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| 1 | Acute renal injury after partial hepatectomy显示文摘Currently, partial hepatectomy is the treatment of choice for a wide variety of liver and biliary conditions. Among the possible complications of partial hepatectomy, acute kidney injury(AKI) should be considered as an important cause of increased morbidity and postoperative mortality. Difficulties in the data analysis related to postoperative AKI after liver resections are mainly due to the multiplicity of factors to be considered in the surgical patients, moreover, there is no consensus of the exact definition of AKI after liver resection in the literature, which hampers comparison and analysis of the scarce data published on the subject. Despite this multiplicity of risk factors for postoperative AKI after partial hepatectomy, there are main factors that clearly contribute to its occurrence. First factor relates to large blood losses with renal hypoperfusion during the operation, second factor relates to the occurrence of post-hepatectomy liver failure with consequent distributive circulatory changes and hepatorenal syndrome. Eventually, patients can have more than one factor contributing to post-operative AKI, and frequently these combinations of acute insults can be aggravated by sepsis or exposure to nephrotoxic drugs. | Luis Alberto Batista Peres Luis Cesar Bredt Raphael Flavio Fachini Cipriani | 2016 | World Journal of Hepatology2016，8，21： | 3 |
| 2 | Computer planned, image-guided combined resection and ablation for bilobar colorectal liver metastases显示文摘For patients with extensive bilobar colorectal liver metastases(CRLM),initial surgery may not be feasible and a multimodal approach including microwave ablation(MWA)provides the only chance for prolonged survival.Intraoperative navigation systems may improve the accuracy of ablation and surgical resection of so-called'vanishing lesions',ultimately improving patient outcome.Clinical application of intraoperative navigated liver surgery is illustrated in a patient undergoing combined resection/MWA for multiple,synchronous,bilobar CRLM.Regular follow-up with computed tomography(CT)allowed for temporal development of the ablation zones.Of the ten lesions detected in a preoperative CT scan,the largest lesion was resected and the others were ablated using an intraoperative navigation system.Twelve months post-surgery a new lesion(SegⅣa)was detected and treated by trans-arterial embo-lization.Nineteen months post-surgery new liver and lung metastases were detected and a palliative chemotherapy started.The patient passed away four years after initial diagnosis.For patients with extensive CRLM not treatable by standard surgery,navigated MWA/resection may provide excellent tumor control,improving longer-term survival.Intraoperative navigation systems provide precise,real-time information to the surgeon,aiding the decision-making process and substantially improving the accuracy of both ablation and resection.Regular follow-ups including 3D modeling allow for early discrimination between ablation zones and recurrent tumor lesions. | Vanessa M Banz Matthias Baechtold Stefan Weber Matthias Peterhans Daniel Inderbitzin Daniel Candinas | 2014 | World Journal of Gastroenterology2014，20，40： | 2 |
| 3 | Missing metastases as a model to challenge current therapeutic algorithms in colorectal liver metastases显示文摘In oncosurgical approach to colorectal liver metastases, surgery remains considered as the only potentially curative option, while chemotherapy alone represents a strictly palliative treatment. However, missing metastases, defined as metastases disappearing after chemotherapy, represent a unique model to evaluate the curative potential of chemotherapy and to challenge current therapeutic algorithms. We reviewed recent series on missing colorectal liver metastases to evaluate incidence of this phenomenon, predictive factors and rates of cure defined by complete pathologic response in resected missing metastases and sustained clinical response when they were left unresected. According to the progresses in the efficacy of chemotherapeutic regimen, the incidence of missing liver metastases regularly increases these last years. Main predictive factors are small tumor size, low marker level, duration of chemotherapy, and use of intra-arterial chemotherapy. Initial series showed low rates of complete pathologic response in resected missing metastases and high recurrence rates when unresected. However, recent reports describe complete pathologic responses and sustained clinical responses reaching 50%, suggesting that chemotherapy could be curative in some cases. Accordingly, in case of missing colorectal liver metastases, the classical recommendation to resect initial tumor sites might have become partially obsolete. Furthermore, the curative effect of chemotherapy in selected cases could lead to a change of paradigm in patients with unresectable liver-only metastases, using intensive first-line chemotherapy to intentionally induce missing metastases, followed by adjuvant surgery on remnant chemoresistant tumors and close surveillance of initial sites that have been left unresected. | Valerio Lucidi Alain Hendlisz Jean-Luc Van Laethem Vincent Donckier | 2016 | World Journal of Gastroenterology2016，22，15： | 1 |
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