Liver transplantation for non-resectable liver metastases from colorectal cancer: a systematic review and meta-analysis

Backgrounds Colorectal liver metastases were historically considered a contraindication to liver transplantation, but dismal outcomes for those with metastatic colorectal cancer and advancements in liver transplantation (LT) have led to a renewed interest in the topic. We aim to compare the current evidence for liver transplantation for non-resectable colorectal liver metastases (NRCLM) with the current standard treatment of palliative chemotherapy. Methods A systematic review and meta-analysis of proportions was conducted following screening of MEDLINE, EMBASE, SCOPUS and CENTRAL for studies reporting liver transplantation for colorectal liver metastases. Post-operative outcomes measured included one-, three- and five-year survival, overall survival, disease-free survival and complication rate. Results Three non-randomised studies met the inclusion criteria, reporting a total of 48 patients receiving LT for NRCLM. Survival at one-, three- and five-years was 83.3–100%, 58.3–80% and 50–80%, respectively, with no significant difference detected (p = 0.22, p = 0.48, p = 0.26). Disease-free survival was 35–56% with the most common site of recurrence being lung. Thirteen out of fourteen deaths were due to disease recurrence. Conclusion Although current evidence suggests a survival benefit conferred by LT in NRCLM compared to palliative chemotherapy, the ethical implications of organ availability and allocation demand rigorous justification. Concomitant improvements in the management of patients following liver resection and of palliative chemotherapy regimens is paramount

Pancreatic Surgery

Markus Trochsler, Thomas Satyadas and Harsh A. Kanher

Surgical outcomes following pancreatic resection at a low-volume community hospital. Do all patients need to be sent to a regional cancer center?

Harsh Kanhere, Thomas Satyadas, Guy J. Madder

Evolution in technique of laparoscopic pancreaticoduodenectomy: a decade long experience from a tertiary center

Thomas Satyadas, Harsh A. Kanhere, Chris Lauder and Guy J. Madder

Pyogenic liver abscess trends in South Australia

Article first published online: 14 OCT 2013Background: Pyogenic liver abscess (PLA) is an uncommon but potentially life-threatening condition. Due to advances in diagnostic and treatment methods, the mortality rate has reduced in recent decades. The aim of this study was to gather recent data to examine PLA trends in South Australia. Methods: The medical records of all patients admitted to The Queen Elizabeth Hospital, South Australia, between November 2000 and November 2009 with a primary or secondary diagnosis of PLA were retrospectively reviewed. Results: Thirty-six patients were identified. Twenty (55.6%) were male and 16 (44.4%) female. The mean patient age was 70.2 years. A single PLA was found in 21 (58.3%) patients and multiple abscesses in 15 (41.7%) patients. Segment 7 of the liver was most commonly affected (10 cases). In 12 patients, multiple organisms were identified. Escherichia coli, Klebsiella pneumonia and Streptococcus species were most commonly identified. All patients received antibiotics and 27 (75%) received additional treatment. Nine patients received open abscess drainage. Fourteen received ultrasound-guided or computed tomography-guided percutaneous drainage or aspiration. One patient died as a direct result of a PLA. Discussion: Since its first description, the epidemiology of PLA has changed. Patients diagnosed with PLA are now older, the male predominance is less and the organism more likely to originate from the biliary tract. The approach to PLA has also progressed with more accurate imaging and better treatment methods becoming available, which has resulted in a low mortality rate. This series confirms the described trends in South Australia.Angela Christine Chang, Ngoc Buu Ha, Thomas Satyadas and Guy Madder

Primary amyloidosis presenting as cholestatic jaundice

This case report describes a rare but fatal presentation of amyloidosis. Multiple organs and systems can be affected by the condition. Cholestatic jaundice is a infrequent manifestation of amyloidosis. An 80-year-old patient died within a month after onset of jaundice as a result of irreversible damage caused by deposition of amyloid. The relatively short period of time did not allow a tissue sample to be obtained from the patient and the final diagnosis was made postmortem