Kin-Pan Au, See-Ching Chan, Kenneth Siu-Ho Chok, Albert Chi-Yan Chan, Tan-To Cheung, Kelvin Kwok-Chai Ng, Chung-Mau Lo
{"title":"Child-Pugh Parameters and Platelet Count as an Alternative to ICG Test for Assessing Liver Function for Major Hepatectomy.","authors":"Kin-Pan Au, See-Ching Chan, Kenneth Siu-Ho Chok, Albert Chi-Yan Chan, Tan-To Cheung, Kelvin Kwok-Chai Ng, Chung-Mau Lo","doi":"10.1155/2017/2948030","DOIUrl":"https://doi.org/10.1155/2017/2948030","url":null,"abstract":"<p><strong>Objective: </strong>To study the correlations and discrepancies between Child-Pugh system and indocyanine green (ICG) clearance test in assessing liver function reserve and explore the possibility of combining two systems to gain an overall liver function assessment.</p><p><strong>Design: </strong>Retrospective analysis of 2832 hepatocellular carcinoma (HCC) patients graded as Child-Pugh A and Child-Pugh B with ICG clearance test being performed was conducted.</p><p><strong>Results: </strong>ICG retention rate at 15 minutes (ICG15) correlates with Child-Pugh score, however, with a large variance. Platelet count improves the correlation between Child-Pugh score and ICG15. ICG15 can be estimated using the following regression formula: estimated ICG15 (eICG15) = 45.1 + 0.435 × bilirubin - 0.917 × albumin + 0.491 × prothrombin time - 0.0283 × platelet (<i>R</i><sup>2</sup> = 0.455). Patients with eICG15 >20.0% who underwent major hepatectomy had a tendency towards more posthepatectomy liver failure (4.1% versus 8.0%, <i>p</i> = 0.09) and higher in-hospital mortality (3.7% versus 8.0%, <i>p</i> = 0.052). They also had shorter median overall survival (5.10 ± 0.553 versus 3.01 ± 0.878 years, <i>p</i> = 0.015) and disease-free survival (1.37 ± 0.215 versus 0.707 ± 0.183 years, <i>p</i> = 0.018).</p><p><strong>Conclusion: </strong>eICG15 can be predicted from Child-Pugh parameters and platelet count. eICG15 correlates with in-hospital mortality after major hepatectomy and predicts long-term survival.</p>","PeriodicalId":77165,"journal":{"name":"HPB surgery : a world journal of hepatic, pancreatic and biliary surgery","volume":"2017 ","pages":"2948030"},"PeriodicalIF":0.0,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2017/2948030","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35446120","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Christine S M Lau, Aleksander Zywot, Krishnaraj Mahendraraj, Ronald S Chamberlain
{"title":"Gallbladder Carcinoma in the United States: A Population Based Clinical Outcomes Study Involving 22,343 Patients from the Surveillance, Epidemiology, and End Result Database (1973-2013).","authors":"Christine S M Lau, Aleksander Zywot, Krishnaraj Mahendraraj, Ronald S Chamberlain","doi":"10.1155/2017/1532835","DOIUrl":"https://doi.org/10.1155/2017/1532835","url":null,"abstract":"<p><strong>Introduction: </strong>Gallbladder carcinoma (GBC) is the most common malignancy of the biliary tract and the third most common gastrointestinal tract malignancy. This study examines a large cohort of GBC patients in the United States in an effort to define demographics, clinical, and pathologic features impacting clinical outcomes.</p><p><strong>Methods: </strong>Demographic and clinical data on 22,343 GBC patients was abstracted from the SEER database (1973-2013).</p><p><strong>Results: </strong>GBC was presented most often among Caucasian (63.9%) females (70.7%) as poorly or moderately differentiated (42.5% and 38.2%) tumors, with lymph node involvement (88.2%). Surgery alone was the most common treatment modality for GBC patients (55.0%). Combination surgery and radiation (10.6%) achieved significantly longer survival rates compared to surgery alone (4.0 ± 0.2 versus 3.7 ± 0.1 years, <i>p</i> = 0.004). Overall mortality was 87.0% and cancer-specific mortality was 75.4%.</p><p><strong>Conclusions: </strong>GBC is an uncommon malignancy that presents most often among females in their 8th decade of life, with over a third of cases presenting with distant metastasis. The incidence of GBC has doubled in the last decade concurrent with increases in cholecystectomy rates attributable in part to improved histopathological detection, as well as laparoscopic advances and enhanced endoscopic techniques. Surgical resection confers significant survival benefit in GBC patients.