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Utility of plasma D-dimer for diagnosis of venous thromboembolism after hepatectomy

World Journal of Clinical Cases 2024年第2期12卷 276-284页

作者： Taiichiro Miyake Hiroaki Yanagimoto Daisuke Tsugawa Masayuki Akita Riki Asakura Keisuke Arai Toshihiko Yoshida Shinichi So Jun Ishida Takeshi Urade Yoshihide Nanno Kenji Fukushima Hidetoshi Gon Shohei Komatsu Sadaki Asari Hirochika Toyama Masahiro Kido Tetsuo Ajiki Takumi Fukumoto division of hepato-biliary-pancreatic surgery Department of SurgeryKobe University Graduate School of MedicineKobe 650-0017HyogoJapan

BACKGROUND Venous thromboembolism(VTE)is a potentially fatal complication of *** use of postoperative prophylactic anticoagulation in patients who have undergone hepatectomy is controversial because of the risk of postoperative ***,we hypothesized that monitoring plasma D-dimer could be useful in the early diagnosis of VTE after *** To evaluate the utility of monitoring plasma D-dimer levels in the early diagnosis of VTE after *** The medical records of patients who underwent hepatectomy at our institution between January 2017 and December 2020 were retrospectively *** were divided into two groups according to whether or not they developed VTE after hepatectomy,as diagnosed by contrast-enhanced computed tomography and/or ultrasonography of the lower *** factors,including demographic data and perioperative D-dimer values,were compared between the two *** operating characteristic curve analysis was performed to determine the D-dimer cutoff *** and multivariate analyses were performed using logistic regression analysis to identify significant *** In total,234 patients who underwent hepatectomy were,of whom(5.6%)were diagnosed with VTE following hepatectomy.A comparison between the two groups showed significant differences in operative time(529 vs 403 min,P=0.0274)and blood loss(530 vs 138 mL,P=0.0067).The D-dimer levels on postoperative days(POD)1,3,5,7 were significantly higher in the VTE group than in the non-VTE *** the multivariate analysis,intraoperative blood loss of>275 mL[odds ratio(OR)=5.32,95%confidence interval(CI):1.05-27.0,P=0.044]and plasma D-dimer levels on POD 5≥21μg/mL(OR=10.1,95%CI:2.04-50.1,P=0.0046)were independent risk factors for VTE after *** Monitoring of plasma D-dimer levels after hepatectomy is useful for early diagnosis of VTE and may avoid routine prophylactic anticoagulation in the

关键词： Hepatectomy Malignant tumor Postoperative complication D-dimer Early diagnosis Venous thromboembolism

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TRIANGLE operation,combined with adequate adjuvant chemotherapy,can improve the prognosis of pancreatic head cancer:A retrospective study

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World Journal of Gastrointestinal Oncology 2024年第5期16卷 1773-1786页

作者： Jia-Hao Chen Li-Yong Zhu Zhi-Wei Cai Xiao Hu Abousalam Abdoulkader Ahmed Jie-Qiong Ge Xiao-Yan Tang Chun-Jing Li Yun-Long Pu Chong-Yi Jiang Department of hepato-biliary-pancreatic surgery Huadong Hospital Affiliated to Fudan UniversityShanghai 200040China Shanghai Key Laboratory of Clinical Geriatric Medicine Fudan UniversityShanghai 200040China Department of Nursing Huadong Hospital Affiliated to Fudan UniversityShanghai 200040China

