The primary endpoint of this study was to evaluate the outcome of surgery for perihilar cholangiocarcinoma in a high-volume tertiary referral center.
The study population consisted of 196 consecutive ...patients with histologically confirmed perihilar cholangiocarcinoma-PHC-who were candidates to surgical treatment. Factors affecting postoperative morbidity were evaluated in the whole series (primary endpoint) and after stratification of patients according to the following criteria: (a) perioperative management protocol implementation; (b) monocentric management (secondary endpoint).
The postoperative morbidity rate was 51.5% and mortality 4.1%. The most frequent cause of death was postoperative liver failure. At multivariate analysis, factors affecting the risk of morbidity were: side of hepatectomy, liver volume, intraoperative blood loss, preoperative optimization and single-center management. Patients treated according to preoperative optimization protocol, as well as patients with monocentric management experienced a significant reduction of postoperative morbidity. Preoperative optimization and single-center management significantly affected even long term outcome of patients.
Despite continuous improvement in the surgical field, hilum-infiltrating tumors still remain associated with therapeutic and management challenges: a correct preoperative management in a tertiary referral center provides a benefit in terms of morbidity and mortality, thus improving long term results.
Hepatopancreatoduodenectomy (HPD) is an aggressive operation for treatment of advanced bile duct and gallbladder cancer associated with high perioperative morbidity and mortality, and uncertain ...oncological benefit in terms of survival. Few reports on HPD from Western centers exist. The purpose of this study was to evaluate safety and efficacy for HPD in European centers.
Members of the European-African HepatoPancreatoBiliary Association were invited to report all consecutive patients operated with HPD for bile duct or gallbladder cancer between January 2003 and January 2018. The patient and tumor characteristics, perioperative and survival outcomes were analyzed.
In total, 66 patients from 19 European centers were included in the analysis. 90-day mortality rate was 17% and 13% for bile duct and gallbladder cancer respectively. All factors predictive of perioperative mortality were patient and disease-specific. The three-year overall survival excluding 90-day mortality was 80% for bile duct and 30% for gallbladder cancer (P = 0.013). In multivariable analysis R0-resection had a significant impact on overall survival.
HPD, although being associated with substantial perioperative mortality, can offer a survival benefit in patient subgroups with bile duct cancer and gallbladder cancer. To achieve negative resection margins is paramount for an improved survival outcome.
The REDISCOVER guidelines present 34 recommendations for the selection and perioperative care of borderline-resectable (BR-PDAC) and locally advanced ductal adenocarcinoma of the pancreas (LA-PDAC). ...These guidelines represent a significant shift from previous approaches, prioritizing tumor biology over anatomical features as the primary indication for resection. Condensed herein, they provide a practical management algorithm for clinical practice. However, the guidelines also highlight the need to redefine LA-PDAC to align with modern treatment strategies and to solve some contradictions within the current definition, such as grouping "difficult" and "impossible" to resect tumors together. Furthermore, the REDISCOVER guidelines highlight several areas requiring urgent research. These include the resection of the superior mesenteric artery, the management strategies for patients with LA-PDAC who are fit for surgery but unable to receive multi-agent neoadjuvant chemotherapy, the approach to patients with LA-PDAC who are fit for surgery but demonstrate high serum Ca 19.9 levels even after neoadjuvant treatment, and the optimal timing and number of chemotherapy cycles prior to surgery. Additionally, the role of primary chemoradiotherapy versus chemotherapy alone in LA-PDAC, the timing of surgical resection post-neoadjuvant/primary chemoradiotherapy, the efficacy of ablation therapies, and the management of oligometastasis in patients with LA-PDAC warrant investigation. Given the limited evidence for many issues, refining existing management strategies is imperative. The establishment of the REDISCOVER registry ( https://rediscover.unipi.it/ ) offers promise of a unified research platform to advance understanding and improve the management of BR-PDAC and LA-PDAC.
