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1.
Kartik S. Jhaveri Sandra E. Fischer Hooman Hosseini-Nik Boraiah Sreeharsha Ravi J. Menezes Steven Gallinger Carol-Anne E. Moulton 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2017,19(11):992-1000
Objective
To prospectively compare the diagnostic performance of gadoxetic acid-enhanced MRI (EOB-MRI) and contrast-enhanced CT (CECT) for preoperative detection of colorectal liver metastases (CRLM) following chemotherapy and to evaluate the potential change in the hepatic resection plan.Methods
51 patients with CRLM treated with preoperative chemotherapy underwent liver imaging by EOB-MRI and CECT prospectively. Two independent blinded readers characterized hepatic lesions on each imaging modality using a 5-point scoring system. 41 patients underwent hepatic resection and histopathological evaluation.Results
151 CRLM were confirmed by histology. EOB-MRI, compared to CECT, had significantly higher sensitivity in detection of CRLM ≤1.0 cm (86% vs. 45.5%; p < 0.001), significantly lower indeterminate lesions diagnosis (7% vs. 33%; p < 0.001) and significantly higher interobserver concordance rate in characterizing the lesions ≤1.0 cm (72% vs. 51%; p = 0.041). The higher yield of EOB-MRI could have changed the surgical plan in 45% of patients.Conclusion
Following preoperative chemotherapy, EOB-MRI is superior to CECT in detection of small CRLM (≤1 cm) with significantly higher sensitivity and diagnostic confidence and interobserver concordance in lesion characterization. This improved diagnostic performance can alter the surgical plan in almost half of patients scheduled for liver resection. 相似文献2.
Chen Lin Hongmei Dai Xiafei Hong Haiyu Pang Xianze Wang Peiran Xu Jialin Jiang Wenming Wu Yupei Zhao 《Pancreatology》2018,18(5):608-614
Background
Whether primary tumor resection benefits patients with synchronous multifocal liver metastases from pancreatic neuroendocrine tumors remains controversial. We investigated whether primary tumor resection significantly affects survival in this study.Methods
A retrospective study of patients with synchronous multifocal liver metastases from pancreatic neuroendocrine tumors between 1998 and 2016 was performed. Patient demographics, operation details, adjuvant treatment, and pathological and survival information were collected, and relevant clinical-pathological parameters were assessed in univariate and multivariate survival analyses.Results
Sixty-three patients were included in this study, including 35 who underwent primary tumor resection. The median survival time and 5-year survival rate of this cohort were 50 months and 44.5%, respectively. Median survival time in the resected group was significantly longer at 72 months than that of 32 months in the nonresected group (p?=?0.010). Multivariate analysis showed that primary tumor surgery was a significant independent prognostic factor (HR 0.312, 95% CI: 0.128–0.762, p?=?0.011).Conclusions
Primary tumor resection significantly benefits patients with synchronous multifocal liver metastases from pancreatic neuroendocrine tumors. 相似文献3.
Christian Sturesson Valentinus T. Valdimarsson Erik Blomstrand Sam Eriksson Jan H. Nilsson Ingvar Syk Gert Lindell 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2017,19(1):52-58
Background
The liver-first strategy signifies resection of liver metastases before the primary colorectal cancer. The aim of the present study was to compare failure to complete intended treatment and survival in liver-first and classical strategies.Methods
All patients with colorectal cancer and synchronous liver metastases planned for sequential radical surgery in a single institution between 2011 and 2015 were included.Results
A total of 109 patients were presented to a multidisciplinary team conference (MDT) with un-resected colorectal cancer and synchronous liver metastases. Seventy-five patients were planned as liver-first, whereas 34 were recommended the classical strategy. Twenty-six patients (35%) failed to complete treatment in the liver-first group compared to 10 patients in the classical group (P = 0.664). Reason for failure was most commonly disease progression.A total of 91 patients had the primary tumor resected before the liver metastases of which 67 before referral and 24 after allocation at MDT. Median survival after diagnosis in this group was 60 (48–73) months compared to 46 (31–60) months in the group operated with liver-first strategy (n = 49), (P = 0.310).Discussion
Up to 35% of patients with colorectal cancer and synchronous liver metastases do not complete the intended treatment of liver and bowel resections, irrespective of treatment strategy. 相似文献4.
