[Large primary liver cancer (> 10 cm)- diagnosis and surgical treatment].

BACKGROUND: Primary liver cancer (PLC) over 10 cm. in diameter at the time of diagnosis continues to account for a number of patients undergoing hepatic resection. This study evaluated the clinicopathological features and outcome following surgery for large PLC. METHODS: Between January 1991 and December 2002 , 105 patients were operated, 68 of them (64.7%) the size of tumor was > 10 cm. Forty-five patients (66.2%) with a large PLC(greater than 10 cm) were resected and studied retrospectively. They were compared with 27 patients who had tumor less than 10 cm. They were 31 men and 14 women of mean age 53,8 (from 1 to 78 years). Cirrhosis had 13 patients (28,9%) - Child A- 10, Child B - 3. RESULTS: Surgical procedures were: major resections in 33 patients and minor resections in 12. Eight patients (17,7%) died by the 30-th day. 16 patients had postoperative complications - 6 patients developed liver failure. The 1-, 2-, 3- and 5-year overall survival rates were 68%, 43%, 22% , 2,2% respectively. CONCLUSION: Large primary liver cancer can be safely resected when cirrhosis is absent. Liver cirrhosis is contraindication for major hepatic resection. The lack of cirrhosis increases resectability and decreases morbidity and mortality.

[Prognostic factors for survival in primary liver cancer].

BACKGROUND: The aim of this study was to identify the prognostic factors of survival after curative resection of primary liver cancer (PLC). STUDY DESIGN: Thirty four patients underwent resection PLC between January 1991 and December 2000. Univariate and multivariable analysis were used to retrospectively identify factors associated with overall survival when resection was curative for primary tumor. RESULTS: Overall 1, 2, 3 and 5 - year survival rates were 76.0%, 57.5%, 35.2% and 6.0% respectively. Recurrence after one year was 35%. Eleven predictive factors - clinical, laboratory, pathological and surgical were analyzed. Independent prognostic factors for overall survival were vascular invasion (p = 0.006) and stage (p = 0.023). CONCLUSIONS: Hepatic resection is an effective treatment for PLC, even in advanced cases. The overall survival were low, because of late diagnosis and recurrence of the tumors.

[Giant primary retroperitoneal teratoma--case report and review of the literature].

Teratomas are germ cell tumors of a nonseminomatous type. Their incidence is characterized with a bimodal curve, but basically they are a pathology of the small age. Primary localization in the retroperitoneal space is seen in over 40% of cases with teratoma Preoperative differentiation from other bulky pathologic processes in this region presents a challenge to the surgeon. An interesting case of a primary retroperitoneal teratoma is presented and a review of the literature is done.

[Clamping procedures in hepatic surgery].

The advance of liver surgery and transplantation offers a new procedures--vascular clamping. Results of hepatic resections depends essentially on proper control of intraoperative hemorrhage. We present here the different procedures for vascular clamping and discussing their indications. Four parametres can be used to define the type of clamping: 1) place of application--control of arterial or glisson pedicles and portal veins (pedicles, selective hilar, suprahilar and intrahepatic clamps), suprahepatic veins or vena cava; 2) selectivity--partial or total clamp of hepatic blood supply; 3) duration--continuous or intermittent; 4) association measures to favor tolerence to ischemia (cooling, preservation fluids) or to limit downstream consequences (extracorporal circulaton, derivation). The clamping procedures depends on the localisation of the lesion and its relationships with the great vessels, presence of liver desease and the patients general and cardiovascular status. The aim is to use clamp moderate, favoring selective clamps to avoid ischemia.

[Giant primary retroperitoneal teratoma--case report and review of the literature].

Teratomas are germ cell tumors of a nonseminomatous type. Their incidence is characterized with a bimodal curve, but basically they are a pathology of the small age. Primary localization in the retroperitoneal space is seen in over 40% of cases with teratoma. Preoperative differentiation from other bulky pathologic processes in this region presents a challenge to the surgeon. An interesting case of a primary retroperitoneal teratoma in a 23 year old male is presented and a review of the literature is done.

[Cholangiocellular carcinoma--clinical features and surgical treatment]. / Kholangiotselularen kartsinom--klinika i khirurgichno lechenie.

