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Robotic-assisted placement of hepatic artery infusion pump for the treatment of colorectal liver metastases:Role of indocyanine green(with video)

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Hepatobiliary & Pancreatic Diseases International 2022年第4期21卷 387-391页

作者： Mario Spaggiari Kiara A Tulla Gabriela Aguiluz Pierpaolo Di Cocco Lola Castro Gil Enrico benedetti Ivo G Tzvetanov Pier Cristoforo Giulianotti division of Transplantation Department of SurgeryUniversity of Illinois at ChicagoChicagoILUSA division of General Minimally Invasiveand Robotic SurgeryDepartment of SurgeryUniversity of Illinois at ChicagoChicagoILUSA

Surgical resection remains the only definitive treatment for colorectal liver metastasis(CRLM). However, only a minority of cases are deemed resectable at the time of diagnosis. Systemic chemotherapy along with hepatic artery infusion(HAI) is an effective and safe regional chemotherapy modality for the downstaging of patients with isolated unresectable CRLM [1].

关键词： chemotherapy liver artery treatment metastasis

Safety of high-carbohydrate fluid diet 2 h versus overnight fasting before non-emergency endoscopic retrograde cholangiopancreatography: A single-blind, multicenter, randomized controlled trial

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中华医学杂志(英文版) 2024年第12期137卷 2023 Aug 24页

作者： Meng Wenbo Leung Joseph W. Wang Zhenyu Li Qiyong Zhang Leida Zhang Kai Wang Xuefeng Wang Meng Wang Qi Shao Yingmei Zhang Jijun Yue Ping Zhang Lei Zhu Kexiang Zhu Xiaoliang Zhang Hui Hou Senlin Cai Kailin Sun Hao Xue Ping Liu Wei Wang Haiping Zhang Li Ding Songming Yang Zhiqing Zhang Ming Weng Hao Wu Qingyuan Chen bendong Jiang Tiemin Wang Yingkai Zhang Lichao Wu Ke Yang Xue Wen Zilong Liu Chun Miao Long Wang Zhengfeng Li Jiajia Yan Xiaowen Wang Fangzhao Zhang Lingen bai Mingzhen Mi Ningning Zhang Xianzhuo Zhou Wence Yuan Jinqiu Suzuki Azumi Tanaka Kiyohito Liu Jiankang Nur Ula Weiderpass Elisabete Li Xun Department of Hepatobiliary surgery The General Hospital of Ningxia Medical University Yinchuan Ningxia China Department of Hepatobiliary & Hydatid Digestive and Vascular Surgery Center Xinjiang Key Laboratory of Echinococcosis and Liver Surgery Research The First Affiliated Hospital of Xinjiang Medical University Urumqi Xinjiang China Department of Hepatobiliary and Pancreatic surgery The First Hospital of Shanxi Medical University Taiyuan Shanxi China Department of General surgery The Second Hospital of Lanzhou University Lanzhou Gansu China Department of biliopancreatic Endoscopic surgery The Second Hospital of Hebei Medical University Shijiazhuang Hebei China Gastrointestinal surgery Department Union Hospital Tongji Medical College Huazhong University of Science and Technology Wuhan Hubei China Department of Hepatobiliary surgery The First Affiliated Hospital of Xi’an Jiaotong University Xi’an Shaanxi China Department of Hepatobiliary surgery the Second Affiliated Hospital of Guangzhou Medical University Guangzhou Guangdong China division of biliopancreatic surgery Department of General Surgery Second Xiangya Hospital Central South University Changsha Hunan China Department of General surgery The First Hospital of Lanzhou University Lanzhou Gansu China The First Clinical Medical College of Lanzhou University Lanzhou Gansu China Clinical Research Centre Scientific Research Centre The Seventh Affiliated Hospital Sun Yat-sen University Shenzhen Guangdong China Department of Gastroenterology Hamamatsu Medical Center Hamamatsu Japan Department of Gastroenterology Kyoto Second Red Cross Hospital Kyoto Japan Cardiovascular division Brigham and Women’s Hospital Harvard Medical School Boston MA USA Department of Public Health College of Health Sciences Qatar University Doha Qatar International Agency for Research on Cancer (IARC) Lyon France. Key Laboratory of biological Therapy and Regenerative Medicine Transformation Gansu Province Lanzhou G

