Browsing by Author "Krige, Jake E J"

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    Fibrolamellar hepatocellular carcinoma at a tertiary centre in South Africa
    (Health and Medical Publishing Group, 2009) Bhaijee, Feriyl; Locketz, Michael L; Krige, Jake E J
    Background: Fibrolamellar carcinoma (FLC) is an uncommon malignant tumour of hepatocyte origin that differs from hepatocellular carcinoma (HCC) in aetiology, demographics, condition of the affected liver, and tumour markers. Controversy exists whether FLC demonstrates a more favourable prognosis than typical HCC. A review of existing literature reveals a dearth of FLC data from the African continent. Methods: We utilised the prospective liver resection database at Groote Schuur Hospital to identify all patients who underwent surgery for FLC between 1990 and 2008. Results: Seven patients (median age 21 years, range 19 - 42, 5 men, 2 women) underwent surgery for FLC. No patient had underlying liver disease or an elevated alpha fetoprotein (AFP) at either initial presentation or recurrence. Six patients had a solitary tumour at diagnosis (mean largest diameter = 12cm), and underwent left hepatectomy (N=2), right hepatectomy (N=1), extended right hepatectomy (N=1), and segmentectomies (N=2). Three patients underwent a portal lymphadenectomy for regional lymphatic tumour involvement. One patient with advanced extrahepatic portal nodal metastasis was unresectable. No peri-operative deaths occurred. Recurrence occurred post resection in all 6 patients. Median overall survival was 60 months, and overall 5-year survival was 4 out of 7 (57%). Post-resection survival (N=6) was 61 months, with a 5-year survival rate of 4 out of 6 (67%). The patient with unresectable disease survived 38 months after tumour embolisation with Lipiodol. Conclusion: Our series suggests that despite (i) a high resection rate of solitary lesions with clear tumour resection margins, and (ii) absence of underlying liver disease, FLC has a high recurrence rate with an ultimately poor clinical outcome. These findings concur with recent international experience of FLC.
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    Resection of biliary mucinous cystic neoplasms: Study of a single institutional cohort and a literature review
    (2017) Kloppers, Jacobus Christoffel; Krige, Jake E J; Jonas, Eduard
    Background: Biliary mucinous cystic neoplasms (BMCNs) are uncommon neoplastic septated intrahepatic cysts which are often incorrectly diagnosed and have the potential for malignant transformation. Aim: The aim of this study was to assess the outcome of surgical resection of BMCNs. Methods: Data from a departmental and faculty registered prospective liver surgery database was used to identify patients who underwent surgery at Groote Schuur and the University of Cape Town Private Academic Hospitals for BMCN from 1999 to 2015. Standard demographic variables including age and gender were documented as well as detailed preoperative imaging, location and size, operative treatment, extent of resection, histology, post-operative complications using the Clavien-Dindo classification and long-term outcome. Results: Thirteen female patients (median age 45 years) had surgery. Eleven were diagnosed by computer tomography scan after investigation of abdominal pain or a palpable mass. Two were jaundiced. One cyst was found incidentally during an elective cholecystectomy. Five cysts were located centrally in the liver. Before referral three cysts were treated inappropriately with percutaneous aspiration or drainage and two were treated with operative deroofing. Six patients had anatomical liver resections and seven patients had non anatomical liver resections of which two needed ablation of residual cyst wall. One patient needed a biliary-enteric reconstruction to treat a fistula of the left hepatic duct. Median operative time was 183 minutes (range: 130-375). No invasive carcinoma was found on histology. There was no operative mortality. One surgical site infection was treated and one patient developed an intra-abdominal collection one month post-operatively. Two patients developed recurrent BMCN after 24 months. Conclusion: BMCNs should be considered in middle aged women who have well encapsulated multilocular liver cysts. Treatment of large central BMCNs adjacent to vascular and biliary structures in particular may require technically complex liver resections and are best managed in a specialized hepato-pancreatico-biliary unit.