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Annals of hepato-biliary-pancreatic surgery最新文献

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Parenchymal-sparing non-anatomic resection vs. classic anatomic resection in colorectal cancer liver metastases.
IF 1.1 Q4 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2025-02-18 DOI: 10.14701/ahbps.24-151
Sungwon Jung

Backgrounds/aims: Although anatomical liver resection is considered more effective in preventing complications and recurrence in hepatocellular carcinoma, its efficacy has yet to be clearly defined in colorectal cancer liver metastasis (CLM).

Methods: From January 2000 to December 2023, 145 patients underwent liver resections for CLM, divided into anatomic and non-anatomic resection cohorts. The dataset included demographic details, tumor size, number and distribution of metastases, neoadjuvant chemotherapy, primary tumor location and stage, type of liver surgery, transfusion rates, duration of hospital stay, postoperative complications, and completeness of resection.

Results: Of the 145 patients who underwent liver resections for metastases from colorectal cancer, 62 were in the anatomic group and 83 were in the non-anatomic group. The anatomic group had larger tumors (6.71 cm vs. 3.18 cm). Intraoperative transfusion rates were higher in the anatomic group (56.5% vs. 12.0%). Hospital stays, positive resection margin rates, and postoperative complication rates showed no significant differences. One surgery-related death occurred in the anatomic group. Disease-free and overall survival rates were comparable between groups.

Conclusions: Anatomic liver resection did not demonstrate a reduction in recurrence or an improvement in survival rates compared to non-anatomic resection. As such, anatomical resection does not offer a survival advantage over non-anatomical resection. Consequently, surgical method selection should prioritize patient safety, preservation of residual liver parenchyma, and tumor-specific factors.

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引用次数: 0
A comprehensive study on postoperative complications and postoperative pancreatic fistula in sporadic non-functional pancreatic neuroendocrine tumors: A retrospective cohort study.
IF 1.1 Q4 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2025-02-13 DOI: 10.14701/ahbps.24-215
Juwan Kim, Seung Soo Hong, Sung Hyun Kim, Ho Kyoung Hwang, Chang Moo Kang

Backgrounds/aims: Balancing surgical risks and benefits is crucial for managing non-functional pancreatic neuroendocrine tumors (NF-PNETs). Despite high postoperative pancreatic fistula (POPF) rates, studies on postoperative complications of sporadic NFPNETs are scarce. Thus, this study aimed to investigate postoperative complications and identify risk factors for POPF.

Methods: A retrospective review of 166 NF-PNET surgeries performed at Severance Hospital between February 2000 and August 2023 was conducted.

Results: Age > 65 years and higher American Society of Anesthesiology (ASA) grade were not significantly correlated with severe complications (odds ratio [OR]: 1.10, p = 0.871 and OR: 1.47, p = 0.491, respectively). Surgical procedures included enucleation (13.9%), distal pancreatectomy (50.0%), central pancreatectomy (4.8%), pancreaticoduodenectomy (PD) (26.5%), and total pancreatectomy (4.8%). Severe complications occurred in 12.05% of surgeries. The overall incidence of all POPFs including biochemical leaks was 53%, while clinically relevant POPF (grade B or C) occurred in 7.8% of patients. Logistic regression showed that PD (OR: 3.94, p = 0.092) tended to be risk factor for POPF and that diameter of the main pancreatic duct (MPD) ≤ 3 mm was a significant risk factor for POPF (OR: 0.22, p = 0.008). A pancreas thickness (PT)/MPD ratio > 4.47 on preoperative computed tomography predicted all POPFs in PD patients (OR: 11.70, p = 0.001).

Conclusions: Age and comorbidities had no significant impact on surgical outcomes. PD was associated with higher serious complications and POPF rates. The PT/MPD ratio is a valuable preoperative tool for predicting POPF risk in PD patients.

