ABSTRACT
Portal vein thrombosis [PVT] has been mentioned as a potential obstacle to liver transplantation [LTx]. To review the impact of PVT on orthotopic liver transplant [OLT] outcome. Between January 2006 and April 2009, 440 OLT were performed in Shiraz Transplant Unit of whom, 35 [7.9%] cases had old PVT with recanalization. Data were retrospectively collected regarding the demograph- ics, indication for OLT, Child-Turgot-Pugh classification, pre-transplant diagnosis of PVT, perioperative course and managements, relapse of PVT, early post-operative mortality and morbidity. All patients received liver from deceased donors, underwent thrombendvenectomy with end-to-end anastomosis without interposition graft and evaluated daily for 5 days and thereafter, biweekly by duplex sonography during the follow-up period for 2 months. They were treated by therapeutic doses of heparin followed by warfarin to maintain an INR of 2-2.5. The causes of end-stage liver disease were hepatitis B in 11, cryptogenic cirrhosis in 11, primary scle- rosing cholangitis in 5 and other causes in 8 recipients. Extension of thrombosis was through confluence of superior mesenteric and splenic vein in 32 and to superior mesenteric vein in 3 patients. The mean +/- SD op- eration time was 7.2 +/- 1.5 hrs. The mean +/- SD transfusion requirement was 5.4 +/- 2.8 units of packed cells. The mean +/- SD duration of hospital stay in these patients was 17.7 +/- 10.9 days. Eight patients died; 1 developed early in-hospital PVT, 1 had hepatic vein thrombosis, and 1 died of in-hospital ischemic cerebrovascular ac- cident, despite a full anticoagulant therapy. The mean +/- SD follow-up period for those 28 patients discharged from hospital was 16.6 +/- 7.9 months; none of them developed relapse of PVT. The overall mortality and mor- bidity was 28% and 32%, respectively. There was no relapse of PVT in the other patients. The presence of PVT at the time of OLT is not a contraindication for the operation but those with PVT have a more difficult surgery, develop more postoperative complications, and experience a higher in-hospital mortality
ABSTRACT
With promising results from several institutions, many centers began to treat patients with esophageal squamous cell carcinoma [SCC] with neoadjuvant chemoradiotherapy followed by esophagectomy. The aim of this research is to determine the feasibility of this method in our selected patients. In this prospective phase I clinical trial, 10 patients [7 male, 3 female; 58.4 +/- 2.5 Y/O] with stage III and VIA lower thoracic esophageal SCC, were treated with intravenous infusion of 1000 mg/m[2]/day 5-flourouracil during day 1 to 4, 75 mg/m[2] cisplatin in day 1, and a total dose of 18 Gray external beam radiation during day 1 to 6 and underwent transhiatal esophagectomy during day 7 till 10. This group was compared with a retrospective group of 61 patients which treated with surgery alone. Age, sex, duration and grading of the dysphagea, differentiation and staging of the tumor were not different in these two groups. There is no complete pathologic response in the study group. One patient died because of severe leukopenia and sepsis and other because of azygos vein rupture. Other complications were: chylothorax which required later thoracotomy [10%], recurrent nerve paresis [10%], superficial wound infection of the neck incision [10%]. All patients had mild to moderate leukopenia [2600'400/mm3] during days 11 to 16. Total postoperative intensive care unit stay was 2.2 +/- 0.5 days and postoperative hospitalization was 15.7 +/- 1.8 days and in-hospital operative mortality was 20% and total morbidity was 50% which were not significantly different from control group [p<0.05]. Postoperative blood transfusion was 5.3 +/- 0.8 unit per patient which was significantly greater than control group[P<0.05]. The perioperative mortality and morbidity of this neoadjuvant protocol is acceptable comparing with our control group and we can propose phase II and III studies for determining the long-term effect of these protocol