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Segments 4, 7, and 8 liver resection: A case report. 第 4、7 和 8 节段肝切除术:病例报告
IF 1.1 Q4 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-11-30 Epub Date: 2024-07-25 DOI: 10.14701/ahbps.24-092
Pilar Leal-Leyte, Carlos Ulises Camarillo-Sánchez, Daniel Zamora-Valdés

Right superior resection (segments 7 and 8) is an uncommon resection for liver malignancies, with most of the literature limited to case reports and small series. Resection of segments 4, 7, and 8 has been reported in only a few cases. When the right hepatic vein is resected, venous reconstruction or identification of one or more right inferior hepatic veins is considered mandatory, to maintain segmentary function of segments 5 and 6. We present a case of liver resection of segments 4, 7, and 8 including the right and middle hepatic veins for symptomatic benign liver disease with no right hepatic vein reconstruction, nor a prominent right inferior hepatic vein(s). After the resection, there was no change in liver function tests, and the patient made an unremarkable recovery. Three months after the operation, partial atrophy of segments 5 and 6 with hypertrophy of the left lateral section was observed, while two and one half years after resection, the patient is asymptomatic. When right hepatic vein reconstruction would add unnecessary operative time, and there is low likelihood of the need for repeated resection, particularly when the hepatic vein is difficult to dissect, this approach can be safe and useful, while providing an adequate postoperative liver mass in the short-term to recover uneventfully from major liver resection.

右上段切除术(第7和第8节段)是一种不常见的肝脏恶性肿瘤切除术,大多数文献仅限于病例报告和小型系列研究。对第4、7和8节段进行切除的报道屈指可数。当切除右肝静脉时,必须进行静脉重建或确定一条或多条右肝下静脉,以保持第5和第6节段的分段功能。我们介绍了一例因症状性良性肝病而切除肝脏第 4、7 和 8 节段(包括肝右静脉和肝中静脉)的病例,该病例没有进行肝右静脉重建,也没有突出的肝右下静脉。切除术后,肝功能检查无变化,患者恢复良好。术后三个月,观察到第 5 段和第 6 段部分萎缩,左外侧部分肥大,而切除术后两年半,患者已无症状。当右肝静脉重建会增加不必要的手术时间,而且需要重复切除的可能性较低时,特别是当肝静脉难以解剖时,这种方法是安全和有用的,同时在短期内提供足够的术后肝脏肿块,使肝脏大部切除术后恢复顺利。
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引用次数: 0
Liver transplantation for organ failure following multiple locoregional treatments for breast cancer metastasis. 肝移植治疗乳腺癌转移多次局部治疗后的器官衰竭。
IF 1.1 Q4 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-11-30 Epub Date: 2024-08-05 DOI: 10.14701/ahbps.24-101
Giammauro Berardi, Valerio Giannelli, Marco Colasanti, Roberto Cianni, Roberto Meniconi, Nicola Guglielmo, Stefano Ferretti, Ludovica Di Cesare, Adriano Pellicelli, Guido Ventroni, Enrico Cortesi, Giuseppe Maria Ettorre

Patients with nonresectable breast cancer liver metastasis (BCLM) face a dismal prognosis. Despite liver transplantation (LT) for metastatic liver tumors having recently shown good results, BCLM represents an absolute contraindication. This study aimed to investigate the potential for long-term survival after LT for BCLMs in a patient experiencing end-stage liver disease, following multiple oncologic treatments. In July 2019, we performed a deceased donor LT on a 41-year-old female with BCLM controlled with human epidermal growth factor receptor 2 targeted therapy, who developed liver failure following multiple locoregional liver-directed treatments. The primary tumor was treated with surgical resection and adjuvant chemoradiation in 2000. The procedure was performed under a protocol approved by the local ethical committee, and by the Italian National Transplant Center. A 12-month treatment with trastuzumab was performed immediately after LT. Immunosuppression following transplantation was undertaken without steroids, and with everolimus. The patient completed 12 months of follow-up without recurrence. Trastuzumab was then withdrawn. Fifteen months after LT, a liver recurrence occurred that was treated with chemotherapy. In October 2021, she developed 2 brain lesions that were treated with stereotactic radiation. The patient is still alive, with a positron emission tomography/computed tomography performed in January 2024 showing no disease. LT for this patient with BCLM of extreme selectivity showed a good clinical outcome. Perioperative systemic treatment and tumor control are necessary. A specific protocol should be discussed within a multidisciplinary team, and with local and national authorities. Even if tumor recurrence occurs, multimodal therapy can control the disease.

