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Outcomes of robotic vs laparoscopic hepatectomy:A systematic review and meta-analysis

World Journal of Gastroenterology 2015年第27期21卷 8441-8451页

作者： Roberto Montalti Giammauro Berardi Alberto Patriti Marco Vivarelli Roberto Ivan Troisi Department of general and Hepato-Biliary surgery Liver Transplantation Service Ghent University Hospital and Medical School Department of Gastroenterology and Transplantation surgery Polytechnic University of Marche-Ospedali Riuniti division of general Minimally Invasive and Robotic Surgery General Hospital of Spoleto

AIM: To perform a systematic review and metaanalysis on robotic-assisted vs laparoscopic liver ***: A systematic literature search was performed using Pub Med, Scopus and the Cochrane Library Central. Participants of any age and sex, who underwent robotic or laparoscopic liver resection were considered following these criteria:(1) studies comparing robotic and laparoscopic liver resection;(2) studies reporting at least one perioperative outcome; and(3) if more than one study was reported by the same institute, only the most recent was included. The primary outcome measures were set for estimated blood loss, operative time, conversion rate, R1 resection rate, morbidity and mortality rates, hospital stay and major hepatectomy ***: A total of 7 articles, published between 2010 and 2014, fulfilled the selection criteria. The laparoscopic approach was associated with a significant reduction in blood loss and lower operative time(MD = 83.96, 95%CI: 10.51-157.41, P = 0.03; MD = 68.43, 95%CI: 39.22-97.65, P < 0.00001, respectively). No differences were found with respect to conversion rate, R1 resection rate, morbidity and hospital ***: Laparoscopic liver resection resulted in reduced blood loss and shorter surgical times compared to robotic liver resections. There was no difference in conversion rate, R1 resection rate, morbidity and length of postoperative stay.

关键词： Laparoscopic liver resections Robotic liverresections Outcome Systematic review Meta-analysis

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Peroral cholangioscopy for non-invasive papillary cholangio-carcinoma with extensive superficial ductal spread

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World Journal of Gastroenterology 2005年第41期11卷 6554-6556页

作者： Toshifumi Wakai Yoshio Shirai Katsuyoshi Hatakeyama division of Digestive and general surgery Niigata University Graduate School of Medical and Dental Sciences NiigataJapan

Papillary carcinoma arising from the extrahepatic bile duct often shows superficial ductal spread. We report herein the case of a patient with extensive superficial spread of non-invasive papillary cholangiocarcinoma,which was depicted with peroral cholangioscopy. A 65-year-old woman presented with the sudden-onset of severe epigastric pain. Ultrasonography revealed acute acalculous cholecystitis. Endoscopic retrograde cholangiography found small protruding lesions around the confluence of the cystic duct, suggestive of a cholangiocarcinoma. As the contour of the middle and upper bile ducts it was slightly irregular on the cholangiogram, the presence of superficial ductal spread was suspected. Peroral cholangioscopy revealed small papillary lesions around the confluence of the cystic duct and fine granular mucosal lesions in the middle and upper bile ducts and the right hepatic duct, suggesting a superficially spreading tumor. A right hepatectomy with bile duct resection was performed and no residual tumor was found. Histological examination revealed a non-invasive papillary carcinoma arising from the cystic duct with extensive superficial spread. Our experience of this case and a review of the literature suggest that a fine granular or fine papillary appearance of the ductal mucosae on cholangioscopy indicates superficial spread of papillary cholangiocarcinoma, for which peroral cholangioscopy is an efficient diagnostic option.

关键词： Cholangiocarcinoma Bile duct neoplasms Peroral cholangioscopy Papillary carcinoma Superficial ductal spread surgery

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Gastric leaks post sleeve gastrectomy:Review of its prevention and management

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World Journal of Gastroenterology 2014年第38期20卷 13904-13910页

作者： Antoine Abou Rached Melkart Basile Hicham El Masri Department of Internal Medicine Gastroenterology DivisionLebanese University Department of general surgery Lebanese University

