Hpb最新文献

Background: Portal vein embolization (PVE) is a well-established technique for inducing liver hypertrophy in the future liver remnant (FLR) before major hepatectomy. A frequently used method in bilobar disease is the two-stage hepatectomy (TSH) technique combined with PVE (TSH-PVE). A novel approach is PVE, followed by a one-stage hepatectomy (OSH), combining major hepatectomy with clearing of the FLR (PVE-OSH). This study aimed to compare FLR hypertrophy between these two strategies for induced liver hypertrophy.

Material/methods: Patients with bilobar colorectal liver metastases (CRLM) who underwent PVE from January 2013 to December 2021 were included in this retrospective, multicenter study. Aspects of hypertrophy of the FLR were compared between the groups.

Results: The study included 188 patients, 127 in the PVE-OSH group and 61 in the TSH-PVE group. There were no statistically significant differences between the two groups regarding FLR hypertrophy measured by absolute and relative growth, degree of hypertrophy or kinetic growth rate. No major complications were reported.

Discussion/conclusion: No differences in FLR hypertrophy were demonstrated between the two different treatment strategies of TSH-PVE or PVE-OSH. This supports PVE-OSH as a feasible treatment option that reduces the surgical burden for patients with advanced, bilobar CRLM disease.

Background: There are limited data on the usefulness of endoscopic ultrasonography (EUS) in determining malignancy in gallbladder wall thickening.

Methods: In this multicenter retrospective study, patients who underwent EUS for gallbladder wall thickening from 2011 to 2021 at seven tertiary hospitals were reviewed. The main outcome was the diagnostic performance of EUS in differentiating gallbladder tumors. Logistic regression analyses were performed to identify key EUS findings.

Results: We reviewed 309 patients who underwent EUS for gallbladder wall thickening and excluded 83 patients who did not undergo surgical resection. Among 226 patients who underwent cholecystectomy, 48 patients were diagnosed with gallbladder tumors and 176 patients were diagnosed with benign diseases. EUS showed a sensitivity of 79.31 % and a specificity of 92.86 % for diagnosing gallbladder tumors. Multivariate analysis revealed that wall thickness greater than 14 mm (P < 0.001) and disrupted layer (P < 0.001) were associated with gallbladder tumors. On the other hand, the presence of intramuscular cysts (P = 0.013) and comet tail sign (P = 0.004) were associated with benign diseases.

Conclusion: EUS is a useful method for differential diagnosis of gallbladder wall thickening. Wall thickness greater than 14 mm and layer disruption are key findings of gallbladder tumors.

Background: Liver surgery carries a high risk of complications due to the interplay of patient-related factors, disease characteristics and liver function. This European consensus provides evidence-based guidance on selected aspects of perioperative care.

Methods: A modified Delphi process was used to achieve consensus, with a 70 % agreement threshold. The expert panel comprised hepatobiliary surgeons, anaesthetists, hepatologists, a nurse and physiotherapist. Systematic literature search was conducted in PubMed/Medline, EMBASE, Web of Science, and Cochrane databases. Evidence appraisal and statement development followed Scottish Intercollegiate Guidelines Network methodology.

Results: Six topics were addressed: (i) thromboprophylaxis, (ii) antibiotics, (iii) prehabilitation-nutrition-mobilisation, (iv) bile leaks, including bilio-enteric anastomosis, (v) post-hepatectomy haemorrhage, (vi) post-hepatectomy liver failure (PHLF). Screening yielded 204 included publications (initial 6514) and thirty-two statements were formulated (median evidence-level:2). Evidence strength varied by topic with lower evidence-levels in complex surgery settings and subcohorts. Study heterogeneity and specific inclusion criteria resulted in some topics in conditional recommendations despite high-level evidence. Weakest evidence was found for thromboprophylaxis and PHLF managment. Strong recommendations were formulated for prehabilitation, mobilisation, and avoidance of routine drainage. Several evidence gaps warranting multicentre studies were identified.

Conclusion: Optimising perioperative care after hepatectomy remains challenging. Standardising key practices and addressing evidence gaps through collaborative research are vital to improve outcomes.