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1.
Clinical influence of preoperative factor XIII activity in patients undergoing pancreatoduodenectomy
Nobuyuki Watanabe Yukihiro Yokoyama Tomoki Ebata Gen Sugawara Tsuyoshi Igami Takashi Mizuno Junpei Yamaguchi Masato Nagino 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2017,19(11):972-977
Background
The influence of decreased factor XIII (FXIII) activity on perioperative bleeding has been reported in some surgical procedures. The purposes of this study were to investigate the perioperative dynamics of FXIII in patients undergoing pancreatoduodenectomy and to clarify the effects of low preoperative FXIII activity on intraoperative bleeding and postoperative complications.Methods
Total of 43 patients who underwent a pancreatoduodenectomy were enrolled. The perioperative FXIII activities were measured, and their associations with intraoperative bleeding and postoperative outcomes were analyzed.Results
Fifteen patients (35%) had low FXIII activities (<70%, lower than the institutional normal range). The patients with preoperative FXIII activities <70% experienced significantly greater blood loss (median, 1309 mL) during surgery compared to those with FXIII levels of ≥70% (median, 710 mL) (p = 0.001). The postoperative morbidity rates, including pancreatic fistula, were comparable between the patients with FXIII activities <70% and those with FXIII activities ≥70%. The FXIII levels substantially decreased on postoperative day 1 and remained at low levels until postoperative day 7.Conclusion
Unexpectedly high proportions of patients undergoing pancreatoduodenectomy had low preoperative FXIII activities. Preoperative FXIII deficiency may increase intraoperative bleeding but had no influence on the postoperative outcomes. 相似文献2.
Minas Baltatzis Ryan Low Panagiotis Stathakis Aali J. Sheen Ajith K. Siriwardena Saurabh Jamdar 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2017,19(4):289-296
Background
Current guidelines recommend pharmacological prophylaxis for patients undergoing abdominal surgery for malignancy. Liver resection exposes patients to risk factors for venous thromboembolism, but there is a risk of bleeding. The aim of this study is to evaluate the evidence base supporting the use of pharmacological thromboprophylaxis in liver surgery.Methods
An electronic search was carried out for studies reporting the incidence of VTE following liver resection comparing patients receiving pharmacological prophylaxis with those who did not. The search resulted in 990 unique citations. Following the application of strict eligibility criteria 5 studies comprise the final study population.Results
Included studies report on 3675 patients undergoing liver resection between 1999 and 2013. 2256 patients received chemical thromboprophylaxis, 1412 had mechanical prophylaxis only and 7 received no prophylaxis. Meta-analysis revealed lower VTE rates in patients receiving chemical thromboprophylaxis (2.6%) compared to without prophylaxis (4.6%) (Dichotomous correlation test, odds ratio: 0.631 [95% Cl: 0.416–0.959], Fixed model, p = 0.030). Data regarding bleeding could not be pooled for meta-analysis, but chemical thromboprophylaxis was reported as safe in four studies.Conclusion
This systematic review and meta-analysis of retrospective studies indicates that the use of perioperative chemical thromboprophylaxis reduces VTE incidence following liver surgery without an apparent increased risk of bleeding. 相似文献3.
Ricky Jrearz Anand Govindarajan Shiva Jayaraman 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2017,19(1):42-46
Background
The purpose of this survey was to determine the extent to which laparoscopy is used in hepatopancreatobiliary (HPB) resections in Canada, and to assess HPB surgeons' attitudes and their perceived barriers to its further adoption.Methods
Using an electronic questionnaire, 68 Canadian Hepatopancreatobiliary Association (CHPBA) surgical members were surveyed. The questionnaire consisted of 12 questions regarding: surgeon demographics, the use and limitations of laparoscopy in their practice, and interest in increasing the use of laparoscopic techniques.Results
The survey response rate was 75%. Of the 51 respondents, 86% reported performing minor laparoscopic resections such as hepatic wedge resections. Only 23% of surgeons reported performing laparoscopic liver lobectomies. Eighty-two percent of respondents indicated a wish to increase the use of laparoscopy in their practice. Barriers identified included operating time constraints (61%), a lack of equipment (41%) and lack of adequate training (43%).Discussion
This survey demonstrates that currently, most Canadian HPB surgeons use laparoscopy for minor HPB resections; however, there is a strong desire to expand the use of minimally invasive techniques amongst Canadian HPB surgeons. Training centered on addressing the limitations and barriers to the uptake of minimally invasive techniques in HPB surgery are needed. 相似文献4.
