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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)

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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 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

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Hepatic vein reconstruction during hepatectomy:A feasible and underused technique

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Hepatobiliary & pancreatic Diseases International 2024年第4期23卷 421-427页

作者： Manish Ahuja Kunal Joshi Chris Coldham paulo Muiesan Bobby Dasari Manuel Abradelo Ravi Marudanayagam Darius Mirza John Isaac David Bartlett Nikolaos A Chatzizacharias robert p.sutcliffe Keith J roberts Department of HpB and Liver Transplant Surgery University Hospitals Birmingham NHS Foundation TrustBirminghamUK Institute of Immunology and Immunotherapy University of BirminghamBirminghamUK

Complete surgical resection(R0)of liver tumors,primary or metastatic,remains the main objective in management of primary and metastatic liver tumors[1].Tumors invading to the proximity of the hepatic venous outflow pose a peculiar challenge to achieve R0 resections,because this location may render a tumor *** median survival of patients with liver tumor without surgery is less than 12 months[2].Even with surgery,post-hepatectomy liver failure and subsequently increased mortality are the main problems associated with complex resection[3].Moreover,when the vein is affected,vein resection and subsequent reconstruction are *** resection is a standard practice in liver resection and transplantation[4],for example,hepatic vein reconstruction during a living-donor liver transplant,porto-mesenteric axis reconstruction during resection of advanced pancreatic cancer and caval reconstruction during resection of retroperitoneal ***,novel techniques like total hepatic vascular exclusion(HVE)[5],veno-venous bypass[6]and ex vivo hepatic resection[7,8]have facilitated curative resections of tumors close to one or more major hepatic veins.

关键词： hepatectomy surgery mortality

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Robotic versus laparoscopic liver resection for huge (≥10 cm) liver tumors: an international multicenter propensity-score matched cohort study of 799 cases

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Hepatobiliary Surgery and Nutrition 2023年第2期12卷 205-215,I0005页

作者： Tan-To Cheung Rong Liu Federica Cipriani Xiaoying Wang Mikhail Efanov David Fuks Gi-Hong Choi Nicholas L.Syn Charing C.N.Chong Fabrizio Di Benedetto Ricardo Robles-Campos Vincenzo Mazzaferro Fernando Rotellar Santiago Lopez-Ben James O.park Alejandro Mejia Iswanto Sucandy Adrian K.H.Chiow Marco V.Marino Mikel Gastaca Jae Hoon Lee Tpeter Kingham Mathieu D’Hondt Sung Hoon Choi robert p.sutcliffe Ho-Seong Han Chung-Ngai Tang Johann pratschke roberto I.Troisi Go Wakabayashi Daniel Cherqui Felice Giuliante Davit L.Aghayan Bjorn Edwin Olivier Scatton Atsushi Sugioka Tran Cong Duy Long Constantino Fondevila Mohammad Abu Hilal Andrea Ruzzenente Alessandro Ferrero paulo Herman Kuo-Hsin Chen Luca Aldrighetti Brian K.p.Goh International robotic and laparoscopic liver resection study group investigators Department of Surgery Queen Mary HospitalThe University of Hong KongHong Kong SARChina Faculty of Hepatopancreatobiliary Surgery The First Medical Center of Chinese People’s Liberation Army(PLA)General HospitalBeijingChina Hepatobiliary Surgery Division IRCCS San Raffaele HospitalMilanItaly Department of Liver Surgery and Transplantation Liver Cancer InstituteZhongshan HospitalFudan UniversityShanghaiChina Department of Hepato-pancreato-Biliary Surgery Moscow Clinical Scientific CenterMoscowRussia Department of Digestive Oncologic and Metabolic SurgeryInstitute Mutualiste MontsourisUniversite Paris DescartesParisFrance Division of Hepatopancreatobiliary Surgery Department of SurgerySeverance HospitalYonsei University College of MedicineSeoulKorea Department of Hepatopancreatobiliary and Transplant Surgery Singapore General Hospital and Yong Loo Lin School of MedicineNational University of SingaporeSingaporeSingapore Division of Hepatobiliary and pancreatic Surgery Department of SurgeryPrince of Wales HospitalThe Chinese University of Hong KongHong Kong SARChina HpB Surgery and Liver Transplant Unit University of Modena and Reggio EmiliaModenaItaly Department of General Visceral and Transplantation SurgeryClinic and University Hospital Virgen de la ArrixacaIMIB-ARRIXACAMurciaSpain HpB Surgery Hepatology and Liver TransplantationFondazione IRCCS Istituto Nazionale Tumori di MilanoMilanItaly HpB and Liver Transplant Unit Department of General SurgeryClinica Universidad de NavarraUniversidad de NavarraPamplonaSpain Institute of Health Research of Navarra(IdisNA) PamplonaSpain Hepatobiliary and pancreatic Surgery Unit Department of SurgeryDr.Josep Trueta HospitalIdIBGiGironaSpain Hepatobiliary Surgical Oncology Department of SurgeryUniversity of Washington Medical CenterSeattleWAUSA The Liver Institute Methodist Dallas Medical CenterDallasTXUSA AdventHealth Tampa Digestive Health InstituteTampaFLUSA Hepatopancreatobiliary Unit Department of SurgeryChangi General