</p>","PeriodicalId":77165,"journal":{"name":"HPB surgery : a world journal of hepatic, pancreatic and biliary surgery","volume":"2017 ","pages":"1532835"},"PeriodicalIF":0.0,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2017/1532835","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35108802","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Durairaj Segamalai, Abdul Rehman Abdul Jameel, Naveen Kannan, Amudhan Anbalagan, Benet Duraisamy, Prabhakaran Raju, Kannan Devy Gounder
{"title":"Mediastinal Pseudocyst: Varied Presentations and Management-Experience from a Tertiary Referral Care Centre in India.","authors":"Durairaj Segamalai, Abdul Rehman Abdul Jameel, Naveen Kannan, Amudhan Anbalagan, Benet Duraisamy, Prabhakaran Raju, Kannan Devy Gounder","doi":"10.1155/2017/5247626","DOIUrl":"https://doi.org/10.1155/2017/5247626","url":null,"abstract":"<p><p>Pseudocysts are a recognised complication following acute or chronic pancreatitis. Usually located in peripancreatic areas, they have also been reported to occur in atypical regions like liver, pelvis, spleen, and mediastinum. Mediastinal pseudocysts are a rare entity and present with myriad of symptoms due to their unique location. They are a clinical challenge to diagnose and manage. In this paper, we describe the clinical and radiological characteristics of mediastinal pseudocysts in 7 of our patients, as well as our experience in managing these patients along with their clinical outcome.</p>","PeriodicalId":77165,"journal":{"name":"HPB surgery : a world journal of hepatic, pancreatic and biliary surgery","volume":"2017 ","pages":"5247626"},"PeriodicalIF":0.0,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2017/5247626","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34898473","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Pancreatic Cancer: 80 Years of Surgery—Percentage and Repetitions","authors":"B. Gudjonsson","doi":"10.1155/2016/6839687","DOIUrl":"https://doi.org/10.1155/2016/6839687","url":null,"abstract":"Objective. The incidence of pancreatic cancer is estimated to be 48,960 in 2015 in the US and projected to become the second and third leading causes of cancer-related deaths by 2030. The mean costs in 2015 may be assumed to be $79,800 per patient and for each resection $164,100. Attempt is made to evaluate the results over the last 80 years, the number of survivors, and the overall survival percentage. Methods. Altogether 1230 papers have been found which deal with resections and reveal survival information. Only 621 of these report 5-year survivors. Reservation about surgery was first expressed in 1964 and five-year survival of nonresected survivors is well documented. Results. The survival percentage depends not only on the number of survivors but also on the subset from which it is calculated. Since the 1980s the papers have mainly reported the number of resections and survival as actuarial percentages, with or without the actual number of survivors being reported. The actuarial percentage is on average 2.75 higher. Detailed information on the original group (TN), number of resections, and actual number of survivors is reported in only 10.6% of the papers. Repetition occurs when the patients from a certain year are reported several times from the same institution or include survivors from many institutions or countries. Each 5-year survivor may be reported several times. Conclusion. Assuming a 10% resection rate and correcting for repetitions and the life table percentage the overall actual survival rate is hardly more than 0.3%.","PeriodicalId":77165,"journal":{"name":"HPB surgery : a world journal of hepatic, pancreatic and biliary surgery","volume":"2016 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2016-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2016/6839687","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"64492763","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Miguel Sánchez-Carrasco, J. C. Rodríguez-Sanjuán, F. Martín-Acebes, Francisco J. Llorca-Díaz, M. Gómez‐Fleitas, Rocío Zambrano Muñoz, F. J. Sánchez-Manuel
