When one deals with cancer, the hepatobiliary malignancies present a chal lenge to the oncologists that can be characterized as a series of unsolved clinical and biological dilemmas. Liver metastases from colorectal and other gastrointestinal malignancies, hepatocellular carcinoma, cholangiocar cinoma, and gall bladder cancer present an array of problems but have two features in common. These are high morbidity and mortality with an overall poor result from treatment. Why is it that hepatobiliary cancer carries with it such a dismal prognosis? First of all, these diseases present, for the most part, in an advanced state. To this point in time the oncologist has had no help from early diagnosis or screening. Only the occasional patient followed by ultrasound or a tumor marker has the disease diagnosed in an asymptomatic state. By the time these diseases become symptomatic, curative treatment options have usually disappeared. Evolution has placed the liver in a protected position in order to avoid injury to the soft parenchyma. As with many other internal organs, the nerve supply is extremely limited. These two anatomic features result in a great lack of early warning signs of cancer.

Klappentext

When one deals with cancer, the hepatobiliary malignancies present a chal­ lenge to the oncologists that can be characterized as a series of unsolved clinical and biological dilemmas. Liver metastases from colorectal and other gastrointestinal malignancies, hepatocellular carcinoma, cholangiocar­ cinoma, and gall bladder cancer present an array of problems but have two features in common. These are high morbidity and mortality with an overall poor result from treatment. Why is it that hepatobiliary cancer carries with it such a dismal prognosis? First of all, these diseases present, for the most part, in an advanced state. To this point in time the oncologist has had no help from early diagnosis or screening. Only the occasional patient followed by ultrasound or a tumor marker has the disease diagnosed in an asymptomatic state. By the time these diseases become symptomatic, curative treatment options have usually disappeared. Evolution has placed the liver in a protected position in order to avoid injury to the soft parenchyma. As with many other internal organs, the nerve supply is extremely limited. These two anatomic features result in a great lack of early warning signs of cancer.

Inhalt

1. Inefficiency of metastasis from colorectal carcinomas.- 2. Cytoreductive approach to treatment of multiple liver metastases.- 3. Hepatoma registry of the western world.- 4. Resection of hepatic metastases from colorectal carcinoma.- 5. Surgical managemet of hepatic metastases from large bowel cancer.- 6. Repeat resections of primary hepatic malignancies.- 7. Repeat resections for recurrent colorectal liver metastases.- 8. Liver transplantation as an option for primary malignancy.- 9. Surgical treatment of cholangiocarcinoma.- 10. Treatment of gallbladder cancer.- 11. Use of clamps in hepatobiliary surgery.- 12. Chemotherapy after hepatic resection of colorectal metastases.- 13. Radiological evaluation of metastases to the liver: The Emory experience.- 14. Hepatic vascular exclusion for hepatic resection.- 15. Radiologic evaluation and treatment of gallbladder and biliary tree carcinoma.- 16. Repeat liver resections from colorectal metastasis.- 17. Intraoperative ultrasound and liver tumor.- 18. Parenchymal dissection techniques.- 19. Surgical resection and transplantation for hepatocellular carcinom.- 20. Causes of death in patients undergoing liver surgery.- 21. Liver transplantation as an option in patients with cholangiocellular and bile duct carcinoma.- 22. Surgical management of hepatoma.- 23. Liver resectability based on physical characteristics.- 24. Prediction of the safe limits of hepatectomy by combined volumetric and functional measurements in patients with impaired hepatic function.- 25. Quantitative liver function testing as a preoperative parameter in hepatic resection.- 26. Decreasing posthepatectomy liver failure.- 27. Current status in liver function tests: Technical considerations.