101 results on '"Kuemmerli C"'
Search Results
2. Are enhanced recovery protocols after pancreatoduodenectomy still efficient when applied in elderly patients? A systematic review and individual patient data meta-analysis
- Author
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Kuemmerli, C, Balzano, G, Bouwense, S, Braga, M, Coolsen, M, Daniel, S, Dervenis, C, Falconi, M, Hwang, D, Kagedan, D, Kim, S, Lavu, H, Nussbaum, D, Partelli, S, Passeri, M, Pecorelli, N, Pillarisetty, V, Pucci, M, Sutcliffe, R, Tingstedt, B, van der Kolk, M, Vrochides, D, Armstrong, M, Wei, A, Williamsson, C, Yeo, C, Zani, S, Zouros, E, Rozzini, R, Abuhilal, M, Kuemmerli C., Balzano G., Bouwense S. A., Braga M., Coolsen M., Daniel S. K., Dervenis C., Falconi M., Hwang D. W., Kagedan D. J., Kim S. C., Lavu H., Nussbaum D., Partelli S., Passeri M. J., Pecorelli N., Pillarisetty V. G., Pucci M. J., Sutcliffe R. P., Tingstedt B., van der Kolk M., Vrochides D., Armstrong M., Wei A., Williamsson C., Yeo C. J., Zani S., Zouros E., Rozzini R., AbuHilal M., Kuemmerli, C, Balzano, G, Bouwense, S, Braga, M, Coolsen, M, Daniel, S, Dervenis, C, Falconi, M, Hwang, D, Kagedan, D, Kim, S, Lavu, H, Nussbaum, D, Partelli, S, Passeri, M, Pecorelli, N, Pillarisetty, V, Pucci, M, Sutcliffe, R, Tingstedt, B, van der Kolk, M, Vrochides, D, Armstrong, M, Wei, A, Williamsson, C, Yeo, C, Zani, S, Zouros, E, Rozzini, R, Abuhilal, M, Kuemmerli C., Balzano G., Bouwense S. A., Braga M., Coolsen M., Daniel S. K., Dervenis C., Falconi M., Hwang D. W., Kagedan D. J., Kim S. C., Lavu H., Nussbaum D., Partelli S., Passeri M. J., Pecorelli N., Pillarisetty V. G., Pucci M. J., Sutcliffe R. P., Tingstedt B., van der Kolk M., Vrochides D., Armstrong M., Wei A., Williamsson C., Yeo C. J., Zani S., Zouros E., Rozzini R., and AbuHilal M.
- Abstract
Background: This meta-analysis investigated the effects of enhanced recovery after surgery (ERAS) protocols compared to conventional care on postoperative outcomes in patients aged 70 years or older undergoing pancreatoduodenectomy (PD). Methods: Five databases were systematically searched. Comparative studies with available individual patient data (IPD) were included. The main outcomes were postoperative morbidity, length of stay, readmission and postoperative functional recovery elements. To assess an age-dependent effect, the group was divided in septuagenarians (70–79 years) and older patients (≥80 years). Results: IPD were obtained from 15 of 31 eligible studies comprising 1109 patients. The overall complication and major complication rates were comparable in both groups (OR 0.92 [95% CI: 0.65–1.29], p =.596 and OR 1.22 [95% CI: 0.61–2.46], p =.508). Length of hospital stay tended to be shorter in the ERAS group compared to the conventional care group (−0.14 days [95% CI: −0.29 to 0.01], p =.071) while readmission rates were comparable and the total length of stay including days in hospital after readmission tended to be shorter in the ERAS group (−0.28 days [95% CI: −0.62 to 0.05], p =.069). In the subgroups, the length of stay was shorter in octogenarians treated with ERAS (−0.36 days [95% CI: −0.71 to −0.004], p =.048). The readmission rate increased slightly but not significantly while the total length of stay was not longer in the ERAS group. Conclusion: ERAS in the elderly is safe and its benefits are preserved in the care of even in patients older than 80 years. Standardized care protocol should be encouraged in all pancreatic centers.
- Published
- 2024
3. INSPIRA: study protocol for a randomized-controlled trial about the effect of spirometry-assisted preoperative inspiratory muscle training on postoperative complications in abdominal surgery
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Birrer, D. L., Kuemmerli, C., Obwegeser, A., Liebi, M., von Felten, S., Pettersson, K., and Horisberger, K.
- Published
- 2022
- Full Text
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4. Learning Curves in Open, Laparoscopic, and Robotic Pancreatic Surgery: A Systematic Review and Proposal of a Standardization
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Müller, P. C., Kuemmerli, C., Cizmic, A., Sinz, S., Probst, P., de Santibanes, M., Shrikhande, S. V., Tschuor, C., Loos, M., Mehrabi, A., Z’graggen, K., Müller-Stich, B. P., Hackert, T., Büchler, M. W., and Nickel, F.
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- 2022
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5. Enterothorax After Hepatic Surgery: A Single-Center Experience
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Manzini, G., Kuemmerli, C., Reiner, C. S., Petrowsky, H., and Gutschow, C. A.
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- 2019
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6. Impact of enhanced recovery protocols after pancreatoduodenectomy: Meta-Analysis
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Kuemmerli, C, Tschuor, C, Kasai, M, Alseidi, A, Balzano, G, Bouwense, S, Braga, M, Coolsen, M, Daniel, S, Dervenis, C, Falconi, M, Hwang, D, Kagedan, D, Kim, S, Lavu, H, Liang, T, Nussbaum, D, Partelli, S, Passeri, M, Pecorelli, N, Pillai, S, Pillarisetty, V, Pucci, M, Su, W, Sutcliffe, R, Tingstedt, B, Van Der Kolk, M, Vrochides, D, Wei, A, Yeo, C, Zani, S, Zouros, E, Abu Hilal, M, Kuemmerli C., Tschuor C., Kasai M., Alseidi A. A., Balzano G., Bouwense S., Braga M., Coolsen M., Daniel S. K., Dervenis C., Falconi M., Hwang D. W., Kagedan D. J., Kim S. C., Lavu H., Liang T., Nussbaum D., Partelli S., Passeri M. J., Pecorelli N., Pillai S. A., Pillarisetty V. G., Pucci M. J., Su W., Sutcliffe R. P., Tingstedt B., Van Der Kolk M., Vrochides D., Wei A., Yeo C. J., Zani S., Zouros E., Abu Hilal M., Kuemmerli, C, Tschuor, C, Kasai, M, Alseidi, A, Balzano, G, Bouwense, S, Braga, M, Coolsen, M, Daniel, S, Dervenis, C, Falconi, M, Hwang, D, Kagedan, D, Kim, S, Lavu, H, Liang, T, Nussbaum, D, Partelli, S, Passeri, M, Pecorelli, N, Pillai, S, Pillarisetty, V, Pucci, M, Su, W, Sutcliffe, R, Tingstedt, B, Van Der Kolk, M, Vrochides, D, Wei, A, Yeo, C, Zani, S, Zouros, E, Abu Hilal, M, Kuemmerli C., Tschuor C., Kasai M., Alseidi A. A., Balzano G., Bouwense S., Braga M., Coolsen M., Daniel S. K., Dervenis C., Falconi M., Hwang D. W., Kagedan D. J., Kim S. C., Lavu H., Liang T., Nussbaum D., Partelli S., Passeri M. J., Pecorelli N., Pillai S. A., Pillarisetty V. G., Pucci M. J., Su W., Sutcliffe R. P., Tingstedt B., Van Der Kolk M., Vrochides D., Wei A., Yeo C. J., Zani S., Zouros E., and Abu Hilal M.
- Abstract
Background: This individual-patient data meta-Analysis investigated the effects of enhanced recovery after surgery (ERAS) protocols compared with conventional care on postoperative outcomes in patients undergoing pancreatoduodenectomy. Methods: The Cochrane Library, MEDLINE, Embase, Scopus, and Web of Science were searched systematically for articles reporting outcomes of ERAS after pancreatoduodenectomy published up to August 2020. Comparative studies were included. Main outcomes were postoperative functional recovery elements, postoperative morbidity, duration of hospital stay, and readmission. Results: Individual-patient data were obtained from 17 of 31 eligible studies comprising 3108 patients. Time to liquid (mean difference (MD)-3.23 (95 per cent c.i.-4.62 to-1.85) days; P < 0.001) and solid (-3.84 (-5.09 to-2.60) days; P < 0.001) intake, time to passage of first stool (MD-1.38 (-1.82 to-0.94) days; P < 0.001) and time to removal of the nasogastric tube (3.03 (-4.87 to-1.18) days; P = 0.001) were reduced with ERAS. ERAS was associated with lower overall morbidity (risk difference (RD)-0.04, 95 per cent c.i.-0.08 to-0.01; P = 0.015), less delayed gastric emptying (RD-0.11,-0.22 to-0.01; P = 0.039) and a shorter duration of hospital stay (MD-2.33 (-2.98 to-1.69) days; P < 0.001) without a higher readmission rate. Conclusion: ERAS improved postoperative outcome after pancreatoduodenectomy. Implementation should be encouraged.
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- 2022
7. Artificial intelligence in pancreatic surgery –Current applications
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Kuemmerli, C., primary, Rössler, F., additional, Berchtold, C., additional, Frey, M.C., additional, Studier-Fischer, A., additional, Cizmic, A., additional, Jonas, J.P., additional, Hackert, T., additional, Nickel, F., additional, and Müller, P.C., additional
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- 2023
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8. Can Operative Time Be a Surrogate Marker for Postoperative Complications in Liver Surgery? A Procedure and Approach-specific International Multicentre Cohort
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Kuemmerli, C., primary, Sijberden, J., additional, Sutcliffe, R., additional, Aldrighetti, L., additional, Cillo, U., additional, Edwin, B., additional, Rotellar, F., additional, Vivarelli, M., additional, Fuks, D., additional, D'Hondt, M., additional, and Hilal, M., additional
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- 2023
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9. Vascular Injury during Cholecystectomy: A Multicenter Critical Analysis behind the Drama
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Lopez-Lopez, V., primary, Kuemmerli, C., additional, Cutillas, J., additional, Lopez-Andujar, R., additional, Ramos, E., additional, Valdievieso, A., additional, Serrablo, A., additional, Grochola, L.F., additional, Clavien, P.-A., additional, Petrowsky, H., additional, and Robles-Campos, R., additional
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- 2023
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10. Long Term Oncological Outcomes for HALS/Hybrid vs Pure Laparoscopic Approach in Colorectal Liver Metastases: A Propensity Score Matched Analysis
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Lopez-Lopez, V., primary, Arthur, J.A. Jaime, additional, Kuemmerli, C., additional, Tohme, S., additional, Gómez-Gavara, C., additional, Dogeas, E., additional, Dalmau, M., additional, Sanches-Esquer, I., additional, Geller, D.A., additional, Herman, P., additional, and Robles-CAmpos, R., additional
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- 2023
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11. Absorbable Biliary Stent as a Preventive Treatment of Biliary Complications in Liver Transplantation: A Pilot Study
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Lopez-Lopez, V., primary, Kuemmerli, C., additional, Guillermo, A. Hiciano, additional, Cascales-Campos, P., additional, Baroja-Mazo, A., additional, Miura, K., additional, Martinez-Alarcon, L., additional, Pons, J.A., additional, Sanchez-Bueno, F., additional, Ramirez, P., additional, and Robles-Campos, R., additional
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- 2023
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12. BJS commission on surgery and perioperative care post-COVID-19
