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From conventional two-stage hepatectomy to ALPPS:Fifteen years of experience in a hepatobiliary surgery unit

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hepatobiliary & Pancreatic Diseases International 2021年第6期20卷 542-550页

作者： Javier Maupoey Ibáñez Eva María MontalváOrón Andrea BoscàRobledo Alonso Camacho Ramírez Ana Hernando Sanz Pablo Granero Castro Alberto Alegre Delgado Rafael López-Andújar hepatobiliary surgery and Transplant Unit La Fe University and Polytechnic HospitalValenciaSpain Department of Radiology La Fe University and Polytechnic HospitalValenciaSpain

Background:Hepatectomy in patients with large tumor load may result in postoperative liver failure and associated complications due to excessive liver parenchyma *** two-stage hepatectomy(TSH)and associating liver partition and portal vein ligation for staged hepatectomy(ALPPS)technique are possible solutions to this *** liver metastases(CRLM)is the most frequent indication,and there is a need to assess outcomes for both techniques to improve surgical and long-term oncological outcomes in these ***:A single-center retrospective study was designed to compare TSH with ALPPS in patients with initially unresectable bilateral liver tumors between January 2005 and January *** was performed from January 2012 onwards as the technique of ***-term overall survival(OS)and disease-free survival(DFS)were evaluated as primary outcome in CRLM *** morbidity,mortality and liver growth in all patients were also ***:A total of 38 staged hepatectomies were performed:17 TSH and 21 *** resection rate was 76.5%(n=13)in the TSH group and 85.7%(n=18)in the ALPPS group(P=0.426).Overall major morbidity(Clavien-Dindo≥3 a)(stage 1+stage 2)was 41.2%(n=7)in TSH and 33.3%(n=7)in ALPPS patients(P=0.389),and perioperative 90-day mortalities were 11.8%(n=2)vs.19.0%(n=4)in each group,respectively(P=0.654).Intention-to-treat OS rates at 1 and 5 years in CRLM patients for TSH(n=15)were 80%and 33%,and for ALPPS(n=17)76%and 35%,*** rates at 1 and 5 years were 36%and 27%in the TSH group vs.33%and 27%in the ALPPS group,***:ALPPS is an effective alternative to TSH in bilateral affecting liver tumors,allowing higher resection rate,but patients must be carefully *** CRLM patients similar long-term OS and DFS can be achieved with both techniques.

关键词： ALPPS Two-stage hepatectomy Colorectal liver metastases Posthepatectomy liver failure

Laparoscopic liver resections at the gates of 2020: a stand-alone field of hepatobiliary surgery

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hepatobiliary surgery and Nutrition 2020年第3期9卷 371-373页

作者： Federica Cipriani Francesca Ratti Luca Aldrighetti hepatobiliary surgery Division IRCCS San Raffaele HospitalVia Olgettina 6020132 MilanItaly

We read with interest the review entitled"Laparoscopic liver resection:the current status and the future"written by *** Cai and published in hepatobiliary surgery and Nutrition(1).

关键词： Laparoscopic surgery liver

Healing time of incision infection after hepatobiliary surgery treated by needle-free incision suture closure

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World Journal of Gastroenterology 2014年第42期20卷 15815-15819页

作者： Wen-Jie Ma Yong Zhou Hui Mao Rui-Hua Xu Anuj Shrestha Fu-Yu Li Alex Lorance Qin Yang Yong-Qiong Zhang Ting Jiang Huan Feng Wei Zhang Nan-Sheng Cheng Department of hepatobiliary surgery West China Hospital of Sichuan University Department of Medicine West China Hospital of Sichuan University Department of Medicine the George Washington University Washington District of Columbia Washington DC 20052 United States

AIM: To compare the effectiveness of needle-free incision suture closure with butterfly tape and traditional secondary suturing techniques in treating incision infection. METHODS: Two hundred and twenty-three patients with incision infection following hepatobiliary surgery at a tertiary hospital were randomly divided into three groups: 90 patients were closed by needle-free incision suture closure, which gradually closed the incision wound when drainage from incision infection was visibly decreased and healthy granulation tissues had grown; 79 patients were closed by butterfly bandage; another 54 patients were closed by traditional secondary suturing technique. Healing time of incision infection was calculated from the beginning of dressing change to the healing of the incision. RESULTS: Healing time in the needle-free incision suture closure group (24.2 +/- 7.2 d) was significantly shorter than that in the butterfly bandage group (33.3 +/- 11.2 d) and the traditional secondary suturing group (36.2 +/- 15.3 d) (P 0.05). CONCLUSION: Needle-free incision suture closure could gradually close the infection wound at the same time of drainage and dressing change, thereby shortening the healing time. (C) 2014 Baishideng Publishing Group Inc. All rights reserved.

