[The importance of the I-colic time in colorectal cancer with synchronous hepatic metastases. Specifics of surgical strategy]. / Importanta timpului I-colic în cancerul colo-rectal cu metastaze hepatice sincrone. Particularitati de tactica chirurgicala.

AIM: This paper proposes the presentation of a decision-making algorithm in colorectal cancer with synchronous hepatic metastases, as stressing the importance of I-colic time in obtaining the R0 desideratum. MATERIAL AND METHOD: There is no worldwide consensus regarding the surgical attitude in metastatic colorectal cancer. There are some predominantly conservative attitudes which use stenting and neoadjuvant chemotherapy followed by periodical re-evaluation or more aggressive surgical treatment. In the pertinent literature, emphasis is on surgery in two stages, on the separation of the colic stage from the hepatic one, the majority proposing stage one cholic and stage two hepatic, thus there are also situations in which the liver may be dealt with from the first intention. RESULTS: We propose to present, taking the examples from clinical cases, the main techniques of dealing with the cases of metastatic colorectal cancer, stressing personal attitude: aggressive surgery in a short step, which is either radical or creates the conditions for a step II radical one. CONCLUSION: In our vision the liver is the key to the surgical treatment in metastatic colorectal cancer and we must take into account from the first step through interventions with radical intent any time it is possible or through other operations: ligature of portal branch, partial hepatectomies, unilateral local destruction, preparing the way to radical step II.

[Vascular exclusion of the liver: surgical technique and initial clinical experience]. / Excluzia vasculara a ficatului (EVF): tehnica chirurgicala si experienta clinica initiala.

The intraoperative hemorrhage is the most life threatening complication during a liver resection, reason why the intraoperative vascular control represents one of the key points in the liver resection. This work presents the liver vascular exclusion without caval occlusion technique and also studies the first cases operated in University Surgery Clinic Nr. 1, Targu Mures, Romania. LVE consists of an association between hilum occlusion by Pringle manoeuvre and selective clampage of the three hepatic veins. Once achieved, the technique allows resection without blood lose and no special cautions, a continue clampage of 60-90 minutes being useful for the reconstruction of the possibly harmed or resected structures during the hepatectomy. The indications of the technique are voluminous center located liver tumors, multiple liver tumors, tumors in contact with hepatic veins or with hilum bifurcation. University Surgery Clinic Nr. 1 Targu Mures's experience in this technique began in 2005 consists in 8 cases. Preoperative diagnosis were: 2 right liver voluminous benign tumors (hemangiomas), 5 cases of colo-rectal metastasis and one resection for metastases of gastro-intestinal stromal tumor. Postsurgery evolution was very good with an average hospitalisation of 6 days. Mortality rate and morbidity were zero. We strongly recommend the use of LVE technique for selected cases of difficult liver resection, LVE being one of the most advanced techniques of liver resection.