862 results on '"Hepatobiliary surgery"'
Search Results
102. Surgical Indication for Advanced Gallbladder Cancer Considering the Optimal Preoperative Carbohydrate Antigen 19-9 Cutoff Value.
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Yamamoto, Yusuke, Sugiura, Teiichi, Okamura, Yukiyasu, Ito, Takaaki, Ashida, Ryo, Ohgi, Katsuhisa, and Uesaka, Katsuhiko
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SURGICAL indications , *GALLBLADDER cancer , *OPERATIVE surgery , *CARBOHYDRATES , *ANTIGENS , *CA 19-9 test - Abstract
Background: Selecting patients who will benefit from resection among those with advanced gallbladder cancer (GBCa) having poor prognostic factors is difficult. Methods: One hundred twenty-one patients who underwent resection for stage II–IV GBCa and 19 unresected patients (unresectable group) were enrolled. The clinical impact of carbohydrate antigen 19-9 (CA19-9) and advanced surgical procedures for GBCa was evaluated. Results: The optimal CA19-9 cutoff value (based on the greatest difference in overall survival) was 250 U/mL. CA19-9 ≥250 U/mL was found to be an independent prognostic factor. Patients with CA19-9 <250 U/mL who developed jaundice (median survival time [MST], 49.1 months) or who required major hepatectomy (MST, 21.5 months) or pancreatoduodenectomy (PD; MST, 50.3 months) had a better prognosis than those with CA19-9 ≥250 U/mL who developed jaundice (MST, 16.1 months; p = 0.061) or who required major hepatectomy (MST, 9.2 months; p = 0.066) or PD (MST, 8.6 months; p = 0.025); their prognosis was comparable to that of the unresectable group (jaundice: p = 0.145, major hepatectomy: p = 0.292, PD: p = 0.756). Conclusions: Even if GBCa patients develop jaundice or require major hepatectomy, or combined PD, resection can be considered for those with CA19-9 <250 U/mL. However, surgical indication should be carefully determined in patients with CA19-9 ≥250 U/mL. [ABSTRACT FROM AUTHOR] more...
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- 2020
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103. Surgical education interventions in liver surgery: a systematic review.
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Rashidian, Nikdokht, Vierstraete, Maaike, Alseidi, Adnan, Troisi, Roberto Ivan, and Willaert, Wouter
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The objective of the study was to identify and to evaluate the impact of educational interventions to learn and train liver surgery outside the operating room. A systematic literature search was conducted using PubMed, Web of Science, Embase, and ERIC databases from inception to September 2019 according to the PRISMA guidelines. Studies describing and assessing outcomes of educational interventions in liver surgery, outside the operating room, were included. Neither language nor date of publication restriction was applied. Methodological quality was appraised using NOS-E (Newcastle–Ottawa Scale for Education), and the level of evidence was evaluated based on GRADE (Grades of Recommendation Assessment, Development, and Evaluation) standards. Of the 10,403 screened abstracts, 53 articles were eligible for inclusion, comprising 27 descriptive studies (50.9%), 14 case series assessing any relevant outcome (26.4%), 8 non-randomized controlled trials (15.1%), and 4 randomized controlled studies (7.5%). Almost half (26/53) of the studies did not include any participants, while the remainder of the publications (27/53) involved 1306 learners. The majority of the studies focused on cognitive knowledge (31/53) and/or psychomotor skills training (24/53). Only one publication assessed affective skills. The GRADE score was very low or low in most articles (46/53). Five studies were scored high (5–6) according to NOS-E. Two studies reported data regarding the reliability and validity of employed assessment tools. High-quality studies, particularly well-designed randomized controlled trials that evaluate the effectiveness of simulation-based training on learner behavior and patient outcomes in liver surgery, are still lacking. Forthcoming studies should use robust assessment tools supported by validity evidence. [ABSTRACT FROM AUTHOR] more...
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- 2020
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104. Large mucinous cystic neoplasm of the pancreas during pregnancy: a case report.
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Carvalho, Lúcia, Ferreira, Tiago, Frutuoso, Luísa, Matos, Leonor, Castro, Tiago, Rodrigues, Domingos, Oliveira, Vera, Gonçalves, Gil, Nora, Mário, and Scigliano, Horácio
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PANCREAS , *TUMORS , *PREGNANCY , *PREGNANT women , *CYSTADENOMA , *PANCREATIC surgery - Abstract
Mucinous cystic neoplasms (MCNs) of the pancreas occurring during pregnancy constitute a rare condition requiring special management due to its large size, malignant potential and the risk of fetal growth restriction. The key points to manage MCNs are to perform a correct diagnosis, accurately evaluate the grade of malignant potential in order to establish the right time for pancreatic surgery and to choose the most appropriate fetal mode of delivery. We describe a case of an incidental abdominal mass detected in a third-trimester pregnant woman. At surgery, a huge pancreatic cystic tumour was found and a distal pancreatectomy with splenic preservation was performed. The histopathological analysis revealed an MCN of the pancreas with low-grade dysplasia. To our knowledge, this is the largest pancreatic MCN detected in a pregnant woman reported in the literature and one of the few successfully resected after vaginal delivery. [ABSTRACT FROM AUTHOR] more...
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- 2020
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105. ПОДХОД ЗА УСКОРЕНО ВЪЗСТАНОВЯВАНЕ СЛЕД ОПЕРАЦИЯ (ERAS) В ЖЛЪЧНО- ЧЕРНОДРОБНАТА ХИРУРГИЯ
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Михайлов, Васил, Йончева, Мариана, Григоров, Евгени, and Салчев, Петко
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DRUG information materials ,LENGTH of stay in hospitals ,PSYCHOLOGICAL stress ,PATIENT satisfaction ,SURGICAL complications - Abstract
Enhanced recovery after surgery (ERAS) is a standardized and evidence-based multimodal, perioperative strategy. It includes a series of measures aimed at reducing the physical and psychological stress responses to surgery and improving postoperative outcomes, reducing complications, reducing hospital length of stay (LOS) and the associated financing costs. The aim of this study is to analyze current scientific evidence on the application of the concept of ERAS in hepatobiliary surgery and the associated socio-economic consequences, as well as the possibilities for introducing this approach in Bulgaria. A search was performed in MEDLINE®, EMBASE, COCHRANE and PubMed® for the time period 2007 - 2019. Indicators such as: postoperative complications and mortality, LOS, frequency of rehospitalization, quality of life, return to normal activity and work, financial and socio-economic consequences. This review was performed in accordance with the PRISMA statement guidelines. This article review clearly shows that the application of the ERAS protocol in hepatic and biliary surgery is possible and safe, leading to a significant reducing hospital LOS, reducing the incidence of postoperative complications. All this is associated with reduced costs and increased patient satisfaction. The introduction of these protocols in Bulgaria is associated with appropriate staff training, preparation of information materials for patients, creating the necessary regulatory and logistical basis for this. The ERAS protocol is dynamic and requires constant adaptation to the specific conditions and needs of patients. [ABSTRACT FROM AUTHOR] more...
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- 2020
106. 规范化疼痛管理在肝胆外科术后患者疼痛控制中的应用.
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林雪芬, 徐晓艳, 冯美雯, 班红玉, 王娜, and 纪翠红
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Copyright of Nursing of Integrated Traditional Chinese & Western Medicine is the property of Journal of Clinical Nursing in Practice (Editorial Board, Shanghai Jiao Tong University Press) and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.) more...
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- 2020
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107. Application of image‐guided navigation system for laparoscopic hepatobiliary surgery.
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Yasuda, Jungo, Okamoto, Tomoyoshi, Onda, Shinji, Fujioka, Shuuichi, Yanaga, Katsuhiko, Suzuki, Naoki, and Hattori, Asaki
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LAPAROSCOPIC surgery , *OPERATIVE ultrasonography , *SURGERY , *HEPATECTOMY - Abstract
Background: To achieve safety of the operation, preoperative simulation became a routine practice for hepatobiliary and pancreatic (HBP) surgery. The use of intraoperative ultrasonography (IOUS) is essential in HBP surgery. There is a limitation in the use of IOUS in laparoscopic surgery (LS), for which a new intraoperative system is expected. We have developed an image‐guided navigation system (IG‐NS) for open HBP surgery since 2006, and we have applied our system to LS. The aim of this study is to evaluate the results of clinical application of IG‐NS in LS. Materials and methods: Eight patients underwent LS using IG‐NS; LS consisted of cholecystectomy and hepatectomy in four patients each. After registration, the 3D models were superimposed on the surgical field. We performed LS while observing the navigation image. Moreover, we developed a support system for operations. Results: The average registration error was 8.8 mm for LS. Repeated registration was effective for organ deformation and improved the precision of IG‐NS. By using various countermeasures, identification of the tumor's position and the setting of the resection line became easy. Conclusion: As IG‐NS provided real‐time detailed and intuitive information, this intraoperative assist system may be an effective tool in LS. [ABSTRACT FROM AUTHOR] more...
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- 2020
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108. Hepatic Epithelioid Hemangioendothelioma
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Renz, John F., Ferguson, Mark K, Series editor, Millis, J. Michael, editor, and Matthews, Jeffrey B., editor
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- 2016
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109. Cystic Diseases of the Liver
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Renz, John F., Ferguson, Mark K, Series editor, Millis, J. Michael, editor, and Matthews, Jeffrey B., editor
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- 2016
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110. Cost-effective surgical management of liver disease in an university hospital: A retrospective study
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Ioanna Tseka, Michael Chrisofos, Elissaios Kontis, Christos Triantafyllou, Panagiotis Kokoropoulos, and Nikolaos Arkadopoulos
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Cultural Studies ,cost estimation ,cost-effective method ,Religious studies ,Hepatobiliary surgery ,adverse events - Abstract
Background: Hepatobiliary surgery is a high-end surgery comprising of complex operations associated with high economic burden to a healthcare system. The aim of this study was to evaluate the cost-effectiveness of a hepatobiliary surgery highly standardized operative protocol, that minimizes intraoperative and postoperative costs, implemented by the same surgical team, in a Greek university hospital for a five-year period (2012-2016). Method and Material: The digital medical records of all patients undergoing liver resection at a tertiary university hospital from January 2012 to December 2016 by a single surgical team were retrospectively reviewed. The financial cost of the patients’ treatment was calculated in collaboration with the hospital’s logistics department, and it involved all preoperative, intraoperative, and postoperative expenses from admission to discharge, excluding physician fees and salary cost of the hospital’s nurses. Results: In this study, 127 patients underwent hepatectomy. The patient’s health status was improved after the surgery in most of the cases (121, 95.2%). The mean Length of Stay (LOS) was 13.4 (SD±17.3) days. The mean total hospitalization cost was 4,729 (SD ± 5,486) euros (€), while the cost of surgery, the higher mean cost was noted in 2013 (925, SD±974.64 €) and the lower in 2015 (142, SD±219 €). Conclusions: This protocol allows the performance of hepatectomies with a significantly decreased cost without compromising patient outcomes. more...
