Background: Minimally invasive methods for liver resection operations have increased throughout the world. We aimed to determine the trends and cost differences in liver resections conducted by open and laparoscopic approaches at a teaching hospital in South Australia. Methods: We conducted a retrospective analysis of 284 liver resections (247 open (OLR); 37 laparoscopic (LLR); subgroup analysis of 135 major and 149 minor) at Flinders Medical Centre between the 2013/14 and 2021/22 financial years. Trends were calculated using Mann Kendall and statistical analysis was conducted using the Welch t-test. Results: 87% of all resections, 98% major, and 77% of minor resections were OLRs. There was a significant decrease in the number of liver resections in total (tau = -0.686, p<0.05) and OLR (tau = -0.817, p < 0.05). OLR had a significantly higher length of stay (8.17±6.34days) vs. LLR(4.35±3.4days) (p<0.001) in total and for minor resections (4.30±3.43 days vs 7.45±5.05 days, p<0.001). OLR also had a significantly higher total cost ($42,873±20182vs.$23,958±14,700,p<0.001) in total and minor resections ($21,982±10,344 vs.$38,210±16,936, p<0.001). Operating room (OR) was the largest cost bucket in total and subgroup analysis. LLR had a significantly lower OR cost in total ($9,079±5,160vs$14,238±5,739, p<0.001) and in minor resections ($8,891±3,671 VS. 12,225±4,794, p<0.001) Conclusions: Over the study period there has been a decrease in the total number of liver resections, especially OLR. LLR can reduce costs in appropriately selected patients.

INTRODUCTION:Resection of primary tumor and liver metastases is the gold standard for colorectal cancer with liver-only metastases (CRLM). Although treatment options have expanded to enable conversion of unresectable to resectable CRLM, about 40% of patients will have definitively unresectable disease. Major advances in surgical techniques, immunosuppressive protocols and patient selection criteria for liver transplantation have resulted in improved outcomes. AREAS COVERED:A literature search has been conducted in Pubmed for articles published between 2014 and 2024. This review paper comments on current liver-directed treatment options for CRLM: resection, percutaneous ablation, conversion-chemotherapy, TACE, SIRT, and SABR. We explore evidence for liver transplantation in patients with unresectable CRLM, comment on possible limitations for implementation in clinical practice and give an overview of the current guidelines on liver transplantation in the USA, Europe, the United Kingdom, and Australia/New Zealand. EXPERT OPINION:The recent randomized TRANSMET trial, investigating liver transplantation versus chemotherapy in unresectable CRLM, shows promising 5-year OS reaching similar values as for other accepted liver transplantation indications. Further investigations with RCTs to investigate reproducibility and feasibility in clinical practice are needed. Before liver transplantation can be implemented as a standard treatment option, reorganizations at federal, regional and hospital levels would be required.

Access to appropriate supportive care resources and services is essential to improve outcomes for cancer survivors. This study aimed to identify, evaluate and content-map Australian online supportive care resources and services for people living with pancreatobiliary cancers. A structured online search was conducted of Australian cancer organisations to identify pancreatobiliary cancer resources and services. Resources and service sites were evaluated (cost, readability, active engagement, diversity (age, sex, gender and culture), consumer voice) and content mapped against published categories of informational needs. A total of 180 unique online resources and seven service webpages were identified from 19 Australian cancer organisations. On evaluation, 99

Background: Despite advances in surgical techniques and chemotherapy, poor outcomes persist in pancreatic malignancy. This study aimed to investigate clinical outcomes and describe the impact of factors like the closest resection margin on overall survival following open pancreatoduodenectomy at a tertiary referral centre over a ten-year period. Methods: Patients who underwent a pancreaticoduodenectomy at a tertiary hospital in South Australia between 2009-2019 were included in this retrospective study. Patient demographics, systemic treatments, complications, and histological features were analysed for their role in overall survival. Kaplan-Meier survival curves were used to assess patient survival and estimate median survival time. Results: There were 134 open pancreaticoduodenectomy procedures during 2009-2019. Majority of patients were male (54.7%) between 65-75 years of age (41%) with an ASA physical status classification grade of 3 (63.3%). 56.7% of patients experienced a complication with 5 in-hospital deaths recorded and 12 ISPGF grade B or C pancreatic anastomotic leaks (n=5, n=7 respectively). 88% of resected specimens were malignant with an overall 5-year survival of 32%. A resection margin of >2 mm had a significantly improved overall survival compared to 0 mm (p=0.01). There was no survival benefit for a resection margin of <1 mm or 1-2 mm compared 0mm margin (p=0.6 and p=0.2 respectively). 65 patients (54.6%) experienced either local or distal disease recurrence by the end of the study period. Conclusions: There has been no improvement in overall survival post pancreatoduodenectomy for pancreatic malignancy. Further research into the clinical significance of the R status classification is required.

