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Functional assessment of liver regeneration after major hepatectomy

Hepatobiliary Surgery and Nutrition 2022年第4期11卷 530-538页

作者： Fadi Rassam Pim B.Olthof Bart Takkenberg marc g.besselink Olivier R.Busch Joris I.Erdmann Rutger-Jan Swijnenburg Krijn Pvan Lienden Ulrich H.Beuers Roelof J.Bennink Thomas Mvan gulik Department of Surgery Cancer Center AmsterdamAmsterdam UMCUniversity of AmsterdamThe Netherlands Department of gastroenterology&Hepatology Amsterdam UMCUniversity of AmsterdamAmsterdamThe Netherlands Departments of Radiology and Nuclear Medicine Cancer Center AmsterdamAmsterdam UMCUniversity of AmsterdamAmsterdamThe Netherlands

Background: Liver regeneration is crucial to restore the functional liver mass after liver resection. The aim of this study was to evaluate the early postoperative changes in remnant liver function, volume and liver stiffness after major liver resection and their correlation with postoperative outcomes. Methods: Patients undergoing major liver resection (≥3 segments) between February and November 2018 underwent both functional assessment using technetium-99m mebrofenin hepatobiliary scintigraphy (HBS) and CT-volumetry of the (future) remnant liver on preoperative day 1, the 5th postoperative day, and 4-6 weeks after resection. At the same time points, patients underwent transient elastography (TE) for the assessment of liver stiffness. Severe postoperative complications (Clavien-Dindo ≥ 3A) and mortality were correlated with the functional and volumetric increases of the remnant liver. Liver failure was graded according to the International Study group of Liver Surgery (ISgLS) criteria. Results: A total of 18 patients were included of whom 10 (56%) had severe complications and one patient (5%) developed liver failure. Function and volume of the remnant liver had increased by the 5th postoperative day from 6.9 (5.4-10.9) to 9.6 (6.7-13.8) %/min/m2, P=0.004 and from 795.5 (538.3-1,037.5) to 1,080.0 (854.0-1,283.3) mL, Pgnificant, further increase [from 9.6 (6.7-13.8) to 10.9 (8.8-13.6) %/min/m2, P=0.177]. Liver elasticity of the future remnant liver (FRL) increased [from 10.8 (5.7-18.7) to 17.5 (12.4-22.6) kPa, P=0.018] and gradually recovered after 4-6 weeks to a median of 10.9 (5.7-18.8) kPa (T3 vs. T4, P=0.079). Patients who had severe postoperative complications did not show a significant increase in liver function on the 5th postoperative day (P=0.203), despite increas

关键词： Hepatobiliary scintigraphy(HBS) liver resection liver regeneration posthepatectomy liver failure liver function test

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International assessment and validation of the prognostic role of lymph node ratio in patients with resected pancreatic head ductal adenocarcinoma

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Hepatobiliary Surgery and Nutrition 2022年第6期11卷 822-833页

作者： gaetan-Romain Joliat Ismail Labgaa Jesse Sulzer Dionisios Vrochides Alessandro Zerbi gennaro Nappo Julie Perinel Mustapha Adham Stijn van Roessel marc g.besselink JSven D.Mieog Jesse V.groen Nicolas Demartines Markus Schafer Department of Visceral Surgery Lausanne University Hospital CHUVLausanneSwitzerland graduate School for Health Sciences University of BernBernSwitzerland Division of Hepatobiliary and Pancreatic Surgery Carolinas Medical CenterCharlotteNCUSA Humanitas Clinical and Research Center-IRCCS MilanItaly Department of Biomedical Sciences Humanitas UniversityMilanItaly Department of Digestive Surgery Edouard Herriot HospitalLyonFrance Department of Surgery Cancer Center AmsterdamAmsterdam UMCUniversity of AmsterdamAmsterdamThe Netherlands Department of Surgery Leiden University Medical CenterLeidenThe Netherlands

