IF 2.7 3区医学

Hpb Pub Date : 2024-09-01 DOI: 10.1016/j.hpb.2024.06.007

引用次数: 0

Tumor burden score as a prognostic factor in patients with intermediate and locally advanced hepatocellular carcinoma undergoing liver resection: an attempt to extend resectability criteria 肿瘤负荷评分作为接受肝切除术的中晚期和局部晚期肝细胞癌患者的预后因素：扩展可切除性标准的尝试。

IF 2.7 3区医学

Hpb Pub Date : 2024-09-01 DOI: 10.1016/j.hpb.2024.05.021

{"title":"Tumor burden score as a prognostic factor in patients with intermediate and locally advanced hepatocellular carcinoma undergoing liver resection: an attempt to extend resectability criteria","authors":"","doi":"10.1016/j.hpb.2024.05.021","DOIUrl":"10.1016/j.hpb.2024.05.021","url":null,"abstract":"<div><h3>Background</h3><p>Surgery is currently recommended as a curative treatment option for hepatocellular carcinomas (HCC) belonging to Barcelona Clinic Liver Cancer (BCLC) stage A only. This study aims to classify various BCLC groups as per Tumor Burden Score (TBS) in an attempt to identify patients who could benefit from resection.</p></div><div><h3>Materials and methods</h3><p>A retrospective analysis of a prospectively maintained database of all patients operated for HCC between January 2010 and July 2022 was performed. TBS was defined as, TBS<sup>2</sup> = (maximum tumor diameter)<sup>2</sup> + (number of tumors)<sup>2</sup>.</p></div><div><h3>Results</h3><p>Two hundred and ninety-one patients who underwent resection were staged as per the latest BCLC (A = 219, B = 45, C = 27) staging. Patients were segregated into low (<7.3) and high (>7.3) TBS. With a median follow-up of 36.2 months, the median OS for stages, A and B in the low TBS group was 107.4 and 42.7 months respectively. Median OS was not reached for patients in the BCLC C stage. In patients with high TBS, the median OS for BCLC A, B and C was 42.3, 25.72, and 16.9 months respectively.</p></div><div><h3>Conclusion</h3><p>TBS is a significant factor influencing survival in patients of HCC. TBS can be used to stratify patients in BCLC B and C stages and help select patients who would benefit from surgical resection to achieve good long-term survival with acceptable morbidity.</p></div>","PeriodicalId":13229,"journal":{"name":"Hpb","volume":"26 9","pages":"Pages 1180-1189"},"PeriodicalIF":2.7,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141330786","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Initial laparoscopic liver resection is associated with reduced adhesions and transfusions at the time of salvage liver transplantation 首次腹腔镜肝脏切除术可减少肝脏粘连和挽救性肝脏移植时的输血量

IF 2.7 3区医学

Hpb Pub Date : 2024-09-01 DOI: 10.1016/j.hpb.2024.06.001

{"title":"Initial laparoscopic liver resection is associated with reduced adhesions and transfusions at the time of salvage liver transplantation","authors":"","doi":"10.1016/j.hpb.2024.06.001","DOIUrl":"10.1016/j.hpb.2024.06.001","url":null,"abstract":"<div><h3>Background</h3><p><span><span><span>Laparoscopic liver resection (LLR) has been associated with improved patient recovery as well as reduced </span>postoperative adhesions compared to open LR (OLR) and could therefore facilitate redo liver surgery. LLR prior to </span>liver transplantation<span> (LT) is increasingly performed, LT being saved for HCC recurrence. LT is still performed by open surgery due to vascular reconstructions and underlying </span></span>liver chronic disease. We evaluated the impact of laparoscopic approach for LR prior to LT in terms of intraoperative transfusions, adhesions severity and outcome.</p></div><div><h3>Methods</h3><p>Data from all patients who underwent a LT after LR in two French high-volume tertiary centers were retrospectively reviewed. The impact of LLR on per operative and postoperative outcome was assessed using logistic regression.</p></div><div><h3>Results</h3><p>170 patients were included, 43 patients in the LLR group and 127 in the OLR group. Preoperative characteristics were comparable between both groups, except LLR group included more patients with “very early-stage” BCLC tumors than OLR group (51% vs. 33%, p = 0.02) and less anatomical resections (54% vs. 75%, p = 0.015). During LT, the transfusion rate was significantly higher in the OLR group (71.4% vs 44.2%, p = 0.002) as well as the proportion of type III adhesions according to OLSG classification (p < 0.001). Multivariate analysis found LLR to be an independent protective factor for adhesions and transfusion (p = 0.001 and p = 0.03 respectively).</p></div><div><h3>Conclusion</h3><p>Laparoscopic liver resection was associated with reduced postoperative adhesions and transfusion requirements during subsequent liver transplantation.</p></div>","PeriodicalId":13229,"journal":{"name":"Hpb","volume":"26 9","pages":"Pages 1190-1199"},"PeriodicalIF":2.7,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141400550","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Highlights in this issue 本期亮点

