Hepatobiliary surgery and nutrition最新文献

Background and objective: Obesity is a global health issue closely linked to multiple cardiovascular and metabolic conditions. The renaming of nonalcoholic fatty liver disease (NAFLD) to metabolic dysfunction-associated fatty liver disease (MAFLD) has sparked discussions about renaming nonalcoholic fatty pancreas disease (NAFPD). This narrative review explores the potential benefits and challenges of renaming NAFPD to metabolic dysfunction-associated fatty pancreas disease (MAFPD) and its potential clinical implications.

Methods: The review employs a narrative approach, synthesizing existing literature and expert opinions to evaluate the rationale behind and the possible implications of renaming NAFPD to MAFPD.

Key content and findings: NAFPD is increasingly recognized worldwide but lacks standardized diagnostic criteria, hindering its independent classification as a disease. Renaming NAFPD to MAFPD may enhance diagnostic accuracy, prognostic prediction, and personalized treatment strategies. It may also facilitate global epidemiological research, data sharing, and collaboration. Major challenges include establishing uniform diagnostic guidelines for promoting and educating about the newly proposed terminology.

Conclusions: The proposed renaming from NAFPD to MAFPD may offer promising benefits despite challenges. It may also lead to improved management and understanding of the disease, potentially benefiting global healthcare strategies aimed at addressing obesity-related pancreatic complications.

Keywords: Metabolic dysfunction-associated fatty liver disease (MAFLD); nonalcoholic fatty liver disease (NAFLD); metabolic dysfunction-associated fatty pancreas disease (MAFPD); nonalcoholic fatty pancreas disease (NAFPD); metabolic syndrome (MetS).

Background: The impact of donor-recipient sex-matching patterns on the outcomes of liver transplantation (LT) remains controversial. We aim to compare the long-term graft and recipient survival of LT among four donor-recipient sex-matching patterns using United Network of Organ Sharing (UNOS) database, and develop a grading system for prognostic stratification.

Methods: Adult primary LT recipients from February, 2002 to June, 2022 in the UNOS database were divided into four donor-recipient sex groups, including female donor-female recipient (F-F) group, female donor-male recipient (F-M) group, male donor-female recipient (M-F) group and male donor-male recipient (M-M) group. Propensity score matching (PSM) analysis, inverse probability treatment weighting and multivariable adjustment were used to minimize between-group imbalances. Univariate and multivariate Cox regression analyses were performed to determine risk factors.

Results: A total of 107,183 recipients were included, consisting of 46,037 (43.0%) recipients in M-M group, 25,699 (24.0%) in F-M group, 18,340 (17.1%) in M-F group and 17,107 (15.9%) in F-F group. After PSM, there were significant differences in the graft survival (GS) and overall survival (OS) among four groups (both P<0.001). F-F group showed best prognosis, with 1-, 5- and 10-year GS of 89.1%, 76.3% and 63.1%, respectively, while F-M group showed poor prognosis, with 1-, 5- and 10-year GS of 87.4%, 73.6% and 58.4%, respectively. In F-M group, three subgroups with distinctive prognosis were precisely stratified based on a grading system incorporating six independent risk factors.

Conclusions: Donor-recipient sex-matching patterns significantly influence long-term LT outcomes. The grading system provides potential value to amend allocation process and optimize organ utility.

The growing trend towards minimally invasive hepato-biliary and pancreatic (HPB) surgery has led to the evolution of multiple techniques in the performance of the pancreaticoduodenectomy (PD), either Whipple's procedure or pylorus-preserving pancreaticoduodenectomy (PPPD), for lesions in the head of the pancreas and other indications. Recent trials have highlighted the limitations of the laparoscopic technique when it comes to PD. The use of robotic assistance allows surgeons to circumvent these limitations and carry out robotic pancreaticoduodenectomy (RPD) with good outcomes. The technique described has been adopted and practiced in multiple UK HPB centres and is based on a collective experience of performing over 200 purely robotic PDs. The technique has been implemented in over 20 robotic HPB centers across the UK and Europe and has been widely adopted as the go-to technique in the implementation of RPD. The method is described as distinct steps to allow for a systematic stepwise approach to the procedure. This technique is particularly suitable for all cases where there is no risk of vascular involvement, as confirmed by a preoperative scan conducted two weeks prior to surgery, especially in malignant conditions. A video description of all the steps is included with the publication. The method described has been adopted successfully in HPB programs across the UK and some European centers, with some variations according to local preferences. A separate article is being constructed with the data on short and long-term outcomes being collated across the UK centers in a prospective manner. This paper is to share the British technique of purely robotic PD.