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Patel NS, Herzog I, Dunn C, Merchant AM. Impact of Operative Approach on Acute Kidney Injury Risk Prediction Models for Colectomy. J Surg Res 2024; 299:224-236. [PMID: 38776578 DOI: 10.1016/j.jss.2024.04.026] [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: 09/24/2023] [Revised: 04/07/2024] [Accepted: 04/21/2024] [Indexed: 05/25/2024]
Abstract
INTRODUCTION Acute kidney injury (AKI) is a serious postoperative complication associated with increased morbidity and mortality. Identifying patients at risk for AKI is important for risk stratification and management. This study aimed to develop an AKI risk prediction model for colectomy and determine if the operative approach (laparoscopic versus open) alters the influence of predictive factors through an interaction term analysis. METHODS The American College of Surgeons National Surgical Quality Improvement Program database was analyzed from 2005 to 2019. Patients undergoing laparoscopic and open colectomy were identified and propensity score matched. Multivariable logistic regression identified significant preoperative demographic, comorbidity, and laboratory value predictors of AKI. The predictive ability of a baseline model consisting of these variables was compared to a proposed model incorporating interaction terms between operative approach and predictor variables using the likelihood ratio test, c-statistic, and Brier score. Shapley Additive Explanations values assessed relative importance of significant predictors. RESULTS 252,372 patients were included in the analysis. Significant AKI predictors were hypertension, age, sex, race, body mass index, smoking, diabetes, preoperative sepsis, Congestive heart failure, preoperative creatinine, preoperative albumin, and operative approach (P < 0.001). The proposed model with interaction terms had improved predictive ability per the likelihood ratio test (P < 0.05) but had no statistically significant interaction terms. C-statistic and Brier scores did not improve. Shapley Additive Explanations analysis showed hypertension had the highest importance. The importance of age and diabetes showed some variation between operative approaches. CONCLUSIONS While the inclusion of interaction terms collectively improved AKI prediction, no individual operative approach interaction terms were significant. Including operative approach interactions may enhance predictive ability of AKI risk models for colectomy.
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Affiliation(s)
| | - Isabel Herzog
- Rutgers New Jersey Medical School, Newark, New Jersey
| | - Colin Dunn
- Department of Surgery, Good Samaritan Hospital, San Jose, California
| | - Aziz M Merchant
- Rutgers New Jersey Medical School, Newark, New Jersey; Division of General and Minimally Invasive Surgery, Department of Surgery, Hackensack Meridian School of Medicine, JFK Hackensack Meridian Medical Center, Edison, New Jersey.
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Ng KTP, Pang L, Wang JQ, She WH, Tsang SHY, Lo CM, Man K, Cheung TT. Indications of pro-inflammatory cytokines in laparoscopic and open liver resection for early-stage hepatocellular carcinoma. Hepatobiliary Pancreat Dis Int 2024; 23:257-264. [PMID: 37903711 DOI: 10.1016/j.hbpd.2023.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 10/06/2023] [Indexed: 11/01/2023]
Abstract
BACKGROUND Our clinical practice of laparoscopic liver resection (LLR) had achieved better short-term and long-term benefits for patients with hepatocellular carcinoma (HCC) over open liver resection (OLR), but the underlying mechanisms are not clear. This study was to find out whether systemic inflammation plays an important role. METHODS A total of 103 patients with early-stage HCC under liver resection were enrolled (LLR group, n = 53; OLR group, n = 50). The expression of 9 inflammatory cytokines in patients at preoperation, postoperative day 1 (POD1) and POD7 was quantified by Luminex Multiplex assay. The relationships of the cytokines and the postoperative outcomes were compared between LLR and OLR. RESULTS Seven of the circulating cytokines were found to be significantly upregulated on POD1 after LLR or OLR compared to their preoperative levels. Compared to OLR, the POD1 levels of granulocyte-macrophage colony-stimulating factor (GM-CSF), interleukin-6 (IL-6), IL-8, and monocyte chemoattractant protein-1 (MCP-1) in the LLR group were significantly lower. Higher POD1 levels of these cytokines were significantly correlated with longer operative time and higher volume of blood loss during operation. The levels of these cytokines were positively associated with postoperative liver injury, and the length of hospital stay. Importantly, a high level of IL-6 at POD1 was a risk factor for HCC recurrence and poor disease-free survival after liver resection. CONCLUSIONS Significantly lower level of GM-CSF, IL-6, IL-8, and MCP-1 after liver resection represented a milder systemic inflammation which might be an important mechanism to offer better short-term and long-term outcomes in LLR over OLR.
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Affiliation(s)
- Kevin Tak-Pan Ng
- Department of Surgery, HKU-SZH & School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Li Pang
- Department of Surgery, HKU-SZH & School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Jia-Qi Wang
- Department of Surgery, HKU-SZH & School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Wong Hoi She
- Department of Surgery, HKU-SZH & School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Simon Hing-Yin Tsang
- Department of Surgery, HKU-SZH & School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Chung Mau Lo
- Department of Surgery, HKU-SZH & School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Kwan Man
- Department of Surgery, HKU-SZH & School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Tan To Cheung
- Department of Surgery, HKU-SZH & School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China; State Key Laboratory of Liver Research, The University of Hong Kong, Hong Kong, China.
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3
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Fichtinger RS, Aldrighetti LA, Abu Hilal M, Troisi RI, Sutcliffe RP, Besselink MG, Aroori S, Menon KV, Edwin B, D'Hondt M, Lucidi V, Ulmer TF, Díaz-Nieto R, Soonawalla Z, White S, Sergeant G, Olij B, Ratti F, Kuemmerli C, Scuderi V, Berrevoet F, Vanlander A, Marudanayagam R, Tanis P, Dewulf MJ, Dejong CH, Eminton Z, Kimman ML, Brandts L, Neumann UP, Fretland ÅA, Pugh SA, van Breukelen GJ, Primrose JN, van Dam RM. Laparoscopic Versus Open Hemihepatectomy: The ORANGE II PLUS Multicenter Randomized Controlled Trial. J Clin Oncol 2024; 42:1799-1809. [PMID: 38640453 PMCID: PMC11107897 DOI: 10.1200/jco.23.01019] [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: 05/11/2023] [Revised: 11/13/2023] [Accepted: 01/17/2024] [Indexed: 04/21/2024] Open
Abstract
PURPOSE To compare outcomes after laparoscopic versus open major liver resection (hemihepatectomy) mainly for primary or metastatic cancer. The primary outcome measure was time to functional recovery. Secondary outcomes included morbidity, quality of life (QoL), and for those with cancer, resection margin status and time to adjuvant systemic therapy. PATIENTS AND METHODS This was a multicenter, randomized controlled, patient-blinded, superiority trial on adult patients undergoing hemihepatectomy. Patients were recruited from 16 hospitals in Europe between November 2013 and December 2018. RESULTS Of the 352 randomly assigned patients, 332 patients (94.3%) underwent surgery (laparoscopic, n = 166 and open, n = 166) and comprised the analysis population. The median time to functional recovery was 4 days (IQR, 3-5; range, 1-30) for laparoscopic hemihepatectomy versus 5 days (IQR, 4-6; range, 1-33) for open hemihepatectomy (difference, -17.5% [96% CI, -25.6 to -8.4]; P < .001). There was no difference in major complications (laparoscopic 24/166 [14.5%] v open 28/166 [16.9%]; odds ratio [OR], 0.84; P = .58). Regarding QoL, both global health status (difference, 3.2 points; P < .001) and body image (difference, 0.9 points; P < .001) scored significantly higher in the laparoscopic group. For the 281 (84.6%) patients with cancer, R0 resection margin status was similar (laparoscopic 106 [77.9%] v open 122 patients [84.1%], OR, 0.60; P = .14) with a shorter time to adjuvant systemic therapy in the laparoscopic group (46.5 days v 62.8 days, hazard ratio, 2.20; P = .009). CONCLUSION Among patients undergoing hemihepatectomy, the laparoscopic approach resulted in a shorter time to functional recovery compared with open surgery. In addition, it was associated with a better QoL, and in patients with cancer, a shorter time to adjuvant systemic therapy with no adverse impact on cancer outcomes observed.
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Affiliation(s)
- Robert S. Fichtinger
- Department of Surgery, Maastricht University Medical Center+, Maastricht, the Netherlands
- Department of Surgery and Transplantation, University Hospital RWTH Aachen, Aachen, Germany
| | | | - Mohammed Abu Hilal
- Department of Surgery, Southampton University Hospital NHS Foundation Trust, Southampton, United Kingdom
- Department of Surgery, Poliambulanza Hospital, Brescia, Italy
| | - Roberto I. Troisi
- Division of HPB, Minimally Invasive and Robotic Surgery, Department of Clinical Medicine and Surgery, Transplantation Service, Federico II University, Naples, Italy
- Department of General, Hepatobiliary and Liver Transplantation Surgery, Ghent University Hospital, Ghent, Belgium
| | - Robert P. Sutcliffe
- Department of Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Marc G. Besselink
- Department of Surgery, Amsterdam UMC, Location University of Amsterdam, Amsterdam, the Netherlands
- Cancer Center Amsterdam, the Netherlands
| | - Somaiah Aroori
- Department of Surgery, Plymouth Hospitals NHS Trust, Plymouth, United Kingdom
| | - Krishna V. Menon
- Department of Surgery, King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Bjørn Edwin
- Intervention Center and Department of Hepatic, Pancreatic and Biliary Surgery, Oslo University Hospital and Institute of Medicine, University of Oslo, Oslo, Norway
| | - Mathieu D'Hondt
- Department of Digestive and Hepatobiliary/Pancreatic Surgery, AZ Groeninge, Kortrijk, Belgium
| | - Valerio Lucidi
- Department of Digestive Surgery, Unit of Hepatobiliary Surgery and Transplantation, Hôpitaux Universitaires de Bruxelles, Hôpital Erasme, Brussels, Belgium
| | - Tom F. Ulmer
- Department of Surgery, Maastricht University Medical Center+, Maastricht, the Netherlands
- Department of Surgery and Transplantation, University Hospital RWTH Aachen, Aachen, Germany
| | - Rafael Díaz-Nieto
- Department of Hepato-Biliary Surgery, Aintree University Hospital NHS Foundation Trust, Liverpool, United Kingdom
| | - Zahir Soonawalla
- Department of Surgery, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Steve White
- Department of Surgery, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, United Kingdom
| | - Gregory Sergeant
- Department of Digestive and Hepatobiliary/Pancreatic Surgery, Jessa Hospital, Hasselt, Belgium
| | - Bram Olij
- Department of Surgery, Maastricht University Medical Center+, Maastricht, the Netherlands
- Department of Surgery and Transplantation, University Hospital RWTH Aachen, Aachen, Germany
- GROW—School for Oncology and Reproduction, Maastricht University, Maastricht, the Netherlands
| | - Francesca Ratti
- Hepatobiliary Surgery Division, IRCCS San Raffaele Hospital, Milan, Italy
| | - Christoph Kuemmerli
- Department of Surgery, Southampton University Hospital NHS Foundation Trust, Southampton, United Kingdom
| | - Vincenzo Scuderi
- Department of General, Hepatobiliary and Liver Transplantation Surgery, Ghent University Hospital, Ghent, Belgium
| | - Frederik Berrevoet
- Department of General, Hepatobiliary and Liver Transplantation Surgery, Ghent University Hospital, Ghent, Belgium
| | - Aude Vanlander
- Department of Surgery, Free University Hospital, AZ Jette Hospital, Brussels, Belgium
| | - Ravi Marudanayagam
- Department of Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Pieter Tanis
- Department of Surgery, Amsterdam UMC, Location University of Amsterdam, Amsterdam, the Netherlands
- Cancer Center Amsterdam, the Netherlands
| | - Maxime J.L. Dewulf
- Department of Surgery, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - Cornelis H.C. Dejong
- Department of Surgery, Maastricht University Medical Center+, Maastricht, the Netherlands
- Department of Surgery and Transplantation, University Hospital RWTH Aachen, Aachen, Germany
- Deceased
| | - Zina Eminton
- Southampton Clinical Trials Unit, University of Southampton, Southampton, United Kingdom
| | - Merel L. Kimman
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - Lloyd Brandts
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - Ulf P. Neumann
- Department of Surgery, Maastricht University Medical Center+, Maastricht, the Netherlands
- Department of Surgery and Transplantation, University Hospital RWTH Aachen, Aachen, Germany
- Department of Surgery, University Hospital Essen, Essen, Germany
| | - Åsmund A. Fretland
- Intervention Center and Department of Hepatic, Pancreatic and Biliary Surgery, Oslo University Hospital and Institute of Medicine, University of Oslo, Oslo, Norway
| | - Siân A. Pugh
- Department of Oncology, Addenbrooke's Hospital, Cambridge, United Kingdom
| | - Gerard J.P. van Breukelen
- Department of Methodology and Statistics, CAPHRI Care and Public Health Research Institute Maastricht University, Maastricht, the Netherlands
| | - John N. Primrose
- Department of Surgery, Southampton University Hospital NHS Foundation Trust, Southampton, United Kingdom
| | - Ronald M. van Dam
- Department of Surgery, Maastricht University Medical Center+, Maastricht, the Netherlands
- Department of Surgery and Transplantation, University Hospital RWTH Aachen, Aachen, Germany
- GROW—School for Oncology and Reproduction, Maastricht University, Maastricht, the Netherlands
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Ratti F, Maina C, Clocchiatti L, Marino R, Pedica F, Casadei Gardini A, De Cobelli F, Aldrighetti LAM. Minimally Invasive Approach Provides Oncological Benefit in Patients with High Risk of Very Early Recurrence (VER) After Surgery for Intrahepatic Cholangiocarcinoma (iCCA). Ann Surg Oncol 2024; 31:2557-2567. [PMID: 38165575 DOI: 10.1245/s10434-023-14807-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 12/07/2023] [Indexed: 01/04/2024]
Abstract
BACKGROUND Surgery for intrahepatic cholangiocarcinoma (iCCA) is jeopardized by significant risk of early recurrence (≤ 6 months). The aim of the present study is to analyze the oncological benefit provided by laparoscopic over open approach for iCCA in patients with high risk of very early recurrence (VER). MATERIALS AND METHODS A total of 532 liver resections (LR) were performed for iCCA [265 by minimally invasive surgery (MIS) and 267 with open approach, matched through a 1:1 propensity score] and stratified using the postoperative prediction model of VER. Outcomes were compared between open and laparoscopic approaches, specifically evaluating oncological benefit. RESULTS The percentage of patients with high risk of VER was similar (32.7% in the laparoscopic group and 35.3% in the open group, pNS). The number of retrieved nodes as well as the rate and depth of negative resection margins were comparable between laparoscopic and open. The surgery-adjuvant treatment interval was shorter in laparoscopic patients in the overall series, as well in the subgroup of high risk of VER. The rate of patients starting adjuvant treatments within 2 months from surgery was higher in laparoscopic group compared with open group. In VER high-risk group both disease-free survival (DFS) and overall survival (OS) were significantly improved in MIS compared with open group (p = 0.032 and p = 0.026, respectively). CONCLUSIONS In patients with high risk of VER, laparoscopy translates into an advantage in terms of recurrence-free survival, likely related to lower biological impact of surgery, together with a shorter interval between surgery and start of adjuvant treatments, even allowing for a higher number of patients to start adjuvant therapies within 2 months from resection.
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Affiliation(s)
- Francesca Ratti
- Hepatobiliary Surgery Division, IRCCS San Raffaele, Milan, Italy.
