Tag: pubmed

Ann Hepatobiliary Pancreat Surg. 2021 Jun 30;25(Suppl 1):S324. doi: 10.14701/ahbps.EP-126.

ABSTRACT

INTRODUCTION: Gallbladder cancer (GBC) is the most common biliary tract malignancy. There is conflicting evidence in literature regarding curative surgery in presence of retroperitoneal lymph nodal (interaorto-caval and para-aortic) metastasis. This is a study of patients, in whom a curative resection was abandoned due to the presence of retroperitoneal lymph node metastasis (RLNM) or distant metastasis (DM), to see the effect of RLNM on survival of the GBC patients.

METHODS: A retrospective analysis of the patients with GBC found to have RLNM or DM on frozen section biopsy at surgery, between January 2013 and December 2018. Data was analyzed using the Statistical Package for the Social Sciences (SPSS) software (version 22.0). Survival in these two groups (RLNM and DM) was compared with log rank test. p-value of < 0.05 was considered significant.

RESULTS: 235 patients with ostensibly resectable GBC underwent surgical exploration. The planned curative resection was abandoned in 91 (39%) patients because of RLNM (n = 20, 9%) or DM (n = 71, 30%) on frozen section biopsy. Demographic profile and blood parameters were similar in the two groups. The median survival for RLNM and DM groups were 5 (range 2-26; interquartile range [IQR] 3-11) and 6 (range 2-24; IQR 4-10) months, respectively. No significant difference was documented on log rank test (p = 0.64). There was no 3-year in either group.

CONCLUSIONS: RLNM should be considered as DM and every effort should be made to target suspicious RLNM pre-operatively. At surgery retroperitoneal lymph nodes should be sampled as a routine for frozen section histological examination to avert a futile exercise.

PMID:34230389 | DOI:10.14701/ahbps.EP-126

Ann Hepatobiliary Pancreat Surg. 2021 Jun 30;25(Suppl 1):S331. doi: 10.14701/ahbps.EP-133.

ABSTRACT

INTRODUCTION: Single-incision-robotic cholecystectomy (SIRC) using the da Vinci Xi system (Xi) (Intuitive, Sunnyvale, CA, USA) is a safe and effective operation. Recently, the da Vinci SP system (SP) (Intuitive) which is a new platform specialized for single-port surgery has been released. The study aimed to compare perioperative outcomes of Xi and SP in regards to SIRC.

METHODS: In this multicenter retrospective cohort study, patients who underwent SIRC with benign gallbladder disease between 2019 and 2020 were enrolled. In Seoul National University Hospital, Xi was used with 3 separate arms of instruments inserted through the single incision made in umbilical area. In Ewha Womans University Seoul Hospital, SP was used with single multi-channel port through the umbilical incision. Patient’s demographics, intraoperative factors, postoperative complications, and postoperative pain were investigated.

RESULTS: 258 patients underwent SIRC with Xi, and 72 patients with SP. There were significant differences between Xi and SP groups in operation time at console (23.1 vs. 20.3 min, p = 0.018), numbers of postoperative analgesic injection (4.0 vs. 3.2, p < 0.001), NRS at day of operation (5.7 vs. 4.9, p < 0.001), but no difference in total operation time (43.4 vs. 45.9, p = 0.155) and postoperative complication (0.8% vs. 0.0%, p > 0.999). SP group showed more estimated blood loss (14.3 vs. 19.2 mL, p = 0.031).

CONCLUSIONS: Although operation time at console was shorter and pain was less in SP group statistically, clinical benefit appears to be minimal. Both Xi and SP can be a safe and feasible platform to perform SIRC, but further investigation is needed as prospective study.

PMID:34230396 | DOI:10.14701/ahbps.EP-133

Ann Hepatobiliary Pancreat Surg. 2021 Jun 30;25(Suppl 1):S269. doi: 10.14701/ahbps.EP-68.

ABSTRACT

INTRODUCTION: Hepatic artery (HA) reconstruction during living donor liver transplantation (LDLT) is the key step due to the small diameter of the artery and risk of HA thrombosis (HAT). To overcome this risky procedure, it has been preferred to using microscope during HA reconstruction by experienced microsurgeon. However, it takes long time to complete the procedure and has long and steep learning curve. To make this procedure simple, some transplant surgeons recently try the procedure using surgical loupe. We conduct this study to compare the outcomes after HA reconstruction using conventional microscope versus surgical loupe.

