IF 2.7 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Hpb

Pub Date : 2025-03-01 DOI: 10.1016/j.hpb.2024.12.002

Michael Scott , Mudassar Ghazanfar , John Windsor , George Ramsay , Mohamed Bekheit

Background

Splanchnic vein thrombosis (SpVT) occurs in 17%–23 % of acute pancreatitis cases. Serious sequelae include hepatic and bowel ischaemia. However, management with therapeutic anticoagulation remains controversial due to potential bleeding risk. We aim to determine the level of consensus on prognosis, diagnosis, management, and outcomes of SpVT through a DELPHI process.

Methods

Using purposive, non-probability sampling and DELPHI methodology, 173 clinicians with experience of SpVT in acute pancreatitis were approached. From April 2022 to April 2023, a three-round DELPHI process was implemented to completion. A total of 88 statements were posed for ranking via a four-point Likert scale.

Results

The mean acute pancreatitis caseload per respondent per year was 68·0, 72·6 and 73·0 for DELPHI rounds 1,2 and 3 respectively. For SpVT anatomical location, there was strong consensus favouring anticoagulation for portal vein (89·1 %) and SMV thrombosis (90·9 %), and no consensus to treat splenic vein thrombosis (47·3 %). 74·1 % rejected radiological resolution as a definitive anticoagulation endpoint. Majority consensus favoured death, bleeding risk, bowel or liver ischaemia, hospital admission length and ITU admission as significant outcomes for experimental research design.

Conclusion

There was significant consensus for anticoagulation treatment of SpVT of the portal and superior mesenteric veins, especially with complete occlusion by thrombosis. Randomised controlled trials are required to grade management recommendations.

背景：17%- 23%的急性胰腺炎病例发生内脏静脉血栓形成。严重的后遗症包括肝和肠缺血。然而，由于潜在的出血风险，治疗性抗凝治疗仍然存在争议。我们的目的是通过德尔菲过程确定对SpVT的预后、诊断、管理和结果的共识水平。方法：采用目的性、非概率抽样和德尔菲法，对173名有急性胰腺炎SpVT治疗经验的临床医生进行访谈。从2022年4月到2023年4月，实施了三轮DELPHI过程直至完成。共有88个陈述通过4分李克特量表进行排名。结果：在DELPHI第1轮、第2轮和第3轮中，每位应答者每年平均急性胰腺炎病例数分别为68.0、72.6和73.0。对于SpVT的解剖位置，赞成门静脉抗凝（89.1%）和SMV血栓形成（90.9%）的意见强烈，赞成脾静脉血栓形成的意见不一致（47.3%）。74.1%的患者拒绝将放射学分辨率作为明确的抗凝终点。多数共识赞成将死亡、出血风险、肠或肝缺血、住院时间和国际电联入院作为实验研究设计的重要结果。结论：门静脉和肠系膜上静脉SpVT的抗凝治疗有重要的共识，特别是血栓形成完全闭塞。对管理建议进行分级需要随机对照试验。

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引用次数: 0

Textbook outcome in liver surgery for intrahepatic cholangiocarcinoma: defining predictors of an optimal postoperative course using machine learning 肝内胆管癌肝手术的教科书结果：使用机器学习确定最佳术后病程的预测因素。

IF 2.7 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Hpb

Pub Date : 2025-03-01 DOI: 10.1016/j.hpb.2024.12.013

Abdullah Altaf , Mujtaba Khalil , Miho Akabane , Zayed Rashid , Jun Kawashima , Shahzaib Zindani , Andrea Ruzzenente , Luca Aldrighetti , Todd W. Bauer , Hugo P. Marques , Guillaume Martel , Irinel Popescu , Matthew J. Weiss , Minoru Kitago , George Poultsides , Shishir K. Maithel , Carlo Pulitano , Feng Shen , François Cauchy , Bas G. Koerkamp , Timothy M. Pawlik

Background

We sought to define textbook outcome in liver surgery (TOLS) for intrahepatic cholangiocarcinoma (ICC) by considering the implications of perioperative outcomes on overall survival (OS).

Methods

Using a multi-institutional database, TOLS for ICC was defined by employing novel machine learning (ML) models to identify perioperative factors most strongly predictive of OS ≥ 12 months. Subsequently, clinicopathologic factors associated with achieving TOLS were investigated.

