EASL-EORTC clinical practice guidelines : management of hepatocellular carcinoma

Since the publication of the American Association for the Study of Liver Diseases (AASLD) practice guidelines on the management of hepatocellular carcinoma (HCC) in 2005, new information has emerged that requires that the guidelines be updated. The full version of the new guidelines is available on the AASLD Web site at http://www.aasld.org/practiceguidelines/ Documents/Bookmarked%20Practice%20Guidelines/ HCCUpdate2010.pdf. Here, we briefly describe only new or changed recommendations.

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AASLD PRACTICE GUIDELINE Management of Hepatocellular Carcinoma: An Update

Background The role of orthotopic liver transplantation in the treatment of patients with cirrhosis and hepatocellular carcinoma is controversial, and determining which patients are likely to have a good outcome after liver transplantation is difficult. Methods We studied 48 patients with cirrhosis who had small, unresectable hepatocellular carcinomas and who underwent liver transplantation. In 94 percent of the patients, the cirrhosis was related to infection with hepatitis B virus, hepatitis C virus, or both. The presence of tumor was confirmed by biopsy or serum alpha-fetoprotein assay. The criteria for eligibility for transplantation were the presence of a tumor 5 cm or less in diameter in patients with single hepatocellular carcinomas and no more than three tumor nodules, each 3 cm or less in diameter, in patients with multiple tumors. Twenty-eight patients with sufficient hepatic function underwent treatment for the tumor, mainly chemoembolization, before transplantation. After liver transplantation...

Liver transplantation for the treatment of small hepatocellular carcinomas in patients with cirrhosis

https://aasldpubs.onlinelibrary.wiley.com/doi/pdf/10.1002/hep.20933

Management of hepatocellular carcinoma.

Clinical Management of Hepatocellular Carcinoma. Conclusions of the Barcelona-2000 EASL Conference

Background: Gastrectomy often leads to malnutrition. Objective: The aim of this study was to analyze nutritional and digestive effects of gastrectomy for cancer. Patients and methods: Gastrectomized patients were studied by nutritional assessment including a weekly nutritional diary exploring digestive symptoms. Results: Thirty-two patients were analyzed after a mean follow-up of 41.8 months. The mean percentage of weight loss was 12.9% ± 13.5%. After total gastrectomy, mean weight loss was 22% ± 1.2%, against 7.4% ±11.9% for subtotal gastrectomy (p = 0.002). Moreover, advancing age was related to weight loss (p = 0.02), with a peak around 70 years. The most frequent postprandial symptoms were abdominal swelling (62%) and early satiety (59%). Finally, findings of the present study imply that over a long follow-up, there are no specific intolerances related to gastrectomy. Conclusions: Patients who have undergone a total gastrectomy and elderly gastrectomized patients are at risk of malnutrition and need postoperative nutritional support.

/pdf/nutritional-and-digestive-effects-of-gastrectomy-for-gastric-8k94rh8899.pdf

Nutritional and digestive effects of gastrectomy for gastric cancer

Several retrospective analyses have recently shown the advantage of liver transplantation (OLT) for patients with hepatocellular carcinoma (HCC) at early tumor stages. Preliminary results of a prospective series of OLT for unresectable small HCC arising in cirrhosis are reported. Eighteen out of 22 patients (82%) are alive without evidence of HCC recurrence after a median follow-up of 11 months.

Reappraisal of the role of liver transplantation in the treatment of hepatocellular carcinoma arising in cirrhosis

127 anterior resections for adenocarcinoma of the rectum and sigmoid were performed at the Istituto Nazionale Tumori from 1950 to 1972 In 48% of cases the site of tumor was upper rectum and recto-sigmoid The surgical mortality rate was 4,7% Complications were observed in about 40%, fecal fistula being the most frequent It seems correlable with the anastomotic technique and is significantly reduced by colostomy Local failure occurred in 8,3% of patients with maximum rate (28,5%) for tumors located under 12 cm from the anus The 5-year over-all survival rate was 73,3% with substantial differences according to the extent in initial disease

[Immediate and long-term results of anterior resection in tumors of the rectum and sigmoid (author's transl)].

The main features of the hemangiopericytoma: its ubiquity, the different grades of malignancy, the lack of correlation between clinical and histological features are discussed in the light of the literature and the experience gained at the National Cancer Institute of Milan. Surgical excision plays a very important role in the management of this tumor. The palliative results recently obtained with chemotherapy are set forth.

Roberto Doci

Papers

Nutritional and digestive effects of gastrectomy for gastric cancer

Reappraisal of the role of liver transplantation in the treatment of hepatocellular carcinoma arising in cirrhosis

[Immediate and long-term results of anterior resection in tumors of the rectum and sigmoid (author's transl)].

[Report of 11 cases of hemangiopericytoma and review of the most recent literature (author's transl)].

Treatment of a duodenojejunal fistula with percutaneous transgastric drainage