RESUMO
Laparoscopic liver resection (LLR) has been progressively developed along the past two decades. Despite initial skepticism, improved operative results made laparoscopic approach incorporated to surgical practice and operations increased in frequency and complexity. Evidence supporting LLR comes from case-series, comparative studies and meta-analysis. Despite lack of level 1 evidence, the body of literature is stronger and existing data confirms the safety, feasibility and benefits of laparoscopic approach when compared to open resection. Indications for LLR do not differ from those for open surgery. They include benign and malignant (both primary and metastatic) tumors and living donor liver harvesting. Currently, resection of lesions located on anterolateral segments and left lateral sectionectomy are performed systematically by laparoscopy in hepatobiliary specialized centers. Resection of lesions located on posterosuperior segments (1, 4a, 7, 8) and major liver resections were shown to be feasible but remain technically demanding procedures, which should be reserved to experienced surgeons. Hand-assisted and laparoscopy-assisted procedures appeared to increase the indications of minimally invasive liver surgery and are useful strategies applied to difficult and major resections. LLR proved to be safe for malignant lesions and offers some short-term advantages over open resection. Oncological results including resection margin status and long-term survival were not inferior to open resection. At present, surgical community expects high quality studies to base the already perceived better outcomes achieved by laparoscopy in major centers' practice. Continuous surgical training, as well as new technologies should augment the application of laparoscopic liver surgery. Future applicability of new technologies such as robot assistance and image-guided surgery is still under investigation.
RESUMO
The hanging liver maneuver is a useful technique to guide the transection of liver parenchyma by lifting a tape passed between the anterior surface of the inferior vena cava and the liver. Modified hanging liver maneuvers have been described in different types of liver resection. Surgical resection of hilar cholangiocarcinoma can involve the portal vein and the caudate lobe for margin clearance. However, hilar dissection and resection of the caudate lobe can be a challenging during the hanging maneuver once the tape is positioned. Herein, we describe a modified hanging liver maneuver for a hilar "en bloc" extended right hepatectomy with portal vein resection for the treatment of hilar cholangiocarcinoma including the caudate lobe. J. Surg. Oncol. 2016;113:427-431. © 2016 Wiley Periodicals, Inc.
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Neoplasias dos Ductos Biliares/cirurgia , Colangiocarcinoma/cirurgia , Hepatectomia/métodos , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
OBJECTIVE: To evaluate perioperative outcomes, safety and feasibility of video-assisted resection for primary and secondary liver lesions. METHODS: From a prospective database, we analyzed the perioperative results (up to 90 days) of 25 consecutive patients undergoing video-assisted resections in the period between June 2007 and June 2013. RESULTS: The mean age was 53.4 years (23-73) and 16 (64%) patients were female. Of the total, 84% were suffering from malignant diseases. We performed 33 resections (1 to 4 nodules per patient). The procedures performed were non-anatomical resections (n = 26), segmentectomy (n = 1), 2/3 bisegmentectomy (n = 1), 6/7 bisegmentectomy (n = 1), left hepatectomy (n = 2) and right hepatectomy (n = 2). The procedures contemplated postero-superior segments in 66.7%, requiring multiple or larger resections. The average operating time was 226 minutes (80-420), and anesthesia time, 360 minutes (200-630). The average size of resected nodes was 3.2 cm (0.8 to 10) and the surgical margins were free in all the analyzed specimens. Eight percent of patients needed blood transfusion and no case was converted to open surgery. The length of stay was 6.5 days (3-16). Postoperative complications occurred in 20% of patients, with no perioperative mortality. CONCLUSION: The video-assisted liver resection is feasible and safe and should be part of the liver surgeon armamentarium for resection of primary and secondary liver lesions.
Assuntos
Hepatectomia , Neoplasias Hepáticas/cirurgia , Cirurgia Vídeoassistida , Adulto , Idoso , Feminino , Humanos , Laparoscopia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Resultado do Tratamento , Adulto JovemRESUMO
Objective: To evaluate perioperative outcomes, safety and feasibility of video-assisted resection for primary and secondary liver lesions. Methods : From a prospective database, we analyzed the perioperative results (up to 90 days) of 25 consecutive patients undergoing video-assisted resections in the period between June 2007 and June 2013. Results : The mean age was 53.4 years (23-73) and 16 (64%) patients were female. Of the total, 84% were suffering from malignant diseases. We performed 33 resections (1 to 4 nodules per patient). The procedures performed were non-anatomical resections (n = 26), segmentectomy (n = 1), 2/3 bisegmentectomy (n = 1), 6/7 bisegmentectomy (n = 1), left hepatectomy (n = 2) and right hepatectomy (n = 2). The procedures contemplated postero-superior segments in 66.7%, requiring multiple or larger resections. The average operating time was 226 minutes (80-420), and anesthesia time, 360 minutes (200-630). The average size of resected nodes was 3.2 cm (0.8 to 10) and the surgical margins were free in all the analyzed specimens. Eight percent of patients needed blood transfusion and no case was converted to open surgery. The length of stay was 6.5 days (3-16). Postoperative complications occurred in 20% of patients, with no perioperative mortality. Conclusion : The video-assisted liver resection is feasible and safe and should be part of the liver surgeon armamentarium for resection of primary and secondary liver lesions.
