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1. Post cholecystectomy bile duct injury: early, intermediate or late repair with hepaticojejunostomy – an E-AHPBA multi-center study

Author

Rystedt, Jenny M.L., Kleeff, Jörg, Salvia, Roberto, Besselink, Mark G., Prasad, Raj, Lesurtel, Mickael, Sturesson, Christian, Abu Hilal, M., Aljaiuossi, A., Antonucci, A., Ardito, F., Ausania, F., Bernon, M., Berrevoet, F., Björnsson, B., Bonsing, B.A., Boonstra, E.A., Bracke, B., Brusadin, R., Burda, L., Caraballo, M., Casellas-Robert, M., Çoker, A., Davide, J., De Gelder, A., De Rose, A.M., Djokic, M., Dudek, K., Ekmekçigil, E., Filauro, M., Fülöp, A., Gallagher, T., Gastaca, M., Gefen, R., Giuliante, F., Habibeh, H., Halle-Smith, J., Haraldsdottir, K.H., Hartman, V., Hauer, A., Hemmingsson, O., Hoskovec, D., Isaksson, B., Jonas, E., Khalaileh, A., Klug, R., Krige, J., Lignier, D., Lindemann, J., López-López, V., Lucidi, V., Mabrut, J.-Y., Månsson, C., Mieog, S., Mirza, D.F., Oldhafer, K.J., Omoshoro-Jones, J.A.O., Ortega-Torrecilla, N., Otto, W., Panaro, F., Pando, E., Paterna-López, S., Pekmezci, S., Pesce, A., Porte, R.J., Poves, I., Prieto Calvo, M., Primavesi, F., Puleo, S., Recordare, A., Rizell, M., Roberts, K., Robles-Campos, R., Sanchiz-Cardenas, E., Sandström, P., Saribeyoglu, K., Schauer, M., Schreuder, M., Siriwardena, A.K., Smith, M.D., Sousa Silva, D., Sparrelid, E., Stättner, S., Stavrou, G.A., Straka, M., Strömberg, C., Sutcliffe, R.P., Szijártó, A., Taflin, H., Trotovšek, B., van Gulik, T., Wallach, N., and Zieniewicz, K.

Published
2019
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5. Utility of the Iwate difficulty scoring system for laparoscopic right posterior sectionectomy: do surgical outcomes differ for tumors in segments VI and VII?