METHODS: We retrospectively reviewed outcomes of 300 LDLTs at our institution from April 2014 to July 2020. From April 2014 to September 2017 (era 1), HA reconstruction was performed with conventional microscope by an experienced plastic surgeon. From September 2017 to end date (era 2), it was performed using surgical loupe (× 5.0) by an experienced transplantation surgeon.

RESULTS: There was no difference in most perioperative outcomes between two groups including major postoperative complications: HAT (2/150 versus 1/150, p-value = 0.562), postoperative bleeding (13/150 versus 6/150, p-value = 0.097) and biliary leak (18/150 versus 13/150, p-value = 0.343). It was statistically significant between two groups for total operation time (436.66 ± 83.91 versus 415.35 ± 68.55, p-value = 0.035). Multivariable regression modeling to adjust for baseline differences showed that the use of surgical loupe was not associated with HAT.

CONCLUSIONS: HA reconstruction with surgical loupe makes results as good as with microscope for the transplant surgeon and contributes to reducing operating time.

PMID:34230374 | DOI:10.14701/ahbps.EP-68

Ann Hepatobiliary Pancreat Surg. 2021 Jun 30;25(Suppl 1):S315. doi: 10.14701/ahbps.EP-117.

ABSTRACT

INTRODUCTION: The purpose of this study is to recommend an optimal indication of single incision laparoscopic cholecystectomy (SILC).

METHODS: We retrospectively reviewed the 1,405 consecutive patients who underwent SILC at a single institution between April 2010 and June 2020. We defined difficult surgery (DS; conversion to multiport or open, adjacent organ injury, operation time ≥ 90 minutes, or estimated blood loss ≥ 100 milliliters) and poor postoperative outcomes (PPO; postoperative hospital stays ≥ 5 days, or postoperative complication ≥ grade II Clavien-Dindo classification). Subgroup analysis of acute cholecystitis (AC) was conducted according to the Tokyo guideline 18.

RESULTS: Of the 1,405 patients, 338 were for gallbladder (GB) stone, 121 were for GB polyp, 478 were for chronic cholecystitis, and 423 were for AC. The conversion and postoperative complication rate were 2.4% and 3.5%, the mean operation time and length of postoperative hospital stay were 51.8 minutes and 2.5 days. 89 and 94 patients were included in DS group and PPO group, respectively. In multivariable analysis, both grade I or grade II/III AC, and body mass index ≥ 30 kg/m² were statistically significant predictors of DS. Grade II/III AC and age ≥ 70 years were statistically significant predictors of PPO. In subgroup analysis of AC, grade II/III AC group had longer operation time (57.2 vs. 67.4 minutes, p < 0.001), postoperative hospital stays (2.7 vs. 3.7 days, p = 0.001), higher complication rate (4.2 vs. 15.8%, p < 0.001), and conversion rate (3.9 vs. 15.8%, p < 0.001) than grade I AC group.

CONCLUSIONS: SILC should be avoided in patients with grade II/III AC for better surgical outcomes.

PMID:34230380 | DOI:10.14701/ahbps.EP-117

Ann Hepatobiliary Pancreat Surg. 2021 Jun 30;25(Suppl 1):S322. doi: 10.14701/ahbps.EP-124.

ABSTRACT

INTRODUCTION: Hepaticojejunostomy (HJ), a standard method of bilioenteric anastomosis, is done with interrupted sutures by most surgeons. This audit of a prospective database compares the safety, economics, short term and long term outcome of continuous suture HJ (CSHJ) and interrupted suture HJ (ISHJ).

METHODS: An audit of a prospecrive database of all HJ performed between January 2014 and December 2018 after IEB approval. Patients with type IV or higher biliary strictures, duct diameter < 8 mm and/or associated vascular injury and liver transplant recipients were excluded. Patient demographics, diagnosis, pre-operative parameters, intra-operative findings, type and number of sutures, suturing time, and postoperative morbidity (Clavien Dindo) were recorded, and patients followed up to 60 months. McDonald’s grade A and B were considered as good outcome. Cost of suture (polydioxanone) 3-0/5-0 mean cost – ₹686/length, polyglactin 3-0, 4-0 mean cost – ₹486/length), operating room time (₹5,000/hour) were considered for comparison of economics of both techniques. Statistical analysis done on SPSS 22 software.

