scholarly journals RESULTS OF RADICAL SURGICAL TREATMENT OF CHOLANGIOCARCINOMA

2017 ◽  
Vol 4 ◽  
pp. 18-24
Author(s):  
Valeriy Boyko ◽  
Yuriy Avdosyev ◽  
Anastasiia Sochnieva
Keyword(s):  
Surgical Treatment ◽  
Portal Vein ◽  
Biliary Duct ◽  
Hepatic Parenchyma ◽  
Biliary Decompression ◽  
Right Hemihepatectomy ◽  
Left Hemihepatectomy ◽  
Distal Localization ◽  
Taj Mahal

Radical operations of cholangiocarcinomas are connected with the great number of post-operative complications, and lethality reaches 15-30 %. The most debatable questions remain the choice of the operation type depending on localization and spreading of a tumor and also the expedience of using mini-invasive technologies as a preoperational preparation to the radical surgical treatment. We would like to share the little experience of the radical surgical treatment of cholangiocarcinomas. The research aim is to analyze results of radical surgical treatment of patients with cholangiocarcinoma. Matherials and methods. We have analyzed the outcomes of surgical treatment in 18 patients with cholangiocarcinomas. Tumor localization was determined according to the Bismuth-Corlett classification. Type 1 tumors were found in 2 (11.1 %), type 2 in 4 (22.2 %), type 3А in 5 (27.8 %), type 3B in 4 (22.2 %), type 4 in 1 (5.6 %), and distal localization in 2 (11.1 %) patients. As biliary decompression, 9 (50 %) patients underwent percutaneous transhepatic biliary duct drainage (PTBD), and another 9 (50 %) patients were operated without preoperative biliary decompression Pre-operative embolization of portal vein branches with the aim to increase the low volume of liver after anticipated resection was performed in 4 (22.2 %) patients. Results. After the embolization of portal vein branches, the estimated residual volume of hepatic parenchyma increased from 33.4 % to 45.7 %. Patients with cholagiocarcinomas of different localization performed the radical operations: isolated hepaticocholedochus resection in 5 (27.8 %) patients, hepaticocholedochus resection combined with Taj Mahal hepatic resection in 1 (5.6 %), right hemihepatectomy in 5 (27.8 %), left hemihepatectomy in 4 (22.2 %), extended right hemihepatectomy in 1 (5.6 %), and pancreoduodenal resection in 2 (11.1 %) patients. Complications of radical surgeries were observed in 4 (22.2 %) patients. Lethal outcomes occurred in 3 (16.7 %) patients. Conclusions. Radical operations are attended with complications in 22,2 % and lethality in 16,7 %. As a preoperative preparation it is possible to use mini-invasive interventions for the biliary decompression and increase of hepatic parenchyma volume.

scholarly journals Value of preoperative computed tomography for meso-Rex bypass in children with extrahepatic portal vein obstruction

2021 ◽  
Vol 12 (1) ◽  
Author(s):  
Huiying Wu ◽  
Ning Zhou ◽  
Lianwei Lu ◽  
Xiwen Chen ◽  
Tao Liu ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Portal Vein ◽  
Predictive Value ◽  
Extrahepatic Portal Vein Obstruction ◽  
Portal Vein Obstruction ◽  
Left Portal Vein ◽  
History Of ◽  
Associated Malformations ◽  
Sensitivity Specificity

Abstract Background Extrahepatic portal vein obstruction (EHPVO) is the most important cause of hematemesis in children. Intrahepatic left portal vein and superior mesenteric vein anastomosis, also known as meso-Rex bypass (MRB), is becoming the gold standard treatment for EHPVO. We analyzed the value of preoperative computed tomography (CT) in determining whether MRB is feasible in children with EHPVO. Results We retrieved data on 76 children with EHPVO (50 male, 26 female; median age, 5.9 years) who underwent MRB (n = 68) or the Warren procedure (n = 8) from 2013 to 2019 and retrospectively analyzed their clinical and CT characteristics. The Rex recess was categorized into four subtypes (types 1–4) depending on its diameter in CT images. Of all 76 children, 7.9% had a history of umbilical catheterization and 1.3% had leukemia. Sixteen patients (20 lesions) had associated malformations. A total of 72.4% of Rex recesses could be measured by CT, and their mean diameter was 3.5 ± 1.8 mm (range 0.6–10.5 mm). A type 1, 2, 3, and 4 Rex recess was present in 9.2%, 53.9%, 11.8%, and 25.0% of patients, respectively. MRB could be performed in patients with types 1, 2, and 3, but those with type 4 required further evaluation. The sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy of CT were 100%, 83.8%, 42.1%, 100%, and 85.5%, respectively. Conclusions Among the four types of Rex recesses on CT angiography, types 1–3 allow for the performance of MRB.

