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Simultaneous portal and hepatic vein embolization is better than portal embolization or ALPPS for hypertrophy of future liver remnant before major hepatectomy: A systematic review and network meta-analysis

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Hepatobiliary & Pancreatic Diseases International 2023年第3期22卷 221-227页

作者： Paschalis Gavriilidis gabriele marangoni Jawad Ahmad Daniel Azoulay Department of Hepatobiliary and Pancreatic Surgery University Hospitals of Coventry and Warwickshire NHS TrustClifford Bridge RoadCoventry CV22DXUK Department of Hepato-Biliary and Liver Transplantation Surgery Paul Brousse University HospitalParis-Saclay UniversityVillejuif 94800France

Background:Post-hepatectomy liver failure(PHLF)is the Achilles’heel of hepatic resection for colorectal liver *** most commonly used procedure to generate hypertrophy of the functional liver remnant(FLR)is portal vein embolization(PVE),which does not always lead to successful *** liver partition and portal vein ligation for staged hepatectomy(ALPPS)has been proposed to overcome the limitations of *** venous deprivation(LVD),a technique that includes simultaneous portal and hepatic vein embolization,has also been proposed as an alternative to *** present study aimed to conduct a systematic review as the first network meta-analysis to compare the efficacy,effectiveness,and safety of the three regenerative *** sources:A systematic search for literature was conducted using the electronic databases Embase,PubMed(MEDLINE),Google Scholar and ***:The time to operation was significantly shorter in the ALPPS cohort than in the PVE and LVD cohorts by 27 and 22 days,*** parameters of blood loss and the Pringle maneuver demonstrated non-significant differences between the PVE and LVD *** was evidence of a significantly higher FLR hypertrophy rate in the ALPPS cohort when compared to the PVE cohort,but non-significant differences were observed when compared to the LVD ***,the LVD cohort demonstrated a significantly better FLR/body weight(BW)ratio compared to both the ALPPS and PVE *** the PVE and LVD cohorts demonstrated significantly lower major morbidity rates compared to the ALPPS *** LVD cohort also demonstrated a significantly lower 90-day mortality rate compared to both the PVE and ALPPS ***:LVD in adequately selected patients may induce adequate and profound FLR hypertrophy before major *** evidence demonstrated significantly lower major morbidity and mortality rates in the LVD cohort than in the ALPPS and PVE coho

关键词： Portal vein embolization Hepatic vein embolization Future liver remnant ALPPS

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Clinical features and treatment of sump syndrome following hepaticojejunostomy

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Hepatobiliary & Pancreatic Diseases International 2011年第3期10卷 261-264页

作者： gabriele marangoni Amir Ali Walid Faraj Nigel Heaton Mohamed Rela King's College London School of Medicine at King's College Hospital Institute of Liver StudiesDenmark Hill

BACKGROUND:Cholangitis after Roux-en-Y hepaticojejunostomy is usually caused by anastomotic stricture.A small number of cases present without evidence of obstruction and are ascribed to reflux of gastro-intestinal content into the biliary tree above the anastomosis (sump syndrome).Despite prophylactic rotating antibiotic therapy,the cholangitic episode may be severe and ***:From 2001 to 2006,six patients who had undergone an end-to-side hepaticojejunostomy presented to our institution with recurrent episodes of biliary *** stricture was excluded by liver MRI/MRCP and percutaneous transhepatic cholangiogram (PTC).Barium meal showed reflux of contrast into the biliary tree in all *** patients had a short jejunal Roux limb (less than 50 cm) on pre-operative ***:Five patients underwent surgery and two of them had two *** patient had a Tsuchida antireflux valve and subsequently underwent lengthening of the Roux *** patients had lengthening of the Roux loop;one underwent re-do hepaticojejunostomy and one had concomitant revision of the hepaticojejunostomy and lengthening of the Roux *** latter underwent further lengthening of the Roux *** patients are cholangitis-free 6,36 and 60 months after surgery;two still experience mild episodes of ***:An adequate length of the Roux loop is important to prevent ***,Roux loop lengthening to 70 cm or more does not always resolve the problem and cholangitis,although generally less frequent and severe,may recur despite appropriate reconstructive or antireflux *** these cases,life-long rotating antibiotics is the only available measure.

关键词： biliary tract surgical procedures biliary tract disease septicemia

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Budd-Chiari syndrome secondary to caval recurrence of renal cell carcinoma

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Hepatobiliary & Pancreatic Diseases International 2010年第3期9卷 321-324页

作者： gabriele marangoni Adrian O'Sullivan Amir Ali Walid Faraj Nigel Heaton Institute of Liver Studies King's College London School of Medicine at King's College Hospital

BACKGROUND:Renal cell carcinoma(RCC)involves the inferior vena cava(IVC)in a minority of *** commonly,it presents with Budd-Chiari *** untreated, the condition progresses towards liver failure and ***:We report a case of Budd-Chiari syndrome due to infiltration of the IVC and right atrium by recurrence of RCC 7 years after successful treatment by primary ***:Surgery was performed with a combined abdominal and thoracic approach with cardio-pulmonary by-pass and *** tumor was removed and a cadaveric iliac vein graft used to re-establish venous continuity between the right atrium and hepatic ***:Although it is a complex and high-risk procedure,aggressive surgery performed by an experienced team with liver transplant and cardiothoracic skills may enable resection of apparently advanced caval *** case is discussed in the light of the current literature.

