ABSTRACT
The recipients of liver transplantation [LT] are subjected to lifelong immunosuppression with its many drawbacks. De novo and recurrent malignancy in transplant recipients are attributed to attenuation of immunosurveillance. In the present study, we present our experience with de novo malignancies encountered after both deceased and living donor liver transplantations. Retrospective study of patients referred to LT center between April 2001 and January 2010. Various data were collected including type of malignancy and histopathologic features, immunosuppression regimen, and patient survival. Of 248 LT procedures performed in 238 patients [10 retransplants], 8 patients [3.4%] developed de novo post-LT malignancies. De novo malignancies included post-LT lymphoproliferative disorders [PTLD] in 5 patients who were all Epstein-Barr virus [EBV] positive, and who were treated successfully with anti-CD20 monoclonal antibody therapy, reduction of immunosuppression, and control of EBV activity; urinary bladder cancer in 1 patient who was treated with radical surgical resection and chemotherapy but died of bone and lung metastasis within 1 year of diagnosis; endometrial carcinoma in 1 patient who was treated with radical surgical resection; and Kaposi sarcoma in 1 patient who was successfully treated with surgical excision and reduction of immunosuppression. EBV-associated PTLD is the most frequently encountered de novo malignancy after LT and is easily treatable by chemotherapy and reduction of immunosuppression
ABSTRACT
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
Subject(s)
Humans , Male , Female , Hepatectomy , Postoperative Complications , Recurrence , Follow-Up Studies , Survival RateABSTRACT
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