Results

A total of 1556 patients with ICC were included. The ML classification models demonstrated that the absence of post-hepatectomy liver failure, intraoperative blood loss <750 mL, absence of major infectious complications, and R0 resection were the perioperative outcomes associated with prolonged OS, thereby defining TOLS for ICC. On multivariable analysis, older age, ASA class >2, lymph node metastasis, receipt of neoadjuvant therapy, advanced T status, poor histological grade and microvascular invasion were independently associated with lower odds of achieving TOLS (all p-values<0.05). Overall, 60.2 % (n = 936) of the patients achieved TOLS, demonstrating markedly improved OS and recurrence-free survival (RFS) than individuals who did not (both p < 0.05).

Conclusion

A standardized definition of TOLS for ICC was established that may be used to evaluate hospital performance at the patient level and help optimize surgical outcomes for patients with ICC.

背景：我们试图通过考虑围手术期结局对总生存期（OS）的影响来定义肝内胆管癌（ICC）肝手术（TOLS）的教科书结局。方法：使用多机构数据库，通过采用新颖的机器学习（ML）模型确定最能预测OS≥12个月的围手术期因素，定义ICC的TOLS。随后，研究了与实现TOLS相关的临床病理因素。结果：共纳入1556例ICC患者。ML分类模型显示，无肝切除术后肝功能衰竭、术中出血量、淋巴结转移、接受新辅助治疗、T状态晚期、组织学分级差、微血管侵犯与TOLS实现几率较低独立相关（均p值）。建立了ICC TOLS的标准化定义，可用于评估医院在患者层面的表现，并有助于优化ICC患者的手术结果。

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引用次数: 0

Research Letter: variability in anticoagulation practices following pancreatic surgery with vascular resection 研究报告：胰腺血管切除术后抗凝治疗的变异性。

IF 2.7 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Hpb

Pub Date : 2025-03-01 DOI: 10.1016/j.hpb.2024.11.010

Artur Rebelo, Shailesh Shrikhande, Qiaofei Liu, Johannes Klose, Jörg Kleeff, Peter Szatmary

引用次数: 0

Percutaneous hepatic artery infusion chemotherapy with oxaliplatin and fluoropyrimidines in treatment-resistant colorectal cancer patients with unresectable liver metastases: a retrospective cohort study 经皮肝动脉输注奥沙利铂和氟嘧啶类药物化疗不可切除肝转移的耐药结直肠癌患者：一项回顾性队列研究。

IF 2.7 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Hpb

Pub Date : 2025-03-01 DOI: 10.1016/j.hpb.2024.11.008

William Pat Fong , Zi-Jing Li , Chao Ren , Wen-Long Guan , Meng-Xuan Zuo , Tian-Qi Zhang , Bin-Kui Li , Yun Zheng , Xiao-Jun Wu , Pei-Rong Ding , Gong Chen , Zhi-Zhong Pan , Yun-Fei Yuan , Qiong Tan , Zhi-Qiang Wang , Yu-Hong Li , De-Shen Wang

Background

Subsequent lines of therapy for chemotherapy-resistant metastatic colorectal cancer (CRC) have shown limited efficacy. Herein, we retrospectively investigated the efficacy and safety of hepatic artery infusion chemotherapy (HAIC) using oxaliplatin plus 5-FU/FUDR in patients with unresectable colorectal liver metastases (CRLM) who progressed following standard chemotherapy regimens.

Methods

From March 2017 to April 2023, CRC patients with unresectable CRLM who progressed following standard chemotherapy and subsequently received HAIC oxaliplatin plus 5-FU/FUDR were evaluated. Objective response rate (ORR), disease control rate (DCR), median depth of tumor response (DpR), no evidence of disease (NED) rate, progression-free survival (PFS), overall survival (OS), and safety were assessed.

Results

A total of 21 patients who progressed after a median of two (range: 1–4) lines of standard systemic chemotherapy were included. The ORR and DCR were 28.6 % and 95.2 %, respectively, with six patients reaching partial response. Additionally, the median DpR was 10.6 %, and seven patients underwent successful conversion surgery. Stratification revealed significantly better PFS in patients with liver-limited metastases compared to those with concurrent hepatic and extrahepatic metastases (P = 0.0003).

Conclusion

HAIC oxaliplatin plus 5-FU/FUDR is a robust regimen for treatment-resistant CRC patients with unresectable CRLM, particularly those with liver-limited disease.