Patients with high model for end-stage liver disease (MELD) scores waiting for liver transplantation in Australia and New Zealand (ANZ) have had limited access to deceased donor livers and therefore binational sharing of livers, for patients with a MELD score >= 35 was introduced in February 2016. Waiting list mortality, post-transplant outcomes and intention-to-treat survival were compared between patients whose MELD score reached 35 on the waiting list between October 2013 and April 2015 (Pre-Share 35 group, n = 23) and patients who were Share 35 listed between February 2016 and May 2022 (Share 35 group, n = 112). There was significantly reduced waiting list mortality in share 35 listed patients in comparison to the pre-Share 35 group (11.7% vs. 52.2%, OR .120 95% CI .044-.328, P < .001). Post-transplant patient and graft survival were not significantly different between the groups (5-year patient survival 82% vs. 84%, P = .991, 5-year graft survival 82% vs. 76%, P = .543). Intention-to-treat survival was superior in the Share 35 group (HR .302, 95% CI .149-.614, P < .001). Introduction of Share 35 in ANZ resulted in a 78% risk reduction in waiting list mortality, equivalent post-transplant survival and an improvement in intention-to-treat survival.

The present series of experiments was conducted to investigate whether the previously reported ethanol intake reducing effects of the 5-HT1A receptor agonist ipsapirone could be based on possible stimulus similarities between both compounds. Rats were trained to discriminate ethanol (12.5% w/v, 1000 mg/kg, IP) from saline in a two-lever food-reinforced drug discrimination (DD) procedure. Discrimination criterion was reached after a mean number of training sessions of 42. In subsequent generalization sessions, a dose-response curve was established for ethanol (125-1000 mg/kg, IP, ED(50) value: 355 mg/kg). In additional cross-generalization tests with ipsapirone (1-30 mg/kg, IP), stimulus substitution for the ethanol cue was not noted (maximal degree of generalization: 33%, at 10 and 30 mg/kg). To confirm the DD findings that ipsapirone does not substitute for ethanol, an alternative cross-familiarization conditioned taste aversion paradigm (CF-CTA) was utilized. In rats, 1000 mg/kg IP ethanol was used as the reference drug producing a conditioned taste aversion (CTA). It was found that preexposure to ethanol (500-1500 mg/kg, IP) dose-dependently attenuates the CTA produced by this same drug. Full familiarization was noted with 1000 and 1500 mg/kg. In contrast with this, ipsapirone (1-30 mg/kg, IP) failed to abolish ethanol-induced CTA, suggesting again that the ipsapirone stimulus complex is dissimilar to that produced by ethanol. Because the present findings indicate that, in rats, ipsapirone does not substitute for ethanol, it is suggested that the reported ethanol intake-reducing effects of ipsapirone in animal models of alcoholism are not due to simple stimulus substitution.

Background & Aims: Globally, there has been a concerning rise in the incidence of young-onset cancers. The aim of this study was to provide trends in the incidence and survival of gastrointestinal adenocarcinomas (oesophagus, stomach, pancreas, and colorectal) in South Australia over a 27-year period. Methods: This is a cross-sectional analysis of a prospective longitudinal database including all cases of gastrointestinal adenocarcinomas prospectively reported to the South Australian (State) Cancer Registry from 1990 to 2017. Results: A total of 28,566 patients diagnosed with oesophageal, stomach, pancreatic, or colorectal adenocarcinoma between 1990 and 2017 were included in the study. While the overall incidence for gastrointestinal adenocarcinomas in individuals >50 years has decreased since 2000 (IRR of 0.97 (95% CI 0.94–1.00; p = 0.06)) compared to 1990–1999, the rate amongst individuals aged 18–50 has significantly increased (IRR 1.41 (95% CI 1.27–1.57; p < 0.001)) during the same reference time period. Although noted in both sexes, the rate of increase in incidence was significantly greater in males (11.5 to 19.7/100,000; p < 0.001). The overall survival from adenocarcinomas across all subsites improved in the >50-year cohort in the last decade (HR 0.89 (95% CI 0.86–0.93; p < 0.001)) compared to 1990–1999. In individuals aged 18–50 years, there has only been a significant improvement in survival for colorectal cancer (HR 0.82 (95% CI 0.68–0.99; p < 0.04)), but not the other subsites. A lower overall survival was noted for males in both age cohorts (18–50 years—HR 1.24 (95% CI 1.09–1.13; p < 0.01) and >50 years—HR 1.13 (95% CI 1.10–1.16; p < 0.001), respectively) compared to females. Conclusions: This study from South Australia demonstrates a significant increase in young-onset gastrointestinal adenocarcinomas over the last 28 years, with a greater increase in the male sex. The only significant improvement in survival in this cohort has been noted in colorectal cancer patients.