Background:Lymph node ratio(LNR;positive/harvested lymph nodes)was identified as overall survival predictor in several cancers,including pancreatic *** remains unclear if LNR is predictive of overall survival in pancreatic adenocarcinoma patients staged *** study assessed the prognostic overall survival role of LNR in pancreatic adenocarcinoma patients in relation with lymph node ***:A retrospective international study in six different centers(Europe and United States)was *** adenocarcinoma patients who underwent pancreatoduodenectomy from 2000 to 2017 were *** with neoadjuvant treatment,metastases,R2 resections,or missing data regarding nodal status were *** curves were calculated using Kaplan-Meier method and compared using log-rank *** Cox regressions were performed to find independent overall survival predictors adjusted for potential ***:A total of 1,327 patients were *** node involvement(pN+)was found in 1,026 patients(77%),561 pN1(55%)and 465 pN2(45%).Median LNR in pN+patients was 0.214[interquartile range(IQR):0.105-0.364].On multivariable analysis,LNR was the strongest overall survival predictor in the entire cohort[hazard ratio(HR)=5.5;95%confidence interval(CI):3.1-9.9;Pgnostic factor in patients undergoing surgery for pancreatic adenocarcinoma and permitted to stratify overall survival in pN2 *** should be routinely used in complement to tumor-node-metastasis(TNM)stage to better predict patient prognosis.

关键词： Pancreatectomy cancer lymphatic involvement

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Therapeutic anticoagulation for splanchnic vein thrombosis in acute pancreatitis: A national survey and case-vignette study

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World Journal of gastroenterology 2023年第21期29卷 3328-3340页

作者： Noor J Sissingh Jesse V groen Hester C Timmerhuis marc g besselink Bas Boekestijn Thomas L Bollen Bert A Bonsing Frederikus A Klok Hjalmar C van Santvoort Robert C Verdonk Casper H J van Eijck Jeanin E van Hooft Jan Sven D Mieog Department of gastroenterology and Hepatology Leiden University Medical CentreLeiden 2333 ZANetherlands Department of Research and Development St.Antonius HospitalNieuwegein 3420 EMNetherlands Department of Surgery Leiden University Medical CentreLeiden 2333 ZANetherlands Department of Surgery St.Antonius HospitalNieuwegein 3420 EMNetherlands Department of Surgery Amsterdam UMCLocation University of AmsterdamAmsterdam 1081 HZNetherlands Amsterdam gastroenterology Endocrinology Metabolism Amsterdam 1105 AZNetherlands Department of Radiology Leiden University Medical CentreLeiden 2333 ZANetherlands Department of Radiology St.Antonius HospitalNieuwegein 3420 EMNetherlands Department of Medicine-Thrombosis and Hemostasis Leiden University Medical CentreLeiden 2333 ZANetherlands Department of Surgery University Medical Centre UtrechtUtrechtUtrecht 3584 CXNetherlands Department of gastroenterology and Hepatology St.Antonius HospitalNieuwegein 3420 EMNetherlands Department of Surgery Erasmus Medical CentreRotterdam 3015 GDNetherlands

BACKgROUND Splanchnic vein thrombosis(SVT)is a major complication of moderate and severe acute *** is no consensus on whether therapeutic anticoagulation should be started in patients with acute pancreatitis and *** To gain insight into current opinions and clinical decision making of pancreatologists regarding SVT in acute *** A total of 139 pancreatologists of the Dutch Pancreatitis Study group and Dutch Pancreatic Cancer group were approached to complete an online survey and case vignette *** threshold to assume group agreement was set at 75%.RESULTS The response rate was 67%(n=93).Seventy-one pancreatologists(77%)regularly prescribed therapeutic anticoagulation in case of SVT,and 12 pancreatologists(13%)for narrowing of splanchnic vein *** most common reason to treat SVT was to avoid complications(87%).Acute thrombosis was the most important factor to prescribe therapeutic anticoagulation(90%).Portal vein thrombosis was chosen as the most preferred location to initiate therapeutic anticoagulation(76%)and splenic vein thrombosis as the least preferred location(86%).The preferred initial agent was low molecular weight heparin(LMWH;87%).In the case vignettes,therapeutic anticoagulation was prescribed for acute portal vein thrombosis,with or without suspected infected necrosis(82%and 90%),and thrombus progression(88%).Agreement was lacking regarding the selection and duration of long-term anticoagulation,the indication for thrombophilia testing and upper endoscopy,and about whether risk of bleeding is a major barrier for therapeutic *** In this national survey,the pancreatologists seemed to agree on the use of therapeutic anticoagulation,using LMWH in the acute phase,for acute portal thrombosis and in the case of thrombus progression,irrespective of the presence of infected necrosis.

关键词： Acute pancreatitis Splanchnic vein thrombosis Therapeutic anticoagulation Bleeding Recanalization Outcomes

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Short-and long-term outcomes after hemihepatectomy for perihilar cholangiocarcinoma:does left or right side matter?

