Emma J. Mullin

Useless and dangerous—fine needle aspiration of hepatic colorectal metastases

Fine needle aspiration cytology (FNAC) is an established tool for diagnosing liver tumours. It has recognised complications, however. Use of the procedure in abdominal tumours is fatal in 0.006 to 0.031% of cases.1 2 Most deaths occur with liver tumours and are due to haemorrhage. Another complication is that metastases can seed along biopsy needle tracts, although this has been reported to be rare, with an incidence of 0.003% to 0.07%, mostly from pancreatic tumours.1 2 More recently, much higher rates (0.4% to 5.1%) of needle tract metastases have been reported when FNAC is used in liver lesions, usually for primary liver tumours.3–7 Only 13 cases of needle tract colorectal metastases caused by FNAC in liver lesions are described in journals listed in Medline.7–13 Several authors have commented that the procedure should be avoided because of the risk of this complication. A further similar case is reported here, extending the contraindication of FNAC in hepatic tumours to include lesions for which no primary malignancy has been found. Therefore in Western populations, in which primary liver malignancy is rare, the diagnosis of apparently malignant liver lesions should centre on searching for the primary tumour, rather than on FNAC of the lesion. A 78 year old man presenting with back pain was found on computed tomography of his abdomen to have a lesion in the right lobe of his liver. FNAC of the lesion was done without referral to a surgeon, …

Detecting curable disease following hepatectomy for colorectal metastases

Introduction:  Although resection may be curative for patients with hepatic colorectal metastases, recurrence occurs in the majority. Recurrence is occasionally amenable to repeated resection. The aim of the present study was to evaluate which modalities, at what intervals, detected potentially curable resection.

Systematic review of day-case laparoscopic Nissen fundoplication

Background:  Laparoscopic Nissen fundoplication is increasingly being performed on a day‐case basis. The aim of the present paper was to systematically review published data on day‐case or ambulatory laparoscopic fundoplication and discuss the differing criteria for patient selection, postoperative management and patient outcomes presented in each series.

Hepatectomy for metastatic noncolorectal gastrointestinal, breast and testicular tumours.

Background:  The indications for hepatectomy for colorectal or neuroendocrine metastases are becoming clear with increasing experience reported. For other primary diseases, however, the overall number of cases is relatively small, and it is more difficult to derive clear guidelines. This paper reviews the reported experience of hepatectomy for metastases from non‐colorectal gastrointestinal primary cancers, breast cancer and testicular teratoma. The aim is to determine for each whether and under what circumstances hepatectomy is indicated.

RELAXATION OF THE CRITERIA FOR DAY SURGERY LAPAROSCOPIC CHOLECYSTECTOMY

Background:  For day case laparoscopic cholecystectomy programmes, studies suggest that overnight admission may be predicted by the following factors: gall bladder wall thickness, patient age over 55 years and previous sphincterotomy. This study investigated the effect of relaxing selection for a day surgery laparoscopic cholecystectomy programme, by removing these factors from the exclusion criteria.

Differentiation of metastatic follicular thyroid cancer from hepatocellular carcinoma using Hep Par 1.

Hepatocellular carcinoma usually arises in a cirrhotic liver. Multiple hepatic nodules in a non‐cirrhotic liver are more likely to be metastatic. The primary focus commonly arises from the gastrointestinal tract, breast or lung, but in the absence of these a primary liver pathology must be considered. The case is reported of a middle‐aged woman presenting with multiple nodules on computed tomography with no clinically apparent primary for whom results of initial diagnostic investigations were potentially misleading.

Fine needle aspiration of hepatic colorectal metastases: Authors' reply

EDITOR—We are delighted to have provoked such a lively debate with our article. The only weakness anticipated in advance of publication was that it perhaps represented rather “old news.” It is gratifying then to find that its message merited vigorous reiteration. In response to the specific points of Sanz and del Valle, laparoscopic …