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Mentha G, Schopfer C, Vadas L, Belenger J, Morel P, Criado F, Rohner A. Influence of hepatic dysfunction on cyclosporine metabolism in the pig. Transpl Int 2018. [DOI: 10.1111/tri.1992.5.s1.511] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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2
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Labgaa I, Slankamenac K, Schadde E, Jibara G, Alshebeeb K, Mentha G, Clavien PA, Schwartz M. Liver resection for metastases not of colorectal, neuroendocrine, sarcomatous, or ovarian (NCNSO) origin: A multicentric study. Am J Surg 2018; 215:125-130. [DOI: 10.1016/j.amjsurg.2017.09.030] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Revised: 08/25/2017] [Accepted: 09/19/2017] [Indexed: 12/24/2022]
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Laurent A, Dokmak S, Nault JC, Pruvot FR, Fabre JM, Letoublon C, Bachellier P, Capussotti L, Farges O, Mabrut JY, Le Treut YP, Ayav A, Suc B, Soubrane O, Mentha G, Popescu I, Montorsi M, Demartines N, Belghiti J, Torzilli G, Cherqui D, Hardwigsen J. European experience of 573 liver resections for hepatocellular adenoma: a cross-sectional study by the AFC-HCA-2013 study group. HPB (Oxford) 2016; 18:748-55. [PMID: 27593592 PMCID: PMC5011084 DOI: 10.1016/j.hpb.2016.06.011] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Revised: 06/13/2016] [Accepted: 06/14/2016] [Indexed: 12/12/2022]
Abstract
BACKGROUND Hepatocellular adenoma (HCA) is a benign hepatic lesion that may be complicated by bleeding and malignant transformation. The aim of the present study is to report on large series of liver resections for HCA and assess the incidence of hemorrhage and malignant transformation. METHODS A retrospective cross-sectional study, from 27 European high-volume HPB units. RESULTS 573 patients were analyzed. The female: male gender ratio was 8:2, mean age: 37 ± 10 years. Of the 84 (14%) patients whose initial presentation was hemorrhagic shock (Hemorrhagic HCAs), hemostatic intervention was urgently required in 25 (30%) patients. No patients died after intervention. Tumor size was >5 cm in 74% in hemorrhagic HCAs and 64% in non-hemorrhagic HCAs (p < 0.001). In non-hemorrhagic HCAs (n = 489), 5% presented with malignant transformation. Male status and tumor size >10 cm were the two predictive factors. Liver resections included major hepatectomy in 25% and a laparoscopic approach in 37% of the patients. In non-hemorrhagic HCAs, there was no mortality and major complications occurred in 9% of patients. DISCUSSION Liver resection for HCA is safe. Presentation with hemorrhage was associated with larger tumor size. In males with a HCA >10 cm, a HCC should be suspected. In such situation, a preoperative biopsy is preferable and an oncological liver resection should be considered.
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Affiliation(s)
- Alexis Laurent
- Department of Digestive and Hepatobiliary Surgery, AP-HP, Henri Mondor University Hospital, Créteil, France; INSERM, UMR 955, Créteil, France.
| | - Safi Dokmak
- Department of Hepatopancreatobiliary Surgery and Liver Transplantation, Beaujon Hospital, Clichy, France
| | - Jean-Charles Nault
- Department of hepatology, Hôpital Jean Verdier, Bondy, France; Inserm, UMR-1162, Paris, France
| | - François-René Pruvot
- Department of Digestive Surgery and Transplantation, CHU, Univ Nord de France, Lille, France
| | - Jean-Michel Fabre
- Department of Digestive Surgery and Transplantation, St Eloi Hospital, Montpellier, France
| | | | - Philippe Bachellier
- Department of Surgery, University Hospital of Hautepierre, Strasbourg, France
| | - Lorenzo Capussotti
- Department of HPB and Digestive Surgery, Ospedale Mauriziano Umberto I, Turin, Italy
| | - Olivier Farges
- Department of Hepatopancreatobiliary Surgery and Liver Transplantation, Beaujon Hospital, Clichy, France
| | | | | | - Ahmet Ayav
- Department of Digestive, Hepato-Biliary, Endocrine Surgery, and Surgical Oncology, Université de Lorraine, CHU, Nancy, France
| | - Bertrand Suc
- Department of Digestive Surgery and Transplantation, Hôpital Rangueil, Toulouse, France
| | - Olivier Soubrane
- Department of Hepatopancreatobiliary Surgery and Liver Transplantation, Beaujon Hospital, Clichy, France
| | - Gilles Mentha
- Department of Visceral and Transplantation Surgery, University Hospitals, Geneva, Switzerland
| | - Irinel Popescu
- Center of Gastrointestinal Disease and Liver Transplantation, Fundeni Clinical Institute, Bucharest, Romania
| | - Marco Montorsi
- Department of General Surgery, Humanitas University and Research Hospital, Milano, Italy
| | - Nicolas Demartines
- Department of Visceral Surgery, University Hospital of Lausanne (CHUV), Lausanne, Switzerland
| | - Jacques Belghiti
- Department of Hepatopancreatobiliary Surgery and Liver Transplantation, Beaujon Hospital, Clichy, France
| | - Guido Torzilli
- Department of General Surgery, Humanitas University and Research Hospital, Milano, Italy
| | - Daniel Cherqui
- Hepatobiliary Center, Paul Brousse Hospital, Villejuif, France
| | - Jean Hardwigsen
- Department of Surgery, Hôpital de la Timone, Marseille, France
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Djaafar S, Dunand-Sautier I, Gonelle-Gispert C, Lacotte S, DE Agostini A, Petro M, Rubbia-Brandt L, Morel P, Toso C, Mentha G. Enoxaparin Attenuates Mouse Colon Cancer Liver Metastases by Inhibiting Heparanase and Interferon-γ-inducible Chemokines. Anticancer Res 2016; 36:4019-4032. [PMID: 27466508] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Accepted: 07/08/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND/AIM Low-molecular-weight heparin (LMWH) has been suggested to reduce the risk of cancer progression in both preclinical and clinical studies but the underlying mechanisms remain poorly explored. The aim of the study was to investigate the anti-metastatic role of enoxaparin, a clinically-used LMWH, in a murine model of colon cancer and to explore its underlying mechanisms. MATERIALS AND METHODS Using a reproducible mouse model of colon carcinomas, we assessed the capacity of enoxaparin, a LMWH, to affect tumor metastasis of colon carcinoma cell lines in mice. RESULTS The hepatic growth of colon carcinoma metastases was strongly inhibited by enoxaparin compared to (Ctrl) group (p=0.001). This effect was associated to an inhibition of heparanase mRNA expression and protein production both in vivo and in vitro. In addition, enoxaparin inhibited the liver and serum production of interferon gamma (Ifnγ)-inducible chemokine receptor ligands. Overexpression of heparanase prompted proliferation, migration and growth of colon carcinoma in vitro and in vivo to a point that was not affected by enoxaparin in vivo anymore. CONCLUSION Enoxaparin decreased liver metastases in a mouse model of colon carcinoma. These results suggest that enoxaparin may benefit patients with cancer and deserves further laboratory and clinical investigations.
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Affiliation(s)
- Souad Djaafar
- Department of Surgery, Geneva University Hospitals, Faculty of Medicine, Geneva, Switzerland
| | - Isabelle Dunand-Sautier
- Division of Clinical Pathology, Geneva University Hospitals, Faculty of Medicine, Geneva, Switzerland
| | - Carmen Gonelle-Gispert
- Department of Surgery, Geneva University Hospitals, Faculty of Medicine, Geneva, Switzerland Hepato-Pancreato-Biliary Center, Geneva University Hospitals, Geneva, Switzerland
| | - Stephanie Lacotte
- Department of Surgery, Geneva University Hospitals, Faculty of Medicine, Geneva, Switzerland
| | - Ariane DE Agostini
- Division of Clinical Pathology, Geneva University Hospitals, Faculty of Medicine, Geneva, Switzerland
| | - Majno Petro
- Department of Surgery, Geneva University Hospitals, Faculty of Medicine, Geneva, Switzerland Hepato-Pancreato-Biliary Center, Geneva University Hospitals, Geneva, Switzerland
| | - Laura Rubbia-Brandt
- Division of Clinical Pathology, Geneva University Hospitals, Faculty of Medicine, Geneva, Switzerland
| | - Philippe Morel
- Department of Surgery, Geneva University Hospitals, Faculty of Medicine, Geneva, Switzerland Hepato-Pancreato-Biliary Center, Geneva University Hospitals, Geneva, Switzerland
| | - Christian Toso
- Department of Surgery, Geneva University Hospitals, Faculty of Medicine, Geneva, Switzerland Hepato-Pancreato-Biliary Center, Geneva University Hospitals, Geneva, Switzerland
| | - Gilles Mentha
- Department of Surgery, Geneva University Hospitals, Faculty of Medicine, Geneva, Switzerland Hepato-Pancreato-Biliary Center, Geneva University Hospitals, Geneva, Switzerland
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Lutz MP, Zalcberg JR, Glynne-Jones R, Ruers T, Ducreux M, Arnold D, Aust D, Brown G, Bujko K, Cunningham C, Evrard S, Folprecht G, Gerard JP, Habr-Gama A, Haustermans K, Holm T, Kuhlmann KF, Lordick F, Mentha G, Moehler M, Nagtegaal ID, Pigazzi A, Pucciarelli S, Roth A, Rutten H, Schmoll HJ, Sorbye H, Van Cutsem E, Weitz J, Otto F. Second St. Gallen European Organisation for Research and Treatment of Cancer Gastrointestinal Cancer Conference: consensus recommendations on controversial issues in the primary treatment of rectal cancer. Eur J Cancer 2016; 63:11-24. [PMID: 27254838 DOI: 10.1016/j.ejca.2016.04.010] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [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: 01/20/2016] [Revised: 04/10/2016] [Accepted: 04/17/2016] [Indexed: 01/12/2023]
Abstract
Primary treatment of rectal cancer was the focus of the second St. Gallen European Organisation for Research and Treatment of Cancer (EORTC) Gastrointestinal Cancer Conference. In the context of the conference, a multidisciplinary international expert panel discussed and voted on controversial issues which could not be easily answered using published evidence. Main topics included optimal pretherapeutic imaging, indication and type of neoadjuvant treatment, and the treatment strategies in advanced tumours. Here we report the key recommendations and summarise the related evidence. The treatment strategy for localised rectal cancer varies from local excision in early tumours to neoadjuvant radiochemotherapy (RCT) in combination with extended surgery in locally advanced disease. Optimal pretherapeutic staging is a key to any treatment decision. The panel recommended magnetic resonance imaging (MRI) or MRI + endoscopic ultrasonography (EUS) as mandatory staging modalities, except for early T1 cancers with an option for local excision, where EUS in addition to MRI was considered to be most important because of its superior near-field resolution. Primary surgery with total mesorectal excision was recommended by most panellists for some early tumours with limited risk of recurrence (i.e. cT1-2 or cT3a N0 with clear mesorectal fascia on MRI and clearly above the levator muscles), whereas all other stages were considered for multimodal treatment. The consensus panel recommended long-course RCT over short-course radiotherapy for most clinical situations where neoadjuvant treatment is indicated, with the exception of T3a/b N0 tumours where short-course radiotherapy or even no neoadjuvant therapy were regarded to be an option. In patients with potentially resectable tumours and synchronous liver metastases, most panel members did not see an indication to start with classical fluoropyrimidine-based RCT but rather favoured preoperative short-course radiotherapy with systemic combination chemotherapy or alternatively a liver-first resection approach in resectable metastases, which both allow optimal systemic therapy for the metastatic disease. In general, proper patient selection and discussion in an experienced multidisciplinary team was considered as crucial component of care.
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Affiliation(s)
| | - John R Zalcberg
- Department of Epidemiology and Preventive Medicine, School of Public Health, Monash University, The Alfred Centre, Melbourne, Australia
| | - Rob Glynne-Jones
- Department of Medical Oncology, Mount Vernon Cancer Centre, Northwood, UK
| | - Theo Ruers
- The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Michel Ducreux
- Gustave Roussy, Université Paris-Saclay, Département de Médecine, Villejuif, France
| | - Dirk Arnold
- CUF Hospitals, Oncology Center, Lisbon, Portugal
| | - Daniela Aust
- Universitätsklinikum Carl Gustav Carus, Dresden, Germany
| | - Gina Brown
- Department of Diagnostic Imaging, The Royal Marsden NHS Foundation Trust, London, UK
| | - Krzysztof Bujko
- The Maria Sklodowska-Curie Memorial Cancer Centre, Warsaw, Poland
| | | | - Serge Evrard
- Institut Bergonié, Université de Bordeaux, Bordeaux, France
| | | | | | | | - Karin Haustermans
- Department of Radiation Oncology, University Hospitals Leuven, Belgium
| | - Torbjörn Holm
- Center for Digestive Diseases, Karolinska University Hospital, Stockholm, Sweden
| | | | - Florian Lordick
- University Cancer Center Leipzig (UCCL), University Medicine Leipzig, Germany
| | | | - Markus Moehler
- I. Med. Klinik und Poliklinik, Johannes Gutenberg Universität Mainz, Mainz, Germany
| | - Iris D Nagtegaal
- Department of Pathology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Alessio Pigazzi
- Department of Surgery, University of California, Irvine, CA, USA
| | | | | | - Harm Rutten
- Catharina Hospital Eindhoven, Eindhoven and GROW: School of Oncology and Developmental Biology, University Maastricht, Maastricht, The Netherlands
| | - Hans-Joachim Schmoll
- Department of Oncology/Haematology, Martin-Luther-University Halle, Halle (Saale), Germany
| | - Halfdan Sorbye
- Department of Oncology, Haukeland University Hospital, University of Bergen, Norway; Department of Clinical Science, Haukeland University Hospital, University of Bergen, Norway
| | - Eric Van Cutsem
- Digestive Oncology, University Hospitals Gasthuisberg/Leuven, Leuven, Belgium
| | - Jürgen Weitz
- Universitätsklinikum Carl Gustav Carus, Dresden, Germany
| | - Florian Otto
- Tumor- und Brustzentrum ZeTuP, St. Gallen, Switzerland
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Orci LA, Berney T, Majno PE, Lacotte S, Oldani G, Morel P, Mentha G, Toso C. Donor characteristics and risk of hepatocellular carcinoma recurrence after liver transplantation. Br J Surg 2015; 102:1250-7. [PMID: 26098966 DOI: 10.1002/bjs.9868] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Revised: 04/05/2015] [Accepted: 05/07/2015] [Indexed: 01/27/2023]
Abstract
BACKGROUND To date, studies assessing the risk of post-transplant hepatocellular carcinoma (HCC) recurrence have focused on tumour characteristics. This study investigated the impact of donor characteristics and graft quality on post-transplant HCC recurrence. METHODS Using the Scientific Registry of Transplant Recipients patients with HCC who received a liver transplant between 2004 and 2011 were included, and post-transplant HCC recurrence was assessed. A multivariable competing risk regression model was fitted, adjusting for confounders such as recipient sex, age, tumour volume, α-fetoprotein, time on the waiting list and transplant centre. RESULTS A total of 9724 liver transplant recipients were included. Patients receiving a graft procured from a donor older than 60 years (adjusted hazard ratio (HR) 1.38, 95 per cent c.i. 1.10 to 1.73; P = 0.006), a donor with a history of diabetes (adjusted HR 1.43, 1.11 to 1.83; P = 0.006) and a donor with a body mass index of 35 kg/m(2) or more (adjusted HR 1.36, 1.04 to 1.77; P = 0.023) had an increased rate of post-transplant HCC recurrence. In 3007 patients with documented steatosis, severe graft steatosis (more than 60 per cent) was also linked to an increased risk of recurrence (adjusted HR 1.65, 1.03 to 2.64; P = 0.037). Recipients of organs from donation after cardiac death donors with prolonged warm ischaemia had higher recurrence rates (adjusted HR 4.26, 1.20 to 15.1; P = 0.025). CONCLUSION Donor-related factors such as donor age, body mass index, diabetes and steatosis are associated with an increased rate of HCC recurrence after liver transplantation.
