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Major Resection (major + resection)

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Medical Sciences100%

Selected Abstracts

Practical questions in liver metastases of colorectal cancer: general principles of treatment

HPB, Issue 4 2007
Héctor Daniel González
Abstract Liver metastases of colorectal cancer are currently treated by multidisciplinary teams using strategies that combine chemotherapy, surgery and ablative techniques. Many patients classically considered non-resectable can now be rescued by neoadjuvant chemotherapy followed by liver resection, with similar results to those obtained in initial resections. While many of those patients will recur, repeat resection is a feasible and safe approach if the recurrence is confined to the liver. Several factors that until recently were considered contraindications are now recognized only as adverse prognostic factors and no longer as contraindications for surgery. The current evaluation process to select patients for surgery is no longer focused on what is to be removed but rather on what will remain. The single most important objective is to achieve a complete (R0) resection within the limits of safety in terms of quantity and quality of the remaining liver. An increasing number of patients with synchronous liver metastases are treated by simultaneous resection of the primary and the liver metastatic tumours. Multilobar disease can also be approached by staged procedures that combine neoadjuvant chemotherapy, limited resections in one lobe, embolization or ligation of the contralateral portal vein and a major resection in a second procedure. Extrahepatic disease is no longer a contraindication for surgery provided that an R0 resection can be achieved. A reverse surgical staged approach (liver metastases first, primary second) is another strategy that has appeared recently. Provided that a careful selection is made, elderly patients can also benefit from surgical treatment of liver metastases. [source]

IGG4-RELATED SCLEROSING LYMPHOPLASMACYTIC PANCREATITIS AND CHOLANGITIS MIMICKING CARCINOMA OF PANCREAS AND KLATSKIN TUMOUR

ANZ JOURNAL OF SURGERY, Issue 4 2008
Moon-Tong Cheung
Background: Autoimmune sclerosing pancreatitis is a well-known disease entity for years, particularly recognizing the difficulty in distinguishing it from malignancy. Immunohistochemical study showed that immunoglobulin IgG4 staining was positive in plasma cells of some autoimmune pancreatitis or cholangitis. The term ,autoimmune sclerosing pancreatocholangitis' was used as it was believed that they belonged to a range of disease involving both pancreas and biliary tree. It may also be part of a systemic fibro-inflammatory disease. Patients and Methods: All the patients suffering from immunoglobulin G4 (IgG4)-related pancreatitis and cholangitis from May 2003 to September 2006 in Queen Elizabeth Hospital, Hong Kong were retrospectively studied. Results: A total of five patients with clinical diagnosis of IgG4-related autoimmune pancreatitis or cholangitis were analysed. All presented with jaundice or abdominal pain, mimicking carcinoma. Two patients had major resection, two patients were diagnosed by intraoperative biopsy and one was based on serum IgG4 level. Conclusion: With the growing awareness of this relatively recently characterized clinical entity and its similar presentation to pancreatic carcinoma or bile duct cholangiocarcinoma, it is important for autoimmune sclerosing pancreatocholangitis to be included in the differential diagnosis of pancreaticobiliary disease. The management strategy has shown to be modified , from major resection to intraoperative biopsy and to the assay of serum IgG4 level without the necessity of histology confirmation. [source]

Impact of radiotherapy on local recurrence of rectal cancer in Norway

BRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 1 2007
M. H. Hansen
Background: The purpose of this study was to analyse the impact of radiotherapy on local recurrence of rectal cancer in Norway after the national implementation of total mesorectal excision (TME). Methods: This was a prospective national cohort study of 4113 patients undergoing major resection of rectal carcinoma between November 1993 and December 2001. Results: The proportion of patients who had radiotherapy before or after operation increased from 4·6 per cent in 1994 to 23·0 per cent in 2001. The cumulative 5-year local recurrence rate decreased from 16·2 to 10·7 per cent. Multivariable analysis showed that preoperative radiotherapy significantly reduced local recurrence (hazard ratio 0·59 (95 per cent confidence interval 0·39 to 0·87)). The use of preoperative radiotherapy in patients from a local hospital offering radiotherapy was 50 per cent higher than that for patients from a hospital without such services (P = 0·003); cumulative 5-year local recurrence rates for these patients were 10·6 and 15·8 per cent respectively (P < 0·001). Conclusion: Following national implementation of TME for rectal cancer, increased use of preoperative radiotherapy appeared to reduce recurrence rates further. Copyright © 2006 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. [source]

Gyrus PlasmaKinetic bipolar coagulation device for liver resection

ANZ JOURNAL OF SURGERY, Issue 3 2010
Jeremy Tan
Abstract Background:, Liver parenchymal transection can be associated with significant blood loss and morbidity. We present our initial experience with the Gyrus PlasmaKinetic coagulation device in liver parenchymal resection in both cirrhotic and non-cirrhotic patients. Methods:, Liver resections were performed in 51 consecutive patients, from 20 July 2005 to 31 August 2007, using the Gyrus PlasmaKinetic coagulator. Requirement for blood transfusions, operating time, duration of hospital stay and major complications were evaluated initially for the group as a whole. Subsequently, the 11 patients with histologically confirmed cirrhosis (nine men, two women, median age 54 years, range 24,74 years) were compared with 40 patients without cirrhosis (25 men, 15 women, median age 57 years, range 24,87 years). Results:, There were 34 men and 17 women. The median age was 56 (range 24,87 years). There were 48 open procedures and 3 laparoscopic procedures. There were 30 major resections (>2 segments) and 21 minor resections (one to two segments). The overall median operating time was 260 min (range 90,690). Length of stay had a median of 9 days, range 4,50 days. Twenty-one patients (41%) required a blood transfusion. Two biliary leaks were observed in non-cirrhotic patients initially before the settings of the Gyrus device were optimized. Conclusions:, The Gyrus PlasmaKinetic coagulation device is a novel instrument for hepatic parenchymal transection in liver resection, which can be safely used in cirrhotic and non-cirrhotic patients. [source]