RESULTS: 556 eligible patients – 468 with ISHJ and 88 with CSHJ analyzed. 258 (54%) had benign and 300 (46%) had malignant pathology. The groups were similar. PDS sutures dominated in CSHJ. Number of sutures, cost, time, and postoperative bile leak was significantly more in ISHJ group. Fifty four patients had bile leak (6 CSHJ and 48 ISHJ). There were 16 mortalities (3 CSHJ, 13 ISHJ) due to septic shock. Morbidity was comparable according to Clavien Dindo grading. Anastomotic stricture rate was comparable.

CONCLUSIONS: CSHJ is safe, economic and worthy of routine practice.

PMID:34230387 | DOI:10.14701/ahbps.EP-124

Ann Hepatobiliary Pancreat Surg. 2021 Jun 30;25(Suppl 1):S251. doi: 10.14701/ahbps.EP-50.

ABSTRACT

INTRODUCTION: Laparoscopic minor liver resections (LLR) of the posterosuperior (PS) segments have been increasingly performed at our institution. The aim of this study was to compare the surgical outcomes of LLR and open minor liver resection (OLR) of hepatocellular carcinoma (HCC) located in the PS segments.

METHODS: We included 113 patients: 55 who underwent LLR, and 58 OLR for HCC in the PS segments from January 2008 to August 2019. Propensity score matching in a 1:1 ratio was conducted. The perioperative and long-term outcomes of 37 matched patients were retrospectively analyzed.

RESULTS: There was no intra-operative mortality or reoperation in either group. One conversion to open surgery was necessary due to severe post-operative adhesions. The LLR group compared to OLR had statistically significantly shorter operative time (215.16 vs. 251.41 min, p = 0.025), lesser blood loss (218.11 vs. 358.92 mL, p = 0.046), lower complication rate (8.1% vs. 29.7%, p = 0.018), and shorter hospital stay (7.03 vs. 11.78 days, p = 0.001). Intraoperative transfusion, R0 resection, resection margin, 5-year disease-free survival and 5-year overall survival were comparable.

CONCLUSIONS: Our standardized LLR for HCC in the PS segments provided improved short-term outcomes and similar long-term outcomes compared with OLR.

PMID:34230356 | DOI:10.14701/ahbps.EP-50

Ann Hepatobiliary Pancreat Surg. 2021 Jun 30;25(Suppl 1):S255. doi: 10.14701/ahbps.EP-54.

ABSTRACT

INTRODUCTION: Tacrolimus (TAC) is a main therapy for liver transplantation (LT) patients, but it has side effects such as chronic nephrotoxicity that progressively aggravate renal function. The purpose of this study was to retrospectively compare the renal function between a TAC group and a combination of everolimus and reduced TAC (EVR-TAC) group after deceased donor liver transplantation (DDLT).

METHODS: The study comprised 131 patients who underwent DDLT between January 2013 and April 2018 at our institution. They received TAC or EVR-TAC after DDLT. EVR was introduced between one and six months after DDLT.

RESULTS: Thirty-six of 131 patients (27.5%) received EVR-TAC. The incidence of chronic kidney disease (CKD) (eGFR <60 mL/1.73 m²) in the EVR-TAC group was higher than in the TAC group (25% vs. 8.4%; p = 0.019). Increasing serum creatinine (n = 23, 63.9%) was the most common cause for adding EVR to treatment of the post-transplant patients. There were no statistical differences in acute rejection and CKD between the two groups. The TAC trough level was significantly lower in the EVR-TAC group than in the TAC group, and the renal function of the EVR-TAC group was worse than that of the TAC group until one year after DDLT. However, the renal function of the EVR-TAC group improved and became similar to that of TAC group at 3 years post-transplant.

CONCLUSIONS: The present study suggests that EVR should be introduced as soon as possible after DDLT to reduce exposure to high doses of TAC to improve the renal function.

PMID:34230360 | DOI:10.14701/ahbps.EP-54

Ann Hepatobiliary Pancreat Surg. 2021 Jun 30;25(Suppl 1):S397. doi: 10.14701/ahbps.EP-198.

ABSTRACT

INTRODUCTION: Although molecular insights about biliary tract cancer (BTC) increased in the last decade, new therapeutic strategy like inhibition of histone deacetylases (HDACs) could additionally improve the still dismal outcome of this tumor entity.

METHODS: Therefore, we performed comprehensive investigation of HDAC expression and pharmacological inhibition in a panel of eight established BTC cell lines and in a cohort resected native BTC specimens (n = 78).

