Multiple focal nodular hyperplasias induced by oxaliplatin-based chemotherapy.

Focal nodular hyperplasia (FNH) is a benign condition that affects normal liver with low prevalence. Recently, the extensive use of oxaliplatin to treat patients with colorectal cancer has been reported to be associated with the development of different liver injuries, as well as focal liver lesions. The present work describes two patients with multiple bilateral focal liver lesions misdiagnosed as colorectal liver metastases, and treated with liver resection.

Long-term effectiveness of resection and radiofrequency ablation for single hepatocellular carcinoma ≤3 cm. Results of a multicenter Italian survey.

Background & Aims: The aim of this study was to compare liver resection and radiofrequency ablation in patients with single hepatocellular carcinoma ≤3 cm and compensated cirrhosis.

Methods: The study involved 544 Child-Pugh A cirrhotic patients (246 in the resection group and 298 in the radiofrequency group) observed in 15 Italian centers. Overall survival and tumor recurrence rates were analyzed using the Kaplan Meier method before and after propensity score matching.

Tailoring the area of hepatic resection using inflow and outflow modulation.

The performance of hepatic surgery without a parenchyma-sparing strategy carries significant risks for patient survival because of the not negligible occurrence of postoperative liver failure. The key factor of modern hepatic surgery is the use of the intraoperative ultrasound (IOUS), not only to stage the disease, but more importantly to guide resection with the specific aim to maximize the sparing of the functional parenchyma. Whether in patients with hepatocellular carcinoma and underlying liver cirrhosis, or in patients with colorectal liver metastasis, IOUS allows the performance of the so-called "radical but conservative surgery", which is the pivotal factor to offer a chance of cure to an increasing proportion of patients, who until few years ago were considered only for palliative care.

Is stereotactic body radiation therapy an attractive option for unresectable liver metastases? A preliminary report from a phase 2 trial.

Purpose: To evaluate the feasibility of high-dose stereotactic body radiation therapy (SBRT) in the treatment of unresectable liver metastases.

Methods And Materials: Patients with 1 to 3 liver metastases, with maximum individual tumor diameters less than 6 cm and a Karnofsky Performance Status of at least 70, were enrolled and treated by SBRT on a phase 2 clinical trial. Dose prescription was 75 Gy on 3 consecutive days.

A snapshot of the effective indications and results of surgery for hepatocellular carcinoma in tertiary referral centers: is it adherent to the EASL/AASLD recommendations?: an observational study of the HCC East-West study group.

Objective: The aim of this study was to investigate in a retrospective setting the patients' profile and results of those undergoing surgery for hepatocellular carcinoma (HCC) in high-volume surgical centers throughout the world.

Background: Whether surgery for HCC is a suitable approach and for which subset of patients is still controversial. The EASL/AASLD (European Association for the Study of Liver Disease/American Association for the Study of Liver Disease) guidelines, based on the Barcelona Clinic Liver Cancer (BCLC) classification, leave little room for hepatic resection; inversely, other reports promote its wider application.

Anatomical resection of segment 8 by means of ultrasound-guided vessel compression.

Background: Anatomical resection is the gold standard for liver resection in patients with hepatocellular carcinoma (HCC). Bimanual hepatic vessel compression has been already described, although segmental and subsegmental resection of segment 8 (S8) remain challenging by this technique. We demonstrate how to obtain a S8 demarcation by means of ultrasound-guided vessel compression.

Upper transversal hepatectomy.

Background: For tumors involving hepatic veins (HV) at hepato-caval confluence (HC), major hepatectomy or vascular reconstruction, are recommended. Detection of communicating veins (CV) between adjacent HVs allows conservative hepatectomies.

Methods: A 61 year-old man was operated for multiple colorectal liver metastases (CLM).

Potential role of cholinesterases to predict short-term outcome after hepatic resection for hepatocellular carcinoma.

Estimation of functional liver reserve in patients with hepatocellular carcinoma (HCC) is of paramount importance to properly select candidates for surgical resection. Together with the value of bilirubin, the presence/absence of ascites and esophageal varices, and the rate of residual liver volume, which are our current parameters to measure functional liver reserve, we sought to investigate the value of preoperative cholinesterases (CHE) in predicting postoperative outcome after hepatic resection for HCC. We reviewed the records of 279 consecutive patients who underwent hepatic resection for HCC in our Unit between 2001 and 2011.

Surgical Approach for Long-term Survival of Patients With Intrahepatic Cholangiocarcinoma: A Multi-institutional Analysis of 434 Patients.

OBJECTIVES To examine the outcomes of a hepatectomy for intrahepatic cholangiocarcinoma (IHC) and to clarify the prognostic impact of a lymphadenectomy and the surgical margin. Large series of patients who were surgically treated for IHC are scarce. Thus, prognostic factors and long-term survival after resection of IHC remain uncertain.

A comprehensive meta-regression analysis on outcome of anatomic resection versus nonanatomic resection for hepatocellular carcinoma.

Background: It remains unclear whether hepatectomy for hepatocellular carcinoma should be performed as an anatomic resection (AR) or a nonanatomic resection (NAR). Because no randomized controlled trials are currently available on this topic, a meta-regression analysis was performed on available observational studies to control for confounding variables.

Methods: A systematic review of studies published from 1990 to 2011 in the PubMed and Embase databases was performed.

