[Giant lipomas or retroperitoneal liposarcomas? Controversies in their diagnosis and treatment]. / ¿Lipoma gigante o liposarcoma retroperitoneal? Controversias en su diagnóstico y tratamiento.

BACKGROUND: Retroperitoneal lipomas are extremely rare tumors that must be differentiated from well-differentiated liposarcomas (WD-LPS). OBJECTIVES: To summarize the evidence about giant retroperitoneal lipomas or liposarcomas; and to elaborate recommendations for their management. DATA SOURCES: A systematic literature search from January 1985 to December 2019 and a review of our own cases was performed. RESULTS: Our series comprises four patients, two females and two males. The diagnosis was incidental in two cases. The medium size was 26 cm, being two cases located exclusively in the retroperitoneum, one in the inguinal region and one in the buttock via pelvic space. All cases were surgically removed being confirmed the initial diagnosis of retroperitoneal lipomas in two cases, as the rest two cases were classified as WD_LPS after MDM2/CDK4 genetic analysis. The review of the available literature plus our own cases revealed 30 cases, of which 58% were woman. Only two cases were asymptomatic. The main symptom was abdominal mass (53%) followed by abdominal pain (40,6%). The median size of the lesions was 24,9 cm with a median weight of 4.576,3 g. All cases were surgically removed, being necessary to remove contiguous organs in only four cases (12,5%). CONCLUSIONS: Retroperitoneal lipoma is a rare tumor which must be differentiated from WD-LPS. This is a very difficult task, being necessary to determinate MDM2 status (by FISH or MLPA), present in liposarcoma but not in lipomas, for its correct diagnosis. The treatment must be based on a complete surgical resection with negative margins.

Liver Transplantation for Hepatic Trauma: A Study From the European Liver Transplant Registry.

BACKGROUND: Liver transplantation is the most extreme form of surgical management of patients with hepatic trauma, with very limited literature data supporting its use. The aim of this study was to assess the results of liver transplantation for hepatic trauma. METHODS: This retrospective analysis based on European Liver Transplant Registry comprised data of 73 recipients of liver transplantation for hepatic trauma performed in 37 centers in the period between 1987 and 2013. Mortality and graft loss rates at 90 days were set as primary and secondary outcome measures, respectively. RESULTS: Mortality and graft loss rates at 90 days were 42.5% and 46.6%, respectively. Regarding general variables, cross-clamping without extracorporeal veno-venous bypass was the only independent risk factor for both mortality (P = 0.031) and graft loss (P = 0.034). Regarding more detailed factors, grade of liver trauma exceeding IV increased the risk of mortality (P = 0.005) and graft loss (P = 0.018). Moreover, a tendency above the level of significance was observed for the negative impact of injury severity score (ISS) on mortality (P = 0.071). The optimal cut-off for ISS was 33, with sensitivity of 60.0%, specificity of 80.0%, positive predictive value of 75.0%, and negative predictive value of 66.7%. CONCLUSIONS: Liver transplantation seems to be justified in selected patients with otherwise fatal severe liver injuries, particularly in whom cross-clamping without extracorporeal bypass can be omitted. The ISS cutoff less than 33 may be useful in the selection process.

Treatment of hepatocellular carcinoma in the transplant era.

BACKGROUND: hepatocellular carcinoma (HCC) is one of the most frequent malignant diseases of the liver. It is clearly related to cirrhosis, especially to that caused by liverbound viruses. This study addresses the behavior of this disease in patients treated under different protocols at two third-level hospitals. METHODS: we conducted a longitudinal, prospective and retrospective study including patients diagnosed with HCC and invasively treated at Hermanos Ameijeiras and Juan Canalejo Hospitals. Subjects were grouped according to treatment and were compared with those patients who underwent liver transplant. Mean comparison tests were used as well as survival analysis. RESULTS: overall recurrence patterns showed variable recurrence for all patients with a clear benefit for the transplanted group of patients including those with expanded criteria. Overall survival analysis at 3, 5 and 10 years showed that (patient) survival was 70%, 59% and 55%, respectively, for the transplanted group. On the other hand, those patients who did not undergo transplant showed significantly lower survival rates of 40%, 17% and 9%, respectively. CONCLUSIONS: this study, like others, demonstrated a clear benefit for liver transplant in the treatment of HCC. This is more evident in patients with an underlying liver disease, as long as low-recurrence selection criteria are considered. These results are important in the evaluation of effectiveness of treatments considering both groups are comparable.

Trasplante ortotópico de hígado en pacientes con trombosis portal extensa mediante técnicas intravasculares intraoperatorias / No disponible

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Auxiliary liver transplantation with portal arterialization in the rat: description of a new model.

In recent years, portal arterialization has been used in liver transplantation to increase the portal flow, as a solution for singular technical problems. We have developed a new auxiliary liver transplantation model in the rat with portal arterialization, so the native hepatic hilium remains untouched, consisting on a graft with a previous 70% hepatectomy. It is sited on the right renal bed, joining the infrahepatic inferior vena cava (IVC) of the graft with the recipient IVC. With an abdominal aortic graft, we connect the recipient aorta with the portal vein from the auxiliary liver. All the animals survived at the seventh day. No thrombosis was seen in any graft and an important rejection was observed in all the fields. We have developed a new experimental model of an auxiliary liver with portal arterialization, avoiding the utilisation of the native hepatic hilium, necessary for the possible recovering of the proper liver in the case of a reversible fulminant hepatitis.