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Systematic review of the outcomes of surgical resection for intermediate and advanced Barcelona Clinic Liver Cancer stage hepatocellular carcinoma:A critical appraisal of the evidence

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World Journal of Hepatology 2018年第6期10卷 433-447页

作者： Ye Xin Koh Hwee Leong Tan Weng Kit Lye Juinn Huar Kam Adrian Kah Heng Chiow Siong San Tan Su Pin Choo Alexander Yaw Fui Chung brian kim poh goh Department of Hepatopancreatobiliary and Transplant Surgery Singapore General HospitalSingapore 169608Singapore Center for Quantitative Medicine Duke-NUS Graduate Medical SchoolSingapore 169857Singapore Department of General Surgery Hepatopancreatobiliary ServiceChangi General HospitalSingapore 529889Singapore Department of Medical Oncology National Cancer Centre SingaporeSingapore 169610Singapore Duke-NUS Graduate Medical School Singapore 169857Singapore

AIM To perform a systematic review to determine the survival outcomes after curative resection of intermediate and advanced hepatocellular carcinomas(HCC).METHODS A systematic review of the published literature was performed using the PubM ed database from 1 st January 1999 to 31 st Dec 2014 to identify studies that reported outcomes of liver resection as the primary curative treatment for Barcelona Clinic Liver Cancer(BCLC) stage B or C HCC. The primary end point was to determine the overall survival(OS) and disease free survival(DFS) of liver resection of HCC in BCLC stage B or C in patients with adequate liver reserve(i.e., Child's A or B status). The secondary end points were to assess the morbidity and mortality of liver resection in large HCC(defined as lesions larger than 10 cm in diameter) and to compare the OS and DFS after surgical resection of solitary vs multifocal *** We identified 74 articles which met the inclusion criteria and were analyzed in this systematic review. Analysis of the resection outcomes of the included studies were grouped according to(1) BCLC stage B or C HCC,(2) Size of HCC and(3) multifocal tumors. The median 5-year OS of BCLC stage B was 38.7%(range 10.0-57.0); while the median 5-year OS of BCLC stage C was 20.0%(range 0.0-42.0). The collective median 5-year OS of both stages was 27.9%(0.0-57.0). In examining the morbidity and mortality following liver resection in large HCC, the pooled RR for morbidity [RR(95%CI) = 1.00(0.76-1.31)] and mortality [RR(95%CI) = 1.15(0.73-1.80)] were not significant. Within the spectrum of BCLC B and C lesions, tumors greater than 10 cm were reported to have median 5-year OS of 33.0% and multifocal lesions 54.0%.CONCLUSION Indication for surgical resection should be extended to BCLC stage B lesions in selected patients. Further studies are needed to stratify stage C lesions for resection.

关键词： Barcelona Clinic Liver Cancer Hepatocellular carcinoma Hepatectomy Milan criteria

International consensus guidelines on robotic pancreatic surgery in 2023

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Hepatobiliary Surgery and Nutrition 2024年第1期13卷 89-104页