BACKGROUND The TRIANGLE operation involves the removal of all tissues within the triangle bounded by the portal vein-superior mesenteric vein,celiac axis-common hepatic artery,and superior mesenteric artery to improve patient *** previously promising in patients with locally advanced pancreatic ductal adenocarcinoma(PDAC),data are limited regarding the long-term oncological outcomes of the TRIANGLE operation among resectable PDAC patients undergoing pancreaticoduodenectomy(PD).AIM To evaluate the safety of the TRIANGLE operation during PD and the prognosis in patients with resectable *** This retrospective cohort study included patients who underwent PD for pancreatic head cancer between January 2017 and April 2023,with or without the TRIANGLE *** were divided into the PD_(TRIANGLE)and PD_(non-TRIANGLE)*** and survival outcomes were compared between the two *** adjuvant chemotherapy was defined as adjuvant chemotherapy≥6 *** The PD_(TRIANGLE)and PD_(non-TRIANGLE) groups included 52 and 55 patients,*** were no significant differences in the baseline characteristics or perioperative indexes between the two ***,the recurrence rate was lower in the PD_(TRIANGLE) group than in the PD_(non-TRIANGLE) group(48.1%vs 81.8%,P<0.001),and the local recurrence rate of PDAC decreased from 37.8%to 16.0%.Multivariate Cox regression analysis revealed that PD_(TRIANGLE)(HR=0.424;95%CI:0.256-0.702;P=0.001),adequate adjuvant chemotherapy≥6 months(HR=0.370;95%CI:0.222-0.618;P<0.001)and margin status(HR=2.255;95%CI:1.252-4.064;P=0.007)were found to be independent factors for the recurrence *** The TRIANGLE operation is safe for PDAC patients undergoing ***,it reduces the local recurrence rate of PDAC and may improve survival in patients who receive adequate adjuvant chemotherapy.

关键词： TRIANGLE operation pancreatic ductal adenocarcinoma Heidelberg triangle Adjuvant chemotherapy Prognosis pancreaticoduodenectomy

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Quality of life after pancreatic surgery

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World Journal of Gastroenterology 2024年第8期30卷 943-955页

作者： Shi-Zhen Li Ting-Ting Zhen Yi Wu Min Wang Ting-Ting Qin Hang Zhang Ren-Yi Qin Department of biliary-pancreatic surgery Affiliated Tongji HospitalTongji Medical CollegeHuazhong University of Science and TechnologyWuhan 430030Hubei ProvinceChina

BACKGROUND pancreatic surgery is challenging owing to the anatomical characteristics of the *** attention has been paid to changes in quality of life(QOL)after pancreatic *** To summarize and analyze current research results on QOL after pancreatic *** A systematic search of the literature available on PubMed and EMBASE was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses *** studies were identified by screening the references of retrieved *** on patients’QOL after pancreatic surgery published after January 1,2012,were *** included prospective and retrospective studies on patients'QOL after several types of pancreatic *** results of these primary studies were summarized *** A total of 45 articles were included in the study,of which 13 were related to pancreaticoduodenectomy(PD),seven to duodenum-preserving pancreatic head resection(DPPHR),nine to distal pancreatectomy(DP),two to central pancre-atectomy(CP),and 14 to total pancreatectomy(TP).Some studies showed that 3-6 months were needed for QOL recovery after PD,whereas others showed that 6-12 months was more *** TP and PD had similar influences on QOL,patients needed longer to recover to preoperative or baseline levels after *** QOL was better after DPPHR than ***,the superiority of the QOL between patients who underwent CP and PD remains *** decrease in exocrine and endocrine functions postoperatively was the main factor affecting the *** invasive surgery could improve patients’QOL in the early Core Tip:This review summarizes and analyzes current research results on quality of life(QOL)after pancreatic *** article covers the discussion and analysis of the QOL of various pancreatic *** kind of surgical procedure has better QOL is *** long-term benefits on QOL of minimally invasive su

关键词： Quality of life pancreaticoduodenectomy Duodenum-preserving pancreatic head resection Distal pancreatectomy Central pancreatectomy Total pancreatectomy

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Cholangiocarcinoma combined with biliary obstruction:an exosomal circRNA signature for diagnosis and early recurrence monitoring

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Signal Transduction and Targeted Therapy 2024年第6期9卷 2642-2654页

作者： Ningyuan Wen Dingzhong Peng Xianze Xiong Geng Liu Guilin Nie Yaoqun Wang Jianrong Xu Shaofeng Wang Sishu Yang Yuan Tian Bei Li Jiong Lu Nansheng Cheng division of biliary surgery Department of General SurgeryWest China HospitalSichuan UniversityChengduSichuanChina Research Center for biliary Diseases West China HospitalSichuan UniversityChengduSichuanChina