Author

Choi S. H., Chen K. -H., Syn N. L., Cipriani F., Cheung T. -T., Chiow A. K. H., Choi G. -H., Siow T. -F., Sucandy I., Marino M. V., Gastaca M., Chong C. C., Lee J. H., Ivanecz A., Mazzaferro V., Lopez-Ben S., Fondevila C., Rotellar F., Campos R. R., Efanov M., Kingham T. P., Sutcliffe R. P., Troisi R. I., Pratschke J., Wang X., D'Hondt M., Yong C. C., Levi Sandri G. B., Tang C. N., Ruzzenente A., Cherqui D., Ferrero A., Wakabayashi G., Scatton O., Aghayan D., Edwin B., Coelho F. F., Giuliante F., Liu R., Sijberden J., Abu Hilal M., Sugioka A., Long T. C. D., Fuks D., Aldrighetti L., Han H. -S., Goh B. K. P., Kang I., Jang J. Y., Chan C. -Y., D'Silva M., Schotte H., De Meyere C., Lai E., Krenzien F., Schmelzle M., Kadam P., Montalti R., Giglio M., Liu Q., Lee K. -F., Salimgereeva D., Alikhanov R., Lee L. -S., Prieto M., Lim C., Nghia P. P., Kojima M., Kato Y., Forchino F., Herman P., Kruger J. A. P., Saleh M., Pascual F., Dalla Valle B., Lopez-Lopez V., Casellas-Robert M., Giustizieri U., Citterio D., Mishima K., Fretland A. A., Ghotbi J., Ettorre G. M., Colasanti M., Guzman Y., Ardito F., Vani S., Wang H. -P., Choi, S. H., Chen, K. -H., Syn, N. L., Cipriani, F., Cheung, T. -T., Chiow, A. K. H., Choi, G. -H., Siow, T. -F., Sucandy, I., Marino, M. V., Gastaca, M., Chong, C. C., Lee, J. H., Ivanecz, A., Mazzaferro, V., Lopez-Ben, S., Fondevila, C., Rotellar, F., Campos, R. R., Efanov, M., Kingham, T. P., Sutcliffe, R. P., Troisi, R. I., Pratschke, J., Wang, X., D'Hondt, M., Yong, C. C., Levi Sandri, G. B., Tang, C. N., Ruzzenente, A., Cherqui, D., Ferrero, A., Wakabayashi, G., Scatton, O., Aghayan, D., Edwin, B., Coelho, F. F., Giuliante, F., Liu, R., Sijberden, J., Abu Hilal, M., Sugioka, A., Long, T. C. D., Fuks, D., Aldrighetti, L., Han, H. -S., Goh, B. K. P., Kang, I., Jang, J. Y., Chan, C. -Y., D'Silva, M., Schotte, H., De Meyere, C., Lai, E., Krenzien, F., Schmelzle, M., Kadam, P., Montalti, R., Giglio, M., Liu, Q., Lee, K. -F., Salimgereeva, D., Alikhanov, R., Lee, L. -S., Prieto, M., Lim, C., Nghia, P. P., Kojima, M., Kato, Y., Forchino, F., Herman, P., Kruger, J. A. P., Saleh, M., Pascual, F., Dalla Valle, B., Lopez-Lopez, V., Casellas-Robert, M., Giustizieri, U., Citterio, D., Mishima, K., Fretland, A. A., Ghotbi, J., Ettorre, G. M., Colasanti, M., Guzman, Y., Ardito, F., Vani, S., Wang, H. -P., Choi, Sung Hoon, Chen, Kuo-Hsin, Syn, Nicholas L, Cipriani, Federica, Cheung, Tan-To, Chiow, Adrian K H, Choi, Gi-Hong, Siow, Tiing-Foong, Sucandy, Iswanto, Marino, Marco V, Gastaca, Mikel, Chong, Charing C, Lee, Jae Hoon, Ivanecz, Arpad, Mazzaferro, Vincenzo, Lopez-Ben, Santiago, Fondevila, Constantino, Rotellar, Fernando, Campos, Ricardo Roble, Efanov, Mikhail, Kingham, T Peter, Sutcliffe, Robert P, Troisi, Roberto I, Pratschke, Johann, Wang, Xiaoying, D'Hondt, Mathieu, Yong, Chee Chien, Levi Sandri, Giovanni Battista, Tang, Chung Ngai, Ruzzenente, Andrea, Cherqui, Daniel, Ferrero, Alessandro, Wakabayashi, Go, Scatton, Olivier, Aghayan, Davit, Edwin, Bjørn, Coelho, Fabricio Ferreira, Giuliante, Felice, Liu, Rong, Sijberden, Jasper, Abu Hilal, Mohammad, Sugioka, Atsushi, Long, Tran Cong Duy, Fuks, David, Aldrighetti, Luca, Han, Ho-Seong, and Goh, Brian K P

Subjects
Carcinoma, Hepatocellular, Laparoscopic liver, Settore MED/18 - CHIRURGIA GENERALE, Operative Time, Liver Neoplasms, Carcinoma, Hepatocellular, Difficulty score, Length of Stay, Iwate, Laparoscopic hepatectomy, Right posterior sectionectomy, Treatment Outcome, Postoperative Complications, Humans, Hepatectomy, Surgery, Laparoscopy, Retrospective Studies
Abstract

Introduction: The Iwate Score (IS) have not been well-validated for specific procedures, especially for right posterior sectionectomy (RPS). In this study, the utility of the IS was determined for laparoscopic (L)RPS and the effect of tumor location on surgical outcomes was investigated. Methods: Post-hoc analysis of 647 L-RPS performed in 40 international centers of which 596L-RPS cases met the inclusion criteria. Baseline characteristics and perioperative outcomes of patients stratified based on the Iwate score were compared to determine whether a correlation with surgical difficulty existed. A 1:1 Mahalanobis distance matching was utilized to investigate the effect of tumor location on L-RPS outcomes. Results: The patients were stratified into 3 levels of difficulty (31 intermediate, 143 advanced, and 422 expert) based on the IS. When using a stepwise increase of the IS excluding the tumor location score, only Pringle’s maneuver was more frequently used in the higher surgical difficulty level (35.5%, 54.6%, and 65.2%, intermediate, advanced, and expert levels, respectively, Z = 3.34, p = 0.001). Other perioperative results were not associated with a statistical gradation toward higher difficulty level. 80 of 85 patients with a segment VI lesion and 511 patients with a segment VII lesion were matched 1:1. There were no significant differences in the perioperative outcomes of the two groups including open conversion, operating time, blood loss, intraoperative blood transfusion, postoperative stay, major morbidity, and mortality. Conclusion: Among patients undergoing L-RPS, the IS did not significantly correlate with most outcome measures associated with intraoperative difficulty and postoperative outcomes. Similarly, tumor location had no effect on L-RPS outcomes.

Published
2022

6. Utility of the Iwate difficulty scoring system for laparoscopic right posterior sectionectomy: do surgical outcomes differ for tumors in segments VI and VII?

