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Recurrence and survival following microwave, radiofrequency ablation, and hepatic resection of colorectal liver metastases: A systematic review and network meta-analysis

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Hepatobiliary & Pancreatic Diseases International 2021年第4期20卷 307-314页

作者： Paschalis Gavriilidis keith j roberts Nicola de’Angelis Luca Aldrighetti Robert P Sutcliffe Department of Hepato-Pancreato-Biliary and Liver Transplant Surgery Queen Elizabeth University Hospitals Birmingham NHS Foundation TrustB152THUnited Kingdom Department of Digestive Surgery University Hospital Henri Mondor(AP-HP)94010 Créteil and University of Paris EstCréteilFrance Division of Hepatobiliary surgery San Raffaele HospitalVia Olgettina 60Milan 20132Italy

Background: Gold standard for colorectal liver metastases(CRLM) remains hepatic resection(HR). However, patients with severe comorbidities, unresectable or deep-situated resectable CRLM are candidates for ablation. The aim of the study was to compare recurrence rate and survival benefit of the microwave ablation(MWA), radiofrequency ablation(RFA) and HR by conducting the first network meta-analysis. Data sources: Systematic search of the literature was conducted in the electronic databases. Both updated traditional and network meta-analyses were conducted and the results were compared between them. Results: HR cohort demonstrated significantly less local recurrence rate and better 3-and 5-year diseasefree(DFS) and overall survival(OS) compared to MWA and RFA cohorts. HR cohort included significantly younger patients and with significantly lower preoperative carcinoembryonic antigen(CEA) by 10.28 ng/m L compared to RFA cohort. Subgroup analysis of local recurrence and OS of solitary and ≤3 cm CRLMs did not demonstrate any discrepancies when compared with the whole sample. Conclusions: For resectable CRLM the treatment of choice still remains HR. MWA and RFA can be used as a single or adjunct treatment in patients with unresectable CRLM and/or prohibitive comorbidities.

关键词： Microwave ablation Radiofrequency ablation Hepatic resection Liver resection

Pancreaticopleuralfistula:etiology,treatmentandlong-termfollow-up

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Hepatobiliary & Pancreatic Diseases International 2012年第2期11卷 215-219页

作者： keith j roberts Maria Sheridan Gareth Morris-Stiff Andrew M Smith Department of Pancreatic Surgery St James University HospitalLeedsUK

BACKGROUND:Pancreaticopleural fistula(PPF) are *** multidisciplinary treatment is required due to nutritional compromise and *** is the first description of long-term follow-up of patients with ***:Eleven patients with PPF treated at a specialist unit were ***,investigation,treatment and outcomes were ***:Pancreatitis was the etiology of the PPF in 9 patients,and in the remaining 2 the PPF developed following distal ***-sectional imaging demonstrated the site of duct disruption in 10 cases,with endoscopic retrograde cholangiopancreatography identifying the final *** of pancreatic exocrine secretion and percutaneous drainage formed the mainstay of *** cases resolved following pancreatic duct stent insertion and three patients required surgical treatment for established *** were no *** all cases that resolved there has been no recurrence of PPF over a median follow-up of 50 months(range 15-62).CONCLUSIONS:PPF is an uncommon event complicating pancreatitis or pancreatectomy;pancreatic duct disruption is the common link.A step-up approach consisting of minimally invasive techniques treats the majority with surgery needed for refractory sepsis.

关键词： pancreatic disease pancreatitis pancreatic pseudocyst

Double-blind randomized sham controlled trial of intraperitoneal bupivacaine during emergency laparoscopic cholecystectomy

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Hepatobiliary & Pancreatic Diseases International 2013年第3期12卷 310-316页

作者： keith j roberts jeff Gilmour Ruplay Pande james Hodson For Tai Lam Saboor Khan Department of Hepatopancreatobiliary Surgery University Hospitals Coventry and Warwickshire Wolfson Laboratory University Hospitals Birmingham

