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Rethinking the Barcelona clinic liver cancer guidelines:Intermediate stage and Child-Pugh B patients are suitable for surgery?

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World Journal of Gastroenterology 2021年第21期27卷 2784-2794页

作者： Fabrizio Romano Marco Chiarelli Mattia Garancini Mauro Scotti Mauro Zago Gerardo Cioffi Matilde De Simone Ugo Cioffi Department of surgery School of Medicine and SurgeryUniversity of Milano-BicoccaMonza 20900Italy Emergency and Robotic surgery A.Manzoni HospitalASST LeccoLecco 23900Italy Department of General surgery San Gerardo HospitalMonza 20900Italy Department of Sciences and Technologies Universitàdegli Studi del Sannio di BeneventoBenevento 82100Italy Department of surgery University of MilanMilano 20122Italy

According to Barcelona clinic Liver Cancer recommendations,intermediate stage hepatocellular carcinomas(stage B)are excluded from liver resection and are referred to palliative ***,Child-Pugh B patients are not usually candidates for liver ***,many hepatobiliary centers in the world manage patients with intermediate stage hepatocellular carcinoma or Child-Pugh B cirrhosis with liver resection,maintaining that hepatic resection is not contraindicated in selected patients with non–early-stage hepatocellular carcinoma and without normal liver *** studies demonstrate that resection provides the best survival benefit for selected patients in very early/early and even in intermediate stages of Barcelona clinic Liver Cancer classification,and this treatment gives good results in the setting of multinodular,large tumors in patients with portal hypertension and/or Child-Pugh B *** this review we explore this controversial topic,and we show through the literature analysis how liver resection may improve the short-and long-term survival rate of carefully selected Barcelona clinic Liver Cancer B and Child-Pugh B hepatocellular carcinoma ***,other large clinical studies are needed to clarify which patients with intermediate stage hepatocellular carcinoma are most likely to benefit from liver resection.

关键词： Liver surgery Hepatocellular carcinoma Barcelona liver clinic cancer Child B Intermediate stage

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Silk-based nerve guidance conduits with macroscopic holes modulate the vascularization of regenerating rat sciatic nerve

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Neural Regeneration Research 2025年第6期20卷 1789-1800页

作者： Carina Hromada Patrick Heimel Markus Kerbl LászlóGál Sylvia Nürnberger Barbara Schaedl James Ferguson Nicole Swiadek Xavier Monforte Johannes C.Heinzel Antal Nógrádi Andreas H.Teuschl-Woller David Hercher Department Life Science Engineering University of Applied Sciences Technikum WienViennaAustria Austrian Cluster for Tissue Regeneration ViennaAustria Ludwig Boltzmann Institute for Traumatology The Research Center in Cooperation with AUVAViennaAustria University clinic of Dentistry Medical University of ViennaViennaAustria Department of Plastic Reconstructive and Aesthetic SurgeryLandesklinikum Wiener Neustadt2700 Wiener NeustadtAustria Department of Anatomy Histology and EmbryologyAlbert Szent-Györgyi Medical SchoolUniversity of SzegedSzegedHungary Medical University of Vienna Department of Orthopedics and Trauma SurgeryDevision of Trauma SurgeryViennaAustria Department of Hand- PlasticReconstructive and Burn SurgeryBG Unfallklinik TuebingenUniversity of TuebingenTuebingenGermany

