Pub Date : 2024-11-01DOI: 10.1016/j.hpb.2024.08.005
Sofía De la Serna, Alejandra García-Botella
{"title":"“Proposal of a new model for training in biliary laparoscopic surgery: biliary ovine-model training in transcystic laparoscopic exploration (BOTTLE model)”","authors":"Sofía De la Serna, Alejandra García-Botella","doi":"10.1016/j.hpb.2024.08.005","DOIUrl":"10.1016/j.hpb.2024.08.005","url":null,"abstract":"","PeriodicalId":13229,"journal":{"name":"Hpb","volume":"26 11","pages":"Pages 1429-1431"},"PeriodicalIF":2.7,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142035781","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}
Pub Date : 2024-11-01DOI: 10.1016/j.hpb.2024.10.011
Ugo Marchese, Xavier Lenne, Gaanan Naveendran, Stylianos Tzedakis, Martin Gaillard, Yasmina Richa, Laurent Boyer, Didier Theis, Amelie Bruandet, Stephanie Truant, David Fuks, Mehdi El Amrani
Background: The use of 1-year mortality following pancreatectomy for PDAC as a measure of surgical quality has not been evaluated. We aim to i) assess the 1-year mortality rate following pancreatectomy for PDAC, and ii) identify patient and hospital characteristics associated with 1-year mortality.
Methods: Data was extracted retrospectively from the French national medico-administrative database. The study included patients who underwent pancreatectomy for PDAC between January 2012 and December 2019. The primary outcome was 1-year postoperative mortality. Hospitals were classified based on volume (high (≥26 resections/year) and low volume (<26)).
Results: Overall, 17,183 patients who underwent pancreatectomy for PDAC were included. The overall 90-day and 1-year mortalities were 6.5 % and 21.5 %, respectively. 1-year mortality varied significantly between low and high-volume hospitals (23.6 % vs. 18.6 %, respectively, p < 0.001). Older age, Charlson Comorbidity Index (CCI), readmission, major complications were predictive factors for 1-year mortality. Pancreatectomy in low volume hospitals increased the risk of 1-year mortality by 1.23-fold (OR = 1.23, 95 % CI [1.15-1.32], p < 0.001).
Conclusion: The overall 1-year mortality after pancreatectomy for PDAC was 21.5 %, and was higher in patients of older age, with higher comorbidities, who experienced major complications, and who did not receive adjuvant therapy. Management in high-volume centers decreased mortality rates, regardless of the patient's condition.
{"title":"Nationwide analysis of one-year mortality following pancreatectomy in 17,183 patients with pancreatic cancer.","authors":"Ugo Marchese, Xavier Lenne, Gaanan Naveendran, Stylianos Tzedakis, Martin Gaillard, Yasmina Richa, Laurent Boyer, Didier Theis, Amelie Bruandet, Stephanie Truant, David Fuks, Mehdi El Amrani","doi":"10.1016/j.hpb.2024.10.011","DOIUrl":"https://doi.org/10.1016/j.hpb.2024.10.011","url":null,"abstract":"<p><strong>Background: </strong>The use of 1-year mortality following pancreatectomy for PDAC as a measure of surgical quality has not been evaluated. We aim to i) assess the 1-year mortality rate following pancreatectomy for PDAC, and ii) identify patient and hospital characteristics associated with 1-year mortality.</p><p><strong>Methods: </strong>Data was extracted retrospectively from the French national medico-administrative database. The study included patients who underwent pancreatectomy for PDAC between January 2012 and December 2019. The primary outcome was 1-year postoperative mortality. Hospitals were classified based on volume (high (≥26 resections/year) and low volume (<26)).</p><p><strong>Results: </strong>Overall, 17,183 patients who underwent pancreatectomy for PDAC were included. The overall 90-day and 1-year mortalities were 6.5 % and 21.5 %, respectively. 1-year mortality varied significantly between low and high-volume hospitals (23.6 % vs. 18.6 %, respectively, p < 0.001). Older age, Charlson Comorbidity Index (CCI), readmission, major complications were predictive factors for 1-year mortality. Pancreatectomy in low volume hospitals increased the risk of 1-year mortality by 1.23-fold (OR = 1.23, 95 % CI [1.15-1.32], p < 0.001).</p><p><strong>Conclusion: </strong>The overall 1-year mortality after pancreatectomy for PDAC was 21.5 %, and was higher in patients of older age, with higher comorbidities, who experienced major complications, and who did not receive adjuvant therapy. Management in high-volume centers decreased mortality rates, regardless of the patient's condition.</p>","PeriodicalId":13229,"journal":{"name":"Hpb","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142638824","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}
Pub Date : 2024-11-01DOI: 10.1016/j.hpb.2024.08.002
Kristjan Ukegjini , Philip C. Müller , Rene Warschkow , Ignazio Tarantino , Jan P. Jonas , Christian E. Oberkofler , Henrik Petrowsky , Bruno M. Schmied , Thomas Steffen
Background
The aim of this study was to assess the predictive value of discharge C-reactive protein (CRP) and white blood cell (WBC) levels for 90-day readmission after pancreatoduodenectomy (PD).
