Ambispective comparative study of two surgical strategies for liver hydatidosis

AIM:To investigate the morbidity,mortality,recurrence and technical aspects of two distinct surgical strategies that were implemented in successive periods.METHODS:Ninty-two patients with 113 cysts underwent surgical procedures.The study was divided into 2 periods.Data from first period(P1) were compiled retrospectively.The surgical strategy was conservative surgery.The second period(P2) included a prospective study conducted according to a protocol following the criterion that radical procedures should be performed whenever it is technically feasible.RESULTS:Patients of both periods showed no statistically significant differences in age,gender,cyst location or mortality.Among the P2 group,patients exhibited more preoperative jaundice,and cyst size was smaller(P < 0.05).Changes in surgical strategy increased the rate of radical surgery,decreases morbidity and in-hospital stay(P < 0.001).A negative result in P2 was the death of two old patients(4.8%) who had undergone conser-vative treatments.The rate of radical surgery in P2 was around 75%.CONCLUSION:Radical surgery should be the technique of choice whenever it is feasible,because it diminishes morbidity and in-hospital stay.Conservative surgery must be employed only in selected cases.

Liver metastasis of endometrial stromal sarcoma

Resection of liver metastases from gynaecological tumours is uncommon.Endometrial stromal sarcomas(ESS) are low incidence gynecological tumours which can originate in previous sites of endometriosis or following metaplasia of the pelvic peritoneal wall,and which are exceptionally associated with liver metastasis.We present a 68-year-old woman with a ESS and metachronic liver metastasis treated by liver resection.There is very little literature on clinical management about liver metastasis from ESS,but extrapolating the data obtained with liver metastasis from sarcomas and uterine tumours,we should recommend resection as this is considered a resectable extrauterine metastasis.In cases with more sites of extrauterine disease,liver resection should also be performed if the other sites are resectable.

Percutaneous drainage as a first therapeutic step prior to surgery in liver hydatid cyst abscess:Is it worth it?

AIMTo delay surgery until the patient is in a better condition, and thus to decrease postoperative morbidity. METHODSUsing this algorithm we treated three patients aged 55, 75 and 80 years. In all three patients the clinical presentation was fever without a clear source of infection; all had nonspecific symptoms such as general malaise, dyspnea, and abdominal discomfort in the previous 15 d. They came to the emergency room at our hospital due to deterioration of their general condition. Analytical tests showed leukocytosis, neutrophilia and increased polymerase chain reaction. In all cases an abdominal computed tomography (CT) was performed and liver hydatid abscess (LHA) was detected. The mean size of the LHA was 12 cm. RESULTSAll patients underwent CT-guided percutaneous drainage. The purulent material obtained was cultured, and Klebsiella pneumoniae, Streptococcus viridans and Streptococcus salivarius were identified. Antibiotic treatment was given adapted to antibiotic sensitivity testing. Surgery was performed two weeks after admission, once the patient&rsquo;s condition had improved. All three patients underwent an almost total cystectomy, cholecystectomy and omentoplasty in the residual cavity. Complications were: Clavien I (atelectasis and pleural effusion) and Clavien II (transfusion). The average length of stay (pre and postoperative) was 23 d. At the follow-up, no relapses were recorded. CONCLUSIONLHA management is not standardized. Emergency surgery offers suboptimal results. Percutaneous drainage plus antibiotics allows improving patient&rsquo;s general condition. This enables treating patients in greater safety and also reduces complications.

Complete clinical response of liver metastasis after chemotherapy:To resect or not?

This paper aims to update the therapeutical strategies in liver metastasis with complete clinical response(CCR) after chemotherapy and to determine if surgery is always necessary after CCR.The aim of chemotherapy is to achieve a good clinical response rather than CCR of liver metastasis.The CCR of liver metastasis after chemotherapy cannot be considered synonymous with a cure.The resection of the hepatic segment where there was hepatic metastases with CCR after chemotherapy theoretically prevents recurrence,improves survival and makes it possible to conf irm whether there has been a complete pathological response.However,the medical literature about this topic is scarce and sometimes contradictory.

Liver Metastases from Gynecological Cancers: Time to Resection?

Aim: To perform an update of liver resection as treatment of liver metastases of gynecological cancers, as well as an update on these metastases. Bibliographical search: PubMed Search 1990-2011 in English language. Authors reviewed only relevant articles. Results: No more than 20 relevant articles have been published on this topic, including case reports. We performed a classical review of the information published in the literature. Conclusions: Liver Metastases from Gynecological cancers, not peritoneal implants in the liver, usually appear in patients with disseminated disease, so it is uncommon to perform a liver resection. In some patients with limited extrahepatic disease or only liver disease, liver resection is a safe alternative and improves the oncological results. We try to emphasize which patients may benefit from liver resection and the importance of tailoring medical decisions.