Treatment of liver metastases from neuroendocrine tumours in relation to the extent of hepatic disease.

BACKGROUND: Hepatic surgery is presumed to improve survival of patients with liver metastases (LM) from neuroendocrine tumours (NET). This study identified LM-specific variables that could be used as additional selection criteria for aggressive treatment. METHODS: A novel classification of LM from NET was established based on their localization and presentation. RESULTS: From 1992 to 2006, 119 patients underwent staging and treatment of LM. Three growth types of LM were identified radiologically: single metastasis (type I), isolated metastatic bulk accompanied by smaller deposits (type II) and disseminated metastatic spread (type III). The three groups differed significantly in terms of chronological presentation of LM, hormonal symptoms, Ki-67 index, 5-hydroxyindoleacetic acid and chromogranin A levels, lymph node involvement, presence of bone metastases and treatment options. The 3-, 5- and 10-year disease-specific survival rates for the entire cohort were 76.4, 63.9 and 46.5 per cent respectively. There were significant differences in survival between the three groups: 5- and 10-year rates were both 100 per cent for type I, 84 and 75 per cent respectively for type II, and 51 and 29 per cent for type III. CONCLUSION: The localization and biological features of LM from NET defines therapeutic management and is predictive of outcome.

[Living donor liver transplantation]. / Leberlebendspende.

Sixteen years after its first successful application, living donor liver transplantation now has a small but well-established role in treatment for liver failure in Germany. It remains problematic in both child and adult patients concerning effort, expected results, and assessment of risks to the donor. Therefore the method shall remain limited to more research-oriented institutions for the time being before it can be established more broadly as an alternative to postmortal donation. In Germany it presents generally the same limitations as living donor kidney transplantation.

The "territorial belonging" of the middle hepatic vein: a troublesome dilemma in adult live donor liver transplantation--anatomical evidence based on virtual 3-dimensional-computed tomography-imaging reconstructions.

BACKGROUND: The venous drainage of the liver plays an essential role in securing viability of both graft and remnant in live donor liver transplantation (LDLT). There is still controversy on whether the middle hepatic vein (MHV) should be routinely included as part of the graft or retained with the remnant liver. The purpose of this study was to analyze hepatic venous drainage patterns based on information obtained by 3-dimensional CT-imaging reconstructions. METHODOLOGY: Fifty five potential live liver donors were evaluated between January 2003 and May 2004 at our Institution. We analyzed two anatomical definitions of liver dominance: total liver dominance (TLD) and hemiliver dominance (HLD). The following concepts were addressed: 1) Hepatic vein territories, 2) Hepatic vein dominance relationship, 3) Territorial belonging- patterns of the MHV to the right and left hemilivers, additionally an analysis of venous outflow in the central liver sectors was performed. RESULTS: Our results showed that: 1) The definitions of dominance: TLD vs. HLD overlap, displaying the MHV belonging, by taking into account the individual right hepatic vein (RHV) variability; 2) A dominant RHV for the whole liver indicates that the RHV is also dominant in the right hemiliver; 3) The MHV belongs predominantly to the left hemiliver (LHL); 4) The left hepatic vein (LHV) is dominant in the LHL. CONCLUSION: Both dominance definitions provide independent mappings of the liver and offer helpful insight into venous dominance relationship.