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Affiliation(s)
- L A Orci
- Division of Abdominal and Transplantation Surgery, Department of Surgery, University of Geneva, Geneva, Switzerland.,Hepato-Pancreato-Biliary Centre, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - T Berney
- Division of Abdominal and Transplantation Surgery, Department of Surgery, University of Geneva, Geneva, Switzerland.,Hepato-Pancreato-Biliary Centre, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - P E Majno
- Division of Abdominal and Transplantation Surgery, Department of Surgery, University of Geneva, Geneva, Switzerland.,Hepato-Pancreato-Biliary Centre, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - S Lacotte
- Division of Abdominal and Transplantation Surgery, Department of Surgery, University of Geneva, Geneva, Switzerland
| | - G Oldani
- Division of Abdominal and Transplantation Surgery, Department of Surgery, University of Geneva, Geneva, Switzerland.,Hepato-Pancreato-Biliary Centre, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - P Morel
- Division of Abdominal and Transplantation Surgery, Department of Surgery, University of Geneva, Geneva, Switzerland.,Hepato-Pancreato-Biliary Centre, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - G Mentha
- Division of Abdominal and Transplantation Surgery, Department of Surgery, University of Geneva, Geneva, Switzerland.,Hepato-Pancreato-Biliary Centre, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - C Toso
- Division of Abdominal and Transplantation Surgery, Department of Surgery, University of Geneva, Geneva, Switzerland.,Hepato-Pancreato-Biliary Centre, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland
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7
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Viganò L, Rubbia-Brandt L, De Rosa G, Majno P, Langella S, Toso C, Mentha G, Capussotti L. Nodular Regenerative Hyperplasia in Patients Undergoing Liver Resection for Colorectal Metastases After Chemotherapy: Risk Factors, Preoperative Assessment and Clinical Impact. Ann Surg Oncol 2015; 22:4149-57. [DOI: 10.1245/s10434-015-4533-0] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2014] [Indexed: 12/15/2022]
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8
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Andres A, Mentha G, Adam R, Gerstel E, Skipenko OG, Barroso E, Lopez-Ben S, Hubert C, Majno PE, Toso C. Surgical management of patients with colorectal cancer and simultaneous liver and lung metastases. Br J Surg 2015; 102:691-9. [DOI: 10.1002/bjs.9783] [Citation(s) in RCA: 76] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2014] [Revised: 11/24/2014] [Accepted: 01/14/2015] [Indexed: 02/06/2023]
Abstract
Abstract
Background
The management of patients with colorectal cancer and simultaneously diagnosed liver and lung metastases (SLLM) remains controversial.
Methods
The LiverMetSurvey registry was interrogated for patients treated between 2000 and 2012 to assess outcomes after resection of SLLM, and the factors associated with survival. SLLM was defined as liver and lung metastases diagnosed 3 months or less apart. Survival was compared between patients with resected isolated liver metastases (group 1, control), those with resected liver and lung metastases (group 2), and patients with resected liver metastases and unresected (or unresectable) lung metastases (group 3). An Akaike test was used to select variables for assessment of survival adjusted for confounding variables.
Results
Group 1 (isolated liver metastases, hepatic resection alone) included 9185 patients, group 2 (resection of liver and lung metastases) 149 patients, and group 3 (resection of liver metastases, no resection of lung metastases) 285 patients. Ten variables differed significantly between groups and seven were included in the model for adjusted survival (age, number of liver metastases, synchronicity of liver metastases with primary tumour, carcinoembryonic antigen level, node status of the primary tumour, initial resectability of liver metastases and inclusion in group 3). Adjusted overall 5-year survival was similar for groups 1 and 2 (51·5 and 44·5 per cent respectively), but worse for group 3 (14·3 per cent) (P = 0·001).
Conclusion
Patients who had resection of liver and lung metastases had similar overall survival to those who had undergone removal of isolated liver metastases.
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Affiliation(s)
- A Andres
- Abdominal and Transplantation Surgery, Geneva University Hospital and Faculty of Medicine, Geneva, Switzerland
- Hepato-pancreato-biliary Centre, Geneva, Switzerland
| | - G Mentha
- Abdominal and Transplantation Surgery, Geneva University Hospital and Faculty of Medicine, Geneva, Switzerland
- Hepato-pancreato-biliary Centre, Geneva, Switzerland
| | - R Adam
- Assistance Publique–Hôpitaux de Paris Hôpital Paul Brousse, Centre Hépato-Biliaire, Inserm U776, Université Paris-Sud, Villejuif, France
| | - E Gerstel
- Clinical Epidemiology, Geneva University Hospital, Geneva, Switzerland
- La Colline Clinic, Geneva, Switzerland
| | - O G Skipenko
- National Research Centre of Surgery, Moscow, Russia
| | - E Barroso
- Centro Hepato-bilio-pancreatico e de Transplantacao do Hospital de Curry Cabral, Lisbon, Portugal
| | - S Lopez-Ben
- Department of Hepatobiliary and Pancreatic Surgery, Dr Josep Trueta Hospital, Girona, Spain
| | - C Hubert
- Department of Abdominal Surgery and Transplantation, Division of Hepato-Biliary and Pancreatic Surgery, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - P E Majno
- Abdominal and Transplantation Surgery, Geneva University Hospital and Faculty of Medicine, Geneva, Switzerland
- Hepato-pancreato-biliary Centre, Geneva, Switzerland
| | - C Toso
- Abdominal and Transplantation Surgery, Geneva University Hospital and Faculty of Medicine, Geneva, Switzerland
- Hepato-pancreato-biliary Centre, Geneva, Switzerland
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9
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Viganò L, Capussotti L, Majno P, Toso C, Ferrero A, De Rosa G, Rubbia-Brandt L, Mentha G. Liver resection in patients with eight or more colorectal liver metastases. Br J Surg 2015; 102:92-101. [PMID: 25451181 DOI: 10.1002/bjs.9680] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2013] [Revised: 09/11/2014] [Accepted: 09/22/2014] [Indexed: 12/19/2022]
Abstract
BACKGROUND Patients with large numbers of colorectal liver metastases (CRLMs) are potential candidates for resection, but the benefit from surgery is unclear. METHODS Patients undergoing resection for CRLMs between 1998 and 2012 in two high-volume liver surgery centres were categorized according to the number of CRLMs: between one and seven (group 1) and eight or more (group 2). Overall (OS) and recurrence-free (RFS) survival were compared between the groups. Multivariable analysis was performed to identify adverse prognostic factors. RESULTS A total of 849 patients were analysed: 743 in group 1 and 106 in group 2. The perioperative mortality rate (90 days) was 0.4 per cent (all group 1). Median follow-up was 37.4 months. Group 1 had higher 5-year OS (44.2 versus 20.1 per cent; P < 0.001) and RFS (28.7 versus 13.6 per cent; P < 0.001) rates. OS and RFS in group 2 were similar for patients with eight to ten, 11-15 or more than 15 metastases (48, 40 and 18 patients respectively). In group 2, multivariable analysis identified three preoperative adverse prognostic factors: extrahepatic disease (P = 0.010), no response to chemotherapy (P = 0.023) and primary rectal cancer (P = 0.039). Patients with two or more risk factors had very poor outcomes (median OS and RFS 16.9 and 2.5 months; 5-year OS zero); patients in group 2 with no risk factors had similar survival to those in group 1 (5-year OS rate 44 versus 44.2 per cent). CONCLUSION Liver resection is safe in selected patients with eight or more metastases, and offers reasonable 5-year survival independent of the number of metastases. However, eight or more metastases combined with at least two adverse prognostic factors is associated with very poor survival, and surgery may not be beneficial.
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Affiliation(s)
- L Viganò
- Department of Hepatobiliary Surgery, Humanitas Research Hospital, Humanitas University, Rozzano, Italy; Departments of Hepatopancreatobiliary and Digestive Surgery, Ospedale Mauriziano Umberto I, Torino, Italy
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10
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Lüthold SC, Kaseje N, Jannot AS, Mentha G, Majno P, Toso C, Belli DC, McLin VA, Wildhaber BE. Risk factors for early and late biliary complications in pediatric liver transplantation. Pediatr Transplant 2014; 18:822-30. [PMID: 25263826 DOI: 10.1111/petr.12363] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/14/2014] [Indexed: 12/14/2022]
Abstract
BC are a common source of morbidity after pediatric LT. Knowledge about risk factors may help to reduce their incidence. Retrospective analysis of BC in 116 pediatric patients (123 LT) (single institution, 05/1990-12/2011, medium follow-up 7.9 yr). One-, five-, and 10-yr survival was 91.1%, no patient died of BC. Prevalence and risk factors for anastomotic and intrahepatic BC were examined. There were 29 BC in 123 LT (23.6%), with three main categories: 10 (8.1%) primary anastomotic strictures, eight (6.5%) anastomotic leaks, and three (2.4%) intrahepatic strictures. Significant risk factors for anastomotic leaks were total operation time (increase 1.26-fold) and early HAT (<30 days post-LT; increase 5.87-fold). Risk factor for primary anastomotic stricture was duct-to-duct choledochal anastomosis (increase 5.96-fold when compared to biliary-enteric anastomosis). Risk factors for intrahepatic strictures were donor age >48 yr (increase 1.09-fold) and MELD score >30 (increase 1.2-fold). To avoid morbidity from anastomotic BC in pediatric LT, the preferred biliary anastomosis appears to be biliary-enteric. Operation time should be kept to a minimum, and HAT must by all means be prevented. Children with a high MELD score or receiving livers from older donors are at increased risk for intrahepatic strictures.
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Affiliation(s)
- Samuel C Lüthold
- Division of Pediatric Surgery, Geneva University Hospitals, Geneva, Switzerland
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11
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Spolverato G, Kim Y, Alexandrescu S, Popescu I, Marques HP, Aldrighetti L, Clark Gamblin T, Miura J, Maithel SK, Squires MH, Pulitano C, Sandroussi C, Mentha G, Bauer TW, Newhook T, Shen F, Poultsides GA, Wallis Marsh J, Pawlik TM. Is Hepatic Resection for Large or Multifocal Intrahepatic Cholangiocarcinoma Justified? Results from a Multi-Institutional Collaboration. Ann Surg Oncol 2014; 22:2218-25. [PMID: 25354576 DOI: 10.1245/s10434-014-4223-3] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2014] [Indexed: 12/11/2022]
Abstract
BACKGROUND The role of surgical resection for patients with large or multifocal intrahepatic cholangiocarcinoma (ICC) remains unclear. This study evaluated the long-term outcome of patients who underwent hepatic resection for large (≥7 cm) or multifocal (≥2) ICC. METHODS Between 1990 and 2013, 557 patients who underwent liver resection for ICC were identified from a multi-institutional database. Clinicopathologic characteristics, operative details, and long-term survival data were evaluated. RESULTS Of the 557 patients, 215 (38.6 %) had a small, solitary ICC (group A) and 342 (61.4 %) had a large or multifocal ICC (group B). The patients in group B underwent an extended hepatectomy more frequently (16.9 vs. 30.4 %; P < 0.001). At the final pathology exam, the patients in group B were more likely to show evidence of vascular invasion (22.5 vs. 38.5 %), direct invasion of contiguous organs (6.5 vs. 12.9 %), and nodal metastasis (13.3 vs. 21.0 %) (all P < 0.05). Interestingly, the incidences of postoperative complications (39.3 vs. 46.8 %) and hospital mortality (1.1 vs. 3.7 %) were similar between the two groups (both P > 0.05). The group A patients had better rates for 5-year overall survival (OS) (30.5 vs. 18.7 %; P < 0.05) and disease-free survival (DFS) (22.6 vs. 8.2 %; P < 0.05) than the group B patients. For the patients in group B, the factors associated with a worse OS included more than three tumor nodules [hazard ratio (HR), 1.56], nodal metastasis (HR, 1.47), and poor differentiation (HR, 1.48). CONCLUSIONS Liver resection can be performed safely for patients with large or multifocal ICC. The long-term outcome for these patients can be stratified on the basis of a prognostic score that includes tumor number, nodal metastasis, and poor differentiation.
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Affiliation(s)
- Gaya Spolverato
- The Johns Hopkins University School of Medicine, Baltimore, MD, USA
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12
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Toso C, Mazzaferro V, Bruix J, Freeman R, Mentha G, Majno P. Toward a better liver graft allocation that accounts for candidates with and without hepatocellular carcinoma. Am J Transplant 2014; 14:2221-7. [PMID: 25220672 DOI: 10.1111/ajt.12923] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [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: 04/02/2014] [Revised: 06/13/2014] [Accepted: 07/06/2014] [Indexed: 01/25/2023]
Abstract
In some countries where the Model for End-Stage Liver Disease (MELD) score is used for graft allocation, selected patients with hepatocellular carcinoma (HCC) receive a fixed number of exception points at listing, and increasing priority on the list by accruing additional exception points at regular time intervals. This system originally aimed at balancing the risks of HCC patients of developing contraindications and of non-HCC patients of dying before transplantation, is not ideal because it appears to offer an advantage to HCC patients, regardless of tumor characteristics and response to loco-regional treatment. Scores modulated by HCC characteristics have been proposed. They are based on a more refined estimate of the risk of pretransplant drop-out or of the posttransplant transplant benefit expressed as the life-years gained for each graft. This review describes the newly proposed systems, and discusses their advantages and drawbacks. We believe that the current exception points allocation should be revised and that drop-out-equivalent or transplant benefit-equivalent models should be studied further. As with all policy changes, these should be done under close monitoring that allows subsequent revisions.
