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1. Nouveautés dans la prise en charge de l’échinococcose alvéolaire [Novelties on the management of alveolar echinococcosis]

Author

Joliat, G.R., Roulin, D., Labgaa, I., Uldry, E., Demartines, N., Halkic, N., and Melloul, E.

Abstract

Alveolar echinococcosis is an endemic parasitosis in Switzerland. This pathology mainly infects the liver and develops similarly as a malignant tumor with its ability to spread into the hepatic parenchyma and its capacity of developing distant lesions via hematogenous dissemination. Treatment is based on complete surgical resection coupled with albendazole treatment. Recently, ex vivo liver resections with auto-transplantation have been shown to be feasible in case of end-stage alveolar echinococcosis. Moreover, new biomarkers such as programmed death-ligand 1 (PD-L1), a protein with immunomodulation property, have shown their potential impact on the treatment and follow-up of patients with alveolar echinococcosis.

Published
2023

5. Long-term outcomes of ruptured hepatocellular carcinoma: An international multicentric propensity score-matched study

Author

Joliat, G-R, primary, de Man, R, additional, Rijckborst, V, additional, Cimino, M, additional, Torzilli, G, additional, Choi, G H, additional, Lee, H S, additional, Goh, B, additional, Kokudo, T, additional, Shirata, C, additional, Hasegawa, K, additional, Nishioka, Y, additional, Vauthey, J-N, additional, Baimas-George, M, additional, Vrochides, D, additional, Demartines, N, additional, Halkic, N, additional, and Labgaa, I, additional

Published
2022
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6. Hepatic Resection for Early and Intermediate-stage Hepatocellular Carcinoma: A Multicenter Study on Long-Term Outcomes

Author

Martin, D., primary, Smet, H., additional, Da Silva Costa, A.C., additional, Halkic, N., additional, Uldry, É., additional, Tabrizian, P., additional, Schwartz, M., additional, Goumard, C., additional, Scatton, O., additional, Perinel, J., additional, Adham, M., additional, Demartines, N., additional, and Melloul, E., additional

Published
2022
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7. Long-Term Outcomes of Ruptured Hepatocellular Carcinoma: An International Multicentric Propensity Score-Matched Study

Author

Joliat, G.-R., primary, de Man, R., additional, Rijckborst, V., additional, Cimino, M., additional, Torzilli, G., additional, Choi, G.H., additional, Lee, H.S., additional, Goh, B., additional, Kokudo, T., additional, Shirata, C., additional, Hasegawa, K., additional, Nishioka, Y., additional, Vauthey, J.-N., additional, Baimas-George, M., additional, Vrochides, D., additional, Demartines, N., additional, Halkic, N., additional, and Labgaa, I., additional

Published
2022
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8. Embolisation portale et sus-hépatique combinée avant hépatectomie majeure [Preoperative liver venous deprivation]

Author

Martin, D., Labgaa, I., Uldry, E., Kobayashi, K., Denys, A., Halkic, N., Demartines, N., and Melloul, E.

Subjects
Embolization, Therapeutic, Hepatectomy, Hepatic Veins, Humans, Liver, Liver Neoplasms/surgery, Portal Vein, Preoperative Care, Treatment Outcome
Abstract

Some hepato-biliary cancers require major liver resections. Post hepatectomy liver failure is a complication that occurs when the remnant liver cannot maintain its synthetic and excretory functions. To overcome this issue, portal vein embolization has been developed to induce future remnant liver hypertrophy preoperatively. However, up to 20% of patients cannot proceed to the hepatectomy due to insufficient hypertrophy or tumor progression in the interval between the embolization and the planned surgery. Liver venous deprivation (LVD) is a technique that combine ipsilateral portal and hepatic vein embolization. With this technique, the hypertrophy seems to be faster and more important, with low complications rate and no mortality associated with the procedure.

Published
2021

13. Reappraisal of Laennec's capsule

Author

Shirata, C., Kokudo, T., Gillet, M., Uldry, E., Demartines, N., Kokudo, N., Hasegawa, K., and Halkic, N.