- Vita-Salute San Raffaele University, Milan, Italy.
| | - Cecilia Maina
- Hepatobiliary Surgery Division, IRCCS San Raffaele, Milan, Italy
| | | | - Rebecca Marino
- Hepatobiliary Surgery Division, IRCCS San Raffaele, Milan, Italy
| | - Federica Pedica
- Department of Experimental Oncology, Pathology Unit, San Raffaele Hospital, Milan, Italy
| | - Andrea Casadei Gardini
- Vita-Salute San Raffaele University, Milan, Italy
- Department of Medical Oncology, IRCCS San Raffaele Hospital, Milan, Italy
| | - Francesco De Cobelli
- Vita-Salute San Raffaele University, Milan, Italy
- Department of Radiology, IRCCS San Raffaele Hospital, Milan, Italy
- Experimental Imaging Center, IRCCS San Raffaele Scientific Institute, Milan, Italy
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5
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Zarogoulidis P, Ioannidis A, Vagionas A, Perdikouri EI, Christakidis V, Anemoulis M, Kesisoglou I, Matthaios D, Oikonomou P, Nikolaou C, Papalavrentios L, Charalampidis C, Machairiotis N, Papadopoulos V, Sapalidis K. Simultaneous Resection for Colorectal and Liver Metastases, new equipment and personalized medicine. J Cancer 2024; 15:610-614. [PMID: 38213718 PMCID: PMC10777028 DOI: 10.7150/jca.90519] [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] [Received: 09/26/2023] [Accepted: 11/14/2023] [Indexed: 01/13/2024] Open
Abstract
Nowadays we perform synchronous colorectal cancer resection along with synchronous liver metastases. We investigated whether colon resection first is safer than liver resection first and if simultaneous surgeries are in general safe. Patients and Methods: Twenty patients were included in our multicenter study. In our study patients had simultaneous laparoscopic resection of primary colorectal cancer and liver metastases. The patients included were divided into two groups based on their first surgery. Group A had colon resection first (n = 10) and group B had liver resection first (n = 10). All adverse effects and outcomes were compared after the first day of hospitalization. Results: The only difference between the two groups was the operative blood loss. It was observed to be less in group B. Conclusion: In our study we did not observe any significant difference regarding the order of the operation.
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Affiliation(s)
- Paul Zarogoulidis
- 3 rd Department of Surgery, ``AHEPA`` University Hospital, Aristotle University of Thessaloniki, Medical School, Thessaloniki, Greece
| | - Aris Ioannidis
- Surgery Department, General Clinic Private Hospital, Thessaloniki, Greece
| | | | | | | | - Marios Anemoulis
- Surgery Department, Genesis Private Clinic, Thessaloniki, Greece
| | - Isaak Kesisoglou
- 3 rd Department of Surgery, ``AHEPA`` University Hospital, Aristotle University of Thessaloniki, Medical School, Thessaloniki, Greece
| | | | - Panagoula Oikonomou
- Second Department of Surgery, University Hospital of Alexandroupolis, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | - Christina Nikolaou
- Second Department of Surgery, University Hospital of Alexandroupolis, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | | | | | - Nikolaos Machairiotis
- Third Department of Obstetrics and Gynecology, University General Hospital “ATTIKON”, Medical School of the National and Kapodistrian University of Athens, Athens, Greece
| | - Vasilis Papadopoulos
- Oncology Department, University General Hospital of Larissa, University of Thessaly, Greece
| | - Konstantinos Sapalidis
- 3 rd Department of Surgery, ``AHEPA`` University Hospital, Aristotle University of Thessaloniki, Medical School, Thessaloniki, Greece
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Pascale MM, Ratti F, Cipriani F, Marino R, Catena M, Clocchiatti L, Buonanno S, Aldrighetti L. A "cui prodest" evaluation on the development of a minimally invasive liver surgery program: a differential benefit analysis of open and laparoscopic approach for left and right hemihepatectomies. Surg Endosc 2023; 37:8204-8213. [PMID: 37648797 DOI: 10.1007/s00464-023-10382-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 08/06/2023] [Indexed: 09/01/2023]
Abstract
BACKGROUND The correlation between technical feasibility and short-term clinical advantage provided by laparoscopic over open technique for major hepatectomies is unclear. This monocentric retrospective study investigates the possible differences in the benefit provided by minimally invasive approach between left and right hepatectomy, deepening the concept of differential benefit in the setting of anatomical major resections. METHODS All hemihepatectomies performed from January 2004 to December 2021 were identified in the institutional database. A propensity score method was used to match minimal invasive (MILS) and open pairs in the left hemihepatectomies (LH) and right hemihepatectomies (RH) groups with a 1:1 ratio to adjust any potential selection bias. The differential benefit for left and right hepatectomy provided by laparoscopic over open technique was evaluated in a pure analysis (i.e., including cases converted to open) and a risk-adjusted analysis (i.e., after excluding open conversion from the laparoscopic series). RESULTS The analysis of the risk-adjusted differential benefit demonstrated better result of the MILS in the RH group than in the LH group, in terms of blood loss (∆ blood loss - 150 and - 350, respectively; differential benefit: 200 mL, p < 0.05), morbidity (∆ rate of morbidity - 11.3% and - 18.1%, respectively; differential benefit: 6.8%, p < 0.05) and length of stay, LOS (∆ LOS - 1 day and - 3 days, respectively; differential benefit: 2 days, p < 0.05). CONCLUSION While MILS is associated with improved clinical outcomes both in left and right hepatectomy procedures, the greater advantage provided by laparoscopy was documented in patients undergoing right hepatectomy, i.e. for more technically demanding procedures. A MILS program should include the broadest range of liver resections to ensure the full benefits of the laparoscopic technique.
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Affiliation(s)
- Marco Maria Pascale
- Hepatobiliary Surgery Division, IRCCS San Raffaele Hospital, 20132, Milan, Italy
| | - Francesca Ratti
- Hepatobiliary Surgery Division, IRCCS San Raffaele Hospital, 20132, Milan, Italy.
- Faculty of Medicine, University Vita-Salute San Raffaele, 20132, Milan, Italy.
| | - Federica Cipriani
- Hepatobiliary Surgery Division, IRCCS San Raffaele Hospital, 20132, Milan, Italy
| | - Rebecca Marino
- Hepatobiliary Surgery Division, IRCCS San Raffaele Hospital, 20132, Milan, Italy
| | - Marco Catena
- Hepatobiliary Surgery Division, IRCCS San Raffaele Hospital, 20132, Milan, Italy
| | - Lucrezia Clocchiatti
- Hepatobiliary Surgery Division, IRCCS San Raffaele Hospital, 20132, Milan, Italy
| | - Silvia Buonanno
- Hepatobiliary Surgery Division, IRCCS San Raffaele Hospital, 20132, Milan, Italy
| | - Luca Aldrighetti
- Hepatobiliary Surgery Division, IRCCS San Raffaele Hospital, 20132, Milan, Italy
- Faculty of Medicine, University Vita-Salute San Raffaele, 20132, Milan, Italy
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7
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Sahakyan MA, Brudvik KW, Angelsen JH, Dille-Amdam RG, Sandvik OM, Edwin B, Nymo LS, Lassen K. Preoperative Inflammatory Markers in Liver Resection for Colorectal Liver Metastases: A National Registry-Based Study. World J Surg 2023; 47:2213-2220. [PMID: 37140610 PMCID: PMC10387457 DOI: 10.1007/s00268-023-07035-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/26/2023] [Indexed: 05/05/2023]
Abstract
BACKGROUND Preoperative inflammatory markers were shown to be associated with prognosis following surgery for hepato-pancreato-biliary cancer. Yet little evidence exists about their role in patients with colorectal liver metastases (CRLM). This study aimed to examine the association between selected preoperative inflammatory markers and outcomes of liver resection for CRLM. METHODS Data from the Norwegian National Registry for Gastrointestinal Surgery (NORGAST) was used to capture all liver resections performed in Norway within the study period (November 2015-April 2021). Preoperative inflammatory markers were Glasgow prognostic score (GPS), modified Glasgow prognostic score (mGPS) and C-reactive protein to albumin ratio (CAR). The impact of these on postoperative outcomes, as well as on survival were studied. RESULTS Liver resections for CRLM were performed in 1442 patients. Preoperative GPS ≥ 1 and mGPS ≥ 1 were present in 170 (11.8%) and 147 (10.2%) patients, respectively. Both were associated with severe complications but became non-significant in the multivariable model. GPS, mGPS, CAR were significant predictors for overall survival in the univariable analysis, but only CAR remained such in the multivariable model. When stratified by the type of surgical approach, CAR was a significant predictor for survival after open but not laparoscopic liver resections. CONCLUSIONS GPS, mGPS and CAR have no impact on severe complications after liver resection for CRLM. CAR outperforms GPS and mGPS in predicting overall survival in these patients, especially following open resections. The prognostic significance of CAR in CRLM should be tested against other clinical and pathology parameters relevant for prognosis.
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Affiliation(s)
- Mushegh A Sahakyan
- The Intervention Center, Oslo University Hospital, Rikshospitalet, Oslo, Norway.
- Department of Research & Development, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway.
- Department of Surgery N1, Yerevan State Medical University after M. Heratsi, Yerevan, Armenia.
| | | | - Jon-Helge Angelsen
- Department of Acute and Digestive Surgery, Haukeland University Hospital, Bergen, Norway
| | - Rachel G Dille-Amdam
- Department of Gastrointestinal Surgery, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Oddvar M Sandvik
- Department of Gastrointestinal Surgery, Stavanger University Hospital, Stavanger, Norway
| | - Bjørn Edwin
- The Intervention Center, Oslo University Hospital, Rikshospitalet, Oslo, Norway
- Department of Research & Development, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway
- Department of HPB Surgery, Oslo University Hospital, Rikshospitalet, Oslo, Norway
- Institute of Clinical Medicine, Medical Faculty, University of Oslo, Oslo, Norway
| | - Linn S Nymo
- Department of Gastrointestinal Surgery, University Hospital of North Norway, Tromsø, Norway
- Institute of Clinical Medicine, UiT, the Arctic University of Norway, Tromsø, Norway
| | - Kristoffer Lassen
- Department of HPB Surgery, Oslo University Hospital, Rikshospitalet, Oslo, Norway
- Institute of Clinical Medicine, UiT, the Arctic University of Norway, Tromsø, Norway
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8
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Liu Y, Du W, Guo Y, Tian Z, Shen W. Identification of high-risk factors for recurrence of colon cancer following complete mesocolic excision: An 8-year retrospective study. PLoS One 2023; 18:e0289621. [PMID: 37566586 PMCID: PMC10420346 DOI: 10.1371/journal.pone.0289621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 07/21/2023] [Indexed: 08/13/2023] Open
Abstract
BACKGROUND Colon cancer recurrence is a common adverse outcome for patients after complete mesocolic excision (CME) and greatly affects the near-term and long-term prognosis of patients. This study aimed to develop a machine learning model that can identify high-risk factors before, during, and after surgery, and predict the occurrence of postoperative colon cancer recurrence. METHODS The study included 1187 patients with colon cancer, including 110 patients who had recurrent colon cancer. The researchers collected 44 characteristic variables, including patient demographic characteristics, basic medical history, preoperative examination information, type of surgery, and intraoperative information. Four machine learning algorithms, namely extreme gradient boosting (XGBoost), random forest (RF), support vector machine (SVM), and k-nearest neighbor algorithm (KNN), were used to construct the model. The researchers evaluated the model using the k-fold cross-validation method, ROC curve, calibration curve, decision curve analysis (DCA), and external validation. RESULTS Among the four prediction models, the XGBoost algorithm performed the best. The ROC curve results showed that the AUC value of XGBoost was 0.962 in the training set and 0.952 in the validation set, indicating high prediction accuracy. The XGBoost model was stable during internal validation using the k-fold cross-validation method. The calibration curve demonstrated high predictive ability of the XGBoost model. The DCA curve showed that patients who received interventional treatment had a higher benefit rate under the XGBoost model. The external validation set's AUC value was 0.91, indicating good extrapolation of the XGBoost prediction model. CONCLUSION The XGBoost machine learning algorithm-based prediction model for colon cancer recurrence has high prediction accuracy and clinical utility.
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Affiliation(s)
- Yuan Liu
- Department of General Surgery, Wuxi People’s Hospital Affiliated to Nanjing Medical University, Wuxi, China
| | - Wenyi Du
- Department of General Surgery, Wuxi People’s Hospital Affiliated to Nanjing Medical University, Wuxi, China
| | - Yi Guo
- Department of General Practice, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong Province, China
| | - Zhiqiang Tian
- Department of General Surgery, Wuxi People’s Hospital Affiliated to Nanjing Medical University, Wuxi, China
| | - Wei Shen
- Department of General Surgery, Wuxi People’s Hospital Affiliated to Nanjing Medical University, Wuxi, China
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9
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Aliseda D, Sapisochin G, Martí-Cruchaga P, Zozaya G, Blanco N, Goh BKP, Rotellar F. Association of Laparoscopic Surgery with Improved Perioperative and Survival Outcomes in Patients with Resectable Intrahepatic Cholangiocarcinoma: A Systematic Review and Meta-Analysis from Propensity-Score Matched Studies. Ann Surg Oncol 2023; 30:4888-4901. [PMID: 37115372 PMCID: PMC10319676 DOI: 10.1245/s10434-023-13498-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 03/26/2023] [Indexed: 04/29/2023]
Abstract
BACKGROUND Recent studies have associated laparoscopic surgery with better overall survival (OS) in patients with hepatocellular carcinoma (HCC) and colorectal liver metastasis (CRLM). The potential benefits of laparoscopic liver resection (LLR) over open liver resection (OLR) have not been demonstrated in patients with intrahepatic cholangiocarcinoma (iCC). METHODS A systematic review of the PubMed, EMBASE, and Web of Science databases was performed to search studies comparing OS and perioperative outcome for patients with resectable iCC. Propensity-score matched (PSM) studies published from database inception to May 1, 2022 were eligible. A frequentist, patient-level, one-stage meta-analysis was performed to analyze the differences in OS between LLR and OLR. Second, intraoperative, postoperative, and oncological outcomes were compared between the two approaches by using a random-effects DerSimonian-Laird model. RESULTS Six PSM studies involving data from 1.042 patients (530 OLR vs. 512 LLR) were included. LLR in patients with resectable iCC was found to significantly decrease the hazard of death (stratified hazard ratio [HR]: 0.795 [95% confidence interval [CI]: 0.638-0.992]) compared with OLR. Moreover, LLR appears to be significantly associated with a decrease in intraoperative bleeding (- 161.47 ml [95% CI - 237.26 to - 85.69 ml]) and transfusion (OR = 0.41 [95% CI 0.26-0.69]), as well as with a shorter hospital stay (- 3.16 days [95% CI - 4.98 to - 1.34]) and a lower rate of major (Clavien-Dindo ≥III) complications (OR = 0.60 [95% CI 0.39-0.93]). CONCLUSIONS This large meta-analysis of PSM studies shows that LLR in patients with resectable iCC is associated with improved perioperative outcomes and, being conservative, yields similar OS outcomes compared with OLR.
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Affiliation(s)
- Daniel Aliseda
- HPB and Liver Transplant Unit. Department of General Surgery, Clinica Universidad de Navarra, University of Navarra, Pamplona, Spain.
| | - Gonzalo Sapisochin
- Abdominal Transplant and HPB Surgical Oncology, Division of General Surgery, Ajmera Transplant Center, Toronto General Hospital, University of Toronto, Toronto, ON, Canada
| | - Pablo Martí-Cruchaga
- HPB and Liver Transplant Unit. Department of General Surgery, Clinica Universidad de Navarra, University of Navarra, Pamplona, Spain
- Institute of Health Research of Navarra (IdisNA), Pamplona, Spain
| | - Gabriel Zozaya
- HPB and Liver Transplant Unit. Department of General Surgery, Clinica Universidad de Navarra, University of Navarra, Pamplona, Spain
- Institute of Health Research of Navarra (IdisNA), Pamplona, Spain
| | - Nuria Blanco
- HPB and Liver Transplant Unit. Department of General Surgery, Clinica Universidad de Navarra, University of Navarra, Pamplona, Spain
| | - Brian K P Goh
- Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital and National Cancer Centre, Singapore, Singapore
- Duke-National University Singapore Medical School, Singapore, Singapore
| | - Fernando Rotellar
- HPB and Liver Transplant Unit. Department of General Surgery, Clinica Universidad de Navarra, University of Navarra, Pamplona, Spain
- Institute of Health Research of Navarra (IdisNA), Pamplona, Spain
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10
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Brown LR, Ramage MI, Dolan RD, Sayers J, Bruce N, Dick L, Sami S, McMillan DC, Laird BJA, Wigmore SJ, Skipworth RJE. The Impact of Acute Systemic Inflammation Secondary to Oesophagectomy and Anastomotic Leak on Computed Tomography Body Composition Analyses. Cancers (Basel) 2023; 15:cancers15092577. [PMID: 37174044 PMCID: PMC10177546 DOI: 10.3390/cancers15092577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 04/28/2023] [Indexed: 05/15/2023] Open
Abstract
This study aimed to longitudinally assess CT body composition analyses in patients who experienced anastomotic leak post-oesophagectomy. Consecutive patients, between 1 January 2012 and 1 January 2022 were identified from a prospectively maintained database. Changes in computed tomography (CT) body composition at the third lumbar vertebral level (remote from the site of complication) were assessed across four time points where available: staging, pre-operative/post-neoadjuvant treatment, post-leak, and late follow-up. A total of 20 patients (median 65 years, 90% male) were included, with a total of 66 computed tomography (CT) scans analysed. Of these, 16 underwent neoadjuvant chemo(radio)therapy prior to oesophagectomy. Skeletal muscle index (SMI) was significantly reduced following neoadjuvant treatment (p < 0.001). Following the inflammatory response associated with surgery and anastomotic leak, a decrease in SMI (mean difference: -4.23 cm2/m2, p < 0.001) was noted. Estimates of intramuscular and subcutaneous adipose tissue quantity conversely increased (both p < 0.001). Skeletal muscle density fell (mean difference: -5.42 HU, p = 0.049) while visceral and subcutaneous fat density were higher following anastomotic leak. Thus, all tissues trended towards the radiodensity of water. Although tissue radiodensity and subcutaneous fat area normalised on late follow-up scans, skeletal muscle index remained below pre-treatment levels.
