الفهرس 
Review of literature
Anatomy&functionOnly 14 pages are availabe for public view
 |  | from | 23 |  |  |
| | | from | 23 | | |
Abstract
AIM OF THE WORK
This work aims to evaluate some modalities of management of malignant hepatic focal lesions (surgical resection, hepatic transplantation, radiofrequency ablation, percutaneous ethanol injection, chemoembolisation, regional &systemic chemotherapy, cryoablation, hepatic artery ligation) as regard indications, applicability, and technique, complications and survival rate.
Conclusion
The management of hepatic malignancy is one of the most controversial areas in medicine. It is a continuously evolving field which requires a multimodal approach and the inclusion of a medical oncologist, a hepato-biliary surgeon, a radiotherapist, an interventional radiologist and in some cases a transplant surgeon. In addition, the recent development of novel approaches such as neoadjuvant tumour therapy, cryosurgery, thermal ablative techniques as well as biological and immunological manipulation of malignant cells has added to the complexity of this field.
Today, the availability of such innovative modalities, in the absence of an extrahepatic localisation of disease, allows the potential to cure many large primary and secondary hepatic tumours. However, the appropriate use of these various treatment modalities should be limited to centers with experience in treating patients with advanced disease where innovative study protocols are available. Experience of the surgeon with difficult hepatectomies is of paramount importance. Currently, mortality following major hepatectomies in non-cirrhotic patients is below 5% in centers of reference. It reached 2% in non-cirrhotic patients with malignant diseases. Mortality, however, reached 5% in cirrhotic patients undergoing a resection involving more than 2 segments.
The resectability rate for HCC is low, only about 3-30%. Successful local resection depends on size (less than 5 cm in diameter), position particularly in relation to large vessels, vascular invasion, capsular invasion, absence of satellite lesions, cirrhosis grade, number of lesions, age and general condition
The improved results of liver transplantation can be related to more careful patient selection, better surgical techniques and post-operative care. Better immunosuppression, particularly with cyclosporin, has contributed.
Local tumor ablation means Intratumoral injections of ethanol or acetic acid, heat (via radiofrequency, microwave, or laser ablation), or cold (cryoablation with liquid nitrogen) and used to locally control tumors smaller than 4-5 cm. These techniques are frequently performed percutaneously as outpatient procedures. In general, these procedures are reserved for patients who are not candidate for surgical resection .
Systemic chemotherapy has been of limited value in clinical practice, because only a small portion of patients obtain significant effects, and because the toxicity of chemotherapy often outweighs the benefits
recent options as Immunotherapy, Hormonal therapy, Octreotide, Gene therapy( growth control) and Targeted therapy needs larger studies and more data in order to define their role and effect.
HEPATOCELLULAR CARCINOMA
Hepato-cellular cancer remains a fatal disease. In a large trial of 123 patients with stage I HCC, usually with cirrhosis, all treatments increased the probability of survival .
Results, however, did not differ between resection, liver transplantation and transarterial oily embolization. (farmer et al 1998),
Small tumours (less than 3cm in diameter) are associated with a 1-year survival of 90.7% , a 2-year survival of 55% and a 3-year survival of 12.8%. Infiltrating tumours have a worse prognosis than expanding ones (Colombo 1992).
Patients less than 45 years old survive longer than older ones. A tumour size exceeding 50 % of the liver, a serum albumin less the 3g / dl and a raised serum Bilirubin level are ominous features (Okuda 1980).
ANGIOSARCOMA(HAEMANGIO-ENDOTHELIOMA)
The prognosis is very poor (Chowdhury et al 1977).
HEPATIC METASTASES
prognosis depends on the site of the primary and the malignancy. In general, patients die within 1 year of diagnosis of hepatic metastases. Secondaries from tumours of colon and rectum have the best outlook. Patients with hepatic metastases at the time of colonic resection have a mean survival of 12 months with an 8 month median.