Peripheral nerve injuries induce a severe motor and sensory deficit. Since the availability of autologous nerve transplants for nerve repair is very limited, alternative treatment strategies are sought, including the use of tubular nerve guidance conduits(tNGCs). However, the use of tNGCs results in poor functional recovery and central necrosis of the regenerating tissue, which limits their application to short nerve lesion defects(typically shorter than 3 cm). Given the importance of vascularization in nerve regeneration, we hypothesized that enabling the growth of blood vessels from the surrounding tissue into the regenerating nerve within the tNGC would help eliminate necrotic processes and lead to improved regeneration. In this study, we reported the application of macroscopic holes into the tubular walls of silk-based tNGCs and compared the various features of these improved silk^(+) tNGCs with the tubes without holes(silk^(–) tNGCs) and autologous nerve transplants in an 8-mm sciatic nerve defect in rats. Using a combination of micro-computed tomography and histological analyses, we were able to prove that the use of silk^(+) tNGCs induced the growth of blood vessels from the adjacent tissue to the intraluminal neovascular formation. A significantly higher number of blood vessels in the silk^(+) group was found compared with autologous nerve transplants and silk^(–), accompanied by improved axon regeneration at the distal coaptation point compared with the silk^(–) tNGCs at 7 weeks postoperatively. In the 15-mm(critical size) sciatic nerve defect model, we again observed a distinct ingrowth of blood vessels through the tubular walls of silk^(+) tNGCs, but without improved functional recovery at 12 weeks postoperatively. Our data proves that macroporous tNGCs increase the vascular supply of regenerating nerves and facilitate improved axonal regeneration in a short-defect model but not in a critical-size defect model. This study suggests that further optimizatio

关键词： axon regeneration blood vessel functional recovery macroporous nerve lesion peripheral nerve repair sciatic nerve silk-based nerve guidance conduit vascularization

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clinical and therapeutic considerations of rectal lymphoma: A case report and literature review

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World Journal of Gastroenterology 2005年第3期11卷 460-461页

作者： Yilmaz Bilsel Emre Balik Sumer Yamaner Dursun Bugra General surgery clinic Department of General surgery

Primary rectal lymphoma is a rare presentation of gastrointestinal lymphomas. Its clinical presentation is indistinguishable from that of rectal carcinoma. Although surgical resection is often technically feasible, optimal therapy for colorectal lymphoma has not yet been *** report a case of primary rectal lymphoma (nonHodgkin's large cell lymphoma of type B) with high-grade features that disappeared completely after chemoradiotherapy. This case underlines that primary treatment with systemic chemotherapy and involved-field radiotherapy can be successful for rectal lymphoma, with surgery reserved for complications and chemotherapy failures.

关键词： Rectal lymphoma Systemic chemotherapy Involved-field radiotherapy

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Single Incision Laparoscopic surgery Development at the Hospital clinic: Our 4-Year Experience

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International Journal of clinical Medicine 2015年第1期6卷 26-32页

作者： Josep Martí Oscar Vidal Mauro Valentini Cesar Ginestà Juan José Espert Miss Yolanda Rodriguez Guerson Benarroch Juan Carlos García-Valdecasas General surgery and Emergency Unit Department of General and Digestive Surgery Digestive Diseases and Metabolism Institute Hospital Clínici Provincial Universitat de Barcelona IDIBAPS Barcelona Spain

Background: Single incision laparoscopic surgery (SILS) has still not replaced conventional laparoscopic surgery in many centers because of its special instruments requirements and training needs. In our Institution we introduced SILS procedures in a procedural stepwise manner, with progression to more difficult procedures only allowed if complete proficiency in low-complexity ones is achieved. Methods: We studied the evolution of performed SILS procedures in our Institution from the beginning of the program (mainly appendectomies, cholecystectomies, left adrenalectomies) and the results from these techniques. Results: Among 328 SILS procedures there were 148 appendectomies (24 by suprapubic access), 141 cholecystectomies, 32 left adrenalectomies, 6 diagnostic laparoscopies and 1 resection of Meckel’s diverticulum. The majority of appendectomies accounted for non-perforated appendicitis cases and there were no significant differences between transumbilical and suprapubic access groups. In cholecystectomies the majority of patients were elective cases and oral intake could be resumed within the 6 postoperative hours. In left adrenalectomies no conversion to open surgery was required and there were no intraoperative or postoperative complications. Conclusions: Procedural stepwise approach in SILS is a valid, feasible and safe option that can be applied at any institution starting a SILS program.