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Affiliation(s)
- Leo R Brown
- Clinical Surgery, University of Edinburgh, Royal Infirmary of Edinburgh, Edinburgh EH16 4SA, UK
| | - Michael I Ramage
- Clinical Surgery, University of Edinburgh, Royal Infirmary of Edinburgh, Edinburgh EH16 4SA, UK
| | - Ross D Dolan
- Academic Unit of Surgery, University of Glasgow, Glasgow Royal Infirmary, Glasgow G31 2ER, UK
| | - Judith Sayers
- Clinical Surgery, University of Edinburgh, Royal Infirmary of Edinburgh, Edinburgh EH16 4SA, UK
- St Columba's Hospice, Edinburgh EH5 3RW, UK
| | - Nikki Bruce
- Department of General Surgery, Borders General Hospital, Melrose TD6 9BS, UK
| | - Lachlan Dick
- Department of General Surgery, Victoria Hospital, Kirkcaldy KY2 5AH, UK
| | - Sharukh Sami
- Department of General Surgery, Dumfries and Galloway Royal Infirmary, Dumfries DG2 8RX, UK
| | - Donald C McMillan
- Academic Unit of Surgery, University of Glasgow, Glasgow Royal Infirmary, Glasgow G31 2ER, UK
| | - Barry J A Laird
- St Columba's Hospice, Edinburgh EH5 3RW, UK
- Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh EH4 2XR, UK
| | - Stephen J Wigmore
- Clinical Surgery, University of Edinburgh, Royal Infirmary of Edinburgh, Edinburgh EH16 4SA, UK
| | - Richard J E Skipworth
- Clinical Surgery, University of Edinburgh, Royal Infirmary of Edinburgh, Edinburgh EH16 4SA, UK
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11
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Ratti F, Cipriani F, Fiorentini G, Catena M, Paganelli M, Aldrighetti L. Have we really understood when the efforts of laparoscopic liver resection are justified?-a complexity-based appraisal of the differential benefit. Hepatobiliary Surg Nutr 2022; 11:363-374. [PMID: 35693407 PMCID: PMC9186211 DOI: 10.21037/hbsn-20-562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 08/28/2020] [Indexed: 08/22/2023]
Abstract
Background The implementation of minimally invasive liver resection surgery (MILS) programs starts from procedures with a low degree of technical difficulty. Data regarding the real short-term advantage of laparoscopy according to technical difficulty are still lacking. The aim of the present study is to evaluate the differential benefit of laparoscopic over open technique according to the technical difficulty of the procedures and to investigate if efforts associated with laparoscopic approach are always justified. Methods Nine hundred and thirty-six MILS resections performed between 2005 and 2018 were stratified according to technical complexity (low, intermediate and high difficulty) and to approach (MILS or open) and matched in a 1:1 ratio using propensity scores to obtain three pairs of groups (Pair 1: Low-MILS and Low-Open, including 274 cases respectively; Pair 2: Int-MILS and Int-Open, including 237 patients respectively; Pair 3: High-MILS and High-Open, including 226 patients respectively). Results MILS approach resulted in a statistically significant lower blood loss, reduced morbidity, reduced and shorter time for functional recover and length of stay within all pairs. The evaluation of the differential benefit showed a greater advantage of laparoscopic approach in high degree procedures compared with intermediate and low degree, both in terms of blood loss (-250 and -200 mL respectively) and morbidity rate (-5.7% and -4.1% respectively). Conclusions The favorable biological scenario associated with laparoscopic approach allows to obtain significant benefits in the setting of technically complex procedures. The commitment towards MILS approach should be therefore stronger in this setting, where the advantage of laparoscopy seems to be enhanced.
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Affiliation(s)
- Francesca Ratti
- Hepatobiliary Surgery Division, IRCCS San Raffaele Hospital, Milano, Italy
| | - Federica Cipriani
- Hepatobiliary Surgery Division, IRCCS San Raffaele Hospital, Milano, Italy
| | - Guido Fiorentini
- Hepatobiliary Surgery Division, IRCCS San Raffaele Hospital, Milano, Italy
| | - Marco Catena
- Hepatobiliary Surgery Division, IRCCS San Raffaele Hospital, Milano, Italy
| | - Michele Paganelli
- Hepatobiliary Surgery Division, IRCCS San Raffaele Hospital, Milano, Italy
| | - Luca Aldrighetti
- Hepatobiliary Surgery Division, IRCCS San Raffaele Hospital, Milano, Italy
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12
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Matsuo Y, Hokuto D, Yasuda S, Yoshikawa T, Kamitani N, Doi S, Nakagawa K, Nishiwada S, Nagai M, Terai T, Sho M. Impact of laparoscopic liver resection on liver regeneration. Surg Endosc 2022; 36:7419-7430. [PMID: 35277763 DOI: 10.1007/s00464-022-09155-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Accepted: 02/18/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Liver regeneration after liver resection plays an important role in preventing posthepatectomy liver failure. In this study, we aimed to evaluate and compare the impact of laparoscopic liver resection (LLR) and open liver resection (OLR) on liver regeneration. METHODS Patients who underwent curative anatomical liver resection for hepatocellular carcinoma, cholangiocellular carcinoma, and colorectal liver metastases at our institution between January 2010 and December 2018 were included in this study. The patients were divided into the OLR and LLR groups. Preoperative liver volume (PLV), future remnant liver volume, resected liver volume (RLV), liver volume at 1 month after the surgery, and liver volume at 6 months after the surgery were calculated. The liver regeneration rate was defined as the increase in the rate of RLV, and the liver recovery rate was defined as the rate of return to the PLV. RESULTS The study included 72 patients. Among them, 43 were included in the OLR group and 29 were included in the LLR group. No differences were observed in the baseline characteristics and surgical procedures between the two groups. Moreover, no significant difference was observed in the liver regeneration rate at 1 month after the surgery (OLR vs. LLR: 68.9% vs. 69.0%, p = 0.875) and at 6 months after the surgery (91.8% vs. 93.2%, p = 0.995). Furthermore, the liver recovery rates were not significantly different between the two groups at 1 month after the surgery (90.3% vs. 90.6%, p = 0.893) and at 6 months after the surgery (96.9% vs. 98.8%, p = 0.986). CONCLUSION Liver regeneration after liver resection is not affected by the type of surgical procedure and both laparoscopic and open procedures yield similar regeneration and recovery rates.
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Affiliation(s)
- Yasuko Matsuo
- Department of Surgery, Nara Medical University, 840 Shijo, Kashihara, Nara, 634-8522, Japan.
| | - Daisuke Hokuto
- Department of Surgery, Nara Medical University, 840 Shijo, Kashihara, Nara, 634-8522, Japan
| | - Satoshi Yasuda
- Department of Surgery, Nara Medical University, 840 Shijo, Kashihara, Nara, 634-8522, Japan
| | - Takahiro Yoshikawa
- Department of Surgery, Nara Medical University, 840 Shijo, Kashihara, Nara, 634-8522, Japan
| | - Naoki Kamitani
- Department of Surgery, Nara Medical University, 840 Shijo, Kashihara, Nara, 634-8522, Japan
| | - Shunsuke Doi
- Department of Surgery, Nara Medical University, 840 Shijo, Kashihara, Nara, 634-8522, Japan
| | - Kenji Nakagawa
- Department of Surgery, Nara Medical University, 840 Shijo, Kashihara, Nara, 634-8522, Japan
| | - Satoshi Nishiwada
- Department of Surgery, Nara Medical University, 840 Shijo, Kashihara, Nara, 634-8522, Japan
| | - Minako Nagai
- Department of Surgery, Nara Medical University, 840 Shijo, Kashihara, Nara, 634-8522, Japan
| | - Taichi Terai
- Department of Surgery, Nara Medical University, 840 Shijo, Kashihara, Nara, 634-8522, Japan
| | - Masayuki Sho
- Department of Surgery, Nara Medical University, 840 Shijo, Kashihara, Nara, 634-8522, Japan
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13
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Kaida T, Hayashi H, Sato H, Kinoshita S, Matsumoto T, Shiraishi Y, Kitano Y, Higashi T, Imai K, Yamashita YI, Baba H. Assessment for the minimal invasiveness of laparoscopic liver resection by interleukin-6 and thrombospondin-1. World J Hepatol 2022; 14:234-243. [PMID: 35126851 PMCID: PMC8790401 DOI: 10.4254/wjh.v14.i1.234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Revised: 06/23/2021] [Accepted: 12/11/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Laparoscopic surgery has been introduced as a minimally invasive technique for the treatment of various field. However, there are few reports that have scientifically investigated the minimally invasive nature of laparoscopic liver resection (LLR).
AIM To investigate whether LLR is scientifically less invasive than open liver resection.
METHODS During December 2011 to April 2015, blood samples were obtained from 30 patients who treated with laparoscopic (n = 10, 33%) or open (n = 20, 67%) partial liver resection for liver tumor. The levels of serum interleukin-6 (IL-6) and plasma thrombospondin-1 (TSP-1) were measured using ELISA kit at four time points including preoperative, immediate after operation, postoperative day 1 (POD1) and POD3. Then, we investigated the impact of the operative approaches during partial hepatectomy on the clinical time course including IL-6 and TSP-1.
RESULTS Serum level of IL-6 on POD1 in laparoscopic hepatectomy was significantly lower than those in open hepatectomy (8.7 vs 30.3 pg/mL, respectively) (P = 0.003). Plasma level of TSP-1 on POD3 in laparoscopic hepatectomy was significantly higher than those in open hepatectomy (1704.0 vs 548.3 ng/mL, respectively) (P = 0.009), and have already recovered to preoperative level in laparoscopic approach. In patients with higher IL-6 Levels on POD1, plasma level of TSP-1 on POD3 was significantly lower than those in patients with lower IL-6 Levels on POD1. Multivariate analysis showed that open approach was the only independent factor related to higher level of IL-6 on POD1 [odds ratio (OR), 7.48; 95% confidence interval (CI): 1.28-63.3; P = 0.02]. Furthermore, the higher level of serum IL-6 on POD1 was significantly associated with lower level of plasm TSP-1 on POD3 (OR, 5.32; 95%CI: 1.08-32.2; P = 0.04) in multivariate analysis.
CONCLUSION In partial hepatectomy, laparoscopic approach might be minimally invasive surgery with less IL-6 production compared to open approach.
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Affiliation(s)
- Takayoshi Kaida
- Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, Kumamoto 860-8556, Japan
| | - Hiromitsu Hayashi
- Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, Kumamoto 860-8556, Japan
| | - Hiroki Sato
- Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, Kumamoto 860-8556, Japan
| | - Shotaro Kinoshita
- Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, Kumamoto 860-8556, Japan
| | - Takashi Matsumoto
- Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, Kumamoto 860-8556, Japan
| | - Yuta Shiraishi
- Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, Kumamoto 860-8556, Japan
| | - Yuki Kitano
- Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, Kumamoto 860-8556, Japan
| | - Takaaki Higashi
- Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, Kumamoto 860-8556, Japan
| | - Katsunori Imai
- Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, Kumamoto 860-8556, Japan
| | - Yo-ichi Yamashita
- Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, Kumamoto 860-8556, Japan
| | - Hideo Baba
- Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, Kumamoto 860-8556, Japan
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14
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Ypsilantis P, Lambropoulou M, Anagnostopoulos K, Kiroplastis K, Tepelopoulos G, Bangeas P, Ypsilantou I, Pitiakoudis M. Gut-Barrier Disruption After Laparoscopic Versus Open Major Liver Resection in the Rat. Surgery 2021; 171:973-979. [PMID: 34876288 DOI: 10.1016/j.surg.2021.11.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 10/11/2021] [Accepted: 11/02/2021] [Indexed: 11/15/2022]
Abstract
BACKGROUND Major liver resection may compromise gut-barrier function, increasing the risk of postoperative infectious complications. The aim of the present experimental study was to compare the effect of the laparoscopic versus the open technique for major liver resection on integrity as well as inflammatory and immune responses of the gut barrier. METHODS Wistar rats were subjected to open 70% hepatectomy (group H), laparoscopic 70% hepatectomy (group LH), sham operation (group S) or no intervention (group C). At various timepoints (1 hour-1 week) after operation, ileal tissue was excised for oxidative state assessment (TBARS levels), histopathologic examination, histomorphometric analysis, immunohistochemical assessment of the mitotic and apoptotic activity, and tissue expression of inflammatory (interleukin-6, tumor necrosis factor-α, nuclear factor-κB and vascular cell adhesion molecule-1) and immune response biomarkers (CD4+ and CD8+ T-lymphocytes) of the intestinal mucosa. RESULTS No changes were noted in oxidative state. The histopathologic profile was less deteriorated in group LH compared to group H. Intestinal mucosa atrophy was less intense in group LH compared to group H and was related to an equally compromised crypt cell mitotic activity. Tissue overexpression of interleukin-6, tumor necrosis factor-α, nuclear factor-κΒ, vascular cell adhesion molecule-1, CD4+, and CD8+ T-lymphocytes was less pronounced in group LH compared to group H. CONCLUSION The employment of the laparoscopic technique for major liver resection in the rat attenuated disruption of the gut barrier compared to the open procedure. This was related to less pronounced inflammatory and immune responses of the intestinal mucosa.
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Affiliation(s)
- Petros Ypsilantis
- Laboratory of Experimental Research and Surgical Research, School of Medicine, Democritus University of Thrace, Alexandroupolis, Greece.
| | - Maria Lambropoulou
- Laboratory of Histology and Embryology, School of Medicine, Democritus University of Thrace, Alexandroupolis, Greece
| | | | - Konstantinos Kiroplastis
- Laboratory of Experimental Research and Surgical Research, School of Medicine, Democritus University of Thrace, Alexandroupolis, Greece
| | - Georgios Tepelopoulos
- Laboratory of Experimental Research and Surgical Research, School of Medicine, Democritus University of Thrace, Alexandroupolis, Greece
| | - Petros Bangeas
- Laboratory of Experimental Research and Surgical Research, School of Medicine, Democritus University of Thrace, Alexandroupolis, Greece
| | - Ifigenia Ypsilantou
- Laboratory of Experimental Research and Surgical Research, School of Medicine, Democritus University of Thrace, Alexandroupolis, Greece
| | - Michael Pitiakoudis
- Laboratory of Experimental Research and Surgical Research, School of Medicine, Democritus University of Thrace, Alexandroupolis, Greece
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15
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Sim JH, Lee JS, Jang DM, Kim HJ, Lee SW, Cho HS, Choi WJ. Effects of Perioperative Inflammatory Response in Cervical Cancer: Laparoscopic versus Open Surgery. J Clin Med 2021; 10:jcm10184198. [PMID: 34575308 PMCID: PMC8467117 DOI: 10.3390/jcm10184198] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 08/31/2021] [Accepted: 09/14/2021] [Indexed: 12/31/2022] Open
Abstract
There are few studies between postoperative neutrophil to lymphocyte ratio (NLR) and survival in cervical cancer. We compared postoperative changes in NLR according to surgical methods and analyzed the effect of these changes on 5-year mortality of cervical cancer patients. A total of 929 patients were assigned to either the laparoscopic radical hysterectomy (LRH) (n = 721) or open radical hysterectomy (ORH) (n = 208) group. Propensity score matching analysis compared the postoperative NLR changes between the two groups, and multivariate logistic regression analysis evaluated the association between NLR changes and 5-year mortality. Surgical outcomes between the two groups were also compared. In the LRH group, NLR changes at postoperative day (POD) 0 and POD 1 were significantly lower than in the ORH group after matching (NLR change at POD 0, 10.4 vs. 14.3, p < 0.001; NLR change at POD 1, 3.5 vs. 5.4, p < 0.001). In multivariate logistic regression analysis, postoperative NLR change was not associated with 5-year mortality (2nd quartile: OR 1.55, 95% CI 0.56–4.29, p = 0.401; 3rd quartile: OR 0.90, 95% CI 0.29–2.82, p = 0.869; 4th quartile: OR 1.40, 95% CI 0.48–3.61, p = 0.598), whereas preoperative NLR was associated with 5-year mortality (OR 1.23, 95% CI 1.06–1.43, p = 0.005). After matching, there were no significant differences in surgical outcomes between the two groups. There were significantly fewer postoperative changes of NLR in the LRH group. However, the extent of these NLR changes was not associated with 5-year mortality. By contrast, preoperative NLR was associated with 5-year mortality.