background: Although overnight fasting is recommended prior to endoscopic retrograde cholangiopancreatography (ERCP), the benefits and safety of high-carbohydrate fluid diet (CFD) intake 2 h before ERCP remain unclear. This study aimed to analyze whether high-CFD intake 2 h before ERCP can be safe and accelerate patients’ recovery.Methods: This prospective, multicenter, randomized controlled trial involved 15 tertiary ERCP centers. A total of 1330 patients were randomized into CFD group (n = 665) and fasting group (n = 665). The CFD group received 400 mL of maltodextrin orally 2 h before ERCP, while the control group abstained from food/water overnight (>6 h) before ERCP. All ERCP procedures were performed using deep sedation with intravenous propofol. The investigators were blinded but not the patients. The primary outcomes included postoperative fatigue and abdominal pain score, and the secondary outcomes included complications and changes in metabolic indicators. The outcomes were analyzed according to a modified intention-to-treat principle.Results: The post-ERCP fatigue scores were significantly lower at 4 h (4.1 ± 2.6vs. 4.8 ± 2.8,t = 4.23,P but not pancreatitis (5.5% [35/634]vs. 6.5% [43/658],χ2 = 0.59,P = 0.444). Subgroup analysis revealed that CFD reduced the incidence of complications in patients with native papilla (odds ratio [OR]: 0.61, 95% CI: 0.39–0.95,P = 0.028) in the multivariable models.Conclusion: Ingesting 400 mL of CFD 2 h before

关键词： Endoscopic retrograde cholangiopancreatography ERCP Carbohydrate Fasting Safety Complications Enhanced recovery after surgery Randomized controlled trial

Artificial intelligence in the diagnosis and management of colorectal cancer liver metastases

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World Journal of Gastroenterology 2022年第1期28卷 108-122页

作者： Gianluca Rompianesi Francesca Pegoraro Carlo DL Ceresa Roberto Montalti Roberto Ivan Troisi division of Hepato-bilio-Pancreatic Minimally Invasive and Robotic SurgeryDepartment of Clinical Medicine and SurgeryFederico II University HospitalNaples 80125Italy Department of Hepato-Pancreato-biliary surgery Oxford University Hospitals NHS Foundation TrustOxford OX39ESUnited Kingdom division of Hepato-bilio-Pancreatic Minimally Invasive and Robotic SurgeryDepartment of Public HealthFederico II University HospitalNaples 80125Italy

Colorectal cancer(CRC)is the third most common malignancy worldwide,with approximately 50%of patients developing colorectal cancer liver metastasis(CRLM)during the follow-up period.Management of CRLM is best achieved via a multidisciplinary approach and the diagnostic and therapeutic decision-making process is complex.In order to optimize patients’survival and quality of life,there are several unsolved challenges which must be overcome.These primarily include a timely diagnosis and the identification of reliable prognostic factors.Furthermore,to allow optimal treatment options,a precision-medicine,personalized approach is required.The widespread digitalization of healthcare generates a vast amount of data and together with accessible high-performance computing,artificial intelligence(AI)technologies can be applied.by increasing diagnostic accuracy,reducing timings and costs,the application of AI could help mitigate the current shortcomings in CRLM management.In this review we explore the available evidence of the possible role of AI in all phases of the CRLM natural history.Radiomics analysis and convolutional neural networks(CNN)which combine computed tomography(CT)images with clinical data have been developed to predict CRLM development in CRC patients.AI models have also proven themselves to perform similarly or better than expert radiologists in detecting CRLM on CT and magnetic resonance scans or identifying them from the noninvasive analysis of patients’exhaled air.The application of AI and machine learning(ML)in diagnosing CRLM has also been extended to histopathological examination in order to rapidly and accurately identify CRLM tissue and its different histopathological growth patterns.ML and CNN have shown good accuracy in predicting response to chemotherapy,early local tumor progression after ablation treatment,and patient survival after surgical treatment or chemotherapy.Despite the initial enthusiasm and the accumulating evidence,AI technologies’role in healthcare and CRLM management is not yet full