关键词： Adrenal Appendix Cholecystectomy Training/Courses Education

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Laparoscopic liver resection for malignancy:A review of the literature

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World Journal of Gastroenterology 2014年第37期20卷 13599-13606页

作者： Eyas Alkhalili Eren Berber Department of General surgery Cleveland Clinic

AIM: To review the published literature about laparoscopic liver resection for malignancy.

关键词： Laparoscopic liver resection Laparoscopy Laparoscopic liver surgery Hepatectomy Liver malignancy

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Idiopathic fistula-in-ano

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World Journal of Gastroenterology 2011年第28期17卷 3277-3285页

作者： Sherief Shawki Steven D Wexner Department of Colorectal surgery Cleveland Clinic Florida Department of surgery Suez Canal University

Fistula-in-ano is the most common form of perineal ***,a fistula includes an internal opening,a track,and an external *** external opening might acutely appear following infection and/or an abscess,or more insiduously in a chronic *** includes control of infection,assessment of the fistulous track in relation to the anal sphincter muscle,and finally,definitive treatment of the *** was the most commonly used mode of management,but concerns about post-fistulotomy incontinence prompted the use of sphincter preserving techniques such as advancement flaps,fibrin glue,collagen fistula plug,ligation of the intersphincteric fistula track,and stem *** descriptive and comparative studies have evaluated these different techniques with variable *** lack of consistent results,level I evidence,or long-term follow-up,as well as the heterogeneity of fistula pathology has prevented a definitive treatment *** article will review the most commonly available modalities and techniques for managing idiopathic fistula-in-ano.

关键词： Anal fistula Seton Fistulotomy Advancement flap Fibrin glue Fistula plug

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Minimally invasive surgery and transsulcal parafascicular approach in the evacuation of intracerebral haemorrhage

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Stroke & Vascular Neurology 2020年第1期5卷 40-49页

作者： Lina Marenco-Hillembrand Paola Suarez-Meade Henry Ruiz Garcia Ricardo Murguia-Fuentes Erik H Middlebrooks Lindsey Kangas W David Freeman Kaisorn L Chaichana Neurological surgery Mayo ClinicJacksonvilleFloridaUSA Radiology Neurological SurgeryMayo ClinicJacksonvilleFloridaUSA

Intracerebral haemorrhage(ICH)describes haemorrhage into the brain parenchyma that may result in a decline of the patient’s neurological *** is a common cause of morbidity and mortality *** surgical treatment for ICH has remained controversial as clinical trials have failed to demonstrate substantial improvement in patient outcome and ***,promising mechanical and pharmacological minimally invasive surgery(MIS)techniques for the treatment of ICH have been *** was designed with the objective of reducing morbidity due to complications of surgical *** MIS includes the use of tubular retractors and small diameter instruments for ICH *** methods consist of catheter placement inside the haematoma cavity for the passive drainage of the haematoma over the course of several *** of the most favourable approaches for MIS is the use of natural corridors for reaching the lesion,such as the transsulcal parafascicular *** approach provides an anatomical dissection of the subjacent white matter tracts,causing the least amount of damage while evacuating the haematoma.A detailed description of the currently known MIS techniques and devices is presented in this *** attention is given to the transsulcal parafascicular approach,which has particular benefits to provide a less traumatic MIS with promising overall patient outcome.

关键词： approach surgery cavity

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Liver transplantation in patients with incidental hepatocellular carcinoma/cholangiocarcinoma and intrahepatic cholangiocarcinoma： a single-center experience

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Hepatobiliary & Pancreatic Diseases International 2017年第3期16卷 264-270页

作者： Mohammed Elshamy Naftali Presser Abdulrahman Y Hammad Daniel J Firl Christopher Coppa John Fung Federico N Aucejo Hepatobiliary and Transplant surgery Digestive Disease and Surgery Institute Cleveland Clinic Cleveland OH USA Imaging Institute Cleveland Clinic Cleveland OH USA

