Laparoscopic Excision of a Large Hepatic Cyst

The authors suggest that laparoscopic techniques may be feasible in the pediatric patient with rare, benign hepatic cysts

Laparoscopic Gastrojejunostomy for the Treatment of Gastric Outlet Obstruction

These authors found that laparoscopic gastrojejunostomy for the management of gastric outlet obstruction can be performed with good outcomes and acceptable complication rates

Resection or transplant‐listing for solitary hepatitis C‐associated hepatocellular carcinoma: an intention‐to‐treat analysis

AbstractObjectivesThe relative roles of liver resection (LR) and liver transplantation (LT) in the treatment of a solitary hepatocellular carcinoma (HCC) remain unclear. This study was conducted to provide a retrospective intention‐to‐treat comparison of these two curative therapies.MethodsRecords maintained at the study centre for all patients treated with LR or listed for LT for hepatitis C‐associated HCC between January 2002 and December 2007 were reviewed. Inclusion criteria required: (i) an initial diagnosis of a solitary HCC lesion measuring ≤ 5 cm, and (ii) Child–Pugh class A or B cirrhosis. The primary endpoint analysed was intention‐to‐treat survival.ResultsA total of 75 patients were listed for transplant (LT‐listed group) and 56 were resected (LR group). Of the 75 LT‐listed patients, 23 (30.7%) were never transplanted because they were either removed from the waiting list (n = 13) or died (n = 10). Intention‐to‐treat median survival was superior in the LR group compared with the LT‐listed group (61.8 months vs. 30.6 months), but the difference did not reach significance. Five‐year recurrence was higher in the LR group than in the 52 LT patients (71.5% vs. 30.5%; P < 0.001).ConclusionsIn the context of limited donor organ availability, partial hepatectomy represents an efficacious primary approach in properly selected patients with hepatitis C‐associated HCC

European Society of Organ Transplantation (ESOT) Consensus Report on Downstaging, Bridging and Immunotherapy in Liver Transplantation for Hepatocellular Carcinoma

Liver transplantation offers the best chance of cure for most patients with non-metastatic hepatocellular carcinoma (HCC). Although not all patients with HCC are eligible for liver transplantation at diagnosis, some can be downstaged using locoregional treatments such as ablation and transarterial chemoembolization. These aforementioned treatments are being applied as bridging therapies to keep patients within transplant criteria and to avoid them from dropping out of the waiting list while awaiting a liver transplant. Moreover, immunotherapy might have great potential to support downstaging and bridging therapies. To address the contemporary status of downstaging, bridging, and immunotherapy in liver transplantation for HCC, European Society of Organ Transplantation (ESOT) convened a dedicated working group comprised of experts in the treatment of HCC to review literature and to develop guidelines pertaining to this cause that were subsequently discussed and voted during the Transplant Learning Journey (TLJ) 3.0 Consensus Conference that took place in person in Prague. The findings and recommendations of the working group on Downstaging, Bridging and Immunotherapy in Liver Transplantation for Hepatocellular Carcinoma are presented in this article.</p

Resection of Nonalcoholic Steatohepatitis-Associated Hepatocellular Carcinoma: A Western Experience

Introduction. Hepatocellular carcinoma is now known to arise in association with nonalcoholic steatohepatitis. The aim of this study is to examine the clinicopathological features of this entity using liver resection cases at a large Western center. Methods. We retrospectively reviewed all cases of partial liver resection for hepatocellular carcinoma over a 10-year period. We included for the purpose of this study patients with histological evidence of nonalcoholic steatohepatitis and excluded patients with other chronic liver diseases such as viral hepatitis and alcoholic liver disease. Results. We identified 9 cases in which malignancy developed against a parenchymal background of histologically-active nonalcoholic steatohepatitis. The median age at diagnosis was 58 (52–82) years, and 8 of the patients were male. Median body mass index was 30.2 (22.7–39.4) kg/m(2). Hypertension was present in 77.8% of the patients and diabetes mellitus, obesity, and hyperlipidemia in 66.7%, respectively. The background liver parenchyma was noncirrhotic in 44% of the cases. Average tumor diameter was 7.0 ± 4.8 cm. Three-fourths of the patients developed recurrence within two years of resection, and 5-year survival was 44%. Conclusion. Hepatocellular carcinoma may arise in the context of nonalcoholic steatohepatitis, often before cirrhosis has developed. Locally advanced tumors are typical, and long-term failure rate following resection is high