T. Peter Kingham Linda M. Pak Amber L. Simpson Universe Leung Alexandre Doussot Michael I. D&#x;Angelica Ronald P. DeMatteo Peter J. Allen William R. Jarnagin 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2018,20(3):260-267
Background
Neoadjuvant treatment of colorectal liver metastases has become increasingly common, and while effective, often renders small metastases difficult to visualize on intraoperative US. The objective of this study was to determine the utility of a 3D image-guidance system in patients with intraoperative sonographically-occult CRLM.Methods
50 patients with at least one CRLM ≤ 1.5 cm were enrolled in this prospective trial of an FDA-approved Explorer image-guidance system. If the tumor(s) seen on preoperative imaging were not identified with intraoperative US, Explorer was used to target the US examination to the involved area for a more focused assessment. The primary endpoint was the proportion of cases with sonographically-occult metastases identified using Explorer.Results
Forty-eight patients with preoperative scans within eight weeks of surgery were included for analysis. Forty-six patients were treated with preoperative chemotherapy (median 4 months, range 2–24 months). Overall, 22 sonographically-occult tumors in 14 patients were interrogated by Explorer, of which 15 tumors in 10 patients were located with image-guidance assistance. The only difference between patients with tumors not identified on US and those who did was the number of tumors (median 3 vs. 2, p = 0.018).Conclusion
3D image-guidance can assist in identifying small CRLM, particularly after treatment with chemotherapy.Trial registration
ClinicalTrials.gov, NCT02806037, https://clinicaltrials.gov/ct2/show/NCT02806037. 相似文献5.
Jesse Clanton Stephen Oh Stephen J. Kaplan Emily Johnson Andrew Ross Richard Kozarek Adnan Alseidi Thomas Biehl Vincent J. Picozzi William S. Helton David Coy Russell Dorer Flavio G. Rocha 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2018,20(10):925-931
Background
Accurate prediction of mesenteric venous involvement in pancreatic ductal adenocarcinoma (PDAC) is necessary for adequate staging and treatment.Methods
A retrospective cohort study was conducted in PDAC patients at a single institution. All patients with resected PDAC and staging CT and EUS between 2003 and 2014 were included and sub-divided into “upfront resected” and “neoadjuvant chemotherapy (NAC)” groups. Independent imaging re-review was correlated to venous resection and venous invasion. Sensitivity, specificity, positive and negative predictive values were then calculated.Results
A total of 109 patients underwent analysis, 60 received upfront resection, and 49 NAC. Venous resection (30%) and vein invasion (13%) was less common in patients resected upfront than those who received NAC (53% and 16%, respectively). Both CT and EUS had poor sensitivity (14–44%) but high specificity (75–95%) for detecting venous resection and vein invasion in patients resected upfront, whereas sensitivity was high (84–100%) and specificity was low (27–44%) after NAC.Conclusions
Preoperative CT and EUS in PDAC have similar efficacy but different predictive capacity in assessing mesenteric venous involvement depending on whether patients are resected upfront or received NAC. Both modalities appear to significantly overestimate true vascular involvement and should be interpreted in the appropriate clinical context. 相似文献6.
David G. Brauer Ryan C. Fields Benjamin R. Tan M.B. Majella Doyle Chet W. Hammill William G. Hawkins Graham A. Colditz William C. Chapman 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2018,20(5):470-476
Background
Lymph node (LN) status is an important predictor of overall survival for resected IHCC, yet guidelines for the extent of LN dissection are not evidence-based. We evaluated whether the number of LNs resected at the time of surgery is associated with overall survival for IHCC.Methods
Patients undergoing curative-intent (R0 or R1) resection for IHCC between 2004 and 2012 were identified within the US National Cancer Database. LN thresholds were evaluated using maximal chi-square testing and five-year overall survival was modeled using Kaplan–Meier and Cox regressions.Results
57% (n = 1,132) of 2,000 patients had one or more LNs resected and pathologically examined. In the 631 patients undergoing R0 resection with pN0 disease, maximal chi-square testing identified ≥3 LNs as the threshold most closely associated with overall survival. Only 39% of resections reached this threshold. On multivariable survival analysis, no threshold of LNs was associated with overall survival, including ≥3 LNs (p = 0.186) and the current American Joint Committee on Cancer recommendation of ≥6 LNs (p = 0.318).Conclusion
In determining the extent of lymphadenectomy at the time of curative-intent resection for IHCC, surgeons should carefully consider the prognostic yield in the absence of overall survival benefit. 相似文献7.