Jan Grendar Zeljka Jutric Julie N. Leal Chad G. Ball Kimberly Bertens Elijah Dixon Chet W. Hammill Zachary Kastenberg Pippa H. Newell Flavio Rocha Brendan Visser Ronald F. Wolf Paul D. Hansen 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2017,19(6):508-514
Background
Fistula Risk Score (FRS) is a previously developed tool to assess the risk of clinically relevant postoperative pancreatic fistula (CR-POPF) following pancreatoduodenectomy (PD).Methods
Prospectively collected databases from 4 university affiliated and non-affiliated HPB centers in United States and Canada were used. The influence of individual baseline characteristics, FRS and FRS group on CR-POPF was assessed in univariate and multivariate analyses. FRS calculator performance was assessed using a C-statistic.Results
444 patients were identified. Pathology, soft pancreas texture and pancreatic duct size were associated with CR-POPF rates (p < 0.001 for each); EBL was not (p = 0.067). The negligible risk group consisted of 50 (11.3%) patients, low risk of 118 (26.6%), moderate 234 (52.7%) and high risk group of 42 (9.5%) patients. The overall rate of CR-POPF was 20%. Of the patients in the negligible risk group, 2% developed CR-POPF, 13.6% of the low risk, 23.1% moderate and 42.9% in the high risk group (p < 0.001). Overall C-statistic was 0.719.Conclusion
FRS is robust and able to stratify the risk of developing CR-POPF following PD in diverse North American academic and non-academic institutions. The FRS should be used in research and to guide clinical management of patients post PD in these institutions. 相似文献5.
Ibrahim Nassour Sam C. Wang Alana Christie Ali A. Mokdad Matthew R. Porembka Michael A. Choti Mathew M. Augustine Adam C. Yopp Xian-Jin Xie John C. Mansour Rebecca M. Minter Patricio M. Polanco 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2017,19(12):1037-1045
Background
Despite the development of pathways to enhance recovery and discharge to home, a significant proportion of patients are discharged to inpatient facilities after pancreaticoduodenectomy (PD). The aim of this study was to determine the rate of non-home discharge (NHD) following PD in a national cohort of patients and to develop predictive nomograms for NHD.Methods
The National Surgical Quality Improvement Program was used to construct and validate pre- and postoperative nomograms for NHD following PD.Results
A total of 6856 patients who underwent PD were identified, of which 927 (13.5%) had an NHD. The independent preoperative predictors of NHD were being female, older age, higher BMI, low serum albumin, >10% weight loss, ASA class III/IV, and being diagnosed with a bile duct/ampullary neoplasm or neuroendocrine tumor. A preoperative nomogram was constructed with a concordance index of 0.77. When postoperative variables were added to the model, the concordance index increased to 0.82. The postoperative predictors of NHD were return to the operating room, length of stay of ≥14 days, and any inpatient complications.Conclusions
These nomograms could be useful risk assessment tools to predict NHD after PD and therefore facilitate patient counseling and improve resource utilization and discharge planning. 相似文献6.
Jony van Hilst Thijs de Rooij Mohammed Abu Hilal Horacio J. Asbun Jeffrey Barkun Uggo Boggi Olivier R. Busch Kevin C.P. Conlon Marcel G. Dijkgraaf Ho-Seong Han Paul D. Hansen Michael L. Kendrick Andre L. Montagnini Chinnusamy Palanivelu Bård I. Røsok Shailesh V. Shrikhande Go Wakabayashi Herbert J. Zeh Marc G.H. Besselink 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2017,19(3):190-204
Background
The introduction of minimally invasive pancreatic resection (MIPR) into surgical practice has been slow. The worldwide utilization of MIPR and attitude towards future perspectives of MIPR remains unknown.Methods
An anonymous survey on MIPR was sent to the members of six international associations of Hepato-Pancreato-Biliary (HPB) surgery.Results
The survey was completed by 435 surgeons from 50 countries, with each surgeon performing a median of 22 (IQR 12–40) pancreatic resections annually. Minimally invasive distal pancreatectomy (MIDP) was performed by 345 (79%) surgeons and minimally invasive pancreatoduodenectomy (MIPD) by 124 (29%). The median total personal experience was 20 (IQR 10–50) MIDPs and 12 (IQR 4–40) MIPDs. Current superiority for MIDP was claimed by 304 (70%) and for MIPD by 44 (10%) surgeons. The most frequently mentioned reason for not performing MIDP (54/90 (60%)) and MIPD (193/311 (62%)) was lack of specific training. Most surgeons (394/435 (90%)) would consider participating in an international registry on MIPR.Discussion
This worldwide survey showed that most participating HPB surgeons value MIPR as a useful development, especially for MIDP, but the role and implementation of MIPD requires further assessment. Most HPB surgeons would welcome specific training in MIPR and the establishment of an international registry. 相似文献7.
