RESUMEN

Mucoepidermoid carcinoma of the anal canal is a rare tumor. We herein report the case of a 74-year-old male patient with a high-grade mucoepidermoid carcinoma of the anal canal who was treated by local surgical resection and subsequent irradiation. However, the patient succumbed to liver and lung metastases 2 years after the procedure. The characteristic findings of mucoepidermoid carcinoma of the anus remain unclear to date due to rarity of this tumor. Since 1954, when this type of tumor was first described, only 58 cases of patients diagnosed with mucoepidermoid carcinoma of the anus have been reported to date. In this context, a review of the existing English literature on this rare tumor was also performed.

RESUMEN

Currently, the rate of aging is increasing rapidly and the number of elderly patients in hospitals is rising in Japan. Under such circumstances, we established an emergency care unit for the elderly at our hospital in July 2014 to provide acute healthcare of the community. Our unit has been active in providing treatment for acute diseases in elderly individuals in the community. We are also pursuing continuous medical care for elderly individuals in collaboration with the community comprehensive care unit at our hospital and other facilities in the community, such as care facilities for the elderly and specialist elderly nursing homes. From January to December 2015, we examined treatment policies for colon cancer at our hospital. The presence or absence of dementia and patient's age are factors considered before treatment at our hospital; however, in many cases colon cancer was treated using surgery if the patient's generalcondition permitted it. In colon cancer patients, this takes into consideration the decreased quality of life resulting from losing the ability to eat due to bleeding and intestinal obstruction. We hereby report specific cases of colon cancer treatment policies for elderly patients at our hospital, together with a discussion of the literature.

Asunto(s)

Neoplasias del Colon/terapia , Anciano , Anciano de 80 o más Años , Colectomía , Neoplasias del Colon/diagnóstico , Demencia/complicaciones , Femenino , Humanos , Masculino , Pronóstico

RESUMEN

Case 1 involved an 87-year-old woman. She had increased serum amylase levels, and intraductal papillary mucinous adenocarcinoma( IPMC)in the accessory pancreatic duct was diagnosed following various medical examinations. Radical surgery is possible for such a lesion when there are no issues detected following evaluation. The patient and her family decided that she should undergo surgery; therefore, pancreatoduodenectomy was performed for Stage III IPMC. Various morbidities required medical treatment, but she was finally discharged from hospital 89 days after surgery. She has had no recurrence 2 years and 11 months after surgery. Case 2 involved a 90-year-old man. He had liver dysfunction, and progressive hepatocellular carcinoma( HCC)was diagnosed based on computed tomography(CT)findings. The tumor size reduced to around 10 cm with enforced 2 degrees TACE. The patient and his family chose for him to undergo radical surgery; therefore, right trisegmentectomy of the liver was performed for Stage III HCC. He was discharged from the hospital 22 days after surgery, and has had no recurrence for the past 1.6 years. More careful examination and a general assessment are necessary to make decisions on surgical indications in super elderly patients.

Asunto(s)

Adenocarcinoma Mucinoso/cirugía , Carcinoma Hepatocelular/cirugía , Neoplasias Hepáticas/cirugía , Neoplasias Pancreáticas/cirugía , Adenocarcinoma Mucinoso/diagnóstico por imagen , Anciano de 80 o más Años , Carcinoma Hepatocelular/diagnóstico por imagen , Femenino , Humanos , Neoplasias Hepáticas/diagnóstico por imagen , Masculino , Neoplasias Pancreáticas/patología , Pancreaticoduodenectomía , Tomografía Computarizada por Rayos X , Resultado del Tratamiento

RESUMEN

Chemotherapy is not effective for metastatic hepatocellular carcinoma(HCC); however, prolonged survival can be expected for patients with multiple metastases who are treated with surgical resection in addition to chemotherapy. We present a case of a 36-year-old woman with hepatitis B who developed HCC with multiple intrahepatic and lung metastases after undergoing resection of HCC in 2010 in Canada. The patient returned to Japan for additional treatment. She was treated with TACE therapy and systemic chemotherapy, but her lung metastases did not improve. The patient's PIVKA-Ⅱ levels remained moderately elevated after initiation of chemotherapy. Therefore, we performed surgical resection of the lung metastases in March 2014. Five months later, the patient received additional TACE therapy when an isolated metastasis was found in the residual liver. Since then, no recurrence of HCC has been found, and the patient's PIVKA-Ⅱ levels have remained in the normal range. This case demonstrates that surgical resection for multiple lung metastases is possible in select patients.

