scholarly journals Integrative Concepts for Liver Surgery

2020 ◽  
Vol 36 (5) ◽  
pp. 351-358
Author(s):  
Stefan Heinrich ◽  
Felix Watzka ◽  
Hauke Lang
Keyword(s):  
Liver Transplantation ◽  
Patient Selection ◽  
Liver Surgery ◽  
Liver Tumors ◽  
Treatment Options ◽  
Molecular Characteristics ◽  
Primary Tumors ◽  
Primary Liver Tumors ◽  
Liver Resections ◽  
Systemic Treatments

<b><i>Background:</i></b> Surgery is the standard treatment for primary tumors and metastases. Due to improvements in surgical outcomes as well as the efficacy of systemic treatments, the role of surgery has changed in recent years. <b><i>Summary:</i></b> Liver surgery has become safe and efficient, with resectability being increased by multimodality concepts as well as staged liver resections and orthotopic liver transplantation. These concepts may be applied to primary liver tumors but also to selected patients with liver metastases from various diseases. In addition, even debulking surgery may be indicated for selected patients with endocrine metastases. While patient selection for liver resections was limited to clinical parameters in the past, histological and molecular characteristics have become increasingly important. Moreover, the response to regional or systemic chemotherapy has been demonstrated to be strong for a beneficial course of the disease even in advanced diseases. <b><i>Key-Messages:</i></b> Due to the variety of available treatment options, optimal patient selection is crucial. Besides liver surgery, staged concepts as well as liver transplantation are curative tools for many patients.

Orthotopic liver transplantation in primary liver tumors

1993 ◽  
Vol 53 (S3) ◽  
pp. 74-77 ◽  
Author(s):  
Enrique Moreno-González ◽  
Carmelo Loinaz ◽  
Ramon Gómez ◽  
Ignacio Garclá ◽  
Ignacio González-Pinto ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Orthotopic Liver Transplantation ◽  
Liver Tumors ◽  
Primary Liver Tumors

A decade of liver transplantation in primary liver tumors

1998 ◽  
Vol 30 (7) ◽  
pp. 3296-3297 ◽  
Author(s):  
C Loinaz ◽  
R Gómez ◽  
I González-Pinto ◽  
C Jiménez ◽  
M Manzanera ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Liver Tumors ◽  
Primary Liver Tumors

scholarly journals Recurrent Glioblastoma: From Molecular Landscape to New Treatment Perspectives

Cancers ◽  
2020 ◽  
Vol 13 (1) ◽  
pp. 47
Author(s):  
Cristina Birzu ◽  
Pim French ◽  
Mario Caccese ◽  
Giulia Cerretti ◽  
Ahmed Idbaih ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Kinase Inhibitors ◽  
Treatment Options ◽  
Gene Mutations ◽  
Genetic Alterations ◽  
Recurrent Glioblastoma ◽  
Molecular Characteristics ◽  
Specific Gene ◽  
Primary Tumors ◽  
First Line Therapy

Glioblastoma is the most frequent and aggressive form among malignant central nervous system primary tumors in adults. Standard treatment for newly diagnosed glioblastoma consists in maximal safe resection, if feasible, followed by radiochemotherapy and adjuvant chemotherapy with temozolomide; despite this multimodal treatment, virtually all glioblastomas relapse. Once tumors progress after first-line therapy, treatment options are limited and management of recurrent glioblastoma remains challenging. Loco-regional therapy with re-surgery or re-irradiation may be evaluated in selected cases, while traditional systemic therapy with nitrosoureas and temozolomide rechallenge showed limited efficacy. In recent years, new clinical trials using, for example, regorafenib or a combination of tyrosine kinase inhibitors and immunotherapy were performed with promising results. In particular, molecular targeted therapy could show efficacy in selected patients with specific gene mutations. Nonetheless, some molecular characteristics and genetic alterations could change during tumor progression, thus affecting the efficacy of precision medicine. We therefore reviewed the molecular and genomic landscape of recurrent glioblastoma, the strategy for clinical management and the major phase I-III clinical trials analyzing recent drugs and combination regimens in these patients.

scholarly journals A vena cava inferiort infiltráló májtumorok kapcsán végzett reszekciókról

2019 ◽  
Vol 160 (33) ◽  
pp. 1304-1310
Author(s):  
Péter Lukovich ◽  
Balázs Pőcze ◽  
Jenő Nagy ◽  
Tamás Szpiszár ◽  
Alpár György ◽  
...  
Keyword(s):  
Liver Resection ◽  
Liver Surgery ◽  
Liver Tumors ◽  
Vena Cava ◽  
Laparoscopic Approach ◽  
Operation Time ◽  
Liver Resections ◽  
R1 Resection ◽  
Major Vessel ◽  
Histological Data