Objetivo: avaliar os resultados perioperatórios, segurança e exequibilidade das ressecções videoassistidas para lesões hepáticas primárias e secundárias. Métodos: a partir de um banco de dados prospectivo, foram analisados os resultados perioperatórios (até 90 dias) de 25 pacientes consecutivos submetidos à ressecções videoassistidas, no período entre junho de 2007 e junho de 2013. Resultados: a média de idade foi 53,4 anos (23 a 73 anos), sendo 16 (64%) pacientes do sexo feminino. Do total, 84% eram portadores de patologias malignas. Foram realizadas 33 ressecções (1 a 4 nódulos por paciente). Os procedimentos realizados foram: ressecções não regradas (n=26), segmentectomia (n=1), bissegmentectomia 2/3 (n=1), bissegmentectomia 6/7 (n=1), hepatectomia esquerda (n=2), hepatectomia direita (n=2). Do total, 66,7% dos procedimentos foram em segmentos póstero-superiores, necessitaram de resecções múltiplas ou ressecções maiores. O tempo médio de operação foi 226 minutos (80-420 min) e o tempo de anestesia de 360 minutos (200-630 min). O tamanho médio dos nódulos ressecados foi 3,2cm (0,8 a 10 cm) e as margens cirúrgicas foram livres em todos os espécimes analisados. Foram transfundidos 8% dos pacientes e nenhum caso foi convertido. O tempo de internação foi 6,5 dias (3 a 16 dias). Complicações pós-operatórias ocorreram em 20% dos pacientes, não havendo mortalidade perioperatória. Conclusão: a ressecção hepática videoassistida é exequível e segura, devendo fazer parte do armamentário do cirurgião de fígado para ressecções de lesões hepáticas primárias e secundárias.
Assuntos
Humanos , Masculino , Feminino , Adulto , Idoso , Adulto Jovem , Cirurgia Vídeoassistida , Hepatectomia , Neoplasias Hepáticas/cirurgia , Estudos Prospectivos , Resultado do Tratamento , Laparoscopia , Pessoa de Meia-IdadeRESUMO
AIM: To report experience with liver resection in a select group of patients with postoperative biliary stricture associated with vascular injury. METHODS: From a prospective database of patients treated for benign biliary strictures at our hospital, cases that underwent liver resections were reviewed. All cases were referred after one or more attempts to repair bile duct injuries following cholecystectomy (open or laparoscopic). Liver resection was indicated in patients with Strasberg E3/E4 (hilar stricture) bile duct lesions associated with vascular damage (arterial and/or portal), ipsilateral liver atrophy/abscess, recurrent attacks of cholangitis, and failure of previous hepaticojejunostomy. RESULTS: Of 148 patients treated for benign biliary strictures, nine (6.1%) underwent liver resection; eight women and one man with a mean age of 38.6 years. Six patients had previously been submitted to open cholecystectomy and three to laparoscopic surgery. The mean number of surgical procedures before definitive treatment was 2.4. All patients had Strasberg E3/E4 injuries, and vascular injury was present in all cases. Eight patients underwent right hepatectomy and one underwent left lateral sectionectomy without mortality. Mean time of follow up was 69.1 mo and after long-term follow up, eight patients are asymptomatic. CONCLUSION: Liver resection is a good therapeutic option for patients with complex postoperative biliary stricture and vascular injury presenting with liver atrophy/abscess in which previous hepaticojejunostomy has failed.
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Colecistectomia/efeitos adversos , Colestase/cirurgia , Hepatectomia , Lesões do Sistema Vascular/cirurgia , Adulto , Brasil , Colestase/diagnóstico , Colestase/etiologia , Constrição Patológica , Bases de Dados Factuais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Reoperação , Estudos Retrospectivos , Fatores de Tempo , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Lesões do Sistema Vascular/diagnóstico , Lesões do Sistema Vascular/etiologiaAssuntos
Neoplasias Colorretais/mortalidade , Hepatectomia/mortalidade , Neoplasias Hepáticas/mortalidade , Veia Porta/cirurgia , Adulto , Neoplasias Colorretais/patologia , Neoplasias Colorretais/cirurgia , Feminino , Seguimentos , Humanos , Ligadura , Neoplasias Hepáticas/secundário , Neoplasias Hepáticas/cirurgia , Masculino , Pessoa de Meia-Idade , Veia Porta/patologia , Prognóstico , Taxa de SobrevidaRESUMO
BACKGROUND: Identification of molecular markers in pancreatic adenocarcinoma (PA) has the potential to guide targeted therapy. The objective of this study is to determine the prognostic significance of epidermal growth factor receptor (EGFR) expression (membrane and cytoplasmic) in resected PA and its correlation with lymph node metastasis and survival. METHODS: EGFR overexpression was determined by immunohistochemistry, and the pattern of expression was compared between the primary tumour, adjacent normal pancreas and involved lymph nodes. RESULTS: A total of 88 patients had curative resection. No difference was found in mEGFR overexpression between tumoural and metastatic nodal tissues (P = 0.28). Median overall survival time was 22.9 months. Overall cumulative 1-, 3- and 5-year survival was 48%, 20% and 18%, respectively. In positive mEGFR tumour expression, survival was 46% at 1 year, 8% at 3 years and 0% at 5 years (P < 0.05). Univariate analysis showed that male gender, portal vein (PV) resection, perineural, lymphovascular and peri-pancreatic invasion, positive margins and positive mEGFR expression in tumour tissue had worse survival. Multivariate analysis showed that male gender, PV resection, vascular and perineural invasion remained independent predictors of poor survival. CONCLUSION: Positive mEGFR overexpression is associated with decreased survival; however, it is not an independent prognostic factor.
