BACKGROUND:Laparoscopic liver resection is one of the most complex procedures in hepatobiliary surgery.In the last two decades,laparoscopic liver surgery has emerged as an option at major academic institutions.The pur...BACKGROUND:Laparoscopic liver resection is one of the most complex procedures in hepatobiliary surgery.In the last two decades,laparoscopic liver surgery has emerged as an option at major academic institutions.The purpose of this study is to describe the initial experience of minimally invasive liver resections at a non-academic institution. METHODS:We retrospectively reviewed medical records of patients undergoing laparoscopic liver resections between June 2006 and December 2009 at our center.Indications, technical aspects,and outcomes of these patients are described. RESULTS:Laparoscopic liver resection was attempted in 28 patients.Of these,27 patients underwent laparoscopic liver resection(22 total laparoscopic and 5 hand assisted)and one needed conversion to open surgery.Twenty patients had a benign lesion and 8 had malignant lesions.Three patients had multiple lesions in different segments requiring separate resections.The lesions were located in segments Ⅱ-Ⅲ(n=18), Ⅳ(n=3),Ⅴ-Ⅵ(n=9),and VII(n=1).Tumor size ranged from 1.5 cm to 8.5 cm.The surgical procedures included left lateral sectionectomy(n=17),left hepatectomy(n=2),sectionectomy (n=8),and local resections(n=4).Median operative time was 110 minutes(range 55-210 minutes),and the median length of hospital stay was 2.5 days(range 1-7 days).There was no perioperative mortality.One patient developed hernia at the site of tumor extraction requiring repair at 3 months. CONCLUSIONS:Laparoscopic liver resections can be safely performed in selected patients with benign and malignant liver tumors.With increasing experience,laparoscopic liver resections are likely to become a favorable alternative to open resection.展开更多
BACKGROUND: Giant cell tumors are rare and highly malignant tumors of the pancreas. Based on two distinct cell populations, they have been divided into two subtypes corresponding to the osteoclast-like giant cell tumo...BACKGROUND: Giant cell tumors are rare and highly malignant tumors of the pancreas. Based on two distinct cell populations, they have been divided into two subtypes corresponding to the osteoclast-like giant cell tumor and the pleomorphic giant cell carcinoma of the pancreas. Distinctive imaging features of the tumors remain uncharacterized. Surgical removal is the only appropriate treatment for them, but responses to chemotherapy or radiotherapy remain undocumented. METHODS: Clinical, radiological, histopathologic, and immuno- histochemical features of two cases of giant cell tumor of the pancreas are presented along with a brief review of the literature. RESULTS: En-bloc resection was done successfully in both cases. The patient with an osteoclast-like giant cell tumor remained disease-free with no clinical or radiological evidence of recurrence at 6 months after surgery. However, the patient with the pleomorphic type died 4 months later due to diffuse pulmonary metastasis. CONCLUSIONS: En-bloc surgical resection is the only appropriate treatment for giant cell tumors. The overall prognosis of these tumors is poorer than that of pancreatic ductal adenocarcinoma, especially the pleomorphic type. More studies are required to document the management and outcomes of the tumors.展开更多
文摘BACKGROUND:Laparoscopic liver resection is one of the most complex procedures in hepatobiliary surgery.In the last two decades,laparoscopic liver surgery has emerged as an option at major academic institutions.The purpose of this study is to describe the initial experience of minimally invasive liver resections at a non-academic institution. METHODS:We retrospectively reviewed medical records of patients undergoing laparoscopic liver resections between June 2006 and December 2009 at our center.Indications, technical aspects,and outcomes of these patients are described. RESULTS:Laparoscopic liver resection was attempted in 28 patients.Of these,27 patients underwent laparoscopic liver resection(22 total laparoscopic and 5 hand assisted)and one needed conversion to open surgery.Twenty patients had a benign lesion and 8 had malignant lesions.Three patients had multiple lesions in different segments requiring separate resections.The lesions were located in segments Ⅱ-Ⅲ(n=18), Ⅳ(n=3),Ⅴ-Ⅵ(n=9),and VII(n=1).Tumor size ranged from 1.5 cm to 8.5 cm.The surgical procedures included left lateral sectionectomy(n=17),left hepatectomy(n=2),sectionectomy (n=8),and local resections(n=4).Median operative time was 110 minutes(range 55-210 minutes),and the median length of hospital stay was 2.5 days(range 1-7 days).There was no perioperative mortality.One patient developed hernia at the site of tumor extraction requiring repair at 3 months. CONCLUSIONS:Laparoscopic liver resections can be safely performed in selected patients with benign and malignant liver tumors.With increasing experience,laparoscopic liver resections are likely to become a favorable alternative to open resection.
文摘BACKGROUND: Giant cell tumors are rare and highly malignant tumors of the pancreas. Based on two distinct cell populations, they have been divided into two subtypes corresponding to the osteoclast-like giant cell tumor and the pleomorphic giant cell carcinoma of the pancreas. Distinctive imaging features of the tumors remain uncharacterized. Surgical removal is the only appropriate treatment for them, but responses to chemotherapy or radiotherapy remain undocumented. METHODS: Clinical, radiological, histopathologic, and immuno- histochemical features of two cases of giant cell tumor of the pancreas are presented along with a brief review of the literature. RESULTS: En-bloc resection was done successfully in both cases. The patient with an osteoclast-like giant cell tumor remained disease-free with no clinical or radiological evidence of recurrence at 6 months after surgery. However, the patient with the pleomorphic type died 4 months later due to diffuse pulmonary metastasis. CONCLUSIONS: En-bloc surgical resection is the only appropriate treatment for giant cell tumors. The overall prognosis of these tumors is poorer than that of pancreatic ductal adenocarcinoma, especially the pleomorphic type. More studies are required to document the management and outcomes of the tumors.
