IF 2.7 3区医学

Hpb Pub Date : 2025-02-06 DOI: 10.1016/j.hpb.2025.01.010

Abdullah Altaf, Miho Akabane, Mujtaba Khalil, Zayed Rashid, Shahzaib Zindani, Jun Kawashima, Andrea Ruzzenente, Luca Aldrighetti, Todd W Bauer, Hugo P Marques, Guillaume Martel, Irinel Popescu, Mathew J Weiss, Minoru Kitago, George Poultsides, Shishir K Maithel, Vincent Lam, Tom Hugh, Ana Gleisner, Kazunari Sasaki, Federico Aucejo, Carlo Pulitano, Feng Shen, François Cauchy, Bas G Koerkamp, Itaru Endo, Timothy M Pawlik

{"title":"Impact of intraoperative blood loss on postoperative morbidity after liver resection for primary and secondary liver cancer.","authors":"Abdullah Altaf, Miho Akabane, Mujtaba Khalil, Zayed Rashid, Shahzaib Zindani, Jun Kawashima, Andrea Ruzzenente, Luca Aldrighetti, Todd W Bauer, Hugo P Marques, Guillaume Martel, Irinel Popescu, Mathew J Weiss, Minoru Kitago, George Poultsides, Shishir K Maithel, Vincent Lam, Tom Hugh, Ana Gleisner, Kazunari Sasaki, Federico Aucejo, Carlo Pulitano, Feng Shen, François Cauchy, Bas G Koerkamp, Itaru Endo, Timothy M Pawlik","doi":"10.1016/j.hpb.2025.01.010","DOIUrl":"https://doi.org/10.1016/j.hpb.2025.01.010","url":null,"abstract":"<p><strong>Background: </strong>We sought to determine the association between intraoperative blood loss (IBL) and postoperative morbidity among patients undergoing surgery for liver cancer.</p><p><strong>Methods: </strong>Patients undergoing surgery for primary and secondary liver cancer were identified from a multi-institutional database. Adjusted blood loss (aBL) was calculated by normalizing IBL to body weight; the comprehensive complication index (CCI) was used to evaluate postoperative complications.</p><p><strong>Results: </strong>A total of 2491 patients were included. Mean CCI was 10.6 (±5.2) for patients with aBL <10 mL/kg versus 15.2 (±7.2) for individuals with aBL ≥10 mL/kg (p < 0.001). On cubic spline regression, a nonlinear correlation between aBL and CCI was observed. CCI increased exponentially for aBL ranging from 5 to 10 mL/kg, then reached a plateau between an aBL of 10-30 mL/kg before dramatically increasing for aBL >30 mL/kg. Recursive partitioning technique demonstrated that an aBL threshold of 8.5 mL/kg best distinguished CCI (p < 0.001). Additionally, patients with an aBL ≥8.5 mL/kg had worse recurrence-free and overall survival versus patients with an aBL <8.5 mL/kg.</p><p><strong>Conclusion: </strong>A nonlinear incremental correlation between aBL and CCI was identified among patients undergoing surgery for liver cancer. Maintaining an aBL <8.5 mL/kg during LR may help reduce postoperative morbidity.</p>","PeriodicalId":13229,"journal":{"name":"Hpb","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143433177","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

Decision to operate on hepatocellular cancer patients is not driven by comorbidities in Louisiana.

IF 2.7 3区医学

Hpb Pub Date : 2025-02-04 DOI: 10.1016/j.hpb.2025.01.013

Annie Talbot, Denise Danos, Yong Yi, Lauren Maniscalco, Xiao-Cheng Wu, Omeed Moaven, Mary Maluccio, John Lyons

