Il trattamento chirurgico delle metastasi epatiche da carcinoma colo-rettale: nostra esperienza

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COD: 2000_04_499-504 Categorie: ,

S. Gangi, M. Furci, G. Di Mauro, G. Basile, F. Catalano, F. Basile

Ann. Ital. Chir., LXXI, 4, 2000

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Data from twelve patients who had hepatic resections for colorectal liver metastases were retrospectively analyzed to determine: 1) whether the use of the ultrasonic surgical dissector and the Argon laser can significantly simplify major hepatic resections and decrease both perioperative blood loss and postoperative morbidity and mortality, and 2) whether an adequate patients selection for surgery can effectively determine an improvement in recurrence rate. We performed 4 bisegmentectomies (2 of V and VI; 2 of VI and VII); 1 trisegmentectomy (V, VI, VII); 2 left lobectomies; 1 right hepatetomy and 4 wedge resections, using both the ultrasonic surgical dissector to fractionate and aspirate the hepatic parenchyma and to clear major vascular and biliary structures and the Argon laser for the coagulation of minor vascular and biliary vessels. The resected metastases averaged 5,5 cm (range: 1,5-7,5); blood transfusion requirements were significantly reduced from previous reports, averaging only 1,25 units (range: 0,3); the average operative time was 238 minutes (110 to 420 minutes). There were no operative deaths, operative morbidity rate was 16,6. The results indicate that the ultrasonic surgical dissector andthe Argon laser have made a significant contribution to our marked decrease in the average blood loss and transfusion requirement. The long-term results seems to be improved by an adequate patients selection.

 

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