BACKGROUND： Reports of fiver transplantation （LT） in patients with mixed hepatocellular carcinoma/cholangiocarcinoma （HCC/CC） and intrahepatic cholangiocarcinoma （ICC） are modest and have been mostly retrospective after pathological categorization in the setting of presumed HCC. Some studies suggest that patients undergoing LT with small and unifocal ICC or mixed HCC/CC can achieve about 40%-60% 5-year post-transplant survival. The study aimed to report our experience in patients undergoing LT with explant pathology revealing HCC/CC and ICC. METHODS： From a prospectively maintained database, we performed cohort analysis. We identified 13 patients who underwent LT with explant pathology revealing HCC/CC or ICC. RESULTS： The observed recurrence rate post-LT was 31% （4/13） and overall survival was 85%, 51%, and 51% at 1, 3 and 5 years, respectively. Disease-free survival was 68%, 51%, and 41% at 1, 3 and 5 years, respectively. In our cohort, four patients would have qualified for exception points based on updated HCC Organ Procurement and Transplantation Network imaging guidelines. CONCLUSIONS： Lesions which lack complete imaging characteristics of HCC may warrant pre-LT biopsy to fully elucidate their pathology. Identified patients with early HCC/CC or ICC may benefit from LT if unresectable. Additionally, incorporating adjunctive perioperative therapies such as in the case of patients undergoing LT with hilar cholangiocarcinoma may improve outcomes but this warrants further investigation.

关键词： mixed hepatocellular carcinoma/ cholangiocarcinoma liver transplantation survival outcomes

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Advancements and challenges in treating advanced gastric cancer in the West

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World Journal of Gastrointestinal Oncology 2019年第9期11卷 652-664页

作者： Jennifer L Leiting Travis E Grotz Division of Hepatobiliary and Pancreas surgery Mayo Clinic

Gastric cancer is a leading cause of cancer incidence and death *** with advanced gastric cancer benefit from a multi-modality treatment *** oncologic resection with negative margins and complete lymphadenectomy plays a crucial role in long-term survival for patients with resectable *** utilization of minimally invasive techniques for gastric cancer has been slowly increasing and is proving to be both technically and oncologically *** chemotherapy is the current standard of care for advanced gastric cancer.A variety of chemotherapy regimens have been used with the combination of docetaxel,oxaliplatin,5-fluorouracil,and leucovorin being the current recommendation given its superior ability to induce a complete pathologic response and prolong *** use of radiation has been more controversial with its optimal place in the treatment sequence being *** are current ongoing studies assessing the impact of radiation as an adjunct or in place of *** treatments(e.g.,trastuzumab for human epidermal growth factor receptor 2 positive tumors and pembrolizumab for programmed death-ligand 1 positive tumors)are showing promise and are part of a continued emphasis on individualized *** chemotherapy may also play a role in preventing peritoneal recurrences for patients with high risk *** treatment of patients with advanced gastric cancer in the West continues to advance and improve with a better understanding of optimal treatment sequences and the utilization of personalized treatment regimens.

关键词： Gastric cancer D2 lymphadenectomy Minimally invasive surgery Neoadjuvant chemotherapy Chemoradiation Targeted treatments

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Current status of laparoscopy for the treatment of rectal cancer

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World Journal of Gastroenterology 2014年第41期20卷 15125-15134页

作者： Noam Shussman Steven D Wexner Department of Colorectal surgery Cleveland Clinic Florida

surgery for rectal cancer in complex and entails many *** the laparoscopic approach in general and specific to colon cancer has been long proven to have short term benefits and to be oncologically safe,it is still a debatable topic for rectal *** attempt to benefit rectal cancer patients with the known advantages of the laparoscopic approach while not compromising their oncologic outcome has led to the conduction of many studies during the past *** we describe our technique for laparoscopic proctectomy and assess the current literature dealing with short term outcomes,immediate oncologic measures(such as lymph node yield and specimen quality) and long term oncologic outcomes of laparoscopic rectal cancer *** also briefly evaluate the evolving issues of robotic assisted rectal cancer surgery and the current innovations and trends in the minimally invasive approach to rectal cancer surgery.

关键词： Laparoscopy Rectal cancer Minimally invasive surgery Oncological outcomes Short term benefits

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