Asunto(s)

Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Carcinoma Hepatocelular/terapia , Neoplasias Hepáticas/terapia , Neoplasias Pulmonares/terapia , Adulto , Carcinoma Hepatocelular/secundario , Terapia Combinada , Femenino , Hepatectomía , Hepatitis B/complicaciones , Humanos , Neoplasias Hepáticas/patología , Neoplasias Pulmonares/secundario , Neumonectomía , Recurrencia

RESUMEN

We present a case of a 74-year-old woman treated with maintenance dialysis for chronic renal failure. She had undergone intravascular treatment of lower limb arteriosclerosis obliterans 3 times. Low anterior resection was performed for rectal cancer StageⅡ, but adjuvant chemotherapy was not administered after the operation. S5/S6 partial hepatectomy was performed after confirming a liver metastatic recurrence 7 months after the first operation. Tumor pathology examination of the resected specimen revealed necrosis in most parts of the specimen. Residual primary lesion similar to adenocarcinoma tissue was found only in a small part of the specimen. Artery wall embolism and recanalization image with cholesterol crystals indicated a Grison's lesion, which was considered to have likely developed into tumor necrosis from the embolization. Spontaneous regression of a malignant tumor is a rare condition found 1 case in 6-10 ten thousand cases. In hepatocellular carcinoma, secondary tumor infarction from tumor invasion and tumor thrombus may occur. The present case was a metastatic liver cancer, in which the cholesterol crystal embolism possibly reached the tumor necrosis. The suggested cause of the cholesterol crystal embolism in this case was intravascular treatment related.

Asunto(s)

Adenocarcinoma/terapia , Neoplasias Hepáticas/patología , Neoplasias Hepáticas/terapia , Neoplasias del Recto/patología , Adenocarcinoma/secundario , Anciano , Embolización Terapéutica , Femenino , Hepatectomía , Humanos , Neoplasias Hepáticas/secundario , Necrosis , Neoplasias del Recto/terapia

RESUMEN

INTRODUCTION: Primary endocrine cell tumors in the gallbladder are uncommon, and the coexistence of an endocrine cell tumor and adenocarcinoma, squamous cell carcinoma, and sarcomatoid components is extremely rare. PRESENTATION OF CASE: A rare case of adeno-endocrine cell carcinoma of the gallbladder in an 81-year-old woman is reported. Abdominal ultrasonography (US) revealed a hypo-echoic, solid tumor, 2.0cm×1.8cm in size, at the fundus of the gallbladder. On computed tomography (CT), the tumor was well-enhanced, well-demarcated, and homogeneous. The tumor, which was papillary, protruded into the gallbladder with no direct invasion to the liver. The tumor was diagnosed as gallbladder carcinoma; its depth appeared not to pass the subserosa layer. A cholecystectomy and hepatic bed resection with regional lymph node dissection were performed. Histologically, the tumor consisted of several components, including well to poorly differentiated papillary and tubular adenocarcinoma with squamous and sarcomatoid differentiations, and endocrine cell carcinoma. Histochemical studies of these tumor cells were positive for chromogranin A, synaptophysin, and cluster of differentiation 56 (CD56). The lymph node consisted of metastatic adeno-endocrine carcinoma. The patient survived and has remained disease-free for 4 years without adjuvant chemotherapy. DISCUSSION: Adeno-endocrine cell carcinoma of the gallbladder generally has a poor prognosis. CONCLUSION: The present case suggests that adeno-endocrine cell carcinoma with various components may be derived from a common precursor cell. This observation would require further investigation.

RESUMEN

INTRODUCTION: Previous studies have demonstrated that oxidative stress by mediating the excessive production of reactive oxygen species is involved in tissue damage and organ failure during and after surgery. The impact of the preoperative immunonutrition including antioxidants on the postoperative course of patients undergoing hepatic surgery was investigated in this pilot study. PATIENTS AND METHODS: Twenty-three living donor liver transplantation (LDLT) donors were randomly assigned to either an experimental (AO) group, received a commercial supplement enriched with antioxidant nutrients for each of the 5 days immediately prior to surgery while maintaining normal food intake, or a control (CT) group, administered no supplement. Antioxidative capacity was measured by spectrophotometry of patient serum using a free-radical analytical system. RESULTS: The antioxidative capacity of 90.9% patients in the AO group increased after immunonutrition. Compared to the CT group, the AO group was found to have higher antioxidant capacity and transferrin levels; lower WBC, lymphocyte, and neutrophil counts; and briefer duration of postoperative fever during the postsurgical period. No significant differences were found between the 2 groups regarding the nutritional parameters; liver functioning parameters; immunological parameters; intraoperative factors; postoperative outcomes. CONCLUSION: Preoperative immunonutrition including antioxidants might play a beneficial role in improving postsurgical immunological response but the modest biological advantage was not associated with any significant clinical outcome.

