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Antimicrobial management of intra-abdominal infections:Literature's guidelines

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World Journal of Gastroenterology 2012年第9期18卷 865-871页

作者： Massimo Sartelli Fausto Catena Federico Coccolini Antonio Daniele Pinna Department of general surgery Macerata Hospital Department of general Emergency and Transplant SurgerySant'Orsola-Malpighi University Hospital

Antimicrobial management of severe intra-abdominal infections (IAIs) involves a delicate balance of optimizing empirical therapy,which has been shown to improve clinical outcomes,while simultaneously reducing unnecessary antimicrobial *** sets of guidelines for the management of intra-abdominal infections were recently *** 2010,the Surgical Infection Society and the Infectious Diseases Society of America (SIS-IDSA) created guidelines for the diagnosis and management of complicated *** new SIS-IDSA guidelines replace those previously published in 2002 and *** World Society of Emergency surgery (WSES) guidelines represent additional contributions,made by specialists worldwide,to the debate regarding proper antimicrobial drug *** guidelines represent the conclusions of the consensus conference held in Bologna,Italy,in July 2010 during the first congress of the WSES.

关键词： Intra-abdominal infections Antimicrobial the-rapy Literature's guidelines

Risk factors for postoperative bile leakage:a retrospective single-center analysis of 411 hepatectomies

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Hepatobiliary & Pancreatic Diseases International 2016年第1期15卷 81-86页

作者： Fabrizio Panaro Lisa Hacina Hassan Bouyabrine Al-Warith Al-Hashmi Astrid Herrero Francis Navarro Department of general and Liver transplant surgery Montpellier University HospitalCollege of Medicine

BACKGROUND： The primary focus of the study was to ana- lyze the risk factors for bile leakage after hepatectomy for be- nign or malignant tumors. METHODS： A total of 411 patients who had undergone hepa- tectomy between December 2006 and December 2011 were ret- rospectively analyzed. The severity of bile leakage was graded according to the ISGLS classification. Twenty-eight pre- and postoperative parameters were analyzed. RESULTS： The overall bile leakage incidence was 10.2% （42/411）. The severity of the leakage was classified according to the IS- GLS classification. Bile leakage was detected early in case of abdominal drainage （11.4% vs 1.9%, P=0.034）. It prolonged the time of hospitalization （16 vs 9 days, P=0.001）. In all patients, wedge resection was associated with a higher incidence of bile leakage in contrast to anatomical resections （25.6% vs 4.1%, P〈0.0001） regardless of the underlying liver disease. Furthermore, total vascular exclusion increased risk of bile leakage （P=0.008）. CONCLUSIONS： Bile leakage as a major issue after hepatic resection is related to the postoperative morbidity and the hospitalization time. It is associated with non-anatomical re- section and a total vascular exclusion.

关键词： liver resection bile leakage wedge total vascular exclusion

Transjugular portosystemic shunt for early-onset refractory ascites after liver transplantation

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Hepatobiliary & Pancreatic Diseases International 2021年第1期20卷 90-93页

作者： Giuseppe Bianco Marco Maria Pascale Francesco Frongillo Erida Nure Salvatore Agnes Gabriele Spoletini general surgery and Liver transplant unit Fondazione IRCCS-Policlinico Universitario“A.Gemelli”Rome 00168Italy

Liver transplantation(LT)is the most effective treatment for end-stage liver disease and complications of portal hypertension(PHT).However,PHT can relapse as a consequence of viral,alcoholic or metabolic chronic liver disease(CLD)recurrence,rejection,vascular abnormalities,small-for-size syndrome and technical complications(e.g.,portal or hepatic veins stenosis and/or thrombosis)[1].LT recipients with PHT may suffer from com plications similarly to non-transplanted cirrhotic patients(e.g.,refractory ascites,variceal hemorrhages and hydrothorax)although with higher morbidity and mortality due to their postoperative status and concomitant immunosuppressive therapy[2].

