery allowed to perform increasingly difficult procedures with similar outcomes of less difficult liver resections.


Assuntos
Laparoscopia , Neoplasias Hepáticas , Procedimentos Cirúrgicos Robóticos , Robótica , Feminino , Hepatectomia/efeitos adversos , Humanos , Tempo de Internação , Neoplasias Hepáticas/cirurgia , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Estudos Retrospectivos , Procedimentos Cirúrgicos Robóticos/efeitos adversos
11.
BMC Surg ; 21(1): 420, 2021 Dec 15.
Artigo em Inglês | MEDLINE | ID: mdl-34911513

RESUMO

BACKGROUND: To evaluate the efficacy and safety of our new surgical procedures for primary intra- and extrahepatic hepatolithiasis. Hepatolithiasis is an intractable disease with frequent recurrences. METHODS: From 1996 to 2005, 142 patients with intrahepatic and/or extrahepatic hepatolithiasis treated with the conventional surgical methods were included as the control group, while 128 consecutive patients treated with new surgical methods from 2006 to 2015 were included as the observation group. The new surgical procedures included a comprehensive intraoperative exploration of the bile ducts, focusing on the structure and function of the hilar bile duct and duodenal papilla, exploration of the affected liver, and bile culture. RESULTS: The observation group had a significantly higher complete stone clearance rate than the control group (100% vs. 65.96%). The observation group had significantly lower incidences of cholangitis and bile duct stones, as well as a higher excellent and good long-term surgical efficacy rate (86.24% vs. 52.73%). Multivariate Cox analysis showed that the control group had a higher risk for fair + poor efficacy than the observation group (HR: 8.47). CONCLUSIONS: Our new surgical procedures are safe and can provide a good long-term efficacy for treating primary hepatolithiasis intra- and extrahepatic hepatolithiasis.


Assuntos
Ductos Biliares Extra-Hepáticos , Litíase , Hepatopatias , Ductos Biliares Extra-Hepáticos/cirurgia , Ductos Biliares Intra-Hepáticos , Hepatectomia , Humanos , Litíase/cirurgia , Hepatopatias/cirurgia , Estudos Retrospectivos , Resultado do Tratamento
12.
Orv Hetil ; 162(50): 2010-2016, 2021 12 12.
Artigo em Húngaro | MEDLINE | ID: mdl-34896985

RESUMO

Összefoglaló. Bevezetés: A colorectalis eredetu májáttétek (CRCLM-ek) kuratív célú kezelésében elsodleges a sebészi reszekció. A mutét elott különbözo képalkotó vizsgálatok végezhetok, az egyik ilyen speciális vizsgálat a májsejtspecifikus kontrasztanyaggal végzett MR-vizsgálat. Célkituzés: Tanulmányunkban a májsejtspecifikus kontrasztanyaggal végzett MR-vizsgálat helyét és szerepét vizsgáltuk a májsebészeti gyakorlatban colorectalis áttétes betegek esetében. Módszer: Az Uzsoki Utcai Kórház Sebészeti-Onkosebészeti Osztályán 2017. 01. 01. és 2019. 12. 31. között CRCLM miatt májreszekcióra kerülo betegek adatait elemeztük. Retrospektív módon vizsgáltuk a betegek általános sebészeti és onkosebészeti paramétereit, a képalkotó diagnosztikai eredményeket, a mutéti adatokat és a patológiai leleteket. Eredmények: 132, CRCLM miatt operált betegbol 73 szoliter áttét (55%), míg 59 beteg (45%) többszörös áttét miatt került mutétre. 94 betegnél (71%) történt májsejtspecifikus MR-vizsgálat. Szoliter áttét esetén 60%-ban, multiplex áttétek esetén 85%-ban történt májsejtspecifikus MR-vizsgálat (p = 0,02). A szoliter áttétes betegek 8%-ában, míg a multiplex áttétes betegek 39%-ában mutatott további áttétet a májspecifikus kontrasztanyaggal végzett MR-vizsgálat (p = 0,001). A betegek 5%-ában igazolódott fals pozitivitás és 6%-ában fals negativitás a májsejtspecifikus MR-vizsgálat során. 264 góc vizsgálata alapján a májspecifikus kontrasztanyaggal végzett MR-vizsgálat szenzitivitása CRCLM esetén 95%-os, míg pozitív prediktív értéke 93%-os volt vizsgálatunkban. Következtetés: A májsejtspecifikus kontrasztanyaggal végzett MR-vizsgálat hasznos diagnosztikai módszer a CRCLM-ek sebészi reszekciója elott. Leginkább többszörös áttétek esetén, preoperatív szisztémás onkológiai kezelést követoen, illetve más képalkotó vizsgálaton igazolt eltunt áttét esetén javasolható az alkalmazása. Orv Hetil. 2021; 162(50): 2010-2016. INTRODUCTION: Liver resection is the only curtive treatment option of colorectal cancer liver metastases (CRCLMs). While different diagnostic modalities are available before surgery, a specific diagnostic tool is the liver-specific contrast-enhanced MRI. OBJECTIVE: The purpose of this study was to evaluate the role of liver-specific contrast-enhanced MRI before resection of colorectal liver metastases. METHOD: Patients with CRCLM, resected at the Department of Surgical Oncology, Uzsoki Teaching Hospital, between 01. 01. 2017 and 31. 12. 2019 were enrolled in our study. Clinical data, diagnostic, intraoperative and pathological findings were analyzed in a retrospective setting. RESULTS: 132 CRCLM patients were resected in this period, 73 patients had solitary (55%), and 59 patients (45%) had multiple metastases. Liver-specific contrast-enhanced MRI was performed in 94 patients (71%). 60% of the patients with solitary and 85% of the patients with multiple CRCLM had liver-specific contrast-enhanced MRI (p = 0.02). Compared to other modalities, liver-specific contrast-enhanced MRI showed additional metastases in 8% of the patients with solitary, and in 39% of the patients with multiple metastases (p = 0.001). Liver-specific contrast-enhanced MRI had a 5% false-positivity and a 6% false-negativity rate. 264 leasions were analyzed, and the sensitivity of the liver-specific contrast-enhanced MRI was 95% with a predictive positive value of 93%. CONCLUSION: Liver-specific contrast-enhanced MRI is a useful diagnostic tool in CRCLM patients before liver resection. It is highly recommended in the case of multiple metastases, after preoperative chemotherapy and in the case of disappearing metastases. Orv Hetil. 2021; 162(50): 2010-2016.