Subjects
Humans, Liver/surgery, Membranes/surgery, Peritoneal Cavity/surgery, Portal Vein/surgery, Anatomy, Glisson, Hepatectomy, Laennec, Liver parenchyma
Abstract

No abstract available

Published
2020

27. Pancreaticobiliary Maljunctions in European Patients with Bile Duct Cysts: Results of the Multicenter Study of the French Surgical Association (AFC)

Author

Ragot E., Mabrut J. -Y., Ouaissi M., Sauvanet A., Dokmak S., Nuzzo G., Halkic N., Dubois R., Letoublon C., Cherqui D., Azoulay D., Irtan S., Boudjema K., Pruvot F. -R., Gigot J. -F., Kianmanesh R., Adham M., Doussot A., Branchereau S., Ayav A., Balladur P., Adam R., Troisi R. I., Regimbeau Jean M. -A., Majno P., Sommacale D., Bouzid C., Falconi M., Service de chirurgie, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Beaujon [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Département de chirurgie digestive, Hôpital de la Croix-Rousse [CHU - HCL], Hospices Civils de Lyon (HCL)-Hospices Civils de Lyon (HCL), Centre de Recherches en Oncologie biologique et Oncopharmacologie (CRO2), Aix Marseille Université (AMU)- Hôpital de la Timone [CHU - APHM] (TIMONE)-Institut National de la Santé et de la Recherche Médicale (INSERM), Service d’Hépatologie [Hôpital Beaujon], Hôpital Beaujon [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Service de chirurgie hepato-pancreato-biliaire, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Diderot - Paris 7 (UPD7)-Hôpital Beaujon [AP-HP], Département de chirurgie digestive et de l'urgence, CHU Grenoble-Hôpital Michallon, Physiopathologie et traitement des maladies du foie, Université Paris-Sud - Paris 11 (UP11)-Hôpital Paul Brousse-Institut National de la Santé et de la Recherche Médicale (INSERM), Université Paris-Est (UPE), Service de Chirurgie Digestive Hépato-Billiaire [Henri Mondor], Hôpital Henri Mondor, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Henri Mondor-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Henri Mondor-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), Service de neurochirurgie pédiatrique [CHU Necker], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Necker - Enfants Malades [AP-HP], Service de Chirurgie Hépatobiliaire et Digestive [Rennes] = Hepatobiliary and Digestive Surgery [Rennes], CHU Pontchaillou [Rennes], Centre d'Investigation Clinique [Rennes] (CIC), Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Hôpital Pontchaillou-Institut National de la Santé et de la Recherche Médicale (INSERM), Foie, métabolismes et cancer, Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), Chirurgie digestive et transplantation [Lille], Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille)-Espace éthique hospitalier et universitaire de Lille - EEHU, Ragot, E., Mabrut, J. -Y., Ouaissi, M., Sauvanet, A., Dokmak, S., Nuzzo, G., Halkic, N., Dubois, R., Letoublon, C., Cherqui, D., Azoulay, D., Irtan, S., Boudjema, K., Pruvot, F. -R., Gigot, J. -F., Kianmanesh, R., Adham, M., Doussot, A., Branchereau, S., Ayav, A., Balladur, P., Adam, R., Troisi, R. I., Regimbeau Jean, M. -A., Majno, P., Sommacale, D., Bouzid, C., Falconi, M., Université de Rennes (UR)-Hôpital Pontchaillou-Institut National de la Santé et de la Recherche Médicale (INSERM), Université de Rennes (UR)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), Institut National de la Santé et de la Recherche Médicale (INSERM)- Hôpital de la Timone [CHU - APHM] (TIMONE)-Aix Marseille Université (AMU), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Diderot - Paris 7 (UPD7), Assistance publique - Hôpitaux de Paris (AP-HP)-Hôpital Beaujon, Hospices Civils de Lyon ( HCL ) -Hospices Civils de Lyon ( HCL ), Centre de Recherches en Oncologie biologique et Oncopharmacologie ( CRO2 ), Aix Marseille Université ( AMU ) - Hôpital de la Timone [CHU - APHM] ( TIMONE ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ), Hôpital Beaujon, Assistance publique - Hôpitaux de Paris (AP-HP)-Université Paris Diderot - Paris 7 ( UPD7 ) -Hôpital Beaujon, Université Paris-Sud - Paris 11 ( UP11 ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ) -AP-HP Hôpital Paul Brousse, Université Paris-Est ( UPE ), Assistance publique - Hôpitaux de Paris (AP-HP)-Hôpital Henri Mondor-Université Paris-Est Créteil Val-de-Marne - Paris 12 ( UPEC UP12 ) -Assistance publique - Hôpitaux de Paris (AP-HP)-Hôpital Henri Mondor-Université Paris-Est Créteil Val-de-Marne - Paris 12 ( UPEC UP12 ), Assistance publique - Hôpitaux de Paris (AP-HP)-CHU Necker - Enfants Malades [AP-HP], Service de Chirurgie Hépatobiliaire et Digestive, Université de Rennes 1 ( UR1 ), Université de Rennes ( UNIV-RENNES ) -Université de Rennes ( UNIV-RENNES ) -Hôpital Pontchaillou-CHU Pontchaillou [Rennes], Centre d'Investigation Clinique [Rennes] ( CIC ), Université de Rennes ( UNIV-RENNES ) -Université de Rennes ( UNIV-RENNES ) -Hôpital Pontchaillou-Institut National de la Santé et de la Recherche Médicale ( INSERM ), Université de Rennes ( UNIV-RENNES ) -Université de Rennes ( UNIV-RENNES ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ) -Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), Centre Hospitalier Régional Universitaire [Lille] ( CHRU Lille ) -Espace éthique hospitalier et universitaire de Lille - EEHU, Working Group of the French Surgical Association, Troisi, R.I., Regimbeau Jean, M.A., Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-Hôpital Beaujon, Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-Université Paris Diderot - Paris 7 (UPD7)-Hôpital Beaujon, Université Paris-Sud - Paris 11 (UP11)-Institut National de la Santé et de la Recherche Médicale (INSERM)-AP-HP Hôpital Paul Brousse, Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-Hôpital Henri Mondor-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12)-Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-Hôpital Henri Mondor-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), CHU Necker - Enfants Malades [AP-HP]-Assistance publique - Hôpitaux de Paris (AP-HP) (APHP), and Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Hôpital Pontchaillou-CHU Pontchaillou [Rennes]

