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  • Liver resection  (2)
  • Alcohol relapse  (1)
  • Arterial complications  (1)
  • 1
    ISSN: 1435-2451
    Keywords: Hilar carcinoma ; Liver resection ; Hiluscarcinom ; Leberresektion
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung Neben verbesserten Möglichkeiten der Drainagebehandlung von Hiluscarcinomen haben Fortschritte der Leberchirurgie auch zu einer höheren Rate der Resektabilität dieser Tumoren geführt. Möglicherweise ist die Infiltrationstiefe mancher dieser Tumoren begrenzter als bei anderen Malignomen, so daß Resektion geeignet ist. Bei 65 zentralen Hilustumoren konnte 31mal ein resezierendes Verfahren, davon 17mal mit Teilleberresektion angewandt werden. Die 1-Jahres-Überlebenshöhe nach Resektion liegt bei 65%. Die Operation erfordert ein sehr sorgfältiges, häufig zeitaufwendiges präparatives Vorgehen.
    Notes: Summary Palliative treatment of hilar carcinoma has been improved by transhepatic and endoscopic techniques. Moreover, advances in liver surgery have allowed the resection of a higher percentage of these tumors, which sometimes do not infiltrate deeply into the hepatic parenchyma. Resection may thus be worthwhile. Of 65 central hilar tumors, 31 have been resected, in 17 of which resection was combined with partial hepatectomy. The 1 year survival of patients after resection is about 65%. Resection of these tumors requires skilful and mostly time consuming preparative surgical technique.
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  • 2
    ISSN: 1435-2451
    Keywords: Key words Hepatoma ; Liver resection ; Liver transplantation
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  Introduction: Despite recent advances with techniques of in situ tumor ablation, surgical therapy remains at present the mainstay in the treatment of primary hepatic malignancies. Discussion: After an initial endeavor to establish liver transplantation as a treatment option, especially for unresectable liver tumors, only a few indications, for example early hepatocellular carcinoma in cirrhosis, are currently agreed upon. Other indications, such as peripheral cholangiocarcinoma and hepatocellular carcinoma in non-cirrhotics, have largely been abandoned or are still under debate, as with fibrolamellar carcinoma. Selection of patients suffering from hepatocellular carcinoma in cirrhosis for liver transplantation is still based on tumor size and node number, because the current state of diagnostic imaging fails to reliably predict the most important prognostic parameter: vascular infiltration. Other selection criteria are under investigation. Studies on multimodal therapy are also underway but have not yet demonstrated a benefit.
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  • 3
    ISSN: 1432-2277
    Keywords: Key words Liver transplantation ; Alcoholic cirrhosis ; Alcohol relapse ; Outcome
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Because of the donor shortage, there are concerns for liver transplantation in patients with alcoholic cirrhosis. We therefore analyzed patients transplanted for alcoholic cirrhosis at our center with respect to patient and graft survival, recurrence of disease, and postoperative complications. Out of 1000 liver transplantations performed in 911 patients, 167 patients were transplanted for alcoholic cirrhosis; 91 patients received CsA- and 76 patients FK506-based immunosuppression. Recurrence was diagnosed by patient's or relative's declaration, blood alcohol determination, and delirium. Diagnosis and treatment of acute and chronic rejection was performed as previously described. One- (96.8 % versus 91.3 %) and 9-year patient survival (83.3 % versus 80 %) compared well with other indications. Five of 15 patients died due to disease recurrence. Recurrence of disease was significantly related to the duration of alcohol abstinence prior to transplantation. In patients who were abstinent for less than 6 months (17.1 %), recurrence rate was 65 %, including four of the five patients who died of recurrence. Recurrence rate decreased to 11.8 %, when abstinence time was 6–12 months and to 5.5 %, when the abstinence times was 〉 2 years. Next to duration of abstinence, alcohol relapse was significantly related to sex, social environment, and psychological stability. The incidence of acute rejection compared well with other indications (38.1 %); CsA: 40.1 % versus 33.3 % in FK506 patients. In all, 18.2 % of CsA patients experienced steroid-resistant rejection compared with 2.6 % of FK506 patients. Seven patients (7.6 %) in the CsA group and one patient (1.3 %) in the FK506 group developed chronic rejection. A total of 57.1 % developed infections; 5.7 % were life-threatening. CMV infections were observed in 14.3 % (versus 25 % for other indications). New onset of insulin-dependent diabetes was observed in 8.6 % and hypertension in 32.4 %. In conclusion, alcoholic cirrhosis is a good indication for liver transplantation with respect to graft and patient survival and development of postoperative complications. FK506 therapy was favourable to CsA treatment. Patient selection is a major issue and established criteria should be strictly adhered to. Patients with alcohol abstinence times shorter than 6 months should be excluded, since recurrence and death due to recurrence was markedly increased in this group of patients.
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  • 4
    ISSN: 1432-2277
    Keywords: Key words Liver transplantation ; Arterial complications
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract From September 1988 through April 1998, 1000 liver transplantations were performed on 911 patients. During the postoperative control examinations of 837 patients, we found 23 (2.74 %) with hepatic artery thromboses, 27 stenoses of the hepatic artery (3.22 %), and 6 aneurysms of the graft artery. Seventeen patients underwent retransplantation because of arterial complications. Depending on the clinical symptoms, we treated both the local situation as well as the resulting complications of inadequate arterial graft flow. The aneurysms were primarily treated surgically. The first choice of treatment of stenoses was balloon angioplasty. Early postoperative artery thromboses were also treated surgically by thrombectomy in selected cases. For the resulting biliary and local septic complications we preferred endoscopic and drainage procedures. Our clinical experiences have led us to find pretransplantation angiography recommendable, especially in the case of splanchnic artery stenoses, for bypassing from the aorta for arterial perfusion of the graft.
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