[Chemoembolization with Drug Eluting Beads (TACE DEB) in patients with primary unresectable hepatocellular carcinoma (HCC)]. / Transarteriální chemoembolizace pomocí "drug eluting beads" (TACE DEB) u nemocných s radikálne neodstranitelným hepatocelulárním karcinomem (HCC).

INTRODUCTION: The incidence of HCC is growing all over the word. Liver resection and transplantation are the methods of choice in only 25% of patients, representing radical treatment approaches. TACE is a method of palliative treatment in patients with primary unresectable disease. MATERIAL AND METHODS: 35 patients (27 men and 8 women) of an average age of 73.4 ± 7.2 years with HCC of average cumulative diameter 83.8 ± 36.3 mm were treated by TACE DEB with Doxorubicin. Solitary and multiple lesions were presented in 28 and 7 patients, respectively. 31 patients were classified as Child A, and 4 as Child B. One year overall survival, disease-specific, disease-free interval and their correlation with patients age, gender, as well as the number and cumulative diameter of tumours and complications after procedure were evaluated. RESULTS: 30-day mortality and morbidity rate was 0 and 8.6%, respectively. The so-called postembolization syndrome developed in 25.7% of patients. Repeated TACE was performed in 14 (40%) patients due to tumour progression. In two patients (5.7%) we performed liver resection after TACE. According to the RECIST criteria there was no complete response, partial response was presented in 17.1, stable disease in 37.1 and progression of disease in 25.7% of patients. One year overall survival, tumour-specific survival and disease-free survival was 69.7%, 88.9 and 49.3%, respectively. Better overall survival (p < 0.02) was achieved in patients < 75 years old. Worse disease-free interval was observed in patients with complication after TACE (p < 0.01). No significant differences were found in the other evaluated parameters. CONCLUSION: TACE is the method of palliative treatment in patients with unresectable HCC. There is no progression of HCC in one-half of patients after TACE. Better results are achieved in younger patients and in patients with no complications of procedure.

[Liver and pulmonary metastases of the colorectal carcinoma - the experience of the Department of Surgery, University Hospital in Pilsen]. / Jaterní a plicní metastázy kolorektálního karcinomu - zkusenosti Chirurgické kliniky FN v Plzni.

INTRODUCTION: Liver and pulmonary metastases of the colorectal carcinoma develop in about 20-70%, resp. in 10-22% patients with the colorectal carcinoma. Their treatment is still a matter of discussion. The aim of our study was to evaluate the results of surgical treatment as a part of the multimodal approach. MATERIAL AND METHODS: 30 patients with liver and pulmonary colorectal metastases were operated on between 2002 and 4/2013. The average age was 62.8 ± 10.7 years. 19 patients had metachronous and 11 synchronous metastases. The liver metastases preceded pulmonary in 14 cases, and vice versa in 5 patients. Both types of metastases developed in seven patients simultaneously. Liver resection was performed in 23, radiofrequency ablation (RFA) in 7 patients. Laser pulmonary metastasectomy was performed in 15, pulmonary resection in 14 and RFA in one patient. The liver procedure preceded pulmonary in 25 patients. 73.3% patients had adjuvant oncological treatment. RESULTS: 30 days mortality rate was 3.3% (N=1) for the actinomycotic sepsis complicated with MRSA infection. Morbidity rate was 10%. Recurrence of liver metastases developed in 6 patients. RFA was performed in all patients. The median of overall and disease free survival was 6.9, resp. 1.1 years. CONCLUSION: Surgical treatment as a part of the multimodal treatment is the only radical treatment for patients with liver and pulmonary metastases. It offers good long-term results.

Portal vein embolization and application of autologous stem cells in patients with primary unresectable liver tumours.