Subjects
Male, Gastroenterology, [ SDV.CAN ] Life Sciences [q-bio]/Cancer, 0302 clinical medicine, Prevalence, Medicine, Cyst, Child, Aged, 80 and over, education.field_of_study, Bile duct, Incidence, Middle Aged, 3. Good health, medicine.anatomical_structure, Biliary Tract Neoplasms, Biliary tract, 030220 oncology & carcinogenesis, Child, Preschool, Choledochal Cyst, Amylases, [ SDV.MHEP.HEG ] Life Sciences [q-bio]/Human health and pathology/Hépatology and Gastroenterology, 030211 gastroenterology & hepatology, Female, France, Adult, medicine.medical_specialty, Adolescent, Population, Intrahepatic bile ducts, chemical and pharmacologic phenomena, [SDV.CAN]Life Sciences [q-bio]/Cancer, Congenital Abnormalities, 03 medical and health sciences, Young Adult, Predictive Value of Tests, Internal medicine, Carcinoma, Humans, education, Aged, Common Bile Duct, business.industry, fungi, Pancreatic Ducts, Cancer, Infant, [SDV.MHEP.HEG]Life Sciences [q-bio]/Human health and pathology/Hépatology and Gastroenterology, Lipase, Amylases/metabolism, Biliary Tract Neoplasms/complications, Biliary Tract Neoplasms/epidemiology, Choledochal Cyst/complications, Choledochal Cyst/enzymology, Choledochal Cyst/epidemiology, Common Bile Duct/abnormalities, Congenital Abnormalities/diagnosis, Congenital Abnormalities/epidemiology, Lipase/metabolism, Pancreatic Ducts/abnormalities, medicine.disease, Pancreatic juice, Surgery, business
Abstract

