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Lotte C. Franken Pim B. Olthof Joris I. Erdmann Otto M. van Delden Joanne Verheij Marc G. Besselink Olivier R. Busch Thomas M. van Gulik 《肝胆外科与营养》2021,10(2):154
BackgroundThe only potentially curative option for patients with perihilar cholangiocarcinoma (PHC) is resection, typically an extrahepatic bile duct resection in combination with (extended) liver resection. Complications such as bile leakage and liver failure have been suggested to be more common after right-sided resections compared to left-sided resections, whilst superior oncological outcomes have been reported after right-sided resections. However, data on outcomes after right-sided or left-sided liver resections in PHC are scarce. Therefore, we aimed to investigate short- and long-term outcomes after left and right hemihepatectomy in patients with PHC.MethodsIn this retrospective study, patients undergoing major liver resection for suspected PHC in a tertiary center between 2000–2018 were included. Patients who had undergone left-sided resections were compared to patients with right-sided resections in terms of complications (90-day mortality, overall and severe morbidity and specific complications). For long-term outcomes, only patients with pathologically proven PHC were included in the survival analysis.ResultsA total of 178 patients undergoing hemihepatectomy for suspected PHC were analysed, including 76 left-sided and 102 right-sided resections. Overall 90-day mortality was 14% (24 out of 178), with no significant difference after left-sided resection (11%; 8 out of 76) versus right-sided resection (16%; 16 out of 102) (P=0.319). Severe morbidity (Clavein Dindo ≥3) was also comparable in both groups: 54% versus 61% (P=0.361). No differences in specific complications including bile leakage were observed, although liver failure appeared to occur more frequently after right hemihepatectomy (22% versus 11%, P=0.052). Five-year overall survival for pathologically proven PHC, excluding in-hospital mortality, did not differ; 43.7% after left-sided resection vs. and 38.2% after right-sided resection (P=0.553).ConclusionsBoth short- and long-term outcomes between patients undergoing left and right hemihepatectomy for PHC were comparable. Post-hepatectomy liver failure was more common after right-sided resection. 相似文献
44.
de Geus HJ Besselink H Brouwer A Klungsøyr J McHugh B Nixon E Rimkus GG Wester PG de Boer J 《Environmental health perspectives》1999,107(Z1):115-144
Toxaphene production, in quantities similar to those of polychlorinated biphenyls, has resulted in high toxaphene levels in fish from the Great Lakes and in Arctic marine mammals (up to 10 and 16 microg g-1 lipid). Because of the large variabiliity in total toxaphene data, few reliable conclusions can be drawn about trends or geographic differences in toxaphene concentrations. New developments in mass spectrometric detection using either negative chemical ionization or electron impact modes as well as in multidimensional gas chromatography recently have led researchers to suggest congener-specific approaches. Recently, several nomenclature systems have been developed for toxaphene compounds. Although all systems have specific advantages and limitations, it is suggested that an international body such as the International Union of Pure and Applied Chemistry make an attempt to obtain uniformity in the literature. Toxicologic information on individual chlorobornanes is scarce, but some reports have recently appeared. Neurotoxic effects of toxaphene exposure such as those on behavior and learning have been reported. Technical toxaphene and some individual congeners were found to be weakly estrogenic in in vitro test systems; no evidence for endocrine effects in vivo has been reported. In vitro studies show technical toxaphene and toxaphene congeners to be mutagenic. However, in vivo studies have not shown genotoxicity; therefore, a nongenotoxic mechanism is proposed. Nevertheless, toxaphene is believed to present a potential carcinogenic risk to humans. Until now, only Germany has established a legal tolerance level for toxaphene--0.1 mg kg-1 wet weight for fish. 相似文献
45.
Timothy H. Mungroop Bart F. Geerts Denise P. Veelo Timothy M. Pawlik Aurélie Bonnet Mickaël Lesurtel Koen M. Reyntjens Takehiro Noji Chao Liu Eduard Jonas Christopher L. Wu Eduardo de Santibañes Mohammed Abu Hilal Markus W. Hollmann Marc G. Besselink Thomas M. van Gulik 《Surgery》2019,165(2):337-344
Background
Fluid and pain management during liver surgery (eg, low central venous pressure) is a classic topic of controversy between anesthesiologists and surgeons. Little is known about practices worldwide. The aim of this study was to assess perioperative practices in liver surgery among and between surgeons and anesthesiologists worldwide that could guide the design of future international studies.Methods
An online questionnaire was sent to 22 societies, including 4 international hepatopancreatobiliary societies, the American Society of Anesthesiologists, and 17 other (inter-)national societies.Results
A total of 913 participants (495 surgeons and 418 anesthesiologists) from 66 countries were surveyed. A large heterogeneity in fluid management practices was identified, with 66% using low central venous pressure, 22% goal-directed fluid therapy, and 6% normovolemia. In addition, large heterogeneity was found regarding pain management practices, with 49% using epidural analgesia, 25% patient-controlled analgesia with opioids, and 12% regional techniques. Most participants assume that there is a relation between perioperative pain management and morbidity and mortality (78% of surgeons vs 89% of anesthesiologists; P < .001). Both surgeons and anesthesiologists have the highest expectations for minimally invasive surgery and enhanced recovery pathways for improving outcomes in liver surgery. No clear differences between continents were found.Conclusion
Worldwide there is a large heterogeneity in fluid and pain management practices in liver surgery. This survey identified several areas of interest for future international studies aiming to improve outcomes in liver surgery. 相似文献46.