作者： Rong Liu Mohammed Abu Hilal Marc G.Besselink Thilo Hackert Chinnusamy Palanivelu Yupei Zhao Jin He Ugo Boggi Jin-Young Jang Fabrizio Panaro brian K.P.goh Mikhail Efanov Yuichi Nagakawa Hong-Jin kim Xiaoyu Yin Zhiming Zhao Yi-Ming Shyr Shridhar Iyer Eli Kakiashvili Ho-Seong Han Jae Hoon Lee Roland Croner Marco Vito Marino Arun Prasad Wei Wang Songqing He Kehu Yang Qu Liu Zizheng Wang Mengyang Li Shuai Xu Kongyuan Wei Zhaoda Deng Yuze Jia Tess M.E.van Ramshorst Faculty of Hepatopancreatobiliary Surgery The First Medical Center of Chinese People’s Liberation Army(PLA)General HospitalBeijingChina Department of Surgery Poliambulanza Foundation HospitalBresciaItaly Department of Surgery University Hospital Southampton NHS Foundation TrustSouthamptonUK Amsterdam UMC location University of AmsterdamDepartment of SurgeryAmsterdamThe Netherlands Cancer Center Amsterdam AmsterdamThe Netherlands Department of General Visceral and Thoracic SurgeryUniversity Hospital Hamburg-EppendorfHamburgGermany Department of Minimal Invasive Hernia Surgery GEM Hospital and Research CentreChennaiTamil NaduIndia Department of General Surgery Peking Union Medical College Hospital BeijingBeijingChina Department of Surgery Johns Hopkins University School of MedicineBaltimoreMDUSA Division of General and Transplant Surgery University of PisaPisaItaly Department of Surgery Seoul National University HospitalSeoul National University College of MedicineSeoulKorea Department of Surgery/Division of HBP Surgery&Transplantation University of MontpellierMontpellierFrance Department of Hepatopancreatobiliary and Transplant Surgery Singapore General Hospital and National Cancer Centre SingaporeSingaporeSingapore Department of Hepato-Pancreato-Biliary Surgery Moscow Clinical Scientific CenterMoscowRussia Department of Gastrointestinal and Pediatric Surgery Tokyo Medical UniversityShinjukuTokyoJapan Department of Surgery Yeungnam University College of MedicineDaeguKorea Department of Pancreato-Biliary Surgery The First Affiliated Hospital of Sun Yat-sen UniversityGuangzhouChina 18 Division of Hepatobiliary Pancreatic Surgery and Liver TransplantationNational University HospitalSingaporeSingapore Department of Surgery Galilee Medical CenterNahariyaIsrael Department of Surgery Seoul National University Bundang HospitalSeoul National University College of MedicineSeongnam-siKorea Division of Hepato-Biliary and Pancreatic Surgery Department of SurgeryAsan Medical Cente

Background:With the rapid development of robotic surgery,especially for the abdominal surgery,robotic pancreatic surgery(RPS)has been applied increasingly around the ***,evidence-based guidelines regarding its application,safety,and efficacy are still *** harvest robust evidence and comprehensive clinical practice,this study aims to develop international guidelines on the use of ***:World Health Organization(WHO)Handbook for Guideline Development,GRADE Grid method,Delphi vote,and the AGREE-II instrument were used to establish the Guideline Steering Group,Guideline Development Group,and Guideline Secretary Group,formulate 19 clinical questions,develop the recommendations,and draft the *** online meetings were held on 04/12/2020,30/11/2021,and 25/01/2022 to vote on the recommendations and get advice and suggestions from all involved *** the experts focusing on minimally invasive surgery from America,Europe and Oceania made great contributions to this consensus ***:After a systematic literature review 176 studies were included,19 questions were addressed and 14 recommendations were developed through the expert assessment and comprehensive judgment of the quality and credibility of the ***:The international RPS guidelines can guide current practice for surgeons,patients,medical societies,hospital administrators,and related social *** randomized trials are required to determine the added value of RPS as compared to open and laparoscopic surgery.

关键词： Robotic surgery guidelines pancreatectomy pancreaticoduodenectomy distal pancreatectomy(DP)

海外旅游业企业直播营销策略优化研究——基于马来西亚A旅游公司的案例研究

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海外旅游业企业直播营销策略优化研究——基于马来西亚A旅游公司...

作者： goh kim poh 北京外国语大学

学位级别：硕士

疫情寒冬即将结束,饱受打击的旅游业,特别是出境旅游业迎来了机会。旅游直播模式是其中最具生命力的恢复模式。基于此,本文选择马来西亚A旅游公司作为研究对象,采取定性与定量相结合的研究方法,展开网络直播营销现状分析、问题发现与作... 详细信息