BACKGROUND: Intraperitoneal local anesthesia (IPLA) during elective laparoscopic cholecystectomy (el-LC) decreases post-operative pain. None of the studies have explored the efficacy of IPLA at emergency laparoscopic cholecystectomy (em-LC). A longer operative duration, the greater frequency of washing, and the inflammation associated with cholecystitis or pancreatitis are a few reasons why it cannot be assumed that a benefit in pain scores will be seen in em-LC with IPLA. This study was undertaken to assess the efficacy of IPLA in patients undergoing em-LC. METHODS: Double-blind randomized sham controlled trial was conducted of 41 consecutive subjects undergoing em-LC. IPLA was delivered by a combination of injection to the diaphragmatic and topical wash over the liver and gallbladder with bupivacaine or saline. The primary outcome was visual analogue scale pain scores until discharge. Secondary outcomes included pain scores in theatre recovery and analgesic consumption. RESULTS: One patient had a procedure converted to open and was excluded. There was no significant difference in pain scores in the ward or theatre recovery. Analgesic use, respiratory rate, oxygen saturation, duration to ambulation, eating, satisfaction scores, and time to discharge were comparable between the two groups. CONCLUSIONS: IPLA during em-LC does not influence postoperative pain. Other modalities of analgesia should be explored for decreasing the interval between diagnosis of acute admission and em-LC.

关键词： gallbladder stone disease gallbladder cholecystectomy

Venous resection at pancreaticoduodenectomy can be safely performed in the presence of jaundice

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Hepatobiliary & Pancreatic Diseases International 2020年第5期19卷 488-491页

作者： Rupaly Pande james Hodson Ravi Marudanayagam Darius Mirza john Isaac keith j roberts HPB Surgery University Hospitals Birmingham NHS Foundation TrustBirmingham B152THUK Institute of Translational Medicine University Hospitals Birmingham NHS Foundation TrustBirmingham B152THUK Institute of Immunology and Immunotherapy University of BirminghamBirmingham B152THUK

Venous resection at pancreaticoduodenectomy(PD)has established itself as a viable treatment for borderline resectable cancer,with equivalent survival to those patients undergoing PD for cancer without venous resection[1].Thus surgery for these patients is clearly desirable,when possible,compared to palliative ***,there is concern and debate about the safety of venous resection at PD[2].There is a need to improve patient pathways,outcome and experience[3].To this end,in patients who present with jaundice,it is clear that surgery without preoperative biliary drainage(PBD)reduces complications[4].In 2015,our team introduced a‘fast track’program to routinely perform PD in the presence of jaundice[5].This change of practice has become routine,with most patients now undergoing surgery without *** is,however,unclear whether portal vein(PV)resection+PD is safe in the setting of *** aim of this study,therefore,was to compare outcomes and complications between patients with or without jaundice undergoing PD with associated resection of the superior mesenteric vein(SMV)and/or PV.

关键词： jaundice resection routine

Appraisal of the current guidelines for management of cholangiocarcinoma-using the Appraisal of Guidelines Research and Evaluation Ⅱ (AGREE Ⅱ) Instrument

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Hepatobiliary Surgery and Nutrition 2020年第2期9卷 126-135,中插1页

作者： Paschalis Gavriilidis Alan Askari keith j.roberts Robert P.Sutcliffe Department of Hepato-Pancreato-Biliary and Liver Transplant Surgery Queen Elizabeth University Hospitals Birmingham NHS Foundation TrustBirminghamUK Department of Upper Gastro-Intestinal Surgery West Hertfordshire Hospitals NHS TrustWatfordUK

Cholangiocarcinoma(CC)is the second most common primary liver ***-quality guidelines are essential for effective patient stratification and individualised *** study aimed to appraise the methodological quality of existing guidelines for the resection of CC using the Appraisal of Guidelines for Research&Evaluation(AGREE II)instrument.A systematic search of the literature in Cochrane,PubMed,Google Scholar,and Embase was *** of the clinical practice guidelines(CPGs)and consensuses was performed using the AGREE II instrument by four clinicians experienced in surgical practice and the AGREE II appraisal *** searches identified 13 guidelines of highly variable quality according to the AGREE II *** guidelines scored well in certain domains such as scope&purpose(median score across all guidelines;65%),clarity of presentation(76%),and editorial independence(56%).However,they scored poorly for applicability(13%),rigour of development(30%),and stakeholder involvement(39%).None of the 13 guidelines was recommended universally for use without ***,the methodological quality of guidelines on the surgical management of CC is *** updates should address and modify shortcomings detected by the AGREE II instrument,thereby facilitating better patient stratification and individualised treatment strategies.