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- 2022
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111. Robotic Applications in Advancing General Surgery
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Hagen, Monika E., Tauxe, William M., Morel, Philippe, Latifi, Rifat, editor, Rhee, Peter, editor, and Gruessner, Rainer W.G., editor
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- 2015
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112. Postoperative Hepatic Insufficiency
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Shindoh, Junichi, Vauthey, Jean-Nicolas, Pawlik, Timothy M., editor, Maithel, Shishir K., editor, and Merchant, Nipun B., editor
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- 2015
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113. Inflammation and pro-resolution inflammation after hepatobiliary surgery
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Juan P. Cata, Jose F. Velasquez, Maria F. Ramirez, Jean-Nicolas Vauthey, Vijaya Gottumukkala, Claudius Conrad, Bradford J. Kim, and Thomas Aloia
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Inflammation ,Resolution ,Hepatobiliary surgery ,Complications ,Surgery ,RD1-811 ,Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,RC254-282 - Abstract
Abstract Background The magnitude of the perioperative inflammatory response plays a role in surgical outcomes. However, few studies have explored the mechanisms of the resolution of inflammation in the context of surgery. Here, we described the temporal kinetics of interleukin-6, cortisol, lipoxin A4, and resolvin D in patients who underwent oncologic liver resections. Methods All patients gave written informed consent. Demographic and perioperative surgical data were collected, along with blood samples, before surgery and on the mornings of postoperative days 1, 3, and 5. Interleukin-6, cortisol, lipoxin-A4, and resolvin D were measured in plasma. A P value more...
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- 2017
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114. Egyptian Liver Journal
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hepatology ,liver ,hepatobiliary surgery ,Surgery ,RD1-811 ,Diseases of the digestive system. Gastroenterology ,RC799-869 - Published
- 2019
115. Efficacy and safety of terlipressin infusion during liver surgery: a protocol for systematic review and meta-analysis.
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Ding L, Duan Y, Yao L, and Gao Z
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- Humans, Research Design, Liver Diseases surgery, Blood Transfusion statistics & numerical data, Liver surgery, Terlipressin therapeutic use, Terlipressin administration & dosage, Systematic Reviews as Topic, Blood Loss, Surgical prevention & control, Meta-Analysis as Topic, Vasoconstrictor Agents administration & dosage, Vasoconstrictor Agents therapeutic use
- Abstract
Introduction: Liver disease causes 2 million deaths annually, accounting for 4% of all deaths worldwide. Liver surgery is one of the effective therapeutic options. Bleeding is a major complication during liver surgery. Perioperative bleeding and allogeneic blood transfusion may deteriorate the prognosis. Terlipressin (TP), a synthetic analogue of the antidiuretic hormone, may reduceblood loss during abdominal surgery. Several clinical centres have attempted to use TP during liver surgery, but the evidence for its effectiveness in reducing blood loss and the need for allogeneic blood transfusion, as well as its safety during the perioperative period, remains unclear. The aim of this systematic review and meta-analysis is to evaluate the efficacy and safety of TP in reducing blood loss and allogeneic blood transfusion needs during liver surgery., Methods and Analysis: We will search PubMed, EMBASE, the Cochrane Library and Web of Science for studies on perioperative use of TP during liver surgery from inception to July 2023. We will limit the language to English, and two reviewers will independently screen and select articles. The primary study outcomes are estimated blood loss and the need for allogeneic blood transfusion. Secondary outcomes include operating time, intensive care unit stay, length of stay, intraoperative urine output, acute kidney injury rate, postoperative complications, hepatic and renal function during follow-up, and TP-related adverse effects. We will include studies that met the following criteria: (1) randomised controlled trials (RCTs), cohort studies or case-control studies; (2) the publication time was till July 2023; (3) adult patients (≥18 years old) undergoing elective liver surgery; (4) comparison of TP with other treatments and (5) the study includes at least one outcome. We will exclude animal studies, case reports, case series, non-original articles, reviews, paediatric articles, non-controlled trials, unpublished articles, non-English articles and other studies that are duplicates. We will use Review Manager V.5.3 software for meta-analysis and perform stratification analysis for the study quality of RCTs based on the Jadad score. For cohort or case-control studies, the study quality will be analysed based on Newcastle-Ottawa Scale scores. Grading of Recommendations, Assessment, Development and Evaluation will be used to assess confidence in the cumulative evidence. For primary outcomes, we will conduct subgroup analyses based on meta-regression. We will also perform leave-one-out sensitivity analyses to evaluate the effect of each individual study on the combined results by removing the individual studies one by one for outcomes with significant heterogeneity. The protocol follows the Cochrane Handbook for Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols guidelines., Ethics and Dissemination: This study is a secondary analysis of existing data; therefore, it does not require ethical approval. We will disseminate the results through peer-reviewed publications., Prospero Registration Number: CRD42023450333., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.) more...
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- 2024
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116. Thoracic spinal anaesthesia for abdominal surgery in a humanitarian military field hospital: a prospective observational study.
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Aissaoui Y, Bahi M, El Khader A, El Barni R, and Belhadj A
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- Adult, Aged, Female, Humans, Male, Middle Aged, Mobile Health Units, Nausea, Vomiting, Prospective Studies, Anesthesia, Spinal methods, Anesthetics, Military Personnel, Post-Dural Puncture Headache, Urinary Retention
- Abstract
Background: Providing safe and effective anaesthesia in the context of humanitarian medicine is always a challenging situation. Spinal anaesthesia, and in particular its thoracic approach, represents a promising technique for such a limited-resource environment. This prospective observational study investigated the feasibility of thoracic spinal anaesthesia (TSA) for abdominal surgery in a field-deployed military hospital., Materials and Methods: We included adults scheduled for elective open cholecystectomy in a field hospital. Patients received TSA at the T9-T10 level. The primary outcomes were the feasibility of surgery under TSA and the haemodynamic/respiratory stability of this anaesthetic technique. The secondary outcomes included patient satisfaction and surgeon comfort regarding the anaesthesia technique and postoperative events (nausea and vomiting, urinary retention, postdural puncture headache)., Results: Surgery was performed successfully in 61 patients under TSA (90% female, 53±13 years old). Intraoperative pain scores were low, with a median Numeric Rating Scale score of 0 (IQR 0-2). Surgeon and patient satisfaction scores were excellent. The haemodynamic and respiratory parameters remained stable throughout the surgery. The incidence of postoperative events was low (nausea/vomiting=8%). None of our patients presented with postdural puncture headache or urinary retention., Conclusion: TSA could be an effective anaesthetic technique for abdominal surgery in the context of a field hospital or austere environment., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ.) more...
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- 2024
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117. Rare anatomic variations of the right hepatic biliary system.
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Garg, Shallu, Kumar, Hemanth, Sahni, Daisy, Yadav, T. D., Aggarwal, Anjali, and Gupta, Tulika
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DRAINAGE , *LIVER , *DISSECTION - Abstract
Purpose: To report rare and clinically significant anatomic variations in the biliary drainage of right hepatic lobe. Methods: Unique variations in the extra- and intrahepatic biliary drainage of right hepatic lobe were observed in 6 cadaveric livers during dissection on 100 formalin-fixed en bloc cadaveric livers. Results: There was presence of aberrant drainage of right segmental and sectorial ducts in four cases and of accessory right posterior sectorial duct in two cases. Conclusions: We encountered some extensively complicated biliary drainage of right hepatic lobe, unsuccessful recognition of which can lead to serious biliary complications during hepatobiliary surgeries and biliary interventions. [ABSTRACT FROM AUTHOR] more...
- Published
- 2019
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118. Cytopathology and ultrastructure identification of primary hepatic acinar cell carcinoma: Case report.
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Grab, J.G., Skubleny, D., and Kneteman, N.M.
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• Acinar cell carcinoma originating in the liver proper remains a diagnostic quandary. • Non-specific imaging features may have led to prior misdiagnosis and poor outcomes. • Ultrastructural electron microscopy represents a novel tool for identification. • Heterotopia or metaplastic mechanisms may underlie hepatic acinar cell localization. • The previous literature is summarized in context of the present case of hepatic ACC. A primary acinar cell carcinoma (ACC) of the liver was incidentally diagnosed in a clinically asymptomatic 80-year-old man. This study aimed to delineate critical diagnostic characteristics of an ACC originating uniquely from the liver to improve its future identification. Enhanced MRI revealed a heterogenous, cystic 7.7 × 11.1 × 10.4 cm tumour occupying hepatic segments II and III. The mass demonstrated mild diffuse enhancement in hepatic arterial phase with minimal portal venous washout in a liver without cirrhotic features. A central stellate T2-hyperintense necrotic scar and outer capsule were apparent. No primary lesion or metastasis outside the liver was discernable. Post-left hepatic lobectomy, the tumour immunophenotype was atypical for presumptive diagnoses of hepatocellular carcinoma (HCC) or cholangiocarcinoma. Extensive morphologic workup on electron microscopy definitively diagnosed primary hepatic ACC by establishing presence of secretory zymogen-like granules, intracytoplasmic microvilli and acinar cell differentiation. Cytopathology revealed cellular lumen expressing PAS-positive diastase-resistant granular cytoplasmic contents. This case showcased the novel utility of electron microscopy that was crucial in yielding the definitive diagnosis. The previous literature on hepatic ACC was compiled here in context of the present case. The mechanism of hepatic acinar cell localization was also discussed. Primary hepatic ACC may easily be confused for other lesions due to nonspecific imaging patterns. Specifically, the presence of a central scar without risk factors for HCC can favour a diagnosis of benign entities such as focal nodular hyperplasia (FNH). Electron microscopy presents an important tool to identify primary hepatic ACC and may improve future patient outcomes. [ABSTRACT FROM AUTHOR] more...