Background: Pancreaticobiliary maljunctions (PBMs) are congenital anomalies of the junction between pancreatic and bile ducts, frequently associated with bile duct cyst (BDC). BDC is congenital biliary tree diseases that are characterized by distinctive dilatation types of the extra- and/or intrahepatic bile ducts. Todani’s types I and IVa, in which dilatation involves principally the main bile duct, are the most frequent. PBM induces pancreatic juice reflux into the biliary tract that is supposed to be one of the main factors of biliary cancer degeneration, although the diagnostic criteria of PBM that can be either morphological and/or functional are not well defined especially in Western series. Objective: The aim of this study was to assess the relative prevalence of PBM in BDC in a large European multicenter study, to analyze the characteristics of PBM and try to propose diagnostic criteria of PBMs based on morphological and/or functional criteria and define the positive, negative predictive values, sensibility and specificity of either criteria. Results: From 1975 to 2012, 263 patients with BDC were analyzed. Among them, 190 (72.2%) were considered to present PBM. Types I and IVa had a similar rate of PBM association. According to the “AFC classification,” 57.2% had a C–P type, 34.5% a P–C type and 8.3% a complex type (“anse-de-seau”). The median length of the common channel in patients with PBM was 15.8±6.8mm (range 5–40mm). The median intrabiliary amylase and lipase levels were 65,249 and 172,104UI/L, respectively. For the diagnostic of PBM, a common channel length of more than 8mm and an intrabiliary amylase level superior to 8000UI/L were associated with a predictive positive value and a specificity of more than 90%. Synchronous biliary cancer had an incidence of 8.7% in all patients with BDC and PBM 11.1% in adults. Compared to type IV, the type I BDC was associated with statistically more cancer patients in the presence of PBM. Conclusions: Characteristics of PBM associated with BDC in Western population are quite close to reported Eastern series. The results suggest considering both the intrabiliary value of amylase >8000UI/L and a length of a common channel >8mm as appropriate values for positive diagnosis of PBM.

Published
2017

30. Biological impact of an enhanced recovery after surgery programme in liver surgery.

Author

Gonvers, S., Jurt, J., Joliat, G.-R., Halkic, N., Melloul, E., Hübner, M., Demartines, N., and Labgaa, I.

Subjects
LIVER surgery, ECONOMIC impact, LAPAROSCOPY
Abstract

Background: The clinical and economic impacts of enhanced recovery after surgery (ERAS) programmes have been demonstrated extensively. Whether ERAS protocols also have a biological effect remains unclear. This study aimed to investigate the biological impact of an ERAS programme in patients undergoing liver surgery. Methods: A retrospective analysis of patients undergoing liver surgery (2010-2018) was undertaken. Patients operated before and after ERAS implementation in 2013 were compared. Surrogate markers of surgical stress were monitored: white blood cell count (WBC), C-reactive protein (CRP) level, albumin concentration, and haematocrit. Their perioperative fluctuations were defined as Δvalues, calculated on postoperative day (POD) 0 for Δalbumin and Δhaematocrit and POD 2 for ΔWBC and ΔCRP. Results: A total of 541 patients were included, with 223 and 318 patients in non-ERAS and ERAS groups respectively. Groups were comparable, except for higher rates of laparoscopy (24.8 versus 11.2 per cent; P < 0.001) and major resection (47.5 versus 38.1 per cent; P = 0.035) in the ERAS group. Patients in the ERAS group showed attenuated ΔWBC (2.00 versus 2.75 g/l; P = 0.013), ΔCRP (60 versus 101 mg/l; P <0.001) and Δalbumin (12 versus 16 g/l; P < 0.001) compared with those in the no-ERAS group. Subgroup analysis of open resection showed similar results. Multivariable analysis identified ERAS as the only independent factor associated with high ΔWBC (odds ratio (OR) 0.65, 95 per cent c.i. 0.43 to 0.98; P = 0.038), ΔCRP (OR 0.41, 0.23 to 0.73; P = 0.003) and Δalbumin (OR 0.40, 95 per cent c.i. 0.22 to 0.72; P = 0.002). Conclusion: Compared with conventional management, implementation of ERAS was associated with an attenuated stress response in patients undergoing liver surgery. [ABSTRACT FROM AUTHOR]

Published
2021
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32. Aberrant Right Hepatic Artery with a Prepancreatic Course Visualized Prior to Pancreaticoduodenectomy

Author

Venara, A., Pittet, O., Lu, T., Demartines, N., Halkic, N., Venara, A., Pittet, O., Lu, T., Demartines, N., and Halkic, N.

Abstract

Liver vascularization is known to present with several different variations. Generally, a normal vascular anatomy is reported in up to 50-80 % of cases. For this reason, a precise preoperative mapping of the hepatic vascularization prior to pancreatic surgery is essential to avoid injuries and subsequent complications. We report here a case of a young patient scheduled for Whipple procedure, who presented an arterial pattern type Michels IV, variation reported in 0.6 to 3 % in the literature. Another interesting particularity of this case was the fact that the right hepatic artery had a prepancreatic course. We think that every surgeon performing hepatopancreatic surgery should have heard of this special and rare situation

Published
2018

33. A case of Muir-Torre syndrome associated with mucinous hepatic cholangiocarcinoma and a novel germline mutation of the MSH2 gene

Author

Vernez, M., Hutter, P., Monnerat, C., Halkic, N., Gugerli, O., Bouzourene, H., Vernez, M., Hutter, P., Monnerat, C., Halkic, N., Gugerli, O., and Bouzourene, H.