{"title":"Decision to operate on hepatocellular cancer patients is not driven by comorbidities in Louisiana.","authors":"Annie Talbot, Denise Danos, Yong Yi, Lauren Maniscalco, Xiao-Cheng Wu, Omeed Moaven, Mary Maluccio, John Lyons","doi":"10.1016/j.hpb.2025.01.013","DOIUrl":"https://doi.org/10.1016/j.hpb.2025.01.013","url":null,"abstract":"<p><strong>Background: </strong>The mortality rate of Hepatocellular cancer (HCC) in Louisiana is second worst in the United States. This has been linked to underutilization of curative treatment (CT). This study aimed to identify risk factors associated with underutilization of CT in Louisiana.</p><p><strong>Methods: </strong>Patients with AJCC T1 HCC diagnosed from 2011 to 2020 were identified from the Louisiana Tumor Registry (LTR) using site and histology codes. Patients who underwent CT (ablation, resection, and transplantation) were compared to those who did not undergo CT. Logistic regression was performed and results reported as adjusted odds ratios.</p><p><strong>Results: </strong>CT was utilized in 462 (37 %) of 1247 patients with T1 HCC. There were no significant differences observed in age, race, BMI, poverty, or rurality between CT and non-CT patients. The percentage of cirrhosis was similar in both groups (35.3 % vs. 37.7 %, NS). On multivariant analysis, lack of CT was independently associated with low socioeconomic status (SES; p = 0.040), treatment outside a COC center (p < 0.001), and lack commercial/private insurance (p < 0.001).</p><p><strong>Conclusion: </strong>Utilization of CT is driven not by comorbidities, but by insurance type, low SES, and treatment facility indicating the profound effect that care disparities have on HCC treatment.</p>","PeriodicalId":13229,"journal":{"name":"Hpb","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143482799","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

Identification of a pancreatic juice-specific fluorescent probe through 411 probes activated by aminopeptidases/proteases or phosphatases/phosphodiesterases 通过由氨基肽酶/蛋白酶或磷酸酶/磷酸二酯酶激活的411个探针鉴定胰液特异性荧光探针。

IF 2.7 3区医学

Hpb Pub Date : 2025-02-01 DOI: 10.1016/j.hpb.2024.10.012

Yusuke Seki , Takeaki Ishizawa , Genki Watanabe , Toru Komatsu , Aika Nanjo , Tasuku Ueno , Yasuteru Urano , Mitsuyasu Kawaguchi , Hidehiko Nakagawa , Kiyoshi Hasegawa

{"title":"Identification of a pancreatic juice-specific fluorescent probe through 411 probes activated by aminopeptidases/proteases or phosphatases/phosphodiesterases","authors":"Yusuke Seki , Takeaki Ishizawa , Genki Watanabe , Toru Komatsu , Aika Nanjo , Tasuku Ueno , Yasuteru Urano , Mitsuyasu Kawaguchi , Hidehiko Nakagawa , Kiyoshi Hasegawa","doi":"10.1016/j.hpb.2024.10.012","DOIUrl":"10.1016/j.hpb.2024.10.012","url":null,"abstract":"<div><h3>Background</h3><div>This study is a retrospective review aimed to identify pancreatic juice-specific fluorescent probes to visualize pancreatic juice using a library of 381 aminopeptidase/protease-activatable fluorescent probes and 30 phosphatase/phosphodiesterase probes. In 2013, we developed a fluorescence imaging technique using a chymotrypsin probe to visualize pancreatic juice, linked to postoperative pancreatic fistula (POPF). This probe required addition of trypsin to convert pancreatic chymotrypsinogen to chymotrypsin. Recently we accessed libraries of enzyme-activatable fluorescent probes to find probes that facilitated target-specific imaging.</div></div><div><h3>Methods</h3><div>Pancreatic juice and ascitic fluid samples were collected in eight patients undergoing pancreaticoduodenectomy. Reaction rates of pancreatic juice to background ascitic fluids were calculated for these 411 fluorescent probes.</div></div><div><h3>Results</h3><div>Forty-four fluorescent probes were screened in terms of high reactivity with pancreatic juice. Only one candidate probe targeting ectonucleotide pyrophosphatase/phosphodiesterase (ENPP) 1 was selected for a pancreatic juice-specific fluorescent probe. Inhibitor experiments and Western blotting supported the presence of ENPP1 in the pancreatic juice.</div></div><div><h3>Conclusion</h3><div>ENPP1-targeting fluorescent probe may have the potential to visualize pancreatic juice leakage during surgery. This finding may allow surgeons to suture leaking sites and decide the necessity of prophylactic abdominal drains; however, the role of ENPP1 in pancreatic juice remains to be clarified.</div></div>","PeriodicalId":13229,"journal":{"name":"Hpb","volume":"27 2","pages":"Pages 150-158"},"PeriodicalIF":2.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142778963","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

