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Late recurrence after surgery for cholangiocarcinoma:implications for follow-up?

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Hepatobiliary & Pancreatic Diseases International 2008年第5期7卷 544-546页

作者： Harun Thomas nigel David heaton Institute of Liver Studies Kings College Hospital Denmark HillLondonSE5 9RSUK

BACKGROUND:Biliary tract cancer is uncommon,but has a high rate of early recurrence and a poor prognosis. There is only limited information on patients surviving more than 5 years after resection. METHODS:We report a patient who developed recurrence 8 years after resection of *** of late recurrence after excision of cholangiocarcinoma are reviewed. RESULTS:Few long-term survivors with biliary tract cancer have been *** survivors tend to have well differentiated or papillary *** present case had no recurrence for 8 years despite poor prognostic factors including poor differentiation,invasion through the muscle wall and perineural *** has been suggested that tumor cells left after the first operation grow and present as late *** is a need to differentiate a new primary and field change from recurrence of the previous tumor. CONCLUSIONS:Long-term follow-up after resection of cholangiocarcinoma is needed because late recurrence after 5 years *** mortality rate between 5 and 10 years after resection of cholangiocarcinoma ranges from 6%to 43%in different *** detection of local recurrence may give an opportunity for further surgical resection.

关键词： cholangiocarcinoma late recurrence long-term survivors

Minimizing the risk of small-for-size syndrome after liver surgery

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Hepatobiliary & Pancreatic Diseases International 2022年第2期21卷 113-133页

作者： Michail Papamichail Michail Pizanias nigelD heaton Department of Hepato-Pancreato-Biliary Surgery Royal Blackburn HospitalBlackburn BB23HHUK Department of General Surgery Whittington HospitalLondon N195NFUK Department of Liver Transplant and Hepato-Pancreato-Biliary Surgery Institute of Liver StudiesKings Health Partners at King’s College Hospital NHS TrustLondon SE59RSUK

Background: Primary and secondary liver tumors are not always amenable to resection due to location and size. Inadequate future liver remnant(FLR) may prevent patients from having a curative resection or may result in increased postoperative morbidity and mortality from complications related to small-forsize syndrome(SFSS). Data sources: This comprehensive review analyzed the principles, mechanism and risk factors associated with SFSS and presented current available options in the evaluation of FLR when planning liver surgery. In addition, it provided a detailed description of specifc modalities that can be used before, during or after surgery, in order to optimize the conditions for a safe resection and minimize the risk of SFSS. Results: Several methods which aim to reduce tumor burden, preserve healthy liver parenchyma, induce hypertrophy of FLR or prevent postoperative complications help minimize the risk of SFSS. Conclusions: With those techniques the indications of radical treatment for patients with liver tumors have signifcantly expanded. The successful outcome depends on appropriate patient selection, the individualization and modifcation of interventions and the right timing of surgery.

关键词： Small-for-size syndrome Liver resection Future liver remnant

Cancer of the uncinate process of the pancreas:surgical anatomy and clinicopathological features

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Hepatobiliary & Pancreatic Diseases International 2009年第6期8卷 569-574页

作者： Adrian W. O'Sullivan nigel.heaton Mohamed Rela Institute of Liver Studies King's College Hospital National Health Service(NHS) Foundation Trust

BACKGROUND:The clinicopathological features of uncinate process pancreatic cancer(UPPC) are poorly *** the anatomy of the uncinate process and its division during surgery are central to pancreaticoduodenectomy for *** set out to describe the embryology and anatomy of the uncinate process and the clinicopathological features of *** SOURCES:All published case series of UPPC were reviewed and included in this ***:The true incidence of UPPC is difficult to quantify,with the reported incidence ranging from 2.5% to 10.7% of pancreatic *** are 5 published series of UPPC including 117 patients,72 males and 45 females,aged from 45-53 years to 61-84 *** median survival was 5 or 5.5 months in 3 of the series,12.1 months in another based only on potentially resectable lesions and 17 months in another based only on resected ***:The number of reported series of UPPC is limited,with vague symptoms as the predominant presenting features of the *** prognosis is poor with synchronous venous resection demonstrating a survival advantage.

