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Resection and reconstruction in high-grade pancreatic head injuries

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World Journal of Gastrointestinal Surgery 2024年第5期16卷 1467-1469页

作者： Jake Krige Eduard Jonas Andrew John Nicol Pradeep Harkson Navsaria hpb Surgery University of Cape Town Health Sciences FacultyCape Town 7925Western CapeSouth Africa Trauma Center Department of SurgeryGroote Schuur HospitalCape Town 7925Western CapeSouth Africa Department of Surgery Trauma CenterGroote Schuur HospCape Town 7925Western CapeSouth Africa

This study by Chui et al adds further important evidence in the treatment of highgrade pancreatic injuries and endorses the concept of the model of pancreatic trauma care designed to optimize treatment,minimize morbidity and enhance survival in patients with complex pancreatic *** the authors have demonstrated favorable outcomes based on their limited experience of 5 patients who underwent a pancreaticoduodenectomy(PD),including 2 patients who were“unstable”and did not have damage control surgery(DCS),we would caution against the general recommendations promoting index PD without DCS in“unstable”grade 5 pancreatic head injuries.

关键词： Pancreas Injury Surgery Pancreaticoduodenectomy

Hepatolithiasis:Epidemiology,presentation,classification and management of a complex disease

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World Journal of Gastroenterology 2024年第13期30卷 1836-1850页

作者： Rodrigo V.Motta Francesca Saffioti Vasileios K Mavroeidis Translational Gastroenterology and Liver unit Nuffield Department of MedicineUniversity of OxfordOxford OX39DUUnited Kingdom Department of Gastroenterology and Hepatology Oxford University Hospitals NHS Foundation TrustJohn Radcliffe HospitalOxford OX39DUUnited Kingdom UCL Institute for Liver and Digestive Health and Sheila Sherlock Liver unit Royal Free Hospital and University College LondonLondon NW32QGUnited Kingdom Department of hpb Surgery Bristol Royal InfirmaryUniversity Hospitals Bristol and Weston NHS Foundation TrustBristol BS28HWUnited Kingdom Department of Transplant Surgery North Bristol NHS TrustSouthmead HospitalBristol BS105NBUnited Kingdom Department of Gastrointestinal Surgery North Bristol NHS TrustSouthmead HospitalBristol BS105NBUnited Kingdom

The term hepatolithiasis describes the presence of biliary stones within the intrahepatic bile ducts,above the hilar confluence of the hepatic *** disease is more prevalent in Asia,mainly owing to socioeconomic and dietary factors,as well as the prevalence of biliary *** the last century,owing to migration,its global incidence has *** main pathophysiological mechanisms involve cholangitis,bile infection and biliary strictures,creating a self-sustaining cycle that perpetuates the disease,frequently characterised by recurrent episodes of bacterial infection referred to as syndrome of“recurrent pyogenic cholangitis”.Furthermore,long-standing hepatolithiasis is a known risk factor for development of intrahepatic *** classifications have aimed at providing useful insight of clinically relevant aspects and guidance for *** management of symptomatic patients and those with complications can be complex,and relies upon a multidisciplinary team of hepatologists,endoscopists,interventional radiologists and hepatobiliary surgeons,with the main goal being to offer relief from the clinical presentations and prevent the development of more serious *** comprehensive review provides insight on various aspects of hepatolithiasis,with a focus on epidemiology,new evidence on pathophysiology,most important clinical aspects,different classification systems and contemporary management.