不可切除的乳腺癌肝转移(BCLM)患者预后很差。尽管最近针对转移性肝肿瘤的肝移植(LT)取得了良好的效果,但BCLM仍是绝对禁忌症。本研究旨在调查一名接受过多种肿瘤治疗的终末期肝病患者在接受LT治疗BCLM后的长期生存潜力。2019年7月,我们为一名41岁的女性BCLM患者实施了已故供体LT,该患者接受了人表皮生长因子受体2靶向治疗,并在多次局部肝脏定向治疗后出现肝功能衰竭。原发肿瘤于 2000 年接受了手术切除和辅助化疗。手术是根据当地伦理委员会和意大利国家移植中心批准的方案进行的。LT术后立即接受了为期12个月的曲妥珠单抗治疗。移植后的免疫抑制不使用类固醇,而是使用依维莫司。患者接受了 12 个月的随访,没有复发。随后撤销了曲妥珠单抗。LT 15 个月后,肝脏复发,接受了化疗。2021 年 10 月,她出现了 2 处脑部病变,接受了立体定向放射治疗。该患者目前仍然存活,2024年1月进行的正电子发射断层扫描/计算机断层扫描显示无病变。对这名患有极度选择性 BCLM 的患者进行的 LT 治疗取得了良好的临床效果。围手术期系统治疗和肿瘤控制是必要的。应在多学科团队内与当地和国家当局讨论具体方案。即使肿瘤复发,多模式疗法也能控制病情。
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引用次数: 0
The impact of myosteatosis on postoperative outcomes and survival of patients undergoing pancreatoduodenectomy for suspected/confirmed malignancy. 因疑似/确诊恶性肿瘤而接受胰十二指肠切除术的患者,肌骨发育不良对其术后效果和存活率的影响。
IF 1.1 Q4 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-11-30 Epub Date: 2024-08-29 DOI: 10.14701/ahbps.23-115
Paul Jenkins, Andrew MacCormick, Adam Streeter, Mark Puckett, Gemma Miles, Somaiah Aroori

Backgrounds/aims: While the effects of myosteatosis are emerging, the evidence for its use as a predictor of outcomes in patients undergoing pancreatoduodenectomy (PD) still needs to be established. The study aims to evaluate the effect of myosteatosis on the shortand long-term outcomes of PD.

Methods: We analyzed the effect of myosteatosis on the short- and long-term outcomes of patients who underwent PD between July 2006 and May 2013. Myosteatosis was measured retrospectively from preoperative computed tomography (CT) at the L3 vertebra level, and dichotomized as a binary exposure variable as < 38.5 Hounsfield unit (HU) for males, and < 36.1 HU for females.

Results: A total of 214 patient (median age 62 years, range: 41-80 years) CTs were analyzed for myosteatosis. Overall, 120/214 (56.1%) patients were classed as having myosteatosis. Both groups had similar comorbidity profiles. The presence of myosteatosis was not shown to increase the rate of any short- or long-term complication. However, pancreatic leak (29.8% vs. 13.3%; p = 0.006) and postoperative bleeding (13.8% vs. 5.0%; p = 0.034) were higher in the non-myosteatosis group. The median intensive care (2 days) and hospital stay (12 days) were the same in both groups. The 30-day mortality (myosteatosis: 3.3% vs. non-myosteatosis: 3.2%; p = 0.95), and 5-year overall survival (myosteatosis: 26.7% vs. non-myosteatosis: 31.9%; p = 0.5), were similar in both groups.

Conclusions: We have found no evidence supporting myosteatosis affecting either the short-term or long-term outcomes of patients undergoing PD for suspected/confirmed malignant tumors.