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Abahuje, E, Abbas, A, Abd El Aziz Abd El Maksoud, M, Abdelhady, A, Abdelhamid, S, Abdelkarem Ahmed Faraj, H, Abdelqader, B, Abdelrahman, T, Abdou, H, Abdullah, A, Abedua Harrison, M, Abem Owusu, E, Aboalazayem, A, Aboulhosn, R, Abu Oda, S, Abubakar, A, Abutaka, A, Acevedo Fontalvo, D, Acuna, S, Adefemi, A, Adegbola, S, Adenuga, T, Adeyeye, A, Adil Hilmi, A, Adisa, A, Aditya, K, Adjeso, T, Aftab, R, Afzal, A, Aggarwal, V, Aggarwal, A, Aguilera, R, Aguilera-Arevalo, M, Aguirre Salamanca, E, Aguirre-Allende, I, Ahari, D, Ahmad, H, Ahmad Rauf, F, Ahmad Zartasht Khan, A, Ahmed, S, Ahmed Fieturi, N, Ahmed Mohamed, S, Ahmed-Bakhsh, Z, Ahsan Javed, M, Akano, L, Akbar, A, Akhbari, M, Akhmedov, P, Aksit, G, Akula, Y, Alagaratnam, A, Al Majid, S, Al Mukhtar, O, Al Omran, H, Alasali, N, Al-Azzawi, M, Al-Habsi, R, Al-Iraqi, H, Al-Naggar, H, Alameer, E, Albirnawi, H, Alderson, D, Aldulaijan, F, Alejandro Miranda Ojeda, R, Alhasan, A, Ali, S, Ali, A, Ali Khan, M, Alimova, Y, Aljanadi, F, Aljubure, R, Allopi, N, Almedbal, H, Almubarak, M, Alqaidoom, Z, Alselaim, N, Alshaar, M, Alshammari, R, Altaf, K, Altiner, S, Altunpak, B, Alvarez Lozada, L, Amal Nahal, E, Amer, A, Amin, K, Aminu, U, Amisi Numbi, N, Amjad, T, Amoah, R, An, Y, Anastasopoulos, N, Andres Urrutia, J, Angarita, F, Angarita, K, Angel Freiria Eiras, M, Antypas, A, Anwar, M, Anwar, H, Apampa, T, Apostolou, K, Aquina, C, Arachchige Adithi Himika Randeni, R, Archila Godinez, M, Arez, O, Arezzo, A, Armonis, P, Arshad, S, Arshad Salman, M, Arshid, A, Arteaga Asensio, P, Arthur, T, Arumuga Jothi, A, Aryo Damara, F, Asensio Gomez, L, Ashcroft, J, Ashraf, S, Asif, A, Atif, M, Attaullah Khan, M, Avellaneda, N, Awad, S, Awadh, M, Axiaq, A, Ayad Mohammed Shuwayyah, A, Ayalew, D, Aytac, E, Azam, F, Azevedo, J, Azhar, B, Aziz, J, Aziz, A, Azzam, A, Baba Ndajiwo, A, Baig, M, Baker, D, Bakko, F, Balachandran, R, Balachandran, G, Balagizi Mudekereza, J, Balai, E, Balci, B, Balduzzi, A, Balhareth, A, Bandyopadhyay, S, Banerjee, D, Bangalore Mahalinga, D, Bankhead-Kendall, B, Bankole, N, Banwell, V, Baris Bengur, F, Baris Ozmen, B, Barnard, M, Barnett, R, Barreras Espinoza, J, Barrios, A, Bass, G, Bass, M, Bausys, A, Bavikatte, A, Bayram, J, Belousov, M, Berardi, A, Beamish, A, Beattie, C, Belia, F, Bellato, V, Bellikatti, S, Benjamens, S, Benlice, C, Bennedsgaard, S, Bennett, S, Bentounsi, Z, Bergenfeldt, H, Bergenfelz, A, Besselink, M, Bhandoria, G, Bhangu, E, Bhatia, M, Bhatti, M, Bilgili, Z, Bislenghi, G, Bisset, C, Biswas, S, Blake, J, Blanco, R, Boccalatte, L, Boden, R, Bojanic, C, Boland, M, Boland, P, Bollen, E, Bonci, E, Boni, L, Booth, A, Booth, R, Borakati, A, Borunda Escudero, G, Bosco, S, Bostrom, P, Botelho De Alencar Ferreira Cruz, P, Bouchagier, K, Bouhuwaish, A, Boutros, M, Boyce, K, Boyle, C, Bradshaw, L, Brandl, A, Brar, A, Brat, G, Brenkman, H, Brennan, C, Brines, C, Brookmyre, A, Brosnan, C, Brouwers, L, Brown, A, Brown, L, Brown, C, Brown, J, Bs, V, Buksh, M, Bunani Emmanuel, M, Burbano, D, Burelli, A, Burke, A, Burke, J, Burlov, N, Burns, A, Burton, O, Butt, A, Buzra Ozkan, B, Cabrera Silva, L, Caicedo, E, Calderbank, T, Cambridge, W, Campelo, G, Can Tatar, O, Carbone, F, Carrano, F, Casallas, D, Casanova Portoles, D, Casciani, F, Cassimjee, I, Castaneda Ramirez, O, Catalan, V, Caviedes, J, Cayetano, L, Ceresoli, M, Chan, M, Chan, V, Chandrasinghe, P, Chapman, S, Chaturvedi, A, Chaudhry, D, Chaudry, H, Chen, H, Cheng, A, Chernykh, M, Cherrie, A, Cheruiyot, I, Cheung, J, Chia, C, Chica, J, Chinai, N, Chirwa, A, Chiwaligo, J, Choi, A, Choi, J, Chowdhury, M, Christopher, E, Christou, N, Chu, T, Chua, D, Chua, H, Chung, C, Cihat Yildirim, A, Cillo, M, Cioffi, S, Claireaux, H, Clermonts, S, Clifford, R, Climent, M, Clynch, A, Coelen, R, Colas-Ruiz, E, Collar, A, Collard, M, Conlon, K, Connelly, T, Connor, K, Cook, J, Correia De Sa, T, Cosgun Acar, N, Costa, T, Couch, D, Cowper, S, Creavin, B, Crook, B, Curell, A, D'Alessio, R, Dale, J, Damgaard Eriksen, J, Dario Martin Gonzalez, I, Darwish, A, Das, M, Das, R, Das, K, Dave, R, David, S, Davies, T, Davis, C, Davison, S, Davletshina, V, Dawidziuk, A, Dawson, A, De Andres Crespo, M, De Berker, H, De Dieu Ngo, P, Dekker, E, De La Caridad Espinosa Luis, R, De Lacy, B, Demartines, N, De Montserrat Medina Sifuentes, A, De Silva, S, Del Rio, C, Delaune, V, Dell, A, Demirbas, I, Demirli Atici, S, Deniz Tepe, M, Derebey, M, Desai, G, Desai, M, Devarakonda, S, Deveras, N, Di Franco, G, Di Martino, M, Di Marzo, F, Diaz, A, Diaz Del Gobbo, G, Diazcastrillon, C, Dick, L, Dickinson, K, Diego, E, Dimasi, I, Ding, A, Dingemans, S, Dixon, L, Dixon, B, Doherty, W, Dooreemeah, D, Donohue, C, Dornseifer, M, Dossa, F, Dossou, W, Drake, T, Drami, I, Drevin, G, Du Plessis, M, Dudi-Venkata, N, Dudley, R, Duffy, S, Duklas, D, Dumbrava, B, Duygu Avlar, F, Dworzynska, A, Ebrahim, W, Ebrahim, A, Efren Lozada Hernandez, E, Ehigie, N, El Boghdady, M, El Hasnaoui, C, El Sheikh, M, El-Hussuna, A, Eldurssi, O, Elfeki, H, Elhadi, M, Elhassan, M, Elhissi, A, Elliot, B, Elsenbroek, C, Elsolh, B, Elson, N, Eltyeb, H, Emerson, H, Emile, S, Endalle, G, English, W, Ercisli, C, Espinosa, G, Essam Abdelraheem, M, Essangri, H, Etienne, P, Evans, M, Evans, T, Ezeme, C, Ezzahraa, F, Fadalla, T, Fagan, J, Fahmy, M, Fairfield, C, Falade, O, Famularo, S, Faqar-Uz-Zaman, F, Farid, Y, Farooq, A, Farooq, H, Farooqui, F, Farquharson, B, Faruqi, A, Faulder, R, Faut, M, Fechner, K, Feenstra, T, Fehervari, M, Fernandez, L, Fernandez Alberti, J, Ferrario, L, Field, D, Fiore, L, Fingerhut, S, Finlayson, S, Fleming, N, Fleming, C, Florial, E, Fok, M, Fokin, D, Foley, M, Forero, M, Forgan, T, Fornasiero, M, Fowler, H, Fowler, G, Franchi, E, Franklin, L, Fredriksson, A, Fruhling, P, Fuentes Navarrette, G, Fulop, A, Furtado, M, Gaarder, T, Galbraith, N, Gallagher, I, Gallo, G, Gana, T, Gaskin, E, Gasparini, M, Gatan, R, Geary, E, Gelaye Wudineh, K, Gemenetzis, G, Georgi, M, Ghalige, H, Ghareeb, W, Ghatwary Tantawy, T, Ghomsi, C, Ghuman, A, Giannakis, P, Giron, F, Gjengedal, K, Gkotsis, E, Glasbey, J, Godahewa, S, Godula, D, Goffredo, P, Goh, S, Golriz, M, Gomez, L, Gomez Gomez, D, Gonzalez, R, Gonzalez, D, Gonzalez Gutierrez, E, Gopar, D, Gordini, L, Gori, A, Gortazar, S, Gousy, N, Gowda, R, Gowda, M, Gqada, J, Grechenig, M, Greer, J, Gregorio, L, Grigorova, A, Grimes, H, Groot, V, Grossman, R, Gruber, R, Gruter, A, Guest, R, Gujjuri, R, Gulcek, E, Gulcu, B, Gull, K, Gulmez, M, Gupta, V, Gutlic, A, Guven, T, Gwatirisa, T, Gwini, G, Gwodog, P, Gysling, S, Habib, M, Hafeez Bhatti, A, Hallesmith, J, Halloran, S, Hamza Sadiq, M, Haney, C, Hanna, N, Hanna, L, Hannington, M, Harbjerg, J, Haribaskaran, D, Harran, N, Harrington, B, Harrison, E, Hasan, R, Hashmi, S, Hassan, M, Hassan, A, Haverkamp, L, Hazen, S, Heer, B, Heil, J, Helliwell, J, Henriksen, N, Henshall, D, Hermanson, M, Hermena, S, Hettiarachchi, D, Hextall, C, Hidalgo, M, Hidayat, H, Hider, A, Higgins, P, Hinchliffe, R, Hirani, D, Hirpara, D, Hisham, I, Hite, M, Hoh, S, Holmberg, C, Holmich, E, Holst, F, Hossam, A, Hossam Elfallal, A, Howard, P, Huaman, E, Huang, Y, Huang, L, Huang, D, Huber, T, Hugh, J, Hughes, J, Huttner, F, Huynh, R, Hylands, A, Iannuzzi, J, Ielpo, B, Iftikhar Talib, A, Ignacio, J, Ignatavicius, P, Ike, S, Ikwu, C, Inama, M, Ing, A, Ingels, A, Isik, A, Islam, N, Ives, I, Al-Hasan, A, Perez Rivera, C, Jacome, F, Jaffer, T, Jagiella-Lodise, O, Jain, M, Jain, K, Jakubauskas, M, Jalal, M, James, H, Jang, Y, Janssen, B, Jansson, H, Jariod-Ferrer, U, Javanmard, H, Javed, S, Jayarajah, U, Jayasuriya, I, Je, J, Jessop, Z, Jia Lin Tang, E, Jiang, H, Jiayan, Y, Jih Huei, T, Jimenez-Rodriguez, R, Joh, D, Johnson, A, Jones, N, Jones, C, Jordan, C, Jose Nunez Ju, J, Jose Pizarro, M, Jose Salazar, C, Joseph, J, Justiniano, C, Kabir, T, Kadhum, M, Kalfountzos, C, Kalogiannaki, E, Kalyanasundaram, K, Kamarajah, S, Kamil Quraishi, M, Kanemitsu, Y, Kapila, A, Kapila, V, Karagiannidis, G, Kashif, M, Kathiravelupillai, S, Kathiravelupillai, A, 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O., Davies T., Davis C., Davison S., Davletshina V., Dawidziuk A., Dawson A., De Andres Crespo M., De Berker H., De Dieu Ngo P., Dekker E., De La Caridad Espinosa Luis R., De Lacy B., Demartines N., De Montserrat Medina Sifuentes A., De Silva S., Del Rio C., Delaune V., Dell A., Demirbas I., Demirli Atici S., Deniz Tepe M., Derebey M., Desai G., Desai M., Devarakonda S., Deveras N., Di Franco G., Di Martino M., Di Marzo F., Diaz A., Diaz Del Gobbo G., DiazCastrillon C., Dick L., Dickinson K., Diego E., Dimasi I., Ding A., Dingemans S., Dixon L., Dixon B., Doherty W., Dooreemeah D., Donohue C., Dornseifer M., Dossa F., Dossou W., Drake T., Drami I., Drevin G., Du Plessis M. C., Dudi-Venkata N., Dudley R., Duffy S., Duklas D., Dumbrava B. -D., Duygu Avlar F., Dworzynska A., Ebrahim W., Ebrahim A., Efren Lozada Hernandez E., Ehigie N., El Boghdady M., El Hasnaoui C., El Sheikh M., El-Hussuna A., Eldurssi O., Elfeki H., Elhadi M., Elhassan M., Elhissi A., Elliot B., Elsenbroek C., Elsolh B., Elson N., Eltyeb H., Emerson H., Emile S. H., Endalle G., English W., Ercisli C., Espinosa G., Essam Abdelraheem M., Essangri H., Etienne P., Evans M. D., Evans T., Ezeme C., Ezzahraa F., Fadalla T., Fagan J., Fahmy M., Fairfield C., Falade O., Famularo S., Faqar-Uz-Zaman F., Farid Y., Farooq A., Farooq H., Farooqui F., Farquharson B., Faruqi A., Faulder R., Faut M., Fechner K., Feenstra T., Fehervari M., Fernandez L., Fernandez Alberti J., Ferrario L., Field D., Fiore L., Fingerhut S., Finlayson S., Fleming N., Fleming C., Florial E., Fok M., Fokin D., Foley M., Forero M. P., Forgan T., Fornasiero M., Fowler H., Fowler G., Franchi E., Franklin L., Fredriksson A., Fruhling P., Fuentes Navarrette G., Fulop A., Furtado M., Gaarder T., Galbraith N., Gallagher I. T. K., Gallo G., Gana T., Gaskin E., Gasparini M., Gatan R. G., Geary E., Gelaye Wudineh K., Gemenetzis G., Georgi M., Ghalige H., Ghareeb W., Ghatwary Tantawy T., Ghomsi C., Ghuman A., Giannakis P., Giron F., Gjengedal K., Gkotsis E., Glasbey J., Godahewa S., Godula D., Goffredo P., Goh S., Golriz M., Gomez L., Gomez Gomez D., Gonzalez R., Gonzalez D., Gonzalez Gutierrez E., Gopar D., Gordini L., Gori A., Gortazar S., Gousy N., Gowda R., Gowda M., Gqada J., Grechenig M., Greer J., Gregorio L., Grigorova A., Grimes H., Groot V., Grossman R. C., Gruber R., Gruter A., Guest R., Gujjuri R., Gulcek E., Gulcu B., Gull K., Gulmez M., Gupta V., Gutlic A., Guven T., Gwatirisa T., Gwini G., Gwodog P., Gysling S., Habib M., Hafeez Bhatti A. B., Hallesmith J., Halloran S., Hamza Sadiq M., Haney C., Hanna N., Hanna L., Hannington M., Harbjerg J., Haribaskaran D., Harran N., Harrington B., Harrison E., Hasan R., Hashmi S., Hassan M., Hassan A., Haverkamp L., Hazen S., Heer B., Heil J., Helliwell J., Henriksen N., Henshall D., Hermanson M., Hermena S., Hettiarachchi D., Hextall C., Hidalgo M., Hidayat H., Hider A., Higgins P., Hinchliffe R., Hirani D., Hirpara D., Hisham I., Hite M., Hoh S. M., Holmberg C., Holmich E., Holst F., Hossam A., Hossam Elfallal A., Howard P., Huaman E., Huang Y., Huang L., Huang D., Huber T., Hugh J., Hughes J., Huttner F., Huynh R., Hylands A., Iannuzzi J., Ielpo B., Iftikhar Talib A., Ignacio J., Ignatavicius P., Ike S., Ikwu C., Inama M., Ing A., Ingels A., Isik A., Islam N., Ives I. J., Al-Hasan A. J. M. S., Perez Rivera C. J., Jacome F., Jaffer T., Jagiella-Lodise O., Jain M., Jain K., Jakubauskas M., Jalal M., James H., Jang Y., Janssen B., Jansson H., Jariod-Ferrer U., Javanmard H., Javed S., Jayarajah U., Jayasuriya I., Je J., Jessop Z., Jia Lin Tang E., Jiang H., Jiayan Y., Jih Huei T., Jimenez-Rodriguez R., Joh D., Johnson A., Jones N., Jones C., Jordan C., Jose Nunez Ju J., Jose Pizarro M., Jose Salazar C., Joseph J., Justiniano C., Kabir T., Kadhum M., Kalfountzos C., Kalogiannaki E., Kalyanasundaram K., Kamarajah S., Kamil Quraishi M., Kanemitsu Y., Kapila A., Kapila V., Karagiannidis G., Kashif M., Kathiravelupillai S., Kathiravelupillai A., Katsogridakis E., Kaur K., Kaur Sekhon Inderjit Singh H., Kausur N., Kawka M., Keehan G., Kehlet Watt S., Kelly M., Kelly M. E., Kelvin Egbuchulem I., Kembuan G., Khajeh E., Khaled Elfaitur A., Khan M. F., Khan S., Khan M., Khan D., Khan H., Khatkar H., Khatkov E., Khaw R., Kim B., Kishore Siddiraju K., Kitua D., Kirimtay B., Kmezic S., Knight S., Koeter T., Koh A., Koh Hong Xiang F., Kojo Anyomih T., Kok A. I. N., Kokelaar R., Koliarakis I., Kolli S., Kong J., Konig D., Koshy M., Kotze P., Kourdouli A., Kowal M., Kraima A., Kramer F., Kryzauskas M., Kuchynskyi I., Kuemmerli C., Kuiper S., Kumar S., Kumar A., Kumar L., Kumar H., Kumar N., Kumar Bandyopadhyay S., Kumar Garg P., Kumar Venkatappa S., Kung J., Kural S., Kushairi A., Kuuzie E., Kvietkauskas M., Kwek I., La J., Lai L., Lakpriya S., Lam K., Lami M., Lansdorp-Vogelaar I., Lapolla P., Larsen H., Latif J., Laudari U., Laurnezi A., Lawal A., Lawday S., Lederhuber H., Lednev A., Lee R., Van Leerdam M. E., Lefevbre G., Lesmus M., Leyva Moraga F. A., Leyva Moraga E., Leyva Moraga F., Li H. L., Li A., Li Z., Licardie E., Light A., Lightner A. L., Lin A., Lincango E., Litta F., Liu H., Lofthouse B., Londono M. A., Lopes R., Lopes De Freitas R., Lopez L., Lopez A. I., Lopez-Gomez J., Lopez-Pena G., Lowe R., Lowe D., Lowey M., Loy G., Lozanovski V., Luzon J., Lynn P., MacCabe T., MacHielsen A., Mafla Herreria C. A., Maggino L., Mahawar K., Mahmood D., Mahmoud M., Mahtani K., Maitra I., Maji S., Majiet I., Mal L., Malherbe J., Malhotra K., Malkomes P., Man E., Manan Sheikh A., Manjunath S., Manzano Nunez R., Manzoor S., Maqsood R., Marchegiani G., Marchegiani F., Marin D., Marin A., Marks I., Marson E., Martensen A., Martin D., Martin Martin G., Martin-Perez B., Martinez P., Marwaha P., Mashauri C., Mashbari H., Masior L., Masri R., Masud L., Masudi S., Mateu Calabuig G., Math S., Matrachisia A., Mayol J., Mazingi D., Mazzotta A., McAlinden J., McCabe G., McColm L., McElvaney H., McGivern K., McGovern J., McGuinness E., McInerney N., McKay S., McKee C., McKenna M., McKenna N., McLean K., Mediratta S., Medkova Y., Medzhidov O., Mehraj A., Mekhael M., Mekinde O., Mellenthin C., Melucci A., Mentor K., Merchant J., Messias H., Messeha M., Meza C., Mhango P., Miladinov M., Milagros Niquen Jimenez M., Miller P., Mills E., Milton A., Minayeva O. A., MinHua Zheng Z., Mischlinger H., Mockli B., Modi R., Mohamed H. M., Mohamed M., Mohamed Abulghasm T., Mohammad S. A., Mohammed T. O., Mohammed A., Mohan H., Mohan M., Moin I., Mok V., Molina G., Moloney J., Moneim J., Monfort Mira M., Montcusi Ventura B., Montouri M., Moossdorff M., Mora-Guzman I., Moran B., Moran R. A. R., Moreno-Ordaz S., Morera A., Morgan R., Morley R., Moro-Valdezate D., Moros S., Moss J. -L., Morven A., Morton D., Moynihan A., Moyon M., Muduli N., Mugla N., Mugla W., Muller P., Mun G., Mundhada R., Munir I., Munoz F., Munoz E., Munoz A., Munoz Balderas D. C., Murgitroyd E., Murray V., Murthy S., Mushiwokufa W., Mustafa H., Mustakimov B., Mutambanengwe P., Myint P., Nadkarni S., Naess P. A., Nahar S., Naidoo P., Nam R., Nandhra S., Nanjappa N., Narasimhan V., Nardi W., Nasir M., Naughton A., Naumann D., Navarro S., Nawaaz Karimbocus M., Nazir A., Ndereya S., Ndong A., Negoi I., Nel D., Nelson D., Nepal S., Nugent T., Nepogodiev D., Neufeld J., Ng J., Ng D., Ng C. E., Ngaserin S., Ngu L., Ngwenya E., Fhearaigh R. N., Nikolousakis T. -K., Ninkovic M., Nita G., Nitschke C., Noren E., Noton T., Novikova A., Nowinka Z., Nyakunengwa T., Nyalundja A., Nzenwa I., Kristensen H. O., O'Brien C., O'Brien L., O'Brien S., O'Reilly J., O'Rourke S., O'Sullivan M., O'Dwyer M., Ochieng L., Oderoha E., Oh K. E., Ohlberger L., Olcum M., Olkina A., Omkumar M., Omnitel B., Oncel Yakar D., Ong K., Ong Wei Lin L., Ooi R., Ooi S., Oomman A., Oon Tyjet D., Opiyo S., Oscullo Yepez J. 