BACKGROUND:There is a growing disparity between the number of liver transplant (LT) candidates and availability of suitable liver allografts. Antibody-mediated rejection (AMR), secondary to positive donor-specific antibodies (DSA), remains a concern in liver transplantation. This study aimed to correlate expression of DSA on pre-transplant screening and outcomes of LT, specifically development of AMR in liver allografts and liver function profile in the post-operative period.METHODS:Data of consecutive patients undergoing orthotopic LT (OLT) at the South Australian Liver Transplant Unit was analysed. All patients underwent DSA testing pre-transplant.RESULTS:Within a cohort of 96 patients, over a post-OLT median follow-up of 849 days, only 2 patients (2%) developed AMR. While both patients had a positive DSA test preoperatively, overall DSA positivity was noted in 31% patients, with a specificity for prediction of AMR of 0.708. No significant association was noted between AMR (p = 0.092), T cell-mediated rejection/TCMR (p = 0.797) or late hepatic artery thrombosis/LHAT (p = 0.521). There was no significant interaction effect between DSA positivity and serum bilirubin or transaminases over a period of 100 days.CONCLUSION:AMR following LT is uncommon. A positive DSA pre-transplant does not imply a definite risk of AMR. Also, there does not exist a significant interaction in time between DSA expression and serum bilirubin or transaminase levels. Until there emerges evidence to the contrary, it appears reasonable to consider DSA-positive donors within the broad context of marginal donors in the context of a worldwide shortage of LT donor allografts.

BackgroundThe aim of the current study was to assess outcomes following liver resection in metastatic CRC (mCRC) in South Australia across two study periods (pre-2006 versus post-2006).MethodsThe South Australian (SA) Clinical Registry for mCRC maintains data prospectively on all patients in SA with mCRC diagnosed from 01 February 2006. This data was linked with a prospectively collated database on liver resections for mCRC from 01/01/1992 to 01/02/2006. The primary end point was overall survival.Results757 patients underwent liver resection for mCRC. Liver resection was performed on 286 patients pre-2006 and 471 patients post-2006. The median age of the study population was 62 years, and this was similar across both eras. Overall survival was significantly better in the post-2006 era (hazard ratio HR = 0.45, p = 0.001). Complications (59% pre-2006 versus 23% post-2006) and transfusion rates (34% pre-2006 versus 2% post-2006) were significantly higher in the pre-2006 era. Repeat liver resection rates were significantly higher in the post-2006 era (1% pre-2006 versus 10% post-2006).ConclusionsOutcomes following liver resection for mCRC have improved over time, with significantly better overall survival in the post-2006 era compared to pre-2006.

Background: The International Study Group for Liver Surgery (ISGLS) definition of post hepatectomy liver failure (PHLF) was developed to be consistent, widely applicable, and to include severity stratification. This international multicentre collaborative study aimed to prospectively validate the ISGLS definition of PHLF. Methods: 11 HPB centres from 7 countries developed a standardised reporting form. Prospectively acquired anonymised data on liver resections performed between 01 July 2010 and 30 June 2011 was collected. A multivariate analysis was undertaken of clinically important variables. Results: Of the 949 patients included, 86 (9%) met PHLF requirements. On multivariate analyses, age >= 70 years, pre-operative chemotherapy, steatosis, resection of >3 segments, vascular reconstruction and intraoperative blood loss >300 ml significantly increased the risk of PHLF. Receiver operator curve (ROC) analysis of INR and serum bilirubin relationship with PHLF demonstrated post-operative day 3 and 5 INR performed equally in predicting PHLF, and day 5 bilirubin was the strongest predictor of PHLF. Combining ISGLS grades B and C groups resulted in a high sensitivity for predicting mortality compared to the 50-50 rule and Peak bilirubin >7 mg/dl. Conclusions: The ISGLS definition performed well in this prospective validation study, and may be the optimal definition for PHLF in future research to allow for comparability of data.

