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Comprehensive review of hepatocellular carcinoma with portal vein tumor thrombus:State of art and future perspectives

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Hepatobiliary & Pancreatic Diseases International 2024年第3期23卷 221-227页

作者： paschalis gavriilidis Timothy M Pawlik Daniel Azoulay Department of Surgery Colchester General HospitalTurner RoadColchester CO45JLUK Department of Surgery The Ohio State Wexner Medical CenterJames Comprehensive Cancer CenterColumbusOHUSA Department of Hepato-Biliary and Liver Transplantation surgery Paul Brousse University HospitalParis-Saclay UniversityVillejuif 94800France

Background:Despite advances in the diagnosis of patients with hepatocellular carcinoma(HCC),70%-80%of patients are diagnosed with advanced stage disease.Portal vein tumor thrombus(PVTT)is among the most ominous signs of advanced stage disease and has been associated with poor survival if untreated.Data sources:A systematic search of MEDLINE(PubMed),Embase,Cochrane Library and Database for Systematic Reviews(CDSR),Google Scholar,and National Institute for Health and Clinical Excellence(NICE)databases until December 2022 was conducted using free text and MeSH terms:hepatocellular carcinoma,portal vein tumor thrombus,portal vein thrombosis,vascular invasion,liver and/or hepatic resection,liver transplantation,and systematic review.Results:Centers of surgical excellence have reported promising results related to the individualized surgical management of portal thrombus versus arterial chemoembolization or systemic chemotherapy.Critical elements to the individualized surgical management of HCC and portal thrombus include precise classification of the portal vein tumor thrombus,accurate identification of the subgroups of patients who may benefit from resection,as well as meticulous surgical technique.This review addressed five specific areas:(a)formation of PVTT;(b)classifications of PVTT;(c)controversies related to clinical guidelines;(d)surgical treatments versus non-surgical approaches;and(e)characterization of surgical techniques correlated with classifications of PVTT.Conclusions:Current evidence from Chinese and Japanese high-volume centers demonstrated that patients with HCC and associated PVTT can be managed with surgical resection with acceptable results.

关键词： Hepatectomy Liver surgery Liver neoplasms Portal vein tumor thrombus

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Alternatives to left lateral sector in paediatric liver transplantation-a systematic review on monosegmental and reduced grafts

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Hepatobiliary Surgery and Nutrition 2022年第4期11卷 567-576,I0005页

作者： paschalis gavriilidis Ernest Hidalgo Department of Hepatopanceaticobiliary Surgery.Imperial College Healthcare NHS Trust Hammersmith HospitalLondonUK Department of Hepato-Pancreatic-Biliary Surgery and Liver Transplantation Hospital Universitari Vall d’HebronBarcelonaSpain

Background: Paediatric liver transplantation (pLT) is the treatment of choice for many liver conditions. However, it still poses relevant challenges, mainly related to the size of the recipients. Unlike in adults, excessive graft volume might represent an issue when the estimated graft-recipient-weight-ratio (GRWR) is significantly disproportionate. In this situation, the traditional left lateral sector (LLS) grafts are too big and other alternatives are required, such as monosegmental or reduced (including hyper-reduced) grafts (RLLS/HRLLS). Results with conventional LLS-pLT are excellent and replicating them with monosegmental or RLLS is challenging given (I) the technical complexity and (II) the need to overcome the large-for-size scenario. This article is to review the existing experience with monosegmental, RLLS/HRLLS grafts and appraise its results. Methods: Systematic search of the electronic databases, conducted from their inception until May 2020. Results: After scrutiny of the available literature, 16 studies were included reporting 330 patients transplanted with monosegmental and RLLS/HRLLS grafts. There were 10 re-grafts (6 of them <90 days);90% of grafts were LDLT. Overall, median recipient’s age and weight were 7 months (range, 5 days-22 months) and 5.8 kg (range, 2.6-8 kg) respectively. Median graft weight was 209 grams (range, 124-264 grams) and median GRWR was 3.5% (range, 2.7-5.6%). Hepatic artery and portal vein thrombosis overall incidence were 1.5% and 4.2%;120 out of the 330 pLT were monosegmental (37%) producing a smaller graft (median of 164 grams) and accordingly a lower GRWR (median 3.2%) compared to reduced LLS. With a median follow-up of 39 months (range, 6-87 months), the overall graft and patient survival were 84% (285/340) and 89% (295/330). Discussion: Monosegmental and RLLS/HRLLS grafts provide access to liver transplantation for very small recipients with excellent results comparable to the standard LLS.