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- 2019
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119. Laparoscopic right posterior sectionectomy: single-center experience and technical aspects.
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D'Hondt, Mathieu, Ovaere, Sander, Knol, Joep, Vandeputte, Mathieu, Parmentier, Isabelle, De Meyere, Celine, Vansteenkiste, Franky, Besselink, Marc, Pottel, Hans, and Verslype, Chris
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RIGHT hemicolectomy , *LIVER metastasis , *HEPATOCELLULAR carcinoma , *EXPERIENCE - Abstract
Purpose: Laparoscopic right posterior sectionectomy (LRPS) is a technically demanding procedure. The aim of this article is to share our experience with LRPS and to highlight technical aspects of this procedure.Methods: This is a single-center retrospective analysis of all patients who underwent LRPS between September 2011 and October 2017. Data were retrieved from a prospectively maintained database. Video-in-picture (VIP) technology is used to facilitate and to highlight the technical aspects of this procedure.Results: In total, 18 patients underwent LRPS. Indication for surgery was mainly liver metastases (n = 11) and hepatocellular carcinoma (n = 6). The Glissonean approach for inflow control was used in 13 patients. Median operative time was 162 (140-190) minutes. Median blood loss was 325 mL (IQR: 150-450). One conversion (5.5%) was required. There were two minor complications and one major complication. Median hospital stay was 6 days (range 5-8 days). All patients had an R0 resection. There was no 90-day mortality.Conclusion: The results of our experience in LRPS add weight to the feasibility and safety of this approach. [ABSTRACT FROM AUTHOR] more...
- Published
- 2019
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120. Incisional hernia in hepatobiliary and pancreatic surgery: incidence and risk factors.
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Chen-Xu, J., Bessa-Melo, R., Graça, L., and Costa-Maia, J.
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PANCREATIC surgery , *SURGICAL site infections , *HERNIA , *SURGICAL complications , *DISEASE incidence , *OBESITY complications , *SURGICAL wound dehiscence , *DISEASE risk factors , *STATURE , *ABDOMINAL surgery , *RETROSPECTIVE studies , *ARTHRITIS Impact Measurement Scales - Abstract
Purpose: The occurrence of incisional hernia (IH) is one of the main complications after open abdominal surgery. However, its incidence in hepatobiliary and pancreatic surgery is not known. Studies on hepatectomy and necrotizing pancreatitis show that the incidence can reach up to 42%. This study aims at evaluating the incidence of IH and its risk factors.Methods: Patients submitted to open hepatobiliary and pancreatic surgery at our centre between 2010 and 2016 were selected. IH was defined as discontinuity in the abdominal fascia reported during physical examination or on computed tomography. Variables analysed range from individual characteristics and medical history to surgical and postoperative aspects.Results: The cumulative incidence of IH was 21.6% at 72 months. In pancreatic surgery, this incidence was 11.6%, while hepatobiliary patients presented an incidence of 27.0%. Cox regression showed that height (p = 0.028), subcutaneous fat (p = 0.037), wound dehiscence (p = 0.001) and superficial surgical site infection (p = 0.001) correlate positively with IH in pancreatic surgery patients. BMI (p = 0.037) and perirenal fat (p = 0.043) associated independently with IH in hepatobiliary surgery.Conclusions: Height, obesity and wound complications are risk factors for IH in patients submitted to pancreatic surgery, whereas obesity presents as risk factor in hepatobiliary surgery patients. The incidence of IH goes up to 12% in patients submitted to pancreatic surgery, while this risk is higher in the hepatobiliary group (27%). It is suggested the adoption of strategies in the clinical practice prevents this high incidence, namely in high-risk patients. [ABSTRACT FROM AUTHOR] more...- Published
- 2019
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121. Radiofrequency-assisted transection of the pancreas versus stapler in distal pancreatectomy. Study protocol for a multicentric randomised clinical trial (TRANSPAIRE)
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Patricia Sánchez-Velázquez, Eva Pueyo-Périz, J M Álamo, Gonzalo Suarez Artacho, Miguel Ángel Gómez Bravo, Manuel Marcello, Emilio Vicente, Yolanda Quijano, Valentina Ferri, Riccardo Caruso, Dimitri Dorcaratto, Luis Sabater, Pilarena González Chávez, Jose Noguera, Ana Navarro Gonzalo, Juan Bellido-Luque, Clara Téllez-Marques, Benedetto Ielpo, and Fernando Burdio more...
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Pancreatic surgery ,General Medicine ,Hepatobiliary surgery ,Pancreatic Fistula ,Pancreatectomy ,Postoperative Complications ,Clinical trials ,Risk Factors ,Quality of Life ,Humans ,Multicenter Studies as Topic ,Pancreas ,Randomized Controlled Trials as Topic - Abstract
IntroductionTo date, no pancreatic stump closure technique has been shown to be superior to any other in distal pancreatectomy. Although several studies have shown a trend towards better results in transection using a radiofrequency device (radiofrequency-assisted transection (RFT)), no randomised trial for this purpose has been performed to date. Therefore, we designed a randomised clinical trial, with the hypothesis that this technique used in distal pancreatectomies is superior in reducing clinically relevant postoperative pancreatic fistula (CR-POPF) than mechanical closures.Methods and analysisTRANSPAIRE is a multicentre randomised controlled trial conducted in seven Spanish pancreatic centres that includes 112 patients undergoing elective distal pancreatectomy for any indication who will be randomly assigned to RFT or classic stapler transections (control group) in a ratio of 1:1. The primary outcome is the CR-POPF percentage. Sample size is calculated with the following assumptions: 5% one-sided significance level (α), 80% power (1−β), expected POPF in control group of 32%, expected POPF in RFT group of 10% and a clinically relevant difference of 22%. Secondary outcomes include postoperative results, complications, radiological evaluation of the pancreatic stump, metabolomic profile of postoperative peritoneal fluid, survival and quality of life. Follow-ups will be carried out in the external consultation at 1, 6 and 12 months postoperatively.Ethics and disseminationTRANSPAIRE has been approved by the CEIM-PSMAR Ethics Committee. This project is being carried out in accordance with national and international guidelines, the basic principles of protection of human rights and dignity established in the Declaration of Helsinki (64th General Assembly, Fortaleza, Brazil, October 2013), and in accordance with regulations in studies with biological samples, Law 14/2007 on Biomedical Research will be followed. We have defined a dissemination strategy, whose main objective is the participation of stakeholders and the transfer of knowledge to support the exploitation of activities.Registration detailsClinicalTrials.gov Registry (NCT04402346). more...
- Published
- 2023
122. Pre operative fitness score accurately predicts uneventful post operative course in gastrointestinal and hepatobiliary surgery.
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Vasavada, Bhavin and Patel, Hardik
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GASTROINTESTINAL agents ,GASTROINTESTINAL surgery ,BLOOD products ,MEDICAL care ,UNIVARIATE analysis - Abstract
Background: Aim of our study was to analyse if we can accurately predict uneventful post operative course pre operatively in gastrointestinal and HPB surgery patients. Material and methods: We retrospectively evaluated patients who have undergone gastrointestinal and hepatobiliary surgery at our institute in last 3 years and analysed 90 days mortality and morbidity rates among these patients. We described any 90 day morbidity and mortality as an "event". We performed univariate and multivariate analyses for factors predicting an "event". Then based on pre operative factors that predicted an "event" we formulated a score. Statistical analysis was done using SPSS version 23. Results: Total 264 patient operated for gastrointestinal and HPB surgeries between April 2016 to may 2019 were evaluated. Total 45 (17%) events occurred. On univariate analysis CDC grade, ASA score, Operative time, Blood products used, emergency surgeries and open surgeries predicted an event. We developed score based on pre operative factors like ASA score, CDC grade of surgery, open surgery and emergency surgeries included in the score. We proposed score grater than 2 was associated with 90 day event. This score had sensitivity of 77.78%, specificity of 81.65%. low positive predictive value of 46.67% but very high negative predictive value of 94.68%. AUROC showed AUROC of 0.797 (p < 0.0001, 95% confidence interval 0.721-0.874). Pre operative fitness score and Open Surgery independently predicted an "event" on multivariate analysis. (p =0.003 and 0.026 respectively. Conclusions: Pre-operative fitness score accurately predicts uneventful post operative course in gastrointestinal and hepatobiliary surgery. [ABSTRACT FROM AUTHOR] more...
- Published
- 2021
123. Rare anastomosis between a replaced right hepatic artery and left branch of the proper hepatic artery
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Krishna Kotecha, Luca Borruso, Animesh Singla, Rudra Maitra, Anubhav Mittal, and Jaswinder S. Samra
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medicine.medical_specialty ,Right hepatic artery ,business.industry ,Abdominal aorta ,Anastomosis ,Pathology and Forensic Medicine ,Hepatobiliary surgery ,medicine.anatomical_structure ,medicine.artery ,medicine ,Radiology, Nuclear Medicine and imaging ,Surgery ,Upper gastrointestinal surgery ,Superior mesenteric artery ,Radiology ,Anatomy ,business ,Artery - Abstract
Appreciation of the potential anatomical variation of the hepatic arterial supply and branches of the abdominal aorta is of paramount importance in pancreatic and hepatobiliary surgery. Here we describe a hitherto un-reported coelio-mesenteric anastomotic connection between a replaced right hepatic artery, originating from the superior mesenteric artery, and the left hepatic branch of the proper hepatic artery. The embryological origins of the variant anatomy as well as its potential surgical implications are discussed with a view to encourage thorough pre-operative interrogation of available imaging by radiologists and surgeons to successfully identify such variants and take advantage of their potentially useful functionality. more...
