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The first 25 slides, exactly as they appear. The full deck has 179 content slides.
General Surgery
Benign and Malignant Primary Liver Neoplasms
Built from Maingot's Abdominal Operations
What’s inside
16 sections · 179 slides
Overview
- Scope of this topic
- Two families of primary liver tumour
Benign tumours of the liver
Common, usually harmless, and easy to mistake for cancer
- Frequency of benign liver tumours
- Benign tumours of the liver
- Reading the classification
- Behaviour decides treatment
- Imaging tests for a benign liver lesion
- Radiographic features of benign tumours of the liver
- Key contrasts in the imaging table
- Indications for and limitations of liver biopsy
- Indications for resection of a benign tumour
- Evidence that observation is safe
- Treatment algorithm for a presumed solitary benign liver tumour
- Surgical approaches for benign tumours
Hepatic hemangioma
A tangle of blood-filled spaces, and the commonest liver tumour of all
- Hemangioma: epidemiology
- Sex hormones and hemangioma
- Pathology of cavernous hemangioma
- Tumour-parenchymal interface patterns
- The four tumour-parenchyma interface patterns
- Biopsy of a suspected hemangioma
- CT appearance of hepatic hemangioma
- Five CT criteria diagnostic of hemangioma
- MRI features of hemangioma
- Other imaging tests for hemangioma
- Nonoperative management of hemangioma
- Observation data from a Dutch series
- Indications for resection of hemangioma
- Controversy over operating for symptom relief
- Selecting patients for surgery for symptoms
- Complications of hepatic hemangioma
- Kasabach-Merritt syndrome
- Enucleation versus formal resection
- Steps in enucleation of a hepatic hemangioma
- Technique of hemangioma enucleation
Focal nodular hyperplasia
Not a true tumour but an overgrowth around an abnormal artery
- Focal nodular hyperplasia: epidemiology
- Proposed pathogenesis of FNH
- Oral contraceptives and FNH
- Gross pathology of FNH
- Typical and atypical FNH
- Subtypes of atypical focal nodular hyperplasia
- CT appearance of FNH
- MRI in focal nodular hyperplasia
- MRI of a large left lateral section focal nodular hyperplasia
- Delayed-phase features of focal nodular hyperplasia
- Percutaneous biopsy in FNH
- Treatment of focal nodular hyperplasia
Hepatocellular adenoma
The benign lesion that bleeds, ruptures and can turn malignant
- Hepatocellular adenoma and the contraceptive pill
- Contraceptive use and adenoma complications
- Complications of hepatocellular adenoma
- Rupture risk in a multicentre series
- Malignant transformation of adenoma
- Pathology of hepatocellular adenoma
- Histology and the absence of bile ducts
- Ultrasound and CT of hepatocellular adenoma
- Contrast washout in adenoma
- CT of a hepatic adenoma of the right hemiliver
- MRI findings in hepatocellular adenoma
- Separating hepatocellular adenoma from focal nodular hyperplasia
- Treatment of hepatocellular adenoma
Uncommon benign liver lesions
Three rarities that turn up on scans and in the operating room
- Nodular regenerative hyperplasia
- Peliosis hepatis
- Bile duct adenoma
Hepatocellular carcinoma: causes and pathology
The commonest solid organ cancer in the world
- Primary malignant liver tumours
- Three reasons hepatocellular carcinoma is hard to treat
- Global burden of hepatocellular carcinoma
- Hepatitis B virus and hepatocellular carcinoma
- Hepatitis C virus and hepatocellular carcinoma
- Factors associated with the development of hepatocellular carcinoma
- Chemical carcinogens and alcohol
- Aflatoxin exposure
- Inherited and metabolic conditions
- Histologic grading and growth pattern
- Three growth patterns of hepatocellular carcinoma
- Growth pattern and resectability
- Hanging and pushing growth patterns of hepatocellular carcinoma
- Infiltrating growth pattern of hepatocellular carcinoma
- Fibrolamellar variant of hepatocellular carcinoma
- Standard hepatocellular carcinoma compared with the fibrolamellar variant
- Key numbers from the fibrolamellar comparison
How hepatocellular carcinoma presents
Silent when small, dramatic when large
- Late presentation of hepatocellular carcinoma
- Common symptoms and signs of HCC
- General and febrile presentations
- Hepatic decompensation as a presentation
- Gastrointestinal bleeding in HCC
- Rupture of a hepatocellular carcinoma
- CT of a ruptured hepatocellular carcinoma
- Jaundice in hepatocellular carcinoma
- Paraneoplastic syndromes in HCC
Diagnosis and assessment of liver reserve
Confirm the tumour, map its extent, and measure what the liver can survive