Yusuke Nakayama Motokazu Sugimoto Tatsushi Kobayashi Naoto Gotohda Shinichiro Takahashi Masahiko Kusumoto Masaru Konishi 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2018,20(1):49-56
Background
The aim of this study was to investigate the impact of pancreaticoduodenal arcade (PDA) dilation on postoperative outcomes after pancreaticoduodenectomy.Methods
Consecutive patients submitted to pancreaticoduodenectomy between 2008 and 2016 underwent preoperative multi-detector computed tomography, the images of which were re-reviewed. The patients were categorized according to the grade of PDA dilation into 3 groups (remarkably-dilated, slightly-dilated, and non-dilated).Results
Among the 443 patients, 25 patients (5.6%) were categorized as remarkably-dilated PDA and 24 patients (5.4%) as having slightly-dilated PDA. The patients with remarkably-dilated PDA had undergone pancreaticoduodenectomy with additional surgical maneuvers to restore celiac arterial flow as needed, and had an uneventful postoperative recovery relative to those with non-dilated PDA. In contrast, patients with slightly-dilated PDA underwent only pancreaticoduodenectomy without additional surgical maneuvers, and developed clinically relevant postoperative pancreatic fistula (POPF) more frequently than those with non-dilated PDA (42% vs. 21%, P = 0.021). Moreover, slightly-dilated PDA was shown to be an independent risk factor for clinically relevant POPF (odds ratio = 2.719, P = 0.042).Discussion
For patients with PDA dilation requiring pancreaticoduodenectomy, a preoperative evaluation of the vascular anatomy, intraoperative assessment of the celiac arterial flow, and additional surgical maneuvers might be necessary to reduce the risk of postoperative complications. 相似文献8.
Bing Liu Max Heckler Ulrike Heger Susanne Roth Ulla Klaiber Markus W. Büchler Oliver Strobel Christoph W. Michalski Thilo Hackert 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2018,20(11):1028-1033
Background
The number of lymph nodes to be resected in surgery for non-pancreatic periampullary cancer remains unclear.Methods
The Surveillance, Epidemiology, and End Results (SEER) database was used to gather information from a large retrospective cohort. To define a novel, reasonable cut-off associated with survival, we stratified patients into subgroups depending on the number of resected lymph nodes.Results
1481 nodal-negative patients resected for periampullary cancer (excluding pancreatic ductal adenocarcinoma) were included. The median number of resected lymph nodes was ten. Median overall survival in the subgroup with less than 10 removed lymph nodes was 40 months, while median survival for patients with ≥10 lymph nodes was 97 months (p < 0.001). A significant survival benefit was seen if ≥ 16 lymph nodes were harvested (median survival, 117 months), while no further benefit was observed if more than 21 nodes were removed (median survival, >120 months).Conclusion
Sixteen or more resected lymph nodes are associated with improved survival in node-negative periampullary carcinoma. We propose to aim at harvesting and analyzing at least 16 lymph nodes. 相似文献9.