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Affiliation(s)
- Ji-Hoon Sim
- Asan Medical Center, Department of Anesthesiology and Pain Medicine, University of Ulsan College of Medicine, Seoul 05505, Korea; (J.-H.S.); (J.-S.L.); (D.-M.J.); (W.-J.C.)
| | - Ju-Seung Lee
- Asan Medical Center, Department of Anesthesiology and Pain Medicine, University of Ulsan College of Medicine, Seoul 05505, Korea; (J.-H.S.); (J.-S.L.); (D.-M.J.); (W.-J.C.)
| | - Dong-Min Jang
- Asan Medical Center, Department of Anesthesiology and Pain Medicine, University of Ulsan College of Medicine, Seoul 05505, Korea; (J.-H.S.); (J.-S.L.); (D.-M.J.); (W.-J.C.)
| | - Hwa Jung Kim
- Asan Medical Center, Department of Clinical Epidemiology and Biostatistics, University of Ulsan College of Medicine, Seoul 05505, Korea;
| | - Shin-Wha Lee
- Asan Medical Center, Department of Obstetrics and Gynecology, University of Ulsan College of Medicine, Seoul 05505, Korea;
| | - Hyun-Seok Cho
- Asan Medical Center, Department of Anesthesiology and Pain Medicine, University of Ulsan College of Medicine, Seoul 05505, Korea; (J.-H.S.); (J.-S.L.); (D.-M.J.); (W.-J.C.)
- Correspondence: ; Tel.: +82-2-3010-0807; Fax: +82-2-3010-6790
| | - Woo-Jong Choi
- Asan Medical Center, Department of Anesthesiology and Pain Medicine, University of Ulsan College of Medicine, Seoul 05505, Korea; (J.-H.S.); (J.-S.L.); (D.-M.J.); (W.-J.C.)
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16
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Laparoscopy in Emergency: Why Not? Advantages of Laparoscopy in Major Emergency: A Review. Life (Basel) 2021; 11:life11090917. [PMID: 34575066 PMCID: PMC8470929 DOI: 10.3390/life11090917] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 08/24/2021] [Accepted: 08/30/2021] [Indexed: 01/09/2023] Open
Abstract
A laparoscopic approach is suggested with the highest grade of recommendation for acute cholecystitis, perforated gastroduodenal ulcers, acute appendicitis, gynaecological disorders, and non-specific abdominal pain (NSAP). To date, the main qualities of laparoscopy for these acute surgical scenarios are clearly stated: quicker surgery, faster recovery and shorter hospital stay. For the remaining surgical emergencies, as well as for abdominal trauma, the role of laparoscopy is still a matter of debate. Patients might benefit from a laparoscopic approach only if performed by experienced teams and surgeons which guarantee a high standard of care. More precisely, laparoscopy can limit damage to the tissue and could be effective for the reduction of the overall amount of cell debris, which is a result of the intensity with which the immune system reacts to the injury and the following symptomatology. In fact, these fragments act as damage-associated molecular patterns (DAMPs). DAMPs, as well as pathogen associated molecular patterns (PAMPs), are recognised by both surface and intracellular receptors of the immune cells and activate the cascade which, in critically ill surgical patients, is responsible for a deranged response. This may result in the development of progressive and multiple organ dysfunctions, manifesting with acute respiratory distress syndrome (ARDS), coagulopathy, liver dysfunction and renal failure. In conclusion, none of the emergency surgical scenarios preclude laparoscopy, provided that the surgical tactic could ensure sufficient cleaning of the abdomen in addition to resolving the initial tissue damage caused by the “trauma”.
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17
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Long-term oncological outcomes after laparoscopic parenchyma-sparing redo liver resections for patients with metastatic colorectal cancer: a European multi-center study. Surg Endosc 2021; 36:3374-3381. [PMID: 34462867 PMCID: PMC9001231 DOI: 10.1007/s00464-021-08655-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 07/16/2021] [Indexed: 11/10/2022]
Abstract
Background Laparoscopic redo resections for colorectal metastases are poorly investigated. This study aims to explore long-term results after second, third, and fourth resections. Material and methods Prospectively updated databases of primary and redo laparoscopic liver resections in six European HPB centers were analyzed. Procedure-related overall survival after first, second, third, and fourth resections were evaluated. Furthermore, patients without liver recurrence after first liver resection were compared to those with one redo, two or three redo, and patients with palliative treatment for liver recurrence after first laparoscopic liver surgery. Survival was calculated both from the date of the first liver resection and from the date of the actual liver resection. In total, 837 laparoscopic primary and redo liver resections performed in 762 patients were included (630 primary, 172 first redo, 29 second redo, and 6 third redo). Patients were bunched into four groups: Group 1—without hepatic recurrence after primary liver resection (n = 441); Group 2—with liver recurrence who underwent only one laparoscopic redo resection (n = 154); Group 3—with liver recurrence who underwent two laparoscopic redo resections (n = 29); Group 4—with liver recurrence who have not been found suitable for redo resections (n = 138). Results No significant difference has been found between the groups in terms of baseline characteristics and surgical outcomes. Rate of positive resection margin was higher in the group with palliative recurrence (group 4). Five-year survival calculated from the first liver resection was 67%, 62%, 84%, and 7% for group 1, 2, 3, and 4, respectively. Procedure-specific 5-year overall survival was 50% after primary laparoscopic liver resection, 52% after the 1st reoperation, 52% after the 2nd, and 40% after the 3rd reoperation made laparoscopic. Conclusions Multiple redo recurrences can be performed laparoscopically with good long-term results. Liver recurrence does not aggravate prognosis as long as the patient is suitable for reoperation.
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Lopez-Lopez V, Gómez Ruiz A, Pelegrin P, Abellán B, Lopez-Conesa A, Brusadin R, Cayuela V, García A, Robles Campos R. Impact of Immune Response in Short-term and Long-term Outcomes After Minimally Invasive Surgery for Colorectal Liver Metastases: Results From a Randomized Study. Surg Laparosc Endosc Percutan Tech 2021; 31:690-696. [PMID: 34292210 DOI: 10.1097/sle.0000000000000980] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 05/07/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND The potential benefit related to laparoscopic liver surgery (LLS) for colorectal liver metastases outcomes is not well known. MATERIALS AND METHODS Serum cytokines associated with Th1 (tumor necrosis factor-α) and Th2 [interleukin (IL)-10 and IL-6] phenotypes were measured in 36 patients operated on for colorectal liver metastases by open liver surgery (OLS) and LLS. Measurements were performed at 3 time points: 1 day before surgery, day 3 postoperative, and 1 month postoperative. We compared the postoperative inflammatory response influence between LLS and OLS on long-term outcomes. RESULTS In both groups, only IL-6 levels on day 3 postoperative were higher than those measured preoperatively and at 1 month. Comparing the tumor necrosis factor-α levels between the LLS and OLS groups, preoperative (7.28 vs. 2.36), day 3 (7.99 vs. 4.08) and 1 month (7.39 vs. 1.99) postoperative levels were higher in the OLS group (P<0.01, <0.01, and <0.01, respectively). In contrast, IL-10 levels were higher in the LLS group preoperatively (7.51 vs. 4.57) and on day 3 postoperative (13.40 vs. 4.57) (P=0.03 and 0.01, respectively). A cut-off IL-6 level of ≥4.41 in the first month was associated with a higher risk of recurrence (logrank=4.8, P=0.02). CONCLUSIONS Both LLS and OLS induce an initial increase in IL-6 that normalizes one month after surgery, showing a similar pattern. In addition, a cut-off IL-6 value of 4.41 pg/mL was established, with a higher concentration at 1 month postoperative possibly related to a higher risk or recurrence.
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Affiliation(s)
- Victor Lopez-Lopez
- Departments of Surgery
- Biomedical Research Institute of Murcia (IMIB), Clinical University Hospital Virgen de la Arrixaca
| | - Alvaro Gómez Ruiz
- Departments of Surgery
- Biomedical Research Institute of Murcia (IMIB), Clinical University Hospital Virgen de la Arrixaca
| | | | - Beatriz Abellán
- Department of Surgery, Reina Sofía University Hospital, Murcia, Spain
| | - Asunción Lopez-Conesa
- Departments of Surgery
- Biomedical Research Institute of Murcia (IMIB), Clinical University Hospital Virgen de la Arrixaca
| | - Roberto Brusadin
- Departments of Surgery
- Biomedical Research Institute of Murcia (IMIB), Clinical University Hospital Virgen de la Arrixaca
| | - Valentin Cayuela
- Departments of Surgery
- Biomedical Research Institute of Murcia (IMIB), Clinical University Hospital Virgen de la Arrixaca
| | - Ana García
- Inmunology, Virgen de la Arrixaca Clinic and University Hospital, Biomedical Research Institute of Murcia-Virgen de la Arrixaca (IMIB-Arrixaca)
| | - Ricardo Robles Campos
- Departments of Surgery
- Biomedical Research Institute of Murcia (IMIB), Clinical University Hospital Virgen de la Arrixaca
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19
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Sun Q, Zhang X, Gong X, Hu Z, Zhang Q, He W, Chang X, Hu Z, Chen Y. Survival analysis between laparoscopic and open hepatectomy for hepatocellular carcinoma: a meta-analysis based on reconstructed time-to-event data. Hepatol Int 2021; 15:1215-1235. [PMID: 34258665 DOI: 10.1007/s12072-021-10219-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 06/06/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND/PURPOSE OF THE STUDY Laparoscopic hepatectomy (LH) has been widely used in the treatment of hepatocellular carcinoma (HCC). It is generally believed that the long-term outcomes of LH are not inferior to open hepatectomy (OH). However, the quality of evidence is low. The purpose of this study was to reconstruct time-to-event data for meta-analysis based on Kaplan-Meier curves from propensity-score matched studies and compare survival rates following LH and OH for hepatocellular carcinoma. METHODS All published propensity-score matched studies reported in English that compared LH and OH for hepatocellular carcinoma with Kaplan-Meier curves were screened. Patients' survival information was reconstructed with the aid of a computer vision program. Different models (fixed-effects model for two-stage survival analysis and Cox regression for one-stage survival analysis) were performed for sensitivity analysis. In addition to the primary meta-analysis, two specific subgroup analyses were performed on patients by types of resection, cirrhosis status. RESULTS Time-to-event data were extracted from 45 propensity-score matched studies (N = 8905). According to the time-to-event data and the reconstructed Kaplan-Meier curves, the cumulative overall survival rate was 49.0% and 50.9% in the LH and OH cohorts, respectively, a log-rank test did not demonstrate statistical significance (p > 0.05). The cumulative recurrence-free survival (RFS) probability was both close to 0.0%. The median RFS time was 49.1 (95% CI 46.1 ~ 51.7) and 44.3 (95% CI 41 ~ 46.1) months. The difference in disease status was statistically significant by the Log-rank test (p < 0.05). Using the random-effects model of two-stage analysis, the minor hepatectomy subgroup (HR = 1.32, 95% CI [1.09, 1.55], I2 = 6.2%, p = 0.383) and the shared fragile model of one-stage analysis (HR = 1.44 95% CI [1.23, 1.69], p < 0.001) suggested that LH could significantly prolong RFS of patients compared with OH. This result was consistent with sensitivity analysis using different models. CONCLUSION This study was the first reconstructed time-to-event data based on a high-quality propensity-score matching study to compare the survival outcomes of LH and OH in the treatment of HCC. Results suggested that LH can improve RFS in patients with HCC undergoing minor hepatectomy and may also benefit long-term RFS in overall patients.
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Affiliation(s)
- Qiang Sun
- General Surgery Dept. 1, Zhongshan People's Hospital, Zhongshan Hospital of Sun Yat-Sen University, Zhongshan, China
| | - Xiangda Zhang
- School of Public Health and Preventive Medicine, Monash University, Clayton, Australia
| | - Xueyi Gong
- General Surgery Dept. 1, Zhongshan People's Hospital, Zhongshan Hospital of Sun Yat-Sen University, Zhongshan, China
| | - Zhipeng Hu
- General Surgery Dept. 1, Zhongshan People's Hospital, Zhongshan Hospital of Sun Yat-Sen University, Zhongshan, China
| | - Qiao Zhang
- General Surgery Dept. 1, Zhongshan People's Hospital, Zhongshan Hospital of Sun Yat-Sen University, Zhongshan, China
| | - Weiming He
- General Surgery Dept. 1, Zhongshan People's Hospital, Zhongshan Hospital of Sun Yat-Sen University, Zhongshan, China
| | - Xiaojian Chang
- General Surgery Dept. 1, Zhongshan People's Hospital, Zhongshan Hospital of Sun Yat-Sen University, Zhongshan, China
| | - Zemin Hu
- General Surgery Dept. 1, Zhongshan People's Hospital, Zhongshan Hospital of Sun Yat-Sen University, Zhongshan, China
| | - Yajin Chen
- Department of Hepatobiliary Surgery, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China.
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20
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Heise D, Bednarsch J, Kroh A, Eickhoff R, Coolsen MME, van Dam R, Lang SA, Neumann UP, Ulmer F. Safety of laparoscopic hepatectomy in patients with severe comorbidities - A propensity score matched analysis. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2021; 29:609-617. [PMID: 34245125 DOI: 10.1002/jhbp.1020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Revised: 05/22/2021] [Accepted: 07/06/2021] [Indexed: 11/12/2022]
Abstract
BACKGROUND Laparoscopic hepatectomy (LH) is nowadays considered as the standard of care for various liver malignancies. However, studies focusing on perioperative outcome after LH in patients with severe comorbidities are still sparse. METHODS 247 patients, who underwent LH between January 2016 and March 2020 at European surgical center Aachen Maastricht (ESCAM) were retrospectively analyzed regarding surgical outcome. All patients were categorized according to the ASA guidelines and a propensity score matched (PSM) analysis was performed to compare patients with severe comorbidities with patients with minor or no comorbidities. RESULTS After PSM, no statistically significant differences regarding clinical characteristics were observed. We performed major resections in 26.4% of h-ASA (ASA > 2) patients and 19.4% of l-ASA (ASA≤2) patients, respectively (P = .322). Overall morbidity (Clavien-Dindo≥1) was observed more frequently in the h-ASA group (h-ASA: 25.0% vs. l-ASA: 8.3%; P = .007) while analysis of major morbidity (Clavien-Dindo≥3b) showed a non-significant tendency for more complications in h-ASA patients (h-ASA: 8.3% vs. l-ASA: 1.4%; P = .053). A subgroup analysis identified major resection (HR = 5.05; P = .006) as an independent risk factor for the occurrence of any postoperative complication and chronic kidney disease (HR = 22.59; P = .030) and liver fibrosis (HR = 30.16; P = .031) as risk factors for the occurrence of major complications in h-ASA patients. CONCLUSION LH in patients with severe systemic comorbidities shows a strong tendency towards an increased rate of major complications. Careful patient selection with respect to the planned extent of resection and the presence of chronic kidney disease and liver fibrosis should be performed to improve perioperative results.