Cholangiocarcinoma(CCA)is a highly malignant biliary tract cancer with currently suboptimal diagnostic and prognostic *** present a novel system to monitor CCA using exosomal circular RNA(circRNA)via serum and biliary liquid biopsies.A pilot cohort consisting of patients with CCA-induced biliary obstruction(CCA-BO,n=5)and benign biliary obstruction(BBO,n=5)was used to identify CCA-derived exosomal circRNAs through microarray *** was followed by a discovery cohort(n=20)to further reveal a CCA-specific circRNA complex(hsa-circ-0000367,hsa-circ-0021647,and hsa-circ-0000288)in both bile and serum *** vitro and in vivo studies revealed the three circRNAs as promoters of CCA *** and prognostic models were established and verified by two independent cohorts(training cohort,n=184;validation cohort,n=105).An interpreter-free diagnostic model disclosed the diagnostic power of biliary exosomal circRNA signature(Bile-DS,AUROC=0.947,RR=6.05)and serum exosomal circRNA signature(Serum-DS,AUROC=0.861,RR=4.04)compared with conventional CA19-9(AUROC=0.759,RR=2.08).A prognostic model of CCA undergoing curative-intent surgery was established by calculating early recurrence score,verified with bile samples(Bile-ERS,C-index=0.783)and serum samples(Serum-ERS,C-index=0.782).These models,combined with other prognostic factors revealed by COX-PH model,enabled the establishment of nomograms for recurrence monitoring of *** study demonstrates that the exosomal triple-circRNA panel identified in both bile and serum samples serves as a novel diagnostic and prognostic tool for the clinical management of CCA.

关键词： biliary diagnosis Serum

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Robotic versus laparoscopic surgery for sporadic benign insulinoma:Short-and long-term outcomes

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hepatobiliary & pancreatic Diseases International 2024年第4期23卷 399-405页

作者： Zhu-Zeng Yin Yuan-Xing Gao Zhi-Ming Zhao Ming-Gen Hu Wen-Bo Tang Rong Liu Faculty of hepato-Pancreato-biliary surgery The First Medical CenterChinese PLA General HospitalBeijing 100853China Institute of hepatobiliary surgery of Chinese PLA Beijing 100853China Key Laboratory of Digital hepatobiliary surgery of Chinese PLA Beijing 100853China

Background:Minimally invasive surgery is the optimal treatment for *** present study aimed to compare short-and long-term outcomes of laparoscopic and robotic surgery for sporadic benign ***:A retrospective analysis of patients who underwent laparoscopic or robotic surgery for insulinoma at our center between September 2007 and December 2019 was *** demographic,perioperative and postoperative follow-up results were compared between the laparoscopic and robotic ***:A total of 85 patients were enrolled,including 36 with laparoscopic approach and 49 with robotic *** was the preferred surgical ***-nine patients(69.4%)underwent enucleation;among them,26 and 33 patients underwent laparoscopic and robotic surgery,*** enucleation had a lower conversion rate to laparotomy(0 vs.19.2%,P=0.013),shorter operative time(102.0 vs.145.5 min,P=0.008)and shorter postoperative hospital stay(6.0 vs.8.5 d,P=0.002)than laparoscopic *** were no differences between the groups in terms of intraoperative blood loss,the rates of postoperative pancreatic fistula and *** a median follow-up of 65 months,two patients in the laparoscopic group developed a functional recurrence and none of the patients in the robotic group had a ***:Robotic enucleation can reduce the conversion rate to laparotomy and shorten operative time,which might lead to a reduction in postoperative hospital stay.

关键词： Robotic surgical procedures Laparoscopy Insulinoma Enucleation Pancreatectomy

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Advances in immunotherapy for biliary tract cancers

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Chinese Medical Journal 2024年第5期137卷 524-532页

作者： Yuhao Zhao Mao Yang Jiayi Feng Xu’an Wang Yingbin Liu Department of biliary–pancreatic surgery Renji Hospital Affiliated to Shanghai Jiao Tong University School of MedicineShanghai 200127China Shanghai Cancer Institute State Key Laboratory of Oncogenes and Related GenesShanghai 200127China Shanghai Key Laboratory of biliary Tract Disease Shanghai 200082China

biliary tract cancers(BTC),a heterogeneous disease with poor prognosis,including gallbladder cancer(GBC),intrahepatic cholangiocarcinoma(ICC),and extrahepatic cholangiocarcinoma(ECC).Although surgery is currently the primary regimen to treat BTC,most BTC patients are diagnosed at an advanced stage and miss the opportunity of surgical *** a result,non-surgical therapy serves as the main intervention for advanced *** recent years,immunotherapy has emerged as one of the most promising therapies in a number of solid cancers,and it includes immune checkpoint inhibitors(ICIs)monotherapy or combined therapy,tumor vaccines,oncolytic virus immunotherapy,adoptive cell therapy(ACT),and cytokine ***,these therapies have been practiced in limited clinical settings in patients with *** this review,we focus on the discussion of latest advances of immunotherapy in BTC and update the progress of multiple current clinical trials with different immunotherapies.