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P., Forgan T., Fornasiero M., Fowler H., Fowler G., Franchi E., Franklin L., Fredriksson A., Fruhling P., Fuentes Navarrette G., Fulop A., Furtado M., Gaarder T., Galbraith N., Gallagher I. T. K., Gallo G., Gana T., Gaskin E., Gasparini M., Gatan R. G., Geary E., Gelaye Wudineh K., Gemenetzis G., Georgi M., Ghalige H., Ghareeb W., Ghatwary Tantawy T., Ghomsi C., Ghuman A., Giannakis P., Giron F., Gjengedal K., Gkotsis E., Glasbey J., Godahewa S., Godula D., Goffredo P., Goh S., Golriz M., Gomez L., Gomez Gomez D., Gonzalez R., Gonzalez D., Gonzalez Gutierrez E., Gopar D., Gordini L., Gori A., Gortazar S., Gousy N., Gowda R., Gowda M., Gqada J., Grechenig M., Greer J., Gregorio L., Grigorova A., Grimes H., Groot V., Grossman R. C., Gruber R., Gruter A., Guest R., Gujjuri R., Gulcek E., Gulcu B., Gull K., Gulmez M., Gupta V., Gutlic A., Guven T., Gwatirisa T., Gwini G., Gwodog P., Gysling S., Habib M., Hafeez Bhatti A. B., Hallesmith J., Halloran S., Hamza Sadiq M., Haney C., Hanna N., Hanna L., Hannington M., Harbjerg J., Haribaskaran D., Harran N., Harrington B., Harrison E., Hasan R., Hashmi S., Hassan M., Hassan A., Haverkamp L., Hazen S., Heer B., Heil J., Helliwell J., Henriksen N., Henshall D., Hermanson M., Hermena S., Hettiarachchi D., Hextall C., Hidalgo M., Hidayat H., Hider A., Higgins P., Hinchliffe R., Hirani D., Hirpara D., Hisham I., Hite M., Hoh S. M., Holmberg C., Holmich E., Holst F., Hossam A., Hossam Elfallal A., Howard P., Huaman E., Huang Y., Huang L., Huang D., Huber T., Hugh J., Hughes J., Huttner F., Huynh R., Hylands A., Iannuzzi J., Ielpo B., Iftikhar Talib A., Ignacio J., Ignatavicius P., Ike S., Ikwu C., Inama M., Ing A., Ingels A., Isik A., Islam N., Ives I. J., Al-Hasan A. J. M. S., Perez Rivera C. J., Jacome F., Jaffer T., Jagiella-Lodise O., Jain M., Jain K., Jakubauskas M., Jalal M., James H., Jang Y., Janssen B., Jansson H., Jariod-Ferrer U., Javanmard H., Javed S., Jayarajah U., Jayasuriya I., Je J., Jessop Z., Jia Lin Tang E., Jiang H., Jiayan Y., Jih Huei T., Jimenez-Rodriguez R., Joh D., Johnson A., Jones N., Jones C., Jordan C., Jose Nunez Ju J., Jose Pizarro M., Jose Salazar C., Joseph J., Justiniano C., Kabir T., Kadhum M., Kalfountzos C., Kalogiannaki E., Kalyanasundaram K., Kamarajah S., Kamil Quraishi M., Kanemitsu Y., Kapila A., Kapila V., Karagiannidis G., Kashif M., Kathiravelupillai S., Kathiravelupillai A., Katsogridakis E., Kaur K., Kaur Sekhon Inderjit Singh H., Kausur N., Kawka M., Keehan G., Kehlet Watt S., Kelly M., Kelly M. E., Kelvin Egbuchulem I., Kembuan G., Khajeh E., Khaled Elfaitur A., Khan M. F., Khan S., Khan M., Khan D., Khan H., Khatkar H., Khatkov E., Khaw R., Kim B., Kishore Siddiraju K., Kitua D., Kirimtay B., Kmezic S., Knight S., Koeter T., Koh A., Koh Hong Xiang F., Kojo Anyomih T., Kok A. I. N., Kokelaar R., Koliarakis I., Kolli S., Kong J., Konig D., Koshy M., Kotze P., Kourdouli A., Kowal M., Kraima A., Kramer F., Kryzauskas M., Kuchynskyi I., Kuemmerli C., Kuiper S., Kumar S., Kumar A., Kumar L., Kumar H., Kumar N., Kumar Bandyopadhyay S., Kumar Garg P., Kumar Venkatappa S., Kung J., Kural S., Kushairi A., Kuuzie E., Kvietkauskas M., Kwek I., La J., Lai L., Lakpriya S., Lam K., Lami M., Lansdorp-Vogelaar I., Lapolla P., Larsen H., Latif J., Laudari U., Laurnezi A., Lawal A., Lawday S., Lederhuber H., Lednev A., Lee R., Van Leerdam M. E., Lefevbre G., Lesmus M., Leyva Moraga F. A., Leyva Moraga E., Leyva Moraga F., Li H. L., Li A., Li Z., Licardie E., Light A., Lightner A. L., Lin A., Lincango E., Litta F., Liu H., Lofthouse B., Londono M. A., Lopes R., Lopes De Freitas R., Lopez L., Lopez A. I., Lopez-Gomez J., Lopez-Pena G., Lowe R., Lowe D., Lowey M., Loy G., Lozanovski V., Luzon J., Lynn P., MacCabe T., MacHielsen A., Mafla Herreria C. A., Maggino L., Mahawar K., Mahmood D., Mahmoud M., Mahtani K., Maitra I., Maji S., Majiet I., Mal L., Malherbe J., Malhotra K., Malkomes P., Man E., Manan Sheikh A., Manjunath S., Manzano Nunez R., Manzoor S., Maqsood R., Marchegiani G., Marchegiani F., Marin D., Marin A., Marks I., Marson E., Martensen A., Martin D., Martin Martin G., Martin-Perez B., Martinez P., Marwaha P., Mashauri C., Mashbari H., Masior L., Masri R., Masud L., Masudi S., Mateu Calabuig G., Math S., Matrachisia A., Mayol J., Mazingi D., Mazzotta A., McAlinden J., McCabe G., McColm L., McElvaney H., McGivern K., McGovern J., McGuinness E., McInerney N., McKay S., McKee C., McKenna M., McKenna N., McLean K., Mediratta S., Medkova Y., Medzhidov O., Mehraj A., Mekhael M., Mekinde O., Mellenthin C., Melucci A., Mentor K., Merchant J., Messias H., Messeha M., Meza C., Mhango P., Miladinov M., Milagros Niquen Jimenez M., Miller P., Mills E., Milton A., Minayeva O. A., MinHua Zheng Z., Mischlinger H., Mockli B., Modi R., Mohamed H. M., Mohamed M., Mohamed Abulghasm T., Mohammad S. A., Mohammed T. O., Mohammed A., Mohan H., Mohan M., Moin I., Mok V., Molina G., Moloney J., Moneim J., Monfort Mira M., Montcusi Ventura B., Montouri M., Moossdorff M., Mora-Guzman I., Moran B., Moran R. A. R., Moreno-Ordaz S., Morera A., Morgan R., Morley R., Moro-Valdezate D., Moros S., Moss J. -L., Morven A., Morton D., Moynihan A., Moyon M., Muduli N., Mugla N., Mugla W., Muller P., Mun G., Mundhada R., Munir I., Munoz F., Munoz E., Munoz A., Munoz Balderas D. C., Murgitroyd E., Murray V., Murthy S., Mushiwokufa W., Mustafa H., Mustakimov B., Mutambanengwe P., Myint P., Nadkarni S., Naess P. A., Nahar S., Naidoo P., Nam R., Nandhra S., Nanjappa N., Narasimhan V., Nardi W., Nasir M., Naughton A., Naumann D., Navarro S., Nawaaz Karimbocus M., Nazir A., Ndereya S., Ndong A., Negoi I., Nel D., Nelson D., Nepal S., Nugent T., Nepogodiev D., Neufeld J., Ng J., Ng D., Ng C. E., Ngaserin S., Ngu L., Ngwenya E., Fhearaigh R. N., Nikolousakis T. -K., Ninkovic M., Nita G., Nitschke C., Noren E., Noton T., Novikova A., Nowinka Z., Nyakunengwa T., Nyalundja A., Nzenwa I., Kristensen H. O., O'Brien C., O'Brien L., O'Brien S., O'Reilly J., O'Rourke S., O'Sullivan M., O'Dwyer M., Ochieng L., Oderoha E., Oh K. E., Ohlberger L., Olcum M., Olkina A., Omkumar M., Omnitel B., Oncel Yakar D., Ong K., Ong Wei Lin L., Ooi R., Ooi S., Oomman A., Oon Tyjet D., Opiyo S., Oscullo Yepez J. J., Osei-Kuffour N., Osunronbi T., Ottlakan A., Oussama Kacimi S., Ovaere S., Ozair A., Pachler F., Pai Oo S., Paiella S., Panaiotti L., Panda N., Pandarinath S., Pandey D., Pandrowala S., Papa Mamadou F., Paranathala M., Park J., Parmar C., Parvez A., Pasovic L., Pasquer A., Pasumarthy N., Pata F., Patel T., Patel P., Patel N., Patel M., Patron Uriburu N., Patrone R., Paul A., Pavan Kumar O. M., Pavithran A., Pedraza Ciro M., Pellino G., Peloso A., Pena Gallardo M. T., Pena Velazquez A., Perea J., Perez-Sanchez L. E., Perra T., Perrotta G., Petersson P., Petra G., Petrucciani N., Pickin C., Pino V., Pinotti E., Pinto F., Plum P., Podesta F., Pollini T., Pompeu Sa M., Ponce Leon F., Ponniah H. S., Ponte De Sousa X., Ponton J., Pontula A., Popa M., Portilla A. L., Posner F., Post S., Potolicchio A., Pouwels S., Povo A., Prasad P., Preciado S., Preece R., Proud D., Pulido Segura J. A., Puliyath N., Qui M., Quimbaya Rodriguez A. S., Raby-Smith W., Racovita A., Rad A., Radwan R., Rafaih Iqbal M., Rafik A., Raguan B., Rahi M., Rahiri J. -L., Rahme J., Rai L., Raj A., Raj Saksena A., Raja M., Ramirez J., Ramzi J., Ranstam J., Rao C., Rashid A., Ratnayake B., Rattanasirivilai K., Raubenheimer K., Ravikumar N., Ravn S., Razoz N., Rea W., Regan A., Rela M., Remme A., Rey Chaves C. E., Reyes A., Riad A., Rice D., Rios Quintana K., Ritter A., Roalso M., Robinson D., Rodriguez J., Rodriguez F., Rodriguez M. C., Rogers A., Rohila J., Romanyuc D., Romic I., Rommaneh M., Rompianesi G., Rosa F., Roscio F., Rose A., Rotimi T., Ruiz H., Ruiz Yucuma J., Ruiz-Ucar E., Ruslan M., Rutegard M., Ryan Harper E., Ryckx A., Rydbeck D., Sa-Marta E., Sadien I., Safari Nteranya D., Sagoo K., Sakata S., Saladino E., Saleem A., Saleem S., Salehi M., Salih S., Sallinen V., Salvans S., Sam Z. H., Samadov E., Sampaio Alves M., Sanad A., Sanchez Fonseca S., Sanchez Teran A., Sanchez Ussa S., Sandli O., Sanfey H., Sanghera J., Sani I., Santafe Guerrero M., Sante Fornasiero M., Santes Jasso O., Santos Pereira I., Santos Sousa H., Saratzis A., Sarmiento Alarcon A., Saumtally T., Sayyed R., Schettino M., Schleimer L., Schmidt T., Schondffelt K., Schwab M., Scott A., Searle H., Sebopelo L., Seeglier B., Seishima R., Semenvov D., Senent-Boza A., Sepulveda J., Serenari M., Serrano Navidad M., Sert I., Sewart E., Sgro A., Shadrina V., Shah K., Shahid F., Shalaby M., Shankar B., Shapiro J., Sharma L., Sheel A., Shenfine A., Shenoy S., Sherif A., Shetty N., Shetty R., Sia T. C., Sichimba D., Siddique H., Siddiqui I., Simkens G., Simoe J., Simon H., Sinan L., Singh T., Singh K., Singh Y., Sinha L., Siragusa L., Sluckin T., Smart Y. W., Smith H., Smith K., Smits L., Sneep-Van Kessel C., Sohrabi C., Solorzano Pineda O., Soma A., Sooriyapiragasam L., Soreide K., Sparavigna M., Spence R., Spencer N., Spiers H., Spinelli A., Sprakel J., Sravanam S., Srinivasan M., Srinivasan R., Staniszewska A., Stanworth S. J., Stasinos K., Steele R. J. C., Steinholt I., Steinruecke M., Stephen B. -J., Stijns J., Still M., Stupalkowska W., Subba S., Subbotin V. V., Sucharitkul P., Sudarsanam A., Sudhamsh Reddy D., Suhardja T., Suliman M., Sund M., Sunilkumar A., Suresh N., Sussmes S., Sutton P., Syltern J., Taha A., Takamizawa Y., Takoutsing Dongmo A. B., Tamas T., Tan L., Tan J. L., Tan K., Tan E., Tan Yong Hui A., Tanase A., Tariverdiev A., Tasnem A., Tatar C., Tay E., Tejedor P., Tesfaye G., Tetinou F., Thorpe C., Thyo A., Tlelo Amastal D., Tolani M., Tolga Saracoglu K., Tolgyes T., Tong J., Torrent Jansa L., Toscano Igartua S., Tovani Palone M. R., Traff H., Trevis J., Tummers W., Tur A., Turchenko I., Uche V., Uddin A., Udonsak N., Ullah M., Urbonas T., Uwins C., Uy Magadia E., Uzair Qureshi A., Uzun K., Vadim P., Valarche G., Valdez Gonzalez R. A., Vallee M., Van Beek D. -J., Van Dalen A. S., Van Den Hondel D., Van Der Stok E., Van Dorp M., Van Oostendorp S., Van Praag E., Van Rees J., Van Silfhout L., Varga Z., Varghese S., Varghese C., Varghese J., Vasilica A. -M., Vasquez Ojeda X., Vega E., Vehler S., Venchiarutti R., Vengatesan S., Venn M., Verma D., Vianey Partida Nava G., Victoria D., Vieira P., Vilar Alvarez M. E., Vinci D., Viscasillas Pallas G., Viswanath M., Vivanco J., Vizcaya Rodriguez V., Vo J., Volchanski D., Voron T., Voronovskyi Y., Vu J., Wadhwa M., Wadhwa S., Wagner G., Wallace M., Wang Y. Y., Wang J., Wani A., Wanigasooriya K., Wanjara S., Wanjiku N., Warner C., Wei Leow T., Weiser T., Weisters M., Wellington M. J., Wells C., Wenzelberg C., Wettstein D., Wezel A., Wheldon L., Widmer L., Wilson M., Wigmore S., Wijayaratne T., Wijeyaratne M., Wijnhoven B. P. L., Wilkin R., Williams E., Willis F., Winter D., Wirsik M. M., Wishah B., Wong G., Wong W. J., Wong K., Wong K. -Y., Worku D., Wright E., Wright J., Wroe Wright O., Xenacki S., Xia W., Xu W., Xu Z., Yalcinkaya A., Yang W., Yang P. -C., Yanishev A., Yanzon De La Torre A., Yao H., Yaqoob E., Yen Ling Quake S., Yeo D., Yeom B., Yershov D., Yiasemidou M., Yildiz A., Yiu A., Yoav M., Yong E., Yoshimura R., Younis M. U., Younis Ringshawl Z., Youssef M., Yue Y., Yuen S., Yuldashev R., Yurttas C., Yves B., Zaborowski A., Zackeri R., Zafar A., Zahra W., Zaidi A., Zainudin S., Zakeri R., Zamora I., Zamora A. T., Zawistowski M., Zbikowska G., Zegers W., Zehra S., Zeyra A., Zhagniyev Z., Zhukova L. G., Zivanovic M., Zmuc J., Zope M., Zubayraeva A., and Zucker B.