BACKGROUND: Only 15-20 % of patients with liver tumours can undergo radical surgery. Insufficient future liver remnant volume (FLRV) is one of the main causes of tumours unresectability. Portal vein embolization (PVE) together with administration of haematopoietic stem cells (HSC) may expand the operability of primary unresectable liver tumours. METHODS: In this pilot study, the authors reported on five patients (1 hepatocellular carcinoma, 4 colorectal cancer metastases) with FLRV <30 %, who underwent PVE on the side of the tumour with a subsequent application of HSC to the non-embolized branch of portal vein. RESULTS: PVE with HSC application was without any complications. In three patients, a sufficient increase of FLRV occurred within 2-4 weeks followed by a liver resection. All patients were between 5-12 months after the surgery in good condition; one of them was diagnosed with pulmonary metastasis after nine months that was successfully treated with laser metastasectomy. In one patient with hepatocellular carcinoma, an increase of FLRV and progression of the tumour in the liver occurred following the PVE with administration of HSC and the patient was treated only symptomatically. Despite an adequate increase of FLRV, severe intraabdominal adhesions hampered liver resection in one patient. CONCLUSIONS: Combination of PVE with HSC administration appeared to be a promising method that stimulated growth of FLRV with a subsequent possibility of an early radical liver resection. The issue is a danger of tumour progression in the liver parenchyma following the PVE with HSC. The current randomized study should answer these questions (Tab. 1, Fig. 4, Ref. 38).

[Surgical treatment of complicated hepatic echinococcosis in two Bulgarian citizens at two surgical departments in the Czech Republic]. / Chirurgické resení komplikované jaterní echinokokózy u dvou bulharských obcanu na dvou pracovistích v Ceské republice.

Echinococcosis, also referred to as hydatidosis, is a parasitic infection caused by the tapeworm Echinococcus in its larval stage. It has worldwide distribution and endemic areas in Europe include especially the regions surrounding the Mediterranean Sea. In the Czech Republic, its incidence tends to be quite rare. Although it may affect any organ or tissue in the human body, the liver (60%) and lungs (20%) are the most frequently affected sites. The authors present two cases of Bulgarian patients with hepatic echinococcosis operated on the same day at two different surgical departments in the Czech Republic. Treatment is based on the surgical removal of the cysts in combination with anti-parasite treatment by benzimidazoles (Albendazol, Mebendazol). Treatment with anti-parasitic drugs needs to be started preoperatively and should continue for at least 1-2 months after surgery. The success of the treatment can be monitored by imaging methods, especially PET/CT and serology. Patients after surgical as well as conservative therapy need to be followed up on an outpatient basis due to the long-term risk of recurrence.

[Surgical therapy of pulmonary metastases of colorectal cancer--ten-year results]. / Chirurgická léba plicních metastáz kolorektálního karcinomu--desetileté výsledky.