Zhijian Wen Anfeng Si Jue Yang Pinghua Yang Xinwei Yang Hu Liu Xingzhou Yan Wengang Li Baohua Zhang 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2017,19(11):951-956
Aims
The aim of this study was to determine whether a combination of the tumour markers carcinoembryonic (CEA) and carbohydrate antigen 19-9 (CA19-9) would be helpful in predicting the prognosis of patients with gallbladder carcinoma (GBC) who underwent resection.Methods
A retrospective analysis of clinico-pathological features and survival of 390 patients with GBC who were treated between January 2003 and December 2013. Time-dependent receiver operating characteristic (ROC) was used to evaluate the prognostic ability of tumour markers. Combinations of preoperative CEA and CA19-9 were tested as potential prognostic factors.Results
The evaluation of preoperative CEA and CA19-9 showed that patients with both tumour markers within the normal range had the best prognosis with a median survival of 27 months and R0 rate of 86%. Patients with both tumour markers elevated had the poorest prognosis and lower R0 rate (p < 0.001). The combination of CEA and CA19-9 was an independent risk factor for overall survival. The AUROC at 5 years of combination of CEA and CA19-9 was 0.798, which was similar to CEA (0.765) or CA19-9 (0.771) alone (p = 0.103, p = 0.147).Conclusions
A combination of an elevated preoperative CEA and CA19-9 was associated with a worse prognosis for patients with GBC who underwent resection. 相似文献8.
Ryan K. Schmocker David J. Vanness Caprice C. Greenberg Jeff A. Havlena Noelle K. LoConte Jennifer M. Weiss Heather B. Neuman Glen Leverson Maureen A. Smith Emily R. Winslow 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2017,19(5):465-472
Background
Endoscopic ultrasound (EUS) is used for pancreatic adenocarcinoma staging and obtaining a tissue diagnosis. The objective was to determine patterns of preoperative EUS and the impact on downstream treatment.Methods
The Surveillance, Epidemiology, and End Results (SEER) Medicare-linked database was used to identify patients with pancreatic adenocarcinoma. The staging period was the first staging procedure within 6 months of surgery until surgery. Logistic regression was used to determine factors associated with preoperative EUS. The main outcome was EUS in the staging period, with secondary outcomes including number of staging tests and time to surgery.Results
2782 patients were included, 56% were treated at an academic hospital (n = 1563). 1204 patients underwent EUS (43.3%). The factors most associated with receipt of EUS were: earlier year of diagnosis, SEER area, and a NCI or academic hospital (all p < 0.0001). EUS was associated with a longer time to surgery (17.8 days; p < 0.0001), and a higher number of staging tests (40 tests/100 patients; p < 0.0001).Conclusions
Factors most associated with receipt of EUS are geographic, temporal, and institutional, rather than clinical/disease factors. EUS is associated with a longer time to surgery and more preoperative testing, and additional study is needed to determine if EUS is overused. 相似文献9.