Clinical significance of CA 19-9 elevation during postoperative surveillance for extrahepatic bile duct cancer: a nomogram-based approach for the prediction of short-term recurrence 肝外胆管癌术后监测期间 CA 19-9 升高的临床意义：基于提名图的短期复发预测方法。

IF 2.7 3区医学

Hpb Pub Date : 2025-02-01 DOI: 10.1016/j.hpb.2024.10.015

Yong Jae Kwon , Ji Hye Min , Jeong Ah Hwang , Seong Hyun Kim , Young Kon Kim , Honsoul Kim , Kyowon Gu , Jeong Hyun Lee , Jaeseung Shin , Seo-Youn Choi , Sun-Young Baek

{"title":"Clinical significance of CA 19-9 elevation during postoperative surveillance for extrahepatic bile duct cancer: a nomogram-based approach for the prediction of short-term recurrence","authors":"Yong Jae Kwon , Ji Hye Min , Jeong Ah Hwang , Seong Hyun Kim , Young Kon Kim , Honsoul Kim , Kyowon Gu , Jeong Hyun Lee , Jaeseung Shin , Seo-Youn Choi , Sun-Young Baek","doi":"10.1016/j.hpb.2024.10.015","DOIUrl":"10.1016/j.hpb.2024.10.015","url":null,"abstract":"<div><h3>Background</h3><div>This study aimed to assess the significance of elevated carbohydrate antigen (CA) 19-9 in postoperative surveillance of extrahepatic bile duct cancer and to identify short-term recurrence predictors.</div></div><div><h3>Methods</h3><div>This retrospective study included patients with elevated CA 19-9 post-curative surgery. Patients were categorized into positive and negative CT groups based on the detection of recurrence at CA 19-9 elevation. Short-term recurrence was defined as recurrence within 6 months in the negative CT group. We identified the factors associated with short-term recurrence and devised a predictive nomogram.</div></div><div><h3>Results</h3><div>Among the 190 patients, 91 (47.9 %) exhibited tumor recurrence with CA 19-9 elevation (CT-positive group), whereas 99 (52.1 %) showed no recurrence (CT-negative group). In the CT-negative group (n = 99), 22 (22.2 %) experienced short-term tumor recurrence within 6 months. Preoperative CA 19-9 (odds ratio [OR]: 1.5, <em>p</em> = 0.016), postoperative CA 19-9 (OR: 1.9, <em>p</em> = 0.047), adjuvant treatment (OR: 3.5, <em>p</em> = 0.032), and the absence of inflammation (OR: 3.5, <em>p</em> = 0.045) were predictors of short-term recurrence. The area under the curve of the nomogram was 0.80 (95 % CI: 0.69–0.90).</div></div><div><h3>Conclusion</h3><div>Despite elevated CA 19-9 levels, approximately 50 % of patients exhibited no recurrence during postoperative surveillance for extrahepatic bile duct cancer. Factors influencing short-term recurrence encompass pre- and postoperative CA 19-9, adjuvant treatment, and inflammatory status.</div></div>","PeriodicalId":13229,"journal":{"name":"Hpb","volume":"27 2","pages":"Pages 195-205"},"PeriodicalIF":2.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142716228","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

Primary closure compared with T-tube drainage following laparoscopic common bile duct exploration among elderly patients with hepatolithiasis and/or choledocholithiasis: a comparative study using a propensity score matching 老年肝结石和/或胆总管结石患者腹腔镜胆总管探查术后t管引流与初步闭合的比较：一项使用倾向评分匹配的比较研究