Abstract

Muir-Torre syndrome (MTS) is a rare cancer-predisposing syndrome that is autosomal dominantly inherited and characterized by the development of sebaceous skin lesions (adenomas, epitheliomas, basaliomas and carcinomas). These lesions are typically associated with tumors that belong to the spectrum of hereditary nonpolyposis colorectal cancer (HNPCC) (i.e. tumors of the colorectum, endometrium, stomach or ovary). Biliary malignancy in association with MTS has only rarely been reported. We report a case of Muir-Torre syndrome associated with intrahepatic cholangiocarcinoma, a location not previously described, and associated with a novel missense mutation of the MSH2 gene (c.2026T>C), predicted to disrupt the function of the gene

Published
2018

34. Traitement chirurgical du carcinome hépatocellulaire : les recommandations actuelles sont-elles trop restrictives ? [Current surgical treatment for hepatocellular carcinoma : critical appraisal of current guidelines]

Author

Clerc, D., Halkic, N., Demartines, N., and Melloul, E.

Subjects
Carcinoma, Hepatocellular/pathology, Carcinoma, Hepatocellular/surgery, Catheter Ablation/methods, Chemoembolization, Therapeutic/methods, Embolization, Therapeutic/methods, Humans, Liver Neoplasms/pathology, Liver Neoplasms/surgery, Neoplasm Recurrence, Local, Practice Guidelines as Topic, Treatment Outcome, Yttrium Radioisotopes
Abstract

Hepatocellular carcinoma (HCC) management has evolved in the last decades. Current available treatments include interventional radiology like radiofrequency ablation, transarterial chemoembolization or Yttrium 90 radioembolization. Surgery, when possible, has been proven to be the most effective treatment in reducing the risk of long-term local recurrence. American and European societies (AASLD, EASL, respectively) guidelines for the management of HCC endorse The Barcelona Clinic Liver Cancer (BCLC) treatment allocation system. One drawback of the BCLC system is its restrictiveness regarding surgical indications. This present article aims in reviewing the indications of surgical resection for HCC.

Published
2017

35. Quoi de neuf en chirurgie? [Novelties in surgery in 2016]

Author

Fournier, P., Allemann, P., Hubner, M., Halkic, N., Schäfer, M., and Demartines, N.

Subjects
Appendectomy/methods, Appendectomy/rehabilitation, Appendectomy/trends, Bariatric Surgery/rehabilitation, Bariatric Surgery/trends, Cholecystectomy/methods, Cholecystectomy/rehabilitation, Cholecystectomy/trends, Digestive System Surgical Procedures/methods, Digestive System Surgical Procedures/rehabilitation, Digestive System Surgical Procedures/standards, Digestive System Surgical Procedures/trends, Gastroesophageal Reflux/surgery, Humans, Perioperative Care/methods, Perioperative Care/standards, Perioperative Care/trends
Abstract

The year 2016 allowed further implementation of previous years innovations with the PIPAC treatment for peritoneal carcinomatosis, the development of new surgical technologies and procedures and challenging general principles in general and digestive surgery, including cholecystectomy and appendectomy. Prevention, improved general and perioperative care (ERAS program) become an integral part of our standard surgical activity.

Published
2017

45. Pulmonary sequestration: a review of 26 cases

Author

Halkic, N., Cuénoud, P.F., Corthésy, M.E., Ksontini, R., Boumghar, M., Halkic, N., Cuénoud, P.F., Corthésy, M.E., Ksontini, R., and Boumghar, M.

