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Haemoxygenase modulates cytokine induced neutrophil chemoattractant in hepatic ischemia reperfusion injury

World Journal of Gastroenterology 2016年第33期22卷 7518-7535页

作者： Niteen Tapuria Sameer Junnarkar Mahmoud Abu-amara Barry Fuller Alexander M Seifalian Brian R Davidson Department of hpb surgery and liver transplantation Royal Free Hospital

AIM To investigate the hepatic microcirculatory changes due to Haemoxygenase(HO),effect of HO inhibition on remote ischemic preconditioning(RIPC) and modulation of *** Eight groups of animals were studied- Sham,ischemia reperfusion injury(IRI) the animals were subjected to 45 min of hepatic ischemia followed by three hours of reperfusion,RIPC(remote ischemic preconditioning) + IRI group,remote ischemic preconditioning in sham(RIPC + Sham),PDTC + IR(Pyridodithiocarbamate,HO donor),Zn PP + RIPC + IRI(Zinc protoporphyrin prior to preconditioning),IR-24(45 min of ischemia followed by 24 h of reperfusion),RIPC+IR-24(preconditioning prior to. After 3 and 24 h of reperfusion the animals were killed by exsanguination and samples were taken. RESULTS Velocity of flow(160.83 ± 12.24 μm/s),sinusoidal flow(8.42 ± 1.19) and sinusoidal perfusion index(42.12 ± 7.28) in hepatic IR were lower(P < 0.05) in comparison to RIPC and PDTC(HO inducer). RIPC increased velocity of flow(328.04 ± 19.13 μm/s),sinusoidal flow(17.75 ± 2.59) and the sinusoidal perfusion index(67.28 ± 1.82)(P < 0.05). PDTC(HO induction) reproduced the effects of RIPC in hepatic IR. PDTC restored RBC velocity(300.88 ± 22.109 μm/s),sinusoidal flow(17.66 ± 3.71) and sinusoidal perfusion(82.33 ± 3.5) to near sham levels. Zn PP(HO inhibition) reduced velocity of flow of RBC in the RIPC group(170.74 ± 13.43 μm/s and sinusoidal flow in the RIPC group(9.46 ± 1.34). Zn PP in RIPC(60.29 ± 1.82) showed a fall in perfusion only at 180 min of reperfusion. Neutrophil adhesion in IR injury is seen in both postsinusoidal venules(769.05 ± 87.48) and sinusoids(97.4 ± 7.49). Neutrophil adhesion in RIPC + IR injury is reduced in both postsinusoidal venules(219.66 ± 93.79) and sinusoids(25.69 ± 9.08)(P < 0.05). PDTC reduced neutrophil adhesion in both postsinusoidal venules(89.58 ± 58.32) and sinusoids(17.98 ± 11.01)(P < 0.05) reproducing the effects of RIPC. Zn PP(HO inhibition) increased venular(589.04 ± 144.36) and sinusoida

关键词： Reperfusion injury CINC Microcirculation Ischaemic preconditioning Remote preconditioning Haemoxygenase

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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

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Acute pancreatitis induced by transarterial chemoembolization:a single-center experience of over 1500 cases

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Hepatobiliary & Pancreatic Diseases International 2016年第1期15卷 93-98页

作者： Wong Hoi She Albert CY Chan Tan To Cheung Kenneth SH Chok See Ching Chan Ronnie TP Poon Chung Mau Lo division of Hepatobiliary & Pancreatic surgery and liver transplantation Department of SurgeryThe University of Hong Kong