{"title":"Evaluation of Early Cholecystectomy versus Delayed Cholecystectomy in the Treatment of Acute Cholecystitis","authors":"Miguel Sánchez-Carrasco, J. C. Rodríguez-Sanjuán, F. Martín-Acebes, Francisco J. Llorca-Díaz, M. Gómez‐Fleitas, Rocío Zambrano Muñoz, F. J. Sánchez-Manuel","doi":"10.1155/2016/4614096","DOIUrl":"https://doi.org/10.1155/2016/4614096","url":null,"abstract":"Objective. To evaluate if early cholecystectomy (EC) is the most appropriate treatment for acute cholecystitis compared to delayed cholecystectomy (DC). Patients and Methods. A retrospective cohort study of 1043 patients was carried out, with a group of 531 EC cases and a group of 512 DC patients. The following parameters were recorded: (1) postoperative hospital morbidity, (2) hospital mortality, (3) days of hospital stay, (4) readmissions, (5) admission to the Intensive Care Unit (ICU), (6) type of surgery, (7) operating time, and (8) reoperations. In addition, we estimated the direct cost savings of implementing an EC program. Results. The overall morbidity of the EC group (29.9%) was significantly lower than the DC group (38.7%). EC demonstrated significantly better results than DC in days of hospital stay (8.9 versus 15.8 days), readmission percentage (6.8% versus 21.9%), and percentage of ICU admission (2.3% versus 7.8%), which can result in reducing the direct costs. The patients who benefited most from an EC were those with a Charlson index > 3. Conclusions. EC is safe in patients with acute cholecystitis and could lead to a reduction in the direct costs of treatment.","PeriodicalId":77165,"journal":{"name":"HPB surgery : a world journal of hepatic, pancreatic and biliary surgery","volume":"32 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2016-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2016/4614096","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"64388185","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
H. Bruns, Veronika Kortendieck, H. Raab, D. Antolovic
{"title":"Intraoperative Fluid Excess Is a Risk Factor for Pancreatic Fistula after Partial Pancreaticoduodenectomy","authors":"H. Bruns, Veronika Kortendieck, H. Raab, D. Antolovic","doi":"10.1155/2016/1601340","DOIUrl":"https://doi.org/10.1155/2016/1601340","url":null,"abstract":"Background. After pancreaticoduodenectomy (PD), pancreatic fistulas (PF) are a frequent complication. Infusions may compromise anastomotic integrity. This retrospective analysis evaluated associations between intraoperative fluid excess and PF. Methods. Data on perioperative parameters including age, sex, laboratory findings, histology, infusions, surgery time, and occurrence of grade B/C PF was collected from all PD with pancreaticojejunostomy (PJ) performed in our department from 12/2011 till 02/2015. The glomerular filtration rate (GFR), infusion rate, and the ratio of both and its association with PF were calculated. ROC analysis was employed to identify a threshold. Results. Complete datasets were available for 83 of 86 consecutive cases. Median age was 66 years (34–84; 60% male), GFR was 93 mL/min (IQR 78–113), and surgery time was 259 min (IQR 217–307). Intraoperatively, 13.6 mL/min (7–31) was infused. In total, n = 18 (21%) PF occurred. When the infusion : GFR ratio exceeded 0.15, PF increased from 11% to 34% (p = 0.0157). No significant association was detected for any of the other parameters. Conclusions. This analysis demonstrates for the first time an association between intraoperative fluid excess and PF after PD with PJ even in patients with normal renal function. A carefully patient-adopted fluid management with due regard to renal function may help to prevent postoperative PF.","PeriodicalId":77165,"journal":{"name":"HPB surgery : a world journal of hepatic, pancreatic and biliary surgery","volume":"2016 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2016-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2016/1601340","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"64233177","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Charalampos Markakis, A. Tsaroucha, A. Papalois, M. Lambropoulou, E. Spartalis, C. Tsigalou, K. Romanidis, C. Simopoulos