Table 1 Previously announced initiatives surrounding artificial intelligence (AI) and large language models (LLMs) in healthcare (not exhaustive) Initiative Participants Scope Alan Turing Institute ...Academic collaboration Research focused on understanding and advancing models, techniques and principles that underpin AI/LLM Health Data Research UK Academic and institutional collaboration Clinical AI data analyses HealTex.org Academic, institutional and industrial collaboration Healthcare-related text analysis AI4Health Academic Research group The Partnership on Artificial Intelligence for Health (PAIHealth) Academic, civil society, media, industry Not focused on medical applications Allen institute for AI Non-profit research institute Development of AI applications, including medical The Chan Zuckerberg Initiative Philanthropic organisation Development of AI applications, including medical Digital Medicine and AI (DiMeAI) Academic, clinical and industrial collaboration Advancement of AI in healthcare The HeAL (Healthcare AI Language) Group—HeALgroup.AI was founded to better understand medicine-science applications of LLM and its implication on medical practice.5 We aim to provide a community-based, low-threshold, open platform for healthcare providers, researchers and patient representatives. Twitter @baschi85 Collaborators Dimitri Raptis (Liver Transplant and HPB Surgery, Organ Transplant Center of Excellence, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia); Sebastian Staubli (Department of HPB Surgery and Liver Transplant, Royal Free Hospital, London, UK); Michael Spiro (Department of Anaesthesia and Intensive Care, Royal Free Hospital, London, UK); Saleh Al Qahtani, (H.E. Dr.) Chairman, Board of Directors & Executive Director (Royal Clinics, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia); Basel Jobeir (Surgery, Organ Transplant Center of Excellence, King Faisal Specialist Hospital and Research Center & Alfaisal University, Riyadh, Saudi Arabia); Abdulrahman K. Alobied (Head of Development and Loyalty, Amyal Smart, Riyadh, Saudi Arabia); Alexandra Aldana (Pediatric Transplant Hepatology, Organ Transplant Center of Excellence, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia); Arvinder Singh Soin (Medanta Institute of Liver Transplantation and Regenerative Medicine, Medanta-The Medicity, Delhi, India); Deniz Saner (ENLYZE, Co-founder, IIoT Manufacturing Data Platform, Cologne, Germany); Camila Hidalgo Salinas (Surgery, Global Healthcare Sciences, University of Oxford, UK); Ehab Abufarhaneh (Gastroenterology and Hepatology, Quality & Patient Experience, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia); Fuat Saner (Intensive Care, Organ Transplant Center of Excellence, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia); Jennie Engstrand (Division of Surgery, Karolinska Institutet at Danderyd Hospital, Stockholm, Sweden); Johannes Wienker (Department of Interventional Pneumonology, Medical Center University Duisburg-Essen, Germany); Harriet Louise Walker (Department of Obstetrics and Gynaecology, University College London NHS Foundation Trust, London, UK); Kris Marquez (Clinical Trial Coordinator, Organ Transplant Center of Excellence, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia); Maha Assubayii (Transplant Psychology, Organ Transplant Center of Excellence, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia); Mamdouh Alenazi (Transplant Psychology, Organ Transplant Center of Excellence, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia); Matthias Malago (Pythia Labs, ML Engineer, Los Angeles, CA, USA); Massimo Malago (Liver transplant, HPB and Upper GI Surgery, Organ Transplant Center of Excellence, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia); Mohamed El hibouri (Pythia Labs, Head of AI, Los Angeles, CA, USA); Maha Nadine Bassas (Healthcare Systems Engineer, Organ Transplant Center of Excellence, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia); Noman Mahmood (Department of Anaesthesia and Intensive Care, Royal Free Hospital, London, UK); Noor Al Saadoun (Senior Lecturer in Cancer Biology, Alfaisal University, Riyadh, Saudi Arabia); Nicholas Syn (Division of Biomedical Informatics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore); Vincent Ochs (Department of Biomedical Engineering, Faculty of Medicine, University of Basel, Allschwil, Switzerland); Pascale Tinguely (Department of HPB and Liver Transplant, Royal Free Hospital, London, UK); Ryan Alenazi (Pharmaceutical Care Services, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia); Sarah Bigham (Department of Intensive Care, Royal Devon University Hospital NHS Foundation Trust, Exeter, UK); Yasemin Saner (Department of Urology, Essen University Hospital, Germany). J Med Internet Res 2023; 25: e47479. doi:10.2196/47479 2 Sallam M. ChatGPT utility in healthcare education, research, and practice: systematic review on the promising perspectives and valid concerns.