背景/目的:虽然骨质疏松的影响正在逐渐显现,但将其用作胰十二指肠切除术(PD)患者预后预测指标的证据仍有待确定。本研究旨在评估肌骨质疏松对胰十二指肠切除术短期和长期预后的影响:我们分析了2006年7月至2013年5月期间接受腹腔镜手术的患者中,肌骨骼疏松对短期和长期预后的影响。通过术前计算机断层扫描(CT)在L3椎体水平对骨质疏松进行回顾性测量,并将其作为二元暴露变量进行二分:男性< 38.5 Hounsfield unit (HU),女性< 36.1 HU:共对 214 例患者(中位年龄 62 岁,范围:41-80 岁)的 CT 进行了肌骨质疏松症分析。总的来说,214 名患者中有 120 名(56.1%)被归类为肌骨质疏松症。两组患者的合并症情况相似。没有证据表明肌骨骼疏松会增加任何短期或长期并发症的发生率。不过,非肌营养不良组的胰漏(29.8% 对 13.3%;P = 0.006)和术后出血(13.8% 对 5.0%;P = 0.034)发生率较高。两组的重症监护中位数(2 天)和住院时间中位数(12 天)相同。两组的30天死亡率(肌骨质疏松症:3.3% vs. 非肌骨质疏松症:3.2%;P = 0.95)和5年总生存率(肌骨质疏松症:26.7% vs. 非肌骨质疏松症:31.9%;P = 0.5)相似:结论:我们没有发现任何证据表明肌骨骼疏松会影响因疑似/确诊恶性肿瘤而接受腹腔镜手术的患者的短期或长期预后。
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引用次数: 0
Perioperative outcomes of robot-assisted pancreatoduodenectomy (PD) and totally laparoscopic PD after overcoming learning curves with comparison of oncologic outcomes between open PD and minimally invasive PD. 克服学习曲线后机器人辅助胰十二指肠切除术(PD)和全腹腔镜胰十二指肠切除术的围手术期疗效,以及开放式胰十二指肠切除术和微创胰十二指肠切除术的肿瘤学疗效比较。
IF 1.1 Q4 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-11-30 Epub Date: 2024-09-24 DOI: 10.14701/ahbps.24-121
Jae Seung Kang, Mirang Lee, Jun Suh Lee, Youngmin Han, Hee Ju Sohn, Boram Lee, Moonhwan Kim, Wooil Kwon, Ho-Seong Han, Yoo-Seok Yoon, Jin-Young Jang

Backgrounds/aims: Minimally invasive pancreatoduodenectomy (MIPD), such as totally laparoscopic pancreatoduodenectomy (TLPD) or robot-assisted pancreatoduodenectomy (RAPD), is increasingly performed worldwide. This study aimed to compare the perioperative outcomes of TLPD and RAPD, and compare the oncologic outcomes between MIPD and open pancreatoduodenectomy (OPD) for malignant disease.

Methods: This retrospective study was conducted at two hospitals that followed similar oncological surgical principles, including the extent of resection. RAPD was performed at Seoul National University Hospital, and TLPD at Seoul National University Bundang Hospital. Patient demographics, perioperative outcomes, and oncological outcomes were analyzed. Propensity score matching (PSM) analysis was performed to compare oncologic outcomes between MIPD and OPD.

Results: Between 2015 and 2020, 332 RAPD and 178 TLPD were performed. The rates of Clavian-Dindo grade ≥ 3 complications (19.3% vs. 20.2%, p = 0.816), clinically relevant postoperative pancreatic fistula (9.9% vs. 11.8%, p = 0.647), and open conversions (6.6% vs. 10.5%, p = 0.163) were comparable between the two groups. The mean operation time (341 minutes vs. 414 minutes, p < 0.001) and postoperative hospital stay were shorter in the RAPD group (11 days vs. 14 days, p = 0.034). After PSM, the 5-year overall survival rate was comparable between MIPD and OPD for overall malignant disease (58.4% vs. 55.5%, p = 0.180).

Conclusions: Both RAPD and TLPD are safe and feasible, and MIPD has clinical outcomes that are comparable to those of OPD. Although RAPD exhibits some advantages, its perioperative outcomes are similar to those associated with TLPD. A surgical method may be selected based on the convenience of surgical movements, medical costs, and operator experience.