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Adenocarcinoma/cirurgia , Biomarcadores Tumorais/metabolismo , Receptores ErbB/metabolismo , Pancreatectomia , Neoplasias Pancreáticas/cirurgia , Pancreaticoduodenectomia , Adenocarcinoma/metabolismo , Adenocarcinoma/mortalidade , Adenocarcinoma/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Imuno-Histoquímica , Metástase Linfática , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Neoplasias Pancreáticas/metabolismo , Neoplasias Pancreáticas/mortalidade , Neoplasias Pancreáticas/patologia , Prognóstico , Análise de Sobrevida , Resultado do TratamentoRESUMO
BACKGROUND: Fibrolamellar hepatocellular carcinoma (FLHCC) is a rare disease with an indolent behavior. Its prognosis is better than that of patients with hepatocellular carcinoma. The authors present their experience with resection of FLHCC. METHODS: Twenty-one patients with FLHCC were treated at our institution between 1990 and 2012. Of these patients, 14 were subjected to resection of the tumor. Patient demographics, medical history, results of imaging studies and laboratory tests, surgical data, and pathologic findings were evaluated. RESULTS: The median age of the patients at the diagnosis of the tumor was 20 years and 14 patients were female. None of the patients had tumor-associated chronic liver disease or cirrhosis. The mean tumor size was 12.8 cm (range 6-19) and 18 patients had a single liver nodule. Fourteen patients were subjected to hepatectomy and six of them had lymph node metastases resected. Pathologic evaluation revealed that 5 (35.7%) patients had major vascular invasion. Tumor recurrence was seen in 8 patients (66.7%), during a follow-up. The median survival time for patients who were subjected to resection was 36 months. The 5-year overall survival rate and disease free survival rate were 28.0% and 8.5%, respectively. Univariate analysis showed that vascular invasion was the only variable associated with the disease free survival rate. CONCLUSIONS: Despite an aggressive treatment, patients with FLHCC presented unexpected low survival rates. It seems that an underestimated malignant behavior is attributed to this disease, and that the forms of adjuvant treatment should be urgently evaluated.
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Carcinoma Hepatocelular/secundário , Carcinoma Hepatocelular/cirurgia , Neoplasias Hepáticas/patologia , Neoplasias Hepáticas/cirurgia , Adolescente , Adulto , Vasos Sanguíneos/patologia , Carcinoma Hepatocelular/patologia , Intervalo Livre de Doença , Feminino , Hepatectomia , Humanos , Metástase Linfática , Masculino , Pessoa de Meia-Idade , Invasividade Neoplásica , Recidiva Local de Neoplasia , Taxa de Sobrevida , Carga Tumoral , Adulto JovemRESUMO
AIM: To propose a less invasive surgical treatment for schistosomal portal hypertension. METHODS: Ten consecutive patients with hepatosplenic schistosomiasis and portal hypertension with a history of upper gastrointestinal hemorrhage from esophageal varices rupture were evaluated in this study. Patients were subjected to a small supraumbilical laparotomy with the ligature of the splenic artery and left gastric vein. During the procedure, direct portal vein pressure before and after the ligatures was measured. Upper gastrointestinal endoscopy was performed at the 30(th) postoperative day, when esophageal varices diameter were measured and band ligature performed. During follow-up, other endoscopic procedures were performed according to endoscopy findings. RESULTS: There was no intra-operative mortality and all patients had confirmed histologic diagnoses of schistosomal portal hypertension. During the immediate postoperative period, two of the ten patients had complications, one characterized by a splenic infarction, and the other by an incision hematoma. Mean hospitalization time was 4.1 d (range: 2-7 d). Pre- and post-operative liver function tests did not show any significant changes. During endoscopy thirty days after surgery, a decrease in variceal diameters was observed in seven patients. During the follow-up period (57-72 mo), endoscopic therapy was performed and seven patients had their varices eradicated. Considering the late postoperative evaluation, nine patients had a decrease in variceal diameters. A mean of 3.9 endoscopic banding sessions were performed per patient. Two patients presented bleeding recurrence at the late postoperative period, which was controlled with endoscopic banding in one patient due to variceal rupture and presented as secondary to congestive gastropathy in the other patient. Both bleeding episodes were of minor degree with no hemodynamic consequences or need for blood transfusion. CONCLUSION: Ligature of the splenic artery and left gastric vein with supraumbilical laparotomy is a promising and less invasive method for treating presinusoidal schistosomiasis portal hypertension.