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Affiliation(s)
- C Toso
- Division of Transplant and Abdominal Surgery, Department of Surgery, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland; Hepato-Pancreato-Biliary Centre, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
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13
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Hyder O, Marques H, Pulitano C, Marsh JW, Alexandrescu S, Bauer TW, Gamblin TC, Sotiropoulos GC, Paul A, Barroso E, Clary BM, Aldrighetti L, Ferrone CR, Zhu AX, Popescu I, Gigot JF, Mentha G, Feng S, Pawlik TM. A nomogram to predict long-term survival after resection for intrahepatic cholangiocarcinoma: an Eastern and Western experience. JAMA Surg 2014; 149:432-8. [PMID: 24599477 DOI: 10.1001/jamasurg.2013.5168] [Citation(s) in RCA: 250] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
IMPORTANCE Intrahepatic cholangiocarcinoma (ICC) is a primary cancer of the liver that is increasing in incidence, and the prognostic factors associated with outcome after surgery remain poorly defined. OBJECTIVE To combine clinicopathologic variables associated with overall survival after resection of ICC into a prediction nomogram. DESIGN, SETTING, AND PARTICIPANTS We performed an international multicenter study of 514 patients who underwent resection for ICC at 13 major hepatobiliary centers in the United States, Europe, and Asia from May 1, 1990, through December 31, 2011. Multivariate Cox proportional hazards regression modeling with backward selection using the Akaike information criteria was used to select variables for construction of the nomogram. Discrimination and calibration were performed using Kaplan-Meier curves and calibration plots. INTERVENTIONS Surgical resection of ICC at a participating hospital. MAIN OUTCOMES AND MEASURES Long-term survival, effect of potential prognostic factors, and performance of proposed nomogram. RESULTS Median patient age was 59.2 years, and 53.1% of the patients were male. Most patients (74.7%) had a solitary tumor, and median tumor size was 6.0 cm. Patients were treated with an extended hepatectomy (202 [39.3%]), a hemihepatectomy (180 [35.0%]), or a minor liver resection (<3 segments) (132 [25.7%]). Most patients underwent R0 resection (87.9%), and 35.7% of patients had N1 disease. Using the backward selection of clinically relevant variables, we found that age at diagnosis (hazard ratio [HR], 1.31; P < .001), tumor size (HR, 1.50; P < .001), multiple tumors (HR, 1.58; P < .001), cirrhosis (HR, 1.51; P = .08), lymph node metastasis (HR, 1.78; P = .01), and macrovascular invasion (HR, 2.10; P < .001) were selected as factors predictive of survival. On the basis of these factors, a nomogram was created to predict survival of ICC after resection. Discrimination using Kaplan-Meier curves, calibration curves, and bootstrap cross-validation revealed good predictive abilities (C index, 0.692). CONCLUSIONS AND RELEVANCE On the basis of an Eastern and Western experience, a nomogram was developed to predict overall survival after resection for ICC. Validation revealed good discrimination and calibration, suggesting clinical utility to improve individualized predictions of survival for patients undergoing resection of ICC.
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14
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Buchs NC, Ris F, Majno PE, Andres A, Cacheux W, Gervaz P, Roth AD, Terraz S, Rubbia-Brandt L, Morel P, Mentha G, Toso C. Rectal outcomes after a liver-first treatment of patients with stage IV rectal cancer. Ann Surg Oncol 2014; 22:931-7. [PMID: 25201505 DOI: 10.1245/s10434-014-4069-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2014] [Indexed: 12/13/2022]
Abstract
BACKGROUND The treatment of patients with metastatic rectal cancer remains controversial. We developed a reverse strategy, the liver-first approach, to optimize the chance of a curative resection. The aim of this study was to assess rectal outcomes after reverse treatment of patients with metastatic rectal cancer. METHODS From May 2000 to November 2013, a total of 34 consecutive selected patients with histology-proven adenocarcinoma of the rectum and liver metastases were prospectively entered into a dedicated computerized database. All patients were treated via our reverse strategy. Rectal and overall survival outcomes were analyzed. RESULTS Most patients presented with advanced disease (median Fong clinical risk score of 3; range 2-5). One patient failed to complete the whole treatment (3%). Rectal surgery was performed after a median of 3.9 months (range 0.4-17.8 months). A total of 73.3% patients received preoperative radiotherapy. Perioperative mortality and morbidity rates were 0 and 27.3% after rectal surgery. Severe complications were reported in two patients (6.1%): one anastomotic leak and one systemic inflammatory response syndrome. The median hospital stay was 11 days (range 5-23 days). Complete local pathological response was observed in three patients (9.1%). The median number of lymph nodes collected was 14. The R0 rate was 93.9%. There was no positive circumferential margin. After a mean follow-up of 36 months after rectal surgery, 5-year overall survival was 52.5%. Five patients experienced pelvic recurrence. CONCLUSIONS In our cohort of selected patients with stage IV rectal cancer, the reverse strategy was not only safe and effective, but also oncologically promising, with a low morbidity rate and high long-term survival.
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Affiliation(s)
- Nicolas C Buchs
- Department of Surgery, Clinic for Visceral and Transplantation Surgery, University Hospital of Geneva, Geneva, Switzerland,
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Orci LA, Lacotte S, Oldani G, Morel P, Mentha G, Toso C. The role of hepatic ischemia-reperfusion injury and liver parenchymal quality on cancer recurrence. Dig Dis Sci 2014; 59:2058-68. [PMID: 24795038 DOI: 10.1007/s10620-014-3182-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [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: 03/13/2014] [Accepted: 04/20/2014] [Indexed: 12/29/2022]
Abstract
Hepatic ischemia/reperfusion (I/R) injury is a common clinical challenge. Despite accumulating evidence regarding its mechanisms and potential therapeutic approaches, hepatic I/R is still a leading cause of organ dysfunction, morbidity, and resource utilization, especially in those patients with underlying parenchymal abnormalities. In the oncological setting, there are growing concerns regarding the deleterious impact of I/R injury on the risk of post-surgical tumor recurrence. This review aims at giving the last updates regarding the role of hepatic I/R and liver parenchymal quality injury in the setting of oncological liver surgery, using a "bench-to-bedside" approach. Relevant medical literature was identified by searching PubMed and hand scanning of the reference lists of articles considered for inclusion. Numerous preclinical models have depicted the impact of I/R injury and hepatic parenchymal quality (steatosis, age) on increased cancer growth in the injured liver. Putative pathophysiological mechanisms linking I/R injury and liver cancer recurrence include an increased implantation of circulating cancer cells in the ischemic liver and the upregulation of proliferation and angiogenic factors following the ischemic insult. Although limited, there is growing clinical evidence that I/R injury and liver quality are associated with the risk of post-surgical cancer recurrence. In conclusion, on top of its harmful early impact on organ function, I/R injury is linked to increased tumor growth. Therapeutic strategies tackling I/R injury could not only improve post-surgical organ function, but also allow a reduction in the risk of cancer recurrence.
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Affiliation(s)
- Lorenzo A Orci
- Division of Abdominal and Transplantation Surgery, Department of Surgery, Geneva University Hospitals and Faculty of Medicine, University of Geneva, 4 rue Gabrielle-Perret-Gentil, 1211, Geneva, Switzerland,
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16
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Oldani G, Crowe LA, Orci LA, Slits F, Rubbia-Brandt L, de Vito C, Morel P, Mentha G, Berney T, Vallée JP, Lacotte S, Toso C. Pre-retrieval reperfusion decreases cancer recurrence after rat ischemic liver graft transplantation. J Hepatol 2014; 61:278-85. [PMID: 24713189 DOI: 10.1016/j.jhep.2014.03.036] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2013] [Revised: 02/28/2014] [Accepted: 03/27/2014] [Indexed: 01/14/2023]
Abstract
BACKGROUND & AIMS Liver transplantation from marginal donors is associated with ischemia/reperfusion (I/R) lesions, which may increase the risk of post-transplant hepatocellular carcinoma (HCC) recurrence. Graft reperfusion prior to retrieval (as for extracorporeal membrane oxygenation--ECMO) can prevent I/R lesions. The impact of I/R on the risk of cancer recurrence was assessed on a syngeneic Fischer-rat liver transplantation model. METHODS HCC cells were injected into the vena porta of all recipients at the end of an orthotopic liver transplantation (OLT). Control donors were standard heart-beating, ischemic ones (ISC), underwent 10 min or 30 min inflow liver clamping prior to retrieval, and ischemic/reperfused (ISC/R) donors underwent 2h liver reperfusion after the clamping. RESULTS I/R lesions were confirmed in the ISC group, with the presence of endothelial and hepatocyte injury, and increased liver function tests. These lesions were in part reversed by the 2h reperfusion in the ISC/R group. HCC growth was higher in the 10 min and 30 min ISC recipients (p = 0.018 and 0.004 vs. control, as assessed by MRI difference between weeks one and two), and was prevented in the ISC/Rs (p = 0.04 and 0.01 vs. ISC). These observations were associated with a stronger pro-inflammatory cytokine profile in the ISC recipients only, and the expression of hypoxia and HCC growth-enhancer genes, including Hmox1, Hif1a and Serpine1. CONCLUSIONS This experiment suggests that ischemia/reperfusion lesions lead to an increased risk of post-transplant HCC recurrence and growth. This observation can be reversed by graft reperfusion prior to retrieval.
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Affiliation(s)
- Graziano Oldani
- Divisions of Transplant and Abdominal Surgery, Department of Surgery, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland; Department of Surgery, University of Pavia, Italy
| | - Lindsey A Crowe
- Division of Radiology, Department of Medical Imaging, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Lorenzo A Orci
- Divisions of Transplant and Abdominal Surgery, Department of Surgery, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Florence Slits
- Divisions of Transplant and Abdominal Surgery, Department of Surgery, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Laura Rubbia-Brandt
- Division of Clinical Pathology, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Claudio de Vito
- Division of Clinical Pathology, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Philippe Morel
- Divisions of Transplant and Abdominal Surgery, Department of Surgery, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Gilles Mentha
- Divisions of Transplant and Abdominal Surgery, Department of Surgery, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Thierry Berney
- Divisions of Transplant and Abdominal Surgery, Department of Surgery, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Jean-Paul Vallée
- Division of Radiology, Department of Medical Imaging, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Stéphanie Lacotte
- Divisions of Transplant and Abdominal Surgery, Department of Surgery, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Christian Toso
- Divisions of Transplant and Abdominal Surgery, Department of Surgery, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland.
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Iranmanesh P, Frossard JL, Mugnier-Konrad B, Morel P, Majno P, Nguyen-Tang T, Berney T, Mentha G, Toso C. Initial cholecystectomy vs sequential common duct endoscopic assessment and subsequent cholecystectomy for suspected gallstone migration: a randomized clinical trial. JAMA 2014; 312:137-44. [PMID: 25005650 DOI: 10.1001/jama.2014.7587] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE The optimal management of treatment for patients at intermediate risk of a common duct stone (including increased liver function tests but bilirubin <4 mg/dL and no cholangitis) is a matter of debate. Many stones migrate spontaneously into the duodenum, making preoperative common duct investigations unnecessary. OBJECTIVE To compare strategies of cholecystectomy first vs a sequential endoscopic common duct assessment and cholecystectomy for the management of patients with an intermediate risk of a common duct stone. The main objective was to reduce the length of stay and the secondary objectives were to reduce the number of common duct investigations, morbidity, and costs. DESIGN, SETTING, AND PARTICIPANTS Interventional, randomized clinical trial with 2 parallel groups performed between June 2011 and February 2013, with a patient follow-up of 6 months. The trial comprised a random sample of 100 adult patients admitted to Geneva University Hospital, Geneva, Switzerland, for acute gallstone-related conditions with an intermediate risk of a common duct stone. Fifty patients were randomized to each group. INTERVENTIONS Cholecystectomy first with intraoperative cholangiogram for the study group and endoscopic common duct assessment and clearance followed by cholecystectomy for the control group. MAIN OUTCOMES AND MEASURES Length of initial hospital stay (primary end point), number of common duct investigations and morbidity and mortality within 6 months after initial admission, and quality of life at 1 and 6 months after discharge (EQ-5D-5L [EuroQol Group, 5-level] questionnaire). RESULTS Patients who underwent cholecystectomy as a first step had a significantly shorter length of hospital stay (median, 5 days [interquartile range {IQR}, 1-8] vs median, 8 days [IQR, 6-12]; P < .001), with fewer common duct investigations (25 vs 71; P < .001), no significant difference in morbidity or quality of life. CONCLUSIONS AND RELEVANCE Among patients at intermediate risk of a common duct stone, initial cholecystectomy compared with sequential common duct endoscopy assessment and subsequent surgery resulted in a shorter length of stay without increased morbidity. If these findings are confirmed, initial cholecystectomy with intraoperative cholangiogram may be a preferred approach. TRIAL REGISTRATION Clinicaltrials.gov Identifier: NCT01492790.