Asunto(s)

Antioxidantes/administración & dosificación , Hepatectomía , Inmunoterapia/métodos , Trasplante de Hígado , Donadores Vivos , Cuidados Preoperatorios , Recolección de Tejidos y Órganos , Adulto , Biomarcadores/sangre , Suplementos Dietéticos , Femenino , Radicales Libres/efectos adversos , Radicales Libres/sangre , Humanos , Masculino , Persona de Mediana Edad , Terapia Nutricional/métodos , Estrés Oxidativo/fisiología , Proyectos Piloto , Adulto Joven

RESUMEN

PURPOSES: Delayed gastric emptying (DGE) after hepatectomy affects the quality of life of patients, although the causes and related conditions have not been investigated. This study evaluated the relationship between hepatectomy and DGE by the objective assessment of gastric emptying (GE). METHODS: Nineteen patients who underwent major hepatectomy were prospectively enrolled in the study. Their GE was studied using the (13)C-acetic acid breath test before and after hepatectomy. The results of the GE analysis were correlated with the postoperative course after hepatectomy. RESULTS: Clinically evident DGE, which was defined as the inability to take in an appropriate amount of solid food orally by postoperative day 14, was not found in these patients, but the gastric half-emptying times before and after hepatectomy were 20.2 ± 9.7 and 28.6 ± 12.2 min, respectively (P = 0.01). The GE time was significantly delayed in patients aged ≥ 41 years, or who underwent right hemihepatectomy. CONCLUSIONS: Gastric emptying was significantly inhibited in patients who underwent major hepatectomy, and aging and a right-sided hemihepatectomy may be related to the development of DGE.

Asunto(s)

Ácido Acético , Pruebas Respiratorias/métodos , Vaciamiento Gástrico , Hepatectomía/efectos adversos , Adulto , Anciano , Radioisótopos de Carbono , Estudios de Cohortes , Síndrome de Vaciamiento Rápido/diagnóstico , Síndrome de Vaciamiento Rápido/etiología , Femenino , Hepatectomía/métodos , Humanos , Laparotomía/efectos adversos , Laparotomía/métodos , Masculino , Persona de Mediana Edad , Cuidados Posoperatorios/métodos , Complicaciones Posoperatorias/diagnóstico , Cuidados Preoperatorios/métodos , Estudios Prospectivos , Sensibilidad y Especificidad , Estadísticas no Paramétricas , Factores de Tiempo , Adulto Joven

RESUMEN

INTRODUCTION: Invasion of the portal and hepatic veins by hepatocellular carcinoma (HCC) is common, but macroscopic bile duct invasion is rare. Once a tumor thrombus completely obstructs the main bile duct, it causes obstructive jaundice. This type of HCC, known as icteric-type HCC (IHCC), has a poor prognosis. PRESENTATION OF CASE: A 72-year-old woman had been treated for chronic hepatitis C since 1997. In 2002, percutaneous ethanol injection therapy was performed for HCC in segment 8. HCC recurrence occurred in 2004, and she underwent transarterial embolization (TAE) and radiofrequency ablation (RFA). In 2006, an S8 segmentectomy was performed for re-recurrence of HCC. Three years after surgery, computed tomography (CT) revealed a tumor occupying the right anterior intrahepatic bile duct and extending into its right main branch. With a preoperative diagnosis of HCC recurrence in the bile duct, we performed a right hepatectomy and thrombectomy. Histological examination showed moderately to poorly differentiated HCC. No tumor tissue other than the intrahepatic bile duct tumor was detected in the resected liver specimen. DISCUSSION: HCC with biliary tumor thrombus is associated with a poor prognosis. In general, IHCC is difficult to diagnose and treat in the early stages. A characteristic radiological finding for this type of IHCC is the hypervascularity of the tumor thrombus. CONCLUSION: To the best of our knowledge, this is a rare case of IHCC recurrence as a tumor thrombus without recurrence in the resected liver specimen.