关键词： Cholelithiasis Intrahepatic stones Cholangiocarcinoma Biliary parasites Recurrent pyogenic cholangitis Oriental cholangiohepatitis Hepatectomy Cholangioscopy Liver transplant Paediatric

Dynamics and cytokinic regulation of immune cell infiltration in genetically engineered mouse models of pancreatic cancer dictate the sensitivity to immunotherapy

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Cancer Communications 2024年第1期44卷 178-182页

作者： Okan Safak Shenghan Wang Carmen Mota Reyes Ibrahim Halil Gürcinar Sergey Tokalov Nedim Can Cevik Kivanc Görgülü Bengi Su Yilmaz Emre Erdogan Linhan Ye Qiaolin Li Elif Arik Sever SamedÖzer Güldal Süyen Helmut Friess Güralp Onur Ceyhan Rouzanna Istvanffy Hana Algül Ihsan Ekin Demir Department of Surgery Klinikum rechts der IsarTechnical University of MunichSchool of MedicineMunichBavariaGermany Department of General Surgery HPB-UnitSchool of MedicineAcibadem Mehmet Ali Aydinlar UniversityIstanbulIstanbulTurkey Comprehensive Cancer Center München Klinikum rechts der IsarTechnical University of MunichSchool of MedicineMunichBavariaGermany Department of Hematology Oncology and Tumor ImmunologyCharitéUniversity Medicine BerlinCampus Virchow ClinicBerlinBerlinGermany Graduate School of Health Sciences Acibadem Mehmet Ali Aydinlar UniversityIstanbulIstanbulTurkey Department of Physiology Acibadem Mehmet Ali Aydinlar UniversityIstanbulIstanbulTurkey Else Kröner Clinician Scientist Professorship for Translational Pancreatic Surgery MunichGermany Neural Influences in Cancer(NIC)International Research Consortium MunichGermany

Dear Editor,Targeting the immune compartment in pancreatic duc-tal adenocarcinoma(PDAC)holds promise for prognostic improvement,yet our knowledge on the spatial and tem-poral dynamics and the molecular modulators of t... 详细信息

关键词： immune adenocarcinoma immunotherapy

Prophylactic drains in totally laparoscopic distal gastrectomy:are they always necessary?

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World Journal of Gastroenterology 2022年第3期28卷 399-401页

作者： Tommaso Maria Manzia Alessandro Parente Roberta Angelico hpb and Transplant unit Department of Surgery ScienceUniversity of Rome Tor VergataRome 00133Italy Queen Elizabeth Hospital Liver UnitUniversity of BirminghamBirmingham UK and HPB and Transplant UnitDepartment of Surgery ScienceUniversity of Rome Tor VergataRome 00133Italy

Prophylactic drains have always been a useful tool to detect early complications and prevent postoperative fluid collections,particularly in gastrointestinal ***,the utilization of such drains has been debated,due to mounting evidence that they could be harmful rather than *** on recent published articles,Liu et al reported that the routine use of prophylactic drains in total laparoscopic distal gastrectomy might not be necessary for all ***,we express our opinion regarding this interesting publication.

关键词： Gastric cancer Prophylactic drainage Totally laparoscopic gastrectomy Enhanced recovery after surgery Minimally invasive surgery Early gastric cancer

Pancreatic surgery and tertiary pancreatitis services warrant provision for support from a specialist diabetes team

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World Journal of Diabetes 2024年第4期15卷 598-605页

作者： Vasileios K Mavroeidis Jennifer Knapton Francesca Saffioti Daniel L Morganstein Department of hpb Surgery Bristol Royal InfirmaryUniversity Hospitals Bristol and Weston NHS Foundation TrustBristol BS28HWUnited Kingdom Department of Gastrointestinal Surgery Southmead HospitalNorth Bristol NHS TrustBristol BS105NBUnited Kingdom Department of Academic Surgery Royal Marsden NHS Foundation TrustLondon SW36JJUnited Kingdom Department of Gastroenterology and Hepatology Oxford University Hospitals NHS Foundation TrustOxford OX39DUUnited Kingdom UCL Institute for Liver and Digestive Health University College LondonLondon NW32PFUnited Kingdom Department of Endocrinology Chelsea and Westminster Hospital NHS Foundation TrustLondon SW109NHUnited Kingdom Department of Gastrointestinal unit Royal Marsden NHS Foundation TrustLondon SW36JJUnited Kingdom

