[Ablation of malignant liver tumors with radiofrequency. A series of cases in Mexico.]. / Ablación de neoplasias hepáticas malignas con radiofrecuencia. Una serie de casos en México.

BACKGROUND: Surgical resection is the treatment of choice for most of the primary and secondary liver tumors, unfortunately, many patients are not suitable for resection. Several ablative alternatives have been employed for treatment; the most commonly used has been radiofrequency ablation. OBJECTIVE: To establish the safety and results of treatment with radiofrequency ablation (RF) of malignant liver tumors. MATERIAL AND METHODS: A retrospective review of clinical files of patients with malignant hepatic tumors treated with RF was performed. Epidemiological variables, selection criteria pre- treatment and morbidity and mortality related to the procedure were analyzed. Descriptive statistics were used. RESULTS: From September 2002 to August 2006, 30 patients were treated: eighteen females and 12 males with a median age of 62 years (range 41-83 years). Histologic type was as follows: 18 hepatocellular carcinomas; 10 metastatic tumors (four breast, four colorectal and two neuro- endocrine); one gallbladder carcinoma and one peripheral cholangiocarcinoma. Indications for ablative procedure were the presence of cirrhosis, poor functional reserve, bilobar disease, proximity to major vascular structures and patients with increased operative risk. The size of the lesion range from 2 to 20 cm (mean 5.6 cm) and the median time of ablation was 30.2 min (range 5-50 min). Two minor complications (6.6%) and no operative mortality were recorded. At 18 months of follow-up, 23 patients (76.6%) are still alive and seven patients have died for tumor progression. CONCLUSION: Radiofrequency ablation is a safe procedure that allows local control of the disease with satisfactory results, when the surgical resection is not feasible.

[Laparoscopic partial hepatectomy. Report of the first case in Mexico]. / Hepatectomía parcial por laparoscopia. Informe del primer caso en México.

The authors report the case of a 47-year-old female patient referred to the Instituto Nacional de Cancerología with abdominal pain and a focal liver lesion in the left lateral segment. After a careful tumor work-up, a laparoscopic left lateral segmentectomy was performed. The postoperative course was uneventful and the patient was discharged at the 2nd postoperative day. Histologic examination revealed focal nodular hyperplasia. In a search of the literature we find this to be the first case treated by this approach in Mexico.

[Indications and results of hepatic resection in benign and malignant tumors]. / Indicaciones y resultados de la resección hepática en tumores benignos y malignos.

OBJECTIVE: The authors analyze the indications and results in 75 consecutive liver resections. BACKGROUND: In recent years, the morbidity and mortality of this procedure have been reduced at specialized centers due to better control of intraoperative bleeding and improved perioperative management. METHODS: The clinical records of 72 patients who had a liver resection over a 4-year period were reviewed. RESULTS: Fifty-two were females and 23, males. Ages ranged between 15 and 88 years (X: 50 +/- 22 years). The indications for surgery were liver, secondary in 28, gallbladder or bile duct cancer in 17, benign liver tumors in 16, and primary malignant liver tumors in 14. Forty-seven major liver resections were performed and included 25 right hepatectomies, 13 left hepatectomies, five right trisegmentectomies, and four left trisegmentectomies. Additionally, 28 minor resections included 12 resections of the left lateral segment, nine bisegmentectomies, five segmentectomies and two resections of the caudate lobe. Operative time ranged from 60-540 min (X: 260 +/- 97 min); the mean operative bleeding was 1439 +/- 660 mL (range 20-5,000 mL). The pringle maneuver was used in 63 patients and ranged from 20-100 min (X: 42 +/- 25 min). Twenty-five patients presented complications (33%), the most frequent being hepatic failure, postoperative bleeding, ascitis and bilomas. Six patients died (8%) due to hepatic and multiorganic failure in four pneumonia and myocardial infarct in one, and systemic sepsis in the other. CONCLUSIONS: Liver resection is an excellent therapeutic alternative in patients with benign and malignant liver focal lesions.

[Angiomyolipoma of the liver not associated with tuberous sclerosis]. / Angiomiolipoma de hígado no asociado a esclerosis tuberosa.

Angiomyolipoma is a rare benign mesenchymal tumor of the liver. We present the case of a 32-year-old female patient that seeks medical consultation to confirm pregnancy. Ultrasound was performed and a hyperechoic lesion was detected in the left lobe of the liver. CT scan showed a heterogenic mass arising from the left lobe of the liver, fine needle aspiration biopsy was performed and diagnosis of liposarcoma was made. A laparotomy was done and a left lateral segmentectomy performed, postoperative course was uneventful. Histology and immunohistochemical analysis of the tumor revealed classical findings of primary angiomyolipoma of the liver. This case shows the difficulty often found when a preoperative diagnosis of fatty liver lesions is made. A literature review is presented and the diagnosis and management of these lesions is discussed.

Amebic liver abscess "a 5 year Mexican experience with a multimodality approach".

BACKGROUND/AIMS: Amebic liver abscess is a frequent problem in Mexico. The morbidity and mortality is reported to be high in different series. The aim of this study was to evaluate the morbidity and mortality of ALA in our center and evaluate our current management used. MATERIALS AND METHODS: Fifty patients were included in our study. Thirty-four (68%) were males, 16 (22%) were females. The age range was between 22 and 83 years (mean 50 years). The majority presented abdominal pain (95%), fever (82%) and hepatomegaly (72%). leukocytosis was observed in 72%, hypoalbuminaemia in 62%, thrombocytosis in 42%. The seroemeba reaction was positive in 90%. The diagnostic methods used were ultrasound in 42, computed tomography in 20 and isotope scan in 12. RESULTS: Medical treatment alone was used in 24 patients, 15 required percutaneous drainage and 11 surgery. Fifteen patients (38%) presented medical complications. The hospital stay raged between 5 and 44 days (mean 15 days). One patient died in a median follow up of 31.4 months. Multimodality management was liberally used in our patients. Amebicidal drugs were used initially and controlled the disease in 24 patients, 15 patients required percutaneous drainage because of lack of control of the disease or risk of complications and 11 patients required surgery to treat complications. CONCLUSION: With these approaches the morbidity and mortality of ALA in our center has remained low.

[Epithelial hepatoblastomas in the adult]. / Hepatoblastomas epiteliales en el adulto.

Hepatoblastoma is the most frequent primary malignant liver neoplasm in childhood; in adults it is extremely rare and only 27 cases have been published. The prognosis of this neoplasm is poor because it is usually discovered late. Surgery, chemotherapy and liver transplantation have been tried with poor results. We present two adult patients who were diagnosed with an epithelial hepatoblastoma. The pathogenesis, histologic features and current management is reviewed.