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Affiliation(s)
- Daniel Heise
- Department of Surgery and Transplantation, University Hospital RWTH Aachen, Aachen, Germany
| | - Jan Bednarsch
- Department of Surgery and Transplantation, University Hospital RWTH Aachen, Aachen, Germany
| | - Andreas Kroh
- Department of Surgery and Transplantation, University Hospital RWTH Aachen, Aachen, Germany
| | - Roman Eickhoff
- Department of Surgery and Transplantation, University Hospital RWTH Aachen, Aachen, Germany
| | - Marielle M E Coolsen
- Department of Surgery, Maastricht University Medical Centre (MUMC), Maastricht, The Netherlands
| | - Ronald van Dam
- Department of Surgery, Maastricht University Medical Centre (MUMC), Maastricht, The Netherlands
| | - Sven Arke Lang
- Department of Surgery and Transplantation, University Hospital RWTH Aachen, Aachen, Germany
| | - Ulf Peter Neumann
- Department of Surgery and Transplantation, University Hospital RWTH Aachen, Aachen, Germany.,Department of Surgery, Maastricht University Medical Centre (MUMC), Maastricht, The Netherlands
| | - Florian Ulmer
- Department of Surgery and Transplantation, University Hospital RWTH Aachen, Aachen, Germany
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21
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Ratti F, Casadei-Gardini A, Cipriani F, Fiorentini G, Pedica F, Burgio V, Cascinu S, Aldrighetti L. Laparoscopic Surgery for Intrahepatic Cholangiocarcinoma: A Focus on Oncological Outcomes. J Clin Med 2021; 10:jcm10132828. [PMID: 34206930 PMCID: PMC8268981 DOI: 10.3390/jcm10132828] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 06/21/2021] [Accepted: 06/23/2021] [Indexed: 12/17/2022] Open
Abstract
Background: The aim of the present study was to analyze the long-term outcomes of laparoscopic and open surgery for intrahepatic cholangiocarcinoma (iCCA) in a series, collected in a tertiary referral center with a high annual volume of laparoscopic activity. Methods: Between January 2004 and June 2020, 446 liver resections (LR) were performed for iCCA: of these, 179 were performed by laparoscopic surgery (LS) and 267 with the open approach. The two groups were matched through a 1:1 propensity score using covariates representative of patient and disease characteristics. The study and control groups were compared, with specific attention given to oncological outcomes (rate of R0, depth of resection margins, overall and disease-free survival, rate, and site of recurrence). Results: The number of retrieved nodes, rate, and depth of negative resection margins were comparable between the two groups. The interval time between surgery and subsequent adjuvant treatments was significantly shorter in LS patients. No differences were shown even in the comparison between the LS and the open group in terms of median disease-free and overall survival. Moreover, the disease recurrence rate was comparable between the LS and the open groups (45.2% versus 56.7%), and the recurrence pattern was similar. Conclusions: The minimally invasive approach for iCCA was once again confirmed to be associated with advantages in terms of intraoperative and short-term outcomes, but was also proven to be oncologically non-inferior to the open counterpart. In the present study, overall and disease-free survival were found to be similar between the two approaches.
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Affiliation(s)
- Francesca Ratti
- Hepatobiliary Surgery Division, IRCCS San Raffaele Hospital, 20132 Milano, Italy; (F.C.); (G.F.); (L.A.)
- Correspondence: ; Tel.: +39-02-26435778 (ext. 7808) or +39-348-2411961; Fax: +39-02-26437807
| | - Andrea Casadei-Gardini
- Department of Medical Oncology, IRCCS San Raffaele Hospital, 20132 Milano, Italy; (A.C.-G.); (V.B.); (S.C.)
| | - Federica Cipriani
- Hepatobiliary Surgery Division, IRCCS San Raffaele Hospital, 20132 Milano, Italy; (F.C.); (G.F.); (L.A.)
| | - Guido Fiorentini
- Hepatobiliary Surgery Division, IRCCS San Raffaele Hospital, 20132 Milano, Italy; (F.C.); (G.F.); (L.A.)
| | - Federica Pedica
- Department of Experimental Oncology, Pathology Unit, San Raffaele Hospital, 20132 Milano, Italy;
| | - Valentina Burgio
- Department of Medical Oncology, IRCCS San Raffaele Hospital, 20132 Milano, Italy; (A.C.-G.); (V.B.); (S.C.)
| | - Stefano Cascinu
- Department of Medical Oncology, IRCCS San Raffaele Hospital, 20132 Milano, Italy; (A.C.-G.); (V.B.); (S.C.)
| | - Luca Aldrighetti
- Hepatobiliary Surgery Division, IRCCS San Raffaele Hospital, 20132 Milano, Italy; (F.C.); (G.F.); (L.A.)
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22
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Aghayan DL, Kazaryan AM, Fretland ÅA, Røsok B, Barkhatov L, Lassen K, Edwin B. Evolution of laparoscopic liver surgery: 20-year experience of a Norwegian high-volume referral center. Surg Endosc 2021; 36:2818-2826. [PMID: 34036419 PMCID: PMC9001574 DOI: 10.1007/s00464-021-08570-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 05/18/2021] [Indexed: 01/22/2023]
Abstract
BACKGROUND Laparoscopic liver surgery has evolved to become a standard surgical approach in many specialized centers worldwide. In this study we present the evolution of laparoscopic liver surgery at a single high-volume referral center since its introduction in 1998. METHODS Patients who underwent laparoscopic liver resection (LLR) between August 1998 and December 2018 at the Oslo University Hospital were analyzed. Perioperative outcomes were compared between three time periods: early (1998 to 2004), middle (2005 to 2012) and recent (2013-2018). RESULTS Up to December 2020, 1533 LLRs have been performed. A total of 1232 procedures were examined (early period, n = 62; middle period, n = 367 and recent period, n = 803). Colorectal liver metastasis was the main indication for surgery (68%). The rates of conversion to laparotomy and hand-assisted laparoscopy were 3.2% and 1.4%. The median operative time and blood loss were 130 min [interquartile range (IQR), 85-190] and 220 ml (IQR, 50-600), respectively. The total postoperative complications rate was 20.3% and the 30-day mortality was 0.3%. The median postoperative stay was two (IQR, 2-4) days. When comparing perioperative outcomes between the three time periods, shorter operation time (median, from 182 to 120 min, p < 0.001), less blood loss (median, from 550 to 200 ml, p = 0.023), decreased rate of conversions to laparotomy (from 8 to 3%) and shorter postoperative hospital stay (median, from 3 to 2 days, p < 0.001) was observed in the later periods, while the number of more complex liver resections had increased. CONCLUSION During the last two decades, the indications, the number of patients and the complexity of laparoscopic liver procedures have expanded significantly. Initially being an experimental approach, laparoscopic liver surgery is now safely implemented across our unit and has become the method of choice for surgical treatment of most liver tumors.
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Affiliation(s)
- Davit L Aghayan
- The Intervention Centre, Oslo University Hospital - Rikshospitalet, 0027, Oslo, Norway.
- Department of Surgery N1, Yerevan State Medical University After M. Heratsi, Yerevan, Armenia.
| | - Airazat M Kazaryan
- The Intervention Centre, Oslo University Hospital - Rikshospitalet, 0027, Oslo, Norway
- Department of Surgery N1, Yerevan State Medical University After M. Heratsi, Yerevan, Armenia
- Institute of Clinical Medicine, Medical Faculty, University of Oslo, Oslo, Norway
- Department of Gastrointestinal Surgery, Østfold Hospital Trust, Grålum, Norway
- Department of Faculty Surgery, №2I.M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - Åsmund Avdem Fretland
- The Intervention Centre, Oslo University Hospital - Rikshospitalet, 0027, Oslo, Norway
- Department of HPB Surgery, Oslo University Hospital - Rikshospitalet, Oslo, Norway
| | - Bård Røsok
- Department of HPB Surgery, Oslo University Hospital - Rikshospitalet, Oslo, Norway
| | - Leonid Barkhatov
- The Intervention Centre, Oslo University Hospital - Rikshospitalet, 0027, Oslo, Norway
- Institute of Clinical Medicine, Medical Faculty, University of Oslo, Oslo, Norway
- Department of Gastrointestinal Surgery, Haukeland University Hospital, Bergen, Norway
| | - Kristoffer Lassen
- Department of HPB Surgery, Oslo University Hospital - Rikshospitalet, Oslo, Norway
| | - Bjørn Edwin
- The Intervention Centre, Oslo University Hospital - Rikshospitalet, 0027, Oslo, Norway
- Institute of Clinical Medicine, Medical Faculty, University of Oslo, Oslo, Norway
- Department of HPB Surgery, Oslo University Hospital - Rikshospitalet, Oslo, Norway
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23
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Thorgersen EB, Asvall J, Frøysnes IS, Schjalm C, Larsen SG, Dueland S, Andersson Y, Fodstad Ø, Mollnes TE, Flatmark K. Increased Local Inflammatory Response to MOC31PE Immunotoxin After Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy. Ann Surg Oncol 2021; 28:5252-5262. [PMID: 34019185 PMCID: PMC8349350 DOI: 10.1245/s10434-021-10022-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 02/26/2021] [Indexed: 11/18/2022]
Abstract
Background Despite extensive cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS-HIPEC), most patients with resectable peritoneal metastases from colorectal cancer experience disease relapse. MOC31PE immunotoxin is being explored as a novel treatment option for these patients. MOC31PE targets the cancer-associated epithelial cell adhesion molecule, and kills cancer cells by distinct mechanisms, simultaneously causing immune activation by induction of immunogenic cell death (ICD). Methods Systemic and local cytokine responses were analyzed in serum and intraperitoneal fluid samples collected the first three postoperative days from clinically comparable patients undergoing CRS-HIPEC with (n = 12) or without (n = 26) intraperitoneal instillation of MOC31PE. A broad panel of 27 pro- and antiinflammatory interleukins, chemokines, interferons, and growth factors was analyzed using multiplex technology. Results The time course and magnitude of the systemic and local postoperative cytokine response after CRS-HIPEC were highly compartmentalized, with modest systemic responses contrasting substantial intraperitoneal responses. Administration of MOC31PE resulted in changes that were broader and of higher magnitude compared with CRS-HIPEC alone. Significantly increased levels of innate proinflammatory cytokines, such as interleukin (IL)-6, IL-1β, and tumor necrosis factor (TNF) as well as an interesting time response curve for the strong T-cell stimulator interferon (IFN)-γ and its associated chemokine interferon gamma-induced protein/chemokine (C-X-C motif) ligand 10 (IP-10) were detected, all associated with ICD. Conclusions Our study revealed a predominately local rather than systemic inflammatory response to CRS-HIPEC, which was strongly enhanced by MOC31PE treatment. The MOC31PE-induced intraperitoneal inflammatory reaction could contribute to improve remnant cancer cell killing, but the mechanisms remain to be elucidated in future studies. Supplementary Information The online version contains supplementary material available at 10.1245/s10434-021-10022-0.
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Affiliation(s)
- Ebbe Billmann Thorgersen
- Department of Gastroenterological Surgery, Oslo University Hospital The Radium Hospital, Oslo, Norway. .,Department of Immunology, Oslo University Hospital Rikshospitalet, Oslo, Norway.
| | - Jørund Asvall
- Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Ida Storhaug Frøysnes
- Department of Tumor Biology, Oslo University Hospital The Radium Hospital, Oslo, Norway
| | - Camilla Schjalm
- Department of Immunology, Oslo University Hospital Rikshospitalet, Oslo, Norway.,Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Stein Gunnar Larsen
- Department of Gastroenterological Surgery, Oslo University Hospital The Radium Hospital, Oslo, Norway
| | - Svein Dueland
- Department of Oncology, Oslo University Hospital The Radium Hospital, Oslo, Norway
| | - Yvonne Andersson
- Department of Tumor Biology, Oslo University Hospital The Radium Hospital, Oslo, Norway
| | - Øystein Fodstad
- Department of Tumor Biology, Oslo University Hospital The Radium Hospital, Oslo, Norway
| | - Tom Eirik Mollnes
- Department of Immunology, Oslo University Hospital Rikshospitalet, Oslo, Norway.,Faculty of Medicine, University of Oslo, Oslo, Norway.,Research Laboratory, Nordland Hospital, Bodø, and Faculty of Health Sciences, K.G. Jebsen TREC, University of Tromsø, Tromsø, Norway.,Centre of Molecular Inflammation Research, Norwegian University of Science and Technology, Trondheim, Norway
| | - Kjersti Flatmark
- Department of Gastroenterological Surgery, Oslo University Hospital The Radium Hospital, Oslo, Norway.,Department of Tumor Biology, Oslo University Hospital The Radium Hospital, Oslo, Norway.,Faculty of Medicine, University of Oslo, Oslo, Norway
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24
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Ratti F, Rawashdeh A, Cipriani F, Primrose J, Fiorentini G, Abu Hilal M, Aldrighetti L. Intrahepatic cholangiocarcinoma as the new field of implementation of laparoscopic liver resection programs. A comparative propensity score-based analysis of open and laparoscopic liver resections. Surg Endosc 2021; 35:1851-1862. [PMID: 32342213 DOI: 10.1007/s00464-020-07588-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Accepted: 04/22/2020] [Indexed: 01/08/2023]
Abstract
BACKGROUND The aim of the present study is to analyze the outcomes of laparoscopic and open liver resections for (Intrahepatic CholangioCarcinoma) ICC in the modern era of laparoscopic liver surgery. METHODS Patients undergoing laparoscopic and open liver resections for ICC in two European referral centers were included. Finally, 104 patients from the open group and 104 patients from the laparoscopic group were compared after propensity scores matching according to seven covariates representative of patients and disease characteristics. Indications to surgery and short- and long-term outcomes were compared. RESULTS Operative time, number of retrieved nodes, rate, and depth of negative resection margins were comparable between the two groups. Blood loss was lower in the MILS (150 ± 100 mL, mean ± SD) compared with the Open group (350 ± 250 mL, p = 0.030). Postoperative complications occurred in 14.4% of patients in the MILS and in the 24% of patients in the Open group (p = 0.02). There were no significant differences in long-term outcomes between groups. CONCLUSIONS Our results confirm feasibility, safety, and oncological efficiency of the laparoscopic approach in the management of ICC. However, this surgery is often complex and should be only considered in centers with large experience in laparoscopic liver surgery.
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Affiliation(s)
- Francesca Ratti
- Hepatobiliary Surgery Division, San Raffaele Hospital, Via Olgettina 60, 20132, Milano, Italy.
| | - Arab Rawashdeh
- Department of Hepatobiliary and Pancreatic Surgery, University Hospital Southampton, NHS Foundation Trust, Southampton, UK
| | - Federica Cipriani
- Hepatobiliary Surgery Division, San Raffaele Hospital, Via Olgettina 60, 20132, Milano, Italy
| | - John Primrose
- Department of Hepatobiliary and Pancreatic Surgery, University Hospital Southampton, NHS Foundation Trust, Southampton, UK
| | - Guido Fiorentini
- Hepatobiliary Surgery Division, San Raffaele Hospital, Via Olgettina 60, 20132, Milano, Italy
| | - Mohammed Abu Hilal
- Department of Hepatobiliary and Pancreatic Surgery, University Hospital Southampton, NHS Foundation Trust, Southampton, UK
| | - Luca Aldrighetti
- Hepatobiliary Surgery Division, San Raffaele Hospital, Via Olgettina 60, 20132, Milano, Italy
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25
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Aghayan DL, Kazaryan AM, Dagenborg VJ, Røsok BI, Fagerland MW, Waaler Bjørnelv GM, Kristiansen R, Flatmark K, Fretland ÅA, Edwin B. Long-Term Oncologic Outcomes After Laparoscopic Versus Open Resection for Colorectal Liver Metastases : A Randomized Trial. Ann Intern Med 2021; 174:175-182. [PMID: 33197213 DOI: 10.7326/m20-4011] [Citation(s) in RCA: 53] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Despite the recent worldwide dissemination of laparoscopic liver surgery, no high-level evidence supports the oncologic safety of this approach. OBJECTIVE To evaluate long-term oncologic outcomes after laparoscopic versus open liver resection in patients with colorectal metastases. DESIGN A single-center, assessor-blinded, randomized controlled trial (OSLO-COMET [Oslo Randomized Laparoscopic Versus Open Liver Resection for Colorectal Metastases Trial]). (ClinicalTrials.gov: NCT01516710). SETTING Oslo University Hospital, the only provider of liver surgery for the 3 million inhabitants of southeastern Norway. PARTICIPANTS Patients with resectable colorectal liver metastases were randomly assigned to have open or laparoscopic liver resection. INTERVENTION From February 2012 to January 2016, a total of 280 patients were included in the trial (laparoscopic surgery: n = 133; open surgery: n = 147). MEASUREMENTS The primary outcome was postoperative morbidity within 30 days. Five-year rates of overall and recurrence-free survival were predefined secondary end points. RESULTS At a median follow-up of 70 months, rates of 5-year overall survival were 54% in the laparoscopic group and 55% in the open group (between-group difference, 0.5 percentage point [95% CI, -11.3 to 12.3 percentage points]; hazard ratio, 0.93 [CI, 0.67 to 1.30]; P = 0.67). Rates of 5-year recurrence-free survival were 30% in the laparoscopic group and 36% in the open group (between-group difference, 6.0 percentage points [CI, -6.7 to 18.7 percentage points]; hazard ratio, 1.09 [CI, 0.80 to 1.49]; P = 0.57). LIMITATION The trial was not powered to detect differences in secondary end points and was not designed to address a noninferiority hypothesis for survival outcomes. CONCLUSION In this randomized trial of laparoscopic and open liver surgery, no difference in survival outcomes was found between the treatment groups. However, differences in 5-year overall survival up to about 10 percentage points in either direction cannot be excluded. This trial should be followed by pragmatic multicenter trials and international registries. PRIMARY FUNDING SOURCE The South-Eastern Norway Regional Health Authority.