- Abstract
Background: Coronavirus disease 2019 (COVID-19) was declared a pandemic by the WHO on 11 March 2020 and global surgical practice was compromised. This Commission aimed to document and reflect on the changes seen in the surgical environment during the pandemic, by reviewing colleagues experiences and published evidence. Methods: In late 2020, BJS contacted colleagues across the global surgical community and asked them to describe how severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) had affected their practice. In addition to this, the Commission undertook a literature review on the impact of COVID-19 on surgery and perioperative care. A thematic analysis was performed to identify the issues most frequently encountered by the correspondents, as well as the solutions and ideas suggested to address them. Results: BJS received communications for this Commission from leading clinicians and academics across a variety of surgical specialties in every inhabited continent. The responses from all over the world provided insights into multiple facets of surgical practice from a governmental level to individual clinical practice and training. Conclusion: The COVID-19 pandemic has uncovered a variety of problems in healthcare systems, including negative impacts on surgical practice. Global surgical multidisciplinary teams are working collaboratively to address research questions about the future of surgery in the post-COVID-19 era. The COVID-19 pandemic is severely damaging surgical training. The establishment of a multidisciplinary ethics committee should be encouraged at all surgical oncology centres. Innovative leadership and collaboration is vital in the post-COVID-19 era.
- Published
- 2021
13. Prevalence and consequences of non-proportional hazards in surgical randomized controlled trials
- Author
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Kuemmerli, C, primary, Sparn, M, additional, Birrer, D L, additional, Müller, P C, additional, and Meuli, L, additional
- Published
- 2021
- Full Text
- View/download PDF
14. Eight pillars to provide guidance when performing a diamond technique laparoscopic resection of a lesion in a posterosuperior segment
- Author
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Sijberden, J., primary, Kuemmerli, C., additional, Zimmitti, G., additional, Manzoni, A., additional, and Hilal, M. Abu, additional
- Published
- 2021
- Full Text
- View/download PDF
15. Impact of enhanced recovery after surgery on open and laparoscopic liver surgery: A single center cohort study.
- Author
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Moekotte, A., primary, Giovinazzo, F., additional, Kuemmerli, C., additional, Rawashdeh, A., additional, Clarke, H., additional, Al Jaiuossi, A., additional, Alzoubi, M., additional, Primrose, J., additional, Takhar, A., additional, Armstrong, T., additional, Hamady, Z., additional, and Hilal, M Abu, additional
- Published
- 2020
- Full Text
- View/download PDF
16. Laparoscopic versus open parenchymal preserving liver resections posterosuperior segments (ORANGE segments): a multicentre, patient-blinded, randomised controlled trial.
- Author
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Sijberden, J., Kuemmerli, C., Ratti, F., D'Hondt, M., Sutcliffe, R.P., Troisi, R.I., Efanov, M., Fichtinger, R.S., Díaz-Nieto, R., Ettorre, G.M., Sheen, A.J., Menon, K., Besselink, M.G., Soonawalla, Z., Aroori, S., de Meyere, C., Marudanayagam, R., Eminton, Z., Brandts, L., and Ferrari, C.
- Published
- 2024
- Full Text
- View/download PDF
17. Randomized Clinical Trial of Laparoscopic versus Open Hemihepatectomy within an Enhanced Recovery after Surgery Program (ORANGE-II-PLUS Study): A Quality of Life Analysis
- Author
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Olij, B., Fichtinger, R., Aldrghetti, L., Troisi, R., Hilal, M. Abu, Sutcliffe, R., Besselink, M., Aroori, S., Menon, K., Edwin, B., D'Hondt, M., Lucidi, V., Ulmer, T., Diaz-Nieto, R., Soonawalla, Z., White, S., Sergeant, G., Ratti, F., Kümmerli, C., Brandts, L., Pugh, S., Eminton, Z., Kimman, M., Primrose, J., and Van Dam, R.
- Published
- 2022
- Full Text
- View/download PDF
18. Laparoscopic Versus Open Hemihepatectomy: The ORANGE II PLUS Multicenter Randomized Controlled Trial
- Author
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Fichtinger, R., Aldrighetti, L., Troisi, R., Abu Hilal, M., Sutcliffe, R., Besselink, M., Aroori, S., Menon, K., Edwin, B., D'Hondt, M., Lucidi, V., Ulmer, T., Diaz-Nieto, R., Soonawalla, Z., White, S., Sergeant, G., Ratti, F., Olij, B., Kümmerli, C., Brandts, L., Pugh, S., Eminton, Z., Van Breukelen, G., Primrose, J., and Van Dam, R.
- Published
- 2022
- Full Text
- View/download PDF
19. Feasibility of delayed vascular repair after surgical combined injury to the bile duct and hepatic artery: case series and systematic review
- Author
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Grochola, L.F., primary, Kuemmerli, C., additional, Lopez, V.L., additional, Oberkofler, C., additional, Campos, R.R., additional, Clavien, P.A., additional, and Petrowsky, H., additional
- Published
- 2019
- Full Text
- View/download PDF
20. 384O Laparoscopic versus open hemihepatectomy: The ORANGE II PLUS multicenter randomized controlled trial
- Author
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Fichtinger, R.S., Aldrighetti, L., Troisi, R., Abu Hilal, M., Sutcliffe, R., Besselink, M., Aroori, S., Menon, K., Edwin, B., D'Hondt, M., Lucidi, V., Ulmer, F., Díaz-Nieto, R., Ratti, F., Kümmerli, C., Brandts, L., Pugh, S., Eminton, Z., Primrose, J., and van Dam, R.
- Published
- 2021
- Full Text
- View/download PDF
21. First Analysis of d-ALPPS, a Safe Alternative to ALPPS
- Author
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Kron, P.D., Linecker, M., Kümmerli, C., Mueller, P., Nana, G., Petrowsky, H., Clavien, P.-A., and Lodge, P.
- Published
- 2021
- Full Text
- View/download PDF
22. Enterothorax After Hepatic Surgery: A Single-Center Experience
- Author
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Manzini, G., primary, Kuemmerli, C., additional, Reiner, C. S., additional, Petrowsky, H., additional, and Gutschow, C. A., additional
- Published
- 2018
- Full Text
- View/download PDF
23. Machine learning based texture analysis predicts postoperative pancreatic fistula in preoperative non-contrast enhanced computed tomography
- Author
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Kambakamba, P., Mannil, M., Herrera, P., Linecker, M., Müller, P., Kümmerli, C., Petrowsky, H., Alkadhi, H., and Clavien, P.A.
- Published
- 2020
- Full Text
- View/download PDF
24. Bile leak and recurrence rate after pericystectomy using a water-jet device
- Author
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Kümmerli, C., Oberkofler, C., Tschuor, C., Sanchez Velazquez, P., Petrowsky, H., Clavien, P.-A., and Horisberger, K.
- Published
- 2018
- Full Text
- View/download PDF
25. BJS commission on surgery and perioperative care post-COVID-19
- Author
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E. Abahuje, A. Abbas, M. Abd El Aziz Abd El Maksoud, A. Abdelhady, S. Abdelhamid, H. Abdelkarem Ahmed Faraj, B. Abdelqader, T. Abdelrahman, H. Abdou, A. Abdullah, M. Abedua Harrison, E. Abem Owusu, A. Aboalazayem, R. Aboulhosn, S. Abu Oda, A. Abubakar, A. Abutaka, D. Acevedo Fontalvo, S. Acuna, A. Adefemi, S. Adegbola, T. Adenuga, A. Adeyeye, A. Adil Hilmi, A. Adisa, K. Aditya, T. Adjeso, R. Aftab, A. Afzal, V. Aggarwal, A. Aggarwal, R. Aguilera, M. -L. Aguilera-Are´valo, E. J. Aguirre Salamanca, I. Aguirre-Allende, D. Ahari, H. Ahmad, F. Ahmad Rauf, A. Ahmad Zartasht Khan, S. Ahmed, N. Ahmed Fieturi, S. Ahmed Mohamed, Z. Ahmed-Bakhsh, M. Ahsan Javed, L. Akano, A. Akbar, M. Akhbari, P. Akhmedov, G. Aksit, Y. Akula, A. S. Alagaratnam, S. Al Majid, O. Al Mukhtar, H. Al Omran, N. AlAsali, M. Al-Azzawi, R. Al-Habsi, H. Al-Iraqi, H. Al-Naggar, E. Alameer, H. Albirnawi, D. Alderson, F. Aldulaijan, R. Alejandro Miranda Ojeda, A. AlHasan, S. Ali, A. Ali, M. Ali Khan, Y. Alimova, F. Aljanadi, R. Aljubure, N. Allopi, H. Almedbal, M. Almubarak, Z. Alqaidoom, N. Alselaim, M. Alshaar, R. Alshammari, K. Altaf, S. Altıner, B. Altunpak, L. A. Alvarez Lozada, E. Amal Nahal, A. Amer, K. Amin, U. Aminu, N. Amisi Numbi, T. Amjad, R. Amoah, Y. An, N. -A. Anastasopoulos, J. Andre´s Urrutia, F. Angarita, K. -L. Angarita, M. A´ ngel FreirI´a Eiras, A. Antypas, M. A. Anwar, H. Anwar, T. O. Apampa, K. Apostolou, C. Aquina, R. Arachchige Adithi Himika Randeni, M. I. Archila Godı´nez, O. Arez, A. A. Arezzo, P. Armonis, S. Arshad, M. Arshad Salman, A. Arshid, P. C. Arteaga Asensio, T. Arthur, A. Arumuga Jothi, F. Aryo Damara, L. Asensio Gomez, J. Ashcroft, S. Ashraf, A. Asif, M. Atif, M. Attaullah Khan, N. Avellaneda, S. Awad, M. Awadh, A. Axiaq, A. Ayad Mohammed Shuwayyah, D. Ayalew, E. Aytac, F. Azam, J. Azevedo, B. Azhar, J. Aziz, A. Aziz, A. Azzam, A. Baba Ndajiwo, M. Baig, D. Baker, F. Bakko, R. Balachandran, G. Balachandran, J. Balagizi Mudekereza, E. Balai, B. Balci, A. Balduzzi, A. Balhareth, S. Bandyopadhyay, D. Banerjee, D. Bangalore Mahalinga, B. Bankhead-Kendall, N. D. A. Bankole, V. Banwell, F. Baris Bengur, B. Baris Ozmen, M. Barnard, R. Barnett, J. A. Barreras Espinoza, A. Barrios, G. Bass, M. Bass, A. Bausys, A. Bavikatte, J. Bayram, M. Belousov, A. G. Berardi, A. Beamish, C. Beattie, F. Belia, V. Bellato, S. Bellikatti, S. Benjamens, C. Benlice, S. Bennedsgaard, S. Bennett, Z. Bentounsi, H. Bergenfeldt, A. Bergenfelz, M. Besselink, G. Bhandoria, E. Bhangu, M. Bhatia, M. T. Bhatti, Z. Bilgili, G. Bislenghi, C. Bisset, S. Biswas, J. Blake, R. Blanco, L. Boccalatte, R. Boden, C. Bojanic, M. Boland, P. Boland, E. Bollen, E. -A. Bonci, L. Boni, A. Booth, R. Booth, A. Borakati, G. E. Borunda Escudero, S. J. Bosco, P. Bostro¨ m, P. Botelho de Alencar Ferreira Cruz, K. Bouchagier, A. Bouhuwaish, M. Boutros, K. Boyce, C. Boyle, L. Bradshaw, A. Brandl, A. Brar, G. Brat, H. Brenkman, C. Brennan, C. Brines, A. Brookmyre, C. Brosnan, L. Brouwers, A. Brown, L. Brown, C. Brown, J. Brown, V. BS, M. Buksh, M. Bunani Emmanuel, D. Burbano, A. Burelli, A. Burke, J. Burke, N. Burlov, A. Burns, O. Burton, A. Butt, B. Buzra Ozkan, L. Cabrera Silva, E. Y. Caicedo, T. Calderbank, W. Cambridge, G. Campelo, O. Can Tatar, F. Carbone, F. Carrano, D. Casallas, D. Casanova Portoles, F. Casciani, I. Cassimjee, O. A. Castaneda Ramı´rez, V. Catala´ n, J. Caviedes, L. Cayetano, M. ~ Ceresoli, M. Chan, V. Chan, P. Chandrasinghe, S. Chapman, A. Chaturvedi, D. Chaudhry, H. Chaudry, H. W. Chen, A. Cheng, M. Chernykh, A. M. Cherrie, I. Cheruiyot, J. Cheung, C. Chia, J. Chica, N. Chinai, A. Chirwa, J. Chiwaligo, A. Choi, J. Choi, M. R. Chowdhury, E. Christopher, N. Christou, T. Chu, D. Chua, H. W. Chua, C. Chung, A. Cihat Yildirim, M. Cillo, S. Cioffi, H. Claireaux, S. Clermonts, R. Clifford, M. Climent, A. Clynch, R. -J. Coelen, E. Cola´ s-Ruiz, A. Collar, M. Collard, K. C. Conlon, T. Connelly, K. Connor, J. A. Cook, T. Correia de Sa´, N. Cos¸gun Acar, T. Costa, D. Couch, S. Cowper, B. Creavin, B. Crook, A. Curell, R. D’alessio, J. Dale, J. Damgaard Eriksen, I. Dario Martin Gonzalez, A. Darwish, M. Das, R. Das, K. Das, R. Dave, S. O. David, T. Davies, C. Davis, S. Davison, V. Davletshina, A. Dawidziuk, A. Dawson, M. de Andres Crespo, H. de Berker, P. de Dieu Ngo, E. Dekker, R. de la Caridad Espinosa Luis, B. de Lacy, N. Demartines, A. de Montserrat Medina Sifuentes, S. De Silva, C. del Rio, V. Delaune, A. Dell, I. Demirbas¸, S. Demirli Atici, M. Deniz Tepe, M. Derebey, G. Desai, M. Desai, S. Devarakonda, N. Deveras, G. Di Franco, M. Di Martino, F. Di Marzo, A´ . Dı´az, G. Diaz del Gobbo, C. DiazCastrillon, L. Dick, K. Dickinson, E. Diego, I. Dimasi, A. Ding, S. Dingemans, L. Dixon, B. Dixon, W. Doherty, D. Dooreemeah, C. Donohue, M. Dornseifer, F. Dossa, W. Dossou, T. Drake, I. Drami, G. Drevin, M. C. du Plessis, N. Dudi-Venkata, R. Dudley, S. Duffy, D. Duklas, B. -D. Dumbrava, F. Duygu Avlar, A. Dworzynska, W. Ebrahim, A. Ebrahim, E. 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Dongmo, A, Tamas, T, Tan, L, Tan, J, Tan, K, Tan, E, Tan Yong Hui, A, Tanase, A, Tariverdiev, A, Tasnem, A, Tatar, C, Tay, E, Tejedor, P, Tesfaye, G, Tetinou, F, Thorpe, C, Thyo, A, Tlelo Amastal, D, Tolani, M, Tolga Saracoglu, K, Tolgyes, T, Tong, J, Torrent Jansa, L, Toscano Igartua, S, Tovani Palone, M, Traff, H, Trevis, J, Tummers, W, Tur, A, Turchenko, I, Uche, V, Uddin, A, Udonsak, N, Ullah, M, Urbonas, T, Uwins, C, Uy Magadia, E, Uzair Qureshi, A, Uzun, K, Vadim, P, Valarche, G, Valdez Gonzalez, R, Vallee, M, Van Beek, D, Van Dalen, A, Van Den Hondel, D, Van Der Stok, E, Van Dorp, M, Van Oostendorp, S, Van Praag, E, Van Rees, J, Van Silfhout, L, Varga, Z, Varghese, S, Varghese, C, Varghese, J, Vasilica, A, Vasquez Ojeda, X, Vega, E, Vehler, S, Venchiarutti, R, Vengatesan, S, Venn, M, Verma, D, Vianey Partida Nava, G, Victoria, D, Vieira, P, Vilar Alvarez, M, Vinci, D, Viscasillas Pallas, G, Viswanath, M, Vivanco, J, Vizcaya Rodriguez, V, Vo, J, Volchanski, D, Voron, T, Voronovskyi, Y, Vu, J, Wadhwa, M, Wadhwa, S, Wagner, G, Wallace, M, Wang, Y, Wang, J, Wani, A, Wanigasooriya, K, Wanjara, S, Wanjiku, N, Warner, C, Wei Leow, T, Weiser, T, Weisters, M, Wellington, M, Wells, C, Wenzelberg, C, Wettstein, D, Wezel, A, Wheldon, L, Widmer, L, Wilson, M, Wigmore, S, Wijayaratne, T, Wijeyaratne, M, Wijnhoven, B, Wilkin, R, Williams, E, Willis, F, Winter, D, Wirsik, M, Wishah, B, Wong, G, Wong, W, Wong, K, Worku, D, Wright, E, Wright, J, Wroe Wright, O, Xenacki, S, Xia, W, Xu, W, Xu, Z, Yalcinkaya, A, Yang, W, Yang, P, Yanishev, A, Yanzon De La Torre, A, Yao, H, Yaqoob, E, Yen Ling Quake, S, Yeo, D, Yeom, B, Yershov, D, Yiasemidou, M, Yildiz, A, Yiu, A, Yoav, M, Yong, E, Yoshimura, R, Younis, M, Younis Ringshawl, Z, Youssef, M, Yue, Y, Yuen, S, Yuldashev, R, Yurttas, C, Yves, B, Zaborowski, A, Zackeri, R, Zafar, A, Zahra, W, Zaidi, A, Zainudin, S, Zakeri, R, Zamora, I, Zamora, A, Zawistowski, M, Zbikowska, G, Zegers, W, Zehra, S, Zeyra, A, Zhagniyev, Z, Zhukova, L, Zivanovic, M, Zmuc, J, Zope, M, Zubayraeva, A, Zucker, B, Aguilera-Arévalo, M -L, Aguirre Salamanca, E