Assuntos
Neoplasias Colorretais , Neoplasias Hepáticas , Neoplasias Colorretais/cirurgia , Hepatectomia , Humanos , Neoplasias Hepáticas/cirurgia , Imageamento por Ressonância Magnética , Estudos Retrospectivos
13.
Rev. ecuat. pediatr ; 22(3): 1-10, 30 de diciembre del 2021.
Artigo em Espanhol | LILACS | ID: biblio-1352456

RESUMO

Introducción: La resección hepática sigue siendo el método más efectivo de tratamiento de tumores hepáticos. Actualmente, el abordaje laparoscópico se considera como el estándar de oro frente al abordaje abierto; sin embargo, el surgimiento de la cirugía robótica brinda una nueva opción de abordaje mínimamente invasiva con aparentes mejores resultados. El objeti-vo de esta revisión sistemática es valorar los beneficios de la hepatectomía robótica frente a la hepatectomía laparoscópica en la resección de tumores hepáticos. Metodología: En esta revisión sistemática se incluirán estudios comparativos, de cohorte, de casos y controles, con recolección de datos prospectivos o retrospectivos. Los participantes de los estudios serán pacientes diagnosticados con tumores hepáticos benignos o malignos, in-cluidos niños y adolescentes, no cirróticos o cirróticos compensados sometidos a intervencio-nes de hepatectomía robótica y hepatectomía laparoscópica. Las medidas de resultado pri-marias son: 1. Pérdida de sangre estimada durante el acto quirúrgico, 2. Tiempo operatorio, 3. Tasa de conversión a laparotomía, 4. Tasa de mortalidad intraoperatoria, 5. Tasa de morbili-dad (complicaciones postquirúrgicas), 6. Estancia hospitalaria postquirúrgica. Las búsquedas electrónicas se realizarán en PUBMED, MEDLINE, SCIENCEDIRECT (2010 hasta el presente). Se usará la evaluación del riesgo de sesgo de estudios de Cochrane. Como medidas de efecto del tratamiento se utilizarán las diferencias de medias (DM) y los intervalos de confianza (IC) del 95. La evaluación de heterogeneidad se realizará mediante la inspección visual del diagrama de embudo. La evaluación de la calidad de la evidencia y tablas de 'Resumen de hallazgos' se usará el test GRADE.