背景/目的:微创胰十二指肠切除术(MIPD),如全腹腔镜胰十二指肠切除术(TLPD)或机器人辅助胰十二指肠切除术(RAPD),在全世界越来越多地开展。本研究旨在比较TLPD和RAPD的围手术期疗效,并比较MIPD和开腹胰十二指肠切除术(OPD)治疗恶性疾病的肿瘤疗效:这项回顾性研究在两家医院进行,这两家医院遵循相似的肿瘤手术原则,包括切除范围。RAPD在首尔大学医院进行,TLPD在首尔大学盆唐医院进行。对患者人口统计学、围手术期结果和肿瘤学结果进行了分析。为比较MIPD和OPD的肿瘤治疗效果,进行了倾向得分匹配(PSM)分析:2015年至2020年间,共进行了332例RAPD和178例TLPD手术。两组的Clavian-Dindo≥3级并发症发生率(19.3% vs. 20.2%,P = 0.816)、术后临床相关胰瘘发生率(9.9% vs. 11.8%,P = 0.647)和开腹手术转换率(6.6% vs. 10.5%,P = 0.163)相当。RAPD 组的平均手术时间(341 分钟对 414 分钟,p < 0.001)和术后住院时间更短(11 天对 14 天,p = 0.034)。PSM术后,MIPD和OPD的总体恶性疾病5年总生存率相当(58.4% vs. 55.5%,p = 0.180):结论:RAPD和TLPD均安全可行,MIPD的临床结果与OPD相当。尽管 RAPD 显示出一些优势,但其围手术期疗效与 TLPD 相似。可以根据手术移动的便利性、医疗成本和操作者的经验来选择手术方法。
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引用次数: 0
Comparative accuracy of four guidelines to predict high-grade dysplasia or malignancy in surgically resected pancreatic intraductal papillary mucinous neoplasms: Small nuances between guidelines lead to vastly different results. 比较四种指南预测手术切除的胰腺导管内乳头状黏液瘤高级别发育不良或恶性的准确性:指南之间的细微差别导致了截然不同的结果。
IF 1.1 Q4 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-11-30 Epub Date: 2024-06-20 DOI: 10.14701/ahbps.24-049
Irene C Perez, Andrew Bigelow, Vanessa M Shami, Bryan G Sauer, Andrew Y Wang, Daniel S Strand, Alexander J Podboy, Todd W Bauer, Victor M Zaydfudim, Allan Tsung, Ross C D Buerlein

Backgrounds/aims: The guidelines regarding the management of intraductal papillary mucinous neoplasms (IPMNs) all have slightly different surgical indications for high-risk lesions. We aim to retrospectively compare the accuracy of four guidelines in recommending surgery for high-risk IPMNs, and assess the accuracy of elevated CA-19-9 levels and imaging characteristics of IPMNs considered high-risk in predicting malignancy or high-grade dysplasia (HGD).

Methods: The final histopathological diagnosis of surgically resected high-risk IPMNs during 2013-2020 were compared to preoperative surgical indications, as enumerated in four guidelines: the 2015 American Gastroenterological Association (AGA), 2017 International Consensus, 2018 European Study Group, and 2018 American College of Gastroenterology (ACG). Surgery was considered "justified" if histopathology of the surgical specimen showed HGD/malignancy, or there was postoperative symptomatic improvement.

Results: Surgery was postoperatively justified in 26/65 (40.0%) cases. All IPMNs with HGD/malignancy were detected by the 2018 ACG and the combined (absolute and relative criteria) 2018 European guidelines. The combined ("high-risk stigmata" and "worrisome features") 2017 International guideline missed 1/19 (5.3%) IPMNs with HGD/malignancy. The 2015 AGA guideline missed the most cases (11/19, 57.9%) of IPMNs with HGD/malignancy. We found the features most-associated with HGD/malignancy were pancreatic ductal dilation, and elevated CA-19-9 levels.

Conclusions: Following the 2015 AGA guideline results in the highest rate of missed HGD/malignancy, but the lowest rate of operating on IPMNs without these features; meanwhile, the 2018 ACG and the combined (absolute and relative criteria) 2018 European guidelines result in more operations for IPMNs without HGD/malignancy, but the lowest rates of missed HGD/malignancy in IPMNs.