IF 2.7 3区医学

Hpb Pub Date : 2024-09-01 DOI: 10.1016/S1365-182X(24)02244-5

引用次数: 0

Impact of pancreas transection site on incidence of pancreatic fistula after distal pancreatectomy: a propensity score matched study 胰腺移植部位对远端胰腺切除术后胰腺纤维瘤发生率的影响：倾向得分匹配研究

IF 2.7 3区医学

Hpb Pub Date : 2024-09-01 DOI: 10.1016/j.hpb.2024.05.012

{"title":"Impact of pancreas transection site on incidence of pancreatic fistula after distal pancreatectomy: a propensity score matched study","authors":"","doi":"10.1016/j.hpb.2024.05.012","DOIUrl":"10.1016/j.hpb.2024.05.012","url":null,"abstract":"<div><h3>Background</h3><p>Distal pancreatectomy (DP) is performed for lesions in the body and tail of the pancreas. The morbidity profile is considerable, mainly due to clinically relevant postoperative pancreatic fistula (CR-POPF). This study aims to investigate potential differences in CR-POPF related to transection site.</p></div><div><h3>Methods</h3><p>An observational cohort study from a prospectively maintained database was performed. Subtotal distal pancreatectomy (SDP) was defined as transection over the superior mesenteric vein, and DP was defined as transection lateral to this point. Propensity score matching (PSM) in 1:1 fashion was applied based on demographical and perioperative variables.</p></div><div><h3>Results</h3><p>Six hundred and six patients were included in the analysis (1997–2020). Four hundred twenty (69.3%) underwent DP, while 186 (30.7%) underwent SDP. The rate of CR-POPF was 19.3% after DP and 20.4% after SDP (p = 0.74). SDP was associated with older age (63.1 vs 60.1 years, p = 0.016), higher occurrence of ductal adenocarcinoma (37.1 vs 17.6%, p = 0.001) and more frequent use of neoadjuvant chemotherapy (3.8 vs 0.7%, p = 0.012). After PSM, 155 patients were left in each group. The difference in CR-POPF between DP and SDP remained statistically non-significant (20.6 vs 18.7%, p = 0.67).</p></div><div><h3>Conclusion</h3><p>This study found no difference in CR-POPF related to transection site during distal pancreatectomy.</p></div>","PeriodicalId":13229,"journal":{"name":"Hpb","volume":"26 9","pages":"Pages 1164-1171"},"PeriodicalIF":2.7,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1365182X24017386/pdfft?md5=bbc1133a0cb52c705bfc72b864c78a7c&pid=1-s2.0-S1365182X24017386-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141141114","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Hepato-pancreato-biliary surgery in West Africa: a timely capacity assessment 西非的肝胆胰外科：及时的能力评估

IF 2.7 3区医学

Hpb Pub Date : 2024-09-01 DOI: 10.1016/j.hpb.2024.05.009

{"title":"Hepato-pancreato-biliary surgery in West Africa: a timely capacity assessment","authors":"","doi":"10.1016/j.hpb.2024.05.009","DOIUrl":"10.1016/j.hpb.2024.05.009","url":null,"abstract":"<div><h3>Background</h3><p>West Africa has among the highest rates of hepato-pancreato-biliary (HPB) malignancies in the world. Although surgery is critical for treatment, the availability of HPB surgery in Africa is unknown. This cross-sectional study investigated the current HPB surgical capacity of West African hospitals.</p></div><div><h3>Method</h3><p>The Surgeons OverSeas Personnel, Infrastructure, Procedure, Equipment, and Supplies (PIPES) survey was modified to include HPB-specific parameters and quantify capacity. The survey was completed by consultant surgeons from West Africa. A PIPES index was calculated, and a higher score corresponded to greater HPB surgical capacity.</p></div><div><h3>Results</h3><p>The HPB PIPES survey was completed by 35 institutions from The Gambia, Ghana, Ivory Coast, and Nigeria. Most institutions (94.2%) were tertiary referral centres; five had an HPB-trained surgeon. The most commonly available procedure was an open cholecystectomy (91.4%), followed by gastric bypass (88.6%). Major hepatic resections (14.3%) and the Whipple procedure (17.1%) were rare. ICU capabilities were present at 88.6% of facilities while interventional radiology was present in 25.7%.</p></div><div><h3>Conclusions</h3><p>This is the first HPB capacity assessment in Africa. This study showed the limited availability of HPB surgery in West Africa. These results can be used for regional quality improvement initiatives and as a baseline for future capacity assessments.</p></div>","PeriodicalId":13229,"journal":{"name":"Hpb","volume":"26 9","pages":"Pages 1123-1130"},"PeriodicalIF":2.7,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1365182X24017350/pdfft?md5=a21cf16774b434e6f55c74e24fa167cb&pid=1-s2.0-S1365182X24017350-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141134385","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Conversion to open surgery in obese patients undergoing minimally invasive distal pancreatectomy: results from a multicenter analysis 接受微创胰腺远端切除术的肥胖患者转为开放手术：多中心分析结果