关键词： Colorectal cancer Liver metastases Artificial intelligence Machine learning Deep learning Neural networks Radiomics

Sengstaken-blakemore tubes:a rescue system during liver transplantation

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Hepatobiliary surgery and Nutrition 2022年第1期11卷 171-172页

作者： Antonio Cubisino Fabrizio Panaro division of General Minimally Invasive and Robotic SurgeryUniversity of Illinois at ChicagoChicagoILUSA division of HbP surgery and Transplantation Department of SurgeryHôpital Saint EloiCHU-MontpellierMontpellierFrance

A 52-year-old woman has undergone liver transplantation(LT)owing to fulminant viral hepatitis,MELD 42.The first cadaveric graft allocated was a large-for-size graft.LT was performed with a piggyback side-to-side cavocaval anastomosis.At the end of the procedure,the removal of the abdominal retractor produced,due to a narrow ribcage,a caval compression with liver congestion because of a reduced caval outflow.

关键词： liver anastomosis graft

Feasibility and safety of minimally invasive multivisceral resection for T4b rectal cancer:A 9-year review

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World Journal of Gastrointestinal surgery 2024年第3期16卷 777-789页

作者： Kai Siang Chan biquan Liu Ming Ngan Aloysius Tan Kwang Yeong How Kar Yong Wong Department of General surgery Tan Tock Seng HospitalSingapore 308433Singapore

bACKGROUND Colorectal cancer is the third most common cancer and the second highest cause of cancer-related mortality worldwide.About 5%-10%of patients are diagnosed with locally advanced rectal cancer(LARC)on presentation.For LARC invading into other structures(i.e.T4b),multivisceral resection(MVR)and/or pelvic ex-enteration(PE)remains the only potential curative surgical treatment.MVR and/or PE is a major and complex surgery with high post-operative morbidity.minimally invasive surgery(MIS)has been shown to improve short-term post-operative outcomes in other gastrointestinal malignancies,but there is little evi-dence on its use in MVR,especially so for robotic MVR.This is a single-center retrospective cohort study from 1st January 2015 to 31st March 2023.Inclusion criteria were patients diagnosed with cT4b rectal cancer and underwent MVR,or stage 4 disease with resectable systemic metastases.Pa-tients who underwent curative MVR for locally recurrent rectal cancer,or me-tachronous rectal cancer were also included.Exclusion criteria were patients with systemic metastases with non-resectable disease.All patients planned for elective surgery were enrolled into the standard enhanced recovery after surgery pathway with standard peri-operative management for colorectal surgery.Complex sur-gery was defined based on technical difficulty of surgery(i.***.total PE,bladder-sparing prostatectomy,pelvic lymph node dissection or need for flap creation).Our primary outcomes were the margin status,and complication rates.Cate-gorical values were described as percentages and analysed by the chi-square test.Continuous variables were expressed as median(range)and analysed by Mann-Whitney U test.Cumulative overall survival(OS)and recurrence-free survival(RFS)were analysed using Kaplan-Meier estimates with life table analysis.Log-rank test was performed to determine statistical significance between cumulative estimates.Statistical significance was defined as Pble analysis.Log-rank test was performed to

关键词： Laparoscopy minimally invasive surgical procedures Multivisceral resection Pelvic Exenteration Rectal neoplasms Robotic surgical procedures

Impact of pre- and peri-operative risk factors on length of stay and hospital readmission following minimally-invasive partial nephrectomy