Shunsuke Onoe Atsuyuki Maeda Yuichi Takayama Yasuyuki Fukami Yuji Kaneoka 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2017,19(5):406-410
Purpose
The aim of this study was to develop a preoperative scoring system to predict the ability to achieve the critical view of safety (CVS) in patients undergoing emergency laparoscopic cholecystectomy (LC) for acute cholecystitis (AC).Methods
A retrospective review of patients who underwent LC for AC between 2012 and 2015 was performed. The achievement or failure of creating the CVS was judged by operative records, video recordings, and interviews of the surgeons. Independent preoperative variables associated with failure were determined by multivariate logistic regression analysis and a prediction scoring system created.Results
A C-reactive protein (CRP) >5.5 mg/dl, gallstone impaction, and symptom onset to operation >72 h were identified as independently correlated risk factors for the failure to achieve the CVS. A preoperative risk scoring system for the failure to create the CVS (0–5 points) was constructed using these 3 factors: CRP >5.5 mg/dl (2 points), gallstone impaction (1 points), and time from symptom onset to operation >72 h (2 points). When monitoring the frequency of patients who had a failure to create the CVS at each score, the incidence of failure increased as the score increased (P<0.001).Conclusions
Using only three preoperative factors, the proposed scoring system provides an objective evaluation of the likelihood that CVS can be achieved in patients undergoing emergency LC for AC. 相似文献10.
Paschalis Gavriilidis Ernest Hidalgo Nicola de&#x;Angelis Peter Lodge Daniel Azoulay 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2017,19(1):16-20
Aim
The benefit of prophylactic drainage after uncomplicated hepatectomy remains controversial. The aim of this study was to update the existing evidence on the role of prophylactic drainage following uncomplicated liver resection.Methods
Cochrane, Medline (Pubmed), and Embase were searched. The Medline search strategy was adopted for all other databases. A grey literature search was performed. Meta-analyses were performed with Review Manager 5.3. Primary outcomes were mortality and ascitic leak, secondary outcomes were infected intra-abdominal collection, chest infection, wound infection of the surgical incision, biliary fistula, and length of stay.Results
The incidence of ascitic leak was higher in the drained group (Odds Ratio = 3.33 [95% Confidence Interval: 1.66–5.28]). Infected intra-abdominal collections, wound infections, chest infections, biliary fistula, length of stay and mortality were not statistically different between groups.Conclusions
The routine utilisation of drains after elective uncomplicated liver resection does not translate into a lower incidence of postoperative complications. Therefore, based on the current available evidence, routine abdominal drainage is not recommended in elective uncomplicated hepatectomy. 相似文献11.
The impact of a clinical pathway on patient postoperative recovery following pancreaticoduodenectomy
Amélie Tremblay St-Germain Katharine S. Devitt Daniel J. Kagedan Beverly Barretto Stephanie Tung Steven Gallinger Alice C. Wei 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2017,19(9):799-807
Background
Pancreaticoduodenectomies (PD) are complex surgical procedures. Clinical pathways (CPW) are surgical process improvement tools that guide postoperative recovery and are associated with high quality care. Our objective was to report the quality of surgical care following implementation of a CPW.Methods
We developed and implemented a CPW for patients undergoing PD at a single high volume hepato-pancreato-biliary (HPB) centre. Patient outcomes were collected prospectively during the implementation period. A comparator cohort was selected by identifying patients that underwent a PD prior to CPW development.Results
122 patients underwent a PD during the CPW implementation period; 83 patients were initiated on the CPW. 74 patients underwent PD during the 12-month period prior to the CPW. The median hospital stay decreased after the implementation of the CPW (11 vs 8 days, p < 0.01) with no significant changes to mortality, morbidity, reoperation, or readmission rates. In-hospital complications were significantly higher in patients that were not initiated on the CPW (54% vs 74%, p = 0.03).Conclusion
Results suggest the CPW reduced variability and allowed a greater proportion of patients to receive all elements of care, resulting in improved quality and efficiency of care based on current best evidence recommendations. 相似文献12.
