Over the past decade,radiofrequency ablation(RFA) has evolved into an important therapeutical tool for the treatment of non resectable primary and secondary liver tumors.The clinical benefit of RFA is represented in s...Over the past decade,radiofrequency ablation(RFA) has evolved into an important therapeutical tool for the treatment of non resectable primary and secondary liver tumors.The clinical benefit of RFA is represented in several clinical studies.They underline the safety and feasibility of this new and modern concept in treating liver tumors.RFA has proven its clinical impact not only in hepatocellular carcinoma(HCC) but also in metastatic disease such as colorectal cancer(CRC).Due to the increasing number of HCC and CRC,RFA might play an even more important role in the future.Therefore,the refinement of RFA technology is as important as the evaluation of data of prospective randomized trials that will help define guidelines for good clinical practice in RFA application in the future.The combination of hepatic resection and RFA extends the feasibility of open surgical procedures in patients with extensive tumors.Adverse effects of RFA such as biliary tract damage,liver failure and local recurrence remain an important task today but overall the long term results of RFA application in treating liver tumors are promising.Incomplete ablation of liver tumors due to insufficient technology of ablation needles,tissue cooling by the neighbouring blood vessels,large tumor masses and ablation of tumors in close vicinity to heat sensitive organs remain difficult tasks for RFA.Future solutions to overcome these limitations of RFA will include refinement of ultrasonographic guidance(accuracy of probe placement),improvements in needle technology(e.g.needles preventing charring)and intraductal cooling techniques.展开更多
AIM To evaluate liver resections without Pringle maneuver, i.e., clamping of the portal triad. METHODS Between 9/2002 and 7/2013, 175 consecutive liver resections(n = 101 major anatomical and n = 74 large atypical >...AIM To evaluate liver resections without Pringle maneuver, i.e., clamping of the portal triad. METHODS Between 9/2002 and 7/2013, 175 consecutive liver resections(n = 101 major anatomical and n = 74 large atypical > 5 cm) without Pringle maneuver were performed in 127 patients(143 surgeries). Accompanying, 37 wedge resections(specimens < 5 cm) and 43 radiofrequency ablations were performed. Preoperative volumetric calculation of the liver remnant preceeded all anatomical resections. The liver parenchyma was dissected by waterjet. The median central venous pressure was 4 mmH g(range: 5-14). Data was collected prospectively. RESULTS The median age of patients was 60 years(range: 16-85). Preoperative chemotherapy was used in 70 cases(49.0%). Liver cirrhosis was present in 6.3%, and liver steatosis of ≥ 10% in 28.0%. Blood loss was median 400 mL(range 50-5000 mL). Perioperative blood transfusions were given in 22/143 procedures(15%). The median weight of anatomically resected liver specimens was 525 g(range: 51-1850 g). One patient died postoperatively. Biliary leakages(n = 5) were treated conservatively. Temporary liver failure occurred in two patients.CONCLUSION Major liver resections without Pringle maneuver are feasible and safe. The avoidance of liver inflow clamping might reduce liver damage and failure, and shorten the hospital stay.展开更多
Laparoscopic colorectal surgery(LCS) is an evolving subject.Recent studies show that LCS can not only offer safe surgery but evidence is growing that this new technique can be superior to classical open procedures.Few...Laparoscopic colorectal surgery(LCS) is an evolving subject.Recent studies show that LCS can not only offer safe surgery but evidence is growing that this new technique can be superior to classical open procedures.Fewer perioperative complications and faster postoperative recovery are regularly mentioned when studies of LCS are presented.Even though the learning curve of LCS is frequently debated when limitations of laparoscopic surgeries are reviewed,studies show that in experienced hands LCS can be a safe procedure for colorectal cancer treatment.The learning curve however,is associated with high conversion rates and economical aspects such as higher costs and prolonged hospital stay.Nevertheless,laparoscopic colorectal cancer surgery(LCCR) offers several advantages such as less co-morbidity and less postoperative pain in comparison with open procedures.Furthermore,the good exposure of the pelvic cavity by laparoscopy and the magnification of anatomical structures seem to facilitate pelvic dissection laparoscopically.Moreover,recent studies describe no difference in safety and oncological radicalness in LCCR compared to the open total mesorectal excision(TME).The oncological adequacy of LCCR still remains unproven today,because long-term results do not yet exist.To date,only a few studies have described the results of laparoscopic TME combined with preoperative adjuvant treatment for colorectal cancer.The aim of this review is to examine the various areas of development and controversy of LCCR in comparison to the conventional open approach.展开更多