Paschalis Gavriilidis Robert P. Sutcliffe James Hodson Ravi Marudanayagam John Isaac Daniel Azoulay Keith J. Roberts 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2018,20(1):11-19
Objective
This was a systematic review and meta-analysis to compare outcomes between patients undergoing simultaneous or delayed hepatectomy for synchronous colorectal liver metastases.Background
The optimal strategy for treating liver disease among patients with resectable synchronous colorectal liver metastases (CRLM) is unclear. Simultaneous resection of primary tumour and liver metastases may improve patient experience by reducing the number of interventions. However, there are concerns of increased morbidity compared to delayed resections.Methods
A systematic literature search was performed using EMBASE, Medline, Cochrane library and Google scholar databases. Meta-analyses were performed using both random-effects and fixed-effect models. Publication and patient selection bias were assessed with funnel plots and sensitivity analysis.Results
Thirty studies including 5300 patients were identified. There were no statistically significant differences in parameters relating to safety and efficacy between the simultaneous and delayed hepatectomy cohorts. Patients undergoing delayed surgery were more likely to have bilobar disease or undergo major hepatectomy. The average length of hospital stay was six days shorter with simultaneous approach [MD = ?6.27 (95% CI: ?8.20, ?4.34), p < 0.001]. Long term survival was similar for the two approaches [HR = 0.97 (95%CI: 0.88, 1.08), p = 0.601].Conclusion
In selected patients, simultaneous resection of liver metastases with colorectal resection is associated with shorter hospital stay compared to delayed resections, without adversely affecting perioperative morbidity or long-term survival. 相似文献10.
Epameinondas Dogeas Charing C.N. Chong Matthew J. Weiss Nita Ahuja Michael A. Choti 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2018,20(3):237-243
Background
Determining the biologic behavior of neuroendocrine liver metastases (NELM) is important when managing patients with this disease. We sought to define the intraoperative ultrasound (IOUS) characteristics of NELM and correlate with tumor biology and prognosis.Methods
Prospective data on patients who underwent IOUS and surgical intervention for NELM were collected, with images digitally recorded, blindly reviewed, and scored for echogenicity. Association between sonographic appearance, clinicopathologic factors and long-term outcomes was analyzed.Results
A total of 216 lesions from 65 patients were analyzed, with IOUS identifying at least one additional metastasis than preoperative imaging in 41 patients (63.1%) with subsequent change of surgical strategy in 14 patients (21.5%). Most NELM appeared hypoechoic (49.1%) on IOUS, while 38.9% demonstrated hyperechogenicity and 12% isoechogenicity. Hypoechoic lesions were associated with poorly-differentiated tumor (p?=?0.005) and smaller tumor size (p?=?0.004). Patients with hypoechoic metastases demonstrated significantly shorter median disease-free survival compared with isoechoic or hyperechoic lesions (9 vs 20 vs 18 months, p?=?0.049).Discussion
In addition to improved tumor detection of NELM, IOUS was found to be associated with features of tumor biology, specifically tumor grade and risk-of-recurrence. Echogenicity should be considered a potential prognostic factor in the management of patients with neuroendocrine tumors. 相似文献11.
Katherine T. Ostapoff Emmanuel Gabriel Kristopher Attwood Boris W. Kuvshinoff Steven J. Nurkin Steven N. Hochwald 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2017,19(7):587-594
Background
Current guidelines recommend adjuvant chemotherapy for resected pancreatic adenocarcinoma (PDAC). However, no studies have addressed its survival benefit for stage I patients as they comprise <10% of PDAC.Methods
Using the NCDB 2006–2012, resected PDAC patients with stage I disease who received adjuvant therapy (chemotherapy or chemoradiation) were analyzed. Factors associated with overall survival (OS) were identified.Results
3909 patients with resected stage IA or IB PDAC were identified. Median OS was 60.3 months (mo) for stage IA and 36.9 mo for IB. 45.5% received adjuvant chemotherapy; 19.9% received adjuvant chemoradiation. There was OS benefit for both stage IA/IB patients with adjuvant chemotherapy (HR = 0.73 and 0.76 for IA and IB, respectively, p = 0.002 and <0.001). For patients with Stage IA disease (n = 1,477, 37.8%), age ≥70 (p < 0.001), higher grade (p < 0.001), ≤10 lymph nodes examined (p = 0.008), positive margins (p < 0.001), and receipt of adjuvant chemoradiation (p = 0.002) were associated with worse OS. For stage IB patients (n = 2,432, 62.2%), similar associations were observed with the exception of adjuvant chemoradiation whereby there was no significant association (p = 0.35).Conclusion
Adjuvant chemotherapy was associated with an OS benefit for patients with stage I PDAC; adjuvant chemoradiation was either of no benefit or associated with worse OS. 相似文献12.