Pancreatic surgery units undertake several complex operations,albeit with consi-derable morbidity and mortality,as is the case for the management of complicated acute pancreatitis or chronic *** centralisation of pancreatic surgery services,with the development of designated large-volume centres,has contribu-ted to significantly improved *** this editorial,we discuss the complex associations between diabetes mellitus(DM)and pancreatic/periampullary disease in the context of pancreatic surgery and overall management of complex pancreatitis,highlighting the consequential needs and the indispensable role of specialist diabetes teams in support of tertiary pancreatic *** 3c pan-creatogenic DM,refers to DM developing in the setting of exocrine pancreatic disease,and its identification and management can be challenging,while the glycaemic control of such patients may affect their course of treatment and *** preoperative diabetes assessment is warranted to aid identification of patients who are likely to need commencement or escalation of glucose lowering therapy in the postoperative *** incidence of new onset diabetes after pancreatic resection is widely variable in the literature,and depends on the type and extent of pancreatic resection,as is the case with pancreatic parenchymal loss in the context of severe *** involvement of a specialist diabetes team is essential to ensure a holistic *** the current era,large volume pancreatic surgery services commonly abide by the principles of enhanced recovery after surgery,with inclusion of provisions for optimisation of the perioperative glycaemic control,to improve *** various guidelines are available to aid perioperative management of DM,auditing and quality improvement platforms have highlighted deficiencies in the perioperative management of diabetic patients and areas of required *** need for perioperative support of diabetic

关键词： Pancreatectomy Pancreatoduodenectomy Whipple’s Pancreatitis Diabetes specialist Type 3c pancreatogenic diabetes mellitus

Liver transplantation for hepatocellular carcinoma in India: Are we ready for 2040?

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World Journal of Transplantation 2024年第1期14卷 141-153页

作者： Hirak Pahari Amruth Raj Ambreen Sawant Dipak S Ahire Raosaheb Rathod Chetan Rathi Tushar Sankalecha Sachin Palnitkar Vikram Raut Department of Liver Transplant and hpb Surgery Medicover HospitalsNavi Mumbai 410210MaharashtraIndia Department of Liver Transplant Anaesthesia Medicover HospitalsNavi Mumbai 410210MaharashtraIndia Department of Gastroenterology and Hepatology Medicover HospitalsNavi Mumbai 410210India Department of Gastroenterology and Hepatology Medicover HospitalsNavi Mumbai 410210MaharashtraIndia Department of Gastroenterology and Hepatology Medicover HospitalsAurangabad 431003India Department of Gastroenterology and Hepatology Medicover HospitalsNashik 422009India Department of Gastroenterology and Hepatology Medicover HospitalsPune 411026India

BACKGROUND Liver transplantation(LT)for hepatocellular carcinoma(HCC)has been widely researched and is well established *** cornerstone of this treatment lies in the various criteria formulated by expert consensus and *** variations among the criteria are staggering,and the short-and long-term outcomes are *** To study the differences in the current practices of LT for HCC at different centers in India and discuss their clinical implications in the *** We conducted a survey of major centers in India that performed LT in December 2022.A total of 23 responses were *** centers were classified as high-and low-volume,and the current trend of care for patients undergoing LT for HCC was *** Of the 23 centers,35%were high volume center(>500 Liver transplants)while 52%were high-volume centers that performed more than 50 transplants/*** 39%of centers had performed>50 LT for HCC while the percent distribution for HCC in LT patients was 5%–15%in approximately 73%of the *** a few,most centers were divided equally between University of California,San Francisco(UCSF)and center-specific criteria when choosing patients with HCC for LT,and most(65%)did not have separate transplant criteria for deceased donor LT and living donor LT(LDLT).Most centers(56%)preferred surgical resection over LT for a Child A cirrhosis patient with a resectable 4 cm HCC ***-emission tomography-computed tomography(CT)was the modality of choice for metastatic workup in the majority of centers(74%).Downstaging was the preferred option for over 90%of the centers and included transarterial chemoembolization,transarterial radioembolization,stereotactic body radiotherapy and atezolizumab/bevacizumab with varied *** alphafetoprotein(AFP)cut-off was used by 74%of centers to decide on transplantation as well as to downstage tumors,even if they met the *** criteria for successful downstaging v