Introduction: Liver resection remains the most effective method of treating liver tumors. Currently, the laparoscopic approach is considered the gold standard compared to the open approach; however, the emergence of robotic surgery offers a new minimally invasive approach option with apparently better re-sults. The objective of this systematic review is to assess the benefits of robotic hepatectomy versus laparo-scopic hepatectomy in the resection of liver tumors. Methodology: This systematic review will include comparative, cohort, case-control studies with prospec-tive or retrospective data collection. Study participants will be patients diagnosed with benign or malignant liver tumors, including children and adolescents, noncirrhotic or compensated cirrhotic, undergoing robotic hepatectomy and laparoscopic hepatectomy procedures. The primary outcome measures are: 1. Estimated blood loss during surgery, 2. Operative time, 3. Laparotomy conversion rate, 4. Intraoperative mortality rate, 5. Morbidity rate (postoperative complications), 6. Post-surgical hospital stay. Electronic searches will be conducted on PubMed, Medline, and ScienceDirect (2010 to present). The Cochrane study risk of bias as-sessment will be used. The mean differences (MD) and the 95 confidence intervals (CI) will be used as measures of the treatment effect. The evaluation of heterogeneity will be carried out by visual inspection of the funnel diagram. The evaluation of the quality of the evidence and 'Summary of findings' tables will be used by the GRADE test.


Assuntos
Humanos , Criança , Adolescente , Adulto , Procedimentos Cirúrgicos Robóticos , Hepatectomia , Resultado do Tratamento , Laparoscopia , Neoplasias Hepáticas
14.
An. Fac. Cienc. Méd. (Asunción) ; 54(3): 161-166, Dec. 2021.
Artigo em Espanhol | LILACS | ID: biblio-1352984

RESUMO

Mujer de 54 años sometida a colecistectomía laparoscópica programada por colecistolitiasis sintomática, el procedimiento fue convertido a abordaje abierto por presencia de bilirragia perioperatoria no localizada, tratada con sutura primaria del lecho vesicular bajo sospecha de un conducto aberrante de Luschka. Al vigésimo día postoperatorio se diagnostica una fístula biliar tras la aparición de bilirragia a través de la herida quirúrgica. Una colangiografía transhepática percutánea mostró una pérdida completa de continuidad con fuga a ese nivel, confirmando la lesión del conducto hepático derecho, con un extremo cortado retraído del conducto hepático. Debido a la compleja lesión de la vía biliar proximal, a los 3 meses de la primera cirugía se realiza una hepatectomía derecha. Aunque la hepatectomía no es un procedimiento estándar para pacientes con lesiones quirúrgicas de la via biliar, debe considerarse como parte del arsenal quirúrgico para la reparación de un grupo seleccionado de pacientes en lesiones postcolecistectomía


A 54-year-old female underwent a planned laparoscopic cholecystectomy due to a symptomatic cholecystolithiasis, the procedure was converted to an open approach due to the presence of a not located perioperative bilirhagia, treated with a primary suture of the gallbladder bed under the suspicion of an aberrant duct of Luschka. On the 20th postoperative day, the patient is diagnosed with a biliary fistula after the appearance of bilirhagia through the surgical wound. A percutaneous transhepatic cholangiography showed a complete loss of continuity with leakage at that level, confirming the right hepatic duct injury, with a retracted cut end from the hepatic duct. Due to the complex proximal bile duct injury, 3 months after the first surgery, a right hepatectomy is performed. Although an hepatectomy is not a standard procedure for patients with IBDI, it should be considered as a part of the surgical armamentarium for the repair of a selected group of patients in postcholecystectomy injuries


Assuntos
Colecistectomia , Hepatectomia , Ductos Biliares
15.
Acta Gastroenterol Belg ; 84(4): 660-662, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34965048

RESUMO

We present here two hepatocellular carcinoma (HCC) patients with gastrointestinal tract involvement (GITI). Hemorrhage due to duodenal involvement was the inaugural event of the HCC for the first patient. Dysphagia due to HCC recurrence in the oesophagus four years after left hepatectomy was the call symptom for the second. As incidence of HCC increases, and overall survival improves, incidence of GITI in HCC patients is expected to increase.