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- 2021
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124. Evolution of bile duct surgery by the scientific school of professor S.P. Fedorov
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Arsen K. Aliev, Nicolay A. Maistrenko, Rustam K. Aliev, and Pavel N. Romashchenko
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medicine.medical_specialty ,media_common.quotation_subject ,Philosophy ,Subject (documents) ,Social issues ,Surgery ,Hepatobiliary surgery ,State (polity) ,Scientific school ,History of surgery ,medicine ,Biliary Tract Surgery ,Surgical treatment ,media_common - Abstract
This study highlighted the main stages of the formation and development of surgery of bile ducts by the scientific school of Doctor of Medical Sciences, Honored Scientist of the Russian Soviet Federative Socialist Republic, Professor Sergey Petrovich Fedorov. The current state of this area of surgery and its prospects are also considered. The works of S.P. Fedorov and his students opened a new page in surgery of that time: surgical treatment of patients with liver and biliary tract diseases. The results of research of the last three decades are the subject of particular pride in the successful continuation of the work of the founder of hepatobiliary surgery in our country. The scientific search and relay of the achievements of the scientific school of Professor S.P. Fedorov were performed in numerous publications, such as in periodicals, monographs, manuals, and speeches in our country and abroad, in a cumulated form, and this is presented in dissertations. In the study of the peculiarities of housing and communal services, both fundamental and applied aspects of solving this social problem of modern society are being developed. After the death of Sergey Petrovich, 17 candidate and 5 doctoral dissertations on the problems of biliary tract surgery were defended in the clinic of S.P. Fedorov Faculty of Surgery of S.M. Kirov Military Medical Academy. After over the past years, more than 200 articles, four monographs and manuals were published, and many messages were made at scientific forums in our country and abroad. more...
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- 2021
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125. Intraductal tubulopapillary neoplasms of the pancreas and biliary tract: The black swan of hepatobiliary surgery
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Megan Brown, Oscar K. Serrano, Amanda Cavanaugh, Jilyan Decker, and Saverio Ligato
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medicine.medical_specialty ,business.industry ,Pancreatic intraductal neoplasms ,Case Report ,Bile Duct Neoplasm ,medicine.disease ,Hepatobiliary surgery ,medicine.anatomical_structure ,Biliary tract ,medicine ,Adenocarcinoma ,Bile duct neoplasms ,General Materials Science ,Radiology ,Presentation (obstetrics) ,Pancreas ,business - Abstract
Intraductal tubulopapillary neoplasms (ITPNs) of the pancreas and biliary tract are rare pre-malignant entities of the biliary tract and pancreas that are difficult to diagnose preoperatively. While there are imaging characteristics that can differentiate these lesions from more common entities like adenocarcinoma or intraductal papillary mucinous neoplasms (IPMN), ITPNs are not always distinctive. Herein we present two cases of ITPN, one of biliary and the other of pancreatic origin, which had a preoperative diagnosis of cholangiocarcinoma and IPMN, respectively. We discuss our findings in these cases, patient presentation and course, review the radiographic and pathologic findings, and propose a more effective approach to the preoperative workup and diagnosis of ITPN based on our review of the contemporary literature. more...
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- 2021
126. Biliary Leakage Following Cholecystectomy: A Prospective Population Study
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del Khdair Abbas
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biliary leakage ,Medicine (General) ,R5-920 ,Dentistry ,RK1-715 ,cholecystectomy ,hepatobiliary surgery - Abstract
Background: Biliary leakage is the most common and serious complication following cholecystectomy. Because bile duct injury can lead to lifelong disability or even death, iatrogenic bile duct injury therefore should promptly be identified and repaired or the patient should be referred to the specialist who has experience in hepatobiliary surgery. Early diagnosis and treatment is the cornerstone for pleasant outcome. Unrecognized or late diagnosis of bile duct injury can lead to serious consequences such as hepatic failure or death. The objectives of this study were to determine the incidence of biliary leakage following cholecystectomy and to evaluate its outcome following this procedure. Objectives: To determine the incidence of biliary leakage following cholecystectomy and to evaluate its outcome following this procedure. Patient and Methods: A prospective study was conducted among 968 patients in Al – Kadhimain medical city from January 2019 to February 2020. The data were obtained from the patients getting admitted with biliary leakage after cholecystectomy or developed biliary leakage after cholecystectomy at the surgical department in our hospital. The patients were assessed by thorough history, clinical examination and postoperative investigations including abdominal ultrasound, CT abdomen and MRCP to determine the site of bile leakage and the modalities of management that can be used and those patients were followed adequately. Results: A total of 968 cholecystectomies were carried out in this study, out of which 311 were open cholecystectomies and the rest 657 were laparoscopic cholecystectomies. The overall incidence of biliary leak following cholecystectomy was 1.75%. The incidence of major bile duct injury was 0.61% while the incidence of leakage from gallbladder bed, duct of Luschka or minor bile duct injury was 1.13%. 70.58% of bile leak resolve spontaneously with conservative treatment and controlled external fistula but interventions in the form of primary suturing of bile duct and hepaticojejunostomy were done in 29.41% of patients. Two patients (11.76%) died due to delayed presentation. Conclusion: Major bile duct injury following cholecystectomy can be devastating to the patient and needs prompt diagnosis and timely surgical intervention but leakage from gallbladder bed, duct of Luschka or accessory bile duct needs only conservative treatment and careful observation and mostly leads to disappearance of leak without any residual effect. more...
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- 2021
127. Liver transplantation and hepatobiliary surgery in 2020.
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Ekser, Burcin, Halazun, Karim J., Petrowsky, Henrik, and Balci, Deniz
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- 2020
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128. Non surgical procedure related postoperative complications independently predicts perioperative mortality in gastrointestinal and hepatobiliary surgery. A retrospective analysis of prospectively maintained data.
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Vasavada, Bhavin and Patel, Hardik
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SURGICAL complications ,GASTROINTESTINAL surgery ,COMORBIDITY ,MANN Whitney U Test ,PANCREATIC surgery - Abstract
Introduction: The Aim of the study was to evaluate relationship between non surgical procedure related complication and 30 days mortality. Material and Methods: All gastrointestinal and hepatobiliary procedures performed in last 3 years have been evaluated retrospectively. Non surgical procedure related postoperative complications were defined as perioperative complications non related to surgical procedures or techniques and related to patients' physiological health or comorbidities (e.g acute kidney injury, ARDS, acute respiratory failure, pre existing sepsis, etc.), Surgical related complications were defined as perioperative complications related to surgical procedures or techniques (e.g. bleeding, leaks, sepsis due to leaks etc.). Factors affecting 30 days mortality and morbidity were analysed using univariate and multivariate analysis. Chi square test was used for categorical values, Mann Whitney U test was used for numerical values. Multivariate logistic regression analysis was used for multivariate analysis. Statistical analysis was used suing SPSS version 21. Results: Total 325 major hepatobiliary and pancreatic surgery was done in our institute in last 2 years. 30 days overall mortality rate was 6.4%. In univariate analysis mortality was significantly associated with nonsurgical procedure related complications. (p < 0.0001). Surgical complications were not associated with mortality. On univariate analysis other factors associated with mortality were emergency surgeries, high CDC grade of surgery, higher ASA grades, increase operative duration, increased blood product requirements. However on multivariate analysis only nonsurgical procedure related postoperative complications independently predicted mortality. (p=0.001). Conclusions: Non surgical procedure related post operative complications (Physiological) is strongly associated with 30 days mortality, suggesting improved perioperative care can help to reduce post operative mortality. [ABSTRACT FROM AUTHOR] more...
- Published
- 2020
129. Future Perspectives
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Nimura, Yuji, Madoff, David C., editor, Makuuchi, Masatoshi, editor, Nagino, Masato, editor, and Vauthey, Jean-Nicolas, editor
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- 2011
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130. History of Major Liver Resections
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Chun, Yun Shin, Vauthey, Jean-Nicolas, Madoff, David C., editor, Makuuchi, Masatoshi, editor, Nagino, Masato, editor, and Vauthey, Jean-Nicolas, editor
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- 2011
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131. Randomised, placebo-controlled, phase 3 trial of the effect of the omega-3 polyunsaturated fatty acid eicosapentaenoic acid (EPA) on colorectal cancer recurrence and survival after surgery for resectable liver metastases: EPA for Metastasis Trial 2 (EMT2) study protocol.
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Hull MA, Ow PL, Ruddock S, Brend T, Smith AF, Marshall H, Song M, Chan AT, Garrett WS, Yilmaz O, Drew DA, Collinson F, Cockbain AJ, Jones R, Loadman PM, Hall PS, Moriarty C, Cairns DA, and Toogood GJ
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- Humans, Eicosapentaenoic Acid therapeutic use, Quality of Life, Treatment Outcome, Neoplasm Recurrence, Local drug therapy, Double-Blind Method, Randomized Controlled Trials as Topic, Clinical Trials, Phase II as Topic, Clinical Trials, Phase III as Topic, Colorectal Neoplasms pathology, Liver Neoplasms drug therapy, Liver Neoplasms surgery, Liver Neoplasms secondary
- Abstract
Introduction: There remains an unmet need for safe and cost-effective adjunctive treatment of advanced colorectal cancer (CRC). The omega-3 polyunsaturated fatty acid eicosapentaenoic acid (EPA) is safe, well-tolerated and has anti-inflammatory as well as antineoplastic properties. A phase 2 randomised trial of preoperative EPA free fatty acid 2 g daily in patients undergoing surgery for CRC liver metastasis showed no difference in the primary endpoint (histological tumour proliferation index) compared with placebo. However, the trial demonstrated possible benefit for the prespecified exploratory endpoint of postoperative disease-free survival. Therefore, we tested the hypothesis that EPA treatment, started before liver resection surgery (and continued postoperatively), improves CRC outcomes in patients with CRC liver metastasis., Methods and Analysis: The EPA for Metastasis Trial 2 trial is a randomised, double-blind, placebo-controlled, phase 3 trial of 4 g EPA ethyl ester (icosapent ethyl (IPE; Vascepa)) daily in patients undergoing liver resection surgery for CRC liver metastasis with curative intent. Trial treatment continues for a minimum of 2 years and maximum of 4 years, with 6 monthly assessments, including quality of life outcomes, as well as annual clinical record review after the trial intervention. The primary endpoint is CRC progression-free survival. Key secondary endpoints are overall survival, as well as the safety and tolerability of IPE. A minimum 388 participants are estimated to provide 247 CRC progression events during minimum 2-year follow-up, allowing detection of an HR of 0.7 in favour of IPE, with a power of 80% at the 5% (two sided) level of significance, assuming drop-out of 15%., Ethics and Dissemination: Ethical and health research authority approval was obtained in January 2018. All data will be collected by 2025. Full trial results will be published in 2026. Secondary analyses of health economic data, biomarker studies and other translational work will be published subsequently., Trial Registration Number: NCT03428477., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY. Published by BMJ.) more...
