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The role of graft reperfusion sequence in the development of non-anastomotic biliary strictures following orthotopic liver transplantation: A meta-analysis

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Hepatobiliary & Pancreatic Diseases International 2019年第1期18卷 4-11页

作者： Mohamed Bekheit Matteo Catanzano Stuart Shand Irfan Ahmed ELSaid ELKayal Gihan Mohamed Shehata Adel Zaki Center of Liver Surgery and Transplantation Paul Brousse Hospital University of Paris-Sud Medical Research Institute University of Alexandria hpb Surgery unit Department of Surgery Aberdeen Royal Infirmary Department of Surgery Elkabbary General Hospital University of Aberdeen Department of Surgery Alexandria Main University Hospital Faculty of Medicine

Background: Liver transplant is a potential cure for liver failure and hepatic malignancy but there are many techniques which have been described for vascular reconstruction. This study was to compare the prevalence of non-anastomotic biliary stricture and other surgical complications based on Clavien-Dindo scoring system, in initial portal reperfusion(sequential) versus simultaneous or initial artery reperfusion. Data sources: Meta-analysis of published studies comparing the outcomes of both techniques was carried out. Data search was conducted across the major databases and studies were selected under the guidance of the Cochrane guidelines for systematic reviews and meta-analysis. Results: Seven studies were included to address the primary and the secondary outcomes. No statistical difference was found in the incidence of non-anastomotic biliary strictures(OR = 0.40; P = 0.14), regardless of reperfusion technique. The pooled estimate of the Clavien-Dindo grading of complications was not significantly different between the techniques, though Clavien-Dindo II complications were higher in the simultaneous or initial artery reperfusion group than the initial portal reperfusion group(OR = 2.73; P = 0.01). Similarly, there was no difference in the operative time, hospital stay and other outcomes addressed in this report. Conclusions: The available evidence suggests that there is no significant difference demonstrated in the rate of non-anastomotic biliary strictures or other complications, between the two techniques, except for Clavien-Dindo II complications.

关键词： Liver transplantation Organ transplantation Liver surgery Rejection

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Systematic review of novel ablative methods in locally advanced pancreatic cancer

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World Journal of Gastroenterology 2014年第9期20卷 2267-2278页

作者： Margaret G Keane Konstantinos Bramis Stephen P Pereira Giuseppe K Fusai Institute for Liver and Digestive Health University College London Royal Free Campus London NW3 2PF United Kingdom hpb and Liver Transplant unit Royal Free Hospital London NW3 2QG United Kingdom

Unresectable locally advanced pancreatic cancer with or without metastatic disease is associated with a very poor *** standard therapy is limited to chemotherapy or *** regimens have been shown to have a substantial survival advantage and novel treatment strategies are urgently *** and laser based ablative techniques are widely used in many solid organ *** studies in the pancreas were associated with significant morbidity and mortality,which limited widespread *** to the various applications,in particular combining the techniques with high quality imaging such as computed tomography and intraoperative or endoscopic ultrasound has enabled real time treatment monitoring and significant improvements in *** conducted a systematic review of the litera-ture up to October *** studies suggest that ablative therapies may confer an additional survival benefit over best supportive care but randomised studies are required to validate these findings.

关键词： Pancreatic cancer Radiofrequency ablation Photodynamic therapy Cryoablation Microwave ablation High frequency focused ultrasound Irreversible electroporation

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Early tacrolimus exposure does not impact long-term outcomes after liver transplantation

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World Journal of Hepatology 2021年第3期13卷 362-374页

作者： Mikel Gastaca Patricia Ruiz Javier Bustamante Lorea Martinez-Indart Alberto Ventoso JoséRamón Fernandez Ibone Palomares Mikel Prieto Milagros Testillano Patricia Salvador Maria Senosiain Maria Jesus Suárez Andres Valdivieso Department of hpb Surgery and Liver Transplantation unit Hospital Universitario CrucesBilbao 48903Spain Department of Hepatology unit Hospital Universitario CrucesBilbao 48903Spain Department of Bioinformatics and Statistics Platform Biocruces Bizkaia Health Research InstituteHospital Universitario CrucesBilbao 48903Spain