RESUMEN

INTRODUCTION: The presence of left-sided gallbladder is closely associated with multiple combined anomalies of the portal vein, hepatic vein, hepatic artery, and bile duct. This requires special attention for preoperative evaluation for the purpose of preventing postoperative complications. PRESENTATION OF CASE: A 70-year-old woman with metastatic liver cancer and intrahepatic portal vein, biliary system and hepatic artery anomalies with left-sided gallbladder is reported. On computed tomography (CT), a solitary low density mass occupied from the right anterior to the posterior segment of the liver. The gallbladder bed was on the left of the hepatic fissure. On drip-infusion-cholangiography (DIC) CT three-dimensional (3D) reconstruction, the left medial bile duct arose from the right umbilical portion after arising from the left lateral bile duct. Following a right hepatectomy and lymph node dissection of the hepatoduodenal ligament, hepaticojejunostomy was conducted separately to the left medial and left lateral bile duct. DISCUSSION: The left-sided gallbladder accompanies with several anomalies of hepatic vascular and bile duct anomalies in a frequent manner. A safe hepatectomy needs accurate operative plans to ascertain the range of hepatectomy, because it often has the diversity of a combined anomaly. CONCLUSION: Preoperative DIC-CT 3D reconstruction was extremely useful because it provided an important information that could not be obtained with 2D-DIC-CT. 3D imaging has the ability to demonstrate complex anatomical relationships, this devise is a effective new tool for making appropriate preoperative strategy.

RESUMEN

INTRODUCTION: Torsion of the greater omentum is unusual. In most cases, the preoperative diagnosis was difficult due to the non-specific clinical presentation. PRESENTATION OF CASE: We present a case of greater omental torsion in a 28-year-old man with an untreated right inguinal hernia since childhood. Computed tomography (CT) revealed characteristic signs of omental torsion, which was important in making correct diagnosis. We made correct preoperative diagnosis and performed laparoscopic omentecomy. The greater omentum distal to the twisted part was dark red and showed necrotic change. This case was secondary omental torsion associated with a right inguinal hernia. DISCUSSION: Omental torsion should always be included in the differential diagnosis of acute abdomen. CONCLUSION: CT multi-planar reconstruction (MPR) imaging played a particularly important role in making a precise diagnosis. Laparoscopic approach could be useful in both diagnostic and therapeutic intervention. A successful laparoscopic omentectomy was performed in the present case.

RESUMEN

PURPOSE: We reviewed a series of patients who underwent hepatic resection at our institution, to investigate the risk factors for postoperative complications after hepatic resection of liver tumors and for procurement of living donor liver transplantation (LDLT) grafts. METHODS: Between April 2004 and August 2007, we performed 304 hepatic resections for liver tumors or to procure grafts for LDLT. Preoperative volumetric analysis was done using 3-dimensional computed tomography (3D-CT) prior to major hepatic resection. We compared the clinicopathological factors between patients with and without postoperative complications. RESULTS: There was no operative mortality. According to the 3D-CT volumetry, the mean error ratio between the actual and the estimated remnant liver volume was 13.4%. Postoperative complications developed in 96 (31.6%) patients. According to logistic regression analysis, histological liver cirrhosis and intraoperative blood loss >850 mL were significant risk factors of postoperative complications after hepatic resection. CONCLUSIONS: Meticulous preoperative evaluation based on volumetric analysis, together with sophisticated surgical techniques, achieved zero mortality and minimized intraoperative blood loss, which was classified as one of the most significant predictors of postoperative complications after major hepatic resection.

Asunto(s)

Hepatectomía/mortalidad , Trasplante de Hígado/métodos , Hígado/diagnóstico por imagen , Obtención de Tejidos y Órganos/métodos , Adulto , Anciano , Anciano de 80 o más Años , Carcinoma Hepatocelular/secundario , Carcinoma Hepatocelular/cirugía , Femenino , Humanos , Imagenología Tridimensional , Hígado/citología , Neoplasias Hepáticas/secundario , Neoplasias Hepáticas/cirugía , Donadores Vivos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Análisis Multivariante , Tamaño de los Órganos , Estudios Prospectivos , Radiografía , Factores de Riesgo , Tasa de Supervivencia , Ultrasonografía , Adulto Joven