背景/目的:有关导管内乳头状粘液瘤(IPMNs)治疗的指南对高危病变的手术指征都略有不同。我们旨在回顾性比较四种指南在推荐高危 IPMNs 手术治疗方面的准确性,并评估 CA-19-9 水平升高和被视为高危 IPMNs 的影像学特征在预测恶性或高级别发育不良(HGD)方面的准确性:将 2013-2020 年间手术切除的高危 IPMN 的最终组织病理学诊断与 2015 年美国胃肠病学会 (AGA)、2017 年国际共识、2018 年欧洲研究组和 2018 年美国胃肠病学会 (ACG) 四项指南中列举的术前手术指征进行比较。如果手术标本的组织病理学显示为 HGD/恶性肿瘤,或术后症状有所改善,则认为手术 "合理":26/65(40.0%)例术后认为手术是合理的。所有伴有HGD/恶性肿瘤的IPMN均通过2018年ACG和2018年欧洲联合指南(绝对标准和相对标准)检测。2017年国际指南的合并标准("高风险标志 "和 "令人担忧的特征")漏检了1/19(5.3%)例伴有HGD/恶性肿瘤的IPMN。2015 年 AGA 指南漏诊了最多病例(11/19,57.9%)伴有 HGD/恶性肿瘤的 IPMN。我们发现与HGD/恶性肿瘤最相关的特征是胰腺导管扩张和CA-19-9水平升高:按照 2015 年 AGA 指南,HGD/恶性肿瘤的漏诊率最高,但对无这些特征的 IPMN 的手术率最低;同时,2018 年 ACG 和 2018 年欧洲联合指南(绝对标准和相对标准)对无 HGD/恶性肿瘤的 IPMN 的手术率较高,但 IPMN 中 HGD/恶性肿瘤的漏诊率最低。
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引用次数: 0
Impact of post-hepatectomy biliary leaks on long-term survival in different liver tumors: A single institute experience. 不同肝脏肿瘤肝切除术后胆漏对长期生存的影响:一家研究所的经验。
IF 1.1 Q4 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-11-30 Epub Date: 2024-07-17 DOI: 10.14701/ahbps.24-078
Devesh Sanjeev Ballal, Shraddha Patkar, Aditya Kunte, Sridhar Sundaram, Nitin Shetty, Kunal Gala, Suyash Kulkarni, Mahesh Goel

Backgrounds/aims: A postoperative biliary leak is one of the most morbid complications occurring after a liver resection, the long-term impact of which remains unknown.

Methods: Retrospective analysis of consecutive liver resections performed from 1 January 2011 to 31 December 2021. Primary endpoint of disease-free survival (DFS) was compared between patients with and without a bile leak, stratifying for tumor type. Survival curves were plotted using Kaplan-Meier estimates, and differences between them were analyzed using the log-rank test.

Results: In toto, 862 patients were analyzed, and included 306 (35.5%) hepatocellular carcinomas, 212 (24.6%) metastatic colorectal cancers, and 111 (12.9%) cholangiocarcinomas (69 intrahepatic cholangiocarcinomas, 42 hilar cholangiocarcinomas). Occurrence of a bile leak was associated with significantly poorer DFS only in patients with cholangiocarcinoma (median DFS 9.9 months vs. 24.9 months, p = 0.013), and further analysis was restricted to this cohort. A Cox regression performed for factors associated with DFS detriment in patients with cholangiocarcinoma showed that apart from node positivity (hazard ratio [HR]: 2.482, p = 0.033) and margin positivity (HR: 2.65, p = 0.021), development of a bile leak was independently associated with worsening DFS on both univariate and multiple regression analyses (HR: 1.896, p = 0.033).

Conclusions: Post-hepatectomy biliary leaks are associated with significantly poorer DFS only in patients with cholangiocarcinoma, but not in patients with hepatocellular carcinoma or metastatic colorectal cancer. Methods to mitigate this survival detriment need to be explored.

背景/目的:术后胆漏是肝切除术后最常见的并发症之一,其长期影响尚不清楚:方法:对2011年1月1日至2021年12月31日期间进行的连续肝脏切除术进行回顾性分析。比较有胆漏和无胆漏患者的无病生存期(DFS),并根据肿瘤类型进行分层。采用卡普兰-梅耶估计法绘制生存曲线,并采用对数秩检验分析两者之间的差异:共分析了 862 例患者,其中包括 306 例(35.5%)肝细胞癌、212 例(24.6%)转移性结直肠癌和 111 例(12.9%)胆管癌(69 例肝内胆管癌、42 例肝门部胆管癌)。只有胆管癌患者发生胆漏与较差的 DFS 显著相关(中位 DFS 9.9 个月 vs. 24.9 个月,p = 0.013),进一步分析仅限于该队列。对胆管癌患者的DFS不利相关因素进行的Cox回归显示,除了结节阳性(危险比[HR]:2.482,p = 0.033)和边缘阳性(HR:2.65,p = 0.021)外,胆漏的发生与单变量和多元回归分析中的DFS恶化独立相关(HR:1.896,p = 0.033):结论:肝切除术后胆漏仅与胆管癌患者的 DFS 明显降低有关,而与肝细胞癌或转移性结直肠癌患者无关。减轻这种生存损害的方法有待探索。
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引用次数: 0
Deep learning-based surgical phase recognition in laparoscopic cholecystectomy. 基于深度学习的腹腔镜胆囊切除术手术阶段识别。
IF 1.1 Q4 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-11-30 Epub Date: 2024-07-29 DOI: 10.14701/ahbps.24-091
Hye Yeon Yang, Seung Soo Hong, Jihun Yoon, Bokyung Park, Youngno Yoon, Dai Hoon Han, Gi Hong Choi, Min-Kook Choi, Sung Hyun Kim

