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1.
Dmitri Bezinover Ethan Reeder Faisal Aziz Fuat Saner Patrick McQuillan Zakiyah Kadry Thomas Riley Dmitri Guvakov Piotr K. Janicki 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2017,19(7):620-628
Background
Perioperative vascular thrombotic events in patients undergoing liver transplantation (LT) are associated with significant morbidity and mortality.Methods
In this retrospective UNOS database analysis, we evaluated the prevalence of portal vein thrombosis (PVT) and factors contributing to PVT development in different ethnic groups.Results
Of the 47 953 LT performed between 2002 and 2015, we identified 3642 cases of PVT. African Americans (AA) had a significantly lower prevalence of PVT compared to other ethnic groups (p = 0.0001). Multivariable regression analysis confirmed that AA were less likely than other ethnicities to have PVT (OR = 0.6). AA cohort was more likely to have infectious or autoimmune causes of liver failure (OR = 1.6, 1.7 respectively) as well as higher creatinine and INR compared to other groups (OR = 1.6, 1.3 respectively). AA's were less likely to have encephalopathy, ascites, or variceal bleeding, which might indicate lower portal pressures. AA's were listed for LT later than other ethnicities and had both a lower functional status and higher MELD score at the time of registration.Discussion
AA's had a significantly lower prevalence of preoperative PVT despite having a greater number of factors predisposing to thrombosis. This predisposition should be considered before instituting perioperative antithrombotic therapy. 相似文献2.
Nicolas Golse Kayvan Mohkam Agnès Rode Pierre Pradat Christian Ducerf Jean-Yves Mabrut 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2017,19(6):498-507
Background
Indications for splenectomy (SP) during whole liver transplantation (LT) remain controversial and SP is often avoided because of common complications. We aimed to evaluate specific complications of these combined procedures.Methods
Data were retrospectively analysed. Splenectomy was performed in patients with splenorenal shunt and/or splenic artery aneurysms or hypersplenism. Patients undergoing simultaneous transplantation and splenectomy (LTSP group) were matched to a non-splenectomy group (LT group).Results
Between 1994 and 2013, we included 47 and 94 patients in LTSP and LT groups, respectively. The LTSP patients had a higher rate of pre-LT portal vein thrombosis (PVT). The LTSP group had a longer operative time and greater blood loss. Mean follow-up was 101 months and 5-year survivals were identical (LTSP 85% vs LT 88%, p = 0.831). Hospital morbidity and rejection incidence were comparable, whereas de novo PVT (34% vs 2%, p < 0.0001) and infection (47% vs 25%, p = 0.014) rates were higher after SP.Conclusion
Splenectomy during LT is technically demanding and exposes recipients to a higher thrombosis rate, therefore portal vein patency must be specifically assessed postoperatively. In selected recipients, SP can be performed without increased mortality but at the price of worsening outcome as evidenced by greater risk of infection and PVT. 相似文献3.
Claire L. Stevens Andrew Awad Saleh M. Abbas David A.K. Watters 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2017,19(8):653-658
Background
Surgical techniques and pre-operative patient evaluation have improved since the initial development of the Barcelona clinic liver cancer staging system. The optimal treatment for solitary hepatocellular carcinoma ≥5 cm remains unclear. The aim of this study was to review the long-term survival outcomes of hepatic resection versus transarterial chemoembolisation (TACE) for solitary large tumours.Methods
EMBASE, MEDLINE, Pubmed and the Cochrane database were searched for studies comparing resection with TACE for solitary HCC ≥5 cm. The primary outcome was overall survival at 1, 3 and 5 years.Results
The meta-analysis combined the results of four cohort studies including 861 patients where 452 underwent hepatic resection and 409 were treated with TACE to an absence of viable tumour. The pooled HR for 3 year OS rate calculated using the random effects model was 0.60 (95% CI 0.46–0.79, p < 0.001; I2 = 54%, P = 0.087). The pooled HR for 5 year OS rate calculated using the random effects model was 0.59 (95% CI 0.43–0.81, p = 0.001; I2 = 80%, P = 0.002).Conclusion
Hepatic resection has been shown to result in greater survivability and time to disease progression than TACE for solitary HCC ≥5 cm. Where a patient is fit for surgery, has adequate liver function and a favourable tumour, resection should be considered. 相似文献4.
