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A ten-year experience of inferior vena cava reconstruction for malignancy:The importance of a multidisciplinary approach with hepatobiliary surgery

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Hepatobiliary & Pancreatic Diseases International 2020年第4期19卷 396-398页

作者： Maria R.Baimas-George Ryan C.Pickens jesse k.sulzer Dionisios Vrochides John B.Martinie David M.Levi David A.Iannitti Division of Hepatopancreatobiliary Surgery Department of SurgeryCarolinas Medical Center1025 Morehead Medical DriveSuite 600CharlotteNC 28204USA Division of Transplant Surgery Department of SurgeryCarolinas Medical CenterCharlotteNCUSA

To the Editor,Tumor invasion of the inferior vena cava(IVC)through direct erosion is a rare and poor prognostic feature of aggressive hepatic or perihepatic malignancies[1,2].Literature shows poor response to chemotherapy,such that resection often is the only option for improved survival[3].Multidisciplinary collaborations can expand technical options;incorporation of transplant techniques has led to successful R0 resection involving difficult vascular reconstruction and extended resection[4,5].This study describes and analyzes the ten-year collaborative experience of hepatobiliary(HPB)surgeons in management of malignancies involving the perihepatic IVC.

关键词： hepato hepatic invasion

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Prognostic impact of the Bismuth-Corlette classification:Higher rates of local unresectability in stageⅢb hilar cholangiocarcinoma

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Hepatobiliary & Pancreatic Diseases International 2020年第2期19卷 157-162页

作者： Michael J Passeri Maria R Baimas-George jesse k.sulzer David A Iannitti John B Martinie Erin H Baker Lee M Ocuin Dionisios Vrochides Division of HPB Surgery Department of SurgeryCarolinas Medical Center1025 Morehead Medical Dr.Suite 600CharlotteNC 28204USA

Background:The Bismuth-Corlette(BC)classification is used to categorize hilar cholangiocarcinoma by proximal extension along the biliary *** the right hepatic artery crosses just behind the left bile duct,we hypothesized that BCⅢb tumors would have a higher likelihood of local unresectability due to involvement of the contralateral ***:A retrospective review of a prospectively maintained database identified patients with hilar cholangiocarcinoma taken to the operating room for intended curative resection between April 2008 and September *** were assigned BC stages based on preoperative ***:Sixty-eight patients were included in the *** underwent staging laparoscopy after which 16 cases were aborted for metastatic *** the remaining 52 cases,14 cases were explored and aborted for locally advanced ***-eight underwent attempt at curative *** exclud-ing cases aborted for metastatic disease,the chance of proceeding with resection was 55.6%for BCⅢb staged lesions compared to 80.0%of BCⅢa lesions and to 82.4%for BCⅠ-Ⅲa staged lesions(Pkely involving the right hepatic artery.

关键词： Bismuth-Corlette stage Cholangiocarcinoma Biliary tract surgical procedures Biliary tree Liver surgery

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Laparoscopic liver resection in the cirrhotic patient

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Hepatoma Research 2016年第1期2卷 248-252页

作者： Ben Robichaux jesse sulzer Joseph F.Buell Department of Surgery Louisiana State University School of MedicineBaton RougeLA 70803USA Tulane Transplant Institute Departments of SurgeryTulane University School of MedicineNew OrleansLA 70112USA

Aim:The adoption of laparoscopic liver resection has been expansive in the last 2 decades with the exception of cirrhotic *** current study examines the outcomes of our cirrhotic resections to determine the potential limitations of this ***:Retrospective analysis of 114 cirrhotic ***-five(65.8%)laparoscopic resections were compared to 39 open ***-six(66.7%)resections in the series were minor resections(less than 3 segments).Surgical approach and extent of resection were analyzed using student’s t test and regression multivariate analysis with ***:The laparoscopic group had lower operative times(2.4 vs.4.8 h;P<0.001),blood loss(250 vs.609 mL;P<0.001),length of stay(4.4 vs.10.1 days;P=0.013)a nd c omplications(28%vs.48%;P=0.028).Subset analysis by technique and extent of resection identified the laparoscopic group lost the advantage in blood loss and lengths of stay when utilized in major *** regression analysis for blood loss further confirmed open resection(P=0.014)a nd major resection(P=0.026)a s significant i ndicators of bleeding and ***:Laparoscopic liver resection in cirrhotic patients is safe and ***,the significant variability in outcomes for major resections in cirrhotics leads us to recommend further examination of the learning curve and significant caution in the selection of cirrhotics requiring major hepatic resections.

关键词： Laparoscopic liver resection cirrhosis complications outcomes

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International assessment and validation of the prognostic role of lymph node ratio in patients with resected pancreatic head ductal adenocarcinoma

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Hepatobiliary Surgery and Nutrition 2022年第6期11卷 822-833页

作者： Gaetan-Romain Joliat Ismail Labgaa jesse sulzer Dionisios Vrochides Alessandro Zerbi Gennaro Nappo Julie Perinel Mustapha Adham Stijn van Roessel Marc G.Besselink JSven D.Mieog jesse V.Groen Nicolas Demartines Markus Schafer Department of Visceral Surgery Lausanne University Hospital CHUVLausanneSwitzerland Graduate School for Health Sciences University of BernBernSwitzerland Division of Hepatobiliary and Pancreatic Surgery Carolinas Medical CenterCharlotteNCUSA Humanitas Clinical and Research Center-IRCCS MilanItaly Department of Biomedical Sciences Humanitas UniversityMilanItaly Department of Digestive Surgery Edouard Herriot HospitalLyonFrance Department of Surgery Cancer Center AmsterdamAmsterdam UMCUniversity of AmsterdamAmsterdamThe Netherlands Department of Surgery Leiden University Medical CenterLeidenThe Netherlands

Background:Lymph node ratio(LNR;positive/harvested lymph nodes)was identified as overall survival predictor in several cancers,including pancreatic *** remains unclear if LNR is predictive of overall survival in pancreatic adenocarcinoma patients staged *** study assessed the prognostic overall survival role of LNR in pancreatic adenocarcinoma patients in relation with lymph node ***:A retrospective international study in six different centers(Europe and United States)was *** adenocarcinoma patients who underwent pancreatoduodenectomy from 2000 to 2017 were *** with neoadjuvant treatment,metastases,R2 resections,or missing data regarding nodal status were *** curves were calculated using kaplan-Meier method and compared using log-rank *** Cox regressions were performed to find independent overall survival predictors adjusted for potential ***:A total of 1,327 patients were *** node involvement(pN+)was found in 1,026 patients(77%),561 pN1(55%)and 465 pN2(45%).Median LNR in pN+patients was 0.214[interquartile range(IQR):0.105-0.364].On multivariable analysis,LNR was the strongest overall survival predictor in the entire cohort[hazard ratio(HR)=5.5;95%confidence interval(CI):3.1-9.9;P<0.001]and pN+patients(HR=3.8;95%CI:2.2-6.6;P<0.001).Median overall survival was better in patients with LNR<0.225 compared to patients with LNR≥0.225 in the entire cohort and pN+*** results were found in pN2 patients(worse overall survival when LNR≥0.225).Conclusions:LNR appeared as an important prognostic factor in patients undergoing surgery for pancreatic adenocarcinoma and permitted to stratify overall survival in pN2 *** should be routinely used in complement to tumor-node-metastasis(TNM)stage to better predict patient prognosis.

关键词： Pancreatectomy cancer lymphatic involvement

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