Jin Hong Lim Joon Seong Park Dong Sup Yoon 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2017,19(5):388-395
Background
The clinical relevance of fibrosis with regard to tumor progression is supported by the correlation between fibrosis and poor outcomes. Fecal elastase-1 (FE-1) level has been used to assess exocrine dysfunction of the pancreas and to predict pancreas fibrosis. The aim of this study was to assess the impact of FE-1 on the survival of pancreatic cancer patients.Methods
Between January 2006 and December 2014, 136 patients with pancreatic adenocarcinoma underwent R0 resection at Gangnam Severance Hospital, Korea. Preoperative FE-1 levels were available in 94 patients who were enrolled in the study. Patients were classified into two groups according to preoperative FE-1: “normal” (≥200 μg/g) or “reduced” (<200 μg/g).Results
Median preoperative FE-1 level was 130.1 μg/g (IQR 32.0; 238.3). 62 patients (66.0%) had reduced pancreatic function and 32 patients (34.0%) had normal pancreatic function. The two groups had significantly different disease-free survival (P < 0.001). On multivariate analysis, normal FE-1, no lymph node metastasis and completion of adjuvant chemotherapy were found to be independent prognostic factors for better DFS (P = 0.001, P = 0.017, P = 0.038, respectively).Conclusion
FE-1 is a simple and non-invasive predictive clinical marker for prognosis of pancreatic cancer after attempted curative resection. 相似文献13.
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14.
Ayesha Kamal Amitasha Sinha Susan M. Hutfless Elham Afghani Mahya Faghih Mouen A. Khashab Anne Marie Lennon Dhiraj Yadav Martin A. Makary Dana K. Andersen Anthony N. Kalloo Vikesh K. Singh 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2017,19(1):21-28
Background
Multiple factors influence mortality in Acute Pancreatitis (AP).Methods
To evaluate the association of demographic, clinical, and hospital factors with the in-hospital mortality of AP using a population-based administrative database. The Maryland HSCRC database was queried for adult (≥18 years) admissions with primary diagnosis of AP between 1/94-12/10. Organ failure (OF), interventions, hospital characteristics and referral status were evaluated.Results
There were 72,601 AP admissions across 48 hospitals in Maryland with 885 (1.2%) deaths. A total of 1657 (2.3%) were transfer patients, of whom 101 (6.1%) died. Multisystem OF was present in 1078 (1.5%), of whom 306 (28.4%) died. On univariable analysis, age, male gender, transfer status, comorbidity, OF, all interventions, and all hospital characteristics were significantly associated with mortality; however, only age, transfer status, OF, interventions, and large hospital size were significant in the adjusted analysis. Patients with commercial health insurance had significantly less mortality than those with other forms of insurance (OR 0.65, 95% CI: 0.52, 0.82, p = 0.0002).Conclusion
OF is the strongest predictor of mortality in AP after adjusting for demographic, clinical, and hospital characteristics. Admission to HV or teaching hospital has no survival benefit in AP after adjusting for OF and transfer status. 相似文献15.
Stefano Andrianello Giovanni Marchegiani Giuseppe Malleo Tommaso Pollini Deborah Bonamini Roberto Salvia Claudio Bassi Luca Landoni 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2017,19(3):264-269
Background
Biliary fistula (BF) occurs in 3–8% of patients following pancreaticoduodenectomy (PD). It usually pursues a benign course, but rarely may represent a life-threatening event.Study design
Data from 1618 PDs were collected prospectively. BF was defined as the presence of bile stained fluid from drains by post-operative day 3 and confirmed by sinogram in the majority of cases. Three classifications were validated.Results
BF occurred in 58 (3.6%) patients. In 22 cases was associated with pancreatic fistula (POPF). POPF, PPH, operative time and a smaller common bile duct (CBD) were significantly associated with BF. Only CBD diameter (HR 0.55, CI 95% 0.44–0.7, p < 0.01) was an independent predictor of BF. Patients with smaller CBDs developing concomitant BF and POPF carried the highest mortality rate (34.8%, n = 8/22). All the existing classifications resulted in discrete categories of BFs when considering hospital stay and total cost as dependent variables.Conclusions
Biliary fistula is rare, but it can be life threatening when associated with POPF. As the sole independent risk factor is the CBD diameter, surgical technique is crucial. Regardless of the existing classification systems, further studies must assess the additive burden of BF when a concomitant POPF is present. 相似文献16.