Shogo Fukutomi Yoriko Nomura Osamu Nakashima Hirohisa Yano Hiroyuki Tanaka Yoshito Akagi Koji Okuda 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2017,19(12):1119-1125
Background/Purpose
The pattern of tumor cell spread via the portal system has not been fully clarified in patients with hepatocellular carcinoma (HCC). This study aimed to evaluate the intrahepatic distribution of cancer cells derived from the main tumor by assessing histological portal invasion and/or intrahepatic metastasis (vp/im).Methods
In 14 patients who underwent anatomical resection of primary solitary HCC ≤ 50 mm in diameter, vp/im were examined pathologically, and the sites of the lesions were reproduced on preoperative 3D-CT images. The number of vp/im and the distance of each lesion from the tumor margin were also determined.Results
The tumor diameter was <30 mm in seven patients (smaller HCCs) and 30–50 mm in seven patients (larger HCCs). 3D mapping revealed that almost all vp/im were localized to the peritumoral area within one cm of the tumor margin in smaller HCCs, whereas vp/im seemed to spread extensively to the feeding 3rd level portal branches in larger HCCs. The number of vp/im was greater in patients with larger HCCs than in those with smaller HCCs.Conclusions
3D mapping suggested tumor cells of HCC spread via the portal vein extensively in several cases. 相似文献5.
Fei Ji Yao Liang Shunjun Fu Dubo Chen XiuQin Cai Shaoqiang Li Baogang Peng Lijian Liang Yunpeng Hua 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2017,19(8):695-705
Background
Malnutrition and immunological status are associated with survival in many cancers. Prognostic nutritional index (PNI) and body mass index (BMI) are recognized immune-nutritional indices and associated with postoperative outcome in hepatocellular carcinoma (HCC) patients. However, this association is still controversial. Our aim was to determine whether the combination of PNI and BMI is better than either alone in HCC patients' prognosis.Material and methods
Preoperative PNI and BMI, patient demographics, clinical and pathological data from 322 HCC patients were collected and analyzed.Results
Low PNI was correlated with age, cirrhosis, total bilirubin (TBIL) ≥34.2 μmol/L, and recurrence. Likewise, low BMI was associated with TBIL ≥34.2 μmol/L, portal vein tumor thrombi (PVTT), tumor size, tumor differentiation, TNM stage, and recurrence. Multivariate analysis identified TNM stage, PVTT, tumor size, PNI, and BMI as independent predictors of outcome in HCC patients. Low PNI combined with BMI (PNI + BMI) accurately predicted poorer outcome, particularly in patients with TNM stage I HCC. The predictive range of PNI + BMI was more sensitive than that of either alone.Conclusions
preoperative PNI/BMI is an independent predictor of outcome for HCC patients, especially in patients with early stage HCC. Intriguingly, the PNI + BMI combination can enhance the accuracy of prognosis. 相似文献6.
Yanming Zhou Lupeng Wu Dong Xu Tao Wan Xiaoying Si 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2017,19(9):768-774
Background
Limited data are currently available to address the safety and efficacy of combined resection of the liver and inferior vena cava (IVC) for hepatic malignancies.Methods
A systematic review was performed to identify relevant studies. Pooled individual data were examined for the clinical outcome of combined resection of the liver and IVC for hepatic malignancies.Results
A total of 258 patients were described in 38 articles eligible for inclusion. Resections were performed for colorectal liver metastasis (CLM) [n = 128 (50%)], intrahepatic cholangiocarcinoma (ICC) [n = 51 (20%)], hepatocellular carcinoma (HCC) [n = 48 (19%)], and other pathologies [n = 31 (11%)]. There were 14 (5%) perioperative deaths. The median survival duration was 34 months, and the 1-, 3- and 5-year overall survival (OS) rate was 79%, 46% and 33%, respectively. The 5-year OS rate was 26% for CLM, 37% for ICC, and 30% for HCC.Conclusion
Combined resection of the liver and IVC for hepatic malignancies is safe and applicable, and offers acceptable survival outcomes. 相似文献7.
