Survival and recurrence after hepatic resection in cirrhotic patients

Although hepatic resection is one of the most effective treatments for hepatocellular carcinoma [HCC], the long term results of hepatic resection of this malignancy are far from satisfactory. The potential benefits of hepatectomy for patients with HCC have not been fully delineated. This study aimed to identify surgical outcomes of 18 consecutive cirrhotic patients with HCC undergoing hepatic resection. 18 patients with cirrhotic liver underwent hepatic resection between March 2002 and January 2007. We had 14 men and 4 women. The mean age was 55 years with a range between 42 and 67 years. The 30-day [operative] mortality rate was one case [5.5%] and there was one additional late death [5.5%]. Ten patients [62.5%] had recurrence after curative resection. Major hepatectomy was performed in 14 patients [77%] and the other 4 [22%] had minor hepatectomy In our study, the overall survival of patients after 3 years was 43.75% while the disease-free survival was 37.5%. The survival rate after operation remains unsatisfactory mainly because of the high recurrence rate. The improved care of cirrhotic patients, early detection and effective treatment of recurrent HCC may play an important role in achieving better prognosis and survival after operation

Role of spiral CT scan and endoscopic ultrasonography in assessing operability of peri-ampullary tumors

Pancreatic cancer is associated with an extremely poor prognosis with less than 5% of patients surviving 5 years after the diagnosis. Current preoperative staging modalities include various cross sectional imaging techniques. including spiral CT and endoscopic ultrasound [EUS]. This prospective study aimed at demonstrating the role of spiral CT and endoscopic ultrasonography in early diagnosis staging and assessment of operability of periampullary tumors. Sixty-two patients with periampullary tumors were included in this study. All cases were subjected to abdominal ultrasound. Spiral CT. ERCP. EUS and operative interference. Surgical findings were considered the gold standard for assessing the sensitivity of spiral CT and EUS in diagnosing, staging arid estimating resectability of periampullary tumors. Endoscopic Ultrasonography was very sensitive in detecting periampullary masses [93.5%] especially masses smaller than 20mm while the sensitivity of spiral CT was 71%. EUS was also very sensitive in detecting ampullary masses [100%] in contrast to spiral CT chat missed the diagnosis of the 14 ampullary masses found in our work. EUS was more sensitive than Spiral CT in detecting malignant vascular invasion [95% versus 75%] while it was slightly less specific than spiral CT in that context [74 versus 80%]. The predictive value of spiral CT was 60% for tumor resectability while it was 100% for tumor unresectability. The predictive value of EUS was 735% for tumor resectability while it was 96.4% for tumor unresectability. When combining both techniques the predictive value for tumor resectability was 65% while it was 100% for tumor unresectability. No complications were encountered in both techniques. We concluded that EUS is more sensitive than spiral CT in detection and staging of periampullary masses. Also. the non-invasive spiral CT and the minimally invasive EUS are very valuable tools in predicting uresectability of periampullary masses while EUS is slightly more valuable in detecting tumor resectability

Experience with vascular delay in unipedicled transverse rectus abdominis myocutaneous flap breast reconstruction

The transverse rectus abdominis myocutaneous flap [TRAM] is a popular method of autologous breast reconstruction that results in a soft, natural looking ptotic breast and does not need addition prosthetic volume replacement giving an excellent cosmetic result, however, ischaemic related complications including partial-or total flap loss and fat necrosis continue to occur. In this report we describe our experience in TRAM flap breast reconstruction using vascular delay in high-risk patients in an effort to decrease ischaemic related flap complications. Nineteen patients underwent unilateral breast reconstruction using a unipedicled vascular delay TRAM flap between March, 1997 and May, 2000. All patients had one or more risk factors including obesity, previous irradiation, chronic cigarette smoking,diabetes or abdominal scars. Eleven cases had mastectomy with vascular delay then reconstruction while 8 had reconstruction done- after completion of their.adjuvant therapy There. Were nmo cases with total flap loss. We had one case with partial flap loss needing debridment and secondary sutures and one with a patch of epidermal sloughing which responded to conservative measures. Minimal fat necrosis was seen in one case. There was no mortality in our cases and the cosmetic results and patient satisfaction ranged from satisfactory to excellent. We believe that vascular delay and unipedicled TRAM flap reconstruction of the breast in high-risk patients is a simple, reliable procedure with a predictable outcome and satisfactory results. Its only drawback is the need for 2 surgical procedures which is a small price to pay especially in high-risk patients who have a very high flap complication rate using other methods of reconstruction