疫情寒冬即将结束,饱受打击的旅游业,特别是出境旅游业迎来了机会。旅游直播模式是其中最具生命力的恢复模式。基于此,本文选择马来西亚A旅游公司作为研究对象,采取定性与定量相结合的研究方法,展开网络直播营销现状分析、问题发现与作用机制分析,旨在明确问题与不足,提出相应提升直播营销效果的策略。本文选择A旅游公司网络直播营销作为研究切入点,首先分析了网络直播营销现状,介绍了其组织结构与直播产品,然后从直播主体、直播内容形式以及直播效果三个方面分析了直播营销发展情况。其次总结了直播营销中的问题,包括两个层面,直播营销层面与管理层面。其中直播营销层面的问题有五点,市场定位不明确、产品同质化现象严重、营销平台陈旧,吸引力不足、营销工具单一以及客户管理不足五方面问题,管理层面的问题有四点,分别是组织架构不合理、创新能力不足、员工知识结构不完善以及缺少详细的市场调研。通过对旅游直播的分析,我们发现它对认知价值和旅游意愿产生了积极的负面影响。特别是,感知价值在直播临场感和互动式的直接影响中发挥了重要的中介作用。因此,我们可以更好地理解直播营销的效果机制。而平台服务对感知价值与旅游意愿的影响不显著。基于问题发现与作用机制分析,从营销层面、管理层面与直播层面提出了直播营销策略,包括明确定位、创新产品、灵活定价、丰富营销工具;优化团队、定期回访;优化互动性感知以提升临场感,丰富直播内容以提升感知价值,利用社交直播平台提升互动性。作为一名留学生,笔者希望通过本次研究为本国内旅游公司复苏活力提供一点参考,也希望中国与马来西亚之间的旅游事业共同发展。

关键词：网络直播直播营销旅游意愿营销策略

Liver resection versus liver transplantation for hepatocellular carcinoma within Milan criteria:a meta-analysis of 18,421 patients

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Hepatobiliary Surgery and Nutrition 2022年第1期11卷 78-93,I0009-I0013页

作者： Jin Hean Koh Darren Jun Hao Tan Yuki Ong Wen Hui Lim Cheng Han Ng Phoebe Wen Lin Tay Jie Ning Yong Mark D.Muthiah Eunice X.Tan Ning Qi Pang Beom Kyung kim Nicholas Syn Alfred Kow brian K.P.goh Daniel Q.Huang Yong Loo Lin School of Medicine National University of SingaporeSingaporeSingapore Division of Gastroenterology and Hepatology Department of MedicineNational University HospitalSingaporeSingapore National University Centre for Organ Transplantation National University Health SystemSingaporeSingapore Division of Hepatobiliary&Pancreatic Surgery Department of SurgeryNational University HospitalSingaporeSingapore Department of Internal Medicine Yonsei University College of MedicineSeoulRepublic of Korea Yonsei Liver Center Severance HospitalYonsei University Health SystemSeoulRepublic of Korea Biostatistics and Modelling Domain Saw Swee Hock School of Public HealthNational University of Singapore and National University Health SystemSingaporeSingapore Department of Hepato-Pancreato-Biliary and Transplant Surgery Division of SurgerySingapore General HospitalSingaporeSingapore Liver Transplant Service SingHealth Duke-NUS Transplant CentreSingaporeSingapore

Background:Outcomes after liver resection(LR)and liver transplantation(LT)for hepatocellular carcinoma(HCC)are heterogenous and may vary by region,over time periods and disease *** aimed to compare overall survival(OS)and disease-free survival(DFS)between LT versus LR for HCC within the Milan ***:Two authors independently searched Medline and Embase databases for studies comparing survival after LT and LR for patients with HCC meeting the Milan ***-analyses and meta-regression were conducted using random-effects ***:We screened 2,278 studies and included 35 studies with 18,421 *** was associated with poorer OS[hazard ratio(HR)=1.44;95%confidence interval(CI):1.14-1.81;P<0.01]and DFS(HR=2.71;95%CI:2.23-3.28;P<0.01)compared to LT,with similar findings among intention-to-treat(ITT)*** uninodular disease,OS in LR was comparable to LT(P=0.13)but DFS remained poorer(HR=2.95;95%CI:2.30-3.79;P<0.01).By region,LR had poorer OS versus LT in North America and Europe(P≤0.01),but not Asia(P=0.25).LR had inferior survival versus LT in studies completed before 2010(P=0.01),but not after 2010(P=0.12).Cohorts that underwent enhanced surveillance had comparable OS after LT and LR(P=0.33),but cohorts undergoing usual surveillance had worse OS after LR(HR=1.95;95%CI:1.24-3.07;P<0.01).Conclusions:Mortality after LR for HCC is nearly 50%higher compared to *** between LR and LT were similar in uninodular *** risk of recurrence after LR is threefold that of LT.

关键词： Hepatocellular carcinoma(HCC) liver resection(LR) liver transplant survival recurrence