Surgical treatment of liver metastases from colorectal cancer: experience of a single institution.

BACKGROUND: This report analyses an experience with 42 liver resections for metastatic colorectal carcinoma. METHODS: Forty-two patients underwent curative resection for liver metastasis from colorectal cancer between January 2004 and December 2007, with a follow up period that ranged from 3 to 66 months. In this retrospective study, early postoperative 30 day mortality and morbidity in addition to the effects of Dukes' stage, type of resection, number and size of the tumor, synchronous or metachronous metastases, resection margin, sex, age and chemotherapy protocol on three year survival were analyzed retrospectively. Univariate analyses of survival were estimated using the Kaplan-Meier method. Multivariate analysis was evaluated using Cox regression method. The value of P<0.05 was accepted as significant. RESULTS: Early postoperative morbidity and mortality rates were 7.14% and 0%, respectively. Fourteen patients died during the follow-up period of 3 to 66 months (mean, 40.40±12.87). Median survival was 56 months and three year survival rate was 71.30%. Recurrence occurred in 11 patients (26.00%) after liver resection and additional surgery was performed for two of them. At univariate analysis, the number of tumors (<4), tumor size (<4 cm), type of resection and negative resection margins were significantly correlated with three year survival. Sex, age, Dukes' stage, synchronous or metachronous metastasis, recurrence and chemotherapy protocol were not predictive of long-term prognosis. Multivariate analysis revealed that tumor size>4 cm and presence of more than four tumors before surgery were associated with a 5.89 and 2.18-fold increased risk of death, respectively. CONCLUSION: Curative resection is one of the most important treatment options that can demonstrate long-term survival for patients.

Clipless cholecystectomy: which sealer should be used?

BACKGROUND: The use of the Harmonic Scalpel (HS) for cystic duct ligation began with little data about its efficacy or safety. On the other hand, there is not any literature available about the use of PlasmaKinetic Sealer (PK) for closing the cystic duct in laparoscopic cholecystectomy (LC). Therefore, this study was designed to compare the efficacy and safety of HS and PK for achieving safe closure of the cystic ducts after LC. METHODS: Ninety patients with symptomatic gallstone disease were enrolled in this prospective case control study. The patients were operated with laparoscopic technic and divided into three groups (n = 30) randomly. After the dissection of Calot's triangle, proximal cystic ducts on common bile ducts were sealed with single surgical clips (SC) in all groups, and in the first group, distal of the cystic ducts also was sealed with single SC and the gallbladders were removed with SC. In the second and third groups, distal of the cystic ducts were sealed with HS and PK, respectively. The gallbladders were removed as sealed cystic ducts with HS and PK. Then, gallbladders were connected to a transducer set and increasing pressure with saline was applied. The bursting pressures of gallbladders were measured and differences between the groups were calculated by using Student's t test. The value of P < 0.05 was accepted as significant. RESULTS: In this study, the mean cystic duct bursting pressures were 332.46 ± 4.62 mmHg with SC, 326.56 ± 4.53 mmHg with PK, and 343.06 ± 4.28 mmHg with HS. Differences of the mean cystic duct bursting pressures between the groups were indicated the superior results of HS. CONCLUSIONS: The results of this study indicated that HS is more effective than PK and as safe and effective as SC for cystic duct closure.

Verification of clipless closure of cystic duct by harmonic scalpel.

INTRODUCTION: The excellent results of harmonic scalpel (HS) for closure of blood vessels encouraged surgeons to use these instruments for cystic ducts. The use of HS on tissues other than blood vessels was started with little data about its efficacy or safety. Therefore, this study was designed to verify the safety and efficacy of HS for achieving safe closure of the cystic ducts after laparoscopic cholecystectomy. MATERIALS AND METHODS: Sixty patients with symptomatic gallstone disease were enrolled in this prospective case control study. The patients were operated with laparoscopic technic and divided into two groups (n = 30). After the dissection of Calot's triangle, proximal cystic ducts on common bile ducts were sealed with single surgical clips (SC) in both groups. In the first group, distal of the cystic ducts was sealed with single SC and the gallbladders were removed with SC. In the second group, distal of the cystic ducts was sealed with HS and the gallbladders were removed as sealed cystic ducts with HS. Twenty-gauge catheters were inserted into the fundus of gallbladders in vitro and connected to the arterial line transducer set. A gradually increasing pressure was applied through a sphygmomanometer. The bursting pressures of the gallbladders were measured, and differences between HS and single SC groups were calculated with independent samples t-test. The value of P < 0.05 was accepted as significant. RESULTS: The mean cystic duct bursting pressures in single SC and HS groups were 332.46 +/- 4.62 and 343.06 +/-4.28 mmHg, respectively. The mean values between the groups were found significant and indicated the superior results of HS. CONCLUSIONS: HS sealer could be an alternative method for cystic duct closure, especially for avoiding the clip displacement and migration of the clip. Results of this study indicated that HS sealer was as reliable as single SC and it could be accepted as a standard closure technic.

Liver enzyme alterations after laparoscopic cholecystectomy.

AIMS: We aimed to investigate the alterations in serum levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST), gamma-glutamyl-transferase (GGT), alkaline phosphatase (ALP) and lactate dehydrogenase (LDH) in patients who had undergone laparoscopic cholecystectomy (LC) and compare these changes with those occurring after open cholecystectomy (OC). METHODS: Of 267 patients who underwent LC between January 2003 and December 2005, 86 patients without complications were eligible for study. Twenty-six patients who underwent OC during the same interval were also enrolled in the study as a control group. Blood samples were taken preoperatively and 24 hours after operation for biochemical tests. RESULTS: Statistical analyses revealed significant increases in AST, ALT, GGT and LDH levels in the LC group postoperatively. Compared with the OC group, the differences between elevations of enzyme levels were also significant for LC group. CONCLUSION: We conclude that these enzyme elevations could mostly be attributed to the negative effects of the pneumoperitoneum on the hepatic blood flow. Although these changes do not seem to be clinically important, care should be taken before deciding to perform LC in patients with hepatic insufficiency.

Granulomatous mastitis: surgical outcomes.

OBJECTIVE: To report the clinical and pathological features and surgical treatment outcomes of patients with granulomatous mastitis. DESIGN: Case series. PLACE AND DURATION OF STUDY: Ankara Oncology Training and Research Hospital, between 1999-2003. PATIENTS AND METHODS: Data of 16 patients with granulomatous mastitis treated surgically by total excision with disease-free margins were reviewed. Patients given additional medical therapy or treated with mastectomy because of the size and extent of the disease were excluded. RESULTS: The mean age of patients at the time of diagnosis was 31.8 (range: 22-45 years). All patients were diagnosed from the pathological tissue specimens obtained by surgery. Clinical and radiological examinations suggested breast carcinoma in 82.1% patients. Except one patient who developed a fistula from the incision which was treated again with surgery, no other complications were noted, including recurrence of disease during a median follow-up period of 12.8 months (range: 4-30 months). CONCLUSION: Although granulomatous mastitis is a rare benign breast disease, it usually mimics breast carcinoma both clinically and radiologically, making the diagnosis difficult and challenging. As long as good cosmetic results can be achieved, surgical excision is quick, safe and effective treatment method for idiopathic granulomatous mastitis.