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Affiliation(s)
- Davit L Aghayan
- The Intervention Centre at Oslo University Hospital and Institute of Clinical Medicine at University of Oslo, Oslo, Norway, and Yerevan State Medical University after Mkhitar Heratsi, Yerevan, Armenia (D.L.A.)
| | - Airazat M Kazaryan
- The Intervention Centre at Oslo University Hospital, Oslo, and Østfold Hospital Trust, Grålum, Norway, Yerevan State Medical University after Mkhitar Heratsi, Yerevan, Armenia, and I.M. Sechenov First Moscow State Medical University, Moscow, Russia (A.M.K.)
| | - Vegar Johansen Dagenborg
- Institute of Clinical Medicine at University of Oslo and Oslo University Hospital, Oslo, Norway (V.J.D., K.F.)
| | - Bård I Røsok
- Oslo University Hospital Rikshospitalet, Oslo, Norway (B.I.R.)
| | - Morten Wang Fagerland
- Oslo Centre for Biostatistics and Epidemiology, Oslo University Hospital, Oslo, Norway (M.W.F.)
| | | | - Ronny Kristiansen
- The Intervention Centre at Oslo University Hospital, Oslo, Norway (R.K., Å.A.F.)
| | - Kjersti Flatmark
- Institute of Clinical Medicine at University of Oslo and Oslo University Hospital, Oslo, Norway (V.J.D., K.F.)
| | | | - Bjørn Edwin
- The Intervention Centre at Oslo University Hospital and Institute of Clinical Medicine at University of Oslo, Oslo, Norway (B.E.)
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Heinrich S, Lang H. [Evidence of minimally invasive oncological surgery of the liver]. Chirurg 2021; 92:316-325. [PMID: 33449156 DOI: 10.1007/s00104-020-01338-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/14/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND The evidence for minimally invasive surgery (MIS) of the liver has significantly increased with the increasing number of publications on this topic in recent years; however, this technique has not yet gained broad acceptance among surgeons. OBJECTIVE Analysis and presentation of the current literature on MIS of the liver. MATERIAL UND METHODS Structured PubMed literature search and analysis. RESULTS According to the literature, MIS and open liver surgery are equivalent regarding the oncological quality. In addition to parenchyma-preserving resections, major hepatectomies (e.g. hemihepatectomy and sectorectomy), two-stage concepts and re-resections have increasingly been reported. The MIS of the liver is associated with less blood loss and other immunological advantages in addition to a shorter hospital stay. The highest level of evidence has been achieved for colorectal liver metastases for which a systematic review even revealed a survival benefit for patients undergoing MIS surgery. From an oncological perspective, laparoscopic and robotic liver surgery are considered to be equivalent. CONCLUSION According to the current literature MIS of the liver is recommended for the resection of colorectal liver metastases and hepatocellular carcinoma.
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Affiliation(s)
- Stefan Heinrich
- Klinik f. Allgemein‑, Viszeral- und Transplantationschirurgie, Universitätsmedizin Mainz, Langenbeckstraße 1, 55131, Mainz, Deutschland
| | - Hauke Lang
- Klinik f. Allgemein‑, Viszeral- und Transplantationschirurgie, Universitätsmedizin Mainz, Langenbeckstraße 1, 55131, Mainz, Deutschland.
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Giglio MC, Troisi RI. Laparoscopic surgery for colorectal liver metastases: moving forward while keeping feet on the ground. Hepatobiliary Surg Nutr 2021; 10:107-109. [PMID: 33575296 PMCID: PMC7867729 DOI: 10.21037/hbsn.2020.04.06] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 04/01/2020] [Indexed: 12/29/2022]
Affiliation(s)
- Mariano Cesare Giglio
- Division of HPB, Minimally Invasive and Robotic Surgery, Department of Clinical Medicine and Surgery, Federico II University Hospital, Naples, Italy
| | - Roberto Ivan Troisi
- Division of HPB, Minimally Invasive and Robotic Surgery, Department of Clinical Medicine and Surgery, Federico II University Hospital, Naples, Italy
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Akahoshi S, Beppu T, Mori Y, Kinoshita K, Sato N, Kikuchi K. Does laparoscopic liver resection for colorectal liver metastases provide a true survival benefit compared with open liver resection? Hepatobiliary Surg Nutr 2020; 9:657-660. [PMID: 33163518 DOI: 10.21037/hbsn.2020.01.01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/07/2022]
Affiliation(s)
| | - Toru Beppu
- Department of Surgery, Yamaga City Medical Center, Kumamoto, Japan
| | - Yasuhisa Mori
- Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Koichi Kinoshita
- Department of Surgery, Yamaga City Medical Center, Kumamoto, Japan
| | - Nobutaka Sato
- Department of Surgery, Yamaga City Medical Center, Kumamoto, Japan
| | - Ken Kikuchi
- Adviser, Sakurajuji Hospital, Kumamoto, Japan
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Ypsilantis P, Lambropoulou M, Anagnostopoulos K, Panidou-Tsoulou E, Ioannidis O, Totsi A, Pitiakoudis M, Simopoulos C. Effect of laparoscopic liver resection versus the open technique on hepatocyte regenerating activity in the rat. Surg Endosc 2020; 34:4812-4817. [PMID: 31741154 DOI: 10.1007/s00464-019-07257-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Accepted: 11/11/2019] [Indexed: 12/22/2022]
Abstract
BACKGROUND Laparoscopic liver resection offers a safe and feasible option primarily for the excision of hepatic neoplasms. Timely recovery of liver volume is a key factor for improving prognosis and post-operative mortality of patients undergone liver resection. The aim of the present study was to compare liver regeneration after laparoscopic over open partial hepatectomy. METHODS Wistar rats were subjected to laparoscopic 70% hepatectomy (group LAP-HEP), open 70% hepatectomy (group HEP), sham operation (group Sham) or no intervention (group Control). At various timepoints following operation (1 h-2 weeks), the liver was excised to assess relative liver weight, thiobarbituric acid reactive substances (TBARS) levels, mitotic activity, tissue expression of Nuclear Factor-κB (NFκB), Intercellular Adhesion Molecule-1 (ICAM-1) and Vascular Cell Adhesion Molecule-1 (VCAM-1) and the histopathologic profile. RESULTS No differences were seen in relative liver weight between hepatectomy groups. Mitotic index was increased in all operative study groups, being higher in group LAP-HEP than in group HEP. TBARS levels were higher in group LAP-HEP compared to group HEP. NFκB and VCAM-1 tissue expression scores were increased in all operative study groups with VCAM-1 being higher in group HEP, while ICAM-1 was overexpressed only in hepatectomy groups. Mild histopathologic lesions were noted in hepatectomy groups with the histopathologic score being higher in group HEP (24 h). CONCLUSIONS Laparoscopic liver resection enhanced hepatocyte mitotic activity which was accompanied by mild oxidative stress and a less pronounced local inflammatory response and tissue injury to that of the open technique.
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Affiliation(s)
- Petros Ypsilantis
- Laboratory of Experimental Research and Surgical Research, School of Medicine, Democritus University of Thrace, Alexandroupolis, Greece.
| | - Maria Lambropoulou
- Laboratory of Histology and Embryology, School of Medicine, Democritus University of Thrace, Alexandroupolis, Greece
| | | | - Eleni Panidou-Tsoulou
- Laboratory of Experimental Research and Surgical Research, School of Medicine, Democritus University of Thrace, Alexandroupolis, Greece
| | - Orestis Ioannidis
- Laboratory of Experimental Research and Surgical Research, School of Medicine, Democritus University of Thrace, Alexandroupolis, Greece
| | - Albion Totsi
- Laboratory of Experimental Research and Surgical Research, School of Medicine, Democritus University of Thrace, Alexandroupolis, Greece
| | - Michael Pitiakoudis
- Laboratory of Experimental Research and Surgical Research, School of Medicine, Democritus University of Thrace, Alexandroupolis, Greece
| | - Constantinos Simopoulos
- Laboratory of Experimental Research and Surgical Research, School of Medicine, Democritus University of Thrace, Alexandroupolis, Greece
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Kazaryan AM, Solberg I, Aghayan DL, Sahakyan MA, Reiertsen O, Semikov VI, Shulutko AM, Edwin B. Does tumor size influence the outcome of laparoscopic distal pancreatectomy? HPB (Oxford) 2020; 22:1280-1287. [PMID: 31843445 DOI: 10.1016/j.hpb.2019.11.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2019] [Revised: 11/09/2019] [Accepted: 11/24/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND Laparoscopic distal pancreatectomy (LDP) is a safe procedure, but its role in resection of large pancreatic lesions has been questioned. METHODS Patients who underwent LDP for pancreatic solitary tumors in 1997-2017 were included in this study. The patients were divided into three groups in accordance with tumor size: <3.5 cm (group I); from 3.5 cm to 7.0 cm (group II), and ≥7 cm (group III). RESULTS 218, 146 and 58 patients were identified in the groups I, II and III. Median tumor size in the groups I, II and III was 20, 47 and 81.5 mm (p < 0.001). Nine procedures (2.1%) were converted including 1(0.5%), 5(3.4%) and 3(5.2%) in the groups I, II and III (p = 0.036). Median operative time was longer in the group III compared with the groups I and II - 195 vs 158 and 159 min (p = 0.005). Median blood loss did not differ. Regression analysis revealed correlation between tumor size and operative time (R = 0.103; P = 0.035) and no correlation between tumor size and blood loss (R = 0.075; P = 0.125). Hospital stay was 5 days, similar in all groups.Postoperative morbidity was similar - 38.5, 32 and 34% in the group I, II and III. CONCLUSION LDP can be safely performed laparoscopically with outcomes similar to those for smaller tumors.
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Affiliation(s)
- Airazat M Kazaryan
- Department of Gastrointestinal Surgery, Østfold Hospital Trust, Grålum, Norway; Intervention Centre, Oslo University Hospital - Rikshospitalet, Oslo, Norway; Department of Faculty Surgery N2, I.M.Sechenov First Moscow State Medical University, Moscow, Russia; Department of Surgery N1, Yerevan State Medical University After M. Heratsi, Yerevan, Armenia.
| | | | - Davit L Aghayan
- Intervention Centre, Oslo University Hospital - Rikshospitalet, Oslo, Norway; Department of Surgery N1, Yerevan State Medical University After M. Heratsi, Yerevan, Armenia; Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Mushegh A Sahakyan
- Department of Surgery N1, Yerevan State Medical University After M. Heratsi, Yerevan, Armenia; Department of General and Laparoscopic Surgery, Central Clinical Military Hospital, Yerevan, Armenia
| | - Ola Reiertsen
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Vasiliy I Semikov
- Department of Faculty Surgery N2, I.M.Sechenov First Moscow State Medical University, Moscow, Russia
| | - Alexander M Shulutko
- Department of Faculty Surgery N2, I.M.Sechenov First Moscow State Medical University, Moscow, Russia
| | - Bjørn Edwin
- Intervention Centre, Oslo University Hospital - Rikshospitalet, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Department of Hepatopancreatobiliary Surgery, Oslo University Hospital - Rikshospitalet, Oslo, Norway
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Syn NL, Kabir T, Koh YX, Tan HL, Wang LZ, Chin BZ, Wee I, Teo JY, Tai BC, Goh BKP. Survival Advantage of Laparoscopic Versus Open Resection For Colorectal Liver Metastases: A Meta-analysis of Individual Patient Data From Randomized Trials and Propensity-score Matched Studies. Ann Surg 2020; 272:253-265. [PMID: 32675538 DOI: 10.1097/sla.0000000000003672] [Citation(s) in RCA: 79] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To perform an individual participant data meta-analysis using randomized trials and propensity-score matched (PSM) studies which compared laparoscopic versus open hepatectomy for patients with colorectal liver metastases (CLM). BACKGROUND Randomized trials and PSM studies constitute the highest level of evidence in addressing the long-term oncologic efficacy of laparoscopic versus open resection for CLM. However, individual studies are limited by the reporting of overall survival in ways not amenable to traditional methods of meta-analysis, and violation of the proportional hazards assumption. METHODS Survival information of individual patients was reconstructed from the published Kaplan-Meier curves with the aid of a computer vision program. Frequentist and Bayesian survival models (taking into account random-effects and nonproportional hazards) were fitted to compare overall survival of patients who underwent laparoscopic versus open surgery. To handle long plateaus in the tails of survival curves, we also exploited "cure models" to estimate the fraction of patients effectively "cured" of disease. RESULTS Individual patient data from 2 randomized trials and 13 PSM studies involving 3148 participants were reconstructed. Laparoscopic resection was associated with a lower hazard rate of death (stratified hazard ratio = 0.853, 95% confidence interval: 0.754-0.965, P = 0.0114), and there was evidence of time-varying effects (P = 0.0324) in which the magnitude of hazard ratios increased over time. The fractions of long-term cancer survivors were estimated to be 47.4% and 18.0% in the laparoscopy and open surgery groups, respectively. At 10-year follow-up, the restricted mean survival time was 8.6 months (or 12.1%) longer in the laparoscopy arm (P < 0.0001). In a subgroup analysis, elderly patients (≥65 years old) treated with laparoscopy experienced longer 3-year average life expectancy (+6.2%, P = 0.018), and those who live past the 5-year milestone (46.1%) seem to be cured of disease. CONCLUSIONS This patient-level meta-analysis of high-quality studies demonstrated an unexpected survival benefit in favor of laparoscopic over open resection for CLM in the long-term. From a conservative viewpoint, these results can be interpreted to indicate that laparoscopy is at least not inferior to the standard open approach.
