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Role of colectomy in preventing recurrent primary sclerosing cholangitis in liver transplant recipients

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World Journal of Gastroenterology 2018年第28期24卷 3171-3180页

作者： Bettina M Buchholz Panagis M Lykoudis Reena Ravikumar Joerg M Pollok Giuseppe K Fusai department of HPB Surgery and liver transplantation Royal Free Hospital London

AIM To study the published evidence on the impact of colectomy in preventing recurrent primary sclerosing cholangitis(r PSC). METHODS An unrestricted systematic literature search in Pub Med, EMBASE, Medline Ovid SP, ISI Web of Science, Lista(EBSCO) and the Cochrane library was performed on clinical studies investigating colectomy in liver transplantation(LT) recipients with and without r PSC in the liver allograft. Study quality was evaluated according to a modification of the methodological index for non-randomized studies(MINORS) criteria. Primary endpoints were the impact of presence, timing and type of colectomy on r PSC. Overall presence of inflammatory bowel disease(IBD), time of IBD diagnosis, posttransplant IBD and immunosuppressive regimen were investigated as secondary *** The literature search yielded a total of 180 publications. No randomized controlled trial was identified. Six retrospective studies met the inclusion criteria of which 5 studies were graded as high quality articles. Reporting of IBD was heterogenous but in four publications, either inflammatory bowel disease, ulcerative colitis or in particular active colitis post-LT significantly increased the risk of r PSC. The presence of an intact(i.e., retained) colon at LT was identified as risk factor for r PSC in two of the high quality studies while four studies found no effect. Type of colectomy was not associated with r PSC but this endpoint was underreported(only in 33% of included studies).Neither tacrolimus nor cyclosporine A yielded a significant benefit in disease recurrence of primary sclerosing cholangitis(PSC).CONCLUSION The data favours a protective role of pre-/peri-LT colectomy in r PSC but the current evidence is not strong enough to recommend routine colectomy for r PSC prevention.

关键词： Recurrent primary sclerosing cholangitis Risk factor Ulcerative colitis Colectomy liver transplantation

Deep learning-based radiomics allows for a more accurate assessment of sarcopenia as a prognostic factor in hepatocellular carcinoma

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Journal of Zhejiang University-Science B(Biomedicine & Biotechnology) 2024年第1期25卷 83-90页

作者： Zhikun LIU Yichao WU Abid Ali KHAN Lun LU Jianguo WANG Jun CHEN Ningyang JIA Shusen ZHENG Xiao XU Key Laboratory of Integrated Oncology and Intelligent Medicine of Zhejiang Province Department of Hepatobiliary and Pancreatic SurgeryAffiliated Hangzhou First People’s HospitalZhejiang University School of MedicineHangzhou310006China Zhejiang University School of Medicine Hangzhou310058China department of Radiology Easter Hepatobiliary Surgery HospitalNaval Medical UniversityShanghai200438China department of Hepatobiliary and Pancreatic Surgery the First Affiliated HospitalZhejiang University School of MedicineHangzhou310003China NHC Key Laboratory of Combined Multi-organ transplantation Hangzhou310003China department of Hepatobiliary and Pancreatic Surgery Shulan(Hangzhou)HospitalHangzhou310022China

Hepatocellular carcinoma(HCC)is one of the most common malignancies and is a major cause of cancer-related mortalities worldwide(Forner et al.,2018;He et al.,2023).Sarcopenia is a syndrome characterized by an accelerated loss of skeletal muscle(SM)mass that may be age-related or the result of malnutrition in cancer patients(Cruz-Jentoft and Sayer,2019).Preoperative sarcopenia in HCC patients treated with hepatectomy or liver transplantation is an independent risk factor for poor survival(Voron et al.,2015;van Vugt et al.,2016).

关键词： cancer patients

Should we resect distant metastases?-reconsidering radical resection of pancreatic cancer with liver metastases

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Hepatobiliary Surgery and Nutrition 2024年第5期13卷 905-907页

作者： Niv Pencovich Ido Nachmany department of General Surgery and transplantation Sheba Medical CenterTel-HashomerIsrael Faculty of Medicine and Health Sciences Tel-Aviv UniversityTel-AvivIsrael

The mechanism of cancer metastasis is far more complex than the mere mechanical shedding of tumor cells into the circulation,followed by cell proliferation within an organ where they accidentally get *** spread is also not random;different primary tumors exhibit predilections for specific organs they metastasize *** notion dates back to 1889 when Stephen Paget described the“seed and soil”hypothesis,suggesting that the spread of tumor cells is governed by close interactions between specific cancer cells(seed)and the host organ(soil).Other crucial processes of metastatic spread,such as cell intravasation,extravasation,tumor latency,metastatic niche formation,and the development of micrometastasis and macrometastasis,have been delineated over the last few decades.

