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Bonny P, Bogaert C, Abreu de Carvalho LF, Gryspeerdt F, Eker H, Hermie L, Berrevoet F. Evolution in liver trauma management: a single centre experience. Acta Chir Belg 2024:1-12. [PMID: 38607666 DOI: 10.1080/00015458.2024.2342132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 04/08/2024] [Indexed: 04/13/2024]
Abstract
OBJECTIVES Liver trauma is common and can be treated non-operatively, through radiological embolisation, or surgically. Non-operative management (NOM) is preferred when possible, but specific criteria remain unclear. This retrospective study at a level I trauma centre assessed the evolution and outcomes of liver injury management over more than 20 years. METHODS Data from January 1996 to June 2020 were analysed for liver trauma cases. Variables were evaluated, including the type of injury, diagnostic modalities, liver injury grade, transfer from other hospitals, treatment type, and length of hospital stay. Outcomes were assessed using soft (hospitalisation time and intensive care unit stay) and hard (mortality) endpoints. RESULTS In total 406 patients were analysed, of which 375 (92.4%) had a blunt and 31 (7.6%) a penetrating liver trauma. Approximately one-third (31.2%) were hemodynamically unstable, although 78.8% had low-grade liver lesions. The initial treatment was non-operative in 72.9% of the patients (68.5% conservative, 4.4% interventional radiology). Blunt trauma was treated by surgery in 23.2% of the patients, while 74.2% in case of penetrating trauma. Overall mortality was 11.1% including death caused by associated lesions. The 24-h mortality was 5.7%. Indication for surgical treatment was determined by hemodynamic instability, high grade liver lesion, penetrating trauma, and associated lesions. CONCLUSIONS Although the role of surgery in liver trauma management has strongly diminished over recent decades, hemodynamically unstable patients, high-grade lesions, penetrating trauma, and severe associated lesions are the main indications for surgery. In other situations, NOM by full conservative therapy or radiological embolisation seems effective.
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Affiliation(s)
- Paulien Bonny
- Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
- Department of General and HPB Surgery and Liver Transplantation, Ghent University Hospital, Ghent, Belgium
| | - Constantijn Bogaert
- Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
- Department of General and HPB Surgery and Liver Transplantation, Ghent University Hospital, Ghent, Belgium
| | | | - Filip Gryspeerdt
- Department of General and HPB Surgery and Liver Transplantation, Ghent University Hospital, Ghent, Belgium
| | - Hasan Eker
- Department of General and HPB Surgery and Liver Transplantation, Ghent University Hospital, Ghent, Belgium
| | - Laurens Hermie
- Division of Interventional Radiology, Department of Radiology, Ghent University Hospital, Ghent, Belgium
| | - Frederik Berrevoet
- Department of General and HPB Surgery and Liver Transplantation, Ghent University Hospital, Ghent, Belgium
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Goetz MR, Heumann A, Bassi C, Landoni L, Khatib-Chahidi K, Ghadimi M, von Heessen M, Berrevoet F, Gryspeerdt F, Besselink M, van Bodegraven EA, Adham M, Pratschke J, Schöning W, Izbicki JR, Bockhorn M. Safety and performance of a synthetic sealant patch aimed to prevent postoperative pancreatic fistula after distal pancreatectomy (SHIELDS) - Prospective international multicenter phase II study. HPB (Oxford) 2024:S1365-182X(24)00059-5. [PMID: 38653711 DOI: 10.1016/j.hpb.2024.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 01/26/2024] [Accepted: 03/08/2024] [Indexed: 04/25/2024]
Abstract
OBJECTIVE The incidence for clinically relevant postoperative pancreatic fistulas (CR-POPF) in distal pancreatectomy (DP) ranges up to 25%. None of the available sealants significantly reduce CR-POPF. A new biodegradable sealant patch was able to reduce POPF and to achieve bleeding control in a preclinical porcine DP model. The aim of this first-in-human study was to assess the safety and performance of the sealant patch. METHODS In this multicenter, single-arm study, 40 patients undergoing distal pancreatectomy were prospectively enrolled from 8 centers. Following surgical resection, the transection plane was closed according to the standard of care and manually covered with the sealant patch. As primary endpoint the incidence of CR-POPF up to 30-days postoperatively was evaluated. The secondary endpoints included the assessment of complications and device usability. RESULTS Among 40 patients after distal pancreatectomy, CR-POPF occurred in 7 (17.5%) up to postoperative day 30. No type C POPF was observed. There was no intraoperative bleeding observed after patch application. CONCLUSION The results of this international phase II study demonstrate promising results of a new sealant patch regarding the rate of CR-POPF. Randomized studies are now needed to confirm the superiority of the current patch as compared to the best current practice.