Elena F. Wurster Solveig Tenckhoff Pascal Probst Katrin Jensen Eva Dölger Phillip Knebel Markus K. Diener Markus W. Büchler Alexis Ulrich 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2017,19(6):491-497
Background
Recurrence of colorectal liver metastases after a first hepatectomy is common (4–48% of patients). This review investigates the utility of repeated hepatic resection of colorectal liver metastases.Methods
A systematic search of the literature was performed in the Cochrane Library, MEDLINE, EMBASE, and trial registers. All studies comparing repeated hepatic resection for colorectal liver metastases with patients who underwent only one hepatectomy were eligible. Outcome criteria were safety parameters and survival rates. Data were analyzed using the random-effects model.Results
In eight observational clinical studies, 450 patients with repeated hepatic resection were compared with 2669 single hepatic resections. Morbidity such as hepatic insufficiency (OR [95% CI] 1.46 [0.69; 3.08], p = 0.32) and biliary leakage and fistula (OR [95% CI] 1.22 [0.80; 1.85], p = 0.35) was comparable between the two groups. Mortality (OR [95% CI] 1.13 [0.46; 2.74], p = 0.79) and overall survival (HR [95% CI] 1.00 [0.63; 1.60], p = 0.99) were not significantly different between the two groups.Discussion
Repeated hepatic resection for colorectal liver metastases is safe in selected patients. A prospective, multicenter high-quality trial or register study of repeated hepatic resection will be required to clarify patient-oriented outcomes such as overall survival and quality of life. 相似文献13.
Giulia A. Zamboni Maria Chiara Ambrosetti Caterina Zivelonghi Fabio Lombardo Giovanni Butturini Sara Cingarlini Paola Capelli Roberto Pozzi Mucelli 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2017,19(11):986-991
Background
Since prognosis and treatment of pancreatic endocrine tumors (pNET) are based on tumor grade, contrast-enhanced multidetector computed tomography (MDCT) features of solid non-functioning pNETs were studied and correlated with pathology tumor grading.Methods
MDCTs of diagnosed pNETs were reviewed retrospectively. Each tumor was analyzed for location, size, homogeneity, margins, arterial and venous phase enhancement, main pancreatic duct diameter, calcifications, vascular invasion, lymph-nodes enlargement, and liver metastases.Results
Of 154 pNETs presenting between January 2000 and May 2016 with available histology from resected specimen or biopsy, there were 65 G1, 72 G2 and 17 G3 pNETs. Tumor diameter varied significantly between the three groups. Tumors >20 mm were more frequently malignant and non-homogeneous than smaller tumors. G1 tumors were more commonly hypervascular and G3 tumors more often non-hypervascular in the arterial phase. Arterial phase non-hyperdensity and tumor non-homogeneity had a higher rate of metastatic lesions. Vascular invasion correlated with presence of metastases and histological grade. G3 tumors were all >20 mm (p = 0.007), more often non-hypervascular in the arterial phase (p = 0.0025), and non-hyperdense in the venous phase (p = 0.009), and showed more often vascular invasion (p = 0.0198).Conclusion
CT correlated with tumor grade; differentiating low-grade and high-grade pNETs through routine CT imaging might improve patient management. 相似文献14.
