Summary Conventional orthotopic liver transplantation (CON‐LT) involves resection of recipient cava, usually with extra‐corporeal circulation (veno‐venous bypass, VVB), while in the piggyback technique (PC‐LT) the cava is preserved. Along with a temporary portacaval shunt (TPCS), better haemodynamic maintenance is purported with PC‐LT. A prospective, consecutive series of 384 primary transplants (2000–2003) were analysed, 138 CON‐LT (with VVB) and 246 PC‐LT (54 without TPCS). Patient/donor characteristics were similar in the two groups. PC‐LT required less usage of fresh‐frozen plasma and platelets, intensive care stay, number of patients requiring ventilation after day 1 and total days spent on ventilator. The results were not different when comparing, total operating and warm ischaemia time (WIT), red cell usage, requirement for renal support, day 3 serum creatinine and total hospital stay. TPCS had no impact on outcome other than WIT (P = 0.02). Three patients in PC‐LT group (three of 246;1.2%) developed caval outflow obstruction (P = 0.02). There was no difference in short‐ or long‐term graft or patient survival. PC‐LT has an advantage over CON‐LT unsing VVB with respect to intraoperative blood product usage, postoperative ventilation requirement and ITU stay. VVB is no longer required and TPCS may be used selectively in adult transplantation.

Background/Aim: A cholangiocarcinoma, the second most common primary hepatic malignancy, can present with diagnostic dilemmas. The aim of this study is to assess the role of CA 19-9 in patients with a cholangiocarcinoma without primary sclerosing cholangitis. Methods: The prospectively collected information on patients with biopsy-proven cholangiocarcinomas who had the CA 19-9 level measured was obtained (n = 68) from our computer database and medical records. These patients were compared with patients who had benign liver tumours (n = 25) and benign bile duct strictures (n = 13) who also had their CA 19-9 concentration measured. Results: Sensitivity and specificity of CA 19-9 in the diagnosis of a cholangiocarcinoma were 77.9 and 76.3%, respectively, when using a cut-off value of 35 kU/l, while sensitivity and specificity were 67.5 and 86.8%, respectively, when the cut-off value was raised to 100 kU/l. The specificity was found to be higher in patients with peripheral cholangiocarcinomas (96%) using a CA 19-9 cut-off value >100 kU/l. A CA 19-9 value >600 kU/l was associated with non-resectable tumours (p = 0.05). Conclusions: This study demonstrates that CA 19-9 is a useful adjunct in the diagnosis of cholangiocarcinomas without primary sclerosing cholangitis, especially in the diagnosis of peripheral cholangiocarcinomas. However, it does not provide a reliable guide for the pathological staging of these tumours.

Background: The aim of this study was to look into our experience of resection for hepatocellular carcinomas (HCCs) in a tertiary Hepatobiliary and Liver Transplant Unit in the UK. Methods: A retrospective analysis of our prospective database was carried out. Results: 715 cases of HCC were seen. 100 (13.9%) underwent hepatic resection and 159 (22.2%) orthotopic liver transplant. The 1-, 3- and 5-year overall survival following resection was 75.3, 37.0 and 21.5% respectively. Factors affecting long-term survival included resection margin (p < 0.001), recurrence (p < 0.007), α-fetoprotein >50 (p < 0.001) and serum albumin (p < 0.03). On multivariate analysis, recurrence (p < 0.001) and histological grade (p < 0.044) were significant. The 1- and 3-year recurrence rates were 27.3 and 72.5% respectively. Histological grade (p < 0.007), α-fetoprotein >50 (p < 0.033), female gender (p < 0.016) and portal vein involvement (p < 0.016) were significant in recurrence. Conclusions: Resection data from the East may not be comparable to the West owing to the higher transplant activity in the latter. Liver function tests and imaging would be sufficient to assess liver function prior to hepatic resection. HCC with cirrhosis should be assessed by a transplant unit prior to any treatment. The MELD (Model for End-Stage Liver Disease) score would be a valuable preoperative tool in the assessment of cirrhotics.

Although often described as the fourth modality of treatment after surgery, radiotherapy and chemotherapy, many antiangiogenic drugs have failed to live up to expectations. Nevertheless, research continues and there are reasons to believe that antiangiogenic therapy may yet have a future in the clinical setting.