关键词： Hepatocellular carcinoma Liver transplant India Downstaging Survey Milan University of California,San Francisco Portal vein tumor thrombus Expanded criteria

Incidental gallbladder cancer diagnosis confers survival advantage irrespective of tumour stage and characteristics

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World Journal of Gastroenterology 2022年第18期28卷 1996-2007页

作者： Moath Alarabiyat Syed Soulat Raza John Isaac Darius Mirza Ravi Marudanayagam Keith Roberts Manuel Abradelo David C Bartlett Bobby V Dasari Robert P Sutcliffe Nikolaos A Chatzizacharias hpb and Liver Transplant unit Queen Elizabeth HospitalBirmingham B152GWUnited Kingdom Department of hpb and Liver Transplantation Queen Elizabeth HospitalUniversity Hospitals BirminghamBirmingham B152THUnited Kingdom

BACKGROUND Incidental gallbladder cancer(IGBC)represents 50%-60%of gallbladder cancer *** are conflicting on the role of IGBC diagnosis in oncological *** studies suggest that IGBC diagnosis does not affect outcomes,while others that overall survival(OS)is longer in these cases compared to non-incidental diagnosis(NIGBC).Furthermore,some studies reported early tumour stages and histopathologic characteristics as possible confounders,while others *** To investigate the role of IGBC diagnosis on patients’overall survival,especially after surgical treatment with curative *** Retrospective analysis of all patient referrals with gallbladder cancer between 2008 and 2020 in a tertiary hepatobiliary *** comparison of patient and tumour characteristics between IGBC and NIGBC subgroups was *** analysis for the whole cohort,surgical and non-surgical subgroups was done with the Kaplan-Meier method and the use of log rank *** analysis was performed with univariable and multivariable Cox regression *** The cohort included 261 patients with gallbladder cancer.65%of cases had NIGBC and 35%had IGBC.A total of 90 patients received surgical treatment(66%of IGBC cases and 19%of NIGBC cases).NIGBC patients had more advanced T stage and required more extensive resections than IGBC *** was longer in patients with IGBC in the whole cohort(29 vs 4 mo,P<0.001),as well as in the non-surgical(14 vs 2 mo,P<0.001)and surgical subgroups(29 vs 16.5 mo,P=0.001).Disease free survival(DFS)after surgery was longer in patients with IGBC(21.5 mo vs 8.5 mo,P=0.007).N stage and resection margin status were identified as independent predictors of OS and *** diagnosis was identified as an independent predictor of *** IGBC diagnosis may confer a survival advantage independently of the pathological stage and tumour *** studies are required to further investigate this,including detailed

关键词： Gallbladder cancer Incidental gallbladder cancer Non-incidental gallbladder cancer Gallbladder cancer survival

Cold ischemia time in liver transplantation:An overview

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World Journal of Hepatology 2024年第6期16卷 883-890页

作者： Manuela Cesaretti Alessandro Izzo Roberta Anna Pellegrino Alessandro Galli Orestes Mavrothalassitis Department of hpb and Liver Transplantation Brotzu HospitalCagliari 09122Italy Department of Nanophysic Istituto Italiano di TecnologiaGenova 16163Italy Department of Critical Care Medicine and Anesthesia ASST Papa Giovanni XXIIIBergamo 24100Italy Department of Anesthesia and Perioperative Care University of California San FranciscoSan FranciscoCA 94143United States

The standard approach to organ preservation in liver transplantation is by static cold storage and the time between the cross-clamping of a graft in a donor and its reperfusion in the recipient is defined as cold ischemia time(CIT).This simple definition reveals a multifactorial time frame that depends on donor hepatectomy time,transit time,and recipient surgery time,and is one of the most important donor-related risk factors which may influence the graft and recipient’s ***,the growing demand for the use of marginal liver grafts has prompted scientific exploration to analyze ischemia time factors and develop different organ preservation *** review details the CIT definition and analyzes its different *** also explores the most recent strategies developed to implement each timestamp of CIT and to protect the graft from ischemic injury.