UNLABELLED: Cholangiocellular carcinoma is the second on rate primary liver cancer (7-10%), after hepatocellular carcinoma--(80-85%). The aim of this study is to present some diferrencies in clinical and pathological features in comparison to other liver tumors. MATERIALS AND METHODS: In the period 1991-2002 years, 105 patients with primary liver cancer were operated; 9 of them (8.5%) had cholangiocellular carcinoma (CCC). The men were 5, the women--4, and the mean age 51 years. Hepatic resection was performed in 5 patients, in 1--biliary drainage, in 3--explorative laparotomy. RESULTS: Until 30th postoperative day there was no death in resected patients, but one--the drained patient. Morbidity was: ascites, hepatocellular insuficiency, fever. One patient is alive more than 4 years. CONCLUSIONS: Cholangiocarcinoma affects young people, sometimes they are jaundiced; tumours become big, because asymptomatic grow. Hepatic resection remains to be the best therapeutical option in nonjaundiced patients.

[Anterior approach for major hepatic resection for large liver malignancy]. / Chernodrobni rezektsii tip ANTERIOR APPROACH -- pri golemi maligneni tumorina cherniia drob -- 2 sluchaia ot praktikata.

The large liver cancers in the right lobe are difficult to be resected with conventional approach. We report for 2 cases--43 old year man with cholangiocellular carcinoma and 50-old year woman with metastatic liver tumor from breast cancer, both with diameter of 30 cm, successfully resected using nonconventional "anterior approach". The postoperative period was uneventful. They were discharged from hospital in 10 and 14 days.

[Postoperative liver failure after hepatic resections for hepatocellular carcinoma]. / Postoperativna chernodrobna nedostatuchnost sled chernodrobni rezektsii pri bolni s khepatotselularen kartsinom.

Postoperative liver failure is a life-threatening complication after hepatic resection. The purpose of this study was to review the liver failure as a result of hepatic resection and to propose strategy for decreasing the risk of its developing. From January 1991 to December 2000 73 patients with primary liver cancer (PLC) were operated and identified in a retrospective database. Seven (13.2%) of resected 53 patients developed postoperative liver failure. There were 4 male and 3 female with mean age 52.3+/-29.2 (from 1 to 78). 3 patients had underlying cirrhosis. Major resections were 5 and minor--2. Mean hemotransfusion was 1012, 13 ml (370-2000 ml). Five patients (71%) died by the 30th day. The causes of liver failure were analyzed, based on both the preoperative data and the intraoperative findings. Significant prognostic factors were the preoperative serum level of bilirubin (p=0.024) and intraoperative hemotransfusion (0.031). The right hemihepatectomy was a prevalent hepatic resection in these patients.

[Results of surgical treatment of primary liver cancer]. / Rezultati ot khirurgichnoto lechenie na purvichniia rak na cherniia drob.

Using a single institution experience, the authors examine hepatic resections in treatment of primary liver cancer (PLC), the postoperative complications and mortality. Seventy-three patients were operated on between January 1991 and December 2000 and identified in a retrospective database. They were 53 men and 20 women of mean age 54.6 (from 1 to 78 years). Of the 73 operated patients with PLC, 53 underwent hepatic resection. Two patients had PLC at stage II, 43--stage III, 8--stage IV. 25 (34%) patients had underlying cirrhosis: 14--Child A and 11--Child B. 34 patients underwent major resections and 19--minor resections. 7 patients (13.2%) died of the hepatic resection--by the 30-th day. Mortality among cirrhotic patients was 25% (4 patients). 16 patients had postoperative complications. 6 patients developed liver failure. Hepatic resection is a basic method in treatment of the PLC. The presence of cirrhosis, especially Child B, increases surgical morbidity and mortality.

[Hepatic resections for hepatocellular carcinoma and cirrhosis]. / Chernodrobni rezektsii pri bolni s khepatotselularen kartsinom i tsiroza.