INTRODUCTION: Nowadays, surgical therapy of pulmonary metastases of colorectal cancer is a generally accepted therapeutic approach that has been proven to extend long term patient survival with acceptable perioperative morbidity and mortality rates. The aim of the study is to retrospectively analyse a group of patients who underwent surgery for pulmonary metastases of colorectal cancer over a period of ten years. MATERIALS AND METHODS: From 2000 to 2009, 39 patients with pulmonary metastases of colorectal cancer underwent surgical therapy at the site of the authors, out of whom 21 were males (53.8%), with a mean age of 60.4 years. Out of the total, 24 patients (61.5%) presented with solitary metastases, multiple metastases were found in the remaining patients. 8 patients (20.5%) bileral affection was detected. 34 patients (87.2%) underwent adjuvant oncological therapy of a radically surgically curable primary tumor before metastasectomy and 6 patients (15.4%) underwent surgery for liver metastases. Five patients in the group (12.8%) had both pulmonary and secondary liver affections at the same time. The median disease-free period after the primary tumor surgery was 27 months in the whole group. RESULTS: In total, we performed 31 unilateral (79.5%) and 8 bilateral (20.5%) one- or two- step surgeries. The most common type of surgery included anatomical pulmonary resections (18 procedures), laser excisions (13 procedures) and wedge resections (9 procedures). In total, we performed 73 radical resections of metastases and 5 metastases were treated by radiofrequency ablation (RFA). Metastatic affection of hilar lymph nodes was found in three patients (7.7%). Perioperative morbidity reached 12.8%, mortality was zero, and two re-operations were required because of complications (5.1%). 53.8% of patients with metastasectomy are still alive, the median survival time is 38 months. The three-year survival rate is 52% and the five-year survival rate is 41% five years. Pre-operatively increased value of tissue polypeptid specific antigen (TPS) was the only statistically significant factor that had a negative impact on the overall survival. 30.7% of patients with metastasectomy show no disease progression, the median disease- free interval is 14 months. There is a statistically significant correlation between DFI (Disease Free Interval) following metastasectomy and the type of surgery and the lowest value of DFI was achieved with radiofrequency ablation. The risk of disease progression is 3.4-times higher in patients with two and more metastases of colorectal cancer up to 3.9-times higher in subjects with three and more metastases. CONCLUSION: The positive effect of pulmonary metastasectomy on the long-term survival is evident. However, careful selection of patients with individual evaluation of each single case is required. In particular, indication for metastasectomy should be carefuly considered in cases of multiple affection, which are associated with higher risk of disease progression. The essential requirement is to achieve complete resection of the pathological focus, with a maximum effort aimed at sparing healthy pulmonary tissue, which allows for potential necessary reoperations in case of the disease recurrence. Systematic mediastinal lymphadenectomy (SMLA) should be an integral part of any pulmonary metastasectomy.

Immediately preoperative use of biological therapy does not influence liver regeneration after large resection--porcine experimental model with monoclonal antibody against epidermal growth factor.

BACKGROUND: The aim of this work was to study the influence of isolated biological therapy administered immediately before extended liver resection on liver function and regenerative capacity of future liver remnant (FLR) in a large-animal experiment. MATERIALS AND METHODS: Nineteen piglets were included in this study (10 in the control group and 9 in the experimental group). A port-a-cath was introduced into the superior caval vein. On days 11 and 4 before liver resection, cetuximab was administered via this port at 400 mg/m2 of piglet body surface. Physiological solution was applied to the control group. Resection of the left lateral, left medial and right medial hepatic lobes was followingly performed (reduction of 50-60% of liver parenchyma). Blood samples were collected at different times before the operation and after liver resection. Serum levels of bilirubin, urea, creatinine, alkaline phosphatase, gamma glutamyltransferase, cholinesterase, aspartate aminotransferase, alanine aminotransferase, albumin, C-reactive protein and transforming growth factor-ß1 were assessed. The ultrasonographic examinations at different time points were performed pre-operatively and after liver resection in order to assess the liver volume. The biopsies from the liver parenchyma were examined for proliferative activity, binocluated hepatocytes, size of hepatocytes, and the length of the lobuli. The comparison of distribution of the studied parameters between the groups was carried out using the Wilcoxon test. The Spearman rank correlation co-efficient was used because of the non-Gaussian distribution of the parameter values. The whole development of the studied parameters over time was compared between the groups using ANOVA. RESULTS: There were no important complications of administration of biologic therapy during the operation or throughout the peri-operative period. There was no statistically significant difference in the regeneration of FLR nor were any differences in biochemical, immunoanalytical and histological parameters detected. CONCLUSION: The achieved results of comparable liver regeneration in both the experimental and control groups confirms the use of biological treatment with cetuximab in the pre-operative period for minimizing the recovery period.

Matrix metalloproteinases and their inhibitors in correlation to proliferative and classical tumour markers during surgical therapy of colorectal liver metastases.