背景：化疗耐药转移性结直肠癌（CRC）的后续治疗显示出有限的疗效。在此，我们回顾性研究了奥沙利铂加5-FU/FUDR肝动脉输注化疗（HAIC）在标准化疗方案后进展的不可切除的结直肠癌肝转移（CRLM）患者中的疗效和安全性。方法：2017年3月至2023年4月，对标准化疗后进展的CRC不可切除CRLM患者进行评估，随后接受HAIC奥沙利铂+ 5-FU/FUDR。评估客观缓解率（ORR）、疾病控制率（DCR）、肿瘤反应中位深度（DpR）、无疾病证据（NED）率、无进展生存期（PFS）、总生存期（OS）和安全性。结果：共有21名患者在接受中位2线（范围：1-4）标准全身化疗后出现进展。ORR和DCR分别为28.6%和95.2%，其中6例达到部分缓解。此外，中位DpR为10.6%，7例患者成功进行了转换手术。分层显示，肝局限性转移患者的PFS明显优于同时发生肝和肝外转移的患者（P = 0.0003）。结论：HAIC奥沙利铂加5-FU/FUDR是治疗难治性CRC患者不可切除CRLM的有效方案，特别是肝局限性疾病患者。

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引用次数: 0

Clinical features, risk factors, outcomes, and prediction model for intrahepatic and perihepatic abscess following hepatectomy for hepatocellular carcinoma 肝细胞癌肝切除术后肝内和肝周脓肿的临床特征、危险因素、结局和预测模型。

IF 2.7 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Hpb

Pub Date : 2025-03-01 DOI: 10.1016/j.hpb.2024.12.003

Shuo Zhu , Li-Hui Gu , Yang Shen , Gui-Lin Xie , Qing-Xin Zhuang , Yong-Yi Zeng , Xue-Dong Wang , Ya-Hao Zhou , Wei-Min Gu , Hong Wang , Ting-Hao Chen , Yao-Ming Zhang , Hong-Wei Guo , Ying-Jian Liang , Xian-Ming Wang , Wan-Guang Zhang , Lei Cai , Chao Li , Lan-Qing Yao , Ming-Da Wang , Tian Yang

Background

Intrahepatic and perihepatic abscess (IPHA) is a severe yet understudied complication that can occur after hepatectomy. This multicenter study aimed to elucidate the clinical features, risk factors, and outcomes of IPHA after hepatectomy for hepatocellular carcinoma (HCC), and to develop a novel prediction model for personalized risk assessment.

Methods

This was a multicenter cohort study of HCC patients who underwent curative-intent hepatectomy. IPHA was defined as an imaging-confirmed abscess located in the hepatic or perihepatic space within 30 days after surgery. A nomogram-based prediction model was developed using preoperative and intraoperative variables, and its performance was evaluated by the concordance index (C-index).

Results

Among the 4621 patients identified, 154 (3.3 %) developed IPHA. IPHA was associated with significantly prolonged hospital stays (median: 16 vs. 11 days, P < 0.001), increased 30-day readmission rates (33.0 % vs. 3.1 %, P < 0.001), and higher 90-day mortality (11.7 % vs. 2.8 %, P < 0.001). Multivariate analysis identified obesity, diabetes mellitus, portal hypertension, major hepatectomy, open surgery, and intraoperative diaphragmatic incision as independent risk factors. The prediction model demonstrated robust discrimination (C-index: 0.747) and calibration.

Conclusions

IPHA significantly impacts postoperative outcomes following HCC resection. The novel prediction model aids in preoperative risk assessment to improve patient outcomes.

背景：肝内和肝周脓肿（IPHA）是肝切除术后可能发生的严重并发症，但尚未得到充分研究。本多中心研究旨在阐明肝细胞癌（HCC）切除术后IPHA的临床特征、危险因素和预后，并建立一种新的个性化风险评估预测模型。方法：这是一项多中心队列研究，研究对象是接受治疗目的肝切除术的HCC患者。IPHA定义为术后30天内影像学证实的位于肝脏或肝周间隙的脓肿。采用术前和术中变量建立基于形态图的预测模型，并用一致性指数（C-index）评价模型的性能。结果：在4621例患者中，154例（3.3%）发展为IPHA。IPHA与住院时间显著延长相关（中位数：16天vs 11天，P）。结论：IPHA显著影响HCC切除术后的术后预后。新的预测模型有助于术前风险评估，以改善患者的预后。