47.
Proposal of success criteria for strabismus surgery in patients with Graves' orbitopathy based on a systematic literature review
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48.
Janneke van Grinsven Sandra van Brunschot Mark C. van Baal Marc G. Besselink Paul Fockens Harry van Goor Hjalmar C. van Santvoort Thomas L. Bollen The Dutch Pancreatitis Study Group 《Journal of gastrointestinal surgery》2018,22(9):1557-1564
Background
Decision-making on invasive intervention in patients with clinical signs of infected necrotizing pancreatitis is often related to the presence of gas configurations and the degree of encapsulation in necrotic collections on imaging. Data on the natural history of gas configurations and encapsulation in necrotizing pancreatitis are, however, lacking.Methods
A post hoc analysis was performed of a previously described prospective cohort in 21 Dutch hospitals (2004–2008). All computed tomography scans (CTs) performed during hospitalization for necrotizing pancreatitis were categorized per week (1 to 8, and thereafter) and re-assessed by an abdominal radiologist.Results
A total of 639 patients with necrotizing pancreatitis were included, with median four (IQR 2–7) CTs per patient. The incidence of first onset of gas configurations varied per week without a linear correlation: 2–3–13–11–10–19–12–21–12%, respectively. Overall, gas configurations were found in 113/639 (18%) patients and in 113/202 (56%) patients with infected necrosis. The incidence of walled-off necrosis increased per week: 0–3–12–39–62–76–93–97–100% for weeks 1–8 and thereafter respectively. Clinically relevant walled-off necrosis (largely or fully encapsulated necrotic collections) was seen in 162/379 (43%) patients within the first 3 weeks.Conclusions
Gas configurations occur in every phase of the disease and develop in half of the patients with infected necrotizing pancreatitis. Opposed to traditional views, clinically relevant walled-off necrosis occurs frequently within the first 3 weeks.49.
Jeroen L.A. van Vugt Marcia P. Gaspersz Robert J.S. Coelen Jaynee Vugts Tim A. Labeur Jeroen de Jonge Wojciech G. Polak Olivier R.C. Busch Marc G. Besselink Jan N.M. IJzermans Chung Y. Nio Thomas M. van Gulik François E.J.A. Willemssen Bas Groot Koerkamp 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2018,20(1):83-92
Background
Although several classifications of perihilar cholangiocarcinoma (PHC) include vascular involvement, its prognostic value has not been investigated. Our aim was to assess the prognostic value of unilateral and main/bilateral involvement of the portal vein (PV) and hepatic artery (HA) on imaging in patients with PHC.Methods
All patients with PHC between 2002 and 2014 were included regardless of stage or management. Vascular involvement was defined as apparent tumor contact of at least 180° to the PV or HA on imaging. Kaplan–Meier method with log-rank test was used to compare overall survival (OS) between groups. Cox regression was used for multivariable analysis.Results
In total, 674 patients were included with a median OS of 12.2 (95% CI 10.6–13.7) months. Patients with unilateral PV involvement had a median OS of 13.3 (11.0–15.7) months, compared with 14.7 (11.7–17.6) in patients without PV involvement (p = 0.12). Patients with main/bilateral PV involvement had an inferior median OS of 8.0 (5.4–10.7, p < 0.001) months.Median OS for patients with unilateral HA involvement was 10.6 (9.3–12.0) months compared with 16.9 (13.2–20.5) in patients without HA involvement (p < 0.001). Patients with main/bilateral HA involvement had an inferior median OS of 6.9 (3.3–10.5, p < 0.001). Independent poor prognostic factors included unilateral and main/bilateral HA involvement, but not PV involvement.Conclusion
Both unilateral and main HA involvement are independent poor prognostic factors for OS in patients presenting with PHC, whereas PV involvement is not. 相似文献50.
Annemiek M. Dekker Jimme K. Wiggers Robert J. Coelen Rowan F. van Golen Marc G.H. Besselink Olivier R.C. Busch Joanne Verheij Markus W. Hollmann Thomas M. van Gulik 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2016,18(3):262-270