The comparison of local tumor control after microwave ablation, surgical resection and combined treatment for colorectal liver metastases

Aim. We aimed to compare the local therapeutic efficiency of microwave ablation (MWA), surgical resection, and combined treatment, assess the outcomes, and identify predictive factors for local treatment response in colorectal liver metastases (CLMs). Methods. From March 2013 to September 2019, a total of 54 patients with 302 CLMs were enrolled in this retrospective study. Eleven patients (20.4%) were treated with MWA, 9 patients (16.7%) with surgery, and 34 patients (63%) with the combined method. Univariate and multivariate analyses were performed to investigate overall survival (OS) and hepatic progression-free survival (HPFS) using the Cox proportional hazard regression model. The logistic regression analysis was used to identify the predictive factors for the local treatment response. Results. Total treatment response was achieved in 46.3% (n=25) of the patients. Local tumor progression was seen in 7.4% (n=4) of the patients, and the rate of intrahepatic distal recurrence was 46.3% (n=25). There were no significant differences in HPFS and OS between the three groups (p=0.56 and 0.90, respectively). Younger age

Fully automated preoperative liver volumetry incorporating the anatomical location of the central hepatic vein

The precise preoperative calculation of functional liver volumes is essential prior major liver resections, as well as for the evaluation of a suitable donor for living donor liver transplantation. The aim of this study was to develop a fully automated, reproducible, and quantitative 3D volumetry of the liver from standard CT examinations of the abdomen as part of routine clinical imaging. Therefore, an in-house dataset of 100 venous phase CT examinations for training and 30 venous phase ex-house CT examinations with a slice thickness of 5 mm for testing and validating were fully annotated with right and left liver lobe. Multi-Resolution U-Net 3D neural networks were employed for segmenting these liver regions. The Sorensen-Dice coefficient was greater than 0.9726 +/- 0.0058, 0.9639 +/- 0.0088, and 0.9223 +/- 0.0187 and a mean volume difference of 32.12 +/- 19.40 ml, 22.68 +/- 21.67 ml, and 9.44 +/- 27.08 ml compared to the standard of reference (SoR) liver, right lobe, and left lobe annotation was achieved. Our results show that fully automated 3D volumetry of the liver on routine CT imaging can provide reproducible, quantitative, fast and accurate results without needing any examiner in the preoperative work-up for hepatobiliary surgery and especially for living donor liver transplantation.Projekt DEA

Safety of reconversion to calcineurin inhibitor (CNI) based immunosuppression in liver transplant recipients who had been converted to everolimus for post-transplant renal impairment

Joint International Congress of ILTS, ELITA and LICAGE -- MAY 23-26, 2018 -- Lisbon, PORTUGALWOS: 000436897700436…International Liver Transplantation Society, European Liver and Intestine Transplant Association, Liver Intensive Care Group of Europ

The evalution of anterior sector venous drainage in right lobe living donor liver transplantation: does one technique fit all?

İstanbul Bilim Üniversitesi, Tıp Fakültesi.In living donor liver transplantation (LDLT), an adequate hepatic venous outflow constitutes one of the basic principles of a technically successful procedure. The issue of whether the anterior sector (AS) of the right lobe (RL) graft should or should not be routinely drained has been controversial. The aim of this 10-year, single-center, retrospective cohort study was to review the evolution of our hepatic venous outflow reconstruction technique in RL grafts and evaluate the impact of routine AS drainage strategy on the outcome. The study group consisted of 582 primary RL LDLT performed between July 2004 and December 2014. The cases were divided into 3 consecutive periods with different AS venous outflow reconstruction techniques, which included middle hepatic vein (MHV) drainage in Era 1 (n=119), a more selective AS drainage with cryopreserved homologous grafts in Era 2 (n=391), and routine segment 5 and/or 8 oriented AS drainage with synthetic grafts in Era 3 (n=72). Intraoperative portal flow measurement with routine splenic artery ligation (SAL) technique (in RL grafts with a portal flow of ≥ 250 mL/min/100 g liver tissue) was added later in Era 3. These 3 groups were compared in terms of recipient and donor demographics, surgical characteristics and short-term outcome. The rate of AS venous drainage varied from 58.8% in Era 1 and 35.0% in Era 2 to 73.6% in Era 3 (P<0.001). Perioperative mortality rate of recipients significantly decreased over the years (15.1% in Era 1 and 8.7% in Era 2 vs. 2.8% in Era 3, P=0.01). After the addition of SAL technique in the 45 cases, there was only 1 graft loss and no perioperative mortality. One-year recipient survival rate was also significantly higher in Era 3 (79.6% in Era 1 and 86.1% in Era 2 vs. 92.1% in Era 3, P=0.002). Routine AS drainage via segment 5 and/or 8 veins using synthetic grafts is a technique to fit all RL grafts in LDLT. Addition of SAL effectively prevents early graft dysfunction and significantly improves the outcome