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引用次数: 0
Comparative analysis of postoperative outcomes of single-incision cholecystectomy: Propensity score matching of robotic surgery using the da Vinci SP system and da Vinci Xi system vs. laparoscopic surgery. 单切口胆囊切除术术后结果的比较分析:达芬奇SP系统和达芬奇Xi系统与腹腔镜手术机器人手术的倾向评分匹配。
IF 1.1 Q4 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2025-01-20 DOI: 10.14701/ahbps.24-198
Jeong-Ik Park, Yong-Kyu Chung, Young Min Lee, Chang Woo Nam, Yang Won Nah

Backgrounds/aims: We compared the postoperative outcomes of single-incision laparoscopic cholecystectomy (SILC) with those of single-incision robotic cholecystectomy (SIRC) using the da Vinci Xi and SP systems.

Methods: We retrospectively analyzed data from 206 patients who underwent these procedures by a single surgeon between August 2020 and April 2022. Propensity score matching was used to adjust for confounders and evaluate outcomes.

Results: SILC exhibited shorter operation times compared to SIRC with Xi and SP (44.9 ± 14.5 min vs. 55.3 ± 12.2 min vs. 55.2 ± 16.2 min, p < 0.001). SIRC with Xi had shorter docking times (6.2 ± 2.8 min vs. 10.3 ± 2.3 min, p < 0.001), while SIRC with SP demonstrated reduced console times (11.2 ± 2.4 min vs. 18.6 ± 8.0 min, p < 0.001). Pain scores and complications did not significantly differ between the groups.

Conclusions: Both SILC and SIRC showed comparable outcomes, with the SP system providing advantages such as reduced console time and fully articulated arms, likely reducing surgeon stress.

背景/目的:我们比较了单切口腹腔镜胆囊切除术(SILC)和单切口机器人胆囊切除术(SIRC)使用达芬奇Xi和SP系统的术后效果。方法:我们回顾性分析了2020年8月至2022年4月期间由一名外科医生接受这些手术的206例患者的数据。倾向评分匹配用于调整混杂因素和评估结果。结果:与Xi和SP的sic相比,SILC的手术时间更短(44.9±14.5 min vs. 55.3±12.2 min vs. 55.2±16.2 min, p < 0.001)。Xi组SIRC的对接时间较短(6.2±2.8 min vs. 10.3±2.3 min, p < 0.001),而SP组SIRC的对接时间较短(11.2±2.4 min vs. 18.6±8.0 min, p < 0.001)。两组间疼痛评分和并发症无显著差异。结论:SILC和SIRC均显示出类似的结果,SP系统具有诸如减少控制台时间和完全铰接式臂等优势,可能减少外科医生的压力。
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引用次数: 0
Heterotopic pancreas of the gallbladder: A case report of a rare and commonly incidental finding. 胆囊异位胰腺:一个罕见的和通常偶然发现的病例报告。
IF 1.1 Q4 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2025-01-13 DOI: 10.14701/ahbps.24-190
Nelson Chen, Jessica Gu

Heterotopic pancreas (HP) refers to the presence of ectopic pancreatic tissue located outside of the normal pancreatic location without anatomical or vascular continuity with the pancreas. HP within the gallbladder (HPGB) was first described by Otschkin in 1916. It remains an exceedingly rare pathology with few reported cases. Here we describe a case of HPGB in a 42-year-old female following laparoscopic cholecystectomy for symptoms of biliary colic. She presented with epigastric pain, elevated levels in liver function tests, and gallbladder sludge on ultrasound. Her lipase and bilirubin levels were within normal limits. Histopathological assessment of the gallbladder identified mild chronic cholecystitis and pancreatic heterotopia adjacent to the cystic duct of the gallbladder with all three elements (ducts, acini, and endocrine islets) of the pancreas, consistent with type 1 based on the classification of Gaspar Fuentes et al. HPGB is often diagnosed incidentally during histopathological examination after cholecystectomy. Preoperative diagnosis is challenging due to its rarity. It is thought to be asymptomatic. Although the clinical significance of HPGB remains uncertain, it has been hypothesized that HPGB can cause acalculous cholecystitis and also have the potential for malignant transformation. Our case supports the theory that the exocrine function of an ectopic pancreatic tissue may contribute to chronic inflammation in the gallbladder. In conclusion, although HPGB is a rare finding with unclear clinical relevance, its potential for malignancy and association with cholecystitis warrant further investigation. Given its scarcity, most knowledge about HPGB comes from case reports and case series. This report adds to the existing literature.

