Repeat hepatectomy for recurrent colorectal metastases.

BACKGROUND: The oncological benefit of repeat hepatectomy for patients with recurrent colorectal metastases is not yet proven. This study assessed the value of repeat hepatectomy for these patients within current multidisciplinary treatment. METHODS: Consecutive patients treated by repeat hepatectomy for colorectal metastases between January 1990 and January 2010 were included. Patients undergoing two-stage hepatectomy were excluded. Postoperative outcome was analysed and compared with that of patients who had only a single hepatectomy. RESULTS: A total of 1036 patients underwent 1454 hepatectomies for colorectal metastases. Of these, 288 patients had 362 repeat hepatectomies for recurrent metastases. Some 225 patients (78·1 per cent) had two hepatectomies, 52 (18·1 per cent) had three hepatectomies, and 11 patients (3·8 per cent) had a fourth hepatectomy. Postoperative morbidity following repeat hepatectomy was similar to that after initial liver resection (27·1 per cent after first, 34·4 per cent after second and 33·3 per cent after third hepatectomy) (P = 0·069). The postoperative mortality rate was 3·1 per cent after repeat hepatectomy versus 1·6 per cent after first hepatectomy. Three- and 5-year overall survival rates following first hepatectomy in patients who underwent repeat hepatectomy were 76 and 54 per cent respectively, compared with 58 and 45 per cent in patients who had only one hepatectomy (P = 0·003). In multivariable analysis, repeat hepatectomy performed between 2000 and 2010 was the sole independent factor associated with longer overall survival. CONCLUSION: Repeat hepatectomy for recurrent colorectal metastases offers long-term survival in selected patients.

Impact of portal vein embolization on long-term survival of patients with primarily unresectable colorectal liver metastases.

BACKGROUND: : Portal vein embolization (PVE) increases the resectability of initially unresectable colorectal liver metastases (CLM). This study evaluated long-term survival in patients with CLM who underwent hepatectomy following PVE. METHODS: : In a retrospective analysis patients treated by PVE before major hepatectomy were compared with those who did not have PVE, and with those who had PVE without resection. RESULTS: : Of 364 patients who underwent hepatectomy, 67 had PVE beforehand and 297 did not. Those who had PVE more often had more than three liver metastases (68 versus 40.9 per cent; P < 0.001) that were more frequently bilobar (78 versus 55.2 per cent; P < 0.001), and a higher proportion underwent extended hepatectomy (63 versus 18.1 per cent; P < 0.001). Postoperative morbidity rates were 55 and 41.1 per cent respectively (P = 0.035), and overall 3-year survival rates were 44 and 61.0 per cent (P = 0.001). Thirty-two other patients who were treated by PVE but did not undergo resection all died within 3 years. CONCLUSION: : PVE increased the resectability rate of initially unresectable CLM. Among patients who had PVE, long-term survival was better in those who had resection than in those who did not. PVE is of importance in the multimodal treatment of advanced CLM.

[Pathologicoanatomic analysis of deaths from acute myocardial infarct with and without arterial hypertension]. / Patologoanatomichen analiz na pochinali ot ostur miokarden infarkt sus i bez arterialna khipertoniia.

Analysis was performed on 220 cases--decreased with acute myocardial infarction, subdivided into two groups--not hypertonics and hypertonics. The average age of the decreased with acute myocardial infarction with arterial hypertension is higher. Substantial differences are absent in the carriers of coronary type, degree of atherosclerotic affection and coronaries myocardiosclerosis and past infarctions, preceding the development of the acute myocardial infarction, being the cause of the death. Coronary thrombosis, mural thrombosis, acute aneurysms, and embolic complications in the systemic and pulmonary circulation proved to be more frequent among hypertonic. Discrepancies are absent as regards the localization of the necrotic zone and involvment of the ventricular muscles. Rupture incidence in both groups is very high and almost the same--over 25 per cent. External ruptures are found to be more frequent, being most often posterior in hypertonics. Parillary ruptures are characteristic for them. No difference is established concerning the exitus. Left ventricle insufficiency ranks first for both groups--over 67 per cent; second to follow are the heart ruptures with tamponade--about 20 per cent; and third--the arterial embolias in systemic circulation--9--10 per cent.