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Hepatobiliary Surgery and Nutrition 2021年第2期10卷 154-162,I0001,I0002页

作者： Lotte C.Franken Pim B.Olthof Joris I.Erdmann Otto M.van Delden Joanne Verheij marc g.besselink Olivier R.Busch Thomas M.van gulik Department of Surgery Cancer Center AmsterdamAmsterdam UMCUniversity of AmsterdamThe Netherlands Department of Surgery Erasmus Medical CenterErasmus UniversityRotterdamThe Netherlands Department of Radiology and Nuclear Medicine Amsterdam UMCUniversity of AmsterdamAmsterdamThe Netherlands Department of Pathology Cancer Center AmsterdamAmsterdam UMCUniversity of AmsterdamAmsterdamThe Netherlands

Background:The only potentially curative option for patients with perihilar cholangiocarcinoma(PHC)is resection,typically an extrahepatic bile duct resection in combination with(extended)liver *** such as bile leakage and liver failure have been suggested to be more common after right-sided resections compared to left-sided resections,whilst superior oncological outcomes have been reported after right-sided ***,data on outcomes after right-sided or left-sided liver resections in PHC are ***,we aimed to investigate short-and long-term outcomes after left and right hemihepatectomy in patients with ***:In this retrospective study,patients undergoing major liver resection for suspected PHC in a tertiary center between 2000-2018 were *** who had undergone left-sided resections were compared to patients with right-sided resections in terms of complications(90-day mortality,overall and severe morbidity and specific complications).For long-term outcomes,only patients with pathologically proven PHC were included in the survival ***:A total of 178 patients undergoing hemihepatectomy for suspected PHC were analysed,including 76 left-sided and 102 right-sided *** 90-day mortality was 14%(24 out of 178),with no significant difference after left-sided resection(11%;8 out of 76)versus right-sided resection(16%;16 out of 102)(P=0.319).Severe morbidity(Clavein Dindo≥3)was also comparable in both groups:54%versus 61%(P=0.361).No differences in specific complications including bile leakage were observed,although liver failure appeared to occur more frequently after right hemihepatectomy(22%versus 11%,P=0.052).Five-year overall survival for pathologically proven PHC,excluding in-hospital mortality,did not differ;43.7%after left-sided resection *** 38.2%after right-sided resection(P=0.553).Conclusions:Both short-and long-term outcomes between patients undergoing left and right hemihepate

关键词： Perihilar cholangiocarcinoma(PHC) hepatectomy outcomes mortality survival

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Clinical outcomes of patients with duodenal adenocarcinoma and intestinal-type papilla of Vater adenocarcinoma

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World Journal of gastrointestinal Oncology 2020年第3期12卷 347-357页

作者： Laura L Meijer Marin Strijker Jacob K de Bakker Jurgen gJ Toennaer Barbara M Zonderhuis Hans J van der Vliet Hanneke Wilmink Joanne Verheij Freek Daams Olivier R Busch Nicole CT van grieken marc g besselink geert Kazemier Department of Surgery Cancer Center AmsterdamAmsterdam UMCVU University AmsterdamAmsterdamNoord-Holland 1081HVThe Netherlands Department of Surgery Cancer Center AmsterdamAmsterdam UMCUniversity of AmsterdamAmsterdamNoord-Holland 1105AZThe Netherlands Department of Medical Oncology Cancer Center AmsterdamAmsterdam UMCVU University AmsterdamAmsterdamNoord-Holland 1081HVThe Netherlands Department of Medical Oncology Cancer Center AmsterdamAmsterdam UMCUniversity of Amsterdam AmsterdamNoord-Holland 1105AZThe Netherlands Department of Pathology Cancer Center AmsterdamAmsterdam UMCUniversity of Amsterdam AmsterdamNoord-Holland 1105AZThe Netherlands Department of Pathology Cancer Center AmsterdamAmsterdam UMCVU University Amsterdam Noord-Holland 1081HVThe Netherlands

BACKgROUND Duodenal adenocarcinoma(DA)and intestinal-type papilla of Vater adenocarcinoma(it-PVA)are rare malignancies of the gastrointestinal *** therapeutic options are translated nowadays from treatment strategies for patients with colorectal cancer due to histopathological *** To retrospectively investigate the clinical outcome of patients with DA and *** All patients with DA and it-PVA diagnosed between 2000 and 2017 were included at two academic centers in the *** patients with histopathologically-confirmed DA or it-PVA were eligible for *** outcome was compared between DA and it-PVA per disease *** the subgroup of stage IV disease,survival after local treatment of oligometastases was compared with systemic therapy or supportive *** In total,155 patients with DA and it-PVA were *** with it-PVA more often presented with stage I disease,while DA was more often diagnosed at stage IV(Pge IV disease underwent resection of the primary tumor,combined with local treatment of *** treatment of metastases was associated with an overall survival of 37 mo,compared to 14 and 6 mo for systemic therapy and supportive care,*** Survival of patients with DA and it-PVA is comparable per disease *** results suggest a potential benefit for local treatment strategies in selected patients with oligometastases,although additional prospective studies are needed.

