Hepatobiliary surgery and nutrition最新文献

The robotic platform enables surgeons to operate with a similar level of freedom and control as in open surgery, while still providing the patient with the benefits of a minimally invasive approach. More centres continue to adopt robotic liver surgery however standardized training materials and consensus on the surgical technique are currently lacking. The availability of a standardized surgical protocol could benefit the further dissemination of the robotic approach while promoting safe and effective operating techniques. We present a comprehensive surgical technique description for robotic hepatectomy agreed upon by seven expert robotic liver surgeons in Europe. They contributed insights from their extensive experience with the robot to develop this report, highlighting the key steps and important considerations for performing robotic hepatectomy. We describe the surgical technique for four most common hepatectomy types with varying complexity: partial anterolateral resections, partial posterosuperior resections, left hepatectomy and right hepatectomy. This report encompasses recommendations from the experts, covering the preparatory steps such as patient selection and pre-operative imaging, and extending through to care in the postoperative phase. The step-by-step surgical technique description serves as a compendium of best practice methods presently utilized in robotic liver surgery. Although some variations in technique cannot be eliminated from practice, general recommendations in a structured form will help to homogenize the technique, safeguarding surgical quality. This paper aims to inform and advise surgeons in the process of adopting robotic liver surgery and can act as a starting point for further optimization and refinement of the technique.

Background: Sarcopenia at the time of liver transplantation (LT) is an established risk factor for mortality following LT. However, most studies in this context have defined sarcopenia by one-time, static measurements. The aims of this study were (I) to determine the impact of the rate of muscle loss in waitlisted LT recipients on post-LT outcomes and (II) to identify patterns of serum metabolites associated with patients with more progressive sarcopenia.

Methods: Patients undergoing liver transplant from 2008 to 2018 who received more than one computed tomography (CT) scans within 12 months prior to liver transplant were included (n=61). The psoas muscle index (PMI) was calculated using Slice-O-Matic software and corrected for patient height (m²). Patients were classified into two groups based the rate of reduction in PMI-high wasting [HW; change in PMI (ΔPMI) ≤-1%/month] and low wasting (LW; ΔPMI >-1%/month). Pre-transplant serum metabolic profiles were collected using nuclear magnetic resonance (NMR) spectroscopy. Living kidney donor sera was used as healthy controls.

Results: Median ΔPMI was -2.0%/month in HW and -0.15%/month in LW patients (P<0.001). Post-transplant 1-year mortality was significantly higher in HW patients. There were no significant differences in metabolite concentrations between HW and LW patients. However, perturbations in taurine, sarcosine, betaine and the aromatic amino acids (AAAs), were observed in patients with liver disease as compared to healthy controls. Liver disease was also associated with a decrease in lipoprotein profiles, especially high-density lipoprotein (HDL) particles.

Conclusions: In patients undergoing LT, the rate of progression of sarcopenia is a strong prognostic indicator of post-LT death. Serum metabolite profiles were not characteristically unique to HW patients, and most closely resemble derangements associated with chronic liver disease.