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Liver resection and metabolic disorders: An undescribed mechanism leading to postoperative mortality

World Journal of Gastroenterology 2014年第39期20卷 14455-14462页

作者： alban zarzavadjian le bian Renato Costi Mohamed Said Sbai-Idrissi Claude Smadja Service de Chirurgie Digestive H?pital Antoine BéclèreClamart Assistance Publique-H?pitaux de ParisUniversité Paris Sud-XI 91400 Orsay France Laboratoire d’Ethique Médicale et de Médecine Légale Université Paris Descartes-V 75006 Paris France Service de Chirurgie Digestive H?pital Simone Veil95600 Eaubonne France Dipartimento di Scienze Chirurgiche Università degli Studi di Parma 43100 Parma Italy

AIM: To investigate the mechanism leading to perioperative mortality in patients undergoing major liver resection and presenting with metabolic disorders.

关键词： Metabolic syndrome Major hepatectomy Liver resection Postoperative mortality Hepatorenal syndrome

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Consequences of metabolic syndrome on postoperative outcomes after pancreaticoduodenectomy

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World Journal of Gastroenterology 2017年第17期23卷 3142-3149页

作者： alban zarzavadjian le bian David Fuks Sophie Chopinet Sébastien Gaujoux Manuela Cesaretti Renato Costi Ajay P Belgaumkar Claude Smadja Brice Gayet Department of Digestive Surgery Centre Hospitalier Simone Veil Laboratory of Medical Ethics and legal Medicine University Paris Descartes Department of Digestive disease-Institut Mutualiste Montsouris UniversitéParis Descartes Department of Digestive Surgery Assistance PubliqueHopitaux de Paris Hopital Cochin Department of Digestive Surgery Assistance PubliqueHopitaux de Paris Hopital Antoine Béclère157 rue de la Porte Trivaux Boulevard Général Leclerc

AIM To analyze immediate postoperative outcomes after pancreaticoduodenectomy regarding metabolic *** In two academic centers, postoperative outcomes of patients undergoing pancreaticoduodenectomy from 2002 to 2014 were prospectively recorded. Patients presenting with metabolic syndrome [defined as at least three criteria among overweight(BMI ≥ 28 kg/m2), diabetes mellitus, arterial hypertension and dyslipidemia] were compared to patients without metabolic *** Among 270 consecutive patients, 29(11%) presented with metabolic syndrome. In univariable analysis, patients with metabolic syndrome were significantly older(69.4 years vs 62.5 years, P = 0.003) and presented more frequently with soft pancreas(72% vs 22%, P = 0.0001). In-hospital morbidity(83% vs 71%) and mortality(7% vs 6%) did not differ in the two groups so as pancreatic fistula rate(45% vs 30%, P = 0.079) and severity of pancreatic fistula(P = 0.257). In multivariable analysis, soft pancreas texture(P = 0.001), pancreatic duct diameter 30 kg/m2(P = 0.041) were identified as independent risk factors of pancreatic fistula after pancreaticoduodenectomy, but not metabolic *** In spite of logical reasoning and appropriate methodology, present series suggests that metabolic syndrome does not jeopardize postoperative outcomes after pancreaticoduodenectomy. Therefore, definition of metabolic syndrome seems to be inappropriate and fatty pancreas needs to be assessed with an international consensual histopathological classification.

关键词： Soft pancreas Postoperative outcomes Metabolic syndrome Pancreaticoduodenectomy

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Metabolic syndrome and non-alcoholic fatty liver disease in liver surgery: The new scourges?

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World Journal of Hepatology 2014年第5期6卷 306-314页

作者： Francois Cauchy David Fuks alban zarzavadjian le bian Jacques Belghiti Renato Costi Service de Chirurgie Hépato-Bilio-Pancréatique et Transplantation Hépatique Hopital BeaujonAssistance Publique-Hopitaux de Paris92110 ClichyFrance Laboratoire de Recherche en Ethique Médicale et Médecine Légale Universitéde Paris 5 Descar-tes75006 ParisFrance Dipartimento di Scienze Chirurgiche Univer-sitàdegli Studi di ParmaAzienda Ospedaliero-Universitaria diParma43100 ParmaItaly

The aim of this topic highlight is to review relevant evidence regarding the influence of the metabolic syndrome(MS) and its associated liver manifestation, non-alcoholic fatty liver disease(NAFLD), on the development of liver cancer as well as their impact on the results of major liver surgery. MS and NAFLD, whose incidences are significantly increasing in Western countries, are leading to a changing profile of the patients undergoing liver surgery. A MEDLINE search was performed for relevant articles using the key words "metabolic syndrome", "liver resection", "liver transplantation", "non alcoholic fatty liver disease", "non-alcoholic steatohepatitis" and "liver cancer". On one hand, the MS favors the development of primary liver malignancies(hepatocellular carcinoma and cholangiocarcinoma)either through NAFLD liver parenchymal alterations(steatosis, steatohepatitis, fibrosis) or in the absence of significant underlying liver parenchyma changes. Also, the existence of NAFLD may have a specific impact on colorectal liver metastases recurrence. On the other hand, the postoperative period following partial liver resection and liver transplantation is at increased risk of both postoperative complications and mortality. These deleterious effects seem to be related to the existence of liver specific complications but also higher cardio-vascular sensitivity in a setting of MS/NAFLD. Finally, the long-term prognosis after curative surgery joins that of patients operated on with other types of underlying liver diseases. An increased rate of patients with MS/NAFLD referred to hepatobiliary units has to be expected. The higher operative risk observed in this subset of patients will require specific improvements in their perioperative management.

关键词： Metabolic syndrome Non-alcoholic fatty liver disease Non-alcoholic steatohepatitis Neoplasia Hepatocarcinoma Liver surgery Complications Morbidity

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再次腹腔镜结直肠切除手术的安全性与可行性分析

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结直肠肛门外科 2020年第3期26卷 363-363页

作者：俞少俊 zarzavadjian le bian A GENSER L DENET C 浙江大学医学院附属第二医院大肠外科浙江杭州310003 不详

背景:再次腹腔镜结直肠切除术(repeat laparoscopic colorec⁃tal resection,LCRR)的围手术期结果尚未被广泛报道。方法:患者于2010—2018年在一家专家级医疗中心接受了LCRR手术治疗,他们的资料来源于一个前瞻性数据库且按照2:1进行了配... 详细信息

背景:再次腹腔镜结直肠切除术(repeat laparoscopic colorec⁃tal resection,LCRR)的围手术期结果尚未被广泛报道。方法:患者于2010—2018年在一家专家级医疗中心接受了LCRR手术治疗,他们的资料来源于一个前瞻性数据库且按照2:1进行了配比,配比因素基于人口统计学、外科手术指征【结直肠癌(colorectal cancer,CRC)或良性病变】,以及切除类型(右半结肠切除,或左半结肠切除,或直肠切除)方面的考虑。

关键词：右半结肠切除左半结肠切除直肠切除外科手术指征人口统计学围手术期结直肠癌可行性分析

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