BACKGROUND： Acute pancreatitis is a relatively rare but po- tentially lethal complication after transarterial chemotherapy. This study aimed to review the complications such as acute pancreatitis after transarterial chemotherapy with or without embolization for hepatocellular carcinoma. METHODS： A total of 1632 patients with hepatocellular car- cinoma who had undergone transarterial chemoembolization from ]anuary 2000 to February 2014 in a single-center were reviewed retrospectively. We investigated the potential com- plications of transarterial chemoembolization, such as acute pancreatitis and acute pancreatitis-related complications. RESULTS： Of the 1632 patients with hepatocellular carcinoma who had undergone 5434 transarterial chemoembolizations, 1328 were male and 304 female. The median age of these pa- tients was 61 years. Most （79.6%） of the patients suffered from HBV-related hepatoceUular carcinoma. The median tumor size was 5.2 cm. Of the 1632 patients, 145 patients underwent transarterial chemoembolization with doxorubicin elut- ing bead, making up a total of 538 episodes. The remaining patients underwent transarterial chemoembolization with cisplatin. Seven （0.4%） patients suffered from acute pancre- atitis post-chemoembolization. Six patients had chemoembo- lization with doxorubicin and one had chemoembolization with cisplatin. Patients who received doxornbicin eluting bead had a higher risk of acute pancreatitis [6/145 （4.1%） vs 1/1487 （0.1%）, P〈0.0001]. Two patients had anatomical arterial variations. Four patients developed acute pancreatitis- related complications including necrotizing pancreatitis （n=3） and pseudocyst formation （n=1）. All of the 4 patients resolved after the use of antibiotics and other conservative treatment. Three patients had further transarterial chemoembolization without any complication. CONCLUSIONS： Acute pancreatitis after transarterial chemo- embolization could result in serious complications, especially after treatment wit

关键词： transarterial chemoembolization acute pancreatitis hepatocellular carcinoma

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Laparoscopic approach for hepatocellular carcinoma: where is the limit?

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Chinese Journal of Cancer Research 2014年第3期26卷 222-223页

作者： Giuseppe Maria Ettorre Giovanni Battista Levi Sandri division of General surgery and liver transplantation S.Camillo Hospital

Hepatocellular cancer （HCC） is the sixth most common malignant tumor worldwide and the most common primary liver cancer （1）. liver resection or liver transplantation is the therapeutic gold standards in patient with HCC. Due to advanced disease, extrahepatic metastases, or inadequate liver reserve, only 15% to 30% of patients with HCC can undergo to surgery （2）. Five-year risk of recurrence of HCC after resection is as high as 70% because the underlying chronic liver disease continues to put the patient at risk for the development of new cancer nodules （3）. Starting from the assumption that recurrence may be newly treated with surgery, laparoscopic approach is recommended,

关键词： HCC Laparoscopic approach for hepatocellular carcinoma where is the limit

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Role of neoadjuvant therapy for nonmetastatic pancreatic cancer:Current evidence and future perspectives

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World Journal of Gastrointestinal Oncology 2023年第6期15卷 911-924页

作者： Gianluca Cassese Ho-Seong Han Yoo-Seok Yoon Jun Suh Lee Boram Lee Antonio Cubisino Fabrizio Panaro Roberto Ivan Troisi Department of Clinical Medicine and surgery Division of Minimally Invasive HPB Surgery and Transplantation ServiceFederico II University HospitalNaples 80131Italy Department of surgery Seoul National University College of MedicineSeongnam 13620Gyeonggi-doSouth Korea Department of hpb surgery and transplantation Beaujon HospitalClichy 92110France Department of Digestive surgery and liver transplantation CHU MontpellierMontpellier 34100France

Pancreatic adenocarcinoma(PDAC)is one of the most common and lethal human cancers *** followed by adjuvant chemotherapy offers the best chance of a long-term survival for patients with PDAC,although only approximately 20%of the patients have resectable tumors when *** chemotherapy(NACT)is recommended for borderline resectable pancreatic *** studies have investigated the role of NACT in treating resectable tumors based on the recent advances in PDAC biology,as NACT provides the potential benefit of selecting patients with favorable tumor biology and controls potential micro-metastases in high-risk patients with resectable *** such challenging cases,new potential tools,such as ct-DNA and molecular targeted therapy,are emerging as novel therapeutic options that may improve old *** review aims to summarize the current evidence regarding the role of NACT in treating non-metastatic pancreatic cancer while focusing on future perspectives in light of recent evidence.

关键词： Pancreatic cancer Pancreatic duct adenocarcinoma Neoadjuvant chemotherapy Borderline resectable Locally advanced pancreatic cancer

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Laparoscopic liver resection:Wedge resections to living donor hepatectomy, are we heading in the right direction?