Methods
A two-centre, retrospective study was performed between 2008 and 2022. Receiver operating characteristic (ROC) curve analysis was used to determine the predictive value of CRP level and WBC count at discharge. A conditional inference tree (CTREE) was constructed to identify combined risks within subgroups using variables associated with readmission.
Results
Of 438 patients, 54 (12%) were readmitted. The median WBC count at discharge was comparable between the readmitted and not readmitted groups (9.1 vs. 8.5 G/l). The CRP levels at discharge were predictive of 90-day readmission, with an area under the ROC curve (AUC) of 0.63 (95% CI: 0.55−0.63). A CRP concentration below 105 mg/l ruled out 90-day readmission, with a negative predictive value (NPV) of 90% (95% CI: 81%–95%). CTREE confirmed the diagnostic value of CRP at discharge (AUC = 0.68, 95% CI 0.60–0.68). CTREE additionally identified previous wound infection as a second risk factor for readmission in patients with CRP levels less than 101 mg/l (P = 0.003).
Conclusion
CRP levels below 105 mg/l at discharge allow for a safe discharge with a low 90-day readmission rate. Wound infection, but not WBC count, was a positive predictor of 90-day readmission with moderate accuracy, suggesting the need for predischarge imaging for undetected complications in this patient cohort.
Trial registration
Our retrospective analysis did not require registration with a publicly accessible registry.
{"title":"Discharge C-reactive protein predicts 90-day readmission after pancreatoduodenectomy: a conditional inference tree analysis","authors":"Kristjan Ukegjini , Philip C. Müller , Rene Warschkow , Ignazio Tarantino , Jan P. Jonas , Christian E. Oberkofler , Henrik Petrowsky , Bruno M. Schmied , Thomas Steffen","doi":"10.1016/j.hpb.2024.08.002","DOIUrl":"10.1016/j.hpb.2024.08.002","url":null,"abstract":"<div><h3>Background</h3><div>The aim of this study was to assess the predictive value of discharge C-reactive protein (CRP) and white blood cell (WBC) levels for 90-day readmission after pancreatoduodenectomy (PD).</div></div><div><h3>Methods</h3><div>A two-centre, retrospective study was performed between 2008 and 2022. Receiver operating characteristic (ROC) curve analysis was used to determine the predictive value of CRP level and WBC count at discharge. A conditional inference tree (CTREE) was constructed to identify combined risks within subgroups using variables associated with readmission.</div></div><div><h3>Results</h3><div>Of 438 patients, 54 (12%) were readmitted. The median WBC count at discharge was comparable between the readmitted and not readmitted groups (9.1 vs. 8.5 G/l). The CRP levels at discharge were predictive of 90-day readmission, with an area under the ROC curve (AUC) of 0.63 (95% CI: 0.55−0.63). A CRP concentration below 105 mg/l ruled out 90-day readmission, with a negative predictive value (NPV) of 90% (95% CI: 81%–95%). CTREE confirmed the diagnostic value of CRP at discharge (AUC = 0.68, 95% CI 0.60–0.68). CTREE additionally identified previous wound infection as a second risk factor for readmission in patients with CRP levels less than 101 mg/l (P = 0.003).</div></div><div><h3>Conclusion</h3><div>CRP levels below 105 mg/l at discharge allow for a safe discharge with a low 90-day readmission rate. Wound infection, but not WBC count, was a positive predictor of 90-day readmission with moderate accuracy, suggesting the need for predischarge imaging for undetected complications in this patient cohort.</div></div><div><h3>Trial registration</h3><div>Our retrospective analysis did not require registration with a publicly accessible registry.</div></div>","PeriodicalId":13229,"journal":{"name":"Hpb","volume":"26 11","pages":"Pages 1387-1398"},"PeriodicalIF":2.7,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142008752","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}
Pub Date : 2024-11-01DOI: 10.1016/j.hpb.2024.06.012
Harini Dharanikota , Lachlan Dick , Stephen J. Wigmore , Richard J.E. Skipworth , Steven Yule
Background
In order to identify opportunities to streamline hepatopancreaticobiliary (HPB) multidisciplinary teams (MDT) for cancer care, it is important to first document variability in MDT team practices worldwide. We aimed to develop a comprehensive checklist of parameters to evaluate existing practices and guide the development of MDTs for new cancer services.