- Three aims of the diagnostic work-up
- Noninvasive diagnosis of hepatocellular carcinoma
- Role of percutaneous needle biopsy in HCC
- Biopsy in patients not fit for surgery
- Extent of disease evaluation
- Cross-sectional imaging of the liver in HCC
- Hepatic angiography and lipiodol
- Single laboratory measures of liver reserve
- Child-Turcotte-Pugh classification
- Child-Turcotte-Pugh grading system for cirrhosis
- Scoring the Child-Turcotte-Pugh criteria
- Dynamic tests of liver function
- Hepatic venous wedge pressure
Resection of hepatocellular carcinoma
The only potentially curative option, and how cirrhosis changes it
- The range of treatments for HCC
- Partial hepatectomy in a noncirrhotic liver
- Survival after hepatectomy for hepatocellular carcinoma
- Outcomes after liver resection for hepatocellular carcinoma
- Outcomes after liver resection for hepatocellular carcinoma (continued)
- Trends across the resection outcome series
- Why cirrhosis makes hepatectomy dangerous
- Mechanism of liver failure after resection in cirrhosis
- Mortality and patient selection in cirrhosis
- Inflow occlusion in the cirrhotic liver
- Anatomic versus nonanatomic resection
- Factors that no longer prevent resection
- Major intravascular tumour extension
- Staging systems and the prognostic nomogram
- Prognostic nomogram for survival after resection
Treatment before and after resection
Shrinking the tumour first, and attacking what surgery leaves behind
- Rationale for neoadjuvant therapy
- Neoadjuvant chemoembolization before resection
- Transarterial immunoembolization
- Randomised data on neoadjuvant treatment
- Preoperative portal vein embolization
- Adjuvant trials that failed
- Adjuvant trials that succeeded
- Sorafenib in advanced hepatocellular carcinoma
Transplantation and palliative treatment
Replacing the whole diseased liver, and what to do when nothing can be removed
- Rationale for total hepatectomy and transplantation
- Early experience with transplantation for HCC
- The Milan criteria
- Outcomes after liver transplantation for hepatocellular carcinoma
- Outcomes after liver transplantation for hepatocellular carcinoma (continued)
- Trends across the transplantation outcome series
- Comparing resection with transplantation
- Palliative treatment of hepatocellular carcinoma
Intrahepatic cholangiocarcinoma
Cancer of the bile duct lining, and the inflammatory diseases that cause it
- Bile duct cancer: incidence and age distribution
- Location, resectability and survival
- Chronic biliary inflammation as the common cause
- Primary sclerosing cholangitis
- Choledochal cysts and Caroli's disease
- Cycle of recurrent biliary infection and stone formation
- Pyogenic cholangiohepatitis and liver flukes
- Environmental toxins and cholangiocarcinoma
- Anatomic classification and operative planning
- Three anatomic groups of cholangiocarcinoma
- Presentation of intrahepatic cholangiocarcinoma
- Distinguishing intrahepatic cholangiocarcinoma
- Resection for intrahepatic cholangiocarcinoma
- Predictors of outcome after resection
- Transplantation for cholangiocarcinoma
- Chemotherapy for cholangiocarcinoma
Other primary liver malignancies
Hepatoblastoma, angiosarcoma and epithelioid hemangioendothelioma
- Hepatoblastoma
- Outcome and treatment of hepatoblastoma
- Angiosarcoma of the liver
- Outcome of hepatic angiosarcoma
- Other primary hepatic sarcomas
- Epithelioid hemangioendothelioma
- Treatment of epithelioid hemangioendothelioma
Technique of hepatic resection
Why liver surgery became safe, and how the inflow is controlled
- Improvement in perioperative outcome
- Segmental anatomy and parenchymal sparing
- Complications and mortality by number of hepatic segments resected
- Benefits of parenchymal-sparing resection
- Extrahepatic control of vascular inflow
- Intrahepatic pedicle ligation
- Posterior and anterior approaches to the pedicle
- Hepatotomy placement for pedicle ligation
- Steps of right pedicle ligation
- Stapling the isolated right portal pedicle
- Controlling the hepatic venous outflow
- Dividing the liver parenchyma
- Transection in a cirrhotic or fatty liver
Pulling it together
The decisions that matter most in primary liver tumours
- Take-home points on benign tumours
- Take-home points on hepatocellular carcinoma
- Take-home points on other primary liver cancers
- Take-home points on operative technique
- References
- References (continued)
- References (continued)
- References (continued)
- References (continued)
- References (continued)
- Maingot's Abdominal Operations, 12th Edition