Pim B. Olthof Robert J.S. Coelen Jimme K. Wiggers Bas Groot Koerkamp Massimo Malago Roberto Hernandez-Alejandro Stefan A. Topp Marco Vivarelli Luca A. Aldrighetti Ricardo Robles Campos Karl J. Oldhafer William R. Jarnagin Thomas M. van Gulik 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2017,19(5):381-387
Introduction
Resection of perihilar cholangiocarcinoma (PHC) entails high-risk surgery with postoperative mortality reported up to 18%, even in specialized centers. The aim of this study was to compare outcomes of PHC patients who underwent associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) to patients who underwent resection without ALPPS.Methods
All patients who underwent ALPPS for PHC were identified from the international ALPPS registry and matched controls were selected from a standard resection cohort from two centers based on future remnant liver size. Outcomes included morbidity, mortality, and overall survival.Results
ALPPS for PHC was associated with 48% (14/29) 90-day mortality. 90-day mortality was 13% in 257 patients who underwent major liver resection for PHC without ALPPS. The 29 ALPPS patients were matched to 29 patients resected without ALPPS, with similar future liver remnant volume (P = 0.480). Mortality in the matched control group was 24% (P = 0.100) and median OS was 27 months, comparted to 6 months after ALPPS (P = 0.064).Discussion
Outcomes of ALPPS for PHC appear inferior compared to standard extended resections in high-risk patients. Therefore, portal vein embolization should remain the preferred method to increase future remnant liver volume in patients with PHC. ALPPS is not recommended for PHC. 相似文献8.
Hideaki Uchiyama Shinji Itoh Tomoharu Yoshizumi Toru Ikegami Norifumi Harimoto Yuji Soejima Noboru Harada Kazutoyo Morita Takeo Toshima Takashi Motomura Yoshihiko Maehara 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2017,19(12):1082-1090
Background
Expanding patient selection beyond the Milan criteria in living donor liver transplantation (LDLT) for hepatocellular carcinoma (HCC) has long been a matter for debate. We have used the Kyushu University Criteria – maximum tumor diameter <5 cm or des-γ-carboxy prothrombin <300 mAU/ml – in LDLT for HCC since June 2007. The aim of the present study was to present the results of our prospective patient selection by Kyushu University Criteria and to confirm whether or not our criteria were justified.Methods
The entire study period was divided into the pre-Kyushu era (July 1999–May 2007) and the Kyushu era (June 2007–November 2014). Eighty-nine and 90 patients underwent LDLT for HCC in the pre-Kyushu era and the Kyushu era, respectively.Results
In the pre-Kyushu era, there were significant differences in recurrence-free and disease-specific survival between the beyond-Milan and the within-Milan patients. In the Kyushu era, however, the differences in recurrence-free and disease-specific survival between the beyond-Milan and the within-Milan patients disappeared. The 5-year overall patient survival in the Kyushu era was 89.4%.Conclusion
Our selection criteria enabled a considerable number of beyond-Milan patients to undergo LDLT without jeopardizing the recurrence-free, and disease-specific, and overall patient survival. 相似文献9.
Matthew D. Taussig Mary Ellen Irene Koran Samdeep K. Mouli Asma Ahmad Sunil Geevarghese Jennifer C. Baker Andrew J. Lipnik Fil Banovac Daniel B. Brown 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2017,19(5):458-464
Background
Prospectively predicting response to intra-arterial therapy for hepatocellular carcinoma (HCC) is challenging. Neutrophil/lymphocyte ratio (NLR) is a serum biomarker that is associated with survival for multiple malignancies. It was hypothesized that increased NLR would be associated with early disease progression after intra-arterial therapy of HCC.Methods
The outcomes of 86 treatment-naïve patients who had chemoembolization or radioembolization of HCC between July 2013–July 2014 were reviewed. Pre-treatment laboratory tests and imaging were used to measure NLR, Child-Pugh (CP) score, tumor number and tumor size. High/low NLR groups were defined as >3 and <3 respectively. Follow-up imaging at two months with assessed response using modified response criteria in solid tumors (mRECIST).Results
NLR >3 was seen in 25/86 patients (range 3.0–21.6). NLR >3 patients had a significantly higher baseline CP score. Comorbidities were otherwise similar between groups as was tumor number/size. Disease control was significantly worse (p = 0.014) with NLR >3. Logistic regression for tumor response revealed NLR >3 as the best predictor of early progression (p < 0.0001).Discussion
NLR may be a serologic biomarker of early progressive disease after intra-arterial therapy of HCC. Future research should focus on outcomes by treatment type or potentially combining arterial therapies with ablation and/or targeted biologic agents. 相似文献10.
