Intraoperative ultrasonography in surgery of liver tumors.
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Carcinoma, Hepatocellular↗
Biomedical subjects
G L Grazi
Publications and source records attributed to G L Grazi.
Hepatic resection for tumours in cirrhotic livers.
A liver resection was performed in 25 out of 36 cirrhotic patients operated on for liver cell carcinomas. In the remaining 11 cases hepatectomy was not performed mainly because of the presence of other intrahepatic neoplastic nodules or thrombi in the portal branches revealed by intraoperative echography. The operative mortality in the 25 patients operated on was 16%; the actuarial survival at three years is 58%. Liver resection was carried out using a transparenchymal procedure; in 18 cases clamping of the hepatic pedicle was performed for an average period of 15 min. Twenty patients with small tumours had a segmentary or sub-segmentary resection; intraoperative echography proved indispensable in this situation, making it possible to recognize the lesion and outline the limits of the resection. The presence of a peritumoral capsule seems to have been an important prognostic factor.
Aged↗
Beware of TIPS in liver transplant candidates. Transjugular Intrahepatic Portosystemic Shunt.
Transjugular intrahepatic portosystemic shunt (TIPS) reduce portal pressure and prevent bleeding from esophageal varices in cirrhotic patients. The method is often used in liver transplant candidates. Two cases of TIPS malpositioning in liver transplantation candidates are reported. In the first patient, the caudal end of the TIPS was situated distally in the portal trunk and during transplantation it was necessary to isolate the spleno-portal confluence in order to ensure anastomosis in an area of the wall without endothelial lesions. In the second case, still on the waiting list, the cephalead end of the stent is situated in the right atrium and in this case a more complex trans-diaphragmatic and probably trans-atrial approach is foreseen to allow extraction of the stent. In cirrhotic patients who may be possible transplant candidates, shorter TIPS must be used and positioned with care intrahepatically. Careful radiological evaluation is recommended, together with a CT scan and possibly angiography, in patients with TIPS before liver transplantation is performed, to avoid surprises with detrimental effects during the transplant.
Adult↗
Orthotopic liver transplantation for alcoholic liver disease: rates of survival, complications and relapse.
BACKGROUND/AIMS: Liver transplantation for alcoholic end-stage liver disease remains controversial at many transplant centers. The aim of the present study was to evaluate the outcome of patients with alcoholic liver disease who underwent liver transplantation at Centro Trapianti, Policlinico S. Orsola, Bologna. METHODOLOGY: We describe the outcomes of 18 alcoholic patients with end-stage liver disease who received orthotopic liver transplants at our center from April, 1986 to February, 1996. The data obtained was compared with that of 114 patients with virus-related cirrhosis selected as transplant controls. An absolute period of abstinence from alcohol consumption for at least six months was required. RESULTS: Regarding the actuarial survival rate and non-fatal post-transplant complications, no significant differences were noted in comparing the non-alcoholic with the alcoholic recipients, except for a higher incidence of Cytomegalovirus infection in the alcoholic group followed-up for more than four months. The alcoholic relapse rate was 27.2%, but only one patient returned to harmful drinking. Seventy-three percent of subjects who were followed-up for at least six months were occupied in gainful employment. Alcoholic relapse did not affect employment status. CONCLUSION: This data demonstrates that liver transplantation for selected patients with end-stage alcohol-related cirrhosis achieves good results in survival, complications and employment status, and it appears difficult to defend an inflexible claim to have demonstrated an absolute long-term abstinence before transplantation when a severe deterioration of liver function is present.
Actuarial Analysis↗
Hepatic resective surgery in cirrhotic patients. Techniques and results of anatomical segmentectomies.
The paper describes the technique of anatomical liver segmentectomies based on the extraparenchymal clamping, at the hepatic hilum, of the afferent vascular pedicles. The resection is started on the liver surface along the demarcation line caused by the ischemia. During parenchymal transection the technique of hemihepatic vascular occlusion has been undertaken. The results obtained with 125 segmentary hepatic resections performed for hepatocellular carcinoma arised on cirrhosis are also reported. The overall operative mortality has been 6.4%. The actuarial 1 and 3 year survivals were 93.3% and 70.4% respectively. Hepatic segmentary resections are recommended for limited hepatic lesions, mainly in well compensated cirrhotic patients.
Hepatectomy↗