关键词： Duodenal adenocarcinoma Papilla of Vater adenocarcinoma Clinical outcomes Local treatment Metastases Survival

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Occurrence of seeding metastases in resectable perihilar cholangiocarcinoma and the role of low-dose radiotherapy to prevent this

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World Journal of Hepatology 2020年第11期12卷 1089-1097页

作者： Lotte C Franken Eva Roos Job Saris Jeanin E van Hooft Otto M van Delden Joanne Verheij Joris I Erdmann marc g besselink Olivier R Busch geertjan van Tienhoven Thomas M van gulik Department of Surgery Cancer Center AmsterdamAmsterdam UMCUniversity of AmsterdamAmsterdam 1105 AZNetherlands Department of Pathology Amsterdam UMCUniversity of AmsterdamAmsterdam 1105 AZNetherlands Department of gastroenterology Amsterdam UMCUniversity of AmsterdamAmsterdam 1105 AZNetherlands Department of Interventional Radiology Amsterdam UMCUniversity of AmsterdamAmsterdam 1105 AZNetherlands Department of Radiation Oncology Amsterdam UMCUniversity of AmsterdamAmsterdam 1105 AZNetherlands

BACKgROUND Preoperative biliary drainage in patients with presumed resectable perihilar cholangiocarcinoma(PHC)is hypothesized to promote the occurrence of seeding *** metastases can occur at the surgical scars or at the site of postoperative drains,and in case of percutaneous biliary drainage,at the catheter *** prevent seeding metastases after resection,we routinely treated PHC patients with preoperative radiotherapy(RT)for over 25 years until January *** To investigate the incidence of seeding metastases following resection of *** All patients who underwent resection for pathology proven PHC between January 2000 and march 2019 were included in this retrospective *** 2000-January 2018,patients received preoperative RT(3×3.5 gray).RT was omitted in patients treated after January *** A total of 171 patients underwent resection for PHC between January 2000 and march *** 171 patients undergoing resection,111 patients(65%)were treated with preoperative *** bile cytology showed no difference in the presence of viable tumor cells in bile of patients undergoing preoperative RT or ***,two patients(1.2%)with seeding metastases were identified,both in the laparotomy scar and both after preoperative RT(one patient with endoscopic and the other with percutaneous and endoscopic biliary drainage).CONCLUSION The incidence of seeding metastases in patients with resected PHC in our series was low(1.2%).This low incidence and the inability of providing evidence that preoperative low-dose RT prevents seeding metastases,has led us to discontinue preoperative RT in patients with resectable PHC in our center.

关键词： Perihilar cholangiocarcinoma Seeding metastases Preventive radiotherapy

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渐进式和开放式坏死组织清除术治疗坏死性胰腺炎

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肝胆外科杂志 2010年第4期18卷 316-316页

作者： Hjalmar C.van Santvoort marc g.besselink Olaf J.Bakker 张志功耿小平

1背景胰腺炎继发感染性坏死后传统的手术方式是通过开放式手术完全清除感染坏死组织,该手术方式存在较高的并发症发生率(34－95%)和死亡率(11－39%),同时有长期胰腺分泌功能不全的风险。作为以上手术方式的替代,低侵袭性的技术,包括经... 详细信息

1背景胰腺炎继发感染性坏死后传统的手术方式是通过开放式手术完全清除感染坏死组织,该手术方式存在较高的并发症发生率(34－95%)和死亡率(11－39%),同时有长期胰腺分泌功能不全的风险。作为以上手术方式的替代,低侵袭性的技术,包括经皮穿刺引流、内镜下穿刺引流、微创腹膜后坏死组织清除术等被越来越多地应用。[第一段]

关键词：坏死组织清除术坏死性胰腺炎开放式手术渐进式经皮穿刺引流继发感染性摘要治疗

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Finite-time consensus protocols for multi-dimensional multi-agent systems

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Control Theory and Technology 2020年第4期18卷 419-430页