BACKGROUND Tacrolimus trough levels(TTL)during the first weeks after liver transplantation(LT)have been related with long-term renal function and hepatocellular carcinoma ***,the significance of trough levels of tacrolimus during the early post-transplant period for the long-term outcome is under debate AIM To evaluate the effect of TTL during the first month on the long-term outcomes after *** One hundred fifty-five LT recipients treated de novo with once-daily tacrolimus were retrospectively *** with repeated LT or combined transplantation were excluded as well as those who presented renal dysfunction prior to transplantation and/or those who needed induction *** were classified into 2 groups according to their mean TTL within the first month after transplantation:≤10(n=98)and>10 ng/mL(n=57).Multivariate analyses were performed to assess risk factors for patient *** Mean levels within the first month post-transplant were 7.4±1.7 and 12.6±2.2 ng/mL in the≤10 and>10 groups,*** age was higher in the high TTL group 62.9±16.8 years vs 45.7±17.5 years(P=0.002)whilst mycophenolate-mofetil was more frequently used in the low TTL group 32.7%vs 15.8%(P=0.02).Recipient features were generally similar across *** a median follow-up of 52.8 mo(range 2.8-81.1),no significant differences were observed in:Mean estimated glomerular filtration rate(P=0.69),hepatocellular carcinoma recurrence(P=0.44),de novo tumors(P=0.77),new-onset diabetes(P=0.13),or biopsy-proven acute rejection rate(12.2%and 8.8%,respectively;P=0.50).Eighteen patients died during the follow-up and were evenly distributed across groups(P=0.83).Five-year patient survival was 90.5%and 84.9%,respectively(P=0.44),while 5-year graft survival was 88.2%and 80.8%,respectively(P=0.42).Early TTL was not an independent factor for patient mortality in multivariate *** Differences in tacrolimus levels restricted to the fi

关键词： Liver transplantation Tacrolimus levels Prolonged released tacrolimus Oncedaily tacrolimus Renal function Survival Outcomes

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COVID-19 in a pregnant kidney transplant recipient-what we need to know:A case report

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World Journal of Transplantation 2022年第10期12卷 325-330页

作者： Roberta Angelico Maria Luisa Framarino-dei-Malatesta Giuseppe Iaria Department of Surgical Sciences HPB and Transplant UnitUniversity of Rome Tor VergataRome 00100Italy Department of Gynecologic-Obstetrical and Urologic Sciences Policlinico Umbero ISapienza University of RomeRome 00100Italy Kidney Transplant unit San Camillo ForlaniniRome 00100Italy

BACKGROUND In the era of the coronavirus disease 2019(COVID-19)pandemic,kidney transplant recipients are more susceptible to severe acute respiratory syndrome coronavirus(SARS-CoV-2)infection,developing severe morbidity and graft *** women are also more likely to develop severe COVID-19 disease,causing pregnancy complications such as preterm births and acute kidney *** SUMMARY Herein,we report the case of a pregnant woman with a third kidney transplantation who developed COVID-19 *** reduction of immunosuppressive drugs and strict monitoring of trough blood levels were needed to avoid severe SARS-CoV-2-related complications,and permitted to continue a healthy pregnancy and maintain good graft *** such a complex scenario,the concomitance of COVID-19-related morbidity,the risk of acute rejection in the hyperimmune recipient,graft dysfunction and pregnancy complications make the management of immunosuppression a very difficult task and clinicians must be *** Tailoring the immunosuppressive regimen is a key factor affecting both the graft outcome and pregnancy safety.