RESUMEN

Spontaneous regression of hepatocellular carcinoma (HCC) is an extremely rare phenomenon. We herein report the case of a 73-year-old man who showed the spontaneous regression of multiple pulmonary recurrences of HCC that had occurred after hepatectomy. The patient was undergoing dialysis due to diabetic renal failure when ultrasonography revealed a liver tumor (diameter ~ 10 cm). A preoperative diagnosis of HCC with hepatic vein thrombosis was made. The liver function was well preserved and then the right hepatic vein area was resected. Two months after hepatectomy the α-fetoprotein level increased, and multiple lung nodules were observed on follow-up computed tomography. A diagnosis of multiple lung metastases was made, but no therapy was started because of the patient's renal failure. Five months after hepatectomy the α-fetoprotein level normalized, and the metastases regressed completely. The patient is now doing well without any recurrence at 13 months after the surgery. The associated literature on spontaneous HCC regression is also reviewed.

Asunto(s)

Carcinoma Hepatocelular/cirugía , Hepatectomía , Neoplasias Hepáticas/cirugía , Recurrencia Local de Neoplasia/cirugía , Regresión Neoplásica Espontánea , Anciano , Carcinoma Hepatocelular/secundario , Humanos , Neoplasias Pulmonares/diagnóstico por imagen , Neoplasias Pulmonares/secundario , Masculino , Radiografía

RESUMEN

AIM: To determine whether absorbable sutures or non-absorbable sutures are better in preventing surgical site infection (SSI), in this paper we discuss the results of a randomized clinical trial which examined the type of sutures used during hepatectomy. METHODS: All hepatic resections performed from January 2007 to November 2008 at the Department of Surgery at Iizuka Hospital in Japan were included in this study. There were 125 patients randomly assigned to an absorbable sutures (Vicryl) group or non-absorbable sutures (Silk) group. RESULTS: SSI was observed in 13.6% (17/125) patients participating in this study, 11.3% in the Vicryl group and 15.8% in the Silk group. Incisional SSI including superficial and deep SSI, was observed in 8% of the Vicryl group and 9.5% of the Silk group. Organ/space SSI was observed in 3.2% of the Vicryl group and 6.0% of the Silk group. There were no significant differences, but among the patients with SSI, the period for recovery was significantly shorter for the Vicryl group compared to the Silk group. CONCLUSION: The incidence of SSI in patients receiving absorbable sutures and silk sutures is not significantly different in this randomized controlled study; however, the period for recovery in patients with SSI was significantly shorter for absorbable sutures.

Asunto(s)

Hepatectomía , Hepatopatías/cirugía , Poliglactina 910 , Seda , Suturas , Anciano , Femenino , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Factores de Riesgo , Infección de la Herida Quirúrgica/prevención & control

RESUMEN

Cholestatic hepatitis is a life-threatening recurrent pattern of hepatitis C virus (HCV) in immunosuppressed patients, for which curative treatment has not yet been established. We report the successful treatment of cholestatic hepatitis in a 59-year-old man who had undergone right lobe living donor liver transplantation (LDLT) for liver cirrhosis (LC) caused by HCV. Following uneventful surgery and an uncomplicated posttransplant clinical course, there was an abrupt increase in total bilirubin in comparison to aminotransferase on postoperative day (POD) 60 (total bilirubin 16.2 mg/dl, alanine aminotransferase 100 U/l, HCV-RNA 390 kIU/ml). The histological findings of the liver tissue showed lymphocyte infiltration in the periportal zone and severe cholestasis. Considering the clinical course, cholestatic hepatitis was strongly suspected and pegylated interferon and ribavirin therapy was started immediately, resulting in not only a viral response, but minimal progression of fibrosis. This case serves to demonstrate that early diagnosis and timely initiation of optimal antiviral therapy is essential for the resolution of cholestatic hepatitis C.