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引用次数: 0

Reappraisal of carcinoma in situ residue at the bile duct margin: a single-center review of 681 patients with perihilar cholangiocarcinoma 胆管边缘原位癌残留的重新评估：681例肝门周围胆管癌的单中心回顾。

IF 2.7 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Hpb

Pub Date : 2025-03-01 DOI: 10.1016/j.hpb.2024.12.005

Ryusei Yamamoto , Shunsuke Onoe , Takashi Mizuno , Nobuyuki Watanabe , Shoji Kawakatsu , Masaki Sunagawa , Junpei Yamaguchi , Atsushi Ogura , Taisuke Baba , Tsuyoshi Igami , Mihoko Yamada , Yoshie Shimoyama , Tomoki Ebata

Background

A histologically involved surgical margin (R1) is often observed after resection for cholangiocarcinoma. Compared with a negative margin (R0), R1 with invasive carcinoma (R1inv) markedly worsens survival, whereas the prognostic effect of R1 with carcinoma in situ (R1cis) remains controversial.

Methods

Patients who underwent resection for perihilar cholangiocarcinoma between 2002 and 2019 were retrospectively reviewed. According to the pathological assessment, the duct margin was classified as R0, R1cis, or R1inv; radial margin positivity was treated as R1inv. Recurrence and survival were compared.

Results

Among the 681 patients, 457 had R0, 69 had R1cis, and 155 had R1inv. The overall five-year recurrence rate was 82.8 % with R1inv, 67.8 % with R1cis, and 47.6 % with R0 (P < 0.001); the local recurrence rate also significantly differed among these groups (P < 0.001). The five-year survival rate was significantly worse with R1cis than with R0 (37.3 % vs. 56.7 %, P < 0.001) and better than that with R1inv (20.9 %, P = 0.007). Multivariate analysis revealed that R1cis was an independent predictor of survival (hazard ratio, 1.65; P < 0.001).

Conclusion

Compared with R0, R1cis significantly deteriorated overall survival in the whole resection subset of patients with perihilar cholangiocarcinoma. However, the prognostic impact of R1cis was milder than that of R1inv.

背景：胆管癌切除术后常观察到组织学累及的手术切缘（R1）。与阴性切缘（R0）相比，R1合并浸润性癌（R1inv）明显恶化生存，而R1合并原位癌（R1cis）的预后影响仍存在争议。方法：回顾性分析2002年至2019年接受肝门周围胆管癌切除术的患者。根据病理评估，将导管缘分为R0、R1cis、R1inv；径向缘阳性按R1inv处理。比较复发率和生存率。结果：681例患者中，R0患者457例，R1cis患者69例，R1inv患者155例。R1inv组总5年复发率为82.8%，R1cis组为67.8%，R0组为47.6% (P)结论：与R0相比，R1cis显著降低了肝门周围胆管癌患者全切除术亚群的总生存率。然而，R1cis对预后的影响比R1inv要轻。

{"title":"Reappraisal of carcinoma in situ residue at the bile duct margin: a single-center review of 681 patients with perihilar cholangiocarcinoma","authors":"Ryusei Yamamoto , Shunsuke Onoe , Takashi Mizuno , Nobuyuki Watanabe , Shoji Kawakatsu , Masaki Sunagawa , Junpei Yamaguchi , Atsushi Ogura , Taisuke Baba , Tsuyoshi Igami , Mihoko Yamada , Yoshie Shimoyama , Tomoki Ebata","doi":"10.1016/j.hpb.2024.12.005","DOIUrl":"10.1016/j.hpb.2024.12.005","url":null,"abstract":"<div><h3>Background</h3><div>A histologically involved surgical margin (R1) is often observed after resection for cholangiocarcinoma. Compared with a negative margin (R0), R1 with invasive carcinoma (R1inv) markedly worsens survival, whereas the prognostic effect of R1 with carcinoma <em>in situ</em> (R1cis) remains controversial.</div></div><div><h3>Methods</h3><div>Patients who underwent resection for perihilar cholangiocarcinoma between 2002 and 2019 were retrospectively reviewed. According to the pathological assessment, the duct margin was classified as R0, R1cis, or R1inv; radial margin positivity was treated as R1inv. Recurrence and survival were compared.</div></div><div><h3>Results</h3><div>Among the 681 patients, 457 had R0, 69 had R1cis, and 155 had R1inv. The overall five-year recurrence rate was 82.8 % with R1inv, 67.8 % with R1cis, and 47.6 % with R0 (<em>P</em> < 0.001); the local recurrence rate also significantly differed among these groups (<em>P</em> < 0.001). The five-year survival rate was significantly worse with R1cis than with R0 (37.3 % vs. 56.7 %, <em>P</em> < 0.001) and better than that with R1inv (20.9 %, <em>P</em> = 0.007). Multivariate analysis revealed that R1cis was an independent predictor of survival (hazard ratio, 1.65; <em>P</em> < 0.001).</div></div><div><h3>Conclusion</h3><div>Compared with R0, R1cis significantly deteriorated overall survival in the whole resection subset of patients with perihilar cholangiocarcinoma. However, the prognostic impact of R1cis was milder than that of R1inv.</div></div>","PeriodicalId":13229,"journal":{"name":"Hpb","volume":"27 3","pages":"Pages 362-370"},"PeriodicalIF":2.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142894205","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