关键词： Cold ischemia time Liver transplantation Organ donation Donation after cardiac death Warm ischemia time Machine perfusion

Clinical profile and outcomes of hepatocellular carcinoma in primary Budd-Chiari syndrome

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World Journal of Gastrointestinal Oncology 2024年第3期16卷 699-715页

作者： Ankit Agarwal Sagnik Biswas Shekhar Swaroop Arnav Aggarwal Ayush Agarwal Gautam Jain Anshuman Elhence Arun Vaidya Amit Gupte Ravi Mohanka Ramesh Kumar Ashwani Kumar Mishra Shivanand Gamanagatti Shashi Bala Paul Subrat Kumar Acharya Akash Shukla Shalimar Department of Gastroenterology and Human Nutrition All India Institute of Medical SciencesNew Delhi 110029DelhiIndia Department of Gastroenterology Seth Gordhandas Sunderdas Medical College and KEM HospitalMumbai 400012MaharashtraIndia Department of Gastroenterology Sir HN Reliance Foundation HospitalMumbai 400004India Department of Liver Transplant and hpb Sir HN Reliance Foundation HospitalMumbai 400004India Department of Gastroenterology All India Institute of Medical SciencesPatna 801507India Professor of Biostatistics National Drug Dependence Treatment Centre(NDDTC)All India Institute of Medical SciencesNew Delhi 110029India Department of Radiodiagnosis All India Institute of Medical SciencesNew Delhi 110029DelhiIndia

BACKGROUND There is scant literature on hepatocellular carcinoma(HCC)in patients with Budd-Chiari syndrome(BCS).AIM To assess the magnitude,clinical characteristics,feasibility,and outcomes of treatment in *** A total of 904 BCS patients from New Delhi,India and 1140 from Mumbai,India were *** prevalence and incidence of HCC were determined,and among patients with BCS-HCC,the viability and outcomes of interventional therapy were *** In the New Delhi cohort of 35 BCS-HCC patients,18 had HCC at index presentation(prevalence 1.99%),and 17 developed HCC over a follow-up of 4601 person-years,[incidence 0.36(0.22-0.57)per 100 person-years].BCS-HCC patients were older when compared to patients with BCS alone(P=0.001)and had a higher proportion of inferior vena cava block,cirrhosis,and long-segment vascular *** median alpha-fetoprotein level was higher in patients with BCS-HCC at first presentation than those who developed HCC at follow-up(13029 ng/mL vs 500 ng/mL,P=0.01).Of the 35 BCS-HCC,26(74.3%)underwent radiological interventions for BCS,and 22(62.8%)patients underwent treatment for HCC[transarterial chemoembolization in 18(81.8%),oral tyrosine kinase inhibitor in 3(13.6%),and transarterial radioembolization in 1(4.5%)].The median survival among patients who underwent interventions for HCC compared with those who did not was 3.5 years vs 3.1 mo(P=0.0001).In contrast to the New Delhi cohort,the Mumbai cohort of BCS-HCC patients were predominantly males,presented with a more advanced HCC[Barcelona Clinic Liver Cancer C and D],and 2 patients underwent liver *** HCC is not uncommon in patients with *** interventions and liver transplantation are feasible in select primary BCS-HCC patients and may improve outcomes.

关键词： Budd chiari syndrome Cancer Cirrhosis Thrombosis Liver Varices Transarterial chemoembolization Hepatic venous outflow tract obstruction