{"title":"The Role of Eugenol in the Prevention of Acute Pancreatitis-Induced Acute Kidney Injury: Experimental Study","authors":"Charalampos Markakis, A. Tsaroucha, A. Papalois, M. Lambropoulou, E. Spartalis, C. Tsigalou, K. Romanidis, C. Simopoulos","doi":"10.1155/2016/3203147","DOIUrl":"https://doi.org/10.1155/2016/3203147","url":null,"abstract":"Aim. Acute pancreatitis is an inflammatory intra-abdominal disease, which takes a severe form in 15–20% of patients and can result in high mortality especially when complicated by acute renal failure. The aim of this study is to assess the possible reduction in the extent of acute kidney injury after administration of eugenol in an experimental model of acute pancreatitis. Materials and Methods. 106 male Wistar rats weighing 220–350 g were divided into 3 groups: (1) Sham, with sham surgery; (2) Control, with induction of acute pancreatitis, through ligation of the biliopancreatic duct; and (3) Eugenol, with induction of acute pancreatitis and eugenol administration at a dose of 15 mg/kg. Serum urea and creatinine, histopathological changes, TNF-α, IL-6, and MPO activity in the kidneys were evaluated at predetermined time intervals. Results. The group that was administered eugenol showed milder histopathological changes than the Control group, TNF-α activity was milder in the Eugenol group, and there was no difference in activity for MPO and IL-6. Serum urea and creatinine levels were lower in the Eugenol group than in the Control group. Conclusions. Eugenol administration was protective for the kidneys in an experimental model of acute pancreatitis in rats.","PeriodicalId":77165,"journal":{"name":"HPB surgery : a world journal of hepatic, pancreatic and biliary surgery","volume":"2016 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2016-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2016/3203147","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"64323364","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Amir H Fathi, Terence Jackson, Mehdi Barati, Babak Eghbalieh, Kelly A Siegel, Christopher T Siegel
{"title":"Extended Perioperative Antibiotic Coverage in Conjunction with Intraoperative Bile Cultures Decreases Infectious Complications after Pancreaticoduodenectomy.","authors":"Amir H Fathi, Terence Jackson, Mehdi Barati, Babak Eghbalieh, Kelly A Siegel, Christopher T Siegel","doi":"10.1155/2016/3031749","DOIUrl":"https://doi.org/10.1155/2016/3031749","url":null,"abstract":"<p><p>Background. Bile contamination from the digestive tract is a well-known risk factor for postoperative complications. Despite the literature concerning prevalence of bacterobilia and fungobilia in patients with biliary pathologies, there are no specific recommendations for perioperative antimicrobial coverage for biliary/pancreatic procedures. We evaluated the effect of at least 72 hours of perioperative broad spectrum antibiotic coverage on outcomes of pancreaticoduodenectomy (PD). Materials and Methods. A retrospective review of all patients at Case Medical Center of Case Western Reserve University undergoing PD procedure, from 2006 to 2011, was performed (n = 122). Perioperative data including demographics, comorbidities, biliary instrumentation, antibiotic coverage, culture results, and postoperative outcomes were analyzed. Propensity score matching method was used to match the patients according to duration of antibiotic coverage into two groups: 72 hours (A72) and 24 hours (A24). Results. Longer broad spectrum antibiotic coverage in group A72 resulted in significantly less surgical site infections after PD, compared to routine 24 hours of perioperative antibiotics in group A24. This study did not reveal a statistically significant decrease in postoperative fungal infections