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Asian Journal of Urology 2024年第1期11卷 72-79页

作者： Vanessa A.Lukas Rahul Dutta Ashok K.Hemal Matvey Tsivian Timothy E.Craven Nicholas A.Deebel David D.Thiel Ram Anil Pathak brigham and Women's Hospital Division of UrologyDepartment of Surgery75 Francis StreetBostonMAUSA Atrium Health Wake Forest baptist Medical Center Department of Urology1 Medical Center BlvdWinston-SalemNCUSA Mayo Clinic Florida Department of Urology4500 San Pablo RoadJacksonvilleFLUSA

Objective:We conducted an analysis of the American College of Surgeons National Surgical Quality Improvement Program database for minimally-invasive partial nephrectomy cases reported with the goal to identify pre-and peri-operative variables associated with length of stay(LOS)greater than 3 days and readmission within 30 days.Methods:Records from 2008 to 2018 for“laparoscopy,surgical;partial nephrectomy”for prolonged LOS and readmission cohorts were compiled.Univariate analysis with Chi-square,t-tests,and multivariable logistic regression analysis with odds ratios(ORs),p-values,and 95%confidence intervals assessed statistical associations.Results:Totally,20306 records for LOS greater than 3 days and 15854 for readmission within 30 days were available.Univariate and multivariable analysis exhibited similar results.For LOS greater than 3 days,undergoing non-elective surgery(OR=5.247),transfusion of greater than four units within 72 h prior to surgery(OR=5.072),pre-operative renal failure or dialysis(OR=2.941),and poor pre-operative functional status(OR=2.540)exhibited the strongest statistically significant associations.For hospital readmission within 30 days,loss in body weight greater than 10%in 6 months prior to surgery(OR=2.227)and bleeding disorders(OR=2.081)exhibited strongest statistically significant associations.Conclusion:Multiple pre-and peri-operative risk factors are independently associated with prolonged LOS and hospital readmission within 30 days of surgery using the American College of Surgeons National Surgical Quality Improvement Program data.Recognizing the risks factors that can potentially be improved prior to minimally-invasive partial nephrectomy is crucial to informing patient selection,optimization strategies,and patient education.

关键词： minimally-invasive partial nephrectomy The American College of Surgeons National Surgical Quality Improvement Program Lengthof stay Hospital readmission

Sustained release of hydrogen sulfide from anisotropic ferrofluid hydrogel for the repair of spinal cord injury

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bioactive Materials 2023年第5期23卷 118-128页

作者： Ruofei Wang Xia-Xiao Wu Zhenming Tian Tian Hu Chaoyang Cai Guan-Ping Wu Gang-biao Jiang bin Liu Department of Spine surgery The Third Affiliated Hospital of Sun Yat-Sen UniversityGuangzhou510630China Guangdong Provincial Center for Quality Control of minimally invasive Spine surgery Guangzhou510630China Guangdong Provincial Center for Engineering and Technology Research of minimally invasive Spine surgery Guangzhou510630China Key Laboratory for biobased Materials and Energy of Ministry of Education College of Materials and EnergySouth China Agricultural UniversityGuangzhou510642China

Spinal cord injury(SCI)results in massive neuronal death,axonal disruption,and cascading inflammatory response,which causes further damage to impaired neurons.The survived neurons with damaged function fail to form effective neuronal circuits.It is mainly caused by the neuroinflammatory microenvironment at injury sites and regenerated axons without guidance.To address this challenge,a ferrofluid hydrogel(FFH)was prepared with Ferric tetrasulfide(Fe3S4),carboxymethyl chitosan,and gold.Its internal structural particles can be oriented in a magnetic field to acquire anisotropy.Moreover,Fe3S4 can release hydrogen sulfide(H2S)with anti-inflammatory effects under acidic conditions.Regarding in vitro experiments,0.01g/ml Fe3S4 FFH significantly reduced the inflammatory factors produced by LPS-induced bV2 cells.Oriented and longer axons of the induced neural stem cells loaded on anisotropic FFH were observed.In vivo experiments showed that FFH reduced the activated microglia/macrophage and the expression of pro-inflammatory factors in SCI rats through the NF-κb pathway.Moreover,it significantly promoted directional axonal regrowth and functional recovery after SCI.Given the critical role of inhibition of neuroinflammation and directional axonal growth,anisotropic Fe3S4 FFH is a promising alternative for the treatment of SCI.