作者： Jieqiang Wei Bart besselink Junfeng Wu Henrik Sandberg Karl H.Johansson Ericsson global AI Accelerator Torshamnsgatan 21StockholmSweden Bernoulli Institute for Mathematics Computer Science and Artificial IntelligenceUniversity of GroningenP.O.Box 4079700 GroningenAKThe Netherlands College of Control Science and Engineering Zhejiang University310027 HangzhouChina Division of Decision and Control Systems KTH Royal Institute of Technology10044 StockholmSweden

A fnite.-time consensus protocol is proposed for multi -dimensional multi- agent systems, using direction peserving signumcontrols. Flipp solutions and nonsmooh analysis tehniques are adopted to handle discontinuities. Suficient and ncessaryconditions are provided to guarantee infinte time convergence and boundedness of the solutions. It turns out that the numberof agents which have cotinuous contol law plays an ssenan role in fnite-tine conerence In adidio it is shown thatthe unit bals itoduced bylp, norms. where p ∈[1,∞] , are inariat for the closed lop.

关键词： Multi-agent systems Network consensus Finite time convergence Nonsmooth analysis

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急性胰腺炎

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英国医学杂志中文版 2017年第7期20卷 381-386页

作者： C D Johnson M g besselink R Carter 阮戈冲吴东 University Surgery University Hospital Southampton SO 16 6YD UK Dutch Pancreatitis Study group Academic Medical Center Amsterdam Netherlands West of ScotlandPancreatic Unit Glasgow Royalinfirmary GlasgowUK 北京协和医院消化科

急性胰腺炎是急诊人院的常见病因。在英国，覆盖30万～40万人口的医院每年大多会收治100例左右的急性胰腺炎患者。本文将介绍目前关于急性胰腺炎诊断、评估和治疗的研究证据。

关键词：急性胰腺炎治疗方法患者疾病

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基于算法的管理方案和常规管理方案在胰腺切除术后并发症早期识别和处理中的应用对比:一项荷兰国家级RCT研究

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肝胆外科杂志 2022年第4期30卷 245-245页

作者： Smits FJ Henry AC besselink Mg 马平川(译) 赵义军(校) Department of Surgery Regional Academic Cancer Centre Utrecht St Antonius Hospital Nieuwegein and University Medical Centre Utrecht Utrecht Netherlands Department of Surgery Cancer Centre Amsterdam Amsterdam UMC University of Amsterdam Amsterdam Netherlands Department of Surgery Erasmus MC Cancer Institute Rotterdam Netherlands Department of Radiology Radboud University Medical Centre Nijmegen Netherlands Department of Radiology Regional Academic Cancer Centre Utrecht St Antonius Hospital Nieuwegein and University Medical Centre Utrecht Utrecht Netherlands Department of Radiology Cancer Centre Amsterdam Amsterdam UMC University of Amsterdam Amsterdam Netherlands Department of Radiology Maastricht University Medical Centre Maastricht Netherlands Department of Radiology and Nuclear Medicine Erasmus MC Cancer Institute Rotterdam Netherlands Department of Surgery Leiden University Medical Centre Leiden Netherlands Department of Surgery Jeroen Bosch Hospital Den Bosch Netherlands Department of Surgery Maastricht University Medical Centre Maastricht Netherlands

研究背景:超过20%的患者在大手术后发生围术期并发症,耗费了大量医疗资源和医保费用。因此,改善预后的重点应包括及时识别和并发症管理。胰腺切除术作为一种复杂手术,其并发症发生率和死亡率均较高。早期识别和处理并发症可以改善患者... 详细信息

研究背景:超过20%的患者在大手术后发生围术期并发症,耗费了大量医疗资源和医保费用。因此,改善预后的重点应包括及时识别和并发症管理。胰腺切除术作为一种复杂手术,其并发症发生率和死亡率均较高。早期识别和处理并发症可以改善患者预后。研究方法:本研究是一项开放标签、全国性、阶梯楔形聚类随机试验,纳入所有接受胰腺切除术的患者,无针对中心或患者的排除标准。所有17家进行胰腺手术的中心均被随机分配到常规术后管理(对照组)和根据多模式、多学科算法早期识别和微创处理术后并发症组(干预组)。本研究开发了一个智能手机软件,该软件结合了该算法包括临床和生化标志物的日常评估,确定何时进行腹部CT、穿刺引流、抗感染和拔除腹部引流管。研究终点为需要侵入性干预的出血、器官衰竭以及术后90天内死亡。算法开发的源数据来自既往研究报道和国家数据库。

关键词：胰腺切除术器官衰竭生化标志物医保费用胰腺手术医疗资源穿刺引流早期识别

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