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Affiliation(s)
- Pouya Iranmanesh
- Division of Digestive Surgery, Department of Surgery, Geneva University Hospital and Faculty of Medicine, Geneva, Switzerland2Division of Transplant Surgery, Department of Surgery, Geneva University Hospital and Faculty of Medicine, Geneva, Switzerland3He
| | - Jean-Louis Frossard
- Hepato-Pancreato-Biliary Centre, Geneva University Hospital and Faculty of Medicine, Geneva, Switzerland4Division of Gastroenterology and Hepatology, Department of Medical Specialties, Geneva University Hospital and Faculty of Medicine, Geneva, Switzerlan
| | - Béatrice Mugnier-Konrad
- Division of Digestive Surgery, Department of Surgery, Geneva University Hospital and Faculty of Medicine, Geneva, Switzerland2Division of Transplant Surgery, Department of Surgery, Geneva University Hospital and Faculty of Medicine, Geneva, Switzerland
| | - Philippe Morel
- Division of Digestive Surgery, Department of Surgery, Geneva University Hospital and Faculty of Medicine, Geneva, Switzerland2Division of Transplant Surgery, Department of Surgery, Geneva University Hospital and Faculty of Medicine, Geneva, Switzerland3He
| | - Pietro Majno
- Division of Digestive Surgery, Department of Surgery, Geneva University Hospital and Faculty of Medicine, Geneva, Switzerland2Division of Transplant Surgery, Department of Surgery, Geneva University Hospital and Faculty of Medicine, Geneva, Switzerland3He
| | - Thai Nguyen-Tang
- Hepato-Pancreato-Biliary Centre, Geneva University Hospital and Faculty of Medicine, Geneva, Switzerland4Division of Gastroenterology and Hepatology, Department of Medical Specialties, Geneva University Hospital and Faculty of Medicine, Geneva, Switzerlan
| | - Thierry Berney
- Division of Digestive Surgery, Department of Surgery, Geneva University Hospital and Faculty of Medicine, Geneva, Switzerland2Division of Transplant Surgery, Department of Surgery, Geneva University Hospital and Faculty of Medicine, Geneva, Switzerland3He
| | - Gilles Mentha
- Division of Digestive Surgery, Department of Surgery, Geneva University Hospital and Faculty of Medicine, Geneva, Switzerland2Division of Transplant Surgery, Department of Surgery, Geneva University Hospital and Faculty of Medicine, Geneva, Switzerland3He
| | - Christian Toso
- Division of Digestive Surgery, Department of Surgery, Geneva University Hospital and Faculty of Medicine, Geneva, Switzerland2Division of Transplant Surgery, Department of Surgery, Geneva University Hospital and Faculty of Medicine, Geneva, Switzerland3He
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Spolverato G, Ejaz A, Kim Y, Sotiropoulos GC, Pau A, Alexandrescu S, Marques H, Pulitano C, Barroso E, Clary BM, Aldrighetti L, Bauer TW, Walters DM, Groeschl R, Gamblin TC, Marsh W, Nguyen KT, Turley R, Popescu I, Hubert C, Meyer S, Gigot JF, Mentha G, Pawlik TM. Tumor size predicts vascular invasion and histologic grade among patients undergoing resection of intrahepatic cholangiocarcinoma. J Gastrointest Surg 2014; 18:1284-91. [PMID: 24841438 DOI: 10.1007/s11605-014-2533-1] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [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: 03/30/2014] [Accepted: 05/01/2014] [Indexed: 02/06/2023]
Abstract
The association between tumor size and survival in patients with intrahepatic cholangiocarcinoma (ICC) undergoing surgical resection is controversial. We sought to define the incidence of major and microscopic vascular invasion relative to ICC tumor size, and identify predictors of microscopic vascular invasion in patients with ICC ≥5 cm. A total of 443 patients undergoing surgical resection for ICC between 1973 and 2011 at one of 11 participating institutions were identified. Clinical and pathologic data were evaluated using uni- and multivariate analyses. As tumor sized increased, the incidence of microscopic vascular invasion increased: <3 cm, 3.6 %; 3-5 cm, 24.7 %; 5-7 cm, 38.3 %; 7-15 cm, 32.9 %, ≥15 cm, 55.6 %; (p < 0.001). Increasing tumor size was also found to be associated with worsening tumor grade. The incidence of poorly differentiated tumors increased with increasing ICC tumor size: <3 cm, 9.7 %; 3-5 cm, 19.8 %; 5-7 cm, 24.2 %; 7-15 cm, 21.1 %; >15 cm, 31.6 % (p = 0.04). The presence of perineural invasion (odds ratio [OR] = 2.98) and regional lymph node metastasis (OR = 4.43) were independently associated with an increased risk of microscopic vascular invasion in tumors ≥5 cm (both p < 0.05). Risk of microscopic vascular invasion and worse tumor grade increased with tumor size. Large tumors likely harbor worse pathologic features; this information should be considered when determining therapy and prognosis of patients with large ICC.
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Affiliation(s)
- Gaya Spolverato
- Department of Surgery at Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Iranmanesh P, Vazquez O, Terraz S, Majno P, Spahr L, Poncet A, Morel P, Mentha G, Toso C. Accurate computed tomography-based portal pressure assessment in patients with hepatocellular carcinoma. J Hepatol 2014; 60:969-74. [PMID: 24362073 DOI: 10.1016/j.jhep.2013.12.015] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2013] [Revised: 11/18/2013] [Accepted: 12/10/2013] [Indexed: 12/19/2022]
Abstract
BACKGROUND & AIMS Liver resection is generally restricted to patients without clinically significant portal hypertension (Hepatic Venous Pressure Gradient - HVPG - ⩽10mmHg) and several teams perform transjugular HVPG measurements as part of the pre-operative work-up. The present study investigates whether a non-invasive Computed Tomography (CT)-based assessment could be as accurate as the invasive transjugular measurement. METHODS A cohort of patients with hepatocellular carcinoma (HCC) treated by resection (n=36) or transplantation (n=39) was selected (mean age: 61±9.2years, male/female ratio: 4/1). Pre-operative CTs were read by two independent investigators, and potential CT-based HVPG predictors were compared to the transjugular HVPG measurements. A validation was conducted on another cohort of 70 non-surgical patients. RESULTS The invasive HVPG values were significantly correlated to liver/spleen volume ratio, spleen volume, platelet count, and peri-hepatic ascites (p<0.001), which all showed high inter-observer agreements (intra-class correlation coefficients ⩾0.927, Kappa ⩾0.945). The presence of a HVPG >10mmHg was best predicted by the liver/spleen volume ratio (AUC: 0.883 [0.805-0.960]) and the peri-hepatic ascites (p<0.001). These two variables were combined into an accurate model for predicting HVPG >10mmHg (AUC: 0.911 [0.847-0.975]), with sensitivity, specificity, and positive and negative predictive values of 92%, 79%, 91%, and 81%. The model was also accurate in the validation cohort with an AUC of 0.820 [0.719-0.921]. The computed formula was: CONCLUSIONS The proposed CT-based model showed a high accuracy in the prediction of HVPG and, if further confirmed by prospective validation, could replace the invasive transjugular assessment in patients not requiring a biopsy of the non-tumoral liver.
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Affiliation(s)
- Pouya Iranmanesh
- Department of Digestive Surgery, Geneva University Hospitals and Faculty of Medicine, Switzerland.
| | - Oscar Vazquez
- Department of Digestive Surgery, Geneva University Hospitals and Faculty of Medicine, Switzerland
| | - Sylvain Terraz
- Department of Radiology, Geneva University Hospitals and Faculty of Medicine, Switzerland
| | - Pietro Majno
- Department of Digestive Surgery, Geneva University Hospitals and Faculty of Medicine, Switzerland
| | - Laurent Spahr
- Department of Gastroenterology and Hepatology, Geneva University Hospitals and Faculty of Medicine, Switzerland
| | - Antoine Poncet
- Department of Clinical Epidemiology, Geneva University Hospitals and Faculty of Medicine, Switzerland
| | - Philippe Morel
- Department of Digestive Surgery, Geneva University Hospitals and Faculty of Medicine, Switzerland
| | - Gilles Mentha
- Department of Digestive Surgery, Geneva University Hospitals and Faculty of Medicine, Switzerland
| | - Christian Toso
- Department of Digestive Surgery, Geneva University Hospitals and Faculty of Medicine, Switzerland.
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Toso C, Majno P, Berney T, Morel P, Mentha G, Combescure C. Validation of a dropout assessment model of candidates with/without hepatocellular carcinoma on a common liver transplant waiting list. Transpl Int 2014; 27:686-95. [PMID: 24649861 DOI: 10.1111/tri.12323] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [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: 09/24/2013] [Revised: 11/07/2013] [Accepted: 03/16/2014] [Indexed: 12/14/2022]
Abstract
The model of end-stage liver disease (MELD) score is often used for liver graft allocation, and patients with hepatocellular carcinoma (HCC) receive exception points (22 in the US). A better model is desirable for patients with HCC as they tend to have a privileged access to transplantation, without taking HCC characteristics into account. A new simpler model designed from a training set of US patients (n = 49 026) was tested on two validation sets (US and UK patient cohorts with, respectively, n = 20 475 and n = 1781). The risk of dropout was between 3.2 and 7.8% at 3 months in patients with HCC, and was captured into a score, including HCC size, HCC number, AFP, and MELD (-37.8 +1.9*MELD+5.9 if HCC Nb ≥ 2 + 5.9 if AFP > 400 + 21.2 if HCC size > 1 cm). This new model could be validated on external US and UK liver candidate cohorts. It provides a dynamic and more accurate assessment of dropout than the use of exception MELD (C-indices of 66.2-73.7% vs. 52.7-56.6%). In addition, the model shows a similar distribution as MELD for patients with non-HCC, and both scores could be used in parallel for the management of waiting-list patients with and without HCC.
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Affiliation(s)
- Christian Toso
- Divisions of Transplant and Abdominal Surgery, Department of Surgery, University of Geneva Hospitals, Geneva, Switzerland; Hepato-Pancreato-Biliary Centre, University of Geneva Hospitals, Geneva, Switzerland
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Lacotte S, Oldani G, Slits F, Orci LA, Rubbia-Brandt L, Morel P, Mentha G, Toso C. Alloimmune activation promotes anti-cancer cytotoxicity after rat liver transplantation. PLoS One 2014; 9:e91515. [PMID: 24651497 PMCID: PMC3961266 DOI: 10.1371/journal.pone.0091515] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2013] [Accepted: 02/11/2014] [Indexed: 12/31/2022] Open
Abstract
Liver transplantation for hepatocellular carcinoma (HCC) results in a specific condition where the immune response is potentially directed against both allogeneic and cancer antigens. We have investigated the level of anti-cancer immunity during allogeneic immune response. Dark Agouti-to-Lewis and Lewis-to-Lewis rat liver transplantations were performed and the recipients anti-cancer immunity was analysed at the time of alloimmune activation. The occurrence of rejection in the allogeneic recipients was confirmed by a shorter survival (p<0.01), increased liver function tests (p<0.01), the presence of signs of rejection on histology, and a donor-specific ex vivo mixed lymphocyte reaction. At the time of alloimmune activation, blood mononuclear cells of the allogeneic group demonstrated increased anti-cancer cytotoxicity (p<0.005), which was related to an increased natural killer (NK) cell frequency (p<0.05) and a higher monocyte/macrophage activation level (p<0.01). Similarly, liver NK cell anti-cancer cytotoxicity (p<0.005), and liver monocyte/macrophage activation levels (p<0.01) were also increased. The alloimmune-associated cytotoxicity was mediated through the NKG2D receptor, whose expression was increased in the rejected graft (p<0.05) and on NK cells and monocyte/macrophages. NKG2D ligands were expressed on rat HCC cells, and its inhibition prevented the alloimmune-associated cytotoxicity. Although waiting for in vivo validation, alloimmune-associated cytotoxicity after rat liver transplantation appears to be linked to increased frequencies and levels of activation of NK cells and monocyte/macrophages, and is at least in part mediated through the NKG2D receptor.
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Affiliation(s)
- Stéphanie Lacotte
- Department of Surgery, Geneva University Hospitals, University of Geneva, Geneva, Switzerland
- * E-mail: (SL); (CT)
| | - Graziano Oldani
- Department of Surgery, Geneva University Hospitals, University of Geneva, Geneva, Switzerland
| | - Florence Slits
- Department of Surgery, Geneva University Hospitals, University of Geneva, Geneva, Switzerland
| | - Lorenzo A. Orci
- Department of Surgery, Geneva University Hospitals, University of Geneva, Geneva, Switzerland
| | - Laura Rubbia-Brandt
- Hepato-pancreato-biliary Centre, Geneva University Hospitals, University of Geneva, Geneva, Switzerland
- Department of Pathology, Geneva University Hospitals, University of Geneva, Geneva, Switzerland
| | - Philippe Morel
- Department of Surgery, Geneva University Hospitals, University of Geneva, Geneva, Switzerland
| | - Gilles Mentha
- Department of Surgery, Geneva University Hospitals, University of Geneva, Geneva, Switzerland
- Department of Pathology, Geneva University Hospitals, University of Geneva, Geneva, Switzerland
| | - Christian Toso
- Department of Surgery, Geneva University Hospitals, University of Geneva, Geneva, Switzerland
- Department of Pathology, Geneva University Hospitals, University of Geneva, Geneva, Switzerland
- * E-mail: (SL); (CT)
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Majno P, Mentha G, Toso C, Morel P, Peitgen HO, Fasel JHD. Anatomy of the liver: an outline with three levels of complexity--a further step towards tailored territorial liver resections. J Hepatol 2014; 60:654-62. [PMID: 24211738 DOI: 10.1016/j.jhep.2013.10.026] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [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: 06/30/2013] [Revised: 09/27/2013] [Accepted: 10/25/2013] [Indexed: 12/22/2022]
Abstract
The vascular anatomy of the liver can be described at three different levels of complexity according to the use that the description has to serve. The first--conventional--level corresponds to the traditional 8-segments scheme of Couinaud and serves as a common language between clinicians from different specialties to describe the location of focal hepatic lesions. The second--surgical--level, to be applied to anatomical liver resections and transplantations, takes into account the real branching of the major portal pedicles and of the hepatic veins. Radiological and surgical techniques exist nowadays to make full use of this anatomy, but this requires accepting that the Couinaud scheme is a simplification, and looking at the vascular architecture with an unprejudiced eye. The third--academic--level of complexity concerns the anatomist, and the need to offer a systematization that resolves the apparent contradictions between anatomical literature, radiological imaging, and surgical practice. Based on the real number of second-order portal branches that, although variable averages 20, we submit a system called the "1-2-20 concept", and suggest that it fits best the number of actual--as opposed to idealized--anatomical liver segments.