Backgrounds/aims: Artificial intelligence (AI) technology has been used to assess surgery quality, educate, and evaluate surgical performance using video recordings in the minimally invasive surgery era. Much attention has been paid to automating surgical workflow analysis from surgical videos for an effective evaluation to achieve the assessment and evaluation. This study aimed to design a deep learning model to automatically identify surgical phases using laparoscopic cholecystectomy videos and automatically assess the accuracy of recognizing surgical phases.

Methods: One hundred and twenty cholecystectomy videos from a public dataset (Cholec80) and 40 laparoscopic cholecystectomy videos recorded between July 2022 and December 2022 at a single institution were collected. These datasets were split into training and testing datasets for the AI model at a 2:1 ratio. Test scenarios were constructed according to structural characteristics of the trained model. No pre- or post-processing of input data or inference output was performed to accurately analyze the effect of the label on model training.

Results: A total of 98,234 frames were extracted from 40 cases as test data. The overall accuracy of the model was 91.2%. The most accurate phase was Calot's triangle dissection (F1 score: 0.9421), whereas the least accurate phase was clipping and cutting (F1 score: 0.7761).

Conclusions: Our AI model identified phases of laparoscopic cholecystectomy with a high accuracy.

背景/目的:在微创手术时代,人工智能(AI)技术已被用于利用视频记录评估手术质量、教育和评价手术表现。为实现评估和评价的有效评估,人们非常关注从手术视频中自动分析手术工作流程。本研究旨在设计一种深度学习模型,利用腹腔镜胆囊切除术视频自动识别手术阶段,并自动评估识别手术阶段的准确性:从公共数据集(Cholec80)中收集了120个胆囊切除术视频,并收集了一个机构在2022年7月至2022年12月期间录制的40个腹腔镜胆囊切除术视频。这些数据集按 2:1 的比例分为人工智能模型的训练数据集和测试数据集。测试场景是根据训练模型的结构特征构建的。没有对输入数据或推理输出进行预处理或后处理,以准确分析标签对模型训练的影响:从 40 个案例中共提取了 98 234 个帧作为测试数据。模型的总体准确率为 91.2%。最准确的阶段是卡洛氏三角解剖(F1 得分:0.9421),而最不准确的阶段是剪切和切割(F1 得分:0.7761):我们的人工智能模型能准确识别腹腔镜胆囊切除术的各个阶段。
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引用次数: 0
Construction and validation of a preoperative prognostic model integrating the novel aspartate aminotransferase-albumin score for hepatocellular carcinoma patients undergoing liver resection. 针对接受肝脏切除术的肝细胞癌患者,构建并验证了结合新型天冬氨酸氨基转移酶-白蛋白评分的术前预后模型。
IF 1.1 Q4 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-11-30 Epub Date: 2024-08-12 DOI: 10.14701/ahbps.24-110
Shinichi Ikuta, Tsukasa Aihara, Meidai Kasai, Takayoshi Nakajima, Naoki Yamanaka

Backgrounds/aims: Patients undergoing liver resection for hepatocellular carcinoma (HCC) often possess good liver reserve, which may limit the prognostic effectiveness of existing liver function scores. This study aimed to develop a novel liver function score and a preoperative prognostic model specifically for HCC resection patients.

Methods: Eight hundred twenty-seven HCC patients undergoing initial liver resection were segregated into training and validation cohorts in a 6:4 ratio. Cox regression analysis was employed to identify significant parameters influencing overall survival. The efficacy of the liver function score and prognostic model was evaluated using metrics such as the area under the receiver operating characteristic curve.