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Affiliation(s)
- Mara R Goetz
- Department of General, Visceral and Thoracic Surgery, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Asmus Heumann
- Department of General, Visceral and Thoracic Surgery, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Claudio Bassi
- Department of Surgery, Pancreas Institute, Verona University Hospital, Verona, Italy
| | - Luca Landoni
- Department of Surgery, Pancreas Institute, Verona University Hospital, Verona, Italy
| | - Karl Khatib-Chahidi
- Department for General- and Visceral Surgery, University Hospital Oldenburg, Oldenburg, Germany
| | - Michael Ghadimi
- Department of General, Visceral, and Pediatric Surgery, University Medical Center Göttingen, Göttingen, Germany
| | - Maximillian von Heessen
- Department of General, Visceral, and Pediatric Surgery, University Medical Center Göttingen, Göttingen, Germany
| | - Frederik Berrevoet
- Department of General and Hepatopancreatobiliary Surgery and Liver Transplantation, Ghent University Hospital, Ghent, Belgium
| | - Filip Gryspeerdt
- Department of General and Hepatopancreatobiliary Surgery and Liver Transplantation, Ghent University Hospital, Ghent, Belgium
| | - Marc Besselink
- Department of Surgery, Amsterdam UMC, Location University of Amsterdam, Amsterdam, the Netherlands; Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - Eduard A van Bodegraven
- Department of Surgery, Amsterdam UMC, Location University of Amsterdam, Amsterdam, the Netherlands; Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - Mustapha Adham
- Department of Digestive, Hepato-Biliary and Pancreatic Surgery, Edouard Herriot Hospital, Lyon, France
| | - Johann Pratschke
- Department of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Charité- Universitätsmedizin Berlin, Berlin, Germany
| | - Wenzel Schöning
- Department of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Charité- Universitätsmedizin Berlin, Berlin, Germany
| | - Jakob R Izbicki
- Department of General, Visceral and Thoracic Surgery, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Maximilian Bockhorn
- Department for General- and Visceral Surgery, University Hospital Oldenburg, Oldenburg, Germany.
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de Carvalho LFA, Gryspeerdt F, Rashidian N, Van Hove K, Maertens L, Ribeiro S, Hoorens A, Berrevoet F. Predictive factors for survival in borderline resectable and locally advanced pancreatic cancer: are these really two different entities? BMC Surg 2023; 23:296. [PMID: 37775737 PMCID: PMC10541717 DOI: 10.1186/s12893-023-02200-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 09/18/2023] [Indexed: 10/01/2023] Open
Abstract
BACKGROUND The treatment of borderline resectable (BR) and locally advanced (LA) pancreatic ductal adenocarcinoma (PDAC) has evolved with a wider application of neoadjuvant chemotherapy (NACHT). The aim of this study was to identify predictive factors for survival in BR and LA PDAC. METHODS Clinicopathologic data of patients with BR and LA PDAC who underwent surgical exploration between January 2011 and June 2021 were retrospectively collected. Survival from the date of surgery was estimated using the Kaplan-Meier method. Simple and multiple Cox proportional hazards models were fitted to identify factors associated with survival. Surgical resection was analyzed in combination with the involvement of lymph nodes as this last was only known after a formal resection. RESULTS Ninety patients were surgically explored (BR: 45, LA: 45), of which 51 (57%) were resected (BR: 31, LA: 20). NACHT was administered to 43 patients with FOLFIRINOX being the most frequent regimen applied (33/43, 77%). Major complications (Clavien-Dindo grade III and IV) occurred in 7.8% of patients and 90-day mortality rate was 3.3%. The median overall survival since surgery was 16 months (95% CI 12-20) in the group which underwent surgical resection and 10 months (95% CI 7-13) in the group with an unresectable tumor (p=0.001). Cox proportional hazards models showed significantly lower mortality hazard for surgical resection compared to no surgical resection, even after adjusting for National Comprehensive Cancer Network (NCCN) classification and administration of NACHT [surgical resection with involved lymph nodes vs no surgical resection (cHR 0.49; 95% CI 0.29-0.82; p=0.007)]. There was no significant difference in survival between patients with BR and LA disease (cHR= 1.01; 95% CI 0.63-1.62; p=0.98). CONCLUSIONS Surgical resection is the only predictor of survival in patients with BR and LA PDAC, regardless of their initial classification as BR or LA. Our results suggest that surgery should not be denied to patients with LA PDAC a priori. Prospective studies including patients from the moment of diagnosis are required to identify biologic and molecular markers which may allow a better selection of patients who will benefit from surgery.