Abstract: Introduction: Despite all new promising agents of oncotherapy, it is still liver resection that gives potential curative solution for primary and secondary liver tumors. The size of tumorous liver section for resection means no question any more but major vessel infiltration of tumor proposes challenge in liver surgery. Patients and method: Retrospective analysis was carried out covering 33 patients who underwent liver resection in St. Janos Hospital Surgery Department between 1st May 2017 and 1st May 2019. Demographic, surgical, histological data and postoperative course were taken into consideration and comparison with two of our patients who needed vena cava excision simultaneously with liver resection. Results: Patients with liver resection only (LR) had a mean operation time of 91.7 minutes, while operation time for patients with cava resection (CR) was 250 minutes. The average amount of blood transfusion was 1.2 units (200 ml) in group LR and 5 units in group CR. Among LR patients, resection was rated R0 in 23 and R1 in 8 cases, R2 resection could be performed in 2 cases, in group CR in both cases R1 resection was registered. 5 patients with colorectal liver metastasis were operated after previous chemotherapy. Two patients underwent laparoscopic liver resection and two had synchronous colorectal and liver resection, one of these was treated via laparoscopic approach. Conclusion: Liver resections in case of large vessel (vena cava, hepatic vein) infiltrating by liver tumors are indicated the most challenging procedures of liver surgery. The relating literature refers to oncological liver resections with vena cava excision and reconstruction to be safe and applicable. Orv Hetil. 2019; 160(33): 1304–1310.

scholarly journals Hepatoblastoma experience in terms of surgery

Acta Medica ◽  
2020 ◽  
Vol 51 (1) ◽  
pp. 32-37
Author(s):  
Onder Ozden ◽  
Seref Selcuk Kılıc ◽  
Abdullah Ulku ◽  
Gulay Sezgin ◽  
RRecep Tuncer
Keyword(s):  
Distant Metastasis ◽  
Liver Tumors ◽  
Treatment Options ◽  
Vena Cava ◽  
Surgical Margin ◽  
Caudate Lobe ◽  
University Hospital ◽  
Primary Liver Tumors ◽  
The Mean ◽  
Neo Adjuvant Chemotherapy

Introduction: Although hepatoblastoma is a rare tumor, it is the most common abdominal malignant tumor after nephroblastoma and neuroblastoma in children under 3 years of age. In addition, 95% of primary liver tumors in children are hepatoblastoma. In this study, we aimed to present the patients with hepatoblastoma who had undergone surgery. Materials and Methods: Patients who were operated for hepatoblastoma in the last 10 years at Çukurova University Hospital were included in the study. Age, gender, complaints, blood Alpha Feto Protein (AFP) levels, whether or not neoadjuvant chemotherapy, size, stage, surgical findings, the presence of distant metastasis, post-operative complication, follow-up, and mortality were evaluated. Results: We operated on 22 patients with hepatoblastoma in the last 10 years. We have access to 17 patients’ data. The mean age of the patients was 22.4 years (4 months - 8 years). 88% of the patients were younger than 5 years old and 76% were younger than 3 years of age. Seven patients were male and 10 were female. Fourteen patients presented with abdominal distention and swelling. One was admitted to the hospital with weight loss, one with diarrhea and one with fever. In the first evaluation, 8 patients were stage 2 and 9 patients were stage 3 according to PRETEXT staging. We did not have stage 1 or 4 patients. Two patients had a tumor in the caudate lobe. AFP levels were high in 16 patients. The mean size of the mass was 11.5 cm in the first evaluation. The tru-cut biopsy was performed all the patients before taking neo-adjuvant chemotherapy. Thereafter, the patients underwent surgery. One patient was undergoing surgery for trans-arterial chemo-embolization (TACE) due to the fact that the tumor could not be excised after chemotherapy, and after TACE, the tumor was able to totally removed. In one patient, the surgical margin was excised positively due to the invasion of the vena cava. Two patients had portal vein thrombus and one was excised during surgery. Seven patients had right, 3 patients had right expanded, 3 patients had left expanded, 1 patient had segment 6-7 and 3 patients had left hepatectomy. The distant metastasis was in 2 patients (lungs). Mortality was in 1 patient. Conclusion: Multidisciplinary approach is very important in hepatoblastoma and other malignant masses. Not only pediatric oncology but also alternative treatment options such as trans-arterial chemotherapy should be evaluated.

scholarly journals Induction of liver hypertrophy for extended liver surgery and partial liver transplantation: State of the art of parenchyma augmentation–assisted liver surgery