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- 2023
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132. Big data and RCT's in surgical oncology: Impact on improving hepatopancreatobiliary cancer surgical care on the global stage.
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Shrikhande SV, Kunte AR, Chopde AN, Chaudhari VA, and Bhandare MS
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- Humans, Big Data, Delivery of Health Care, Forecasting, Randomized Controlled Trials as Topic, Surgical Oncology, Neoplasms therapy
- Abstract
Randomized controlled clinical trials (RCTs) are at the heart of "evidence-based" medicine. Conducting well-designed RCTs for surgical procedures is often challenged by inadequate recruitment accrual, blinding, or standardization of the surgical procedure, as well as lack of funding and evolution of the treatment strategy during the many years over which such trials are conducted. In addition, most clinical trials are performed in academic high-volume centers with highly selected patients, which may not necessarily reflect a "real-world" practice setting. Large databases provide easy and inexpensive access to data on a large and diverse patient population at a variety of treatment centers. Furthermore, large database studies provide the opportunity to answer questions that would be impossible or very arduous to answer using RCTs, including questions regarding health policy efficacy, trends in surgical practice, access to health care, the impact of hospital volume, and adherence to practice guidelines, as well as research questions regarding rare disease, infrequent surgical outcomes, and specific subpopulations. Prospective data registries may also allow for quality benchmarking and auditing. There are several high-quality RCTs providing evidence to support current practices in hepatopancreatobiliary (HPB) oncology. Evidence from big data bridges the gap in several instances where RCTs are lacking. In this article, we review the evidence from RCTs and big data in HPB oncology identify the existing lacunae, and discuss the future directions of research in HPB oncology., (© 2023 Wiley Periodicals LLC.) more...
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- 2023
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133. Preoperative percutaneous or transvascular marking for curative resection of small liver tumours with potential for missing during hepatectomy: a study protocol for an open-label, single-arm phase II study.
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Fukuhara S, Kuroda S, Kobayashi T, Takei D, Namba Y, Oshita K, Matsubara K, Honmyo N, Nakano R, Sakai H, Tahara H, Ohira M, Kawaoka T, Tsuge M, Chosa K, Awai K, and Ohdan H
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- Humans, Research, Japan, Clinical Trials, Phase II as Topic, Hepatectomy methods, Liver Neoplasms surgery
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Introduction: Small liver tumours are difficult to identify during hepatectomy, which prevents curative tumour excision. Preoperative marking is a standard practice for small, deep-seated tumours in other solid organs; however, its effectiveness for liver tumours has not been validated. The objective of this study is to evaluate the effectiveness of preoperative markings for curative resection of small liver tumours., Methods and Analysis: This is an open-label, single-arm, single-centre, phase II study. Patients with liver tumours of ≤15 mm requiring hepatectomy will be enrolled and will undergo preoperative marking by placing a microcoil near the tumour using either the percutaneous or transvascular approach. The tumours, including the indwelling markers, will be excised. The primary endpoint will be the successful resection rate of liver tumours, defined as achieving a surgical margin of ≥5 mm and ≤15 mm. Secondary endpoints will include the results of preoperative marking and hepatectomy., Ethics and Dissemination: Ethical approval for this trial was obtained from the Ethical Committee for Clinical Research of Hiroshima University, Japan. The results will be published at an academic conference or by submitting a paper to a peer-reviewed journal., Trial Registration Number: jRCTs062220088., Competing Interests: Competing interests: This study will be conducted with the provision of research targeting medical equipment from Piolax Medical Devices, Yokohama, Japan. Piolax Medical Devices provides information on research equipment but does not intervene in research data management, statistical analysis and auditing., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.) more...
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- 2023
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134. Laparoskopia v detskom veku - apendektómia, záchovná resekcia sleziny, hepatobiliárne operácie.
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Babala, J., Pechanová, R., Zahradnikova, P., and Béder, I.
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Objective: The aim of this article is to inform about certain existing laparoscopic procedures in children and to focus on the benefit as well as eventual challenges and limitations especially in very small children. Methods: We have evaluated laparoscopic surgeries similar to those in adults that are performed more frequently and are more available: appendectomy and cholecystectomy and specific less frequent surgeries based on the congenital developmental defects: biliary atresia and choledochal cysts. The spleen-preserving resection describes the preservation of an organ by using an innovative method. Results: The results indicate that it is easier to make recommendations for surgical procedures performed more frequently (531 patients with appendectomy and 75 patients with cholecystectomy) and sometimes there are no clear-cut indication criteria for surgical procedures performed less frequently despite the summary of multicentre studies (22 patients having surgery for the suspected biliary atresia and 4 patients having surgery for the cystic malformation of the bile duct). Conclusion: Minimally invasive surgical procedures in the smallest children exclusive due to their low frequency require centralization and multidisciplinary collaboration. The literary data indicate that it will not be easy to make the general guidelines for the selected surgical procedure. [ABSTRACT FROM AUTHOR] more...
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- 2018
135. Der zentrale Venendruck in der Leberchirurgie : Ein primäres Therapieziel oder ein hämodynamischer Mosaikstein?
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Behem, C. R., Gräßler, M. F., and Trepte, C. J. C.
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Central venous pressure (CVP) is deemed to be an important parameter of anesthesia management in liver surgery. To reduce blood loss during liver resections, a low target value of CVP is often propagated. Although current meta-analyses have shown a connection between low CVP and a reduction in blood loss, the underlying studies show methodological weaknesses and advantages with respect to morbidity and mortality can hardly be proven. The measurement of the CVP itself is associated with numerous limitations and influencing factors and the measures to reduce the CVP have been insufficiently investigated with respect to hepatic hemodynamics. The definition of a generally valid target area for the CVP must be called into question. The primary objective is to maintain adequate oxygen supply and euvolemia. The CVP should be regarded as a mosaic stone of hemodynamic management. [ABSTRACT FROM AUTHOR] more...
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- 2018
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136. Impact of the FloTrac/VigileoTM Monitoring on Intraoperative Fluid Management and Outcome after Liver Resection.
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Giustiniano, Enrico, Procopio, Fabio, Ruggieri, Nadia, Grimaldi, Stefania, Torzilli, Guido, and Raimondi, Ferdinando
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- *
FLUID therapy , *CENTRAL venous pressure - Abstract
Backgrounds: Perioperative fluid-therapy is a still a debated issue. In hepatic surgery, volume load must be strictly monitored to assure both a safe hemodynamics and low central venous pressure (CVP) to limit the backflow bleeding. Retrospectively, we compared intraoperative fluid management before and after the adoption of a semi-invasive hemodynamic monitoring.Methods: We compared patients submitted to liver resection monitored by FloTrac/VigileoTM (group A) vs. patients who did not (group B). We searched for differences about hemodynamics, fluid therapy and outcome.Results: Three hundred fifty-five patients underwent hepatic resection due to neoplasm: group A – n = 179 and group B – n = 176. At the end of the resection, patients of group A showed a higher mean arterial pressure (MAP) than group B (74 ± 12 vs. 49.4 ± 8 mm Hg, respectively; p < 0.001). Cardiac index and stroke volume variation in group A were within a normal range. Fluid input was higher in group B than in group A (12.0 ± 3.4 vs. 7.6 ± 3.1 mL/kg/h, respectively; p < 0.001) and fluid balance was significantly different: group A –400 ± 1,527 vs. group B 326 ± 1,527 mL (p < 0.001). Group B showed a greater number of cases complicated outcomes (36 vs. 20; p = 0.014). Considering only those subjects who were able to reach their hemodynamic targets (MAP ≥65 mm Hg and CVP ≤7 mm Hg), we found similar data.Conclusions: Patients who received a monitored fluid therapy experienced a safer outcome. [ABSTRACT FROM AUTHOR] more...- Published
- 2018
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137. Current Perspective of Laparoscopic Cholecystectomy for Acute Cholecystitis.