异位胰腺(HP)是指位于正常胰腺位置之外的异位胰腺组织与胰腺没有解剖或血管连续性。1916年,Otschkin首次描述了胆囊内HP (HPGB)。它仍然是一种极其罕见的病理,报告的病例很少。我们在此报告一例42岁女性因胆绞痛症状行腹腔镜胆囊切除术后的HPGB病例。她表现为胃脘痛,肝功能检查水平升高,超声显示胆囊淤积。她的脂肪酶和胆红素水平在正常范围内。胆囊的组织病理学评估发现轻度慢性胆囊炎和胆囊胆囊管附近的胰腺异位,并伴有胰腺的所有三种成分(导管、腺泡和内分泌胰岛),根据Gaspar Fuentes等人的分类,符合1型。HPGB常在胆囊切除术后的组织病理学检查中偶然发现。由于罕见,术前诊断具有挑战性。它被认为是无症状的。虽然HPGB的临床意义尚不确定,但已有假设HPGB可引起无结石性胆囊炎,也有恶性转化的可能。本病例支持异位胰腺组织的外分泌功能可能导致胆囊慢性炎症的理论。总之,尽管HPGB是一种罕见的发现,临床相关性不明确,但其潜在的恶性肿瘤及其与胆囊炎的关系值得进一步研究。鉴于其稀缺性,大多数关于HPGB的知识来自病例报告和病例系列。这份报告补充了现有的文献。
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引用次数: 0
Post-cholecystectomy total bile duct strictures: Cases for magnetic compression anastomosis. 胆囊切除术后全胆管狭窄:磁压迫吻合术1例。
IF 1.1 Q4 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-12-23 DOI: 10.14701/ahbps.24-186
Freddy Pereira Graterol, Francisco Salazar Marcano, Yajaira Venales Barrios, Yeisson Rivero-Moreno, Dong Ki Lee

Bile duct injuries are a serious issue, and their surgical treatment carries the risk of morbidity and mortality. In selected cases, non-surgical treatments are possible, even for total strictures. We outline the technique and results of using magnetic compression anastomosis (MCA) to treat post-cholecystectomy bile duct stricture (PCBDS), in two female patients. Initially, a bilio-cutaneous tract was established via external biliary drainage, followed by the positioning of both endoscopic and percutaneous biliary magnets. After their approximation and subsequent removal, a fully covered self-expandable metal stent (FCSEMS) was deployed across the stricture. The magnet coupling was successfully achieved within the first two weeks of placement. The FCSEMS was maintained for durations of 12 and 16 months. Follow-up durations were 28 and 15 months post-FCSEMS removal. Both patients remain asymptomatic, with normal laboratory and imaging studies, and no adverse events were reported. MCA proves to be a safe and effective method for treating selected cases of total PCBDS. However, further studies and long-term follow-up are required to fully assess the efficacy of this technique.

胆管损伤是一个严重的问题,其手术治疗有发病和死亡的风险。在某些情况下,非手术治疗是可能的,即使是完全狭窄。我们概述了使用磁压缩吻合术(MCA)治疗胆囊切除术后胆管狭窄(PCBDS)的技术和结果。最初,通过胆道外引流建立胆道-皮道,然后定位内镜和经皮胆道磁铁。在它们的近似和随后的移除后,一个完全覆盖的自膨胀金属支架(fcems)被放置在狭窄的地方。磁铁耦合在放置的前两周内成功实现。fcems维持了12个月和16个月。随访时间分别为fcems移除后28个月和15个月。两例患者均无症状,实验室和影像学检查正常,无不良事件报告。MCA被证明是一种安全有效的治疗全PCBDS的方法。然而,需要进一步的研究和长期随访来充分评估该技术的疗效。
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引用次数: 0
Impact of longitudinal tumor location on postoperative outcomes in gallbladder cancer: Fundus and body vs. neck and cystic duct, a retrospective multicenter study. 肿瘤纵向位置对胆囊癌术后结果的影响:胆囊底和胆囊体与胆囊颈和胆囊管的对比,一项回顾性多中心研究。
IF 1.1 Q4 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-11-30 Epub Date: 2024-08-20 DOI: 10.14701/ahbps.24-117
Kil Hwan Kim, Ju Ik Moon, Jae Woo Park, Yunghun You, Hae Il Jung, Hanlim Choi, Si Eun Hwang, Sungho Jo

