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A letter to the editor is presented which describes surgical approaches to treating patients with biliary cystadenoma of the liver.

In our study, we arbitrarily define complex hydatid cysts of the liver as either cysts with a diameter ≥ 10 cm, or as multiple and recurrent cysts. These types of cysts were then divided into two subgroups: giant cyst identified as a cyst with a diameter ≥ 10 cm, and complicated cyst as multiple, recurrent, abscessed cysts, or those resistant to conservative treatment. The aim of this study was to retrospectively analyze a series of 38 consecutive patients who underwent surgery for complex hydatid cysts over a period of 9 years at the same institute to determine the evolution of the surgical treatment and the risk factors for recurrence. Fourteen (36.8%) of these patients were women and 24 (63.2%) men (median age 48.1; range 16-71 years). The mean postoperative follow-up was 24 ± 10.8 months. All patients were treated prophylactically with albendazole (10 mg/Kg/ day) for 15 days preoperatively and for 2 months postoperatively. Partial cystectomy was performed in two cases (5.26%) and radical pericystectomy in 20 cases (52.63%). In 15 cases the patients underwent liver resection (39.47%): left hepatectomy was performed in eight cases (21.05%), and right hepatectomy in seven cases (18.42%). In one case, both wedge resection and pericystectomy were performed. There were no deaths and only one patient (2.63%) showed signs of recurrence at follow-up. Radical surgery is the most effective treatment for complex hydatid cysts. In our experience, partial or total pericystectomy virtually eliminated, over time, the need for hepatic resection. [ABSTRACT FROM AUTHOR]

The article describes the case of a 35-year-old woman who presented with a metastases of the pancreatic head from uterine leiomyosarcoma linked with venous involvement. It describes the hysterectomy and bilateral oophorectomy performed on the patient. Tests performed include magnetic resonance angiography and endoscopic ultrasound. It also states that the patient underwent pylorus-preserving pancreaticoduodenectomy.

Today, giant hydatid cysts are fairly rare even in endemic areas. We describe a case of an extremely large hydatid cyst of the liver that was causing massive compression of the neighboring organs, giving rise to a subocclusive syndrome of the intestine. After considering the various approaches available for the treatment of this disease, it was decided that radical surgery was still the best therapeutic choice, especially when extremely large cysts are involved. In particular, in clinical situations where it is difficult to perform radical surgical procedures, less aggressive surgery followed by drug treatment should be the treatment of choice. [ABSTRACT FROM AUTHOR]