Assuntos
Carcinoma Hepatocelular , Neoplasias Hepáticas , Carcinoma Hepatocelular/cirurgia , Esôfago , Trato Gastrointestinal , Hepatectomia , Humanos , Neoplasias Hepáticas/cirurgia , Invasividade Neoplásica , Recidiva Local de Neoplasia/cirurgia , Estudos Retrospectivos
16.
Chirurgia (Bucur) ; 116(6): 678-688, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34967713

RESUMO

Background: Surgery for severe liver trauma remains challenging even for HPB surgeons, mainly due the hemodynamical instability, involvement of major vascular and biliary elements, impaired background liver and frequent anatomical variants. In this setting, despite conservative policy, major liver resection is still required in selected cases. Also salvage liver transplantation may be needed. Our study aims to analyze the results after definitive surgery for hepatic injury (HI) in a tertiary HPB center. Methods: Sixty-six patients with HI were admitted and treated in our center between June 2000 and June 2021. The median age was 29 years (mean 35, range 10-76). The male/female ratio was 50/16. According to the American Association for the Surgery of Trauma (AAST) system, HIs were grade II in one patient (1.5%), grade III in 11 pts (16.7%), grade IV in 25 pts (37.9%), and grade V in 29 pts (43.9%); no patient had grade I or VI HI. Results: Fifty-two pts (78.8%) benefitted from surgery and 14 pts (21.2%) from non-operative treatment (NOT). Perihepatic packing was previously performed in 38 pts (73.1%). Surgery consisted in hepatic resections (HR) in 51 pts (77.3%) and liver transplantation in one patient (1.5%). The rate of major HR was 51.9% (27 HRs). The overall major morbidity and mortality rates were 33.3% (20 pts) and 13.6% (9 pts), respectively. For surgery, the major complication rate was 35.3% (18 pts), while for major and minor HR were 40.7% (11 pts) and 29.2% (7 pts), respectively; the mortality rate was 15.7% (8 pts). After NOT, the major morbidity and mortality rates were 14.3% (2 pts) and 7.1% (1 pt), respectively. Conclusions: Hepatic resections, especially major ones and/or involving vascular and biliary reconstructions, as well as non-operative treatment for severe hepatic injuries, are to be carried out in tertiary HPB centers, thus minimizing the morbidity and mortality rates, while having the liver transplantation as salvage option.


Assuntos
Traumatismos Abdominais , Traumatismos Abdominais/cirurgia , Adulto , Feminino , Hepatectomia , Humanos , Fígado/cirurgia , Masculino , Estudos Retrospectivos , Resultado do Tratamento
17.
World J Gastroenterol ; 27(45): 7813-7830, 2021 Dec 07.
Artigo em Inglês | MEDLINE | ID: mdl-34963744

RESUMO

BACKGROUND: Surgical resection is a treatment of choice for gallbladder cancer (GBC) patients but only 10% of patients have a resectable disease at presentation. Even after surgical resection, overall survival (OS) has been poor due to high rates of recurrence. Combination of surgery and systemic therapy can improve outcomes in this aggressive disease. AIM: To summarize our single-center experience with multimodality management of resectable GBC patients. METHODS: Data of all patients undergoing surgery for suspected GBC from January 2012 to December 2018 was retrieved from a prospectively maintained electronic database. Information extracted included demographics, operative and perioperative details, histopathology, neoadjuvant/adjuvant therapy, follow-up, and recurrence. To know the factors associated with recurrence and OS, univariate and multivariate analysis was done using log rank test and cox proportional hazard analysis for categorical and continuous variables, respectively. Multivariate analysis was done using multiple regression analysis. RESULTS: Of 274 patients with GBC taken up for surgical resection, 172 (62.7%) were female and the median age was 56 years. On exploration, 102 patients were found to have a metastatic or unresectable disease (distant metastasis in 66 and locally unresectable in 34). Of 172 patients who finally underwent surgery, 93 (54%) underwent wedge resection followed by anatomical segment IVb/V resection in 66 (38.4%) and modified extended right hepatectomy in 12 (7%) patients. The postoperative mortality at 90 d was 4.6%. During a median follow-up period of 20 mo, 71 (41.2%) patients developed recurrence. Estimated 1-, 3-, and 5-years OS rates were 86.5%, 56%, and 43.5%, respectively. Estimated 1- and 3-year disease free survival (DFS) rates were 75% and 49.2%, respectively. On multivariate analysis, inferior OS was seen with pT3/T4 tumor (P = 0.0001), perineural invasion (P = 0.0096), and R+ resection (P = 0.0125). However, only pT3/T4 tumors were associated with a poor DFS (P < 0.0001). CONCLUSION: Multimodality treatment significantly improves the 5-year survival rate of patients with GBC up to 43%. R+ resection, higher T stage, and perineural invasion adversely affect the outcome and should be considered for systemic therapy in addition to surgery to optimize the outcomes. Multimodality treatment of GBC has potential to improve the survival of GBC patients.