Assuntos
Endoscopia , Hipertensão Portal/cirurgia , Pressão na Veia Porta , Esquistossomose/parasitologia , Artéria Esplênica/cirurgia , Adulto , Idoso , Varizes Esofágicas e Gástricas/parasitologia , Feminino , Hemorragia Gastrointestinal/parasitologia , Humanos , Hipertensão Portal/diagnóstico , Hipertensão Portal/parasitologia , Hipertensão Portal/fisiopatologia , Tempo de Internação , Ligadura , Testes de Função Hepática , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Complicações Pós-Operatórias/etiologia , Estudos Prospectivos , Esquistossomose/complicações , Esquistossomose/diagnóstico , Artéria Esplênica/fisiopatologia , Fatores de Tempo , Resultado do TratamentoRESUMO
INTRODUCTION: Minimally invasive laparoscopic liver surgery is being performed with increased frequency. Lesions located on the anterior and lateral liver segments are easier to approach through laparoscopy. On the other hand, laparoscopic access to posterior and superior segments is less frequent and technically demanding. AIM: Technical description for laparoscopic transthoracic access employed on hepatic wedge resection. TECHNIQUE: Laparoscopic transthoracic hepatic wedge resection on segment 8. CONCLUSION: Transthoracic approach allows access to the posterior and superior segments of the liver, and should be considered for oddly located tumors and in patients with numerous previous abdominal interventions. .
INTRODUÇÃO: As ressecções hepáticas minimamente invasivas vêm sendo realizadas com frequência crescente. O fígado é facilmente abordável através de laparoscopia para o tratamento de lesões localizadas nos segmentos anteriores e laterais; porém, o acesso aos segmentos posteriores é infrequente e tecnicamente difícil. OBJETIVO: Descrever a técnica empregada no acesso laparoscópico transtorácico para realização de ressecção hepática. TÉCNICA: Ressecção hepática em cunha no segmento 8 do fígado realizada através de laparoscopia com auxílio de portais transtorácicos. CONCLUSÃO: A abordagem transtorácica permite o acesso à parte posterior e aos segmentos superiores do fígado; deve ser considerada para tumores localizados excentricamente, e em pacientes com numerosas intervenções abdominais anteriores. .
Assuntos
Idoso , Humanos , Masculino , Hepatectomia/métodos , Laparoscopia/métodos , Neoplasias Hepáticas/cirurgia , TóraxRESUMO
INTRODUCTION: The treatment of portal hypertension is complex and the the best strategy depends on the underlying disease (cirrhosis vs. schistosomiasis), patient's clinical condition and time on it is performed (during an acute episode of variceal bleeding or electively, as pre-primary, primary or secondary prophylaxis). With the advent of new pharmacological options and technical development of endoscopy and interventional radiology treatment of portal hypertension has changed in recent decades. AIM: To review the strategies employed in elective and emergency treatment of variceal bleeding in cirrhotic and schistosomotic patients. METHODS: Survey of publications in PubMed, Embase, Lilacs, SciELO and Cochrane databases through June 2013, using the headings: portal hypertension, esophageal and gastric varices, variceal bleeding, liver cirrhosis, schistosomiasis mansoni, surgical treatment, pharmacological treatment, secondary prophylaxis, primary prophylaxis, pre-primary prophylaxis. CONCLUSION: Pre-primary prophylaxis doesn't have specific treatment strategies; the best recommendation is treatment of the underlying disease. Primary prophylaxis should be performed in cirrhotic patients with beta-blockers or endoscopic variceal ligation. There is controversy regarding the effectiveness of primary prophylaxis in patients with schistosomiasis; when indicated, it is done with beta-blockers or endoscopic therapy in high-risk varices. Treatment of acute variceal bleeding is systematized in the literature, combination of vasoconstrictor drugs and endoscopic therapy, provided significant decline in mortality over the last decades. TIPS and surgical treatment are options as rescue therapy. Secondary prophylaxis plays a fundamental role in the reduction of recurrent bleeding, the best option in cirrhotic patients is the combination of pharmacological therapy with beta-blockers and endoscopic band ligation. TIPS or surgical treatment, ...