J, Al-Asali, N, Altıner, S, Alvarez Lozada, L A, Anastasopoulos, N -A, Andrés Urrutia, J, Angarita, K -L, Ángel FreirÍa Eiras, M, Anwar, M A, Apampa, T O, Archila Godínez, M I, Arteaga Asensio, P C, Bankole, N D A, Barreras Espinoza, J A, Bhatti, M T, Bonci, E -A, Borunda Escudero, G E, Bosco, S J, Boström, P, Botelho de Alencar Ferreira Cruz, P, Caicedo, E Y, Castañeda Ramírez, O A, Catalán, V, Chen, H W, Chowdhury, M R, Chua, H W, Coelen, R -J, Colás-Ruiz, E, Correia de Sá, T, Coşgun Acar, N, D’Alessio, R, David, S O, de Andres Crespo, M, de Berker, H, de Dieu Ngo, P, de la Caridad Espinosa Luis, R, de Lacy, B, de Montserrat Medina Sifuentes, A, del Rio, C, Demirbaş, I, Díaz, Á, Diaz del Gobbo, G, Diaz-Castrillon, C, du Plessis, M C, Dumbrava, B -D, Efrén Lozada Hernández, E, Fernández Alberti, J, Forero, M P, Fredriksson, Å, Fülöp, A, Gatan, R G, Gortázar, S, Gregório, L, Grüter, A, Gülçek, E, Hafeez Bhatti, A B, Hoh, S M, Hölmich, E, Hüttner, F, Alhasan, A J M S, Perez Rivera, C J, Jácome, F, Jariod-Ferrer, Ú, José, J, José Núñez Ju, J, José Pizarro, M, Khan, M F, Kırımtay, B, Kmezić, S, Koëter, T, König, D, Leyva Moraga, F A, Li, H L, Londoño, M A, Lopes de Freitas, R, López, A I, Mafla Herrería, C A, Manzano Nuñez, R, Marín, D, Martín Martín, G, Masior, Ł, Möckli, B, Mohamed, H M, Mohammad, S A, Mohammed, T O, Montcusí Ventura, B, Mora-Guzmán, I, Morán, R A R, Morera, Á, Moss, J -L, Moyón, M, Müller, P, Muñoz, F, Muñoz, E, Muñoz, A, Muñoz Balderas, D C, Ng, C E, Fhearaigh, R N, Nikolousakis, T -K, Kristensen, H Ø, O’Brien, L, O’Brien, S, O’Reilly, J, O’Rourke, S, O’Sullivan, M, O’Dwyer, M, Oh, K E, Öhlberger, L, Ölçüm, M, Oscullo Yepez, J J, Osei-kuffour, N, Ottlakán, A, Pavan Kumar, O M, Peña Gallardo, M T, Peña Velazquez, A, Pérez-Sánchez, L E, Pompeu Sá, M, Ponniah, H S, Ponte de Sousa, X, Portilla, A L, Pulido Segura, J A, Quimbaya Rodríguez, A S, Racoviţă, A, Rahiri, J -L, Rey Chaves, C E, Roalsø, M, Rodríguez, F, Rodriguez, M C, Ruiz-Úcar, E, Rutegård, M, Sá-Marta, E, Sam, Z H, Emile, Sameh H, Sánchez Fonseca, S, Sgrò, A, Sia, T C, Smart, Y W, Sneep-van Kessel, C, Solórzano Pineda, O, Stephen, B -J, Takoutsing Dongmo, A B, Tamás, T, Tan, J L, Thyø, A, Tölgyes, T, Torrent Jansà, L, Tovani Palone, M R, Valdez Gonzalez, R A, van Beek, D -J, van Dalen, A S, van den Hondel, D, van der stok, E, van Dorp, M, van Oostendorp, S, van Praag, E, van Rees, J, van Silfhout, L, Vasilica, A -M, Vásquez Ojeda, X, Vilar Alvarez, M E, Viscasillas Pallàs, G, Vizcaya Rodríguez, V, Wang, Y Y, Wellington, M J, Wirsik, M M, Wong, W J, Wong, K -Y, Wright, O Wroe, Yang, P -C, Yanzon de la Torre, A, Younis, M U, Zamora, A T, and Surgery
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Adult ,Male ,medicine.medical_specialty ,Biomedical Research ,Coronavirus disease 2019 (COVID-19) ,International Cooperation ,Practice Patterns ,Commission ,Global Health ,Health Services Accessibility ,Perioperative Care ,Education ,Surgeon ,COVID-19 ,surgery ,perioperative care ,Medical ,Pandemic ,Humans ,Medicine ,Practice Patterns, Physicians' ,Graduate ,Pandemics ,Surgeons ,Health Resource ,Infection Control ,Physicians' ,Surgical Procedures ,business.industry ,General surgery ,Middle Aged ,Operative ,Education, Medical, Graduate ,Surgical Procedures, Operative ,Perioperative care ,Health Resources ,Surgery ,Female ,business ,Human - Abstract
Background Coronavirus disease 2019 (COVID-19) was declared a pandemic by the WHO on 11 March 2020 and global surgical practice was compromised. This Commission aimed to document and reflect on the changes seen in the surgical environment during the pandemic, by reviewing colleagues’ experiences and published evidence. Methods In late 2020, BJS contacted colleagues across the global surgical community and asked them to describe how severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) had affected their practice. In addition to this, the Commission undertook a literature review on the impact of COVID-19 on surgery and perioperative care. A thematic analysis was performed to identify the issues most frequently encountered by the correspondents, as well as the solutions and ideas suggested to address them. Results BJS received communications for this Commission from leading clinicians and academics across a variety of surgical specialties in every inhabited continent. The responses from all over the world provided insights into multiple facets of surgical practice from a governmental level to individual clinical practice and training. Conclusion The COVID-19 pandemic has uncovered a variety of problems in healthcare systems, including negative impacts on surgical practice. Global surgical multidisciplinary teams are working collaboratively to address research questions about the future of surgery in the post-COVID-19 era. The COVID-19 pandemic is severely damaging surgical training. The establishment of a multidisciplinary ethics committee should be encouraged at all surgical oncology centres. Innovative leadership and collaboration is vital in the post-COVID-19 era.
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- 2021
26. Laparoscopic versus open resections in the posterosuperior liver segments within an enhanced recovery programme (ORANGE Segments): study protocol for a multicentre randomised controlled trial
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Christoph, Kuemmerli, Robert S, Fichtinger, Alma, Moekotte, Luca A, Aldrighetti, Somaiah, Aroori, Marc G H, Besselink, Mathieu, D'Hondt, Rafael, Díaz-Nieto, Bjørn, Edwin, Mikhail, Efanov, Giuseppe M, Ettorre, Krishna V, Menon, Aali J, Sheen, Zahir, Soonawalla, Robert, Sutcliffe, Roberto I, Troisi, Steven A, White, Lloyd, Brandts, Gerard J P, van Breukelen, Jasper, Sijberden, Siân A, Pugh, Zina, Eminton, John N, Primrose, Ronald, van Dam, Mohammed Abu, Hilal, Surgery, CCA - Cancer Treatment and Quality of Life, AGEM - Amsterdam Gastroenterology Endocrinology Metabolism, RS: NUTRIM - R2 - Liver and digestive health, MUMC+: KIO Kemta (9), RS: GROW - R1 - Prevention, RS: CAPHRI - R1 - Ageing and Long-Term Care, RS: CAPHRI - R6 - Promoting Health & Personalised Care, FPN Methodologie & Statistiek, FHML Methodologie & Statistiek, RS: FPN M&S I, RS: GROW - R3 - Innovative Cancer Diagnostics & Therapy, MUMC+: MA Heelkunde (9), Kuemmerli, C., Fichtinger, R. S., Moekotte, A., Aldrighetti, L. A., Aroori, S., Besselink, M. G. H., D'Hondt, M., Diaz-Nieto, R., Edwin, B., Efanov, M., Ettorre, G. M., Menon, K. V., Sheen, A. J., Soonawalla, Z., Sutcliffe, R., Troisi, R., White, S. A., Brandts, L., van Breukelen, G. J. P., Sijberden, J., Pugh, S. A., Eminton, Z., Primrose, J. N., van Dam, R., Hilal, M. A., Kuemmerli, Christoph, Fichtinger, Robert S, Moekotte, Alma, Aldrighetti, Luca A, Aroori, Somaiah, Besselink, Marc G H, D'Hondt, Mathieu, Díaz-Nieto, Rafael, Edwin, Bjørn, Efanov, Mikhail, Ettorre, Giuseppe M, Menon, Krishna V, Sheen, Aali J, Soonawalla, Zahir, Sutcliffe, Robert, Troisi, Roberto I, White, Steven A, Brandts, Lloyd, van Breukelen, Gerard J P, Sijberden, Jasper, Pugh, Siân A, Eminton, Zina, Primrose, John N, van Dam, Ronald, and Hilal, Mohammed Abu
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CLINICAL-OUTCOMES ,SURGERY ,Medicine (miscellaneous) ,BODY-IMAGE ,Hepatectomy/adverse effects ,Liver Neoplasms/surgery ,PROGNOSTIC-FACTORS ,QUALITY-OF-LIFE ,HEPATOCELLULAR-CARCINOMA ,Hepatectomy ,Humans ,Multicenter Studies as Topic ,Pharmacology (medical) ,Liver surgery ,Enhanced recovery ,Randomized Controlled Trials as Topic ,Randomised controlled trial ,Liver Neoplasms ,SEVERITY GRADING SYSTEM ,PARENCHYMAL-SPARING RESECTIONS ,Length of Stay ,Posterosuperior segments ,Posterosuperior segment ,METASTASES ,Treatment Outcome ,Laparoscopy/adverse effects ,DIFFICULTY ,Quality of Life ,Laparoscopy ,Human - Abstract
Background A shift towards parenchymal-sparing liver resections in open and laparoscopic surgery emerged in the last few years. Laparoscopic liver resection is technically feasible and safe, and consensus guidelines acknowledge the laparoscopic approach in the posterosuperior segments. Lesions situated in these segments are considered the most challenging for the laparoscopic approach. The aim of this trial is to compare the postoperative time to functional recovery, complications, oncological safety, quality of life, survival and costs after laparoscopic versus open parenchymal-sparing liver resections in the posterosuperior liver segments within an enhanced recovery setting. Methods The ORANGE Segments trial is an international multicentre randomised controlled superiority trial conducted in centres experienced in laparoscopic liver resection. Eligible patients for minor resections in the posterosuperior segments will be randomised in a 1:1 ratio to undergo laparoscopic or open resections in an enhanced recovery setting. Patients and ward personnel are blinded to the treatment allocation until postoperative day 4 using a large abdominal dressing. The primary endpoint is time to functional recovery. Secondary endpoints include intraoperative outcomes, length of stay, resection margin, postoperative complications, 90-day mortality, time to adjuvant chemotherapy initiation, quality of life and overall survival. Laparoscopic liver surgery of the posterosuperior segments is hypothesised to reduce time to functional recovery by 2 days in comparison with open surgery. With a power of 80% and alpha of 0.04 to adjust for interim analysis halfway the trial, a total of 250 patients are required to be randomised. Discussion The ORANGE Segments trial is the first multicentre international randomised controlled study to compare short- and long-term surgical and oncological outcomes of laparoscopic and open resections in the posterosuperior segments within an enhanced recovery programme. Trial registration ClinicalTrials.gov NCT03270917. Registered on September 1, 2017. Before start of inclusion. Protocol version: version 12, May 9, 2017
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- 2021
27. First Long-term Oncologic Results of the ALPPS Procedure in a Large Cohort of Patients With Colorectal Liver Metastases
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Carlos Castro-Benitez, Roberto Brusadin, Jun Li, Martin Teutsch, Luca Aldrighetti, Patryk Kambakamba, Jan Bednarsch, Arianeb Mehrabi, Mauro E Tun Abraham, Marcus N. Scherer, François-René Pruvot, Roberto Hernandez-Alejandro, Eduardo Fernandes, Christoph Kuemmerli, Emir Hoti, Onur Elvan Kirimker, Federico Tomassini, Tim Reese, Francesca Ratti, Pim B. Olthof, Stéphanie Truant, Ivan Capobianco, Roberto Troisi, Mohammad-Hossein Fard-Aghaie, Henrik Petrowsky, Victor Lopez-Lopez, Philipp Kron, Pierre-Alain Clavien, Hans J. Schlitt, Ricardo Robles-Campos, Omid Ghamarnejad, Silvio Nadalin, Thomas M. van Gulik, René Adam, Deniz Balci, Marcel Autran C. Machado, Peter Lodge, Ralph Fritsch, Dimitri A. Raptis, Sergey Voskanyan, Georg Lurje, Karl J. Oldhafer, Massimo Malagó, Michael Linecker, Eduardo de Santibañes, Victoria Ardiles, Petrowsky, H., Linecker, M., Raptis, D. A., Kuemmerli, C., Fritsch, R., Kirimker, O. E., Balci, D., Ratti, F., Aldrighetti, L., Voskanyan, S., Tomassini, F., Troisi, R., Bednarsch, J., Lurje, G., Fard-Aghaie, M. -H., Reese, T., Oldhafer, K. J., Ghamarnejad, O., Mehrabi, A., Abraham, M. E. T., Truant, S., Pruvot, F. -R., Hoti, E., Kambakamba, P., Capobianco, I., Nadalin, S., Fernandes, E. S. M., Kron, P., Lodge, P., Olthof, P. B., van Gulik, T., Castro-Benitez, C., Adam, R., Machado, M. A., Teutsch, M., Li, J., Scherer, M. N., Schlitt, H. J., Ardiles, V., de Santibanes, E., Brusadin, R., Lopez-Lopez, V., Robles-Campos, R., Malago, M., Hernandez-Alejandro, R., and Clavien, P. -A.
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Male ,medicine.medical_specialty ,Multivariate analysis ,medicine.medical_treatment ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,Postoperative Complications ,Randomized controlled trial ,law ,Risk Factors ,medicine ,Hepatectomy ,Humans ,Registries ,Survival analysis ,Aged ,business.industry ,Liver Neoplasms ,Perioperative ,Middle Aged ,Survival Analysis ,Confidence interval ,Surgery ,Response Evaluation Criteria in Solid Tumors ,030220 oncology & carcinogenesis ,Cohort ,030211 gastroenterology & hepatology ,Female ,business ,Colorectal Neoplasms - Abstract
Objectives: To analyze long-term oncological outcome along with prognostic risk factors in a large cohort of patients with colorectal liver metastases (CRLM) undergoing ALPPS. Background: ALPPS is a two-stage hepatectomy variant that increases resection rates and R0 resection rates in patients with primarily unresectable CRLM as evidenced in a recent randomized controlled trial. Long-term oncologic results, however, are lacking. Methods: Cases in- and outside the International ALPPS Registry were collected and completed by direct contacts to ALPPS centers to secure a comprehensive cohort. Overall, cancer-specific (CSS), and recurrence-free (RFS) survivals were analyzed along with independent risk factors using Cox-regression analysis. Results: The cohort included 510 patients from 22 ALPPS centers over a 10-year period. Ninety-day mortality was 4.9% and median overall survival, CSS, and RFS were 39, 42, and 15 months, respectively. The median follow-up time was 38 months (95% confidence interval 32-43 months). Multivariate analysis identified tumor-characteristics (primary T4, right colon), biological features (K/N-RAS status), and response to chemotherapy (Response Evaluation Criteria in Solid Tumors) as independent predictors of CSS. Traditional factors such as size of metastases, uni versus bilobar involvement, and liver-first approach were not predictive. When hepatic recurrences after ALPPS was amenable to surgical/ablative treatment, median CSS was significantly superior compared to chemotherapy alone (56 vs 30 months, P < 0.001). Conclusions: This large cohort provides the first evidence that patients with primarily unresectable CRLM treated by ALPPS have not only low perioperative mortality, but achieve appealing long-term oncologic outcome especially those with favorable tumor biology and good response to chemotherapy.
