Extended hepatic resection with transplantation back-up for an "unresectable" tumour
Φόρτωση...
Ημερομηνία
Συγγραφείς
Millar, A. J.
Hartley, P.
Khan, D.
Spearman, W.
Andronikou, S.
Rode, H.
Τίτλος Εφημερίδας
Περιοδικό ISSN
Τίτλος τόμου
Εκδότης
Περίληψη
Τύπος
Είδος δημοσίευσης σε συνέδριο
Είδος περιοδικού
peer-reviewed
Είδος εκπαιδευτικού υλικού
Όνομα συνεδρίου
Όνομα περιοδικού
Pediatr Surg Int
Όνομα βιβλίου
Σειρά βιβλίου
Έκδοση βιβλίου
Συμπληρωματικός/δευτερεύων τίτλος
Περιγραφή
Liver transplantation (LT) for malignancy has had disappointing long-term results due to tumour recurrence. Ex-vivo dissection and auto-transplantation have had poor results when the tumor was obstructing bile ducts. Advances in liver surgery have made extensive liver resection safer, but cases of "unresectable" tumours due to site and size still present. A 10-year-old boy was referred with jaundice due to a 6 x 8-cm central (segment 4) tumour shown on biopsy to be a fibrolamellar hepatocellular carcinoma. Ultrasound (US) and Computed Tomography also showed dilatation of intrahepatic bile ducts in both lobes. Angiography showed a large tumour mass supplied by the left branch of the hepatic artery, a low take-off of a right branch of the hepatic artery, and a very displaced but patent portal vein. The initial surgical consensus was that the tumour was unresectable. The patient was listed for LT with the plan of first attempting resection with a liver graft-in-waiting. An extended left hepatectomy was performed under total vascular exclusion with resection of the tumour, which had extended from segment 4 into surrounding segments 1, 3, 5, and 8. Intraoperative US assisted in planning the resection. The right hepatic vein, artery, and the right branch of the portal vein could be preserved and a Roux loop was anastomosed to a markedly dilated segment 6 and 7 intrahepatic duct for bile drainage. Vascular exclusion time was 30 min. The patient made a good recovery without major complications. Jaundice and bile-duct dilatation resolved. On follow up at 5 years there was no recurrence. The liver graft-in-waiting gave the surgical team confidence to proceed with an extensive resection beyond a "point of no return" and allowed good clearance of the disease and avoidance of LT with all the long-term consequences of immunosuppression. This mandates that extensive hepatic surgery in children should be carried out in centres that have a facility for LT should the need arise.
Περιγραφή
Λέξεις-κλειδιά
Carcinoma, Hepatocellular/pathology/*surgery, Child, Decision Making, Hepatectomy/*methods, Humans, Liver Neoplasms/pathology/*surgery, Liver Transplantation, Male
Θεματική κατηγορία
Παραπομπή
Σύνδεσμος
http://www.ncbi.nlm.nih.gov/pubmed/11527170
Γλώσσα
en
Εκδίδον τμήμα/τομέας
Όνομα επιβλέποντος
Εξεταστική επιτροπή
Γενική Περιγραφή / Σχόλια
Ίδρυμα και Σχολή/Τμήμα του υποβάλλοντος
Πανεπιστήμιο Ιωαννίνων. Σχολή Επιστημών Υγείας. Τμήμα Ιατρικής