关键词： pancreatic neoplasms uncinate process anatomy embryology surgery

Liver resection for the treatment of a congenital intrahepatic portosystemic venous shunt

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Hepatobiliary & Pancreatic Diseases International 2016年第3期15卷 329-333页

作者： michail papamichail amir ali alberto quaglia john karani nigel.heaton Department of Hepatobiliary Pancreatic Surgery First Affiliated Hospital:King's Healthcare PartnersKing's College Hos-pital FT NHS Trust Institute of Liver Studies Denmark HillLondon SE5 9RSUK

Intrahepatic portosystemic shtmts （IPSS） are rare congenital anomalies arising from disordered portal vein em- bryogenesis. It has been described in both children and adults and may be asymptomatic or be associated with a variety of neurophysiological and pulmonary complications. When rec- ognized, early intervention to occlude the shunt will reverse the associated complications. Literature review reports of surgical and radiological occlusion of the shunt, but due to its rarity, a standard therapeutic protocol has not been established. A case of a 38-year-old woman with abdominal pain and low grade encephalopathy, diagnosed with an IPSS and treated by right hepatectomy was reported.

关键词： intrahepatic portosystemic shunt liver resection

Clinical features and treatment of sump syndrome following hepaticojejunostomy

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Hepatobiliary & Pancreatic Diseases International 2011年第3期10卷 261-264页

作者： Gabriele Marangoni Amir Ali Walid Faraj nigel.heaton Mohamed Rela King's College London School of Medicine at King's College Hospital Institute of Liver StudiesDenmark Hill

BACKGROUND:Cholangitis after Roux-en-Y hepaticojejunostomy is usually caused by anastomotic stricture.A small number of cases present without evidence of obstruction and are ascribed to reflux of gastro-intestinal content into the biliary tree above the anastomosis (sump syndrome).Despite prophylactic rotating antibiotic therapy,the cholangitic episode may be severe and ***:From 2001 to 2006,six patients who had undergone an end-to-side hepaticojejunostomy presented to our institution with recurrent episodes of biliary *** stricture was excluded by liver MRI/MRCP and percutaneous transhepatic cholangiogram (PTC).Barium meal showed reflux of contrast into the biliary tree in all *** patients had a short jejunal Roux limb (less than 50 cm) on pre-operative ***:Five patients underwent surgery and two of them had two *** patient had a Tsuchida antireflux valve and subsequently underwent lengthening of the Roux *** patients had lengthening of the Roux loop;one underwent re-do hepaticojejunostomy and one had concomitant revision of the hepaticojejunostomy and lengthening of the Roux *** latter underwent further lengthening of the Roux *** patients are cholangitis-free 6,36 and 60 months after surgery;two still experience mild episodes of ***:An adequate length of the Roux loop is important to prevent ***,Roux loop lengthening to 70 cm or more does not always resolve the problem and cholangitis,although generally less frequent and severe,may recur despite appropriate reconstructive or antireflux *** these cases,life-long rotating antibiotics is the only available measure.

关键词： biliary tract surgical procedures biliary tract disease septicemia

Cystic dystrophy in heterotopic pancreas:a rare indication for pancreaticoduodenectomy

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Hepatobiliary & Pancreatic Diseases International 2009年第2期8卷 215-217页

作者： Harun Thomas Paul Marriott Bernard Portmann nigel.heaton Mohamed Rela Institute of Liver Studies Kings College School of Medicine at Denmark Hill

BACKGROUND:Cystic dystrophy in heterotopic pancreas (CDHP)is a rare benign condition characterized by the presence of cysts in the wall of the digestive tract associated with inflammation and fibrosis,intermingled with heterotopic pancreatic *** options for CDHP are poorly defined. METHOD:We report a case of CDHP,and review the literature focusing on the diagnosis and management. RESULTS:CDHP is mainly encountered in men in the fifth decade of life in association with chronic pancreatitis secondary to alcohol *** and mechanical obstruction of heterotopic pancreatic ducts have been implicated in its *** presentation is varied and current imaging provides the diagnosis. Treatment options include somatostatin analogue injections, endoscopic cyst fenestration and surgical resection (pancreaticoduodenectomy or gastrointestinal bypass). CONCLUSION:CDHP is rare and presents a diagnostic and therapeutic *** long term efficacy and indications for different treatment options need to be refined.