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AlShamy, Abdelghany Mahmoud, El Moaty, Karim Fahmy Abd, and Mohamed Salem, Yehia Khaled Said
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- *
CHOLECYSTITIS , *GALLSTONES , *LAPAROSCOPIC surgery , *THERAPEUTICS - Abstract
Background: Acute cholecystitis is a potentially life-threatening condition, which affects >5 million Egyptian yearly and causes high economic burden around the world. Gallstones are the major contributor to acute cholecystitis. Laparoscopic cholecystectomy (LC) is an important approach for treating acute cholecystitis nowadays. Issued data indicated that approximately 600,000 LCs and >30,000 LCs were annually performed to treat acute cholecystitis in the Egypt. Although LCs have been extensively performed to manage acute cholecystitis, the optimal timing of LC for this given condition is inconclusive. Aim of the Study: To highlight the optimal time for LC in acute cholecystitis, comparing ELC or DLC is better in terms of surgical complications as bile duct injury, bile leakage, cystic artery bleeding, conversion to open surgery, duration of the surgery. Patients and Methods: This study was done on 30 patients in Ain Shams University Hospitals in 12 months duration starting from June 2017 to June 2018 reviewing reports on ELC vs. DLC with all patients received medical treatment as antibiotics (3rd generation cephalosporins) and proper analgesia for 48-72 hours and if the patient responded to medical treatment so he/she was go with DLC group and if no response, he/she was go ELC group. This study was classified into two groups: Group (A) underwent laparoscopic cholecystectomy in the first seventy two hours from the onset of symptoms. Group (B) underwent laparoscopic cholecystectomy after delayed interval of six to eight weeks after initial period of conservative treatment. Results: The mean operative time (100.3 ± 14.75 minutes) in the early group was more than the mean operative time (80.3 ± 12.4 minutes) in the delayed group. The conversion rate to open cholecystectomy (6.7%) in the early group was less than the conversion rate (13.3%) in the delayed group. The mean total hospital stay (4.8 ± 0.91 days) in the early group was less than the mean total hospital stay (9.2 ± 1.61days) in the delayed group. Finally, the overall complications in (53%) the early group were slightly more than complications occurred (47%) in the delayed group. Conclusion: Early laparoscopic cholecystectomy for acute cholecystitis within 72 hours has been shown to be superior to late or delayed cholecystectomy as regard the outcome and cost of treatment. Laparoscopic cholecystectomy should be carried out as soon as the diagnosis of acute cholecystitis is established and preferably before 3 days following the onset of symptoms. Early laparoscopic cholecystectomy can reduce both the conversion rate and the total hospital stay as medical and economic benefits. [ABSTRACT FROM AUTHOR] more...
- Published
- 2018
138. Low skeletal muscle mass outperforms the Charlson Comorbidity Index in risk prediction in patients undergoing pancreatic resections.
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Wagner, D., Marsoner, K., Tomberger, A., Werkgartner, G., Cerwenka, H., Bacher, H., Mischinger, H.J., Kornprat, P., Haybaeck, J., and Haas, J.
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COMORBIDITY ,OLDER people ,FRAGILITY (Psychology) ,SKELETAL muscle ,HEALTH outcome assessment - Abstract
Introduction Low skeletal muscle mass is a known predictor of morbidity and mortality in patients undergoing major pancreatic surgeries. We sought to combine low skeletal muscle mass with established risk predictors to improve their prognostic capacity for postoperative outcome and morbidity. Methods As established parameters to predict preoperative mortality risk for patients, the ASA classification and the Charlson Comorbidity Index (CCI) were used. The Hounsfield Units Average Calculation (HUAC) was measured to define low skeletal muscle mass in 424 patients undergoing pancreatic resections for malignancies. Patients in the lowest sex-adjusted quartile for HUAC were defined as having low skeletal muscle mass (muscle wasting). Multivariable Cox regression analysis was utilized to identify preoperative risk factors associated with postoperative morbidity. Results Median patient age was 63 years (19–87), 47.9% patients were male, and half the cohort had multiple comorbidities (Charlson Comorbidity Index [CCI]>6, 63.2%), 30-day mortality was 5.8% (n = 25). Median HUAC was 19.78 HU (IQR: 15.94–23.54) with 145 patients (34.2%) having low skeletal muscle mass. Preoperative frailty defined by low skeletal muscle mass was associated with an increased risk for postoperative complications (OR 1.55, CI 95% 0.98–2.45, p = 0.014), and a higher 30-day mortality (HR 5.17, CI 95% 1.57–16.69, p = 0.004). With an AUC of 0.85 HUAC showed the highest predictability for 30-day mortality (CI 95% 0.78–0.91, p = 0.0001). Patients with CCI ≥6 and low skeletal muscle mass defined by the HUAC had a 9.78 higher risk of dying in the immediate postoperative phase (HR 9.78, CI 95% 2.98–12.2, p = 0.0001). Conclusion Low skeletal muscle mass predicts postoperative mortality and complications best and it should be incorporated to conventional risk scores to identify high risk patients. [ABSTRACT FROM AUTHOR] more...
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- 2018
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139. The Emerging Role of Minimally-Invasive Surgery For Gallbladder Cancer: A Comparison to Open Surgery.
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GEORGAKIS, GEORGIOS V., NOVAK, STEPHANIE, BARTLETT, DAVID L., ZUREIKAT, AMER H., ZEH III, HERBERT J., and HOGG, MELISSA E.
- Abstract
Background: Minimally-invasive surgery (MIS) is gaining traction within surgical oncology. We aim to evaluate outcomes of patients with gallbladder cancer undergoing MIS surgery compared to open surgery. Methods: Using the institutional cancer registry and administrative databases, we retrospectively reviewed patients who underwent a central hepatectomy with portal lymphadenectomy for gallbladder cancer from 2011 - 2014. We excluded gallbladder cancer patients without oncologic resection and those with metastatic disease. Results: Thirty-four patients underwent surgery: 17 MIS (14 robotic, three laparoscopic), and 17 open. There was no statistically significant difference in median operative time (MIS = 182 vs open = 190 min; P = .23) or R0 resection (MIS = 88.2% vs open = 88.2%; P = 1.0); however, the MIS cohort had less intraoperative blood loss (median 50 ml vs 400 ml; P = .006) and placement of perihepatic drains (29.4% vs 76.5%; P = .01) compared to open. MIS cohort went to oral pain medications quicker (two vs three days; P = .02) and discharged home earlier (four vs six days; P = .018), than the open cohort. No differences in postoperative 30-day complication rates were noted (52.9% vs 52.9%; P = 1.0). Conclusion: The minimally-invasive approach to liver surgery is a safe and equally effective technique for the management of the gallbladder cancer with improvement in blood loss and length of stay. [ABSTRACT FROM AUTHOR] more...
- Published
- 2018
140. Comparison of Single-Port Versus Standard Multiport Left Lateral Liver Sectionectomy.
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Struecker, Benjamin, Haber, Philipp, Öllinger, Robert, Bahra, Marcus, Pascher, Andreas, Pratschke, Johann, and Schmelzle, Moritz
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It remains unclear if single incision laparoscopic liver surgery is superior to standard multiport resections and in what regard patients might benefit from this approach. We retrospectively analyzed the course of all patients undergoing laparoscopic left lateral sectionectomy at our center between 2009 and 2017. In total, 11 single incision and 31 multiport left lateral sectionectomies were performed at our center between July 2009 and May 2017. Six patients were excluded due to multivisceral resections. Indications included adenoma (n = 7 vs n = 2), focal nodular hyperplasia (n = 4 vs n = 3), hepatocellular carcinoma (n = 4 vs n = 4), colorectal liver metastasis (n = 4 vs n = 0), noncolorectal metastasis (n = 2 vs n = 1), hemangioma (n = 3 vs n = 0), abscess (n = 1 vs n = 0), and cysts (n = 1 vs n = 0). Length of operation was significantly shorter in the single incision group (206 vs 137 minutes, P = .003). One complication was observed in the single incision group (grade IIIb, n = 1) while 3 patients in the multiport group suffered from postoperative complications (grade II, n = 1; grade IIIa, n = 2), resulting in a morbidity rate of 12.5% and 11.5%, respectively. No mortality was observed in both groups. Length of hospital stay did not significantly differ in both groups (median 7 vs 7 days, P = .513). The single incision approach is safe and has become the standard approach for the left lateral sectionectomy at our center. Shorter operation times technique might well be due to the easy retrieval of the liver specimen via the umbilical incision with no need for a Pfannenstiel incision. [ABSTRACT FROM AUTHOR] more...
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- 2018
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141. Laparoscopic versus open parenchymal preserving liver resections in the posterosuperior segments: a case-matched study.
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D'hondt, Mathieu, Tamby, Esther, Boscart, Isabelle, Turcotte, Simon, Parmentier, Isabelle, Pottel, Hans, Lapointe, Réal, Ovaere, Sander, Vansteenkiste, Franky, and Vandenbroucke-Menu, Franck
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- *
LAPAROSCOPY , *LIVER surgery , *CANCER chemotherapy , *COLON polyps , *FIBROLAMELLAR hepatocellular carcinoma , *BLOOD loss estimation , *ADENOCARCINOMA , *RESEARCH , *LIVER tumors , *RESEARCH methodology , *PAIRED comparisons (Mathematics) , *RETROSPECTIVE studies , *EVALUATION research , *MEDICAL cooperation , *TREATMENT effectiveness , *COMPARATIVE studies , *HEPATOCELLULAR carcinoma , *HEPATECTOMY - Abstract
Background: Patients with lesions in the posterosuperior (PS) segments of the liver have been considered poor candidates for laparoscopic liver resection (LLR). This study aims to compare short-term outcomes of LLR and open liver resections (OLR) in the PS segments.Methods: This multicenter study consisted of all patients who underwent LLR in the PS segments and all patients who underwent OLR in the PS segments between October 2011 and July 2016. Laparoscopic cases were case-matched with those who had an identical open procedure during the same period based on tumor location (same segment) and the Brisbane classification of the resection. Demographics, comorbid factors, perioperative outcomes, short-term outcomes, necessity of adjuvant chemotherapy, and the interval between surgery and initiation of adjuvant chemotherapy were compared between the two groups. Data were retrieved from a prospectively maintained electronic database.Results: Both groups were comparable for age, sex, ASA score, maximum tumor diameter, and number of patients with additional liver resections outside the posterior segments. Operative time was similar in both groups (median 140 min; p = 0.92). Blood loss was less in the LLR-group (median: 150 vs. 300 ml in OLR-group). Median hospital stay was 6 days in both groups. There was no significant difference in postoperative complications (OLR-group: 31.4% vs. LLR-group: 25.7%; p = 0.60). There was no significant difference in R0 resections (LLR: 97.2 vs. 100% in OLR; p = 1.00). Tumor-free margins were less in the LLR group (LLR: 5 vs. 9.5 mm in OLR; p = 0.012). Patients undergoing LLR were treated with chemotherapy sooner compared to those undergoing OLR (41 vs. 56 days, p = 0.02).Conclusion: This study suggests that laparoscopic parenchymal preserving liver resections in the PS segments can be performed with comparable short-term outcomes as similar OLR. The shorter interval to chemotherapy might provide long-term oncologic benefits in patients who underwent LLR. [ABSTRACT FROM AUTHOR] more...- Published
- 2018
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142. A novel combined interventional radiologic and hepatobiliary surgical approach to a complex traumatic hilar biliary stricture.