Backgrounds/aims: Systematic investigations into the prognostic impact of the longitudinal tumor location in gallbladder cancer (GBC) remain insufficient. To address the limitations of our pilot study, we conducted a multicenter investigation to clarify the impact of the longitudinal tumor location on the oncological outcomes of GBC.

Methods: A retrospective multicenter study was conducted on 372 patients undergoing radical resections for GBC from January 2010 to December 2019 across seven hospitals that belong to the Daejeon-Chungcheong branch of the Korean Association of Hepato-Biliary-Pancreatic Surgery. Patients were divided into GBC in the fundus/body (FB-GBC) and GBC in the neck/cystic duct (NC-GBC) groups, based on the longitudinal tumor location.

Results: Of 372 patients, 282 had FB-GBC, while 90 had NC-GBC. NC-GBC was associated with more frequent elevation of preoperative carbohydrate antigen (CA) 19-9 levels, requirement for more extensive surgery, more advanced histologic grade and tumor stages, more frequent lymphovascular and perineural invasion, lower R0 resection rates, higher recurrence rates, and worse 5-year overall and disease-free survival rates. Propensity score matching analysis confirmed these findings, showing lower R0 resection rates, higher recurrence rates, and worse survival rates in the NC-GBC group. Multivariate analysis identified elevated preoperative CA 19-9 levels, lymph node metastasis, and non-R0 resection as independent prognostic factors, but not longitudinal tumor location.

Conclusions: NC-GBC exhibits more frequent elevation of preoperative CA 19-9 levels, more advanced histologic grade and tumor stages, lower R0 resection rates, and poorer overall and disease-free survival rates, compared to FB-GBC. However, the longitudinal tumor location was not analyzed as an independent prognostic factor.

