Combined hepatic and inferior vena cava (IVC) resection is the only potentially curative treatment for patients with colorectal liver metastases (CRLM) involving the IVC. Most of the existing data ...come from case reports or small case series. In this paper, a systematic review based on the PICO strategy was performed in accordance with the PRISMA statement. Papers from January 1980 to December 2022 were searched in Embase, PubMed, and the Cochrane Library databases. Articles considered for inclusion had to present data on simultaneous liver and IVC resection for CRLM and report surgical and/or oncological outcomes. From a total of 1175 articles retrieved, 29, including a total of 188 patients, met the inclusion criteria. The mean age was 58.3 ± 10.8 years. The most frequent techniques used were right hepatectomy ± caudate lobe for hepatic resections (37.8%), lateral clamping (44.8%) for vascular control, and primary closure (56.8%) for IVC repair. The thirty-day mortality reached 4.6%. Tumour relapse was reported in 65.8% of the cases. The median overall survival (OS) was 34 months (with a confidence interval of 30-40 months), and the 1-year, 3-year, and 5-year OS were 71.4%, 19.8%, and 7.1%, respectively. In the absence of prospective randomized studies, which are difficult to perform, IVC resection seems to be safe and feasible.
Metabolic syndrome is a group of disorders including central obesity, decreased levels of high-density lipoprotein cholesterol, increased triglyceride concentration, hypertension, and hyperglycemia. ...This syndrome has become a 21st-century epidemic. Causal agents include insulin resistance, leptin and adiponectin, changes in microbiota, and epigenetics. Incidence is estimated to be around 25% of the European population. Non-alcoholic fatty liver disease is the hepatic manifestation of metabolic syndrome. Its prevalence parallels that of obesity, and has increased exponentially over the last few decades. Recently, several publications have associated metabolic risk factors with the development and progression of hepatocellular carcinoma. In this context establishing whether patients with non-alcoholic fatty liver disease should go through a screening protocol for hepatocellular carcinoma is of the utmost importance. To date, the reported worldwide incidence of hepatocellular carcinoma in patients with non-alcoholic fatty liver disease without cirrhosis is 2.7% at 10 years. Although screening for hepatocellular carcinoma in patients with non-alcoholic fatty liver disease and cirrhosis is mandatory, the low incidence of hepatocellular carcinoma in patients without cirrhosis does not justify a systematic surveillance of this population. Efforts are made to determine which subgroups of patients with non-alcoholic fatty liver disease are at higher risk of developing hepatocellular carcinoma. Keywords: Metabolic syndrome. Hepatocellular carcinoma. Non-alcoholic fatty liver disease. Non-alcoholic steatohepatitis.
Intracholecystic papillary neoplasia (IPN) is a rare entity rarely described in the literature, of incidental anatomopathological diagnosis in a cholecystectomy specimen that presents a premalignant ...behavior, with progression to carcinoma in more than 50% of cases. In the absence of an invasive component, clinical follow-up is recommended, without associating another surgical gesture, with a 5-year prognosis (90% survival). We present a case of a patient with an incidental diagnosis of NPIC after laparoscopic cholecystectomy due to presenting a gallbladder polyp.
Background Parathyroid carcinoma (PC) is an uncommon disease that generally is detected postoperatively and traditionally is associated with a poor prognosis. Our purpose was to evaluate treatment ...outcomes, prognostic factors, and usefulness of some proposed staging systems for this disease. Methods A multicenter review of patients with surgically resected PC was performed, led by the Spanish Association of Surgery. All surgical units affiliated with its endocrine surgery section were invited to answer a questionnaire that collected several hospital-related, clinical, biochemical, operative, pathologic, and follow-up data. Their relationships with prognosis were assessed by both univariate and multivariate analysis, as well as the effectiveness of three staging systems for parathyroid carcinoma. Result Of the 6,863 patients undergoing parathyroidectomy, 62 (0.9%) had PC. Of them, 12 (19.3%) died, in 5 cases (8%) because of disease, and 14 (22.6%) suffered recurrence, after a median follow-up of 55 months. The most predictive independent variables on tumor recurrence were intraoperative tumor rupture (hazard ratio HR 6.22; 95% confidence interval CI 1.19–32.36; P = .030); the presence of mitotic figures within tumor parenchyma cells (HR 4.76; 95% CI 1.24–18.21; P = .022); and allocation in class III according to Schulte differentiated staging classification (HR 5.23; 95% CI 1.41–19.31; P = .013). As to disease-specific survival, poor outcomes were associated with intraoperative tumor rupture (HR 58.71; 95% CI 2.39–1,439.96; P = .013) and distant recurrence (HR 38.74; 95% CI 3.44–435.62; P = .003). Conclusion In addition to factors associated with tumor histopathology and stage, prognosis of PC is greatly influenced by surgeon's performance, which emphasizes the importance of preoperative diagnosis.