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NeMoyer, Rachel E., Shah, Mihir M., Hasan, Omar, Nosher, John L., and Carpizo, Darren R.
- Abstract
Introduction Benign strictures of the biliary system are challenging and uncommon conditions requiring a multidisciplinary team for appropriate management. Presentation of case The patient is a 32-year-old male that developed a hilar stricture as sequelae of a gunshot wound. Due to the complex nature of the stricture and scarring at the porta hepatis a combined interventional radiologic and surgical approach was carried out to approach the hilum of the right and left hepatic ducts. The location of this stricture was found by ultrasound guidance intraoperatively using a balloon tipped catheter placed under fluoroscopy in the interventional radiology suite prior to surgery. This allowed the surgeons to select the line of parenchymal transection for best visualization of the stricture. A left hepatectomy was performed, the internal stent located and the right hepatic duct opened tangentially to allow a side-to-side Roux-en-Y hepaticojejunostomy (a Puestow-like anastomosis). Discussion Injury to the intrahepatic biliary ductal confluence is rarely fatal, however, the associated injuries lead to severe morbidity as seen in this example. Management of these injuries poses a considerable challenge to the surgeon and treating physicians. Conclusion Here we describe an innovative multi-disciplinary approach to the repair of this rare injury. [ABSTRACT FROM AUTHOR] more...
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- 2018
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143. Current trends in three-dimensional visualization and real-time navigation as well as robot-assisted technologies in hepatobiliary surgery
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Nobuhiro Ohkohchi, Yun-Wen Zheng, Di Cao, Si-Lin Chen, Yun Wang, and Yu-Mei Li
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Three-dimensional printing ,medicine.medical_specialty ,Three-dimensional visualization ,business.industry ,Electromagnetic tracking ,ComputerApplications_COMPUTERSINOTHERSYSTEMS ,Review ,Hepatobiliary surgery ,Surgery ,Visualization ,Three dimensional printing ,Three dimensional visualization ,medicine ,Robot-assisted surgery ,Robot ,Computer vision ,Artificial intelligence ,InformationSystems_MISCELLANEOUS ,Current (fluid) ,business ,Real-time navigation ,Real time navigation - Abstract
With the continuous development of digital medicine, minimally invasive precision and safety have become the primary development trends in hepatobiliary surgery. Due to the specificity and complexity of hepatobiliary surgery, traditional preoperative imaging techniques such as computed tomography and magnetic resonance imaging cannot meet the need for identification of fine anatomical regions. Imaging-based three-dimensional (3D) reconstruction, virtual simulation of surgery and 3D printing optimize the surgical plan through preoperative assessment, improving the controllability and safety of intraoperative operations, and in difficult-to-reach areas of the posterior and superior liver, assistive robots reproduce the surgeon’s natural movements with stable cameras, reducing natural vibrations. Electromagnetic navigation in abdominal surgery solves the problem of conventional surgery still relying on direct visual observation or preoperative image assessment. We summarize and compare these recent trends in digital medical solutions for the future development and refinement of digital medicine in hepatobiliary surgery. more...
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- 2021
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144. Intraoperative support with three-dimensional holographic cholangiography in hepatobiliary surgery
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Mitsuo Shimada, Yu Saito, Maki Sugimoto, Tetsuya Ikemoto, Shinichiro Yamada, Satoru Imura, and Yuji Morine
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medicine.medical_specialty ,medicine.diagnostic_test ,business.industry ,Bile duct ,Holography ,Origination site ,law.invention ,Hepatobiliary surgery ,Cholangiography ,medicine.anatomical_structure ,law ,Biliary tract ,Medicine ,Hybrid operating room ,Surgery ,Radiology ,business ,Intraductal Papillary Neoplasm - Abstract
This study was performed to investigate the potential of intraoperative three-dimensional (3D) holographic cholangiography, which provides a computer graphics model of the biliary tract, with mixed reality techniques. Two patients with intraductal papillary neoplasm of the bile duct were enrolled in the study. Intraoperative 3D cholangiography was performed in a hybrid operating room. Three-dimensional polygon data using the acquired cholangiography data were installed into a head mount display (HoloLens; Microsoft Corporation, Redmond, WA, USA). Upon completion of intraoperative 3D cholangiography, a hologram was immediately and successfully made in the operating room using the acquired cholangiography data, and several surgeons wearing the HoloLens succeeded in sharing the same hologram. Compared with usual two-dimensional cholangiography, this 3D holographic cholangiography technique contributed to more accurate reappearance of the bile ducts, especially the B1 origination site, and moving the hologram from the respective operators’ angles by means of easy gesture-handling without any monitors. Intraoperative 3D holographic cholangiography might be a new next-generation operation-support tool in terms of immediacy, accurate anatomical reappearance, and ease of handling. more...
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- 2021
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145. Significance of Rouviere’s Sulcus in Hepatobiliary Surgery: A Cadaveric study
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Neelesh Kanaskar, P Vatsalaswamy, Pallavi Bajpayee, and PR Manivikar
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Hepatobiliary surgery ,Embryology ,Histology ,medicine.anatomical_structure ,business.industry ,Medicine ,Cell Biology ,Anatomy ,Sulcus ,Cadaveric spasm ,business - Abstract
Background: Rouviere’s sulcus (RS) was first identified in 1924 by Henri Rouviere. It lies oblique to the anterior and inferior border of the liver and holds the right portal pedicle. Material and Methods: The study was conducted in the Department of Anatomy of a Medical College in Maharashtra, India, on 45 cadaveric livers. The morphological observations made were: presence/ absence RS; direction of RS (oblique/ horizontal/ vertical); sulcus type ( deep/ slit/ scar); length, width and depth; presence of right hepatic pedicle; distance of the hepatic vessels from edge of the sulcus . Results: 40 livers showed the presence of Rouviere’s Sulcus. It was absent in five specimens. Direction was horizontal in 40%, oblique in 57.5% and vertical in 2.5% .26 livers showed a deep type of sulcus, 12 showed the slit type and 2 showed scar type .29 livers showed the right hepatic pedicle entering the RS. Average length, depth, of the RS was 2.35 cm and1.07 cm respectively. The average width was 0.32cm at medial end, 0.22cm at midpoint and 0.1cm at lateral end. Present study has added the details of depth of vessels from the edge of RS, which was not recorded in earlier studies. Depth of vessels from the edge of the sulcus was average 5mm (0.5cm) for the right branch of the hepatic artery and was 12mm (1.2cm) for the right branch of portal vein. Conclusion: Rouviere’s sulcus is a reference landmark for surgeons during laparoscopic surgeries on gall bladder and during hepatic resection to avoid injuries. This study wishes to provide detailed morphological data of the Rouviere’s Sulcus to hepatobiliary surgeons including depth of hepatic vessels in the RS as an added parameter to aid them in their surgical endeavor. KEY WORDS: Rouviere’s sulcus, Anatomical Landmark, Morphology, Depth, Hepatobiliary Surgery. more...
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- 2021
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146. Y-en-Roux reconstruction in abdominal surgery: historical retrospective of operative method’s evolution. Part I
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Concept evolution ,medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,General surgery ,Digestive tube ,General Medicine ,Routine practice ,Gastroenterostomy ,Resection ,Hepatobiliary surgery ,03 medical and health sciences ,0302 clinical medicine ,030220 oncology & carcinogenesis ,medicine ,030211 gastroenterology & hepatology ,Gastrectomy ,business - Abstract
Target of this historical review is focused on analysis of highly relevant, unique method proposed by A. Wölfler, E. Doyen and C. Roux more than 140 years ago, also we try to present main facts and chronology of development of concept Y-reconstruction of digestive tube. Hereby we present historical retrospective of theoretic concept creation, experimental verification and initial clinical experience of Y-shaped reconstruction of digestive tube on Roux-en-Y-loop, stages of concept evolution and development till the end of XIX age till our days. The founders’ scientific research onducted in surgical gastroenterology, oncology, pancreatology and hepatobiliary surgery, has expanded application of Roux-en-Y-reconstruction from distal resection of the stomach and gastroenterostomy to gastrectomy, repeated operations on the upper part of the digestive tube, the formation of biliary-digestive and pancreatic anastomoses, as well as the use in the routine practice of bariatric surgery. more...
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- 2021
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147. Study protocol for a multicentre nationwide prospective cohort study to investigate the natural course and clinical outcome in benign liver tumours and cysts in the Netherlands: the BELIVER study
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Furumaya, A., Haring, M.P.D., Rosmalen, B.V. van, Klompenhouwer, A.J., Besselink, M.G., Man, R.A. de, IJzermans, J.N.M., Thomeer, M.G.J., Kramer, M., Coolsen, M.M.E., Tushuizen, M.E., Schaapherder, A.F., Haas, R.J. de, Duiker, E.W., Kazemier, G., Delden, O.M. van, Verheij, J., Takkenberg, R.B., Cuperus, F.J.C., Meijer, V.E. de, Erdmann, J.I., Dutch Benign Liver Tumor Grp DBLTG, Faculteit Medische Wetenschappen/UMCG, Center for Liver, Digestive and Metabolic Diseases (CLDM), Surgery, Gastroenterology & Hepatology, Radiology & Nuclear Medicine, MUMC+: MA Maag Darm Lever (9), MUMC+: MA Heelkunde (9), MUMC+: MA AIOS Heelkunde (9), RS: FHML non-thematic output, CCA - Cancer Treatment and quality of life, Pathology, Targeted Gynaecologic Oncology (TARGON), Groningen Institute for Organ Transplantation (GIOT), Graduate School, CCA - Cancer Treatment and Quality of Life, Amsterdam Gastroenterology Endocrinology Metabolism, Radiology and Nuclear Medicine, Amsterdam Cardiovascular Sciences, Cancer Center Amsterdam, and Gastroenterology and Hepatology more...