背景/目的:关于胆囊癌(GBC)纵向肿瘤位置对预后影响的系统研究仍然不足。针对试验性研究的局限性,我们开展了一项多中心调查,以明确纵向肿瘤位置对 GBC 肿瘤预后的影响:方法:我们对 2010 年 1 月至 2019 年 12 月期间在韩国肝胆胰外科协会大田-忠清分会所属七家医院接受 GBC 根治性切除术的 372 例患者进行了回顾性多中心研究。根据肿瘤的纵向位置,将患者分为胃底/体部 GBC 组(FB-GBC)和颈部/囊管 GBC 组(NC-GBC):在372名患者中,282人患有FB-GBC,90人患有NC-GBC。NC-GBC与以下因素相关:术前碳水化合物抗原(CA)19-9水平升高更频繁、需要更广泛的手术、组织学分级和肿瘤分期更晚期、淋巴管和神经周围侵犯更频繁、R0切除率更低、复发率更高、5年总生存率和无病生存率更低。倾向得分匹配分析证实了这些结果,显示NC-GBC组的R0切除率较低、复发率较高,生存率较低。多变量分析发现,术前CA 19-9水平升高、淋巴结转移和非R0切除是独立的预后因素,但纵向肿瘤位置不是:与FB-GBC相比,NC-GBC术前CA 19-9水平升高的频率更高,组织学分级和肿瘤分期更晚,R0切除率更低,总生存率和无病生存率更低。然而,纵向肿瘤位置并未作为独立的预后因素进行分析。
{"title":"Impact of longitudinal tumor location on postoperative outcomes in gallbladder cancer: Fundus and body vs. neck and cystic duct, a retrospective multicenter study.","authors":"Kil Hwan Kim, Ju Ik Moon, Jae Woo Park, Yunghun You, Hae Il Jung, Hanlim Choi, Si Eun Hwang, Sungho Jo","doi":"10.14701/ahbps.24-117","DOIUrl":"10.14701/ahbps.24-117","url":null,"abstract":"<p><strong>Backgrounds/aims: </strong>Systematic investigations into the prognostic impact of the longitudinal tumor location in gallbladder cancer (GBC) remain insufficient. To address the limitations of our pilot study, we conducted a multicenter investigation to clarify the impact of the longitudinal tumor location on the oncological outcomes of GBC.</p><p><strong>Methods: </strong>A retrospective multicenter study was conducted on 372 patients undergoing radical resections for GBC from January 2010 to December 2019 across seven hospitals that belong to the Daejeon-Chungcheong branch of the Korean Association of Hepato-Biliary-Pancreatic Surgery. Patients were divided into GBC in the fundus/body (FB-GBC) and GBC in the neck/cystic duct (NC-GBC) groups, based on the longitudinal tumor location.</p><p><strong>Results: </strong>Of 372 patients, 282 had FB-GBC, while 90 had NC-GBC. NC-GBC was associated with more frequent elevation of preoperative carbohydrate antigen (CA) 19-9 levels, requirement for more extensive surgery, more advanced histologic grade and tumor stages, more frequent lymphovascular and perineural invasion, lower R0 resection rates, higher recurrence rates, and worse 5-year overall and disease-free survival rates. Propensity score matching analysis confirmed these findings, showing lower R0 resection rates, higher recurrence rates, and worse survival rates in the NC-GBC group. Multivariate analysis identified elevated preoperative CA 19-9 levels, lymph node metastasis, and non-R0 resection as independent prognostic factors, but not longitudinal tumor location.</p><p><strong>Conclusions: </strong>NC-GBC exhibits more frequent elevation of preoperative CA 19-9 levels, more advanced histologic grade and tumor stages, lower R0 resection rates, and poorer overall and disease-free survival rates, compared to FB-GBC. However, the longitudinal tumor location was not analyzed as an independent prognostic factor.</p>","PeriodicalId":72220,"journal":{"name":"Annals of hepato-biliary-pancreatic surgery","volume":" ","pages":"474-482"},"PeriodicalIF":1.1,"publicationDate":"2024-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11599822/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142006015","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Minimally invasive pancreatoduodenectomy with combined venous vascular resection: A comparative analysis with open approach. 结合静脉血管切除术的微创胰十二指肠切除术:与开放式方法的比较分析
IF 1.1 Q4 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-11-30 Epub Date: 2024-09-24 DOI: 10.14701/ahbps.24-082
Dong Hyun Shin, Munseok Choi, Seoung Yoon Rho, Seung Soo Hong, Sung Hyun Kim, Ho Kyoung Hwang, Chang Moo Kang

Backgrounds/aims: This study aimed to compare the minimally invasive pancreatoduodenectomy with venous vascular resection (MI-PDVR) and open pancreatoduodenectomy with venous vascular resection (O-PDVR) for periampullary cancer.

Methods: Data of 124 patients who underwent PDVR (45 MI-PDVR, 79 O-PDVR) between January 1, 2016, and December 31, 2023, was retrospectively reviewed.

Results: MI-PDVR is significantly better than O-PDVR in terms of perioperative outcomes (median operation time [452.69 minutes vs. 543.91 minutes; p = 0.004], estimated blood loss [410.44 mL vs. 747.59 mL; p < 0.01], intraoperative transfusion rate [2 cases vs. 18 cases; p = 0.01], and hospital stay [18.16 days vs. 23.91 days; p = 0.008]). The complications until the discharge day showed no significant difference between the two groups (Clavien-Dindo < 3, 84.4% vs. 82.3%; Clavien-Dindo ≥ 3, 15.6% vs. 17.7%; p = 0.809). In terms of long-term oncological outcomes, there was no statistical difference in overall survival (OS, 51.55 months [95% CI: 35.95-67.14] vs. median 49.92 months [95% CI: 40.97-58.87]; p = 0.340) and disease-free survival (DFS, median 35.06 months [95% CI: 21.47-48.65] vs. median 38.77 months [95% CI: 29.80-47.75]; p = 0.585), between the two groups. Long-term oncological outcomes for subgroup analysis focusing on pancreatic ductal adenocarcinoma also showed no statistical differences in OS (40.86 months [95% CI: 34.45-47.27] vs. 48.48 months [95% CI: 38.16-58.59]; p = 0.270) and DFS (24.42 months [95% CI: 17.03-31.85] vs. 34.35 months, [95% CI: 25.44-43.27]; p = 0.740).