IF 2.7 3区医学

Hpb Pub Date : 2024-09-01 DOI: 10.1016/j.hpb.2024.05.016

{"title":"Conversion to open surgery in obese patients undergoing minimally invasive distal pancreatectomy: results from a multicenter analysis","authors":"","doi":"10.1016/j.hpb.2024.05.016","DOIUrl":"10.1016/j.hpb.2024.05.016","url":null,"abstract":"<div><h3>Background</h3><p>Although minimally invasive distal pancreatectomy (MIDP) is considered a standard approach it still presents a non-negligible rate of conversion to open that is mainly related to some difficulty factors, as obesity. The aim of this study is to analyze the preoperative factors associated with conversion in obese patients with MIDP.</p></div><div><h3>Methods</h3><p>In this multicenter study, all obese patients who underwent MIDP at 18 international expert centers were included. The preoperative factors associated with conversion to open surgery were analyzed.</p></div><div><h3>Results</h3><p>Out of 436 patients, 91 (20.9%) underwent conversion to open, presenting higher blood loss, longer operative time and similar rate of major complications. Twenty (22%) patients received emergent conversion. At univariate analysis<span><span>, the type of approach, radiological invasion of adjacent organs, preoperative enlarged lymphnodes and ASA ≥ III were significantly associated with conversion to open. At </span>multivariate analysis, robotic approach showed a significantly lower conversion rate (14.6 % vs 27.3%, OR = 2.380, p = 0.001). ASA ≥ III (OR = 2.391, p = 0.002) and preoperative enlarged lymphnodes (OR = 3.836, p = 0.003) were also independently associated with conversion.</span></p></div><div><h3>Conclusion</h3><p>Conversion rate is significantly lower in patients undergoing robotic approach. Radiological enlarged lymphnodes and ASA ≥ III are also associated with conversion to open. Conversion is associated with poorer perioperative outcomes, especially in case of intraoperative hemorrhage.</p></div>","PeriodicalId":13229,"journal":{"name":"Hpb","volume":"26 9","pages":"Pages 1172-1179"},"PeriodicalIF":2.7,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141259496","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

High frequency of germline variants in CFTR identified in PDAC patients enrolled in an expanded panel multi-gene panel testing program 在参加扩大的多基因面板检测项目的 PDAC 患者中发现了高频率的 CFTR 基因变异。

IF 2.7 3区医学

Hpb Pub Date : 2024-08-01 DOI: 10.1016/j.hpb.2024.05.005

引用次数: 0

Glycaemic control following total pancreatectomy: room for improvement? 全胰腺切除术后的血糖控制：还有改进的余地吗？

IF 2.7 3区医学

Hpb Pub Date : 2024-08-01 DOI: 10.1016/j.hpb.2024.04.015

引用次数: 0

Impact of an artificial intelligence based model to predict non-transplantable recurrence among patients with hepatocellular carcinoma 基于人工智能的模型对预测肝细胞癌患者不可移植复发的影响

IF 2.7 3区医学

Hpb Pub Date : 2024-08-01 DOI: 10.1016/j.hpb.2024.05.006

{"title":"Impact of an artificial intelligence based model to predict non-transplantable recurrence among patients with hepatocellular carcinoma","authors":"","doi":"10.1016/j.hpb.2024.05.006","DOIUrl":"10.1016/j.hpb.2024.05.006","url":null,"abstract":"<div><h3>Objective</h3><p>We sought to develop Artificial Intelligence (AI) based models to predict non-transplantable recurrence (NTR) of hepatocellular carcinoma<span> (HCC) following hepatic resection (HR).</span></p></div><div><h3>Methods</h3><p>HCC patients who underwent HR between 2000-2020 were identified from a multi-institutional database. NTR was defined as recurrence beyond Milan Criteria. Different machine learning (ML) and deep learning (DL) techniques were used to develop and validate two prediction models for NTR, one using only preoperative factors and a second using both preoperative and postoperative factors.</p></div><div><h3>Results</h3><p>Overall, 1763 HCC patients were included. Among 877 patients with recurrence, 364 (41.5%) patients developed NTR. An ensemble AI model demonstrated the highest area under ROC curves (AUC) of 0.751 (95% CI: 0.719–0.782) and 0.717 (95% CI:0.653–0.782) in the training and testing cohorts, respectively which improved to 0.858 (95% CI: 0.835–0.884) and 0.764 (95% CI: 0.704–0.826), respectively after incorporation of postoperative pathologic factors. Radiologic tumor burden score and pathological microvascular invasion were the most important preoperative and postoperative factors, respectively to predict NTR. Patients predicted to develop NTR had overall 1- and 5-year survival of 75.6% and 28.2%, versus 93.4% and 55.9%, respectively, among patients predicted to not develop NTR (p < 0.0001).</p></div><div><h3>Conclusion</h3><p>The AI preoperative model may help inform decision of HR versus LT for HCC, while the combined AI model can frame individualized postoperative care (<span><span>https://altaf-pawlik-hcc-ntr-calculator.streamlit.app/</span><svg><path></path></svg></span>).</p></div>","PeriodicalId":13229,"journal":{"name":"Hpb","volume":"26 8","pages":"Pages 1040-1050"},"PeriodicalIF":2.7,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141041606","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

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