Technique of vessel-skeletonized parenchyma-sparing hepatectomy for the oncological treatment of bilobar colorectal liver metastases

Background To aid in the oncological management of multiple bilobar colorectal liver metastases (CRLMs), we describe a new surgical procedure, VEssel-Skeletonized PArenchyma-sparing Hepatectomy (VESPAH). Study design Of 152 patients with CRLMs treated with hepatectomy, 33 patients had multiple bilobar liver metastases (≥8 liver metastases); their surgical procedures and clinical outcomes were retrospectively summarized and compared between those who underwent VESPAH and those who underwent major hepatectomy (Major Hx). Results Of the 33 patients, 20 patients were resected by VESPAH (the VESPAH group) and 13 patients by major hepatectomy (Major Hx group). The median number of CRLMs was 13 (range, 8–53) in the VESPAH group and 10 (range, 8–41) in the Major Hx group (P=0.511). No operative mortality nor severe morbidity was observed in either group. The VESPAH group showed earlier recovery of remnant liver function after surgery than the Major Hx group; the incidence of grade B/C post hepatectomy liver failure was 5% in the VESPAH group and 38% in the Major Hx group, P=0.048). Intrahepatic tumor recurrence was confirmed in 14 (70%) and 7 (54%) patients in the VESPAH and Major Hx groups, respectively (P=0.416). There was no significant difference in median overall survival (OS) after hepatectomy between the two groups; the median OS was 47 months in the VESPAH group and 33 months in the Major Hx group (P=0.481). The VESPAH group showed the higher induction rate of adjuvant chemotherapy within 2 months after surgery (P=0.002) and total number of repeat hepatectomy for intrahepatic recurrence (P=0.060) than the Major Hx group. Conclusions VESPAH enables us to clear surgical navigation by hepatic vessel skeletonization and may enhance patient tolerability of not only adjuvant chemotherapy but also repeat hepatectomies during the patients’ lifetimes.

Endovascular repair of a complex renal artery aneurysm using Pipeline (TM) Embolization Device (PED) assisted coil embolization

Background: We describe the treatment of a renal artery aneurysm with complex anatomy using coils and the Pipeline (TM) Embolization Device (Medtronic, Irvine, CA), a flow-diverting stent typically used for the treatment of intracranial aneurysms. Methods: A 62-year-old female with history of an asymptomatic right renal artery aneurysm that was discovered incidentally 10 years ago was found to have enlargement of the aneurysm (1.9cm to 2.7cm) on a repeat surveillance CT scan. She was successfully treated with combined Pipeline Embolization Device and coil embolization of the aneurysm sac. Results: Post-procedural angiography showed complete occlusion of the aneurysm with maintenance of perfusion to the entire kidney. Conclusion: Pipeline (TM) assisted coil embolization may be an option for parenchyma-sparing treatment of renal artery aneurysms with complex anatomy.

Our Parenchyma-Sparing Surgical Treatment Results in Carcinoid Tumors and Changes in the Surgical Approach

INTRODUCTION: Hilar/mediastinal lymph node sampling with lobectomy are the most common surgical methods used for the surgical treatment of carcinoid tumors. Bronchoplastic approaches together with lobectomy enable sparing of normal lung tissue and provide an alternative surgical approach to avoid pneumonectomy by enabling sleeve resection for centrally located tumors. The aim of this study was to present our parenchyma-sparing open surgical treatment experiences with the carcinoid tumor cases operated in our clinic in light of the new developments in the literature METHODS: The 11 tumor cases that had been diagnosed with carcinoid tumor and undergone surgical resection at our clinic between 2006 and 2012 were retrospectively revealed for tumor epidemiology, diagnostic methods, tumor localization, surgical treatment method, type and stage and postoperative complications. RESULTS: There were 7 males and 4 females with a mean age of 54.81±13.75 years (31-72 years). Cough was the most common presentation symptom with 8 cases (72.7%). A bronchoscopic biopsy was used for the definite diagnosis in 8 cases (72.7%). There were 11 (84.6%) typical and 2 (15.4%) atypical carcinoid tumors in the 11 cases. The most common surgical methods were lobectomy in 7 cases (53.8%) (3 sleeve, 1 bronchoplastic) and wedge resection in 4 cases. We found bilateral synchronous and 3 years later metachronous carcinoid tumor in a single case. The postoperative pathology diagnosis was T2N0M0 in 6 cases (54.5%) and T1N0M0 in 3 cases (27.2%). There was 1 atelectasis and 1 prolonged air leak in the postoperative stage. DISCUSSION AND CONCLUSION: Although we still use thoracotomy and lobectomy for the surgical treatment of carcinoid tumors in our clinic, we currently prefer minimal invasive surgery with the VATS and robotic surgery techniques that are gradually becoming more popular.