OBJECTIVES: Classical and proliferative tumour markers and matrix metalloproteinases and their tissue inhibitors reflect the features of malignancy and are useful in prediction of prognosis in patients with colorectal liver metastases. There is very limited information about their physiological functions during regeneration and healing of liver parenchyma after any type of liver surgery for malignancy. METHODS: The presented study included the patients, who underwent following surgical procedures for CLM, benign liver lesions and inguinal hernias: Group A: 22 patients with inguinal hernias, Group B: 26 patients with benign liver lesions, Group C: 30 patients with colorectal liver metastases (CLM) who were treated by radiofrequency ablation, Group D: 41 patients with CLM who underwent a radical surgical therapy - resection, and Group E: 22 patients with inoperable CLM who underwent an explorative laparotomy without any surgical procedure. RESULTS: The preoperative and postoperative serum levels of CEA, CA 19-9, TK, TPA, TPS, MMP-2, MMP-9, TIMP-1, and TIMP-2 were statistically analyzed and compared within the groups to estimate the influence of a surgical procedure type. These results reflect the influence of surgical procedure on the serum levels of studied tumour markers during operation. CONCLUSIONS: It was the first description using these types of comparison to all metalloproteinases, their inhibitors, and proliferative and classical tumour markers. It could help us to estimate the critical relations of these tumour markers in prognoses of disease free survival or overall survival in patients after a surgical procedure for CLM (Tab. 5, Ref. 26).

Liver abscess in human toxocariasis.

BACKGROUND: Toxocariasis is a parasitic infection caused by Toxocara canis or Toxocara cati. It is distributed worldwide. Liver is the main organ affected by Toxocara infection, typically with multiple eosinophilic infiltrates. Liver abscess formation is a very rare condition. METHOD: The authors report on a case of Toxocariasis infection with abscess formation in the right liver lobe. The diagnosis was made upon patient's history, clinical examination, use of ultrasonography, computed tomography and especially upon positive serologic test and hypereosinophilia. After unsuccessful conservative treatment (Mebendazole, antibiotics and corticoids), right hepatectomy was performed. RESULTS: The postoperative course was complicated by biliary fistula in the resection area. The complication was successfully managed by temporary stent implantation to the left hepatic duct. Six months after the operation, the patient is with no complications. CONCLUSION: Liver abscess formation is a rare condition associated with Toxocara infection. It is still a matter of debate whether liver abscess results from severe parasitic infection or whether human toxocariasis is a predisposing cause of pyogenic liver abscess formation. Liver resection is the only treatment option when sepsis fails to respond to conservative treatment (Fig. 5, Ref. 22).

[Can tumor markers predict outcomes of portal vein branch embolization in patients with primary inoperable liver tumors?]. / Mohou nádorové markery predpovídat výsledek embolizace vetve portální zíly u nemocných s primárne inoperabilním nádorem jater?

INTRODUCTION: Portal vein embolization (PVE) is one of the options to increase the number of resecable cases in patients with primary inoperable liver tumors. However, insufficient growth of liver parenchyma or postoperative tumor progression remains problematic in PVE procedures. Generally, tumor markers are of significance in patient postoperative monitoring for the disease recurrence. The aim of this study is to assess the potential of tumor markers in predicting PVE outcomes. METHOD: The study group included 43 subjects with primary or secondary tumors, in whom serum alpha-fetoprotein (AFP), carcinoembryonic antigen (CEA), thymidine kinase (TK), tissue polypetide antigen (TPS) and MonoTotal levels were assessed 28 days following PVE. The liver parenchyma growth or tumor progression were assessed based on computer tomography. RESULTS: Sufficient liver parenchyma hypertrophy was recorded in 27 (62.8 %) patients with subsequent liver resection. Insufficient post-PVE liver parenchyma growth was recorded in 5 (11.6 %) patients and tumor progression was recorded in 11 (25.6 %) subjects. The following tests were considered significant predictive tumor markers of PVE outcomes: serum levels of CEA, TPA, Mono Total prior to PVE, and serum levels of TK, TPA, Mono Total within 28 days following PVE. CONCLUSION: Tumor markers may be significant in predicting PVE outcomes in patients with primary inoperable liver tumors. However, in order to make final conclusions on their clinical significance, larger patient group studies should be performed.

[Non-tumor bile duct strictures]. / Nenádorové stenózy zlucových cest.