Ville Sallinen Tessa Y.S. Le Large Shamil Galeev Zahar Kovalenko Elke Tieftrunk Raphael Araujo Güralp O. Ceyhan Sebastien Gaujoux 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2017,19(4):310-320
Background
Non-functional pancreatic neuroendocrine tumors (NF-PNET) are rare neoplasms being increasingly diagnosed. Surgical treatment or expectant management are both suggested for small NF-PNETs. The aim of this study was to evaluate the outcome of surveillance strategy for small NF-PNETs.Methods
A systematic search was performed up to March 2016 in MEDLINE, EMBASE and the Cochrane Library according to the PRISMA guidelines. Data was pooled using the random-effects model.Results
Nine articles including 344 patients with sporadic and 64 patients with MEN1 related NF-PNET were selected. Tumor growth was observed in 22% and 52%, development of metastases were reported on 0% and 9%, and rate of secondary surgical resection was 12% and 25% in patients with sporadic or MEN1 related NF-PNETs, respectively. All metastases (1 distant, 4 nodal) were reported by a single study in patients with MEN1. Reason for secondary surgery was tumor growth in half of patients undergoing surgery.Discussion
Expectant management of small asymptomatic, sporadic, NF-PNETs could be a reasonable option in highly selected patients. However, the level of evidence is low and longer follow-up is needed to identify patients could benefit from upfront surgery instead of expectant treatment. 相似文献15.
Ryota Kiuchi Takashi Mizuno Yukiyasu Okamura Teiichi Sugiura Hideyuki Kanemoto Katsuhiko Uesaka 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2018,20(5):385-391
Background
Circumportal pancreas (CP) is an anatomical anomaly in the form of abnormal parenchymal fusion between the uncinate process and the pancreatic body, and it requires an additional parenchymal dissection during pancreaticoduodenectomy (PD). This study aimed to investigate the prevalence of CP in PD and to evaluate the incidence of postoperative pancreatic fistula (POPF) among CP patients.Methods
Patients who underwent PD from 2002 to 2012 (n = 552) were included. Operative records and preoperative images were independently reviewed to identify the presence of CP. The incidence of POPF was compared between CP and non-CP patients and was evaluated via multivariate analysis.Results
CP was confirmed from operative records in 7 (1.3%) patients, and abnormal parenchymal fusion was identified from preoperative images in 8 (1.4%) patients. The incidence of POPF was significantly higher in CP patients than in non-CP patients (71% vs 32%, P = 0.039). On multivariate analysis, CP was an independent predictive factor for POPF (odds ratio, 9.97; 95% confidence interval, 1.76–56.6; P = 0.009).Discussion
Surgeons should heed the presence of CP in PD because this rare anomaly requires an additional parenchymal dissection and may increase the incidence of POPF. 相似文献16.
Mariam Adamu Philipp Nitschke Petar Petrov Anke Rentsch Marius Distler Christoph Reissfelder Thilo Welsch Hans-Detlev Saeger Juergen Weitz Nuh N. Rahbari 《Pancreatology》2018,18(5):585-591
Background/objectives
A better stratification of patients into risk groups might help to select patients who might benefit from more aggressive therapy. The aim of this study was to validate five prognostic scores in patients resected for pancreatic ductal adenocarcinoma (PDAC).Methods
Included were 307 PDAC patients who underwent resection with curative intent. Five clinical risk scores were selected and applied to our study population. Survival analyses were carried out using univariate and multivariate proportional hazards regression.Results
Prognostic stratification was strong for the Heidelberg score (p?<?0.001) and the Memorial Sloan Kettering Cancer Center (MSKCC) nomogram (p?=?0.001) and moderate for the Botsis score (p?=?0.033). There was no significant prognostic value for the Early Mortality Risk Score (p?=?0.126) and McGill Brisbane Symptom Score (p?=?0.133). Positive resection margin (HR 1.53, 95% CI 1.08–2.16) and pain [pain (HR 1.40, CI 1.03–1.91), back pain (HR 1.67, 95% CI 1.08–2.57)] were independent prognostic factors on multivariate analysis.Conclusions
The Heidelberg score and MSKCC nomogram provided adequate risk stratification in our independent study cohort. Further studies in independent patient cohorts are required to achieve higher levels of validation. 相似文献17.