关键词： Immunotherapy biliary tract cancers Immune checkpoint inhibitors Cholangiocarcinoma Gallbladder cancer

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Development and validation of a nomogram model for predicting the risk of gallstone recurrence after gallbladder-preserving surgery

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hepatobiliary & pancreatic Diseases International 2024年第3期23卷 288-292页

作者： Peng Liu Yong-Wei Chen Che Liu Yin-Tao Wu Wen-Chao Zhao Jian-Yong Zhu Yang An Nian-Xin Xia Faculty of hepato-Pancreato-biliary surgery the First Medical CenterChinese PLA General HospitalBeijing 100853China Institute of hepatobiliary surgery of Chinese PLA Beijing 100853China Key Laboratory of Digital Hepetobiliary surgery of Chinese PLA Beijing 100853China

Background:The high incidence of gallstone recurrence was a major concern for laparoscopic gallbladderpreserving *** study aimed to investigate the risk factors for gallstone recurrence after gallbladder-preserving surgery and to establish an individualized nomogram model to predict the risk of gallstone ***:The clinicopathological and follow-up data of 183 patients who were initially diagnosed with gallstones and treated with gallbladder-preserving surgery at our hospital from January 2012 to January 2019 were retrospectively *** independent predictive factors for gallstone recurrence following gallbladder-preserving surgery were identified by multivariate logistic regression analysis.A nomogram model for the prediction of gallstone recurrence was constructed based on the selected *** C-index,receiver operating characteristic(ROC)curve and calibration curve were used to evaluate the predictive power of the nomogram model for gallstone ***:During the follow-up period,a total of 65 patients experienced gallstone recurrence,and the recurrence rate was 35.5%.Multivariate logistic regression analysis revealed that the course of gallstones>2 years[odds ratio(OR)=2.567,95%confidence interval(CI):1.270-5.187,P=0.009],symptomatic gallstones(OR=2.589,95%CI:1.059-6.329,P=0.037),multiple gallstones(OR=2.436,95%CI:1.133-5.237,P=0.023),history of acute cholecystitis(OR=2.778,95%CI:1.178-6.549,P=0.020)and a greasy diet(OR=2.319,95%CI:1.186-4.535,P=0.014)were independent risk factors for gallstone recurrence after gallbladder-preserving surgery.A nomogram model for predicting the recurrence of gallstones was established based on the above five *** results showed that the C-index of the nomogram model was 0.692,suggesting it was valuable to predict gallstone ***,the calibration curve showed good consistency between the predicted probability and actual ***:The nomogram model for

关键词： Gallstone Gallbladder-preserving surgery Recurrence Risk factors Nomogram

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Achieving laparoscopic anatomic resection for hepatocellular carcinoma by fluorescence guided positive staining of hepatic cone unit

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hepatobiliary & pancreatic Diseases International 2024年第4期23卷 406-411页

作者： Jun-Fang Deng Chuan-Hui Peng Yu Zhang Xiao-Feng Xu Rong-Liang Tong Zheng-Long Zhai Di-Yu Chen Cheng Zhang Li-Ming Wu Jian Wu division of hepatobiliary pancreatic surgery the First Affiliated HospitalZhejiang University School of MedicineHangzhou 310003China

Laparoscopic anatomical liver resection has been increasingly reported worldwide,but how to demarcate the resection planes is technically challenging[1].Positive staining technique with intraoperative indocyanine green(ICG)-fluorescence imaging has been introduced as an effective tool for real-time intraoperative guidance[2].Liver anatomy is ***,liver is composed of 9 segments,each is composed of two to three subsegments,and each subsegment contains several hepatic cone units.A hepatic cone unit is dominated by a tertiary or quaternary hepatic pedicles[3].

