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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

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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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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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