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Soyama A, Yamamoto H, Eguchi S, Nanashima A, Kakeji Y, Kitagawa Y, Nakamura M, Endo I. Short-term outcomes after liver resection with vascular reconstruction: Results from a study with the National Clinical Database of Japan. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2024. [PMID: 38679741 DOI: 10.1002/jhbp.1435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 03/15/2024] [Accepted: 03/22/2024] [Indexed: 05/01/2024]
Abstract
BACKGROUND Although curative resection with vascular reconstruction improves the prognosis of blood-invading locally advanced hepatobiliary tumors, the mortality and morbidity of the procedure remains unclear. This study aimed to clarify the risk factors associated with mortality and morbidity in patients undergoing liver resection with vascular reconstruction. METHODS This retrospective observational study included 1215 patients undergoing hepatectomy of more than one section with vascular reconstruction, except for left lateral sectionectomy registered in the National Clinical Database (NCD) between 2015 and 2019. The rates of surgical mortality and relevant clinical factors were evaluated. RESULTS Among the four types of vascular reconstruction, portal venous reconstruction was frequently performed in 724 patients (59.6% of the enrolled patients). Surgical mortality was 8.1%. Patients with hepatic artery reconstruction had the highest surgical mortality rate of 15.8%. In other types of reconstruction, surgical mortality was 9.1% in the portal vein, 5.2% in inferior vena cava, and 4.9% in hepatic vein. Factors significantly associated with surgical mortality include age, sex (male), preoperative comorbidity (American Society of Anesthesiologists grade >3, respiratory distress, diabetes, preoperative pneumonia, weight loss, and obstructive jaundice), poorer liver functional reserve (indocyanine green retention rate at 15 min and prothrombin time/international normalized ratio >1.1) and accompanying biliary reconstruction. CONCLUSIONS The NCD revealed the detailed status of liver resection combined with vascular reconstruction in Japan. Based on the results of this analysis, understanding the factors that influence the outcome and postoperative course of each procedure will provide patients with accurate information and opportunities to improve future outcomes.
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Affiliation(s)
- Akihiko Soyama
- Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Hiroyuki Yamamoto
- Department of Healthcare Quality Assessment, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Susumu Eguchi
- Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | | | - Yoshihiro Kakeji
- The Japanese Society of Gastroenterological Surgery, Tokyo, Japan
| | - Yuko Kitagawa
- The Japanese Society of Gastroenterological Surgery, Tokyo, Japan
| | | | - Itaru Endo
- Japanese Society of Hepato-Biliary-Pancreatic Surgery, Tokyo, Japan
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Co LMB, Puno FLMA, Ong EP, Ho FDV, Eala MAB, Dee EC, Maslog EAS, Barroso RT, Kingham TP, Ang SD, Ang CDU. Access to surgical treatment for hepatopancreaticobiliary cancer in the Philippines. Surgery 2024; 175:561-563. [PMID: 37953137 DOI: 10.1016/j.surg.2023.09.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Revised: 09/05/2023] [Accepted: 09/26/2023] [Indexed: 11/14/2023]
Abstract
Hepatopancreaticobiliary cancers are among the most diagnosed cancers in the world. However, although high-income countries have the highest incidence rates, low- and middle-income countries have the highest mortality rates. In this article, we describe the geographic distribution of board-certified hepatopancreaticobiliary surgeons who provide surgical management for patients with these diseases in the Philippines. We draw attention to the geographic disparities in the distribution of these surgeons and the other factors that contribute to the lack of access. Lastly, we suggest ways forward.
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Affiliation(s)
- Luis Miguel B Co
- School of Medicine and Public Health, Ateneo de Manila University, Pasig City, Philippines
| | | | - Erika P Ong
- College of Medicine, University of the Philippines, Manila, Philippines
| | | | - Michelle Ann B Eala
- Department of Radiation Oncology, University of California Los Angeles, Los Angeles, CA
| | | | | | - Ryan T Barroso
- Hepato-Pancreato-Biliary Unit, Rizal Medical Center, Pasig, Bago Bantay, Quezon City, Metro Manila
| | - T Peter Kingham
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Samuel D Ang
- Department of Surgery, Chinese General Hospital and Medical Center, Santa Cruz, Manila
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Gulla A, Ignatavicius P, Kvietkauskas M, Atstupens K, Plaudis H, Kutner S, Adamson M, Barauskas G, Ozolins A, Teras J, Strupas K. New Baltic chapter of the E-AHPBA: uniting towards surgical quality, research and innovations. HPB (Oxford) 2024; 26:154-155. [PMID: 37863741 DOI: 10.1016/j.hpb.2023.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 09/20/2023] [Accepted: 10/02/2023] [Indexed: 10/22/2023]
Affiliation(s)
- Aiste Gulla
- Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Lithuania Vilnius, Lithuania.