关键词： hepatic resection anatomy

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Post-operative morbidity after neoadjuvant chemotherapy and resection for gallbladder cancer: A national surgical quality improvement program analysis

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World Journal of Gastrointestinal surgery 2024年第1期16卷 95-102页

作者： Minha Kim Stephanie Stroever Krist Aploks Alexander Ostapenko Xiang Da Dong Ramanathan Seshadri Department of General surgery Danbury HospitalDanburyCT 06810United States Department of Research and Innovation Nuvance HealthDanburyCT 06810United States division of Surgical Oncology/hepato-Pancreato-biliary surgery Danbury HospitalDanburyCT 06810United States

BACKGROUND Gallbladder cancer is the most common malignancy of the biliary ***-adjuvant chemotherapy(NACT)has improved overall survival by enabling R0 ***,there is no consensus of guidelines for neoadjuvant therapy in gallbladder *** investigations continue to analyze the regimen and benefit of NACT for ongoing care of gallbladder cancer patients,we examined American College of Surgeons National Surgical Quality Improvement Program(NSQIP)database to determine if there was higher morbidity among the neo-adjuvant group within the 30-day post-operative *** hypothesized patients who underwent NACT were more likely to have higher post-operative *** To investigate the 30-day post-operative morbidity outcomes between patients who received NACT and underwent surgery and patients who only had *** A retrospective analysis of the targeted hepatectomy NSQIP data between 2015 and 2019 was performed to determine if NACT in gallbladder cancer increased the risk for post-operative morbidity(bile leak,infection rate,rate of converting to open surgery,etc.)compared to the group who only had *** calculate the odds ratio for the primary and secondary outcomes,a crude logistic regression was *** Of the 452 patients,52 patients received NACT prior to *** were no statistically significant differences in the odds of morbidity between the two groups,including bile leak[odds ratio(OR),0.69;95%confidence interval(95%CI):0.16-2.10;P=0.55],superficial wound infection(OR,0.58;95%CI:0.03-3.02;P=0.61),and organ space wound infection(OR,0.63;95%CI:0.18-1.63;P=0.61).CONCLUSION There was no significant difference in the risk of 30-day post-operative morbidity between the NACT and surgery group and the surgery only group.

关键词： Gallbladder cancer Neoadjuvant chemotherapy Radical cholecystectomy National surgery Quality Improvement Program Postoperative outcome

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Role of ablation therapy in conjunction with surgical resection for neuroendocrine tumors involving the liver

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World Journal of Gastrointestinal surgery 2024年第3期16卷 768-776页

作者： Alexander Ostapenko Stephanie Stroever Lud Eyasu Minha Kim Krist Aploks Xiang Da Dong Ramanathan Seshadri Department of General surgery Danbury HospitalDanburyCT 06810United States Department of Research and Innovation Nuvance HealthDanburyCT 06810United States division of Surgical Oncology/hepato-Pancreato-biliary surgery Danbury HospitalDanburyCT 06810United States

BACKGROUND Resection of hepatic metastasis from neuroendocrine tumors(NETs)improves quality of life and prolongs 5-year *** can be utilized with surgery to achieve complete *** several studies report long-term out-comes for patients undergoing ablation,none have explored perioperative effects of ablation in patients with metastatic *** To determine if intra-operative ablation during hepatectomy increases risk of ad-verse outcomes such as surgical site infections(SSIs),bleeding,and bile *** A retrospective analysis of the hepatectomy National Surgical Quality Impro-vement Program database from 2015-2019 was performed to determine the odds of SSIs,bile leaks,or bleeding in patients undergoing intraoperative ablation when compared to hepatectomy *** Of the 966 patients included in the study,298(30.9%)underwent ablation during *** were 78(11.7%)patients with SSIs in the hepatectomy alone group and 39(13.1%)patients with a SSIs in the hepatectomy with ablation *** leak occurred in 41(6.2%)and 14(4.8%)patients in the two groups,respec-tively;bleeding occurred in 117(17.5%)and 33(11.1%),*** con-trolling for confounding variables,ablation did not increase risk of SSI(P=0.63),bile leak(P=0.34)or bleeding(P=0.07)when compared to patients undergoing resection alone on multivariate *** Intraoperative ablation with hepatic resection for NETs is safe in the perioperative period without significant increased risk of infection,bleeding,or bile *** should utilize this modality when appropriate to a-chieve optimal disease control and outcomes.

关键词： Hepatectomy Neuroendocrine tumor Ablation Bile leaks Bleeding Surgical site infections

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