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World Journal of Gastroenterology 2014年第37期20卷 13369-13381页

作者： P Thomas Cherian Ashish Kumar Mishra Palaniappen Kumar Vijayant Kumar Sachan Anand Bharathan Gadiyaram Srikanth Baiju Senadhipan Mohamad S Rela Department of hpb surgery and liver transplantation Global Hospital Department of Gastro-intestinal surgery BGS-Global Hospital Department of Gastro-intestinal surgery SUT-Royal Hospital

Despite inception over 15 years ago and over 3000 completed procedures, laparoscopic liver resection has remained mainly in the domain of selected centers and enthusiasts. Requirement of extensive open liver resection(OLR) experience, in-depth understanding of anatomy and considerable laparoscopic technical expertise may have delayed wide application. However healthy scepticism of its actual benefits and presence of a potential publication bias; concern about its safety and technical learning curve, are probably equally responsible. Given that a large proportion of our work, at least in transplantation is still OLR, we have attempted to provide an entirely unbiased, mature opinion of its pros and cons in the current invited review. We have dividedthis review into two sections as we believe they merit separate attention on technical and ethical grounds. The first part deals with laparoscopic liver resection(LLR) in patients who present with benign or malignant liver pathology, wherein we have discussed its overall outcomes; its feasibility based on type of pathology and type of resection and included a small section on application of LLR in special scenarios like cirrhosis. The second part deals with the laparoscopic living donor hepatectomy(LDH) experience to date, including its potential impact on transplantation in general. Donor safety, graft outcomes after LDH and criterion to select ideal donors for LLR are discussed. Within each section we have provided practical points to improve safety in LLR and attempted to reach reasonable recommendations on the utilization of LLR for units that wish to develop such a service.

关键词： liver Laparoscopic transplantation Resection Living donor Minimally invasive Technique Hepatocellular Hepatectomy Cirrhosis

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Double cholecystectomy in case of accessory gallbladder:Not as easy as two cholecystectomies

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Hepatobiliary & Pancreatic Diseases International 2019年第1期18卷 93-95页

作者： Benjamin Darnis Kayvan Mohkam Fran?ois Cauchy Jean-Yves Mabrut Department of General surgery and liver transplantation Hospices Civils de Lyon Croix-Rousse University Hospital Ecole Doctorale EDISS 205 Université Lyon 1 hpb surgery and liver transplantation Unit Beaujon Hospital

To the Editor:Accessory gallbladders(AG)are rare and their management are usually *** variations are related with an abnormal division of the bile ducts precursors between the 5th and the 12th week of *** et al.[1]proposed an anatomical classification of these variations based on the embryologic abnormalities *** type 1 both gallbladders are connected to the common bile duct at the same *** type 2 the AG can reach either the common bile duct(ductular type)or an intrahepatic biliary duct(trabecular type).In type 3,three gallbladders are present.

关键词： gallbladders Harlaftis

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Current protective strategies in liver surgery

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World Journal of Gastroenterology 2010年第48期16卷 6098-6103页

作者： Kurinchi S Gurusamy Hector D Gonzalez Brian R Davidson hpb and liver transplantation Royal Free CampusUniversity College London Medical SchoolRoyal Free Hospital

During liver resection surgery for cancer or liver transplantation,the liver is subject to ischaemia (reduction in blood flow) followed by reperfusion (restoration of blood flow),which results in liver injury [ischemiareperfusion (IR) or IR injury]. Modulation of IR injury can be achieved in various ways. These include hypothermia,ischaemic preconditioning (IPC) (brief cycles of ischaemia followed by reperfusion of the organ before the prolonged period of ischaemia i.e. a conditioning response),ischaemic postconditioning (conditioning after the prolonged period of ischaemia but before the reperfusion),pharmacological agents to decrease IR injury,genetic modulation of IR injury,and machine perfusion (pulsatile perfusion). Hypothermia decreases the metabolic functions and the oxygen consumption of organs. Static cold storage in University of Wisconsin solution reduces IR injury and has prolonged organ storage and improved the function of transplanted grafts. There is currently no evidence for any clinical advantage in the use of alternate solutions for static cold storage. Although experimental data from animal models suggest that IPC,ischaemic postconditioning,various pharma-cological agents,gene therapy,and machine perfusion decrease IR injury,none of these interventions can be recommended in clinical practice. This is because of the lack of randomized controlled trials assessing the safety and efficacy of ischaemic postconditioning,gene therapy,and machine perfusion. Randomized controlled trials and systematic reviews of randomized controlled trials assessing the safety and efficacy of IPC and various pharmacological agents have demonstrated biochemical or histological improvements but this has not translated to clinical benefit. Further well designed randomized controlled trials are necessary to assess the various new protective strategies in liver resection.