关键词： Metastasis oligometastases systemic disease chemotherapy local disease

Targeting angiogenesis for liver cancer: Past, present, and future

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Genes & Diseases 2020年第3期7卷 328-335页

作者： Xiao-Dong Zhu Zhao-You Tang Hui-Chuan Sun department of liver Surgery and transplantation Liver Cancer Institute and Zhongshan HospitalFudan UniversityShanghai200032China

liver cancer,mostly hepatocellular carcinoma(HCC),is the second leading cause of cancer mortality *** patients were diagnosed at an advanced stage,and systemic therapy is the standard of *** the approved systemic therapies for HCC are molecular targeted therapies with anti-angiogenic effects targeting the vascular endothelial growth factor signaling *** and lenvatinib are the first-line treatment,and regorafenib,ramucirumab,and cabozantinib are second-line treatment *** anti-PD-1 antibodies,including nivolumab and pembrolizumab,demonstrated promising anti-tumor effects as monotherapy for advanced HCC in phase II clinical trials,both failed in phase III ***-angiogenic treatment remains the backbone of systemic therapy for *** this review,we summarized the approved anti-angiogenic medicines and discussed the potential strategies to improve the efficacy of anti-angiogenic therapy,including combination therapy with other treatments,and discussed the approaches to overcome the drawbacks of anti-angiogenic therapies.

关键词： Anti-angiogenic therapy Combinational therapy Hepatocellular carcinoma Molecular targeted therapy Systemic therapy

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)

Adjuvant therapies after curative treatments for hepatocellular carcinoma: Current status and prospects

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Genes & Diseases 2020年第3期7卷 359-369页

作者： Xiao-Dong Zhu Kang-Shuai Li Hui-Chuan Sun department of liver Surgery and transplantation Liver Cancer Institute and Zhongshan HospitalFudan UniversityShanghai200032China

Tumor recurrence rate after surgery or ablation of hepatocellular carcinoma(HCC)is as high as 70%.However,there are no widely accepted adjuvant therapies;therefore,no treatment has been recommended by guidelines from the American Association for the Study of liver Disease or the European Association for the Study of the *** the registered trials failed to find any treatment to prolong recurrence-free survival,which is the primary outcome in most studies,including *** investigator-initiated studies revealed that antihepatitis B virus agents,interferon-a,transcatheter chemoembolization,chemokine-induced killer cells,and other treatments prolonged patient recurrence-free survival or overall survival after curative *** this review,we summarize the current status of adjuvant treatments for HCC and explain the challenges associated with designing a clinical trial for adjuvant *** new treatments being used as adjuvant therapy,especially anti-PD-1 antibodies,are also discussed.

关键词： Adjuvant therapy Anti-PD-1 antibody Clinical trial Hepatocellular carcinoma Molecular targeted therapy Recurrence-free survival

Adult-to-adult living donor liver transplantation for acute liver failure in China

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World Journal of Gastroenterology 2012年第48期18卷 7234-7241页

作者： Ding Yuan Fei Liu Yong-Gang Wei Bo Li Lv-Nan Yan Tian-Fu Wen Ji-Chun Zhao Yong Zeng Ke-Fei Chen department of liver and Vascular Surgery and liver transplantation Center of West China Hospital Sichuan University department of Hepatopancreatobiliary Surgery of West China Hospital Sichuan University

AIM:To investigate the long-term outcome of recipients and donors of adult-to-adult living-donor liver transplantation(AALDLT) for acute liver failure(ALF).METHODS:Between January 2005 and March 2010,170 living donor liver transplantations were performed at West China Hospital of Sichuan *** living liver donor was voluntary and provided informed *** ALF patients underwent AALDLT for rapid deterioration of liver *** was defined based on the criteria of the American Association for the Study of liver Diseases,including evidence of coagulation abnormality [international normalized ratio(INR) ≥ 1.5] and degree of mental alteration without pre-ex-isting cirrhosis and with an illness of liver disease was 37.1 ± 8.6,and the waiting duration of recipients was 5 ± 4 *** graft types included right lobe(n = 17) and dual graft(n = 3).The mean graft weight was 623.3 ± 111.3 g,which corresponded to graft-torecipient weight ratio of 0.95% ± 0.14%.The segment Ⅴor Ⅷ hepatic vein was reconstructed in 11 right-lobe *** 1-year and 3-year recipient's survival and graft survival rates were 65%(13 of 20).Postoperative results of total bilirubin,INR and creatinine showed obvious improvements in the survived ***,the creatinine level of the deaths was increased postoperatively and became more aggravated compared with the level

关键词： Acute liver failure Adult-to-adult liver donor liver transplantation Recipient Donor Risk factors

Clinical profile and outcomes of hepatocellular carcinoma in primary Budd-Chiari syndrome

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World Journal of Gastrointestinal Oncology 2024年第3期16卷 699-715页

