Hepatectomy for hemangioma; safe, but is it successful?

Background/aims: Large hepatic hemangiomata may give rise to abdominal discomfort, prompting consultation with a hepatobiliary surgeon. The effectiveness of liver resection to treat such symptoms has varied in previously published reports. We sought to examine outcomes related to resection of hepatic hemangioma at a high-volume HPB center.

Defining the role of adjuvant external beam radiotherapy on resected adenocarcinoma of the ampulla of vater.

The role of adjuvant radiotherapy in the treatment of ampullary carcinoma (AC) remains unclear. We hypothesized that adjuvant radiotherapy (RT) does not improve survival following resection for AC. The SEER database was queried for patients with non-metastatic AC who underwent surgery (S) from 2004 to 2010.

Duplicate pancreas meets gastric duplication cyst: A tale of two anomalies.

Introduction: Congenital anomalies are a rare cause of pancreatitis in adults. Gastric duplications are the least common duplication of the gastrointestinal tract and are even more uncommon in the setting of a duplicate pancreas.

Presentation Of Case: This manuscript contains a case report and review of the literature of an adult who presented with recurrent pancreatitis and was found to have a gastric duplication cyst that communicated with a duplicate pancreas.

Recurrence after microwave ablation of liver malignancies: a single institution experience.

Background: Microwave ablation (MWA) is increasingly used to achieve local control for liver tumours. This study sought to examine a monocentric experience with MWA, with a primary hypothesis that primary tumour histology was a significant predictor of early recurrence.

Methods: Retrospective single-institution review identified consecutive patients with liver tumours treated by MWA.

Recent advances in systemic therapies and radiotherapy for gallbladder cancer.

Adjuvant treatment is not routine following resection for gallbladder cancer as most regimens have low response rates. In the palliative setting, recent advances have been made regarding combination chemotherapies and both gemcitabine/cisplatin and gemcitabine/oxaliplatin appear to be superior to single-agent 5FU, which has very little efficacy in this disease. There are isolated reports of dramatic responses to targeted monoclonal agents.

Zollinger-Ellison syndrome associated with a history of alcohol abuse: coincidence or consequence?

Background: This 47-year observational study suggests that sporadic Zollinger-Ellison (Z-E) syndrome, particularly duodenal wall gastrinomas (DWG), is associated with a history of alcohol abuse.

Methods: Thirty-nine consecutive Z-E patients were followed from 1962 through 2010. The drinking patterns of these patients were assessed and compared with 3,786 community controls.

Portal vein resection.

The American Hepato-Pancreatico-Biliary Association and Society of Surgical Oncology published a consensus statement in 2009 on the subject of vein resection and reconstruction during pancreaticoduodenectomy (PD), and concluded that PD with vein resection and reconstruction is a viable option for treatment of some pancreatic adenocarcinomas. This article describes the current approaches and recent advances in the management, staging, and surgical techniques regarding portal vein resection. With proper patient selection, a detailed understanding of the anatomy of the root of mesentery, and adequate surgeon experience, vascular resection and reconstruction can be performed safely and does not impact survival duration.

Hepatic neuroendocrine metastases: chemo- or bland embolization?

Introduction: Aggressive management of hepatic neuroendocrine (NE) metastases improves symptoms and prolongs survival. Because of the rarity of these tumors, however, the best method for hepatic artery embolization has not been established. We hypothesized that in patients with hepatic NE metastases, hepatic artery chemoembolization (HACE) would result in better symptom improvement and survival compared to bland embolization (HAE).

Chemoembolization in patients at high risk: results and complications.

Purpose: Transarterial chemoembolization (TACE) has become a standard treatment option for unresectable hepatocellular carcinoma (HCC) and is often used to palliate hepatic metastases. Many patients who are candidates for TACE present with poor hepatic reserve, advanced tumor stage with major portal vein (PV) invasion or thrombosis, and/or biliary dilation. These factors have been associated with a poor prognosis and increased complications after chemoembolization.

Bland embolization of telangiectatic subtype of hepatic focal nodular hyperplasia.

Focal nodular hyperplasia (FNH) is a common benign liver tumor that is usually treated conservatively. This report describes a histologic subtype of FNH that is more likely to be symptomatic as a result of hemorrhage and necrosis. The patient in this case was treated initially with surgical resection for multiple focal nodular hyperplasias and subsequently with bland embolization of an unresectable, symptomatic lesion.

Neuroendocrine hepatic metastases: does aggressive management improve survival?

Objective: The aim of this study was to determine whether aggressive management of neuroendocrine hepatic metastases improves survival.

Summary Background Data: Survival in patients with carcinoid and pancreatic neuroendocrine tumors is significantly better than adenocarcinomas arising from the same organs. However, survival and quality of life are diminished in patients with neuroendocrine hepatic metastases.

Improved survival in resected biliary malignancies.

Background: For many years the prognosis for patients with biliary malignancies has been poor. However, recent advances in radiology and laparoscopy have improved staging, and active biliary stent management may improve outcome in these patients. In the past the goal with surgery was to excise all gross tumor.