Abstract

Objectives: Pulmonary sequestration is a continuum of lung anomalies for which no single embryonic hypothesis is yet available. The aim of this study was to assess the diagnostic tools and treatment for the rare condition, pulmonary sequestration, in an unspecialised centre. Methods: We performed an analysis of 26 cases of pulmonary sequestration (paediatric and adult) operated at the Centre Hospitalier Universitaire Vaudois between May 1959 and May 1997. A review of the extralobar and intralobar types of sequestrations is discussed. Angiography is compared to other diagnostic tools in this condition, and treatment is discussed. Results: Twenty-six cases of pulmonary sequestrations, a rare congenital pulmonary malformation, were operated on in the defined time period. Seventy-three percent (19) of the cases were intralobar and 27% (seven) extralobar. Extralobar localisation was basal in 71% and situated between the upper and the lower lobe in 29%. In six cases, the diagnosis was made by exploratory thoracotomy. In the other 20 cases, diagnosis was evoked on chest X-ray and confirmed by angiography. Lobectomy (46%) was the most common treatment procedure. Segmental resection was performed in 30% of the cases and bilobectomy in 4%. Post-operative morbidity was low. The most significant complications were pleural empyema, haemothorax and haemopneumoperitoneum in case of extralobar sequestration. There was no evidence of metaplasia or pre-neoplastic changes. Conclusions: Despite its rarity, some radiological features are sufficiently suggestive of diagnosis of pulmonary sequestration. Investigations are necessary in order to avoid unexpected pathology at the time of operation. Resection of the involved lung leads to excellent results and the long-term outcome is highly favourable

Published
2017

46. Bilan préopératoire de l'hépatectomie majeure [Preoperative assessment for extended hepatic resection]

Author

Martin, D., Roulin, D., Takamune, Y., Demartines, N., and Halkic, N.

Subjects
Algorithms, Clinical Decision-Making, Hepatectomy/methods, Humans, Imaging, Three-Dimensional, Liver/diagnostic imaging, Preoperative Care, Radiography
Abstract

The number of major hepatectomy performed for the treatment of primary or secondary liver cancer has increased over the past two decades. By definition, a major hepatectomy includes the resection of at least three liversegments. Advances in anesthesiology, surgical and radiological techniques and perioperative management allowed a broad patient selection with increased security. Every case must be discussed in multidisciplinary tumor board, and preoperative assessment should include biological, volumetric and functional hepatic parameters. In case of preoperative insufficient liver volume, portal vein embolization allows increasing the size of liver remnant. This paper aims describing preoperative work-up.

Published
2016

47. Prise en charge chirurgicale des métastases hépatiques de cancer colorectal [Surgical managment of colorectal liver metastasis]

Author

Prot, T., Halkic, N., and Demartines, N.

Subjects
Chemotherapy, Adjuvant, Colonic Neoplasms, Embolization, Therapeutic, Hepatectomy, Humans, Liver Neoplasms, Neoadjuvant Therapy, Patient Care Planning, Rectal Neoplasms, Survival Rate
Abstract

Surgery offer the only curative treatment for colorectal hepatic metastasis. Nowadays, five-year survival increases up to 58% in selected cases, due to the improvement and combination of chemotherapy, surgery and ablative treatment like embolisation, radio-frequency or cryoablation. Surgery should be integrated in a multi disciplinary approach and initial work-up must take in account patient general conditions, tumor location, and possible extra hepatic extension. Thus, a surgical resection may be performed immediately or after preparation with chemotherapy or selective portal embolization. Management of liver metastasis should be carried out in oncological hepato-biliary centre.

Published
2016

50. Ruptured subcapsular hematoma after laparoscopic cholecystectomy attributed to ketorolac-induced coagulopathy

Author

Vuilleumier, H. and Halkic, N.

Abstract

Ketorolac is the first injectable nonsteroidal antiinflammatory drug used as an analgesic in the perioperative period. However, gastrointestinal bleeding is a risk associated with its perioperative administration. A 23-year-old woman was admitted for elective laparoscopic cholecystectomy. Her medical history was unremarkable except for a complaint of intermittent right upper quadrant pain for several months. The operative procedure was uneventful. Thirty milligrams of ketorolac were given intravenously just prior to termination of surgery. Eighteen hours after surgery, the patient developed right upper quadrant pain associated with tachycardia and hypotension. Abdominal computed tomography (CT) scan demonstrated a large subcapsular hematoma of the liver. A few hours later, the hemodynamic condition worsened, and the patient was taken to the operating room. Laparoscopic exploration showed a ruptured subcapsular hematoma with active bleeding. No evidence of parenchymal injury of the gallbladder bed was found. The hematoma was evacuated and hemostasis was performed laparoscopically. Ketorolac has a strong antiplatelet activity and further acts by the inibition of platelet function, which may last as long as 24 h after the last administration. Surgeons and anesthesiologists should be aware that ketorolac may cause or aggravate bleeding.

Published
2024
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