Methods
Participants were recruited via the International Hepato-Pancreato-Biliary Association (IHPBA) and European-African HPB Association (E-AHPBA) and emailed an anonymised online survey. The survey comprised 29 questions, including a combination of closed-ended and open-ended questions. Responses were analysed using descriptive statistics and inductive content analysis.
Results
Analysing 72 responses from 31 countries, we found substantial variations in HPB MDT practices across regions. Notable variability was found in core team composition, chairing practices, caseload planning, information practices and MDT audit practices. Issues impacting efficiency were common to many MDTs.
Discussion
MDT care is understood and applied differently across the world. There is a lack of standardisation of practice, and an apparent need for better case preparation, effective specialist contribution, improved audit frequency and metrics to improve performance. It may be valuable to consider human factors while designing MDTs to support team decision processes, minimise errors, and enhance efficiency.
{"title":"Not all MDTs are created equal: international survey of HPB MDT practices","authors":"Harini Dharanikota , Lachlan Dick , Stephen J. Wigmore , Richard J.E. Skipworth , Steven Yule","doi":"10.1016/j.hpb.2024.06.012","DOIUrl":"10.1016/j.hpb.2024.06.012","url":null,"abstract":"<div><h3>Background</h3><div>In order to identify opportunities to streamline hepatopancreaticobiliary (HPB) multidisciplinary teams (MDT) for cancer care, it is important to first document variability in MDT team practices worldwide. We aimed to develop a comprehensive checklist of parameters to evaluate existing practices and guide the development of MDTs for new cancer services.</div></div><div><h3>Methods</h3><div>Participants were recruited via the International Hepato-Pancreato-Biliary Association (IHPBA) and European-African HPB Association (E-AHPBA) and emailed an anonymised online survey. The survey comprised 29 questions, including a combination of closed-ended and open-ended questions. Responses were analysed using descriptive statistics and inductive content analysis.</div></div><div><h3>Results</h3><div>Analysing 72 responses from 31 countries, we found substantial variations in HPB MDT practices across regions. Notable variability was found in core team composition, chairing practices, caseload planning, information practices and MDT audit practices. Issues impacting efficiency were common to many MDTs.</div></div><div><h3>Discussion</h3><div>MDT care is understood and applied differently across the world. There is a lack of standardisation of practice, and an apparent need for better case preparation, effective specialist contribution, improved audit frequency and metrics to improve performance. It may be valuable to consider human factors while designing MDTs to support team decision processes, minimise errors, and enhance efficiency.</div></div>","PeriodicalId":13229,"journal":{"name":"Hpb","volume":"26 11","pages":"Pages 1399-1410"},"PeriodicalIF":2.7,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142055421","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}
Pub Date : 2024-11-01DOI: 10.1016/j.hpb.2024.07.409
Lingpeng Yang, Ming Yang, Tao Wang, Yiwen Qiu, Yi Yang, Wentao Wang
Background
The clinical efficacy and safety between liver venous deprivation (LVD) and portal vein embolization (PVE) prior to major hepatectomy is still unclear.