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Affiliation(s)
- Nicholas L Syn
- Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital, Singapore, Singapore
- Biostatistics & Modelling Domain, Saw Swee Hock School of Public Health, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Tousif Kabir
- Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital, Singapore, Singapore
| | - Ye Xin Koh
- Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital, Singapore, Singapore
| | - Hwee Leong Tan
- Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital, Singapore, Singapore
| | - Louis Z Wang
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | | | - Ian Wee
- Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Jin Yao Teo
- Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | - Bee Choo Tai
- Biostatistics & Modelling Domain, Saw Swee Hock School of Public Health, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Biostatistics Core, Investigational Medicine Unit, National University Health System, Singapore, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Brian K P Goh
- Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
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Yanase F, Naorungroj T, Bellomo R. Glycocalyx damage biomarkers in healthy controls, abdominal surgery, and sepsis: a scoping review. Biomarkers 2020; 25:425-435. [DOI: 10.1080/1354750x.2020.1787518] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Fumitaka Yanase
- Department of Intensive Care, Austin Hospital, Melbourne, Australia
- Australian and New Zealand Intensive Care Research Centre, Monash University School of Public Health and Preventive Medicine, Melbourne, Australia
| | - Thummaporn Naorungroj
- Department of Intensive Care, Austin Hospital, Melbourne, Australia
- Department of Intensive Care, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Rinaldo Bellomo
- Department of Intensive Care, Austin Hospital, Melbourne, Australia
- Australian and New Zealand Intensive Care Research Centre, Monash University School of Public Health and Preventive Medicine, Melbourne, Australia
- Centre for Integrated Critical Care, Department of Medicine and Radiology, University of Melbourne, Melbourne, Australia
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Kabir T, Syn N, Goh BKP. Current status of laparoscopic liver resection for the management of colorectal liver metastases. J Gastrointest Oncol 2020; 11:526-539. [PMID: 32655931 PMCID: PMC7340801 DOI: 10.21037/jgo.2020.02.05] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2019] [Accepted: 01/22/2020] [Indexed: 12/11/2022] Open
Abstract
Colorectal cancer (CRC) is one of the most prevalent malignancies worldwide. The commonest site of spread is the liver, with up to 40% of patients developing colorectal liver metastasis (CLRM) during the course of their lifetime. Significant advances in surgical techniques, as well as breakthroughs in chemotherapy and biologic agents, have resulted in dramatic improvements in prognosis. A multimodal approach comprising of liver resection coupled with systemic therapy offers these patients the best chance of cure. The arrival of laparoscopic liver resection (LLR) within the last 3 decades has added a whole new dimension to the management of this condition. Today, CLRM is one of the most frequent indications for LLR globally. Meta-analyses of retrospective studies and two randomized trials have demonstrated superior short-term outcomes following LLR, with no differences in mortality rates. Oncologically, R0 resection rates are comparable to the open approach, while overall and disease-free survival rates are also similar. As surgeons gain confidence, boundaries are pushed even further. High-volume centers have published their early experiences with complex LLR of recurrent CLRM as well as totally laparoscopic synchronous resection of CRC and liver metastases, with very encouraging results. In the presence of extensive bilobar CLRM, two-stage hepatectomy (TSH) and associating liver partition with portal vein ligation (ALPPS) may be adopted to augment an inadequate future liver remnant to facilitate metastasectomy. Interestingly, the adoption of LLR for these techniques also seem to confer additional benefits. Despite the plethora of advantages, LLR comes with its own unique set of limitations such as a steep learning curve and high cost. The surgical world eagerly awaits the results of prospective trials currently underway in order to further advance the management of this disease.
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Affiliation(s)
- Tousif Kabir
- Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital, Singapore, Singapore
- Department of General Surgery, Sengkang General Hospital, Singapore, Singapore
| | - Nicholas Syn
- Yong Loo Lin School of Medicine, Singapore, Singapore
| | - Brian K. P. Goh
- Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital, Singapore, Singapore
- Duke NUS Medical School, Singapore, Singapore
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Ratti F, Cipriani F, Fiorentini G, Catena M, Paganelli M, Aldrighetti L. Reappraisal of the advantages of laparoscopic liver resection for intermediate hepatocellular carcinoma within a stage migration perspective: Propensity score analysis of the differential benefit. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2020; 27:510-521. [PMID: 32189450 DOI: 10.1002/jhbp.736] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 03/02/2020] [Accepted: 03/15/2020] [Indexed: 12/23/2022]
Abstract
OBJECTIVE The aim of the present study was to analyze the outcome of laparoscopic approach specifically in patients with Intermediate-stage disease and to define the differential benefit with Early-stage patients. METHODS Six hundred twenty-two resections for HCC were dichotomized according to staging (Early and Intermediate) and to approach and then matched in a 1:1 ratio using propensity scores to obtain four groups (E-MILS and E-Open, including 104 patients respectively; Int-MILS and Int-Open, including 142 patients, respectively). The differential benefit associated with the minimally invasive technique was evaluated between intermediate-stage and early-stage patients taking into account blood loss and morbidity rate as outcome indicators. RESULTS Laparoscopic approach resulted in a statistically significant lower blood loss, reduced morbidity, reduced incidence of hepatic decompensation and shorter time for functional recover and length of stay. The evaluation of the differential benefit showed a greater advantage of laparoscopic approach in Intermediate-stage patients compared with Early-stage patients, both in terms of blood loss and morbidity rate. CONCLUSIONS The favorable biological scenario associated with laparoscopic approach allows to obtain enhanced benefits in the setting of more advanced liver disease. The push towards minimal invasiveness and the incremental benefit associated with it could potentially promote stage migration in suitable patients.
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Affiliation(s)
- Francesca Ratti
- Hepatobiliary Surgery Division, IRCCS San Raffaele Hospital, Milano, Italy
| | - Federica Cipriani
- Hepatobiliary Surgery Division, IRCCS San Raffaele Hospital, Milano, Italy
| | - Guido Fiorentini
- Hepatobiliary Surgery Division, IRCCS San Raffaele Hospital, Milano, Italy
| | - Marco Catena
- Hepatobiliary Surgery Division, IRCCS San Raffaele Hospital, Milano, Italy
| | - Michele Paganelli
- Hepatobiliary Surgery Division, IRCCS San Raffaele Hospital, Milano, Italy
| | - Luca Aldrighetti
- Hepatobiliary Surgery Division, IRCCS San Raffaele Hospital, Milano, Italy
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Perihilar cholangiocarcinoma: are we ready to step towards minimally invasiveness? Updates Surg 2020; 72:423-433. [DOI: 10.1007/s13304-020-00752-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Accepted: 03/19/2020] [Indexed: 12/17/2022]
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Vecchio R, Cacciola E, Cacciola RR, Marchese S, Troina G, Intagliata E, Basile F. Hemocoagulative post-operative changes after laparoscopic surgery compared to open surgery: the role of lupus anticoagulant. Updates Surg 2020; 72:1223-1227. [PMID: 32170631 DOI: 10.1007/s13304-020-00724-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2019] [Accepted: 02/12/2020] [Indexed: 10/24/2022]
Abstract
Although still debated, post-operative modification of hemostasis seems to be less pronounced after laparoscopy compared to open surgery. Antiphospholipid antibodies might play a role in the post-operative thromboembolic risk, although their evaluation in surgical patients has never been performed. Post-operative modification of antiphospholipid antibodies could be related to the surgical approach (laparoscopic or open). In this prospective study, the authors statistically compared the pre-operative values and post-operative modification of antiphospholipid antibodies in two homogeneous groups of patients operated on by laparoscopic and open surgery. No statistical differences within each group and between the two groups were shown comparing mean values of pre-operative and post-operative antiphospholipid antibodies. In the open group, there was a significant difference between pre-operative and post-operative LAC means (P < 0.01). In the laparoscopic group, on the contrary, no significant change in LAC values between pre- and post-operative tests (P = 0.55) was observed. Since LAC could be related to coagulation disorders, this study seems to support that laparoscopic surgery might induce a less risk of post-operative thromboembolic disease.
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Affiliation(s)
- Rosario Vecchio
- Department of Surgery, University of Catania, Catania, Italy
| | - Emma Cacciola
- Department of Medical Sciences, Surgical Sciences and Advanced Technologies, Hemostasis Unit, University of Catania, Catania, Italy
| | | | | | - Graziano Troina
- Department of Clinic and Specialist Medicine, University of Palermo, Palermo, Italy
| | - Eva Intagliata
- Department of Surgery, University of Catania, Catania, Italy.
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Long-term outcomes of laparoscopic versus open liver resection for hepatocellular carcinoma: Retrospective case-matched study. INTERNATIONAL JOURNAL OF SURGERY OPEN 2020. [DOI: 10.1016/j.ijso.2020.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Robles-Campos R, Lopez-Lopez V, Brusadin R, Lopez-Conesa A, Gil-Vazquez PJ, Navarro-Barrios Á, Parrilla P. Open versus minimally invasive liver surgery for colorectal liver metastases (LapOpHuva): a prospective randomized controlled trial. Surg Endosc 2019. [PMID: 30701365 DOI: 10.1007/s00464-019-06679-0/tables/3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
OBJECTIVE To present surgical and oncological outcomes using a prospective and randomized trial (LapOpHuva, NCT02727179) comparing minimally invasive liver resection (LLR) versus open liver resection (OLR) in patients with colorectal liver metastases (CRLM). METHODS Between February 2005 and March 2016, 204 selected patients with CRLM were randomized and 193 were included: LLR (n = 96) and OLR (n = 97). The primary endpoint was to compare postoperative morbidity. Other secondary endpoints were oncological outcomes, use of the Pringle maneuver, surgical time, blood losses, transfusions, hospital stay, mortality and OS, and disease-free survival (DFS) at 3, 5, and 7 years. RESULTS LLR presented with lower global morbidity (11.5% vs. 23.7%, p = 0.025) but with similar severe complications. Long-term survival outcomes were similar in both groups. The cumulative 1-, 3-, 5-, 7-year OS for LLR and OLR were 92.5%, 71.5%, 49.3%, 35.6% versus 93.6%, 69.7%, 47.4%, 35.5%, respectively (log-rank = 0.047, p = 0.82). DFS for LLR and OLR was 72.7%, 33.5%, 22.7%, and 20.8% versus 61.6%, 27.2%, 23.9%, and 17.9%, respectively (log-rank = 1.427, p = 0.23). LLR involved more use of the Pringle maneuver (15.5% vs. 30.2%, p = 0.025) and a shorter hospital stay (4 vs. 6 days, p < 0.001). There were no differences regarding surgical time, blood losses, transfusion, and mortality. CONCLUSIONS In selected patients with CRLM, LLR presents similar oncological outcomes with the advantages of the short-term results associated with LLR.
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Affiliation(s)
- Ricardo Robles-Campos
- Department of Liver Surgery and Transplantation, Virgen de la Arrixaca Clinic and University Hospital, IMIB, El Palmar, Murcia, Spain.
| | - Víctor Lopez-Lopez
- Department of Liver Surgery and Transplantation, Virgen de la Arrixaca Clinic and University Hospital, IMIB, El Palmar, Murcia, Spain
| | - Roberto Brusadin
- Department of Liver Surgery and Transplantation, Virgen de la Arrixaca Clinic and University Hospital, IMIB, El Palmar, Murcia, Spain
| | - Asunción Lopez-Conesa
- Department of Liver Surgery and Transplantation, Virgen de la Arrixaca Clinic and University Hospital, IMIB, El Palmar, Murcia, Spain
| | - Pedro José Gil-Vazquez
- Department of Liver Surgery and Transplantation, Virgen de la Arrixaca Clinic and University Hospital, IMIB, El Palmar, Murcia, Spain
| | - Álvaro Navarro-Barrios
- Department of Liver Surgery and Transplantation, Virgen de la Arrixaca Clinic and University Hospital, IMIB, El Palmar, Murcia, Spain
| | - Pascual Parrilla
- Department of Liver Surgery and Transplantation, Virgen de la Arrixaca Clinic and University Hospital, IMIB, El Palmar, Murcia, Spain
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Buanes TA. The role of laparoscopic pancreaticoduodenectomy-how take care of patient security? ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:S94. [PMID: 31576302 DOI: 10.21037/atm.2019.04.54] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Trond A Buanes
- Department of Hepato-Pancreatico-Biliary Surgery, Oslo University Hospital (OuS), Oslo, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
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Agier J, Krawczyk K, Żelechowska P, Kozłowska E, Brzezińska-Błaszczyk E, Wiktorska M. Expression of Toll-like receptors 2 and 4 on peripheral mononuclear cells (PBMCs) after laparoscopic cholecystectomy. Scandinavian Journal of Clinical and Laboratory Investigation 2019; 79:449-454. [PMID: 31453712 DOI: 10.1080/00365513.2019.1658895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Increasing evidence suggests that the course and intensity of inflammation, as well as repair processes, developed in response to stress, injury, and trauma, depend on the interaction between immediately released endogenous molecules, called alarmins or danger/damage-associated molecular patterns (DAMPs) and cellular pattern recognition receptors (PRR) including Toll-like receptors (TLRs) and activation of inflammatory/immune cells. Therefore, the aim of this study was to examine the expression of TLRs in peripheral blood mononuclear cells (PBMCs), CD3+, and CD14+ cells in control group and in patients before the laparoscopic cholecystectomy, and three and seven days after surgery. Flow cytometry was used to evaluate expression of TLR2 and TLR4. TLR2 and especially TLR4 expression levels on PBMCs were significantly lower in patients with asymptomatic cholelithiasis than in the control group. Laparoscopic surgery did not induce the significant changes in the expression of TLR2, both on PBMCs and CD3+ and CD14+ cell subpopulations. On the contrary, TLR4 expression level on PBMCs was significantly lower on the third and seventh postoperative day than before surgery. Collectively, the expression levels of cellular TLRs, and especially TLR2 and TLR4, might strongly influence the responsiveness of cells to DAMP activation, and in this way can regulate the intensity of inflammatory response to surgical injury.
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Affiliation(s)
- Justyna Agier
- Department of Experimental Immunology, Medical University of Lodz , Lodz , Poland
| | - Katarzyna Krawczyk
- Department of Experimental Immunology, Medical University of Lodz , Lodz , Poland.,Specialist Hospital , Lodz , Poland
| | - Paulina Żelechowska
- Department of Experimental Immunology, Medical University of Lodz , Lodz , Poland
| | - Elżbieta Kozłowska
- Department of Experimental Immunology, Medical University of Lodz , Lodz , Poland
| | | | - Magdalena Wiktorska
- Department of Molecular Cell Mechanisms, Medical University of Lodz , Lodz , Poland
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41
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Ye Z, Zhang B, Chen Y, Lin J. Comparison of single utility port video-assisted thoracoscopic surgery (VATS) and three-port VATS for non-small cell lung cancer. Oncol Lett 2019; 18:1311-1317. [PMID: 31423191 PMCID: PMC6607390 DOI: 10.3892/ol.2019.10394] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Accepted: 04/24/2019] [Indexed: 11/11/2022] Open
Abstract
Clinical efficacy of single utility port video-assisted thoracoscopic surgery (VATS) and three-port VATS for patients with non-small cell lung cancer (NSCLC) was compared. A total of 156 patients with NSCLC who underwent VATS in Taizhou Hospital of Zhejiang Province from July 2015 to January 2017 were selected as subjects. They were randomly divided into group A (n=74) and group B (n=82), in which group A was treated with single utility port VATS and group B was treated with three-port VATS. Perioperative indicators such as operation time, intraoperative blood loss, postoperative drainage, removal of drainage tube, lymph node dissection, hospitalization time, postoperative complications, postoperative pain and postoperative quality of life were observed. Expression levels of CRP and IL-6 in serum were detected by enzyme-linked immunosorbent assay (ELISA). There was no significant difference in the operation time, postoperative drainage volume, drainage tube removal time and lymph node dissection between groups A and B (P>0.05). Blood loss and hospitalization time in group A were significantly lower than those in group B (P<0.001). VAS scores at 1–3 days after operation in group A were significantly lower than those in group B (P<0.001). Levels of serum CRP and IL-6 at 1–7 days after operation in group A were significantly lower than those in group B (P<0.001). Incidence of complication in group A was not significantly different from that in group B (P>0.05). Overall quality of life scores of group A and B were significantly lower than the preoperative scores (P<0.001). Overall status score of group A was significantly higher than that of group B (P<0.001). Clinical efficacies of single utility port VATS and three-port VATS were similar. Single utility port VATS can reduce trauma during surgery, reduce stress response, relieve postoperative pain, and facilitate the recovery of postoperative quality of life.
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Affiliation(s)
- Zhongrui Ye
- Department of Thoracic Surgery, Taizhou Hospital of Zhejiang Province, Taizhou, Zhejiang 317000, P.R. China
| | - Bo Zhang
- Department of Thoracic Surgery, Taizhou Hospital of Zhejiang Province, Taizhou, Zhejiang 317000, P.R. China
| | - Yu Chen
- Department of Thoracic Surgery, Taizhou Hospital of Zhejiang Province, Taizhou, Zhejiang 317000, P.R. China
| | - Jiang Lin
- Department of Thoracic Surgery, Taizhou Hospital of Zhejiang Province, Taizhou, Zhejiang 317000, P.R. China
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Guilbaud T, Marchese U, Gayet B, Fuks D. Highlights, limitations and future challenges of laparoscopic resection for colorectal liver metastases. J Visc Surg 2019; 156:329-337. [PMID: 31101548 DOI: 10.1016/j.jviscsurg.2019.04.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
The liver is the most common site for metastatic colorectal cancer (CRLM). Despite advances in oncologic treatment, resection of metastases is still the only curative option. Although laparoscopic surgery for primary colorectal cancer is well documented and widely used, laparoscopic surgery for liver metastases has developed more slowly. However, in spite of some difficulties, laparoscopic approach demonstrated strong advantages including minimal parietal damage, decreased morbidity (reduced blood loss and need for transfusion, fewer pulmonary complications), and simplification of subsequent iterative hepatectomy. Up to now, more than 9 000 laparoscopic procedures have been reported worldwide and long-term results in colorectal liver metastases seem comparable to the open approach. Only one recent randomized controlled trial has compared the laparoscopic and the open approach. The purpose of the present update was to identify the barriers limiting widespread acceptance of laparoscopic approach, the benefits and the limits of laparoscopic hepatectomies in CRLM.