关键词： Monosegmental monosegment(MSG) reduced hyper-reduced left lateral sector graft liver transplantation

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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 metastases.The 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 hypertrophy.Associating liver partition and portal vein ligation for staged hepatectomy(ALPPS)has been proposed to overcome the limitations of PVE.Liver venous deprivation(LVD),a technique that includes simultaneous portal and hepatic vein embolization,has also been proposed as an alternative to ALPPS.The 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 techniques.Data sources:A systematic search for literature was conducted using the electronic databases Embase,PubMed(MEDLINE),Google Scholar and Cochrane.Results:The time to operation was significantly shorter in the ALPPS cohort than in the PVE and LVD cohorts by 27 and 22 days,respectively.Intraoperative parameters of blood loss and the Pringle maneuver demonstrated non-significant differences between the PVE and LVD cohorts.There 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 cohort.Notably,the LVD cohort demonstrated a significantly better FLR/body weight(BW)ratio compared to both the ALPPS and PVE cohorts.Both the PVE and LVD cohorts demonstrated significantly lower major morbidity rates compared to the ALPPS cohort.The LVD cohort also demonstrated a significantly lower 90-day mortality rate compared to both the PVE and ALPPS cohorts.Conclusions:LVD in adequately selected patients may induce adequate and profound FLR hypertrophy before major hepatectomy.Present evidence demonstrated significantly lower major morbidity and mortality rates in the LVD cohort than in the ALPPS and PVE cohorts.

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

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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 flow.Consequently,it may mitigate the extent of bowel congestion following portal vein clamping.By 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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Associating liver partition and portal vein ligation or combined transarterial chemo-embolisation and portal vein embolisation for staged hepatectomy for HBV-related hepatocellular carcinoma

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Hepatobiliary Surgery and Nutrition 2023年第2期12卷 272-275页

作者： paschalis gavriilidis Timothy M.Pawlik Tomer Meirson Daniel Azoulay Department of Surgery Colchester General HospitalColchesterUK Department of Surgery The Ohio State University Wexner Medical CenterJames Comprehensive Cancer CenterColumbusOHUSA Davidoff Cancer Center Rabin Medical Center-Bellinson HospitalPetah TikyaIsrael Department of Hepato-Biliary and Liver Transplantation Surgery Paul Brousse University HospitalParis-Saclay UniversityVillejuifFrance

Many patients with hepatocellular carcinoma are diagnosed with large tumours at an advanced stage.In addition,conditions such as liver fibrosis,cirrhosis,portal hypertension,viral load,and portal vein thrombosis due to either non-neoplastic or portal vein tumour thrombus limit the indications for surgical management to a select subset of individuals(1).

关键词： Associating liver partition and portal vein ligation(ALPPS) transarterial chemoembolization(TACE) portal vein embolisation(PVE)

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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 surgery.The 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 imaging.The 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)databases.Results:Fifty-one pertinent articles were retrieved and included.The different types of digital imaging technologies and the real-time navigated liver surgery were estimated and compared.Conclusions: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 fluorescence.Furthermore,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 margins.In liver transplantation and especially in living donor liver transplantation(LDLT),3D printed models of the donor’s liver and models of the recipient’s hilar anatomy ca

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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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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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 tumour.High-quality guidelines are essential for effective patient stratification and individualised treatment.This 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 performed.Assessment 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 method.Literature searches identified 13 guidelines of highly variable quality according to the AGREE II criteria.The 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 modification.Overall,the methodological quality of guidelines on the surgical management of CC is poor.Future 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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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)technique.The 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 search.Updated traditional metaanalysis and NMA were performed and compared.Mortality and major morbidity were selected as primary outcomes.Results:Nineteen studies including 1200 patients were selected from the pool of 436 studies.Of these patients,315(31%)and 702(69%)underwent ALPPS and portal vein occlusion(PVO),respectively.Ninetyday 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 cohorts.Moreover,analysis of RCTs did not demonstrate significant differences of major morbidity between the ALPPS and PVO cohorts.The ALPPS cohort demonstrated significantly more favorable outcomes in hypertrophy parameters,time to operation,definitive hepatectomy,and R0 margins rates compared with the PVO cohort.In contrast,1-year disease-free survival was significantly higher in the PVO cohort compared to the ALPPS cohort.Conclusions: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 approaches.Furthermore,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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A Multi-Objective Optimal Experimental Design Framework for Enhancing the Efficiency of Online Model Identification Platforms

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Engineering 2019年第6期5卷 1049-1059页

作者： Arun Pankajakshan Conor Waldron Marco Quaglio Asterios gavriilidis Federico Galvanin Department of Chemical Engineering University College LondonLondon WC1E 7JEUK

Recent advances in automation and digitization enable the close integration of physical devices with their virtual counterparts, facilitating the real-time modeling and optimization of a multitude of processes in an automatic way. The rich and continuously updated data environment provided by such systems makes it possible for decisions to be made over time to drive the process toward optimal targets. In many man- ufacturing processes, in order to achieve an overall optimal process, the simultaneous assessment of mul- tiple objective functions related to process performance and cost is necessary. In this work, a multi- objective optimal experimental design framework is proposed to enhance the ef ciency of online model-identi cation platforms. The proposed framework permits exibility in the choice of trade-off experimental design solutions, which are calculated online that is, during the execution of experiments. The application of this framework to improve the online identi cation of kinetic models in ow reactors is illustrated using a case study in which a kinetic model is identi ed for the esteri cation of benzoic acid and ethanol in a microreactor.

关键词： Multi-objective optimization Optimal design of experiments Online

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