关键词： Incision infection Needle-free incision suture closure Secondary suture Drainage Wound healing hepatobiliary surgery

Neutrophil-to-lymphocyte ratio predicts acute kidney injury occurrence after gastrointestinal and hepatobiliary surgery

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World Journal of Gastrointestinal surgery 2020年第7期12卷 326-335页

作者： Jian-Bin Bi Jia Zhang Yi-Fan Ren Zhao-Qing Du Zheng Wu Yi Lv Rong-Qian Wu National Local Joint Engineering Research Center for Precision surgery & Regenerative Medicine Shaanxi Provincial Center for Regenerative Medicine and Surgical EngineeringInstitute of Advanced Surgical Technology and EngineeringFirst Affiliated Hospital of Xi’an Jiaotong UniversityXi’an 710061 Shaanxi Province China Department of hepatobiliary surgery First Affiliated Hospital of Xi’an Jiaotong UniversityXi’an 710061 Shaanxi Province China

BACKGROUND Postoperative acute kidney injury(AKI) is a complex pathological process involved intrarenal and systemic inflammation caused by renal hypoperfusion, nephrotoxic drugs and urinary obstruction. Neutrophil-to-lymphocyte ratio(NLR) is a marker of inflammation reflecting the progress of many diseases. However, whether NLR at admission can predict the occurrence of AKI after surgery in the intensive care unit(ICU) remains *** To clarify the relationship between NLR and the occurrence of AKI in patients with gastrointestinal and hepatobiliary surgery in the *** A retrospective analysis of 282 patients receiving surgical ICU care after gastrointestinal and hepatobiliary surgery in our hospital from December 2014 to December 2018 was *** Postoperative AKI occurred in 84 patients(29.79%) in this cohort. NLR by the multivariate analysis was an independent risk factor for occurrence of postoperative AKI in patients with gastrointestinal and hepatobiliary surgery in the ICU. In this cohort, receiver operating characteristic curves of AKI occurrence showed that the optimal cut-off value of NLR was 8.380. NLR was found to be significantly correlated with the white blood cell count, neutrophil count, lymphocyte count, arterial lactate and dialysis(P hepatobiliary surgery in ICU. NLR should be included in the routine assessment of AKI occurrence.

关键词： Neutrophil-to-lymphocyte ratio Acute kidney injury Gastrointestinal and hepatobiliary surgery Surgical intensive care unit Arterial lactate Sepsis

A ten-year experience of inferior vena cava reconstruction for malignancy:The importance of a multidisciplinary approach with hepatobiliary surgery

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hepatobiliary & Pancreatic Diseases International 2020年第4期19卷 396-398页

作者： Maria R.Baimas-George Ryan C.Pickens Jesse K.Sulzer Dionisios Vrochides John B.Martinie David M.Levi David A.Iannitti Division of Hepatopancreatobiliary surgery Department of SurgeryCarolinas Medical Center1025 Morehead Medical DriveSuite 600CharlotteNC 28204USA Division of Transplant surgery Department of SurgeryCarolinas Medical CenterCharlotteNCUSA

To the Editor,Tumor invasion of the inferior vena cava(IVC)through direct erosion is a rare and poor prognostic feature of aggressive hepatic or perihepatic malignancies[1,2].Literature shows poor response to chemotherapy,such that resection often is the only option for improved survival[3].Multidisciplinary collaborations can expand technical options;incorporation of transplant techniques has led to successful R0 resection involving difficult vascular reconstruction and extended resection[4,5].This study describes and analyzes the ten-year collaborative experience of hepatobiliary(HPB)surgeons in management of malignancies involving the perihepatic IVC.

关键词： hepato hepatic invasion

The Janus of mIS in hepatobiliary surgery:Importance of maximally invasive surgery in an era of minimally invasive surgery

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hepatobiliary & Pancreatic Diseases International 2020年第5期19卷 409-410页

作者： Maria R.Baimas-George Christoph Tschuor John B.Martinie David A.Iannitti Erin H.Baker Dionisios Vrochides Division of HPB surgery Department of SurgeryAtrium Health-Carolinas Medical Center1025 Morehead Medical DriveSuite 600CharlotteNC 28204USA

As surgeons formidably continue to forge into the twentytwenties,after a considerably coronavirus-induced rocky start,one can predict that the era of minimally invasive surgery(mIS),an era of robotics,telehealth,and enhanced recovery after surgery(ERAS■),is not only here to stay but will continue to thrive,develop,and transform our *** of robotics platforms would be hard pressed not to indulge in this *** the satisfyingly large midline“stem to stern”,the impressing exposuregenerating Makuuchi or transverse abdominal,the Kocher,paramedian,McBurney,Chevron,and Pfannenstiel incisions begin to disappear and fade away into a scar minimizing future precluding trauma laparotomies?Most likely *** and developing the skill and technique for a minimally invasive“mIS”approach does not negate or abrogate the maximally invasive“MIS”*** is not one or the other;not a“to be or not to be”Shakespearean *** surgery is a qualified landscape upon which to illuminate and exemplify this declaration:the necessity and companionship of“mIS”and“MIS”–minimally and maximally invasive surgery.