Conclusions: MI-PDVR can provide better perioperative outcomes than O-PDVR, and has similar oncological impact.

背景/目的:本研究旨在比较微创胰十二指肠切除加静脉血管切除术(MI-PDVR)和开放胰十二指肠切除加静脉血管切除术(O-PDVR)治疗胰周癌的效果:回顾性分析了2016年1月1日至2023年12月31日期间接受胰十二指肠静脉血管切除术的124例患者(45例MI-PDVR,79例O-PDVR)的数据:就围术期结果而言,MI-PDVR明显优于O-PDVR(中位手术时间[452.69分钟 vs. 543.91分钟;p = 0.004],估计失血量[410.44毫升 vs. 747.59毫升;p < 0.01],术中输血率[2例 vs. 18例;p = 0.01],住院时间[18.16天 vs. 23.91天;p = 0.008])。两组患者在出院前的并发症无明显差异(Clavien-Dindo < 3,84.4% vs. 82.3%;Clavien-Dindo ≥ 3,15.6% vs. 17.7%;P = 0.809)。在长期肿瘤学结果方面,两组患者的总生存期(OS,51.55 个月 [95% CI:35.95-67.14] vs. 中位数 49.92 个月 [95% CI:40.97-58.87];P = 0.340)和无病生存期(DFS,中位数 35.06 个月 [95% CI:21.47-48.65] vs. 中位数 38.77 个月 [95% CI:29.80-47.75];P = 0.585)无统计学差异。胰腺导管腺癌亚组分析的长期肿瘤学结果显示,OS(40.86 个月 [95% CI:34.45-47.27] vs. 48.48 个月 [95% CI:38.16-58.59];p = 0.270)和 DFS(24.42 个月 [95% CI:17.03-31.85] vs. 34.35 个月,[95% CI:25.44-43.27];p = 0.740)也无统计学差异:结论:MI-PDVR能提供比O-PDVR更好的围手术期疗效,而且对肿瘤的影响相似。
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引用次数: 0
Internal and external validation of indocyanine green plasma disappearance rate to discard liver grafts before procurement. 对吲哚菁绿血浆消失率进行内部和外部验证,以在采购前丢弃肝脏移植物。
IF 1.1 Q4 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-11-30 Epub Date: 2024-06-20 DOI: 10.14701/ahbps.24-086
Sergio Cortese, Katherine Plua, Alejandro J Perez-Alonso, María Savoie Hontoria, David Pacheco, Natalia Zambudio Carroll, Manuel Ángel Barrera Gómez, José María Pérez Peña, Álvaro G Morales Taboada, María Fernández Martínez, Sergio Hernández Kakauridze, Ana María Matilla, José Ángel López Baena, José Manuel Asencio

Backgrounds/aims: Thirty percent of liver grafts in donors after brain death (DBD) in Spain are rejected by procurement surgeons owing to marginal graft quality. Poor donor indocyanine green (ICG) clearance has been associated with graft discard and malfunction. This study aimed to internally and externally validate the predictive value of ICG-plasma disappearance rate (ICG-PDR) to reject grafts before donation and set a cut-off to avoid missing any potential effective donors.

Methods: Between March 2017 and August 2023, ICG clearance test was performed immediately before procurement in 71 DBD. The surgeon was blinded to test results. Univariate and multivariate analyses were performed to detect independent predictors of graft discard. Discrimination and calibration of predictors were assessed and a cut-off with 100% specificity was set. External validation was performed on 17 donors evaluated by three other transplantation teams.

Results: In the training cohort, 30 of 71 grafts were discarded for transplantation. ICG-PDR was the only donor variable independently associated with graft discard. The area under receiver operating characteristic curve for ICG-PDR was 0.875 (95% confidence interval: 0.768-0.947) and good calibration was observed. Below a PDR of 13.5%/min, no graft was accepted for transplantation. These results were successfully validated using the external cohort of donors.

