L'image du mois. Une varice duodenale compliquant une hypertension portale

in Revue Médicale de Liège (2003), 58(11), 657-8

Liver resection for noncolorectal, nonneuroendocrine metastases

in Acta Chirurgica Belgica (2003), 103(5), 458-462

In noncolorectal, nonendocrine liver metastases, the role of surgery is less define than in colorectal or neuroendocrine cancer. This role is marginal as liver is not the primary site of metastases of ... [more ▼]

In noncolorectal, nonendocrine liver metastases, the role of surgery is less define than in colorectal or neuroendocrine cancer. This role is marginal as liver is not the primary site of metastases of these cancers. Less than 2 to 5% of the patients with these malignancies might be one day considered as potential candidates for liver resection, as most patients suffer from extra hepatic tumour spread at the time they develop liver involvement. However, in these few cases with liver metastases only, as no other therapeutic option may provide mid- or long-term tumour-free survival, liver resection is indicated in resectable liver metastases. Some prognostic factors have been established in the literature from the few published series : unique versus multiple hepatic metastases, unilobar vs bilobar, metachronous vs synchronous, R0 vs R1 or R2 liver resections. The type of primary tumour is also of great importance, as cutaneous melanoma, pancreatic and gastric adenocarcinoma have a very bad prognosis for liver resection of metastases, even after R0 resection. In these cases, percutaneous or laparoscopic radiofrequency ablation may find its place. In sarcoma, breast carcinoma, uveal melanoma, and genitourinary cancers, liver resection may provide satisfactory long-term results in selected cases, and is the standard of care for isolated, resectable metastasis. However, due to the scarcity of indication of liver resection for noncolorectal, nonneuroendocrine metastases, the decision should be multidisciplinary, and the patients should be informed of the advantages and pitfalls of the surgical procedure. [less ▲]

Liver transplantation for hepatocarcinoma. Highlights of the 9th Meeting of the International Liver Transplantation Society (ILTS) and the 13th Meeting of the Liver Intensive Care Group of Europe (LICAGE)

in Medscape (2003)

Laparoscopic liver resection of benign liver tumors - Results of a multicenter European experience

in Surgical Endoscopy and Other Interventional Techniques (2003), 17(1), 23-30

Objective: The objective of this study was to assess the feasibility, safety, and outcome of laparoscopic liver resection for benign liver tumors in a multicenter setting. Background: Despite restrictive ... [more ▼]

Objective: The objective of this study was to assess the feasibility, safety, and outcome of laparoscopic liver resection for benign liver tumors in a multicenter setting. Background: Despite restrictive, tailored indications for resection in benign liver tumors, an increasing number of articles have been published concerning laparoscopic liver resection of these tumors. Methods: A retrospective study was performed in 18 surgical centres in Europe regarding their experience with laparoscopic resection of benign liver tumors. Detailed standardized questionnaires were used that focused on patient's characteristics, clinical data, type and characteristics of the tumor, technical details of the operation, and early and late clinical outcome. Results: From March 1992 to September 2000, 87 patients suffering from benign liver tumor were included in this study: 48 patients with focal nodular hyperplasia (55%), 17 patients with liver cell adenoma (21%), 13 patients with hemangioma (15%), 3 patients with hamartoma (3%), 3 patients with hydatid liver cysts (3%), 2 patients with adult polycystic liver disease (APLD) (2%), and 1 patient with liver cystadenoma (1%). The mean size of the tumor was 6 cm, and 95% of the tumors were located in the left liver lobe or in the anterior segments of the right liver. Liver procedures included 38 wedge resections, 25 segmentectomies, 21 bisegmentectomies (including 20 left lateral segmentectomies), and 3 major hepatectomies. There were 9 conversions to an open approach (10%) due to bleeding in 45% of the patients. Five patients (6%) received autologous blood transfusion. There was no postoperative mortality, and the postoperative complication rate was low (5%). The mean postoperative hospital stay was 5 days (range, 2-13 days). At a mean follow-up of 13 months (median, 10 months; range, 2-58 months), all patients are alive without disease recurrence, except for the 2 patients with APLD. Conclusions: Laparoscopic resection of benign liver tumors is feasible and safe for selected patients with small tumors located in the left lateral segments or in the anterior segments of the right liver. Despite the use of a laparoscopic approach, selective indications for resection of benign liver tumors should remain unchanged. When performed by expert liver and laparoscopic surgeons in selected patients and tumors, laparoscopic resection of benign liver tumor is a promising technique. [less ▲]