关键词： surgery maximal continue

Managing injuries of hepatic duct confluence variants after major hepatobiliary surgery:An algorithmic approach

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World Journal of Gastroenterology 2008年第19期14卷 3049-3053页

作者： Georgios Fragulidis Athanasios Marinis Andreas Polydorou Christos Konstantinidis Georgios Anastasopoulos John Contis Dionysios Voros Vassilios Smyrniotis Second Department of surgery Areteion University HospitalAthens Medical SchoolUniversity of Athens

AIM:To investigate injuries of anatomy variants of hepatic duct confluence during hepatobiliary surgery and their impact on morbidity and mortality of these procedures. An algorithmic approach for the management of these injuries is proposed. METHODS:During a 6-year period 234 patients who had undergone major hepatobiliary surgery were retrospectively reviewed in order to study postoperative bile leakage. Diagnostic workup included endoscopic and magnetic retrograde cholangiopancreatography (E/MRCP), scintigraphy and fistulography. RESULTS:Thirty (12.8%) patients who developed postoperative bile leaks were identified. Endoscopic stenting and percutaneous drainage were successful in 23 patients with bile leaks from the liver cut surface. In the rest seven patients with injuries of hepatic duct confluence, biliary variations were recognized and a stepwise therapeutic approach was considered. Conservative management was successful only in 2 patients. Volume of the liver remnant and functional liver reserve as well as local sepsis were used as criteria for either resection of the corresponding liver segment or construction of a biliary-enteric anastomosis. Two deaths occurred in this group of patients with hepatic duct confluence variants (mortality rate 28.5%). CONCLUSION:Management of major biliary fistulaethat are disconnected from the mainstream of the biliary tree and related to injury of variants of the hepatic duct confluence is extremely challenging. These patients have a grave prognosis and an early surgical procedure has to be considered.

关键词： Biliary aberrations Bile duct injury Postope-rative bile leakage Hepatic duct confluence Hepatectomy

Use of health-related quality of life tools in hepatobiliary surgery

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hepatobiliary & Pancreatic Diseases International 2008年第2期7卷 135-137页

作者： Muhammad Shafique Sajid Mawara Iftikhar Jasmin Rimple Mirza Khurrum Baig Department of surgery Worthing Hospital West Sussex BN11 2DH UK

BACKGROUND: The objective of this article is to review the literature and discuss the various tools used in hepatobiliary surgery for the measurement of health related quality of life (HR-QOL) and highlight various outcome variables that affect the HR-QOL among patients with common hepatobiliary disorders. DATA SOURCES: We reviewed HR-QOL articles published in the last 20 years on different hepatobiliary curative or palliative procedures in all languages. RESULTS: HR-QOL is a questionnaire tool which is utilized to assess the changes in the health status of patients after a hepatobiliary intervention. These surveys are of increasingly importance, as health care providers are challenged to justify treatment approaches and rationale for any surgical intervention. These HR-QOL tools are very helpful for the evaluation of subjective outcome of common hepatobiliary procedures like gastrointestinal quality of life index (GIQLI) for cholecystectomy, functional assessment in cancer therapy (FACT) for liver resection, short form 36 (SF-36) for liver transplantation, and quality of life questionnaire for patients with pancreatic cancer (QLQ-PAN). CONCLUSIONS: Use of validated and reliable health instruments in hepatobiliary surgery is directed at measuring the impact in a reproducible and valid fashion. Curative or palliative procedures should be offered to the patients of hepatobiliary disorders after the assessment by HR-QOL tools. Because the impairments of function that may occur after different operations vary considerably, an operation-specific assessment of HR-QOL for each type of surgical procedure is becoming an essential principle to follow in a successful healthcare system.

关键词： quality of life questionnaire hepatobiliary surgery hepatectomy

Application Effect of Medium-Length Peripheral Catheter in Critically Ill Patients Undergoing hepatobiliary surgery

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Proceedings of Anticancer Research 2023年第2期7卷 18-21页

作者： Xiaoxue Song Xiaoyan Liu Xiaomei Liu Xi Chen Department of hepatobiliary surgery Shaanxi Provincial People’s HospitalXi’an 710068Shaanxi ProvinceChina

Objective:To investigate the effect of using peripheral medium-length catheters in critically ill patients undergoing hepatobiliary ***:A retrospective analysis of the nursing experience and effect of using medium-length catheters for infusion in 102 critically ill patients undergoing hepatobiliary surgery from March 2021 to April 2022 was ***:All 102 patients had successful catheter placement with no catheter-associated infections,blockage,decannulation,or ***,four cases had blood oozing from the puncture site,but it resolved after changing the ***:Medium-length catheters are superior to traditional infusion tools in terms of benefit;thus,they deserve to be widely promoted in clinical practice.

关键词： Medium-length peripheral catheter in critically ill patients Application effect