Role of pre-transplant 18F-FDG PET/CT in predicting hepatocellular carcinoma recurrence after liver transplantation

WOS: 000450964500006PubMed ID: 30364796The last two decades have seen a paradigm shift in the selection of patients with hepatocellular carcinoma (HCC) for liver transplantation. Microvascular invasion and differentiation have been the most significant factors affecting post-transplant recurrence; however, because of inherent disadvantages of pre-transplant biopsy, histological criteria never gained popularity. Recently, the selection criteria evolved from morphological to biological criteria, such as biomarkers and response to loco-regional therapy. With the introduction of multimodality imaging, combination of computed tomography with nuclear medicine imaging, particularly, 18F-fluorodeoxyglucose positron emission tomography fulfilled an unmet need and rapidly became a critical component of HCC management. This review article will focus on the use of 18F-fluorodeoxyglucose positron emission tomography combined with computed tomography in the pre-transplant evaluation of HCC patients with special discussion on its ability to predict HCC recurrence after liver transplantation

Is routine reconstruction for all sizeable anterior sector drainage veins necessary in right lobe living donor liver transplantation?

---International Liver Transplantation Societ

Postmastektomi seroma modelinde doğal kollagen ve traneksamik asitin etkinliği (Deneysel çalışma)

Carcinoma of the breast is the most common site-specific cancer in women. It accounts for approximately 35 % of all female cancers. Different surgical procedures have been defined for the management of breast cancer, and following these procedures, seroma is the most common complication, with an incidence of 26-52. Prevention of seroma is still one of the main topics of the investigators, who deal with breast carcinoma. For the same purpose, we tried to investigate the effects of tranexamic acid and natural collagen on postmastectomy seromas. Standart procedure of mastectomy and axillary dissection was performed to three different groups of rats. Three different medical agents were administrated to the operation site before skin closure, which were saline, tranexamic asid, naturel collagen; and the groups were named as control group, tranexamic acid group and collagen group, respectively. The seroma collected at the operation site was aspirated at the fifth and seventh postoperative days. Statistical analysis was performed to compare the results of the three groups. As a result, both tranexamic acid and natural collagen have been found to he effective in the prevention of postmastectomy seroma, when compared with the control group (p;lt;0.0034 and p;lt;0.0006, respectively). Natural collogen was more potent than tranexamic acid as approved by statistical analysis (p;lt;0.0027).Meme kanseri, kadınlardaki en sık kanser tipidir. Kadınlardaki kanserlerin % 35'ini oluşturur. Meme kanserinin tedavisinde birçok cerrahi prosedür tanımlanmıştır ve bu prosedürlere ait komplikasyonlar içinde en sık görüleni, % 26-52 ile seromadır. Seromanın önlenmesi, halen meme kanseri ile uğraşan araştırmacıların ana başlıklarından birini oluşturmaktadır. Biz de aynı amaçla, traneksamik asit ve doğal kollagenin postmastektomi seromalardaki etkilerini araştırdık. Standart mastektomi ve aksiller diseksiyon prosedürü, 3 ayrı rat grubuna uygulandı. Serum fizyolojik, traneksamik asit ve doğal kollagenden oluşan 3 ajan, cilt dikişleri öncesi loja bırakıldı. Kontrol grubu, traneksamik asit grubu ve kollagen grubu olarak adlandırılan rotlara, postoperatif 5. ve 7. günlerde serama aspirasyonu uygulandı. Üç grubun sonuçlarını kıyaslamak için istatistiki analiz yapıldı ve hem traneksamik asit, hem de doğal kollagen, kontrol grubuyla kıyaslandığında postmastektomi seromasının önlenmesinde etkili bulundu (sırasıyla p0.0034 ve p0.0006). İstatistiki analiz sonucunda doğal kollagen, traneksamik aside göre daha etkin bulundu (p0.0027)

Delta MELD as a predictor of early outcome in adult-to-adult living donor liver transplantation

Background/Alms: An increased post-operative mortality risk has been reported among patients who undergo living donor liver transplantation (LDLT) with higher model for end-stage liver disease (MELD) scores. In this study, we investigated the effect of MELD score reduction on post-operative outcomes in patients with a high MELD (>= 20) score by pre-transplant management.Materials and Methods: We retrospectively analyzed 386 LDLT cases, and patients were divided into low-MELD (= 20, n=93) groups according to their MELD score at the time of index hospitalization. Patients in the high-MELD group were managed specifically according to a treatment algorithm in an effort to decrease the MELD score. Patients in the high-MELD group were further divided into 2 subgroups: (1) responders (n=34) to pre-transplant treatment with subsequent reduction of the MELD score by a minimum of I point vs. (2) non-responders (n=59), whose MELD score remained unchanged or further increased on the day of LDLT. Responders vs. non-responders were compared according to etiology, demographics, and survival

How to select which anterior sector drainage veins to reconstruct in right lobe living donor liver transplantation?

..