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Affiliation(s)
- Luís Filipe Abreu de Carvalho
- Department of HPB surgery and liver transplantation, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium.
| | - Filip Gryspeerdt
- Department of HPB surgery and liver transplantation, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Niki Rashidian
- Department of HPB surgery and liver transplantation, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Kobe Van Hove
- Department of HPB surgery and liver transplantation, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Lambertine Maertens
- Department of HPB surgery and liver transplantation, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Suzane Ribeiro
- Department of Gastroenterology, Division of Digestive Oncology, Ghent University Hospital, Ghent, Belgium
| | - Anne Hoorens
- Department of Pathology, Ghent University Hospital, Ghent, Belgium
| | - Frederik Berrevoet
- Department of HPB surgery and liver transplantation, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
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Maris L, De Man K, Gryspeerdt F, Hoorens A, Keereman V, Kiekens A, Van den Broeck B, Van de Sande L, Vanhove C, Berrevoet F. 18F-FDG-PET-CT specimen imaging for perioperative visualization of pancreatic adenocarcinoma: a proof-of-concept study. European Journal of Surgical Oncology 2023. [DOI: 10.1016/j.ejso.2022.11.445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
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Abstract
BACKGROUND Midgut volvulus is a rare cause of acute abdomen characterized by a twisting of the entire small intestine around its mesenteric pedicle. It is a well-known complication of intestinal malrotation usually occurring in infants and young children. We report a rare case of a midgut volvulus without any underlying condition occurring in a young adult. CASE PRESENTATION A 24-year-old male was admitted to our surgical department with symptoms and signs of small bowel obstruction. The abdominal computed tomography (CT) scan showed dilatation of the entire small intestine and a rotation of the mesentery. The patient underwent an urgent explorative laparoscopy with conversion to median laparotomy, revealing a midgut volvulus with marked intestinal ischemia. Mesenteric fixation was normal but the mesenteric pedicle was described as relatively narrow. The midgut volvulus was untwisted with subsequent recovery of the intestinal ischemia. RESULTS The postoperative period was marked by prolonged ileus requiring nasogastric tube decompression that gradually resolved after 1 week. The patient was discharged on the tenth postoperative day. He had fully resumed his daily activities 1 month after surgery and had experienced no recurrent symptoms 6 months later. CONCLUSION Primary midgut volvulus is an extremely rare condition that must be considered in all young adults presenting with intestinal obstruction without previous abdominal surgery. Early diagnosis and immediate surgical intervention are the key factors to a successful outcome.