Purpose
Pancreatic solid pseudopapillary neoplasms (SPNs) are rare borderline tumours mainly affecting young female patients. The number of patients diagnosed with SPNs has increased significantly in ...the last decades owing to the increased use of cross-sectional imaging investigating different abdominal symptoms, whilst a significant proportion are incidentally discovered during the process of evaluating other pathologies. We herein present our institutional experience of patients with SPN who underwent curative resection focusing on clinical, pathological features, and the long-term outcomes.
Methods
All patients undergoing pancreatectomy in our institution for SPN from January 2010 until December 2018 were included. Clinical, perioperative, histological, and long-term outcomes were collected and analysed.
Results
During the inclusion period, a total of 19 patients had a pathological diagnosis of SPNs after surgical resection. Sixteen of them were female (84%), while the median patient age was 30 (range 16–66) years. Nine patients (47%) underwent distal pancreatectomy and splenectomy, 2 (11%) underwent spleen preserving distal pancreatectomy, 6 (32%) underwent pancreatoduodenectomy, one (5%) underwent total pancreatectomy, and one (5%) central pancreatectomy. Seventeen patients underwent R0 resection. During a median follow-up of 23 months, no tumour recurrence or death was recorded.
Conclusion
In our experience, SPNs are rare tumours with low malignant potentials. Surgical resection remains the gold standard treatment and is associated with good prognosis.
Pancreatoduodenectomy (PD) is frequently the surgical treatment indicated for a number of pathologies. Elderly patients may be denied surgery because of concerns over poor perioperative outcomes. The ...aim of this study was to evaluate postoperative clinical outcomes and provide evidence on current UK practice in the elderly population after PD.
This was a multicentre retrospective case-control study of octogenarians undergoing PD between January 2008 and December 2017, matched with younger controls from seven specialist centres in the UK. The primary endpoint was 90-day mortality. Secondary endpoints were index admission mortality, postoperative complications, and 30-day readmission rates.
In total, 235 octogenarians (median age 81 (range 80-90) years) and 235 controls (age 67 (31-79) years) were included in the study. Eastern Cooperative Oncology Group performance status (median 0 (range 0-3) versus 0 (0-2); P = 0.010) and Charlson Co-morbidity Index score (7 (6-11) versus 5 (2-9); P = 0.001) were higher for octogenarians than controls. Postoperative complication and 30-day readmission rates were comparable. The 90-day mortality rate was higher among octogenarians (9 versus 3 per cent; P = 0.030). Index admission mortality rates were comparable (4 versus 2 per cent; P = 0.160), indicating that the difference in mortality was related to deaths after hospital discharge. Despite the higher 90-day mortality rate in the octogenarian population, multivariable Cox regression analysis did not identify age as an independent predictor of postoperative mortality.
Despite careful patient selection and comparable index admission mortality, 90-day and, particularly, out-of-hospital mortality rates were higher in octogenarians.
Pancreatic surgery remains associated with high morbidity rates. Although postoperative mortality appears to have improved with specialization, the outcomes reported in the literature reflect the ...activity of highly specialized centres. The aim of this study was to evaluate the outcomes following pancreatic surgery worldwide.
