[Thermo-necrosis in nonresectable colorectal hepatic malignant tumors. Preliminary results]. / Termonecroza metastazelor hepatice nerezecabile de origine colorectala cu vapori de apa sub presiune. Rezultate preliminare.

MATERIAL AND METHOD: We report the 19 months followup results after thermo-necrosis with steam water of non-resectable colorectal liver metastases. The studied group included 24 (18 men + 6 women) cases, aged 39-85 (mean age = 61), that were subjected to thermo-necrosis procedure between 2004-2006. Thermo-necrosis was performed per primam (1 case with non-resectable primary tumor), or either synchronous (8 cases) or at up to 53 months (15 cases) after primary tumor resection, and implied delivering of 6.7 - 87 kiloJoules to targeted lesions (for a median of 5 targets per patient liver). Concomitant with thermo-necrosis, in 8 cases some metastatic lesions were also resected (for tumor mass reduction). Followup consisted in echographic, CT, clinical and laboratory evaluation each 1-2 month. RESULTS: The thermo-necrosis procedure was completed within 3 to 20 (median = 10) minutes, and no peri-operatory deaths or complication were recorded. After procedure, the treated lesions either shrunken or were stationary under imaging explorations; increasing images marked the time to tumor progression. Tumor progression was recorded in 12 cases, time to tumor progression ranging from 1 to 14 (median = 5) months; the follow up time for the remaining 12 cases ranging 3 - 18 (median = 8) months. Nine cases died at 6-15 (median = 9) months after thermo-necrosis; for the remaining 15 cases the followup time ranged 4-19 (median= 10) months. One year survival was 61%; median survival (50%) time was 9 months. CONCLUSIONS: Thermo-necrosis with steam water of non-resectable colorectal liver metastases associate low invasiveness, good compliance, and time interval for tumor progression and survival comparable or better than other thermo-necrosis techniques, representing a promising palliative therapy in secondary liver cancer.

[Liver resection for hepatocellular carcinoma in cirrhotic patients]. / Rezectia hepatica in carcinomul hepatocelular dezvoltat pe ciroza.

The incidence of hepatocellular carcinoma (HCC) in cirrhotic patients is increasing. Despite advances in imaging and laboratory screening which allow earlier diagnosis, the surgeon is all too often confronted with an HCC of advanced stage or arising in the setting of severe cirrhosis. Hepatic resection is still considered the treatment of choice for hepatocellular carcinoma in patients with liver cirrhosis. From 1998 to 2005, 6 patients (5 males, 1 female, age 52-70 years, mean age 64.1 years) with HCC associated severe, but well compensated liver cirrhosis (Child A-- 4 patients, Child B--2 patients) underwent 9 hepatic resection in our department. Mean tumor size was 56 mm (range 23-86 mm). Two of these lesions were in the left liver and four in the right lobe. Doppler ultrasonography was performed in all cases and CT in 3 cases to confirm the extension of the lesions. Laparoscopy was performed in 3 patients under CO2 pneumoperitoneum. The Pringle maneuver was not used. The transection of the liver parenchyma was obtained by the use of Ligasure and harmonic scalpel. Nine hepatic resections were performed: 7 segmentectomy and 2 non-anatomical resections. The resection margin was 1 cm. The mean operative time was 90 minutes (range 60-120). Mean blood loss was 250 ml and 2 patients required blood transfusion. One patient died on the tenth postoperative day from a severe respiratory distress syndrome and hepatic failure. Major morbidities occurred in three patients who developed moderate postoperative ascites, which resolved successfully with conservative treatment in two patients. Limited liver resection in cirrhotic patients with HCC is feasible with a low complication rate when careful selection criteria are followed (tumor size smaller than 8 cm, Child-Pugh A class and the good general conditions of the patients). Other medical and interventional treatments (chemoembolization, chemotherapy) can only slow the progress of HCC.