关键词： pancreas diseases duodenum cysts heterotopia

Budd-Chiari syndrome secondary to caval recurrence of renal cell carcinoma

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Hepatobiliary & Pancreatic Diseases International 2010年第3期9卷 321-324页

作者： Gabriele Marangoni Adrian O'Sullivan Amir Ali Walid Faraj nigel.heaton Institute of Liver Studies King's College London School of Medicine at King's College Hospital

BACKGROUND:Renal cell carcinoma(RCC)involves the inferior vena cava(IVC)in a minority of *** commonly,it presents with Budd-Chiari *** untreated, the condition progresses towards liver failure and ***:We report a case of Budd-Chiari syndrome due to infiltration of the IVC and right atrium by recurrence of RCC 7 years after successful treatment by primary ***:Surgery was performed with a combined abdominal and thoracic approach with cardio-pulmonary by-pass and *** tumor was removed and a cadaveric iliac vein graft used to re-establish venous continuity between the right atrium and hepatic ***:Although it is a complex and high-risk procedure,aggressive surgery performed by an experienced team with liver transplant and cardiothoracic skills may enable resection of apparently advanced caval *** case is discussed in the light of the current literature.

关键词： inferior vena cava renal cell carcinoma recurrence Budd-Chiari syndrome

Non-functioning well-differentiated neuroendocrine tumor of the extrahepatic bile duct:an unusual suspect?

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Hepatobiliary & Pancreatic Diseases International 2007年第5期6卷 549-552页

作者： Harsheet Sethi Mansoor Madanur Parthi Srinivasan Bernard Portmann nigel.heaton Mohamed Rela Department of Hepatobiliary and Transplant Surgery Kings College HospitalDenmark HillLondon SE5 9RSUK Department of Histopathology Kings College HospitalDenmark HillLondon SE5 9RSUK

BACKGROUND:Neuroendocrine tumors(NETs)arising in the biliary tree are extremely rare,and 37 cases were identified in the English literature. METHODS:A well-differentiated NET was found arising from the junction of the cystic and common hepatic ducts, in a 51-year-old male presenting with pedal edema and weight loss with abnormal liver enzymes and a normal serum bilirubin *** mass was seen on radiological imaging and biopsy of the liver was suggestive of an early cholangiopathy.A bile leak complicating the liver biopsy led to an ERCP that demonstrated a filling defect suggestive of a mass in the common bile duct(CBD). RESULTS:He underwent a successful excision of the tumor with a Roux-en-Y *** diagnosis of NET was made on histological and immunohistochemical analysis of the resected *** remains well and disease free 22 months after surgery. CONCLUSIONS:Recognition of biliary NET continues to be a challenge and an increased awareness of these tumors in rare sites will result in optimal management of these tumors.

关键词： carcinoid neuroendocrine tumor biliary common bile duct

Pancreaticoduodenectomy with radical lymphadenectomy is not contraindicated for patients with established chronic liver disease and portal hypertension

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Hepatobiliary & Pancreatic Diseases International 2008年第1期7卷 82-85页

作者： Harsheet Sethi Parthi Srinivasan Gabriele Marangoni Andreas Prachalias Mohamed Rela nigel.heaton Institute of Liver Studies Kings College London School of Medicine at Kings College HospitalDenmark HillLondon SE5 9RSUK

BACKGROUND: hronic liver disease has been considered a contraindication to radical surgery for intra-abdominal tumors because of the risk of decompensation. METHODS: In a retrospective analysis of all patients undergoing pancreaticoduodenectomy for cancer treated from January 2000 to December 2006 at our center, 4 patients were identified with operable pancreatic tumors and well-compensated chronic liver disease. The preoperative staging, decompression of the biliary tree, liver biopsy, Child-Turcot-Pugh and MELD scores were ***: All patients underwent pancreaticoduodenectomy successfully with minimal blood loss, and no peri-operative blood transfusions or liver decompensation. There was no postoperative mortality. Two patients received adjuvant chemotherapy. One patient died with recurrent disease at 18 months, one is alive with disease recurrence, and two are alive and disease ***: Patients with pancreatic cancer and well-compensated chronic liver disease should routinely be considered for radical surgery at specialist hepatobiliary centres with expertise available to manage complex liver disease.

关键词： pancreaticoduodenectomy Whipple's cirrhosis chronic liver disease portal hypertension