关键词： Spinal cord injury Anisotropic Ferrofluid Hydrogen sulfide

Immunotherapy for hepatocellular carcinoma:A promising therapeutic option for advanced disease

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World Journal of Hepatology 2022年第10期14卷 1862-1874页

作者： Gianluca Cassese Ho-Seong Han boram Lee Hae Won Lee Jai Young Cho Fabrizio Panaro Roberto Ivan Troisi Department of Clinical Medicine and surgery Division of Minimally Invasive and Robotic HPB SurgeryFederico II UniversityNaples 80131Italy Department of surgery Seoul National University Bundang HospitalSeongnam 13620South Korea Department of surgery Division of HBP Surgery and TransplantationMontpellier University Hospital-School of MedicineMontpellier 34000France

Hepatocellular carcinoma(HCC)is the third leading cause of cancer-related deaths worldwide,and its incidence continues to increase.Despite improvements in both medical and surgical therapies,HCC remains associated with poor outcomes due to its high rates of recurrence and mortality.Approximately 50% of patients require systemic therapies that traditionally consist of tyrosine kinase inhibitors.Recently,however,immune checkpoint inhibitors have revolutionized HCC management,providing new therapeutic options.Despite these major advances,the different factors involved in poor clinical responses and molecular pathways leading to resistance following use of these therapies remain unclear.Alternative strategies,such as adoptive T cell transfer,vaccination,and virotherapy,are currently under evaluation.Combinations of immunotherapies with other systemic or local treatments are also being investigated and may be the most promising opportunities for HCC treatment.The aim of this review is to provide updated information on currently available immunotherapies for HCC as well as future perspectives.

关键词： Hepatocellular Carcinoma Immunotherapy Hepatocellular Carcinoma management Hepatocellular Carcinoma therapy Molecular targeted therapy

minimally invasive pelvic exenteration for primary or recurrent locally advanced rectal cancer:A glimpse into the future

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World Journal of Gastrointestinal surgery 2024年第7期16卷 1960-1964页

作者： Dimitrios Kehagias Charalampos Lampropoulos Ioannis Kehagias Department of General surgery General University Hospital of PatrasPatras 26504Greece Intensive Care Unit Saint Andrew’s General HospitalPatras 26335Greece division of bariatric and Metabolic surgery Department of SurgeryUniversity of PatrasPatras 26504Greece

Surgeons have grappled with the treatment of recurrent and T4b locally advanced rectal cancer(LARC)for many years.Their main objectives are to increase the overall survival and quality of life of the patients and to mitigate postoperative complications.Currently,pelvic exenteration(PE)with or without neoadjuvant treatment is a curative treatment when negative resection margins are achieved.The traditional open approach has been favored by many surgeons.However,the technological advancements in minimally invasive surgery have radically changed the surgical options.Recent studies have demonstrated promising results in postoperative complications and oncological outcomes after robotic or laparoscopic PE.A recent retrospective study entitled“Feasibility and safety of minimally invasive multivisceral resection for T4b rectal cancer:A 9-year review”was published in the World Journal of Gastrointestinal surgery.As we read this article with great interest,we decided to delve into the latest data regarding the benefits and risks of minimally invasive PE for LARC.Currently,the small number of suitable patients,limited surgeon experience,and steep learning curve are hindering the establishment of minimally invasive PE.

关键词： Locally advanced rectal cancer Pelvic exenteration Multivisceral resection minimally invasive surgical procedures Robotic surgical procedures