Assuntos
Neoplasias da Vesícula Biliar , Feminino , Neoplasias da Vesícula Biliar/patologia , Neoplasias da Vesícula Biliar/cirurgia , Hepatectomia , Humanos , Pessoa de Meia-Idade , Terapia Neoadjuvante , Estadiamento de Neoplasias , Estudos Retrospectivos , Taxa de Sobrevida , Atenção Terciária à Saúde
18.
Khirurgiia (Mosk) ; (11): 27-33, 2021.
Artigo em Russo | MEDLINE | ID: mdl-34786913

RESUMO

OBJECTIVE: To study the risk factors of severe blood loss in extensive liver resections, consequences of hemorrhagic problems and their correction. MATERIAL AND METHODS: The study included 374 patients. Group 1 comprised 282 patients (118 men and 164 women aged 54.1±0.7 years) who underwent surgery between 2000 and 2012. Group 2 included 92 patients (34 women and 58 men aged 53.6±1.3 years) operated on for the period 2013-2019. RESULTS: Technical equipment for mobilization and dissection of hepatic parenchyma has fundamentally changed for the period 2013-2019. This processes reduced blood loss by more 50% and consumption of donor blood components (red blood cells by 2.8 times, FFP by 1.8 times). Compression of hepatoduodenal ligament (Pringle maneuver) and tumor type did not affect intraoperative blood loss. Neoplasms over 10 cm increased blood loss. An increase in the number of resected segments by 2 times contributed to increase of blood loss by 2.7 times. Body mass index >25 kg/m2 was also associated with higher blood loss.


Assuntos
Hepatectomia , Neoplasias Hepáticas , Perda Sanguínea Cirúrgica/prevenção & controle , Feminino , Hepatectomia/efeitos adversos , Humanos , Fígado , Neoplasias Hepáticas/cirurgia , Masculino , Fatores de Risco
19.
Rev Col Bras Cir ; 48: e20213164, 2021.
Artigo em Inglês, Português | MEDLINE | ID: mdl-34816883

RESUMO

OBJECTIVE: to evaluate the influence of acetylsalicylic acid (ASA) on cell proliferation after partial hepatectomy in rats. METHODS: 40 male Wistar rats were separated into four groups of ten rats each. Groups 1 and 2 (controls): undergoing 30% partial hepatectomy and, after one day (group 1) and seven days (group 2), to euthanasia; daily administration of 0.9% saline solution (1mL per 200g of body weight). Groups 3 and 4 (experimental): undergoing 30% partial hepatectomy and, after one day (group 3) and seven days (group 4), to euthanasia; daily administration of ASA (40mg/mL, 1mL per 200g of body weight). The absolute number of cells stained with PCNA was counted in photomicrographs, in five fields, and it was calculated the mean of positive cells per animal and per group. RESULTS: the final mean of PCNA+ cells per group was: in group 1, 17.57 ± 6.77; in group 2, 19.31 ± 5.30; in group 3, 27.46 ± 11.55; and, in group 4, 12.40 ± 5.23. There was no significant difference at the two evaluation times in the control group (p=0.491), but there was in the experimental group (p=0.020), with a lower number of PCNA+ cells on the seventh day. The comparison between the two groups, on the first day, showed more PCNA+ cells in the livers of the animals that received ASA (p=0.047), and on the seventh day the number was lower in the experimental group (p=0.007). CONCLUSION: ASA induced greater hepatocyte proliferation.


Assuntos
Aspirina , Regeneração Hepática , Animais , Hepatectomia , Fígado , Masculino , Ratos , Ratos Wistar
20.
Cir Cir ; 89(S1): 87-92, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34762637

RESUMO

INTRODUCTION: Intrabiliary growth of colorectal liver metastasis determines their capability of dissemination and relapse. CASE REPORT: 65-year-old woman underwent sigmoidectomy (2011) and left hepatectomy due to liver metastases affecting the bile tract (2014). In 2020 she developed a 2cm tumour in the union of both hepatic ducts. Cholangiocarcinoma was suspected so resection of the main bile duct, the caudate lobe and lymphadenectomy were performed. On immunohistochemical examination, colorectal liver metastasis was confirmed. CONCLUSIONS: Liver metastases should be considered as the most likely diagnosis when bile duct dilatation or intrabiliary growth is seen in patients with a history of colorectal cancer.


Assuntos
Neoplasias dos Ductos Biliares , Colangiocarcinoma , Neoplasias Colorretais , Neoplasias Hepáticas , Idoso , Neoplasias dos Ductos Biliares/cirurgia , Ductos Biliares Intra-Hepáticos , Feminino , Hepatectomia , Humanos , Neoplasias Hepáticas/cirurgia , Recidiva Local de Neoplasia
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