History of solid organ transplantation at the University of Liege

in Acta Chirurgica Belgica (2003), 103(3 Sp. Iss. SI), 32-36

La carcinomatose hepatique du cancer colorectal: actualites therapeutiques

in Revue Médicale de Liège (2002), 57(12), 771-8

Important progress has been made in the treatment of liver metastases of advanced colorectal cancer. Surgery with curative intent, when possible, shows evidence of prolonged survival. Response rate and ... [more ▼]

Important progress has been made in the treatment of liver metastases of advanced colorectal cancer. Surgery with curative intent, when possible, shows evidence of prolonged survival. Response rate and overall survival can be improved with modern polychemotherapy. Cytotoxic drug combinations and sequential treatments sometimes make surgery possible for initially non resectable lesions. Impact of loco-regional treatment such as hepatic arterial infusion chemotherapy must be defined in randomised trials. Radiofrequency ablation is also currently evaluated in clinical trials. In this review the benefit of each treatment is discussed. [less ▲]

Strictureplasty in Crohn's disease : Short- and long-term follow-up

in Acta Chirurgica Belgica (2002), 102(4, JUL-AUG), 253-255

Strictureplasty for obstructive Crohn's disease is still controversial because lesions are left in place and the suture is performed on a diseased bowel. Many surgeons prefer to perform bowel resection ... [more ▼]

Strictureplasty for obstructive Crohn's disease is still controversial because lesions are left in place and the suture is performed on a diseased bowel. Many surgeons prefer to perform bowel resection, hoping for fewer complications and a lower recurrence rate. In this paper, the authors reports their strictureplasty experience. They performed a systematic retrospective review of the patients suffering from Crohn's disease who underwent strictureplasties during a 10-year period in the abdominal surgery department of the University Hospital of Liege Sart Tilman, and studied the short- and long-term clinical results of 68 strictureplasties performed in 18 patients. Median follow-up was 63 months (range 12 to 144). Mortality was 0% and septic morbidity was 11% (one wound abscess and one leakage). Among the 16 patients available for the latest follow-up, symptomatic stenotic recurrence had to be medically treated in hospital for 4 patients (25%) with a recurrence delay range of 19 to 49 months. Stenosis recurrence needed re-intervention in one patient 48 months after surgery: stenosis occurred at a distance from the corrected site. These results confirmed that strictureplasty is a safe and efficient procedure in selected patients undergoing surgery for obstructive Crohn's disease. [less ▲]

Effect of perioperative infusion of antioxidants on neutrophil activation during liver transplantation in humans

in Transplantation Proceedings (2002), 34(3), 755-758

Enucleation of a giant hepatic hemangioma in a Jehovah's Witness

in Acta Chirurgica Belgica (2002), 102(1), 54-56

Diagnostic et traitement du syndrome hépatorénal

in Médecine et Hygiène (2002), 60

Le syndrome hépatorénal (SHR) est une insuffisance rénale propre au patient porteur d’une hépatopathie chronique à un stade avancé. Le mécanisme physiopathologique, encore imparfaitement connu, associe ... [more ▼]

Le syndrome hépatorénal (SHR) est une insuffisance rénale propre au patient porteur d’une hépatopathie chronique à un stade avancé. Le mécanisme physiopathologique, encore imparfaitement connu, associe une vasoconstriction rénale à une vasodilatation splanchnique. Aucun examen n’est spécifique au SHR qui reste ainsi un diagnostic d’exclusion. Le pronostic du SHR est très sombre, l’évolution spontanée étant presque toujours fatale en moyenne dans le mois du diagnostic. La transplantation hépatique représente le traitement idéal mais est d’application limitée étant donné la courte survie des patients. Depuis peu, un traitement médical combinant un vasoconstricteur splanchnique, la terlipressine, et un expanseur plasmatique, l’albumine, donne des résultats favorables, permettant au patient de survivre jusqu’à la transplantation hépatique. [less ▲]