tailieunhanh - HEPATIC SURGERY_2

Longmire, called it a "hostile" organ because it welcomes malignant cells and sepsis so warmly, bleeds so copiously, and is often the ?rst organ to be injured in blunt abdominal trauma. To balance these negative factors, the liver has two great attributes: its ability to regenerate after massive loss of substance, and its ability, in many cases, to forgive insult. This book covers a wide spectrum of topics including, history of liver surgery, surgical anatomy of the liver, techniques of liver resection, benign and malignant liver tumors, portal hypertension, and liver trauma. Some important topics were covered in more than. | Chapter 14 Liver Resection for Hepatocellular Carcinoma Mazen Hassanain Faisal Alsaif Abdulsalam Alsharaabi and Ahmad Madkhali Additional information is available at the end of the chapter http 54175 1. Introduction Hepatocellular carcinoma HCC an epithelial tumor derived from hepatocytes accounts for 80 of all primary liver cancers and ranks globally as the fourth leading cause of cancer-related deaths. Annual mortality rates of HCC remain comparable to its yearly incidence making it one of the most lethal varieties of solid-organ cancer. Well-established risk factors for the development of HCC include hepatitis B carrier state chronic hepatitis C infection hereditary hemochromatosis and cirrhosis of any etiology as well as certain environmental toxins. HCC treatment is a multidisciplinary and a multimodal task with surgery in the form of liver resection and liver transplantation representing the only potentially curative modalities. Here we going to discuss the liver resection as treatment modality for HCC in detail. . Pathology of HCC Three gross morphologic types of HCC have been identified nodular massive and diffuse. Nodular HCC is often associated with cirrhosis and is characterized by well-circumscribed nodules. The massive type of HCC usually associated with a non-cirrhotic liver occupies a large area with or without satellite nodules in the surrounding liver. The less common diffuse type is characterized by diffuse involvement of many small indistinct tumor nodules throughout the liver. Histologically six growth forms of HCC can be differentiated. The most common form is the trabecular type usually comprising highly differentiated carcinomas with polygonal tumor cells similar to hepatocytes they grow in multilayered trabeculae and enclose blood spaces lined with endothelium usually without Kupffer cells . The pseudoglandular type is generally found in combination with the trabecular form. It is characterized by the formation of .