关键词： inferior vena cava renal cell carcinoma recurrence Budd-Chiari syndrome

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Pancreaticoduodenectomy with radical lymphadenectomy is not contraindicated for patients with established chronic liver disease and portal hypertension

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Hepatobiliary & Pancreatic Diseases International 2008年第1期7卷 82-85页

作者： Harsheet Sethi Parthi Srinivasan gabriele marangoni Andreas Prachalias Mohamed Rela Nigel Heaton Institute of Liver Studies Kings College London School of Medicine at Kings College HospitalDenmark HillLondon SE5 9RSUK

BACKGROUND: hronic liver disease has been considered a contraindication to radical surgery for intra-abdominal tumors because of the risk of decompensation. METHODS: In a retrospective analysis of all patients undergoing pancreaticoduodenectomy for cancer treated from January 2000 to December 2006 at our center, 4 patients were identified with operable pancreatic tumors and well-compensated chronic liver disease. The preoperative staging, decompression of the biliary tree, liver biopsy, Child-Turcot-Pugh and MELD scores were ***: All patients underwent pancreaticoduodenectomy successfully with minimal blood loss, and no peri-operative blood transfusions or liver decompensation. There was no postoperative mortality. Two patients received adjuvant chemotherapy. One patient died with recurrent disease at 18 months, one is alive with disease recurrence, and two are alive and disease ***: Patients with pancreatic cancer and well-compensated chronic liver disease should routinely be considered for radical surgery at specialist hepatobiliary centres with expertise available to manage complex liver disease.

关键词： pancreaticoduodenectomy Whipple's cirrhosis chronic liver disease portal hypertension

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Liver resection in liver transplant recipients

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Hepatobiliary & Pancreatic Diseases International 2008年第6期7卷 590-594页

作者： gabriele marangoni Walid Faraj Harsheet Sethi Mohamed Rela Paolo Muiesan Nigel Heaton King's College London School of Medicine at King's College Hospital Institute of Liver StudiesDenmark Hill SE5 9RS University Hospital Birmingham EdgbastonB15 2TH

BACKGROUND:Liver resection after liver transplantation is a relatively uncommon *** for liver resection include hepatic artery thrombosis(HAT),non- anastomotic biliary stricture(ischemic biliary lesions), liver abscess,liver trauma and recurrence of hepatocellular carcinoma(HCC).Organ shortage and lower survival after re-transplantation have encouraged us to make attempts at graft salvage. METHODS:Eleven resections at a mean of 59 months after liver transplantation were made over 18 *** for liver resection included HCC recurrence in 4 patients, ischemic cholangiopathy,segmental HAT,sepsis and infected hematoma in 2 each,and ischemic segmentⅣafter split liver transplantation in 1. RESULTS:There was no perioperative *** included one re-laparotomy for small bowel perforation, one bile leak treated conservatively,one right subphrenic collection,one wound infection and 5 episodes of Gram- negative *** patient underwent re-transplantation 4 months after resection for chronic *** were 3 deaths,two from HCC recurrence and one from post- transplant lymphoproliferative *** overall mean follow-up after resection was 48 months. CONCLUSIONS:Liver resection in liver transplant recipients is safe,and has good outcome in selected patients and avoids re-transplantation in the majority of patients. Recipients with recurrent HCC in graft may benefit from resection,but cure is uncommon.

关键词： liver transplantation liver resection hepatocellular carcinoma recurrence

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Postoperative day one serum alanine aminotransferase does not predict patient morbidity and mortality after elective liver resection in non-cirrhotic patients

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Hepatobiliary & Pancreatic Diseases International 2016年第6期15卷 655-659页

作者： Ricky Harminder Bhogal Amit Nair Davide Papis Zaed Hamady Jawad Ahmad For Tai Lam Saboor Khan gabriele marangoni Department of Hepato-pancreatico-biliary Surgery University Hospitals of Coventry and Warwickshire University of Birmingham Centre for Liver ResearchInstitute for Biomedical ResearchThe Medical School

ABSTRACT： Serum aminotransferases have been used as surrogate markers for liver ischemia-reperfusion injury that follows liver surgery. Some studies have suggested that rises in serum alanine aminotransferase （ALT） correlate with patient outcome after liver resection. We assessed whether postoperative day 1 （POD 1） ALT could be used to predict patient morbidity and mortality following liver resection. We reviewed our prospectively held database and included consecutive adult patients undergoing elective liver resection in our institution between January 2013 and December 2014. Primary outcome assessed was correlation of POD 1 ALT with patient＇s morbidity and mortality. We also assessed whether concurrent radiofrequency ablation, neoadjuvant chemotherapy and use of the Pringle maneuver significantly affected the level of POD 1 ALT. A total of 110 liver resections were included in the study. The overall in-hospital patient morbidity and mortality were 31.8% and 0.9%, respectively. The median level of POD 1 ALT was 275 IU/L. No correlation was found between POD 1 serum ALT levels and patient morbidity after elective liver resection, whilst correlation with mortality was not possible because ofthe low number of mortalities. Patients undergoing concurrent radiofrequency ablation were noted to have an increased level of POD 1 serum ALT but not those given neoadjuvant chemotherapy and those in whom the Pringle maneuver was used. Our study demonstrates POD 1 serum ALT does not correlate with patient morbidity after elective liver resection.

关键词： alanine aminotransferase hepatectomy reperfusion injury aminotransferases postoperative complications

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