Abstract
Background
The potential of haemostatic patches to reduce the rate of postoperative pancreatic fistula remains unclear. The aim of this trial was to evaluate the impact of a polyethylene ...glycol-coated haemostatic patch on the incidence of clinically relevant postoperative pancreatic fistula after pancreatoduodenectomy.
Methods
In this randomized, single-centre, clinical trial, patients undergoing pancreatoduodenectomy were randomized 1 : 1 to receive pancreatojejunostomy reinforced with two polyethylene glycol-coated haemostatic patches (patch group) or without any reinforcement (control group). The primary outcome was clinically relevant postoperative pancreatic fistula, defined as grade B/C according to International Study Group of Pancreatic Surgery criteria, within 90 days. Key secondary outcomes were length of hospital stay, total rate of postoperative pancreatic fistula, and overall complication rate.
Results
From 15 May 2018 to 22 June 2020, 72 patients were randomized, and 64 were included in the analyses (31 in the patch group and 33 in the control group). The risk of clinically relevant postoperative pancreatic fistula was reduced by 90 per cent (OR 0.10, 95 per cent c.i. 0.01 to 0.89, P = 0.039). Moreover, the use of the polyethylene glycol-coated patch retained its protective effect on clinically relevant postoperative pancreatic fistula in a multivariable regression model, significantly reducing the risk of clinically relevant postoperative pancreatic fistula by 93 per cent (OR 0.07, 95 per cent c.i. 0.01 to 0.67, P = 0.021), regardless of patient age, sex, or fistula risk score. The incidence of secondary outcomes did not significantly differ between the groups. One patient died within 90 days in the patch group versus three patients in the control group.
Conclusions
A polyethylene glycol-coated haemostatic patch reduced the incidence of clinically relevant postoperative pancreatic fistula after pancreatoduodenectomy.
Registration number
NCT03419676 (http://www.clinicaltrials.gov).
Hemopatch™ significantly reduced the incidence of clinically relevant postoperative pancreatic fistula in patients who underwent a pancreatoduodenectomy. The effectiveness of the patch was related to the fistula risk score.
We present a multicenter retrospective study of patients undergoing surgery for duodenal adenocarcinoma, from January 2010 to August 2020, in order to determine the epidemiological characteristics ...and the oncological results after surgical resection obtained in this rare tumor. Variables: demographics; tumor location; surgical intervention and immediate postoperative period; and post-surgical follow-up information, such as recurrence, overall survival (OS), and disease-free survival (DFS). A total of 32 patients underwent surgery. The median age was 69.74 years (IQR 60.47–79.09) and the male/female distribution was 3:1. The surgeries performed were: pancreaticoduodenectomy (PD) in 16 (50%) patients, segmental resection in 13 (40.6%), and the local excision of the lesion in three (9.4%). The R0 rate was higher in PD (86.7% vs. 42.9%; p = 0.013). The OS and DFS rate at one, three and five years was 95%, 70%, and 60% and 86%, 55%, and 48%, respectively. There was a greater trend towards recurrence in patients who did not undergo PD (53.8% vs. 25%; p = 0.14) and conservative surgery seemed to be associated with more local recurrence than PD (57.1% vs. 33.3%; p = 0.49). PD and limited resection are both valid options in the cases of non-ampullary duodenal adenocarcinoma, although PD presented lower rates of loco-regional recurrence.
Abstract
Bile duct injury (BDI) is a dangerous complication of cholecystectomy, with significant postoperative sequelae for the patient in terms of morbidity, mortality, and long-term quality of ...life. BDIs have an estimated incidence of 0.4–1.5%, but considering the number of cholecystectomies performed worldwide, mostly by laparoscopy, surgeons must be prepared to manage this surgical challenge. Most BDIs are recognized either during the procedure or in the immediate postoperative period. However, some BDIs may be discovered later during the postoperative period, and this may translate to delayed or inappropriate treatments. Providing a specific diagnosis and a precise description of the BDI will expedite the decision-making process and increase the chance of treatment success. Subsequently, the choice and timing of the appropriate reconstructive strategy have a critical role in long-term prognosis. Currently, a wide spectrum of multidisciplinary interventions with different degrees of invasiveness is indicated for BDI management. These World Society of Emergency Surgery (WSES) guidelines have been produced following an exhaustive review of the current literature and an international expert panel discussion with the aim of providing evidence-based recommendations to facilitate and standardize the detection and management of BDIs during cholecystectomy. In particular, the 2020 WSES guidelines cover the following key aspects: (1) strategies to minimize the risk of BDI during cholecystectomy; (2) BDI rates in general surgery units and review of surgical practice; (3) how to classify, stage, and report BDI once detected; (4) how to manage an intraoperatively detected BDI; (5) indications for antibiotic treatment; (6) indications for clinical, biochemical, and imaging investigations for suspected BDI; and (7) how to manage a postoperatively detected BDI.