关键词： Cholangiocarcinoma(CC) clinical practice guidelines(CPGs) Appraisal of Guidelines for Research and Evaluation instrument(AGREE II instrument)

Prognostic factors and survival after surgical resection of pancreatic neuroendocrine tumor with validation of established and modified staging systems

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Hepatobiliary & Pancreatic Diseases International 2018年第2期17卷 169-175页

作者： Nikolaos Benetatos james Hodson Ravi Marudanayagam Robert P Sutcliffe john R Isaac john Ayuk Tahir Shah keith j roberts The HPB Unit Queen Elizabeth Hospital Birmingham University Hospitals Birmingham NHS Foundation Trust Institute of Translational Medicine Queen Elizabeth Hospital Birmingham University Hospitals Birmingham Endocrinology Queen Elizabeth Hospital Birmingham University Hospitals Birmingham Liver Unit Queen Elizabeth Hospital Birmingham University Hospital of Birmingham NHS Foundation Trust

Background: Pancreatic neuroendocrine tumors(PNETs) display wide heterogeneity with highly variable prognosis. This study aimed to identify variables related to survival after surgical resection of ***: A total of 143 patients were identified from a prospectively maintained database. Patient characteristics were analyzed and prognostic factors for overall survival and progression-free survival were evaluated. The WHO, ENETS and AjCC scoring systems were applied to the cohort, and their ability to predict patient outcomes were ***: Multivariate analysis found that female gender, lymph node metastases and increasing WHO2010 grade to be independently associated with reduced overall survival(P jCC scoring systems to be similarly predictive of 5-year overall survival. Modified Ki67 significantly improved its accuracy in predicting 5-year overall survival(AUROC: 0.699 vs 0.605;P < 0.01).Conclusions: Multi-visceral or debulking surgery is associated with poor outcomes. There seems to be no significant difference between enucleation and anatomical segmental resection. Available scoring systems have reasonable accuracy in stratifying disease severity, with no system identified as being *** stratification with modified grading systems needs further validation before applied in clinical practice.

关键词： Pancreatic neuroendocrine tumors Prognostic factors Validation of staging systems

No difference in mortality among ALPPS,two-staged hepatectomy,and portal vein embolization/ligation:A systematic review by updated traditional and network meta-analyses

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Hepatobiliary & Pancreatic Diseases International 2020年第5期19卷 411-419页

作者： Paschalis Gavriilidis Robert P Sutcliffe keith j roberts Madhava Pai Duncan Spalding Nagy Habib Long R jiao Mikael H Sodergren Department of Hepatopanceaticobiliary Surgery Imperial College Healthcare NHS TrustHammersmith HospitalLondon W120HSUK Department of Hepato-Pancreato-Biliary and Liver Transplant Surgery Queen Elizabeth University Hospitals Birmingham NHS Foundation TrustBirmingham B152THUK

Background:There is an ongoing debate on the feasibility,safety,and oncological efficacy of the associating liver partition and portal vein ligation for staged hepatectomy(ALPPS)*** aim of this study was to compare ALPPS,two-staged hepatectomy(TSH),and portal vein embolization(PVE)/ligation(PVL)using updated traditional meta-analysis and network meta-analysis(NMA).Data sources:Electronic databases were used in a systematic literature *** traditional metaanalysis and NMA were performed and *** and major morbidity were selected as primary ***:Nineteen studies including 1200 patients were selected from the pool of 436 *** these patients,315(31%)and 702(69%)underwent ALPPS and portal vein occlusion(PVO),*** mortality based on updated traditional meta-analysis,subgroup analysis of the randomized controlled trials(RCTs),and both Bayesian and frequentist NMA did not demonstrate significant differences between the ALPPS cohort and the PVE,PVL,and TSH ***,analysis of RCTs did not demonstrate significant differences of major morbidity between the ALPPS and PVO *** ALPPS cohort demonstrated significantly more favorable outcomes in hypertrophy parameters,time to operation,definitive hepatectomy,and R0 margins rates compared with the PVO *** contrast,1-year disease-free survival was significantly higher in the PVO cohort compared to the ALPPS ***:This study is the first to use updated traditional meta-analysis and both Bayesian and frequentist NMA and demonstrated no significant differences in 90-day mortality between the ALPPS and other hepatic hypertrophy ***,two high quality RCTs including 147 patients demonstrated no significant differences in major morbidity between the ALPPS and PVO cohorts.

