Francisco Castro Sousa

Study of perioperative liver function by dynamic monitoring of ICG-clearance.

BACKGROUND/AIMS To investigate the impact of liver resection on the perioperative hepatic function by evaluation of ICG-clearance. METHODOLOGY Twenty-five patients underwent major hepatic resection (Group A) and 36 underwent minor hepatic resection (Group B). Thirteen patients who received no liver surgery, acted as control group (Group C). ICG-clearance measured by a non-invasive technique was expressed in terms of plasma disappearance rate (PDR-ICG-%/min) and retention rate of ICG 15 min (ICG-R15-%) after administration ICG (0.5mg/kg) before anesthesia induction (T0), immediately after the surgery (T1) and 24h after (T2). RESULTS There was statistically significant differences between the three groups: ICG-PDR (p<0.004) and ICG-R15 (p<0.040). These differences were observed between groups A and C at T1, between A and B, or A and C, at T2 for ICG-PDR and between groups A and B at T2 for ICG-R15. There were no differences between groups for hemoglobin, platelets, PT, creatinine, albumin, total protein, bilirubin and ALP. CONCLUSIONS ICG clearance is a safe non-invasive dynamic tool to quantify the liver function in patients following hepatic surgery. It also can be used to evaluate the liver surgery impact on hepatic function which can help to diagnose early hepatic dysfunction and guide the therapeutic decision making process.

Functional hepatocellular regeneration in elderly patients undergoing hepatectomy

More than 50% of liver tumours occur in patients aged 65 years or more. Assessment of functional liver regeneration capacity is crucial to minimize postoperative liver failure. We aimed to study functional hepatocellular regeneration, through scintigraphic quantification of Mebrofenin hepatic extraction fraction (HEF), after partial hepatectomy, comparing elderly patients with younger ones.

Liver transplantation for colorectal liver metastasis: Survival without recurrence can be achieved

The management of patients with colorectal liver metastases has improved significantly over the recent years. However, most patients still cannot undergo complete resection, generally because the location of the metastases within the liver prevents any radical management, which explains the interest for transplantation. The first structured attempts were performed in the 1980s with poor outcomes, in part due to a high proportion of death not related to the neoplastic disease. More recently, the group of Oslo has shown a 60% 5-year survival in 21 patients with colorectal metastases. Such a survival was better than the one expected on chemotherapy alone. However, 95% (20/21) of patients had cancer recurrence, most within the first 18 months after transplantation. At present, liver transplantation for colorectal metastases remains highly controversial. The potential for longterm disease-free survival needs to be explored, which is the aim of this multicentric collaborative retrospective study. A total of 12 patients (6 females/6 males) underwent liver transplantation for colorectal liver metastasis at centers affiliated to the “Compagnons H epatoBilaires” (see Supporting Information), an association of hepato-pancreato-biliary and transplant surgeons, most trained at the Paul Brousse Hospital, Paris, France, under the guidance of Professor H. Bismuth. Median age at transplant was 56 years (Table 1). Patients were managed in Lisbon (n5 8), Coimbra (n5 2), Paris (n5 1), and Geneva (n5 1) between October 1995 and October 2015 (date of transplant), and no other patient underwent transplantation for this indication at these respective transplant centers. Data collection was conducted according the relevant ethical standards at each institution. The location of the primary adenocarcinoma was the colon in 11 patients, and the rectum in 1 patient. Most primary cancers were T3 on pathology, and many presented between 1 and 3 involved—N1—lymph nodes (2 patients were N2 with more than 3 nodes involved; Table 1). For most patients, liver metastases (9/12) were diagnosed within 12 months after the diagnosis of the primary cancer and were considered as synchronous. When not diagnosed at the same time as the primary, liver metastases were discovered 4, 7, 19, 24, and 29 months after the primary. At the time of transplantation, patients presented a median of 9 liver metastases. Two had lesions> 5 cm, of 5.5 and 8 cm. Median carcinoembryonic antigen (CEA) level was 16.9 mg/L, and 1 patient had CEA> 200 mg/L, of 314mg/L. Most (11/12) patients received chemotherapy prior to transplantation. Chemotherapy included irinotecan and oxaliplatin in 9 (82%) patients, and a biological agent in 6 (cetuximab [cetux] in 2, bevacizumab [beva] in 3, and both agents in 1). Another patient was treated by intrahepatic chemotherapy prior to transplantation. All patients responded to chemotherapy, and none was in progression at the time of the transplantation. The decision to conduct a posttransplant Abbreviations: beva, bevacizumab; CEA, carcinoembryonic antigen; cetux, cetuximab; DFS, disease-free survival; NA, not available; O/I, oxaliplatin/irinotecan; RAPID, Resection And Partial Liver Segment 2/3 Transplantation With Delayed Total Hepatectomy; RFA, radiofrequency ablation.

Solitary necrotic nodule of the liver: a very challenging diagnosis!

Solitary necrotic nodule of the liver is a rare entity of unknown aetiology. We describe the case of a 59-year-old woman reporting sporadic right upper quadrant pain. An abdominal CT scan revealed a liver nodule located in segment 4. The complementary investigation was unable to identify the neoplastic lesion, and its surgical resection was performed, with an uneventful recovery. Pathological examination revealed a ‘solitary necrotic nodule of the liver.’ The patient remains asymptomatic and free of recurrence 3 years after surgery. This case corroborates that despite the advances in liver imaging and biopsy, liver nodules are sometimes a diagnostic challenge; quite often, only its surgical resection allows a definitive diagnosis.

Rupture of splenic angiosarcoma: a rare cause of spontaneous haemoperitoneum

Primary splenic angiosarcoma, a very rare mesenchymal tumour of endothelial cell origin, comprises 2.6% of all cases of angiosarcoma and 10% of all primitive splenic tumours. Clinical presentation is usually unspecific, with abdominal pain and anaemia. Rupture is a rare complication and should prompt emergency splenectomy. Prognosis is usually poor because of liver, lung or bone metastases. We describe the case of an 80-year-old woman admitted to the emergency room with syncope, hypotension and vomiting. She stabilised after fluid resuscitation. Investigations showed anaemia, a large, heterogeneous spleen and free fluid in the abdominal cavity. She underwent emergency splenectomy. Pathology revealed primary splenic angiosarcoma. The postoperative period was complicated by respiratory failure but the patient made an otherwise uneventful course and was discharged 2 weeks after surgery. Six months after the operation she remains free of disease with no adjuvant treatment.

Haemoptysis and left upper quadrant abdominal pain: an unusual presentation of partial thoracic migration of an adjustable gastric band's tube

Laparoscopic gastric banding is considered the safest bariatric procedure, holding satisfactory long-term weight loss results, low rates of early complications and negligible mortality. Long-term follow-up are showing a high prevalence of late complications. We describe the case of a 40-year-old female patient, with a medical history of laparoscopic gastric banding, admitted in the emergency department complaining of haemoptysis, left upper quadrant abdominal pain and a slight tachycardia. After an exhaustive clinical evaluation with laboratorial and radiological assessments, diagnosis of partial thoracic migration of the bands tube was established. Despite the unusual clinical setting, this case emphasises the necessity of awareness for the potential long-term complications of gastric banding either from primary or secondary care providers.