Rescue partial ALPPS for left hemihepatectomy with reconstruction of the middle hepatic vein

2021 ◽  
Author(s):  
Masaharu Kogure ◽  
Takaaki Arai ◽  
Hirokazu Momose ◽  
Ryota Matsuki ◽  
Yutaka Suzuki ◽  
...  
Keyword(s):  
Portal Vein ◽  
Hepatic Vein ◽  
Retention Rate ◽  
Liver Volume ◽  
Future Liver Remnant ◽  
Middle Hepatic Vein ◽  
Liver Remnant ◽  
Total Liver Volume ◽  
Left Hemihepatectomy ◽  
Icg R15

Major hepatectomy in patients with insufficient future liver remnant (FLR) volume and impaired liver functional reserve has considerable risks for posthepatectomy liver failure (PHLF). The patient was a male in his 70 with an intrahepatic cholangiocarcinoma (ICC) in left hemiliver, involving the middle hepatic vein (MHV). Although FLR volume after left hemihepatectomy was estimated to be 64.4% of the total liver volume, an indocyanine green retention rate at 15 min (ICG-R15) value was 24.2%, thus the patient underwent left portal vein embolization (PVE). The FLR volume increased to 71.3%, however, the non-congestive FLR volume was re-estimated as 45.8% after resection of the MHV, the ICG-R15 value was 29.0%, and ICG-Krem was calculated as 0.037. We performed partial rescue ALPPS (Associating Liver Partition and Portal vein occlusion for Staged hepatectomy) for left hemihepatectomy with the MHV reconstruction. On the first stage, partial liver partition was done along Rex-Cantlie’s line, preserving the MHV and sacrificing the remaining branches to segment 8. The FLR volume increased to 77.4% on day 14. The ICG-R15 value was 29.6%, but ICG-Krem after MHV reconstruction was estimated to be 0.059. The second stage operation on day 21 was left hemihepatectomy with the MHV reconstruction using the left superficial femoral vein graft. The usage of rescue partial ALPPS may contribute to preventing PHLF by introducing occlusion of the portal and/or venous branches in the left hemiliver before curative hepatectomy.

scholarly journals Primary Tumor Location Is a Prognostic Factor for Intrahepatic Progression-Free Survival in Patients with Colorectal Liver Metastases Undergoing Portal Vein Embolization as Preparation for Major Hepatic Surgery

Cancers ◽  
2020 ◽  
Vol 12 (6) ◽  
pp. 1638
Author(s):  
Lea Hitpass ◽  
Daniel Heise ◽  
Maximilian Schulze-Hagen ◽  
Federico Pedersoli ◽  
Florian Ulmer ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Confidence Interval ◽  
Portal Vein ◽  
Liver Metastases ◽  
Portal Vein Embolization ◽  
Hepatic Metastases ◽  
Progression Free Survival ◽  
Tumor Location ◽  
Free Survival ◽  
Right Hemihepatectomy

The aim of this study was to identify prognostic factors affecting intrahepatic progression-free survival (ihPFS) and overall survival (OS) in patients with colorectal cancer liver metastases (CRCLM) undergoing portal vein embolization (PVE) and subsequent (extended) right hemihepatectomy. A total of 59 patients (mean age: 60.8 ± 9.3 years) with CRCLM who underwent PVE in preparation for right hemihepatectomy were included. IhPFS and OS after PVE were calculated using the Kaplan–Meier method. Cox regression analyses were conducted to investigate the association between the following factors and survival: patient age, laterality of the colorectal cancer (right- versus left-sided), tumor location (colon versus rectal cancer), time of occurrence of hepatic metastases (synchronous versus metachronous), baseline number and size of hepatic metastases, presence or absence of metastases in the future liver remnant (FLR) before PVE, preoperative carcinoembryogenic antigen (CEA) levels, time between PVE and surgery, history of neoadjuvant or adjuvant chemotherapy, and the presence or absence of extrahepatic disease before PVE. Median follow up was 18 months. The median ihPFS was 8.2 months (95% confidence interval: 6.2–10.2 months), and median OS was 34.1 months (95% confidence interval: 27.3–40.9 months). Laterality of the primary colorectal cancer was the only statistically significant predictor of ihPFS after PVE (hazard ratio (HR) = 2.242; 95% confidence interval: 1.125, 4.465; p = 0.022), with patients with right-sided colorectal cancer having significantly shorter median ihPFS than patients with left-sided cancer (4.0 ± 1.9 months versus 10.2 ± 1.5 months; log rank test: p = 0.018). Other factors, in particular also the presence or absence of additional metastases in the FLR, were not associated with intrahepatic progression-free survival. The presence of extrahepatic disease was associated with worse OS (HR = 3.050, 95% confidence interval: 1.247, 7.459; p = 0.015).

scholarly journals Spontaneous hemothorax associated with neurofibromatosis type I: A review of the literature

2014 ◽  
Vol 05 (03) ◽  
pp. 269-271 ◽  
Author(s):  
Swaroopa Pulivarthi ◽  
Byron Simmons ◽  
John Shearen ◽  
Murali Krishna Gurram
Keyword(s):  
Surgical Treatment ◽  
Neurofibromatosis Type ◽  
Benign Disease ◽  
Type I ◽  
Neurofibromatosis Type I ◽  
Review Of The Literature ◽  
Spontaneous Hemothorax ◽  
Massive Hemothorax ◽  
Fatal Complications