文摘Over the past decade,radiofrequency ablation(RFA) has evolved into an important therapeutical tool for the treatment of non resectable primary and secondary liver tumors.The clinical benefit of RFA is represented in several clinical studies.They underline the safety and feasibility of this new and modern concept in treating liver tumors.RFA has proven its clinical impact not only in hepatocellular carcinoma(HCC) but also in metastatic disease such as colorectal cancer(CRC).Due to the increasing number of HCC and CRC,RFA might play an even more important role in the future.Therefore,the refinement of RFA technology is as important as the evaluation of data of prospective randomized trials that will help define guidelines for good clinical practice in RFA application in the future.The combination of hepatic resection and RFA extends the feasibility of open surgical procedures in patients with extensive tumors.Adverse effects of RFA such as biliary tract damage,liver failure and local recurrence remain an important task today but overall the long term results of RFA application in treating liver tumors are promising.Incomplete ablation of liver tumors due to insufficient technology of ablation needles,tissue cooling by the neighbouring blood vessels,large tumor masses and ablation of tumors in close vicinity to heat sensitive organs remain difficult tasks for RFA.Future solutions to overcome these limitations of RFA will include refinement of ultrasonographic guidance(accuracy of probe placement),improvements in needle technology(e.g.needles preventing charring)and intraductal cooling techniques.
文摘AIM To evaluate liver resections without Pringle maneuver, i.e., clamping of the portal triad. METHODS Between 9/2002 and 7/2013, 175 consecutive liver resections(n = 101 major anatomical and n = 74 large atypical > 5 cm) without Pringle maneuver were performed in 127 patients(143 surgeries). Accompanying, 37 wedge resections(specimens < 5 cm) and 43 radiofrequency ablations were performed. Preoperative volumetric calculation of the liver remnant preceeded all anatomical resections. The liver parenchyma was dissected by waterjet. The median central venous pressure was 4 mmH g(range: 5-14). Data was collected prospectively. RESULTS The median age of patients was 60 years(range: 16-85). Preoperative chemotherapy was used in 70 cases(49.0%). Liver cirrhosis was present in 6.3%, and liver steatosis of ≥ 10% in 28.0%. Blood loss was median 400 mL(range 50-5000 mL). Perioperative blood transfusions were given in 22/143 procedures(15%). The median weight of anatomically resected liver specimens was 525 g(range: 51-1850 g). One patient died postoperatively. Biliary leakages(n = 5) were treated conservatively. Temporary liver failure occurred in two patients.CONCLUSION Major liver resections without Pringle maneuver are feasible and safe. The avoidance of liver inflow clamping might reduce liver damage and failure, and shorten the hospital stay.
文摘Laparoscopic colorectal surgery(LCS) is an evolving subject.Recent studies show that LCS can not only offer safe surgery but evidence is growing that this new technique can be superior to classical open procedures.Fewer perioperative complications and faster postoperative recovery are regularly mentioned when studies of LCS are presented.Even though the learning curve of LCS is frequently debated when limitations of laparoscopic surgeries are reviewed,studies show that in experienced hands LCS can be a safe procedure for colorectal cancer treatment.The learning curve however,is associated with high conversion rates and economical aspects such as higher costs and prolonged hospital stay.Nevertheless,laparoscopic colorectal cancer surgery(LCCR) offers several advantages such as less co-morbidity and less postoperative pain in comparison with open procedures.Furthermore,the good exposure of the pelvic cavity by laparoscopy and the magnification of anatomical structures seem to facilitate pelvic dissection laparoscopically.Moreover,recent studies describe no difference in safety and oncological radicalness in LCCR compared to the open total mesorectal excision(TME).The oncological adequacy of LCCR still remains unproven today,because long-term results do not yet exist.To date,only a few studies have described the results of laparoscopic TME combined with preoperative adjuvant treatment for colorectal cancer.The aim of this review is to examine the various areas of development and controversy of LCCR in comparison to the conventional open approach.