Author

Choi, S. H., Chen, K. -H., Syn, N. L., Cipriani, F., Cheung, T. -T., Chiow, A. K. H., Choi, G. -H., Siow, T. -F., Sucandy, I., Marino, M. V., Gastaca, M., Chong, C. C., Lee, J. H., Ivanecz, A., Mazzaferro, V., Lopez-Ben, S., Fondevila, C., Rotellar, F., Campos, R. R., Efanov, M., Kingham, T. P., Sutcliffe, R. P., Troisi, R. I., Pratschke, J., Wang, X., D'Hondt, M., Yong, C. C., Levi Sandri, G. B., Tang, C. N., Ruzzenente, A., Cherqui, D., Ferrero, A., Wakabayashi, G., Scatton, O., Aghayan, D., Edwin, B., Coelho, F. F., Giuliante, Felice, Liu, R., Sijberden, J., Abu Hilal, M., Sugioka, A., Long, T. C. D., Fuks, D., Aldrighetti, L., Han, H. -S., Goh, B. K. P., Kang, I., Jang, J. Y., Chan, C. -Y., D'Silva, M., Schotte, H., De Meyere, C., Lai, E., Krenzien, F., Schmelzle, M., Kadam, P., Montalti, R., Giglio, M., Liu, Q., Lee, K. -F., Salimgereeva, D., Alikhanov, R., Lee, L. -S., Prieto, M., Lim, C., Nghia, P. P., Kojima, M., Kato, Y., Forchino, F., Herman, P., Kruger, J. A. P., Saleh, M., Pascual, F., Dalla Valle, B., Lopez-Lopez, V., Casellas-Robert, M., Giustizieri, U., Citterio, D., Mishima, K., Fretland, A. A., Ghotbi, J., Ettorre, G. M., Colasanti, M., Guzman, Y., Ardito, Francesco, Vani, S., Wang, H. -P., Giuliante F. (ORCID:0000-0001-9517-8220), Ardito F. (ORCID:0000-0003-1596-2862), Choi, S. H., Chen, K. -H., Syn, N. L., Cipriani, F., Cheung, T. -T., Chiow, A. K. H., Choi, G. -H., Siow, T. -F., Sucandy, I., Marino, M. V., Gastaca, M., Chong, C. C., Lee, J. H., Ivanecz, A., Mazzaferro, V., Lopez-Ben, S., Fondevila, C., Rotellar, F., Campos, R. R., Efanov, M., Kingham, T. P., Sutcliffe, R. P., Troisi, R. I., Pratschke, J., Wang, X., D'Hondt, M., Yong, C. C., Levi Sandri, G. B., Tang, C. N., Ruzzenente, A., Cherqui, D., Ferrero, A., Wakabayashi, G., Scatton, O., Aghayan, D., Edwin, B., Coelho, F. F., Giuliante, Felice, Liu, R., Sijberden, J., Abu Hilal, M., Sugioka, A., Long, T. C. D., Fuks, D., Aldrighetti, L., Han, H. -S., Goh, B. K. P., Kang, I., Jang, J. Y., Chan, C. -Y., D'Silva, M., Schotte, H., De Meyere, C., Lai, E., Krenzien, F., Schmelzle, M., Kadam, P., Montalti, R., Giglio, M., Liu, Q., Lee, K. -F., Salimgereeva, D., Alikhanov, R., Lee, L. -S., Prieto, M., Lim, C., Nghia, P. P., Kojima, M., Kato, Y., Forchino, F., Herman, P., Kruger, J. A. P., Saleh, M., Pascual, F., Dalla Valle, B., Lopez-Lopez, V., Casellas-Robert, M., Giustizieri, U., Citterio, D., Mishima, K., Fretland, A. A., Ghotbi, J., Ettorre, G. M., Colasanti, M., Guzman, Y., Ardito, Francesco, Vani, S., Wang, H. -P., Giuliante F. (ORCID:0000-0001-9517-8220), and Ardito F. (ORCID:0000-0003-1596-2862)