Hepato-thoracic cystic echinococcosis transit. Clinical features, postoperative complications and hospital mortality. A systematic review 肝胸囊性包虫病。临床特征、术后并发症和住院死亡率。系统回顾。

IF 2.7 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Hpb

Pub Date : 2025-03-01 DOI: 10.1016/j.hpb.2024.12.001

Carlos Manterola , Josue Rivadeneira , Tamara Otzen , Claudio Rojas-Pincheira

Background

Hepato-thoracic hydatid transit (HTT) is an evolutionary complication of hepatic cystic echinococcosis. This study aimed to report the available evidence regarding postoperative complications (POC) and hospital mortality (HM).

Methods

Systematic review. Studies related to HTT were included. Searches were performed in Trip Database, SciELO, BIREME-BVS, WoS, PubMed, EMBASE and SCOPUS. Primary outcomes: POC and HM. Secondary outcomes: publication date, origin and designs, number of patients, cyst type, hospital stance, treatments; and methodological quality (MQ) of studies applying MInCir-T and MInCir-Pr₂ scales. Descriptive statistics, weighted means (WM) and their comparison using least squares logistic regression, and meta-analysis of prevalence of POC and HM were applied.

Results

604 studies were retrieved (101 met selection criteria, representing 1020 patients). WM age: 42.6 years, 58.3 % male. Reports are mainly from Spain (19.8 %) and Turkey (17.8 %). With a WM of 18.3 days of hospital stance, it was verified 28.9 % of POC, 12.6 % needed re-interventions, and 9.7 % died. MQ of studies: 9.1 ± 1.9 (MInCir-T) and 13.2 ± 2.9 (MInCir-Pr₂). Comparing the behavior of variables in two periods (1983–2002 vs. 2003–2024), statistically significant differences were observed in POC, HM, and reinterventions.

Conclusion

HTT is associated with high POC, and significant HM, despite the passage of time.

背景：肝胸包虫病（HTT）是肝囊性包虫病的一种进化并发症。本研究旨在报告有关术后并发症（POC）和住院死亡率（HM）的现有证据。方法：系统评价。纳入了与HTT相关的研究。在Trip Database、SciELO、BIREME-BVS、WoS、PubMed、EMBASE和SCOPUS中进行检索。主要结局：POC和HM。次要结局：发表日期、来源和设计、患者数量、囊肿类型、医院位置、治疗方法；以及使用minir - t和minir - pr2量表的研究的方法学质量（MQ）。采用描述性统计、加权均值（WM）及其最小二乘logistic回归的比较，以及POC和HM患病率的meta分析。结果：检索到604项研究（101项符合选择标准，代表1020例患者）。年龄：42.6岁，58.3%为男性。报告主要来自西班牙（19.8%）和土耳其（17.8%）。WM为18.3天，证实有28.9%的POC， 12.6%需要再次干预，9.7%死亡。研究的MQ: 9.1±1.9 （minir - t）和13.2±2.9 （minir - pr2）。比较两个时期（1983-2002年和2003-2024年）变量的行为，在POC、HM和再干预方面观察到统计学上的显著差异。结论：随着时间的推移，HTT与高POC和显著HM相关。

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引用次数: 0

Significance of frailty in mortality and complication after hepatectomy for patients with liver cancer: a systematic review and meta-analysis 虚弱在肝癌患者肝切除术后死亡率和并发症中的意义：一项系统回顾和荟萃分析。

IF 2.7 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Hpb

Pub Date : 2025-03-01 DOI: 10.1016/j.hpb.2024.12.009

Fei Zhang , Ying Yan , Baifeng Li , Chunlin Ge

Background

Frailty has been associated with increased mortality and complications among liver cancer patients. However, the frailty prevalence and outcomes in frail populations with primary liver cancer have not been systematically validated.