Xiaobin Feng Yongjie Su Shuguo Zheng Feng Xia Kuansheng Ma Jun Yan Xiaowu Li Wei Tang Shuguang Wang Ping Bie Jiahong Dong 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2017,19(8):667-674
Background
The aim of this study was to determine the effect of anatomic resection (AR) versus non-anatomic resection (NAR) on recurrence rates in patients with hepatocellular carcinoma (HCC).Methods
Eligible patients were randomized to AR or NAR from January 2006 to July 2007 at a single center. The primary outcome was the 2-year recurrence-free survival (RFS). Secondary outcomes were postoperative complications, time to first recurrence, 1-, 3-, and 5-year RFS, and overall survival (OS).Results
Fifty-three (51%) and 52 (50%) patients underwent NAR and AR, respectively. A larger proportion of patients achieved margins ≥20 mm in the AR group (52% vs. 30%; P = 0.023). Complications (blood loss, transfusion requirement, and hospital stay) were similar between the two groups. Median follow-up was 33 (range, 2–77) months. Incidence of local recurrence at 2 years was 30% and 59% in the AR and NAR groups, respectively. Median time to first local recurrence in the AR group was significantly longer than in the NAR group (53 vs. 10 months, P = 0.010). There was no difference in overall RFS between the two groups (P = 0.290).Discussion
AR decreased the 2-year local recurrence rate and increased the time to first local recurrence compared to NAR in patients with HCC. 相似文献11.
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12.
Haruyoshi Tanaka Akimasa Nakao Kenji Oshima Kiyotsugu Iede Yukiko Oshima Hironobu Kobayashi Yasunori Kimura 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2017,19(9):785-792
Background
Superior mesenteric vein–portal vein confluence resection combined with pancreatoduodenectomy (SMPVrPD) is occasionally required for resection of pancreatic head tumors. It remains unclear whether such situations require splenic vein (SV) reconstruction for decompression of left-sided portal hypertension (LSPH).Methods
The data from 93 of 104 patients who underwent pancreatoduodenectomy (PD) for pancreatic head malignancies were reviewed. Surgical outcomes in three groups—standard PD (control group), PD combined with vascular resection and SV preservation (SVp group), and SMPVrPD with SV resection (SVr group)—were compared. The influence of division and preservation of the two natural confluences (left gastric vein–portal vein and/or inferior mesenteric vein–SV confluences) on portal hemodynamics were evaluated using three-dimensional computed tomographic portography.Results
No mortality occurred. The morbidity rates were not significantly different among the three groups (18/43, 8/21, and 7/29, respectively; p = 0.306). In the SVr group, three patients had gastric remnant venous congestion, and three had esophageal varices without hemorrhagic potential. No patients had splenomegaly, or severe or prolonged thrombocytopenia. These LSPH-associated findings were less frequently observed when the two confluences were preserved.Conclusions
SMPVrPD without SV reconstruction can be safely conducted. Additionally, preservation of these two confluences may reduce the risk of LSPH. 相似文献13.