This was an international, prospective, multicentre, cross-sectional snapshot study of consecutive patients undergoing pancreatic operations worldwide in a 3-month interval in 2021. The primary outcome was postoperative mortality within 90 days of surgery. Multivariable logistic regression was used to explore relationships with Human Development Index (HDI) and other parameters.
A total of 4223 patients from 67 countries were analysed. A complication of any severity was detected in 68.7 per cent of patients (2901 of 4223). Major complication rates (Clavien-Dindo grade at least IIIa) were 24, 18, and 27 per cent, and mortality rates were 10, 5, and 5 per cent in low-to-middle-, high-, and very high-HDI countries respectively. The 90-day postoperative mortality rate was 5.4 per cent (229 of 4223) overall, but was significantly higher in the low-to-middle-HDI group (adjusted OR 2.88, 95 per cent c.i. 1.80 to 4.48). The overall failure-to-rescue rate was 21 per cent; however, it was 41 per cent in low-to-middle- compared with 19 per cent in very high-HDI countries.
Excess mortality in low-to-middle-HDI countries could be attributable to failure to rescue of patients from severe complications. The authors call for a collaborative response from international and regional associations of pancreatic surgeons to address management related to death from postoperative complications to tackle the global disparities in the outcomes of pancreatic surgery (NCT04652271; ISRCTN95140761).
The outcomes of liver surgery worldwide remain unknown. The true population-based outcomes are likely different to those vastly reported that reflect the activity of highly specialized academic ...centers. The aim of this study was to measure the true worldwide practice of liver surgery and associated outcomes by recruiting from centers across the globe. The geographic distribution of liver surgery activity and complexity was also evaluated to further understand variations in outcomes.
LiverGroup.org was an international, prospective, multicenter, cross-sectional study following the Global Surgery Collaborative Snapshot Research approach with a 3-month prospective, consecutive patient enrollment within January-December 2019. Each patient was followed up for 90 days postoperatively. All patients undergoing liver surgery at their respective centers were eligible for study inclusion. Basic demographics, patient and operation characteristics were collected. Morbidity was recorded according to the Clavien-Dindo Classification of Surgical Complications. Country-based and hospital-based data were collected, including the Human Development Index (HDI). (NCT03768141).
A total of 2159 patients were included from six continents. Surgery was performed for cancer in 1785 (83%) patients. Of all patients, 912 (42%) experienced a postoperative complication of any severity, while the major complication rate was 16% (341/2159). The overall 90-day mortality rate after liver surgery was 3.8% (82/2,159). The overall failure to rescue rate was 11% (82/ 722) ranging from 5 to 35% among the higher and lower HDI groups, respectively.
This is the first to our knowledge global surgery study specifically designed and conducted for specialized liver surgery. The authors identified failure to rescue as a significant potentially modifiable factor for mortality after liver surgery, mostly related to lower Human Development Index countries. Members of the LiverGroup.org network could now work together to develop quality improvement collaboratives.
Purpose
A preoperative estimate of the risk of malignancy for intraductal papillary mucinous neoplasms (IPMN) is important. The present study carries out an external validation of the Shin score in a ...European multicenter cohort.
Methods
An observational multicenter European study from 2010 to 2015. All consecutive patients undergoing surgery for IPMN at 35 hospitals with histological-confirmed IPMN were included.
Results
A total of 567 patients were included. The score was significantly associated with the presence of malignancy (
p
< 0.001). In all, 64% of the patients with benign IPMN had a Shin score < 3 and 57% of those with a diagnosis of malignancy had a score ≥ 3. The relative risk (
RR
) with a Shin score of 3 was 1.37 (95%
CI
: 1.07–1.77), with a sensitivity of 57.1% and specificity of 64.4%.
Conclusion
Patients with a Shin score ≤ 1 should undergo surveillance, while patients with a score ≥ 4 should undergo surgery. Treatment of patients with Shin scores of 2 or 3 should be individualized because these scores cannot accurately predict malignancy of IPMNs. This score should not be the only criterion and should be applied in accordance with agreed clinical guidelines.
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