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Affiliation(s)
- Nicolas De Hous
- Department of Abdominal Surgery, H.-Hartziekenhuis, Lier, Belgium
| | | | | | - Filip Gryspeerdt
- Department of Abdominal Surgery, H.-Hartziekenhuis, Lier, Belgium
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Mansour L, Nassabein RM, Gryspeerdt F, Vandenbroucke-Menu F, Aubin F, Ayoub JPM, Dagenais M, Lapointe RW, Letourneau R, Plasse M, Roy A, Turcotte S, Tehfe M. Outcomes of elderly patients with resectable liver metastases from colorectal cancer (CRLM): Single center experience. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.4_suppl.34] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
34 Background: Half of patients with colorectal cancer develop liver metastases during the course of their disease. Surgery is the only potentially curative option for CRLM if resectable. Treatment of patients over 70 years old is challenging mainly because of comorbidities and other geriatric syndromes. Thus, we intended to report our experience with elderly patients with resectable CRLM. Methods: After approval by the Institutional Review Board (IRB), all records from a prospectively collected database at Centre Hospitalier de l’Université de Monréal (CHUM) were retrospectively analyzed. Clinicopathological characteristics, surgery and chemotherapy treatment modalities were reviewed. RFS and OS in patients ≥ 70y were calculated using the Kaplan Meier survival curve. Results: From 2010 to 2016, 101 patients older than 70 years were identified. Safety and surgical complications were previously reported. Median age was 75 years. CRLM were synchronous in 46.5% and metachronous in 53.5%. Relapse free survival (RFS) of patients ≥ 70 years was 33.7 months. Overall survival (OS) of patients ≥70 years was comparable to those of less than 65 years old (median OS: 56 vs 62 months; p = 0.15, respectively). Hepatic relapse showed worse survival when compared to extra-liver recurrence, mOS: 44 vs 33.2 vs 29.3 months for non-hepatic, hepatic only and hepatic with other sites respectively (trend p = 0.034). Although non-statistically significant, Patients with metachronous CRLM had superior mOS compared to those with synchronous disease (58.7 vs 44.7 months; p = 0.22). Conclusions: Survival Outcomes of patients with an age ≥ 70 years were comparable to those of younger patients and what is reported in literature. Age should not be a limiting factor in the management of elderly patients with resectable CRLM. Hepatic metastatectomies +/- chemotherapy should be offered with curative intents.
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Affiliation(s)
| | | | - Filip Gryspeerdt
- Centre Hospitalier d'Université de Montreal, Montreal, QC, Canada
| | - Franck Vandenbroucke-Menu
- Hepato-Pancreato-Biliary Surgery Service, Centre Hospitalier De L'université De Montréal (CHUM), Montréal, QC, Canada
| | - Francine Aubin
- Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, QC, Canada
| | | | - Michel Dagenais
- Hepato-Pancreato-Biliary Surgery Service, Centre Hospitalier De L'université De Montréal (CHUM), Montréal, QC, Canada
| | | | - Richard Letourneau
- Hepato-Pancreato-Biliary Surgery Service, Centre Hospitalier De L'université De Montréal (CHUM), Montréal, QC, Canada
| | - Marylene Plasse
- Hepato-Pancreato-Biliary Surgery Service, Centre Hospitalier De L'université De Montréal (CHUM), Montréal, QC, Canada
| | - Andre Roy
- Hepato-Pancreato-Biliary Surgery Service, Centre Hospitalier De L'université De Montréal (CHUM), Montréal, QC, Canada
| | - Simon Turcotte
- Hepato-Pancreato-Biliary Surgery Service and Research Centre, Centre Hospitalier De L'université De Montréal (CHUM), Montréal, QC, Canada
| | - Mustapha Tehfe
- Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, QC, Canada
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Abstract
INTRODUCTION Hepatocellular adenoma (HCA) is a benign neoplasm of the liver, however, with a potential for life-threatening hemorrhage. The unpredictable course during pregnancy poses a clinical dilemma in the pregnant patient. Intra-peritoneal rupture may lead to life-threatening situations with adverse outcome for mother and unborn child. A pre-emptive strategy with adequate treatment before pregnancy is strongly advised. However, the strategy for treating symptomatic HCA during pregnancy remains challenging as experience is limited. CASE PRESENTATION A 31-year-old pregnant patient at the gestational age of 17 weeks presented with an acute episode of right upper abdomen pain. MR-imaging revealed a lesion of 9 cm located in segment III with stigmata of recent hemorrhage. At 18 weeks of gestation, she underwent a semi-elective laparoscopic left lateral sectionectomy. RESULTS Surgery and postoperative recovery were uneventful. Patient was discharged at POD +6. At 40 weeks of gestation, she went in spontaneous labor and delivered a healthy baby. Histological examination confirmed a HCA, inflammatory subtype, showing features of hemorrhage. CONCLUSION In the pregnant patient, HCA represents a significant diagnostic and therapeutic challenge. Anatomically favorable located lesions can be safely managed with laparoscopic liver resection. We suggest that laparoscopic liver resection should be considered as part of the currently available strategies for HCA during pregnancy.
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Affiliation(s)
- F. Gryspeerdt
- Department of Abdominal Surgery, UZ Leuven, Leuven, Belgium
| | - R. Aerts
- Department of Abdominal Surgery, UZ Leuven, Leuven, Belgium
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