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- 2020
28. Competency, Proficiency, and Mastery: Learning Curves for Robotic Distal Pancreatectomy at 16 International Expert Centers.
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Müller PC, Kuemmerli C, Billeter AT, Shen B, Jin J, Nickel F, Guidetti C, Kauffmann E, Purchla J, Tschuor C, Krohn PS, Burgdorf SK, Jonas JP, Bussmann FJ, Saint-Marc O, Iben-Khayat A, Andel PCM, Molenaar IQ, Wellner U, Keck T, Moeckli B, Toso C, Di Benedetto F, Valle V, Giulianotti P, Roulin D, Martinie JB, Rama M, Lavu H, Yeo C, Mavani PT, Shah MM, Kooby DA, He J, Boggi U, Hackert T, Borel-Rinkes IHM, Müller BP, and Clavien PA
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Objective: The aim of this study was to evaluate the different phases of the learning curve for robotic distal pancreatectomy (RDP) in international expert centers., Summary Background Data: RDP is an emerging minimally invasive approach; however, only limited, mostly single center data are available on its safe implementation, including the learning curve., Methods: Consecutive patients undergoing elective RDP from 16 expert centers across three continents were included to assess the learning curve. Based on the first 100 RDPs at each center, three cutoffs were used to define the learning curve: operative time for competency, major complications (Clavien-Dindo grade ≥III) for proficiency, and textbook outcome for mastery. Clinical outcomes before and after the cutoffs were compared., Results: The learning curve analysis was conducted on 1109 of 2403 RDPs. Competency, proficiency, and mastery, respectively, were reached after 46, 63, and 73 RDP procedures. After competency, operative time decreased from 245 to 235 minutes (P=0.002). Attaining proficiency was reflected by a reduction in the rate of major complications from 20% to 15% (P=0.012), and mastery was associated with a higher proportion of patients with textbook outcome (71% vs. 63%; P=0.028). The postoperative pancreatic fistula rate remained stable along the learning curve, ranging between 18.5% and 21.5%. Previous laparoscopic experience accelerated the learning process by virtue of reduced operative time and an earlier decrease in major complications., Conclusion: Competency, proficiency, and mastery for RDP were reached after 46, 63, and 73 procedures, respectively, at international expert centers. The findings highlight that the learning curves for intraoperative parameters are completed earlier; however, extensive experience is needed to master RDP., Competing Interests: Conflict of interest: The authors declare that they have no conflict of interest. Conflict of interest: The authors declare that no conflict of interest exists. No grants and financial support were received for this study., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)
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- 2024
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29. Experience-based transition to robotic surgery in an experienced program in minimally invasive hepatobiliary surgery.
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Lopez-Lopez V, Sánchez-Esquer I, Kuemmerli C, Brusadin R, López-Conesa A, Navarro Á, Pastor P, Iniesta M, Carrión-Retuerto LO, and Robles-Campos R
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Background: The adoption of robotic techniques in liver surgery introduces significant challenges for their safe integration within hepatobiliary surgery units. This study is designed to investigate the complexities associated with establishing a robotic surgery program., Methods: Data on robotic hepatobiliary surgeries were prospectively collected from October 2021 to October 2023. Historical cohorts from the institutional experiences for comparison were hand-assisted (HALS) and purely laparoscopic procedures (PLS). Inverse probability of treatment weighting and propensity score matching were employed to compare outcomes between PLS and robotic resections. The learning curve for robotic surgeries was evaluated by the cumulative sum method., Results: In this study, 454 patients were enrolled (113 robotic surgeries, 157 HALS, and 184 PLS). The posterosuperior segments resections were significantly higher in the robotic group (47.8%) compared to PLS (31.5%) and HALS (35.7%). There were no conversions in the robotic group, in PLS 2.7% and HALS 3.8%. The degree of difficulty according to the median of the IWATE score and IMM score was significantly higher in the robot group (p < 0.001 and p = 0.008, respectively). No significant differences in short-term outcomes were observed between robotic procedures and PLS in a matched subset of patients. Operative efficiency and blood loss improved significantly after the 75th robotic surgery patient, with high-difficulty cases (IWATE ≥ 10) incorporated from the beginning., Conclusion: This study suggests that robotic liver surgery in units with prior experience in minimally invasive liver surgery offers benefits, such as a lower conversion rate and a higher rate of successful difficult resections., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)
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- 2024
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30. Is prolonged operative time associated with postoperative complications in liver surgery? An international multicentre cohort study of 5424 patients.
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Kuemmerli C, Sijberden JP, Cipriani F, Osei-Bordom D, Aghayan D, Lanari J, de Meyere C, Cacciaguerra AB, Rotellar F, Fuks D, Liu R, Besselink MG, Zimmitti G, Ruzzenente A, di Benedetto F, Succandy I, Efanov M, Memeo R, Jovine E, Vrochides D, Dagher I, Croner R, Lopez-Ben S, Geller D, Ahmad J, Gallagher T, White S, Alseidi A, Goh BKP, Sparrelid E, Ratti F, Marudanayagam R, Fretland ÅA, Vivarelli M, D'Hondt M, Cillo U, Edwin B, Sutcliffe RP, Aldrighetti LA, and Hilal MA
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Background: The relation between operative time and postoperative complications in liver surgery is unclear. The aim of this study is to assess the impact of operative time on the development of postoperative complications in patients who underwent minimally invasive or open liver resections of various anatomical extent and technical difficulty levels., Methods: In this retrospective cohort study, patients that underwent a right hemihepatectomy (RH), technically major resection (anatomically minor resection in segment 1, 4a, 7 or 8; TMR) or left lateral sectionectomy (LLS) between 2000 and 2022 were extracted from a multicenter database comprising the prospectively maintained databases of 31 centers in 13 countries. Minimally invasive procedures performed during the learning curve were omitted. Logistic regression models, performed separately for 9 different groups based on stratification by procedure type and allocated surgical approach, were used to assess the association between the fourth quartile of operative time (25% of patients with the longest operative time) and postoperative complications., Results: Overall, 5424 patients were included: 1351 underwent RH (865 open, 373 laparoscopic and 113 robotic), 2821 TMR (1398 open, 1225 laparoscopic and 198 robotic), and 1252 LLS (241 open, 822 laparoscopic and 189 robotic). After adjusting for potential confounders (age, BMI, gender, ASA grade, previous abdominal surgery, disease type and extent, blood loss, Pringle, intraoperative transfusions and incidents), the fourth quartile of operative time, compared to the first three quartiles, was associated with an increased risk of postoperative complications after open, laparoscopic and robotic TMR (aOR 1.35, p = 0.031; aOR 1.74, p = 0.001 and aOR 3.11, p = 0.014, respectively), laparoscopic and robotic RH (aOR 1.98, p = 0.018 and aOR 3.28, p = 0.055, respectively) and solely laparoscopic LLS (aOR 1.69, p = 0.019)., Conclusions: A prolonged operative time is associated with an increased risk of postoperative complications, although it remains to be defined if this is a causal relationship., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)
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- 2024
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31. Are You in the State of Mind for Multistate Models?
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Meuli L and Kuemmerli C
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- 2024
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32. Defining non-inferiority margins in randomised controlled surgical trials: a protocol for a systematic review.
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Kuemmerli C, Gallagher IJ, Skipworth R, and Laird B
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- Humans, Abdomen surgery, Systematic Reviews as Topic, Equivalence Trials as Topic, Research Design standards
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Background: The reporting of randomised controlled non-inferiority (NI) drug trials is poor with less than 50% of published trials reporting a justification of the NI margin. This is despite the introduction of the Consolidated Standards of Reporting Trials (CONSORT) extension on reporting of NI and equivalence in randomised trials. It is critical to set the appropriate NI margin as this choice dictates the conclusions of the trial. Methods to estimate the margin are heterogeneous but generally based on clinical judgement and statistical reasoning, and hence tailored to each clinical situation. Yet an appraisal of NI in clinical trials has not been undertaken. Therefore the aim of this systematic review is to assess the reporting and methodological quality of defining the NI margin. Surgical NI trials have been chosen as our prototype to assess this., Methods: We will conduct a systematic review of published randomised controlled trials in abdominal surgery that use an NI design. Key eligibility criteria will be: surgical intervention in at least one trial arm; adult patients and a sample size of 100 or more. Ovid MEDLINE, EMBASE and the Cochrane Central Register of Controlled Trials will be searched from inception until the date of the search. Identified studies will be assessed for reporting according to the CONSORT recommendations. The outcomes are the description of the methods for defining the NI margin, and the robustness of the NI margin estimation. The latter will be based on simulations using alternative assumptions for model parameters. The results of the simulation will be compared with the trial authors' conclusions., Anticipated Results: The review will describe and appraise the design and reporting of surgical NI trials including shortcomings thereof and allow a comparison with pharmaceutical trials. These findings will inform researchers on the appropriate design and pitfalls when conducting surgical randomised controlled trials with an NI design and promote thorough and standardised reporting of study findings., Ethics and Dissemination: Ethical approval is not required and any changes to the protocol will be communicated via the registration platform. The final manuscript will be submitted to a journal for publication and the findings will be disseminated through conference presentations to inform researchers and the public., 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.)
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- 2024
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33. Efficacy of Self-Expandable Absorbable Stents during Liver Transplant to Minimize Early Biliary Complications.
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Lopez-Lopez V, Kuemmerli C, Iniesta M, Hiciano-Guillermo A, Cascales-Campos P, Baroja-Mazo A, Antonio-Pons J, Sánchez-Esquer I, Ferreras D, Sánchez-Bueno F, Ramírez P, and Robles-Campos R
- Abstract
Objective: We analyzed the use of a self-expandable absorbable biliary stent (SEABS) to reduce biliary complications in liver transplant (LT)., Background: Complications related to biliary anastomosis are a still a challenge in LT with a high impact on the patient outcomes and hospital costs., Methods: This non-randomized prospective study was conducted between July 2019 and September 2023 in adult LT patients with duct-to-duct biliary anastomoses. The primary endpoint was to assess early biliary complications at 90 days in LT patients with intraoperative SEABS versus no SEABS. We also compared overall biliary complications, costs and SEABS- adverse effects related., Results: A total of 158 patients were included, 78 with SEABS and 80 no-SEABS (22 T-tube and 58 no-stent). There were no adverse effects related to SEABS. Early biliary complications (23.8 vs 2.6%, P <0.001) and hospital stay (19 vs 15 days, P= 0.001) were higher in no-SEABS. No-SEABS group required 63 ERCPs and 13 surgeries (including 2 LT) versus 35 ERCPs and 2 surgeries in SEABS group. After PSM between SEABS (n=58) vs no-SEABS (n=58), early biliary complications (40% vs 0%, P<.001) were higher in no-SEABS group. T-tube had more early biliary complications (22.7% vs 5%, P=0.23) compared SEABS high-risk biliary anastomosis. SEABS excess cost per patient was lower compared to T-Tube and no-stent (6.988€ vs 17.992€ vs 36.364€, P=0.036 and P=0.002, respectively)., Conclusions: SEABS during biliary anastomosis in LT is feasible with no adverse effects and avoid the T-tube in high-risk biliary anastomoses. It use has been associated with less early biliary complications, hospital costs and reoperations or interventional treatments for biliary complications resolution., Competing Interests: Authors declare no conflict of interest., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)
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- 2024
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34. The Risk of Competing Risks in Time to Event Analysis.
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Birrer DL, Kuemmerli C, and Meuli L
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- 2024
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35. Towards a Standardization of Learning Curve Assessment in Minimally Invasive Liver Surgery.
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Kuemmerli C, Toti JMA, Haak F, Billeter AT, Nickel F, Guidetti C, Santibanes M, Vigano L, Lavanchy JL, Kollmar O, Seehofer D, Abu Hilal M, Di Benedetto F, Clavien PA, Dutkowski P, Müller BP, and Müller PC
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Objective: The aim was to analyze the learning curves of minimal invasive liver surgery(MILS) and propose a standardized reporting., Summary Background Data: MILS offers benefits compared to open resections. For a safe introduction along the learning curve, formal training is recommended. However, definitions of learning curves and methods to assess it lack standardization., Methods: A systematic review of PubMed, Web of Science, and CENTRAL databases identified studies on learning curves in MILS. The primary outcome was the number needed to overcome the learning curve. Secondary outcomes included endpoints defining learning curves, and characterization of different learning phases(competency, proficiency and mastery)., Results: 60 articles with 12'241 patients and 102 learning curve analyses were included. The laparoscopic and robotic approach was evaluated in 71 and 18 analyses and both approaches combined in 13 analyses. Sixty-one analyses (60%) based the learning curve on statistical calculations. The most often used parameters to define learning curves were operative time (n=64), blood loss (n=54), conversion (n=42) and postoperative complications (n=38). Overall competency, proficiency and mastery were reached after 34 (IQR 19-56), 50 (IQR 24-74), 58 (IQR 24-100) procedures respectively. Intraoperative parameters improved earlier (operative time: competency to proficiency to mastery: -13%, 2%; blood loss: competency to proficiency to mastery: -33%, 0%; conversion rate (competency to proficiency to mastery; -21%, -29%), whereas postoperative complications improved later (competency to proficiency to mastery: -25%, -41%)., Conclusions: This review summarizes the highest evidence on learning curves in MILS taking into account different definitions and confounding factors. A standardized three-phase reporting of learning phases (competency, proficiency, mastery) is proposed and should be followed., Competing Interests: Compliance with Ethical Standards: Conflict of interest: The authors declare that they have no conflict of interest. Conflict of interest: The authors declare no conflict of interest. No grants and financial support were received for this study., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)
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- 2024
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36. The PLET (Portable Laparoscopic Endo-Trainer) study: a randomized controlled trial of home- versus hospital-based surgical training.
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Kuemmerli C, Linke K, Daume D, Germann N, Peterli R, Müller-Stich B, and Klasen JM
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- Humans, Female, Male, Switzerland, Adult, COVID-19, Laparoscopy education, Clinical Competence, Internship and Residency
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Purpose: The purpose of this study was to assess the effect of training with a personal, portable laparoscopic endo-trainer (PLET) on residents' laparoscopic skills., Methods: The study took place at a tertiary-care academic university hospital in Switzerland. All participants were randomized to either a home- or hospital-based PLET training group, and surgical skill performance was assessed using five laparoscopic exercises. 24 surgical residents, 13 females and 11 males, were enrolled at any training stage. Nine residents completed the assessments. Endpoints consisted of subjective and objective assessment ratings as well as exercise time and qualitative data up to 12 weeks. The primary outcome was the difference in exercise time and secondary outcomes included performance scores as well as qualitative data., Results: The hospital-based training group performed exercises number 1, 3 and 4 faster at 12 weeks than at baseline (p = .003, < 0.001 and 0.024). Surgical skill performance was not statistically significantly different in any of the endpoints between the hospital- and home-based training groups at 12 weeks. Both the subjective and objective assessment ratings significantly improved in the hospital-based training group between baseline and 12 weeks (p = .006 and 0.003, respectively). There was no statistically significant improvement in exercise time as well as subjective and objective assessment ratings over time in the home-based training group. The qualitative data suggested that participants who were randomized to the hospital-based training group wished to have the PLET at home and vice versa. Several participants across groups lacked motivation because of their workload or time constraints, though most believed the COVID-19 pandemic had no influence on their motivation or the time they had for training., Conclusion: The PLET enhances laparoscopic surgical skills over time in a hospital-based training setting. In order to understand and optimize motivational factors, further research is needed., Trial Registration: This trial was retrospectively registered on clinicaltrials.gov (NCT06301230)., (© 2024. The Author(s).)