关键词： ascites liver mortality

Refining selection criteria to further increase survival benefit in liver transplantation for unresectable colorectal liver metastases

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Hepatobiliary surgery and Nutrition 2020年第4期9卷 490-492页

作者： Matteo Serenari Matteo Ravaioli general surgery and transplant unit Department of Medical and Surgical SciencesUniversity of BolognaBolognaItaly

Liver transplantation(LT)for hepatocellular carcinoma(HCC)was characterized in its early experience by high recurrence rates due to extensive tumor burden(1).Only after the adoption of Milan criteria(2),LT was recognized as a standard treatment for HCC(3).Besides HCC,other hepatic malignancies were proposed to be treated in the past with LT but due to the poor results observed(4),these indications were *** them,colorectal liver metastases(CRLM)were considered an absolute contraindication until recently.

关键词： colorectal metastases absolute

Esophagogastric junction gastrointestinal stromal tumor:Resection vs enucleation

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World Journal of Gastroenterology 2010年第35期16卷 4374-4376页

作者： Federico Coccolini Fausto Catena Luca Ansaloni Daniel Lazzareschi Antonio Daniele Pinna unit of general Emergency and Transplant SurgerySt.Orsola-Malpighi University Hospital Department of Integrative Biology University of CaliforniaBerkeley

Esophageal gastrointestinal stromal tumors(GISTs) are extremely uncommon,representing approximately 5% of GISTs with the majority of esophageal GISTs occurring at the esophagogastric junction(EGJ).The treatment options available for these GISTs are fairly *** different options are nowadays at our *** surgery to the target therapies we have the possibility to treat the majority of GISTs,including those which are defined as *** EGJ GISTs represent a stimulating challenge for the *** anatomical location increases the possibility of postoperative *** the role of negative margins in GIST surgery is still controversial and the eff icacy of target therapy has been demonstrated,why not treat EGJ GISTs with enucleation and,where indicated,adjuvant target therapy?

关键词： Esophagogastric junction Gastrointestinal stromal tumor Surgical approach Resection Enucleation

Liver transplantation for hepatocellular carcinoma:Role of inflammatory and immunological state on recurrence and prognosis

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World Journal of Gastroenterology 2013年第48期19卷 9174-9182页

作者： Matteo Cescon Valentina Rosa Bertuzzo Giorgio Ercolani Matteo Ravaioli Federica Odaldi Antonio Daniele Pinna general surgery and transplant unit Department of Medical and Surgical Sciences Alma Mater Studiorum-University of Bologna40138 Bologna Italy

Criteria for liver transplantation(LT)for hepatocellular carcinoma(HCC)and post-LT indicators of prognosis are historically based on the measurement of the tumor ***,high throughput technologies have increased the prediction of recurrence,but these tools are not yet routinely *** interaction between HCC and the immune system has revealed an imbalance of lymphocyte phenotypes in the peritumoral tissue,and the increase of regulatory T cells with respect to cytotoxic lymphocytes has been linked to a higher rate of post-LT HCC ***,some inflammatory markers have shown good reliability in predicting cancer reappearance after surgery,as a result of either a systemic inflammatory response or a decreased capacity of the organism to control the tumor *** these markers,the neutrophil-tolymphocyte ratio appears to be the most promising and easily available serum parameter able to predict HCC recurrence after LT and following other types of treatment,although the exact mechanisms determining its elevation have not been ***-LT immunosuppression may impact on cancer control,and the exposure to high levels of calcineurin inhibitors or other immunusuppressants has recently emerged as a negative prognostic factor for HCC recurrence and patient *** the absence of prospective randomized trials,inhibitors of the mammalian target of rapamycin have been shown to be associated with lower rates of tumor recurrence compared to other immunosuppressors,suggesting their use especially in patients with HCC exceeding the conventional indication criteria for LT.