IF 2.7 3区医学

Hpb Pub Date : 2025-02-01 DOI: 10.1016/j.hpb.2024.11.004

Phu V. La , Hieu T. Le , Thang M. Tran , Quan M. Tran , Phuc V. La , Vu A. Doan

{"title":"Primary closure compared with T-tube drainage following laparoscopic common bile duct exploration among elderly patients with hepatolithiasis and/or choledocholithiasis: a comparative study using a propensity score matching","authors":"Phu V. La , Hieu T. Le , Thang M. Tran , Quan M. Tran , Phuc V. La , Vu A. Doan","doi":"10.1016/j.hpb.2024.11.004","DOIUrl":"10.1016/j.hpb.2024.11.004","url":null,"abstract":"<div><h3>Background</h3><div>Laparoscopic common bile duct exploration (LCBDE) is commonly used for hepatolithiasis and/or choledocholithiasis, but the ideal method for common bile duct closure remains uncertain, especially for elderly patients (≥65 years). This study compared outcomes of primary closure versus T-tube drainage following LCBDE in elderly patients.</div></div><div><h3>Methods</h3><div>Data from elderly patients undergoing LCBDE for hepatolithiasis and/or choledocholithiasis between May 2016 and December 2020 at two Vietnamese hospitals were analyzed. Patients were divided into groups A (T-tube drainage, n = 52) and B (primary closure, n = 57). Propensity score matching (PSM) was utilized to adjust for baseline characteristics, comparing short- and long-term outcomes between groups.</div></div><div><h3>Results</h3><div>PSM yielded 56 matched patients. Pre-PSM, group A had longer operating times and hospital stays than Group B (p = 0.001). Group A had higher postoperative complications (17.9 % vs. 7.1 %) but was not statistically significant (p = 0.422). Group A also had more complex biliary stones. Post-PSM, Group B maintained shorter operating times and hospital stays. Regarding long-term results, stone recurrence rates were similar (5.8 % vs. 3.5 %, p = 0.668).</div></div><div><h3>Conclusion</h3><div>Primary closure following LCBDE is a safe and effective alternative to T-tube drainage for treating hepatolithiasis and/or choledocholithiasis in elderly patients.</div></div>","PeriodicalId":13229,"journal":{"name":"Hpb","volume":"27 2","pages":"Pages 232-239"},"PeriodicalIF":2.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142768375","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

Lymphadenectomy for perihilar cholangiocarcinoma: therapeutic benefit of lymph node number and station 肝门周围胆管癌的淋巴结切除术：淋巴结数量和位置的治疗效果。

IF 2.7 3区医学

Hpb Pub Date : 2025-02-01 DOI: 10.1016/j.hpb.2024.11.007

Jun Kawashima , Abdullah Altaf , Yutaka Endo , Selamawit Woldesenbet , Diamantis I. Tsilimigras , Zayed Rashid , Alfredo Guglielmi , Hugo P. Marques , Shishir K. Maithel , Bas Groot Koerkamp , Carlo Pulitano , Federico Aucejo , Itaru Endo , Timothy M. Pawlik

{"title":"Lymphadenectomy for perihilar cholangiocarcinoma: therapeutic benefit of lymph node number and station","authors":"Jun Kawashima , Abdullah Altaf , Yutaka Endo , Selamawit Woldesenbet , Diamantis I. Tsilimigras , Zayed Rashid , Alfredo Guglielmi , Hugo P. Marques , Shishir K. Maithel , Bas Groot Koerkamp , Carlo Pulitano , Federico Aucejo , Itaru Endo , Timothy M. Pawlik","doi":"10.1016/j.hpb.2024.11.007","DOIUrl":"10.1016/j.hpb.2024.11.007","url":null,"abstract":"<div><h3>Background</h3><div>We sought to characterize the benefit of lymphadenectomy among patients undergoing curative-intent surgery for perihilar cholangiocarcinoma (pCCA) utilizing the therapeutic index.</div></div><div><h3>Methods</h3><div>Data on patients who underwent curative-intent resection for pCCA were obtained from 8 high-volume international hepatobiliary centers. Multivariable Cox regression analysis was used to assess clinicopathological factors associated with overall survival (OS). The therapeutic index was determined to assess the therapeutic benefit of lymphadenectomy.</div></div><div><h3>Results</h3><div>Among 341 patients, median number of lymph nodes (LNs) evaluated was 7 (IQR: 4–11). A total of 127 (37.2 %) patients underwent lymphadenectomy of station 12 only, while 146 (42.8 %) patients had LNs from stations 12 plus 8 ± 13 harvested. On multivariable analysis, lymphadenectomy of stations 12 plus 8 ± 13 was associated with improved OS (referent, station 12 only: HR 0.51, 95%CI 0.32–0.80). The therapeutic index was highest among patients who underwent LN evaluation of stations 12 plus 8 ± 13 (33.1) and had ≥6 LNs harvested (26.3).</div></div><div><h3>Conclusion</h3><div>At the time of surgery of pCCA, lymphadenectomy should include station 12, as well as stations 8 and 13, with the goal to evaluate ≥6 LNs to ensure optimal staging and maximize the therapeutic benefit for patients.</div></div>","PeriodicalId":13229,"journal":{"name":"Hpb","volume":"27 2","pages":"Pages 250-259"},"PeriodicalIF":2.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142791607","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