ANZ Journal of SurgeryVolume 86, Issue 7-8 p. 533-533 EDITORIAL Avoiding bile duct injury in cholecystectomy through anatomical appreciation Mark E. Brooke-Smith MBBS, PhD, FRACS, Mark E. Brooke-Smith MBBS, PhD, FRACS Department of Surgery, Flinders Medical Centre, Royal Adelaide Hospital, Adelaide, South Australia, AustraliaSearch for more papers by this author Mark E. Brooke-Smith MBBS, PhD, FRACS, Mark E. Brooke-Smith MBBS, PhD, FRACS Department of Surgery, Flinders Medical Centre, Royal Adelaide Hospital, Adelaide, South Australia, AustraliaSearch for more papers by this author First published: 26 July 2016 https://doi.org/10.1111/ans.13581Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume86, Issue7-8July-August 2016Pages 533-533 RelatedInformation

BackgroundThe role of hormones in focal nodular hyperplasia (FNH) has been investigated with conflicting results.ObjectiveThe aim of this study was to evaluate oestrogen and progesterone receptor immunohistochemical expression in FNH and surrounding normal liver (control material).MethodsBiopsy materials from FNH and control tissue were investigated using an immunostainer. Receptor expression was graded as the proportion score (percentage of nuclear staining) and oestrogen receptor intensity score.ResultsStudy material included tissue from 11 resected FNH lesions and two core biopsies in 13 patients (two male). Twelve samples showed oestrogen receptor expression. The percentage of nuclear oestrogen receptor staining was <33% in eight FNH biopsies, 34-66% in two FNH biopsies, and >67% in both core biopsies. The better staining in core biopsies relates to limitations of the staining technique imposed by the fibrous nature of larger resected FNH. Control samples from surrounding tissue were available for nine of the resected specimens and all showed oestrogen receptor expression. Progesterone receptor expression was negligible in FNH and control samples.ConclusionsBy contrast with previous studies, the majority of FNH and surrounding liver in this cohort demonstrated oestrogen receptor nuclear staining. The implications of this for continued oral contraceptive use in women of reproductive age with FNH remain uncertain given the lack of consistent reported growth response to oestrogen stimulation or withdrawal.

Background: Pancreatic cancer (PC) has the worst survival of all periampullary cancers. This may relate to histopathological differences between pancreatic cancers and other periampullary cancers. Our aim was to examine the distribution and histopathologic features of pancreatic, ampullary, biliary and duodenal cancers resected with a pancreaticoduodenectomy (PD) and to examine local trends of periampullary cancers resected with a PD.Methods: A retrospective review of PD between January 2000 and December 2012 at a public metropolitan database was performed. The institutional ethics committee approved this study.Results: There were 142 PDs during the study period, of which 70 cases were pre-2010 and 72 post-2010, corresponding to a recent increase in the number of cases. Of the 142 cases, 116 were for periampullary cancers. There were also proportionately more PD for PC (26/60, 43% pre-2010 vs 39/56, 70% post-2010, P = 0.005). There were 65/116 (56%) pancreatic, 29/116 (25%), ampullary, 17/116 (15%) biliary and 5/116 (4%) duodenal cancers. Nodal involvement occurred more frequently in PC (78%) compared to ampullary (59%), biliary (47%) and duodenal cancers (20%), P = 0.002. Perineural invasion was also more frequent in PC (74%) compared to ampullary (34%), biliary (59%) and duodenal cancers (20%), P = 0.002. Microvascular invasion was seen in 57% pancreatic, 38% ampullary, 41% biliary and 20% duodenal cancers, P = 0.222. Overall, clear margins (R0) were achieved in fewer PC 41/65 (63%) compared to ampullary 27/29 (93%; P = 0.003) and biliary cancers 16/17 (94%; P = 0.014).Conclusions: This study highlights that almost half of PD was performed for cancers other than PC, mainly ampullary and biliary cancers. The volume of PD has increased in recent years with an increased proportion being for PC. PC had higher rates of nodal and perineural invasion compared to ampullary, biliary and duodenal cancers.