Gastric sleeve gastrectomy has become a frequent bariatric procedure. Its apparent simplicity hides a number of serious,sometimes fatal,complications. This is more important in the absence of an internationally adopted algorithm for the management of the leaks complicating this operation. The debates exist even regarding the definition of a leak,with several classification systems that can be used to predict the cause of the leak,and also to determine the treatment plan. Causes of leak are classified as mechanical,technical and ischemic causes. After defining the possible causes,authors went into suggesting a number of preventive measures to decrease the leak rate,including gentle handling of tissues,staple line reinforcement,larger bougie size and routine use of methylene blue test per operatively. In our review,we noticed that the most important clinical sign or symptom in patients with gastric leaks are fever and tachycardia,which mandate the use of an abdominal computed tomography,associated with an upper gastrointrstinal series and/or gastroscopy if no leak was detected. After diagnosis,the management of leak depends mainly on the clinical condition of the patient and the onset time of leak. It varies between prompt surgical intervention in unstable patients and conservative management in stable ones in whom leaks present lately. The management options include also endoscopic interventions with closure techniques or more commonly exclusion techniques with an endoprosthesis. The aim of this review was to highlight the causes and thus the prevention modalities and find a standardized algorithm to deal with gastric leaks post sleeve gastrectomy.

关键词： Gastrectomy bariatric surgery Obesity Anastomotic leak Gastric fistula Algorithms Laparoscopy

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Intrahepatic cholangiocarcinoma,are we making progress?

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Hepatobiliary surgery and Nutrition 2018年第2期7卷 127-129页

作者： Andre Gorgen Nicolas Goldaracena Wei Zhang Gonzalo Sapisochin division of general surgery Department of SurgeryUniversity Health NetworkUniversity of TorontoTorontoCanada

There is a worldwide increase in the annual incidence of intrahepatic cholangiocarcinoma(iCCA)(1).For this reason,the review from Bupathi et *** a highly relevant *** work shows several important advances in the management of iCCA in the past few decades(2).They review the role of adjuvant therapy for patients with early stages and adverse prognostic factors(i.e.,lymph nodal disease).Also,they report recent achievements in the management of advanced *** the progress made in the management of iCCA,much is still to be done.

关键词： al. hepatic carcinoma

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Improvement of lenvatinib-induced nephrotic syndrome after adaptation to sorafenib in thyroid cancer:A case report

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World Journal of Clinical Cases 2020年第20期8卷 4883-4894页

作者： Che Hseuh Yang Kuo Tung Chen Yi Sheng Lin Chao Yu Hsu Yen Chuan Ou Min Che Tung division of Urology Department of SurgeryTungs'Taichung MetroHarbor HospitalTaichung City 435403Taiwan division of general surgery Department of SurgeryTungs'Taichung MetroHarbor HospitalTaichung City 435403Taiwan

BACKGROUND Target therapy is licensed by United States Food and Drug Administration on certain *** sorafenib and lenvatinib are tyrosine kinase inhibitor and indicated on radioactive iodine(RAI)-refractory differentiated thyroid cancer(DTC).Lenvatinib is more effective in cancers'control than sorafenib,but causes more nephrotoxicity than sorafenib *** case is the second published case about the serial adaptions from lenvatinib to sorafenib for improving the proteinuria and,meanwhile,achieving the therapeutic *** SUMMARY A 56-year-old man suffered from bilateral edematous lower extremities after 1-mo prescription of lenvatinib of 20 mg/d for RAI-refractory *** from this symptom,he also developed *** laboratory showed grade-3 proteinuria(estimated 24-h urine protein:9993 mg),hypoalbuminemia and ***-vascular endothelial growth factor(VEGF)therapyinduced nephrotic syndrome was *** reduced dosage of lenvatinib of 10 mg/d and related symptomatic drugs,limited improvement was observed in both adverse effects and caner *** this condition,we substituted sorafenib of 400 mg/d for lenvatinib of 10 mg/*** a 5-mo prescription,not only hypertension and peripheral edema were greatly improved,but also proteinuria was improved from grade three to grade one(estimated 24-h urine protein:962 mg).At the same time the cancer control was achieved,judged from computed tomography and laboratory evidence[thyroglobulin(Tg)before prescription of sorafenib:354.7 ng/m L;Tg after prescription of sorafenib:108.9 ng/m L].CONCLUSION Adaption from lenvatinib to sorafenib is a feasible method to improve the antiVEGF therapy-induced nephrotic syndrome and achieve the therapeutic goal at the same time.