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Affiliation(s)
- T Guilbaud
- Department of Digestive, Oncological and Metabolic Surgery, Institut Mutualiste Montsouris, 42, boulevard Jourdan, 75014 Paris, France; Université Paris Descartes, 15, rue de l'école de médecine, 75005 Paris, France.
| | - U Marchese
- Department of Digestive, Oncological and Metabolic Surgery, Institut Mutualiste Montsouris, 42, boulevard Jourdan, 75014 Paris, France; Université Paris Descartes, 15, rue de l'école de médecine, 75005 Paris, France
| | - B Gayet
- Department of Digestive, Oncological and Metabolic Surgery, Institut Mutualiste Montsouris, 42, boulevard Jourdan, 75014 Paris, France; Université Paris Descartes, 15, rue de l'école de médecine, 75005 Paris, France
| | - D Fuks
- Department of Digestive, Oncological and Metabolic Surgery, Institut Mutualiste Montsouris, 42, boulevard Jourdan, 75014 Paris, France; Université Paris Descartes, 15, rue de l'école de médecine, 75005 Paris, France
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43
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44
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Oh TK, Oh AY, Ryu JH, Koo BW, Lee YJ, Do SH. Retrospective analysis of the association between intraoperative magnesium sulfate infusion and postoperative acute kidney injury after major laparoscopic abdominal surgery. Sci Rep 2019; 9:2833. [PMID: 30808887 PMCID: PMC6391431 DOI: 10.1038/s41598-019-39106-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Accepted: 01/17/2019] [Indexed: 12/12/2022] Open
Abstract
Magnesium sulfate can be used as a co-adjuvant drug during the perioperative period and has multiple benefits. Recent evidence suggested that perioperative magnesium sulfate infusion may lower the risk of postoperative acute kidney injury (AKI). We investigated the association between intraoperative magnesium sulfate infusion and incidence of AKI after major laparoscopic abdominal surgery. We retrospectively analyzed the medical records of adult patients 20 years or older who underwent elective major laparoscopic abdominal surgery (>2 hours) between 2010 and 2016. We investigated the association between intraoperative magnesium sulfate infusion and the incidence of postoperative AKI until postoperative day (POD) 3 using a multivariable logistic regression analysis. We included 3,828 patients in this analysis; 357 patients (9.3%) received an intraoperative magnesium sulfate infusion and 186 patients (4.9%) developed postoperative AKI by POD 3. A multivariable logistic regression analysis showed that magnesium infusion was associated with a significant decrease (63%) in postoperative AKI (odds ratio, 0.37; 95% confidence interval, 0.14–0.94; P = 0.037). Our study suggested that intraoperative magnesium sulfate infusion is associated with a reduced risk of postoperative AKI until POD 3 for patients who underwent laparoscopic major abdominal surgery. Well-designed, prospective studies should be conducted to further substantiate these findings.
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Affiliation(s)
- Tak Kyu Oh
- Department of Anesthesiology and Pain medicine, Seoul National University Bundang Hospital, Seoul, Korea
| | - Ah-Young Oh
- Department of Anesthesiology and Pain medicine, Seoul National University Bundang Hospital, Seoul, Korea.,Department of Anesthesiology and Pain Medicine, College of Medicine, Seoul National University, Seoul, Korea
| | - Jung-Hee Ryu
- Department of Anesthesiology and Pain medicine, Seoul National University Bundang Hospital, Seoul, Korea.,Department of Anesthesiology and Pain Medicine, College of Medicine, Seoul National University, Seoul, Korea
| | - Bon-Wook Koo
- Department of Anesthesiology and Pain medicine, Seoul National University Bundang Hospital, Seoul, Korea
| | - Yea Ji Lee
- Department of Anesthesiology and Pain medicine, Seoul National University Bundang Hospital, Seoul, Korea
| | - Sang-Hwan Do
- Department of Anesthesiology and Pain medicine, Seoul National University Bundang Hospital, Seoul, Korea. .,Department of Anesthesiology and Pain Medicine, College of Medicine, Seoul National University, Seoul, Korea.
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45
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Open versus minimally invasive liver surgery for colorectal liver metastases (LapOpHuva): a prospective randomized controlled trial. Surg Endosc 2019; 33:3926-3936. [DOI: 10.1007/s00464-019-06679-0] [Citation(s) in RCA: 89] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Accepted: 01/17/2019] [Indexed: 12/11/2022]
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46
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Laparoscopic Versus Open Resection for Colorectal Liver Metastases: The OSLO-COMET Randomized Controlled Trial. Ann Surg 2019; 267:199-207. [PMID: 28657937 DOI: 10.1097/sla.0000000000002353] [Citation(s) in RCA: 432] [Impact Index Per Article: 86.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To perform the first randomized controlled trial to compare laparoscopic and open liver resection. SUMMARY BACKGROUND DATA Laparoscopic liver resection is increasingly used for the surgical treatment of liver tumors. However, high-level evidence to conclude that laparoscopic liver resection is superior to open liver resection is lacking. METHODS Explanatory, assessor-blinded, single center, randomized superiority trial recruiting patients from Oslo University Hospital, Oslo, Norway from February 2012 to January 2016. A total of 280 patients with resectable liver metastases from colorectal cancer were randomly assigned to undergo laparoscopic (n = 133) or open (n = 147) parenchyma-sparing liver resection. The primary outcome was postoperative complications within 30 days (Accordion grade 2 or higher). Secondary outcomes included cost-effectiveness, postoperative hospital stay, blood loss, operation time, and resection margins. RESULTS The postoperative complication rate was 19% in the laparoscopic-surgery group and 31% in the open-surgery group (12 percentage points difference [95% confidence interval 1.67-21.8; P = 0.021]). The postoperative hospital stay was shorter for laparoscopic surgery (53 vs 96 hours, P < 0.001), whereas there were no differences in blood loss, operation time, and resection margins. Mortality at 90 days did not differ significantly from the laparoscopic group (0 patients) to the open group (1 patient). In a 4-month perspective, the costs were equal, whereas patients in the laparoscopic-surgery group gained 0.011 quality-adjusted life years compared to patients in the open-surgery group (P = 0.001). CONCLUSIONS In patients undergoing parenchyma-sparing liver resection for colorectal metastases, laparoscopic surgery was associated with significantly less postoperative complications compared to open surgery. Laparoscopic resection was cost-effective compared to open resection with a 67% probability. The rate of free resection margins was the same in both groups. Our results support the continued implementation of laparoscopic liver resection.
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47
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Ratti F, Fiorentini G, Cipriani F, Catena M, Paganelli M, Aldrighetti L. Laparoscopic vs Open Surgery for Colorectal Liver Metastases. JAMA Surg 2018; 153:1028-1035. [PMID: 30027220 PMCID: PMC6583700 DOI: 10.1001/jamasurg.2018.2107] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Accepted: 04/22/2018] [Indexed: 12/18/2022]
Abstract
Importance Surgery represents the mainstay treatment of colorectal liver metastases. Indications for the laparoscopic approach in this setting have been widened and there is a need to confirm the benefits of minimally invasive liver surgery (MILS) in patients with complex disease states. Objective To compare outcomes of laparoscopic surgery with those of open surgery for liver metastases from colorectal cancer, focusing on the characteristics of modern MILS and therefore overcoming possible selection bias related to different policies for patients' eligibility for MILS over time. Design, Setting, and Participants A cohort study of 885 resections performed for liver metastases from colorectal cancer between January 1, 2004, and June 30, 2017, at the Hepatobiliary Surgery Unit of San Raffaele Hospital, Milano, Italy, comprising 187 laparoscopic and 698 open resections. Procedures performed using the MILS approach with a ratio of MILS to total resections per year of more than 30% were considered and were matched by propensity scores (ratio of 1:4) to procedures performed using the open approach with a ratio of MILS to total resections per year of less than 30%. Main Outcomes and Measures The primary end point was short-term outcomes, including morbidity, mortality, functional recovery, and interval between surgery and adjuvant treatments; the secondary end point was long-term outcomes. Results Among this cohort (104 patients in the MILS group; 46 women and 58 men; median age, 62 years [range, 35-81 years]; and 412 patients in the open group; 181 women and 231 men; median age, 60 years [range, 37-80 years]), primary end-point data showed a significantly higher incidence of postoperative morbidity in patients who underwent open resections compared with those who underwent MILS (94 [22.8%] vs 21 [20.2%]; P = .04). Patients in the MILS group had fewer major complications (Dindo-Clavien grades III-V) compared with patients in the open group (Dindo-Clavien grades III-V; 7 [6.7%] vs 35 [8.5%]; P = .03) as well as shorter lengths of stay (median [range] duration, 3 [2-35] vs 5 [4-37] days; P = .02). Oncologic results were not compromised by the laparoscopic approach. Conclusions and Relevance In this study, the results of the propensity score matching analysis between modern laparoscopic surgery and previous open surgery appear to confer more comparable cohorts for complexity, further supporting the advantages of laparoscopy in the surgical treatment of liver metastases from colorectal cancer. The increase in use that laparoscopy has experienced appears to be based on increased feasibility, widening of eligibility criteria for patients, enhanced clinical effectiveness, and oncologic outcomes. All these elements together suggest that up to 70% of patients appear to be candidates for this minimally invasive surgical approach in high-volume centers.
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Affiliation(s)
- Francesca Ratti
- Hepatobiliary Surgery Division, Istituto Ricovero e Cura a Carattere Scientifico San Raffaele Hospital, Milano, Italy
| | - Guido Fiorentini
- Hepatobiliary Surgery Division, Istituto Ricovero e Cura a Carattere Scientifico San Raffaele Hospital, Milano, Italy
| | - Federica Cipriani
- Hepatobiliary Surgery Division, Istituto Ricovero e Cura a Carattere Scientifico San Raffaele Hospital, Milano, Italy
| | - Marco Catena
- Hepatobiliary Surgery Division, Istituto Ricovero e Cura a Carattere Scientifico San Raffaele Hospital, Milano, Italy
| | - Michele Paganelli
- Hepatobiliary Surgery Division, Istituto Ricovero e Cura a Carattere Scientifico San Raffaele Hospital, Milano, Italy
| | - Luca Aldrighetti
- Hepatobiliary Surgery Division, Istituto Ricovero e Cura a Carattere Scientifico San Raffaele Hospital, Milano, Italy
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Proteasome Activity and C-Reactive Protein Concentration in the Course of Inflammatory Reaction in Relation to the Type of Abdominal Operation and the Surgical Technique Used. Mediators Inflamm 2018; 2018:2469098. [PMID: 30405319 PMCID: PMC6204193 DOI: 10.1155/2018/2469098] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Revised: 09/04/2018] [Accepted: 09/10/2018] [Indexed: 11/30/2022] Open
Abstract
Surgical tissue damage and the accompanying inflammatory response lead to proteasome activation, initiation of damaged protein degradation, and induction of acute-phase inflammatory response. The aim of this study was to investigate the rate of change in proteasome chymotrypsin-like (ChT-L) activity and C-reactive protein concentration depending on the degree of tissue damage and their correlation with prealbumin concentrations in children before and after abdominal surgery. This experimental study included children who underwent abdominal surgery between 2015 and 2017. Plasma prealbumin concentrations and C-reactive protein levels (CRP) were determined by standard biochemical laboratory procedures. Proteasome activity was assessed using a Suc-Leu-Leu-Val-Tyr-AMC peptide substrate. Elevation of plasma proteasome activity was noted in children after laparoscopic and open abdominal surgeries. However, 20S proteasome activity in children undergoing conventional open surgery was significantly higher (P < 0.05) than in patients subjected to laparoscopy. At the same time, an increase in the CRP level was observed. However, there was no correlation between C-reactive protein concentrations and the type of abdominal surgery while there was a correlation observed in the case of proteasomes. Proteasome activity correlates with the degree of surgical tissue damage and prealbumin concentrations. More invasive surgery leads to a stronger activation of the proteasome involved in removing proteins that were damaged due to the surgical procedure. Proteasomes are more specific markers because there is a correlation between proteasome activity and the type of abdominal surgery in contrast to C-reactive protein concentrations which are not different in response to surgery performed in regard to ovarian cysts or cholelithiasis.
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Béduer A, Piacentini N, Aeberli L, Da Silva A, Verheyen C, Bonini F, Rochat A, Filippova A, Serex L, Renaud P, Braschler T. Additive manufacturing of hierarchical injectable scaffolds for tissue engineering. Acta Biomater 2018; 76:71-79. [PMID: 29883809 DOI: 10.1016/j.actbio.2018.05.056] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Revised: 04/28/2018] [Accepted: 05/31/2018] [Indexed: 12/22/2022]
Abstract
We present a 3D-printing technology allowing free-form fabrication of centimetre-scale injectable structures for minimally invasive delivery. They result from the combination of 3D printing onto a cryogenic substrate and optimisation of carboxymethylcellulose-based cryogel inks. The resulting highly porous and elastic cryogels are biocompatible, and allow for protection of cell viability during compression for injection. Implanted into the murine subcutaneous space, they are colonized with a loose fibrovascular tissue with minimal signs of inflammation and remain encapsulation-free at three months. Finally, we vary local pore size through control of the substrate temperature during cryogenic printing. This enables control over local cell seeding density in vitro and over vascularization density in cell-free scaffolds in vivo. In sum, we address the need for 3D-bioprinting of large, yet injectable and highly biocompatible scaffolds and show modulation of the local response through control over local pore size. STATEMENT OF SIGNIFICANCE This work combines the power of 3D additive manufacturing with clinically advantageous minimally invasive delivery. We obtain porous, highly compressible and mechanically rugged structures by optimizing a cryogenic 3D printing process. Only a basic commercial 3D printer and elementary control over reaction rate and freezing are required. The porous hydrogels obtained are capable of withstanding delivery through capillaries up to 50 times smaller than their largest linear dimension, an as yet unprecedented compression ratio. Cells seeded onto the hydrogels are protected during compression. The hydrogel structures further exhibit excellent biocompatibility 3 months after subcutaneous injection into mice. We finally demonstrate that local modulation of pore size grants control over vascularization density in vivo. This provides proof-of-principle that meaningful biological information can be encoded during the 3D printing process, deploying its effect after minimally invasive implantation.
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50
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Binnebösel M, Lambertz A, Dejong K, Neumann UP. [Oligometastasized colorectal cancer-modern treatment strategies]. Chirurg 2018; 89:497-504. [PMID: 29872867 DOI: 10.1007/s00104-018-0661-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND The prognosis of colorectal cancer in UICC stage IV has been improved in the last decades by improvements in interdisciplinary treatment. MATERIAL AND METHODS Treatment strategies for oligometastasized colorectal cancer are developing more and more into an individualized treatment. An overview of the current literature of modern treatment concepts in oligometastasized colorectal cancer UICC stage IV is given. RESULTS Surgery still has the supreme mandate in resectable colorectal liver metastases, as neoadjuvant and adjuvant treatment strategies to not provide any benefits for these patients. In marginal or non-resectable stages systemic treatment is superior in these patients depending on the prognostic parameters. Also in curative settings local treatment options should be considered as a reasonable additive tool. An interesting treatment approach for isolated liver metastases and non-resectable colorectal cancer is liver transplantation. CONCLUSION Irrespective of new developments in treatment strategies for metastasized colorectal cancer, resection of colorectal liver metastases remains the gold standard whenever possible.
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Affiliation(s)
- M Binnebösel
- Klinik für Allgemein‑, Viszeral- und Transplantationschirurgie, Uniklinik der RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Deutschland.,Department of Surgery, University Medical Center Maastricht, Maastricht, Niederlande
| | - A Lambertz
- Klinik für Allgemein‑, Viszeral- und Transplantationschirurgie, Uniklinik der RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Deutschland
| | - K Dejong
- Klinik für Allgemein‑, Viszeral- und Transplantationschirurgie, Uniklinik der RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Deutschland.,Department of Surgery, University Medical Center Maastricht, Maastricht, Niederlande
| | - U P Neumann
- Klinik für Allgemein‑, Viszeral- und Transplantationschirurgie, Uniklinik der RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Deutschland. .,Department of Surgery, University Medical Center Maastricht, Maastricht, Niederlande.
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