Tag: pubmed

Ann Hepatobiliary Pancreat Surg. 2021 Jun 30;25(Suppl 1):S338. doi: 10.14701/ahbps.EP-140.

ABSTRACT

INTRODUCTION: Acute cholecystitis is a major complication of biliary lithiasis. Cholecystectomy is the gold standard treatment for gallbladder disease. According to the 2015 Statistics Office in Korea, 4.51% of the population is aged 80 to 89 years and 0.3% is aged 90 to 99 years. The safety and feasibility of cholecystectomy in octogenarians have been proven in many studies. In this study, we aimed to assess the outcomes of cholecystectomy in octogenarians and nonagenarians with acute cholecystitis.

METHODS: A total of 393 patientsaged 80 to 89 years (352 octogenarians) and 90 to 99 years (41 nonagenarians) diagnosed with acute cholecystitis underwent cholecystectomy between March 2012 and June 2020. All patients were classified according to the Tokyo guidelines. The evaluated parameters included demographic data, surgical outcomes, American Society of Anesthesiologists score (ASA), and Tokyo guidelines. All data were analyzed with SPSS ver. 1.0.0.1406.

RESULTS: All 393 patients were analyzed and divided into two groups according to age: octogenarians (83.57 ± 2.64 years) and nonagenarians (92.98 ± 3.15 years). The survival rate was 97.7% for octogenarians and 97.6% for nonagenarians. Laparoscopic surgery was performed more in both groups (96.8% in octogenarians and 92.7% in nonagenarians) than open surgery (3.2% in octogenarians and 7.3% in nonagenarians). The incidences of postoperative complications in the octogenarian and nonagenarian groups were as follows: pneumonia, 5.7% and 7.3%; bleeding, 1.7% and 2.4%; gastrointestinal symptoms, 6.0% and 2.4%.

CONCLUSIONS: Cholecystectomy is a safe and efficient procedure for the treatment of acute cholecystitis in both octogenarians and nonagenarians.

PMID:34230403 | DOI:10.14701/ahbps.EP-140

Ann Hepatobiliary Pancreat Surg. 2021 Jun 30;25(Suppl 1):S339. doi: 10.14701/ahbps.EP-141.

ABSTRACT

INTRODUCTION: Statins are widely prescribed both for primary and secondary prevention of cardiovascular diseases. Preclinical studies indicate that statins have anticancer properties. Epidemiological studies have shown that statin use is associated with decreased risks of various cancer and cancer related mortality. We performed a meta-analysis of all existing studies investigating the association between statin use and the risk of developing cholangiocarcinoma (CCA), which to the best of our knowledge is the first meta-analysis on this issue.

METHODS: A comprehensive literature search for articles and abstracts published up to June 2020 was carried out. For inclusion, studies had to report odds ratio (OR), relative risk, or hazard ratio, with 95% confidence interval (CI). Pooled adjusted ORs with corresponding 95% CIs were calculated using random effects model. Publication bias was assessed through Egger’s test and Begg test. Heterogeneity was accessed by means of the I2 value.

RESULTS: Five observational studies were included in our analysis, with 8,450 CCA subjects and 978,008 healthy controls. Administration of statins significantly reduced the incidence of CCA (OR = 0.79, 95% CI: 0.73-0.86, p = 0.0001). No heterogeneity was found in the study (I² = 46%, p = 0.12). No evidence of publication bias was observed in this meta-analysis.

CONCLUSIONS: Our study shows statistically significant association between the use of statins and 0.79-fold decreased risk of CCA.

PMID:34230404 | DOI:10.14701/ahbps.EP-141

Ann Hepatobiliary Pancreat Surg. 2021 Jun 30;25(Suppl 1):S349. doi: 10.14701/ahbps.EP-151.

ABSTRACT

INTRODUCTION: Apart from bacterial infections Procalcitonin (PCT) also increases in burns, trauma, and surgery.

METHODS: In a prospective study 45 cases (30 male and 15 female) of hepatobiliary and gastrointestinal cancer were taken, which were undergone surgery. It included the cases without (34) and with (11) prior radiotherapy. TPO and PCT were measured (ELISA) on day-1 preoperatively and day-3 (D3) & 5 (D5) postoperatively.

RESULTS: At base level prior to surgery lower value of TPO was noted in the group not given RT (174.8 ± 98.2 pg/mL) than the group who were given (220.3 ± 120.7 pg/mL), although statistically insignificant (p-value 0.2). On D3, TPO value in the cases without RT was 287.2 ± 177.3 pg/mL and in the cases with RT, it was 472.6 ± 265.2 pg/mL, was statistically significant (p-value 0.01). On D5, TPO in patients without RT was 409.57 ± 318.34 pg/mL (further increased) & in cases with RT 585.00 ± 469.61 pg/mL (further increased), p-value 0.2, was statistically insignificant. The corresponding PCT preoperatively was 171.6 ± 563.7 pg/mL & 100.0 ± 42.08 pg/mL in the cases without RT & with RT respectively (p-value 0.2, statistically insignificant). On D3, PCT value was 668.56 ± 1,114.09 pg/mL and 400.63 ± 660.64 pg/mL in the cases without & with RT respectively; p-value 0.4, statistically insignificant. On D5, PCT was 265.54 ± 513.77 & 648.27 ± 1,771.99 pg/mL in cases without & with RT respectively; p-value 0.3, statistically insignificant.

CONCLUSIONS: – Higher TPO level after surgery or radiotherapy is indicator of better response. – TPO level may be indicator therapeutic response after radiotherapy or cancer surgery.

PMID:34230414 | DOI:10.14701/ahbps.EP-151

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):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):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