RESULTS: HDAC profiling revealed a heterogeneous expression of HDACs across the studied cell lines and the BTC cancer specimen. Cytotoxicity of six established HDAC inhibitors (HDACi) covering pan- and class-specific HDACis was dose- as well as cell line-dependent and did not show a statistical correlation with HDAC isoform expression. Romidepsin (a class II HDACi), induced the highest reduction of cell viability and apoptosis in BTC cells which was paralleled by reducing HDAC1/2 activity and increasing histone 3 lysine 9 acetylation. Furthermore, non-toxic concentrations of romidepsin could augment the cytotoxic effect of the standard chemotherapeutic cisplatin. Related to the clinical tumor specimen, HDAC expression pattern correlated with the tumor grading and the survival of BTC patients.

CONCLUSIONS: In conclusion, in-vitro-experiments provide clear evidence that the HDAC class I inhibitor romidepsin is effective for BTC alone and acts supportively in combination with standard chemotherapeutics. Additionally, the observed HDAC expression in BTC specimens could serve as a predictive and prognostic biomarker for BTC patients.

PMID:34230294 | DOI:10.14701/ahbps.EP-198

Ann Hepatobiliary Pancreat Surg. 2021 Jun 30;25(Suppl 1):S226. doi: 10.14701/ahbps.EP-25.

ABSTRACT

INTRODUCTION: Chronic hepatitis B is still an infectious disease that is a major problem in Asia. The success of antiviral therapy against hepatitis B infection has been widely supported by very sensitive laboratory tests to monitor hepatitis B virus (HBV)-DNA. However, in developing countries like Indonesia, the measurement of HBV-DNA level is still a challenge. Apart from limited access, a limited health insurance system contributes to this obstacle. Potential markers are transaminase enzymes (ALT and AST) although not all studies show a strong association. This study aims to analyze the relationship between HBV-DNA viral load and transaminase enzymes (ALT and AST) in hepatitis B patients in a low setting area.

METHODS: This study was funded by Deputi Bidang Penguatan Riset dan Pengembangan, Kemenristek/BRIN. This study using observational research with secondary data from January to November 2020 in hepatitis B patients at Dr. Sardjito Hospital. This study has been approved by the Committee of Ethics Committee of the Faculty of Medicine, Public Health and Nursing (FK-KMK), Universitas Gadjah Mada.

RESULTS: The subjects of this study were 139 hepatitis B patients. The median of HBV-DNA level was 4.56 log IU/mL (0.84-8.20 IU/mL). The median ALT and AST levels were 41.0 U/L (6.0-1041.0 U/L) and 43.0 U/L (13.0-1058.0 U/L), respectively. Correlation analysis showed that there was a weak but statistically significant relationship between HBV-DNA and both ALT and AST levels (r = 0.383; p < 0.01; r = 0.334; p < 0.01).

CONCLUSIONS: This study demonstrates the possibility of using transaminase enzymes to monitor hepatitis B patients in a low setting area.

PMID:34230331 | DOI:10.14701/ahbps.EP-25

Ann Hepatobiliary Pancreat Surg. 2021 Jun 30;25(Suppl 1):S248. doi: 10.14701/ahbps.EP-47.

ABSTRACT

INTRODUCTION: Portal vein embolization (PVE) has been documented as an essential strategy for patient with small future liver remnant, to minimize postoperative morbidity and mortality. The majority of hepatectomy requiring preoperative PVE is approached using conventional operation because of the anticipated complexity of the case. Laparoscopic liver resection (LLR) has been gradually increased and similar outcomes have been reported when compared to open hepatectomy. However, it is very difficult to find the reports about LLR after PVE. Hence, we will present our experiences and outcomes for LLR after PVE in hepatocellular carcinoma (HCC) patients with significant technical tips.

METHODS: We performed laparoscopic right hepatectomy after PVE in 8 HCC patients from 2016 to 2020. The operation was performed within 3 weeks after PVE. We confirmed the atrophy of resected liver and compensatory hypertrophy of future liver remnant using preoperative computed tomography scan. During surgery, individual inflow control was easier because right portal vein had been already occluded.

RESULTS: There was no blood transfusion and open conversion. There was no statistical difference in operation time, intraoperative complications and postoperative morbidity including hospital stay, compared to open hepatectomy.

CONCLUSIONS: PVE is very useful procedure even in laparoscopic right hepatectomy as in open hepatectomy. However, caution is needed when PVE is applied cirrhotic livers. Therefore, adequate candidate selection for PVE and technical refinement are needed to decrease morbidity and increase surgical outcomes.

PMID:34230353 | DOI:10.14701/ahbps.EP-47