Background
Surgical hemostasis has become one of the key principles in the advancement of surgery. Hemostatic agents are commonly administered in many surgical specialties, although the lack of ...consensus on the definition of intraoperative bleeding or of a standardized system for its classification means that often the most suitable agent is not selected. The recommendations of international organizations highlight the need for a bleeding severity scale, validated in clinical studies, that would allow the selection of the best hemostatic agent in each case. The primary objective of this study is to evaluate the VIBe scale (Validated Intraoperative Bleeding Scale) in humans. Secondary objectives are to evaluate the scale's usefulness in liver surgery; to determine the relationship between the extent of bleeding and the hemostatic agent used; and to assess the relationship between the grade of bleeding and postoperative complications.
Methods
Prospective multicenter observational study including 259 liver resections that meet the inclusion criteria: patients scheduled for liver surgery at one of 10 medium-high volume Spanish HPB centers using an open or minimally invasive approach (robotic/laparoscopic/hybrid), regardless of diagnosis, ASA score <4, age ≥18, and who provide signed informed consent during the study period (September 2023 until the required sample size has been recruited). The participating researchers will be responsible for collecting the data and for reporting them to the study coordinators.
Discussion
This study will allow us to evaluate the VIBe scale for intraoperative bleeding in humans, with a view to its subsequent incorporation in daily clinical practice.
Clinical Trial Registration
https://clinicaltrials.gov/ct2/show/NCT05369988?term = serradilla&draw = 2&rank = 3
, NCT0536998.
Introduction:
Postoperative pancreatic fistula (POPF) is the most dreaded complication after distal pancreatectomy (DP). This multicenter randomized trial evaluated the efficacy, safety, and ...tolerance of Hemopatch in preventing clinically relevant (grades B/C according to the ISGPS classification) POPF after DP.
Material and methods:
After stump closure, patients were randomized to affix Hemopatch to the stump or not. Statistical significance was set at 0.025. Clinical significance was defined as the number of patients needed to treat (NNT) to avoid 1 B/C POPF.
Results:
Of 631 eligible patients, 360 were randomized and 315 analyzed per protocol (155 in the standard closure group; 160 in the Hemopatch group). The rates of B/C POPF (the primary endpoint) were 23.2% and 16.3% (
P
= 0.120), while the number of patients with 1 or more complications (including patients with B/C POPF) was 34.8% and 24.4% (
P
= 0.049) in the standard and Hemopatch groups, respectively. In patients with hand-sewn stump and main duct closure, the rates were 26.2% versus 10.0% (
P
= 0.014) and 23.3% versus 7.7% (
P
= 0.015) in the standard and Hemopatch groups, respectively. The NNT in these 2 subgroups was 6 and 6.4, respectively.
Conclusion:
The results of the first randomized trial evaluating Hemopatch-reinforced pancreatic stump after DP to prevent type B/C POPF do not allow us to conclude that the risk of B/C POPF was lower. Based on the NNT, however, routine use of Hemopatch after DP may result in fewer complications (including POPF) overall, especially in cases with hand-sewn closure of the pancreatic stump or main pancreatic duct.
Duodenal stenosis surgical treatment in Crohn's disease Chóliz Ezquerro, Jorge; Aparicio López, Daniel; García López, Santiago ...
Revista española de enfermedades digestivas,
12/2023, Letnik:
115, Številka:
12
Journal Article
Recenzirano
Odprti dostop
We present the case of a 34-year-old man with daily vomiting and 20% weight loss in a year. A gastroduodenoscopy was performed, noticing 2nd and 3rd duodenal portion dilatation and inflammatory ...involvement of the 3rd and 4th portion, causing luminal stenosis. These findings are the same than in the magnetic resonance . The biopsy proves the histological diagnosis of Crohn's disease. At the beginning the patient was treated with Prednisone, Adalimumab and Ustekinumab. After 9 months, surgery was decided because the disease was refractory to treatment and there was corticosteroid dependence. A partial resection of 3rd and 4th portion of the duodenum and the first loop of jejunum was performed, with duodenojejunal anastomosis. The patient presents good postoperative evolution and after 1 year he remained asymptomatic under treatment with Ustekinumab.
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