INTRODUÇÃO: O tratamento da hipertensão portal é complexo e a definição da melhor estratégia depende da causa subjacente (cirrose vs. Esquistossomose), da condição clínica e do momento em que é realizado (episódio agudo de hemorragia ou como profilaxia pré-primária, primária ou secundária). Com o advento de novas opções medicamentosas e o desenvolvimento da endoscopia e radiologia intervencionista, o tratamento da hipertensão portal tem sofrido grande transformação nas últimas décadas. OBJETIVO: Avaliar os avanços e as estratégias empregadas no tratamento emergencial e eletivo da hemorragia varicosa em pacientes cirróticos e esquistossomóticos. MÉTODO: Revisão bibliográfica nas bases de dados PubMed, Embase, Lilacs, SciELO e Cochrane até junho de 2013, com os descritores: portal hypertension, esophageal and gastric varices, variceal bleeding, liver cirrhosis, schistosomiasis mansoni, surgical treatment, pharmacological treatment, secondary prophylaxis, primary prophylaxis, pré-primary prophylaxis. CONCLUSÃO: Com relação à profilaxia pré-primária não existem estratégias específicas; a melhor recomendação é tratamento da doença de base. A proflaxia primária em pacientes cirróticos deve ser feita com betabloqueadores ou terapêutica endoscópica com ligadura elástica. Existe controvérsia quanto à efetividade da profilaxia primária em pacientes esquistossomóticos; quando indicada, faz-se com betabloqueadores ou terapêutica endoscópica nas varizes de maior risco. O tratamento do sangramento agudo é o com melhor sistematização e mais alto nível de evidência; a associação de drogas vasoconstritoras e terapia endoscópica ...
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Humanos , Hemorragia Gastrointestinal/terapia , Tratamento de Emergência , Varizes Esofágicas e Gástricas/complicações , Hemorragia Gastrointestinal/etiologia , Cirrose Hepática/complicações , Esquistossomose/complicaçõesRESUMO
INTRODUCTION: The treatment of portal hypertension is complex and the the best strategy depends on the underlying disease (cirrhosis vs. schistosomiasis), patient's clinical condition and time on it is performed (during an acute episode of variceal bleeding or electively, as pre-primary, primary or secondary prophylaxis). With the advent of new pharmacological options and technical development of endoscopy and interventional radiology treatment of portal hypertension has changed in recent decades. AIM: To review the strategies employed in elective and emergency treatment of variceal bleeding in cirrhotic and schistosomotic patients. METHODS: Survey of publications in PubMed, Embase, Lilacs, SciELO and Cochrane databases through June 2013, using the headings: portal hypertension, esophageal and gastric varices, variceal bleeding, liver cirrhosis, schistosomiasis mansoni, surgical treatment, pharmacological treatment, secondary prophylaxis, primary prophylaxis, pre-primary prophylaxis. CONCLUSION: Pre-primary prophylaxis doesn't have specific treatment strategies; the best recommendation is treatment of the underlying disease. Primary prophylaxis should be performed in cirrhotic patients with beta-blockers or endoscopic variceal ligation. There is controversy regarding the effectiveness of primary prophylaxis in patients with schistosomiasis; when indicated, it is done with beta-blockers or endoscopic therapy in high-risk varices. Treatment of acute variceal bleeding is systematized in the literature, combination of vasoconstrictor drugs and endoscopic therapy, provided significant decline in mortality over the last decades. TIPS and surgical treatment are options as rescue therapy. Secondary prophylaxis plays a fundamental role in the reduction of recurrent bleeding, the best option in cirrhotic patients is the combination of pharmacological therapy with beta-blockers and endoscopic band ligation. TIPS or surgical treatment, are options for controlling rebleeding on failure of secondary prophylaxis. Despite the increasing evidence of the effectiveness of pharmacological and endoscopic treatment in schistosomotic patients, surgical therapy still plays an important role in secondary prophylaxis.
Assuntos
Hemorragia Gastrointestinal/terapia , Tratamento de Emergência , Varizes Esofágicas e Gástricas/complicações , Hemorragia Gastrointestinal/etiologia , Humanos , Cirrose Hepática/complicações , Esquistossomose/complicaçõesRESUMO
CONTEXT: Colorectal cancer is the second most prevalent cancer worldwide, and the liver is the most common site of metastases. Surgical resection of colorectal liver metastases provides the sole possibility of cure and the best odds of long-term survival. Objectives To describe surgical outcomes and identify features associated with disease prognosis in patients submitted to synchronous colorectal cancer liver metastasis resection. METHODS: Retrospective study of 59 patients who underwent surgery for synchronous colorectal cancer liver metastasis. Actuarial survival and disease-free survival were assessed, depending on the prognostic variable of interest. RESULTS: Postoperative mortality and morbidity rates were 3.38% and 30.50% respectively. Five-year disease-free survival was estimated at 23.96%, and 5-year overall survival, at 38.45%. Carcinoembryonic antigen levels ≥ 50 ng/mL and presence of three or more liver metastasis were limiting factors for disease-free survival, but did not affect late survival. No patient with liver metastases and extrahepatic disease had disease-free interval longer than 20 months, but this had no significance or impact on long-term survival. None of the prognostic factors assessed had an impact on late survival, although no patients with more than three liver metastases survived beyond 40 months. CONCLUSIONS: Although Carcinoembryonic antigen levels and number of metastases are prognostic factors that limit disease-free survival, they had no impact on 5-year survival and, therefore, should not determine exclusion from surgical treatment. Resection is the best treatment option for synchronous colorectal liver metastases, and even for patients with multiple metastases, large tumors and extrahepatic disease, it can provide long-term survival rates over 38%.