| | - Povilas Ignatavicius
- Department of Surgery, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Mindaugas Kvietkauskas
- Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Lithuania Vilnius, Lithuania
| | - Kristaps Atstupens
- Department of Surgery, Riga East Clinical University Hospital, Riga, Latvia
| | - Haralds Plaudis
- Department of Surgery, Pauls Stradins Clinical University Hospital, Riga, Latvia
| | - Sander Kutner
- Center for Surgical Oncology and General Surgery, North Estonia Medical Center Foundation, Tallinn, Estonia
| | - Martin Adamson
- Center for Surgical Oncology and General Surgery, North Estonia Medical Center Foundation, Tallinn, Estonia
| | - Giedrius Barauskas
- Department of Surgery, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Arturs Ozolins
- Department of Surgery, Pauls Stradins Clinical University Hospital, Riga, Latvia
| | - Jüri Teras
- Institute of Chemistry and Biotechnology, Tallinn University of Technology, Tallinn, Estonia
| | - Kestutis Strupas
- Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Lithuania Vilnius, Lithuania
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Oshita K, Kuroda S, Kobayashi T, Aoki G, Mashima H, Onoe T, Shigemoto N, Hirata T, Tashiro H, Ohdan H. A Multicenter, Open-Label, Single-Arm Phase I Trial of Dual-Wield Parenchymal Transection: A New Technique of Liver Resection Using the Cavitron Ultrasonic Surgical Aspirator and Water-Jet Scalpel Simultaneously (HiSCO-14 Trial). Cureus 2023; 15:e49028. [PMID: 38116351 PMCID: PMC10728581 DOI: 10.7759/cureus.49028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/18/2023] [Indexed: 12/21/2023] Open
Abstract
PURPOSE This study evaluated the safety and feasibility of a technique of liver resection named dual-wield parenchymal transection technique (DWT), using cavitron ultrasonic surgical aspirator (CUSA) and water-jet scalpel simultaneously. METHODS This multicenter, prospective, open-label, and single-arm phase I trial included patients aged 20 years or older with hepatic tumors indicated for surgical resection and scheduled for open radical resection. This study was conducted at two institutions affiliated with the Hiroshima Surgical Study Group of Clinical Oncology (HiSCO). The primary endpoint was the proportion of massive intraoperative blood loss (≥ 1000 mL). The secondary endpoints were the amount of blood loss, operative time, parenchymal transection speed, postoperative complications, and mortality. The safety endpoints were device failure and adverse events associated with devices. RESULTS From June 2022 to May 2023, 20 patients were enrolled; one was excluded and 19 were included in the full analysis set (FAS). In the FAS, segmentectomy was performed in nine cases, sectionectomy in four cases, and hemihepatectomy in six cases. Radical resection was achieved in all patients. Intraoperative blood loss greater than 1000 mL was observed in five patients (26.3%). The median amount of blood loss was 545 mL (range, 180-4413), and blood transfusions were performed on two patients (10.5%). The median operative time was 346 minutes (range, 238-543) and the median parenchymal transection speed was 1.2 cm2/minute (range, 0.5-5.1). Postoperative complications of Clavien-Dindo classification ≥ Grade 3 occurred in four patients (21.1%). No mortalities occurred in this study. In the safety analysis, there were no device failures or adverse events associated with devices. CONCLUSIONS This study demonstrated the safety and feasibility of DWT for liver resection. The efficacy of the DWT will be evaluated in future clinical trials.
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Affiliation(s)
- Ko Oshita
- Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, JPN
| | - Shintaro Kuroda
- Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, JPN
| | - Tsuyoshi Kobayashi
- Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, JPN
| | - Gaku Aoki
- Department of Biostatistics, Clinical Research Center, Hiroshima University, Hiroshima, JPN
| | - Hiroaki Mashima
- Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, JPN
- Department of Surgery, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, JPN
| | - Takashi Onoe
- Department of Surgery, Kure Medical Center and Chugoku Cancer Center, National Hospital Organization, Kure, JPN
| | | | - Taizo Hirata
- Translational Research Center, Hiroshima University, Hiroshima, JPN
| | - Hirotaka Tashiro
- Department of Surgery, Kure Medical Center and Chugoku Cancer Center, National Hospital Organization, Kure, JPN
| | - Hideki Ohdan
- Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, JPN
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