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Labadie KP, Melstrom LG, Lewis AG. Safe implementation of a minimally invasive hepatopancreatobiliary program, a narrative review and institutional experience. J Surg Oncol 2023; 128:1347-1352. [PMID: 37781938 DOI: 10.1002/jso.27455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 09/17/2023] [Indexed: 10/03/2023]
Abstract
Laparoscopic and robotic-assisted approaches to hepatopancreatobiliary (HPB) operations have expanded worldwide. As surgeons and medical centers contemplate initiating and expanding minimally invasive surgical (MIS) programs for complex HPB surgical operations, there are many factors to consider. This review highlights the key components of developing an MIS HPB program and shares our recent institutional experience with the adoption and expansion of an MIS approach to pancreaticoduodenectomy.
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Affiliation(s)
- Kevin P Labadie
- Department of Surgery, City of Hope National Medical Center, Division of Surgical Oncology, Duarte, California, USA
| | - Laleh G Melstrom
- Department of Surgery, City of Hope National Medical Center, Division of Surgical Oncology, Duarte, California, USA
| | - Aaron G Lewis
- Department of Surgery, City of Hope National Medical Center, Division of Surgical Oncology, Duarte, California, USA
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Rocca A, Porfidia C, Russo R, Tamburrino A, Avella P, Vaschetti R, Bianco P, Calise F. Neuraxial anesthesia in hepato-pancreatic-bilio surgery: a first western pilot study of 46 patients. Updates Surg 2023; 75:481-491. [PMID: 36607598 PMCID: PMC9817460 DOI: 10.1007/s13304-022-01437-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 12/04/2022] [Indexed: 01/07/2023]
Abstract
The most common anesthetic approach in hepato-pancreatic-biliary (HPB) surgery is general anesthesia (GA), but it may result in increased morbidity and mortality and peri-operative risks especially in frail patients. The aim of this study was to assess the safety and effectiveness of neuraxial anesthesia (NA) in HPB in a pilot clinical series. This analysis was conducted on 46 consecutive patients undergoing HPB surgery in an Italian Tertial referral center. Data were prospectively collected and retrospectively analyzed. continuous spinal anesthesia (CSA), combined spino-epidural anesthesia (CSEA) and peridural anesthesia (PA) were used in major and minor hepatectomies and bilio-pancreatic surgery instead of GA. NA was evaluated by analyzing the surgical and anesthesiological short-term outcomes. 46 patients were considered eligible for the study between February 2018 and May 2020. The average age was 69.07 (± 9.95) years. 22 were males and 24 were females. According to the ASA score, 19 (41.30%) patients had ASA II, 22 (47.83%) had ASA III and 5 (10.87%) had ASA IV. 22 (47.83%) patients underwent CSA, 20 (43.48%) CSEA and 4 (8.69%) PA. We performed 8 major and 19 minor hepatectomies, 7 bilio-digestive derivations, 5 Whipple procedures, 4 iatrogenic biliary duct injuries, 2 splenopancreatectomies and 1 hepatic cyst fenestration. Clavien-Dindo ≥ 3 was observed in 3 patients. The conversion rate to endotracheal intubation occurring in 3 of 46 (6.52%) patients. After surgery, no local or pulmonary complications and delirium were reported in our series. The present study demonstrates that NA is a safe and feasible option in selected patients, if performed in referral centers by well-trained anaesthesiologists and surgeons.
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Affiliation(s)
- Aldo Rocca
- HPB Surgery Unit, Pineta Grande Hospital, 81030, Castel Volturno, CE, Italy.
- Department of Medicine and Health Sciences "V. Tiberio", University of Molise, 86100, Campobasso, CB, Italy.
| | - Carmela Porfidia
- Intensive Care Unit, Pineta Grande Hospital, 81030, Castel Volturno, CE, Italy
| | - Raffaele Russo
- Intensive Care Unit, Pineta Grande Hospital, 81030, Castel Volturno, CE, Italy
| | | | - Pasquale Avella
- Department of Medicine and Health Sciences "V. Tiberio", University of Molise, 86100, Campobasso, CB, Italy
| | - Roberto Vaschetti
- Department of Medicine and Health Sciences "V. Tiberio", University of Molise, 86100, Campobasso, CB, Italy
| | - Paolo Bianco
- HPB Surgery Unit, Pineta Grande Hospital, 81030, Castel Volturno, CE, Italy
| | - Fulvio Calise
- HPB Surgery Unit, Pineta Grande Hospital, 81030, Castel Volturno, CE, Italy
- Department of Medicine and Health Sciences "V. Tiberio", University of Molise, 86100, Campobasso, CB, Italy
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Janatmakan F, Javaherforoosh Zadeh F, Alizadeh M, Alizadeh Z, Bahreini A. The Comparison of the Effect of Mannitol and N Acetyl Cysteine on Liver Function in Partial Hepatectomy. Anesth Pain Med 2018; 8:e79677. [PMID: 30533390 PMCID: PMC6240830 DOI: 10.5812/aapm.79677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Revised: 08/25/2018] [Accepted: 09/08/2018] [Indexed: 12/04/2022] Open
Abstract
The alterations in liver function in patients after major liver resection are complex. Partial hepatectomy surgery is considered as a selective therapeutic approach in many benign and malignant liver tumors, secondary metastases, and liver trauma. According to surgical techniques most often based on vascular control and hepatic venous closure (Pringle maneuver), related complications such as ischemia and decreased venous return during and after surgery can be seen. In this study, the effects of Mannitol and N-acetylcysteine, on liver function, after hepatectomy surgery, were compared. This study was shown that infusion N-acetylcysteine next to mannitol, in partial hepatectomy surgeries, was not the significant difference to improve liver function, hemodynamic status, and laboratory tests.