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Neoplasias Colorretais/patologia , Neoplasias Hepáticas/secundário , Neoplasias Hepáticas/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Antígeno Carcinoembrionário/sangue , Neoplasias Colorretais/mortalidade , Feminino , Hepatectomia , Humanos , Neoplasias Hepáticas/mortalidade , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Análise de Sobrevida , Fatores de Tempo , Adulto JovemRESUMO
Context Colorectal cancer is the second most prevalent cancer worldwide, and the liver is the most common site of metastases. Surgical resection of colorectal liver metastases provides the sole possibility of cure and the best odds of long-term survival. Objectives To describe surgical outcomes and identify features associated with disease prognosis in patients submitted to synchronous colorectal cancer liver metastasis resection. Methods Retrospective study of 59 patients who underwent surgery for synchronous colorectal cancer liver metastasis. Actuarial survival and disease-free survival were assessed, depending on the prognostic variable of interest. Results Postoperative mortality and morbidity rates were 3.38% and 30.50% respectively. Five-year disease-free survival was estimated at 23.96%, and 5-year overall survival, at 38.45%. Carcinoembryonic antigen levels ≥50 ng/mL and presence of three or more liver metastasis were limiting factors for disease-free survival, but did not affect late survival. No patient with liver metastases and extrahepatic disease had disease-free interval longer than 20 months, but this had no significance or impact on long-term survival. None of the prognostic factors assessed had an impact on late survival, although no patients with more than three liver metastases survived beyond 40 months. Conclusions Although Carcinoembryonic antigen levels and number of metastases are prognostic factors that limit disease-free survival, they had no impact on 5-year survival and, therefore, should not determine exclusion from surgical treatment. Resection is the best treatment option for synchronous colorectal liver metastases, and even for patients with multiple metastases, large tumors and extrahepatic disease, it can provide long-term survival rates over 38%. .
Contexto O câncer colorretal é o segundo câncer mais prevalente no mundo e, o fígado é o principal local das metástases. A ressecção cirúrgica da metástases hepáticas colorretais proporciona a única possibilidade de cura e as melhores chances de sobrevida a longo prazo. Objetivos Avaliar os resultados do tratamento cirúrgico e identificar fatores associados ao prognóstico da doença em pacientes com metástases hepáticas sincrônicas de câncer colorretal submetidos à ressecção. Métodos Estudo retrospectivo de 59 pacientes submetidos à ressecção de metástases hepáticas sincrônicas do câncer colorretal, visando à identificação de fatores relacionados ao prognóstico. Foram estudadas a sobrevida atuarial e sobrevida livre de doença, conforme as variáveis. Resultados A mortalidade e morbidade pós-operatórias foram de 3,38%, e 30,50%, respectivamente. A sobrevida livre de doença estimada em 5 anos foi de 23,96%, e a sobrevida tardia, no mesmo período, foi de 38,45%. O valor do antígeno cárcino-embrionário igual ou superior a 50 ng/mL e o número de metástases maior que três representaram fatores prognósticos limitantes da sobrevida livre de doença, porém sem interferir na sobrevida tardia. Pacientes com metástases hepáticas e doença extra-hepática, submetidos à ressecção, não apresentaram sobrevida livre de doença acima de 20 meses, porém sem significância e sem impacto na sobrevida a longo prazo. Nenhum dos fatores prognósticos estudados interferiu na sobrevida tardia, porém não foi observada sobrevida além de 40 meses em pacientes com mais de três metástases hepáticas. Conclusões Apesar do valor do antígeno ...
Assuntos
Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem , Neoplasias Colorretais/patologia , Neoplasias Hepáticas/secundário , Neoplasias Hepáticas/cirurgia , Antígeno Carcinoembrionário/sangue , Neoplasias Colorretais/mortalidade , Hepatectomia , Neoplasias Hepáticas/mortalidade , Prognóstico , Estudos Retrospectivos , Análise de Sobrevida , Fatores de TempoRESUMO
PURPOSE: The aim of this study was to evaluate short- and intermediate-term results of laparoscopic liver resection in selected patients with hepatocellular carcinoma (HCC). PATIENTS AND METHODS: Eighty-five patients with HCC were subjected to liver resection between February 2007 and January 2013. From these, 30 (35.2%) were subjected to laparoscopic liver resection and were retrospectively analyzed. Special emphasis was given to the indication criteria and to surgical results. RESULTS: There were 21 males and 9 females with a mean age of 57.4 years. Patients were subjected to 10 nonanatomic and 20 anatomic resections. Two patients were subjected to hand-assisted procedures (right posterior sectionectomies); all other patients were subjected to totally laparoscopic procedures. Conversion to open surgery was necessary in 4 patients (13.3%). Postoperative complications were observed in 12 patients (40%), and the mortality rate was 3.3%. Mean overall survival was 29.8 months, with 3-year overall and disease-free survival rates of 76% and 58%, respectively. CONCLUSIONS: Laparoscopic treatment of selected patients with HCC is safe and feasible and can lead to good short- and intermediate-term results.
