RATIONALE: The liver is the most common site of metastasis from colorectal cancer. Curative intent liver metastasectomy has shown improvement in overall survival. This manuscript will present the long-term oncologic outcomes of hepatic metastasectomy for colorectal cancer with resectable liver metastasis. METHODS: Data of patients with resectable liver metastases from colorectal cancer who underwent hepatic resection at the Philippine General Hospital over a 10-year period was reviewed. The primary outcome investigated was overall survival. RESULTS: Thirty patients were included in the study. The median overall survival was 20 months, with a 2-year and 5-year overall survival rate of 40% and 6.67% respectively. Eleven (36.67%) patients had disease recurrence, with a median disease-free survival of 16 months. A significant difference in survival was seen between patients with synchronous and metachronous liver metastasis (20.38 and 36.78 months respectively, p=0.0393) and in patients given adjuvant chemotherapy at any time in relation to the occurrence of the liver metastases versus patients who did not receive any adjuvant treatment (34.08 and 18.59 months respectively, p=0.0349). Trends towards improved overall survival were seen in patients 50 years old or less (36.86 versus 21.78 months, p=0.0837) and in patients with a clinical risk score of 2 or less (29.65 versus 19.62 months, p=0.1823), which may show significance in a higher powered study CONCLUSION Improved overall survival was observed among patients with colorectal liver metastases undergoing hepatic metastasectomy compared to no liver resection.
Metastasectomy ; Philippines

Left sided portal vein anomalies are exceedingly rare but with the advent of complex surgical and interventional radiologic liver procedures, knowledge of major and subtle portal vein variations is becoming essential to ensure patient safety and treatment success. We present a purely left sided portal vein variant shown as a left sided common trunk that gives off all the major portal sectoral branches.

A 30 year old female who previously underwent open chlecystectomy presented with anemia postoperatively and was detected ultrasonographically to have a variant portal vein anatomy that was confirmed by triphasic CT scan with 3D reconstruction. Ultrasound and CT revealed the absence of a normal right portal vein with the left portal vein serving as the main portal trunk that would eventually give rise to all the major sectoral branches of the right and left portal veins.

Familiarity with portal vein anomalies is essential particularly in liver transplant surgery, interventional radiology and major hepatic resections. Knowledge of these variations would help prevent or minimize treatment complications.

Human ; Female ; Adult ; Portal Vein ; Liver Transplantation ; Radiology, Interventional ; Patient Safety ; Imaging, Three-dimensional ; Hepatic Veins ; Liver ; Ultrasonography ; Anemia

Endoscopic Retrogate Chloangiopancreatography (ERCP) has become an invaluable non-invasive tool in the management of common bile duct obstruction and as such has lessened the need for operative biliary exploration. While most complications associated with ERCP are usually treated conservatively, some are exceedingly rare and can be catastrophic. The authors present a 51-year old male, with a history of two previous abdominal surgeries, who underwent ERCP for obstructive jaundice. Subsequently, he was re-operated for an ileal perforation from stent migration due to postoperative adhesions. The result was favorable.

Human ; Male ; Middle Aged ; Jaundice, Obstructive ; Cholangiopancreatography, Endoscopic Retrograde ; Cholestasis, Extrahepatic ; Stents ; Biliary Tract

A two-year retrospective study (January 1995 to December 1996) of 328 patients who underwent outpatient postoperative choledochoscopy is reported, 299 patients (91.2%) had retained biliary stones and 90 patients (30.1%) had stones located at the common bile duct. One hundred fourteen patients (46.8%) had primary stones. One hundred fourteen patients (38.1%) with multiple stones found at several locations required an average of 2 postoperative choledochoscopic sessions for complete clearance of biliary tree. Our overall clearance rate was 87 per cent. Only 8 patients (2.54%) had morbidities consisting of hemobilia and pain. (Author)

Human ; Hemobilia ; Common Bile Duct ; Cholelithiasis ; Biliary Tract ; Biliary Tract Surgical Procedures ; Pain

An open, prostective, randomized multicenter clinical trial randomly allocated successive patient who were scheduled for a surgical procedure for serious intra-abdominal infections to receive either treatment CM (ceftazidine plus metronidazole) or monotherapy with treatment IC (imipenem/cilastatin). Out of 90 eligible patients, 87 were clinically evaluable of which 71 were clinically and bacteriologically evaluable (CBE). Cases allocated to each treatment group were comparable as to age, sex, diagnostic group distribution, mean APACHE II scores, and bacteriologic evaluability. Among the 87 clinically evaluable patients, there were 4 (9.1%) and 2 (4.7%) treatment failures among those who received treatments CM and IC respectively (p=0.486). For all eligible patients, the mean fever days was 2.07, mean treatment days was 6.01, and mean hospital days was 11.57, and was not significantly different between the two treatment groups. Among clinically evaluable cases, the mean APACHE II scores of patients with succesful outcomes (5.8) was very significantly lower (p=0.000) than that of patients whose treatment failed (13.8). This was also true for CBE cases. Logistic regression analysis showed that among six variables (diagnostic group, APACHE II score, antibiotic used, fever days, hospital days and treatment days) only the APACHE II score signficantly contributed to treatment failure (p=0.001).

Human ; Cilastatin ; Imipenem ; Metronidazole ; Drug Combinations ; Sex Distribution ; Age Distribution ; Intraabdominal Infections ; Anti-bacterial Agents