Liver resection in a patient with cirrhosis carries increased risk. The purposes of this study were to review the results of cirrhotic liver resection in the past decade and to propose strategies for low morbidity and mortality. From January 1991 to December 2000 73 patients with primary liver cancer (PLC) were operated and identified in a retrospective database. Twenty five (34%) patients had underlying cirrhosis: 14--Child A and 11--Child B. There were 18 male and 7 female with mean age 60.9 +/- 9.2 (from 44 to 78). There were 16 (64%) resections: 11--stage Child A and 5--stage Child B. Major resections were 7 and minor--9. Eight patients received hemotransfusion--mean 939.13 ml (370-2000 ml). Four patients (25%) died of the hepatic resection--by the 30-th day. Seven patients had postoperative complications. 4 patients developed liver failure. Major resections had 42.86% mortality, minor resections--11.11%. Hepatic resection is potentially curative therapy for HCC and cirrhosis especially in Child A. Child B produce high rate of postoperative morbidity and mortality.

[Liver resection in a state of normothermic ischemia]. / Chernodrobni rezektsii v s'stoianie na normotermichna iskhemiia.

Thirty-three patients undergoing liver resection in a state of normothermic ischemia are described: portal clamping is done in 25 cases at mean duration 41 +/- 8 min, and vascular exclusion of liver--10 cases at mean duration 44 +/- 12 min. This is a procedure accounting for a substantial reduction of intraoperative hemorrhages. In 17 patients hemotransfusion proves unnecessary, while in the remainder the amount of blood transfused averaged 1500 +/- 950 ml.

[Vascular exclusion during liver resection--an experimental rabbit model]. / Vaskularno izkliuchvane pri chernodrobni rezektsii--eksperimentalen model vurkhu zaitsi.

Vascular exclusion of the liver (VEL) consists in clamping of the portal triad (VCI) below and above the liver. An experimental model of the technique is presented, accomplished in 20 rabbits divided in three groups according to vascular exclusion pattern. Complete VEL reduces the hazards of intraoperative hemorrhage and air embolism during major liver resections.

[Vascular exclusion of the liver]. / Vaskularno izkliuchvane na cherniia drob.

Vascular exclusion of the liver (VEL) is a comparatively new and seldom used procedure. It is developed and practically implemented along with liver transplantation, and corresponds to the nonhepatic phase of the latter. VEL reduces considerably the risks of intraoperative hemorrhage, and is indicated in handling large and vascular tumors located in the vicinity of vessels. Its safe duration may reach up to 90 min, and is free of serious postoperative complications. VEL allows for broadening the scope of liver resection, and reduction of intra- and postoperative hemotransfusions.

[Diagnostic laparoscopy and laparoscopic surgery--their development and outlook]. / Diagnostichna laparoskopiia i laparoskopska khirurgiia--razvitie i perspektivi.

Laparoscopy was introduced in the beginning of the 20 century. It is developed as a diagnostic procedure, often combined with biopsy. In the 80 ies the laparoscopy came in surgery, first in appendectomy, later in cholecystectomy, where it achieved exclusive appliance and became an alternative method of conventional surgery. In the beginning of 90-ies the laparoscopic surgery treats more and more of diseases of abdominal surgery.

[Biligenic hepatic and subhepatic abscesses--observations on 9 cases]. / Biliogenni khepatalni i subkhepatalni abstsesi--nabliudeniia vurkhu devet sluchaia.

This review presents 9 cases with pyogenic hepatic and subhepatic abscesses developed by biliary route. An ultrasonography and computed tomographic scan was performed on 3 patients. Eight patients were treated with open surgical drainage and one with percutaneous drainage under ultrasonic control. All of them received a triple antibiotic therapy. Five patients had diabetes mellitus. Mortality was null.

[7 cases of liver transplantation with preservation of the vena cava inferior]. / Nabliudeniia vurkhu sedem sluchaia na chernodrobna transplantatsiia sus zapazvane na vena cava inferior.

Orthotopic liver transplantation (OLT) with preservation of the inferior vena cava (IVC) was performed in 7 patients during a period of 7 weeks. For 5 years in this center are realized 180 OLT, the last 93 of them with preservation VCI (51.6%). This method had important advantages versus standard operation--blood loss and operating time are reduced, IVC does not clamped. This operation can be used in the majority of cases.