关键词： Molecular targeted therapy/methods Receptors Vascular endothelial growth factor/drug effects Vascular endothelial growth factor/therapeutic use Vascular endothelial growth factor A/drug effects Nephrotic syndrome/drug therapy Case report

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Chest pain in a heart transplant recipient:A case report

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World Journal of Clinical Cases 2021年第16期9卷 3966-3970页

作者： Yu-Jen Chen Chien-Sung Tsai Tsai-Wang Huang Department of surgery Tri-Service General HospitalNational Defense Medical CenterTaipei 11490Taiwan division of Cardiovascular surgery Department of SurgeryTri-Service General HospitalNational Defense Medical CenterTaipei 11490Taiwan division of Thoracic surgery Department of SurgeryTri-Service General HospitalNational Defense Medical CenterTaipei 11490Taiwan

BACKGROUND Heart transplantation is recommended for the treatment of patients with refractory heart *** pain after heart transplantation is usually considered noncardiac owing to the denervated ***,data from case reports on tacrolimus-induced achalasia after heart transplantation are *** aimed to present a case of tacrolimus-induced achalasia that developed after heart tran-splantation,which was successfully relieved by laparoscopic Heller *** SUMMARY A 67-year-old man with a history of Type 2 diabetes mellitus,hyperlipidemia,and dilated cardiomyopathy had congestive heart failure following orthotopic heart transplantation with tacrolimus treatment 12 years *** the 10-year follow-up after the heart transplantation,the patient presented with persistent cough,dysphagia,heartburn,and retrosternal chest pain lasting for 2 *** endoscopy revealed no specific *** years later,the patient experienced the same symptoms,including chest pain lasting for 4 *** and manometry confirmed the presence of *** reports showed that discontinuing calcineurin inhibitor(CNI)treatment and endoscopic botulinum toxin injection could treat CNI-induced *** to the risk of rejection of the transplanted heart and considering the temporary benefits of botulinum toxin injection in achalasia,the patient underwent laparoscopic Heller *** was relieved without *** months later,he had no signs of recurrence of the *** In transplant patients with chest pain and gastrointestinal symptoms, CNIinducedachalasia may be one of the differential diagnoses. Esophagogram/manometry is useful for diagnosis.

关键词： Heart transplantation Refractory heart failure Chest pain Achalasia Esophagogram Case report

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Diabetes mellitus is a risk factor of acute kidney injury in liver transplantation patients

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Hepatobiliary & Pancreatic Diseases International 2021年第3期20卷 215-221页

作者： Yu-Jia Wang Jian-Hua Li Yi Guan Qiong-Hong Xie Chuan-Ming Hao Zheng-Xin Wang division of Nephrology Huashan HospitalFudan UniversityShanghai 200040China division of general surgery Huashan HospitalFudan UniversityShanghai 200040China

Background: Diabetes mellitus has become an increasing global health burden with rapid growing prevalence. Patients with diabetes have higher susceptibility to acute kidney injury(AKI). Liver transplantation(LT) predisposes the kidney to injury. However, the association between diabetes and AKI in LT patients remains unclear. Methods: We conducted a retrospective cohort study examining risk factors for AKI in patients undergone orthotopic LT. Potential risk factors including baseline estimated glomerular filtration rate(e GFR), the model for end-stage liver disease(MELD) score, diabetes, hypertension and intraoperative blood loss were screened. The primary endpoint was AKI occurrence. Multivariate logistic regression was used to analyze the association between potential risk factors and AKI. Results: A total of 291 patients undergone orthotopic LT were included in the present study. Among them, 102 patients(35.05%) developed AKI within 5 days after LT. Diabetes was identified as an independent risk factor for AKI. Patients who developed AKI had worse graft function recovery and higher mortality within 14 days after LT compared to those who did not develop AKI. AKI patients with diabetes had a significant decline of e GFR within the first postoperative year, compared with patients who did not develop AKI and who developed AKI but without diabetes. Conclusions: Diabetes is an independent risk factor for AKI after orthotopic LT. AKI is associated with delayed graft function recovery and higher mortality in short-term postoperative period. Diabetic patients who developed AKI after LT experience a faster decline of e GFR within the first year after surgery.

关键词： Acute kidney injury Liver transplantation Diabetes Renal function

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Dual loop(Roux en Y) reconstruction with isolated gastric limb reduces delayed gastric emptying after pancreatico-duodenectomy

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World Journal of Gastrointestinal surgery 2019年第2期11卷 93-100页

作者： Offir Ben-Ishay Reem Abu Zhaya Yoram Kluger Surgical Oncology Unit Division of General Surgery Rambam Health Care Campus

BACKGROUND Single loop reconstruction(SLR) was routine in our institution for patients undergoing pancreatico-duodenectomy(PD). Roux-en Y reconstruction with an isolated gastric limb(RIGL) recently became the reconstruction of *** To evaluate the impact of RIGL on incidence and severity of delayed gastric emptying(DGE).METHODS This is a single institution, retrospective analysis of patients undergoing PD. All patients undergoing PD from July 2010 through December 2016 were included in the study. Outcome of RIGL were compared to SLR. Primary measure of outcome included incidence and severity of DGE. Secondary measures of outcome were overall complications and postoperative *** One hundred and seventy-nine patients were included in the study. Fifty-two had RIGL, 127 had SLR. Overall complication rate was 40.2%, patients in the RIGL group experienced lower rates of DGE(15.4% vs 59.1%, P = 0.001). Other patient related outcomes were also significantly reduced: day of nasogastric tube removal(3 vs 5, P < 0.001), regain of normal diet(8 vs 9, P < 0.001). On multivariate analysis RIGL was associated independently with reduced rates of DGE(P < 0.001, OR 0.14)CONCLUSION The current study shows that RIGL reduces the rate of DGE after PD. Further prospective randomized controlled trials are required to affirm the current data.