The authors rectrospectively evaluate the possibilities of the solutions and the complications regarding benign stenoses of the biliary tract in 10 patients, who were treated within the years 2008 - 4/2011 at the Surgical Clinic of Medical Faculty of Charles University and the Faculty Hospital in Plzen. The injury of the biliary tree at cholecystectomy - 6 cases - was the most often cause of the benign stenosis of the biliary tree development in our collection. Once it was the case of a rare incidence of M. Crohn's disease of the biliary tract, once it was the case of stenosis in Mirrizi syndrome and two times it was the case of stenosis after the repeated instrumental procedures at ERCP after choledocholithiasis. Three times stenosis was solved by help of the repeated dilations of stenosis in the way of ERCP procedure. In other 7 cases stenosis was solved surgically by help of hepaticojejunalanastomosis to the excluded Roux-en-Y gastric bypass. The dilation of stenosis of the biliary tree requested two sessions on average, the surgical solution had a minimal peri-operative morbidity - 0% and within a 30-day peri-operative period there was noted 1 death in connection with the solution of stenosis of the biliary tract with the massive bleeding at decubitus of the stent of the left biliary duct into hepatic artery. Long-term results with respect to a short-time period were not evaluated.

[Portal vein branch embolization in patients with primary inoperable liver tumors]. / Problematika embolizace vetve portální zíly u nemocných s primárne neoperabilními nádory jater.

INTRODUCTION: Portal vein embolization (PVE) is indicated in patients with insufficient liver remnants following liver resections for tumor disorders. Therefore, due to PVE, the number of primary operable patients is higher. Insufficient growth of the liver parenchyma or malignant progression remain the PVE cons. AIM OF THE STUDY: To date outcomes of PVE are assessed based on the authors' own experience and literature data. In particular, the authors focus on difficulties with PVE, i.e. its failures. METHODS: 40 patients (35 with colorectal carcinoma metastases, 2 with breast carcinoma metastases and one with ovarian carcinoma metastases, 2 with hepatocellular carcinoma) were indicated for PVE due to insufficient liver reserve following planned liver resection. RESULTS: Liver resections were completed in 22 subjects, 42.6 days (mean value) after PVE. In 14 (35%) subjects, the liver resection could not be performed (11x tumor progression, 3x insufficient liver tissue growth). In four subjects, only radiofrequency ablation was performed. At year one, two and three after the procedure, the survival rate is 83.7, 69.7 and 52.3% (resp.) of the subjects, while the survival rate following exploration and in unoperated subjects was 22.2% (25 subjects) (p < 0.001). A one-year, resp. two-year relapse--free survival rate was 30.3, resp. 7%. CONCLUSION: PVE has become an established procedure in stage liver procedures, due to its potential to facilitate operability of primary and secondary liver tumors. In order to improve the outcomes, attention must be paid to the post- PVE growth of the liver parenchyma and further assessment of oncological treatment approaches during the pre- and post- PVE period, with the aim to reduce liver and extra-liver malignant progression rates prior to the liver resection procedure.

[Surgical treatment of liver and pulmonary metastases of colorectal carcinoma]. / Chirurgickái lécba jaterních a plicních metastáz kolorektálního karcinomu.