IF 2.7 3区医学

Hpb Pub Date : 2025-02-01 DOI: 10.1016/S1365-182X(25)00009-7

引用次数: 0

Advancing excellence: a national peer-coaching program for advanced laparoscopic HPB techniques 追求卓越：先进腹腔镜 HPB 技术的全国同行指导计划。

IF 2.7 3区医学

Hpb Pub Date : 2025-02-01 DOI: 10.1016/j.hpb.2024.11.001

Alice Zhu , Marisa Louridas , Sean P. Cleary , Shiva Jayaraman

{"title":"Advancing excellence: a national peer-coaching program for advanced laparoscopic HPB techniques","authors":"Alice Zhu , Marisa Louridas , Sean P. Cleary , Shiva Jayaraman","doi":"10.1016/j.hpb.2024.11.001","DOIUrl":"10.1016/j.hpb.2024.11.001","url":null,"abstract":"<div><h3>Background</h3><div>Surgical coaching is valuable for disseminating knowledge, refining skills, and fostering continuous professional development for surgeons in practice. This work aims to implement a national coaching program for Canadian HPB surgeons, emphasizing advanced laparoscopic techniques, and to assess subsequent adoption. Secondary objectives include evaluating surgeon perceptions, barriers, and experiences.</div></div><div><h3>Methods</h3><div>Mid-to-late career HPB surgeons across Canada joined a peer surgical coaching program for advanced laparoscopic skills. The program included didactic sessions followed by practical coaching with case observation, simulation labs, and real-time coaching in the operating room. One lead surgeon from each center was invited to participate in the exit interview.</div></div><div><h3>Results</h3><div>Eight centers across four provinces completed the program, and one lead surgeon from each site was interviewed. Surgeons reported a 34.9 % increase in self-perceived comfort levels in laparoscopic HPB surgeries, with a 24.2 % and 56.7 % increase in laparoscopic liver and pancreas resections, respectively. Participants acknowledged challenges in implementing surgical coaching, citing barriers related to surgeon and societal factors. Overcoming these challenges required mutual respect, openness to learning, and building sustained change through team collaboration and long-term coach relationships.</div></div><div><h3>Discussion</h3><div>This work demonstrated the practicality of a nationwide coaching program and its capacity to effect substantial, long-term change in clinical practice.</div></div>","PeriodicalId":13229,"journal":{"name":"Hpb","volume":"27 2","pages":"Pages 206-213"},"PeriodicalIF":2.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142681767","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

Perioperative safety and oncological efficacy of simultaneous versus colorectal and liver first two-staged resections in patients with synchronous colorectal liver metastases: a systematic review and network meta-analysis 同步结直肠肝转移患者围手术期安全性和肿瘤疗效：系统综述和网络荟萃分析。

IF 2.7 3区医学

Hpb Pub Date : 2025-02-01 DOI: 10.1016/j.hpb.2024.10.010

Jasper P. Sijberden , Maria S. Alvarez Escribano , Meidai Kasai , Carlotta Ferretti , Paola Cesaro , Claudio Bnà , Alberto Zaniboni , Ajith K. Siriwardena , Pieter J. Tanis , Mohammed Abu Hilal