关键词： ALPPS Hepatectomy Portal vein embolization Portal vein ligation Network meta-analysis

Distinct risk factors for early and late blood transfusion following pancreaticoduodenectomy

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Hepatobiliary & Pancreatic Diseases International 2018年第4期17卷 349-357页

作者： Sukhchain S.Bansal james Hodson Khalid Khalil Bobby Dasari Ravi Marudanayagam Robert P.Sutcliffe john Isaac keith j.roberts Department of Hepatobiliary Pancreatic Surgery Queen Elizabeth Hospital BirminghamUniversity Hospitals Birmingham Institute of Translational Medicine Queen Elizabeth Hospital BirminghamUniversity Hospitals Birmingham

Background: The International Study Group of Pancreatic Surgery(ISGPS) has defined two periods of postpancreatectomy hemorrhage, early(24 h). A previously published Blood Usage Risk Score(BURS) aimed to predict early and late blood transfusion. The primary aim of this study was to define risk factors for early and late blood transfusion after pancreaticoduodenectomy. Secondary aims were to assess the predictive accuracy of the ***: In this retrospective observational study, multivariable analyses were used to identify independent risk factors for both early and late blood transfusion. The predictive ability of the BURS was then assessed using a receiver operating characteristic(ROC) curve ***: Among 628 patients, 99(15.8%) and 144(22.9%) received early and late blood transfusion, respectively. Risk factors for blood transfusion differed between early and late periods. Preoperative anemia and venous resection were associated with early blood transfusion whilst Whipple’s resection(as opposed to pylorus preserving pancreaticoduodenectomy), lack of biliary stent and a narrow pancreatic duct were predictors of late blood transfusion. The BURS was significantly predictive of early blood transfusion,albeit with a modest degree of accuracy(AUROC: 0.700, P < 0.001), but not of late blood transfusion(AUROC: 0.525, P = 0.360). Late blood transfusion was independently associated with increasing severity of postoperative pancreatic fistula(POPF)(OR: 1.85, 3.18 and 9.97 for biochemical, types B and C POPF,respectively, relative to no POPF).Conclusions: Two largely different sets of variables are related to early and late blood transfusion following pancreaticoduodenectomy. The BURS was significantly associated with early, albeit with modest predictive accuracy, but not late blood transfusion. An understanding of POPF risk allows assessment of the need for late blood transfusion.

关键词： Pancreatic cancer Blood transfusion Pancreaticoduodenectomy

Lymphoepithelial cysts of the pancreas:a management dilemma

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Hepatobiliary & Pancreatic Diseases International 2014年第5期13卷 539-544页

作者： julie Martin keith j roberts Maria Sheridan Gavin A Falk Daniel joyce R Matthew Walsh Andrew M Smith Gareth Morris-Stiff Departments of Pancreatic Surgery St James's University Hospital Departments of Radiology St James's University Hospital Department of General Surgery Section of Surgical Oncology/HPB Cleveland Clinic Foundation

Pancreatic lymphoepithelial cysts（LECs） are rare,benign lesions that are typically unexpected post-operative pathological findings. We aimed to review clinical, radiological and pathological features of LECs that may allow their preoperative diagnosis. Histopathology databases of two large pancreatic units were searched to identify LECs and notes reviewed to determine patient demographic details, mode of presentation, investigations, treatment and outcome. Five male and one female patients were identified. Their median age was 60 years. Lesions were identified on computed tomography performed for abdominal pain in two patients, and were incidentally observed in four patients. Five LECs were located in the tail and one in the body of the pancreas, with a median cyst size of 5 cm. Obtaining cyst fluid was difficult and a largely acellular aspirate was yielded. The pre-operative diagnosis was mucinous cystic neoplasm in all patients. This series of patients were treated distal pancreatectomy and splenectomy. A retrospective review of radiological examinations suggested that LECs have a relatively low signal on T2 imaging and a high signal intensity on T1 weighted images. LECs appear more common in elderly males, and are typically incidental, large, unilocular cysts. Close attention to signal intensity on MRI may allow preoperative diagnosis of these lesions.

关键词： lymphoepithelial cyst pancreas