Cavernous hemangiomas of the liver: Resect or observe?

Surgical decisions regarding cavernous hemangioma of the liver require consideration of the natural history of the lesion. To provide background, we retrospectively evaluated 49 cases of such hemangiomas exceeding 4 cm in diameter. There were 36 female patients (including 4 infants) and 13 males. Their ages ranged from 1 month to 68 years and averaged 44 years. Surgical procedures that ranged from simple excision to hepatic lobectomy were performed on 13 patients. Four had postoperative complications. There were no surgical deaths or any late deaths attributable to hemangioma. The other 36 patients have been observed for up to 15 years (mean 5.5 years) without the need for surgery. None of the patients in this group died, and none has experienced intraperitoneal hemorrhage or intensification of symptoms, although the size of four lesions increased. The benign course should be considered when deciding on management of lesions that are asymptomatic or so large as to pose significant operative risk.     

To ablate or not to ablate,that is the question

Onychocryptosis (ingrowing toe nails) are most commonly the result of a local occurrence, be it through micro-trauma of ill fitting shoes, direct forceful trauma or poor nail care. The nail plate ruptures the nail fold and a pyogranuloma develops. Systemic disease may be an aetiological factor, as in this case where a renal transplant recipient received the immuno-suppressive drug Cyclosporin A.     

Hepatic Hydatid: PAIR, Drain or Resect?

Study Background  

Hydatid disease of the liver is endemic in India and is a common health problem. Although various treatment options have been described ranging from pharmacotherapy to radiological interventions and surgical procedures (both conservative and radical), the best treatment option in an individual case continues to be debated.     

Colorectal cancer liver metastases -- neoadjuvant concepts for preoperative down-sizing

Liver resection for colorectal metastases disease can be performed with curative intent at low morbidity and mortality. Only 15-30 % of liver metastases are amenable to potentially curative resection. Five year survival following primary and repeat liver resection has consistently been reported as 25-40 %. Future strategies focus at widening the indication and extending therapeutic options. The aim of neoadjuvant treatment of irresectable liver metastasis is the conversion to secondary resectability either via increasing residual liver mass (portal vein embolisation/2-stage resection) and/or reducing tumor load via chemotherapy ("down-sizing"). Current data suggest resectability following neoadjuvant chemotherapy in around 8 % of cases but varying between 1-33 %.     

Colorectal cancer: managing distant metastases

The best opportunity for cure in colorectal cancer is early diagnosis and complete excision of the primary disease. Currently, metastatic disease develops in about 50% of patients, most often in the liver. Resection of solitary liver metastases is warranted, and a 5-year survival of at least 25% can be expected. Patients with limited unilobar multiple metastases may also benefit from resection. Extensive metastatic disease to the liver may respond to single or combination chemotherapy. Response rates are highest with hepatic artery infusion chemotherapy, but improvement in survival has not clearly been shown. Solitary or limited lung metastases, when unassociated with other metastatic disease, should also be resected. Multiorgan involvement may respond to systemic chemotherapy but results are generally poor. Palliation is an important objective of therapy, involving not only anticancer treatment (surgery, chemotherapy, radiotherapy) but also general supportive care.     

结直肠癌肝转移相关临床病理危险因素分析

目的分析与结直肠癌肝转移相关的临床病理学危险因素。方法收集2002年1月至2004年12月经手术切除原发灶、病理证实和完成随访的390例结直肠癌患者的临床病理资料。采用成组病例-对照研究法,将患者分为肝转移和无肝转移两组,选择肿瘤部位、大体类型、肿瘤长径、浸润周径、浸润深度、静脉癌栓、淋巴结转移位置、淋巴结转移数目和组织学类型等因素,用SAS6.12进行结直肠癌肝转移单因素分析和多因素Logistic回归分析,并对有意义的因素进行交互作用分析。结果单因素分析显示:结直肠癌浸润肠管壁的周径(P=0.022)、浸润深度(P=0.001)、静脉癌栓(P=0.001)、淋巴结转移位置(P=0.001)和肝转移相关;多因素分析显示:静脉癌栓(P=0.005)和淋巴结转移位置(P=0.001)和肝转移相关,静脉癌栓和淋巴结转移位置无交互作用。结论肿瘤浸润周径、浸润深度、静脉癌栓及淋巴结转移与发生结直肠癌肝转移密切相关,术后病理检查发现伴随有静脉癌栓及淋巴结转移的结直肠癌患者发生肝转移的危险性较大,而癌肿部位、大体类型、肿瘤长径、淋巴结转移数目和组织学类型与肝转移的发生无关。     

Colorectal lung metastases: results of surgical excision.

