[Our experiences with surgical treatment of gastrointestinal stromal tumors]. / A GastroIntestinalis Stroma Tumorok sebészi kezelésében szerzett tapasztalataink néhány eset kapcsán.

INTRODUCTION: Stromal tumors of the gastrointestinal tract are rare neoplasms, but they are the most common ones of mesenchymal origin. In a large proportion of patients clinical onset is represented by surgical emergencies. Incidence of GIST is calculated to be 10-20 cases per million per year. GISTs account for 0.1-3% of all gastrointestinal tumors, up to 20% of small bowel malignancies. At least 30-70% of the cases are malignant. PATIENTS: We summary our experiences of surgical treatment of GIST, apropos of five patients handled at our department in 2003. There were 3 male, 2 female, 55.8 years. The 5 patients had altogether 21 operations. Diagnosis was recognized before op. in three cases. RESULTS: In one case the tumor was inoperable, in one other technical operable, but oncologically not complete. In another case recurrence is known, and in one dissemination was observed during operation. There is only one case of fives, where we can hope, that a tumor-free situation had been left. Diagnosis was confirmed in every case with CD117 strain. SUMMARY: Surgery remains the standard treatment for GISTs. Disease recurrence is quite common, the rate is 65-75%, even when surgery is performed with intent to cure. In a surgical emergency or in the absence of a perioperative diagnosis, the surgeon is responsible for recognizing and treating these tumors. The benefit of surgical exercises for recurrent disease is unclear. In our opinion it is worth operating these cases, because in some cases amazing survival can be available.

[Percutaneous portal vein embolization before major hepatic resection]. / Perkután vena portae embolizáció májreszekció elótt.

Major liver resection cannot be performed when the remaining liver mass is too small. Preoperative embolization of the portal vein (PVE) helps to increase the volume of the non-tumorous liver segments, and patients' liver function will remain stable postoperatively. CT, MRI, CTAP examinations help to decide about surgery. Volume measurements are performed based on data of CT scans. PVE is indicated, when the remaining, non-tumorous liver volume is too small. The procedure starts with percutaneous portal vein catheterization, then selected portal vein branches are embolized with a mixture of contrast material, antibiotics and Gelfoam particles. The patients stay in the hospital 3-5 days after the procedure. Control CT-volumetry is done after 3-6 weeks. From November 2001 to April 2002 3 patients were selected to have this procedure. PVE of the right portal branches were performed successfully in two cases. Control CT-volumetry showed significant increase of the volume of the left liver lobe. One patient underwent successful right hemihepatectomy. On the third patient we could not catheterize the portal vein. PVE is a relatively safe and tolerable procedure. The increased remaining liver volume helps in performing major liver resection.