Background
The aim of the study is to analyze the feasibility, the safety and short- and medium-term survival of totally laparoscopic simultaneous resections (LSR) of colorectal cancer (CRC) and ...synchronous liver metastases (LM).
Methods
This is a retrospective study of a single-center series. Patients ASA IV, ECOG ≥ 2, major hepatectomies (≥ 3 segments), symptomatic CRC as well as low rectal tumors were excluded from indication. The difficulty level of all liver resections was classified as low or intermediate according to the Iwate Criteria. Dindo–Clavien classification for postoperative complications evaluation was used.
Results
15 Patients with 21 liver lesions were included. Laparoscopic liver surgery was performed first in every case. Median size of the lesions was 20 mm (r 8–69). Major complications (Dindo–Clavien ≥ 3) occurred in 3 patients (20%); median hospital stay was 7 days (r 4–35), and only one patient (6.6%) was readmitted upon the first month from the surgery. 90-day mortality rate was 0%. After a median follow-up of 24 months (r 7–121), disease-free survival at 1, 2 and 3 years was 58%, 36% and 24%, respectively; overall survival at 1, 2 and 3 years was 92.3%.
Conclusions
In selected patients, LSR of CRC and LM is technically feasible and has an acceptable morbidity rate and mid-term survival.
The present study aims to assess the results obtained after surgical treatment of cholangiocarcinoma (CC) recurrences.
We carried out a single-center retrospective study, including all patients with ...recurrence of CC. The primary outcome was patient survival after surgical treatment compared with chemotherapy or best supportive care. A multivariate analysis of variables affecting mortality after CC recurrence was performed.
Eighteen patients were indicated surgery to treat CC recurrence. Severe postoperative complication rate was 27.8% with a 30-day mortality rate of 16.7%. Median survival after surgery was 15 months (range 0-50) with 1- and 3-year patient survival rates of 55.6% and 16.6%, respectively. Patient survival after surgery or CHT alone, was significantly better than receiving supportive care (p< 0.001). We found no significant difference in survival when comparing CHT alone and surgical treatment (p=0.113). Time to recurrence of <1 year, adjuvant CHT after resection of the primary tumor and undergoing surgery or CHT alone versus best supportive care were independent factors affecting mortality after CC recurrence in the multivariate analysis.
Surgery or CHT alone improved patient survival after CC recurrence compared to best supportive care. Surgical treatment did not improve patient survival compared to CHT alone.
BACKGROUNDThe management of a vascular injury during cholecystectomy is still very complicated, especially in centers not specialized in complex hepatobiliary surgery. METHODSThis was a ...multi-institutional retrospective study in patients with vascular injuries during cholecystectomy from 18 centers in 4 countries. The aim of the study was to analyze the management of vascular injuries focusing on referral, time to perform the repair, and different treatments options outcomes. RESULTSA total of 104 patients were included. Twenty-nine patients underwent vascular repair (27.9%), 13 (12.5%) liver resection, and 1 liver transplant as a first treatment. Eighty-four (80.4%) vascular and biliary injuries occurred in nonspecialized centers and 45 (53.6%) were immediately transferred. Intraoperative diagnosed injuries were rare in referred patients (18% vs 84%, P = .001). The patients managed at the hospital where the injury occurred had a higher number of reoperations (64% vs 20%, P ˂ .001). The need for vascular reconstruction was associated with higher mortality (P = .04). Two of the 4 patients transplanted died. CONCLUSIONVascular lesions during cholecystectomy are a potentially life-threatening complication. Management of referral to specialized centers to perform multiple complex multidisciplinary procedures should be mandatory. Late vascular repair has not shown to be associated with worse results.
Introduction
Transplantation-mediated alloimmune thrombocytopenia (TMAT) is a rare complication affecting the recipient of an organ from a donor with immune thrombocytopenia (ITP).
Methods
We present ...a case of TMAT following liver transplantation successfully treated by retransplantation, along with a review of previously published cases.
Clinical presentation: The liver donor had lupus and ITP and died from an intracranial hemorrhage. The recipient’s platelet count fell to 2x109/L on postoperative day 2. Due to the lack of response to medical treatment, emergency retransplantation was undertaken with a steady recovery of the platelet count within a few days.
Discussion
Six additional cases of transplantation-mediated alloimmune thrombocytopenia after liver transplantation have been reported. In all cases, severe thrombocytopenia ensued within 3 days after liver transplantation. Four patients suffered hemorrhagic complications. Three patients died. Early retransplantation was needed in three out of four patients receiving a graft from a donor with ITP and splenectomy. All recovered shortly after the new graft was in place.
Conclusion
Severe refractory transplantation-mediated alloimmune thrombocytopenia can develop in liver recipients from donors with ITP, especially those with previous splenectomy. Early retransplantation should be considered if there is no rapid response to medical therapy.
Primary health care integration in day surgery programs Aranda Escaño, Elena; Rebollo García, Antonio M; Tellaeche De La Iglesia, Miriam ...
International journal of integrated care,
08/2019, Letnik:
19, Številka:
4
Journal Article
Recenzirano
Odprti dostop
Introduction: KIRUBIDE system was a pilot project to promote the collaboration between Primary Health Care (PHC) and the Day Surgery Team in Cruces University Hospital. After its implementation, more ...PHC centres were interested and Health Organization (Osakidetza) has increased its activity area. Description of practice change implemented: Involvement of PHC doctors supposes a new role in simple surgical pathology (such as hernias or sinus) ordering preoperative tests and sending a non-presence-consult (ICTs) to the Day Surgery Team. So a presence-consult with surgeon and anesthesiologist is coordinated the same day to establish the date of surgery in that moment. After the surgery, the follow up is also made by PHC. This simplifies the usual process, also establishing a professional relationship to solve any problem easily. Aim and theory of change: Improve the health care pathway optimizing the process by cooperation with PHC in diagnoses and follow-up in the whole attention and simplifying preoperative activity and surgical scheduling. Targeted population and stakeholders: Patients suffering major ambulatory surgery pathology from the PHC centres. Promote Primary Care selection of patients and follow-up until the end of the process. Timeline: KIRUBIDE system was implemented in 2014, after two years 150 were included in the pilot project from different PHC centres. As a result, more centres were interested and reached 300 patients after recent implantation. Highlights: There was a voluntary participation from PHC doctors of 40%. 150 patients were included in the project and 114 finally were operated. Waiting list was reduced to a mean of 15 days since surgical team consult and to 43 days after PHC consult compared to 73 and 101 days from the usual pathway. A satisfaction survey was made obtaining high level (90%) in both patients and professionals in reduction of waiting list and improvement of communication. Comments on sustainability: KIRUBIDE system may increase the workload per patient of PHC doctors. There is no investment because the communication is established online by electronic health records system. Cost effectiveness was not studied but it's assumed to improve as less appointments are needed. Comments on transferability: KIRUBIDE allows a great integration of PHC in Major Ambulatory Surgery programs and it can be applied to other hospitals that have the same organizational structure as our own increasing the efficiency. Conclusions: KIRUBIDE system simplifies the care model of candidate patients, reducing the steps in the usual assistance circuit and surgery-waiting-lists with people satisfaction. It also favours the integration of medical specialties and improves the patients’ follow-up. This program improves resources’ use and care quality because it optimizes the process by reducing steps. Discussions: KIRUBIDE system is mostly focused in simple pathology but it may be applied in others such as cholecystectomy. It only analyses a limited area with a specific organization structure not available in other places. Lesson learned: Patients need more information than the one given. Primary Health Care doctors think that time needed with each patient increases but agree that a better communication implies benefits for professionals and patients.
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