Abstract: BACKGROUND AND OBJECTIVES: The recurrence of hepatocellular carcinoma (HCC) after percutaneous ablation is poorly evaluated. METHODS: Thirty-six cases of recurrence after percutaneous ablation (PA) (Group 1) are compared to those after surgery, treated with re-resection (26 patients, Group 2) and PA (31 patients, Group 3). RESULTS: Recurrence was usually local after PA and distant after resection. Compared to Groups 2 and 3, local recurrences after PA were larger (4.2 vs. 2.3 cm) and more often invasive (43% vs. 10%). No different clinical/pathological aspects were noted in distant recurrences among the groups. After treatment the survival rate (1, 2, 3 and 5 years) was no different between the groups; in an intention-to-treat analysis of survival for local recurrences, survival was significantly lower in Group 1 (78%, 78%, 67% and 28%) than in Groups 2 and 3 (100%, 88%, 75% and 45%) (P < 0.05). CONCLUSIONS: PA and surgery can be sequentially employed for HCC. The type of primary treatment does not influence the features of distant liver recurrence, while local recurrence after PA often requires more extensive liver resection.
Abstract: BACKGROUND: The treatment of hepatic metastases from gastric cancer is controversial, due to biologic aggressiveness of the disease. OBJECTIVE: To survey the clinical approach to the subset of patients presenting with metachronous hepatic metastases as sole site of recurrence after curative resection of gastric cancer, focusing on the results achieved by different therapies and to investigate the prognostic factors of major clinical relevance. METHODS: Retrospective multi-center chart review evaluating 73 patients, previously submitted to D >or= 2 gastrectomy for gastric cancer, who developed exclusive hepatic recurrence. Prognostic factors related to the patient, to the gastric malignancy and its treatment, and to the metastatic disease and its therapy were evaluated. RESULTS: Forty-five patients received supportive care, 17 were submitted to chemotherapy, and 11 to hepatic resection. Survival was independently influenced by the variables T (p=0.019), N (p=0.05) and G (p=0.018) of the gastric primary and by the therapeutic approach to the metastases (p<0.005). In particular, T4 gastric cancer, presence of lymph-node metastases and G3 tumor displayed a negative prognostic value. Therapeutic approach to the metastases was the principal prognostic variable: 1, 2, and 3 years survival rates were 22.2%, 4.4% and 2.2%, respectively, for patients without specific treatment; 44.9%, 12.8% and 6.4% after chemotherapy (p=0.08) and 80.8%, 30.3% and 20.2% after surgical resection (p<0.001). CONCLUSIONS: Our data suggest some clinical criteria that may facilitate selection of therapy for patients with hepatic recurrence after primary gastric cancer resection. The best survival rates are associated with surgical treatment, which should be chosen whenever possible.
Abstract: BACKGROUND: Intrahepatic cholangiocarcinoma (ICC) is an unusual tumour. METHODS: The clinicopathological data of 67 patients with ICC and combined hepatocellular-cholangiocarcinoma (HCC-ICC) are presented. RESULTS: HCV-HBV infection was present in 37.3% and chronic liver disease in 38.7% of cases, a rate higher than in the normal population; in these patients the cancer was small, often asymptomatic and of combined type. Liver resection was performed in 51 patients; at 1, 3 and 5 years, overall survival was 87.9%, 59.0%, and disease-free survival was 47.7% and 78.8%, 51.4%, and 46.7%, respectively. The better results were in the group of cirrhotic patients in whom ICC was diagnosed by a screening program for HCC (5-year survival 76.6%). Nodal metastasis showed negative prognostic value for both overall and disease-free survival; in N+ patients mean survival was 14.7 months after liver resection and lymph node dissection. CONCLUSION: Viral infection and cirrhosis may be considered risk conditions for ICC and combined HCC-ICC; in resected patients survival was good. Nodal metastases must not be considered a contraindication for liver resection.
Abstract: BACKGROUND/AIMS: Post discharge prescriptions and follow-up protocols after non-operative treatment of blunt liver injuries are still controversial. The aim of this study was to detail the evolution of the hepatic injuries considering their different patterns and severity grades, stated by the Liver Injury Scale. METHODOLOGY: Analysis of a database concerning 79 consecutive patients submitted to ultrasound follow-up until complete recovery of liver injury. RESULTS: All patients had an uncomplicated course and the liver restoration was demonstrated between 3 and 300 days after the trauma. The median healing time of hematomas increased with the grading (p<0.001): 6 days (IQR=6.75), 45.5 days (IQR=91) and 108 days (IQR=89) for I, II and III grade lesions, respectively. Similarly behaved the lacerations and 29 days (IQR=14.25), 34 days (IQR=43.5) and 77.5 days (IQR=83.5) was the median healing time of II, III and IV grade lesions, statistical significance emerging only comparing II to IV grade lacerations (p<0.035). Considering the different lesion patterns within the same severity grade, the liver restoration was more prompt after lacerations (p<0.001). CONCLUSIONS: These data suggest that medical prescriptions and follow-up protocols can be tailored considering the lesion characteristics.