Liver resection for hepatocellular carcinoma ≤3 cm: results of an Italian multicenter study on 588 patients.

Background: The best treatment for patients with small hepatocellular carcinoma (S-HCC) is still controversial. The aim of this study was to evaluate operative and long-term results after liver resection (LR) for S-HCC, defined as tumor ≤3 cm.

Study Design: Retrospective multicenter study of 588 LRs for S-HCC from 8 Italian hepatobiliary surgery units (years 1992 to 2008).

Improvement in perioperative and long-term outcome after surgical treatment of hilar cholangiocarcinoma: results of an Italian multicenter analysis of 440 patients.

Objective: To evaluate improvements in operative and long-term results following surgery for hilar cholangiocarcinoma.

Design: Retrospective multicenter study including 17 Italian hepatobiliary surgery units.

Patients: A total of 440 patients who underwent resection for hilar cholangiocarcinoma from January 1, 1992, through December 31, 2007.

Safety of intermittent Pringle maneuver cumulative time exceeding 120 minutes in liver resection: a further step in favor of the "radical but conservative" policy.

Objective: We retrospectively compared the short-term outcome of a consecutive cohort of patients who underwent hepatectomy with intermittent clamping ranging between 60 and 120 minutes with those having a clamping time exceeding 120 minutes.

Background: Intermittent Pringle maneuver is widely used to minimize blood loss during hepatectomy, without an established time limit. However, many authors claim it is dangerous for patient outcome.

A simple, effective technique for port-site closure after laparoscopy.

Background And Objectives: Fascial closure of port sites represents a challenging issue in laparoscopic surgery. The aim of this article is to introduce a procedure that allows the safe suturing of the abdominal fascia in these wounds.

Methods: We herein describe a simple technique for fascial closure after laparoscopy using a transcutaneous approach and standard surgical instruments for suture.

Intraoperative ultrasound with contrast medium in resective pancreatic surgery: a pilot study.

Background: The introduction of contrast-enhanced ultrasound has been a major innovation in liver and pancreatic imaging. Previous studies have validated its intraoperative use during liver surgery, while there is a lack of data regarding its use during pancreatic surgery. The purpose of the present study was to prospectively evaluate the possible role of contrast-enhanced intraoperative ultrasound (CEIOUS) during resective pancreatic surgery for primary lesion characterization and intraoperative staging.

Advances in the surgical treatment of colorectal cancer liver metastases through ultrasound.

Surgery remains the gold standard of treatment for colorectal cancer liver metastases (CLM). The only limitation of surgery for CLM is its technical feasibility, the key point being to leave enough remnant liver to ensure patient survival. This report describes a surgical procedure based extensively on ultrasound guidance, which allows for curative resection in one stage and also for multiple bilobar CLM.

Melatonin exerts by an autocrine loop antiproliferative effects in cholangiocarcinoma: its synthesis is reduced favoring cholangiocarcinoma growth.

Cholangiocarcinoma (CCA) is a devastating biliary cancer. Melatonin is synthesized in the pineal gland and peripheral organs from serotonin by two enzymes, serotonin N-acetyltransferase (AANAT) and acetylserotonin O-methyltransferase (ASMT). Cholangiocytes secrete neuroendocrine factors, including serotonin-regulating CCA growth by autocrine mechanisms.

Total or partial anatomical resection of segment 8 using the ultrasound-guided finger compression technique.

Background: A new surgical technique to define intra-operatively segmental and subsegmental areas of the liver using ultrasound-guided bimanual liver compression has been recently described. However, this technique does not allow disclosure of the subsegmental ventral (S8v) and dorsal (S8d) portions of segment 8 (S8). Another technique that overcomes these limitations is described.

From mesohepatectomy to mini-mesohepatectomy: evolving the concept of resectability of hepatic tumors at the hepatocaval confluence.

In the case of tumors in contact with or invading the middle hepatic vein (MHV) at the hepatocaval confluence, extended right hepatectomy or mesohepatectomy is usually recommended. Major or extended hepatectomy is associated with significant rates of morbidity and mortality, and a more conservative approach would be desirable. Thus, we developed a new conservative operation, the so-called mini-mesohepatectomy that, in some specific circumstances, allowed the en-bloc resection of segment 8, segment 4-sup and the MHV at the hepatocaval confluence and at the same time preservation of the remaining parenchyma of the right anterior section and left median section drained by the MHV.

Anatomical right posterior sectionectomy: a further expansion of the ultrasound-guided compression technique.

Dissection or encirclement of the sectional pedicles for resection area demarcation is generally required for anatomical right posterior sectionectomy (RPS). These maneuvers are sometime unfeasible and potentially dangerous. A new technique for performing an RPS is herein described.

Radiological estimation of size in colorectal liver metastases: is it reliable? Comparison with post-resectional measurements.

Since the efficiency of percutaneous ablation techniques in treating colorectal liver metastases is dependent on tumor size, the aim of this study was to verify the accuracy of computed tomography or magnetic resonance in estimating the maximum diameter of colorectal liver metastases by comparing these findings with those of pathology in a series of patients who underwent liver resection. Radiological and pathological tumor measurements in 39 patients operated for 69 colorectal liver metastasis were recorded. The radiological measurement was performed by magnetic resonance in 40 tumors (23 cases) and by computed tomography in 29 tumors (16 patients).