BACKGROUND:The International Study Group for Liver Surgery (ISGLS) proposed a definition for bile leak after liver surgery. A multicentre international prospective study was designed to evaluate this definition.METHODS:Data collected prospectively from 949 consecutive patients on specific datasheets from 11 international centres were collated centrally.RESULTS:Bile leak occurred in 69 (7.3%) of patients, with 31 (3.3%), 32 (3.4%) and 6 (0.6%) classified as grade A, B and C, respectively. The grading system of severity correlated with the Dindo complication classification system (P < 0.001). Hospital length of stay was increased when bile leak occurred, from a median of 7 to 15 days (P < 0.001), as was intensive care stay (P < 0.001), and both correlated with increased severity grading of bile leak (P < 0.001). 96% of bile leaks occurred in patients with intra-operative drains. Drain placement did not prevent subsequent intervention in the bile leak group with a 5-15 times greater risk of intervention required in this group (P < 0.001).CONCLUSION:The ISGLS definition of bile leak after liver surgery appears robust and intra-operative drain usage did not prevent the need for subsequent drain placement.

BACKGROUND:Portal vein (PV) resection is used increasingly in pancreatic resections. There is no agreed policy regarding anticoagulation.METHODS:A systematic review was performed to compare studies with an anticoagulation policy (AC+) to no anticoagulation policy (AC-) after venous resection.RESULTS:There were eight AC+ studies (n = 266) and five AC- studies (n = 95). The AC+ studies included aspirin, clopidogrel, heparin or warfarin. Only 50% of patients in the AC+ group received anticoagulation. There were more prosthetic grafts in the AC+ group (30 versus 2, Fisher's exact P < 0.001). The overall morbidity and mortality was similar in both groups. Early PV thrombosis (EPVT) was similar in the AC+ group and the AC- group (7%, versus 3%, Fisher's exact P = 0.270) and was associated with a high mortality (8/20, 40%). When prosthetic grafts were excluded there was no difference in the incidence of EPVT between both groups (1% vs 2%, Fisher's exact test P = 0.621).CONCLUSION:There is significant heterogeneity in the use of anticoagulation after PV resection. Overall morbidity, mortality and EPVT in both groups were similar. EPVT has a high associated mortality. While we have been unable to demonstrate a benefit for anticoagulation, the incidence of EPVT is low in the absence of prosthetic grafts.

Background. Autoimmune pancreatitis (AIP) often mimics pancreatic cancer. The diagnosis of both conditions is difficult preoperatively let alone when they coexist. Several reports have been published describing pancreatic cancer in the setting of AIP.Case Report. The case of a 53-year-old man who presented with abdominal pain, jaundice, and radiological features of autoimmune pancreatitis, with a “sausage-shaped” pancreas and bulky pancreatic head with portal vein impingement, is presented. He had a normal serum IgG4 and only mildly elevated Ca-19.9. Initial endoscopic ultrasound-(EUS-) guided fine-needle aspiration (FNA) of the pancreas revealed an inflammatory sclerosing process only. A repeat EUS guided biopsy following biliary decompression demonstrated both malignancy and features of autoimmune pancreatitis. At laparotomy, a uniformly hard, bulky pancreas was found with no sonographically definable mass. A total pancreatectomy with portal vein resection and reconstruction was performed. Histology revealed adenosquamous carcinoma of the pancreatic head and autoimmune pancreatitis and squamous metaplasia in the remaining pancreas.Conclusion. This case highlights the diagnostic and management difficulties in a patient with pancreatic cancer in the setting of serum IgG4-negative, Type 2 AIP.