Background:The use of laparoscopic(LLR)and robotic liver resections(RLR)has been safely performed in many institutions for liver tumours.A large scale international multicenter study would provide stronger evidence and insight into application of these techniques for huge liver tumours≥10 ***:This was a retrospective review of 971 patients who underwent LLR and RLR for huge(≥10 cm)tumors at 42 international centers between ***:One hundred RLR and 699 LLR which met study criteria were *** comparison between the 2 approaches for patients with huge tumors were performed using 1:3 propensity-score matching(pSM)(73 vs.219).Before pSM,LLR was associated with significantly increased frequency of previous abdominal surgery,malignant pathology,liver cirrhosis and increased median *** pSM,RLR and LLR was associated with no significant difference in key perioperative outcomes including media operation time(242 vs.290 min,p=0.286),transfusion rate rate(19.2%vs.16.9%,p=0.652),median blood loss(200 vs.300 mL,p=0.694),open conversion rate(8.2%vs.11.0%,p=0.519),morbidity(28.8%vs.21.9%,p=0.221),major morbidity(4.1%vs.9.6%,p=0.152),mortality and postoperative length of stay(6 vs.6 days,p=0.435).Conclusions:RLR and LLR can be performed safely for selected patients with huge liver tumours with excellent *** was no significant difference in perioperative outcomes after RLR or LLR.

关键词： Laparoscopic liver resection(LLR) robotic liver resection(RLR) hepatocellular carcinoma colorectal liver metastases huge

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Terlipressin versus placebo in living donor liver transplantation

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Hepatobiliary & pancreatic Diseases International 2022年第1期21卷 76-79页

作者： paschalis Gavriilidis Ernest Hidalgo robert p.sutcliffe Keith J roberts Department of Hepato-pancreato-Biliary and Liver Transplant surgery Queen Elizabeth University Hospitals Birmingham NHS Foundation TrustBirmingham B152THUK Department of Hepato-pancreatico-Biliary Surgery and Transplantation Hospital Universitari Vall d’HebronBarcelona 08035Spain

To the Editor:Terlipressin is a long-acting synthetic analogue of vasopressin,demonstrating several potential benefits in the context of living donor liver transplantation(LDLT).During the recipient hepatec-tomy,terlipressin reduces the portal ***,it may mitigate the extent of bowel congestion following portal vein *** decreasing portal hyperperfusion and hypertension,it protects the graft from further injury and improves renal blood flow.

关键词： donor liver Terlipressin

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Navigated liver surgery:State of the art and future perspectives

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Hepatobiliary & pancreatic Diseases International 2022年第3期21卷 226-233页

作者： paschalis Gavriilidis Bjørn Edwin Egidijus pelanis Ernest Hidalgo Nicola de’Angelis Riccardo Memeo Luca Aldrighetti robert p.sutcliffe Department of Hepato-pancreato-Biliary and Liver Transplant Surgery Queen Elizabeth University Hospitals Birmingham NHS Foundation TrustB152THUK The Intervention Centre and Department of HpB Surgery Oslo University Hospital and Faculty of MedicineUniversity of OsloOsloNorway Department of Hepato-pancreatico-Biliary Surgery and Transplantation Hospital Universitari Vall d’HebronBarcelonaSpain Department of Digestive Surgery University Hospital Henri Mondor(AP-HP)94010 Creteil and University of Paris EstCreteilFrance Department of Hepatobiliary and pancreatic Surgery Miulli HospitalAcquaviva delle FontiBari 70021Italy Division of Hepatobiliary Surgery San Raffaele HospitalVia Olgettina 60Milan 20132Italy