ABSTRACTNeurofibromatosis is generally a benign disease, but has the potential for rare and fatal complications, such as spontaneous hemothorax. We report a case of massive hemothorax due to neurofibroma in a 49-year-old woman with neurofibromatosis type 1. The configuration of the radiological opacity and frank blood withdrawn on thoracentesis should suggest the diagnosis of hemothorax in a patient with neurofibromatosis. Surgical treatment for hemothorax is limited by arterial fragility and the prognosis is relatively poor. Any evidence of aneurysmal disease in the thoracic vessels should be aggressively managed percutaneously by coil embolization to prevent future rupture.

SOLUBLE FORMS OF ADHESIVE MOLECULES IN BLOOD SERUM AS A MARKER OF ENDOTHELIAL DYSFUNCTION IN CHRONIC GENERALIZED PARODONTITIS

2019 ◽  
Vol 64 (12) ◽  
pp. 747-752
Author(s):  
Tatyana Valerievna Govorunova ◽  
E. B. Popykhova ◽  
V. Yu. Shirokov ◽  
A. N. Ivanov
Keyword(s):  
Surgical Treatment ◽  
Endothelial Dysfunction ◽  
Adhesion Molecules ◽  
Long Term Results ◽  
Short Term ◽  
Adhesive Properties ◽  
Systemic Manifestations ◽  
Adhesive Molecules

An important factor in the pathogenesis of chronic inflammation in periodontitis is endothelial dysfunction (ED). Adhesion molecules are markers of impaired barrier function, adhesive properties and vascular permeability. The study of the concentration of soluble adhesion molecules is very promising in the diagnosis of ED. The purpose of this research was to study changes in the concentration of soluble forms of adhesive molecules of the selectin family and the immunoglobulin superfamily when used as markers of systemic manifestations of ED in the dynamics of the treatment of chronic generalized periodontitis (CP) using surgical and therapeutic schemes. 60 patients with CP (33 women and 27 men) and 20 clinically healthy volunteers (10 men and 10 women) were examined. The state of the endothelium was assessed by the content in the serum of soluble forms of adhesive molecules - sP- and sE-selectins, intercellular adhesive molecules of type 1 (sICAM-1), vascular molecules of cell adhesion of type 1 (VCAM-1) by ELISA. The short-term results of non-surgical treatment of CP are more effective in correction of vascular wall adhesive properties disorders compared with surgical treatment. Conservative treatment of chronic hepatitis C effectively adjusted the blood content of adherent endothelium molecules in women than in men. The long-term results of applying this scheme were characterized by partial preservation of a positive effect on the adhesive properties of the endothelium, however, long-term results were inferior to short-term ones. Surgical treatment of CP in women in the early postoperative period was accompanied by reactive impairment of the adhesive properties of the endothelium. The long-term results of this treatment regimen testified to its greater effectiveness. In women, the effectiveness of treatment of CP in restoring the adhesive properties of the endothelium was higher than in men. The results obtained allow us to conclude that the systemic manifestations of ED in CP were characterized by an increase in the concentration in the blood of soluble forms of adhesion molecules. The dynamics of the concentration of adhesive molecules during the treatment of СР testified to the dependence of the sex of patients on the effectiveness of the influence of therapeutic and surgical treatment regimens on the systemic manifestations of ED.

The Pathogenesis, Route of Migration, and Development of Crenosoma vulpis in the Dog

1970 ◽  
Vol 7 (1) ◽  
pp. 28-42 ◽  
Author(s):  
P. H. G. Stockdale ◽  
T. J. Hulland
Keyword(s):  
Portal Vein ◽  
Pulmonary Circulation ◽  
Hepatic Parenchyma ◽  
Crenosoma Vulpis ◽  
Infective Larvae ◽  
The Third ◽  
Third Stage ◽  
Hepatic Portal Vein ◽  
Hepatic Portal ◽  
Migration And Development

In the dog infective larvae of Crenosoma vulpis migrate from the stomach to the lungs via the hepatic portal vein, hepatic parenchyma, hepatic vein, heart, and pulmonary circulation, arriving in the lungs as early as 6 h after infection. Third-stage larvae induce the formation of necrotic foci throughout the liver during the first 24 h after infection. The discarded cuticles of the third-stage larvae elicit granulomata which become the centre of foci of interstitial pneumonia. Adult C. vulpis cause bronchitis and bronchiolitis.

scholarly journals Enhancement of hepatic parenchyma, aorta, and portal vein in helical CT: comparison of iodixanol and iopromide.

1997 ◽  
Vol 168 (1) ◽  
pp. 213-217 ◽  
Author(s):  
O Graf ◽  
G S Gazelle ◽  
S Kreuzer ◽  
E F Halpern ◽  
P Boehm ◽  
...  
Keyword(s):  
Portal Vein ◽  
Helical Ct ◽  
Hepatic Parenchyma
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