Methods
Studies comparing LVD and PVE were obtained by systemically searching PubMed, Embase, and Cochrane Library Central databases through 22 December 2023.
Results
Ten studies including 588 patients were reviewed. Compared with PVE group, LVD group exhibited an increased liver resection rate (OR, 1.89; 95% CI, 1.13–3.15; P = 0.01), a faster KGR (MD, 1.37; 95% CI, 0.31–2.42; P = 0.01), and a shorter time to hepatectomy (MD, −6.66; 95% CI, −8.03 to −5.30; P < 0.0001). The pooled results showed that post-embolization complications (OR, 1.35; 95% CI, 0.66–2.74), overall postoperative complications (OR, 1.09; 95% CI, 0.68–1.75), severe complications (Clavien–Dindo ≥ III) (OR, 0.70; 95% CI, 0.43–1.14), and 90-day mortality (OR, 0.38; 95% CI, 0.13–1.09) were not significantly different in both groups. LVD group had significantly lower post-hepatectomy liver failure (PHLF) than PVE group (OR, 0.45; 95% CI, 0.22–0.91; P = 0.03).
Conclusion
LVD outperforms PVE regarding liver resection rate and future liver remnant (FLR) hypertrophy and shows comparable safety to PVE. In addition, LVD allowed for major hepatectomy with lower incidence of PHLF.
{"title":"Comparison of liver venous deprivation with portal vein embolization alone in patients undergoing major liver resection: a systematic review and meta-analysis","authors":"Lingpeng Yang, Ming Yang, Tao Wang, Yiwen Qiu, Yi Yang, Wentao Wang","doi":"10.1016/j.hpb.2024.07.409","DOIUrl":"10.1016/j.hpb.2024.07.409","url":null,"abstract":"<div><h3>Background</h3><div>The clinical efficacy and safety between liver venous deprivation (LVD) and portal vein embolization (PVE) prior to major hepatectomy is still unclear.</div></div><div><h3>Methods</h3><div>Studies comparing LVD and PVE were obtained by systemically searching PubMed, Embase, and Cochrane Library Central databases through 22 December 2023.</div></div><div><h3>Results</h3><div>Ten studies including 588 patients were reviewed. Compared with PVE group, LVD group exhibited an increased liver resection rate (OR, 1.89; 95% CI, 1.13–3.15; P = 0.01), a faster KGR (MD, 1.37; 95% CI, 0.31–2.42; P = 0.01), and a shorter time to hepatectomy (MD, −6.66; 95% CI, −8.03 to −5.30; P < 0.0001). The pooled results showed that post-embolization complications (OR, 1.35; 95% CI, 0.66–2.74), overall postoperative complications (OR, 1.09; 95% CI, 0.68–1.75), severe complications (Clavien–Dindo ≥ III) (OR, 0.70; 95% CI, 0.43–1.14), and 90-day mortality (OR, 0.38; 95% CI, 0.13–1.09) were not significantly different in both groups. LVD group had significantly lower post-hepatectomy liver failure (PHLF) than PVE group (OR, 0.45; 95% CI, 0.22–0.91; P = 0.03).</div></div><div><h3>Conclusion</h3><div>LVD outperforms PVE regarding liver resection rate and future liver remnant (FLR) hypertrophy and shows comparable safety to PVE. In addition, LVD allowed for major hepatectomy with lower incidence of PHLF.</div></div>","PeriodicalId":13229,"journal":{"name":"Hpb","volume":"26 11","pages":"Pages 1329-1338"},"PeriodicalIF":2.7,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141714921","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}
Pub Date : 2024-11-01DOI: 10.1016/j.hpb.2024.07.411
IHPBA-APHPBA International Study Group of Gallbladder Cancer, Jagannath Palepu , Itaru Endo , Vikram Anil Chaudhari , G.V.S. Murthy , Sirshendu Chaudhuri , Rene Adam , Martin Smith , Philip R. de Reuver , Javier Lendoire , Shailesh V. Shrikhande , Xabier De Aretxabala , Bhawna Sirohi , Norihiro Kokudo , Wooil Kwon , Sujoy Pal , Chafik Bouzid , Elijah Dixon , Sudeep Rohit Shah , Rodrigo Maroni , William Jarnagin
Background
The Delphi consensus study was carried out under the auspices of the International and Asia-Pacific Hepato-Pancreato-Biliary Associations (IHPBA-APHPBA) to develop practice guidelines for management of gallbladder cancer (GBC) globally.