Alison A. Smith Michael Darden Zaid Al-Qurayshi Anil S. Paramesh Mary Killackey Emad Kandil Geoffrey Parker Luis Balart Paul Friedlander Joseph F. Buell 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2017,19(9):793-798
Background
Racial disparity in access to liver transplantation among African Americans (AA) compared to Caucasians (CA) has been well described. The aim of this investigation was to examine the presentation of AA liver transplant recipients in a socioeconomically challenged region.Methods
680 adult liver transplant candidates and 233 resultant recipients between 2007 and 2015 were analyzed using univariate and multivariate analyses to evaluate factors significant for transplantation.Results
Percentages of wait list patients transplanted were similar between CA and AA (34.9% vs. 32.2%, p = 0.5205). AA were younger (50.4 ± 1.8 vs. 56.3 ± 0.7 yrs, p = 0.0003) with higher average MELD scores (22.9 ± 1.6 vs. 19.4 ± 0.7, p = 0.0230). Overall patient mortality was similar (AA 22.7% vs. CA 26.3%, p = 0.5931). A multiple linear regression showed that male gender was strongly associated with transplantation.Conclusions
Equal access to liver transplantation remains challenging for racial minorities. At our institution, AA were accepted and transplanted at an equivalent rate as CA despite a higher AA population, HCV rate and diagnosed HCC. AA were younger and sicker at the time of transplant, but overall had similar outcomes compared to CA. Our study highlights the need for studies to delineate the underpinnings of disparity in transplantation access. 相似文献14.
Ahmer M. Hameed Germaine Wong Jerome M. Laurence Vincent W.T. Lam Henry C. Pleass Wayne J. Hawthorne 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2017,19(11):933-943
Background
This study aimed to identify the most effective solution for in situ perfusion/preservation of the pancreas in donation after brain death donors, in addition to optimal in situ flush volume(s) and route(s) during pancreas procurement.Methods
Embase, Medline and Cochrane databases were utilized (1980–2017). Articles comparing graft outcomes between two or more different perfusion/preservation fluids (University of Wisconsin (UW), histidine–tryptophan–ketoglutarate (HTK) and/or Celsior) were compared using random effects models where appropriate.Results
Thirteen articles were included (939 transplants). Confidence in available evidence was low. A higher serum peak lipase (standardized mean difference 0.47, 95% CI 0.23–0.71, I2 = 0) was observed in pancreatic grafts perfused/preserved with HTK compared to UW, but there were no differences in one-month pancreas allograft survivals or early thrombotic graft loss rates. Similarly, there were no significant differences in the rates of graft pancreatitis, thrombosis and graft survival between UW and Celsior solutions, and between aortic-only and dual aorto-portal perfusion.Conclusion
UW cold perfusion may reduce peak serum lipase, but no quality evidence suggested UW cold perfusion improves graft survival and reduces thrombosis rates. Further research is needed to establish longer-term graft outcomes, the comparative efficacy of Celsior, and ideal perfusion volumes. 相似文献15.
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16.
Thiery Chapelle Bart Op de Beeck Geert Roeyen Bart Bracke Vera Hartman Kathleen De Greef Ivan Huyghe Thijs Van der Zijden Stuart Morrison Sven Francque Dirk Ysebaert 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2017,19(2):108-117
Background
Estimation of the future liver remnant function (eFLRF) can avoid post-hepatectomy liver failure (PHLF). In a previous study, a cutoff value of 2.3%/min/m2 for eFLRF was a better predictor of PHLF than future liver remnant volume (FLRV%). In this prospective interventional study, investigating a management strategy aimed at avoiding PHLF, this cutoff value was the sole criterion assessing eligibility for hepatectomy, with or without portal vein occlusion (PVO).Methods
In 100 consecutive patients, eFLRF was determined using the formula: eFLRF = FLRV% × total liver function (TLF). Group 1 (eFLRF >2.3%/min/m2) underwent hepatectomy without preoperative intervention. Group 2 (eFLRF <2.3%/min/m2) underwent PVO and re-evaluation of eFLRF at 4–6 weeks. Hepatectomy was performed if eFLRF had increased to >2.3%/min/m2, but was considered contraindicated if the value remained lower.Results
In group 1 (n = 93), 1 patient developed grade B PHLF. In group 2 (n = 7) no PHLF was recorded. Postoperative recovery of TLF in patients with preoperative eFLRF <2.3%/min/m2 occurred more rapidly when PVO had been performed.Conclusion
A predefined cutoff for preoperatively calculated eFLRF can be used as a tool for selecting patients prior to hepatectomy, with or without PVO, thus avoiding PHLF and PHLF-related mortality. 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.
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19.
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20.
Joal D. Beane Michael G. House Susan C. Pitt Ben Zarzaur E. Molly Kilbane Bruce L. Hall Taylor S. Riall Henry A. Pitt 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2017,19(3):254-263