{"title":"Perioperative safety and oncological efficacy of simultaneous versus colorectal and liver first two-staged resections in patients with synchronous colorectal liver metastases: a systematic review and network meta-analysis","authors":"Jasper P. Sijberden , Maria S. Alvarez Escribano , Meidai Kasai , Carlotta Ferretti , Paola Cesaro , Claudio Bnà , Alberto Zaniboni , Ajith K. Siriwardena , Pieter J. Tanis , Mohammed Abu Hilal","doi":"10.1016/j.hpb.2024.10.010","DOIUrl":"10.1016/j.hpb.2024.10.010","url":null,"abstract":"<div><h3>Background</h3><div>Previous meta-analyses have yielded conflicting results on the optimal surgical treatment strategy in patients with synchronous colorectal liver metastases (sCRLM). This network meta-analysis aims to provide an overview on colorectal-, liver first and simultaneous resections to treat sCRLM.</div></div><div><h3>Methods</h3><div>A search was conducted in MEDLINE, Embase and Cochrane CENTRAL (inception-July 11,2023). Pairwise and network meta-analyses were conducted to compare the three strategies, using colorectal-first resections as reference group.</div></div><div><h3>Results</h3><div>Overall, 46 studies with a total of 20,991 patients were included, a significant portion at a high risk of bias. Simultaneous resections were associated with less blood loss (MD -145.44 ml, 95%CI -239.40 to −51.48) and shorter hospital stays (MD -6.39 days, 95%CI -7.78 to −4.99). Liver-first resections were associated with more transfusions (OR 1.89, 95%CI 1.04 to 3.42) and shorter hospital stays (MD -4.53 days, 95%CI -7.99 to −1.06). Simultaneous resections were associated with less incomplete macroscopic disease clearances (OR 0.33, 95%CI 0.12 to 0.92), while liver-first resections were associated with more incomplete macroscopic disease clearances (OR 2.80, 95%CI 1.16 to 6.73) and less microscopically radical (R0) resections (OR 0.64, 95%CI 0.45 to 0.90). There were no significant differences in morbidity, mortality, disease-free or overall survival.</div></div><div><h3>Conclusion</h3><div>Based on meta-analysis of mainly observational studies, simultaneous resections were associated with less blood loss, shorter length of stay and more complete macroscopic disease clearances.</div></div>","PeriodicalId":13229,"journal":{"name":"Hpb","volume":"27 2","pages":"Pages 135-149"},"PeriodicalIF":2.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142710036","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

Association of chemotherapy completion rates and overall survival with postoperative complications after pancreaticoduodenectomy for pancreatic ductal adenocarcinoma 胰腺导管腺癌胰十二指肠切除术后化疗完成率和总生存率与术后并发症的关系。

IF 2.7 3区医学

Hpb Pub Date : 2025-02-01 DOI: 10.1016/j.hpb.2024.11.002

Sophie L.G. Kollbeck , Carsten P. Hansen , Emilie E. Dencker , Paul S. Krohn , Jan H. Storkholm , Stefan K. Burgdorf , Andreas S. Millarch , Thomas B. Piper , Jens G. Hillingsø , Martin Sillesen

{"title":"Association of chemotherapy completion rates and overall survival with postoperative complications after pancreaticoduodenectomy for pancreatic ductal adenocarcinoma","authors":"Sophie L.G. Kollbeck , Carsten P. Hansen , Emilie E. Dencker , Paul S. Krohn , Jan H. Storkholm , Stefan K. Burgdorf , Andreas S. Millarch , Thomas B. Piper , Jens G. Hillingsø , Martin Sillesen","doi":"10.1016/j.hpb.2024.11.002","DOIUrl":"10.1016/j.hpb.2024.11.002","url":null,"abstract":"<div><h3>Introduction</h3><div>Despite the benefits of surgical resection and adjuvant chemotherapy for pancreatic ductal adenocarcinoma (PDAC), over 30 % of patients fail to complete adjuvant oncological treatment. Whether postoperative complications affect chemotherapy completion rates and overall survival remains uncertain. We hypothesized that postoperative complications would be associated with chemotherapy delays, omission, and reduced overall survival (OS).</div></div><div><h3>Methods</h3><div>This was a retrospective analysis of patients undergoing pancreaticoduodenectomy for PDAC from 2008 to 2022 to assess whether serious surgical complications, defined as Clavien Dindo Grade 3b or higher, were associated with the omission or delay of adjuvant oncologic treatment as well as OS.</div></div><div><h3>Results</h3><div>A total of 920 patients were available for analysis. Pancreatic and bile leakage were associated with risk of chemotherapy omission (OR 1.97 [CI 95 % 1.25–3.12], p = 0.004 and OR 1.96 [CI 95 % 1.04–3.67], p = 0.032, respectively). No delay of adjuvant chemotherapy >90 days nor change in OS was found.</div></div><div><h3>Conclusion</h3><div>Major surgical complications influence the likelihood of omitting adjuvant chemotherapy but not delaying it > 90 days. Patients with pancreatic or bile leakage were at greater risk of not completing planned chemotherapy but had the same OS.</div></div>","PeriodicalId":13229,"journal":{"name":"Hpb","volume":"27 2","pages":"Pages 222-231"},"PeriodicalIF":2.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142739132","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

Hpb最新文献