Background:In recent years,the development of digital imaging technology has had a significant influence in liver *** ability to obtain a 3-dimensional(3D)visualization of the liver anatomy has provided surgery with virtual reality of simulation 3D computer models,3D printing models and more recently holograms and augmented reality(when virtual reality knowledge is superimposed onto reality).In addition,the utilization of real-time fluorescent imaging techniques based on indocyanine green(ICG)uptake allows clinicians to precisely delineate the liver anatomy and/or tumors within the parenchyma,applying the knowledge obtained preoperatively through digital *** combination of both has transformed the abstract thinking until now based on 2D imaging into a 3D preoperative conception(virtual reality),enhanced with real-time visualization of the fluorescent liver structures,effectively facilitating intraoperative navigated liver surgery(augmented reality).Data sources:A literature search was performed from inception until January 2021 in MEDLINE(pub Med),Embase,Cochrane library and database for systematic reviews(CDSR),Google Scholar,and National Institute for Health and Clinical Excellence(NICE)***:Fifty-one pertinent articles were retrieved and *** different types of digital imaging technologies and the real-time navigated liver surgery were estimated and ***:ICG fluorescent imaging techniques can contribute essentially to the real-time definition of liver segments;as a result,precise hepatic resection can be guided by the presence of ***,3D models can help essentially to further advancing of precision in hepatic surgery by permitting estimation of liver volume and functional liver remnant,delineation of resection lines along the liver segments and evaluation of tumor *** liver transplantation and especially in living donor liver transplantation(LDLT),3D printed models of the donor’s live

关键词： Navigated Hepatic surgery 3D Computer assistance Image guidance Image guided surgery Indocyanine green 3D print Visual simulation Virtual reality Augmented reality Real-time navigated liver surgery

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Incidental gallbladder cancer diagnosis confers survival advantage irrespective of tumour stage and characteristics

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World Journal of Gastroenterology 2022年第18期28卷 1996-2007页

作者： Moath Alarabiyat Syed Soulat Raza John Isaac Darius Mirza Ravi Marudanayagam Keith roberts Manuel Abradelo David C Bartlett Bobby V Dasari robert p.sutcliffe Nikolaos A Chatzizacharias HpB and Liver Transplant Unit Queen Elizabeth HospitalBirmingham B152GWUnited Kingdom Department of HpB and Liver Transplantation Queen Elizabeth HospitalUniversity Hospitals BirminghamBirmingham B152THUnited Kingdom

BACKGROUND Incidental gallbladder cancer(IGBC)represents 50%-60%of gallbladder cancer *** are conflicting on the role of IGBC diagnosis in oncological *** studies suggest that IGBC diagnosis does not affect outcomes,while others that overall survival(OS)is longer in these cases compared to non-incidental diagnosis(NIGBC).Furthermore,some studies reported early tumour stages and histopathologic characteristics as possible confounders,while others *** To investigate the role of IGBC diagnosis on patients’overall survival,especially after surgical treatment with curative *** Retrospective analysis of all patient referrals with gallbladder cancer between 2008 and 2020 in a tertiary hepatobiliary *** comparison of patient and tumour characteristics between IGBC and NIGBC subgroups was *** analysis for the whole cohort,surgical and non-surgical subgroups was done with the Kaplan-Meier method and the use of log rank *** analysis was performed with univariable and multivariable Cox regression *** The cohort included 261 patients with gallbladder cancer.65%of cases had NIGBC and 35%had IGBC.A total of 90 patients received surgical treatment(66%of IGBC cases and 19%of NIGBC cases).NIGBC patients had more advanced T stage and required more extensive resections than IGBC *** was longer in patients with IGBC in the whole cohort(29 vs 4 mo,ppps(29 vs 16.5 mo,p=0.001).Disease free survival(DFS)after surgery was longer in patients with IGBC(21.5 mo vs 8.5 mo,p=0.007).N stage and resection margin status were identified as independent predictors of OS and *** diagnosis was identified as an independent predictor of *** IGBC diagnosis may confer a survival advantage independently of the pathological stage and tumour *** studies are required to further investigate this,including detailed

关键词： Gallbladder cancer Incidental gallbladder cancer Non-incidental gallbladder cancer Gallbladder cancer survival

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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

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para-aortic lymph node involvement should not be a contraindication to resection of pancreatic ductal adenocarcinoma

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World Journal of Gastrointestinal Surgery 2022年第5期14卷 429-441页

作者： Rupaly pande Shafiq Chughtai Manish Ahuja Rachel Brown David C Bartlett Bobby V Dasari Ravi Marudanayagam Darius Mirza Keith roberts John Isaac robert p.sutcliffe Nikolaos A Chatzizacharias Department of Hepato-pancreato-Biliary and Liver Transplant Surgery University Hospitals Birmingham NHS Foundation TrustBirmingham B152GWUnited Kingdom Department of pathology University Hospitals Birmingham NHS Foundation TrustBirmingham B152GWUnited Kingdom