Abstract

Introduction: The Iwate Score (IS) have not been well-validated for specific procedures, especially for right posterior sectionectomy (RPS). In this study, the utility of the IS was determined for laparoscopic (L)RPS and the effect of tumor location on surgical outcomes was investigated. Methods: Post-hoc analysis of 647 L-RPS performed in 40 international centers of which 596L-RPS cases met the inclusion criteria. Baseline characteristics and perioperative outcomes of patients stratified based on the Iwate score were compared to determine whether a correlation with surgical difficulty existed. A 1:1 Mahalanobis distance matching was utilized to investigate the effect of tumor location on L-RPS outcomes. Results: The patients were stratified into 3 levels of difficulty (31 intermediate, 143 advanced, and 422 expert) based on the IS. When using a stepwise increase of the IS excluding the tumor location score, only Pringle’s maneuver was more frequently used in the higher surgical difficulty level (35.5%, 54.6%, and 65.2%, intermediate, advanced, and expert levels, respectively, Z = 3.34, p = 0.001). Other perioperative results were not associated with a statistical gradation toward higher difficulty level. 80 of 85 patients with a segment VI lesion and 511 patients with a segment VII lesion were matched 1:1. There were no significant differences in the perioperative outcomes of the two groups including open conversion, operating time, blood loss, intraoperative blood transfusion, postoperative stay, major morbidity, and mortality. Conclusion: Among patients undergoing L-RPS, the IS did not significantly correlate with most outcome measures associated with intraoperative difficulty and postoperative outcomes. Similarly, tumor location had no effect on L-RPS outcomes.

Published
2022

7. P-252 Residual fibrosis after treatment with anti-epidermal growth factor receptor or bevacizumab in colorectal liver metastases and its correlation with survival: A retrospective pooled analysis

Author

Hernández-Yagüe, X., primary, Lopez-Ben, S., additional, Llavata, L., additional, Mateu Esquerda, G., additional, Casellas-Robert, M., additional, Ortiz-Duran, R., additional, Buxó, M., additional, Albiol-Quer, M., additional, Meléndez-Muñoz, C., additional, Brunet-Vidal, J., additional, and Figueras-Felip, J., additional

Published
2021
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8. Post cholecystectomy bile duct injury : early, intermediate or late repair with hepaticojejunostomy - an E-AHPBA multi-center study

Author

Rystedt, Jenny M. L., Kleeff, Joerg, Salvia, Roberto, Besselink, Mark G., Prasad, Raj, Lesurtel, Mickael, Sturesson, Christian, Abu Hilal, M., Aljaiuossi, A., Antonucci, A., Ardito, F., Ausania, F., Bernon, M., Berrevoet, F., Bjornsson, B., Bonsing, B. A., Boonstra, E. A., Bracke, B., Brusadin, R., Burda, L., Caraballo, M., Casellas-Robert, M., Coker, A., Davide, J., De Gelder, A., De Rose, A. M., Djokic, M., Dudek, K., Ekmekcigil, E., Filauro, M., Fulop, A., Gallagher, T. K., Gastaca, M., Gefen, R., Giuliante, F., Habibeh, H., Halle-Smith, J., Haraldsdottir, K. H., Hartman, V, Hauer, A., Hemmingsson, O., Hoskovec, D., Isaksson, Bengt, Jonas, E., A, Khalaileh, Klug, R., Krige, J., Lignier, D., Lindemann, J., Lopez-Lopez, V, Lucidi, V, Mabrut, J-Y, Månsson, Christopher, Mieog, S., Mirza, D. F., Oldhafer, K. J., Omoshoro-Jones, J. A. O., Ortega-Torrecilla, N., Otto, W., Panaro, F., Pando, E., Paterna-Lopez, S., Pekmezci, S., Pesce, A., Porte, R. J., Poves, I, Prieto Calvo, M., Primavesi, F., Puleo, S., Recordare, A., Rizell, M., Roberts, K., Robles-Campos, R., Sanchiz-Cardenas, E., Sandstrom, P., Saribeyoglu, K., Schauer, M., Schreuder, M., Siriwardena, A. K., Smith, M. D., Silva, Sousa D., Sparrelid, E., Staettner, S., Stavrou, G. A., Straka, M., Stromberg, C., Sutcliffe, R. P., Szijarto, A., Taflin, H., Trotovsek, B., van Gulik, T., Wallach, N., Zieniewicz, K., Rystedt, Jenny M. L., Kleeff, Joerg, Salvia, Roberto, Besselink, Mark G., Prasad, Raj, Lesurtel, Mickael, Sturesson, Christian, Abu Hilal, M., Aljaiuossi, A., Antonucci, A., Ardito, F., Ausania, F., Bernon, M., Berrevoet, F., Bjornsson, B., Bonsing, B. A., Boonstra, E. A., Bracke, B., Brusadin, R., Burda, L., Caraballo, M., Casellas-Robert, M., Coker, A., Davide, J., De Gelder, A., De Rose, A. M., Djokic, M., Dudek, K., Ekmekcigil, E., Filauro, M., Fulop, A., Gallagher, T. K., Gastaca, M., Gefen, R., Giuliante, F., Habibeh, H., Halle-Smith, J., Haraldsdottir, K. H., Hartman, V, Hauer, A., Hemmingsson, O., Hoskovec, D., Isaksson, Bengt, Jonas, E., A, Khalaileh, Klug, R., Krige, J., Lignier, D., Lindemann, J., Lopez-Lopez, V, Lucidi, V, Mabrut, J-Y, Månsson, Christopher, Mieog, S., Mirza, D. F., Oldhafer, K. J., Omoshoro-Jones, J. A. O., Ortega-Torrecilla, N., Otto, W., Panaro, F., Pando, E., Paterna-Lopez, S., Pekmezci, S., Pesce, A., Porte, R. J., Poves, I, Prieto Calvo, M., Primavesi, F., Puleo, S., Recordare, A., Rizell, M., Roberts, K., Robles-Campos, R., Sanchiz-Cardenas, E., Sandstrom, P., Saribeyoglu, K., Schauer, M., Schreuder, M., Siriwardena, A. K., Smith, M. D., Silva, Sousa D., Sparrelid, E., Staettner, S., Stavrou, G. A., Straka, M., Stromberg, C., Sutcliffe, R. P., Szijarto, A., Taflin, H., Trotovsek, B., van Gulik, T., Wallach, N., and Zieniewicz, K.

