Extent of hepatic resection does not correlate with toxicity following adjuvant chemotherapy

Role of adjuvant therapy after resection of colorectal cancer liver metastases

Liver resection is the goal of treatment strategies for liver-confined metastatic colorectal cancer. However, after resection the majority of patients will experience recurrence. Chemotherapy seems to improve outcomes compared with surgery alone. We reviewed the data of the role of adjuvant chemotherapy after resection of liver- confined metastatic colorectal cancer. Optimal regimens and sequencing of chemotherapies when liver resection is an option are unclear. Some suggest that resectable liver metastases, in the absence of high-risk features, should begin with surgery and consideration given to adjuvant chemotherapy after surgery. If high-risk features are present, most physicians prefer a short course of systemic preoperative chemotherapy. Perioperative therapy and regional therapy with hepatic arterial infusion (HAI) both increase disease-free survival (DFS) when compared with surgery alone. In unresectable disease, consideration should be given to systemic chemotherapy with or without a biologic agent or HAI with systemic therapy. If the disease becomes resectable, adjuvant treatment should follow surgery. Adjuvant chemotherapy is usually FOLFOX, but HAI combined with systemic chemotherapy is also an option. The role of adjuvant treatment post-liver resection should not be viewed in isolation but rather in the context of prior treatment, surgical preference, and individual patient characteristics. Perioperative therapy and regional therapy have both shown an increase in DFS. Conducting randomized trials examining the role of adjuvant chemotherapy has been difficult because of rapidly changing chemotherapies.

Antioxidative effects of novel synthetic organoselenium compound in rat lung and kidney

The effects of environmental chemicals, drugs, and physical agents on the developing lung and kidney are influenced by the state of development and maturation. Selenium is an essential element with physiological nonenzymatic antioxidant properties. Therefore, we undertook the present study to evaluate the antioxidant potential of the novel synthetic organoselenium compounds (Se I and Se II). In this study, adult female Wistar rats were treated with DMBA and the novel organoselenium compounds [1-isopropyl-3-methylbenzimidazole-2-selenone (Se I) and 1,3-di-p-methoxybenzylpyrimidine-2-selenone (Se II)] in the determined doses. The protective effects of novel synthetic organoselenium compounds (Se I and Se II) against DMBA-induced changes in levels of some [superoxide dismutase (SOD), catalase (CAT), glutathione peroxidase (GPx), and glutathione reductase (GR) activities and total glutathione (GSH), malonedialdehyde (MDA)] parameters in rat lung and kidney were investigated. As a result, it was found that both Se I and Se II had provided the antioxidant effects against DMBA-induced oxidative stress in rat lung and kidney and lipid peroxidation had also been decreased by these organoselenium compounds.

The investigation of the antioxidative properties of the novel synthetic organoselenium compounds in some rat tissues

DMBA (7,12-dimethylbenz[a]anthracene) is a polycyclic aromatic hydrocarbon (PAH) known to cause tumors in rats. Selenium is an essential element with physiological non-enzymatic antioxidant properties. Because of the health problems induced by many environmental pollutants, many efforts have been undertaken in evaluating the relative antioxidant potential of selenium and synthetic organoselenium compounds. In this study, adult female Wistar rats were treated with DMBA and the novel organoselenium compounds (1-isopropyl-3-methylbenzimidazole-2-selenone [SeI] and 1,3-di-p-methoxybenzylpyrimidine-2-selenone [SeII]) in the determined doses. The protective effects of novel synthetic organoselenium compounds (SeI and SeII) against DMBA-induced changes in superoxide dismutase (SOD), catalase (CAT), glutathione peroxidase (GPx), and glutathione reductase (GR) activities and total glutathione (GSH) and malone-dialdehyde (MDA) levels of rat heart and brain were investigated. It was determined that SeI and SeII fully or partially restored enzyme activity. It was also found that lipid peroxidation was also decreased in SeI and SeII treated groups. Consequently, it was determined that novel synthetic organoselenium compounds (SeI and SeII) provided protection of antioxidant activity, and protection against lipid peroxidation measured as MDA in SeI and SeII treated groups was provided by novel synthesized organoselenium compounds. The ability of the organoselenium compounds to prevent oxidative damage induced by DMBA in rats was rationalized.

A technique for safely teaching major hepatectomy to surgical residents

In this era of combination chemotherapy and biologic treatment, the ability to downsize tumors that were previously unresectable will increase the need for major hepatic resections. This makes teaching consistent surgical approaches to these difficult cases imperative. Herein we outline a standardized surgical approach to right hepatectomy, which allows the procedure to be divided into a series of well-defined technical maneuvers. Preoperative preparation and communication with anesthesia to ensure a low central venous pressure is emphasized. A right hepatectomy is described by dividing the procedure into 5 steps: (1) initial mobilization and intraoperative ultrasound, (2) cholecystectomy and extrahepatic inflow occlusion and, (3) posterior mobilization and extrahepatic venous outflow ligation, (4) parenchymal transection, and (5) hemostasis and closure. Such techniques, once adopted by the surgeon, will allow for controlled parenchymal transection, minimal need for inflow occlusion to the liver remnant, and safe and efficient hepatectomy.

[Toward zero mortality in liver resection. Presentation of 200 consecutive cases]

INTRODUCTION

Liver resection (LR) morbidity and mortality rates have dropped in recent decades. Mortality is now below 5% and morbidity is less than 30%. Our objective was to present a series of 200 LRs without mortality and to analyze the factors that may be related to complications.

PATIENTS AND METHOD

Between January 1996 and October 2003, 200 LRs were performed in 177 patients. The most common indication was liver metastases in 123 patients (61.5%), primary malignant liver tumors in 27 patients (13.5%), bile duct tumors in 27 patients (13.5%) and benign disease in 23 patients (11.5%). Fifty-one percent of the resections were performed under hemihepatic vascular control and 49% were resections of central segments, segmentary and atypical resections. We studied the association between morbidity and age, sex, previous comorbidity, liver status, indication for surgery, number of resections, major and minor resections, resection extended to other organs, type of vascular occlusion, transfusion requirements, operating time, length of hospital stay and experience of the surgical team.

RESULTS

There was no postoperative mortality. The morbidity rate was 17.5% (35 patients) and the most common complications were biliary (8%). Morbidity was related to transfusion (transfused patients presented more complications) (P < .001). Transfusion was greater in major resections, the first 100 resections and prolonged operations. Among the segmentary resections the Pringle maneuver reduced transfusion requirements but this difference was not statistically significant. Morbidity decreased in the second 100 resections, without significant differences.

CONCLUSION

LRs can be performed with low mortality and morbidity. Biliary complications and blood transfusion should be avoided whenever possible.