Method
GBC experts from 17 countries, spanning 6 continents, participated in a hybrid four-round Delphi consensus development process. The methodology involved email, online consultations, and in-person discussions. Sixty eight clinical questions (CQs) covering various domains related to GBC, were administered to the experts. A consensus recommendation was accepted only when endorsed by more than 75% of the participating experts.
Results
Out of the sixty experts invited initially to participate in the consensus process 45 (75%) responded to the invitation. The consensus was achieved in 92.6% (63/68) of the CQs. Consensus covers epidemiological aspects of GBC, early, incidental and advanced GBC management, definitions for radical GBC resections, the extent of liver resection, lymph node dissection, and definitions of borderline resectable and locally advanced GBC.
Conclusions
This is the first international Delphi consensus on GBC. These recommendations provide uniform terminology and practical clinical guidelines on the current management of GBC. Unresolved contentious issues like borderline resectable/locally advanced GBC need to be addressed by future clinical studies.
{"title":"‘IHPBA-APHPBA clinical practice guidelines’: international Delphi consensus recommendations for gallbladder cancer","authors":"IHPBA-APHPBA International Study Group of Gallbladder Cancer, Jagannath Palepu , Itaru Endo , Vikram Anil Chaudhari , G.V.S. Murthy , Sirshendu Chaudhuri , Rene Adam , Martin Smith , Philip R. de Reuver , Javier Lendoire , Shailesh V. Shrikhande , Xabier De Aretxabala , Bhawna Sirohi , Norihiro Kokudo , Wooil Kwon , Sujoy Pal , Chafik Bouzid , Elijah Dixon , Sudeep Rohit Shah , Rodrigo Maroni , William Jarnagin","doi":"10.1016/j.hpb.2024.07.411","DOIUrl":"10.1016/j.hpb.2024.07.411","url":null,"abstract":"<div><h3>Background</h3><div>The Delphi consensus study was carried out under the auspices of the International and Asia-Pacific Hepato-Pancreato-Biliary Associations (IHPBA-APHPBA) to develop practice guidelines for management of gallbladder cancer (GBC) globally.</div></div><div><h3>Method</h3><div>GBC experts from 17 countries, spanning 6 continents, participated in a hybrid four-round Delphi consensus development process. The methodology involved email, online consultations, and in-person discussions. Sixty eight clinical questions (CQs) covering various domains related to GBC, were administered to the experts. A consensus recommendation was accepted only when endorsed by more than 75% of the participating experts.</div></div><div><h3>Results</h3><div>Out of the sixty experts invited initially to participate in the consensus process 45 (75%) responded to the invitation. The consensus was achieved in 92.6% (63/68) of the CQs. Consensus covers epidemiological aspects of GBC, early, incidental and advanced GBC management, definitions for radical GBC resections, the extent of liver resection, lymph node dissection, and definitions of borderline resectable and locally advanced GBC.</div></div><div><h3>Conclusions</h3><div>This is the first international Delphi consensus on GBC. These recommendations provide uniform terminology and practical clinical guidelines on the current management of GBC. Unresolved contentious issues like borderline resectable/locally advanced GBC need to be addressed by future clinical studies.</div></div>","PeriodicalId":13229,"journal":{"name":"Hpb","volume":"26 11","pages":"Pages 1311-1326"},"PeriodicalIF":2.7,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141849630","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}
Pub Date : 2024-11-01DOI: 10.1016/j.hpb.2024.08.001
Ahad M. Azimuddin , Yuki Hirata , Artem Boyev , Anish J. Jain , Reed Ayabe , Jeeva Ajith , Jason A. Schmeisser , Timothy E. Newhook , Naruhiko Ikoma , Ching-Wei D. Tzeng , Yun-Shin Chun , Jean-Nicolas Vauthey , Hop S. Tran Cao
Introduction
Cost-effectiveness of Robotic-assisted hepatectomy compared to the open approach is scrutinized. We compared the costs of robotic versus open hepatectomy at a large cancer center.