THE AIM: The aim of the work was to evaluate the set of 10 patients, who were operated on hepatic and pulmonary metastases of colorectal carcinoma at the Surgical Clinic of Medical Faculty of Charles University and Faculty Hospital in Plzen in years from 2005 till 2009. With regard to limited experience with the patients who underwent hepatic as well as pulmonary resection, we focused on the evaluation of a long-term survival of the patients and their mortality and morbidity. THE SET OF THE PATIENTS: In years from 2005 till 12/2009 we operated 10 patients during whose affection there occurred hepatic and pulmonary metastases of colorectal carcinoma and these were solved surgically. This concerned 5 men and 5 women at an average age of 62.4 years (42-71 years). In 10% it was hepatic resection in the first period after the operation of primary carcinoma, it was the first performance on the hepatic parenchyma in 90%. THE RESULTS: Morbidity of the set was 20.1% regarding hepatic resections and 5.6% regarding pulmonary resections. A 30-day postoperative mortality was 0%. In three cases a hepatic involvement was bilateral, in two cases in the left lung and 5 patients had an involvement of the right pulmonary lobe. In 4 cases primary carcinoma was in the rectum and in 6 cases in the large intestine. The period of three months was an average time between hepatic and pulmonary resection. Resection on liver parenchyma was the most often performance and metastasectomy with the help of laser on the pulmonary parenchyma. Rectal carcinoma spread into lungs in 50%. An average time of a 5-year survival in the patients after resection of hepatic and pulmonary metastases of colorectal carcinoma was 26%. THE CONCLUSION: Hepatic and pulmonary resection in the selected patients with generalized colorectal carcinoma extends the period of a survival and does not worsen the quality of the life. The patients after resection of both--hepatic and pulmonary metastases have got a worse long-term survival than the patients being only after hepatic resections.

[Liver metastases of other than colorectal origin]. / Jaterní metastázy jiného nez kolorektálního puvodu.

AIM: Colorectal carcinoma is the commonest malignancy with liver metastases. Approximately 25-30% of these metastases are resectable with good long-term outcomes. Liver metastases of so called non-colorectal carcinomas are significantly less common, and considering different biological character of these metastases, compared to colorectal ones, surgical management of some of these types is debatable, however, in some cases remains highly successful. The aim of this study was to assess the authors' outcomes of surgical and termoablation therapy of non-colorectal liver metastases. METHODS: The authors present their experience with surgical treatment in 68 patients - mean age of 58.2 y.o.a (33.1-77.5) with liver metastases of non-colorectal carcinomas- NKJM (the commonest types: breast carcinoma--32.4%, carcinoid--20.6%, renal carcinoma--13.3%, gynecological tumors--13.3%, gastrointestinal stromal tumor--4.4%, gastric carcinoma--4.4% ) during 2001-2008. The mean time after primary surgery for carcinoma was 3.9 years (0-8.5 let). The surgical procedures included the following: radiofrequency ablation (RFA)--50 patients (73.5%), resections in 26.5%. Preoperative chemotherapeutical "downstaging" or portal vein embolization on the tumor side, in order to improve the NKJM resecability, was performed in 10 subjects (14.7%). Resecable or RFA--manageable extrahepatic metastases were removed using one- or more- step procedures in 25 subjects (36.7%). The total number of liver metastases within the whole study group ranged from 1 (28x) to 8 (1x) metastases. Postoperative adjuvant chemotherapy, combined with biological treatment in some patients, was administered to a total of 33 patients (48.5%). RESULTS: One year after the procedure and RFA, a total of 88.6% of patients were surviving, at 3 years 72.5 % and at 5 years 36.9% of the subjects. Considering four commonest tumors (breast carcinoma, carcinoid, gynecological carcinomas and renal carcinoma), the best 5-year survival rates were recorded in patients with carcinoid metastases (100%), 33.8% of patients with breast metastases were surviving at 5 years, 44.4% of patients with renal carcinoma metastases were surviving at 3 years and 72.9% of patients with gynecological tumors were surviving at 2 years. There were no statistically significant differences in long-term survival rates between RFA and resections. Patients with extrahepatic metastases had worse prognosis (p < 0.01). CONCLUSION: Liver resection and RFA have their definite place in multimodal treatment strategy in the management of non- colorectal carcinoma liver metastases (NKJM). Indication for surgery must be made on strictly individual basis, in particular in patients with NKJM, in order to achieve quality long-term survival in these patients.

Chemo-embolization of inoperable liver tumors.