Yiyin Chen Marjorie Funk Jia Wen Xianghua Tang Guixiang He Hong Liu 《Heart & lung : the journal of critical care》2018,47(1):24-31
Background
Multidisciplinary disease management programs (MDMP) for patients with heart failure (HF) have been delivered, but evidence of their effectiveness in China is limited.Objective
To determine if a MDMP improves quality of life (QoL), physical performance, depressive symptoms, self-care behaviors and mortality or rehospitalization in patients with HF in China.Methods
This is a randomized controlled single center trial in which patients with HF received either MDMP with discharge education, physical training, follow-up visits and telephone calls for 180 days (n = 31) or standard care (SC, n = 31).Results
Compared with SC, QoL, depressive symptoms, and self-care behaviors were significantly improved by MDMP from baseline to 180 days (37% vs 66%, 20% vs 61%, and 8% vs 33%, respectively, all p < 0.001). There were no differences in physical performance and mortality or rehospitalization during follow-up.Conclusions
A HF MDMP can improve QoL, depressive symptoms and self-care behaviors in China. 相似文献18.
Yuta Kobayashi Kiyohiko Omichi Yoshikuni Kawaguchi Junichi Arita Nobuhisa Akamatsu Junichi Kaneko Yoshihiro Sakamoto Kiyoshi Hasegawa Norihiro Kokudo 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2018,20(1):93-99
Background
Real-time tissue elastography during open hepatectomy facilitates the differential diagnosis of liver tumors by providing information on elasticity. This study investigated the utility of intraoperative real-time tissue elastography (IORTE) during laparoscopic hepatectomy (LH).Methods
Between 2012 and 2014, IORTE was performed during LH for 21 hepatocellular carcinomas (HCCs), 16 adenocarcinomas and 5 other tumors in 32 patients. The elasticity images were classified into six categories according to the modified criteria on the elasticity type of liver tumors, in which type 1 tumors show more strain than the surrounding liver and type 6 tumors no strain. The concordance of the IORTE findings with those of the pathological examination of the tumors was assessed (The registration no. 1418).Results
Among the 21 HCCs, 20 were classified as “HCC pattern” (type 3, 4, or 5), resulting in a sensitivity of 95.2%, a specificity of 66.7% and an accuracy of 81.0%. Ten out of the 16 adenocarcinomas were classified as “adenocarcinoma pattern” (type 6), resulting in a sensitivity of 62.5%, a specificity of 92.3% and an accuracy of 81.0%.Conclusion
IORTE is feasible and provides useful information on the elasticity of liver tumors in LH, in which conventional tumor palpation is difficult. 相似文献19.
Anh-Thu Le Jennifer W. Harris Erin Maynard Sean P. Dineen Ching-Wei D. Tzeng 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2017,19(2):154-161
Background
We hypothesized hepato-pancreato-biliary (HPB) surgery patients are more likely to be hypercoagulable than hypocoagulable, and that bleeding risks from VTE chemoprophylaxis are low. This study sought to use thromboelastography (TEG) to compare coagulation profiles with bleeding/thrombotic events in HPB patients receiving standardized perioperative chemoprophylaxis.Methods
Consecutive patients undergoing HPB resections by three surgeons at one institution (January 2014–December 2015) received preoperative and early postoperative VTE chemoprophylaxis and were evaluated with TEGs. Coagulation profiles were compared to bleeding/thrombotic events.Results
Of 87 total patients, 83 (95.4%) received preoperative chemoprophylaxis and 100% received it postoperatively. Median estimated blood loss was 190 ml. Only 2 (2.3%) patients received intraoperative transfusions. None required transfusions at 72-hours. Only 2 were transfused within 30 days. There was 1 (1.1%) 30-day VTE event. Of 83 preoperative TEGs, 29 (34.9%) were hypercoagulable and only 8 (9.6%) were hypocoagulable/fibrinolytic. Of 73 postoperative TEGs, 34 (46.6%) were hypercoagulable and just 8 (11.0%) were hypocoagulable/fibrinolytic. .Conclusion
With routine perioperative chemoprophylaxis, both VTE and bleeding events were negligible. Perioperative TEG revealed a considerable proportion (46.6%) of HPB patients were hypercoagulable. HPB patients can receive standardized preoperative/early postoperative VTE chemoprophylaxis with effective results and minimal concern for perioperative hemorrhage. 相似文献20.
Michele Ghidini Gianluca Tomasello Andrea Botticelli Sandro Barni Giampietro Zabbialini Silvia Seghezzi Rodolfo Passalacqua Chiara Braconi Fausto Petrelli 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2017,19(9):741-748