作者： Ankit Agarwal Sagnik Biswas Shekhar Swaroop Arnav Aggarwal Ayush Agarwal Gautam Jain Anshuman Elhence Arun Vaidya Amit Gupte Ravi Mohanka Ramesh Kumar Ashwani Kumar Mishra Shivanand Gamanagatti Shashi Bala Paul Subrat Kumar Acharya Akash Shukla Shalimar department of Gastroenterology and Human Nutrition All India Institute of Medical SciencesNew Delhi 110029DelhiIndia department of Gastroenterology Seth Gordhandas Sunderdas Medical College and KEM HospitalMumbai 400012MaharashtraIndia department of Gastroenterology Sir HN Reliance Foundation HospitalMumbai 400004India department of liver Transplant and HPB Sir HN Reliance Foundation HospitalMumbai 400004India department of Gastroenterology All India Institute of Medical SciencesPatna 801507India Professor of Biostatistics National Drug Dependence Treatment Centre(NDDTC)All India Institute of Medical SciencesNew Delhi 110029India department of Radiodiagnosis All India Institute of Medical SciencesNew Delhi 110029DelhiIndia

BACKGROUND There is scant literature on hepatocellular carcinoma(HCC)in patients with Budd-Chiari syndrome(BCS).AIM To assess the magnitude,clinical characteristics,feasibility,and outcomes of treatment in *** A total of 904 BCS patients from New Delhi,India and 1140 from Mumbai,India were *** prevalence and incidence of HCC were determined,and among patients with BCS-HCC,the viability and outcomes of interventional therapy were *** In the New Delhi cohort of 35 BCS-HCC patients,18 had HCC at index presentation(prevalence 1.99%),and 17 developed HCC over a follow-up of 4601 person-years,[incidence 0.36(0.22-0.57)per 100 person-years].BCS-HCC patients were older when compared to patients with BCS alone(P=0.001)and had a higher proportion of inferior vena cava block,cirrhosis,and long-segment vascular *** median alpha-fetoprotein level was higher in patients with BCS-HCC at first presentation than those who developed HCC at follow-up(13029 ng/mL vs 500 ng/mL,P=0.01).Of the 35 BCS-HCC,26(74.3%)underwent radiological interventions for BCS,and 22(62.8%)patients underwent treatment for HCC[transarterial chemoembolization in 18(81.8%),oral tyrosine kinase inhibitor in 3(13.6%),and transarterial radioembolization in 1(4.5%)].The median survival among patients who underwent interventions for HCC compared with those who did not was 3.5 years vs 3.1 mo(P=0.0001).In contrast to the New Delhi cohort,the Mumbai cohort of BCS-HCC patients were predominantly males,presented with a more advanced HCC[Barcelona Clinic liver Cancer C and D],and 2 patients underwent liver *** HCC is not uncommon in patients with *** interventions and liver transplantation are feasible in select primary BCS-HCC patients and may improve outcomes.

关键词： Budd chiari syndrome Cancer Cirrhosis Thrombosis liver Varices Transarterial chemoembolization Hepatic venous outflow tract obstruction

Repair of a mal-repaired biliary injury:A case report

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World Journal of Gastroenterology 2009年第18期15卷 2283-2286页

作者： Awad Aldumour Paolo Aseni Mohmmad Alkofahi Luca Lamperti Elias Aldumour Paolo Girotti Luciano Gregorio De Carlis department of Hepatobiliary Surgery and liver transplantation Unit Niguarda Hospital20162 MilanItaly

Iatrogenic bile-duct injury post-laparoscopic cholecystectomy remains a major serious complication with unpredictable long-term results. We present a patient who underwent laparoscopic cholecystectomy for gallstones, in which the biliary injury was recognized intraoperatively. The surgical procedure was converted to an open one. The first surgeon repaired the injury over a T-tube without recognizing the anatomy and type of the biliary lesion, which led to an unusual biliary mal-repair. Immediately postoperatively, the abdominal drain brought a large amount of bile. A T-tube cholangiogram was performed. Despite the contrast medium leaking through the abdominal drain, the mal-repair was recognized intraoperatively. The surgical procedure was converted to an open one. The first surgeon repaired the injury over a T-tube without recognizing the anatomy and type of the biliary lesion, which led to an unusual biliary mal-repair. Immediately postoperatively, the abdominal drain brought a large amount of bile. A T-tube cholangiogram was performed. Despite the contrast medium leaking through the abdominal drain, the mal-repair was unrecognized. The patient was referred to our hospital for biliary leak. Ultrasound and cholangiography was repeated, which showed an unanatomical repair （right to left hepatic duct anastomosis over the T-tube）,with evidence of contrast medium coming out through the abdominal drain. Eventually the patient was subjected to a definitive surgical treatment. The biliary continuity was re-established by a Roux-en-Y hepaticojejunostomy, over transanastomotic external biliary stents. The patient is now doing well 4 years after the second surgical procedure. In reviewing the literature, we found a similar type of injury but we did not find a similar surgical real-repair. We propose an algorithm for the treatment of early and late biliary injuries.

关键词： Biliary tract injury Surgical complication Biliary surgery Laparoscopic cholecystectomy