ANZ Journal of SurgeryVolume 83, Issue 12 p. 996-997 IMAGES FOR SURGEONS Bouveret's syndrome: gastric outlet obstruction caused by a gallstone David Smolilo BMedSc, BMBS (Hons), David Smolilo BMedSc, BMBS (Hons) Flinders University Department of Surgery, Flinders Medical Centre, Bedford Park, South Australia, AustraliaSearch for more papers by this authorMayank Bhandari MBBS, PhD, FRACS, Mayank Bhandari MBBS, PhD, FRACS Flinders University Department of Surgery, Flinders Medical Centre, Bedford Park, South Australia, AustraliaSearch for more papers by this authorThomas G. Wilson MBBS, FRACS, Thomas G. Wilson MBBS, FRACS Flinders University Department of Surgery, Flinders Medical Centre, Bedford Park, South Australia, AustraliaSearch for more papers by this authorMark Brooke-Smith MBBS, PhD, FRACS, Mark Brooke-Smith MBBS, PhD, FRACS Flinders University Department of Surgery, Flinders Medical Centre, Bedford Park, South Australia, AustraliaSearch for more papers by this authorDavid I. Watson MBBS, MD, FRACS, David I. Watson MBBS, MD, FRACS Flinders University Department of Surgery, Flinders Medical Centre, Bedford Park, South Australia, AustraliaSearch for more papers by this author David Smolilo BMedSc, BMBS (Hons), David Smolilo BMedSc, BMBS (Hons) Flinders University Department of Surgery, Flinders Medical Centre, Bedford Park, South Australia, AustraliaSearch for more papers by this authorMayank Bhandari MBBS, PhD, FRACS, Mayank Bhandari MBBS, PhD, FRACS Flinders University Department of Surgery, Flinders Medical Centre, Bedford Park, South Australia, AustraliaSearch for more papers by this authorThomas G. Wilson MBBS, FRACS, Thomas G. Wilson MBBS, FRACS Flinders University Department of Surgery, Flinders Medical Centre, Bedford Park, South Australia, AustraliaSearch for more papers by this authorMark Brooke-Smith MBBS, PhD, FRACS, Mark Brooke-Smith MBBS, PhD, FRACS Flinders University Department of Surgery, Flinders Medical Centre, Bedford Park, South Australia, AustraliaSearch for more papers by this authorDavid I. Watson MBBS, MD, FRACS, David I. Watson MBBS, MD, FRACS Flinders University Department of Surgery, Flinders Medical Centre, Bedford Park, South Australia, AustraliaSearch for more papers by this author First published: 02 December 2013 https://doi.org/10.1111/ans.12227Citations: 1Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL No abstract is available for this article. References 1 Bouveret L. Stenose du pylore adherent a la vesicule. Rev. Med. 1896; 39: 1– 16. 2 Reisner RM, Cohen JR. Gallstone ileus: a review of 1001 reported cases. Am. Surg. 1994; 60: 441– 446. 3 Brooks Brennan G, Rosenberg RD, Aurora S. Bouveret syndrome. Radiographics 2004; 24: 1171– 1175. 4 Cappell MS, Davis M. Characterization of Bouveret's syndrome: a comprehensive review of 128 cases. Am. J. Gastroenterol. 2006; 81: 1493– 1495. 5 Malvaux P, Degolla R, De Saint-Hubert M, Farchakh E, Hauters P. Laparoscopic treatment of a gastric outlet obstruction caused by a gallstone (Bouveret's syndrome). Surg. Endosc. 2002; 16: 1108– 1109. 6 Heinrich D, Meier J, Wehrli H, Bunhler H. Upper gastrointestinal hemorrhage preceding development of Bouveret's syndrome. Am. J. Gastroenterol. 1993; 88: 777– 780. 7 Modi BP, Owens C, Ashley SW, Colson YL. Bouveret meets Boerhaave. Ann. Thorac. Surg. 2006; 81: 1493– 1495. Citing Literature Volume83, Issue12December 2013Pages 996-997 ReferencesRelatedInformation

BACKGROUND:Liver resection (LR) and liver transplantation (LT) are two modalities offering potential for cure in patients with hepatocellular carcinoma (HCC). The objective of this study was to evaluate the long-term survival of patients with HCC treated with LT and LR and to analyse variables influencing these outcomes. METHODS:Patients referred to the South Australian Liver Transplant Unit and Hepatopancreatobiliary Unit at Flinders Medical Centre from January 1992 to September 2009 with a diagnosis of HCC who underwent LT or LR were included in the study. Histopathological parameters analysed included size, number and grade of tumour, microscopic vascular invasion and presence or absence of cirrhosis in remnant liver. RESULTS:Eighty-five patients with a median age of 58 years (range 26-85 years) underwent LT or LR. Median follow-up was 40 months in both groups. Overall, 5-year actuarial survival for all patients with HCC in both groups was 55%. LR patients were significantly older (P < 0.001) than LT patients. Their tumours were larger (P < 001) and more often solitary (P < 0.001) compared with the LT group. In multivariate analysis, age >60 (P < 0.02), histopathological evidence of vascular invasion (P < 0.02) and presence of cirrhosis (P < 0.02) were associated with a significantly reduced survival. Patients without vascular invasion and cirrhosis had an actuarial 5-year survival >70%. CONCLUSIONS:Our study indicates that LT (within University of California, San Francisco criteria) and LR can lead to acceptable long-term survival outcomes in patients with HCC. Microscopic vascular invasion and cirrhosis were the most significant prognostic factors impacting on survival.