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Affiliation(s)
- Pietro Majno
- Hepatobiliary Center, Digestive Surgery and Transplantation Units, Department of Surgery, University Hospitals of Geneva, Switzerland.
| | - Gilles Mentha
- Hepatobiliary Center, Digestive Surgery and Transplantation Units, Department of Surgery, University Hospitals of Geneva, Switzerland
| | - Christian Toso
- Hepatobiliary Center, Digestive Surgery and Transplantation Units, Department of Surgery, University Hospitals of Geneva, Switzerland
| | - Philippe Morel
- Hepatobiliary Center, Digestive Surgery and Transplantation Units, Department of Surgery, University Hospitals of Geneva, Switzerland
| | - Heinz O Peitgen
- Fraunhofer Institute for Medical Image Computing, Bremen, Germany
| | - Jean H D Fasel
- Anatomy Sector, Department of Cellular Physiology and Metabolism, Faculty of Medicine, University of Geneva, Switzerland
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23
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Naiken SP, Toso C, Rubbia-Brandt L, Thomopoulos T, Roth A, Mentha G, Morel P, Gervaz P. Complete pathological response (ypT0N0M0) after preoperative chemotherapy alone for stage IV rectal cancer. BMC Surg 2014; 14:4. [PMID: 24438090 PMCID: PMC3900671 DOI: 10.1186/1471-2482-14-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2013] [Accepted: 12/11/2013] [Indexed: 12/29/2022] Open
Abstract
Background Complete pathological response occurs in 10–20% of patients with rectal cancer who are treated with neoadjuvant chemoradiation therapy prior to pelvic surgery. The possibility that complete pathological response of rectal cancer can also occur with neoadjuvant chemotherapy alone (without radiation) is an intriguing hypothesis. Case presentation A 66-year old man presented an adenocarcinoma of the rectum with nine liver metastases (T3N1M1). He was included in a reverse treatment, aiming at first downsizing the liver metastases by chemotherapy, and subsequently performing the liver surgery prior to the rectum resection. The neoadjuvant chemotherapy consisted in a combination of oxaliplatin, 5-FU, irinotecan, leucovorin and bevacizumab (OCFL-B). After a right portal embolization, an extended right liver lobectomy was performed. On the final histopathological analysis, all lesions were fibrotic, devoid of any viable cancer cells. One month after liver surgery, the rectoscopic examination showed a near-total response of the primary rectal adenocarcinoma, which convinced the colorectal surgeon to perform the low anterior resection without preoperative radiation therapy. Macroscopically, a fibrous scar was observed at the level of the previously documented tumour, and the histological examination of the surgical specimen did not reveal any malignant cells in the rectal wall as well as in the mesorectum. All 15 resected lymph nodes were free of tumour, and the final tumour stage was ypT0N0M0. Clinical outcome was excellent, and the patient is currently alive 5 years after the first surgery without evidence of recurrence. Conclusion The presented patient with stage IV rectal cancer and liver metastases was in a unique situation linked to its inclusion in a reversed treatment and the use of neoadjuvant chemotherapy alone. The observed achievement of a complete pathological response after chemotherapy should promote the design of prospective randomized studies to evaluate the benefits of chemotherapy alone in patients with stages II-III rectal adenocarcinoma (without metastasis).
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Affiliation(s)
- Surennaidoo P Naiken
- Services de chirurgie viscérale et transplantation, Département de chirurgie, Hôpitaux Universitaires de Genève, Rue Gabrielle-Perret-Gentil 4, Genève 14 1211, Suisse.
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24
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Orci LA, Oldani G, Berney T, Andres A, Mentha G, Morel P, Toso C. Systematic review and meta-analysis of fibrin sealants for patients undergoing pancreatic resection. HPB (Oxford) 2014; 16:3-11. [PMID: 23461684 PMCID: PMC3892308 DOI: 10.1111/hpb.12064] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2012] [Accepted: 01/11/2013] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Post-operative pancreatic fistula (POPF) is a common complication after partial pancreatic resection, and is associated with increased rates of sepsis, mortality and costs. The role of fibrin sealants in decreasing the risk of POPF remains debatable. The aim of this study was to evaluate the literature regarding the effectiveness of fibrin sealants in pancreatic surgery. METHODS A comprehensive database search was conducted. Only randomized controlled trials comparing fibrin sealants with standard care were included. A meta-analysis regarding POPF, intra-abdominal collections, post-operative haemorrhage, pancreatitis and wound infections was performed according to the recommendations of the Cochrane collaboration. RESULTS Seven studies were included, accounting for 897 patients. Compared with controls, patients receiving fibrin sealants had a pooled odds ratio (OR) of developing a POPF of 0.83 [95% confidence interval (CI): 0.6-1.14], P = 0.245. There was a trend towards a reduction in post-operative haemorrhage (OR = 0.43 (95%CI: 0.18-1.0), P = 0.05) and intra-abdominal collections (OR = 0.52 (95%CI: 0.25-1.06), P = 0.073) in those patients receiving fibrin sealants. No difference was observed in terms of mortality, wound infections, re-interventions or hospital stay. CONCLUSION On the basis of these results, fibrin sealants cannot be recommended for routine clinical use in the setting of pancreatic resection.
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Affiliation(s)
- Lorenzo A Orci
- Division of Visceral and Transplantation Surgery, Department of Surgery, Geneva University Hospitals, Geneva, Switzerland
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25
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Buchs NC, Oldani G, Orci LA, Majno PE, Mentha G, Morel P, Toso C. Current status of robotic liver resection: a systematic review. Expert Rev Anticancer Ther 2013; 14:237-46. [PMID: 24313681 DOI: 10.1586/14737140.2014.863155] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Robotic surgery is an emerging technique for the management of patients with liver disease, and only a limited number of reports are available. A systematic search of electronic databases (PubMed, Embase and Cochrane), including only case series with more than five patients, identified nine series (with one from our institution), which totaled to 232 patients. Overall, the peri-operative outcomes of the reported patients are similar to those utilizing the laparoscopic and open approaches. Robotic surgery appears to be a valid option for selected hepatic resections in experienced hands. It could represent a bridge toward minimally invasive approaches for confirmed liver surgeons. By contrast, the long-term oncological outcomes remain uncertain and need further studies.
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Affiliation(s)
- Nicolas C Buchs
- Department of Surgery, Clinic for Visceral and Transplantation Surgery, University Hospital of Geneva, Switzerland
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Morard I, Gasche Y, Kneteman M, Toso C, Mentha A, Meeberg G, Mentha G, Kneteman N, Giostra E. Identifying Risk Factors for Central Pontine and Extrapontine Myelinolysis After Liver Transplantation: A Case–Control Study. Neurocrit Care 2013; 20:287-95. [DOI: 10.1007/s12028-013-9928-9] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Toso C, Cader S, Mentha-Dugerdil A, Meeberg G, Majno P, Morard I, Giostra E, Berney T, Morel P, Mentha G, Kneteman NM. Factors predicting survival after post-transplant hepatocellular carcinoma recurrence. J Hepatobiliary Pancreat Sci 2013; 20:342-7. [PMID: 22710887 PMCID: PMC3590406 DOI: 10.1007/s00534-012-0528-4] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Although factors associated with an increased risk of recurrence after liver transplantation for hepatocellular carcinoma (HCC) have been extensively studied, the history of patients with a post-transplant recurrence is poorly known. METHODS Patients experiencing a post-transplant HCC recurrence from 1996 to 2011 in two transplant programs were included. Demographic, transplant, and post-recurrence variables were assessed. RESULTS Thirty patients experienced an HCC recurrence-22 men and 8 women with a mean age of 55 ± 6 years. Sixteen (53 %) were outside the Milan criteria at the time of transplantation. Most recurrences (60 %) appeared within the first 18 months after transplantation, ranging between 1.7 and 109 months (median 14.2 months). Mean post-recurrence survival was 33 ± 31 months. On univariate analysis, total tumor volume (TTV; p = 0.047), microvascular invasion (p = 0.011), and time from transplant to recurrence (p = 0.001) predicted post-recurrence survival. On multivariate analysis, both time from transplant to recurrence (p = 0.001) and history of rejection (p = 0.043), but not the location of the recurrence or the type of recurrence treatment, predicted post-recurrence survival. CONCLUSION This study suggests that patients with early post-transplant HCC recurrence have worse outcomes. Those with a history of graft rejection have better survivals, possibly due to more active anti-cancer immunity.
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Affiliation(s)
- Christian Toso
- Divisions of Transplant and Abdominal Surgery, Department of Surgery, University of Geneva Hospitals, Rue Gabrielle-Perret-Gentil, 1211, Geneva, Switzerland.
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Abstract
In this review, the authors describe the management of patients with colorectal liver metastases in the era of effective chemotherapies and advanced interventional radiology. They give special attention to the surgical procedures that decrease the operative mortality and morbidity and produce clear margins. They discuss the best timing for chemotherapy, resection of the primary tumor, and resection of the liver metastases in an effort to improve long-term survival. The use of preoperative portal vein embolization, two-stage hepatectomy for bilobar synchronous liver metastases, and the liver-first strategy have allowed for treatment of patients with advanced disease with a curative intent, and to obtain 5-year overall survival of 30 to 60% despite poor prognostic factors and a cure (no recurrence at 10 years) in more than 20% of patients. These rates would have been unimaginable only two decades ago.
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Affiliation(s)
- Gilles Mentha
- Divisions of Transplantation and Visceral Surgery, Department of Surgery, University Hospitals of Geneva, Switzerland.
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Calinescu-Tuleasca AM, Bottani A, Rougemont AL, Birraux J, Gubler MC, Le Coultre C, Majno P, Mentha G, Girardin E, Belli D, Wildhaber BE. Caroli disease, bilateral diffuse cystic renal dysplasia, situs inversus, postaxial polydactyly, and preauricular fistulas: a ciliopathy caused by a homozygous NPHP3 mutation. Eur J Pediatr 2013; 172:877-81. [PMID: 21845392 DOI: 10.1007/s00431-011-1552-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [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: 05/20/2011] [Revised: 07/27/2011] [Accepted: 08/03/2011] [Indexed: 01/30/2023]
Abstract
UNLABELLED We report the rare association of Caroli disease (intrahepatic bile duct ectasia associated with congenital hepatic fibrosis), bilateral cystic renal dysplasia, situs inversus, postaxial polydactyly, and preauricular fistulas in a female child. She presented with end-stage renal disease at the age of 1 month, followed by a rapidly progressing hepatic fibrosis and dilatation of the intrahepatic bile ducts, leading to secondary biliary cirrhosis and portal hypertension. Combined liver-kidney transplantation was performed at the age of 4 years, with excellent outcome. DNA analysis showed a NPHP3 (coding nephrocystin-3) homozygote mutation, confirming that this malformation complex is a ciliopathy. CONCLUSION This rare association required an exceptional therapeutic approach: combined simultaneous orthotopic liver and kidney transplantation in a situs inversus recipient. The long-term follow-up was excellent with a very good evolution of the renal and hepatic grafts and normalization of growth and weight. This malformation complex has an autosomal recessive inheritance with a 25% recurrence risk in each pregnancy.
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Toso C, Cader S, Mentha-Dugerdil A, Meeberg G, Majno P, Morard I, Giostra E, Berney T, Morel P, Mentha G, Kneteman NM. Erratum to: Factors predicting survival after post-transplant hepatocellular carcinoma recurrence. Journal of Hepato-Biliary-Pancreatic Sciences 2013. [PMCID: PMC4079682 DOI: 10.1007/s00534-013-0618-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Christian Toso
- Divisions of Transplant and Abdominal Surgery, Department of Surgery; University of Geneva Hospitals; Rue Gabrielle-Perret-Gentil 1211 Geneva Switzerland
| | - Sonia Cader
- Division of Transplantation, Department of Surgery; University of Alberta; 2D4.44 Mackenzie Center Edmonton AB T6G 2B7 Canada
| | - Ariane Mentha-Dugerdil
- Divisions of Transplant and Abdominal Surgery, Department of Surgery; University of Geneva Hospitals; Rue Gabrielle-Perret-Gentil 1211 Geneva Switzerland
| | - Glenda Meeberg
- Division of Transplantation, Department of Surgery; University of Alberta; 2D4.44 Mackenzie Center Edmonton AB T6G 2B7 Canada
| | - Pietro Majno
- Divisions of Transplant and Abdominal Surgery, Department of Surgery; University of Geneva Hospitals; Rue Gabrielle-Perret-Gentil 1211 Geneva Switzerland
| | - Isabelle Morard
- Division of Gastro-enterology, Department of Internal Medicine; University of Geneva Hospitals; Rue Gabrielle-Perret-Gentil 1211 Geneva Switzerland
| | - Emiliano Giostra
- Division of Gastro-enterology, Department of Internal Medicine; University of Geneva Hospitals; Rue Gabrielle-Perret-Gentil 1211 Geneva Switzerland
| | - Thierry Berney
- Divisions of Transplant and Abdominal Surgery, Department of Surgery; University of Geneva Hospitals; Rue Gabrielle-Perret-Gentil 1211 Geneva Switzerland
| | - Philippe Morel
- Divisions of Transplant and Abdominal Surgery, Department of Surgery; University of Geneva Hospitals; Rue Gabrielle-Perret-Gentil 1211 Geneva Switzerland
| | - Gilles Mentha
- Divisions of Transplant and Abdominal Surgery, Department of Surgery; University of Geneva Hospitals; Rue Gabrielle-Perret-Gentil 1211 Geneva Switzerland
| | - Norman M. Kneteman
- Division of Transplantation, Department of Surgery; University of Alberta; 2D4.44 Mackenzie Center Edmonton AB T6G 2B7 Canada
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Oldani G, Lacotte S, Orci L, Morel P, Mentha G, Toso C. Manufacturing devices and instruments for easier rat liver transplantation. J Vis Exp 2013:e50380. [PMID: 23685736 PMCID: PMC3676266 DOI: 10.3791/50380] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
Orthotopic rat liver transplantation is a popular model, which has been shown in a recent JoVE paper with the use of the "quick-linker" device. This technique allows for easier venous cuff-anatomoses after a reasonable learning curve. The device is composed of two handles, which are carved out from scalpel blades, one approximator, which is obtained by modifying Kocher's forceps, and cuffs designed from fine-bore polyethylene tubing. The whole process can be performed at a low-cost using common laboratory material. The present report provides a step-by-step protocol for the design of the required pieces and includes stencils.
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Affiliation(s)
- Graziano Oldani
- Transplantation Division, Department of Surgery, University of Geneva Hospitals.
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Klein J, Tran SN, Mentha-Dugerdil A, Giostra E, Majno P, Morard I, Berney T, Dendauw P, Morel P, Mentha G, Iselin CE, Toso C. Assessment of sexual function and conjugal satisfaction prior to and after liver transplantation. Ann Transplant 2013; 18:136-45. [PMID: 23792513 DOI: 10.12659/aot.883860] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND The aims of this study were to assess sexual function and conjugal satisfaction in patients prior to and after liver transplantation, and in comparison to healthy individuals. MATERIAL AND METHODS A cross-sectional cohort questionnaire assessment was performed in adult liver recipients, including the International Index of Erectile Function (IIEF) for men or the Female Sexual Function Index (FSFI) for women. Conjugal satisfaction was assessed with the Locke-Wallace Marital Adjustment Test. Waitlist candidates and age-matched healthy individuals were used as controls. RESULTS Questionnaires of 136 patients were assessed (45 women/91 men, mean age: 57 ± 11 years). Overall, sexual function improved after transplantation (male: p=0.065 and female: p=0.072), but remained lower than in aged-matched healthy individuals. The post-transplant level of conjugal satisfaction was stable and similar to healthy controls in men, but improved significantly in women (p=0.008), with higher levels than in healthy subjects (p=0.05). CONCLUSIONS The present study shows that sexual function improves after transplantation, yet not to the level of healthy controls. It also demonstrates, for the first time, that post-transplant conjugal satisfaction is at least similar to the one of healthy controls.