Methods

Embase, PubMed, Scopus, and Web of Science were searched for eligible studies that explored the prevalence and impact of frailty in liver cancers from inception until October 26, 2023. The pooled prevalence, hazard ratio (HR), and odds ratio (OR) corresponding to 95 % confidence intervals (CI) in mortality and major complication estimates were conducted.

Results

A total of 18 studies containing 38,157 primary liver cancer patients were included. The prevalence of frailty in liver cancer was 35 % (95 % CI = 25–46; p = 0.000). Frailty was associated with an increased hazard ratio for 30-day mortality (HR = 7.03; 95 % CI = 0.71–69.45; p = 0.97) and 90-day mortality (HR = 4.59; 95 % CI = 1.76–11.95; p = 0.38). Furthermore, frailty was associated with an increased odds ratio for major complications in liver cancer patients (OR = 4.01; 95 % CI = 2.25–7.14; p = 0.49).

Conclusion

Frailty is frequent in liver cancer patients and may predict adverse outcomes in primary liver cancer patients with hepatectomy. Our findings highlight the importance of frailty assessment in this population.

背景：虚弱与肝癌患者死亡率和并发症的增加有关。然而，原发性肝癌虚弱人群的虚弱患病率和预后尚未得到系统验证。方法：检索Embase、PubMed、Scopus和Web of Science，从研究开始到2023年10月26日，这些研究探讨了虚弱在肝癌中的患病率和影响。在死亡率和主要并发症的估计中，汇总患病率、危险比（HR）和比值比（OR）对应95%置信区间（CI）。结果：共纳入18项研究，共38157例原发性肝癌患者。衰弱在肝癌中的患病率为35% (95% CI = 25-46；p = 0.000)。虚弱与30天死亡率的风险比增加相关(HR = 7.03；95% ci = 0.71-69.45；p = 0.97)和90天死亡率(HR = 4.59；95% ci = 1.76-11.95；p = 0.38)。此外，虚弱与肝癌患者主要并发症的优势比增加相关(OR = 4.01；95% ci = 2.25-7.14；p = 0.49)。结论：虚弱是肝癌患者的常见病，可能预示原发性肝癌肝切除术患者的不良预后。我们的研究结果强调了在这一人群中进行脆弱性评估的重要性。

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引用次数: 0

Outcome following pylorus resecting pancreaticoduodenectomy versus classical Whipple’s pancreaticoduodenectomy: a randomised controlled trial 幽门切除胰十二指肠切除术与经典惠普尔胰十二指肠切除术的结果：一项随机对照试验。

IF 2.7 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Hpb

Pub Date : 2025-03-01 DOI: 10.1016/j.hpb.2024.12.011

Ameet Kumar , Rajesh Panwar , Sujoy Pal , Nihar R. Dash , Peush Sahni

Objective

To compare pylorus resecting pancreaticoduodenectomy (PRPD) with classical pancreaticoduodenectomy (classical PD) in terms of short term outcomes.

Background

There is some evidence that Pylorus resecting PD (PRPD) is associated with lesser incidence of DGE when compared to pylorus preserving PD (PPPD). However, no study has previously compared PRPD with classical PD.

Methods

Patients requiring PD were randomly assigned to either PRPD or classical PD after intraoperative assessment to rule out metastases and unresectable disease. Occurrence of DGE was the primary end point.