Abstract

Background: Treatment of bile duct injuries (BDI) during cholecystectomy depends on the severity of injury and the timing of diagnosis. Standard of care for severe BDIs is hepaticojejunostomy. The aim of this retrospective multi-center study was to assess the optimal timing for repair of BDI with hepaticojejunostomy. Methods: Members of the European-African HepatoPancreatoBiliary Association were invited to report all consecutive patients with hepaticojejunostomy after BDI from January 2000 to June 2016. Patients were stratified according to the timing of biliary reconstruction with hepaticojejunostomy: early (day 0–7), intermediate (1–6 weeks) and late (6 weeks–6 months). Primary endpoint was re-intervention >90 days after the hepaticojejunostomy and secondary endpoints were severe 90-day complications and liver-related mortality. Results: In total 913 patients from 48 centers were included in the analysis. In 401 patients (44%) the bile duct injury was diagnosed intraoperatively, and 126 patients (14%) suffered from concomitant vascular injury. In multivariable analysis the timing of hepaticojejunostomy had no impact on postoperative complications, the need for re-intervention after 90 days nor liver-related mortality. The rate of re-intervention more than 90 days after the hepaticojejunostomy was significantly increased in male patients but decreased in older patients. Severe co-morbidity increased the risk for liver-related mortality (HR 3.439; CI 1.37–8.65; p = 0.009). Conclusion: After BDI occurring during cholecystectomy, the timing of biliary reconstruction with hepaticojejunostomy did not have any impact on severe postoperative complications, the need for re-intervention or liver-related mortality. Individualised treatment after iatrogenic bile duct injury is still advisable.

Published
2019
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9. Post cholecystectomy bile duct injury: early, intermediate or late repair with hepaticojejunostomy – an E-AHPBA multi-center study