Assuntos
Carcinoma Hepatocelular/cirurgia , Hepatectomia/métodos , Laparoscopia/métodos , Neoplasias Hepáticas/cirurgia , Recidiva Local de Neoplasia/terapia , Neoplasias das Glândulas Suprarrenais/secundário , Neoplasias das Glândulas Suprarrenais/cirurgia , Adulto , Idoso , Carcinoma Hepatocelular/mortalidade , Conversão para Cirurgia Aberta , Intervalo Livre de Doença , Embolização Terapêutica , Estudos de Viabilidade , Feminino , Hepatectomia/normas , Humanos , Laparoscopia/normas , Tempo de Internação , Neoplasias Hepáticas/mortalidade , Neoplasias Pulmonares/tratamento farmacológico , Neoplasias Pulmonares/secundário , Masculino , Pessoa de Meia-Idade , Cuidados Paliativos/métodos , Seleção de Pacientes , Complicações Pós-Operatórias , Guias de Prática Clínica como Assunto , Estudos Retrospectivos , Taxa de Sobrevida , Resultado do TratamentoRESUMO
BACKGROUND: Surgical resection is the gold standard therapy for the treatment of colorectal liver metastases (CRM). The aim of this study was to investigate the impact of tumor growth patterns on disease recurrence. METHODS: We enrolled 91 patients who underwent CRM resection. Pathological specimens were prospectively evaluated, with particular attention given to tumor growth patterns (infiltrative vs pushing). RESULTS: Tumor recurrence was observed in 65 patients (71.4%). According to multivariate analysis, 3 or more lesions (P = .05) and the infiltrative tumor margin type (P = .05) were unique independent risk factors for recurrence. Patients with infiltrative margins had a 5-year disease-free survival rate significantly inferior to patients with pushing margins (20.2% vs 40.5%, P = .05). CONCLUSIONS: CRM patients with pushing margins presented superior disease-free survival rates compared with patients with infiltrative margins. Thus, the adoption of the margin pattern can represent a tool for improved selection of patients for adjuvant treatment.
Assuntos
Neoplasias Colorretais/patologia , Neoplasias Hepáticas/secundário , Recidiva Local de Neoplasia/patologia , Estadiamento de Neoplasias/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Brasil/epidemiologia , Progressão da Doença , Intervalo Livre de Doença , Feminino , Seguimentos , Hepatectomia , Humanos , Neoplasias Hepáticas/diagnóstico , Neoplasias Hepáticas/cirurgia , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/mortalidade , Prognóstico , Estudos Prospectivos , Taxa de Sobrevida/tendênciasRESUMO
INTRODUCTION: Minimally invasive laparoscopic liver surgery is being performed with increased frequency. Lesions located on the anterior and lateral liver segments are easier to approach through laparoscopy. On the other hand, laparoscopic access to posterior and superior segments is less frequent and technically demanding. AIM: Technical description for laparoscopic transthoracic access employed on hepatic wedge resection. TECHNIQUE: Laparoscopic transthoracic hepatic wedge resection on segment 8. CONCLUSION: Transthoracic approach allows access to the posterior and superior segments of the liver, and should be considered for oddly located tumors and in patients with numerous previous abdominal interventions.
Assuntos
Hepatectomia/métodos , Laparoscopia/métodos , Neoplasias Hepáticas/cirurgia , Idoso , Humanos , Masculino , TóraxRESUMO
RACIONAL: Aproximadamente 50% dos pacientes com tumor colorretal apresentam metástase hepática sendo a hepatectomia o procedimento terapêutico de escolha. Discutem-se diversos fatores prognósticos; entre eles, a margem cirúrgica é fator sempre recorrente, pois não existe consenso da distância mínima necessária entre o nódulo metastático e a linha de secção hepática. OBJETIVOS: Avaliar as margens cirúrgicas nas ressecções de metástases hepáticas de câncer colorretal e sua correlação com recidiva local e sobrevida. MÉTODOS: Estudo retrospectivo, baseado na revisão dos prontuários de 91 pacientes submetidos à ressecção de metástases hepáticas de neoplasia colorretal. Foi realizada revisão histopatológica de todos os casos com aferição da menor margem cirúrgica e observar o resultado tardio em relação à recidiva e sobrevida. RESULTADOS: Não houve diferença estatística nas taxas de recidiva e no tempo de sobrevivência global entre os pacientes com margens livres ou acometidas (R0vsR1), assim como não houve diferença entre as margens subcentimétricas e as maiores de 1 cm. A sobrevida livre de doença dos pacientes com margens microscopicamente acometidas foi significativamente menor do que dos com margens livres. A análise uni e multivariada não identificou a margem cirúrgica (R1, exígua ou menor que 1 cm) como fator de risco para recidiva. CONCLUSÕES: As ressecções de metástases hepáticas com margens livres de doença, independentemente das dimensões da margem, não influenciou na recidiva tumoral (intra ou extra-hepática) ou na sobrevida dos pacientes.