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Affiliation(s)
- Jacques Klein
- Division of Urologic Surgery, Department of Surgery, Geneva University Hospitals, Geneva, Switzerland
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Hyder O, Hatzaras I, Sotiropoulos GC, Paul A, Alexandrescu S, Marques H, Pulitano C, Barroso E, Clary BM, Aldrighetti L, Ferrone CR, Zhu AX, Bauer TW, Walters DM, Groeschl R, Gamblin TC, Marsh JW, Nguyen KT, Turley R, Popescu I, Hubert C, Meyer S, Choti MA, Gigot JF, Mentha G, Pawlik TM. Recurrence after operative management of intrahepatic cholangiocarcinoma. Surgery 2013; 153:811-8. [PMID: 23499016 DOI: 10.1016/j.surg.2012.12.005] [Citation(s) in RCA: 203] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2012] [Accepted: 12/19/2012] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Data on recurrence after operation for intrahepatic cholangiocarcinoma (ICC) are limited. We sought to investigate rates and patterns of recurrence in patients after operative intervention for ICC. METHODS We identified 301 patients who underwent operation for ICC between 1990 and 2011 from an international, multi-institutional database. Clinicopathologic data, recurrence patterns, and recurrence-free survival (RFS) were analyzed. RESULTS During the median follow up duration of 31 months (range 1-208), 53.5% developed a recurrence. Median RFS was 20.2 months and 5-year actuarial disease-free survival, 32.1%. The most common site for initial recurrence after operation of ICC was intrahepatic (n = 98; 60.9%), followed by simultaneous intra- and extrahepatic disease (n = 30; 18.6%); 33 (21.0%) patients developed extrahepatic recurrence only as the first site of recurrence. Macrovascular invasion (hazard ratio [HR], 2.08; 95% confidence interval [CI], 1.34-3.21; P < .001), nodal metastasis (HR, 1.55; 95% CI, 1.01-2.45; P = .04), unknown nodal status (HR, 1.57; 95% CI, 1.10-2.25; P = .04), and tumor size ≥ 5 cm (HR, 1.84; 95% CI, 1.28-2.65; P < .001) were independently associated with increased risk of recurrence. Patients were assigned a clinical score from 0 to 3 according to the presence of these risk factors. The 5-year RFS for patients with scores of 0, 1, 2, and 3 was 61.8%, 36.2%, 19.5%, and 9.6%, respectively. CONCLUSION Recurrence after operative intervention for ICC was common. Disease recurred both at intra- and extrahepatic sites with roughly the same frequency. Factors such as lymph node metastasis, tumor size, and vascular invasion predict highest risk of recurrence.
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Affiliation(s)
- Omar Hyder
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Mayo SC, Pulitano C, Marques H, Lamelas J, Wolfgang CL, de Saussure W, Choti MA, Gindrat I, Aldrighetti L, Barrosso E, Mentha G, Pawlik TM. Surgical management of patients with synchronous colorectal liver metastasis: a multicenter international analysis. J Am Coll Surg 2013; 216:707-16; discussion 716-8. [PMID: 23433970 DOI: 10.1016/j.jamcollsurg.2012.12.029] [Citation(s) in RCA: 116] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2012] [Accepted: 12/07/2012] [Indexed: 02/06/2023]
Abstract
BACKGROUND The goal of this study was to investigate the surgical management and outcomes of patients with primary colorectal cancer (CRC) and synchronous liver metastasis (sCRLM). STUDY DESIGN Using a multi-institutional database, we identified 1,004 patients treated for sCRLM between 1982 and 2011. Clinicopathologic and outcomes data were evaluated with uni- and multivariable analyses. RESULTS A simultaneous CRC and liver operation was performed in 329 (33%) patients; 675 (67%) underwent a staged approach ("classic" staged approach, n = 647; liver-first strategy, n = 28). Patients managed with the liver-first approach had more hepatic lesions and were more likely to have bilateral disease than those in the other 2 groups (p < 0.05). The use of staged operative strategies increased over the time of the study from 58% to 75% (p < 0.001). Liver-directed therapy included hepatectomy (90%) or combined resection + ablation (10%). A major resection (>3 segments) was more common with a staged approach (39% vs 24%; p < 0.001). Overall, 509 patients (50%) received chemotherapy in either the preoperative (22%) or adjuvant (28%) settings, with 11% of patients having both. There were 197 patients (20%) who had a complication in the postoperative period, with no difference in morbidity between staged and simultaneous groups or major vs minor hepatectomies (p > 0.05). Ninety-day postoperative mortality was 3.0%, with no difference between simultaneous and staged approaches (p = 0.94). The overall median and 5-year survivals were 50.9 months and 44%, respectively; long-term survival was the same regardless of the operative approach (p > 0.05). CONCLUSIONS Simultaneous and staged resections for sCRLM can be performed with comparable morbidity, mortality, and long-term oncologic outcomes.
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Affiliation(s)
- Skye C Mayo
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Kaseje N, Lüthold S, Mentha G, Toso C, Belli D, McLin V, Wildhaber B. Donor hypernatremia influences outcomes following pediatric liver transplantation. Eur J Pediatr Surg 2013; 23:8-13. [PMID: 23165516 DOI: 10.1055/s-0032-1329703] [Citation(s) in RCA: 3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
INTRODUCTION With the rising demand for liver transplantations (LTs), and the shortage of organs, extended criteria including donor hypernatremia have been adopted to increase the donor pool. Currently, there is conflicting evidence on the effect of donor hypernatremia on outcomes following LT. Our aim was to investigate differences in outcome in patients receiving grafts from hypernatremic donors compared with patients receiving grafts from normonatremic donors in the pediatric population. METHODS We retrospectively reviewed 94 pediatric patients with LTs from 1994 to 2011. We divided the patients into two groups: patients receiving organs from donors with sodium levels < 150 µmol/L, n = 67 (group 1), and patients receiving organs from donors with sodium levels ≥ 150 µmol/L, n = 27 (group 2). Using proportions and means, we analyzed patient age, sex, weight, model for end-stage liver disease (MELD) score, primary diagnosis, emergency of procedure, intraoperative transfusion volume, cold ischemia time, donor age, graft type, and postoperative graft function. Rates of mortality, rejection, early biliary, infectious, and vascular complications were calculated. RESULTS Mean age was 3.9 years in group 1 and 3.7 years in group 2 (p = 0.69). Mean weight and MELD scores were similar in the two study groups (16.0 vs. 15.9 and 21.2 vs. 22.0, respectively). There were no significant differences in mean cold ischemia times 6.4 versus 6.9 hours (p = 0.29), and mean intraoperative transfusion volumes 1,068.5 mL versus 1,068.8 mL (p = 0.89). There were no statistically significant differences in mortality rates (7.3 vs. 11.1%, p = 0.68). Prothrombin time (PT) at day 10 post-LT was significantly lower in group 2 (79 vs. 64, p = 0.017), and there was a higher relative risk (RR) for early thrombotic vascular complications in group 2 (RR = 2.48); however, this was not significant (p = 0.26). No significant differences in RR for rejection (0.97, p = 0.86), viral infections (1.24, p = 0.31), bacterial infections (0.86, p = 0.62), or early biliary complications (1.03, p = 1.00) were observed. CONCLUSION In pediatric LT patients receiving grafts from hypernatremic donors, there are no significant increases in rates of mortality, rejection, early biliary, and infectious complications. However, there is a statistically significant lower PT at postoperative day 10 following transplantation, and a more than double RR for early thrombotic vascular complications although this was not statistically significant.
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Affiliation(s)
- Neema Kaseje
- Department of Pediatric Surgery, University Children's Hospital Geneva, 6 rue Willy Donzé, Geneva, Switzerland
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Orci LA, Toso C, Mentha G, Morel P, Majno PE. Systematic review and meta-analysis of the effect of perioperative steroids on ischaemia-reperfusion injury and surgical stress response in patients undergoing liver resection. Br J Surg 2013; 100:600-9. [PMID: 23339056 DOI: 10.1002/bjs.9035] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/08/2012] [Indexed: 12/31/2022]
Abstract
BACKGROUND Several therapeutic strategies, such as ischaemic preconditioning, intermittent or selective pedicle clamping and pharmacological interventions, have been explored to reduce morbidity caused by hepatic ischaemia-reperfusion injury and the surgical stress response. The role of steroids in this setting remains controversial. METHODS A comprehensive literature search in MEDLINE, Embase and the Cochrane Register of Clinical Trials (CENTRAL) was conducted (1966 onwards), identifying studies comparing perioperative administration of intravenous steroids with standard care or placebo, in the setting of liver surgery. Randomized Controlled trials (RCTs) and non-RCTs were included. Critical appraisal and meta-analysis were carried out according to the Preferred Reporting Items for Systematic reviews and Meta-analyses (PRISMA) statement. RESULTS Six articles were included; five were RCTs. Pooling the results revealed that patients receiving intravenous glucocorticoids were 24 per cent less likely to suffer postoperative morbidity compared with controls (risk ratio 0.76, 95 per cent confidence interval 0.57 to 0.99; P = 0.047). The treated group experienced a significantly greater rise in early postoperative interleukin (IL) 10 levels compared with controls. In addition, steroids significantly reduced postoperative blood levels of bilirubin, and of inflammatory markers such as IL-6 and C-reactive protein. There was no evidence supporting a risk difference in infectious complications and wound healing between study groups. CONCLUSION Perioperative steroids have a favourable impact on postoperative outcomes after liver resection.
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Affiliation(s)
- L A Orci
- Hepatopancreaticobiliary Centre, Division of Visceral Surgery and Transplantation, Department of Surgery, Faculty of Medicine, Geneva University Hospitals, 4 Rue Gabrielle Perret-Gentil, 1211 Geneva 4, Switzerland.
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Affiliation(s)
- Théodoros Thomopoulos
- Department of Surgery, Abdominal and Transplant Surgery, University Hospitals of Geneva, Switzerland.
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Orci LA, Majno PE, Berney T, Morel P, Mentha G, Toso C. The impact of wait list body mass index changes on the outcome after liver transplantation. Transpl Int 2012. [PMID: 23199077 DOI: 10.1111/tri.12017] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Obesity is associated with poor health outcomes in the general population, but the evidence surrounding the effect of body mass index (BMI) on postliver transplantation survival is contradictory. The aim of this study was to assess the impact of wait list BMI and BMI changes on the outcomes after liver transplantation. Using the Scientific Registry of Transplant Recipients, we compared survival among different BMI categories and examined the impact of wait list BMI changes on post-transplantation mortality for patients undergoing liver transplantation. Cox proportional hazards multivariate regression was carried out to adjust for confounding factors. Among 38 194 recipients, underweight patients had a poorer survival compared with normal weight (HR = 1.3, 95% CI: 1.13-1.49). Conversely, overweight and mildly obese men experienced better survival rates compared with their lean counterparts (HR = 0.9, 95% CI: 0.84-0.96, and HR = 0.86, 95% CI: 0.79-0.93 respectively). Female patients gaining weight over 18.5 kg/m(2) while on the wait list showed improving outcomes (HR = 0.46, (95% CI: 0.28-0.76)) compared with those remaining underweight. This study supports the harmful impact of underweight on postliver transplant survival, and highlights the need for a specific monitoring and management of candidates with BMIs close to 18.5 kg/m(2) . Obesity does not constitute an absolute contraindication to liver transplantation.
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Affiliation(s)
- Lorenzo A Orci
- Divisions of visceral and transplantation surgery, Department of surgery, Geneva University Hospitals, Geneva, Switzerland.
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Lacotte S, Borot S, Ferrari-Lacraz S, Villard J, Demuylder-Mischler S, Oldani G, Morel P, Mentha G, Berney T, Toso C. Posttransplant Cellular Immune Reactivity against Donor Antigen Correlates with Clinical Islet Transplantation Outcome: Towards a Better Posttransplant Monitoring. Cell Transplant 2012; 21:2339-50. [DOI: 10.3727/096368912x655000] [Citation(s) in RCA: 3] [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: 02/07/2023] Open
Abstract
The aim of the present study was to assess the efficiency of cell-based immune assays in the detection of alloreactivity after islet transplantation and to correlate these results with clinical outcome. Mixed lymphocyte cultures were performed with peripheral blood mononuclear cells from recipients ( n = 14), donors, or third party. The immune reactivity was assessed by the release of IFN-γ (ELISpot), cell proliferation (FACS analysis for Ki67), and cytokine quantification (Bioplex). Islet function correlated with the number of IFN-γ-secreting cells following incubation with donor cells ( p = 0.007, r = –0.50), but not with third party cells ( p = 0.61). Similarly, a high number of donor-specific proliferating cells was associated with a low islet function ( p = 0.006, r = −0.51). Proliferating cells were mainly CD3+CD4+ lymphocytes and CD3-CD56+ natural killer cells (with low levels of CD3+CD8+ lymphocytes). Patients with low islet function had increased levels of CD4+Ki67+cells ( p ≤ 0.0001), while no difference was observed in CD8+Ki67+ and CD56+Ki67+ cells. IFN-γ, IL-5, and IL-17 levels were increased in patients with low islet function, but IL-10 levels tended to be lower. IFN-γ-ELISpot, proliferation, and cytokines were similarly accurate in predicting clinical outcome (AUC = 0.77 ± 0.088, 0.85 ± 0.084, and 0.88 ± 0.074, respectively). Cellular immune reactivity against donor cells correlates with posttransplant islet function. The tested assays have the potential to be of substantial help in the management of islet graft recipients and deserve prospective validation.