Author

Rystedt, J. M. L., Kleeff, J., Salvia, R., Besselink, M. G., Prasad, R., Lesurtel, M., Sturesson, C., Abu Hilal, M., Aljaiuossi, A., Antonucci, A., Ardito, Francesco, Ausania, F., Bernon, M., Berrevoet, F., Bjornsson, B., Bonsing, B. A., Boonstra, E. A., Bracke, B., Brusadin, R., Burda, L., Caraballo, M., Casellas-Robert, M., Coker, A., Davide, J., De Gelder, A., De Rose, A. M., Djokic, M., Dudek, K., Ekmekcigil, E., Filauro, M., Fulop, A., Gallagher, T., Gastaca, M., Gefen, R., Giuliante, Felice, Habibeh, H., Halle-Smith, J., Haraldsdottir, K. H., Hartman, V., Hauer, A., Hemmingsson, O., Hoskovec, D., Isaksson, B., Jonas, E., Khalaileh, A., Klug, R., Krige, J., Lignier, D., Lindemann, J., Lopez-Lopez, V., Lucidi, V., Mabrut, J. -Y., Mansson, C., Mieog, S., Mirza, D. F., Oldhafer, K. J., Omoshoro-Jones, J. A. O., Ortega-Torrecilla, N., Otto, W., Panaro, F., Pando, E., Paterna-Lopez, S., Pekmezci, S., Pesce, A., Porte, R. J., Poves, I., Prieto Calvo, M., Primavesi, F., Puleo, S., Recordare, A., Rizell, M., Roberts, K., Robles-Campos, R., Sanchiz-Cardenas, E., Sandstrom, P., Saribeyoglu, K., Schauer, M., Schreuder, M., Siriwardena, A. K., Smith, M. D., Sousa Silva, D., Sparrelid, E., Stattner, S., Stavrou, G. A., Straka, M., Stromberg, C., Sutcliffe, R. P., Szijarto, A., Taflin, H., Trotovsek, B., van Gulik, T., Wallach, N., Zieniewicz, K., Ardito F. (ORCID:0000-0003-1596-2862), Giuliante F. (ORCID:0000-0001-9517-8220), Rystedt, J. M. L., Kleeff, J., Salvia, R., Besselink, M. G., Prasad, R., Lesurtel, M., Sturesson, C., Abu Hilal, M., Aljaiuossi, A., Antonucci, A., Ardito, Francesco, Ausania, F., Bernon, M., Berrevoet, F., Bjornsson, B., Bonsing, B. A., Boonstra, E. A., Bracke, B., Brusadin, R., Burda, L., Caraballo, M., Casellas-Robert, M., Coker, A., Davide, J., De Gelder, A., De Rose, A. M., Djokic, M., Dudek, K., Ekmekcigil, E., Filauro, M., Fulop, A., Gallagher, T., Gastaca, M., Gefen, R., Giuliante, Felice, Habibeh, H., Halle-Smith, J., Haraldsdottir, K. H., Hartman, V., Hauer, A., Hemmingsson, O., Hoskovec, D., Isaksson, B., Jonas, E., Khalaileh, A., Klug, R., Krige, J., Lignier, D., Lindemann, J., Lopez-Lopez, V., Lucidi, V., Mabrut, J. -Y., Mansson, C., Mieog, S., Mirza, D. F., Oldhafer, K. J., Omoshoro-Jones, J. A. O., Ortega-Torrecilla, N., Otto, W., Panaro, F., Pando, E., Paterna-Lopez, S., Pekmezci, S., Pesce, A., Porte, R. J., Poves, I., Prieto Calvo, M., Primavesi, F., Puleo, S., Recordare, A., Rizell, M., Roberts, K., Robles-Campos, R., Sanchiz-Cardenas, E., Sandstrom, P., Saribeyoglu, K., Schauer, M., Schreuder, M., Siriwardena, A. K., Smith, M. D., Sousa Silva, D., Sparrelid, E., Stattner, S., Stavrou, G. A., Straka, M., Stromberg, C., Sutcliffe, R. P., Szijarto, A., Taflin, H., Trotovsek, B., van Gulik, T., Wallach, N., Zieniewicz, K., Ardito F. (ORCID:0000-0003-1596-2862), and Giuliante F. (ORCID:0000-0001-9517-8220)

Abstract

Background: Treatment of bile duct injuries (BDI) during cholecystectomy depends on the severity of injury and the timing of diagnosis. Standard of care for severe BDIs is hepaticojejunostomy. The aim of this retrospective multi-center study was to assess the optimal timing for repair of BDI with hepaticojejunostomy. Methods: Members of the European-African HepatoPancreatoBiliary Association were invited to report all consecutive patients with hepaticojejunostomy after BDI from January 2000 to June 2016. Patients were stratified according to the timing of biliary reconstruction with hepaticojejunostomy: early (day 0–7), intermediate (1–6 weeks) and late (6 weeks–6 months). Primary endpoint was re-intervention >90 days after the hepaticojejunostomy and secondary endpoints were severe 90-day complications and liver-related mortality. Results: In total 913 patients from 48 centers were included in the analysis. In 401 patients (44%) the bile duct injury was diagnosed intraoperatively, and 126 patients (14%) suffered from concomitant vascular injury. In multivariable analysis the timing of hepaticojejunostomy had no impact on postoperative complications, the need for re-intervention after 90 days nor liver-related mortality. The rate of re-intervention more than 90 days after the hepaticojejunostomy was significantly increased in male patients but decreased in older patients. Severe co-morbidity increased the risk for liver-related mortality (HR 3.439; CI 1.37–8.65; p = 0.009). Conclusion: After BDI occurring during cholecystectomy, the timing of biliary reconstruction with hepaticojejunostomy did not have any impact on severe postoperative complications, the need for re-intervention or liver-related mortality. Individualised treatment after iatrogenic bile duct injury is still advisable.

Published
2019

13. Which is the limit for laparoscopic hepatectomies?

Author

Lopez-Ben, S., primary, Albiol Quer, M.T., additional, Falgueras Verdaguer, L., additional, Castro Gutierrez, E., additional, Codina Barreras, A., additional, Casellas Robert, M., additional, Gil Garcia, J., additional, and Figueras Felip, J., additional

Published
2016
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14. Treatment strategies for rectal cancer with synchronous liver metastases: surgical and oncological outcomes with propensity-score analysis.

Author

Salvador-Rosés, H., López-Ben, S., Planellas, P., Canals, E., Casellas-Robert, M., Farrés, R., Ramos, E., Codina-Cazador, A., and Figueras, J.