关键词： liver Hepatectomy liver transplantation Ischemia-reperfusion injury Hypothermia Ischaemic preconditioning

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A gist of gastrointestinal stromal tumors: A review

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World Journal of Gastrointestinal Oncology 2013年第6期5卷 102-112页

作者： Ashwin Rammohan Jeswanth Sathyanesan Kamalakannan Rajendran Anbalagan Pitchaimuthu Senthil-Kumar Perumal UP Srinivasan Ravi Ramasamy Ravichandran Palaniappan Manoharan Govindan The Institute of Surgical Gastroenterology and liver transplantation Centre for GI Bleed Division of HPB Diseases Stanley Medical College Hospital

Gastrointestinal stromal tumors (GISTs) have been recognized as a biologically distinctive tumor type, different from smooth muscle and neural tumors of the gastrointestinal tract (GIT). They constitute the majority of gastrointestinal mesenchymal tumors of the GIT and are known to be refractory to conventional chemotherapy or radiation. They are defined and diagnosed by the expression of a proto-oncogene protein detected by immunohistochemistry which serves as a crucial diagnostic and therapeutic target. The identification of these mutations has resulted in a better understanding of their oncogenic mechanisms. The remarkable antitumor effects of the molecular inhibitor imatinib have necessitated accurate diagnosis of GIST and their distinction from other gastrointestinal mes-enchymal tumors. Both traditional and minimally invasive surgery are used to remove these tumors with minimal morbidity and excellent perioperative outcomes. The revolutionary use of specific, molecularlytargeted therapies, such as imatinib mesylate, reduces the frequency of disease recurrence when used as an adjuvant following complete resection. Neoadjuvant treatment with these agents appears to stabilize disease in the majority of patients and may reduce the extent of surgical resection required for subsequent complete tumor removal. The important interplay between the molecular genetics of GIST and responses to targeted therapeutics serves as a model for the study of targeted therapies in other solid tumors. This review summarizes our current knowledge and recent advances regarding the histogenesis, pathology, molecular biology, the basis for the novel targeted cancer therapy and current evidence based management of these unique tumors.

关键词： Gastrointestinal stromal tumors c-KIT Imatinib mesylate surgery Review

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Risk factors and classifications of hilar cholangiocarcinoma

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World Journal of Gastrointestinal Oncology 2013年第7期5卷 132-138页

作者： Miguel Angel Suarez-Munoz Jose Luis Fernandez-Aguilar Belinda Sanchez-Perez Jose Antonio Perez-Daga Beatriz Garcia-Albiach Ysabel Pulido-Roa Naiara Marin-Camero Julio Santoyo-Santoyo General Digestive and transplantation surgery Service HPB and Liver Transplant UnitUniversity Hospital Carlos Haya29010 MalagaSpain

Cholangiocarcinoma is the second most common primary malignant tumor of the *** cholangiocarcinoma or Klatskin tumor represents more than 50% of all biliary tract cholangiocarcinomas.A wide range of risk factors have been identified among patients with Perihilar cholangiocarcinoma including advanced age,male gender,primary sclerosing cholangitis,choledochal cysts,cholelithiasis,cholecystitis,parasitic infection(Opisthorchis viverrini and Clonorchis sinensis),inflammatory bowel disease,alcoholic cirrhosis,nonalcoholic cirrhosis,chronic pancreatitis and metabolic *** classifications have been used to describe the pathologic and radiologic appearance of *** three systems most commonly used to evaluate Perihilar cholangiocarcinoma are the Bismuth-Corlette(BC) system,the Memorial Sloan-Kettering Cancer Center and the TNM *** BC classification provides preoperative assessment of local *** Memorial Sloan-Kettering cancer center proposes a staging system according to three factors related to local tumor extent:the location and extent of bile duct involvement,the presence or absence of portal venous invasion,and the presence or absence of hepatic lobar *** TNM classification,besides the usual descriptors,tumor,node and metastases,provides additional information concerning the possibility for the residual tumor(R) and the histological grade(G).Recently,in 2011,a new consensus classification for the Perihilar cholangiocarcinoma had been *** consensus was organised by the European Hepato-PancreatoBiliary Association which identified the need for a new staging system for this type of *** classification includes information concerning biliary or vascular(portal or arterial) involvement,lymph node status or metastases,but also other essential aspects related to the surgical risk,such as remnant hepatic volume or the possibility of underlying disease.

关键词： Hilar cholangiocarcinoma Klatskin tumor Perihilar cholangiocarcinoma Bile duct cancer

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