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Male gender and increased body mass index independently predicts clinically relevant morbidity after spleen-preserving distal pancreatectomy

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World Journal of Gastrointestinal surgery 2018年第8期10卷 84-89页

作者： Traian Dumitrascu Mihai Eftimie ANDra Aiordachioae Cezar Stroescu Simona Dima Mihnea Ionescu Irinel Popescu Department of General Surgery and Liver Transplant Fundeni Clinical Institute

AIM To identify risk factors for clinically relevant complications after spleen-preserving distal pancreatectomy(SPDP). No previous studies explored potential predictors of morbidity after SPDP.METHODS The data of 41 patients who underwent a SPDP in a single surgical center between 2000 and 2015 were retrospectively reviewed from a prospectively maintained electronic database established in our Department of surgery. The database included demographic, clinical, bioumoral, pathological, intraoperative and postoperative parameters. Uni-and multivariate ana-lyses were performed to assess potential predictors of clinically relevant morbidity. Postoperative morbidity was defined as in-hospital complications and mortality was assessed at 90 d. Clinically relevant morbidity was defined as complication ≥ grade 2 Dindo.RESULTS Overall morbidity rate was 34.1%(14 patients): grade Ⅰ(6 patients, 14.6%), grade Ⅱ(2 patients, 4.8%), grade Ⅲa(1 patient, 2.4%), and grade Ⅲb(5 patients, 12.2%). A number of 5 patients(12.2%) required re-laparotomy for postoperative complications. There was no postoperative mortality. Thus, at least one clinically relevant complication occurred in 8 patients(19.5%). Univariate analysis identified male gender(P = 0.034), increased body mass index(P = 0.002) and neuroendocrine pathology(P = 0.013) as statistically significant risk factors. Multivariate analysis identified male gender [odds ratio(OR): 1.29, 95%CI: 1.07-1.55, P = 0.005] and increased body mass index(OR: 23.18, 95%CI: 1.72-310.96, P = 0.018) as the only independent risk factors of clinically relevant morbidity after SPDP.CONCLUSION Male gender and increased body mass index are independently associated with increased risk of clinically relevant morbidity after SPDP. These findings may assist a surgeon in clinical decision-making to better select patients suitable for SPDP.

关键词：脾脏胰腺切除术并发症治疗方法

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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

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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 worldwide.Surgical intervention with curative intent is the treatment of choice for liver tumors as it provides long-term survival.However,only 20%of patients with metastatic liver lesions can be managed by curative liver resection.In 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 resection.Procedures of staged hepatectomy include conventional two-stage hepatectomy,portal vein embolization,and associating liver partition and portal vein ligation for a staged hepatectomy.Technical success is high for each of these procedures but variable between them.All the procedures have been reported as being effective in achieving a satisfactory FLR and completing the second-stage resection.Moreover,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 observed.We suggest that this type of procedure should be carried out in high-flow centers and through a multidisciplinary approach.An 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

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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

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Fulminant liver failure following a marathon: Five case reports and review of literature

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World Journal of Clinical Cases 2019年第12期7卷 1467-1474页

作者： Wojciech Figiel Marcin Morawski Michal Grat Oskar Kornasiewicz Grzegorz Niewiński Joanna Raszeja-Wyszomirska Maciej Krasnodebski Arkadiusz Kowalczyk Waclaw Holówko Waldemar Patkowski Krzysztof Zieniewicz Department of general Transplant and Liver Surgery Medical University of Warsaw Warsaw 02097 Poland Department of Anaesthesiology and Intensive Care Medical University of Warsaw Warsaw 02097 Poland liver and Internal Medicine Unit Department of General Transplant and Liver Surgery Medical University of Warsaw Warsaw 02097 Poland

BACKGROUND The growing popularity of marathon and half-marathon runs has led to an increased number of patients presenting with exertion-induced heat stroke. Mild hepatic involvement is often observed in these patients;however, fulminant liver failure may occur in approximately 5% of all cases. liver transplantation is a potentially curative approach for exertion-induced liver failure, although there is a lack of consensus regarding the criteria and optimal timing of this intervention. CASE SUMMARY This paper describes 5 patients (4 men and 1 woman) who were referred to the department where this study was performed with the diagnosis of exertioninduced acute liver failure. Three patients underwent liver transplantation, 1 recovered spontaneously, and 1 patient died on day 11 following the exertion. CONCLUSION Exertion-induced heat stroke may present as fulminant liver failure. These patients may recover with conservative treatment, may require liver transplantation, or may die. No definitive criteria are available to determine patient suitability for a conservative vs surgical approach.

关键词： Heat Stroke Hepatic insufficiency liver transplantation Case report

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Hepatic flow is an intraoperative predictor of early allograft dysfunction in whole-graft deceased donor liver transplantation: An observational cohort study

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World Journal of Hepatology 2019年第9期11卷 689-700页

作者： Pablo Lozano Lominchar Maitane Igone Orue-Echebarria Lorena Martín Cristina Julia Lisbona María Magdalena Salcedo Luis Olmedilla Hemant Sharma Jose Manuel Asencio JoséAngel López-Baena general surgery Department Liver Transplant UnitHospital General Universitario Gregorio MaranonMadrid 28007Spain Anesthesiology Department Liver Transplant UnitHospital General Universitario Gregorio MaranonMadrid 28007Spain Hepatology Department Liver Transplant UnitHospital General Universitario Gregorio MaranonMadrid 28007Spain Department of transplant surgery Oschner Medical CenterNew OrleansLA 70816United States