Abstract

Background: The optimal sequence of surgery for rectal cancer (RC) with synchronous liver metastases (SLM) is controversial.Objectives: The primary objective was to explore differences between the rectum first (RF) and the liver first strategy (LF) to achieve the complete resection (CR) of both tumors.Methods: Patients diagnosed of RC with resectable or potentially resectable SLM were included. Data collected prospectively were analyzed with an intention-to-treat perspective, adjusting for between-sample differences (propensity score). The complete resection rate (CRR) was the main outcome variable.Results: During a 5-year period, 23 patients underwent the LF strategy and 24 patients the RF strategy. Median overall survival (OS) was 32 months in the LF group and 41 months in the RF group (p = 0.499), and was 51 and 17 months, respectively, for patients achieving or not achieving CR of both tumors (p < 0.001). CRR’s were 65% in liver first group and 63% in rectum first group, (p = 0.846). No between-strategy differences in morbidity or duration of treatment were observed.Conclusions: This study supports the notion that the achievement of CR of RC and SLM should be the goal of oncological treatment. Both RF and LF strategies are feasible and safe, but no between-strategy differences have been found in the CRR. [ABSTRACT FROM AUTHOR]

Published
2018
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15. Laparoscopic Liver Resection for Hepatocellular Carcinoma in Child-Pugh A Patients With and Without Portal Hypertension: A Multicentre Study.

Author

Casellas-Robert M, Lim C, Lopez-Ben S, Lladó L, Salloum C, Codina-Font J, Comas-Cufí M, Ramos E, Figueras J, and Azoulay D

Subjects
Hepatectomy, Humans, Liver Cirrhosis complications, Liver Cirrhosis surgery, Carcinoma, Hepatocellular complications, Carcinoma, Hepatocellular surgery, Hypertension, Portal complications, Hypertension, Portal surgery, Laparoscopy, Liver Neoplasms complications, Liver Neoplasms surgery
Abstract

Background: Laparoscopic liver resection (LLR) may improve outcomes for cirrhotic patients with hepatocellular carcinoma (HCC) and portal hypertension (PHT). The aim of this study was to compare the short-term outcomes after LLR for HCC in cirrhotic patients with and without PHT., Methods: This multicentric study included 96 HCC patients who underwent LLR. Clinically significant portal hypertension (CSPH) was defined by a hepatic venous pressure gradient ≥10 mmHg. Short-term outcomes and liver-specific complications including post-hepatectomy liver failure (PHLF), ascites and encephalopathy were compared between patients with and without CSPH., Results: Thirty-one patients (32%) had CSPH. The CSPH group had higher post-operative morbidity (52% vs. 15%; p < 0.001), PHLF (10% vs. 0%; p = 0.03) and encephalopathy (10% vs. 0%; p = 0.03). There was no difference in terms of post-operative ascites between the two groups (CSPH: 16% vs. no CPSH: 8%, p = 0.28). The length of stay was longer in patients with CSPH than in those without CSPH (6 vs. 4 days; p < 0.001)., Conclusions: The laparoscopic approach is feasible in selected HCC patients with CSPH, at the price of significant increases in liver-specific complications and length of stay.

Published
2020
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16. Liver resection for hepatocellular carcinoma in patients with clinically significant portal hypertension.

Author

Azoulay D, Ramos E, Casellas-Robert M, Salloum C, Lladó L, Nadler R, Busquets J, Caula-Freixa C, Mils K, Lopez-Ben S, Figueras J, and Lim C

Abstract

Background & Aims: Liver resection (LR) in patients with hepatocellular carcinoma (HCC) and clinically significant portal hypertension (CSPH) defined as a hepatic venous pressure gradient (HVPG) ≥10 mmHg is not encouraged. Here, we reappraised the outcomes of patients with cirrhosis and CSPH who underwent LR for HCC in highly specialised liver centres., Methods: This was a retrospective multicentre study from 1999 to 2019. Predictors for postoperative liver decompensation and textbook outcomes were identified., Results: In total, 79 patients with a median age of 65 years were included. The Child-Pugh grade was A in 99% of patients, and the median model for end-stage liver disease (MELD) score was 8. The median HVPG was 12 mmHg. Major hepatectomies and laparoscopies were performed in 28% and 34% of patients, respectively. Ninety-day mortality and severe morbidity rates were 6% and 27%, respectively. Postoperative and persistent liver decompensation occurred in 35% and 10% of patients at 3 months. Predictors of liver decompensation included increased preoperative HVPG ( p  = 0.004), increased serum total bilirubin ( p  = 0.02), and open approach ( p  = 0.03). Of the patients, 34% achieved a textbook outcome, of which the laparoscopic approach was the sole predictor ( p  = 0.004). The 5-year overall survival and recurrence-free survival rates were 55% and 43%, respectively., Conclusions: Patients with cirrhosis, HCC and HVPG ≥10 mmHg can undergo LR with acceptable mortality, morbidity, and liver decompensation rates. The laparoscopic approach was the sole predictor of a textbook outcome., Lay Summary: Patients with cirrhosis, hepatocellular carcinoma, and clinically significant portal hypertension (defined as a hepatic venous pressure gradient ≥10 mmHg) can undergo resection with acceptable mortality, morbidity, liver decompensation rates, and a textbook outcome. These results can be achieved in selected patients with preserved liver function, good general status, and sufficient remnant liver volume., Competing Interests: The authors declare no conflicts of interest that pertain to this work. Please refer to the accompanying ICMJE disclosure forms for further details., (© 2020 The Author(s).)