Methods
Patients undergoing hepatectomy (1/2019-2/2022) were collected from a prospectively maintained database and 1:1 propensity score matched for 61 robotic and 61 open hepatectomy patients by complexity, tumor diagnosis, and age >65. Financial data was collected and converted to a ratio of service cost to average OR cost. Short-term and economic outcomes were compared.
Results
Median length of stay (2 vs. 3 days), major complication rates (0% vs. 8.2%), and 90-day readmission rates (3.3% vs. 11.5%) were lower for robotic hepatectomy (all p < 0.05). Total 90-day perioperative costs were lower by 19.5% for the robotic cohort (mean 6.89 vs 8.56; p < 0.01). Intraoperative costs were higher in the robotic cohort (mean 2.75 vs. 2.44; p < 0.01). Cost reduction drivers during postoperative care were supplies (mean 0.26 vs. 0.75), laboratory (mean 0.27 vs. 0.49), regular surgery unit (mean 0.19 vs. 0.32), recovery room (mean 0.26 vs. 0.29) and pharmacy cost (median 0.21 vs. 0.32; all p < 0.05).
Conclusion
Hospital costs of robotic hepatectomy were lower than those of open hepatectomy due to significantly reduced postoperative costs.
导言：与开放式方法相比，机器人辅助肝切除术的成本效益备受关注。我们在一家大型癌症中心比较了机器人与开放式肝切除术的成本：从前瞻性维护的数据库中收集了接受肝切除术的患者（2019年1月至2022年2月），并按照复杂程度、肿瘤诊断和年龄大于65岁对61名机器人肝切除术患者和61名开腹肝切除术患者进行了1:1倾向评分匹配。收集了财务数据，并将其转换为服务成本与手术室平均成本的比率。比较了短期疗效和经济效益：结果：机器人肝切除术的中位住院时间（2 天 vs. 3 天）、主要并发症发生率（0% vs. 8.2%）和 90 天再入院率（3.3% vs. 11.5%）均低于机器人肝切除术（所有 p 均为 0）：由于术后费用显著降低，机器人肝切除术的住院费用低于开放式肝切除术。
{"title":"A propensity score matched cost analysis of robotic versus open hepatectomy","authors":"Ahad M. Azimuddin , Yuki Hirata , Artem Boyev , Anish J. Jain , Reed Ayabe , Jeeva Ajith , Jason A. Schmeisser , Timothy E. Newhook , Naruhiko Ikoma , Ching-Wei D. Tzeng , Yun-Shin Chun , Jean-Nicolas Vauthey , Hop S. Tran Cao","doi":"10.1016/j.hpb.2024.08.001","DOIUrl":"10.1016/j.hpb.2024.08.001","url":null,"abstract":"<div><h3>Introduction</h3><div>Cost-effectiveness of Robotic-assisted hepatectomy compared to the open approach is scrutinized. We compared the costs of robotic versus open hepatectomy at a large cancer center.</div></div><div><h3>Methods</h3><div>Patients undergoing hepatectomy (1/2019-2/2022) were collected from a prospectively maintained database and 1:1 propensity score matched for 61 robotic and 61 open hepatectomy patients by complexity, tumor diagnosis, and age >65. Financial data was collected and converted to a ratio of service cost to average OR cost. Short-term and economic outcomes were compared.</div></div><div><h3>Results</h3><div>Median length of stay (2 vs. 3 days), major complication rates (0% vs. 8.2%), and 90-day readmission rates (3.3% vs. 11.5%) were lower for robotic hepatectomy (all p < 0.05). Total 90-day perioperative costs were lower by 19.5% for the robotic cohort (mean 6.89 vs 8.56; p < 0.01). Intraoperative costs were higher in the robotic cohort (mean 2.75 vs. 2.44; p < 0.01). Cost reduction drivers during postoperative care were supplies (mean 0.26 vs. 0.75), laboratory (mean 0.27 vs. 0.49), regular surgery unit (mean 0.19 vs. 0.32), recovery room (mean 0.26 vs. 0.29) and pharmacy cost (median 0.21 vs. 0.32; all p < 0.05).</div></div><div><h3>Conclusion</h3><div>Hospital costs of robotic hepatectomy were lower than those of open hepatectomy due to significantly reduced postoperative costs.</div></div>","PeriodicalId":13229,"journal":{"name":"Hpb","volume":"26 11","pages":"Pages 1379-1386"},"PeriodicalIF":2.7,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142092819","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}
Pub Date : 2024-11-01DOI: 10.1016/j.hpb.2024.08.003
Muhammad Emmamally , Sanju Sobnach , Rufaida Khan , Urda Kotze , Marc Bernon , Mark W. Sonderup , C. Wendy Spearman , Eduard Jonas
Background
Hepatocellular carcinoma (HCC) presents a significant global health burden, with varying survival rates across regions. The presence of pulmonary metastases (PM) in HCC predicts a poorer prognosis, yet the global understanding of the progression and management is limited.