关键词： Kidney transplantation Pregnancy SARS-CoV-2 infection COVID-19 disease Immunosuppression Complications Case report

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Resection of isolated liver oligometastatic disease in pancreatic ductal adenocarcinoma:Is there a survival benefit?A systematic review

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World Journal of Gastrointestinal Surgery 2023年第7期15卷 1512-1521页

作者： James M Halle-Smith Sarah Powell-Brett Keith Roberts Nikolaos A Chatzizacharias Department of hpb and Liver Transplant Queen Elizabeth HospitalUniversity of BirminghamBirmingham B152GWUnited Kingdom

BACKGROUND Presence of liver metastatic disease in pancreatic ductal adenocarcinoma(PDAC),either synchronous or metachronous after pancreatic resection,is a terminal diagnosis that warrants management with palliative intent as per all international practice ***,there is an increasing interest on any potential value of surgical treatment of isolated oligometastatic disease in selected *** To present the published evidence on surgical management of PDAC liver metastases,synchronous and metachronous,and compare the outcomes of these treatments to the current standard of *** A systematic review was performed in line with the Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines to compare the outcomes of both synchronous and metachronous liver metastases resection to standard *** 356 studies were identified,31 studies underwent full-text review and of these 10 were suitable for *** synchronous resection of liver metastases was compared to standard care,most studies did not demonstrate a survival benefit with the exception of one study that utilised neoadjuvant ***,resection of metachronous disease appeared to confer a survival advantage when compared to treatment with chemotherapy *** A survival benefit may exist in resection of selected cases of metachronous liver oligometastatic PDAC disease,after disease biology has been tested with time and systemic *** survival benefit is less clear in synchronous cases;however an approach with neoadjuvant treatment and consideration of resection in some selected cases may confer some *** studies should focus on pathways for selection of cases that may benefit from an aggressive approach.

关键词： Pancreas cancer Liver metastases Surgical resection Systematic review

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Comment on:a multicentre outcome analysis to define global benchmarks for donation after circulatory death liver transplantation

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Hepatobiliary Surgery and Nutrition 2022年第2期11卷 270-272页

作者： Christian Hobeika Mickaël Lesurtel François Cauchy Department of hpb and Liver Transplantation PitiéSalpêtrière HospitalUniversity Paris-SorbonneAP-HPParisFrance Department of hpb and Liver Transplantation Beaujon HospitalUniversity of ParisAPHPClichyFrance Inflammation Research Center UMR INSERM 1149ParisFrance

In this multicenter,international retrospective study,Schlegel et *** at determining reference results of liver transplantation(LT)with Maastricht type 3 donation after cardiac death(DCD)grafts using the well-known benchmark methodology(1).Seventeen European(n=11)and North American(n=6)centers enrolling more than 2,000 DCD LT over a period of 16 years were *** harvested and preserved using“dynamic”(regional normothermic circulation and/or machine perfusion)techniques were not included.

关键词： centers analysis global

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Emerging concepts in the management of pancreatic ductal adenocarcinoma

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Laparoscopic, Endoscopic and Robotic Surgery 2019年第4期2卷 83-88页

作者： Sanket Srinivasa Rowan Parks hpb Surgery Royal Infirmary of EdinburghEdinburghUK Department of Clinical Surgery University of EdinburghEdinburghUK

Pancreatic ductal adenocarcinoma is characterised by poor oncological outcomes with curative treatment only possible for a *** are dependent on the stage of the disease and location within the pancreas with constitutional decline often *** require biochemical investigations and accurate imaging with CT to determine stage of disease and local ***-PET and endoscopic ultrasound are increasingly used *** remains the cornerstone of curative management and can be performed using minimally invasive *** resection and combination treatment with chemoradiotherapy are also utilised for suitable *** outcomes may be optimised using enhanced recovery *** standards have been defined for individual clinicians and units to benchmark their clinical *** developments described hold promise in improving outcomes from pancreatic ductal adenocarcinoma.

关键词： Pancreatic ductal adenocarcinoma Pancreatic resection Laparoscopic surgery Robotic surgery

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Laparoscopic liver resection:Wedge resections to living donor hepatectomy, are we heading in the right direction?