A small percentage of patients suitable for radical surgery require us to introduce alternative palliative methods prolonging the good quality of life in patients with malignant liver tumors. Apart from thermoablation or cryo-ablation, one of the alternative methods with palliative influence on tumors is the chemoembolization of tumors. A group of 18 patients, who underwent chemo-embolization at the Surgical Clinic and Radiodiagnostic Clinic, Medical Faculty, Charles University in Pilsen from 2007 to 2008, were assessed from the point of view of complications, overall survival and the patients' life quality. The most common complication was temperature and pain in the right infracostal area in connection with the performed procedure. The patients' quality of life after chemo-embolization was very good and the time of hospitalization was only 3.5 days on average. We had to perform the procedure repeatedly in 30% of cases. The chemo-embolization was done on inoperable liver metastases of colorectal carcinoma and on inoperable hepatocellular carcinoma (Tab. 1, Fig. 2, Ref. 5).

Cytokines and liver regeneration after partial portal vein ligation in porcine experimental model.

THE AIM OF STUDY: The limits of liver surgery are restricted today by the functional reserves of remnant parenchyma. The aim of this article was to acquaint the general surgical and medical public with the results of experimental liver regeneration stimulated by cytokines and thus to enhance their effort to carry on with implementing the research results in clinical practice. METHODS: Authors present their experimental model of liver regeneration after ligation of portal branches for caudate and right lateral, and right medial liver lobes. The regeneration was induced by application of TNF-alpha and IL-6 into the non-occluded portal branches, and compared with the results of other experimental teams. RESULTS AND CONCLUSION: The absolute volume of hypertrophic lobes increases after application of TNF-alpha more rapidly, whereas in the control group, practically no changes were recorded in hypertrophic liver lobes volumes in first three days. The achieved acceleration of growth of hypertrophic liver lobes after application of TNF-alpha and IL-6 confirmed the key role of studied pleiotropic cytokines in the priming of liver parenchyma regeneration after portal vein ligation (Fig. 3, Ref. 26).

[Hepatolithiasis--a rare disorder in our population]. / Hepatolitiáza--vzácné onemocnení v nasí populaci.

AIM: The authors describe diagnostic and therapeutic options of hepatolithiasis, which is a rare disorder in our population. METHODOLOGY: The authors present 3 case--reviews of patients operated for hepatolithiasis in the Plzen Faculty Hospital Surgical Clinic during 2000-2008. In a single subject, the finding was related to a Caroli syndrome. All subjects suffered from symptomatic hepatolithiases (abdominal pains, cholangiogenic sepsis), which was complicated by advanced liver cirrhosis in one case. The diagnostic measures included ultrasonography, computer tomography, MRI cholangiography and endoscopic retrograde cholangiography. In all the subjects, left-sided lobectomy was performed for findings located in the liver segments 2 and 3. RESULTS: The 30-day postoperative mortality was nil. In a single female patient, liver resection (segment 4) was performed for segmental bile duct dilation, bile fistule and chilangiogenic sepsis. CONCLUSION: Resection of the affected liver region is the method of choice in the management of hepatolithiasis.

[Surgical management of the colorectal carcinoma liver metastases]. / Chirurgická lécba jaterních metastáz kolorektálního karcinomu.

INTRODUCTION: Unfortunately, the Czech Republic rates of the colorectal carcinoma are the highest in the world. Surgical procedures for colorectal carcinoma liver metastases (JMKRK) are well established and have good long-term outcomes. AIM: The aim of the study was to assess own results with a reference on modern trends in liver surgery. SUBJECTS AND METHODOLOGY: From 01- 01- 2000 to 01-12- 2008, a total of 442 liver procedures in 346 patients with colorectal carcinoma liver metastases were performed in the Faculty Hospital and the Charles University Medical Faculty Surgical Clinic in Plzen. RESULTS: The 30-day postoperative mortality rate was 0.3%, the morbidity rate was 8.1%. Five years following the liver procedure for the colorectal carcinoma liver metastases, 34.0% of the subjects are surviving. 3 years following radiofrequency ablation (RFA) of the colorectal carcinoma liver metastases, 35.5% of the patients are surviving. CONCLUSION: Nowadays, surgical management of the colorectal carcinoma liver metastases is the method of choice. The other alternative is radiofrequency ablation (RFA) in non-resectable colorectal carcinoma liver metastases. However, currently, only 20% of the patients are operable using the radical methods at the time, when the diagnosis is established. Therefore, the new trends in liver surgery include several-stage/phase, combined procedures and re-resections, aimed to improve resecability of the colorectal carcinoma liver metastases with low patient postoperative mortality and morbility rates.