关键词： Pancreaticoduodenectomy Delayed gastric emptying Complications Roux en Y

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Impact of Operative and Peri-operative Factors on the Long-term Prognosis of Primary Liver Cancer Patients Undergoing Hepatectomy

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Journal of Huazhong University of Science and Technology(Medical Sciences) 2016年第4期36卷 523-528页

作者：徐立宁徐盈盈高德伟 Department of general surgery Clinical Division of South Building Chinese PLA General Hospital Department of Internal Medicine Henan Cancer Hospital

This study examined the impact of the operative and peri-operative factors on the long-term prognosis of patients with primary liver cancer undergoing hepatectomy. A total of 222 patients with primary liver cancer who underwent hepatectomy were followed up from January 1986 to December 2010 at Chinese PLA general Hospital. The post-operative complication rate was 14.0% for all cases, 13.7% for hepatocellular carcinoma（HCC）, 10.0% for cholangiocarcinoma. The 1-, 3-, 5- and 10-year overall survival rates in patients with primary liver cancer after resection were 76.6%, 57.6%, 41.4%, and 21.0%. The survival rates were significantly higher in the HCC group than in the cholangiocarcinoma group（P=0.000）, in the non-anatomical resection group than in the anatomical resection group（P=0.005）, in the female group than in the male group（P=0.002）, in patients receiving no blood transfusion than in those who were given intra-operative blood transfusion（P=0.000）, in patients whose intra-operative blood loss was less than 400 m L than in those who intra-operatively lost more than 400 m L（P=0.000）. No significant difference was found in the survival rate between the HBs Ag-positive group and the HBs Ag-negative group（P=0.532）. Our study showed that anatomical resection, blood loss and blood transfusion were predictors of poor survival after hepatectomy for primary liver cancer patients, and concomitant hepatitis B virus infection bore no relation with the post-resection survival.

关键词： primary liver cancer prognosis hepatectomy perioperative time influencing factors

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Contralateral prophylactic mastectomy rate stable at major Canadian breast cancer center

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World Journal of Clinical Oncology 2016年第3期7卷 302-307页

作者： Amanda Roberts Lakhbir Sandhu Tulin D Cil Stefan O P Hofer Toni Zhong Department of surgery University of Toronto division of general surgery University Health Network and Women’s College Hospital division of Plastic and Reconstructive surgery University Health Network Toronto General Hospital

AIM: To examine trends of contralateral prophylactic mastectomy(CPM) rates at a Canadian academic breast cancer ***: A single-institution retrospective cohort study was completed. Women of any age who underwent at least a unilateral mastectomy(UM) for primary unilateral breast carcinoma between January 1, 2004 and December 31, 2010 were included. Patients who underwent CPM on the same day as UM were isolated to create two distinct cohorts. Patient and procedure characteristics were compared across groups using R software(version 3.1.0). The percentage of CPMs per year was determined. The Cochrane-Armitage test was used to assess the trend of CPMs over time. A P value of < 0.05 was considered ***: A total of 811 women met the inclusions/exclusion criteria; 759(93.6%) underwent UM alone and 52(6.4%) underwent UM with immediate CPM. The absolute number of procedures(UM and UM + CPM) increased over time, from 83 in 2004 to 147 in 2010 reflecting an increase in mastectomy volume. Annual CPM rates did not increase over time(P = 0.7) and varied between 2.6% to 10.7%. Family history of breast cancer [OR 3.6(1.8-7.3)] and immediate reconstruction [10.0(5.2-19.3)] were both significantly associated with CPM. Women who underwent CPM were younger(median age CPM 49 years vs UM 52 years, P < 0.0001) but age less than 50 years was not statistically associated with increased rates of CPM. CONCLUSION: CPM rates from 2004 to 2010 at a high-volume Canadian breast cancer center did not increase over time, in contrast to trends observed in the United States.

关键词： Breast Oncology Prophylactic Mastectomy surgery

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