in patients receiving preoperative antifungals. Conclusion. Prolonged perioperative antibiotic therapy in conjunction with intraoperative bile cultures decreases the short-term infectious complications of PD, with no significant increase in Clostridium difficile colitis incidence. </p>","PeriodicalId":77165,"journal":{"name":"HPB surgery : a world journal of hepatic, pancreatic and biliary surgery","volume":"2016 ","pages":"3031749"},"PeriodicalIF":0.0,"publicationDate":"2016-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2016/3031749","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34373137","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Saleem Ahmed, Nurun Nisa de Souza, Wang Qiao, Meidai Kasai, Low Jee Keem, Vishal G Shelat
{"title":"Quality of Life in Hepatocellular Carcinoma Patients Treated with Transarterial Chemoembolization.","authors":"Saleem Ahmed, Nurun Nisa de Souza, Wang Qiao, Meidai Kasai, Low Jee Keem, Vishal G Shelat","doi":"10.1155/2016/6120143","DOIUrl":"https://doi.org/10.1155/2016/6120143","url":null,"abstract":"<p><p>Hepatocellular carcinoma (HCC) is one of the most commonly diagnosed cancers worldwide. Majority of patients with HCC are diagnosed in the advanced stages of disease and hence they are only suitable for palliative therapy. TACE (transarterial chemoembolization) is the most commonly used treatment for unresectable HCC. It is however unclear if TACE improves the quality of life (QoL) in patients with HCC. The aim of this review is to evaluate the impact of TACE on QoL of HCC patients. </p>","PeriodicalId":77165,"journal":{"name":"HPB surgery : a world journal of hepatic, pancreatic and biliary surgery","volume":"2016 ","pages":"6120143"},"PeriodicalIF":0.0,"publicationDate":"2016-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2016/6120143","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34454600","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Jordan Levy, Mehdi Tahiri, Tsafrir Vanounou, Geva Maimon, Simon Bergman
{"title":"Diagnostic Laparoscopy with Ultrasound Still Has a Role in the Staging of Pancreatic Cancer: A Systematic Review of the Literature.","authors":"Jordan Levy, Mehdi Tahiri, Tsafrir Vanounou, Geva Maimon, Simon Bergman","doi":"10.1155/2016/8092109","DOIUrl":"https://doi.org/10.1155/2016/8092109","url":null,"abstract":"<p><p>Background. The reported incidence of noncurative laparotomies for pancreatic cancer using standard imaging (SI) techniques for staging remains high. The objectives of this study are to determine the diagnostic accuracy of diagnostic laparoscopy with ultrasound (DLUS) in assessing resectability of pancreatic tumors. Study Design. We systematically searched the literature for prospective studies investigating the accuracy of DLUS in determining resectability of pancreatic tumors. Results. 104 studies were initially identified and 19 prospective studies (1,573 patients) were included. DLUS correctly predicted resectability in 79% compared to 55% for SI. DLUS prevented noncurative laparotomies in 33%. Of those, the most frequent DLUS findings precluding resection were liver metastases, vascular involvement, and peritoneal metastases. DLUS had a morbidity rate of 0.8% with no mortalities. DLUS remained superior to SI when analyzing studies published only in the last five years (100% versus 81%), enrolling patients after the year 2000 (74% versus 58%), or comparing DLUS to modern multidimensional CT (100% versus 78%). Conclusion. DLUS seems to still have a role in the preoperative staging of pancreatic cancer. With its ability to detect liver metastases, vascular involvement, and peritoneal metastases, the use of DLUS leads to less noncurative laparotomies. </p>","PeriodicalId":77165,"journal":{"name":"HPB surgery : a world journal of hepatic, pancreatic and biliary surgery","volume":"2016 ","pages":"8092109"},"PeriodicalIF":0.0,"publicationDate":"2016-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2016/8092109","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34352024","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}