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The hanging manoeuver to complete liver resection for a locally advanced angiosarcoma: A case report

INTRODUCTION: Angiosarcomas arising in the liver are rare tumours in the Western world. We report a case of a locally advanced primary hepatic angiosarcoma and also describe the manoeuvres used to achieve operative resection. PRESENTATION OF A CASE: A 52-year old woman presented with vague right upp...

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Autores principales: Cawich, Shamir O., Thomas, Dexter, Ragoonanan, Vindra, Naraynsingh, Vijay
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier 2015
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4643337/
https://www.ncbi.nlm.nih.gov/pubmed/26413923
http://dx.doi.org/10.1016/j.ijscr.2015.09.006
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author Cawich, Shamir O.
Thomas, Dexter
Ragoonanan, Vindra
Naraynsingh, Vijay
author_facet Cawich, Shamir O.
Thomas, Dexter
Ragoonanan, Vindra
Naraynsingh, Vijay
author_sort Cawich, Shamir O.
collection PubMed
description INTRODUCTION: Angiosarcomas arising in the liver are rare tumours in the Western world. We report a case of a locally advanced primary hepatic angiosarcoma and also describe the manoeuvres used to achieve operative resection. PRESENTATION OF A CASE: A 52-year old woman presented with vague right upper quadrant pain. Abdominal imaging revealed a heterogenous tumour in the right liver measuring 15 centimetres in maximal diameter. Although the tumour was deemed to be resectable, there was free fluid in the right paracolic gutter suggestive of rupture. Intra-operatively, the peritoneal cavity was noted to be free of metastatic disease. However, tumour was adherent to the diaphragm precluding traditional mobilization of the liver. Therefore, a modified hanging manoeuvre was performed using a nasogastric tube. This allowed controlled mobilization of the right liver, parenchymal transection and en-bloc resection of the diaphragm with good hemostasis. Histologic examination revealed a primary angiosarcoma with uninvolved margins. DISCUSSION: When they occur, primary hepatic angiosarcomas are most often locally advanced. Nevertheless, surgeons should be aggressive in the pursuit of complete resections because this is the only therapeutic modality that has been shown to have a survival advantage. CONCLUSION: Hepatobiliary surgeons should keep the hanging manoeuver in their armamentarium when performing complex liver resections for locally advanced angiosarcomas.
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spelling pubmed-46433372015-12-08 The hanging manoeuver to complete liver resection for a locally advanced angiosarcoma: A case report Cawich, Shamir O. Thomas, Dexter Ragoonanan, Vindra Naraynsingh, Vijay Int J Surg Case Rep Case Report INTRODUCTION: Angiosarcomas arising in the liver are rare tumours in the Western world. We report a case of a locally advanced primary hepatic angiosarcoma and also describe the manoeuvres used to achieve operative resection. PRESENTATION OF A CASE: A 52-year old woman presented with vague right upper quadrant pain. Abdominal imaging revealed a heterogenous tumour in the right liver measuring 15 centimetres in maximal diameter. Although the tumour was deemed to be resectable, there was free fluid in the right paracolic gutter suggestive of rupture. Intra-operatively, the peritoneal cavity was noted to be free of metastatic disease. However, tumour was adherent to the diaphragm precluding traditional mobilization of the liver. Therefore, a modified hanging manoeuvre was performed using a nasogastric tube. This allowed controlled mobilization of the right liver, parenchymal transection and en-bloc resection of the diaphragm with good hemostasis. Histologic examination revealed a primary angiosarcoma with uninvolved margins. DISCUSSION: When they occur, primary hepatic angiosarcomas are most often locally advanced. Nevertheless, surgeons should be aggressive in the pursuit of complete resections because this is the only therapeutic modality that has been shown to have a survival advantage. CONCLUSION: Hepatobiliary surgeons should keep the hanging manoeuver in their armamentarium when performing complex liver resections for locally advanced angiosarcomas. Elsevier 2015-09-16 /pmc/articles/PMC4643337/ /pubmed/26413923 http://dx.doi.org/10.1016/j.ijscr.2015.09.006 Text en © 2015 The Authors http://creativecommons.org/licenses/by-nc-nd/4.0/ This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
spellingShingle Case Report
Cawich, Shamir O.
Thomas, Dexter
Ragoonanan, Vindra
Naraynsingh, Vijay
The hanging manoeuver to complete liver resection for a locally advanced angiosarcoma: A case report
title The hanging manoeuver to complete liver resection for a locally advanced angiosarcoma: A case report
title_full The hanging manoeuver to complete liver resection for a locally advanced angiosarcoma: A case report
title_fullStr The hanging manoeuver to complete liver resection for a locally advanced angiosarcoma: A case report
title_full_unstemmed The hanging manoeuver to complete liver resection for a locally advanced angiosarcoma: A case report
title_short The hanging manoeuver to complete liver resection for a locally advanced angiosarcoma: A case report
title_sort hanging manoeuver to complete liver resection for a locally advanced angiosarcoma: a case report
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4643337/
https://www.ncbi.nlm.nih.gov/pubmed/26413923
http://dx.doi.org/10.1016/j.ijscr.2015.09.006
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