Results

A total of 154 patients (103 males; Mean age:53.3 ± 12.2 years) were included in the final analysis (PRPD = 78, classical PD = 76). PRPD group had significantly shorter operation [Mean difference: 41 min (95 % CI:18–65)]. There was no significant difference in the incidence of DGE [32 (41.0 %)vs37 (48.7 %); p = 0.339] and clinically significant DGE [22 (28.2 %)vs19 (25.0 %); p = 0.789] between PRPD and classical PD. There was also no difference in the rates of clinically relevant pancreatic fistula [20 (25.6 %)vs22 (28.9 %); p = 0.780], severe morbidity [21 (26.9 %)vs19 (25.0 %); p = 0.930], operative mortality [6 (7.7 %)vs2 (2.6 %); p = 0.157] and median postoperative stay [12 (5–47) days vs 12 (6–56) days; p = 0.861].

Conclusion

We found no significant difference in the early postoperative outcomes between PRPD and classical PD. PRPD was found to be significantly faster than the classical PD.

目的：比较幽门胰十二指肠切除术（PRPD）与经典胰十二指肠切除术（classic胰十二指肠切除术）的近期疗效。背景：有证据表明，与保留幽门的PD （PPPD）相比，幽门切除PD （PRPD）的DGE发生率较低。然而，之前没有研究将PRPD与经典PD进行比较。方法：需要PD的患者在术中评估后随机分配到PRPD或经典PD，以排除转移和不可切除的疾病。DGE的发生是主要终点。结果：共154例患者(男103例；平均年龄：53.3±12.2岁)纳入最终分析（PRPD = 78，经典PD = 76）。PRPD组手术时间明显缩短[平均差异：41分钟（95% CI:18-65）]。DGE的发生率[32 (41.0%)vs37(48.7%)]无显著差异；p = 0.339]和有临床意义的DGE [22 (28.2%)vs19 (25.0%)；p = 0.789]。临床相关胰瘘发生率也无差异[20 (25.6%)vs22 (28.9%)；21 (p = 0.780),严重的发病率(26.9%)vs19 (25.0%);p = 0.930),手术死亡率[6 (7.7%)vs2 (2.6%);P = 0.157]和中位术后停留时间[12（5-47）天vs 12（6-56）天；p = 0.861]。结论：PRPD与经典PD术后早期预后无明显差异。PRPD明显快于经典PD。

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引用次数: 0

Assessment and treatment considerations for patients with colorectal liver metastases: AHPBA consensus guideline and update for surgeons 结直肠肝转移患者的评估和治疗考虑：AHPBA共识指南和外科医生的更新。

IF 2.7 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Hpb

Pub Date : 2025-03-01 DOI: 10.1016/j.hpb.2024.12.006

Background

Colorectal cancer most commonly metastasizes to the liver. While various treatment strategies have been developed, surgical management of these patients has vital implications on the prognosis and survival of this group of patients. There remains a need for a consensus guideline regarding the surgical evaluation and management of patients with colorectal liver metastases (CRLM).

Methods

This review article is a consensus guideline established by the members of the AHPBA Professional Standards Committee, as an amalgamation of existent literature and a guide to surgeons managing this complex disease.

Results

These guidelines reports the benefits and shortcomings of various diagnostic modalities including imaging and next-generation sequencing in the management of patients with CRLM. While surgery has established survival benefits in patients with resectable disease, this report notes the importance of treatment sequencing with non-surgical modalities as well as between colon and liver resection. Finally, the guidelines address the various treatment modalities for patients with unresectable disease, that may have significant impact on survival.

Conclusion

CRLM is a complex diagnosis which warrants multidisciplinary approach with early surgical involvement in both assessment and management of the disease, to optimize patient outcomes and survival.

背景：结直肠癌最常转移到肝脏。虽然已经开发了各种治疗策略，但这些患者的手术处理对这组患者的预后和生存具有重要意义。对于结直肠肝转移（CRLM）患者的手术评估和治疗，仍然需要一个共识指南。方法：这篇综述文章是由AHPBA专业标准委员会成员制定的共识指南，作为现有文献的合并和外科医生处理这种复杂疾病的指南。结果：这些指南报告了各种诊断方式的优点和缺点，包括成像和下一代测序在CRLM患者管理中的应用。虽然手术已确定可切除疾病患者的生存获益，但该报告指出，非手术方式以及结肠和肝脏切除之间的治疗排序非常重要。最后，指南讨论了可能对生存有重大影响的不可切除疾病患者的各种治疗方式。结论：CRLM是一种复杂的诊断，需要多学科的方法，早期手术参与疾病的评估和治疗，以优化患者的预后和生存率。

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引用次数: 0

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