[Surgical treatment of benign liver tumours--indications and results]. / Wann sollte man benigne Lebertumoren chirurgisch behandeln?*

The authors present their results on the treatment of benign liver tumors. 65 patients were operated upon in the University Hospital in Pil-sen from 2000 until July 2006. Benign liver lesions were rather rare compared to malignant tumours, for which 273 patients were treated within the same period. The most often found benign -lesions were hepatocellular adenoma, focal nodular hyperplasia (FNH) and hemangioma. Sometimes, it was not possible to make a correct diagnosis preoperatively. The surgical procedures used for benign tumours were mostly enucleation and non-anatomic parenchyma-saving resection (55.4 %). Morbidity in this group was 26.5 %, mortality 0 %.

[Liver cystadenoma]. / Cystadenom jater.

THE INTRODUCTION: Biliary cystadenomas of the liver are less often complicated cystic lesions of the liver with a malignant potential. THE AIM: The aim of the work was to assess the results of the set of an own working place emphasising new findings in the diagnostics and the treatment of benign tumours of the liver. THE SET OF THE PATIENTS AND THE METHOD: From 2004 till 2009 three patients were operated on biliary cystadenomas of the liver at the Surgical Clinic of Medical Faculty of Charles University and Faculty Hospital in Plzen. In all cases these patients were women with the average age 42 years of the age category 36-58 years. In all cases the formation was located centrally close to the branching of the big biliary ducts. The diagnosis was established preoperativelly in 66% of cases. An enucleation was performed two times and the right hepatectomy once. Mortality was 0% and morbidity was 33%. THE CONCLUSION: Regarding to the fact that cystadenomas of the liver as benign tumours have a malignant potential for rising the cystadenocarcinoma, it is always necessary to perform their surgical removing--resection or the enucleation. With respect to their central location their surgical treatment belongs to more difficult performances carried out on the liver parenchyma. Long-term results after the surgical treatment are very good.

[Carcinoma of the gallbladder--current surgical treatment options]. / Karcinom zlucníku--soucasné moznosti chirurgické lécby.

BACKGROUND: The effect of radical resection in gallbladder cancer is still area of debate. AIM OF STUDY: To determine the criteria of surgery in primary and incidental gallbladder cancer. method: Eighty-four patients with gallbladder cancer were evaluated between 1999 and 2008. Sixty patients (72.4%) were symptomatic. Explorative laparotomy was performed in 40 (66.7%), palliative procedure in 5 (8.3%) patients in stage pT3-4, N1, M0-1. Cholecystectomy only or completed with wedge resection of the gallbladder bed and lymfadenectomy as radical procedure was performed only in 7 (1.7%) patients in pT1-2, N0-1, M0. Twenty four (28.6%) patients had incidental gall bladder carcinoma. Radical cholecystectomy was performed in 4 (16.7%) - pT1a, N0, M0, palliative cholecystectomy in 3 patients (12.5%) - pT3, N1, M0. Radical reoperation was performed in 15 (62.5%) patients in stage pT1b-2, N0-1, M0. RESULTS: Patients survival after explorative laparotomy and palliative procedures was no longer than 7 months. Four from seven patients died after radical operation 12-18 months after operation. Six from 15 radically re-operated patients are alive in interval 4 months and 8 years. Nine patients died in interval 9 months and 4 years after re-operation. CONCLUSION: Radical surgical procedure is the treatment of choice for patients with gall bladder carcinoma especially in stage pT1-2, N0, M0.