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From December 1985 to December 1990 100 orthotopic liver transplantations were performed in 89 adult patients in the Department of Transplantation, Niguarda Hospital, Milan. Techniques of donor's and recipient's operation were, with some modifications, those described by Starzl and associates. Patients were divided into two series (the first 32 OLTX and the last 68) on the basis of substantial variation occurred in operative indications, graft preservation and immunosuppression. Cumulative survival was 63% after 12 months, 46% after 36 and 42 months; in the second group it was 78% after 12 and 24 months. In neoplastic patients survival was 49% at 18 months and 23% at 36 and 42 months; in the second group, however, which included 5 occasional findings in cirrhotic patients, survival at 24 months was markedly better (83%). Out of 13 patients who were HBsAg positive before OLTX with a follow-up of more than 3 months, 10 were anti-HDV positive. Five (38%) had HBV recurrence (4 co-infection HBV-HDV), 1 with histological picture of active liver cirrhosis after 8 months. The other 8 patients did not evidence recurrence. Six patients underwent OLTX for acute fulminant hepatitis and all were negative for HGsAg and anti-HCV: 3 survived and are in good condition. Survival was markedly influenced by the preoperative status of the patients and by intraoperative blood loss. The improved survival in the second group is accounted for, in conclusion, by a better surgical/intensive care experience and methodological differences: 1. emergency operations in terminal patients are now limited; 2. selection criteria are much more restrictive; 3. actual preservation solutions allow improved graft function; 4. multidrug immunosuppression permit a better control of rejection

Hepatic resection of colo-rectal metastases, by strictly oncological criteria, does not seem to be a logical approach but, in practice, as reported in the literature proved to have a significant therapeutic value with a 5-year actuarial survival of about 25-30%. The Authors retrospectively analyzed the records of 44 patients operated on for liver resection of single or multiple metastases from colo-rectal cancer in their surgical Department from 1970 to 1988. Twenty-nine were typical hepatic resections and 15 were atypical wedge excisions of the tumor; in all the cases oncological radicality was respected in performing the resection at least at 1 centimeter far from the neoplastic lesion. Perioperative mortality was 7%. Five years actuarial survival was 27%. Single metastases showed a significant better survival (61% at 5 years) than multiple (respectively 18% and 0% for patients with 2-3 nodules and more than 3 nodules). Patients with B-Dukes lesions had significantly improved prognosis 5 years after the hepatic resection (58%) in respect with the patients in stage C or with synchronous metastases. Resection of liver metastases from colo-rectal cancer seems to be a real therapeutic option in patients with single nodule and/or in B-Dukes stage

Coinaud's segmental hepatic resection are rarely performed in western world and generally major resections are preferred. From 1973 to 1987, 83 patients underwent different kinds of segmental resections in our Surgical Department. A transparenchimal approach has been adopted in almost all cases. In 28 patients the hepatic parenchima has been transected during normothermic hepatic ischemia by temporary portal triad crossclamping. In our experience the adoption of Pringle manouvre represents an important technical adjunct in the execution of segmental hepatic resections. The near bloodless operative field makes the identification of the vascular structures easier and safer to be ligated and those to be resected. The procedures are characterized by limited operating time (115 ± 20 minutes), reduced blood losses (570 ± 125 ml in noncirrhotic patients, 1250 ± 490 in cirrhotic patients) and favourable postoperative courses