3 research outputs found
Surgery for malignant liver tumors
Recent decades have witnessed an increase in liver resections. There is
a need for an update on factors related to the management of liver
tumors in view of newer published data. A systematic search using
Medline, Embase, and Cochrane Central Register of Controlled Trials for
the years 1983-2008 was performed. The IHPBA classification provides a
suitable nomenclature of liver resections. While one randomized trial
has provided an objective time of 30 min as optimal for intermittent
pedicle occlusion, another randomized study has demonstrated the
feasibility of performing liver resections without pedicle clamping. A
randomized trial has demonstrated the benefit of clamp crushing over
newer techniques of liver transection. Cohort studies support
anatomical resections when feasible in terms of outcomes. Nonrandomized
studies also support nonanatomical and ablative therapies in patients
with cirrhosis and small remnant livers. A randomized trial has shown
comparable long-term outcomes of radiofrequency ablation (RFA) and
surgery for tumors < 5 cm. No randomized trials comparing
laparoscopy and open surgery exist. Surgery remains an important
treatment modality for malignant hepatic neoplasms. While anatomical
resections provide improved survival, the choice of nonanatomical
versus anatomical resections should be individualized taking into
account factors such as cirrhosis and function of the liver remnant. A
clear margin of resection is essential in all surgically resected
cases. RFA is emerging as a useful, often complimentary tool, to
surgery when dealing with complex tumors or tumors in patients with a
poor liver function. Laparoscopic ultrasonography is useful in staging
and performance of RFA