Chapters authored
Diagnostic and Therapeutic Challenges in Nonparasitic Liver Cysts
Nonparasitic hepatic cysts constitute a heterogeneous group of disorders. A proper diagnosis of hepatic cyst is necessary in order to adopt the best treatment. The term hepatic cyst usually refers to simple hepatic cysts. Nonparasitic hepatic cysts are also linked to genetic disorders such as polycystic liver disease (PLD) with/without autosomal dominant polycystic kidney disease (ADPKD) or Caroli disease. Generally, patients with nonparasitic hepatic cysts less than 3 cm are asymptomatic. These cysts become symptomatic when are large, multiple, or complicated. Percutaneous abdominal ultrasound is the best imaging modality to diagnose hepatic cysts but must be completed by other imaging and serological tests. It is important to differentiate simple hepatic cyst from hydatid cyst, cystadenoma, and cystadenocarcinoma before proceeding with the treatment. Sometimes the diagnosis is very challenging. Asymptomatic single liver cysts need only surveillance, but symptomatic and complicated ones require therapeutic intervention. Percutaneous aspiration of the cyst under ultrasound guidance is a mini-invasive procedure generally associated with sclerotherapy. The highest success rates were reported for laparoscopic or open cyst fenestration. Liver transplantation is indicated for patients with severe PLD.
Part of the book: Recent Advances in Liver Diseases and Surgery
Onco-Surgical Management of Liver Metastases from Colorectal Cancer
Metastatic disease is the main cause of death in patients with colorectal cancer and the most frequent location of metastases is in the liver. The treatment of liver metastases of colorectal origin is multimodal and should be based on a multidisciplinary team decision. A systematic review of the literature revealed that the number of liver metastases, their maximum size, CEA level, advanced age of the patients, and presence of extrahepatic disease are no longer contraindications to liver resection. The resectability rate of colorectal liver metastases increased from 10 to almost 40%, enabling 5-year overall survival rates higher than 30%. Short-term and long-term results achieved by simultaneous resection (SR) are similar to those achieved by staged resections in patients with synchronous colorectal liver metastases. Whenever possible, major hepatectomies should be replaced by ultrasound-guided limited liver resections, and primary tumor should be approached in a minimally invasive manner. Even initially unresectable colorectal liver metastases could be rendered resectable by an aggressive multimodal approach (“two-stage” hepatectomies, hepatectomy after portal vein embolization/ligation, resection after conversion chemotherapy, and hepatectomy associated with ablation). The presence of extrahepatic metastases is no longer a contraindication to liver resection, when extrahepatic disease is resectable. Repeat hepatectomy improves survival in patients with recurrent liver metastases.
Part of the book: Updates in Liver Cancer
Pancreatic Resections for Metastatic Disease
Although the incidence of metastases to the pancreas from various primaries is very low, these lesions are usually being described as part of the systemic recurrence of different malignancies, in certain cases isolated pancreatic metastases might be encountered. When it comes to the malignancies, which might lead to the apparition of pancreatic metastases, the most common origins have been reported to be renal cell carcinoma, colon cancer, ovarian cancer and melanomas. In certain cases, patients with pancreatic metastases might be submitted to surgery with curative intent. However, it should not be omitted that pancreatic resections can be associated with higher rates of perioperative morbidity; therefore, a precise selection of the cases that are considered suitable for such procedures is mandatory. It seems that the best results in regard with long-term survival are expected in cases with isolated pancreatic metastases as well as in cases with limited extrapancreatic lesions, amenable to complete cytoreductive surgery. This chapter reviews the most important studies conducted on the theme of pancreatic resections for metastatic disease from various primaries.
Part of the book: Advances in Pancreatic Cancer