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- 2024
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37. Laparoscopic Versus Open Hemihepatectomy: The ORANGE II PLUS Multicenter Randomized Controlled Trial.
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Fichtinger RS, Aldrighetti LA, Abu Hilal M, Troisi RI, Sutcliffe RP, Besselink MG, Aroori S, Menon KV, Edwin B, D'Hondt M, Lucidi V, Ulmer TF, Díaz-Nieto R, Soonawalla Z, White S, Sergeant G, Olij B, Ratti F, Kuemmerli C, Scuderi V, Berrevoet F, Vanlander A, Marudanayagam R, Tanis P, Dewulf MJL, Dejong CHC, Eminton Z, Kimman ML, Brandts L, Neumann UP, Fretland ÅA, Pugh SA, van Breukelen GJP, Primrose JN, and van Dam RM
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- Humans, Male, Female, Middle Aged, Aged, Postoperative Complications etiology, Postoperative Complications epidemiology, Adult, Treatment Outcome, Hepatectomy methods, Hepatectomy adverse effects, Laparoscopy adverse effects, Laparoscopy methods, Liver Neoplasms surgery, Liver Neoplasms secondary, Quality of Life
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Purpose: To compare outcomes after laparoscopic versus open major liver resection (hemihepatectomy) mainly for primary or metastatic cancer. The primary outcome measure was time to functional recovery. Secondary outcomes included morbidity, quality of life (QoL), and for those with cancer, resection margin status and time to adjuvant systemic therapy., Patients and Methods: This was a multicenter, randomized controlled, patient-blinded, superiority trial on adult patients undergoing hemihepatectomy. Patients were recruited from 16 hospitals in Europe between November 2013 and December 2018., Results: Of the 352 randomly assigned patients, 332 patients (94.3%) underwent surgery (laparoscopic, n = 166 and open, n = 166) and comprised the analysis population. The median time to functional recovery was 4 days (IQR, 3-5; range, 1-30) for laparoscopic hemihepatectomy versus 5 days (IQR, 4-6; range, 1-33) for open hemihepatectomy (difference, -17.5% [96% CI, -25.6 to -8.4]; P < .001). There was no difference in major complications (laparoscopic 24/166 [14.5%] v open 28/166 [16.9%]; odds ratio [OR], 0.84; P = .58). Regarding QoL, both global health status (difference, 3.2 points; P < .001) and body image (difference, 0.9 points; P < .001) scored significantly higher in the laparoscopic group. For the 281 (84.6%) patients with cancer, R0 resection margin status was similar (laparoscopic 106 [77.9%] v open 122 patients [84.1%], OR, 0.60; P = .14) with a shorter time to adjuvant systemic therapy in the laparoscopic group (46.5 days v 62.8 days, hazard ratio, 2.20; P = .009)., Conclusion: Among patients undergoing hemihepatectomy, the laparoscopic approach resulted in a shorter time to functional recovery compared with open surgery. In addition, it was associated with a better QoL, and in patients with cancer, a shorter time to adjuvant systemic therapy with no adverse impact on cancer outcomes observed.
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- 2024
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38. Textbook outcome in patients with biliary duct injury during cholecystectomy.
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Lopez-Lopez V, Kuemmerli C, Maupoey J, López-Andujar R, Lladó L, Mils K, Müller P, Valdivieso A, Garcés-Albir M, Sabater L, Cacciaguerra AB, Vivarelli M, Valladares LD, Pérez SA, Flores B, Brusadin R, Conesa AL, Cortijo SM, Paterna S, Serrablo A, Toop FHW, Oldhafer K, Sánchez-Cabús S, Gil AG, Masía JAG, Loinaz C, Lucena JL, Pastor P, Garcia-Zamora C, Calero A, Valiente J, Minguillon A, Rotellar F, Alcazar C, Aguilo J, Cutillas J, Ruiperez-Valiente JA, Ramírez P, Petrowsky H, Ramia JM, and Robles-Campos R
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- Humans, Male, Female, Middle Aged, Aged, Retrospective Studies, Cholecystectomy adverse effects, Adult, Anastomosis, Surgical, Cholecystectomy, Laparoscopic adverse effects, Treatment Outcome, Postoperative Complications etiology, Postoperative Complications epidemiology, Conservative Treatment, Bile Ducts injuries, Bile Ducts surgery, Iatrogenic Disease, Intraoperative Complications etiology
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Background: Iatrogenic bile duct injury (BDI) during cholecystectomy is associated with a complex and heterogeneous management owing to the burden of morbidity until their definitive treatment. This study aimed to define the textbook outcomes (TOs) after BDI with the purpose to indicate the ideal treatment and to improve it management., Methods: We collected data from patients with an BDI between 1990 and 2022 from 27 hospitals. TO was defined as a successful conservative treatment of the iatrogenic BDI or only minor complications after BDI or patients in whom the first repair resolves the iatrogenic BDI without complications or with minor complications., Results: We included 808 patients and a total of 394 patients (46.9%) achieved TO. Overall complications in TO and non-TO groups were 11.9% and 86%, respectively (P < .001). Major complications and mortality in the non-TO group were 57.4% and 9.2%, respectively. The use of end-to-end bile duct anastomosis repair was higher in the non-TO group (23.1 vs 7.8, P < .001). Factors associated with achieving a TO were injury in a specialized center (adjusted odds ratio [aOR], 4.01; 95% CI, 2.68-5.99; P < .001), transfer for a first repair (aOR, 5.72; 95% CI, 3.51-9.34; P < .001), conservative management (aOR, 5.00; 95% CI, 1.63-15.36; P = .005), or surgical management (aOR, 2.45; 95% CI, 1.50-4.00; P < .001)., Conclusion: TO largely depends on where the BDI is managed and the type of injury. It allows hepatobiliary centers to identify domains of improvement of perioperative management of patients with BDI., (Copyright © 2024. Published by Elsevier Inc.)
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- 2024
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39. Are enhanced recovery protocols after pancreatoduodenectomy still efficient when applied in elderly patients? A systematic review and individual patient data meta-analysis.
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Kuemmerli C, Balzano G, Bouwense SA, Braga M, Coolsen M, Daniel SK, Dervenis C, Falconi M, Hwang DW, Kagedan DJ, Kim SC, Lavu H, Nussbaum D, Partelli S, Passeri MJ, Pecorelli N, Pillarisetty VG, Pucci MJ, Sutcliffe RP, Tingstedt B, van der Kolk M, Vrochides D, Armstrong M, Wei A, Williamsson C, Yeo CJ, Zani S, Zouros E, Rozzini R, and Abu Hilal M
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- Humans, Aged, Aged, 80 and over, Age Factors, Recovery of Function, Female, Male, Patient Readmission statistics & numerical data, Pancreaticoduodenectomy adverse effects, Enhanced Recovery After Surgery, Length of Stay statistics & numerical data, Postoperative Complications epidemiology
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Background: This meta-analysis investigated the effects of enhanced recovery after surgery (ERAS) protocols compared to conventional care on postoperative outcomes in patients aged 70 years or older undergoing pancreatoduodenectomy (PD)., Methods: Five databases were systematically searched. Comparative studies with available individual patient data (IPD) were included. The main outcomes were postoperative morbidity, length of stay, readmission and postoperative functional recovery elements. To assess an age-dependent effect, the group was divided in septuagenarians (70-79 years) and older patients (≥80 years)., Results: IPD were obtained from 15 of 31 eligible studies comprising 1109 patients. The overall complication and major complication rates were comparable in both groups (OR 0.92 [95% CI: 0.65-1.29], p = .596 and OR 1.22 [95% CI: 0.61-2.46], p = .508). Length of hospital stay tended to be shorter in the ERAS group compared to the conventional care group (-0.14 days [95% CI: -0.29 to 0.01], p = .071) while readmission rates were comparable and the total length of stay including days in hospital after readmission tended to be shorter in the ERAS group (-0.28 days [95% CI: -0.62 to 0.05], p = .069). In the subgroups, the length of stay was shorter in octogenarians treated with ERAS (-0.36 days [95% CI: -0.71 to -0.004], p = .048). The readmission rate increased slightly but not significantly while the total length of stay was not longer in the ERAS group., Conclusion: ERAS in the elderly is safe and its benefits are preserved in the care of even in patients older than 80 years. Standardized care protocol should be encouraged in all pancreatic centers., (© 2024 Japanese Society of Hepato‐Biliary‐Pancreatic Surgery.)
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- 2024
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40. Short-term Outcomes of Robotic Versus Open Pancreatoduodenectomy: Propensity Score-matched Analysis.
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Nickel F, Wise PA, Müller PC, Kuemmerli C, Cizmic A, Salg GA, Steinle V, Niessen A, Mayer P, Mehrabi A, Loos M, Müller-Stich BP, Kulu Y, Büchler MW, and Hackert T
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- Humans, Pancreaticoduodenectomy adverse effects, Propensity Score, Pancreas surgery, Postoperative Complications etiology, Learning Curve, Retrospective Studies, Robotic Surgical Procedures adverse effects, Pancreatic Neoplasms surgery, Pancreatic Neoplasms complications, Laparoscopy adverse effects
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Objective: The goal of the current study was to investigate the perioperative outcomes of robotic pancreaticoduodenectomy (RPD) and open pancreaticoduodenectomy (OPD) in a high-volume center., Background: Despite RPDs prospective advantages over OPD, current evidence comparing the 2 has been limited and has prompted further investigation. The aim of this study was to compare both approaches while including the learning curve phase for RPD., Methods: A 1:1 propensity score-matched analysis of a prospective database of RPD with OPD (2017-2022) at a high-volume center was performed. The main outcomes were overall- and pancreas-specific complications., Results: Of 375 patients who underwent PD (OPD n=276; RPD n=99), 180 were included in propensity score-matched analysis (90 per group). RPD was associated with less blood loss [500 (300-800) vs 750 (400-1000) mL; P =0.006] and more patients without a complication (50% vs 19%; P <0.001). Operative time was longer [453 (408-529) vs 306 (247-362) min; P <0.001]; in patients with ductal adenocarcinoma, fewer lymph nodes were harvested [24 (18-27) vs 33 (27-39); P <0.001] with RPD versus OPD. There were no significant differences for major complications (38% vs 47%; P =0.291), reoperation rate (14% vs 10%; P =0.495), postoperative pancreatic fistula (21% vs 23%; P =0.858), and patients with the textbook outcome (62% vs 55%; P =0.452)., Conclusions: Including the learning phase, RPD can be safely implemented in high-volume settings and shows potential for improved perioperative outcomes versus OPD. Pancreas-specific morbidity was unaffected by the robotic approach. Randomized trials with specifically trained pancreatic surgeons and expanded indications for the robotic approach are needed., Competing Interests: The authors report no conflicts of interest., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)
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- 2024
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41. Multimodal prehabilitation program in patients with resectable perihilar cholangiocarcinoma: keypoints for an implementation protocol and literature review.
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Lopez-Lopez V, Gongora E, Miura K, Kuemmerli C, Hernández-Kakauridze S, Eshmuminov D, Birrer D, García-Zafra V, López-Conesa A, Brusadin R, Navarro Á, Monteagudo M, and Robles-Campos R
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- Humans, Bile Ducts, Intrahepatic, Preoperative Exercise, Retrospective Studies, Bile Duct Neoplasms surgery, Cholangiocarcinoma, Klatskin Tumor surgery
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Background: Postoperative complications after perihilar cholangiocarcinoma surgical procedure are still very high. The implementation of a multimodal prehabilitation program could improve these outcomes. Based on our experience and that of the literature in hepatobiliary and pancreatic surgery, we propose a protocol to promote its implementation., Methods: First, we performed a retrospective analysis of the implementation feasibility of a multimodal prehabilitation program in patients' candidates for elective perihilar cholangiocarcinoma surgery in our center. Second, we conducted a literature search of publications in PubMed until December 2022. Relevant data about hepato-pancreato-biliary surgery and prehabilitation programs in features and postoperative outcomes was analyzed., Results: Since October 2020, 11 patients were evaluated for prehabilitation in our hospital. Two of them could not be resected intraoperatively due to disease extension. The median hospital stay was 10 days (iqr, 7-11). There were no major complications and 1 patient died. Of a total of 17 articles related to prehabilitation in hepato-biliary-pancreatic surgery, no reports focusing exclusively on perihilar cholangiocarcinoma were found. Six of the studies had nutritional therapies in addition to physical interventions, and 12 studies used home-based exercise therapy., Conclusions: Based on our experience and the data obtained from other studies, a prehabilitation program could be useful to improve perioperative physical and mental fitness in patients' candidates for elective perihilar cholangiocarcinoma surgery. However, more well-designed studies are needed to allow us to obtain more evidence., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)
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- 2024
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42. The PAncreatic Surgery Composite Endpoint PACE - Development and Validation of a Clinically Relevant Endpoint Requiring Lower Sample Sizes.
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Nickel F, Kuemmerli C, Müller PC, Schmidt MW, Schmidt LP, Wise P, Klotz R, Tjaden C, Diener M, Probst P, Hackert T, and Büchler MW
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Objective: To provide a composite endpoint in pancreatic surgery., Summary Background Data: Single endpoints in prospective and randomized studies have become impractical due to their low frequency and the marginal benefit of new interventions., Methods: Data from prospective studies were used to develop (n=1273) and validate (n=544) a composite endpoint based on postoperative pancreatic fistula, post-pancreatectomy hemorrhage as well as reoperation and reinterventions. All patients had pancreatectomies of different extents. The association of the developed PAncreatic surgery Composite Endpoint (PACE) with prolonged length of hospital stay (LOS) >75th percentile and mortality was assessed. A single-institution database was used for external validation (n = 2666). Sample size calculations were made for single outcomes and the composite endpoint., Results: In the internal validation cohort, the PACE demonstrated an AUC of 78.0%, a sensitivity of 90.4% and a specificity of 67.6% in predicting a prolonged LOS. In the external cohort, the AUC was 76.9%, the sensitivity 73.8% and the specificity 80.1%. The 90-day mortality rate was significantly different for patients with a positive versus a negative PACE both in the development and internal validation cohort (5.1% vs 0.9%; P< 0.001), as well as in the external validation cohort (8.5% vs 1.2%, P< 0.001). The PACE enabled sample size reductions of up to 80.5% compared to single outcomes., Conclusion: The PACE performed well in predicting prolonged hospital stays and can be used as a standardized and clinically relevant endpoint for future prospective trials enabling lower sample sizes and therefore improved feasibility compared to single outcome parameters., Competing Interests: The authors report no conflicts of interest, (Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc.)
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- 2024
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43. Autogenic splenic implantation versus splenectomy in patients undergoing distal pancreatectomy for benign or low-grade malignant lesions of the distal pancreas: study protocol for a multicentre, open-label, randomized controlled trial (RESTORE).
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Hilal MA, Kuemmerli C, Sijberden JP, Moekotte A, Zimmitti G, Alseidi A, Asbun HJ, Marudanayagam R, Bonds M, Kunzler F, Sutcliffe R, Eren E, Primrose JN, and Williams AP
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- Humans, Multicenter Studies as Topic, Pancreas, Randomized Controlled Trials as Topic, Spleen surgery, Pancreatectomy, Splenectomy, Vaccines
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Background: The spleen plays a significant role in the clearance of circulating microorganisms. Sequelae of splenectomy, especially immunodeficiency, can have a deleterious effect on a patient's health and even lead to death. Hence, splenectomy should be avoided and spleen preservation during elective surgery has become a treatment goal. However, this cannot be achieved in every patient due to intraoperative technical difficulties or oncological reasons. Autogenic splenic implantation (ASI) is currently the only possible way to preserve splenic function when a splenectomy is necessary. Experience largely stems from trauma patients with a splenic rupture. Splenic immune function can be measured by the body's clearing capacity of encapsulated bacteria. The aim of this study is to assess the splenic immune function after ASI was performed during minimally invasive (laparoscopic or robotic) distal pancreatectomy with splenectomy., Methods: This is the protocol for a multicentre, randomized, open-labelled trial. Thirty participants with benign or low-grade malignant lesions of the distal pancreas requiring minimally invasive distal pancreatectomy and splenectomy will be allocated to either additional intraoperative ASI (intervention) or no further intervention (control). An additional 15 patients who will undergo spleen-preserving distal pancreatectomy serve as the control group with normal splenic function. Six months postoperatively, after assumed restoration of splenic function, patients will be given a Salmonella typhi (Typhim Vi™) vaccine. The Salmonella typhi vaccine is a polysaccharide vaccine. The specific antibody titres immediately before and 4 to 6 weeks after vaccination will be measured. The ratio between pre- and post-vaccination antibody count is the primary outcome measure and secondary outcome measures include intraoperative details, length of hospital stay, 30-day mortality and morbidity., Discussion: This study will investigate the splenic immune function of patients who undergo ASI during minimally invasive distal pancreatectomy with splenectomy. The splenic immune function will be measured using the surrogate outcome of specific antibody titre after vaccination with a Salmonella typhi vaccine. The results will reveal details about splenic function after ASI and guide further treatment options for patients when a splenectomy cannot be avoided. It might eventually lead to a new standard of care making sometimes more demanding and time-consuming spleen-preserving procedures redundant., Trial Registration: International Standard Randomized Controlled Trials Number (ISRCTN) ISRCTN10171587. Prospectively registered on 18 February 2019., (© 2024. The Author(s).)