Results: Aspartate aminotransferase (AST) and albumin emerged as significant prognostic indicators. The AST-albumin (ASAL) score, calculated as exp [AST (IU/L) × 0.005 - albumin (g/dL) × 1.043] × 100, outperformed existing scores such as Child-Turcotte-Pugh, albumin-bilirubin, platelet-albumin, and AST-platelet ratio index in both training and validation cohorts. Additionally, a scoring model that combined the ASAL score with alpha-fetoprotein and the up-to-seven criterion exhibited superior discriminatory capabilities compared to the American Joint Committee on Cancer tumor, node, metastasis stage, and Barcelona Clinic Liver Cancer stage.

Conclusions: The proposed prognostic model that integrates the novel ASAL score offers promising prognostic potential for HCC patients undergoing liver resection.

背景/目的:接受肝细胞癌(HCC)肝切除术的患者通常拥有良好的肝脏储备,这可能会限制现有肝功能评分的预后效果。本研究旨在为 HCC 切除术患者开发一种新型肝功能评分和术前预后模型:827 名接受初次肝切除术的 HCC 患者按 6:4 的比例分为训练组和验证组。采用 Cox 回归分析确定影响总生存期的重要参数。使用接收者操作特征曲线下面积等指标评估肝功能评分和预后模型的有效性:结果:天冬氨酸氨基转移酶(AST)和白蛋白是重要的预后指标。天门冬氨酸氨基转移酶-白蛋白(AST-albumin,ASAL)评分(计算公式为 exp [AST (IU/L) × 0.005 - albumin (g/dL) × 1.043] × 100)在训练队列和验证队列中均优于现有评分,如 Child-Turcotte-Pugh、白蛋白-胆红素、血小板-白蛋白和 AST-血小板比值指数。此外,与美国癌症联合委员会的肿瘤、结节、转移分期和巴塞罗那临床肝癌分期相比,将ASAL评分与甲胎蛋白和up-to-seven标准相结合的评分模型显示出更优越的判别能力:整合了新型 ASAL 评分的预后模型为接受肝切除术的 HCC 患者提供了良好的预后潜力。
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引用次数: 0
Minimally invasive versus open central pancreatectomy: A systematic review and meta-analysis. 微创与开腹中央胰腺切除术:系统回顾和荟萃分析。
IF 1.1 Q4 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-11-30 Epub Date: 2024-06-25 DOI: 10.14701/ahbps.24-093
Shahab Hajibandeh, Shahin Hajibandeh, Nicholas George Mowbray, Matthew Mortimer, Guy Shingler, Amir Kambal, Bilal Al-Sarireh

To compare the procedural outcomes of minimally invasive and open central pancreatectomy. A systematic review in compliance with PRISMA statement standards was conducted to identify and analyze studies comparing the procedural outcomes of minimally invasive (laparoscopic or robotic) central pancreatectomy with the open approach. Random effects modeling using intention to treat data, and individual patient as unit of analysis, was used for analyses. Seven comparative studies including 289 patients were included. The two groups were comparable in terms of baseline characteristics. The minimally invasive approach was associated with less intraoperative blood loss (mean difference [MD]: -153.13 mL, p = 0.0004); however, this did not translate into less need for blood transfusion (odds ratio [OR]: 0.30, p = 0.06). The minimally invasive approach resulted in less grade B-C postoperative pancreatic fistula (OR: 0.54, p = 0.03); this did not remain consistent through sensitivity analyses. There was no difference between the two approaches in operative time (MD: 60.17 minutes, p = 0.31), Clavien-Dindo ≥ 3 complications (OR: 1.11, p = 0.78), postoperative mortality (risk difference: -0.00, p = 0.81), and length of stay in hospital (MD: -3.77 days, p = 0.08). Minimally invasive central pancreatectomy may be as safe as the open approach; however, whether it confers advantage over the open approach remains the subject of debate. Type 2 error is a possibility, hence adequately powered studies are required for definite conclusions; future studies may use our data for power analysis.