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Affiliation(s)
- Stéphanie Lacotte
- Department of Surgery, Geneva University Hospitals, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Sophie Borot
- Department of Surgery, Geneva University Hospitals, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Sylvie Ferrari-Lacraz
- Transplant Immunology Unit, Geneva University Hospitals, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Jean Villard
- Transplant Immunology Unit, Geneva University Hospitals, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Sandrine Demuylder-Mischler
- Department of Surgery, Geneva University Hospitals, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Graziano Oldani
- Department of Surgery, Geneva University Hospitals, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Philippe Morel
- Department of Surgery, Geneva University Hospitals, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Gilles Mentha
- Department of Surgery, Geneva University Hospitals, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Thierry Berney
- Department of Surgery, Geneva University Hospitals, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Christian Toso
- Department of Surgery, Geneva University Hospitals, Faculty of Medicine, University of Geneva, Geneva, Switzerland
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Mentha G. KRAS status and outcome of liver resection after neoadjuvant chemotherapy including bevacizumab (Br J Surg 2012; 99: 1575-1582). Br J Surg 2012; 99:1582-3. [PMID: 23027076 DOI: 10.1002/bjs.8910] [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] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Important predictor of survival
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Affiliation(s)
- G Mentha
- Department of Surgery and Hepato-biliary and Pancreas Centre, University Hospitals of Geneva, 1211 Geneva 14, Switzerland.
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Abstract
Clinical progress in the field of liver transplantation has been largely supported by animal models(1,2). Since the publication of the first orthotopic rat liver transplantation in 1979 by Kamada et al.(3), this model has remained the gold standard despite various proposed alternative techniques(4). Nevertheless, its broader use is limited by its steep learning curve(5). In this video paper, we show a simple and easy-to-establish revision of Kamada's two-cuff technique. The suprahepatic vena cava anastomosis is performed manually with a running suture, and the vena porta and infrahepatic vena cava anastomoses are performed utilizing a quick-linker cuff system(6). Manufacturing the quick-linker kit is shown in a separate video paper.
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Affiliation(s)
- Graziano Oldani
- Transplantation Division, Department of Surgery, University of Geneva Hospitals, University of Geneva.
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Toso C, Dupuis-Lozeron E, Majno P, Berney T, Kneteman NM, Perneger T, Morel P, Mentha G, Combescure C. A model for dropout assessment of candidates with or without hepatocellular carcinoma on a common liver transplant waiting list. Hepatology 2012; 56:149-56. [PMID: 22271250 DOI: 10.1002/hep.25603] [Citation(s) in RCA: 84] [Impact Index Per Article: 7.0] [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: 07/04/2011] [Accepted: 01/02/2012] [Indexed: 02/06/2023]
Abstract
UNLABELLED In many countries, the allocation of liver grafts is based on the Model of End-stage Liver Disease (MELD) score and the use of exception points for patients with hepatocellular carcinoma (HCC). With this strategy, HCC patients have easier access to transplantation than non-HCC ones. In addition, this system does not allow for a dynamic assessment, which would be required to picture the current use of local tumor treatment. This study was based on the Scientific Registry of Transplant Recipients and included 5,498 adult candidates of a liver transplantation for HCC and 43,528 for non-HCC diagnoses. A proportional hazard competitive risk model was used. The risk of dropout of HCC patients was independently predicted by MELD score, HCC size, HCC number, and alpha-fetoprotein. When combined in a model with age and diagnosis, these factors allowed for the extrapolation of the risk of dropout. Because this model and MELD did not share compatible scales, a correlation between both models was computed according to the predicted risk of dropout, and drop-out equivalent MELD (deMELD) points were calculated. CONCLUSION The proposed model, with the allocation of deMELD, has the potential to allow for a dynamic and combined comparison of opportunities to receive a graft for HCC and non-HCC patients on a common waiting list.
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Affiliation(s)
- Christian Toso
- Division of Transplant, Department of Surgery, University of Geneva Hospitals, Geneva, Switzerland.
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Thomopoulos T, Naiken S, Rubbia-Brandt L, Mentha G, Toso C. Management of a ruptured hydatid cyst involving the ribs: Dealing with a challenging case and review of the literature. Int J Surg Case Rep 2012; 3:253-6. [PMID: 22503916 DOI: 10.1016/j.ijscr.2012.03.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2012] [Revised: 03/13/2012] [Accepted: 03/14/2012] [Indexed: 12/17/2022] Open
Abstract
INTRODUCTION Hydatid liver cysts can rupture into neighboring structures in 15-60% of patients, and most often involves the bile duct, the bronchi, and the peritoneal/pleural cavities. Rarely, chest or abdominal wall involvement occurs that are challenging to manage. This case report and literature review describes the management of patients with chest wall and rib invasion. PRESENTATION OF CASE A 74-year-old woman, of Spanish origin, presented with right upper quadrant abdominal pain and tender localized swelling. On computer tomography (CT) assessment, the rupture of a hydatid cyst into the right anterior chest wall was identified. Partial involvement of the 10th and 11th rib were noted. The diagnosis was confirmed by a serological test. Surgical treatment involved a radical en bloc right hepatic resection together with resection of the involved ribs, diaphragm and subcutaneous tissue. Primary diaphragm and wall closures were performed. The postoperative course was uneventful with three weeks of albendazole treatment. CT follow-up at six months demonstrated the absence of recurrence. DISCUSSION Complete resection is the gold standard treatment of patients with hydatid cysts with the aim to remove all parasitic and pericystic tissues. CONCLUSION The present report illustrates that an aggressive surgical en bloc resection is feasible and should be preferred for the treatment of hydatid cysts with rupture into the chest wall, even when the ribs are involved.
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Affiliation(s)
- Theodoros Thomopoulos
- Department of Surgery, Clinics of Visceral and Transplantation Surgery, University Hospitals of Geneva (HUG), 1211 Geneva 14, Geneva, Switzerland
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de Jong MC, Marques H, Clary BM, Bauer TW, Marsh JW, Ribero D, Majno P, Hatzaras I, Walters DM, Barbas AS, Mega R, Schulick RD, Choti MA, Geller DA, Barroso E, Mentha G, Capussotti L, Pawlik TM. The impact of portal vein resection on outcomes for hilar cholangiocarcinoma: a multi-institutional analysis of 305 cases. Cancer 2012; 118:4737-47. [PMID: 22415526 DOI: 10.1002/cncr.27492] [Citation(s) in RCA: 141] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2011] [Revised: 12/31/2011] [Accepted: 01/11/2012] [Indexed: 12/13/2022]
Abstract
UNLABELLED BACKGROUND. Surgical strategy for hilar cholangiocarcinoma often includes hepatectomy, but the role of portal vein resection (PVR) remains controversial. In this study, the authors sought to identify factors associated with outcome after surgical management of hilar cholangiocarcinoma and examined the impact of PVR on survival. METHODS Three hundred five patients who underwent curative-intent surgery for hilar cholangiocarcinoma between 1984 and 2010 were identified from an international, multi-institutional database. Clinicopathologic data were evaluated using univariate and multivariate analyses. RESULTS Most patients had hilar cholangiocarcinoma with tumors classified as T3/T4 (51.1%) and Bismuth-Corlette type II/III (60.9%). Resection involved extrahepatic bile duct resection (EHBR) alone (26.6%); or hepatectomy and EHBR without PVR (56.7%); or combined hepatectomy, EHBR, and PVR (16.7%). Negative resection (R0) margin status was higher among the patients who underwent hepatectomy plus EHBR (without PVR, 64.2%; with PVR, 66.7%) versus EHBR alone (54.3%; P < .001). The median number of lymph nodes assessed was higher among the patients who underwent hepatectomy plus EHBR (without PVR, 6 lymph nodes; with PVR, 4 lymph nodes) versus EHBR alone (2 lymph nodes; P < .001). The 90-day mortality rate was lower for patients who underwent EHBR alone (1.2%) compared with the rate for patients who underwent hepatectomy plus EHBR (without PVR, 10.6%, with PVR, 17.6%; P < .001). The overall 5-year survival rate was 20.2%. Factors that were associated with an adverse prognosis included lymph node metastasis (hazard ratio [HR], 1.79; P = .002) and R1 margin status (HR, 1.81; P < .001). Microscopic vascular invasion did not influence survival (HR, 1.23; P = .19). Among the patients who underwent hepatectomy plus EHBR, PVR was not associated with a worse long-term outcome (P = .76). CONCLUSIONS EHBR alone was associated with a greater risk of positive surgical margins and worse lymph node clearance. The current results indicated that hepatectomy should be considered the standard treatment for hilar cholangiocarcinoma, and PVR should be undertaken when necessary to extirpate all disease. Combined hepatectomy, EHBR, and PVR can offer long-term survival in some patients with advanced hilar cholangiocarcinoma.
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Affiliation(s)
- Mechteld C de Jong
- Division of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Hatzaras I, Choti MA, Schulick RD, Alexandrescu S, Pulitano C, Clary BM, Zhu AX, Popescu I, Marques H, Barroso E, Ferrone C, Bauer TW, Walters DM, Gamblin TC, Nguyen KT, Hubert C, Gigot JF, Mentha G, Pawlik TM. Patterns of recurrence after resection of intrahepatic cholangiocarcinoma: Results from a multi-institutional cohort of 449 patients. J Clin Oncol 2012. [DOI: 10.1200/jco.2012.30.4_suppl.267] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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
267 Background: Outcomes following surgical management of intrahepatic cholangiocarcionma (ICC) have largely focused on overall survival. Data on recurrence following surgery for ICC are limited. We sought to investigate rates and patterns of recurrence in patients following curative intent surgery for ICC. Methods: 449 patients who underwent surgery for ICC between 1973 and 2010 were identified from an international multi-institutional database. Clinicopathologic data, recurrence patterns, and recurrence-free survival (RFS) were analyzed. Results: Most patients had a solitary tumor (70%) with a median tumor size of 6.5 cm. The majority of lesions did not have vascular invasion (69%). Surgical treatment was < hemi-hepatectomy (47%), hemi-hepatectomy (26%), or extended hepatectomy (27%). On pathology, 23% patients had lymph node metastasis and 18% had a microscopically positive (R1) margin. A subset of patients received adjuvant chemotherapy (32%) or chemoradiation (39%). While 5-year overall survival was 31%, 351 (78%) patients recurred with a median RFS time of 13.2 months. First recurrence site was intra-hepatic only (54%), extra-hepatic only (24%), intra- and extra-hepatic (22%). There was no difference in RFS based on site of recurrence (intra-hepatic: 11.2 months; extra-hepatic 11.6 months; intra- and extra-hepatic: 9.6 months; P=0.16). An R1 surgical margin (HR: 1.56, p=0.02) and neural invasion (HR: 1.55, p=0.02) were associated with overall recurrence, while male gender (HR: 1.70, p=0.011), >50% liver parenchyma resection HR: 1.97, p=0.03), primary tumor size (1.05, p=.02), and poor differentiation (HR: 1.92, p=0.01, were associated with intrahepatic recurrence. Receipt of adjuvant therapy was not associated with risk of recurrence (P>0.05). Conclusions: Over 75% of patients developed recurrence following curative intent surgery for ICC. The pattern of failure was distributed relatively equally with half of patients recurring with liver only disease while half had an extrahepatic metastatic site of recurrence. Future efforts need to be directed toward identifying more effective adjuvant regimens given the high rate of recurrence.