Published
2020
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17. Impact on Oncological Outcomes and Intent-to-Treat Survival of Resection Margin for Transplantable Hepatocellular Carcinoma in All-Comers and in Patients with Cirrhosis: A Multicenter Study.

Author

Lim C, Goumard C, Casellas-Robert M, Lopez-Ben S, Lladó L, Busquets J, Salloum C, Albiol-Quer MT, Castro-Gutiérrez E, Rosmorduc O, Feray C, Ramos E, Figueras J, Scatton O, and Azoulay D

Subjects
Aged, Carcinoma, Hepatocellular complications, Carcinoma, Hepatocellular pathology, Female, Hepatectomy methods, Humans, Intention to Treat Analysis, Liver Neoplasms complications, Liver Neoplasms pathology, Male, Middle Aged, Salvage Therapy, Survival Rate, Treatment Outcome, Carcinoma, Hepatocellular surgery, Liver Cirrhosis complications, Liver Neoplasms surgery, Liver Transplantation, Margins of Excision, Neoplasm Recurrence, Local surgery
Abstract

Background: The outcomes of liver resection (LR) with a narrow margin in patients with transplantable hepatocellular carcinoma (HCC) have not been studied. The aim was to assess whether narrow margin following up-front LR impacts the incidence, timing, pattern, and transplantability of tumor recurrence in patients with initially transplantable HCC., Methods: All initially transplantable HCC patients undergoing hepatectomy with either narrow (<10 mm) or wide (≥10 mm) margins from 2007 to 2016 at four Western university centers were compared in terms of recurrence, transplantability of recurrence, recurrence-free survival (RFS), and intention-to-treat overall survival (ITT-OS). Independent predictors of non-transplantability of recurrence were assessed., Results: This study included 187 patients (narrow group, n = 107 vs. wide group, n = 80). Recurrence was significantly more frequent in the narrow margin group (44% vs. 26%; p = 0.01) with a shorter RFS (p = 0.03). The transplantability of recurrence and ITT-OS were, however, not different between the two groups. The presence of satellite nodules on the resected specimens emerged as the sole independent predictor of non-transplantability of tumor recurrence. The stratification of the analysis according to the presence of cirrhosis achieved essentially the same results as in the whole study population., Conclusions: Narrow margin was associated with a higher tumor recurrence rate and a shorter RFS for patients with initially transplantable HCC. However, transplantability of recurrence and long-term ITT-OS were not impaired.

Published
2020
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18. Open versus laparoscopic hepatectomies within an ERAS (Enhanced Recovery After Surgery) program. Are there differences?

Author

Nari GA, Castro-Gutiérrez E, Layún J, Falgueras-Verdaguer L, Mariot D, Albiol-Quer MT, and Casellas-Robert M

Subjects
Early Ambulation, Female, Hepatectomy adverse effects, Humans, Male, Middle Aged, Operative Time, Enhanced Recovery After Surgery, Hepatectomy methods, Laparoscopy adverse effects, Length of Stay, Postoperative Complications
Abstract

Background: Laparoscopic procedures have gained popularity because they favor a faster recovery. In the same way, the establishment of an enhanced recovery after surgery (ERAS) program in major abdominal surgery has shortened the hospital stay. There are several studies that report the results on ERAS programs applied to open or laparoscopic hepatectomies or comparing one of them with the classic approach but few have compared the results between both within an ERAS program., Objective: To compare the results between open and laparoscopic hepatectomies in the same ERAS program., Method: Thirty-six patients undergoing hepatectomies were enrolled in this study and were either laparoscopically or open in an identical ERAS program. Hospital stay and the number of complications were taken as primary end points., Results: There were no significant differences between both groups in terms of hospital stay or number of complications. The differences were in a shorter time of surgery and an earlier ambulation in favor of open surgery and a better full recovery in favor of the laparoscopic approach., Conclusions: Initial data suggest that there would be no benefits in terms of hospital stay and complication rate of laparoscopic hepatectomies over open ones within an ERAS program., (Copyright: © 2020 Permanyer.)

Published
2020
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