比较微创和开腹中央胰腺切除术的手术效果。我们按照 PRISMA 声明标准进行了系统性回顾,以确定并分析比较微创(腹腔镜或机器人)中央胰腺切除术与开放式方法的手术效果的研究。分析采用随机效应模型,使用意向治疗数据,以单个患者为分析单位。共纳入了七项对比研究,包括 289 名患者。两组患者的基线特征具有可比性。微创方法与术中失血较少有关(平均差[MD]:-153.13 mL,P = 0.0004);但这并不意味着输血需求减少(几率比[OR]:0.30,P = 0.06)。微创方法减少了术后 B-C 级胰瘘(OR:0.54,p = 0.03);但在敏感性分析中这一结果并不一致。两种方法在手术时间(MD:60.17 分钟,p = 0.31)、Clavien-Dindo ≥ 3 并发症(OR:1.11,p = 0.78)、术后死亡率(风险差异:-0.00,p = 0.81)和住院时间(MD:-3.77 天,p = 0.08)方面没有差异。微创中央胰腺切除术可能与开放式方法一样安全,但是否比开放式方法更有优势仍有争议。2型误差是有可能发生的,因此需要进行充分的研究才能得出明确的结论;未来的研究可能会使用我们的数据进行功率分析。
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引用次数: 0
Primary treatments for solitary hepatocellular carcinoma ≤ 3 cm: A systematic review and network meta-analysis. 3厘米以下单发肝细胞癌的初次治疗:系统综述和网络荟萃分析。
IF 1.1 Q4 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-11-30 Epub Date: 2024-08-23 DOI: 10.14701/ahbps.24-103
Sang-Hoon Kim, Ki-Hun Kim, Byeong-Gon Na, Sung Min Kim, Rak-Kyun Oh

Various treatment modalities are available for small solitary hepatocellular carcinoma (HCC), yet the optimal primary treatment strategy for tumors ≤ 3 cm remains unclear. This network meta-analysis investigates the comparative efficacy of various interventions on the long-term outcomes of patients with solitary HCC ≤ 3 cm. A systematic search of electronic databases from January 2000 to December 2023 was conducted to identify studies that compared at least two of the following treatments: surgical resection (SR), radiofrequency ablation (RFA), microwave ablation (MWA), and transarterial chemoembolization (TACE). Survival data were extracted, and pooled hazard ratios with 95% confidence intervals were calculated using a frequentist network meta-analysis. A total of 30 studies, comprising 2 randomized controlled trials and 28 retrospective studies, involving 8,053 patients were analyzed. Surgical resection showed the highest overall survival benefit with a p-score of 0.95, followed by RFA at 0.59, MWA at 0.23, and TACE, also at 0.23. Moreover, SR provided the most significant recurrence-free survival advantage, with a p-score of 0.95, followed by RFA at 0.31 and MWA at 0.19. Sensitivity analyses, excluding low-quality or retrospective non-matched studies, corroborated these findings. This network meta-analysis demonstrates that SR is the most effective first-line curative treatment for single HCC ≤ 3 cm, followed by RFA in patients with preserved liver function. The limited data on MWA and TACE underscore the need for further studies.

对于小的单发性肝细胞癌(HCC)有多种治疗方法,但对于≤3厘米的肿瘤,最佳的主要治疗策略仍不明确。这项网络荟萃分析研究了各种干预措施对≤3厘米单发HCC患者长期疗效的比较。研究人员对 2000 年 1 月至 2023 年 12 月的电子数据库进行了系统检索,以确定至少比较了以下两种治疗方法的研究:手术切除(SR)、射频消融(RFA)、微波消融(MWA)和经动脉化疗栓塞(TACE)。研究人员提取了生存数据,并采用频数网络荟萃分析法计算了汇总的危险比和 95% 的置信区间。共分析了 30 项研究,包括 2 项随机对照试验和 28 项回顾性研究,涉及 8053 名患者。手术切除的总生存率最高,P 值为 0.95,其次是 RFA(0.59)、MWA(0.23)和 TACE(也是 0.23)。此外,SR 的无复发生存率优势最为明显,p 值为 0.95,其次是 RFA(0.31)和 MWA(0.19)。敏感性分析排除了低质量或回顾性非匹配研究,证实了这些发现。这项网络荟萃分析表明,对于肝功能保留的患者,SR是治疗单发HCC≤3厘米最有效的一线治疗方法,其次是RFA。有关 MWA 和 TACE 的数据有限,这凸显了进一步研究的必要性。
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引用次数: 0
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Annals of hepato-biliary-pancreatic surgery
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