关键词： Liver transplantation Hepatocellular carcinoma Inflammation Immunosuppression Recurrence

Liver function impairment in liver transplantation and after extended hepatectomy

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World Journal of Gastroenterology 2013年第44期19卷 7922-7929页

作者： Matteo Serenari Matteo Cescon Alessandro Cucchetti Antonio Daniele Pinna general surgery and transplant unit Department of Medical and Surgical Sciences Alma Mater Studiorum-University of Bologna 40138 Bologna Italy

Extended hepatectomy,or liver transplantation of reduced-size graft,can lead to a pattern of clinical manifestations,namely"post-hepatectomy liver failure"and"small-for-size syndrome"respectively,that can range from mild cholestasis to irreversible organ non-function and death of the *** mechanisms are involved in their occurrence but in the recent past,high portal blood flow through a relatively small liver vascular bed has taken a central ***,several techniques of inflow modulation have been attempted in cases of portal hyperperfusion first in liver transplantation,such as portocaval shunt,mesocaval shunt,splenorenal shunt,splenectomy or ligation of the splenic ***,high portal flow is not the only factor responsible,and before major liver resections,preoperative assessment of the residual liver function is *** such as portal vein embolization or portal vein ligation can be adopted to increase the future liver volume,preventing posthepatectomy liver *** recently,a new surgical procedure,that combines in situ splitting of the liver and portal vein ligation,has gradually come to light,inducing remarkable hypertrophy of the healthy liver in just a few *** studies are needed to confirm this hypothesis and overcome one of the biggest issues in the field of liver surgery.

关键词： Small-for-size syndrome Liver transplantation Extended hepatectomy Liver failure Cirrhosis

Outcomes of staged hepatectomies for liver malignancy

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World Journal of Hepatology 2019年第6期11卷 513-521页

作者： Naif A Albati Ali A Korairi Ibrahim Al Hasan Helayel K Almodhaiberi Abdullah A Algarni Hepatobiliary and Liver transplant unit Department of General Surgery Prince Sultan Military Medical City

Liver malignancies are the fifth most common cause of death *** intervention with curative intent is the treatment of choice for liver tumors as it provides long-term ***,only 20%of patients with metastatic liver lesions can be managed by curative liver *** most of the cases,hepatectomy is not feasible because of insufficient future liver remnant(FLR).Two-stage hepatectomy is advocated to achieve liver resection in a patient who is considered to not be a candidate for *** of staged hepatectomy include conventional two-stage hepatectomy,portal vein embolization,and associating liver partition and portal vein ligation for a staged *** success is high for each of these procedures but variable between *** the procedures have been reported as being effective in achieving a satisfactory FLR and completing the second-stage ***,the overall survival and disease-free survival rates have improved significantly for patients who were otherwise considered nonresectable;yet,an increase in the morbidity and mortality rates has been *** suggest that this type of procedure should be carried out in high-flow centers and through a multidisciplinary *** experienced surgeon is key to the success of those interventions.

关键词： Staged hepatectomy Portal vein embolization Portal vein ligation Colorectal liver metastasis Hepatocellular carcinoma Associated liver partition and portal vein ligation for staged hepatectomy

Selection criteria for cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in gastric cancer

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World Journal of Gastroenterology 2011年第37期17卷 4153-4156页

作者： Ingmar Knigsrainer Department of general Visceral and Transplant SurgeryTübingen University Hospital

Peritoneal carcinomatosis in gastric cancer is associated with a dismal *** chemotherapy is not effective because of the existence of a blood-peritoneal *** surgery and intraperitoneal chemotherapy can improve survival and quality of life in selected *** selection for this multimodal approach is one of the most critical issues,and calls for interdisciplinary evaluation by radiologists,medical and surgical oncologists,and *** article sets forth criteria for selection of gastric cancer patients suffering from peritoneal carcinomatosis.

关键词： Peritoneal carcinomatosis Gastric cancer Hyperthermic intraperitoneal chemotherapy Cytoreductive surgery Selection criteria