Keywords : hepatocellular carcinoma

Outcome of Major Liver Resection in Gastroenterology & Hepatology Teaching Hospital Review of Nine Cases

ami; Talib AL-Jasha

Iraqi Postgraduate Medical Journal, 2012, Volume 11, Issue 1, Pages 113-117

Major hepatectomies consider one of the most challenging procedure and did not become
commonplace until the dramatic improvement in periopertive care in the 1980s.
Review the outcome of liver resection performed recently in Gastroenterology& Hepatology
Teaching Hospital .
From June 2008 to March 2011, nine major anatomic hepatic resection was performed. Enucleation,
Non- anatomic or wedge resection was excluded from this study.
There were 4 men, 4 women and one child. Age range between 5-43 years median age 40 years.
Nine major resection was done this include; extended right hepatectomy 1 patient, right hepatectomy
2 patients, left hepatectomy 3patients, left lateral lobectomy 2 patients, right anterior sectionectomy
one patient. The inflow pedicle was controlled either by extrahepatic approach in 6 patients or
intrahepatic pedicle ligation by vascular stapler in 3 patients. Post-operative hospitalization was 3-16
days, median 8 days. There were no mortality. Two patients developed bile leak in form of biloma
which was treated by percutaneous drainage under ultrasound for 2weeks. Two patients develop
intra-operative hypothermia that led to stop the operation for one hour until warming of the patient.
Major liver resection can be performed in our hospital with acceptable morbidity rate.

Hepatocellular Carcinoma Presentation & Management , A Prospective Study in the Medical City Baghdad - Iraq

Wissam Jaffar Altaee

Iraqi Postgraduate Medical Journal, 2011, Volume 10, Issue 2, Pages 253-260

The development of HCC is a major global health problem , It's incidence has increased world wide and nowadays it constitute the 5th most frequent cancer representing around 5% of all cancers, and estimated to rank 4th in terms of mortality of cancers incidence world wide , it accounts for 80 –90% of all primary liver tumors . The Etiology of this tumor is multifactorial , certain viral, environmental & hereditary causes of cirrhosis have a strong correlation with HCC . HCC is a highly malignant tumor with poor prognosis .
To evaluated the Etiological , Epidemiological , Patho physiological , Diagnostic series , Therapeutic approaches & Advanced studies in detection and prevention of HCC .
Across sectional study of (57) patients with HCC ( 43 males , 14 females ) during the period from January 2000 to December 2002 . The patients were collected from medical & surgical units of Baghdad teaching hospital & the gastroenterology & hepatology teaching hospital .
History taken from these patients & physical examination , Lab investigation ,CBP, liver function test ,Virology study , serum AFP. Titer ,U/S study , MRI , CT scan . Ascitic fluid tapping , Liver biopsy.
Modalities of treatment : Palliative Treatment, Chemotherapy, Injection of Alcohol , Hemilobectomy ,Segmental resection , Debulking resection of tumor in the liver, Conservative treatment , any complications or hazards during surgical procedures were recorded.
Male to female ratio is approximately (3:1), The mean age of (57.1) yr . more common between (51-60) yrs old ( 28.25% ) , Most of the patients were from Baghdad ( 47.4% ) . Increasing no. of patients from 2000 ( 21.1 % ) to 2002 ( 45.6 % ). (84% ) have previous history of chronic liver disease & (16%) haven't such a history . Most of chronic liver diseases are due to previous history of hepatitis B- infection (41.6%) . High level of AFP ( 66.6% ), all of them are of standard type of HCC. Ascitic fluid cytological study bloody (14%) & positive malignant cells (17.2%) . Liver biopsy (82.7%) had chronic liver diseases, and (96.5%) moderate to poorly differentiated type of standard HCC,(3.5%) fibrolamellar type .Outcome of treatment , Conservative (35%), Injection therapy (3.5%) , Chemotherapy (28%), Surgical procedures (16%) , Segmental & Right lobectomy (3.5%) for each , Debulking (9%) .
AFP and U/S study are very important in the early detection and follow up of the patient with HCC , Liver biopsy - very important study to detect various type of HCC , Surgical resection is the only potentially curative treatment of HCC

Hepatectomy Experience in Baghdad Teaching Hospital

Safa M. Al-Obaidi; Omar R. Mahjoub; Saieb S. Al-Gailani

Iraqi Postgraduate Medical Journal, 2010, Volume 9, Issue 2, Pages 196-199

ABSTRACT: BACKGROUND: Hepatectomy is usually performed because it is the most effective way of removing liver tumour(s). Cryosurgery, Radiofrequency, Laser, Microwave and Chemo-therapies are less effective alternatives. OBJECTIVE: To review the experience of hepatectomy in Baghdad Teaching Hospital – Medical city,Iraq with a review of the obstacles and needs for promotion and development. PATIENTS AND METHODS: During the period from March 1999 to September 2005, Out of 27 patients admitted to the second surgical unit in Baghdad Teaching Hospital – Medical City with liver tumours, 15 had hepatectomy done by the same surgical team. The remaining 12 cases were beyond resection. RESULTS: The age of patients ranged from 2 to 65 years old with mean age of 34.4 years. Only one (6.7%) patient underwent left lobectomy, 2 (13.3%) left segmentectomy, while the rest 12 patients (80%) underwent right partial or total lobectomy, divided equally between anatomical & non-anatomical resection. Two main techniques were used in transection of liver parenchyma: CUSA Dissector which is used in 9 patients (60%) and clamp-crushing or finger fracture technique was used in the remainder. In addition to CUSA knife, argon beam was used in 5 cases (33.3%). Postoperative mortality rate was 26.7% (4patients). The histopathological examination of resected segments of the liver revealed 11 (73.3%) cases of hepatocellular carcinoma, 2 (13.3%) of hepatoblastoma, 1 (6.7%) case metastatic colorectal carcinoma, and 1 (6.7%) case of benign cells (haemangioma). CONCLUSION: Hepatectomy for liver tumours can be performed with acceptable safety and efficacy in a suitably staffed and equipped center. The outcome will improve with time and experience

Intestinal Perforation of Pedunculated Hepatocellular Carcinoma CASEREPORT (Rare among rarities)

Raafat Roof Ahmed

Iraqi Postgraduate Medical Journal, 2008, Volume 7, Issue 2, Pages 187-191

vascular stalk and is easily resected without sacrifice of significant amount of non-neoplastic liver tissue (1).
Pedunculated type is a rare macroscopical form of hepatocellular carcinoma. THE IRAQI POSTGRADUATE MEDICAL JOURNAL VOL.7, NO. 2, 2008
47 years old male complained from vague abdominal pain, anorexia, weight loss and malena during the last few months. Abdominal ultrasound and spiral CT scan revealed a vascular mass 17x13 cm. in diameter occupying the whole right side of the abdomen. On exploration the mass was perforated into a segment of ileum due to direct invasion and attached to the liver by vascular pedicle. The mass was completely excised with segment of ileum followed by end-end anastomosis. Immunohistochemical study shows that the tumor was stained by alpha-fetoprotein staining confirming the diagnosis of pedunculated hepatocellular carcinoma.
This is a case report of pedunculated HCC which perforated into small bowel causing severe bleeding per rectum, to highlight the importance of this rare and potentially curative disease.
pedunculated hepatocellular carcinoma should be kept in mind in any differential diagnosis of large intraperitoneal mass even if it is not related to the liver by imagining study.