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World Journal of Gastroenterology 2014年第37期20卷 13369-13381页

作者： P Thomas Cherian Ashish Kumar Mishra Palaniappen Kumar Vijayant Kumar Sachan Anand Bharathan Gadiyaram Srikanth Baiju Senadhipan Mohamad S Rela Department of hpb Surgery and Liver Transplantation Global Hospital Department of Gastro-intestinal Surgery BGS-Global Hospital Department of Gastro-intestinal Surgery SUT-Royal Hospital

Despite inception over 15 years ago and over 3000 completed procedures, laparoscopic liver resection has remained mainly in the domain of selected centers and enthusiasts. Requirement of extensive open liver resection(OLR) experience, in-depth understanding of anatomy and considerable laparoscopic technical expertise may have delayed wide application. However healthy scepticism of its actual benefits and presence of a potential publication bias; concern about its safety and technical learning curve, are probably equally responsible. Given that a large proportion of our work, at least in transplantation is still OLR, we have attempted to provide an entirely unbiased, mature opinion of its pros and cons in the current invited review. We have dividedthis review into two sections as we believe they merit separate attention on technical and ethical grounds. The first part deals with laparoscopic liver resection(LLR) in patients who present with benign or malignant liver pathology, wherein we have discussed its overall outcomes; its feasibility based on type of pathology and type of resection and included a small section on application of LLR in special scenarios like cirrhosis. The second part deals with the laparoscopic living donor hepatectomy(LDH) experience to date, including its potential impact on transplantation in general. Donor safety, graft outcomes after LDH and criterion to select ideal donors for LLR are discussed. Within each section we have provided practical points to improve safety in LLR and attempted to reach reasonable recommendations on the utilization of LLR for units that wish to develop such a service.

关键词： Liver Laparoscopic Transplantation Resection Living donor Minimally invasive Technique Hepatocellular Hepatectomy Cirrhosis

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The prognostic relevance of examined lymph nodes for accurate staging of resected pancreatic adenocarcinoma

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Hepatobiliary Surgery and Nutrition 2022年第4期11卷 632-635页

作者： Claudia Zaharia Marcus Roalsø Kjetil Søreide Department of Pathology Stavanger University HospitalStavangerNorway Department of Gastrointestinal Surgery HPB UnitStavanger University HospitalStavangerNorway Department of Quality and Health Technology University of StavangerStavangerNorway Department of Clinical Medicine University of BergenBergenNorway

Pancreatic ductal adenocarcinoma(PDAC)is a disease with a particular aggressive cancer biology and,unfortunately,a very poor prognosis for most *** is no question about the lethality of pancreatic ***,the question why this malignancy is so deadly remains a biological puzzle both to investigators and caretakers *** of pancreatic cancer undergoing resection-while important to compare cohorts across studies and trials-also allows for a clinical clue about the progress of the disease.

关键词： adenocarcinoma cancer prognosis

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Laparoscopic surgery for colorectal liver metastases:moving forward while keeping feet on the ground

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Hepatobiliary Surgery and Nutrition 2021年第1期10卷 107-109页

作者： Mariano Cesare Giglio Roberto Ivan Troisi Division of hpb Minimally Invasive and Robotic SurgeryDepartment of Clinical Medicine and SurgeryFederico II University HospitalNaplesItaly

The laparoscopic approach to the surgical treatment of colorectal liver metastases(CRLMs)is supported nowadays by high evidence(1).In the hand of expert surgeons,patients undergoing laparoscopic liver surgery(LLS)for CLRMs benefit from a number of advantages,including a shorter postoperative in-hospital stay,less pain,fewer complications and a faster recovery(1).More importantly,all these profits are achieved while preserving the oncological outcomes,which are not-inferior to those achieved by open procedures(1).Recently published long-term results of randomized trials have shown similar patient survival after laparoscopic and open surgery for CRLM(2).

关键词： surgery colorectal faster

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