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Vol 8, No 1 (2006)
Published online: 2006-03-17
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The early results of the surgical treatment of liver focal lesions in the 15-year experience of the Department of General and Vascular Surgery at the Medical University of Silesia

Krzysztof Ziaja, Tomasz Ludyga, Marek Kazibudzki, Arkadiusz Krupowies, Damian Ziaja, Wacław Kuczmik, Dariusz Stańczyk, Jakub Żmudzki, Grzegorz Biolik, Przemysław Nowakowski, Tomasz Orawczyk, Tomasz Urbanek
Chirurgia Polska 2006;8(1):64-72.

open access

Vol 8, No 1 (2006)
Published online: 2006-03-17

Abstract

Introduction: A prevalence of imaging examinations facilitating diagnosis and differentiations of hepatic tumors contributes to the introduction of surgery in very early moment what improves the final results of treatment. It has a great impact on the number of surgical operations on the liver enhancement in the recent years. Authors analyzed the early results of surgical treatment of hepatic tumors performed in the Department of General and Vascular Surgery Silesian Medical Academy in the last 15 years. We focused especially on post-operative complications and causes of death.
Material and methods: Between September 1991 and January 2006 242 patients who were treated in the Department of General and Vascular Surgery because of hepatic tumors, which were recognized in ultrasound or tomographic examination. Among them there were 104 men (43%) and 138 women (57%), in the age from 22 to 77 years (average 53). The 203 (84%) patients were symptomatic. In 156 patients hepatic resection were done, 29 patients underwent bill ducts drainage using Goetze-Rodney-Smith manner, whereas in the rest of the patients with non-operable tumor specimens were taken for histological analysis, tumor alcoholization was done or only laparotomy was performed. In all the patients the abdominal approach was used and Pringle’s maneuver was applied during parenchymal dissection. The method of digitaloclastic in segment dissection was used.
Results: In post-operative period 19 patients died; 7 of them after paliative Goetze-Rodney-Smith drainage, 9 after liver resection and 3 after laparotomy. The causes of death after paliative operation were: myocardial infarct, hepatic coma, acute circulatory and respiratory insufficiency, massive bleeding from gastrointestinal tract and neoplasmatic cachexia. After laparotomy neoplasmatic process advancement, cachexia, liver insufficiency. In the group of patients after hepatic resection the cause of death was: an acute circulatory insufficiency as a result of myocardial infarction, an acute circulatory insufficiency due to significant intraoperative blood loss, an acute hepatic and renal failure and an acute hepatic failure with increasing jaundice with leucocytosis. Among complications observed postoperatively, the most frequent were: fever and prolong subfebrlie status, circulatory insufficiency, wounds suppuration and icterus.
Conclusions: 1. Paliative decompression of mechanical jaundience using drainage procedures improves quality of life of the patients with non-operable hepatic hilus tumors.
2. A liver resection is the treatment of choice in patients with liver tumors.
3. A surgical liver resections should also be undertaken when it is impossible to establish unambiguous diagnosis during the diagnostic process.

Abstract

Introduction: A prevalence of imaging examinations facilitating diagnosis and differentiations of hepatic tumors contributes to the introduction of surgery in very early moment what improves the final results of treatment. It has a great impact on the number of surgical operations on the liver enhancement in the recent years. Authors analyzed the early results of surgical treatment of hepatic tumors performed in the Department of General and Vascular Surgery Silesian Medical Academy in the last 15 years. We focused especially on post-operative complications and causes of death.
Material and methods: Between September 1991 and January 2006 242 patients who were treated in the Department of General and Vascular Surgery because of hepatic tumors, which were recognized in ultrasound or tomographic examination. Among them there were 104 men (43%) and 138 women (57%), in the age from 22 to 77 years (average 53). The 203 (84%) patients were symptomatic. In 156 patients hepatic resection were done, 29 patients underwent bill ducts drainage using Goetze-Rodney-Smith manner, whereas in the rest of the patients with non-operable tumor specimens were taken for histological analysis, tumor alcoholization was done or only laparotomy was performed. In all the patients the abdominal approach was used and Pringle’s maneuver was applied during parenchymal dissection. The method of digitaloclastic in segment dissection was used.
Results: In post-operative period 19 patients died; 7 of them after paliative Goetze-Rodney-Smith drainage, 9 after liver resection and 3 after laparotomy. The causes of death after paliative operation were: myocardial infarct, hepatic coma, acute circulatory and respiratory insufficiency, massive bleeding from gastrointestinal tract and neoplasmatic cachexia. After laparotomy neoplasmatic process advancement, cachexia, liver insufficiency. In the group of patients after hepatic resection the cause of death was: an acute circulatory insufficiency as a result of myocardial infarction, an acute circulatory insufficiency due to significant intraoperative blood loss, an acute hepatic and renal failure and an acute hepatic failure with increasing jaundice with leucocytosis. Among complications observed postoperatively, the most frequent were: fever and prolong subfebrlie status, circulatory insufficiency, wounds suppuration and icterus.
Conclusions: 1. Paliative decompression of mechanical jaundience using drainage procedures improves quality of life of the patients with non-operable hepatic hilus tumors.
2. A liver resection is the treatment of choice in patients with liver tumors.
3. A surgical liver resections should also be undertaken when it is impossible to establish unambiguous diagnosis during the diagnostic process.
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Keywords

liver surgery; liver tumor; symptoms; results

About this article
Title

The early results of the surgical treatment of liver focal lesions in the 15-year experience of the Department of General and Vascular Surgery at the Medical University of Silesia

Journal

Chirurgia Polska (Polish Surgery)

Issue

Vol 8, No 1 (2006)

Pages

64-72

Published online

2006-03-17

Bibliographic record

Chirurgia Polska 2006;8(1):64-72.

Keywords

liver surgery
liver tumor
symptoms
results

Authors

Krzysztof Ziaja
Tomasz Ludyga
Marek Kazibudzki
Arkadiusz Krupowies
Damian Ziaja
Wacław Kuczmik
Dariusz Stańczyk
Jakub Żmudzki
Grzegorz Biolik
Przemysław Nowakowski
Tomasz Orawczyk
Tomasz Urbanek

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