Asunto(s)

Antivirales/uso terapéutico , Colestasis Intrahepática/diagnóstico , Diagnóstico Precoz , Hepatitis C Crónica/diagnóstico , Trasplante de Hígado/efectos adversos , Donadores Vivos , Biopsia , Colangiografía , Colestasis Intrahepática/etiología , Colestasis Intrahepática/terapia , Diagnóstico Diferencial , Portadores de Fármacos , Estudios de Seguimiento , Hepacivirus/genética , Hepatitis C Crónica/complicaciones , Hepatitis C Crónica/terapia , Humanos , Interferón alfa-2 , Interferón-alfa/uso terapéutico , Cirrosis Hepática , Neoplasias Hepáticas/cirugía , Masculino , Persona de Mediana Edad , Polietilenglicoles/uso terapéutico , Complicaciones Posoperatorias , ARN Viral/análisis , Proteínas Recombinantes , Ribavirina/uso terapéutico , Ultrasonografía Doppler

RESUMEN

BACKGROUND AND AIMS: The importance of hyponatremia in deceased donor liver transplantation (DDLT) has been recently discussed frequently. However, its impact on the outcomes in living donor liver transplantation (LDLT) has not yet been elucidated. The current study was designed to demonstrate the impact of pre-transplant sodium concentration on postoperative clinical outcomes. METHODS: One hundred and thirty-four patients who underwent LDLT for end-stage liver diseases were examined to evaluate the significance of pre-transplant hyponatremia (Na < or = 130 mEq/L) on the short-term clinical outcomes and the efficacy of the Model for End-Stage Liver Disease and serum sodium (MELD-Na) score using the sodium concentration and original MELD score. RESULTS: The preoperative sodium and MELD score for all patients were 133.9 mEq/L (range: 109-142) and 16.2 (range: 6-38), respectively. According to a multivariate analysis, not only the MELD score (P = 0.030) but also the sodium concentration (P = 0.005) were found to be significant predictive factors for short-term graft survival. Preoperative hyponatremia was a significant risk factor for the occurrence of sepsis (P < 0.001), renal dysfunction (P < 0.001) and encephalopathy (P = 0.026). The MELD-Na score was 19.6 (range: 6-51) and the area under the receiver-operator curve of that (c-statistics: 0.867) was higher than MELD score and sodium concentration (c-statistics: 0.820 and 0.842, respectively). CONCLUSION: Preoperative hyponatremia was a significant risk for postoperative complications and short-term graft loss. The addition of sodium concentration to MELD score might therefore be an effective predictor for post-transplant short-term mortality in LDLT.

Asunto(s)

Hiponatremia/complicaciones , Hepatopatías/cirugía , Trasplante de Hígado , Donadores Vivos , Sodio/sangre , Adulto , Anciano , Biomarcadores/sangre , Femenino , Rechazo de Injerto/sangre , Rechazo de Injerto/etiología , Supervivencia de Injerto , Encefalopatía Hepática/sangre , Encefalopatía Hepática/etiología , Humanos , Hiponatremia/sangre , Japón , Estimación de Kaplan-Meier , Enfermedades Renales/sangre , Enfermedades Renales/etiología , Hepatopatías/sangre , Hepatopatías/complicaciones , Trasplante de Hígado/efectos adversos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Medición de Riesgo , Factores de Riesgo , Sepsis/sangre , Sepsis/etiología , Factores de Tiempo , Resultado del Tratamiento , Adulto Joven

RESUMEN

PURPOSE: Interleukin-8 (IL-8) is a neutrophil chemotactic factor, which is associated with some inflammatory diseases and various types of surgical stress. The aim of this study was to investigate whether the early postoperative serum IL-8 level may potentially be a new indicator of a surgical stress in patients undergoing a hepatic resection. METHODS: The serum IL-8 levels were measured in 37 patients who underwent a hepatectomy. The serum IL-8 levels were serially measured using an enzyme-linked immunosorbent assay both before and after a hepatic resection. In addition, the correlation between the postoperative IL-8 value and several clinical variables were examined. RESULTS: The mean level of IL-8 significantly increased immediately after the operation (P < 0.01 vs before the operation) and decreased on the first postoperative day (POD 1, P < 0.05 vs after the operation). The early postoperative IL-8 levels positively correlated with the length of the procedure (r = 0.383; P < 0.05), the estimated blood loss (r = 0.483; P < 0.01) and the serum bilirubin level on POD 1 (r = 0.390; P < 0.05), and inversely correlated with the white blood cell counts (r = -0.388; P < 0.05) and lymphocyte counts on POD 1 (r = -0.424; P < 0.05). In a comparison of the postoperative IL-8 levels with the surgical factors, there was a significant difference in the extension of the resection (P < 0.05) and in blood transfusion. The patients with a fever of more than 38 degrees C showed higher levels of IL-8 immediately after the operation than those without fever (P < 0.01). CONCLUSIONS: The early postoperative serum IL-8 level was found to correlate with the degree of the severity of surgery in patients undergoing a hepatic resection, and it is also considered to be a new indicator of surgical stress and liver injury.