BACKGROUND Early allograft dysfunction(EAD)after liver transplantation(LT)is an important cause of morbidity and mortality.To ensure adequate graft function,a critical hepatocellular mass is required in addition to an appropriate blood supply.We hypothesized that intraoperative measurement of portal venous and hepatic arterial flow may serve as a predictor in the diagnosis of EAD.AIM To study whether hepatic flow is an independent predictor of EAD following LT.METHODS This is an observational cohort study in a single institution.Hepatic arterial blood flow and portal venous blood flow were measured intraoperatively by transit flow.EAD was defined using the Olthoff criteria.Univariate and multivariate analyses were used to determine the intraoperative predictors of EAD.Survival analysis and prognostic factor analysis were performed using the Kaplan-Meier and Cox regression models.RESULTS A total of 195 liver transplant procedures were performed between January 2008 and December 2014 in 188 patients.A total of 54(27.7%)patients developed EAD.The median follow-up was 39 mo.Portal venous flow,hepatic arterial flow(HAF)and total hepatic arterial flow were associated with EAD in both the univariate and multivariate analyses.HAF is an independent prognostic factor for 30-d patient mortality.CONCLUSION Intraoperative measurement of blood flow after reperfusion appears to be a predictor of EAD;Moreover,HAF should be considered a predictor of 30-d patient mortality.

关键词： Hepatic flow Early allograft dysfunction liver transplant

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Current status of surgical management of patients with gastroenteropancreatic neuroendocrine neoplasms

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World Journal of Gastrointestinal surgery 2022年第4期14卷 276-285页

作者： Rafał Stankiewicz Michał Grąt Department of general Transplant and Liver SurgeryMedical University of WarsawWarsaw 02-097Poland

Neuroendocrine neoplasms(NENs)of the gastroenteropancreatic system are rare and heterogeneous tumours,yet with increasing prevalence.The most frequent primary sites are the small intestine,rectum,pancreas,and stomach.For a localized disease,surgical resection with local lymph nodes is usually curative with good overall and disease free survival.More complex situation is the treatment of locally advanced lesions,liver metastases,and,surprisingly,small asymptomatic tumours of the rectum and pancreas.In this review,we focus on the current role of surgical management of gastroenteropancreatic NENs.We present surgical approach for the most frequent primary sites.We highlight the role of endoscopic surgery and the watch-and-wait strategy for selected cases.As liver metastases pose an important clinical challenge,we present current indications and contraindications for liver resection and a role of liver transplantation for metastatic NENs.

关键词： Gastroenteropancreatic neuroendocrine neoplasms Treatment Management liver metastases liver transplantation surgery

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Simultaneous liver mucinous cystic and intraductal papillary mucinous neoplasms of the bile duct:A case report

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World Journal of Gastroenterology 2014年第14期20卷 4102-4105页

作者： Agnieszka Budzynska Marek Hartleb Ewa Nowakowska-Dulawa Robert Krol Piotr Remiszewski Michal Mazurkiewicz Department of Gastroenterology and Hepatology Medical University of Silesia Department of general Vascular and Transplant SurgeryMedical University of Silesia Department of general Transplant and Liver SurgeryMedical University of Warsaw Department of Pathological Anatomy Medical University of Warsaw

Cystic hepatic neoplasms are rare tumors,and are classified into two separate entities:mucinous cystic neoplasms(MCNs)and intraductal papillary mucinous neoplasms of the bile duct(IPMN-B).We report the case of a 56-year-old woman who presented with abdominal pain and jaundice due to the presence of a large hepatic multilocular cystic tumor associated with an intraductal tumor.Partial hepatectomy with resection of extrahepatic bile ducts demonstrated an intrahepatic MCN and an intraductal IPMN-B.This is the first report of the simultaneous occurrence of these two histologically distinct entities in the liver.

关键词： liver Mucinous cystic neoplasm Intraductal papilla

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Early markers of reperfusion injury after liver transplantation: association with primary dysfunction

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Hepatobiliary & Pancreatic Diseases International 2015年第3期14卷 246-252页

作者： Helge Bruns Jan Heil Daniel Schultze Mohammed Al Saeedi Peter Schemmer Department of general and transplant surgery University Hospital Heidelberg

BACKGROUND： In patients with end-stage fiver disease, fiver transplantation is the only available curative treatment. Al- though the outcome and quality of life in the patients have improved over the past decades, primary dys- or nonfimction （PDF/PNF） can occur. Early detection of PDF and PNF is crucial and could lead to individual therapies. This study was designed to identify early markers of reperfusion injury and PDF in liver biopsies taken during the first hour after reperfusion.

关键词： primary dysfunction liver transplantation predictive markers reperfusion injury microarray

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New insights in the management of the middle hepatic vein dilemma

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Hepatobiliary & Pancreatic Diseases International 2019年第2期18卷 101-102页

作者： Quirino Lai Fabio MelANDro Gianluca Mennini Massimo Rossi Hepato-Bilio-Pancreatic and liver transplant Unit Department of General Surgery and Organ Transplantation Sapienza University of Rome Umberto I Policlinic of Rome

When the first series of adult-to-adult living donor liver transplantation(A2A-LDLT)were performed in Hong Kong[1],it was immediately clear that great technical challenges existed,mainly concerning the middle hepatic ... 详细信息

关键词： New insights middle hepatic vein dilemma

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