Methods
This study aims to systematically review the burden of PM in HCC, document current treatment approaches, and evaluate treatment effectiveness through meta-analysis. A comprehensive literature search was conducted across multiple databases. Articles were screened, and data extraction was performed independently by two reviewers. Statistical analyses were conducted to synthesise data and assess treatment outcomes.
Results
A total of 82 articles were included, comprising a population of 3241 participants with documented PM. Our analysis revealed a linear relationship between the HCC population size and the occurrence of PM (p < 0.005). Surgical intervention demonstrated the lowest hazard ratio (0.128) and significantly improved survival rates compared to other treatment modalities. However, data quality limitations underscore the need for further research to delineate patient subsets benefitting from surgical intervention for PM.
Conclusion
Our findings advocate for continued investigation into PM management strategies, notably the role of surgical resection alongside systemic therapies, to improve outcomes in HCC patients with PM.
{"title":"Prevalence, management and outcomes of pulmonary metastases in hepatocellular carcinoma: a systematic review and meta-analysis","authors":"Muhammad Emmamally , Sanju Sobnach , Rufaida Khan , Urda Kotze , Marc Bernon , Mark W. Sonderup , C. Wendy Spearman , Eduard Jonas","doi":"10.1016/j.hpb.2024.08.003","DOIUrl":"10.1016/j.hpb.2024.08.003","url":null,"abstract":"<div><h3>Background</h3><div>Hepatocellular carcinoma (HCC) presents a significant global health burden, with varying survival rates across regions. The presence of pulmonary metastases (PM) in HCC predicts a poorer prognosis, yet the global understanding of the progression and management is limited.</div></div><div><h3>Methods</h3><div>This study aims to systematically review the burden of PM in HCC, document current treatment approaches, and evaluate treatment effectiveness through meta-analysis. A comprehensive literature search was conducted across multiple databases. Articles were screened, and data extraction was performed independently by two reviewers. Statistical analyses were conducted to synthesise data and assess treatment outcomes.</div></div><div><h3>Results</h3><div>A total of 82 articles were included, comprising a population of 3241 participants with documented PM. Our analysis revealed a linear relationship between the HCC population size and the occurrence of PM (p < 0.005). Surgical intervention demonstrated the lowest hazard ratio (0.128) and significantly improved survival rates compared to other treatment modalities. However, data quality limitations underscore the need for further research to delineate patient subsets benefitting from surgical intervention for PM.</div></div><div><h3>Conclusion</h3><div>Our findings advocate for continued investigation into PM management strategies, notably the role of surgical resection alongside systemic therapies, to improve outcomes in HCC patients with PM.</div></div>","PeriodicalId":13229,"journal":{"name":"Hpb","volume":"26 11","pages":"Pages 1339-1348"},"PeriodicalIF":2.7,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142017303","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}
Pub Date : 2024-11-01DOI: 10.1016/j.hpb.2024.07.412
Saxon Connor
{"title":"Consensus achieved, but now to take action","authors":"Saxon Connor","doi":"10.1016/j.hpb.2024.07.412","DOIUrl":"10.1016/j.hpb.2024.07.412","url":null,"abstract":"","PeriodicalId":13229,"journal":{"name":"Hpb","volume":"26 11","pages":"Pages 1327-1328"},"PeriodicalIF":2.7,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141912444","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}
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