Conclusions: ICG clearance test performed in DBD was internally and externally validated to predict liver graft discard. It could be used as a screening tool before donation to avoid unnecessary costs of travel and human resources.

背景/目的:在西班牙,脑死亡(DBD)后供体的肝脏移植物中有 30% 因移植物质量不佳而被采购外科医生拒绝。供体吲哚青绿(ICG)清除率低与移植物丢弃和功能障碍有关。本研究旨在对ICG-血浆消失率(ICG-PDR)的预测价值进行内部和外部验证,以在捐赠前拒绝移植物,并设定一个临界值,避免遗漏任何潜在的有效捐赠者:方法:2017 年 3 月至 2023 年 8 月期间,在 71 例 DBD 中,在采集前立即进行了 ICG 清除测试。外科医生对检测结果保持盲法。进行单变量和多变量分析以检测移植物废弃的独立预测因素。对预测因子的鉴别和校准进行了评估,并设定了特异性为 100% 的临界值。由其他三个移植团队对 17 名捐献者进行了评估,并进行了外部验证:在训练队列中,71 例移植物中有 30 例被放弃移植。ICG-PDR是唯一一个与移植物丢弃独立相关的供体变量。ICG-PDR的受体操作特征曲线下面积为0.875(95%置信区间:0.768-0.947),校准效果良好。如果 PDR 低于 13.5%/分钟,则不接受移植。这些结果通过外部供体队列得到了成功验证:结论:在 DBD 中进行的 ICG 清除率测试经内部和外部验证可预测肝脏移植物的废弃。结论:在 DBD 中进行的 ICG 清除率测试通过了内部和外部验证,可预测肝脏移植物的废弃,可用作捐赠前的筛查工具,以避免不必要的差旅和人力资源成本。
{"title":"Internal and external validation of indocyanine green plasma disappearance rate to discard liver grafts before procurement.","authors":"Sergio Cortese, Katherine Plua, Alejandro J Perez-Alonso, María Savoie Hontoria, David Pacheco, Natalia Zambudio Carroll, Manuel Ángel Barrera Gómez, José María Pérez Peña, Álvaro G Morales Taboada, María Fernández Martínez, Sergio Hernández Kakauridze, Ana María Matilla, José Ángel López Baena, José Manuel Asencio","doi":"10.14701/ahbps.24-086","DOIUrl":"10.14701/ahbps.24-086","url":null,"abstract":"<p><strong>Backgrounds/aims: </strong>Thirty percent of liver grafts in donors after brain death (DBD) in Spain are rejected by procurement surgeons owing to marginal graft quality. Poor donor indocyanine green (ICG) clearance has been associated with graft discard and malfunction. This study aimed to internally and externally validate the predictive value of ICG-plasma disappearance rate (ICG-PDR) to reject grafts before donation and set a cut-off to avoid missing any potential effective donors.</p><p><strong>Methods: </strong>Between March 2017 and August 2023, ICG clearance test was performed immediately before procurement in 71 DBD. The surgeon was blinded to test results. Univariate and multivariate analyses were performed to detect independent predictors of graft discard. Discrimination and calibration of predictors were assessed and a cut-off with 100% specificity was set. External validation was performed on 17 donors evaluated by three other transplantation teams.</p><p><strong>Results: </strong>In the training cohort, 30 of 71 grafts were discarded for transplantation. ICG-PDR was the only donor variable independently associated with graft discard. The area under receiver operating characteristic curve for ICG-PDR was 0.875 (95% confidence interval: 0.768-0.947) and good calibration was observed. Below a PDR of 13.5%/min, no graft was accepted for transplantation. These results were successfully validated using the external cohort of donors.</p><p><strong>Conclusions: </strong>ICG clearance test performed in DBD was internally and externally validated to predict liver graft discard. It could be used as a screening tool before donation to avoid unnecessary costs of travel and human resources.</p>","PeriodicalId":72220,"journal":{"name":"Annals of hepato-biliary-pancreatic surgery","volume":" ","pages":"458-465"},"PeriodicalIF":1.1,"publicationDate":"2024-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11599826/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141428391","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
A review of ergonomic positions to improve musculoskeletal distress in hepatobiliary pancreatic surgeons according to open, laparoscopic, and robotic surgeries. 根据开腹、腹腔镜和机器人手术,对改善肝胆胰外科医生肌肉骨骼不适的人体工程学体位进行回顾。
IF 1.1 Q4 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-11-30 Epub Date: 2024-09-09 DOI: 10.14701/ahbps.24-127
Young Jae Cho, Jin-Young Jang

