Showing papers by "René Adam published in 1997"

Influence of preoperative transarterial lipiodol chemoembolization on resection and transplantation for hepatocellular carcinoma in patients with cirrhosis.

Abstract: OBJECTIVE: To investigate the impact of preoperative transarterial lipiodol chemoembolization (TACE) in the management of patients undergoing liver resection or liver transplantation for hepatocellular carcinoma PATIENTS AND METHODS: TACE was performed before surgery in 49 of 76 patients undergoing resection and in 54 of 111 patients undergoing liver transplantation Results were retrospectively analyzed with regard to the response to treatment, the type of procedure performed, the incidence of complications, the incidence and pattern of recurrence, and survival RESULTS: In liver resection, downstaging of the tumor by TACE (21 of 49 patients [42%]) and total necrosis (24 of 49 patients [50%]) were associated with a better disease-free survival than either no response to TACE or no TACE (downstaging, 29% vs 10% and 11 % at 5 years, p = 008 and 010; necrosis, 22% vs 13% and 11% at 5 years, p = 01 and 03) Five patients (10%) with previously unresectable tumors could be resected after downstaging In liver transplantation, downstaging of tumors >3 cm (19 of 35 patients [54%]) and total necrosis (15 of 54 patients [28%]) were associated with better disease-free survival than either incomplete response to TACE or no TACE (downstaging, 71 % vs 29% and 49% at 5 years, p = 001 and 009; necrosis, 87% vs 47% and 60% at 5 years, p = 003 and 014) Multivariate analysis of the factors associated with response to TACE showed that downstaging occurred more frequently for tumors >5 cm CONCLUSIONS: Downstaging or total necrosis of the tumor induced by TACE occurred in 62% of the cases and was associated with improved disease-free survival both after liver resection and transplantation In liver resection, TACE was also useful to improve the resectability of primarily unresectable tumors In liver transplantation, downstaging in patients with tumors >3 cm was associated with survival similar to that in patients with less extensive disease

Repeat hepatectomy for colorectal liver metastases.

Abstract: Objective The authors assess the long-term results of repeat hepatectomies for recurrent metastases of colorectal cancer and determine the factors that can predict survival. Summary background data Safer techniques of hepatic resection have allowed surgeons to consider repeat hepatectomy for colorectal metastases in an increasing number of patients. However, higher operative bleeding and increased morbidity have been reported after repeat hepatectomies, and the long-term benefit of these procedures needs to be evaluated. Study population Sixty-four patients from a group of 243 patients resected for colorectal liver metastases were submitted to 83 repeat hepatectomies (64 second, 15 third, and 4 fourth hepatectomies). Combined extrahepatic surgery was performed in 21 (25%) of these 83 repeat hepatectomies. Results There was no intraoperative or postoperative mortality. Operative bleeding was not significantly increased in repeat hepatectomies as compared to first resections. Morbidity and duration of hospital stay were comparable to first hepatectomies. Overall and disease-free survival after a second hepatectomy were 60% and 42%, respectively, at 3 years and 41% and 26%, respectively, at 5 years. Factors of prognostic value on univariate analysis included the curative nature of first and second hepatectomies (p = 0.04 and p = 0.002, respectively), an interval between the two procedures of more than 1 year (p = 0.003), the number of recurrent tumors (p = 0.002), serum carcinoembryonic antigen levels (p = 0.03), and the presence of extrahepatic disease (p = 0.03). Only the curative nature of the second hepatectomy and an interval of more than 1 year between the two procedures were independently related to survival on multivariate analysis. Conclusions Repeat hepatectomies can provide long-term survival rates similar to those of first hepatectomies, with no mortality and comparable morbidity. Combined extrahepatic surgery can be required to achieve tumor eradication. Repeat hepatectomies appear worthwhile when potentially curative.

Place of cryosurgery in the treatment of malignant liver tumors.

Abstract: ObjectiveThe authors evaluate the results of cryosurgery in malignant liver tumors.Summary Background DataThe outcome of primary or secondary liver tumors is poor when resection can not be achieved. Encouraging results of cryosurgery have been reported in unresectable liver tumors, but this trea

Long-term results of combined kidney and liver transplantation at one center

Abstract: RENAL FAILURE associated with end stage hepatopathy has been, until recently, considered as a contraindication for orthotopic liver transplantation (OLT).1 This was because of the high mortality rate and the serious complications found during the posttransplant period.2 Because the global results of combined kidney and liver transplantation (CKLT) have improved and there are increasing numbers of patients in dialysis who have chronic liver diseases, CKLT has emerged as the technique of choice.3 This study reports our single-center experience of 22 CKLTs performed between April 1986 and December 1995 in patients with end stage chronic renal failure or with biopsy-proven kidney disease associated with end stage liver failure. This study also compares these results with a control series of 785 kidney-transplanted patients in the same unit during the same period.

Assessment of the results of liver transplantation and definition of criteria for the evaluation of transplant centers.

Abstract: T HE first NIH Consensus Conference held in Washington in 1983l accepted for the first time, liver transplantation as a treatment modality. The following years were characterised by a dramatic increase in the number of transplant centers both in Europe and the United States. This was paralleled by an increase in the number of indications and potential donor candidates motivating in 1993 a second Conference of the Consensus in Paris on the indications of transplantation.2 Both Consensus Conferences stressed that a careful evaluation of results was necessary to allow the full therapeutic potential of liver transplantation to be realised. Furthermore, it was recognised that there was a need for standard parameters which would facilitate the comparison of results from different units. The aim of this study was to address this issue based on a single-center experience of more than 1000 transplantations.