Mustafa Raoof Aaron Lewis Leanne Goldstein Sinziana Dumitra Susanne G. Warner Gagandeep Singh Yuman Fong Laleh Melstrom 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2017,19(4):371-377
Background
In order to decrease cost and increase healthcare quality there is an ongoing effort to reduce readmissions after complex operations. The timing and severity of post-discharge complications after hepatectomy need to be better defined.Methods
All patients undergoing liver resection at a single institution from Jan 2009–Jun 2015 were included. Complications were scored using the comprehensive complication index (CCI). Multivariate analysis is performed using logistic regression. Receiver operating characteristics (ROCs) were analyzed to optimize the Readmission Risk Index (RRI).Results
Of the 258 patients that met the inclusion criteria, 26 (10%) were readmitted within 30 days of discharge after hepatectomy. On multivariate analysis age ≥68 years (OR 3.76; 95% CI 1.47–9.63, p = 0.006), CCI ≥ 15 (OR 3.65; 95% CI 1.39–9.56, p = 0.008), maximum temperature within 48 h of discharge (OR 3.02; 95% CI 1.17–7.75, p = 0.022) and white blood cell count ≥10.2 billion cells/L within 48 h of discharge (OR 2.88; 95% CI 1.04–8, p = 0.043) were independent predictors of 30-day readmission. These variables were used to develop the RRI (ROC area 0.80; 95% CI 0.70–0.9, p < 0.001).Conclusion
The CCI and pre-discharge variables can help identify individuals at risk of readmission. Readmission risk reduction efforts should focus on this subset of patients. 相似文献17.
Callisia N. Clarke Haesun Choi Ping Hou Catherine H. Davis Jingfei Ma Asif Rashid Jean-Nicolas Vauthey Thomas A. Aloia 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2017,19(8):706-712
Background
The obesity epidemic has significantly increased the incidence and severity of hepatic steatosis in liver surgery patients and liver donors, potentially impacting postoperative liver regeneration and function. Development of a non-invasive means to quantify hepatic steatosis would facilitate selection of candidates for liver resection and transplant donation.Methods
An IRB-approved protocol prospectively enrolled 28 patients with liver tumors requiring hepatic resection. In all patients, fast dual-echo gradient-echo MR images were acquired using 2-Point Dixon technique in 2D and 3D. The degree of steatosis was quantified by percent fat fraction (%FF) from in- and out-of-phase, and water-only and fat-only images. The technique-specific %FFs were compared to intraoperative and histopathological findings.Results
For patients with >30% steatosis by histology, the mean %FF was 22% (SD ± 5.2%) compared to a mean %FF of 5.0% (SD ± 2.1%, p = 0.0001) in patients with <30% steatosis. Using scaled values for the MR-calculated %FF, all patients with >30% pathologic steatosis could be identified preoperatively.Conclusions
Quantitative MRI identified patients with clinically-relevant steatosis with 100% accuracy. These findings could have significant impact on the management of liver resection patients and transplant donors. 相似文献18.
Aafke H. van Dijk Philip R. de Reuver Marc G. Besselink Kees J. van Laarhoven Ewen M. Harrison Stephen J. Wigmore Tom J. Hugh Marja A. Boermeester 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2017,19(4):297-309
Background
Gallstone disease is a frequent disorder in the Western world with a prevalence of 10–20%. Recommendations for the assessment and management of gallstones vary internationally. The aim of this systematic review was to assess quality of guideline recommendations for treatment of gallstones.Methods
PubMed, EMBASE and websites of relevant associations were systematically searched. Guidelines without a critical appraisal of literature were excluded. Quality of guidelines was determined using the AGREE II instrument. Recommendations without consensus or with low level of evidence were considered to define problem areas and clinical research gaps.Results
Fourteen guidelines were included. Overall quality of guidelines was low, with a mean score of 57/100 (standard deviation 19). Five of 14 guidelines were considered suitable for use in clinical practice without modifications. Ten recommendations from all included guidelines were based on low level of evidence and subject to controversy. These included major topics, such as definition of symptomatic gallstones, indications for cholecystectomy and intraoperative cholangiography.Conclusion
Only five guidelines on gallstones are evidence-based and of a high quality, but even in these controversy exists on important topics. High quality evidence is needed in specific areas before an international guideline can be developed and endorsed worldwide. 相似文献19.
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20.
David G. Brauer Matthew S. Strand Dominic E. Sanford Vladimir M. Kushnir Kian-Huat Lim Daniel K. Mullady Benjamin R. Tan Andrea Wang-Gillam Ashley E. Morton Marianna B. Ruzinova Parag J. Parikh Vamsi R. Narra Kathryn J. Fowler Majella B. Doyle William C. Chapman Steven S. Strasberg William G. Hawkins Ryan C. Fields 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2017,19(2):133-139