Advances in surgical ergonomics are essential for the performance, health, and career longevity of surgeons. Many surgeons experience work-related musculoskeletal disorders (WMSDs) resulting from various surgical modalities, including open, laparoscopic, and robotic surgeries. To prevent WMSDs, individual differences may exist depending on the surgical method; however, the key is to maintain a neutral posture, and avoid static postures. This review aims to summarize the concepts of ergonomics and WMSDs; identify the ergonomic challenges of open, laparoscopic, and robotic surgeries; and discuss ergonomic recommendations to improve them.

外科人体工程学的进步对外科医生的工作表现、健康和职业寿命至关重要。许多外科医生都经历过因各种手术方式(包括开腹、腹腔镜和机器人手术)导致的与工作相关的肌肉骨骼疾病(WMSDs)。要预防 WMSD,不同的手术方式可能存在个体差异;但关键是要保持中立姿势,避免静态姿势。本综述旨在总结人体工程学和WMSDs的概念,确定开腹、腹腔镜和机器人手术在人体工程学方面的挑战,并讨论改善这些挑战的人体工程学建议。
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引用次数: 0
Robotic management of huge hepatic angiomyolipoma: A case report and literature review. 巨大肝血管脂肪瘤的机器人手术治疗:病例报告和文献综述。
IF 1.1 Q4 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-11-30 Epub Date: 2024-06-13 DOI: 10.14701/ahbps.24-033
Andrew Park, Kush Savsani, Anjelica Alfonso, Ester Jo, Bryce Hatfield, Daisuke Imai, Aamir Khan, Amit Sharma, Irfan Saeed, Vinay Kumaran, Adrian Cotterell, David Bruno, Yuzuru Sambommatsu, Seung Lee

Hepatic angiomyolipoma (HAML) is a rare, benign mesenchymal liver tumor encountered in Asia, primarily in females, and can be found within the right hepatic lobe, but also in other areas of the liver. Immunohistochemically, HAMLs are characteristically positive for human melanoma black-45 antigen (HMB-45) and can histochemically vary in the composition of angiomatous, lipomatous, and myomatous tissue, together with the presence of epithelioid cells. In this case report, we discuss a previously healthy patient presenting with bloating and previously documented concern of liver lesions, found to have HAML confirmed by surgical pathology. Surgery was decided, as HAMLs greater than 10 cm are at risk of rupture. This is one of the first documented cases of HAML resected through robot-assisted bisegmentectomy and cholecystectomy, and therefore, intraoperative images have been included to assist in the planning of future robotic cases.

肝血管肌脂肪瘤(HAML)是一种罕见的良性肝间质肿瘤,在亚洲多见,主要发生在女性身上,可发生在右肝叶,也可发生在肝脏的其他部位。从免疫组化角度看,HAML的特征性特征是人类黑色素瘤黑-45抗原(HMB-45)阳性,从组织化学角度看,HAML可由血管瘤组织、脂肪瘤组织、肌瘤组织以及上皮样细胞组成。在本病例报告中,我们讨论了一名以前健康的患者,该患者出现腹胀,以前曾有过肝脏病变的记录,经手术病理证实发现患有 HAML。由于大于 10 厘米的 HAML 有破裂的风险,因此决定进行手术。这是首例通过机器人辅助双段切除术和胆囊切除术切除HAML的病例,因此术中图像也被纳入其中,以协助未来机器人病例的规划。
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Annals of hepato-biliary-pancreatic surgery
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