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- 2024
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44. Hepatic Artery Infusion Chemotherapy for Primary and Secondary Malignancies of the Liver: State of the Art and Current High-Level Evidence.
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Kuemmerli C, Hess V, Dutkowski P, Sinz S, Kessler U, Hess GF, Billeter AT, Müller-Stich BP, Kollmar O, and Müller PC
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- Humans, Hepatic Artery pathology, Antineoplastic Combined Chemotherapy Protocols, Fluorouracil, Treatment Outcome, Colorectal Neoplasms drug therapy, Liver Neoplasms drug therapy
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Background: Hepatic artery infusion chemotherapy (HAI) has been proposed as a valuable adjunct for multimodal therapy of primary and secondary liver malignancies. This review provides an overview of the currently available evidence of HAI, taking into account tumor response and long-term oncologic outcome., Summary: In colorectal liver metastases (CRLM), HAI in combination with systemic therapy leads to high response rates (85-90%) and conversion to resectablity in primary unresectable disease in up to 50%. HAI in combination with systemic therapy in CRLM in the adjuvant setting shows promising long-term outcomes with up to 50% 10-year survival in a large, non-randomized single-center cohort. For hepatocellular carcinoma patients, response rates as high as 20-40% have been reported for HAI and long-term outcomes compare well to other therapies. Similarly, survival for patients with unresectable intrahepatic cholangiocarcinoma 3 years after treatment with HAI is reported as high as 34%, which compares well to trials of systemic therapy where 3-year survival is usually below 5%. However, evidence is mainly limited by highly selected, heterogenous patient groups, and outdated chemotherapy regimens. The largest body of evidence stems from small, often non-randomized cohorts, predominantly from highly specialized single centers., Key Message: In well-selected patients with primary and secondary liver malignancies, HAI might improve response rates and, possibly, long-term survival. Results of ongoing randomized trials will show whether a wider adoption of HAI is justified, particularly to increase rates of resectability in advanced malignant diseases confined to the liver., (© 2024 The Author(s). Published by S. Karger AG, Basel.)
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- 2024
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45. Reliability of Medical Information Provided by ChatGPT: Assessment Against Clinical Guidelines and Patient Information Quality Instrument.
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Walker HL, Ghani S, Kuemmerli C, Nebiker CA, Müller BP, Raptis DA, and Staubli SM
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- Humans, Reproducibility of Results, Internet, Language, Artificial Intelligence, Health Personnel
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Background: ChatGPT-4 is the latest release of a novel artificial intelligence (AI) chatbot able to answer freely formulated and complex questions. In the near future, ChatGPT could become the new standard for health care professionals and patients to access medical information. However, little is known about the quality of medical information provided by the AI., Objective: We aimed to assess the reliability of medical information provided by ChatGPT., Methods: Medical information provided by ChatGPT-4 on the 5 hepato-pancreatico-biliary (HPB) conditions with the highest global disease burden was measured with the Ensuring Quality Information for Patients (EQIP) tool. The EQIP tool is used to measure the quality of internet-available information and consists of 36 items that are divided into 3 subsections. In addition, 5 guideline recommendations per analyzed condition were rephrased as questions and input to ChatGPT, and agreement between the guidelines and the AI answer was measured by 2 authors independently. All queries were repeated 3 times to measure the internal consistency of ChatGPT., Results: Five conditions were identified (gallstone disease, pancreatitis, liver cirrhosis, pancreatic cancer, and hepatocellular carcinoma). The median EQIP score across all conditions was 16 (IQR 14.5-18) for the total of 36 items. Divided by subsection, median scores for content, identification, and structure data were 10 (IQR 9.5-12.5), 1 (IQR 1-1), and 4 (IQR 4-5), respectively. Agreement between guideline recommendations and answers provided by ChatGPT was 60% (15/25). Interrater agreement as measured by the Fleiss κ was 0.78 (P<.001), indicating substantial agreement. Internal consistency of the answers provided by ChatGPT was 100%., Conclusions: ChatGPT provides medical information of comparable quality to available static internet information. Although currently of limited quality, large language models could become the future standard for patients and health care professionals to gather medical information., (©Harriet Louise Walker, Shahi Ghani, Christoph Kuemmerli, Christian Andreas Nebiker, Beat Peter Müller, Dimitri Aristotle Raptis, Sebastian Manuel Staubli. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 30.06.2023.)
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- 2023
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46. Long-term oncological outcomes for HALS/Hybrid vs pure laparoscopic approach in colorectal liver metastases: a propensity score matched analysis.
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Lopez-Lopez V, Krürger JAP, Kuemmerli C, Tohme S, Gómez-Gavara C, Iniesta M, López-Conesa A, Dogeas E, Dalmau M, Brusadin R, Sánchez-Esquer I, Geller DA, Herman P, and Robles-Campos R
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- Humans, Propensity Score, Retrospective Studies, Treatment Outcome, Laparoscopy methods, Liver Neoplasms surgery, Colorectal Neoplasms surgery
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Background: Studies comparing hand-assisted laparoscopic (HALS)/Hybrid and pure laparoscopic (PLS) resection for colorectal cancer liver metastasis have focused on short-term results, while long-term oncological outcomes remain understudied., Methods: We established a multi-institutional retrospective cohort study from four centers with experience in minimally invasive surgery between 2004 and 2020. Primary endpoints were overall survival (OS) and disease-free survival (DFS). Other endpoints analyzed were intraoperative and postoperative outcomes. Propensity score matching (PSM) was used to minimize baseline differences., Results: A total of 219 HALS/Hybrid (57.8%) and 160 PLS (42.2%) patients were included. After PSM, 155 patients remained in each group. Operative time (182 vs. 248 min, p = 0.012), use of intraoperative ablation (12.3 vs. 4.5%, p = 0.024), positive resection margin (4.5 vs 13.2%, p = 0.012), and pringle time (21 vs. 37 min, p = 0.001) were higher in PLS group. DFS at 1, 3, 5, and 7 years in HALS/Hybrid and PLS groups were 65.4%, 39.3%, 37.5%, and 36.3% vs. 64.9%, 38.0%, 33.1%, and 33.1%, respectively (p = 0.84). OS at 1, 3, 5, and 7 years in HALS/Hybrid and PLS groups were 94.5%, 71.4%, 54.3%, and 46.0% vs. 96.0%, 68.5%, 51.2%, and 41.2%, respectively (p = 0.73)., Conclusion: Our study suggests no differences in long-term oncologic outcomes between the two techniques. We discovered that longer total operative, pringle time, higher rates of intraoperative ablation, and positive resection margins were associated with PLS. These differences in favor of HALS/Hybrid could be due to a shorter learning curve and a greater ability to control hemorrhage., (© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)
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- 2023
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47. Selecting the Appropriate Downstaging and Bridging Therapies for Hepatocellular Carcinoma: What Is the Role of Transarterial Radioembolization? A Pooled Analysis.
- Author
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Lopez-Lopez V, Miura K, Kuemmerli C, Capel A, Eshmuminov D, Ferreras D, Baroja-Mazo A, Cascales-Campos P, Jiménez-Mascuñán MI, Pons JA, Castellon MI, Sánchez-Bueno F, Robles-Campos R, and Ramírez P
- Abstract
Background: Transarterial radioembolization in HCC for LT as downstaging/bridging has been increasing in recent years but some indication criteria are still unclear., Methods: We conducted a systematic literature search of primary research publications conducted in PubMed, Scopus and ScienceDirect databases until November 2022. Relevant data about patient selection, HCC features and oncological outcomes after TARE for downstaging or bridging in LT were analyzed., Results: A total of 14 studies were included (7 downstaging, 3 bridging and 4 mixed downstaging and bridging). The proportion of whole liver TARE was between 0 and 1.6%. Multiple TARE interventions were necessary for 16.7% up to 28% of the patients. A total of 55 of 204 patients across all included studies undergoing TARE for downstaging were finally transplanted. The only RCT included presents a higher tumor response with the downstaging rate for LT of TARE than TACE (9/32 vs. 4/34, respectively). Grade 3 or 4 adverse effects rate were detected between 15 and 30% of patients., Conclusions: TARE is a safe therapeutic option with potential advantages in its capacity to necrotize and reduce the size of the HCC for downstaging or bridging in LT.
- Published
- 2023
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48. Trends in pancreatic surgery in Switzerland: a survey and nationwide analysis over two decades.
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Kuemmerli C, Schneider MA, Joliat GR, Moeckli B, Ukegjini K, Bolli M, Worni M, and Birrer DL
- Subjects
- Humans, Switzerland, Retrospective Studies, Pancreaticoduodenectomy, Hospitals, High-Volume, Surveys and Questionnaires, Pancreatectomy, Pancreatic Neoplasms surgery
- Abstract
Background: Centralisation of highly specialised medicine (HSM) has changed practice and outcome in pancreatic surgery (PS) also in Switzerland. Fewer hospitals are allowed to perform pancreatic surgery according to nationally defined cut-offs., Objective: We aimed to examine trends in PS in Switzerland. First, to assess opinions and expected trends among Swiss pancreatic surgeons in regard of PS practice and second, to assess the evolution of PS performance in Switzerland by a nationwide retrospective analysis., Methods: First, a 26-item survey among all surgeons who performed PS in 2016 in Switzerland was performed. Then, nationwide data from 1998 to 2018 from all hospitals performing PS was analysed including centre volume, perioperative morbidity and mortality, surgical indications and utilisation of minimally invasive pancreatic surgery (MIPS). The national cut-off for regulatory accredited volume centres (AVC) was ≥ 12. Additionally, an international benchmark definition for high volume (≥ 20 surgeries/year) was used., Results: Among 25 surgeons from 15 centres (response rate 51%), the survey revealed agreement that centralisation is important to improve perioperative outcomes. Respondents agreed on a minimum case load per surgeon or centre. Within the nationwide database, 8534 pancreatic resections were identified. Most resections were performed for pancreatic ductal adenocarcinoma (58.9%). There was a significant trend towards centralisation of PS with fewer non-accredited volume centres (nAVC) (36 in 1998 and 17 in 2018, p < 0.001) and more AVC (2 in 1998 and 18 in 2018, p < 0.001). A significantly higher adjusted mortality after pancreatoduodenectomy (PD) was observed in low-volume compared to high-volume hospitals (OR 1.45 [95% CI 1.15-1.84], p = 0.002) and a similar trend compared among AVC and nAVC (OR 1.25 [95% CI 0.98-1.60], p = 0.072), while mortality after distal pancreatectomy (DP) was not influenced by centre volume., Conclusions: Over the last two decades, centralisation of PS towards higher-volume centres was observed in Switzerland with a decrease of mortality after PD and low mortality after DP. Further centralisation is supported by most pancreatic surgeons. However, the ideal metric and outcome measures for the allocation of highly specialised medicine need further discussion to allow a fair and outcome-focused allocation., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)
- Published
- 2022
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49. Vascular injury during cholecystectomy: A multicenter critical analysis behind the drama.
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Lopez-Lopez V, Kuemmerli C, Cutillas J, Maupoey J, López-Andujar R, Ramos E, Mils K, Valdivieso A, Valero AP, Martinez PA, Paterna S, Serrablo A, Reese T, Oldhafer K, Brusadin R, Conesa AL, Valladares LD, Loinaz C, Garcés-Albir M, Sabater L, Mocchegiani F, Vivarelli M, Pérez SA, Flores B, Lucena JL, Sánchez-Cabús S, Calero A, Minguillon A, Ramia JM, Alcazar C, Aguilo J, Ruiperez-Valiente JA, Grochola LF, Clavien PA, Petrowsky H, and Robles-Campos R
- Subjects
- Bile Ducts surgery, Cholecystectomy adverse effects, Humans, Intraoperative Complications diagnosis, Intraoperative Complications epidemiology, Intraoperative Complications etiology, Reoperation, Retrospective Studies, Cholecystectomy, Laparoscopic, Vascular System Injuries diagnosis, Vascular System Injuries etiology, Vascular System Injuries surgery
- Abstract
Background: The management of a vascular injury during cholecystectomy is still very complicated, especially in centers not specialized in complex hepatobiliary surgery., Methods: This was a multi-institutional retrospective study in patients with vascular injuries during cholecystectomy from 18 centers in 4 countries. The aim of the study was to analyze the management of vascular injuries focusing on referral, time to perform the repair, and different treatments options outcomes., Results: A total of 104 patients were included. Twenty-nine patients underwent vascular repair (27.9%), 13 (12.5%) liver resection, and 1 liver transplant as a first treatment. Eighty-four (80.4%) vascular and biliary injuries occurred in nonspecialized centers and 45 (53.6%) were immediately transferred. Intraoperative diagnosed injuries were rare in referred patients (18% vs 84%, P = .001). The patients managed at the hospital where the injury occurred had a higher number of reoperations (64% vs 20%, P ˂ .001). The need for vascular reconstruction was associated with higher mortality (P = .04). Two of the 4 patients transplanted died., Conclusion: Vascular lesions during cholecystectomy are a potentially life-threatening complication. Management of referral to specialized centers to perform multiple complex multidisciplinary procedures should be mandatory. Late vascular repair has not shown to be associated with worse results., (Copyright © 2022 Elsevier Inc. All rights reserved.)
- Published
- 2022
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50. Magnetic resonance cholangiopancreatography enhanced by virtual reality as a novel tool to improve the understanding of biliary anatomy and the teaching of surgical trainees.
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Staubli SM, Maloca P, Kuemmerli C, Kunz J, Dirnberger AS, Allemann A, Gehweiler J, Soysal S, Droeser R, Däster S, Hess G, Raptis D, Kollmar O, von Flüe M, Bolli M, and Cattin P
- Abstract
Objective: The novel picture archiving and communication system (PACS), compatible with virtual reality (VR) software, displays cross-sectional images in VR. VR magnetic resonance cholangiopancreatography (MRCP) was tested to improve the anatomical understanding and intraoperative performance of minimally invasive cholecystectomy (CHE) in surgical trainees., Design: We used an immersive VR environment to display volumetric MRCP data (Specto VR
TM ). First, we evaluated the tolerability and comprehensibility of anatomy with a validated simulator sickness questionnaire (SSQ) and examined anatomical landmarks. Second, we compared conventional MRCP and VR MRCP by matching three-dimensional (3D) printed models and identifying and measuring common bile duct stones (CBDS) using VR MRCP. Third, surgical trainees prepared for CHE with either conventional MRCP or VR MRCP, and we measured perioperative parameters and surgical performance (validated GOALS score)., Setting: The study was conducted out at Clarunis, University Center for Gastrointestinal and Liver Disease, Basel, Switzerland., Participants: For the first and second study step, doctors from all specialties and years of experience could participate. In the third study step, exclusively surgical trainees were included. Of 74 participating clinicians, 34, 27, and 13 contributed data to the first, second, and third study phases, respectively., Results: All participants determined the relevant biliary structures with VR MRCP. The median SSQ score was 0.75 (IQR: 0, 3.5), indicating good tolerability. Participants selected the corresponding 3D printed model faster and more reliably when previously studying VR MRCP compared to conventional MRCP: We obtained a median of 90 s (IQR: 55, 150) and 72.7% correct answers with VR MRCP versus 150 s (IQR: 100, 208) and 49.6% correct answers with conventional MRCP, respectively ( p < 0.001). CBDS was correctly identified in 90.5% of VR MRCP cases. The median GOALS score was higher after preparation with VR MRCP than with conventional MRCP for CHE: 16 (IQR: 13, 22) and 11 (IQR: 11, 18), respectively ( p = 0.27)., Conclusions: VR MRCP allows for a faster, more accurate understanding of displayed anatomy than conventional MRCP and potentially leads to improved surgical performance in CHE in surgical trainees., Competing Interests: P.C. Cattin is the inventor and owner of the VR application (Specto VRTM) described in this study. The other authors have no conflicts of interest or financial ties to disclose., (© 2022 Staubli, Maloca, Kuemmerli, Kunz, Dirnberger, Allemann, Gehweiler, Soysal, Droeser, Däster, Hess, Raptis, Kollmar, von Flüe, Bolli and Cattin.)- Published
- 2022
- Full Text
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