2021 ◽  
Author(s):  
Philip C. Müller ◽  
Michael Linecker ◽  
Elvan O. Kirimker ◽  
Christian E. Oberkofler ◽  
Pierre-Alain Clavien ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Liver Surgery ◽  
Treatment Options ◽  
Future Liver Remnant ◽  
Tissue Loss ◽  
Liver Remnant ◽  
Chemotherapeutic Regimen ◽  
Minimum Requirement ◽  
Partial Liver Transplantation ◽  
Vein Occlusion

Abstract Background Liver surgery and transplantation currently represent the only curative treatment options for primary and secondary hepatic malignancies. Despite the ability of the liver to regenerate after tissue loss, 25–30% future liver remnant is considered the minimum requirement to prevent serious risk for post-hepatectomy liver failure. Purpose The aim of this review is to depict the various interventions for liver parenchyma augmentation–assisting surgery enabling extended liver resections. The article summarizes one- and two-stage procedures with a focus on hypertrophy- and corresponding resection rates. Conclusions To induce liver parenchymal augmentation prior to hepatectomy, most techniques rely on portal vein occlusion, but more recently inclusion of parenchymal splitting, hepatic vein occlusion, and partial liver transplantation has extended the technical armamentarium. Safely accomplishing major and ultimately total hepatectomy by these techniques requires integration into a meaningful oncological concept. The advent of highly effective chemotherapeutic regimen in the neo-adjuvant, interstage, and adjuvant setting has underlined an aggressive surgical approach in the given setting to convert formerly “palliative” disease into a curative and sometimes in a “chronic” disease.

Occult Primary

2008 ◽  
Vol 6 (10) ◽  
pp. 1026
Author(s):  
_ _
Keyword(s):  
Treatment Options ◽  
Survival Rates ◽  
Undifferentiated Carcinoma ◽  
Unknown Primary ◽  
Term Survival ◽  
Primary Tumors ◽  
Nccn Guidelines ◽  
Clinical Presentations ◽  
Systemic Treatments ◽  
Tumor Types

Occult primary tumors, or cancers of unknown primary, account for 5% to 10% of all diagnosed cancers, and are manifested by a wide variety of clinical presentations, while conferring a poor prognosis for most patients. Even after postmortem examination, the primary tumor is not identified in 20% to 50% of patients. Multiple sites of involvement are observed in more than 50% of patients. Although certain patterns of metastases suggest possible primaries, occult primaries can metastasize to any site. In most patients, occult primary tumors are refractory to systemic treatments, and chemotherapy is only palliative and does not significantly improve long-term survival. However, special pathologic studies can identify subsets of patients with tumor types that are more responsive. Treatment options should be individualized for this selected group to achieve improved response and survival rates. Important updates for the NCCN guidelines include the additions of tables on tumor-specific markers and their staining pattern as well as analysis of undifferentiated carcinoma. For the most recent version of the guidelines, please visit NCCN.org

scholarly journals Vascular surgery in liver resection

2021 ◽  
Author(s):  
Olga Radulova-Mauersberger ◽  
Jürgen Weitz ◽  
Carina Riediger
Keyword(s):  
Liver Transplantation ◽  
Liver Resection ◽  
Vascular Surgery ◽  
Liver Surgery ◽  
Liver Tumors ◽  
Vascular Reconstruction ◽  
Vascular Involvement ◽  
Term Survival ◽  
Long Term Survival

AbstractVascular surgery in liver resection is a standard part of liver transplantation, but is also used in oncological liver surgery. Malignant liver tumors with vascular involvement have a poor prognosis without resection. Surgery is currently the only treatment to provide long-term survival in advanced hepatic malignancy. Even though extended liver resections are increasingly performed, vascular involvement with need of vascular reconstruction is still considered a contraindication for surgery in many institutions. However, vascular resection and reconstruction in liver surgery—despite being complex procedures—are safely performed in specialized centers. The improvements of the postoperative results with reduced postoperative morbidity and mortality are a result of rising surgical and anesthesiological experience and advancements in multimodal treatment concepts with preconditioning measures regarding liver function and systemic treatment options. This review focuses on vascular surgery in oncological liver resections. Even though many surgical techniques were developed and are also used during liver transplantation, this special procedure is not particularly covered within this review article. We provide a summary of vascular reconstruction techniques in oncological liver surgery according to the literature and present also our own experience. We aim to outline the current advances and standards in extended surgical procedures for liver tumors with vascular involvement established in specialized centers, since curative resection improves long-term survival and shifts palliative concepts to curative therapy.

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