Asunto(s)

Hepatectomía/efectos adversos , Interleucina-8/sangre , Estrés Fisiológico , Biomarcadores/sangre , Humanos , Periodo Posoperatorio

RESUMEN

This report presents a rare case of an acute biliary obstruction caused by the postoperative development of an intracholedochal hematoma in a 57-year-old female patient who underwent living-donor liver transplantation for end-stage liver disease of cryptogenic origin. This is the first report to describe the development of an intracholedochal hematoma after livingdonor liver transplantation.

Asunto(s)

Enfermedades de las Vías Biliares/etiología , Enfermedades de las Vías Biliares/cirugía , Hematoma/complicaciones , Hematoma/cirugía , Trasplante de Hígado , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/cirugía , Bilirrubina/sangre , Femenino , Humanos , Donadores Vivos , Persona de Mediana Edad , Transaminasas/sangre

RESUMEN

BACKGROUND: The aim of this study was to elucidate the predictors of extrahepatic hepatocellular carcinoma (HCC) recurrence after hepatectomy. MATERIALS AND METHODS: A cohort of 252 patients with HCC who underwent hepatectomy following a recurrence were reviewed. The patients were categorized into 2 groups according to the pattern of their initial recurrence. Clinicopathological and survival data were compared between the groups. RESULTS: Of the 252 patients, 218 had intrahepatic recurrence (IHR) (86.5%) and 34 had extrahepatic recurrence (EHR) (13.5%) as their initial recurrence. The mean duration of time until the initial recurrence after hepatectomy of the EHR and IHR groups was 1.8 and 2.2 years, respectively. The rate of recurrence within 6 months after hepatectomy of EHR and IHR groups was 35.3 and 14.2%, respectively (P = .002). The 3-, 5-, and 10-year cumulative survival rates of EHR group were 60.3, 24.0, and 6.0%, respectively, which were significantly lower than that of IHR group (74.5, 57.7, and 23.1%, P = .004). A multivariate analysis showed that blood loss during surgery and microscopic hepatic vein invasion remained as independent risk factors for increased EHR after hepatectomy for HCC. Furthermore, the combination of these 2 independent factors showed a significant association with the EHR. CONCLUSIONS: EHR of HCC was associated with early recurrence and a poor survival after a hepatectomy. The combination of 2 independent factors for EHR, the presence of microscopic hepatic vein invasion and the blood loss during surgery, may be useful for predicting the risk for occurrence of EHR during the follow-up period.

Asunto(s)

Neoplasias Óseas/cirugía , Carcinoma Hepatocelular/cirugía , Hepatectomía , Neoplasias Hepáticas/cirugía , Neoplasias Pulmonares/cirugía , Recurrencia Local de Neoplasia/diagnóstico , Neoplasias Peritoneales/cirugía , Adulto , Anciano , Neoplasias Óseas/secundario , Carcinoma Hepatocelular/secundario , Femenino , Estudios de Seguimiento , Humanos , Neoplasias Hepáticas/patología , Neoplasias Pulmonares/secundario , Metástasis Linfática , Masculino , Persona de Mediana Edad , Recurrencia Local de Neoplasia/cirugía , Estadificación de Neoplasias , Neoplasias Peritoneales/secundario , Pronóstico , Tasa de Supervivencia

RESUMEN

Undifferentiated carcinomas with osteoclast-like giant cells are rare periampullary neoplasms, which morphologically mimic giant cell tumors of the bone. The terminology, histogenesis, biological behavior, and chemosensitivity of these tumors, and their treatment protocol, remain controversial. We report the case of a 71-year-old man with periampullary carcinoma who underwent pancreaticoduodenectomy under the diagnosis of periampullary carcinoma. Histologically, the neoplasm was composed of undifferentiated cells and evenly spaced osteoclast-like giant cells. Liver and paraaortic lymph node metastases were detected 6 months later and were treated effectively with intravenous gemcitabine. The patient remains in remission 2 years after surgery.

Asunto(s)

Ampolla Hepatopancreática , Carcinoma/patología , Neoplasias del Conducto Colédoco/patología , Anciano , Carcinoma/cirugía , Neoplasias del Conducto Colédoco/cirugía , Humanos , Masculino , Osteoclastos/patología , Pancreaticoduodenectomía