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Affiliation(s)
- Ioannis Hatzaras
- Johns Hopkins University, Baltimore, MD; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore, MD; Fundeni Clinical Institute of Digestive, Bucharest, Romania; Liver Unit, Scientific Institute San Raffaele, Milan, Italy; Duke University Medical Center, Durham, NC; Division of Hematology and Oncology, Massachusetts General Hospital, Boston, MA; Center of General Surgery and Liver Transplantation, Fundeni Clinical Institute of Digestive Diseases and Liver Transplantation,
| | - Michael A. Choti
- Johns Hopkins University, Baltimore, MD; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore, MD; Fundeni Clinical Institute of Digestive, Bucharest, Romania; Liver Unit, Scientific Institute San Raffaele, Milan, Italy; Duke University Medical Center, Durham, NC; Division of Hematology and Oncology, Massachusetts General Hospital, Boston, MA; Center of General Surgery and Liver Transplantation, Fundeni Clinical Institute of Digestive Diseases and Liver Transplantation,
| | - Richard D. Schulick
- Johns Hopkins University, Baltimore, MD; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore, MD; Fundeni Clinical Institute of Digestive, Bucharest, Romania; Liver Unit, Scientific Institute San Raffaele, Milan, Italy; Duke University Medical Center, Durham, NC; Division of Hematology and Oncology, Massachusetts General Hospital, Boston, MA; Center of General Surgery and Liver Transplantation, Fundeni Clinical Institute of Digestive Diseases and Liver Transplantation,
| | - Sorin Alexandrescu
- Johns Hopkins University, Baltimore, MD; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore, MD; Fundeni Clinical Institute of Digestive, Bucharest, Romania; Liver Unit, Scientific Institute San Raffaele, Milan, Italy; Duke University Medical Center, Durham, NC; Division of Hematology and Oncology, Massachusetts General Hospital, Boston, MA; Center of General Surgery and Liver Transplantation, Fundeni Clinical Institute of Digestive Diseases and Liver Transplantation,
| | - Carlo Pulitano
- Johns Hopkins University, Baltimore, MD; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore, MD; Fundeni Clinical Institute of Digestive, Bucharest, Romania; Liver Unit, Scientific Institute San Raffaele, Milan, Italy; Duke University Medical Center, Durham, NC; Division of Hematology and Oncology, Massachusetts General Hospital, Boston, MA; Center of General Surgery and Liver Transplantation, Fundeni Clinical Institute of Digestive Diseases and Liver Transplantation,
| | - Bryan M. Clary
- Johns Hopkins University, Baltimore, MD; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore, MD; Fundeni Clinical Institute of Digestive, Bucharest, Romania; Liver Unit, Scientific Institute San Raffaele, Milan, Italy; Duke University Medical Center, Durham, NC; Division of Hematology and Oncology, Massachusetts General Hospital, Boston, MA; Center of General Surgery and Liver Transplantation, Fundeni Clinical Institute of Digestive Diseases and Liver Transplantation,
| | - Andrew X. Zhu
- Johns Hopkins University, Baltimore, MD; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore, MD; Fundeni Clinical Institute of Digestive, Bucharest, Romania; Liver Unit, Scientific Institute San Raffaele, Milan, Italy; Duke University Medical Center, Durham, NC; Division of Hematology and Oncology, Massachusetts General Hospital, Boston, MA; Center of General Surgery and Liver Transplantation, Fundeni Clinical Institute of Digestive Diseases and Liver Transplantation,
| | - Irinel Popescu
- Johns Hopkins University, Baltimore, MD; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore, MD; Fundeni Clinical Institute of Digestive, Bucharest, Romania; Liver Unit, Scientific Institute San Raffaele, Milan, Italy; Duke University Medical Center, Durham, NC; Division of Hematology and Oncology, Massachusetts General Hospital, Boston, MA; Center of General Surgery and Liver Transplantation, Fundeni Clinical Institute of Digestive Diseases and Liver Transplantation,
| | - Hugo Marques
- Johns Hopkins University, Baltimore, MD; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore, MD; Fundeni Clinical Institute of Digestive, Bucharest, Romania; Liver Unit, Scientific Institute San Raffaele, Milan, Italy; Duke University Medical Center, Durham, NC; Division of Hematology and Oncology, Massachusetts General Hospital, Boston, MA; Center of General Surgery and Liver Transplantation, Fundeni Clinical Institute of Digestive Diseases and Liver Transplantation,
| | - Eduardo Barroso
- Johns Hopkins University, Baltimore, MD; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore, MD; Fundeni Clinical Institute of Digestive, Bucharest, Romania; Liver Unit, Scientific Institute San Raffaele, Milan, Italy; Duke University Medical Center, Durham, NC; Division of Hematology and Oncology, Massachusetts General Hospital, Boston, MA; Center of General Surgery and Liver Transplantation, Fundeni Clinical Institute of Digestive Diseases and Liver Transplantation,
| | - Cristina Ferrone
- Johns Hopkins University, Baltimore, MD; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore, MD; Fundeni Clinical Institute of Digestive, Bucharest, Romania; Liver Unit, Scientific Institute San Raffaele, Milan, Italy; Duke University Medical Center, Durham, NC; Division of Hematology and Oncology, Massachusetts General Hospital, Boston, MA; Center of General Surgery and Liver Transplantation, Fundeni Clinical Institute of Digestive Diseases and Liver Transplantation,
| | - Todd W. Bauer
- Johns Hopkins University, Baltimore, MD; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore, MD; Fundeni Clinical Institute of Digestive, Bucharest, Romania; Liver Unit, Scientific Institute San Raffaele, Milan, Italy; Duke University Medical Center, Durham, NC; Division of Hematology and Oncology, Massachusetts General Hospital, Boston, MA; Center of General Surgery and Liver Transplantation, Fundeni Clinical Institute of Digestive Diseases and Liver Transplantation,
| | - Dustin M Walters
- Johns Hopkins University, Baltimore, MD; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore, MD; Fundeni Clinical Institute of Digestive, Bucharest, Romania; Liver Unit, Scientific Institute San Raffaele, Milan, Italy; Duke University Medical Center, Durham, NC; Division of Hematology and Oncology, Massachusetts General Hospital, Boston, MA; Center of General Surgery and Liver Transplantation, Fundeni Clinical Institute of Digestive Diseases and Liver Transplantation,
| | - T. Clark Gamblin
- Johns Hopkins University, Baltimore, MD; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore, MD; Fundeni Clinical Institute of Digestive, Bucharest, Romania; Liver Unit, Scientific Institute San Raffaele, Milan, Italy; Duke University Medical Center, Durham, NC; Division of Hematology and Oncology, Massachusetts General Hospital, Boston, MA; Center of General Surgery and Liver Transplantation, Fundeni Clinical Institute of Digestive Diseases and Liver Transplantation,
| | - Kevin Tri Nguyen
- Johns Hopkins University, Baltimore, MD; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore, MD; Fundeni Clinical Institute of Digestive, Bucharest, Romania; Liver Unit, Scientific Institute San Raffaele, Milan, Italy; Duke University Medical Center, Durham, NC; Division of Hematology and Oncology, Massachusetts General Hospital, Boston, MA; Center of General Surgery and Liver Transplantation, Fundeni Clinical Institute of Digestive Diseases and Liver Transplantation,
| | - Catherine Hubert
- Johns Hopkins University, Baltimore, MD; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore, MD; Fundeni Clinical Institute of Digestive, Bucharest, Romania; Liver Unit, Scientific Institute San Raffaele, Milan, Italy; Duke University Medical Center, Durham, NC; Division of Hematology and Oncology, Massachusetts General Hospital, Boston, MA; Center of General Surgery and Liver Transplantation, Fundeni Clinical Institute of Digestive Diseases and Liver Transplantation,
| | - Jean Francois Gigot
- Johns Hopkins University, Baltimore, MD; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore, MD; Fundeni Clinical Institute of Digestive, Bucharest, Romania; Liver Unit, Scientific Institute San Raffaele, Milan, Italy; Duke University Medical Center, Durham, NC; Division of Hematology and Oncology, Massachusetts General Hospital, Boston, MA; Center of General Surgery and Liver Transplantation, Fundeni Clinical Institute of Digestive Diseases and Liver Transplantation,
| | - Gilles Mentha
- Johns Hopkins University, Baltimore, MD; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore, MD; Fundeni Clinical Institute of Digestive, Bucharest, Romania; Liver Unit, Scientific Institute San Raffaele, Milan, Italy; Duke University Medical Center, Durham, NC; Division of Hematology and Oncology, Massachusetts General Hospital, Boston, MA; Center of General Surgery and Liver Transplantation, Fundeni Clinical Institute of Digestive Diseases and Liver Transplantation,
| | - Timothy M Pawlik
- Johns Hopkins University, Baltimore, MD; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore, MD; Fundeni Clinical Institute of Digestive, Bucharest, Romania; Liver Unit, Scientific Institute San Raffaele, Milan, Italy; Duke University Medical Center, Durham, NC; Division of Hematology and Oncology, Massachusetts General Hospital, Boston, MA; Center of General Surgery and Liver Transplantation, Fundeni Clinical Institute of Digestive Diseases and Liver Transplantation,
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Ditisheim S, Giostra E, Burkhard PR, Goossens N, Mentha G, Hadengue A, Spahr L. A capillary blood ammonia bedside test following glutamine load to improve the diagnosis of hepatic encephalopathy in cirrhosis. BMC Gastroenterol 2011; 11:134. [PMID: 22151412 PMCID: PMC3253684 DOI: 10.1186/1471-230x-11-134] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2011] [Accepted: 12/08/2011] [Indexed: 12/29/2022] Open
Abstract
Background Hepatic encephalopathy (HE) is a frequent and severe complication of cirrhosis. A single determination of ammonia in venous blood correlates poorly with neurological symptoms. Thus, a better biological marker is needed. Aim To make a diagnosis of HE, we explored the value of ammonia in capillary blood, an equivalent to arterial blood, measured at bedside following an oral glutamine challenge. Methods We included 57 patients (age 56 yrs; M/F: 37/20) with cirrhosis (alcoholic = 42; MELD score 13.8 [7-29], esophageal varices = 38) and previous episodes of HE (n = 19), but without neurological deficits at time of examination, and 13 healthy controls (age 54 yrs). After psychometric tests and capillary (ear lobe) blood ammonia measurements, 20 gr of glutamine was administered orally. Tests were repeated at 60 minutes (+ blood ammonia at 30'). Minimal HE was diagnosed if values were > 1.5 SD in at least 2 psychometric tests. Follow-up lasted 12 months. Results The test was well tolerated (nausea = 1; dizziness = 1). Patients showed higher values of capillary blood ammonia over time as compared to controls (0'-30'-60 minutes: 75, 117, 169 versus 52, 59, 78 umol/L, p < 0.05). At baseline, 25 patients (44%) had minimal HE, while 38 patients (67%) met the criteria for HE at 60 minutes (chi2: p < 0.01). For the diagnosis of minimal HE, using the ROC curve analysis, baseline capillary blood ammonia showed an AUC of 0.541 (CI: 0.38-0.7, p = 0.6), while at 60 minutes the AUC was 0.727 (CI: 0.58-0.87, p < 0.006). During follow-up, 18 patients (31%) developed clinical episodes of HE. At multivariate analysis, the MELD score (1.12 [1.018-1.236]), previous episodes of HE (3.2[1.069-9.58]), but not capillary blood ammonia, were independent predictors of event. Conclusions In patients with cirrhosis and normal neurological examination, bedside determination of ammonia in capillary blood following oral glutamine load is well tolerated and achieves a better diagnostic performance for minimal HE than basal capillary ammonia levels. However, capillary blood ammonia is a poor predictor of development of clinically overt HE.
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Affiliation(s)
- Saskia Ditisheim
- Gastroenterology and Hepatology, University Hospitals and Faculty of Medicine, 4, Rue Gabrielle Perret-Gentil, 1211 Geneva, Switzerland
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Terris B, Genevay M, Rouquette A, Audebourg A, Mentha G, Dousset B, Rubbia-Brandt L. Acinar cell carcinoma: a possible diagnosis in patients without intrapancreatic tumour. Dig Liver Dis 2011; 43:971-4. [PMID: 21893434 DOI: 10.1016/j.dld.2011.07.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [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: 03/03/2011] [Revised: 07/14/2011] [Accepted: 07/22/2011] [Indexed: 12/11/2022]
Abstract
BACKGROUND Acinar cell carcinomas of the pancreas are rare neoplasms. Usually diagnosed at an advanced stage, in general they are large solid pancreatic tumours with an average size of more than 10 cm. AIMS AND RESULTS We report 3 cases of acinar cell carcinomas involving the peripancreatic lymph nodes, the liver hilum and the colon respectively, without clinical or pathological evidence of pancreatic tumours. These highly cellular neoplasms showed a predominantly acinar cell differentiation intermingled with a ductal component, with intracellular or extracellular mucin production by at least 25% of tumour cells. In addition, one case showed endocrine differentiation. Diffuse immunoreactivity for acinar enzymes trypsin and chymotrypsin was present in all cases. CONCLUSION The occurrence of acinar cell carcinomas outside the pancreas underlines the notion that acinar cell carcinomas may originate in extrapancreatic sites and probably develop from heterotopic or metaplastic pancreatic foci present along the biliary tract.
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Affiliation(s)
- Benoît Terris
- Service d'Anatomie et Cytologie Pathologiques, Hôpital Cochin, Université Paris Descartes, Paris, France.
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Moldovan B, Mentha G, Majno P, Berney T, Morard I, Giostra E, Wildhaber BE, Van Delden C, Morel P, Toso C. Demographics and outcomes of severe herpes simplex virus hepatitis: a registry-based study. J Hepatol 2011; 55:1222-6. [PMID: 21703210 DOI: 10.1016/j.jhep.2011.02.029] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2010] [Revised: 02/21/2011] [Accepted: 02/23/2011] [Indexed: 01/09/2023]
Abstract
BACKGROUND & AIMS Herpes simplex virus hepatitis is a rare, but severe disease, thus far only documented by case reports and short series. The present study was based on the SRTR registry, and included all listed patients for liver transplantation from 1985 to 2009 with a diagnosis of HSV hepatitis. METHODS We assessed demographics and outcome of all listed patients, and further conducted a case-control study, matching each transplanted patient with 10 controls. Matching criteria included: transplant status, MELD score ±5, transplant date ±6 months, and age at transplant ±5 years. During the study period, 30 patients were listed for HSV hepatitis. Of the 30 listed patients, seven recovered spontaneously and five died, prior to transplantation. The remaining 10 children and eight adults were transplanted. RESULTS The chance of recovery was significantly higher in children than in adults (7/19 vs. 0/11, p=0.02). In children, survival was similar between HSV patients and the matched controls (5-year survival: 69% vs. 64%, p=0.89). Conversely, survival was poor in adult HSV (5-year survival: 38% vs. 65%, p=0.006), with 62% of them dying within the first 12 months. All three reported post-transplant deaths in children were independent from HSV. Among the seven adult post-transplant deaths, four were related to infection (bacterial, fungal, or viral). CONCLUSIONS Children listed for HSV hepatitis have a significantly better survival than adults both prior and after liver transplantation. While HSV fulminant hepatitis is an appropriate indication for liver transplantation in children, it should only be performed in selected adult patients in otherwise good condition.
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Affiliation(s)
- Bogdan Moldovan
- Transplantation Division, Department of Surgery, Geneva, Switzerland
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Ambrosioni J, Kaiser L, Giostra E, Meylan P, Mentha G, Toso C, Genevay-Infante M, Rubbia-Brandt L, van Delden C. Herpes simplex virus load to monitor antiviral treatment after liver transplantation for acute herpetic hepatitis. Antivir Ther 2011; 17:401-4. [PMID: 22290285 DOI: 10.3851/imp1922] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/12/2011] [Indexed: 10/16/2022]
Abstract
Herpes simplex virus (HSV) hepatitis is an uncommon cause of acute liver failure (ALF), primarily affecting immunocompromised patients. So far, 148 cases have been published, of which 9 underwent liver transplantation (LT). The reported post-transplant survival is poor, with over 60% dying in the first year. Dosing and duration of antiviral therapy after LT are not established. Concerns include both the risk of hepatic recurrence after LT and emergence of viral resistance during prolonged therapy. HSV DNA plasma levels might be helpful to monitor therapeutic response and guide duration of therapy. We present a case of ALF complicating a primary HSV-1 infection in an immunocompetent host, who required emergency LT. We further discuss the value of measuring serial HSV DNA plasma loads to monitor antiviral therapy.
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Affiliation(s)
- Juan Ambrosioni
- Service of Infectious Diseases, Department of Medical Specialities, University Hospitals of Geneva, Geneva, Switzerland
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Abstract
Liver transplantation is the best treatment of patients with unresectable early hepatocellular carcinoma, allowing disease-free survival rates of 60-80% at 5 years. Despite these good results, some 10% of recipients experience a posttransplant HCC recurrence, which leads to death in almost all patients. Recurrence is either due to the growth of occult metastases or to the engraftment of circulating tumor cells. It can be hypothesized that strategies to decrease the engraftment of circulating tumor cells could decrease the risk of recurrence and, in addition, extend access to transplantation to patients with more advanced HCC. These potential strategies can be schematized into five steps, including (1) selecting recipients with low baseline levels of circulating HCC cells, by adding biological markers (such as alpha fetoprotein or molecular signatures) to the accepted combination of morphological criteria; (2) decreasing the perioperative release of HCC cells, with careful perioperative handling of the tumors; (3) preventing the engraftment of circulating HCC cells by decreasing liver graft ischemia-reperfusion injury, which has been shown to promote cancer cell engraftment and growth; (4) using anticancer drugs, including mammalian target of rapamycin inhibitors and (5) tuning immunity toward HCC clearance.
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Affiliation(s)
- C Toso
- Abdonimal and Transplant Surgery, Department of Surgery, Geneva University Hospitals, Geneva, Switzerland.
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