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Adenoma ,Cysts ,Netherlands/epidemiology ,General Medicine ,hepatobiliary tumours ,hepatobiliary surgery ,hepatobiliary disease ,Liver Neoplasms/surgery ,Cohort Studies ,Observational Studies as Topic ,Liver Cell/surgery ,Humans ,Multicenter Studies as Topic ,Prospective Studies ,Adenoma, Liver Cell/surgery - Abstract
IntroductionBenign liver tumours and cysts (BLTCs) comprise a heterogeneous group of cystic and solid lesions, including hepatic haemangioma, focal nodular hyperplasia and hepatocellular adenoma. Some BLTCs, for example, (large) hepatocellular adenoma, are at risk of complications. Incidence of malignant degeneration or haemorrhage is low in most other BLTCs. Nevertheless, the diagnosis BLTC may carry a substantial burden and patients may be symptomatic, necessitating treatment. The indications for interventions remain matter of debate. The primary study aim is to investigate patient-reported outcomes (PROs) of patients with BLTCs, with special regards to the influence of invasive treatment as compared with the natural course of the disease.Methods and analysisA nationwide observational cohort study of patients with BLTC will be performed between October 2021 and October 2026, the minimal follow-up will be 2 years. During surveillance, a questionnaire regarding symptoms and their impact will be sent to participants on a biannual basis and more often in case of invasive intervention. The questionnaire was previously developed based on PROs considered relevant to patients with BLTCs and their caregivers. Most questionnaires will be administered by computerised adaptive testing through the Patient-Reported Outcomes Measurement Information System. Data, such as treatment outcomes, will be extracted from electronic patient files. Multivariable analysis will be performed to identify patient and tumour characteristics associated with significant improvement in PROs or a complicated postoperative course.Ethics and disseminationThe study was assessed by the Medical Ethics Committee of the University Medical Center Groningen and the Amsterdam UMC. Local consultants will provide information and informed consent will be asked of all patients. Results will be published in a peer-reviewed journal.Study registrationNL8231—10 December 2019; Netherlands Trial Register. more...
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- 2022
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148. Indocyanine green clearance test in liver transplantation: defining cut-off levels for graft viability assessment during organ retrieval and for the prediction of post-transplant graft function recovery - the Liver Indocyanine Green (LivInG) Trial Study Protocol
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Alessandro Coppola, Giuseppe Bianco, Quirino Lai, Giuseppe Marrone, Miriam Caimano, Salvatore Agnes, and Gabriele Spoletini
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Indocyanine Green ,hepatobiliary surgery ,hepatology ,transplant surgery ,Graft Survival ,General Medicine ,Recovery of Function ,Liver Transplantation ,Observational Studies as Topic ,Liver ,Tissue and Organ Harvesting ,Humans ,Prospective Studies - Abstract
Introduction Viability assessment of the graft is essential to lower the risk of liver transplantation (LT) failure and need for emergency retransplantation, however, this still relies mainly on surgeon’s experience. Post-LT graft function recovery assessment is also essential to aid physicians in the management of LT recipients and guide them through challenging decision making. This study aims to trial the use of indocyanine green clearance test (IGT) in the donor as an objective tool to assess graft viability and in the recipient to assess graft function recovery after LT. Methods and analysis This is an observational prospective single-centre study on consecutive liver transplant donors and recipients. Primary objective To determine the capability of IGT of predicting graft viability at the time of organ retrieval. Indocyanine green will be administered to the donor and the plasma disappearance rate (PDR) measured using the pulsidensitometric method. Some 162 IGT donor procedures will be required (α, 5%; β, 20%) using an IGT-PDR cut-off value of 13% to achieve a significant discrimination between viable and non-viable grafts. Secondary objective IGT-PDR will be measured at different time-points in the LT recipient: during the anhepatic phase, after graft reperfusion, at 24 hours, on day 3 and day 7 after LT. The slope of IGT values from the donor to the recipient will be evaluated for correlation with the development of early allograft dysfunction. Ethics and dissemination This research protocol was approved by Fondazione Policlinico Universitario Agostino Gemelli IRCCS Ethics Committee (reference number: 0048466/20, study ID: 3656) and by the Italian National Transplant Center (CNT) (reference number: Prot.11/CNT2021). Liver recipients will be required to provide written informed consent. Results will be published in international peer-reviewed scientific journals and presented in congresses. Trial registration number NCT05228587. more...
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- 2022
149. Prognostic impact of additive chemotherapy after curative resection of metachronous colorectal liver metastasis: a single-centre retrospective study
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Julia Schollbach, Nicolas Schlegel, Ingo Klein, Matthias Kelm, Friedrich Anger, Stefan Löb, Volker Kunzmann, Christoph-Thomas Germer, and Armin Wiegering
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Oncology ,Male ,Cancer Research ,Time Factors ,Organoplatinum Compounds ,Colorectal cancer ,medicine.medical_treatment ,Leucovorin ,Kaplan-Meier Estimate ,Metachronous liver metastasis ,Metastasis ,law.invention ,Randomized controlled trial ,Surgical oncology ,law ,Risk Factors ,Antineoplastic Combined Chemotherapy Protocols ,RC254-282 ,Aged, 80 and over ,Liver Neoplasms ,Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,Middle Aged ,Prognosis ,Survival Rate ,Chemotherapy, Adjuvant ,Colonic Neoplasms ,Female ,Fluorouracil ,Research Article ,Adult ,medicine.medical_specialty ,Prognostic variable ,Disease-Free Survival ,Internal medicine ,Genetics ,medicine ,Hepatectomy ,Humans ,Capecitabine ,Aged ,Proportional Hazards Models ,Retrospective Studies ,Chemotherapy ,Additive chemotherapy ,business.industry ,Proportional hazards model ,Rectal Neoplasms ,Retrospective cohort study ,Hepatobiliary surgery ,medicine.disease ,Camptothecin ,business ,Colorectal liver metastasis - Abstract
Background A prognostic benefit of additive chemotherapy in patients following resection of metachronous colorectal liver metastases (CRLM) remains controversial. Therefore, the goal of this retrospective study was to investigate the impact of perioperative chemotherapy on disease-free survival (DFS) and overall survival (OS) of patients after curative resection of metachronous CRLM. Methods In a retrospective single-centre study, patients after curative resection of metachronous CRLM were included and analysed for DFS and OS with regard to the administration of additive chemotherapy. The Kaplan-Meier method was applied to compare DFS and OS while Cox regression models were used to identify independent prognostic variables. Results Thirty-four of 75 patients were treated with additive 5-FU based chemotherapy. OS was significantly prolonged in this patient subgroup (62 vs 57 months; p = 0.032). Additive chemotherapy significantly improved 10-year survival rates (42% vs 0%, p = 0.023), but not 5-year survival (58% vs 42%, p = 0.24). Multivariate analysis identified additive chemotherapy (p = 0.016, HR 0.44, 95% CI 0.23–0.86), more than five CRLM (p = 0.026, HR 2.46, 95% CI 1.16–10.32) and disease recurrence (0.009, HR 2.70, 95% CI 1.29–5.65) as independent risk factors for OS. Conclusion Additive chemotherapy significantly prolonged OS and 10-year survival in patients after curative resection of metachronous CRLM. Randomized clinical trials are needed in the future to identify optimal chemotherapy regimens for those patients. more...
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- 2021
150. Novel method of intraoperative liver tumour localisation with indocyanine green and near-infrared imaging
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Brian K. P. Goh, Chung Yip Chan, Hui Jun Lim, Ye Xin Koh, Lip Seng Lee, Ser Yee Lee, Adrian Kah Heng Chiow, and Siong San Tan
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Indocyanine Green ,medicine.medical_specialty ,Cirrhosis ,genetic structures ,medicine.medical_treatment ,Palpation ,03 medical and health sciences ,chemistry.chemical_compound ,0302 clinical medicine ,medicine ,Hepatectomy ,Humans ,Near infrared imaging ,Prospective Studies ,Adverse effect ,medicine.diagnostic_test ,business.industry ,Liver Neoplasms ,Optical Imaging ,General Medicine ,medicine.disease ,eye diseases ,Hepatobiliary surgery ,Editorial ,chemistry ,Homogeneous ,030220 oncology & carcinogenesis ,030211 gastroenterology & hepatology ,Radiology ,business ,Indocyanine green - Abstract
INTRODUCTION Fluorescence imaging (FI) with indocyanine green (ICG) is increasingly implemented as an intraoperative navigation tool in hepatobiliary surgery to identify hepatic tumours. This is useful in minimally invasive hepatectomy, where gross inspection and palpation are limited. This study aimed to evaluate the feasibility, safety and optimal timing of using ICG for tumour localisation in patients undergoing hepatic resection. METHODS From 2015 to 2018, a prospective multicentre study was conducted to evaluate feasibility and safety of ICG in tumour localisation following preoperative administration of ICG either on Day 0–3 or Day 4–7. RESULTS Among 32 patients, a total of 46 lesions were resected: 23 were hepatocellular carcinomas (HCCs), 12 were colorectal liver metastases (CRLM) and 11 were benign lesions. ICG FI identified 38 (82.6%) lesions prior to resection. The majority of HCCs were homogeneous fluorescing lesions (56.6%), while CLRM were homogeneous (41.7%) or rim-enhancing (33.3%). The majority (75.0%) of the lesions not detected by ICG FI were in cirrhotic livers. Most (84.1%) of ICG-positive lesions detected were < 1 cm deep, and half of the lesions ≥ 1 cm in depth were not detected. In cirrhotic patients with malignant lesions, those given ICG on preoperative Day 0−3 and Day 4−7 had detection rates of 66.7% and 91.7%, respectively. There were no adverse events. CONCLUSION ICG FI is a safe and feasible method to assist tumour localisation in liver surgery. Different tumours appear to display characteristic fluorescent patterns. There may be no disadvantage of administering ICG closer to the operative date if it is more convenient, except in patients with liver cirrhosis. more...
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- 2021
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