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12LIVER RESECTIONS IN BENIGN LIVER TUMORS. STATISTICAL DATA
Dr. Rusenov D.
MD
Clinic of liver, biliary pancreatic and general surgery Acibadem City Clinic Tokuda Hospital EAD Sofia https://doi.org/10.5281/zenodo.7495001
Abstract.
There are numerous publications in the world and in our specialized literature on liver resection surgery in primary hepatic tumors, metastases from colorectal and non-colorectal cancer, as well as benign diseases. Undoubtedly, radical surgical resection, when possible, is the treatment of choice and is accepted as the "gold standard".
To determine the prognostic role of the type of liver resection for the risk of occurrence, early postoperative mortality, we can indicate the following points:
1. Which is the more appropriate method-anatomical liver resections (AnatLR) or atypical (non-anatomical) liver resections (AtypLR) ?
2. Method of resection for liver metastases. Liver metastases are also a dilemma, asking the question: "Which is the most appropriate resection"
There are a number of factors that are important for determining the type of liver resection in metastatic tumors: number of lesions, size, location, type of pathological lesion (primary location - cancer ?, NET, GIST?); the volume of the "healthy" parenchyma.
We formulated the following goal of the study: Determining the possible prognostic role of the type of liver resection for the risk of occurrence, frequency and severity of hemorrhage as an early postoperative specific complication.
Keywords: liver resections. reasons INTRODUCTION:
In order to achieve clarity and with an effort not to fall into well-known details and generally accepted principles and criteria, the main indications for Liver resection surgery are indicated with brief statistical and clinico-pathological data about them, as nosological units. The basic prerequisites related to the chance of success and the risks of liver resection are presented in more detail.
OBJECTIVE:
Data processing and analysis regarding the indication for liver resection - benign, malignant, primary or metastatic, in the case of metastatic - synchronous or metachronous;
As in all areas of medicine and all medical specialties, the selection of the volume and method of liver resection should be based on generally accepted algorithms and standards in liver resection surgery, i.e. enters the rubric „evidence based medicine". MATERIALS AND METHODS: For the period from January, 2007 - March, 2018 in Clinic of liver, biliary pancreatic and general surgery, Acibadem City Clinic Tokuda Hospital ,1021 interventions were performed on the liver:
Cases of intervention other than liver resection by definition were excluded ISGLS, "removal of part of the liver parenchyma due to involvement by a disease process or traumatic injury resulting in devitalization of the parenchyma".
Thus, the study did not find the cases of: J hepatotomy;
cystotomies and cyst resections, practically without removal of functioning or pathologically altered liver parenchyma;
J liver biopsies, alcoholization of tumors. liver
biopsies, alcoholization of tumors;
r interruption of trunk branches of the hepatic artery and/or portal vein with the aim of hypoperfusion of a given area (segments, lobe); r suture of the liver in trauma; Thus, a total of 852 cases of liver resections were included in the series RESULTS:
INDICATIONS FOR LIVER RESECTIONS: 1. Benign diseases requiring liver resection This mainly includes benign tumors and less often parasitosis (hepatic echinococcus), abscesses, trauma. The most common benign lesions of the liver are hemangioma, focal nodular hyperplasia (FNH) and hepatic (hepatocellular) adenoma (HCA). [1-6]
1.1. Hemangiomas affect 1-5% of the population. They contain fibrous tissue and small blood vessels that grow and range in size from < 1 centimeters in diameter to >10 centimeters (so-called "giant" cavernous hemangiomas). They are usually small and asymptomatic, i.e. not indicated for surgical removal. Symptomatic ones are >4 centimeters in size. Most are discovered accidentally during ultrasound, CT, MRI or even intraoper-atively - the so-called. "accidentals". Hepatic resection of hemangioma is discussed in two cases. / Fig. 1 /[7~14 ] r symptoms are disturbing - they are the result of an acute / subacute / chronic complication, such as acute pain in the right hypochondrium or upper abdomen due to thrombosis, hemorrhagic shock from intraabdominal rupture, compression on the stomach or duodenum, biliary ducts, portal vein or inferior vena cava vein;
L hemangioma grows rapidly - a prerequisite for malignant degeneration into hemangiosarcoma?
Fig. 1 Hemangioma hepatis
1.2. Follicular nodular hyperplasia is defined by some authors as "localized hamartoma". Histologically, it often resembles macronodular cirrhosis. Diagnostic
over 90% of the cases are "accidentalomas" detected by
MRI or CT. Each unclear case may require a fine-needle punctory biopsy under as ultrasonography-control confirmation. Indications for liver resection
resemble those for hemangiomas./ Fig.2 /[914]
Fig.2 FNH in a 47-year-old woman with visible nodularity
1.3.HCA / hepatocellular adenoma / is a rare, usually solitary lesion that has a low risk of spontaneous rupture or malignancy (facultative precancer for hepatocellular carcinoma). It has long been proven to be associated with the use of oral contraceptives, as well as regression in more than 50% of cases after stopping them. Most HCA are
asymptomatic, but large ones can cause right upper quadrant discomfort. Rarely, adenomas manifest as peritonitis and shock due to rupture and intraperitoneal hemorrhage. Liver resection is indicated in HCA > 5 centimeters in diameter, in rapidly growing tumors, in symptomatic cases, and in unclear/uncertain histological verification. / Fig.3 / [9-19]
Fig.3 HCA, A 47-year-old woman with thickened, irregular liver cells
DISCUSSION:
When it comes to a benign process, only the early results are of interest - experiencing the resection without general or specific complications.
Maximal preservation of functioning parenchyma with adequate blood supply and biliary passage is appropriate, with meticulous definitive hemostasis and biliostasis of the resection surface.
In these cases it is not prosecuted:
(a)- "clean line of resection" that is a minimum of 1 centimeters (even 3 centimeters) from the macroscopic border of the tumor is not pursued in order to remove also satellite micrometastases and/or remove adjacent blood vessels with cancer emboli in them or direct tumor invasion;
(b)- very rarely occur against the background of cirrhotic changes.
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