Between 1960 and 1988, 139 consecutive patients underwent pulmonary resection for metastatic colorectal carcinoma. Median interval between colon resection and lung resection was 34 months. Ninety-eight patients (70.5%) had a solitary metastasis. Wedge excision was performed in 68 patients, lobectomy in 53, lobectomy plus wedge excision in 9, bilobectomy in 4, and pneumonectomy in 5. Operative mortality was 1.4%. Localized extrapulmonary colorectal cancer was also resected in 20 patients. Median follow-up was 7 years (range 1 to 20.4 years). Overall 5- and 20-year survival was 30.5% and 16.2%, respectively. Five-year survival for patients with solitary metastasis was 36.9%, as compared with 19.3% for those with two metastases (p less than 0.05) and 7.7% for those with more than two (p less than 0.01). Patients with normal carcino-embryonic antigen had a 5-year survival of 46.8% versus 16.0% for patients with increased levels (p less than 0.01). Five-year survival for patients with resected extrapulmonary disease was 30.0% versus 30.7% for those without extrapulmonary cancer (p = not significant). Repeat thoracotomy for recurrent metastases was done in 19 patients. Five-year survival after the second lung resection was 30.2%. We conclude that resection of colorectal lung metastases is safe and effective, that resectable extrapulmonary disease does not necessarily contraindicate pulmonary resection, and that repeat thoracotomy is warranted in selected patients with recurrent colorectal lung metastases.     

Debunking dogma: Surgery for four or more colorectal liver metastases is justified

Treatment of four or more colorectal liver metastases (CRLMs) is controversial and remains a relative contraindication to surgery at some institutions. We sought to assess the outcome of patients with four or more CRLMs treated with surgery. Patients (159) with four or more CRLMs were treated surgically at a single institution. The median number of treated lesions was 5 (range, 4–14). The majority of patients received neoadjuvant chemotherapy (89.9%). Forty-six (29.0%) patients underwent resection only, 12 (7.5%) underwent radiofrequency ablation (RFA) only, and 101 (63.5%) underwent resection plus RFA. The 5-year actuarial disease-free and overall survival rates were 21.5% and 50.9%, respectively. Patients who underwent RFA as part of their surgical procedure (hazard ratio [HR] =1.81, P =0.03) and those with a positive surgical resection margin (HR=1.52, P =0.01) were more likely to have a shorter time to recurrence. Patients who did not have a reduction in tumor size following neoadjuvant chemotherapy had a higher likelihood of death following surgical treatment (HR=2.53, P =0.01). Patients with four or more CRLMs should be considered for aggressive surgical treatment, including liver resection with or without RFA, in order to improve the chance of long-term survival. Certain clinicopathologic factors, including lack of response to neoadjuvant chemotherapy, were associated with a worse prognosis. Presented at the American Hepato-Pancreato-Biliary Association 2005 meeting, Hollywood, Florida, April 14–17, 2005.     

结直肠癌肝转移手术切除及全身、区域化疗

结直肠癌肝转移发病率高,是结直肠癌的常见死亡原因。其主要治疗方法有手术切除和全身化疗与区域化疗,而手术切除是提高存活率的关键。目前,结直肠癌肝转移以手术治疗为核心的综合治疗体系已经形成,然而,手术切除与全身、区域化疗的科学选择是进一步提高该类病人存活率和使病人获得最大收益的关键。     

结直肠癌肝转移消融与外科切除的治疗选择与时机

结直肠癌是全球第三高发恶性肿瘤,易发生肝转移。消融治疗与外科切除是结直肠癌肝转移有效且安全的局部治疗方法,可在全身治疗有效的基础上,有效控制局部病灶,延长患者生存期。药物治疗的进步使很多既往不宜局部治疗的结直肠癌肝转移患者获得了局部转化治疗机会。然而对于不同治疗目标、不同肿瘤负荷的结直肠癌肝转移,消融治疗与外科切除干预的时机以及术式尚没有明确的界限。本文对结直肠癌肝转移消融治疗与外科切除的研究进展以及治疗时机选择进行讨论。