BACKGROUND: Approximately 50% of the patients with a colorectal tumor develop liver metastasis, for which hepatectomy is the standard care. Several prognostic factors have been discussed, among which is the surgical margin. This is a recurring issue, since no consensus exists as to the minimum required distance between the metastatic nodule and the liver transection line. AIM: To evaluate the surgical margins in liver resections for colorectal metastases and their correlation with local recurrence and survival. METHODS: A retrospective study based on the review of the medical records of 91 patients who underwent resection of liver metastases of colorectal cancer. A histopathological review was performed of all the cases; the smallest surgical margin was verified, and the late outcome of recurrence and survival was evaluated. RESULTS: No statistical difference was found in recurrence rates and overall survival between the patients with negative or positive margins (R0 versus R1); likewise, there was no statistical difference between subcentimeter margins and those greater than 1 cm. The disease-free survival of the patients with microscopically positive margins was significantly worse than that of the patients with negative margins. The uni- and multivariate analyses did not establish the surgical margin (R1, narrow or less than 1 cm) as a risk factor for recurrence. CONCLUSION: The resections of liver metastases with negative margins, independently of the margin width, had no impact on tumor recurrence (intra- or extrahepatic) or patient survival.
Assuntos
Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias Colorretais/patologia , Neoplasias Colorretais/cirurgia , Hepatectomia , Neoplasias Hepáticas/patologia , Neoplasias Hepáticas/cirurgia , Recidiva Local de Neoplasia/epidemiologia , Neoplasias Colorretais/mortalidade , Hepatectomia/métodos , Neoplasias Hepáticas/mortalidade , Neoplasias Hepáticas/secundário , Estudos Retrospectivos , Taxa de SobrevidaRESUMO
PURPOSE: To investigate superoxide dismutase (SOD) activity in the portal vein endothelium and malondialdehyde acid (MDA) production in liver tissue of rats submitted to 70% hepatectomy. METHODS: Twelve rats were distributed in two groups (hepatectomy and sham). Animals were sacrificed on post operative day 1 and portal vein, liver tissue and blood samples were collected. Portal vein SOD production was measured using lucigenin-amplified chemiluminescence assays. MDA measurement was used as an index of oxidative stress through the formation of TBARS (Thiobarbituric Acid Reactive Species). RESULTS: There was no difference in post operative bilirubin, AST, ALT levels between groups. DHL level was higher in the hepatectomy group (p=0.01). MDA production in the remnant liver tissue and endothelial portal vein SOD activity were also significantly (p<0.05) elevated in the hepatectomy group when compared to control group. There was no correlation between MDA and SOD activity. SOD activity, on the other hand, showed a positive correlation with LDH level (p=0.038) and MDA levels showed a positive correlation with AST and ALT levels (p<0.001). CONCLUSION: There is an increased production of malondialdehyde acid in liver tissue after partial hepatectomy and increased activity of superoxide dismutase in portal vein endothelium as well.
Assuntos
Endotélio Vascular/enzimologia , Hepatectomia/métodos , Fígado/metabolismo , Veia Porta/enzimologia , Superóxido Dismutase/metabolismo , Alanina Transaminase/sangue , Animais , Aspartato Aminotransferases/sangue , Lactato Desidrogenases/sangue , Medições Luminescentes , Masculino , Malondialdeído/análise , Malondialdeído/metabolismo , Estresse Oxidativo , Ratos , Ratos Wistar , Superóxido Dismutase/análise , Substâncias Reativas com Ácido Tiobarbitúrico , Fatores de TempoRESUMO
PURPOSE: To investigate superoxide dismutase (SOD) activity in the portal vein endothelium and malondialdehyde acid (MDA) production in liver tissue of rats submitted to 70% hepatectomy. METHODS:Twelve rats were distributed in two groups (hepatectomy and sham). Animals were sacrificed on post operative day 1 and portal vein, liver tissue and blood samples were collected. Portal vein SOD production was measured using lucigenin-amplified chemiluminescence assays. MDA measurement was used as an index of oxidative stress through the formation of TBARS (Thiobarbituric Acid Reactive Species). RESULTS: There was no difference in post operative bilirrubin, AST, ALT levels between groups. DHL level was higher in the hepatectomy group (p=0.01). MDA production in the remnant liver tissue and endothelial portal vein SOD activity were also significantly (p<0.05) elevated in the hepatectomy group when compared to control group. There was no correlation between MDA and SOD activity. SOD activity, on the other hand, showed a positive correlation with LDH level (p=0.038) and MDA levels showed a positive correlation with AST and ALT levels (p<0.001). CONCLUSION: There is an increased production of malondialdehyde acid in liver tissue after partial hepatectomy and increased activity of superoxide dismutase in portal vein endothelium as well.(AU)