BACKGROUND para-aortic lymph nodes(pALN)are found in the aortocaval groove and they are staged as metastatic disease if involved by pancreatic ductal adenocarcinoma(pDAC).The data in the literature is conflicting with some studies having associated pALN involvement with poor prognosis,while others not sharing the same *** resection is not included in the standard lymphadenectomy during pancreatic resections as per the International Study Group for pancreatic Surgery and there is no consensus on the management of these *** To investigate the prognostic significance of pALN metastases on the oncological outcomes after resection for *** This is a retrospective cohort study of data retrieved from a prospectively maintained database on consecutive patients undergoing pancreatectomies for pDAC where pALN was sampled between 2011 and *** comparison of the data between pALN+and pALN-subgroups,survival analysis with the Kaplan-Meier method and risk analysis with univariable and multivariable time to event Cox regression analysis were performed,specifically assessing oncological outcomes such as median overall survival(OS)and disease-free survival(DFS).RESULTS 81 cases had pALN sampling and 17(21%)were *** N stage was significantly different between pALN+and pALN-patients(p=0.005),while no difference was observed in any of the other *** imaging diagnosed pALN positivity in one *** and DFS were comparable between pALN+and pALN-patients with lymph node positive disease(OS:13.2 mo vs 18.8 mo,p=0.161;DFS:13 mo vs 16.4 mo,p=0.179).No difference in OS or DFS was identified between pALN positive and negative patients when they received chemotherapy either in the neoadjuvant or in the adjuvant setting(OS:23.4 mo vs 20.6 mo,p=0.192;DFS:23.9 mo vs 20.5 mo,p=0.718).On the contrary,when patients did not receive chemotherapy,pALN disease had substantially shorter OS(5.5 mo vs 14.2 mo;p=0.015)and DFS(4.4 mo

关键词： para-aortic lymph node pancreatectomy Survival pancreatic adenocarcinoma Chemotherapy Lymph node sampling

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Ventilation after pancreaticoduodenectomy increases perioperative mortality: Identification of risk factors and their relevance in Germany that do not apply in England

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Hepatobiliary & pancreatic Diseases International 2019年第4期18卷 379-388页

作者： Rieke-Sophie Homeyer Keith Jroberts robert p.sutcliffe Alexander Kaltenborn Darius Mirza Zhi Qu Jurgen Klempnauer Harald Schrem Core Facility Quality Management Transplantation Integrated Research and Treatment Center Transplantation(IFB-Tx)Hannover Medical SchoolCarl-Neuberg-Str.130625 HannoverGermany General Visceral and Transplant SurgeryHannover Medical SchoolCarl-Neuberg-Str.130625 HannoverGermany Department of HpB Surgery Queen Elizabeth Hospital BirminghamMindelsohn Way EdgbastonBirmingham B15 2GWUnited Kingdom Department of General Visceral and Transplant SurgeryMedical University GrazAuenbrugger Platz 58036 GrazAustria

Background:pre-operative risk factors for post-operative ventilation and their influence on survival after pancreaticoduodenectomy for malignancy are ***:Totally 391 patients operated in Hannover,Germany were investigated with multivariable logistic regression and Cox regression modeling to identify independent risk factors for post-operative ventilation≥6 h,patient survival and 90-day *** 84 patients operated in Birmingham,United Kingdom were analyzed to assess the external relevance of ***:Longer operations,history of thrombosis,intra-operative blood transfusion,lower estimated glomerular filtration rates(eGFR)and higher values of the age at operation divided by the Horovitz Quotient independently increased the risk of post-operative ventilation≥6 h in German patients(n=108;27.6%)(ppre-operative eGFR levels increased the risk of early death in German patients significantly and independently of established prognostic factors.A history of thrombosis and lower eGFR levels were also independent significant risk factors for 90-day mortality in German patients but not in English *** of the English patients received post-operative *** more German patients were>75 years,had a history of thrombosis,received blood transfusions,and had significantly worse lung function ***4 tumors were detected in 18 German patients(4.6%),but not in the English ***:Identified risk factors for post-operative ventilation are clinically relevant in Germany but not in England and may be used to lower mortality *** German and the English cohorts displayed significant differences in the approach to patient selection and early post-operative extubation.

关键词： pancreatic cancer Cholangiocellular carcinoma periampullary carcinoma Comorbidity Outcome

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