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Affiliation(s)
- Farahzad Janatmakan
- Department of Anesthesia, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
- Corresponding Author: Assistant Professor of Anesthesia, Department of Anesthesia, Pain Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran, Tel: +98-9161113376.
| | - Fatemeh Javaherforoosh Zadeh
- Department of Anesthesia, Ahvaz Anesthesiology and Pain Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Masomeh Alizadeh
- Department of Anesthesia, Pain Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
- Corresponding Author: Assistant of Anesthesia, Department of Anesthesia, Pain Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran, Tel: +98-9173428394.
| | - Zeinab Alizadeh
- Department of Anesthesia, Pain Research Center, Yasouj University of Medical Sciences, Yasouj, Iran
| | - Amin Bahreini
- Department of Surgery, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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Analysis of results after the implementation of fast recovery protocols in hepatopancreatobiliary surgery. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2018. [DOI: 10.1097/cj9.0000000000000067] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Krüger JAP, Fonseca GM, Makdissi FF, Jeismann VB, Coelho FF, Herman P. Evolution in the surgical management of colorectal liver metastases: Propensity score matching analysis (PSM) on the impact of specialized multidisciplinary care across two institutional eras. J Surg Oncol 2018; 118:50-60. [PMID: 29878362 DOI: 10.1002/jso.25098] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Accepted: 04/16/2018] [Indexed: 12/27/2022]
Abstract
BACKGROUND AND OBJECTIVES Liver metastases are indicators of advanced disease in patients with colorectal cancer. Liver resection offers the best possibility of long-term survival. Surgical strategies have evolved in complexity in order to offer resection to a greater number of patients, requiring specialized multidisciplinary care. The current paper focused on analyzing outcomes of patients treated after the development of a dedicated cancer center in our institution. METHODS Patients operated on for CLM from our databank were paired through propensity score matching (PSM), and the initial experience of surgery for CLM was compared with the treatment performed after specialized multidisciplinary management. The demographic, oncological, and surgical features were analyzed between groups. RESULTS Overall, 355 hepatectomies were performed in 336 patients. Patients operated on during the second era of had greater use of preoperative chemotherapy (P < 0.001) as well as exposure to more effective oxaliplatin-based regimens (P < 0.001). Surgical management also changed, with minor (P = 0.002) and non-anatomic (P = 0.006) resections preferred over major operations. We also noted an increased number of minimally invasive resections (P < 0.001). CONCLUSION Treatment in a multidisciplinary cancer center led to changes in oncological and surgical management. Perioperative chemotherapy was frequently employed, and surgeons adopted a conservative approach to liver parenchyma.
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Affiliation(s)
- Jaime A P Krüger
- Instituto do Cancer do Estado de Sao Paulo (ICESP) e Hospital das Clinicas (HC), University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Gilton M Fonseca
- Instituto do Cancer do Estado de Sao Paulo (ICESP) e Hospital das Clinicas (HC), University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Fabio F Makdissi
- Instituto do Cancer do Estado de Sao Paulo (ICESP) e Hospital das Clinicas (HC), University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Vagner B Jeismann
- Instituto do Cancer do Estado de Sao Paulo (ICESP) e Hospital das Clinicas (HC), University of Sao Paulo Medical School, Sao Paulo, Brazil
| | | | - Paulo Herman
- Instituto do Cancer do Estado de Sao Paulo (ICESP) e Hospital das Clinicas (HC), University of Sao Paulo Medical School, Sao Paulo, Brazil
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Real MI, Cortés M. A commentary on “Red blood cell transfusion practice in elective liver resection: Single center scenario” by Dr M. Isabel Real and Dr Manuel Cortes. TRENDS IN ANAESTHESIA AND CRITICAL CARE 2015. [DOI: 10.1016/j.tacc.2015.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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